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Objective:To investigate the clinical outcome of arthroscopic suture-button Bristow procedure using suture-button fixation for treatment of recurrent anterior shoulder instability.Methods:A retrospective case series study was conducted to analyze 28 patients with recurrent anterior shoulder instability admitted to Shanghai Sixth People’s Hospital from March 2015 to September 2018，including 26 males and 2 females，aged 18-36 years ［（24.1 ± 3.2）years］. Preoperative MRI showed Bankart injury and three-dimensional CT showed glenoid bone defect > 15%. The Hill-Sachs injury was found in 27 patients. Arthroscopic Bristow procedure was used to fix coracoid process graft with the suture-button plate and glenoid labial complex was repaired with the suture anchor to treat anterior instability of the shoulder joint. The visual analogue scale （VAS），American shoulder and elbow surgeon （ASES） scale，Constant score and Rowe score were used to evaluate the shoulder joint function preoperatively，at postoperative 3，6，12 months and at the last follow-up. The postoperative infection，neurovascular injury，redislocation and other complications were recorded，and the incidence rate was calculated. The bone resorption and bone healing of coracoid process graft were analyzed by CT.Results:All patients were followed up for 22 - 36 months ［（24.5 ± 6.3） months］. Three months after operation，the VAS，ASES scale and Constant score were not significantly different from those before operation （ P > 0.05）. In comparison，the Rowe score was significantly higher than that before operation （ P < 0.05）. Six and twelve months after operation，the VAS，ASES scale，Constant score and Rowe score were significantly improved from those before operation （ P < 0.05）. At the last follow-up，the VAS decreased from （2.7 ± 1.5）points preoperatively to （0.8 ± 0.3）points，the ASES scale increased from （78.6 ± 12.7）points preoperatively to （92.4 ± 8.4）points，the Constant score increased from （43.4 ± 5.2） points preoperatively to （81.6 ± 6.7） points，the Rowe score increased from （52.3 ± 7.1）preoperatively to （92.7 ± 5.4） points （ P < 0.05）. During the follow-up，there was no infection，neurovascular injury，re-dislocation and other complications. In addition，24 （86%） out of the 28 patient showed healing of coracoid process grafts，and the overall bone resorption rate was （18.4 ± 6.1）%. No patients had glenohumeral joint osteoarthritis. Conclusion:Arthroscopic Bristow procedure using suture-button fixation for treatment of recurrent anterior shoulder instability has advantages of a low rate of postoperative complications and a high union rate，indicating an effective and safe surgical procedure.
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Objective To evaluate the operation and review the clinical effectiveness of arthroscopic tenodesis through double-needles positioning approach to treat proximal lesions of Biceps tendon.Methods From January 2010 to January 2013,55 patients (25 men,30 women) with the mean age of 52.4 (range,37-65) years old who underwent arthroscopic tenodesis through double-needles positioning portal to treat proximal lesions of Biceps tendon were retrospectively analyzed.Shoulder pain of all the patients occurred in pre-operation and aggravated at the time of abduction shoulder joint,which affected the normal life for reasons of weakness.Diagnosis of magnetic resonance imaging (MRI) was proximal lesions of Biceps tendon,which was failed to respond to conservative management of six months.All patients underwent biceps tenodesis under arthroscopy with fixation of two suture anchors through bone,and removed tendon stump finally.All the portals of operation and observation of tendon fixation used double-needles positioning portal.We recorded the general condition of shoulder as the level of pain,sphere of activity,active forward flexion and intensity of adduction in pre-operation,3 months,6 months,12 months and 18 months after operation with American Shoulder and Elbow Surgeons (ASES),shoulder function score of Constant-Murley (Constant) and University of California,Los Angeles (UCLA).Then all data were analyzed statistically.Results All patients were operated successfully and got the mean follow-up of 20 months (range,18-24).The result of MRI showed well healing of tendon without rupture.The shoulder function had basically recovered.In pre-operation,ASES,constant and UCLA scores was 10.22±3.02,35.89±7.25,8.53±2.07 respectively.In 18 months after operation,the scores were 32.07± 1.26,89.75±4.07,31.87±2.07 respectively.The outcomes demonstrated that all scores in 18 months after operation had significantly improved,compared to pre-operation.Conclusion The technique of arthroscopic tenodesis through double-needles positioning approach to treat proximal lesions of Biceps tendon is reliable and simple,and can achieve satisfactory clinical outcomes.
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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.
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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 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 degradation of dicalcium phosphate dehydrate-coated Mg-Zn alloy in vivo and bone formation. Methods Left femoral condyles were drilled in 72 New Zealand rabbits, and were randomly divided into experiment group (n＝24, implanted with dicalcium phosphate dehydrate-coated Mg-Zn alloy rods), Mg-Zn alloy control group (n＝24, implanted with Mg-Zn alloy rods) and poly-L-lactide acid rod group (n＝24, implanted with poly-L-lactide acid rods). Serum concentrations of Mg~(2+) were examined 1 d pre-operation, and 1 d, 1 week, 2 weeks, 5 weeks and 10 weeks post-operation in experiment group and Mg-Zn alloy control group. Operation sites were examined by X-rays at 3, 6, 12 and 18 weeks post-operation. After X-ray examination at each time point, 6 rabbits in each group were sacrificed, and subjected to histopathological observation of live and kidney tissues by HE staining. Tissues from condyles of femur were observed by HE staining and 2, 4, 6-trinitrophenol rosein staining, and mineral apposition rate of bone was calculated. Results There was no significant difference in the concentrations of serum Mg~(2+) at each time point between Mg-Zn alloy control group and experiment group (P>0.05). X-ray examination revealed gas emerged near the implants 3 weeks after surgery in Mg-Zn alloy control group. However, there was no obvious histological abnormality in liver and kidney tissues. The mineral apposition rate was higher and the degradation of material was lower in experiment group than those in the other two groups. Conclusion Dicalcium phosphate dehydrate-coated Mg-Zn alloy has a favourable biocompatibility, and degrades more slowly in vivo.
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BACKGROUND: A novel biodegradable Mg-Zn alloy is designed which the density and the Young's modulus are proximal to human bone. At the same time, it depletes the toxicity of aluminium and rare earth element in commercial magnesium alloys. OBJECTIVE: To observe the effect of Mg-Zn alloy (Mg-6%Zn) on the integrin βi expression of preosteoblasts MC3T3-E1. DESIGN, TIME AND SETTING: A contrast study was performed at the Central Laboratory of the Sixth People's Hospital Affiliated to Shanghai Jiao Tong University between March and May 2008. MATERIALS: The Mg-6% Zn was prepared by School of Materials Science and Engineering of Shanghai Jiao Tong University, which the density was 1.82 g/cm~3 and the Young's modulus was nearly 44 GPa. Poly-L-lactic acid (PLLA) was used as the controls. MC3T3-E1 cells were provided by Chinese Academy of Science Type Culture Collection. METHODS: The cell attachment was observed after cultured with Mg-Zn and PLLA at 2, 24 and 48 hours under scanning electron microscope; the integrin β1 mRNA expression of MC3T3-E1 cultured with Mg-Zn and PLLA was estimated by real-time fluorescent quantitative polymerase chain reaction (real-time PCR) at days 1, 3, 6, 9,12 and 15 after culture. MAIN OUTCOME MEASURES: The MC3T3-E1 cells attachment on the material surface and the integrin β1 mRNA expression. RESULTS: MC3T3-E1 cell adhesion was better on the Mg-Zn alloy surfaces than on the PLLA surface; The integrin (31 mRNA of osteoblasts on Mg-Zn kept on expressing during experiment and increased with time (P < 0.01), but there was no significantly difference between the two groups at the same time (P > 0.05). CONCLUSION: MC3T3-E1 cell adhesion is better on the Mg-Zn alloy surfaces than on the PLLA surface, but it is not mediated by inducing the integrin p1 mRNA expression.
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BACKGROUND:A novel biodegradable Mg-Zn alloy has been designed,in which the density and the Young's modulus are proximal to human bone,at the same time,it depletes the toxicity of aluminium and rare earth element in commercial magnesium alloys.OBJECTIVE:To evaluate the cytocompatibility of biodegradable Mg-Zn alloy.DESIGN,TIME AND SETTING:Contrast study was performed in the central laboratory of the Sixth People's Hospital of Shanghai Jiao Tong University between November 2007 and March 2008.MATERIALS:The Mg-6wt%Zn was prepared by School of Materials Science and Engineering of Shanghai Jiao Tong University,with the density was 1.82 g/cm3 and the Young's modulus was 44 GPa.L-929 cells for cytocompatibility test were provided by Chinese Academy of Science Type Culture Collection.Ten male New Zealand rabbits were employed in the hemolysis test.METHODS:The Mg-Zn alloy extraction medium was prepared by serial dilutions with fresh medium to 10%,50% and 100%.The experiments were carried out in a 96-well tissue-culture plate.Simple DMEM culture solution was taken as negative controls,while DMEM culture solution supplemented with 0.64% phenol served as positive controls.MAIN OUTCOME MEASURES:Relative proliferation rate of L-929 cells was determined at 2,4 and 7 days with MTT assay.The cytotoxicity of Mg-Zn alloy was evaluated according to ISO 10993-5:1999.The L-929 cell morphology and growth at 2,4 and 7 days were determined under inverted microscope.Based on ISO 10993-4:2002,hemolysis in vitro was evaluated through measuring erythrocyte lysis and ferrohemoglobin freeing degree with indirect contact method.RESULTS:The number of L-929 cells increased significantly and the morphology was not changed.The growth and morphology of cells in different Mg-Zn extraction medium had no difference from negative control group.Cytotoxicity test showed that biodegradable Mg-Zn alloy did not have obvious toxicity on L-929 cells,and the cytotoxicity of these extracts was in grade 0-1.Hemolysis test suggested that the Mg-Zn alloys did not have obvious hemolysis reaction,and the hemolysis index was 3.4%,which was less than the national standard (5%).CONCLUSION:The Mg-Zn alloys do not have obvious cytotoxicity and hemolysis reaction,which demonstrate that Mg-Zn alloys have good cytocompatibility.
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Objective To compare the clinical results of two bundle anterior cruciate ligament(ACL) reconstruction respectively with four and eight strands of hamstring tendons. Methods 76 patients with chronic ACL rupture were randomized separated in two groups for two bundle ACL reconstruction. In the first group the semitendinous tendon was used to make two two-stranded grafts. In the second group the semitendinous tendon was used to make one four-stranded graft, and the gracilis tendon was used to make the other four-stranded graft. 33 patients in the four-strands group and 35 patients in the eight-strands group were followed up for more than one year. IKDC and Lysholm scales were used to evaluate the clinical results. Results In the four-stranded graft group, the side to side difference was
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Objective To introduce the way of arthroscopic patellar retinaculum adjustment and Fulkerson osteotomy, and to study its clinical results. Methods 35 cases of recurrent patella dislocation were treated by modified Fulkerson tibial tubercle anteromedial transfer, and arthroscopic patellar retinaculum adjustment including the medial retinaculum plication and lateral retinaculum releasing. The tibial tubercle was transferred 1.5 cm anteriorly and medially, and fixed with three Kirschner wires. The patients were followed for 25 months in average. The rate of reccurence, the subjective symptoms and the function of the injured leg were evaluated according to the IKDC and Lysholm rating scale. X-ray examination was taken to evaluate the patella-femur congruence. Results There were no recurrence at the last follow-up. Anterior knee pain, though in slight degree, still existed in 8 cases. The IKDC subjective knee scores were 37.4?4.9 and 92.1?5.3(P
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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.