[Objective]To assess the functional outcome,influence factors and its management of lateral wedge high tibial osteotomy(HTO)in patients with symptomatic lateral thrust and varus malalignment.[Method]The results of 19 lateral closing wedge HTOs in patients with a symptomatic hyperextension-varus thrust were evaluated from 2000 to 2004.The average age of the patients at the time of surgery was 49 years(ranged,47~54 years).Radiographs were analyzed to compare changes in femorotibial angle,tibial slope,and the height of the fibular head pre-and postoperatively.Functional results were evaluated according to the scoring system of HSS.The varus stress test was used to evaluated the posterolateral knee injury.We used a 5-point visual analogue scale to assess change in knee stability.[Result]Patients were followed for an average of 21 months.Femorotibial axis alignment was 184.5?～197?preoperatively and 167?～176?postoperatively;Posterior tibial slope was 2?～17?preoperatively and-4?～13?postoperatively;The height of fibular head was 7.7～18.5 mm preoperatively and-3.5～10.7 mm postoperatively(P=0.00).All patients had an increase in their HSS score postoperatively.Sixteen patients had Grade 1 posterolateral injuries and 3 patients had Grade 2 injures preoperatively,9 patients had Grades 1 injures and 10 patients had Grade 2 injures(P

Objective To study the effect of the high molecular weight polyethylene on the periprosthetic tissue in diabetic model and investigate the effect of TNF-α in periprosthetic tissue.Methods Induction of experimental diabetes in rabbit with streptozotocin was performed successfully,every rabbit's lower limb was implanted a kirschner wire plug in femur by intereondylar notch.In experimental group,15 mg polyethylene particles,dispersed in 1.5 ml normal saline solution,were injected into one knee joint.The other knee joint was injected 1.5 ml normal saline solution ag control.This procedure was repeated for 2,4,6,8,10,and 12 weeks after the implantation.All animals were killed on the 2nd week after the last injection.Knee joint capsule tissues and periprosthetie tissues were examined by optical microscope.ELISA was used for determing the concentration of TNF-α.Results The results showed that kirschner wire were surrounded by multinueleated foreign-body giant cells and osteoclagt in the experimental group.Synovial membrane proliferation was obvious in the control group.There were no polyethylene particles and multinucleated foreign-body giant cells around plug in the marrpw.New bone wag found,kitschner wire was surrounded by suosteoblast,and normal synovial membrane was appeared.The concentration of TNF-α in experimental group was higher than that in control group.Conclusion Maximal ultra high molecular weight polyethylene and diabetic mellitus can restrain diabetic rabbit pefiprosthetic bone formation and increase the secretion of TNF-α.which may play an important role in the periprosthetic osteolysis.

Objective To observe the results of preventing knee postoperative adhesions after synovectomy by chitosan membrane. Methods Thirty-two New Zealand white rabbits were randomly divided into two groups, the chitosan membrane experimental group and the control group. All animals underwent synovectomy of the right knee joint. Chitosan membrane was inserted in the suprapatellar pouch areas in the experimental group, whereas no film was inserted in the control group. After operation, the knee joints were immobilized with a plaster cast for 4 weeks. Rabbits in each group were assessed macroscopically, semiquantitatively, biomechanically and biochemically. All quantitative data were analysed by t test. Results Macroscopical finding: dense fibrous adhesion was observed in the control group, whereas little adhesion was found in experimental group. The former groups scores was higher than the later groups(P

Objective To analyse the relationship between lumbar discectomy outcomes and herniated type and annular integrity. Methods Two hundred and sixty patients who underwent conventional posterior discectomy for lumbar herniated disc were reviewed and followed-up for 6-14 years, with an average of 8.5 years. The criteria of enrolled patients include: all of the cases with low lumbar disc herniation at a single level, laterally protruded disc(one side sciatica) without spinal canal stenosis. Four categories of intraoperative findings were found basing on the defect size of annular and extruded fragments, and postoperative outcomes was compared statistically. Results The patients with larger disc fragments and minimal annular defects had the better outcomes and lowest incidence of recurrence after surgery. On the contrary, small fragments with massive annular defects did worse by comparison. Conclusion The outcomes of lumbar discectomy have close relationship with herniation type and annular integrity. Patients with mild clinical symptoms, small and broad-based disc herniations should be exempted from open discectomy. If open discectomy unavoidable, annular integrity and bony stability should be preserved as much as possible.

Objective To investigate the pathogenesis of pain around the medial site of knee joint in osteoarthritis, the expressions of nerve growth factor (NGF) and substance P (SP) were observed in the synovial membrane of medial, lateral, and suprapatellar sites of knees in osteoarthritis and simple meniscus tear. Methods Synovial tissues were obtained from medial, lateral, and suprapatellar sites of 13 knees (12 patients with an average age of 57 years) with OA at surgery. Synovial tissues as control were harvested from medial, lateral, and suprapatellar sites of 6 knees (6 patients with an average of 52 years) and simple meniscus tear during the arthroscopic operation. The tissues were cut into small fragments, fixed with formalin and then embedded in paraffin. The expressions of NGF and SP in synovium of the knees were detected using immunohistochemical staining. Gless nerve fiber staining was adopted to observe the distribution of nerve fibers in synovium of the knee. Results NGF revealed in granular pattern in the muscular wall of the vessels in synovium. The positive vessel rates of NGF in the medial synovium of knee osteoarthritis (67.2%) were higher than those in lateral synovium (47.6%,P

0.05). But when the flexion exceeded 30?, especially when it exceeded 60?, the displacement in pPc increased markedly, much greater than that of an intact knee (P0.05), while a slight over-restriction may be found at some angles. Conclusion Double-band reconstruction could effectively restrict the posterior displacement of the tibia and restore anteroposterior stability to the knee joint within its full range of flexion. aPc reconstruction could also maintain the posterior stability of the knee, while the result of pPc reconstruction is most unsatisfactory.

Objective The purpose was to explore the preventive measures of patellar baja following high tibial osteotomy for osteoarthritis, and the correlation between alteration in the inclination of the proximal tibial articular surface and patellar baja was evaluated as well. Methods In the group, there were 41 cases (48 knees), which included 30 males and 11 females, aging from 45 to 56 years with the mean age of 52 years. The size of resected bone of the arthritic knee needed to achieve a normal angle was calculated, and an additional 3 to 5 degrees of overcorrection was added to achieve approximately 10 degrees of genu valgum. The Insall-Salvati ratio, the inclination of the proximal tibial articular surface, the tibial tubercle height and the anatomic axis of the affected limbs were measured on the preoperative, postoperative as well as the final follow-up radiographs respectively. Chi-square test and linear regression analysis were used to assess the influence of loss of proximal tibial articular inclination on the patellar height. In the statistical analysis, loss more than 5 degrees of proximal tibial articular inclination and lowering more than 10% of the patella following tibial osteotomy were assumed of clinical significance. Results Compared with the preoperative results, the postoperative inclination of the proximal tibial articular surface was decreased by a mean of 6.14 degrees; the postoperative Insall-Salvati ratio was decreased by a mean of 10.6%; the postoperative height of the tibial tubercle was decreased by a mean of 3.13 mm. 64.6% (31/48 knees) endured loss more than 5 degrees of posterior tibial inclination after high tibial osteotomy, whereas 56.2% (28/48 knees) showed a relative lowering of patellar height more than 10%, as measured by the Insall-Salvati ratio. The loss of the normal posterior tibial inclination was found to have a statistically significant correlation with the subsequent loss of the patellar height. Conclusion The loss of inclination of the proximal tibial articular surface is found to have a correlation with the loss of the patellar height. Clinically, the result suggests that preserving the inclination of the proximal tibial articular surface at the time of high tibial osteotomy could minimize the risk of patellar lowering after the high tibial osteotomy.

Objective To evaluate the possibility for the treatment of chondral defects on the femoral bearing surface with autologous osteochondral transplantation under arthroscopy. Methods There were 17 patients with cartilaginous surface defects, including 12 males and 5 females. The average age of patients was 29 years ranging from 18 to 45 years. The defects were located at 10 left knees and 7 right knees. The functional status of patients were evaluated according to the Brittberg-Peterson scoring scale system, the results were average 80.65?9.69 points ranging from 65 to 105. 3 patients had no an obvious history of trauma, but suffered from the rheumatoid disease; however, the other 14 patients had been injured at the knee joint with pain and followed with muscle atrophy on the thigh. 3 patients experienced interlocking, and 2 had snapping in their knee joints. All the 14 patients with traumatic history had only solitary lesion, the area of local cartilaginous defects at the bearing surface of the lateral femoral condyle was of 2.5-3.0 cm2; the local defects of the other 3 patients were located at the medial femoral condyle with defect area of 2.0-2.5 cm2, which was diagnosed either as chondomalacia or corruption. The procedures of the mosaicoplasty consisted of harvesting osteochondral cylinders from non-weight bearing surface of the knee and then implanting the grafts into the cartilaginous defects under arthroscopy. Results All the patients were followed up for 10 to 20 months (mean, 15 months). The joint mobility recovered to nearly normal. According to the Brittberg-Peterson system, 14 patients had score of 0, and 3 had scores of 2-3 because of mild pain. The follow-up MRI showed adequate cartilaginous coverage in the original lesions and excellent position of the cylindrical osteochondral grafts. Conclusion The autologous osteochondral mosaicplasty is proved to have good and reliable clinical results for the cartilaginous defects in the knee bearing surface.

0.05). Measured by KT-1000 arthrometer, the posterior tibial translations in the group of the uni-bundle at 0? and 30? flexion were (5.9?0.4) mm and (6.2?0.5) mm; but the posterior tibial translations in the group of the double-bundle at 0? and 30? flexion were (3.5?0.3) mm and (4.0?0.4) mm. It was of statistical significance (P0.05). Conclusion The clinical results of double-bundle PCL reconstruction is superior to that of the uni-bundle. Arthroscopic double-bundle PCL reconstruction is able to restrict the posterior tibial translation and restore the stability of the knee joint within its full range of flexion.

Objective To provide an essential features of the knee for the prothesis design more suitable in Chinese. Methods 240 knees of 120 healthy Chinese adults were selected on trial, with an average age of 30.6 years (range, 21 to 40 years) and an average height of 1.68 m ranging from 1.60 m to 1.75 m. Each individual was asked to do deep flexion activities. Fluoroscopy were used to determine accurately the weightbearing kinematics in vivo of 240 knees at different position. The anterior articular surface of the femoral condyle was designated as the "extension facet"(EF), while the posterior surface as the "flexion facet"(FF). Their centers are labelled as EFC and FFC respectively. The distances between the ipsilateral posterior tibial cortex and the center of the posterior femoral condylar circles at different position were measured by drawing a line through the most protruding points in the medial and lateral tibial subchondral bony landmark. A second line was drawn perpendicular to the first and tangent to the posterior tibial cortex. The distance d1 and d2 were measured perpendicularly from FFC and EFC to the second line respectively. The change of d1 and d2 in different positions denoted the relative movement between the tibia and femur. The data were used by ANOVA analysis containing two factors with SAS software. Results The difference of sex and side had no influence on the relative movements between the tibia and femur. In normal adults, the range of relative motion at the medial and lateral condyle during deep flexion was (1.4?0.3) mm and (15.9?4.7) mm respectively. Conclusion The lateral condyle undergoes posterior translation including sliding and rolling significantly during the deep flexion that leads to the relative axial rotation of the tibia to the femur.