Objective To investigate the effectiveness of reconstructing medial patellofemoral l igament with hamstring tendon autografts for the treatment of recurrent patellar dislocation under arthroscopy. Methods Between January 2005 and January 2010, 22 cases of recurrent patellar dislocation were treated by lateral retinacular release and reconstructionof the medial patellofemoral ligament with hamstring tendon autografts under arthroscopy. There were 5 males and 17 females, aged 15-19 years (mean, 17.3 years). The average number of dislocation was 4 (range, 3-8). The main cl inical symptoms were pain and swell ing of knee joint, weakness in the leg, and limited range of motion (ROM). The patellar tilt test, pressing pain of patellofemoral ligament insertion, and apprehension sign showed positive results. According to International Knee Documentation Committee (IKDC) scoring criteria, the subjective IKDC score was 36.7 ± 4.7, and the Lysholm score was 69.3 ± 3.8. X-ray films showed that the patella inclined outwards. Results All incisions healed by first intention. Twenty-two cases were followed up 18-49 months (mean, 34 months). Pain and swelling of knee joint and weakness were improved obviously. No recurrence was found during follow-up. The ROM of knee in flexion and extension was improved when compared with preoperative ROM. The subjective IKDC score was 92.4 ± 5.3 and the Lysholm knee score was 91.7 ± 5.2, showing significant differences when compared with preoperative scores (P lt; 0.05). Conclusion Reconstruction of the medial patellofemoral ligament with hamstring tendon autografts under arthroscopy is an effective method to treat recurrent patellar dislocation.
ObjectiveTo conclude the effectiveness of arthroscopy combined with Burks and SchaVer's approach in the treatment of posterior cruciate ligament (PCL) avulsion fractures in a floppy lateral position. MethodsBetween May 2010 and March 2014, 21 patients with PCL avulsion fractures were treated. There were 13 males and 8 females, aged 21 to 62 years (mean, 39.1 years). The causes included traffic accident injury in 10 cases, sports injury in 5 cases, and falling injury from height in 6 cases. The time from injury to hospital was 1-6 days (mean, 2.5 days). The results of posterior drawer test were all positive, and the results of anterior drawer test and lateral stress test were all negative. The Lysholm score was 28.0±5.5 before operation. And the American Orthopaedic Foot and Ankle Society (IKDC) score was 46.2±7.6 before operation. According to Meyer standards for fractures classification, 11 cases were rated as type II and 10 cases as type III. Arthroscopy was used to inspect and treat the intra-articular lesions, then avulsion fracture was fixed by Burks and SchaVer's approach in lateral position. Postoperative functional exercises were performed. ResultsPrimary healing of incision was obtained, without nerve and vascular injury or joint infection. All patients were followed up 18-36 months (mean, 27.2 months). The X-ray films of the knee joint showed good fractures reduction and healing at 3 months after operation. The results of posterior drawer test and reverse Lachman test were negative. The knee range of motion was recovered to normal level. At last follow-up, the Lysholm score of the knee joint was significantly improved to 90.9±1.4 from preoperative one (t=54.584, P=0.000), and the IKDC score was significantly increased to 90.5±5.3 from preoperative one (t=15.638, P=0.000), including 19 cases of grade A and 2 cases of grade B. ConclusionA combination of arthroscopy and Burks and SchaVer's approach for the treatment of PCL avulsion fractures in a floppy lateral position has the advantages of minimal invasion and safe approach, short operative time, and early postoperative rehabilitation exercises, so it can provide satisfactory function recovery of the knee joint.
Objective To assess the effectiveness of suture button fixation Latarjet procedure under total arthroscopy for anterior shoulder instability with severe bone defects. MethodsThe clinical data of 15 patients with severe bone defects and anterior shoulder instability treated with suture button fixation Latarjet procedure under total arthroscopy between June 2020 and February 2023 was retrospectively analyzed, including 11 males and 4 females, with an average age of 31.1 years (range, 20-54 years). Three-dimensional CT showed that the average glenoid bone defect was 24.4% (range, 16.3%-35.2%). The average number of shoulder dislocation was 4.2 times (range, 3-8 times). The disease duration ranged from 6 to 21 months with an average of 10.6 months. The operation time and intraoperative blood loss were recorded. The pain relief was evaluated by visual analogue scale (VAS) score, and the functional recovery of shoulder joint was evaluated by Rowe score, Walch-Duplay score, and American Association for Shoulder and Elbow Surgery (ASES) score before and after operation. The range of motion (ROM) of the shoulder joint was assessed, including active flexion, lateral external rotation, abduction 90° external rotation, and internal rotation. Three-dimensional CT was performed at 6 months after operation and at last follow-up to observe the absorption of bone graft, the position of bone graft and glenoid, and the healing of bone graft. Results The operation was successfully completed in all patients. The operation time was 85-195 minutes, with an average of 123.0 minutes. The intraoperative blood loss was 20-75 mL, with an average of 26.5 mL. All patients were followed up 13-32 months, with an average of 18.7 months. During the follow-up, there was no serious complication such as shoulder joint infection, joint stiffness, or vascular and nerve injury. One patient had partial absorption of the transplanted bone and bone nonunion at 3 months after operation, but the pain of the shoulder joint relieved at last follow-up, and no redislocation of the shoulder joint occurred; no obvious bone fracture or dislocation of the shoulder joint was found in the other patients. Bone union was achieved at 6 months during follow-up. At last follow-up, the VAS score, Rowe score, Walch-Duplay score, and ASES score significantly improved when compared with those before operation (P<0.05), while the ROM of active flexion, lateral external rotation, abduction 90° external rotation, and internal rotation of the shoulder joint was not significantly different from those before operation (P>0.05).ConclusionSuture button fixation Latarjet procedure under total arthroscopy can improve shoulder joint function in patients with severe anterior shoulder instability caused by bone defects, and imaging also indicates satisfactory placement of transplanted bone blocks.
Objective To compare the effectiveness of simultaneous and delayed repair of combined full-thickness rotator cuff rupture in proximal humerus fracture. Methods Between January 2015 and January 2017, 44 patients with proximal humerus fractures complicated with full-thickness rotator cuff injuries were included. Twenty-four patients underwent open reduction and internal fixation (ORIF) and rotator cuff repair simultaneously (simultaneous operation group), and 20 patients underwent delayed arthroscopic rotator cuff repair more than 90 days after ORIF (delayed operation group). There was no significant difference in gender, age, cause of injury, and side of injury between the two groups (P>0.05). The fracture healing was observed by X-ray films. The shoulder function was assessed at 3, 6, and 12 months after operation by using the University of California at Los Angeles (UCLA) score. Results All incisions healed by first intention. All patients were followed up 12-24 months (mean, 17 months). Fractures all healed at 3 months after operation in simultaneous operation group. According to UCLA score, the patients had achieved significantly better outcomes in function, active forward flexion, strength of forward flexion, and subjective satisfaction in simultaneous operation group than in delayed operation group at 3, 6, and 12 months after operation (P<0.05). However, there was no significant difference in pain between the two groups (P>0.05). Conclusion For patients with proximal humerus fracture complicated with full-thickness rotator cuff rupture, performing ORIF and simultaneous repair of rotator cuff can improve shoulder function and achieve better effectiveness when compared with delayed repair of rotator cuff.
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.
ObjectiveTo investigate the effectiveness of arthroscopic GraftLink technique reconstruction combined with suture anchor fixation in treatment of anterior cruciate ligament (ACL) rupture and medial collateral ligament (MCL) grade Ⅲ injury.MethodsBetween June 2015 and February 2018, 28 patients with ACL rupture and MCL grade Ⅲ injury were treated. Arthroscopic GraftLink technique was used to reconstruct ACL with autologous peroneus longus tendon (PLT), and suture anchor fixation was used to repair MCL. There were 22 males and 6 females, aged 21-47 years, with an average age of 30.4 years. The cause of injury included traffic accident in 18 cases, falling from height in 7 cases, and sports injury in 3 cases. The time from injury to admission was 1-2 weeks, with an average of 1.3 weeks. The preoperative Lysholm score of knee joint was 46.8±3.0 and the International Knee Documentation Commission (IKDC) score was 49.2±2.7. The American Orthopaedic Foot and Ankle Society (AOFAS) score of ankle joint was 98.29±0.72. Both Lachman test and valgus stress test were positive. There were 8 cases of meniscus injury and 2 cases of cartilage injury.ResultsThe operation time ranged from 55 to 90 minutes, with an average of 72.5 minutes. All incisions healed by first intention after operation, and no complications related to operation occurred. All patients were followed up 6-38 months, with an average of 20.7 months. At 3 months after operation, the range of motion of the knee joint was 116- 132°, with an average of 122°. Lachman test showed that the anterior translation more than 5 mm in 2 cases, and the others were negative; while the valgus stress test showed that all patients were positive. At 6 months after operation, the Lysholm score and IKDC score of knee joint were 90.2±1.8 and 93.5±2.3, respectively, which were significantly higher than preoperative scores (t=31.60, P=0.00; t=29.91, P=0.01); AOFAS score of ankle joint was 97.86±0.68, with no significant difference compared with preoperative score (t=2.89, P=0.08). KT-1000 test showed that the difference of anterior relaxation between bilateral knee joints was less than 2 mm in 25 cases and 3 to 5 mm in 3 cases.ConclusionThe method of ACL reconstruction via arthroscopic GraftLink technique with PLT and MCL repair via suture anchor fixation has the advantages of less knee injury and faster recovery, and there is no significant impact on ankle function after tendon removal.
ObjectiveTo investigate the effectiveness of one-stage arthroscopic reconstruction and strict immobilization for 6 weeks for treatment of knee dislocation. MethodBetween August 2010 and May 2013, 22 cases (22 knees) of knee dislocation were treated with one-stage reconstruction and strict immobilization for 6 weeks. There were 15 males and 7 females, aged 21-54 years (mean, 31.5 years). The left knee and right knee were involved in 8 cases and 14 cases respectively. The disease causes were traffic accident in 12 cases, falling from height in 6 cases, and sports injury in 4 cases. The time between injury and operation was less than 2 weeks in 6 cases, 2-3 weeks in 10 cases, and more than 3 weeks in 6 cases. The results of anterior drawer test, posterior drawer test, and Lachman test were positive in all patients. The posterior displacement of the tibia was more than 10 mm. The results of valgus stress test and varus stress test were positive in 13 cases and 11 cases respectively. The preoperative knee range of motion was (58.2±28.4) °, Lysholm score was 39.7±4.6. All patients had anterior cruciate ligament rupture and posterior cruciate ligament rupture; combined injuries included medial collateral ligament rupture in 11 cases, lateral collateral ligament rupture in 9 cases, both medial and lateral collateral ligament rupture in 2 cases, femoral condylar avulsion fracture in 2 cases, and meniscus injury in 7 cases. No nerve or blood vessel injury was observed. ResultsAll cases obtained primary healing of incision without infection. All the patients were followed up 12-48 months (mean, 27.8 months). At 12 months after operation, the results of the anterior drawer test, posterior drawer test, Lachman test, valgus stress test, and varus stress test were all negative; the knee range of motion increased was significantly to (121.3±7.9) °(t=30.061, P=0.000) ; Lysholm score was 87.2±6.1, showing significant difference when compared with preoperative score (t=24.642, P=0.000) . ConclusionsA combination of arthroscopic one-stage reconstruction and strict immobilization for treatment of knee dislocation is a safe and effective method, good stability and joint function can be achieved.
Objective To investigate the method and the effectiveness of arthroscopy and/or arthrotomy combinedwith postoperative radiotherapy for diffuse pigmented villonodular synovitis (PVNS) of the knee. Methods BetweenSeptember 2000 and August 2010, 97 patients with diffuse PVNS of the knee were treated. There were 38 males and 59 femaleswith a median age of 33 years (range, 8-75 years). The disease duration ranged from 1 week to 30 years, including 52 left kneesand 45 right knees. There were 10 recurrent cases. The extention and flexion of the knee joint were (1.9 ± 2.3)° and (122.9 ± 5.6)°,respectively; the Lysholm score was 43.2 ± 6.7; and the International Knee Documentation Committee (IKDC) score was53.2 ± 5.7, preoperatively. According to the scope and degree of the knee joint lesions, simultaneous anterior and posteriorsynovectomy was performed under arthroscopy in 82 cases, synovectomy under arthroscopy and removal of posterior extraarticularlesion by arthrotomy in 3 cases, synovectomy and the soft tissue lesions resection under arthroscopy in 9 cases, andstaging resection and bone graft in 3 cases. After operation, 76 patients received postoperative radiotherapy. Results Poplitealartery was injuryed in 1 case and the branch of popl iteal veins were injuryed in 3 cases during operation. Intra-articularhemorrhage occurred in 1 case at 3 days after operation. The other patients achieved heal ing of incision by first intentionwithout nerve damage and other complications. All patients were followed up 1 year and 3 months to 11 years and 2 months(median, 61 months) postoperatively. During follow-up, 89 cases had no relapse. At 15 months after operation, the extentionand flexion of the knee joint were (0.2 ± 1.3)° and (135.9 ± 6.6)°, respectively; the Lysholm score was 89.8 ± 5.8; and the IKDCscore was 87.8 ± 5.8. All indexes were significantly improved when compared with the preoperative ones (P lt; 0.05). At 6 monthsto 8 years postoperatively, 8 cases had occurrence, and they had sl ight limitation of the range of motion but had no pain andswelling of the knees after reoperation. Conclusion According to the scope and degree of the knee joint lesions, arthroscopyand/or arthrotomy combined with postoperative radiotherapy should be chosen for diffuse PVNS of the knee so as to obtain good effectiveness. Radiotherapy and enough total radiation dose are important factors to insure no recurrence.
Objective To investigate the mid-term effectiveness of arthroscopic Bankart repair for recurrent anterior shoulder dislocation. Methods The clinical data of 107 patients with recurrent anterior shoulder dislocation who met the inclusion criteria between January 2017 and June 2021 was retrospectively analyzed, and all patients underwent arthroscopic Bankart repair. There were 88 males and 19 females. The age of the primary dislocation ranged from 13 to 48 years (mean, 23.3 years). The number of preoperative dislocations was 2-160 times (median, 7 times). The duration of preoperative instability was 0.2-240.0 months (median, 36.0 months). The mean age at operation was 28.2 years (range, 16-61 years). There were 43 cases of left shoulder and 64 cases of right shoulder. The proportion of glenoid defects in 63 patients was 1.7%-16.1% (mean, 8.1%). MRI showed that none of the patients had rotator cuff tears or shoulder stiffness. The CT three-dimensional reconstruction was performed at 1 day after operation to evaluate the distribution of implanted anchors and the occurrence of glenoid split fracture and whether there were nails pullout at the implant site. The postoperative complications were observed, and the pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, Rowe score, Constant-Murley score, and American Shoulder and Elbow Surgeons (ASES) score. The recurrence of instability, the results of apprehension test, the number of patients who returned to preoperative sports level, and the satisfaction rate of patients were recorded. Results All patients were successfully operated and were followed up 20-73 months (mean, 41.5 months). All incisions healed by first intention. The CT three-dimensional reconstruction at 1 day after operation showed that the anchors were located at the 2 : 00-5 : 30 positions of the glenoid, and there was no glenoid split fracture or nails pullout at the implant site. At last follow-up, VAS score was significantly lower than that before operation, and Rowe score, Constant-Murley score, and ASES score were significantly higher than those before operation (P<0.05). Seven patients (6.5%) had recurrence of anterior shoulder dislocation at 23-55 months (mean, 39.9 months) after operation, including 6 cases of dislocation and 1 case of subluxation. At last follow-up, 51 patients (47.7%) returned to preoperative sports level, and 11 patients (10.3%) had a positive apprehension test. The patients’ satisfaction rate was 90.7% (97/107). Among the 10 patients who were not satisfied with the surgical effectiveness, 7 patients had postoperative recurrence of instability, and 3 patients felt that they did not return to preoperative sports level. Conclusion Arthroscopic Bankart repair has good mid-term effectiveness in patients with recurrent anterior shoulder dislocations, minimal or no glenohumeral bone defects and low sports need.
Objective To evaluate the clinical effectiveness and safety of tranexamic acid (TXA) in arthroscopic rotator cuff repair by meta-analysis. Methods Randomized controlled trials evaluating the clinical effectiveness and safety of TXA use in the perioperative period of arthroscopic rotator cuff repair were identified from the Cochrane Library, PubMed, Embase, VIP Chinese Science and Technology Periodical Database, Chinese National Knowledge Infrastructure, and Wanfang database, with a search time span from the inception of the database to August 2024. Meta-analysis was conducted using RevMan 5.3 software, and mean difference (MD) and risk difference (RD) were used as measures of effect size. Results A total of 7 randomized controlled trials were included. Meta-analysis demonstrated significant differences in good visual clarity [MD=9.10, 95% confidence interval (CI) (4.05, 14.15), P=0.0004] and operative time [MD=?12.07 min, 95%CI (?17.21, ?6.93) min, P<0.00001]. There was no significant difference in mean arterial pressure [MD=?1.08 mm Hg (1 mm Hg=0.133 kPa), 95%CI (?3.13, 0.98) mm Hg, P=0.30] or adverse event rate [RD=0.02, 95%CI (?0.01, 0.06), P=0.22] between the two groups. Conclusion TXA is effective and safe in enhancing visual clarity and significantly reducing operative time in arthroscopic rotator cuff repair, without increasing the incidence of adverse events.