Objective To explore rehabilitative nursing of patients with recurrent patellar dislocation treated with retinaculum patellae mediale reconstruction under arthroscopy. Method Systematic rehabilitative nursing was performed to 18 patients with recurrent patellar dislocation treated with retinaculum patellae mediale reconstruction under arthroscopy , including the perioperative psychological nursing, systematic and standard rehabilitative training plan, and discharge guidance. Results The symptoms of unstable retinaculum disappeared, their motor ability was improvement and there was no patellar dislocation. All patients were scheduled for follow-up three months, six months, nine months and one year after surgery, and annually thereafter. The preoperative and postoperative Kujala and Lysholm scores were with statistical difference between pre-and post-surgery (P<0.001). Conclusion Systematic and standard rehabilitative nursing can be important for the recovery of patients , including preoperative psychological nursing and postoperative functional exercise.

BACKGROUND:During autologous tendon grafting, the ultimate tensile strength used for suturing the end of the ligament is important for successful surgery. Improving suturing strength and increasing the number of stitches is a good choice for increasing the fixed intensity. But excess amount of stitches can produce too many thread residues, thereby affecting tendon healing.
OBJECTIVE:To investigate the essential number of suturing pins for the anterior cruciate ligament revascularization in ligament end suture fixation to reduce suturing thread exposure.
METHODS:(1) In vitro biomechanics test:12 patel ar ligament specimens were divided into two groups:the specimens were sutured with 5 or 3 stitches using Krackow suture method. The suturing thread was J&J tendon suture thread. The strength of tensile was compared between the two groups by Tensile mechanical test was conducted to compare the strength of tensile between the two groups and to explore the optimal number of stitches and suturing method. (2) Clinical application:According to the results of in vitro experiments, modified Krackow suture method was used clinical y for arthroscopic anterior cruciate ligament reconstruction in 125 cases, including 62 cases receiving 3-stitch suture, and 63 cases undergoing 5-stitch suture.
RESULTS AND CONCLUSION:The fixed strength of tensile at suture sites was over 100 N for 3-stitch double-lock suture and 110 N for 5-stitch double-lock suture. There was no significant difference in the fixed strength between the two groups, but their strength values were both over the breaking strength of suturing materials. Moreover, the fixed strength could not be reduced by suturing throughout the ligament at the first stitch. Al the 125 cases were fol owed for 6.4 months averagely, and both 3-stitch and 5-stitch suture methods achieved good outcomes. The satisfaction rate was up to 99%, and no suture breakage or loosing occurred at early and late stages. These findings suggest that, using 3-stitch double-lock suture method, a satisfactory fixed strength can be achieved with reduced thread exposure. The suturing thread can run through the ligament at the first stitch, which can reduce thread exposure but not reduce the fixed strength.

Objective MRI was a powerful technique for evaluation of the meniscus injury.However,meniscal injuries were the most common reason for arthroscopy of the knee.The research was to reveal the relationship between the classification on MRI and the morphological changes of the meniscus injury under the arthroscopy in order to indicate the surgical procedures according to the MRI degree of meniscus in-juries.Methods From October2000to December2001,157knees of152cases with meniscus tears were analyzed retrospectively,who were classified into the osteoarthritis group and sport injury group depending on the causes of injury.There were107knees in osteoarthritis group,50knees in sport injury group.All cases were made MRI examination with T 1 and T 2 sequences,and152of them underwent arthroscopic oper-ation.According to the different signal intensity,changes of contour and edge of meniscus,juried meniscus were divided into four degrees,referring to the standard described by Stoller.The conditions of torn menis-cus were observe and recorded while performing arthroscopy in order to compare with that on MRI.Results The MRI classification in osteoarthritis group,there were gradeⅠin21knees,gradeⅡin34knees,gradeⅢin40knees,and gradeⅣin12knees;Depending on the exploration in arthroscopy,the accurate rate of diagnosis of MRI for meniscus injury was100%(21/21)for gradeⅠ,91.2%(31/34)for gradeⅡ,92.5%(37/40)for gradeⅢand100%(12/12)for gradeⅣ.The patients with gradeⅢand gradeⅣinjury of the meniscus all underwent the operation of arthroscopy.The MRI classification in sport injury group,there were gradeⅠin5knees,gradeⅡin4knees,gradeⅢin26knees,and gradeⅣin15knees.The accurate rate of diagnosis of MRI was75%(3/4)for gradeⅡ,92.3%(24/26)for gradeⅢand93.3%(14/15)for gradeⅣ.Conclusion In the meniscus tears,gradeⅠinjury on MRI is not indicated to surgical treatment,gradeⅡcan be explored in arthroscopy or observed when it is in need based on clinical symptoms.GradeⅢand gradeⅣof meniscus injury necessitate partial meniscectomy or meniscoplasty.

Objective One of the characteristics of rheumatoid arthritis was multiple joints involved symmetrically. The purpose was to study the method of early diagnosis and treatment for the atypical rheumatoid arthritis involving solitary joint. Methods From April 1997 to December 2002, 5 cases which were 1 male and 4 female patients with an average age of 36.8 years (range, 23 to 47 years), suffered from the swelling and pain of knee joint, and were diagnosed as early rheumatoid arthritis. The interval of the onset to surgical treatment ranged from 2 months to 3 years with a mean of 16.2 months. The patients were evaluated with serum test, joint fluids examination and radiological imaging. They were treated by the synovectomy under the arthroscopy, while the appearances of the joint under arthroscopy were recorded, and the synovial tissue was sent to the pathological examination. The improvements of the joints symptoms and the range of motion were assessed at final follow up. Results During the operation, the light green and little muddy joint fluids were found in all patients. ESR of the patients ranged from 29 to 51 mm/1h with an average of 32.2 mm/1h, all of which were higher than normal value, whereas, 3 cases had positive rheumatoid factor and 4 cases showed significant higher ?2-MG. The radiographic findings were osteoporosis in 3 cases, soft tissue swelling in 4 cases and narrowed joint space in 1 case. The synovium were proliferated and enlarged in dark violet, there were creeping pannus and necrosis fibrin deposition in the cartilage. All of the patients were diagnosed as rheumatoid arthritis confirmed by pathological changes of the synovium. The patients were followed up from 4 months to 5 years (mean, 18.7 months). Pain released in 5 cases, swelling reduced in 3 cases, the range of motion improved by 19 degrees. Unfortunately, all of the patients developed later into typical rheumatoid arthritis after the mean interval of 10.9 months (range, 3 to 25 months), the symptoms were consistent with the criteria of American Rheumatoid Association . Conclusion Solitary joint with rheumatoid arthritis is rare and may be the early status of rheumatoid arthritis. The specific appearance under the arthroscopy prompt the early diagnosis of the knee rheumatoid arthritis, and synovectomy by arthroscopy may be benificial to release the symptoms of rheumatoid arthritis.

Objective To explore the effect of elbow release and debridment with arthroscopy for elbow malfunction. Methods The study was carried out on 15 patients (male 11, female 4; age 21-63 years old, average 40.1 years old) with the use of arthroscopy to brisement accretion and articular capsule from August 2001 to December 2003. The mean course was 55.2 months (range, 8-24 months). The flexion angle of joint preopration was 15?-60?, average 30.4?, the extension angle was -80?--20?, average -51.2?. The diagnosis was osteophyma and liberum in 4. The old fracture of radius capitulum was in 2; the old fracture of ulnar olecranon in 2; the old fracture of condyle of humerus in 3; degeneration in 4. The brachial plexus anesthesia,the elbow hung to traction, interna and extra-pathway, to cut synovium and accretion fibers with shver, removal liberum and milling osteophyma, meanwhile brisement articular capsule. Pathology manifestation in arthroscopy: there were a lot hyperemia synovium and fiber accretion. There was cartilage exfoliation in 8, hyperplasy and liberum in 5, ossification of cicatricle in 2. The motion range of elbow was reexamined, if the extension function was restricted, release was performed on anterior soft tissue and capsule. If the flexion function was restricted, release was carried out on posterior capsule via posterior straight approach(3 cm supra point of olecranon). Results All patients recovered daily life and occupation postoperative 7 to 14 days. Transient ulnar nerve paralysis occurred postoperatively in one case, which recovered three months later. There were no blood vessel and nerve injury. The mean follow-up period was 14.1 months (range, 7-20 months). At the final follow-up, the flexion of joint post operation was 70?-120?, to improve average 60.5?; the extension of joint post operation was -20?--5?, to improve average 37.6?. In accordance with HSS scoring system, excellent 7, good 5, fail 3. Conclusion Using of arthroscopy to release elbow joint have many advantages such as less trauma, quick recovery and less sequela. The application in release with arthroscopy is a good way for elbow malfunction.

Objective Risk factor of radial and horizontal tear for posterior horn of medial meniscus is analyzed in present study.Methods A total of 390 patients diagnosed with medial meniscus tear received during January 2011 to December 2012 were of retrospective analysis.94 cases with radial tear of medial meniscus posterior horn and 95 horizontal cases were chosen as research objects.Age,gender,duration of symptoms,body weight index,trauma history,posterior slop of tibia plateau,knee valgus angle and Outerbridge cartilage classification of patients with radial or horizontal tear were recorded and analyzed.Multifactor unconditioned Logistic regression analysis was employed to analyze risk factor of meniscus radial tear.Results Significant difference could be spotted in the analysis of gender (x2=9.059,P=0.003),body weight index (t=2.549,P=0.012),knee valgus angle (t=-5.609,P=0.000) and Outerbridge cartilage classification (x2=42.300,P=0.000) between patients with radial or horizontal tear.Meanwhile,no significant difference could be spotted in the analysis of trauma history (x2=0.368,P=0.544),posterior slop of tibia plateau (x2=1.021,P=0.312),age (t=-1.228,P=0.221) and symptom duration (t=0.272,P=0.786).According to the results of multi-factor analysis,valgus angle (OR=12.581,P=0.001),age (OR=0.875,P=0.026) and Outerbridge cartilage classification (OR=33.790,P=0.000; OR=15.558,P=0.000; OR=39.891,P=0.000; OR=91.041,P=0.000) were risk factors of meniscus radial tear.Conclusion High incidence of posterior horn of medial meniscus tear was found in patients with senile osteoarthritis.The incidence of radial tear of medial meniscus posterior horn in elderly patients with knee varus or serious articular cartilage was higher than that of horizontal tear.

Objective The purpose of this study was to examine the clinical features, radiological and arthroscopic characteristics of mucoid degeneration of the anterior cruciate ligament (ACL) and to assess the results of arthroscopic treat?ment. Methods From January 2012 to August 2013, 32 knees (24 females and 8 males with left knee of 14 and 18 of right) were diagnosed with mucoid degeneration of the ACL and underwent arthroscopic treatment, all of whom with a mean age of 58.81±7.97 years (42-74 years). All 32 patients have pain on terminal extension, in which 12 patients have pain on both terminal flexion and extension. Arthroscopic debridement of hypertrophied ACL was performed in conjunction with notchplasty. Biopsy specimens were taken from yellowish degenerative lesions of ACL posterolateral bundles. Manual Lachman and Anterior Drawer tests were taken or measured preoperatively, as well as, visual analogue scale (VAS), range of motion (ROM) of knee, Lysh?lm scores, Western On?tario and McMaster Universities (WOMAC) scores. Results The narrow intercondylar notch show in all 32 radiographs and sagit?tal magnetic resonance image showing with its attachment thickened and ill?defined ACL. All patients received follow?up. The mean follow?up time was 21.16 ± 5.53 months (15-32 months). The mean VAS score decreased significantly from 5.75 ± 1.32 to 1.13±1.36 (t=13.44, P=0.00). Extension deficits decrease gradually from a mean angle of 11.62°±3.52° preoperatively. Almost sta?ble 6 months postoperatively and the mean score was 0.41° ± 1.01° 1 year after operation. The extension deficit improved signifi?cantly. Manual Lachman tests and Anterior Drawer tests were all negative. At the same time, Lysh?lm scores increased from 50.13 ± 11.57 to 91.97 ± 3.04 and WOMAC scores decreased from 35.13 ± 7.88 to 6.25 ± 2.78, which is statistically significant (t=-20.20, P=0.00;t=24.72, P=0.00). Conclusion Mucoid degeneration of the ACL has a typical clinical feature and the MRI find?ings are fairly specific for clinical diagnosis before arthroscopy. Arthroscopic debridement of mucoid hypertrophy of the ACL in conjunction with notchplasty can effectively provide symptomatic improvement without instability.

BACKGROUND: Anterior cruciate ligament injury accompanied by unstable rotation is a hotspot in sports medicine. Further understanding of the anatomy and biomechanics of the anterolateral ligament can play a guiding significance for the recovery of knee joint rotational stability.
OBJECTIVE:To systematicaly review current literature on the anterolateral ligament of the knee and to understand the incidence, anatomy, morphology and histology of the anterolateral ligament as wel as mechanism of anterolateral ligament injury.
METHODS: The first author searched the PubMed, Medline, CNKI, Wanfang, VIP databases for articles specificaly addressing the anterolateral ligament. Data extraction related to the incidence, anatomy, morphometry, biomechanics, and histology of the anterolateral ligament and its relation to the “Segond” fracture was performed. The retrieve time ranged from 1878 to 2015. Totaly 362 literatures were retrieved, including 342 articles in English and 20 in Chinese. According to inclusive and exclusive criteria, 42 articles were included in result analysis.
RESULTS AND CONCLUSION:The occurrence rate of the anterolateral ligament ranges from 83% to 100%, and this range occurs because of smal discrepancies in the definition of the bony insertions of the anterolateral ligament. The anterolateral ligament originates anterior and distal to the femoral attachment of the lateral colateral ligament. It spans the joint in an oblique fashion and inserts between the fibular head and Gerdy tubercle of the tibia. Exact anatomic and morphometric descriptions vary in the literature, and there are discrepancies regarding the anterolateral ligament attachment to the capsule and lateral meniscus. The anterolaterial ligament is a contributor to the stability of tibial internal rotation, and histologicaly, it exhibits paralel, crimped fibers consistent with a ligamentous microstructure. The footprint of the anterolateral ligament has been shown to be at the exact location of the Segond fracture. The anterolateral ligament is a distinct ligamentous structure at the anterolateral plane of the knee, and it is likely involved in the control of excessive tibial internal rotation that can cause the Segond fracture.

Objective To evaluate the changes in the number and activities of endothelial progenitor cells (EPCs) from peripheral blood in patients with primary Budd-Chiari syndrome (BCS),and to explore the possible mechanisms of BCS.Methods Eighty-two patients with BCS and 20 healthy subjects used as controls were recruited for this study.The EPCs from peripheral blood were counted by flow cytometry for CD34,CDl33 and KDR for positivity.The peripheral blood mononuclear cells were isolated by density gradient centrifugation and cultured for 7 days.Characterization of EPCs as adherent cells was done using double staining of FITC-UEA-1 and DiI-Ac-LDL binding.The proliferation,adhesion and migration activities were assayed by MTT chromatometry,adhesion activity assay and Transwell assay,respectively.Results EPCs (CD34+/CD133 +/KDR+) were depleted in the BCS patients as compared to the healthy controls [(0.020 ± 0.005) ％ vs (0.038 ± 0.007) ％].The proliferation activities (0.20 ± 0.04 vs 0.58 ± 0.07),adhesion activities (15.8 ± 1.6 vs 35.0 ± 2.5) and migration activities (16.1 ± 1.7 vs 23.9 ± 2.6) were significantly lower in the BCS group than the control group (P ＜ 0.05).Conclusion EPCs from the peripheral blood in patients with BCS exhibited reduced numbers and impaired proliferation,adhesion and migration activity,which may be the key factors for vasculopathy formation in primary BCS patients.

Objective To investigate the expression and significance of epithelial cell adhesion molecule (Ep-CAM) in breast cancer.Methods Twenty-three cases of breast cancer tissue samples and paired lymph node metastases confirmed pathologically were collected.Isobaric tags for relative and absolute quantitation (iTRAQ) proteomics technology was used to screen and identify the differentially expressed proteins between primary tumor and lymph node metastasis of breast cancer.The expression of Ep-CAM was detected by Western blotting in 4 cases of primary breast cancer tissues and paired lymph node metastases.And the expressions of Ep-CAM in 252 cases of breast lesions were detected by immunohistochemical method.Results Quantitative proteomic examination results showed that differentially expressed proteins existed in breast cancer primary tumor and lymph node metastasis,and the expression of Ep-CAM in metastatic lesions was higher than that in primary tumor.Western blotting results showed that the expression of Ep-CAM in metastatic lesions (1.46 ± 0.22) was higher than that in primary tumor (1.16 ± 0.09),which was consistent with the results of proteomic.The immunohistochemical results showed that the positive expression rate of Ep-CAM in lymph node metastasis tissues (93.16％,109/117) was significantly higher than that in primary breast cancer without metastasis (72.73％,64/88),and the difference was statistically significant (x2 =15.921,P =0.000).The positive expression rate of Ep-CAM in primary breast cancer with lymphatic metastasis (72.65％,85/117) was lower than that in paired lymph node metastases (P =0.001).Conclusion Ep-CAM is differentially expressed in primary tumor and lymph node metastasis of breast cancer,which may be related to the lymphatic metastasis of breast cancer.