Correlation analysis for the lateral condylar tibial plateau fracture and complete medial collateral ligament rupture / 中华骨科杂志

Objective:To investigate the relationship between the CT images of a lateral condylar tibial plateau fractures and complete medial collateral ligament (MCL) injury.Methods:Data of 59 patients with lateral condylar fracture of tibial plateau complicated with MCL injury admitted to Tianjin Hospital from January 2020 to November 2021 were collected, including 32 males and 27 females, aged 42.4±12.3 years (range, 19-65 years), there were 26 cases of extension injury and 33 cases of flexion injury. The patients were separated into two groups: those with partial MCL injury and those with total rupture based on preoperative MR examination and intraoperative valgus stress test following fracture fixation. According to the ABC fracture classification of lateral condyle tibial plateau proposed by Sun et al., the fracture locations were determined on CT images, and the lateral plateau collapse depth (LPD) was measured. The relationship between LPD and MCL complete rupture was analyzed by receiver operating characteristic (ROC) curve.Results:Among 59 patients with lateral condylar tibial plateau fracture and MCL injury, 42 had partial injuries and 17 had complete ruptures. According to the ABC fracture classification, there were 26 cases of extension injury (involving area A), 21 cases of AB type, and 5 cases of ABC type; and 33 cases of flexion type injury, 19 cases of B type, 12 cases of BC type, and 2 cases of C type. All the 17 cases of MCL complete fracture occurred in extension injury, including type AB (14 cases) and type ABC (3 cases). The difference between the mean LPDs of the MCL full rupture group and the partial injury group was not statistically significant ( t=0.11, P=0.567), and the mean LPDs of both groups were 11.7±5.3 mm (range, 4.3-28.1 mm) and 11.5±4.8 mm (range, 3.8-23.6 mm), respectively. The area under the curve (AUC) of the ROC curve analysis was 0.504, and there was no statistical correlation between lateral platform collapse depth and MCL injury. Among the 26 patients with extensional injury area, MCL was completely ruptures in 17 cases and partially injury in 9 cases, LPD was 11.7±5.3 mm (range, 4.3-28.1 mm) and 6.6±1.8 mm (range, 3.8-9.4 mm), respectively, and the difference was statistically significant ( t=3.57, P=0.009). The best predictive cut-off value of LPD was 7.25 mm, the sensitivity was 88.2%, the specificity was 77.8%, and the AUC was 0.868. Conclusion:When the lateral condyle fracture of the tibial plateau is located in the extensional injury area (involving the A area in the ABC fracture classification) and the LPD measured on the CT image is greater than 7.25 mm, the complete rupture of the MCL should be considered. Clinical MCL repair is required after the fracture fixation surgery for improved surgical outcomes.

Comparison of the effect of medial open wedge high tibial osteotomy for moderate and severe knee osteoarthritis / 中华骨科杂志

Objective:To investigate the effect of medial open wedge high tibial osteotomy (HTO) on moderate and severe medial compartmental knee osteoarthritis.Methods:This study retrospectively reviewed patients treated with medial open wedge HTO between January 2017 and January 2019. All cases were followed up for more than 2 years. There were 28 patients with severe osteoarthritis, including 11 males and 17 females, aged 56.36±5.06 years. There were 32 patients with moderate osteoarthritis, including 12 males and 20 females, aged 54.16±6.3 years. Kellgren-Lawrence (K-L) grading, hip-knee-ankle angle (HKA), weight bearing line (WBL) ratio, joint line convergence angle (JLCA), medial joint space (MJS), posterior tibial slope (PTS), medial meniscus extrusion (MME) and medial meniscus extrusion ratio (MMER) were evaluated on radiographs before and 2 years after surgery. The International Cartilage Repair Society (ICRS) of the cartilage of medial femoral condyle (MFC) and medial tibial condyle (MTC) were evaluated under arthroscopy. The clinical outcomes were assessed by the Western Ontario and McMaster University (WOMAC) score, visual analogue scale (VAS) and the degree of medial collateral ligament (MCL) pseudo-relaxation. Predictors of MCL pseudo-relaxation were screened by binary logistic regression analysis.Results:K-L grading, HKA, WBL ratio and MJS improved in both groups after surgery, with no statistical significance between groups ( P>0.05). The postoperative JLCA was improved, whereas MME and MMER were not. And the severe group was higher than the moderate group before and after surgery ( P<0.05). Cartilage of MFC: in the severe group, 2 cases of ICRS 3 grade, 26 of 4 grade improved to 11 of 2 grade, 12 of 3 grade, 5 of 4 grade; in the moderate group, 12 cases of ICRS 2 grade, 18 of 3 grade, 2 of 4 grade improved to 30 of 2 grade, 2 of 3 grade. Cartilage of MTC: in the severe group, 2 cases of ICRS 3 grade, 26 of 4 grade improved to 17 of 2 grade, 8 of 3 grade, 3 of 4 grade; in the moderate group, 11 of 2 grade, 8 of 3 grade, 3 of 4 grade improved to 27 of 2 grade, 5 of 3 grade. The postoperative WOMAC score of the severe group improved from 50.71±8.07 to 3.86±1.84, while in the moderate group it improved from 44.09±6.63 to 3.34±2.24. The postoperative VAS score of the severe group decreased from 7.14±1.21 to 3.34±2.24, whereas it decreased from 6.38±1.24 to 0.44±0.62 in the moderate group ( P<0.05). There was no significant difference between the postoperative groups ( P>0.05). In the severe group, the degree of pseudo-relaxation of the MCL improved from preoperative 25 of I degree, 3 of II degree to postoperative 28 of 0 degree at the 0° position, and from 25 of I degree, 3 of II degree to 24 of 0 degree, 4 of I degree at 30° position ( P<0.05). In the moderate group, the degree of pseudo-relaxation of the MCL improved from preoperative 31 of 0 degree, 1 of I degree to postoperative 32 of 0 degree at the 0° position, and from 28 of 0 degree, 4 of I degree to 32 of 0 degree at the 30° position ( P<0.05). JLCA ( OR=0.08, 95% CI: 0.007, 0.948, P=0.045), MME ( OR=0.11, 95% CI: 0.100, 1.32, P=0.082) and MMER ( OR=0.66, 95% CI: 0.422, 1.030, P=0.067) were independent predictors of MCL pseudo-relaxation (the difference was statistically significant at P<0.10). Conclusion:Medial open wedge HTO has significant short-term clinical effect on the treatment of moderate and severe medial compartmental knee osteoarthritis, which can effectively relieve pain symptoms, improve joint function, and restore medial knee stability. Preoperative large JLCA, MME and MMER indicate pseudo-relaxation of the MCL.

Comparative study on posterior cruciate ligament reconstruction with autologous hamstring tendon and LARS artificial ligament in the treatment of KD-Ⅲ-M knee dislocation / 中国骨伤

OBJECTIVE@#To observe the curative effect of one-stage reconstruction of anterior cruciate ligament(ACL), posterior cruciate ligament (PCL) and medial collateral ligament (MCL) in patients with KD-Ⅲ-M knee injury, and to compare the operation time, hospitalization cost and curative effect after arthroscopic reconstruction of PCL with LARS artificial ligament and autogenous hamstring tendon, ACL reconstruction with autogenous hamstring tendon and MCL repair combined with limited incision.@*METHODS@#From March 2016 to January 2019, a total of 36 patients met the criteria of this study. Twenty patients in group A were treated with autogenous hamstring tendon reconstruction of ACL and PCL and repair of MCL, including 17 males and 3 females, with an average age of (34.7±9.2) years old. Sixteen patients in group B with LARS artificial ligament reconstruction of PCL, with an autogenous hamstring tendon reconstruction of PCL and MCL repair as before as group B, including 15 males and 1 female, with an average age of (36.8±8.6) years old. The operation time, hospitalization time and total hospitalization cost were compared between the two groups. The preoperative and postoperative functions of the two groups were evaluated by Hospital for Sepcial Surgery (HSS) score and Lysholm score respectively, and the curative effects were compared within and between groups.@*RESULTS@#All the patients in the two groups were followed up for at least 1 year. There were no complications such as infection and poor wound healing in both groups. There was significant difference in operation time between (120.25±9.55) min in group A and (106.63±8.85) min in group B (@*CONCLUSION@#There was no significant difference in the average hospitalization days between the two groups, but the operation time in group A was longerthan that in group B, and the hospitalization cost in group B was higher than that in group A. There was no difference in HSS score and Lysholm score before and follow-up for a certain period of time after operation.

Application of percutaneous pie-crusting deep medial collateral ligament release for posterior horn surgery of medial meniscus / 中国骨伤

OBJECTIVE@#To explore clinical and radiographic effects of percutaneous pie-crusting deep medial collateral ligament release in patients with posterior horn tear of medial meniscus combined with tight medial compartment.@*METHODS@#From January 2012 to December 2016, 35 patients with medial meniscus posterior horn injury were treated with percutaneous pie crusting deep medial collateral ligament release technique, including 21 males and 14 females, aged from 21 to 55 years old with an average of (39.1±6.5) years old. Degree of meniscus extrusion were recorded before and 24 months after operation. The knee valgus stress test was performed to evaluate stability of medial collateral ligament, and compared difference between healthy and affected side. Lysholm and IKDC functional scores were compared before and 24 months after operation.@*RESULTS@#All patients were followed up from 27 to 60 months with an average of (36.7±6.8) months. All patients were underwent operation, the wound healed well without complications. Operative time ranged from 0.5 to 1.2 h with an average of (0.8±0.4) h. Nineteen patients were performed partial meniscectomy, 16 patients were performed repair suture. Convex of meniscus before operation was (1.5±0.7) mm, and (1.7±0.4) mm after operation;had no statistical difference(@*CONCLUSION@#For patients with medial meniscus tear of posterior horn combined with tight medial compartment, percutaneous pie-crusting deep medial collateralligament release could improve medial compartment space, and Knee valgus instability and meniscus extrusion are not affected.

Biomechanical study of the effect of platelet rich plasma on the treatment of medial collateral ligament lesion in rabbits

Abstract Purpose: To evaluate the use of platelet-rich plasma in the early stages of healing of traumatic injury of the medial collateral ligament in the knee of rabbits. Methods: Thirty rabbits were subjected to surgical lesion of the medial collateral ligament. Of these, 16 were treated with platelet-rich plasma and 14 with saline (control). After 3 and 6 weeks of treatment, 50% of the animals from each group were sacrificed, and biomechanical tests were performed on the injured ligament to compare the tensile strength between the two groups. Results: Platelet-rich plasma significantly increased the tensile strength of the ligament in the groups treated after3 and 6 weeks. In the group treated with platelet-rich plasma vs. saline, the tensile strength values were 3192.5 ± 189.7 g/f vs. 2851.1 ± 193.1 g/f at3 weeks (p = 0.005) and 5915.6 ± 832.0 g/f vs. 4187.6 ± 512.9 g/f at 6 weeks (p = 0.0001). Conclusion: The use of platelet-rich plasma at the injury site accelerated ligament healing in an animal model, demonstrated by an increase in the tensile strength of the medial collateral ligament.

Clinical research on the arthroscopic treatment for recurrent patellar dislocation by anatomical reconstruction of medial patellarfemoral ligament / 中国骨伤

<p><b>OBJECTIVE</b>To observe the therapeutic effects of arthroscopic treatment for recurrent patellar dislocation by anatomical reconstruction of medial patellarfemoral ligament.</p><p><b>METHODS</b>From June 2009 to December 2014, 25 patients with recurrent patellar dislocation were treated with anatomical reconstruction of medial patellarfemoral ligament surgery under arthroscopy. There were 10 males and 15 females, with an average age of 18.4 years old (ranged, 15 to 25 years old ). There were 15 patients who had a medical history of sports injury, 7 patients had a chronic impairment history, and the other 3 patients had the symptoms without obvious predisposing causes. Fourteen patients had injuries on the right knee and 11 patients had injuries on the left knee. All the patients suffered from patellar dislocation 3 to 10 times. After operation, the exercise of knee joint were performed postoperatively. The knee range of motion, Lysholm score, Kujala score, Insall criteria, Patellar apprehension test and patellar grinding test were observed to evaluate the clinical effects.</p><p><b>RESULTS</b>All the patients were followed up, and the duration ranged from 12 to 48 months, with an average of 24.8 months. After surgery, all the wounds were healed excellent and there were no complications like surgical incision infection or patellar redislocation. The ranges of motion was increased from preoperative (105.40±5.93)° to postoperative(122.60±5.42)°. At the latest follow-up, the Lysholm scores were increased from preoperative 64.12±7.49 to postoperative 91.44±5.53, the Kujala scores were increased from preoperative 57.88±5.10 to postoperative 92.44±2.69. According to the Insall criteria, 19 patients got an excellent result, 5 good and 1 fair.</p><p><b>CONCLUSIONS</b>It has a satisfactory clinical therapeutic effect on anatomical reconstruction of medial patellarfemoral ligament under arthroscopy for the treatment of recurrent patellar dislocation. It is helpful for the relief of clinical symptoms and improvement of knee joint function.</p>

Anatomical reconstruction of old injury of knee medial collateral ligament by tendon allograft / 重庆医学

Objective To observe the effectiveness of tendon allograft in the treatment of old knee medial collateral ligament in‐jury .Methods Thirty‐two cases of old knee medial collateral ligament injury were treated .Tendon allograft was used to reconstruct old injury of knee medial collateral ligament and was fixed in bone with absorbable screws in operation .Results All incisions were healed by first intention .No infection ,deep vein thrombosis ,or other postoperative complications occurred .Thirty two cases were followed up fro 12 to 58 months with an average of 30 months .At 3 months after operation ,the knee X ray films of valgus stress position showed the medial joint space differences between both knees were less than 1 mm .According to the Lysholm Scale score average (92 .3 ± 4 .2) ,the results were excellent in 20 cases ,good in 11 cases ,and fair in 1 case with excellent rate of 97% at last follow up ,the knee scores were (42 .5 ± 5 .3) before operation and (92 .3 ± 4 .2) after operation ,showed significant difference(P<0 .05) .Conclusion Anatomical reconstruction of old injury of knee medial collateral ligament with tendon allograft is all‐sided and the fixation method was solid .The operation is easy to operate and achieves better effectiveness .

Analysis of two approaches for the treatment of the knee joint medial collateral ligament injury / 中国医师进修杂志

Objective To comparatively analyse the effects and methods for the treatment of the medial collateral ligament injury ( Ⅲ degree injury) of knee by direct suture repair and autologous semitendinosus transferred to reconstruct the repair.Methods Sixty-two cases of medial collateral ligament injury were treated by direct suture repair (suturing group,23 cases) and autologous semitendinosus transferred to reconstruct the repair (rebuild group,39 cases) with knee joint injury from March 2002 to September 2009.All cases of knee joints functional assessment were evaluated according to the Lysholm-Scale upgrades function scoring.Compared the effectiveness for stability measurement of genu valgum stress test 6 months after operation.Results All patients were followed up for 6 - 60 ( 12.4 ± 4.8) months.The outcome according to the Lysholm-Scale upgrades function scoring,the excellent and good rate was 65.2%( 15/23 ) with suturing group and 92.3% (36/39) with rebuild group.The curative effectiveness of stabilization for knee joint's medial collateral,as following:the excellent and good rate was 65.2% (15/23)with suturing group and 97.4%(38/39) with rebuild group.The curative effectiveness of stabilization for knee joint's posteromedial,as following the excellent and good rate was 60.9% (14/23) with suturing group and 92.3% (36/39) with rebuild group.There were statistical significance in excellent and good rate between the two groups (P ＜ 0.05 ).Conclusions The treatment of reconstruction medial collateral ligament injury with autologous semitendinosus transfer could provide enough tension to direct suture joint capsule,more robust on anatomy.It can play to inhere biological effect.The therapy of anatomy reconstruction is very satisfactory,has merits of firm fixation,and the method is simple,convenient and available,which is an ideal one.

The Role of an Axial MR Scan on the Diagnosis of a Meniscal Tear of the Knee Joint

PURPOSE: To evaluate the role of standard axial MR images for the diagnosis of meniscal tears of the knee. MATERIALS AND METHODS: Forty-five patients with a prior MRI examination that underwent arthroscopic surgery of the knee due to clinical impression of a meniscal tear were included in the study group. The sequence for meniscal evaluation was an axial fat-saturated proton density-weighted image with a 4 mm slice thickness. Axial MR images were independently reviewed by two radiologists and were compared with findings of arthroscopy. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of the axial MR scan for the diagnosis of the meniscal tear were calculated. RESULTS: A total 90 menisci of 45 patients were evaluated in the axial MR scans. Forty-two patients had meniscal tears, and two of the patients had tears in both menisci; thus, a total of44 meniscal tears were found by arthroscopy. For meniscal tears, the sensitivity of the axial plane was 76.2%, the specificity was 89.1% and the accuracy was 81.1%. False negative meniscal tears were seen in 12 cases and false positive meniscal tears were seen in 5 cases on the axial MR images. CONCLUSION: In standard knee MRI examinations, axial images may be valuable for the detection and localization of meniscal tears.

Effect of soft tissue balance in total knee replacement of varus knee / 中华骨科杂志

Objective To analyze contribution of varus knee with osteoarthritis and investigate the role of soft tissue balance in total knee replacement ( TKR) of that. Methods One hundred cases (145 varus knees) were operated with TKR. There were 18 males (25 knees) and 82 females (120 knees), with the average age of 64.6 years, from 45 to 80 years old. During the operation, accurate osteotomy and soft tissue balance was made to correct the varus knee joint. The contribution angles of varus knee was measured on weight bearing X ray images pre and postoperatively, in order to evaluate the results of the combination of the osteotomy and soft tissue balance. Results The gross varus angle was average 9.2? ? 3.1? , ranging from 5? to 30? preoperatively. In the total angle, the varus angle caused by soft tissue imbalance was 53.2% , the osseous varus angles caused by the tibia varus was 22.8% , the osseous varus angles caused by tibia plateau destruction was 24.0% . The measurement of the postoperative X ray films suggested that the average angle of the tibia plateau osteotomy was 4.3? , obtaining the correction of 27.9% of the total varus angle, and the angles corrected by soft tissue balance was 10.7? ,getting the correction of 72.1% of the total varus angle. According to HSS score system, the preoperative score was 38 points, ranging from 5 to 57, and postoperative scores was 87 points, ranging from 75 to 90. Conclusion The contribution of varus knee with osteoarthritis were include: 1) Bony structural varus angle composed of tibial varus and tibial plateau destruction; 2) Collateral ligaments and soft tissue imbalance around the knee. Articular surface destruction and soft tissue imbalance are the main contribution of varus knee. For TKR of varus knees like this, besides accurate osteotomy, correct soft tissue balance is the key of the operation. [

Development of soft tissue balance system and its application for quantitative knee collateral ligament release:an experimental study / 中华骨科杂志

Objective In order to meet the quantitative measurement of soft tissues balance required in the TKR,a new soft tissues balance navigation system have been developed and used experimentally in adjusting the soft tissue release of medial collateral ligament(MCL)and quantitative measurement of the force change in extension gap or flexion gap after various kinds of MCL release during TKA.Methods Six precise load sensors have been embedded in the front measure device,which is inserted into the cutting gaps of the 5 knee joints of cadavers to measure the force of MCL before or after various types of releases.The device has the function of changing distance between its upper and lower plates by the mechanical structure for the adjustment of different bone cutting space.The reading of the sensors representing the force are displayed in three or two-dimensional manner in real-time with accuracy of better than 0.098 N per bit.Results The preliminary test shows that the measurement system can accomplish the force measurement and the distance adjustment in the knee joint,and its application for measuring the force of medial collateral ligament shows a quantitative force change in MCL in different knee position and different way of release.Release of the posterior portion of MCL mainly produces laxity of MCL at full extension with 33.61% reduction rate of tensional force in value.Complete medial collateral ligament release causes laxity of MCL both at full extension and 90? flexion with reduction rate of 44.96% or 41.30% respectively.Conclusion The soft tissues balance measurement device are capable of clinical use for navigation of soft tissue balance in TKA and performing knee dynamics research.It has been proved quantitatively that the posterior portion of MCL plays an important role in stability for extended knee while the anterior portion of MCL mainly stabilizes the knee in flexion.