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Objective:To investigate the characteristics of an abnormal attachment point of the anterior horn of the medial meniscus (AHMM) by methods of arthroscopy, radiological imaging, and pathology.Methods:A total of seven cases of a rare abnormal attachment (anteromedial meniscofemoral ligament, AML) connecting the AHMM and anterior cruciate ligament (ACL) were identified in the more than six thousand arthroscopic procedures from January 2018 to April 2021. During the procedures, subtotal meniscal resection or meniscal repair was performed in all cases. Tissue removed intraoperatively was used for pathologic examination. For this study, the preoperative MRI films of these patients were retrospectively examined.Results:Finally, seven cases with diagnosed meniscal tears were included in this study, including 4 males and 3 females with a mean age of 37.85±7.70 years (range, 27-50 years). The AML, which extends outward and upward and is anterior to the ACL, begins at the AHMM and ends anterior to the femoral attachment of the ACL. The histological staining showed that the AML was a bundle of collagen fibers, whereas the ACL was a bundle of dense fibrous collagen. The AML could be clearly identified in the proton-weighted image of sagittal MRI preoperatively and showed a low signaling similar to the signal intensity of the ACL. AML was easily identified on sagittal MRI but not on axial and coronal MRI. In three patients who underwent bilateral MRI, the AML structure was found in both knees.Conclusion:The incidence of rare anatomic variation between the AHMM and the lateral condyle of the femur is 0.1%, usually occurring in both knees simultaneously. In cases with this variation, there is no bony attachment in the AHMM connected to the ACL via the AML. After transection of the AML, the annular fibrous structure and mechanical properties of the meniscus are damaged, as consequently the AML should be carefully protected in clinical practice.
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Objective:To investigate the early curative effect of the new autologous semitendinosus ribbon-like graft in reconstruction of anterior cruciate ligament (ACL) tear.Methods:A retrospective cohort study was conducted to analyze the clinical data of 65 patients with knee ACL tear admitted to Zhengzhou Orthopedics Hospital from June 2019 to January 2021, including 52 males and 13 females, aged 16-50 years [(30.5±8.4)years]. According to the reconstruction method and graft selection, the patients were divided into ribbon-like reconstruction group ( n=31) and circular bundle reconstruction group ( n=34). All patients underwent anatomical ACL reconstruction using the new autologous semitendinosus ribbon-like graft in ribbon-like reconstruction group and the traditional circular bundle graft in circular bundle reconstruction group. The operation time, morphological difference in ACL graft immediately after surgery with original ACL, Lysholm score before and at 3 months after surgery, Lachman test and axial shift test immediately and at 3 months after surgery, and intraoperative and postoperative complications were compared between the two groups. Results:All patients were followed up for 3-15 months [(6.0±3.1)months]. The operation time was (61.6±6.7)minutes in ribbon-like reconstruction group and was (48.0±6.3)minutes in circular bundle reconstruction group ( P<0.01). Under arthroscopic observation, the original ACL was ribbon-shaped in the joint, the graft in ribbon-like reconstruction group was also ribbon-like structure, the graft in circular bundle reconstruction group was bundle structure. Therefore, the grafts in ribbon-like reconstruction group better simulated the ribbon-like structure of the original ACL than those in circular bundle reconstruction group. The ribbon-like graft mimiced the natural twisting of the ACL when the knee was bent. Lysholm score was (82.8±5.2)points in ribbon-like reconstruction group at 3 months after surgery, significantly higher than (47.5±8.7)points before surgery ( P<0.01). Lysholm score was (79.9±7.5)points in circular bundle reconstruction group at 3 months after surgery, significantly higher than (44.2±9.4)points before surgery ( P<0.01). There were no significant differences in Lysholm score between the two groups before and at 3 months after surgery (all P>0.05). Lachman and axial shift tests were negative in both groups immediately and at 3 months after surgery. The ribbon-like reconstruction group showed breakage or wear of Kirschner wires in 4 patients and hollow drill deformation in 1 intraoperatively. The circular bundle reconstruction group showed wear of Kirschner wires in 2 patients intraoperativley. There was no significant difference in intraoperative complications between the two groups ( P>0.05). One patient experienced tibial incision infection in ribbon-like reconstruction group at 3 months after surgery. All wounds were healed at stage I with no incision infection in circular bundle reconstruction group. No patients had ligament failure or function limitation. There was no significant difference in postoperative complications between the two groups ( P>0.05). Conclusions:The clinical effect of new autogenous semitendinosus ribbon-like graft in ACL reconstruction is comparable to that of traditional circular bundle graft. However, arthroscopic observation reveals that the parenchymal part of the ribbon-like graft is ribbon-shaped, which better simulates the physiological morphology of the original ACL. The natural distortion of the simulated ACL during knee bend may better simulate the physiological function of the original ACL.
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Objective:To compare the clinical outcome between arthroscopically-assisted modified outside-in technique and inside-out technique for reconstruction of posterior cruciate ligament (PCL).Methods:A retrospective cohort study was conducted to analyze the clinical data of 53 patients with PCL rupture treated at Zhengzhou Orthopaedics Hospital from September 2015 to March 2019. There were 36 males and 17 females, at age of 21-58 years [(37.2±12.5)years]. There were 29 patients with right knee injury and 24 patients with left knee injury. All patients underwent minimally invasive arthroscopically- assisted PCL reconstruction, including the femoral tunnel established using the modified outside-in technique in 22 patients (outside-in group) and the inside-out technique with 120° of knee flexion in 31 patients (inside-out group). The two groups were compared in terms of operation time, length of femoral tunnel intraoperatively, angle between femoral tunnel and intra-articular graft at postoperative 3 days, and posterior drawer test (PDT), International Knee Documentation Committee (IKDC) score, Lysholm knee score, knee range of motion (ROM), knee extension muscle strength at the last follow-up. The complications were recorded after operation.Results:All patients were followed up for 15-38 months [(21.4±8.7) months]. There were no significant differences between the two groups in operation time and last follow-up evaluation of PDT, IKDC score, Lysholm knee score and knee ROM (all P>0.05). The length of femoral tunnel in outside-in group [(38.6±2.9)mm] was longer than that in inside-out group [(32.4±2.5)mm] ( P<0.05). The angle between femoral tunnel and intra-articular graft in outside-in group [(147.5±3.1)°] was larger than that in inside-out group [(136.4±2.6)°] ( P<0.01). The knee extension muscle strength of all patients reached grade V at the last follow-up. There were 2 patients with 5° flexion limitation in outside-in group, comparable to 3 patients with 5° flexion limitation and 1 patient with 10° flexion limitation in inside-out group ( P>0.05). No incision infection, implant loosening or injury of the extension apparatus of the knee occurred after operation. Conclusions:In treating PCL rupture, both arthroscopically-assisted modified outside-in technique and inside-out technique can achieve satisfied stability and functional recovery. However, the length and angle of femoral tunnel is more controllable when using the the modified outside-in technique.
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Objective To compare the primary clinical results of arthroscopic figure of 8 suture and ladder mesh suture fixations in treating anterior cruciate ligament (ACL) tibial avulsion fractures.Methods From August 2013 to November 2016,a total of 37 patients with ACL tibial avulsion fracture who had closed epiphyses underwent arthroscopy.By the Meyers-McKeeverZaricznyj classification,10 cases were type Ⅱ,22 type Ⅲ and 5 type Ⅳ.There were 25 cases in the figure of 8 suture fixation group with two No.2 high-strength sutures crossed to form a 8 figure to pull out and fix the fracture through the tibial tunnels,including 17 males and 8 females with an average age of 18.91 ±9.34 years (range 14-36 years).The ladder mesh suture fixation group with three No.2 high-strength sutures woven into a mesh to pull out and fix the fracture through the tibial tunnels had 12 cases,including 8 males and 4 females with an average age of 19.63±7.85 years (range 15-33 years).At the latest follow-up,the Lysholm and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function,while the Lachman test and Pivot-shift test were used to estimate knee joint instability.The operation duration,knee range of motion (ROM) and the number of case with flexion contracture were evaluated.Results All 37 cases were followed up.The average follow-up duration was 16.35±5.27 months (range 10-22 months) in figure of 8 suture fixation group and 14.06±7.18 months (range 10-21 months) in ladder mesh suture fixation group.In figure of 8 suture fixation group,the Lysholm and IKDC average scores were 95.86±5.74 and 90.53±4.61,respectively.However,they were 96.53±3.17 and 92.15±5.54 in ladder mesh suture fixation group with no significant difference between the two groups after operation (t=0.723,P=0.462;t=l.018,P=0.279).The percentage of negative Lachman test and Pivot-shift test in the figure of 8 suture group was 92％ (23/25).There was no significant difference in the negative rate in the ladder mesh suture fixation group 100％ (12/12,x2=0.904,P=0.265).The average operation duration of ladder mesh suture fixation group was 61.8±6.3 minutes,which was longer than that of figure of 8 suture fixation group 43.5±5.9 minutes (t=2.714,P=0.025).Flexion contracture of ≥5° occurred in 4 cases in the figure of 8 suture group and 0 case in the ladder mesh suture fixation group with significant difference between the two groups (x2=0.450,P=0.032).Conclusion In treating ACL tibial avulsion fractures,arthroscopic figure of 8 suture fixation and ladder mesh suture fixation can achieve satisfied functional recovery and stability.The ladder mesh suture fixation can effectively achieve reduction of fracture fragments and knee flexion contracture.It may have more advantages in treating rotational type Ⅲ and type Ⅳ comminuted fractures.However,some disadvantages in this technique,such as high technical requirements and long operation time,have to be considered.
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Objective@#To compare the primary clinical results of arthroscopic figure of 8 suture and ladder mesh suture fixations in treating anterior cruciate ligament (ACL) tibial avulsion fractures.@*Methods@#From August 2013 to November 2016, a total of 37 patients with ACL tibial avulsion fracture who had closed epiphyses underwent arthroscopy. By the Meyers-McKeever-Zaricznyj classification, 10 cases were type II, 22 type III and 5 type IV. There were 25 cases in the figure of 8 suture fixation group with two No.2 high-strength sutures crossed to form a 8 figure to pull out and fix the fracture through the tibial tunnels, including 17 males and 8 females with an average age of 18.91±9.34 years (range 14-36 years). The ladder mesh suture fixation group with three No.2 high-strength sutures woven into a mesh to pull out and fix the fracture through the tibial tunnels had 12 cases, including 8 males and 4 females with an average age of 19.63±7.85 years (range 15-33 years). At the latest follow-up, the Lysholm and International Knee Documentation Committee (IKDC) scores were used to estimate knee joint function, while the Lachman test and Pivot-shift test were used to estimate knee joint instability. The operation duration, knee range of motion (ROM) and the number of case with flexion contracture were evaluated.@*Results@#All 37 cases were followed up. The average follow-up duration was 16.35±5.27 months (range 10-22 months) in figure of 8 suture fixation group and 14.06±7.18 months (range 10-21 months) in ladder mesh suture fixation group. In figure of 8 suture fixation group, the Lysholm and IKDC average scores were 95.86±5.74 and 90.53±4.61, respectively. However, they were 96.53±3.17 and 92.15±5.54 in ladder mesh suture fixation group with no significant difference between the two groups after operation (t=0.723, P=0.462; t=1.018, P=0.279). The percentage of negative Lachman test and Pivot-shift test in the figure of 8 suture group was 92% (23/25) . There was no significant difference in the negative rate in the ladder mesh suture fixation group 100% (12/12, χ2=0.904, P=0.265). The average operation duration of ladder mesh suture fixation group was 61.8±6.3 minutes, which was longer than that of figure of 8 suture fixation group 43.5±5.9 minutes (t=2.714, P=0.025). Flexion contracture of ≥5° occurred in 4 cases in the figure of 8 suture group and 0 case in the ladder mesh suture fixation group with significant difference between the two groups (χ2=0.450, P=0.032).@*Conclusion@#In treating ACL tibial avulsion fractures, arthroscopic figure of 8 suture fixation and ladder mesh suture fixation can achieve satisfied functional recovery and stability. The ladder mesh suture fixation can effectively achieve reduction of fracture fragments and knee flexion contracture. It may have more advantages in treating rotational type III and type IV comminuted fractures. However, some disadvantages in this technique, such as high technical requirements and long operation time, have to be considered.
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Objective: To evaluate the effectiveness of arthroscopic anterior cruciate ligament (ACL) reconstruction via tibial tunnel made by three-portal technique. Methods: Between July 2015 and December 2016, 45 patients with ACL ruptures were treated. There were 29 males and 16 females with an average age of 27.5 years (range, 18-42 years). There were 18 cases in the left side and 27 cases in the right side. There were 28 cases of sports injuries, 13 cases of traffic accidents, and 4 cases of other injuries. The average time from injury to operation was 21.6 days (range, 5-36 days). There were 25 cases of simple ACL injury and 20 cases of ACL complicated with medial collateral ligament, medial meniscus or lateral meniscus injuries. The Lachman tests of all patients were positive. The pivot shift tests of all patients were positive with grade Ⅰ in 27 cases, grade Ⅱ in 13 cases, and grade Ⅲ in 5 cases. The preoperative International Knee Documentation Committee (IKDC) score was 70.28±6.12, and the Lysholm score was 63.27±7.62. All patients underwent arthroscopic single-bundle ACL reconstruction, and the tibial tunnel was created through the anterolateral, high anteromedial, and additional low anteromedial approaches. Results: All incisions healed by the first intention. All patients were followed up 18.7 months on average (range, 14-32 months). The three-dimensional CT at 3 days after operation showed that the tibial tunnel positions were accurate and the middle points were located in the 36.81%-43.35% of tibial plateau on sagittal plane. The medial borders of the tibial tunnel on coronal plane were located at the lateral to the medial eminence of the tibia. There were 3 cases of thrombosis of intermuscular vein of lower limbs, 2 cases of joint swelling and pain, and 3 cases of stiffness of knee joint. At last follow-up, the Lachman tests of all patients were negative and the pivot shift test were negative in 42 patients and positive in 3 patients (grade Ⅰ). The IKDC score (92.59±4.36) and Lysholm score (93.15±5.53) were significantly higher than preoperative scores ( t=11.35, P=0.00; t=12.27, P=0.00). Conclusion: Arthroscopic ACL reconstruction via tibial tunnel made by three-portal technique, which was simple and accurate, can obtain the satisfactory function of the knee in the early stage after operation.