ObjectiveTo assess the outcomes in indirect reduction technique via Nice knot for transverse patellar fractures.MethodsThe clinical data of 25 patients with transverse patellar fractures meeting the inclusion criteria between January 2017 and December 2018 were retrospectively analyzed. The patients were divided into trial group (n=13) and control group (n=12) according to different intraoperative reduction methods. No significant difference was found in gender, age, affected side, cause of fracture, classification, or the time from injury to operation between the two groups (P>0.05). In the trial group, No.2 suture was used to cross the quadriceps tendon and patellar tendon to construct the Nice knot, then the suture was tightened to make the distal and proximal fracture segments contact in an indirect reduction pattern. Depend on Nice knot’s sliding compression and self-stabilizing function, the suture mesh created an anterior tension band as a temporary fixation. In the control group, Weber’s clamp was used to hold the fracture segments directly and fixed temporarily. After reduction, terminal fixation was conducted using a titanium Kirschner wire with titanium cable in both groups. The operation time, intraoperative blood loss, follow-up time, fracture healing time, and complications were recorded and compared in the two groups. At last follow-up, the knee function was evaluated according to the Böstman scoring criteria for efficacy in patellar fractures.ResultsThe operation time in the trial group was significantly shorter than that in the control group (t=−2.165, P=0.041). There was no significant difference of intraoperative blood loss between the two groups (t=0.514, P=0.612). The incisions of the two groups healed by first intention. All the patients were followed up 12-16 months, with an average of 14.4 months, no significant difference was found in the follow-up time between the two groups (t=−0.309, P=0.760). One patient in the control group developed soft tissue irritation symptoms at 1 day after operation, and no special treatment was given, the symptoms disappeared at 2 months after operation. The fractures of the two groups healed at the 12-week follow-up. During the follow-up, there was no complication such as loosening and fracture of titanium cables and tendon tissue calcification. At last follow-up, the Böstman score presented no significant difference between the two groups (t=−0.086, P=0.932). In the trial group, an 80-year-old female patient was evaluated as good (score, 27) due to atrophy of the quadriceps femoris, leg weakness, and affected stair climbing, and the rest 24 patients were all evaluated as excellent.ConclusionThe indirect reduction with Nice knot can shorten the operation time in the treatment of transverse patellar fractures, and obtain good effectiveness.
To investigate the feasibility of using the pedicled patella for repaire of the superior articular surface of the medial tibial condyle, 37 lower limbs were studied by perfusion. In this series, there were 34 obsolete specimens and 3 fresh specimens of lower legs. Firstly, the vessels which supply to patella were observed by the methods of anatomy, section and casting mould. Then, the form and area of the patellar and tibial medial conylar articular surface were measured in 30 cases. The results showed: (1) the arteries supplied to patella formed a prepatellar arterial ring around patella, and the ring gave branches to patella; (2) medial inferior genicular artery and inferior patellar branches of the descending genicular arterial articular branch merge and acceed++ to prepatellar ring at inferior medial part of patella; (3) the articular surface of patella is similar to the superior articular surface of the tibial medial condyle on shape and area. It was concluded that the pedicled patella can be transposed to medial tibial condyle for repaire of the defect of the superior articular surface. The function of the knee can be reserved by this method.
Objective To investigate the effectiveness of arthroscopic medial retinaculum plication (MRP) for acute patellar dislocation (APD) in adolescents. Methods Between March 2007 and June 2011, 24 adolescent patients suffering from APD were treated by arthroscopic MRP. There were 14 males and 10 females, aged 8-18 years (mean, 12.7 years). The location was the left knee in 16 cases and the right knee in 8 cases. Injury was caused by sports in 19 cases, by traffic accident in 4 cases, and by heavy bruising in 1 case. The duration from injury to operation was 3 to 21 days with an average of 7.8 days. The results of floating patella test and dislocation apprehension test were both positive. MRI examination showed the arthroedema in all cases; associated injuries included medial retinaculum injury in 20 cases, medial patellar injury in 8 cases, and meniscus tear in 5 cases. Results All incisions healed by first intention without complication of infection or neurovascular injury. All the patients were followed up 12-36 months (mean, 14.6 months). Only 2 patients suffered from patellar re-dislocation at 4 months and 6 months after operation respectively. The knee joint activity returned to normal at 12 months. The Lysholm, Kujala, and International Knee Documentation Committee (IKDC) scores at 3 and 12 months after operation were significantly higher than those before operation (P lt; 0.05), and the scores at 12 months were significantly higher than those at 3 months (P lt; 0.05). Conclusion Treatment of APD with arthroscopic MRP has the advantages of minor trauma and good knee functional improvement. The technique can decrease incidence of patellar re-dislocation in adolescent.
Objective To investigate the treatment and effectiveness of inferior polar comminuted fractures of patella and patellar tendon injury. Methods Between January 2003 and December 2008, 5 patients with inferior polar comminuted fractures of patella and patellar tendon injury were treated with Nitinol Patellar Concentrator and fascia lata allograft. There were 3 males and 2 females with a mean age of 33.7 years (range, 20-48 years). The interval of injury and operation was 1-5 days. Fracture degree: 3 cases had 3 fractures of patella, 2 cases had 4 fractures; patellar tendon injury degree: 3cases had horizontal rupture of middle l igament, 1 case had obl ique rupture of tibial tubercle, and 1 case had longitudinal partial rupture. Results Heal ing of incision by first intention was achieved in all patients, and no compl ication of infection or deep venous thrombosis occurred. The X-ray films at 2 days after surgery showed that patella recovered to normal height, which meaned ratio of patella height to patellar tendon length recovered to 1 : 1. Five cases were followed up 18 months on average (range, 10-22 months). At 3-12 weeks after surgery, the knee function of the injury side almost reached that of the normal side in 4 patients, and the knee range of motion was about 100° in 1 patient. The fracture heal ing time was 3-5 months. At 12-15 months after surgery, patella holder was taken out and no lost of reduction or refracture occurred. During follow-up, there was no fracture displacement, loosening and breakage of implant, or rerupture of patellar tendon. According to ZHANG Chuncai’ s criterion for knee joint function, the results were excellent in 3 cases, good in 1 cases, and fair in 1 case with an excellent and good rate of 80%. According to XU Shaoting’s criterion for knee joint function, the results were excellent in 2 cases, good in 2 cases, and fair in 1 case with an excellent and good rate of 80%. Conclusion Nitinol Patellar Concentrator and fascia lata allograft is a new method to treat inferior polar comminuted fractures of patella and patellar tendon injury, and it can ensure the knee joint stabil ity in early motion after surgery.
Objective To review the influencing factors of medial patellofemoral ligament (MPFL) reconstruction for patellar dislocation. Methods The literature of MPFL reconstruction for patellar dislocation at home and abroad in recent years were summarized and analyzed. Results The influencing factors such as the location of the femoral insertion point, the tension and the fixed angle of the grafts, the dysplasia of the femoral trochlear before operation, the abnormal tuberositas tibiae-trochlear groove value, the high position of the patellar, and the tilting angle of the patellar, are all the factors affecting the effectiveness of MPLF reconstruction. Conclusion During MPFL reconstruction, the surgical techniques and elimination of other factors that caused patellar instability need to be focused in order to reduce the complications and operation failure.
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 cl inical therapeutic results of allograft tendon for anatomical reconstruction of medial patellofemoral l igament (MPFL) in patellar dislocations. Methods From September 2005 to June 2008, 20 patientswith patellar dislocation underwent MPFL reconstructions. There were 4 males and 16 females, aged 13 to 31 years (19 years on average). Patellar dislocations occurred in 7 left and 13 right knees, including 6 cases of acute dislocation and 14 cases of recurrent dislocation. The disease course was 1 day to 2 years. The frequency of dislocation was 1-6 (4 on average). Affected knee joint showed pain, swell ing and patellar instabil ity; the range of action for patella obviously increased. The X-ray films showed patellar dislocation or medial margin avulsion fracture. The preoperative Q angle was (15 ± 3)°, the congruence angle was (10 ± 11)°. Reconstruction was performed via allograft tendon. Allograft tendon was anchored to the superomedial pole of the patella by two bone anchors, and the other end was fixed at the natural MPFL insertion site near the medial femoral condyle with an interference screw in a bone tunnel. All patients were evaluated postoperatively; Kujala patellofemoral scores, objective knee function, compl ications, and reoperations were assessed. Results Primary heal ing was achieved in 18 cases and secondary heal ing in 2 cases. No infection or necrosis and absorption of grafts was observed. All patients were followed up for an average of 25.6 months (range, 6-34 months) postoperatively. At last follow-up, other patients had no pain, swell ing and patellar instabil ity except 1 case; neither patella redislocation nor fracture occurred. The X-ray films showed good position of anchors and tunnel 6 months after operation, and the congruence angle was (3 ± 8)°, showed statistically significant difference when compared with preoperation (P lt; 0.05). The postoperative Q angle was (15 ± 2)°, the Kujala knee function score improvedsignificantly from 60.8 ± 7.2 to 83.4 ± 8.0 at last follow-up, showing statistically significant difference (P lt; 0.05). According to Insall et al. for function, the results were excellent in 12 cases, good in 6 cases, and fair in 2 cases, the excellent and good rate was 90%. Conclusion MPFL reconstruction improves cl inical symptoms. Anatomical MPFL reconstruction is effective for patellar dislocation, and it offer good recovery of the pre-morbid patella mechanics. There would be l ittle bone loss when tendon is fixed by anchors, and there would be less patellar fracture than bone tunnel technique. The bone anchors also provide firm fixation. Allograft can avoid the graft harvest site morbidity, but it increases the cost of the surgery.
Objective To summarize the surgical treatment methods and progress of inferior patellar pole fractures and provide reference for clinical application. Methods The literature on surgical treatment of inferior patellar pole fractures was extensively reviewed, and the relevant research progress, advantages, and limitations were summarized. Results The inferior pole of the patella is an important part of the knee extension device, which can strengthen the force arm of the quadriceps. Inferior patellar pole fractures are relatively rare and often comminuted, usually requiring surgical treatment. At present, there are various methods to treat inferior patellar pole fractures, including patellectomy of inferior pole, tension-band wiring technique, plate internal fixation, suture anchor fixation, claw-like shape memory alloy, separate vertical wiring technique. Different methods have their own characteristics, advantages, and disadvantages. The single internal fixation method has more complications and is easy to cause fixation failure. Therefore, the trend of combining various internal fixation methods is developing at present. Conclusion When the main fragment of the inferior patellar pole fracture is large and mainly distributed transversely, the combination protocol based on tension-band wiring technique can be regarded as an ideal choice. When the fragments are severely damaged and small, the comprehensive protocol based on suture fixation can result in a better postoperative functional recovery.
Objective To evaluate an improving operative procedure and the cl inical results of arthroscopically assisted treatment for acute patellar dislocation. Methods Between April 2006 and March 2009, 22 patients (25 knees) with primary acute complete dislocation of the patella underwent an improving arthroscopic operation, release of lateral retinaculum and suture of medial capsule and retinaculum structure. There were 5 males and 17 females with an average age of 23.6 years (range, 14-34 years). Three patients had bilateral procedure. Eleven left knees and 14 right knees were involved. The disease duration was 1-10 days with an average of 5.9 days. All patients had lateral dislocation; of them, 14 patients showed reduction without treatment, and 8 patients showed dislocation at admission and were given close manipulative reduction. The results were positive for apprehension test in all patients with the l imitation of passive motion and for Ballottable Patella Sign in 15 cases. Lysholm score, visual analogue scale (VAS) score, and Insall scale were adopted to evaluate the effect. Results All incisions healed by first intention. All the patients were followed up 12-36 months (17 months on average). During the first 3 months after operation, sunken skin in the puncture point medial to the patella was observed in 12 knees; 10 knees suffered pain of the soft tissue lateral to the patella; 15 knees felt tense in the soft tissue medial to the patella, however, all these problems disappeared or recovered gradually after rehabil itation and conservative treatment. No recurrence of dislocation was observed during the follow-up. Lysholm score was significantly improved from preoperative 67.3 ± 5.7 to postoperative 96.6 ± 4.5 (t=3.241, P=0.003) and VAS score from 6.5 ± 0.5 to 1.8 ± 0.4 (t=2.154, P=0.040). According to Insall scale, the results were excellent in 18 knees, good in 5 knees, and fair in 2 knees at 1 year after operation with an excellent and good rate of 92%. Conclusion The improving procedure of arthroscopically assisted treatment for acute patellar dislocation is a minimally invasive operation and has a number of benefits. Its short-term cl inical outcome was satisfactory.
目的:探讨带线锚钉治疗急性创伤性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤的疗效。方法:自2003年9月至2008年7月共收治28例急性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤患者。对28例患者均采用开放手术下带线锚钉固定髌骨骨折及修复内侧髌股韧带损伤。术后1年进行术后的髌骨骨折Levack功能评分。结果:所有患者术后随访时间12~30个月,平均(16±3.50)个月。术后1年的髌骨骨折Levack功能评分标准优23例,可3例,差2例,优秀率达82.14%。无再次髌骨脱位或伴脱位患者。结论:开放手术下带线锚钉治疗对髌骨骨折固定及内侧髌股韧带修复可靠,是治疗急性创伤性髌骨脱位后髌骨内侧缘撕脱骨折伴内侧髌股韧带损伤的有效方法。