OBJECTIVE: To evaluate clinical effect of quadriceps tendon autograft and bone-patellar tendon-bone autograft on anterior cruciate ligament reconstruction by Meta-analysis. METHODS: From the time of building databases to May 2019, literatures on case control study on quadriceps tendon and bone-patellar tendon-bone autograft on anterior cruciate ligament reconstruction were searched form PubMed, EMbase, the Cochrane library, Wanfang and CNKI database. Literature screening, quality evaluation and data extraction were carried out according to include and exclude standard. Difference of forward displacement between the affected and health knee, Lachman test, axial shift test, Lysholm score, international knee documentation committee (IKDC) objective grade, anterior knee joint pain and transplant failure rate were analyzed by Meta analysis. RESULTS: Totally 6 literatures were included, including 915 patients with anterior cruciate ligament reconstruction, 495 patients with quadriceps tendon autograft and 420 patients with bone patellar tendon bone autograft. There were no statistical differences in anterior displacement of tibia was less than 3 mm[=1.53, 95%CI(0.68, 3.44), =0.31], 3 to 5 mm [=0.64, 95%CI(0.31, 1.35), =0.24], greater than 5 mm[=1.18, 95%CI(0.33, 4.22), =0.80], negative rate of Lachman test[=0.88, 95%CI(0.38, 2.02), =0.76], negative rate of axial shift test[=0.63, 95%CI(0.24, 1.68), =0.36] between two groups. There were no differences in Lyshlom score[=-0.56, 95%CI(-2.00, 0.89), =0.45], IKDC objective grade A and B[=0.87, 95%CI (0.47, 1.60), =0.66], and transplant failure rate [=0.76, 95%CI (0.28, 2.02), = 0.58]. In reducing anterior knee pain, quadriceps tendon autograft was better than that of bone patellar tendon bone autograft [=0.16, 95%CI (0.09, 0.29), <0.000 01]. CONCLUSION Quadriceps tendon autograft and bone patellar tendon bone autograft on anterior cruciate ligament reconstruction has equal clinical and functional outcomes, transplant failure rate, quadriceps tendon autograft could reduce anterior knee pain. For patients with anterior cruciate ligament reconstruction, quadriceps tendon autograft could be seen as suitable alternative bone graft substitutes for anterior cruciate ligament reconstruction.
Anterior Cruciate Ligament Injuries ; surgery ; Anterior Cruciate Ligament Reconstruction ; Autografts ; Case-Control Studies ; Humans ; Patellar Ligament ; surgery ; Tendons ; Transplantation, Autologous ; Treatment Outcome

The knowledge about detailed morphology and relation of saphenous nerve is important to obtain successful saphenous nerve regional blocks to achieve pre- and post-operative anesthesia and analgesia, nerve entrapment treatments and to avoid damage of saphenous nerve during knee and ankle surgeries. The literature describing detailed morphology of saphenous nerve is very limited. We dissected 42 formalin fixed well embalmed cadaveric lower limbs to explore detailed anatomy, relation and mode of termination of saphenous nerve and measured the distances from the nearby palpable bony landmarks. The average distance of origin of saphenous nerve from inguinal crease was 7.89±1.42 cm, the distance from upper end of medial border of patella to saphenous nerve at that level was 8.11±0.85 cm, distance from tibial tuberosity was 7.53±0.98 cm and from midpoint of anterior border of medial malleolus was 0.45±0.14 cm. Saphenous nerve provided two infrapatellar branches at the level of mid to lower limit of patellar ligament in 90% cases. It was in close contact or adhered to great saphenous vein across the lower 2/3rd of leg lying either anterior, posterior or deep to the vein. The saphenous nerve terminated by bifurcating proximal to medial malleolus in majority of cases though no obvious bifurcation was observed in 9.52% cases. The detailed morphology, relations and the distances from palpable bony landmarks may be helpful for clinicians to achieve successful saphenous nerve block and to avoid saphenous nerve damage and related complications during orthopedic procedures.
Anesthesia and Analgesia ; Ankle ; Cadaver ; Deception ; Formaldehyde ; Knee ; Leg ; Lower Extremity ; Nerve Block ; Nerve Compression Syndromes ; Orthopedic Procedures ; Patella ; Patellar Ligament ; Saphenous Vein ; Veins

PURPOSE: This study aimed to investigate anterior knee symptoms in patients who underwent anterior cruciate ligament (ACL) reconstruction using bone-patellar tendon-bone (BPTB) graft followed by implantation of a beta-tricalcium phosphate (β-TCP) block as a bone void filler. MATERIALS AND METHODS: We retrospectively reviewed 84 cases of synthetic bone grafting using a β-TCP block for the patellar bone defect in ACL reconstruction with a BPTB autograft. Computed tomography of the operated knee was performed immediately after the surgery to evaluate whether the grafted β-TCP block protruded forward from the anterior surface of the patella. On the basis of the results, the cases were divided into a protrusion group (n=31) and a non-protrusion group (n=53). Anterior knee symptoms at 12 months postoperatively and absorption of the grafted β-TCP block were compared between the two groups. RESULTS: Except for patellofemoral crepitus, there was no significant difference in anterior knee symptoms between the two groups (p>0.05). The incidence of patellofemoral crepitus was significantly lower in the protrusion group than in the non-protrusion group (p=0.027). The groups showed no significant difference in β-TCP absorption. CONCLUSIONS: The present study demonstrated that the protrusion of β-TCP that was used as a bone void filler had no adverse effects.
Absorption ; Anterior Cruciate Ligament Reconstruction ; Anterior Cruciate Ligament ; Autografts ; Bone Transplantation ; Bone-Patellar Tendon-Bone Grafts ; Humans ; Incidence ; Knee ; Patella ; Retrospective Studies ; Tissue Donors ; Transplants

A 20-year-old National Serviceman presented with left knee pain and swelling after training for his physical fitness test. Lateral knee radiography and magnetic resonance (MR) imaging showed patellar tendon-lateral femoral condyle friction syndrome (PT-LFCFS), on a background of patella alta and patellar malalignment. The patient was treated non-operatively with a course of physiotherapy and given advice on rest and activity modification. PT-LFCFS is a less well-recognised but important cause of anterior knee pain and represents an entity in a spectrum of disorders related to patellofemoral instability. We herein discuss the MR imaging findings specific to and associated with this condition, as well as briefly describing treatment options. In addition, we showcase a range of commonly encountered abnormalities that affect the infrapatellar fat pad and briefly discuss their specific MR imaging findings.
Adult ; Arthralgia ; diagnostic imaging ; Female ; Femur ; diagnostic imaging ; Humans ; Knee ; diagnostic imaging ; Knee Injuries ; diagnostic imaging ; therapy ; Knee Joint ; diagnostic imaging ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Pain ; diagnostic imaging ; Patella ; diagnostic imaging ; Patellar Ligament ; diagnostic imaging ; Physical Therapy Modalities ; Radiography ; Young Adult

BACKGROUND: We conducted this study to determine the optimal length of patellar and tibial bone blocks for the modified transtibial (TT) technique in anterior cruciate ligament (ACL) reconstruction using the bone-patellar tendon-bone (BPTB) graft. METHODS: The current single-center, retrospective study was conducted in a total of 64 patients with an ACL tear who underwent surgery at our medical institution between March 2015 and February 2016. After harvesting the BPTB graft, we measured its length and that of the patellar tendon, patellar bone block, and tibial bone block using the arthroscopic ruler and double-checked measurements using a length gauge. Outcome measures included the length of tibial and femoral tunnels, inter-tunnel distance, length of the BPTB graft, patellar tendon, patellar bone block, and tibial bone block and graft-tunnel length mismatch. The total length of tunnels was defined as the sum of the length of the tibial tunnel, inter-tunnel distance and length of the femoral tunnel. Furthermore, the optimal length of the bone block was calculated as (the total length of tunnels − the length of the patellar tendon) / 2. We analyzed correlations of outcome measures with the height and body mass index of the patients. RESULTS: There were 44 males (68.7%) and 20 females (31.3%) with a mean age of 31.8 years (range, 17 to 65 years). ACL reconstruction was performed on the left knee in 34 patients (53%) and on the right knee in 30 patients (47%). The optimal length of bone block was 21.7 mm (range, 19.5 to 23.5 mm). When the length of femoral tunnel was assumed as 25 mm and 30 mm, the optimal length of bone block was calculated as 19.6 mm (range, 17 to 21.5 mm) and 22.1 mm (range, 19.5 to 24 mm), respectively. On linear regression analysis, patients' height had a significant correlation with the length of tibial tunnel (p = 0.003), inter-tunnel distance (p = 0.014), and length of patellar tendon (p < 0.001). CONCLUSIONS: Our results indicate that it would be mandatory to determine the optimal length of tibial tunnel in the modified TT technique for ACL reconstruction using the BPTB graft. Further large-scale, multi-center studies are warranted to establish our results.
Anterior Cruciate Ligament Reconstruction* ; Anterior Cruciate Ligament* ; Body Mass Index ; Bone-Patellar Tendon-Bone Grafts ; Female ; Humans ; Knee ; Linear Models ; Male ; Outcome Assessment (Health Care) ; Patellar Ligament ; Retrospective Studies ; Tears ; Transplants*

PURPOSE: The purpose of this study was to evaluate the results of high-flexion total knee arthroplasty. MATERIALS AND METHODS: We evaluated 355 patients (372 cases) who underwent total knee arthroplasty using high-flexion implants from January 2005 to December 2011. The patients included 36 men and 336 women with a mean age of 70.6 (52-88 years) years. Average follow-up duration was 59 months (36-77 months) months. Three types of high flexion implants were used in this study. We performed preoperative assessment and last follow-up clinical evaluation was performed using range of motion (ROM), knee score and function score according to the knee society clinical rating system and complications. Radiologic evaluation was performed using plain radiographs to evaluate loosening or osteolysis. RESULTS: The mean ROM increased from 114.9° preoperatively to 127.0° at the final follow-up. The average knee score improved from 60.5 points preoperatively to 90.9 points at final follow-up and knee function score improved from 49.0 to 84.4 points. The clinical results were improved in each type of implants. A radiolucent line was detected in 2 cases in the Sigma rotating platform flexion group and patellar tendon rupture occurred in 1 case in the NexGex legacy posterior-stabilized-flex group. Infection occurred in 2 cases after 2 and 5 years postoperatively in the Scorpio non-restrictive geometry group and were treated with revision arthroplasty. No significant loosening was observed. CONCLUSION: This study obtained good results after total knee arthroplasty using high-flexion implants, and no loosening was observed. There were no differences in the type of implants in regard to the ROM and clinical variables.
Arthroplasty* ; Female ; Follow-Up Studies* ; Humans ; Knee* ; Male ; Osteolysis ; Patellar Ligament ; Range of Motion, Articular ; Rupture

Bilateral patella tendon rupture is rare, particulary when associated with osteogenesis imperfecta. Brittleness of the bone in osteogenenesis imperfect patients may cause this rupture. We report on this rare case and suggest the direct repair with the additional wire loop as a proper treatment option for patients with the substantial rupture of patella tendon.
Humans ; Osteogenesis Imperfecta* ; Osteogenesis* ; Patellar Ligament* ; Rupture*

PURPOSE: This study aims to evaluate magnetic resonance imaging (MRI) findings in young adults with symptomatic Osgood-Schlatter disease (OSD) and compare those in young adults without OSD. MATERIALS AND METHODS: We compared MRI findings between young adults with OSD (OS group, n=30) and the equivalent number of young adults without OSD (control group). Visual analog scale scores and Kujala scores were evaluated and correlation analysis was performed in the OS group. RESULTS: In the OS group, MRI revealed that the patellar tendon was attached to the tibia more widely, resulting in a reduced free tendon portion, and more proximally to the articular surface (p<0.001). The correlation analysis between MRI findings and clinical scores showed statistically significant correlations (p<0.01). In the OS group, 43% presented with patellar tendinopathy or bone marrow edema at the distal attachments. CONCLUSIONS: Compared to the control group, the relatively small free portion and relatively proximal attachment of the patellar tendon were observed with MRI in the OS group. The free portion of the patellar tendon was positively correlated with the clinical scores. Patellar tendinopathy was also frequently encountered in the OS group.
Bone Marrow ; Edema ; Humans ; Knee ; Magnetic Resonance Imaging ; Osteochondrosis ; Patellar Ligament ; Tendinopathy ; Tendons ; Tibia ; Visual Analog Scale ; Young Adult

OBJECTIVETo explore the effectiveness of hamstring tendon graft embedding reconstruction of medial patellofemoral ligament for the treatment of recurrent dislocation of the patella.

METHODSFrom March 2008 to June 2013,67 patients with recurrent dislocation of patella were treated, including 28 males, 39 females with an average age of 22 years ranging from 10 to 42 years old. The clinical manifestations involved knee joint instability,"giving way", sense of patellar dislocation, anterior knee pain. All 67 patients underwent arthroscopic hamstring tendon graft embedding reconstruction of the medial patellofemoral ligament. The curative effect were evaluated by preoperative and postoperative Lysholm score and Q angle changes.

RESULTSAll cases were followed up after operation and the mean follow-up time was(27.5±13.4) months(4 to 69 months). Postoperative incision were healed well and no patellar dislocation or subluxation occurred. Lysholm score improved from preoperative 76.35±2.86 to 82.71±2.29 postoperatively; Q angle decreased from preoperative (18.75±2.33)° to postoperative(13.28±1.75)°.

CONCLUSIONThe method for the reconstruction of medial patellofemoral ligament can provide enough tension, patellar stability.imoroving the function of knee ioint.

Adolescent ; Adult ; Child ; Female ; Humans ; Male ; Patellar Dislocation ; surgery ; Patellar Ligament ; surgery ; Patellofemoral Joint ; surgery ; Reconstructive Surgical Procedures ; methods ; Recurrence ; Tendons ; transplantation

BACKGROUNDHamstring (HS) autograft and bone-patellar tendon-bone allograft are the most common choice for reconstruction of anterior cruciate ligament (ACL). There was a little report about the clinical outcome and difference of arthroscopic ACL reconstruction using allograft and autograft. This study aimed to compare the clinical outcome of autograft and allograft reconstruction for ACL tears.

METHODSA total of 106 patients who underwent surgery because of ACL tear were included in this study. The patients were randomly divided into two groups, including 53 patients in each group. The patients in group I underwent standard ACL reconstruction with HS tendon autografts, while others in group II underwent reconstruction with bone-patellar tendon-bone allograft. All the patients were followed up and analyzed; the mean follow-up was 81 months (range: 28-86 months). Clinical outcomes were evaluated using the International Knee Documentation Committee (IKDC), Lysholm scores, physical instability tests, and patient satisfaction questionnaires. The complication rates of both groups were compared. Tibial and femoral tunnel widening were assessed using lateral and anteroposterior radiographs.

RESULTSAt the end of follow-up, no significant differences were found between the groups in terms of IKDC, Lysholm scores, physical instability tests, patient satisfaction questionnaires, and incidences of arthrofibrosis. Tibial and femoral tunnel widening was less in the HS tendon autografts. This difference was more significant on the tibial side.

CONCLUSIONSIn the repair of ACL tears, allograft reconstruction is as effective as the autograft reconstruction, but the allograft can lead to more tunnel widening evidently in the tibial tunnel, particularly.

Adolescent ; Adult ; Anterior Cruciate Ligament Injuries ; surgery ; Anterior Cruciate Ligament Reconstruction ; methods ; Female ; Humans ; Male ; Patellar Ligament ; surgery ; Transplantation, Autologous ; methods ; Transplantation, Homologous ; methods ; Treatment Outcome ; Young Adult