ObjectiveTo observe the anatomical morphology of the tibial insertion of the anterior cruciate ligament (ACL) in Chinese adults so as to offer theoretical guidance for ACL reconstruction and meniscus transplantation. MethodsFifteen adult cadaveric knees (8 left knees and 7 right knees) were dissected, including 10 males and 5 females, with an age ranged from 25 to 47 years (mean, 32.4 years). All knees were generally observed through standard medial parapatellar approaches, then the ACL midsubstance and the tibial insertion (direct and indirect insertions) were anatomically measured. ResultsIn all specimens, the ACL was flat with a lot of fine fibers. The anteromedial bundle and posterolateral bundle could be observed in 13 of 15 knees. However, no obvious bundles were found in 2 knees. The arc-shaped tibial direct insertion started at the medial tibial eminence and ended at the anterior horn of the lateral meniscus. The width of the arc was (11.2±2.4) mm; the thickness was (3.0±0.3) mm; and the cross-sectional area was (28.8±7.8) mm2. And the left-right diameter of the whole insertion was (9.5±1.8) mm; anteroposterior diameter was (11.9±0.6) mm; and the cross-sectional area was (117.8±12.5) mm2. The width of the anterior horn of lateral meniscus was (12.3±2.0) mm. The anterior horn of lateral meniscus was surrounded by arc-shaped direct insertion in the middle, and its fibers were partly intertwined with indirect insertion of ACL. ConclusionAnatomical ACL reconstruction may therefore require a arc-shaped tibial footprint. There are overlap covering relationship between the attachment location of anterior horn of the lateral meniscus and tibial insertion of ACL. It should pay more attention to protecting tibial insertion of ACL in lateral meniscus transplantation.
ObjectiveTo investigate the feasibility and effectiveness of a novel remnant-preserving anterior cruciate ligament (ACL) reconstruction with bidirectional barbed suture.MethodsBetween February 2014 and January 2016, 96 patients (96 knees) with ACL injury who met the inclusion criteria were recruited and randomly divided into 2 groups (n=48). All patients underwent ACL reconstruction with autologous tendon. The tibial remnant was fixed with PDS-Ⅱ suture (control group) and bidirectional barbed suture (trial group). There was no significant difference in age, gender, injury side, the interval from injury to operation, and preoperative knee stability (KT-1000 test), International Knee Documentation Committee (IKDC) score, and Lysholm score (P>0.05). The knee stability (KT-1000 test), IKDC score, Lysholm score, proprioception, and Cyclops lesion after operation were recorded.ResultsAll incisions healed by first intention in both groups. Forty-four patients in control group were followed up 26-47 months (mean, 36.6 months), and 45 patients in trial group were followed up 26-48 months (mean, 35.6 months). At last follow-up, the IKDC score, Lysholm score, and KT-1000 test were significantly improved when compared with preoperative ones in both groups (P<0.05); but no significant difference was found between 2 groups (P>0.05). There was no significant difference in proprioception between 2 groups at 1 and 2 years after operation, and between 1 year after operation and 2 years after operation (P>0.05) in the same group. The incidences of Cyclops lesion at 6 months, 1 year and 2 years after operation were 0, 4.44% (2/45), and 4.44% (2/45) in trial group, and 13.6% (6/44), 13.6% (6/44), 20.5% (9/44) in control group, showing significant differences between 2 groups at 6 months and at 2 years after operation (P=0.012; P=0.022) and no significant difference at 1 year after operation (P=0.157).ConclusionThe remnant-preserving ACL reconstruction with bidirectional barbed suture can decrease the incidence of Cyclops lesions. However, this technique can not improve the effectiveness in terms of the clinical function and stability compared with the traditional technique.
ObjectiveTo review the bioactive strategies that enhance tendon graft healing after anterior cruciate ligament reconstruction (ACLR), and to provide insights for improving the therapeutic outcomes of ACLR. Methods The domestic and foreign literature related to the bioactive strategies for promoting the healing of tendon grafts after ACLR was extensively reviewed and summarized. ResultsAt present, there are several kinds of bioactive materials related to tendon graft healing after ACLR: growth factors, cells, biodegradable implants/tissue derivatives. By constructing a complex interface simulating the matrix, environment, and regulatory factors required for the growth of native anterior cruciate ligament (ACL), the growth of transplanted tendons is regulated at different levels, thus promoting the healing of tendon grafts. Although the effectiveness of ACLR has been significantly improved in most studies, most of them are still limited to the early stage of animal experiments, and there is still a long way to go from the real clinical promotion. In addition, limited by the current preparation technology, the bionics of the interface still stays at the micron and millimeter level, and tends to be morphological bionics, and the research on the signal mechanism pathway is still insufficient.ConclusionWith the further study of ACL anatomy, development, and the improvement of preparation technology, the research of bioactive strategies to promote the healing of tendon grafts after ACLR is expected to be further promoted.
Objective To explore the therapeutic efficacy of arthroscopic reconstruction of anterior cruciate ligament (ACL) with autologous multistranded semitendinous tendon (ST). Methods From September 2000 to December 2004, 50 casesof ruptures of ACLs were diagnosed by clinical and arthroscopic examinations. There were 32 males and 18 females with an average age of 26.3 years (18-51 years). The locations were left knee in 31 cases and right knee in 19 cases. All patients had the history of knee joint injury. Arthroscopy showed 26 cases of rupture, 14cases of defect, 4 cases of avulsion and 6 cases of laceration. All patients were operated upon arthroscopically by using autologous multistranded ST. Plaster splints were used for 4 weeks after operation. The result was estimated by AO Yingfang’s standards and Lysholm knee scores. Results All patients achieved healing bythe first intention. The extension and flexion function was restored normal at 8-10 weeks. The patients were followed up averagely 1 year and 8 months (6.48 months). The results of drawer test and Lachman test were positive in 3 cases and suspiciously positive in 8 cases. The results were excellent in 23 patients, good in 18 and fair in 9. Lysholm knee scores were 4057±1068 preoperatively and 86.43±9.33 postoperatively, showing significant difference (P＜0.01). Conclusion Arthroscopy reconstruction of ACL with autologous multistranded ST may be one of the excellentmethods bringing less injury.
Objective To evaluate the primary cl inical results of double-bundle anterior cruciate l igament reconstruction (ACLR) with semitendinosus allografts. Methods From March 2006 to October 2006, 33 patients underwent double-bundle ACLR with semitendinosus allografts. The complete followed-up data of 31 patients was analyzed retrospectively. There were 24 males and 7 females aged 18-35 years old (average 25 years old). The injury was caused by sports accidents in 23cases and traffic accidents in 8 cases, involving the left knee in 18 cases and the right knee in 13 cases. Anterior cruciate l igament rupture were confirmed by MRI and arthroscopy in all the patients, without lateral collateral l igaments injuries and posterior cruciate l igament injuries. The time from injury to operation was 1-43 months (average 11 months). The knee was fixed at 0° position after operation for 2 weeks and got knee joint rehabil itation exercises gradually. Results The incision of 2 patients showed effusion 4 and 7 days after operation, respectively, and healed after symptomatic treatment. The incision of 29 patients healed by first intention. There were no compl ications such as stiffness of knee joint, neurovascular injuries and joint infections. All the patients were followed up for 24-29 months (average 26 months). MRI displayed the anterior cruciate l igament grafts presented with good connection and signal similar to the normal 2 years after operation. There was significant difference between the preoperational value and the final follow-up value in terms of bilateral knee joint difference of prior laxity, Lachman test, and pivot shift test (P lt; 0.05 ). The circumference difference between the injured and the normal was (11.6 ± 7.9) mm before operation and (5.0 ± 3.1) mm at the final follow-up (P lt; 0.05). The Tegner score, Lysholm score, and International Knee Documentation Committee score was 3.83 ± 1.15, 64.38 ± 6.81, and 41.42 ± 6.30, respectively, before operation, and 6.29 ± 0.64, 94.45 ± 3.03, and 95.72 ± 3.10, respectively, at the final follow-up. There was a significant difference between before and after operation (P lt; 0.05). Conclusion The primary cl inical results of double-bundle ACLR with semitendinosus allografts are satisfactory and the allogeneic semitendinosus are good grafts for double-bundle ACLR.
ObjectiveTo detect the expression of human transforming growth factor β1 (hTGF-β1) gene mediated by adenovirus (Ad) in hamstring tendon after anterior cruciate ligament (ACL) reconstruction in rabbits. MethodsAd-hTGF-β1 and Ad-green fluorescent protein (GFP) were diluted to 5×108 PFU/mL with DMEM. Forty-eight New Zealand white rabbits were divided into 3 groups randomly (n=16) for ACL reconstruction with hamstring tendon autograft. Hamstring tendon was cultured and transfected with Ad-hTGF-β1 (group A) and Ad-GFP (group B) for 12 hours before ACL reconstruction, and was cultured with DMEM in group C. After 12 hours of transfection, green fluorescence was observed in groups A and B under fluorescence microscopy. At 2, 4, 6, and 8 weeks after operation, the hamstring tendon was harvested to detect the mRNA and protein expressions of hTGF-β1 by real time fluorescence quantitative PCR and Western blot. ResultsGreen fluorescence was observed after 12 hours of transfection in groups A and B. TGF-β1 protein level reached (221.0±12.2) ng/mL at 12 hours in group A. The hTGF-β1 mRNA expression could be detected in group A, but it could not be detected in group B and group C. The mRNA expression levels of hTGF-β1 were 1.004±0.072 at 2 weeks, 0.785±0.038 at 4 weeks, 0.469±0.053 at 6 weeks, and 0.172±0.021 at 8 weeks in group A, showing significant difference (P<0.05). Western blot results showed weakly positive band in groups B and C; the protein expression of TGF-β1 in group A was significantly higher than that in groups B and C (P<0.05), but no significant difference was found between groups B and C P>0.05). The protein expression of TGF-β1 gradually reduced with time, showing significant difference between different time points (P<0.05). ConclusionAd-hTGF-β1 can transfect the hamstring tendon successfully, and it can effectively express for a long time after ACL reconstruction.
OBJECTIVE: To observe the strength of thigh muscles after reconstruction of anterior cruciate ligament by autogenous bone-patellar tendon-bone graft. METHODS: Twenty-three patients, 9 males and 14 females, were followed up one year after reconstruction of the anterior cruciate ligament with autogenous bone-patellar tendon-bone graft. Through arthroscope, no intra-articular derangement was found. The strengths of isometric and isotonic contractions of the quadri ceps and the hamstrings muscles of the affected and contralateral thighs were recorded. RESULTS: The donor side for autogenous bone-patellar tendon-bone graft showed significant decrease (P lt; 0.01), but no effect on that of the hamstrings muscle(P gt; 0.05). CONCLUSION: To reconstruct the anterior cruciate ligament, harvest of the bone-patellar tendon-bone graft as a reparative material may markedly lower the strength of the quadriceps femoris muscle.
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.
Objective To explore the effectiveness of arthroscopic single-bundle anterior cruciate ligament (ACL) reconstruction using six-strand autograft hamstring tendon plus TightRope suspension plate. Methods Between September 2014 and August 2015, 24 patients with ACL rupture accepted arthroscopic single-bundle ACL reconstruction using six-strand autograft hamstring tendon plus TightRope suspension plate. There were 16 males and 8 females with an age range of 18-54 years (mean, 36.2 years). The disease causes included sport injury in 15 cases, traffic accident injury in 4 cases, and sprain in 5 cases. The mean time from injury to operation was 3.9 months (range, 18 days to 8 months). The results of anterior drawer test, pivot shift test, and Lachman test were positive before operation. The preoperative International Knee Documentation Committee (IKDC) score was 38.69±3.85 and Lysholm knee functional score was 36.45±7.85. Results The incisions healed by first intention. No infection, deep vein thrombosis, or vessel and nerve injuries occurred. MRI showed the good tunnel position and ACL morphology. All patients were followed up 6-16 months with an average of 12 months. At last follow-up, Lysholm and IKDC scores were significantly increased to 81.31±7.58 and 79.62±5.39 respectively (P < 0.05). The results of anterior drawer test were negative in 17 cases and positive degree I in 7 cases; the results of Lachman test were negative in 20 cases and positive degree I in 4 cases; the results of pivot shift test were negative in 21 cases and positive degree I in 3 cases; and all showed significant differences compared with preoperative results (P < 0.05). Conclusion Arthroscopic single-bundle reconstrustion using six-strand autograft hamstring tendon plus TightRope suspension plate is a simple technique for ACL reconstruction, which can obtain satisfactory short-term effectiveness.
OBJECTIVE To investigate the outcome of anterior cruciate ligament (ACL) by free autograft of middle one third of bone-patellar tendon-bone complex which was formed by lower edge of patella, middle one third of patellar tendon, and tibial tubercle. METHODS From April 1994 to August 1996, ACL reconstruction by bone-patellar tendon-bone complex was performed in 8 patients with ACL injury. RESULTS All cases were followed up 5 months to 3 years, averaged 26 months, excellent results were obtained in 4 cases, better in 3 cases and moderate in 1 case. The Lanchman test and/or anterior drawer test were positive in 8 cases preoperatively and only 1 case was positive postoperatively. Instability existed in 5 cases preoperatively were disappeared after operation. All patients could basically meet the demands of daily life. CONCLUSION Reconstruction of ACL by free autograft of middle one third of bone-patellar tendon-bone complex is an effective method for the restoration of stability in knee joint.