OBJECTIVETo evaluate the early clinical effects of arthroscopic treatment for cruciate ligament cysts of the knee.

METHODSFrom September 2008 to January 2014, 23 patients with cruciate cysts were treated with arthroscopic surgery. There were 11 males and 17 females, with an average age of 28.3 years old (ranged, 16 to 56 years old). Twenty patients had injuries on the right knee and 8 patients had injuries on the left knee. Eight patients had a history of injury,5 patients had a history of chronic injury,and the other 15 patients had no obvious reasons for the symptom. Before the operation, 24 patients were clearly diagnosed as the cruciate ligament cysts of knee joint,and 4 patients were diagnosed as other problems of the knee, but the diagnosis were corrected after the operation. According to the MRI before the surgery,all the patients could be divided into 3 types: 14 were type I, 6 were type II, 8 were type III. After the operation, the patients were suggested to have a rest for 2 weeks, and take exercises everyday at the same time. The knee range of motion, Lysholm score, International Knee Documentation Committee (IKDC) 2000 subjective score, GLASGOW criteria, and McMurray test, pivot shift test, and anterior drawer test were observed to evaluate clinical results.

RESULTSAll the incisions healed at the first stage without complications. Twenty-five patients were followed up, and the duration ranged from 12 to 52 months, with a mean of 26.7 months. Three patients accepted the reconstruction of ACL or tightened elongated ACL using bipolar radio frequency. The Lysholm score increased from preoperative 59.80 +/- 6.58 to 75.32 +/- 6.49 at the latest follow-up; IKDC 2000 score increased from preoperative 65.36 +/- 6.26 to 81.00 +/- 5.76 at the latest follow-up. According to GLASGOW criteria,23 patients got an excellent result and 2 good.

CONCLUSIONIt has a satisfactory curative effect on ACL reconstruction using bipolar radio frequency. It has advantages of firm fixation, simple and secure operation as well as quick postoperative recovery. It's very important to check the MRI before operations, and carefully seek the cysts during the operations, avoiding the omission of any cysts,especially the cases of multiple cysts. Finally, patients should take exercises actively after operations.

Adolescent ; Adult ; Anterior Cruciate Ligament ; physiopathology ; surgery ; Anterior Cruciate Ligament Injuries ; Anterior Cruciate Ligament Reconstruction ; Arthroscopy ; Cysts ; surgery ; Female ; Humans ; Knee Injuries ; physiopathology ; surgery ; Knee Joint ; physiopathology ; surgery ; Male ; Middle Aged ; Range of Motion, Articular ; Young Adult

Evaluation of muscle function can be helpful in rehabilitation programs with knee injuries. The purposes of this study were to evaluate muscle performance and functional level through eccentric and concentric isokinetic testing after anterior cruciate ligament reconstruction, and to determine whether eccentric and concentric isokinetic values were correlated with functional level using the Modified Cincinnati Scale (MCS). In order to compare the characteristics of eccentric and concentric parameters, we tested 24 male patients (mean age; 31.1 years) after primary reconstruction of ruptured anterior cruciate ligaments of the knee (mean duration; 20.2 months), at angular velocities of 60 degree/sec using Cybex 6000 isokinetic dynamometer. We also evaluated the functional level using the MCS. The values of peak torque of the involved knee extensors and flexors were significantly lower than the uninvolved limb in all eccentric and concentric tests (p<0.01). The deficiency ratios of peak torque in knee extensors were significantly larger than knee flexors in both eccentric and concentric tests (p<0.01). The MCS was inversely correlated with the deficiency ratio in peak torque of eccentric knee extensors (p<0.05). These results suggest that eccentric knee extensor training is essential to restore the functional capacity of the injured knee and that isokinetic evaluation is necessary to plan rehabilitation programs to correct possible imbalances which may be predispose subjects to future injury.
Adult ; Anterior Cruciate Ligament/surgery* ; Anterior Cruciate Ligament/physiopathology ; Anterior Cruciate Ligament/injuries* ; Comparative Study ; Exercise Test/methods* ; Human ; Male ; Muscle, Skeletal/physiopathology ; Postoperative Period ; Severity of Illness Index ; Wounds and Injuries/surgery* ; Wounds and Injuries/physiopathology ; Time Factors

OBJECTIVETo evaluate the clinical effects of arthroscopic reconstruction of anterior cruciate ligament (ACL) and minimally invasive reconstruction of posteromedial corner (PMC).

METHODSThere were 22 cases of ACL and PMC tear were performed with reconstruction from March 2012 to February 2014. The patients were 29.4 years old on average, including 8 males and 14 females. ACL reconstruction was performed under arthroscopy and PMC reconstruction was performed minimally invasively through the ACL incision. The stability of knee was assessed by anterior drawer test,Lachman test,vulgus stress test and Slocum test. The function of knee was assessed by Lysholm score and Tegner activity rating. MRI of knee was checked 12 months after operation.

RESULTSThe stability tests of all patients were negative at 2 and 6 months after operation, and there was one positive case in anterior drawer test and another positive case in vulgus stress test at 12 months after operation. Lysholm score of all patients 12 months after operation was 96.8 +/- 6.8, which was significantly better than 32.0 +/- 11.2 before operation. Tegner activity rating of all patients at 12 months postoperatively was 6.1 +/- 0.9, which was significantly better than 0.9 +/- 0.5 before operation. It showed the grafts were very well in the MRI 12 months postoperatively.

CONCLUSIONArthroscopic ACL reconstruction and minimally invasive PMC reconstruction can restore the stability of knee.

Adult ; Anterior Cruciate Ligament ; physiopathology ; surgery ; Anterior Cruciate Ligament Injuries ; Anterior Cruciate Ligament Reconstruction ; Female ; Humans ; Knee Injuries ; physiopathology ; surgery ; Knee Joint ; physiopathology ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate clinical outcomes of anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction under arthroscopy combined with limited open repair of medial collateral ligament (MCL) for the treatment of multiple ligament injuries of knee joints.

METHODSFrom March 2006 and June 2012,the data of 14 patients (14 knees) with multiple injuries of ACL, PCL, and MCL were collected. There were 8 males and 6 females with an average age of (31.8 +/- 8.1) years old (ranged, 20 to 49 years old). All the patients were performed with X-ray and MRI examination, and the results showed that 10 patients had combined with injuries of anterior cruciate ligament (ACL), posterior cruciate ligament (PCL) and medial collateral ligament (MCL); 4 patients had ALC,PCL and posterolateral corner (PLC) injuries. Four patients had medial meniscus injuries and 2 patients had lateral meniscus injuries. The MCL,PLC and meniscus injuries were treated with operation on the first stage, and functional exercises were performed 3 weeks after fixation. The reconstruction operation of ACL and (or) PCL was performed at the second stage under arthroscopy 3 to 6 months later when the movement range of knee joint recovered to the normal level with obvious relaxation.

RESULTSAll incisions healed by primary intention. All the patients were followed up with a mean duration of 48.9 months (ranged, 24 to 80 months). The Lysholm score was improved from preoperative 19.6 +/- 0.9 to the latest follow-up 87.1 +/- 2.8 (t=12.3, P<0.01). The International Knee Documentation Committee (IKDC) rating: 9 cases nearly recovered to normal, 5 cases were abnormal.

CONCLUSIONFor multiple ligament injuries in the knee, staged repair and reconstruction can effectively restore knee joint stability and function.

Adult ; Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Female ; Follow-Up Studies ; Humans ; Knee Injuries ; physiopathology ; surgery ; Knee Joint ; physiopathology ; surgery ; Male ; Middle Aged ; Posterior Cruciate Ligament ; injuries ; surgery ; Reconstructive Surgical Procedures ; Treatment Outcome ; Young Adult

OBJECTIVETo evaluate the effect of length of tibial stump on proprioceptive recovery after anterior cruciate ligament (ACL) reconstruction.

METHODSFrom March 2011 to December 2011,42 patients with ACL tear were performed with reconstruction. The patients were divided randomly into three groups: group A, the patients with remained length of tibial stump ranging from 15 to 20 mm, including 8 males and 6 females, with an average age of (28.2 ± 6.6) years old; group B, the patients with remained length of tibial stump ranging from 5 to 10 mm, including 9 males and 5 females, with an average age of (27.9 ± 6.4) years old; group C, the patients with remained length of tibial stump less than 2 mm, including 9 males and 5 females, with an average age of (28.6 ± 6.8) years, old. The stability of knee were assessed by Lanchman test and anterior drawer test. The function of knee was assessed by Lysholm score and Tegner activity rating. The proprioceptive recovery was evaluated by assessing the passive reproduction of the angles with limb movement into flexion and extension in no weight bearing position.

RESULTSLanchman test and anterior drawer test of all patients were negative at 6 months postoperatively., and there was one case of positive outcome in each group at 12 month and 18 month postoperatively. Lysholm score and Tegner activity score of all patients at 18 month postoperatively were significantly better than that preoperatively, and there were no significant difference among three groups at 18 month postoperatively. There were no significant difference in the production of the angles at flexion to 20° and extention to 80° and 20° among these groups before and after operation. The reproduction of the angles of group A and B at flexion to 50° and extention to 50° at 6 month postoperatively were significantly better than that of group A and B preoperatively and that of group C at 6 month postoperatively, and there were no significant difference among three groups at 18 month postoperatively. The reproduction of the angles of group A and B at flexion to 80° at 12 month postoperatively were significantly better than that of group A and B preoperatively and that of group C at 12 month postoperatively, and there were no significant difference among three groups at 18 month postoperatively.

CONCLUSIONPreservation of tibial stump in ACL reconstruction has benefit in proprioceptive recovery at early stage postoperatively and the length of tibial stump should be reserved with a range from 5 to 10 mm.

Adult ; Anterior Cruciate Ligament ; physiopathology ; surgery ; Anterior Cruciate Ligament Injuries ; Anterior Cruciate Ligament Reconstruction ; Female ; Humans ; Knee Joint ; physiopathology ; surgery ; Male ; Proprioception ; Range of Motion, Articular ; Tibia ; chemistry ; physiopathology ; surgery ; Young Adult

PURPOSE: Anterior cruciate ligament (ACL) repair was first described in the mid 1900's. However, due to poorly selected patients led to unsatisfactory early results. We aim to study the outcome of ACL repair in a carefully selected cohort. METHODS: Thirteen consecutive patients of acute Type 1 (proximal ACL avulsion) were treated with arthroscopic ACL repair using a suture pull out technique. At the latest follow-up the patients were evaluated for Lysholm score, KT-1000 measurement and clinical assessment for any laxity. RESULTS: At a mean follow-up of 31.3 months, none of the patients had any subjective laxity. The mean Lysholm score was 95 and instrumented laxity measurement did not reveal any significant laxity compared to the opposite knee. CONCLUSION The proximal ACL avulsion has healing potential similar to proximal MCL injuries. Performing microfracture of the lateral wall of the notch optimizes the healing environment by negating the effects of the synovial fluid. Performing ACL repair in a carefully selected patient leads to good short term results and saves the patient of a reconstruction procedure, at least in the immediate future.
Adult ; Aged ; Anterior Cruciate Ligament ; physiopathology ; surgery ; Anterior Cruciate Ligament Injuries ; physiopathology ; surgery ; Anterior Cruciate Ligament Reconstruction ; methods ; Female ; Follow-Up Studies ; Fractures, Avulsion ; physiopathology ; surgery ; Humans ; Joint Instability ; Male ; Sutures ; Time Factors ; Treatment Outcome ; Young Adult

BACKGROUND: The purpose of this study was to determine the tibial fixation strength provided by different intraosseous soft tissue graft lengths within the tibial tunnel. METHODS: Porcine tibial bones and digital flexor tendons were used for testing. Bone mineral densities of proximal tibial medial condyles were measured, and two-strand tendon bundles of 8 mm diameter were used. An intraosseous graft length of 2 cm was used in group 1 (n = 10), and a graft length of 4 cm was used in group 2 (n = 10). Tunnels were 4 cm in length and 8 mm in diameter. Tibial fixation was performed using a suture tied around a screw post with a washer and an additionally inserted 7 x 20 mm bioabsorbable screw. After applying preconditioning loading of 10 cycles, 1,000 cycles between 70-220 N were applied at a frequency of 1 Hz. Graft slippage and total graft movement were recorded. Ultimate tensile strength was measured by pull-out testing at an Instron crosshead speed of 1,000 mm/min. RESULTS: No significant intergroup difference was found for total graft movement after cyclic loading (slippage in group 1, 1.2 mm and group 2, 1.2 mm, respectively, p = 0.917; and total graft movement in group 1, 3.3 mm and group 2, 2.7 mm, respectively, p = 0.199). However, mean ultimate tensile strength in group 2 was significantly higher than that in group 1 (group 1, 649.9 N; group 2, 938 N; p = 0.008). CONCLUSIONS: In a porcine model, ultimate tensile strength was greater for a 4 cm long intraosseous flexor tendon in the tibial tunnel. However, no intergroup difference in graft slippage or total graft movement was observed. The results show that a 2 cm intraosseous graft length in the tibial tunnel is safe and has sufficient strength (> 450 N) for adequate rehabilitation after anterior cruciate ligament reconstruction.
Animals ; Anterior Cruciate Ligament/injuries/*physiopathology/surgery ; *Anterior Cruciate Ligament Reconstruction ; Biomechanical Phenomena ; Bone Density ; Models, Animal ; Swine ; Tendons/*transplantation ; Tensile Strength ; Tibia/*surgery

The use of isokinetic dynamometry has often been criticised based on the face-validity argument that isokinetic movements poorly resemble the everyday multi-segmented, dynamic activities of human movements. In the anterior cruciate ligament (ACL) reconstruction or deficiency population where muscle deficits are ubiquitous, this review paper has made a case for using isokinetic dynamometry to isolate and quantify these deficits in a safe and controlled manner. More importantly, the usefulness of isokinetic dynamometry, as applied in individuals with ACL reconstruction or deficiency, is attested by its established known-group and convergent validity. Known-group validity is demonstrated by the extent to which a given isokinetic measure is able to identify individuals who could and could not resume pre-morbid athletic or strenuous activities with minimal functional limitations following an ACL injury. Convergent validity is demonstrated by the extent to which a given isokinetic measure closely associates with self-report measures of knee function in individuals with ACL reconstruction. A basic understanding of the measurement properties of isokinetic dynamometry will guide the clinicians in providing reasoned interventions and advancing the clinical care of their clients.
Adolescent ; Adult ; Anterior Cruciate Ligament ; physiopathology ; surgery ; Anterior Cruciate Ligament Injuries ; Biomechanical Phenomena ; Female ; Humans ; Knee Injuries ; physiopathology ; surgery ; Male ; Middle Aged ; Muscle Contraction ; physiology ; Orthopedic Procedures ; Range of Motion, Articular ; physiology ; Torque

OBJECTIVETo evaluate the feasibility of hamstring autograft anterior cruciate ligament reconstruction with hamstring tendons insertion on tibia preserved and an implant fixation technique of hamstring tendons knot and bone bolt press-fit.

METHODSTwenty cases of injured anterior cruciate ligament were reconstructed. There were 15 males and 5 females with the average age of 22 years old. Ten left knees and 10 right knees were involved. Hamstring tendons were taken, and pretension was performed. Tibial tunnel and femoral tunnel were prepared,and the femoral tunnel was a frame of narrow inside and wide outside. The hamstring tendons knot and bone bolt were pulled inside of femoral tunnel. The tendons distal of tendons knot were brought to pass the femoral tunnel, joint capsule and another tibial tunnel. Then, the tendons distal of tendons knot were tightened together with the part of hamstring tendons of which the insertion were on tibia. After the operation, the knee was fixed at a flexion of 45 degrees by brace.

RESULTSThe patients were followed up for 8 to 24 months. The function of troubled knees was evaluated by Lysholm knee functional scale. The average knee score were 61.5 +/- 4.6 and 92.5 +/- 3.7 respectively before and after operation, and the difference was statistically significant (P < 0.05).

CONCLUSIONHamstring tendons insertion on tibia preserved and an implant fixation technique of hamstring tendons knot and bone bolt press-fit was biological fixation for anterior cruciate ligament reconstruction with hamstring. The advantage of this method was avoidance of using high cost material for fixation,which lessened spending for the patients. And it was also benefit for tendon-bone healing.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; transplantation ; Anterior Cruciate Ligament Injuries ; Bone-Patellar Tendon-Bone Grafting ; Female ; Humans ; Knee Joint ; physiopathology ; surgery ; Male ; Reconstructive Surgical Procedures ; Tendons ; surgery ; transplantation

OBJECTIVETo study clinical outcomes of Chinese medidine fumigation and massage therapy for the treatment of knee stability and functional recovery after anterior cruciate ligament reconstruction operation,and to explore the effect on tendon-bone healing.

METHODSTotal 50 patients were divided into two groups: the control group (normal rehabilitation therapy group),the treatment group (Chinese medicine fumigation and manipulation group). There were 25 patients in the control group, including 16 males and 9 females, who were treated with isometric muscle training, with the gradually enlarging amplitude of flexion and progressive loading of bearing training for knee recovery. There were 25 patients in the treatment group, including 15 males and 10 females,who were treated with the conventional rehabilitation therapy combined with Chinese medicine fumigation and massage therapy. The Chinese herbs named as Haitongpi decoction was steamed by a special equipment to fumigate the knee after operation; Based on the biomechanical parameters of the ligament reconstruction, the massage therapy was designed to control the degree of the knee flexion and release the adhesion for early recovery of knee functions. The Lysholm knee function evaluation system was used, and MRI examination was performed to measure the change in width of ligament tunnel in femur and tibia to evaluate the safety and stability of the treatment.

RESULTSLysholm system showed that two groups both had improving results from the 1st month after operation to the 3rd month (treatment group, F=36.54, P<0.05; the control group, F=28.12, P<0.05), and the results of the treatment group was better than that of the control group at the observation point (the 1st month, t=0.105, P<0.05; the 3rd month, t=5.361, P<0.01). There was no difference between the two groups when evaluating the bone and tendon healing 3 and 12 months after operation (P>0.05), indicating that Chinese rehabilitation therapy was a safety treatment without the influence on the loosing of tendon.

CONCLUSIONChinese medicine fumigation and massage therapy can early improve the knee function after the anterior cruciate ligament reconstruction operation without the disturbance of the knee stability.

Adult ; Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Anterior Cruciate Ligament Reconstruction ; Case-Control Studies ; Combined Modality Therapy ; Drugs, Chinese Herbal ; administration & dosage ; chemistry ; Female ; Fumigation ; Humans ; Knee Injuries ; drug therapy ; physiopathology ; surgery ; therapy ; Knee Joint ; drug effects ; physiopathology ; surgery ; Male ; Massage ; Range of Motion, Articular ; Recovery of Function