ObjectiveTo study the effect of the femoral tunnel position on the knee function recovery after medial patellofemoral ligament (MPFL) reconstruction. MethodsA retrospective analysis was made on the clinical date of 43 cases (43 knees) of recurrent patellar dislocation undergoing MPFL reconstruction and patellofemoral lateral retinaculum lysis between August 2013 and March 2014. There were 12 males and 31 females, aged 19.4 years on average (range, 9-35 years). All patients had trauma history and recurrent dislocations. The results of apprehesion test and J syndrom were positive. The patellar tilt test showed patellofemoral lateral retinaculum was tension. The effectiveness was evaluated using Lysholm knee functional score after operation. The distance from the center of the femoral tunnel to the femoral isometric point was measured on CT three dimensional reconstruction image. Whether the femoral tunnel position was isometric was evaluated. The correlation was analyzed between the distance from the center of the femoral tunnel to the femoral isometric point and Lysholm score. ResultsPrimary healing of incision was obtained in all patients. The patients were followed up 13-18 months (mean, 15 months). No patellar dislocation or subluxation occurred. The result of apprehensive test was negative. At last follow-up, the average Lysholm score was 93.8 (range, 83-100). The average distance from the center of the femoral tunnel to the femoral isometric point was 5.61 mm (range, 2-16 mm). The femoral tunnel position was isometric in 30 cases (69.8%) and non-isometric in 13 cases (30.2%). The distance from the center of the femoral tunnel to the femoral isometric point was negatively correlated with postoperative Lysholm score (r=-0.851, P=0.000). The postoperative Lysholm score was 95.7±2.3 in patients with isometric tunnel and was 89.4±3.5 in patients with non-isometric tunnel, showing significant difference (t=6.951, P=0.000). ConclusionFor patellofemoral joint instability, preparing the femoral isometric tunnel can establish a good foundation for the recovery of the knee function in MPFL reconstruction.
ObjectiveTo evaluate the clinical results of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fractures in adolescents with epiphyseal unclosure. MethodsBetween January 2011 and October 2013, 35 knees with ACL tibial eminence avulsion fractures (35 patients with epiphyseal unclosure) were arthroscopically treated with suture fixation. There were 25 males and 10 females, aged 8-16 years (mean, 14.7 years). The causes included sports injury in 24 cases, traffic accident injury in 9 cases, and daily life injury in 2 cases. According to Meyers-McKeever classification criteria, there were 27 cases of type Ⅱ and 8 cases of type Ⅲ. Five cases had meniscus injury. The preoperative the International Knee Documentation Committee (IKDC) score was 48.7±3.2, and Lysholm score was 51.2±4.5. The time from injury to operation was 2-16 days (mean, 5 days). ResultsPrimary healing of incision was obtained in all patients. The mean follow-up time was 22.4 months (range, 12-32 months). Anatomical reduction was achieved in 28 cases and satisfactory reduction in 7 cases. X-ray films showed all fractures healing at last follow-up. There was no limb shortening deformity, varus knee, or valgus knee. Lachman test results were all negative. The other knees had normal range of motion except 1 knee with limited flexion, whose range of motion returned to 0-120° after treatment. At last follow-up, the IKDC score was significantly improved to 93.2±4.1 (t=-53.442, P=0.000), and the Lysholm score was significantly increased to 96.2±2.5 (t=-56.242, P=0.000). ConclusionThe arthroscopic fixation technique has satisfactory results for the reduction and fixation of ACL tibial eminence avulsion fracture in the adolescents with epiphyseal unclosure because of little trauma and quick recovery.
ObjectiveTo evaluate the effectiveness of arthroscopically assisted treatment of posterior cruciate ligament (PCL) tibial eminence avulsion fractures associated with meniscus posterior horn tear. MethodsBetween January 2012 and December 2014, 21 patients with PCL avulsion fracture and meniscus posterior horn tear were arthroscopically treated with polyester suture and hollow screw fixation. There were 10 males (10 knees) and 11 females (11 knees), aged 14-53 years (mean, 35.7 years). The causes included sport injury in 11 cases, traffic accident injury in 9 cases, and daily life injury in 1 case. Based on the anteroposterior and lateral X-ray films, CT, and MRI, PCL avulsion fractures were diagnosed, and 2 cases had anterior cruciate ligament avulsion fractures. The results of posterior drawer test were positive in all patients, with no end point in 14 cases and with soft end point in 7 cases; all patients showed tibial sink. The preoperative International Knee Documentation Committee (IKDC) score and Lysholm score were 46.5±5.5 and 43.3±4.5 respectively. The time from injury to operation was 6-22 days (mean, 10 days). ResultsThe operation time was 60-100 minutes (mean, 75 minutes). Primary healing of incision was obtained in all patients, without no complication of infection. The mean follow-up time was 27.4 months (range, 12-46 months). The results of posterior drawer test were negative in 19 cases, and positive in 2 cases (having hard end point). Tibial sink disappeared. At last follow-up, X-ray film showed good healing of fracture, and no displacement. The patients had no locking knee, snapping or tenderness of joint space, and the Mcmurray sign was negative; the IKDC score and Lysholm score were significantly improved to 92.0±2.5 and 92.7±2.6 respectively (t=-39.903, P=0.000; t=-43.242, P=0.000). The range of motion was normal in 20 patients (0-130°) except 1 patient having limited flexion (0-80°), whose range of motion returned to 0-120° after release. ConclusionThe arthroscopic fixation technique has satisfactory results for the reduction and fixation of PCL avulsion fracture associated with meniscus posterior horn tear because of easy operation, firm fixation, and economic price.