Objective To investigate the effectiveness of transosseous suture in medial patellofemoral ligament (MPFL) double bundle reconstruction. Methods The clinical data of 75 patients with recurrent patella dislocation who met the selection criteria between January 2014 and December 2017 were retrospectively analyzed. All of them were treated with MPFL double bundle reconstruction, and divided into study group (39 cases, using new transosseous suture technique) and control group (36 cases, using traditional suture anchor fixation) depending on the intraoperative fixation technique. There was no significant difference in gender, age, body mass index, affected knee side, preoperative tibial tuberosity-trochlear groove distance, Insall-Salvati ratio, knee range of motion, Kujala score, International Knee Documentation Committee (IKDC) score, congruence angle, and tilt angle between the two groups (P>0.05). The operation time, intraoperative blood loss, hospital stay, and postoperative complications were recorded and compared between the two groups. Kujala score, IKDC score, and knee range of motion were used to evaluate the functional improvement of patients before and after operation. The congruence angle and tilt angle were measured on X-ray films. Results There was no significant difference in operation time, intraoperative blood loss, and hospital stay between the two groups (P>0.05). Patients in both groups were followed up 24-36 months, with an average of 29.4 months. There was no complication such as incision infection, fat liquefaction, patellar redislocation, and prepatellar pain during follow-up. At last follow-up, the Kujala score, IKDC score, knee range of motion, congruence angle, and tilt angle of two groups significantly improved when compared with those before operation (P<0.05), while there was no significant difference between the two groups (P>0.05). ConclusionThe application of suture anchor or transosseous suture to complete MPFL double bundle reconstruction can restore patellar stability, and there is no significant difference in the short-term effectiveness between them.
Objective To analyze the reasons for internal fixation failure after internal fixation of nickel-titanium memory alloy patella claw for patella fracture, and to explore the countermeasures. Methods The clinical data of patients with patellar fracture treated by internal fixation of nickel-titanium memory alloy patella claw in the Second Orthopedic Ward of Chongqing Orthopedic Hospital of Traditional Chinese Medicine from May 2015 to April 2020 were analyzed retrospectively. Patients with postoperative internal fixation failure were identified. The reasons for internal fixation failure were analyzed. Results A total of 436 patients were included. Internal fixation failure occurred in 10 patients. There were 6 cases (1.38%) of patellar claw detachment, and 4 cases of simple fracture block displacement witharticular surface displacement≥2 mm (0.92%). Internal fixation failure occurred 4 to 48 days postoperatively, with an average of (18.20±10.86)days. The analysis showed that the reason for internal fixation failure in 4 patients was improper early postoperative functional exercise. The reason for 3 patients was that the auxiliary internal fixation was not selected. The reason for 2 patients was that the size of the patellar claw was too small. The reason for 1 patient was the improper fixation of the auxiliary internal fixation. Conclusion The failure of internal fixation after patella fracture with nickel-titanium memory alloy patella claw is mainly related to whether the model of the patella claw is appropriate, whether the auxiliary internal fixation is selected, whether the auxiliary internal fixation is properly fixed, and whether the early postoperative functional exercise is appropriate.
Objective To investigate the clinical effect of chitosan in prevention of knee dysfunction due to adhesion after operation for patellar fracture. Methods From March to October 1999, 40 cases of patellar fracturewere treated by internal fixation, with intraarticular injection of 2% chitosan in only 24 cases after fixation and with no chitosan injection in 16 cases(control group). The function of the knee joint, including extension and flexion, was evaluated 1month and 1 year after operation respectively. Results One month after operation, the knees with chitosan injection could actively move in the average range of 104°±23°, and the knees in the control group could move in the average range of72°±16°, which showed significant difference between two groups(P＜0.01); 1 year after operation, the range of movement of the knees with injection was 165°±38° on average, and that of the knees in the control group was 110°± 31°, which also indicated significant difference between two groups (P＜0.05). Conclusion Medical chitosan could effectively prevent or reduce the post-operative adhesion of knee joint after patellar operation.
ObjectiveTo investigate the short-term effectiveness of derotational distal femoral osteotomy (DDFO) combined with medial patellofemoral ligament (MPFL) reconstruction in treatment of recurrent patellar dislocation with excessive femoral anteversion angle (FAA≥30°). MethodsBetween June 2017 and August 2019, 17 patients with recurrent patellar dislocation with FAA≥30° were treated with DDFO and MPFL reconstruction. There were 5 males and 12 females, aged 14-22 years, with an average of 17.7 years. The patella dislocated for 2 to 8 times (mean, 3.6 times). The disease duration was 2-7 years (mean, 4.6 years). The patellar apprehension tests were positive. Preoperative pain visual analogue scale (VAS) score, Lysholm score, Tegner score, and Kujala score were 4.2±1.1, 47.8±8.1, 3.6±1.1, and 56.8±5.7, respectively. FAA, mechanical lateral distal femoral angle (mLDFA), lateral patella displacement (LPD), tibial tuberosity-trochlear groove distance (TT-TG) were (34.9±3.4)°, (85.8±3.0)°, (13.7±3.8) mm, and (23.1±2.1) mm, respectively. ResultsAll incisions healed by first intention, and there was no complications such as knee stiffness, infection, and re-dislocation of the patella. All patients were followed up 13-25 months, with an average of 17.7 months. The imaging review showed that 1 case of osteotomy did not union, and achieved satisfactory results after the secondary revision and strengthening fixation; the osteotomies of other patients healed completely after 3 to 4 months of operation. The patellar apprehension tests were negative. At last follow-up, the FAA, mLDFA, LPD, and TT-TG were (15.6±2.7)°, (83.0±2.1)°, (5.0±2.6) mm, and (20.5±2.5) mm, respectively; the VAS score, Lysholm score, Tegner score, and Kujala score were 2.4±1.4, 93.4±7.8, 6.8±1.5, and 89.0±8.0, respectively. There were significant differences in the above indicators between pre- and post-operation (P<0.05). ConclusionDDFO combined with MPFL reconstruction for the recurrent patellar dislocation with excessive FAA (≥30°) can achieve good short-term effectiveness, significantly reduce knee pain, and improve function.
ObjectiveTo investigate the effectiveness of anterior knee incision by the patellar longitudinal approach for osteotomy in treating type C fractures of the distal femur. MethodsBetween March 2010 and June 2014, 36 patients with type C fractures of the distal femur underwent fracture reduction and internal fixation by patellar longitudinal approach for osteotomy. There were 25 males and 11 females, aged 26-72 years (mean, 49 years). Injury causes included traffic accident injury (19 cases), falling injury from height (8 cases), and crushing injury (9 cases). There were 34 cases of closed fracture and 2 cases of open fracture. Associated fractures included 2 cases of patellar fracture and 4 cases of clavicular fracture; combined injuries included 4 cases of anterior cruciate ligament injury, 1 case of posterior cruciate ligament injury, 12 cases of meniscus injury, and 9 cases of medial and lateral collateral ligament injuries. It was 3-11 days from injury to operation (mean, 6 days). ResultsAmong 36 patients, 29 were followed up 12-24 months (mean, 18 months). Primary healing of incision was obtained, without infection or lower limb deep venous thrombosis. X-ray films showed fracture healing at 12-32 weeks (mean, 16.4 weeks). Neither loosening of screw and plate breakage nor valgus and varus knee occurred. Pain and stiff of the knee joint were observed in 4 and 2 cases, respectively; 4 cases walked with a cane. According to Hospital for Special Surgery (HSS) scoring system, the results were excellent in 21 cases, good in 7 cases, and fair in 1 case; and the excellent and good rate was 96.55%. The internal fixation was removed at 10-14 months after operation, and there was no re-fracture. ConclusionThe patellar longitudinal approach has the advantages of sufficient exposure, easy reduction, short operation time, good internal fixation, less damage of soft tissue, and less complication. So it is the appropriate approach to treat type C fractures of the distal femur.
【Abstract】 Objective To explore the flexibil ity and rel iabil ity of cementless total knee arthroplasty (TKA) without patellareplacement through a retrospective study of the mid-term therapeutic effect of the treatment of the patients. Methods FromJune 1997 to March 2000, a consecutive series of 152 (152 knees) cementless TKA performed in Hessing-Stiftung was studied. Among them, there were 63 males and 89 females, with 70 left knees and 82 right knees. Their ages ranged from 51 years to 72 years, with an average of 59 years. There were 146 cases of osteoarthritis and 6 cases of traumatic arthritis. The course of the disease lasted for 1.0 years to 3.5 years. The EFK prostheses of German Plus company were used in all the cases. The HSS score before the operation was 41.5 ± 12.3, and the average range of motion was 55º (ranging from 30º to 90º). Results Five patients underwent anterior knee pain, and the pain was released after the appropriate treatment. No deep infection happened in all cases. A total of 145 patients (145 knees) were followed up for 5 years to 8 years. The HSS score was 87.5 ± 8.2 at the end of the follow-up, showing significant difference (P lt; 0.05). The average range of motion was 95º (ranging from 90º to 110º). Partial radiolucencies occurred at the tibia side in 18knees 3 to 6 months after the operation. Among them, the width was less than 2 mm in 15 knees without symptom, and more than 2 mm in 3 knees. There were 2 of the 3 knees which were revised at the tibia side because of the aseptic loosing, while 1 patient had only mild pain in the knee during the follow-up, with no sign of loosing. Conclusion The mid-term effect of cementless TKA is satisfactory. The ingrowth of femur and tibial bones is rel iable. The early stage migration of the component is the main reason of loosing. Satisfying outcomes can also be achieved without patella replacement during TKA.
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.