OBJECTIVE: To summarize the research progress on knee laxity of biomechanics and prevention and treatment after posterior cruciate ligament (PCL) reconstruction. METHODS: The domestic and international literature on the prevention and treatment of knee laxity after PCL reconstruction in recent years was extensively reviewed and analyzed. RESULTS: Different degrees of knee laxity often occur after PCL reconstruction, which can lead to poor prognosis in patients. The causes are associated with a variety of factors, including abnormal graft remodeling (such as differences in healing time and biomechanics among different types of grafts), tunnel position deviation (such as graft wear caused by the "killer turn" effect), and mechanical factors in postoperative rehabilitation (such as improper early weight-bearing and range of motion). These factors may promote graft elongation, increase early posterior tibial translation, and thereby induce knee laxity. CONCLUSION While PCL reconstruction improves knee stability, it is crucial to focus on and prevent postoperative knee laxity. However, current surgical methods are limited by factors such as graft characteristics, surgical technique flaws, and rehabilitation protocols, and thus can not fully correct the issue of abnormal postoperative laxity. Surgical techniques and treatment strategies still need further improvement and optimization to enhance patients' postoperative outcomes and quality of life.
Humans ; Joint Instability/surgery* ; Posterior Cruciate Ligament Reconstruction/adverse effects* ; Posterior Cruciate Ligament/surgery* ; Knee Joint/physiopathology* ; Biomechanical Phenomena ; Range of Motion, Articular ; Postoperative Complications/prevention & control* ; Knee Injuries/surgery*

INTRODUCTION: Arthroscopic Bankart repair is a widely accepted procedure to treat recurrent shoulder dislocation. This study aims to describe our experience with arthroscopic Bankart repair and its functional outcome. METHODS: 107 patients who underwent arthroscopic Bankart repair from 2008 to 2013 were followed up for a minimum of three years and reviewed by an independent observer. 80 consented to being interviewed using the Oxford Shoulder Instability Score (OSIS) and Simple Shoulder Test. RESULTS: 82 shoulders (two bilateral) were studied. Mean age at first dislocation was 19.4 ± 3.4 (12.0-31.0) years. Mean follow-up was 4.4 ± 1.3 (3.0-9.0) years and 2.5 ± 3.0 (0.1-15.4) years elapsed from first dislocation to surgery. 41 (50.0%) patients played overhead or contact sports and 44 (53.7%) played competitive sports before injury; 8 (9.8%) patients reported recurrence of dislocation, which was significantly associated with playing competitive sports before injury (p <0.039), 5 (6.1%) underwent revision surgery and 22 (26.8%) reported residual instability after surgery. 49 (59.8%) patients returned to playing sports, 75 (91.5%) were satisfied with their surgery and 79 (96.3%) were willing to undergo the surgery again. 74 (90.2%) patients had two-year good/excellent OSIS, which was significantly associated with playing competitive sports before injury (p = 0.039), self-reported stability after surgery (p = 0.017), satisfaction with surgery (p = 0.018) and willingness to undergo surgery again (p = 0.024). CONCLUSION Arthroscopic Bankart repair yields good functional outcomes and is associated with high patient satisfaction, although not all patients return to sports.
Humans ; Adolescent ; Young Adult ; Adult ; Shoulder Dislocation/complications* ; Joint Instability/surgery* ; Shoulder Joint/surgery* ; Return to Sport ; Patient Satisfaction ; Retrospective Studies ; Recurrence ; Arthroscopy/methods*

OBJECTIVE: To investigate clinical outcomes of countertraction method in treating irreducible subcoracoid dislocation of shoulder joint combined with Hill-Sacks injury. METHODS: A total of 56 patients with irreducible subcoracoid dislocation of the shoulder joint combined with Hill-Sacks injury admitted from December 2013 to June 2020 were retrospectively analyzed. Under the anesthesia of shoulder joint cavity injection, the reduction was performed by using anti-traction method (experimental group) and traditional Hippocrates method (control group), 28 cases in each group. There were 11 males and 17 females in experimental group, with an average age of (61.95±19.32) years old, 9 cases on the left side, and 19 cases on the right side. Twelve males and 16 females in control group, with an average age of (63.13±12.75) years old, 11 cases on the left side, 17 cases on the right side. The curative effects between two groups were evaluated before and after operation, including the success rate of reduction, the duration of reduction, the distance from successful reduction to injury, complications and functional rehabilitation(Constant score of shoulder joint). RESULTS: The success rates of reduction in experimental group and control group were 92.86%(26/28) and 67.86% (19/28), respectively, and the difference was statistically significant (P<0.05). The duration of simple reduction was (4.25±2.13) min and ( 6.31±1.69) min, the difference was statistically significant (P<0.05);the time from successful reduction to injury was (9.16±0.94) h and (8.94±1.31) h, respectively, with no significant difference(P>0.05). There were no complications such as vascular nerve injury and fracture in experimental group, 2 cases of axillary nerve injury and 1 case of humeral head fracture in control group. Constant scores of shoulder joint between experimental group and control group were (92.34±5.62) points and (90.91±4.73) points, respectively, with no significant difference (P>0.05). CONCLUSION For patients with irreducible subcoracoid dislocation of the shoulder joint with Hill-Sacks injury, the countertraction method under anesthesia of the shoulder joint cavity achieved a higher success rate and few complications.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Aged, 80 and over ; Shoulder Joint/surgery* ; Shoulder Dislocation/complications* ; Retrospective Studies ; Shoulder Injuries ; Joint Dislocations/complications* ; Joint Instability/surgery*

Radial head excision has always been a safe commonly used surgical procedure with a satisfactory clinical outcome for isolated comminuted radial head fractures. However, diagnosis of elbow instability is still very challenging and often underestimated in routine orthopaedic evaluation. We present the case of a 21-years old female treated with excision after radial head fracture, resulting in elbow instability. The patient underwent revision surgery after four weeks. We believe that ligament reconstruction without radial head substitution is a safe alternative choice for Mason III radial head fractures accompanied by complex ligament lesions.
Adult ; Elbow Joint ; injuries ; Female ; Fracture Fixation ; Humans ; Joint Instability ; therapy ; Lateral Ligament, Ankle ; surgery ; Radius Fractures ; complications ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

INTRODUCTIONThe purpose of this study is to compare the sensitivities and positive predictive values (PPV) of the anterior apprehension test and magnetic resonance imaging (MRI) in the diagnosis of anterior labral tears in young patients with shoulder instability and to determine if surgery could be carried out without this investigation in selected patients.

MATERIALS AND METHODSWe undertook a retrospective study of 168 patients aged between 15 and 30 years with a history of shoulder dislocation and compared the sensitivities and the PPV of the apprehension test with both MRI and magnetic resonance arthrograms (MRA) in the diagnosis of a Bankart lesion. The radiological investigations were interpreted by general practice radiologists and specialised musculoskeletal radiologists. All patients had their diagnosis confirmed by shoulder arthroscopy.

RESULTSOur results showed that the apprehension test was highly reliable when it was positive with a PPV of 96%. It was more sensitive than MRI in the diagnosis of a Bankart lesion. The clinical test was significantly better when a musculoskeletal radiologist interpreted the MRI. The MRA interpreted by a musculoskeletal radiologist had the highest rates of sensitivity in detecting Bankart lesions. The figure was similar to that for the apprehension test. There was no difference in the PPVs among the clinical test, the MRI and the MRA read by the 2 categories of radiologists.

CONCLUSIONWe conclude that a routine MRI may be unnecessary in evaluating a young patient with clinically evident anterior shoulder instability if the apprehension test is positive. A MRA that can be interpreted by a musculoskeletal radiologist will be the next best investigation if the clinical test is negative or equivocal.

Adolescent ; Adult ; Arthroscopy ; Female ; Humans ; Joint Instability ; diagnosis ; etiology ; surgery ; Magnetic Resonance Imaging ; Male ; Physical Examination ; methods ; Predictive Value of Tests ; Retrospective Studies ; Sensitivity and Specificity ; Shoulder Dislocation ; complications ; diagnosis ; surgery ; Shoulder Joint ; surgery ; Young Adult

BACKGROUND: Unstable simple elbow dislocation (USED) repair is challenged by the maintenance of joint reduction; hence, primary repair or reconstruction of disrupted ligaments is required to maintain the congruency and allow early motion of the elbow. We evaluated the effectiveness and the outcome of lateral collateral ligament (LCL) complex repair with additional medial collateral ligament (MCL) repair in cases of USED. METHODS: We retrospectively reviewed 21 cases of diagnosed USED without fractures around the elbow that were treated with primary ligament repair. In all cases, anatomical repair of LCL complex with or without common extensor origin was performed using suture anchor and the bone tunnel method. Next, the instability and congruency of elbow for a full range of motion were evaluated under the image intensifier. MCL was repaired only if unstable or incongruent elbow was observed. Clinical outcomes were evaluated using the Mayo elbow performance score (MEPS) and radiographic outcomes on last follow-up images. RESULTS: All cases achieved a stable elbow on radiographic and clinical results. LCL complex repair alone was sufficient to obtain the stable elbow in 17 of 21 cases. Four cases required additional MCL repair after restoration of the LCL complex. The overall mean MEPS was 91 (range, 70 to 100): excellent in 12 cases, good in 7 cases, and fair in 2 cases. All 17 cases with LCL complex repair only and 2 of 4 cases with additional MCL repair had excellent or good results by MEPS. CONCLUSIONS: USED requires surgical treatment to achieve a congruent and stable joint. If the repair of lateral stabilizer such as LCL complex acquires enough joint stability to maintain a full range of motion, it may not be necessary to repair the medial stabilizer in all cases of USED.
Adult ; Aged ; Collateral Ligaments/*surgery ; Dislocations/complications/physiopathology/*surgery ; Elbow Joint/*injuries/physiopathology/*surgery ; Female ; Humans ; Joint Instability/complications/physiopathology/*surgery ; Male ; Middle Aged ; Orthopedic Procedures/methods ; Range of Motion, Articular ; Retrospective Studies ; Young Adult

INTRODUCTIONThis study aimed to evaluate the two-year clinical outcomes of arthroscopic Bankart repair augmented by plication of the inferior glenohumeral ligament (IGHL) via horizontal mattress suturing.

METHODSThis study was a retrospective analysis of 76 arthroscopic Bankart repairs by a single surgeon from 2004 to 2008. Bioabsorbable suture anchors were used, with anchors placed at the 5:30, 4 and 3 o'clock positions of the right shoulder (correspondingly at the 6:30, 8 and 9 o'clock positions for the left shoulder). The lower most anchor was tied via horizontal mattress suture with plication of the IGHL, while the remaining two anchors were tied using simple sutures. The patients were postoperatively assessed, clinically and using the University of California Los Angeles (UCLA) shoulder rating scale.

RESULTSThe mean age of the patients at the time of presentation was 24.09 ± 7.98 years, and the mean duration of follow-up was 28.7 months. The postoperative recurrence rate of dislocation was 7.89% (six shoulders), of which five shoulders required revision surgeries. Excluding the revision cases, clinical assessment of the strength of the supraspinatus and the range of motion of the operated shoulders at two years post operation were either maintained or full in all patients. Analysis of the UCLA results showed pre- and postoperative mean scores of 25.94 ± 3.43 and 33.77 ± 3.07, respectively (p < 0.05).

CONCLUSIONArthroscopic Bankart repair augmented by plication of the IGHL and anchored via horizontal mattress suturing is a safe and reliable treatment for shoulder instability, with good clinical outcomes and low recurrence rates.

Adult ; Arthroscopy ; methods ; Female ; Follow-Up Studies ; Humans ; Joint Instability ; etiology ; physiopathology ; surgery ; Male ; Range of Motion, Articular ; Retrospective Studies ; Shoulder Dislocation ; complications ; physiopathology ; surgery ; Shoulder Joint ; injuries ; physiopathology ; surgery ; Suture Anchors ; Suture Techniques ; instrumentation ; Treatment Outcome ; Young Adult

OBJECTIVETo introduce the procedure of the 1st ray stabilization combined with resection of the lesser metatarsal heads for patient with severe forefoot deformity caused by rheumatoid arthritis (RA) and evaluate the short to mid-term clinical results.

METHODSFrom Oct. 2006 to Aug. 2010,97 patients (129 feet) aged from 36 to 67 years (average 54), with forefoot deformity caused by rheumatoid arthritis were reviwed. There were 88 males and 9 females,65 single lateral involved and 32 bilateral involved, the average duration of disease was 17 years (6 to 32 years). The 1st ray instability and lesser metatarsophalangeal (MTP) joint stiff dislocation were found in all cases. The first ray stabilization combined with resection of the lesser metatarsal head procedure were performed for all cases. The radiographic Hallux valgus angle (HVA) and intermetatarsal angle (IMA) were measurde and the JSSF (Japanese Society for Surgery of the Foot) score were evaluated before operation and every follow up.

RESULTSThe average followed-up was 37 months (6 to 52 months) for all patients except 5 (7 feet) and 1 died for acute cardiac infarction 1 year after operation. The average JSSF score improved from (33.2 +/- 8.2) points preoperative to (67.3 +/- 3.1) points at final followed-up (P < 0.01); the average HVA was corrected from (50.0 +/- 11.8) degrees preoperative to (21.2 +/- 3.2) degrees at final follow up (P < 0.01); the average IMA was corrected from (15.5 +/- 3.6) degrees preoperative to (9.7 +/- 6.6) degrees at final follow up (P < 0.01). MTP joint nonunion was found in 4 feet. A radiographic high density mass was found in the 1st cuneiform bone during 8 to 11 months followed-up in 3 feet; delayed wound healing was happened in 9 feet; MTP joint infection was happened in 2 feet; tarsometatarsal joint infection was happened in 1 foot; lesser MTP joints deformity recurrence were found in 16 feet.

CONCLUSIONThe characters of forefoot with RA in later stage are the 1st ray deformity and instability compound with the lesser toes deformity. The 1st ray stability procedure which include the 1st MTP arthrodesis and the Lapidus procedure can correct the 1st ray deformities and rebuilt its stability. The lesser toes metatarsal head resection is effective in correct their deformity. This combined procedure is reliable. It is suitable for patients with severe Hallux valgus, increased IMA, tarsometatarsal joint instability and the lesser MTP joint stiff dislocation.

Adult ; Aged ; Arthritis, Rheumatoid ; complications ; surgery ; Female ; Foot Deformities, Acquired ; surgery ; Forefoot, Human ; abnormalities ; surgery ; Hallux Valgus ; surgery ; Humans ; Joint Instability ; surgery ; Male ; Metatarsal Bones ; surgery ; Metatarsophalangeal Joint ; surgery ; Middle Aged

Posterolateral rotatory instability of the elbow describes a condition that radial head subluxation or dislocation occurs when forearm rotates externally in relation to humerus. It is difficult to diagnose and treat. We reported a typical case which was confirmed by physical examination and MR images. Ligamentous insufficiency was confirmed under direct vision, and was reconstructed with triceps fascia as described by Gong et al with slight modification. Regain of full function was achieved one year after surgery.
Adult ; Elbow Joint ; physiopathology ; Female ; Humans ; Joint Instability ; complications ; diagnosis ; physiopathology ; surgery ; Magnetic Resonance Imaging ; Shoulder Dislocation ; complications

Paralabral cyst of the shoulder joint can be observed in 2% to 4% of the general population, particularly in men during the third and fourth decade. On average, these cysts measure 10 mm to 20 mm in diameter and are located preferentially on the postero-superior aspect of the glenoid. The MRI has increased the frequency of the diagnosis of paralabral cysts of the shoulder joint. Paralabral cysts of the shoulder joint usually develop in the proximity of the labrum. The relationship between shoulder instability and labral tears is well known, however, the association of shoulder instability with a paralabral cyst is rare. Shoulder instability may cause labral injury or labral injury may cause shoulder instability, and then injured tear develops paralabral cyst. In our patient, the inferior paralabral cyst may be associated with inferior labral tears and instability MRI.
*Arthroscopy ; Cysts/complications/*diagnosis/surgery ; Humans ; Joint Instability/complications/surgery ; *Magnetic Resonance Imaging ; Male ; Shoulder Dislocation/complications/surgery ; *Shoulder Joint/pathology/surgery ; Young Adult