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Background: Despite advancements in surgical techniques for anterior cruciate ligament (ACL) treatment, persistent functional impairment, reduced quality of life, and limited physical activity participation continue to be common after postoperative rehabilitation. We modify the traditional ACL reconstruction method by using hamstring tendons grafts and re-tensioning them. Indications: This procedure is indicated for patients undergoing ACL reconstruction surgery with soft tissue grafts, utilizing femoral fixation with an adjustable button and tibial fixation with an interference screw. Technique Description: We employ hamstring grafts for ACL reconstruction and perform femoral fixation using an adjustable button. Initially, we pull the graft approximately 10 mm less than the length of the thickest tunnel drill. This allows for subsequent graft traction after tibial fixation. Following tibial fixation, we pull the graft proximally, inserting it a few millimeters further into the femoral tunnel. This re-tensioning increases tension and enhances physical examination results. In addition, we incorporate the braid graft technique to augment the graft's final thickness. Results: This technique yields reduced postoperative residual laxity during physical examinations. Our institution's ethics committee is currently reviewing a clinical study comparing functional outcomes with traditional techniques. Discussion/Conclusion: The ACL re-tensioning technique is easily implemented and involves a subtle modification to the traditional approach, allowing for graft re-tensioning and diminishing the risk of residual laxity post-interference screw fixation. This approach acknowledges that insertion of the interference screw can inadvertently reduce graft tension, counteracting the tension applied during fixation. Consequently, this technique is expected to yield superior clinical outcomes.

Background: This article describes a standardized, minimally invasive approach for harvesting the quadriceps tendon through a 2 to 3 cm transverse skin incision, presenting it as a viable option. Indications: This procedure is indicated for patients undergoing anterior cruciate ligament (ACL), posterior cruciate ligament, medial collateral ligament, or lateral collateral ligament reconstruction surgery using soft tissue quadriceps grafts. Technique Description: A transverse incision is made on the anterior face of the knee, followed by a longitudinal incision of the central third of the rectus femoris. We perform the distal detachment of the patella of the same tendon. Then, the tendon is extracted using a closed stripper. The graft is prepared and folded on itself, resulting in a double graft. Results: Twenty patients, 16 male and 4 female with complete rupture of ACL, were submitted to an ACL reconstruction using the quadriceps soft tissue graft with minimally invasive harvesting technique. The results were satisfactory for all patients. All patients showed good evolution in the immediate and late postoperative period, with no cases of joint stiffness, wound dehiscence, and no infections. Discussion/Conclusion: We can conclude that harvesting the quadriceps tendon with a minimally invasive approach is a valid and reliable option for the treatment of ligament tears of the knee. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form.

The indications for combining anterior cruciate ligament reconstruction with anterolateral ligament reconstruction have increased considerably in recent years since several anatomical, clinical, and biomechanical studies have proven the importance of the anterolateral periphery in knee rotational stability. Much is still being discussed on how to combine these techniques in terms of which grafts and fixation options to use, as well as avoiding tunnel convergence. This study aims to describe anterior cruciate ligament reconstruction with a triple-bundle semitendinosus tendon graft all-inside technique combined with an anterolateral ligament reconstruction maintaining the gracilis tendon insertion on the tibia, using independent anatomical tunnels. With this, we were able to reconstruct both using only hamstring autografts, reducing morbidity in other possible donor areas, in addition to allowing stable fixation of both grafts without tunnel convergence.

Chronic proximal patellar tendinopathy is a challenging condition for its troublesome management in the active patient and difficulty in defining the failure of conservative treatment to indicate surgery. Usually, patients with chronic proximal patellar tendinopathy have already tried several physiotherapeutic modalities and are away from their preferred physical activities for variable periods. The current literature presents some open and even arthroscopic options for treating recalcitrant patellar tendinopathy using a variable magnitude of resources and costs. The purpose of this article was to depict a very simple and inexpensive surgical option for treating this condition, which can be applied worldwide.

During an ordinary dissection, a cadaver showed a bilateral anomalous origin of the deep brachial artery, where this vessel appeared like a branching of the subscapular artery with common trunk, which included the posterior circumflex humeral artery. The course and distribution of the deep brachial artery in the back compartment were relatively consistent with previous reports. Arterial variations can be damaged through iatrogenic means if not properly documented. The knowledge of this case is very important in clinical medicine and in surgeries in this compartment to prevent any injury.Durante dissecação em prática usual, um cadáver apresentou origem anômala da artéria braquial profunda, na qual este vaso apareceu como um ramo da artéria subescapular com um tronco comum, que incluiu a artéria circunflexa posterior do úmero. O curso e a distribuição da artéria braquial profunda no compartimento posterior foram relativamente coincidentes com relatos prévios. Variações arteriais podem ser danificadas de maneira iatrogênica se não forem adequadamente documentadas. O conhecimento desse caso é muito importante na prática clínica e em cirurgias nesse compartimento para prevenção de qualquer injúria.

OBJECTIVE: The aim of this study was to evaluate the effect of oral tamoxifen treatment on the number of myofibroblasts present during the healing process after experimental bile duct injury. METHODS: The sample consisted of 16 pigs that were divided into two groups (the control and study groups). Incisions and suturing of the bile ducts were performed in the two groups. Tamoxifen (20 mg/day) was administered only to the study group. The animals were sacrificed after 30 days. Quantification of myofibroblasts in the biliary ducts was made through immunohistochemistry analysis using anti-alpha smooth muscle actin of the smooth muscle antibody. Immunohistochemical quantification was performed using a digital image system. RESULTS: In the animals treated with tamoxifen (20 mg/day), there was a significant reduction in immunostaining for alpha smooth muscle actin compared with the control group (0.1155 vs. 0.2021, p = 0.046). CONCLUSION: Tamoxifen reduced the expression of alpha smooth muscle actin in the healing tissue after bile duct injury, suggesting a decrease in myofibroblasts in the scarred area of the pig biliary tract. These data suggest that tamoxifen could be used in the prevention of biliary tract stenosis after bile duct surgeries.