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Objective:To evaluate the relationship of rotator cuff muscle function with shoulder abduction function after posterior superior rotator cuff tear via dynamic biomechanical study.Methods:By using the customized dynamic shoulder biomechanical testing system, seven freshly frozen cadaveric shoulders were used to stimulate shoulder abduction at 90° under four statuses: (1) intact rotator cuff with activation (normal rotator cuff group); (2) posterior superior rotator cuff tear with activation (posterior superior rotator cuff tear with activation group); (3) posterior superior rotator cuff tear with posterior superior rotator cuff deactivation (posterior superior rotator cuff tear with deactivation group); (4) none rotator cuff tissue above the geometric rotation center of the humeral head with deactivation (global tear group). The peak and stable value of middle deltoid force were used to evaluate biomechanical status in different rotator cuff tear conditions during shoulder abduction procedure. The peak subacromial pressure, average subacromial pressure, subacromial contact area, and subacromial force were used to evaluate subacromial pressed conditions under different rotator cuff tear conditions. The peak and stable ratio of glenohumeral contact force/middle deltoid force were used to evaluate shoulder stability under different rotator cuff tear conditions.Results:During dynamic abduction at 90°, the peak and stable value of middle deltoid force were (42.1±8.7)N and (29.9±7.4)N in normal rotator cuff group, (45.7±10.3)N and (30.5±7.2)N in posterior superior rotator cuff tear with activation group, and (48.4±13.4)N and (29.9±4.8)N in posterior superior rotator cuff tear with deactivation group (all P>0.05). But the peak and stable value of middle deltoid force were (69.7±9.7)N and (53.7±8.9)N in global tear group, significantly increased compared with other three groups (all P<0.05). The elevated middle deltoid force increased the subacromial contact pressure between glenohumeral head and acromion. The peak subacromial pressure, average subacromial pressure, subacromial contact area, and subacromial force were (0.40±0.05)MPa, (0.22±0.03)MPa, (7.71±5.09)mm 2, and (1.66±1.06)N respectively in normal rotator cuff group, (0.41±0.05)MPa, (0.26±0.07)MPa, (12.71±11.35)mm 2, and (2.93±2.46)N respectively in posterior superior rotator cuff tear with activation group, and (0.50±0.12)MPa, (0.26±0.07)MPa, (17.29±9.11)mm 2, and (4.09±1.46)N respectively in posterior superior rotator cuff tear with deactivation group (all P>0.05). However, the peak subacromial pressure, average subacromial pressure, subacromial contact area, and subacromial force were (3.64±1.70)MPa, (0.98±0.49)MPa, (47.63±11.91)mm 2, and (45.48±23.86)N respectively in global tear group, significantly higher than those in other three groups (all P<0.05). The peak and stable ratio of glenohumeral contact force/middle deltoid force were 2.24±0.30 and 2.46±0.13 in normal rotator cuff group, 2.21±0.19 and 2.52±0.08 in posterior superior rotator cuff tear with activation group, and 2.03±0.14 and 2.42±0.16 in posterior superior rotator cuff tear with deactivation group (all P>0.05). However, the peak and stable ratio of glenohumeral contact force/middle deltoid force were 1.40±0.14 and 1.52±0.41 in global tear group, significantly higher than those in other three groups (all P<0.05). No significant differences of the above parameters were observed in posterior superior rotator cuff tear with activation group, posterior superior rotator cuff tear with deactivation group and global tear group (all P>0.05). Conclusions:After posterior superior rotator cuff tear, rotator cuff muscle function does not affect the whole abduction function of shoulder. When the size of rotator cuff tear involves the whole superior humeral head rotation center, the normal abduction function of shoulder will be significantly impaired.
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Tendons and bones are connected at the tendon-bone interface to transmit force and exchange biological information. However, the formation of fibrous scars after injury to the tendon-bone interface makes it difficult to recover the original structure during surgery and thus reduces its performance. Therefore, the healing of the tendon-bone interface is a hotspot in sports medicine. Numerous studies have already demonstrated that a variety of molecules and cells participate in the tendon-bone interface reconstruction process, and yet the specific mechanism remains unclear. At present, a great number of studies have been carried out on treatment methods, but clinical treatment are varied with no unification. Therefore, the authors review the advances in the biology and mechanics of healing mechanisms of tendon-bone interface as well as the main methods promoting tendon-bone interface healing, so as to provide references and new ideas for further researches on tendon-bone interface healing.
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Objective:To explore the diagnostic performance of patella-tilt angle and congruence angle in episodic patellar dislocation (EPD) and the quantitative measurements of the patellar and femoral axial parameters as well as their correlation with and contributions to the patellofemoral joint alignment with the knee extended.Methods:A case control study was conducted to analyze the radiological data of EPD patients (EPD group, n=106) and patients without patellar instability (control group, n=106) admitted to Sixth People′s Hospital Affiliated to Shanghai Jiao Tong University from January 2016 to December 2019. Each group consisted of 55 females and 51 males with the age range of 14-45 years [(23.0±5.3)years], showing 1∶1 match. Axial parameters included patellar parameters (patellar width, patellar thickness, Wiberg angle and Wiberg index), femoral parameters [trochlear sulcus angle, trochlear sulcus depth, trochlear sulcus height, trochlear width ratio (lateral/medial), trochlear height ratio (lateral/medial), lateral trochlear inclination and trochlear groove medialization], and patellofemoral joint parameters (patellar tilt angle and congruence angle). The receiver operating characteristic (ROC) curve of patellofemoral joint parameters for the prediction of EPD was analyzed. Univariate analysis was performed to determine the difference of those axial parameters between the two groups. Pearson correlation analysis was used to identify the correlation between those bony parameters and patellofemoral joint parameters. Stepwise regression model was further established to determine the influencing factors and corresponding contributions for patellofemoral joint parameters. Results:When the optimal cut-off values of patellar tilt angle and congruence angle were 17.2° and 25.5°, the area under the ROC curve (AUC) for predicting EPD was 0.91 (95% CI 0.87-0.95, P<0.01) and 0.92 (95% CI 0.87-0.95, P<0.01), and the Youden index was 0.745 (sensitivity=83.96%, specificity=90.57%) and 0.717 (sensitivity=81.13%, specificity=90.57%). Univariate analysis showed that Wiberg index, femoral parameters and patellofemoral joint parameters were significantly different between the two groups (all P<0.01). For all patients, Pearson correlation analysis showed that patellar tilt angle was moderately to strongly correlated with Wiberg index, trochlear sulcus angle, trochlear sulcus depth, trochlear width ratio (lateral/medial), trochlear height ratio (lateral/medial) and lateral trochlear inclination ( r=0.51, 0.41, -0.62, 0.43, -0.49, -0.65, all P<0.01) and that congruence angle has a moderate correlation with trochlear sulcus angle, trochlear sulcus depth, trochlear width ratio (lateral/medial) and lateral trochlear inclination ( r=0.43,-0.59,0.38,-0.51, all P<0.01). For all patients, Stepwise regression model analysis showed that lateral trochlear inclination, trochlear sulcus depth, trochlear sulcus angle, Wiberg index and trochlear height ratio (lateral/medial) could explain 60% of the variation of patellar tilt angle ( R 2=0.60, P<0.01) and that trochlear sulcus depth, lateral trochlear inclination, trochlear groove medialization, trochlear sulcus angle and Wiberg index could explain 44% of the variation of congruence angle ( R 2=0.44, P<0.01). Conclusions:The patellar tilt angle and congruence angle are reliable quantitative indicators representing patellofemoral axial alignment, with a good diagnostic performance for EPD. Variations in the patellar and femoral bony structures of EPD patients are related to the patellofemoral axial alignment, with the axial parameters differently contributing to the patellofemoral alignment.
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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 clinical efficacy of arthroscopic debridement, transtendon repair and tear completion and repair in treating Ellman II partial articular surface tendon avulsions.Methods:A retrospective case control study was conducted on 45 patients with partial articular surface tendon avulsions admitted to East Division of Shanghai Sixth Hospital Affiliated to Shanghai Jiao Tong University from December 2017 through December 2019. There were 18 males and 27 females, with a mean age of (56.4±5.0)years (range, 38-66 years). The patients were assigned to arthroscopic debridement group ( n=15), arthroscopic transtendon repair group ( n=15), and arthroscopic tear completion and repair group ( n=15). Operation time and complications were recorded. American Shoulder and Elbow Surgeons (ASES) score and University of California, Los Angeles (UCLA) score were measured preoperatively, at postoperative 3 months and at the latest follow-up. Results:All the patients were followed up for 8-32 months [(18.2±6.3)months]. In arthroscopic debridement group, arthroscopic transtendon repair group and arthroscopic tear completion and repair group, the operation time was (43.7±3.1)minutes, (89.1±5.4)minutes, (62.2±3.6)minutes, respectively ( P<0.05). No complications such as nerve injury, infection and arthrofibrosis were observed after operation. In arthroscopic debridement group, arthroscopic transtendon repair group and arthroscopic tear completion and repair group, the ASES score was preoperative (48.7±2.9)points, (49.1±3.0)points, (48.3±3.6)points, respectively ( P>0.05); the UCLA score was preoperative (15.5±1.3)points, (15.4±1.8)points, (15.2±1.4)points, respectively ( P>0.05). In arthroscopic debridement group, arthroscopic transtendon repair group and arthroscopic tear completion and repair group, the ASES score at the latest follow-up was (90.1±1.6)points, (89.3±1.0)points, (89.4±1.0)points, respectively ( P>0.05); the UCLA score at the latest follow-up was (30.3±2.1)points, (29.0±2.3)points, (28.9±2.7)points, respectively( P>0.05). In arthroscopic debridement group, arthroscopic transtendon repair group and arthroscopic tear completion and repair group, the ASES score at postoperative 3 months was (84.4±2.3)points, (73.5±3.6)points, (73.6±3.2)points, respectively; the UCLA score at postoperative 3 months was (26.9±1.4)points, (21.4±1.0)points, (21.1±1.0)points, respectively. In comparison, no significant difference was found between arthroscopic transtendon group and arthroscopic tear completion and repair group ( P>0.05). However, ASES score and UCLA score in arthroscopic debridement group were significantly higher than those in arthroscopic transtendon group and arthroscopic tear completion and repair group ( P<0.05). Conclusions:Arthroscopic debridement, transtendon repair and tear completion and repair are effective techniques for treatment of Ellman II partial articular surface tendon avulsions. However, the operation time and early efficacy of arthroscopic debridement are better than other two techniques.
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Objective To evaluate availability and outcomes of using anterior half of the peroneus longus tendon (AHPLT) in knee ligament reconstruction as an autograft source.Methods From July 2007 to January 2008,100 patients with knee ligament injuries were recruited in this study.There were 33 males and 67 females aging from 16 to 62 years (mean,32.3 years).49 cases had undergone medial patellofemoral ligament reconstruction,19 cases multiligament reconstruction,18 cases double-bundle posterior cruciate ligament (PCL) reconstruction and 14 cases double-bundle anterior cruciate ligament (ACL) reconstruction.AHPLT was used as sole (49 cases) or part (51 cases) of reconstruction materials.One-incision or two-incision striping techniques were adopted to harvest AHPLT.Ligaments were fixed with screws.Post-operative assessments included Kujala knee score,Lysholm knee score,Marx knee score,International Knee Documentation Committee (IKDC) subjective evaluation form and objective evaluation grade,the Foot and Ankle Disability Index (FADI) and the American Orthopedic Foot and Ankle Society (AOFAS) scale.Results 92 cases were followed up for more than 24 months.Postoperative Kujala score,IKDC subjective score,Lysholm score and Marx score were improved significantly in all four groups of patients.According to IKDC objective evaluation grade,the number of patients reaching Grade A (normal) or Grade B (near-normal) in multiligament,PCL and ACL reconstruction were 17,15 and 12,with an excellent rate of 89.5％ (17/19),93.7％ (15/16) and 100％ (12/12),respectively.Preoperative and postoperative AOFAS scores were 97.4±2.0 and 97.2±1.6,respectively,while the FADI scores preoperatively and postoperatively were 96.8±2.2 and 96.9±2.5,respectively.These results had no statistical significance.No signs of peroneal nerve injury or peroneus longus tendon rupture was found.Conclusion It is acceptable to use AHPLT as an autograft due to its feasibility to harvest,good clinical outcome,and low rate of donor site morbidity at a minimum of two-year follow-up.
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Objective The purpose of this study is to evaluate the relevance of the recovery of proprioception function and the reservation of residual torn ligamentous fiber in the anterior cruciate ligament (ACL)reconstruction.Methods A retrospective study was carried out in 65 cases of ACL injury,who were treated with double-bundle ACL reconstruction and tibial remnant preservation and tensioning.All the patients were divided into four groups according to the degree of tibial residual fiber observed in the operation,no residual fiber was found(Group A),the length of the residual fiber was less than one third of the normal ACL(Group B),the length of the residual fiber was more than one third less than two thirds of the normal (Group C),the length of the residual fiber was more than two thirds of the normal(Group D).After one year follow-up,the passive angle reproduction test was performed with magnetic angle instrument in 3 flexion ranges(flexion of 90°-60°,60°-30°,and 30°-0°).All the results were contrasted among the four groups by statistical methods.Results In the passive angle reproduction test of the 3 flexion ranges,Group A and B showed a significant difference between the test side and control side(P＜0.05),and Group C showed a significant difference between the test side and control side at the flexion of 30°-0°(P＜0.05),but Group D showed no significant difference at the 3 flexion ranges(P＞0.05).Conclusion During double-bundle ACL reconstruction,with the reservation of tibial residual tom ligamentous and tensioning may have a good effect on the recovery of proprioception function of the knees,which ensure a better functional outcome in the reconstructed knee.
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Objective To describe the surgical technique and outcomes of arthroscopic reconstruction anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) and repair of the injured posteromedial complex (PMC) or posterolateral complex (PLC) structures of the knee joint in treatment of multiple ligaments injuries of knee. Methods From March 2005 to May 2007, 43 patients with multiple ligaments injuries of knee underwent arthroscopic reconstruction. Twenty-four patients were treated with arthroscopic reconstruction of combined ACL and PCL with allograft tendons and augmentation of PMC. The other 19 patients were treated with repair the PLC in addition to reconstruction of ACL and PCL. The International Knee Documentation Committee (IKDC) and Lysholm knee score were used for function evaluation. Results All patients were followed up for 24 to 48 months with an average of 33.10±9.65 months. The stability recovered when stress was applied to the knee at 0° and 20° of flexion. According to IKDC there was a significant improvement from severely abnormal (graded D) in 43 cases before surgery to normal (graded A) in 29 cases (67%), nearly normal (graded B) 11 cases (26%) and abnormal (graded C) 3 cases (7%) at follow-up. The average Lysholm score of the all cases were 46.7±4.2 and 89.6±2.8 before operation and at final follow-up, respectively (t=8.563, P＜0.01). Conclusion Excellence clinical results and good stability were achieved with arthrescopic reconstruction of ACL and PCL combined with repair or augmentation of the PMC and PLC simultaneously.
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Objective To evaluate and compare the clinical effects of forward and reverse anterior cruciate ligament (ACL) reconstruction through the arthroscopy. Methods From April 2008 to August 2009,97 cases with simple ACL injures were treated with eight strands of hamstring tendons in way of two-bundle and four-tunnel reconstruction. The patients were randomly divided into two groups according to the number of hospital admissions: odd numbers (A group, 47 cases) were treated with forward double-bundle reconstruction and even (B group,50 cases) were treated with reverse. The grafts were fixed with a suspension technique by mini-plates and mini-buttons. Mean follow-up exceeded one year. The function of knee joint were assessed by the IKDC, Lysholm and Tegner rating scale. Results Mean follow-up was 13.71 months.At the last follow-up, 2 patients in A group had a 10°extension deformity and 5 had a less than 15° flexion limitation. All patients in B group showed normal knee extension, and 4 had a 5° flexion limitation. According to Lachman test, there were one case with one plus positive and one with two plus positive in A group,and one with two plus in B. KT-1000 examination (30° flexion and 30 N) showed the side to side mean difference of anterior knee laxity was (1.04±1.11) mm in A group and (0.86±1.12)mm in B. According to objective IKDC evaluation, the results were graded as normal or nearly normal in 46 patients in A group and 48in B. There were no statistical differences in the IKDC, Lysholm, and Teguer scores between two groups.Conclusion Forward or reverse ACL double-bundle reconstruction with eight strands of hamstring tendons can both restore knee stability, and there is no significant deviation between the two techniques.
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Objective The purpose of this study is to evaluate the results of double-bundle anterior cruciate ligamen (ACL) reconstruction with remnant preservation and tensioning in acute stage. Methods Fifty-six cases of acute ACL injury were treated with double-bundle ACL reconstruction and tibial remnant preservation and tensioning. The double-bundle reconstruction is performed in a four-tunnel manner with eight-strands of hamstring tendon graft. The tibial remnant was tensioned with PDS sutures pulling through the femoral tunnel for the deep bundle. Fifty-three were followed up for a minimum of two years and evaluat-ed according to IKDC and Lysholm rating scale. Results At the last follow-up, all patients had negative Lachman test. KT-1000 examination in 25° knee flexion showed an average side-to-side difference of anterior laxity of (-0.44±1.53) mm compared with (8.01 1.83) mm before surgery (t=37.03, P=0.0001). Twenty-nine (54.7%) patients showed less than 0 mm side-to-side difference, which indicate a more stable or tight status of the injured knee compared with the normal side; 24(45.3%) patients showed 0 to 2 mm laxity. All patients showed negative pivot shift test. Forty-eight patients showed normal range of motion; 2 patients had 5° flexion deficit, 1 patient had less than 5° flexion deficit and 2 patients had 5° hyper-extension loss. In IKDC e-valuation 51 patients (96.2%) were graded as normal and 2 patients (3.8%) were graded as nearly normal. The IKDC subjective score was 95.6±3.1, and the Lysholm score was 94.8±2.9. The average Tegner score was 7.3 before injury and 7.1 at last follow-up. Conclusion Double-bundle ACL reconstruction with rem-nant preservation and tensioning in acute stage could get 96.2% normal and 3.8% nearly normal rates ac-cording to the IKDC scale at a minimum of two year follow-up.
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Objective To introduce an augmentation technique with 4-strand semitendinesus ten-don in treatment of partial anterior cruciate ligament (ACL) injury of under arthroscope and investigate the clinical outcome of the technique. Methods A total of 26 patients with posterolateral bundle rup-tures of ACL were treated arthroscopically with 4-strand semitendinosus tendon augmentation. The Inter-nationnal Knee Documentation Committee (IKDC) and Lysholm knee score scale were used for evaluation of knee function. The side-to-side difference in anterior knee laxity was examined by KT-1000 (25 de-grees flexion and 301b). Results There was no knee extension limitation, with knee flexion of 130°-150 °(average 142°). The patients were followed up for 12-18 months, which showed grade A in 25 pa-tients (96%) and grade B in one (4%) according to IKDC grade at final follow-up. The subjective IK-DC score was increased from preoperative (71.4±3.7) points to (95.8±3.4) points at final follow-up (t =9.836,P <0.01). The average side-to-side difference in maximal manual test with KT-1000 ar-thrometer at 25° flexion decreased from preoperative (5.1±1.2) mm to (2.1±1.3)mm at final follow-up (t = 10.48 ,P < 0.01). The Lysholm score of all patients was (76.7±3.2) preoperatively and (95. 7±2.4) at final follow-up (t =7.356,P<0.01). Conclusion Augmentation with 4-strand semiten-dinosus tendon under arthroscope can attain excellent clinical results and good anterior stability in treat-ment of partial tears of posterolateral bundle of ACL.
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Objective To investigate the feasibility and clinical effect of the posterolateral depressed tibial plateau fracture by arthroscopically assisted treatment. Methods From March 2006 to September 2007, 26 patients with the posterolateral depressed tibial plateau fracture were reduced by arthroscopy and fixed laterigradely with lag screw through the capitulum fibulae. There were 17 males and 9females, and the patient age at surgery ranged from 19 to 58 years (mean, 34.5 years). According Schatzker classification, type Ⅱ for 21 patients, type Ⅲ for 5 patients. The injury mechanism included traffic injury for 15 cases, building injury for 4 cases, and sport injury for 7 cases. All patients were performed arthroscopy mean 8 days after injury. The operation time, bone union time, full weight-bearing time, range of motion, and related complications in all patients were observed, and HSS scores were used to evaluate the knee function. Results All patients got followed up. The follow-up periods ranged from 4 to 11 months (mean, 9 months). The mean operation time was 35 minutes (range, 20 to 50 minutes). The mean full weight-bearing time and radiographic bone union time were 11 and 13.1 weeks respectively, and the average ROM was 135°. None of the cases was found for infection, deep vein thrombosis, compartment syndrome, screw loosing and broken. The average HSS scores was 93 at the ultimated follow up (range, 84 to 98). There were 25 excellent cases, and 1 good case. The excellent and good rate was 100%. Conclusion Arthroscopically assisted treatment of the posterolateral depressed tibial plateau fracture was an very effective treatment methods, which showed less invasive and direct good reduction.
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Objective To investigate the outcome of augmentation of posterior cruciate ligament (PCL) using suture fixation technique. Methods Thirteen cases of simple PCL raptures were treated arthroscopically with suture fixation to maintain tibial neutralization and augment PCL. The patients were followed up for 12 to 18 months. The IKDC and Lysholm knee score were used for function evaluation. The posterior knee laxity was examined by KT-1000. Results There was no limitation to knee extension.Knee flexion was between 120° and 140°, with an average of 128°. The final IKDC grade was A in 6 cases and B in 7 cases. The IKDC subjective score increased from preoperative 67.4±3. 3 to postoperative 92.5±4. 5 (t=9. 837, P < 0. 01) . The average side-to-side difference in maximal manual test with KT-1000 arthremeter at 90° flexion decreased from 8. 1±1.7 mm to 2.0±1.3 mm ( t = 12. 230, P < 0. 01) . The Lysholm score in the 4 chronic cases was 87.5±3. 1 before surgery and 95.8±3.5 at the last follow-up( t = 5. 376, P < 0.01 ). Conclusion In some cases of PCL injury, excellent clinical results and good posterior stability can be achieved by augmentation of the tom PCL using suture fixation technique.
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BACKGROUND: Anterior cruciate ligament reconstruction is the major treatment for anterior cruciate ligament injury. Studies on anterior cruciate ligament reconstruction with hamstring tendons developed rapidly. OBJECTIVE: To summarize anatomy, biodynamics and surgery approaches of anterior cruciate ligament, and the progress of anterior cruciate ligament reconstruction with hamstring tendons. RETRIEVAL STRATEGY: Pubmed database was undertaken to identify relevant articles on anterior cruciate ligament reconstruction with hamstring tendons published from January 1990 to October 2007 with the key words of "anterior cruciate ligament, hamstring tendons, reconstruction, tendon regeneration, bone tunnel enlargement" in English. Ninety-two articles were selected primarily, and checked by reading titles and abstracts. Inclusive criteria: articles on anterior cruciate ligament reconstruction with hamstring tendons were included. Excusive criteria: articles with different aims and repetitive contents were excluded. Totally 42 articles were included, of which 2 articles were on animals, 2 articles on system evaluation/Meta analysis and 38 articles on clinical research. LITERATURE EVALUATION: Of them, 22 articles were on anatomy, biodynamics, surgery approaches and clinical results of anterior cruciate ligament, 9 on bone tunnel enlargement of anterior cruciate ligament after reconstruction and 11 on regeneration of hamstring tendons after harvest. DATA SYNTHESIS: With the deep understanding of double-bundle dissection and biodynamics of anterior cruciate ligament and bad control of single-bundle reconstruction on rotary stability, double-bundle anterior cruciate ligament reconstruction with hamstring tendons has become the major treatment. Bone tunnel enlargement of anterior cruciate ligament after reconstruction is multifactorial process of biology and biodynamics, possibly resulting in reduction in primary stability after reconstruction and severe problems in graft fixation in revision surgery. Most hamstring tendons (first selected graft of double-bundle anterior cruciate ligament reconstruction) can regenerate, and partially recover its function, which determined its foundation for anterior cruciate ligament reconstruction used by orthopedists. Bone tunnel enlargement of anterior cruciate ligament after reconstruction still deserves further studies. CONCLUSION: Double-bundle dissection and biodynamics of anterior cruciate ligament lay the foundation for improving surgery scheme. Double-bundle anterior cruciate ligament reconstruction can better control rotary stability of knee joint.
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Injury to anterior cruciate ligament (ACL) is the most common lesions of the knee joint. Reconstruction of ACL has been the primary treatment for the instability of the knee. Compared with the traditional reconstruction with patellar tendon, the hamstring tendon has many advantages, such as less damage to the donor site and less incidence of antero-patellar or kneeling pain. This paper highlights the basic and clinical research on ACL reconstruction.
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Objective To summarize the managements for acute injury of kne e posterolateral corner structure, and to evaluate the clinical results. Methods 27 cases of acute posterolateral corner injury of the knee were treated by eith er repair or reconstruction, according to the type of injury. The posterolateral stability of the knee was evaluated after follow-up of more than one year. Res ults One year after operation, there was no varus knee instability in full exten sion. At 30-degree flexion, one-degree varus instability was found in one case , but with firm endpoint. No varus instability was found in other cases. Compare d with the uninjured side, leg external rotation slightly increased in three cas es, remained the same in sixteen cases, and decreased in eight cases. Conclusio n First stage treatment of acute posterolateral corner injury of the knee is rel iable for the restoration of stability.
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Objective To introduce the arthroscopic treatment of acute tibial insertion avulsion fracture of posterior cruciate ligament through double posteromedial portal and "Y" shaped bony tunnel, and to evaluate the clinical results. Methods 33 cases of acute tibial insertion avulsion fracture of posterior cruciate ligament were treated arthroscopically through routine portal and double posteromedial portal. The high posteromedial portal was 4 cm proximal to the joint line, and the low posteromedial portal was just at the level of the joint line. The posterior cruciate ligament and avulsion bone fragment were held together with two USP 6 Aesculap polyester threads, which were first wrapped around the posterior cruciate ligament from anterior to posterior, and then tied behind the posterior cruciate ligament and over the bone fragment. The "Y" shaped bone tunnel was made with the common opening at the anteromedial aspect of the tibia and the tunnel arms opened backward at the inferomedial and inferolateral side of the tibial bed respectively. The threads were pulled out through the "Y" shaped bony tunnel and fixed on titanic button. With twisting of the button the threads were tightened and the fixation was insured. The patients were followed up for six months. Fracture reduction and union, knee stability, range of motion, as well as the total knee function were evaluated. Results All fractures were united without displacement. Six months postoperatively, except for one case with Ⅰ degree of positive posterior drawer test, no knee instability was detected; knee extension restored to normal in all cases and average range of flexion were 139??4.1?. 10? to 15? flexion limitation was found in 3 cases. The mean Lysholm knee score was 91.4?3.6. Conclusion Arthroscopic treatment of acute tibial insertion avulsion fracture of posterior cruciate ligament is minimally invasive. The procedure through double posteromedial portal is appropriate, the use of "Y" shaped bony tunnel and button twisting are useful to assure the fixation.
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Objective To introduce the method of knee posterolateral complex reconstruction with the long head of biceps femoris tendon, and to evaluate the short-term outcomes. Methods Anatomic reconstruction of the chronic posterolateral complex injury of knee joint in 23 cases, were performed with the long head of the biceps femoris tendon from February 2001 to November 2002. All of the patients complained of knee instability with abnormal gait, all of which were associated with other knee ligament injury. With retention of the distal attachment or insertion of the long head of the biceps femoris tendon, a distally pedicled tendon slip was made 8-10 mm of width and 16-18 cm of length. Then the tendon slip was divided longitudinally into halves. The posterior half was folded to reconstruct the popliteofibular ligament and popliteal tendon, with the femoral insertion at the anatomical attachment site of the popliteal tendon, the free end fixed into the tunnel at the posterolateral corner of the tibial plateau. The anterior half was folded to reconstruct the lateral collateral ligament, with the femoral insertion at the anatomical attachment site of the lateral collateral ligament, and the free end fixed into the tunnel or sutured to the fibular head. Results The posterolateral stability of the knee was evaluated in more than 6 months follow-up, mainly through examination of knee varus instability and leg external rotation range. 6 months after operation, there was no varus knee instability in full extension. At 30? flexion, one-grade varus instability was found in 2, but with firm endpoint, no varus instability was found in other cases; external rotation increased in 2, remained the same in 16, and decreased in 5 compared with the healthy side. One year after operation, the stability of the posterolateral corner of the knee had no change compared with that of the 6 months examination. Conclusion Simultaneous reconstruction of knee lateral collateral ligament, popliteofibular ligament, and popliteal tendon with the long head of biceps femoris tendon is effective to restore posterolateral stability of the knee joint.
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Objective To explore the technique of arthroscopic treatment of diffused pigmented villonodular synovitis, and to evaluate its clinical results. Methods 32 cases of diffused pigmented villonodular synovitis were treated by arthroscopic total synovectomy, using routine anterior approach, combined with posteromedial, posterolateral and trans-posterior-septal approach. There were 23 males and 9 females with an average of 31 years (range, 11 to 57 years). The history lasted from 9 to 39 months (mean, 27 months). 12 of the patients had been operated and recurred. Debridement of the synovium in the posteromedial and posterolateral chambers, and excision of the lesion outside the joint were emphasized. Systematic rehabilitation program were followed. The patients were followed up for 13 to 47 months, and were evaluated for pain, swelling, effusion, range of motion, and function of the whole leg. Results One year after operation, there was slight pain in 2 cases and slight swelling in 1, but no effusion was found. The range of motion was 143??5.1? on average. At the last follow-up, 23 cases received MR examination. No recurrence was found in all cases but one suspected beneath the posterior horn of the medial meniscus without symptoms. According the International Knee Documentation Committee(IKDC)criteria, subjective knee score was 63.4?5.1 and 87.9?4.9, and the Lysholm score were 35.6?4.7 and 86.3?5.6 respectively before surgery and at the last follow-up. 3 cases with postoperative knee instability were subjected to anterior cruciate ligament reconstruction because of its deficiency 3-5 months after synovectomy. Conclusion In case of diffused pigmented villonodular synovitis of the knee joint, arthroscopical total synovectomy is able to prevent recurrence and to assure the good surgical results. The procedure is minimally invasive, and useful to restore knee function.
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Objective To study the clinical outcome of arthroscopic reconstruction of posterior cruciate ligament (PCL) with hamstring tendons and mini-plate and button. Methods From January 1998 to December 2000, 21 cases of PCL ruptures were reconstructed arthroscopically with five to seven strands of hamstring tendons and mini-plate and button. There were 14 males and 7 females aging from 27 to 49 years with the mean age of 36.4 years. All of the patients were free from posterolateral corner ligament injury. The interval from injury to diagnosis was 2.5 months ranging from 2 weeks to 15 months. There were 3 fresh and 18 old injuries. The patients were followed up for more than 12 months and were evaluated for knee function. Results No extension limitation occurred and the flexion degree were more than 120? in all cases 3 months postoperatively. One year after operation, the quadriceps-hamstrings peak torque ratio reached more than 90% of the uninjured leg; posterior drawer test at 70? flexion were negative in all but two cases who had one-degree instability; posterior drawer test at 30? flexion were one degree positive in six cases, and negative in other cases; the Lysholm knee score were 90.7?2.3. Conclusion Arthroscopic reconstruction of PCL with hamstring tendons and mini-plate and button is relatively simple and reliable for the restoration of knee function.