Objective To provide the anatomic evidences and the choice of tendon graft for anatomic reconstruction of posterolateral complex through the morphological and biomechanical study on posterolateral structures of the knee in normal adult cadavers. Methods Twenty-three fresh lower l imb specimens from voluntary donators and 9 lower l imbs soaked by Formal in were selected for anatomic study on the posterolateral complex of the knee. Six fresh specimens were appl ied to measure the maximum load, intensity of popl iteus tendon, lateral collateral l igament, and popl iteofibular l igament, which were key components of the posterolateral complex. Results Popl iteus musculotendinous junction was located at 7.02-11.52 mm beneath lateral tibial plateau and 8.22-13.94 mm medially to fibular styloid process. The distances from femoral insertion of popl iteus tendon to the lower border of femoral condyle and to posterior edge of femoral condyle were 10.52-14.38 mm and 14.24-26.18 mm, respectively. Popl iteofibular l igament originated from popl iteus musculotendinous junction and ended at fibular styloid process. Lateral collateral l igament was located at 10.54-16.48 mm inferior to fibular styloid process, and the distances from femoral insertion to the lower border of femoral condyle and to posterior edge of femoral condyle were 14.92-19.62 mm and 14.66-27.08 mm, respectively. The maximum load and intensity were 579.60-888.40 N and 20.50-43.70 MPa for popl iteus tendon, were 673.80-1 003.20 N and 24.30-56.40 MPa for lateral collateral l igament, and were 101.56-567.35 N and 8.94-36.16 MPa for popl iteofibular l igament, respectively. Conclusion During anatomical reconstruction of posterolateral complex, the bony tunnel of the key components should be located according to the insertion mentioned above. On the basis of this study, the maximum load and intensity of selectable grafts should exceed 833 N and 36 MPa.
Objective To introduce the research advance of the ligament injury and ligament healing.Methods Recent original articlesrelated to such aspects of ligament were reviewed extensively.Results The ligament properties would be influenced when the situations of the biochemistry and biomechanics had changed. Injuries to ligaments induce a healing response that is characterized by scar formation. Graft could not recovery the ultrastructure, anatomy and biomechanics of the normal ligament.Conclusion The healing ligament is weaker than normal one, and the graft could not reconstruct normal ligament at present.
ObjectiveTo review the research progress of tissue engineered ligament. MethodsThe literature in recent years on tissue engineered ligament in repair of anterior cruciate ligament (ACL) injury was extensively reviewed, including cell sources, scaffold materials, growth factors, and mechanical stimulation in tissue engineered ligament. ResultsTissue engineered ligament constructed by mesenchymal stem cells and ACL fibroblasts has been successfully used in animal experiments. It is crucial for qualified tissue engineered ligament to choose appropriate seed cells, scaffold, mechanical stimulation, and essential cytokines. To further optimize culture condition and how to realize the tissue engineered ligament in vivo better survival and prognosis need to be further studied. ConclusionEnormous progress has been made in tissue engineered ligament for repair and regeneration of ACL. With the development of biochemistry and scaffold materials, tissue engineered ligament will be used in clinic in the near future.
Based on peer-reviewed systematic reviews and randomized controlled trials published from January 1990 to April 2016 with regards to the management of osteoarthritis (OA) of the hip, the American Academy of Orthopaedic Surgeons (AAOS) developed the clinical practice guideline for the treatment of hip OA. This guideline provided practice recommendations including risk factors for hip OA, oral drugs and intraarticular injectables, physical therapies, perioperative hemostatic drug, anesthetic types, approach exposures, etc. The evidence of guideline was graded according to it’s strength. This article interpreted this guideline so as to provide reference for Chinese medical staffs and guideline developers.
ObjectiveTo summarize the application status and progress of platelet-rich plasma (PRP) in clinical orthopedics. MethodsThe recent related literature concerning the application of PRP in clinical orthopedics was extensively reviewed and analyzed. ResultsRecently, a large number of clinical studies on PRP have been carried out, which are applied in bone defects or nonunion, spinal fusion, osteoarthritis and cartilage injuries, ligament reconstruction, muscle strain, tendon terminal diseases, and a variety of acute and chronic soft tissue injuries. Some results show certain effectiveness, while others demonstrate invalid. ConclusionEasily drawing, achieving autologous transplantation, and the biological repair potential of the musculoskeletal tissues make PRP to be widely used in clinical orthopedics. However, there are still no uniform standards accepted and reliable clinical guidelines about the application of PRP. Furthermore, a variety of PRP products and their respective indications are also different. The clinical evidences with the greater sample size and higher quality are still needed to further support the safety and effectiveness of PRP in clinical orthopedics.
ObjectiveTo review the research progress of the preparation and components of the platelet rich plasma (PRP). MethodsThe recent literature concerning the biological mechanism, preparation, and components of PRP was analyzed and summarized. ResultsThe biological function of PRP depends on a series of intricate cascade of cellular and molecular events. PRP contains different concentrations of platelets, which would release a large number of the activated molecules, and also contains a small amount of white blood cells and red blood cells. The preparation of PRP is based on platelet concentration. Different preparation techniques would lead to different platelet concentrations, recovery ratios, and components. ConclusionThere is no uniform standard for the preparation of PRP. Different preparation methods and technical parameters of PRP will get different components and different concentrations of PRP, which also provide a reference for cl inicians to select the most appropriate PRP for individual patient.