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 investigate effectiveness of applying the Bone Morphingbased image-free computer-assisted system for the ligament balancing managementin the total knee arthroplasty (TKA). Methods Between November 2002 and June 2003, twenty-one posterior stabilized total knee prostheses (Ceraver, France) were implanted in 21 patients using the Bone Morphing based image-free Ceravision system.This cohort included 5 men and 16 women with an average age of 72.4 years, two undergoing high tibial osteotomy and 1 undergoing distal femoral osteotomy before. The preoperative deviation was measured by the full-length AP X-rays. The knees were in varus deviation in 14 patients and in valgus deviation in 7 patients, with an average of 2.36°(varus 13°-valgus 13°). The frontal X-rays ofthe knee were assessed, the mean value of the varus force-stress test was 8.47°(varus 2°-varus 20°), and the mean value of the valgus forcestress test was 3.63°(varus 7°-valgus 12°). Results With the Ceravisionrecorded data, the intraoperative alignment was assessed, the mean lower limb axis was 3.33°(varus 12°-valgus 10°),and compared with the preoperative data, the difference was significant (Plt;0.05); the mean value of the varus force-stress test was 6.47°(varus 0°-varus 24°), the mean value of the valgus force-stress test was 4.32°(varus 8°- valgus 15°), and compared with the preoperative data, the difference was significant (Plt;0.05). The post-prosthetic alignment on Ceravision with a deviation of 0.175°(varus 2°- valgus 3°) was compared with the postoperative alignment by the full-length AP X-rays, with a deviation of 0.3°(varus 3.5°-valgus 1.5°), the difference wasn’t significant(Pgt;0.05).The clinical check-up performed 3 months after operation showed that the average range of movement (ROM) was 115°(105-130°), the mean frontal laxity was 0.27 mm(0.2-0.5 mm). The femoral and tibial components were implanted in the satisfactory 3 dimensional position without ligament imbalance in all the patients, andthere were no instability or patella complications.Conclusion Utilization of the Bone Morphing based image-free computer-assisted system can achieve an accurate component 3 dimensional alignment, optimal bone resection, optimal control of surgical decision in releasing the soft tissues, rotating the femoral component to gain an extension/flexion rectangular gap, and managing theligament balancing so as to achieve a satisfactory initial clinical outcome. This system can be routinely used in the TKA.
摘要:目的:探讨地震伤员中膝关节损伤的机制、类型及处理方法。 方法:对我院收入住院的2728例 5·12汶川特大地震伤员伤情特点进行分析,筛选出有膝关节损伤的病例进行分析。 结果: 膝关节损伤前三位分别是髌骨骨折(42.15%)、胫骨平台骨折(21.05%)、股骨髁骨折(13.16%),这与人们在地震时奔跑摔伤以及被房屋倒塌砸伤有很大关系。结论:地震后膝关节损伤其发病率、受伤机制、损伤类型、合并伤情况及治疗处理均有其特点,总结这些特点和规律将对地震伤膝关节损伤患者的处理产生积极作用。Abstract: Objective: To investigate the knee joint injury mechanisms, types and treatment of the earthquake wounded. Methods: Analysis the characteristics of the 2728 cases of West China Hospital from 5.12 Wenchuan earthquake wound, screen out the cases of knee joint injury. Results: Patellar fracture (42.15%),tibial plateau fracture(21.05%), femoral condyle fracture (13.16%), were the top three of knee joint injuries, which have a great relationship with falling down and (or) injured by collapsed houses when people were running in the earthquake. Conclusion: After the earthquake the knee joint damages its disease incidence rate, is injured the mechanism, the damage type, the merge wound situation and treatment processing has its characteristic, will summarize these characteristics and the rule damages patient’s processing to the earthquake wound knee joint to have the positive role.
Objective To design a new custom-made artificial semi-knee joint based on rapid prototyping(RP) technique and to explore a method to solve necroses of allocartilage in hemi-joint allotransplantation. Methods Based on the extracted 3D contour image of the articular cartilage of femoral condyle, the custom-made artificial semi-knee joint was designed with Surfacer 9.0 image processingsoftware. The artificial semi-knee joint design used the femoral condylar 3D contour of the patient as the outer face and the subchondral bone 3D contour of allograft bone as inner face. One dado for medullary nailand two for special designing cages which were used to fix the cartilage into the allograft were added on the inner face. After being converted into RP data format, the computerassisted design was imported into the LPS600 rapid prototyping machine, and the prototype was achieved. Furthermore, the prototype could be modified by hand according to the design. Then the RP model was used as a positive mould to build up a silica gel negativemould, and the negative mould was sent to the factory to manufacture Ti-6Al-4V alloy articular cartilage through ordinary mould-melted founding process. Finally, the whole metal cartilage was completed after melting two special cages on it andpolishing it. Results A new custom-made artificial semi-knee joint was made ad used to treat a 14-year old patient. The custom-made artificial semi-knee joint and the subchondral bone were a perfect match. The operative result was satisfactory. The patient could walk 5 weeks after operation. The bone healing of the auto-bone and allo-bone was achieved 6 months later. A follow-up period lasting 1 yearshowed that the knee joint played a good function. Conclusion The artificial semi-knee joint is a good match for the allograft boneand a good idea to solve necroses of allocartilage in hemijoint allotransplantation.
Objective To systematically review the rehabilitation effect of isokinetic muscle training on knee muscle strength, functional walking ability and dynamic balance in post-stroke patients. Methods PubMed, Ovid Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, Chongqing VIP, and Wanfang databases were searched online for randomized controlled trials on isokinetic muscle training of lower limbs in post-stroke patients. The retrieval time was from inception to October, 2022. Endnote X9 software was used to manage the literature. Cochrane Manual 5.1.0 was used for quality assessment, and RevMan 5.4 software was used for meta-analysis. Results A total of 20 randomized controlled trials were included in the study, with the intervention group using isokinetic muscle training of the lower extremities or combined with conventional rehabilitation training and the control group using conventional rehabilitation training and/or other intervention, with a total of 1448 study subjects. Meta-analysis results showed that the differences in knee flexion peak torque [mean difference (MD)=5.85 N·m, 95% confidence interval (CI) (4.84, 6.85) N·m, P<0.00001], knee extension peak torque [MD=9.09 N·m, 95%CI (4.83, 13.36) N·m, P<0.0001], Time Up Go test [MD=–4.70 s, 95%CI (–6.68, –2.72) s, P<0.00001], 10-meter walking test [MD=–4.71 s, 95%CI (–9.12, –0.31) s, P=0.04], Fugl-Meyer Lower Extremity Motor Function Assessment score [MD=6.61, 95%CI (3.52, 9.70), P<0.0001], and Berg Balance Scale score [MD=5.61, 95%CI (0.91, 10.31), P=0.02] were statistically significant. Conclusion Isokinetic training may improve knee strength and functional walking ability in post-stroke patients, but there is still no strong evidence of improvement in motor function and balance.
Objective To evaluate the effectiveness of total knee arthroplasty (TKA) using three-dimensional (3D) printing technology for knee osteoarthritis (KOA) accompanied with extra-articular deformity. Methods Between March 2013 and December 2015, 15 patients (18 knees) with extra-articular deformity and KOA underwent TKA. There were 6 males (6 knees) and 9 females (12 knees), aged 55-70 years (mean, 60.2 years). The mean disease duration was 10.8 years (range, 7-15 years). The unilateral knee was involved in 12 cases and bilateral knees in 3 cases. The clinical score was 57.44±1.06 and the functional score was 60.88±1.26 of Knee Society Score (KSS). The range of motion of the knee joint was (72.22±0.18)°. The deviation of mechanical axis of lower limb was (18.89±0.92)° preoperatively. There were 8 cases (10 knees) with extra-articular femoral deformity, 5 cases (5 knees) with extra-articular tibial deformity, and 2 cases (3 knees) with extra-articular femoral and tibial deformities. Bone models and the navigation templates were printed and the operation plans were designed using 3D printing technology. The right knee joint prostheses were chosen. Results The operation time was 65-100 minutes (mean, 75.6 minutes). The bleeding volume was 50-150 mL (mean, 90.2 mL). There was no poor incision healing, infection, or deep venous thrombosis after operation. All patients were followed up 12- 30 months (mean, 22 months). Prostheses were located in the right place, and no sign of loosening or subsidence was observed by X-ray examination. At last follow-up, the deviation of mechanical axis of lower limb was (2.00±0.29)°, showing significant difference when compared with preoperative one (t=13.120, P=0.007). The KSS clinical score was 87.50±0.88 and function score was 81.94±1.41, showing significant differences when compared with preoperative ones (t=27.553, P=0.000; t=35.551, P=0.000). The range of motion of knee was (101.94±1.42)°, showing significant difference when compared with preoperative one (t=31.633, P=0.000). Conclusion For KOA accompanied with extra-articular deformity, TKA using 3D printing technology has advantages such as individualized treatment, reducing the difficulty of operation, and achieving the satisfactory function.
ObjectiveTo introduce the arthroscopic single bundle posterior cruciate ligament (PCL) reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers, and to evaluate the clinical results. MethodsBetween June 2010 and April 2014, 57 patients with PCL rupture were treated with arthroscopic single bundle PCL reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers. There were 41 males and 16 females, aged 19-42 years (mean, 27.7 years). All the patients had history of injury. The results of posterior drawer test were positive, including 9 cases of grade Ⅱ and 48 cases of grade Ⅲ. The disease duration ranged from 2 weeks to 25 months (mean, 13 months). The Lysholm score and the range of motion of knee joint were used to evaluate the knee function. ResultsThe operation performed smoothly, and no complications of blood vessel and nerve injuries and infection occurred. Primary healing was obtained in all incisions; no early complication occurred after operation. The patients were followed up 16.6 months on average (range, 12-20 months). At last follow-up, the knee range of motion returned to normal in all cases (120-130° in flexion). MRI at last follow-up showed good continuity of the PCL graft and complete healing of the remnant PCL tissues between the femoral and tibial attachments. The Lysholm score was significantly improved when compared with preoperative score (t=-27.429, P=0.000). ConclusionArthroscopic single bundle PCL reconstruction using hamstring tendons through posterior trans-septum portal approach with preservation of the remnant PCL fibers has the advantages of firm fixation, simple operation, and good knee function recovery.
Objective To explore the coronal alignment of tibial prosthesis after osteotomy using personalized extramedullary positioning technique on tibia side in total knee arthroplasty (TKA). Methods A clinical data of 170 patients (210 knees) who underwent primary TKA between January 2020 and June 2021 and met the selection criteria was retrospectively analyzed. Personalized and traditional extramedullary positioning techniques were used in 93 cases (114 knees, personalized positioning group) and 77 cases (96 knees, traditional positioning group), respectively. The personalized extramedullary positioning was based on the anatomical characteristics of the tibia, a personalized positioning point was selected as the proximal extramedullary positioning point on the articular surface of the tibial plateau. There was no significant difference between the two groups in gender, age, body mass index, surgical side, course of osteoarthritis, and Kellgren-Lawrence classification (P>0.05). The preoperative tibial bowing angle (TBA) formed by the proximal and distal tibial coronal anatomical axes in the personalized positioning group was measured and the tibia axis was classified, and the distribution of personalized positioning point was analyzed. The pre- and post-operative hip-knee-ankle angle (HKA), the lateral distal tibial angle (LDTA), and the postoperative tibia component angle (TCA), the excellent rate of tibial prosthesis alignment in coronal position were compared between the two groups. Results In the personalized positioning group, 58 knees (50.88%) were straight tibia, 35 knees (30.70%) were medial bowing tibia, and 21 knees (18.42%) were lateral bowing tibia. The most positioning points located on the highest point of the lateral intercondylar spine (62.07%) in the straight tibia group, while in the medial bowing tibia and lateral bowing tibia groups, most positioning points located in the area between the medial and lateral intercondylar spines (51.43%) and the lateral slope of the lateral intercondylar spine (57.14%), respectively. The difference in HKA between pre- and post-operation in the two groups was significant (P<0.05); while the difference in LDTA was not significant (P>0.05). There was no significant difference in preoperative LDTA and HKA and the difference between pre- and post-operation between groups (P>0.05). But there was significant difference in postoperative TCA between groups (P<0.05). The postoperative tibial plateau prosthesis in the traditional positioning group was more prone to varus than the personalized positioning group. The excellent rates of tibial prosthesis alignment in coronal position were 96.5% (110/114) and 87.5% (84/96) in personalized positioning group and traditional positioning group, respectively, showing a significant difference between groups (χ2=7.652, P=0.006). Conclusion It is feasible to use personalized extramedullary positioning technique for coronal osteotomy on the tibia side in TKA. Compared with the traditional extramedullary positioning technique, the personalized extramedullary positioning technique has a higher excellent rate of tibial prosthesis alignment in coronal position.
Objective To explore the therapeutic efficacy of arthroscopic reconstruction of anterior cruciate ligament (ACL) with autologous multistranded semitendinous tendon (ST). Methods From September 2000 to December 2004, 50 casesof ruptures of ACLs were diagnosed by clinical and arthroscopic examinations. There were 32 males and 18 females with an average age of 26.3 years (18-51 years). The locations were left knee in 31 cases and right knee in 19 cases. All patients had the history of knee joint injury. Arthroscopy showed 26 cases of rupture, 14cases of defect, 4 cases of avulsion and 6 cases of laceration. All patients were operated upon arthroscopically by using autologous multistranded ST. Plaster splints were used for 4 weeks after operation. The result was estimated by AO Yingfang’s standards and Lysholm knee scores. Results All patients achieved healing bythe first intention. The extension and flexion function was restored normal at 8-10 weeks. The patients were followed up averagely 1 year and 8 months (6.48 months). The results of drawer test and Lachman test were positive in 3 cases and suspiciously positive in 8 cases. The results were excellent in 23 patients, good in 18 and fair in 9. Lysholm knee scores were 4057±1068 preoperatively and 86.43±9.33 postoperatively, showing significant difference (P＜0.01). Conclusion Arthroscopy reconstruction of ACL with autologous multistranded ST may be one of the excellentmethods bringing less injury.