Objective To investigate the clinicalvalue of modified Weaver-Dunn technique in repair of acute acromioclavicular dislocation. Methods From January 1993 to December 1998, 18 cases of acromioclavicular dislocation were treated bymodified Weaver-Dunn technique, and other 17 cases of the same suffering were treated by tension band fixation of the acromioclavicular joints. All of the patients were followed up for 12-36 months before clinical evaluation of the functionof shoulder joints, according to University of Pennsylvanian Shoulder Score System. Results In short term, the shoulder joints recovered much more rapidly in the cases repaired by modified Weaver-Dunn technique; 12, 24 and 36 months after operation, the scores of the cases repaired by modified Weaver-Dunn technique were (1897±67), (193.7±3.6) and (194.7±3.4) respectively according to the Shoulder Score System, while those of the cases treated by tension band fixation were (167.3±7.8), (170.2±6.3) and (165.6±5.9) respectively. The above data indicated that there was significant difference between two groups (P＜0.05). Conclusion The modified Weaver-Dunn technique was a better surgical approach than tension band fixation for repair of acute acromioclavicular dislocation.
Objective To explore the technique of arthroscopic treatment of local ized pigmented villonodular synovitis of the knee and to evaluate its cl inical results. Methods From February to December 2006, 22 cases of local ized pigmented villonodular synovitis of the knee were treated by arthroscopic excision of the focus and partial synovectomy. There were 8 males and 14 females, with an average age of 24 years old (16 to 35 years old). Eight patients had a trauma history, the others had no obvious inducement. The disease course was from 1 month to 30 months with an average of 10 months. The Lysholm score was 68.5 ± 8.2, and the International Knee Documentation Committee (IKDC) score was 72.7 ± 5.2 before operation. MRI showed that 20 knees had definite focuses and 2 had no ones. In all the cases, routine arthroscopic approach combined with assistant approach adjacent to the focus was used. Results All the patients were diagnosed as having local ized pigmented villonodular synovitis of the knee by pathological examination. The incisions healed at stage I. No compl ications occurred after operation. All patients were followed up 18-28 months (average 22 months). The angle of genuflex was less than 90° in 2 cases after 6 weeks, and the range of motion of the knee was recovery after manipulation release. At last followup, MRI showed no recurrence was found in 19 patients. The IKDC score was 92.8 ± 2.4, and the Lysholm score was 94.5 ± 3.5, respectively, indicating significant differences when compered with before operation (P lt; 0.01). Conclusion Local ized pigmented villonodular synovitis of the knee can be effectively treated by arthroscopic excision of the focus along with a rim of surrounding healthy synovium with most minimal invasive and best knee function.
【Abstract】 Objective To compare the short-term effects of arthroscopic partial meniscectomy in treating medial versuslateral meniscus injuries. Methods From January 2003 to January 2006, 207 patients with meniscus injury(without intraarticularligament injury) underwent arthroscopic partial meniscectomy. The medial meniscus injury group included 115 cases, 50males and 65 females; aged 14 to 78 years(mean 46.9 years); 66 left knees and 49 right knees. Twenty-six cases had injury histories,the delayed time from injury to surgery ranged from 6 d to 6 months (mean 2.1 months). The lateral meniscus injury group included92 cases, 18 males and 74 females; aged 16 to 62 years (mean 41.1 years); 57 left knees and 35 right knees. Twenty-four caseshad injury histories, the delayed time from injury to surgery ranged from 9 d to 6 months (mean 1.9 months). Lysholm score systemwas applied and the scors of pre- and post-operation and were compared between two groups. Results The period of followupranged from 12 to 45 months (mean 31.5 months). In medial meniscus injury group and lateral meniscus injury roup, theLysholm score increased from 61.3±16.9 and 57.4±17.6 preoperation to 95.0±7.9 and 93.3±7.4 postoperation respectively. Therewas statistically significant difference between preoperation and postoperation (P lt; 0.01), and there was no statistically significantdifference between two groups（P gt; 0.05）. The excellent and good rates for function of knee joint were 97.39% (excellent in 107cases, good in 5 cases and fair in 3 cases) in medial meniscus injury group and 100%(excellent in 80 cases and good in 12 cases)in lateral meniscus injury group. Conclusion Arthroscopic partial meniscectomy is a safe and effective treatment for meniscusinjury, there is no diference in short-term effects in treating medial versus lateral meniscus injuries.
Objective To evaluate the primary cl inical results of double-bundle anterior cruciate l igament reconstruction (ACLR) with semitendinosus allografts. Methods From March 2006 to October 2006, 33 patients underwent double-bundle ACLR with semitendinosus allografts. The complete followed-up data of 31 patients was analyzed retrospectively. There were 24 males and 7 females aged 18-35 years old (average 25 years old). The injury was caused by sports accidents in 23cases and traffic accidents in 8 cases, involving the left knee in 18 cases and the right knee in 13 cases. Anterior cruciate l igament rupture were confirmed by MRI and arthroscopy in all the patients, without lateral collateral l igaments injuries and posterior cruciate l igament injuries. The time from injury to operation was 1-43 months (average 11 months). The knee was fixed at 0° position after operation for 2 weeks and got knee joint rehabil itation exercises gradually. Results The incision of 2 patients showed effusion 4 and 7 days after operation, respectively, and healed after symptomatic treatment. The incision of 29 patients healed by first intention. There were no compl ications such as stiffness of knee joint, neurovascular injuries and joint infections. All the patients were followed up for 24-29 months (average 26 months). MRI displayed the anterior cruciate l igament grafts presented with good connection and signal similar to the normal 2 years after operation. There was significant difference between the preoperational value and the final follow-up value in terms of bilateral knee joint difference of prior laxity, Lachman test, and pivot shift test (P lt; 0.05 ). The circumference difference between the injured and the normal was (11.6 ± 7.9) mm before operation and (5.0 ± 3.1) mm at the final follow-up (P lt; 0.05). The Tegner score, Lysholm score, and International Knee Documentation Committee score was 3.83 ± 1.15, 64.38 ± 6.81, and 41.42 ± 6.30, respectively, before operation, and 6.29 ± 0.64, 94.45 ± 3.03, and 95.72 ± 3.10, respectively, at the final follow-up. There was a significant difference between before and after operation (P lt; 0.05). Conclusion The primary cl inical results of double-bundle ACLR with semitendinosus allografts are satisfactory and the allogeneic semitendinosus are good grafts for double-bundle ACLR.
Objective To make a comparison for the change of maximum tensile intensity and stiffness of a whole implant that is placed into bone tunnel with various lengths tendon, by using beagle dog’s autogenous flexor tendons to reconstruct anterior cruciate l igament (ACL). Methods Sixty male beagle dogs were included in the experiment (weighting 13-16 kg). Three dogs were used for intact flexor tendon of both knees (normal control group), 3 dogs for the intact ACL andfemur-graft-tibia complex (auto control group) and 54 dogs (108 knees) for models of reconstructed ACL (6 experimentalgroups according to different lengths of tendon: 5, 9, 13, 17, 21 and 25 mm in the bone tunnel). The tensile intensity and stiffness were measured after 45, 90 and 180 days separately after operation. Results In the normal control group, the maximum tensile intensity of the intact flexor tendon was (564.15 ± 36.18) N, the stiffness was (59.89 ± 4.28) N/ mm. In the auto control group, the maximum tensile intensity of the intact ACL was (684.75 ± 48.10) N, the stiffness was (74.34 ± 6.99) N/ mm, all ruptured through the intra-articular portion of the graft. The maximum tensile intensity of femur-graft-tibia complex in the auto control group was (301.92 ± 15.04) N, the stiffness was (31.35 ± 1.97) N/mm. After 45 days of operation, all failure occurred at the tibial or femoral insertion site. After 90 days of operation, 24 of the breakpoints were scattered in tendon-bone junction, 12 (3 in 17 mm group, 5 in 21 mm group, 4 in 25 mm group) ruptured through the intra-articular portion. After 180 days of the operation, all breakpoints were distributed inside joint of the implant. The maximum tensile intensity and the stiffness were ber in 17, 21 and 25 mm groups than in 5, 9 and 13 mm groups after operation (P lt; 0.05). Conclusion Tendon with 17 mm length, which will be implanted into bone tunnel, is an appl icable index, in reconstruction of ACL by autogenous tendons.