The double-edged sword of mesh use in pelvic organ prolapse surgery: a case report.

Introduction: Pelvic organ prolapse (POP) is a prevalent condition among parous women, often warranting surgical intervention. This case accentuates the complications associated with mesh in POP surgeries, iterating the imperative need for an evidence-based approach towards its utilization and exhaustive patient counselling. Case presentation: A 60-year-old female, post-mesh-augmented POP repair, embarked on a 13-year journey characterized by persistent pelvic pain and multiple interventions. Despite undergoing several surgeries across different countries, involving mesh and stone removals, her symptoms, notably pelvic pain and dyspareunia, persisted. Clinical examinations revealed mesh erosion into the perivesical tissue, bladder, and associated stones, which were addressed through multiple interventions, albeit with transient success. Discussion: The complex journey of this patient exemplifies the intricate challenges mesh poses in POP surgeries. While mesh application offers a minimally invasive approach and has proven successful in numerous cases, it simultaneously opens a Pandora's box of potential severe complications, necessitating thorough patient counselling and post-surgery management. Conclusion: The case delineates the challenging path that clinicians and patients tread when navigating through mesh-associated complications post-POP repair. Although mesh has been heralded as a revolutionary approach in POP surgeries, its potential drawbacks necessitate judicious application, ensuring clinicians are well-versed with its associated risks and are adept in managing ensuing complications.

Arthroscopic long head of the biceps tendon transposition for augmented repair of massive rotator cuff tear / 中国组织工程研究

BACKGROUND:Transposition of the long head of biceps tendon is a commonly surgical method for massive rotator cuff tears.Currently,there are a few reports on the clinical efficacy of the transposition of the long head of biceps tendon and there is no consensus on the influencing factors for retearing. OBJECTIVE:To observe the outcome of arthroscopic long head of the biceps tendon in the treatment of massive rotator cuff tear. METHODS:The clinical data of 28 patients with massive rotator cuff tears,aged(61.79±10.50)years,admitted at Jiangsu Province Hospital of Chinese Medicine from March 2019 to May 2022 were retrospectively analyzed.All patients underwent arthroscopic long head of the biceps tendon.Patients were assessed for visual analog scale scores,University of California at Los Angeles scores,American Shoulder and Elbow Surgeons scores,Constant-Murley scores,and shoulder range of motion before and 1 year after operation.MRI of the shoulder joint was performed for observing the integrity of the repaired structure at 1 year after operation.Twenty-three patients(5 of 28 lost to follow-up)were categorized into the intact tendon group(n=18)and the tendon retear group(n=5)according to the Sugaya typing at 1 year after operation;the patients were divided into the normal group(n=8),the degeneration group(n=9),and the partial tear group(n=6)according to the intraoperative quality of the long head of the biceps tendon.Differences in the above indexes were compared between groups. RESULTS AND CONCLUSION:When followed up at 1 year after surgery,the range of motion,visual analog scale scores,University of California at Los Angeles scores,American Shoulder and Elbow Surgeons scores,Constant-Murley scores of the shoulder were significantly improved compared with preoperative data(P＜0.05).There was a significant difference in Goutellier grading between intact tendon and tendon retear groups(P＜0.05),while no significant difference was observed in the other influencing factors(P＞0.05).There were no significant differences in visual analog scale scores,University of California at Los Angeles scores,American Shoulder and Elbow Surgeons scores,Constant-Murley scores,and shoulder range of motion at 1 year after operation among the normal,degeneration,and partial tear groups(P＞0.05).MRI findings indicated that the sutured tendon healed well in 18 patients,with a healing rate of 78%.Arthroscopic long head of the biceps tendon for augmented repair can provide a reliable repair for massive rotator cuff tear that is refractory,significantly alleviate the pain of the shoulder joint,and restore the function of the shoulder joint.

Comparison between primary repair and augmented repair with gastrocnemius turn-down flap for acute Achilles tendon rupture: a retrospective study with minimum 2-year follow-up.

BACKGROUND: To explore and compare the clinical outcomes in patients undergoing primary repair versus augmented repair with a gastrocnemius turn-down flap for acute Achilles tendon rupture. METHODS: From 2012 to 2018, the clinical data of 113 patients with acute Achilles tendon rupture who were treated with primary repair or augmented repair with a gastrocnemius turn-down flap by the same surgeon were retrospectively reviewed. The patients' preoperative and postoperative scores on the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society Ankle⁃Hindfoot (AOFAS) score, the Victorian Institute of Sport Assessment⁃Achilles (VISA-A), the Achilles tendon total rupture score (ATRS), and the Tegner Activity Scale were examined and compared. The postoperative calf circumference was measured. A Biodex isokinetic dynamometer was used to evaluate the plantarflexion strength on both sides. The time to return to life and exercise as well as the strength deficits in both groups were recorded. Finally, the correlation analyses between patient characteristics and treatment details with clinical outcomes were conducted. RESULTS: In total, 68 patients were included and completed the follow-up. The 42 and 26 patients who were treated with primary repair and augmented repair were assigned to group A and B, respectively. No serious postoperative complications were reported. No significant between-group differences in any outcomes were observed. It was found that female sex was correlated with poorer VISA-A score (P = 0.009), complete seal of paratenon was correlated with higher AOFAS score (P = 0.031), and short leg cast was correlated with higher ATRS score (P = 0.006). CONCLUSIONS: Augmented repair with a gastrocnemius turn-down flap provided no advantage over primary repair for the treatment of acute Achilles tendon rupture. After surgical treatment, females tended to had poorer outcomes, while complete seal of paratenon and short leg cast contributed to better results. LEVEL OF EVIDENCE: Cohort study; Level of evidence, 3.

Atraumatic Acromioclavicular Joint Dislocation: A Case Report Treated with Excision of the Distal Clavicle Margin and Button Slide System with Allograft Tendon Reinforcement at Coracoclavicular and Acromioclavicular Joint.

Although acromioclavicular joint (ACJ) dislocation is a common injury following trauma involving the shoulder, it is rare in the absence of trauma. In this manuscript, we describe a case of ACJ in a 15-year-old girl who presented a painful dislocation with spontaneous shortening of the right acromioclavicular joint that forced her to temporarily abandon her sports career. After failure of conservative physiotherapy treatment, surgical intervention was proposed by performing an arthroscopic-assisted button slide combined with augmented hamstring allograft reconstruction. After the intervention and the subsequent recovery period, the athlete was able to return to her semi-professional training. The follow-up of the patient is 5.5 years post-surgery. The result obtained could help in planning the treatment of future cases.

Pelvic organ prolapse repair-relapse risk factors: A 10-year retrospective study / Reparación del prolapso de órganos pélvicos: factores de riesgo de recaída. Estudio retrospectivo de 10 años

ObjectivesPelvic organ prolapse (POP) is a common problem among older female. The usual treatment for POP is surgery but there are high recurrence rates, with a 29% reoperation rate. This study aims to identify risk factors for both primary prolapse and recurrence after surgical treatment.MethodsRetrospectively assessment of clinical records of patients who underwent surgery for POP in a 10-year period. Statistical analysis was performed using the version 26.0 of Statistical Package for the Social Science (SPSS®) software.Results746 women entered our study. The population was predominantly post-menopausal, multiparous, and obese/overweight. The most affected compartment was the anterior. Almost 90% of the patient presented with major prolapse. Being overweight or obese, having apical compartment POP, major POP or all compartment POP were risk factors for recurrence with statistical significance. The recurrence rate was nearly one-third but the reoperation incidence was low, reaching less than 6%.ConclusionsPOP surgery has a high satisfaction rate. The only modifiable risk factor for recurrence is being overweight/obese and a nutritional plan should be considered before surgery so we can achieve the best possible results.

ObjetivosEl prolapso de órganos pélvicos (POP) es un problema común entre las mujeres. El tratamiento habitual del POP es la cirugía, pero existen altas tasas de recurrencia, con una tasa de reintervención del 29%. Este estudio tiene como objetivo identificar los factores de riesgo tanto para el prolapso primario como para la recurrencia después del tratamiento.MétodosEvaluación retrospectiva de historias clínicas de pacientes intervenidos por POP en un período de 10 años. El análisis estadístico se realizó utilizando la versión 26.0 del software Statistical Package for the Social Science (SPSS®).ResultadosIngresaron a nuestro estudio 746 mujeres. La población era predominantemente posmenopáusica, multípara y obesa/con sobrepeso. El compartimento más afectado fue el anterior. Casi el 90% de los pacientes presentó prolapso mayor. Tener sobrepeso u obesidad, tener POP de compartimento apical, POP mayor o POP de todos los compartimentos fueron factores de riesgo de recurrencia con significación estadística. La tasa de recurrencia fue de casi un tercio, pero la incidencia de reintervención fue baja, alcanzando menos del 6%.ConclusionesLa cirugía POP tiene un alto índice de satisfacción. El único factor de riesgo modificable de recurrencia es el sobrepeso/obesidad y se debe considerar un plan nutricional antes de la cirugía para que podamos lograr los mejores resultados posibles.

Augmented Repair of Acute Total Achilles Tendon Rupture With Peroneus Brevis Tendon Transfer Using Oblique Transosseous Calcaneal Tunnel: A Prospective Case Series.

Acute Achilles tendon rupture is one of the most common tendon injuries. This prospective study aimed to evaluate the functional outcomes of augmented repair of acute Achilles tendon rupture with peroneus brevis tendon transfer and fixation to an oblique calcaneal transosseous tunnel. Functional evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and Achilles Tendon Total Rupture Score (ATRS). Postoperative complications were recorded. This study included 33 males and 9 females, with a mean age of 26.1 ± 4.2 years. The Achilles tendon ruptures were right in 24 patients and left in 18 patients. The cause of rupture was sports injuries in all patients. The mean distance from the calcaneal insertion to the tear site was 4.4 ± 1.3 cm. The mean time from injury to surgery was 2.4 ± 1.6 days. The mean follow-up time was 40.3 ± 4.9 months. The mean AOFAS and ATRS scores were 99.3 ± 1.2 and 95.9 ± 1.9, respectively, at 12 months of follow-up. The mean time to return to work was 12.1 ± 1.2 weeks. The mean time to return to light sports activities was 16.1 ± 1.8 weeks postoperatively. None of the patients developed re-rupture. Augmented repair of acute Achilles tendon ruptures with peroneus brevis tendon transfer is a robust repair with excellent functional outcomes and early weight-bearing and return to sports activities.

The effect of adipose-derived stem cells on enthesis healing after repair of acute and chronic massive rotator cuff tears in rats.

BACKGROUND: Chronic massive rotator cuff tears heal poorly and often retear. This study investigated the effect of adipose-derived stem cells (ADSCs) and transforming growth factor-ß3 (TGF-ß3) delivered in 1 of 2 hydrogels (fibrin or gelatin methacrylate [GelMA]) on enthesis healing after repair of acute or chronic massive rotator cuff tears in rats. METHODS: Adult male Lewis rats underwent bilateral transection of the supraspinatus and infraspinatus tendons with intramuscular injection of botulinum toxin A (n = 48 rats). After 8 weeks, animals received 1 of 8 interventions (n = 12 shoulders/group): (1) no repair, (2) repair only, or repair augmented with (3) fibrin, (4) GelMA, (5) fibrin + ADSCs, (6) GelMA + ADSCs, (7) fibrin + ADSCs + TGF-ß3, or (8) GelMA + ADSCs + TGF-ß3. An equal number of animals underwent acute tendon transection and immediate application of 1 of 8 interventions. Enthesis healing was evaluated 4 weeks after the repair by microcomputed tomography, histology, and mechanical testing. RESULTS: Increased bone loss and reduced structural properties were seen in chronic compared with acute tears. Bone mineral density of the proximal humerus was higher in repairs of chronic tears augmented with fibrin + ADSCs and GelMA + ADSCs than in unrepaired chronic tears. Similar improvement was not seen in acute tears. No intervention enhanced histologic appearance or structural properties in acute or chronic tears. CONCLUSIONS: Surgical repair augmented with ADSCs may provide more benefit in chronic tears compared with acute tears, although there was no added benefit to supplementing ADSCs with TGF-ß3.

Augmented Versus Nonaugmented Repair of Acute Achilles Tendon Rupture: A Systematic Review and Meta-analysis.

BACKGROUND: Although simple end-to-end repair of the Achilles tendon is common, many augmented repair protocols have been implemented for acute Achilles tendon rupture. However, whether augmented repair is better than nonaugmented repair of an acute Achilles tendon rupture is still unknown. PURPOSE: To conduct a meta-analysis to determine whether augmented surgical repair of an acute Achilles tendon rupture improved subjective patient satisfaction without an increase in rerupture rates. Secondary outcomes assessed included infections, ankle range of motion, calf muscle strength, and minor complications. STUDY DESIGN: Meta-analysis. METHODS: A systematic literature search of peer-reviewed articles was conducted to identify all randomized controlled trials (RCTs) comparing augmented repair and nonaugmented repair for acute Achilles tendon rupture from January 1980 to August 2016 in the electronic databases of PubMed, Web of Science (SCI-E/SSCI/A&HCI), and EMBASE. The keywords (Achilles tendon rupture) AND (surg* OR operat* OR repair* OR augment* OR non-augment* OR end-to-end OR sutur*) were combined, and results were limited to human RCTs and controlled clinical trials published in the English language. Four RCTs involving 169 participants were eligible for inclusion; 83 participants were treated with augmented repair and 86 were treated with nonaugmented repair. RESULTS: Augmented repair led to similar responses when compared with nonaugmented repair for acute Achilles tendon rupture (93% vs 90%, respectively; P = .53). The rerupture rates showed no significant difference for augmented versus nonaugmented repair (7.2% vs 9.3%, respectively; P = .69). No differences in superficial and deep infections occurred in augmented (7 infections) and nonaugmented (8 infections) repair groups during postoperative follow-up ( P = .89). The average incisional infection rate was 8.4% with augmented repair and 9.3% with nonaugmented repair. No significant differences in other complications were found between augmented (7.2%) and nonaugmented (8.1%) repair ( P = .80). CONCLUSION: Augmented repair, when compared with nonaugmented repair, was not found to improve patient satisfaction or reduce rerupture rate or infection rate. These conclusions are based on 4 trials with small sample sizes, and larger randomized trials are required to confirm these results.

Surgical outcomes and quality of life post-synthetic mesh-augmented repair for pelvic organ prolapse in the Chinese population.

AIM: To investigate the surgical outcomes, urinary incontinence and quality of life (QOL) of patients with pelvic organ prolapse after synthetic mesh-augmented repair in the Chinese population. METHOD: This is a retrospective study of women who underwent synthetic mesh-augmented repair. Surgical outcomes were investigated by recurrence rate of prolapse and Organ Prolapse Quantification, and QOL by Pelvic Floor Impact Questionnaire-7 (PFIQ-7) and Pelvic Floor Distress Inventory-20 (PFDI-20). The sex life quality was evaluated by Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-31 (PISQ-31). RESULTS: Eighty-three patients completed the entire study. Anatomical success was 90.36%. Of patients with preoperative stress urinary incontinence, 91.89% claimed that the incontinence symptoms were completely relieved. The 6-month PFDI-20 and PFIQ-7 scores were significantly decreased, indicating that improved QOL occurs. However, the PISQ-31 showed no significant difference between preoperative and postoperative data in sex life quality. CONCLUSION: The synthetic polypropylene mesh is effective in treating POP and may improve QOL with no significant difference in the sexual life postoperatively. De novo stress urinary incontinence may occur after synthetic mesh-augmented repair.

Superficial medial collateral ligament anatomic augmented repair versus anatomic reconstruction: an in vitro biomechanical analysis.

BACKGROUND: When surgical intervention is required for a grade 3 superficial medial collateral ligament (sMCL) tear, there is no consensus on the optimal surgical treatment. Anatomic augmented repairs and anatomic reconstructions for treatment of grade 3 sMCL tears have not been biomechanically validated or compared. HYPOTHESIS: Anatomic sMCL augmented repairs and anatomic sMCL reconstruction techniques will reproduce equivalent knee kinematics when compared with the intact state, while creating significant improvements in translational and rotational laxity compared with the sMCL sectioned state. STUDY DESIGN: Controlled laboratory study. METHODS: Eighteen match-paired, fresh-frozen cadaveric knees (average age, 52.6 years; range, 40-59 years) were each used to test laxity of an intact sMCL, a deficient sMCL, and either an anatomic augmented repair or an anatomic reconstruction. Knees were biomechanically tested in a 6 degrees of freedom robotic system, which included valgus rotation, internal and external rotation, simulated pivot shift, and coupled anterior drawer with external rotation. RESULTS: Anatomic augmented repairs and anatomic reconstructions had significantly less medial joint gapping than the sectioned state at all tested flexion angles and showed significant reductions in valgus rotation compared with the sectioned state at all flexion angles. No significant differences between the anatomic augmented repair and anatomic reconstruction were found for any test performed. Despite the similar behavior between the 2 reconstruction groups, neither technique was able to reproduce the intact state. CONCLUSION: Anatomic sMCL augmented repairs and anatomic sMCL reconstructions were not significantly different when tested at time zero. Both the anatomic augmented repair and the anatomic reconstruction were able to improve knee stability and provide less than 2 mm of medial joint gapping at 0° and 20° of flexion. CLINICAL SIGNIFICANCE: These results suggest that both an anatomic sMCL augmented repair and an anatomic sMCL reconstruction improve knee kinematics compared with a deficient sMCL and provide equivalent joint stability.

Augmented Repair of Degenerative Tears of Tendo Achilles Using Peroneus Brevis Tendon: Early Results

Reconstruction of degenerated ruptures of the tendoachilles is a challenge. Ruptured tendons and the remaining tendon ends are abnormal. A number of methods have been described in literature reconstruct the tendoachilles, but with variable results1. We used peroneus brevis tendon in 20 patients to augment the repair of degenerated tendoachilles tears by creating a dynamic loop as described by Teuffer et al2. All patients were followed up for atleast 18 months. At the last postoperative visit, 18 out of 20 patients were able to do a toe raise. Eighty-five per cent of patients had excellent or good results and 15% had fair or poor results using modified Rupp scoring. Advantages offered by this procedure are the use of a single incision and mini incision and use of a dispensable tendon such as the peroneus brevis without entirely depending on the damaged tendon for healing.

Augmented repair of acute tendo Achilles ruptures with gastrosoleus turn down flap.

BACKGROUND: We present the results of primary repair of acute tendo Achilles (TA) rupture augmented with gastrosoleus turn down flap technique. PATIENTS AND METHODS: 78 consecutive patients with a complete acute rupture of the Achilles tendon operated between 1993 and 2004 were included in study. We performed a modification of the Lindholm technique in which the primary Kessler suture repair of the tendon was augmented by a turn-down ~3 cm × 10 cm gastrosoleus aponeurosis flap. In all cases, a short-leg circular walking cast was applied at 90° of the ankle dorsiflexion for 3 weeks and all the patients were encouraged to full weightbearing ambulation immediately. After removal of the cast, isometric and isokinetic ankle exercises were performed for 3 weeks. Modified Rupp Score was used to evaluate the subjective satisfaction. RESULTS: All of patients returned to daily activity and 54 (69%) of them returned to previous sport activity. The tendon repair failed in two patients and they were reoperated with an allograft. Three patients developed infection and one of them required débridement. One developed deep venous thrombosis and two permanent sural nerve injuries were encountered. One of the patients had a severe skin necrosis, which was treated with rotation flap. The mean Rupp score was 29 (3-33). CONCLUSION: Primary repair of acute tendo Achilles rupture augment with gastrosoleus turn down flip technique in combination of immediate weightbearing ambulation provides a good outcome, but is associated with similar complication rates to the previous literature.

Surgical Treatments of the Acute Anterior Cruciate Ligament Injuries / 대한정형외과학회잡지

Primary repair of anterior cruciate ligament is superior to late reconstruction procedures for two reasons; objective stability is more easily restored due to intact secondary restraints not subjected to chronic stress, and the quality of the joint is superior with greater chance of intact menisci and normal articular cartilage not yet damaged through recurrent subluxation. We present the result of thirty-eight kness in thirty-seven patients who had been treated with primary repair of augmented repair for acute ACL rupture from March, 1984 to August, 1990. Twenty-one knees were treated with primary repair and seventeen knees augmented repair. At an average 33 months follow up, the results obtained were as follows: 1. The patients were 23 males and 14 females with an average age of 27.1 years. 2. Twenty four knees were injuried during athletic endeavors, 9 knees by automobile accident, and 5 knees by landing from height. In 18 knees anterior cruciate ligament was ruptured at the proximal attachment, in 17 knees at the midsubstance tear and in 3 at the near distal attachment. 3. The average interval from injury to operation was 7.5 days (ranged from 1 to 14 days). 4. The results were evaluated by Hospital for Special Surgery knee rating scale (modified by Marshall) at an average 33 months (range from 13 months to 7 years and 6 months) follow-up study. 16 (76%) out of 21 knees treated with primary repair were rated as good or excellent. 12 (86%) out of 14 knees treated with augmented repair were rated as good or excellent. As the result of this study, acutely torn anterior cruciate ligaments appear to be successfully treated with primary repair or augmented repair according to torn site and shape of ligaments.