Objective To investigate the effectiveness of reconstructing medial patellofemoral l igament with hamstring tendon autografts for the treatment of recurrent patellar dislocation under arthroscopy. Methods Between January 2005 and January 2010, 22 cases of recurrent patellar dislocation were treated by lateral retinacular release and reconstructionof the medial patellofemoral ligament with hamstring tendon autografts under arthroscopy. There were 5 males and 17 females, aged 15-19 years (mean, 17.3 years). The average number of dislocation was 4 (range, 3-8). The main cl inical symptoms were pain and swell ing of knee joint, weakness in the leg, and limited range of motion (ROM). The patellar tilt test, pressing pain of patellofemoral ligament insertion, and apprehension sign showed positive results. According to International Knee Documentation Committee (IKDC) scoring criteria, the subjective IKDC score was 36.7 ± 4.7, and the Lysholm score was 69.3 ± 3.8. X-ray films showed that the patella inclined outwards. Results All incisions healed by first intention. Twenty-two cases were followed up 18-49 months (mean, 34 months). Pain and swelling of knee joint and weakness were improved obviously. No recurrence was found during follow-up. The ROM of knee in flexion and extension was improved when compared with preoperative ROM. The subjective IKDC score was 92.4 ± 5.3 and the Lysholm knee score was 91.7 ± 5.2, showing significant differences when compared with preoperative scores (P lt; 0.05). Conclusion Reconstruction of the medial patellofemoral ligament with hamstring tendon autografts under arthroscopy is an effective method to treat recurrent patellar dislocation.
Objective To investigate the effectiveness of transosseous suture in medial patellofemoral ligament (MPFL) double bundle reconstruction. Methods The clinical data of 75 patients with recurrent patella dislocation who met the selection criteria between January 2014 and December 2017 were retrospectively analyzed. All of them were treated with MPFL double bundle reconstruction, and divided into study group (39 cases, using new transosseous suture technique) and control group (36 cases, using traditional suture anchor fixation) depending on the intraoperative fixation technique. There was no significant difference in gender, age, body mass index, affected knee side, preoperative tibial tuberosity-trochlear groove distance, Insall-Salvati ratio, knee range of motion, Kujala score, International Knee Documentation Committee (IKDC) score, congruence angle, and tilt angle between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, and postoperative complications were recorded and compared between the two groups. Kujala score, IKDC score, and knee range of motion were used to evaluate the functional improvement of patients before and after operation. The congruence angle and tilt angle were measured on X-ray films. Results There was no significant difference in operation time, intraoperative blood loss, and hospital stay between the two groups (P>0.05). Patients in both groups were followed up 24-36 months, with an average of 29.4 months. There was no complication such as incision infection, fat liquefaction, patellar redislocation, and prepatellar pain during follow-up. At last follow-up, the Kujala score, IKDC score, knee range of motion, congruence angle, and tilt angle of two groups significantly improved when compared with those before operation (P<0.05), while there was no significant difference between the two groups (P>0.05). ConclusionThe application of suture anchor or transosseous suture to complete MPFL double bundle reconstruction can restore patellar stability, and there is no significant difference in the short-term effectiveness between them.
Objective
To investigate the impact of joint capsule repair and external rotators suture on the prognosis in primary total hip arthroplasty (THA) by posterolateral approach.
Methods
Between January 2006 and June 2009, 159 patients with femoral neck fracture underwent primary THA by posterolateral approach, and were divided into 4 groups according to different treatments: joint capsule repair and external rotators suture were given in group A (n=38), only joint capsule repair in group B (n=39), only external rotators suture in group C (n=41), and no joint capsule repair or external rotators suture in group D (n=41). There was no significant difference in gender, age, cause of injure, disease duration, type of fracture, combined medical disease, or prosthesis selection among 4 groups (P gt; 0.05). The bleeding volume, drainage, postoperative hip dislocation rate, hip Harris score, and the hip range of motion (ROM) in internal rotation and external rotation were compared.
Results
There was no significant difference in operative time, bleeding volume, or drainage among 4 groups (P gt; 0.05). Postoperative hip dislocation occurred in 0, 0, 4 (9.8%), and 4 (9.8%) cases of groups A, B, C, and D, respectively, showing significant difference in incidence of postoperative hip dislocation among 4 groups (χ2=7.910, P=0.048). The hip Harris scores were significantly improved after operation when compared with preoperative scores in 4 groups (P lt; 0.05). Significant differences were found in hip Harris score at 6 weeks and 6 months after operation among 4 groups (P lt; 0.05); group D was significantly lower than groups A, B, and C, and groups B and C were significantly lower than group A (P lt; 0.05). There was no significant difference in the hip ROM in internal rotation among 4 groups at 6 weeks and 6, 12 months after operation (P gt; 0.05); but the hip ROM in external rotation were significantly bigger in groups A and C than in groups B and D at 6 weeks and 6 months after operation (P lt; 0.05).
Conclusion
Joint capsule repair and external rotators suture in primary THA by posterolateral approach do not increase the bleeding volume and drainage, but can reduce the early postoperative hip dislocation risk, increase the Harris score, and recover the external rotation function of involved hip. So joint capsule and external rotators should be repaired in THA by posterolateral approach.
ObjectiveTo evaluate the effectiveness of nitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid perilunate dislocation.MethodsBetween September 2011 and October 2018, 17 patients with trans-scaphoid perilunate dislocation were treated with nitinol memory alloy two foot fixator and Kirschner wire. There were 12 males and 5 females, with an average age of 32.6 years (range, 23-52 years). The disease duration was 8 hours to 9 days, with an average of 6.5 days. The causes of injury included 6 cases of falling injury, 4 cases of traffic accident injury, 3 cases of stress injury of wrist caused by sports, 2 cases of violent injury of wrist caused by machine impact, 1 case of military training injury, and 1 case of other injury. One case was complicated with nerve injury. According to Herbert’s classification, all the fractures were type B4. At 1 week before operation, 3 months, 6 months after operation and last follow-up, the wrist function was evaluated according to the Krimmer scale score.ResultsAll the 17 patients were followed up 10.5-48 months, with an average of 18.6 months. There was no loosening or infection of the internal fixator, no necrosis of the scaphoid and lunate. The periosteal dislocations of the patients were well reduced and the scaphoid fractures all healed. The healing time was 4-18 months, with an average of 11.3 months. The Krimmer wrist scores were 37.5±4.4, 61.3±7.2, 83.3±9.3, 87.3±8.2 at 1 week before operation, 3 months, 6 months after operation and last follow-up, respectively. The Krimmer wrist score at each time point after operation was significantly improved when compared with that before operation (P<0.05), and at 6 months after operation and last follow-up than at 3 months after operation (P<0.05). There was no significant difference between at 6 months and last follow-up (P>0.05). At last follow-up, the Krimmer wrist function was excellent in 13 cases, good in 2 cases, fair in 1 case, poor in 1 case, and the excellent and good rate was 88.23%.ConclusionNitinol memory alloy two foot fixator combined with Kirschner wire in the treatment of trans-scaphoid periosteal dislocation has definite effectiveness, simple operation, and good recovery of wrist function after operation.
Twelve cases (13 hips) of congenital dislocation of hip (CDH)in a group above the age of six were treated by Chiari pelvic osteotomy from Jan. 1991 to Dec. 1992. The results following operative treatment rated as good in 85 percents according to the clinical and radiologic examinations. The indications, and the results with the operation as the functional reconstuction of the hip concerned were discussed.
ObjectiveTo summarize the surgical accidents and postoperative complications of the treatment of recurrent shoulder dislocation by suture button fixation and bone occlusion, and to provide clinical reference.MethodsThe clinical data of 16 patients with recurrent shoulder dislocation treated with modified arthroscopic Latarjet suture button fixation and bone occlusion between July 2017 and April 2023 were retrospectively analyzed. Among them, 15 were male and 1 was female. The age ranged from 16 to 45 years, with an average of 26 years. Admission examination showed the range of motion of shoulder joint was normal; the shoulder joint fear test was positive; En-face CT scan measured 10%-20% of the glenoid defects, averaging 13.4%; and MRI examination revealed bone Bankart injury. The disease duration ranged from 2 to 20 years, with an average of 7.1 years. The shoulder joint was dislocated 8- 45 times, with an average of 17.4 times, and the shoulder joint was unstable. The occurrence of surgical accidents and postoperative complications as well as corresponding measures and outcomes were recorded. Results All the incisions healed by first intention without any complications such as incision infection or vascular injury. All 16 cases were followed up for an average of 3.6 years (range, 1-7 years), and no shoulder redislocation occurred. Four types of intraoperative surgical accidents and two types of postoperative complications occurred in the early stage of implementation of the technique. Intraoperative surgical accidents included 1 case of difficulty in passing subscapular muscle through coracotomy with large size, which was treated with exchange rod or finger through subscapular muscle split; 2 cases of coracoidal process fracture, of which 1 case was treated conservatively, and the other case was sutured to the base of tendon and fixed through tunnel; 1 case of glenoid fracture occurred in the glenoid tunnel, which was fixed with knot-free anchors; the posterior loop plate fixation was abnormal in 2 cases, of which 1 case was re-fixed and the other case was renovated. Postoperative complications included coracoid bone mass displacement in 1 case, conservative biceps rehabilitation was given to avoid premature external rotation; 1 case of radial nerve injury of healthy upper limb and musculocutaneous nerve injury of affected side was given oral medication and physiotherapy. The above conditions recovered well after corresponding treatment. ConclusionSuture button fixation with bone occlusion is a safe method for the treatment of recurrent shoulder dislocation. Careful operation should be performed during coracoid interception and glenoid tunnel drilling, especially in the fixation process.
ObjectiveTo review the research progress of the biomechanical study of the Bristow-Latarjet procedure for anterior shoulder dislocation. MethodsThe related biomechanical literature of Bristow-Latarjet procedure for anterior shoulder dislocation was extensively reviewed and summarized. ResultsThe current literature suggests that when performing Bristow-Latarjet procedure, care should be taken to fix the bone block edge flush with the glenoid in the sagittal plane in the direction where the rupture of the joint capsule occurs. If traditional screw fixation is used, a double-cortical screw fixation should be applied, while details such as screw material have less influence on the biomechanical characteristics. Cortical button fixation is slightly inferior to screws in terms of biomechanical performance. The most frequent site of postoperative bone resorption is the proximal-medial part of the bone block, and the cause of bone resorption at this site may be related to the stress shielding caused by the screw. ConclusionThere is no detailed standardized guidance for bone block fixation. The optimal clinical treatment plan for different degrees of injury, the factors influencing postoperative bone healing and remodeling, and the postoperative osteoarticular surface pressure still need to be further clarified by high-quality biomechanical studies.
Objective To summarize the method and effectiveness of open reduction and internal fixation in the treatment of 4 cases of bipolar clavicle dislocations. Methods Between June 2017 and June 2022, 4 patients with bipolar clavicle dislocations were admitted. There were 3 males and 1 female. The age ranged from 27 to 63 years, with an average age of 45 years. There were 2 cases of crushing injury of mine car, 1 case of traffic accident injury, and 1 case of heavy object injury. The time from injury to operation was 3-7 days, with an average of 5.0 days. The sternoclavicular joint dislocations were classified as Grade Ⅱ in 1 case and type Ⅲ in 3 cases, and anterior dislocation in 3 cases and posterior dislocation in 1 case. The acromioclavicular joint dislocations were classified as Tossy type Ⅱ in 2 cases and type Ⅲ in 2 cases. After open reduction, the sternoclavicular joint and acromioclavicular joint were fixed with lateral malleolus locking titanium plate and clavicular hook plate, respectively. ResultsAll operations were successfully completed without vascular or nerve injury. All incisions healed by first intention. All patients were followed up 12-18 months, with an average of 14 months. At last follow-up, the shoulder joint functions were rated as excellent in 3 cases and good in 1 case according to Rockwood score. During follow-up, there was no loosening of internal fixator or fracture. The internal fixators were removed in all patients at 5-7 months after operation (mean, 6 months), and no re-dislocation occurred after removal. Conclusion For bipolar clavicle dislocation, open reduction combined with lateral malleolus locking titanium plate fixation of the sternoclavicular joint and clavicle hook plate fixation of the acromioclavicular joint can achieve good effectiveness. It has the advantages of simple operation, high safety, firm fixation, and fewer complications, and the shoulder function recovers well.
Objective To investigate arthroscopic treatment for acute acromioclavicular dislocation by using Twin Tail TightRope combined with distal joint capsular repair. Methods The clinical data of 40 patients with acromioclavicular dislocation treated between February 2016 and December 2017 were retrospectively analyzed. The patients were divided into arthroscopic group (20 cases, using arthroscopic Twin Tail TightRope combined with distal joint capsular repair for anatomical repair of stable structure of acromioclavicular joint) and control group (20 cases, treated with clavicular hook plate internal fixation) according to different surgical methods. There was no significant difference in gender, age, cause of injury, Rockwood classification, time from injury to operation, preoperative visual analogue scale (VAS) score and Constant score between the two groups (P>0.05), which were comparable. Postoperative VAS score and Constant score were used to assess shoulder function and re-dislocation was also observed. Results The incisions of the two groups healed by first intention, and no early postoperative complications occurred. All patients were followed up 12-18 months (mean, 13.5 months). Postoperative X-ray films showed good anatomical reduction in both groups, but the clavicular hook had a presense in the subacromial space in control group. All patients in arthroscopic group achieved satisfactory shoulder function and returned to work after operation; there was no obvious pain, no complications such as exposure of implant after operation, and no need to remove the implant. In the control group, 4 patients had obvious subacromial impingement pain after operation, and 1 patient had re-dislocation after removal of internal fixator at 1 year after operation; the rest had no complications related to internal fixation, and the internal fixators were removed at 1.0-1.5 years after operation, without re-dislocation. The VAS score and Constant score at 3 months and 1 year after operation in both groups significantly improved when compared with those before operation, and further improved at 1 year after operation (P<0.05). The VAS score and Constant score at 3 months and 1 year after operation in arthroscopic group were significantly better than those in control group (P<0.05). Conclusion Arthroscopic treatment for acute acromioclavicular joint dislocation by using Twin Tail TightRope combined with distal capsular repair is more effective than traditional incision surgery and can obtain more satisfactory results in patient compliance and function recovery because of minimally invasive surgery.
To cure patients suffering from atlanto-axial instability following old fracture of odontoid process concomitant with stenosis of lower end of cervical spinal canal, a new operative method was designed. It included atlanto-axial fusion by Gallie technique and resection of right half of the laminae of C3-C7 spine at one stage. A female of 63 years old was treated. She was admitted with neck pain and numbness of the upper and lower limbs. A history of neck injury was noted in enquiry. In physical examination showed the sensation of pain of the upper limbs was decreased and the muscle power of the upper and lower limbs ranged from III degree to IV degree. The X-ray film and MRI suggested that there was instability of the atlanto-axial joint with stenosis of 4th-6th cervical spinal canal. The operation was satisfactory. After operation, the patient was followed up for 11 months. The physical examination indicated that sensation of the upper limbs had recovered to normal and the muscle power of the upper limbs reached IV degree and that the lower limbs reached V degree and X-ray showed bony fusion of the atlanto-axial joint. The conclusions were: 1. The stability of atlanto-axial joint was reconstructed with expanding of the spinal canal at the same time. 2. The duration, risk and cost of the therapy were reduced, and maintenance of the stability of the cervical spine throughout whole period of treatment was recommended.
