RESUMEN
Objective: To highlight a case of an athlete with a symptomatic pretibial cyst 4-years post-ACL reconstruction surgery. Case presentation: A 23-year-old female soccer athlete presented with right-sided knee pain, locking and catching, and diminished sensation along the anteroinferior knee. She had a history of an ipsilateral ACL hamstring autograft four years prior. Physical evaluation revealed a visible and palpable swelling medial to the patellar tendon, limited and painful range, and hypoesthesia within the infrapatellar branch of the saphenous nerve. MRI revealed a tubular ganglion cyst along the anterior aspect of the tibial tunnel, medial to the patellar tendon, and anterior to the ACL graft. Summary: Post-surgical ganglion cyst formation in the reconstructed ACL is a rare complication that can present years following ACL surgery. This case aims to bring awareness to this condition as a potential long-term complication in the ACL-reconstructed athlete.
Objectif: Mettre en évidence le cas d'un athlète présentant un kyste ganglionnaire symptomatique du tunnel tibial quatre ans après une chirurgie de reconstruction du LCA. Exposé de cas: Une athlète de soccer âgée de 23 ans s'est présentée avec une douleur au genou droit, un blocage et un accrochage, et une diminution de la sensation le long du genou antéro-inférieur. Elle avait subi une autogreffe du ligament croisé antérieur ipsilatéral quatre ans auparavant. L'examen physique a révélé un gonflement visible et palpable en dedans du tendon rotulien, une amplitude limitée et douloureuse, et une hypoesthésie dans la branche sous-rotulienne du nerf saphène. L'IRM a révélé un kyste ganglionnaire tubulaire le long de la face antérieure du tunnel tibial, en dedans du tendon rotulien et en avant de la greffe du LCA. Résumé: La formation d'un kyste ganglionnaire post-chirurgical dans le LCA reconstruit est une complication rare qui peut se présenter des années après la chirurgie du LCA. Ce cas vise à attirer l'attention sur ce problème comme une complication potentielle à long terme chez l'athlète dont le LCA a été reconstruit.
RESUMEN
Acute kidney injury (AKI) is defined by changes in serum creatinine and urine output (UO). Significant limitations exist regarding accurate ascertainment of urine output even within the intensive care unit. We sought to evaluate an automated urine output collections system and compare it to nursing measurements. We prospectively collected urine output using an electronic urine monitoring system and compared it to charted hourly UO in 44 patients after cardiac surgery at a single university hospital ICU. We calculated UO and oliguria rates and compared them to data from the sensor and from nursing charting. A total of 187 hourly UO measurements were obtained and on average, UO was reported 47 min late, with a median of 18 min, and a maximum of almost 6 h. Patients had a mean hourly UO of 76.3 ml over the observation period. Compared to manual measurements by study personnel, nurses significantly overestimated hourly UO by 19.9 ml (95% CI: 10.3; 29.5; p = < 0.001). By contrast, the mean difference between the UO measured with the sensor and by study personnel was 2.29 ml (95% CI: - 6.7; 11.3), p = 0.61. Electronic UO monitoring is significantly more accurate than nurse-performed manual measurements in actual intensive care patients. Furthermore, timely ascertainment of UO is difficult to achieve with manual technique, resulting in important delays in detecting oliguria perhaps leading to missed cases of AKI.