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After failed conservative therapy or in the absence of any intervention, a rupture of the digital subcutaneous extensor tendon at the distal interphalangeal (DIP) joint, known as mallet finger, may lead to a chronic extension deficit due to excessive scarring and tendon elongation. Various surgical techniques to restore the extension of the distal phalanx have been proposed, but an optimal approach has not yet been established. To tighten the extensor tendon, a purse-string suture can be applied. Although it has shown efficacy, it can result in significant bulging and scar formation. Using the "abbreviato" technique, the elongated part of the extensor tendon is excised, and the tendon is re-sutured. Also, tenodesis has been described, particularly in pediatric cases. In this retrospective follow-up study, we aimed to investigate if the step-plasty procedure previously described by Baumeister provides comparable, if not superior, functional and aesthetic outcomes compared to existing techniques for patients with chronic mallet finger. In this retrospective study, a consecutive series of 68 patients with chronic mallet fingers was enrolled. Patients were treated surgically using step-plasty of the respective extensor tendon. After skin incision and tenolysis, the elongated extensor tendon was incised in a Z-like fashion and stepwise resected in the transverse portion of the Z. The functional and aesthetic effects of this step-plasty technique were compared with results of 44 patients previously treated using purse-string sutures of the extensor tendon and evaluated using Crawford's and Levante's criteria. In all patients undergoing the step-plasty procedure, the extension deficit was significantly reduced from an average of 42 degrees preoperatively to 11 degrees postoperatively. In contrast, the control group treated by purse-string sutures showed a slightly higher postoperative extension deficit of 15 degrees. According to Levante's criteria, the results of our step-plasty procedure were significantly better than those achieved with purse-string sutures. Our study demonstrated that the treatment of older or chronic subcutaneous extensor tendon ruptures using the step-plasty technique led to a significant reduction in extension deficits. According to Levante's criteria, the postoperative outcome was significantly better in comparison to the purse-string suture technique. Additionally, no skin resection was required to improve the extension capability of the distal finger joint, compared to established surgical procedures. [ABSTRACT FROM AUTHOR]

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Background: The rate of failed anterior cruciate ligament reconstruction (ACLR) remains high in the younger and more active patient populations. Suture tape augmentation (STA) in addition to ACLR may reduce the risk for revision surgery. Purpose/Hypothesis: The purpose of this study was to compare patient outcomes between patients who underwent primary all-inside quadrupled semitendinosus hamstring tendon autograft (QST-HTA) ACLR with and without STA. It was hypothesized that the STA cohort would demonstrate a lower incidence of subsequent revision ACLR while maintaining comparable patient-reported outcomes. Study Design: Cohort study; Level of evidence, 3. Methods: All patients ≤40 years of age who received primary all-inside QST-HTA ACLR with and without independent STA augmentation were identified. The following validated patient-reported outcome measures (PROMs) were collected: visual analog scale for pain, Single Assessment Numeric Evaluation, Knee injury and Osteoarthritis Outcome Score subscales, and Tegner activity scale. KT-1000 arthrometer measurements were collected pre- and postoperatively. Cox proportional hazards model and nominal logistic regression analysis were used to assess additional variables associated with revision ACLR. Results: A total of 104 patients with a mean age of <22 years were included in the final data analysis (STA: 36 patients; control: 68 patients). Significantly fewer patients in the STA group sustained a graft failure necessitating revision surgery at the final follow-up (5.6% vs 24%; relative risk, 0.24 [95% CI, 0.06-0.97]; P =.017). Four-year graft survival was significantly higher in the STA group (97.2% vs 82.4%; P =.031). All PROMs significantly improved postoperatively except for Tegner levels, which decreased in both groups compared with their preinjury levels (P <.001). Return to sports was similar in both groups with >70% of patients returning to their previous level of competition. Regression analysis demonstrated increased risk for revision ACLR in younger patients, high school athletes, and those with higher postoperative activity levels. Conclusion: QST-HTA ACLR with STA was associated with reduced risk for revision ACLR compared with nonaugmented QST-HTA ACLR in this young patient population. Furthermore, the addition of suture tape did not appear to affect postoperative patient-reported and return-to-sports outcomes. [ABSTRACT FROM AUTHOR]

Plasma derivatives have extensive applications in the field of regenerative medicine. Platelet-rich plasma (PRP) is a blood component acquired through centrifugation and can be administered through periwound injection or direct application to the wound bed area. PRP aids in shifting the healing process from chronic to acute, fostering regeneration in traumatic and surgical wounds. Here, we present seven cases of challenging wounds in paediatric patients that were treated using PRP at our institution. [ABSTRACT FROM AUTHOR]

Copyright of Namık Kemal Tıp Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Ultrasound gel is used as a coupling medium in ultrasound procedures, thereby ensuring the entry of sound waves into the body of the patient and providing ultrasound images of high quality. In this paper, we present an approach to automatically supply ultrasound gel during robot guided ultrasound examinations. For this purpose, we combine a simple mechanical design consisting of a gel tube and a push mechanism with a specialized control strategy exploiting the robotic nullspace of 7 DoF redundant manipulator. Functionality is demonstrated by robotic ultrasound scans on phantoms, with gel being automatically applied when needed. [ABSTRACT FROM AUTHOR]

In laboratory conditions, composite sutures based on polylactide (PLA) containing chitin nanofibrils modified with polyethylene glycol (CN‐PEG) and poviargol (silver nanoparticles stabilized with poly(N‐vinylpyrrolidone)) were obtained, studied, and used as a prototype. Surgical sutures threads with the addition of CN‐PEG have stable mechanical properties both in air and in a buffer simulating the environment of a living organism. The yield strength of oriented threads decreased by an average of 15%, whereas for non‐oriented threads the decrease was 3–4 times. The strength values in simple units of unfilled PLA, PLA containing 5 wt % CN‐PEG, and PLA with 1 wt % Poviargol were on average 50% higher than the national standard 31620‐2012. The results of in vivo experiments on albino rats (cross‐linking skin and muscle tissue in the linea alba area) showed that composite sutures are best for suturing muscle tissue, whereas unfilled PLA sutures are more suitable for suturing skin. When suturing muscle tissue, suturing with composite sutures increased the number of collagen fibers of different diameters. [ABSTRACT FROM AUTHOR]

The author recalls an article by Ion Zabalegui and colleagues on the treatment of multiple adjacent gingival recessions using the "tunnel" surgical approached published in "The International Journal of Periodontics & Restorative Dentistry" in 1999. He discusses the basis of the surgical technique, modifications introduced since the original description of the tunnel technique, and recommendations for specialists in periodontology.

This study aims to illustrate our laparoscopic salpingostomy approach for two types of hydrosalpinx, emphasizing various reproductive surgical techniques. A step-by-step demonstration of the technique is provided alongside narrated video footage. University hospital. Infertile patients with hydrosalpinx seeking natural conception. Laparoscopic salpingostomy for clubbed hydrosalpinx is demonstrated with video and includes the following steps: creating an opening into the tube at the terminal end for hydrosalpingeal fluid drainage; dissecting and removing peritubal and periovarian adhesions; excising redundant fimbrial tissues to restore fimbrial mobility; evert the mucosa using an intussusception method until endothelial folds are visible; confirming tubal patency with a dye test; heating the serosal surface of the tube to evert the edges; suturing the edges using 5-0 vicryl to the proximal serosa of the tube circumferentially with an inverting suture technique; thoroughly irrigating with Ringer's solution to remove blood clots and debris; and applying auto-crosslinked hyaluronan gel to the exposed raw surface. Salpingostomy for the cystic type differs, notably in carefully shaving the adhesive tubal end from the ovary until the tubo-ovarian ligament is completely exposed. The primary aim of salpingostomy is to reduce the likelihood of distal tube re-obstruction. If hydrosalpinx recurs after salpingostomy, there remains a possibility of requiring additional surgery, such as salpingectomy, before in vitro fertilization. Extensive adhesions were meticulously dissected and removed from the peritoneal cavity. Fimbrial mobility was restored to establish a patent fallopian tube capable of ovum pickup. Electrocoagulation and suturing techniques were employed to evert the tube edges, effectively reducing the risk of re-obstruction. The utilization of an inverting suture technique aided in inwardly turning the cut edges, minimizing the risk of adhesion formation. Laparoscopic salpingostomy, when performed by surgeons proficient in reproductive surgical techniques, provides a significant option for patients with hydrosalpinx seeking natural conception. The decision to preform salpingostomy or salpingectomy is usually made intraoperatively on the basis of the severity of tubal disease. Clinical history is also an important factor in decision to perform salpingostomy. [ABSTRACT FROM AUTHOR]

ABSTRACT: This case report describes the successful robotic-assisted repair of a large Morgagni hernia in an 8-month-old infant. Using the da Vinci Xi system, the hernial sac was excised, and the patient recovered without complications. It highlights the advantages of robotic surgery, including enhanced optics and precision, for complex hernia repairs in infants. [ABSTRACT FROM AUTHOR]

Large iris defects are challenging to close due to shortage of tissue and opposite vector force. By using two pupilloplasty methods, we can close large iris defects with less tractional force or tethering. The trifold technique is a combination of trocar-assisted iris repair and single-pass four-throw (SFT) pupilloplasty for non-appositional large iris defects. The initial two trocar-assisted iris repair sutures oppose the unopposed iris ends and the subsequent SFT seals the defect. The combination procedure is less manipulative with no complications for the iris and pupil diaphragm. [ABSTRACT FROM AUTHOR]

We present a case of inadvertent left renal vein clipping during right retroperitoneoscopic nephrectomy (RPN) and describe its expeditious identification and management. A 13-year-old girl underwent RPN for nonfunctioning kidney due to urolithiasis. During the dissection of the right renal vein, the inferior vena cava (IVC) got lifted off the parietal wall and the left renal vein was mistakenly ligated. Based on a strong intra-operative suspicion, the patient underwent an urgent computed tomography angiography which confirmed the ligation of the left renal vein. The patient was reoperated immediately and an end-to-side anastomosis was performed between the left renal vein and the IVC. [ABSTRACT FROM AUTHOR]

Although ventriculoperitoneal shunt tip migration into an inguinal hernia is considered common in children, while in adults it is quite rare. In fact, only a handful of cases have been reported in the literature. We report a rare case whereby two catheter tips (one from a lateral ventricle shunt and a second from a 4th ventricular shunt) migrated into an inguinal hernia. This migration caused distal shunt malfunction, and only distal catheter shortening and suturing to the abdominal wall caused the two shunts to function again. [ABSTRACT FROM AUTHOR]

This study aimed to describe the step-by-step procedure of the polydioxanone dome technique associated with guided bone regeneration (GBR) and to report the results up to 72 months after implant loading. Patients with maxillary horizontal bone defects (< 5 mm residual width, confirmed by CBCT scan) were treated with the proposed intervention. During the GBR procedure, four bone perforations were strategically prepared in a roughly square configuration. Segments of polydioxanone suture material were introduced in the perforations, forming a dome-shaped structure. Six months after bone augmentation, a new CBCT was performed. After implant restoration, periapical radiographs were taken, which were then repeated annually. The following outcomes were analyzed: implant survival, horizontal bone gain, marginal bone level, and complications. Twenty implants were placed in 11 patients with a survival rate of 100% in a mean follow-up of 38.18 ± 19.65 months after loading. Mean horizontal bone gain was 3.82 ± 1.67 mm and mean marginal bone level was –0.12 ± 1.17 mm. Only minor complications were observed. The present results suggest that the polydioxanone dome technique may represent a promising approach during horizontal GBR, alone or in combination with implant placement. [ABSTRACT FROM AUTHOR]

Background: The internship period in medical education serves as a critical phase for students transitioning from theoretical learning to practical application within clinical settings. Surgical specialties, in particular, demand a high level of skill and competence from interns due to the inherent risks associated with surgical procedures. However, there is often a gap between the theoretical knowledge gained in medical college and the practical skills required in surgical practice. Aims and Objectives: Therefore, keeping all the above facts in mind, the present study was undertaken to implement direct observation of procedural skills (DOPS) as a method for evaluating the suturing skills performance in interns. Materials and Methods: This study focused on an intern in the Department of Surgery, aiming to assess their suturing skills using the DOPS method. A structured workshop was conducted to provide interns with hands-on training in suturing techniques. Subsequently, interns were divided into groups and assessed by assigned assessors using the checklist. Feedback was provided to interns after each assessment session. Data were collected through self-administered questionnaires distributed to interns and assessors, and statistical analysis was performed using SPSS software. Results: Analysis of the data revealed a significant improvement in suturing skill scores among interns following the implementation of DOPS assessments. Mean scores increased substantially from the initial to subsequent attempts, indicating enhanced proficiency in suturing skills. Interns expressed positive perceptions of the DOPS methodology, highlighting its effectiveness in driving learning and improving confidence in performing surgical procedures. Conclusion: DOPS not only facilitates skill development but also promotes confidence and competence in interns, preparing them for clinical practice. Overall, DOPS emerges as a valuable approach for evaluating and improving suturing skills among interns, contributing to their professional development as competent health-care practitioners.

Immediate implant placement and provisionalization with subepithelial connective tissue graft is considered the reference therapy for achieving a good esthetic outcome, especially in cases with a thin periodontal phenotype. Positioning sutures are usually required to maintain graft stability. This article describes the use of a modified suture technique involving vertical/horizontal double-parallel mattress sutures in immediate implant placement to achieve stable passive fixation of the graft in the appropriate position and to provide a more equal distribution of tension in the wound. A novel, simplified, reproducible technique is described in two cases of immediate implant placement and provisionalization with subepithelial connective tissue grafting and double-parallel mattress sutures. [ABSTRACT FROM AUTHOR]

Background: Recently, natural tissue repair has become popular in the treatment of pelvic organ prolapsed. In this study, we compared patients who underwent cystocele repair with the rug-weaving plication technique, a natural tissue repair method implemented since 2022 for anterior prolapse, with those treated using conventional colporrhaphy. Methods: We retrospectively reviewed the data of 65 patients who underwent anterior vaginal wall repair with the rug-weaving plication technique (n = 33, Group 1) or conventional colporrhaphy (n = 32, Group 2). We recorded the patients' clinicodemographic and surgical data. At the 6-month postoperative follow-up, we assessed patients' complaints, degree of prolapse (using the simplified Pelvic Organ Prolapse Quantification system), and pelvic floor muscle strength (using the Modified Oxford Score). Anterior vaginal wall thickness was measured using transvaginal ultrasonography. We compared clinicodemographic and surgical data and postoperative outcomes between the two groups. Results: The two groups were comparable in terms of age (p = 0.326), number of pregnancies (p = 0.307), number of parities (p = 0.555), preoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p = 0.380), preoperative apical prolapse simplified Pelvic Organ Prolapse Quantification grade (p = 0.518), postoperative Modified Oxford Score (p = 0.857), operation time (p = 0.809), postoperative haemoglobin (p = 0.674), and amount of bleeding (p = 0.951). Compared with Group 2, Group 1 had significantly higher postoperative anterior vaginal wall thickness (p < 0.001) and significantly lower postoperative anterior wall simplified Pelvic Organ Prolapse Quantification grade (p < 0.001). Conclusions: The rug-weaving plication technique may offer a viable alternative for cystocele repair without mesh, using natural tissue and potentially reducing mesh-related complications and recurrence rates. Clinical trial number: NCT06410469 (03/05/2024). [ABSTRACT FROM AUTHOR]

Objective: To assess the rate at which sutureless partial nephrectomy (SLPN) transitions to standard partial nephrectomy (SPN), focusing on preoperative factors that might prompt such conversions. Patients and methods: In this retrospective study, we analyzed the efficacy of SLPN performed on adults at our institution from 2016 to 2023. The subjects were patients diagnosed with localized solid renal tumors. The primary technique employed was resection with scissors and argon beam coagulation for hemostasis, with suturing techniques used only when necessary. Predictive factors necessitating conversion to SPN were identified, and the associations among multiple variables were explored using various statistical analysis methods, including logistic regression, to identify key preoperative predictive factors. Results: Our institution performed 353 SLPN, with 21 cases (5.9%) necessitating conversion to SPN. The conversion rates for the Laparoscopic Partial Nephrectomy (LPN) subgroup and the Robotic-assist Partial Nephrectomy (RPN) subgroup were 7.9% (17/215) and 2.9% (4/138), respectively, nearing statistical significance (P =.066). Significant differences were observed between the conversion group and the no conversion group in terms of preoperative estimated Glomerular Filtration Rate (eGFR), age at surgery, tumor size, and exophytic/endophytic characteristics. Multivariate analysis identified age at surgery, preoperative eGFR, radiological tumor size, and tumor exophytic/endophytic nature as significant predictors for conversion to SPN. Conclusion: This investigation highlights the efficacy and feasibility of SLPN while identifying critical factors influencing the necessity for conversion to SPN. The identified predictors, including younger surgical age, superior preoperative eGFR, and specific tumor characteristics, provide valuable insights for refining surgical strategies. [ABSTRACT FROM AUTHOR]

Objectives: Tibial eminence fractures account for 2% to 5% of all knee injuries. Low-grade fractures, such as Type I, are typically treated conservatively, whereas high-grade fractures, such as Types III and IV, usually require surgical intervention. This paper describes a modified surgical arthroscopic technique, which employs pull-through triangle suture fixation for Type II and Type III arthroscopic intercondylar eminence avulsion fractures. In addition, we examined the efficacy and complication rate compared to the existing literature. Methods: Data were prospectively collected for knee arthroscopy surgeries and retrospectively analyzed with a minimum two-year follow-up. Twenty-three consecutive adults underwent arthroscopic treatment of displaced intercondylar Type II and Type III eminence fractures, as evidenced by clinical examination and imaging studies between May/2008 and May/2021. The patient's knee evaluation was performed using clinical symptoms and physical examination, along with International Knee Documentation Committee (IKDC) questionnaire and Tegner Activity Score. Compared to the literature, post-hoc power was calculated based on the mean Tegner Activity Score in our analysis. Results: fifteen females and eight males (mean age 33.9 years, range 19–56 years) were enrolled. The average postoperative follow-up was 35.4 months (27–53). The post-hoc power was 95% confidence in terms of the Tegner Activity Score. The mean ± standard deviation postoperative Tegner Activity Score was 8.2 ± 1.7 (6.8–10.0). Fifteen patients were classified as IKDC A (normal), six as IKDC B (nearly normal), and two as IKDC C (abnormal). The mean IKDC subjective score was 72.7 ± 23 (23–100). Twenty-four patients achieved normal flexion degrees compared with the unaffected side, while one patient achieved a flexion of only 0–90°. The group's mean flexion range of motion was 123 ± 16° (90–150°). Conclusion: This study presents a modified surgical arthroscopic suture fixation technique for tibial eminence fractures. The procedure is relatively simple and requires no more than basic arthroscopy equipment. The clinical and radiographic results indicate that this technique is safe, efficient, enables early initiation of rehabilitation, and has a lower complication rate in a variety of aspects compared with other fixation techniques used for tibial eminence fractures. [ABSTRACT FROM AUTHOR]

Purpose: Mitigating unwanted refractive errors is crucial for surgeons to ensure quality vision after penetrating keratoplasty (PK). The primary objective of the present study is to highlight the importance of microstructural matching of the host and the donor cornea during PK on the distribution of the corneal tissue while suturing. Methods: For this purpose, the present study undertakes an in-vitro PK model to analyse the effect of suturing and host-donor misalignment on corneal birefringence. Five groups of experiments were performed using five corneoscleral buttons. In each group, N = 16 data points (corresponding to 16 simple interrupted sutures) were assessed before and after PK with five degrees of misalignments, 0°, 30°, 45°, 60° and 90° to detect the variations in corneal birefringence post-PK. The technique of digital photoelasticity is utilized to capture the corneal birefringence experimentally. Results: The local and global features of corneal birefringence provided interesting insights into the nuances of corneal birefringence in PK. Statistical analysis was performed to study the effects of suturing on the birefringence around the suture bites. It was observed that the interaction of the suture tension and structural misalignment between the host and the donor cornea influences the corneal birefringence in PK. Conclusions The zero-degree structural misalignment of the host and the donor tissue is preferable to minimize the topographical irregularities and related astigmatism post-PK. The findings of the present study envisage an additional step of structurally aligning the donor tissue with the host before suturing to minimize topographical irregularities in PK. [ABSTRACT FROM AUTHOR]

Purpose Methods Results Conclusions Level of Evidence This study aimed to clarify the characteristics of delaminated rotator cuff tears (RCTs) and evaluate the clinical outcomes of a modified arthroscopic en masse suture bridge repair for delaminated RCTs.Patients with full‐thickness RCTs, who underwent arthroscopic suture bridge repair with a minimum 2‐year follow‐up, were retrospectively reviewed. Patients were categorized into two groups based on the presence of delamination. Delaminated RCTs were treated using a modified en masse suture bridge technique, while nondelaminated RCTs received a conventional suture bridge technique. Preoperative and postoperative Constant scores and American Shoulder and Elbow Surgeons (ASES) scores were determined to evaluate clinical outcomes. Postoperative magnetic resonance imaging (MRI) was carried out to identify the integrity and retear of the repaired rotator cuff.A total of 172 patients were included in our study cohort, in which 67 (39%) delaminated RCTs were confirmed intraoperatively. The prevalence of delamination was significantly higher in large tears (53/102, 52%) compared to medium tears (14/70, 20%) (p < 0.001). No significant differences in age (n.s.) or gender (n.s.) were observed between the two groups. Both groups showed significant improvements in Constant and ASES scores postoperatively (both p < 0.001), with no significant differences between the groups (n.s.). The retear rates were 2/67 (3.0%) in the delamination group and 3/105 (2.9%) in the nondelamination group, showing no significant difference (n.s.).The modified arthroscopic en masse suture bridge technique was effective for repairing delaminated RCTs, yielding favourable clinical outcomes comparable to those of nondelaminated tears.Level IV. [ABSTRACT FROM AUTHOR]

This case report highlights the successful application of a robotic-assisted surgical approach in managing Nutcracker syndrome. The patient, a 36-year-old female presented with severe symptoms and underwent robotic left renal vein transposition after failing conservative management. The procedure was performed through a minimally invasive approach utilizing the Da Vinci robotic system™ which offers enhanced visualization and precision. However, challenges arose during the renal vein anastomosis due to tension and poor flow through the transposition, requiring two revisions with a bovine pericardial patch. Ultimately, an 8 mm ringed PTFE bypass was anastomosed from the distal left renal vein to the Inferior Vena Cava. Despite these challenges, the patient experienced a successful outcome with complete symptom resolution of this complicated pathology. [ABSTRACT FROM AUTHOR]

En bloc resection is required for treatment of intermediate-grade talar tumors with extraosseous extension (Enneking stage 3) and malignant talar tumors without intra-articular invasion (Enneking stages IA and IIA). After resection, reconstruction options include tibiocalcaneal fusion, frozen autograft, and talar prosthesis; however, a talar prosthesis is preferable because it preserves ankle range of motion, does not cause leg length discrepancy, and is associated with good long-term outcomes. To the best of our knowledge, en bloc resection and reconstruction of a malignant talar tumor has not been previously reported in detail. We report a detailed surgical technique for en bloc resection of a malignant talar bone tumor using combined anterior and lateral approaches followed by reconstruction using a talar prosthesis. [ABSTRACT FROM AUTHOR]

Background: The all-inside technique is now the most established treatment for meniscal repair, this usually involves a suture-based repair utilising interrupted sutures. A similar technique using continuous sutures can also be used; however there are no studies in the literature appraising this technique. This study aims to review outcomes for patients undergoing meniscal repair using a continuous suture all-inside technique. Methods: We reviewed patients undergoing meniscal repair using a continuous suture all-inside technique over a 5 year period. We recorded demographic details, injury type, surgical procedure, incidence of reoperation, functional outcomes (Tegner–Lysholm and International Knee Documentation Committee (IKDC) score) return to sport and failure of repair. Results: Data were collected for 37 patients. Mean age was 25.8 years, 81%, were male, median time to theatre was 169 days, mean follow-up time was 2.9 years. Concurrent ACL ruptures were present in 57%, all underwent ACL reconstruction in the same sitting. The mean Tegner–Lysholm score was 89. Mean IKDC score was 90.2. 78% were able to return to sport. Overall failure rate was 10.81%. Increasing age was associated with a decreased IKDC score (p = 0.02). Tegner–Lysholm score was significantly greater in patients with concurrent ACL injuries (p = 0.03) and patients with lateral meniscal tears (p = 0.04). Conclusion: In the first study to review outcomes following continuous all-inside suture-based meniscal repair we demonstrate excellent clinical outcomes with IKDC, Tegner–Lysholm, return to play and failure rates comparable to other commonly used techniques. We conclude that this is an acceptable and cost-effective technique. [ABSTRACT FROM AUTHOR]

Purpose: Fresh-frozen specimen availability and cost may be a barrier for initiation of biomechanical studies where soft tissue is used in a construct with other medical devices. The impact of soft tissue preservation method on the outcomes of biomechanical studies in the specific case of graft-suture constructs is relatively unexplored. This study aimed to observe peak loads and failure modes in biomechanical testing of fresh-frozen (FF) versus formalin embalmed (FE) quadriceps tendon (QT) graft-suture constructs for soft tissue fixation in ACLR and assess suitability of FE QT graft constructs for load-to-fail testing. Methods: Twenty QT grafts were harvested from human cadaver specimens. Ten grafts came from fresh-frozen donors and 10 from embalmed donors. All grafts were prepared with the modified Prusik knot using a braided composite suture and subjected to tensile loading. Comparisons between the biomechanical properties of the graft-suture constructs were made with unpaired t tests with α = 0.05. Results: FE and FF constructs displayed similar peak loads and failure modes. FF constructs had greater elongation after pre-tensioning than FE (7.3 vs. 5.5 mm, p = 0.02) and greater elongation after cyclic loading than FE constructs (17.5 vs. 10.5 mm, p = 0.01). Hysteresis was greater for FF constructs at the 50th, 100th, 150th, and 200th cycle (p = 0.02, p = 0.07, p < 0.001, p = 0.004, respectively). FE constructs were stiffer than fresh-frozen (103 vs. 84 N/mm, p < 0.001). Conclusion: FE constructs were significantly stiffer but displayed similar peak load and failure mode to FF which was reflective of the strength of the suture material. FE grafts can offer an alternative to FF grafts in graft-suture constructs for biomechanical studies where load at failure and knot security and strength is of main interest. [ABSTRACT FROM AUTHOR]

Background: Bariatric surgery has been proven to be the most effective therapy for obesity and Roux-en-Y gastric bypass (RYGB) is one of the most commonly performed procedure. However, weight regain and dumping syndrome occur over time. The transoral outlet reduction (TORe) procedure using an endoscopic suturing device may be an option to treat these conditions. We aimed to analyze outcome parameters and long-term results for this endoscopic technique. Methods: A retrospective data analysis of patients who underwent TORe using an endoscopic suturing system at our institution from January 2015 to December 2020 was performed. A total of 71 subjects were included. Forty-five patients received the intervention for weight regain, 9 for dumping syndrome and 17 for both. The primary endpoint was weight stabilization or weight loss for subjects with weight regain, and resolution of symptoms for those with dumping syndrome. Secondary endpoints were intraoperative complications, procedure time, length of hospital stay and diameter of gastrojejunal anastomosis 1 year post-intervention. Results: The median size of the gastrojejunal anastomosis was estimated at 30 mm before intervention, and after performing a median of 3 endoscopic sutures, the median estimated gastrojejunal anastomosis width was reduced to 9.5 mm. Eight perioperative complications occurred. Overall mean follow-up was 26.5 months. All interventions achieved weight stabilization or weight loss or resolution of dumping symptoms within the first 3 months, 98.2% at 12 months, 91.4% at 24 months and 75.0% at 48 months. In 22/26 subjects a persisting improvement of dumping syndrome was achieved. Conclusions: TORe is a safe and effective procedure in the treatment of patients with dumping syndrome after laparoscopic RYGB, the effect on weight stabilization is less significant. A prospective randomized trial should be conducted to compare the effects of TORe with other surgical methods like banding the gastrojejunal anastomosis. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to determine the presence and incidence of accessory sutures and bipartite zygomatic bone types, and their effects on population affinity and clinical significance. Methods: We examined 120 dry skulls and 50 zygomatic bones to evaluate the presence, frequency, and location of accessory zygomatic sutures as well as subtypes of bipartite zygomatic bones. Morphometric analysis included measuring the total width and length of the zygomatic bone with accessory sutures (ASs), the total length of the AS, and the shortest distance between the AS and various anatomical landmarks. Results: Bipartite zygomatic bone was observed in 14 of 120 dry skulls (11.6%) and 1 of 50 zygomatic bones (2%), indicating an overall incidence of 16 occurrences (8.82%). The ASs were predominantly located posterolaterally in 11 cases (six males, five females), anteromedially in two cases (one male, one female), superiorly in one case (male), and superolaterally in one case (male). Significant differences were noted in the distribution of the ASs (p < 0.001). Notably, a vertical inferior bipartite zygomatic type, which has not been reported in the literature, was identified. Correlations were observed between the various anatomical landmarks. Among females, the length of AS was significantly different (p = 0.038). Significant differences were also noted in the shortest distance between the AS and the zygomaticofacial foramen (ZFF) based on the body side (p = 0.034). Conclusions: Our study suggests that the bipartite zygomatic bone is not a common occurrence, indicating its significance as a morphological variation present in certain individuals. The type VII bipartite zygomatic bone exhibited the highest incidence rate, suggesting potential ethnic-specific differences in the prevalence of certain subtypes. The consistent pattern of suture distribution, along with the asymmetry and variability in suture patterns, emphasizes its potential clinical relevance. [ABSTRACT FROM AUTHOR]

This article traces the trajectory of critical geographical scholarship on the body's intertwinement with infrastructure systems. In doing so, it argues that although the body is not ontologically infrastructure, it can nevertheless enable infrastructure's functioning – whether by being made into infrastructure of surplus value production or by suturing widening gaps in sub-optimal infrastructure systems. Analysing these dynamics, the article theorises the body as infrastructured – given over to the violence of capital and its infrastructures that subject specifically gendered, racialised, and classed bodies to surplus value extraction and/or abandonment; but also as simultaneously fleeting in its irreversible exposure to this violence. [ABSTRACT FROM AUTHOR]

One of the parameters related to the result of Whipple's procedure or Pancreaticoduodenectomy (PD) is the suture knot-tying force during pancreaticogastrostomy anastomosis. We hypothesize that an imbalanced suture force during surgical anastomosis can result in postoperative problems such as postoperative pancreatic fistula (POPF). The consequences are potentially fatal, discouraging the surgeon from conducting such complex surgery. The purpose of this study was to find the best suture knot-tying force for pancreaticogastrostomy anastomosis in PD and to determine the best force range for suture knot-tying to prevent pancreatic leaks. In 36 patients, the designed suture force measurement device (SFD) was clinically evaluated. The patients were monitored postoperatively for any complications, and the suture knot-tying force data were used for analysis. The optimal force range and surgical success had a significant positive connection (P < 0.01). The best suture knot-tying force to avoid pancreatic leak following PD was (3.39 SD0.71) for the soft pancreas, (4.38 SD0.71) for the firm pancreas, and (7.70 SD0.62) for the hard pancreas. Suture knot strength is a significant factor in determining the surgical outcome. A suture knot tied at the optimal force range speeds up healing and avoids other postoperative problems. Suture knots performed beyond the optimal range, on the other hand, were observed with POPF. The study to prevent pancreatic leakage after PD revealed the best suture force range for pancreaticogastrostomy anastomosis. The trial was approved by the Institutional Ethics Committee of Government Stanley Medical College. The Institutional Ethics Committee is reregistered with the Central Drugs Standards Control Organization, ethics committee division with register number ECR/131/Inst/TN/2013/RR19. [ABSTRACT FROM AUTHOR]

The septocolumellar sutures are very helpful to obtain planned rotation and projection. The goal of this study is to revitalize the septocolumellar techniques described before and present an easy new classification for these sutures, and to present their multiple uses on the same patient as a new option for surgeons. Eighty patients were involved in this retrospective study. All the patients were females except one. A detailed preoperative preparation was performed on all patients by following the principles of precision profileplasty. In this study, five main types of septocolumellar sutures were used. Type 4 septocolumellar suture was used in 39 cases, type 3 in 33, type 2 in 22, type 1 in 5, and type 5 in 2 cases. In 21 cases, more than one suture was used. In conclusion, the new practical classification presented in this study gives the surgeon powerful tools to reshape the tip during surgery. [ABSTRACT FROM AUTHOR]

Introduction: Automated skills assessment can provide surgical trainees with objective, personalized feedback during training. Here, we measure the efficacy of artificial intelligence (AI)-based feedback on a robotic suturing task. Materials and Methods: Forty-two participants with no robotic surgical experience were randomized to a control or feedback group and video-recorded while completing two rounds (R1 and R2) of suturing tasks on a da Vinci surgical robot. Participants were assessed on needle handling and needle driving, and feedback was provided via a visual interface after R1. For feedback group, participants were informed of their AI-based skill assessment and presented with specific video clips from R1. For control group, participants were presented with randomly selected video clips from R1 as a placebo. Participants from each group were further labeled as underperformers or innate-performers based on a median split of their technical skill scores from R1. Results: Demographic features were similar between the control (n = 20) and feedback group (n = 22) (p > 0.05). Observing the improvement from R1 to R2, the feedback group had a significantly larger improvement in needle handling score (0.30 vs −0.02, p = 0.018) when compared with the control group, although the improvement of needle driving score was not significant when compared with the control group (0.17 vs −0.40, p = 0.074). All innate-performers exhibited similar improvements across rounds, regardless of feedback (p > 0.05). In contrast, underperformers in the feedback group improved more than the control group in needle handling (p = 0.02). Conclusion: AI-based feedback facilitates surgical trainees' acquisition of robotic technical skills, especially underperformers. Future research will extend AI-based feedback to additional suturing skills, surgical tasks, and experience groups. [ABSTRACT FROM AUTHOR]

Accurate tumor localization and resection margin acquisition are essential in gastric cancer surgery. Preoperative placement of marking clips in laparoscopic gastrectomy as well as intraoperative gastroscopy can be used for gastric cancer surgery. However, these procedures are not available at all institutions. We conducted a prospective clinical trial to investigate the diagnostic performance of near-infrared fluorescent clips (ZEOCLIP FS) in laparoscopic gastrectomy. Patients with gastric cancer or neuroendocrine tumor in whom laparoscopic distal, pylorus-preserving, or proximal gastrectomy was planned were enrolled (n = 20) in this study. Fluorescent clips were placed proximal and/or distal to the tumor via gastroscopy on the day before surgery. During surgery, the clips were detected using a fluorescent laparoscope, and suturing was performed where fluorescence was detected. The clip locations were then confirmed via gastroscopy, and the stomach was transected. The primary endpoint was the detection rate of the marking clips using fluorescence, and the secondary endpoints were complications and distance between the clips and stitches. Among the 20 patients enrolled, distal and pylorus-preserving gastrectomies were performed in 18 and 2 patients, respectively. All clips were detected in 15 patients, indicating a detection rate of 75.0% (90% confidence interval: 54.4%-89.6%). Furthermore, no complications related to the clips were observed. The median distance between the clips and stitches was 5 (range, 0–10) mm. We report the feasibility and safety of preoperative placement and intraoperative detection of near-infrared fluorescent marking clips in laparoscopic gastrectomy. • This study analyzed diagnostic performance of fluorescent marking clips in laparoscopic gastrectomy. • The detection rate of the clips under fluorescent observation was 75.0%. • Placement and detection of the fluorescent clips in laparoscopic gastrectomy are feasible and safe. [ABSTRACT FROM AUTHOR]

Purpose: In craniofacial surgery, the stable fixation of transposed bone segments is crucial in order to ensure good long-term results. The use of absorbable material in fixation avoids the need for a second surgery, which would otherwise be required to remove osteosynthesis material. The authors of the present manuscript have already demonstrated that absorbable sutures ensure the stable fixation of bone segments in patients up to 24 months of age. However, it has thus far remained unclear whether stable fixation is possible in older patients by using only absorbable sutures due to the slower bone remodelling and prolonged healing time in this cohort. Method: For the present study, osteosynthesis was performed in 50 patients ranging from 25.7 to 192.1 months of age (mean, 61.4 ± 21.7 months) using solely absorbable sutures (PDS II®, Ethicon, Germany). Post-operative stability and possible restrictions—such as foreign body reactions—were evaluated within clinical and radiological routine follow-ups. Results: All children demonstrated clinically and radiologically stable osteosynthesis both directly post-operatively and in follow-ups. No significant foreign body reaction could be seen. Conclusion: The present study demonstrates—for the first time—that absorbable sutures with a longer absorption period are also very well suited for the fixation of bone segments in patients over 24 months of age. The sole use of absorbable sutures in children over 24 months of age is a safe procedure with nearly no foreign body reactions. The procedure enables stable and highly cost-effective osteosynthesis without altering the osteotomy design. [ABSTRACT FROM AUTHOR]

Background: Clinical trials have shown reduced incisional hernia rates 1 year after elective median laparotomy closure using a short-stitch technique. With hernia development continuing beyond the first postoperative year, we aimed to compare incisional hernias 3 years after midline closure using short or long stitches in patients from the ESTOIH trial. Methods: The ESTOIH trial was a prospective, multicenter, parallel-group, double-blind, randomized-controlled study of primary elective midline closure. Patients were randomized to fascia closure using a short- or long-stitch technique with a poly-4-hydroxybutyrate-based suture. A predefined 3-year follow-up analysis was performed with the radiological imaging-verified incisional hernia rate as the primary endpoint. Results: The 3-year intention-to-treat follow-up cohort consisted of 414 patients (210 short-stitch and 204 long-stitch technique) for analysis. Compared with 1 year postoperatively, incisional hernias increased from 4.83% (20/414 patients) to 9.02% (36/399 patients, p = 0.0183). The difference between the treatment groups at 3 years (short vs. long stitches, 15/198 patients (7.58%) vs. 21/201 (10.45%)) was not significant (OR, 1.4233; 95% CI [0.7112–2.8485]; p = 0.31). Conclusion: Hernia rates increased significantly between one and 3 years postoperatively. The short-stitch technique using a poly-4-hydroxybutyrate-based suture is safe in the long term, while no significant advantage was found at 3 years postoperatively compared with the standard long-stitch technique. Trial registry: NCT01965249, registered on 18 October 2013. [ABSTRACT FROM AUTHOR]

Purpose: Metachronous contralateral inguinal hernia (MCIH) may occur after unilateral inguinal hernia (IH) repair, potentially as a result of occult IH (OIH). Contralateral OIH can be checked for during laparoscopic transabdominal hernioplasty for the treatment of unilateral IH. This study aims to assess the efficacy of laparoscopic iliopubic tract repair (IPTR) in treating contralateral OIH to reduce MCIH. Methods: The medical charts of 3165 patients aged > 18 years who underwent laparoscopic transabdominal hernioplasty for unilateral IH from January 2013 to December 2021 were retrospectively reviewed. The patients were categorized into two groups based on contralateral OIH presence: negative OIH (nOIH, 2657 patients) and OIH (508 patients). In cases of OIH, IPTR was performed, involving suturing of the iliopubic tract and transversalis fascia arch. Results: MCIH was indirect in 26 and direct in 4 patients in the nOIH group, and was direct in 3 patients in the OIH group. The incidence of indirect MCIH was higher in the nOIH group than in the OIH (1.0% [n = 26/2657] vs. 0.0% [n = 0/508], p = 0.048). There was no difference in postoperative complication rates, pain scores, return to daily life, or duration of hospitalization between the nOIH and OIH groups. Conclusion: Laparoscopic IPTR for OIH treatment is an effective method for reducing the risk of indirect MCIH. [ABSTRACT FROM AUTHOR]

Background Closure of gastrointestinal defects can reduce postprocedural adverse events. Over-the-scope clips and an over-the-scope suturing system are widely available, yet their use may be limited by defect size, location, operator skill level, and need to reinsert the endoscope with the device attached. The introduction of a through-the-scope helix tack suture system (TTSS) allows for closure of large irregular defects using a gastroscope or colonoscope, without the need for endoscope withdrawal. Since its approval 3 years ago, only a handful of studies have explored outcomes using this novel device. Methods Multiple databases were searched for studies looking at TTSS closure from inception until August 2023. The primary outcomes were the success of TTSS alone and TTSS with clips for complete defect closure. Secondary outcomes included complete closure based on procedure type (endoscopic mucosal resection [EMR], endoscopic submucosal dissection [ESD]) and adverse events. Results Eight studies met the inclusion criteria (449 patients, mean defect size 34.3 mm). Complete defect closure rates for TTSS alone and TTSS with adjunctive clips were 77.2% (95%CI 66.4–85.3; I2=79%) and 95.2% (95%CI 90.3–97.7; I2=42.5%), respectively. Complete defect closure rates for EMR and ESD were 99.2% (95%CI 94.3–99.9; I2 = 0%) and 92.1% (95%CI 85–96; I2=0%), respectively. The adverse event rate was 5.4% (95%CI 2.7–10.3; I2=55%). Conclusion TTSS is a novel device for closure of postprocedural defects, with relatively high technical and clinical success rates. Comparative studies of closure devices are needed. [ABSTRACT FROM AUTHOR]

A 65-year-old woman presented with right elbow pain after a fall. Imaging showed an avulsion fracture of the olecranon. The patient subsequently underwent surgery using the suture bridge technique with anchors. However, loosening was observed intraoperatively. Therefore, a McLaughlin cerclage with an artificial ligament was added, resulting in a rigid fixation. Bone union was achieved at 4 months postoperatively. At 18 months postoperatively, no limitation was observed in the range of motion of the elbow joint; the disabilities of the arm, shoulder and hand score was 0. McLaughlin cerclage with an artificial ligament provided additional fixation, demonstrating greater strength compared with suture anchors and minimizing the risk of cut-through in the osteoporotic bone. This approach offers a promising alternative for such cases by combining firm fixation with a reduced risk of complications, particularly in older patients with osteoporosis. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to compare the clinical outcomes of deep sclerectomy and trabeculectomy surgeries, both utilizing 5-fluorouracil. Methods: In this study, 11 eyes of 10 patients (14.3%) in the deep sclerectomy group and 66 eyes of 61 patients (85.7%) in the trabeculectomy group were retrospectively examined. Success in intraocular pressure (IOP) was defined as being below 21 mmHg without medication, partially successful if achieved below 21 mmHg with a single molecule, considered less successful with two to four molecules for maintaining IOP below 21 mmHg, and deemed unsuccessful if IOP exceeded 21 mmHg. Results: The deep sclerectomy group showed a success rate of 81.8% on post-operative day 1, with 18.2% considered unsuccessful; at post-operative 6 months, the success rate was 12.5%, with 50% partially successful and 37.5% less successful. In the trabeculectomy group, the success rate was 97% on post-operative day 1, with 3% considered unsuccessful; at post-operative 6 months, the success rate was 60.8%, with 15.7% partially successful, 13.7% less successful, and 9.8% unsuccessful. Trabeculectomy patients experienced complications such as choroidal detachment (6.1%), shallow anterior chamber (4.5%), tight suturing (3%), internal ostium occlusion (3%), posterior synechia (3%), bleb failure (1.5%), cyclodialysis/iridodialysis (1.5%), and hyphema (1.5%). In the deep sclerectomy group, tight suturing (36.3%), and dellen (9.09%) were observed, with no other complications reported. Conclusion: Trabeculectomy surgery has been observed to be superior to deep sclerectomy in follow-ups up to 48 months postoperatively. However, it is noted that there is a higher risk of post-operative complications. [ABSTRACT FROM AUTHOR]

Background: Both knotless and knot-tying anchors are commonly employed in the arthroscopic repair of hip labral tears. Purpose: To compare the midterm clinical results of arthroscopic hip labral repair using knot-tying versus knotless suture anchors. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent arthroscopic hip labral repair between January 2017 and January 2021 and who had at least 2 years of follow-up were included. The patients were divided into 2 groups based on the suture anchor type: a 2.9-mm knotless suture anchor (knotless group) or a 1.8-mm knot-tying suture anchor (knot-tying group). All patients underwent femoroplasty for cam lesions and acetabular rim trimming for pincer lesions. The modified Harris Hip Score (mHHS), Hip Outcome Score–Sport-Specific Subscale (HOS-SSS), Hip Outcome Score–Activities of Daily Living (HOS-ADL), 12-item International Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain were administered both preoperatively and postoperatively. The consistency of the outcome scores was assessed using the minimal clinically important difference and Patient Acceptable Symptom State. The statistical significance between groups was evaluated using the Mann-Whitney test and quantile-based analysis of variance. Results: A total of 413 patients were included: 256 patients in the knotless group (median age, 35 years [interquartile range, 31-38 years]; median follow-up, 34 months) and 157 patients in the knot-tying group (median age, 34 years [interquartile range, 30-38 years]; median follow-up, 25 months). There were no significant differences in postoperative mHHS, HOS-ADL, or iHOT-12 scores between the 2 groups. However, there were significant differences, favoring the knotless group over the knot-tying group, in postoperative HOS-SSS (87 ± 2 vs 86 ± 1, respectively) and VAS pain (1 vs 2, respectively) scores (P <.0001 for both). Postoperative synovitis was found in significantly more patients in the knot-tying group than in the knotless group (17 vs 5, respectively; P =.01). Conclusion: In this study, patients who underwent arthroscopic hip labral repair with knotless suture anchors had slightly better postoperative HOS-SSS and VAS pain scores and a lower incidence of postoperative synovitis compared with patients who underwent repair with knot-tying suture anchors. [ABSTRACT FROM AUTHOR]

Background: Approximately 6% of people will report Achilles tendon pain during their lifetime, and one-third of these individuals will have Achilles insertional tendinopathy (AIT). For patients who have failed conservative treatment, surgical repair is performed. Achilles tendon repair can occur through various techniques, including a single-row or double-row repair. Purpose: To determine if there are significant advantages to double-row repair over single-row repair with respect to biomechanical and clinical outcomes. Study design: Systematic review; Level of evidence, 3. Methods: A systematic review of the literature was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic search of the EMBASE and PubMed databases was performed for all studies related to surgical treatment of AIT, which yielded 1431 unique results. These included both biomechanical and clinical studies. Clinical studies in which patients were not diagnosed with AIT, underwent surgery for repair of acute Achilles tendon rupture, or studies that included additional procedures such as a concomitant flexor hallucis longus transfer were excluded. Eligible studies were independently screened by 2 reviewers. A risk-of-bias assessment was conducted using the Cochrane Risk Of Bias In Non-randomized Studies–of Interventions and risk-of-bias tool for randomized trials tools. Results: A total of 23 studies were included, 4 of which were biomechanical studies and 19 were clinical studies. Biomechanical comparison found that there was a significant advantage to using double-row versus single-row fixation with respect to load at yield (354.7 N vs 198.7 N; P =.01) and mean peak load (433.9 N vs 212 N; P =.042). There was no significant difference between double-row and single-row repair with respect to load to failure. Significant heterogeneity of the studies did not allow for a statistical comparison of the clinical outcomes between double-row and single-row repairs. Conclusion: Although biomechanical studies favor double-row repair for AIT, the current data available on the clinical outcomes are not sufficient to determine if there is a clinical advantage of double-row repair. Larger, prospective randomized controlled trials utilizing validated outcome measures are needed to further elucidate whether the biomechanical advantages associated with double-row repair also translate into improved patient-reported outcomes. [ABSTRACT FROM AUTHOR]

Background: The use of all-suture anchors for rotator cuff repair is increasing. Potential benefits include decreased bone loss and decreased damage to the chondral surface. Minimal evidence exists comparing outcomes among medial-row anchor fixation methods in double-row suture bridge rotator cuff repair. Purpose: To compare the clinical outcomes between all-suture and solid medial-row anchors in double-row suture bridge rotator cuff repair. Study Design: Case series; Level of evidence, 4. Methods: A total of 352 patients (mean age at surgery, 60.3 years) underwent double-row suture bridge rotator cuff repair at our institution. Patients were separated into 2 groups based on whether they underwent all-suture (n = 280) or solid (n = 72) anchor fixation for the medial row. Outcomes data were collected via an ongoing longitudinal data repository or through telephone calls (minimum follow-up time, 2.0 years; mean follow-up time, 3.0 years). Outcomes were evaluated using the American Shoulder and Elbow Surgeons (ASES) standardized shoulder assessment form and the visual analog scale (VAS). The same rehabilitation protocol was administered to all patients. The proportions of patients meeting previously published Patient Acceptable Symptom State (PASS) thresholds were calculated for the outcome measures, and outcome scores and the proportions of patients meeting PASS thresholds between groups were compared using linear and logistic regression, respectively. Results: The groups did not differ in terms of age at surgery, sex distribution, rotator cuff tear size, or number of medial-row anchors used. The solid anchor group had a longer follow-up time compared with the all-suture anchor group (3.6 ± 0.7 vs 2.8 ± 0.8 years, respectively; P <.01). After controlling for follow-up time, the solid and all-suture anchor groups did not differ in ASES scores (89.6 ± 17.8 vs 88.8 ± 16.7, respectively; P =.44) or VAS scores (1.1 ± 2.1 vs 1.2 ± 2.1, respectively; P =.37). Similarly, after controlling for follow-up time, the solid and all-suture anchor groups did not differ in the proportions of patients meeting PASS cutoffs for the ASES (84.7% vs 80.7%, respectively; P =.44) or the VAS (80.6% vs 75.0%, respectively; P =.83). Conclusion: Double-row suture bridge rotator cuff repair using all-suture anchors for medial-row fixation demonstrated similar excellent clinical outcomes to rotator cuff repair using solid medial-row anchors. [ABSTRACT FROM AUTHOR]

Purpose: To assess the clinical efficacy of arthroscopic treatment for posterior cruciate ligament (PCL) tibial avulsion fractures using high-intensity suture binding combined with button plate suspension fixation. Methods: We retrospectively analyzed clinical data from 32 patients with PCL tibial avulsion fractures treated at our hospital from July 2020 to August 2023. We recorded operation time, intraoperative and postoperative complications, and used imaging to assess fracture reduction and healing. Pain and knee function were evaluated using the Visual Analogue Scale (VAS), range of knee motion, Lysholm score, and International Knee Documentation Committee (IKDC) score. Study Design: Case series; Level of evidence, 4. Results: All patients were followed for 6 to 18 months, averaging 13.6 months. All incisions healed successfully without postoperative complications. X-rays taken on the first postoperative day showed satisfactory fracture reduction. Three-month post-surgery imaging confirmed healed fractures and no internal fixation failures. At the final follow-up, knee function was well recovered, with only one patient exhibiting a positive posterior drawer test of degree I. Furthermore, the mean VAS score was 0. 5 (range 0.0 to 1.0), active knee extension was 2. 2° (range 0.0 to 5.0), and active knee flexion was 137.7° (range 130.0 to 145.0). The mean Lysholm score was 91.5(range 89.3 to 94.0), and the IKDC score averaged 83.8 ± 3.7, and these outcomes showed statistically significant improvement from preoperative levels (P < 0.001). Conclusions: Arthroscopic high-intensity suture binding combined with button plate suspension fixation for PCL tibial avulsion fractures offers several benefits: it is minimally invasive, results in less postoperative pain, enables earlier functional exercise, and provides satisfactory clinical outcomes with fewer complications. [ABSTRACT FROM AUTHOR]

Background: To assess the viability and efficiency of performing arthroscopic meniscoplasty in treating discoid meniscus (DM) in the knee joint. Methods: A total of 29 patients diagnosed with symptomatic lateral DM between October 2014 and December 2019 were included in the study. Among them, 7 patients with intact DM underwent arthroscopic discoid meniscoplasty (group A), while 22 patients with torn DM received arthroscopic DM plasty along with repair and suturing (group B). Both Visual Analog Scale (VAS) score and Lysholm score assessments were conducted preoperatively and postoperatively. Result: The favorable and acceptable outcome rate was 85.71% in group A and 95.45% in group B (P > 0.05). The VAS scores post-operatively at each follow-up time point were consistently lower compared to pre-operative values, while the Lysholm knee function scores showed improvement. There were no significant differences in VAS score and Lysholm score between group A and group B at different stages (P > 0.05). Both surgical techniques (discoid meniscoplasty and discoid meniscoplasty combined with repair and suture) showed significant improvement in postoperative VAS score and Lysholm score, but there was no difference in outcomes between the two groups. Conclusion: Overall, the two surgical techniques studied in this study (discoid meniscoplasty and discoid meniscoplasty combined with repair and suture) produced similar results in terms of pain reduction and improved knee function. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Purpose: To present our technical modifications of single incision laparoscopic percutaneous extraperitoneal closure (SILPEC) of the internal inguinal ring (IIR) for pediatric inguinal hernia (PIH). Methods: The prospectively collected data of all children diagnosed with PIH undergoing SILPEC at our center from 2016 to 2023 were reviewed and divided into two groups for result comparison: Group A: before and Group B: after the implementation of full modifications. Our modifications included using a nonabsorbable monofilament suture, creating a peritoneal thermal injury at the internal inguinal ring (IIR), employing a cannula to ensure the suture at the IIR ligates only the peritoneum, and double ligation of the IIR in selected cases. Results: 1755 patients in group A and in group B (1 month to 14 years old) were enrolled. There were no significant differences regarding baseline patient characteristics between the two groups. At a median follow-up of 40 months, the rate of recurrent CIH and subcutaneous stitch granuloma (SSG) was 2.3% and 1.5% in group A vs. 0% and 0% in group B (p < 0.001). There were no hydroceles, no ascended or atrophic testis. Conclusions: Our SILPEC technical modifications can achieve zero recurrence and zero SSG for PIH. [ABSTRACT FROM AUTHOR]