Objective To explore the technique of arthroscopic treatment of synovial chondromatosis of the hip and to evaluate its effectiveness. Methods Between July 2009 and June 2011, 15 patients with synovial chondromatosis of the hip underwent arthroscopic synovectomy and removal of loose bodier. Of 15 patients, 11 were male and 4 were female, aged from 21 to 45 years with an average of 33.1 years. The location was the left side in 6 cases and the right side in 9 cases. The disease duration was 12-43 months (mean, 23 months) Pain and functional motion limitation were the main clinical symptoms. The visual analogue scale (VAS) score was 5.8 ± 1.1; the range of motion (ROM) of the hip was (149.8 ± 27.5)°; the Harris hip score was 54.5 ± 13.3. Results All incisions healed by first intention. All the patients were followed up 6 months to 2 years (mean, 17.4 months). At last follow-up, the VAS score was 2.0 ± 1.2; the ROM of the hip was (258.3 ± 35.4)°; the Harris hip score was 93.0 ± 18.7; and the above indexes were significantly improved when compared with preoperative values (P lt; 0.05). No recurrence was found on postoperative MRI. Conclusion Arthroscopic treatment of synovial chondromatosis of the hip has the advantages of minimal invasion, quick recovery, and best recovery of hip function and ROM.
Objective To explore the methods of repairing cartilagedefects and to introduce the clinical experience with the autologous osteochondral transplantation. Methods Twenty-five patients with chondral and osteochondral defects of the weight-bearing surfaces were treated by the autologous osteochondral transplantation for the repair of the chondral and osteochondral defects of the unweightbearing surfaces under arthroscope. According to the shape of the defects, the different dimensions of the osteochondral autograft were selected. All the patients began the training of the continuous passive motion after operation. Six weeks after operation, the patients began to walk in the weightbearing habitus. However, in the control group, another 25 patients were retrospectively analyzed, who had chondral and osteochondral defects of the weight-bearing surfaces but were treated only by the cleaning and drilling procedures. The scores evaluated bythe Brittberg-Peterson scoring scale of the 2 group were 98.65±9.87 and 96.98±8.94 respectively. Results The follow-upfor 3-24 months after operation revealed that the treated knee joint had a goodmotion extent. The pain was obviously alleviated. Based on the longitudinal study with the three-dimensional spoiled magnetic resonance imaging (MRI), the signal intensity of the repaired tissues approached to the normal condition. The scores evaluated by the Brittberg-Peterson scoring scale were almost zero 3 monthsafter operation in the experimental group, and the scores were 58.48±6.98 inthe control group. There were significant differences between the experimental group and the control group(P＜0.01). Conclusion Autologous osteochondral transplanation under arthroscope is a good curative method for the cartilage defects, with advantages of minimal invasiveness and avoidanceofrejections resulting from allografts. However, its long-term effect needs to befurther studied. The conventional therapies including cleaning and drilling are useful in alleviating the symptoms.
Objective To compare the effect of two different operations on treating severely comminuted intercondylar fracture. Methods From December 2001 to October 2003, 20 cases of severely comminuted intercondylar fracture were operated. Of the 20 cases, 7(group 1) were treated with closed reduction and retrograde intramedullary nailing through arthroscope, 13(group2) were treated with open reduction and retrograde intramedullary nailing without arthroscope. Follow-ups were conducted after operation. Results All cases of fracture were recovered. Swelling in group 1 was alleviated more obviously than that in group 2. In group 1, all knees could flex to 120° during 6th to 9th weeks after the operation. In group 2, only 4 could flex 110°.Conclusion Retrograde intramedullary nailing through arthroscope proves to be less invasive and more effective in treating heavily comminuted intercondylar fracture.
Objective To investigate the result of the arthroscopicrepair of the meniscus tears with the absorbable sutures. Methods From June 1998 to May2003，the meniscus tears in 110 patients (78 males, 32 females; aged 1466 years, averaged 27.5 years) were repaired with absorbable sutures under an arthroscope. In the patients, there were 93 vertical split injuries, 12 transverse split injuries, and 5 hidden split injuries. There were 78 tears in the lateral margin of the meniscus, 23 tears in the anterior angle of the meniscus, and 9 tears in the posterior angle of the meniscus. Ninetyone patients had 2 sutures, 13 patients had 4 sutures, 4 patients had 6 sutures, and 2 patients had 8 sutures. The rehabilitation program was performed in all the patients postoperatively, and the clinical outcome was observed. The Lysholm score was 57±12 preoperatively. Results Thefollow-up for an average of 26 months (range,12-67 months) showed that 3 patients had a light pain on exertion in the surgically-treated knee;1 patientunderwent an operation again for recurrence of the symptoms due to a failure in the healing of the meniscus tear, so a second arthroscopic operation was performed; and the other patients had a satisfactory result with an excellent knee function. The Lysholm score was 92±7 after operation. Conclusion The arthroscopic repair of the meniscustears has advantages of safety and reliability in the suturing and easier to perform. The repaired meniscus can play much better physiological and biomechanical functions, and will not limit the normal movement of the meniscus during the knee flexion after the sutures are absorbed.
Objective To investigate the effectiveness of percutaneous reduction by leverage and fixation using nonabsorbable suture with neckwear knot loop l igature to treat tibial intercondylar eminence avulsion fractures under the arthroscope. Methods Between February 2003 and December 2008, 28 patients with tibial intercondylar eminence avulsion fractures were treated, including 16 left knees and 12 right knees. There were 15 males and 13 females with an average age of19.5 years (range, 14-45 years). The injury causes included traffic accident injury in 11 cases, sport injury in 10 cases, and sprain injury in 7 cases. Based on Meyers-McKeever classification, there were 18 cases of type III and 10 cases of type IV. The X-ray films showed the tibial intercondylar eminence displaced fracture. The mean time between trauma and operation was 7 days (range, 4-12 days). All patients were treated surgically with an arthroscopically assisted reduction by leverage and fixation using 5-0 Ethibond suture with neckwear knot loop l igature. Results All incisions healed by first intention without infection or injuries of nerves and vessels. Twenty-eight patients were followed up 26 months on average (range, 12-66 months). The X-ray films showed fracture heal ing within 9-13 weeks (mean, 11 weeks). At last follow-up, all patients were able to return to their pre-injury activity and daily l ife. The knee joint was stable with no l imp or impingement of intercondylar fossa. The knee joint range of motion was 0-130°. The results of Lachman and anterior drawer tests were negative in all patients. At last follow-up, the Lysholm score was 93.5 ± 2.5, showing significant difference when compared with the preoperative one (29.0±2.2, t=53.000, P=0.000). Conclusion Percutaneous reduction by leverage and fixation using nonabsorbable suture with neckwear knot loop l igature is minimally invasive and satisfied reduction and fixation in treating the tibial intercondylar eminence avulsion fracture under the arthroscope, so it is benefit for early functional exercises, and can achieve excellent results.
【Abstract】 Objective When knee medial collateral ligament (MCL) rupture, the upper surface of medial meniscus is exposed totally, like the gulf panoramic, which is called “panoramic views of the bay sign” or the “bay sign”. To investigate the reliability and significance of the “bay sign” in diagnosis of knee MCL rupture under arthroscope. Methods Between March 2007 and March 2011, 127 patients with knees injuries were divided into the observation group (n=59) and control group (n=68) based on the MRI results. In the observation group, 59 patients had MCL rupture by MRI, including 12 cases of MCL injury alone, 16 cases of MCL injury with lateral meniscus torn, 27 cases of MCL injury with anterior cruciate ligament (ACL) injury, 3 cases of MCL injury with ACL and posterior cruciate ligament (PCL) injury, and 1 case of MCL injury with patellar dislocation; there were 38 males and 21 females with an average age of 23.2 years (range, 16-39 years). In the control group, 68 patients had no MCL rupture by MRI, including 38 cases of ACL injury, 4 cases of ACL and PCL injury, and 26 cases of ACL and lateral meniscus injury; there were 45 males and 23 females with an average age of 31.8 years (range, 25-49 years). The “bay sign” was observed under arthroscope in 2 groups before and after operation. Results The positive “bay sign” was seen under arthroscope in the patients of the observation group before MCL repair; the “bay sign” disappeared after repair. No “bay sign” was seen in patients of the control group before and after ACL reconstruction. Conclusion The “bay sign” is a reliable diagnostic evidence of MCL injury. It can be used as a basis to judge the success of MCL reconstruction during operation.
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 compare the effectiveness of arthroscopy assisted percutaneous internal fixation and open reduction and internal fixation for Schatzker types II and III tibial plateau fractures. Methods Between August 2006 and April 2010, 58 patients with tibial plateau fractures of Schatzker types II and III were treated with arthroscopy assisted percutaneous internal fixation (arthroscopy group, n=38), and with open reduction and internal fixation (control group, n=20). There was no significant difference in gender, age, disease duration, fracture type, and compl ication between 2 groups (P gt; 0.05). The operation time, incision length, fracture heal ing time, and compl ications were compared between 2 groups. Knee function score and the range of motion were measured according to American Hospital for Special Surgery (HSS) scorestandard. Results All patients achieved primary incision heal ing. The arthroscopy group had smaller incision length andlonger operation time than the control group, showing significant differences (P lt; 0.05). The patients of 2 groups were followed up 12 to 14 months. At 6 months, the HSS score and the range of motion of the arthroscopy group were significantly greater than those of the control group (P lt; 0.05). The X-ray films showed bony union in 2 groups. The fracture heal ing time of the arthroscopy group was shorter than that of the control group, but no significant difference was found (t=2.14, P=0.41). Morning stiffness occurred in 2 cases (5.3%) of the arthroscopy group, joint pain in 6 cases (30.0%) of the control group (3 cases had joint stiffness) at 1 week, which were cured after symptomatic treatment. There was significant difference in the incidence of compl ications between 2 groups (χ2=6.743, P=0.016). Conclusion The arthroscopy assisted percutaneous internal fixation is better than open reduction and internal fixation in the treatment of tibial plateau fractures of Schatzker types II and III, because it has smaller incision length and shorter fracture heal ing time.
ObjectiveTo investigate the effectiveness of distraction therapy assisted by arthroscope in the treatment of ankle traumatic osteoarthritis. MethodsBetween October 2013 and October 2014, 13 patients with ankle traumatic osteoarthritis were treated, including 8 males and 5 females with an age range of 44-63 years (mean, 55.2 years). The left ankle and the right ankle were involved in 4 and 9 cases respectively. The disease duration was 1.5-10.0 years (median, 5 years). The American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hind foot scale score was 51.00±7.09; the short-form 36 health survey scale (SF-36) score was 40.82±4.62. According to Scranton grade system, 9 cases were rated as grade II and 4 cases as grade III. First, ankle hyperplasia osteophytes was removed under arthroscope, then Ilizarov apparatus was used to maintain distraction of 5-10 mm ankle space for 3 months. ResultsOne case had postoperative pin tract infection after removing the external fixation, and infection was controlled by dressing treatment; no related complications occurred in the other patients. All patients got follow-up of 12-18 months (mean, 14.7 months). Patients achieved disappearance of ankle swelling, pain relief, and were able to walk after rehabilitation. The ankle activity was obviously improved. At last follow-up, AOFAS ankel-hind foot scale score and SF-36 score were significantly increased to 85.23±6.41 and 56.29±6.20 respectively (t=20.756, P=0.025; t=11.647, P=0.018). According to AOFAS scores, the results were excellent in 4 cases, good in 8 cases, and fair in 1 case; the excellent and good rate was 92.3%. Postoperative X-ray film showed normal ankle position and alignment, osteophytes at the edges of the tibia and talus, articular surface sclerosis, normal joint space, and no joint swelling. ConclusionDistraction therapy assisted by arthroscope is an effective method for treating ankle traumatic osteoarthritis.
Objective The anterior cruciate l igament (ACL) is the important stable structure of the knee. To evaluate the method and outcome of bone-ACL-bone (B-ACL-B) allograft under arthroscope in reconstruction of ACL. Methods Between October 2007 and February 2010, arthroscopic ACL reconstruction with deep-freezing B-ACL-B allograft was performed on 22 patients with ACL ruptures. There were 15 males and 7 females with an average age of 27.6 years (range, 19-55 years). The causes of ACL rupture were sport trauma in 12 cases, fall ing injury in 1 case, heavy crush in 2 cases, and traffic accident in 7 cases. The locations were the left knee in 14 cases and the right knee in 8 cases. The disease durationwas 7 days to 12 months (median, 65 days). Nineteen patients showed the positive results of anterior drawer test and pivot shift test, and 21 patients showed the positive results of Lachman test. According to International Knee Documentation Committee (IKDC) criteria, there were 5 abnormal and 17 severely abnormal. The subjective IKDC score was 49.6 ± 6.9. The Lysholm score was 48.5 ± 5.3. The Tegner scale scores were 6.8 ± 1.2 before injury and 2.1 ± 0.5 before operation. The MRI showed the ACL injuries in 18 of 20 patients. Results The mean operative time was 75 minutes (range, 65-85 minutes); the mean blood loss was 110 mL (range, 80-150 mL). All incisions healed by first intention. No immunologic rejection and deep vein thrombosis of lower l imbs occurred. All patients were followed up 7-34 months (mean, 18 months). At last follow-up, the flexion of the knee ranged from 125 to 135° (mean, 130.5°). Two patients showed the positive results of anterior drawer test, 1 patient showed the positive result of pivot shift test, and 3 patients showed the positive results of Lachman test. According to the IKDC criteria, 10 patients rated as normal, 11 patients as nearly normal, 1 patient as abnormal. The subjective IKDC score was 90.0 ± 5.8, showing significant difference when compared with preoperative one (t=4.653, P=0.021). The Lysholm score was 91.6 ± 7.1, showing significant difference when compared with preoperative one (t=4.231, P=0.028). The Tegner scale score was 6.1 ± 1.5, showing no significant difference when compared with one before injury (t=1.321, P=0.070) and showing significant difference when compared preoperative one (t=3.815, P=0.033). The arthroscopic examination showed no rupture of grafts in 19 patients, 17 grafts showed normal tension, and 2 showed sl ight relaxation at 6 months after operation. Conclusion Reconstruction of the ACL with B-ACL-B allograft under arthroscope is a safe and effective method, which can anatomically reconstruct ACL and obtain a good recovery of the knee function after operation.