Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Anterior Cruciate Ligament Reconstruction ; methods ; Humans ; Knee Injuries ; surgery

OBJECTIVETo find out the relationship between different rehabilitation procedures and the tibial tunnel widening after ACL reconstruction.

METHODSSixty-five patients undergone ACL reconstructions by using quadrupled semitendinosus and gracilis tendons were divided into two groups. Group A had 33 patients, 19 male, 14 female, average age (31.2 +/- 12.4) years, only ACL reconstruction was performed with Germanic Professor Paessler's technique, and aggressive rehabilitation procedure was used for functional recovery. Group B had 32 patients, 20 male, 12 female, average age (30.3 +/- 10.3) years. Besides ACL reconstruction, every patient in Group B accepted meniscus repair or cartilage repair with microfracture technique, then postoperative conservative rehabilitation procedure was used. Six months after operation, standard posterior-anterior radiographic plates were taken for each patient, CorelDRAW 8.0 software was used to digitize all X-ray plates and measure the upper, middle and lower parts of the tibial tunnel. Magnification of X-ray plates was taken out after measurement. Statistic analysis was done by t-test.

RESULTSSix months after ACL reconstruction, on both the posterior-anterior and lateral X-ray plates the tibial tunnel widening of the upper, middle and lower parts in Group B with aggressive rehabilitation procedure was significantly serious than in Group A with conservative rehabilitation.

CONCLUSIONSRehabilitation procedure after ACL reconstruction is one of the reasons for tunnel widening. It perhaps influences the functional recovery and long-term clinical result of the operated knee by affecting the tunnel widening.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Female ; Humans ; Joint Instability ; etiology ; Knee Injuries ; rehabilitation ; surgery ; Male ; Reconstructive Surgical Procedures ; methods ; rehabilitation ; Rehabilitation ; methods ; Retrospective Studies ; Tendons ; transplantation ; Transplantation, Autologous

Objective To investigate the clinical effects and postoperative complications of arthrotomy and arthroscopy in repair of 170 menisci in 168 cases.Methods One hundred and sixty-eight patients with meniscus injury were repaired by arthrotomy or arthroscopy.They were 121 males and 47 females.There were 77 left knees and 91 right knees;117 medial menisci and 53 lateral ones.Their average age was 25.5?8.4 years old.Arthro- scopic repair methods included puncture and grinding,bio-absorbable meniscus arrow fixation,Outside-In suturing, Inside-Out suturing,Elite scuff instrument repairing,T-Fix fixation and FasT-Fix fixation techniques.The clinical results were assessed on the basis of symptoms,physical signs,Tegner scores and Lysholm scores of the cases. Postoperative complications were also investigated.Re-arthroscopic exploration was done for patients with obvious symptoms and physical signs.Results The average folluw-up time was 49.3?28.8 months.Their mean pre- operative Tegner score was 3.3?2.3,and their postoperative one 6.8?2.1 (P＜0.05).Their preoperative Lysholm score was 30.1?18.2,and their postoperative one 87.5?22.5 (P＜0.01).There were significant differences in Tegner and Lysholm scores before operation and after operation.Ninety-eight repaired menisci were rated as excellent(57.7%),57 as good (33.5%),10 as fair (5.9%),and five as poor (2.9%).The total ex- cellent and good result was 91.2%.Of the 19 patients with obvious symptoms and physical signs,re-arthroscopic exploration found no healing in five and partial healing in six.Postoperative complications included pain at the Outside-In suture nodes in three cases,referred pain at posterior articular capsule resulted from failed Outside-In meniscus anterior horn suturing in one case,and twinge at the meniscus arrow site in the posterior capsule in five cases.No serious lesion occurred at blood vessels or nerves.The postoperative complication incidence was 5.3%. Conclusion The eight methods of arthrotomy and arthroscopy to repair injured menisci investigated in our study can have a high successful rate and low perioperative and postoperative risk.

BACKGROUNDPosterior cruciate ligament (PCL) tear is a severe injury to the knee joint and often requires surgical reconstruction. A number of PCL reconstruction techniques have been reported. However, the problem of residual laxity after surgery is not unusual with conventional techniques. This study aims to introduce a modified PCL reconstruction with remnant preservation and graft tension relieving.

METHODSBetween December 2008 and June 2011, 36 cases of PCL reconstruction were performed in our institute, 20 with conventional technique (Group I) and 16 with modified technique (Group II). Pre- and post-operative results of the international knee documentation committee knee evaluation form (IKDC), Lysholm, Tegner, and KT2000 side-to-side difference were obtained.

RESULTSSignificant improvements of IKDC, Lysholm, Tegner, and KT2000 results after surgery were found in both groups. Group II showed better improvement in all subjective examinations and significantly more decrease of KT 2000 side-to-side difference.

CONCLUSIONModified PCL reconstruction with remnant preservation and graft tension relieving showed better results in restoration of posterior stability compared to conventional technique.

Adult ; Female ; Humans ; Knee Joint ; surgery ; Male ; Middle Aged ; Posterior Cruciate Ligament ; surgery ; Reconstructive Surgical Procedures ; methods

BACKGROUNDIt has been demonstrated that bone tunnel widening could appear after knee anterior cruciate ligament (ACL) reconstruction, especially for those patients whose ruptured ACL were reconstructed with semitendinosus and gracilis tendons. Many factors can influence the extent of tunnel widening. Few studies have investigated the relationship between bone tunnel widening and rehabilitation procedures. This research was carried out to find the rehabilitation procedures' influence on the tibial bone tunnel widening after ACL reconstruction.

METHODSSixty-five cases, whose ACL reconstructions were done using quadrupled semitendinosus and gracilis tendons, were divided into two groups. Group A had 33 cases, 19 men, 14 women, averaged (31.2 +/- 12.4) years old, only ACL reconstruction was done using Paessler's technique, and aggressive rehabilitation procedure was used for function recovery post operation. Group B had 32 cases, 20 men, 12 women, averaged (30.3 +/- 10.3) years old. Except for ACL reconstruction, every patient in group B accepted meniscus repair using re-fixation methods or cartilage repair using microfracture technique, conservative rehabilitation procedure was used post operation. Six months post operation, standard posterior-anterior radiographic plates were taken for each case, CorelDRAW 8.0 software was used to digitize all X-ray plates and measure the upper, middle and lower parts of the tibial tunnel. Magnification effect of X-ray plates was taken out after measurement.

RESULTSSix months after ACL reconstruction the tibial tunnel widening of the upper, middle and lower parts on both the posterior-anterior and lateral X-ray plates in Group A with aggressive rehabilitation procedure was much more serious than in Group B with conservative rehabilitation. KT-1000 knee stability measurement and clinical manifestation showed no difference between the two groups.

CONCLUSIONSRehabilitation procedure after ACL reconstruction is one of the reasons for tunnel widening. It not only can directly influence the function recovery of ACL reconstructed knee, but also perhaps indirectly influence the function recovery and long-term clinical result of the operated knee by influencing the tunnel widening.

Adult ; Anterior Cruciate Ligament ; diagnostic imaging ; surgery ; Female ; Humans ; Joint Instability ; Knee Injuries ; rehabilitation ; surgery ; Male ; Middle Aged ; Orthopedic Procedures ; Radiography ; Reconstructive Surgical Procedures ; Retrospective Studies ; Tendons ; transplantation ; Tibia ; diagnostic imaging ; pathology

OBJECTIVETo compare the clinical results of double and single bundle anterior cruciate ligament (ACL) reconstruction.

METHODSFrom 2005 May to December the data of 33 patients (4 lost follow) with double-bundle and 41 patients (8 lost follow) with single-bundle reconstruction of ACL using auto-hamstring tendons was retrospectively investigated. The follow-up was 14-22 months (average 18 months) of double-bundle group and 14-21 months (average 18 months) of single-bundle group. The IKDC, Lysholm and Tegner scores, KT-2000 and Biodex were used to evaluate the clinical results.

RESULTSThe IKDC, Lysholm and Tegner scores were increased significantly from 60, 66, 4 before the operation to 85, 94 and 6 respectively after the double-bundle reconstruction. The KT-2000 results showed that at 30 and 90 degree 134 N the anterior-posterior translations were significantly decreased from 5.8 and 2.4 mm to 1.2 and 1.1 mm respectively of the double-bundle group (P < 0.01). The peak torques of the extend and flex muscles of the involved knee at 60 degrees/s and 120 degrees/s were only at 81%, 87%, 76% and 85% of the contralateral knee of the double-bundle group. And the differences were statistically significant (P < 0.01). There were no differences between the two groups of any index, but the KT value at 30 degree and the extensor peak torque of the double-bundle group manifested a better tendency.

CONCLUSIONSBoth double-bundle and single-bundle ACL reconstruction can restore the stability and improve the function of the knee, and the double-bundle group shows a better tendency at the 30 degree stability and the extensor strength.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Female ; Follow-Up Studies ; Humans ; Joint Instability ; surgery ; Knee Injuries ; surgery ; Male ; Tendons ; transplantation ; Transplantation, Autologous ; Treatment Outcome

OBJECTIVESTo study and analyze the clinical factors contributing to the failure of primary posterior cruciate ligament (PCL) reconstruction and to guide our clinical treatment.

METHODSFrom November 2001 to May 2007, 8 patients underwent PCL reconstruction revision because of pathological instability after primary PCL reconstruction. And the clinical failure factors of the primary reconstruction were analyzed.

RESULTSOne case was reconstructed with bone-patellar tendon-bone (B-T-B) autografts, 7 cases with hamstring tendon autograft. The most probable causes of failure were improper graft placement in 7 cases (both femoral bone tunnels were behind the predicted one and tibial tunnels were in front of the predicted one). The reconstructed PCL in 4 cases ruptured absolutely and had been absorbed. Three cases had obviously loosen but still partly linked reconstructed ligament. These 8 cases all received primary PCL revision reconstruction. Among them, 6 cases were reconstructed with autograft (using a single-bundle quadruple hamstring graft in 3 cases, double-bundle quadruple hamstring graft in 1 case, single-bundle B-T-B autograft in 2 case), and 2 cases were reconstructed with allograft (using a single-bundle and a double-bundle B-T-B allograft reconstruction).

CONCLUSIONSIncorrect bone tunnel placement is the major factor contributing to the surgical failure in many reasons for the failure of PCL reconstruction. So, it might be suggested that there is a great need for a more precise anatomical bone tunnel placement.

Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Posterior Cruciate Ligament ; surgery ; Reoperation ; statistics & numerical data ; Retrospective Studies ; Treatment Failure ; Young Adult

BACKGROUNDAlthough the early clinical outcomes of total knee arthroplasty (TKA) using minimally invasive surgery techniques have been widely described, data on the mid- to long-term outcomes are limited. We designed a retrospective study to compare the two most common TKA techniques - The modified quadriceps-sparing (m-QS) approach and the mini-medial parapatellar (MMP) approach - In terms of the clinical and radiographic parameters, over a minimum follow-up period of 5 years.

METHODSThe m-QS approach was used in 31 knees and the MMP approach, in 36 knees. Knees in both groups were compared for component position and alignment, knee alignment, length of the skin incision, range of motion, Visual Analog Scale score, muscle torques, Knee Society Score, Western Ontario and McMaster Universities Osteoarthritis Index, and number of complications.

RESULTSThere were no major intergroup differences in any of the clinical and radiographic outcomes assessed at the final follow-up examination.

CONCLUSIONSOn the basis of numbers studied, the m-QS group, which requires more technique, showed equivalent results with the MMP group in the postoperative 5 years. Preservation of the extensor mechanism in the m-QS approach could not ensure any improvement in the clinical outcomes during the mid-term follow-up duration.

Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Knee Joint ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Minimally Invasive Surgical Procedures ; adverse effects ; methods ; Quadriceps Muscle ; diagnostic imaging ; Radiography ; Retrospective Studies

BACKGROUNDRevision anterior cruciate ligament (ACL) surgery can be expected to become more common as the number of primary reconstruction keeps increasing. This study aims to investigate the factors causing instability after primary ACL reconstruction, which may provide an essential scientific base to prevent surgical failure.

METHODSOne hundred and ten revision ACL surgeries were performed at our institute between November 2001 and July 2012. There were 74 men and 36 women, and the mean age at the time of revision was 27.6 years (range 16 - 56 years). The factors leading to instability after primary ACL reconstruction were retrospectively reviewed.

RESULTSFifty-one knees failed because of bone tunnel malposition, with too anterior femoral tunnels (20 knees), posterior wall blowout (1 knee), vertical femoral tunnels (7 knees), too posterior tibial tunnels (12 knees), and too anterior tibial tunnels (10 knees). There was another knee performed with open surgery, where the femoral tunnel was drilled through the medial condyle and the tibial tunnel was too anterior. Five knees were found with malposition of the fixation. One knee with allograft was suspected of rejection and a second surgery had been made to take out the graft. Three knees met recurrent instability after postoperative infection. The other factors included traumatic (48 knees) and unidentified (12 knees).

CONCLUSIONTechnical errors were the main factors leading to instability after primary ACL reconstructions, while attention should also be paid to the risk factors of re-injury and failure of graft incorporation.

Adolescent ; Adult ; Anterior Cruciate Ligament Reconstruction ; adverse effects ; Female ; Humans ; Joint Instability ; etiology ; Male ; Middle Aged ; Retrospective Studies

BACKGROUNDSeveral techniques have been described for posterior cruciate ligament (PCL) reconstruction. However, double-bundle PCL reconstruction using the quadruple bone-tunnel technique has been seldom reported. The current study investigated this technique, focusing on the anatomy of the femoral and tibial insertions of the anterolateral (AL) and posteromedial (PM) bundles of the PCL.

METHODSTwenty-two fresh, healthy adult cadaveric knees were dissected and measured. The PCL was divided into the AL bundle and PM bundle at the insertion footprint. The insertion footprints of the AL and PM bundles, their location, size, and the clock positions were measured and described.

RESULTSOn the femur, the clock position of the footprint of the AL bundle was 11:21 ± 0:23 (left) or 0:39 ± 0:23 (right), and the PM bundle was 9:50 ± 0:18 (left) or 2:10 ± 0:18 (right), with the knee flexed at 90 degrees. The distances from the center of the femoral insertions of the AL and PM bundles to the anterior cartilage margins of the medial femoral condyle were (7.79 ± 1.22) mm and (8.36 ± 1.63) mm, respectively. On the tibia, the vertical distances from the center of the tibial insertions of the AL and PM bundles to the tibial articular surface were (3.25 ± 1.20) mm and (6.91 ± 1.57) mm, respectively.

CONCLUSIONSThese results have led to a better definition of the anatomy of the AL and PM bundle footprint of the PCL. The technique of double-bundle PCL reconstruction using quadruple bone-tunnel is feasible. Application of these data during PCL reconstruction using the quadruple bone-tunnel technique may help optimize knee stability.

Female ; Humans ; In Vitro Techniques ; Knee Joint ; anatomy & histology ; Male ; Posterior Cruciate Ligament ; anatomy & histology