One hundred and fifty cases were followed up after quadricepsplasty. Hamstring M. were used in 112 cases. M. rectus femoris or obliquis abdominis was used in 38 cases. The validity and force analysis of such two kinds of operation were analyzed and compared. It was confirmed that the power of the transferred muscle depended on the angle between the force line and the neutral axis of the joint, provided the arm of the force and the area of transection of the muscle were constant. The bigger the angle was, the longer the arm of the force was, and the smaller was the labour. If this angle was negative or the knee joint was in a position of flexion deformity, the smaller the negative angle was, the smaller the componend force of the joint was, and the larger was the component force of extension.
OBJECTIVE: Extension stiffness of knee joint is always treated by the quadricepsplasty, but the main deficiency of this method is that patient feels weakness of lower limb and easily kneels down. The aim of this article is to explore the method to resolve the complications after quadricepsplasty. METHODS: Since 1978 to 1997, on the basis of traditional procedures of quadricepsplasty, sartorius muscle was used to reinforce the extension of knee joint. The lower 2/3 of sartorius muscle was fully dissociated only with its insertion intact. A tendon-periosteal-bone flap, about 2 cm in width, was managed on the anterior surface of patella, with its pedicle on the medial edge of patella. The tendon-periosteal-bone flap was used to fix the dissociated sartorious into patella to reinforce the extension of knee joint. The very lower part of sartorius was mainly aponeurosis, with the help of an aponeurosis bundle of iliotibial tract, it was fixed into the insertion of patellar ligament, through a bony tunnel chiseled adjacent to the insertion of patellar ligament. By now the movement of knee joint extension was strengthened by the transferred sartorius muscle. Postoperatively, every patient was required to extend and flex knee joint actively and/or passively. Altogether 12 patients were treated, 9 of them were followed up with an average of 14 months. RESULTS: The average movement was increased from 15 degrees to 102 degrees, and the average myodynamia was improved from grade II to grade IV. CONCLUSION: Traditional quadricepsplasty co-operated with transfer of sartorius muscle can strengthen the myodynamia of knee joint extension. It is simple method and can really achieve good function.
OBJECTIVE: To observe the strength of thigh muscles after reconstruction of anterior cruciate ligament by autogenous bone-patellar tendon-bone graft. METHODS: Twenty-three patients, 9 males and 14 females, were followed up one year after reconstruction of the anterior cruciate ligament with autogenous bone-patellar tendon-bone graft. Through arthroscope, no intra-articular derangement was found. The strengths of isometric and isotonic contractions of the quadri ceps and the hamstrings muscles of the affected and contralateral thighs were recorded. RESULTS: The donor side for autogenous bone-patellar tendon-bone graft showed significant decrease (P lt; 0.01), but no effect on that of the hamstrings muscle(P gt; 0.05). CONCLUSION: To reconstruct the anterior cruciate ligament, harvest of the bone-patellar tendon-bone graft as a reparative material may markedly lower the strength of the quadriceps femoris muscle.
Objective To investigate the effects of ergometer cycling training based on the internet of things and quadriceps strengthening based on internet mobile phones on joint stiffness, function and walking ability in patients with knee osteoarthritis (KOA) in a community setting. Methods KOA patients attending West China Hospital, Sichuan University were selected between April and July 2022. The patients were randomly divided into ergometer cycling group, quadriceps strengthening group and control group (treated with traditional therapy) using a random number table method. The patient underwent a 12 week intervention. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) scale, Timed Up and Go Test (TUG) were used to evaluate the degree of joint stiffness, joint function and walking ability of patients. Data was collected and evaluated before intervention and at 4, 8, and 12 weeks after the initial intervention.Results A total of 72 patients were included, with 24 cases in each group. There were interactive effects between group and time in WOMAC joint stiffness score, joint functional score and TUG test time (P<0.05). At 8 and 12 weeks after intervention, the joint stiffness scores of the ergometer cycling group and the quadriceps strengthening group were better than those of the control group. At 4, 8 and 12 weeks after intervention, the joint function scores of the ergometer cycling group and the quadriceps strengthening group were better than those of the control group (P<0.05). At 8, 12 weeks after intervention, the TUG test scores of the ergometer cycling group were better than those of the control group and the quadriceps strengthening group (P<0.05). Conclusions In a community setting, both 12-week Internet of thing-based ergometer cycling and internet video-based quadriceps strengthening were effective on improving knee stiffness and function in KOA patients and were superior to traditional methods, the two effects were comparable. Ergometer cycling is superior to quadriceps strengthening and traditional methods in improving walking ability.
Objective To explore the effect of internet of things-based power bicycle training or quadriceps training alone on pain and quality of life in patients with knee osteoarthritis in a community setting. Methods Patients with knee osteoarthritis who were admitted to West China Hospital of Sichuan University between April and July 2022 were selected. They were randomly divided into a power bicycle training group, a quadriceps muscle training group and a control group by random number table method. The primary outcome was improvement in knee pain, assessed by the Numerical Rating Scale (NRS) score. The secondary outcome was health-related quality of life, assessed by the 36-Item Short Form Health Survey (SF-36) score. Outcomes were assessed at baseline and 4, 8, and 12 weeks after the initial intervention. The statistical analysis was conducted using generalized estimating equations. Results A total of 72 patients were included, with 24 in each group. There was no significant difference in age, gender or other demographic characteristics among the three groups (P>0.05). The results of generalized estimating equations showed that there were interaction effects (group × time) on the NRS score, SF-36 physical functioning score, SF-36 bodily pain score, and SF-36 vitality score (P<0.05), while there was no interaction effect (group × time) on the role physical score, general health score, social functioning score, role emotional score or mental health score of SF-36 (P>0.05). At baseline, there was no statistically significant difference in the NRS score or SF-36 scores among the three groups (P>0.05). After 12 weeks of intervention, the two training groups were better than the control group in the NRS score, SF-36 physical functioning score, and SF-36 bodily pain score, the power bicycle training group was better than the quadriceps training group in the NRS score, the power bicycle training group was better than the control group in the SF-36 social functioning score, and the differences were statistically significant (P<0.05). Conclusions In a community setting, 12 weeks of internet of things-based power bicycle training and quadriceps training can significantly improve joint pain, physiological function and physical pain indicators in patients with knee osteoarthritis, and the power bicycle training is better than the quadriceps training in improving the knee pain of patients.
In the study of the efficacy of internal fixation with tension band of musculofascial tendon in the treatment of fracture of patella, 52 cases were reported. After a following-up of 6 months to 13 months the bone healing was observed, in 7.5 weeks in average, and the function of the knee joint had recovered to normal or almost normal. It was concluded that the treatment of fracture of patella by internal fixation with tension band from musculofascial tendon was a ideal and practicable method.
Objective To summarize the research progress of the analgesic effect of adductor canal block (ACB) applied to knee arthroplasty, in order to find the ACB mode that can obtain better effectiveness. MethodsThe research progress of the analgesic effect of ACB after knee arthroplasty was reviewed by widely consulting the related literature on ACB at home and abroad in recent years. Results In recent years, multimodal analgesia has become the mainstay of postoperative pain management after knee arthroplasty. Among these, ACB replaces the once “gold standard” femoral nerve block (FNB) by offering comparable and effective analgesia with better preservation of quadriceps function. It is generally safe and efficient to use 0.2% ropivacaine ACB with initial loading doses of 15-30 mL and continual loading doses of less than 8 mL/hour to give analgesia comparable to FNB with minimal impact on lower extremity muscular strength. However, the risk of patient falls must still be taken into consideration by medical staff. Adjuvants like dexmedetomidine and dexamethasone used in ACB can increase the analgesic duration and postoperative analgesic impact. As a perineural adjunct for ACB, 1 µg/kg dexmedetomidine may strike a balance between safety and analgesic efficacy. Conclusion ACB is a safe and effective analgesia method after knee arthroplasty. The adductor canal anatomy, the optimum blocking strategy and blocking site of ACB are all hotly debated and still require additional study due to the significant variety of the nerve structures in adductor canal.
Objective To investigate effectiveness of a improved technique for perforation of patella combined with suture anchor and non-tourniquet for repairing acute rupture of the bone tendon junction of quadriceps tendon. Methods Between June 2010 and June 2016, 15 patients with acute rupture of the bone tendon junction of quadriceps tendon were treated with the improved technique for perforation of patella combined with suture anchor and non-tourniquet. Of them, 14 were male and 1 was female, aged from 19 to 74 years (mean, 44 years). Seven cases were sports injuries, 5 cases were caused by slipping, and 3 cases were caused by violent trauma. The duration of quadriceps tendon rupture ranged from 3 hours to 3 days (median, 2 days). The right side was involved in 9 cases, and the left side in 6 cases. All of the cases were closed injuries. The patients had no sequelae of limb dysfunction and no limb joint surgery in the past. All the patients received anteroposterior and lateral X-ray films of the knee joint and patella axial films during follow-up. Knee function of the patients after operation was evaluated by Lysholm scoring system and Kujala scoring system. Results The operation time was 50-60 minutes (mean, 55 minutes). The intraoperative blood loss was 50-150 mL, with an average of 87 mL. Primary healing of incision was obtained in all patients without complications. All patients were followed up 12-24 months (mean, 18 months). At 1 year after operation, the knee joint function of all patients recovered well; the knee Lysholm score was 92-96, with an average of 94 and the patellofemoral joint Kujala score was 90-95, with an average of 93. There was no re-rupture of quadriceps tendon or loosening of internal fixation during follow-up. According to the lateral and axial X-ray films at 1 year after operation, the patella depth index, femur trochlea depth, sulcus angle, and Insall-Salvati index were 3.62-4.09 (mean, 3.84), 4.45-6.50 (mean, 5.56), 137-145° (mean, 142°), and 0.90-1.18 (mean, 1.06). The lateral patellofemoral angle increased, and the patellar tilt angle and the patella lateral shift distance reduced, all showing significant differences when compared with preoperative ones (P<0.05). Conclusion The improved technique for perforation of patella combined with suture anchor and non-tourniquet for repairing acute rupture of the bone tendon junction of quadriceps tendon can reconstruct a stable patellofemoral joint, increase the strength of fixing, disperse stress effectively and evenly, and increase the area for tendon-bone healing.