ObjectiveTo explore the effectiveness of one-stage posterior medial corner (PMC) repair or reconstruction combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction in treating KD-ⅢM dislocation. Methods The clinical data of 15 patients with knee KD-ⅢM dislocation who met the selection criteria between January 2016 and July 2019 were retrospectively analyzed. There were 9 males and 6 females, aged 22-61 years (mean, 40.3 years). Injuries were caused by violence of flexion, valgus, and external rotation, including 10 cases of traffic accident injuries, 3 cases of crush injuries, 1 case of winch injury, and 1 case of explosion injury. The time from injury to operation ranged from 3 days to 6 months, with an average of 18.5 days. PMC repair combined with PCL+ACL reconstruction was performed in 10 cases in acute stage (within 3 weeks after injury), including 3 cases of irreducible dislocation. PMC+PCL+ACL reconstruction was performed in 5 cases with chronic dislocation. Before operation and at last follow-up, the knee joint function was evaluated by Lysholm score and International Knee Documentation Committee (IKDC) 2000 score. KT-3000 was used to evaluate the forward stability of the knee (calculated the difference of tibial anterior displacement of both knees), the X-ray films of the stress position of the knee joint was used to evaluate the valgus of the knee (calculated the difference of medial joint space width of both knees) and the backward stability (calculated the difference of tibial posterior displacement of both knees), and the internal and external rotation stability was evaluated by knee flexion 30° tibial external rotation and knee flexion 90° tibial internal rotation tests (calculated the difference of tibial internal rotation and the difference of tibial external rotation of both knees). Results The operation time was 120-240 minutes, with an average of 186.5 minutes. Patients were followed up 24-48 months, with an average of 27.4 months. There was no complication such as infection, deep vein thrombosis, vascular injury, or heterotopic ossification. At last follow-up, the Lysholm score, IKDC2000 score, the difference of tibial anterior displacement of both knees, the difference of medial joint space width of both knees, the difference of tibial posterior displacement of both knees, the difference of tibial internal rotation and the difference of tibial external rotation of both knees significantly improved when compared with preoperative ones (P<0.05). According to the IKDC2000 valgus stability grading standard, there were 3 cases of grade C and 12 cases of grade D before operation, and 10 cases of grade A and 5 cases of grade B at last follow-up, which was significantly improved when compared with that before operation (Z=?4.930, P=0.000). At last follow-up, the pivot shift tests of 15 patients were negative. The anterior and posterior drawer tests of 10 patients were negative, 5 patients had mild instability, both the anterior and posterior drawer tests were positive. ConclusionKD-ⅢM dislocation of the knee joint can lead to the posterior medial and anterior instability. Acute dislocation combined with “dimple sign” requires surgical reduction as soon as possible to repair PMC and reconstruct PCL and ACL. In chronic patients, PMC is difficult to repair, it is recommended to reconstruct PMC, PCL, and ACL at one stage to improve knee joint stability. The early and middle effectiveness are satisfactory.
ObjectiveTo discuss the effectiveness of posterior cruciate ligament (PCL) reconstruction with autologous peroneus longus tendon under arthroscopy.MethodsBetween January 2016 and December 2018, 46 patients with PCL injuries were enrolled. There were 34 males and 12 females, with an average age of 40.7 years (range, 20-58 years). There were 43 cases of acute injury and 3 cases of old injury. The anterior drawer test and the posterior tibia sign were positive in 4 cases, the posterior drawer tests and the posterior tibia sign were positive in 46 cases, the varus stress tests were positive in 10 cases, and the valgus stress tests were positive in 6 cases. The difference of dial-test at 30° knee flexion between affected and healthy sides was (5.20±3.91)°. The tibia posterior displacement under posterior stress position was (12.03±2.38) mm. The Lysholm score of the knee joint was 36.68±7.89, the International Knee Documentation Committee (IKDC) score was 33.58±5.97, and the American Orthopaedic Foot and Ankle Association (AOFAS) score of the ankle joint was 97.60±1.85. PCL was reconstructed with autologous peroneus longus tendon under arthroscopy, and the combined meniscus injury, posterolateral complex injury, and anterior cruciate ligament injury were all treated according to the degree of injury.ResultsAll incisions healed by first intention. Forty patients were followed up 12-26 months, with an average of 16.0 months. At last follow-up, the Lysholm score of the knee joint was 84.85±7.03, and the IKDC score was 87.13±6.27, which were significant different from preoperative ones (t=?13.45, P=0.00; t= ?39.12, P=0.00); the AOFAS score of ankle joint was 93.98±2.14, which was not significant different from preoperative one (t=8.09, P=0.90). The tibia posterior displacement under posterior stress position was (2.75±1.76) mm and the difference of dial-test at 30° knee flexion between affected and healthy sides was (1.75±2.09)°, which were significant different from preoperative ones (t=29.00, P=0.00; t=4.96, P=0.00). The posterior drawer test and the posterior tibia sign were positive in 1 case and negative in 39 cases; the anterior drawer test and the varus and valgus stress tests were all negative.ConclusionReconstruction of PCL with autologous peroneus longus tendon under arthroscopy can significantly improve the stability and function of the knee joint, with satisfactory clinical results.
Objective To review the application progress of internal brace ligament augmentation (IBLA) technology in the repair and reconstruction of anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL) injuries, and to clarify the development trends of IBLA technology. Methods A comprehensive review of recent domestic and international in vitro and in vivo biomechanical studies, animal experiments, and clinical research on IBLA technology was conducted. The effects of this technology on postoperative biomechanics, histological changes, and clinical outcomes following ACL and PCL repair and reconstruction were analyzed and summarized. Results IBLA technology provides enhanced knee stability in the early postoperative period after ACL and PCL repair and reconstruction. It promotes healing at the ligament injury site and increases the biomechanical strength of tendon grafts, thereby reducing postoperative failure rates. IBLA demonstrates good histocompatibility in vivo. Clinical follow-up shows that IBLA improves early postoperative knee stability, range of motion, and functional scores. Patients undergoing rapid rehabilitation achieve more satisfactory outcomes, with no reported serious complications. Conclusion The combination of IBLA with ACL and PCL repair and reconstruction promotes rapid early postoperative recovery and shows promising application prospects. However, further optimization of IBLA material properties and related surgical techniques is needed. Additionally, the long-term effectiveness, structural remodeling of the grafts and repaired ligaments, and the underlying biomechanical functional mechanisms require further clarification.
ObjectiveTo summarize the research progress of killer turn in posterior cruciate ligament (PCL) reconstruction.MethodsThe literature related to the killer turn in PCL reconstruction in recent years was searched and summarized.ResultsThe recent studies show that the killer turn is considered to be the most critical cause of graft relaxation after PCL reconstruction. In clinic, this effect can be reduced by changing the fixation mode of bone tunnel, changing the orientation of bone tunnel, squeezing screw fixation, retaining the remnant, and grinding the bone at the exit of bone tunnel. But there is still a lack of long-term follow-up.ConclusionThere are still a lot of controversies on the improved strategies of the killer turn. More detailed basic researches focusing on biomechanics to further explore the mechanism of the reconstructed graft abrasion are needed.
Objective To explore the effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament (PCL) tibial insertion fractures in adults. Methods Between October 2019 and October 2021, 16 patients with PCL tibial insertion fractures were treated with arthroscopic binding fixation using suture through single bone tunnel. There were 11 males and 5 females with an average age of 41.1 years (range, 26-58 years). The fractures were caused by traffic accident in 12 cases and sports in 4 cases. The time from injury to operation ranged from 2 to 10 days with an average of 6.0 days. The fractures were classified as Meyers-McKeever type Ⅱ in 4 cases and type Ⅲ in 9 cases, and Zaricznyi type Ⅳ in 3 cases. There were 2 cases of grade Ⅰ, 7 cases of grade Ⅱ, and 7 cases of grade Ⅲ in the posterior drawer test. There were 3 cases combined with lateral collateral ligament injury and 2 cases with meniscus injury. The visual analogue scale (VAS) score, Lysholm score, International Knee Documentation Committee (IKDC) score, and knee range of motion were used to evaluate knee joint function. The posterior drawer test and knee stability tester (Kneelax 3) were used to evaluate knee joint stability. The X-ray films were used to evaluate fracture reduction and healing. Results All incisions healed by first intention after operation. There was no incision infection, popliteal neurovascular injury, or deep venous thrombosis of lower limbs. All patients were followed up 6-12 months, with an average of 10 months. X-ray films at 6 months after operation showed the fractures obtained bone union. There were 11 cases of grade 0, 4 cases of gradeⅠ, and 1 case of grade Ⅱin posterior drawer test, showing significant difference when compared with preoperative results (Z=23.167, P<0.001). The VAS score, Lysholm score, IKDC score, knee range of motion, and the results of Kneelax3 examination all significantly improved when compared with preoperative results (P<0.05). Conclusion For adult patients with PCL tibial insertion fractures, the arthroscopic binding fixation using suture through single bone tunnel has the advantages of minimal trauma, good fracture reduction, reliable fixation, and fewer complications. The patient’s knee joint function recovers well.
ObjectiveTo investigate the short-term effectiveness of arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon for posterior cruciate ligament (PCL) injuries.MethodsA clinical data of 30 patients with PCL injury, who were admitted between December 2015 and September 2018 and met the selection criteria, was retrospectively analyzed. All patients were treated with arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon and TightRope technique. Among them, 19 were male and 11 were female, aged 17-48 years (mean, 28.2 years). The PCL injury was caused by traffic accident in 8 cases, sport in 14 cases, falling and bruising by a heavy objective in 5 cases, and other injuries in 3 cases. The interval between injury and operation was 10-90 days (mean, 39.3 days). The PCL injury was rated as grade Ⅱ in 6 cases and grade Ⅲ in 24 cases. The posterior drawer test was positive in 26 cases and the inverse Lachman test was positive in 24 cases. The International Knee Documentation Committee (IKDC) score was 61.37±8.49, and the objective IKDC ligament grading was near normal in 2 cases, abnormal in 8 cases, and significantly abnormal in 20 cases. The modified Lysholm knee score was 62.20±5.67. The knee range of motion (ROM) was (101.83±8.15) °.ResultsThe operative time ranged from 70 to 110 minutes (mean, 79.7 minutes). All incisions healed by first intetion. All patients were followed up 12-24 months (mean, 19.0 months). There were 3 cases of deep vein thrombosis in the lower extremity after operation, and 1 case of approximately 10° limitation of knee extension. At last follow-up, the posterior drawer test was positive in 2 cases and the inverse Lachman test was positive in 1 case, with significant differences compared with the preoperative period (χ2=38.571, P=0.000; χ2=36.274, P=0.000). The IKDC score was 84.67±3.67, and the objective IKDC ligament grading was normal in 16 cases, nearly normal in 10 cases, abnormal in 3 cases, and significantly abnormal in 1 case; the modified Lysholm knee score was 90.37±4.49; all of the above indexes were significantly better than preoperative ones, and the differences were significant (t=?12.387, P=0.000; Z=?2.810, P=0.005; t=?22.865, P=0.000). Knee ROM was (88.33±9.86)° at 1 month after operation and reached (113.33±13.48)° at last follow-up, showing significant differences between pre- and post-operation (P<0.05). MRI re-examination showed that the form and position of reconstructed PCL were satisfactory.ConclusionIt can obtain good short-term effectiveness for PCL injuries by arthroscopic single bundle four-strand reconstruction using autologous semitendinosus tendon and anterior half of peroneus longus tendon, which has the advantages of reliable surgical approach, safe operation, and precise effectiveness.
ObjectiveTo compare the effectiveness of partial versus intact posterior cruciate ligament (PCL)-retaining in total knee arthroplasty (TKA) with cruciate-retaining (CR) prosthesis.MethodsA total of 200 patients with osteoarthritis, who met the selection criteria and proposed unilateral TKA with CR prosthesis, were included in the study and randomly assigned into two groups (n=100). The patients were treated with intact retention of the double bundles of PCL in intact group and with partial resection of the anterior lateral bundle of PCL and the anterior bone island at the time of intraoperative tibial osteotomy in partial group. Patients with lost follow-up and re-fracture were excluded, and 84 cases in partial group and 88 cases in intact group were included in the final study. There was no significant difference between the two groups (P>0.05) in terms of gender, age, body mass index, course and grade of osteoarthritis, preoperative varus deformity of knee joint, flexion contracture, range of motion, clinical and functional scores of Knee Society Score (KSS). The operation time, wound drainage volume during 24 hours after operation, visual analogue scale (VAS) score at 24 hours after operation, range of motion of knee joint, clinical and functional scores of KSS, and the anteroposterior displacement of knee joint at 30° and 90° flexion positions were compared between the two groups.ResultsThere was no significant difference between the two groups in operation time, wound drainage volume during 24 hours after operation, and VAS score at 24 hours after operation (P>0.05). Patients in both groups were followed up after operation. The follow-up time was 25-40 months (mean, 30.2 months) in intact group and 24-40 months (mean, 31.8 months) in partial group. There was no significant difference in the range of motion and clinical scores of KSS between the two groups at 6, 12, and 24 months after operation (P>0.05). The functional scores of KSS were significantly higher in intact group than in partial group (P<0.05). There was no significant difference between the two groups in the anteroposterior displacement of knee joints at 30° flexion position at 6, 12, and 24 months after operation (P>0.05). When the knee was at 90° flexion position, there was no significant difference between the two groups at 6 and 12 months after operation (P>0.05), but the intact group was significantly smaller than partial group at 24 months after operation (P<0.05). Postoperative incision continued exudation in 4 patients (2 cases of partial group and 2 cases of intact group), and incision debridement in 2 patients (1 case of partial group and 1 case of intact group). No prosthesis loosening, excessive wear, or dislocation of gasket was found during follow-up.ConclusionThe double bundle of PCL plays an equally important role in maintaining the stability of the knee joint, and the integrity of PCL should be kept as much as possible when TKA is performed with CR prosthesis.
ObjectiveTo investigate the effectiveness of the reconstruction of posterior cruciate ligament (PCL) with platelet rich plasma (PRP) and 3-strand peroneal longus tendons under arthroscope.MethodsBetween June 2014 and December 2017, 58 patients with PCL rupture were randomly divided into two groups: the trial group (PRP assisted reconstruction of 3-strand peroneal longus tendons) and the control group (4-strand hamstring tendon reconstruction alone), 29 cases in each group. There was no significant difference in gender, age, injury side, Kellgren-Lawrence grade, time from injury to operation, and preoperative American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, International Knee Documentation Committee (IKDC) score, Lysholm score between the two groups (P>0.05). Before operation, at 3 months and 12 months after operation, the IKDC score and Lysholm score of the two groups were recorded to evaluate the knee joint function, AOFAS ankle-hindfoot score was used to evaluate ankle function; KT-2000 examination (knee flexion of 90°, 30 lbs) was used to evaluate the difference of bilateral knee joint posterior relaxation at 12 months after operation, and MRI was used to evaluate ligament reconstruction; CT was used to evaluate the bone tunnel expansion of femur and tibia at 3 months and 12 months after operation.ResultsThe operation was completed successfully in both groups, there was no complication in the donor tendon area. All the incisions healed by first intention. All the patients were followed up for more than 1 year. The follow-up time of the trial group was 13-17 months, with an average of 15.0 months; that of the control group was 15-20 months, with an average of 15.4 months. At 3 and 12 months after operation, there was no significant difference in AOFAS ankle-hindfoot score when compared with preoperative score and between the two groups (P>0.05). At 3 and 12 months after operation, the IKDC score and Lysholm score of the two groups were significantly improved, and further improvement was found at 12 months when compared with at 3 months (P<0.05); the scores in the trial group were significantly better than those of the control group (P<0.05). At 12 months after operation, the difference of the posterior relaxation of the bilateral knees in the trial group was less than 5 mm in 27 cases, 6-10 mm in 2 cases; in the control group was less than 5 mm in 20 cases, 6-10 mm in 6 cases, and >10 mm in 3 cases; the difference between the two groups was not significant (Z=0.606, P=0.544). At 12 months after operation, MRI of knee joint showed that all patients had good PCL graft. The MRI score of the trial group was better than that of the control group (t=2.425, P=0.019). CT examination at 3 and 12 months after operation showed that the bone tunnel expansion of femur and tibia in the trial group were significantly better than those in the control group (P<0.05).ConclusionPRP combined with 3-stand peroneal longus tendons can significantly improve the function and stability of knee joint, effectively promote graft remodeling, and promote tendon bone healing, reduce the expansion of bone tunnel. The effectiveness is satisfactory.
ObjectiveTo compare the effectiveness of arthroscopic one-stage reconstruction of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) with LARS artificial ligament and autogenous hamstring tendon, respectively.MethodsA retrospective study was performed on 23 patients with ACL and PCL injuries, who were treated with one-stage reconstruction, between June 2013 and June 2017. The ACL and PCL were reconstructed with LARS artificial ligament in 11 patients (artificial ligament group) and autogenous hamstring tendon in 12 patients (autogenous tendon group). There was no significant difference in gender, age, side of injury, cause of injury, time from injury to operation, and preoperative Lysholm score and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The operation time, the time of recovery of daily activities and preoperative exercise level, the occurrence of surgical-related complications, Lysholm score, IKDC score, and the results of knee stability assessment were recorded and compared between the two groups.ResultsThe operation time and the time of recovery of daily activities and preoperative exercise level were significantly shorter in artificial ligament group than in autogenous tendon group (P<0.05). All incisions healed primarily. In autogenous tendon group, the common fibular nerve injury occurred in 1 case and intermuscular vein thrombosis occurred in 1 case. No complication occurred in the remaining patients of the two groups. All the patients were followed up 24-54 months (mean, 36.4 months). At last follow-up, the Lysholm score and IKDC score of the two groups were significantly higher than preoperative scores (P<0.05). There was no significant difference between the two groups (P>0.05). The varus and valgus stress tests of the two groups were negative. There was no significant difference in anterior drawer test, posterior drawer test, and Lachman test between the two groups (P>0.05).ConclusionThe effectiveness of arthroscopic one-stage reconstruction of ACL and PCL with LARS artificial ligament or autogenous hamstring tendon was similar. The knee function and stability recover well. But the patients with LARS artificial ligament reconstruction can resume daily activities and return to exercise earlier.
Objective To evaluate the effectiveness of arthroscopic reconstruction of posterior cruciate ligament (PCL) with embedded “tibial tendon bolt” fixation. MethodsThe clinical data of 32 patients who underwent arthroscopic reconstruction of PCL using embedded “tibial tendon bolt” fixation through the tibial “8”-shaped tunnel between February 2012 and April 2016 were analyzed retrospectively. There were 23 males and 9 females, aged 15-57 years (mean, 39.9 years). The causes included traffic accident injury in 12 cases and sports injury in 20 cases. The clinical manifestations were swelling of knee joint, tenderness of knee joint space, and (+) Ⅲ degree in posterior drawer test; McMurry test (+) in 13 cases, valgus stress test (+) in 8 cases, Lachman test (+) in 9 cases, and Dial test (+) in 2 cases. The preoperative Lysholm score was 18.8±10.9, the International Knee Documentation Committee (IKDC) score was 18.0±15.2, and the detection value of KT-1000 was (14.34±2.73) mm. The time from injury to operation was 8-225 days, with a median of 11 days. Results All 32 patients were followed up 25-36 months, with an average of 26.4 months. The patients had no tenderness of joint space, and the McMurry tests were all (?). At last follow-up, the Lysholm score and IKDC score were 90.2±2.4 and 87.2±6.2, respectively, which were significantly improved when compared with preoperative ones (t=?38.400, P<0.001; t=?27.190, P<0.001). The results of posterior drawer test were (?) in 21 cases, (+) Ⅰ degree in 9 cases, and (+) Ⅱ degree in 2 cases. At 1 and 2 years after operation, the detection value of KT-1000 were (5.56±2.28) mm and (5.87±1.78) mm, respectively, which were significantly improved when compared with preoperative values (P<0.05). ConclusionThe application of arthroscopic reconstruction of PCL using embedded “tibial tendon bolt” fixation through the tibial “8”-shaped tunnel is an effective, simple, and safe surgical procedure.