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Objective To observe the short-term clinical outcomes of arthroscopic single-tibial tunnel Pushlock fixation in the treatment of tibial avulsion fracture of the posterior cruciate ligament (PCL).Methods From December 2015 to January 2018,15 patients with tibial avulsion fracture of PCL were treated at Department of Articular Surgery,The Third Affiliated Hospital to Hebei Medical University.They were treated with arthroscopic single-tibial tunnel Pushlock fixation.All the fractures were fresh.They were 9 males and 6 females,aged from 14 to 64 years (average,33.6 years).The short-term outcomes were evaluated by comparing their preoperative and postoperative flexion of the knee,International Knee Documentation Committee (IKDC) and Lysholm scores.Results The operation lasted from 40 to 70 minutes (average,53 minutes).The 15 patients were successfully followed up for 10 to 18 months (average,12.2 months).All the fractures united well within 3 months after operation.All the posterior drawer tests were negative,showing no displacements or no complications like lesions of popliteal fossa,nerves and vessels,or impaired knee extension.At 6 months after surgery,the knee flexion (123.4°± 6.5°),the Lysholm scores (91.8 ± 3.5) and the IKDC scores (95.5 ± 1.6) were all significantly improved compared with the preoperative values (77.5°±13.1°,46.8 ±8.9 and 37.0±8.9) (P ＜0.05).Conclusion The tibial avulsion fracture of PCL can be treated by arthroscopic single-tibial tunnel Pushlock fixation with satisfactory early outcomes.
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Objective To compare the short-term outcomes between lateral retinacular release (LRR) via a prolonged incision versus arthroscopic LRR in osteofascial medial patellofemoral ligament reconstruction (MPFL-R) for recurrent patellofemoral dislocation.Methods From May 2012 to March 2015,51 patients with recurrent patellofemoral dislocation were treated at the Department of Joint Surgery,The Third Affiliated Hospital to Hebei Medical University.They were 16 males and 35 females,aged from 20 to 36 years (mean 27.2 years).Of them,28 underwent LRR via a prolonged incision in MPFL-R (incision group) and 23 did arthroscopic LRR in MPFL-R (microscopic group).Imaging changes were assessed by comparing preoperative and postoperative values of patella extensibility,patellar tilt angle,trochlear groove angle and tibial tuberosity-trochlear groove spacing (TT-TG);the knee joints were scored with Kujala and Lysholm functional rating systems at the last follow-ups.Results The 2 groups were compatible due to insignificant differences in the general data between them preoperatively (P ＞ 0.05).The 51 patients were followed up for 10 to 32 months (average,20 months).The rate of dislocation in the incision and microscopic groups were 0 and 8.7％ (2/23),respectively.There were no such complications in either group as patellar fracture,deep venous thrombosis of the lower extremity or limited joint extension or flexion.The last follow-ups revealed that no patients in either group were inflicted with patellofemoral re-dislocation.In the incision group,the patella extensibility,patellar tilt angle,Kujala score and Lysholm score were,respectively,19.65％ ± 0.75％,12.39°±0.76°,56.37 ±2.94 points and 51.64 ±6.22 points preoperatively,and 10.34％ ± 0.60％,8.83°±0.89°,92.68 ±2.75,and 90.71 ± 1.91 points postoperatively;in the microscopic group,the patella extensibility,patellar tilt angle,Kujala score and Lysholm score were,respectively,19.56％ ±0.62％,12.35° ± 0.66°,57.46 ± 3.08 points and 52.20 ± 6.94 points preoperatively,and 10.24％ ±0.66％,8.78° ± 0.92°,92.53 ± 3.32 points and 90.41 ± 2.90 points postoperatively.There were significant differences between the preoperative and postoperative values in both 2 groups (P ＜ 0.05).However,there were no significant differences between the preoperative and the postoperative values in trochlear groove angle or TT-TG in either group (P ＞ 0.05).There were no significant differences between the 2 groups in all the above preoperative and postoperative values (P ＞ 0.05).Conclusion In MPFL-R for recurrent patellofemoral dislocation,both LRR via a prolonged incision and arthroscopic LRR can improve the patellofemoral joint alignment and stability of the tibia,leading to good short-term outcomes.
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The pivot shift test is the most specific physical examination to assess the rotatory laxity of knee joint following anterior cruciate ligament injury.It is also one of the most important physical examinations to assess the stability and recovery of the knee joint after anterior cruciate ligament reconstruction.The following anterior lateral structures of knee joint contribute to the grade of the pivot shift,including the lateral meniscus,anterolateral capsule,iliotibial band and the morphology of tibial plateau.Lateral meniscus is a secondary stabilizer to rotatory loads in the anterior cruciate ligament deficient knee.Anterolateral capsule controls anterior tibial translation and internal rotation.Iliotibial band is an important secondary restraint to anterior tibial translation and internal rotation at high flexion angles.Posteroinferior slope of the tibial plateau results in increased anterior tibial translation during pivot shift.The size of the lateral tibial plateau is also associated with the grade of poivt shift.The integrity destruction of the anterolateral soft tissue in the anterior cruciate ligament deficient knee leads to higher grade of poivt shift.The morphological features of the tibial plateau can also affect the stability of the knee joint.However,there is still a paucity of knowledge about the anatomical and morphological features responsible for a high grade pivot shift.Higher grade pivot shift indicates the injury of anterolateral structures and the abnormality of tibial plateau.In order to restore the integrity of anterolateral soft tissue,the injury of lateral meniscus and iliotibial band should be repaired via anterior cruciate ligament reconstruction surgery with an addition of a lateral extraarticular reconstruction when the anterior cruciate ligament deficiency combined with injuries to anterolateral capsule.
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The pivot shift test is the most specific physical examination to assess the rotatory laxity of knee joint following anterior cruciate ligament injury.It is also one of the most important physical examinations to assess the stability and recovery of the knee joint after anterior cruciate ligament reconstruction.The following anterior lateral structures of knee joint contribute to the grade of the pivot shift,including the lateral meniscus,anterolateral capsule,iliotibial band and the morphology of tibial plateau.Lateral meniscus is a secondary stabilizer to rotatory loads in the anterior cruciate ligament deficient knee.Anterolateral capsule controls anterior tibial translation and internal rotation.Iliotibial band is an important secondary restraint to anterior tibial translation and internal rotation at high flexion angles.Posteroinferior slope of the tibial plateau results in increased anterior tibial translation during pivot shift.The size of the lateral tibial plateau is also associated with the grade of poivt shift.The integrity destruction of the anterolateral soft tissue in the anterior cruciate ligament deficient knee leads to higher grade of poivt shift.The morphological features of the tibial plateau can also affect the stability of the knee joint.However,there is still a paucity of knowledge about the anatomical and morphological features responsible for a high grade pivot shift.Higher grade pivot shift indicates the injury of anterolateral structures and the abnormality of tibial plateau.In order to restore the integrity of anterolateral soft tissue,the injury of lateral meniscus and iliotibial band should be repaired via anterior cruciate ligament reconstruction surgery with an addition of a lateral extraarticular reconstruction when the anterior cruciate ligament deficiency combined with injuries to anterolateral capsule.
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Objective To evaluate the clinical outcomes and report the second-look arthroscopic findings of reconstructed anterior cruciate ligament (ACL) using deep-frozen allograft.Methods Sixty-six patients undergoing ACL reconstruction using deep-frozen allograft in our institute with at least twelve months follow-up from January 2012 to March 2016 were included and received second-look arthroscopy.The patients consisted of 51 males and 15 females with an average age of 30.6 years (range,18 to 55 years) at the time of ACL reconstruction.Knee functions were evaluated by Lysholm score and International Knee Documentation Committee (IKDC) score.Knee stability was evaluated by drawer test,Lachman test and KT-1000 arthrometer.Second-look arthroscopic evaluation was performed in all patients,focused on continuity of the reconstructed ACL,the synovial coverage and subjective tension of the graft,and the prevalence of cyclops-like lesion and other changes after reconstruction procedures.Resuits All patients were followed up for average 18.3 months (range,12 to 36 months).Thirty-one patients underwent second-look arthroscopy from 12 to 18 months,and the other 35 patients underwent second-look arthroscopy from 18 to 36 months after ACL reconstruction.No infection,rejection reaction and other serious complication were reported after operation.The knee range of motion was normal in all cases,except that 10° extension limitation in one case.The Lysholm score significantly improved from preoperative 54.95±9.01 to 12 months postoperatively 86.14±5.86,and the IKDC improved from 54.79±9.12 to 85.11±5.77.Lachman test was positive in 8 cases,but negative in 58 cases postoperatively.KT-1000 arthrometer measurement showed that the side-toside difference significantly improved from preoperative 6.70± 1.24 mm to postoperative 1.52± 1.02 mm.Complete discontinuity occurred in 2 cases of the reconstructed grafts,graft tear in 4 cases.Cyclops-like mass was identified in 2 cases.The overall synovial coverage was slightly better in the patients who were followed up more than 18 months than those less than 18 months.However,there was no significant difference among the groups in the field of graft tension.The patients with taut grafts showed statistically better KT-1000 values (1.14±0.35 mm) than those with lax grafts (2.95±1.38 mm).Conclusion Frozen allograft could be a reasonable choice for ACL reconstruction.However,the graft integration and remodeling could tend to be slow.
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Objective: To establish a mice model of congenital heart disease transposition of great arteries in order to provide a research reference for the occurrence and development of transposition of great arteries. Methods: A total of 20 pregnant ICR mice at 8-10 weeks of age were divided into 2 groups: Control group, the mice received a single dose of DMSO 70 mg/kg at 8.5 days of gestation,n=5 and Experiment group, the mice received a single dose of all-trans retinoic acid 70 mg/kg at 8.5 days of gestation,n=15. All animals were treated for 18 days and then the embryos were taken to observe cardiac morphology under stereomicroscope. Results: Compared with Control group, Experiment group had obviously increased occurrence rates of premature delivery, abortion and embryo absorption, and 61.2% phenotype for transposition of great arteries; meanwhile, combining with non-heart defect phenotypeas exophthalmos and spinal malformation. Conclusion: All-trans retinoic acid may induce transposition of great arteries in mice embryos, which is a feasible animal model in experimental research.
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BACKGROUND:Due to limitations of the physicochemical properties of soft denture liner material itself, whisker has been added in the soft lining material in recent years, so as to enhance its mechanical properties. OBJECTIVE:To investigate the effect of different additive amount of anhydrous calcium sulfate whisker on the mechanical function of self-curing soft denture liner. METHODS: There were six groups in this experiment. Anhydrous calcium sulfate whisker at the mass fraction of 0 (control), 1%, 2%, 3%, 4%, 5% was respectively added into self-curing soft liner materials, 10 test specimens in each group, a total of 60 test specimens. The shear bond strength, Shore hardness and tensile strength were detected. RESULTS AND CONCLUSION: With the increasing amount of the anhydrous calcium sulfate whisker, the Shore hardness of the soft lining material was increased continuously, and the tensile strength was increased firstly and then reduced. When 3% anhydrous calcium sulfate whisker was added, the bond strength and tensile strength of soft lining material reached the peak. Taken together, the mechanical properties of the soft lining materials became perfect when 3% anhydrous calcium sulfate whisker was added. These results demonstrate that anhydrous calcium sulfate whisker may affect the mechanical properties of self-curing soft liner.
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BACKGROUND:Microleakage between restoration, tooth structure and bonding agent can cause the entry of bacteria and liquid in the mouth into the gap, thereby damaging the bonding interface between the restoration and tooth tissues, and leading to bond failure. Microleakage detection can directly show whether the closure of the root canal of post and core system is good or bad. The severity of microleakage directly affects the restorative effects of post and core. OBJECTIVE: To evaluate the effects of different root canal cleaning methods on the microleakage between the fiber post and root canal dentin. METHODS: Thirty fresh non-caries premolar posts with free root canalin vitro were randomly divided into five groups, and the root canal wal was respectively washed with saline, 5.25% sodium hypochlorite solution+17% ethylenediamine tetra-acetic acid (EDTA)+saline, 3% hydrogen peroxide solution+5.25% sodium hypochlorite+ saline, 3% hydrogen peroxide solution+2% chlorhexidine solution+saline, and 2% chlorhexidine solution+17% EDTA+saline in different groups. Super-bond C&B adhesive agent was used for bonding fiber post, and the microleakage of each sample was observed under stereomicroscope. RESULTS AND CONCLUSION: The severity of microleakage in the al groups was ranged as folows: saline group > 3% hydrogen peroxide solution+5.25% sodium hypochlorite+saline group > 5.25% sodium hypochlorite solution+17% EDTA+saline and 3% hydrogen peroxide solution+2% chlorhexidine solution+saline groups > 2% chlorhexidine solution+17% EDTA+saline group.
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BACKGROUND:Selection of resin core materials may affect the overal strength of the fiber posts. OBJECTIVE:To compare the overal flexural strength of five kinds of resin core materials combined with glass fiber posts. METHODS:Fifty viva glass fiber posts were randomly divided into five groups respectively binding to five different resin materials for repair:group A, MEDENTAL dual curing resin cement+glass fiber post;Group B, Tina dual curing resin cement+glass fiber post;group C, Bisco BisCem+glass fiber post;group D, 3M nano composite resin curing light P60+glass fiber post;group E, PULPDENT dual curing resin cement+glass fiber post. The root canals were embedded with self-curing plastic, and fixed in the universal testing machine. The load in tooth length axis was added onto the core at a 135° angle with a loading speed of 1.0 mm/min, until the fracture. Then, the stress at fracture and the fracture mode were measured. RESULTS AND CONCLUSION:The flexural strength was (83.248±7.857) N in group, (89.230±4.326) N in group B, (95.188±5.147) N in group C, (76.646±6.463) N in group D, and (83.064±3.964) N in group E. Except groups A and E, there were significant differences between every two groups (P<0.05). These findings indicate that Bisco BisCem resin cement binding to the fiber post can obtain a higher flexural strength.
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BACKGROUND:At present, there are stil differences in the studies of total-etch, self-etch and self-bonding resin cement effect on the coronal microleakage and bonding strength of fiber posts. OBJECTIVE:To evaluate the coronal microleakage and the bonding strength of fiber posts treated with three kinds of resin cements. METHODS:Total y 32 upper incisors were randomly divided into five groups, including three experimental groups and two control groups. After the root canal preparation, three kinds of resin cements (EMBRACE WetBond, LuxaCore, Medental Multi-cure) were used to fiber posts with the bond diameter of 1.4 mm. Stereomicroscope was used to observe the microleakage. Then, the specimens were cut into 2 mm wafer along the axis of tooth, and universal testing machine for push-out test was used to observe the failure mode. In the positive control group, no root canal preparation was done, the root was coated with nail polish, and the crown was directly exposed to the dye. In the negative control group, no root canal preparation was done, the root canal orifice was covered with the resin, the tooth was overal coated with nail polish and then embedded 1 mm below the section. RESULTS AND CONCLUSION:The microleakage was observed in al the three resin cements, Medental Multi-cure showed the least microleakage and LuxaCore showed the largest microleakage, and there was significantly different among the three kinds of resin cements (P<0.05). The bonding strength of three cements had significant differences (P<0.05), and ranked from high to low:Mdental Multi-cure, LuxaCore, and EMBRACE WetBond. The main fracture modes were binder/fiber post fracture and mixed failure. The results suggest that the total-etch resin cement binds tightly with the dentin, and owns a superiority in the microleakage and bonding property as compared with the self-etch resin cements and self-bonding resin cements.
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BACKGROUND:Studies have confirmed that the surface treatment methods such as silane coupling agent and sand blasting could improve bonding strength of zirconia ceramics and resin binder. In addition, the increase of micro cracks on the surface of zirconia ceramics can also improve the bonding strength of zirconia ceramics and resin binder. But there is a lack of related studies addressing whether repeatedly sintering would have an impact on shear bond strength of zirconia ceramics. OBJECTIVE:To determine the effect of decorative porcelain temperature firing on the shear bond strength between dental zirconia ceramics and resin binder. METHODS:Twenty pieces of zirconia ceramics specimens were selected from 40 tablets, and then randomly divided into five groups according to the number of sintered times:control group (without sintering), sintering groups for 2, 4, 6, 8 times. Heat starting temperature was 500 ℃, and final temperature was 1 000 ℃ with a heating rate of 55 ℃/min. The vacuum time was 7 minutes. During the sintering, the final temperature was constant. Unsintered ceramic pieces were bonded using resin binder. Universal testing machine was used to test the shear strength of the interface between the two pieces of zirconia ceramics. The interface after shearing was characterized by scanning electron microscope. RESULTS AND CONCLUSION:The shear strength of sintering groups for 4, 6, 8 times was significantly higher than that of the control group (P0.05). Shear strength of specimens sintered 8 times was slightly higher than that sintered 4 and 6 times (P<0.05). Under the scanning electron microscope, there was no crack on the surface of non-sintered zirconia ceramics. After 2 times sintering, the surface appeared to have fine cracks. After sintering 4 times, visible cracks were increased. After six rounds of sintering, the surface began to have significant changes;cracks rose along with slight gaps and a smal amount of adhesive residues were found. After sintering for 8 times, cracks and voids were obviously increased on the sintered surface and adhesive residues were found. It indicated that after sintering for 4, 6 and 8 times, zirconia ceramics could have a good shear strength binding to resin adhesives;with the increasing of sintering times, the shear bond strength could be increased.
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Objective To evaluate the surgical treatment of the acute posterolateral complex(PLC)injuries of knee joint and then observe the clinical outcome.Methods Twelve cases(12 knees)of acute PLC injuries were treated from May 2006 to October 2008.Patients' age ranged from 23 to 47 years old,average 31 years.There were 9 males and 3 females.Rebuild the anterior cruciate ligament(ACL)and posterior cruciate ligament(PCL)under arthroscope and then,locally suture the PLC injuries sites on those patients with PLC avulsion fraction.If there is PLC rupture,then locally suture the injury sites plus PLC reconstruction.Knee functions were evaluated by IKDC and Lysholm score.Results All patients were followed up for 12-18 months(mean,13.3 months).The preoperative range of motion was 118.00°±6.77°,which was 130.75°±3.05° after surgery.KT-1000 arthrometer measurement showed that the average posterior translation improved from(14.85+1.83)mm preoperatively to(4.18±1.88)mm postoperatively.Seven cases were normal(A grade),3 cases were nearly normal(B grade),1 abnormal(C grade),and 1 severely abnormal(D grade)according to IKDC standard.The preoperative Lysholm joint function score was 35-44,average 38.83 ±3.16,which was 79-91,average 84.92±3.73 after surgery.Conclusion To those acute PLC injuries with avulsion at the ligament extremities,locally suture should be taken.But for those with PLC rupture at the mid part of ligament,locally suture the injury sites plus PLC reconstruction helps get satisfactory outcome.
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BACKGROUND: Graft selection and histological fate for anterior cruciate ligament reconstruction is a hot topic in the fields of reconstruction and repair of anterior cruciate ligament.OBJECTIVE: To review structure of anterior cruciate ligament and graft selection.METHODS: Articles were retrieved from Medline database with the key words of "Anterior cruciate ligament, implant,reconstruction" between January 1980 and January 2010. inclusion criteria: ① Reconstructive surgery of anterior cruciate ligament injury; ② graft selection of anterior cruciate ligament. Exclusion criteria: ① the old literatures; ② repetitive studies. A total of articles related to reconstruction of anterior cruciate ligament were retrieved, but 33 ones were included in the final analysis. The old, duplicated, and similar studies were excluded.RESULTS AND CONCLUSION: At present, the major therapy for anterior cruciate ligament injury includes arthroscopy and arthroscopy-assisted reconstruction. For clincal application, there are a lot of grafts, including autogenous grafts, allografts,heterologous allograft, biological materials, artificial materials and tissue engineering grafts. Autogenous semitendinosus tendon and gracilis tendon or autogenous bone-patellar tendon (middle 1/3)-bone (BPTB) are mainly used for anterior cruciate ligament reconstruction at home and abroad.
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[Objective]To evaluate efficacy and method of arthroscopic meniscoplasty for horizontal tear of discoid lateral meniscus in a short follow-up term. [Method]A series of 27 patients (27 knees) (mean age 32 years, range 6 years to 42 years) who underwent arthroscopic evaluation and treatment of a discoid lateral meniscus between 2002 and 2006 was reviewed. All the patients who were selected had the horizontal type of tear. Of those discoid menisci classified intraoperatively (n=27), 85.2% (n=23) were complete discoid lateral menisci and 14.2% (n=4) were incomplete discoid lateral menisci. No Wrisberg type was noted. Arthroscopic meniscoplasty was performed in all cases. The horizontal tear meant meniscus was divided into two leaves. The auther removed the unstable leaf to the peripheral rim and preserved the stable one. Arthroscopic meniscoplasty was performed in the stable leaf.[Result]All the patients were evaluated at follow-up according to the Lysholm knee Scoring Scale. At follow-up, patients were reviewed to recognize possible of retear and requirement of arthroscopic revision. The knee score of these patients improved from 72.48?4.64 points preoperatively to 92.18?4.52 points postoperatively. Recurrence of tear or requirement of arthroscopic revision was not noted at the final follow-up. [Conclusion]Arthroscopic meniscoplasty of the horizontal tear of discoid meniscus is an effective method.
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[Objective]To analyze the reasons of complications in high tibial valgus osteotomy in the varus osteoarthritic knee and its management.[Method]We studied the results of valgus-producing high tibial osteotomies in patients who had medial unicompartmental osteoarthritis and varus malalignment.We performed the operation for 126 patients from January 2000 to October 2004.Twenty-one patients had complications,including four men and seventeen women,with average age of 61 years(ranged:48～64 years).The femorotibial angle was measured on the standing anteroposterior film of knee preoperatively in order to get high accuracy in preoperative planning.A lateral closing-wedge osteotomy was performed,the osteotomy site was stabilized by Giebel blade plate or stepped staple.[Result]The mean duration of follow-up was 7.5 months(ranged,6 to 12 months).There were twenty-three complications(21 patients,16.7%):tibial fracture in four cases,deep-vein thrombosis in five cases,peroneal nerve palsy in three cases,recurrence of varus deformity in six cases,internal fixation failure in four cases(recurrence of varus deformity developed in two patients),a superficial wound infection developed in one patient.[Conclusion]To reduce the incidence of complications in high tibial valgus osteotomy,we should make familiarication with anantomy and take more accuracy in preoperative planning,improve surgical skill as well as appropriate perioperative management.
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[Objective]To evaluate the results of treatment with arthroscope and high tibial osteotomy with fixation of staple made of retention alligation for osteoarthritis of the knee,and to discuss the indication for this technique.[Method]From March 1999 to May 2003,42 arthroscopic treatment and high tibial osteotomies were performed in 34 patients.There were 6 men(8 knees)and 28 women(34 knees,with a mean age of 54.2 years(ranged,42～67 years.The average postoperative follow-up was 36 months(ranged,16～44 months.The indications for high tibial osteteotomy were unicompartmental osteoarthritis and varus malalignment.After arthroscopic treatment,a lateral closing-wedge osteotomy was performed with fixation of staple made of retention alligation.The arthroscopic examination showed:plica synovialis in l0 knees,medial meniscus injuries in 12 knees,lateral meniscus injuries in 6 knees,articular cartilage injuries in 20 knees,body loose in joint in 7 knees,intercondylar fossa stenosis in 9 knees.Common peroneal nerve was not exposed and the periosteum opposite to the insicion position was left intact for sake of stability and acted as a hinge around which the wedge osteotomy was closed.The patients were reexamined to obtain a knee score,to make lateral andanteroposterior radiograph of the involved knee with the patient standing.[Result]During the follow-up,the patients showed satifying pain relief,improvement of joint function,correction of yams deformity.The average preoperative knee score was 53.714?6.7,The average postoperative knee score at the time of the latest follow-up was 91.02?7.7.Comparing preoperative with postoperative,there were significant differences(P
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0.05).Twelve months after TKA, the pain score of HO group was 15.56,lower than 2 weeks and comparison group in 12 months(P
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0.05). But when the flexion exceeded 30?, especially when it exceeded 60?, the displacement in pPc increased markedly, much greater than that of an intact knee (P0.05), while a slight over-restriction may be found at some angles. Conclusion Double-band reconstruction could effectively restrict the posterior displacement of the tibia and restore anteroposterior stability to the knee joint within its full range of flexion. aPc reconstruction could also maintain the posterior stability of the knee, while the result of pPc reconstruction is most unsatisfactory.
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Objective The purpose was to explore the preventive measures of patellar baja following high tibial osteotomy for osteoarthritis, and the correlation between alteration in the inclination of the proximal tibial articular surface and patellar baja was evaluated as well. Methods In the group, there were 41 cases (48 knees), which included 30 males and 11 females, aging from 45 to 56 years with the mean age of 52 years. The size of resected bone of the arthritic knee needed to achieve a normal angle was calculated, and an additional 3 to 5 degrees of overcorrection was added to achieve approximately 10 degrees of genu valgum. The Insall-Salvati ratio, the inclination of the proximal tibial articular surface, the tibial tubercle height and the anatomic axis of the affected limbs were measured on the preoperative, postoperative as well as the final follow-up radiographs respectively. Chi-square test and linear regression analysis were used to assess the influence of loss of proximal tibial articular inclination on the patellar height. In the statistical analysis, loss more than 5 degrees of proximal tibial articular inclination and lowering more than 10% of the patella following tibial osteotomy were assumed of clinical significance. Results Compared with the preoperative results, the postoperative inclination of the proximal tibial articular surface was decreased by a mean of 6.14 degrees; the postoperative Insall-Salvati ratio was decreased by a mean of 10.6%; the postoperative height of the tibial tubercle was decreased by a mean of 3.13 mm. 64.6% (31/48 knees) endured loss more than 5 degrees of posterior tibial inclination after high tibial osteotomy, whereas 56.2% (28/48 knees) showed a relative lowering of patellar height more than 10%, as measured by the Insall-Salvati ratio. The loss of the normal posterior tibial inclination was found to have a statistically significant correlation with the subsequent loss of the patellar height. Conclusion The loss of inclination of the proximal tibial articular surface is found to have a correlation with the loss of the patellar height. Clinically, the result suggests that preserving the inclination of the proximal tibial articular surface at the time of high tibial osteotomy could minimize the risk of patellar lowering after the high tibial osteotomy.
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Objective To evaluate the possibility for the treatment of chondral defects on the femoral bearing surface with autologous osteochondral transplantation under arthroscopy. Methods There were 17 patients with cartilaginous surface defects, including 12 males and 5 females. The average age of patients was 29 years ranging from 18 to 45 years. The defects were located at 10 left knees and 7 right knees. The functional status of patients were evaluated according to the Brittberg-Peterson scoring scale system, the results were average 80.65?9.69 points ranging from 65 to 105. 3 patients had no an obvious history of trauma, but suffered from the rheumatoid disease; however, the other 14 patients had been injured at the knee joint with pain and followed with muscle atrophy on the thigh. 3 patients experienced interlocking, and 2 had snapping in their knee joints. All the 14 patients with traumatic history had only solitary lesion, the area of local cartilaginous defects at the bearing surface of the lateral femoral condyle was of 2.5-3.0 cm2; the local defects of the other 3 patients were located at the medial femoral condyle with defect area of 2.0-2.5 cm2, which was diagnosed either as chondomalacia or corruption. The procedures of the mosaicoplasty consisted of harvesting osteochondral cylinders from non-weight bearing surface of the knee and then implanting the grafts into the cartilaginous defects under arthroscopy. Results All the patients were followed up for 10 to 20 months (mean, 15 months). The joint mobility recovered to nearly normal. According to the Brittberg-Peterson system, 14 patients had score of 0, and 3 had scores of 2-3 because of mild pain. The follow-up MRI showed adequate cartilaginous coverage in the original lesions and excellent position of the cylindrical osteochondral grafts. Conclusion The autologous osteochondral mosaicplasty is proved to have good and reliable clinical results for the cartilaginous defects in the knee bearing surface.