Objective To explore the diagnosis and treatment of anterior cruciate l igament (ACL) cysts of the knees. Methods The cl inical data were retrospectively analysed from 13 patients with ACL cysts between December 2000 and August 2007. The patients included 7 males and 6 females with an average age of 46.3 years (range, 32-55 years). The locationswere the left knee in 6 cases and the right knee in 7 cases. Seven cases had an obvious history of trauma, 4 cases had a history of chronic injury, and 2 cases had no obvious incentive factor. The disease duration was from 6 to 29 months (mean, 20 months). Anterior drawer test was positive in 1 case, pivot shift test was positive in 1 case, and McMurray test was positive in 3 cases. Six cases were preoperatively diagnosed by MRI. The cysts located near the tibial insertion in 6 cases, between the ACL and the posterior cruciate l igament in 3 cases, and near the femoral attachment in 4 cases. All cysts were arthroscopically resected and had the pathohistological examination. Results The pathohistological examination showed mucoid degeneration of collagen and connective tissues, and the diagnosis result was ACL cyst. All incisions healed by first intention, and no compl ication occurred. Thirteen patients were followed up 2 to 5 years (mean, 2 years and 6 months). The symptoms of arthralgia, swell ing, and interlocking of the affected knees disappeared. At 24 months postoperatively, the anterior drawer test was positive in 1 case, the pivot shift test was positive in 1 case, and McMurray test was positive in 4 cases. There was no recurrence during the follow-up. There were significant differences in the range of motion and Lysholm score between pre- and post-operation (P lt; 0.01). Conclusion ACL cysts may be indicated by simple knee pain, especially when accompanied by l imitation of joint motion without imaging evidence of osteoarthritis. The MRI finding is very important in the diagnosis of ACL cysts, and arthroscopic resection and debridement is the first choice in the treatment of ACL cysts.
Objective To investigate the effectiveness of percutaneous reduction by leverage and fixation using nonabsorbable suture with neckwear knot loop l igature to treat tibial intercondylar eminence avulsion fractures under the arthroscope. Methods Between February 2003 and December 2008, 28 patients with tibial intercondylar eminence avulsion fractures were treated, including 16 left knees and 12 right knees. There were 15 males and 13 females with an average age of19.5 years (range, 14-45 years). The injury causes included traffic accident injury in 11 cases, sport injury in 10 cases, and sprain injury in 7 cases. Based on Meyers-McKeever classification, there were 18 cases of type III and 10 cases of type IV. The X-ray films showed the tibial intercondylar eminence displaced fracture. The mean time between trauma and operation was 7 days (range, 4-12 days). All patients were treated surgically with an arthroscopically assisted reduction by leverage and fixation using 5-0 Ethibond suture with neckwear knot loop l igature. Results All incisions healed by first intention without infection or injuries of nerves and vessels. Twenty-eight patients were followed up 26 months on average (range, 12-66 months). The X-ray films showed fracture heal ing within 9-13 weeks (mean, 11 weeks). At last follow-up, all patients were able to return to their pre-injury activity and daily l ife. The knee joint was stable with no l imp or impingement of intercondylar fossa. The knee joint range of motion was 0-130°. The results of Lachman and anterior drawer tests were negative in all patients. At last follow-up, the Lysholm score was 93.5 ± 2.5, showing significant difference when compared with the preoperative one (29.0±2.2, t=53.000, P=0.000). Conclusion Percutaneous reduction by leverage and fixation using nonabsorbable suture with neckwear knot loop l igature is minimally invasive and satisfied reduction and fixation in treating the tibial intercondylar eminence avulsion fracture under the arthroscope, so it is benefit for early functional exercises, and can achieve excellent results.
【Abstract】 Objective To introduce several navigation systems in anterior cruciate l igament reconstructionand to investigate the appl ication of navigation systems for the improvement in reconstruction of the anterior cruciatel igament. Methods The related l iterature was reviewed extensively, and the main current computer assisted surgery systems(OthoPilot system, Bone Morphing system, Fluoroscopic-based system, etc) for util ization in the anterior cruciate l igament reconstructionwere analyzed. Results The computer-assisted systems can enhance the accurate placement of tunnels. Accordingto the anatomical and isometric parameters, graft impingement on the intercondylar notch could be avoided, and individualideal implantation using 3D visual ization local isers was achieved. Conclusion It is possible that computer-assisted systemswill enable surgeons to better acquire the accuracy and rel iabil ity of the various operative techniques, to meet the demand ofsurgeon’s surgical optimisation and to improve the cl inical results.
Objective To make a comparison for the change of maximum tensile intensity and stiffness of a whole implant that is placed into bone tunnel with various lengths tendon, by using beagle dog’s autogenous flexor tendons to reconstruct anterior cruciate l igament (ACL). Methods Sixty male beagle dogs were included in the experiment (weighting 13-16 kg). Three dogs were used for intact flexor tendon of both knees (normal control group), 3 dogs for the intact ACL andfemur-graft-tibia complex (auto control group) and 54 dogs (108 knees) for models of reconstructed ACL (6 experimentalgroups according to different lengths of tendon: 5, 9, 13, 17, 21 and 25 mm in the bone tunnel). The tensile intensity and stiffness were measured after 45, 90 and 180 days separately after operation. Results In the normal control group, the maximum tensile intensity of the intact flexor tendon was (564.15 ± 36.18) N, the stiffness was (59.89 ± 4.28) N/ mm. In the auto control group, the maximum tensile intensity of the intact ACL was (684.75 ± 48.10) N, the stiffness was (74.34 ± 6.99) N/ mm, all ruptured through the intra-articular portion of the graft. The maximum tensile intensity of femur-graft-tibia complex in the auto control group was (301.92 ± 15.04) N, the stiffness was (31.35 ± 1.97) N/mm. After 45 days of operation, all failure occurred at the tibial or femoral insertion site. After 90 days of operation, 24 of the breakpoints were scattered in tendon-bone junction, 12 (3 in 17 mm group, 5 in 21 mm group, 4 in 25 mm group) ruptured through the intra-articular portion. After 180 days of the operation, all breakpoints were distributed inside joint of the implant. The maximum tensile intensity and the stiffness were ber in 17, 21 and 25 mm groups than in 5, 9 and 13 mm groups after operation (P lt; 0.05). Conclusion Tendon with 17 mm length, which will be implanted into bone tunnel, is an appl icable index, in reconstruction of ACL by autogenous tendons.
Objective To compare the effectiveness of anatomical single-bundle (ASB) and over-the-top singlebundle (OSB) reconstruction of the anterior cruciate l igament (ACL). Methods Between January 2008 and June 2008, 64 patients with ACL injury underwent arthroscopic ACL reconstruction. ASB ACL reconstruction was performed in 28 cases (ASB group) and OSB ACL reconstruction in 36 cases (OSB group). There was no significant difference in gender, age, diseaseduration, International Knee Documentation Committee (IKDC) score, Lysholm score, and side-to-side difference between 2 groups (P gt; 0.05). Results All incisions healed by first intention; no infection or other compl ications occurred. All cases were followed up 20-24 months (mean, 21.5 months). There were significant differences in the IKDC score, Lysholm score, and the side-to-side difference between last follow-up and preoperation in 2 groups (P lt; 0.05), but there was no significant difference between 2 groups at last follow-up (P gt; 0.05). Significant differences were found in negative rate of the pivot shift test between last follow-up and preoperation in ASB group and between 2 groups at last follow-up (P lt; 0.05), but there was no significant difference between last follow-up and preoperation in OSB group (P gt; 0.05). Conclusion The effectiveness of arthroscopic ASB ACL reconstruction is better than that of arthroscopic OSB ACL reconstruction, especially in controll ing rotational stabil ity.
【Abstract】 Objective To compare the therapeutic effect of anterior cruciate l igament (ACL) reconstruction bymeans of four-strand semitendinosus tendon autograft and l igament advanced reinforcement system (LARS) by arthroscopy. Methods From July 2002 to April 2005, 42 patients underwent ACL reconstruction by arthroscopy. Twenty-seven patients were treated by four-strand semitendinosus tendon autograft (semitendinosus tendon autograft group), including 22 males and 5 females, with the age from 20 years to 52 years. Among these patients, there were 12 sports injuries, 8 traffic accidents and 7 other injuries. There were 16 cases of left knees and 11 of right knees. The pre-operation Lysholm score was 50.70 ± 6.68, and the course of the disease was 2 to 12 months. Other 15 patients were treated by LARS artificial l igament (LARS group), including 12 males and 3 females, with the age from 17 years to 40 years. Among these patients, there were 8 sports injuries, 4 traffic accidents and 3 other injuries. There were 6 cases of left knees and 9 of right knees. The pre-operation Lysholm score was 50.20 ± 6.22, and the course of the disease was 3 to 12 months. There was no statistically significant difference between the two groups (P gt; 0.05). The ranges of motion, stabil ity and compl ication of the knee were evaluated during the follow-up. Results All incisions healed at the first stage. The patients in the semitendinosus tendon autograft group were followed up for 22 months to 43 months, while 18 months to 40 months in the LARS group. There were 5 patients (19%) whose tensile gap was more than3 mm when the max tensile force text was done in the semitendinosus tendon autograft group, and 3 patients (20%) in the LARS group. The Lysholm score was 87.80 ± 3.41 in the semitendinosus tendon autograft autograft group, and 88.90 ± 3.30 in the LARS group. There was no statistically significant difference between the two groups (P gt; 0.05). The final evaluation based on the improved Lysholm classification standard showed the choiceness rate was 92.6% (18 excellent cases, 7 good cases and 2 faircases) in the semitendinosus tendon autograft group, and 93.3% (11 excellent cases, 3 good cases, 1 fair case) in the LARS group. There was no statistically significant difference between the two groups (P gt; 0.05). The joint motion capabil ity evaluation, according to the Tegner standard, showed 3 to 6 class (with the average class of 4.93) in the semitendinosus tendon autograft group, and 3 to 7 class (with the average class of 5.03) in the LARS group. There was no statistically significant difference (P gt; 0.05). The knee extension in 2 cases was 5° less than the normal, and in 5 cases 5-10° less than the normal in the semitendinosus tendon autograft group. But in all cases in the LARS group, joint motion recovered to the normal (P lt; 0.05). There was no sign of synovitis in both groups. Conclusion The recent cl inical result of ACL reconstruction with the four-strand semitendinosus tendon autograft or LARS artificial l igament by arthroscopy is satisfactory without significant difference. LARS can shorten the recovery time without compl ications such as synovitis in 2-year follow-up.
Objective To investigate the effect of the anterior cruciate l igament (ACL) rupture on the biomechanics of the lateral collateral l igament (LCL). Methods The specimens in this experiment were knee joints from 6 normal fresh adult male cadavers which was donated voluntarily, aged of 26-35 years with an average of 31.4 years. The knee joints were dissymmetry with 3 in left and right sides respectively. At first, all the 6 specimens lying on the self-made movement tooting, whose LCL straining were measured by strain gauges at different angles (0, 30, 60 and 90°) under axial loads of 400 N by e-testing machine for simulation of the normal knee joint force, were regarded as the intact ACL group. Then, the ACL in all 6 specimens were cut off completely as the deficiency group and did the same step. Results The strain of the LCL were as follows at 0, 30, 60 and 90°: (0.00 ± 1.63), (—17.2 ± 8.57), (—24.00 ± 4.80) and (26.50 ± 4.65) με in intact ACL group; (0.75 ± 8.22), (— 52.75 ± 3.33), (24.30 ± 4.99) and (26.30 ± 4.27) με in deficiency group. There was no significant difference at 0° and 90° flexion (P gt; 0.05), but significant difference at 30° and 60° flexion (P lt; 0.05) between the two groups. Conclusion The rupture of the ACL has significantly effect on the strain of the LCL which suffering abnormal load in the state at 30° and 60° flexion. At 30° flexion the relaxation of the LCL increased, which means the possibil ity of the injury of the LCL is rare; and at 60° flexion the LCL become very tense and thereby at the high risk of instabil ity.
Objective To explore the best flexion angle of the transplantation tendon for fixing joint in simultaneously reconstructing of the anterior cruciate l igament (ACL) and posterior cruciate l igament (PCL) using semitendinosus tendon as autologous graft. Methods Twenty-four clean level New Zealand White rabbits [(aged 6-8 months, male or female, and weighing (2.5 ± 0.2) kg] were selected and divided randomly into 3 groups (n=8) according to fixation angle of the reconstructed l igaments. The bilateral semitendinosus tendons of hind legs were used to reconstruct the PCL and ACL of right hind leg, and the reconstructed l igaments were fixed at knee flexion angles of 90° (group A), 60° (group B), and 30° (group A). The rabbit general situation was observed after operation, and the specimens of the knee joints (including 10 cmdistal end and 10 cm proximal end) were harvested for testing extension and flexion, displacement, and internal and external rotation at 3 months after operation. Results All the rabbits survived to the end of experiment. There was no significant difference in maximal displacements of ACL and PCL among 3 groups (P gt; 0.05). The anterior and posterior displacements of shift in 3 groups were less than 1 mm, suggesting good stabil ity. The anterior displacement and the posterior displacement at 30° flexion and 90° flexion in group A were significantly larger than those in group C (P lt; 0.05). There were significant differences in internal rotation angle and external rotation angle between group A and group C (P lt; 0.05), and there was no significant difference among other groups (P gt; 0.05). Conclusion When simultaneously reconstructing ACL and PCL, the knee flexion angle of 60° for fixing the reconstructed l igaments can achieve the best effect.
Objective To review the methods and progress of arthroscopic reconstruction of anterior cruciate l igament (ACL) with the remnant preservation technique. Methods Recent l iterature about arthroscopic reconstruction of ACL with the remnant preservation technique was reviewed and analyzed. Results The preserved ACL after injuries could be single-bundle or remnant. The preserved remnant provided synovium for the reconstructed ACL, and it could accelerate revascularization of the graft, and it was benefit for the proprioception too, and certain kinds of remnant could contribute to the stabil ity of the joint. The preserved remnant could prevent the washing-effect of the joint fluid, then prevent the enlargement of the tibial tunnel. Cyclops or impingement may occurred in remnant preservation technique. Conclusion Remnant preservation in ACL reconstruction can provide good cl inical result. But remnant preservation is a skill demanded technique. There should be more research and cl inical trials about remnant preservation in ACL reconstruction about its necessity and advantage, also disadvantage.
Objective To compare the effectiveness between arthroscopic double-bundle and single-bundle anterior cruciate l igament (ACL) reconstruction with deep-frozen allografts. Methods Between January 2008 and January 2009, 105 patients undergoing arthroscopic ACL reconstruction with deep-frozen allografts were selected and randomly divided intosingle-bundle (n=59) or double-bundle (n=46) groups. Patients were evaluated preoperatively and postoperatively 6, 12, and 24 months. Of the patients, 93 (51 in the single-bundle group and 42 in the double-bundle group) were available for full evaluation. There was no significant difference in gender, age, height, weight, disease duration, compl ication, the International Knee Documentation Committee (IKDC) score, and Lysholm score between 2 groups (P gt; 0.05). The anterior drawer test and the Lachman test for all were rated as + in 2 groups, and the pivot shift test were rated as ++ before operation. Results All wounds healed by first intention, and no related compl ication such as fracture, infection, or deep venous thrombosis was observed. There was no significant difference in the IKDC score, Lysholm score, anterior drawer test, pivot shift test, and Lachman test between 2 groups at 6-month and 12-month follow-up (P gt; 0.05). The IKDC score, Lysholm score, pivot shift test, Lachman test, and the side-to-side difference measured by KT-1000 arthrometer in the double-bundle group were significantly better than those in single-bundle group at 24-month follow-up (P lt; 0.05). Conclusion The double-bundle ACL reconstruction with deep-frozen allografts has better effectiveness than the single-bundle ACL reconstruction.