SURGICAL TREATMENT OF ANTERO-MEDIAL ROTATORY INSTABILITY OF KNEE JOINT CAUSED BY MOTORCYCLE_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHOU Yan ¹ , FENG Feng ¹ , QU Xincong ¹ , FANG Zuyi ¹ , LIU Xiang ¹ , PAN Xiaohui ¹ , XU Laifeng ²

1Department of Orthopaedics, Luotian People’s Hospital, Luotian Hubei, 438600, P.R.China;;
2Department of Orthopaedics, Gongan People’s Hospital. Corresponding author: ZHOU Yan, E-mail: zy_0827@yahoo.com.cn;

Corresponding author：

Keywords：

Knee joint Antero-medial rotatory; instability; Anterior cruciate ligament injury; Medial collateral ligament injury; Ligament repair

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Objective To discuss the effectiveness of operation technique for antero-medial rotatory instability (AMRI) of the knee joint caused by motorcycle. Methods Between June 2007 and December 2009, 32 cases of AMRI caused by motorcycle were treated. There were 28 males and 4 females with an average age of 35.5 years (range, 20-50 years). The interval between injury and surgery was 5-10 days (mean, 7 days). The anterior cruciate ligament (ACL) was injured at the attachment point of the condyles crest; the medial collateral ligament (MCL) was injured at central site in 19 cases, at medial condyles of femur in 10 cases, and at medial condyles of tibia in 3 cases, which were all closed injuries. The bone avulsion of condyles crest was fixed by steel wire and MCL was repaired. Results Red swelling and a little effusion occurred at the incision in 1 case, and the other incisions healed by first intention. Traumatic arthritis of the knee occured in 5 cases. Thirty-two cases were followed up 16-22 months (mean, 18.5 months). The X-ray examination showed that the fracture union time was 5-8 weeks (mean, 6 weeks) after operation. At last follow-up, the extension of knee joint was 0° and the flexion of the knee joint was 110-170° (mean, 155°). According to the synthetic evaluating standard of International Knee Documentation Committee, 24 cases were rated as A level, 6 cases as B, 1 case as C, and 1 case as D at last follow-up. Lysholm knee score was 85.93 ± 3.76 at last follow-up, which was significantly higher (t=53.785, P=0.000) than preoperative score 37.54 ± 3.43. Conclusion In patients with AMRI caused by motorcycle, steel wire is used to fix the bone avulsion of condyles crest and MCL should be repaired simultaneously as far as possible. And associating with the early postoperative functional exercise, the short-term effectiveness is satisfactory, but long-term effectiveness still need further follow-up observation.

Citation： ZHOU Yan,FENG Feng,QU Xincong,FANG Zuyi,LIU Xiang,PAN Xiaohui,XU Laifeng. SURGICAL TREATMENT OF ANTERO-MEDIAL ROTATORY INSTABILITY OF KNEE JOINT CAUSED BY MOTORCYCLE. Chinese Journal of Reparative and Reconstructive Surgery, 2012, 26(8): 922-925. doi: Copy

1.	刘宪民, 刘松波, 张志富, 等. 膝关节后内侧结构损伤合并单一交叉韧带断裂的早期治疗. 中华创伤骨科杂志, 2009, 11(1): 18-21.
2.	Irrgang JJ, Ho H, Harner CD, et al. Use of International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 1988, 6(2): 107-114.
3.	Lysholm J, Gillguist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
4.	蒋青, 陈东阳, 徐志宏, 等. 膝关节内侧副韧带、前交叉韧带、后交叉韧带联合损伤的手术治疗. 中华创伤杂志, 2005, 21(5): 329-332.
5.	Krohn K. Footwear alterations and bracing as treatments for knee osteoarthritis. Curr Opin Rheumatol, 2005, 17(5): 653-656.
6.	Shimmin AJ, Bare J, Back DL. Complications associated with hip resurfacing arthroplasty. Orthop Clin North Am, 2005, 36(2): 187-193.
7.	段鑫, 杨勇, 肖国庆, 等. 关节镜下修复重建膝关节脱位合并多发韧带损伤的疗效观察. 中国修复重建外科杂志, 2008, 22(6): 673-675.
8.	Dowson D, Jin ZM. Metal-on-metal hip joint tribology. Proc Inst Mech Eng H, 2006, 220(2): 107-118．.
9.	陈坚, 吕厚山, 倪磊. 生物可吸收挤压螺钉在膝关节韧带重建术中的应用. 中国修复重建外科杂志, 2007, 21(3): 247-250.
10.	高石军, 李彤, 陆博, 等. 局部修复和(或)异体肌腱重建治疗急性膝关节后外侧复合结构损伤. 中华骨科杂志, 2011, 31(7): 774-778.
11.	赵金忠, 皇甫小桥. 保留并牵张残留纤维的前十字韧带双束重建术. 中华骨科杂志, 2010, 30(6): 563-568.
12.	皇甫小桥, 赵金忠, 何耀华, 等. 膝关节多发韧带损伤的修复与重建. 中华骨科杂志, 2011, 31(2): 164-168.
13.	Nicandri GT, Klineberg EO, Wahl CJ, et al. Treatment of posterior cruciate ligament tibial avulsion fractures through a modified open posterior approach: operative technique and 12-to 48-mouth outcomes. J Orthop Trauma, 2008, 22(5): 317-324.
14.	张辉, 冯华, 洪雷, 等. 全关节镜下膝关节后外复合体重建. 中华骨科杂志, 2011, 31(5): 447-455.
15.	Hirschmann MT, Mayer RR, Kentsch A, et al. Physeal sparing arthroscopic fixation of displaced tibial eminence fractures: a new surgical technique. Knee Surg Sports Traumatol Arthrosc, 2009, 17(7): 741-747．.
16.	Huang TW, Hsu KY, Cheng CY, et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy, 2008, 24(11): 1232-1238.
17.	李国风, 王予彬, 蔡俊丰, 等. 关节镜下带线锚钉治疗胫骨髁间嵴撕脱骨折. 中国微创外科杂志, 2008, 8(8): 696-697.
18.	吴萌, 高莉, 汉华, 等. 关节镜下空心钉内固定治疗陈旧性胫骨髁间嵴撕脱骨折的临床观察. 中华显微外科杂志, 2010, 33(6): 509-510.
19.	周炎, 瞿兴崇, 方祖怡. 外翻应力位X线片对膝踝关节内侧不稳定损伤的诊疗意义. 中国骨与关节损伤杂志, 2010, 25(10): 945-946.
20.	戴章生, 吴文华, 姚学东, 等. 带刺垫片及螺钉治疗膝关节内侧副韧带止点撕脱伤. 中国骨与关节损伤杂志, 2008, 23(3): 233-234.

1. 刘宪民, 刘松波, 张志富, 等. 膝关节后内侧结构损伤合并单一交叉韧带断裂的早期治疗. 中华创伤骨科杂志, 2009, 11(1): 18-21.
2. Irrgang JJ, Ho H, Harner CD, et al. Use of International Knee Documentation Committee guidelines to assess outcome following anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc, 1988, 6(2): 107-114.
3. Lysholm J, Gillguist J. Evaluation of knee ligament surgery results with special emphasis on use of a scoring scale. Am J Sports Med, 1982, 10(3): 150-154.
4. 蒋青, 陈东阳, 徐志宏, 等. 膝关节内侧副韧带、前交叉韧带、后交叉韧带联合损伤的手术治疗. 中华创伤杂志, 2005, 21(5): 329-332.
5. Krohn K. Footwear alterations and bracing as treatments for knee osteoarthritis. Curr Opin Rheumatol, 2005, 17(5): 653-656.
6. Shimmin AJ, Bare J, Back DL. Complications associated with hip resurfacing arthroplasty. Orthop Clin North Am, 2005, 36(2): 187-193.
7. 段鑫, 杨勇, 肖国庆, 等. 关节镜下修复重建膝关节脱位合并多发韧带损伤的疗效观察. 中国修复重建外科杂志, 2008, 22(6): 673-675.
8. Dowson D, Jin ZM. Metal-on-metal hip joint tribology. Proc Inst Mech Eng H, 2006, 220(2): 107-118．.
9. 陈坚, 吕厚山, 倪磊. 生物可吸收挤压螺钉在膝关节韧带重建术中的应用. 中国修复重建外科杂志, 2007, 21(3): 247-250.
10. 高石军, 李彤, 陆博, 等. 局部修复和(或)异体肌腱重建治疗急性膝关节后外侧复合结构损伤. 中华骨科杂志, 2011, 31(7): 774-778.
11. 赵金忠, 皇甫小桥. 保留并牵张残留纤维的前十字韧带双束重建术. 中华骨科杂志, 2010, 30(6): 563-568.
12. 皇甫小桥, 赵金忠, 何耀华, 等. 膝关节多发韧带损伤的修复与重建. 中华骨科杂志, 2011, 31(2): 164-168.
13. Nicandri GT, Klineberg EO, Wahl CJ, et al. Treatment of posterior cruciate ligament tibial avulsion fractures through a modified open posterior approach: operative technique and 12-to 48-mouth outcomes. J Orthop Trauma, 2008, 22(5): 317-324.
14. 张辉, 冯华, 洪雷, 等. 全关节镜下膝关节后外复合体重建. 中华骨科杂志, 2011, 31(5): 447-455.
15. Hirschmann MT, Mayer RR, Kentsch A, et al. Physeal sparing arthroscopic fixation of displaced tibial eminence fractures: a new surgical technique. Knee Surg Sports Traumatol Arthrosc, 2009, 17(7): 741-747．.
16. Huang TW, Hsu KY, Cheng CY, et al. Arthroscopic suture fixation of tibial eminence avulsion fractures. Arthroscopy, 2008, 24(11): 1232-1238.
17. 李国风, 王予彬, 蔡俊丰, 等. 关节镜下带线锚钉治疗胫骨髁间嵴撕脱骨折. 中国微创外科杂志, 2008, 8(8): 696-697.
18. 吴萌, 高莉, 汉华, 等. 关节镜下空心钉内固定治疗陈旧性胫骨髁间嵴撕脱骨折的临床观察. 中华显微外科杂志, 2010, 33(6): 509-510.
19. 周炎, 瞿兴崇, 方祖怡. 外翻应力位X线片对膝踝关节内侧不稳定损伤的诊疗意义. 中国骨与关节损伤杂志, 2010, 25(10): 945-946.
20. 戴章生, 吴文华, 姚学东, 等. 带刺垫片及螺钉治疗膝关节内侧副韧带止点撕脱伤. 中国骨与关节损伤杂志, 2008, 23(3): 233-234.

Chinese Journal of Reparative and Reconstructive Surgery

SURGICAL TREATMENT OF ANTERO-MEDIAL ROTATORY INSTABILITY OF KNEE JOINT CAUSED BY MOTORCYCLE

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