ObjectiveTo investigate the effectiveness of double-bundle anterior cruciate ligament (ACL) reconstruction combined with anterolateral ligament (ALL) reconstruction in the treatment of revision patients with ACL graft failure.MethodsBetween January 2018 and June 2019, 15 patients underwent ACL revision with double-bundle ACL reconstruction combined with ALL reconstruction. There were 12 males and 3 females with an average age of 30.1 years (range, 17-49 years). The technique of primary ACL reconstruction included single-bundle reconstruction in 13 cases and double-bundle reconstruction in 2 cases. These reconstructions applied autografts in 14 cases and allograft in 1 case. The causes of ACL reconstruction failure were identified as traumatic rupture in 9 cases and non-traumatic failure in 6 cases, including 2 cases of graft absorption and 3 cases of graft laxity. The average time from the primary ACL reconstruction to revision was 28.5 months (range, 8-60 months). The subjective and objective indicators of knee joint function were compared before operation and at last follow-up to evaluate the effectiveness. The subjective indicators included International Knee Documentation Committee (IKDC) score, Lysholm score, and Tegner score. The objective indicators included anterior tibial translation (dynamic and static) and side-to-side difference (SSD), pivot-shift test, Lachman test, the difference of single-legged hop test, and the loss ratio of extensor muscle strength on the affected side.ResultsAll incisions healed by first intetion, and no complications such as infection, venous thrombosis of lower extremity, or neurovascular injury occurred. All patients were followed up for an average of 19.1 months (range, 12-30 months). At last follow-up, all patients had returned to pre-injury sports level. The IKDC score, Lysholm score, and Tegner score were significantly improved (P<0.05); anterior tibial translations (dynamic and static) significantly decreased when compared with preoperative one (P<0.05) and returned to the physiological range. The SSD, Lachman test, pivot-shift test, the difference of single-legged hop test, and the loss ratio of extensor muscle strength on the affected side were significantly better than those before operation (P<0.05).During the follow-up, there was no re-rupture of the graft, no stiffness of the knee joint and limitation of mobility; 1 case had a protruding femoral end compression screw, which was removed through the original incision under local anesthesia. ConclusionDouble-bundle ACL reconstruction combined with ALL reconstruction can significantly improve the knee function in revision patients with ACL graft failure. It can reduce the anterior translation of tibia, and effectively prevent postoperative rotational instability of the knee.
ObjectiveTo investigate the method and effectiveness of transosseous suture in situ technique in repairing anterior cruciate ligament (ACL) avulsion injury for the multiple ligament injuries with knee dislocation (MLIKD).MethodsThe clinical data of 27 patients (27 knees) with MLIKD between September 2010 and April 2016 were analyzed retrospectively. There were 21 males and 6 females, with an average age of 42 years (range, 24-60 years). The injury was caused by traffic accident in 9 cases, heavy-weight crushing in 9 cases, sports sprain in 6 cases, falling from height in 3 cases. The interval from injury to operation was 1-19 days (mean,10.8 days). There were 20 cases of femoral avulsion injury of ACL, 7 cases of tibial avulsion injury of ACL, and there were 17 cases of posterior cruciate ligament (PCL) injuries. According to the Schenck classification, there were 15 cases of KD-Ⅲ-M type, 8 cases of KD-Ⅲ-L type, and 4 cases of KD-Ⅳ type. All patients were positive in the posterior drawer test and Lachman test; 8 cases were degree Ⅲ positive in varus stress test, and 15 cases were degree Ⅲ positive in valgus stress test. The Lysholm score of knee was 27.6±6.5, the International Knee Documentation Committee (IKDC) score was 25.5±6.2, and the range of motion (ROM) of knee was (45.1±10.2)°. The injured PCL was reconstructed with a single bundle of autologous hamstring tendon. ACL was repaired with double bundle traction by transosseous suture in situ technique. Medial cruciate ligament, lateral cruciate ligament, joint capsule, and other damaged structures were repaired at the same time.ResultsAll incisions healed by first intention. There were 3 cases with joint effusion and 3 cases with incomplete flexion. All patients were followed up 12-36 months (mean, 22 months). The X-ray films showed good stability in all directions. At last follow-up, the anterior and posterior drawer tests were all negative; Lachman test was degreeⅠpositive in 4 cases, valgus stress test was degreeⅠpositive in 3 cases, varus stress test was degreeⅠpositive in 1 case; and all tests were negative in the rest patients. At 1 year after operation, the ROM of knee was (119.3 ±12.6)°, Lysholm score was 87.2±6.3, and IKDC score was 87.9±6.3, showing significant differences when compared with the preoperative scores (P<0.05).ConclusionTransosseous suture in situ technique can be used to repair the ACL avulsion injury for MLIKD, which can significantly improve the stability, mobility and function of the knee joint, and obtain satisfied short-term effectiveness.
Objective To investigate the effectiveness of individual surgery for chronic Achilles tendon rupture. Methods A retrospective analysis was made on the clinical data of 25 patients (26 Achilles tendons) with chronic Achilles tendon rupture between September 2009 and March 2016, including 22 males and 3 females with a mean age of 38 years (range,18-59 years). The median disease duration was 12 weeks (range, 4 weeks to 12 years). The repairing method depended on the defect size, injury site, and tissue condition of the involved Achilles tendon: 9 Achilles tendons were repaired by end-to-end anastomosis, 8 by a gastrocnemius turndown flap, and 9 by auto free tendon (4 ipsilateral hamstring tendon and 5 ipsilateral 2/3 peroneus longus tendon). The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hind foot score, heel lifting of the affected leg, active ankle range of motion (plantar flexion and dorsiflexion), maximum calf circumference, and complications were applied to assess the effectiveness. Results Hypersensitivity occurred in 1 incision, and stage I healing was obtained in the other incisions. No complication of re-rupture, infection, nerve injury, or deep venous thrombosis occurred. All the patients were followed up 8-85 months (mean, 34 months). The AOFAS ankle-hind foot score was significantly improved to 95.81±5.34 at last follow-up from preoperative 50.54±5.52 (t=–34.844,P=0.000); the excellent and good rate was 100% (excellent in 21 cases and good in 4 cases). The active dorsiflexion of the operated side [(13.9±2.4)°] was significantly lower than that of normal side [(16.7±2.0)°] (t=–9.099,P=0.000), but the active plantar flexion showed no significant difference between affected side [(39.8± 3.2)°] and normal side [(40.6±2.6°)] (t=–1.917,P=0.068). The maximum calf circumference of the operated side [(379.4±18.8) mm] was significantly lower than that of normal side [(387.1±16.6) cm] (t=–5.053,P=0.000). The other patients could finish heel lifting of the affected leg without limitation except for 1 patient. All patients returned to normal work and activity, and 12 patients returned to normal sports. Conclusion Individual surgery depending on the defect, injury site, and tissue condition of the involved Achilles tendon can repair all kinds of chronic Achilles tendon rupture with a low rate of complications.
ObjectivesTo systematically review the differences of operative outcomes between early surgery and delayed surgery in multiple ligament injury of knee joint (MLIK) patients.MethodsPubMed, The Cochrane Library, EMbase, CNKI, CBM, WanFang Data and VIP databases were searched to collect cohort studies about operative outcomes of different surgery times in MLIK patients from inception to September 23rd, 2018. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies. Meta-analysis was then performed using RevMan 5.3 software.ResultsA total of 8 cohort studies involving 153 early and 90 delayed operatively treated patients were included. The results of meta-analysis showed that: compared with delayed surgery, early surgery received higher Lysholm score (MD=7.52, 95%CI 2.00 to 13.04, P=0.008) and superior IKDC score rate (OR=2.97, 95%CI 1.51 to 5.84, P=0.002). There were no significant differences in Tegner score (MD=–0.08, 95%CI –1.07 to 0.92, P=0.88) and ROM (MD=4.08, 95%CI –2.38 to 10.55, P=0.22) between two groups. The main adverse reactions of MLIK included neurovascular injury, deep venous thrombosis of lower extremities, common peroneal nerve injury, tourniquet paralysis and limited joint activity. Early surgery had a lower incidence of complications than delayed surgery (7.1% vs. 30%).ConclusionThe current evidence shows that early surgery can receive higher Lysholm score and superior IKDC score rate in treatment of MLIK, and have a lower incidence of complications. Due to limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
ObjectiveTo investigate the effectiveness of modified patellar tendon reconstruction using hamstring autograft in the treatment of chronic patellar tendon rupture and defects.MethodsThe clinical data of 11 patients with chronic patellar tendon rupture and defects admitted between January 2015 and August 2018 were retrospectively analyzed. The patient were treated with inverted U-shaped reconstruction technique using hamstring autografts, in which 2 bone tunnels were created at the level of 1/2 and lower 3/4 of the patella, and 1 bone tunnel was created beneath the tibial tuberosity. There were 8 males and 3 females with an average age of 30.1 years (range, 10-61 years). The average interval from the primary injury to the operation was 9.5 months (range, 2-36 months). According to Yousef classification, there were 7 cases of type A2, 3 cases of type B2, and 1 case of type C2. The length of the patella tendon defect was measured when the patella was reducted intraoperatively with an average of 4.5 cm (range, 2.7-7.1 cm). Subjective function scores [including International Knee Documentation Committee (IKDC) subjective score, Tegner activity level, and Lysholm score] were evaluated before operation and at last follow-up. The loss of knee extension, Caton index, and thigh circumference difference at 15 cm above the patella between bilateral limbs were also measured.ResultsAll patients were followed up 24-66 months (mean, 34.2 months). All incisions were primary healing, and there were no complications such as wound infection, venous thrombosis of the lower extremities, stiffness of the knee joint, graft failure, neurovascular injury, etc. No second revision surgery was performed during the follow-up. At last follow-up, the subjective function scores (IKDC subjective score, Tegner activity level, Lysholm score), loss of knee extension, thigh circumference difference, and Caton index were significantly improved when compared with those before operation (P<0.05). Two patients still had patella alta, with Caton indexes of 1.29 and 1.32, respectively.ConclusionIn the treatment of chronic patellar tendon ruptures and defects, the modified patellar tendon reconstruction using hamstring autograft can significantly improve the postoperative knee function, restore the normal range of knee extension, enhance the extensor and correct the patella alta.