Objective To evaluate the influence of patellar replacement on total knee arthroplasty by comparing with non pattelar replacement. Methods Between September 2010 and November 2010, 63 patients (63 knees) with osteoarthritis who met the selection criteria and underwent total knee arthroplasty, were randomly divided into 2 groups: patellar replacement in 32 cases (replacement group), non patellar replacement in 31 cases (non pattelar replacement group). There was no significant difference in gender, age, disease duration, osteoarthritis grading, the clinical and functional scores of American Knee Society Score (KSS), the patellar tilt angle, tibiofemoral angle, and patellar ligament ratio between 2 groups (P gt; 0.05), they were comparable. After 6 weeks, 3, 6, and 12 months of operation, clinical and imaging evaluation methods were used to assessment the effectiveness. Results Primary healing of incision was obtained in all patients of 2 groups. Deep venous thrombosis occurred in 6 cases of replacement group and in 8 cases of non pattelar replacement group. All patients were followed up 12 months. The postoperative incidence of anterior knee pain in replacement group was significantly lower than that in non pattelar replacement group (P lt; 0.05) at 3, 6, and 12 months after operation. No significant difference was found in the postoperative KSS clinical score between 2 groups at each time point (P gt; 0.05). The joint function score of the replacement group was significantly higher than that of the non pattelar replacement group at the other time point (P lt; 0.05) except the score at 6 weeks and 3 months. Significant difference was found in the patella score between 2 groups at 12 months (P lt; 0.05), but no significant difference at the other time points (P gt; 0.05). X-ray film showed no patellar fracture and dislocation, or loosening and breakage of internal fixation. At 12 months after operation, the tibiofemoral angle, the patellar ligament ratio, and the patellar tilt angle showed no significant difference between 2 groups (P gt; 0.05). Conclusion Patella replacement can improve knee function score and the patella score, and reduce the incidence of postoperative anterior knee pain.
Objective To evaluate the influence of patellar non-resurfacing on the effectiveness after total knee arthroplasty (TKA). Methods Between April 2008 and April 2011, 163 patients with degenerative osteoarthritis of the knee underwent TKA without patellar resurfacing, and the clinical data were retrospectively analyzed. There were 65 males and 98 females, with a mean age of 63 years (range, 54-78 years). According to Outerbridge classification for cartilage degeneration, 22 cases were classified as grade I, 38 cases as grade II, 64 cases as grade III, and 39 cases as grade IV. There was no significant difference in gender, age, and sides among patients at 4 grades (P gt; 0.05). The intraoperative tourniquet-using time and postoperative complications were recorded; the knee society score (KSS), patella score (PS), patients’ satisfaction, and anterior knee pain [using visual analogue scale (VAS)] were used to evaluate the knee function. X-ray films were routinely taken to observe the position of the prosthesis and the patella. Results The mean tourniquet-using time was 125 minutes (range, 90-150 minutes). All incisions obtained healing by first intention, and no early postoperative complication occurred. All patients were followed up 2-5 years (mean, 3.6 years). The KSS and PS scores were significantly improved at 6 months and last follow-up when compared with preoperative scores (P lt; 0.05), but no significant difference between at 6 months and last follow-up (P gt; 0.05). Significant differences in KSS and PS scores were found among patients with different grades of cartilage degeneration at preoperation (P lt; 0.05), but no significant difference at last follow-up (P gt; 0.05). At last follow-up, 7 patients experienced anterior knee pain (mild pain in 5, moderate pain in 2). The results of satisfaction were very satisfied in 90 cases, satisfied in 66 cases, not certain in 5 cases, and not satisfied in 2 cases. No significant difference was found in satisfaction and anterior knee pain among patients with different grades of cartilage degeneration (P gt; 0.05). Conclusion Patellar non-resurfacing has no effect on the effectiveness after TKA.
Objective To review the progress in the prevention and repair of patellar ligament injury in total knee arthroplasty. Methods Recent literature about the prevention and repair of patellar ligament injury in total knee arthroplasty was reviewed and analyzed. Results Increased exposure can prevent the patellar ligament injury, and treatments of acute patellar ligament rupture can be obtained by simple repair, reconstruction with allograft materials or artificial materials, and auxiliary strengthening. Conclusion Patellar ligament injury in total knee arthroplasty should not be ignored. Active prevention and repair of patellar ligament injury can obtain better function of knee joint.
Objective To investigate the management of extention apparatus and cl inical results of total knee arthroplasty (TKA) of osteoarthritis. Methods Between June 2007 and June 2009, 386 patients (460 knees) with osteoarthritis received TKA, including 216 left knees and 244 right knees. There were 125 males (145 knees) and 261 females (315 knees) with an average age of 60.3 years (range, 58-85 years). The disease duration was 4-12 years (mean, 6.7 years). The X-ray films and CT scanning showed that all patients had femur-tibia joint degeneration and osteophyte formation at the edgeof joint. According to modified Burnett patellar resurfacing indication, whether or not to replace the patellar was determined, and the patellar track was determined by combining no thumb test and towel clamp traction test. Patella resurfacing was performed in 53 cases (56 knees, resurfacing group), no patella resurfacing in 333 cases (404 knees, non-resurfacing group), and lateral retinacular releasing 68 cases (72 knees). The postoperative imaging and knee society score (KSS), patellofemoral compl ications were analyzed. Results All wounds healed by first intention. All the patients were followed up 1-3 years (mean, 26 months). Deep infection occurred in 3 cases (1 case of resurfacing group and 2 cases of non-resurfacing group) at 3-7 months and they were cured after two-stage reversion. Patellofemoral compl ications occurred in 2 cases of resurfacing group (2/56, 3.57%) and in 9 cases of non-resurfacing group (9/404, 2.23%), showing no significant difference (χ2=0.38, P=0.54). There were significant differences in KSS and visual analogue scale (VAS) at 2 and 3 year after operation when compared with before operation (P lt; 0.05). No significant difference in KSS and VAS of resurfacing group and non-resurfacing group were observed at 3 years after operation (P gt; 0.05). Conclusion It is benefit for selective patellar resurfacing and the patellar tract improvement to select patellar resurfacing indication according to the multi-factor assessment and to determine the patellar tract by combining no thumb test and towel clamp traction test, which can reduce the patellofemoral compl ication rate after TKA.
Objective To investigate the treatment and effectiveness of inferior polar comminuted fractures of patella and patellar tendon injury. Methods Between January 2003 and December 2008, 5 patients with inferior polar comminuted fractures of patella and patellar tendon injury were treated with Nitinol Patellar Concentrator and fascia lata allograft. There were 3 males and 2 females with a mean age of 33.7 years (range, 20-48 years). The interval of injury and operation was 1-5 days. Fracture degree: 3 cases had 3 fractures of patella, 2 cases had 4 fractures; patellar tendon injury degree: 3cases had horizontal rupture of middle l igament, 1 case had obl ique rupture of tibial tubercle, and 1 case had longitudinal partial rupture. Results Heal ing of incision by first intention was achieved in all patients, and no compl ication of infection or deep venous thrombosis occurred. The X-ray films at 2 days after surgery showed that patella recovered to normal height, which meaned ratio of patella height to patellar tendon length recovered to 1 : 1. Five cases were followed up 18 months on average (range, 10-22 months). At 3-12 weeks after surgery, the knee function of the injury side almost reached that of the normal side in 4 patients, and the knee range of motion was about 100° in 1 patient. The fracture heal ing time was 3-5 months. At 12-15 months after surgery, patella holder was taken out and no lost of reduction or refracture occurred. During follow-up, there was no fracture displacement, loosening and breakage of implant, or rerupture of patellar tendon. According to ZHANG Chuncai’ s criterion for knee joint function, the results were excellent in 3 cases, good in 1 cases, and fair in 1 case with an excellent and good rate of 80%. According to XU Shaoting’s criterion for knee joint function, the results were excellent in 2 cases, good in 2 cases, and fair in 1 case with an excellent and good rate of 80%. Conclusion Nitinol Patellar Concentrator and fascia lata allograft is a new method to treat inferior polar comminuted fractures of patella and patellar tendon injury, and it can ensure the knee joint stabil ity in early motion after surgery.
Objective To investigate the cl inical therapeutic results of allograft tendon for anatomical reconstruction of medial patellofemoral l igament (MPFL) in patellar dislocations. Methods From September 2005 to June 2008, 20 patientswith patellar dislocation underwent MPFL reconstructions. There were 4 males and 16 females, aged 13 to 31 years (19 years on average). Patellar dislocations occurred in 7 left and 13 right knees, including 6 cases of acute dislocation and 14 cases of recurrent dislocation. The disease course was 1 day to 2 years. The frequency of dislocation was 1-6 (4 on average). Affected knee joint showed pain, swell ing and patellar instabil ity; the range of action for patella obviously increased. The X-ray films showed patellar dislocation or medial margin avulsion fracture. The preoperative Q angle was (15 ± 3)°, the congruence angle was (10 ± 11)°. Reconstruction was performed via allograft tendon. Allograft tendon was anchored to the superomedial pole of the patella by two bone anchors, and the other end was fixed at the natural MPFL insertion site near the medial femoral condyle with an interference screw in a bone tunnel. All patients were evaluated postoperatively; Kujala patellofemoral scores, objective knee function, compl ications, and reoperations were assessed. Results Primary heal ing was achieved in 18 cases and secondary heal ing in 2 cases. No infection or necrosis and absorption of grafts was observed. All patients were followed up for an average of 25.6 months (range, 6-34 months) postoperatively. At last follow-up, other patients had no pain, swell ing and patellar instabil ity except 1 case; neither patella redislocation nor fracture occurred. The X-ray films showed good position of anchors and tunnel 6 months after operation, and the congruence angle was (3 ± 8)°, showed statistically significant difference when compared with preoperation (P lt; 0.05). The postoperative Q angle was (15 ± 2)°, the Kujala knee function score improvedsignificantly from 60.8 ± 7.2 to 83.4 ± 8.0 at last follow-up, showing statistically significant difference (P lt; 0.05). According to Insall et al. for function, the results were excellent in 12 cases, good in 6 cases, and fair in 2 cases, the excellent and good rate was 90%. Conclusion MPFL reconstruction improves cl inical symptoms. Anatomical MPFL reconstruction is effective for patellar dislocation, and it offer good recovery of the pre-morbid patella mechanics. There would be l ittle bone loss when tendon is fixed by anchors, and there would be less patellar fracture than bone tunnel technique. The bone anchors also provide firm fixation. Allograft can avoid the graft harvest site morbidity, but it increases the cost of the surgery.
Objective To explore the surgical method and cl inical short-term outcomes of internal fixation combined closed reduction with arthroscope aid in treating patellar fracture. Methods From June 2004 to July 2008, 42 patients with fresh simple patellar fracture underwent internal fixation combined closed reduction with arthroscope aid, included28 males and 14 females, aged 16-59 years (35 years on average). The locations were 19 left knees and 23 right knees. Injury was by traffic accident in 21 cases, by fall ing in 11 cases, by sports in 7 cases and by crush in 3 cases. All the patients had fresh closed fracture, including 38 cases of transverse fracture and 4 cases of stellate fracture. The Lysholm score was 68.60 ± 15.20; the proprioceptive function of the knee joints was (3.72 ± 0.12)°. The time from injury to operation was 3-42 hours (12 hours on average). After the treatment of affil iated injury under the arthroscope, patellar fracture was reduced with manipulation method, fracture was fixed with tensile force screw or modified tension band. Results All incisions obtained heal ing by first intention after operation, 42 patients were followed up for 12-39 months (16 months on average). The X-ray films showed callus at the fracture and the smooth cartilage surface 6-9 weeks (7 weeks on average) after operation. The flexed motion range of knee joint at last follow-up was at normal range in 38 cases, was l imited in 4 cases. Circumference of suffered l imbs 15 cm above the patella was the same as normal ones in 23 cases, atrophied 0.7 cm in 19 cases. There were no breakage of internal fixation and shift of fracture and patellofemoral arthritis at last follow-up. The proprioceptive function of the knee joints was (2.06 ± 0.11)° and the Lysholm score was 95.10 ± 3.92; all showing statistically significant differences when compared with preoperation (P lt; 0.05). Conclusion This treatment method has advantages as follows: mini-wound, early exercises and few compl ications, which can rinse articular cavity and repair the affil iated injury at the same time.
Objective To investigate the advance in surgical treatment of inferior pole fracture of patella and to explore the existing problems and further research directions. Methods Domestic and foreign l iterature in recent years on patella fracture was extensively reviewed, the surgical treatment of inferior pole fracture of patella was summarized by combining the research findings with cl inical experience. Results The surgical treatment of inferior pole of patella fractures included retaining the integrity of the patella and partial patellectomy of inferior pole of patella and extending knee installationreconstruction. There were kinds of ways to retain the integrity of the patella, such as circular wire fixation, tension bandfixation, NiTi-patella concentrotor fixation, basket plate fixation, reforming McLaughl in way and polydioxanone suture netfixation; the latter category is partial patellectomy and extensor device reconstruction. Every surgical way had its advantages and l imitations. Conclusion Most studies tend to retain the integrity of the patella, but some researches have shown that partial resection of inferior pole of patella had no significant effect on knee function. It is important to obtain the security excisional range and elongation range postoperative by experiment for regulating the treatment of comminuted fractures of inferior pole of patella.
Objective To explore the cl inical effectiveness of arthroscopic reconstruction of medial patellofemoral l igament (MPFL) with trabs of medial soft tissues in the treatment of patellar instabil ity of adolescence. Methods From January 2005 to December 2006, 23 cases of patellar instabil ity were treated, including 10 males and 13 females with an average age of 16 years old (13 to 20 years old). The locations were left knee in 11 cases, right knee in 12 cases. The disease course was 1-28 weeks (mean 15 weeks). All patients had patellar instabil ity sense and knee arthralgia during strenuous exercise. Preoperative, the International Knee Documentation Committee (IKDC) score and Lysholm score were 48.30 ± 5.77 and 50.80 ± 7.61. The congruence angle, lateral patellar angle, and Q angle were (9.00 ± 2.46), (2.94 ± 2.55) and (19.10 ± 4.16)°. All of the patients experienced the operation of reconstruction of MPFL with trabs of medial soft tissues (medial patellar retinaculum, joint capsule and vastus medial is obl ique muscle fiber) through arthroscope. Results All the wounds healed by first intention, and no postoperative early compl ication occurred. All cases were followed up 19 months on average (12 to 24 months). Apprehensive test and patella tilt test were negative. The range of motion returned to normal. There was no recurrence of dislocation after operation. At 12 months after operation, the congruence angle, lateral patellar angle, and Q angle were (—7.03 ± 0.60), (11.00 ± 3.47) and (11.30 ± 1.90)°; the IKDC score and Lysholm score were 93.20 ± 3.51 and 94.10 ± 4.26. There were statistically significant differences between preoperation and postoperation (P lt; 0.05). Conclusion Arthroscopic reconstruction of MPFL with trabs of medial soft tissues can improved obviously the affected limb function in treatment of patellar instabil ity of adolescence.
【Abstract】 Objective To make the young patients with osteoarthritis and genu varum of knee delay total knee arthroplasty,to observe the cl inical effect of mosaicplasty of femoral medial condyle, patellar-plasty and high tibial osteotomy inthe treatment of osteoarthritis of knee with varum. Methods From June 2004 to February 2006, 8 patients with osteoarthritisof knee with varum(10 knees) were treated with combined operation such as mosaicplasty of femoral medial condyle, patellarplastyand high tibial osteotomy. There were 2 males with 3 knees, and 6 females with 7 knees,with an average age of 50 years(42-56 years). The left knees and right knees were involved in 3 cases respectively and bilateral knees in 2 cases. All patients hadknee ache after walk or long-time standing. The X-ray showed hyperosteogeny at peri-patella and circum ferential femur-tibialjoint，especially in the medial. The gap between patella and femur narrowed or disappeared，especially in the medial femurtibialjoint. The femoral tibial angel (FTA) was 185-200°(mean 190°). The HSS score of knee was 55-75(mean 60). The history ofknee ache was 1-12 years(mean 5 years). Results All patients were followed up for 7-24 months (mean 15 months). All theincisions healed by first intention, no early compl ication occurred. The cl inical bone heal ing time was 8-11 weeks(mean 9 weeks).Rectification of FTA was 15-30°(mean 20°). Normal weight-loading al ignment was recovered. The valgus angle of knee was 10°.The range of motion of knee was 100-120° after operation, increasing by 5-20° (mean 10°) when compared with preoperation.The X-ray of postoperation showed that genu varum was corrected obviously and that no displacement, loosening and breakageoccurred. The mean score of HSS was 80 (75-88), increasing by 20 when compared with preoperation. Conclusion Mosaicplastyof femoral medial condyle can make articular cartilage repair in certain degrees, patellar-plasty can rel ieve ache of fore region of knee effectively, and high tibial osteotomy can recover normal weight-loading al ignment. The curative effect is good withthe combined methods.