Objective To explore the effectiveness of arthroscopic medial retinaculum pl ication (MRP) for recurrent patellar dislocation in adolescents. Methods Between March 2000 and October 2007, 30 adolescent patients with recurrent patellar dislocation underwent arthroscopic MRP, and 28 of them (12 left knees and 16 right knees) completed thefinal follow-up and were enrolled. There were 5 males and 23 females with an average age of 14.7 years (range, 12-19 years). The dislocation duration was 4 to 39 months with an average of 18.8 months. All patients experienced 2-4 episodes of dislocation. Before operation, all the patients showed positive apprehension test; the degree of lateral patellar translation was (2.9 ± 0.7)° and there was no hardness termination in lateral translation. The International Knee Documentation Committee (IKDC), Lysholm, Kujala, and Tegner scores were 47.7 ± 3.7, 52.6 ± 4.9, 66.7 ± 5.9, and 3.1 ± 1.3, respectively. All patients underwent arthroscopic MRP procedure. Results All incisions healed by first intention without compl ication. All the patients were followed up 2-7 years (4.8 years on average). During the follow-up, more and more patients showed positive apprehension test, and at 24 months of follow-up, 12 patients showed positive apprehension test; less and less patients had hardness termination in lateral translation, only 3 patients at 24 months of follow-up; the degree of lateral patellar translation increased, (2.3 ± 1.1)° at 24 months of follow-up. There were significant differences in positive apprehension test and hardness termination between preoperation and 24 months of follow-up (P lt; 0.05). Moreover, 6 patients suffered from redislocation, and 23 patients experienced patella instabil ity. The IKDC, Lysholm, Kujala, and Tegner scores at 24 months of follow-up were 62.5 ± 6.2, 70.7 ± 5.1, 76.6 ± 4.8, and 3.9 ± 0.7, respectively, showing significant differences when compared with preoperative scores (P lt; 0.05). CT examination showed that the congruence angle, lateral patellar angle, and patellar tilt angle were recovered to normal level after operation immediately, however, the final patellar position at 24 months of follow-up was not significantly betterthan that before surgery (P gt; 0.05). There was significant difference in the lateral patellar displacement between preoperation and 24 months of follow-up (P lt; 0.05). Conclusion Arthroscopic MRP is not rel iable for maintaining the corrected position of the patella for recurrent patellar dislocation in adolescents, though functional improvements are significant.
Objective To evaluate the survival condition and quantitative variation of mechanoreceptors in the tibial remnant of ruptured anterior cruciate l igament (ACL) in human knees. Methods Between April 2009 and May 2010, 60 patients who underwent arthroscopic ACL reconstruction were included and divided into 4 groups according to the time of injury, with 15 patients in each group. In group A, there were 14 males and 1 female aged 20-37 years (mean, 27 years); the injury was caused by traffic accident in 5 cases and by sports in 10 cases, and the time between injury and surgery was not more than 3 months. In group B, there were 14 males and 1 female aged 17-43 years (mean, 24 years); the injury was caused by traffic accident in 2 cases and by sports in 13 cases; and the time between injury and surgery was 3 to 6 months. In group C, there were 11 males and 4 females aged 16-53 years (mean, 28 years); the injury was caused by traffic accident in 2 cases and by sports in 13 cases; and the time between injury and surgery was 6 to 12 months. In group D, there were 12 males and 3 females aged 18-41 years (mean, 26 years); the injury was caused by sports in 11 cases, and the other 4 cases had no defined etiology; and the time between injury and surgery was more than 12 months. Specimens were donated by the volunteers from the anteromedial side of the ACL tibial remnant (40 sl ices per specimen) and stained via immunohistochemical method. The type, size, and quantity of mechanoreceptors were observed under l ight microscope. Results Totally 80 Ruffini-l ike corpuscles, 8 Pacini-l ike corpuscles, 5 atypical neural endings and no distinct Golgi organ-l ike corpuscles were observed under l ight microscope in 60 specimens (2 400 sl ices) of 4 groups. There was no obvious difference in size and type of mechanoreceptors among 4 groups. However,some degenerative and atrophic changes could be observed in the specimens of group D. The total number of echanoreceptors was 31 (35.2%) in group A, 22 (25.0%) in group B, 23 (26.1%) in group C, and 12 (13.7%) in group D. There was no significant difference (P gt; 0.05) in Ruffini-l ike corpuscles and Pacini-l ike corpuscles among 4 groups. Mechanoreceptors were found in 9,8, 9, and 6 patients in groups A, B, C, and D, respectively; the detection rates were 60.0%, 53.3%, 60.0%, and 40.0%, respectively; showing no significant difference (P gt; 0.05). Conclusion The mechanoreceptors in tibial residual of ruptured ACL have a long survival without obvious degeneration and atrophy within 12 months. So it may contribute to restoration of proprioceptive function after operation if the remnant is preserved during ACL reconstruction.
Objective To review the details of the current effortsto reconstruct or replace the meniscus.Methods Three kinds of proceduresof reconstructing or replacing the meniscus were analyzed and evaluated by an extensive review of the latest literatures concerned. Results Three kinds of techniques were established to reconstruct the meniscus clinically, i.e., the allograft of the meniscus, meniscal reconstruction with the autotendon, and the meniscus scaffold. There were still a few defects in the meniscal replacement, and so the curative techniques would still be investigated. Conclusion Many efforts have been made to reconstruct the meniscus after its injury or its resection so as to prevent degeneration of the knee joint. The meniscal replacement has been employed for many years, but it has not worked so well. The establishment of an ideal replacement of the meniscus requires further studies. Therefore, reconstruction of the meniscus function is still a challenging problem to the surgeons concerned.
Objective To explore the effects of the basic fibroblast growth factor（bFGF） gene transfection on the meniscal fibrochondrocytes with the reconstructed lentivirus and to observe the response of the meniscal fibrochondrocytes to the bFGF gene transfection. Methods The cultured meniscal fibrochondrocytes were isolated from the same 3-monthold New Zealand rabbit. The cultured first-generation meniscal fibrochondrocytes were divided into 3 groups:Group A (experimental group), Group B (control group), and Group C (blank group). Each group comprised the cells in a 24hole flask in which each hole contained 2×104 cells. At the confluence of 60%, the fibrochondrocytes in Group A were cultured with the reconstructed lentivirus carrying the bFGF gene. The fibrochondrocytes in Group B were cultured with the lentivirus carrying no bFGF gene. The fibrochondrocytes in Group C were cultured without any intervention. After 48 h, the cell cycle, the collagen synthesis ability, the expression of bFGF, and the cell proliferation ability in each group were investigated. Results In Group A, the bFGF expression of 870±60 pg/ml was detected in the cells 48 h afterthe co-culture; however, in Group B and Group C, no expression of bFGF was found. After the co-culture for 6 days, the results of the MTT colorimetry revealed that the cells in Group A had an absorbtance of 0.427±0.037, which had a significant difference when compared with that in Group B and Group C (0.320±0.042,0.308±0.034,Plt;0.01). The cell cycle was significantly shorter in GroupA than in Group B and Group C (Plt;0.05); The durations of G1, S and G2M of the cells in Group A were 16.28, 12.60 and 11.04 h, but those in Group B and Group C were 23.61, 16.90, 21.33 h and 21.56, 19.80, 21.41 h, respectively. The disintegration per minute of the cells was significantly greater in Group A than in Group B and Group C (7281.69±805.50 vs 5916.40±698.11 and 5883.57±922.63，Plt;0.05). Conclusion The lentivirus vector can transfer the bFGF gene into the meniscal fibrochondrocytes, resulting in an increase of the cell proliferation and the collagen synthesis.