Objective To evaluate the short-term results of reconstruction of stiff elbow under arthroscopy technique in patients with elbow osteoarthritis. Methods Between March 2006 and March 2009, 38 cases of elbow osteoarthritis with contracture were treated under arthroscopy technique. There were 26 males and 12 females with an average age of 47.8 years (range, 26-66 years). Unilateral side was affected in all cases, including 13 cases at the left side and 25 at the right side with 30 patients on the dominant side. The disease duration was more than 6 months. X-ray examination showed that 31 patients had free body, and 28 had osteophytosis. Seven patients had ulnar neuritis. The arthroscopy functional reconstruction was performed including synovectomy, free body removal, and osteocapsular arthroplasty. Results All incisions healed by first intention. All patients were followed up 6-10 months (mean, 8 months). Transient radial nerve injury occurred in 1 case, re-adhesion of elbow joint in 1 case, and heterotopic ossification of brachial ulnar joint in 1 case at 6 months after operation. In 1 patient compl icated by ulnar neuritis, the disorder of ulnar nerve was not improved, nervous symptoms disappeared after the re-operation of ulnar nerve relaxation after 2 months. The range of motion, Mayo Elbow Performance Score (MEPS), and visual analogue scale (VAS) for pain at 3 and 6 months had significant differences when compared with those before operation (P lt; 0.05), but had no significant difference between two time points after operation (P gt; 0.05). According to MEPS functional criteria, the results were classified as excellent in 20 cases, good in 15 cases, fair in 2 cases, and poor in 1 case at 6 months after operation, and the excellent and good rate was 92.1%. No new free body or osteophytosis occurred after operation by X-ray examination. Conclusion The arthroscopy is an effective technique to reconstruct the function of stiff elbow, which can obviously improve the range of motion and the function of elbow joint, and has good short-term results.
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.
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.
Objective To explore latest changes of joint proprioceptive function after posterior cruciate l igament (PCL) reconstruction using double-bundle semitendinosus and gracil is under arthroscope. Methods From June 2001 to November 2002, 25 patients with PCL ruptures were treated by arthroscope PCL reconstruction using double-bundle semitendinosus and gracil is, among whom 19 were males and 6 were females, aged 16-58 years old (36 on average). There were 6 cases of exercise injury, 15 of vehicle accident and 4 of fall ing injury. The duration before the operation was 1 week to 4 months (2.5 months on average). The posterior drawer test showed 23 patients were positive and 2 patients in the acute stagewere not cooperative. MRI indicated that all the patients had PCL injuries. The proprioceptive function of the knee joints was (4.73 ± 0.12)° before operation. Results All patients’ incisions obtained heal ing by first intention after the operation. The posterior drawer test showed that all the patients were negative. All 25 patients were followed up for 20-41 months (30.1 months on average). Eighteen months after operation, MRI indicated that bone marrow canal healed and internal fixation was stable. At the time of the last follow-up, the Lysholm score increased from (58.6 ± 15.2) before operation to (93.2 ± 7.4), and there was statistical difference (P lt; 0.05). The proprioceptive function of the knee joints was (5.67 ± 0.32)°, (5.45 ± 0.16)°, (3.80 ± 0.01)° and (3.67 ± 0.25)° at 5, 10, 15 and 20 months after operation, respectively. Statistical differences were observed between groups at 5, 10, 15, 20 months and the group before operation (P lt; 0.05). The proprioceptive function of the knee joints was (4.56 ± 0.11)° at the final follow-up, and was significantly different from that of the normal knee joints was (2.13 ± 0.41)°, (P lt; 0.05). Conclusion Joint proprioceptive function decreases temporally after the arthroscopy PCL reconstruction and begins to restore 15 months after operation, and improves sharply 20 months after operation. All patients’ Lysholm scores and symptoms improve after operation. Therefore, the operation is effective.
Objective To investigate the treatment and therapeutic efficacy of intra-articular meniscal cysts by arthroscopy. Methods From January 2005 to December 2009, 9 cases of intra-articular meniscal cysts were treated by arthroscopy, including 5 males and 4 females, with an average age of 33.8 years (range, 24-46 years). Six patients suffered in left knees, 3 in right ones. Just 1 case had trauma history, the others had no obvious predisposing causes. The average course of the disease was 24.2 months (range, 4-36 months). The Lysholm score was (74.2 ± 11.6) points. Arthroscopy showed that the locations of cysts were the anterior horn of lateral meniscus in 8 cases and the anterior horn of medial meniscus in 1 case; all being single cyst (of them, 3 being multilocular cyst). Results All incisions healed primarily with no compl ications of infection and joint effusion. All 9 patients were followed up from 3 to 48 months with an average of 12.7 months. Preoperative symptoms disappeared or reduced and the range of motion of the knee returned to normal. TheLysholm score was (95.1 ± 3.4) points after 3 months of operation, showing significant difference (P lt; 0.01) when compared with the socre before operation. According to assessment standard described by Choy, the treatment outcome was excellent in 6 cases, good in 2 cases, and general in 1 case; the excellent and good rate was 88.9%. No recurrence was found during follow-up. Conclusion Arthroscopic surgery shows the advantages to maintain good function of knee for the treatment of meniscal cyst, it is the best choice for intra-articular meniscal cysts because of its mini-trauma, rapid recovery, thorough treatment and less recurrence. Simultaneously, partial or tatol meniscectomy or menicus repairing under arthroscopy is performed.
ObjectivesTo systematically review the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy.MethodsPubMed, EMbase, The Cochrane Library, CNKI, CBM and WanFang Data databases were electronically searched to collect clinical studies on the efficacy of prophylactic antimicrobial use on preventing infections after arthroscopy from January 1990 to September 2020. Two reviewers independently screened literature, extracted data and assessed risk of bias of included studies; then, meta-analysis was performed by using RevMan 5.3 software and Stata 15.0 software.ResultsA total of 8 retrospective cohort studies and 1 randomized controlled trial involving 60 136 subjects were included. The results of the meta-analysis showed that: there was no difference in the post-operational infection rate among patients with and without antimicrobial prophylaxis for arthroscopies (OR=0.51, 95%CI 0.25 to 1.04, P=0.06). For knee arthroscopies, the post-operational infection rate had no difference between patients with and without antimicrobial prophylaxis (OR=0.89, 95% CI 0.65 to 1.23, P=0.48). However, for shoulder arthroscopies, the post-operational infection rate in the antimicrobial prophylaxis group was significantly lower than that in the group without the antimicrobial prophylaxis(OR=0.18, 95%CI 0.08 to 0.37, P<0.000 01).ConclusionsCurrent evidence shows that there is no association between preoperative antimicrobial prophylaxis and a decreased infection rate for knee arthroscopies. Antimicrobial prophylaxis appears to lead to fewer infections after shoulder arthroscopies. Due to the limited quality and quantity of the included studies, more high-quality studies are required to verify above conclusions.
Objective To investigate the methods and effectiveness of surgical treatment for posteromedial corner (PMC) injury combined with anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) ruptures. Methods Between February 2009 and February 2012, 15 patients (15 knees) with PMC injury combined with ACL and PCL ruptures underwent PMC repair with suture anchor and ACL and PCL reconstruction. There were 7 males and 8 females with an average age of 39 years (range, 15-59 years). The causes of injury were traffic accident injury in 6 cases, sport injury in 7 cases, and sprain injury in 2 cases. The disease duration was 3-15 days with an average of 7 days. All patients presented positive results of anterior drawer test, posterior drawer test and valgus stress test, and dysfunction of knee joint. Of 15 cases, 3 had ACL and PCL ruptures, 5 had ACL rupture, 3 had ACL injury at the attachment point of the condyles crest, and 4 had PCL rupture; 9 had PMC tear at the femur insertion, 5 had PMC tear at the tibia insertion, and 1 had PMC tear in the body area. Results All incisions healed by first intention with no complication of infection or stiffness of knee. All cases were followed up 18.4 months on average (range, 10-36 months). At last follow-up, 14 cases had normal knee flexion and extension ranges, but 1 case had 10° limitation of the knee extension. Except 1 case which had weakly positive valgus stress test, the other patients showed negative results of anterior drawer test, posterior drawer test, and valgus stress test. Based on the improved Lysholm classification standard, the results were excellent in 8 cases, good in 5 cases, and fair in 2 cases; the excellent and good rate was 86.7%. Conclusion Early repair of the PMC and reasonable reconstruction of cruciate ligament can effectively restore the knee stability for patients with PMC injury combined with ACL and PCL ruptures.
Objective To investigate the clinical outcomes of autologous platelet rich plasma (PRP) for anterior cruciate ligament (ACL) reconstruction. Methods Between August 2014 and August 2016, 42 patients with ACL ruptures who underwent arthroscopic ACL reconstruction were randomly divided into 2 groups: 21 patients received graft soaked with PRP (trial group) and 21 patients received routine graft in ACL reconstruction (control group). Because 6 patients failed to be followed up, 17 patients of trial group and 19 of control group were enrolled in the study. There was no significant difference in gender, age, body mass index, side, injury reason, disease duration, Kellgren-Lawrence grade, and preoperative visual analogue scale (VAS), Lysholm score, and International Knee Documentation Committee (IKDC) activity scores between 2 groups (P>0.05). VAS score, Lysholm score, and IKDC activity scores were used to evaluate pain and function at 3 and 12 months postoperatively. Further, second arthroscopy and MRI examination were performed at 12 months postoperatively. Results The patients in both groups were followed up 3 to 12 months with an average of 9.83 months. The VAS score, Lysholm score, and IKDC activity scores were significantly improved at 3 and 12 months after operation in 2 groups (P<0.05), and the scores of trial group were significantly better than those of control group at 3 months (P<0.05), but no significant difference was found between 2 groups at 12 months (P>0.05). No complications of effusion, infection, and allergy were observed in 2 groups during follow-up. MRI showed good position of ACL grafts and good signal quality of the graft in the majority of the cases. However, mixed hyperintense and presence of synovial fluid at the femoral bone-tendon graft interface were found in 3 patients of trial group and 4 patients of control group, indicating poor remodeling ligamentation. MRI score was 3.53±1.13 in trial group and was 3.21±0.92 in control group, showing no significant difference (t=0.936,P=0.356). The second arthroscopy examination showed ligament remodeling score was higher in trial group than control group (t=3.248,P=0.014), but no significant difference was found in synovial coverage score and the incidence of cartilage repair (t=2.190,P=0.064;χ2=0.090,P=0.764). Conclusion PRP application in allograft ACL reconstruction can improve knee function and relieve pain after operation, which may also accelerate graft remodeling.
Objective To summarize the biomechanical characteristics, diagnosis, and hip arthroscopic treatment of borderline developmental dysplasia of hip (BDDH) with Cam-type femoroacetabular impingement (Cam FAI). Methods The literature on BDDH with Cam FAI at home and abroad in recent years was extensively reviewed and analyzed. Results In patients with BDDH and Cam FAI, the femoral neck anteversion angle and femoral neck shaft angle increase, the pelvis tilts, and the acetabulum rotates, resulting in instability of the hip joint. In order to maintain the stability of the hip joint, the direction of biomechanical action of the hip joint has changed, which further affects the anatomical structures such as the proximal femur and acetabular morphology. BDDH with Cam FAI can be diagnosed clinically by combining lateral center edge angle, anterior center edge angle, and acetabular index. BDDH with Cam FAI can be effectively treated through arthroscopic polishing of the edges of the acetabular proliferative bone, excision of Cam malformations, and minimally invasive repair of the glenoid lip and cartilage of the hip joint. Conclusion Currently, there is no unified standard for the diagnosis and treatment of BDDH with Cam FAI. Minimally invasive treatment of the hip under arthroscopy can achieve good early- and medium-term effectiveness, and has certain advantages in repairing and maintaining the integrity of the glenoid lip and suturing/compression joint capsule. However, the long-term effectiveness needs to be further followed up to determine. The timing of surgery, intraoperative bone edge depth polishing, and joint capsule suturing/compression techniques also need to be further explored.
Objective To investigate the effectiveness of posterior cruciate ligament (PCL) reconstruction with remnant preservation and autogenous quadrupled hamstring tendons under arthroscopy. Methods Between October 2007 and August 2012, 32 patients with PCL rupture were treated and followed up for more than 1 year. There were 24 males and 8 females, aged 20-53 years (mean, 35.6 years). The causes of injury included traffic accident injury in 21 cases, sports injury in 8 cases, and falling injury from height in 3 cases. The disease duration ranged 1 week to 2 years (median, 6.3 weeks). Nine patients had simple PCL rupture, 23 patients complicated by ligament injury, including 10 cases of anterior cruciate ligament rupture, 11 cases of posterolateral corner injury, and 2 cases of posteromedial corner injury. Preoperative Lysholm score was 53.8 ± 7.1. According to the International Knee Documentation Committee (IKDC) rating criteria, 10 cases were classified as grade C and 22 cases as grade D. PCL was reconstructed with autogenous quadrupled hamstring tendons, the tendons were fixed with EndoButton at the femoral side and with interference screw at the tibial side; floats of stump were cleaned up, and the structural stability and continuity ligament remnants were preserved. Results Primary healing was obtained in all incisions; no early complication occurred after operation. Thirty-two patients were followed up 23.4 months on average (range, 12-36 months). All patients had no symptom of knee instability; the results of tibia sags sign, posterior drawer test, and Lachman test were negative. At last follow-up, the knee range of motion (ROM) returned to normal in all cases. The Lysholm score was 92.3 ± 2.0, showing significant difference when compared with preoperative score (t= — 34.32, P=0.00). According to the IKDC rating criteria, 26 cases were classified as grade A and 6 cases as grade B at last follow-up, showing significant difference when compared with preoperative grade (Z= — 5.57, P=0.00). Conclusion Arthroscopic single-bundle reconstruction of PCL with remnant preservation and quadrupled hamstring tendons has advantages of minimal trauma, simple operation, and good knee function recovery.