OBJECTIVE: To summarize the research progress of suture augmentation (SA) in anterior cruciate ligament (ACL) reconstruction. METHODS: A comprehensive review of recent literature about SA in ACL reconstruction at home and abroad was conducted. The efficacy of SA in ACL reconstruction was evaluated by examining the definition, biomechanics, and histological studies of SA, along with its clinical application status in ACL reconstruction. RESULTS: SA demonstrates significant advantages in enhancing the biomechanical stability of ACL grafts, reducing the risk of re-rupture, and accelerating postoperative recovery. Specifically, SA improves graft stiffness, ultimate failure strength, and cyclic stability, thereby diminishing the risk of early postoperative failure and joint instability. Histologically, it fosters remodeling and tendon-bone integration through early load-sharing mechanisms; however, stress shielding may interfere with natural remodeling processes, warranting further attention. Clinically, SA reduces graft failure rates and the need for revision surgeries, markedly improving knee joint stability and functional recovery in young patients. Nevertheless, its impact on graft maturation and potential complications remains controversial. CONCLUSION Despite the many advantages of SA in ACL reconstruction, future endeavors should focus on optimizing tensioning techniques, developing bioactive materials, and conducting large-scale randomized controlled trials to further elucidate its clinical value and scope of applicability, providing a more reliable solution for ACL reconstruction.
Humans ; Anterior Cruciate Ligament Reconstruction/methods* ; Biomechanical Phenomena ; Anterior Cruciate Ligament/surgery* ; Anterior Cruciate Ligament Injuries/surgery* ; Suture Techniques ; Sutures ; Tendons/transplantation* ; Joint Instability/prevention & control* ; Knee Joint/surgery*

OBJECTIVE: To summarize the research progress on knee laxity of biomechanics and prevention and treatment after posterior cruciate ligament (PCL) reconstruction. METHODS: The domestic and international literature on the prevention and treatment of knee laxity after PCL reconstruction in recent years was extensively reviewed and analyzed. RESULTS: Different degrees of knee laxity often occur after PCL reconstruction, which can lead to poor prognosis in patients. The causes are associated with a variety of factors, including abnormal graft remodeling (such as differences in healing time and biomechanics among different types of grafts), tunnel position deviation (such as graft wear caused by the "killer turn" effect), and mechanical factors in postoperative rehabilitation (such as improper early weight-bearing and range of motion). These factors may promote graft elongation, increase early posterior tibial translation, and thereby induce knee laxity. CONCLUSION While PCL reconstruction improves knee stability, it is crucial to focus on and prevent postoperative knee laxity. However, current surgical methods are limited by factors such as graft characteristics, surgical technique flaws, and rehabilitation protocols, and thus can not fully correct the issue of abnormal postoperative laxity. Surgical techniques and treatment strategies still need further improvement and optimization to enhance patients' postoperative outcomes and quality of life.
Humans ; Joint Instability/surgery* ; Posterior Cruciate Ligament Reconstruction/adverse effects* ; Posterior Cruciate Ligament/surgery* ; Knee Joint/physiopathology* ; Biomechanical Phenomena ; Range of Motion, Articular ; Postoperative Complications/prevention & control* ; Knee Injuries/surgery*

OBJECTIVETo evaluate biomechanical properties in different methods of internal fixation combined with distal tibiofibular syndesmosis injury, in order to provide a theoretical basis for clinical choice.

METHODSSix lower limbs specimens were collected and divided into 5 groups, including normal group, distal tibiofibular syndesmosis injury (injury group), 3 cortexes group, 4 cortexes group and hook-plate fixation group. Neutral position, plantar flexion position (30°), dorsiflexion (20°) supination external rotation position of foot movement were simulated on universal materials tester. Strength, stiffness and stability of ankle joint in 4 kinds of motion conditions were measured.

RESULTSThere was significant differences in strength and stiffness of ankle joint between injury group and normal group in 4 different kinds of motion conditions (P<0.05). Strength and stiffness of ankle joint in 3 cortexes group, 4 cortexes group and hook-plate fixation group were improved obviously in 4 different kinds of motion conditions, and biomechanical indexes were recovered normally or better than normal group. Stiffness of the three fixation groups were better than normal group,but there was no significant differences among three groups (P > 0.05), while stiffness of hook-plate fixation group was closed to normal group.

CONCLUSIONFor distal tibiofibular syndesmosis injury, 1 screw with 3 cortexes, 4 cortexes and hook-plate had a positive impact on strength, stiffness and stability of distal tibiofibular syndesmosis injury stress,and could restore the normal stabllity of ankle joint after reconstruction. While fixing by screw fixation would limit the rototary motion of ankle joint,ankle mortise could not adapt to changes of talus bone, thus induces screw breakage and traumatic arthritis. Hook-plate fixation is more suitable than 3 cortexes or 4 cortexes fixation for bilmechanical properties,and its' stress is more balance and can reduce postoperative complcations.

Ankle Injuries ; physiopathology ; surgery ; Biomechanical Phenomena ; Fibula ; injuries ; surgery ; Fracture Fixation, Internal ; methods ; Humans ; Joint Instability ; physiopathology ; prevention & control ; Reconstructive Surgical Procedures ; methods ; Tibia ; injuries ; surgery

OBJECTIVETo investigate the results and indication of differently internal fixation for intertrochanteric fracture and prevent for complication.

METHODSOne hundred and two patients of intertrochanteric fracture of femur from January 1997 to December 2007 were reviewed and analysed. There were 46 males and 56 females, with an average age of 76.5 years ranging from 60 to 93 years. There were 34 cases of stability fractures and 68 of instability fractures. The methods of internal fixation included dynamic hip screw in 82 cases, proximal interlocking nail in 5, multi-screw fixation in 9, dynamic codylar screw in 6.

RESULTSThese patients were followed up for 6 to 72 months (36 months in average). The time of fracture healing was from 8 to 12 weeks. According to evaluation criterion of effect, the results were excellent in 72 cases, good in 20, fair in 10. After operation, there were 3 cases of coax vara, 2 cases of lag screws cutting out, 1 case of breakage of screw, 2 cases of avascular necrosis of the femoral head, 1 case of postoperative infection, 1 case of delayed union.

CONCLUSIONSuitable implant selection according the type of fracture, health condition is an important factor to reduce the incidence of complication for unstable fracture in aged patients. DHS is a main treatment of intertrochanteric fracture. PFN is recommended for serious osteoporosis or unstable intertrochanteric fracture. Compression screws is a choice for the fixation of type I and type II fracture of bad health condition.

Aged ; Aged, 80 and over ; Bone Screws ; Female ; Fracture Fixation, Internal ; methods ; Fracture Fixation, Intramedullary ; methods ; Fracture Healing ; physiology ; Hip Fractures ; complications ; surgery ; Humans ; Joint Instability ; physiopathology ; Male ; Middle Aged ; Postoperative Complications ; prevention & control

A new kind of Cage made of poly-DL-lactic acid was designed and an in-vitro study was conducted to evaluate the biomechanical effect of PDLLA Cage on a goat cervical spine model. 27 goat cervical spines were divided into four groups randomly: intact group, PDLLA Cage group, titanium Cage group, and autologous tricortical iliac crest bone group. Different implants were implanted after complete discectomy (C3-4) was performed, then they were tested in flexion, extension, axial rotation, and lateral bending with a nondestructive stiffness method using a nonconstrained testing apparatus, and three-dimensional displacement was measured. The range of motion (ROM) and the mean stiffness values were calculated and compared between groups. The result showed that the ROM values between PDLLA Cage group and the titanium Cage group were not significantly different in extensional and rotational movement (P > 0.05), but they were lower than that of rest groups (P < 0.05). In flexional loading mode, the ROM values showed statistically significant difference between the four groups (P < 0.05). And in lateral bending loading mode, no significant difference was found between PDLLA Cage group and iliac crest bone group (P > 0.05), but significant difference was found among the other groups (P < 0.05). The stiffness of cervical spine was raised after Cage was implanted. In flexional and rotational loading mode, significant difference in stiffness was found between PDLLA Cage group and control group or iliac crest bone group (P < 0.05). So PDLLA Cage can provide enough primary stability for cervical intervertebral fusion.
Animals ; Biomechanical Phenomena ; Bone Transplantation ; Cervical Vertebrae ; physiology ; surgery ; Equipment Design ; Female ; Goats ; Joint Instability ; prevention & control ; Lactic Acid ; Orthopedic Fixation Devices ; Polyglycolic Acid ; Prostheses and Implants ; Spinal Fusion ; instrumentation

OBJECTIVETo investigate the etiologies and prevention of patellar instability after total knee arthroplasty (TKA).

METHODSFrom September 1997 to April 2005, 94 patients (105 knees) underwent TKA without patellar resurfacing. All of them were osteoarthritis. Ten patients (14 knees) were performed with Rotation Knee (RK) prostheses. Forty patients were performed with mobile bearing TACK prostheses, and 44 patients with GEMINI prostheses. Subluxation and tilt of patella were evaluated by X-rays before or after operation.

RESULTSThe incidence of patellar instability after operation was 28.6% in patients who had genu valgus deformity, and was 29.5% in whom had patellar instability preoperative. The incidence of patellar instability in RK, TACK, and GEMINI group was 28.6%, 20.9%, and 16.7% respectively after operations. Four patients had obvious femoral or tibial components malrotation.

CONCLUSIONSThe etiologies of patellofemoral instability include pre-operative conditions, prosthetic design, and improper positioning of the prosthetic component. So the suitable component design and skillful operative technique will help the surgeon to avoid this complication.

Aged ; Arthroplasty, Replacement, Knee ; adverse effects ; methods ; Female ; Follow-Up Studies ; Humans ; Joint Instability ; etiology ; prevention & control ; Male ; Middle Aged ; Osteoarthritis, Knee ; surgery ; Patella ; Postoperative Complications ; etiology ; prevention & control

The authors hypothesized that the placement of the interspinous implant would show a similar clinical outcome to the posterior lumbar interbody fusion (PLIF) in patients having spinal stenosis with mild segmental instability and that this method would be superior to PLIF without significantly affecting degeneration at the adjacent segments. Forty two adult patients having degenerative spinal stenosis with mild segmental instabilit who underwent implantation of Coflex(TM) (Spine motion, Germany) or PLIF at L4-5 between January 2000 and December 2003 were consecutively selected and studied for one-year clinical outcome. At 12 months after surgery, both groups showed a significant improvement in the visual analogue scale score and Oswestry disability index score for both lower extremity pain and low back pain. However, the range of motion at the upper adjacent segments (L3-4) increased significantly after surgery in the PLIF group, which was not manifested in the Coflex(TM) group during the follow-up. The authors assumed that interspinous implantation can be an alternative treatment for the spinal stenosis with segmental instability in selected conditions posing less stress on the superior adjacent level than PLIF.
Treatment Outcome ; Spinal Stenosis/complications/*surgery ; Spinal Fusion/*instrumentation/methods ; Prosthesis Design ; Pain Measurement ; Outcome Assessment (Health Care) ; Middle Aged ; Male ; Lumbar Vertebrae/*surgery ; Longitudinal Studies ; Joint Instability/complications/*prevention & control ; Intermittent Claudication/diagnosis/etiology/*prevention & control ; Humans ; Female ; Equipment Failure Analysis ; Back Pain/diagnosis/etiology/*prevention & control ; Aged ; Adult

OBJECTIVETo determine the initial stability of a novel construct in cadaveric cervical spine in comparison with a conventional method.

METHODSTwelve specimens of fresh human cadaveric cervical spines (C(3)-C(7)) were randomly divided into the test group and control group. In the former group, one-level corpectomy of C(5) and three cortical iliac step-cut grafting with absorbable screw fixation was performed, and one-level corpectomy of C(5) and three cortical iliac strut grafting with anterior plate fixation in the control group. Flexibility test and graft push of strength test were carried out before and after grafting and fixation to determine the range of motion (ROM), neutral zone (NZ) and graft push out strength (POS).

RESULTSThe cervical spines of the two groups all had increased initial stability in all 6 rotational degrees of freedom with also enhanced graft POS after fixation. Compared with the control group, the test group had higher stability in extension and comparable stability in flexion and axial rotation, but lower stability in lateral bending. The graft POS after fixation in the test group, however, was lowered in comparison with the control group.

CONCLUSIONStep-cut grafting and absorbable screw fixation provides sufficient stability potential for the cervical spine in vitro and allows optimum biomechanical and biological environments to enhance graft fusion and reduce complications.

Absorbable Implants ; Biomechanical Phenomena ; Bone Screws ; Bone Transplantation ; methods ; Cadaver ; Cervical Vertebrae ; physiopathology ; surgery ; Humans ; Joint Instability ; physiopathology ; prevention & control ; Orthopedic Procedures ; instrumentation ; methods ; Spinal Fusion ; instrumentation ; methods

Spinal instrumentation is a common method for the treatment of spinal disorders, but it can lead to the changes of spine biomechanics. Because of the stress changes, accelerated degeneration of the adjacent segment may occur as time goes by, namely adjacent segment disease. The accelerated degeneration can lead to secondary spinal stenosis, articulated joint degeneration, acquired spondylolisthesis, and spine instability, and some patients may have to receive surgery again. In recent years, the researchers gradually recognized the importance of this disease, and began to investigate its pathogenesis and management.
Humans ; Joint Instability ; etiology ; prevention & control ; Postoperative Complications ; diagnosis ; prevention & control ; Spinal Diseases ; surgery ; Spinal Fusion ; adverse effects ; instrumentation ; Spinal Stenosis ; etiology ; prevention & control ; Spondylolisthesis ; etiology ; prevention & control

OBJECTIVETo discuss the reasons for the operation performed on 13 patients with upper cervical disease and to explore the management and prevention of upper cervical disease.

METHODSThirteen patients with upper cervical disease were retrospectively reviewed. The reason for of reoperations on these patients were analyzed. The measures to reduce upper cervical operational complication and bad prognosis were discussed to avoid reoperations.

RESULTSThe reasons for reoperations included 9 cases with unstable or re-dislocated atlantoaxial joint, 10 cases with residual spinal cord compression, 1 case with malposition of odontoid screw, 1 case with adjacent cervical spine regression, 1 case with occipital-cervical fusion failure, 1 case with spinal cord injury during operation, 1 case with bone-plant slipped into canales spinalis, and 1 case with demand to take out internal fixation for aggravated symptom.

CONCLUSIONSThe common reasons for upper cervical reoperations were due to instability or redislocation of atlantoaxial joint and residual of spinal cord compression. Some measures such as reducing operate miss, using firm internal fixation and decompressing were advisable to decrease the incidence of reoperations.

Adolescent ; Adult ; Atlanto-Axial Joint ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; Female ; Humans ; Joint Instability ; etiology ; prevention & control ; surgery ; Male ; Middle Aged ; Postoperative Complications ; etiology ; prevention & control ; surgery ; Reoperation ; statistics & numerical data ; Spinal Cord Compression ; etiology ; prevention & control ; surgery ; Spinal Fusion ; Young Adult