Radiographic diagnosis of distal fibula avulsion fractures: Comparison of ankle X-ray and three-dimensional reconstruction of CT / 北京大学学报(医学版)

OBJECTIVE@#To investigate the difference in sensitivity between X-ray and three-dimensional reconstruction of computed tomography (3D-CT) for the diagnosis of distal fibular avulsion fracture, and the radiographic presentation of the ossicle.@*METHODS@#From January to October 2018, 92 patients with distal fibular avulsion fracture were visited for surgical treatment in Department of Sports Medicine, Peking University Third Hospital, and 60 cases were finally enrolled according to the inclusion and exclusion criteria. Intraoperative detection was regarded as the gold standard, and the diagnostic sensitivity of preoperative ankle X-ray and 3D-CT for the distal fibular avulsion fractures was statistically determined. The ossicle maximum diameter as well as the degree of its displacement were also measured. On 3D-CT, the distance from the ossicle center point to the anterior fibular tuberosity (a), the distance to the fibular tip (b), and the a/b value was used to present the ossicle displacement.@*RESULTS@#Among the 60 patients, 36 and the 52 patients were correctly detected by X-ray and 3D-CT, respectively, and the sensitivities was 60.0% and 86.7%, respectively (P=0.004). The mean diameter of the ossicle on X-ray and 3D-CT was (9.2±3.9) mm and (10.5±3.2) mm, respectively. The mean distance from the ossicle center to the anterior fibular tuberosity (a) was (17.5±3.6) mm and the mean distance to the fibular tip (b) was (17.4±4.8) mm, with mean a/b values of 1.1±0.7. The intraclass correlation coefficients (ICC) for each measurement ranged from 0.891-0.998 with a high degree of consistency.@*CONCLUSION@#Compared with X-ray, 3D-CT has higher sensitivity in diagnosing distal fibular avulsion fractures, can help clinicians evaluate ossicle's location and choose surgical methods, and is recommended to be performed in patients with suspected distal fibula avulsion fractures in clinical practice.

Characteristics and related factors of plantar pressure in the chronic ankle instability individuals / 北京大学学报(医学版)

OBJECTIVE@#To analyze characteristics and related factors of the plantar pressure during the level walking and single leg standing in the chronic ankle instability (CAI) individuals.@*METHODS@#From April 2019, 75 CAI individuals and 40 healthy individuals were enrolled in this study. Both of the static and dynamic plantar pressure were measured during six times level walking and three times single leg standing testing. The data including peak force, time to peak force in various foot contact areas and the time to boundary (TTB) and velocity of center of pressure (COP) were measured and compared between the affected side and the unaffected side and between the CAI cases and the healthy individuals. The correlations between the plantar pressure and the gender, Beighton score, affected side and body mass index (BMI) were analyzed.@*RESULTS@#The characteristics of plantar pressure distribution in the CAI individuals included: (1) During the level walking, the affected side showed the similar pressure contribution as the unaffected side (P>0.05). While compared with healthy individuals, there was a significantly higher peak force in the 5th metatarsal area (t=-3.86, P=0.03) of the affected side, lower peak force in the 1st (t=2.99, P=0.02), 2nd metatarsal head areas (t=2.09, P=0.01) of the affected side, medial hindfoot areas of both sides (affected, t=2.33, P=0.01; unaffected, t=3.74, P=0.02) and toes areass of both sides (affected, t=2.23, P=0.01; unaffected, t=3.28, P=0.02) and a delay to peak force in the 4th metatarsal head area (t=3.33, P=0.01) of the affected side. (2) During the single leg standing, the CAI individuals showed significantly worse balance control in the anterior/posterior direction (P < 0.05) and lateral/medial direction (P < 0.05) compared with the healthy controls, and the affected side had more severe balance control deficit in the lateral/medial direction (P < 0.05). (3) The women (P < 0.05) and the individuals with higher Beighton scores (P < 0.05) showed worse balance control deficit in the lateral/medial direction.@*CONCLUSION@#CAI individuals showed significantly a more lateral shifted plantar distribution during the level walking compared with the healthy individuals and the tendency was worse on the affected sides, and showed worse balance control in the anterior/posterior direction and lateral/medial direction during the single leg standing. The women and those with generalized ligament laxity showed significantly worse balance control.

Mid-to-long term outcomes and influence factors of postoperative concurrent chronic ankle instability and posterior ankle impingement / 北京大学学报(医学版)

OBJECTIVE@#To investigate the mid-to-long-term efficacy of patients with chronic ankle instability combined with posterior impingement syndrome after 3-9 years of follow-up, and to analyze the influencing factors.@*METHODS@#From February 2010 to December 2015, 46 patients underwent concurrent lateral ankle ligament repair with posterior ankle arthroscopic surgery at the Institute of Sports Medicine, Peking University Third Hospital. The patient was first placed in a prone position and underwent arthroscopic debridement for the posterior impingement. After finishing the posterior arthroscopy, the surgeon and assistants first translated the patient to the affected side, then turned to the healthy side, and changed the position to the supine position. During the turning over, another assistant held the arthroscope and the instrument to ensure that it was sterile and could be used without replacement. The anterior ankle arthroscopy was operated if necessary and the lateral ankle ligament repair was anatomic repaired with anchors. The 42 patients were followed up, including 26 males and 16 females. The average age was (28.9±10.0) years. The patient's clinical symptoms, joint stability, mobility and motor function were compared by questionnaire and physical examination. The preoperative and postoperative visual analogue scale (VAS) scores, American Orthopaedic Foot and Ankle Society (AOFAS) scores, Tegner scores were compared, and the clinical scores and the patient age, gender, height and weight were compared. The correlations between body mass index (BMI), preoperative duration, surgery duration, and cartilage injury were analyzed.@*RESULTS@#The mean follow-up time was (71.8±22.8) months. The postoperative VAS scores (1.0 vs. 5.0, P<0.001), AOFAS scores (92 vs. 80, P<0.001), and Tegner scores (6.5 vs. 2, P<0.001) were significantly superior to the preoperative levels. The excellent and good rate was 97.6%. The postoperative VAS score (t=2.719, P=0.10), AOFAS score (t=-2.853, P=0.10), Tegner score (t=-3.443, P=0.001) and time to return exercise (t=2.814, P=0.008) were negatively correlated with the patient age, and the postoperative VAS score was negatively correlated with cartilage injury (Z=-2.195, P=0.028).@*CONCLUSION@#The mid-to-long-term clinical outcomes of the chronic ankle ligament instability combined with the posterior impingement were good. The age of the patients was negatively correlated with the clinical outcome. The combined cartilage injury could aggravate the postoperative pain.

Arthroscopic treatment for osteochondral lesions of the talus: analysis of outcome predictors / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Compared with traditional arthrotomy procedures, arthroscopic treatment for osteochondral lesions of the talus has some advantages. However, there has been considerable debate about the outcome predictors for this surgical technique. This study aimed to investigate the outcomes of arthroscopic treatment for osteochondral lesions of the talus, and analyze its outcome predictors.</p><p><b>METHODS</b>Clinical data of 48 patients with osteochondral lesions of the talus who underwent ankle arthroscopy were studied. Arthroscopic debridement was performed on all patients, and microfracture was also performed in 36 cases. Scores on a subjective satisfaction questionnaire, visual analog scale (VAS) for pain, and the American Orthopedic Foot & Ankle Society (AOFAS) ankle and hindfoot scores were obtained before and after surgery.</p><p><b>RESULTS</b>Five patients lost to follow up. The other forty-three patients, 8 of whom were athletes, were followed up for an average of 23.9 months. The average AOFAS post-operative score was 90.16 +/- 9.96, compared with 70.81 +/- 6.96 before surgery (t = 9.353, P < 0.001). The VAS pain score after the operation (2.51 +/- 2.45) was significantly lower than that before the operation (6.95 +/- 1.40) (t = 8.647, P < 0.001). Of the 43 patients, 35 (81.4%) had good or excellent results. There was no significant difference in outcome between the medial and lateral groups (z = 0.205, P = 0.838), while a better outcome was found with lesions smaller than 10 mm than those with larger lesions (z = 2.199, P = 0.028). Age, sex, athletic profession and location of the lesion did not significantly correlate with outcomes.</p><p><b>CONCLUSIONS</b>Arthroscopic treatment is effective and safe for osteochondral lesions of the talus. A strong correlation was found between the size of the lesion and successful outcome.</p>

Diagnosis and arthroscopic treatment of osteochondral lesions of the talus / 中华外科杂志

<p><b>OBJECTIVE</b>To summarize and analyze the diagnosis and arthroscopic treatment of osteochondral lesion of talus (OLT).</p><p><b>METHODS</b>From 2000 to 2005 the data of 34 patients of OLT of the talus were retrospectively studied, including the symptom, physical examination, image, arthroscopic treatment All patients took X-ray and MRI examination before the arthroscopic surgery. Arthroscopic debridement was performed for all patients, in addition to drilling in 5 cases, and microfracture in 18 cases. Before operation, ankle-hindfoot score of American Orthopaedic Foot and Ankle Society (AOFAS) was 71 +/- 8, and the score of pain (visual analogue scale, VAS) was 7.5 +/- 1.3.</p><p><b>RESULTS</b>Weight-bearing pain of the ankle joint aggravated after exercise was the predominant complaint of OLT. X-ray examination was negative in 13 cases, and all lesions were detected by MRI, which was significantly better than X-ray (chi2 = 16.07, P < 0. 001). Thirty-one patients were followed up for an average of 28 months. The average post-operative AOFAS was 91 +/- 9 (t = 9.147, P < 0.001); And VAS was 2.4 +/- 2. 3, which was significantly lower than that in pre-operation (t = 10.853, P < 0.001). Of the 31 patients, 27 (87.1%) had good or excellent results.</p><p><b>CONCLUSIONS</b>MRI could improve the accuracy of diagnosis. The results of arthroscopic treatment for OLT are satisfactory.</p>

Diagnosis and management of septic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction / 中华外科杂志

<p><b>OBJECTIVE</b>To summary the experience in the diagnosis and management of septic arthritis after anterior cruciate ligament (ACL) reconstruction.</p><p><b>METHODS</b>The knee joint infections after arthroscopic anterior cruciate ligament reconstruction were retrospectively studied. From January 1997 to July 2007, 16 of 3638 patients undergoing anterior cruciate ligament reconstructions experienced postoperative septic arthritis. The incidence, cause, presentation, laboratory results, treatment, and outcome of all infected patients were analyzed. The experiences of diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction were summarized.</p><p><b>RESULTS</b>The incidence of septic arthritis after ACL reconstruction was 0.44%. The most common symptoms of the infected patients were fever, swelling, severe pain, tenderness, restricted motion. Eleven (68.8%) patients were positive for bacteria cultures, and Staphylococcus epidermidis was the most common bacteria. Nine of the 16 patients were performed arthroscopic debridement, and the other 7 patients were conservatively treated. All patients regained full range of motion and normal stability at the 19.7 months follow-up.</p><p><b>CONCLUSIONS</b>Septic arthritis, which could bring the dysfunction of the joint, is subsequent with cartilage injury and the failure of the ACL grafts. Early diagnosis and treatment of arthroscopic debridement in time are essential to the ultimate clinical outcome.</p>