Objective To investigate the early effectiveness of fixed-bearing unicompartmental knee arthroplasty (FBUKA) in patients with anterior cruciate ligament deficiency (ACLD), and to evaluate postoperative muscle strength and functional recovery through isokinetic muscle strength testing. Methods A retrospective analysis was performed on the clinical data of 181 patients with unilateral medial compartment knee osteoarthritis who underwent FBUKA treatment between January 2023 and June 2024 and met the selection criteria. According to the integrity of the anterior cruciate ligament, the patients were divided into the ACLD group (45 cases) and the anterior cruciate ligament intact (ACLI) group (136 cases). There was no significant difference in baseline data between the two groups (P>0.05), including age, gender, body mass index, affected side, disease duration, and preoperative Hospital for Special Surgery (HSS) score, Lysholm score, and visual analogue scale (VAS) score. A standardized rehabilitation protocol was adopted after surgery. Isokinetic muscle strength parameters [peak torque (PT) and total work (TW) of quadriceps and hamstring, and hamstring-to-quadriceps ratio (H/Q) at angular velocities of 60°/s and 180°/s] and HSS score, Lysholm score, and VAS score were measured preoperatively and at 6 weeks, 3 months, 6 months, and 12 months after operation; posterior tibial slope (PTS) was measured at 12 months after operation. Results All patients were followed up 12-18 months, with a mean of 13.6 months. No complication such as aseptic loosening of the prosthesis, dislocation of the mobile bearing insert, infection, or revision occurred after operation. Isokinetic muscle strength testing showed that at angular velocities of 60°/s and 180°/s, the PT and TW of quadriceps and hamstring significantly decreased and H/Q increased in both groups at 6 weeks after operation when compared with preoperative values (P<0.05); then PT and TW increased gradually, and H/Q decreased gradually. Except for no significant difference at 3 months after operation compared with preoperative values (P>0.05), all indicators were significantly different from preoperative values at 6 and 12 months after operation (P<0.05). There was no significant difference in isokinetic muscle strength parameters between the two groups at any time point before and after operation (P>0.05). The HSS score, Lysholm score, and VAS score at each postoperative time point in both groups significantly improved when compared with preoperative values (P<0.05), and there was no significant difference in each score between the two groups at each postoperative time point (P>0.05). At 12 months after operation, the PTS in the ACLD group was significantly smaller than that in the ACLI group (P<0.05). Conclusion For ACLD patients without anteroposterior knee instability, the isokinetic muscle strength recovery trajectory and clinical functional scores after FBUKA are comparable to those of ACLI patients. For such patients, FBUKA can achieve satisfactory muscle strength and functional recovery, and isokinetic muscle strength testing can provide objective quantitative evidence for postoperative rehabilitation evaluation.
Objective To investigate the operational method of cervical vertebral flavectomy and its cl inical appl ication in the management of cervical canal stenosis.? Methods From June 1997 to June 2007, 25 patients suffering from cervical spinal canal stenosis caused by obvious flaval l igament hypertrophy were given flavectomy. There were 22 males and 3 females, with an age range of 32 to 68 years (average 54 years). The course of disease was from 3 weeks to 7 years, with an average of 3 years and 7 months. All patients had degenerative cervical canal stenosis; of them, 5 cases had a history of cervical injury 2 to 3 weeks before operation (3 cases of fall ing injury and 2 cases of traffic accident injury). The X-ray film, CT, and MRI examinations showed that the compression locations were C4-7 in 12 cases, C3-7 in 9 cases, C5-7 in 3 cases, and C6,7 in 1 case. Spinous process and vertebral lamella were exposed by central posterior approach. The insertions of flaval l igaments were cut off at the superior vertebral lamella border, then the starting points of which were cut down from the anterior side of the upper vertebral lamella at their inferior border after l ifting up the flaval l igaments. The residual flaval l igaments in front of the vertebral lamella were scraped off by slope rongeur, the dura mater then could be seen to inflate from the intervertebral lamella space, showing the compression having been rel ieved. Twenty-five cases were all given posterior flavectomy. At 1 week to 3 months after operation, 12 patients received anterior cervical discectomy or vertebral gaining decompression with fusion by bone graft.? Results? The time for flavectomy was from 60 to 180 minutes, with an average of 95 minutes. The blood loss during operation was from 90 to 360 mL, with an average of 210 mL. The dura maters were lacerated by knife tips during operation with the cervical vertebrae in hyperflexion in 2 cases. Immediate suture and repair were performed and there were no postoperative cerebrospinal fluid leakage. All the incisions healed by first intension after operation. All of the 25 cases were followed up from 2 to 10 years, with an average of 3 years and 9 months. All patients had no compl ication of axial symptoms, and no restenosis at their operation site of cervical canal stenosis. The section area ratios of functional spinal canal to spinal cord were 1.12 ± 0.07 before operation and 2.11 ± 0.19 at 24 months after operation, showing significant difference (P lt; 0.05). The range of motion of cervical vertebrae was (39.4 ± 3.2)o befeore operation and (42.1 ± 2.9)° at 24 months after operation in 13 cases without anterior cervical discectomy fusion, showing no significant difference (P gt; 0.05); was (34.3 ± 3.4)° before operation and (29.2 ± 3.6)° at 24 months after operation in 12 cases with anterior cervical discectomy fusion, showing significant difference (P lt; 0.05). The bone graft achieved bony union 3-5 months after operation (average 3.8 months). The Japanese Orthopaedic Association (JOA) scores were 7.9 ± 2.2 before operation and 15.6 ± 1.4 at 24 months after operation, showing significant difference (P lt; 0.05), with an average improvement rate of 86.3%.? Conclusion Cervical flavectomy could rel ieve compression to spinal cord and nerves caused by the flaval l igament hypertrophy without damaging the normal integral ity of bony canal, thus avoiding the compl ication of axial symptoms and so on which are encountered in open-door expansile cervical laminoplasty.
