Risk factors for contralateral anterior cruciate ligament injury after primary anterior cruciate ligament reconstruction / 中国修复重建外科杂志

OBJECTIVE@#To investigate the risk factors of contralateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction.@*METHODS@#A retrospective review was conducted on the 716 patients with ACL injury who received primary ACL reconstruction surgery and met the selection criteria between January 2012 and September 2018. After a mean follow-up period of 7.6 years (range, 4-10 years), 65 patients (9.1%) experienced contralateral ACL injury (injured group) and 651 patients (90.9%) did not (uninjured group). There was no significant difference in age, body mass index, and preoperative Lachman test degree between groups ( P>0.05). However, the proportion of female in the injured group was significantly higher than that of male ( P<0.05), and the preoperative posterior tibial slope (PTS) was significantly higher than that of the uninjured group ( P<0.05). Using the outcome of contralateral ACL injury as the dependent variable, the clinical data of the patient was first used as the independent variable, and univariate COX regression was used to analyze the prognostic influencing factors. Then, the indicators with differences in univariate COX regression were used as the independent variable, and multivariate COX regression was used to analyze the independent risk factors affecting prognosis. Log-Rank (Mantel-Cox) test was used to test and analyze the occurrence time of contralateral ACL injury in patients of different genders; X-tile software was used to analyze the occurrence time of contralateral ACL injury in patients with different PTS using Log-Rank (Mantel-Cox) test and PTS cut-off values.@*RESULTS@#Univariate COX regression analysis showed that gender and PTS were influence factors for contralateral ACL injury ( P<0.05); further multivariate COX regression analysis showed that female and increased PTS were independent risk factors for contralateral ACL injury ( P<0.05). The Log-Rank (Mantel-Cox) test results showed that the contralateral ACL injury occurred in female at 8.853 (8.600, 9.106) years, which was significantly shorter than that in male [9.661 (9.503, 9.819) years] ( χ 2=20.323, P<0.001). Using X-tile software to analyze the cut-off value of PTS, it was found that the cut-off value of PTS for contralateral ACL injury was 10.92°. According to the Log-Rank (Mantel-Cox) test, it was found that the contralateral ACL injury occurred in 5.762 (4.981, 6.543) years in patients with PTS≥10.92°, which was significantly shorter than patients with PTS<10.92° [9.751 (9.650, 9.853) years]( χ 2 =302.479, P<0.001).@*CONCLUSION@#Female and PTS≥10.92° after primary ACL reconstruction are independent risk factors for contralateral ACL injury.

Lesiones ligamentarias de rodilla asociadas a fracturas de diáfisis femoral: epidemiología y diagnóstico: revisión narrativa de la bibliografía / Knee ligamentous injury associated to femoral shatf fracture: epidemiology and diagnosis: narrative review of the literatur / Lesões ligamentares do joelho associadas a fraturas diafisárias do fêmur: epidemiologia e diagnóstico: revisão narrativa da literatura

Introducción: Las fracturas de la diáfisis femoral son lesiones que requieren gran energía y a menudo asocian otras lesiones. Este es el caso de las lesiones ligamentarias de rodilla, las cuales pueden pasar desapercibidas por el equipo médico tratante. El objetivo de nuestro trabajo es revisar la literatura existente sobre esta asociación lesional. Dentro de la misma se buscará la metodología diagnóstica utilizada y la incidencia de las lesiones ligamentarias. Materiales y métodos: Se realizó una búsqueda bibliográfica de forma sistematizada a través de los portales de búsqueda PubMed y Timbó. La búsqueda alcanzó un total de 3099 artículos y de acuerdo a los criterios de inclusión y exclusión se seleccionaron 15 trabajos. Resultados: Los diferentes artículos utilizaron examen físico bajo anestesia, radiografías en estrés, artroscopía o resonancia nuclear magnética para establecer el diagnóstico de las lesiones ligamentarias asociadas a las fracturas de diáfisis femoral. Un 22,5% de las fracturas femorales asoció lesión ligamentaria de rodilla, siendo la lesión del ligamento cruzado anterior el 34% de las lesiones reportadas. Discusión: Se evidencia una gran variabilidad en la incidencia de lesiones ligamentarias y de cuál es el ligamento más frecuentemente lesionado, yendo desde 5,3% a 52,5% en estudios tanto retrospectivos como prospectivos con bajos números de pacientes. Se plantea un algoritmo diagnóstico para los pacientes que puedan presentar esta asociación lesional, para evitar que los mismos pasen desapercibidos al equipo médico tratante. Logrando un diagnóstico precoz se puede mejorar el pronóstico de estos pacientes. Conclusión: De nuestra revisión se desprende que en el contexto de una fractura de diáfisis femoral un 22,5% de los pacientes presenta lesiones ligamentarias de rodilla con un 34% de compromiso del LCA. Sin embargo, estas cifras son muy variables en los distintos trabajos. Por esta razón, creemos necesario llevar a cabo un estudio prospectivo con mayor número de pacientes para lograr valorar la verdadera epidemiología de estas lesiones.

Introduction: Femoral shaft fractures require great energy and are often associated with other injuries. This is the case of knee ligament injuries, which can go unnoticed by the treating physician The objective of our work is to review the existing literature on this injury association. Within it, the diagnostic methodology used and the incidence of ligamentous injuries will be sought. Materials and methods: A bibliographic search was carried out in a systematic way through the search portals PubMed and Timbó. The search reached a total of 3099 articles and according to the inclusion and exclusion criteria, 15 works were selected. Results: The different articles used physical examination under anesthesia, stress radiographs, arthroscopy or magnetic resonance imaging to establish the diagnosis of ligamentous injuries associated with femoral diaphysis fractures. 22.5% of femoral fractures were associated with knee ligament injury, with anterior cruciate ligament accounting for 34% of reported injuries. Discussion: There is evidence of a great variability in the incidence of ligament injuries and which is the most frequently injured ligament, ranging from 5.3% to 52.5% in both retrospective and prospective studies with low numbers of patients. A diagnostic algorithm is proposed for patients who may present this lesional association, to prevent them from going unnoticed by the treating medical team. Achieving an early diagnosis can improve the prognosis of these patients. Conclusion: Our review shows that in the context of a femoral diaphysis fracture, 22.5% of patients present knee ligament injuries with 34% of ACL involvement. However, these figures are highly variable in the different studies. For this reason, we believe it is necessary to carry out a prospective study with a larger number of patients in order to assess the true epidemiology of these lesions.

Introdução: As fraturas da diáfise do fêmur são lesões que requerem grande energia e muitas vezes estão associadas a outras lesões. É o caso das lesões ligamentares do joelho, que podem passar despercebidas pela equipe médica que o trata. O objetivo do nosso trabalho é revisar a literatura existente sobre essa associação lesional. Dentro dele, será buscada a metodologia diagnóstica utilizada e a incidência de lesões ligamentares. Materiais e métodos: Foi realizada uma busca bibliográfica de forma sistemática através dos portais de busca PubMed e Timbó. A busca atingiu um total de 3099 artigos e de acordo com os critérios de inclusão e exclusão, 15 trabalhos foram selecionados. Resultados: Os diferentes artigos utilizaram o exame físico sob anestesia, radiografias de estresse, artroscopia ou ressonância magnética para estabelecer o diagnóstico de lesões ligamentares associadas às fraturas da diáfise do fêmur. 22,5% das fraturas do fêmur foram associadas à lesão ligamentar do joelho, sendo a lesão do ligamento cruzado anterior responsável por 34% das lesões relatadas. Discussão: Há evidências de uma grande variabilidade na incidência de lesões ligamentares e qual é o ligamento mais frequentemente lesado, variando de 5,3% a 52,5% em estudos retrospectivos e prospectivos com baixo número de pacientes. Um algoritmo diagnóstico é proposto para os pacientes que podem apresentar essa associação lesional, para evitar que passem despercebidos pela equipe médica responsável. O diagnóstico precoce pode melhorar o prognóstico desses pacientes. Conclusão: Nossa revisão mostra que no contexto de fratura da diáfise do fêmur, 22,5% dos pacientes apresentam lesões ligamentares do joelho com 34% de envolvimento do LCA. No entanto, esses números são altamente variáveis ​​nos diferentes estudos. Por esse motivo, acreditamos ser necessário realizar um estudo prospectivo com um número maior de pacientes para avaliar a verdadeira epidemiologia dessas lesões.

Research progress in the stability evaluation and treatment of ankle fracture / 中华创伤杂志

Ankle fracture is caused by direct or indirect violence to the integrity and continuity of the distal tibia and/or fibula, often associated with ligament and other soft tissue injuries. However, ankle fracture can be easily overlooked during diagnosis and treatment due to hidden injuries or lack of experience, often resulting in poor prognosis. The existing classifications are sometimes difficult to provide guidances for clinical decision making, so the classification of ankle fracture based on stability criteria comes into being. Improper management of unstable ankle fracture can lead to serious complications such as loss of function and traumatic arthritis, requiring individualized treatment based on the specific injury. The authors review the concept, anatomy and imageological evaluation of ankle fracture stability as well as its treatment based on stability classification, so as to provide new ideas for the stability evaluation and treatment of ankle fracture.

Comparison of short-term clinical effects of three fixation methods in anterior cruciate ligament reconstruction / 中国综合临床

Objective:To compare the short-term clinical effects of absorbable cross nail, sheath compression nail and suspension fixation on the femoral side and sheath compression nail on the tibial side in anterior cruciate ligament reconstruction (ACLR) with autologous hamstring tendon.Methods:The clinical data of 373 patients with anterior cruciate ligament injuries treated with surgery in the First Hospital of Qinhuangdao Affiliated to Chengde Medical College from December 2008 to December 2018 were collected for a retrospective case-control study. There were 125 cases of absorbable cross nail (absorbable cross nail group), 112 cases of sheath compression nail (sheath compression nail group) and 136 cases of suspension fixation (suspension fixation group). The mean follow-up time was (13.96±1.42) months. The international knee documentation committee (IKDC) score and Lysholm score were used to score the patients, and the differences were statistically analyzed. The measurement data of normal distribution was represented by xˉ± s, and repeated measurement analysis of variance was used to compare the three groups in different time periods, and the operation time of the three groups of samples was compared by one-way analysis of variance. The counting data were compared by χ 2 test. Results:(1) There were no complications such as infection, adhesion, stiffness and neurovascular injury in the three groups at the last follow-up. (2) Comparison of preoperative and postoperative knee scores: Lysholm score: preoperative absorbable cross nail group (65.98±1.37), sheath compression nail group(66.13±2.13), suspension fixation group (65.76±1.55). Three months after operation, absorbable cross nail group (80.14±2.02), sheath compression nail group (79.70±1.98) and suspension fixation group (79.84±1.86). Twelve months after operation, there were (94.56±2.35) points in the absorbable cross nail group, (94.96±1.34) points in the sheath compression nail group and (94.40±3.15) points in the suspension fixation group.There was significant difference in the scores before and after operation in the same group ( Fintra-group=17 584.14, P<0.001), and there was no significant difference among the three groups ( Finter-group=2.65, P=0.072), There was no statistical significance in the trend of scores before and after operation in the three groups ( Finter-action=1.28, P=0.277). IKDC scores: Preoperative (62.02±1.43) in absorbable cross nail group, preoperative (61.95±0.82) in sheath compression nail group, preoperative (62.25±2.05) in the suspension fixation group. Three months after operation, absorbable cross nail group (77.99±2.18), sheath compression nail group (78.13±2.02) and suspension fixation group (77.97±2.24). Twelve months after operation, the absorbable cross nail group (92.68±3.21), the sheath compression nail group (93.25±2.04) and the suspension fixation group (92.96±3.11). There was significant difference in the scores before and after operation in the same group ( Fintra-group=18 338.15, P<0.001), and there was no significant difference among the three groups ( Finter-group=0.91, P=0.402), and there was no significant trend in the scores before and after operation in the three groups ( Finteraction=0.98, P=0.419). (3) Comparison of operation time: absorbable cross nail group (99.04±18.01) min, sheath compression nail group (112.88±19.79) min and suspension fixation group (83.81±16.69) min. there was significant difference among the three groups ( F=79.74, P<0.001). Further comparison between the three groups, the time of suspension fixation group was the shortest than the other two groups (all P<0.001). Conclusion:There is no significant difference in the short-term efficacy of ACLR with autologous hamstring tendon among the three groups, and there were no complications such as infection, adhesion, stiffness and neurovascular injury in the last follow-up. In terms of operation time, the suspension fixation group has the shortest time and is simple and easy to operate.

Fractura intraarticular de calcáneo asociada a lesión de ligamentos colaterales laterales del tobillo / Intra-articular fracture of the calcaneus associated with injury to lateral collateral ligaments of the ankle

Resumen: Las fracturas de calcáneo son las más frecuentes del tarso (3.5% de todas las fracturas). Afectan a adultos jóvenes, siendo más frecuentes en hombres (5.9:1). Por otro lado, las lesiones ligamentarias asociadas a fractura de calcáneo no son muy frecuentes. Presentamos un caso de un paciente de 39 años que sufrió entorsis de tobillo. Mostraba inestabilidad en flexión plantar e inversión. Radiografías mostraron una fractura de calcáneo. Durante la cirugía se evidenció una lesión completa del complejo ligamentario lateral. Se realizó la reducción y osteosíntesis asociada a la reconstrucción ligamentaria. Ante fracturas de calcáneo es importante corroborar la estabilidad del tobillo. La falta de diagnóstico en este tipo de lesiones puede generar inestabilidades crónicas.

Abstract: Calcaneal fractures are the most frequent of the tarsus (3.5% of all fractures). Young adults are mainly affected, being more frequent in men (5.9:1). On the other hand, ligament injuries associated with fracture of the calcaneus are very infrequent. We describe a case of a 39 year old patient who suffered ankle trauma. He presented instability in plantar flexion and inversion. A fracture of the calcaneus was diagnosed. During surgery, a complete lesion of the lateral ligament complex was found. The reduction and osteosynthesis associated with ligament reconstruction was performed. We consider important to confirm the stability of the ankle after a calcaneus fracture. Lack of diagnosis in this type of injuries can evolve into chronic instability.

Combined Reconstruction of the Anterior Cruciate Ligament and Anterolateral Ligament Injury Compared to the Isolated Reconstruction of the Anterior Cruciate Ligament: A Meta-Analysis / Reconstrução combinada do ligamento cruzado Anterior e lesão do ligamento anterolateral comparada àreconstrução isolada do ligamento cruzado anterior: Uma metanálise

Abstract The present research aims to compare the outcomes from the combined reconstruction of the anterior cruciate ligament (ACL) and of the anterolateral ligament (ALL) with the standard isolated ACL reconstruction in patients with chronic ACL injury. To do so, a meta-analysis was carried out to determine whether the combined ACL and ALL reconstruction would lead to a significant improvement in knee function according to the International Knee Documentation Committee (IKDC), the Lysholm test and KT-2000 evaluation scores and lower graft rupture rates in comparison with isolated reconstruction. To identify randomized controlled trials (RCTs) comparing the combined ACL and ALL reconstruction with the isolated ACL reconstruction, papers published between 2010 and 2019 were searched in the MEDLINE, EMBASE, SPORTDiscus, LILACS and Cochrane Central Register of Controlled Trials databases, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria. The stability of the knee joint is only marginally improved with the combined reconstruction of ACL and ALL, and both reconstruction techniques show functional results. The main outcomes sought were patient function and graft stability and rupture rates after ACL reconstruction. Out of the 421 studies identified, 6 were included in our meta-analysis. Study quality (internal validity) was assessed using the Cochrane risk-of-bias tool; in general, the studies included presented moderate-quality evidence. The graft rupture rate was higher in patients undergoing isolated ACL reconstruction (relative risk, 0.22; 95% confidence interval, 0.12 to 0.41; p < 0.00001).

Resumo O objetivo da presentepesquisa é comparar, por meio de uma metanálise, os resultados da reconstrução combinada do ligamento cruzado anterior (LCA) e do ligamento anterolateral (LLA), comparado com a reconstrução isolada padrão, em pacientes com lesão crônica do ligamento cruzado anterior. Buscando alcançar o objetivo da pesquisa, foi realizada uma meta-análise para determinar se a combinação da reconstrução combinada LCA e LLA levaria àmelhoria significativa da função do joelho, medida pelos escores de avaliação International Knee Documentation Committee (IKDC), Lysholm, KT-2000 e menor taxa de ruptura do enxerto, em comparação com a reconstrução isolada. Para identificar ensaios clínicos randomizados (ECR) comparando a reconstrução combinada do LCA e LLA com a reconstrução isolada do LCA, foram pesquisados artigos publicados entre 2010 e 2019 nas bases MEDLINE, EMBASE, SPORTDiscus, LILACS e Cochrane Central RegisterofControlledTrials e seguiram os critérios de Itens de Relatórios Preferidos para Revisões Sistemáticas e Metanálises (PRISMA). A estabilidade da articulação do joelho é apenas marginalmente aprimorada com a reconstrução combinada de LCA e LLA, e ambas as técnicas de reconstrução mostram resultados funcionais. Os principais desfechos procurados foram a função do paciente e as taxas de estabilidade e ruptura do enxerto após a reconstrução do LCA. Dos 421 estudos identificados, 6estudos foram incluídos em nossa meta-análise. A qualidade do estudo (validade interna) foi avaliada usando o instrumento Cochrane risco-de-viés; em geral, foi encontrada uma qualidade moderada de evidências dos estudos incluídos. Os pacientes submetidos à reconstrução isolada do LCA mostraram maior taxa de ruptura do enxerto (RR 0,22; índice de confiança [IC]95%: 0,12-0,41; p< 0,00001).

Characteristics and related factors of plantar pressure in the chronic ankle instability individuals / 北京大学学报(医学版)

OBJECTIVE@#To analyze characteristics and related factors of the plantar pressure during the level walking and single leg standing in the chronic ankle instability (CAI) individuals.@*METHODS@#From April 2019, 75 CAI individuals and 40 healthy individuals were enrolled in this study. Both of the static and dynamic plantar pressure were measured during six times level walking and three times single leg standing testing. The data including peak force, time to peak force in various foot contact areas and the time to boundary (TTB) and velocity of center of pressure (COP) were measured and compared between the affected side and the unaffected side and between the CAI cases and the healthy individuals. The correlations between the plantar pressure and the gender, Beighton score, affected side and body mass index (BMI) were analyzed.@*RESULTS@#The characteristics of plantar pressure distribution in the CAI individuals included: (1) During the level walking, the affected side showed the similar pressure contribution as the unaffected side (P>0.05). While compared with healthy individuals, there was a significantly higher peak force in the 5th metatarsal area (t=-3.86, P=0.03) of the affected side, lower peak force in the 1st (t=2.99, P=0.02), 2nd metatarsal head areas (t=2.09, P=0.01) of the affected side, medial hindfoot areas of both sides (affected, t=2.33, P=0.01; unaffected, t=3.74, P=0.02) and toes areass of both sides (affected, t=2.23, P=0.01; unaffected, t=3.28, P=0.02) and a delay to peak force in the 4th metatarsal head area (t=3.33, P=0.01) of the affected side. (2) During the single leg standing, the CAI individuals showed significantly worse balance control in the anterior/posterior direction (P < 0.05) and lateral/medial direction (P < 0.05) compared with the healthy controls, and the affected side had more severe balance control deficit in the lateral/medial direction (P < 0.05). (3) The women (P < 0.05) and the individuals with higher Beighton scores (P < 0.05) showed worse balance control deficit in the lateral/medial direction.@*CONCLUSION@#CAI individuals showed significantly a more lateral shifted plantar distribution during the level walking compared with the healthy individuals and the tendency was worse on the affected sides, and showed worse balance control in the anterior/posterior direction and lateral/medial direction during the single leg standing. The women and those with generalized ligament laxity showed significantly worse balance control.

Posterior cruciate ligament injury: Diagnosis, treatments and rehabilitation strategies / 中国组织工程研究

BACKGROUND: With the increasing cases of posterior cruciate ligament injury, there are endless protocols for diagnosing and treating posterior cruciate ligament injury. However, there are few reviews of the integrity of posterior cruciate ligament. OBJECTIVE: To complete a comprehensive review of posterior cruciate ligament injury in terms of anatomy, clinical manifestations, auxiliary examination, treatment methods and rehabilitation strategies. METHODS: The PubMed, Ovid, CKNI, and WanFang databases were retrieved using the key words of “posterior cruciate ligament, PCL, anatom*, diagnos*, treatments, surger*, rehabilitation.” A total of 223 articles were searched. After removal of repetitive and ineligible literature, 65 articles were included for review. RESULTS AND CONCLUSION: Missed diagnosis and misdiagnosis of posterior cruciate ligament injury certainly exist. Posterior cruciate ligament injuries are mostly caused by traffic injuries and sports injuries, and are accompanied by other structural injuries to a certain degree. A full understanding of patient’s medical history, accurate physical examination methods, and sophisticated auxiliary examinations can help to correctly identify injuries to the posterior cruciate ligament and the surrounding structures, so as to formulate a reasonable diagnosis and treatment protocol. Research suggests that patients with posterior cruciate ligament injury should be subjected to reconstruction of the posterior cruciate ligament as soon as possible to reduce the risk of further degeneration. At present, there are still large disagreements on the diagnosis, treatment methods, and rehabilitation strategies of posterior cruciate ligament injury. So, a large number of rigorous randomized controlled trials are urgently needed to select the most suitable diagnosis and treatment methods.

Role and significance of anterior cruciate ligament injury in the development of post-traumatic knee osteoarthritis / 中国组织工程研究

BACKGROUND: Anterior cruciate ligament has the function of stabilizing the knee joint and restricting the tibiofemoral joint in the translation and rotation of the tibia. Most patients with anterior cruciate ligament reconstruction have an increased risk of knee pain and knee instability. Knee osteoarthritis after trauma is a serious complication of anterior cruciate ligament injury. Knee osteoarthritis is a chronic progressive disease, and the mechanism of osteoarthritis after anterior cruciate ligament injury remains unclear. OBJECTIVE: To review the relationship between anterior cruciate ligament injury and the risk factors of post-traumatic knee osteoarthritis, so as to provide guidance for the treatment of post-traumatic knee osteoarthritis. METHODS: The first author searched related articles in PubMed database from the establishment of the database to October 2019. The key words were “ACL injury, traumatic knee osteoarthritis, ACL reconstruction, meniscus status, body mass index, cartilage injury, age, graft selection, time interval between injury and surgery”. A total of 123 articles were retrieved, and 66 articles were eligible for the inclusion criteria. RESULTS AND CONCLUSION: (1) Meniscus status, body mass index, cartilage damage, age, graft selection, and time between injury and surgery may influence the development of post-traumatic knee osteoarthritis. (2) Although anterior cruciate ligament reconstruction is primarily performed to restore stability after anterior cruciate ligament rupture, a long-term goal of the process is to reduce the risk of knee osteoarthritis and maintain long-term joint health. (3) Meniscus resection in patients with anterior cruciate ligament rupture accompanied by meniscus injury is also the cause of knee osteoarthritis, which is likely to be caused by weakened endurance and kinematic changes of the joint.

Difference of Isokinetic Angle-Specific Moment Curves in Anterior Cruciate Ligament-injured Patients with or without Patellofemoral Articular Cartilage Injury / 中国康复理论与实践

Objective:To investigate the difference of isokinetic angle-specific moment curves between anterior cruciate ligament (ACL)-injured patients with and without patellofemoral cartilage injury (PFCI). Methods:A retrospective analysis was performed on patients underwent knee arthroscopy and isokinetic muscle strength testing before surgery from September, 2018 to September, 2019. Seventeen ACL-injured patients with PFCI and 17 ACL-injured patients without PFCI who matched in age, sex and meniscus injury were selected. Before arthroscopy, isometric and isokinetic strength of knee flexion and extension at velocity of 180°/s and 60°/s was tested by isokinetic dynamometer. Normalized torque-angle curves (torque/body mass) were generated in steps of 1° and the differences in angle-specific moment curves between two groups were compared. Results:At 180°/s, there was no significant difference in flexion isokinetic torque both healthy side and affected side between two groups (P >0.05); and no difference in extension torque of the healthy side (P >0.05), however, there was significant difference in extension torque of the affected side at 88° to 90° between two groups (t > 2.102, P <0.05). At 60°/s, there was significant difference in flexion torque of the healthy side at 62° to 82° between two groups (|t| >2.056, P <0.05), and no significant difference was found in flexion torque of the affected side (P >0.05), nor in extension torque of both sides between two groups (P > 0.05). A curve change was found at the beginning of the flexion and extension isokinetic moment curves at the velocity of 180°/s. The isometric knee extension torque was significantly different in the affected side between two groups (t = 2.858, P < 0.01), and no difference was found in isometric knee flexion torque in the affected side as well as both extension and flexion torques in the healthy side between two groups (t < 1.905, P > 0.05). Conclusion:The lower the isokinetic speed, the more significant the difference of strength is between ACL-injury patients with and without PFCI. High speed exercise is recommended for ACL-injured patients with PFCI.

Effectiveness of repairing the deep layer of deltoid ligament by suture anchor repair method in treatment of mixed medial injury associated with ankle fractures / 中国修复重建外科杂志

Objective: To explore the necessity of repairing the deep layer of deltoid ligament in the treatment of mixed medial injury associated with ankle fractures. Methods: Between January 2016 and December 2018, 12 patients with mixed medial injury associated with ankle fractures were treated with the fixation of the lateral malleolus by bone plates, the fixation of the anterior colliculus of medial malleolus by cannulated screws, and the repair of the deltoid ligament by suture anchors. There were 8 males and 4 females, with an average age of 42 years (range, 18-56 years). According to the Lauge-Hansen classification criteria, there were 11 cases of supination-external rotation type and 1 case of pronation-external rotation type. According to the Weber classification criteria, all cases were type B. The time from injury to operation was 3-6 days, with an average of 4.7 days. In each patient, X-ray films of anteroposterior and lateral views and mortise view of ankle were taken postoperatively. The motion range of ankle joints was observed. The function of the ankle and the outcome of the treatment were evaluated according to the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system, Olerud-Molander scoring system, and the visual analogue scale (VAS) score. Results: All cases were followed up 12-42 months (mean, 28 months). The 12 patients returned to their pre-injury jobs. Five patients with sports injury completely recovered to their pre-injury motor function. No patient experienced persistent medial ankle pain or ankle instability. At last follow-up, the ankle range of motion in dorsiflexion was 9°-25° (mean, 17.96°), which was 0°-11° (mean, 4.02°) less than that in normal side; the range of motion in plantar flexion was 38°-50° (mean, 43.90°), which was 0°-7° (mean, 2.53°) less than that in normal side. The AOFAS score was 88-100 (mean, 96.7); the Olerud-Molander score was 90-100 (mean, 96.5); the VAS score was 0-3 (mean, 1.1). Conclusion: It is necessary to repair the deep layer of deltoid ligament in the mixed medial injuries associated with ankle fracture, which include anterior colliculus fracture and deep deltoid ligament injury. A better outcome can be achieved by employing the suture anchor repair method.

Relative Telomere Length in Blood Leukocytes of Patients with Anterior Cruciate Ligament Injury: A Pilot Study

@#Introduction: Anterior cruciate ligament (ACL) tear is the most common knee ligament injury, especially in athletes. The objective of this study was to investigate relative telomere length (RTL) in blood leukocytes of patients with ACL injury compared with that of controls. Materials and Methods: A total of 187 subjects were invited to participate in this study. Ninety-two patients with clinically diagnosed ACL rupture were enrolled. Ninety-five age and gender-matched healthy controls were also recruited. Blood leukocyte RTL were analysed using quantitative real-time polymerase chain reaction. Results:Patients with ACL rupture had significantly longer relative telomere length than healthy controls (P=0.002). The patients with ACL rupture were classified into two groups according to the sport history of patients which are contact sports and non-contact sports. RTL in patients with non-contact sports was significantly greater than those with contact sports (P=0.006). Moreover, RTL was inversely correlated with body mass index of patients with ACL injury (r=-0.34, P=0.001). Logistic regression analysis indicated that long RTL was associated with a higher risk of ACL rupture. Conclusion: The present study showed that subjects with ACL rupture had significantly greater telomere length compared with their age and gender-matched controls. This finding may result from the increases in physical activity and overexpression of telomerase which acts as a protective mechanism against ACL injury. RTL in blood leukocytes is associated with a risk of ACL rupture.

Bilateral atlantoaxial lamina hook and atlantoaxial joint space screw for the treatment of acute type I transverse ligament injury in school-age children / 中国骨伤

OBJECTIVE@#To evaluate the effect of bilateral atlantoaxial lamina hook and atlantoaxial joint space screw combined with autologous iliac bone graft on atlantoaxial dislocation caused by acute type I transverse ligament injury in school-age children.@*METHODS@#From February 2006 to February 2019, 8 school-age children with atlantoaxial dislocation caused by acute type I transverse ligament injury were systematically reviewed, including 6 males and 2 females; aged 9 to 12 years old; 8 acute injuries included 4 high-level falls, 2 car accidents and 2 sports injuries; the atlantoaxial interval(ADI) was 5 to 8 mm. Eight cases presented with pain, stiffness, numbness and cervical spine dysfunction in different degrees. Two of them were accompanied by nerve compression and ASIA grade D. The preoperative C₁,₂ angle averaged 20.7° to 23.4°. All patients received cranial traction and surgical treatment after complete reduction or atlantoaxial reduction. The changes of Japanese Orthopaedic Association(JOA) score, space available for the cord(SAC), neck disability index(NDI), ADI, ASIA classification(ASIA) injury classification(1992) and C₁,₂ angle before and after treatment were observed.@*RESULTS@#The average follow-up time was 8 to 156 months. Clinical and radiological follow-up showed that the atlantoaxial joint was completely relieved, the reduction was satisfactory and the arthrodesis was stable. Nerve and vascular injuries associated with this technique were not observed. JOA score, SAC, NDI, C₁,₂ angle of the last follow-up of the children were significantly improved. Two children of ASIA grade D recovered to grade E.@*CONCLUSIONS@#Bilateral atlantoaxial lamina hook and atlantoaxial joint space screw combined with autologous iliac bone graft is simple, less bleeding, strong stability and high fusion rate. It is an ideal surgical procedure for acute type I transverse ligament injury with atlantoaxial dislocation in school-age children.

Effect of Rehabilitation on Patients with Anterior Talofibular Ligament Injury at Different Stages / 中国康复理论与实践

Objective:To compare the clinical efficacy of rehabilitation training at different stages on patients with anterior talofibular ligament injury after conservative treatment. Methods:From October 2017 to October 2018, 58 patients with anterior talofibular ligament injury were divided into six-week rehabilitation group (n = 29) and twelve-week rehabilitation group (n = 29), according to the time they began rehabilitation after injury. Visual Analogue Score (VAS) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot function scoring system were used to evaluate ankle function before rehabilitation, and two weeks, four weeks and eight weeks after rehabilitation, respectively. Results:Two weeks, four weeks and eight weeks after rehabilitation, the scores of VAS and AOFAS improved in both groups (|t| > 4.137, P < 0.001), the scores of VAS were lower (|t| > 3.110, P < 0.01), and the scores of AOFAS were higher (|t| > 3.016, P < 0.01) in the six-week rehabilitation group than in the twelve-week rehabilitation group. Conclusion:It is suggested to begin rehabilitation within six weeks for patients with anterior talofibular ligament injury after conservative treatment.

Estado funcional actual de pacientes con reconstrucción quirúrgica de esquina posteromedial de rodilla por lesiones KD I: serie de casos / Current functional status of patients with surgical reconstruction of KD I posteromedial injuries of the knee injuries: Case series

Introducción Se evalúan los resultados funcionales actuales obtenidos en los pacientes intervenidos por lesión de esquina medial de la rodilla KD I. Se comparan los resultados obtenidos en pacientes con compromiso anteromedial (ligamento cruzado anterior, LCA) con los de compromiso posteromedial (ligamento cruzado posterior, LCP). Materiales y métodos Estudio descriptivo observacional transversal de tipo serie de casos donde se valoraron pacientes con lesiones de esquina posteromedial de rodilla KD I intervenidos entre 2008 y 2013. La valoración clínica y funcional actual se realizó con las escalas IKDC, Lysholm, Tegner y EVA, y pruebas de movilidad y de estabilidad. Resultados Se examinaron 9 pacientes con 2 años y medio de seguimiento. La media de edad fue 36 años. Hubo 6 casos por accidentes de tránsito, con 4 lesiones del LCP y 5 del LCA. Durante la valoración clínica, se encontró a 7 pacientes asintomáticos durante las actividades cotidianas; la mitad obtuvo más de 70 y 82 puntos IKDC y Lysholm, respectivamente, con funcionalidad aceptable y disminución de la actividad física (Tegner de 7 a 5). Todos presentaron algún grado de inestabilidad residual anteroposterior según la lesión, en 4 casos inestabilidad medial leve y en 2, flexión limitada. Discusión El manejo quirúrgico de las lesiones mediales acompañadas de lesión del LCA o el LCP restaura la estabilidad en valgo con persistencia de leve inestabilidad anteroposterior y rotacional. Nivel de evidencia clínica Nivel IV.

Background To evaluate current functional results in patients operated by medial corner injury of the knee KD I we compared the results obtained in patients with anteromedial involvement (LCA) with those of posteromedial involvement (LCP) Materials & methods Case series study where patients were assessed with posteromedial corner injuries knees KD I operated on between 2008 and 2013. The current clinical and functional assessment was performed with the IKDC, Lysholm, Tegner and EVA scales, and mobility and stability tests. Results Nine patients were included with a 21/2 years follow-up, the average age was 36 years. There were 6 cases of traffic accidents, 4 LCP injuries and 5 LCA injuries. During the clinical evaluation, we found 7 asymptomatic patients during daily activities, half of patients get more than 70 and 82 points on IKDC and Lysholm scales respectively, with acceptable functionality and decreased physical activity (Tegner from 7 to 5). All had some degree of residual anteroposterior instability, in 4 cases mild medial instability and limited flexion 2. Discussion The surgical management of medial injury with ACL or LCP lesions restores valgus stability with persistent mild anterior-posterior and rotational instability. Evidence leve IV.

Comparison of Magnetic Resonance Imaging and Stress Radiography in Diagnosing Chronic Anterior Talofibular Ligament Injury / 中国运动医学杂志

Objective To compare Magnetic Resonance Imaging(MRI) and stress radiography in diagnosing chronic anterior talofibular ligament (ATFL) injury.Methods Among 45 patients undergoing ankle arthroseopy between October 2016 and December 2016,39 patients were included in this study.The ankle arthroscopy was used as the gold standard for diagnosing the chronic ATFL injury.The sensitivity,speciality and accuary of MRI and stress radiography were calculated according to the arthroscopic findings.Results The ankle arthroscopy revealed ATFL injury in 30 cases and intact ATFL in 9 cases,while MRI results found ATFL injury in 28 cases and intact ATFL in 11 cases with thesensitivity,speciality and accuary of 90.0％,88.9％ and 89.7％ respectively.The stress radiography results revealed ATFL injury in 21 cases and intact ATFL in 18 cases,with the sensitivity,speciality and accuary of 63.3％,77.8％ and 66.7％.Conclusion MRI was more reliable in diagnosing chronic ATFL injury compared with the stress radiography.

Anterolateral Ligament Reconstruction in ACL Insufficient Knee with High-grade Pivot Shift——Surgical Technique and Early Follow-up Results / 中国运动医学杂志

Objective To evaluate the effectiveness of anterior cruciate ligament (ACL) reconstruction combined with anterolateral ligament(ALL)reconstruction in ACL injury patients with high-grade pivot shift.Methods From May 2015 to April 2016,156 patients underwent ACL reconstruction by the same surgeon,and 22 of them with grade 2/3 pivot shift were included in this study.Anteroposterior knee stability was evaluated using KT1000 measurement,and the rotatory stability was assessed using the pivot-shift test.The Lysholm score was used to monitor the clinical function.Results There were 14 male subjects and 8 females,with an average age of 29.3 years.The mean follow-up period was 8.6 months.The mean side-to-side difference of anteroposterior knee laxity was 2.1 ± 0.6 mm,significantly improved compared with the preoperative 8.9 ± 3.1 mm.The preoperative pivot-shift indicated 2+ in 20 patients and 3+ in 2 patients,while at the final follow-up,21 patients had negative pivot shift with 1 of 1+ pivot shift.The difference was significant.The average Lysholm score improved significantly from 60.5 ± 12.3 preoperatively to 79.2 ± 7.8 at the final follow-up.Conclusion The rotatory instability can be effectively restored through the ACL reconstruction combined with ALL reconstruction in patients with high-grade pivot shift.The early-stage knee stability and functional outcomes indicate significant improvement postoperatively.

Arthroscopic Modified Broström Operation for Lateral Ankle Instability / 대한정형외과학회잡지

Lateral ankle sprain is the most common ankle injuries. Patients who fail conservative treatments are candidates for modified Broström operation (MBO). Traditionally, the primary surgical treatment performed is the open MBO. Recently, there has been an evolution in the arthroscopic treatment of lateral ankle injury. Several reports reveal biomechanically equivalent results of arthroscopic vs . open MBO when using matched cadaver pairs. Also there was no difference in the clinical or radiologic outcomes between the arthroscopic and open MBO in randomized controlled trial. Therefore, arthroscopic MBO is reasonable and good alternative treatment for lateral ankle injury. Actually new techniques of arthroscopic treatment for ankle injury is introduced about arthroscopic syndesmotic repair and arthroscopic deltoid repair. Arthroscopic techniques for ankle injuries seem to develop further in the future.

Common Peroneal Nerve Palsy Associated with Multiple Knee Ligament Injury / 대한스포츠의학회지

Common peroneal nerve (CPN) injury associated with multiple-ligament knee injury is relatively rare. A 38-year-old male presented with left knee pain occurred during ssireum (Korean wrestling). The patient exhibited positive Lachman, grade 3 varus stress, and also positive dial testing at 30°. Sensory loss of some area of left foot and foot drop were observed. Magnetic resonance imaging showed complete anterior cruciate ligament (ACL) rupture and posterolateral corner (PLC) injury. Motor nerve conduction velocity indicated left CPN palsy. ACL and PLC reconstructions were performed 10 days after injury and nerve exploration was done simultaneously. Neurolysis and primary repair were also performed. At 26 months after injury, muscle power of the tibialis anterior and extensor hallucis longus improved to grade 3, and sensation in CPN area recovered to about 60%. There was good stability in injured knee. To the best of our knowledge, this is the first case report describing CPN palsy with multiple-ligament knee injury during ssireum.

Tratamiento de la lesión del ligamento cruzado anterior en pacientes con fisis abiertas / Treatment of anterior cruciate ligament injury in patients with open physis

Contexto: las roturas del ligamento cruzado anterior (LCA) en pacientes con fisis abiertas representan el 3,3% de las roturas del LCA, En el tratamiento de las roturas intersticiales del LCA en pacientes con fisis abiertas existe controversia en la elección entre tratamiento conservador y tratamiento quirúrgico. Objetivo: analizar la reconstrucción del ligamento cruzado anterior LCA con fisis abierta en el Servicio de Ortopedia y Traumatología del Hospital de Especialidades FFAA No 1. Sujetos y métodos: estudio retrospectivo en pacientes sometidos a cirugía artroscópica para tratamiento de lesión del LCA con fisis abiertas, en el periodo enero 2012 y abril de 2015. En relación al tratamiento, se utilizó la técnica transfisaria completa (monotúnel); el injerto se fija al fémur con un endobotón y a la tibia con un tornillo de interferencia; el injerto fue obtenido del músculo semitendinoso. Resultados: fueron intervenidos 9 pacientes de sexo masculino, con edades entre 13 y 16 años, con lesiones del ligamento cruzado anterior en rodilla derecha (n=7, 78%) e izquierda (n=2, 22%); la ruptura del menisco es la lesión asociada más frecuente. Conclusión: las roturas del LCA con fisis abiertas son cada vez más frecuentes en la actualidad. La reconstrucción del LCA debe ser precoz para evitar lesiones condrales y meniscales. Se recomienda el tratamiento quirúrgico por los óptimos resultados clínicos y funcionales. (AU)

Background: anterior cruciate ligament (ACL) tears in open physis patients represent 3.3% of ACL tears. In the treatment of ACL interstitial tears in patients with open physis, there is controversy in the choice between conservative treatment and surgical treatment. Objective: to analyze the reconstruction of the anterior cruciate ligament ACL with open physis in the Orthopedics and Traumatology Service of the Specialty Hospital FFAA No 1. Subjects and methods: retrospective study in patients undergoing arthroscopic surgery for treatment of ACL injury with open physis, in the period January 2012 and April 2015. In relation to the treatment, the complete transfusion technique (monotunnel) was used; the graft is fixed to the femur with an endobotton and to the tibia with an interference screw; the graft was obtained from the semitendinous muscle. Results: were operated on 9 male patients, with ages between 13 and 16 years, with injuries of the anterior cruciate ligament in the right knee (n = 7, 78%) and left (n = 2, 22%); the rupture of the meniscus is the most common associated lesion. Conclusion: ACL tears with open physis are becoming more frequent today. The reconstruction of the ACL must be early to avoid chondral and meniscal lesions. Surgical treatment is recommended for optimal clinical and functional results. (AU)