Bone tunnel positions in anterior cruciate ligament reconstruction evaluated by three-dimensional CT reconstruction based on Mimics software:modified transtibial versus anteromedial portal technique / 中国骨伤

OBJECTIVE@#To compare the femoral and tibial tunnel positions of anterior cruciate ligament reconstruction using the modified transtibial (MTT) technique and anteromedial (AM) portal technique.@*METHODS@#Between January 2017 and September 2020, 78 patients with anterior cruciate ligament rupture underwent single-bundle reconstruction with the modified transtibial technique in 39 cases (group MTT) and through anteromedial approach in 39 cases (group AM). There were 25 males and 14 females in group MTT, with an average age of (37.0±2.3) years old; 27 males and 12 females in group AM, with an average age of (37.5±2.2) years old. CT scan of the affected knee was conducted one week after the surgery to measure and compare the femoral tunnels positioning (Fx, Fy), tibial tunnels positioning in the frontal plane(Tx1), tibial tunnels positioning in the sagittal plane (Ty1), and tibial tunnels positioning in the axial plane (Tx2, Ty2) in patients undergoing anterior cruciate ligament reconstruction through Mimics software.@*RESULTS@#Three-dimensional CT reconstruction after the surgery showed that the average Fx and Fy were(25.2±2.1)% and (34.9±3.0)% respectively and the Tx1 and Ty1 were (45.5±3.3)% and (44.7± 3.0)% respectively, while the Tx2 and Ty2 were (47.0±3.0)% and (39.9±4.2)% respectively in group MTT. In group AM, the average Fx and Fy were (26.0±2.0)% and (36.1±3.9)% respectively and the Tx1 and Ty1 were (46.5±3.1)% and (45.6± 3.1)% respectively, while the Tx2 and Ty2 were (47.4±2.5)% and (39.6±3.9)% respectively. There were no statistically significant differences in the femoral and tibial tunnels between the two groups (@*CONCLUSION@#Both the MTT and AM technique can achieve good anatomical positioning of the femoral and tibial tunnels, without significant differences in the positioning of the bone tunnels.

Inestabilidad acromioclavicular. Tratamiento combinado artroscópico y miniinvasivo / Acromioclavicular instability: arthroscopic and mini-open combined treatment

Resumen: Introducción: el tratamiento quirúrgico de la luxación acromioclavicular es aún motivo de controversia. En esta publicación se describirá una técnica combinada en la que se realizó un primer tiempo artroscópico y un segundo tiempo con abordaje miniinvasivo. Material y métodos: 41 pacientes con luxación acromioclavicular grados III, IV y V. Para el seguimiento se incluyeron luxaciones agudas, crónicas y cirugías de revisión; se excluyeron pacientes con otras patologías de hombro, la edad promedio fue de 28.6 años. Los pacientes fueron evaluados con el score de UCLA Constant, la escala visual analógica para dolor preoperatorio y control radiológico para evaluar la estabilidad tanto en plano coronal como axial, osificaciones coracoclaviculares, signos de artrosis acromioclavicular y/o osteólisis distal de clavícula a los 6 y 12 meses postoperatorio. Resultados: se obtuvo un score de Constant preoperatorio de 41.3; 6 meses: 89.4; 12 meses: 92.3. El score de UCLA preoperatorio: 21.7; 6 meses: 29.1 y 12 meses: 31.4. VAS: 8.4; 2.3; 1.2. Hubo dos casos de relesión por trauma y un caso de insatisfacción estética de la cicatriz. En cuanto al examen radiológico se presentaron dos casos de pérdida de estabilidad y un caso de osteólisis distal de clavícula. Conclusión: la combinación de dos métodos de reducción, uno sintético y otro biológico, permitió una reconstrucción anatómica sólida, estable en plano coronal y axial con muy buenos resultados a mediano plazo.

Abstract: Introduction: The surgical treatment of acromioclavicular dislocation remains controversial. We describe herein a combined two-stage technique that includes an arthroscopic approach followed by a mini-invasive approach. Material and methods: 41 patients with acromioclavicular dislocation grades III, IV and V. Acute and chronic lesions and revision surgeries were included during the follow-up. Patients with other shoulder conditions were excluded. Mean age was 28.6 years. Patients were assessed preoperatively with the UCLA and Constant scores, and the pain visual analog scale. The 6- and 12-month postoperative evaluation included X-rays to assess coronal and axial stability, coracoclavicular ossifications, signs of acromioclavicular arthrosis and/or distal clavicular osteolysis. Results: The Constant scores were as follows: 41.3 preoperatively; 89.4 at 6 months; 92.3 at 12 months. The UCLA scores were as follows: 21.7 preoperatively; 29.1 at 6 months; 31.4 at 12 months. The VAS scores were 8.4, 2.3 and 1.2, for the same periods respectively. Two cases had repeated injury due to trauma and one case was dissatisfied with the cosmetic appearance of the scar. The X-ray assessment showed two cases of loss of stability and one case of distal clavicular osteolysis. Conclusion: The combination of two reduction methods, a synthetic one and a biological one allows for a solid anatomical reconstruction that is stable in the coronal and axial planes and good medium-term results.

Effect of single bundle anatomic reconstruction of the anterior cruciate ligament with the hamstring autograft through anteromedial approach / 中国内镜杂志

Objective To investigate the effect of single bundle anatomic reconstruction of the anterior cruciate ligament (ACL) with the hamstring autograft through anteromedial approach. Methods From January 2012 to Jan-uary 2014, 39 patients with ACL tore had been treated with single bundle anatomic ACL reconstruction with the hamstring autograft. In this group, 20 males and 19 females, 16 cases of the left knee and 23 cases of the right knee;including 27 cases of sports injuries, 5 cases of traffic accident injury and 7 cases of fall injury.8 cases were acute injury the others were old injury. 22 cases were had the meniscus injury. All patients were treated with single bundle anatomic ACL reconstruction with the hamstring autograft. The femoral tunnel was establish through the anteromedial approach. The medial meniscus suture was performed in 10 cases, partial resection in 2 cases, lateral meniscus su-ture in 9 cases, partial resection in 1 cases. The hamstring autograft was fixed with the RIGFIX system in the femoral tunnel and the BIOSURE SYNC in the tibia tunnel. The Lysholm score was used to evaluate the recovery of knee function, and the MRI score was used to evaluate the integraty of the grafts. Results All cases were followedup for 15 to 39 months with an average of 21.5 months. All cases had no vascular nerve injury, joint stiffness, infec-tion and other complications. All cases had good stability after 1 year and recover to normal sports after six months and intense sports after half past a year postoperation. The anterior drawer test and the Pivot shift tests were negative in all patients. The Lacheman test wasⅠin 1 patient and others were negative. The mean Lysholm score was (93.85± 4.33) which significantly increased compared with preoperative scores which was (36.84 ± 5.60) after 15 months (P <0.05). The MRI showed good maturity and normal morphology of the ACL autograft, the MRI score was (9.80 ±1.70) after 1 year postoperation. Conclusion The arthroscopic single bundle individual anatomic ACL reconstruction with hamstring autograft through anteromedial approach is effective, simple to perform and gives a graft the same as nor-mal anatomy. The grafts revascularization is good and effectively restore the stability of the knee.

Reconstrucción de ligamento cruzado anterior. Comparación de técnica transtibial versus técnica simple banda anatómica versus doble banda. Evaluación clínica y por resonancia magnética / Anterior cruciate ligament reconstruction. Comparison between transtibial vs. anatomic single bundle vs. double bundle technique. Clinical and MRI evaluation

Introducción: El objetivo de nuestro estudio fue realizar una comparación retrospectiva clínica y con RMI, entre tres técnicas quirúrgicas de reconstrucción de LCA y compararlas con el LCA nativo. Nuestra hipótesis fue que desde portal medial se consigue mayor semejanza anatómica y que este resultado mejora la estabilidad articular objetiva y subjetiva. Material y métodos: comparación retrospectiva de 3 grupos de pacientes varones (20 pacientes por grupo), operados entre diciembre 2006 y diciembre 2007 por el mismo cirujano; seguimiento promedio de 5 años y 7 meses (rango 5 a 6 años). Grupo TT: reconstrucción con técnica monotúnel transtibial. Grupo SBA: reconstrucción con técnica anatómica simple banda. Grupo DBA: reconstrucción con técnica doble banda-doble túnel anatómica. Todos evaluados con score de Lysholm, IKDC, test de Lachman medido con artrómetro, test de pivot shift y RMI. Resultados: la reconstrucción de LCA con técnica SBA y DBA es muy precisa para alcanzar los puntos anatómicos de inserción y la inclinación del LCA comparándola con la técnica TT. No hubo diferencias significativas entre los 3 grupos a los 5 años de seguimiento en el score de Lysholm, en el IKDC; tampoco las hubo en el rango de movilidad, Lachman y pivot shift, siendo estos últimos menos marcados en el grupo de DBA y de SBA. Conclusión: las reconstrucciones con SBA y DBA son más anatómicas demostradas por RMI posoperatoria, sin embargo dicha ventaja teórica, no tiene expresión clínica significativa. Nivel de evidencia: III. Tipo de estudio: comparativo retrospectivo.

Purpose: To do a retrospective clinical and with MRI comparison between three surgical techniques of ACL reconstruction compared with the native ACL. We hypothesized that more anatomical similarity is achieved from medial portal and that this result improves objective and subjective joint stability. Methods: retrospective comparison of 3 groups of male patients that received surgery from December 2006 to December 2007, all performed by the same surgeon; average follow up 5 years and 7 months (range 5 to 6 years). TT group: 20 patients with conventional (transtibial) single bundle reconstruction; ASB group: 20 patients with anatomic single-bundle reconstruction; ADB group: 20 patients with anatomic double-bundle reconstruction. The outcomes were evaluated by an independent blinded observer using the Lysholm score, IKDC, Lachman test performed with KT1000 arthrometer, pivot-shift test and MRI to determine ACL graft obliquity and femoral and tibial insertion. Results: ASB and ADB reconstruction demonstrated a more anatomical graft placement and angulation in comparison with TT technique. There were no significant differences between the 3 groups at 5 years after surgery in the Lysholm score, IKDC; neither in Range Of Motion, Lachman test and pivot-shift test. Nevertheless, patients of ASB and ADB had better outcomes in the pivot shift and Lachman test. Conclusions: the postoperative MRI showed that ASB and ADB reconstructions are more anatomical; however, this theoretical advantage is not clinically relevant. Level of Evidence: III. Type of study: retrospective comparative.

Técnica quirúrgica de reconstrucción de ligamento patelofemoral medial / Surgical technique of medial patellofemoral ligament reconstruction

El ligamento patelofemoral medial (LPFM) es el principal limitador de la lateralización rotuliana. En un episodio de luxación patelar externa se produce una rotura de éste ligamento, el cual tiene una baja capacidad de cicatrización, por lo que una vez dañado, en la mayoría de los casos al no cicatrizar, genera un incremento en la laxitud de las estructuras mediales y síntomas relacionados con inestabilidad. Es relevante describir en forma detallada la técnica quirúrgica, debido que ante un segundo episodio de luxación, en un joven activo (grupo que más afecta), en el cual el primero fue tratado en forma adecuada, consideramos conveniente realizar la reconstrucción de LPFM. Teniendo en cuenta que si bien es una patología que tiene baja incidencia, limita mucho el desarrollo normal del individuo y que la cirugía es un procedimiento efectivo por el bajo índice de re luxación y el alivio de la sintomatología. En la cirugía se debe intentar realizar una reconstrucción anatómica y tener en cuenta si se debe adicionar otros procedimientos como la liberación del retináculo lateral y la osteotomía de la tuberosidad anterior de la tibia (TAT).

The patellofemoral ligament is the main limiting component of the patellar lateral instability. The ligament has poor cicatrization properties, reason why, at the time of injury it does not have a good cicatrization. That situation increases the medial tissue laxity and lateral instability symptoms It is important to describe the surgical technique due to the fact that when a second episode occurs in a active young patient (the most frequent group) and when the first one had been treated correctly, we recommend the ligament reconstruction surgery. Although, this pathology has a low incidence, and it compromise the normal development of young patients. The surgery is an effective procedure, because of its low index of reluxation episodes and relief the symptoms. During the surgery we must try an anatomic reconstruction and the surgeon has to take into account the necessity to add others procedures like anterior tuberosity osteotomy or the lateral retinaculum cut.

Measurement with a scale in arthroscopic anatomic anterior cruciate ligament reconstruction / 中国综合临床

ObjectiveTo evaluate the value of the measurement with a scale in arthroscopic anatomic anterior cruciate ligament (ACL) reconstruction.Methods Thirty-six patients with unilateral ACL-deficient knees were divided into single bundle group and double bundle group based on the length of the major axis of the native ACL footprint measured with a scale.Consistent with the International Knee Documentation Committee (IKDC) scoring systems,Lysholm knee scoring scale and Tegner activity rating were used to evaluate the clinical results,and data from 23 to 26 months follow-up were gathered and analyzed statistically.ResultsIn terms of IKDC evaluation,19 patients( 90.4％ ) in the double band group and 13 patients( 86.7％ )in the single band group were graded as normal or nearly normal ( Z =7.82,6.33 ; P ＜ 0.05 ).The mean Lysholm scores were 93.8 ± 9.9 and 94.2 ± 9.6 and the mean Tegner scores were 6.6 ± 1.9 and 6.5 ± 1.7 for the double and single band groups,respectively( t =2.31,5.60,3.55,7.09 ;P ＜0.05 ).ConclusionArthroscopic measurement with a scale combined with other traditional methods to determine the tunnel location is easy to conduct and intuitional to understand.It could be useful in anatomic ACL reconstruction.

Anatomic Reconstruction of the Lateral Ankle Instability Using the Semitendinosus Allograft Tendon and Interference Screws / 대한정형외과학회잡지

PURPOSE: To evaluate the clinical outcome of the anatomic reconstruction of the lateral ankle instability using the semitendinosus allograft tendon and the interference screws. MATERIALS AND METHODS: This study is based on the 12 feet of lateral ankle instability that had been treated with anatomic reconstruction of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) using the semitendinosus allograft tendon and the interference screws. The majority of patients were young and physically active. We evaluated the patients' VAS pain scores, AOFAS scores and Karlsson-Peterson ankle scores for the 11 feet involved with at least 12 months follow up, both pre- and post-operative. In addition, we evaluated patient satisfaction. We measured the talar tilt angles and the talar anterior translations from ankle stress views. RESULTS: The average age at surgery was 25.9 years old (19-57 years); patients had symptoms of recurrent sprain for average 31.4 months before surgery. The average follow up period was 14 months. For reconstruction, we used 4.0mm thick allograft semitendinosus tendon and interference screws. VAS pain scores decreased from 6.0 to 1.1 (p<0.05) and AOFAS scores improved from 70.4 to 90.4 postoperatively (p<0.05). Karlsson-Peterson ankle scores improved significantly from 54.6 to 92.4 (p<0.05). Radiographic talar tilt decreased from 15.7degrees to 3.2degrees postoperatively (p<0.05). Eighy-two percent of the patients were satisfied with the results and the patients had returned to their jobs by 3.7 months after surgery. CONCLUSION: Anatomic reconstruction of the ATFL and the CFL in the lateral ankle instability patients using the semitendinosus tendon and the interference screws is an ideal surgical option especially for young athletes with high grade instabilities.