ObjectiveTo compare the effectiveness of open reduction of posterior cruciate ligament (PCL) avulsion fracture at tibial insertion of knee joint with absorbable screws fixation and absorbable screw combined with suture anchor fixation. Methods The clinical data of 26 patients with PCL avulsion fracture at tibial insertion who met the selection criteria between March 2015 and October 2021 were retrospectively analyzed. Among them, 14 patients were fixed with simple absorbable screw (group A), and 12 patients were fixed with absorbable screw combined with suture anchors (group B). All patients were confirmed by X-ray film, CT, or MRI preoperatively, and got positive results in preoperative posterior drawer tests. There was no significant difference in gender, age, side of affected limb, time from injury to operation, comorbidities, and preoperative Meyers & McKeever classification, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The operation time and postoperative complications were recorded and compared between the two groups. At last follow-up, Lysholm score and IKDC score were used to evaluate the improvement of knee function. ResultsThere was no significant difference in operation time between the two groups (P>0.05). All incisions healed by first intention, and no complication such as vascular and nerve injury or venous thrombosis occurred. All 26 patients were followed up 9-89 months, with an average of 55.3 months. The follow-up time of group A and group B was (55.7±23.2) and (56.8±29.3) months, respectively, with no significant difference (t=−0.106, P=0.916). Radiographs showed bone healing in both groups at 3 months after operation, and no complication such as infection and traumatic arthritis occurred. At last follow-up, the posterior drawer test was negative in both groups, and the Lysholm score and IKDC score significantly improved when compared with the pre-operative values (P<0.05). However, there was no significant difference in the improvement value between the two groups (P>0.05). ConclusionFor PCL avulsion fracture at tibial insertion of the knee joint, the open reduction and absorbable screw combined with suture anchor fixation can achieve reliable fracture reduction and fixation, which is conducive to the early rehabilitation and functional exercise, and the postoperative functional recovery of the knee joint is satisfactory.
OBJECTIVE To measure the isometric point of the attachment site in femur during the reconstruction of posterior cruciate ligament (PCL). METHODS Seven fresh knee specimens from cadavers were adopted in this experiment. The anterior, posterior, proximal, distal and central points of the PCL’s femoral attachment site were respectively anchored to the middle of the PCL’s tibial attachment site by the trial isometer wires. The length changes of the intra-articular part of the wires were recorded while the knee was flexed from 0 degree to 120 degrees by a continuous passive motion(CPM) machine. RESULTS The maximal length changes in every points were compared. It showed that the length change in anterior point was the biggest, the distal point was less than that of anterior point, and the proximal point was the least. There was significant difference between proximal and posterior points, but no significant difference between proximal and central points, neither between central and posterior points. All of the maximal length changes of proximal, central and posterior points were not greater than 2 mm. CONCLUSION The femoral tunnel for the PCL reconstruction should be located at the proximal point, which is the middle point of upper edge of femoral attachment site. The selected point for femoral tunnel also may be moved slightly in the direction to central or posterior points according to the needs of operation.
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 probe the clinical results of a new designed operation-double semitendinous reconstruction of posterior cruciate ligament (PCL) with invasive mini-plate. METHODS The new surgical technique was performed on 28 patients with PCL deficient knee in our department from September 1994 to October 1997. Protection of popliteal nerves and blood vessels was emphasized in the operation, and the femoral and tibial tunnel placement was critical to the procedure’s success. RESULTS All patients were followed up 18 to 36 months, averaged 22 months, they gained stable knees. The knee function of 28 patients recovered to normal after the operation, 1 patients had a small range of limitation of the knee flexion, but no obvious dysfunction. CONCLUSION Double semitendinous reconstruction of PCL with invasive mini-plate has advantages in the operated field exposure, adequate tibial and femoral fixation and excellent results in motion, stability and function of the knee after the operation.
Objective To study the method and cl inical results of arthroscopic double-bundle posterior cruciate l igament (PCL) reconstruction using achilles tendon allograft. Methods From September 2005 to September 2006, 17 patients with PCL injuries of grade III received arthroscopic double-bundle PCL reconstruction using achilles tendon allograft. There were 12 males and 5 females with an average age of 31.7 years (range, 19-48 years), including 10 cases of left PCL injuries and 7 cases of right PCL injuries. Injury was caused by sports in 6 cases and traffic accident in 11 cases. The average time from injury to surgery was 16 days (range, 7-30 days). The preoperative knee flexion was (121.8 ± 4.1)°. The posterior drawer test was positive and the varus angulation test was negative in all 17 patients. Lysholm score was 50.8 ± 6.1 and Tegner score was 1.3 ± 0.7. The side-to-side difference was (10.5 ± 1.6) mm by KT-1000 arthrometer. Results The hospital ization were (13.6 ± 2.4) days. The operation time was (67.8 ± 9.4) minutes. The time was (5.4 ± 1.2) days when the body temperature was higher than 37.4 ℃ after operation. All incisions healed by first intention. No compl ication occurred. All 17 patients were followed up 25 months on average (range, 18-30 months). The knee flexion was (116.9 ± 3.1)° at the final follow-up, showing no significant difference when compared with that of preoperation (P gt; 0.05). The posterior drawer test and the varus angulation test were negative in all 17 patients. Lysholm score and Tegner score were 91.6 ± 3.2 and 6.0 ± 0.7, respectively, and the side-to-side difference was (2.7 ± 1.7) mm, showing significant differences when compared with those of preoperation (P lt; 0.05).Conclusion Achilles tendon allograft is fit for PCL reconstruction. Arthroscopic double-bundle posterior cruciate l igament reconstruction using achilles tendon allograft can reconstruct both anterolateral and posteromedial bundles of the PCL. The knee joint function can be restored effectively. The short-term outcome has been proved, but the long-term outcome needs more observations
Objective To explore latest changes of joint proprioceptive function after posterior cruciate l igament (PCL) reconstruction using double-bundle semitendinosus and gracil is under arthroscope. Methods From June 2001 to November 2002, 25 patients with PCL ruptures were treated by arthroscope PCL reconstruction using double-bundle semitendinosus and gracil is, among whom 19 were males and 6 were females, aged 16-58 years old (36 on average). There were 6 cases of exercise injury, 15 of vehicle accident and 4 of fall ing injury. The duration before the operation was 1 week to 4 months (2.5 months on average). The posterior drawer test showed 23 patients were positive and 2 patients in the acute stagewere not cooperative. MRI indicated that all the patients had PCL injuries. The proprioceptive function of the knee joints was (4.73 ± 0.12)° before operation. Results All patients’ incisions obtained heal ing by first intention after the operation. The posterior drawer test showed that all the patients were negative. All 25 patients were followed up for 20-41 months (30.1 months on average). Eighteen months after operation, MRI indicated that bone marrow canal healed and internal fixation was stable. At the time of the last follow-up, the Lysholm score increased from (58.6 ± 15.2) before operation to (93.2 ± 7.4), and there was statistical difference (P lt; 0.05). The proprioceptive function of the knee joints was (5.67 ± 0.32)°, (5.45 ± 0.16)°, (3.80 ± 0.01)° and (3.67 ± 0.25)° at 5, 10, 15 and 20 months after operation, respectively. Statistical differences were observed between groups at 5, 10, 15, 20 months and the group before operation (P lt; 0.05). The proprioceptive function of the knee joints was (4.56 ± 0.11)° at the final follow-up, and was significantly different from that of the normal knee joints was (2.13 ± 0.41)°, (P lt; 0.05). Conclusion Joint proprioceptive function decreases temporally after the arthroscopy PCL reconstruction and begins to restore 15 months after operation, and improves sharply 20 months after operation. All patients’ Lysholm scores and symptoms improve after operation. Therefore, the operation is effective.
Objective To assess the feasibility, safety, and validity of the TC-Dynamic posterior stabilized prosthesis implanted in the total knee arthroplasty (TKA). Methods Twelve knees of 10 patients (the TC-Dynamic group) were followed up, who had been implanted with the TC-Dynamic posterior stabilized prosthesis from September 2003 to March 2004. Preoperative KSS knee scores were 16.08±11.58, function scores 13.75±19.79, and the range of motion (ROM) of the knee 75.00±26.46°. Meanwhile, 50 knees of 30 patients (the Scorpio group) werefollowed up, who had undergone TKA with the Scorpio posterior stabilized prosthesis.Preoperative KSS knee scores were 19.48±967, function scores 3.16±19.82,andthe ROM of the knee 80.80±22.82°. The anteroposterior and lateral X-ray filmsof each knee were examined before and after operation. The statistical Z-test was used to analyze the differences between the 2 groups in the improvement of the KSS knee scores, function scores, and ROM after operation. Results The average of the 130 days’ follow-up revealed that the patients implanted with the TC-Dynamic prosthesis had an excellent result. In the TC-Dynamic group, the KSS knee scores were 88.83±4.04 with improved scores of 72.75±14.47 compared with those before operation; function scores were 79.17±5.15 with improved scores of 65.42±19.47; the ROM of the knee was 107.92±11.57° with increased degrees of 32.92±32.22°.Meanwhile, in the Scorpio group, the KSS knee scores were 85.68±7.36 with improved scores of 66.20±10.44 compared with those before operation; function scores were 71.40±12.70 with improved scores of 68.24±25.35; the ROM of the knee was 109.20±11.13° withincreaseddegrees of 28.40±26.41°.There was no significant difference in the improvement of the KSS knee scores, function scores, and ROM after operation between the 2 groups （Pgt;0.01）. All the X-ray films of the knees implanted with both the Scorpio prosthesis and the TC-Dynamic prosthesis were analyzed.No malalignment or lucent line with the prosthesis was seen in all these X-ray films. Conclusion The short-term follow-up indicates that the patients implanted with the TC-Dynamic prosthesis have an excellent result. The TC-Dynamic prosthesis with a scientific and proper design is more suitable for the Chinese. However, the long-term outcome of the patients implanted with the TC-Dynamic prosthesis should be observed in a larger number of TKA operations. The basic surgical principles, including excision of both the cruciate ligaments and correction of thebone deformity with the proper balancing of the soft tissues in flexion and extension, are still crucial to successful TKA and to the longterm high survivalrate of the knee prosthesis.
ObjectiveTo systematically review the effectiveness of double-bundle versus single-bundle for arthroscopic transtibial reconstruction of posterior cruciate ligament (PCL). MethodsWe searched PubMed, The Cochrane Library, EMbase, VIP and WanFang Data to collect randomized controlled trials (RCTs) of PCL reconstruction treated with double-bundle versus single-bundle arthroscopic transtibial technique. Two reviewers screened literature according to the inclusion and exclusion criteria, extracted data and assessed the methodological quality of included studies, and then meta-analysis was performed by using RevMan 5.3 software. ResultsA total of 4 RCTs involving 186 patients were included. The results of meta-analysis showed that double-bundle was superior to single-bundle in Lysholm score (MD=2.17, 95%CI 0.29 to 4.05, P=0.02), Tegner score (MD=0.62, 95%CI 0.09 to 1.16, P=0.02), IKDC objective score (A:RR=1.57, 95%CI 1.09 to 2.26, P=0.02; A+B:RR=1.15, 95%CI 1.01 to 1.32, P=0.04). However, there was no significant difference in the KT-1000 posterior between both groups (MD=-0.65, 95%CI -3.29 to 1.99, P=0.63). ConclusionThe current evidence shows that the double bundle arthroscopic transtibial is superior to the single bundle PCL reconstruction. Due to the limited quality and quantity of the included studies, more high quality studies with large sample-size are needed to validate the conclusion.
Objective To investigate the effectiveness of arthroscopic suspension fixation with Endobutton in the treatment of tibial insertion avulsion fractures of posterior cruciate ligament (PCL). Methods A retrospective analysis was conducted on the clinical data of 52 patients (52 knees) with tibial insertion avulsion fractures of PCL, who were treated by arthroscopic suspension fixation with Endobutton between June 2017 and October 2022. There were 29 males and 23 females, with an average age of 40.6 years (range, 19-66 years). There were 24 cases of traffic accident injuries, 17 cases of sports injuries, and 11 cases of fall injuries. The time from injury to operation ranged from 6 to 19 days (mean, 13.3 days). According to the Meyers-McKeever classification, there were 30 cases of type Ⅱ and 22 cases of type Ⅲ fractures. All patients exhibited positive posterior drawer test results. Preoperative knee joint function was assessed with Lysholm score (21.3±6.7), International Knee Documentation Committee (IKDC) score (20.7±5.8), and visual analogue scale (VAS) score (5.3±0.7); and knee joint range of motion was (41.73±3.17)°. Based on preoperative CT three-dimensional reconstruction measurements, the longitudinal diameter of the avulsed bone fragment ranged from 13 to 25 mm (mean, 18.1 mm). Operation time and occurrence of complications were recorded, and postoperative imaging was used to assess fracture healing. Knee joint function and pain severity were evaluated using knee joint range of motion, Lysholm score, IKDC score, and VAS score. Results The operation time ranged from 46 to 81 minutes (mean, 56.2 minutes). All patients were followed up 12-28 months (mean, 20.1 months). The iatrogenic fractures of bone fragments occurred during operation in 4 cases; and knee effusion occurred in 2 cases and anterior knee pain in 1 case after operation. All incisions healed by first intention. Imaging evaluations at 3 months after operation showed the fracture healing and no internal fixation failure. All patients demonstrated good knee function and had returned to normal activities at 12 months after operation. At last follow-up, the knee joint range of motion was (133.44±4.17)°, Lysholm score 93.6±3.1, IKDC score 93.4±2.5, and VAS score 1.0±0.6, with significant differences compared to preoperative scores (P<0.05). Conclusion Arthroscopic suspension fixation with Endobutton in the treatment of tibial insertion avulsion fractures of PCL is simple to operate, and the knee joint function recovers well.
Objective To observe the posterior condylar offset (PCO) changes and anteroposterior femorotibial translation, to investigate the influence of them on the maximum knee range of flexion (ROF) in patients with posterior cruciatesacrificingself al ignment bearing total knee arthroplasty (TKA). Methods The cl inical data were analyzed retrospectively from 40 patients (40 knees) undergoing primary unilateral TC-PLUSTM SB posterior cruciate-sacrificing self al ignment andbearing TKA for osteoarthritis between January 2007 and June 2009. There were 18 males and 22 females with an average age of 70.6 years (range, 56-87 years). The disease duration was 5-14 years (mean, 9.1 years). The locations were the left side in 11 cases and the right side in 29 cases. Preoperative knee society score (KSS) and ROF were 48.0 ± 5.5 and (77.9 ± 9.0)°, respectively. The X-ray films were taken to measure PCO and anteroposterior femorotibial translation. Multi ple regression analysis was performed based on both the anteroposterior femorotibial translation and PCO changes as the independent variable, and maximum knee flexion as the dependent variable. Results All incisions healed by first intention. The patients were followed up 12-19 months (mean, 14.7 months). At last follow-up, there were significant differences in the KSS (91.9 ± 3.7, t=— 77.600, P=0.000), the ROF [(102.0 ± 9.3)°, t=— 23.105, P=0.000] when compared with preoperative values. Significant difference was observed in PCO (t=3.565, P=0.001) between before operation [(31.6 ± 5.5) mm] and at last follow-up [(30.6 ± 5.9) mm]. At ast follow-up, the anteroposterior femorotibial translation was (— 1.2 ± 2.1) mm (95%CI: — 1.9 mm to — 0.6 mm); femoral roll forward occurred in 27 cases (67.5%), no roll in 1 case (2.5%), and femoral roll back in 12 cases (30.0%). By multiple regression analysis (Stepwise method), the regression equation was establ ished (R=0.785, R2=0.617, F=61.128, P=0.000). Anteroposterior femorotibial translation could be introducted into the equation (t=7.818, P=0.000), but PCO changes were removed from the equation (t=1.471, P=0.150). Regression equation was y=25.587+2.349x. Conclusion Kinematics after TC-PLUSTM SB posterior cruciate-sacrificing self al ignment bearing TKA with posterior cruciate l igament-sacrificing show mostly roll forwardof the femur relative to the tibia, which have a negative effect on postoperative range of motion. There is no correlation between PCO changes and postoperative change in ROF in TC-PLUSTM SB posterior cruciate-sacrificing self al ignment bearing TKA.