Background::To perform anatomical anterior cruciate ligament reconstruction (ACLR), tunnels should be placed relatively higher in the femoral anterior cruciate ligament (ACL) footprint based on the findings of direct and indirect femoral insertion. But the clinical results of higher femoral tunnels (HFT) in double-bundle ACLR (DB-ACLR) remain unclear. The purpose was to investigate the clinical results of HFT and lower femoral tunnels (LFT) in DB-ACLR.Methods::From September 2014 to February 2016, 83 patients who underwent DB-ACLR and met the inclusion and exclusion criteria were divided into HFT-ACLR (group 1, n = 37) and LFT-ACLR (group 2, n = 46) according to the position of femoral tunnels. Preoperatively and at the final follow-up, clinical scores were evaluated with International Knee Documentation Committee (IKDC), Tegner activity, and Lysholm score. The stability of the knee was evaluated with KT-2000, Lachman test, and pivot-shift test. Cartilage degeneration grades of the International Cartilage Repair Society (ICRS) were evaluated on magnetic resonance imaging (MRI). Graft tension, continuity, and synovialization were evaluated by second-look arthroscopy. Return-to-sports was assessed at the final follow-up. Results::Significantly better improvement were found for KT-2000, Lachman test, and pivot-shift test postoperatively in group 1 ( P >0.05). Posterolateral bundles (PL) showed significantly better results in second-look arthroscopy regarding graft tension, continuity, and synovialization ( P <0.05), but not in anteromedial bundles in group 1. At the final follow-up, cartilage worsening was observed in groups 1 and 2, but it did not reach a stastistically significant difference ( P >0.05). No statistically significant differences were found in IKDC subjective score, Tegner activity, and Lysholm score between the two groups. Higher return-to-sports rate was found in group 1 with 86.8% (32/37) vs. 65.2% (30/46) in group 2 ( P = 0.027). Conclusion::The HFT-ACLR group showed better stability results, better PL, and higher return-to-sports rate compared to the LFT-ACLR group.

Humans ; Arthroplasty, Replacement, Knee ; Follow-Up Studies ; Cohort Studies ; Treatment Outcome ; Minimally Invasive Surgical Procedures ; Knee Joint/surgery* ; Knee Prosthesis ; Osteoarthritis, Knee/surgery*

Objective:To characterize the femoral dense insertion (FDI) of the anterior cruciate ligament (ACL) using 3D magnetic resonance imaging (MRI) so as to guide the femoral tunnel placement in ACL reconstruction.Methods:The 3D MRI data of the contralateral healthy knees were collected from 20 young and middle-aged patients who had been followed up for 2 years at the Department of Sports Medicine, Peking University Third Hospital from June to October 2019 after ACL reconstruction. There were 10 males and 10 females with an age of (34.5±7.8) years. The 3D models of FDI of ACL, as well as of the lateral femoral condyle and its cartilage were reconstructed using Mimics 15.01. The heights and front and rear positions of anteromedial (AM) bundle, center, and posterolateral (PL) bundle of FDI were measured with reference to the apex of deep cartilage (ADC), the deep cortical border of the lateral condyle, and the shallow and inferior cartilage margins.Results:In 3D MRI models, dense fibers of ACL femoral insertion were near the shallow and inferior cartilage margins to the shallow side, and extended obliquely deep and superior toward the over-the-top (OTP) in a band-like shape. The oblique angle was 12.5°. The AM bundle, FDI center, and PL bundle were all higher than ADC, being (4.5±0.7) mm, (3.5±0.8) mm and (2.2±0.6) mm away from ADC, respectively. The median distances to the deep cortical border of the lateral condyle and the shallow cartilage margin were (6.9±1.2) mm and (16.4±1.8) mm for the AM bundle, (11.0±1.4) and (12.1±1.6) mm for the FDI center, and (14.9±1.8) mm and (8.0±1.3) mm for the PL bundle.Conclusions:Dense fibers of ACL femoral insertion are near the shallow and inferior cartilage margin to the shallow side, and extend obliquely deep and superior toward the OTP in a band-like shape. As the height and depth measurements of the FDI in 3D MRI models supplement to the anatomy of ACL femoral insertion, they could be used to guide femoral tunnel placement in ACL reconstruction.

The anterior cruciate ligament (ACL) injury is a common sports injury that has a significant impact on knee function and patients′ mobility. With the popularity of national fitness campaign in China, the incidence of ACL injury is increasing year by year. Currently, there still lacks clinical standards or guidelines on how to choose appropriate treatment methods, surgical plans and rehabilitation protocols for ACL injury. In order to timely reflect the new treatment concept of ACL injury, standardize its diagnosis and treatment and improve the curative effect, the Sports Medicine Society of Chinese Research Hospital Association and the Editorial Board of Chinese Journal of Trauma organized domestic orthopedic and sports medicine experts to formulate the "clinical evidence-based guideline for the diagnosis and treatment of anterior cruciate ligament injury (2022 version)" based on the level of evidence-based medicine and in compliance with the principle of scientificity, practicability and advancement. The present guideline includes 12 recommendations for the diagnosis, treatment and rehabilitation of ACL injury in order to provide guidance and assistance for the clinical diagnosis and treatment of ACL injury in China.

Objective To compare the femur tibia angle(FTA) and tibia tubercle to trochlear groove (TT-TG) measured on the magnetic resonance imaging(MRI) between patients with anterior cruciate ligament(ACL) rupture and healthy controls with intact ACL,and to observe the change of the tibia-femur rotation and explore its relationship with the patellofemoral cartilage injury.Methods Fifty patients with ACL ruptures were divided into an experimental group,while another 50 healthy counterparts were chosen into a control group.All subjects were given MRI to get FTA and TT-TG.For the experimental group,all parameters were measured before and after ACL reconstruction.The results were analyzed by variance analysis and t test.Results MRI measurements showed that the average FTA in the experimental group was 6.5° ± 6.1° and 6.0° ± 5.6° before and after the ACL reconstruction,significantly higher than that in the control group,which was 3.6° ± 4.9° (P=0.0003 and P=0.033,respectively).No significant differences were found in the average TT-TG of the experimental group,6.4 ± 3.3 mm before ACL reconstruction and 6.9 mm ± 4.0 mm after ACL reconstruction,and that of the control group,6.3 ± 3.6 mm(P=0.678).Moreover,all patients in the experimental group underwent a second check under the arthroscopy,which revealed that the patellofemoral cartilage injury was aggravat ed in 26 patients measured by the Outerbridge grading.However,there was no significant difference in FTA and TT-TG between patients with and without aggravated patellofemoral cartilage degeneration.Conclusions After ACL reconstruction,the external rotation angle of the knee could not completely recover to the normal level with the knee extension at 0°.Patellofemoral cartilage degeneration after the ACL reconstruction is caused by many factors.The results of the second arthroscopy after the ACL reconstruction find no relationship between patellofemoral cartilage degeneration and the increased tibia external rotation angle relative to the femur.Moreover,after the ACL reconstruction,if the femur tibia angle is bigger than the range of motion of the knee,it cannot be concluded that the anterior cruciate ligament is reruptured.

[Summary] Gender difference study of meniscus injury shows certain clinical significance in understanding epidemiologic characteristics of meniscus injury .Several large amount case studies demonstrated that the risk of meniscus tears was significantly higher in male than in female .However , in certain kinds of sports and special types or locations of meniscus tears , especially in medial meniscus posterior root tear ( MMPRT ) , there were more females than males .Further large amount case studies were needed for a deeper understanding of meniscus tears .In this paper,we reviewed the current situation and progress of gender difference of menisus tear .

BACKGROUND: Thawed allografts are usually discarded for various reasons. Whether these discarded allografts can be refrozen for later use and their histological changes in vivo have not been reported. OBJECTIVE: To investigate the histological characteristics of anterior cruciate ligament (ACL) reconstructed with the repetitive freeze-thawing allogenic Achilles tendon in New Zealand white rabbits. METHODS: Allogenic Achilles tendons were harvested from adult male New Zealand white rabbits, and were stored at -8 ℃ and thawed at 20 ℃ for 1, 2, 3 and 10 times, respectively, after sealed package and 60Co irradiation. Twenty-four adult male New Zealand white rabbits were enrolled: the left and right knees of 12 rabbits were respectively reconstructed with 1 (control group) and 2 times of freeze-thawing allogenic Achilles tendon, and another 12 rabbits underwent reconstruction with 3 and 10 times of freeze-thawing allogenic Achilles tendon, respectively. Three specimens from each group were evaluated with modified histology grading scores at 6, 12 and 24 weeks to assess the cell morphology, cell quantity, matrix staining intensity, fibrocartilage formation, new bone formation, tendon healing and cartilage injury. RESULTS AND CONCLUSION: The cell morphology, matrix staining intensity and total scores of the 10 times group were significantly higher than those of the other groups at 6 weeks (P < 0.05), but other parameters showed no significant differences among groups (P > 0.05). ACL reconstructed with 10 times of repetitive freeze-thawing allogenic Achilles tendons had higher histological scores at 6 weeks after modeling, but no significant differences were shown at 12 and 24 weeks after modeling. To conclude, our study only testifies better histological scores on the multiple times of freezethawing Achilles tendon than the less times of freeze-thawing Achilles tendon at the early period after operation.

Objective To study the biological behavior of peripheral blood mesenchymal stem cells (PBMSCs) in 3D composite scaffolds.Methods The proliferation and chondrogenesis of rabbit PBMSCs seeded on porcine cancellous bone (DCB) scaffolds were evaluated,and bone marrow mesenchymal stem cells (BMMSCs) and articular chondrocytes (ACCs) were used as controls.Cell morphology and distribution in scaffolds were observed using scanning electron microscopy (SEM).Live/Dead staining was employed to detect cell viability,Hoechst 33258 method to measure DNA content,dimethylmethylene blue (DMMB) assay to detect glycosaminoglycan (GAG),enzyme-linked immunosorbent assay (ELISA) and immunofluorescence to detect the content of type 2 collagen (COL 2),and RT-PCR to analyze chondrogenesis-related gene expression.Results SEM showed that three kinds of cells uniformly adhered and evenly distributed in DCB scaffolds.Live/Dead staining observed the similar viability of the three kinds of cells three days after seeding (P＞0.05).There was no significant difference in the proliferation ability and DNA content among three kinds of cells after seven days of in vitro culture.After 21 days of chondrogenic culture,both PBMSCs and BMMSCs secreted more GAGs than ACCs,while the secretion of COL 2 was similar to that of ACCs.Moreover,the gene expression of AGC,COL 2 and alkaline phosphatase (ALP) were significantly up-regulated (P＜0.05) in PBMSCs and BMMSCs but significantly down-regulated in ACCs (P＜0.05).The expression of COL 1 in MSCs groups displayed an increasing trend but a decreasing trend in ACCs group (P＞0.05).The gene expression of COL 2 and ALP,but not of AGC and COL 1,in PBMSCs and BMMSCs was higher than those in ACCs (P＜0.05).Conclusions PBMSCs and BMMSCs have similarly excellent proliferation and chondrogenesis potential in 3D porous DCB scaffolds.However,hypertrophic gene expression is still observed under in vitro culturing condition,suggesting the need to further optimize the culture system.

BACKGROUNDThe tibial plateau is asymmetric with a larger medial plateau. We observed from clinical practice that the shape of the tibial plateau does not always present a larger medial plateau. Tibial plateau also showed other shapes. The purpose of this study was to analyze the anthropometric data of the proximal tibia in a large group of Chinese patients undergoing total knee arthroplasty and to investigate the morphology of the resected proximal tibial surface and its gender differences.

METHODSA total of 822 knees (164 males, 658 females) from the Chinese population were measured intraoperatively for medial anteroposterior (MAP) and lateral anteroposterior (LAP) dimensions of the resected proximal tibial surface. The difference of MAP and LAP (DML) was also calculated as MAP minus LAP. We then classified the data into three groups based on the DML (<-2, -2 to 2, and >2 mm) to analyze the morphology of the proximal tibia and its distribution between male and female.

RESULTSThe shape of proximal tibial plateau was of three types: larger medial plateau type, symmetric type, and larger lateral plateau type. There were significant differences between males and females in relation to the shape distribution of the proximal tibial plateau (P < 0.05). Most of the proximal tibial plateau was asymmetric, with 517 of 822 (62.9%) tibia having a DML >2 mm and 120 of 822 (14.6%) tibia having a DML<-2 mm. Only 185 of 822 (22.5%) tibia had a DML between -2 and 2 mm.

CONCLUSIONThe results of this study can be used as a guideline to design tibial components with different DMLs to better match the different anthropometry of the resected tibial surface.

Aged ; Anthropometry ; methods ; Arthroplasty, Replacement, Knee ; methods ; Asian Continental Ancestry Group ; Female ; Humans ; Knee Joint ; surgery ; Male ; Middle Aged ; Sex Factors ; Tibia ; surgery

Objective To evaluate the diagnostic value of different sequences of magnetic resonance imaging (MRI) in repaired meniscus.Methods From September 2002 to December 2008,118 patients (130 menisci) underwent arthroscopic meniscus suture in our hospital,including 94 males and 24 females,aged from 15 to 50 years (average,25.7t7.5 years).All patients underwent MRI and second-look arthroscopy postoperatively.Different sequences of MRI were taken to evaluate the grade of meniscal signal at repaired site and the slices involved by grade 3 signal.The diagnostic sensitivity,specificity,accuracy,positive predict value (PPV) and negative predict value (NPV) were calculated for each sequence by using second-look arthroscopy as the gold standard.Results The total healing rate was 80.8％ (105/130) by second-look arthroscopy,which was higher than that by different sequences of MRI.The integrated T2 sequence held the highest diagnostic value,and the sensitivity,specificity,accuracy,PPV and NPV were 76.0％,71.4％,72.3％,38.8％ and 92.6％,respectively.According to the second-look arthroscopy result,the menisci were divided into the healed group and unhealed group.In the healed group,28.6％ of cases (30/105) showed grade 3 signal in MRI,which was less than that (76.0％) in the unhealed group.The rate of the new grade 3 signal (8.6％) and the slices involved by grade 3 signal (0.8±1.0) in the healed group were less than those (16.0％ and 3.0±2.0) in the unhealed group.Conclusion The diagnostic value of the integrated T2 sequence is encouraging with high sensitivity,specificity and accuracy.The new grade 3 signal in the repaired meniscus usually implies that the meniscus is not healed.