Anterior Labrum Periosteal Sleeve Avulsion Lesions of the Shoulder: A Scoping Review.

Background: Anterior labrum periosteal sleeve avulsion (ALPSA) lesion of the shoulder is defined as a labral avulsion with an intact periosteum of the glenoid neck resulting in medial malattachment of the labrum, which is both nonanatomic and nonfunctional. It is relatively rare compared with Bankart lesions, and its results are usually reported in combination with other anterior labroligamentous lesions in the literature. Purpose: To (1) assess the size and scope of the literature on ALPSA lesions, (2) highlight the importance of this lesion, and (3) distinguish between ALPSA and Bankart lesions in diagnostic and treatment strategies. Study Design: Scoping review; Level of evidence, 4. Methods: The PubMed, Scopus, Embase, and Google Scholar databases were searched with the keywords "ALPSA,""anterior labrum periosteal sleeve avulsion,""anterior labral periosteal sleeve avulsion," and "anterior labroligamentous periosteal sleeve avulsion" lesion. Duplicate articles and those that did not meet the inclusion criteria were excluded, resulting in the identification of 42 relevant articles. Their references were analyzed for further data curation. Results: This scoping review demonstrated that ALPSA lesions are difficult to clinically identify. Magnetic resonance angiography in the adduction internal rotation position is the most sensitive and specific imaging modality for identification. Optimal views are the anterosuperior portal for accurate identification and the anteroinferior portal for surgical repair during arthroscopy. Treatment begins with correctly identifying the labrum, in contradistinction to dense reactive fibrous tissue, and reattaching the labrum to the correct anatomic glenoid footprint. Chronic lesions with bone loss require either bone block or soft tissue augmentation procedures. Conclusion: There is paucity of exclusive literature on ALPSA lesions. It is important to distinguish this lesion from the Bankart lesion as it is associated with worse outcomes. The higher failure rates of ALPSA lesion repair indicate that the current repair techniques require further refinement to improve the outcomes to the standard of Bankart lesions.

Concurrent Undisplaced Patellar Fracture and Posterior Cruciate Ligament Avulsion Fracture Managed With Surgical Fixation and Rehabilitation: A Case Report.

This case report explains the successful management of a rare, combined injury: an undisplaced patellar fracture and a posterior cruciate ligament (PCL) avulsion fracture at the tibial attachment in a 44-year-old male patient following a motorbike accident. While both injuries are frequently seen in orthopedic practice, their concurrent occurrence is uncommon. The patient presented with significant knee swelling, limited range of motion, and pain following the accident. An X-ray revealed a patellar fracture and magnetic resonance imaging (MRI) confirmed an undisplaced fracture, a PCL tear, and a medial meniscus injury. The patient underwent surgical intervention for PCL fixation with a cannulated cancellous (CC) screw under spinal anesthesia. Following surgery, a comprehensive rehabilitation program was implemented, focusing on pain management, reducing swelling, regaining range of motion, and strengthening the surrounding musculature. The program progressed through three phases, steadily increasing the intensity and complexity of exercises. The patient exhibited significant improvement in pain, swelling, range of motion, and muscle strength throughout the rehabilitation program. By week 12, he had achieved near-normal knee function and was able to resume most daily activities.

Patients return to sport after repair of anterior humeral avulsion of the glenohumeral ligament lesions: a systematic review.

Background: Anterior humeral avulsions of the glenohumeral ligament (aHAGL) lesions are relatively rare causes of shoulder instability that affect athletes at a higher rate than other populations. The purpose of this study is to evaluate rate of return to sport (RTS) after HAGL repair. Methods: A search of the PubMed (MEDLINE), Scopus, and Cochrane CENTRAL databases was conducted on April 13, 2022 with the search terms "HAGL" or "humeral avulsion glenohumeral ligament" was used to conduct the systematic review. Inclusion criteria required that lesions were limited to aHAGL, axillary pouch or central HAGL, or both anterior and posterior HAGL lesions as specified by lesion description or direction of instability. Results: Screening and full-text manuscript review identified 7/967 studies eligible for inclusion with a total of 46 aHAGL lesions in athletes. Average rate of RTS was 93.5% (standard deviation [SD] = 13.4%, n = 43/46) with rate of RTS at previous levels of play averaging 80.0% (SD = 22.1%, n = 28/35). Neither rates of concomitant procedures nor concomitant pathology were associated with variation in RTS rates overall or level of RTS. Weighted average Rowe, subjective shoulder value, and Constant scores were 87.5 (SD = 4.9), 86.0 (SD = 2.0), and 82.2 (SD = 5.1), respectively, and 78.6% (n = 22/28) of patients reported postoperative satisfaction or "good/excellent" ratings following aHAGL repair. Adverse events occurred in 18.5% of patients (n = 10/54), most frequently recurrent instability (n = 3/54). Ultimately, 6.2% of patients eventually underwent reoperation (n = 3/17). Conclusion: As with other forms of anterior shoulder instability, RTS rates after aHAGL repair are high and many patients achieve their previous level of play. The most frequent adverse event was subjective recurrent instability with reoperation in 6.2% of patients. The findings from this study provide valuable pooled data on outcomes specific to aHAGL repair, particularly in the athlete population, and contribute to further understanding of outcomes regarding operative management of this rare pathology.

Levator Ani Muscle Avulsion After Vaginal Delivery Comparing Routine Versus Restrictive Episiotomy: A Pilot Study.

INTRODUCTION AND HYPOTHESIS: The objective was to compare the rate of levator ani muscle avulsion following vaginal birth after routine and restrictive episiotomy. METHODS: This study consists of two cohorts of pregnant women prospectively enrolled between September 2015 and December 2017 at a university hospital. The pregnant women were subject to a randomized controlled trial, in which participants received a restrictive episiotomy protocol versus a routine episiotomy protocol for vaginal delivery. Levator ani avulsion was evaluated by four-dimensional ultrasound screening. RESULTS: Sixty-one post-partum primipara women were enrolled in our study. Thirty-two women (52.5%) had undergone routine episiotomy whereas 29 women (47.5%) had gone through restrictive episiotomy. Right mediolateral episiotomies were performed in all cases. The rate of anal sphincter tear was 12.5% in the routine episiotomy group versus 13.8% in the restrictive episiotomy group (p = 1.00). Levator ani avulsion was detected in 9.4% of the routine episiotomy group (only on the right side) and in 10.3% of the restrictive episiotomy group (p = 1.00). No bilateral levator avulsion was detected in either of the groups. There were no statistical differences in the distances of the bladder neck descent, cystocele descent, uterine descent, rectocele descent, and the ballooning of the genital hiatus area between the groups. CONCLUSIONS: In our pilot study, there was no reduction of the rate of levator ani avulsion in women with restrictive episiotomy compared with routine episiotomy. There were no differences in pelvic floor ultrasound parameters between the two groups.

Biogenic Tooth-Integrated Fixed Functional Space Maintainer for Pediatric Use: A Novel Approach.

Preschoolers frequently experience traumatic dental injuries, particularly during their two to four years of life. The majority of these injuries result in tooth avulsion because of the alveolar bone resiliency around the primary teeth. This study explains an instance of damage sustained during play that resulted in an early knockout of the primary incisor. Hence, a biogenic tooth-integrated space maintainer was created using the natural crown of the traumatized tooth, and the child was asked to come for a regular follow-up. This treatment may be viewed as a great alternative for natural aesthetic rehabilitation as it promotes speech development, improves oral cleanliness, restores aesthetics and masticatory function, and inhibits the development of aberrant tongue habits and malocclusions.

Technical aspects of rod-insertion forceps (persuader) application in reducing construct failure after lumbar spine fusion surgery: a biomechanical cadaveric study in Germany.

Study Design: A prospective experimental study. Purpose: This biomechanical in vitro study aimed to examine the extent to which the use of a rod persuader (RP) leads to additional mechanical stress on the screw-rod system and determine its influence on the bony anchoring of primary pedicle screws. Overview of Literature: Degenerative spine diseases and deformities are the most common indications for the stabilization and fusion of spinal segments. The pedicle screw-rod system is considered the gold standard for dorsal stabilization, and an RP is also increasingly being considered to fit the spondylodesis material. Methods: Ten lumbar spines from body donors were examined. Bisegmental dorsal spinal lumbar interbody fusion of the L3-L5 segments was performed using a pedicle screw-rod system (ROCCIA Multi-LIF Cage; Silony Medical, Germany). In group 1, the titanium rod was inserted without tension, whereas in group 2, the rod was attached to the pedicle screws at the L4 and L5 levels, creating a 5-mm gap. To attach the rod, the RP was used to press the rod into the pedicle screw. The rod was left in place for 30 minutes and then removed. Results: The rod reduction technique significantly increased the mechanical load on the overall construct measured by strain gauges (p<0.05) and resulted in outright implant failure with pedicle screw pullout in 88.9%. Conclusions: In cases where the spondylodesis material is not fully attached within the pedicle screw, an RP can be used with extreme caution, particularly in osteoporotic bones, to avoid pedicle screw avulsion and screw anchor failure.

[Clinical Efficacy of Anchor Suture Bridge Technique for Avulsion Fractures of the Posterior Cruciate Ligament Tibial Insertion Point in the Knee Joint]. / é”šé’‰ç¼çº¿æ¡¥æŠ€æœ¯å¯¹è†å ³èŠ‚åŽäº¤å‰éŸ§å¸¦èƒ«éª¨æ­¢ç‚¹æ’•è„±éª¨æŠ˜çš„ä¸´åºŠç–—æ•ˆ.

Objective: To investigate the clinical efficacy of the anchor suture bridge technique in treating avulsion fractures at the tibial insertion point of the posterior cruciate ligament (PCL) in the knee joint. Methods: In this study, we reviewed 80 patients with PCL tibial avulsion fractures treated using the anchor suture bridge technique in our department from February 2010 to December 2023. Follow-ups were conducted starting at 3 months post-surgery, then every 3 months until 12 months post-surgery. Clinical and follow-up data of each patient were analyzed. The Lysholm and Hospital for Special Surgery Knee-Rating Scale (HSS) scores of knee function before surgery and at the last follow-up were compared to assess the surgical treatment outcome. Results: The 80 patients were followed up for an average of (12.16±1.08) months post-surgery. Re-examination X-rays showed that all fractures had healed, with an average healing time of (3.66±0.51) months. All patients recovered well, with primary healing of surgical incisions and no complications such as neurovascular injury, skin necrosis, incision infection, fracture displacement, or ligament laxity. Postoperative knee Lysholm and HSS scores were significantly higher than preoperative scores. At the last follow-up, the Lysholm score increased from (46.30±6.10) preoperatively to (90.85±3.27), and the HSS score increased from (45.30±5.80) to (91.15±2.66), with statistically significant differences (P<0.025). Conclusion: The anchor suture bridge technique is effective in treating avulsion fractures of the PCL tibial insertion point in the knee joint. It has a high safety profile and leads to good postoperative knee function recovery, with no serious postoperative complications, demonstrating excellent clinical efficacy.

Point-of-care ultrasound detection of anterior inferior iliac spine avulsion fracture in an adolescent: A case report.

Purpose: This study presents a rare case of avulsion fracture of the anterior inferior iliac spine, typically occurring in adolescents engaged in physical activities. The purpose of this study is to emphasize the diagnostic challenges and conservative treatment options available for this condition. Method: We describe the case of a 14-year-old healthy adolescent who suffered from an avulsion fracture following pelvic trauma after participating in a short-distance sprint. Initial physical examination and X-ray imaging were inconclusive, showing no apparent fractures. Due to parental refusal of a Computerized Tomography (CT) scan by concerns over the potential risks associated with radiation exposure, a diagnostic ultrasound was performed, which confirmed the presence of an avulsion fracture at the anterior inferior iliac spine. Results: The ultrasound findings led to a conservative treatment approach, involving rest, and unloading of the affected limb. Follow-up assessments indicated significant pain relief within four weeks and enabled the resumption of partial physical activity after six months. Conclusion: This case highlights the utility of ultrasound as an effective alternative diagnostic tool in situations where CT scans are not permissible. Additionally, it demonstrates that conservative management can be successful in treating avulsion fractures of the anterior inferior iliac spine in adolescents, leading to satisfactory recovery and return to activity.

The Cobra sign: A marker for overestimation of tendon retraction in proximal semimembranosus tendon avulsion.

PURPOSE: To introduce a new magnetic resonance imaging (MRI) sign, termed the Cobra sign, and identify its diagnostic metrics. The secondary aim was to demonstrate that this sign can be a source of false evaluation of tendon retraction in patients with proximal hamstring avulsion injury. METHOD: This retrospective cohort study targeted patients surgically treated for proximal hamstring avulsion injury from January 2019 to June 2023. The MRI Cobra sign was defined as a wavy curved T2-hypointense band with the free end folding distally over itself, resembling a cobra head. The primary outcome measure was the characterization of the Cobra sign in patients with proximal hamstring avulsion injury. The secondary outcome was the association of this sign with tendon retraction. The study included 81 proximal hamstring avulsion injury patients (mean age of 45.7, SD = 13.9), with 41 (50.6%) complete avulsions, 33 semimembranosus, and 7 conjoint tendons. RESULTS: The MRI Cobra sign was found in 25 patients (17 semimembranosus and 8 complete). It was confirmed surgically only in semimembranosus cases. It demonstrated 51.5% sensitivity and 83.3% specificity for isolated semimembranosus avulsions, with a significant positive likelihood ratio of 3.0. MRI retraction was 10.05 cm (±3.0), reducing to 7.9 cm (±2.5) on surgical measurement (mean difference = 2.0 cm, p < 0.001). The regression analysis confirmed MRI retraction's influence on the Cobra sign, with a 1.4 odds increase per unit (p < 0.001). In linear regression analysis, each unit increase in MRI retraction corresponded to a 79% increase in surgical retraction (coefficient 0.7, t = 11.1, p < 0.001). CONCLUSION: The Cobra sign demonstrated acceptable diagnostic accuracy for isolated semimembranosus avulsion, with a high specificity of 83.3%, a low sensitivity of 51.5%, and a positive likelihood ratio of 3.0. The presence of the Cobra sign indicates an overestimated MRI retraction by approximately 21%. LEVEL OF EVIDENCE: Level III.

Treating a Dentoalveolar Fracture in a Four-Year-Old Girl With a Functional Removable Partial Denture.

In children and young adults, traumatic dental injuries are common. Children's tooth loss is mostly caused by dentoalveolar trauma. Owing to anatomical variations and developmental phases, treating such injuries is difficult. Trauma to deciduous teeth might harm the permanent tooth beneath; however, trauma to permanent teeth can worsen their long-term outlook. An alveolar segment trauma may result in the irreversible loss of dental tissues, malalignment, and deformity. The periodontium and pulpal tissues suffer significant harm as a result of this. In the current case, there was a segmental cortical fracture in the mandible of a four-year-old girl child.

Subspine Impingement of the Hip Secondary to Ossified Rectus Femoris Avulsion Injury.

This case report describes the evaluation, surgical intervention, and postoperative outcome of a 36-year-old male patient with chronic left hip pain following a rectus femoris injury which persisted despite conservative management and intra-articular steroid injection. Imaging revealed prominent ossification extending from the anterior inferior iliac spine at the proximal rectus femoris insertional, a femoral cam lesion, and tearing of the superior through anterior labrum, compatible with both subspine and femoroacetabular impingement. Subsequent arthroscopic femoroplasty, acetabuloplasty, labral repair, and excision of rectus femoris ossification provided lasting symptomatic relief. Identification of lesions resulting in subspine impingement is essential in the preoperative work up of patients with hip pain to ensure appropriate surgical management and optimize postoperative outcomes.

Effect of an Intrapartum Pelvic Dilator Device on Levator Ani Muscle Avulsion During Primiparous Vaginal Delivery: A Pilot Randomized Controlled Trial.

INTRODUCTION AND HYPOTHESIS: The objective was to evaluate the safety and effectiveness of an intrapartum electromechanical pelvic floor dilator designed to reduce the risk of levator ani muscle (LAM) avulsion during vaginal delivery. METHODS: A multicenter, randomized controlled trial enrolled nulliparous participants planning vaginal delivery. During the first stage of labor, participants were randomized to receive the intravaginal device or standard-of-care labor management. The primary effectiveness endpoint was the presence of full LAM avulsion on transperineal pelvic-floor ultrasound at 3 months. Three urogynecologists performed blinded interpretation of ultrasound images. The primary safety endpoint was adverse events (AEs) through 3 months. RESULTS: A total of 214 women were randomized to Device (n = 113) or Control (n = 101) arms. Of 113 Device assignees, 82 had a device placed, of whom 68 delivered vaginally. Of 101 Control participants, 85 delivered vaginally. At 3 months, 110 participants, 46 Device subjects who received full device treatment, and 64 Controls underwent ultrasound for the per-protocol analysis. No full LAM avulsions (0.0%) occurred in the Device group versus 7 out of 64 (10.9%) in the Control group (p = 0.040; two-tailed Fisher's test). A single maternal serious AE (laceration) was device related; no neonate serious AEs were device related. CONCLUSIONS: The pelvic floor dilator device significantly reduced the incidence of complete LAM avulsion in nulliparous individuals undergoing first vaginal childbirth. The dilator demonstrated an acceptable safety profile and was well received by recipients. Use of the intrapartum electromechanical pelvic floor dilator in laboring nulliparous individuals may reduce the rate of LAM avulsion, an injury associated with serious sequelae including pelvic organ prolapse.

Surgical Treatment of Proximal Hamstring Avulsion Injuries Compared With Nonsurgical Treatment: A Matched Comparative Study With a Mean Follow-up of >4 Years From the Proximal Hamstring Avulsion Surgery Cohort Study.

BACKGROUND: Surgical outcomes for proximal hamstring avulsion injury (PHAI) are well documented, yet comparative analyses with nonsurgical approaches remain scarce. PURPOSE: To compare the functional outcomes between surgical and nonsurgical interventions for PHAI. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: This comparative study, conducted at a sports surgery center between January 2012 and July 2021, focused on patients with primary PHAI. The study was a retrospective analysis of prospectively collected data. Group selection involved utilizing propensity score matching to compare an arm of patients who were surgically treated (indications included patients with complete injury, patients with partial injury with >2 cm of retraction, and patients for whom 6 months of nonsurgical treatment failed) with another arm of patients who refused surgery. The primary outcome was evaluated using the Parisian Hamstring Avulsion Score (PHAS). The secondary outcomes included the Tegner Activity Scale (TAS) score; University of California, Los Angeles (UCLA) score; rate and quality of return to sport (RTS); and patient satisfaction. RESULTS: The study included 32 patients (mean age, 55.8 years [SD, 8.4 years]) in the nonsurgical treatment arm and 95 patients in the surgical treatment arm (mean age, 53.4 years [SD, 7.7 years]) (P > .05). The interval from injury to treatment was 5.7 months (SD, 9.6 months) for the surgical group and 12.7 months (SD, 25.9 months) for the nonsurgical group (P > .05). At the final follow-up (nonsurgical group: mean, 56.5 months [SD, 28.2 months]; surgical group: mean, 50.7 months [SD, 33.1 months]), the PHAS was significantly higher in the surgical group (mean, 86.3 [SD, 13.7]) compared with the nonsurgical group (mean, 69.8 [SD, 15.1]) (P < .0001). Higher activity scores were also observed in the surgical group for the TAS and UCLA scores (P = .0224 and P = .0026, respectively). A higher percentage of the surgical group (68.4%) returned to sports compared with the nonsurgical group (46.9%) (P = .0354), with a greater proportion in the surgical group returning at the same or higher level (67.7% vs 26.7%) (P = .0069). Additionally, a higher satisfaction level was reported by patients in the surgical group (89.5%) in contrast to the nonsurgical group (25%) (P < .0001). Three patients in the surgical group experienced complications (2 reruptures and 1 hyperesthesia at the pudendal nerve territories). Odds ratios (ORs) indicated that patients in the surgical group were significantly more likely to achieve or exceed median scores for the PHAS (OR, 6.79; P < .001), TAS score (OR, 2.29; P = .045), and UCLA score (OR, 3.63; P = .003), as well as to RTS at any level (OR, 2.46; P = .031) or at the preinjury level or higher (OR, 6.04; P < .001). CONCLUSION: This study demonstrated that surgical treatment of PHAI significantly enhances long-term functional scores, including the PHAS, TAS score, UCLA score, satisfaction, and RTS, at a mean follow-up of >4 years compared with nonsurgical treatment. REGISTRATION: NCT02906865 (ClinicalTrials.gov identifier).

Open Repair of Posterior Cruciate Ligament Tibial Bony Avulsion With Metal Anchor: A Case Report.

Introduction: The posterior cruciate ligament (PCL) is the largest and strongest intra-articular ligament of the knee joint and the primary posterior stabilizer. PCL injuries are less frequent than other knee ligament injuries and are typically combined with meniscal and chondral injuries or in the context of multiligamentous injuries. It is critical to properly diagnose and treat these lesions in order to avoid the risk of PCL insufficiency, subsequent knee instability, and early osteoarthritis. Surgical management can vary, and the ideal fixation device is still debated. Suture anchors are an unusual mean of fixation of PCL tibial bony avulsion. We report on two patients treated with open anchor fixation for PCL tibial bony avulsion with a follow-up of 3 years. Case Presentation: A 15-year-old male and a 65-year-old male were treated with open anchor fixation for bony tibial avulsion of the PCL. Surgical treatment was performed at 5 weeks and 3 weeks after the trauma, respectively. Diagnosis was made with an X-ray followed by CT and MR scans. Repair was achieved by reinserting the PCL bony fragment to its posterior tibial eminence with suture anchors through an open posterior approach. Both patients recovered full knee stability and a pain-free full range of motion (ROM) within 4 months and returned to their previous activities with a high satisfaction. The patient has been followed up for 3 years, and no complications were observed. Conclusion: PCL bony avulsions are rare, and their optimal treatment remains a significant subject of debate, particularly in the skeletally immature patient. We believe that open repair with metal anchors could be a good choice to repair PCL bony tibial avulsion in patients without concomitant intra-articular lesions and immature growth plates or severe fragmentation.

Trans-medial gastrocnemius approach (Badet approach) for displaced posterior cruciate ligament tibial avulsion.

Avulsions of the retrospinal surface are rare injuries resulting from high-energy trauma. Displacement of this fracture frequently indicates a surgical treatment to restore posterior cruciate ligament function. Several approaches have been proposed in the literature, either open or arthroscopic, which can be tricky due to the fracture's proximity to the popliteal vascular-nervous elements. Badet's open approach is a medial trans-gastrocnemius approach, providing a direct access to the retro-spinal surface for osteosynthesis. In this technique, an L-shaped incision is made along precise skin lines, followed by discision of the muscle fibers. The capsule is then approached, allowing a view of the retro-spinal surface protected from the popliteal vasculo-nervous elements by the muscular lateral lip of the gastrocnemius. A reduction followed by screw osteosynthesis is usually performed, allowing early mobilization of the patient. In this technical note, we describe the Badet approach supporting by video and case series. LEVEL OF EVIDENCE: IV.

The modified suture-bridge technique for treating avulsion fracture of minors tibial eminence of anterior cruciate ligament: a retrospective study.

PURPOSE: This study aimed to evaluate the clinical and radiological outcomes of modified suture-bridge technique fixation for anterior cruciate ligament (ACL) tibial avulsion fracture. METHOD: Minors who underwent arthroscopic reduction and modified suture bridge fixation of ACL tibial avulsion fracture between January 2018 and January 2022 were retrospectively analyzed. Postoperative MRI and X-ray examinations were performed to evaluate the presence of epiphyseal plate injury and fracture healing. Moreover, KT-1000 side-to-side difference, Lachman test, range of motion (ROM), the subjective Knee score of the International Knee Documentation Committee (IKDC), Lysholm Knee score, and Tegner activity grade score were evaluated preoperatively and at the minimum 1-year follow-up visit. RESULTS: A total of 16 participants met the inclusion criteria. They had a mean age of 12.6 years (range, 9-16 years); mean time to surgery, 6.9 days (range, 2-13 days) and had a minimum of 12 months clinical follow-up (mean, 25.4 months; range, 12-36 months) after surgery. Postoperative radiographs and MRI showed no injury to the epiphyseal plate, optimal reduction immediately after the operation, and bone union within three months in all patients. All of the following showed significant improvements (pre- vs. postoperatively): mean KT-1000 side-to-side difference (8.6 vs. 1.5; p < 0.05), Lachman tests (2 grade 9 and 3 grade 7 vs. 0 grade 12 and 1 grade 4; p < 0.05), IKDC subjective score (48.3 vs. 95.0; p < 0.05), mean Lysholm score (53.9 vs. 92.2; p < 0.05), mean Tegner activity score (3.2 vs. 8.3; p < 0.05) and mean ROM (42.9°vs 133.1°; p < 0.05). CONCLUSION: Arthroscopic reduction and modified suture bridge fixation for ACL tibial avulsion fracture is a dependable and recommended treatment that can effectively restore the stability and function of the knee and is worthy of clinical promotion.

Assessment of the effects of citric acid and EDTA on cell viability of cultured human periodontal ligament cells attached to simulated avulsed permanent tooth using a spectrofluorometer-An in vitro study.

BACKGROUND/AIM: The delayed re-implantation of avulsed teeth results in ankylosis, followed by replacement resorption and eventual loss of the tooth within 2-4 years. To prevent tooth loss, the root surface can be etched with acid to expose the collagen fibers present in the cementum layer. This process facilitates normal reattachment and regeneration of the periodontal ligament. This in-vitro study aimed to assess the viability and number of attached cultured Human Periodontal Ligament Cells (HPLC) on the dehydrated root surface of simulated avulsed teeth treated with citric acid and EDTA solutions. MATERIALS AND METHODS: Sound human permanent teeth were included in the study. The root portions of the teeth were sectioned into slices, air-dried for 1 h, and divided into the following three groups: Group A-control; Group B-Citric acid treated for 30 min; Group C-EDTA treated for 5 min. The slices were then placed in cultured HPLC. After a 24-h incubation period, the slices were visualized under the microscope and prepared for reading the viable and dead HPLC using a spectrofluorometer, as well as for counting HPLC in a Neubauer Chamber. RESULTS: The spectrofluorometer intensity for viable and dead HPLC showed a statistically significant difference (p = .003 and p = .002), with the mean intensity for viable HPLC greater in citric acid group (69.52 ± 74.51), followed by EDTA group (31.39 ± 9.12), and control group (-130.93 ± 30.99). The dead HPLC intensity was greater in the EDTA group (19.43 ± 47.31), followed by the citric acid group (1.28 ± 1.85), and the control group (-2.77 ± 0.76). The total number of cells in the Neubauer chamber showed a statistically significant difference (p < 0.001), with a higher count in the citric acid group (10.83 ± 4.08) followed by EDTA group (2.92 ± 2.92). CONCLUSION: The application of citric acid for 30 min on the dehydrated root surface of avulsed teeth demonstrated superior outcomes compared to both EDTA treatment for 5 min and the control group.

Traumatic abdominal wall hernia as a component of the seatbelt syndrome: A case report of complete abdominal wall muscle transection.

INTRODUCTION AND IMPORTANCE: Seat belt syndrome (SBS) is a rare condition described as injuries sustained due to thoracic, abdominal, and pelvic compression in the context of traffic accidents. These injuries can range from minor skin abrasions to large lesions of internal organs and spinal cord involvement. Traumatic abdominal wall hernias (TAWH) are one of the injuries that can be associated. CASE PRESENTATION: A 21-year-old male suffered a severe injury, resulting in complete transection of all abdominal wall musculature due to SBS, with associated visceral injury. Emergency surgery included intestinal and sigmoid colon resection, along with cava vein repair. After a prolonged recovery, a second-stage surgery for abdominal wall reconstruction was planned. Prehabilitation involved botulinum toxin and pneumoperitoneum, with surgical planning utilizing CT scan and 3D reconstruction. The second-stage surgery included transversus abdominis release and placement of double mesh. CLINICAL DISCUSSION: Managing traumatic abdominal wall hernias in polytrauma patients necessitates emergent surgery for vital injuries, while reconstructive surgery timing is crucial, with patient preparation being essential. Surgical planning, including 3D reconstructions, enhances accuracy, and safety, with repair technique selection depending on anatomical features. Given our patient's athletic background and preoperative vascular CT findings, flapless reconstructive surgery was chosen to mitigate vascular risks. CONCLUSION: The therapeutic approach to traumatic abdominal wall injuries should be individualized to each patient, with a focus on addressing vital injuries first and considering abdominal wall reconstruction surgery at a subsequent stage. Utilizing CT scan with 3D reconstruction can be a valuable tool for preoperative planning in cases involving significant abdominal wall defects.

[Injuries of the knee extensor complex in children]. / Verletzungen des Kniestreckapparates im Wachstumsalter.

BACKGROUND: Fractures of the knee extensor complex are relatively rare injuries in children. We distinguish between a pure tendon rupture and ruptures with bony avulsions. A mid-substance tear in children is a relatively rare injury, whereas bony avulsions due to skeletal immaturity are seen more often. Sole bony fractures of the patella also only account for a low number of paediatric related fractures. Sleeve fractures are characterized by an avulsion of cartilage and, usually, bone pulled off from the distal patella pole. Avulsion fractures of the tibia tubercle are found in the group of sportive adolescents. TREATMENT: Especially dislocated fractures should be conveyed to surgical therapy to avoid excessive bone callus. Timely diagnostics and an efficient and consistent treatment are recommended. Deformities and dislocated avulsions will regularly not remodel spontaneously during further growth. Therefore, it is mandatory to reconstruct the articular surface and the knee extensor complex to avoid future complications such as osteoarthritis or elongation of the knee extensors.

Trilogy of isolated deep medial collateral ligament injuries of the knee: A set of three cases and overview of the literature.

The authors present three unique cases of isolated deep medial collateral ligament (dMCL) injuries and comprehensively review the current literature. An isolated dMCL injury is often overlooked in clinical practice, and a consensus on the most adequate treatment is needed. Three male patients were examined at our institution directly following the trauma. The first patient experienced isolated soft-tissue avulsion of the dMCL, the second patient had a bony avulsion from the femoral insertion of the dMCL, and the third patient presented with an isolated "reverse Segond" fracture, which has not previously been described in the literature. All three injuries resulted from a violent external knee joint rotation. The treatment regime included a knee brace for up to 5 weeks and a physical therapy regimen for up to 3 months. All three patients reported satisfactory outcomes regarding restored knee function, absence of symptoms, and early return to activities at the final follow-up. STUDY DESIGN: Case report. LEVEL OF EVIDENCE: IV.