Comparative study of arthroscopic coracoacromial ligament augmentation and clavicular hook plate for treatment of acromioclavicular joint dislocation / 中华创伤杂志

Objective To compare the outcomes of arthroscopic coracoacromial ligament augmentation and clavicular hook plating in treatment of acromioclavicular joint dislocation.Methods From March 2008 to March 2012,47 patients with acute closed type Ⅲ-Ⅴ acromioclavicular joint dislocations underwent an arthroscopic repair with coracoacromial ligament augmentation and suture (ligament augmentation group,23 patients) and with AO clavicular hook plate (hook plate group,24 cases).Mean age of the patients (32 males and 15 females) was 34.8 years (range,17-45 years).There were 32 left and 15 right injuries.Postoperative outcome was assessed through radiographic examination,American Shoulder and Elbow Surgeon (ASES) score and Karlsson scoring method.Results Mean period of follow-up was 18 months (range,12-24 months).In ligament augmentation group ASES score improved from (28.7 ± 7.3) points preoperatively to (96.3 ± 6.9) points postoperatively (t =51.34,P ＜ 0.05).In hook plate group ASES score improved from (29.3 ± 7.6) points preoperatively to (83.6 ± 8.5) points postoperatively (t =43.78,P ＜ 0.05).Postoperative radiographic examination showed well joint reduction of all patients.Good and excellent results with the Karlsson score accounted for 96％ (22/23) in ligament augmentation group and 71％ (17/24) in hook plate group (x2 =9.05,P ＜0.05).Conclusions Efficacy of coracoacromial ligament augmentation and suture for the treatment of acromioclavicular joint dislocation is better than clavicular hook plate.Coracoacromial ligament augmentation and suture are associated with lower incidence of shoulder pain and shoulder activity limitation,shorter recovery time,fewer complications and early activities.

The clinical research on using the anterior half of the peroneus longus tendon as an autograft source / 中华骨科杂志

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.

Treatment of recurrent patellar dislocation via medial patellofemoral ligament reconstruction with partial peroneus longus tendon / 中华创伤杂志

Objective To investigate effects of arthroscopic reconstruction of medial patellofemoral ligament (MPFL) using partial peroneus longus tendon autograft in treating recurrent patellar dislocation.Methods Forty-six patients (53 knees) with recurrent dislocation of patella received autologous partial peroneus longus tendon grafting for MPFL reconstruction after arthroscopic lateral retinaculum release from May 2009 to April 2010.Anatomic relation between femoral trochlea and patella,and motion path of patella were observed arthroscopically in adjustment of flexion and extension strength of grafted tendon in different angles.Successively,the tendon ends were fixed within bone tunnel of medial femoral condyle by using absorbable interface screws with synchronous superomedial displacement of tibial tuberosity.Stability of patellofemoral joint,dislocation recurrence,subjective symptoms of affected knees and general function recovery condition of affected limbs were studied.Results All patients were followed up for average 18 months (range,12-24 months),which showed the improvement of knee joint stability,without recurrence of patellar dislocation.Apprehensive test was negative.Axial X-ray films and CT of patella showed normal anatomical relation of patellofemoral joint.The Kujala patellar stability questionnaire scored (54.6 ±5.4) points before operation and (92.3 ±8.9) points after operation (t =55.41,P ＜ 0.01).All patients showed some improvement of motor ability after operation.CT examination showed that the congruence angle of patella and femoral trochlea was improved from preoperative (27.8 ± 8.1) ° to postoperative (2.3 ± 9.4) ° (t =20.87,P ＜ 0.01).Otherwise,ankle joint in the tendon donor site acted well,with normal function.Conclusion Arthroscopic lateral patellar retinaculum release and MPFL reconstruction using partialperoneus longus tendon autograft are effective in treatment of recurrent patellar dislocation in combination with superomedial displacement of tibial tuberosity,and avoid potential complications in tendon removal from around knee joint.

Arthroscopic reconstruction of multiple ligaments injury of knees / 中华骨科杂志

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.

Double-bundle anterior cruciate ligament reconstruction with remnant preservation and tensioning / 中华骨科杂志

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.

Arthroscopic augmentation technique with 4-strand semitendinosus tendon for partial tears of the anterior cruciate ligament / 中华创伤杂志

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.

Arthroscopically assisted treatment of the posterolateral depressed tibial plateau fracture / 中华骨科杂志

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.

Arthroscopic augmentation of posterior cruciate ligament with suture fixation / 中华创伤骨科杂志

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.