Objective To investigate the effectiveness of arthroscopically assisted treatment of acute tibial insertion avulsion fracture of the posterior cruciate ligament (PCL) via posteromedial incision. Methods Between January 2010 and January 2012, 22 patients with acute tibial insertion avulsion of the PCL underwent arthroscopic reduction and fixation via posteromedial incision. There were 14 males and 8 females with an average age of 32 years (range, 18-48 years). The injury causes included traffic accident injury in 14 cases, sport injury in 4 cases, and falling injury in 4 cases. The disease duration ranged from 7 to 16 days (mean, 10 days). Of 22 patient, 14 had simple PCL injury, 6 had PCL injury with meniscus injury, and 2 with cartilage injury. The results of posterior drawer test were positive in all patients. The preoperative Lysholm score was 51.1 ± 3.4. Results All incisions healed by first intention without infection, deep venous thrombosis of lower limbs, or vessel and nerve injuries. All patients were followed up 12-24 months (mean, 18.4 months). X-ray films showed that all fractures healed with the healing time of 2-4 months (mean, 3 months). The Lysholm score was improved to 96.0 ± 2.2 at 6 months after operation, showing significant difference when compared with preoperative score (t=43.020, P=0.000). Conclusion Arthroscopically assisted treatment of acute tibial insertion avulsion fracture of the PCL via posteromedial incision is a safe, easy, and effective method.
Objective To investigate the effectiveness of posterior cruciate ligament (PCL) reconstruction with remnant preservation and autogenous quadrupled hamstring tendons under arthroscopy. Methods Between October 2007 and August 2012, 32 patients with PCL rupture were treated and followed up for more than 1 year. There were 24 males and 8 females, aged 20-53 years (mean, 35.6 years). The causes of injury included traffic accident injury in 21 cases, sports injury in 8 cases, and falling injury from height in 3 cases. The disease duration ranged 1 week to 2 years (median, 6.3 weeks). Nine patients had simple PCL rupture, 23 patients complicated by ligament injury, including 10 cases of anterior cruciate ligament rupture, 11 cases of posterolateral corner injury, and 2 cases of posteromedial corner injury. Preoperative Lysholm score was 53.8 ± 7.1. According to the International Knee Documentation Committee (IKDC) rating criteria, 10 cases were classified as grade C and 22 cases as grade D. PCL was reconstructed with autogenous quadrupled hamstring tendons, the tendons were fixed with EndoButton at the femoral side and with interference screw at the tibial side; floats of stump were cleaned up, and the structural stability and continuity ligament remnants were preserved. Results Primary healing was obtained in all incisions; no early complication occurred after operation. Thirty-two patients were followed up 23.4 months on average (range, 12-36 months). All patients had no symptom of knee instability; the results of tibia sags sign, posterior drawer test, and Lachman test were negative. At last follow-up, the knee range of motion (ROM) returned to normal in all cases. The Lysholm score was 92.3 ± 2.0, showing significant difference when compared with preoperative score (t= — 34.32, P=0.00). According to the IKDC rating criteria, 26 cases were classified as grade A and 6 cases as grade B at last follow-up, showing significant difference when compared with preoperative grade (Z= — 5.57, P=0.00). Conclusion Arthroscopic single-bundle reconstruction of PCL with remnant preservation and quadrupled hamstring tendons has advantages of minimal trauma, simple operation, and good knee function recovery.
Objective To analyze the effect of the posterior cruciate ligament (PCL) retaining or not on knee-joint proprioception by comparing the proprioceptive difference between PCL retaining and no PCL retaining in total knee arthroplasty (TKA). Methods Between June 2009 and June 2010, 38 osteoarthritis patients meeting the inclusion criteria were divided into PCL retaining group (group A, n=19) and PCL-substituting group (group B, n=19) according to the random number table. There was no significant difference in gender, age, disease duration, the range of motion of the knee between 2 groups (P gt; 0.05). The effectiveness and the knee-joint proprioception were separately assessed by the Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score and the passive angle reproduction test (30, 60, and 90° of knee flexion) preoperatively and 12 months postoperatively. Results All incisons healed by first intention, without complications of infection, fracture, and deep vein thrombosis of lower limb. The patients were followed up 12-17 months (mean, 14.1 months). The knee function after operation was obviously improved when compared with preoperative one; significant differences were observed in the WOMAC scores and the results of passive angle reproduction test between at preoperation and at 12 months after operation (P lt; 0.05), but no significant difference was found between group A and group B (P gt; 0.05). Conclusion Whether PCL retaining or not in TKA both can improve knee-joint proprioception, and no obvious difference between them.
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.
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 compare the single femoral tunnel split-double-bundle posterior cruciate ligament (PCL) reconstruction with the singlebundle PCL reconstruction and to discuss the advantages of the modified reconstruction method. Methods Fourteen donated fresh-frozen human knee specimens were biomechanically tested, which included knee specimens from 12 males and 2 females, and their ages ranged from 20 to 31 years. The specimen length of the femur and the tibia was 20 cm. The tibial posterior translation and the PCL strains were first measured when PCL was in an intact state (the intact group, n=14). Then, PCL was cut (the cut group, n=14). The posterior translation was measured when a posterior load was applied. After that, the specimens were randomly divided into twogroups: the single-bundle group (n=7) and the double-bundle group (n=7). When the posterior load was applied to the tibia, the bundle strain and the tibial posterior translation were measured with the knees flexed at 0, 30, 60, 90 and 120°, respectively. Results While a 100 N posterior force was applied, the posterior tibial displacement of the intact PCL knee ranged from 1.97±0.29 mm to 2.60±0.23 mm at the different knee flexion angles. In the PCL-cutstate, the tibial displacement increased significantly from 11.27±1.06 mm to14.94±0.67 mm (P＜0.05). After the singlebundle reconstruction, the posterior tibial translation ranged from 1.99±0.19 mm to 2.72±0.38 mm at the different knee flexion angles. In the split-double-bundle reconstruction, the posterior tibial translations ranged from 2.27±0.32 mm to 3.05±0.44 mm. The graft of the single-bundle reconstruction was tensioned from 0° to 120°, and the tibial displacement increased significantly at 90° compared with that at theother angles(P＜0.05). In the doublebundle reconstruction, the anterolateral bundle and the posteromedial bundle were tensioned in a reciprocal fashion, and the tibial displacement had no significant difference at the five kinds of the flexion angles. ConclusionThe single femoral tunnel split-double-bundle PCL reconstruction canrestore the posterior tibial displacement at different flexion angles, and the tibial displacement in the single-bundle PCL reconstruction knee can be increased when the knee flexion is at 90°. In the double-bundle reconstruction, the graftcan be tensioned in a reciprocal fashion and the biomechanical features can be nearer to those of the normal PCL bundles.
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.
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.
ObjectiveTo introduce the arthroscopic single bundle posterior cruciate ligament (PCL) reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers, and to evaluate the clinical results. MethodsBetween June 2010 and April 2014, 57 patients with PCL rupture were treated with arthroscopic single bundle PCL reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers. There were 41 males and 16 females, aged 19-42 years (mean, 27.7 years). All the patients had history of injury. The results of posterior drawer test were positive, including 9 cases of grade Ⅱ and 48 cases of grade Ⅲ. The disease duration ranged from 2 weeks to 25 months (mean, 13 months). The Lysholm score and the range of motion of knee joint were used to evaluate the knee function. ResultsThe operation performed smoothly, and no complications of blood vessel and nerve injuries and infection occurred. Primary healing was obtained in all incisions; no early complication occurred after operation. The patients were followed up 16.6 months on average (range, 12-20 months). At last follow-up, the knee range of motion returned to normal in all cases (120-130° in flexion). MRI at last follow-up showed good continuity of the PCL graft and complete healing of the remnant PCL tissues between the femoral and tibial attachments. The Lysholm score was significantly improved when compared with preoperative score (t=-27.429, P=0.000). ConclusionArthroscopic single bundle PCL reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers has the advantages of firm fixation, simple operation, and good knee function recovery.
ObjectiveTo study the results of high tibia osteotomy (HTO) combined with posterior cruciate ligament (PCL) reconstruction for osteoarthritis (OA) of the medial compartment with PCL injury. MethodsBetween March 2008 and June 2014, 11 patients with OA of the medial compartment and PCL injury underwent HTO combined with PCL reconstruction. There were 5 males and 6 females, aged 43-55 years (mean, 50.3 years). All patients had a trauma history, and the duration of injury was 3-5 years (mean, 3.7 years). At preoperation, Hospital for special surgery (HSS) score was 54.73±8.60, Lysholm score was 56.91±4.51, KT-1000 test was (5.71±1.13) mm, and knee range of motion (ROM) was (125.21±4.77)°. The preoperative femoral tibia angle (FTA) and posterior slope angle (PSA) of the tibia plateau were (184.82±2.40)° and (7.18±1.17)° on the X-ray film. ResultsIncisional fat liquefaction occurred in 1 case, and wound healed after dressing change; primary healing of wound was obtained in the other cases. All 11 cases were followed up 12-28 months (mean, 17 months). Bone union was observed at osteotomy site within 6 months, without delayed union or nonunion. After operation, genu varus deformity was corrected with different degrees; the stability of knees was improved in all patients; and the pain of medial knee was released significantly. At 12 months after operation, the FTA was significantly reduced to (176.64±1.96)°; at last follow-up, the HSS score was significantly increased to 88.27±4.76, KT- 1000 test was significantly reduced to (3.18±0.87) mm, and Lyholm score was significantly increased to 86.45±2.34, all showing significant differences when compared with preoperative ones (P<0.05). At last follow-up, the knee ROM was (124.63±2.98)° and the PSA was (7.91±1.30)°, showing no significant difference when compared with preoperative ones (P>0.05). ConclusionThe PSA will not be changed when a combination of HTO and PCL reconstruction is used to treat OA of the medial compartment with PCL injury if the right osteotomy site and reasonable bone graft are selected. The short-term effectiveness is good because of good recovery of the lower extremity force line and knee stability, but the long-term effectiveness remains to be further followed up.