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Objective:To explore the clinical outcomes of intraoperative fluoroscopy on femoral tunnel placement in treating professional snow sports athletes with anterior cruciate ligament (ACL) injury.Methods:A retrospective case series study was used to analyze the clinical data of 13 professional snow sports athletes with ACL injury treated in the National Institute of Sports Medicine, General Administration of Sport of China from January 2016 to January 2019. There were 5 males and 8 females, aged 16-27 years [(18.5±3.0)years]. Intraoperative lateral fluoroscopy combined with quadrant method was performed for the accurate femoral tunnel placement in single-bundle ACL reconstruction by using autologous hamstring tendon in all patients. KT1000 side-to-side difference (KT1000-ssd), pivot shift test, International Knee Documentation Committee (IKDC) subjective score, Lysholm score, Marx activity scale and maximum extension and flexion resistance ratio of the involved and uninvolved knee were compared before operation (or before injury) and at 3, 6, 12 and 24 months after operation. Whether returning to the field, time taken in returning to the field and re-injury were recorded at each follow-up visit. ACL graft signal intensity ratio (SIR) in MRI of the involved knee was evaluated at postoperative 24 months.Results:All patients were followed up for 24-33 months [(25.8±2.7)months]. There were 7 patients with KT1000-ssd degree I, 5 with degree II and 1 with degree III before operation, compared to 12 patients with KT1000-ssd degree 0 and 1 with degree I at 3 and 6 months after operation and 13 patients with KT1000-ssd degree 0 at 12 and 24 months after operation. The pivot shift test was grade I in 8 patients and grade II in 5 before operation, compared to 11 patients with degree 0 and 2 with degree I at 3 months after operation and 12 patients with degree 0 and 1 with degree I at 6, 12 and 24 months after operation. IKDC subjective score was (68.0±4.3)points, (84.7±7.9)points, (94.6±3.3)points and (96.5±1.8)points at postoperative 3, 6, 12 and 24 months, respectively. Six months after operation, IKDC subjective score was significantly improved compared to the preoperative (48.3±25.0)points (all P<0.01). The Lysholm score was (63.4±6.6)points, (80.1±6.5)points, (93.8±4.6)points and (96.5±2.4)points at postoperative 3, 6, 12 and 24 months, respectively. Six months after operation, the Lysholm score was significantly improved compared to the preoperative (47.5±29.4)points (all P<0.01). The Marx activity scale was (7.4±0.5)points, (13.8±0.7)points, (14.6±0.8)points and (15.0±0.7)points at postoperative 3, 6, 12 and 24 months, respectively, significantly lower than (16.0±0.0)points before the injury (all P<0.01). The maximum extension resistance ratio of the involved and uninvolved knee was 0.60±0.10, 0.85±0.08, 0.91±0.06 and 0.97±0.04 at postoperative 3, 6, 12 and 24 months, respectively. Six months after operation, the maximum extension resistance ratio of the involved and uninvolved knee was significantly increased compared to the preoperative 0.57±0.18 (all P<0.01).The maximum flexion resistance ratios of involved and uninvolved knee were 0.64±0.09, 0.82±0.06, 0.89±0.04 and 0.94±0.06 at postoperative 3, 6, 12 and 24 months, respectively. Six months after operation, the maximum flexion resistance ratio of the involved and uninvolved knee was significantly increased compared to the preoperative 0.60±0.12 (all P<0.01). Thirteen athletes returned to the field within 12 months after operation with the time taken in returning to the field ranging from 5-12 months [(8.7±1.9)months]. There was no ACL re-injury at postoperative 24 months. The ACL graft SIR in MRI of the involved knee was 1.80±0.20 at postoperative 24 months. Conclusion:Intraoperative fluoroscopy on femoral tunnel placement in the treatment of professional snow sports athletes with ACL injury can significantly improve the knee joint stability, subjective function, sports performance and muscle strength within 6 months, and can help them return to the field within 12 months, and accelerates graft healing.
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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 investigate the prevalence of degenerative knee osteoarthritis and the relationship between os?teoporosis and knee osteoarthritis. Methods A community?based cross?sectional study was conducted and stratified sampling method was used to select the sample. The permanent residents over 18 years old in Beijing were selected, and self?developed questionnaires were used by face?to?face interview including the disease condition and possible relative factors. The effect of os?teoporosis on knee osteoarthritis was analyzed after controlling the effect of gender, age, BMI, waist?hip ratio, education level, na?ture of work, intensity of work, physical exercise by the Logistic regression model. Results Among the 783 subjects, 53 cases of knee degenerative osteoarthritis were found, with the prevalence rate was 6.77% and the prevalence rate of 95%CI was 5.01%, 8.53%. The prevalence rates of ＜45 years old group, 45-59 year?old group and ≥60?year?old group were 2.54%, 7.02% and 16.67% respectively, and the difference was statistically significant (χ2=36.284, P=0.000). After controlling the other factors, osteo?porosis had an independent effect on knee osteoarthritis with OR value of 3.56 (95% CI : 1.76, 7.18). Conclusion The older the age, the higher the prevalence of degenerative knee arthritis, and there is a correlation between osteoporosis and degenerative knee arthritis.
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Objective@#To investigate the prevalence of degenerative knee osteoarthritis and the relationship between osteoporosis and knee osteoarthritis.@*Methods@#A community-based cross-sectional study was conducted and stratified sampling method was used to select the sample. The permanent residents over 18 years old in Beijing were selected, and self-developed questionnaires were used by face-to-face interview including the disease condition and possible relative factors. The effect of osteoporosis on knee osteoarthritis was analyzed after controlling the effect of gender, age, BMI, waist-hip ratio, education level, nature of work, intensity of work, physical exercise by the Logistic regression model.@*Results@#Among the 783 subjects, 53 cases of knee degenerative osteoarthritis were found, with the prevalence rate was 6.77% and the prevalence rate of 95%CI was 5.01%, 8.53%. The prevalence rates of <45 years old group, 45-59 year-old group and ≥60-year-old group were 2.54%, 7.02% and 16.67% respectively, and the difference was statistically significant (χ2=36.284, P=0.000). After controlling the other factors, osteoporosis had an independent effect on knee osteoarthritis with OR value of 3.56 (95%CI: 1.76, 7.18).@*Conclusion@#The older the age, the higher the prevalence of degenerative knee arthritis, and there is a correlation between osteoporosis and degenerative knee arthritis.
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Objective To compare the knee function recovery at different times of returning to sport after anterior cruciate ligament reconstruction(ACLR) among elite athletes using knee isokinetic muscle strength test and various hop test.Methods Forty-one elite athletes(14 males,27 females,mean age 22.6 ± 4.1 years) undergoing ACLR between January 2013 and September 2014 were chosen from the database of the National Institute of Sports Medicine and Shanghai Huashan Hospital.Rehabilitation was performed using the same protocol by professional physiotherapists and trainers,who recorded the time of returning to sport of each athlete.One week prior to the scheduled return,bilateral knee isokinetic muscle strength test(test value:peak torque;angle velocity:60°/s,180°/s;motion:flexion,extension) and four hop tests(single hop for distance,side-to-side hop,up-down hop and 8 hop) were applied with the limb symmetry index(LSI) calculated.The athletes were then grouped by their returntime referring to surgery into the premature group(6～8 months),timely return group(9～12 months) and delayed group(over 12 months).The tests results were recorded and compared among the three groups.Results Fourteen athletes were selected into the premature group,with 19 in the timely group and 8 in the delayed group.The average LSI of 60°/s flexion peak torque of the premature group (87.4％ ± 7.5％) was significantly lower than the timely group(95.8％ ± 6.6％) and the delayed group(96.0％ ± 2.4％) (P＜0.01).Significant differences were observed between the premature group and delayed group regarding the 60° extension peak torque(85.8％ ± 9.4％ and 94.8％ ± 4.8％,P＜0.05),180°/s flexion peak torque(90.7％ ± 8.7％ and 101.4％ ± 6.8％,P＜0.05),and 180°/s extension peak torque (90.6％ ± 5.2％ and 97.8％ ± 5.6％,P＜0.05).The average LSL of the premature group at single hop for distance,side-to-side hop and up-down hop(93.A％ ± 8.5％,84.7％ ± 7.3％ and 112.5％ ± 5.7％) was significantly lower than that of the timely group(95.7％ ± 6.0％,104.2％ ± 4.3％ and 105.3％ ± 7.9％) and the delayed group regarding(98.1％ ± 1.9％,104.7％ ± 4.0％ and 106.3％ ± 7.4％) (P＜0.01 for all).The relative peak torque of 60°/s extension of the premature group(2.48 ± 0.58 Nm/kg) was significantly lower than the delayed group(3.21 ± 0.51 Nm/kg) (P＜0.01).Conclusions For elite athletes,returning to sport within 9 months after ACLR results in insufficient restoration of the knee function.Delayed return to sport doesn't improve the outcomes of hop tests,but can enhance the maximum extension torque peak,which needs further study.
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Purpose To analyze the gait of patients following reconstruction of posterior cruciate ligament(PCL) and posterolateral corner(PLC).Methods Between March 2007 and April 2008,16 patients with combined PCL and PLC injuries-deficient knee underwent the reconstruction with allograft.Dial test were performed before surgery,and gait analysis and dial test were assessed 1 year after reconstruction.Sixteen healthy volunteers were used as controls.Results There are no differences in the time-distance factors and kinematics between patients and controls(P>0.05).The torque of knee extension revealed significant difference between patients and controls(P<0.01).Mean abtorsion angle of the patients increased 16.5°±6.2° before surgery;whereas the angle increased-4.4°±7.8° 1 year after surgery(P<0.01).The maximal mean abtorsion angnlation from gait analysis was 14.1°±15.7° and from dial test was 29.7°±1 5.2°,respectively.There was a strong linear correlation(r=0.9671,P<0.05)between the outcomes from dial test and gait analysis.Conclusion After reconstruction of the PCL and PLC,the gait of patients became almost normal 1 year after operation,except the torque of knee extension.
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Objective To investigate the changes in kinetic parameters of the major joints of the lower extremity during walking in patients with knee osteoarthritis(KOA),and explore its mechanism for clinical treatment.Methods Sixty patients with KOA in tibia-femoral joint and 30 healthy persons as control group(CON) were recruited.Patients were divided into less severe KOA group(LKOA)and more severe KOA group(MKOA)in accordance to K/L radiological grade,then the kinetic data by 3D-gait analysis system were collect.Results LKOA had more knee maximal abduction movement than MKOA and CON after heel strike(P<0.001);the knee first peak adduction movement of MKOA was significantly greater than LKOA(P<0.05)and CON(P<0.001)during medial stance phase;the knee second peak adduction movement of LKOA was significantly less than CON(P<0.05);the hip first peak adduction movement of MKOA was significantly greater than CON(P<0.05).Conclusion The more severe level of KOA in tibia-femoral joint,the more load on medial compartment of patient's knees was seen,comparing with CON,patients with KOA have greater hip abduction movement and more severe patients have less hip adduction movement.