Introduction: Posterior cruciate ligament (PCL) reconstruction needs a large and long graft. An allograft is a preferable option for thicker graft but its availability is limited in Indonesia. Alternatively, autograft needs to be folded several times for sufficient thickness but it will be shorter and only applicable for the inside-out method. We present a case of PCL reconstruction using a double adjustable button fixation with the outside-in tibia tunneling method. Case Presentation: A fifty-five-year-old male came to our office with an unstable right knee after he fell 1 month ago. Physical examination showed positive posterior drawer and mild right knee effusion, other findings were normal. MRI revealed a total PCL rupture. Two weeks later, the PCL reconstruction was done using autograft from gracillis and semitendinous. A large adjustable button was placed on the tibia tunnel, using the outside-in technique. Knee was stable postoperatively. Discussion: PCL reconstruction using double adjustable buttons was chosen to accommodate larger but shorter autografts. The outside-in tibial tunnel has less risk of graft laxity less expensive and more simple technically compared to inside-out adjustable button tunnel. Conclusion: Tibial fixation using an adjustable large button should be considered in PCL reconstruction with short autograft.
Introduction: Rotator cuff calcific tendinitis (RCCT) frequently manifests as acute shoulder pain during the acute resorptive phase. Pain typically worse at night and limited range of motion (ROM) with muscle spasm. Several treatment options have been proposed. In this case, a single needle ultrasound-guided percutaneous lavage (UGPL) combined with corticosteroid subdeltoid bursa injection (SDBI) with a good outcome. Case Presentation: A Female, 59 years old, presents with left RCCT acute pain (VAS 7/10) for 2 days and limited painful shoulder ROM. Inflammation and local tenderness found on the left shoulder, ultrasonography shows calcification in the left infraspinatus tendon with sub-deltoid bursa fluid. Patient in sitting position, ultrasound probe placed at long axis of infraspinatus tendon. Using a 23G needle 5 ml syringe, 1% lidocaine infiltrated until the needle penetrates the calcification site. Then a small amount of normal saline (NaCl) with lidocaine injected in a pulsating manner, observed until chalky matter backflows, mixed with NaCl in the syringe. Repeat this procedure until chalky backflow is minimal. Finally, 10 ml of Triamcinolone Acetonide 40 mg mixed with 2 ml lidocaine 2% SDBI using the same needle. Dramatic shoulder pain relieve (VAS 2/10) is immediately achieved after the procedure. One week follow up, the patient is pain-free and regains full ROM of her left shoulder. Discussion: Several methods are proposed for the treatment of acute RCCT, including corticosteroid injection and arthroscopy debridement. UPGL is an attractive option because it is minimally invasive, can be performed in-office setting, and pain relief is obtained immediately by decompressing and removing inflamed calcified sites. Conclusion: The treatment in acute pain RCCT using UGPL combined with corticosteroid SDBI provides a good outcome.
Background. Tuberculosis (TB) of the spine is a highly disruptive disease, especially in underdeveloped and developing countries. This condition requires standard TB treatment for 9–18 months, which increases patient risk of drug-resistant TB. Consequently, this raises the concern of adopting additional therapies to shorten the treatment duration, improve the efficacy of anti-TB drugs, and further decrease damage in the affected tissues and organs. Matrix metalloproteinase- (MMP-) 1 is a key regulator of the destruction of the extracellular matrix and associated proteins and is a new potential target for TB treatment research. In the present study, we investigated the effects of doxycycline as an MMP-1 inhibitor in patients with spondylitis TB. Methods. Seventy-two New Zealand white rabbits with spondylitis TB were divided into 12 different groups based on incubation period (2, 4, 6, and 8 weeks) and doxycycline administration (without, 1 mg/kg body weight (BW), and 5 mg/kg BW). We observed the course of infection through the blood concentration changes and immunohistochemical examination of MMP-1, in addition to BTA staining, culture, polymerase chain reaction (PCR), and histopathological examination. Results. Treatment with once daily 5 mg/kg BW doxycycline significantly improved the blood MMP-1 level ( p < 0.05 ) compared with the placebo and 1 mg/kg BW doxycycline. A significantly reduced ongoing infection and a higher healing rate were demonstrated in rabbits with a higher doxycycline dose through BTA staining, culture, PCR, and histopathology. Various degrees of vertebral endplates, vertebral body, and intervertebral disc destruction were observed in 32 rabbits with positive histopathological findings, in addition to positive inflammatory cell infiltration, characterized by numerous lymphocytes, macrophages, and epithelial cells, as well as abundant granulation tissue and necrotic substances proximal to the inoculated vertebral area. Bone and intervertebral disc destructions were more apparent in the untreated rabbits. Conclusion. Our study demonstrated the potential of doxycycline as an adjunctive treatment in spondylitis TB. However, limitations remain regarding the differences in the pathogenesis and virulence of Mycobacterium tuberculosis between rabbit and human systems, sample size, and the dose-dependent effect of doxycycline. Further studies are needed to address these issues.
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