ObjectiveTo analyze the causes of meniscal root tears (MRTs), and to review the progress in its diagnosis and therapy. MethodsThe published literature about MRTs was extensively reviewed and summarized. ResultsMRTs can be divided into acute traumatic injuries and chronic degenerative injuries; MRI examination is an effective way to diagnose according to meniscal extrusion, ghost sign, and meniscal root linear defects. Conservative treatments are mainly performed for chronic MRTs; partial meniscectomy can obtain predictable improvement in symptoms. Acute MRTs can be treated by arthroscopic meniscus repair and reconstruction which can effectively restore meniscal root anatomy and function, and knee joint degeneration can be postponed. ConclusionMRTs diagnosis relies on MRI, appropriate treatment plan should be made based on the specific circumstances of the patient after accurate diagnosis. Usually the satisfied short-term clinical results can be obtained, while the long-term results need more clinical evaluation.
ObjectiveTo investigate the efficiency of total knee arthroplasty (TKA) for varus osteoarthritic knees with tibial bone resection determined by lateral tibiofemoral joint 90° flexional gap measurement. MethodsBetween March and June 2013, 60 patients (60 knees) with varus osteoarthritic knees underwent TKA. All patients were randomly divided into traditional osteotomy group (control group, 30 cases) and lateral tibiofemoral joint 90° flexional gap measurement resection group (trial group, 30 cases). There was no significant difference in gender, age, affected side, body mass index and preoperative knee society score (KSS), range of motion (ROM) of the knee, anatomic tibiofemoral angle (ATFA), patellar tilt angle, posterior condylar offset (PCO), and joint line height between 2 groups (P>0.05). The bone resection thickness of the distal femoral lateral condyle, femoral posterior lateral condyle, and lateral tibial plateau were measured; and the X-ray films were taken to measure and compare ATFA, patellar tilt angle, PCO, and joint line height after TKA. The knee function recovery was evaluated with KSS score and ROM of the knee. ResultsThe bone resection thickness of the lateral tibial plateau and distal femoral lateral condyle in trial group was significantly smaller than that in control group (P<0.05); while the bone resection thickness of the femoral posterior lateral condyle was significantly bigger than that in control group (P<0.05). The 10 mm polyethylene insert was used in 19 cases of the trial group and in 8 cases of the control group, showing significant difference (Z=-4.040, P=0.003). All the patients were followed up 13-16 months (mean, 14.5 months). Radiography at 6 weeks after TKA indicated that the ATFA, patellar tilt angle, and joint line height had no significant difference between 2 groups (P>0.05); the PCO of trial group was significantly lower than that of control group (P<0.05). The KSS score and ROM of the knee at 12 months after operation were significantly improved when compared with preoperative ones in 2 groups (P<0.05), and trial group was significantly better than control group (P<0.05). ConclusionIt was an effective method to determine bone resection thickness using lateral tibiofemoral joint 90° flexional gap measurement in TKA for varus osteoarthritic knees, which can reduce the bone resection thickness of the tibial plateau and distal femoral lateral condyle and restore the joint line and PCO with better early recovery of the knee function.
ObjectiveTo evaluate the safety and efficacy of rivaroxaban for prevention of deep vein thrombosis (DVT) in patients with preoperative abnormal D-dimer after total knee arthroplasty (TKA). MethodsBetween August and September 2013,60 consecutive patients with varus knee osteoarthritis undergoing unilateral TKA were enrolled in the study.According to the preoperative D-dimer level,the patients were divided into 2 groups:D-dimer normal group (control group,n=41) and D-dimer abnormal group (test group,n=19).No significant difference was found in gender,age,body mass index,and preoperative knee range of motion between 2 groups (P>0.05).All patients underwent conventional primary TKA and anticoagulation therapy with rivaroxaban to prevent DVT.The tourniquet use time,postoperative hospitalization time,and total hospitalization time were compared between 2 groups.At 1,3,and 5 days after operation,prothrombin time (PT),activated partial thromboplastin time (APTT),thrombin time (TT),fibrinogen (FIB),and D-dimer were measured.Wound complications and DVT were observed. ResultsThe postoperative hospitalization time of the test group was significantly longer than that of the control group (t=2.327,P=0.031),while the tourniquet use time and total hospitalization time showed no significant difference between 2 groups (P>0.05).All the patients were followed up 6-8 months (mean,7.2 months).Wound complications occurred in 3 cases (7.3%) of the control group and in 2 cases (10.5%) of the test group,showing no significant difference (χ2=0.175,P=0.676).Color ultrasonography showed no pulmonary embolism and DVT at 6 weeks after TKA.There were significant differences in PT,TT,and FIB between at pre- and post-TKA in the same group,but no significant difference was found between 2 groups.The APTT and D-dimer had significant differences between at pre- and post-TKA in the same group,and between groups.There was no significant interaction effect between time and group for each index. ConclusionPreoperative abnormal D-dimer level should not be regarded as a contraindication for TKA.The risks of DVT and wound complications in patients with abnormal D-dimer level are similar to patients with normal D-dimer level using rivaroxaban administration after TKA.It is unnecessary to conventional monitor D-dimer and other coagulation and hemorrhage laboratory tests in the patients after TKA.