Posterior cruciate ligament (PCL) injuries are generally associated with high-energy trauma. There are many controversies regarding optimal surgical technique in regard to graft selection and fixation methods. The recently described onlay technique allows for direct fixation of a hamstring autograft to the posterior aspect of the tibia with cancellous screw and spiked washer, while protecting the neurovascular structures and avoiding the so-called “killer turn.” The objective of this study was to compare immediate postimplantation biomechanics of unicortical versus bicortical tibial fixation of onlay PCL grafts. Eight knees were randomly assigned to one of two onlay PCL techniques (n = 4 knees/technique), performed by a single experienced surgeon. Testing consisted of a posterior-directed force at four knee flexion angles, 10, 30, 60, and 90 degrees, to measure load to 5 mm of posterior displacement, maximum displacement (at 100 N load), and stiffness. For statistical analyses, data for each knee were normalized to the native PCL-intact knee and were then grouped into unicortical or bicortical groups accordingly. Data for load to 5 mm (strength), displacement at 100 N, and stiffness were compared among PCL-intact, PCL-deficient, unicortical fixation, and bicortical fixation categories using one-way analysis of variance to assess for statistically significant (p < 0.05) differences. When compared with PCL-deficient knees, both fixation techniques had less laxity. When compared with PCL-intact knees, unicortical had more laxity at all angles, and bicortical had more laxity only at 90 degrees (p < 0.001). For relative graft strength, intact knees required significantly higher loads than both treatment groups. Bicortical, however, outperformed unicortical at all angles (p < 0.001) for relative strength. Regarding stiffness, there were no significant differences between unicortical and bicortical, and both were superior to PCL-deficient and inferior to PCL-intact knees. Based on cadaveric biomechanical testing, none of the reconstructed PCL knees was able to replicate the intact native PCL, but both techniques were superior to PCL-deficient knees. The bicortical tibial fixation technique appears to have biomechanical advantages when opting for onlay PCL reconstruction.

Introduction: Surgical reconstruction is recommended for symptomatic posterior cruciate ligament (PCL). While anatomic double-bundle PCL reconstruction (PCLR) has been reported to be associated with biomechanical and clinical advantages over other methods, there is still debate regarding the optimal technique for tibial positioning and fixation. Based on reported advantages and disadvantages, we employed two tibial fixation techniques, transtibial (TT) and tibial inlay (TI) for anatomic double-bundle PCLR with technique selection based on BMI, comorbidities, and primary versus revision surgery. This study aimed to compare clinical outcomes following PCLR utilizing either TT or TI techniques in order to validate relative advantages, disadvantages, and indications for each based on review of prospectively collected registry data. Materials & Methods: For 37 patients meeting inclusion criteria, 26 underwent arthroscopic TT PCLR using an all-soft tissue allograft with suspensory fixation in the tibia and 11 patients underwent open TI PCLR using an allograft with calcaneal bone block and screw fixation in the tibia. There were no significant pre-operative differences between cohorts. Results: Success rates were 96% for TT and 91% for TI with all successful cases documented to be associated with good to excellent posterior stability and ROM in the knee at final follow-up. In addition, patient-reported outcomes scores were within clinically meaningful ranges for pain, function, and mental health after PCLR in both cohorts, suggesting similarly favorable functional, social, and psychological outcomes. Patient reported pain scores at six months post-operatively were significantly (p=0.042) lower in the TT cohort, which was the only statistically significant difference in outcomes noted. Conclusion: The results of this study supports the use of transtibial and tibial inlay techniques for double-bundle anatomic PCLR in restoring knee stability and patient function when used for treatment of isolated and multi-ligamentous PCL injuries. Choice between tibial fixation methods for PCLR can be appropriately based on patient and injury characteristics that optimize respective advantages for each technique.

The purpose of this work is to focus the advantages of the transurethral endoscopic resection (TUR) of ureteroceles, regardless of their size, in infants as well as in adults.Ureteroceles arc more frequently found in females and can be diagnosed throughout life. An association with other anomalies is common, mainly with complete renal duplication.The diagnosis of ureterocele is easily done by means of an urogram or by panendoscopy. The authors present 136 cases of ureterocele. In 106 of them surgical treatment was necessary. They indicate the transurethral resection as the surgical procedure of choice in treating a pathologic ureterocele.

RESUMOObjetivo: Estabelecer se há correlação entre o momento da cirurgia e a ocorrência de complicações intra e pós-operatórias no tratamento das fraturas trocanterianas do fêmur no idoso. Método: Estudo retrospectivo avaliando o histórico de 281 pacientes operados entre 2000 e 2009 no Hospital das Clinicas da FMRP-USP. As variáveis avaliadas foram: sexo, idade, data, mecanismo do trauma, momento da admissão, tipo da fratura, complicações pré e pós-operatórias, tempo entre o trauma e a cirurgia, horário e duração da cirurgia, implante utilizado, Tip Apex Distance (TAD), tempo de hospitalização, re-operações. De acordo com o horário da cirurgia os casos foram divididos em dois grupos: Horário Comercial (7:00 -17:00) x Horário Plantão (17:01 -6:59). Resultados: Houve um predomínio de cirurgias no horário comercial, na proporção aproximada de 5:1. O intervalo de tempo médio entre a data do trauma e a cirurgia foi de três dias. Não houve diferença estatística entre os grupos (hora comercial x plantão) relacionada ao TAD médio, tipo da fratura, implante, complicações sistêmicas e mortalidade em um ano. O tempo médio entre o trauma e a cirurgia foi três dias. Conclusões: Para pacientes que são admitidos ou operados com mais de 24 horas decorridas do trauma, o horário da cirurgia não se mostrou uma variável relevante, no que diz respeito à ocorrência de complicações per operatórias. Em nossa realidade, é preferível realizar a fixação destas fraturas em horário comercial, dispondo de completa infra-estrutura de recursos humanos e técnicos.