Objective To investigate the injury mechanism, clinical characteristics, and treatments of Segond fracture and complications. Methods Fifteen patients suffering from Segond fracture were treated between January 2007 and December 2011. There were 10 males and 5 females, aged 16-50 years (mean, 31.8 years). Fracture was caused by traffic accident in 8 cases, by sports in 6 cases, and by bruise in 1 case. Before operation, the knee range of motion (ROM) was (36.60 ± 8.94)°; the Lysholm score was 32.27 ± 3.73; and the International Knee Documentation Committee (IKDC) score was 42.34 ± 4.97. The duration from injury to operation was 1-3 weeks with an average of 1.2 weeks. In 12 patients having associated anterior cruciate ligament (ACL) injury, arthroscopic reconstruction of ACL was performed with allogeneic anterior tibial tendon; in 2 patients having associated avulsion fracture of the intercondylar eminence of the tibia, arthroscopic fracture reduction and fixation with Orthocord wire were performed. In 8 patients having associated meniscus injury, meniscus suture and meniscectomy were performed in 3 and 5 patients, respectively. In 7 patients having associated collateral ligament injury, conservative treatment was given in 5 patients, and medial collateral ligament was repair in 2 patients. Results All incisions healed primarily without complications of infection and nerve or blood vessel injury. All the patient were followed up 12-16 months (mean, 14.3 months). At 12 months after operation, the results of anterior drawer test, Lachman test, and lateral stress test were all negative. The knee ROM was (129.27 ± 5.89)°, the IKDC score and Lysholm score were significantly increased to 89.45 ± 3.05 and 87.87 ± 4.12 at 12 months after operation; all showing significant differences when compared with preoperative values (P lt; 0.05). Conclusion Segond fracture is often combined with ACL, collateral ligament, and meniscus injuries, and the evidence of Segond fracture can bly suggests the knee injury. Personalized treatment should be chosen according to complications.
【Abstract】 Objective When knee medial collateral ligament (MCL) rupture, the upper surface of medial meniscus is exposed totally, like the gulf panoramic, which is called “panoramic views of the bay sign” or the “bay sign”. To investigate the reliability and significance of the “bay sign” in diagnosis of knee MCL rupture under arthroscope. Methods Between March 2007 and March 2011, 127 patients with knees injuries were divided into the observation group (n=59) and control group (n=68) based on the MRI results. In the observation group, 59 patients had MCL rupture by MRI, including 12 cases of MCL injury alone, 16 cases of MCL injury with lateral meniscus torn, 27 cases of MCL injury with anterior cruciate ligament (ACL) injury, 3 cases of MCL injury with ACL and posterior cruciate ligament (PCL) injury, and 1 case of MCL injury with patellar dislocation; there were 38 males and 21 females with an average age of 23.2 years (range, 16-39 years). In the control group, 68 patients had no MCL rupture by MRI, including 38 cases of ACL injury, 4 cases of ACL and PCL injury, and 26 cases of ACL and lateral meniscus injury; there were 45 males and 23 females with an average age of 31.8 years (range, 25-49 years). The “bay sign” was observed under arthroscope in 2 groups before and after operation. Results The positive “bay sign” was seen under arthroscope in the patients of the observation group before MCL repair; the “bay sign” disappeared after repair. No “bay sign” was seen in patients of the control group before and after ACL reconstruction. Conclusion The “bay sign” is a reliable diagnostic evidence of MCL injury. It can be used as a basis to judge the success of MCL reconstruction during operation.
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.
ObjectiveTo evaluate the clinical results of the tibial Inlay technique for the medial collateral ligament (MCL) reconstruction using Achilles tendon allograft in recovery of medial instability of the knee. MethodsBetween January 2011 and December 2012, 21 patients underwent tibial Inlay reconstruction of the MCL using Achilles tendon allograft, and the clinical data were retrospectively analyzed. There were 13 males and 8 females with a mean age of 32 years (range, 19-62 years). Injury was caused by sports in 15 cases and by traffic accident in 6 cases. The disease duration ranged from 15 days to 3 months (mean, 1.5 months). According to International Knee Documentation Committee (IKDC) criteria, 5 cases were classified as degree II and 16 cases as degree III. The results of the valgus stress test were positive in all patients. The complications were observed after operation; IKDC subjective knee score and Lysholm score were used to assess the knee function. ResultsBone block fracture occurred in 1 case during operation. Primary healing of incision was obtained in the other cases except 1 case having unhealing incision who was healed after skin grafting. No complications of knee joint stiffness, vascular nerve injury, and infection occurred. All patients were followed up 7-29 months (mean, 18.5 months). At last follow-up, the results of the valgus stress test were negative in 20 cases, and positive (degree I) in 1 case; the other patients had no knee extension or flexion limitation except 1 patient having 15° flexion limitation. The Lysholm score was significantly improved from 45.4±13.6 to 87.5±9.4, the IKDC 2000 subjective score was significantly improved from 46.5±14.0 to 88.4±9.3 at last follow-up (P<0.05). MRI showed that the reconstructed MCL was continuous. ConclusionThe short-term clinical results of the tibial Inlay technique for MCL reconstruction using Achilles tendon allograft are satisfactory. The Inlay technique for MCL reconstruction can provide good medial stability of the knee, but the lorg-term effectiveness needs further follow-up.
ObjectiveTo evaluate the effectiveness of semitendinous and gracilis transfer for the treatment of medial collateral ligament (MCL) injury caused by total knee arthroplasty (TKA). MethodsBetween March 2009 and May 2014, 11 patients (11 knees) with MCL injuries caused by primary TKA were treated by semitendinous and gracilis transfer in primary TKA (injury group). Another 18 patients (21 knees) without MCL injury were included as the control group. There was no significant difference in gender, age, injury sides, disease duration, body mass index, knee varus deformity, and preoperative Knee Society Score (KSS) between 2 groups (P>0.05), with comparability. KSS score was used to evaluate the function after operation. ResultsPrimary healing of incision was obtained in all patients, and no complications of joint instability and pain occurred. The follow-up time was 6-29 months in injury group and was 7-34 months in control group. At last follow-up, the KSS clinical score and functional score were significantly increased to 89.82±3.76 and 89.54±3.50 in the injury group (P<0.05) and were significantly increased to 90.19±3.39 and 90.00±3.53 in the control group (P<0.05) respectively, but no significant difference was shown between 2 groups (t=0.158, P=0.877; t=0.820, P=0.432). X-ray films showed no prosthetic loosening or subsidence during follow-up. ConclusionThe semitendinous and gracilis transfer is reliable for the treatment of MCL injury caused by TKA. The insertions of semitendinous tendon and gracilis are close to that of the knee MCL, which can effectively improve knee function.