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 analyse the results of posterior cruciate l igament-retained mobile-bearing total knee arthroplasty (TKA) in treatment of rheumatoid arthritis (RA) and to solve the problems often encountered during surgery. Methods From February 1999 to August 2005, the cl inical data from 73 patients with RA undergoing TKA were analysed retrospectively. In 73 patients, 38 patients were treated with posterior cruciate l igament-retained mobile-bearing prosthesis (group A), while 35 patients were treated with posterior stabil ized fixed-bearing prosthesis (group B). Another 70 patients with osteoarthritis (OA) treated with an posterior cruciate l igament-retained mobile-bearing prosthesis served as controls (group C). In group A, there were 8 males and 30 females with an average age of 56.5 years and an average diseasecourse of 16.8 years. In group B, there were 6 males and 29 females with an average age of 57.3 years and an average disease course of 17.1 years. In group C, there were 37 males and 33 females with an average age of 65.4 years and an average disease course of 10.8 years. There was no significant difference (P gt; 0.05) in general data between groups A and B, but there were significant differences (P lt; 0.05) when compared with group C. Results In groups A and B, 2 cases (5.3%) and 1 case (2.9%) had poor heal ing of incision, respectively; in group C, all cases had good heal ing of incision. There were significant differences in heal ing rate of incision between groups A, B and group C (P lt; 0.05). All patients were followed up 7.6 years on average (range, 3.5-10.5 years). Deep infection occurred in 1 case respectively in 3 groups, showing no significant difference (P gt; 0.05). Posterior instabil ity occurred in 1 case (2.6%) 5 years after operation in group A and 2 cases (2.9%) 9 years after operation in group C, and no posterior instabil ity occurred in group B; showing significant differences between groups A, C and group B (P lt; 0.05). There were significant differences (P lt; 0.05) in knee score, Feller patellar score, and anterior knee pain score between pre- and postoperative values among groups A, B, and C. There were significant differences (P lt; 0.05) in the function scores between pre- and post-operative values in 3 groups, between groups A, B and group C pre- and post-operatively. Conclusion Posterior cruciate l igament-retained mobile-bearing TKA can yield satisfactory cl inical results in treatment of RA at intermediate-term followup. This mobile-bearing prosthesis has a low prevalence of posterior instabil ity and a good outcome for anterior knee function without patellar resurfacing.
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 explore the operative techniques and prel iminary cl inical effect of arthroscopic reconstruction of posterior cruciate l igament (PCL) using l igament advanced reinforcement system (LARS). Methods From June 2006 to July 2007, 9 patients with PCL rupture were treated with LARS under arthroscopic observation. There were 8 males and 1 female, aged 23-49 years old. The left knee was involved in 3 cases and the right knee in 6 cases. The main causes of injuries were sports in 5 cases, fall ing in 1 case and traffic accident in 3 cases. The time from injury to reconstruction was6-20 days (13.6 days on average). There were 2 cases with associated medial meniscus injury and 1 with lateral meniscus injury. X-ray films showed no avulsion fracture of tibial plateau was found. The preoperative Lysholm score was 40-55 (50 on average). According to the preoperative international knee documentation commitee (IKDC) grading, 1 case was graded as C and 8 as D. The Lachman test showed that there was 1 case (+), 6 cases (++) and 2 cases (+++). The operation was performed under arthroscopic observation. The tibial isometric point and tunnel were drilled with the help of a drill bit guide, while the femoral isometric point and tunnel were drilled under the C-arm X-ray machine. The diameter of the bone tunnels was 6 mm, while the diameters of LARS artificial l igaments and canulated interference screws were 7 mm. Results All the patients were regularly followed up for 8-16 months (10.5 months on average). The postoperative Lysholm score was 70-95 (85 on average). There were 5 cases of excellent, 3 of good and 1 of fair, with the choiceness rate of 88%. The postoperative IKDC grading showed that 7 cases were graded as A and 2 as B. The Lachman test showed that no case was positive. Compl ications such as infection, spontaneous rupture or laxity of graft were not observed. Conclusion PCL arthroscopic reconstruction with the use of LARS artificial l igaments leads to a good anatomic reconstruction and knee function with minor injury, rapid recovery and satisfactory cl inical effect.