Objective To investigate the effectiveness of arthroscopic medial retinaculum plication (MRP) for acute patellar dislocation (APD) in adolescents. Methods Between March 2007 and June 2011, 24 adolescent patients suffering from APD were treated by arthroscopic MRP. There were 14 males and 10 females, aged 8-18 years (mean, 12.7 years). The location was the left knee in 16 cases and the right knee in 8 cases. Injury was caused by sports in 19 cases, by traffic accident in 4 cases, and by heavy bruising in 1 case. The duration from injury to operation was 3 to 21 days with an average of 7.8 days. The results of floating patella test and dislocation apprehension test were both positive. MRI examination showed the arthroedema in all cases; associated injuries included medial retinaculum injury in 20 cases, medial patellar injury in 8 cases, and meniscus tear in 5 cases. Results All incisions healed by first intention without complication of infection or neurovascular injury. All the patients were followed up 12-36 months (mean, 14.6 months). Only 2 patients suffered from patellar re-dislocation at 4 months and 6 months after operation respectively. The knee joint activity returned to normal at 12 months. The Lysholm, Kujala, and International Knee Documentation Committee (IKDC) scores at 3 and 12 months after operation were significantly higher than those before operation (P lt; 0.05), and the scores at 12 months were significantly higher than those at 3 months (P lt; 0.05). Conclusion Treatment of APD with arthroscopic MRP has the advantages of minor trauma and good knee functional improvement. The technique can decrease incidence of patellar re-dislocation in adolescent.
Objective To investigate the injury mechanism, clinical characteristics, and treatments of Segond fracture and complications. Methods Fifteen patients suffering from Segond fracture were treated between January 2007 and December 2011. There were 10 males and 5 females, aged 16-50 years (mean, 31.8 years). Fracture was caused by traffic accident in 8 cases, by sports in 6 cases, and by bruise in 1 case. Before operation, the knee range of motion (ROM) was (36.60 ± 8.94)°; the Lysholm score was 32.27 ± 3.73; and the International Knee Documentation Committee (IKDC) score was 42.34 ± 4.97. The duration from injury to operation was 1-3 weeks with an average of 1.2 weeks. In 12 patients having associated anterior cruciate ligament (ACL) injury, arthroscopic reconstruction of ACL was performed with allogeneic anterior tibial tendon; in 2 patients having associated avulsion fracture of the intercondylar eminence of the tibia, arthroscopic fracture reduction and fixation with Orthocord wire were performed. In 8 patients having associated meniscus injury, meniscus suture and meniscectomy were performed in 3 and 5 patients, respectively. In 7 patients having associated collateral ligament injury, conservative treatment was given in 5 patients, and medial collateral ligament was repair in 2 patients. Results All incisions healed primarily without complications of infection and nerve or blood vessel injury. All the patient were followed up 12-16 months (mean, 14.3 months). At 12 months after operation, the results of anterior drawer test, Lachman test, and lateral stress test were all negative. The knee ROM was (129.27 ± 5.89)°, the IKDC score and Lysholm score were significantly increased to 89.45 ± 3.05 and 87.87 ± 4.12 at 12 months after operation; all showing significant differences when compared with preoperative values (P lt; 0.05). Conclusion Segond fracture is often combined with ACL, collateral ligament, and meniscus injuries, and the evidence of Segond fracture can bly suggests the knee injury. Personalized treatment should be chosen according to complications.