PURPOSE: To evaluate the clinical outcome in patients who received anterior cruciate ligament (ACL) reconstruction via anteromedial portal with or without posterior wall blowout. METHODS: Twenty patients with ruptured ACL, who have received ACL reconstruction via anteromedial portal between Apr 2012 and Oct 2013 were enrolled. According to the conditions of posterior wall, the patients were divided into 2 groups: posterior wall blowout group (10 patients) and posterior wall intact group (10 patients). The median follow up time were 63 (range 19-75) months and 60.5 (range 25-64) months in the 2 groups respectively. The clinical outcome was evaluated by knee joint physical examination, magnetic resonance imaging (MRI), the International Knee Documentation Committee (IKDC) 2000 subjective score, Lysholm score, Tenger score, difference of thigh circumference, KT-2000 and Biodex isokinetic dynamometer system. RESULTS: No significant differences were found in terms of the IKDC score, Lysholm score, Tegner score, Lachman test positive rate or Pivot Shift test positive rate between the two groups. In KT-2000 and Biodex isokinetic dynamometer tests, the difference of muscle strength between affected knees and unaffected knees in posterior wall blowout group was not significant less than that of posterior wall intact group (p > 0.05). In addition, there is no statistical difference between the two groups in signal/noise quotient (SNQ) of the graft (p > 0.05) in post operative MRI. CONCLUSION Blowout of posterior wall in ACL reconstruction via anteromedial portal does not affect the clinical outcome as long as reliable fixation is taken intraoperatively.
Adolescent ; Adult ; Anterior Cruciate Ligament ; pathology ; surgery ; Anterior Cruciate Ligament Injuries ; diagnosis ; pathology ; rehabilitation ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Orthopedic Procedures ; methods ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Time Factors ; Treatment Outcome ; Young Adult

OBJECTIVE: To investigate the effect and mechanism of mechanical stress on cartilage repair in inflammatory environment. METHODS: The chondrogenic progenitor cells (CPCs) were isolated from the knee joint cartilage of patients with osteoarthritis (OA) undergoing total knee arthroplasty. The CPCs were cultured and expanded in a 3-D scaffold constructed with alginate. Intermittent hydrostatic pressure (IHP) was applied in a inflammatory environment induced by IL-1β, and Western blot was used to detect the expression of MAPK signaling pathway proteins. Cell proliferation was detected by CCK-8 method, and the expression of related genes like matrix metallo-proteinases 13 (MMP-13) and a disintegrins and metalloproteinase with thrombospondin motif 5 (ADAMTS-5) was detected by real-time RT-PCR. The anterior cruciate ligament of the rats was cut to construct the knee joint OA model, and the appropriate mechanical stress was constructed with external fixation to distract the knee joint in order to observe the repair of the cartilage and to explore its mechanism. RESULTS: Adding 0.01 ng/ml IL-1β in cell culture inhibited the proliferation of CPCs. After IHP application, the expression of MAPK pathway protein was decreased, the mRNA expression of MMP-13 and ADAMTS-5 was reduced. The inhibition of IL-1β on CPCs was counteracted by IHP. Four weeks after the anterior cruciate ligament resected, the articular cartilage degeneration was observed in rats. The Mankin score in the OA treatment (joint distraction) group was lower, and the cartilage repair was better than that of the control group (<0.01). Animal experiments found that the suitable mechanical stress reduced the expression of P-p38, MMP-13 and COLL-X, inhibited cartilage cells apoptosis and promoted the repair of OA cartilage. CONCLUSIONS Mechanical stress can promote the proliferation of CPCs, reduce the expression of matrix degrading enzymes, and promote the repair of OA cartilage by inhibiting MAPK signaling pathway.
Animals ; Anterior Cruciate Ligament ; pathology ; surgery ; Cartilage, Articular ; pathology ; Cells, Cultured ; Chondrocytes ; cytology ; Disease Models, Animal ; Gene Expression Profiling ; Humans ; Mitogen-Activated Protein Kinases ; genetics ; Osteoarthritis ; pathology ; Polymerase Chain Reaction ; Rats ; Signal Transduction ; genetics ; Stress, Mechanical

OBJECTIVETo investigate the protective effect of LR-90 on articular cartilage in rabbit model of osteoarthritis.

METHODSThe cultured rabbits chondrocytes were assigned to be treated with IL-1β (10ng/ml) or IL-1β (10ng/ml)+LR-90 (50 mg/L). The mRNA expression of MMP-13, ADAMTS-5, aggrecan and collagen II in chondrocytes were assessed by real-time quantitative reverse transcription polymerase chain reaction (RT-PCR). Twenty male New Zealand white rabbits underwent bilateral anterior cruciate ligament transection (ACLT) to establish a animal model of osteoarthritis. Four weeks after model established, on the basis of randomization one knee of each rabbit was treated with 50 mg/L LR-90 in normal saline (NS) (experimental group) and the other knee was treated with same volume of NS (control group), 1/week × 5. Nine weeks after ACLT all rabbits were sacrificed and the knee joints were evaluated by gross morphology and histology. The mRNA expression of IL-1β, MMP-13, ADAMTS-5, aggrecan and collagen Ⅱ in articular cartilage was analyzed by RT-PCR.

RESULTSGross morphology and Mankin histological evaluation showed that the extent and grade of cartilage damage in the experimental group were less severe than those in the control group.Compared to IL-1β group, LR-90 treatment suppressed the mRNA expression of MMP-13 and ADAMTS-5, and enhanced aggrecan and collagen Ⅱ mRNA expression. Consistent with the in vitro results, the intraarticular LR-90 administration suppressed the mRNA expression of IL-1β,MMP-13 and ADAMTS-5 (all P<0.01), while enhanced mRNA expression of aggrecan and collagen Ⅱ in cartilage (all P<0.01).

CONCLUSIONLR-90 protects against cartilage degradation and inhibits the progression of osteoarthritis in rabbit mode1 of osteoarthritis, which is associated with the suppressing IL-1β, MMP-13, ADAMTS-5 and promoting aggrecan and collagen Ⅱ mRNA expression in cartilage.

ADAM Proteins ; metabolism ; Aggrecans ; metabolism ; Animals ; Anterior Cruciate Ligament ; surgery ; Butyrates ; pharmacology ; Cartilage, Articular ; metabolism ; pathology ; Cells, Cultured ; Chondrocytes ; metabolism ; Collagen Type II ; metabolism ; Disease Models, Animal ; Injections, Intra-Articular ; Interleukin-1beta ; pharmacology ; Male ; Matrix Metalloproteinase 13 ; metabolism ; Osteoarthritis ; drug therapy ; Rabbits

OBJECTIVETo investigate the relationship between degree of abnormal deeper lateral femoral notch between anterior cruciate ligament tear.

METHODSThe radiograph and MRI image material of 16 patients with anterior cruciate ligament injury from January 2013 to November 2013 were reviewed including 14 males and 2 females with an average age of 28.3 years old ranging from 18 to 52 years. Eleven cases was on right side and 5 on left. Survey tool of PASC imaging system was used to measure the depth of lateral femoral notch in patients with abnormal indicated by lateral X-ray view or sagittal view of MRI in knee joint,while clinical data,physical examination,image material in arthroscopy of these patients were retrospective researched.

RESULTSFour patients had an abnormal lateral femoral notch with the depth of 2 mm on lateral X-ray and sagittal MRI, while positive anterior drawer sign and Lachman test as well as anterior cruciate ligament tears on MRI, and completed tears were comfirmed on the operation of arthroscopy. Two patients without abnomal lateral femoral notch on lateral view of X-ray while with the depth of 1 mm on sagittal view of MRI were also coupled with positive anterior drawer sign and Lachman test as well as anterior cruciate ligament tears on MRI, and one of them were comfirmed completed anterior cruciate ligament tears on the arthroscopy operation and completed tear could not comfirmed on another one because of disagreed with arthroscopy operation.

CONCLUSIONThere appears to be an association between abnormal lateral femoral notch on lateral view of knee with anterior cruciate ligament tears. An abnormal deeper lateral femoral notch is an indirect evidence for anterior cruciate ligament tears.

Adult ; Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Female ; Femur ; pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged

Intra-articular ganglion cysts of the anterior cruciate ligament (ACL) are rare, and bilateral ganglion cysts are even rarer. These cysts may cause intermittent or chronic nonspecific knee discomfort. Although three cases of bilateral ganglion cysts have been reported in the literature, the knees were not simultaneously affected in those cases. Herein, we report the case of a 56-year-old woman who presented with simultaneous bilateral ganglion cysts of the ACL that were symptomatic. She was successfully treated with arthroscopic resection and debridement. We also present a brief review of the literature, highlighting the aetiology, diagnosis and management of ganglion cysts of the ACL. To the best of our knowledge, this is the first report of simultaneous bilateral intra-articular ganglion cysts of the ACL.
Anterior Cruciate Ligament ; pathology ; surgery ; Arthroscopy ; methods ; Debridement ; methods ; Delayed Diagnosis ; Female ; Ganglion Cysts ; diagnosis ; surgery ; Humans ; Magnetic Resonance Imaging ; Middle Aged

BACKGROUND: Meniscus tears are commonly associated with anterior cruciate ligament (ACL) ruptures. It is essential to repair meniscal tears as much as possible to prevent early osteoarthritis and to gain additional stability in the knee joint. We evaluated the results of arthroscopic all-inside repair using the Meniscal Viper Repair System (Arthrex) on meniscus tears simultaneously with ACL reconstruction. METHODS: Nineteen out of 22 patients who were treated with arthroscopic all-inside repair using the Meniscal Viper Repair System for meniscus tear associated with ACL rupture were evaluated. ACL reconstructions were performed at the same period. The mean follow-up period was 16.5 months (range, 12 to 24 months). The clinical results of the meniscus repair were evaluated by symptoms (such as catching or locking), tenderness, effusion, range of motion limitation, and the McMurray test. Clinical success was defined by negative results in all five categories. The Hospital for Special Surgery (HSS) score was evaluated. Objective results were evaluated with secondary look arthroscopy or magnetic resonance imaging (MRI). The MRI results were categorized as completely repaired, incompletely repaired, and failure by Henning's classification. The results of second-look arthroscopy were evaluated with the criteria of meniscal healing. RESULTS: The clinical success rate was 95.4% and the HSS scores were 93.9 +/- 5.4 at the final follow-up. According to Henning's classification, 15 out of 18 cases showed complete healing (83.3%) and two cases (11.1%) showed incomplete healing. Seventeen out of 18 cases that underwent second-look arthroscopy showed complete healing (94.4%) according to the criteria of meniscal healing. Only one case showed failure and the failure was due to a re-rupture at the sutured area. Complications of ACL reconstruction or meniscus repair were not present. CONCLUSIONS: The results demonstrate that arthroscopic all-inside repair using the Meniscal Viper Repair System is an effective treatment method when it is performed simultaneously with ACL reconstruction.
Adolescent ; Adult ; Anterior Cruciate Ligament/*injuries/pathology/*surgery ; *Anterior Cruciate Ligament Reconstruction ; Arthroscopy/*methods ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Menisci, Tibial/*injuries/pathology/*surgery ; Middle Aged ; Rupture ; Second-Look Surgery ; Treatment Outcome ; Young Adult

The localized type of tenosynovial giant cell tumor usually occurs on the palmar side of fingers and toes. Tenosynovial giant cell tumors of the tendon sheath are rarely intra-articular. We report a giant cell tumor of the tendon sheath arising from femoral attachment of the anterior cruciate ligament and its treatment with arthroscopy in a 28-year-old man.
Adult ; Anterior Cruciate Ligament/pathology/surgery ; Arthroscopy ; Femur ; Giant Cell Tumors/diagnosis/surgery ; Humans ; Knee ; Male ; Synovitis, Pigmented Villonodular/diagnosis/*surgery ; Tendons/*pathology

BACKGROUNDExtension loss caused by anterior cruciate ligament (ACL) remnants nodule was usually reported by case reports. There is no systematic report analyzing ACL remnants nodule. The purpose of this study was to investigate the characteristics of extension loss caused by remnants of ACL after injury.

METHODSFrom June 2008 to December 2011, ACL remnants were observed by arthroscopy in 1012 cases with ACL injuries at the time of primary reconstruction. ACL remnants nodules were recorded. The time of extension loss occurrence caused by ACL remnants nodule, associated symptom and sign, magnetic resonance imaging (MRI), and arthroscopic findings were observed. Histological examination was performed on the lesion resected.

RESULTSTwenty-four cases with ACL remnants nodules were found by arthroscopy. Among them extension loss caused by remnants of ACL happened in 19 cases (male 13; female 6). The average extension loss were 9.1° (range, 5° - 20°). The average time from injury to operation was 8.9 weeks (range, 3 - 26 weeks). The remnants of ACL depressed in the inter-condylar notch were found on MRI in 15 cases with extension loss. The rupture locations of ACL were all close to the upper insertion of ACL. The microscopic examination of the resected remnants of ACL revealed disorganized fibrous connective tissue and tissue of ACL ligament.

CONCLUSIONSAmong 1012 ACL injury cases, 24 ACL remnants nodules were found with arthroscopy and 19 nodules could cause knee extension loss. ACL remnants nodule should be paid attention to as a potential cause of extension loss.

Adolescent ; Adult ; Anterior Cruciate Ligament ; pathology ; surgery ; Arthroscopy ; Female ; Humans ; Knee Joint ; pathology ; surgery ; Male ; Middle Aged ; Young Adult

A 35-year-old female patient with previous left knee anterior cruciate ligament repair for a skiing injury presented six years later with a traumatic lateral patellar subluxation. Radiographs and magnetic resonance imaging of her left knee joint showed an ossific structure in the region of the lateral meniscus. This was diagnosed as a meniscal ossicle and confirmed during successful arthroscopic excision. The imaging features of meniscal ossicles are reported.
Adult ; Anterior Cruciate Ligament ; surgery ; Anterior Cruciate Ligament Injuries ; Arthroscopy ; Bone and Bones ; pathology ; Diagnostic Imaging ; methods ; Female ; Humans ; Knee Joint ; diagnostic imaging ; pathology ; Magnetic Resonance Imaging ; Menisci, Tibial ; diagnostic imaging ; pathology ; Postoperative Complications ; Radiographic Image Interpretation, Computer-Assisted ; Tibial Meniscus Injuries

OBJECTIVESTo investigate whether tibial intercondylar hyperplasia can cause anterior cruciate ligament (ACL) injuries.

METHODSFrom February 2009 to October 2012, 58 cases (including 70 knees) with knee osteoarthritis (KOA) without trauma history were selected from the out-patient department of orthopaedics in Guang'anmen Hospital attached to China Academy of Chinese Medical Science. All cases were tested by MRI scanning, then vertical height of the medial and lateral intercondylar spine in coronal position and the area of abnormal signal of ACL in sagittal position were tested from patients. Correlation between the height of intercondylar spine and the area of abnormal signal of ACL were analyzed.

RESULTSFives cases of 58 cases( 70 knees) were excluded from episome in knee joint, and other 65 knees were in accordance with the inclusion criteria. Among them, there were 10 males and 48 females aged from 39 to 79 years old with an average of 61 years old. The vertical height of the medial intercondylar spine was (10.02 +/- 1.46) mm and lateral was (8.92 +/- 1.69) mm. The area of abnormal signal ACL was (318.42 +/- 130.10) mm2. There was positive correlation between the height of medial intercondylar spine and the area of abnormal signal of ACL (r=0.06, P=0.00). But there was no correlation between lateral intercondylar spine and the area of abnormal signal of ACL (P=0.10).

CONCLUSIONThe height of medial intercondylar spine and the area of abnormal signal of ACL is positively correlated. The clinical significance is in study, while the clinical meaning still need further study.

Adult ; Aged ; Anterior Cruciate Ligament ; abnormalities ; diagnostic imaging ; surgery ; Female ; Humans ; Hyperplasia ; diagnostic imaging ; surgery ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Osteoarthritis, Knee ; diagnostic imaging ; surgery ; Radiography ; Tibia ; diagnostic imaging ; pathology ; surgery