ObjectiveTo explore the relationship between anterior cruciate ligament (ACL) reconstruction failure and medial meniscus injury and decide whether medial meniscus injury could be the judgment index for ACL reconstruction failure without trauma history. MethodsBetween March 2011 and December 2015, 117 patients underwent ACL reconstruction, and the clinical data were analyzed retrospectively. All patients had no trauma history after ACL resconstruction. MRI examination showed medial meniscus injury in 56 cases (observation group) and no medial meniscus injury in 61 cases (control group). There was no significant difference in gender, age, side, reconstructive surgery, and follow-up time between 2 groups (P>0.05). The KT-2000 arthrometer was used to measure the difference value of tibial anterior displacement between two knees in 30° knee flexion. Then wether the ACL reconsruction failure was judged according to the evaluation criteria proposed by Rijke et al. ResultsIn observation group, the difference value of tibial anterior displacement was <3 mm in 7 patients, 3-5 mm in 11 patients, and >5 mm in 38 patients. In control group, the difference value of tibial anterior displacement was <3 mm in 31 patients, 3-5 mm in 18 patients, and >5 mm in 12 patients. The ACL reconstruction failure rate of observation group (67.9%) was significantly higher than that of control group (19.7%) (χ2=27.700, P=0.000). ConclusionAfter ACL reconstruction, medial meniscus injury occurs under no trauma history circumstances, indicating ACL reconstruction failure.
ObjectiveTo evaluate the safety of arthroscopic operation with artificial space on the buttocks for gluteal muscles contracture (GMC) by measuring the plasma osmolarity. MethodsBetween May and June 2011, 30 cases of GMC were joined in the study. Of them, 11 were male and 19 were female with an age range from 4 to 39 years (mean, 24.4 years). Twenty-eight patients had a definite history of repeat intragluteal injection. The disease duration ranged from 1-30 years (mean, 14 years). During operation, normal saline solution was used as lavage fluid, and radiofrequency energy was used as cutter for releasing GMC. The plasma sodium, plasma potassium, blood glucose, blood urea nitrogen concentrations, and plasma osmolarity were compared before and after operation; input and output volume of lavage fluid and intravenous dropping volume were recorded. Whether patients suffered from water intoxication or not was observed. The effect was evaluated through the criteria proposed by XIA Rongxi et al. ResultsThe operation was successfully completed in all patients, who had no water intoxication. The operation time was 16-70 minutes (mean, 33.4 minutes). The input volume was 2-23 L (mean, 6.3 L), the output volume was 2-22 L (mean, 5.8 L), and the absorption volume was 0.1-1.2 L (mean, 0.5 L); and the intravenous dropping volume was 350-1 300 mL (mean, 850 mL). No significant difference was found in plasma sodium, plasma potassium, blood glucose, blood urea nitrogen concentrations, and plasma osmolarity between before and after operations (P>0.05). All patients were followed up 3-26 months (mean, 12.7 months). At last follow-up, according to XIA Rongxi's et al evaluation standard, the results were excellent in 27 cases, good in 3 cases, and the excellent and good rate was 100%. ConclusionArthroscopic operation with artificial space on the buttocks is safe and reliable in the treatment of GMC.
ObjectiveTo investigate the reliability of the "ripple sign" on the upper surface of the medial femoral condyle in the diagnosis of medial longitudinal meniscal tears under arthroscope. MethodsBetween June 2013 and June 2014, 56 patients with knee injuries were included. There were 35 males and 21 females with an average age of 22.2 years (range, 12-38 years). The causes of injury were sports in 40 cases, falling in 10 cases, and traffic accident in 6 cases. The injury was located at the left knee in 22 cases and at the right knee in 34 cases. The disease duration was 10-40 days (mean, 20.2 days). Of 56 patients, 15 cases had simple medial meniscal injury; 41 cases had combined injuries, including anterior cruciate ligament injury in 38 cases, posterior cruciate ligament injury in 2 cases, and patellar dislocation in 1 case. The "ripple sign" was observed under arthroscope before operation. Repair of medial meniscal injury and reconstruction of cruciate ligament were performed. ResultsThe positive "ripple sign" was seen under arthroscope in all patients, who were diagnosed to have longitudinal meniscal tears, including 23 cases of mild "ripple sign", 28 cases of moderate "ripple sign", and 5 cases of severe "ripple sign". ConclusionThe "ripple sign" on the upper surface of the medial femoral condyle is a reliable diagnostic evidence of medial longitudinal meniscal tears.
ObjectiveTo observe the anatomical morphology of the tibial insertion of the anterior cruciate ligament (ACL) in Chinese adults so as to offer theoretical guidance for ACL reconstruction and meniscus transplantation. MethodsFifteen adult cadaveric knees (8 left knees and 7 right knees) were dissected, including 10 males and 5 females, with an age ranged from 25 to 47 years (mean, 32.4 years). All knees were generally observed through standard medial parapatellar approaches, then the ACL midsubstance and the tibial insertion (direct and indirect insertions) were anatomically measured. ResultsIn all specimens, the ACL was flat with a lot of fine fibers. The anteromedial bundle and posterolateral bundle could be observed in 13 of 15 knees. However, no obvious bundles were found in 2 knees. The arc-shaped tibial direct insertion started at the medial tibial eminence and ended at the anterior horn of the lateral meniscus. The width of the arc was (11.2±2.4) mm; the thickness was (3.0±0.3) mm; and the cross-sectional area was (28.8±7.8) mm2. And the left-right diameter of the whole insertion was (9.5±1.8) mm; anteroposterior diameter was (11.9±0.6) mm; and the cross-sectional area was (117.8±12.5) mm2. The width of the anterior horn of lateral meniscus was (12.3±2.0) mm. The anterior horn of lateral meniscus was surrounded by arc-shaped direct insertion in the middle, and its fibers were partly intertwined with indirect insertion of ACL. ConclusionAnatomical ACL reconstruction may therefore require a arc-shaped tibial footprint. There are overlap covering relationship between the attachment location of anterior horn of the lateral meniscus and tibial insertion of ACL. It should pay more attention to protecting tibial insertion of ACL in lateral meniscus transplantation.