China ; Sports Medicine

Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Arthroscopy ; Biomedical Research ; methods ; trends ; Humans ; Minimally Invasive Surgical Procedures ; Orthopedic Procedures ; instrumentation ; methods ; Reconstructive Surgical Procedures ; instrumentation ; methods ; Tendons ; transplantation ; Transplantation, Autologous ; Transplantation, Homologous

OBJECTIVESTo provide the data on the shape, sizes, and locations of the attachments of the anterolateral bundle (ALB) and posteromedial bundle (PMB) of the posterior cruciate ligament (PCL) to the tibia, and to determine the reference landmarks and the methods for tibial tunnel positioning in double-bundle PCL reconstruction using double-double tunnel.

METHODSThirty cadaveric knees were used as specimens. PCLs were separated into bundles according to the PCL tension pattern during knee flexion-extension, and the functional bundle in each bundle was determined. Data were obtained to describe the size, shape, position, and center of the attachments of PCL bundles. The reference landmarks and methods for tibial tunnels positioning in double-bundle PCL reconstruction using double-double tunnel were determined.

RESULTSThe PCL insertion site was situated in the posterior intercondylar fossa. The longitudinal axis of the tibial attachment of PCL proceeded from proximal medial to distal lateral, and the mean angle between them and the tibial shaft was (16.5 +/- 1.4) degrees . The tibial insertion site of ALB and PMB were arranged in the proximal and distal on the whole, the tibial attachment of ALB could generally be described as rhomb in shape, and the mean area of it was (90 +/- 20) mm(2); the tibial attachment of PMB was rectangle in shape, the mean area of it was (96 +/- 32) mm(2), there was no statistic difference between the area of them (P > 0.05). There were functional bundles in both ALB and PMB persistently, which attached to the distal-lateral portion of the tibial attachment of ALB and the distal-medial portion of the tibial attachment of PMB respectively, they were both oval in shape, the mean area of them were (35 +/- 12) mm(2) and (36 +/- 6) mm(2) respectively, the difference between them was no statistic significant (P > 0.05). The mean distance between the centres of the tibial attachments of the functional bundles of ALB and that of PMB was (12.7 +/- 1.9) mm. The medial tibial spine, lateral tibial spine and the bony ridge on the posterior-proximal tibia were the key anatomic landmarks that could be used to aid in placement of independent tibial tunnels for a 2-bundle PCL reconstruction.

CONCLUSIONSThe tibial attachment of the PCL is sufficiently large to allow for placement of 2 independent tunnels. There are functional bundles in both ALB and PMB persistently and the optimum position for the tibial tunnel in double-bundle PCL reconstruction using double-double tunnel should be located in the attachment sites of the functional bundles of ALB and PMB.

Aged ; Female ; Humans ; Male ; Middle Aged ; Posterior Cruciate Ligament ; anatomy & histology ; surgery ; Tibia ; anatomy & histology ; surgery

OBJECTIVETo investigate the clinical results of anterior cruciate ligament (ACL) reconstruction with Intrafix.

METHODSFrom March to December in 2005, there were 35 patients with ACL rupture using quadruple semitendinosus and gracillis. Endobutton was used to fix the graft at the femoral site. Thirty-two cases were followed up at the average time of 15 months (12-20 months). In 15 patients the subjective knee function evaluation, KT-2000 and X ray were performed, and MRI was performed in 11 cases either. Other 17 cases had only the subjective knee function score.

RESULTSThe average IKDC score was 91 (83-97). In 15 cases there were 10 cases whose knee examination results of IKDC were A grade, 5 cases B grade (because of limited range of motion). Lysholm scores were average 89 (83-93), 17 cases excellent and 15 cases good. The results of KT-2000 were average 1.2 mm (0-2.0 mm) at 30 degree 133 N, average 0.5 mm (-0.5-2.0 mm) at 90 degree 133 N. The appearance and tension of reconstructed ACL were good on MRI. The X ray showed good position of bone tunnel.

CONCLUSIONACL reconstruction with Intrafix can restore the stability of knee, and the clinical result is good.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Arthroscopy ; Bone Screws ; Female ; Femur ; surgery ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Tendons ; transplantation ; Tibia ; surgery ; Transplantation, Autologous ; Treatment Outcome

OBJECTIVESTo measure the size and change of bone tunnel in arthroscopic assisted anterior cruciate ligament (ACL) reconstruction with hamstring tendon autograft by X-ray, and evaluate the incidence, extent, shape and reasons of the bone tunnel expansion and analyze the relationship between bone tunnel expansion and clinical results.

METHODSFifty-one cases of arthroscopic ACL reconstruction with hamstring tendon autograft were performed, and they were followed up at average of 16 months postoperatively. The diameter, shape, position and angle of femoral and tibial bone tunnel were measured using X-ray, and other clinical information had been collected including gender, age, method of tibial fixation, range of motion, KT 2000 and evaluation of muscle strength and so on. All data were entered into the computerized relational database to analyze and compare using the chi square test and correlation analysis.

RESULTSThe incidence of tunnel expansion after ACL reconstruction was 85%-94% in femoral tunnel and 65% in tibial tunnel. The extent of tunnel expansion was 51%-53% in femoral tunnel and 40%-44% in tibial tunnel. The most common shape of tibial tunnel was type O in the A-P X-ray view and type V in the lateral X-ray view. Femoral tunnels anterior to the expected ones were more likely to enlarge. Tibial tunnels anterior to the expected ones were easier to expand. An acute tibial or femoral tunnel angle could result in the femoral tunnel expansion.

CONCLUSIONSThe incidence and extent of bone tunnel expansion in arthroscopic ACL reconstruction with hamstring tendon autograft are more significant in femoral tunnel than in tibial tunnel. Bone tunnel expansion is correlated to patients' age, height, BMI and location of the tunnel. The main factors related to bone tunnel expansion are the location and angle of the tunnel.

Adolescent ; Adult ; Anterior Cruciate Ligament ; surgery ; Arthroscopy ; Female ; Femur ; pathology ; surgery ; Follow-Up Studies ; Humans ; Knee Injuries ; surgery ; Male ; Middle Aged ; Postoperative Period ; Retrospective Studies ; Tendons ; transplantation ; Tibia ; pathology ; surgery

OBJECTIVETo investigate the effect of rupture and reconstruction of the posterior cruciate ligament (PCL) on the degeneration of rabbit knee joint.

METHODSThirty-three mature New Zealand white rabbits were divided into 3 groups. In experiment group I, the PCL of the right knees in 21 rabbits were resected, the contralateral joints as control group, in which only a medial arthrotomy was performed. In experiment group II, the PCL of the right knees in 12 rabbits were immediately reconstructed after PCL were resected. In experiment group I and control group the rabbits were respectively killed 6, 12 and 26 weeks after the operation. In experiment group II the rabbits were respectively killed 12, 26 weeks after the operation. The methods of ink staining, histology, immunohistochemistry and SEM were used to analyze the changes of articular cartilage of the joints.

RESULTSIn experiment group I, the knee joints had obvious degeneration of articular cartilage at 26 weeks. The quantitative analysis of the results of the ink staining method showed the degeneration of knee articular cartilage was more serious at 26 weeks than that at 26 weeks in control group. Histological results demonstrated: the large area of fibrosis of cartilage could be seen in the medial condyle at 26 weeks; the fibrosis was deep into the deep layer of cartilage and the number of cells decreased; the average Mankin's score was 7.7. At 26 weeks, type I and III collagen were detected in fibrotic cartilage, while the staining of type II collagen was slight. In experiment group I, the injuries of cartilage in medial condyle could be seen at every stage through SEM, while the surface of cartilage demonstrated disorder in control group through SEM. In experiment group II, only a few specimens had mild injuries of cartilage, the degeneration of cartilage in medial condyle and trochlea were slighter at 26 weeks than that in experiment group I.

CONCLUSIONSPCL rupture can result in articular cartilage degeneration, which develops as time goes on. The degeneration of articular cartilage is more serious in medial compartment and patellofemoral joint than those in other positions. Immediate reconstruction of PCL can effectively prevent articular cartilage degeneration.

Animals ; Cartilage, Articular ; pathology ; Disease Models, Animal ; Knee Injuries ; pathology ; surgery ; Knee Joint ; pathology ; Orthopedic Procedures ; Posterior Cruciate Ligament ; injuries ; surgery ; Rabbits ; Rupture

BACKGROUNDExtension loss caused by anterior cruciate ligament (ACL) remnants nodule was usually reported by case reports. There is no systematic report analyzing ACL remnants nodule. The purpose of this study was to investigate the characteristics of extension loss caused by remnants of ACL after injury.

METHODSFrom June 2008 to December 2011, ACL remnants were observed by arthroscopy in 1012 cases with ACL injuries at the time of primary reconstruction. ACL remnants nodules were recorded. The time of extension loss occurrence caused by ACL remnants nodule, associated symptom and sign, magnetic resonance imaging (MRI), and arthroscopic findings were observed. Histological examination was performed on the lesion resected.

RESULTSTwenty-four cases with ACL remnants nodules were found by arthroscopy. Among them extension loss caused by remnants of ACL happened in 19 cases (male 13; female 6). The average extension loss were 9.1° (range, 5° - 20°). The average time from injury to operation was 8.9 weeks (range, 3 - 26 weeks). The remnants of ACL depressed in the inter-condylar notch were found on MRI in 15 cases with extension loss. The rupture locations of ACL were all close to the upper insertion of ACL. The microscopic examination of the resected remnants of ACL revealed disorganized fibrous connective tissue and tissue of ACL ligament.

CONCLUSIONSAmong 1012 ACL injury cases, 24 ACL remnants nodules were found with arthroscopy and 19 nodules could cause knee extension loss. ACL remnants nodule should be paid attention to as a potential cause of extension loss.

Adolescent ; Adult ; Anterior Cruciate Ligament ; pathology ; surgery ; Arthroscopy ; Female ; Humans ; Knee Joint ; pathology ; surgery ; Male ; Middle Aged ; Young Adult

To set up a method of amplification for the whole CagA gene of Helicobacter pylori and its fingerprinting by restriction fragment length polymorphism (RFLP), nested PCR was employed in combination with TD-PCR to amplify the gene and EcoRI and Hind III were used to generate the RFLP fingerprinting. Target DNA fragments from 13 of 20 samples were successfully amplified and the relevant RFLP fingerprintings were obtained. It is concluded that the method can be used to amplify the whole CagA gene and CagA gene has apparent diversity of RFLP profile.
Antigens, Bacterial/*genetics ; Bacterial Proteins/*genetics ; DNA Fingerprinting/methods ; Gene Amplification/*genetics ; Helicobacter pylori/*genetics ; Helicobacter pylori/isolation & purification ; *Polymorphism, Restriction Fragment Length

OBJECTIVETo study the effects of continuous passive motion on the tendon-bone healing of the semi-tendinous tendon autograft used for anterior cruciate ligament (ACL) reconstruction in rabbits.

METHODSIn 12 healthy 8-month-old male rabbits, an ACL reconstruction was performed by using double semi-tendinous tendon autograft. Postoperatively these animals were treated by either continuous passive motion (CPM) or cage activity. Specimens of the grafts were collected at 6, 12, 24 weeks postoperatively. Histological change in the tendon-bone healing was studied by haematoxylin-eosin and toluidine blue.

RESULTSThere was more new fiber tissue in the anterior half of the interface. Osteoclasts were most numerous at the tunnel aperture and in the anterior half of the interface. Cartilage in the tendon-bone interface was localized to the posterior aspect of tunnels, the area where compressive stress would be predicted. CPM group developed a denser connective tissue with less vascularity and cellularity. The bone tunnel had more areas with ingrowing denser connective tissue compared with cage activity specimens. With the growth of Sharpery's fibers and fibrocartilage into the interface, a direct ligament insertion was found. In the CPM specimens, the interface tissue was more mature and the direct insertion was broader and more structured.

CONCLUSIONSCompressive stress promotes chondroid formation, and the tension promotes fiber formation. Tendon-bone healing may be optimized by CPM after tendon transplantation into a bone tunnel.

Animals ; Anterior Cruciate Ligament ; surgery ; Femur ; pathology ; surgery ; Male ; Motion Therapy, Continuous Passive ; Rabbits ; Random Allocation ; Tendons ; pathology ; transplantation ; Tibia ; pathology ; surgery ; Transplantation, Autologous ; Wound Healing

OBJECTIVETo determine if double bundle hamstring autograft posterior cruciate ligament (PCL) reconstruction could bring better outcomes than single bundle.

METHODSFrom June 2007 to June 2009, there were 22 subjects, including 16 male and 6 female patients with an average (37 ± 13) years old (16-54 years old) were reconstructed with single bundle PCL reconstruction (single bundle group), 24 subjects, including 18 male and 6 female patients with an average (37 ± 10) years old (17 - 52 years old) were reconstructed with double bundle PCL reconstruction (double bundle group). There were no differences between the two groups on patients' demographics and the duration from the injury to the operation (P > 0.05). Clinical outcomes, KT2000 and tunnel placements of all the patients were measured and analyzed.

RESULTSThe two groups were retrospectively studied and compared with a (29 ± 9) months (24 - 55 months) follow-up. Operation duration of double bundle group was (92 ± 8) minutes which was significantly longer than the single bundle group (78 ± 13) minutes (t = 2.474, P < 0.05). IKDC, Lysholm and Tegner scores were all significantly improved at the last follow-up of both groups (single bundle group: t = 9.578, 13.115 and 8.165, P < 0.01; double bundle group: t = 4.390, 5.522 and 4.313, P < 0.05). Post operative KT2000 side-to-side difference of the double bundle group was significantly smaller than that of the single bundle group under maximum posterior force with the knee in 90° flexion ((1.5 ± 1.5) mm vs. (4.0 ± 2.9) mm, t = 2.538, P = 0.019). There were 66.7% of the patients of double bundle group were normal which was significantly higher than 31.8% of the single bundle group on the IKDC knee examination form (χ² = 5.576, P = 0.018).

CONCLUSIONSSingle or double bundle PCL reconstruction could restore the knee's stability and function satisfied. There are no differences between two groups in clinical scores, but double group manifestes a better anterior-posterior stability.

Adolescent ; Adult ; Female ; Humans ; Male ; Middle Aged ; Posterior Cruciate Ligament ; injuries ; surgery ; Range of Motion, Articular ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Tendons ; transplantation ; Transplantation, Autologous ; Young Adult