ObjectiveTo explore the application value and operation skills of arthroscopic automatic reverse guide wire passer (hereinafter referred to as wire passer) in the posterior meniscus root reconstruction. Methods Between August 2015 and December 2020, 36 patients with posterior meniscus root tears were admitted. There were 16 males and 20 females, with an average age of 46 years (range, 26-66 years). There were 15 cases of sports injury and 21 cases of degenerative injury. The disease duration was 3-180 days, with a median of 28 days. The posterior root of the medial meniscus was injured in 29 cases, and the posterior root of the lateral meniscus was injured in 7 cases. The preoperative Lysholm score of the knee joint was 47.6±3.9, and the International Knee Score Committee (IKDC) score was 39.3±3.0. The meniscus was sutured by using wire passer under arthroscopy. During operation, the suture operation was evaluated according to the self-defined evaluation standard. Lysholm score and IKDC score were used to evaluate knee joint function. Results All meniscuses were sutured successfully by using wire passer. The operation time of suture was 5-15 minutes, with an average of 10 minutes. According to the self-defined evaluation standard, the suture operation was scored as 0-10, with an average of 5. After operation, except for 2 cases of incision fat liquefaction, the incisions of the other patients healed by first intention. All patients were followed up 1-3 years, with an average of 1.5 years. The Lysholm score was 88.2±2.1 and the IKDC score was 51.7±2.3 at 1 year after operation, showing significant difference when compared with preoperative ones (P<0.001). Fifteen cases underwent MRI re-examination, the results showed that the continuity and integrity of the posterior root had been restored. Conclusion Under arthroscopy, the wire passer for the posterior meniscus root reconstruction has the advantages of simple operation, reliable suture quality, and shorter operation time.
ObjectiveTo compare the effectiveness of all-arthroscopic technique and modified open Broström technique in repair of anterior talofibular ligament (ATFL) for lateral instability of the ankle (LIA).MethodsA retrospective analysis was made on 65 patients who underwent ATFL repair with anchors for LIA between January 2014 and January 2017. The ATFL was repaired by all-arthroscopic technique in 35 patients (arthroscopic group) and modified open Broström technique in 30 patients (open group). There was no significant difference in age, gender, the side of injured ankle, the time from injury to operation, and preoperative anterior displacement of talus, tilt angle of talus, the Karlsson Ankle Functional (KAF) score, American Orthopaedic Foot and Ankle Society (AOFAS) score, and Japanese Society for Surgery of the foot ankle-hindfoot (JSSF) scale score between the two groups (P>0.05). The operation time, the intraoperative bleeding volume, and the length of time for surgery recovery were recorded. The anterior displacement of talus, the tilt angle of talus, KAF score, AOFAS score, and JSSF scale score were evaluated at 2 weeks, 3 months, and the last follow-up.ResultsAll patients were followed up 24-30 months, with an average of 26 months. The operation time, intraoperative bleeding volume, and the length of time for surgery recovery of arthroscopic group were superior to open group (P<0.05). There were 2 cases of temporary ankle and dorsum numbness and 1 case of thread reaction in arthroscopic group; and there were 2 cases of temporary ankle and dorsum numbness and 2 cases of thread reaction in open group. The AOFAS score, KAF score, and JSSF scale score in arthroscopic group were significantly higher than those in open group (P<0.05) at 2 weeks after operation; there was no significant difference between the two groups at 3 months and the last follow-up (P>0.05). There was no significant difference in the anterior displacement of talus and the tilt angle of talus between the two groups at 2 weeks, 3 months, and last follow-up (P>0.05).ConclusionCompared with the modified open Broström technique, the all-arthroscopic technique, as a minimally invasive technique, can achieve the same effectiveness, and has the advantages of shorter operation time, less intraoperative bleeding, and less pain in the early stage.
Objective To investigate the effectiveness of a single threaded anchor fixation under shoulder arthroscopy in the treatment of fresh bony Bankart injury. Methods Between January 2017 and May 2021, 12 patients with fresh bony Bankart injury caused by trauma were treated with a single threaded anchor fixation under shoulder arthroscopy. There were 10 males and 2 females with an average age of 38.8 years (range, 21-64 years). The time between injury and operation ranged from 7 to 30 days (mean, 15.8 days). Preoperative American Shoulder and Elbow Surgeons (ASES) score was 44.9±17.4, the University of California at Los Angeles (UCLA) score was 13.1±5.5; the forward supination, lateral external rotation, and lateral internal rotation of shoulder were (130.8±11.8)°, (25.0±7.9)°, and 9.2±1.6, respectively. CT scan and three-dimensional (3D) reconstruction showed that the fracture fragment area was less than 1/4 of the glenoid area in 10 cases, and 1/4-1/2 in 2 cases. The operation time was recorded. During follow-up, ASES score, UCLA score, Rowes score, and shoulder range of motion were used to evaluate the effectiveness, and shoulder CT scan and 3D reconstruction were used to evaluate the fracture position and healing. Results The operation time ranged from 50 to 150 minutes (mean, 85.5 minutes). All patients were followed up 3-18 months (mean, 9.1 months). There was no serious adverse effect such as infection, re-dislocation, or thrombosis. Three patients had shoulder adhesions after operation. At last follow-up, the forward supination of shoulder [(162.1±30.3)°], lateral external rotation [(37.5±11.2)°], and lateral internal rotation (9.2±1.6) significantly improved when compared with those before operation (t=3.331, P=0.003; t=3.153, P=0.005; t=2.716, P=0.013). The ASES score was 89.7±11.8 and the UCLA score was 32.8±2.4, which significantly increased when compared with those before operation (t=7.368, P<0.001; t=11.370, P<0.001). The Rowes score ranged from 75 to 100 (mean, 92.9). Among them, 9 cases were excellent and 3 cases were good, with an excellent and good rate of 100%. CT re-examination showed that the fracture line disappeared in 11 cases, and the fracture alignment was good; the alignment of the fracture fragment was poor in 1 case whose fracture fragment area was between 1/4 and 1/2 of the glenoid area. Conclusion For the fracture fragment area not exceeding 1/4 of the glenoid, the labrum-capsule complex at the lower end of the bone fragment intact, and the non-comminuted fresh bony Bankart injury, a single threaded anchor fixation under shoulder arthroscopy can achieve better effectiveness, has the advantages of less trauma and faster postoperative recovery.
ObjectiveTo investigate the effectiveness of Tang’s arthroscopy approach in treatment of anterior and posterior ankle impingement syndrome.MethodsBetween August 2010 and September 2017, 92 patients with anterior and posterior ankle impingement syndrome were retrospectively analyzed. There were 58 patients were treated with Tang’s arthroscopy approach under floating decubitus (group A) and 34 patients were treated with standard anterior and posterior approaches (group B). There was no significant difference in gender, age, body mass index, side, disease duration, preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score, and preoperative visual analogue scale (VAS) score between the two groups (P>0.05).The operation time, AOFAS score, VAS score, and Roles-Maudsley score were recorded to evaluated the pain and function of the ankle, and patient subjective satisfaction. The X-ray film and MRI at 12 months were used to observe the ankle impingement.ResultsMedian operation time of group A was 50.5 minutes ［95%CI (49.3, 54.6)］, which was significantly shorter than that of group B ［88.5 minutes, 95%CI (76.5, 92.8)］ (Z=−4.685, P=0.000). All incisions in group A healed by first intention; while the incisions of 2 cases in group B delayed healed after debridement. The follow-up time of group A was (54.7±18.8) months, while that of group B was (55.4±17.9) months, and there was no significant difference between the two groups (t=−0.178, P=0.859). The lateral X-ray films at 12 months showed that the talus process was removed incompletely in 2 cases (3.4%) of group A and 1 case (2.9%) of group B. There was no significant difference in the incidence between the two groups (χ2=0.014, P=0.699). At last follow-up, the AOFAS scores were 83.1±6.6 in group A and 85.2±6.4 in group B; the VAS scores were 1.3±1.1 in group A and 1.6±1.0 in group B. The AOFAS and VAS scores at last follow-up were superior to preoperative ones (P<0.05), but there was no significant difference between the two groups (P>0.05). The median subjective satisfaction score of group A was 2.0 ［95%(1.4, 1.7)］, which was better than that of group B ［2.0, 95%(1.6, 2.2)］ (Z=−2.480, P=0.013).ConclusionArthroscopic treatment of anterior and posterior ankle impingement syndrome through Tang’s approach can shorten the operation time, simplify the procedures, and obtain good effectiveness and patient satisfaction.
Objective To evaluate the effectiveness of arthroscopic reconstruction of posterior cruciate ligament (PCL) with embedded “tibial tendon bolt” fixation. MethodsThe clinical data of 32 patients who underwent arthroscopic reconstruction of PCL using embedded “tibial tendon bolt” fixation through the tibial “8”-shaped tunnel between February 2012 and April 2016 were analyzed retrospectively. There were 23 males and 9 females, aged 15-57 years (mean, 39.9 years). The causes included traffic accident injury in 12 cases and sports injury in 20 cases. The clinical manifestations were swelling of knee joint, tenderness of knee joint space, and (+) Ⅲ degree in posterior drawer test; McMurry test (+) in 13 cases, valgus stress test (+) in 8 cases, Lachman test (+) in 9 cases, and Dial test (+) in 2 cases. The preoperative Lysholm score was 18.8±10.9, the International Knee Documentation Committee (IKDC) score was 18.0±15.2, and the detection value of KT-1000 was (14.34±2.73) mm. The time from injury to operation was 8-225 days, with a median of 11 days. Results All 32 patients were followed up 25-36 months, with an average of 26.4 months. The patients had no tenderness of joint space, and the McMurry tests were all (−). At last follow-up, the Lysholm score and IKDC score were 90.2±2.4 and 87.2±6.2, respectively, which were significantly improved when compared with preoperative ones (t=−38.400, P<0.001; t=−27.190, P<0.001). The results of posterior drawer test were (−) in 21 cases, (+) Ⅰ degree in 9 cases, and (+) Ⅱ degree in 2 cases. At 1 and 2 years after operation, the detection value of KT-1000 were (5.56±2.28) mm and (5.87±1.78) mm, respectively, which were significantly improved when compared with preoperative values (P<0.05). ConclusionThe application of arthroscopic reconstruction of PCL using embedded “tibial tendon bolt” fixation through the tibial “8”-shaped tunnel is an effective, simple, and safe surgical procedure.
Objective To investigate the effectiveness of arthroscopic autologous iliac bone grafting with double-row elastic fixation in treatment of recurrent anterior shoulder dislocation combined with massive glenoid bone defects. Methods Between January 2018 and December 2021, 16 male patients with recurrent anterior shoulder dislocation combined with massive glenoid bone defects were treated with arthroscopic autogenous iliac bone grafting and double-row elastic fixation. The patients were 14-29 years old at the time of the first dislocation, with an average age of 18.4 years. The causes of the first dislocation included falling injury in 5 cases and sports injury in 11 cases. The shoulders dislocated 4-15 times, with an average of 8.3 times. The patients were 17-37 years old at the time of admission, with an average age of 25.1 years. There were 5 left shoulders and 11 right shoulders. The preoperative instability severity index (ISIS) score of the shoulder joint was 5.8±2.1, and the Beighton score was 4.3±2.6. The University of California Los Angeles (UCLA) score, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and Rowe score were used to evaluate shoulder function, and the degree of the glenoid bone defect repair was observed based on CT after operation. Results All incisions healed by first intention, and no complication such as incision infection or neurovascular injury occurred. The patients were followed up 12 months. At 12 months after operation, UCLA score, Constant score, ASES score, and Rowe score all significantly improved when compared with the scores before operation (P<0.05). CT imaging showed the degree of glenoid bone defect was significantly smaller at immediate, 6 and 12 months after operation when compared with that before operation (P<0.05), and the bone blocks healed with the scapula, and bone fusion had occurred at 12 months. ConclusionArthroscopic autologous iliac bone grafting with double-row elastic fixation is a safe treatment for recurrent anterior shoulder dislocation combined with massive glenoid bone defects, with good short-term effectiveness.
Objective To testify the spatial relationship between the subscapularis muscle splitting window and the axillary nerve in modified arthroscopic Latarjet procedure, which could provide anatomical basis for the modification of the subscapularis muscle splitting. MethodsA total of 29 adult cadaveric shoulder specimens were dissected layer by layer, and the axillary nerve was finally confirmed to walk on the front surface of the subscapularis muscle. Keeping the shoulder joint in a neutral position, the Kirschner wire was passed through the subscapularis muscle from back to front at the 4 : 00 position of the right glenoid circle (7 : 00 position of the left glenoid circle), and the anterior exit point (point A, the point of splitting subscapularis muscle during Latarjet procedure) was recorded. The vertical and horizontal distances between point A and the axillary nerve were measured respectively. Results In the neutral position of the shoulder joint, the distance between the point A and the axillary nerve was 27.37 (19.80, 34.55) mm in the horizontal plane and 16.67 (12.85, 20.35) mm in the vertical plane. Conclusion In the neutral position of the shoulder joint, the possibility of axillary nerve injury will be relatively reduced when radiofrequency is taken from the 4 : 00 position of the right glenoid (7 : 00 position of the left glenoid circle), passing through the subscapularis muscle posteriorly and anteriorly and splitting outward.
Objective To investigate the effectiveness of modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy for temporomandibular joint anterior disc displacement (ADD). Methods A clinical data of 30 patients (45 sides) with temporomandibular joint ADD, who met selective criteria and were admitted between September 2022 and February 2024, was retrospectively analyzed. Among them, 15 patients (23 sides) were treated with temporomandibular joint disc reduction and suture via small incision (open operation group), and 15 patients (22 sides) with modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy (arthroscopy group). There was no significant difference in gender, age, disease duration, affected side, Wilkes-Bronstein stage, preoperative visual analogue scale (VAS) score, maximal interincisal opening (MIO), and temporomandibular joint dysfunction index (DI), craniomandibular index (CMI), palpation index (PI), and other baseline data between groups (P>0.05). VAS score, MIO, and temporomandibular joint function indicators (PI, DI, CMI) of patients were recorded at 3 months after operation, and the difference (change value) of the above indicators between pre- and post-operation was calculated. At 1 week after operation, MRI was performed to evaluate the reduction of the articular disc compared to the preoperative image. The results were classified as excellent, good, and poor, with excellent and good being considered effective reduction. The condition of condyle process repair was observed by cone beam CT (CBCT) at 3 months after operation. Results All incisions healed by first intention in the two groups. All patients were followed up 3-18 months (mean, 8.2 months). Facial nerve injury occurred in 3 cases in the open operation group and 1 case in the arthroscopy group, all of which returned to normal after physiotherapy and drug treatment. At 3 months after operation, MIO and VAS scores of both groups significantly improved when compared with those before operation (P<0.05), and temporomandibular joint function indicators (PI, DI, CMI) significantly decreased (P<0.05). The change values of MIO and temporomandibular joint function indicators in arthroscopy group were significantly higher than those in open operation group (P<0.05). There was no significant difference in the change value of VAS score between groups (P>0.05). There was no recurrence during follow-up. Postoperative MRI review showed that the effective reduction rate of joint disc was 95.65% (22/23) in the open operation group and 95.45% (21/22) in the arthroscopy group, with no significant difference between groups (P>0.05). Postoperative CBCT found that early and timely effective reduction of joint disc was conducive to condyle process repair and reconstruction. Conclusion Modified temporomandibular joint disc reduction and suture with tragus incision assisted by arthroscopy has a clear effect in the treatment of ADD, with less trauma, fewer postoperative complications, and good early effectiveness.
ObjectiveTo investigate the effectiveness of arthroscopic 360° capsular release for frozen shoulder.MethodsBetween April 2018 and April 2019, 42 patients with frozen shoulders were treated with arthroscopic 360° capsular release. There were 13 males and 29 females, with an average age of 52.3 years (range, 45-56 years). There were 14 left shoulders and 28 right shoulders. The disease duration ranged from 5 to 18 months (mean, 11.1 months). The main clinical symptoms were limited active and passive movement of the shoulder joint with severe pain. All patients excluded impingement syndrome and shoulder osteoarthritis. Preoperative range of motion was as follows: forward flexion (93.2±15.4)°, external rotation at side (15.9±6.0)°, external rotation at 90° abduction (18.4±9.9)°, and internal rotation reaching the greater trochanter in 5 cases, buttocks in 20 cases, S1 level in 17 cases. The visual analogue scale (VAS) score was 6.7±1.7 and the American Society of Shoulder and Elbow Surgery (ASES) score was 41.6±9.3. The active range of motion of shoulder joint, VAS score, and ASES score were recorded during follow-up.ResultsAll incisions healed by first intention, and no early complications occurred. Patients were followed up 12-24 months (mean, 15.6 months). After operation, forward flexion, external rotation at side, and external rotation at 90° abduction significantly improved when compared with preoperatively (P<0.05). The range of internal rotation restored to the level of T6-12 at 3 weeks, which was equivalent to that of the normal side at 12 months after operation (Z=–0.943, P=0.346). VAS scores decreased and ASES scores increased after operation, and the differences between pre- and post-operation were significant (P<0.05); and with time, the VAS scores and ASES scores improved further (P<0.05).ConclusionArthroscopic 360° capsular release can significantly increase the range of motion of the shoulder joint, release pain, and improve function. It is an effective method for the treatment of frozen shoulders.
Objective To compare the intraoperative effects of computer navigation-assisted versus simple arthroscopic reconstruction of posterior cruciate ligament (PCL) tibial tunnel. Methods The clinical data of 73 patients with PCL tears who were admitted between June 2021 and June 2022 and met the selection criteria were retrospectively analysed, of whom 34 cases underwent PCL tibial tunnel reconstruction with navigation-assisted arthroscopy (navigation group) and 39 cases underwent PCL tibial tunnel reconstruction with arthroscopy alone (control group). There was no significant difference in baseline data between the two groups, including gender, age, body mass index, side of injury, time from injury to surgery, preoperative posterior drawer test, knee range of motion (ROM), Tegner score, Lysholm score, and International Knee Documentation Committee (IKDC) score between the two groups (P>0.05). The perioperative indicators (operation time and number of guide wire drillings) were recorded and compared between the two groups. The angle between the graft and the tibial tunnel and the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes respectively were measured on MRI at 1 day after operation. The knee ROM, Tegner score, Lysholm score, and IKDC score were evaluated before operation and at last follow-up. Results The operation time in the navigation group was shorter than that in the control group, and the number of intraoperative guide wire drillings was less than that in the control group, the differences were significant (P<0.05). Patients in both groups were followed up 12-17 months, with an average of 12.8 months. There was no perioperative complications such as vascular and nerve damage, deep venous thrombosis and infection of lower extremity. During the follow-up, there was no re-injuries in either group and no revision was required. The results showed that there was no significant difference in the exit positions of the tibial tunnel in the coronal, sagittal, and transverse planes between the two groups (P>0.05), but the angle between the graft and the tibial tunnel was significantly greater in the navigation group than in the control group (P<0.05). At last follow-up, 30, 3, 1 and 0 cases were rated as negative, 1+, 2+, and 3+ of posterior drawer test in the navigation group and 33, 5, 1, and 0 cases in the control group, respectively, which significantly improved when compared with the preoperative values (P<0.05), but there was no significant difference between the two groups (P>0.05). At last follow-up, ROM, Tegner score, Lysholm score, and IKDC score of the knee joint significantly improved in both groups when compared with preoperative values (P<0.05), but there was no significant difference in the difference in preoperative and postoperative indicators between the two groups (P>0.05). ConclusionComputer-navigated arthroscopic PCL tibial tunnel reconstruction can quickly and accurately prepare tunnels with good location and orientation, with postoperative functional scores comparable to arthroscopic PCL tibial tunnel reconstruction alone.