BJECTIVE: To study the effect of transposition of great adductor muscular tendon pedicled vessels in repairing the medial collateral ligament defect of knee joint. METHODS: From September 1991 to September 1999, on the basis study of applied anatomy, 30 patients with the medial collateral ligament defect were repaired with great adductor muscular tendon transposition pedicled vessels. Among them, there were 28 males and 2 females, aged 26 years in average. RESULTS: Followed up for 17 to 60 months, 93.3% patients reached excellent or good grades. No case fell into the poor grade. CONCLUSION: Because the great adductor muscular tendon is adjacent to the knee joint and similar to the knee ligament, it is appropriate to repair knee ligament. Transposition of the great adductor muscular tendon pedicled vessels is effective in the reconstruction of the medial collateral ligament defect of knee joint.
OBJECTIVE: To observe the strength of thigh muscles after reconstruction of anterior cruciate ligament by autogenous bone-patellar tendon-bone graft. METHODS: Twenty-three patients, 9 males and 14 females, were followed up one year after reconstruction of the anterior cruciate ligament with autogenous bone-patellar tendon-bone graft. Through arthroscope, no intra-articular derangement was found. The strengths of isometric and isotonic contractions of the quadri ceps and the hamstrings muscles of the affected and contralateral thighs were recorded. RESULTS: The donor side for autogenous bone-patellar tendon-bone graft showed significant decrease (P lt; 0.01), but no effect on that of the hamstrings muscle(P gt; 0.05). CONCLUSION: To reconstruct the anterior cruciate ligament, harvest of the bone-patellar tendon-bone graft as a reparative material may markedly lower the strength of the quadriceps femoris muscle.
目的 评价股外侧肌远端筋膜瓣折叠修复重建陈旧性髌韧带断裂的安全性及临床疗效。 方法 对2008年6月－2010年10月收治的10 例陈旧性髌韧带断裂患者，采用股外侧肌远端筋膜瓣折叠联合减张钢丝张力带固定方法重建髌韧带。术后1、2、3、6及12个月随访，采用美国膝关节协会评分对膝关节功能进行评分，包括膝关节疼痛、行走能力和上下楼梯能力、活动度等，同时行超声检查对膝关节髌韧带的连续性进行评估。 结果 10例患者中9 例获得随访，平均随访12个月（6～15个月）。末次随访时平均膝关节疼痛评分、功能评分、膝关节活动范围均较术前明显改善。超声检查显示所有患者肌腱完全愈合，连续性完好，不需要进一步外科手术干预。所有随访患者均未发生手术相关并发症。 结论 采用股外侧肌远端筋膜瓣折叠重建陈旧性髌韧带断裂是一种有效、可靠的方法，能够恢复良好的膝关节功能。
ObjectiveTo summarize the prevention and treatment of iatrogenic medial collateral ligament (MCL) injuries in total knee arthroplasty (TKA).MethodsThe relevant literature about iatrogenic MCL injuries in TKA was summarized, and the symptoms, causes, preventions, and treatments were analyzed.ResultsPreventions on the iatrogenic MCL injuries in TKA is significantly promoted. With the occurrence of MCL injuries, the femoral avulsion can be fixed with the screw and washer or the suture anchors; the tibial avulsion can be treated with the suture anchors fixation, bone staples fixation, or conservative treatment; the mid-substance laceration can be repaired directly; the autologous quadriceps tendon, semitendinosus tendon, or artificial ligament can be used for the patients with poor tissue conditions or obvious residual gap between the ligament ends; the use of implant with greater constraint can be the last alternative method.ConclusionNo consensus has been reached to the management of iatrogenic MCL injuries in TKA. Different solutions and strategies can be integrated and adopted flexibly by surgeons according to the specific situation.
Objective To explore an improved reconstruction of the anterior crucial ligament (ACL) with the allograft hamstring fixed by the Rigidfix and Intrafix anchorages and to evaluate its therapeutic effectiveness in a short term. Methods The ACL reconstruction was performed under the arthroscope on 21 patients’ knees from Janaury 2006 to December 2006. There were 13 males and 8 females aged from 18 to 53 years. The injuries were caused by a traffic accident in 7 patients, a movement damage in 11, and other factors in 3. The medial collateral ligament(MCL) and the medial meniscus were injured in 10 patients, the medial meniscus andthe lateral meniscus were injured in 3, the lateral meniscus was injured in 6, and only the ACl was injured in 2. The operations were performed 7 days to 3 monhs after the injuries. The graft used was the fourstranded allograft hamstring, which was fixed by the Rigidfix and Intrafix anchorages. The therapeutic effect was evaluated according to the Lysholm rating scale. Results The follow-up of all the 21 patients for 3-9 months (average, 5.8 months) revealed that the knees of 19 patients could move beyond 120° after operation. In 1 patient who had the MCL injury, the range of genuflex was limited to 80° at 3 months after operation, and so the operation of lysis was performed under thearthroscope again. In 1 patient, the rejection against the allograft was treated by the irrigating under the arthroscope but had little effect. The anterior drawer test and the pivot shift test were negative in the 21 patients. During the Lanchman test, 1 patient had a positive result (Degree Ⅰ). The Lysholm scores were significantly increased from 56.73±6.58 to 88.14±7.02 (P＜0.01). Conclusion The surgical approach to reconstruction of ACL with the fourstranded allograft hamstring fixed by the Rigidfix and Intrafix anchorages is feasible and safe. The resulting fixation is reliable. The patients can begin their postoperative rehabilitation exercise earlier and their movement function can be restored earlier.
Objective To investigate the clinicalvalue of modified Weaver-Dunn technique in repair of acute acromioclavicular dislocation. Methods From January 1993 to December 1998, 18 cases of acromioclavicular dislocation were treated bymodified Weaver-Dunn technique, and other 17 cases of the same suffering were treated by tension band fixation of the acromioclavicular joints. All of the patients were followed up for 12-36 months before clinical evaluation of the functionof shoulder joints, according to University of Pennsylvanian Shoulder Score System. Results In short term, the shoulder joints recovered much more rapidly in the cases repaired by modified Weaver-Dunn technique; 12, 24 and 36 months after operation, the scores of the cases repaired by modified Weaver-Dunn technique were (1897±67), (193.7±3.6) and (194.7±3.4) respectively according to the Shoulder Score System, while those of the cases treated by tension band fixation were (167.3±7.8), (170.2±6.3) and (165.6±5.9) respectively. The above data indicated that there was significant difference between two groups (P＜0.05). Conclusion The modified Weaver-Dunn technique was a better surgical approach than tension band fixation for repair of acute acromioclavicular dislocation.
OBJECTIVE To probe the clinical results of a new designed operation-double semitendinous reconstruction of posterior cruciate ligament (PCL) with invasive mini-plate. METHODS The new surgical technique was performed on 28 patients with PCL deficient knee in our department from September 1994 to October 1997. Protection of popliteal nerves and blood vessels was emphasized in the operation, and the femoral and tibial tunnel placement was critical to the procedure’s success. RESULTS All patients were followed up 18 to 36 months, averaged 22 months, they gained stable knees. The knee function of 28 patients recovered to normal after the operation, 1 patients had a small range of limitation of the knee flexion, but no obvious dysfunction. CONCLUSION Double semitendinous reconstruction of PCL with invasive mini-plate has advantages in the operated field exposure, adequate tibial and femoral fixation and excellent results in motion, stability and function of the knee after the operation.
ObjectiveTo observe the effect of preserving tibial residual fibers on the expressions of ligament remodeling related genes in rabbit anterior cruciate ligament (ACL) reconstruction model. MethodsSixty healthy adult New Zealand white rabbits were randomly divided into 4 groups:normal control group (group A, n=6) , sham-operation group (group B, n=18) , non tibial remnant preserved group (group C, n=18) , and tibial remnant preserved group (group D, n=18) . At 2, 6, and 12 weeks after operation, the ligament tissue was harvested to detect the mRNA expressions of collagen type 1A1(COL1A1) , collagen type 3A1(COL3A1) , transforming growth factor β1(TGF-β1), vascular endothelial growth factor (VEGF), growth-associated protein 43(GAP-43) , and neurotrophin 3(NT-3) by real-time fluorescent quantitative PCR. ResultsAt each time point, there was no significant difference in the mRNA expressions of COL1A1, COL3A1, VEGF, and NT-3 between group A and group B (P>0.05) . In group D, the mRNA expressions of COL1A1, COL3A1, TGF-β1, and GAP-43 significantly increased when compared with those of group C at 6 weeks after operation (P＜0.05) ; an increased level of VEGF mRNA was also detected in the group D at 12 weeks after operation (P＜0.05) ; and an increased level of NT-3 mRNA was also observed in group D at 2 and 12 weeks after operation (P＜0.05) . ConclusionThere is a time-dependent manner of angiogenesis-promoting, repair-related, and nerve-related gene expressions after ACL reconstruction with preserving tibial residual fibers during the process of ligamentization. Furthermore, the remnant preservation in ACL reconstruction can promote the expressions of related genes in some time points.