ABSTRACT
Objective To explore the feasibility and clinical effect of single bundle anatomic intrathecal reconstruction of proximal injury of anterior cruciate ligament (ACL) using dissociate peroneus longus tendon combined with semitendinosus tendon.Methods From January 2015 to September 2016,a total of 24 patients with proximal injury of ACL,confirmed by arthroscopy,were admitted to the sports medicine department of our hospital.The ACL was completely raptured from the proximal footprint and the tibial side residual remained intact.There were 19 males and 5 females;16 cases on the right side and 8 cases on the left side.The mean age was 27.88±7.13 years old;The interval between injury and surgery was 14.83±9.09 d;The dissociate peroneus longus tendon and semitendinosus tendonfrom the injured extremity were folded in half,then braided and trimmed into ACL graft for use.The ACL remnant was preserved and the graft was pulled through the stump for single bundle anatomic intrathecal reconstruction.The ACL graft was fixed with Endobutton on the femoral side and interference screw on the tibial side.The resuhs of Lachman test,Lysholm scores,Tegner scores and International Knee Documentation Committee (IKDC) subjective scores of knee before operation and at final visit were recorded to evaluate the stability and function of the knee.Visual analogue score (VAS) was used to record the changes of pain at the site where the peroneal longus tendon was harvested.The American Orthopaedic Foot and Ankle Society (AOFAS) Anlle-Hindfoot Scores were recorded before injury and at the final visit to assess the effect of ankle function after peroneal longus tendon resection.Results The diameter of the ACL graft made of dissociate peroneus longus tendon and semitendinosus tendon is 8.88±0.30 mm.All patients were followed up at the outpatient clinic,with an average of 34.38± 5.40 months,and no serious complications such as rerupture and joint infection were found.There were 16 grade B,6 grade C and 2 grade D for preoperative Lachman test,none with hard end point.At last vist,there were 23 cases of grade A and 1 grade B,all with hard end points for Lachman test.At the preoperative and final visit,the Lysholm scores of the knee joint were 35.20±11.92 and 94.29±2.92 (t=23.850,P=0.000).Tegner scores were 3.46±0.93 and 8.04± 1.00 (t=16.653,P=0.000).The subjective IKDC scores of knee joint were 47.63± 13.06 and 91.71 ±3.75 (t=15.972,P=0.000).At the final visit,all the indicators of the knee were improved compared with those before surgery,and the difference was statistically significant.The AOFAS scores before injury and at the final visit were 98.83 (2.78) and 98.17 (4.01),respectively,with no statistically significant difference (t=1.850,P=0.076).The VAS scores for the harvest of theperoneus longus tendon were 4.50± 1.41,0.54±0.65 and 0.29±0.55 immediately and 6 months after the operation and at the last visit.There was statistically significant difference between the scores immediately and 6 months after the operation (t=14.900,P=0.001).There was statistically significant differences between the scores at 6 months after the operation and the final visit (t=2.770,P=0.011).Conclusion Single bundle anatomic intrathecal reconstruction of proximal.injury of ACL using dissociate peroneus longus tendon and semitendinosus tendon is feasible with good clinical effect.
ABSTRACT
Objective@#To explore the feasibility and clinical effect of single bundle anatomic intrathecal reconstruction of proximal injury of anterior cruciate ligament (ACL) using dissociate peroneus longus tendon combined with semitendinosus tendon.@*Methods@#From January 2015 to September 2016, a total of 24 patients with proximal injury of ACL, confirmed by arthroscopy, were admitted to the sports medicine department of our hospital. The ACL was completely ruptured from the proximal footprint and the tibial side residual remained intact. There were 19 males and 5 females; 16 cases on the right side and 8 cases on the left side. The mean age was 27.88±7.13 years old; The interval between injury and surgery was 14.83±9.09 d; The dissociate peroneus longus tendon and semitendinosus tendonfrom the injured extremity were folded in half, then braided and trimmed into ACL graft for use. The ACL remnant was preserved and the graft was pulled through the stump for single bundle anatomic intrathecal reconstruction. The ACL graft was fixed with Endobutton on the femoral side and interference screw on the tibial side. The results of Lachman test, Lysholm scores, Tegner scores and International Knee Documentation Committee (IKDC) subjective scores of knee before operation and at final visit were recorded to evaluate the stability and function of the knee. Visual analogue score (VAS) was used to record the changes of pain at the site where the peroneal longus tendon was harvested. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores were recorded before injury and at the final visit to assess the effect of ankle function after peroneal longus tendon resection.@*Results@#The diameter of the ACL graft made of dissociate peroneus longus tendon and semitendinosus tendon is 8.88±0.30 mm. All patients were followed up at the outpatient clinic, with an average of 34.38±5.40 months, and no serious complications such as rerupture and joint infection were found. There were 16 grade B, 6 grade C and 2 grade D for preoperative Lachman test, none with hard end point. At last vist, there were 23 cases of grade A and 1 grade B, all with hard end points for Lachman test. At the preoperative and final visit, the Lysholm scores of the knee joint were 35.20±11.92 and 94.29±2.92 (t=23.850, P=0.000). Tegner scores were 3.46±0.93 and 8.04±1.00 (t=16.653, P=0.000). The subjective IKDC scores of knee joint were 47.63±13.06 and 91.71±3.75 (t=15.972, P=0.000). At the final visit, all the indicators of the knee were improved compared with those before surgery, and the difference was statistically significant.The AOFAS scores before injury and at the final visit were 98.83 (2.78) and 98.17 (4.01), respectively, with no statistically significant difference (t=1.850, P=0.076) . The VAS scores for the harvest of theperoneus longus tendon were 4.50±1.41, 0.54±0.65 and 0.29±0.55 immediately and 6 months after the operation and at the last visit.There was statistically significant difference between the scores immediately and 6 months after the operation (t=14.900, P=0.001).There was statistically significant differences between the scores at 6 months after the operation and the final visit (t=2.770, P=0.011).@*Conclusion@#Single bundle anatomic intrathecal reconstruction of proximal injury of ACL using dissociate peroneus longus tendon and semitendinosus tendon is feasible with good clinical effect.
ABSTRACT
Objective To investigate the clinical effect of elbow anterolateral approach with internal fixation in the treatment of capitellum fractures.Methods 12 patients with capitellum fractures were divided into types according to Bryan-Morrey classification:type Ⅰ (n=8),type Ⅱ (n=2),type Ⅳ (n=2).Patients were treated with anterolateral approach with AO cannulated screw fixation.Curative effect was evaluated according to Broberg-Morrey scale.Imaging evaluation was conducted.Results No lateral collateral ligament injury,blood vessels or nerve injury were found in patients.Primary healings were obtained after operation.All patients were followed up for 8 to 26 months postoperatively (averaged 16 months).All fractures were healed at 5 to 9 weeks after operation (averaged 7.2 weeks).Postoperative elbow flexion and extension was averaged (127.2±12.8) ° and forearm rotation was averaged (154.6 ± 15.3)°.Postoperative Broberg-Morrey score was averaged 90.5.The 8 cases were excellent,3 cases good and 1 case poor.Conclusions Operation should be applicated according to fracture classification in the treatment of capitellum fractures.Anterolateral approach is better to expose the fracture,which is convenient for operation,and AO cannulated screw fixation can fix the fractures firmly.Clinical effect is satisfactory when taking early functional exercise for elbow joint.