Adult ; Diagnostic Errors ; Femur ; Humans ; Male ; Osteomyelitis ; diagnosis ; Suppuration ; Tuberculosis, Osteoarticular ; diagnosis

OBJECTIVETo analyze the factors contributing to the failure of primary anterior cruciate ligament (ACL) reconstruction.

METHODSFrom November 2001 to July 2006, 13 patients underwent ACL reconstruction revision because of pathological instability in daily activities after primary ACL reconstruction, and the data of the patients were retrospectively analyzed.

RESULTSIn this group, 7 cases were reconstructed with bone-patellar tendon-bone (B-PT-B) autografts, 4 cases with hamstring tendon autograft and 2 cases with hamstring tendon allograft. There were malpositioned bone tunnels in 8 cases. Among them 4 cases had a femoral tunnel in the front of the predicted one, and in the other 4 cases, both the femoral and tibial tunnels were in the front of the predicted ones. In 2 cases reconstructed with allograft, one had to receive a twice operation to take out the allograft because of serious rejection, and the other claimed a failure because of the obviously enlarged bone tunnel. In the 2 cases reconstructed with B-PT-B autograft, malposition of the interference screw using to fasten the bone block had been founded in the upper bone tunnel. One case suffered from postoperative infection and had been cured by the anti-biotic treatment after arthroscopic debridement. Then the reconstructed ACL in 7 cases had absolutely ruptured and been absorbed. Four cases had obviously loosen but still partly linked reconstructed ligament. Two cases had a malposited interference screw, and both of them had no fastening function. One case received the lytic operation due to knee stiffness. Two cases received primary bone transplantation and needed to receive a secondary revision operation owing to severe incompletion of spongy bone. The other 10 cases received primary revision. Among them 4 cases reconstructed with STG obtained from the same lateral, 4 cases reconstructed with STG obtained from the opposite lateral, 1 case reconstructed with B-PT-B obtained from the same lateral and 1 case reconstructed with iliotibiali tractus.

CONCLUSIONSThere are many reasons leading to failure of ACL reconstruction. Nevertheless, malposition of the bone tunnel, invalid fixation, rejection to allograft and other complications such as the enlargement of the bone tunnel, postoperative infection and adhesion are the major factors that predispose the primary construction to failure.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Female ; Humans ; Male ; Middle Aged ; Reconstructive Surgical Procedures ; methods ; Reoperation ; Retrospective Studies ; Treatment Failure

BACKGROUNDThe supraspinatus tendon is the most commonly affected tendon in rotator cuff tears. Early detection of a supraspinatus tear using an accurate physical examination is, therefore, important. However, the currently used physical tests for detecting supraspinatus tears are poor diagnostic indicators and involve a wide range of sensitivity and specificity values. Therefore, the aim of this study was to establish a new physical test for the diagnosis of supraspinatus tears and evaluate its accuracy in comparison with conventional tests.

METHODSBetween November 2012 and January 2014, 200 consecutive patients undergoing shoulder arthroscopy were prospectively evaluated preoperatively. The hug-up test, empty can (EC) test, full can (FC) test, Neer impingement sign, and Hawkins-Kennedy impingement sign were used and compared statistically for their accuracy in terms of supraspinatus tears, with arthroscopic findings as the gold standard. Muscle strength was precisely quantified using an electronic digital tensiometer.

RESULTSThe prevalence of supraspinatus tears was 76.5%. The hug-up test demonstrated the highest sensitivity (94.1%), with a low negative likelihood ratio (NLR, 0.08) and comparable specificity (76.6%) compared with the other four tests. The area under the receiver operating characteristic curve for the hug-up test was 0.854, with no statistical difference compared with the EC test (z = 1.438, P = 0.075) or the FC test (z = 1.498, P = 0.067). The hug-up test showed no statistical difference in terms of detecting different tear patterns according to the position (χ2 = 0.578, P = 0.898) and size (Fisher's exact test, P > 0.999) compared with the arthroscopic examination. The interobserver reproducibility of the hug-up test was high, with a kappa coefficient of 0.823.

CONCLUSIONSThe hug-up test can accurately detect supraspinatus tears with a high sensitivity, comparable specificity, and low NLR compared with the conventional clinical tests and could, therefore, improve the diagnosis of supraspinatus tears in clinical settings.

Adolescent ; Adult ; Aged ; Diagnostic Tests, Routine ; methods ; Female ; Humans ; Male ; Middle Aged ; Rotator Cuff ; pathology ; Rotator Cuff Injuries ; diagnosis ; Tendon Injuries ; diagnosis ; Young Adult

OBJECTIVETo evaluate retrospectively the results of arthroscopic Bankart repair using suture anchors for recurrent anterior shoulder dislocation with a minimum 1-year follow-up and to assess risk factors for recurrence.

METHODSFrom March 2002 to March 2010, 259 patients with recurrent anterior shoulder dislocation underwent arthroscopic Bankart repair with suture anchors. And 188 patients (50 athletes, 138 nonathletes) were available for follow-up. The mean age at the time of surgery was 25.3 years (range, 13 - 58 years). The mean follow-up was 38.6 months (range, 12 - 110 months). All of the 188 patients were evaluated preoperatively and postoperatively with the American Shoulder and Elbow Society (ASES) shoulder score and Rowe score system. The rate of recurrent instability, range of motion, and risk factors for postoperative recurrence were evaluated. The ASES score was 72.6 preoperatively, and Rowe score was 33.4.

RESULTSThe ASES scores improved significantly to 91.9 postoperatively (P < 0.001). The Rowe scores improved to 81.9 postoperatively (P < 0.001). And 152 patients were greatly satisfied with the results, 16 satisfied and 20 unsatisfied. The satisfactory rate was 89.4%. 24 patients (12.8%) suffered a recurrence after surgery, 14 athletes and 10 nonathletes. The recurrence rates were 28.0% in the athlete group and 7.2% in the nonathlete group. On average there was no significant loss of external rotation postoperatively (average, 75.2° preoperatively and 67.2° postoperatively). Patients under age 20, and athlete patients were associated with recurrence (P < 0.05). Other factors including length of time until surgery, type of anchors, number of anchors, presence of bony Bankart lesion, presence of a superior labrum, anterior and posterior tear, presence of posterior or inferior labrum lesion, presence of rotator cuff tear, ligamentous laxity and rotator interval closure did not influence the recurrence rate (P > 0.05).

CONCLUSIONSArthroscopic Bankart repair is a good option for the treatment of recurrent anterior shoulder dislocation. Identification of risk factors for recurrence allows for consideration of open stabilization. In the series, patients under age 20 and athlete patients are the most important risk factors for recurrence.

Adolescent ; Adult ; Arthroscopy ; Athletes ; Female ; Humans ; Joint Instability ; Male ; Middle Aged ; Range of Motion, Articular ; Recurrence ; Retrospective Studies ; Risk Factors ; Shoulder Dislocation ; pathology ; surgery ; Suture Anchors ; Treatment Outcome ; Young Adult

OBJECTIVESTo evaluate the 4- to 10-year results of arthroscopic reconstruction of the posterior cruciate ligament (PCL) using single-bundle bone-patella tendon-bone graft, and to find out the principle and influential factor of the isolated PCL reconstruction.

METHODSFrom May 1998 to July 2004 the data of 29 patients with isolated PCL reconstruction retrospectively investigated, using single-bundle bone-patella tendon-bone graft. Twenty-two cases were followed up with average 7.1 years (5 - 10 years). Follow-up included the subjective knee function evaluation, KT2000, Biodex and the radiographic assessment.

RESULTSThe mean final follow-up IKDC score, Lysholm score, and Tegner score of the 22 cases were 89.4 +/- 8.1, 94.5 +/- 9.2, and 6.9 +/- 2.6 respectively. There were statistically significant improvements in them when compared with preoperative data respectively (P < 0.01). The average posterior displacement measured with KT2000 was (4.9 +/- 1.1) mm (90 degrees flexion) and (4.3 +/- 1.2) mm (30 degrees flexion) respectively. At the final follow-up, KT2000 examination revealed >or= 6 mm of posterior laxity in 6 patients (group A), and

CONCLUSIONSArthroscopic reconstruction of the posterior cruciate ligament using single-bundle bone-patella tendon-bone graft produces well results with moderate to long term follow-up. For the patients with III or IV PCL injury, PCL reconstruction should be done as soon as possible.

Adolescent ; Adult ; Arthroscopy ; Bone-Patellar Tendon-Bone Grafting ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Posterior Cruciate Ligament ; surgery ; Reconstructive Surgical Procedures ; methods ; Transplantation, Autologous ; Treatment Outcome ; Young Adult

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

BACKGROUNDShoulder immobilization can induce adhesion of the joint, capsular contracture or lead to the condition of frozen shoulder. However, little is known about the histological effects of immobilization on the shoulder joint. This study aimed to explore the effect of immobility on the subscapular bursa (SSB) and the joint capsular content, including the distribution of types I and III collagen, within an immobilized rat shoulder.

METHODSForty-six Sprague-Dawley rats were randomly divided into one control group (n = 6) and four immobilization groups (n = 10 in each group), in which the left shoulders were immobilized with plaster for 1, 2, 3 and 4 weeks. At the end of each time point, 2 rats from each group were euthanized and shoulders prepared for serial histological observations of the glenohumeral joints, as well as picrosirius red and immunohistochemical observation of type III collagen. Histological sections of the remaining rat shoulders were used for the immunohistochemical detection of the capsular content of types I and III collagen.

RESULTSThe hyperplastic synovium of the anterior capsule obstructed the communication between the SSB and the glenohumeral joint cavity at 2 and 3 weeks. The adhesion of the SSB appeared at 3 and 4 weeks. The quantitative and qualitative results showed that the capsular contents of types I and III collagen progressively increased at 2, 3 and 4 weeks, and that type III collagen was distributed extensively within the joint capsule at 2 and 3 weeks.

CONCLUSIONImmobilization of the rat shoulder induced synovial hyperplasia of the joint capsule, adhesion of the SSB and an increase of the capsular content of types I and III collagen.

Animals ; Collagen ; metabolism ; Disease Models, Animal ; Immunohistochemistry ; Joint Capsule ; metabolism ; Male ; Rats ; Rats, Sprague-Dawley ; Shoulder Dislocation ; metabolism ; pathology ; Shoulder Joint ; metabolism ; pathology

Adult ; Arthroscopy ; methods ; Female ; Humans ; Male ; Middle Aged ; Muscle, Skeletal ; surgery ; Shoulder Pain ; etiology ; surgery ; Tendons ; surgery ; Treatment Outcome

BACKGROUNDThe deltoid contracture is an uncommon disorder. Long-standing contracture produces winged scapula, abduction and extension contracture of the shoulder. Surgical release has been considered the treatment of choice. However, the method of approach has not been well defined. The purpose of this study was to evaluate the results of arthroscopic release of the deltoid contracture.

METHODSA retrospective study was undertaken to evaluate the results of arthroscopic release in six patients (seven shoulders) who had a contracture of the deltoid muscle. All patients had arthroscopic release. The abduction-contracture and horizontal-adduction angle was measured after operation. The average duration of follow-up was 16 months (range, from 4 to 41 months).

RESULTSThe preoperative abduction contracture resolved completely in three shoulders. Two had a residual abduction contracture of 5° to 7° and two had a poor result with 15° abduction-contracture angle. The average postoperative abduction-contracture angle was 6° (range, 0° to 15°). The preoperative horizontal-adduction contracture was corrected, permitting at least 130° of adduction, in five shoulders. The remaining two shoulders had a postoperative horizontal-adduction angle of 120° and 110°. Overall, the average postoperative horizontal-adduction angle was 130° (range, 110° to 140°).

CONCLUSIONArthroscopic release is an effective surgical technique to treat the deltoid contracture.

Adolescent ; Adult ; Arthroscopy ; methods ; Child ; Contracture ; surgery ; Deltoid Muscle ; surgery ; Female ; Humans ; Male ; Retrospective Studies ; Young Adult

OBJECTIVETo compare open and arthroscopic methods for treatment of recalcitrant lateral epicondylitis.

METHODSA prospective trial of 26 patients (28 elbows) with recalcitrant lateral epicondylitis were treated between May 2006 and September 2008. The mean duration of conservative care was 23. 0 months (4 - 60 months). The mean follow-up was 17.4 months (4 - 32 months). The patients were randomized divided into two groups, 13 elbows with an open Nirschl procedure and 15 with an arthroscopic Nirschl procedure. All patients had pre- and post-operative assessment using VAS (visual analog scale) scores, Mayo 12 points elbow scores, time of return to work or sports, satisfaction, and so on.

RESULTSThere were no significant differences in VAS scores at rest and activities of daily living, time of return to work or sports and satisfaction between the two groups. But there was a statistically significant difference in VAS scores at work and sports and Mayo 12 points elbow scores between the two groups. 100% of the patients had excellent or good results in the open group and 93.3% in arthroscopic group. There were no severe complications in this series.

CONCLUSIONSBoth open and arthroscopic Nirschl procedures are valid and reliable treatments for patients with refractory lateral epicondylitis. The patients in the open group have a better function in the return-to work and sports postoperatively than the arthroscopic group.

Adult ; Arthroscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Orthopedic Procedures ; methods ; Prospective Studies ; Tennis Elbow ; surgery ; Treatment Outcome