To fix the ligaments, tendons or other transplantation materials by passing through bone channels was commonly used and a relialde method in the reconstruction of joint stability. Usually an additional incision was necessary on the side of the outlet of the bone channel, that the screws, plates or U-shaped staple could be applied. An instrument was designed that the steel miniplate could be fixed to the bone by noninvasive method. This technique was applied in 20 cases in which anterior cruciate ligament in 14, posterior cruciate ligament in 4, and collateral ligaments in 2 with carbon fibers. The result was successful in all patients. It was shown that it gave simple manipulation, reliable fixation and no need to have an additional incision, and it could lessen patients’ suffering and lead to satisfactory clinical result.
ObjectiveTo observe the effect of preserving tibial residual fibers on the expressions of ligament remodeling related genes in rabbit anterior cruciate ligament (ACL) reconstruction model. MethodsSixty healthy adult New Zealand white rabbits were randomly divided into 4 groups:normal control group (group A, n=6) , sham-operation group (group B, n=18) , non tibial remnant preserved group (group C, n=18) , and tibial remnant preserved group (group D, n=18) . At 2, 6, and 12 weeks after operation, the ligament tissue was harvested to detect the mRNA expressions of collagen type 1A1(COL1A1) , collagen type 3A1(COL3A1) , transforming growth factor β1(TGF-β1), vascular endothelial growth factor (VEGF), growth-associated protein 43(GAP-43) , and neurotrophin 3(NT-3) by real-time fluorescent quantitative PCR. ResultsAt each time point, there was no significant difference in the mRNA expressions of COL1A1, COL3A1, VEGF, and NT-3 between group A and group B (P>0.05) . In group D, the mRNA expressions of COL1A1, COL3A1, TGF-β1, and GAP-43 significantly increased when compared with those of group C at 6 weeks after operation (P＜0.05) ; an increased level of VEGF mRNA was also detected in the group D at 12 weeks after operation (P＜0.05) ; and an increased level of NT-3 mRNA was also observed in group D at 2 and 12 weeks after operation (P＜0.05) . ConclusionThere is a time-dependent manner of angiogenesis-promoting, repair-related, and nerve-related gene expressions after ACL reconstruction with preserving tibial residual fibers during the process of ligamentization. Furthermore, the remnant preservation in ACL reconstruction can promote the expressions of related genes in some time points.
ObjectiveTo investigate the effect of transforming growth factorβ1 (TGF-β1) and basic fibroblast growth factor 1 (bFGF-1) on the cellular activities, prol iferation, and expressions of ligament-specific mRNA and proteins in bone marrow mesenchymal stem cells (BMSCs) and ligament fibroblasts (LFs) after directly co-cultured. MethodsBMSCs from 3-month-old Sprague Dawley rats were isolated and cultured using intensity gradient centrifugation. LFs were isolated using collagenase. The cells at passage 3 were divided into 6 groups: non-induced BMSCs group (group A), non-induced LFs group (group B), non-induced co-cultured BMSCs and LFs group (group C), induced BMSCs group (group D), induced LFs group (group E), and induced co-cultured BMSCs and LFs group (group F). The cellular activities and prol iferation were examined by inverted contrast microscope and MTT; the concentrations of collagen type Ⅰ and type Ⅲ were determined by ELISA; and mRNA expressions of collagen types I andⅢ, fibronectin, tenascin C, and matrix metalloproteinase 2 (MMP-2) were measured by real-time fluorescent quantitative PCR. ResultsA single cell layer formed in the co-cultured cells under inverted contrast microscope. Group F had fastest cell fusion ( > 90%). The MTT result indicated that group F showed the highest absorbance (A) value, followed by group D, and group B showed the lowest A value at 9 days after culture, showing significant difference (P < 0.05). Moreover, the result of ELISA showed that group F had the highest concentration of collagen type Ⅰ and type Ⅲ (P < 0.05); the concentration of collagen type Ⅲ in group E was significantly higher than that in group D (P < 0.05), but no significant difference was found in the concentration of collagen type Ⅰ between 2 groups (P > 0.05). The ratios of collagen type Ⅰ to type Ⅲ were 1.17, 1.19, 1.10, 1.25, 1.17, and 1.18 in groups A-F; group D was higher than the other groups. The real-time fluorescent quantitative PCR results revealed that the mRNA expressions of collagen type Ⅰ and type Ⅲ and fibronectin were highest in group F; the expression of tenascin C was highest in group D; the expression of MMP-2 was highest in group E; and all differencs were significant (P < 0.05). ConclusionDirectly co-cultured BMSCs and LFs induced by TGF-β1 and bFGF-1 have higher cellular activities, proliferation, and expressions of ligament-specific mRNA and protein, which can be used as a potential source for ligament tissue engineering.
【Abstract】 Objective To investigate the effect of the volar capsular l igament complex on stabil ity of the wrist jointand to provide basic biomechanical theoretical criteria for cl inic appl ication of the external fixator. Methods Nine upperl imbs specimens (left 6, right 3) were taken from fresh adult cadavers to make wrist joint-bone capsular l igament complex specimens. Firstly, soft tissues of forearms and hands were resected and capsular membranes and l igaments were reserved to make the bone-articular l igament complex (normal specimen). Secondly, the volar capsular l igament complex was cut off from radial malleolus to ulnar malleolus (impaired specimen). Thirdly, the impaired volar capsular l igament complex was interruptedly sutured by the use of 4# suture silk (repaired specimen). To simulate cl inical operation with external fixator, the biomechanical test was done according to the sequence (normal, impaired, repaired, repaired and fixed, impaired and fixed). Statistical significance was analyzed through selected loads at the three different shifts (1.5, 2.0, 2.5 cm). Results According to the sequence (normal, impaired, repaired, repaired and fixed, impaired and fixed), when the shift was 1.5 cm, the different respective loads were (60.74 ± 20.60), (35.23 ± 13.88), (44.36 ± 20.78), (168.40 ± 29.21) and (139.00 ± 33.18) N, respectively. When the shift was 2.0 cm, the different loads were (138.46 ± 12.93), (87.17 ± 24.22), (97.52 ± 23.29), (289.00 ± 54.29) and (257.98 ± 55.74) N, respectively. When the shift was 2.5 cm, the different loads were (312.87 ± 37.15), (198.16 ± 37.14), (225.66 ± 30.96), (543.15 ± 74.33) and (450.35 ± 29.38) N, respectively. There was no statistically significant difference between the impaired and repaired specimens (P gt; 0.05). Similarly, there was statistically significant difference among the rest specimens (P lt; 0.05). The same statistical results were obtained when the two different shifts were compared. There was statistically significant difference at the three different shifts for the same specimen (P lt; 0.05). Conclusion Volar capsular l igament complex is an important anatomic structure to keep stabil ity of the wrist joint. The carpal instabil ity arises out of the injured complex. Repairing the injured complex only can not immediately restore stabil ity of the wrist joint. The external fixator can effectively help to diminish the relative shift of the impaired capsular l igament complex, to reduce the load of the repaired complex and to protect the complex accordingly. The device plays an important role in maintaining stabil ity of the wrist joint.
Objective To evaluate the clinical results of bioabsorbable interference screw in knee ligament reconstruction. Methods From April 2002 to August 2004, 39 patients with knee ligament injury were treated, including 33 males and6 females with a median age of 25 years (15 to 65 years). The involved ligament included 29 anterior cruciate ligament of knee(ACL), 6 posterior cruciate ligament of knee(PCL)，4 combined ACL and PCL, 3 medial collateral or lateral collateral ligaments of knee point and 1 posterolateral complex injury of knee. All of patients underwent anatomic ligament reconstructions under arthroscopy or open surgery by autografts and fixation with bioabsorbable interference screw. Results All 34 patients were followed up 6 to 28 months (mean 13.7months). The patients were evaluated by Lysholm knee functional scales, the knee scores were 43.6±13.4 before operation and 85.4±16.3 after operation, showing significant difference (Plt;0.05). There was no limitation of rangeof motion and loosening of the screw. However, one case suffered from infection, and 3 cases suffered from effusion and synovitis after surgery and recovered after management. Conclusion Bioabsorbable interference screw fixation is a reliable method in knee ligament reconstruction and is effective to restore knee joint stability.
ObjectiveTo compare the clinical efficacy between deep medial collateral ligament (dMCL) repair and conservative treatment for complete MCL rupture. MethodsBetween August 2009 and December 2013, 36 patients with grade 3 MCL rupture underwent superior MCL (sMCL) reconstruction with tibial Inlay technique. Of 36 cases, 19 received dMCL repair (repair group), and 17 received conservative treatment (conservation group) after sMCL reconstruction. There was no significant difference in gender, age, knee sides, type of injury, disease duration and preoperative medial joint opening, knee Lysholm scores, and International Knee Documentation Committee (IKDC) score between 2 groups (P > 0.05). The Lysholm and IKDC scores, medial joint opening, range of motion (ROM), visual analogue scale (VAS) scores, and complications were used to assess the knee joint function. ResultsAll patients achieved primary incision healing without acute postoperative complications of incision infection and deep vein thrombosis in the lower limb. The patients were followed up 28-65 months (mean, 46.3 months) in the repair group, and 26-69 months (mean, 45.9 months) in the conservation group. No knee stiffness, vascular or nerve injury, and knee joint infection occurred in 2 groups. All the patients recovered medial stability at 2 years postoperatively. At 2 years after operation, no significant difference was shown in knee ROM between 2 groups (t=0.26, P=0.80); the VAS score of the repair group was significantly lower than that of the conservation group (t=5.22, P=0.00); medial joint opening, IKDC score, and Lysholm score were significantly improved when compared with preoperative ones in 2 groups (P < 0.05), but no significant difference was found between 2 groups (P>0.05). ConclusionWhether or not additional dMCL repair is performed can recover medial stability after sMCL reconstruction. However, the additional dMCL repair is better in relieving medial knee pain than the conservative treatment.
Objective To explore the operative techniques and prel iminary cl inical effect of arthroscopic reconstruction of posterior cruciate l igament (PCL) using l igament advanced reinforcement system (LARS). Methods From June 2006 to July 2007, 9 patients with PCL rupture were treated with LARS under arthroscopic observation. There were 8 males and 1 female, aged 23-49 years old. The left knee was involved in 3 cases and the right knee in 6 cases. The main causes of injuries were sports in 5 cases, fall ing in 1 case and traffic accident in 3 cases. The time from injury to reconstruction was6-20 days (13.6 days on average). There were 2 cases with associated medial meniscus injury and 1 with lateral meniscus injury. X-ray films showed no avulsion fracture of tibial plateau was found. The preoperative Lysholm score was 40-55 (50 on average). According to the preoperative international knee documentation commitee (IKDC) grading, 1 case was graded as C and 8 as D. The Lachman test showed that there was 1 case (+), 6 cases (++) and 2 cases (+++). The operation was performed under arthroscopic observation. The tibial isometric point and tunnel were drilled with the help of a drill bit guide, while the femoral isometric point and tunnel were drilled under the C-arm X-ray machine. The diameter of the bone tunnels was 6 mm, while the diameters of LARS artificial l igaments and canulated interference screws were 7 mm. Results All the patients were regularly followed up for 8-16 months (10.5 months on average). The postoperative Lysholm score was 70-95 (85 on average). There were 5 cases of excellent, 3 of good and 1 of fair, with the choiceness rate of 88%. The postoperative IKDC grading showed that 7 cases were graded as A and 2 as B. The Lachman test showed that no case was positive. Compl ications such as infection, spontaneous rupture or laxity of graft were not observed. Conclusion PCL arthroscopic reconstruction with the use of LARS artificial l igaments leads to a good anatomic reconstruction and knee function with minor injury, rapid recovery and satisfactory cl inical effect.
ObjectiveTo investigate the effectiveness of one-stage arthroscopic reconstruction and strict immobilization for 6 weeks for treatment of knee dislocation. MethodBetween August 2010 and May 2013, 22 cases (22 knees) of knee dislocation were treated with one-stage reconstruction and strict immobilization for 6 weeks. There were 15 males and 7 females, aged 21-54 years (mean, 31.5 years). The left knee and right knee were involved in 8 cases and 14 cases respectively. The disease causes were traffic accident in 12 cases, falling from height in 6 cases, and sports injury in 4 cases. The time between injury and operation was less than 2 weeks in 6 cases, 2-3 weeks in 10 cases, and more than 3 weeks in 6 cases. The results of anterior drawer test, posterior drawer test, and Lachman test were positive in all patients. The posterior displacement of the tibia was more than 10 mm. The results of valgus stress test and varus stress test were positive in 13 cases and 11 cases respectively. The preoperative knee range of motion was (58.2±28.4) °, Lysholm score was 39.7±4.6. All patients had anterior cruciate ligament rupture and posterior cruciate ligament rupture; combined injuries included medial collateral ligament rupture in 11 cases, lateral collateral ligament rupture in 9 cases, both medial and lateral collateral ligament rupture in 2 cases, femoral condylar avulsion fracture in 2 cases, and meniscus injury in 7 cases. No nerve or blood vessel injury was observed. ResultsAll cases obtained primary healing of incision without infection. All the patients were followed up 12-48 months (mean, 27.8 months). At 12 months after operation, the results of the anterior drawer test, posterior drawer test, Lachman test, valgus stress test, and varus stress test were all negative; the knee range of motion increased was significantly to (121.3±7.9) °(t=30.061, P=0.000) ; Lysholm score was 87.2±6.1, showing significant difference when compared with preoperative score (t=24.642, P=0.000) . ConclusionsA combination of arthroscopic one-stage reconstruction and strict immobilization for treatment of knee dislocation is a safe and effective method, good stability and joint function can be achieved.
Objective To investigate the cl inical outcome of treating dorsal wrist gangl ion with an improved surgical strategy by excising the gangl ion completely along their stalk and repairing the dorsal carpal l igaments under brachial anesthesia. Methods From March 2005 to January 2007, 34 patients with dorsal wrist gangl ion were treated and studied retrospectively. There were 14 males and 20 females, aged 25-65 years (43 years on average). The left sides were involved in 22 cases and right sides in 12 cases. Thirteen cases of relapse received excision for 1 to 4 times under local anesthesia, with amean period of 17 months (14 days to 7 years) from excision to recurrence. Twenty-one patients were first attack cases with a mean period of 11 months (15 days to 8 years) from diagnosis to excision. The size of the gangl ion ranged from 1.5 cm × 1.2 cm to 4.5 cm × 4.0 cm. Now, each surgical process was performed under brachial anesthesia, and a pneumathode tourniquet was used. In 6 patients, the stalks of gangl ion did not invade the carpal l igaments, and gangl ion was removed completely without immobil ization after operation. In 28 patients, the stalks of gangl ion invaded the carpal l igaments, gangl ion was excised completely along its stalk to the dorsal carpal structure; the l igaments were sutured directly in 16 cases and were repaired with adjacent tissue such as the wall of sheathing canal of extensor tendon in 12 cases. The wrists were immobil ised for 3 weeks. Results Primary wound heal ing was achieved in all incisions. All patients were followed up for 26-36 months with an average of 31.5 months. Only 2 cases (5.9%) recurred. The range of motion of the wrist remained normal and the symptom of the dorsal wrist was rel ieved sl ightly. Patients’ satisfaction score ranged from 60 to 100, with an average of 83.8. Conclusion The gangl ion should be excised completely together with defect repair of dorsal carpal l igament under brachial anesthesia and the wrist immobil ised for 3 weeks, the recurrence rate will be reduced greatly.
Objective To introduce the research advance of the ligament injury and ligament healing.Methods Recent original articlesrelated to such aspects of ligament were reviewed extensively.Results The ligament properties would be influenced when the situations of the biochemistry and biomechanics had changed. Injuries to ligaments induce a healing response that is characterized by scar formation. Graft could not recovery the ultrastructure, anatomy and biomechanics of the normal ligament.Conclusion The healing ligament is weaker than normal one, and the graft could not reconstruct normal ligament at present.