Patellar tendon reconstruction using LARS ligament: surgical technique and case report

Neglected patella tendon ruptures require reconstruction using tendon grafts. The LARS ligament has been successfully used in cruciate and collateral knee ligament reconstruction. We present a technique using LARS ligament for the reconstruction of a chronic patella tendon rupture in a low-demand patient. The result after 1-year follow-up was deemed successful

Relapsed clubfoot correction with soft-tissue release and selective application of Ilizarov technique

The Ilizarov technique is an alternative for the treatment of complex foot deformities in children. The authors retrospectively reviewed children with relapsed clubfoot deformity, treated with soft tissue procedures and additional correction with an Ilizarov frame. Twelve consecutive patients (13 feet) with relapsed clubfoot deformity after previous surgical correction were reviewed. Treatment included open releases. An Ilizarov frame was applied as an adjunct in seven patients (mean age of 7.8 years) with severe deformity where complete intraoperative correction was not achieved. Clinical and radiographic assessment was undertaken. The mean Laaveg–Ponseti score, for the 7 feet treated with the Ilizarov frame, was 85.1 after minimum 4 years follow-up. One recurrence of forefoot deformity required metatarsal osteotomies. Postoperative radiographic measurements revealed values that can be considered as normal. Complications included pin tract infections (12% of inserted wires). Flat-topped talus was observed in 3 feet. Deformity correction was possible when soft tissue procedures were combined with the use of Ilizarov technique, in order to support and gradually improve surgical correction

Investigation of the Total Phenolic Content and Antioxidant Capacity of Three Sweet Pepper Cultivars (Capsicum annuum L.) at Different Development and Maturation Stages

The aim of the current research was to investigate and compare the total phenolic content and antioxidant capacity of sweet pepper cultivars at different development and maturation stages, in order to optimize the beneficial effects. For that purpose, three important sweet pepper cultivars, namely Dolmy-F1, Yahoo-F1 and Florinis-NS-700, were cultivated in a greenhouse. Their total phenolic content, ascorbic acid content and antioxidant properties were assessed at different development and maturation stages. In the aforementioned cultivars, the total phenolic content ranged from 345.2 to 602.1, 404.9 to 794.5, and 795.7 to 2220.3 μg GAE g−1 FW respectively. The ascorbic acid content ranged from 236 to 957, 258 to 1157, and 410 to 1550 μg AA g−1 FW respectively. The highest antioxidant activity was noted at the red maturity stage. Particularly the cultivar Florinis NS 700 was found to possess higher total phenolic, flavonoid phenol, non-flavonoid phenol, ascorbic acid contents, and greater antioxidant capacity, compared to the other cultivars. The results of our study recommend the consumption of the sweet peppers at red maturity stage, for achieving the maximum health-beneficial effects

Effect of Irrigation and Fertilization Levels on Mineral Composition of Cannabis sativa L. Leaves

A field experiment was conducted in central Greece to study the effect of two irrigation (I1: 100% ETo, I2: 60% ETo) and N-fertilization levels (N1: 244, N2: 184 kg ha-1), on the nutrients concentration of Cannabis sativa leaves (cv. ‘Fibranova’). The  N, K, Ca, Mg, P -concentration in the leaves was ranged by 2.8 to 3.51%, 1.8 to 2.57%, 1.96 to 2.17%, 0.86 to 0.88%, and 0.3 to 0.37% respectively, while by the micronutrients the iron showed the highest concentration that ranged by 129 to 139.8 mg kg-1dw. The treatment I1F1, where the highest level of irrigation and N -fertilization was applied, compared to the other treatments, showed the highest dry biomass yield, however, in the leaves the highest concentrations of N, K, Mn and Cu were not observed. Moreover, it was found that the N, K, Ca, Mg, P and Fe removal only by one ton dry biomass of leaves was ranged by 28 to 35.12 kg, 18.01 to 25.65 kg, 19.6 to 21.7 kg, 8.34 to 8.75 kg, 3.01 to 3.70 kg and 0.129 to 0.140 kg, respectively. These results could contribute optimal fertilizer application and therefore to the reduction of production costs of the crop

Endoscopic debridement for non-insertional Achilles tendinopathy with and without platelet-rich plasma

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Slowed-Down Rehabilitation Following Percutaneous Repair of Achilles Tendon Rupture

Background: Following percutaneous repair of acute Achilles tendon (AT) ruptures, early postoperative weightbearing is advocated; however, it is debatable how aggressive rehabilitation should be. We compared the clinical and functional outcomes in 2 groups of patients who followed either our "traditional" or a "slowed down" rehabilitation after percutaneous surgical repair. Methods: Sixty patients were prospectively recruited to a slowed down (29 patients) or a traditional (31 patients) rehabilitation program. Both groups were allowed immediate weightbearing postoperatively; a removable brace with 5 heel wedges was applied at 2 weeks. In the slowed-down group, 1 wedge was removed after 4 weeks. Gradual removal of the boot took place after 4 wedges were kept for 4 weeks. In the traditional group, 1 wedge was removed every 2 weeks, with removal of the boot after 2 wedges had been kept for 2 weeks. The AT Resting Angle (ATRA) evaluated tendon elongation. Patient reported functional outcomes were assessed using the AT Rupture Score (ATRS). Calf circumference difference and the isometric plantarflexion strength of the gastro-soleus complex were evaluated. Results: At the 12-month follow-up, both ATRA and ATRS were more favorable in the slowed-down group. The isometric strength and the calf circumference were more similar to the contralateral leg in the slowed-down group than in the traditional one. Conclusion: Following percutaneous repair of acute Achilles tendon patients undergoing slowed down rehabilitation performed better than the traditional one. These conclusions must be considered within the limitations of the present study

Epidural bleeding after ACL reconstruction under regional anaesthesia: a case report

Introduction: Epidural bleeding as a complication of catheterization or epidural catheter removal is often associated with perioperative thromboprophylaxis especially in adult reconstructive surgery. Case presentation: We report on a case of a 19 years old male athlete that underwent anterior cruciate ligament reconstruction, receiving low molecular weight heparin for thromboprophylaxis and developed an epidural hematoma and subsequent cauda equina syndrome two days after removal of the epidural catheter. An urgent magnetic resonance imaging scan revealed an epidural hematoma from the level of L3 to L4. Emergent decompression and hematoma evacuation resulted in patient's significant neurological improvement immediately postoperatively. Conclusion: A high index of clinical suspicion and surgical intervention are necessary to prevent such potentially disabling complications especially after procedures on a day-case basis and early patient's discharge. © 2009 Roidis et al; licensee Cases Network Ltd

Ipsilateral free semitendinosus tendon graft transfer for reconstruction of chronic tears of the Achilles tendon

<p>Abstract</p> <p>Background</p> <p>Many techniques have been developed for the reconstruction of the Achilles tendon in chronic tears. In presence of a large gap (greater than 6 centimetres), tendon augmentation is required.</p> <p>Methods</p> <p>We present our method of minimally invasive semitendinosus reconstruction for the Achilles tendon using one para-midline and one midline incision.</p> <p>Results</p> <p>The first incision is a 5 cm longitudinal incision, made 2 cm proximal and just medial to the palpable end of the residual tendon. The second incision is 3 cm long and is also longitudinal but is 2 cm distal and in the midline to the distal end of the tendon rupture. The distal and proximal Achilles tendon stumps are mobilised. After trying to reduce the gap of the ruptured Achilles tendon, if the gap produced is greater than 6 cm despite maximal plantar flexion of the ankle and traction on the Achilles tendon stumps, the ipsilateral semitendinosus tendon is harvested. The semitendinosus tendon is passed through small incisions in the substance of the proximal stump of the Achilles tendon, and it is sutured to the Achilles tendon. It is then passed beneath the intact skin bridge into the distal incision, and passed from medial to lateral through a transverse tenotomy in the distal stump. With the ankle in maximal plantar flexion, the semitendinosus tendon is sutured to the Achilles tendon at each entry and exit point</p> <p>Conclusion</p> <p>This minimally invasive technique allows reconstruction of the Achilles tendon using the tendon of semitendinosus preserving skin integrity over the site most prone to wound breakdown, and can be especially used to reconstruct the Achilles tendon in the presence of large gap (greater than 6 centimetres).</p