ObjectiveTo investigate the short-term effectiveness of novel computer navigation system (Knee 3 software; Brainlab, Germany) assisted total knee arthroplasty (TKA).MethodsBetween July 2020 and December 2020, 19 patients underwent unilateral TKA assisted with Knee 3 software. There were 4 males and 15 females. The mean age was 66.3 years (range, 52-79 years). Eighteen patients were diagnosed with osteoarthritis and 1 patient with rheumatoid arthritis. Sixteen patients had varus knees and 3 patients had valgus knees. Preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) pain, stiffness, function, and total scores were 12.4±3.4, 2 (1, 4), 22 (18, 29), and 37 (29, 43), respectively. Intraoperatively, the medial and lateral gaps in knee extension and in 90° of knee flexion were recorded. The operation time, intraoperative blood loss, blood transfusion, and complications were recorded. The hip-knee-ankle angle (HKA), lateral distal femoral angle, and medial proximal tibial angle were measured to evaluate lower limb alignment and prostheses’s alignment using X-ray films at 6 weeks after operation. Patient’s satisfaction rate and WOMAC pain, stiffness, function, and total scores were investigated.ResultsEighteen patients (94.7%) had medial- lateral gap balancing in knee extension, 18 patients (94.7%) had medial-lateral gap balancing in 90° of knee flexion, 19 patients (100%) had medial gap balancing between knee extension and 90° of knee flexion, and 18 patients (94.7%) had lateral gap balancing between knee extension and 90° of knee flexion. The mean operation time was 126 minutes (range, 100-200 minutes). The mean intraoperative blood loss was 205 mL (range, 100-400 mL). Patients were followed up 4-8 months, with an average of 6.2 months. Postoperative complications included 1 deep vein thrombosis of lower extremities and 1 cerebral infarction. X-ray films showed that the mean HKA, lateral distal femoral angle, and medial proximal tibial angle were 179.8° (range, 178°-182°), 83.5° (range, 80°-87°), and 89.5° (range, 87°-93°), respectively. At last follow-up, WOMAC pain, stiffness, function, and total scores were 3.6±1.9, 0 (0, 2), 4 (2, 6), and 9 (5, 10), respectively, which improved when compared with preoperative scores (P<0.05). Twelve patients were very satisfied with the operation results and 7 patients were satisfied with the operation results. The overall satisfaction rate was 100%.ConclusionKnee 3 software can help to obtain good gap balancing and optimal lower limb alignment, with high patient’s satisfaction and good short-term effecectiveness.
Objective To explore the relationship of the limited resource of the autologous bone marrow mesenchymal stem cells (MSCs) in articularcavity to the treatment results of full-thickness articular cartilage defect, and to investigate whether the extrogenous sodium hyaluronate(SH) promotes the migration of MSCs cultured in vitro tothe articular defect in vivo. Methods Sixty-six Japan rabbits were made the model of the full-thickness articular cartilage defect (5 mm width and 4 mm depth).The autologous MSCs were extracted from the rabbit femur, cultured in vitro, labeledby Brdu, and injected into the injured articular cavity with or without SH. Theexperiment was divided into 4 groups; group A (MSCs and SH, n=15); group B (MSCs, n=15); group C (SH, n=18); and group D (non-treatment, n=18). The morphologic observation was made by HE staining, Mallory staining and immunohistochemical staining after 5 weeks, 8 weeks and 12 weeks of operation. Results There were significant differences in the thickness of repairing tissue between group A and group B(Plt;0.01); but there were no significant differences between group A and group C, and between group B and group D(P＞0.05). Thehistological observation showed that the main repairing tissue was fibrocartilage in group A and fiber tissue in group B. Conclusion MSCs cultured in vitro and injected into the articular cavity can not improve the treatment results of the articular cartilage defect. Extrogenous SH has effect on repairing cartilage defect. The extrogenous SH has no effect on the chemotaxis of the MSCs, and on the collection of MSCs into the joint defect.
Fourteen patients with anterior cruciate ligament (ACL) injuries were treated with carbon fiber—superficial fascia complex and were followed up with an average of 25 months. The overall results in our series were excellent or good. The patients had stable knees and few had some subjective complaints. The influence on the knee function after injury of ACL was discussed.
Objective To review the recent anatomy and biomechanical research progress of knee posteromedial corner, to analyze deficient aspect, and to predict future research directions. Methods Domestic and international l iterature about the anatomy and function of knee posteromedial corner in recent years was reviewed extensively, at the same time, the biomechanics of corresponding structure was summarized and analyzed. Results The anatomical structures ofknee posteromedial corner included the static stabil ity structures and the dynamic stabil ity structures. The dynamic stabil ity structures were more important, including posterior root of medial meniscus, posterior obl ique l igament, semimembranosus extensions, meniscotibial l igament and obl ique popl iteal l igament. The posterior obl ique l igament was most important structure to contribute to stabil ization of valgus, anterior internal rotation of knee and posterior movement of tibia. Conclusion Anatomical reconstruction of knee posteromedial corner especially the posterior obl ique l igament is the key to the reconstruction of knee posteromedial function stabil ity.
Objective To investigate the effect factors of knee function recovery after operation in distal femoral fractures. Methods From January 2001 to May 2007, 92 cases of distal femoral fracture were treated. There were 50 males and 42 females, aged 20-77 years old (average 46.7 years old). Fracture was caused by traffic accident in 48 cases, by fall ing fromheight in 26 cases, by bruise in 12 cases and by tumble in 6 cases. According to Müller’s Fracture classification, there were 29 cases of type A, 12 cases of type B and 51 cases of type C. According to American Society of Anesthesiologists (ASA) classification, there were 21 cases of grade I, 39 cases of grade II, 24 cases of grade III, and 8 cases of grade IV. The time from injury to operation was 4 hours to 24 days with an average of 7 days. Anatomical plate was used in 43 cases, retrograde interlocking intramedullary nail in 37 cases, and bone screws, bolts and internal fixation with Kirschner pins in 12 cases. After operation, the HSS knee function score was used to evaluate efficacy. Ten related factors were appl ied for statistical analysis, to knee function recovery after operation in distal femoral fractures, such as age, sex, preoperative ASA classification, injury to surgery time, fracture type, treatment, reduction qual ity, functional exercise after operation, whether or not CPM functional training and postoperative compl ications. Results Wound healed by first intention in 88 cases, infection occurred in 4 cases. All patients followed up 16-32 months with an average of 23.1 months. Cl inical union of fracture was achieved within 3-7 months after operation. Extensor device adhesions and the scope of activities of lt; 80° occurred in 29 cases, traumatic arthritis in 25 cases, postoperative fracture displacement in 6 cases, mild knee varus or valgus in 7 cases and implant loosening in 6 cases. According to HSS knee function score, the results were excellent in 52 cases, good in 15 cases, fair in 10 cases and poor in 15 cases with an excellent andgood rate of 72.83%. Single factor analysis showed that age, preoperative ASA classification, fracture type, reduction qual ity, whether or not CPM functional exercise, and postoperative compl ications were significantly in knee function recovery (P lt; 0.05). logistic regression analysis showed that the fracture type, qual ity of reduction, whether or not CPM functional exercise, and age were major factors in the knee joint function recovery. Conclusion Age, preoperative ASA classification, fracture type, reduction qual ity, and whether or not CPM functional training, postoperative compl ications factors may affect the knee joint function recovery. Adjustment to the patient’s preoperative physical status, fractures anatomic reduction and firm fixation, early postoperative active and passive functional exercises, less postoperative compl ications can maximize the restoration of knee joint function.
BJECTIVE: To study the effect of transposition of great adductor muscular tendon pedicled vessels in repairing the medial collateral ligament defect of knee joint. METHODS: From September 1991 to September 1999, on the basis study of applied anatomy, 30 patients with the medial collateral ligament defect were repaired with great adductor muscular tendon transposition pedicled vessels. Among them, there were 28 males and 2 females, aged 26 years in average. RESULTS: Followed up for 17 to 60 months, 93.3% patients reached excellent or good grades. No case fell into the poor grade. CONCLUSION: Because the great adductor muscular tendon is adjacent to the knee joint and similar to the knee ligament, it is appropriate to repair knee ligament. Transposition of the great adductor muscular tendon pedicled vessels is effective in the reconstruction of the medial collateral ligament defect of knee joint.
From 1984 to 1993, 49 cases with varioussoft tissue defects around the knee were treated with pedicled calf myocutaneous flap, lateral sural cutaneous artery island skin flap, saphenous neurovascularskin flap and fasciocutaneous flap. The postoperation results were sucessful in 47 cases, and failure 2 cases, in one case with flap infection and theother with scar formation surrounding the knee. Both the failure cases were cured with split skin graft. The patient were followed up for an average of three and a halfyears, the knee function was almost completely regained, and the blood supply of the flaps, the elasticity and colour of the flaps were similiar to that of the normal skin, without being cumbersome. The sensation of the saphenous neurovascular flaps and the lateral suralcutaneous artery island flaps was preserved, except partial numbness was presented at the distal part of the flaps. Operative indications and selection of cases were discussed.
Knee osteoarthritis (KOA) is one of the common degenerative joint diseases, which is more common in the middle-aged and elderly population. It shows significant gender differences, with a significantly higher incidence rate in women than in men, seriously affecting the quality of life of patients. However, there are few research reports on the correlation between gender differences and the incidence of KOA both domestically and internationally. Therefore, this article will summarize and analyze the potential causes of gender differences related to the incidence of KOA from five aspects: hormone levels, anatomical biomechanical characteristics, genes, obesity, and exercise-muscle factors. Through a comprehensive review of research progress, the aim is to provide a theoretical basis for gender based personalized treatment of KOA in clinical practice.
ObjectiveTo explore the surgical treatment for neglected posterolateral rotatory dislocation of knee joint and evaluate the effect. MethodsSixteen patients with neglected knee posterolateral rotatory dislocation treated between January 2006 and December 2010 underwent surgical treatment. Arthroscopic lysis was first performed followed by open reduction, and then ligament reconstruction or repair was carried out in order to restore its stability. Some stiff knee joint patients underwent Patients with joint stiffness were fixed with external fixator across knee for six weeks. All the patients received preoperative and postoperative imaging examination and functional scoring. ResultsTibiofemoral and patellofemoral congruence in all the 16 patients was fully restored. Joint stability was recovered with different degrees. Two patients underwent anterior cruciate ligament reconstruction and 1 underwent posterior cruciate ligament revision during the later stage, and their joint functional status at the end of follow-up was satisfying. ConclusionThe treatment for neglected knee posterolateral rotatory dislocation by combined arthroscopy with open surgery is relatively satisfying, which is a new therapeutic approach for this type of injury.
Objective To study the diagnosis and treatment of the acute medial collateral ligament ruptures of the knee.Methods From August 1998 to August 2003, 87 cases of acute medial collateral ligament ruptures were examined with physical method and MR imaging. Out of them, 35 cases of Ⅰdegree and Ⅱ degree ruptures were treated with non-surgery and 52 cases of Ⅲ degree ruptures were treated surgically. The torn medial collateral ligaments were mended, 21 of which were strengthened with the anterior partial gracilis muscle tendon after the arthroscopy. Results In 35 cases of Ⅰ and Ⅱ degree ruptures, 32 were followed up 13 months on average. According to Lysholm scoring system, the clinical results were classified as excellent or good in 93.7% of the cases. In 52 cases of Ⅲ degree ruptures, 50 were followed up 16 months on average. The excellent or good result was 90%.Conclusion For Ⅰ and Ⅱ degree ruptures, MR imagimg is an important way to definitely- diagnose medial collateral ligament ruptures. Abduction stress test of knee extension shows that the medial direct instability is a main way to definitely diagnose Ⅲ degree ruptures. The results of conservative treatment of Ⅰ degree and Ⅱ degree ruptures are excellent. Surgical therapy are fitfor the cases of Ⅲ degree ruptures.