The Arthroscopic Three-Point Fixation for Anterior Cruciate Ligament Avulsion Fracture: Surgical Technique.

Several arthroscopic repairs and fixation for tibial intercondylar eminence fracture have been developed for restoring anterior cruciate ligament function. Repairing the avulsion fragment with multiple-point fixation provides some benefits over a single-point fixation. It provides multidirectional force control, especially on the posterior part of the fragment, and produces area of compression. We propose a 3-point fixation technique for providing proper reduction and compression in large fragment anterior cruciate ligament avulsion fracture. This includes using hybrid intra-articular and tunnel pull-out suture fixation to provide good posterior reduction and fixation. The number of tunnels is decreased by using a suture anchor.

Avoidance of Direct Posterior Portal During Elbow Arthroscopic Surgery in Posterior Compartment.

Arthroscopic surgery for the posterior compartment in elbow has been used in the treatment of many pathologies. The direct posterior portal has been commonly used for this compartment. However, this portal involves penetrating the triceps brachii tendon responsible for extensor mechanism. This can possibly lead to poor performance during recovery and portal wound sensation with scar formation. An accessory posterolateral portal can be used as a substitute with adequate viewing and working space in all areas of the posterior compartment. This report describes in detail on how to manage pathologies in the posterior compartment without using direct posterior portal and instead using accessory posterolateral, posterolateral, and direct lateral portals.

Arthroscopic lateral collateral ligament imbrication for treatment of atraumatic posterolateral rotatory instability.

BACKGROUND: Among the causative lesions of lateral elbow pain, atraumatic posterolateral rotatory instability (PLRI) is a rare condition, but it produces pain and disability to the elbow. It still lacks published specific treatment literature. According to the development of arthroscopy, the arthroscopic lateral collateral ligament (LCL) imbrication can possibly be an alternative minimal invasive procedure that can eradicate the atraumatic PLRI. Hypothesis/Purpose: To report clinical results of arthroscopic LCL imbrication for the treatment on atraumatic PLRI elbow. Methods: Thirty-three patients with chronic atraumatic lateral elbow pain were presented to our institution between July 2015 and December 2021. Eight patients were diagnosed with atraumatic PLRI and underwent arthroscopic LCL imbrication. Comparison between the pre- and post-operative scores were recorded, which were The Quick-Disabilities of Arm, Shoulder, and Hand (Quick-DASH) score, Mayo Elbow Performance Index (MEPI) and Visual Analog Scale for pain (VAS). Results: Mean follow-up was 16 months (9-24 months). Comparing between pre-operation and post-operation, all of eight patients had significant improved Quick-DASH score (mean 55.62 vs 7.62, p = .004), MEPI (mean 50.00 vs 96.87, p = .000) and VAS for pain (mean 8.14 vs 1.28, p = .000). Conclusion: Atraumatic PLRI is a concerning lesion in patients with lateral elbow pain. Arthroscopic LCL imbrication can be simultaneously performed with other lateral elbow pain causations, such as tennis elbow and pathological plica, and provide painless, stable, and functional elbow. LEVEL OF EVIDENCE: Case Series (Level of evidence: 4).

Arthroscopic Lateral Collateral Ligament Complex Reconstruction for Posterolateral Rotatory Instability of the Elbow, the Operative Technique.

Posterolateral rotatory instability is concerning pathology in patients with recalcitrant lateral elbow pain. An arthroscopic technique can be used to perform reconstruction of lateral collateral ligament for eradicating the instability and also to manage concomitant lesions in a simultaneous operation. Similar to the modified BrostrÓ§m procedure using an inferior extensor retinaculum to augment the lateral collateral ligament for lateral ankle instability, in our Technical Note, we use anconeus muscles and annular ligament to augment the lateral collateral ligament for elbow instability during the reconstruction, allowing all tissue to heal with the bone by using a knotless technique.

Screening exons 16 and 17 of the amyloid precursor protein gene in sporadic early-onset Alzheimer's disease.

Early-onset Alzheimer's disease (EOAD) can be familial (FAD) or sporadic EOAD (sEOAD); both have a disease onset ≤65 years of age. A total of 451 sEOAD samples were screened for known causative mutations in exons 16 and 17 of the amyloid precursor protein (APP) gene. Four samples were shown to be heterozygous for 1 of 3 known causative mutations: p.A713T, p.V717I, and p.V717G; this highlights the importance of screening EOAD patients for causative mutations. Additionally, we document an intronic 6 base pair (bp) deletion located 83 bp downstream of exon 17 (rs367709245, IVS17 83-88delAAGTAT), which has a nonsignificantly increased minor allele frequency in our sEOAD cohort (0.006) compared to LOAD (0.002) and controls (0.002). To assess the effect of the 6-bp deletion on splicing, COS-7 and BE(2)-C cells were transfected with a minigene vector encompassing exon 17. There was no change in splicing of exon 17 from constructs containing either wild type or deletion inserts. Sequencing of cDNA generated from cerebellum and temporal cortex of a patient harboring the deletion found no evidence of transcripts with exon 17 removed.