OBJECTIVE: To compare early graft healing between over-the-top (OTT) and anatomic single-bundle (SB) anterior cruciate ligament (ACL) reconstruction. METHODS: A clinical data of 40 patients underwent ACL reconstruction, who admitted between June 2021 and October 2022 and met the selective criteria, was retrospectively analyzed. Among them, 20 patients were treated with OTT reconstruction (OTT group) and 20 with SB reconstruction (SB group). There was no significant difference between groups ( P>0.05) in the gender, age, affected side, disease duration, degree of meniscus injury, body mass index, and preoperative International Knee Documentation Committee (IKDC) score, Lysholm score, pain visual analogue scale (VAS) score, and KT-2000 measurement. At 3, 6, and 12 months, MRI was performed to measure the signal noise quotient (SNQ) of the proximal end, middle, and distal end of the graft in the two groups, as well as at the corner of the graft with lateral femoral condyle and 1 cm around the femoral fixation point in the OTT group, to observe the degree of graft healing. Before operation and at 3, 6, and 12 months, the knee function and pain were evaluated by IKDC score, Lysholm score, and VAS score. Before operation and at 12 months after operation, the KT-2000 measurement was taken to evaluation the knee joint stability. RESULTS: All operations were successfully completed in both groups and the incisions healed by first intention. All patients were followed up 12-15 months (mean, 12.9 months), with no significant difference in the follow-up time between groups ( P>0.05). After operation, the IKDC score, VAS score, and Lysholm score improved gradually over time in both groups, with significant differences between different time points ( P<0.05). The differences between groups at 3, 6, and 12 months after operation were not significant ( P>0.05). The anterior and posterior stability of the knee joint improved significantly in both groups at 12 months after operation, and the difference in KT-2000 measurements was significant when compared with the preoperative value ( P<0.05), but the difference of pre- and post-operation between groups was not significant ( P>0.05). At 3, 6, and 12 months after operation, MRI showed that the differences in the SNQ of the proximal end and middle of the grafts between the two groups were not significant ( P>0.05), and the SNQ of distal end was significantly higher in the SB group than in the OTT group ( P<0.05). At each time point, grafts in the OTT group had the highest SNQ at the corner and the lowest at the fixation point, and the differences were significant compared to the other sites ( P<0.05). In the two groups, except for the fixation point, the SNQ of the remaining sites were highest at 6 months and lowest at 12 months ( P<0.05). In addition, there were significant differences in SNQ between the different sites of grafts ( P<0.05), and the SNQ was lowest at proximal end and highest at distal end. At last follow-up, the knee grafts in both groups were in good shape and no graft necrosis or loosening of the internal fixation was observed. CONCLUSION The knee joint function and graft healing after OTT reconstruction of ACL are similar to those of SB reconstruction, but it should be noted that the healing at the corner of the graft is slower.
Retrospective Studies ; Treatment Outcome ; Anterior Cruciate Ligament Reconstruction/rehabilitation* ; Follow-Up Studies ; Tibial Meniscus Injuries/surgery* ; Patient Positioning/methods* ; Recovery of Function ; Pain Measurement ; Knee Joint/surgery* ; Humans ; Male ; Female ; Adult ; Wound Healing

Objective:To investigate the clinical efficacy of over-the-top reconstruction combined with the modified Lemaire technique in the treatment of anterior cruciate ligament (ACL) injuries with pivot-shift positive.Methods:From March 2020 to October 2021, a total of 46 patients with ACL injury and pivot-shift test grade II or above were admitted to Xinhua Hospital Affiliated to Dalian University. There were 28 males and 18 females, aged 28.0±10.5 years (range, 15-45 years). All cases were unilateral, including 17 cases of left knee and 29 cases of right knee. The pivot-shift test showed that 30 cases were grade II and 16 cases were grade III, and the cause of injury was sports injury. The semitendinosus muscle and gracilis muscle were harvested, and the ACL was reconstructed with the over-the-top combined modified Lemaire technique. The International Knee Documentation Committee (IKDC) score, Lysholm score and KT-2000 side-to-side difference before and after operation were compared.Results:All patients successfully completed the operation and were followed up for 26.6±2.3 months (range, 24-28 months). The Lysholm scores of the patients at 3 months and 24 months after operation were 73.6±4.3 and 91.6±2.8, which were higher than those before operation (58.5±4.6), and the difference was statistically significant ( F=18.351, P<0.001). The IKDC scores of patients at 3 months and 24 months after operation were 59.0±2.0 and 91.8±3.2, respectively, which were higher than those before operation 50.3±2.8, and the difference was statistically significant ( F=17.290, P<0.001). The side-to-side difference of KT-2000 was 1.7±0.8 mm and 1.5±0.4 mm at 3 and 24 months after operation, respectively, which was lower than that before operation (5.9±1.1 mm), and the difference was statistically significant ( F=14.192, P<0.001). At 24 months after operation, 3 patients had pivot shift test grade I and 4 patients had Lachman test grade I, but they complained of good knee stability and did not receive further treatment. At the last follow-up, there were no complications such as incision and intra-articular infection, deep vein thrombosis, knee stiffness, quadriceps musculus ossificans myositis, and reconstruction ligament rupture. All patients returned to sports with an average time of 15.7±2.6 months (range, 12-24 months). Conclusion:Over-the-top reconstruction combined with the modified Lemaire technique for the treatment of ACL injury with positive pivot shift test effectively improves knee function and promotes the patient's return to sports, with a low incidence of surgical complications.

Objective:To evaluate the short-term clinical outcomes of meniscus reconstruction using autologous peroneus longus tendon grafts.Methods:A retrospective analysis was conducted on 20 patients (12 males, 8 females) with a mean age of 37.8±5.7 years (range, 31-47 years) and a mean body mass index (BMI) of 26.3±5.8 kg/m 2 (range, 20.1-31.3 kg/m 2) who underwent meniscal reconstruction with autologous peroneus longus tendon in Affiliated Xinhua Hospital of Dalian University from June 2020 to June 2022. A control group of 20 patients (15 males, 5 females), with a mean age of 39.1±6.2 years (range, 32-47 years) and a mean BMI of 25.6±5.4 kg/m 2 (range, 20.2-32.7 kg/m 2), underwent partial meniscectomy during the same period. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Lysholm score, visual analogue scale (VAS) for pain, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) at 3, 6, 12, and 24 months postoperatively. The morphology and signal intensity of grafts, Recht grading for cartilage damage, and the need for secondary arthroscopy were also evaluated. Results:The mean follow-up duration was 24.3±4.3 months for the tendon graft group and 24.2±3.6 months for the partial meniscectomy group. At 3 and 6 months postoperatively, the partial meniscectomy group demonstrated superior knee function scores compared to the tendon graft group ( P<0.05). Similarly, VAS were lower in the partial meniscectomy group at 3 months postoperatively ( P<0.05), although no significant difference was found at 6 months ( P>0.05). By 12 months postoperatively, differences in pain and function between the two groups were no longer statistically significant ( P>0.05). At 24 months, the tendon graft group exhibited significantly better outcomes in terms of the Lysholm score (84.31±12.20 vs. 72.67±14.18), IKDC score (82.21±10.55 vs. 74.09±11.68), VAS score (2.10±1.74 vs. 3.80±1.81), and KOOS score (85.37±13.14 vs.75.14±17.94) compared to the partial meniscectomy group ( P<0.05). Regarding graft healing, 19 patients in the tendon graft group demonstrated a grade 3 graft-residual meniscus complex at 24 months, significantly improved from 5 patients at 3 months postoperatively. Furthermore, no grafts showed a grade 3 signal intensity at 3 months, while 19 patients showed such improvements by 24 months. MRI at the 24-month follow-up revealed cartilage damage in 7 patients in the tendon graft group and 20 patients in the partial meniscectomy group, with severe cartilage damage (Recht grade>II) observed in 1 patient in the tendon graft group and 7 patients in the partial meniscectomy group. All 20 patients in the tendon graft group achieved minimal clinically significant differences by 24 months, and 4 of them underwent secondary arthroscopy, which revealed vascularization between the graft and residual meniscal tissue. Conclusion:The use of the peroneus longus tendon for meniscal reconstruction reduces knee pain, enhances knee function, and effectively fills the tibiofemoral joint space while protecting the articular cartilage through graft remodeling.

OBJECTIVE: To evaluate the clinical diagnostic value of knee MRI at 90° flexed position for Ramp lesions of medial meniscus. METHODS: A total of 228 patients with knee pain as the main complaint who were admitted between September 2021 and September 2023 was selected as the research subjects, of which 51 patients met the selection criteria and were enrolled in the study. There were 31 males and 20 females with an average age of 38.6 years (range, 15-67 years). Body mass index was 17.2-28.7 kg/m ² (mean, 23.9 kg/m ²). There were 25 cases of left knee and 36 cases of right knee. The time from injury to admission was 0.1-14.3 weeks (mean, 2.1 weeks). Preoperative knee MRI at fully extended position (knee extension position) and 90° flexed position (knee flexion position) were performed to determine the presence of irregular signs at the posterior edge of the medial meniscus, and PHMM fluid high signal [i.e. complete fluid filling between the posterior horn of the medial meniscus (PHMM) and the capsule margin]. Findings obtained under arthroscopy served as the "gold standard" to analyze the sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of MRI at knee extension and flexion positions for the two specific signs of Ramp lesion. RESULTS: Twenty-one patients (41.2%) were diagnosed with Ramp lesions by using arthroscopy, including 1 case of Thaunat type Ⅰ, 2 cases of type Ⅱ, 6 cases of type Ⅲ, 7 cases of type Ⅳ, and 5 cases of type Ⅴ. The positive rates of irregular signs at the posterior edge of the medial meniscus on MRI at knee extension and flexion positions were significantly different from the diagnosis of Ramp injury under arthroscopy ( P<0.05). The sensitivity, specificity, accuracy, PPV, and NPV of MRI in the diagnosis of irregular signs were 76.1%, 60.0%, 66.7%, 57.1%, and 78.3% respectively at knee extension position, and 85.7%, 73.3%, 78.4%, 69.2%, and 88.0% respectively at knee flexion position. The positive rates of PHMM fluid high signal on MRI at knee extension and flexion positions were significantly different from the diagnosis of Ramp injury under arthroscopy ( P<0.05). The sensitivity, specificity, accuracy, PPV, and NPV of MRI in diagnosing PHMM fluid high signal were 38.1%, 100%, 74.5%, 100%, and 69.8% respectively at knee extension position, and 85.7%, 100%, 94.1%, 100%, and 90.9% respectively at knee flexion position. CONCLUSION Knee MRI at 90° flexed position improves the diagnostic performance of the detection of medial meniscal Ramp lesions compared with MRI at fully extended position.
Humans ; Magnetic Resonance Imaging/methods* ; Female ; Male ; Tibial Meniscus Injuries/diagnostic imaging* ; Adult ; Menisci, Tibial/diagnostic imaging* ; Middle Aged ; Adolescent ; Young Adult ; Arthroscopy/methods* ; Aged ; Knee Injuries/diagnostic imaging* ; Range of Motion, Articular ; Knee Joint/diagnostic imaging* ; Sensitivity and Specificity

Objective:To investigate the clinical effect of long head of biceps tendon (LHBT) insertion reconstruction combined with pulley repair for pulley system injuries.Methods:A total of 46 patients (combined treatment group) with pulley system injury treated with LHBT insertion reconstruction combined with pulley repair in the Sports Medicine Department, Affiliated Xinhua Hospital of Dalian University from January to December 2020 were retrospectively analyzed, including 16 males and 30 females, aged 51.3±5.7 years (range, 45-72 years). 46 patients who underwent simple LHBT insertion reconstruction during the same period were selected as the control group (simple reconstruction group), including 14 males and 32 females, aged 50.6±6.7 years (range, 46-70 years). Visual analogue scale (VAS), Constant-Murley score, American Shoulder and Elbow Surgeon (ASES) score and long head of biceps tendon (LHB) score were compared preoperatively and at 1, 3, 6, 12 and 24 months postoperatively.Results:All patients were followed up for 26.2±1.5 months (range, 24-27 months). The VAS scores of the combined treatment group at 1, 3, and 6 months postoperatively were 3.4±1.3, 2.0±1.1, and 1.7±0.5, respectively, which were significantly lower than those of the simple reconstruction group 5.8±1.3, 3.5±1.1, and 2.6±0.5 ( P<0.05), while there was no significant difference between the two groups at 12 and 24 months postoperatively ( P>0.05). The Constant-Murley scores of the combined treatment group at 1, 3, and 6 months postoperatively were 31.3±4.7, 72.8±4.6, and 89.1±5.4, respectively, which were statistically greater than those of the simple reconstruction group (21.5±6.8, 52.8±5.2, and 80.1±6.2), and the differences were statistically significant ( P<0.05), while there was no statistically significant difference between the two groups at 12 and 24 months postoperatively ( P>0.05). The ASES scores of the combined treatment group at 1 and 3 months postoperatively were 56.2±6.9 and 82.7±8.2, which were statistically greater than those in the simple reconstruction group (40.2±5.6 and 62.9±8.0), while there was no statistically significant difference between the two groups at 6, 12, and 24 months postoperatively ( P>0.05). The LHB scores of the combined treatment group at 6 and 12 months postoperatively were 70.1±5.4 and 86.1±4.6, which were statistically greater than those of the simple reconstruction group (60.2±4.2 and 70.2±5.8), with statistically significant differences ( P<0.05), while there was no statistically significant difference between the two groups at 24 months postoperatively ( P>0.05). Conclusion:Arthroscopic LHBT insertion reconstruction combined with pulley system repair can relieve early postoperative shoulder pain and improve early function. It is an effective method for the treatment of pulley system injury.

Background/Aims: The aim of this study was to analyze the chronological changes in postoperative complications in surgical ulcerative colitis patients over the past decade in China and to investigate the potential parameters that contributed to the changes. Methods: Ulcerative colitis patients who underwent surgery during 2008–2017 were retrospectively enrolled from 13 hospitals in China. Postoperative complications were compared among different operation years. Risk factors for complications were identified by logistic regression analysis. Results: A total of 446 surgical ulcerative colitis patients were analyzed. Fewer short-term complications (24.8% vs. 41.0%, P=0.001) and more laparoscopic surgeries (66.4% vs. 25.0%, P<0.001) were found among patients who received surgery during 2014–2017 than 2008–2013. Logistic regression suggested that independent protective factors against short-term complications were a higher preoperative body mass index (odds ratio [OR], 0.870; 95% confidence interval [CI], 0.785–0.964; P=0.008), laparoscopic surgery (OR, 0.391; 95% CI, 0.217–0.705; P=0.002) and elective surgery (OR, 0.213; 95% CI, 0.067–0.675; P=0.009). The chronological decrease in short-term complications was associated with an increase in laparoscopic surgery. Conclusions Our data revealed a downward trend of short-term postoperative complications among surgical ulcerative colitis patients in China during the past decade, which may be due to the promotion of minimally invasive techniques among Chinese surgeons.

Objective:To investigate the efficacy of shoulder arthroscopic balance point compaction with cross suture-bridge technique inr the treatment of avulsion fracture of the greater tuberosity of the humerus.Methods:A retrospective case series study was conducted on 14 patients with avulsion fracture of the greater tuberosity of the humerus treated in Affiliated Xinhua Hospital of Dalian University from March 2021 to March 2022, including 8 males and 6 females; aged 30-58 years [(40.2±10.5)years]. Among them, 5 patients had fracture in the left shoulder and 9 in the right shoulder. The fracture was classified as the avulsion type according to Mutch classification. All the patients were treated with shoulder arthroscopic balance point compaction with cross suture-bridge technique. The anteroposterior X-ray of the shoulder joint was taken at 1 week, 3 months, and 6 months after surgery to evaluate fracture reduction and fixation. The operative time and intraoperative blood loss were recorded. Fracture healing was evaluated by shoulder MRI at 6 months after surgery. The visual analog score (VAS), Constant shoulder joint score, American Shoulder and Elbow Surgeons (ASES) score, and shoulder range of motion (active abduction angle, active lateral external rotation angle, and active lateral internal rotation) preoperatively, at 3, 6 months after surgery and at the last follow-up were compared. The postoperative complications were observed.Results:All the patients were followed up for 12-15 months [(12.5±0.8)months]. The operative time and intraoperative blood loss were (67.0±10.5)minutes and (20.0±3.8)ml. The anteroposterior X-ray of the shoulder joint showed good reduction and fixation at 1 week, 3 months and 6 months after surgery. MRI T1 image at 6 months after surgery showed locally evenly distributed high signal, suggesting that the fracture was healed well. The values of VAS were (3.2±0.4)points, (2.5±0.5)points, and (0.7±0.3)points at 3, 6 months after surgery and at the last follow-up, which were lower than (7.2±0.6)points preoperatively; the values of Constant joint shoulder score were (53.2±5.3)points, (81.1±4.4)points, and (92.8±5.3)points, which were higher than (42.3±7.6)points preoperatively; the values of ASES score were (55.6±3.6)points, (77.1±3.2)points, and (90.8±3.5)points, which were higher than (45.8±4.2)points preoperatively; the active abduction angles were (60.5±2.5)°, (107.8±6.6)°, and (168.5±3.5)°, which were higher than (18.3±3.3)°preoperatively; the active lateral external rotation angles were (25.8±2.5)°, (30.8±2.2)°, and (63.8±2.8)°, which were higher than (15.6±3.2)°preoperatively ( P<0.05 or 0.01). The level of active internal rotation was L 5, L 1, and T 10, which was better than S 3 before surgery. The VAS, Constant shoulder joint score, ASES score, active abduction and active external rotation were significantly improved at the last follow-up compared with those at 3, 6 months after surgery (all P<0.05), with markedly improved level of active internal rotation. No major complications such as infection, instability of the shoulder joint or acromial impingement were found after surgery. Conclusion:Shoulder arthroscopic balance point compaction with cross suture-bridge technique for the treatment of avulsion fracture of the greater tuberosity of the humerus has advantages of decreased intraoperative blood loss, good reduction and healing, shoulder pain relief, early restoration of shoulder function and mobility, and few complications.

Anterior Cruciate Ligament Reconstruction ; Femur/surgery*

Objective:To investigate the prevalence of sarcopenia among community-dwelling Chinese elderly and to explore the related factors.Methods:Data were obtained from the China Health and Retirement Longitudinal Survey(CHARLS)in 2015, an open national database.According to the criteria of the Asian Working Group(AWGS)on Sarcopenia in 2014, a cross-sectional survey was conducted on 7 584 Chinese residents aged 60 years and over who had undergone the standard sarcopenia test.General socio-demographic characteristics and living habits were compared between different gender groups.The prevalence of sarcopenia was analyzed with stratification.Multivariate Logistic regression analysis was used to analyze risk factors for sarcopenia.Results:The overall prevalence of sarcopenia was 6.4%(95% CI: 5.9-7.0)among the Chinese population aged 60 years or older.In the stratified analysis, the prevalence of sarcopenia was higher in males(9.9%, 95% CI: 9.0-10.9)than in females(3.0%, 95% CI: 2.4-3.5), in rural areas(7.2%, 95% CI: 6.5-7.9)than in urban areas(4.3%, 95% CI: 3.4-5.2), and in smokers(8.8%, 95% CI: 7.6-10.0)than in non-smokers(4.2%, 95% CI: 3.6-4.8). Multivariate Logistic regression showed that male gender( OR=5.368, 95% CI: 4.126-6.985)and old age( OR=1.191, 95% CI: 1.172-1.210)were risk factors for sarcopenia.In addition, the occurrence of sarcopenia was significantly associated with physical pain( OR=2.181, 95% CI: 1.695-2.673), alcohol consumption( OR=1.426, 95% CI: 1.057-1.923), low education level( OR=2.875, 95% CI: 1.577-5.241), increased waist circumference( OR=0.982, 95% CI: 0.973-0.990), decreased peak expiratory flow( OR=0.995, 95% CI: 0.994-0.997)and increased cystatin C levels( OR=2.088, 95% CI: 1.247-3.495)( P<0.05). Conclusions:The prevalence of sarcopenia is high among community-dwelling elderly in China, and the occurrence of sarcopenia is closely related to age, gender, education level, Waist circumference and alcohol consumption.

To compare changes in platelet related parameters in obese patients before and after sleeve gastrectomy (SG), we retrospectively analyzed the clinical data of 31 obese patients who underwent SG in Peking Union Medical College Hospital from December 2012 to September 2020. Results showed that compared with those before surgery, platelet count (PLT) decreased significantly at 2-12 weeks of follow-up ( P=0.009), while platelet distribution width (PDW), mean platelet volume (MPV), and large platelet ratio (P-LCR) increased significantly at the same periods of follow-up after operation ( P<0.001). However, the levels of PDW, MPV, and P-LCR began to decrease at 16-55 weeks when compared with those at 2-12 weeks of follow-up ( P<0.01). PLT was positively correlated with white blood cells and neutrophils at 2-12 weeks of follow-up and positively correlated with high sensitivity C-reactive protein at 16-55 weeks of follow-up after operation ( P<0.05).