ObjectiveTo investigate the effect of the femoral tunnel angle on the femoral tunnel after anterior cruciate ligament (ACL) reconstruction in rabbits. MethodsFifty-four healthy 4-5 months old rabbits (weighing, 1.8-2.3 kg, male or female) were randomly divided into 3 groups (n=18). The ACL reconstruction models of the right knee were established in 3 experimental groups using its Achilles tendons, and the left knee served as the control group. On the coronal position, the angle between the femoral tunnel and the femoral shaft axis was 30°, 45°, and 60°. The level of tumor necrosis factor α (TNF-α) in the synovial fluid at 1, 2, and 4 weeks, the maximum load of the ligament and the rate of bone tunnel enlargement at 4, 8, and 12 weeks were detected. ResultsThe level of TNF-α significantly increased, and the maximum load of the ligament significantly decreased in the 3 experimental groups when compared with ones in the control group (P<0.05), but no significant difference was found among 3 experimental groups (P>0.05). The bone tunnel enlargement was observed in 3 experimental groups at each time point and reached the peak at 4 weeks, but no significant difference was shown among 3 groups (P>0.05). ConclusionThe 30-60° angle between the femoral tunnel and the femoral shaft axis in the coronal position has no significant effect on the femoral tunnel enlargement after ACL reconstruction in rabbits.
Objective To evaluate the feasibility and effectiveness of computer-assisted preoperative planning system—ACL Detector in anterior cruciate ligament (ACL) reconstruction. Methods Between March 2009 and January 2012, 80 patients with ACL rupture received arthroscopic ACL single-bundle reconstruction with autologous hamstring tendon transplantation. Before operation, the preoperative planning was done by computer-assisted preoperative planning system—ACL Detector (trial group, n=40) or by conventional method (control group, n=40). There was no significant difference in gender, age, disease duration, injury cause, preoperative Lysholm score, and preoperative International Knee Documentation Committee (IKDC) score between 2 groups (P gt; 0.05). After operation, the effectiveness was evaluated by Lachman test, pivot shift test, Lysholm score, and IKDC score; the digital three-dimensinal model of knee was reconstructed, and the impingement rate of ACL graft was measured. Results All incisions healed by first intention, and no complication was found. The patients were followed up 18-25 months (mean, 20 months) in trial group and 18-24 months (mean, 21 months) in control group. The Lysholm score and IKDC score were significantly increased at 18 months after operation when compared with preoperative scores (P lt; 0.05), but no significant difference was found between 2 groups (P gt; 0.05). The results of Lachman test and pivot shift test at 18 months after operation were significantly better than those before operation in 2 groups (P lt; 0.05), but no significant difference between 2 groups after operation (P gt; 0.05). MRI showed that impingement was observed in 1 case of trial group (2.50%) and in 8 cases of control group (20.00%), showing significant difference (χ2=4.51, P=0.03). Conclusion The computer-assisted preoperative planning system—ACL Detector could be successfully applied to ACL reconstruction. It has the same improvement in knee functional score as conventional surgery, but it is better than conventional surgery in reducing the impingement incidence.
Objective To investigate the effectiveness of posterior cruciate ligament (PCL) reconstruction with remnant preservation and autogenous quadrupled hamstring tendons under arthroscopy. Methods Between October 2007 and August 2012, 32 patients with PCL rupture were treated and followed up for more than 1 year. There were 24 males and 8 females, aged 20-53 years (mean, 35.6 years). The causes of injury included traffic accident injury in 21 cases, sports injury in 8 cases, and falling injury from height in 3 cases. The disease duration ranged 1 week to 2 years (median, 6.3 weeks). Nine patients had simple PCL rupture, 23 patients complicated by ligament injury, including 10 cases of anterior cruciate ligament rupture, 11 cases of posterolateral corner injury, and 2 cases of posteromedial corner injury. Preoperative Lysholm score was 53.8 ± 7.1. According to the International Knee Documentation Committee (IKDC) rating criteria, 10 cases were classified as grade C and 22 cases as grade D. PCL was reconstructed with autogenous quadrupled hamstring tendons, the tendons were fixed with EndoButton at the femoral side and with interference screw at the tibial side; floats of stump were cleaned up, and the structural stability and continuity ligament remnants were preserved. Results Primary healing was obtained in all incisions; no early complication occurred after operation. Thirty-two patients were followed up 23.4 months on average (range, 12-36 months). All patients had no symptom of knee instability; the results of tibia sags sign, posterior drawer test, and Lachman test were negative. At last follow-up, the knee range of motion (ROM) returned to normal in all cases. The Lysholm score was 92.3 ± 2.0, showing significant difference when compared with preoperative score (t= — 34.32, P=0.00). According to the IKDC rating criteria, 26 cases were classified as grade A and 6 cases as grade B at last follow-up, showing significant difference when compared with preoperative grade (Z= — 5.57, P=0.00). Conclusion Arthroscopic single-bundle reconstruction of PCL with remnant preservation and quadrupled hamstring tendons has advantages of minimal trauma, simple operation, and good knee function recovery.
Objective To study the feasibility of virtual intercondylar notchplasty by applying MRI two-dimensional (2D) images to reconstruct three-dimensional (3D) images and measure the size of intercondylar notch. Methods Thirty healthy volunteers who had no knee joint disease and surgery history were selected. There were 15 females and 15 males with an age range of 20-30 years, weight range of 45-74 kg, and height range of 150-185 cm. They were divided into male group and female group, and the knees of each group were divided into 2 subgroups (the left group and right group). MRI scan of the left and right knees was performed, and the 2D images of MRI were imported into Mimics10.01 medical image control system for 3D reconstruction. The related anatomical data as follows were measured from the 3D digital model and analyzed by statistical software: notch width (NW), condylar width (CW), and notch width index (NWI). Then the 3D knee images of patients with anterior cruciate ligament (ACL) injury were collected between January and March 2010, and 4 patients with narrow intercondylar notch (NWI≤0.2) were selected for reconstructing the 3D model of the knee and simulating the intercondylar notch plasty. Then, the volume of osteotomy in 3D model was calculated and applied in the ACL reconstruction surgery, and whether the graft had impingement with intercondylar notch or not was evaluated. Results There were significant differences in NW and CW between male group and female group (P≤lt;≤0.05), but no significant difference was found in the NWI (P≤gt;≤0.05). And there was no significant difference in NW, CW, and NWI between the left and right knees both in male group and female group (P≤gt;≤0.05). After ACL reconstruction and intercondylar notchplasty, the shape of intercondylar notch became normal (NWI≤gt;≤0.22), no impingement occurred between the graft and intercondylar notch under arthroscopy within 3-month follow-up. Conclusion The shape of intercondylar notch of 3D model based on MRI 2D images is similar to the real intercondylar notch. NWI is one of important indexes which can reflect the narrow level of intercondylar notch. The virtual intercondylar notchplasty may provide preoperative plan and guidence for ACL reconstruction operation to avoid the impingement between graft and intercondylar notch after surgery.
Objective To investigate the effectiveness of portable bracket of lower limb in the reconstruction of anterior cruciate l igament (ACL) by the long fibular muscle tendon under arthroscopy. Methods Between March 2008 and September 2010, 22 patients with ACL injury were treated. The limb position was maintained by portable bracket of lower limb and ACL was reconstructed with the long fibular muscle tendon under arthroscopy. There were 15 males and 7 females with an average age of 33.8 years (range, 19-64 years). The causes of ACL injury were traffic accident injury in 14 cases, sport trauma in 5 cases, and fall ing injury in 3 cases. The locations were the left knee in 10 cases and the right knee in12 cases, including 12 fresh injuries and 10 old injuries. Of 22 patients, 17 had positive anterior drawer test, 19 had positive pivot shift test, and 20 had positive Lachman test. According to International Knee Documentation Committee (IKDC) criteria, there were 6 abnormal and 16 severely abnormal. The subjective IKDC score was 57.64 ± 6.11. The Lysholm score was 55.45 ± 4.37. Results All incisions healed by first intention, and no complication was found. All patients were followed up 9-38 months (mean, 15 months). At last follow-up, the flexion of the knee ranged from 120 to 135° (mean, 127°). One patient had positive anterior drawer test, 1 patient had positive pivot shift test, and 2 patients had positive Lachman test. No ligament loosening and breakage occurred. According to the IKDC criteria, 10 patients rated as normal, 11 patients as nearly normal, and 1 patient as abnormal. The subjective IKDC score was 90.44 ± 6.11, showing significant difference when compared with preoperative one (t=4.653, P=0.021). The Lysholm score was 90.12 ± 5.78, showing significant difference when compared with preoperative one (t=4.231, P=0.028). Conclusion Portable bracket of lower limb in the reconstruction of ACL has the advantages of saving manpower and easy operation. The long fibular muscle tendon is enough long and b to reconstruct the ACL, which can increase the contact surface between the tendon and bone and is beneficial to tendon-bone heal ing.
Objective To compare the recovery of proprioception between autograft and allograft for anterior cruciate l igament (ACL) reconstruction. Methods Between January 2008 and January 2010, 40 patients underwent ACL reconstruction with autologous tendon (autograft group, n=20) and allogeneic tendon (allograft group, n=20). No significant difference was found in gender, age, disease duration, and function scores between 2 groups (P gt; 0.05). All the patients underwent the ACL reconstruction with single-bundle technique. The knee range of motion (ROM), International Knee Documentation Committee (IKDC) score, and Lysholm score were measured after operation. The proprioception was assessedby the joint position sense (JPS) at 3 and 12 months postoperatively. The normal knee was used as control. Results Thepatients of 2 groups achieved heal ing of incision by first intention without compl ication of infection or haemarthrosis. Allpatients were followed up 12-18 months (mean, 13.5 months). There were significant differences in knee ROM, IKDC score, and Lysholm score between preoperation and 12 months postoperatively in 2 groups (P lt; 0.05). There was no significant difference in JPS 30°, JPS 60°, and JPS 90° between affected knees and normal knees in autograft group at 3 months postoperatively (P gt; 0.05). No significant difference was found in JPS 30° between affected knees and normal knees in allograft group at 3 months postoperatively (P gt; 0.05); but significant differences were found in JPS 60° and JPS 90° between affected knees and normal knees in allograft group at 3 months postoperatively (P lt; 0.05). There was no significant difference in JPS 30°, JPS 60°, and JPS 90° between affected knees and normal knees in 2 groups at 12 months postoperatively (P gt; 0.05). Significant differences were also found in JPS 60° and JPS 90° between affected knees of 2 groups (P lt; 0.05) at 3 months postoperatively, whereas no significant difference was found in JPS 30° between affected knees of 2 groups (P gt; 0.05). No significant difference was found in JPS 30°, JPS 60°, and JPS 90° between affected knees of 2 groups at 12 months postoperatively (P gt; 0.05). Conclusion Autologous andACL reconstruction is better than allogeneic ACL reconstruction in the recovery of proprioception at early time after surgery.
Objective To investigate the procedure and effectiveness of medial patellofemoral l igament (MPFL) reconstruction for the treatment of recurrent patellar dislocation. Methods Between June 2005 and September 2007, 29 patients with recurrent patellar dislocation underwent MPFL reconstruction with allograft semitendinosus or allograft anterior tibial is tendon. There were 6 males and 23 females with an average age of 20.3 years (range, 13-45 years). The patients sufferedfrom 2-10 times patellar dislocation preoperatively. The average time between last dislocation and surgery was 43.9 months (range, 1-144 months). CT scan was performed to measure the tibial tuberosity-trochlear groove distance (TT-TG). The femoral tunnel was made at the origin of MPFL insertion, just inferior to the medial epicondyle. The double L-shape patellar tunnels were made on the medial rim of patella with 4.5 mm in diameter. The loop side of the graft was fixed with a bioabsorbable interference screw in the femoral tunnel both ends of the graft. For the TT-TG was more than 20 mm, a modified Elmsl ie-Trillat osteotomy was performed to correct the distal al ignment of patella. The arthroscopic examination was also performed for loosebody and lateral retinacular release. Results Twenty-seven patients were followed up 45.5 months on average (range, 40-67 months). No recurrent dislocation or subdislocation occurred. All the patients showed negative apprehension test at 0° and 30° flexions of knee. The range of motion of knee restored normal 1 year after operation. The Kujala score was improved from 72.03 ± 17.38 preoperatively to 94.10 ± 7.59 postoperatively, and Lysholm score was improved from 72.65 ± 14.70 to 95.44 ± 6.25, both showing significant differences (P lt; 0.05). The Tegner score was decreased from 5.25 ± 1.83 preoperatively to 4.33 ± 1.00 postoperatively, showing no significant difference (t=1.302, P=0.213). In patients whose TT-TG was more than 20 mm, TTTG was decreased from (23.38 ± 3.70) mm to (16.88 ± 5.92) mm at last follow-up, showing significant difference (t=2.822,P=0.026). Conclusion The technique of MPFL reconstruction is an effective surgical procedure for the treatment of recurrent patellar dislocation, which can improve the patella stabil ity and knee function.
Objective To evaluate the tendon regeneration after anterior cruciate ligament (ACL) reconstruction with semitendinosus tendon and gracilis tendon autografts by MRI. Methods Between September 2007 and September 2009, 52 patients undergoing ACL reconstructions with semitendinosus tendon and gracilis tendon autografts were enrolled. There were 29 males and 23 females with an average age of 31.6 years (range, 19-42 years). The left knees were involved in 34 cases and the right knees in 18 cases. The injury was caused by traffic accident in 11 cases, by sports in 38 cases, by heavy pound injury in 2 cases, and by other in 1 case. The time between injury and operation was 6 days to 31 months (median, 11.4 months). Joint pain occurred in 19 cases, joint instability in 28 cases, and joint swelling in 5 cases. The physical examination on admission showed thigh amyotrophy in 7 cases (thigh circumference side-to-side difference gt; 1 cm) and limitation of joint motion in 2 cases. The results of floating patella test, Lachman test, pivot shift test, and anterior drawer test were positive in 5, 51, 49, and 52 cases, respectively. The range of motion of knee was (127.77 ± 5.73)°, International Knee Documentation Committee (IKDC) score was 49.50 ± 4.08, and Lysholm score was 52.40 ± 3.45. Of the patients, 23 were accompanied with medial meniscus tear, 6 with lateral meniscus tear, 2 with plica synovialis, and 1 with loose body. Results All incisions healed by first intention. All the patients were followed up 12-18 months (mean, 14.9 months). At 12 months postoperatively, the results of Lachman test and pivot shift test were positive in 1 case, respectively; the results of anterior drawer test were negative in 52 cases. The range of motion of knee was (131.91 ± 1.81)°, Lysholm score was 94.98 ± 2.77, IKDC score was 93.65 ± 2.42; and there were significant differences when compared with the preoperative ones (P lt; 0.05). At 12 months postoperatively, at 90° resisted flexion of the knee, a very distinct fibrous band could be identified on the posteromedial aspect of the knee in 39 cases. MRI showed that both semitendinosus tendon and gracilis tendon regeneration in 10 cases, only semitendinosus tendon regeneration in 29 cases, only gracilis tendon regeneration in 2 cases, and no tendon regeneration in 11 cases. The regeneration rate of the semitendinosus tendon was 75.0% (39/52); the regeneration rate of the gracilis tendon was 23.1% (12/52); and the regeneration rate of the semitendinosus tendon and gracilis tendon was 78.8% (41/52). Conclusion MRI results suggest that some of the semitendinosus tendon and gracilis tendon could regenerate after harvested for ACL reconstruction.
ObjectiveTo study the analgesia and rehabilitation effect of femoral nerve block after anterior cruciate ligament reconstruction (ACLR). MethodsDuring June to September 2014, 62 patients who were scheduled to undergo ACLR were randomly divided into two groups:femoral nerve block group (n=31) and control group (n=31). All the patients were given celecoxib 200 mg (twice per day) three days before surgery. Patients in the femoral nerve block group were given a single-injection femoral nerve block (SFNB) half an hour before surgery (ropivacaine 0.75%, 30 mL), Both of the two groups underwent ice therapy after surgery. The visual analogue scale (VAS) scores, knee joint range of motion, the muscle strength of quadriceps femoris, the side effects, complications and infection rate were recorded after the operation. ResultsThe VAS scores were significantly lower in the femoral nerve block group within 2 hours to 7 days after surgery (P<0.05), and the use of morphine was less than the control group in all the time points with statistical significance (P<0.05). The muscle strength of quadriceps femoris was significantly weaker in the femoral nerve block group than the control group in the first 12 hours (P<0.05). The side effects and infection rate between the two group had no significant difference (P>0.05). ConclusionThe femoral nerve block in anterior cruciate ligament reconstruction before surgery has a good effect on postoperative analgesia and rehabilitation, which is worth popularizing and applying.
ObjectiveTo evaluate the effectiveness of intra-articular radioulnar ligament reconstruction in the treatment of chronic instability of the distal radioulnar joint. MethodsBetween January 2006 and June 2012, the intra-articular radioulnar ligament reconstruction was used to treat chronic instability of the distal radioulnar joint in 12 patients. Of 12 cases, 8 were males and 4 were females with an average age of 37.3 years (range, 22-54 years). The causes of injury were tumble in 9 patients, traffic accident in 2 patients, and sprain in 1 patient. The average time from initial injury to operation was 6.2 months (range, 2-13 months). The pain and function of the wrists were assessed with Patient-Rated Wrist Evaluation (PRWE) (27.5±4.7). Broadening of the distal radioulnar joint space was seen on the anteroposterior radiograph in all the patients. Lateral view showed dorsal instability in 10 patients and palmar instability in 2 patients. There was no radial fracture, ulnar fractures or degeneration of the distal radioulnar joint. ResultsAll patients achieved primary healing of incision. No complication of deep infection or nerve injury occurred. They were followed up from 12 to 30 months (mean, 20.6 months). Pain and the clicking sound of the wrists disappeared; grip strength increased; the range of motion values of the wrist and forearm were restored. PRWE score was 5.8±2.1 at last follow-up, showing significant difference when compared with preoperative score (t=14.215, P=0.000). Imaging examination showed good appositions of the distal radioulnar joint, with no dislocation or subluxation. ConclusionIntra-articular radioulnar ligament reconstruction can rebuild the anatomic stability of the distal radioulnar joint, which does not damage the adjacent structures of the joints and can obtain satisfactory function of the reconstructed joint. It is a good choice for chronic instability of the distal radioulnar joint without articular degeneration.