This research was supported by the Youth Science and Technology Project of the Department of Health of Hebei Province. (No.20201046).

The protocol follows the guidelines of the Ethics Committee of the Third Hospital of Hebei Medical University. Informed consent was obtained from the patients for including them and the data generated as a part of this study. Patients enrolled in this study were between the ages of 18-60. A total of eight patients were included in the study, five females and three males.
1. Preoperative preparation
<ol>
	<li>Use the following inclusion and exclusion criteria for enrolling patients in this study.
	<ol>
		<li>Use these inclusion criteria: Patients with a clear diagnosis of posterior cruciate ligament cyst by MRI of the knee; patients with significant knee pain, hyperextension pain, and other symptoms that may be caused by posterior cruciate ligament cyst or patients with combined meniscal injuries that require arthroscopic treatment; patients who have an interest in surgery because of the impact on their quality of life.</li>
		<li>Use these exclusion criteria: Patients with other serious medical conditions who cannot tolerate surgery; patients who refuse surgical treatment; patients with posterior cruciate ligament cyst diagnosed by MRI but without symptoms; patients with combined anterior cruciate ligament rupture or posterior cruciate ligament rupture.</li>
	</ol>
	</li>
	<li>Use general anesthesia or neuraxial anesthesia for all patients. Place the patient in the supine position on the surgical bed. Apply a tourniquet to the affected limb in the middle and upper part of the thigh for no more than 1 h. Disinfect the affected limb 2x with iodophor and lay the surgical sheet.</li>
</ol>
2. Establishment of arthroscopic approaches
<ol>
	<li>Use a blood-repellent belt to expel blood from the affected limb. Tighten the blood-repellent belt from the end of the limb to the proximal end. Make each lap overlap by 1/3. Do not insert soft tissue between each turn. Drain blood from the soft tissues of the operated limb. Inflate the tourniquet by applying 50 kPa pressure/force.</li>
	<li>Establish an anterolateral approach, 1 cm above the lateral knee line and 1 cm lateral to the patellar tendon margin. Make an incision of about 0.5 cm in size from the skin to the joint cavity using an 11G sharp blade.</li>
	<li>Establish an anteromedial approach, 1 cm above the medial knee articular line and 1 cm medial to the patellar tendon margin. Make an incision of about 0.5 cm in size from the skin to the joint cavity using an 11G sharp blade.</li>
	<li>Insert the arthroscope parallel to the tibial platform towards the intercondylar fossa in medial and lateral approaches, respectively. Explore the suprapatellar capsule, patellofemoral joint, medial trochanteric clearance, lateral trochanteric sulcus, anterior cruciate ligament, posterior cruciate ligament, medial meniscus, and lateral meniscus.</li>
	<li>Partially remove the injured meniscus or suture the injured meniscus. Remove the joint-free body. Treat all injuries within the joint.</li>
	<li>Establish a normal posteromedial approach as described below.
	<ol>
		<li>Flex the knee at 90&#176;. Insert the arthroscopy in the anteromedial approach to monitor the intercondylar fossa and place the switching rod in the anterolateral approach.</li>
		<li>Insert the exchange rod between the posterior cruciate ligament (PCL) and the medial femoral condyle into the posteromedial joint capsule under arthroscopic surveillance. There is usually a distinct sensation of slipping in and out.</li>
		<li>Rotate the lens to the medial posterior joint capsule. See the triangular area formed by the reverse fold of the joint capsule, the medial femoral condyle, and the medial meniscus.</li>
		<li>Turn off the operating room lights. Observe the translucent area of the posterior medial skin surface of the knee (Figure 2).</li>
		<li>Use a lumbar needle to assist positioning (Figure 3). Eccentric puncture into the joint capsule in the translucent area (usually 0.5-1 cm behind the posterior femoral condyle and proximal to the articular line).</li>
		<li>Make a small incision of about 0.5 cm in the skin using an 11G sharp blade. Insert a straight clamp into the joint capsule under arthroscopic surveillance. Establish a normal posteromedial approach.</li>
	</ol>
	</li>
	<li>Establish a high posteromedial approach as described below.
	<ol>
		<li>Insert the arthroscopy into the posteromedial approach. Insert the lumbar needle in the direction of the joint, 2-3 cm proximal to the posteromedial approach.</li>
		<li>Make the lumbar needle penetrate into the joint capsule in the triangular space of the medial posterior condyle, medial meniscus, and posterior joint capsule.</li>
		<li>Make a small incision in the skin. Insert a straight clamp into the joint capsule under arthroscopic surveillance. Establish a high posteromedial approach.</li>
	</ol>
	</li>
</ol>
3. Exposing and removing posterior cruciate ligament cysts
<ol>
	<li>Insert the arthroscopy in the high posteromedial approach. Insert the shaver in the normal posteromedial approach (Figure 4).</li>
	<li>Remove synovial tissue between the posterior cruciate ligament and the joint capsule using a shaver.</li>
	<li>Find the cyst, which is a translucent, raised synovial membrane around the posterior cruciate ligament (Figure 1C). Remove the cyst wall and see yellow and translucent fluid flowing out of the cyst wall, visualize compartment-like tissue in the cyst.</li>
	<li>Remove the posterior cyst wall completely. Avoid injury to the posterior cruciate ligament and posterior blood vessels and nerves and explore the posterior cruciate ligament without injury.</li>
	<li>Insert the arthroscopy in the anterolateral approach. See a portion of the cyst at the femoral terminus of the posterior cruciate ligament.</li>
	<li>Remove the anterior cyst wall and see yellow and translucent fluid flowing out of the cyst wall. Remove the cyst wall completely.</li>
	<li>Remove the synovial tissue in the V-shaped space between the anterior cruciate ligament and the posterior cruciate ligament. Probe the posterior cruciate ligament and check for damage to the posterior cruciate ligament.</li>
	<li>Insert the arthroscopy in the medial patellar approach. Check the V-shaped space between the anterior cruciate ligament and the posterior cruciate ligament for residual cysts.</li>
	<li>Insert the arthroscopy in the posteromedial approach. Check for residual cysts.</li>
</ol>
4. Closure of the incision
<ol>
	<li>Insert the arthroscopic sheath in the anterolateral approach. Squeeze the suprapatellar capsule and completely drain the intra-articular fluid. Check knee extension and flexion activities from 0&#176; to 120&#176;.</li>
	<li>Suture the incision with silk thread No. 4.</li>
</ol>
5. Postoperative rehabilitation
<ol>
	<li>Quadriceps exercise: Ask the patient to perform this exercise in the supine position. Straighten the affected limb, hook up the toes, slowly lift the leg upward to a height of about 15 cm on the heel, stay for 3 seconds, and then slowly lower it down.</li>
	<li>Joint release training: Ask the patients to perform this as they sit at the bedside and extend and flex the knee joint by themselves.</li>
	<li>Ask the patient to get out of bed on the second day after surgery and move appropriately, and gradually return to normal activities.</li>
	<li>Change the dressing every 3 days after surgery and remove the stitches 14 days after surgery.</li>
	<li>Ask the patient to perform non-confrontational activities such as jogging in the first month after surgery and resume normal activities in the third month after surgery.</li>
</ol>
6. Postoperative care and follow-up
<ol>
	<li>Ask the patient to lie flat without the pillow for 6 hours after surgery. The patient was hospitalized for approximately 3 days.</li>
	<li>At 3 months after surgery, check whether the patient&#39;s range of motion returns to normal and 12 months after surgery, perform an MRI examination of the affected knee combined with arthroscopy to check whether there is discomfort in the affected knee and whether the cyst has recurred.</li>
</ol>

Arthroscopic Double Posteromedial Approach for PCL Cyst Excision

<ol>
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Intraarticular ganglion arising from the posterior cruciate-ligament.</a> Skeletal Radiol. 20 (5), 373-375 (1991).</li><li>Garc&#237;a-Alvarez, F., Garc&#237;a-Pequerul, J. M., Avila, J. L., Sainz, J. M., Castiella, T. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ganglion+cysts+associated+with+cruciate+ligaments+of+the+knee:+A+possible+cause+of+recurrent+knee+pain.">Ganglion cysts associated with cruciate ligaments of the knee: A possible cause of recurrent knee pain.</a> Acta Orthop Belg. 66 (5), 490-494 (2000).</li><li>Brown, M. F., Dandy, D. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-articular+ganglia+in+the+knee.">Intra-articular ganglia in the knee.</a> Arthroscopy. 6 (4), 322-323 (1990).</li><li>Kim, M. G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Intra-articular+ganglion+cysts+of+the+knee:+Clinical+and+MR+imaging+features.">Intra-articular ganglion cysts of the knee: Clinical and MR imaging features.</a> Eur Radiol. 11 (5), 834-840 (2001).</li><li>Kim, R. S., Kim, K. T., Lee, J. Y., Lee, K. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ganglion+cysts+of+the+posterior+cruciate+ligament.">Ganglion cysts of the posterior cruciate ligament.</a> Arthroscopy. 19 (6), e36-e40 (2003).</li><li>Shetty, G. 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K., Abed Ali, A., Alayane, A., Bayoud, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=An+uncommon+finding+of+posterior+cruciate+ligament+intrasubstance+cyst:+A+case+report+and+review+of+literature.">An uncommon finding of posterior cruciate ligament intrasubstance cyst: A case report and review of literature.</a> J Orthop Case Rep. 12 (3), 61-63 (2022).</li><li>Jawish, R., Nemer, C., Assoum, H., Haddad, A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Ganglion+cyst+of+the+anterior+cruciate+ligament+in+children.">Ganglion cyst of the anterior cruciate ligament in children.</a> J Pediatr Orthop B. 18 (5), 234-237 (2009).</li><li>Bui-Mansfield, L. T., Youngberg, R. 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The authors declare that there are no conflicts of interest in this study.

Posterior cruciate ligament cyst is a rare disease. Knee ligament cysts are usually discovered during MRI or knee arthroscopy exams. The causes of knee ligament cyst formation are varied, including post-traumatic formation, synovial tissue hernia formation during embryogenesis, and mesenchymal stem cell proliferation and formation. Recently, trauma and tissue stimulation have been recognized by most experts2,7,14.
<p class="...

Joint cysts are cystic lesions, and the cyst fluid is a transparent jelly-like fluid that can be found in the ligament, meniscus, synovial membrane, and other parts of the knee joint1,2. High mechanical stress can easily lead to cyst formation, which is why cysts are most common in the knee joint3,4, and Baker&#39;s cysts are the most common type of cysts5. Cruciate ligament cysts of the knee are rare, occurring incidentally in 0.2% to 1.3% of cases scanned using knee magnetic resonance imaging (MRI) and in 0.6% of patients tested using knee arthroscopy6,7. Posterior cruciate ligament cysts are rarer, with Brown and Dandy reporting that after performing knee arthroscopy on 6,500 patients, they found only 35 ligament cysts and only 6 from the posterior cruciate ligament5. Knee ligament cysts can occur regardless of sex or age but are more common in men aged 20 years to 40 years4,8.
The cause of cruciate ligament cysts is unknown. For the non-invasive diagnosis of knee ligament cysts, MRI can clearly show the relationship between the size and position of the cyst and is the most accurate diagnostic method4,6,9,10. Arthroscopic removal of cysts is the most effective and recommended treatment method4,6,9,10. Arthroscopy can see the cyst site directly and completely remove the cyst wall, the recurrence rate is extremely low, and the patient recovers quickly after surgery7,9,10. Posterior cruciate ligament cysts are mostly lobulated or multiloculated, most of which are located mainly behind the posterior cruciate ligament, and in 12.5% of patients, the cyst is mainly located anterior to the posterior cruciate ligament11 (Figure 1A,B).
Many treatments can be used to treat posterior cruciate ligament cysts, such as ultrasound and computed tomography-guided joint paracentesis. However, several studies have shown that there is a potentially higher risk of recurrence because of which these procedures do not remove the cyst walls12. Arthroscopic removal of cysts is the gold standard for the treatment of posterior cruciate ligament cysts. Arthroscopic surgery can completely remove the cyst wall, but it&#39;s hard to remove dorsal cruciate ligament cysts by the anterior approach alone. Abreu et al.12 introduced an approach to the arthroscopic excision of PCL cysts using a trans-septal portal, and it&#39;s safe and effective. Tsai et al.13 reported that the trans-septal approach to the resection of posterior cruciate ligament cysts was successful in 15 patients, and there was no recurrence. The trans-septal approach requires the addition of a posterolateral approach, so it increases the risk of damaging the common peroneal nerve and popliteal neurovascular bundle. To avoid these risks, we present a surgical approach to treat posterior cruciate ligament cysts by an arthroscopic double posteromedial approach. Our approach does not require an additional posterolateral approach; there is no risk of injuring the common peroneal nerve. We use the double posteromedial approach, which keeps the entire surgical process on the medial side of the posterior septal, thus reducing the possibility of damaging the popliteal neurovascular bundle. The technique produces the same results while being safer than the trans-septal approach. This surgical approach is particularly suitable for the removal of cysts located on the dorsal side of the posterior cruciate ligament. The surgical approach is more advantageous if the cyst is compartmentalized or close to the tibial end.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>Arthroscopic sheath&#160;</td>
			<td>smith&#38;nephew</td>
			<td>72200829</td>
			<td>6mm</td>
		</tr>
		<tr>
			<td>Arthroscopy</td>
			<td>smith&#38;nephew</td>
			<td>72202087</td>
			<td>30 mm x 4 mm</td>
		</tr>
		<tr>
			<td>Beam guide&#160;&#160;&#160;&#160;&#160;</td>
			<td>smith&#38;nephew</td>
			<td>72204925</td>
			<td>5 mm x 3.6 m</td>
		</tr>
		<tr>
			<td>Beam guide-arthroscopy end connector&#160;</td>
			<td>smith&#38;nephew</td>
			<td>2143</td>
			<td></td>
		</tr>
		<tr>
			<td>Beam guide-panel connector&#160;&#160;</td>
			<td>smith&#38;nephew</td>
			<td>2147</td>
			<td></td>
		</tr>
		<tr>
			<td>Blood-repellent belt</td>
			<td>selani</td>
			<td>tpe15100</td>
			<td>15 cm x 1 m</td>
		</tr>
		<tr>
			<td>Blunt puncture cone&#160;&#160;</td>
			<td>smith&#38;nephew</td>
			<td>4356</td>
			<td>4 mm</td>
		</tr>
		<tr>
			<td>Camera&#160;&#160;&#160;&#160;&#160;</td>
			<td>smith&#38;nephew</td>
			<td>72200561</td>
			<td>NTSC/PAL</td>
		</tr>
		<tr>
			<td>Coupler&#160;&#160;</td>
			<td>smith&#38;nephew</td>
			<td>72200315</td>
			<td></td>
		</tr>
		<tr>
			<td>DYONICS POWER II</td>
			<td>smith&#38;nephew</td>
			<td>72200873</td>
			<td>100-24VAC, 50/60Hz</td>
		</tr>
		<tr>
			<td>DYONICS POWERMAX ELITE</td>
			<td>smith&#38;nephew</td>
			<td>72200616</td>
			<td></td>
		</tr>
		<tr>
			<td>Endoscopic camera system</td>
			<td>smith&#38;nephew</td>
			<td>72201919</td>
			<td>560P NTSC/PAL</td>
		</tr>
		<tr>
			<td>HD monitor&#160;</td>
			<td>smith&#38;nephew</td>
			<td>&#160;LB500031</td>
			<td>27 inch&#160;</td>
		</tr>
		<tr>
			<td>Hook probe&#160;</td>
			<td>smith&#38;nephew</td>
			<td>3312</td>
			<td></td>
		</tr>
		<tr>
			<td>Incisor plus platinum shaver&#160;&#160;&#160;&#160;&#160;</td>
			<td>smith&#38;nephew</td>
			<td>72202531</td>
			<td>&#160;4.5 mm</td>
		</tr>
		<tr>
			<td>Lumbar needle&#160; AN-E/S&#160;<img alt="Equation 1" src="/files/ftp_upload/65620/65620eq01.jpg" style="margin: auto;" /></td>
			<td>tuoren</td>
			<td>AN-E/S&#160;<img alt="Equation 1" src="/files/ftp_upload/65620/65620eq01.jpg" style="margin: auto;" /></td>
			<td>1.6 mm x 80 mm</td>
		</tr>
		<tr>
			<td>Micropunch,teardrop,left&#160;&#160;</td>
			<td>smith&#38;nephew</td>
			<td>7207602</td>
			<td></td>
		</tr>
		<tr>
			<td>Micropunch,teardrop,right&#160;</td>
			<td>smith&#38;nephew</td>
			<td>7207601</td>
			<td></td>
		</tr>
		<tr>
			<td>Micropunch,teardrop,straight&#160;</td>
			<td>smith&#38;nephew</td>
			<td>7207600</td>
			<td></td>
		</tr>
		<tr>
			<td>Pitbull Jr. Grasper&#160;&#160;</td>
			<td>smith&#38;nephew</td>
			<td>14845</td>
			<td></td>
		</tr>
	</tbody>
</table>

arthroscopic excision of posterior cruciate ligament cysts using a double posteromedial approach

Cruciate ligament cysts of the knee are a rare condition. Posterior cruciate ligament cysts of the knee are less common than anterior cruciate ligament cysts. In patients with asymptomatic isolated cruciate ligament cysts of the knee, conservative treatment is recommended. Symptomatic cruciate ligament cysts of the knee are mostly manifested as knee hyperflexion pain, straightening pain, knee discomfort after standing for a long time or walking for a long time, etc., which seriously affects the quality of life, surgical treatment can be performed. The surgical treatments can be divided into ultrasound-guided cyst puncture and fluid extraction procedure and arthroscopic cystectomy. Cysts are mostly lobulated with a multi-layer cyst wall, cyst fluid extraction does not remove the cyst wall completely but simply extracts cyst fluid, leading to a high recurrence rate. Arthroscopic surgery can completely remove the cyst wall with little trauma, a low recurrence rate, and fast postoperative recovery, so arthroscopic resection is the most common and preferred method of treatment. Since posterior cruciate ligament cysts mostly occur posterior to the ligament, we remove the cyst wall by adding a double posteromedial approach to the knee joint, and the cyst wall is removed under direct vision, which is simple to operate, the cyst wall is completely cleared, the trauma is small, the postoperative recovery is fast, and there is no recurrence. Here, 8 posterior cruciate ligament cysts were removed with complete postoperative symptom relief, no surgical complications, and no recurrence at 1-year follow-up.

All eight patients were successfully operated on without any complications. Seven of the 8 patients had isolated posterior cruciate ligament cysts, and 1 patient had medial meniscal injury. The main symptoms of all patients before surgery are knee hyperflexion pain, inability to squat freely, pain, and discomfort in the back of the knee after standing for a long time or walking for a long time. After surgery, all symptoms were relieved and disappeared (Table 1).
Of the 7 patie...

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Author Spotlight: Double Posteromedial Approach for Treating Posterior Cruciate Ligament Cysts

We present a surgical approach to treat posterior cruciate ligament cysts by an arthroscopic double posteromedial approach.

Arthroscopic Excision of Posterior Cruciate Ligament Cysts Using a Double Posteromedial Approach

Cruciate ligament cysts of the knee are a rare condition. Posterior cruciate ligament cysts of the knee are less common than anterior cruciate ligament ...

Cruciate ligament knee cysts, particularly posterior ones, are uncommon. Arthroscopic surgery is the preferred treatment, due to minimal trauma, low recurrence and quick recovery. Making it the most common choice for complete cyst removal.Posterior cruciate ligament cysts located behind the ligament are treated with a double posteromedial approach during arthroscopic surgery. This approach in first developed visual for complete cyst removal;simplifying the procedure with minimal trauma, less recovery and no recurrence. Our surgical approach is particularly suitable for the removal of cysts located on the dorsal side of the posterior cruciate ligament.The third approach is more advantageous if the set is compartmentalized or close to the tibial end.

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450 Views.  The Third Hospital of Hebei Medical University. Cruciate ligament knee cysts, particularly posterior ones, are uncommon. Arthroscopic surgery is the preferred treatment, due to minimal trauma, low recurrence and quick recovery. Making it the most common choice for complete cyst removal.Posterior cruciate ligament cysts located behind the ligament are treated with a double posteromedial approach during arthroscopic surgery. This approach in first developed visual for complete cyst removal;simplifying the procedure with minimal trauma...

Video: Author Spotlight: Double Posteromedial Approach for Treating Posterior Cruciate Ligament Cysts

Posterior Semicircular Canal Approach for Inner Ear Gene Delivery in Neonatal Mouse

Inner ear gene therapy offers great promise as a potential treatment for hearing loss and dizziness. One of the critical determinants of the success of inner ear gene therapy is to find a delivery method which results in consistent transduction efficiency of targeted cell types while minimizing hearing loss. In this study, we describe the posterior semicircular canal approach as a viable method for inner ear gene delivery in neonatal mice. We show that gene delivery through the posterior semicircular canal is able to perfuse the entire inner ear. The easy anatomic identification of the posterior semicircular canal, as well as minimal manipulation of the temporal bone required, make this surgical approach an attractive option for inner ear gene delivery.

In this study, we describe the posterior semicircular canal approach as a reliable method for inner ear gene delivery in neonatal mice. We show that gene delivery through the posterior semicircular canal is able to perfuse the entire inner ear.

Inner ear gene therapy offers great promise as a potential treatment for hearing loss and dizziness. One of the critical determinants of the success of ...

Posterior Approach for Debridement of the Psoas Abscess

This method focuses on outlining a safe zone for irrigation and debridement of a psoas abscess through a posterior approach. Initially, an anterior approach to the spine was performed to ensure that the anterior longitudinal ligament and the psoas muscle could be visualized. All the abdominal organs were removed. Subsequently, a posterior approach was performed to remove the paraspinal muscles from L1&#8211;L5. The transverse processes, pars interarticularis and lamina of L1&#8211;L5 were identified. The exiting nerve root was identified between the transverse processes and followed into the substance of the psoas muscle. Using the anterior and posterior approach, the lumbar plexus was isolated from the substance of the psoas muscle. Before and after various steps of dissection, digital photographs were obtained. These images were uploaded into ImageJ and multiple measurements, including the distance between the lateral superior and inferior tip of each TP to the most lateral region of the plexus, the distance between the lateral superior and inferior tip of the TP to the lateral edge of the psoas, and the width of the lumbar plexus were recorded. The safe zone for entering the substance of the psoas muscle was defined between the lateral edge of the psoas muscle and the lateral edge of the lumbar plexus. The relationship of this interval to the tip of the transverse process at each level was measured and reported.

This is a cadaveric study investigating the landmarks for the posterior approach for irrigation and debridement of the psoas abscess. The interval between the transverse processes (TP) was used to access the substance of the psoas muscle.

This method focuses on outlining a safe zone for irrigation and debridement of a psoas abscess through a posterior approach. Initially, an anterior ...

Endoscopy Guided Photoablation of Endometrial Cysts using a 980 nm Laser with a Contact Fiber in Mares

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. Historical treatments were invasive and had adverse effects on the endometrium. Hysteroscopically guided laser therapy is easy and effective for endometrial cysts resection, with no deleterious effects for the endometrium.
A 110 cm long and 1.0 cm wide endoscope is sterilely introduced in the uterus through the open cervix of an estrous mare after vulvar cleaning. The uterus is slowly infused with less than 1 L of physiologic solution and the laser fiber is inserted in the biopsy canal of the endoscope. Cysts are then cauterized with the 980 nm diode laser with a contact fiber set at 20&#8210;2 5W in continuous mode. Each cyst is punctured&#160;until complete voiding of the cyst and shrinking of the cyst wall around the fiber. Uterine lavages with sterile saline solution are performed directly after the surgery and for one or two days as non-inflammatory fluid can be observed.
This procedure is easy and quickly performed, with no obvious deleterious effects. Cysts resection makes ultrasound pregnancy diagnosis easier and, in some cases, could restore proper embryo migration in the uterine horns between day 6.5 and 17. However, this treatment does not improve the underlying histological lesions related to endometriosis. These considerations should be clearly expressed to the breeder before this procedure.

The aim of this report is to describe the photoablation of endometrial cysts in the mare using an endoscopic laser device, and to discuss the interest and limitations of this new approach to deal with low fertility issues.

In mares, endometrial cysts are associated with endometriosis and can cause maternal recognition failure or compromise and delay pregnancy diagnoses. ...

Development of a Uterosacral Ligament Suspension Rat Model

Pelvic organ prolapse (POP) is a common pelvic floor disorder (PFD) with the potential to significantly impact a woman's quality of life. Approximately 10%-20% of women undergo pelvic floor repair surgery to treat prolapse in the United States. PFD cases result in an overall $26.3 billion annual cost in the United States alone. This multifactorial condition has a negative impact on the quality of life and yet the treatment options have only dwindled in the recent past. One common surgical option is uterosacral ligament suspension (USLS), which is typically performed by affixing the vaginal vault to the uterosacral ligament in the pelvis. This repair has a lower incidence of complications compared to those with mesh augmentation, but is notable for a relatively high failure rate of up to 40%. Considering the lack of standard animal models to study pelvic floor dysfunction, there is an urgent clinical need for innovation in this field with a focus on developing cost-effective and accessible animal models. In this manuscript, we describe a rat model of USLS involving a complete hysterectomy followed by fixation of the remaining vaginal vault to the uterosacral ligament. The goal of this model is to mimic the procedure performed on women to be able to use the model to then investigate reparative strategies that improve the mechanical integrity of the ligament attachment. Importantly, we also describe the development of an in situ tensile testing procedure to characterize interface integrity at chosen time points following surgical intervention. Overall, this model will be a useful tool for future studies that investigate treatment options for POP repair via USLS.

Pelvic organ prolapse affects millions of women worldwide and yet some common surgical interventions have failure rates as high as 40%. The lack of standard animal models to investigate this condition impedes progress. We propose the following protocol as a model for uterosacral ligament suspension and in vivo tensile testing.

Pelvic organ prolapse (POP) is a common pelvic floor disorder (PFD) with the potential to significantly impact a woman's quality of life. Approximately ...

Impact of Non-Invasive ACL Injury and Surgery on Protease Activity in Mice

Non-Invasive Compression-Induced Anterior Cruciate Ligament (ACL) Injury and In Vivo Imaging of Protease Activity in Mice

Traumatic joint injuries such as anterior cruciate ligament (ACL) rupture or meniscus tears commonly lead to post-traumatic osteoarthritis (PTOA) within 10-20 years following injury. Understanding the early biological processes initiated by joint injuries (e.g., inflammation, matrix metalloproteinases (MMPs), cathepsin proteases, bone resorption) is crucial for understanding the etiology of PTOA. However, there are few options for in vivo measurement of these biological processes, and the early biological responses may be confounded if invasive surgical techniques or injections are used to initiate OA. In our studies of PTOA, we have used commercially available near-infrared protease activatable probes combined with fluorescence reflectance imaging (FRI) to quantify protease activity in vivo following non-invasive compression-induced ACL injury in mice. This non-invasive ACL injury method closely recapitulates clinically relevant injury conditions and is completely aseptic since it does not involve disrupting the skin or the joint capsule. The combination of these injury and imaging methods allows us to study the time course of protease activity at multiple time points following a traumatic joint injury.

Author Spotlight: Investigating Early Events and Long-Term Effects of ACL Injuries for Osteoarthritis Progression

Non-invasive ACL injury is a reliable and clinically relevant method for initiating post-traumatic osteoarthritis (PTOA) in mice. This injury method also allows for in vivo quantification of protease activity in the joint at early time points post-injury using protease-activatable near infrared probes and fluorescence reflectance imaging.

Traumatic joint injuries such as anterior cruciate ligament (ACL) rupture or meniscus tears commonly lead to post-traumatic osteoarthritis (PTOA) within ...

Advancing LRPS: Optimal Techniques for Challenging Liver Resections

Techniques of Laparoscopic Right Posterior Sectionectomy: Glissonian Approach and a Parenchymal Transection Technique

Laparoscopic liver resections (LLR) have been widely accepted as a treatment option for liver tumors. They offer several advantages over open liver resections, including less blood loss, reduced wound pain, and shorter hospital stays with a comparable oncological outcome. However, laparoscopic resection of lesions in the right posterior section of the liver is challenging due to difficulties in bleeding control and visualizing the surgical field. In the past, laparoscopic right posterior sectionectomy (LRPS) was still in the exploration phase, with undefined risks in the Second International Consensus Conference on LLR in 2014. However, recent technological advancements and increased surgical experience have shown that LRPS can be safe and feasible. It has been found to reduce hospital stay and blood loss compared to open surgery. This manuscript aims to provide a detailed description of the steps involved in LRPS. The key factors contributing to our success in this challenging procedure include proper liver retraction and exposure, the use of an intrahepatic Glissonian approach for inflow control, a technique called the 'ultrasonic scalpel mimic Cavitron ultrasonic surgical aspirator (CUSA)' for parenchymal transection, early identification of the right hepatic vein, and meticulous bleeding control using bipolar diathermy.

Here, we present a protocol to perform laparoscopic right posterior sectionectomy, focusing on two key aspects: the intrahepatic Glissonian approach for inflow control and a parenchymal transection technique using an ultrasonic surgical aspirator.

Laparoscopic liver resections (LLR) have been widely accepted as a treatment option for liver tumors. They offer several advantages over open liver ...

Rehabilitation Treatment Plan for ACLR Patients

Early Weight-Bearing Rehabilitation Protocol After Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) injury is one of the common sports injuries. Anterior cruciate ligament reconstruction (ACLR) is the mainstream treatment for ACL injury, aiming to regain normal anatomical structure and stability of the knee joint and promote the patient's return to sports. Under the guidance of the concept of enhanced recovery after surgery, early weight-bearing rehabilitation (EWB) is an important factor affecting patient function and quality of life. However, there is no consensus on whether EWB rehabilitation can be performed after ACL surgery. 
This study aims to explore the safety and feasibility of EWB after ACL surgery. The study implemented a gradual EWB rehabilitation program in the experimental group, including weight-shifting training, balance training, and gait training on the affected lower limb, and assessed wound healing and stability of the knee joint. The study found that EWB after ACLR is safe and feasible. EWB rehabilitation not only does not pose a negative effect on the patient's knee pain, swelling, wound healing, and stability, but also helps to improve knee active flexion and quality of life faster and better. The EWB program in this study is simple, safe, and effective, and it provides strong theoretical guidance and practical demonstration for accelerated rehabilitation after ACLR.

Author Spotlight: Implementing the Enhanced Recovery After Surgery Concept in Rehabilitation Following Anterior Cruciate Ligament Reconstruction

Based on the safety and feasibility, this article presents an early weight-bearing rehabilitation protocol after anterior cruciate ligament reconstruction. The protocol is clear and easy to operate, which is helpful to promote its use in clinical practice and accelerate the functional recovery of patients.

Anterior cruciate ligament (ACL) injury is one of the common sports injuries. Anterior cruciate ligament reconstruction (ACLR) is the mainstream treatment ...