ObjectiveTo investigate the influence of lateral posterior tibial slope (LPTS) on tibial tunnel expansion after anatomical single-bundle anterior cruciate ligament (ACL) reconstruction and the effect of tibial tunnel expansion on knee joint function.MethodsA clinical data of 52 patients with ACL rupture, who underwent arthroscopic anatomical single-bundle reconstruction between November 2018 and December 2019, was retrospectively analyzed. There were 32 males and 20 females with an average age of 34.3 years (range, 14-64 years). There were 22 cases of left knee and 30 cases of right knee. The time from injury to operation ranged from 7 to 30 days, with an average of 15.9 days. The knee function was evaluated by International Knee Documentation Committee (IKDC) score and Lysholm score before operation and at 3 and 6 months after operation. At 3 and 6 months after operation, the LPTS and the width of exit, middle segment, entrance, and 2 cm from the exit of the articular surface of the tibial tunnel were measured based on MRI. The expansion of tibial tunnel was calculated and graded (degrees 0-3). According to LPTS, the patients were divided into group A (<6.0°), group B (6°-12°), and group C (>12°), and the difference in the expansion of tibial tunnel between groups was compared.ResultsAll the 52 patients were followed up 6-12 months (mean, 7.1 months). The IKDC and Lysholm scores at 3 and 6 months after operation were significantly different from those before operation (P<0.05); and the difference of knee scores between 3 and 6 months after operation was significant (P<0.05). The tibial tunnel expanded after operation, and the relative expansion at the exit and the middle segment showed significant difference between 3 months and 6 months after operation (P<0.05). The expansion degree of tibial tunnel was rated as degree 0 in 5 cases, degree 1 in 28 cases, degree 2 in 16 cases, and degree 3 in 3 cases at 3 months after operation, and degree 0 in 5 cases, degree 1 in 20 cases, degree 2 in 25 cases, and degree 3 in 2 cases at 6 months after operation. There was no significant difference in IKDC and Lysholm scores between patients with different expansion degrees of tibial tunnels (P>0.05). The LPTS of 52 patients ranged from –0.8° to 18.7° (mean, 10.6°); there were 7 cases in group A, 24 cases in group B, and 21 cases in group C. There was no significant difference in age, gender, preoperative IKDC and Lysholm scores, and initial width of tibial tunnel between groups (P>0.05). There was no significant difference in the relative expansion of tibial tunnel at exit and middle segment between groups at 3 months after operation (P>0.05), and there was significant difference at 6 months after operation (P<0.05).ConclusionAfter anatomical single-bundle reconstruction of ACL, the tibial tunnel would expand to some extent in a short time. LPTS had a significant effect on tibial tunnel expansion, and the larger the angle was, the more obvious the expansion of the proximal tibial tunnel was. However, early knee function is not affected by tibial tunnel expansion.
ObjectiveTo compare the effectiveness of arthroscopic intertubercular groove and open subpectoral tenodesis in treatment of long head of biceps tendon (LHBT) tendinopathy.MethodsA clinical data of 80 patients with LHBT tendinopathy who were admitted between June 2013 and May 2017 and met the selection criteria was retrospectively analyzed. After cutting LHBT under arthroscopy, the arthroscopic intertubercular groove tenodesis was performed in 40 cases (group A) and open subpectoral tenodesis was performed in 40 cases (group B). There was no significant difference in the gender, age, side of the affected shoulder joint, disease duration, and preoperative pain visual analogue scale (VAS) score, Constant score, American Society of Shoulder and Elbow Surgery (ASES) score, Disability of Arm, Shoulder, and Hand (DASH) score, LHBT score (LHBS) between the two groups (P>0.05). The operation time and the scores of shoulder joint pain and function at 12 months after operation were compared between the two groups.ResultsThe operation time was (3.6±2.5) minutes in group A and (8.5±2.3) minutes in group B, showing a significant difference (t=18.584, P=0.000). The incisions of the two groups healed by first intention, and there was no complication such as infection or thrombosis. All patients were followed up. The follow-up time was 24-30 months (mean, 26.0 months) in group A and 24-31 months (mean, 26.0 months) in group B. Both Speed test and Yergason test were negative at 3 months after operation. MRI showed that there was no obvious effusion around the LHTB and no dislocation of LHTB. At 12 months after operation, the VAS score, Constant score, ASES score, DASH score, and LHBS score of the two groups all improved when compared with preoperative ones (P<0.05), and there was no significant difference in the differences before and after operation between the two groups (P>0.05). No Popeye sign appeared during the follow-up.ConclusionThe arthroscopic intertubercular groove and open subpectoral tenodesis can effectively relieve shoulder pain and improve function, but the former has shorter operation time and less trauma.