【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.
Objective To investigate the effect of complete anterior bundle of medial collateral ligament (MCL) on the valgus stability of the elbow after reconstruction and to assess the efficacy of artificial tendon and interference screw in reconstruction the anterior bundle of MCL. Methods The bone-tendon of the elbow were made in 12 adult upper limb specimens. There were 8 males and 4 females, left side and right side in half. Using biomechanic ways and pressure sensitive film, the valgus laxity, the stress area of the humeroulnar joint, and the intra-articular pressure were measured in integrated anterior bundle of MCL (control group, n=12) and reconstructed anterior bundle of MCL with artificial tendon and interference screw (experimental group, n=12) in elbow flexion of 0, 30, 60, and 90°. Results There was no significant difference in the valgus laxity within group and between groups in different flexion degrees (P gt; 0.05). No significant difference was found in the intra-articular pressure in elbow flexion of 30, 60, and 90° within group and between groups (P gt; 0.05) except in elbow flexion of 0° (P lt; 0.05). The stress area of the humeroulnar joint in 0° flexion was significantly larger than that in 30, 60, and 90° flexion in the control group (P lt; 0.05), but no significant difference was found within group and between groups in the other flexion degrees (P gt; 0.05). Conclusion The anterior bundle of MCL has important significance for maintaining the valgus stability of the elbow, after reconstructing the anterior bundle by using artificial tendon and interference screw, the medial stability of elbow can be recovered immediately.
Objective To observe the effectiveness of the combination of dynamic and static stabil ity in the treatment of old knee medial collateral l igament injury. Methods Between March 2004 and June 2008, 26 cases of old knee medial collateral l igament injury were treated, including 19 males and 7 females with a mean age of 38 years (range, 21-48 years). Injury was caused by traffic accident in 6 cases, by sprains in 12 cases, by fall ing from height in 8 cases. The location was left knee in 15 cases and right knee in 11 cases. Of them, 24 patients showed the positive result of knee valgus test, 2 cases showed sl ightly relaxed knee tendon. The knee X-ray films of valgus stress position showed that the medial joint space differences between both knees were 3-5 mm in 2 cases and 5-12 mm in 24 cases. The injuries included avulsion of the medial femoral condyle starting point in 19 cases, central laceration in 6 cases, and tibial point laceration concomitant meniscus injury in 1 case. The time from injury to hospital ization was 3-14 months (mean, 6.4 months). Gracil is muscle was used to repair knee medial collateral l igament and the sartorius muscle transfer to reconstruct the medial rotation of knee stabil ity function. Results All incisions healed by first intention. No joint infection, deep vein thrombosis, or other postoperative compl ications occurred. Twentysix cases were followed up 12-58 months with an average of 30 months. The results of knee valgus stress test were negative with no joint tenderness. At 3 months after operation, the knee X-ray films of valgus stress position showed the medial joint space differences between both knees were less than 1 mm. According to the modified Lysholm-Scale score, the results were excellent in 18 cases, good in 7 cases, and fair in 1 case with an excellent and good rate of 96% at last follow-up. Conclusion A combination of dynamic and static stabil ity in repairing old knee medial collateral l igament injury is easy-to-operate and has the advantages to perform the operation in the same incision, so it can avoid the shortcomings of single repair method and achieve better effectiveness.
Objective To investigate whether or not posterolateral rotatory instabil ity of the elbow is due to type-I and type-II coronoid process fracture together with anterior bundle of medial collateral l igament (AMCL) injury so as to provide a theoretic basis for its cl inical treatment. Methods Ten fresh-frozen upper extremities were collected from cadavera which was donated voluntarily with no evidence of fracture, dislocation, osteoarthritis, mechanical injury of the surrounding l igament and joint capsule. They included 9 males and 1 female with an average age of 25.1 years (range, 19-40 years), including 3 cases at left sides and 7 cases at right sides. All specimens were transected at the upper midhumeral and carpal levels preserving the distal radioulnar joints to get the bone-l igament specimens. An axial load of 100 N compressing the elbow joint was appl ied along the shaft of the forearm in the sagittal plane through the biomechanical study system. The load-displacement plot was measured and analyzed at elbow flexion of 90, 60, and 45° and under four conditions (intact elbow, type-I coronoid process fracture, type-I coronoid process fracture with AMCL deficient, and type-II coronoid process fractures with AMCL deficient). Results The posterior displacements were maximum at 90° elbow flexion. Hence, the results at 90° elbow flexion were analyzed: under condition of intact elbows, the posterior displacement was the smallest (2.17 ± 0.42) mm and the posterolateral rotatory stabil ity was the greatest; under condition of type-I coronoid process fracture, the posterior displacement was (2.20 ± 0.41) mm, showing no significant difference compared with that of the intact elbow (P gt; 0.05); under condition of type-I coronoid process fracture with AMCL deficient, the posterior displacement was (2.31 ± 0.34) mm, showing no significant difference compared with that of intact elbow (P gt; 0.05); and under condition of type-II coronoid process fracture with AMCL deficient, the posterior displacement was (2.65 ± 0.38) mm, showing a significant difference compared with that of intact elbow (P lt; 0.05). There was no macroscopic ulnohumeral dislocation or radial head dislocation during the experiment. Conclusion An simple type-I coronoid process fracture or with AMCL deficient would not cause posterolateral rotatory instabil ity of elbow and may not need to be repaired. But type-II coronoid process fractures with AMCL deficient can cause posterolateral rotatory instabil ity of elbow, so the coronoid process and the AMCL should be repaired or reconstructed to restore posterolateral rotatory stabil ity as well as valgus stabil ity.
Objective To investigate the method and curative effect of malposed-suture hanging and fastening method of double-lariat lock catch knot in repairing origin of medial collateral l igament (MCL) rupture. Methods From February 2008 to February 2009, 36 patients with acute MCL rupture were treated with malposed-suture hanging and fastening method of double-lariat lock catch knot. There were 21 males and 15 females with an average age of 40 years (range, 17-58 years),including 19 left knees and 17 right knees. Repture was caused by traffic accident in 5 cases, by fall ing in 11 cases, by kicking in 3 cases, by crush in 4 cases, and by sprain in 13 cases. The X-ray films of double knees at stress state showed the medial joint space of affected knee joint increased 6.5-13.5 mm (11.2 mm on average) when compared with that of normal knee joint. The time from injury to operation was 36 hours to 8 days (3.5 days on average). Results All wounds healed by first intention. Thirty-one cases were followed up 12-20 months (15 months on average). No compl ication of wound infection, deep venous thrombosis, and l igament rerupture occurred. The medial joint space of affected knee joint increased 1.5-5.6 mm (3.5 mm on average) when compared with that of normal knee joint. According to Lysholm assessment standard, the results were excellent in 20 cases and good in 11 cases, the excellent and good rate was 100%. Conclusion Repair of origin of MCL with malposedsuture hanging and fastening method of double-lariat lock catch knot has advantages of less injury, rel iable fixation, and rapid recovery of knee stabil ity.
Objective To investigate the effect of vanadate on prol iferation and collagen type I production of rat medial collateral l igament (MCL)fibroblasts. Methods A total of 12 adult male SD rats were included, weighing 350-375 g. MCL was cut into small pieces (1 mm × 1 mm × 1 mm) in aseptic conditions, and then placed and cultured in culture chambers. Fibroblasts were passaged with 0.25% trypsin. The vanadate (0, 1.0, 2.5, 5.0 ng/mL) was added in the 3rd passage MCL fibroblasts, respectively, and the samples were divided into 4 groups (0, 1.0, 2.5, 5.0 ng/mL groups). MTT was used to measure the cell prol iferation. The production of collagen type I was measured by RT-PCR and ELISA. Twelve samples in each group were measured. Results In fibroblast prol iferation, the absorbency values of the 1.0, 2.5, 5.0 ng/mL groups were significantly different from that of the 0 ng/mL group (P lt; 0.05). The absorbency values of the 0, 1.0, 2.5, and 5.0 ng/mL groups were 0.213 ± 0.016, 0.327 ± 0.023, 0.449 ± 0.137, and 0.561 ± 0.028, respectively. In collagen secretion, vanadate in 1.0, 2.5, 5.0 ng/mL groups could significantly induce the production of collagen type I (P lt; 0.05) ina dose-dependent manner. The expressions of collagen type I of 0-5 ng/mL groups were 0.47 ± 0.02, 0.51 ± 0.03, 0.60 ± 0.01, and 0.72 ± 0.02, respectively. There was significant difference between the 1.0, 2.5, 5.0 ng/mL groups and 0 ng mL group (P lt; 0.05). RT-PCR displayed a dramatic increase of band density. The ratio of band density in the 0-5 ng mLgroups was 1.37 ± 0.76, 1.97 ± 0.53, 2.41 ± 0.94, and 2.73 ± 0.82, respectively. The gene expression of collagen type I in the 1.0, 2.5 and 5.0 ng/mL groups was higher than that in the 0 ng/mL group, and there was significant difference (P lt;0.05). There were statistical significant differences among 1.0, 2.5 and 5.0 ng/mL groups in each index mentioned above.Conclusion Vanadate can effectively induce the prol iferation of fibroblasts and the production of collagen type I in vitro, which may provide a new approach to the treatment of MCL injury.
Objective To investigate the effect of acid, basic fibroblast growth factor (aFGF, bFGF) and epidermal growth factor (EGF), andtheir combination on the proliferation of rabbit anterior cruciate ligament (ACL) and medial collateral ligament (MCL) in vitro. Methods Thecells of ACL and MCL were isolated and subcultured from the knee joints of tenweek-old New Zealand white rabbits. The cells were seeded into 96-well corning cluster plates. Three growth factors of different concentration alone or in combination were added into the culture medium respectively, which were 0, 1, 5, 10, 50 and 100 ng/ml for aFGF, bFGF and 0, 1.56, 3.13, 6.25, 12.5, 25 and 50 ng/ml for EGF. The proliferation of the fibroblasts was measured for 48 h with XTT method. Results All of the three growth factors alone promoted the cell proliferation of ACL and MCL fibroblasts. The concentration of aFGF hada significant effect on the proliferation of both ACL and MCL fibroblasts. The concentration of 1 ng/ml bFGF and 5 ng/ml EGF was most effective in promoting the proliferation of ACL, and both bFGF and EGF had a significant effect on MCL. 5ng/ml aFGF with 50 ng/ml EGF had effect on ACL. 1 ng/ml aFGF with 3.13 ng/ml EGF had effect on MCL. Conclusion The three growth factors may promote the cell proliferation of ACL and MCL. These findings suggest that topical application of aFGF, either alone or in combination with EGF may have the potential to promote the proliferation of rabbit ACL and MCL,and aFGF of low concentration in combination with EGF is more effective than single growth factor.