OBJECTIVE: To investigate effectiveness of arthroscopic superior capsular reconstruction using a "sandwich" patch combined with platelet-rich plasma (PRP) injection in treating massive irreparable rotator cuff tears. METHODS: A clinical data of 15 patients (15 sides) with massive irreparable rotator cuff tears, who were admitted between September 2020 and March 2023 and met the selective criteria, was retrospectively analyzed. There were 8 males and 7 females with an average age of 62.1 years (range, 40-80 years). The rotator cuff tears were caused by trauma in 7 cases and other reasons in 8 cases. The disease duration ranged from 5 to 25 months, with an average of 17.7 months. According to the Hamada grading, the rotator cuff tears were rated as grade 1 in 2 cases, grade 2 in 8 cases, and grade 3 in 5 cases. All patients were underwent superior capsular reconstruction using the "sandwich" patches (autologous fascia lata+polypropylene patch+autologous fascia lata) combined with PRP injection on patches. The pre- and post-operative active range of motion (ROM) of the shoulder joint, American Shoulder and Elbow Surgeons (ASES) score, Constant-Murley score, University of California, Los Angeles Shoulder Rating Scale (UCLA) score, and visual analogue scale (VAS) score were recorded. The subacromial space was measured on the imaging and rotator cuff integrity was assessed based on Sugaya grading. RESULTS: All incisions healed by first intention after operation without any complications such as infection. All patients were followed up 12-18 months (mean, 14.4 months). At last follow-up, the active ROMs of flexion, abduction, external rotation, internal rotation of the shoulder joint, subacromial space, ASES score, Constant-Murley score, and UCLA score increased, and VAS score decreased, showing significant differences when compared with preoperative values ( P<0.05). There was no significant difference in the Sugaya grading between last follow-up and immediately after operation ( P>0.05). CONCLUSION For massive irreparable rotator cuff tears, arthroscopic superior capsular reconstruction using the "sandwich" patches combined with PRP injection can restore stability of the shoulder joint, relieve pain, promote rotator cuff healing, and achieve good short-term effectiveness.
Humans ; Platelet-Rich Plasma ; Female ; Male ; Middle Aged ; Aged ; Rotator Cuff Injuries/therapy* ; Arthroscopy/methods* ; Adult ; Retrospective Studies ; Aged, 80 and over ; Treatment Outcome ; Plastic Surgery Procedures/methods* ; Rotator Cuff/surgery* ; Range of Motion, Articular ; Shoulder 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*

OBJECTIVE: To investigate the difference of effectiveness between medial-lateral approach and posteromedian approach in the release of elbow stiffness after distal humeral fracture surgery. METHODS: A retrospective analysis was conducted on the clinical data of 41 patients with elbow stiffness following medial and lateral plate fixation for distal humeral fractures, admitted between January 2021 and June 2023 and meeting selection criteria. Patients were divided into the medial-lateral approach release group (study group, 20 cases) and the posteromedian approach release group (control group, 21 cases) based on surgical approach. Baseline data including age, gender, affected side, body mass index, disease duration, and preoperative extension angle, flexion angle, range of motion, visual analogue scale (VAS) pain score, Mayo elbow performance score, ulnar nerve symptoms, and heterotopic ossification showed no significant difference between groups ( P>0.05). The operation time, intraoperative blood loss, and complication incidence were recorded and compared between groups. Clinical effectiveness was evaluated using pre- and postoperative Mayo score, VAS score, elbow extension/flexion angles, and range of motion on the affected side. Statistical analysis focused on changes in these indicators relative to preoperative values. RESULTS: There was no significant difference in operation time and intraoperative blood loss between the two groups ( P>0.05). Patients in both groups were followed up 15-36 months, with a mean of 23.8 months; there was no significant difference in the follow-up time between the two groups ( t=-1.542, P=0.131). In the control group, 1 patient had obvious subcutaneous hematoma and 5 patients had poor wound healing within 2 months after operation, all of which were cured by symptomatic treatment, while no related complications occurred in the study group, there was a significant difference in poor wound healing incidence between the two groups ( P<0.05). At last follow-up, 2 patients in the study group and 3 patients in the control group had mild symptoms of ulnar nerve numbness, and there was no significant difference in the incidence of ulnar nerve symptoms ( P>0.05). All patients had no recurrence or new onset of heterotopic ossification, no skin necrosis or reoperation due to complications. At last follow-up, elbow extension angle, flexion angle, flexion-extension range of motion, VAS score, and Mayo score significantly improved in both groups when compared with the preoperative ones ( P<0.05). There was no significant difference between the change values in elbow extension angle and VAS score between the two groups ( P>0.05); the change values in flexion angle, range of motion, and Mayo score in the study group were significantly better than those in the control group ( P<0.05). CONCLUSION The medial-lateral approach can release the elbow stiffness and concurrently remove the medial, lateral, or posterior lateral plates. The incision minimizes disruption to rehabilitation exercises and reduces complications like inadequate wound healing, ultimately leading to improved treatment outcomes.
Humans ; Humeral Fractures/surgery* ; Male ; Female ; Retrospective Studies ; Elbow Joint/physiopathology* ; Middle Aged ; Fracture Fixation, Internal/adverse effects* ; Range of Motion, Articular ; Adult ; Bone Plates ; Postoperative Complications/surgery* ; Treatment Outcome ; Aged ; Humeral Fractures, Distal

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 safety and effectiveness of reducing posterior malleolar fractures via the modified Rammelt transfibular approach. METHODS: A retrospective analysis was conducted on 26 patients with ankle fractures who met the selection criteria and were admitted between September 2023 and May 2024. There were 13 males and 13 females, aged from 14 to 59 years (median, 43.5 years). Causes of injury included traffic accident (1 case), falls (7 cases), and sprains (18 cases). Time from injury to operation ranged from 1 to 13 days (mean, 3.9 days). According to the Lauge-Hansen classification, there were 5 supination-external rotation type Ⅲ fractures and 21 supination-external rotation type Ⅳ fractures. According to the Bartoníček classification for posterior malleolar fractures, there were 12 type Ⅱ fractures, 10 type Ⅲ fractures, and 4 type Ⅳ fractures. During operation, the fracture was exposed via the modified Rammelt transfibular approach; then, the fracture reduction was achieved under direct vision using techniques such as towel clip traction, posterolateral compression, and lifting with a posterior transverse periosteal elevator; finally, the fracture was fixed using anteroposterior cannulated screws or Kirschner wires. The incision healing was observed after operation. At 4 months after operation, X-ray film and CT were reviewed to evaluate the quality of fracture reduction. The medial clear space, tibiofibular clear space, and the anterior/posterior tibiofibular syndesmotic distances were measured. At last follow-up, the ankle function was assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and the range of motion. RESULTS: The marginal necrosis occurred in 2 lateral malleolar incisions, and superficial infection occurred in 1 lateral malleolar incision; the remaining incisions healed by first intention. All 26 patients were followed up 13-21 months (mean, 15.6 months). X-ray films showed that fractures in 25 patients achieved clinical union within 3-8 months (mean, 5.4 months); 1 case had delayed union of the lateral malleolus. At 4 months after operation, no significant difference was found between the injured and healthy sides in the medial clear space, tibiofibular clear space, or the anterior/posterior tibiofibular syndesmotic distances ( P>0.05). No malreduction of the posterior malleolus or the tibiofibular syndesmosis occurred. At last follow-up, the AOFAS score ranged from 80 to 100 (mean, 91.9). The range of motion ranged from 17° to 22° (mean, 21.0°) in active ankle dorsiflexion and from 40° to 49° (mean, 44.6°) in plantar flexion. Internal fixator was removed in 12 patients at 1 year after operation, with no ankle instability occurring. Ankle joint degeneration was observed in 1 patient at last follow-up. CONCLUSION The modified Rammelt transfibular approach is a safe and reliable technique. It enables precise reduction under direct vision, improves the quality of reduction for the distal tibial articular surface and the tibiofibular syndesmosis, and provides satisfactory ankle functional recovery in short-term follow-up.
Humans ; Male ; Female ; Adult ; Ankle Fractures/diagnostic imaging* ; Middle Aged ; Retrospective Studies ; Fracture Fixation, Internal/instrumentation* ; Adolescent ; Treatment Outcome ; Young Adult ; Bone Screws ; Ankle Joint/surgery* ; Fibula/surgery* ; Range of Motion, Articular

OBJECTIVE: To investigate effectiveness of the bridge combined fixation system (BCFS) for Bado typeⅠchronic Monteggia fractures (CMF) in children. METHODS: A clinical data of 8 children with Bado type ⅠCMF, who were treated with the BCFS between November 2023 and February 2025, was retrospectively analyzed. There were 6 boys and 2 girls, with a mean age of 7.0 years (range, 4-12 years). The time from injury to operation ranged from 29 to 370 days (median, 68.5 days). Preoperative elbow range of motion was (111.3±17.9)° in flexion, (13.1±13.9)° in extension, (71.9±14.6)° in pronation, and (75.6±13.5)° in supination. Fracture healing time and postoperative complications were observed, and clinical outcomes were evaluated using the Mayo elbow performance score. RESULTS: All incisions healed by primary intention without infection, non-healing of the incision, or iatrogenic nerve injury. All children were followed up 4-18 months (mean, 10.3 months). At last follow-up, the elbow range of motion significantly improved to (142.5±2.7)° in flexion, (2.5±2.7)° in extension, (87.5±2.7)° in pronation, and (88.8±2.3)° in supination ( P<0.05). According to the postoperative Mayo elbow performance score, all cases were rated as excellent. Radiographic review showed no radial head dislocation, nonunion at the ulnar osteotomy site, or elbow stiffness, and no breakage of the BCFS or screw loosening. The fracture healing time ranged from 3 to 6 months, with a median of 4 months. CONCLUSION The BCFS was confirmed to be effective in the treatment of pediatric Bado type Ⅰ CMF, with good restoration of elbow function and the advantage of avoiding secondary implant removal surgery.
Humans ; Child ; Monteggia's Fracture/surgery* ; Male ; Female ; Child, Preschool ; Range of Motion, Articular ; Retrospective Studies ; Fracture Fixation, Internal/instrumentation* ; Elbow Joint/physiopathology* ; Bone Plates ; Treatment Outcome ; Fracture Healing ; Bone Screws ; Elbow Injuries

OBJECTIVE: To evaluate the effectiveness of suture anchors combined with headless compression screw fixation in treating inferior pole patellar fractures. METHODS: A retrospective analysis was conducted on 36 patients with inferior pole patellar fractures, who were admitted between January 2018 and October 2024 and met the selective criteria. There were 15 males and 21 females with a mean age of 52.3 years (range, 23-81 years). The fracture were reduced and fixed using suture anchors combined with headless compression screws. The operation time, intraoperative blood loss, and the length of hospital stay were recorded. Functional recovery was assessed using knee range of motion (ROM), Hospital for Special Surgery (HSS) knee score, and Böstman patellar fracture efficacy score. RESULTS: The operation time ranged from 10 to 100 minutes, with an average of 57.6 minutes. The intraoperative blood loss was 10 to 120 mL, with an average of 73.3 mL. The length of hospital stay was 5 to 10 days, with an average of 6.3 days. All incisions healed by first intention. All 36 patients were followed up 18-24 months (mean, 20.6 months). Postoperative X-ray films indicated that the fractures had healed; no screw breakage, anchor loosening, or implant foreign body rejection reactions occurred during follow-up. At last follow-up, the ROM of the affected knee joint was (136.0±2.3)°, and there was no significant difference when compared with the healthy side (136.6±2.3)° ( t=-1.944, P=0.060). The HSS score of the affected knee joint was 96-100 (mean, 99.1), and all cases were rated as excellent. The Böstman patellar fracture efficacy score was 27-30 (mean, 29.1), and 35 cases were rated as excellent and 1 as good. CONCLUSION The suture anchors combined with headless compression screws technique provides reliable fixation for inferior pole patellar fractures. This method combines surgical simplicity with excellent functional outcomes.
Humans ; Male ; Female ; Middle Aged ; Bone Screws ; Aged ; Retrospective Studies ; Patella/surgery* ; Fracture Fixation, Internal/instrumentation* ; Adult ; Aged, 80 and over ; Suture Anchors ; Fractures, Bone/surgery* ; Range of Motion, Articular ; Treatment Outcome ; Young Adult ; Operative Time ; Length of Stay

OBJECTIVE: To compare the impact of different peroneus longus tendon (PLT) stump management techniques on ankle function following arthroscopic anterior cruciate ligament (ACL) reconstruction with autologous PLT grafts. METHODS: A retrospective analysis was conducted on 60 patients with ACL rupture who met the inclusion criteria between August 2020 and July 2024. All patients underwent arthroscopic ACL reconstruction using the autologous PLT grafts. Patients were assigned to group A [PLT stump sutured to peroneus brevis tendon (PBT), n=30] or group B (no stump intervention, n=30). The two groups showed no significant difference ( P>0.05) in baseline data, including gender, age, body mass index, injury mechanism, affected side, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, ankle muscle strength, ankle range of motion, and arch-related angles. Postoperative outcomes were assessed using the AOFAS score, ankle muscle strength (eversion and first-ray plantar flexion), arch-related angles (medial/lateral longitudinal and anterior/posterior arch), ankle range of motion (eversion, inversion, dorsiflexion, plantarflexion), and limb symmetry index (LSI). Change values in muscle strength, arch-related angles, and range of motion from preoperative to 12 months postoperatively were calculated for intergroup comparison. RESULTS: Groups A and B had comparable PLT graft lengths and diameters ( P>0.05). All patients were followed up 13-16 months (mean, 14.5 months). Postoperative complications included 1 case of incision infection, 1 case of deep vein thrombosis, and 1 case of knee stiffness in group A, 1 case of knee stiffness in group B. There was no significant difference in the overall complication incidences between groups ( P>0.05). No significant difference was found in the AOFAS scores between different time points and between groups ( P>0.05). At 12 months after operation, neither group showed significant changes from preoperative baseline in ankle strength, range of motion, or arch-related angles, and there was no significant difference in these change values between groups ( P>0.05). There was no significant difference in LSI between the two groups at 6 or 12 months postoperatively ( P>0.05). CONCLUSION Both suturing and leaving the PLT stump untreated during arthroscopic ACL reconstruction provided comparable ankle outcomes and well-preserved foot and ankle function.
Humans ; Anterior Cruciate Ligament Reconstruction/methods* ; Male ; Retrospective Studies ; Female ; Adult ; Anterior Cruciate Ligament Injuries/surgery* ; Tendons/transplantation* ; Range of Motion, Articular ; Arthroscopy/methods* ; Young Adult ; Treatment Outcome ; Muscle Strength ; Transplantation, Autologous ; Ankle Joint/surgery* ; Middle Aged ; Adolescent

OBJECTIVE: To investigate the effectiveness of hip arthroscopy in the treatment of patients with femoroacetabular impingement (FAI) syndrome combined with ligamentum teres injury. METHODS: A retrospective analysis was conducted on 23 patients (23 hips) with Cam-type FAI syndrome combined with ligamentum teres injury who met the selection criteria between April 2022 and May 2024. The cohort included 12 males and 11 females, with a mean age of 29.16 years (range, 16-57 years). According to Tönnis classification, there were 5 cases of grade 0, 10 cases of grade Ⅰ, and 8 cases of grade Ⅱ in hip osteoarthritis. The disease duration ranged from 6 to 24 months, with an average of 12 months. Under hip arthroscopy, hypertrophic synovium and the damaged ligamentum teres were debrided, while the torn labrum and cartilage were repaired, and femoral head-neck osteoplasty was performed to eliminate impingement, restore the normal morphology of the acetabulum and femoral head-neck, and suture the joint capsule. Acetabular lateral center-edge angle (LCEA) and α angle (reflecting the degree of non-sphericity at the femoral head-neck junction) were measured before and after operation, and the modified Harris hip score (mHHS), the International Hip Outcome Tool-12 (IHOT-12), and the visual analogue scale (VAS) score for pain were evaluated. RESULTS: The operation was successfully completed in all patients. The incisions healed by first intention after operation, and there was no perioperative complications such as iatrogenic cartilage injury, fracture, infection, neurovascular traction injury, or lower extremity venous thrombosis. All the 23 patients were followed up 12-24 months, with an average of 14.6 months. The pain of hip joint significantly relieved, and the function of hip joint improved; no complication such as joint stiffness, joint instability, and osteonecrosis of the femoral head occurred. The α angle, VAS score, mHHS score, and IHOT-12 score at last follow-up were significantly better than those before operation ( P<0.05); there was no significant difference in LCEA compared to preoperative value ( P>0.05). CONCLUSION Hip arthroscopy is a safe and effective treatment for patients with FAI syndrome combined with ligamentum teres injury, which can achieve satisfactory effectiveness.
Humans ; Femoracetabular Impingement/complications* ; Arthroscopy/methods* ; Adult ; Male ; Female ; Retrospective Studies ; Middle Aged ; Adolescent ; Treatment Outcome ; Young Adult ; Hip Joint/surgery* ; Acetabulum/surgery* ; Round Ligaments/surgery* ; Range of Motion, Articular

OBJECTIVE: To compare clinical effect of arthroscopic double row fixation and single row fixation in treating Ideberg typeⅠA scapular glenoid fracture. METHODS: From June 2018 to December 2022, 26 patients with Ideberg typeⅠA scapular glenoid fracture treated with shoulder arthroscopy were divided into single-row anchor group and double-row anchor group according to the fixation method of fracture block. There were 12 patients in single-row anchor group, including 7 males and 5 females, aged from 25 to 53 years old with an average of (38.42±9.61) years old;the time from injury to operation ranged from 2 to 7 days with an average of (4.75±1.82) days. There were 14 patients in double-row anchor group, including 10 males and 4 females, aged from 21to 53 years old with an average of (37.36±10.19) years old;the time from injury to operation ranged from 1 to 8 days with an average of (4.21±2.01) days. The changes of shoulder joint flexion, abduction, lateral lateral rotation, Constant-Murley shoulder function score and Rowe scores were compared between two groups before operation and 1 year after operation. The percentage of bone mass in pelvis area before operation and the percentage of bone defect in pelvis area at the latest follow-up were compared between two groups. RESULTS: All patients were followed up for 12 to 15 months with an average of (13.08±1.17) months in single-row anchor group and 12 to 15 months with an average of (13.29±1.07) months in double-row anchor group, with no statistical significance between two groups (P>0.05). The results of anterior flexion, abduction and lateral lateral rotation in single-row anchor group were(86.67±6.62) °, (79.50±5.68) °, (38.17±1.70) ° before operation, and (162.50±4.52)°, (169.17±3.35)°, (50.67±10.20)° at 1 year after operation; while in double-row anchor group were (84.14±5.48) °, (81.71±5.20) °, (39.29±3.63) ° before operation and (162.29 ± 5.53) °, (167.14±3.61) °, (56.93±9.56) ° at 1 year after operation;the difference between two groups before operation and 1 year after operation was statistically significant (P<0.05). There were no significant difference between two groups (P>0.05). Constant-Murley scores and Rowe scores in single-row anchor group were (55.42±3.75), (43.75±18.49) before operation and (94.83±2.21), (95.42±4.50) at 1 year after operation, respectively;while in double-row anchor group were (54.50±7.88), (41.79±18.25) before operation and (94.36±4.73), (95.00±4.80) at 1 year after operation;there was no significant difference in Constant-Murley score and Rowe score between two groups before operation and 1 year after operation (P>0.05). There was significant difference in the percentage of bone mass in pelvis area between two groups before operation (P>0.05). There was no significant difference in the percentage of bone defect in the shoulder area between single-row anchor group(4.42±1.51)% and double-row anchor group (2.71±1.44)% at 1 year after operation (P<0.05). CONCLUSION Both single and double row fixation techniques for the treatment of Ideberg typeⅠA scapular glenoid fracture could receive satisfactory functional recovery. However, double-row fixation has more advantages in reducing bone resorption of fracture mass.
Humans ; Female ; Male ; Middle Aged ; Arthroscopy/methods* ; Adult ; Scapula/surgery* ; Case-Control Studies ; Fractures, Bone/physiopathology* ; Fracture Fixation, Internal/methods* ; Shoulder Joint/physiopathology* ; Range of Motion, Articular