Objective To discuss the diagnosis and treatment of posterolateral corner injury of the knee joint, and to evaluate the clinical results after anatomical reconstruction. Methods Sixteen cases of posterolateral cornerinjury of the knee were treated, being accompanied with grade Ⅲ or above existing serious varus or external rotation. At a mean follow-up of 13 months(7 to 18 months),weevaluate the clinical results using Lysholm and IKDC(international knee documentation committee) scoring systems. Among them,there were 14 males and 2 females aging 19-46 years (mean 38 years). It was 4-12 d from injury to operation. On conditions of anesthesia, varus stresstest(VST) showed that instability of varus was more than 10° under the 30° and 0° of genuflexion respectively and external rotation test showed that instability of external rotation was more than 10° when compared with normal side. Five cases complicated by rupture of anterior cruciate ligament,8 cases by rupture of posterior cruciate ligament and 3 cases by rupture of both ligaments. Results All patients were followed 7 to 18 months and no patients had instability of the knee. The VST showed that no abnormal lateral instability was found at 0° of flexion except 3 cases at 30° with less than 5°. Cooper test showed that no rotational instability at 90° except 1 cases at 30° with less than 5°. The range of motion of the knee was from 75° to 130° of flexion(mean 118°)and from 0° to 5° of extension. Posteroperative scores were from 54 to 96 according to Lysholm scoring systems and from 46 to 94 according to IKDC scoring systems. Conclusion Although the overall incidence of posterolateral corner injury is less than that of other ligament injuries of the knee, we should pay much attention to posterolateral corner injury because of its important role in resisting posterior tibia translation,external rotation and varus of knee. This injury can result in a significant degree of disability for patients.
ObjectiveTo investigate the differential expression of transient receptor potential vanilloid receptor 4 (TRPV4) protein in the osteoarthritis (OA) and normal cartilages, and explore the role of TRPV4 in the prevention and treatment of OA.MethodsThe cartilage tissues from the patients of knee OA (OA group) and femoral neck fracture (control group) were taken. In OA group, there were 6 males and 9 females; the age ranged from 55 to 78 years (mean, 69 years); the Kellgren-Lawrence (K-L) score was 3.0±0.8. In control group, there were 5 males and 10 females; the age ranged from 57 to 91 years (mean, 71 years). There was no significant difference in gender and age between the two groups (P>0.05). Western blot, real-time fluorescence quantitative PCR, Masson staining, and immunohistochemical staining were used to detect the difference in protein and mRNA expressions of TRPV4 between the OA and normal cartilages. Then the relationship between the K-L score of OA and the rate of TRPV4-positive cells was analyzed.ResultsThe relative expression of TRPV4 protein and mRNA in OA group were 0.454±0.199 and 2.951±1.200, which were higher than those in control group (0.165±0.074, 1.437±0.682). The difference in relative expression of TRPV4 protein was significant (t=2.718, P=0.026). Histology observation showed that the chondrocytes arranged disorderly in OA group, the structure of extracellular matrix was abnormal, and the cartilage defect reached the deep layer. There were more TRPV4-positive cells in the degenerated tissue, and the rate of TRPV4-positive cells was 37.353%±13.496%. The chondrocytes were arranged well in control group, and the rate of TRPV4-positive cells was only 9.642%±3.284%. There was a significant difference between the two groups (t=7.491, P=0.000). The rate of TRPV4-positive cells in OA group was positively correlated with the OA K-L score (r=0.775, P=0.001).ConclusionThe TRPV4 expression increased in OA cartilages that may contribute to the development of OA.
ObjectiveTo investigate the effectiveness of autogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture.MethodsBetween June 2015 and June 2018, 16 patients with chronic Achilles tendon ruptures were treated by autogenous tendon reconstruction under total arthroscopy. Of the 16 patients, 11 were males and 5 were females. Their mean age was 40.7 years (range, 21-55 years). The disease duration was 14-20 months (mean, 16.4 months). Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 41.2±2.2 and the pain visual analogue scale (VAS) score was 7.9±1.2. MRI and B-ultrasonography examinations showed that the Achilles tendon was not continuous. The length of Achilles tendon defect was 5.0-10.3 cm, with an average of 5.8 cm. The rupture of the Achilles tendon happened on top of the insertion of the tendon in 4 cases and at the tendon-muscle belly connection in 12 cases. The operation time, intraoperative blood loss, hospital stay, and related complications were recorded. The AOFAS score and VAS score were used to evaluate the improvement of ankle joint function and pain.ResultsThe average operation time was 77.2 minutes (range, 60-90 minutes). The average intraoperative blood loss was 20.5 mL (range, 15-30 mL). The average hospital stay was 7.2 days (range, 5-10 days). All incisions healed by first intention. There was no skin necrosis, infection, or deep vein thrombosis. All the patients were followed up 8-18 months, with an average of 12 months; and 10 cases were followed up more than 12 months. During the follow-up, there was no Achilles tendon re-rupture, and the symptoms of pain and heel lifting failure significantly improved. MRI reexamination showed that the continuity of Achilles tendon recovered. At 1, 3, 6, and 12 months postoperatively, AOFAS scores significantly improved and VAS scores significantly reduced, except for 1 month postoperatively, the scores at other time points were superior to that before operation, the differences were significant (P<0.05).ConclusionAutogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture has the advantages of small trauma, rapid functional recovery, and satisfactory surgical efficacy.
Objective To investigate the short-term effectiveness of joint distraction by Ilizarov combined with arthroscopic debridement in the treatment of knee osteoarthritis (KOA). Methods Between January 2014 and January 2015, 15 patients (15 knees) with KOA were treated using arthroscopic debridement assisting with the Ilizarov distraction technology. There were 7 males and 8 females, aged from 45 to 64 years (mean, 55 years). The left knee and the right knee were involved in 6 and 9 cases respectively. The disease duration was 2.0-9.5 years (median, 6 years). They all had received conservative treatment for 6 months and got poor clinical improvement. The preoperative visual analogue scale (VAS) score, the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score, the knee injury and osteoarthritis outcome score (KOOS), the range of motion (ROM) for knee, and the radiographic joint space width were 76.2±8.8, 59.3±5.7, 44.3±7.2, (75±21)°, and (2.5±0.4) mm respectively. According to Kellgren-Lawrence grade system, 11 cases were rated as grade III and 4 cases as grade IV. Results There was no poor incision healing, infection, and deep vein thrombosis. All the 15 patients were followed up 12-18 months (mean, 15.5 months). Patients achieved pain relief. The knee activity was obviously improved. The postoperative VAS score, WOMAC score, KOOS score, and ROM at 12 months were 20.9±7.8, 38.2±5.5, 92.1±6.9, and (118±14)° respectively, showing significant difference when compared with preoperative ones (t=18.213, P=0.000; t=10.317, P=0.000; t=18.564, P=0.000; t=6.599, P=0.000). Postoperative X-ray film showed that joint space width at 12 months was (3.8±0.3) mm, showing significant difference when compared with preoperative one (t=10.070, P=0.000). Conclusion Joint distraction by Ilizarov combined with arthroscopic debridement can effectively relieve pain, improve the function and quality of life. It was beneficial to cartilaginous tissue repair and delaying the degenerative process of KOA. The short-term effectiveness is satisfactory.