Objective To compare the clinical outcomes of arthroscopy versus mini-incision surgery for the treatment of avulsion fracture of the tibial attachment of the posterior cruciate ligament (PCL).Methods From March 2001 to September 2009,84 patients with acute displaced avulsion fracture of the tibial PCL attachment were treated operatively in our department.Thirty-five patients were treated with arthroscopic reduction and suture fixation (Group 1); 49 patients were treated with open reduction through a mini-incision and internal fixation with cannulated screw(s) and washer(s) (Group 2).There were 27 males and 8 females in group 1,with a mean age of 29.6 ± 5.6 years old,and 40 males and 9 females in group 2,with a mean age of 32.2 ± 7.6 years old.Based on the Meyers & Mckeever classification,there were 24 type Ⅱ fractures and 11 type Ⅲ fractures in group 1,and 31 type Ⅱ fractures and 18 type Ⅲ fractures in group 2.The 2 groups were compared in terms of range of motion,posterior drawer test (PDT),Lysholm score,International Knee Documentation Committee (IKDC) grading,and clinical results.Results All the patients obtained an average follow-up of 21.5 months (range,13 to 34 months).Primary union was achieved in all the fractures 3 months postoperatively.There were no significant differences between group 1 and group 2 regarding the PDT negative rate [82.9％ (29/35) versus 91.8％ (45/49)],the Lysholm score (95.1 ± 5.6 versus 96.1 ±4.7),therate ofIKDC grade A [88.6％ (31/35) versus91.8％ (45/49)],or the rate of normal range of motion [94.3％ (33/35) versus 93.9％ (46/49)] (P ＞ 0.05).On average,group 1 used significantly longer operative time (92.4 ± 15.9 minutes) than group 2 (53.8 ± 14.3 minutes).Conclusions Both arthroscopy and mini-incision surgery can achieve satisfactory clinical outcomes in the treatment of PCL tibial avulsion fracture.Although the 2 methods make no significant differences in stability of the knee joint and clinical scores,mini-incision surgery can result in much shorter operative time and thus permit an early postoperative rehabilitation.

Objective To describe the arthroscopic reductions and fixation of tibial intercondylar eminence fracture with cannulated screws. Methods During February 2003 to September 2005, 40 patients were treated arthroscopically for fracture of the tibial intercondylar eminence. The average age was 29.5 years (11-58 years), with a mean follow-up time of 20.1 months(6-37 months). Among the 40 patients, there were 4 type Ⅱ fractures (10%), 24 type Ⅲ fractures (60%) and 12 type Ⅳ fractures (30%). The fragments were reduced and fixed with cannulated screws. All-arthroscopic technique was adopted in all cases. The hematoma and the fragment were debrided, and the bony fragment was reduced and temporarily fixed with 2-3 guide wires through the portal superomedial to the patella. Intra-operative X-ray was taken to prove the reduction. One or two cannulated screws were used to fix the fragment as the definite fixation. Results The fracture healed completely in all but 1 patient. Lachman test were negative in all patients postoperatively. The average postoperative KT-1000 manual maximum displacement(MMD) was 0.625 mm(?蛳1-2 mm) and average Lysholm score was 98.3 points(87-100 points). The range of motion was normal in 34 patients. Flexion deficit was found in 5 cases, but within 10?. Knee joint stiffness was found in 1 case with range of extension and flexion 0?-30?-45?. A secondary operation with arthroscopic release was performed. The range of extension and flexion was improved to 0?-10?-80? postoperatively. Mild anterior knee pains were found in 8 patients. For 4 young patients with open epiphysis, the cannulated screws were removed 10-12 weeks post operation. No growth disturbance was detected for these 4 patients at final follow-up. Conclusion Arthroscopic fixation of fracture of the tibial intercondylar eminence with cannulated screw is a simple, safe and effective procedure suitable for both children and adult patients.

Objective To present the preoperative planning protocol and surgical procedures of computerized navigation technique in arthroscopic anterior cruciate ligament (ACL) reconstruction, and the comparative study results of tibial and femoral bone tunnel positions between navigation and arthroscopy technique. Methods The proper placement of femoral and tibial tunnels were planned preoperatively in standard AP and lateral X-ray view. Intraoperative fluoroscopic images were taken and inputed into navigation computer system to form the virtual interactive working fields. After placement and registration, signals from patient trackers being fixed into distal femur and tibia respectively, and tool trackers being attached with ACL tibial and femoral guide, were identified and captured by the optic navigation camera and so, the navigation computer system could pursued the real-time position of the ACL guide tools and the virtual tunnel positions were projeted into the working fields to help precise placement of femoral and tibial tunnels. From December 2005 to April 2006, 46 patients underwent fluoroscopy assisted anterior cruciate ligament reconstruction. Of them, 40 cases were evaluated with the postoperative X-ray lateral view to measure the placement of both femoral and tibial tunnels, and compared with the group of 40 cases of arthroscopy assisted ACL reconstruction in the same study period. Results For the navigation group, the average position of tibial tunnel was 45.35%?3.827% (37% to 53%) and 62.25%?5.610% (52% to 73%) for femoral tunnel. For the arthroscopic group, the average tunnel positions was 41.05%?6.008% (25% to 54%) for the tibia, and 56.62%?7.316% (46% to 77%) for the femur. With reduced SD, the average positions for both of the 2 tunnels in the navigation group were significantly more posterior than the arthroscopic group(P

Objective To determine the incidence of clinically common acute avulsions of the popliteus tendon (PT) and the lateral collateral ligament (LCL) of the femur (peel-off lesion) in knees with multiple injured ligaments.Methods A retrospective review of 48 acute grade 3 posterolateral corner (PLC) knee surgeries was conducted.All office evaluations were reviewed to determine the demographic data,tear description,preoperative MRI examination,physical examination under anesthesia,intraoperative arthroscopic findings and surgical techniques.Results In total,19 patients were surgically verified as having femoral peel-off lesions as a portion of a series of multiple pathologic findings.Tear patterns were typically categorized into 3 patterns:isolated PT tear (pattern 1,4 patients),combined PT and LCL tears (pattern 2,8 patients) and complex tears (associated intrasubstance and/or fibular-based injuries,pattern 3,7 patients).Seventeen of the 19 patients underwent preoperative MRI examination,which demonstrated conclusive signs of femoral insertion separation and discontinuity in 13 patients (76%) and inconclusive signs of femoral insertion separation.Examination under anesthesia (EUA) revealed that for the 4 patients with pattern 1 injuries,the tibial external rotation increases were all greater than 10°.For the 15 patients with pattern 2 and 3 injuries,the yarus instability was as follows:grade 3 in 8 patients,grade 2 in 2,grade 1 in 1,and negative in 4.External rotation increases were greater than 10° in 12 patients and less than 10° in 3.Seventeen of the 19 patients were inspected with an arthroscope prior to PLC surgery:of these patients,94% had acute avulsion findings and positive lateral gutter drive-through sign;8 patients were repaired with recess or reattachment procedures;6 patients were primarily reconstructed;4 patients were treated with combined repair and reconstruction;and 1 patient was left untreated for secondary reconstruction due to priority repair for concurrent patellar tendon rupture.Conclusion For adequate clinical identification,we recommend a comprehensive diagnostic protocol,including MRI,physical examination and arthroscopic inspection,to avoid underdiagnosis of the lesion in multiple-ligament injured knees.The lateral gutter arthroscopic evaluation is particularly sensitive for detecting the lesion.

Dental Occlusion ; Evidence-Based Dentistry ; Evidence-Based Medicine ; Humans

Guidelines as Topic ; Hepatitis B, Chronic ; drug therapy ; prevention & control ; Humans

Adult ; Aged ; Female ; Granuloma, Laryngeal ; etiology ; Humans ; Intubation, Intratracheal ; adverse effects ; Male

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Child ; Female ; Humans ; Lymphocyte Count ; Male ; Middle Aged ; Myelodysplastic Syndromes ; blood ; T-Lymphocytes, Helper-Inducer ; Young Adult

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.