Anatomic assessment of femoral tunnel by transtibial drilling technique in double-bundle anterior cruciate ligament reconstruction: an in vivo study / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To evaluate the anatomy of femoral tunnels created by simulated transtibial technique in double-bundle anterior cruciate ligament (ACL) reconstruction.</p><p><b>METHODS</b>Two tibial tunnels, anteromedial (AM) and posterolateral (PL), were drilled 45?and 55?to tibial plateau respectively. On the femoral side, the AM and PL tunnels were drilled through anteriomedial portal. After the four tunnels were established, the shaft of a reamer was introduced into the joint through tibial tunnel and reached against the lateral wall of intercondylar notch. The position that the reamer shaft can reach was marked and recorded.</p><p><b>RESULTS</b>Neither femoral AM nor PL tunnel opening can be fully or partially reached by the reamer shaft through the tibial AM tunnel in all cases. The evaluation through the tibial PL tunnel showed that only in 8 of 50 cases (16%) the femoral AM tunnel opening and in 4 cases (8%) the PL opening can be fully reached. On the other hand, in 12 cases (24%) the femoral AM tunnel opening and in 10 cases (20%) the PL opening can be partially reached by the shafts through the tibial PL tunnel.</p><p><b>CONCLUSION</b>The result strongly suggests that transtibial technique is not well competent for femoral tunnel drilling in anatomic double-bundle ACL reconstruction as we have hypothesized.</p>

The clinical study of epithelioid angiosarcoma in deep soft tissue / 中华外科杂志

<p><b>OBJECTIVE</b>To analyze the histopathology of, surgery for, and prognosis (survival rate, local recurrence rate, metastases rate, function) of epithelioid angiosarcoma (EA).</p><p><b>METHODS</b>Seven patients diagnosed as EA were received treatment in our department from May 2001 to May 2011. According Enneking staging, 3 patients were classified as IIA, 3 for IIB, and 1 for III. Wide excision was performed in 3 patients and amputation in 4 patients. Seven patients were followed up from 3 to 20 months.</p><p><b>RESULTS</b>One patient had local recurrence 3 months after wide excision. Five patients had metastases at 4 to 20 months postoperatively. The cumulative survival rate at 0.5, 1 and 2 years postoperatively were 67%, 22% and 0. The function of 3 patients after limb salvage operation was good in 2 cases and poor in 1 case. The tumor site, surgical staging, and safe margin were crucial factors affecting survival rate.</p><p><b>CONCLUSIONS</b>The prognosis of EA in deep soft tissue was poor. Customized, multimodality treatment and safe margin in operation may increase the survival rate as well as decrease recurrence and metastasis.</p>

A novel arthroscopic procedure for fixation of avulsion fracture of tibial attachment of anterior cruciate ligament guided by meniscal stitching needle / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To introduce a novel technique in which meniscal stitching needle is used as a puller to induct steel wire to secure the tibial eminence avulsion under arthroscopic visualization, and evaluate the clinical results.</p><p><b>METHODS</b>From 1999 to 2005, fifteen cases of tibial eminence avulsion were treated with this new technique. Lysholm scoring scale system was used to assess knee function before and after surgery. Regular plain anteroposterior and lateral X-ray films were undertaken to detect the bony healing of avulsed fragment.</p><p><b>RESULTS</b>The operating time could be controlled within 30 minutes. No complications such as intraarticular infection, iatrogenic injury, fibroarthritis or nonunion of fracture occurred in this group. X-ray film revealed that bony healing in all 15 cases was achieved from 6 weeks to 12 weeks postoperatively. Lysholm score was improved from 19.1+/-15.2 (ranging from 10 to 56) preoperatively to 97.5+/-3.7 (ranging from 91 to 100) postoperatively on average in 12-54 months follow up (mean 23 months). The statistically significant difference was shown in Student's t test (t equal to 18.483, P equal to 3.100 x 10(-11), P < 0.01). Wire breakage was found in two patients whose wires were removed 8 months and 14 months after initial operation, respectively.</p><p><b>CONCLUSION</b>This technique has many advantages, such as simplicity, wide indications from type II to type IV fractures, minimal invasion, short operating time and predictable satisfactory results.</p>

Histological comparison of fate of ligamentous insertion after reconstruction of anterior cruciate ligament: autograft vs allograft / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To analyze the histological results and the biological remodeling of ligamentous insertion after the reconstruction of anterior cruciate ligament (ACL) with autograft or allograft tendon.</p><p><b>METHODS</b>Extensor digitorum tendon was harvested from hind limb as graft material and transplanted to reconstruct the resected ACL in 12 mongrel dogs. Each free tendon end was secured by holding sutures and then the sutures were tied to the post screw at the femoral and tibial bony tunnel outlet after transplantation respectively. Autograft was randomly performed on one side of knee while allograft on the other side of knee. After transplantation, the histological analysis was undertaken at the 6th, 12th weeks and the 6th month using hematoxylin-eosin (HE) stain under light microscope.</p><p><b>RESULTS</b>The insertion structure of normal ACL typically consisted of four layers, i.e., dense connective tissue, fibrocartilage, mineralized fibrocartilage and bone. There was a distinct regular tidemark line between fibrocartilage and mineralized fibrocartilage. At the 6th week postoperatively, loose connective tissue presented in the interspace between graft and bony tunnel wall in both autograft and allograft groups. At the 12th week postoperatively, the collagenous fibers between autograft and tunnel wall became well organized and the four layers of insertion with discontinuous tidemark line were demonstrated indistinctly in autograft group but not in allograft group. At the 6th month postoperatively, both of a clear and continuous tidemark line and distinct four layers could be seen in autograft group. In allograft group, only a waved discontinuous tidemark line was shown and either the anatomic morphology or the maturity of insertion was inferior to that of autograft group.</p><p><b>CONCLUSIONS</b>At the 6th month postoperatively, although the ligament-cartilage insertion is primarily formed after ACL reconstruction with autograft or allograft tendon, the histological morphology and the maturation of insertion of autograft tendon are better than those of allograft group, which suggests that postoperative rehabilitation should be paid more attention and could be safer if little delayed during ACL reconstruction with allograft tendon.</p>