【Abstract】 Objective To introduce several navigation systems in anterior cruciate l igament reconstructionand to investigate the appl ication of navigation systems for the improvement in reconstruction of the anterior cruciatel igament. Methods The related l iterature was reviewed extensively, and the main current computer assisted surgery systems(OthoPilot system, Bone Morphing system, Fluoroscopic-based system, etc) for util ization in the anterior cruciate l igament reconstructionwere analyzed. Results The computer-assisted systems can enhance the accurate placement of tunnels. Accordingto the anatomical and isometric parameters, graft impingement on the intercondylar notch could be avoided, and individualideal implantation using 3D visual ization local isers was achieved. Conclusion It is possible that computer-assisted systemswill enable surgeons to better acquire the accuracy and rel iabil ity of the various operative techniques, to meet the demand ofsurgeon’s surgical optimisation and to improve the cl inical results.
Objective To investigate the effect of the anterior cruciate l igament (ACL) rupture on the biomechanics of the lateral collateral l igament (LCL). Methods The specimens in this experiment were knee joints from 6 normal fresh adult male cadavers which was donated voluntarily, aged of 26-35 years with an average of 31.4 years. The knee joints were dissymmetry with 3 in left and right sides respectively. At first, all the 6 specimens lying on the self-made movement tooting, whose LCL straining were measured by strain gauges at different angles (0, 30, 60 and 90°) under axial loads of 400 N by e-testing machine for simulation of the normal knee joint force, were regarded as the intact ACL group. Then, the ACL in all 6 specimens were cut off completely as the deficiency group and did the same step. Results The strain of the LCL were as follows at 0, 30, 60 and 90°: (0.00 ± 1.63), (—17.2 ± 8.57), (—24.00 ± 4.80) and (26.50 ± 4.65) με in intact ACL group; (0.75 ± 8.22), (— 52.75 ± 3.33), (24.30 ± 4.99) and (26.30 ± 4.27) με in deficiency group. There was no significant difference at 0° and 90° flexion (P gt; 0.05), but significant difference at 30° and 60° flexion (P lt; 0.05) between the two groups. Conclusion The rupture of the ACL has significantly effect on the strain of the LCL which suffering abnormal load in the state at 30° and 60° flexion. At 30° flexion the relaxation of the LCL increased, which means the possibil ity of the injury of the LCL is rare; and at 60° flexion the LCL become very tense and thereby at the high risk of instabil ity.
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.
ObjectiveTo evaluate the effectiveness of arthroscopic suture and absorbable screw double fixation for both anterior and posterior cruciate ligament avulsion fractures of tibial insertions. MethodsBetween June 2006 and September 2013, 8 patients with anterior and posterior cruciate ligament avulsion fractures of the tibial eminence underwent arthroscopic treatment with suture and absorbable screw double fixation. There were 5 males and 3 females, with a mean age of 28.9 years (range, 18-43 years). The causes of injury included traffic accident in 5 cases and falling from height in 3 cases. The time from injury to operation was 3-10 days (mean, 6.2 days). The Lysholm knee score, International Knee Documentation Committee (IKDC) score, and Tegner rating scales were used to evaluated the knee function. ResultsPrimary healing of incision was obtained, without infection or deep vein thrombosis. The mean follow-up period was 42.4 months (range, 24 to 65 months). At 3 months after operation, X-ray films showed good reduction and healing of fracture. The anterior and posterior drawer tests were negative. The knee range of motion was normal (0-125°), and it recovered to preoperative level in 7 cases. The IKDC score, Tegner score, and Lysholm score were significantly improved to 90.4±5.2, 7.5±1.6, and 89.2±3.5 from preoperative 52.1±3.3, 3.3±1.0, and 51.9±3.5 respectively (t=-38.680, P=0.000; t=-39.520, P=0.000; t=-41.150, P=0.000). ConclusionA combined injury of anterior and posterior cruciate ligament avulsion fractures of tibial insertions is rare. Arthroscopic treatment with suture and absorbable screw double fixation is a useful technique to restore tibial avulsion injuries with well-documented radiographic healing, good clinical outcomes, and low complication rates.
ObjectiveTo study the effectiveness of internal tension-relieving technique for arthroscopic assisted anterior cruciate ligament (ACL) reconstruction. MethodsBetween March 2011 and September 2014, 51 cases of complete ACL rupture were randomly divided into 2 groups. Arthroscopic assisted single-bundle ACL reconstruction combined with internal tension-relieving technique was performed in 26 cases (group A), arthroscopic assisted single-bundle ACL reconstruction in 25 cases (group B). There was no significant difference in gender, age, cause of injury, injured side, body mass index, Outerbridge classification of articular cartilage injury, disease duration, and the preoperative International Knee Documentation Committee (IKDC) score, Lysholm score, and KT-1000 test value between 2 groups (P>0.05). At 3, 6, and 12 months after operation, the KT-1000 was used to measure the anterior stability, and IKDC and Lysholm scores to evaluate the function of knee joint. ResultsHealing of incision by first intention was obtained in all patients of 2 groups, without complications of infection, deep vein thrombosis of lower extremity, and blood vessels and nerves injury. The patients were followed up 12 months after operation. All patients received second microscopic examination. The reconstructed ACL had good continuity and good coverage of synovial tissue. There was no re-rupture in any cases. The range of motion of the knee joint was close to normal. The MRI showed good healing of the ligament and the bone tunnel at 12 months after operation. KT-1000 test value, IKDC score, and Lysholm score at 3, 6, and 12 months after operation were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found among different time points after operation (P>0.05). There was no significant difference in IKDC score and Lysholm score between 2 groups at 3 and 12 months (P>0.05); but IKDC score and Lysholm score of group A were significantly higher than those of group B (P<0.05) at 6 months. At diffenent time points after operation, the KT-1000 test values of group A were significantly lower than those of group B (P<0.05) except the value at 3 months (P>0.05). ConclusionFor patients with ACL rupture, using internal tension-relieving technique can effectively alleviate tension force of reconstructed ligament, which is beneficial to the healing of reconstructed ligament and early rehabilitation of the knee joint.
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.
Objective To evaluate the feasibility of the anterior cruciate ligament (ACL) reconstruction with 6 strands of hamstring tendons enveloped by periosteum. Methods Between April 2008 and April 2009, 34 patients with ACL injury were treated, ACL of whom was reconstructed with 6 strands of hamstring tendons enveloping of periosteum and double Rigidfix fixation. There were 30 males and 4 females, aged 19-54 years with an average of 29.4 years. The causes of injury included sport in 19 cases, traffic accident in 8 cases, falling from height in 5 cases, and other in 2 cases. The locations were left knee in 19 cases and right knee in 15 cases. The disease duration was 3 weeks to 18 months (median, 9.4 months). The results of Lachman test and anterior drawer test were positive. The Lysholm knee score was 61.5 ± 3.6. MRI examination revealed ACL rupture in 26 cases and ACL injury in 8 cases. Results All incisions healed by first intention, and no early complication occurred. Twenty-eight cases were followed up 12-32 months (mean, 16.1 months). The result of Lachman test was negative at 12 months after operation; in all patients, knee extension reached 0°, and flexion reached 120-150° (mean, 132.5°). The AP and lateral X-ray films and MRI showed no bone tunnel expansion. At last follow-up the therapeutic effect evaluation was excellent in 25 cases, good in 1 case, and fair in 2 cases; the excellent and good rate was 92.9%. The postoperative Lysholm score was 91.0 ± 3.2, showing significant difference when compared with preoperative score (t=32.78, P=0.00). Conclusion Six strands of hamstring tendons can ensure sufficient tensile strength, and use of the double Rigidfix absorbable screw makes fixation more reliable. Facing outside suture of periosteal flap can promote tendon-bone healing, so it is a good method of ACL reconstruction.
Objective To compare clinical outcome of bioabsorbable interference screws (BS) with metal Interference screws (MS) for restruction of anterior cruciate ligament (ACL). Methods The electronic databases (PubMed, EMbase, Cochrane Central Register of Controlled Trials, CBM, CNKI, and VIP) were searched in order to retrieve randomized controlled trials (RCTs) about comparing BS with MS for restruction of ACL. In addition, reference lists from original studies and review articles were handsearched. The Jadad’s scale and Cochrane collaboration’s RevMan 5.0 software were used for assessing trial methodological quality and data analyses. Results Eleven RCTs were included. There were 935 participants that met inclusion criteria in all studies. Results of Meta-analyses showed the MS group had a higher Lysholm score. However, no significant differences were found in Lanchman Test, IKDC Data and KT1000 result between patients treated by BS and by MS. Conclusion Bioabsorbable interference screws provide equivalent clinical outcomescompared with metal interference screws. However, further confirmation is required because of varieties of types and complex compositions.