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Objective: Anterior cruciate ligament injury is one of the commonest ligament injuries of knee joint. Arthroscopic acl reconstruction is indicated if patient presents with knee instability and wants to get back to active life style. Incidence of meniscal and chondral injuries is high in chronic acl injured knees .There is still debate on ideal acl reconstruction graft choice, graft fixation methods and tunnel making techniques. So we conducted an observational study on functional evaluation of arthroscopic acl reconstruction using single bundle of quadrupled hamstring graft fixed with endobutton at femoral side and with interference screw at the tibial side using transportal technique. Materials and methods: Arthroscopic acl reconstructed adult patients less than 60 years were included in the study. Those acl injuries in children and older patients with osteoarthritic changes and associated bony injury patients were excluded from the study. Results: There were 40 cases in the study with age ranging from 20 to 47 years with mean age of 31 years. Sports was the most common mode of injury. Isolated acl injury was found in 62.5 percent of cases and combined meniscus injury along with acl injury was found in 37.5 percent of cases in the study. Partial menisectomy was done in 90 percent of cases while meniscus repair was done in 10 percent of cases. The time period from injury to surgery varies from one week to one year with mean time of 3 months. Patients were followed up for a minimum period of one year and evaluated with Lysholm score.The maximum score achieved was 95 and minimum score was 71.There is statiscal significance between pre and postoperative lysholm scores and between associated knee injures and lysholm score. All patients were able to return to their previous job at four months. Conclusion: Arthroscopic Acl

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Caesarean scar ectopic pregnancies are rare but growing in incidence due to increasing rates of caesarean deliveries. These cases have historically been treated with either medical or surgical management which both have significant limitations. More recently, uterine artery embolisation (UAE) has shown significant promise in the treatment of this condition. We present the case of a complex patient with a caesarean scar ectopic successfully managed with combined UAE and surgery.

Intramural haemorrhage causing incomplete small bowel obstructionA 58-year-old gentleman presented to the emergency department with three days of left-sided abdominal pain, distension and nausea. His pain was worse after eating and he had lost his appetite over the course of 3 days. He had not opened his bowels in that time, which was unusual for him.His past history included hypertension, hypercholesterolaemia and a previous mechanical aortic valve replacement. He was on warfarin with a daily dose of 5 mg/day and an international normalized ratio (INR) target of 2.5-3.5. There was no history of previous abdominal surgery.On examination, he was comfortable and able to move freely in the bed. His abdomen was mildly distended and tender from the left hypochondrium down to the left iliac fossa with mild supra-pubic tenderness. There was no tachycardia, tachypnoea, hypotension or fever.Blood tests showed white cell count of 14.9, normal urea and electrolytes, normal liver function tests and lipase but an elevated INR of 4.1.An abdominal radiograph showed dilated loops of small bowel. An abdominal computed tomography (CT) scan with oral and intravenous contrast revealed marked thickening involving 30 cm of the proximal jejunum (Fig. 1), associated mesenteric stranding, hyperaemia and prominence of local lymph nodes (Fig. 2). The bowel was otherwise normal. A diagnosis of a small bowel intramural haemorrhage causing an early partial bowel obstruction was made.