Objective To describe the special ramp lesion, which involves the capsulomeniscal region of posterior horn of medial meniscus and most commonly occurs in association with anterior cruciate ligament(ACL) injury, pre- and intra-operative diagnosis methods, arthroscopy repair technique and follow-up results of arthroscopy second-look & MR review. Methods From April 2002 to April 2005, 89 cases of ACL injury with ramp lesions are enrolled in this series, among them 85 need operation repairing. Arthroscopic ACL reconstruction with hamstring or B-PT-B autograft or allograft and all-inside medial meniscus repair through 2 posteromedial portals and transcondylar portal have been performed. Generally, the ramp lesion accounts for 26.7% of ACL injury, 30.5% for chronic and 19.5% for acute injury respectively. Results Of the repaired ramp lesion cases, 75 cases(88.2%) are available for follow-up, with the duration from 5 to 41 months (mean, 20.2 months). 25 cases underwent arthroscopic second-look and 21 cases received MR evaluation. The study include subjective symptom, clinical examination, and arthroscopic second-look as well as MR review. All of the repaired cases present normal subjective and objective evaluations, and all the 25 second-look cases show completely healing. Of the 21 MR follow-up cases, 18 completely healed, 3 partial healed. Conclusion About 1/3 ACL injuries are associated with medial meniscus ramp lesion, and the morbidity is higher in old injuries than acute injuries. For this combined lesion, one stage ACL reconstruction and meniscus repair was recommended. All-inside meniscus repair is a satisfactory technique for ramp lesion and can get high healing rate.

Objective To present the special arthroscopic all-inside suture technique for repairing medial meniscus posterior horn tears and clinical follow-up results including arthroscopy and MRI outcome. Methods Eighty nine cases of posterior horn tears of medial meniscus combining with anterior cruciate ligament injuries were enrolled in this setting.Arthroscopic all-inside suturing medial meniscus through 2 posteromedial portals and 1 transcondylar portal was performed, with simultaneous ACL reconstruction using hamstring or B-PT-B autograft or allograft. Results Seventy five cases(84.3%)were followed-up for an average of 20.2 months, in which 25 cases underwent arthroscopic evaluation and 21 MRI evaluation.All 25 cases undergoing second-look arthroscopies were completely healed.Of the 21 cases receiving MRI evaluation, 18 were completely healed and 3 were partialy healed. Conclusions Arthroscopic all-inside suture technique is a good alternative for repairing medial meniscus posterior horn tear and a higher healing rate can be obtained using such a technique.

Objective To evaluate the MRI findings of the cruciate ligaments cysts in correlation with clinical feature.Methods Seven patients with cruciate ligaments cysts were reviewed. There were 5 men and 2 women, aged from 22 to 38 years (mean 30.6 years). All patients were examined by the knee MRI. The clinical manifestations such as symptoms, duration of symptoms, sign, and the history of trauma were evaluated and then correlated with the MRI findings.Results Five ganglion cysts were found in the anterior cruciate ligaments and 2 in the posterior cruciate ligaments. All cysts were either oval or lobulated in shape. Most of them were located along the posterior surface of the ligaments. All cysts were resected or aspirated through arthroscopy. After surgery, all patients were asymptomatic without recurrence during follow-up.Conclusion Intraarticular cysts of the cruciate ligaments are uncommon. It can cause knee pain, limitation of knee extension and flexion. The unique MR images of the cysts help to diagnose patients with chronic knee pain, as well as to plan the treatment. The results of arthroscopic treatment for the cysts were satisfied.

Objective:To describe the clinical results of a one-stage operation for posterior cruciate ligament reconstruction and a posterolateral corner reconstruction of popliteus tendon reconstruction,com-pared with an open popliteofibular ligament reconstruction.Methods:Our study included 33 patients who had undergone posterior cruciate ligament reconstruction with use of an achilles tendon-bone allograft and posterolateral corner reconstruction with arthroscopic anatomical reconstruction of popliteus tendon or open reconstruction of popliteofibular ligament.The patients were assessed for knee instability with use of the dial test at 30°and 90°,together with posterior stress radiography and KT-1000 measurement.Re-sults:The mean time of follow-up was more than 2 years.At the final follow-up evaluation,the tibial posterior translation as measured by stress radiography at 90°of knee flexion,the anterior-posterior trans-lation as measured by KT-1000,and the external rotation of tibia as measured by dial test were reduced postoperatively (P<0.001 )in both groups.Between the two groups,the preoperative tibial posterior translation as measured by stress radiography and the preoperative mean anterior-posterior translation as measured by KT-1000 in the popliteofibular ligament group were a little more than those in the popliteus tendon group (P=0.014,P<0.001).But the other comparisons were not significantly different (P>0.05).The final flexion losses were 3.33°±4.88°and 3.06°±3.38°for the two groups.Conclusion:Combined with posterior cruciate ligament reconstruction,anatomical posterolateral corner reconstruc-tion of the popliteus tendon and open reconstruction of popliteofibular ligament showed similar out-comes.This study demonstrated that both posterolateral corner reconstruction techniques were a reliable alternative method in addressing posterolateral corner and posterior cruciate ligament insufficiency of the knee.

BACKGROUND:Routine posterior cruciate ligament(PCL)reconstruction can improve posterior stability of the knee joint.But the wear between graft and outlet of tibial tunnel always reduces graft mechanical strength or enlarges tunnel,resulting residual laxity.OBJECTIVE:To explore the clinical application of fluoroscopy-based navigation technique for assisting tibiai tunnel placement in arthroscopic PCL reconstruction and to investigate the efficacy and feasibility of the technique.DESIGN,TIME AND SETTING:Case analysis was performed at Beijing Jishuitan Hospital between August 2006 and March 2007.PARTICIPANTS:of 15 eases with compound ligament injury,14 underwent allograft,and 1 underwent autograft bone-1/3 of patellar tendon-bone.METHODS:The navigation system consisted of tibia tracker fixed into the proximal tibia and tool tracker attachcd with PCL tibial drill guide.With registration and calibration,the navigation system identi fied and captured the infrared signals actively from the two trackers.The computer calculated the 3D-position of the knee joint relative to the PCL tibial drill guide and then the virtue tibial tunnel was imposed into the interactive images formed by the intraoperative C-aim images.The virtue tunnel was precisely adjusted according to the intraoperative planning protocol until the ideal position achieved.In the standard anteroposterior view,the centre of the outlet of tunnel should be in the midpoint between the medial and lateral eminence and 1.5 cm from the articular surface.In sagittal plane,with the intact posterior wall,the tibial tunnel should be as close as to the posterior proximal tibial cortex to get a maximum angulation.MAIN OUTCOME MEASURES:Fluoroscopy time and times,postoperative standard anterior and lateral X-ray,outlet of tibial tunnel,angle between graft and tunnel,attachment of tunnel to posterior cortex,and integrity of posterior wall.RESULTS:Among 15 patients,14 succeeded without navigation related complications and 1 failed.The frequency of intraoperative fluoroscopy reduced from 2-10 times to 2-4 times and the exposure time for fluoroscopy shortened 10-30minutes.The tibial outlet in all success cases was located within the tibialinsertion area of posterior cruciate ligament.The average angulation between the tibial tunnel and the graft was 123.3°;all cases showed close spatial relationship between tunnel and posterior proximal tibial cortex within 2 mm,with intact posterior wall in 10 cases and slightly broken in 4 cases.CONCLUSION:With high accuracy and time-saving features,fluoroscopy-based navigation system is a feasible technique in assisting tibial tunnel placement in arthroscopic PCL reconstruction surgery.

BACKGROUND: Unrepaired bucket handle meniscus tear(BHMT)could result in partial or total meniscectomy,which aggravates the degeneration of knee joint.The long-term,large sample studies regarding the success rate of BHMT repair are few.OBJECTIVE: To retrospectively analyze the clinical result of arthroscopic BHMT repair and explore the preoperative diagnosis,repair technique,treatment effect evaluation and influential factors,so as to investigate ideal repair method of large meniscus tear injury.METHODS: From May 2002 to November 2005,90 patients with repairable BHMT were treated in Sports Medical Center of Beijing Jishuitan Hospital.Of the 90 patients,61(63 menisci)were followed up for over 2 years with an average duration of 38months(24-66 months).The indications of BHMT repair include red-red area and red-white area injuries,reductable,meniscus with no compound tear or degeneration.RESULTS AND CONCLUSION: Of the 61 followed up patients,53 menisci in 51 patients(84%)were assessed by second-look arthroscopy; 53 of 61 patients(87%)were asymptomatic,4(6%)patients were partial asymptomatic and 4(6%)had recurrent locking showing failure.Second-look arthroscopic examination showed that 44 menisci(83%)were healed completely,5(9%)partially healed,and 4(7%)not healed.The total failure rate was 8%(5/63),and success rate was 92%,including complete healed,partial healed,asymptomatic and partial asymptomatic patients.For large bucket-handle meniscus tears involving red-red and red-white zones,reliable arthroscopic hybrid suture technique,provides stable suture strength along the whole length of injured region and consequently achieves improved clinical outcomes in combination with anterior cruciate ligament.

Objectiye To introduce the surgical technique of arthroscopy assisted anatomical posterolateral corner (PLC) reconstruction,including popliteal ligament,popliteofibular ligament and lateral collateral ligament,and evaluate the results of this technique.Methods From August 2008 to April 2010,34arthroscopic posterior cruciate ligament (PCL) and PLC reconstruction surgeries were performed.The average age of the patients was 34.1 (15-52) years.There were 32 males and 2 females.The average time period from injury to surgery was 10.7 months.All patients were chronic injuries and combined ligament injuries,including PCL and PLC injuries.Some cases had other ligament injury,including 6 patients of anterior cruciate ligament (ACL) injury (17.6%),2 of ACL combined medial cruciate ligament (MCL) injuries (5.9%),and 5 of MCL injuries (14.7%).According to Fanellis classification,for type A posterolateral rotation instability,we performed arthroscopic popliteal ligament reconstruction or popliteal ligament combined popliteofibular ligament reconstruction.For type C posterolateral instability,we performed arthroscopic PLC anatomical reconstruction.Results During the follow-up period,14 patients had undergone a second look arthroscopic examination and removal of hardware.The average follow-up time was 18.5 months (13-25 months).At the final follow-up,physical examination,stability evaluation with KT-1000 and Telos stress view,and dial test were performed.The posterior displacement of the knee had decreased from 15.56 mm preoperatively to 5.16mm postoperatively.The external rotation instability had decreased from 14.92° preoperatively to -0.22°postoperatively.The average limitation of knee flexion was 4.23° and no knee extension was limited.Conclusion With the surgical technique of arthroscopy assisted anatomical PLC reconstruction,we can restore the external rotation stability of knee.This technique can be performed combine with PCL reconstruction.