Objective To provide the anatomic evidences and the choice of tendon graft for anatomic reconstruction of posterolateral complex through the morphological and biomechanical study on posterolateral structures of the knee in normal adult cadavers. Methods Twenty-three fresh lower l imb specimens from voluntary donators and 9 lower l imbs soaked by Formal in were selected for anatomic study on the posterolateral complex of the knee. Six fresh specimens were appl ied to measure the maximum load, intensity of popl iteus tendon, lateral collateral l igament, and popl iteofibular l igament, which were key components of the posterolateral complex. Results Popl iteus musculotendinous junction was located at 7.02-11.52 mm beneath lateral tibial plateau and 8.22-13.94 mm medially to fibular styloid process. The distances from femoral insertion of popl iteus tendon to the lower border of femoral condyle and to posterior edge of femoral condyle were 10.52-14.38 mm and 14.24-26.18 mm, respectively. Popl iteofibular l igament originated from popl iteus musculotendinous junction and ended at fibular styloid process. Lateral collateral l igament was located at 10.54-16.48 mm inferior to fibular styloid process, and the distances from femoral insertion to the lower border of femoral condyle and to posterior edge of femoral condyle were 14.92-19.62 mm and 14.66-27.08 mm, respectively. The maximum load and intensity were 579.60-888.40 N and 20.50-43.70 MPa for popl iteus tendon, were 673.80-1 003.20 N and 24.30-56.40 MPa for lateral collateral l igament, and were 101.56-567.35 N and 8.94-36.16 MPa for popl iteofibular l igament, respectively. Conclusion During anatomical reconstruction of posterolateral complex, the bony tunnel of the key components should be located according to the insertion mentioned above. On the basis of this study, the maximum load and intensity of selectable grafts should exceed 833 N and 36 MPa.
Objective To introduce the research advance of the ligament injury and ligament healing.Methods Recent original articlesrelated to such aspects of ligament were reviewed extensively.Results The ligament properties would be influenced when the situations of the biochemistry and biomechanics had changed. Injuries to ligaments induce a healing response that is characterized by scar formation. Graft could not recovery the ultrastructure, anatomy and biomechanics of the normal ligament.Conclusion The healing ligament is weaker than normal one, and the graft could not reconstruct normal ligament at present.
ObjectiveTo review the research progress of tissue engineered ligament.
MethodsThe literature in recent years on tissue engineered ligament in repair of anterior cruciate ligament (ACL) injury was extensively reviewed, including cell sources, scaffold materials, growth factors, and mechanical stimulation in tissue engineered ligament.
ResultsTissue engineered ligament constructed by mesenchymal stem cells and ACL fibroblasts has been successfully used in animal experiments. It is crucial for qualified tissue engineered ligament to choose appropriate seed cells, scaffold, mechanical stimulation, and essential cytokines. To further optimize culture condition and how to realize the tissue engineered ligament in vivo better survival and prognosis need to be further studied.
ConclusionEnormous progress has been made in tissue engineered ligament for repair and regeneration of ACL. With the development of biochemistry and scaffold materials, tissue engineered ligament will be used in clinic in the near future.
With the implementation of the “Health China 2030” strategy, sports medicine has played an increasingly important role in clinical treatment, chronic disease management, and population health promotion. West China Hospital of Sichuan University has actively explored the development and optimization of its sports medicine discipline outpatient management system, establishing a comprehensive model that integrates diagnosis and treatment, functional rehabilitation, exercise-based health management, and extended care services. This article systematically summarizes the practical experiences of the sports medicine outpatient department, including subspecialty setting, exercise prescription services, outpatient assistant mechanisms, online expert teams, multi-campus coordination, and full-process health management. Emphasizing a function-oriented and patient-centered approach, the article also discusses the extended value of outpatient services in translational research, smart healthcare, and preventive health strategies. This model provides a replicable and scalable reference for the development of sports medicine outpatient clinics.
Based on peer-reviewed systematic reviews and randomized controlled trials published from January 1990 to April 2016 with regards to the management of osteoarthritis (OA) of the hip, the American Academy of Orthopaedic Surgeons (AAOS) developed the clinical practice guideline for the treatment of hip OA. This guideline provided practice recommendations including risk factors for hip OA, oral drugs and intraarticular injectables, physical therapies, perioperative hemostatic drug, anesthetic types, approach exposures, etc. The evidence of guideline was graded according to it’s strength. This article interpreted this guideline so as to provide reference for Chinese medical staffs and guideline developers.
Objective To compare the effectiveness between lower tibial tunnel placement combined with internal tension relieving suture and simple lower tibial tunnel placement for posterior cruciate ligament (PCL) reconstruction. MethodsThe clinical data of 83 patients with simple PCL injury who met the selection criteria between January 2014 and February 2022 were retrospectively analyzed. Among them, 44 patients underwent PCL reconstruction through lower tibial tunnel placement combined with internal tension relieving suture (tension relieving suture group), and 39 patients underwent PCL reconstruction through simple lower tibial tunnel placement (control group). Baseline characteristics, including gender, age, body mass index, side of injury, cause of injury, preoperative side-to-side difference (SSD) in posterior tibial translation, visual analogue scale (VAS) score, knee range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) scores (including symptom, daily activities, and knee function scores) were compared between the two groups, showing no significant difference (P>0.05). The operation time and intraoperative blood loss were recorded and compared between the two groups. The effectiveness was evaluated by Lysholm score, IKDC scores, Tegner score, VAS score, knee ROM, SSD in posterior tibial translation before operation and at last follow-up, the patient satisfaction at last follow-up, and the postoperative graft recovery was evaluated by MRI. ResultsThere was no significant difference in operation time and intraoperative blood loss between the two groups (P>0.05). All patients were followed up 12-60 months, and there was no significant difference between the two groups (P>0.05). Postoperative MRI showed that the graft was in good condition, and the reconstructed PCL graft had good signal, continuity, and tension. During the follow-up, there was no complication such as re-rupture or donor site discomfort in both groups. At last follow-up, the Lysholm score, IKDC scores, Tegner score, VAS score, knee ROM, and SSD in posterior tibial translation significantly improved in both groups when compared with those before operation (P<0.05). The changes of Lysholm score, Tegner score, IKDC knee symptom score, and SSD in posterior tibial translation between pre- and post-operation were significantly superior in the tension relieving suture group compared to the control group (P<0.05). However, no significant difference was found between the two groups in the changes of VAS score, knee ROM, IKDC daily activities score or knee function score between pre- and post-operation, and the satisfaction score (P>0.05). ConclusionLower tibial tunnel placement combined with internal tension relieving suture PCL reconstruction represents a more effective surgical approach for improving postoperative laxity of PCL and knee function recovery comparing to simple lower tibial tunnel placement PCL reconstruction.
ObjectiveTo review the current status and progress of sterilization and preservation for allograft in anterior cruciate ligament reconstruction.MethodsThe related literature about the sterilization and preservation of allografts in anterior cruciate ligament reconstruction was extensively reviewed and summarized.ResultsThere are many sterilization methods for allografts, the most commonly used method is γ-ray irradiation, but the optimal irradiation dose is still unclear. Electron beam irradiation is also available, but excessive dose is harmful to graft shaping. A combined sterilization method combining physics and chemistry methods is still being explored. Cryopreservation is the most commonly used method of preservation. In order to reduce the influence of crystals, the principle of " slow cooling and rapid rewarming” should be adhered to as far as possible.ConclusionThe processing methods of allograft can affect the effectiveness of anterior cruciate ligament reconstruction. The clinical doctors should consider the sterilization and preservation methods in practice.
ObjectivesTo systematically review the disease burden of osteoporotic fracture (OPF) in China.MethodsWe searched PubMed, EMbase, CNKI, WanFang Data and VIP database for observational studies of the disease burden of osteoporosis in China from inception to Jan 30th, 2018. Two reviewers independently screened literature, extracted data, and assessed the risk of bias of included studies.The descriptive analysis was used to analyze the economic burden of OPF in China.ResultsA total of 23 studies were included. The average cost of OPF was 27 561.27 yuan. Women were more prone to OPF than men. Hip and spinal fractures were the diseases which had higher average hospital costs.ConclusionsWomen are more prone to osteoporotic fractures than men. The higher hospital costs of OPF may cause the reason for growing financial burden of patients. Due to limited quality and quantity of the included studies, more high-quality studies are needed to verify conclusions.
