Changes of electroencephalography power spectrum during joint position perception test after anterior cruciate ligament rupture / 北京大学学报(医学版)

OBJECTIVE@#To measure the electroencephalography (EEG) of the patients with anterior cruciate ligament (ACL) rupture when performing joint position perception movement task, to compare the differences between the ACL rupture side and the unaffected side, to identify the EEG change in the power spectrum caused by the ACL rupture, and to provide evidence for the diagnosis, treatment and rehabi-litation for ACL injury as well as knee instability.@*METHODS@#Sixteen male patients, selected from the Department of Sports Medicine, Peking University Third Hospital from November 2014 to April 2015, with only ACL rupture on one side used isokinetic muscle strength testing equipment were enrolled in the study to perform unilateral active knee joint positional movement and passive knee joint positional movement tasks. EEG was recorded to compare between the affected and unaffected limb of ACL rupture patients when doing single leg movement tasks, including passive knee joint position test and active knee joint position sensation test. The target position of the active knee joint position movement task and the passive knee joint position movement task was 30 degrees of knee flexion.@*RESULTS@#During the passive knee joint position test, there was no significant difference in EEG power spectrum of Delta[F (1, 15)=0.003, P=0.957, ηP2 =0.001], Theta[F (1, 15)=0.002, P=0.962, ηP2 < 0.001], Alpha[F (1, 15)=0.002, P=0.966, ηP2 =0.001], Beta[F (1, 15)=0.008, P=0.929, ηP2 =0.001] at Fz, Cz, and Pz between the affected and unaffected limbs in the ACL patients. During the active knee joint position movement task, the EEG power spectrum of Delta, Theta, Alpha, Beta at Fz and Cz location, on the affected side was significant higher than on the unaffected side.@*CONCLUSION@#This study compared the differences between the ACL rupture side and the unaffected side during active knee position movement task and passive knee position movement task, and identifyied the EEG changes in the power spectrum caused by the ACL rupture, It was found that the central changes caused by unilateral ACL rupture still existed during contralateral (unaffected) side movement. The EEG power spectrum of the affected side during active exercise was significantly higher than that of the unaffected side This study provides new electrophysiological evidence for the study of ACL injury.

Surgical Reconstruction in Chronic Posterior Cruciate Ligament Injuries of the Knee

This is a cross-sectional study to evaluate the outcome of posterior cruciate ligament reconstruction in chronic injuries using ipsilateral Bone-patella tendon-Bone graft in nine patients, between January 2000 and January 2003 at our institution. Methods: Eight male and one female patient; their ages ranged from 18 to 36 years old. The surgery was done at an average of 17.2 months (range from 3 and 40 months) post injury. All patients were followed up for a minimum of two years period. The assessment was done at twelve and twenty-four months using Lysholm knee score, IKDC knee examination evaluation score and arthrometric measurement with KT-2000. Results: The result showed only moderate success in restoration of ligament stability with 73.4% satisfactory objective results. However, the functional improvement and patient satisfaction is only 55%. The incidences of degenerative changes were 89% at the time of operation. Conclusion: Surgical reconstruction of chronic Posterior Cruciate Ligament restored satisfactory stability of the knee but the functional outcome was only moderate.

Results of Revision Surgery and Causes of Unstable Total Knee Arthroplasty

BACKGROUND: The aim of this study was to evaluate causes of unstable total knee arthroplasty and results of revision surgery. METHODS: We retrospectively reviewed 24 knees that underwent a revision arthroplasty for unstable total knee arthroplasty. The average follow-up period was 33.8 months. We classified the instability and analyzed the treatment results according to its cause. Stress radiographs, postoperative component position, and joint level were measured. Clinical outcomes were assessed using the Hospital for Special Surgery (HSS) score and range of motion. RESULTS: Causes of instability included coronal instability with posteromedial polyethylene wear and lateral laxity in 13 knees, coronal instability with posteromedial polyethylene wear in 6 knees and coronal and sagittal instability in 3 knees including post breakage in 1 knee, global instability in 1 knee and flexion instability in 1 knee. Mean preoperative/postoperative varus and valgus angles were 5.8degrees/3.2degrees (p = 0.713) and 22.5degrees/5.6degrees (p = 0.032). Mean postoperative alpha, beta, gamma, delta angle were 5.34degrees, 89.65degrees, 2.74degrees, 6.77degrees. Mean changes of joint levels were from 14.1 mm to 13.6 mm from fibular head (p = 0.82). The mean HSS score improved from 53.4 to 89.2 (p = 0.04). The average range of motion was changed from 123degrees to 122degrees (p = 0.82). CONCLUSIONS: Revision total knee arthroplasty with or without a more constrained prosthesis will be a definite solution for an unstable total knee arthroplasty. The solution according to cause is very important and seems to be helpful to avoid unnecessary over-constrained implant selection in revision surgery for total knee instability.

Instability of Knee Associated with Ipsilateral Femoral and Tibial Shaft Fractures

PURPOSE: To establish the incidence, type and significance of knee instability in patients with ipsilateral femoral and tibial shaft fracture, comparing with the patients with femoral shaft or tibial shaft fracture alone. MATERIALS AND METHODS: Two hundreds and seventy-nine consecutive patients were retrospectively reviewed from February 2000 to April 2004. They were composed of 80 patients with femoral shaft fracture alone, 176 patients with tibial shaft fracture alone and 23 patient with ipsilateral femoral and tibial shaft fracture. We evaluate the instability of knee based on physical examinations, plain stress films and MRI. We analyze incidence and period to diagnosis of instability, period to complete bony union and Hospital for Special Surgery (HSS) knee score respectively. RESULTS: There were 6.3% of knee instability in femoral shaft fracture alone, 9.7% in tibial shaft fracture alone and 30.4% in ipsilateral femoral and tibial shaft fracture. The average period to diagnosis of instability, average period to complete bony union and average HSS knee score were 9.2 months, 4.7 months and 65 points in femoral shaft fracture alone, 9.1 months, 4.2 months and 69 points in tibial shaft fracture alone, 8.7 months, 5.3 months (femur), 4.7 months (tibia) and 57 points in ipsilateral femoral and tibial shaft fracture respectively. CONCLUSION: We should consider MRI to evaluate the knee instability in patient with ipsilateral femoral and tibial shaft fracture at the time of injury and make a plan early about the treatment of knee instability.

Experience of Lenox Hill Derotation Brace Application in Knee Instability Cases: Lenox Hill Derotation Brace / 대한정형외과학회잡지

Injuries to the ligament and other supporting structures of the knee joint are becoming very frequent because of the increasing popularity of sports and the complexity of traffic & industrial accidents in the modern society. There have been much development in undtrstanding the anatomy, function and biomechanics of the knee in recent years. Accurate surgical technique, energetic physiotherapy and appropriate use of brace are essential to obtain the maximum rehabilitation of the injured knees. It is long realized that some sort of knee brace is necessary as a means of stabilizing the injured knee either as a conservative treatment or as a adjuvant treatment treatment pre-or postoperatively before full rehabilitation is attained. We have introuced Lenox Hill Derotation Brace for the first time in Korea, employed in 24 case(26 knees) and found the following advantages. 1. It is light and easy to apply. 2. It is possible to control all kind of the knee instability. 3. It is possible to engage in any activity with the Brace in place without limitation of the knee motion. therefore, we recommend the Brace as a very usefull adjuvant for the proper treatment of the injured knee.

Acute traumatic Knee Instability / 대한정형외과학회잡지

Injuries to the ligament and other supporting structures of the knee joint are becoming very frequent because of the increasing popularity of sports and the complexity of traffic and industrial accidents in the modern society. Vast knowledge of the anatomy, function and biomechanics of the knee joint together with the mechanism of its injuries have been recently documented. To obtain complete recovery of the injury as a goal, early diagnosis, prompt definite treatment, sufficient time of immobilization and well planned strenuous exercise are important. The clinical analysis of 28 patients with 31 knees by the concept of knee instability and preliminary result of treatment were reported. Through combined operative and conservative treatment, excellent and good were obtained in 96.8 percent.