Objective To evaluate the effectiveness of anterior talofibular ligament repair in the treatment of lateral ankle stability and the effect of combined tarsal sinus syndrome on results. Methods Between December 2013 and October 2014, 47 cases of lateral ankle instability underwent anatomical repair of anterior talofibular ligament, and the clinical data were retrospectively analyzed. Of 47 cases, 32 had no tarsal sinus syndrome (group A); 15 had tarsal sinus syndrome (group B), arthroscopic debridement of tarsal sinus was performed at the same time. There was no significant difference in gender, age, disease duration, side, American Orthopaedic Foot and Ankle Society (AOFAS), Karlsson score, and Tegner movement function score between 2 groups (P>0.05). Results No early surgical complication of infection occurred, and primary healing of incision was obtained in 2 groups. The patients were followed up 20-31 months (mean, 26.0 months) in group A, and 20-31 months (mean, 24.7 months) in group B. Disappearance of ankle swelling, good joints movement, and recovery of normal walking were observed in all patients. At last follow-up, AOFAS score, Karlsson score, and Tegner movement function score were significantly improved when compared with preoperative ones in 2 groups (P<0.05), but no significant difference was found between 2 groups (P>0.05). No ankle instability recurrence was found during follow-up period. Conclusion The effectiveness of anatomical repair of anterior talofibular ligament in lateral ankle instability is satisfactory for patients with or without tarsal sinus syndrome.
Objective To study the short-term effectiveness of absorbable anchor in repairing of partial anterior cruciate ligament (ACL) rupture. Methods Between December 2013 and February 2015, 22 patients with partial ACL rupture were repaired with absorbable anchor under arthroscopy. There were 12 males and 10 females with an average age of 27.5 years (range, 20-44 years). The injury located at left knee in 8 cases and at right knee in 14 cases. The time from injury to admission ranged from 2 to 13 days (mean, 9.8 days). Sixteen partial ACL ruptures combined with meniscus injury. The effectiveness was assessed by Tegner score, Lysholm score, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) score, and MRI, as well as knee laxity was evaluated by KT-1000. Results All incisions healed at stage Ⅰ without any complication. All patients were followed up 12 months. ACL rerupture did not occurred during follow-up. There was no significant difference in Tegner score, Lysholm score, and IKDC score between before injury and at 12 months after operation (P>0.05). And the median satisfaction VAS score was 9.5 (range, 9-10). The tibial anterior translation difference was 0.5 mm (range, 0-6 mm). MRI showed that the scarring and continuity of the ligament were rated as grade 1 in all patients. Conclusion Arthroscopic repairing by absorbable anchor is a feasible method for partial ACL rupture, with ideal knee function, good satisfaction, and satisfactory short-term effectiveness.
ObjectiveTo investigate effect of posterior oblique ligament (POL) repair on the rotational stability of the knee joint for the medial collateral ligament (MCL) combined with anterior cruciate ligament (ACL) ruptures.MethodsThe clinical data of 50 patients (50 knees) with grade-3 MCL-ACL combined injuries who met the selection criteria between January 2013 and December 2015 were retrospectively analyzed. All ACLs were reconstructed with autogenous tendon and the superficial and deep layers of MCLs were sutured; then, POLs were also sutured in 25 patients of repair group and only received conservation treatment postoperatively in 25 patients of conservation group. There was no significant difference in gender, age, disease duration, and preoperative KT-1000 measuring, medial joint space opening, International Knee Documentation Committee (IKDC) score, visual analogue scale (VAS) score, and knee range of motion between the two groups (P>0.05).ResultsAll incisions of the two groups healed by first intention, no surgical related complications occurred. All patients were followed up, with follow-up time of 28-56 months (mean, 38.1 months) in repair group and 26-55 months (mean, 29.1 months) in conservation group. At last follow-up, the IKDC score, VAS score, KT-1000 measuring, medial joint space opening, and knee range of motion significantly improved in the two groups when compared with preoperative ones (P<0.05); but there was no significant difference between the two groups (P>0.05). The Slocum test showed that there was no instability of the anterior medial rotation in the two groups.ConclusionThe POL repair can’t obtain more medial stability after ACL reconstruction and MCL repair (superficial and deep layers) for patients who have MCL-ACL combined injuries.
ObjectiveTo investigate effectiveness of allogeneic tendon of " W” type knit in repair of traumatic anterior dislocation of sternoclavicular joint.MethodsBetween June 2013 and June 2017, 12 patients with traumatic anterior dislocation of sternoclavicular joint after poor conservative treatment were treated with allogeneic tendon of " W” type knit. Of them, 10 were males and 2 were females, aged from 25 to 58 years (mean, 42 years). All injuries were caused by traffic accidents. The time from injury to operation was 4-12 weeks (median, 6 weeks). All of them were closed injuries. The patients had no fracture around the shoulder, or blood vessels, nerves, and other adjacent limb joint injuries. The operation time, intraoperative blood loss, incision healing, and complications were recorded. The sternoclavicular joint was observed by X-ray film and CT at 1 year after operation. Visual analogue scale (VAS) score, University of California Los Angeles (UCLA) score, Rockwood score, modified Hospital for Special Surgery (HSS) score, and Constant-Murley score were used to evaluate the function of shoulder joint after operation.ResultsThe operation time was 60-80 minutes (mean, 70 minutes). The intraoperative blood loss was 50-100 mL (mean, 60 mL). Primary healing of incision was obtained in all patients without complications. All the patients were followed up 12-24 months (mean, 18 months). At 1 year after operation, X-ray film and CT examination showed that the position of sternoclavicular joint was satisfactory. At 1 year after operation, the Rockwood score was 12-14 (mean, 13). The UCLA score was 28-34 (mean, 31). The VAS score was significant lower than that before operation (P<0.05), and the Constant-Murley score and modified HSS score were significantly higher than those before operation (P<0.05).ConclusionThe repair of traumatic anterior dislocationr of sternoclavicula joint with allogeneic tendon of " W” type knit can effectively reconstruct the stability of the joint, retain the physiological fretting, and obtain satisfactory results.
ObjectiveTo compare the effectiveness of all-arthroscopic technique and modified open Broström technique in repair of anterior talofibular ligament (ATFL) for lateral instability of the ankle (LIA).MethodsA retrospective analysis was made on 65 patients who underwent ATFL repair with anchors for LIA between January 2014 and January 2017. The ATFL was repaired by all-arthroscopic technique in 35 patients (arthroscopic group) and modified open Broström technique in 30 patients (open group). There was no significant difference in age, gender, the side of injured ankle, the time from injury to operation, and preoperative anterior displacement of talus, tilt angle of talus, the Karlsson Ankle Functional (KAF) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Japanese Society for Surgery of the foot ankle-hindfoot (JSSF) scale score between the two groups (P>0.05). The operation time, the intraoperative bleeding volume, and the length of time for surgery recovery were recorded. The anterior displacement of talus, the tilt angle of talus, KAF score, AOFAS score, and JSSF scale score were evaluated at 2 weeks, 3 months, and the last follow-up.ResultsAll patients were followed up 24-30 months, with an average of 26 months. The operation time, intraoperative bleeding volume, and the length of time for surgery recovery of arthroscopic group were superior to open group (P<0.05). There were 2 cases of temporary ankle and dorsum numbness and 1 case of thread reaction in arthroscopic group; and there were 2 cases of temporary ankle and dorsum numbness and 2 cases of thread reaction in open group. The AOFAS score, KAF score, and JSSF scale score in arthroscopic group were significantly higher than those in open group (P<0.05) at 2 weeks after operation; there was no significant difference between the two groups at 3 months and the last follow-up (P>0.05). There was no significant difference in the anterior displacement of talus and the tilt angle of talus between the two groups at 2 weeks, 3 months, and last follow-up (P>0.05).ConclusionCompared with the modified open Broström technique, the all-arthroscopic technique, as a minimally invasive technique, can achieve the same effectiveness, and has the advantages of shorter operation time, less intraoperative bleeding, and less pain in the early stage.
Objective To investigate the effectiveness of personalized treatment based on Hua Xi-knee dislocation and multiple ligament injury (HX-KDMLI) diagnosis and treatment system. Methods A clinical data of 36 patients (36 knees) with KDMLI met the selective criteria between February 2019 and September 2020 was retrospectively analyzed. There were 24 males and 12 females with an average age of 45.7 years (range, 21-62 years). The KDMLI was caused by traffic accident in 15 cases, heavy pound in 8 cases, sports sprain in 7 cases, falling from height in 4 cases, and machine cutting in 2 cases. The interval between injury and operation was 1-9 weeks (mean, 3.6 weeks). All patients were categorized according to HX-KDMLI diagnosis and treatment system. Twenty patients were categorized as acute period and 16 patients as chronic period. Three patients were type HX-Ⅰ-A, 1 type HX-Ⅰ-P, 10 type HX-Ⅲ-L, 13 type HX-Ⅲ-M, 4 type HX-Ⅳ-S, 3 type HX-Ⅴ-F, and 2 type HX-Ⅴ-T. Thirty-five patients were positive in both the anterior drawer test and Lachman test, 31 were positive in the posterior drawer test; 19 patients were positive in varus stress test, 23 were positive in valgus stress test. According to the Internation Knee Documentation Committee (IKDC) grading, there was 1 case of grade A, 5 cases of grade B, 8 cases of grade C, and 2 cases of grade D. Surgical interventions included arthroscopic surgery, open surgery, or arthroscopy combined with open surgery, ligament suture or reconstruction, and internal fixation after anatomical reduction of the fracture. Different rehabilitation protocols were assigned to patients during different postoperative period, according to patient’s individualized classification. ResultsAll incisions healed by first intention with no obvious complications. All patients were followed up 12-19 months (mean, 15 months). At 12 months after operation, all patients retained muscle strength of grade Ⅴ, and range of motion of the knee joint could reach 0° extension and over 120° flexion. Radiographic examination showed no sign of knee instability, healed fractures, ideal joint alignment, good continuity and tension, and clear image of repaired or reconstructed ligaments. The anterior and posterior drawer tests were all negative. Lachman test was degreeⅠpositive in 5 cases, valgus stress test was degreeⅠpositive in 2 cases, varus stress test was degreeⅠpositive in 2 cases; the other patients were all negative. At 12 months after operation, according to the IKDC grading, there were 9 cases of grade A, 19 cases of grade B, 5 cases of grade C, and 3 cases of grade D, showing significant differences when compared with the preoperative ones (Z=–5.328, P=0.000). There were significant differences in the IKDC, Lysholm, and Tegner scores between pre- and post-operation (P<0.05). ConclusionThe promising effectiveness of KDMLI can obtain under the guidance of HX-KDMLI.
ObjectiveTo investigate the short-term effectiveness of calcaneal lateral displacement osteotomy with lateral ligament repair in the treatment of Takakura stage Ⅱ varus-type ankle arthritis. MethodsA retrospective analysis was performed on the clinical data of 13 patients with Takakura stage Ⅱ varus-type ankle arthritis treated with calcaneal lateral displacement osteotomy with lateral ligament repair between January 2016 and December 2020. There were 6 males and 7 females aged 31-65 years, with an average age of 53.6 years. The preoperative tibial-ankle surface angle (TASA) was (88.13±1.01)°, medial distal tibial angle (MDTA) was (86.36±1.49)°, tibial talar surface angle (TTSA) was (6.03±1.63)°, talar tilting angle (TTA) was (81.95±2.15)°, and tibiocalcaneal axis angle (TCAA) was (−5.74±6.81)°. The preoperative American Orthopedic Foot and Ankle Society (AOFAS) score was 56.3±7.1 and the pain visual analogue scale (VAS) score was 3.7±0.5. AOFAS scores, VAS scores, TTSA, TTA, and TCAA were compared between pre- and post-operatively. Results All 13 patients were followed up 14-41 months, with an average of 28.7 months. The osteotomies healed in all patients. The last follow-up revealed TTA, TTSA, and TCAA to be (88.27±1.19)°, (−0.13±1.37)°, and (2.09±5.10)° respectively, the AOFAS score was 84.3±4.2 and the VAS score was 0.7±0.5, all showing significant improvement when compared to preoperative values (P<0.05). Conclusion For patients with Takakura stage Ⅱ varus-type ankle arthritis, calcaneal lateral displacement osteotomy with lateral ligament repair can correct the lower limb force line, regain ankle stability, and achieving good short-term effectiveness.