ObjectiveTo summarize the relationship between lateral femoral notch sign (LFNS) and anterior cruciate ligament (ACL) rupture. MethodsThe relevant literature of LFNS at home and abroad in recent years was retrospectively reviewed, and its mechanism, diagnostic criteria and influencing factors in diagnosis of ACL rupture were summarized and analyzed.ResultsThe LFNS is associated with rotational stability of the knee. As an indirect sign of ACL rupture, the LFNS has high clinical diagnostic value, especially the diagnosis of ACL rupture with lateral meniscus injury.ConclusionThe diagnostic criteria and influencing factors of LFNS in diagnosis of ACL rupture are still unclear and controversial, which needs further study.
OBJECTIVE To investigate the clinical result and influence factors of prognosis after repair of ruptured Achilles tendon with operative treatment. METHODS From 1961 to 1994, 62 cases with ruptured Achilles tendon were treated operatively. Among them, "8"-shaped suture was used in 8 cases, aponeurosis flap repair in 30 cases, transfer repair of tendon of peroneus longus muscle in 2 cases, reverse "V-Y" shaped tendon plastic operation in 10 cases, and mattress suture of opposite ends in 12 cases. RESULTS Followed up 3 to 33 years, there was excellent in 40 cases, better in 13 cases, moderate in 6 cases, poor in 3 cases, 85.5% in excellent rate. Postoperative infection and re-rupture were occurred in 6 cases respectively. CONCLUSION Different operative procedures are adopted to achieve better long-term clinical result according to the injury types.
Objective To assess the effectiveness of a novel minimally invasive Achilles tendon suture instrument in the treatment of fresh closed Achilles tendon rupture. Methods A retrospective study was conducted on 150 patients who underwent surgical intervention for fresh closed Achilles tendon rupture. Eighty patients were treated with the novel minimally invasive Achilles tendon suture instrument (minimally invasive group) and 70 patients with traditional open surgery (traditional group). The two groups were comparable in terms of gender, age, injured side, cause of injury, the interval between injury and operation, and the distance from the fracture end to the calcaneal tuberosity (P>0.05). The operation time, intraoperative blood loss, incision length, hospital stays, hospitalization expenses, and complications were recorded and compared. At 1 year after operation, the ankle joint function was evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. Results The minimally invasive group demonstrated significantly shorter operation time, smaller incision length, and lower intraoperative blood loss when compared with the traditional group (P<0.05). However, there was no significant difference in terms of hospital stays and hospitalization expenses between the two groups (P>0.05). All patients were followed up 12-24 months after operation (mean, 15.5 months). In the traditional group, 6 cases of incision necrosis and 7 cases of Achilles tendon adhesion occurred, while in the minimally invasive group, all incisions healed at first intention and no Achilles tendon adhesion occurred. The differences in the incidences of the two complications between the two groups were significant (P<0.05). At 1 year after operation, the AOFAS ankle-hindfoot score in the minimally invasive group was superior to that of the traditional group (P<0.05). Conclusion In comparison with traditional open surgery, the use of self-designed novel minimally invasive Achilles tendon suture instrument proves to be an ideal technique for treating fresh closed Achilles tendon ruptures. This approach offers the benefits of smaller incisions, fewer complications, and better postoperative functional recovery, without increasing hospital costs.
目的 评价股外侧肌远端筋膜瓣折叠修复重建陈旧性髌韧带断裂的安全性及临床疗效。 方法 对2008年6月－2010年10月收治的10 例陈旧性髌韧带断裂患者，采用股外侧肌远端筋膜瓣折叠联合减张钢丝张力带固定方法重建髌韧带。术后1、2、3、6及12个月随访，采用美国膝关节协会评分对膝关节功能进行评分，包括膝关节疼痛、行走能力和上下楼梯能力、活动度等，同时行超声检查对膝关节髌韧带的连续性进行评估。 结果 10例患者中9 例获得随访，平均随访12个月（6～15个月）。末次随访时平均膝关节疼痛评分、功能评分、膝关节活动范围均较术前明显改善。超声检查显示所有患者肌腱完全愈合，连续性完好，不需要进一步外科手术干预。所有随访患者均未发生手术相关并发症。 结论 采用股外侧肌远端筋膜瓣折叠重建陈旧性髌韧带断裂是一种有效、可靠的方法，能够恢复良好的膝关节功能。
OBJECTIVE: To explore the methods of treatment for old achilles tendon rupture merging with skin defect. METHODS: By following up retrospectively 10 patients from February 1995 to December 2001, we analyzed the operative methods, the points for attention and the results. Gastrocnemius musculocutaneous flaps were used in 3 cases, foot lateral skin flaps in 4 cases, superior medial malleolus skin flaps in 2 cases, and sural neural skin flap in 1 case. The Achilles tendon was sutured directly in 8 patients, with Lindholm’s technique in 2 patients. RESULTS: All flaps survived and the wound healed well in 8 cases and reruptured in 2 cases. According to Yin Qing-shui’s criteria to test the efficacy, the results were excellent in 5 patients, good in 4 and poor in 1. CONCLUSION: Repairing the old Achilles tendon rupture merging with skin defect by use of microsurgery has good results and plays an important role in reducing joint contracture and stiffness, and in saving the ability to push forward and flex.
ObjectiveTo explore the effectiveness of posterior median longitudinal W-shaped incision combined with layer-by-layer combing suture in the treatment of acute closed Achilles tendon rupture.MethodsThe clinical data of 32 patients with acute closed Achilles tendon rupture who met the selection criteria between August 2015 and February 2019 were retrospectively analyzed. There were 25 males and 7 females, with an average age of 33 years (range, 21-48 years). All of them were closed rupture of Achilles tendon caused by sports injury. Physical examination on admission: the rupture space of Achilles tendon was palpable; Thompson sign was positive; the rupture of Achilles tendon was confirmed by MRI and ultrasonography before operation, the distance between the broken end and the insertion point of Achilles tendon was 2-8 cm, with an average of 3.5 cm. The average time from injury to operation was 2.7 days (range, 1-10 days). During the operation, the posterior median longitudinal W-shaped incision of Achilles tendon was used to expose the broken end of Achilles tendon, and the deep and shallow double Kessler end-to-end suture+layer-by-layer combing suture were used to suture the Achilles tendon, and the skin incision was sutured by “V-Y”advancement. The postoperative complications were observed; the healing of Achilles tendon was observed by ultrasonography; at last follow-up, Arner Lindholm criteria was used to evaluate ankle function.ResultsThe 32 patients were followed up 8-24 months, with an average of 12 months. The incision healed by first intention, without the complications of skin necrosis, nonunion, delayed healing, and infection, scar hyperplasia or ulcer, and symptom of peroneal nerve injury. No Achilles tendon rupture and deep infection occurred during the follow-up period. The ultrasonography examination showed that the Achilles tendon was healing. At last follow-up, according to Amer Lindholm evaluation standard, the results of ankle function was excellent in 26 cases and good in 6 cases.ConclusionThe treatment of acute closed Achilles tendon rupture with a posterior median longitudinal W-shaped incision combined with deep and shallow double Kessler end-to-end suture+layer-by-layer combing suture is effective, which can fully exposed the incision, the quality of Achilles tendon anastomosis is reliable, and it can effectively avoid wound complications and iatrogenic injury of gastrocnemius nerve.
Objective To introduce a modified technique for treating acute closed Achilles tendon rupture and evaluate the preliminary effectiveness. Methods Between March 2011 and September 2015, 8 cases (8 sides) with acute closed Achilles tendon rupture were repaired with the laminated bevel suturing technique. All of the patients were male with an average age of 39.3 years (range, 22-58 years), injured in nonprofessional sports. The diagnosis was confirmed by typical signs of positive heel-lift test and Thompson test; the complete rupture of Achilles tendon was determined by color Doppler ultrasound or MRI, and the distance between the stump and calcaneus was 2-5 cm (mean, 3.3 cm). The time from injury to operation was 2-12 days (mean, 4.1 days). With the patient in prone position, a posterior longitudinal incision medial to the tendon was made, the broken stumps of Achilles tendon were divided into 3 layers on the coronal plane, fibers made into strips. The strips were staggered and stacked, stitched side to side with absorbable suture. The ankle joint at the plantar flexion position was fixed with plaster, and early rehabilitation exercise was carried out. Results The operation time was 70-135 minutes (mean, 99 minutes); the intraoperative blood loss was 5-30 mL (mean, 15.6 mL). All the incisions healed by first intention without infection, except for 1 case who need dressing exchange because of partial delayed healing. All the patients were followed up 6-50 months (mean, 30.5 months). There was no complication of surgical site infection, sural nerve injury, or deep vein thrombosis. The patients could walk normally with powerful raising heels and return to previous sports, without complication of re-rupture. Compared with the contralateral side, the activity of ankle joint dorsiflexion reduced 0-6° (mean, 3°); plantar flexion reduced 1-5° (mean, 2°). At last follow-up, according to Arner-Lindholm score, the surgical results were excellent in 7 cases and good in 1 case, with an excellent and good rate of 100%. Conclusion Laminated bevel suturing technique is simple for repairing acute closed Achilles tendon rupture without the need of special surgical instruments. It provides enough tensile strength for early rehabilitation exercise to rapid and good recovery.
ObjectiveTo evaluate the short-term effectiveness of the short incision and non-end-to-end suturing system in the treatment of acute closed Achilles tendon rupture. MethodsBetween September 2011 and September 2013, 22 patients with acute Achilles tendon rupture were treated with self-designed minimally invasive non-end-to-end suturing system. There were 16 males and 6 females, aged from 22 to 55 years (mean, 32.6 years). The left side was involved in 12 cases and the right side in 10 cases. The causes included sports injury in 16 patients, violent injury in 4 patients, and falling injury in 2 patients. MRI revealed that the distance from the ruptured site to the calcaneal tuberosity ranged from 40 to 70 mm (mean, 35 mm). The duration from injury to surgery ranged from 0.5 to 7 days (mean, 4.2 days). The incision of 4 cm in length was made at the initial point of Achilles tendon, and minimally invasive non-end-to-end suturing system was used to hold the Achilles. The ruptured tendon was sutured with two non-absorbed thread. The limb was fixed with plaster for 6 weeks. ResultsThe incision all healed by first intention without complications of sural nerve damage and infection. All patients were followed up 8-14 months (mean, 11 months). According to the Arner-Lindholm functional score criteria, the results were excellent in 19 cases and good in 3 cases. No Achilles tendon rupture happened again during follow-up. ConclusionThe small incision with non-end-to-end suturing system is an effective operation strategy for treatment of acute Achilles rupture. The patients can do function exercise at early-stage with satisfatory short-term effectiveness.