ObjectiveTo investigate the effectiveness of arthroscopic reinforced reconstruction of anterior cruciate ligament (ACL) with autologous hamstring tendon combined with anchor suture band. MethodsBetween February 2016 and March 2018, 60 patients who were to be treated with arthroscopic ACL reconstruction and met the selection criteria were selected in the study. Among them, 30 cases were reconstructed with autologous hamstring tendon combined with anchor suture band (trial group), and 30 cases were reconstructed with simple autologous hamstring tendon (control group). There was no significant difference in gender, age, disease duration, cause of injury, injury side, and preoperative Lysholm score, Tegner score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). After reconstruction, the patients in the trial group were allowed to start knee flexion and extension activities early without wearing an adjustable brace, while the patients in the control group were required to wear an adjustable brace for 12 weeks. The knee joint function (Lysholm score, Tegner score, IKDC score) and stability (Lachman test and pivot shift test) were compared between the two groups after operation.ResultsThere was no significant difference in graft diameter between the two groups (t=1.061, P=0.115). Compared with the control group, the operation time of the trial group was significantly different (t=4.924, P=0.000). All incisions healed primarily. In the control group, the intramuscular venous thrombosis occurred in 2 cases after operation. Both groups were followed up 18 months. The Lysholm score, Tegner score, and IKDC score of the two groups at each time point after operation were significantly higher than those before operation (P<0.05); the above scores in the trial group were significantly higher than those in the control group at 3, 6, and 9 months after operation (P<0.05); there was no significant difference between the two groups at 18 months after operation (P>0.05). There was no significant difference in Lachman test results between the two groups at each time point after operation (P>0.05). There was a significant difference in pivot shift test results at 6 months after operation between the two groups (P<0.05); but there was no significant difference at other time points (P>0.05). ConclusionThe effectiveness of ACL reinforcedreconstruction with autologous hamstring tendon combined with anchor suture band is satisfactory. Compared with using autologous hamstring tendon alone, it has better initial strength and joint stability, and is more conducive to early postoperative functional exercise and functional recovery of knee joint.
Objective To investigate whether different degrees of primary varus knee affect joint function and stability in patients undergoing anterior cruciate ligament (ACL) reconstruction. Methods A clinical data of 160 patients with primary varus knee, who were admitted between January 2020 and December 2021 and met the selection criteria, was retrospectively analyzed. All patients underwent primary ACL reconstruction using autologous single-bundle hamstring tendon. Patients were divided into three groups based on the hip-knee-ankle angle (HKA): group A (64 patients with HKA 0°-3°), group B (55 patients with HKA 3°-6°), and group C (41 patients with HKA 6°-9°). Except for the significant difference in HKA among the three groups (P<0.05), baseline data such as age, gender, affected side, body mass index, interval between injury and operation, Kellgren-Lawrence grading, posterior tibial slope, proportion of combined meniscal injuries, Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) objective score, anterior drawer test, Lachman test, pivot shift test, and the results of KT1000 (side-to-side difference, SSD) showed no significant difference (P>0.05). At last follow-up, joint stability was assessed through the anterior drawer test, Lachman test, pivot shift test, and SSD; joint function was evaluated using the Tegner score, Lysholm score, and IKDC objective score. Results All incisions in the three groups healed by first intention after operation. All patients were followed up 24-31 months, with an average of 26 months; there was no significant difference in the follow-up time among the three groups (Z=0.675, P=0.714). At last follow-up, the knee stability and functional assessment indicators in each group significantly improved when compared to preoperative ones (P<0.05); there was no significant difference among the three groups (P>0.05) in terms of the anterior drawer test, Lachman test, pivot shift test, IKDC objective scores, and the changes of the Lysholm scores and Tegner scores. The Kellgren-Lawrence grading and HKA at last follow-up were consistent with preoperative results in the three groups. ConclusionVarying degrees of primary varus knee do not affect early knee joint stability and functional recovery after ACL reconstruction, and there is no significant difference in effectiveness between different degrees of varus knee.
Objective To summarize the current management of anterior cruciate ligament (ACL) injury in children and adolescents, in order to provide reference for the management of ACL injury in children and adolescents. MethodsThe relevant literature at home and abroad in recent years was extensively accessed to summarize the management status of ACL injury in children and adolescent. Results The number of ACL injury in children and adolescents is increasing every year. The diagnosis of ACL mainly depends on symptoms and signs. Rehabilitation, physeal-sparing techniques, partial transphyseal techniques, all-epiphyseal techniques, and transphyseal techniques are used to treat ACL injury in children and adolescents. Conclusion Dynamic monitoring of knee joint in children and adolescents should be strengthened. The best treatment for ACL injury in children and adolescents is selected according to the patients’ actual age, bone age, Tanner stage, and physiological conditions such as menstruation, body growth speed, and other characteristics.
Objective To investigate the effectiveness of slope-reducing tibial osteotomy and anterior cruciate ligament (ACL) revision in the treatment of patients with primary ACL reconstruction failure and abnormally increased posterior tibial slope (PTS). Methods The clinical data of 9 patients with primary ACL reconstruction failure and abnormally increased PTS (≥17°) who met the selection criteria between January 2018 and January 2020 were retrospectively analyzed. There were 8 males and 1 female; the age ranged from 21 to 42 years, with a median age of 30 years. Lachman test was positive in 9 patients. Pivot-shift test was negative in 6 cases, degree Ⅰ positive in 2 cases, and degree Ⅱ positive in 1 case. The PTS was (17.78±1.09)° and the anterior tibial translation (ATT) was (11.58±1.47) mm. The International Knee Documentation Committee (IKDC) score was 51.0±3.8, Lysholm score was 49.7±4.6, and Tegner score was 3.7±0.7. The time from primary reconstruction to revision was 12-33 months, with an average of 19.6 months. Slope-reducing tibial osteotomy and ACL revision were performed. The improvement of knee function was evaluated by IKDC score, Lysholm score, and Tegner score; Lachman test and Pivot-shift test were used to evaluate the stability of knee joint. PTS and ATT were measured to observe the morphological changes of knee joint. Results All the incisions healed by first intention, and there was no complication such as incision infection, fat liquefaction, necrosis, deep vein thrombosis of lower extremities, and neurovascular injury. All 9 patients were followed up 12-36 months, with an average of 25.8 months. At last follow-up, Lachman test and pivot-shift test were negative. IKDC score was 85.0±4.0, Lysholm score was 87.7±2.8, Tegner score was 6.8±0.7, PTS reduced to (9.89±0.60)°, and ATT shortened to (0.91±0.29) mm, which were significantly improved when compared with those before operation (P<0.05). ConclusionSlope-reducing tibial osteotomy and ACL revision in the treatment of patients with primary ACL reconstruction failure and abnormally increased PTS has a satisfactory short-term effectiveness. It can improve the stability of knee joint and maintain the normal shape of knee joint.
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.
Objective Anterior cruciate ligament (ACL) reconstruction using a new generation of artificial ligaments (NGAL) gained popularity in China owing to its good effectiveness and early functional recovery, but iatrogenic surgical failures and preconceived misconceptions have seriously affected its standardized clinical application. A specialist consensus is now developed to provide guidance and reference for orthopaedic sports medicine doctors when adopting or considering the NGAL for ACL reconstruction. Methods The consensus on the core techniques and adverse events in ACL reconstruction using the NGAL was developed by a modified Delphi method, referring exclusively to the NGAL for ACL reconstruction approved by the National Medical Products Administration (NMPA). Consensus specialists were selected from the members of the Chinese Association of Orthopaedic Surgeons (CAOS) and the Chinese Society of Sports Medicine (CSSM). The drafting team summarized the draft consensus terms based on medical evidence and organized rounds of investigation: two rounds of online questionnaire investigation and the final round of face-to-face meeting. After discussion, revision, and voting, a consensus on the draft consensus term was reached when the agreement rate exceeded 85%. The consensus terms were categorized as “strong” (agreement rate: 95.0%-100%), “moderate” (agreement rate: 90.0%-94.9%), and “basic” (agreement rate: 85.0%-89.9%). ResultsThirty-one specialists completed the questionnaire investigation. They all practiced in university teaching hospitals (Grade-A tertiary hospitals) from 16 provinces, autonomous regions, and municipalities in China. Among them, 28 were chief physicians and 3 were associate chief physicians; 22 were professors and 7 were associate professors; the average seniority in orthopedic sports medicine was 25.2 years (range, 12-40 years); the average seniority in performing ACL reconstruction procedures was 13.2 years (range, 7-23 years); in terms of the number of ACL reconstruction using the NGAL, 18 completed more than 100 cases, of which 6 had more than 300 cases; in terms of research, 28 had published more than 1 related paper in the past 5 years, of which 13 had published more than 3 related papers. Twenty-six specialists attended the face-to-face meeting and reached a consensus on 9 terms, including 8 strong terms and 1 moderate term. Conclusion ACL reconstruction using the NGAL must deploy “isometric” or “near-isometric” reconstruction and should preserve the natural ACL remnants as much as possible. Bone tunnel positioning can be performed using intraoperative radiographic measurements or the lateral femoral intercondylar ridge as reference marks. Incorrect positioning of the bone tunnel is the main reason of surgical failure, and there is a lack of consensus on handling interference screws during revision. Bone tunnel enlargement exists after reconstruction but rarely causes related symptoms. Synovitis and infection are uncommon complications. The aging effect of polyethylene terephthalate fiber on the long-term clinical outcomes is unknown and deserves attention.
Objective To investigate the clinical outcomes of autologous platelet rich plasma (PRP) for anterior cruciate ligament (ACL) reconstruction. Methods Between August 2014 and August 2016, 42 patients with ACL ruptures who underwent arthroscopic ACL reconstruction were randomly divided into 2 groups: 21 patients received graft soaked with PRP (trial group) and 21 patients received routine graft in ACL reconstruction (control group). Because 6 patients failed to be followed up, 17 patients of trial group and 19 of control group were enrolled in the study. There was no significant difference in gender, age, body mass index, side, injury reason, disease duration, Kellgren-Lawrence grade, and preoperative visual analogue scale (VAS), Lysholm score, and International Knee Documentation Committee (IKDC) activity scores between 2 groups (P>0.05). VAS score, Lysholm score, and IKDC activity scores were used to evaluate pain and function at 3 and 12 months postoperatively. Further, second arthroscopy and MRI examination were performed at 12 months postoperatively. Results The patients in both groups were followed up 3 to 12 months with an average of 9.83 months. The VAS score, Lysholm score, and IKDC activity scores were significantly improved at 3 and 12 months after operation in 2 groups (P<0.05), and the scores of trial group were significantly better than those of control group at 3 months (P<0.05), but no significant difference was found between 2 groups at 12 months (P>0.05). No complications of effusion, infection, and allergy were observed in 2 groups during follow-up. MRI showed good position of ACL grafts and good signal quality of the graft in the majority of the cases. However, mixed hyperintense and presence of synovial fluid at the femoral bone-tendon graft interface were found in 3 patients of trial group and 4 patients of control group, indicating poor remodeling ligamentation. MRI score was 3.53±1.13 in trial group and was 3.21±0.92 in control group, showing no significant difference (t=0.936,P=0.356). The second arthroscopy examination showed ligament remodeling score was higher in trial group than control group (t=3.248,P=0.014), but no significant difference was found in synovial coverage score and the incidence of cartilage repair (t=2.190,P=0.064;χ2=0.090,P=0.764). Conclusion PRP application in allograft ACL reconstruction can improve knee function and relieve pain after operation, which may also accelerate graft remodeling.
ObjectiveTo discuss the effectiveness of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fracture in adolescents by using double heads compressive cannulated screw fixation.MethodsTwenty-four patients with ACL tibial eminence avulsion fractures were treated by arthroscopic reduction and internal fixation with double heads compressive cannulated screw fixation between June 2014 and June 2017. There were 15 males and 9 females with an average age of 12.3 years (range, 5-18 years). The body mass index was 19.3-26.4 kg/m2 (mean, 23.3 kg/m2). The injury causes included traffic accident injury in 10 cases, sports injury in 8 cases, and falling injury in 6 cases. According to the Meyers-McKeever classification, there were 19 cases of type Ⅱ and 5 cases of type Ⅲa. All patients’ drawer test and pivot shift test were positive. The interval between injury and operation was 3-14 days (mean, 6.2 days). During the follow-up period, the fracture healing condition of patients were determined by X-ray examination; Lysholm score, International Knee literature Committee (IKDC) score, and Tegner score were used to evaluate the knee function.ResultsPrimary healing of incision was obtained in all patients after operation. All the 24 patients were followed up 6-32 months (mean, 16.4 months). At 6 weeks after operation, 3 patients had difficulty in knee flexion. After the release of the knee joint by manipulation, the knee joint function recovered normally at 6 months after operation. At last follow-up, the X-ray films showed that all the fractures healed and no epiphyseal dysplasia, knee joint deformity, or leg length discrepancy occurred. The Lysholm score, IKDC score, and Tegner score were improved from preoperative 44.3±5.4, 43.7±4.4, and 3.0±1.3 to postoperative 93.1±4.3, 94.6±3.3, and 8.1±1.2, the differences were all significant (t=25.152, P=0.000; t=28.634, P=0.000; t=13.226, P=0.000).ConclusionThe arthroscopic reduction and internal fixation with double heads compressive cannulated screw in treatment of ACL tibial avulsion fracture (Meyers-McKeever type Ⅱ and Ⅲ) in adolescents has so many advantages, such as minimal trauma, simple operation, firm fixation, little effect on the epiphyseal plate, and has a good joint function recovery.
Objective To explore the clinical efficacy of arthroscopic simultaneous both anterior cruciate ligament (ACL) reconstruction and suture of the meniscus bucket-handle tear (BHT). Methods Between January 2013 and April 2014, 22 patients (22 knees) with ACL injury and BHT, who accorded with the inclusion criteria, were studied. There were 14 males and 8 females with a mean age of 30.68 years (range, 15-44 years). The left side was involved in 10 cases and the right side in 12 cases. Injury located at the medial meniscus in 14 patients, and at the lateral meniscus in 8 patients. The median of interval from injury to operation was 40 days (range, 9 hours to 4 years). BHT was sutured, and then single bundle reconstruction of ACL was performed under arthroscopy. Results All incisions healed by first intention, and there were no serious complications such as infection, vascular injury, and nerve injury. The patients were followed up for 26.7 months on average (range, 12-42 months). At 6 weeks after operation, one patient had limited motion of the knee, the function was recovered after release under anesthesia; and one patient had joint space tenderness, which was relieved after conservative treatment. The total effective rate was 90.9% (20/22). At last follow-up, the anterior drawer test, Lachman test, and McMurray test were negative in all the cases. The visual analogue scale (VAS), Tegner activity level score, and Lysholm score were significantly improved at 12 months after operation when compared with preoperative scores (P<0.05). At 6-12 months after operation, complete healing was obtained in 7 cases, and partial healing in 11 cases, and nonunion in 4 cases based on MRI evaluation criteria by Crueset al. There was no rupture of reconstruc-tive ligament during follow-up. Conclusion Arthroscopic simultaneous both ACL reconstruction and suture of BHT can improve the symptoms, reduce the risk of re-tear of sutured meniscus effectively, delay degeneration of articular cartilage, and maintain the stability of the knee joint.
Objective To investigate the feasibility of establishing an anterior cruciate ligament (ACL) reconstruction model using hamstring tendon autograft in cynomolgus monkeys. Methods Twelve healthy adult male cynomolgus monkeys, weighing 8-13 kg, were randomly divided into two groups (n=6). In the experimental group, the ACL reconstruction model of the right lower limb was prepared by using a single bundle of hamstring tendon, and the ACL of the right lower limb was only cut off in the control group. The survival of animals in the two groups was observed after operation. Before operation and at 3, 6, and 12 months after operation, the knee range of motion, thigh circumference, and calf circumference of the two groups were measured; the anterior tibial translation D-value (ATTD) was measured by Ligs joint ligament digital body examination instrument under the loads of 13-20 N, respectively. At the same time, the experimental group underwent MRI examination to observe the graft morphology and the signal/ noise quotient (SNQ) was caculated. Results All animals survived to the end of the experiment. In the experimental group, the knee range of motion, thigh circumference, and calf circumference decreased first and then gradually increased after operation; the above indexes were significantly lower at 3 and 6 months after operation than before operation (P<0.05), and no significant difference was found between pre-operation and 12 months after operation (P>0.05). In the control group, there was no significant change in knee range of motion after operation, showing no significant difference between pre- and post-operation (P>0.05), but the thigh circumference and calf circumference gradually significantly decreased with time (P<0.05), and the difference was significant when compared with those before operation (P<0.05). At 6 and 12 months after operation, the thigh circumference and calf circumference were significantly larger in the experimental group than in the control group (P<0.05). At 3 and 6 months after operation, the knee range of motion was significantly smaller in the experimental group than in the control group (P<0.05). Under the loading condition of 13-20 N, the ATTD in the experimental group increased first and then decreased after operation; and the ATTD significantly increased at 3, 6 months after operation when compared with the value before operation (P<0.05). But there was no significant difference between the pre-operation and 12 months after operation (P>0.05). There was no significant change in ATTD in the control group at 3, 6, and 12 months after operation (P>0.05), and which were significantly higher than those before operation (P<0.05). At each time point after operation, the ATTD was significantly smaller in the experimental group than in the control group under the same load (P<0.05). The MRI examination of the experimental group showed that the ACL boundary gradually became clear after reconstruction and was covered by the synovial membrane. The SNQ at each time point after operation was significantly higher than that before operation, but gradually decreased with time, and the differences between time points were significant (P<0.05). Conclusion The ACL reconstruction model in cynomolgus monkey with autogenous hamstring tendon transplantation was successfully established.