A 24 year old otherwise healthy male presented with a chief complaint of giving way in the left knee. MRI reported complete anterior cruciate ligament (ACL) tearing. Arthroscopy showed ACL agenesis, ring-shaped lateral meniscus, and an anomalous thick band extending from the anterior horn of the lateral meniscus to the intercondylar notch of the lateral femoral condyle, which is known as the ANTEROLATERAL meniscofemoral ligament (MFL). The MFL was attached to the anatomic site of anteromedial bundle of ACL. ACL reconstruction surgery was performed using central 1/3 bone tendon bone graft. Practitioners should be aware that ACL reconstruction in lateral meniscofemoral ligament with associated ACL agenesis is a treatment option in which the preservation of MFL, as the stabilizer of anterior horn of lateral meniscus, should be considered during ACL reconstruction.

Ever since its description, ANTEROLATERAL ligament (ALL) of the knee joint remains as the hotspot of controversies. Though it has been described under various descriptions, the structure gained its limelight when it was christened as ANTEROLATERAL ligament by Claes in 2013. The main reason for the controversies around it is the lack of concrete evidences regarding its attachments, morphology, biomechanical aspects and radiological appearance. Similarly the role of ALL in pivot shift phenomenon also remains as a point of debate. The advocates of ALL suggest that because of its ability to modulate internal rotation and attachment to the lateral meniscus, ALL contributes to the pivot shift phenomenon. Similarly, the orientation of ALL stands as the reason for varied documentation with respect to imaging techniques. With the growing body of evidence, it is imperative to fix our stand regarding the structure because, if found to be morphologically persistent, it can be used for concomitant ANTEROLATERAL stabilization along with anterior cruciate ligament reinforcement surgeries. The present review tries to systematically review the anatomy, variations in classifications, descriptions, histology, radiology and biomechanical features of ALL. At the end of the review, we would like to find the answer for the question: Is ALL a distinct ligamentous structure located at the ANTEROLATERAL aspect of the knee? What is the contribution of it to the tibial internal rotation stability?

Aims and Background: Maigne’s or thoracolumbar syndrome is an almost common disease with simple diagnosis based on symptoms and corrects physical examination; besides there are very effective therapeutic methods available for this syndrome. However as there is no special radiologic sign and para-clinic data isnormal in these patients, the diagnosis is usually challenging. Sometimes the patient’s symptoms are very severedespite normal radiography and EMG-NCV findings; therefore early treatment prevents later complications.Case report: A 47 year-old woman complaining of low Back pain, buttock pain, and ANTEROLATERAL leg painfrom a year ago was referred to pain clinic. After Maigne syndrome was diagnosed, Dorsal and Lateral rami block of 11th and 12th thoracic nerves was performed for her and she had pain relief.Conclusion: Maigne’s syndrome is among illnesses which does not have any specific radiologic or labarotorysign despite specific pain symptoms in the areas mentioned, so pain physicians may become confused encountering such patients.

Objective: Robotic mitral valve repair is the least invasive approach to mitral valve repair, yet there are few data comparing its outcomes with those of conventional approaches. Therefore, we compared outcomes of robotic mitral valve repair with those of complete sternotomy, partial sternotomy, and right mini-ANTEROLATERAL thoracotomy.Methods: From January 2006 to January 2009, 759 patients with degenerative mitral valve disease and posterior leaflet prolapse underwent primary isolated mitral valve surgery by complete sternotomy (n=114), partial sternotomy (n=270), right mini-ANTEROLATERAL thoracotomy (n=114), or a robotic approach (n=261). Outcomes were compared on an intent-to-treat basis using propensity- score matching.Results: Mitral valve repair was achieved in all patients except 1 patient in the complete sternotomy group. In matched groups, median cardiopulmonary bypass time was 42 minutes longer for robotic than complete sternotomy, 39 minutes longer than partial sternotomy, and 11 minutes longer than right mini-ANTEROLATERAL thoracotomy (P<.0001); median myocardial ischemic time was 26 minutes longer than complete sternotomy and partial sternotomy, and 16 minutes longer than right mini-ANTEROLATERAL thoracotomy (P<.0001). Quality of mitral valve repair was similar among matched groups (P =.6, .2, and .1, respectively). There were no in-hospital deaths. Neurologic, pulmonary, and renal complications were similar among groups (P>.1). The robotic group had the lowest occurrences of atrial fibrillation and pleural effusion, contributing to the shortest hospital stay (median 4.2 days), 1.0, 1.6, and 0.9 days shorter than for complete sternotomy, partial sternotomy, and right mini-ANTEROLATERAL thoracotomy (all P<.001), respectively.Conclusions: Robotic repair of posterior mitral valve leaflet prolapse is as safe and effective as conventional approaches. Technical complexity and longer operativetimes for robotic repair are compensated for by lesser invasiveness and shorter hospital stay

Introduction: Atrial myxomas are rare benign tumors,causing obstructive or embolic complications, or even death, depending on their site and size. Therefore, once diagnosed, it should be surgically resected. Atrial myxomas are present about 75% in left atrium (LA) and about 15% in right atrium (RA). Early diagnosis is a challenge because of nonspecific manifestations, and sometimes is asymptomatic and may be discovered accidentally during transthoracic echography (TTE). Minimally invasive cardiac surgery (MICS) has benefits over sternotomy include cosmetically, less pain, and shorter total hospital stay. Materials and Methods: Between January 2011 to December 2020, (50) patients [30 Sternotomy, 20 MICS] underwent surgery for isolated resection of cardiac myxoma. We reported outcomes,cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, conversion to median sternotomy (ST), total hospital stay, complications (stroke, renal failure, respiratory failure, reoperation, and infection), pain, patient, s satisfaction, recurrence and survival. Follow-up time was from 6-months to 3-years. Results: There is no significant difference in CPB or cross-clamp time between groups. No minimal invasive (MI) cases required conversion to a median ST. Total hospital stay is shorter in the MI group by 2. 2 days (p-value = 0. 045). No differences present in morbidity or mortality between two groups. Conclusions: Surgical resection of atrial myxoma resection by minimal invasive approach is safe, feasible, and favored over sternotomy.

The posterior cruciate ligament (PCL) is the largest and strongest ligament in the human knee, and the primary posterior stabilizer. Recent anatomy and biomechanical studies have provided an improved understanding of PCL function. PCL injuries are typically combined with other ligamentous, meniscal and chondral injuries. Stress radiography has become an important and validated objective measure in surgical decision making and post-operative assessment. Isolated grade I or II PCL injuries can usually be treated non-operatively. However, when acute grade III PCL ruptures occur together with other ligamentous injury and/or repairable meniscal body/root tears, surgery is indicated. Anatomic singlebundle PCL reconstruction (SB-PCLR) typically restores the larger ANTEROLATERAL bundle (ALB) and represents the most commonly performed procedure. Unfortunately, residual posterior and rotational tibial instability after SB-PCLR has led to the development of an anatomic double-bundle (DB) PCLR to restore the native PCL footprint and co-dominant behavior of the ANTEROLATERAL and posteromedial bundles and re-establish normal knee kinematics. The purpose of this article is to review the pertinent details regarding PCL anatomy, biomechanics, injury diagnosis and treatment options, with a focus on arthroscopically assisted DB-PCLR.

Congenital absence of left circumflex artery is a rare congenital anomaly of the coronary arteries. The prevalence of the anomaly in different studies ranges from 0.6% to 1.3%. Of these, 80% are benign and asymptomatic and 20% are clinically important. We report a 56-year-old man presented with acute resting chest pain who was diagnosed as having acute ANTEROLATERAL infarction accompanied by electrocardiographic changes and elevated cardiac enzymes. Coronary angiography in different views was conducted, however, no left circumflex artery was found. The territory supplied by the artery had been perfused by the super dominant right coronary artery. There was no left circumflex coronary artery with anomalous origin. Sever stenosis of left anterior ascending artery superimposed to the absent left circumflex artery was presented as acute ANTEROLATERAL infarction. Although absence of the artery is mostly considered as a benign condition, atherosclerotic lesions may be more important in such cases because of diminished compensating mechanisms.

A ganglion cyst is a small sac of fluid that forms over a joint or tendon (tissue that connects muscle to bone). A 23-year-old woman, right hand dominant, and Laboratory expert, was referred with a 1-year history of a lump in the anterior aspect of her elbow associated with altered sensation in the ANTEROLATERAL aspect of her left hand. Her elbow was painful and the mass progressive increased in size during the last 1. 5 months. There was no history of trauma, injections or manipulation. The patient had no symptoms of fever, ulcers, or numbness. On physical examination, there was a tendered mass about 4 cm in diameter in the anterior aspect of the elbow. X-ray was normal and MRI confirmed a mass along with a radiocapitellar capsule. The cyst and radial nerve were explored through an ANTEROLATERAL curved incision, with ligation of the radial recurrent vessels. The cyst was on the capsule of the radiocapitellar joint and posterior to the interosseous nerve at the proximal fibers on the edge of the supinator muscle. The cyst was identified as a ganglion clinically, and excised completely. Pathology finding confirmed it. The lateral elbow pain disappeared immediately after surgery, with no neurological deficit. The patient returned to work after 1 month.

Background: Trauma is one of the leading causes of mortality and morbidity worldwide. Among different types of injuries, chest trauma is responsible for a vast majority of trauma-related mortality and morbidity. Methods: This descriptive, cross-sectional study included cases of thoracic trauma that underwent thoracotomy at Shiraz Namazi Hospital from March 2008 to March 2010. The collected data from each patient included: demographics (age and sex), type of trauma, type of surgical intervention, volume of hemothorax, number of packed red blood cells transfusions, and the consequent adverse effects. Results: A total number of 81 patients (mean age= 26. 72 years old) were included in this study, of which 74 cases (91. 4%) were male and 7 cases (8. 6%) were female. Reportedly, the most prevalent type of trauma was penetrating injury (71. 6 %); the most used surgical approach was left ANTEROLATERAL thoracotomy (55. 6%); the mean hemothorax volume was 1686. 53 cc, and the average number of transfused pack red blood cells was 3. 74 units per patient. The mean time of surgery was 161. 25 minutes, and the most susceptible organ for injury was the lung with an injury prevalence rate of 55. 4%. The mean duration of hospital stay was 8. 43 days. 5 patients (6. 2%) underwent a second surgery and 15 cases (18. 5%) did not survive the surgery. Conclusions: According to the findings of this study, ANTEROLATERAL incision was the most used thoracotomy approach in patients with thoracic trauma.

Introduction: Zenker's diverticulum is an acquired sac-like outpouching of the mucosa and submucosa layers originating at the pharyngoesophageal junction. The predominant symptom of Zenker’, s diverticulum is dysphagia. Videofluoroscopy confirms the diagnosis. Forestier disease is a clinical entity characterized by ossification of ANTEROLATERAL vertebral ligament and anterior osteophyte formation along the ANTEROLATERAL spinal column. Its etiopathogenesis remains unknown and common symptoms are dysphagia, dysphonia and airway obstruction. The objective of this study is to identify a pathophysiological correlation between Forestier disease and the onset of Zenker’, s diverticulum. Materials and Methods: A retrospective observational study was conducted. The electronic database of our Radiology Unit was analyzed in order to identify patients with hypopharyngeal diverticulum and osteophytes at the cervical vertebrae level, from January 2010 to January 2021. The search was performed using precise keywords. Results: The computerized database search outlined 10 imaging exams: 5 videofluorographies and 5 computed tomography scans. In 100% of the cases, dysphagia was the main symptom that led to the diagnostic assessment,30% of patients, on the other hand, reported dyspnoea. From the data analysis, the male / female ratio is 1: 1 and the average age of the patients is 64. 8 (+/-11. 31) years. Conclusions: We assume that the anatomical abnormalities in Forestier disease may cause an increase of pharyngeal pressure and consequently support the development of the Zenker’, s diverticulum. Hence, it is always recommended to investigate the presence of Zenker’, s diverticulum in a patient with Forestier disease, especially for the lifethreatening complications of Zenker's diverticulum.