Effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament tibial insertion fracture in adults / 中国修复重建外科杂志

OBJECTIVE@#To explore the effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament (PCL) tibial insertion fractures in adults.@*METHODS@#Between October 2019 and October 2021, 16 patients with PCL tibial insertion fractures were treated with arthroscopic binding fixation using suture through single bone tunnel. There were 11 males and 5 females with an average age of 41.1 years (range, 26-58 years). The fractures were caused by traffic accident in 12 cases and sports in 4 cases. The time from injury to operation ranged from 2 to 10 days with an average of 6.0 days. The fractures were classified as Meyers-McKeever type Ⅱ in 4 cases and type Ⅲ in 9 cases, and Zaricznyi type Ⅳ in 3 cases. There were 2 cases of grade Ⅰ, 7 cases of grade Ⅱ, and 7 cases of grade Ⅲ in the posterior drawer test. There were 3 cases combined with lateral collateral ligament injury and 2 cases with meniscus injury. The visual analogue scale (VAS) score, Lysholm score, International Knee Documentation Committee (IKDC) score, and knee range of motion were used to evaluate knee joint function. The posterior drawer test and knee stability tester (Kneelax 3) were used to evaluate knee joint stability. The X-ray films were used to evaluate fracture reduction and healing.@*RESULTS@#All incisions healed by first intention after operation. There was no incision infection, popliteal neurovascular injury, or deep venous thrombosis of lower limbs. All patients were followed up 6-12 months, with an average of 10 months. X-ray films at 6 months after operation showed the fractures obtained bone union. There were 11 cases of grade 0, 4 cases of gradeⅠ, and 1 case of grade Ⅱin posterior drawer test, showing significant difference when compared with preoperative results ( Z=23.167, P<0.001). The VAS score, Lysholm score, IKDC score, knee range of motion, and the results of Kneelax3 examination all significantly improved when compared with preoperative results ( P<0.05).@*CONCLUSION@#For adult patients with PCL tibial insertion fractures, the arthroscopic binding fixation using suture through single bone tunnel has the advantages of minimal trauma, good fracture reduction, reliable fixation, and fewer complications. The patient's knee joint function recovers well.

Tendon-bone healing in anterior cruciate ligament reconstruction with and without remnant preservation / 中国组织工程研究

BACKGROUND: Whether remnant preservation can improve tendon-bone healing remains a controversy. Experiments were designed to evaluate whether remnant preservation has the biological advantage of promoting tendon-bone healing by histology and imaging. OBJECTIVE: To investigate the effect of preservation of ligament stump on tendon-bone healing in anterior cruciate ligament reconstruction. METHODS: Forty New Zealand rabbits were randomly divided into two groups: anterior cruciate ligament reconstruction group without remnant preservation (group A) and anterior cruciate ligament reconstruction group with remnant preservation (group B), with 20 rabbits in each group. Achilles tendon was selected as the graft, and the bilateral anterior cruciate ligaments of all the rabbits were cut off. In group A, the anterior cruciate ligament stump was completely removed. In group B, the tibia stump was cut off from the femoral stop, and the tibia stump was retained. According to the position of the anterior cruciate ligament of the normal rabbits, the tibia and the femoral canal were selected for reconstruction. At 6 and 12 weeks after surgery, the expression of vascular endothelial growth factor and hypoxia inducible factor-1α was detected by immunohistochemistry. Graft microvessel density was detected by CD34 immunohistochemical staining. The signal intensity of tendon and the width of bone tunnel were observed by MRI and CT. RESULTS AND CONCLUSION: (1) The percentage of hypoxia inducible factor-1α and vascular endothelial growth factor positive cells in group B was significantly higher than that in group A at 6 weeks after operation (P 0.05). (2) At 6 weeks after operation, the expansion of bone tunnel in group B was significantly lower than that in group A, and the signal intensity of tendon graft was lower in group B than that in group A (P 0.05). (3) In this experiment, in the early stage of ligament reconstruction, the anterior cruciate ligament reconstruction with remnant preservation is superior to the anterior cruciate ligament reconstruction without remnant preservation in terms of graft revascularization and reduction of bone tunnel expansion, showing some biological advantages.

Lengths of the fixed loop and the adjustable loop in the coarse bone tunnel were compared to influence the widening of the femoral bone tunnel and the function of the knee joint / 北京大学学报(医学版)

OBJECTIVE@#To evaluate the effects of two different femoral cortical suspension devices (fixation loop and adjustable loop) on tunnel widening and knee function in patients following anterior cruciate ligament reconstruction for 12 months.@*METHODS@#A total of 60 patients who had undergone anterior cruciate ligament reconstruction were included in this study. According to the length of the loop(n)[n= total length of loop-(total length of femoral tunnel-total length of coarse tunnel)] in the rough bone tunnel, the patients were divided into A (adjustable loop was 0 mm in the coarse bone tunnel), B (fixation loop was greater than 0 mm and less than or equal to 10 mm in the coarse bone tunnel) and C (fixation loop was greater than 10 mm in the coarse bone tunnel) groups, of which 11 cases were in group A, 27 cases in group B and 22 cases in group C. In the three-dimensional reconstruction of the knee joint with multi-slice spiral CT, the widening of the bone tunnel in the three groups was compared. At the same time, IKDC, Lysholm and Tegner scores of the patients in the three groups were compared.@*RESULTS@#There were differences in the widening degree of the femoral canal among groups A, B and C, and the median difference of the widening degree of the femoral tunnel 12 months and immediately after the surgery was A < B < C. The difference of femoral canal widening in group A was significantly different from that in groups B and C (P < 0.05).According to the linear regression the relationship between the difference of the width of the femoral canal and the change of the length (n) of the loop in the coarse canal, it was found that there was a linear relationship between the value of n and the difference of the width of the bone canal. With the increase of the value of n, the difference of the width of the bone canal gradually became larger. The median difference of the width of the middle and superior tunnel was negative, while the median difference of the width of the middle and inferior tunnel was positive. During the follow-up, we found that there were no statistical differences in IKDC, Lysholm and Tegner scores among the three groups one year after surgery (P > 0.05).@*CONCLUSION@#Twelve months after surgery, compared with group B (fixed loop group) and group C (fixed loop group), group A (adjustable loop group) had less bone tunnel widening.In groups A, B and C, as the length of the loop in coarse bone tunnel gradually increased, the width of bone tunnel became more significant. At the end of 12 months follow-up after anterior cruciate ligament reconstruction, the medial and inferior femoral tunnel was significantly wider than immediately after surgery, and the medial and superior femoral tunnel had gradually begun to undergo tendon-bone healing. There was no significant difference in knee function scores among groups A, B, and C in the follow-up 12 months after surgery.

A 3D-printed template for preparation of tibial tunnel in reconstruction of anterior cruciate ligament / 中华创伤骨科杂志

Objective@#To evaluate the accuracy of a 3D-printed template used to assist the preparation of tibial tunnel in reconstruction of anterior cruciate ligament (ACL).@*Methods@#Twenty healthy adult cadaveric knees were scanned by computed tomography(CT) and magnetic resonance imaging (MRI). The knees were from 11 males and 9 females who had died at an average age of 36 years (range, from 27 to 68 years) and from 8 left and 12 right sides. Individualized 3D reconstruction models of the knee joint were established based on their imaging data. According to the anatomic footprints of the virtual tibial tunnel, 20 individualized navigation templates were designed and printed by 3D printing. The templates were used to assisst preparation of tibial tunnels in the ACL reconstruction for the 20 cadaveric knees. After operation, CT scanning was conducted again to compare the corresponding postitions between the preoperative virtual tunnel and the postoperative actual tunnel. The positions of the tibial tunnel were described by the Tsukada method.@*Results@#The ratio of the distance between the tunnel outlet center and the medial edge of the tibia to the distance between the median and lateral edges of the tibial plateau was 49.7%±2.1% for the preoperative virtual tibial tunnel and 48.8%±2.8% for the postoperative actural tunnel, showing no significant difference between them (t=1.971, P=0.063). The ratio of the distance between the tunnel outlet center and the anterior edge of the tibia to the distance between the anerior and posterior edges of the tibial plateau was 41.3%±1.3% for the preoperative virtual tibial tunnel and 40.3%±3.7% for the postoperative actural tunnel, showing no significant difference between them(t=1.494, P=0.152).@*Conclusion@#3D printing can be used to design and manufacture a navigation template which can accurately assist preparation of tibial bone tunnel in ACL reconstruction.

A 3D-printed template for preparation of tibial tunnel in reconstruction of anterior cruciate ligament / 中华创伤骨科杂志

Objective To evaluate the accuracy of a 3D-pfinted template used to assist the preparation of tibial tunnel in reconstruction of anterior cruciate ligament (ACL).Methods Twenty healthy adult cadaveric knees were scanned by computed tomography (CT) and magnetic resonance imaging (MRI).The knees were from 11 males and 9 females who had died at an average age of 36 years (range,from 27 to 68 years) and from 8 left and 12 fight sides.Individualized 3D reconstruction models of the knee joint were established based on their imaging data.According to the anatomic footprints of the virtual tibial tunnel,20 individualized navigation templates were designed and printed by 3D printing.The templates were used to assisst preparation of tibial tunnels in the ACL reconstruction for the 20 cadaveric knees.After operation,CT scanning was conducted again to compare the corresponding postitions between the preoperative virtual tunnel and the postoperative actual tunnel.The positions of the tibial tunnel were described by the Tsukada method.Results The ratio of the distance between the tunnel outlet center and the medial edge of the tibia to the distance between the median and lateral edges of the tibial plateau was 49.7％ ±2.1％ for the preoperative virtual tibial tunnel and 48.8％ ± 2.8％ for the postoperative actural tunnel,showing no significant difference between them (t =1.971,P =0.063).The ratio of the distance between the tunnel outlet center and the anterior edge of the tibia to the distance between the anerior and posterior edges of the tibial plateau was 41.3％ ± 1.3％ for the preoperative virtual tibial tunnel and 40.3％ ± 3.7％ for the postoperative actural tunnel,showing no significant difference between them (t =1.494,P =0.152).Conclusion 3D printing can be used to design and manufacture a.navigation template which can accurately assist preparation of tibia] bone tunnel in ACL reconstruction.

Micro-CT Analysis of Bone Tunnel Area after Anterior Cruciate Ligament Reconstruction in the Animal Model / 中国运动医学杂志

Objective To assess the bone tunnel area at different times and sites of the tunnel after the anterior cruciate ligament(ACL) reconstruction in rabbits using Micro-CT.Methods Fifteen rabbits were performed ACL reconstruction using semitendinosus tendon autograft and randomly allocated into 3 groups and killed at 3,6,and 12 weeks after the operation.All samples undertook the micro-CT scanning(using SkyScan 1176,Bruker,U.S.A.) and were analyzed the areas of bone tunnels of femur and tibia after the 3-demension image rebuilding.For each tunnel,the area of the entrance,middle and exit of the tunnel were measured 3 times respectively and compared.Results The average area of the femoral tunnel did not change significantly with time,being 4.84 mm2,4.57 mm2 and 4.46 mm2 at 3,6 and 12 weeks after the operation(P=0.99).At the very beginning,the femoral tunnel area at the entrance was the biggest,while that of the middle was the smallest.Six weeks after the operation,significant differences were observed between the femoral tunnel area at the entrance and middle,as well as that between the exit and middle(P=0.0011,P=0.0106);However,12 weeks after the operation,significant differences were observed only between that at the entrance and middle(P=0.0227).The average tibial tunnel area increased significantly at 6 weeks(6.577 mm2) and decreased at 12 weeks(3.103 mm2) after the operation(P=0.0005).Moreover,no significant differences were observed in the average tibial tunnel area at different time points and sites(P＜0.05).At different sites,the average tibial tunnel area expanded at 6 weeks,and then declined at 12 weeks after the operation.Conclusion The bone tunnel area changes with time after the ACL reconstruction,first increasing followed by decreasing in the average tibial tunnel area.The femur and tibial tunnel have significant differences in the tunnel area at different sites,which change differently with time.The bone tunnel expansion after the anterior cruciate ligament reconstruction can be comprehensively measured repeatedly at different sites.

Achilles tendon graft matches with bone tunnel of different sizes for anterior cruciate ligament reconstruction / 中国组织工程研究

BACKGROUND:Anterior cruciate ligament is the important anatomic structure to maintain the knee joint stability. The tendon bone healing and clinical functional recovery after anterior cruciate ligament have attracted more attention. OBJECTIVE:To observe the healing of graft tendon and surrounding bone with histological method through the same diameter grafts matching with the bone tunnel of different sizes in the anterior cruciate ligament reconstruction surgery, and to detect the functional recovery with biomechanics. METHODS:Middle 1/3 of canine autologous tendon was selected as the anterior cruciate ligament graft, and then trimmed into the same diameter of 4 mm. Sixteen adult mongrel canine were randomly divided into four groups. The anterior cruciate ligament was resected completely, and the tibial and femoral tunnels were prepared on the end sites of tibia and femur with the diameters of 5, 4.5, 4 and 3.5 mm, then implanted into the tendon in prepared and linked into the bone tunnel. At 6 weeks after reconstruction, the experimental canine were sacrificed under general anesthesia to col ect the tissue and organs in the surgical area. Then the hematoxylin-eosin staining, biomechanical testing and statistical analysis were performed. RESULTS AND CONCLUSION:At 6 weeks after anterior cruciate ligament reconstruction, anatomical observation showed that there were no significant differences in growth of grafts and bone tunnels between groups;hematoxylin-eosin staining showed sharpey-like fibronectin could be seen in the tendon bone healing surface, and the col agen fibers in the 3.5 mm bone tunnel group were more compact and regular than those in the other groups;the biomechanical testing results in the 3.5 mm bone tunnel group were better than those in the other groups. The results indicate that during anterior cruciate ligament reconstruction, decreasing the diameter of bone tunnel that matched with grafts in order to make the tendon and the bone tunnel closely matched can provide a more stable cel biological and mechanical environment, accelerate the formation and transformation of tendon-bone healing interface, and can improve the quality of tendon-bone healing.

Outcomes of the Modified-Brostrom Procedure Using Suture Anchor for Chronic Lateral Ankle Instability: a Prospective, Randomized Comparison with the Bone Tunnel Technique / 대한정형외과학회잡지

PURPOSE: This study was performed prospectively and randomly to compare the clinical outcomes of modified-Brostrom procedures using the suture anchor and the bone tunnel for chronic lateral ankle instability. MATERIALS AND METHODS: Thirty patients were followed up for more than 1 year after the modified-Brostrom procedures. Fifteen procedures treated with a suture anchor and 15 procedures treated with a bone tunnel technique assigned randomly were performed by a single surgeon. The clinical evaluation was performed according to the VAS for pain, the Karlsson scale and Sefton grading system. Measurements of the talar tilt and anterior talar translation was performed using anterior and varus stress radiographs. RESULTS: There were no significant differences in the pain VAS between the 2 techniques postoperatively. However, the pain VAS at postoperative 4th day was significantly higher in the bone tunnel group. The Karlsson scale had improved significantly from a preoperative average of 45.2 points to 90.1 points in the suture anchor group, and from 44.6 points to 88.3 points in the bone tunnel group. According to the Sefton grading system, 13 cases (86.7%) in the suture anchor group and 12 cases (80%) in the bone tunnel group achieved satisfactory results. The talar tilt angle and anterior talar translation had improved significantly from preoperative average of 14.2degrees and 6.2 mm to 6.4degrees and 4.5 mm in the suture anchor group, from 13.8degrees and 6.4 mm to 6.1degrees and 4.2 mm in the bone tunnel group. There were no significant differences between 2 techniques. CONCLUSION: The techniques for ligament reattachment produced similar clinical and functional outcomes except for early-stage postoperative pain. Both modified-Brostrom procedures using the suture anchor and bone tunnel appear to be effective treatment methods for chronic lateral ankle instability. However, the suture anchor technique has an advantage of less early-stage postoperative pain.

Correlative study of femur "acute angle" in reconstruction of posterior cruciate ligament with hamstring tendons and evaluation of bone tunnel technique / 中国矫形外科杂志

[Objective]To explore the "acute angle" of femur,and evaluate the bone tunnel technique in posterior cruciate ligament reconstruction.[Method]Using the porcine flexor digitorum tendon as graft,the author reconstructed posterior cruciate ligament.The bone tunnel was established with the angle of 80?,90?and 100?comparison the tunnel and intercondylar fossa of femur side wall,and press sensitive film was set between the edge of tunnel and graft.The pressure between was used to represent abrasion.The bigger the pressure was,the larger the abrasion was.The difference of pressure between bone tunnel technique group and the control group was compared.[Result]The pressure of angle 100?was lowest(3.55?0.21 MPa).And the pressure of burnishing group(3.29?0.19 MPa)was lower than that of the control group(3.55?0.21 MPa).[Conclusion]The bone tunnel technique can reduce the femoral;"acute angle" of femur in posterior cruciate ligament reconstruction.

Effect of reconstituted bone xenografts on tendon-to-bone healing after anterior cruciate ligament reconstruction / 中国矫形外科杂志

[Objective]To investigate the effect of reconstituted bone xenografts(RBX) on tendon-to-bone healing by means of imaging,histological and biomechanical studies.[Method]Anterior cruciate ligament(ACL) reconstruction was performed bilaterally in 25 skeletally mature rabbits using long digital extensor tendon grafts.RBX were implanted into the treated knee of each rabbit,with the contralateral knees as controls.Every three rabbits were killed at 2,6 and 12 weeks postoperatively for routine histological studies.The samples were processed through Micro CT and subsequent HE and toludine blue staining.The remaining 16 rabbits were sacrificed at 6 and 12 weeks.Their femur-tendon graft-tibia complexes were harvested for subsequent mechanical testing.[Result]At 6 and 12 weeks after operation,the values of BMD in the RBX group were higher than those in the control group(P

Biomechanical study on anterior cruciate ligament reconstruction with preserving or removing the remnant under sealing the bone tunnels / 中国矫形外科杂志

[Objective]To explore the biomechanical effects of preserving the remnants in anterior cruciate ligament(ACL) reconstruction under sealing the bone tunnel.[Method]Twelve skeletally matured New Zealand white rabbits underwent ACL reconstruction with preserving the remnants and sealing the bone tunnels on one knee randomly,the opposite knee was served as the paired control―ACL reconstruction with removing the remnants and sealing the bone tunnels.Rabbits were sacrificed at 12 weeks.The maximum loading of the femur-graft-tibia complexes were determined in 858 Mini BionixⅡtestor,and the rupture site was observed.[Result]The mean maximum load at 12 weeks was (23.46?7.4)N in the preserving remnants group,(18.63?4.26)N in the removing remnants group,the maximum load in the expermental group was 126% of the control.There was significant difference between two groups (t=3.058,P

Experimental study of tendon-bone healing using bone mesenchymal stem cells in a bone tunnel and their labeling and tracing / 中国矫形外科杂志

[Objective]To evaluate the effect of bone mesenchymal stem cells(BMSCs) on healing of tendon-bone junction in a bone tunnel and to provide experimental evidence of labeling and tracing the stem cell.[Method]BMSCs from rats were harvested by adherent separation screening method and labeled by SPIO and DiI.Thirty-nine 8-week-old rats were randomly divided into two groups,21 rats injected with double-labeled BMSCs and Pluronic F-127 as experimental group and 18 rats injected with Pluronic F-127 alone as control group.In each group,biomechanical analysis was carried out to assess the effect of healing at 2,4 and 8 weeks.The transplanted BMSCs were traced by fluorescence microscope at 2,4,8 weeks and 7.0T MR instantly,3 and 7days after operation.[Result]BMSCs were labeled effectively by SPIO and DiI.DiI-labeled positive cells were observed between tendon and bone with fluorescence microscope at 2,4 and 8 weeks.No significant signal changes of tendon-bone interface could be observed by 7.0 T MR.Biomechanically,maximum pullout load had no statistical difference between experimental group and control group at 2 weeks.At 4 and 8 weeks,the experimental group had significantly higher maximum pullout load compared with control group(P

Histological research of calcium phosphate biomaterials promoting tendon healing in bone tunnels / 中华创伤骨科杂志

Objective To investigate the effect of osteoinductive calcium phosphate ceramics (OICPC) on tendon healing in bone tunnels. Methods Anterior cruciate ligament reconstruction with semitendonous tendon was performed in the knee joints of 30 New Zealand rabbits by suspended fixation. OICPC grains were implanted into the bone tunnel of 15 rabbits which were the experimental group and the other 15 rabbits without OICPC implants severed as the control group. Specimens were collected four weeks, eight weeks and 12 weeks after surgery. Sections were stained with H. E., Sirius Red and Masson. Histological changes in the interface tissue between the bone tunnel and the tendon graft were observed, and the morphology of interface tissue was classified according to Yamakado method. Histomorphometry was done on Masson stain sections to measure new bone formation around the grafted tendon. Results In OICPC group, histological sections obtained four and eight weeks after surgery showed statistically greater new bone formation than those in the control group. Abundant penetrating Sharpey fibers appeared at eight weeks and direct connection was found at 12 weeks in the experimental group. On the other hand, Sharpey fibers appeared only at 12 weeks in the control group. Conclusion OICPC has a capability of enhancing biological fixation of a tendon to the bone tunnel.

Isometricity of grafts in ACL reconstruction under bone tunnel shifting condition / 中华创伤骨科杂志

Objective To explore the isometricity of grafts in ACL(anterior cruciate ligament)recon- struction under bone tunnel shifting condition.Methods Knee specimens from ten fresh frozen cadavers were used. Femoral tunnels of 2 mm were drilled at three points on the medial aspect of the lateral condyle.The first was“anterior bundle point”(located at the 11 o'clock position in the right knee and 1 o'clock position in the left knee).The second was“error point”(located at the place 5 mm anterior and distal to the“anterior bundle point”).The third was“posterior bundle point”(located at the crossing point of the long axis of the ACL attachment and a vertical line drawn across the femoral-tibial contact point with the knee flexed at 90?).Moreover,tibial tunnels of 2 mm were drilled at three points on the tibial plateau.The first was“central point”(located at the center of original insertion of ACL).The second was“5 mm posterior point”,located at the place 5 mm posterior to the“central point”.The third was“10 mm posterior point”,located at the place 10 mm posterior to the“central point”.Changes in distance between each pair of tibial and femoral tunnels were measured during passive knee flexion-extension.Results The anterior-posterior shifting of the tibial tunnel was found to have little influence(P＞0.05)on the isometricity after the femoral tunnel had been chosen.However,the shifting of the femoral tunnel was found to have significant influence(P＜0.01)on the isometricity.Changes in distance related to the“anterior bundle point”led to lengths within the physiologic isometric range.Changes in distance related to the“error point”led to lengthening(ligament stretching)beyond the physiologic isometric range.Changes in distance related to the“posterior bundle point”led to shortening(ligment relaxing)beyond the physiologic isometric range.Conclusion Anterior-posterior shifting of the tibial tunnel between the center of original insertion and posterior edge of inter-tibial eminence area has little influence on the isometricity of grafts in ACL double bundle reconstruction.

Comparison of Bone Tunnel Widening after ACL Reconstruction between Bioabsorbable Interference Screw and Metallic Interference Screw Fixation

PURPOSE: We evaluated the relationship among the radiographic enlargement of femoral and tibial bone tunnels, fixation material, clinical results and period of follow-up after anterior cruciate ligament(ACL) reconstruction with single incision arthroscopic technique using bone-patella tendon-bone. MATERIALS AND METHODS: We evaluated 91 knees of arthroscopic ACL reconstruction during the period of June 1993 to February 2001 excluding combined posterior cruciate ligament(PCL) injury. Average follow-up period was 44 months(12-78 months). We classified these cases into bioabsorbable screw group and metal screw group according to the screw materials. We took anteroposterior and lateral X-ray films at postoperative 3 months, 1 year, final follow up and measured the size of femoral and tibial tunnel. We evaluated the side-to-side difference using KT-2000 arthrometer and clinical results with Lysholm score. RESULTS: Eight cases of 47 cases in bioabsorbable screw group had bony cystic changes at femoral tunnel and 44 cases in metal screw group had not. Tibial tunnel widening was seen in 38 cases of absorbable screw group and 31 cases of metal screw group. Cases which had femoral and tibial tunnel widening had no knee joint instability clinically. CONCLUSION: There were femoral tunnel widening in bioabsorbable screw group, but not in metal screw group. Delayed inflammatory reaction in bioabsorbable screw may make this phenomenon but there was no correlation between femoral tunnel widening and clinical results. More longterm follow-up will be needed for futher degenerative changes and graft failure.

Mini-Open Approach for Rotator Cuff Repair: Bone Tunnel Versus Suture Anchor Techniques / 대한정형외과학회잡지

PURPOSE: We evaluated and compared the clinical results of mini-open approaches using bone tunnel and suture anchor techniques for rotator cuff repair. MATERIALS AND METHODS: We reviewed 31 cases with full thickness rotator cuff tears repaired using an arthroscopically assisted mini-open technique between February 1997 and August 1999. This study included only those patients who had a minimum follow-up of two years. Group A using bone tunnel technique was 14 cases, and group B using suture anchor technique was 17 cases. We analyzed the patients according to the University of California at Los Angeles shoulder rating scale. RESULTS: Pain score improved from 2.9 preoperatively to 8.4 postoperatively in group A, and 2.6 to 8 in group B. Function score improved from 3.6 to 8.6 in group A, and 3.4 to 7.9 in group B. Strength score improved from 4 to 4.8 in group A, and 3.8 to 4.5 in group B. Overall, 85% of group A and 82% of group B had satisfactory results. However functional outcomes did not differ signifcantly between the two groups (p>0.05). And, any failures of suture anchor within the bone or "saw through "phenomenon in the bone tunnel were not observed. CONCLUSION: Our results suggest that unless bone quality of the tuberosity is poor, both bone tunnel and suture anchor technique are useful for rotator cuff repair.

Tendon-to-Bone Tunnel Healing in a Rabbit Model: The Effect of Periosteum Augmentation at the Tendon-to-Bone Interface / 대한정형외과학회잡지

PURPOSE: This study evaluated the effect of the periosteum-wrapped tendon on tendon-to-bone healing using a rabbit model. MATERIALS AND METHODS: Twenty New Zealand white rabbits were used. The animals were divided into two groups, a group with periosteum-wrapped tendon and a control group without a periosteal wrap. Both legs were operated upon in the same manner. The long digital extensor tendon was harvested and transplanted into the proximal tibial tunnel. One limb was transplanted with the tendon wrapped with periosteum facing the cambium layer to the tendon, while the other was without periosteum. The healed tendon-bone attachment was evaluated at 3-weeks and 6-weeks histologically and by biomechanical testing. RESULTS: At 3 and 6 weeks, histologic examination demonstrated more extensive bone formation around the tendon with closer apposition of new bone to the tendon in the limb with the periosteum-wrapped tendon graft than in the control limb. Biomechanical testing demonstrated the higher pullout strength of tendon in the limb with the periosteum-wrapped tendon graft at 3 and 6 weeks with statistically significant differences between the limb with the periosteum-wrapped tendon graft and the control limb at 3 and 6 weeks. CONCLUSION: Histological and biomechanical data suggest superior healing in the periosteum-wrapped group. This study demonstrates that periosteum can enhance the healing process when a tendon graft is transplanted into a bone tunnel.

Bone tunnel enlargement after anterior cruciate ligament reconstruction / 대한정형외과학회잡지

PURPOSE: To evaluate the bone tunnel enlargement after an anterior cruciate ligament reconstruction (ACLR), We compared the results between a group that had a bone-patellar tendon-bone (BPTB) autograft (group 1) that included the nubbin and one that had a hamstring double looped autograft (group 2). MATERIALS AND METHODS: We evaluated 120 knees over a one year follow-up period. In group 1, the tibial tunnel was completely filled with nubbin. The clinical results were evaluated using the IKDC knee rating system and a KT-2000 arthrometer. Changes in the bone tunnel width on ordinary radiographs were measured periodically. RESULTS: Clinically, there was no significant difference between the two groups. In group 2, more tunnel enlargement occured (p<0.05). ACLR that included the nubbin in the BPTB autograft showed better results in the tunnel enlargement than the others. CONCLUSION: ACLR using the nubbin at the BPTB autograft is one of the solutions available for prevention of bone tunnel enlargement after ACLR.