ObjectiveTo investigate the effectiveness of arthroscopic treatment for combined injury of the posterior horn of the medial meniscus (PHMM) and the anterior horn of the lateral meniscus (AHLM). MethodsBetween September 2009 and December 2012, 36 patients (36 knees) with combined injury of PHMM and AHLM underwent arthroscope surgery. There were 16 males and 20 females with an average age of 47 years (range, 30-64 years), and a median disease duration of 30 months (range, 3 months-9 years). The left knee was involved in 14 cases and the right knee in 22 cases. Two patients had a history of sprain, and other patients had no obvious incentive. The patients had limited activity of the knee in varying degrees; posterior medial tenderness in the medial knee joint space and positive Mcmurray tests were found in all cases, and anterior tenderness in the lateral knee joint space in 26 cases. Effusion of the knee joint occurred in 5 cases. The X-ray and MRI before operation indicated injury of PHMM combined with injury of AHLM in 30 cases and simple injury of PHMM in 6 cases; meniscal cyst was found in 2 cases, and popliteal cyst in 1 case. Partial meniscectomy was used for PHMM, the external-inner suture or partial meniscectomy was used for AHLM. ResultsAll incisions healed primarily with no complication. All cases were followed up 22.5 months on average (range, 10-40 months). At last follow-up, the patients had no pain, weakness, and instability, and tenderness in medial and lateral joint space disappeared. Except 4 patients who had weakly positive Mcmurray test, the results of Mcmurray test were negative in the others. Based on the improved Lysholm classification standard, the results were excellent in 25 cases, good in 8 cases, and fair in 3 cases; the excellent and good rate was 91.7%. ConclusionArthroscopic primary repair of combined injury of PHMM and AHLM can effectively recover the knee function with a better effectiveness.
ObjectiveTo explore the technique of arthroscopic resection of benign tumor in the knee posterior septum and to evaluate its clinical results. MethodsBetween June 2008 and June 2012, 12 cases of benign tumor in the knee posterior septum were treated by arthroscopic surgery. There were 8 males and 4 females with an average age of 36.5 years (range, 22-50 years). The average disease duration was 8.4 months (range, 3 months to 2 years). Of 12 cases, there were 2 cases of chronic synovitis, 5 cases of ganglion, 4 cases of tenosynovial giant cell tumor, and 1 case of synovial hemangioma; solitary tumor involved in the knee posterior septum in 10 cases, and in the posterior septum and other part of the knee in 2 cases. All the patients underwent tumor removal under arthroscope with routine anterolateral and anteromedial portal, additional posteromedial portal and/or posterolateral portal. Trans-septal approach was used in 6 cases because the tumors located in the middle of the posterior septum. ResultsAll wounds healed by first intention with no complications such as infection, haematoma in the knee, injury of vessels and nerves, deep vein thrombosis, osteofascial compartment syndrome, or cutaneous necrosis. All patients were followed up 12-46 months with an average of 18.5 months. All patients achieved relief of knee pain and improvement of knee movement. The range of motion of the knee was significantly improved from (57.08±12.52)° at pre-operation to (120.83±13.95)° at last follow-up (t=-12.84, P=0.00). The visual analogue scale (VAS) score was significantly reduced from 5.00±1.04 at pre-operation to 1.50±0.91 at last follow-up (t=-18.00, P=0.00). The Lysholm score was significantly improved from 49.50±9.07 at pre-operation to 84.58±6.82 at last follow-up (t=-8.04, P=0.00). ConclusionThe benign tumor in the knee posterior septum can be completely resected under arthroscope, and the procedure is minimally invasive and useful to the restore knee function.
ObjectiveTo design a new type of transarticular cuboid bone plate by measuring and collecting the anatomic data of the articular surface around cuboid, and to carry out comparative biomechanical study. MethodsThe angle α (between the fifth metatarsocuboid joint and the fifth metatarsal bone) and the angle β (between the fifth metatarsocuboid joint and the calcaneocuboid joint) were measured in 100 adults on medial oblique X-ray film and 30 adult foot specimens. Based on literature data, the transarticular cuboid bone plate was designed with an angle α of 70° and an angle β of 30°. Six adult cadaver feet were chosen and were transected approximately 15 cm proximal to the ankle. Five strain gauges were placed at the calcaneus, cuboid, and the fourth and fifth metatarsal bones. The vertical pressure was loaded on the foot at 0-600 N, the strain value was measured. Then the cuboid fracture model was established and 600 N load was given on foot to measure the strain value and compare with the strain value before fracture. The specimens were randomly divided into groups A and B (n=3). Fracture was fixed with transarticular cuboid bone plate and 9 screws in group A and with double plate and 8 screws in group B, then the 600 N load was given to measure the strain value and vertical displacement of the fracture fragments. ResultsAfter loads of 0-600 N on the foot, the strain value of the 5 points showed an increased trend. No significant difference was found in the strain value between pre- and post-fracture at a, d, and e points P>0.05), but it was significantly larger at post-fracture than pre-fracture at b and c points (P<0.05). After fracture fixation, no significant difference was shown in the strain value at 5 points between groups A and B when loads of 0-600 N was given P>0.05). The experimental data showed that the strain value change mainly focused on the fracture site under the same load, so the strain value after fracture fixation was similar to that before fracture at b and c points P>0.05). The vertical displacement values of medial and lateral fracture fragments in group A[(0.804±0.011) mm and (0.672±0.036) mm] were significantly less than those in group B[(1.126±0.083) mm and (1.007±1.103) mm] (t=-6.711, P=0.003; t=-5.307, P=0.006). ConclusionThrough biomechanical study, a new type of transarticular cuboid bone plate has better fixation effect.
ObjectiveTo observe the effectiveness of 360° internal fixation by anteromedial and posterior-lateral approaches for high-energy closed Pilon fractures. MethodsBetween February 2013 and February 2015, 18 cases of high-energy closed Pilon fractures were treated. There were 11 males and 7 females with an average age of 40.5 years (range, 20-65 years). The causes were falling injury in 10 cases and traffic accident injury in 8 cases. All fractures were RüediAllgower type Ⅲ Pilon fracture combined with ipsilateral fibula fracture. The average interval from injury to operation was 8 days (range, 5-13 days). Reduction of fracture was performed by anteromedial and posterior-lateral approaches and the fracture fragments were fixed by 360° internal fixation. The effectiveness was assessed by ankle X-ray film and Mazur score at last follow-up. ResultsTwo cases had skin necrosis and received flap surgery, the other cases obtained primary healing of incision. All the cases were followed up 11.2 months on average (range, 3-27 months). X-ray film showed that all fractures healed at 3-4 months after operation (mean, 3.6 months). No deep infection or plate exposure occurred. According to Mazur score, the results were excellent in 8 cases, good in 7 cases, fair in 2 cases, and poor in 1 case, and the excellent and good rate was 83.3%. ConclusionThe effectiveness of the 360° internal fixation for treatment of high-energy closed Pilon fractures has the advantages of reliable fixation, early functional exercise, and good functional recovery of the ankle joint.
ObjectiveTo explore the treatment methed of recurrent patellar dislocation associated with old osteochondral fracture and to evaluate its effectiveness. MethodsBetween August 2010 and August 2014, 12 cases of recurrent patellar dislocation with old osteochondral fracture were treated. There were 4 males and 8 females with an average age of 18.3 years (range, 15-24 years). The left knee was involved in 7 cases and the right knee in 5 cases. All the patients had a history of patellar dislocation, the average interval from injury to first hospitalization was 7.6 months (range, 6-13 months). At preoperation, the range of motion (ROM) of the injured knee was (89.17±13.11)°; the Lysholm score was 56.67±18.91; the Q-angle was (17.50±5.28)°; and tibial tuberosity-trochlear groove (TT-TG) distance was (18.33±4.03) mm. The Q-angle was more than 20° and TT-TG distance was more than 20 mm in 6 of 12 cases. There were 6 cases of patellar osteochondral fracture, 5 cases of lateral femoral condylar osteochondral fracture, and 1 case of patellar osteochondral fracture combined with lateral femoral condylar osteochondral fracture. After osteochondral fracture fragments were removed under arthroscope, lateral patellar retinaculum releasing and medial patellar retinaculum reefing was performed in 2 cases, medial patellofemoral ligament (MPFL) reconstruction combined with both lateral patellar retinaculum releasing and medial patellar retinaculum reefing in 4 cases, and MPFL reconstruction, lateral patellar retinaculum releasing, medial patellar retinaculum reefing, and tibial tubercle transfer in 6 cases. ResultsAll wounds healed by first intention with no complication of infection, haematoma, skin necrosis, or bone nonunion. All patients were followed up 12-60 months with an average of 24.2 months. At 3 months after operation, all patellar dislocations were corrected; the Q-angle was (13.33±1.37)° and the TT-TG distance was (12.17±1.17) mm in 6 patients undergoing tibial tubercle transfer, showing significant differences when compared with preoperative values[(22.50±2.17)° and (21.33±2.34) mm] (t=15.25, P=0.00; t=8.27, P=0.00). All patients achieved relief of knee pain and knee locking; the knee ROM and the Lysholm score at last follow-up were (120.42±11.57)° and 89.25±9.71, showing significant differences when compared with preoperative ones (t=-11.61, P=0.00; t=-8.66, P=0.00). ConclusionIt has satisfactory short-term effectiveness to remove old osteochondral fragments that can not be reset and to correct patellar dislocation for recurrent patellar dislocation with old osteochondral fracture.
ObjectiveTo observe the characteristics of acetabular labrum injury in Pipkin fractures and the effectiveness of repairing the labrum with suture anchor. MethodsBetween July 2010 and July 2013, 10 cases of Pipkin fractures accompanied by acetabular labrum injury were treated. There were 7 males and 3 females with an average age of 32.5 years (range, 24-56 years). The causes of injury included traffic accident in 8 cases and falling from height in 2 cases. According to the Pipkin classification criteria, there were 6 cases of type Ⅱ, 2 cases of type Ⅲ, and 2 cases of type Ⅳ. The average interval from injury to operation was 8 days (range, 6-14 days). All the patients underwent open reduction and internal fixation through transtrochanteric approach with trochanteric osteotomy, and repair the labrum with suture anchor. The effectiveness was evaluated according to the Thompson & Epstein scoring scales after operation. ResultsAll incisions healed primarily without early complication of deep infection or deep vein thrombosis of lower limb. All the cases were followed up 22 months on average (range, 12-48 months). X-ray films showed that all osteotomies and acetabular fractures healed within 3-4 months, femoral head and femoral neck fracture healed within 6-11 months. MRI examinations showed that all repaired acetabular labrums well healed. One case had necrosis of the femoral head at 12 months after operation, and was treated by total hip arthroplasty. According to the Thompson & Epstein scoring scales at last follow-up, the results were excellent in 5 cases, good in 3 cases, fair in 1 case and poor in 1 case, with an excellent and good rate of 80%. ConclusionThe diagnosis of acetabular labrum injury can be easily missed during Pipkin fracture, preoperative diagnosis should be combined with hip MRI. Trochanteric osteotomy through transtrochanteric approach, and repairing the labrum with suture anchor can restore the hip function effectively.