As a common and frequently-occurring disease,glenohumeral instability is become one of disease which restrict upper limb activity. The diagnosis of this disease is easy, but it is very difficult to assess the degree of periarticular soft tissue injuries. With the development of magnetic resonance imaging and arthroscopy, MRA become the gold standard for evaluation of glenoid labrum, joint capsule and ligaments injury. The traditional manual reduction is a fast, simple method, but often can cause adverse consequences,such as rotator cuff tear,ligament relaxation,and habitual dislocation. Open operation can rebuild stability of joint,but with many new treatment methods,especially the arthroscopic reconstruction has gradually replaced the open operation, and become the mainstream trend, but for the long-term effect of capsular tightening surgery, rotator cuff gap closure is not clear,it is need further follow-up observation.
Arthroscopy ; Humans ; Joint Instability ; diagnosis ; etiology ; therapy ; Shoulder Joint

Humans ; Joint Instability ; etiology ; therapy ; Postural Balance ; Spinal Diseases ; etiology ; therapy ; Stress, Mechanical

OBJECTIVETo explore the relation between "Gucuofeng and Jinchucao" and cervical spondylosis.

METHODSFrom March 2006 to October 2011,333 patients with cervical spondylosis were collected in the study as cervical spondylosis group; 30 subjects of control group come from student of Shuguang Hospital and other health volunteer. There were 119 males and 214 females with a mean age of (48.11 +/- 12.21) years in cervical spondylosis group and there were 6 males and 24 females with a mean age of (45.27 +/- 10.12) years in control group. In aspect of the symptom and sign, dynamic palpation, X-ray examination wer performed to find the incidence rate of "Gucuofeng and Jinchucao" in two groups.

RESULTSThere was significant difference in symptom and sign, dynamic palpation, X-ray examination between two groups (P<0.01). In cervical spondylosis group, "Gucuofeng and Jinchucao" occurred in 293 cases (87.99%),there was significant difference compared with control group (P<0.01).

CONCLUSIONCervical "Gucuofeng and Jinchucao" is one of pathological point of cervical spondylosis,and it can provide a guidance for the diagnosis and treatment of cervical spondylosis.

Adult ; Aged ; Cervical Vertebrae ; pathology ; Female ; Humans ; Joint Instability ; complications ; Male ; Medicine, Chinese Traditional ; Middle Aged ; Spondylosis ; etiology ; pathology

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

Spinal instrumentation is a common method for the treatment of spinal disorders, but it can lead to the changes of spine biomechanics. Because of the stress changes, accelerated degeneration of the adjacent segment may occur as time goes by, namely adjacent segment disease. The accelerated degeneration can lead to secondary spinal stenosis, articulated joint degeneration, acquired spondylolisthesis, and spine instability, and some patients may have to receive surgery again. In recent years, the researchers gradually recognized the importance of this disease, and began to investigate its pathogenesis and management.
Humans ; Joint Instability ; etiology ; prevention & control ; Postoperative Complications ; diagnosis ; prevention & control ; Spinal Diseases ; surgery ; Spinal Fusion ; adverse effects ; instrumentation ; Spinal Stenosis ; etiology ; prevention & control ; Spondylolisthesis ; etiology ; prevention & control

BACKGROUND: The aim of this study was to evaluate causes of unstable total knee arthroplasty and results of revision surgery. METHODS: We retrospectively reviewed 24 knees that underwent a revision arthroplasty for unstable total knee arthroplasty. The average follow-up period was 33.8 months. We classified the instability and analyzed the treatment results according to its cause. Stress radiographs, postoperative component position, and joint level were measured. Clinical outcomes were assessed using the Hospital for Special Surgery (HSS) score and range of motion. RESULTS: Causes of instability included coronal instability with posteromedial polyethylene wear and lateral laxity in 13 knees, coronal instability with posteromedial polyethylene wear in 6 knees and coronal and sagittal instability in 3 knees including post breakage in 1 knee, global instability in 1 knee and flexion instability in 1 knee. Mean preoperative/postoperative varus and valgus angles were 5.8degrees/3.2degrees (p = 0.713) and 22.5degrees/5.6degrees (p = 0.032). Mean postoperative alpha, beta, gamma, delta angle were 5.34degrees, 89.65degrees, 2.74degrees, 6.77degrees. Mean changes of joint levels were from 14.1 mm to 13.6 mm from fibular head (p = 0.82). The mean HSS score improved from 53.4 to 89.2 (p = 0.04). The average range of motion was changed from 123degrees to 122degrees (p = 0.82). CONCLUSIONS: Revision total knee arthroplasty with or without a more constrained prosthesis will be a definite solution for an unstable total knee arthroplasty. The solution according to cause is very important and seems to be helpful to avoid unnecessary over-constrained implant selection in revision surgery for total knee instability.
Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Knee/*adverse effects ; Female ; Humans ; Joint Instability/*etiology ; Knee Joint/*surgery ; Knee Prosthesis ; Male ; Middle Aged ; *Prosthesis Failure ; Reoperation ; Retrospective Studies

OBJECTIVETo study the role of lateral collateral ligament complex on the posterolateral rotatory instability and the relationship between the radiocapitellar ratio (RCR) and the injury of lateral collateral ligament complex on X-ray images.

METHODSTwenty elbow joints from fresh-frozen adult cadavers were used to make osteo-ligamentous elbow specimens. The specimens were fixed with a self-made device to maintain posterolateral rotatory instability of the elbow joint. All the specimens were divided into two groups: group A and group B. Surgical procedures were carried out as follows in the lateral structures of group A: A1, intact specimen; A2, transection of radial ulnar collateral ligament firstly; A3, transection of annular ligament secondly; A4, final transection of the radial collateral ligament. The procedures in group B were carried out as follows: B1, intact specimen; B2, transection of the radial collateral ligament firstly; B3, transection of the annular ligament secondly; B4, final transection of the radial ulnar collateral ligament. Lateral X-ray films of elbow joint were taken, and the radiocapitellar ratio (RCR) was measured by using PACS. All analysis was performed with SPSS 17.0 software.

RESULTSGroup A: the increases in RCR had statistical differences among A1, A2, A3, and A4 groups. Group B: the increases in RCR had no statistical differences among B1, B2 and B3 groups; but the increase in RCR in group B4 was more than that in B1, B2 and B3 groups.

CONCLUSIONThe radial ulnar collateral ligament is a key structure to maintain posterolateral rotatory stability;the radial collateral ligament and the annular ligament are the secondary important structures. There are 4 grades of the posterolateral rotatory instability of the elbow, according to the X-ray imaging classification.

Collateral Ligaments ; injuries ; Elbow Joint ; diagnostic imaging ; physiopathology ; Female ; Humans ; Joint Instability ; diagnostic imaging ; etiology ; physiopathology ; surgery ; Magnetic Resonance Imaging ; Male ; Radiography

OBJECTIVE: To determine the curative effect of arthroscopic suture anchor fixation on shoulder bankart injury. METHODS: Sixteen patients with shoulder recurrent dislocation and diagnosed bankart injury were treated with suture anchor fixed by shoulder arthroscopy. Both shoulders of the patients had X-ray, MRI, physical examination before the operation. Suture anchors were used to fix the lesion labrum by shoulder arthroscopy. University of California at Los Angeles (UCLA) score and visual analogue scale (VAS) score were adopted for the final evaluation at the latest follow-up. RESULTS: All patients were followed for a period of 25 (7-68) months. At the latest follow-up, no redislocation and instability occured. The pre- and post-operation UCLA score was (20.8 ± 0.8) vs (32.9 ± 1.5), excellent in 6, good in 10, with no poor score, while the pre- and post-operation VAS score was (3.3 ± 0.8) vs (0.6 ± 0.5). CONCLUSION Suture anchor fixation guided by arthroscopy is good for bankart injury caused by recurrent shoulder dislocation, which has many advantages, such as mini-invasion, rapid recovery and a satisfactory outcome in function and motion.
Adolescent ; Adult ; Arthroscopy ; methods ; Female ; Humans ; Joint Instability ; etiology ; surgery ; Male ; Middle Aged ; Shoulder Dislocation ; surgery ; Shoulder Joint ; injuries ; surgery ; Suture Anchors ; Treatment Outcome ; Young Adult

OBJECTIVE: To investigate the mid-term effectiveness of arthroscopic Bankart repair for recurrent anterior shoulder dislocation. METHODS: The clinical data of 107 patients with recurrent anterior shoulder dislocation who met the inclusion criteria between January 2017 and June 2021 was retrospectively analyzed, and all patients underwent arthroscopic Bankart repair. There were 88 males and 19 females. The age of the primary dislocation ranged from 13 to 48 years (mean, 23.3 years). The number of preoperative dislocations was 2-160 times (median, 7 times). The duration of preoperative instability was 0.2-240.0 months (median, 36.0 months). The mean age at operation was 28.2 years (range, 16-61 years). There were 43 cases of left shoulder and 64 cases of right shoulder. The proportion of glenoid defects in 63 patients was 1.7%-16.1% (mean, 8.1%). MRI showed that none of the patients had rotator cuff tears or shoulder stiffness. The CT three-dimensional reconstruction was performed at 1 day after operation to evaluate the distribution of implanted anchors and the occurrence of glenoid split fracture and whether there were nails pullout at the implant site. The postoperative complications were observed, and the pain and function of the shoulder were evaluated by visual analogue scale (VAS) score, Rowe score, Constant-Murley score, and American Shoulder and Elbow Surgeons (ASES) score. The recurrence of instability, the results of apprehension test, the number of patients who returned to preoperative sports level, and the satisfaction rate of patients were recorded. RESULTS: All patients were successfully operated and were followed up 20-73 months (mean, 41.5 months). All incisions healed by first intention. The CT three-dimensional reconstruction at 1 day after operation showed that the anchors were located at the 2 : 00-5 : 30 positions of the glenoid, and there was no glenoid split fracture or nails pullout at the implant site. At last follow-up, VAS score was significantly lower than that before operation, and Rowe score, Constant-Murley score, and ASES score were significantly higher than those before operation ( P<0.05). Seven patients (6.5%) had recurrence of anterior shoulder dislocation at 23-55 months (mean, 39.9 months) after operation, including 6 cases of dislocation and 1 case of subluxation. At last follow-up, 51 patients (47.7%) returned to preoperative sports level, and 11 patients (10.3%) had a positive apprehension test. The patients' satisfaction rate was 90.7% (97/107). Among the 10 patients who were not satisfied with the surgical effectiveness, 7 patients had postoperative recurrence of instability, and 3 patients felt that they did not return to preoperative sports level. CONCLUSION Arthroscopic Bankart repair has good mid-term effectiveness in patients with recurrent anterior shoulder dislocations, minimal or no glenohumeral bone defects and low sports need.
Male ; Female ; Humans ; Adolescent ; Young Adult ; Adult ; Middle Aged ; Shoulder Dislocation/surgery* ; Retrospective Studies ; Joint Instability/etiology* ; Arthroscopy/methods* ; Shoulder Joint/surgery* ; Recurrence

OBJECTIVESTo compare the paravertebral muscle (such as multifidus, erector spinae, psoas muscle) changes between the patients with degenerative lumbar instability and normal person by MRI and to observe the degeneration of paravertebral muscles. To analyze the relationship between paravertebral muscle degeneration and lumbar curvature of degenerative lumbar instability.

METHODSSixty patients with degenerative lumbar instability were retrospectively enrolled from December 2011 to July 2013 as degeneration group, meanwhile 60 health persons with no degenerative lumbar instability were selected as control group. No significant differences were found in the gender, age and body mass index between the two groups. The cross-sectional area(CSA) and percentage of fat infiltration area (FIA) of the paravertebral muscles at the L4-S1 levels were measured using T2-weighted axial MRI and Image J soft ware. And the lumbar curvature(expressed as lumbar lordosis angle) of all the patients in lumbar X-ray were measured in the two groups. The measured data were analyzed with independent samples t-test.

RESULTSThe difference of multifidus cross-sectional area and the percentage of fat infiltration in the patients of degenerative lumbar instability at the L4-L5, L5-S1 level, compared with the control group, was statistically significant (t = 2.768, t = 6.216, P < 0.05). Between the two groups, the percentage of fatty infiltration in erector spinae showed significant differences (t = 5.862, P < 0.05). The cross-sectional area of erector spinae and the degeneration of the psoas muscle between the two groups was not statistically significant. The lumbar lordsis angle in the patients with degenerative lumbar instability was (43.9 ± 15.6)°, which was higher than the (39.3 ± 14.2)° in control group (t = 2.915, P < 0.05).

CONCLUSIONSCompared with the control group, patients with degenerative lumbar instability exists erector spinae and multifidus muscle degeneration, and erector spinae is more obvious. The degeneration among psoas muscle, erector spinae and multifidus muscle are inconsistent, which may be related to the increasing of the lumbar lordosis angle in the patients with degenerative lumbar instability.

Aged ; Case-Control Studies ; Female ; Humans ; Joint Instability ; diagnosis ; etiology ; pathology ; Lumbosacral Region ; physiopathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Muscle, Skeletal ; pathology ; Muscular Atrophy ; complications ; diagnosis ; pathology