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BACKGROUND@#To perform anatomical anterior cruciate ligament reconstruction (ACLR), tunnels should be placed relatively higher in the femoral anterior cruciate ligament (ACL) footprint based on the findings of direct and indirect femoral insertion. But the clinical results of higher femoral tunnels (HFT) in double-bundle ACLR (DB-ACLR) remain unclear. The purpose was to investigate the clinical results of HFT and lower femoral tunnels (LFT) in DB-ACLR.@*METHODS@#From September 2014 to February 2016, 83 patients who underwent DB-ACLR and met the inclusion and exclusion criteria were divided into HFT-ACLR (group 1, n = 37) and LFT-ACLR (group 2, n = 46) according to the position of femoral tunnels. Preoperatively and at the final follow-up, clinical scores were evaluated with International Knee Documentation Committee (IKDC), Tegner activity, and Lysholm score. The stability of the knee was evaluated with KT-2000, Lachman test, and pivot-shift test. Cartilage degeneration grades of the International Cartilage Repair Society (ICRS) were evaluated on magnetic resonance imaging (MRI). Graft tension, continuity, and synovialization were evaluated by second-look arthroscopy. Return-to-sports was assessed at the final follow-up.@*RESULTS@#Significantly better improvement were found for KT-2000, Lachman test, and pivot-shift test postoperatively in group 1 ( P >0.05). Posterolateral bundles (PL) showed significantly better results in second-look arthroscopy regarding graft tension, continuity, and synovialization ( P <0.05), but not in anteromedial bundles in group 1. At the final follow-up, cartilage worsening was observed in groups 1 and 2, but it did not reach a stastistically significant difference ( P >0.05). No statistically significant differences were found in IKDC subjective score, Tegner activity, and Lysholm score between the two groups. Higher return-to-sports rate was found in group 1 with 86.8% (32/37) vs. 65.2% (30/46) in group 2 ( P = 0.027).@*CONCLUSION@#The HFT-ACLR group showed better stability results, better PL, and higher return-to-sports rate compared to the LFT-ACLR group.
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Humans , Follow-Up Studies , Anterior Cruciate Ligament/surgery , Knee Joint/surgery , Anterior Cruciate Ligament Injuries/surgery , Anterior Cruciate Ligament Reconstruction/methods , Magnetic Resonance Imaging , Treatment OutcomeABSTRACT
The anterior cruciate ligament (ACL) injury is a common sports injury that has a significant impact on knee function and patients′ mobility. With the popularity of national fitness campaign in China, the incidence of ACL injury is increasing year by year. Currently, there still lacks clinical standards or guidelines on how to choose appropriate treatment methods, surgical plans and rehabilitation protocols for ACL injury. In order to timely reflect the new treatment concept of ACL injury, standardize its diagnosis and treatment and improve the curative effect, the Sports Medicine Society of Chinese Research Hospital Association and the Editorial Board of Chinese Journal of Trauma organized domestic orthopedic and sports medicine experts to formulate the "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)" based on the level of evidence-based medicine and in compliance with the principle of scientificity, practicability and advancement. The present guideline includes 12 recommendations for the diagnosis, treatment and rehabilitation of ACL injury in order to provide guidance and assistance for the clinical diagnosis and treatment of ACL injury in China.
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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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[Summary] Gender difference study of meniscus injury shows certain clinical significance in understanding epidemiologic characteristics of meniscus injury .Several large amount case studies demonstrated that the risk of meniscus tears was significantly higher in male than in female .However , in certain kinds of sports and special types or locations of meniscus tears , especially in medial meniscus posterior root tear ( MMPRT ) , there were more females than males .Further large amount case studies were needed for a deeper understanding of meniscus tears .In this paper,we reviewed the current situation and progress of gender difference of menisus tear .
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Objective To study the biological behavior of peripheral blood mesenchymal stem cells (PBMSCs) in 3D composite scaffolds.Methods The proliferation and chondrogenesis of rabbit PBMSCs seeded on porcine cancellous bone (DCB) scaffolds were evaluated,and bone marrow mesenchymal stem cells (BMMSCs) and articular chondrocytes (ACCs) were used as controls.Cell morphology and distribution in scaffolds were observed using scanning electron microscopy (SEM).Live/Dead staining was employed to detect cell viability,Hoechst 33258 method to measure DNA content,dimethylmethylene blue (DMMB) assay to detect glycosaminoglycan (GAG),enzyme-linked immunosorbent assay (ELISA) and immunofluorescence to detect the content of type 2 collagen (COL 2),and RT-PCR to analyze chondrogenesis-related gene expression.Results SEM showed that three kinds of cells uniformly adhered and evenly distributed in DCB scaffolds.Live/Dead staining observed the similar viability of the three kinds of cells three days after seeding (P＞0.05).There was no significant difference in the proliferation ability and DNA content among three kinds of cells after seven days of in vitro culture.After 21 days of chondrogenic culture,both PBMSCs and BMMSCs secreted more GAGs than ACCs,while the secretion of COL 2 was similar to that of ACCs.Moreover,the gene expression of AGC,COL 2 and alkaline phosphatase (ALP) were significantly up-regulated (P＜0.05) in PBMSCs and BMMSCs but significantly down-regulated in ACCs (P＜0.05).The expression of COL 1 in MSCs groups displayed an increasing trend but a decreasing trend in ACCs group (P＞0.05).The gene expression of COL 2 and ALP,but not of AGC and COL 1,in PBMSCs and BMMSCs was higher than those in ACCs (P＜0.05).Conclusions PBMSCs and BMMSCs have similarly excellent proliferation and chondrogenesis potential in 3D porous DCB scaffolds.However,hypertrophic gene expression is still observed under in vitro culturing condition,suggesting the need to further optimize the culture system.
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BACKGROUND: Thawed allografts are usually discarded for various reasons. Whether these discarded allografts can be refrozen for later use and their histological changes in vivo have not been reported. OBJECTIVE: To investigate the histological characteristics of anterior cruciate ligament (ACL) reconstructed with the repetitive freeze-thawing allogenic Achilles tendon in New Zealand white rabbits. METHODS: Allogenic Achilles tendons were harvested from adult male New Zealand white rabbits, and were stored at -8 ℃ and thawed at 20 ℃ for 1, 2, 3 and 10 times, respectively, after sealed package and 60Co irradiation. Twenty-four adult male New Zealand white rabbits were enrolled: the left and right knees of 12 rabbits were respectively reconstructed with 1 (control group) and 2 times of freeze-thawing allogenic Achilles tendon, and another 12 rabbits underwent reconstruction with 3 and 10 times of freeze-thawing allogenic Achilles tendon, respectively. Three specimens from each group were evaluated with modified histology grading scores at 6, 12 and 24 weeks to assess the cell morphology, cell quantity, matrix staining intensity, fibrocartilage formation, new bone formation, tendon healing and cartilage injury. RESULTS AND CONCLUSION: The cell morphology, matrix staining intensity and total scores of the 10 times group were significantly higher than those of the other groups at 6 weeks (P 0.05). ACL reconstructed with 10 times of repetitive freeze-thawing allogenic Achilles tendons had higher histological scores at 6 weeks after modeling, but no significant differences were shown at 12 and 24 weeks after modeling. To conclude, our study only testifies better histological scores on the multiple times of freezethawing Achilles tendon than the less times of freeze-thawing Achilles tendon at the early period after operation.
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<p><b>BACKGROUND</b>The tibial plateau is asymmetric with a larger medial plateau. We observed from clinical practice that the shape of the tibial plateau does not always present a larger medial plateau. Tibial plateau also showed other shapes. The purpose of this study was to analyze the anthropometric data of the proximal tibia in a large group of Chinese patients undergoing total knee arthroplasty and to investigate the morphology of the resected proximal tibial surface and its gender differences.</p><p><b>METHODS</b>A total of 822 knees (164 males, 658 females) from the Chinese population were measured intraoperatively for medial anteroposterior (MAP) and lateral anteroposterior (LAP) dimensions of the resected proximal tibial surface. The difference of MAP and LAP (DML) was also calculated as MAP minus LAP. We then classified the data into three groups based on the DML (<-2, -2 to 2, and >2 mm) to analyze the morphology of the proximal tibia and its distribution between male and female.</p><p><b>RESULTS</b>The shape of proximal tibial plateau was of three types: larger medial plateau type, symmetric type, and larger lateral plateau type. There were significant differences between males and females in relation to the shape distribution of the proximal tibial plateau (P < 0.05). Most of the proximal tibial plateau was asymmetric, with 517 of 822 (62.9%) tibia having a DML >2 mm and 120 of 822 (14.6%) tibia having a DML<-2 mm. Only 185 of 822 (22.5%) tibia had a DML between -2 and 2 mm.</p><p><b>CONCLUSION</b>The results of this study can be used as a guideline to design tibial components with different DMLs to better match the different anthropometry of the resected tibial surface.</p>
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Aged , Female , Humans , Male , Middle Aged , Anthropometry , Methods , Arthroplasty, Replacement, Knee , Methods , Asian People , Knee Joint , General Surgery , Sex Factors , Tibia , General SurgeryABSTRACT
Objective To evaluate the diagnostic value of different sequences of magnetic resonance imaging (MRI) in repaired meniscus.Methods From September 2002 to December 2008,118 patients (130 menisci) underwent arthroscopic meniscus suture in our hospital,including 94 males and 24 females,aged from 15 to 50 years (average,25.7t7.5 years).All patients underwent MRI and second-look arthroscopy postoperatively.Different sequences of MRI were taken to evaluate the grade of meniscal signal at repaired site and the slices involved by grade 3 signal.The diagnostic sensitivity,specificity,accuracy,positive predict value (PPV) and negative predict value (NPV) were calculated for each sequence by using second-look arthroscopy as the gold standard.Results The total healing rate was 80.8％ (105/130) by second-look arthroscopy,which was higher than that by different sequences of MRI.The integrated T2 sequence held the highest diagnostic value,and the sensitivity,specificity,accuracy,PPV and NPV were 76.0％,71.4％,72.3％,38.8％ and 92.6％,respectively.According to the second-look arthroscopy result,the menisci were divided into the healed group and unhealed group.In the healed group,28.6％ of cases (30/105) showed grade 3 signal in MRI,which was less than that (76.0％) in the unhealed group.The rate of the new grade 3 signal (8.6％) and the slices involved by grade 3 signal (0.8±1.0) in the healed group were less than those (16.0％ and 3.0±2.0) in the unhealed group.Conclusion The diagnostic value of the integrated T2 sequence is encouraging with high sensitivity,specificity and accuracy.The new grade 3 signal in the repaired meniscus usually implies that the meniscus is not healed.
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Objective To summarize the clinical effect of arthroscopic Pridie drilling technique for repairing full-thickness articular chondral defects of the knee.Methods A retrospective study was made on clinical data of 28 patients(29 knees) with full-thickness articular cartilage defects treated with arthroscopic Pridie drilling technique from November 1999 to July 2005 in this hospital.A Kirschner wire 1.0~1.2 mm in diameter was used in the procedure to puncture holes in the subchondral bone plate.Holes were made adjacent to each other as closely as possible,but not to break into neighbouring ones,with normally 2~3 mm apart.The depth of the hole was 3~4 mm.A protected weight-bearing protocol lasting 6~8 weeks and continous passive motion(CPM) were used postoperatively.The Tegner activity levels,the Meyers scores,and the Lysholm knee scores were used for evaluation before and after the operation.Results The surgical outcomes were classified as "excellent" in 19 cases,"good" in 5 cases,and "poor" in 4,with the total effective rate being 85.7%(24/28).The Tegner activity levels were elevated from 1.9?1.2 preoperatively to 4.9?1.9 postoperatively(t=10.912,P=0.001),the Meyers scores from 10.3?1.3 preoperatively to 15.9?2.6 postoperatively (t=10.101,P=0.005),and the Lysholm knee scores from 47.7?12.5 to 83.2?15.4(t=10.302,P=0.003),respectively.Conclusions Arthroscopic Pridie drilling is a simple,safe,mini-invasive,and effective technique, which appears to be a practical surgical option for the treatment of full-thickness articular chondral lesions of the knee.
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Objective To study the prognosis of the implanted xenogenic and allogenic menisci, and the implanted menisci's protection effects on articular cartilage. Methods 30 adult New Zealand white rabbits were divided equally into two groups and the medial meniscus defection models were established by medial meniscectomy. Allogenic medial menisci implantation were done in group A. Small pieces of menisci tissue were taken from pig meniscus and moulded them as the same shape and size as rabbit's medial menisci,then, xenogenic menisci implantation were done in group B with these moulded grafts. 6, 12 and 24 weeks after the operations, rabbits were sacrificed to observe the implanted menisci and the articular cartilage on medial tibial plateau, medial femoral condylus and femoral trochlea with naked eye and histological method. Results After allogenic meniscus transplantation, the state of implanted meniscus was good, and healed well around the capsula. 24 weeks post allogenic meniscus transplantation, the injury of the articular cartilage was not in evidence. In short time post xenogenic meniscus transplantation, the state of meniscus and cartilage was good and after 24 weeks the xenogenic meniscus was dissolved and absorbed, the articular cartilage also showed degeneration and injury. Conclusion With xenogenic meniscus moulded from pig meniscus tissue,the implanted meniscus was resolved and absorbed and the cartilage degeneration also appeared after half a year. Post allogenic meniscus transplantation, the meniscus structure and function were reconstructed well and the articular cartilage was also well protected.
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In oder to make the bone tunnel in optimal position, effective and firm fixation, early functional recov- ery and minimally operative injury we reported a new technique in reconstructive anterior cruciate ligament(ACL)using patellar tendon autograft fixed with interference screw. With the assistance of arthroscopy 74 patients with ACL rupture were treated between October 1997 and April 1999. The clinical results showed that the operative injury was minimal, fixed bone grafts were accurate and the reconstructed ACL was isometricity. The reconstructed ligament could be fixed biologically and firmly because of used patellor tendon autograft with bone grafts at two end. Clinical experience of ar- throscopic - assisted ACL reconstruction was summarized.
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Objective To evaluate the mid-term(44 months) outcomes of meniscus allograft transplantation in four patients.Methods Between June and July 2005,four patients(3 medial and 1 lateral;3 men and 1 women;aged 21,27,35,38 years) underwent arthroscopy-assisted meniscus allograft transplantation in our hospital.The clinical outcome of the patients was evaluated by assessing the symptoms and signs,IKDC,Lysholm,and Tegner scores and examining the anteroposterior and lateral radiographs of the transplanted knee,weight-bearing radiographs of the both knees,anteroposterior radiographs of the lower extremities as well as magnetic resonance imaging(MRI).One patient underwent second-look arthroscopy. Results The follow-up time was 44-45 months.During the period,all the patients showed a normal motion range of the knee without pain or effusion of the knee joints.The mean IKDC,Lysholm,and Tegner scores of the patients were 84.75?2.63,91.50?4.43 and 7.00?0.82 respectively,which were significantly higher than those detected before the operation(60.50?14.06,69.25?22.04 and 4.00?0.82).The radiological results revealed no obvious degeneration or alignment changes though a 2-mm narrowing was shown in one of the patients.MRI showed mild extrusion for the body of the transplanted medial menisci and Ⅱ to Ⅲ stage signal for the body and the posterior horn.Almost normal performance and tension of the transplanted meniscus was shown by arthroscopy. Conclusions Meniscus allograft transplantation shows good outcomes in mid-term follow-up.MRI is valuable for evaluating the implanted meniscus.
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Objective To establish a ten-zone divisional method of the knee joint and investigate its clinical application to arthroscopic total synovectomy for rheumatoid arthritis (RA). Methods A total of 22 fresh frozen specimens of adult knee joints were prepared for anatomical study on the sagittal septum of the knee to establish ten-zone divisional method of the knee joint. A retrospective study was carried out on 37 patients with early-stage RA (40 knees) undergone arthroscopic total synovectomy. Among the cases,15 knees were operated according to ten-zone divisional method; and the other 25 were treated with the routine method. The patients were followed up for 10-72 months to evaluate their Lysholm score,Lequesne Index,and Larsen stage classification. Results There was a sagittal septum in the knees,connecting anteriorly to the fat pad,alar fold,or mucous ligament. The middle part of the sagittal septum lied between the anterior and posterior cruciate ligaments,and its posterior part formed the posterior septum of the knee. Considering the anatomy of the sagittal septum,the synovium of the knee could be divided into 10 zones. All of the patients underwent total synovectomy by ten-zone divisional method achieved excellent or good outcomes (100%,15/15),none of them recurred during follow-up. Among the 25 knees that received total synovectomy by routine arthroscopic method,17 achieved excellent or good outcomes (68%,17/25),and 8 had recurrence (Fisher's exact test,P=0.016). Conclusions Arthroscopic total synovectomy was one of the effective treatments for early-stage RA. The ten-zone divisional method for total synovectomy according to the structure of the knee sagittal septum could improve the clinical results of total synovectomy for rheumatoid arthritis.
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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.
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Objective To study the type Ⅰ,Ⅱ,Ⅲ and Ⅹcollag e n expression in meniscus and articular cartilage and immunoreactions post xenoge nic and allogenic meniscus transplantation. Methods After men iscectomy,30 adult New Zealand white rabbits were divded into two groups:group A undertook allogenic medial meniscus transplantation and group B undertook xenog enic meniscus transplantation with fitted meniscus tissues harvested from swine. 6, 12 and 24 weeks post transplantation, the histological and immunohistochemical analysis of type Ⅰ ,Ⅱ,Ⅲ and Ⅹ collagens monoclonal antibody were investigated in menisci and a rticular cartilage. Peripheral blood were obtained for immunoreactions study thr o ugh the methods of CDMT (Complement Dependent Microlymphocytotoxicity Test) and RIA (Radioimmunoassay)of IL-2 and IL-6. Results The meniscu s and articular cartilage were good post allogenic meniscus transplantation, but the transplanted xenogenic meniscus appeared to be dissolved and absorbed and c art ilage lesions were observed in 24 week post operation. No significant difference was found between two groups in type Ⅰ,Ⅱ and Ⅲ collagen expression during e xperiment. From 1～12 weeks, no significant diffe rence was found among type Ⅰ,Ⅱ and Ⅲ collagen expression in articular cartil age in two groups. However,24 weeks post operation, type Ⅹ collagen's expressio n in cartilage was abnormally increased. Neither allogenic nor xenogenic meniscu s transplantation caused fatal immunoreaction during the whole experiment. Con clusion The transplantation meniscus began to be dissolved and absorbed after half a year, but allogenic meniscus transplantation achieved good results . Type Ⅰ,Ⅱ and Ⅲ collagen expression in transplanted meniscus and articular cartilage showed no difference between two groups, but the expression of type Ⅹ collagen was abnormally increased in xenogenic group 24 weeks post operation. No fatal immunoreaction was found in both groups.
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Objective To study the magnetic resonance imaging (MRI) characteristic of bone bruises associated with acute anterior cruciate ligament (ACL) ruptures and to investigate the correlation between bone bruises and cartilage lesions. Methods The MRI findings of 37 cases of acute ACL ruptures associated with bone bruises were studied retrospestively. The classification and distribution of bone bruises were analyzed and the cartilage lesions were also observed under arthroscopy. Results A total of 57 independent bone bruises(type Ⅰ:14, type Ⅱ:32, type Ⅲ:3, type Ⅳ:6 and type Ⅴ:2) were documented by MRI in the 37 patients. 54 (94.7%) bone bruises located in lateral joint compartment with involvement of lateral femoral condyle in 31 and lateral tibial plateau in 23. Nine cases (15.8%) of articular cartilage lesions were found under arthroscopy in the area overlying bone bruises. Conclusion Bone bruises associated with acute ACL ruptures mainly located in the lateral compartment of knee, especially in anterior portion of lateral femoral condyle and posterior portion of lateral tibial plateau. Arthroscopic cartilage lesions were not corresponding to bone bruises.