ObjectiveTo investigate the technique of optimizing the location of femoral attachment in medial patellofemoral ligament (MPFL) reconstruction assisted with arthroscopy and evaluate the effectiveness.MethodsBetween January 2014 and September 2018, 35 patients with patellar dislocation were admitted. There were 14 males and 21 females with an average age of 22.6 years (range, 16-38 years). All patients had a history of knee sprain. The disease duration ranged from 1 to 7 days (mean, 2.8 days). Patellar dislocation occurred 2-4 times (mean, 2.5 times). The preoperative Lysholm score and Kujala score were 47.60±11.24 and 48.37±9.79, respectively. The patellar congruence angle was (31.40±6.81)°, the patellar tilt angle was (29.95±5.44)°, the lateral patellofemoral angle was (−11.46±5.18)°, and the tibial tubercle-trochlear groove distance was (16.66±1.28) mm. All patients were treated by MPFL reconstruction with the semitendinosus tendon under arthroscopy. During operation, the suture anchors were inserted into the midpoint and the 1/3 point of superomedial edge of the patella. Then, the femoral tunnels were created in medial femoral condyle through limited excision. For tendon fixation, the Kirschner wires were inserted into adductor tubercle, medial epicondyle of femur, and the midpoint between the two points, as well as the anteriorly and posteriorly. Afterwards, the changes of ligament length and tension, patellar tracking, and the relationship of patella and femoral trochlea were evaluated, thereby determining the optimized femoral attachment for MPFL reconstruction. Finally, the patellar congruence angle, patellar tilt angle, and lateral patellofemoral angle were measured by imaging to assess the relationship of patella and femoral trochlea. Moreover, Lysholm score and Kujala score were used to evaluate the knee joint function.ResultsAll incisions healed by first intention without infection. All patients were followed up 12-18 months (mean, 15.4 months). At 12 months, the Lysholm score was 94.40±3.99 and the Kujala score was 92.28±4.13, which were significant higher than those before operation (P<0.05). No patellar dislocation occurred during follow-up. At 12 months, the patellar congruence angle was (6.57±4.59)°, the patellar tilt angle was (9.73±2.82)°, the lateral patellofemoral angle was (7.14±4.63)°, which were superior to those before operation (P<0.05).ConclusionDuring the MPFL reconstruction under arthroscopy, a higher positioning accuracy for the femoral attachment and satisfactory effectiveness can be obtained by evaluating MPFL length and tension, patellofemoral joint kinematics, and patellar tracking.
Objective To investigate the effectiveness of personalized treatment based on Hua Xi-knee dislocation and multiple ligament injury (HX-KDMLI) diagnosis and treatment system. Methods A clinical data of 36 patients (36 knees) with KDMLI met the selective criteria between February 2019 and September 2020 was retrospectively analyzed. There were 24 males and 12 females with an average age of 45.7 years (range, 21-62 years). The KDMLI was caused by traffic accident in 15 cases, heavy pound in 8 cases, sports sprain in 7 cases, falling from height in 4 cases, and machine cutting in 2 cases. The interval between injury and operation was 1-9 weeks (mean, 3.6 weeks). All patients were categorized according to HX-KDMLI diagnosis and treatment system. Twenty patients were categorized as acute period and 16 patients as chronic period. Three patients were type HX-Ⅰ-A, 1 type HX-Ⅰ-P, 10 type HX-Ⅲ-L, 13 type HX-Ⅲ-M, 4 type HX-Ⅳ-S, 3 type HX-Ⅴ-F, and 2 type HX-Ⅴ-T. Thirty-five patients were positive in both the anterior drawer test and Lachman test, 31 were positive in the posterior drawer test; 19 patients were positive in varus stress test, 23 were positive in valgus stress test. According to the Internation Knee Documentation Committee (IKDC) grading, there was 1 case of grade A, 5 cases of grade B, 8 cases of grade C, and 2 cases of grade D. Surgical interventions included arthroscopic surgery, open surgery, or arthroscopy combined with open surgery, ligament suture or reconstruction, and internal fixation after anatomical reduction of the fracture. Different rehabilitation protocols were assigned to patients during different postoperative period, according to patient’s individualized classification. ResultsAll incisions healed by first intention with no obvious complications. All patients were followed up 12-19 months (mean, 15 months). At 12 months after operation, all patients retained muscle strength of grade Ⅴ, and range of motion of the knee joint could reach 0° extension and over 120° flexion. Radiographic examination showed no sign of knee instability, healed fractures, ideal joint alignment, good continuity and tension, and clear image of repaired or reconstructed ligaments. The anterior and posterior drawer tests were all negative. Lachman test was degreeⅠpositive in 5 cases, valgus stress test was degreeⅠpositive in 2 cases, varus stress test was degreeⅠpositive in 2 cases; the other patients were all negative. At 12 months after operation, according to the IKDC grading, there were 9 cases of grade A, 19 cases of grade B, 5 cases of grade C, and 3 cases of grade D, showing significant differences when compared with the preoperative ones (Z=–5.328, P=0.000). There were significant differences in the IKDC, Lysholm, and Tegner scores between pre- and post-operation (P<0.05). ConclusionThe promising effectiveness of KDMLI can obtain under the guidance of HX-KDMLI.
ObjectiveTo investigate the effect of vascularized peroneus longus tendon graft reconstruction on anterior cruciate ligament (ACL) insertion in rabbits.MethodsEighty healthy New Zealand white rabbits were harvested to prepare ACL injury models and randomly divided into two groups (n=40). The ACL was reconstructed with vascularized peroneus longus tendon graft in group A and peroneus longus tendon graft without blood supply in group B. The survival of animals and the healing of incision were observed after operation; the grafts were taken for gross and histological observations at 4, 8, and 16 weeks; the biomechanical test of the grafts was carried out to record the maximum tensile strength and incidence of ACL insertion rupture at 8 and 16 weeks.ResultsAll animals survived until the experiment completed. General observation showed that the tunnel was combined with grafts, the vascular infiltration was abundant, and no obvious boundary between the tunnel and grafts existed at 16 weeks in group A; there was still an obvious boundary between the tunnel and graft in group B. Histological observation showed that the collagen fibers between tendon and bone in group A increased gradually, the dense fiber connection was formed, and the “tidal-line” like structure similar to the normal ACL insertion was formed at 16 weeks; but the“tidal-line” like structure was not obvious in group B. Biomechanical test showed that there was no significant difference in the incidence of ACL insertion rupture at 8 and 16 weeks between group A and group B (P=0.680; P=0.590), but the maximum tensile strength at 8 and 16 weeks were higher in group A than in group B (t=18.503, P=0.001; t=25.391, P=0.001).ConclusionThe vascularized peroneus longus tendon graft for ACL reconstruction can obviously promote the outcome of the ACL insertion.
Objective To investigate whether the outlet of the femoral tunnel will cause iatrogenic injury to the medial collateral ligament (MCL) during posterior cruciate ligament reconstruction (PCLR) and estimate the safe angle of femoral tunnel placement. MethodsThirteen formaldehyde-soaked human knee joint specimens were used, 8 from men and 5 from women; the donors’ age ranged from 49 to 71 years, with an average of 61 years. First, the medial part of the femur was carefully dissected to clearly expose the region of the MCL course and attachment on the femoral medial aspect and to outline the anterior margin of the region with a marked line. The marked line divided the medial femoral condyle into an area with an MCL course and a bare bone area which is regarded relatively safe for no MCL course. Then, the posterior cruciate ligament (PCL) was cut to identify the femoral attachment of the PCL. After the knee joint was fixed at a 120° flexion angle, the process of femoral tunnel preparation for the PCL single-bundle reconstruction was simulated. The inside-out technique was used to drill the femoral tunnel from the PCL femoral footprint inside the knee joint with an orientation to exit the medial condyle of the femur, and the combination angle of the two planes, the axial plane and the coronal plane, was adapted to the process of drilling femoral tunnels at different orientations. The following 15 angle combinations were used in the study: 0°/30°, 0°/45°, 0°/60°, 15°/30°, 15°/45°, 15°/60°, 30°/30°, 30°/45°, 30°/60°, 45°/30°, 45°/45°, 45°/60°, 60°/30°, 60°/45°, 60°/60° (axial/coronal). The positional relationship between the femoral tunnel outlet on the femoral medial condyle and the marked line was used to verify whether the tunnel drilling angle was a risk factor for MCL injury or not, and whether the shortest distance between the femoral exit center and the marked line was affected by the various angle combinations. Furthermore, the safe orientation of the femoral tunnel placement would estimated. ResultsWhen creating the femoral tunnel for PCLR, there was a risk of damage to the MCL caused by the tunnel outlet, and the incidence was from 0 to 100%; when the drilling angle of the axial plane was 0° and 15°, the incidence of MCL damage was from 69.23% to 100%. There was a significant difference in the incidence of MCL damage among femoral tunnels of 15 angle combinations (χ2=148.195, P<0.001). By comparison between groups, it was found that when drilling femoral tunnels at 5 combinations of 45°/45°, 45°/60°, 60°/30°, 60°/45°, and 60°/60° (axial/coronal), the shortest distances between the tunnel exit and the marked line were significantly different than 0°/45°, 0°/60°, 15°/45°, 15°/60°, and 30°/30° (axial/coronal) (P<0.05). Additionally, after comparing the median of the shortest distance with other groups, the outlets generated by these 5 angles were farther from the marked line and the posterior MCL. ConclusionThe creation of the femoral tunnel in PCLR can cause iatrogenic MCL injury, and the risk is affected by the tunnel angle. To reduce the risk of iatrogenic injury, angle combinations of 45°/45°, 45°/60°, 60°/30°, 60°/45°, and 60°/60° (axial/coronal) are recommended for preparing the femoral tunnel in PCLR.
Objective To compare the intraoperative effects of computer navigation-assisted versus simple arthroscopic reconstruction of posterior cruciate ligament (PCL) tibial tunnel. Methods The clinical data of 73 patients with PCL tears who were admitted between June 2021 and June 2022 and met the selection criteria were retrospectively analysed, of whom 34 cases underwent PCL tibial tunnel reconstruction with navigation-assisted arthroscopy (navigation group) and 39 cases underwent PCL tibial tunnel reconstruction with arthroscopy alone (control group). There was no significant difference in baseline data between the two groups, including gender, age, body mass index, side of injury, time from injury to surgery, preoperative posterior drawer test, knee range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The perioperative indicators (operation time and number of guide wire drillings) were recorded and compared between the two groups. The angle between the graft and the tibial tunnel and the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes respectively were measured on MRI at 1 day after operation. The knee ROM, Tegner score, Lysholm score, and IKDC score were evaluated before operation and at last follow-up. Results The operation time in the navigation group was shorter than that in the control group, and the number of intraoperative guide wire drillings was less than that in the control group, the differences were significant (P<0.05). Patients in both groups were followed up 12-17 months, with an average of 12.8 months. There was no perioperative complications such as vascular and nerve damage, deep venous thrombosis and infection of lower extremity. During the follow-up, there was no re-injuries in either group and no revision was required. The results showed that there was no significant difference in the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes between the two groups (P>0.05), but the angle between the graft and the tibial tunnel was significantly greater in the navigation group than in the control group (P<0.05). At last follow-up, 30, 3, 1 and 0 cases were rated as negative, 1+, 2+, and 3+ of posterior drawer test in the navigation group and 33, 5, 1, and 0 cases in the control group, respectively, which significantly improved when compared with the preoperative values (P<0.05), but there was no significant difference between the two groups (P>0.05). At last follow-up, ROM, Tegner score, Lysholm score, and IKDC score of the knee joint significantly improved in both groups when compared with preoperative values (P<0.05), but there was no significant difference in the difference in preoperative and postoperative indicators between the two groups (P>0.05). ConclusionComputer-navigated arthroscopic PCL tibial tunnel reconstruction can quickly and accurately prepare tunnels with good location and orientation, with postoperative functional scores comparable to arthroscopic PCL tibial tunnel reconstruction alone.
The anterior cruciate ligament (ACL) reconstruction mostly relies on the experience of surgeons. To improve the effectiveness and adaptability of the tension after ACL reconstruction in knee joint rehabilitation, this paper establishes a lateral force measurement model with relaxation characteristics and designs an on-line stiffness measurement system of ACL. In this paper, we selected 20 sheep knee joints as experimental material for the knee joint stability test before the ACL reconstruction operation, which were divided into two groups for a comparative test of single-bundle ACL reconstruction through the anterolateral approach. The first group of surgeons carried out intraoperative detection with routine procedures. The second group used ACL on-line stiffness measurement system for intraoperative detection. After that, the above two groups were tested for postoperative stability. The study results show that the tension accuracy is (− 2.3 ± 0.04)%, and the displacement error is (1.5 ± 1.8)%. The forward stability, internal rotation stability, and external rotation stability of the two groups were better than those before operation (P < 0.05). But the data of the group using the system were closer to the preoperative knee joint measurement index, and there was no significant difference between them (P > 0.05). The system established in this paper is expected to help clinicians judge the ACL reconstruction tension in the operation process and effectively improve the surgical effect.
ObjectiveTo investigate the diagnosis and treatment of thumb polydactyly with symphalangism in children.MethodsSeven cases of thumb polydactyly with symphalangism were treated between January 2013 and May 2017. There were 5 males and 2 females, aged from 10 months to 11 years, with an average age of 3.1 years. The thumb-polydactyly was diagnosed with MRI and it was seen that the base of radial multi-finger and the proximal phalangeal joint were connected by cartilage. All patients were treated with resection, lateral collateral ligament reconstruction, bone osteotomy and internal fixation.ResultsThe operation was successfully completed, and there was no early complications such as infection and flap necrosis. All patients were followed up 6-23 months (mean, 14.1 months). At last follow-up, there was no deformity finger, scar contracture, and other complications. The extension of the interphalangeal joint was no limited, and the flexion range of the interphalangeal joint was 20-75° (mean, 56.7°). The appearance and function of the thumb was rated as excellent in 3 cases and good in 4 cases by Japanese Society for Surgery of the Hand (JSSH) scoring, with the excellent and good rate of 100%.ConclusionThe thumb polydactyly with symphalangism in children can be combined with clinical manifestations, X-ray film, and MRI examination to diagnose, and can obtain satisfactory results through the reconstruction of lateral collateral ligament, bone osteotomy, and internal fixation.
ObjectiveTo investigate the effectiveness of anterior cruciate ligament (ACL) reconstruction with the autologous ipsilateral peroneus longus tendon (PLT) under arthroscopy.MethodsA retrospective study was conducted on 35 patients with ACL rupture who underwent ACL reconstruction with autologous ipsilateral PLT under arthroscopy between October 2017 and October 2018. There were 19 males and 16 females with an average age of 43.4 years (range, 18-60 years), with 20 cases of left knee and 15 cases of right knee. The causes of injury included traffic accident in 14 cases, falling injury in 13 cases, and sports injury in 8 cases. The time from injury to operation ranged from 3 to 9 days (mean, 4.7 days). The patients suffered from swelling, pain, and limited mobility of knee joint before operation. The anterior drawer test, Lachman test, and pivot-shift test were positive before operation, whereas MRI was taken to confirm the ACL rupture. After operation, the patients were followed up every 3 months until the knee joint’s function returned to normal. MRI and X-ray films were used to observe the tendon-bone healing as well as the position of Endobutton suspension plate and hollow nail. The anterior drawer test, Lachman test, and pivot-shift test were conducted to observe the improvement of knee joint mobility. The functional improvements were evaluated by the International Knee Documents Committee (IKDC) score, Lysholm score, knee injury and osteoarthritis (KOOS) score.ResultsAll the 35 patients were followed up 12-18 months, with an average of 14.2 months. The incisions healed by first intention, and no complications such as infection, joint stiffness, and rerupture occurred. Postoperative anterior drawer test, Lachman test, and pivot-shift test turned to be negative of all patients. MRI showed that the ACL was continuous, and the tendon-bone in the distal femur tunnel and proximal tibia tunnel recovered well after operation. X-ray films showed that the positions of Endobutton suspension plate and hollow nail were stable. The IKDC, Lysholm, and KOOS scores at 3, 6, and 12 months after operation were significantly improved when compared with those before operation, and the scores were further improved with time after operation (P<0.05).ConclusionFor patients with ACL rupture, ACL reconstruction with the autologous ipsilateral PLT under arthroscopy has satisfactory effectiveness of quick recovery, good function, and great stability.
Objective To summarize the current research progress of anterior cruciate ligament (ACL) anatomy, and discuss its effect on the reconstruction technique. Methods The literature concerning ACL anatomy and reconstruction at home and abroad was extensively reviewed and summarized. Results The anatomy and morphology of ACL has gained new recognition in recent years, and the " Ribbon-like” ACL has gradually been paid attention to by researchers. In present researches, it seems the " Ribbon-like” anatomy theory has advantages in theory when compared with the previous anatomy theory. It is more in line with the anatomy and isometric reconstruction. Conclusion The understanding of ACL anatomy guided the development of ACL reconstruction. The " Ribbon-like” ACL anatomy theory is the different understanding of the anatomy theory, which remains controversy. The " Ribbon-like” reconstruction maybe has more advantages in theory, but further study is needed.
ObjectiveTo investigate the effectiveness of arthroscopic medial patellofemoral ligament (MPFL) reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation.MethodsBetween February 2012 and December 2013, 24 patients (24 knees) with recurrent patellar dislocation were treated with arthroscopic MPFL reconstruction combined with tibial tuberosity transfer. There were 7 males and 17 females, with a mean age of 23.2 years (range, 18-37 years). One patient had recurrence dislocation after operation in the other hospital, and the others were the first operation. The disease duration ranged from 6 months to 20 years (mean, 5.6 years). The patellar apprehension tests were positive. The preoperative Lysholm score was 49.79±11.67 and the Kujala score was 49.63±6.28. X-ray films showed that 13 patients had dysplasia of the patella and femoral trochlea; 8 patients had high tibia (Caton-Deschamps index>1.2); the congruence angle was (23.96±5.54)°. CT examination showed that the tibial tuberosity-trochlear groove distance (TT-TG) value was (23.71±2.35) mm.ResultsAll incisions healed by first intention. Twenty-two patients were followed up 59-81 months, with an average of 66.8 months. No dislocation occurred during the follow-up period. The patellar apprehension tests were negative. At 1 week after operation, the results of X-ray films and CT showed that the congruence angle angle was (–1.96±4.65)°, and the TT-TG value was (13.75±1.89) mm, which were significantly lower than those before operation (P<0.05). At 6 months, 1 year, and last follow-up, Lysholm scores were 81.13±17.76, 91.35±3.60, and 92.23±2.71, respectively; and Kujala scores were 84.04±3.98, 91.48±3.64, and 91.45±3.29, respectively. The Lysholm and Kujala scores were significantly increased after operation when compared with the preoperative scores (P<0.05). At last follow-up, the effectiveness was excellent in 11 cases, good in 8 cases, and fair in 3 cases, with an excellent and good rate of 86%.ConclusionArthroscopic MPFL reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation can effectively improve the patellofemoral joint matching relationship and has a satisfactory short- and medium-term effectiveness.