Effect of different femoral tunnel locations on patellofemoral joint during single-bundle anterior cruciate ligament reconstruction / 中国组织工程研究

BACKGROUND: Studies have shown that arthroscopic single-bundle anterior cruciate ligament reconstruction can restore the forward stability of the knee joint, but the rotational stability of the knee joint and the matching degree with the patellofemoral joint are affected by the central position of the femoral and tibial tunnels. OBJECTIVE: To investigate the relationship between the location of different femoral tunnel centers and patellofemoral articulation and cartilage conditions in young and middle-aged patients with anterior cruciate ligament reconstruction, and to carry out the correlation analysis of patient study factors to further explore the location of the femoral tunnel with the least influence on the patellofemoral joint. METHODS: Seventy patients with anterior cruciate ligament rupture were diagnosed by preoperative MRI, physical examination and intraoperative arthroscopy. All patients were divided into quasi-isometric group and quasi-anatomical group according to the parity of random numbers. In the quasi-isometric group, a Kirschner needle was inserted 7 mm distal to the apex of the lateral wall of the intervertebral fossa using a femoral locator. In the quasi-anatomical group, the Kirschner needle was inserted at the lateral wall of the intercondylar fossa and at the foot print center of the original anterior cruciate ligament. The central coordinates of the femoral tunnel were evaluated on the near-far-front-rear plane based on a standardized grid system, while the central coordinates of the tibial tunnel was evaluated on the anterior-posterior-inner-outer plane, labeled as quadrant Y% and quadrant X%. By comparing the baseline data of patients in the two groups, the difference of lateral patellofemoral angle (LPFA), the difference of cartilage quantitative T2 value, and the correlation between various research factors, the surgical operators were further guided to carry out clinical practice. The implementation of the study protocol complied with the relevant ethical requirements of the First Affiliated Hospital of Anhui Medical University, and all patients signed an informed consent form prior to the participation in the trial. RESULTS AND CONCLUSION: There was no significant difference in baseline data between the two groups, but a significant difference in LPFA existed between the two groups, (0.57±0.33)° in the quasi-anatomical group vs. (1.55±0.36)° in the quasi-isometric group (P<0.001). The T2 values of medial patella, lateral patella and trochlear cartilage in the quasi-anatomical group were all smaller than the corresponding values of the quasi-isometric group. Quadrant X% had a significant negative correlation with LPFA difference (R=-0.664, P<0.01). Quadrant Y% was positively correlated with LPFA difference (R=0.804, P<0.01). The difference of LPFA was significantly positively correlated with T2 values of trochlear and patellar outer cartilage (R=0.651, 0.655, P<0.01). T2 values of trochlea and lateral patella cartilage were negatively correlated with postoperative Lysholm score (R=-0.505, -0.529, P<0.01). Quadrant Y% was highly correlated with T2 value of lateral patella (R=0.825, P<0.01), and significantly correlated with T2 value of trochlear cartilage (R=0.798, P<0.01). Quadrant X% was negatively correlated with T2 values of lateral patella and pulley cartilage (R=-0.639, -0.657, P<0.01). By exploring the change of the patellofemoral joint at early stage after single-bundle anterior cruciate ligament reconstruction, we found that the quasi-anatomical reconstruction relative to the quasi-isometric reconstruction requires less patellofemoral articular cartilage degeneration and smaller patellar tilt angle. Therefore, the surgeon is required to local the center point of the femoral tunnel as far as possible at the quasi-anatomical position, thereby minimizing the degeneration of the patellofemoral joint.

Surgical Outcomes of Internal Fixation Using Multiple Screws in Femoral Neck Fractures with Valgus Impaction: When Should We Consider Hip Arthroplasty? A Retrospective, Multicenter Study / 대한고관절학회지

PURPOSE: We analyzed the surgical outcomes at two institutions after internal fixation using multiple screws in femoral neck fractures with valgus impaction to determine independent predictors and their cut-off values for nonunion and reoperation. MATERIALS AND METHODS: Between January 2006 and December 2016, 104 femoral neck fractures with valgus impaction that underwent internal fixation using multiple screws from two institutions were enrolled. The multiple logistic regression model and receiver operating characteristics analysis were used to determine the independent predictors and cut-off values for nonunion and reoperation. RESULTS: There were 20 reoperations (19.2%) due to 11 nonunions (10.6%) and nine cases of femoral head osteonecrosis (8.7%). Multiple logistic regression analysis revealed that independent predictors of nonunion and reoperation were age and posterior tilt angle (P<0.05). The cut-off value for age and the posterior tilt angle for reoperation were 72.5 years and 12.2°, respectively. The patients with a posterior tilt angle of greater than 13° had poorer radiological and clinical outcomes compared with those with a posterior tilt angle of less than 13°, even though they did achieve bone union. CONCLUSION: Primary hip arthroplasty should be considered in patients older than 73 years of age with a posterior tilt angle greater than 13°.

The Correlation of Postoperative Femoral Component Rotation Angle and Patella Tilt Angle with Clinical Results in Total Knee Arthroplasty

PURPOSE: The aim of this study was to analyze the correlation of postoperative femoral component rotation angle and patella tilt angle with clinical results for total knee arthroplasty. MATERIALS AND METHODS: Ninety-six cases in 48 patients who underwent total knee arthroplasty between March 2002 and February 2010 were enrolled. Femoral component rotation angle (FRA) and patella tilt angle (PTA) were measured with postoperative computed tomography. Clinical results were evaluated using American Knee Society knee score & function score and Feller's patella score. We analyzed the correlation of FRA and PTA with clinical outcomes. We also compared clinical results between the PFC(R) Sigma group and the Scorpio NRG(R) group, and the patello-femoral symptom group and a symptom-free group. RESULTS: The mean FRA was 1.40degrees of internal rotation. The patellar tilt angle was 3.79degrees of lateral tilt. The mean knee score was 90.5, the function score was 77.4, and the patella score was 23.9. There was a significant difference between FRA and knee scores (p=0.031, r=-0.284). There were no significant differences between FRA and function score or patella score. The correlation of PTA and clinical results was not significant. The mean FRA was 2.00degrees of internal rotation in the PFC(R) Sigma group, and it was significantly different than for the Scorpio NRG(R) group which had 0.81degrees of internal rotation; but there were no significant differences between the two groups in clinical results. The patello-femoral symptom group deviated more from the mean FRA than did the symptom-free group. CONCLUSION: Internal rotation of the femoral component is correlated with poor clinical results after total knee arthroplasty. The correlation of patella tilt angle and clinical results was not significant.

A Study on the Criteria for Lateral Retinacular Release in Total Knee Arthroplasty: The No Thumb Technique with One Stitch Method

PURPOSE: This study was performed to determine new criteria for performing lateral retinacular release (LRR) without having a detrimental effect on patellar tracking. MATERIALS AND METHODS: For 17 patients who underwent bilateral TKAs, LRR was not performed at one side (A) due to improvement of patellar tracking after deflation of tourniquet although maltracking existed with the inflation of tourniquet. At the other side (B), LRR was not performed either because patellar tracking improved with one stich method although maltracking existed regardless of tourniquet status. We measured the lateral patellar tilt angle (LPTA) of each side inthose 17 patients after 1 year after TKAs and compared them. We also surveyed the incidence of LRR in 225 primary TKAs with the staged method of patellar tracking evaluation during the same period. RESULTS: The average LPTA was 3.4degrees at side (A) and 4.6degrees at side (B) respectively. There was no significant difference in LPTA between side (A) and side (B) (p=0.337). From the survey for incidence of LRR in 225 primary TKAs during the same period, LRR was not required in 19% of patients showing good patellar tracking with inflation of tourniquet, 58% of patients showing improved patellar tracking after deflation of tourniquet and 21% of patients showing improved patellar tracking by one stitch method regardless of tourniquet status. Consequently, only 2% of patients required LRR in primary TKA. CONCLUSION: One stitch method under the deflation of tourniquet in evaluating process of patellar tracking during primary TKAs is supposed to be very effective and to reduce the incidence of LRR to only 2% without influencing the LPTA.

A Study of the Decision Status for the Lateral Retinacular Release based on Lateral Patellar Tilt Angle in Total Knee Arthroplasty: Related with Tourniquet Effect

PURPOSE: The pattern of patellar tracking is changed depending upon whether a tourniquet is operating or not. This study was performed to suggest the criteria of lateral retinacular release(LRR) in total knee arthroplasty(TKA) based on the lateral patellar tilt angle(LPTA). MATERIALS AND METHODS: In study 1, the LPTA was compared in 24 bilateral TKAs, one side was required LRR and performed LRR, but not required and not done LRR on the other side according to the patellar tracking status in deflating tourniquet. In the second prospective study, we performed LRR one side and not the other side intentionally in all 11 patients' knees(22 knees) those who were same situations that the patellar tracking was not good under the condition of operating tourniquet but tracking was improved after deflation of tourniquet. We compared LPTA in both studies with paired t-test of SPSS 11.0. RESULTS: The LPTA was average 4.86 degrees on the side of performed LRR and 4.83 degrees on the other side in 24 patients. There was no significant difference of LPTA between them(p=0.952) in study 1. And the LPTA was average 5.18 degrees on the side of underwent LRR based on the condition of operating tourniquet, 5.45 degree on other not LRR side knee. There were also no significant difference between them(p=0.829) in study 2. CONCLUSION: The incidence of LRR will be reduced with no detrimental effect on lateral patellar tilt angle when making decision of LRR based on the patellar tracking status in deflating tourniquet.

Investigation of Tilt Angle of Head-Up Tilt Test on Children / 实用儿科临床杂志

0.05).The different tilt angles impacted patients' fear psychology(?2=8.038,P=0.018).The order of the extent of children's fear psychology represented from low to high at the angle of 60?,70? and 80?,respectively.The extent of the children's fear psychology had positive correlation with the tilt angle(r=0.669,P=0.002).Conclusions The tilt test angle does not affect the positive rate of HUTT and the hemodynamics in children undergoing HUTT with angles from 60? to 80?.The children at the tilt angle 60? had less fear than at the angle of 70? or 80?.The 60? tilt angle of HUTT in children is recommended in the clinical practice.

Radiology diagnosis of chronic instability of lateral ankle / 解放军医学杂志

Objective To discuss the significance of stress roentgenogram on diagnosis of chronic instability of lateral ankle and. bring forward the radiology diagnosis criteria. Methods 40 patients with chronic instability of lateral ankle and 40 normal people were randomly selected. Bilateral ankles of each subject had two basic roentgenographic measurements named inversion stress anteroposterior roentgenogram and anterior drawer stress radiograph. The talar tilt angel and anterior translation of talus were measured. Results The average TT and ATT of suffered ankles are 9.1 and 7.8mm,while the values of the opposite ankles are 5.4 and 5.4mm, the comparison group are 4.9 and 6.1mm.There is significant difference between the suffered ankles and normal ones(P

Talar Tilt Angle(A Comparative Study with Sagittal Mobility of the Normal Ankle) / 대한정형외과학회잡지

The object of this study was to determine the physiological range of talar tilt angle of the Korean and to establish the basis for diagnosis and treatment of the lateral instability of the ankle. The anteroposterior inversion stress view of both ankles was taken in the 108 healthy Korean who had no history of ankle injury or disease. The sagittal stress films were also performed on 96 ankles (48 cases) of these to further define the physiological limits of the sagittal mobility of the normal talus. We compared these two values of normai mobility of talus to deterrnine the significance and relationship of the rwo. The results obtained were as follows: 1) Talar tilt over 10 degrees was seen in only 6 ankles (1.9%) and most of the ankles (279 ankles, 88.4%) showed a tilt less than 5 degrees. 2) Normal talar tilt angle was increased in 30 degrees plantarflexed position than in 90 degrees neutral position of ankle. In 12 cases the value was different between the right and the left; but there was no significant difference between the sexes. 3) The anterior displacement index over 200 was seen in only 5 ankles (5.2%). 4) There was gross positive inter-relationship between physiological. range of talar tilt angle and talar sagittal mobility.