Résumé
BACKGROUND: Currently, surgical treatment for acetabular labrum injury includes debridement, repair, refixation and acetabular labrum reconstruction. Labrum reconstruction is a newly developed surgical method, which uses autograft or allograft to repair labrum defect. At present, there are many options for graft repair, and the recent follow-up shows that this method can well restore the structure and function of the labrum, and hascertain advantages over debridement, excision, and repair. However, no study has shown the long-term effect of reconstruction, and which situation and which graft are more suitable. OBJECTIVE: To review graft selection of acetabular labrum reconstruction under arthroscopy. METHODS: PubMed and GeenMedica databases were retrieved for studies on acetabular labrum reconstruction published from 2000 to 2019, especially in the past 10 years. The key words were “labrum, reconstruction, graft, hip, acetabulum”. RESULTS AND CONCLUSION: (1) There are a number of options for graft repair, including autograft (iliotibial band, gracilis and semitendinosus, quadriceps tendon, rectus femoris tendon, joint capsule) and allograft (peroneus brevis, tensor fascia lata). Recent follow-up shows that these grafts can restore labrum structures and hip movement. (2) However, as an emerging surgical procedure, there is currently a lack of long-term follow-up and prospective comparative studies to prove the long-term effects of reconstruction and prove which grafts are more suitable in which conditions. (3) In future studies, we need to compare the medium and long-term efficacy of different grafts for clinical selection. With the development of science and technology, the problem of artificial composite materials has been solved, and will become a more promising alternative.
Résumé
BACKGROUND: Anterior cruciate ligament has the function of stabilizing the knee joint and restricting the tibiofemoral joint in the translation and rotation of the tibia. Most patients with anterior cruciate ligament reconstruction have an increased risk of knee pain and knee instability. Knee osteoarthritis after trauma is a serious complication of anterior cruciate ligament injury. Knee osteoarthritis is a chronic progressive disease, and the mechanism of osteoarthritis after anterior cruciate ligament injury remains unclear. OBJECTIVE: To review the relationship between anterior cruciate ligament injury and the risk factors of post-traumatic knee osteoarthritis, so as to provide guidance for the treatment of post-traumatic knee osteoarthritis. METHODS: The first author searched related articles in PubMed database from the establishment of the database to October 2019. The key words were “ACL injury, traumatic knee osteoarthritis, ACL reconstruction, meniscus status, body mass index, cartilage injury, age, graft selection, time interval between injury and surgery”. A total of 123 articles were retrieved, and 66 articles were eligible for the inclusion criteria. RESULTS AND CONCLUSION: (1) Meniscus status, body mass index, cartilage damage, age, graft selection, and time between injury and surgery may influence the development of post-traumatic knee osteoarthritis. (2) Although anterior cruciate ligament reconstruction is primarily performed to restore stability after anterior cruciate ligament rupture, a long-term goal of the process is to reduce the risk of knee osteoarthritis and maintain long-term joint health. (3) Meniscus resection in patients with anterior cruciate ligament rupture accompanied by meniscus injury is also the cause of knee osteoarthritis, which is likely to be caused by weakened endurance and kinematic changes of the joint.
Résumé
To improve the long-term clinical results of coronary artery bypass grafting, we evaluated our graft selections and the designs that were used, in relation to the quality of the anastomoses and patient backgrounds. We retrospectively reviewed the records of 505 patients who underwent isolated coronary artery bypass grafting involving more than 3 vessel reconstructions between May 1999 and March 2007. Neither the selection of a saphenous vein graft nor that of an internal thoracic artery graft was a statistically significant cardiac event factor. The cardiac event-free rates (at 1 and 5 years) according to anastomotic site were as follows : a) 92.9% and 76.6% for a radial artery graft and 93.2% and 83.9% for a saphenous vein graft at the right coronary artery ; b) 93.0% and 70.3% for a radial artery graft and 95.1% and 80.4% for a saphenous vein graft at the distal right coronary artery ; c) 94.5% and 77.8% for a left internal thoracic artery graft and 93.0% and available for a right internal thoracic artery graft at the left anterior descending artery ; d) 96.5% and 79.8% for a radial artery graft, 93.0% and 78.0% for a saphenous vein graft, and 91.3% and 75.6% for an internal thoracic artery graft at the left circumflex artery. Significant cardiac event factors were dialysis (risk ratio, 5.28 ; <i>p</i><0.001), the use of a right gastroepiploic artery graft as the inflow blood vessel of a radial artery graft (risk ratio, 5.75 ; <i>p</i>=0.02), and off-pump coronary artery bypass grafting (risk ratio, 1.62 ; <i>p</i>=0.03). As a tendency toward more frequent early-stage cardiac events among patients with radial artery grafts was confirmed, careful follow-up is important for this group of patients. Right gastroepiploic artery grafts should be chosen carefully with full consideration of the anastomotic site quality and the flow demand, as the blood supply capability of such grafts is limited. For dialysis patients, although the mid-term clinical results are still being evaluated, a saphenous vein grafts have bwer early-stage of cardiac events. In younger patients, off-pump bypass is not the only treatment method available, and revascularization with extracorporeal circulation can reliably achieve good long-term results. To improve the long-term clinical results for coronary artery bypass grafts, graft selection and design should be carefully considered on a case-by-case basis. The quality of the anastomotic site and the patient background are important factors, especially with regard to the selection of a saphenous vein graft or a right gastroepiploic artery graft. A radial artery graft should be selected for use in relatively young patients because of its superior patency. Off-pump bypass may not necessarily be the treatment of choice in some cases because revascularization using extracorporeal circulation can reliably achieve better long-term results.