Objective To summarize the current management of anterior cruciate ligament (ACL) injury in children and adolescents, in order to provide reference for the management of ACL injury in children and adolescents. MethodsThe relevant literature at home and abroad in recent years was extensively accessed to summarize the management status of ACL injury in children and adolescent. Results The number of ACL injury in children and adolescents is increasing every year. The diagnosis of ACL mainly depends on symptoms and signs. Rehabilitation, physeal-sparing techniques, partial transphyseal techniques, all-epiphyseal techniques, and transphyseal techniques are used to treat ACL injury in children and adolescents. Conclusion Dynamic monitoring of knee joint in children and adolescents should be strengthened. The best treatment for ACL injury in children and adolescents is selected according to the patients’ actual age, bone age, Tanner stage, and physiological conditions such as menstruation, body growth speed, and other characteristics.
ObjectiveTo review the bioactive strategies that enhance tendon graft healing after anterior cruciate ligament reconstruction (ACLR), and to provide insights for improving the therapeutic outcomes of ACLR. Methods The domestic and foreign literature related to the bioactive strategies for promoting the healing of tendon grafts after ACLR was extensively reviewed and summarized. ResultsAt present, there are several kinds of bioactive materials related to tendon graft healing after ACLR: growth factors, cells, biodegradable implants/tissue derivatives. By constructing a complex interface simulating the matrix, environment, and regulatory factors required for the growth of native anterior cruciate ligament (ACL), the growth of transplanted tendons is regulated at different levels, thus promoting the healing of tendon grafts. Although the effectiveness of ACLR has been significantly improved in most studies, most of them are still limited to the early stage of animal experiments, and there is still a long way to go from the real clinical promotion. In addition, limited by the current preparation technology, the bionics of the interface still stays at the micron and millimeter level, and tends to be morphological bionics, and the research on the signal mechanism pathway is still insufficient.ConclusionWith the further study of ACL anatomy, development, and the improvement of preparation technology, the research of bioactive strategies to promote the healing of tendon grafts after ACLR is expected to be further promoted.
Objective To study the operative procedure and effect of arthroscopic reconstruction of both anterior cruciate l igament (ACL) and posterior cruciate l igament (PCL) with anterior tibial is tendon allograft. Methods From February 2005 to July 2006, 10 cases of both ACL and PCL rupture were reconstructed with anterior tibial is tendon allograft, including 7 men and 3 women, aging 18-45 years with an average of 30.2 years. The locations were left knee in 6 cases and right knee in 4 cases. All of them had identified trauma history. The disease course was about 1-3 weeks (mean 1.8 weeks). Both ACLand PCL were reconstructed under arthroscope with allograft anterior tibial is tendon of 26-28 cm in length and immobil ization with extention position brace was given for 4 weeks after operation. The active flex knee exercise was done from 0-90° at 4 weeks and more than 90° at 6 weeks. Results All operations were finished successfully, there were no blood vessel and nerve injury. The operative time was 90-110 minutes (mean 100 minutes). The wound healed by first intention and no early compl ication occurred. Ten cases were followed up for 12 months to 15 months with an average of 13.5 months. Thier gait was normal, knee activity degree was 0-135°. The anterior drawing tests and media and lateral stress tests were negative after operation in 10 cases; and the posterior drawing tests were negative in 8 cases and 2 cases was at grade I. Hydra arthrosis of knee occurred in 2 cases and was cured after remove of fluid and injection of sodium hyaluronate. The Lysholm knee function score was increases from 24.89 ± 5.39 before operation to 96.00 ± 4.59 at 12 months after operation, showing significant difference (P lt; 0.05). Conclusion Arthroscopic reconstruction of both ACL and PCL with anterior tibial is tendon allograft has the advantages of short operation time, less compl ications and good cl inical effects.
Objective
To evaluate the short-term effectiveness after static anatomical reconstruction of posterolateral complex (PLC) in the treatment of traumatic multi-ligament injury of the knee.
Methods
Between June 2007 and July 2011, 23 cases of multi-ligament injury of the knee were treated. There were 15 males and 8 females with an average age of 41 years (range, 19-56 years). The injury was caused by traffic accident in 9 cases, sprain in 7 cases, bruise in 3 cases, and falling from height in 4 cases. The time between injury and operation was 13-78 days (mean, 32 days). The results of posterior drawer test and Lachman test were positive, and all cases complicated by varus and external rotation instability. The Lysholm score of the knee was 43.4 ± 5.7. According to International Knee Documentation Committee (IKDC) scoring, all were rated as grade D. According to Fanelli typing, all were classified as type C. The X-ray films showed that load-induced posterior motion of the knee was (13.3 ± 4.2) mm; the lateral joint space was (15.1 ± 2.4) mm. Anterior cruciate ligament/posterior cruciate ligament and PLC were reconstructed simultaneously with auto-semitendinosus, gracilis tendon, and allogeneic tendon.
Results
All incisions healed by first intention, and no complication occurred. All patients were followed up 12-56 months (mean, 28 months). At last follow-up, the results of posterior drawer test and Lachman test were negative; 3 cases had varus instability, and 2 cases had external rotation instability. The Lysholm score of the knee was 85.6 ± 16.7, showing significant difference when compared with preoperative score (t=11.469, P=0.000). According to IKDC scoring, 7 cases were rated as grade A, 12 as grade B, and 4 as grade C; significant difference was found when compared with preoperative value (Z=4.285, P=0.000). The load-induced posterior motion of the knee was (5.1 ± 4.4) mm, the lateral joint space was (3.2 ± 2.8) mm, showing significant differences when compared with preoperative ones (P lt; 0.05).
Conclusion
In the treatment of traumatic multi-ligament injury of the knee, the anatomical reconstruction of the PLC using auto-semitendinosus, gracilis tendon, or allogeneic tendon can obtain good short-term effectiveness.
Objective To investigate the effectiveness of personalized treatment based on Hua Xi-knee dislocation and multiple ligament injury (HX-KDMLI) diagnosis and treatment system. Methods A clinical data of 36 patients (36 knees) with KDMLI met the selective criteria between February 2019 and September 2020 was retrospectively analyzed. There were 24 males and 12 females with an average age of 45.7 years (range, 21-62 years). The KDMLI was caused by traffic accident in 15 cases, heavy pound in 8 cases, sports sprain in 7 cases, falling from height in 4 cases, and machine cutting in 2 cases. The interval between injury and operation was 1-9 weeks (mean, 3.6 weeks). All patients were categorized according to HX-KDMLI diagnosis and treatment system. Twenty patients were categorized as acute period and 16 patients as chronic period. Three patients were type HX-Ⅰ-A, 1 type HX-Ⅰ-P, 10 type HX-Ⅲ-L, 13 type HX-Ⅲ-M, 4 type HX-Ⅳ-S, 3 type HX-Ⅴ-F, and 2 type HX-Ⅴ-T. Thirty-five patients were positive in both the anterior drawer test and Lachman test, 31 were positive in the posterior drawer test; 19 patients were positive in varus stress test, 23 were positive in valgus stress test. According to the Internation Knee Documentation Committee (IKDC) grading, there was 1 case of grade A, 5 cases of grade B, 8 cases of grade C, and 2 cases of grade D. Surgical interventions included arthroscopic surgery, open surgery, or arthroscopy combined with open surgery, ligament suture or reconstruction, and internal fixation after anatomical reduction of the fracture. Different rehabilitation protocols were assigned to patients during different postoperative period, according to patient’s individualized classification. ResultsAll incisions healed by first intention with no obvious complications. All patients were followed up 12-19 months (mean, 15 months). At 12 months after operation, all patients retained muscle strength of grade Ⅴ, and range of motion of the knee joint could reach 0° extension and over 120° flexion. Radiographic examination showed no sign of knee instability, healed fractures, ideal joint alignment, good continuity and tension, and clear image of repaired or reconstructed ligaments. The anterior and posterior drawer tests were all negative. Lachman test was degreeⅠpositive in 5 cases, valgus stress test was degreeⅠpositive in 2 cases, varus stress test was degreeⅠpositive in 2 cases; the other patients were all negative. At 12 months after operation, according to the IKDC grading, there were 9 cases of grade A, 19 cases of grade B, 5 cases of grade C, and 3 cases of grade D, showing significant differences when compared with the preoperative ones (Z=–5.328, P=0.000). There were significant differences in the IKDC, Lysholm, and Tegner scores between pre- and post-operation (P<0.05). ConclusionThe promising effectiveness of KDMLI can obtain under the guidance of HX-KDMLI.
ObjectiveTo investigate the risk factors of contralateral anterior cruciate ligament (ACL) injury after primary ACL reconstruction. Methods A retrospective review was conducted on the 716 patients with ACL injury who received primary ACL reconstruction surgery and met the selection criteria between January 2012 and September 2018. After a mean follow-up period of 7.6 years (range, 4-10 years), 65 patients (9.1%) experienced contralateral ACL injury (injured group) and 651 patients (90.9%) did not (uninjured group). There was no significant difference in age, body mass index, and preoperative Lachman test degree between groups (P>0.05). However, the proportion of female in the injured group was significantly higher than that of male (P<0.05), and the preoperative posterior tibial slope (PTS) was significantly higher than that of the uninjured group (P<0.05). Using the outcome of contralateral ACL injury as the dependent variable, the clinical data of the patient was first used as the independent variable, and univariate COX regression was used to analyze the prognostic influencing factors. Then, the indicators with differences in univariate COX regression were used as the independent variable, and multivariate COX regression was used to analyze the independent risk factors affecting prognosis. Log-Rank (Mantel-Cox) test was used to test and analyze the occurrence time of contralateral ACL injury in patients of different genders; X-tile software was used to analyze the occurrence time of contralateral ACL injury in patients with different PTS using Log-Rank (Mantel-Cox) test and PTS cut-off values. ResultsUnivariate COX regression analysis showed that gender and PTS were influence factors for contralateral ACL injury (P<0.05); further multivariate COX regression analysis showed that female and increased PTS were independent risk factors for contralateral ACL injury (P<0.05). The Log-Rank (Mantel-Cox) test results showed that the contralateral ACL injury occurred in female at 8.853 (8.600, 9.106) years, which was significantly shorter than that in male [9.661 (9.503, 9.819) years] (χ2=20.323, P<0.001). Using X-tile software to analyze the cut-off value of PTS, it was found that the cut-off value of PTS for contralateral ACL injury was 10.92°. According to the Log-Rank (Mantel-Cox) test, it was found that the contralateral ACL injury occurred in 5.762 (4.981, 6.543) years in patients with PTS≥10.92°, which was significantly shorter than patients with PTS<10.92° [9.751 (9.650, 9.853) years](χ2=302.479, P<0.001). ConclusionFemale and PTS≥10.92° after primary ACL reconstruction are independent risk factors for contralateral ACL injury.
ObjectiveTo evaluate the clinical results of the tibial Inlay technique for the medial collateral ligament (MCL) reconstruction using Achilles tendon allograft in recovery of medial instability of the knee.
MethodsBetween January 2011 and December 2012, 21 patients underwent tibial Inlay reconstruction of the MCL using Achilles tendon allograft, and the clinical data were retrospectively analyzed. There were 13 males and 8 females with a mean age of 32 years (range, 19-62 years). Injury was caused by sports in 15 cases and by traffic accident in 6 cases. The disease duration ranged from 15 days to 3 months (mean, 1.5 months). According to International Knee Documentation Committee (IKDC) criteria, 5 cases were classified as degree II and 16 cases as degree III. The results of the valgus stress test were positive in all patients. The complications were observed after operation; IKDC subjective knee score and Lysholm score were used to assess the knee function.
ResultsBone block fracture occurred in 1 case during operation. Primary healing of incision was obtained in the other cases except 1 case having unhealing incision who was healed after skin grafting. No complications of knee joint stiffness, vascular nerve injury, and infection occurred. All patients were followed up 7-29 months (mean, 18.5 months). At last follow-up, the results of the valgus stress test were negative in 20 cases, and positive (degree I) in 1 case; the other patients had no knee extension or flexion limitation except 1 patient having 15° flexion limitation. The Lysholm score was significantly improved from 45.4±13.6 to 87.5±9.4, the IKDC 2000 subjective score was significantly improved from 46.5±14.0 to 88.4±9.3 at last follow-up (P<0.05). MRI showed that the reconstructed MCL was continuous.
ConclusionThe short-term clinical results of the tibial Inlay technique for MCL reconstruction using Achilles tendon allograft are satisfactory. The Inlay technique for MCL reconstruction can provide good medial stability of the knee, but the lorg-term effectiveness needs further follow-up.
【Abstract】 Objective When knee medial collateral ligament (MCL) rupture, the upper surface of medial meniscus is exposed totally, like the gulf panoramic, which is called “panoramic views of the bay sign” or the “bay sign”. To investigate the reliability and significance of the “bay sign” in diagnosis of knee MCL rupture under arthroscope. Methods Between March 2007 and March 2011, 127 patients with knees injuries were divided into the observation group (n=59) and control group (n=68) based on the MRI results. In the observation group, 59 patients had MCL rupture by MRI, including 12 cases of MCL injury alone, 16 cases of MCL injury with lateral meniscus torn, 27 cases of MCL injury with anterior cruciate ligament (ACL) injury, 3 cases of MCL injury with ACL and posterior cruciate ligament (PCL) injury, and 1 case of MCL injury with patellar dislocation; there were 38 males and 21 females with an average age of 23.2 years (range, 16-39 years). In the control group, 68 patients had no MCL rupture by MRI, including 38 cases of ACL injury, 4 cases of ACL and PCL injury, and 26 cases of ACL and lateral meniscus injury; there were 45 males and 23 females with an average age of 31.8 years (range, 25-49 years). The “bay sign” was observed under arthroscope in 2 groups before and after operation. Results The positive “bay sign” was seen under arthroscope in the patients of the observation group before MCL repair; the “bay sign” disappeared after repair. No “bay sign” was seen in patients of the control group before and after ACL reconstruction. Conclusion The “bay sign” is a reliable diagnostic evidence of MCL injury. It can be used as a basis to judge the success of MCL reconstruction during operation.
ObjectiveTo evaluate the effectiveness of semitendinous and gracilis transfer for the treatment of medial collateral ligament (MCL) injury caused by total knee arthroplasty (TKA).
MethodsBetween March 2009 and May 2014, 11 patients (11 knees) with MCL injuries caused by primary TKA were treated by semitendinous and gracilis transfer in primary TKA (injury group). Another 18 patients (21 knees) without MCL injury were included as the control group. There was no significant difference in gender, age, injury sides, disease duration, body mass index, knee varus deformity, and preoperative Knee Society Score (KSS) between 2 groups (P>0.05), with comparability. KSS score was used to evaluate the function after operation.
ResultsPrimary healing of incision was obtained in all patients, and no complications of joint instability and pain occurred. The follow-up time was 6-29 months in injury group and was 7-34 months in control group. At last follow-up, the KSS clinical score and functional score were significantly increased to 89.82±3.76 and 89.54±3.50 in the injury group (P<0.05) and were significantly increased to 90.19±3.39 and 90.00±3.53 in the control group (P<0.05) respectively, but no significant difference was shown between 2 groups (t=0.158, P=0.877; t=0.820, P=0.432). X-ray films showed no prosthetic loosening or subsidence during follow-up.
ConclusionThe semitendinous and gracilis transfer is reliable for the treatment of MCL injury caused by TKA. The insertions of semitendinous tendon and gracilis are close to that of the knee MCL, which can effectively improve knee function.
Objective
To evaluate the short-term effectiveness of arthroscopic single-bundle reconstruction of anterior cruciate ligament (ACL) being centered within the native ligament’s tibial and femoral insertions with independent drilling of tibial and femoral tunnels.
Methods
Between September 2008 and September 2010, 33 patients with chronic ACL ruptures underwent arthroscopic reconstruction with four-stranded hamstring tendons in single-bundle. There were 19 males and 14 females, aged 22-33 years (mean, 26.4 years). Injuries were caused by traffic accident in 15 cases, by falling in 13 cases, and by sports in 5 cases. The location was the left knee in 20 cases and the right knee in 13 cases. The average time from injury to surgery was 6 months (range, 2-20 months). ACL reconstruction could be optimized when single-bundle grafts were centered within the native ligament’s tibial and femoral insertions with independent drilling of tibial and femoral tunnels. KT-1000 test, Lachman test, and pivot-shift test were used to evaluate the knee stability, and the International Knee Documentation Committee (IKDC) and Lysholm scores to assess the knee function.
Results
Primary healing of incision was obtained in all patients, who had no complications of intra-articular infection, deep venous thrombosis of the lower extremity, and injury of blood vessels and nerves. All the patients were followed up 18.6 months on average (range, 13-24 months). At 1 year after operation, the results of Lachman test were negative in 31 cases and I degree positive in 2 cases, showing significant difference when compared with preoperative results (I degree positive in 4, II degree positive in 26, and III degree positive in 3) (Z=
—
5.42, P=0.00). The results of pivot-shift test were negative in 31 cases, I degree positive in 2 cases, showing significant difference when compared with preoperative results (I degree positive in 15 and II degree positive in 18) (Z=
—
5.17, P=0.00). The KT-1000 results of examination (134 N) showed that the side difference of anterior laxity was (1.2 ± 0.7) mm at 25° flexion and (0.8 ± 0.6) mm at 70° flexion, showing significant differences when compared with preoperative ones [(7.8 ± 2.1) mm and (5.0 ± 1.8) mm] (t=16.19, P=0.00; t=13.28, P=0.00). The IKDC score was significantly increased from 39.6 ± 4.5 at preoperation to 95.1 ± 1.6 at postoperation (t=
—
78.88, P=0.00), and Lysholm score was significantly increased from 48.3 ± 3.6 at preoperation to 92.0 ± 2.5 at postoperation (t=
—
42.00, P=0.00).
Conclusion
It is a reliable procedure to restore the stability of the knee that arthroscopic single-bundle reconstruction of ACL is centered within the native ligament’s tibial and femoral insertions with independent drilling of tibial and femoral tunnels.
