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Objective@#To explore the feasibility and clinical effect of single bundle anatomic intrathecal reconstruction of proximal injury of anterior cruciate ligament (ACL) using dissociate peroneus longus tendon combined with semitendinosus tendon.@*Methods@#From January 2015 to September 2016, a total of 24 patients with proximal injury of ACL, confirmed by arthroscopy, were admitted to the sports medicine department of our hospital. The ACL was completely ruptured from the proximal footprint and the tibial side residual remained intact. There were 19 males and 5 females; 16 cases on the right side and 8 cases on the left side. The mean age was 27.88±7.13 years old; The interval between injury and surgery was 14.83±9.09 d; The dissociate peroneus longus tendon and semitendinosus tendonfrom the injured extremity were folded in half, then braided and trimmed into ACL graft for use. The ACL remnant was preserved and the graft was pulled through the stump for single bundle anatomic intrathecal reconstruction. The ACL graft was fixed with Endobutton on the femoral side and interference screw on the tibial side. The results of Lachman test, Lysholm scores, Tegner scores and International Knee Documentation Committee (IKDC) subjective scores of knee before operation and at final visit were recorded to evaluate the stability and function of the knee. Visual analogue score (VAS) was used to record the changes of pain at the site where the peroneal longus tendon was harvested. The American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scores were recorded before injury and at the final visit to assess the effect of ankle function after peroneal longus tendon resection.@*Results@#The diameter of the ACL graft made of dissociate peroneus longus tendon and semitendinosus tendon is 8.88±0.30 mm. All patients were followed up at the outpatient clinic, with an average of 34.38±5.40 months, and no serious complications such as rerupture and joint infection were found. There were 16 grade B, 6 grade C and 2 grade D for preoperative Lachman test, none with hard end point. At last vist, there were 23 cases of grade A and 1 grade B, all with hard end points for Lachman test. At the preoperative and final visit, the Lysholm scores of the knee joint were 35.20±11.92 and 94.29±2.92 (t=23.850, P=0.000). Tegner scores were 3.46±0.93 and 8.04±1.00 (t=16.653, P=0.000). The subjective IKDC scores of knee joint were 47.63±13.06 and 91.71±3.75 (t=15.972, P=0.000). At the final visit, all the indicators of the knee were improved compared with those before surgery, and the difference was statistically significant.The AOFAS scores before injury and at the final visit were 98.83 (2.78) and 98.17 (4.01), respectively, with no statistically significant difference (t=1.850, P=0.076) . The VAS scores for the harvest of theperoneus longus tendon were 4.50±1.41, 0.54±0.65 and 0.29±0.55 immediately and 6 months after the operation and at the last visit.There was statistically significant difference between the scores immediately and 6 months after the operation (t=14.900, P=0.001).There was statistically significant differences between the scores at 6 months after the operation and the final visit (t=2.770, P=0.011).@*Conclusion@#Single bundle anatomic intrathecal reconstruction of proximal injury of ACL using dissociate peroneus longus tendon and semitendinosus tendon is feasible with good clinical effect.
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Objective To explore the feasibility and clinical effect of single bundle anatomic intrathecal reconstruction of proximal injury of anterior cruciate ligament (ACL) using dissociate peroneus longus tendon combined with semitendinosus tendon.Methods From January 2015 to September 2016,a total of 24 patients with proximal injury of ACL,confirmed by arthroscopy,were admitted to the sports medicine department of our hospital.The ACL was completely raptured from the proximal footprint and the tibial side residual remained intact.There were 19 males and 5 females;16 cases on the right side and 8 cases on the left side.The mean age was 27.88±7.13 years old;The interval between injury and surgery was 14.83±9.09 d;The dissociate peroneus longus tendon and semitendinosus tendonfrom the injured extremity were folded in half,then braided and trimmed into ACL graft for use.The ACL remnant was preserved and the graft was pulled through the stump for single bundle anatomic intrathecal reconstruction.The ACL graft was fixed with Endobutton on the femoral side and interference screw on the tibial side.The resuhs of Lachman test,Lysholm scores,Tegner scores and International Knee Documentation Committee (IKDC) subjective scores of knee before operation and at final visit were recorded to evaluate the stability and function of the knee.Visual analogue score (VAS) was used to record the changes of pain at the site where the peroneal longus tendon was harvested.The American Orthopaedic Foot and Ankle Society (AOFAS) Anlle-Hindfoot Scores were recorded before injury and at the final visit to assess the effect of ankle function after peroneal longus tendon resection.Results The diameter of the ACL graft made of dissociate peroneus longus tendon and semitendinosus tendon is 8.88±0.30 mm.All patients were followed up at the outpatient clinic,with an average of 34.38± 5.40 months,and no serious complications such as rerupture and joint infection were found.There were 16 grade B,6 grade C and 2 grade D for preoperative Lachman test,none with hard end point.At last vist,there were 23 cases of grade A and 1 grade B,all with hard end points for Lachman test.At the preoperative and final visit,the Lysholm scores of the knee joint were 35.20±11.92 and 94.29±2.92 (t=23.850,P=0.000).Tegner scores were 3.46±0.93 and 8.04± 1.00 (t=16.653,P=0.000).The subjective IKDC scores of knee joint were 47.63± 13.06 and 91.71 ±3.75 (t=15.972,P=0.000).At the final visit,all the indicators of the knee were improved compared with those before surgery,and the difference was statistically significant.The AOFAS scores before injury and at the final visit were 98.83 (2.78) and 98.17 (4.01),respectively,with no statistically significant difference (t=1.850,P=0.076).The VAS scores for the harvest of theperoneus longus tendon were 4.50± 1.41,0.54±0.65 and 0.29±0.55 immediately and 6 months after the operation and at the last visit.There was statistically significant difference between the scores immediately and 6 months after the operation (t=14.900,P=0.001).There was statistically significant differences between the scores at 6 months after the operation and the final visit (t=2.770,P=0.011).Conclusion Single bundle anatomic intrathecal reconstruction of proximal.injury of ACL using dissociate peroneus longus tendon and semitendinosus tendon is feasible with good clinical effect.
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Objective To determine the lumbar anatomical structure parameters of the lumbar spine posterior column and its sample data of three-dimensional conformation,and based on these data to design the lumber laminar screw dynamic fixation system.Methods 20 human L3 ～ S1 bone specimens,the thickness of the lumber laminar region were measured to obtain the normal anatomical parameters of the lumbar laminar.And 20 healthy lumbar vertebrae L3-S1 for three-dimensional reconstruction were detected by CT scan,which could obtain the structure data of the normal lumbar posterior three-dimensional conformation,and to obtain conformational sample data of three-dimensional space of the posterior structure.Results Lumbar lamina medial 1/3 could serve as a spine laminar screw setting area by anatomical observations and measurements.Lamina thickness of L3-4 on average (6.6 ±0.9) mm,L5 ～ S1average (6.0 ± 0.6) mm.Lumber laminar screw length 6.5 ～ 8.0mm could meet the requirements of bilateral cortical fixation.Conclusion Lower lumbar spinal lamina area can serve as the region to fix the bilateral cortical bone screw,and the optimal length of the laminar screw is 6.5 ～ 8.0rmm.
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Objective To introduce an augmentation technique with 4-strand semitendinesus ten-don in treatment of partial anterior cruciate ligament (ACL) injury of under arthroscope and investigate the clinical outcome of the technique. Methods A total of 26 patients with posterolateral bundle rup-tures of ACL were treated arthroscopically with 4-strand semitendinosus tendon augmentation. The Inter-nationnal Knee Documentation Committee (IKDC) and Lysholm knee score scale were used for evaluation of knee function. The side-to-side difference in anterior knee laxity was examined by KT-1000 (25 de-grees flexion and 301b). Results There was no knee extension limitation, with knee flexion of 130°-150 °(average 142°). The patients were followed up for 12-18 months, which showed grade A in 25 pa-tients (96%) and grade B in one (4%) according to IKDC grade at final follow-up. The subjective IK-DC score was increased from preoperative (71.4±3.7) points to (95.8±3.4) points at final follow-up (t =9.836,P <0.01). The average side-to-side difference in maximal manual test with KT-1000 ar-thrometer at 25° flexion decreased from preoperative (5.1±1.2) mm to (2.1±1.3)mm at final follow-up (t = 10.48 ,P < 0.01). The Lysholm score of all patients was (76.7±3.2) preoperatively and (95. 7±2.4) at final follow-up (t =7.356,P<0.01). Conclusion Augmentation with 4-strand semiten-dinosus tendon under arthroscope can attain excellent clinical results and good anterior stability in treat-ment of partial tears of posterolateral bundle of ACL.
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BACKGROUND: Anterior cruciate ligament reconstruction is the major treatment for anterior cruciate ligament injury. Studies on anterior cruciate ligament reconstruction with hamstring tendons developed rapidly. OBJECTIVE: To summarize anatomy, biodynamics and surgery approaches of anterior cruciate ligament, and the progress of anterior cruciate ligament reconstruction with hamstring tendons. RETRIEVAL STRATEGY: Pubmed database was undertaken to identify relevant articles on anterior cruciate ligament reconstruction with hamstring tendons published from January 1990 to October 2007 with the key words of "anterior cruciate ligament, hamstring tendons, reconstruction, tendon regeneration, bone tunnel enlargement" in English. Ninety-two articles were selected primarily, and checked by reading titles and abstracts. Inclusive criteria: articles on anterior cruciate ligament reconstruction with hamstring tendons were included. Excusive criteria: articles with different aims and repetitive contents were excluded. Totally 42 articles were included, of which 2 articles were on animals, 2 articles on system evaluation/Meta analysis and 38 articles on clinical research. LITERATURE EVALUATION: Of them, 22 articles were on anatomy, biodynamics, surgery approaches and clinical results of anterior cruciate ligament, 9 on bone tunnel enlargement of anterior cruciate ligament after reconstruction and 11 on regeneration of hamstring tendons after harvest. DATA SYNTHESIS: With the deep understanding of double-bundle dissection and biodynamics of anterior cruciate ligament and bad control of single-bundle reconstruction on rotary stability, double-bundle anterior cruciate ligament reconstruction with hamstring tendons has become the major treatment. Bone tunnel enlargement of anterior cruciate ligament after reconstruction is multifactorial process of biology and biodynamics, possibly resulting in reduction in primary stability after reconstruction and severe problems in graft fixation in revision surgery. Most hamstring tendons (first selected graft of double-bundle anterior cruciate ligament reconstruction) can regenerate, and partially recover its function, which determined its foundation for anterior cruciate ligament reconstruction used by orthopedists. Bone tunnel enlargement of anterior cruciate ligament after reconstruction still deserves further studies. CONCLUSION: Double-bundle dissection and biodynamics of anterior cruciate ligament lay the foundation for improving surgery scheme. Double-bundle anterior cruciate ligament reconstruction can better control rotary stability of knee joint.