Objective To study the operative procedure and the effectiveness of arthroscopic therapy for ankle joint impingement syndrome after operation of ankle joint fracture dislocation. Methods Between March 2008 and April 2010, 38 patients with ankle joint impingement syndrome after operation of ankle joint fracture dislocation were treated. Among them, therewere 28 males and 10 females with an average age of 28 years (range, 18 to 42 years). The time from internal fixation to admission was 12-16 months (mean, 13.8 months). There were pressing pain in anterolateral and anterior ankle. The dorsal extension ranged from — 20 to — 5° (mean, —10.6°), and the palmar flexion was 30-40° (mean, 35.5°). The total score was 48.32 ± 9.24 and the pain score was 7.26 ± 1.22 before operation according to American Orthopaedic Foot and Ankle Society (AOFAS) ankle and hindfoot score system. The X-ray films showed osteophyte formation in anterior tibia and talus; MRI showed cartilage injury in 22 cases. Arthroscopic intervention included removing osteophytes, debriding fabric scars and synovial membrane tissues, and removing osteochondral fragments. Arthroscopic microfracture technique was used in 22 patients with cartilage injury. Results All incisions healed primarily. Thirty-eight cases were followed up 10-26 months (mean, 16 months). At last follow-up, 26 patients had normal range of motion (ROM); the dorsal extension was 15-25° (mean, 19.6°) and the palmar flexion was 35-45° (mean, 40.7°). Eight patients had mild l imited ROM; the dorsal extension was 5-15° (mean, 7.2°) and the palmar flexion was 35-45° (mean, 39.5°). Four patients had mild l imited ROM and pain in posterior portion of the ankle after a long walking (3-4 hours); the dorsal extension was 0-5° (mean, 2.6°) and the palmar flexion was 35-40° (mean, 37.5°). The total score was 89.45 ± 9.55 and the pain score was 1.42 ± 1.26 after operation according to AOFAS ankle and hindfoot score system, showing significant differences when compared with preoperative ones (t=21.962, P=0.000; t=16.762, P=0.000). Conclusion Arthroscopic treatment of ankle joint impingement syndrome after operation of ankle joint fracture dislocation is an effective, simple, and safe method.
Objective To determine the short-term effectiveness of matrix-induced autologous chondrocyte implantation (MACI) for femoral trochlea cartilage injury. Methods A retrospective analysis was performed on the clinical data of 10 patients with femoral trochlea cartilage injury treated with MACI between June 2012 and October 2014. There were 6 males and 4 females, aged from 15 to 48 years (mean, 33 years). The left knee was involved in 3 cases and the right knee in 7 cases. Nine patients had a history of trauma, and 1 case suffered from osteochondritis dissecans. Combined injuries included meniscus injury in 1 case, anterior cruciate ligament injury in 3 cases, and lateral collateral ligament tear in 2 cases. The mean lesion depth was 2.80 mm (range, 2-7 mm), with the mean defect size of 84.85 mm2 (range, 28.26-153.86 mm2). The mean duration of definite diagnosis was 14 days (range, 5 days to 3 months). By using arthroscopic biopsy, 200-300 mg healthy articular cartilage at non weight-bearing area of the knee femoral trochlea was collected as a source of seed cells, which were isolated and cultured to prepare MACI membrane. The adhesion activity, growth rate, and mechanical properties of the chondrocytes on the Bio-gide collagen scaffold were evaluated. In addition, the stretch rate, tensile strength, and suture strength of scaffold were tested. MACI membrane was implanted after 2 weeks to 6 months. The visual analogou scale (VAS), Lysholm score, and Tegner movement level score at preoperation and last follow-up were used to assess the function. Results The MACI membrane was successfully prepared, and the human chondrocytes adhered and grew well on the Bio-gide collagen scaffold. Mechanical test showed that MACI membrane had the stretch rate of 65.27%, the tensile strength of 26.81 MPa, and the suture strength of 6.49 N, indicating good mechanical properties. MACI membrane was successfully implanted. The mean operation time was 58.5 minutes (range, 43-99 minutes), and the mean hospitalization time was 7 days (range, 6-15 days). All incisions healed well. Ten cases were followed up 9 to 16 months (mean, 12 months). Four cases underwent iliac bone graft surgery. The mean healing time was 14 weeks (range, 12-16 weeks). No complications of osteochondrolysis, knee pain, nerve and vascular injury, deep vein thrombosis, and knee adhesion occurred during follow-up. The VAS score, Lysholm score, and Tegner score at last follow-up were significantly improved when compared with preoperative scores (t=12.060,P=0.000;t=–9.200,P=0.000;t=–14.000,P=0.000). Conclusion MACI for femoral trochlea cartilage injury has good short-term effectiveness, with less injury and fast function recovery.
Objective To evaluate the treatment and effects of wrist arthroscopy in tear of triangular fibrocartilage complex (TFCC). Methods Between January 2006 and December 2008, 16 patients with tear of TFCC were treated. Of 16 patients, 11 were male and 5 were female with an average age of 32.5 years (range, 25-51 years). Injury was caused by sprain in 12cases, and by fall ing in 4 cases. The locations were the left side in 10 cases and the right side in 6 cases. The mean injury duration was 3 months to 6 years and 2 months. The main cl inical symptoms included wrist powerlessness and ulnar-sided wrist pain which was aggravated with clench fist and l ifting heavy things. The results of the ulnar-sided wrist stress test were positive in 14 cases and negative in 2 cases. The preoperative values of wrist range of motion (ROM) were (45.58 ± 5.18)° at volar flexion, (41.22 ± 3.83)° at dorsal extension, (17.82 ± 2.48)° at radial deviation, (21.35 ± 4.61)° at ulnar deviation, (69.85 ± 8.36)° at pronation, and (70.13 ± 6.34)° at supination. According to Palmer standard, 10 cases of IA were treated with debridement; 3 cases of IB with suture and 1 of them failed and was partially excised; 2 cases of IC with debridment on triangular fibrocartilage disc, ulnolunate l igament, and ulnotriguetrum l igament; and 1 case of ID with trimming plastic operation. Results All incisions healed by first intention, and no compl ications of joint infection or neurovascular injury was found. All patients were followed up 14-38 months (mean, 18.5 months). Fifteen patients were restored to normal l ife and work without ulnar-sided wrist pain. One patient had no pain, but he had wrist powerless. The values of ROM at last follow-up were (50.16 ± 6.21)° at volar flexion, (45.37 ± 4.65)° at dorsal extension, (18.95 ± 3.56)° at radial deviation, (26.28 ± 5.09)° at ulnar deviation, (78.87 ± 7.69)° at pronation, and (76.46 ± 8.31)° at supination; showing significant differences when compared with preoperative values(P lt; 0.05). According to Green-O’Brien standard, the results were excellent in 9 cases, good in 6 cases, fair in 1 case, and the execellent and good rate was 93.75%. Conclusion The wrist arthroscopy not only can definitely diagnose tear of TFCC, but also is useful for treatment. In addition, the incision is small and the function is easy to recover, and the occurence of chronic ulnar-sided wrist pain can be effectively avoided.