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Objective:To investigate the relationship between anterior tibial translation (ATT) and bony morphology around the knee after anterior cruciate ligament (ACL) injury.Methods:A total of 67 patients diagnosed with acute ACL injury without any meniscal lesions were enrolled in this study between September 2019 and August 2020. Preoperative magnetic resonance imaging (MRI) scans were used to measure the ATT of the lateral compartment, and bony morphology was assessed by measuring lateral femoral condyle (LFC) length, LFC height, lateral tibial plateau (LTP) length, LTP slope and by calculating the following ratios: LFC ratio (LFC length/LFC height), knee extension ratio (LFC length/LTP length), and knee flexion ratio (LFC height/LTP length). The status of the anterolateral ligament (ALL) was assessed by preoperative MRI scans and classified as completely injured (44 patients), partially injured (19 patients), or intact (4 patients). The ATT was compared between patients with completely injured ALL and those with partially injured or intact ALL. Pearson correlation analysis between the ATT and each bony variable was performed in ALL-completely-injured patients and ALL-partially-injured or intact patients.Results:Of the 67 patients, 33 were male and 34 were female, with a mean of age 31.7±9.7 years (range 15-47 years). The average of time interval between ACL injury and MRI examination was 26.0±22.0 days (95% CI: 20.7, 31.4 d). The ATT of the lateral compartment was 5.6±4.0 mm (range, -4.9-16.2 mm), the average of LFC length was 37.3±2.5 mm (range, 30.5-43.2 mm), the average of LFC height was 37.4±3.6 mm (range, 30.6-46.3 mm), the average of LTP length was 46.9±4.1 mm (range, 39.0-56.8 mm), the average of LTP slope was 6.3°±3.1° (range, -3.7°-11.6°), LFC ratio was 100.4%±8.1% (range, 84.1%-119.0%), knee extension ratio was 80.0%±5.8% (range, 66.1%-96.3%), and knee flexion ratio was 80.0%±6.0% (range, 66.4%-93.8%). The ATT was greater in patients with completely injured ALL than in patients with partially injured or intact ALL (6.4±4.3 mm vs. 3.9±2.8 mm, t=2.52, P=0.014). The ATT was negatively correlated with LFC height ( r=-0.43, P<0.001) and LTP length ( r=-0.35, P=0.004) and was positively correlated with LFC ratio ( r=0.48, P<0.001), knee extension ratio ( r=0.36, P=0.003), and LTP slope ( r=0.29, P=0.018). All these correlations were still statistically significant in patients with complete ALL injury ( P<0.05), but were no significant in patients with partial ALL injury or intact ALL ( P>0.05). Conclusion:Bony morphology of the distal femur and proximal tibia was associated with ATT after ACL injury. Such an association was more dramatic in patients with a complete ALL injury.
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Objective:To evaluate the clinical outcomes in anterior cruciate ligament (ACL) patients undergoing ACL reconstruction combined with anterolateral ligament (ALL) reconstruction in treating patients with Grade 2 pivot-shift.Methods:From October 2015 to August 2018, a total of 59 patients with Grade 2 pivot shift were allocated into ALL reconstruction group underwent combined ACL and ALL reconstruction ( n=29) and control group underwent isolated ACL reconstruction ( n=30). Lachman, pivot-shift and KT-1000 side-to-side difference test were used to determine the knee laxity. International Knee Documentation Committee (IKDC) subjective score and Lysholm score were used to assess the knee function. The results of Lachman test and pivot-shift test were classified into -, 1+, 2+, 3+. Results:All patients were followed up for 1 year. The average age was 30.5±8.3 years (range, 15-48 years) in ALL reconstruction group with 5 months duration from injury. The left knee was involved in 11 cases, while 18 cases in right knee in ALL reconstruction group. There were 15 cases with injury in medial meniscus and 8 cases in lateral meniscus. In control group, the average age was 32.2±9.7 years (range 17-51 years) with 14 cases in left knees and 16 in right knees. In these patients, 18 of them had medial meniscus injury, while other 11 patients had lateral meniscus injury. The average duration from injury to surgery was 7 months. The Lachman test (-: 25, 1+: 4 vs. -: 25, 1+: 4, Z=-0.91, P=0.361), KT-1000 arthrometer (1.9±1.3 mm vs. 2.2±1.3 mm, t=0.66, P=0.513), IKDC subjective score (92.4±5.6 vs. 90.2±6.7, t=1.37, P=0.176) and Lysholm score (91.0±6.2 vs. 89.1±5.0, t=1.29, P=0.201) did not show significant difference between the two groups. Pivot-shift test (-:27, 1+: 2 vs. -: 20, 1+: 8, 2+: 2, Z=-0.66, P=0.507). Pivot-shift test was significantly superior in ALL reconstruction group compared with that in control group (6.5% vs.33.3%, χ 2=21.70, P<0.001). Conclusion:Patients with preoperative Grade 2 pivot shift had significant improvement in rotatory knee laxity after ACL reconstruction combined with ALL reconstruction compared with isolated ACL reconstruction. However, there was no significant difference in anterior laxity and knee function scores between the two groups.
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Objective:To evaluate the outcome of arthroscopic surgical treatment for recalcitrant tennis elbow combined with degenerative lateral ulnar collateral ligament (LUCL) lesions.Methods:A retrospective case series study was made on clinical data of 27 patients with recalcitrant tennis elbow combined with degenerative LUCL lesions admitted to Beijing Jishuitan Hospital from June 2014 to December 2020. There were 19 males and 8 females, with the age range of 39-56 years [(49.8±6.9)years]. The degenerative LUCL lesions were evaluated arthroscopically. Arthroscopic LUCL debridement and shrinkage combined with repair of extensor carpi radialis brevis (ECRB) were performed in all patients. The operation time, intraoperative bleeding volume and length of hospital stay were recorded. The visual analogue scale (VAS), Mayo elbow performance score (MEPS), patient-rated tennis elbow evaluation (PRTEE) scale, and disability of the arm, shoulder and hand (DASH) questionnaire were evaluated and compared preoperatively and at the final follow-up.Results:All patients were followed up for 12-73 months [(24.1±9.7)months], with the operation time of 0.75-1 hours [(0.8±0.2)hours], intraoperative bleeding volume of 5-10 ml [(7.2±1.5)ml], and length of hospital stay of 4-12 days [(6.2±2.1)days]. The VAS, MEPS, PRTEE and DASH scores were significantly improved at postoperative 1 year [1(1,2)points, 95(85,100)points, 8(6,12)points and 12.9(8.9,15.8)points] when compared with those preoperatively [5(3,6)points, 70(65,85)points, 47(42,62)points and 43.8(36.8,49.0)points] (all P<0.01). No patients had limited range of motion, wound infection, heterotopic ossification, traumatic arthritis and other complications. Conclusion:For recalcitrant tennis elbow combined with degenerative LUCL lesions, arthroscopic LUCL debridement and shrinkage combined with ECRB repair can achieve pain relief and elbow function recovery.
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Objective:To investigate the short-term clinical outcomes of patients who received combined anterior closing-wedge high tibial osteotomy (ACW-HTO) and anterior cruciate ligament (ACL) reconstruction in treating chronic ACL injury with increased posterior tibial slope (PTS).Methods:From January 2017 to June 2018, a total of 54 patients (46 males and 8 females, mean age 30.8±3.9 years, range from 20 to 42 years) with chronic (time from injury to surgery was more than 6 months) ACL injury and increased PTS (>17°) were retrospectively analyzed. Eighteen of them received combined ACW-HTO and ACL reconstruction (ACW-HTO+ACL reconstruction group), while the remaining 36 received isolated ACL reconstruction (ACL reconstruction group). The demographic data, pre-operative and post-operative anterior tibial translation, pivot-shift result, KT-1000 side-to-side difference, subjective Lysholm score, Tegner activity score, and International Knee Documentation Committee (IKDC) objective grading system were collected and compared between the two groups.Results:There were no significant differences between the two groups in terms of age, sex, body mass index, time from injury to surgery and proportion of patients with concomitant medial or lateral meniscus tear ( P>0.05). At 2-year's follow-up, the anterior tibial translation in the ACW-HTO+ACL reconstruction group was 0.9±0.4 mm, which was significantly smaller than that in the ACL reconstruction group 7.3±1.5 mm ( t=10.049, P<0.001). Moreover, there was significant difference in the pivot-shift result between the two groups (ACW-HTO+ACL reconstruction group: 18 low-grade vs. ACL reconstruction group: 31 low-grade, 5 high-grade) (χ 2=16.071, P<0.001). The KT-1000 side-to-side difference in the ACW-HTO+ACL reconstruction group was 1.5±0.6 mm, which was significantly smaller than that in the ACL reconstruction group 4.4±1.2 mm ( t=13.858, P<0.001). In addition, the subjective Lysholm score in the ACW-HTO+ACL reconstruction group was 93.3±4.3, which was significantly higher than that in the ACL reconstruction group 80.3±6.3 ( t=12.176, P<0.001). The Tegner activity score in the ACW-HTO+ACL reconstruction group was 7.3±0.9, which was significantly higher than that in the ACL reconstruction group 6.8±0.6 ( t=6.356, P=0.043). There was significant difference in terms of the IKDC objective grading system between the two groups (ACW-HTO+ACL reconstruction group: 17 grade A, 1 grade B vs. ACL reconstruction group: 29 grade A, 5 grade B, 2 grade C) (χ 2=12.351, P<0.001). Conclusion:The combined ACW-HTO and ACL reconstruction showed superior short-term knee stability and functional scores compared with the isolated ACL reconstruction in treating chronic ACL injury with increased PTS.
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Objective:To explore the risk factors of primary anterior cruciate ligament (ACL) reconstruction failure.Methods:From November 2015 to May 2017, a total of 178 consecutive patients with clinically diagnosed non-contact ACL injury were treated and followed-up more than 2 years. Twenty-five patients (post-operative failure group) who underwent completely ruptured ACL graft confirmed by MRI, positive pivot-shift test, more than 5 mm side-to-side difference (SSD) measured by KT-1000 arthrometer, more than 5 mm static anterior tibial translation (ATT) measured on MRI were determined to be ACL reconstruction failure. They were matched in a 1∶2 fashion to 50 non-failure patients (post-operative non-failure group), who showed intact ACL graft 2 years after ACL reconstruction. The sex, age, body mass index (BMI), affected side, meniscal injury side, time from injury to surgery, KT-1000 SSD, pivot shift test under anesthesia, follow-up duration, posterior tibial slope (PTS) and ATT measured on the pre-operative weight-bearing whole leg radiographs between the two groups were compared using univariate analysis. Moreover, the predictors of ACL reconstruction failure were assessed by multivariable conditional Logistic regression analysis.Results:Post-operative failure group had a significantly higher PTS and ATT values than those in the post-operative non-failure group (17.21°±2.20° vs 14.36°±2.72°, t=4.395, P<0.001; 8.29±3.42 mm vs 4.09±3.06 mm, t=5.504, P<0.001). The sex, age, BMI, affected side, meniscal injury side, time from injury to surgery, KT-1000 SSD, pivot shift test under anesthesia, follow-up duration between the two groups showed no significant difference ( P>0.05). Multivariable Logistic regressions indicated that PTS≥17° ( OR=15.62, P=0.002) and ATT≥6 mm ( OR=9.91, P=0.006) were independent risk factors for primary ACL reconstruction failure. However, sex, age, BMI, meniscal lesions, degree of pivot shift test, KT-1000 SSD were not the independent risk factors. Conclusion:PTS≥17° and ATT≥6 mm could increase the risk of primary ACL reconstruction failure.
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Objective:To evaluate the clinical, radiological and arthroscopic outcomes after surgical repair for chronic lateral meniscus posterior root (LMPR) avulsion combined with anterior cruciate ligament (ACL) reconstruction.Methods:From July 2015 to June 2017, a total of 33 patients who underwent transtibial pull-out suture repair for chronic LMPR avulsion combined with anatomic single-bundle ACL reconstruction with hamstring graft were retrospectively reviewed. There were 30 males and 3 females with an average age of 27.7±7.5 years (range 17-45 years) and a mean BMI of 25.2±3.7 kg/m 2 (range 19.4-36.7 kg/m 2). All patients were available for at least two years of follow-up. A second-look arthroscopy was performed to evaluate the healing status of the repaired meniscus. Subjective knee function was assessed through Lysholm and Tegner scores. Objective knee stability was evaluated using KT-1000 arthrometer side-to-side difference (SSD) and pivot shift test under anesthesia. The tibiofemoral relationship was evaluated by anterior tibial subluxation (ATS) measured on axial MRI. Between patients with preoperative ATS ≥6 mm (18 patients in the ATS positive group) and <6 mm (15 patients in the ATS negative group), the postoperative ATS and the reduction of ATS was also compared. Results:After a mean follow-up of 27.5±4.0 months (range 24-39 months), the LMPR avulsion completely healed in 23 (70%) cases, partially healed in 9 (27%) cases, failed to heal in 1 (3%) case on second-look arthroscopy. The Lysholm score was increased from 60.4±13.6 to 82.7±11.1 at 1 year and to 91.4±9.1 at 2 years operatively ( F=155.996, P<0.001). The Tegner score was increased from 3(2, 5) to 4(3, 5) at 1 year and 6(4, 6) at 2 years postoperatively (χ 2=47.791, P<0.001). The KT-1000 SSD was decreased from 9.1±3.3 mm to 2.0±1.7 mm ( t=11.197, P<0.001). The result of pivot shift test was also improved (10 grade I, 20 grade II, 3 grade III, preoperatively vs 30 grade 0, 3 grade I, postoperatively, U=5.161, P<0.001). The ATS was reduced from 5.7±3.9 mm to 3.5±3.2 mm ( t=3.530, P=0.001). However, there was no statistically significant decrease in the ATS of the ATS negative group ( t=0.400, P=0.695). The ATS of the ATS positive group was reduced from 8.7±1.8 mm to 5.0±3.3 mm ( t=4.765, P<0.001), and the ATS reduction of the ATS positive group was greater than that of the ATS negative group (3.7±3.3 mm vs 0.3±2.8 mm, t=3.115, P=0.004). Conclusion:In patients undergoing ACL reconstruction, the transtibial pull-out suture repair for chronic LMPR avulsion yielded meniscus healing rate of 97% with improved subjective knee function and objective knee stability and better restored the tibiofemoral relationship for patients with excessive ATS.
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Objective@#To investigate the association between high-grade pivot-shift and complete lateral meniscus posterior root (LMPR) tear in patients with anterior cruciate ligament (ACL) ruptures.@*Methods@#From January 2013 to December 2017, a total of 86 ACL injured patients with LMPR tears were reviewed retrospectively. There were 66 males and 20 females with an average age of 27.8±8.3 years (range 16-49 years) and an mean BMI of 25.1±3.2 kg/m2 (range 17.4-33.9 kg/m2). The average duration from injury to surgery was 33.5±79.4 weeks (range 3 days to 11 years). All patients were classified into high-grade pivot-shift group (60 patients of IKDC grade II-III) and low-grade pivot-shift group (26 patients of IKDC grade 0-I) according to the results of pivot-shift tests under anesthesia before ACL reconstructions. Predictive factors of high-grade pivot-shift were analyzed by multivariable Logistic regression, involving degree of LMPR tear, integrity of meniscofemoral ligament, width of lateral meniscal extrusion, KT-1000 arthrometer side-to-side difference, age, sex, and BMI.@*Results@#The prevalence of complete LMPR tear in high-grade pivot-shift group was higher than that in low-grade pivot-shift group. High-grade pivot-shift was associated to complete LMPR tear [OR=4.096, 95% CI(1.339, 12.371), P=0.013] and KT-1000 arthrometer side-to-side difference [OR=9.632, 95% CI (3.095, 29.975), P<0.001]. The association between high-grade pivot-shift and complete LMPR tear was more striking in patients with duration from injury to surgery ≥12 weeks [OR=8.343, 95%CI(1.224, 56.853), P=0.030]. High-grade pivot-shift did not associated with meniscofemoral ligament, lateral meniscal extrusion, age, sex and BMI (P>0.05).@*Conclusion@#In patients with ACL ruptures, complete LMPR tear was an independent risk factor of high-grade pivot-shift, especially for patients with 12 weeks at least duration from injury to surgery.
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Objective To investigate the association between high-grade pivot-shift and complete lateral meniscus posterior root (LMPR) tear in patients with anterior cruciate ligament (ACL) ruptures.Methods From January 2013 to December 2017,a total of 86 ACL injured patients with LMPR tears were reviewed retrospectively.There were 66 males and 20 females with an average age of 27.8±8.3 years (range 16-49 years) and an mean BMI of 25.1±3.2 kg/m2 (range 17.4-33.9 kg/m2).The average duration from injury to surgery was 33.5±79.4 weeks (range 3 days to 11 years).All patients were classified into high-grade pivotshift group (60 patients of IKDC grade Ⅱ-Ⅲ) and low-grade pivot-shift group (26 patients of IKDC grade 0-I) according to the results of pivot-shift tests under anesthesia before ACL reconstructions.Predictive factors of high-grade pivot-shift were analyzed by multivariable Logistic regression,involving degree of LMPR tear,integrity of meniscofemoral ligament,width of lateral meniscal extrusion,KT-1000 arthrometer side-to-side difference,age,sex,and BMI.Results The prevalence of complete LMPR tear in high-grade pivot-shift group was higher than that in low-grade pivot-shift group.High-grade pivot-shift was associated to complete LMPR tear [OR=4.096,95％CI(1.339,12.371),P=0.013] and KT-1000 arthrometer side-to-side difference [OR=9.632,95％CI (3.095,29.975),P＜0.001].The association between high-grade pivot-shift and complete LMPR tear was more striking in patients with duration from injury to surgery ≥12 weeks [OR=8.343,95％CI(1.224,56.853),P=0.030].High-grade pivot-shift did not associated with meniscofemoral ligament,lateral meniscal extrusion,age,sex and BMI (P＞0.05).Conclusion In patients with ACL ruptures,complete LMPR tear was an independent risk factor of high-grade pivot-shift,especially for patients with 12 weeks at least duration from injury to surgery.
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Objective To discover the relationship between the post?operative positive residual patellar J sign and the laxity of reconstructed medial patellofemoral ligament (MPFL) after MPFL reconstruction combined with tibial tubercle osteotomy (TTO). Methods A total of 39 consecutive recurrent patellar dislocation (RPD) adult patients who were performed MPFL recon?struction and TTO with more than 2 follow?up time were analyzed retrospectively in the present study. The patellar tracking of all the patients was evaluated and was classified into positive patellar J sign group and negative J sign control group during knee ac?tive flexion and extension at final follow up. The computed tomography (CT) examination was performed in all patients at 0°exten?sion of the knee. The patellar laxity index measured by patellar glide test (PGT) and the radiographic parameters (tibial tuberosity?trochlear groove distance, bisect offset index, patella trochlear?groove distance, patella lateral tilt angle, femoral anteversion angle, tibial external angle and knee rotational angle) calculated by CT scans slices as well as the pre?/post?operative knee functional scores including International Knee Documentation Committee (IKDC) score, Kujala score, and Lysholm score were compared be?tween the positive group and negative group at final follow up. Results The average follow?up duration was 26.3±6.7 months (range 24-31) and all the patients did not suffer from the RPD during the follow?up. Ten (26%, 10/39) patients performed positive J sign, and the remaining 29 (74%, 29/39) performed negatively. The two groups were compatible with no significant difference in age, gender, injury side, follow?up duration and preoperative knee function scores (P＞0.05). At the final follow up, the patellar laxity index in the positive J sign group was 34.9%±6.9%, while that in the negative group was 24.6%±8.6%. There was signifi?cantly difference in the patellar laxity index between two groups (t=-3.413, P=0.002). The bisect offset index in the positive group was 102.9%±12.4%, while that in the negative group was 76.0%±18.4%. There was significantly difference in the bisect offset in?dex between two groups (t=-4.268, P=0.000). The patella trochlear?groove distance in the positive group was 2.2±3.7 mm, while that in the negative group was-7.6±5.8 mm. There was significantly difference in the patella trochlear?groove distance between two groups (t=-4.233, P=0.000). The two groups were compatible with no significant difference in tibial tuberosity?trochlear groove distance, patella lateral tilt angle, femoral anteversion angle, tibial external angle and knee rotational angle (P＞0.05). The IKDC, Kujala, and Lysholm in the positive group were 86.4±6.5, 85.3±1.1, 91.5±7.9 respectively with significantly differences compared with preoperative scores 53.3±2.4, 73.2±9.7, 76.7±6.6 (t=-10.163, P=0.000; t=-1.274, P=0.023; t=-8.533, P=0.018). The IKDC, Kujala, and Lysholm in the negative group were 87.3±8.6, 84.3±4.7, 93.1±4.3 respectively with significantly differences compared with preoperative scores 49.1±4.6, 71.4±6.5, 79.5±7.0 (t=-14.381, P=0.000; t=-0.068, P=0.037; t=-6.902, P=0.013). There were no significant difference in the postoperative knee function scores between the two groups (P＞0.05). Conclusion RPD patients can recover the patellar instability from the surgical technique of MPFL reconstruction and TTO and none of them suffer from the RPD during the follow?up. However, the morbidity of post?operative positive residual patellar J sign was 26%. The positive J sign might increase the laxity of patella.
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Objective To investigate the effects of excessive pre?operative anterior tibial translation (ATT) on post?opera?tive knee stability after anterior cruciate ligament (ACL) reconstruction. Methods From January 2016 to December 2016, a total of 348 patients with noncontact ACL injuries who underwent primary anatomic single?bundle ACL reconstruction were retrospec?tively analyzed. The hamstring autograft was used as the grafted tendon. The ATT relative to the lateral femoral condyle was mea?sured on pre?operative magnetic resonance imaging (MRI) scans. Among them, twenty patients (ATT positive group) who demon?strated>10 mm ATT distance were matched in a 1∶2 fashion to 40 control participants (ATT negative group) with<3 mm ATT dis?tance. All patients were followed for at least 2 years. The post?operative clinical outcomes, including the ATT distance, the KT?1000 side?to?side difference, and the pivot?shift tests were compared between the two groups. Results The ATT distance of the ATT positive group was 13.5±1.3 mm, which was significantly larger than that of the ATT negative group (2.5±1.4 mm) (t=45.435, P=0.013) pre?operatively. At 2?year follow?up, the ATT distance of the ATT positive group was 9.7±1.8 mm, which was significant?ly larger than that of the ATT negative group (0.9±1.6 mm) (t=49.655, P=0.011). Moreover, the KT?1000 side?to?side difference of the ATT positive group was 4.4±1.5 mm, which was also significantly larger than that of the ATT negative group (0.8±1.1 mm) (t=38.945, P=0.014). There was significantly difference in the pivot?shift test between the two groups (ATT positive group: 1 grade 0, 18 grade I, 1 grade II vs. ATT negative group: 39 grade 0, 1 grade I) (χ2=40.521, P=0.012). Conclusion Excessive ATT could not be completely restored to normal after isolated anatomic single?bundle ACL reconstruction. Compared to the ATT negative group, the ATT positive group has inferior knee stability at 2?year follow?up.
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Objective To investigate the risk factors of J sign in patients with recurrent patellar dislocation, and to estab?lish a new grading system of J sign. Methods From January 2017 to August 2018, a consecutive case series of 111 recurrent pa?tellar dislocation patients were included in the present study. Among these patients, a total of 68 patients had positive J sign (J sign (+) group), and the remaining 43 patients had negative J sign (J sign (-) group). Caton index, Dejour classification, tibial tuber?osity?trochlear groove (TT?TG) distance and rotational parameters of the lower extremity (including femoral anteversion angle, ex?ternal tibial torsion angle and knee rotation angle) were measured to compare the differences of these parameters between the inter?vention group and control group. Furthermore, the risk factors of J sign were analyzed in detail. Meanwhile, a new grading system of J sign was introduced based on the extent and form of lateral patellar shift. Results The prevalence of J sign in recurrent patel?lar dislocation was 61.3% (68/111). Univariate analysis showed that femoral anteversion angle (t=3.376, P=0.001), knee rotation angle (t=4.886, P=0.001), TT?TG distance (t=3.177, P=0.002) and prevalence of patellar alta (χ2=9.809, P=0.002) were much high?er in the J sign (+) group, and the differences were statistically significant when compared with the J sign (-) group. Multivariate Logistic regressions demonstrated that increased femoral anteversion angle ( OR=1.118, P=0.012), enlarged knee rotation angle ( OR=1.178, P=0.016) and patella alta ( OR=3.229, P=0.040) were independent risk factors of J sign in patients with recurrent pa?tellar dislocation. Conclusion Increased femoral anteversion angle, enlarged knee rotation angle, and patellar alta were strongly associated with J sign. These factors may be independent risk factors of J sign in patients with recurrent patellar dislocation.
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Objective To evaluate the effectiveness of anterior cruciate ligament (ACL) reconstruction combined with anterolateral ligament(ALL)reconstruction in ACL injury patients with high-grade pivot shift.Methods From May 2015 to April 2016,156 patients underwent ACL reconstruction by the same surgeon,and 22 of them with grade 2/3 pivot shift were included in this study.Anteroposterior knee stability was evaluated using KT1000 measurement,and the rotatory stability was assessed using the pivot-shift test.The Lysholm score was used to monitor the clinical function.Results There were 14 male subjects and 8 females,with an average age of 29.3 years.The mean follow-up period was 8.6 months.The mean side-to-side difference of anteroposterior knee laxity was 2.1 ± 0.6 mm,significantly improved compared with the preoperative 8.9 ± 3.1 mm.The preoperative pivot-shift indicated 2+ in 20 patients and 3+ in 2 patients,while at the final follow-up,21 patients had negative pivot shift with 1 of 1+ pivot shift.The difference was significant.The average Lysholm score improved significantly from 60.5 ± 12.3 preoperatively to 79.2 ± 7.8 at the final follow-up.Conclusion The rotatory instability can be effectively restored through the ACL reconstruction combined with ALL reconstruction in patients with high-grade pivot shift.The early-stage knee stability and functional outcomes indicate significant improvement postoperatively.
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Objective To investigate the incidence of concomitant anterolateral ligament (ALL) abnormality by magnetic resonance imaging (MRI) on patients with high-grade pivot-shift after anterior cruciate ligament (ACL) injuries.Methods From January 2016 to June 2016,one hundred and sixty-four consecutive patients with acute ACL injury were retrospectively reviewed.All patients underwent comprehensive pre-operative physical examinations and MRI scans.Sixty-eight patients with acute ACL injury who showed high-grade (grade Ⅱ and Ⅲ) pivot-shift phenomenon were enrolled in the high-grade pivot-shift group.They were matched in a 1:1 fashion to another 68 ACL-injured participants who showed low-grade (grade 0 and Ⅰ) pivot-shift phenomenon during the same study period.The grade of ALL injury was divided into grade Ⅰ (sprain),grade Ⅱ (partial tear) and grade Ⅲ (complete tear),and they were further compared between the high-grade pivot-shift group and the low-grade pivot-shift group on the coronal view of their T2WI MRI scans.Results The mean age of the patients in all groups was 29.3 years old.There were 43 male and 25 female patients in each group.There were no significant differences in terms of the time from injury to surgery,the body mass index and the KT-1000 side-to-side difference.Overall,there were 105 patients (77.2％,105/136) showed abnormal signal of the anterolateral ligament on MRI scans.The incidence of concomitant ALL injury in the high-grade pivot-shift group (94.1％,64/68) was significantly higher than that in the low-grade pivot-shift group (60.3％,41/68,x2=10.786,P=0.013).Specifically,there were 15,19 and 30 patients who showed grade Ⅰ,Ⅱ and Ⅲ ALL abnormality in high-grade pivot-shift group.However,there were only 29,8 and 4 patients who showed grade Ⅰ,Ⅱ and Ⅲ ALL abnormality in low-grade pivot-shift group.The incidence of patients who showed grade Ⅱ/Ⅲ MRI evidence of concomitant ALL injury was 76.6％ (49/64) in the high-grade pivot-shift group,which was also significantly higher than that in the low-grade pivot-shift group (29.3％,12/41,x2=18.452,P=0.009).Conclusion In the present study,77.2％ of the patients who showed high-grade pivot-shift demonstrated combined ALL injury on the MRI scan.In addition,patients in the high-grade pivot-shift group showed significantly higher incidence of combined ALL MRI abnormality compared with those in the low-grade pivot-shift group.The high-grade pivot-shift phenomenon might be caused by combined ACL and ALL injury.
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Objective To investigate the clinical and MRI outcomes of the arthroscopic rotator cuff repair for massive ro tator cuff tear at minimum 2 years after surgery.Methods From October,2010 to March,2013,data of 79 shoulders in 77 patients with massive rotator cuff tear who were treated with arthroscopic rotator cuff repair were retrospectively analyzed.There were 42 male (44 shoulders) and 35 female (35 shoulders).The average age before surgery was 57.4 years (43.1-80.4 years).There were 64 right shoulders and 15 left shoulders.The dominate side were involved in 70 cases.A trauma history was documented in 52 shoulders.The symptoms persisted less than 3 months in 42 shoulders,between 3 and 6 months in 11 shoulders,between 6 and 12 months in 11 shoulders and more than 1 year in 15 shoulders.No revision case was included.The clinical results (range of motion,forward elevation strength,external rotation strength and American Shoulder & Elbow Surgeons (ASES) score and MRI results were collected.Results All 77 cases were followed up more than 2 years.The forward elevation (156.9°±20.0° to 103.2°± 54.5°),external rotation (40.6°±15.5° to 32.0°±21.4°),internal rotation (L1 to ~),forward elevation strength (9.7±4.7 lb to 4.6±4.9 lb),external rotation strength (11.1±5.1 lb to 8.3±5.4 lb) and ASES score (82.7±14.6 to 45.2± 17.4) were all improved significantly at the latest follow-up.During the surgery,complete repair were achieved in 68 shoulders.The forward elevation (146.4°±31.4° to 110.0°±56.7°),external rotation (45.0°± 14.8° to 34.1°±20.8°) and ASES score (78.6± 14.9 to 54.5± 13.9) were all improved signifi cantly at the latest follow-up in patients with partial repair during the surgery.But the forward elevation strength (10.5±4.9 lb to 6.2±3.2 lb) and external rotation strength (11.5±5.1 lb to 8.3±3.8 lb) were significantly better improved in patients who had complete repair.In 68 shoulders with complete repair during the surgery,20 shoulders were found to have rotator cuff re-tear.The retear rate was 29.4％.But none of the patient with postoperative re-tear received revision surgery.The forward elevation (152.0± 23.3 to 103.5±60.5),forward elevation strength (8.5±4.7 lb to 5.0±4.7 lb) and ASES score (76.9±16.5 to 40.8±18.6) were all improved significantly at the latest follow-up in patients with postoperative re-tear of the rotator cuff tendon.But the forward elevation (161.4°± 13.4° to 152.0°±23.3°),forward elevation strength (11.3±4.7 lb to 8.5±4.7 lb),external rotation strength (12.4±4.8 lb to 9.6±5.3 lb) and ASES score (86.0±13.0 to 76.9±16.5) were significantly better in patients with complete healed rotator cuff tendon comparing with the re-tear group.Conclusion The rotator cuff repair can significantly improve the shoulder function of massive rotator cuff tear even when the rotator cuff tendon can only be partially repaired or re-tear after the surgery.The shoulder function is significantly better in patients with complete healed rotator cuff tendon comparing with the partial repair group and the re-tear group.
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Purpose To determine the incidence,degree and radiographic characteristics of knee Jsign in recurrent patella dislocation patients.Method It was a retrospective review of a consecutive series of 59 recurrent patella dislocation patients.The knee J-sign was classified into negative (-),positive one degree(mild,l+)and positive two degree(gross,2+)based on the severity of patellar lateral translation at the extreme extension of knees with quadriceps contracted actively.The computed tomography(CT)examination at 0° extension of the knee was performed to quantify the degree of patellar lateral translation and tilt,with three CT parameters measured and calculated in axial slices:patella bisect offset index (BOI),patella trochlear-groove (PTG) distance and patella lateral tilt (PLT) angle.Results In all the 59 patients,72.9％(43/59)showed positive J-sign,27.1％(16/59)of positive one degree(1+) and 45.8％(27/59)of positive two degree(2+).All the three CT parameters increased with the severity of Jsign(P＜0.05).Conclusion Among 59 recurrent patella dislocation patients,we have found 72.9％ of positive knee J-sign.The severity of J-sign has a positive correlation with the degree of patellar lateral translation and tilt.
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Objectives To evaluate the clinical outcome of lateral structure release in the treatment of patients with mild or moderate habitual dislocation of patella(HDP).Methods From 51 HDP patients undergoing surgical treatment between April 2010 and 2014,23 patients were chosen and given the lateral structure release,including isolated lateral retinaculum release (LRR) and LRR combined with vastus lateralis oblique(VLO) lengthening.Other auxiliary surgeries included medial patellofemoral ligament(MPFL) reconstruction and tibial tubercle medialization.Radiological,objective and subjective evaluations were performed at 4 and 8 weeks,as well as and 1 year after the surgery and every year afterwards.Results There were 21 patients followed for a minimum of 2 years.Their average age was 25.0 + 7.4 years (ranging from 17 to 38 years old),and the mean follow-up period was 30.5 ± 5.8months(ranging from 24 to 36 months).Isolated LRR was performed in 42.9％(9/21) of the patients,and LRR combined with VLO lengthening was performed in 57.1％(12/21) of them.No redislocation was reported.Significant improvement was observed in the subjective evaluation score.Conclusions For patients with mild to moderate HDP,lateral structure release can achieve satisfactory results.
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Objective To quantify the patellar mal-tracking combined with J-sign using the computed tomography (CT).Method Fifty-three adult patients diagnosed as recurrent patellar dislocation (RPD) were chosen.According to their patellar tracking during knee active flexion and extension,they were divided into group A(with positive J-sign) and group B(with negative J-sign).The CT examinations were performed in all patients at 0°extension of the knee and the patella bisect offset index (BOI),patella troehlear-groove distance (PTG) and patella lateral tilt (PLT) were measured in the axial position and compared.The receiver operating characteristic analysis (ROC) curve was used to analyse the accuracy and stability of the three J-sign parameters.Results In all the 53 patients,thirty-seven(69.8％) knees were of positive J-sign,while the rest 16 were of negative J-sign.The mean values of CT parameters BOI,PTG and PLT in group A were significantly larger than those of group B.Moreover,the area under the curve for BOI,PTG and PLT were 0.906,0.883 and 0.833 respectively.The sensitivity and specificity of BOI were 83.3％ and 87.5％,while the predicting cut-off value was 97.5％.Conclusion In all the 53 recurrent patella instability patients,the morbidity of patella proximal mal-trackingis 69.8％.The CT parameter BOI can be used to quantify the J-Sign into positive and negative groups.
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Objective To explore the incidence and clinical characteristics of the anterior tibial translation(ATT) after anterior cruciate ligament injury.Methods One hundred and fifty-three patients with the anterior cruciate ligament injury underwent standard magnetic resonance imaging scans with full knee extension.Based on the relative location between the lateral tibial plateau and the lateral femoral condyle,all the patients were divided into an ATT positive group and an ATT negative group.Moreover,the posterior tibial slope angle(PTSA),the continuity of anterolateral ligament(ALL),and the integrity of posterior horn of the lateral meniscus of all the patients were detected so as to find the risking factors for ATT.Results Among the 153 patients,46 patients were finally confirmed to have ATT.Moreover,the average PTSA of the ATT positive group was significantly larger than that of the ATT negative group.However,there were no significant differences between the two groups in the continuity of ALL and the integrity of posterior horn of lateral meniscus.Conclusion In this study,the incidence of ATT was 30.1％,which may be correlated to the increased PTSA.
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Objective To evaluate the clinical outcome of tibial tubercle proximalization in the treatment of patients with severe habitual dislocation of patella (HDP).Methods Among 51 HDP patients treated surgically in our hospital between April 2010 and 2014,28 were eligible for retrospective evaluation.All patients underwent tibial tubercle proximalization and lateral structure release.Additional surgeries included medial patellofemoral ligament (MPFL)reconstruction and tibial tubercle medialization.Radiological and subjective evaluations were performed at 4th and 8th weeks after the operation,as well as 1 year and every year afterwards.Results Twenty-eight patients,with an average age of (27.2 ± 9.4)(ranging from 18 to 39)were followed up for a minimum of 2 years,the mean follow-up period being (26.4 ± 5.8)months (ranging from 24 to 36).It was found 17.2％ (5/29) patients of quadriceps weakness,6.9％ (2/29)of patellofemoral pain and 6.9％ (2/29)of stiffness.No redislocation was reported.Significant improvement was observed in all subjective evaluation scores.Conclusions For patients with severe HDP,tibial tubercle proximalization can achieve satisfactory results.
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Objective To identify the incidence of the anteromedial impingement fracture of tibial plateau in the posterolateral corner injuries,and to confirm the relationship between the extent of the anteromedial tibial impingement fracture and the severity of the posterolateral instability of the knee joint.Methods The radiographic images of the posterolateral corner injuries were reviewed retrospectively to identify the incidence of the anteromedial impingement fracture of the tibial plateau.A matched group of the posterolateral corner injury patients without the anteromedial impingement fracture was compared with the anteromedial impingement fracture group for the posterior instability and varus instability.And the anteromedial impingement fracture group was subdivided into a marginal fracture group and a compression fracture group based on the size of the fracture,and the posterior instability and medial instability were compared between the two groups.Results From January 2007 to January 2017,there were 266 patients with posterolateral corner injuries admitted,with 19 (7.1％) combined with the anteromedial impingement fractures of the tibial plateau.The posterior instability was significantly severer in the fracture group than the control group (P=0.030),while there were no significant differences in the varus instability between them (P=0.800).Similarly,the posterior instability was significantly severer in the marginal group compared to the compression group (P=0.026),but without significant differences in the varus instability (P=0.397).However,the compression fracture group had a higher risk to have neurovascular injuries (of the popliteal artery and the common peroneal nerve) compared with the marginal fracture group.Conclusion The incidence of the anteromedial impingement fracture of the tibial plateau in posterolateral corner injuries was 7.1％.The anteromedial impingement fracture of the tibial plateau may indicate more severe posterior instability,and a compression fracture may suggest more severe posterior instability compared with the marginal fracture.If there is a compression type fracture,the neurovascular status must be carefully evaluated in addition to the examination of the posterolateral and posterior instability.