As total mesorectal excision (TME) for rectal cancer is widely carried out in China, lateral ligament of rectum, as an important anatomical structure of the lateral rectum with certain anatomical value and clinical significance, has been the focus of attention. In this paper, by comparing and analyzing the characteristics about ligaments of the abdomen and pelvis, reviewing the membrane anatomy and the theory of primitive gut rotation, and combining clinical observations and histological studies, the author came to a conclusion that lateral ligament of rectum does not exist, but is only a relatively dense space on the rectal side accompanied by numerous tiny nerve plexuses and small blood vessels penetrating through it.
Humans ; Rectum/anatomy & histology* ; Pelvis/anatomy & histology* ; Rectal Neoplasms/surgery* ; Peritoneum ; Collateral Ligaments ; Cognition

OBJECTIVETo explore the isometric attachment site of knee lateral collateral ligament (LCL) in the femoral lateral condyle; to introduce the isometric reconstruction of knee lateral collateral ligament with the long head of biceps femoris tendon.

METHODSAmong 16 patients with knee injury treated with isometric reconstruction of the lateral collateral ligament, 10 patients were male and 6 patients were female, with an average age of 38.4 years (ranged from 20 to 58 years). Twelve patients were chronic injuries, four patients were acute injuries, with an average duration of 5 days to 11 months. Eleven patients had simple LCL injury,3 patients had LCL injury combined with PCL injury, 2 patients had LCL injury combined with ACL injury. The middle one third of the long head of biceps femoris tendon was cut to be fixed to the isometic bony tunnel of the femoral lateral condyle. The lateral stability of the knee was evaluated mainly through varus stress test.

RESULTSThe better isometric attachment site is from the anatomical caput fibulae attachment site or the middle one third of the long head of biceps femoris to the femoral lateral condyle to 8-10 mm in front of the anatomical femoral attachment site of the lateral collateral ligament. The average follow-up period was 13.5 months (ranged from 12 to 24 months). At the 12th month after operation, there was no varus instability in full extension. At 30 degrees flexion, one-grade varus instability was found in 2 patients. In varus stress test the lateral joint space increased less than 5 mm compared to the healthy side.

CONCLUSIONThe method provided good stability for the knee and acquired satisfactory clinical results.

Adult ; Collateral Ligaments ; injuries ; surgery ; Female ; Humans ; Knee Joint ; surgery ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Tendons ; surgery

OBJECTIVETo investigate the clinical and radiological results of lateral stabilization with reconstruction of the lateral ligaments for the treatment of chronic lateral instability of the ankle.

METHODSFrom September 2005 to March 2010, 29 patients with chronic lateral instability of the ankle were reviewed. There were 24 males and 5 females with an average age of 24 years (15 to 35 years). The duration of the disease ranged from 7 to 10 years, averaged 10 months. The main symptom was repeated ankle sprain. During physical examination, ankle varus and the anterior talar transition were conducted. There was (12.5 +/- 3.2) degrees more inversion activity than the contralateral ankle. Arthroscopy was performed for the chondral injury, and anatomic reconstruction of the lateral ligament with an autologous gracilis tendon graft was performed for lateral instability of the ankle. Clinical and radiological evaluations were performed before surgery and at the most recent follow-up.

RESULTSAll the patients with successful surgery, there was no fracture or infection. All the patients were followed up,and the duration ranged from 16 to 60 months, with an average of 28 months. There was no ankle instability or limited mobility of the 29 cases at the latest follow-up. According to the American Orthopedic Foot and Ankle Society ankle-hind foot scale, the mean score was 48.0 +/- 6.7 before surgery and 92.8 +/- 6.2 at the most recent follow-up (P = 0.010). The talar tilt angles on standard stress radiography were (12.5 +/- 3.2) degrees before surgery and (2.5 +/- 0.8) degrees at the most recent follow-up (P = 0.012). The mean distance of anterior talar translation was (16.3 +/- 4.0) mm before surgery and (3.5 +/- 0.8) mm at the most recent follow-up (P = 0.002). There were no severe complications, the results were satisfactory.

CONCLUSIONAnatomical reconstruction of the lateral ligament with autologous gracilis tendon graft for the treatment of chronic lateral instability of the ankle can be recommended.

Adolescent ; Adult ; Ankle Joint ; surgery ; Chronic Disease ; Collateral Ligaments ; surgery ; Female ; Humans ; Joint Instability ; surgery ; Male ; Reconstructive Surgical Procedures ; methods

Adult ; Bone Screws ; Collateral Ligaments ; injuries ; surgery ; Female ; Humans ; Knee Joint ; surgery ; Male ; Middle Aged ; Tibia ; surgery

OBJECTIVETo evaluate clinical efficacy of suture anchors in treating acute injuries of medial collateral ligament (MCL) of knee at degree III.

METHODSTwenty-seven patients with degree III acute MCL injuries of knee were treated with suture anchors from January 2007 to June 2011. There were 15 males and 12 females, aged from 19 to 56 (averaged 32.6) years old. The time from injury to operation was 3 to 10 days, averaged 6 days. Symptoms and physical signs before and after treatment were observed, Lysholm scoring were used to evluated clinical efficacy.

RESULTSAll patients were followed up from 16 to 30 months with an average of 21.6 months. The stability of knee joints was good in all patients. Abduction stress test was negative when the knee joint was straightened at 0 degrees and flexed at 30 degrees. The average degree of flexed knee (67.00 +/- 5.80) degrees preoperatively was lower than that of postoperatively (136.50 +/- 6.30) degrees at 1 year. According to Lysholm scoring, preoperative scores ranged from 30 to 43 points, averaged 36.46 +/- 1.48; 1 year after operation ranged from 87 to 100 with an average of 91.50 +/- 3.80 and higher than postoperative. Twenty patients got an excellent results, 5 good and 2 fair.

CONCLUSIONSuture anchors in treating acute injuries of medial collateral ligament of knee at degree III has following advantages: small range of tissue dissection, easy to operate, reliable fixation and less complications.

Acute Disease ; Adult ; Collateral Ligaments ; injuries ; surgery ; Female ; Humans ; Knee Injuries ; surgery ; Male ; Middle Aged ; Suture Anchors

OBJECTIVE: To investigate the short-term effectiveness of calcaneal lateral displacement osteotomy with lateral ligament repair in the treatment of Takakura stage Ⅱ varus-type ankle arthritis. METHODS: A retrospective analysis was performed on the clinical data of 13 patients with Takakura stage Ⅱ varus-type ankle arthritis treated with calcaneal lateral displacement osteotomy with lateral ligament repair between January 2016 and December 2020. There were 6 males and 7 females aged 31-65 years, with an average age of 53.6 years. The preoperative tibial-ankle surface angle (TASA) was (88.13±1.01)°, medial distal tibial angle (MDTA) was (86.36±1.49)°, tibial talar surface angle (TTSA) was (6.03±1.63)°, talar tilting angle (TTA) was (81.95±2.15)°, and tibiocalcaneal axis angle (TCAA) was (-5.74±6.81)°. The preoperative American Orthopedic Foot and Ankle Society (AOFAS) score was 56.3±7.1 and the pain visual analogue scale (VAS) score was 3.7±0.5. AOFAS scores, VAS scores, TTSA, TTA, and TCAA were compared between pre- and post-operatively. RESULTS: All 13 patients were followed up 14-41 months, with an average of 28.7 months. The osteotomies healed in all patients. The last follow-up revealed TTA, TTSA, and TCAA to be (88.27±1.19)°, (-0.13±1.37)°, and (2.09±5.10)° respectively, the AOFAS score was 84.3±4.2 and the VAS score was 0.7±0.5, all showing significant improvement when compared to preoperative values ( P<0.05). CONCLUSION For patients with Takakura stage Ⅱ varus-type ankle arthritis, calcaneal lateral displacement osteotomy with lateral ligament repair can correct the lower limb force line, regain ankle stability, and achieving good short-term effectiveness.
Male ; Female ; Humans ; Middle Aged ; Ankle ; Retrospective Studies ; Ankle Joint/surgery* ; Osteoarthritis/surgery* ; Osteotomy ; Collateral Ligaments ; Treatment Outcome

OBJECTIVE: To explore effectiveness and safety of an inside-out, arthroscopic deep medial collateral ligament pie-crusting release in treating posterior horn of medial meniscus (PHMM) tear in tight medial tibiofemoral compartment of knee joint. METHODS: From January 2016 to December 2017, 61 patients (61 knees) were underwent arthroscopic partial meniscectomies for PHMM tear in tight medial tibiofemoral compartment of knee joint, who were divided into valgus group and pie-crusting group according to exposure of PHMM region . There were 28 patients in valgus group, including 12 males and 16 females aged from 27 to 60 years old with an average age of (35.75±7.57) years old;who were performed conventional valgused knee to exporsure PHMM region. There were 33 patients in pie-crusting group, including 15 males and 18 females aged from 26 to 58 years old with an average age of (36.06±7.93) years old;who were treated with inside-out, arthroscopic deep MCL pie crusting release technique with MM-Ⅱ meniscus suture package (Smith & Nephew). Operation time, preoperative and postopertaive Lysholm score of knee joint, injury of MCL between two groups were recorded and compared. RESULTS: All patients were followed up from 12 to 18 months with an average of (15.19±2.22) months. The incisions were healed at stageⅠ. There were no statistical difference in anatomical classification of PHMM between two groups( CONCLUSION The inside-out, arthroscopic deep MCL pie-crusting release for the treatment of posterior horn of medial meniscus tear in tight medial tibiofemoral could expand working apace, shorten operation time, reduce injury to MCL and obtain good clinical efficacy.
Adult ; Arthroplasty, Replacement, Knee ; Arthroscopy ; Collateral Ligaments ; Female ; Humans ; Knee Joint/surgery* ; Male ; Menisci, Tibial/surgery* ; Middle Aged ; Treatment Outcome

OBJECTIVE: To explore clinical and radiographic effects of percutaneous pie-crusting deep medial collateral ligament release in patients with posterior horn tear of medial meniscus combined with tight medial compartment. METHODS: From January 2012 to December 2016, 35 patients with medial meniscus posterior horn injury were treated with percutaneous pie crusting deep medial collateral ligament release technique, including 21 males and 14 females, aged from 21 to 55 years old with an average of (39.1±6.5) years old. Degree of meniscus extrusion were recorded before and 24 months after operation. The knee valgus stress test was performed to evaluate stability of medial collateral ligament, and compared difference between healthy and affected side. Lysholm and IKDC functional scores were compared before and 24 months after operation. RESULTS: All patients were followed up from 27 to 60 months with an average of (36.7±6.8) months. All patients were underwent operation, the wound healed well without complications. Operative time ranged from 0.5 to 1.2 h with an average of (0.8±0.4) h. Nineteen patients were performed partial meniscectomy, 16 patients were performed repair suture. Convex of meniscus before operation was (1.5±0.7) mm, and (1.7±0.4) mm after operation;had no statistical difference( CONCLUSION For patients with medial meniscus tear of posterior horn combined with tight medial compartment, percutaneous pie-crusting deep medial collateralligament release could improve medial compartment space, and Knee valgus instability and meniscus extrusion are not affected.
Adult ; Arthroscopy ; Collateral Ligaments ; Female ; Humans ; Joint Instability ; Knee Joint/surgery* ; Male ; Menisci, Tibial/surgery* ; Middle Aged ; Young Adult

Fracture of bilateral capitulum humeri is a very rare injury. We present a case of a 38-year-old woman, affected by a shear fracture of bilateral capitellum after a motorcycle accident. Intervention was carried out through a lateral approach on both sides and direct fixation of the fragment with headless screws. Consolidation was achieved and no signs of avascular necrosis occurred at 24 months of follow-up. The patient returned to her previous activities with no functional limitations. To the best of our knowledge, only four cases are reported describing different types of treatment and postoperative period of cast immobilization. According to our review of the literature regarding capitellar fractures, we preferred an immediate postoperative rehabilitation of the elbow, following the stable osteosynthesis.
Adult ; Collateral Ligaments ; injuries ; Female ; Fracture Fixation, Internal ; methods ; Humans ; Humeral Fractures ; physiopathology ; rehabilitation ; surgery ; Range of Motion, Articular

BACKGROUND: Locking of metacarpophalangeal joint (MPJ) of the index finger occurs when volar radial osteophytes of the metacarpal head catch the accessory collateral ligament. We devised a ligament-preserving approach to quickly restore the MPJ motion while protecting the radial collateral ligament. METHODS: We retrospectively reviewed the results of nine patients treated for a locked MPJ of the index finger. In three patients, closed reduction was successful. In six cases, volar radial osteophytes were excised from the metacarpal head using a ligament-preserving technique through a longitudinal incision on the radial side. We analyzed osteophyte shape and height as demonstrated by X-ray and computed tomography (CT). Function was evaluated by examining the range of motion, recurrence, Disabilities of the Arm, Shoulder and Hand (DASH) score, and MPJ stability based on the key pinch strength. One male and eight female patients were followed for an average of 33 months (range, 12 to 65 months); the average age of patients was 41 years (range, 34 to 47 years). The average duration of locking of the MPJ was 23 days (range, 1 to 53 days). RESULTS: The sharp type of osteophytes was identified in six patients and the blunt type of osteophytes was indentified in three patients. The average height of radial osteophytes on the index finger metacarpal was 4.6 +/- 0.4 mm in the axial CT image. At the final follow-up, the average extension limitation decreased from 26degrees (range, 10degrees to 45degrees) to 0degrees, and further flexion increased from 83degrees (range, 80degrees to 90degrees) to 86degrees. There was no recurrent locking after surgery. The DASH score improved from 24.3 to 7.2. Key pinch strength improved from 67.3% to 90.4%. CONCLUSIONS: We obtained satisfactory outcomes in irreducible locking of the MPJ of the index finger by excising volar radial osteophytes of the metacarpal head using a ligament-preserving approach.
Adult ; Collateral Ligaments/*surgery ; Female ; Fingers/physiopathology/*surgery ; Humans ; Male ; Metacarpophalangeal Joint/physiopathology/*surgery ; Middle Aged ; Osteophyte/complications/*surgery ; Range of Motion, Articular ; Retrospective Studies