The shoulder joint is the most prone to dislocation in the whole body, and more than 95% of them are anterior dislocation. Improper treatment after the initial dislocation is easy to lead to recurrent anterior dislocation or anterior shoulder instability, and the outcomes following conservative treatment is poor. Anterior shoulder instability can damage the soft tissue structure and bone structure that maintain the stability of shoulder joint, among which bone structure is the most important factor affecting the stability of shoulder joint. Diagnosis should be combined with medical history, physical examination, and auxiliary examination. Currently, three-dimensional CT is the most commonly used auxiliary examination means. However, various bone defect measurement and preoperative evaluation methods based on three-dimensional CT and the glenoid track theory have their own advantages and disadvantages, and there is still a lack of gold standard. Currently, the mainstream treatment methods mainly include Bankart procedure, coracoid process transposition, glenoid reconstruction with free bone graft, Bankart combined with Remplissage procedure, and subscapular tendon binding tamponade, etc. Each of these procedures has its own advantages and disadvantages. For the diagnosis and treatment of anterior shoulder instability, there are still too many unknown, further research and exploration need to be studied.
Objective To review the research progress of diagnosis and treatment system for knee dislocation (KD) based on the stage and classification of posteromedial structure and posterolateral corner injury, so as to provide guidance for clinical work. Methods The relevant literature on the classification, diagnosis and treatment was extensively reviewed. Results At present, the criterion of the stage and classification of KD mainly include classification based on the size of the injury energy, Kennedy classification, and the improved Schenck classification, but they are not perfect because of no stage and classification of multiple ligament injury and no standardized treatment of different injuries. Hua Xi Knee Dislocation and Multiple Ligament Injury (HX-KDMLI) has optimum plan for injury treatment of posteromedial structure and posterolateral corner injury in KD based on stage and classification. Conclusion At present, there is no unified opinion on stages and classifications of the posteromedial structure and posterolateral corner injury in KD as well as on diagnosis and treatment. HX-KDMLI has certain feasibility for the stage and classification of the posteromedial structure and posterolateral corner injury in KD, to a certain extent, it can be used as reference for the diagnosis and treatment of KD.
ObjectiveTo summarize the application status and progress of the strategies to augment tendon-to-bone healing. MethodsThe present researches focused on augmentation of tendon-to-bone healing were extensively reviewed. ResultsThe present strategies to augment healing of tendon-to-bone by enhancing the location environment, and increasing the cell numbers and relative growth factor. The mainly strategies include using calcium phosphate materials, biocompatible scaffolds and glue, growth factors, cell matrix, platelet-rich plasma, and periosteum. Although periosteum have been used in clinical and got some possitive effects, the others still not be used in clinical and needs further studies. ConclusionThere are many strategies to enhance the ability of tendon-to-bone healing, which got some positive results, but results of studies were varied. Thus, further fundamental research and clinical studies are required to achieve the best effects.
ObjectiveTo summarize the diagnosis and measurement methods of bone defect in anterior shoulder instability (glenoid bone defect and Hill-Sachs lesion).MethodsThe related literature on the diagnosis and measurement of the bone defect in anterior shoulder instability was reviewed and summarized.ResultsThe commonly used techniques for the diagnosis of anterior glenoid bone defect and Hill-Sachs lesion of humeral head include X-ray, CT, MRI, arthroscopy, arthrography. The methods for measuring the degree of anterior glenoid bone defect include Griffith method, glenoid index method, Pico method, and best-fit circle method. The indexes for measuring the Hill-Sachs lesion include the length, width, depth, and volume. X-ray is mainly used for primary screening. Best-fit circle method on three-dimensional (3D) CT reconstruction is commonly used to measure the glenoid bone defect currently. Glenoid track theory on 3D CT reconstruction is popular in recent years. Reliability of measuring the glenoid bone defect and Hill-Sachs lesion with MRI and arthroscopy is still debatable. Arthrography is more and more used in the diagnosis of shoulder joint instability of bone defect and concomitant soft tissue injury.ConclusionHow to improve the accuracy of evaluating glenoid bone defect and Hill-Sachs lesion before surgery still need further study.
Objective To evaluate the biomechanical property of tendons repaired with the modified Kessler suture combined with " 8” suture, and to provide evidence for the clinical application of this suture methods in repairing acute Achilles tendon rupture. Methods Forty frozen flexor digitorum longus tendons from fresh pork hind leg were randomly assigned into 4 groups, 10 specimens each group. In group A, the tendons were dissected transversely at the midpoint to forming the model of tendon with transversely cutting injury. The tendons in groups B, C, and D were dissected transversely at the midpoint, then a 2 cm segment of tendon from the incision in each side was dissected longitudinally with 1 mm internal to forming " frayed tendon” model. All the tendons were sutured with2-0 non-absorbable suture material with different suturing methods: in group A, the tendons with transversely cutting injury model with Krackow suture, and in the groups B, C, and D with Krackow suture, Kessler suture, and the modified Kessler suture combined with " 8” suture separately. All repaired tendons were fixed onto the biomechanical testing machine. The length, width, and thickness of each side and midpoint of the tendons were recorded, and the cross-sectional area was calculated. The tendons were stretched at a speed of 15 mm/minutes until failure (suture avulsion or rupture). The computer automatically recorded the maximum load, stress, strain, the failure displacement, and the stiffness. These biomechanical parameters of tendons in different groups were analyzed and compared. Results There was no significant difference in the length and cross-sectional area of each tendon among 4 groups (F=0.245, P=0.863; F=0.094, P=0.963). Two tendons in group B, 1 in group C, and 1 in group D were excluded because of tendon slipping; all tendons in group A and 8 tendons in group B failured due to suture rupture, 9 tendons in group C due to suture slipping, and 9 tendons in group D due to 3 sutures slipping from tendon tissue together. The maximum load, the maximum stress, the maximum strain, the failure displacement, and the stiffness of the tendons between groups A and B showed no significant difference (P>0.05). The maximum load, the maximum stress, and the stiffness of the tendons in group D were larger than those in both groups B and C (P<0.05), but no significant difference was found in the maximum strain and the failure displacement between groups B, C, and D (P>0.05). The maximum load, the maximum stress, the failure displacement, and the stiffness of the tendons in group B were larger than those in group C (P<0.05), but the difference of maximum strain between groups B and C was not significant (P>0.05). Conclusion The modified Kessler suture combined with " 8” suture can provide better biomechanical property of the repaired tendon compared with other suture approaches.
ObjectiveTo evaluate the specific application and effect of balance point fixation technique in arthroscopic fixation of avulsion fracture of anterior cruciate ligament.MethodsThe data of 65 patients with anterior cruciate ligament avulsion fracture treated by arthroscopy in Department of Orthopaedics, Panzhihua Central Hospital between June 2012 and June 2018 were analyzed retrospectively. According to whether the balance point fixation technique was used or not, the patients were divided into routine operation group (group A, n=22) and balance point fixation group (group B, n=43). The operation time, Visual Analogue Scale (VAS) pain score, length of hospital stay, intraoperative bone re-fracture rate, incidences of limb swelling and deep venous thrombosis, Lysholm score and knee joint stability of the two groups were analyzed. Chi-square test or Fisher’s exact test was used for nominal data. Independent samples t-test or paired samples t-test was used for measurement data. Rank sum test was used for ordinal data. Repeated measures analysis of variance was used for repeated measurement data. Two-sided statistical significance level was set at α=0.05.ResultsThere was no statistically significant difference in age, sex composition, fracture type, combined injury, time from injury to operation, preoperative VAS score, or Lysholm score between the two groups (P>0.05). The incisions of all patients healed in the first stage without incision complications. After adjustment, the reduction of fracture in group A was basically satisfactory, 4 cases (18.2%) had re-fracture; 1 case (2.3%) in group B had re-fracture due to poor bone condition, and group B was better than group A in re-fracture incidence (P=0.041). The operation time and length of hospital stay in group B were shorter than those in group A [(90.27±34.27) vs. (49.67±10.44) min,P<0.001; (8.09±1.23) vs. (5.35±1.07) d, P<0.001], the postoperative VAS score in group B was lower than that in group A (4.23±0.87 vs. 2.60±0.62, P<0.001), the degree of pain relief in group B was better than that in group A (3.32±1.29 vs. 4.44±1.50, P=0.004), the incidence of postoperative limb swelling in group B was lower than that in group A (22.7% vs. 4.7%, P<0.05); the difference in incidence of postoperative deep venous thrombosis between the two groups was not statistically significant (P>0.05). All patients were followed up for more than one year, the fractures healed completely, and the postoperative VAS score and Lysholm score at one year after operation were significantly improved compared with those before operation, but there was no significant difference in the postoperative 6-month Lysholm score, stability evaluation, or postoperative 1-year Lysholm score between the two groups (P>0.05).ConclusionsThe balance point fixation technique plays a positive role in relieving postoperative pain, shortening operation time and average hospital stay, and reducing the incidence of complications by realizing the quantification of the best fixed point to reduce repeated operation and side injury. It can provide a technical reference for clinical work.
ObjectiveTo investigate the method and effectiveness of transosseous suture in situ technique in repairing anterior cruciate ligament (ACL) avulsion injury for the multiple ligament injuries with knee dislocation (MLIKD).MethodsThe clinical data of 27 patients (27 knees) with MLIKD between September 2010 and April 2016 were analyzed retrospectively. There were 21 males and 6 females, with an average age of 42 years (range, 24-60 years). The injury was caused by traffic accident in 9 cases, heavy-weight crushing in 9 cases, sports sprain in 6 cases, falling from height in 3 cases. The interval from injury to operation was 1-19 days (mean,10.8 days). There were 20 cases of femoral avulsion injury of ACL, 7 cases of tibial avulsion injury of ACL, and there were 17 cases of posterior cruciate ligament (PCL) injuries. According to the Schenck classification, there were 15 cases of KD-Ⅲ-M type, 8 cases of KD-Ⅲ-L type, and 4 cases of KD-Ⅳ type. All patients were positive in the posterior drawer test and Lachman test; 8 cases were degree Ⅲ positive in varus stress test, and 15 cases were degree Ⅲ positive in valgus stress test. The Lysholm score of knee was 27.6±6.5, the International Knee Documentation Committee (IKDC) score was 25.5±6.2, and the range of motion (ROM) of knee was (45.1±10.2)°. The injured PCL was reconstructed with a single bundle of autologous hamstring tendon. ACL was repaired with double bundle traction by transosseous suture in situ technique. Medial cruciate ligament, lateral cruciate ligament, joint capsule, and other damaged structures were repaired at the same time.ResultsAll incisions healed by first intention. There were 3 cases with joint effusion and 3 cases with incomplete flexion. All patients were followed up 12-36 months (mean, 22 months). The X-ray films showed good stability in all directions. At last follow-up, the anterior and posterior drawer tests were all negative; Lachman test was degreeⅠpositive in 4 cases, valgus stress test was degreeⅠpositive in 3 cases, varus stress test was degreeⅠpositive in 1 case; and all tests were negative in the rest patients. At 1 year after operation, the ROM of knee was (119.3 ±12.6)°, Lysholm score was 87.2±6.3, and IKDC score was 87.9±6.3, showing significant differences when compared with the preoperative scores (P<0.05).ConclusionTransosseous suture in situ technique can be used to repair the ACL avulsion injury for MLIKD, which can significantly improve the stability, mobility and function of the knee joint, and obtain satisfied short-term effectiveness.