ABSTRACT
Objective To discuss the treatment strategy of knee dislocation and to evaluate its outcome.Methods Thirty-six patients with unilateral knee dislocation treated with individualized protocol were studied retrospectively,including 22 males and 14 females with an average age of 35 years (range,19-72 years).There were 30 acute and 6 chronic knee dislocations.According to the modified Schenck's classification of knee dislocation,there were 7 KD- Ⅰ and 23 KD-Ⅲ cases in the acute category,and all 6 chronic cases were KD-Ⅲ.Seven acute KD- Ⅰ and 6 chronic KD-Ⅲ cases underwent one-stage arthroscopic surgery.In 23 acute KD-Ⅲ cases,2 were treated conservatively with splint or brace due to advanced age,18 with staged surgery,3 with one-stage surgery due to concomitant vascular and nerve injury.Functional and clinical evaluation was conducted at final follow-up.Results All 36 patients were followed up for an average of 27 months (range,18-36 months).The Lysholm score (82.0±11.4),Tegner score (5.5±1.3),and knee range of motion (118.3°±19.2°) at final follow-up showed a statistically significant improvement compared with preoperative results (P＜O.O1).Eight (23.5％) patients had residual knee instability:posterior drawer test and Sag sign were positive (++ or +++) in 8 knees,valgus instability (++) in 1 and varus instability (+++) in 1.The remaining 28 knees were stable.Conclusion Special attention should be paid to rotational knee dislocation with single cruciate ligament rupture.Properly individualized treatment plan is the key to optimal outcome.Arthroscopic surgery can lead to successful outcome.Early one-stage arthroscopic surgery is recommended for acute KD-Ⅰ and chronic KD-Ⅲ dislocation,staged arthroscopic surgery for acute KD-Ⅲ dislocation.
ABSTRACT
Objective To study the diagnosis and treatment of multiple-ligament injury to the knee and report the clinical outcomes of the disease.Methods A total of 51 patients with multiple-ligament tear in the knee were enrolled in this study.The lesion involved the ACL and MCL in 21 cases,ACL and PLC in 1,PCL and MCL in 4,PCL and PLC in 6,ACL,PCL,and MCL in 6,ACL,PCL,and PLC in 3,ACL and PCL in 8,and PCL and patella tendon in 2.Among the patients,14 patients had acute Ⅲ grade MCL tear and 3 had acute Ⅲ grade PLC injury;open suture repair were performed on these cases,and then arthroscopic surgery was carried out for other injured ligaments after 3-week immobilization.For 2 patients who had chronic Ⅲ grade MCL injury and 3 cases that were suffering from chronic Ⅲ grade PLC tear,open surgery for ligament reconstruction was employed,arthroscopy were used afterwards to remodel the ACL and PCL.In the 51 patients,totally 39 ACLs were injured,20 of these ligaments were reconstructed under a arthroscope using Hamstring tendon,17 were repaired with BPB by arthroscopy,and 2 were remodelled by implanting allogeneic tendons.In addition,29 PCLs tear were diagnosed,among which arthroscopic PCL reconstruction with autologous Hamstring tendon was performed on 19,allogeneic ligaments were used in 2,and the other 8 injured PCL were not repaied surgically because the lesion was relieved after immobilization(improved from grade Ⅲ to
ABSTRACT
Objective To arthroscopically re-observe the remodeling and maturity process following anterior cruciate ligament(ACL) reconstruction with a hamstring tendon autograft.Methods Thirty-three patients who had undergone a previous arthroscopic ACL reconstruction with a homolateral hamstring autograft were given a second observation under arthroscope.The interval from initial reconstruction to second-look arthroscopy ranged 2~36 months(mean,11.9 months).According to different intervals,the patients were grouped as 1~,4~,7~,10~,13~,18~,and 25~ months.The shape,color,tension,covering synovial tissue,and vascularity of the grafts were evaluated.Results As the interval increased,the hamstring grafts tended to progress to normal ACL morphologically.Under arthroscopic observation,the tendon grafts were characterized as grayish-white thick ligamentous tissues without synovial membrane and blood vessels after 7 months following initial reconstruction,which corresponded with the maturation period of autogenous grafts and simulated normal ACL.Conclusions Remodeling and maturation of the hamstring autografts progresses with time,which is comparable to patellar tendon autografts.