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Objective:To compare the mid-to long-term clinical outcomes between suture anchor and simple suture for acute injury to lateral ankle ligament (cauda equina tear near the insertion).Methods:This retrospective study included 146 patients (professional and semi-professional athletes) who had been treated for acute injury to lateral ankle ligament (cauda equina tear near the insertion) at Department of Sports Medicine, The Third Hospital Affiliated to Peking University from June 2007 to May 2017.They were 101 males and 45 females, with an age of (27.1±10.3) years (from 12 to 62 years). Depending on ligament repair techniques, the patients were divided into a suture anchor group of 81 cases subjected to reconstruction of the torn ligament with a 1.8 mm suture anchor, and a simple suture group of 65 cases subjected to direct suture of the torn ligament with a braided thread. The 2 groups were compared in terms of visual analog scale (VAS) pain scores, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores and Tegner scores at preoperation and the last follow-up, time and level of postoperative motion recovery, proportion of limited joint motion, incidence of re-sprain and patient satisfaction.Results:There was no significant difference in the preoperative general data between the 2 groups, showing they were comparable ( P>0.05). The mean follow-up duration was (46.1±14.1) months (from 36 to 132 months). The VAS pain score, AOFAS ankle-hindfoot score and Tegner score at the last follow-up were significantly improved than those before operation in all the patients ( P<0.05). Postoperatively, there was no significant difference between the 2 groups in VAS pain score, AOFAS ankle-hindfoot score, Tegner score, incidence of re-sprain or proportion of limited joint motion ( P> 0.05). The suture anchor group was significantly better than the simple suture group in the level of postoperative motion recovery (92%±13% versus 89%±13%) and time of postoperative motion recovery [(4.2±1.1) months versus (4.6±1.0) months] ( P<0.05). Conclusions:Ligament repair, either by suture anchor or by simple suture, is a reliable procedure for patients with high sports demands after severe acute injury to the lateral ankle ligament. Compared with simple suture, suture anchor may accelerate postoperative motion recovery to the pre-injury level.
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Objective@#To investigate clinical outcomes of modified reattachment of superior peroneal retinaculum (SPR) for patients with recurrent peroneal tendon dislocation.@*Methods@#A total of 24 cases with recurrent peroneal tendon dislocation from December 2012 to June 2017 were treated with modified reattachment of SPR. There were 20 males and 4 females. The average age was 24.9±9.3 years (14-48 years). The average BMI was 23.18±3.50 kg/m2 (15.8-32.2 kg/m2). A 4-5 cm incision was made along the lateral margin of the fibula and curved distally around the fibular tip in line with the peroneal excursion. The superior peroneal retinaculum, peroneus longus and peroneus brevis were exposed. The periosteum and SPR were stripped from the fibula. The false pouch was formed. Two suture anchors were inserted into the postero-lateral ridge of the lateral malleolus without damaging the cartilaginous ridge, after which the SPR was reattached to the lateral malleolus with the anchored suture. The inner layer of the false pouch was incised, while the outer layer (periosteum) was sutured with the SPR in a pants-over-vest style. The following items, including American Orthopaedic Foot and Ankle Society (AOFAS) score, visual analogue scale (VAS), rate of return to previous sports level, time to return to sports activity, complication, and patients satisfaction were evaluated preoperatively and at the final follow-up.@*Results@#The average operation duration was 36.1±8.8 min (20-51 min). The blood loss was 1-10 ml, average 4.1±2.7 ml. The follow-up was carried out in 22 cases for mean 33.9±15.7 months (13-61 months). AOFAS score was improved from 77.8±7.8 points to 95.5±4.3 points significantly (t=-11.89, P<0.001). VAS score was reduced from 4.2±2.4 to 0.3±0.8 significantly (t=7.69, P<0.001). Mean duration return to sports activity was 5.0±1.9 months (3-10 months). A total of 20 patients (91%) returned to their previous sports level. Only one patient (5%) was found with limitation of range of motion, while two patients (9%) reported pain at the scar site without recurrence. The satisfaction rate was 91%.@*Conclusion@#Clinical outcomes of modified reattachment of SPR for patients with recurrent peroneal tendon dislocation was safe and effective.
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Objective To explore the diagnostic value of MSCT in tumors of intra-abdominal cryptorchidism in children.Methods MSCT findings of 8 children with tumors of intra-abdominal cryptorchidism confirmed by surgery and pathology were analyzed retrospectively.Results Six tumors located in the right,2 (1 tumor of left cryptorchidism turned to the right abdominal) in the left.Eight children showed ovoid soft tissue tumor in abdomen.Three children displayed the long axis of the tumors consistent with regular descending course of embryonic testes.Six teratomas manifested as the cystic and solid mass with fat,calcification (ossification) insidey.Two yolk sac tumors manifested as the large cystic and solid mass with irregular necrosis and abundant tumor vessels.Conclusion The pathologic types of tumors for intra-abdominal cryptorchidism in children are different from adult.Most of them are teratomas or yolk sac tumors,and have some characteristics in MSCT.MSCT is helpful in diagnosis of tumor for intra-abdominal cryptorchidism with medical history.
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[Summary] Ankle joint injury is one of the most common sports injuries , and some patients with chronic ankle instability need surgical treatment .Traditional incision surgeries are characterized with traumatic performance and high complication rates , and the exploration of the joint lesion is not comprehensive .With the development of minimally invasive surgery , the application of arthroscopy in the treatment of chronic ankle instability is increasing , which is conducive to the treatment of intra-articular lesions , while reducing the surgical trauma and improving the postoperative effects .In this paper , we summarized the current status of the application of arthroscopy in the surgery for chronic ankle instability from two aspects , which were arthroscopic surgery in the diagnosis and treatment of the disease, and total arthroscopic repair technology of ankle ligament .We also introduced domestic and overseas operation effects and new concepts .
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[ ABSTRACT] AIM: To investigate the underlying genetic changes of a Chinese patient with infantile malignant osteopetrosis ( IMO) .IMO is a monogenic disease, mostly caused by mutations of TCIRG1 and CLCN7 genes.The former is believed a homozygous gene and only cause the disease in homozygous or compound heterozygous status.However, it has been reported that heterozygous mutations also cause the disease in 6 non-Chinese cases.METHODS:Genomic DNA was extracted from peripheral blood of the patient and his parents.All exons and splice sites of TCIRG1 and CLCN7 genes were amplified by PCR followed by Sanger sequencing.Mutation detection in the 2 genes was also investigated in the parents. Haplotypes were constructed by variations obtained in mutation detection and microsatillites flanking TCIRG1 gene in the family by Cyrillic.Chromosomal microarray analysis ( CMA) was performed to detect copy number variations ( CNV) of the patient and his mother.RESULTS:A novel mutation c.449_452delAGAG ( p.Gln149Glnfs16) was detected in the pa-tient.This mutation truncated 666 amino acids at the C terminal of the V-ATPase 116 kD isoform a3 protein.It wiped out the entire ATPase V0 complex and was predicted to result in total loss of protein function.This mutation was also detected in the patient’ s father.No pathogenic mutation was detected in CLCN7 gene.CMA did not reveal any CNV involving TCIRG1 or CLCN7 gene.CONCLUSION:We reported a novel heterozygous mutation of TCIRG1 gene causing IMO.This represents the first IMO case in China caused by heterozygous TCIRG1 gene mutation.
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Objective To summarize the clinical experience of diagnosis and arthroscopic treatment of intratment of intra ular osteoid osteoma.Methods Seven patients(average 22.4 years old with range from 11～32 years)with intra-articular Osteoid osteoma who underwent arthroscopy treatment from March 2006 to June 2009 were studied respectively.Thin-section CT scanning was used to confirm diagnosis and determine surgery location.Results The time span between the appearance of clinical symptoms and confirmed diagnosis was 26.0 months on average(range from 18 to 36 months).At a mean 19-month follow-up,all patients showed significant improvements including VAS decrease,no recurrence,pain relief and normal range of motion.Conclusion The atypical clinical features and radiographic findings of osetoid osteoma might lead to the delayed diagnosis.Using arthroscopy to remove intro-articular osteoid ostema was a safe and effective way.
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Objective To study the clinical features of meniscal cyst of the knee. Methods From January 2001 to December 2007,totally 5986 cases of meniscus operation were performed in our hospital,104 of them were diagnosed as having meniscal cyst in the knee. The clinical data of these patients,including gender and age distributions,causes and mechanism of injury,clinical presentations,characteristics of the cyst,and the type of the injury,were investigated. Results Incidence rate of meniscal cyst was 1.7% (104/5986) and the ratio between medial and lateral meniscal cysts was 1∶12 (8∶96). The mean age of the 104 patients was (30.7?12.2) years (range,13 to 65 years),and the radio of male to female was 1.2 to 1. Of the patients,60 cases (57.7%) had history of trauma,32 or them were hurt in sports,including football (11 cases),basketball (8 cases) and others. The most common primary symptom was pain (102 cases,98.1%),followed by swelling (50 cases,48.1%). Tenderness over the joint line (85 cases,81.7%) and palpable mass (79 cases,76.0%) with or without signs of meniscal tear were common presentations. The anterior and middle portions of the medial meniscus (5/8,62.5%),and posterior extension of the lateral meniscus (88/96,91.7%) were the most commonly involved sites (?2=15.167,P=0.000). The most frequently observed meniscal tear was a horizontal cleavage,alone (25/104,24.0%) or associated with another types of lesions (52/104,50.0%). In 5.8% (6/104) of the cases,the discoid meniscus was involved. Conclusions Meniscus cysts are unusual. The ratio between medial and lateral meniscal cysts favors the lateral meniscus. Meniscal tear and myxoid degeneration are the common causes of the cyst. The most frequently observed meniscal tear is a horizontal cleavage,and the anterior and middle portions of the medial meniscus and posterior extensions of the lateral meniscus are the most commonly involved sites.
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Objective To analyze the outcomes of arthroscopy for secondary osteoarthrosis of the ankle joint. Methods From March 2000 to February 2006,62 patients with osteoarthrosis of the ankle joint were treated with arthroscopy in our department. Among the cases,52 received follow-up. We analyzed the therapeutic outcomes by evaluating the AOFAS,McGuire,and Mazur scores. Results The 52 cases were followed up for 12 to 84 months (mean,36.2 months). During the follow-up,we observed significantly increased scores of AOFAS,McGuire,and Mazur [postoperation vs. peroperation:57.6?12.8,56.5?14.9,and 61.5?12.6 vs. 82.4?11.5 (t=11.02,P=0.00),84.8?12.6 (t=9.52,P=0.00),and 84.1?14.7 (t=8.70,P=0.00)] with the rate of excellent and good results of 80.8% (42/52),82.7% (43/52),and 84.6% (44/52).Conclusions Arthroscopic treatment is effective for osteoarthrosis of the ankle joint with satisfactory results especially in patients with mild or moderate osteoarthrosis or those with loose bodies.
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Objective To investigate the clinical effects and postoperative complications of arthrotomy and arthroscopy in repair of 170 menisci in 168 cases.Methods One hundred and sixty-eight patients with meniscus injury were repaired by arthrotomy or arthroscopy.They were 121 males and 47 females.There were 77 left knees and 91 right knees;117 medial menisci and 53 lateral ones.Their average age was 25.5?8.4 years old.Arthro- scopic repair methods included puncture and grinding,bio-absorbable meniscus arrow fixation,Outside-In suturing, Inside-Out suturing,Elite scuff instrument repairing,T-Fix fixation and FasT-Fix fixation techniques.The clinical results were assessed on the basis of symptoms,physical signs,Tegner scores and Lysholm scores of the cases. Postoperative complications were also investigated.Re-arthroscopic exploration was done for patients with obvious symptoms and physical signs.Results The average folluw-up time was 49.3?28.8 months.Their mean pre- operative Tegner score was 3.3?2.3,and their postoperative one 6.8?2.1 (P＜0.05).Their preoperative Lysholm score was 30.1?18.2,and their postoperative one 87.5?22.5 (P＜0.01).There were significant differences in Tegner and Lysholm scores before operation and after operation.Ninety-eight repaired menisci were rated as excellent(57.7%),57 as good (33.5%),10 as fair (5.9%),and five as poor (2.9%).The total ex- cellent and good result was 91.2%.Of the 19 patients with obvious symptoms and physical signs,re-arthroscopic exploration found no healing in five and partial healing in six.Postoperative complications included pain at the Outside-In suture nodes in three cases,referred pain at posterior articular capsule resulted from failed Outside-In meniscus anterior horn suturing in one case,and twinge at the meniscus arrow site in the posterior capsule in five cases.No serious lesion occurred at blood vessels or nerves.The postoperative complication incidence was 5.3%. Conclusion The eight methods of arthrotomy and arthroscopy to repair injured menisci investigated in our study can have a high successful rate and low perioperative and postoperative risk.
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Objective To study the injury mechanism, diagnosis and therapy of traumatic dislocation of the peroneal tendons. Methods 18 cases with traumatic dislocation of the peroneal tendons were operated in our institute from 1986 to 2000. The mechanism of injury and clinical findings were investigated. 2 cases with acute dislocation were operated by suturing the peroneal retinaculum directly. 16 cases with recurrent dislocation were treated with Watson-Jones operation. Results 10 cases with recurrent dislocation were follow-up from 1 year to 15 years with an average of 6.2 years. Only one recurrence due to ankle sprain was found and the other 9 cases had no more dislocation and returned to sports without symptom.Conclusion Traumatic dislocation of the peroneal tendons can be caused by the injury of ankle joint in three positions:dorsiflexsion and eversion, dorsiflexsion and inversion, plantflexsion and inversion. Anti-resistant test of dorsiflexsion and eversion may help diagnosis. Watson-Jones operation has the advantages of simple to apply, minor trauma and sound clinical outcome.
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Objective To study clinical and pathological characteristics and effects of arthroscopic treatment of ankle soft tissue impingement syndrome(ASTIS). Methods A total of 21 cases of ASTIS underwent arthroscopic operations from November 2000 to April 2005.The impingement soft tissues were removed under arthroscope at 13.6?9.9 months after injury.The resected tissues were pathologically examined following surgery.The efficacy of arthroscopy was assessed using the American Orthopaedic Foot and Ankle Society(AOFAS) rating scores. Results Arthroscopic findings showed the most common impingement tissue was synovium(20 cases),followed by distal fascicle of the anterior tibiofibular ligament(5 cases),fibrous scar tissue(4 cases),anterior talofibular ligament(3 cases),and meniscoid tissue(3 cases).ASTIS accompanying cartilage injuries was found in 16 cases.All the cases were followed for 7~60 months(mean,34.3?9.4 months).The AOFAS scores significantly increased postoperatively than preoperatively,with total scores from 67.0?9.7 to 94.0?6.4(t=-7.205,P=0.000) and subjective scores from 20.7?6.6 to 35.7?4.9(t=-5.003,P=0.000). Conclusions Ankle soft tissue impingement syndrome often occurs after ankle sprain along the anterolateral portion of the ankle.Common impingement tissues are synovium,ligament,scar tissue,and meniscoid tissue.Arthroscopic treatment of ankle soft tissue impingement syndrome is satisfactory.
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Objective To study surgical techniques for the treatment of traumatic recurrent dislocation of the peroneal tendons. Methods A total of 21 cases of traumatic dislocation of the peroneal tendons from 1986 to 2003 were treated with the Watson-Jones operation. Results A follow-up series was carried out in 15 cases for 1~15 years (mean, 4.9 years). Recurrence of dislocation occurred in 1 case, as a result of trauma, while the rest of 14 cases had returned to normal sports or competitions. Conclusions The Watson-Jones operation for recurrent dislocation is technically feasible and minimally invasive, offering satisfactory outcomes.
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Objective To explore the diagnostic and therapeutic value of arthroscopy for ankle joint sports injury. Methods 52 patients (53 ankles) with ankle sports injury treated by arthroscopy were reviewed retrospectively from December 1992 to December 2001. The modified McGuire Scorting for ankle (1988) was used as efficacy criteria. Results The mean recovery time of daily activities and special sports for the athletes was 10 days and 2.5 months respectively. All of the athletes returned to their previous optimal athletic level except that 1 case recovered slowly due to reinjury. Complications occurred in 3 cases (5 8%). The preoperative score was (60 4?9 1) points and postoperative score (89 0?5 7) points ( t =24 1, P