Arthroscopic Linear Chain Fixation for the Treatment of Medial Meniscus Posterior Root Tear: A Case Study.

BACKGROUND: The repair and reconstruction of medial meniscus posterior root tears (MMPRTs) is an important issue in the field of orthopedic sports medicine. This study reports the first application of arthroscopic linear chain fixation for the treatment of MMPRTs. CASE PRESENTATION: A 78-year-old female patient presented with a 1.5-month history of right knee pain accompanied by a locked facet joint. The patient underwent surgery with the new linear chain fixation method. In this method, the suture and the loop part of the buckle-strap titanium plate were combined into a linear chain mechanical complex, and the tension of the posterior root stump was gradually increased by pulling on the two attachment lines at the external mouth of the tibial tunnel. The postoperative Lysholm score was 89, and the visual analogue scale score was 0.9, indicating a significant improvement in knee joint function. At the 7-month and 1-year post-surgery follow-up, physical and MRI examinations confirmed satisfactory healing of the MMPRTs. CONCLUSION: This surgical approach offers several benefits, including a simplified instrumentation setup, preservation of natural anatomical structures, and reliable residual stump fixation. It has the potential for clinical implementation.

Medial Compartment Decompression by Fibular Osteotomy to Treat Medial Compartment Knee Osteoarthritis: A Pilot Study.

Compared with high tibial osteotomy and total knee arthroplasty, the authors found a simpler surgical procedure, partial fibular osteotomy, could effectively relieve knee pain and also correct the varus deformity for patients with medial compartment knee osteoarthritis (OA). From January 1996 to April 2012, a total of 156 patients with medial compartment OA were treated by proximal fibular osteotomy in the authors' hospital. A 2-cm-long section of fibula was resected 6 to 10 cm below the fibular head. A total of 110 patients with follow-up of more than 2 years were included in the study, including 34 males and 76 females with an average age of 59.2 years. Anteroposterior and lateral weight-bearing radiographs, the femorotibial angle (FTA) and lateral joint space, and the American Knee Society Score (KSS) and the visual analog scale (VAS) score of the knee joint were evaluated preoperatively and at final follow-up, respectively. At final follow-up, mean FTA and lateral joint space were 179.4°±1.8° and 6.9±0.7 mm, respectively, which were significantly smaller than those measured preoperatively (182.7°±2.0° and 12.2±1.1 mm, respectively; both P<.001). Mean KSS at final follow-up was 92.3±31.7, significantly higher than the mean preoperative score of 45.0±21.3 (P<.001). Mean VAS score and interquartile range were 2.0 and 2.0, significantly lower than the preoperative data (7 and 1.0, respectively; P<.001). The authors found that proximal fibular osteotomy can significantly improve both the radiographic appearance and function of the affected knee joint and also achieve long-term pain relief. This procedure may be an alternative treatment option for medial compartment OA.

Prospective randomized comparison of knee stability and joint degeneration for double- and single-bundle ACL reconstruction.

PURPOSE: This study aims to determine the outcome of double-bundle anterior cruciate ligament (ACL) reconstruction using an allograft in comparison with ACL reconstruction using a double-bundle autograft or a single-bundle allograft. METHODS: A total of 424 patients who accepted primary ACL reconstructions were divided randomly into three groups: double-bundle technique with autograft (DB-AU group, n = 154), double-bundle technique with allograft (DB-AL group, n = 128), and single-bundle technique with allograft (SB group, n = 142). The KT-1000 arthrometer and pivot-shift tests were performed at 3, 12, and 36 months after surgery, and clinical outcome measurements include the Lysholm score and the IKDC rating scales. Radiological assessments evaluated arthritic changes and tunnel expansion at 36 months postoperatively. RESULTS: The KT-1000 test scores in the DB-AU and DB-AL groups were significantly better than those in the SB group at 12 and 36 months postoperatively (P < 0.05). The pivot-shift tests scores in the DB-AU and DB-AL groups were significantly better than those in the SB group at the 3, 12, and 36 month follow-ups (P < 0.05). Based on the IKDC score and Lysholm score, there were no significant difference between the three groups during follow-up (P > 0.05). At 36 months postoperatively, 42.3 % of patients in the SB group showed a progression in arthritic changes, which was greater than in the DB-AU (29.2 %) and DB-AL (27.3 %) groups (P < 0.05). At 36 months, the rates of tunnel expansion in the DB-AU group and the DB-AL group were lower than in the SB group (P < 0.05). CONCLUSIONS: Double-bundle ACL reconstruction can be used to achieve better anterior and rotational stability and has a lower rate of arthritic progression and tunnel expansion than the single-bundle procedure. LEVEL OF EVIDENCE: I.

Identification of differently expressed genes and small molecule drugs for Tetralogy of Fallot by bioinformatics strategy.

This study aimed to screen out differentially expressed genes (DEGs) and explore small molecule drugs for Tetralogy of Fallot (TOF). The gene expression profile of TOF GSE26125 was downloaded from the Gene Expression Omnibus database, including 16 idiopathic TOF samples and five healthy controls. The DEGs were identified by the Limma package in R language and underwent functional enrichment analysis via Database for Annotation, Visualization and Integrated Discovery tools. A protein-protein interaction (PPI) network of DEGs was then constructed and the significant clusters were selected for functional analysis. In addition, the DEGs were mapped to the connectivity map (CMap) database to identify potential small-molecule drugs. As a result, a total of 499 DEGs were selected between TOF and healthy controls. Meanwhile, the functional changes of DEGs related to TOF were mainly associated with cellular respiration and energy metabolism. Furthermore, in the PPI network, two clusters were identified via cluster 1 analysis. And only cluster 1 was significantly enriched into gene ontology terms, including respiratory chain, electron transport chain, and oxidation reduction. The hub gene of cluster 1 was NDUFAB1. Additionally, small molecules, such as harmine, solanine, and testosterone, may have the potential to repair the disordered metabolic pathways of TOF.

The application of on-pump beating-heart surgery for partial atrioventricular septal defect: a report of 87 cases.

BACKGROUND: Partial atrioventricular septal defect (P-AVSD) is a common congenital heart disease. Because of the presence of left and right atrioventricular valve deformities and the shift in the atrioventricular node and cardiac conduction bundle, the surgical repair of P-AVSD is difficult. This study was performed to compare the effects on the coronary sinus septum in the left versus the right atrium during surgical treatment for P-AVSD and report our experiences regarding the application of on-pump beating heart surgery under mild hypothermia for patients with P-AVSD. MATERIALS AND METHODS: The effects of on-pump beating heart surgery were analyzed retrospectively in 87 P-AVSD patients. Of the 87 total patients, 84 with anterior mitral leaflet cleft underwent valvuloplasty and 3 underwent mitral valve replacement. Seventy-seven patients underwent tricuspid valve annuloplasty, 2 underwent tricuspid valve replacement, and 1 underwent left superior vena cava ligation, and 3 patients with atrial fibrillation were treated with radiofrequency ablation. Patients with an ostium primum atrial septal defect underwent autologous pericardial modified Kirklin repair. Of these, 46 patients had their coronary sinus septum separated into the left atrium and 41 had their coronary sinus retained in the right atrium. Fingertip oxygen saturation was compared between patients in whom the coronary sinus was separated to the left atrium and those in whom the coronary sinus was retained in the right atrium. RESULTS: There was 1 postoperative early death (1.15%) due to respiratory failure, and 1 patient had a III degree atrioventricular block (1.15%) and underwent implantation of a permanent pacemaker. The fingertip oxygen saturation levels of the left atrium group were 96.81 ± 3.17 preoperatively, 95.37 ± 4.62 at 7 days postoperatively, and 94.53 ± 4.95 at 3 months postoperatively. Those of the right atrium group were 98.53 ± 2.84 preoperatively, 97.19 ± 3.57 at 7 days postoperatively, and 96.89 ± 4.19 at 3 months postoperatively. During the follow-up period, which ranged from 3 months to 7 years, the cardiac function was adequately restored. CONCLUSIONS: On-pump beating heart surgery under mild hypothermia is a safe and feasible method. The retention of the coronary sinus in the right atrium might maintain oxygen saturation.

Medial retinaculum plasty versus medial patellofemoral ligament reconstruction for recurrent patellar instability in adults: a randomized controlled trial.

PURPOSE: The purpose of this study was to evaluate the clinical results of medial retinaculum plasty (MRP) and medial patellofemoral ligament reconstruction (MPFLR) with concomitant lateral retinacular release with respect to imaging and functional results. METHODS: Seventy patients with recurrent patellar instability were randomly divided into 2 groups based on their birth years (even/odd), receiving either MRP or MPFLR. Lateral retinacular release was also performed in all patients. Preoperatively, all patients received magnetic resonance imaging to evaluate the injury to the medial patellofemoral ligament. Computed tomography was performed before surgery and at follow-up. The subjective symptoms and functional outcome were evaluated preoperatively and postoperatively with the Kujala score, the Tegner activity score, and a subjective questionnaire. The physical apprehension test was examined, and redislocation was recorded. RESULTS: Patients were followed up for a mean period of 40 months (range, 24 to 55 months). The measurement results for the congruence angle, patellar tilt angle, and patellar lateral shift decreased significantly from the pretreatment measurements to the normal range at the latest follow-up, without a statistically significant difference between the 2 groups (P > .05). The median Kujala score had significantly improved after surgery. However, no statistically significant difference was found between the 2 groups at the latest follow-up (P > .05). In 6 cases in the MRP group (19%) and 3 in the MPFLR group (9%), we found patellar lateral shift that exceeded 1.5 cm but was less than 2.0 cm with a firm endpoint for the apprehension test, without a significant difference between the 2 groups. CONCLUSIONS: This prospective randomized study showed that MPFLR for recurrent patellar instability could achieve good clinical results, with a good congruous patellofemoral joint and good knee function. MRP could yield similar results to MPFLR for recurrent patellar instability in adults with medial patellofemoral ligament injuries from the patella or midsubstance portions. LEVEL OF EVIDENCE: Level II, prospective comparative study.

Non-surgical treatment for acute patellar dislocation with special emphasis on the MPFL injury patterns.

PURPOSE: The objective of present study was to propose a new classification for acute MPFL injury, which can help choose optimal treatment method for certain injury type. METHODS: Eighty-five patients with acute patellar dislocation treated non-surgically were retrospectively reviewed. They were assigned into two groups according to the newly introduced classification scheme, which classified MPFL injury into three types: injury in overlap region, injury in non-overlap region and combined injury of both regions. For study purpose, patients with combined injury were not included. Of 85 patients, 33 were in the overlap-region group (Group 1) and 52 in the non-overlap-region group (Group 2). Clinical patellar instability rate and patellofemoral score were measured and recorded at 2-year follow-up. RESULTS: The patellar instability rate was 15.2 % in Group 1 and 38.5 % in Group 2, with statistically significant difference between the two groups (P = 0.022). The mean visual analogue scale for Group 1 and Group 2 was 15.6 points and 28.3 points, respectively (P = 0.026). The mean Kujala score was 91.1 points and 82.6 points (P = 0.009), with a good or excellent subjective result recorded for 27 of 33 patients (81.8 %) in Group 1 compared with 30 of 52 patients (57.7 %) in Group 2 (P = 0.021). CONCLUSIONS: Non-surgical treatment achieves better clinical outcomes with respect to a lower patellar instability rate and better subjective function for the overlap-region injury of MPFL than for the non-overlap-region injury, and can be considered as treatment of choice for overlap-region injury of MPFL. The optimal choice for the non-overlap-region injury still requires further researches. LEVEL OF EVIDENCE: Therapeutic, Level IV.

Medial patellar retinaculum plasty versus medial capsule reefing for patellar dislocation in children and adolescents.

INTRODUCTION: The purpose of this study was to evaluate the clinical effect of medial patellar retinaculum plasty for children and adolescent patients with patellar dislocation. MATERIALS AND METHODS: A prospective study was performed between October 2005 and December 2009. Sixty-one cases of children and adolescent patients with patellar dislocation were admitted to our study. Twenty-nine patients received medial capsule reefing, of which 13 patients also received lateral retinacular release (LRR) (Group I). Thirty-two patients received medial patellar retinaculum plasty, of which 12 patients also received LRR (Group II). Preoperatively, all patients received magnetic resonance imaging (MRI) to evaluate the injury of medial patellofemoral ligament. And all patients received computed tomography (CT) scans on which the congruence angle (CA) and patellar lateral shift (PLS) could be evaluated with 30° knee flexion. Physical apprehension tests were examined and the redislocation was recorded. In addition, knee function was evaluated using the Kujala score and subjective questionnaires. RESULTS: Patients were followed up for a mean period of 50 months (25-75 months). For the comparison between the preoperative and postoperative results, the Kujala score improved significantly from 52.3 ± 2.9 to 78.1 ± 3.6 in Group I and from 53.5 ± 3.4 to 82.2 ± 3.4 in Group II (P < 0.05). There was significant difference of CA on CT scans and PLS with a statistical difference between the two groups (P < 0.05). Results of the apprehension test showed that nine patients had patellar lateral shift exceeding 1.5 cm with a soft end point in Group I and two patients had patellar lateral shift exceeding 1.5 cm with a hard end point in Group II (P < 0.05). Moreover, the subjective questionnaire revealed a significant difference of subjective effects between two groups (P < 0.05), including 7 excellent, 10 good and 12 fair in Group I and 18 excellent, 9 good, and 5 fair in Group II. CONCLUSION: The medial retinaculum plasty was better than medial capsule reefing in improving the subjective effects and decreasing the rate of patellar instability postoperatively in children and adolescent patients.

Application of triangular vector to functionally reconstruct the medial collateral ligament with double-bundle allograft technique.

PURPOSE: The purpose of this study was to present a novel medial collateral ligament (MCL) reconstruction technique and investigate the clinical outcomes of this surgical procedure. METHODS: From July 2006 to June 2009, 56 patients with medial instability of the knee were treated with MCL reconstruction and followed up for 33 months on average. These patients were divided into 2 groups based on whether anterior cruciate ligament (ACL) injury was present: 27 patients had isolated MCL injury, whereas 29 patients had combined MCL-ACL injury. All patients underwent reconstruction of the MCL with triangular double-bundle allograft, and we evaluated International Knee Documentation Committee (IKDC) scores, anteromedial rotatory instability (AMRI), and excessive knee medial opening (EKMO) both preoperatively and at follow-up. RESULTS: EKMO was significantly reduced to 2.9 mm at follow-up compared with 10.1 mm preoperatively. The incidence of AMRI was reduced to 9.4% (5 patients) compared with 67.9% (36 patients) preoperatively. Of the patients, 58.9% (33 patients) had a grade A IKDC subjective score and 35.7% (20 patients) had a grade B IKDC subjective score. Most patients had normal or nearly normal range of motion of the knee joint, whereas 4 patients (7.1%) lost more than 6° of range of motion in extension and 2 (3.6%) lost more than 25° in flexion. In 47 patients (83.9%) the symptoms were graded as normal or nearly normal according to IKDC symptom scores. No significant differences in IKDC subjective score, IKDC symptom score, flexion deficit score, AMRI, and EKMO were found between the isolated MCL injury group and the MCL-ACL injury group; however, a significant difference was found in knee extension deficit between groups. CONCLUSIONS: We have presented a new technique for reconstruction of the MCL with a triangular shape. This technique improved both valgus and rotational stability at short-term outcome. The clinical outcomes using IKDC evaluation indicate that no major difference exists in isolated MCL injury and combined MCL-ACL injury treated with this new technique. LEVEL OF EVIDENCE: Level IV, therapeutic case series.

Medial patellar retinaculum plasty versus medial capsule reefing for patellar subluxation in adult.

OBJECTIVE: The purpose of this study was to evaluate the clinical and functional results of surgical treatment for patellar subluxation. METHODS: A retrospective study was undertaken between October 2004 and April 2009 of 78 cases of patellar subluxation: 40 cases with medial capsule reefing, of which 15 cases had the combination of lateral retinacular release (Group A); and 38 cases with medial patellar retinaculum plasty, of which 12 cases had the combination of lateral retinacular release (Group B). All patients had CT scans available for reviewing congruence angle (CA) with knee flexion at 30 degrees. In addition, knee function was evaluated using the Kujala score and subjective questionnaires. RESULTS: Patients were followed up for a mean 60 months (33-87 months). The Kujala score improved significantly from 78.3 ± 1.0 to 88.3 ± 1.6 in Group A and from 77.8 ± 0.9 to 91.2 ± 1.7 in Group B (P < 0.05). Postoperatively, the CA on CT scan had a statistical difference between the two groups (P < 0.05). The subjective questionnaire revealed a significant difference (P < 0.05), including 12 excellent, 20 good and eight fair in Group A, and 25 excellent, and 13 good in Group B. CONCLUSION: The medial retinaculum plasty was better than medial capsule reefing in improving the subjective effects and decreasing the patellar subluxation rate.

Clinicopathological correlation of Krüppel-like factor 5 and matrix metalloproteinase-9 expression and cartilage degeneration in human osteoarthritis.

The present study was designed to investigate the clinicopathological correlation between the expression of KLF5 and MMP-9, which are associated with extracellular matrix degradation and cartilage degeneration in human knee osteoarthritis (OA). Tibiofemoral joint samples from 20 patients with OA, treated with surgery alone, were divided into two groups: 0=no change (NC, n=17), and severe changes with a higher mean score (≥ 3) (SC, n=29). The latter group contains samples with severe damages in cartilages and subchondral bones at medial tibial plateaux. The expression of the proteins was detected by immunofluorescence and quantitative RT-PCR, respectively. Neurovascular invasion was evaluated by protein gene product (PGP) 9.5 and CD34-positive staining and scanning electron microscopy, respectively. Safranin O staining showed that the sections from the SC group had increased cartilage degeneration. The number of vascular invasions in the SC group (16/29, 55.2%) was higher than that in NC controls (2/17, 11.7%, P<0.05). The expression of KLF5 and MMP-9 increased, and was co-localized in the same cells of SC cartilages. The severity of cartilage degeneration and vascular invasion was associated with upregulation of the two protein expressions and was significantly different between SC and NC samples (P<0.05). Taken together, the expression of KLF5 and MMP-9 may be involved in cartilage degeneration, contributing to human OA.

[An experimental study on the basic fibroblast growth factor slow-releasing microsphere for knee osteoarthritis in the rabbit].

OBJECTIVE: To study the therapeutic effect of chitosan-coated basic fibroblast growth factor (bFGF) slow-releasing microspheres on the knee osteoarthritis in the rabbit. METHODS: From November 2008 to July 2009, 54 New Zealand rabbits were divided into 6 groups at random, which were the control group, the model group, the PBS-M group, the bFGF-S group, the 10-bFGF-M group and the 100-bFGF-M group, respectively. The model of knee osteoarthritis was induced by the injection of papain in the rabbit. Except the control and model groups, all the experimental groups were implanted 1 ml intervention solution at the third and sixth weeks, including the PBS microspheres, bFGF solution, 10 µg bFGF microspheres and 100 µg bFGF microspheres, respectively. The rabbits were sacrificed at the ninth week after operation, and then articular cartilage was conducted the morphological and histopathological evaluation. RESULTS: The damage of articular cartilage in the model group was more serious than that in the control group, with statistical differences according to the Ink score (t = 8.22, P = 0.00) and Mankin score (t = 17.20, P = 0.00). The damage of articular cartilage in the PBS-M and bFGF-S groups were similar with that in the model group, according to the Ink score (t = 0.26, P = 0.79; t = 0.80, P = 0.45) and Mankin score (t = 1.51, P = 0.17; t = 0.56, P = 0.60). The Ink and Mankin scores in the 10-bFGF-M and 100-bFGF-M groups were better than that in the model group (Ink score: t = 3.58, P = 0.01; t = 6.82, P = 0.00; Mankin score: t = 3.41, P = 0.01; t = 5.00, P = 0.00), with the 100-bFGF-M group much better (t = 5.29, P = 0.00; t = 2.80, P = 0.02). CONCLUSIONS: The bFGF slow-releasing microsphere can keep its effective intra-articular concentration, which may accelerate the synthesis of proteoglycan and inhibit its decomposition to reverse the damage of articular cartilage.

[Arthroscopic single-bundle anterior cruciate ligament reconstruction with six-strand hamstring tendon and patellar tendon allograft].

OBJECTIVE: To compare the outcome of arthroscopic single-bundle anterior cruciate ligament (ACL) reconstruction with six-strand hamstring tendon and patellar tendon allograft. METHODS: From October 2006 to December 2009, 108 patients with arthroscopic single-bundle ACL reconstruction were retrospectively reviewed, with 58 patients with six-strand hamstring tendon (Group H), and 50 patients with patellar tendon allograft (Group P). Patients were available for clinical evaluation with KT-1000 arthrometer measurements, Lachman and pivot-shift test, and knee function with the International Knee Documentation Committee (IKDC), Lysholm scores. RESULTS: All the patients were followed up at an average of 28.6 months (range 12 - 38 months). The average side-to-side difference was lesser for group H (1.2 ± 1.2) mm than group P (1.8 ± 1.5) mm (P < 0.05). On the pivot-shift test, 55 (94.8%) patients were negative and 3 (5.2%) were positive in group H, whereas 41 (82.0%) were negative and 9 (18.0%) were positive in group P, with significant difference between two groups (P < 0.05). All knee function scores were improved postoperatively, without statistically significant difference between the two groups (P > 0.05). CONCLUSION: Arthroscopic single-bundle ACL reconstruction with six-strand hamstring tendon will achieve better knee stability than patellar tendon allograft.

[Functional reconstruction of the medial collateral ligament with double-bundle allograft technique].

OBJECTIVE: To discuss a new technique about reconstruction of medial collateral ligament (MCL) with double bundle allograft and to evaluate the short-term clinical efficacy. METHODS: All 53 patients who suffered from valgus instability of the knee were selected. All cases were diagnosed of MCL injury because the medial gap of the knee widened more than 5 mm compared with collateral knee by the stress X-ray, MRI displayed discontinuity of MCL and valgus stress test was positive. All patients were accepted arthroscopic evaluation through inferomedial and inferolateral arthroscopy portal incisions to ascertain whether there were intra-articular injuries. An 8 cm incision was made from 1 cm superior adductor tubercle to 5 cm proximal medial tibia joint line in a longitudinal fashion. The anterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 45 mm under the medial tibia joint line. The posterior tibia insertion was defined as 15 mm lateral from the medial tibia edge and 20 mm under the medial tibia joint line. We used 5 mm or 6 mm reamer to drill the tibia tunnel along with guide pin, and then drill the femur tunnel with 6 mm or 7 mm drill in the top of the adductor tubercle about 25 mm or 30 mm length. The allograft was pulled into the tunnel from tibia to the femur and fixed with absorbable interference screw. Patients carried out active rehabilitation program after operation. One year after the operation, IKDC score, Lysholm score were used to evaluate the clinical effect. RESULTS: The IKDC score (A or B, 86.78% vs. 0), Lysholm scores (89.7 ± 3.4 vs. 51.8 ± 4.9, t = -79.724, P < 0.05) were significantly improved compared with preoperative in all patients. Medial joint widened gap decreased from (10.4 ± 2.4) mm preoperative to (2.8 ± 1.5) mm postoperative from X ray and the differences were significant (t = 41.727, P < 0.05). Among these patients, the medial joint widened gap of 46 cases were less than 3 mm, 7 cases were from 3 mm to 5 mm. The range of motion was 135.4° ± 2.5° preoperative and 132.7° ± 3.7° postoperative. The 9 patients still had medial tenderness 1 year after operation. CONCLUSION: Application double bundle allograft technique to reconstruct MCL can significantly improve the stability of the knee and the short-term clinical efficacy was sure.

Combination of medial patellofemoral ligament reconstruction with vastus medialis advancement for chronic patellar dislocation.

BACKGROUND: The medial patellofemoral ligament (MPFL) reconstruction is popular in clinical practice for chronic patellar dislocation; however, the combination with vastus medialis advancement is rare. The aim of this study was to evaluate the clinical outcome of the combination of MPFL reconstruction with vastus medialis advancement. METHODS: We retrospectively analyzed 69 patients with chronic patellar dislocation between July 2004 and October 2008: twenty eight cases with isolated MPFL reconstruction (group I), forty one cases with the combination of MPFL reconstruction with vastus medialis advancement (group C). All patients had CT scans available for review with knee flexion at 30 degree, on which the congruence angle, patellar tilt angle and patellar lateral shift were measured. Physical apprehension tests were examined and the redislocation was recorded. In addition, knee function was evaluated using the Kujala score and subjective questionnaires. RESULTS: Patients were followed up for a mean of 42 months (12 - 65 months) without a recurrent dislocation reported. Postoperatively, all indexes on CT scan were within the normal range without a statistical difference between the two groups. Results from the apprehension test showed eight patients in group I and three in group C had patellar lateral shift exceeding 1.5 cm with a hard end point (P < 0.05). The Kujala score improved significantly from 51.3 ± 4.5 to 79.9 ± 6.2 in group I and from 53.7 ± 5.2 to 83.9 ± 6.5 in group C (P > 0.05). However, the subjective questionnaire revealed a significant difference (P < 0.05), including 12 excellent, seven good and nine fair in group I and 30 excellent, six good and five fair in group C. CONCLUSION: The combination of MPFL reconstruction with vastus medialis advancement is better than isolated reconstruction to improve the subjective effects and decrease the patellar instability rate for chronic patellar dislocation.

[Comparison of clinical results between an isometric and an anatomic technique for medial patellofemoral ligament reconstruction].

OBJECTIVE: To compare the clinical results of single-stranded isometric with double-stranded anatomic reconstruction of medial patellofemoral ligament (MPFL) for recurrent patellar dislocation. METHODS: Retrospective analysis of 60 consecutive patients (72 knees) with recurrent patellar dislocation underwent medial patellofemoral ligament reconstruction between August 2004 and October 2008, 22 cases (27 knees) with single-stranded isometric reconstruction, 38 cases (45 knees) with double-stranded anatomic reconstruction. Postoperatively patellar stability was examined, and recurrent rate was recorded. Patellar lateral shift ratio and tilt were measured on CT scans. Knee function was evaluated with subjective questionnaire and the Kujala score. RESULTS: All patients were followed up for more than 12 months without recurrent redislocation. (1) Recurrent instability rate was 18.5% in single-stranded group and 2.2% in double-stranded group, with statistical difference (P < 0.05). (2) The patellar tilt and lateral shift ratio returned to normal, without statistical difference between groups (P > 0.05). (3) The Kujala score were 59 ± 9 and 62 ± 9 preoperatively and 87 ± 4 and 94 ± 6 postoperatively in single- and double-stranded group, with statistical difference (P < 0.05). (4) The excellect rate was 85.2% in single-stranded group, 97.8% in double-stranded group, with statistical difference(P < 0.05). CONCLUSION: Both reconstruction can improve patellar stability and knee function significantly, with double-stranded anatomic reconstruction better in clinic evaluation.

VKORC1-1639G>A, CYP2C9, EPHX1691A>G genotype, body weight, and age are important predictors for warfarin maintenance doses in patients with mechanical heart valve prostheses in southwest China.

OBJECTIVE: To investigate the contribution of genetic polymorphisms of vitamin K epoxide reductase complex subunit 1 gene VKORC1-1639G>A, cytochrome P450 2C9 gene (CYP2C9), EPHXI, and clinical factors to warfarin sensitivity in southwest Chinese Han patients with mechanical heart valve prostheses. METHODS: A total of 127 patients with mechanical heart valve prostheses who have been followed up at our department during the past 23 years were enrolled in this study and compared to a control group that consisted of 133 randomly selected healthy blood donors. These Chinese patients met stable warfarin dosage requirements and had reached the target international normalized ratio (INR) of 1.5-2.0. PCR and direct sequencing were carried out to identify the polymorphisms of VKORC1-1639G>A (rs9923231), CYP2C9*3 (rs1057910), CYP2C9 IVS3-65G>C (rs9332127), and EPHX1691A>G (rs4653436). In addition, total and free (non-protein-bound) warfarin concentrations were analyzed. RESULTS AND CONCLUSIONS: There were great interindividual differences in warfarin maintenance dosage (ranging from 0.6 to 8.4 mg/day) among the 127 patients with mechanical heart valve prostheses. VKORC1-1639G>A, CYP2C9, EPHX1691A>G polymorphism, body weight, and age were found to affect the dose demands. Multiple linear regression models incorporating genetic polymorphisms of VKORC1, CYP2C9, EPHX1691A>G, and the nongenetic factors of age and body weight were developed, and explained up to 76.8% of the total variation (adjusted R (2) of 0.743) in warfarin maintenance doses in southwest Chinese patients with mechanical heart valve prostheses.

Giant primary leiomyoma of the right ventricle.

Echocardiography detected a giant mass on the lateral wall of the right ventricle in a 13-year-old boy. The mass extended into the cavity of right ventricle without attachment to adjacent structures. We resected the mass under cardiopulmonary bypass. Histology showed it to be a primary leiomyoma of the right ventricle.

[Anterior cruciate ligament reconstruction using periosteum wrapped autologous hamstring tendons: clinical research].

OBJECTIVE: To develop a surgical technique using a periosteal flap wrapped autologous hamstring tendons in ACL reconstruction and to examine its short-term outcome. METHODS: A total of 110 patients (110 knees) were included. The experimental group (n = 52) received ACL reconstruction with hamstring tendons wrapped in periosteum. In the other 58 patients, ACL was reconstructed with autologous hamstring tendons. The mean post-operative follow-up was 19 (12 - 25) months. All patients were assessed at 12 months post-operation. The parameters of efficacy evaluation included IKDC score, Tegner score, modified HSS score, KT-1000 arthrometer reading and a radiographic assessment using anteroposterior and lateral radiographs. The incidence of femoral and tibial bone tunnel enlargement between two groups was compared with chi(2) test. RESULTS: Clinical outcomes in experimental group (periosteum-wrapped grafts) were dependent on the wrap-up of periosteum, bone tunnel, graft fixation and postoperative rehabilitation. The good or excellent outcomes were reported in approximately 90% of the experimental group. And 44 patients showed normal or nearly normal knee function according to IKDC criteria. KT-1000 tests showed an average maximal manual side-to-side difference of 1.7 +/- 1.1 mm. Forty patients showed the outcomes of KT-1000, Lachman's knee ligament test and pivot-shift testing. The evaluation of the level of activity using the Tegner score revealed that 40 patients regained their pre-injury activity level. And 44 patients showed full knee extension and 42 patients showed full knee flexion after surgery. The average HSS score showed no significant difference between experimental group (90.6 +/- 0.57 points) and control group (89.9 +/- 0.8 points) (t = 0.714, P > 0.05). The KT-1000 measurement (133N) was larger in control group (2.3 +/- 1.0 mm) than in experimental group (1.7 +/- 1.1 mm). There was significant difference in laxity between two groups (t = 6.427, P < 0.05). At 12 months post-operation, tunnel enlargement could be observed in both groups. The average enlargement of femoral tunnel was less in experimental group (17.3%) than control group (34.5%) (chi(2) = 4.17, P < 0.05). And the enlargement of tibial tunnel was less in experimental group (19.2%) than control group (36.2%) (chi(2) = 3.90, P < 0.05). CONCLUSIONS: The surgical technique using a periosteal flap wrapped with autologous hamstring tendons in ACL reconstruction has definite clinical efficacies. It can enhance the stability of knee and prevent the enlargement of bone tunnel.