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BACKGROUND: Children and adolescents are in the growth and development stage, so the use of the same reconstruction methods as adults is easy to induce complications including limb length differences, high graft failure rate and re-surgical intervention. Simultaneously, the occurrence of osteoarthritis will also be advanced. OBJECTIVE: To explore the anatomical characteristics of the anterior cruciate ligament between children, adolescents and adults on MRI, and to provide an anatomical basis for the reconstruction of the anterior cruciate ligament in children and adolescents. METHODS: A retrospective analysis of patients undergoing knee MRI examination in Qingdao Municipal Hospital from October 2016 to October 2018 was conducted. These patients were divided into child and adolescent group and adult group (n=48 per group). The angle between the anterior cruciate ligament and the tibia and femur on the sagittal plane and the position of the anterior cruciate ligament tibial insertion, the angle between the anterior cruciate ligament and the tibia on the coronal plane, the tibial insertion of the anterior cruciate ligament and femur, and the position of the femur stop point on the axial position were measured in both groups. The data obtained from the measurement of the anterior cruciate ligament of children and adolescents were processed. The growth curves of the shape and position of the anterior cruciate ligament of children and adolescents were drawn, and the law of its growth changes was analyzed. RESULTS AND CONCLUSION: (1) The angle between the sagittal plane of the anterior cruciate ligament and the femur (t=﹣2.906, P<0.05), the angle between the sagittal plane of the anterior cruciate ligament and the tibia (t=﹣10.280, P < 0.05), the anterior cruciate ligament angle between the coronal plane and the tibia (t=﹣5.714, P<0.05) were smaller in the child and adolescent group than those of the adult group, and the difference was significant. (2) The ratio of the tibia coronal plane of the anterior cruciate ligament (t=﹣7.263, P < 0.05) and the ratio of the anterior cruciate ligament and femur axial plane (t=﹣7.378, P < 0.05) were lower in the child and adolescent group than those of the adult group, and the difference was significant. (3) There was no significant difference in the anterior cruciate ligament and tibia sagittal plane ratio (t=﹣1.588, P>0.05) and anterior cruciate ligament and femoral coronal surface ratio (t=﹣1.647, P>0.05) between the child and adolescent group and the adult group. (4) The growth curve results showed that during the growth and development, the angle between the anterior cruciate ligament and the femur and tibia on the sagittal plane and the angle with the tibia on the coronal plane changed from small to large (P<0.05). The relative position of the tibial insertion in the coronal position changed from small to large, which indicates that during the growth and development, the tibial insertion moved from inside to outside relative to the inside of the tibial plateau on the coronal plane (P < 0.05). (5) The relative position of femoral insertion in the axial position changed from small to large, suggesting that during the growth and development, the femoral insertion moved from the outside to the inside relative to the lateral femoral condyle (P<0.05). (6) There was no significant difference in the tibial insertion and the femoral insertion between the child and adolescent group and adult group (P>0.05).
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BACKGROUND:Total knee arthroplasty had been generaly accepted as the final treatment plan, relieving pain and reconstructing function of knee joint. However, whether drainage tube can be used after replacement is stil controversial. OBJECTIVE:To compare the clinical effects of drainageversusnondrainage after primary unilateral total knee arthroplasty. METHODS:Total 102 patients undergoing primary unilateral total knee arthroplasty were randomly divided into 2 groups. In the drainagegroiup, a drainage tube was used. In the nondrainage group, drainage tube was not used. Total blood loss was calculated by recording the hemoglobin and hematocrit before operation and that after 1, 3, 7 days of operation. The pain visual analogue scale scores, arthrocele, ecchymosis, infection rate, and deep venous thrombosis of lower extremity were examined and analyzed postoperatively. Knee Society Scores were recorded at 1 year postoperatively. Above indexes were compared between the two groups. RESULTS AND CONCLUSION:(1) Total blood loss and blood transfusion rate were significantly higher in the drainage group than in the nondrainage group (P 0.05). (3) No significant difference in Knee Society Scores was detected between the two groups (P> 0.05). (4) Results indicated that the total blood loss and blood transfusion rate may decrease significantly in patients without wound drainage after total knee arthroplasty. Limb sweling and ecchymosis area were not increased. No significant difference in infection, deep venousthrombosis of lower extremity and knee function was detectable between the two groups. Thus, total knee arthroplasty without wound drainage is safe and does not have obvious adverse consequences.
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BACKGROUND:There were certain differences in the anatomical structure of knee joint between man and woman. Gender knee solution is a new type of artificial knee joint prosthesis, which is specialy designed for women. Theoreticaly, the outcome of unisex total knee arthroplasty prosthesis should be related to gender, but we did not find very obvious differences in practical clinical work. OBJECTIVE:To analyze the differences in curative effects of the unisex knee arthroplasty prosthesis between male and female patients undergoing total knee arthroplasty so as to find out if it is necessary to apply female knee prosthesis among appropriate crowd. METHODS: We retrospectively analyzed the clinical data of patients undergoing total knee arthroplasty from May 2001 to June 2011. Among 312 patients (350 knees receiving total knee arthroplasty), patients who died within 3 years after surgery, lost to folow-up and underwent revision were excluded. Changes in knee functions and imaging were observed between males and females. RESULTS AND CONCLUSION:The women and men had similar mean pre-operative knee scores, flexion function, pain score among 285 patients (300 knees). However, the women had significantly lower mean extension function and function scores than the men. There were no significant differences in improvement in the knee scores, flexion, the pain and knee function between women and men before and after surgery. Nevertheless, men had better extension than women. No significant difference in radiolucencies and complications was seen between females and males. Therefore, there was little difference in outcomes between women and men who used the unisex total knee arthroplasty prosthesis.
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BACKGROUND: Traditional repair for Achilles tendon rupture has disadvantages of long cast immobilization times, poor outcomes and many complications.OBJECTIVE: To explore the safety and efficacy of early isokinetic rehabilitation training for patients after repair of Achilles tendon ruptures.METHODS: A total of 11 patients with Achilles tendon ruptures received treatments at the Department of Orthopedics, East District of Qingdao Municipal Hospital, from September 2007 to September 2009, were included. Nine of them underwent 8-week isokinetic exercises by using lsomed-2000 at 4 weeks after tendon repair. The evaluative indicators included Arner-Lindholm score, the ankle range of motion, and extensor-flexor peak torque.RESULTS AND CONCLUSION: The follow-up averaged 6 months, ranging from 3 to 12 months. The excellent and good rate of Arner-Lindholm score was 88.9%. The results showed a significant improvement in the ankle range of motion and extensor-flexor peak torque (P < 0.05). There were no infection or re-rupture cases. It is indicated that early isokinetic rehabilitation is safe and effective for patients with Achilles tendon ruptures at 4 weeks postoperatively. It provides evidence for early rehabilitation in patients with Achilles tendon ruptures.
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Objective To introduce the method of two bundle anatomical reconstruction of the posterolateral corner(PLC) of the knee using auto-harmstring,and to evaluate the short-term clinical outcomes.Methods Using auto-harmstring,23 knees of 21 cases with acute or chronic posterolateral complex injuries were anatomically reconstructed from March 2003 to November 2005.There were 20 male and 1 female patients(mean age:32.3 years,ranging from 17 to 47 years)in this study with follow-up of at least 12 months(average:26.7 months,ranging from 12 to 31 months.Tow cases had isolated PLC injuries,21 knees had multiligamentous injuries,and 5 cases associated with meniscus injuries.The technique used includes:(1)an autogenous semitendinosus placed through trastibial bone tunnel from posterior to anterior and then turned to transfibulur bone tunnel to reconstruct the popliteus and popliteofibular ligament;(2)an autogenous gracilis tendon placed through transfibulur bone tunnel to reconstruct the fibulocolateral ligament(FCL).The transplanted grafts were secured to the femoral insertion of the popliteus and FCL respectively with metal or bioabsorbable interference screw.All patients were followed-up prospectively with clinical examinations and Lysholm knee scores.Results There was no varus knee instability in full extension,and one-grade varus instability with firm endpoint was found in 2 cases at 30? flexion.There was no increased external rotation in all of the 23 knees at 30? flexions(in prone position).Mean Lysholm knee scores were 89.2(range from 88 to 100).Conclusions Two bundle anatomical reconstruction of the PLC of the knee using auto-harmstring yields a stable knee with excellent function,mini-trauma,and reliable fixation of grafts,this technique is an ideal method for the treatment of PLC injuries.
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Objective To describe an alternative procedure of arthroscopic double-bundle posterior cruciate ligament (PCL)reconstruction using deep-frozen fresh allogenic achilles tendon and evaluate the follow-up outcome in early stage. Methods The ruptured PCL was reconstructed under arthroscopy using deep frozen fresh allogenic achilles tendon preparing in Y-shaped allografts, one bundle was used for anterolateral bundle, the other for posteromedial bundle. Absorbable screw was used to fix the soft tendon graft and metal screw was used to fix the bone graft. Results From March 2003 to August 2004, the procedure of arthroscopic double-bundle PCL reconstruction using allogenic achilles tendon was applied in 10 cases. The average follow-up period was 13.2 months(6～24 months, among them 6 cases were more than 12 months ). 2 cases with anterior cruciate ligament (ACL) injury were also reconstructed with hamstring tendons (semitendinosus and gracilis). 3 cases with rupture of postolateral horn of knee joint were anatomically reconstructed with hamstring tendons. Clinical results were carefully compared using the Lysholm score system before and after the operation, the average score was 50.3 preoperatively, and 91.2 postoperatively. The objective examination showed that the tibia post-migrating sign, posterior drawer test and Lachman test were positive in all the 10 cases preoperatively; whereas the posterior drawer test and Lachman test were negative postoperatively; the tibia post-migrating sign were weak positive in 3 cases with longer clinical histories(more than 1 year); the flexion range of the knee were slightly restricted (5?～20?) in the 2 cases with simultaneous ACL injury. Conclusions Allogenic achilles tendon is an ideal material for arthroscopic double-bundle PCL reconstruction. Arthroscopic double-bundle reconstructed PCL is in accordance with the anatomy and physiology of natural PCL. The injury and complications caused by the autograft can be alleviated. The allograft can be prepared in advance and the soft end of the implant can pass through the bone tunnel easily, and thus the operaton time under arthroscopy can be saved and the trauma caused by arthroscopy is abated. Arthroscopic double-bundle PCL reconstruction is sample, safe and effective.
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Objective To evaluate the clinical results of reconstruction of the posterior cruciate ligament by implanting the middle one third of patellar tendon graft under arthroscope. Methods Twelve patients with the posterior cruciate ligament injury reconstructed with middle one third of bone-patellar tendon-bone graft through an anterior approach under arthroscope were reviewed. Results The average follow up period was 17.3 months. The Larson score rose from 60.7 points to 93.4 points. The Lysholm score rose from 55.0 points to 91.6 points. All patients had positive posterior drawer test and positive Lachman test preoperatively,while only 2 patients had slight positive posterior drawer test and one had slight positive Lachman test at the latest follow up study. Conclusion Under direct visulization of arthroscope, one can accurately locate the anatomic insertion of the PCL, drill holes and transplant tissue grafts. Without capsulular incision, this technique has the advantages of less trauma and lower incidence of adhesion.