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Objective To evaluate the knee joint function at 3-7 years after anterior cruciate ligament (ACL) reconstruction with ligament advanced reinforcement system (LARS) artificial ligament and assess the morphologic changes of LARS artificial ligament in human tissues.Methods Fifty-seven patients (58 knees) undergone ACL reconstruction with LARS artificial ligament were recruited to this multi-factor retrospective study and divided into acute injury group and chronic injury group according to time between injury and operation.LARS artificial ligament harvested from the three patients (4 knees)who had an additional surgery were observed histologically.Results Knee joint function and range of movement were significantly improved after surgery (P ＜ O.O1),however subjective and objective estimation on knee joint function presented no statistical differences between the two groups (P ＞0.05).X-ray films and MRI revealed different degree of bone tunnel progressive augmentation in average 1.5 years,indistinctive correlation of knee joint stability with bone tunnel augmentation (P ＞ 0.5) as well as no statistical difference concerning incidence of tibial and femoral bone tunnel augmentation (P ＞ 0.05).Histological observation revealed well-arranged fiber tissue growth into LARS artificial ligament as well as fibrous joint among single-beam polyester fibers as well as a bundle of polyester fibers at postoperative 2 years.Conclusions (1) LARS artificial ligament gains a satisfactory knee joint stability and function in ACL reconstruction.(2) There exists bone tunnel augmentation that tends to stability at postoperative 1.5 years,but knee joint stability is not correlated to the extent of bone tunnel augmentation after surgery.(3) Postoperative data evaluation of acute injury and chronic injury is the same.(4) Human normal fibrous tissues grow into LARS artificial ligament regularly.
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[Objective]To investigate the mechanism and pathologic changes of anterior cruciate ligament impingement syndrome as well as its arthroscopic diagnosis and treatment.[Method]From January 2005 to June 2007,28 patients with a history of anterior cruciate ligament impingement were diagnozed and treated arthroscopically.The patients' clinical findings were mainly anterior patellar pain and limited knee joint.The reasons of anterior cruciate ligament impingement syndrome were indentified by routine arthroscopic examination:straitness of intercondylar notch or osteophytes formation in 19 cases,old avulsion fracture in the tibial intercondylar in 4 cases,anterior cruciate ligament cyst in 3 cases,incorrect tibial tunnel placement on reconstructed anterior cruciated ligament in 2 cases.Different surgical procedures were carried out according to the results of the examination:joint debridement and intercondyle's plasty;intercondyle's plasty and osteophytes resection;joint debridement and ACL cysts resection;ACL tibial eminence insertion reconstruction were performed.[Result]Twenty-eight cases were followed for an average of 15 monthes(6-34 monthes).The rate of good to excellent was 82.1%,recurrence was observed in 1 case.[Conclusion]The gradual constriction of the knee is mainly caused by the anterior cruciate ligament impingement syndrome.Arthroscopy is very valuable in diagnosis and treatment of anterior cruciate ligment impingement syndrome.It can also acquire whole assessment of the joint injuries and makes out reasonable treatment program to normal knee joint function.
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[Objective] To enhance the understanding of the diagnosis of benign tumor in the knee joints.[Method] Thirteen patients(9 males and 4 females,aged 7 to 49 years,38.2 years arerage)with tumor in the knee joints were diagnosed and treated under arthroscopy since 1996.There were 3 with the synovial hemangioma,2 with tensoynovial giant cell tumor,4 with ganglion cysts of cruciate ligament and synovial cysts,1 with chondroma in the soft tissue,2 with desmoid tumor in the cruciate ligament and 1 with cruciate ligament desmoid.The curative effects were observed through a follow-up of more than half a year.[Result]All the cases were diagnozed under arthroscope and confirmed by the pathological examinations.All the patients were treated under arthroscope and followed by 11 months to 6 years.Clinical symptom improved obviously and no recurrence was found after the operation.Assessment of the curative effects were 46% excellent,39% good and 15% fair.[Conclusion]Benign tumor in the knee joints is rare.It's often difficult to diagnoze in the clinical practice.Arthroscopy is a very useful method for the diagnosis and treatment of the suspected patients with benign tumor in knee joints.
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[Objective]To evaluate the value of clinical examination and magnetic resonance imaging in diagnosing chronic anterior cruciate ligament injury.[Method]Sixty-five patients with the diagnosis of chronic anterior cruciate ligament injury were retrospectively analyzed about the course of diagnosis and treatment.To gain the primary diagnosis through clinical examination,8 patients were performed magnetic resonance imaging.Finally all the patients were carried out arthroscopic surgery to make a final diagnosis.[Result]Arthroscopy found 53 cases with complete anterior cruciate ligament tears,12 cases with partial anterior cruciate ligament tears.In the complete anterior cruciate ligament tears cases,79.2% patients had positive anterior drawer test,96.2% had positive Lachman test and 92.5 % had positive pivot shift test.In the partial anterior cruciate ligament tears cases,16.7% patients had positive anterior drawer test,50.0% had positive Lachman test and 33.3 % had positive pivot shift test.The accuracy of MRI in diagnosing anterior cruciate ligament tears was 100%.[Conclusion]Clinical examination and magnetic resonance imaging can diagnose chronic anterior cruciate ligament effectively.
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Objective To study the feasibility and short-term effects of arthroscopic anterior cruciate ligament (ACL) reconstruction by using the Ligament Advancement Reinforcement System (LARS) artificial ligaments. Methods Arthroscopic ACL reconstruction was carried out in 16 patients with ACL injuries by using the LARS artificial ligaments. Bone tunnels of the femur and the tibia were prepared with an identical interval between each other. The artificial tendon was inserted into the tunnels, and then, fixed with 2 interface screws after being tightened, with the free end of the tendon within the articular cavity. The complicated injuries were treated simultaneously. Results The operation time was 51~86 min (mean, 64 min). No postoperative complications such as synovitis, ligament rupture, or movement restriction occurred. A follow-up checkup was made in the 16 patients for 1.5~6 months (mean, 3.8 months). The International Knee Documentation Committee (IKDC) scores showed 6 cases of grade C and 10 cases of grade D before the surgery, while 6 cases of grade A, 9 cases of grade B, and 1 case of grade C after the surgery ( ? 2 =6.264, P
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0.05). Conclusion The procedure of double-tunnel with double-bundle for reconstruction of posterior cruciate ligament (PCL) under arthroscopy can better improve the knee stability at the different flexion degree, and the QT-B is an optimal graft for the double-tunnel reconstruction.
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Objective The attempts was made to compare the results of a quadruple-strand semi-tendinosus tendon versus patellar tendon reconstruction for anterior cruciate ligament by arthroscopy in chronic complete anterior cruciate ligament injury.Methods60patients were enrolled in a prospective,ran-domized,controlled study.30patients underwent reconstruction with a quadruple-strand semitendinosus tendon autograft,30patients were treated with a bone-patellar tendon-bone autograft.The surgery was car-ried out in an alternating sequence with two autograft constructed materials.At the time of arthoscopy,the knee was examined totally,associated joint pathology was documented,and irreparably torn meniscal frag-ments were removed.60patients were followed up14to30months after operation,and evaluated in terms of the clinical test findings,the activity level,the functional status in daily activities,the range of motion,the stability of the knee,the level of return to sports and the patellofemoral crepitus at final follow-up.Results The objective outcome of replacement with a bone-patellar tendon-bone graft was identical to that obtained with a quadruple-strand semitendinosus tendon graft.The stability of the knee in the quadrupled-strand semitendinosus reconstruction was equal with that in the bone-patellar tendon-bone autograft.The return to sport was more frequent in the quadrupled-strand semitendinosus group comparing with in the bone-patellar tendon-bone group,there was80%and73%in each group respectively with no significant difference.A mild loss(≤3?)of knee extension was more frequent in the patellar tendon group than that in the quadru-pled-strand semitendinosus group,there was40%and6%in each group respectively,the difference was sig-nificant statistically.KT-2000arthrometer side-to-side difference of anterior displancement was13%versus20%in the quadrupled-strand semitendinosus group and patellar tendon group at133.4N.Patellofemoral crepitus was6%and17%in the quadrupled-stranded semitendinosus group and patellar tendon group re-spectively.Conclusion In a chronic complete injury of anterior cruciate ligament,the clinical results of re-construction with a quadrupled-strand semitendinosus tendon or patellar tendon by arthroscopy were satis-factory without significant differences between the two operative procedures.
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Objective To analyse the causes of complications and accidents of arthroscopy and a discussion of the preventive measures. Methods 1 540 cases of arthroscopy were carried out from May 1980 to May 1999, including 1 426 cases of the knee, 59 of the ankle, 17 of the wrist, 21 of the first metatarsophalangeal joint, 8 of the hip, 6 of the elbow and 3 of the shoulder. Results Surgical instruments (blade, tip of forceps) broken in the articular cavity took place in 8 cases, injury of the normal tissue including the cartilage, meniscus, and ligaments happened in 40 cases, nerve branch and vascular injured around the inlets in 11 cases, water seeping out in 13 cases, infection following the formation of hematoma in 5 cases, refracture of patella during operation in 1 case, myocardial infarction after operation in 1 case, totally, complications and accidents were seen in 79 cases (5.1％ ). Conclusion Arthroscopic complications are mainly related to unskillful manipulation of the instruments, poor team work, inadequate exposure of intra-articular structure and negligence of timely replacing the nearly worn parts of the apparatus. The complications can all be prevented by improving above mentioned points.
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Objective To preliminarily evaluate the effect of endoscopy in treatment of subcutaneous hematoma in the limbs. Methods From March 1998 to October 2001, endoscope techniques were ferformed in 7 cases of old subcutaneous hematoma, among which were 2 cases of subcutaneous hematoma on the lateral femur, 1 on the medial knee joint, 1 on the traumatic prepatellar bursa and 3 on the anterior tibia. The area of the biggest hematoma was 20 cm?5 cm and that of the smallest 4 cm?6 cm. Results All the patients were followed up with a time range of 3-16 months and got sound healing with no scar in the skin and deeper tissues, pain or dysfunction. Conclusions The endoscope for larger subcutaneous hematoma in the limbs has the advantages such as smaller incision, less scar, accurate manipulation,mild postoperative reaction and fast recovery. Therefore, it can not only obtain similar curative effect to that of the traditional open operation but also avoid the shortcomings of the traditional operation. Endoscope techniques should be the first alternative to hematoma of over 5 cm or hard subcutaneous hematoma in the limbs.