Objective The investigation was to evaluate the method and the efficacy of double-bun-dle anterior cruciate ligament reconstruction with semitendinosus and gracilis tendon through two bone tun-nels.Methods From April1998to May2000,12patients underwent double-bundle anterior cruciate liga-ment reconstruction were reviewed and followed up more than18months.There were12male and2female patients aging from17to38years old(mean,25.5years).5cases were associated with simple anterior cru-ciate ligament injury,and the other7cases suffered from anterior cruciate ligament injury with concomitant torn meniscus.Two bone tunnels of4.5mm diameter were made in the tibial and the femoral attachment site of ACL anteromedial bundle and posterolateral bundle respectively.The anteromedial bundle was recon-structed using semitendinosus tendon,and the posterolateral bundle was reconstructed using the gracilis ten-don.The attachments of the semitendinosus and gracilis tendon outside tibial tunnels were reserved,the re-paired tendons were tied as a knot outside femoral tunnels.There was not need to do any internal fixation.Anterior drawer test was performed in30,60and90degrees of flexion of the knee joint,and Lysholm rating system was used to determine the function of the knee and the level of activity of the patients.Results Be-fore operation,anterior drawer test in30,60and90degrees of flexion of the knee joint was positive in all patients,the mean Lysholm scores were50.5points(range,40to58points).18months after operation,ante-rior drawer test in30,60and90degrees was negative in9cases,anterior drawer test in60,90degrees of flexion of the knee joint was negative in2cases,in90degrees negative in1case;The mean Lysholm scores was85points(range,62to92points).The good and excellent results were obtained in91.7%.Conclusion The combination of double-bundle anterior cruciate ligament reconstruction makes a great progress to anatomic reconstruction,provides better dynamic stability of the knee joint,and predisposes the patients sat-isfactory clinical effects.

Objective To describe a new method of reconstruction of anterior crucial ligament(ACL) so as to avoid additional injury of peripatellar tissue and complications caused by procuring autograft from the patellar tendon. Methods To reconstruct the injuried ACL under arthroscopy by means of identical length of allogenic achilles tendon which was stored in deep hypothermia. At the same time, injuried medial collateral ligament(MCL) was reconstructed by using the achilles tendon. Results From January 1996 to June 2000, the ACLs in 31 cases were reconstructed by allogenic achilles tendon under arthroscopy. The average period of follow up of 25 cases(26 sides) was 18.9 months(12-49 months). Among them, 4 injuried MCLs were also reconstructed, 5 torn meniscus were sutured, and 6 were resected or partially resected. According to the Lysholm score method, the average score was 53.5 preoperatively, and 84 postoperatively, the satisfactory rate was 84.6%. The objective examination showed anterior drawer test(ADT) positive in 23 preoperatively, 1 postoperatively; Lachman test was positive in 25 preoperatively, 1 postoperatively, and weak positive in 2 postoperatively. There were 2 with pain in knee joints and 3 with limitation of activity of knee joints(5?-20?)postoperatively. Conclusion Allogenic achilles tendon, a materials can be procured in advance, and the injury and complications caused by the autograft can be decreased, and MCL can be reconstructed at the same time. With this technique, the material is convenient to obtain, the operative method is simple, and there is no need for internal fixation.

Objective To investigate the effect of total knee arthroplasty ( TKA) following high tibial osteotomy ( HTO) and to analyze the factors that may influence the operation .Methods A total of 16 patients (19 knees) who had undergone a previous HTO were treated with TKA between 2000 and 2010.The American Knee Society Scores ( KSS), femorotibial angle ,quadriceps angle ,posterior slope angle of tibial plateau ,Insall Salvatti Ratio and knee range of motion ( ROM) were evaluated for each patient pre-and post-operatively and the results were evaluated .Results The KSS scores improved from 73.20 ±3.56 scores preoperatively to 153.00 ±3.39 scores postoperatively (P <0.05).The femorotibial angle was corrected from 160.57°±3.30°preoperatively to 169.85°±1.34°postoperatively(P<0.05).The quadriceps angle was corrected from 24.57°±2.07°preoperatively to 17.28°±1.11°postoperatively (P<0.05).The posterior slope angle of tibial plateau was corrected from 2.25°±0.50°preoperatively to 3.75°±0.95°postoperatively (P<0.05).The Insall Salvatti Ratio improved from 0.80 ±0.08 preoperatively to 1.05 ±0.12 postoperatively ( P <0.05).The knee ROM improved to 38.25°±8.88°postoperatively from 96.25°±4.34°preoperatively(P<0.05).Conclusion TKA following HTO demands adequate soft tissue balancing , good limb alignment and appropriate prosthesis .

OBJECTIVE: structure and biomechanics studies of posterior cruciate ligament (PCL) demonstrated that double-bundle hamstring graft has similar function to healthy PCL. semitendinosus and gracilis can stabilize knee joint by preventing anterior tibial displacement. Therefore, the aim of this paper is to evaluate the efficacy of construction a PCL using semitendinosus and gracilis bundles.METHODS: Nine patients who were underwent double bundle PCL reconstruction from March 2006 to December 2007, and received a more than 18 months follow-up, were collected, including 8 males and 1 female, aged 21-42 years. Four patients were suffered simple PCL injury,and the other 5 patients combined with meniscus injury. Two tunnels of 5 mm diameter was made in the femoral attachment site of PCL, one tunnel of 8.0 mm diameter was made in the tibial attachment site of PCL. The anterior bundle was reconstructed using semitendinosus tendon, and the posterior bundle was reconstructed using the gracilis tendon. We reserved the attachment of the semitendinosus and gracilis tendon outside of tibial tunnel, and tied a knot using tendens outside of femoral tunnels. No internal fixation was needed. Posterior drawer test was performed in 30.60 and 90 degrees of flexion of the knee joint, and Lysholm rating system was used to determine the function of the knee and the patient's level of activity. RESULTS: Nine patients were included in the final analysis. Prior to operation, posterior drawer test in 30, 60 and 90 degrees of flexion was positive in all 9 cases. However, at 18 months after operation, posterior drawer test in 30, 60 and 90 degrees was negative in 8 cases, only 1 patient had positive posterior drawer test in 30 degrees. The mean Lysholm score was 55 points (45-68points) prior to operation, which was 88 points (78-94 points) postoperatively. The excellent and good results were obtained in 89%.CONCLUSION: Double bundle reconstruction of the PCL mimics more closely to the natural behavior of the normal PCL, which can restore normal knee laxity across the full range of motion. However, the cases were limited, so the prostecdtive efficacy needs to be followed up.

Objective To analyze the activity of the vastus medialis (VM) and vastus lateralis (VL) muscles in the dynamic stabilization of the patella in patients with patellofemoral pain (PFPS) using standard surface electromyographic (sEMG) tests.Methods This comparative study involved 7 patients with PFPS (13 knees) and 10 healthy subjects (20 knees).They performed weight-bearing squat movements,and sEMG was employed to measure the mean amplitude and the time before peak (TBP) of their VM and VL muscles.Results There was no significant difference between the two groups in the ratio of the mean amplitudes of the VM and VL muscles.However,the ratio in both groups in squatting was significantly higher than when simply standing.In the PFPS group the average TBP delay of the VM relative to the TBP of the VL was significantly longer than in the control group during squat movements.Conclusions The delay in the TBP of the VM relative to the VL during squat movements could serve as a standardized test for assessing treatment effect in patients with local factor PFPS.

Objective To compare the adherence condition of mycobacterium tuberculosis on 2 kinds of artificial joint interface. Methods The Chromium-Cobalt-Alloy with hydroxyapatite ceramic coating and porous coating were cocultured with the bacterial liquid of mycobacterium tuberculosis. The optical density of mycobacterium tuberculosis in different interfaces were detected by turbidimetry. Adherence conditions were observed by electron microscope scanning. Results There was no significant difference between two groups in the optical density value (P>0.05). The electron microscope scanning showed that more mycobacterium tuberculosis adhered to the porous coating than hydroxyapatite ceramic coating (P<0.05). Conclusion The hydroxyapatite ceramic coating has more advantages to the porous coating in prosthetic replacement for patients with joint tuberculosis.

Objective To study the effect of surface physical properties of different materials for the artificial joint pros -thesis interface on Mycobacterium tuberculosis adhesion .Methods The surface polishing coating , titanium coating and hydroxyapatite coating were chosen as the experimental materials to analyze the surface topography and measure the surface roughness, contact angle and surface energy .The M.tuberculosis strains were used by in vitro cultivation method and ob-served by scanning electron microscopy (SEM) to study the morphology of M.tuberculosis and the material surface adhe-sion.The influence of surface physical properties of the interface of the artificial joint prostheses on the proliferation and ad -hesion of bacteria was evaluatd .Results The titanium coating and hydroxyapatite coating materials were hydrophobic , while the surface polishing coating was hydrophilic .The contact angle and surface energy were significantly different ( P<0.05).In the process of bacterial culture of the three types of materials , there was no significant difference (P>0.05)in the OD value of bacterial solution .The titanium coating had the largest amount of interface adhesion for M.tuberculosis, fol-lowed by the hydroxyapatite coating and the polishing coating .The difference between various materials was statistically sig-nificant (P<0.05).Conclusion The adhesion of M.tuberculosis in the surface of artificial joint prosthesis materials is closely related to the surface physical properties .A adhesiveness improves with surface roughness .

Objective To evaluate the clinical results of arthroscopic repair of combined Bankart and superior labrum anterior to posterior (SLAP)lesions in patients with recurrent shoulder dislocations.Methods Between May 2011 and January 2015,we reviewed 15 cases with combined Bankart and SLAP lesions with recurrent shoulder dislocations who underwent arthroscopic repair.Their average age during surgery was 24.2 years (ranging from 16 to 38 years).During the operation,we began by repairing the unstable SLAP lesion with absorbable suture anchors before we repaired Bankart lesion from the inferior to superior.Fifteen patients in the control group had isolated Bankart lesions without SLAP lesions and underwent arthroscopic repair.Their mean age was 24.6 years (ranging from 18 to 35 years).The preoperative and postoperative results were analyzed by Visual Analogue Scale (VAS)for pain,the range of motion,American Shoulder and Elbow Surgeon (ASES)and Rowe Shoulder Scores Systems.We compared the results with the isolated Bankart lesion. Results For patients who underwent arthroscopic repair of combined Bankart and SLAP lesions,the mean postoperative follow-up period was 15 months (ranging from 13 to 28 months),vs 22 months (ranging from 21 to 34 months)in the control group.VAS for pain was decreased from preoperative 4.9 to postoperative 1.9 (P <0.05).Mean ASES and Rowe Shoulder Scores were improved from preoperative 56.4 and 33.7 to postoperative 91.8 and 94.1,respectively (P <0.05). Recurrent dislocation was not observed until the last follow-up and anterior instability in two groups was not noted during the physical examination.Compared with the isolated Bankart lesion group,no statistical significance was found in the ASES score,Rowe Shoulder Score,or VAS for pain (P >0.05 ).Anterior flexion,abduction,and internal rotation of the affected shoulder during the last follow-up were normal after surgery.Conclusion For recurrent dislocation of the shoulder with combined Bankart and SLAP lesion,arthroscopic repair using absorbable suture anchors can achieve favorable clinical results.It can effectively restore shoulder function.

Objective To discuss the significance of the detection of interferon-γ in the diagnosis of active joint tuberculosis. Methods 5 kinds of specific proteins of mycobacterium tuberculosis were used as stimulating protein, the chemiluminescence enzyme immunoassay was used to test the content of interferon-γ. The interferon-γ of 35 cases of patients with active joint tuberculosis and 35 cases of healthy people were detected. The difference of the sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio of 5 kinds of proteins to the diagnostic of active joint tuberculosis were compared. Results CFP10/ESAT6 fusion protein, Rv2041c protein, Rv0057/1352 fusion proteins, Rv1419 protein and Rv1656 protein were used as stimulating protein, the sensitivities of active joint tuberculosis by the whole blood interferon-γ assay were 77.1%, 68.6%, 71.4%, 74.3 % and 65.7%. The specificities were 65.7%, 54.3%, 57.1%, 60.0% and 62.9%. The positive predictive values were 62.9%, 60%, 62.5%, 65% and 63.9%. The negative predictive values were 74.2%, 63.3%, 66.7%, 70% and 64.7%. The positive likelihood ratios were 2.25, 1.5, 1.67, 1.86 and 1.77. The negative likelihood ratios were 0.348, 0.579, 0.5, 0.429 and 0.545. Conclusion The detection of interferon-γ has certain significance to joint tuberculosis. But it is not as an index of diagnosing joint tuberculosis.

BACKGROUND: Peak bone mass and standard deviation (SD) in different regions are varied, which have great influence on diagnosis of osteoporosis. To establish a complete database can provide accurate evidence for osteoporosis diagnosis. OBJECTIVE: To investigate the influence of bone mineral densities (BMD) and their SD of young people on the detective rate of osteoporosis in general population. DESIGN, TIME AND SETTING: Investigation analysis was performed at Beijing, Shanghai, Guangzhou, Nanjing, Jiaxing and Chengdu between January 1997 and December 1999. PARTICIPANTS: 11418 subjects from related 6 centers of BMD reference database in China were investigated and analyzed using prospective and retrospective methods, including 3 666 males, and 7 752 females aged 20-90 years. Of them, 2385 were from Beijing, 1178 from Guangzhou, 1404 from Shanghai, 2938 from Nanjing, 1425 from Chengdu, and 2088 from Jiaxing. The subjects were selected from community investigation, physical examination volunteers. METHODS: BMD of the lumbar spine (L2-4) and the hip in 11, 418 subjects from the related 6 centers in China was measured with GE-Lunar dual energy X-ray absorptiometry (DXA) and the BMD reference database was established. The accuracy rate of the inner machine was 0.3%-0.7%, and the accuracy of different machines averaged 1.1%. MAIN OUTCOME MEASURES: Lumbar BMD distribution of different age groups from 6 centers; influence of young people's BMD and its SD on detective rate of osteoporosis. RESULTS: Different BMD and SD were found in the individual subject from 6 centers, and the maximum differences were 0.098 g/cm2 and 0.027 g/cm2. With mean BMD and SD of the individuals from 6 centers as references, different T-scores and the detective rates of osteoporosis derived from the T-scores were found in the same group. The detective rate increased by 1.6% when BMD of the young people increased by 0.01 g/cm2 (positive correlation), but the detective rate decreased by 4% when SD increased by 0.01g/cm2 (negative correlation). CONCLUSION: Changes in BMD and SD of the young people can influence the detective rate of osteoporosis. To achieve comparability for the detective rate of osteoporosis in different centers, the specific reference database should be established for the same race, the same area, and the same bone densitometry machine. The T-score should be determined with the normal BMD and SD of the young, people as the reference database.