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OBJECTIVE@#To review the research progress of the biomechanical study of the Bristow-Latarjet procedure for anterior shoulder dislocation.@*METHODS@#The related biomechanical literature of Bristow-Latarjet procedure for anterior shoulder dislocation was extensively reviewed and summarized.@*RESULTS@#The current literature suggests that when performing Bristow-Latarjet procedure, care should be taken to fix the bone block edge flush with the glenoid in the sagittal plane in the direction where the rupture of the joint capsule occurs. If traditional screw fixation is used, a double-cortical screw fixation should be applied, while details such as screw material have less influence on the biomechanical characteristics. Cortical button fixation is slightly inferior to screws in terms of biomechanical performance. The most frequent site of postoperative bone resorption is the proximal-medial part of the bone block, and the cause of bone resorption at this site may be related to the stress shielding caused by the screw.@*CONCLUSION@#There is no detailed standardized guidance for bone block fixation. The optimal clinical treatment plan for different degrees of injury, the factors influencing postoperative bone healing and remodeling, and the postoperative osteoarticular surface pressure still need to be further clarified by high-quality biomechanical studies.
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Humans , Shoulder Dislocation/surgery , Shoulder Joint/surgery , Biomechanical Phenomena , Joint Instability/surgery , Bone Resorption , Arthroscopy/methodsABSTRACT
Objective:To investigate the clinical and radiological outcomes of ultrasound guided injection of platelet-rich plasma (PRP) in the treatment of intratendinous rotator cuff tear.Methods:A retrospective study was conducted to analyze the clinical data of 43 patients (46 shoulders) who had been treated for intratendinous partial-thickness rotator cuff tear by ultrasound guided injection of PRP consecutively from July 2021 to March 2022 at Department of Sports Medicine, Peking University Third Hospital. There were 23 males and 20 females, with an age of (47.8±13.5) years and a course of disease of 6 (4, 18) months, involving 22 left shoulders and 24 right shoulders. The visual analog scale (VAS) pain score, the University of California at Los Angeles (UCLA) rating scale, and the shoulder index of the American Shoulder and Elbow Surgeons (ASES) were determined before injection and at the last follow-up. The changes in tear size were also evaluated by magnetic resonance imaging (MRI) before PRP injection and 3 to 5 months after PRP injection.Results:The 43 patients were followed up for 15 (12, 17) months after treatment. Of this cohort, 7 shoulders (15.2%, 7/46) were recovered to complete normal and very satisfied with the injection effects while 19 shoulders(41.3%, 19/46) satisfied with the effects after injection, yielding an overall satisfaction rate of 56.5% (26/46). At the last follow-up, the VAS score [3.0 (2.0, 4.0) points], ASES score [80.0 (65.0, 88.8) points], and UCLA score [29.0 (20.0, 32.0) points] were significantly improved compared with those before injection [5.5 (4.0, 8.0) points, 55.0 (39.2, 65.0) points, and 16.0 (12.0, 20.3) points] ( P < 0.05). MRI evaluation showed the tear volume was significantly reduced after PRP injection [46.1 (20.9, 77.5) mm 3 before injection versus 28.2 (12.5, 63.6) mm 3 after injection] ( P<0.05), and a >50% tear volume diminution was observed in 13 shoulders (34.2%,13/38). There were no complications during or after injection. Conclusion:As the ultrasound guided injection of PRP into intratendinous lesions is effective and safe for patients with intratendinous partial-thickness rotator cuff tear, it can be an alternative treatment for the patients or professional athletes who are unwilling to undergo surgery.
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Lateral epicondylitis is a common clinical disease with characteristics of lateral elbow pain, insidious onset and easy recurrence, which can cause forearm pain and decreased wrist strength, seriously affecting patients′ daily life and work. Although there are various treatment methods for lateral epicondylitis with different effects, standard treatments are still lacking nowadays. Platelet-rich plasma (PRP) has good effects on bone and tendon repair, and is now widely used in the treatment of lateral epicondylitis. However, there is a lack of a unified understanding of the technology and specifications of PRP in the treatment of lateral epicondylitis. Therefore, the Sports Medicine Branch of the Chinese Medical Association and Physical Medicine and Rehabilitation Branch of the Chinese Medical Association organized experts in the fields of sports medicine and rehabilitation medicine in China to formulate the "clinical expert consensus on platelet-rich plasma treatment for lateral epicondylitis (2022 version)", and proposed suggestions based on evidence-based medicine mainly from the concept, epidemiology and pathophysiology of lateral epicondylitis, symptoms, signs and imaging manifestations of lateral epicondylitis, PRP concept and application component requirements, quality control of PRP preparation technology, indications and contraindications of PRP in the treatment of lateral epicondylitis, PRP injection in the treatment of lateral epicondylitis, application of PRP in the operation of lateral epicondylitis, related problems after PRP treatment of lateral epicondylitis, evaluation of the results after PRP treatment of lateral epicondylitis, and health and economic evaluation of PRP treatment of lateral epicondylitis, so as to provide guidance for clinical diagnosis and treatment.
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Objective To compare the femur tibia angle(FTA) and tibia tubercle to trochlear groove (TT-TG) measured on the magnetic resonance imaging(MRI) between patients with anterior cruciate ligament(ACL) rupture and healthy controls with intact ACL,and to observe the change of the tibia-femur rotation and explore its relationship with the patellofemoral cartilage injury.Methods Fifty patients with ACL ruptures were divided into an experimental group,while another 50 healthy counterparts were chosen into a control group.All subjects were given MRI to get FTA and TT-TG.For the experimental group,all parameters were measured before and after ACL reconstruction.The results were analyzed by variance analysis and t test.Results MRI measurements showed that the average FTA in the experimental group was 6.5° ± 6.1° and 6.0° ± 5.6° before and after the ACL reconstruction,significantly higher than that in the control group,which was 3.6° ± 4.9° (P=0.0003 and P=0.033,respectively).No significant differences were found in the average TT-TG of the experimental group,6.4 ± 3.3 mm before ACL reconstruction and 6.9 mm ± 4.0 mm after ACL reconstruction,and that of the control group,6.3 ± 3.6 mm(P=0.678).Moreover,all patients in the experimental group underwent a second check under the arthroscopy,which revealed that the patellofemoral cartilage injury was aggravat ed in 26 patients measured by the Outerbridge grading.However,there was no significant difference in FTA and TT-TG between patients with and without aggravated patellofemoral cartilage degeneration.Conclusions After ACL reconstruction,the external rotation angle of the knee could not completely recover to the normal level with the knee extension at 0°.Patellofemoral cartilage degeneration after the ACL reconstruction is caused by many factors.The results of the second arthroscopy after the ACL reconstruction find no relationship between patellofemoral cartilage degeneration and the increased tibia external rotation angle relative to the femur.Moreover,after the ACL reconstruction,if the femur tibia angle is bigger than the range of motion of the knee,it cannot be concluded that the anterior cruciate ligament is reruptured.
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Objective To measure and determine the position of the tibial attachment of the anterior cruciate ligament (ACL)in relation to its anterior ridge on the magnetic resonance imaging (MRI)of normal knee joints,and to explore the clinical role of the anterior ridge in guiding tunnel positioning during ACL reconstruction as well as in facilitating postoperative radiographic evaluation.Methods The knee MRI of one hundred young adult patients with an intact ACL and normal knee joint (mean age:25.1 years,range:18-40 years)was retrospectively reviewed.All MR images were obtained at full extension of the knee on the same MRI machine.Using digital image software on MRI,the measurements in the sagittal view were taken,including the depth of the tibia,the distance from the anterior edge of the tibial plateau to the most anterior and posterior portions of the ACL insertion on the tibia and the anterior ridge according to Staubli and Rauschning's method.Results The center of the tibial insertion of the ACL is located between 28.43％ and 50.94％ of the total anterior-posterior depth of the tibia,which was less than 43.3％ in 58 patients.The average distance from the anterior edge of the tibial plateau to the anterior ridge was 13.61 ± 2.17 mm (ranging from 8.03 to 18.65 mm),26.80％ ±3.89％ (ranging from 17.74％ to 33.94％)across the tibial plateau.There were significant positive correlations between the distance from the anterior edge of the tibial plateau to the most anterior portion of the ACL insertion and that to the anterior ridge.The distance from the most anterior portion of the ACL insertion to the anterior ridge was averaged 0.56 ± 0.68 mm (ranging from-0.28 to 2.71 mm).During the ACL reconstruction,with the anterior edge of the tibial tunnel determined at posterior 0.5 mm to the anterior ridge,the graft size as 8 mm,and the tibial guider angle set as 55 degree,96of the patients (96％)would have the center of the tibial tunnel located before the center of their native ACL attachment.Conclusions On sagittal MR images,the location of the anterior ridge and the most anterior portion of the ACL insertion correlated well,with the average distance between them of 0.56 mm.The study indicates that during ACL reconstruction,tibial tunnel drilling with the anterior edge of the ACL graft positioned at the anterior ridge can achieve a more anterior position than the traditional methods to orientate according to the center of the bone tunnel.
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Objective To assess the diagnostic value of MRI for the long head of the biceps brachii tendon tear,and to compare the diagnostic efficiency between routing MRI and MR arthrography. Methods A retrospective study was conducted in 215 cases with shoulder MR examination (107 with MR arthrography, and 108 with routing MRI) and subsequent shoulder arthrescopy and surgery. Two radiologists analyzed all MR examinations independently, and the results were compared with those of arthroscopy and surgery. Sensitivity, specificity, and accuracy were calculated. Kappa values were used to quantify the interobserver agreement. Results Based on the results of arthroacopy and surgery, 215 patients comprised 7 cases of complete tear of the long head of the biceps brachii tendon, 29 cases of partial tear, and 179 cases without tear. The overall sensitivity, specificity, and accuracy for the diagnosis of tears (complete and partial tear) of the long head of the biceps brachii tendon were 72.2% (26/36), 91.6% (164/179), and 88.4% (190/215) respectively for observer 1, 80.6% (29/36), 93.8% (168/179), and 91.6% (197/215) respectively for observer 2. The interobserver agreement was good (Kappa value=0.681). For the complete tear of the biceps brachii tendon, the sensitivity, specificity, and accuracy were all 100% (7/7), 100% (208/208), and 100% (215/215) for both observers. For the tear of the long head of the biceps brachii tendon, the accuracy of MR arthrography were 93.4% (100/107) for observer 1 and 96.3% (103/107) for observer 2. They were higher than the Accuracy of routing MRI, which were 83.3% (90/108)and 87.0% (94/108) respectively for two observers (P<0.05). Conclusion Shoulder MRI is a moderate reliable method for evaluating the tear of the long head of the biceps brachii tendon, and the accuracy of MR arthrography is found to be superior to that of routine MRI.
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Objective To evaluate the diagnostic value of shoulder MR arthrography for superior labral anterior-posterior (SLAP) lesions.Methods A retrospective study was conducted in 137 cases of shoulder MR arthrography confirmed by subsequent shoulder arthroscopy.Two radiologists analyzed all MR examinations independently and the results were compared with those of arthrescopy.The superior labrum was described as normal or torn.In addition, each iabral tear was classified as type Ⅰ-Ⅳ.Type Ⅰ lesions were defined as marked fraying of the articulating surface of the superior labrum; type Ⅱ, avulsion of the labral-bicipital complex from the ghnoid; type Ⅲ, displaced bucket handle tear of the superior labrum; and type Ⅳ, bucket handle tear of the superior labrum with extension into the fibers of the biceps tendon.Sensitivity, specificity, and accuracy were calculated.Kappa values were calculated to quantify the level, of inter-observer agreement.Results SLAP lesions were arthroscopically diagnosed in 59 of the 137 patients.Six of the 59 lesions ( 10.2% ) were classified as type Ⅰ , 50 (84.7% ) as type Ⅱ, and 3 (5.1% ) as type Ⅲ.The overall sensitivity, specificity, and accuracy of MR arthrographic detection of SLAP lesions were 86.4% (51/59), 78.2% (61/78), and 81.8% ( 112/137), respectively, for observer A, and 88.1% (52/59), 84.6% (66/78), and 86.1% (118/137), respectively, for observer B.At inter-observer comparison, agreement was very good (Kappa values = 0.796 ).The MR arthrographic classification showed correlation with the arthroscopic classification of SLAP lesions were 83.1% (49/59)and 79.7% (47/59) for two observers, respectively.Conclusion Shoulder MR arthrography is a reliable method for evaluating SLAP lesions.
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Objective To summarize the clinical experience of diagnosis and arthroscopic treatment of intratment of intra ular osteoid osteoma.Methods Seven patients(average 22.4 years old with range from 11～32 years)with intra-articular Osteoid osteoma who underwent arthroscopy treatment from March 2006 to June 2009 were studied respectively.Thin-section CT scanning was used to confirm diagnosis and determine surgery location.Results The time span between the appearance of clinical symptoms and confirmed diagnosis was 26.0 months on average(range from 18 to 36 months).At a mean 19-month follow-up,all patients showed significant improvements including VAS decrease,no recurrence,pain relief and normal range of motion.Conclusion The atypical clinical features and radiographic findings of osetoid osteoma might lead to the delayed diagnosis.Using arthroscopy to remove intro-articular osteoid ostema was a safe and effective way.
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[Objective]To study the accuracy of Helfet test in the diagnosis of the knee meniscus tear.[Method]From Apr.2007 to Oct.2007,52 cases of the lateral meniscus tear and 23 cases of the medial meniscus tear were checked-up with Helfet test,McMurray test ,KS test,and arthroscope comparatively.[Result]The Helfet Test was positive in most of the lateral meniscus tear cases.The consistency with McMurray test and arthroscope was lateral meniscus tear,especially to bucket-handle and Horizontal tear high respectively.The rate of accuracy to lateral menicus was 81.4%.The rate of accuracy to bucket-handle and Horizontal tear were 89.6% and 87.2% respectively.[Conclusion]The "Helfet" test is sensitive to the knee lateral meniscus tear.It is fast,simple,reliable,reproducible,positive for diagnose of lateral meniscus tear,and is worth of being used widely.
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Objective To study clinical results of arthroscopically assisted mini-open rotator cuff repair.Methods Twenty-two patients with rotator cuff tears were treated with arthroscopically assisted mini-open rotator cuff repair from March 1999 to March 2004.Thirteen patients underwent arthroscopic inspection,mini-open subacromial decompression,and rotator cuff repair.Nine patients underwent arthroscopic subacromial decompression and mini-open repair.The UCLA scoring system was used for outcome assessment.Results The 22 patients were followed for 12-72 months(mean,47 months).The UCLA scores were increased from 14.8?3.8 preoperatively to 32.0?4.7 postoperatively(t=15.086,P=0.000).The results were classified as excellent in 7 patients,good in 13 patients,fair in 1 patient,and poor in 1.Twenty patients were satisfied with the operative outcomes.Conclusions Arthroscopically assisted mini-open rotator cuff repair is an effective procedure for rotator cuff tears,with simplicity of performance and little invasion.
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Objective To investigate the clinical effects and postoperative complications of arthrotomy and arthroscopy in repair of 170 menisci in 168 cases.Methods One hundred and sixty-eight patients with meniscus injury were repaired by arthrotomy or arthroscopy.They were 121 males and 47 females.There were 77 left knees and 91 right knees;117 medial menisci and 53 lateral ones.Their average age was 25.5?8.4 years old.Arthro- scopic repair methods included puncture and grinding,bio-absorbable meniscus arrow fixation,Outside-In suturing, Inside-Out suturing,Elite scuff instrument repairing,T-Fix fixation and FasT-Fix fixation techniques.The clinical results were assessed on the basis of symptoms,physical signs,Tegner scores and Lysholm scores of the cases. Postoperative complications were also investigated.Re-arthroscopic exploration was done for patients with obvious symptoms and physical signs.Results The average folluw-up time was 49.3?28.8 months.Their mean pre- operative Tegner score was 3.3?2.3,and their postoperative one 6.8?2.1 (P＜0.05).Their preoperative Lysholm score was 30.1?18.2,and their postoperative one 87.5?22.5 (P＜0.01).There were significant differences in Tegner and Lysholm scores before operation and after operation.Ninety-eight repaired menisci were rated as excellent(57.7%),57 as good (33.5%),10 as fair (5.9%),and five as poor (2.9%).The total ex- cellent and good result was 91.2%.Of the 19 patients with obvious symptoms and physical signs,re-arthroscopic exploration found no healing in five and partial healing in six.Postoperative complications included pain at the Outside-In suture nodes in three cases,referred pain at posterior articular capsule resulted from failed Outside-In meniscus anterior horn suturing in one case,and twinge at the meniscus arrow site in the posterior capsule in five cases.No serious lesion occurred at blood vessels or nerves.The postoperative complication incidence was 5.3%. Conclusion The eight methods of arthrotomy and arthroscopy to repair injured menisci investigated in our study can have a high successful rate and low perioperative and postoperative risk.
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Objective To assess the effectiveness of arthroscopic debridement techniques for osteoarthrosis of the elbow in nonathlete patients. Methods Twenty-six nonathlete patients with elbow osteoarthrosis were treated with arthroscopic debridement from January 1999 to January 2006.Of the 26 patients,23 were followed for 4～86 months (mean,23 months).All of the 23 patients had complained of pain and loss of elbow motion and 4 patients had symptoms of ulnar neuritis. The Mayo Elbow Performance Score was used as evaluation criteria of the efficacy. Results Twenty-three patients were followed for 4～86 months (mean, 23 months). Twenty elbows (87%) were not painful or were only mildly painful, and three (13%) were moderately painful. The mean arc of flexion-extension was improved from 99.6? (range, 65?～135?) preoperatively to 122.1? (range, 80?～150?) at the time of follow-up. According to the Mayo Elbow Performance Score, the result was excellent in 16 elbows, good in 4, and fair in 3, with a rate of excellent or good results of 87%. Symptoms of ulnar neuritis disappeared in the 3 patients and continued without aggravation in the remaining 1 patient. Fourteen patients were greatly satisfied with the results, 6 satisfied, and 3 unsatisfied, the satisfactory rate being 87%. One patient reported a delayed ulnar nerve symptoms after operation. Conclusions Arthroscopic debridement techniques for elbow osteoarthrosis in nonathlete patients can yield satisfactory pain relief, significant increase in the range of motion, and quick recovery.
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Objective To discuss the diagnosis and treatment of partial-thickness rotator cuff tears.Methods A total of 14 cases of partial-thickness rotator cuff tears from April 1999 to January 2004 were surgically treated in this hospital.Before operation,X-ray examinations at anteroposterior view and at scapular outlet view were conducted in all cases,B-ultrasonography was conducted in 11 cases,and magnetic resonance imaging(MRI) or magnetic resonance arthrography(MRA),in 14 cases.Subacromial decompression and tear debridement was performed in 5 cases,while subacromial decompression and rotator cuff repair was performed in 9 cases.The University of California Los Angeles(UCLA) shoulder scoring system was used to evaluate the outcomes.Results The partial tears were identified at bursal-side in 7 cases and at articular-side in 7 cases.The 14 cases were followed for 1~6 years(mean,38 months).The UCLA scores were elevated from 15.9?3.9 preoperatively to 30.9?5.2 postoperatively(t=15.000,P=0.000).The curative results were classified as "good" in 13 cases and "poor" in 1 case.Conclusions Arthroscopy is a reliable method for the diagnosis of partial-thickness rotator cuff tears,which can be effectively treated with rotator cuff repairs.Arthroscopic repair gives little invasion and quick recovery.
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Objective To comprehensively know clinical pathological change of recurrent anterior dislocation of shoulder joint by arthroscopy. Methods 52 patients with recurrent anterior shoulder dislocation were inspected by arthroscopy in our institute, 38 cases were male, 14 cases were female; the mean age were 24.7, from 16 to 49 years old. 2 epilepsy patients were excluded, the other 50 cases were divided into two groups, the first group included 32 shoulder dislocated patients accompanied with shoulder hyper-laxity. The other group included 18 purely traumatic shoulder dislocated patients. All patients were explored by arthroscopy and all pathological changes were recorded and the difference of pathological change between the two groups were contrasted. Results 51 cases showed anterior-inferior labrum injury, 50 cases showed Hill-Sachs injury, 32 cases showed biceps-tendon inflammation or injury, 30 cases showed bone or cartilage injury of anterior-inferior glenoid, 29 cases showed SLAP injury, 7 cases showed rotator cuff injury. Anterior-inferior labrum injury: labrum abraded disappear was more occurred in pure traumatic group(P=0.055) and ALPSA injury was more in hyper-laxity group (59.4% to 38.9%, P=0.164). Bone or cartilage injury of anterior-inferior glenoid were more occurred in purely traumatic group(P=0.083, P=0.052). Hill-Sachs injury was more superficial or only cartilage injury in hyper-laxity group but wider and deeper in purely traumatic group. Conclusion The general pathological changes of recurrent anterior shoulder dislocation sucessively are: anterior-inferior labrum injury, Hill-Sachs injury, biceps-tendon inflammation or injury, bone or cartilage injury of anterior-inferior glenoid, SLAP injury and rotator cuff injury. The pathological changes of the hyper-laxity group were lighter than purely traumatic group.
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Objective To report the diagnostic and therapeutic effects of arthroscopic surgery on elbow sports injuries. Methods Nineteen patients with elbow diseases were treated by arthroscopic methods from January 1996 to February 2000. The modified HSS elbow rating scale was used as criteria of the efficacy. All patients were followed up for 4.5 months to 4.5 years (an average 8.6 months). Results Among nineteen patients, eleven had an excellent results, seven good, one poor, and satisfactory rate was 94.7 percent. Ten patients were satisfied greatly with the results,eight patients satisfied, one unsatisfied, the satisfactory rate was up to 94.7 percent according to the responses of questionnaire from the patients. The time resuming daily was in a medium of 7 days, and that for sports was in an average of 2.5 months. All the 11 cases of athletes and actors(actresses) resumed their previous seats. Complications occurred in 3 earlier cases, one had radial nerve temporary paralysis, the other two had residue loose bodies. Conclusion Elbow arthroscopic treatment is a reliable method with the advantages of minor trauma, quicker recovery and less traumatic manipulation. Careful pre-operative examination, selection of a safer portal of entry, and standard manipulation are very important points for the attainment of better results and less complications.
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Objective To explore the clinical results of arthroscopic subacromial decompression (ASD) for treatment of subacromial impingement syndrome. Methods Twelve cases with subacromial impingement syndrome from October 1998 to November 2003 were retrospectively studied. There was one case at degree Ⅰ, five at degree Ⅱ and six at degree Ⅲ according to Neer classification. Preoperative X-ray of obverse shoulder joint and outlet supraspinatus muscle was made. Seven cases was examined with ultrasonography and 10 with MRI or MRA. All cases were treated with arthroscopic subacromial decompression and arthroscopic acromioplasty and six cases underwent simultaneously arthroscopic suture of the rotator cuff. Results The follow up for 1-6 years (average 26 months) showed significant statistical difference upon preoperative UCLA score and postoperative UCLA score that were 16.9?4.0 and 32.5?1.4, respectively (t=-14.027,P﹤0.01). The results were excellent in two cases and good in ten. All cases were satisfied with the operation. Conclusions ASD is shown to be an effective procedure for subacromial impingement syndrome and has the advantages of minimal trauma and rapid postoperative recovery.