Finite element analysis of different reconstruction methods of coracoclavicular ligament for acromioclavicular joint dislocation / 中国骨伤

OBJECTIVE@#This study aims to examine the biomechanical effects of different reconstruction methods, including single-bundle, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of the coracoclavicular ligament on the acromioclavicular joint using finite element analysis, to provide a theoretical basis for the clinical application of truly anatomical coracoclavicular ligament reconstruction.@*METHODS@#One volunteer, aged 27 years old, with a height of 178 cm and a weight of 75 kg, was selected for CT scanning of the shoulder joint. Three-dimensional finite element models of single-bundle reconstruction, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of coracoclavicular ligament were established by using Mimics17.0, Geomagic studio 2012, UG NX 10.0, HyperMesh 14.0 and ABAQUS 6.14 software. The maximum displacement of the middle point of the distal clavicle in the main loading direction and the maximum equivalent stress of the reconstruction device under different loading conditions were recorded and compared.@*RESULTS@#The maximum forward displacement and the maximum backward displacement of the middle point of the distal clavicle in the double-bundle truly anatomic reconstruction were the lowest, which were 7.76 mm and 7.27 mm respectively. When an upward load was applied, the maximum displacement of the distal clavicle midpoint in the double-beam anatomic reconstruction was the lowest, which was 5.12 mm. Applying three different loads forward, backward, and upward, the maximum equivalent stress of the reconstruction devices in the double-beam reconstruction was lower than that in the single-beam reconstruction. The maximum equivalent stress of the trapezoid ligament reconstruction device in the double-bundle truly anatomical reconstruction was lower than that in the double-bundle anatomical reconstruction, which was 73.29 MPa, but the maximum equivalent stress of the conoid ligament reconstruction device was higher than that of the double-bundle anatomical reconstruction.@*CONCLUSION@#The truly anatomical reconstruction of coracoclavicular ligament can improve the horizontal stability of acromioclavicular joint and reduce the stress of the trapezoid ligament reconstruction device. It can be a good method for the treatment of acromioclavicular joint dislocation.

Application of total anatomical reconstruction during robot-assisted radical prostatectomy / 中华泌尿外科杂志

Objective:To investigate the effect of total anatomical reconstruction (TAR) during robot-assisted radical prostatectomy (RARP) .Methods:The clinical data of 99 patients with RARP performed by a single doctor in our hospital from January 2018 to January 2021 were analyzed retrospectively.There were 38 patients in the TAR+ vesicourethral anastomosis (VUA) group and 61 patients in the VUA group. There were no significant differences between the two groups in the age of patients [ 65.5 (60.8, 71.0) years vs. 66.0 (61.5, 69.0) years], body mass index[ (24.92±2.65) kg/m 2 vs. (25.51±2.80) kg/m 2], prostate volume [28.13 (25.21, 36.53) ml vs. 26.33 (19.75, 47.84) ml], PSA [15.67 (9.02, 31.49) ng/ml vs. 14.58 (9.23, 30.06) ng/ml], neoadjuvant therapy [50.0% (19/38) vs. 63.9% (39/61)], Gleason score (6/7/8/9-10 scores: 8/16/5/9 cases vs. 16/25/9/11 cases) and clinical T stage (T 1/T 2/T 3 stage: 4/29/5 cases vs. 3/53/5 cases)(all P>0.05). The TAR technique was performed as follows. ①The two layers of posterior reconstruction involved the residual Denonvilliers fascia, the striated sphincter and medial dorsal raphe (MDR), and the vesicoprostatic muscle (VPM), the fascia which was 1-2 cm from the cranial side of the bladder neck and MDR. ②The one layer of anterior reconstruction involved detrusor apron, tissues around the urethra and the visceral and parietal layers of the endoplevic fascia. The VUA technique was suturing the bladder neck and urethra consecutively. Perioperative indexes were compared between the two groups. Results:All 99 operations were successfully completed. There were no statistically significant differences between the TAR+ VUA and VUA groups in operation time [ (174.16±47.21) min vs. (188.70±45.39) min], blood loss [ 50 (50, 100) ml vs. 100 (50, 100) ml], incidence of postoperative complications [10.5% (4/38) vs. 14.8% (9/61)], phathological T stage [pT 2/pT 3~4 stage: 25/12 cases vs. 42/19 cases, P=0.895], and the time of indwelling catheter [ 21.0 (19.0, 21.0) d vs. 21.0 (21.0, 21.0) d] (all P>0.05). The difference in postoperative length of stay between the two groups was statistically significant[6.0 (5.0, 6.0) d vs. 7.0 (6.0, 7.5)d, P<0.001]. Follow-up was performed for 1 year after surgery. The recovery rate of urinary continence 3 months after surgery in TAR+ VUA and VUA groups were 86.8% (33/38) vs. 65.6% (40/61), which were statistically significant( P=0.019). There were no significant differences between TAR+ VUA and VUA groups in recovery rate of urinary continence 1 months after surgery [47.4% (18/38) vs. 45.9% (28/61)], 6 months after surgery [94.7% (36/38) vs. 85.2% (52/61)], and 12 months after surgery [94.7% (36/38) vs. 93.4% (57/61)] (all P>0.05). Conclusions:TAR technique has good surgical safety, and can promote recovery of early urinary continence after RARP.

Restablecimiento de la estabilidad horizontal en luxaciones acromioclaviculares III-V mediante la reconstrucción anatómica de los ligamentos coracoclaviculares y acromioclaviculares; técnica quirúrgica / Restoring horizontal stability in III-V acromioclavicular dislocations by anatomic reconstruction of the coracoclavicular and acromioclavicular ligaments; surgical technique

Resumen: Introducción: la luxación de la articulación acromioclavicular (AC) es una lesión frecuente que se observa en adultos jóvenes. El objetivo es describir una técnica quirúrgica que pueda restablecer la estabilidad horizontal y vertical de la articulación AC. Material y métodos: se describe una técnica quirúrgica utilizando un aloinjerto para la reconstrucción anatómica de los ligamentos coracoclaviculares (CC) y AC para luxaciones AC grado III-V de acuerdo con la clasificación de Rockwood. Resultados: es una técnica quirúrgica con reconstrucción anatómica y biológica de los ligamentos CC y AC con injerto. Se realizan dos túneles óseos en la clavícula pasando el cabo lateral del injerto por debajo del acromion; posteriormente se fijan los dos cabos con dos tornillos bioabsorbibles, restaurando de esta manera la estabilidad vertical y horizontal. Conclusión: este procedimiento permite restablecer la estabilidad vertical y horizontal de la articulación AC. Se requieren estudios de seguimiento para reportar resultados funcionales y radiológicos con el fin de poder asegurar ventajas en comparación con las técnicas existentes.

Abstract: Introduction: dislocation of the acromioclavicular (AC) joint is a common injury seen in young adults. The objective is to describe a surgical technique that can restore the horizontal and vertical stability of the AC joint. Material and methods: we describe a surgical technique that can restore horizontal and vertical stability using an allograft for the anatomical reconstruction of the CC and AC ligaments, for AC grade III-V dislocations according to the Rockwood classification. Results: this is a surgical technique with anatomical and biological reconstruction of the CC and AC ligaments, using an allograft. Two bone tunnels are made in the clavicle, passing the lateral end of the graft below the acromion; then the two ends are fixed with two bioabsorbable screws, restoring vertical and horizontal stability. Conclusion: this procedure allows to restore the vertical and horizontal stability of the AC joint. Follow up studies are required to report functional and radiological results, in order to ensure advantages compared to existing techniques.

Anatomical reconstruction of lateral ligament complex with singletunnel pullout stutrue fixation for chronic lateral ankle instability / 中国骨伤

OBJECTIVE@#To explore clinical effects of single-tunnel pullout structure fixation and anatomical reconstruction of lateral ligament complex in treating chronic lateral ankle instability.@*METHODS@#From January 2016 to December 2018, clinical data of 23 patients with chronic lateral malleolus instability who underwent anatomical reconstruction of lateral malleolus ligament complex with single-tunnel pullout structure fixation, were retrospectively studied. Among them, including 7 males and 16 females, aged from 17 to 33 years old with an avergae of (26.0±4.3) years old;16 patients classified to grage 0, and 7 patients classified to gradeⅠaccording to Kellgren-Lawrence(K-L) grading;the time of sprain ranged form 2 to 15 with an average of (5.7±2.9) times;the time from injury to operation ranged to 4 to 18 months with an average of (9.0±3.3) months. The range of movement of operative and uninjured ankle joints were measured at 24 months after opertaion, visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) were used to evaluate ankle joint function and improvement of pain, K-L grading and MRI scoring of osteoarthritis of ankle (MSOA) were used to evaluate degree of cartilage degeneration of ankle joint.@*RESULTS@#All patients were followed up from 24 to 48 months with an average of (33.4±6.7) months. All the anterior talofibular ligaments and calcaneofibular ligaments were dissected and reconstructed by single-tunnel pullout structure fixation. The range of motion of dorsiflexion, plantarflexion, varus, and valgus on the operative side of ankle joint were smaller than those on the healthy side. There were no statistically differences in dorsiflexion and eversion between operative side and healthy side of ankle joint (@*CONCLUSION@#Treatment of chronic lateral ankle instability with reconstruction of lateral ligament complex with single-tunnel pullout structure fixation could provide better tendon and bone healing conditions, improve surgical safety and could achieve satisfactory clinical outcomes.

Reconstrucción de ligamento colateral medial: descripción de una nueva técnica de aumentación con aloinjerto y tornillos biocompuestos interferenciales / Reconstruction of medial collateral ligament: Description of a new augmentation technique with allograft and interference biocomposite screws

Resumen: Introducción: La inestabilidad del ligamento colateral medial (LCM) se asocia con lesiones multiligamentarias. Existen varios procedimientos para la reconstrucción del LCM, presentamos una técnica percutánea de aumentación. Nuestro objetivo es describir una nueva técnica de reconstrucción del LCM mediante injerto y fijación con tornillos biocompuestos. Material y métodos: Presentamos la técnica en un total de 21 pacientes consecutivos con lesión del LCM operados en el período de Diciembre de 2011 a Octubre de 2014. La reconstrucción del LCM se realizó con aloinjertos del tendón del peroneo largo, tibial posterior o flexor largo del Hallux en 18 pacientes y solamente en un paciente se utilizó autoinjerto. De los 20 pacientes, 18 presentaron lesiones asociadas: cinco con lesión de menisco medial, ocho con lesión del ligamento cruzado anterior, (LCA), ocho con lesión condral y uno con lesión del menisco lateral. Conclusión: La técnica quirúrgica presentada es sencilla de realizar, sin daño a otras estructuras y con una fijación resistente.

Abstract: Introduction: Medial Collateral Ligament (LCM) instability is associated with multi-ligamentary lesions. There are several procedures for the reconstruction of MCL, we present a percutaneous technique of augmentation. Our goal is to describe a new technique of reconstruction of the LCM by grafting and fixing with biocomposite screws. Material and methods: We present the technique in a total of 21 consecutive patients with MCL injury operated in the period of December 2011 to October 2014. Reconstruction of MCL was performed with long, tibial or long hallux tendon allografts in 18 patients and only one patient was used autograft. Eighteen of the 20 patients had associated lesions: 5 with medial meniscus injury, 8 with anterior cruciate ligament injury, (ACL), 8 with condral injury and 1 with lateral meniscus injury. Conclusion: The surgical technique presented is simple to perform, without damage to other structures and with a strong fixation.

Acromioclavicular joint dislocation: How to achieve anatomical reduction, sustained stability and micro-motion / 中国组织工程研究

BACKGROUND: There are many ways to treat acromioclavicular joint dislocation, but there is no uniform standard. The therapeutic efficacy is affected by the damage mechanism, the type of dislocation, the choice of treatment mode and postoperative exercise. OBJECTIVE: To summarize the research progress in acromioclavicular joint dislocation. METHODS: The first author searched literature from PubMed (2010-2019) and WanFang (2010-2019) databases. The key words were “acromioclavicular; dislocation; diagnosis; therapy; anatomical reconstruction; endobutton; internal fixators” in English and Chinese, respectively. After repeated studies were excluded, totally 2 187 articles were retrieved, and 55 eligible articles were included for result analysis. RESULTS AND CONCLUSION: At present, Rockwood types I and II are usually treated nonoperatlvely, while Injures of Rockwood types IV-VI are treated surgically. The treatment of Rockwood type III Is still controversial. In order to maximize the shoulder function, It Is recommended to take active surgery for young and functionally demanding patients. Non-surglcal treatment Is mainly based on strap fixation. Surgical treatment Is Increasingly oriented to minimally Invasive anatomical reconstruction of the coracoclavlcular ligament, for example, Endobutton technique assisted by arthroscopy. Although good short-term results can be obtained, long-term follow-up studies with large samples are still needed to confirm its value in clinical application. Further investigations on the treatment of acromioclavicular joint dislocation are warranted. It has been sought for a surgical method that can achieve anatomical reduction and durable stability and ensure micro-motion of the acromioclavicular joint.

Reconstrucción anatómica del Acromion en casos de fracturas traumáticas y posterior a artroplastia reversa del Hombro. Reporte de Casos / Anatomic reconstruction of the acromion in cases of traumatic fractures after reverse shoulder arthroplasty. Report of a series of cases

Introducción Tanto las fracturas traumáticas del acromion, así como las fracturas acromiales por insuficiencia posterior a artroplastia reversa del hombro, son entidades poco frecuentes. Con la ampliación des los criterios operativos para la artroplastia reversa del hombro, es de suponer un aumento en el caso des las fracturas acromiales por insuficiencia posteriores a dicho procedimiento quirúrgico. Al ser estas entidades poco frecuentes hacen falta en la literatura recomendaciones basadas en la evidencia para el manejo de estas, las cuales representan un reto para el especialista tratante. Materiales y Métodos Reporte de seis casos entre 2013 y 2016 en el hospital cantonal de Frauenfeld (Suiza) de dos grupos de pacientes con fracturas del Acromion. En el grupo A se clasificaron tres pacientes que presentaron fractura por insuficiencia del acromion posterior a artroplastia reversa del Hombro. En el grupo B clasificaron tres pacientes con fracturas traumáticas del acromion en las cuales el manejo conservador no fue exitoso. Los dos grupos de pacientes fueron sometidos al mismo método quirúrgico con reducción abierta y reconstrucción anatómica del Acromion por medio de fijación con placa y tornillos interfragmentarios. Resultados Posterior a la intervención quirúrgica, la función del hombro se recuperó en todos los pacientes del Grupo A. La flexión anterior aumentó en promedio de 53° a 127°, y la abducción mejoró de 52° a 125°. Las mediciones posteriores al año de la intervención mostraron puntajes constantes entre 55-71, así como un valor subjetivo de hombro (SSV) de 50-90. En el Grupo B, el rango de movimiento preoperatorio se mantuvo constante. La flexión hacia delante mejoró de 133° a 157° y la abducción aumentó de 147° a 153°. Un año después de la cirugía, los puntajes de Constant en el grupo B variaron de 70 a 86 y el SSV se encontró entre 80 a 100. Los tres pacientes del Grupo B consiguieron retomar sus actividades diarias sin dolor y pudieron regresar al trabajo. La extracción de la placa fue necesaria en la mitad de los pacientes de la cohorte (Grupo A n=1, Grupo B n=2). Discusión La fractura del acromion es una condición seria que puede causar daño significativo al funcionamiento del hombro. Tanto en pacientes con ARH así como en pacientes sin ARH previa, nuestra técnica operativa abierta de reconstrucción anatómica del acromion mostró buenos resultados. Recomendamos el manejo quirúrgico por medio de reconstrucción con placa y clavos de fijación. Nivel de evidencia: IV

Aim To propose a surgical technique to treat the traumatic acromion fractures, as well as acromion fractures before reverse total Shoulder Replacement (TSR). Methods Six patients were treated with the same fixation technique between December 2013 and December 2016. Three patients had acromial insufficiency fractures (type II) following TSR (Group A). The other three patients, who had traumatic acromion fractures, underwent unsuccessful conservative treatment (Group B). Surgical treatment involved reconstruction of the acromion using an open technique with plate and interfragmentary screw fixation. Results Following reconstruction, shoulder function was regained in all patients in Group A. Forward flexion increased, on average, from 53° to 127°, and abduction improved from 52° to 125°. Measurements at one-year follow-up were Constant scores from 55-71, and subjective shoulder value (SSV) from 50-90. In Group B, preoperative range of motion was not substantially diminished. Forward flexion improved from 133° to 157°, and abduction increased from 147° to 153°. One year following surgery, the Constant scores in Group B ranged from 70-86, and SSV was 80-100. All three patients performed daily activities without pain, and were able to return to work. Plate removal was necessary in half the patients in the cohort (Group A n=1; Group B n=2). Conclusion An acromion fracture is a serious condition that can cause significant damage to shoulder functioning. In patients with or without previous TSR, this fixation technique was used successfully to reconstruct the anatomic lateral and basal acromion. Evidence Level: IV

Truly anatomic double Endobutton reconstruction of coracoclavicular ligament for acute acromioclavicular joint dislocation of Rockwood type Ⅴ / 中华创伤骨科杂志

Objective To investigate the therapeutic efficacy of truly anatomic reconstruction of the coracoclavicular ligament with two Endobutton devices for acute acromioclavicular joint dislocation of Rock-wood type Ⅴ.Methods From May 2013 to October 2015,25 patients with acromioclavicular joint dislocation of Rockwood type Ⅴ underwent truly anatomic reconstruction of the coracoclavicular ligament using two Endobutton devices.They were 15 men and 10 women,from 18 to 67 years of age (mean,43.0 years).All the dislocations were unilateral,involving 14 left and 11 right sides.The visual analog scale (VAS) and the Constant scoring were used at 3,6,12,18 and 24 months postoperatively for assessments of pain and shoulder function.The coracoclavicular distances on the healthy and affected sides were measured on their anteroposterior X-ray films of bilateral shoulders.Results The 25 patients were followed up for 24 to 48 months (mean,34.0 months).Their VAS score were decreased significantly from preoperative 5.0 ± 0.9 points to 0 ±0.5 points at 24 months after surgery,their Constant score increased significantly from preoperative 45.0 ± 5.6 points to 95.0 ± 2.9 points at 24 months after surgery,and their coracoclavicular distances at the affected side restored significantly from preoperative 23.0± 5.4 mm to 8.0 ± 0.9 mm at 24 months after surgery (all P ＜ 0.05).There was no significant difference in the coracoclavicular distance between the affected and the healthy sides at 24 months after surgery (P ＞ 0.05).No serious complications like acromioclavicular joint re-dislocation or clavicular condylar fracture occurred in any patient.Conclusions Truly anatomic double Endobutton reconstruction of the coracoclavicular ligament is a safe,reliable and creative surgical technique that may yield good to excellent clinical and radiological outcomes in the treatment of acute acromioclavicular joint dislocation of Rockwood type Ⅴ.

Biomechanical Comparison of Anatomical and Vertical Reconstruction for Coracoclavicular Ligament / 医用生物力学

Objective To conduct a comparative study of the biomechanical characteristics of anatomical and vertical reconstruction for the coracoclavicular ligament. Methods Thirty fresh adult cadaveric specimens of the shoulder joint were dissected, whereas other soft tissues of the shoulder joint were resected, and only the clavicle-coracoclavicular ligament-scapula structures were retained. All the specimens were randomly divided into three groups, with ten specimens in each group. In Group 1, the coracoclavicular ligament was retained; in Group 2, the cone ligament was reconstructed vertically based on the classical Steven technique; and in Group 3, the conical ligament was reconstructed anatomically based on the central site of the original ligament. Biomechanical tests under vertical tensile resistances were conducted separately on the three groups, and the tensile forces that caused the rupture of the coracoclavicular ligament or reconstruction failure were recorded. Results In Group 1, clavicle and coracoid fractures were not found, and the tensile force that caused the coracoclavicular ligament rupture was (650.41 + 35.88) N. In Group 2, clavicle fracture (two cases), endobutton pull-out from the clavicle (two cases) or coracoid (five cases), and coracoid fracture (one case) occurred, and the tensile force that caused the failure of the coracoclavicular reconstruction was (725.68 + 35.37) N. In Group 3, clavicle fracture (three cases ), endobutton pull-out from the clavicle (one case) or coracoid (five cases), and coracoid fracture (one case) occurred, and the tensile force that caused the failure of the coracoclavicular reconstruction was (765.15+13.68) N. Conclusions The tensile forces in the anatomical and vertical reconstruction of the coracoclavicular ligament were both superior to those of the primary ligament, with the anatomical reconstruction being superior to vertical reconstruction under a tensile effect.

Mid-term effects of arthroscopic anatomical reconstruction of double bundles of the anterior cruciate ligament / 中华创伤骨科杂志

Objective To investigate the mid-term clinical outcomes of arthroscopic anatomical re-construction of double bundles of the anterior cruciate ligament ( ACL ) . Methods The clinical data of 78 patients diagnosed with ACL rupture from April 2012 to July 2014 were analyzed retrospectively. They were 60 males and 18 females, aged from 19 to 56 years ( mean, 26. 8 years ) . The time from injury to surgery ranged from one week to 23 months ( mean, 5. 8 months ) . All of them obtained positive results in anterior drawer test and Lachman test preoperatively. Their preoperative KT-1000 examinations showed an average side-to-side difference of 8. 29 ± 1. 81 mm in anterior laxity. They were all treated with arthroscopic anatomical recon-struction of double bundles of the anterior cruciate ligament using autologous hamstrings. The International Knee Documentation Committee ( IKDC ) and Lysholm scores were used to assess their knee function at the last follow-up. Results All the 78 patients were followed up for 34. 6 months on average ( range, from 25 to 56 months ) . At the last follow-up, the IKDC and Lysholm scores were significantly increased from preoper-ative 42. 6 ± 9. 5 and 44. 4 ± 8. 5 to postoperative 92. 9 ± 2. 8 and 94. 2 ± 3. 4, respectively ( P <0. 05 ) . The Lachman test was negative in 73 cases ( 93. 6％) and the pivot shift test was negative in 69 cases ( 88. 5％) . The KT-1000 examinations showed that the side-to-side difference in anterior laxity averaged 1. 47 ± 0. 68 mm, significantly improved from the preoperative values ( P <0. 05 ) . At their last follow-up, 29 patients underwent MRI scans which showed continuity of the anteromedial and posterolateral bundles of the anterior cruciate liga-ment. Conclusion The arthroscopic anatomical reconstruction of double bundles of the anterior cruciate ligament can restore the knee stability and achieve fine mid-term clinical outcomes.

Arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament for chronic ankle instability / 中华创伤骨科杂志

Objective To evaluate the clinical results of arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament for treatment of chronic ankle instability. Methods From June 2012 to August 2016, 27 patients with chronic ankle instability (28 ankles) were treated with arthroscopic anatomical reconstruction of anterior talofibular ligament and calcaneofibular ligament. All the patients were evaluated preoperatively and at the last follow-up using visual analogue scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) score. The talar tilt angle and anterior translation were assessed radiographically in pre- and postoperative ankle stress views.Results The operations lasted for 75.8 minutes (from 72 to 104 minutes). The 27 patients received a mean follow-up of 14.8 months (range, from 12 to 25 months). All the wounds healed by the first intention. No neurovascular complications were observed and no patient reported ankle stiffness or pain in motion. On average, the anterior talar trans-lation was reduced from 10.82 ± 3.32 mm preoperatively to 4.03 ± 1.70 mm at the last follow-up, the talar tilt angle decreased from 15.60°± 3.86°to 6.01°± 2.64°, the VAS pain score decreased from 5.79 ± 1.79 to 1.54 ± 1.35, and the AOFAS ankle-hindfoot score improved from 63.64 ± 11.20 to 90.21 ± 4.48. All the above differences were statistically significant (P <0.01). Conclusion Arthroscopic anatomical re-construction of anterior talofibular ligament and calcaneofibular ligament can improve function and stability of the ankle joint effectively, providing a valid option for treatment of chronic ankle instability.

A modified Laprade technique in treatment of lateral multi-ligament injuries of knee / 中国修复重建外科杂志

Objective: To evaluate the short-term effectiveness of a modified Laprade technique in the treatment of lateral multi-ligament injuries of knee by anatomical reconstruction of posterolateral complex (PLC) and anterior lateral ligament (ALL).

Kinematic Analysis of Five Different Anterior Cruciate Ligament Reconstruction Techniques

Several anatomical anterior cruciate ligament (ACL) reconstruction techniques have been proposed to restore normal joint kinematics. However, the relative superiorities of these techniques with one another and traditional single-bundle reconstructions are unclear. Kinematic responses of five previously reported reconstruction techniques (single-bundle reconstruction using a bone-patellar tendon-bone graft [SBR-BPTB], single-bundle reconstruction using a hamstring tendon graft [SBR-HST], single-tunnel double-bundle reconstruction using a hamstring tendon graft [STDBR-HST], anatomical single-tunnel reconstruction using a hamstring tendon graft [ASTR-HST], and a double-tunnel double-bundle reconstruction using a hamstring tendon graft [DBR-HST]) were systematically analyzed. The knee kinematics were determined under anterior tibial load (134 N) and simulated quadriceps load (400 N) at 0degrees, 15degrees, 30degrees, 60degrees, and 90degrees of flexion using a robotic testing system. Anterior joint stability under anterior tibial load was qualified as normal for ASTR-HST and DBR-HST and nearly normal for SBR-BPTB, SBR-HST, and STDBR-HST as per the International Knee Documentation Committee knee examination form categorization. The analysis of this study also demonstrated that SBR-BPTB, STDBR-HST, ASTR-HST, and DBR-HST restored the anterior joint stability to normal condition while the SBR-HST resulted in a nearly normal anterior joint stability under the action of simulated quadriceps load. The medial-lateral translations were restored to normal level by all the reconstructions. The internal tibial rotations under the simulated muscle load were over-constrained by all the reconstruction techniques, and more so by the DBR-HST. All five ACL reconstruction techniques could provide either normal or nearly normal anterior joint stability; however, the techniques over-constrained internal tibial rotation under the simulated quadriceps load.

Clinical study on coracoclavicular ligament reconstruction with hook plate fixation combined with wire anchors anatom / 实用医学杂志

Objective To compare the effects of application of clavicular hook plate combined with wire anchors anatomical coracoclavicular ligament reconstruction and application of clavicular hook plate in the treatment of NeerII distal clavicle fracture and Tossy Ⅲtype~V acromioclavicular joint dislocation. Methods A retrospective analysis of the clinical data from June 2006 to June 2013. Total 73 cases patients suffered with Neer Ⅱtype distal clavicle fractures and Tossy Ⅲtype~V acromioclavicular joint dislocation. Of which , 41 cases were subjected to treatment with clavicular hook plate , 32 patients subjected to treatment of using clavicular hook plate combined with anchors .The incision length, operative time, postoperative complications, length of hospital stay and postoperative 1 month, 6 month shoulder VAS score of two groups were analyzed; the shoulder function of both groups after 1 month, 6 months were assessed by using Constant shoulder function assessment method. Results Surgical incision length and operational time between the two groups were statistically significant (P<0.05), while the amount of bleeding was not statistically significant. All patients were followed up . The two groups did not occur any complications such as loosening, decoupling, acromioclavicular joint dislocation and wound infections. Hospitalization time was 5~14 d (averaged 10d), no significant difference between two groups. 4 the shoulder Constant score and VAS scores showed no significant difference 1 months postoperation; 6 months after hook plate removed, VAS score and Constant shoulder score improved significantly in anchors hook plate group (P<0.05). Conclusion Anatomical coracoclavicular ligament reconstruction by application of hook plate combined with anchors is a good biomechanical model characterized with simple surgery , less trauma and good clinical outcomes , worthy of clinical application.

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 .

Current Trends in Anterior Cruciate Ligament Reconstruction

The advances in the knowledge of anatomy, surgical techniques, and fixation devices have led to the improvement of anterior cruciate ligament (ACL) reconstruction over the past 10 years. Nowadays, double bundle and anatomical single bundle ACL reconstruction that more closely restores the normal anatomy of the ACL are becoming popular. Although there is still no definite conclusion whether double bundle ACL reconstruction provides better clinical results than single bundle reconstruction, the trend has shifted to anatomic reconstruction regardless of single bundle or double bundle techniques. We could not find any significant differences in the clinical outcomes and stability after ACL reconstruction according to the type of graft or fixation device. Therefore, surgeons should select an ideal ACL reconstruction according to the patient's condition and surgeon's experience.

Biomechanical comparison between triple Endobutton technique and modified Weaver Dunn procedure for anatomical reconstruction of coracoclavicular ligament / 医用生物力学

Objective To compare the biomechanical behavior of a triple Endobutton technique for anatomic reconstruction of coracoclavicular ligament and with a modified Weaver-Dunn procedure. Methods Twelve fresh frozen cadaveric shoulders were applied with 70 N in superior, anterior and posterior direction, respectively, to measure displacement of the acromioclavicular joint. The failure test with the load at the rate of 25 mm/min was conducted to record the failure load and failure mode. The specimens were then randomly assigned to 2 groups: the triple Endobutton technique group and the modified Weaver-Dunn procedure group for reconstruction and to conduct displacement test and failure test again. The stability and mechanical strength of acromioclavicular joints after reconstruction under different states were then compared. Results The triple Endobutton technique group had significantly less anterior ((8.72±1.41) mm vs (37.03±5.05) mm) and posterior ((8.03±3.68) mm vs (14.85±1.89) mm) displacement than that in the modified Weaver-Dunn procedure group after reconstruction (P<0.05), and the former had similar displacement ((7.81±2.22) mm anterior and (7.16±1.95) mm posterior) as compared to the intact state. There were no significant differences in superior displacement among the groups. The modified Weaver-Dunn procedure group had significantly smaller failure loads ((172±9) N) than that in the triple Endobutton technique group ((687±115) N) and the intact ligament group ((685±234) N) (P<0.05). Conclusions The triple Endobutton technique has less anterior and posterior displacement and its stability is more closely approximate to the intact ligament; meanwhile, it has similar strength as coracoclavicular ligaments, which can better restore the function of coracoclavicular ligaments.

Reconstruction for Chronic Lateral Instability of the Ankle by Chen Method / 대한족부족관절학회지

PURPOSE: This study was designed to evaluate the clinical and radiographical results of anatomical reconstruction by Chen method for chronic lateral ankle instability. MATERIALS AND METHODS: Fifteen patients with chronic lateral ankle instability who had undergone anatomical reconstruction of anterior talofibular and calcaneofibular ligaments by Chen method were evaluated retrospectively. Average age of the patients was 31.3 years, and average follow-up period was 15.5 months. Preoperative and postoperative radiographs including varus stress view and magnetic resonance imaging (MRI) were analyzed. The clinical evaluation was performed according to the American Orthopaedic Foot and Ankle Society (AOFAS) scale. RESULTS: Radiographically average talar tilt angle was 15.3degrees preoperatively, and the difference with contralateral normal side was 10.1degrees. At last follow up, talar tile angle and the difference with contralateral side improved to 5.9degrees and 1.3degrees respectively. AOFAS scale was 66.6 preoperatively and 87.3 postoperatively. In MRI findings, four patients had associated intra-articular lesion such as articular cartilage defect, synovitis and osteoarthritis. The talar tilt angle improvement and AOFAS scale of patients without intra-articular lesion was better than those of four patients with intra-articular lesions. Surgical wound pain occurred in six patients and sural neuropathy in three patients. CONCLUSION: The anatomical reconstruction by Chen method was an easy and effective procedure for symptomatic chronic lateral ankle instability. Careful operative technique may prevent the surgical wound pain and sural neuropathy.

Surgical Reconstruction of Lateral Capsule-ligament Complex with Reinforcement by Periosteal Flap of Distal Fibula and Inferior Extensor Retinaculum for Chronic Lateral Ankle Instability / 대한족부족관절학회지

PURPOSE: To evaluate the results of surgical reconstruction of lateral capsule-ligament complex with reinforcement by periosteal flap of distal fibula and inferior extensor retinaculum for chronic lateral ankle instability. MATERIALS AND METHODS: From April 2003 to August 2006, 62 patients with chronic lateral ankle instability were operated. There were 38 males and 24 females with a mean age of 39.6 years (range, 18~61 years). Mean follow-up period was 32 months (range, 10~48 months). All patients were checked with preoperative ankle anteroposterior and lateral view, stress anterior drawer and varus test using Telos device. The clinical results were graded according to the VAS and AOFAS scale. RESULTS: VAS score improved from preoperative 8.2 points to 3.1 points. There were 38 patients who were excellent (above 90 points), 18 who were good (between 76 and 90 points), 5 who were fair (between 60 and 75 points), and 1 who was poor (below 60 points) according to the AOFAS ankle and hindfoot scale. The excellent and good results amounted to 90.3%. CONCLUSION: Surgical reconstruction of lateral capsule-ligament complex with reinforcement by periosteal flap of distal fibula and inferior extensor retinaculum is believed to be a effective method for chronic lateral ankle instability.

Two Cases of Infected Aortic Abdominal Aneurysm with Spondylodiskitis / 日本心臓血管外科学会雑誌

We encountered two cases of infected aortic abdominal aneurysm with spondylodiskitis. Both cases were diagnosed on the basis of fever, back pain and pulsatile abdominal mass. A 69-year-old man, case 1, underwent <i>in situ</i> reconstruction 1 year from the onset, because the infection was controllable by antibiotics and he had diabetes mellitus. A 68-year-old man, case 2, underwent operation while his infection was still active, because of paralysis of the bilateral lower extremities, aggravated by invasion of the vertebrae by the abscess. To prevent artificial graft infection, he underwent axillo-femoral bypass, which was extra-anatomical reconstruction, after the infected aneurysm and vertebrae were removed during aortic clamping above the aneurysm and bilateral common iliac arteries. Each stump was sutured and anterior fixation of the vertebrae was performed using an iliac bone graft. The postoperative course of both patients was successful. These cases suggest that the timing and procedure of the operation for infected aortic abdominal aneurysm with spondylodiskitis should be decided depending on the activity of infection, complications, age and activity of daily life of patients.