Objective To investigate the effectiveness of transosseous suture in medial patellofemoral ligament (MPFL) double bundle reconstruction. Methods The clinical data of 75 patients with recurrent patella dislocation who met the selection criteria between January 2014 and December 2017 were retrospectively analyzed. All of them were treated with MPFL double bundle reconstruction, and divided into study group (39 cases, using new transosseous suture technique) and control group (36 cases, using traditional suture anchor fixation) depending on the intraoperative fixation technique. There was no significant difference in gender, age, body mass index, affected knee side, preoperative tibial tuberosity-trochlear groove distance, Insall-Salvati ratio, knee range of motion, Kujala score, International Knee Documentation Committee (IKDC) score, congruence angle, and tilt angle between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, and postoperative complications were recorded and compared between the two groups. Kujala score, IKDC score, and knee range of motion were used to evaluate the functional improvement of patients before and after operation. The congruence angle and tilt angle were measured on X-ray films. Results There was no significant difference in operation time, intraoperative blood loss, and hospital stay between the two groups (P>0.05). Patients in both groups were followed up 24-36 months, with an average of 29.4 months. There was no complication such as incision infection, fat liquefaction, patellar redislocation, and prepatellar pain during follow-up. At last follow-up, the Kujala score, IKDC score, knee range of motion, congruence angle, and tilt angle of two groups significantly improved when compared with those before operation (P<0.05), while there was no significant difference between the two groups (P>0.05). ConclusionThe application of suture anchor or transosseous suture to complete MPFL double bundle reconstruction can restore patellar stability, and there is no significant difference in the short-term effectiveness between them.
【摘要】 目的 探讨关节镜辅助下经腘窝小切口应用锚钉固定治疗后交叉韧带胫骨止点粉碎骨折的临床效果。 方法 2007年2月-2008年12月对22例急性后交叉韧带胫骨止点骨折患者，采用关节镜辅助下经腘窝小切口切开复位，利用缝合锚钉重建止点，固定治疗后测试交叉韧带的张力和稳定，采用Lysholm膝关节功能评分评定膝关节功能。 结果 骨折平均愈合时间为6周，平均屈膝活动度（120±3）°。Lysholm膝关节功能评分为（92±2）分。 结论 关节镜辅助经腘窝小切口锚钉固定治疗后交叉韧带胫骨止点粉碎骨折，可协助诊断关节内韧带及骨折损伤情况，对韧带止点进行重建，操作简便，早期功能锻炼有助于关节功能恢复。【Abstract】 Objective To explore surgical technique and the results of arthroscopic reduction and fixation for the treatment of comminuted fracture of the posterior cruciate ligament (PCL) from the tibia using suture anchor through an posterolateral portal via popliteal fossa. Methods Twenty-two patients who were operated through an posterolateral portal via popliteal fossa, the fragment was fixed by using suture anchor to reestablish the insertion, test the tension and stabilization of PCL. Lysholm score was used to evaluate the knee function. Results The bone union was confirmed by X-ray films at the 6 weeks postoperatively. The ROM of knee joint relaxation was 120±3°. The Lysholm score was 92±2. Conclusion The displaced fragment of the comminuted fracture of the posterior cruciate ligament from the tibia can be reduced and fixed with the suture anchor arthroscopicly. Using suture anchors demonstrate a reliable and easy to use technique. Operation under arthroscopy helps diagnose and treat other complications inside knee joint. In addition, early functional exercise contributes torapid recovery of knee joint’s function.
ObjectiveTo evaluate the effectiveness of arthroscopic treatment of superior labrum anterior and posterior (SLAP) injury by absorbable anchors through anterior and posterior approach. MethodsBetween January 2010 and August 2012, 28 patients with Snyder II type of SLAP injury underwent arthroscopic operation by absorbable anchors through anterior and posterior approach. There were 15 males and 13 females, aged from 30 to 45 years (mean, 36.5 years). The left shoulder was involved in 12 cases and the right shoulder in 16 cases. All patients had a clear history of trauma. The disease duration ranged from 2 weeks to 3 years (median, 13 months). The results of O'Brien test and Speed test were positive in 25 cases and 26 cases respectively. Shoulder pain visual analogue scale (VAS) was 7.6±1.4. The Constant score of shoulder joint function was 60.2±4.3. ResultsOperation was successfully completed, and the incision healed well in all cases, with no complication. The follow-up time ranged from 12 to 36 months (mean, 24.5 months). The symptoms of shoulder joint interlocking, snapping, and instability disappeared. The joint pain was significantly improved. At 12 months after surgery, Constant score of shoulder joint function was 92.7±4.5, showing significant difference when compared with preoperative score (t=-30.279, P=0.000); the shoulder pain VAS score was 1.1±0.9, showing significant difference when compared with preoperative score (t=23.810, P=0.000). At 1 year after operation, MRI examination showed complete healing in 25 cases, and high signal in 3 cases, but the pain and activity were significantly improved. ConclusionArthroscopic treatment of SLAP injury by absorbable anchors through anterior and posterior approach has the advantages of less injury, small incision, and quick recovery, so it is an ideal operation method.
ObjectiveTo evaluate and compare the effectiveness of double Endobutton technique and suture anchor combined Endobutton plate in the treatment of Tossy type Ⅲ acromioclavicular joint dislocation. MethodsBetween May 2010 and March 2014, a retrospective study was preformed on 56 patients with Tossy type Ⅲ acromioclavicular joint dislocation. The coracoclavicular ligament was reconstructed with double Endobutton technique in 31 cases (Endobutton group), and with suture anchor combined Endobutton plate in 25 cases (Anchor group). There was no significant difference in age, gender, injury causes, injury side, associated injury, medical comorbidities, and disease duration between 2 groups (P>0.05). The operation time, medical device expenses, postoperative complications, preoperative and postoperative Constant-Murley scores, and postoperative Karlsson grading of the injured shoulder were compared between 2 groups. ResultsThe average operation time in Endobutton group was significantly greater than that in Anchor group (t=4.285, P=0.000); there was no significant difference in the medical device expenses between 2 groups (t=1.555, P=0.126). Primary healing of incision was obtained in all patients of 2 groups; no early complications of infection and skin necrosis occurred. All patients were followed up 15.6 months on average (range, 11-35 months). During follow-up, some loss of reduction and ectopic ossification in the coracoclavicular gap were observed in 1 case and 6 cases of Endobutton group, respectively. No recurrence of acromioclavicular joint dislocation, implant fixation loosening and broken, and secondary fractures occurred in the other patients. There was significant difference in the incidence of postoperative complications between 2 groups (P=0.013). Constant-Murley scores of the injured shoulder significantly increased at 9 months after operation when compared with preoperative values in 2 groups (P<0.05), but no significant difference was observed between 2 groups (P>0.05). At last follow-up, there was no significant difference in Karlsson grading between 2 groups (Z=-0.628, P=0.530). ConclusionBoth double Endobutton technique and suture anchor combined Endobutton plate have good effectiveness in the treatment of Tossy type Ⅲ acromioclavicular joint dislocation. But the latter is associated with easier operation, less operation time, and less complications.