OBJECTIVE: To investigate the effectiveness of three-dimentional (3D) printed personalized guide plate-assisted wrist arthroscopic repair for Palmer type ⅠB triangular fibrocartilage complex (TFCC) injury. METHODS: A retrospective analysis was conducted on the clinical data of 20 patients with Palmer type ⅠB TFCC injuries admitted between January 2023 and March 2024 who met the selection criteria. Among them, 13 were male and 7 were female; ages ranged from 23 to 35 years, with a mean age of 30.3 years. All patients had a history of trauma, 12 cases involved falls and 8 cases involved sprains. All patients demonstrated a positive "piano key sign". MRI revealed deep ulnar-side tears of the TFCC. Conservative treatment for 6 weeks yielded poor or no clinical improvement. The interval from injury to surgery ranged from 2 to 9 months, with a mean of 5.0 months. Patients underwent wrist arthroscopic repair assisted by 3D printed personalized guide plate. Functional recovery was assessed preoperatively and postoperatively using the visual analogue scale (VAS) score for pain, modified Mayo wrist score, and range of motion (ROM) measurements for wrist flexion-extension, ulnar-radial deviation, and pronation-supination. At last follow-up, MRI was performed to evaluate the healing of TFCC. RESULTS: All 20 patients underwent successful surgery without complications such as vascular or nerve injury, fracture, incisional infection, or joint stiffness. All patients were followed up 9-18 months (mean, 12.4 months). At last follow-up, patients demonstrated significant improvements in VAS scores, modified Mayo wrist scores, wrist flexion-extension ROM, ulnar-radial deviation ROM, and pronation-supination ROM compared to preoperative levels ( P<0.05). MRI at last follow-up showed preserved TFCC continuity, excellent healing, and secure fixation. CONCLUSION 3D-printed personalized guide plate significantly improve outcomes in wrist arthroscopic TFCC repair for Palmer type ⅠB injuries. They enable high-quality suturing, facilitate anatomical reconstruction, and markedly enhance wrist function.
Humans ; Arthroscopy/methods* ; Male ; Adult ; Triangular Fibrocartilage/diagnostic imaging* ; Female ; Retrospective Studies ; Printing, Three-Dimensional ; Wrist Injuries/diagnostic imaging* ; Young Adult ; Bone Plates ; Treatment Outcome ; Wrist Joint/surgery* ; Magnetic Resonance Imaging ; Range of Motion, Articular

Objective To evaluate the clinical outcomes of 514 cases of anterior cruciate ligament(ACL)reconstruction using hamstring tendon autograft and to observe postoperative changes and recovery of the grafts through second-look arthroscopy.Methods This retrospective study collected data from 514 patients who underwent ACL reconstruction with hamstring tendon autograft between May 2015 and June 2018,with a follow-up of at least one year.Knee function recovery and stability were assessed using the Lysholm score,International Knee Documentation Committee(IKDC)score,and Tegner score,along with the pivot shift test and Lachman test.During the second-look arthroscopy,key observations included the synovial coverage,continuity of the reconstructed ligament,and any intra-articular abnormalities.Results The time interval between ACL reconstruction and second-look arthroscopy ranged from 12 to 28 months,with an average of 20 months.Postoperative infection occurred in 2 cases,both of which were successfully treated with arthroscopic debridement and drainage.No other patients experienced infections,graft resorption,or other complications.At the second-look arthroscopy,the Lysholm score significantly improved from(43.56±9.89)preoperative to(92.21±6.12)postoperatively,the difference was statistically significant(P<0.05);The IKDC score increased from(20.32±7.87)to(85.67±10.43),the difference was statistically significant(P<0.05);The Tegner score improved from(4.31±0.82)to(6.61±1.21),the difference was statistically significant(P<0.05).Second-look arthroscopy revealed that the ligament remained intact in 375 patients,with partial tears in 139 patients,ligament tension was maintained in 447 patients,while 67 patients had laxity,the reconstructed ACL graft was deemed to be in good condition in 435 patients and suboptimal in 79 patients,there were significant differences observed in pre-and post-pivot shift test and Lachman test(P<0.05);Among the 514 patients,188(36.58%)successfully returned to sport.Conclusion ACL reconstruction using hamstring tendon autograft effectively restores knee function and stability.In patients followed for more than one years,the grafts show good vascularization and synovial coverage.Emphasis should be placed on systematic postoperative rehabilitation to optimize recovery.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

BACKGROUND:Impaired hamstring muscle strength,anterior patellar pain,high incidence of osteoarthritis,and loss of proprioception after anterior cruciate ligament reconstruction lead to poor functional recovery due to a higher incidence of osteoarthritis and loss of proprioception.Arthroscopic repair of the anterior cruciate ligament combined with dynamic or static internal brace repair preserves the original ligament structure and results in favorable short-term outcomes. OBJECTIVE:To prospectively observe the efficacy and imaging findings of modified double-bundle arthroscopic repair of the anterior cruciate ligament after Sherman type Ⅰ injury METHODS:From January 2020 to September 2022,a total of 60 patients with anterior cruciate ligament injury admitted at the Department of Sports Medicine,Foshan Hospital of Traditional Chinese Medicine were included and divided into two groups(n=30 per group)according to the treatment protocols.The functional repair group was treated with double bundle repair combined with internal brace fixation,and the reconstruction group was treated with single bundle anatomical reconstruction of autologous hamstring muscle.All cases were followed up for 12 months after surgery,and International Knee Documentation Committee score,Lysholm score and KT-1000 difference between the affected and healthy sides of the two groups were evaluated at 3,6 and 12 months after surgery. RESULTS AND CONCLUSION:Three months after surgery,International Knee Documentation Committee scores,Lysholm scores and KT-1000 difference between the affected and healthy sides were significantly different between the two groups(P＜0.05),and the functional repair group was better than the reconstruction group.At 6 and 12 months after surgery,there was no significant difference in International Knee Documentation Committee score,Lysholm score and KT-1000 difference between the two groups(P＞0.05).To conclude,anterior cruciate ligament repair preserves the original ligament structure,avoids drilling larger marrow tracts and removing autologous tendons for reconstruction,reduces the damage to the original normal structure,and has fewer complications.Early postoperative efficacy is better than that of anterior cruciate ligament reconstruction with stumps,but there is no significant difference in the efficacy of the two groups 6 months after surgery.

Objective To evaluate the clinical outcomes of 514 cases of anterior cruciate ligament(ACL)reconstruction using hamstring tendon autograft and to observe postoperative changes and recovery of the grafts through second-look arthroscopy.Methods This retrospective study collected data from 514 patients who underwent ACL reconstruction with hamstring tendon autograft between May 2015 and June 2018,with a follow-up of at least one year.Knee function recovery and stability were assessed using the Lysholm score,International Knee Documentation Committee(IKDC)score,and Tegner score,along with the pivot shift test and Lachman test.During the second-look arthroscopy,key observations included the synovial coverage,continuity of the reconstructed ligament,and any intra-articular abnormalities.Results The time interval between ACL reconstruction and second-look arthroscopy ranged from 12 to 28 months,with an average of 20 months.Postoperative infection occurred in 2 cases,both of which were successfully treated with arthroscopic debridement and drainage.No other patients experienced infections,graft resorption,or other complications.At the second-look arthroscopy,the Lysholm score significantly improved from(43.56±9.89)preoperative to(92.21±6.12)postoperatively,the difference was statistically significant(P<0.05);The IKDC score increased from(20.32±7.87)to(85.67±10.43),the difference was statistically significant(P<0.05);The Tegner score improved from(4.31±0.82)to(6.61±1.21),the difference was statistically significant(P<0.05).Second-look arthroscopy revealed that the ligament remained intact in 375 patients,with partial tears in 139 patients,ligament tension was maintained in 447 patients,while 67 patients had laxity,the reconstructed ACL graft was deemed to be in good condition in 435 patients and suboptimal in 79 patients,there were significant differences observed in pre-and post-pivot shift test and Lachman test(P<0.05);Among the 514 patients,188(36.58%)successfully returned to sport.Conclusion ACL reconstruction using hamstring tendon autograft effectively restores knee function and stability.In patients followed for more than one years,the grafts show good vascularization and synovial coverage.Emphasis should be placed on systematic postoperative rehabilitation to optimize recovery.

With the rapid development of competitive sports, the incidence of anterior cruciate ligament (ACL) injury is on the rise. Such injuries may shorten athletes′ career and lead to other long-term adverse consequences. Although athletes generally recover well after ACL reconstruction, many still struggle to return to their pre-injury performance levels. Advances in the understanding of ACL anatomy and injury mechanisms, along with the evolution of surgical techniques and rehabilitation methods, have provided more individualized and tailored options for athletes following ACL injuries. However, there is currently no consensus in China regarding surgical and rehabilitation strategies for competitive athletes aiming to return to sports after ACL injuries. To this end, the Sports Medicine Committee of the Chinese Research Hospital Association and the Editorial Board of the Chinese Journal of Trauma jointly formulated the Expert consensus on surgical treatment and rehabilitation for competitive sports athletes returning to sports after anterior cruciate ligament injury ( version 2025), and presented 14 recommendations covering surgical indications, preoperative rehabilitation, surgical timing, surgical strategies and postoperative rehabilitation strategies, aiming to improve the surgical treatment and rehabilitation system for ACL injuries in competitive athletes and facilitate their return to high-level sports performance after injury.

BACKGROUND: The choice of fixation is an important factor affecting the prognosis of anterior cruciate ligament reconstruction. Endobutton and Rigidfix are two kinds of femoral end suspension fixators which are widely used at present. Their advantages are high fixation strength, large contact area between tendon and bone tunnel, and conducive to tendon-bone healing. However, it is still controversial whether there are differences in clinical efficacy and bone tunnel enlargement between the two fixation methods. OBJECTIVE: To analyze the outcomes of two different femoral fixation methods (Endobutton and Rigidfix) with hamstring autograft in anterior cruciate ligament reconstruction. METHODS: A retrospective analysis was performed on the data of 270 cases which accepted the anterior cruciate ligament reconstruction and second arthroscopic look from June 2015 to December 2017. All patients signed the informed consent. This study was approved by the Hospital Ethics Committee. The patients were divided into two groups according to the method of femoral end fixation. The Endobutton femoral fixed reconstruction was performed in Endobutton group (150 cases). The Rigidfix femoral fixed reconstruction was performed in Rigidfix group (120 cases). Reconstruction of anterior cruciate ligament was done using autologous semitendinosus and gracilis tendon. All cases were fixed with Bioabsorbable Interference Screw and AO hollow nail bolt pile fixing screw at the tibial tunnel. The diameter of bone tunnel was also measured by MRI. The knee joint function recovery and stability were evaluated by Lysholm score, International Knee Documentation Committee score, Tenger score table, drawer test, Lachman test, axle shift test, and KT-1000 joint measuring instrument. Second-look arthroscopic evaluation was performed in all patients, focusing on continuity of the reconstructed anterior cruciate ligament, the synovial coverage and the prevalence of abnormal structure at 1 year after surgery. RESULTS AND CONCLUSION: (1) All patients were followed up for 14 to 44 months. (2) Tunnel widening was significantly increased in the Endobutton group than in the Rigidfix group at 1 year after surgery (P < 0.05). (3) In both groups after operation, Lysholm scores, Tegner scores, and International Knee Documentation Committee scores had obviously improvement at 1 year after surgery compared with that before surgery (P < 0.05). No significant difference was found between two groups after operation (P > 0.05). (4) At 1 year after surgery, the range of motion of knee joint was not significantly different between the two groups (P > 0.05). (5) There was no significant difference between the two groups in drawer test, Lachman test and axle shift test (P > 0.05). The side-to-side difference of KT-1000 in the Endobutton group was (1.12±1.20) mm, while that of KT-1000 in Rigidfix group was (1.23±0.91) mm. There was no significant difference between the two groups (P > 0.05). (6) Secondary arthroscopic examination showed that there were 1 case of complete graft absorption, 11 cases of graft wear in Endobutton group, 2 cases of complete graft absorption and 15 cases of graft wear in Rigidfix group. There was no significant difference between the two groups (P > 0.05). (7) There were 59 excellent cases, 61 good cases, 30 poor cases in Endobutton group, 47 excellent cases, 49 good cases and 24 poor cases in Rigidfix group. There was no significant difference between the two groups (P > 0.05). (8) The incidence of complication was 2.6% in the Endobutton group and 6.6% in the Rigidfix group, and no significant difference was found between the two groups (P > 0.05). (9) The results suggested that Endobutton and Rigidfix had the same clinical outcome. There was no significant difference in the coverage and continuity of synovial synovial membrane between the second look grafts. However, compared with Rigidfix transverse screw system, Endobutton fixation at the femoral end is more likely to cause bone tunnel enlargement.

Objective To investigate the clinical efficacy of arthroscopic double Endobutton plate internal fixation in the treatment of acute acromioclavicular joint dislocation.Methods A retrospective case series study was performed to analyze the clinical data of 32 patients with Rockwood type Ⅲ or Ⅴ acute acromioclavicular joint dislocation admitted to Foshan Hospital of TCM from May 2015 to February 2018.There were 26 males and six females,aged 22-56 years [(37.7 ± 1.6)years].There were 22 patients with Rockwood type Ⅲ and 10 patients with type Ⅴ.The duration from injury to operation was 2-5 days.All patients were treated with arthroscopic double Endobutton plate internal fixation for coracoclavicular ligament reconstruction.The operation time,hospitalization time,and postoperative shoulder joint braking time were recorded.The shoulder joint function was evaluated by the Constant-Murley score (CMS),visual analogue scale (VAS),American shoulder and elbow surgeons (ASES) score,University of California Los Angeles (UCLA) score and simple shoulder test (SST) before operation and at the last follow-up.Meanwhile,complications such as infection,loosening and joint dislocation were recorded.Results All patients were followed up for 8-48 months [(27.8 ± 11.6) months].The operation time was 48-93 minutes [(65.0 ± 24.6) minutes],the hospitalization time was 3.2-10 days [(6.5 ± 2.6)days],and the postoperative braking time was 21-35.3 days [(28.2 ± 7.1)days].All patients had a grade A healing of surgical incision.The VAS was decreased from preoperative (5.7 ±2.5)points to (1.2 ±0.8)points at the last follow-up (P ＜0.01);CMS wasvincreased from preoperative (29.3 ± 3.4) points to (93.2 ± 2.1) points at the last follow-up (P ＜0.05);ASES score was increased from preoperative (28.9 ± 10.1) points to (95.7 ± 5.6) points at the last follow-up (P ＜ 0.05);UCLA score was improved from preoperative (11.6 ± 2.8) points to (34.2 ±1.5)points at the last follow-up (P ＜0.05);SST score was improved from preoperative (3.5 ±1.2)points to (9.7± 1.4)points at the last follow-up (P ＜ 0.O1).The incidence of intraoperative and postoperative complications was 16％ (5/32).In two patients,the surgery was changed to U shape fixation circulating the coracoid base due to the coracoidbone tunnel cutting out.One patient was found to have insufficient reduction and received the acromioclavicular joint operation.One patient had reduction loss due to the clavicle button collapsing,and one patient had excessive reduction.Conclusions For Rockwood type Ⅲ or Ⅴ acute acromioclavicular dislocation patients,arthroscopic double Endobutton plates for coracoclavicular ligament reconstruction has the advantages of less intraoperative trauma,quick recovery and satisfactory clinical result.However,the incidence of intraoperative and postoperative complications is relatively high,and indications should be strictly controlled.

In 2010, the Asian Society of Cardiovascular Imaging (ASCI) provided recommendations for cardiac CT and MRI, and this document reflects an update of the 2010 ASCI appropriate use criteria (AUC). In 2016, the ASCI formed a new working group for revision of AUC for noninvasive cardiac imaging. A major change that we made in this document is the rating of various noninvasive tests (exercise electrocardiogram, echocardiography, positron emission tomography, single-photon emission computed tomography, radionuclide imaging, cardiac magnetic resonance, and cardiac computed tomography/angiography), compared side by side for their applications in various clinical scenarios. Ninety-five clinical scenarios were developed from eight selected pre-existing guidelines and classified into four sections as follows: 1) detection of coronary artery disease, symptomatic or asymptomatic; 2) cardiac evaluation in various clinical scenarios; 3) use of imaging modality according to prior testing; and 4) evaluation of cardiac structure and function. The clinical scenarios were scored by a separate rating committee on a scale of 1–9 to designate appropriate use, uncertain use, or inappropriate use according to a modified Delphi method. Overall, the AUC ratings for CT were higher than those of previous guidelines. These new AUC provide guidance for clinicians choosing among available testing modalities for various cardiac diseases and are also unique, given that most previous AUC for noninvasive imaging include only one imaging technique. As cardiac imaging is multimodal in nature, we believe that these AUC will be more useful for clinical decision making.
Area Under Curve ; Asian Continental Ancestry Group* ; Clinical Decision-Making ; Consensus* ; Coronary Artery Disease ; Echocardiography ; Electrocardiography ; Heart Diseases ; Humans ; Magnetic Resonance Imaging ; Methods ; Positron-Emission Tomography ; Radionuclide Imaging ; Tomography, Emission-Computed

Objective To compare of the effect of intravenous zoledronic acid and calcitonin on the elderly with osteoporotic intertrochanteric fractures.Methods From June 2009 to November 2012,610 patients with osteoporotic intertrochanteric fractures were treated with closed reduction and internal fixation.543 consecutive patients were grouped sequentially according to the admission time.From June 2009 to April 2011,control group (n=325)received calcitonin for osteoporosis (male 107,female 218,mean age 75.02±5.65 years).The number of Evans-Jensen type Ⅰ,Ⅱ,and Ⅲ type patients were 87,136,and 102,respectively.Average lumbar bone mineral density (BMD) and hip BMD were 0.737±0.08 g/cm2 and 0.725±0.05 g/cm2,respectively.From May 2011 to November 2012,218 patients (male 82,female 136,mean age 74.71±5.32 years) received zoledronic acid for osteoporosis.The number of Evans-Jensen type Ⅰ,Ⅱ,and Ⅲ type patient were 62,91 and 65,respectively.Average lumbar BMD and hip BMD were 0.738±0.05 g/cm2 and 0.722±0.06 g/cm2,respectively.All patients received once-yearly intravenous zoledronic acid in one week after operation.The BMD during hospitalization and one year after operation were compared between the two groups.Harris score and VAS score were applied to evaluate the function and pain degree of the operated hip joint.Results The average follow-up time were 12.8 months (range,5 to 22 months) in control group and 12.5 months (range,4 to 19 months) in treatment group.The average fracture union time,Harris score,VAS score were 14.25±1.38 weeks,68.88±5.71 points,and 0.36±0.55 points respectively in treatment group and 14.39± 1.12 weeks,69.47±4.60 points,and 0.33±0.48 points respectively in control group.There were no statistical differences between two groups in fracture union time,Harris score and VAS score.The average lumbar BMD and hip BMD were 0.76±0.06 g/cm2 and 0.75±0.04 g/cm2 in treatment group,which were 0.75±0.07 g/cm2 and 0.74± 0.07 g/cm2 in control group one year after operation,respectively.Compared with the baseline,the BMD of lumbar spine and hip one year after operation slightly increased without statistically significant difference in control group.The BMD increased significantly in treatment group.Conclusion Early administration of intravenous zoledronic acid does not influence bone healing and it could increase BMD one year after closed reduction and internal fixation.