ObjectiveTo evaluate the short-term effectiveness of a modified Laprade technique in the treatment of lateral multi-ligament injuries of knee by anatomical reconstruction of posterolateral complex (PLC) and anterior lateral ligament (ALL).MethodsBetween June 2013 and July 2015, 13 cases of lateral multi-ligament injuries of knee were treated. There were 9 males and 4 females with an average age of 38 years (range, 23-49 years). The injury was caused by traffic accident in 7 cases, falling from height in 4 cases, and sport injury in 2 cases. The time between injury and operation was 18-92 days (mean, 43 days). The results of anterior and posterior drawer tests and Lachmann test were positive, and all cases complicated by varus and external rotation instability. The Lysholm score of the knee was 38.4±7.7. According to International Knee Documentation Committee (IKDC) scoring, all were rated as grade D. According to Fanelli classification criteria, all were classified as type C. Anterior cruciate ligament, posterior cruciate ligament, PLC, and ALL were reconstructed simultaneously with autogenous tendon.ResultsAll incisions healed at stage I and no complication occurred. All patients were followed up 12-36 months (mean, 19 months). At last follow-up, the results of anterior and posterior drawer tests and Lachmann test were negative; 2 cases had varus instability, and 1 cases had external rotation instability. There was no anterior external rotation instability. The Lysholm score of the knee was 88.6 ±12.7, showing significant difference when compared with preoperative score (t=13.852, P=0.000). According to IKDC scoring, 8 cases were rated as grade A, 4 as grade B, and 1 as grade C; significant difference was found when compared with preoperative value (Z=3.182, P=0.000).ConclusionIn the treatment of lateral multi-ligament injuries knee, anatomical reconstruction of PLC and ALL with a modified Laprade technique can obtain good short-term effectiveness.
ObjectiveTo evaluate and compare knee joint stability of grade Ⅲ medial collateral ligament (MCL) injury treated by single-bundle and anatomical double-bundle reconstruction methods, thus providing biomechanical basis for clinical treatment.MethodsNine fresh cadaver specimens of normal human knee joints were randomly divided into 3 groups on average. In intact MCL group: The anterior cruciate ligament (ACL) was detached and reconstructed with single-bundle techniques, and the MCL was intact. In single-bundle and double-bundle reconstruction groups, the superficial MCL (sMCL), posterior oblique ligament (POL), and ACL were all detached to manufacturing grade Ⅲ MCL injury models. After single-bundle reconstruction of ACL, the sMCL single-bundle reconstruction and anatomical double-bundle reconstruction of sMCL and POL were performed, respectively. Biomechanical evaluation indexes included anterior tibial translation (ATT), internal rotation (IR), valgus rotation (VAL), and stresses of MCL and ACL under internal rotation and valgus torques at different ranges of motion of the knee joint.ResultsThere was no significant difference in ATT at full extension and flexion of 15°, 30°, 45°, 60°, and 90° between groups (P>0.05). At full extension and flexion of 15°, the IR and VAL were significantly higher in single-bundle reconstruction group than in double-bundle reconstruction group and intact MCL group (P<0.05). At flexion of 30°, the VAL was significantly higher in single-bundle reconstruction group than in double-bundle reconstruction group and intact MCL group (P<0.05). While there was no significant difference between double-bundle reconstruction group and intact MCL group (P>0.05). There was no significant difference in the stresses of MCL and ACL between groups under the internal rotation and valgus torques at all positions (P>0.05).ConclusionMCL anatomical double-bundle reconstruction can acquire better valgus and rotational stability of the knee joint compared with single-bundle reconstruction.
ObjectiveTo investigate the effectiveness of anatomical reconstruction of the anterior talofibular ligament by partial peroneal brevis tendon combined with double intra-fix screws.MethodsA clinical data of 46 patients with the anterior talofibular ligament rupture admitted between September 2015 and October 2019 and met the selection criteria were retrospectively analyzed. All anterior talofibular ligaments were reconstructed with partial peroneal brevis tendon and fixed with double intra-fix screws. There were 22 males and 24 females, with an average age of 28.1 years (range, 16-52 years). Forty cases had a history of ankle sprain, 1 case was injured by a heavy object, and 5 cases were suffered from falls. There were 17 cases on the left side and 29 cases on the right side. The disease duration ranged from 3 months to 10 years (median, 20.3 months). The visual analogue scale (VAS) score, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, varus angle of ankle, and the difference of the anterior talar translation between healthy and affected sides (looseness, similarity, tightness) were recorded before and after operation; 23 patients were evaluated by Patient-Reported Outcomes Measurement Information System (PROMIS) score, including pain interference (PI) and physical function (PF) scores.ResultsThe operation time was 39-179 minutes, with an average of 65.8 minutes. All incisions healed by first intention. All patients were followed up 12-30 months (mean, 23 months). The VAS score, AOFAS ankle-hindfoot score, varus angle of ankle, difference of the anterior talar translation between healthy and affected sides, and PI and PF scores of PROMIS at 6 months and last follow-up significantly improved when compared with those before operation (P<0.05). There was no significant difference in VAS score, PI score of PROMIS, and AOFAS ankle-hindfoot score between at 6 months and at last follow-up (P>0.05). However, the PF score of PROMIS, the difference of the anterior talar translation between healthy and affected sides, and the varus angle of ankle were significant (P<0.05).ConclusionAnatomical reconstruction of the anterior talofibular ligament by partial peroneal brevis tendon and double intra-fix screws has the advantages of small incision, convenient tendon removal, and firm graft fixation. The postoperative patients recover quickly and the effectiveness is satisfactory.
Objective To investigate the surgical technique and effectiveness of anatomical posterolateral complex (PLC) reconstruction in treating severe posterolateral knee instability using Y-shaped allogeneic Achilles tendon. Methods The clinical data of 12 patients with Fanelli type C chronic PLC injury with severe posterolateral knee instability who met the selection criteria between June 2013 and August 2017 were retrospectively analyzed. There were 9 males and 3 females, with a median age of 34.5 years (range, 18-57 years). The average time from injury to surgery was 10.5 months (range, 3-24 months). All of them were multi-ligament injuries and were treated with anatomical reconstruction of Y-shaped allogeneic Achilles tendon. The posterior and varus stress X-ray films were used to measure and calculate the difference of posterior displacement of tibia and difference of lateral joint opening distance between bilateral knees to evaluate the backward stability of LCL and knee joint; the knee flexion 30° tibial external rotation test was used to calculate the difference of tibial external rotation angle between bilateral knees to evaluate the stability of knee external rotation. The knee function was evaluated by the International Knee Documentation Committee (IKDC) 2000 subjective and objective scores. ResultsThe operation successfully completed in 12 patients, and there was no vascular and nerve injury during operation. The operation time was 2.5-3.5 hours, with an average of 2.7 hours; the intraoperative blood loss was 20-100 mL, with an average of 55 mL. All patients were followed up 13-41 months, with an average of 28.1 months. At last follow-up, the difference of posterior displacement of tibia, the difference of lateral joint opening, the difference of tibial external rotation angle between bilateral knees, and the IKDC2000 subjective score, the objective scores of tibial external rotation and knee varus significantly improved when compared with those before operation (P<0.05). The knee joint of 1 patient with anterior cruciate ligament, posterior cruciate ligament, and PLC reconstruction was stiff at 15 months after operation, and the range of motion of the knee joint was 10°-80°. After arthroscopic release, the range of motion of the knee joint was 5°-120°, the reconstructed ligament was stable. In the other patients, the knee flexion angle was normal in 2 cases; 9 cases had knee flexion limitation of 5°-10°, with an average of 6.4°; no knee extension was limited. ConclusionAnatomical PLC reconstruction using Y-shaped allogeneic Achilles tendon can effectively treat Fanelli type C chronic PLC injury with severe posterolateral knee instability and improve the knee joint stability.
Objective To investigate the effectiveness of TightRope system combined with Locking-Loop biplane anatomical reconstruction technique in the treatment of acute acromioclavicular joint dislocation. Methods A clinical data of 28 patients with acute acromioclavicular joint dislocation who met the selection criteria and admitted between June 2018 and December 2021 was retrospectively analyzed. There were 18 males and 10 females, with an average age of 47.7 years (range, 22-72 years). The causes of injury included falling (13 cases) and traffic accidents (15 cases). The acromioclavicular joint dislocation was rated as Rockwood type Ⅲ in 7 cases, type Ⅳ in 16 cases, and type Ⅴ in 5 cases. The time from injury to operation was 4-13 days, with an average of 9.5 days. The acromioclavicular joint dislocation was reconstructed with TightRope system and high-strength wire by Locking-Loop methods during operation. The operation time and complications were recorded. Visual analogue scale (VAS) score, Constant-Murley score, and active range of motion of shoulder (forward flexion and upward lift, abduction and upward lift, and external rotation) were recorded before operation and at 12 months after operation to evaluate the functional recovery of shoulder. The loss of acromioclavicular joint reduction was assessed by comparing the coracoclavicular distance (CCD) based on the anteroposterior X-ray films at 3 days and 12 months after operation. Results The operation time was 58-100 minutes (median, 85 minutes). All incisions healed by first intention. All patients were followed up 12 months. During follow-up, 2 patients developed shoulder adhesion, which recovered after rehabilitation exercise. At 12 months after operation, the VAS score was significantly lower, the Constant-Murley score was significantly higher, and the range of motion of the shoulder joint (forward flexion and upward lift, abduction and upward lift, and external rotation) significantly increased when compared with preoperative ones (P<0.05). X-ray films showed that the CCD was 8.4 (7.3, 9.4) and 9.2 (8.1, 10.1) mm at 3 days and 12 months after operation, respectively, with a significant difference (Z=−4.665, P<0.001). During follow-up, there was no complication such as infection, titanium plate entrapment, fracture, internal fixation failure, or redislocation. ConclusionThe treatment of acute acromioclavicular joint dislocation with TightRope system combined with Locking-Loop biplane anatomical reconstruction has the advantages of small incision, joint reduction under direct vision, high fixation strength, and low incidence of postoperative complications, which can effectively relieve the pain of patients’ shoulder joint and facilitate the recovery of shoulder joint function.