ObjectiveTo explore the effectiveness of knee extensor mechanism reconstruction in the treatment of recurrent patellar subluxation with bone anchor in adolescents. MethodsBetween January 2010 and December 2013, 20 patients with patellar subluxation were treated by knee extensor mechanism reconstruction with bone anchor. There were 11 males and 9 females, aged from 12 to 17 years (mean, 15.3 years). The left knee was involved in 12 cases and the right knee in 8 cases. The disease duration was 5-10 years (mean, 7 years). All the patients had knee pain and lateral subluxation of the patella. Preoperative Lysholm knee score was 71.4±4.7. All the patients received the MRI examination to exclude menisci or ligaments lesion. CT examination showed the tibial tuberosity trochlear groove spacing ranged from 15 to 20 mm (mean, 17 mm). X-ray film examination indicated that no varus or valgus was observed, and bony structure was normal. ResultsAll the incisions healed at first stage. The patients received follow-up of 12-24 months (mean, 13 months). Knee pain occurred in 2 cases and were cured after symptomatic treatment. The axial X-ray films showed good position of the patella and normal anatomic relationship of the patellofemoral joint. No anchor loosening and pulling out, internal fixation failure, pseudoarthrosis formation, and postoperative recurrent patellar subluxation occurred during follow-up. At 1 year, the Lysholm knee score was significantly improved to 94.2±3.4 (t=22.705, P=0.000). According to Insall criterion, the results were excellent in 9 cases, good in 9 cases, and fair in 2 cases, with an excellent and good rate of 90%. ConclusionThe bone anchor for extensor mechanism reconstruction is a convenient and reliable way to treat the recurrent patellar subluxation, with a satisfactory early effectiveness and less complications; however, its long-term effectiveness is required a further follow-up.
ObjectiveTo compare the recovery of proprioception of the knee after the anterior cruciate ligament (ACL) reconstruction with remnant preservation or not. MethodsBetween January 2010 and October 2012, 40 patients with ACL rupture were divided into remnant preservation reconstruction group (trial group, n=20) and traditional reconstruction group (control group, n=20). There was no significant difference in gender, age, disease duration, injury causes, preoperative Lysholm scores, and preoperative International Knee Documentation Committee (IKDC) scores between 2 groups (P>0.05). All the patients received ACL single-bundle reconstruction surgery with autologous hamstring tendon transplantation under arthroscope. After operation, the function of knee was assessed by Lysholm and IKDC scores and the proprioception was assessed by joint position sense (JPS) value which was evaluated by passive repeat angle test with isokinetic test system. ResultsAll incisions healed by first intention in 2 groups. The patients were followed up 12-16 months (mean, 14.0 months) in trial group, and 12-15 months (mean, 14.5 months) in control group. At 12 months after operation, the Lysholm and IKDC scores were significantly increased when compared with preoperative scores (P<0.05) in both groups, but no significant difference was found between 2 groups (P>0.05). At 3 months and 12 months after operation in trial group, the JPS values of operated knee at 15, 45, and 75° of flexion were significantly lower than preoperative values (P<0.05), but no significant difference was found between at 3 months and at 12 months after operation (P>0.05). At 3 months after operation in control group, there was no significant difference (P>0.05) in JPS values of operated knee at 15, 45, and 75° of flexion when compared with preoperative ones; but at 12 months after operation in control group, the JPS values of operated knee at 15, 45, and 75° of flexion were significantly lower than those at preoperation and at 3 months after operation (P<0.05). At 3 months after operation, the JPS of operated knee at 15, 45, and 75° of flexion in trial group were significantly lower than those of operated knee in control group (P<0.05), but no significant difference was found between 2 groups at 12 months after operation (P>0.05). At 3 and 12 months after operation in trial group, there was no significant difference (P>0.05) in JPS values at 15, 45, and 75° of flexion between operated and normal knees; at 3 months after operation in control group, the JPS values of operated knee at 15, 45, and 75° of flexion were significantly higher than those of normal knee, but there was no significant difference between operated knee and normal knee at 12 months after operation (P>0.05). ConclusionACL reconstruction with remnant preservation is helpful for recovery of proprioception in knee joint at early stage.
ObjectiveTo construct and identify the recombinant adenovirus vector expressing bone morphogenetic protein 2(BMP-2) and transforming growth factor β3(TGF-β3) genes,to observe the expressions of BMP-2 and TGF-β3 after transfected into bone marrow mesenchymal stem cells (BMSCs) of the Diannan small-ear pigs. MethodsBMP-2 cDNA and TGF-β3 cDNA were amplified by PCR,and were subcloned into the pEC3.1(+) plasmid to obtain pEC-GIE 3.1-BMP-2 and pEC-GIE3.1-TGF-β3 plasmid respectively.They were subcloned into pGSadeno vector by homologous recombination reaction and HEK293 cells were transfected after linearization to obtain Ad-BMP-2 and Ad-TGF-β3.The BMSCs were isolated from the bone marrow of Diannan small-ear pig and cultured.The 3rd passage BMSCs were transfered with Ad-BMP-2(group A),Ad-TGF-β3(group B),Ad-BMP-2+Ad-TGF-β3(group C),and untransfected cells served as a control (group D).The expressions of BMP-2 and TGF-β3 genes and proteins were detected by PCR,immunofluorescence,and Western blot.The chondrogenic differentiation of BMSCs was evaluated by immunohistochemical of collagen type Ⅱ. ResultsThe Ad-BMP-2 and Ad-TGF-β3 were constructed successfully and confirmed by PCR and sequencing.The expression clones of Ad-BMP-2 and Ad-TGF-β3 were packaged into maturated adenovirus successfully,the titer was 5.6×108 and 1.6×108 pfu/mL respectively.The PCR results showed a light band at 310 bp in group A and at 114 bp in group B,and both 310 bp and 114 bp bands in group C,but no band in group D.The image of immunofluorescence showed that there were red fluorescence and green fluorescence expressions in the cytoplasm of BMSCs at 72 hours after transfection in groups A and B,respectively;in group C,both red and green fluorescence expressions were detected,and no red or green fluorescence was detected in group D.The results of Western blot showed that there was a light band at 18×103 in group A and at 50×103 in group B;both 18×103 and 50×103 bands were detected in group C;but no band was detected in group D.The cells were positive for collagen type Ⅱ in groups A,B,and C;group C acquired strong collagen type Ⅱ staining when compared with group A and group B;in group D,the cells were negative for collagen type Ⅱ staining. ConclusionThe recombinant adenovirus vector expressing BMP-2 and TGF-β3 are constructed successfully.The BMP-2 and TGF-β3 genes could be expressed effectively in BMSCs of Diannan small-ear pig after transfection,which could afford modified seeding cells for cartilage tissue engineering.
ObjectiveTo evaluate the effectiveness of arthroscopic suture and absorbable screw double fixation for both anterior and posterior cruciate ligament avulsion fractures of tibial insertions. MethodsBetween June 2006 and September 2013, 8 patients with anterior and posterior cruciate ligament avulsion fractures of the tibial eminence underwent arthroscopic treatment with suture and absorbable screw double fixation. There were 5 males and 3 females, with a mean age of 28.9 years (range, 18-43 years). The causes of injury included traffic accident in 5 cases and falling from height in 3 cases. The time from injury to operation was 3-10 days (mean, 6.2 days). The Lysholm knee score, International Knee Documentation Committee (IKDC) score, and Tegner rating scales were used to evaluated the knee function. ResultsPrimary healing of incision was obtained, without infection or deep vein thrombosis. The mean follow-up period was 42.4 months (range, 24 to 65 months). At 3 months after operation, X-ray films showed good reduction and healing of fracture. The anterior and posterior drawer tests were negative. The knee range of motion was normal (0-125°), and it recovered to preoperative level in 7 cases. The IKDC score, Tegner score, and Lysholm score were significantly improved to 90.4±5.2, 7.5±1.6, and 89.2±3.5 from preoperative 52.1±3.3, 3.3±1.0, and 51.9±3.5 respectively (t=-38.680, P=0.000; t=-39.520, P=0.000; t=-41.150, P=0.000). ConclusionA combined injury of anterior and posterior cruciate ligament avulsion fractures of tibial insertions is rare. Arthroscopic treatment with suture and absorbable screw double fixation is a useful technique to restore tibial avulsion injuries with well-documented radiographic healing, good clinical outcomes, and low complication rates.