Objective To evaluate the short-term effectiveness of arthroscopic single-bundle reconstruction of anterior cruciate ligament (ACL) being centered within the native ligament’s tibial and femoral insertions with independent drilling of tibial and femoral tunnels. Methods Between September 2008 and September 2010, 33 patients with chronic ACL ruptures underwent arthroscopic reconstruction with four-stranded hamstring tendons in single-bundle. There were 19 males and 14 females, aged 22-33 years (mean, 26.4 years). Injuries were caused by traffic accident in 15 cases, by falling in 13 cases, and by sports in 5 cases. The location was the left knee in 20 cases and the right knee in 13 cases. The average time from injury to surgery was 6 months (range, 2-20 months). ACL reconstruction could be optimized when single-bundle grafts were centered within the native ligament’s tibial and femoral insertions with independent drilling of tibial and femoral tunnels. KT-1000 test, Lachman test, and pivot-shift test were used to evaluate the knee stability, and the International Knee Documentation Committee (IKDC) and Lysholm scores to assess the knee function. Results Primary healing of incision was obtained in all patients, who had no complications of intra-articular infection, deep venous thrombosis of the lower extremity, and injury of blood vessels and nerves. All the patients were followed up 18.6 months on average (range, 13-24 months). At 1 year after operation, the results of Lachman test were negative in 31 cases and I degree positive in 2 cases, showing significant difference when compared with preoperative results (I degree positive in 4, II degree positive in 26, and III degree positive in 3) (Z= — 5.42, P=0.00). The results of pivot-shift test were negative in 31 cases, I degree positive in 2 cases, showing significant difference when compared with preoperative results (I degree positive in 15 and II degree positive in 18) (Z= — 5.17, P=0.00). The KT-1000 results of examination (134 N) showed that the side difference of anterior laxity was (1.2 ± 0.7) mm at 25° flexion and (0.8 ± 0.6) mm at 70° flexion, showing significant differences when compared with preoperative ones [(7.8 ± 2.1) mm and (5.0 ± 1.8) mm] (t=16.19, P=0.00; t=13.28, P=0.00). The IKDC score was significantly increased from 39.6 ± 4.5 at preoperation to 95.1 ± 1.6 at postoperation (t= — 78.88, P=0.00), and Lysholm score was significantly increased from 48.3 ± 3.6 at preoperation to 92.0 ± 2.5 at postoperation (t= — 42.00, P=0.00). Conclusion It is a reliable procedure to restore the stability of the knee that arthroscopic single-bundle reconstruction of ACL is centered within the native ligament’s tibial and femoral insertions with independent drilling of tibial and femoral tunnels.
Objective To evaluate the short-term effectiveness after static anatomical reconstruction of posterolateral complex (PLC) in the treatment of traumatic multi-ligament injury of the knee. Methods Between June 2007 and July 2011, 23 cases of multi-ligament injury of the knee were treated. There were 15 males and 8 females with an average age of 41 years (range, 19-56 years). The injury was caused by traffic accident in 9 cases, sprain in 7 cases, bruise in 3 cases, and falling from height in 4 cases. The time between injury and operation was 13-78 days (mean, 32 days). The results of posterior drawer test and Lachman test were positive, and all cases complicated by varus and external rotation instability. The Lysholm score of the knee was 43.4 ± 5.7. According to International Knee Documentation Committee (IKDC) scoring, all were rated as grade D. According to Fanelli typing, all were classified as type C. The X-ray films showed that load-induced posterior motion of the knee was (13.3 ± 4.2) mm; the lateral joint space was (15.1 ± 2.4) mm. Anterior cruciate ligament/posterior cruciate ligament and PLC were reconstructed simultaneously with auto-semitendinosus, gracilis tendon, and allogeneic tendon. Results All incisions healed by first intention, and no complication occurred. All patients were followed up 12-56 months (mean, 28 months). At last follow-up, the results of posterior drawer test and Lachman test were negative; 3 cases had varus instability, and 2 cases had external rotation instability. The Lysholm score of the knee was 85.6 ± 16.7, showing significant difference when compared with preoperative score (t=11.469, P=0.000). According to IKDC scoring, 7 cases were rated as grade A, 12 as grade B, and 4 as grade C; significant difference was found when compared with preoperative value (Z=4.285, P=0.000). The load-induced posterior motion of the knee was (5.1 ± 4.4) mm, the lateral joint space was (3.2 ± 2.8) mm, showing significant differences when compared with preoperative ones (P lt; 0.05). Conclusion In the treatment of traumatic multi-ligament injury of the knee, the anatomical reconstruction of the PLC using auto-semitendinosus, gracilis tendon, or allogeneic tendon can obtain good short-term effectiveness.
Objective To review the progress in the prevention and repair of patellar ligament injury in total knee arthroplasty. Methods Recent literature about the prevention and repair of patellar ligament injury in total knee arthroplasty was reviewed and analyzed. Results Increased exposure can prevent the patellar ligament injury, and treatments of acute patellar ligament rupture can be obtained by simple repair, reconstruction with allograft materials or artificial materials, and auxiliary strengthening. Conclusion Patellar ligament injury in total knee arthroplasty should not be ignored. Active prevention and repair of patellar ligament injury can obtain better function of knee joint.
Objective To investigate the injury mechanism, clinical characteristics, and treatments of Segond fracture and complications. Methods Fifteen patients suffering from Segond fracture were treated between January 2007 and December 2011. There were 10 males and 5 females, aged 16-50 years (mean, 31.8 years). Fracture was caused by traffic accident in 8 cases, by sports in 6 cases, and by bruise in 1 case. Before operation, the knee range of motion (ROM) was (36.60 ± 8.94)°; the Lysholm score was 32.27 ± 3.73; and the International Knee Documentation Committee (IKDC) score was 42.34 ± 4.97. The duration from injury to operation was 1-3 weeks with an average of 1.2 weeks. In 12 patients having associated anterior cruciate ligament (ACL) injury, arthroscopic reconstruction of ACL was performed with allogeneic anterior tibial tendon; in 2 patients having associated avulsion fracture of the intercondylar eminence of the tibia, arthroscopic fracture reduction and fixation with Orthocord wire were performed. In 8 patients having associated meniscus injury, meniscus suture and meniscectomy were performed in 3 and 5 patients, respectively. In 7 patients having associated collateral ligament injury, conservative treatment was given in 5 patients, and medial collateral ligament was repair in 2 patients. Results All incisions healed primarily without complications of infection and nerve or blood vessel injury. All the patient were followed up 12-16 months (mean, 14.3 months). At 12 months after operation, the results of anterior drawer test, Lachman test, and lateral stress test were all negative. The knee ROM was (129.27 ± 5.89)°, the IKDC score and Lysholm score were significantly increased to 89.45 ± 3.05 and 87.87 ± 4.12 at 12 months after operation; all showing significant differences when compared with preoperative values (P lt; 0.05). Conclusion Segond fracture is often combined with ACL, collateral ligament, and meniscus injuries, and the evidence of Segond fracture can bly suggests the knee injury. Personalized treatment should be chosen according to complications.
【Abstract】 Objective When knee medial collateral ligament (MCL) rupture, the upper surface of medial meniscus is exposed totally, like the gulf panoramic, which is called “panoramic views of the bay sign” or the “bay sign”. To investigate the reliability and significance of the “bay sign” in diagnosis of knee MCL rupture under arthroscope. Methods Between March 2007 and March 2011, 127 patients with knees injuries were divided into the observation group (n=59) and control group (n=68) based on the MRI results. In the observation group, 59 patients had MCL rupture by MRI, including 12 cases of MCL injury alone, 16 cases of MCL injury with lateral meniscus torn, 27 cases of MCL injury with anterior cruciate ligament (ACL) injury, 3 cases of MCL injury with ACL and posterior cruciate ligament (PCL) injury, and 1 case of MCL injury with patellar dislocation; there were 38 males and 21 females with an average age of 23.2 years (range, 16-39 years). In the control group, 68 patients had no MCL rupture by MRI, including 38 cases of ACL injury, 4 cases of ACL and PCL injury, and 26 cases of ACL and lateral meniscus injury; there were 45 males and 23 females with an average age of 31.8 years (range, 25-49 years). The “bay sign” was observed under arthroscope in 2 groups before and after operation. Results The positive “bay sign” was seen under arthroscope in the patients of the observation group before MCL repair; the “bay sign” disappeared after repair. No “bay sign” was seen in patients of the control group before and after ACL reconstruction. Conclusion The “bay sign” is a reliable diagnostic evidence of MCL injury. It can be used as a basis to judge the success of MCL reconstruction during operation.
Objective To discuss the effectiveness of operation technique for antero-medial rotatory instability (AMRI) of the knee joint caused by motorcycle. Methods Between June 2007 and December 2009, 32 cases of AMRI caused by motorcycle were treated. There were 28 males and 4 females with an average age of 35.5 years (range, 20-50 years). The interval between injury and surgery was 5-10 days (mean, 7 days). The anterior cruciate ligament (ACL) was injured at the attachment point of the condyles crest; the medial collateral ligament (MCL) was injured at central site in 19 cases, at medial condyles of femur in 10 cases, and at medial condyles of tibia in 3 cases, which were all closed injuries. The bone avulsion of condyles crest was fixed by steel wire and MCL was repaired. Results Red swelling and a little effusion occurred at the incision in 1 case, and the other incisions healed by first intention. Traumatic arthritis of the knee occured in 5 cases. Thirty-two cases were followed up 16-22 months (mean, 18.5 months). The X-ray examination showed that the fracture union time was 5-8 weeks (mean, 6 weeks) after operation. At last follow-up, the extension of knee joint was 0° and the flexion of the knee joint was 110-170° (mean, 155°). According to the synthetic evaluating standard of International Knee Documentation Committee, 24 cases were rated as A level, 6 cases as B, 1 case as C, and 1 case as D at last follow-up. Lysholm knee score was 85.93 ± 3.76 at last follow-up, which was significantly higher (t=53.785, P=0.000) than preoperative score 37.54 ± 3.43. Conclusion In patients with AMRI caused by motorcycle, steel wire is used to fix the bone avulsion of condyles crest and MCL should be repaired simultaneously as far as possible. And associating with the early postoperative functional exercise, the short-term effectiveness is satisfactory, but long-term effectiveness still need further follow-up observation.
ObjectiveTo compare the effectiveness of anterior cruciate ligament (ACL) reconstruction between the ligament advanced reinforcement system (LARS) and bone-patellar tendon-bone (BPTB) autograft. MethodsBetween July 2007 and July 2011, 50 cases (50 knees) of ACL injury were treated with LARS in 24 cases (LARS group) and with BPTB in 26 cases (BPTB group), respectively. There was no significant difference in age, gender, time from injury to surgery, and injury reason between BPTB group and LARS group (P gt; 0.05). The postoperative rehabilitation protocol was performed in 2 groups. ResultsAll incisions healed at the first stage. All patients were followed up 2-3 years. The results of Lachman test, anterior drawer test, and pivot shift test were negative. Screw loosening in femur and tibia occurred in 1 case of each group respectively, anterior knee pain in 2 cases of BPTB group and in 1 case of LARS group. The Lysholm and Tegner scores were significantly higher in LARS group than in BPTB group at 2 and 6 months after operation (P lt; 0.05); but no significant difference was found between 2 groups at 12 and 24 months (P gt; 0.05). The IKDC scores showed no significant difference between 2 groups at different time points after operation (P gt; 0.05). During follow up, KT-1000 arthrometer and knee stability showed significant differences in antedisplacements of the tibia between 2 groups at all time points after operation (P lt; 0.05). ConclusionLARS has less trauma and earlier functional recovery than BPTB autograft for ACL reconstruction, but the long-term effectiveness is similar.
Objective To review the research progress in the repair and reconstruction of isolated traumatic radial head dislocation with annular l igament injury in children. Methods In recent years, the related l iterature concering isolated traumatic radial head dislocation with annular l igament injury in children was reviewed. Results For isolated traumatic radial head dislocation with annular l igament injury in children, the surgery should be chosen as the main treatment, includingopen reduction and annular l igament reconstruction surgery. Triceps aponeurosis is usually used as reconstruction materials of annular l igament, mainly because the position of taking material of annular l igament is at the operative incision with less surgery trauma and short operative time; aponeurosis is tough and thick with rigid fixation and low risk of re-dislocation. Artificial materials are paid attention to increasingly because they are easy to get, have rigid fixation, and can avoid operative injury caused by taking material of annular l igament. Conclusion Currently active annular l igament reconstruction surgery should be taken; triceps aponeurosis is widely adopted as reconstruction materials of annular l igament and artificial materials have come to be a new research trend.
Objective To evaluate the feasibility of the anterior cruciate ligament (ACL) reconstruction with 6 strands of hamstring tendons enveloped by periosteum. Methods Between April 2008 and April 2009, 34 patients with ACL injury were treated, ACL of whom was reconstructed with 6 strands of hamstring tendons enveloping of periosteum and double Rigidfix fixation. There were 30 males and 4 females, aged 19-54 years with an average of 29.4 years. The causes of injury included sport in 19 cases, traffic accident in 8 cases, falling from height in 5 cases, and other in 2 cases. The locations were left knee in 19 cases and right knee in 15 cases. The disease duration was 3 weeks to 18 months (median, 9.4 months). The results of Lachman test and anterior drawer test were positive. The Lysholm knee score was 61.5 ± 3.6. MRI examination revealed ACL rupture in 26 cases and ACL injury in 8 cases. Results All incisions healed by first intention, and no early complication occurred. Twenty-eight cases were followed up 12-32 months (mean, 16.1 months). The result of Lachman test was negative at 12 months after operation; in all patients, knee extension reached 0°, and flexion reached 120-150° (mean, 132.5°). The AP and lateral X-ray films and MRI showed no bone tunnel expansion. At last follow-up the therapeutic effect evaluation was excellent in 25 cases, good in 1 case, and fair in 2 cases; the excellent and good rate was 92.9%. The postoperative Lysholm score was 91.0 ± 3.2, showing significant difference when compared with preoperative score (t=32.78, P=0.00). Conclusion Six strands of hamstring tendons can ensure sufficient tensile strength, and use of the double Rigidfix absorbable screw makes fixation more reliable. Facing outside suture of periosteal flap can promote tendon-bone healing, so it is a good method of ACL reconstruction.
Objective To analyse and summarize the diagnosis, treatment, and cl inical effects of talus lateral process fracture. Methods Between February 2001 and March 2009, 21 male patients with an average age of 33.6 years (range, 18-46years) with talus lateral process fractures were treated. Fracture was caused by fall ing from height in 18 cases, by tumbl ing in 2 cases, and by sprain in 1 case. According to Hawkins classification, there were 4 cases of type I, 15 cases of type II, and 2 cases of type III, all being closed fractures. The disease course was from 2 hours to 26 days. In 17 patients whose fracture fragments were more than 1 cm × 1 cm × 1 cm or whose fracture fragments shifting was more than 1 mm, open reduction and internal fixation with AO hollow titanium nails were performed in 14 patients, open reduction and internal fixation with door-shape self-made nail in 1 patient, and open reduction and internal fixation with absorbable screws in 2 patients. In 4 patients whose fracture fragments were less than 0.6 cm × 0.5 cm × 0.5 cm or whose fracture fragments shifting was less than 1 mm, fragments removel was performed in 2 patients, Kirschner pins in 1 patient, and plaster conservative therapy in 1 patient. In patients with l igaments injury, the l igaments was reconstructed during the operation. Results All the incisions achieved primary heal ing. Twenty-one patients were followed up 9.5 months to 8 years. No ankle pain occurred and the range of joint motion was normal after operation. The X-ray films showed that all cases achieved fracture union. And the healing time was from 8 weeks to 14 weeks (10 weeks on average). According toAmerican Orthopeadic Foot amp; Ankle Society (AOFAS) for foot, the results were excellent in 17 cases, good in 3 cases, and moderate in 1 case; the excellent and good rate was 95.24%. Conclusion The size and displacement of fracture fragment should be considered first in the treatment of lateral process fracture of talus; in patients who are compl icated by lateral malleolus l igament injury, the l igament should be reconstructed to avoid the chronic non-stabil ity of lateral ankle.