ObjectiveTo investigate the correlation between graft maturity and knee function after anterior cruciate ligament (ACL) reconstruction.MethodsA total of 50 patients who underwent ACL reconstruction with autologous tendons between August 2016 and August 2018 were included in the study. There were 28 males and 22 females, with an average age of 31.0 years (range, 18-50 years). At 6 months and 2 years after operation, the signal to noise quotient (SNQ) values of tibial and femoral ends of graft were measured by MRI, and the mean value was taken as the SNQ value of graft. The function of knee joint was evaluated by Tegner, Lysholm, and International Knee Documentation Committee (IKDC) scores. The differences in SNQ values between tibial and femoral ends were analyzed at 6 months and 2 years after operation. The correlation between SNQ value at 6 months after operation and knee function score at 2 years after operation was analyzed. According to SNQ value at 6 months after operation, the patients were divided into group A (SNQ value≥12) and group B (SNQ value<12) and the correlation between SNQ value and knee function score was further analyzed.ResultsAll incisions healed primarily without infection or injury of blood vessels and nerves. All patients were followed up 24-28 months (mean, 26.6 months). The IKDC, Lysholm, and Tegner scores at 6 months and 2 years after operation were significantly higher than those before operation (P<0.05), and all scores at 2 years after operation were also significantly higher than those at 6 months (P<0.05). The SNQ values at 6 months and 2 years after operation were 12.517±6.272 and 10.900±6.012, respectively, and the difference was significant (t=1.838, P=0.007). The SNQ values of graft at 6 months after operation were significantly different from those at 2 years after operation (P<0.05), and the SNQ values of tibial and femoral ends of graft at the same time point were significantly different (P<0.05). The SNQ value of 50 patients at 6 months after operation was negatively correlated with Lysholm, IKDC, and Tegner scores at 2 years after operation (r=–0.965, P=0.000; r=–0.896, P=0.000; r=–0.475, P=0.003). The patients were divided into groups A and B according to the SNQ value, each with 25 cases; the SNQ values of the two groups at 6 months after operation were negatively correlated with Lysholm, IKDC, and Tegner scores at 2 years after operation (P<0.05).ConclusionAfter ACL reconstruction, the knee function scores and graft maturity of patients gradually improved. The lower the SNQ value in the early stage, the higher the knee function score in the later stage. The SNQ value of MRI in the early stage after ACL reconstruction can predict the knee function in the later stage.
Objective To explore the diagnosis and treatment of anterior cruciate l igament (ACL) cysts of the knees. Methods The cl inical data were retrospectively analysed from 13 patients with ACL cysts between December 2000 and August 2007. The patients included 7 males and 6 females with an average age of 46.3 years (range, 32-55 years). The locationswere the left knee in 6 cases and the right knee in 7 cases. Seven cases had an obvious history of trauma, 4 cases had a history of chronic injury, and 2 cases had no obvious incentive factor. The disease duration was from 6 to 29 months (mean, 20 months). Anterior drawer test was positive in 1 case, pivot shift test was positive in 1 case, and McMurray test was positive in 3 cases. Six cases were preoperatively diagnosed by MRI. The cysts located near the tibial insertion in 6 cases, between the ACL and the posterior cruciate l igament in 3 cases, and near the femoral attachment in 4 cases. All cysts were arthroscopically resected and had the pathohistological examination. Results The pathohistological examination showed mucoid degeneration of collagen and connective tissues, and the diagnosis result was ACL cyst. All incisions healed by first intention, and no compl ication occurred. Thirteen patients were followed up 2 to 5 years (mean, 2 years and 6 months). The symptoms of arthralgia, swell ing, and interlocking of the affected knees disappeared. At 24 months postoperatively, the anterior drawer test was positive in 1 case, the pivot shift test was positive in 1 case, and McMurray test was positive in 4 cases. There was no recurrence during the follow-up. There were significant differences in the range of motion and Lysholm score between pre- and post-operation (P lt; 0.01). Conclusion ACL cysts may be indicated by simple knee pain, especially when accompanied by l imitation of joint motion without imaging evidence of osteoarthritis. The MRI finding is very important in the diagnosis of ACL cysts, and arthroscopic resection and debridement is the first choice in the treatment of ACL cysts.
Objective To make a comparison for the change of maximum tensile intensity and stiffness of a whole implant that is placed into bone tunnel with various lengths tendon, by using beagle dog’s autogenous flexor tendons to reconstruct anterior cruciate l igament (ACL). Methods Sixty male beagle dogs were included in the experiment (weighting 13-16 kg). Three dogs were used for intact flexor tendon of both knees (normal control group), 3 dogs for the intact ACL andfemur-graft-tibia complex (auto control group) and 54 dogs (108 knees) for models of reconstructed ACL (6 experimentalgroups according to different lengths of tendon: 5, 9, 13, 17, 21 and 25 mm in the bone tunnel). The tensile intensity and stiffness were measured after 45, 90 and 180 days separately after operation. Results In the normal control group, the maximum tensile intensity of the intact flexor tendon was (564.15 ± 36.18) N, the stiffness was (59.89 ± 4.28) N/ mm. In the auto control group, the maximum tensile intensity of the intact ACL was (684.75 ± 48.10) N, the stiffness was (74.34 ± 6.99) N/ mm, all ruptured through the intra-articular portion of the graft. The maximum tensile intensity of femur-graft-tibia complex in the auto control group was (301.92 ± 15.04) N, the stiffness was (31.35 ± 1.97) N/mm. After 45 days of operation, all failure occurred at the tibial or femoral insertion site. After 90 days of operation, 24 of the breakpoints were scattered in tendon-bone junction, 12 (3 in 17 mm group, 5 in 21 mm group, 4 in 25 mm group) ruptured through the intra-articular portion. After 180 days of the operation, all breakpoints were distributed inside joint of the implant. The maximum tensile intensity and the stiffness were ber in 17, 21 and 25 mm groups than in 5, 9 and 13 mm groups after operation (P lt; 0.05). Conclusion Tendon with 17 mm length, which will be implanted into bone tunnel, is an appl icable index, in reconstruction of ACL by autogenous tendons.
ObjectiveTo study the effectiveness of internal tension-relieving technique for arthroscopic assisted anterior cruciate ligament (ACL) reconstruction. MethodsBetween March 2011 and September 2014, 51 cases of complete ACL rupture were randomly divided into 2 groups. Arthroscopic assisted single-bundle ACL reconstruction combined with internal tension-relieving technique was performed in 26 cases (group A), arthroscopic assisted single-bundle ACL reconstruction in 25 cases (group B). There was no significant difference in gender, age, cause of injury, injured side, body mass index, Outerbridge classification of articular cartilage injury, disease duration, and the preoperative International Knee Documentation Committee (IKDC) score, Lysholm score, and KT-1000 test value between 2 groups (P>0.05). At 3, 6, and 12 months after operation, the KT-1000 was used to measure the anterior stability, and IKDC and Lysholm scores to evaluate the function of knee joint. ResultsHealing of incision by first intention was obtained in all patients of 2 groups, without complications of infection, deep vein thrombosis of lower extremity, and blood vessels and nerves injury. The patients were followed up 12 months after operation. All patients received second microscopic examination. The reconstructed ACL had good continuity and good coverage of synovial tissue. There was no re-rupture in any cases. The range of motion of the knee joint was close to normal. The MRI showed good healing of the ligament and the bone tunnel at 12 months after operation. KT-1000 test value, IKDC score, and Lysholm score at 3, 6, and 12 months after operation were significantly improved when compared with preoperative ones (P<0.05), but no significant difference was found among different time points after operation (P>0.05). There was no significant difference in IKDC score and Lysholm score between 2 groups at 3 and 12 months (P>0.05); but IKDC score and Lysholm score of group A were significantly higher than those of group B (P<0.05) at 6 months. At diffenent time points after operation, the KT-1000 test values of group A were significantly lower than those of group B (P<0.05) except the value at 3 months (P>0.05). ConclusionFor patients with ACL rupture, using internal tension-relieving technique can effectively alleviate tension force of reconstructed ligament, which is beneficial to the healing of reconstructed ligament and early rehabilitation of the knee joint.
ObjectiveTo evaluate the clinical results of arthroscopic treatment of anterior cruciate ligament (ACL) tibial eminence avulsion fractures in adolescents with epiphyseal unclosure. MethodsBetween January 2011 and October 2013, 35 knees with ACL tibial eminence avulsion fractures (35 patients with epiphyseal unclosure) were arthroscopically treated with suture fixation. There were 25 males and 10 females, aged 8-16 years (mean, 14.7 years). The causes included sports injury in 24 cases, traffic accident injury in 9 cases, and daily life injury in 2 cases. According to Meyers-McKeever classification criteria, there were 27 cases of type Ⅱ and 8 cases of type Ⅲ. Five cases had meniscus injury. The preoperative the International Knee Documentation Committee (IKDC) score was 48.7±3.2, and Lysholm score was 51.2±4.5. The time from injury to operation was 2-16 days (mean, 5 days). ResultsPrimary healing of incision was obtained in all patients. The mean follow-up time was 22.4 months (range, 12-32 months). Anatomical reduction was achieved in 28 cases and satisfactory reduction in 7 cases. X-ray films showed all fractures healing at last follow-up. There was no limb shortening deformity, varus knee, or valgus knee. Lachman test results were all negative. The other knees had normal range of motion except 1 knee with limited flexion, whose range of motion returned to 0-120° after treatment. At last follow-up, the IKDC score was significantly improved to 93.2±4.1 (t=-53.442, P=0.000), and the Lysholm score was significantly increased to 96.2±2.5 (t=-56.242, P=0.000). ConclusionThe arthroscopic fixation technique has satisfactory results for the reduction and fixation of ACL tibial eminence avulsion fracture in the adolescents with epiphyseal unclosure because of little trauma and quick recovery.
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.
Objective To investigate the effect of the anterior cruciate l igament (ACL) rupture on the biomechanics of the lateral collateral l igament (LCL). Methods The specimens in this experiment were knee joints from 6 normal fresh adult male cadavers which was donated voluntarily, aged of 26-35 years with an average of 31.4 years. The knee joints were dissymmetry with 3 in left and right sides respectively. At first, all the 6 specimens lying on the self-made movement tooting, whose LCL straining were measured by strain gauges at different angles (0, 30, 60 and 90°) under axial loads of 400 N by e-testing machine for simulation of the normal knee joint force, were regarded as the intact ACL group. Then, the ACL in all 6 specimens were cut off completely as the deficiency group and did the same step. Results The strain of the LCL were as follows at 0, 30, 60 and 90°: (0.00 ± 1.63), (—17.2 ± 8.57), (—24.00 ± 4.80) and (26.50 ± 4.65) με in intact ACL group; (0.75 ± 8.22), (— 52.75 ± 3.33), (24.30 ± 4.99) and (26.30 ± 4.27) με in deficiency group. There was no significant difference at 0° and 90° flexion (P gt; 0.05), but significant difference at 30° and 60° flexion (P lt; 0.05) between the two groups. Conclusion The rupture of the ACL has significantly effect on the strain of the LCL which suffering abnormal load in the state at 30° and 60° flexion. At 30° flexion the relaxation of the LCL increased, which means the possibil ity of the injury of the LCL is rare; and at 60° flexion the LCL become very tense and thereby at the high risk of instabil ity.
Objective Anterior cruciate l igament (ACL) is an important forward stable structure of knees, when its function impaired, the normal mechanical environment of joint will be destroyed. Now, to explore the effect of ACL rupture on the posterior horn of lateral meniscus by measuring biomechanics. Methods Ten specimens of knee joints (5 left and 5 right sides asymmetrically) were donated voluntarily from 10 normal fresh adult male cadavers, aged 26-35 years with anaverage of 31.4 years. The straining of lateral meniscus posterior horn in 10 knee joint specimens before and after resection of ACL were tested when the knee joints loaded from 0 to 200 N at a velocity of 0.5 mm per second at 0, 30, 60, and 90° of flexion and recorded at the moment when the load was 200 N, the ratio of straining before and after resection of ACL were connted. All the specimens were anatomied and observed in general so as to find injuries such as deformation and tearing in lateral meniscus after test. Results The straining of lateral meniscus posterior horn were as follows: intact ACL group, (—11.70 ± 0.95) με at 0° flexion, (—14.10 ± 1.95) με at 30° flexion, (—20.10 ± 1.20) με at 60° flexion, and (—26.50 ± 1.58) με at 90° flexion; ACL rupture group, (—6.20 ± 1.55) με at 0° flexion, (—26.30 ± 1.89) με at 30° flexion, (—37.70 ± 1.64) με at 60° flexion, and (—46.20 ± 2.78) με at 90° flexion. There were significant differences between intact ACL group and ACL rupture group (P lt; 0.05). The straining ratio of the posterior horn of lateral meniscus rupture ACL to intact ACL were 0.53 ± 0.12, 1.90 ± 0.31, 1.88 ± 0.15, and 1.75 ± 0.16 at 0, 30, 60, and 90° of flexion. The lateral meniscus were intact in general and no injuries such as deformation and tearingwere found. Conclusion ACL has a significant biomechanical effect on posterior horn of lateral meniscus. Consequently, the posterior horn of lateral meniscus is overloaded with ACL rupture at 30, 60, and 90° of flexion, and thereby, it will have the high risk of tear.