The efficacy of absorbable interface screw combined with bone tunnel on knee ligament fractures / 中国医师进修杂志

Objective:To investigate the efficacy of absorbable interface screw combined with bone tunnel on knee ligament fractures.Methods:One hundred and twenty patients with fractures of anterior cruciate ligament (ACL) admitted to Shanxian Haijiya Hospital from January 2018 to April 2020 were selected and according to the random number table method, they were divided into the absorbable group and the metal group, with 60 cases in each group. They adopted absorbable interface screw combined with bone tunnel and metal screw combined with bone tunnel respectively. The clinical efficacy, Lysholm knee function score, bone broadening degree and the incidence of postoperative complications of the two groups were compared.Results:The excellent and good rate in the absorbable group was higher than that in the metal group: 93.33%(56/60) vs. 80.00%(48/60), χ2 = 4.62, P<0.05. After operation for 3 and 6 months, the Lysholm knee fuction scores in the absorbable group were higher than those in the metal group: (78.42 ± 5.26) scores vs. (70.41 ± 4.28) scores, (92.57 ± 6.34) scores vs. (88.26 ± 6.30) scores, the differences were statistically significant ( P<0.05). After operation for 6 months, the broadening degree of the bone tunnels of femur anteroposterior projection, femur lateral position, leg anteroposterior projection, leg lateral position in the absorbable group were lower than those in the metal group: (2.34 ± 0.55) mm vs. (3.18 ± 0.71) mm, (2.31 ± 0.42) mm vs. (3.20 ± 0.61) mm, (2.80 ± 0.77) mm vs. (3.23 ± 0.72) mm, (2.82 ± 0.51) mm vs. (3.22 ± 0.62) mm, the differences were statistically significant ( P<0.05). The incidence of postoperative complications in the absorbable group was lower than that in the metal group: 5.00%(3/60) vs. 16.67%(10/60), χ2 = 4.23, P<0.05. Conclusions:Absorbable interface screw combined with bone tunnel for ACL fractures can effectively improve clinical efficacy, promote knee joint rehabilitation, reduce postoperative bone canal width, and reduce the incidence of postoperative complications.

Comparison of the effect of anterior and posterior cruciate ligaments reconstruction between autologous ;tendon and tendon allograft / 中国基层医药

Objective To investigate the potential differences in efficacy of anterior and posterior cruciate ligaments(ACL &PCL)reconstruction by using arthroscopy between autologous tendon and tendon allograft.Methods A total of 144 patients with ACL or PCL fracture were assigned into two groups,namely anterior tibial muscle tendons allograft(n =82)and tendons autograft(n =63).The graft was fixed by using the Endobutton and Intrafix systems. The general information,drawer test,Lachman test,IKDC score,Lysholm score and Tegner score were compared between groups before and after surgery.The mean follow -up period was 16 months,ranged from 6 to 24 months. Results Both two groups received significant improvement after surgery and met the requirements of ligament reconstruction.However,those patients received autologous tendon had less complications,better knee stability.There were significant differences in Lachman score,ADT/PDT score,IKDC score[(83.43 ±4.37)points vs.(81.05 ± 4.41)points],Lysholm score [(90.59 ±3.43)points vs.(89.03 ±3.25 )points],and Tegner score [(7.79 ± 0.94)points vs.(7.37 ±0.90)points]between the two groups in 12 -month(χ2 =9.509,9.080,t =3.237,2.770, 2.729,all P <0.05).Conclusion The efficacy of autologous tendon is better than tendon allograft in anterior and posterior cruciate ligaments reconstruction,which should be considered has highest priority in treating patients with anterior or posterior cruciate ligaments fracture.

Preoperative Prediction for Length of Patellar Tendon in Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Autograft / 대한스포츠의학회지

Preoperative prediction of patellar tendon length is important during anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) autograft. Three methods of imaging analysis to predict patellar tendon length were compared in this study. One hundred and twenty-three patients who underwent ACL reconstruction using BPTB autograft by single surgeon during October 2002 through April 2011 were included. We measured the patellar tendon length from true and oblique lateral simple radiographs (classified according to degree of rotation) and magnetic resonance image (MRI). These values were compared with actual length measured during operation and assessed accuracy by calculating the coefficient of determination. The mean length of patellar tendon measured during operation and by true lateral and oblique lateral radiographs and MRI were 42.4+/-0.45 mm (range, 32.0-54.0 mm), 41.7+/-0.61 mm (range, 24.2-55.3 mm), 40.7+/-0.57 mm (range, 24.8-51.5 mm), and 41.7+/-0.52 mm (range, 28.7-56.0 mm), respectively. The correlation of patellar tendon length was the most strong between actual length and value from true lateral radiograph (coefficient of determination, r2=0.660) according to simple linear regression analysis. R2 values were 0.361 and 0.332 for oblique lateral radiograph and MRI compared to actual value, respectively. In conclusion, Patellar tendon length measured on true lateral radiograph was the best method to coincide with actual patellar tendon length among various preoperative prediction methods.

Estudo biomecânico da fixação transcortical ou transesponjosa do enxerto de tendão patelar com pinos bioabsorvíveis na reconstrução do LCA em ovinos / Biomechanical study of transcortical or transtrabecular bone fixation of patellar tendon graft with bioabsorbable pins in ACL reconstruction in sheep

OBJETIVO: Determinar a resistência inicial de fixação do sistema RigidFix® e comparar com o método tradicional de fixação que utiliza parafusos de interferência metálicos. Avaliar a resistência da fixação com o sistema RigidFix® ao se modificar o posicionamento rotacional do bloco ósseo no interior do túnel femoral. MÉTODOS: 40 espécimes de joelhos (soldras) de ovinos, foram submetidos à reconstrução do ligamento cruzado anterior (LCA)utilizando enxerto osso-tendão-osso. Em 20 espécimes utilizou-se o método RigidFix®, este grupo foi subdividido em dois, 10 joelhos foram utilizados para fixação através da esponjosa e 10 para fixação cruzando a tábua óssea cortical. Nos 20 espécimes restantes fixou-se o enxerto com parafusos de interferência metálico de 9mm. RESULTADOS: A comparação do método RigidFix® com o método de fixação com parafuso de interferência metálico não mostrou diferenças estatisticamente significativas ao se considerar carga máxima e rigidez, também não houve diferenças estatisticamente significativas ao se modificar o posicionamento rotacional do bloco ósseo no interior do túnel femoral. Para estas avaliações considerou-se o p < 0,017. CONCLUSÃO: A fixação do enxerto osso-tendão-osso com dois pinos bioabsorvíveis, independente do posicionamento rotacional no túnel femoral, permite uma fixação comparável em termos de resistência inicial ao parafuso de interferência metálico neste modelo experimental.

OBJECTIVE: to determine the initial resistance of fixation using the Rigid Fix® system, and compare it with traditional fixation methods using metal interference screws; and to evaluate the resistance of the fixation with the rigid fix system when the rotational position of the bone block is altered in the interior of the femoral tunnel. METHODS: forty ovine knee specimens (stifle joints) were submitted to anterior cruciate ligament reconstruction (ACL) using a bone-tendon-bone graft. In twenty specimens, the RigidFix® method was used; this group was subdivided into two groups: ten knees used for fixation with trabecular bone screw, and ten for fixation passing through the layer of cortical bone. In the twenty remaining specimens, the graft was fixed with 9mm metal interference screws. RESULTS: comparison of the Rigidfix® method with the metal interference screw fixation method did not show any statistically significant differences in terms of maximum load and rigidity; also, there were no statistically significant differences when the rotational position of the bone block was altered inside the femoral tunnel. For these evaluations, a level of significance of p < 0.017 was considered. CONCLUSION: fixation of the bone-tendon-bone graft with 2 bioabsorbable pines, regardless of the rotational position inside the femoral tunnel, gave a comparable fixation in terms of initial resistance to the metal interference screw, in this experimental model.

Resultado de la reconstrucción del ligamento cruzado anterior con el ligamento patelar bajo control artroscópico con un seguimiento superior a 15 años / Arthroscopic reconstruction of the ACL using the patellar tendon follow-up more than 15 years

Los resultados a largo plazo de las reconstrucciones del LCA por artroscopia son raros. Nosotros presentamos los resultados de un estudio de 57 pacientes con un seguimiento superior a 15 años. La reconstrucción es realizada bajo control artroscópico. Nosotros utilizamos un injerto hueso ligamento rotuliano hueso. El túnel femoral es realizado de afuera hacia adentro. La fijación femoral obtenida por "pressfit" y la fijación tibial es realizada con un tornillo de interferencia metálico. 240 pacientes fueron operados con esta técnica en 1992. Nosotros pudimos ver 57 de estos pacientes con un seguimiento promedio de 182 meses. Todos los pacientes fueron evaluados con el formulario IKDC. La laxitud diferencial fue medida con el Rolimeter (aircast). Un examen radiológico completo fue realizado a todos los pacientes. A 15 años de seguimiento 43 por ciento de pacientes fueron clasificados como A, 40 por ciento B, 10 por ciento C 5 por ciento y D según el formulario IKDC objetivo. El IKDC subjetivo promedio fue de 85,8/100. La laxitud diferencial instrumental promedio fue de 1,8 mm. 86 por ciento de los pacientes presentaron radiografías normales y solamente 5 por ciento de artrosis. Este estudio demuestra que esta técnica permite obtener buenos resultados en cuanto a la laxitud y la artrosis.

The results of the ACL by arthroscopy in the long term are rare. The following are the results of a study we made of 57 patients with a folloe-up of more than 15 years. The reconstruction was carried out by arthroscopy. We used a patellar ligament bone graft. The femoral tunnel procedure is outside-inside. The femoral attachment was by "pressfit", and the tibial attachment using a metalic interference screw. 240 patients were operated on in 1992 using this technique. We reviewed 57 of these patient with a mean follow-up time of 182 months. All the patients were evaluated using the IKDC formula. The laxity differential was measured using the Rolimeter (aircast). A complete radiological examination was carried out on all the patients. After 15 years follow-up 43 percent of the patients were classified A 40 percent, B 10 percent, C 5 percent and D using the IKDC formula objective. The mean IKDC subjective score was 85,8/100. The mean instrumental laxity diferrential was 1,8 mm. 86 percent of the patients had normal X-rays and only 5 percent had arthritis. This study demonstrates that using this technique good resultd can be obtained with regard to laxity and arthritis.

The Significance of the Femoral Tunnel Position in PCL Reconstruction Using the Bone-Patellar tendon - Bone Graft

PURPOSE: We compared the clinical and radiological RESULTS of two patient-groups who had had PCL reconstruction for grade III PCL injury using the autogenous bone-patellar tendon-bone graft at the isometric point and at the anatomical point of femoral condyle. MATERIALS AND METHODS: Of 31 patients who were involved in this study, 20 patients had consecutive isometric PCL reconstructions between June 1993 and May 1995(group 1), And 11 patients had anatomi- cal PCL reconstructions between 1995 and 1997(group 2). We evaluated the clinical results using the Lysholm knee scoring system and measured the posterior translation of the tibial condyle on the posterior stress lateral radiographs. RESULT: The average posterior translation at the final follow-up was 7mm in group 1 and 5.9mm in group 2. The Lysholm knee score was 89 points in group 1, and 92 point in group 2. However, there wasn't any statistically significant difference in clinieal and radiological results between the two groups. SUMMARY: The clinical and radiological results can be influenced by several factors inherent to arthro-scopically assisted PCL reconstruction. Although it seems that initial knee kinematics can be improved by more distal PCL graft placement, there may be little effect to the final clinical and radiological results according to the femoral tunnel positions.