ObjectiveTo investigate the effectiveness of anterior cruciate ligament (ACL) reconstruction with the autologous ipsilateral peroneus longus tendon (PLT) under arthroscopy.MethodsA retrospective study was conducted on 35 patients with ACL rupture who underwent ACL reconstruction with autologous ipsilateral PLT under arthroscopy between October 2017 and October 2018. There were 19 males and 16 females with an average age of 43.4 years (range, 18-60 years), with 20 cases of left knee and 15 cases of right knee. The causes of injury included traffic accident in 14 cases, falling injury in 13 cases, and sports injury in 8 cases. The time from injury to operation ranged from 3 to 9 days (mean, 4.7 days). The patients suffered from swelling, pain, and limited mobility of knee joint before operation. The anterior drawer test, Lachman test, and pivot-shift test were positive before operation, whereas MRI was taken to confirm the ACL rupture. After operation, the patients were followed up every 3 months until the knee joint’s function returned to normal. MRI and X-ray films were used to observe the tendon-bone healing as well as the position of Endobutton suspension plate and hollow nail. The anterior drawer test, Lachman test, and pivot-shift test were conducted to observe the improvement of knee joint mobility. The functional improvements were evaluated by the International Knee Documents Committee (IKDC) score, Lysholm score, knee injury and osteoarthritis (KOOS) score.ResultsAll the 35 patients were followed up 12-18 months, with an average of 14.2 months. The incisions healed by first intention, and no complications such as infection, joint stiffness, and rerupture occurred. Postoperative anterior drawer test, Lachman test, and pivot-shift test turned to be negative of all patients. MRI showed that the ACL was continuous, and the tendon-bone in the distal femur tunnel and proximal tibia tunnel recovered well after operation. X-ray films showed that the positions of Endobutton suspension plate and hollow nail were stable. The IKDC, Lysholm, and KOOS scores at 3, 6, and 12 months after operation were significantly improved when compared with those before operation, and the scores were further improved with time after operation (P<0.05).ConclusionFor patients with ACL rupture, ACL reconstruction with the autologous ipsilateral PLT under arthroscopy has satisfactory effectiveness of quick recovery, good function, and great stability.
ObjectiveTo compare the effectiveness of arthroscopic intertubercular groove and open subpectoral tenodesis in treatment of long head of biceps tendon (LHBT) tendinopathy.MethodsA clinical data of 80 patients with LHBT tendinopathy who were admitted between June 2013 and May 2017 and met the selection criteria was retrospectively analyzed. After cutting LHBT under arthroscopy, the arthroscopic intertubercular groove tenodesis was performed in 40 cases (group A) and open subpectoral tenodesis was performed in 40 cases (group B). There was no significant difference in the gender, age, side of the affected shoulder joint, disease duration, and preoperative pain visual analogue scale (VAS) score, Constant score, American Society of Shoulder and Elbow Surgery (ASES) score, Disability of Arm, Shoulder, and Hand (DASH) score, LHBT score (LHBS) between the two groups (P>0.05). The operation time and the scores of shoulder joint pain and function at 12 months after operation were compared between the two groups.ResultsThe operation time was (3.6±2.5) minutes in group A and (8.5±2.3) minutes in group B, showing a significant difference (t=18.584, P=0.000). The incisions of the two groups healed by first intention, and there was no complication such as infection or thrombosis. All patients were followed up. The follow-up time was 24-30 months (mean, 26.0 months) in group A and 24-31 months (mean, 26.0 months) in group B. Both Speed test and Yergason test were negative at 3 months after operation. MRI showed that there was no obvious effusion around the LHTB and no dislocation of LHTB. At 12 months after operation, the VAS score, Constant score, ASES score, DASH score, and LHBS score of the two groups all improved when compared with preoperative ones (P<0.05), and there was no significant difference in the differences before and after operation between the two groups (P>0.05). No Popeye sign appeared during the follow-up.ConclusionThe arthroscopic intertubercular groove and open subpectoral tenodesis can effectively relieve shoulder pain and improve function, but the former has shorter operation time and less trauma.
Objective To evaluate the effectiveness of arthroscopic debridement and release for post-traumatic arthritis of subtalar joint. Methods Between January 2011 and December 2014, 14 cases of post-traumatic arthritis of the subtalar joint underwent arthroscopic debridement and release, and the clinical data were retrospectively analyzed. All patients were male, aged 42 years on average (range, 32-62 years). Calcaneus fracture was caused by falling from height; 8 cases received conservative treatment and the other 6 cases received open reduction and internal fixation. The mean interval from injury to operation was 3.4 years (range, 2-7 years). The arthroscopic debridement and release were performed through lateral portals. The injury degree of articular cartilage was classified as grade 3 in 4 cases and grade 4 in 10 cases based on Outerbridge rating. The degree of pain was assessed by visual analogue scale (VAS) and the function of joint was assessed by the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Scale. Results All incisions healed by first intention and no complication occurred. The follow-up time was 18 months. Pain was relieved obviously; VAS was significantly decreased to postoperative 3.8±0.9 at 18 months from preoperative 7.7±1.2 (t=9.728,P=0.000), and AOFAS Ankle Hindfoot Scale was significantly increased to postoperative 59.1±8.8 from preoperative 37.6±8.2 (t=6.688,P=0.000). During follow-up, no patient was given arthrodesis and no worsened sign was found on the postoperative CT and MRI. Conclusion Arthroscopic debridement and release for post-traumatic arthritis of the subtalar joint can relieve clinical symptoms and delay subtalar arthrodesis.
ObjectiveTo observe the effectiveness of arthroscopic reconstruction of medial patellofemoral ligament (MPFL) with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity for the treatment of recurrent dislocation of patella.Methods Retrospectively analyse the clinical data of 24 patients (24 knees) with recurrent patellar dislocation with tibial tuberosity-trochlear groove distance (TT-TG) values more than 15 mm who were admitted between September 2014 and September 2018. Of which 7 were male and 17 were female; aged 16-35 years old with an average of 25.8 years. The disease duration ranged from 15 to 46 months, with an average of 26.7 months. All patients had a history of knee trauma, and a positive result of apprehension test on the affected knee. All patients underwent the surgery of arthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon, and medial displacement of lateral hemitibial tuberosity. Before and after operation, Kujala score was used to evaluate patellofemoral joint function, Lysholm score was used to evaluate knee joint function; CT and MRI were used to measure and compare the changes of congruence angle (CA), patellar tilt angle (PTA), and lateral patella displacement (LPD) in order to evaluate patella stability.ResultsAll incisions healed by first intention, and no infection or neurovascular injury occurred. Deep vein thrombosis of the lower extremities occurred in 2 cases at 4 and 7 days after operation respectively, and the thrombosis disappeared after symptomatic treatment. All the 24 patients were followed up 12-14 months (mean, 12.9 months). During follow-up, no patellar dislocation reoccurred in the affected knee. At last follow-up, the apprehension test was negative in every patients. The TT-TG, CA, PTA, and LPD were significantly improved when compared with those before operation (P<0.05). The Kujala score and Lysholm score at 1 month and last follow-up were significantly better than those before operation, and the above scores at last follow-up were significantly better than those at 1 month after operation (P<0.05). According to Lysholm score, the patients’ knee joint functions were excellent in 13 cases, good in 10 cases, and fair in 1 case, and the excellent and good rate was 95.8%.ConclusionArthroscopic reconstruction of MPFL with a single bundle of autogenous half peroneal longus tendon combined with medial displacement of lateral hemitibial tuberosity has the advantages of minimal invision and reliable effectiveness. It can be used as one of the effective surgical methods for the treatment of recurrent dislocation of patella.
ObjectiveTo investigate the effectiveness of arthroscopic medial patellofemoral ligament (MPFL) reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation.MethodsBetween February 2012 and December 2013, 24 patients (24 knees) with recurrent patellar dislocation were treated with arthroscopic MPFL reconstruction combined with tibial tuberosity transfer. There were 7 males and 17 females, with a mean age of 23.2 years (range, 18-37 years). One patient had recurrence dislocation after operation in the other hospital, and the others were the first operation. The disease duration ranged from 6 months to 20 years (mean, 5.6 years). The patellar apprehension tests were positive. The preoperative Lysholm score was 49.79±11.67 and the Kujala score was 49.63±6.28. X-ray films showed that 13 patients had dysplasia of the patella and femoral trochlea; 8 patients had high tibia (Caton-Deschamps index>1.2); the congruence angle was (23.96±5.54)°. CT examination showed that the tibial tuberosity-trochlear groove distance (TT-TG) value was (23.71±2.35) mm.ResultsAll incisions healed by first intention. Twenty-two patients were followed up 59-81 months, with an average of 66.8 months. No dislocation occurred during the follow-up period. The patellar apprehension tests were negative. At 1 week after operation, the results of X-ray films and CT showed that the congruence angle angle was (–1.96±4.65)°, and the TT-TG value was (13.75±1.89) mm, which were significantly lower than those before operation (P<0.05). At 6 months, 1 year, and last follow-up, Lysholm scores were 81.13±17.76, 91.35±3.60, and 92.23±2.71, respectively; and Kujala scores were 84.04±3.98, 91.48±3.64, and 91.45±3.29, respectively. The Lysholm and Kujala scores were significantly increased after operation when compared with the preoperative scores (P<0.05). At last follow-up, the effectiveness was excellent in 11 cases, good in 8 cases, and fair in 3 cases, with an excellent and good rate of 86%.ConclusionArthroscopic MPFL reconstruction combined with tibial tuberosity transfer for recurrent patellar dislocation can effectively improve the patellofemoral joint matching relationship and has a satisfactory short- and medium-term effectiveness.
Objective To investigate the short-term effectiveness of transtibial pull-out technique combined with side-to-side suture technique in treatment of complete radial tear of lateral meniscus body. Methods Between May 2020 and August 2023, 15 patients with complete radial tear of lateral meniscus body were repaired by arthroscopic transtibial pull-out technique combined with side-to-side suture technique. There were 11 males and 4 females, with an average age of 25.2 years (range, 15-43 years). Twelve cases were acute injuries and 3 were chronic injuries. All patients had tenderness in the lateral compartment of the knee. No abnormal alignment was observed on the X-ray films of the knee. MRI showed the complete radial tear of lateral meniscus body without associated injuries such as anterior cruciate ligament or cartilage. Preoperative Lysholm score was 44.5±6.4, International Knee Documentation Committee (IKDC) subjective score was 40.2±8.4, Tegner score was 1.3±1.1, and visual analogue scale (VAS) score for pain was 5.1±1.1. The operation time, incision healing, and complications such as vascular/nerve injury were recorded. During follow-up, the range of motion of the knee and tenderness in the lateral compartment of the knee were observed. The knee function and pain were evaluated using Lysholm score, Tegner score, IKDC subjective score, and VAS score. X-ray films and MRI of the knee were reexamined to assess knee degeneration. Results The operation time was 60-145 minutes (mean, 89.6 minutes). All incisions healed by first intention, and no complication such as vascular/nerve injury occurred. All patients were followed up 17-56 months (mean, 38.4 months). All patients had no knee extension limitation and 3 cases had tenderness in the lateral compartment of the knee. At last follow-up, the Lysholm score, IKDC subjective score, Tegner score, and VAS score for pain were 85.3±7.8, 82.1±15.7, 4.7±1.2, and 1.5±1.0, respectively, which were superior to those before operation (P<0.05). Imaging reexamination showed that the meniscus was reset at 1 day after operation, and there was no sign of knee degeneration at last follow-up. Conclusion Transtibial pull-out technique combined with side-to-side suture technique can effectively treat the complete radial tear of lateral meniscus body and obtain good short-term effectiveness.
Objective To review the research progress of arthroscopic long head of biceps tendon (LHBT) transposition in treatment of irreparable massive rotator cuff tears. Methods The domestic and foreign related literature in recent years on the treatment of irreparable massive rotator cuff tears with different LHBT transposition methods under arthroscopy was reviewed and analyzed. Results Arthroscopic LHBT transposition is an effective method for irreparable massive rotator cuff tears, which mainly includes “proximal cut”, “both two cuts”, “distal cut”, and “no cut”. Different methods of LHBT transposition can achieve good effectiveness, but its long-term effectiveness needs further follow-up. Conclusion Arthroscopic LHBT transposition in treatment of irreparable massive rotator cuff tears is simple and effective. The patients can recover quickly after operation with less injury. But the technique has higher requirements for surgeons, and the indications must be strictly controlled.
ObjectiveTo investigate the feasibility and effectiveness of “tail compression fixation+suture bridge” technology under shoulder arthroscopy for treating primary tear in medial enthesis of rotator cuff. Methods The clinical data of 11 patients with primary tear in medial enthesis of rotator cuff who met the selection criteria between October 2020 and October 2022 were retrospectively analyzed, including 3 males and 8 females, aged 39-79 years, with an average of 61.0 years. Rotator cuff injury was caused by traumatic fall in 8 cases, and the time from injury to admission was 1-4 months, with an average of 2.0 months; the remaining 3 cases had no obvious inducement. The active range of motion of the affected shoulder was limited, with an active forward flexion range of motion of (64.1±10.9)°, abduction of (78.1±6.4)°, internal rotation of (48.2±6.6)°, and external rotation of (41.8±10.5)°; 5 cases had shoulder stiffness. The preoperative visual analogue scale (VAS) score was 7.8±0.8 and the American Society of Shoulder and Elbow Surgeons (ASES) score was 23.9±6.4. The patients were treated with “tail compression fixation+suture bridge” technology under shoulder arthroscopy, and the pain and functional recovery were evaluated by VAS score, ASES score, and active range of motion of shoulder joint at last follow-up; MRI was performed after operation, and the integrity of rotator cuff was evaluated by Sugaya classification system. Results All the 11 patients were followed up 2-22 months, with an average of 13.5 months. All incisions healed by first intention, and there was no complication such as infection, rotator cuff re-tear, and anchor falling off. At last follow-up, the VAS score was 0.8±0.7 and the ASES score was 93.5±4.2, which significantly improved when compared with those before operation (P<0.05). All 11 patients had no significant swelling in the shoulders, and the active range of motion was (165.1±8.8)° in flexion, (75.3±8.4)° in abduction, (56.6±5.5)° in internal rotation, and (51.8±4.0)° in external rotation, which significantly improved when compared with those before operation (P<0.05). Shoulder MRI showed adequate tendon thickness and good continuity in 9 cases, including 4 cases with partial high signal area; and 2 cases with inadequate tendon thickness but high continuity and partial high signal area. According to Sugaya classification system, there were 4 cases of type 1 (36.4%), 5 cases of type 2 (45.5%), and 2 cases of type 3 (18.1%).Conclusion For the patients with primary tear in medial enthesis of rotator cuff, the “tail compression fixation+suture bridge” technology under shoulder arthroscopy is simple and effective.
Objective To evaluate the clinical effectiveness and safety of tranexamic acid (TXA) in arthroscopic rotator cuff repair by meta-analysis. Methods Randomized controlled trials evaluating the clinical effectiveness and safety of TXA use in the perioperative period of arthroscopic rotator cuff repair were identified from the Cochrane Library, PubMed, Embase, VIP Chinese Science and Technology Periodical Database, Chinese National Knowledge Infrastructure, and Wanfang database, with a search time span from the inception of the database to August 2024. Meta-analysis was conducted using RevMan 5.3 software, and mean difference (MD) and risk difference (RD) were used as measures of effect size. Results A total of 7 randomized controlled trials were included. Meta-analysis demonstrated significant differences in good visual clarity [MD=9.10, 95% confidence interval (CI) (4.05, 14.15), P=0.0004] and operative time [MD=−12.07 min, 95%CI (−17.21, −6.93) min, P<0.00001]. There was no significant difference in mean arterial pressure [MD=−1.08 mm Hg (1 mm Hg=0.133 kPa), 95%CI (−3.13, 0.98) mm Hg, P=0.30] or adverse event rate [RD=0.02, 95%CI (−0.01, 0.06), P=0.22] between the two groups. Conclusion TXA is effective and safe in enhancing visual clarity and significantly reducing operative time in arthroscopic rotator cuff repair, without increasing the incidence of adverse events.
ObjectiveTo explore the effectiveness of arthroscopic treatment of scaphoid fracture nonunion with bone graft and Kirschner wire combined with screw fixation. MethodsThe clinical data of 14 patients with scaphoid fracture nonunion who met the selection criteria between February 2021 and September 2022 were retrospectively analyzed. There were 13 males and 1 female with an average age of 32 years ranging from 17 to 54 years. The time from injury to operation ranged from 6 to 15 months, with an average of 9.6 months. According to the Slade-Geissler classification of scaphoid fracture nonunion, there were 3 cases of grade Ⅲ, 8 cases of grade Ⅳ, and 3 cases of grade Ⅴ. The preoperative visual analogue scale (VAS) score was 5.9±1.0, and the modified Mayo wrist score was 53.2±9.1. There were 2 cases of scaphoid nonunion advanced collapse, both of which were stage Ⅰ. All patients were treated with arthroscopic bone graft and Kirschner wire combined with screw fixation, and the fracture healing was observed by X-ray film monthly after operation, and the effectiveness was evaluated by VAS score and modified Mayo wrist score before and after operation. ResultsAll patients were followed up 6-14 months, with an average of 8.4 months. All fractures healed in 4-8 months, with an average of 6.3 months. The postoperative pain symptoms and wrist function of the patients significantly improved when compared with those before operation, and the VAS score at last follow-up was 2.4±1.3, and the modified Mayo wrist score was 87.1±6.7, which were significantly different from those before operation (t=12.851, P<0.001; t=−14.410, P<0.001). According to the modified Mayo wrist evaluation, 9 cases were excellent, 3 cases were good, and 2 cases were fair. Conclusion Arthroscopic bone graft and Kirschner wire combined with screw fixation is an effective surgical method for the treatment of scaphoid fracture nonunion.