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The anterior cruciate ligament (ACL) injury is a common sports injury that has a significant impact on knee function and patients′ mobility. With the popularity of national fitness campaign in China, the incidence of ACL injury is increasing year by year. Currently, there still lacks clinical standards or guidelines on how to choose appropriate treatment methods, surgical plans and rehabilitation protocols for ACL injury. In order to timely reflect the new treatment concept of ACL injury, standardize its diagnosis and treatment and improve the curative effect, the Sports Medicine Society of Chinese Research Hospital Association and the Editorial Board of Chinese Journal of Trauma organized domestic orthopedic and sports medicine experts to formulate the "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)" based on the level of evidence-based medicine and in compliance with the principle of scientificity, practicability and advancement. The present guideline includes 12 recommendations for the diagnosis, treatment and rehabilitation of ACL injury in order to provide guidance and assistance for the clinical diagnosis and treatment of ACL injury in China.
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Objective:To compare the application effect of two different kinds of joint mobilization combined with muscle strength training in patients with shoulder impingement syndrome.Methods:From January 2017 to March 2019, 69 patients with shoulder impingement syndrome were divided into control group(34 cases) and observation group(35 cases) by random number table method.The control group received Maitland joint loosening and muscle strength training, and the observation group received Mulligan dynamic joint loosening and muscle strength training.The differences of visual analogue scale(VAS), shoulder pain and disability index(SPADI) and active shoulder joint activity were compared between the two groups before and after treatment.Results:Before treatment, there were no statistically significant differences in VAS score, SPADI and shoulder active joint mobility between the two groups(all P>0.05). After treatment, the VAS score and SPADI score of the control group were (2.75±0.29)points, (29.88±4.85)points, respectively, which of the observation group were (1.20±0.15)points, (12.04±2.29)points, respectively, which of the two groups were significantly improved compared with before treatment(control group: t=9.60, 9.15; observation group: t=17.47, 19.51, all P<0.01). The VAS score and SPADI score of the observation group were better than those of the control group( t=28.00, 19.63, all P<0.01). After treatment, the ranges of motion of the active joint in the control group were (69.06±8.77)°, (67.83±13.25)°, (164.06±17.94)°, (160.15±20.24)°, respectively, which in the observation group were (84.74±10.13)°, (82.24± 15.06)°, (179.84±19.16)°, (176.45±23.26)°, respectively, the differences were statistically significant between the two groups( t=6.87, 4.22, 3.53, 3.10, all P<0.01). Conclusion:Compared with Maitland joint loosening and muscle strength training, Mulligan dynamic joint loosening and muscle strength training can effectively relieve shoulder pain in patients with shoulder impingement syndrome, increase shoulder mobility, improve shoulder mobility limitation and promote shoulder function recovery.
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Objective:To compare the effect of double plate internal fixation with medial and lateral knee incision and anterior straight knee incision on the knee function of patients with complex tibial plateau fracture.Methods:From January 2016 to March 2018, 94 patients with complex tibial plateau fractures treated with double plate internal fixation were divided into the control group(straight incision in the middle of the knee) and the observation group(double incisions on the inside and outside of the knee) according to the random digital table method, with 47 cases in each group.The differences of perioperative indicators, posterior tibial plateau inclination angle, varus angle and knee function scores between the two groups were compared.Results:There was no statistically significant difference in intraoperative blood loss between the two groups( P>0.05). The operation time of the observation group[(84.35±11.85)min]was longer than that of the control group[(62.14±10.05)min], the treatment cost of the observation group[(3.28±0.61)ten thousand CNY]was more than that of the control group[(2.08±0.58)ten thousand CNY]( t=9.80, 9.12, all P<0.01). The days of hospitalization, the time of loading and the time of fracture healing in the observation group were (6.78±2.17)d, (44.76±9.33)d, (3.57±1.04)months, which were shorter than those in the control group[(10.24±2.25)d, (55.09±10.25)d, (5.57±1.37)months]( t=7.59, 5.11, 7.97, all P<0.01). There were no statistically significant differences in the posterior inclination angle and varus angle of the tibial plateau between the two groups at 6 months after surgery(all P>0.05). In the control group, the posterior inclination angle and varus angle of the tibial plateau were significantly increased at 12 months after operation compared with 6 months after operation(all P<0.01). There were no statistically significant differences in the posterior inclination angle and varus angle of the tibial plateau in the study group between 12 months after surgery and 6 months after surgery(all P>0.05). At 12 months after operation, the tibial plateau caster angle[(6.49±1.14)°]and the varus angle[(85.17±2.70)°] in the observation group were significantly lower than those in the control group[(8.05±1.55)° and (91.35±2.88)°]( t=5.56, 10.73, all P<0.01). There were no statistically significant differences in the Rasmussen and Harris scales scores of knee joints between 12 months after surgery and 6 months after surgery in the two groups(all P>0.05). The results of Rasmussen scale and Harris scale in the study group were significantly higher than those in the control group(all P<0.01). Conclusion:Compared with the knees straight incision, although knee inside and outside double incision double plate fixation treatment for patients with complex tibial plateau fractures can lead to increased operation time, high cost of treatment, but can shorten in-hospital time, promote the fracture healing after surgery, promote the recovery of the original anatomical structures, which can effectively improve the function of knee joint, thus is worthy of clinical application.
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Objective:To explore the related factors of anterior cruciate ligament rupture with meniscus injury and the effect of arthroscopic surgery.Methods:From July 2014 to May 2018, 98 patients with anterior cruciate ligament rupture admitted to Shengjing Hospital Affiliated to China Medical University were divided into meniscus injury group(67 cases) and without meniscus injury group(31 cases) according to whether they had meniscus injury.The patients with anterior cruciate ligament rupture and meniscal injury were divided into study group(37 cases underwent arthroscopic reconstruction of anterior cruciate ligament and meniscus injury), and 30 cases in control group(only meniscus was repaired under arthroscopy). The factors affecting the anterior cruciate ligament rupture associated with meniscus were analyzed, and the surgical outcomes of the study group and the control group(the cure rate of meniscus injury and the 1-year reoperation rate, IKDC and Lysholm knee function score) were compared.Results:Multivariate logistic regression analysis showed that early course of disease[95% CI(1.444, 41.68), P<0.05], middle course of disease[95% CI(1.682, 52.147), P<0.05], chronic phase[95% CI(3.623, 180.32), P<0.05]), history of recurrent injury[95% CI(2.649, 27.222), P<0.05]) were risk factors of meniscus injury caused by rupture of anterior cruciate ligament.The treatment rate of meniscus injury in the study group[89.19%(33/37)]was higher than that in the control group[66.67%(20/30)], the reoperation rate in the study group[5.41%(2/37)]was lower than that in the control group[26.67%(8/30)], the differences were statistically significant (χ 2=5.084, 5.898, all P<0.05). At 12 months after operation, the scores of IKDC and Lysholm in the study group were (90.25±14.67)points and (88.36±11.25)points, respectively, which were significantly higher than those in the control group[(73.52±10.12)points and (71.47±10.68)points]( t=12.129, 19.309, all P<0.05). Conclusion:The patients with anterior cruciate ligament rupture complicated with meniscus are associated with history and recurrent injury history.Arthroscopic surgery for simultaneous reconstruction of anterior cruciate ligament and meniscus injury can significantly improve knee joint function, improve the cure rate of meniscus injury in this type of patients, and reduce short-term reoperation rate.
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Objective To investigate the changes of mechanoreceptors in the different state remnant stumps after anterior cruciate ligament(ACL)rupture.Methods From March 2013 to December 2015,fifty-seven cases of complete ACL rupture were collected to record the time interval from injury to surgery.The patients were divided into two groups according to preoperative kneelax joint measurement results:≤6 mm group (group 1)and>6 mm group(group 2).The morphology of each ligament stump in the two groups was recorded.After H&E staining and immunohistochemical labeling,the morphology,type,and quantity of the mechanoreceptors in the ligament stump were observed under an optical microscope.The relationship among the changes of the mechanoreceptors in the remnant stumps and the morphology of the ligament stump,the affected knee stability and the time from injury to surgery were analyzed.Results Twenty specimens were included in group 1.While 37 specimens were included in group 2.There was significant difference between the two groups in the distributions of the 4 types of the remnant stumps(P=0.000).There was significant difference between the two groups in the distributions of the 4 types of mechanoreceptors(P= 0.002).The number of the mechanoreceptors was positively correlated with the affected knee stability(r=0.63,P=0.018).There was no significant correlation between the number of the mechanoreceptors and the time from injury to surgery in group1 (r=-0.37,P=0.136),while the number of the mechanoreceptors was negatively correlated with the time from injury to surgery in group 2(r=-0.51,P =0.022).Conclusion After ACL rupture,the ligament stump in some patients still connect the femur and the tibia in the joint cavity,and exert mechanical stability function, which can retain the mechanoreceptors in the tissue for a long time.
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Objective To compare the outcomes between radiofrequency modification and augmentation reconstruction in the treatment for partial anterior cruciate ligament( ACL) tears. Methods Fifty?four patients with partial ACL tears were divided into radiofrequency modification group( n=16) and augmentation reconstruc?tion group( n=38) according to different treatment methods. Minimum follow?up was 2 years. Patients were eval?uated just after the injury and at the latest follow?up with several parameters, including the international knee documentation committee( IKDC) score,Lysholm knee score,Tegner activity rating,range of motion ( ROM) and the kneelax arthrometer. Results The kneelax was (4. 4±0. 9) mm of preoperative, (5. 0±1. 5) mm of post?operative in radiofrequency modification group,the difference was no signifiacnt( t=1. 372,P=0. 183);in aug?mentation reconstruction group was (4. 7±0. 8) mm and (1. 7±1. 0) mm respectively,the knee stability was in?crease significantly postoperative;knee stability was significantly improved in the augmentation reconstruction group compared with the radiofrequency modification group( t=9. 228,P=0. 000) . In radiofrequency modifica?tion group,ROM,Lysholm score and Tegner score were improved significantly between the results pre?and post?operatively((105. 4±22. 5)° vs. (123. 5±11. 4)°,t=59. 189,P=0. 000;65(51,90)) points vs. 86(59,100) points,Z=3. 852,P=0. 000;3(1,5) points vs. 6(1,9) points,Z=4. 637,P=0. 000). In augmentation recon? struction group, ROM,Lysholm score and Tegner score were improved significantly between the results pre?and post?operatively((99. 4±21. 9)° vs. (125. 3±10. 9)°,t=6. 527,P=0. 000;(65(51,89) points vs. (85 (59, 100) points,Z=4. 427,P=0. 000;3(1,5) points vs. 6(1,9) points,Z=3. 961,P=0. 000). Conclusion Augmentation reconstruction technique is more beneficial to the knee stability than radiofrequency modification in the treatment for the partial ACL tears.
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Objective To compare the curative effect of arthroscopic transtibial single-bundle posterior cruciate ligament(PCL) reconstruction using LARS artificial ligament and hamstring tendon autograft.Methods Thirty-seven patients who underwent isolated single-bundle PCL reconstruction with remnant preservation technique were evaluated.They were divided into LARS group(n=19) and 4-strand hamstring tendon autograft (4SHG) group (n =18).Minimum follow-up was 2 years.Patients were evaluated preoperatively and postoperatively at the latest follow-up with several parameters,including the international knee documentation committee(IKDC) score,Lysholm knee score,Tegner activity rating and physical examination.Results After operation,in LARS group,Lysholm sorce was 89 (51,100) points,Tegner sorce was 6 (1,9) points,IKDC sorces were normal of 5 cases,nearly normal of 10 cases,abnormal of 3 cases,and obviously abnormal of 1 case,significantly improved compared with before operation (62 (28,98) points,2 (1,5) points,abnormal IKDC score of 8 cases,obviously abnormal of 11 cases;P＜0.001).In 4SHG group,Lysholm sorce was 84(36,100) points,Tegner sorce was 6(1,9) points,IKDC sorces were normal of 5 cases,nearly normal of 9 cases,abnormal of 3 cases,and obviously abnormal of 1 case,better than before operation (64 (28,98) points,2 (1,5) points,IKDC score abnormal of 8 cases,obviously abnormal of 10 cases;P＜0.001).There was significant difference about Lysholm sorce between two groups after operation (P=0.037).The drawer test results show that,after operation,there were 15 case of grade 0,4 cases of grade 1 in LARS group,3 cases of grade 0,11 cases of grade 1,4 cases of grade 2 in 4SHG group,all improved significantly compared with before operation,and the differences were statistically significant(LARS group:x2 =38.000,P＜0.001;4SHG group:x2 =29.143,P＜0.001),and the grade of patients in LARS group were superior to 4SHG group after operation (x2 =15.251,P ＜0.001).Conclusion The clinical effect of using a LARS ligament for PCL reconstruction is more useful than using a 4SHG.
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BACKGROUND:Compared with total knee arthroplasty, unicompartmental arthroplasty has the advantage of minimal invasion. Regarding the gold standard of total knee arthroplasty, the survival rate of unicompartmental arthroplasty remains controversial. OBJECTIVE:To establish three-dimensional finite element model of unicompartmental arthroplasty and total knee arthroplasty, and comparatively analyze the changes in stress on the prosthetic contact surface. METHODS:One case underwent unicompartmental arthroplasty on one side, and received total knee arthroplasty on the opposite side. Knees were scanned by 3D CT before operation. Knee models were established by three-dimensional software. The matched prosthesis was designed by parameterization software. Three-dimensional models for unicompartmental arthroplasty and total knee arthroplasty were established. By finite element analysis software, maximal equivalent stress was simulated when knee flexion was 0°, 10°, 30° and 60° in standing and walking cases, and results were compared and analyzed. RESULTS AND CONCLUSION: No significant difference in maximal equivalent stress was detected when knee flexion was 0° and 10° in unicompartmental arthroplasty prosthesis and total knee arthroplasty prosthesis in standing case (P > 0.05). At knee flexion of 30° and 60° in standing case, the maximal equivalent stress was significantly greater in unicompartmental arthroplasty prosthesis than in the total knee arthroplasty prosthesis (15.01%, 6.08%;P < 0.05). When knee flexion was 0°, 10° 30° and 60° in standing case, the maximal equivalent stress was higher in unicompartmental arthroplasty prosthesis than in the total knee arthroplasty prosthesis (5.45%, 6.65%, 6.67%, 9.01%;P < 0.05). These findings verified that in the case of standing, there was no practical significance in wearing of polyethylene insert between unicompartmental arthroplasty prosthesis and total knee arthroplasty prosthesis. In the case of walking, the wearing of unicompartmental arthroplasty may be higher than that of total knee arthroplasty prosthesis, which provides guidance for the clinical practice.
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ObjectiveTo evaluate the value of the measurement with a scale in arthroscopic anatomic anterior cruciate ligament (ACL) reconstruction.Methods Thirty-six patients with unilateral ACL-deficient knees were divided into single bundle group and double bundle group based on the length of the major axis of the native ACL footprint measured with a scale.Consistent with the International Knee Documentation Committee (IKDC) scoring systems,Lysholm knee scoring scale and Tegner activity rating were used to evaluate the clinical results,and data from 23 to 26 months follow-up were gathered and analyzed statistically.ResultsIn terms of IKDC evaluation,19 patients( 90.4％ ) in the double band group and 13 patients( 86.7％ )in the single band group were graded as normal or nearly normal ( Z =7.82,6.33 ; P ＜ 0.05 ).The mean Lysholm scores were 93.8 ± 9.9 and 94.2 ± 9.6 and the mean Tegner scores were 6.6 ± 1.9 and 6.5 ± 1.7 for the double and single band groups,respectively( t =2.31,5.60,3.55,7.09 ;P ＜0.05 ).ConclusionArthroscopic measurement with a scale combined with other traditional methods to determine the tunnel location is easy to conduct and intuitional to understand.It could be useful in anatomic ACL reconstruction.
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Objective To investigate the effects of intra-articular hyaluronan(HA)injection on the expression of cartilage oligomeric matrix protein(COMP)in synovium of strenuous running rats,and investigate the possibility of predicting the effectiveness of HA based on COMP in synovium.Methods 36 healthy male Wistar rats were randomly divided into control group,strenuous running group and strenuous running group and HA injection group.Strenuous running group and HA injection group were intra- articularly injected with HA once a week for 5 consecutive weeks.The histological changes of synovium of knee joint was examined by H.E.staining and immunohistochemical expression of COMP in three groups after 6 weeks' strenuous running.Results Synovial inflammation was less severe in strenuous running and HA injection group than strenuous running group(t =7.15,P ＜0.01).The immunohistochemical expression of COMP in rats'synovium of knee joint in strenuous running and HA injection group was significantly lower than that in rats'synovium in strenuous running group(t = 6.30,P ＜ 0.01).Conclusions Intra- articular HA injection suppressed synovitis,and the expression of COMP in synovium could be used to predict the effectiveness of HA.
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Adenovirus carrying BMP-2 gene, after being mixed with fibrinous gel, was siphoned off on biodegradable scaffolds (PLA/PCL). The composite was used to repair 1.5 cm long radius defect in rabbits. Four methods were in use in the experiments: Ad-BMP-2 plus fibrinous gel and PLA/PCL (Group A), reconstructed hBMP-2 plus fibrinous gel and PLA/PCL (Group B), Ad-Lacz plus fibrinous gel and PLA/PCL (Group C), and fibrinous gel and PLA/PCL (Group D). Results showed that the defects treated in Group A were repaired with much more new bone regenerated, bridged earlier and stronger than those in Group B 12 weeks after operation. The defects treated in the other two groups could not attain osseous tissue healing. BMP-2 gene carried by biodegradable scaffold and fibrinous gel is easy to conduct and has very strong osteoinduction ability. It is really a good method to repair segmental bone defects.
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Animals , Humans , Rabbits , Absorbable Implants , Adenoviridae , Genetics , Metabolism , Biocompatible Materials , Bone Morphogenetic Protein 2 , Genetics , Bone Substitutes , Caprolactam , Chemistry , Fracture Healing , Gels , Genetic Therapy , Implants, Experimental , Lactic Acid , Chemistry , Polyesters , Polymers , Chemistry , Radius Fractures , Therapeutics , Tissue Engineering , Tissue ScaffoldsABSTRACT
To compare the effects between gene therapy and gradual release carrier for bone morphogenetic protein-2 (BMP-2) in repairing bone defects, bone defects for 15 mm were created.on the bilateral radius in rabbits and treated with four kinds of implantations, ie, composite of transgeneic MSCs and PLA/PCL (Group A), composite of MSCs and gradual release carrier for BMP-2 (Group B), composite of MSCs and PLA/PCL (Group C), and PLA/PCL alone (Group D). After 4, 8, and 12 weeks of the operations, X-ray, histological examination, biomechanics analysis, and bone density measurement were conducted. Results showed that both osteoblasts and mesenchymal cells displayed strongly positive expression of BMP-2 in Group A after 4 weeks of the operation, the speed and quality of bone formation in Group A were much better than those in Group B. After 12 weeks of the operations, bone defects were completely repaired in Group A. BMP-2 gene therapy is really a good method to repair segmental bone defects.