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.
Objective To evaluate the diagnostic value of MR imaging for anterior cruciate ligament. Methods We searched PubMed, EMBASE, CBM, CSJD and CJFD to find all diagnostic tests about MR imaging in anterior cruciate ligament. QUADAS items were used to evaluate the quality of the included studies. We used Meta-disc software for data collection, and sensitivity, specificity and SROC curves were calculated to assess the diagnostic value of individual diagnostic tests. Results Twenty-nine studies met the eligibility criteria and were included. Compared with arthroscope, the summary values of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio and SROC curve of MR imaging were 93%, 93%, 9.85, 126.39, and 0.971 4, respectively. Conclusion MR imaging can be regarded as an effective and feasible method for ACL tears diagnosis and screening clinically, based on the results of this systematic review.
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 evaluate knee stability after double-bundle and single-bundle anterior cruciate ligament reconstruction. Methods Randomized controlled trials (RCTs) and quasi-randomized controlled trials (quasi-RCTs) were collected from MEDLINE (1966 to October 2007), OVID (1950 to October 2007), The Cochrane Library (issue 4, 2007) and China Academic Journals Full-text Database (1979 to October 2007). The quality of included trials was assessed. Data analyses were performed with The Cochrane Collaboration’s RevMan 4.2.10 software. Results One RCT (quality B) and 5 quasi-RCTs (quality C) involving 426 patients met the inclusion criteria. Meta-analyses showed significant differences between the two operative procedures in terms of anterior stability (WMD –0.75, 95%CI –1.14 to –0.37, P=0.000 1) and rotational stability [RR 1.38, 95%CI 1.17 to 1.61, Plt;0.000 1]. Conclusion The double-bundle anterior cruciate liagament is superior to single-bundle anterior cruciate ligament in terms of anterior stability and rotational stability. Since the included trials were small and of poor quality, more high-quality, large-scale randomized controlled trials are required.
Objective To evaluate the feasibility of the anterior cruciate ligament (ACL) reconstruction with 6 strands of hamstring tendons enveloped by periosteum. Methods Between April 2008 and April 2009, 34 patients with ACL injury were treated, ACL of whom was reconstructed with 6 strands of hamstring tendons enveloping of periosteum and double Rigidfix fixation. There were 30 males and 4 females, aged 19-54 years with an average of 29.4 years. The causes of injury included sport in 19 cases, traffic accident in 8 cases, falling from height in 5 cases, and other in 2 cases. The locations were left knee in 19 cases and right knee in 15 cases. The disease duration was 3 weeks to 18 months (median, 9.4 months). The results of Lachman test and anterior drawer test were positive. The Lysholm knee score was 61.5 ± 3.6. MRI examination revealed ACL rupture in 26 cases and ACL injury in 8 cases. Results All incisions healed by first intention, and no early complication occurred. Twenty-eight cases were followed up 12-32 months (mean, 16.1 months). The result of Lachman test was negative at 12 months after operation; in all patients, knee extension reached 0°, and flexion reached 120-150° (mean, 132.5°). The AP and lateral X-ray films and MRI showed no bone tunnel expansion. At last follow-up the therapeutic effect evaluation was excellent in 25 cases, good in 1 case, and fair in 2 cases; the excellent and good rate was 92.9%. The postoperative Lysholm score was 91.0 ± 3.2, showing significant difference when compared with preoperative score (t=32.78, P=0.00). Conclusion Six strands of hamstring tendons can ensure sufficient tensile strength, and use of the double Rigidfix absorbable screw makes fixation more reliable. Facing outside suture of periosteal flap can promote tendon-bone healing, so it is a good method of ACL reconstruction.
ObjectiveTo compare the strength difference between the interfacial screw and the interfacial screw combined with bone tunnel crossing technology to fix the tibial end of ligament during anterior cruciate ligament (ACL) reconstruction through the biomechanical test.MethodsTwenty fresh frozen pig tibia were randomly divided into two groups (n=10) to prepare ACL reconstruction models. The graft tendons in the experimental group were fixed with interfacial screw combined with bone tunnel crossing technology, and the graft tendons in the control group were fixed with interfacial screw. The two groups of specimens were fixed in the high-frequency dynamic mechanics test system M-3000, and the length change (displacement), ultimate load, and stiffness of graft tendons were measured through the reciprocating test and load-failure test.ResultsThe results of reciprocating test showed that the displacement of the experimental group was (3.06±0.58) mm, and that of the control group was (2.82±0.46) mm, and there was no significant difference between the two groups (t=0.641, P=0.529). The load-failure test results showed that the stiffness of the experimental group and the control group were (95.39±13.63) and (91.38±14.28) N/mm, respectively, with no significant difference (t=1.021, P=0.321). The ultimate load of the experimental group was (743.15±173.96) N, which was significantly higher than that of the control group (574.70±74.43) N (t=2.648, P=0.016).ConclusionIn ACL reconstruction, the fixation strength of tibial end with interface screw combined with bone tunnel crossing technology is obviously better than that of interface screw alone.
ObjectiveTo observe the effect and significance of autologous fibrin clot on tendon-bone healing after anterior cruciate ligament (ACL) reconstruction.MethodsBetween October 2014 and January 2016, 34 patients (34 knees) with ACL injury were enrolled in the study. During ACL reconstruction, autologous fibrin clot was used in 17 cases (trial group) and was not used in 17 cases (control group). The anterior drawer test, Lachman test, and axial displa-cement test were positive in 2 groups before operation. There was no significant difference in gender, age, causes of injury, injury side, disease cause, and preoperative knee joint activity, Lysholm score, and American Hospital for Special Surgery (HSS) score between 2 groups (P>0.05), with comparable. The results of anterior drawer test, Lachman test, and axial displacement test were recorded and compared between 2 groups after operation. The knee joint activity, Lysholm score, and HSS score were used to evaluate the knee function recovery at 6, 24, and 48 weeks after operation; the graft signal intensity, graft signal to noise ratio, bone tunnel expansion, and graft tendon-bone node T2 value were measured.ResultsAll patients were followed up 48 weeks. Surgical incision healed at stage I. No joint infection and joint adhesion occurred. The drawer test, Lachman test, and axial shift test were negative in 2 groups. At 6, 24, and 48 weeks after operation, the Lysholm score of trial group was significantly higher than that of control group (P<0.05); there was no significant difference in knee joint activity between 2 groups (P>0.05). The HSS score of trial group was significantly higher than that of control group at 24 and 48 weeks (P<0.05), but no significant difference was found at 6 weeks (P>0.05). MRI measu-rement showed that there was significant difference in graft signal intensity, bone tunnel expansion, and graft signal to noise ratio between 2 groups at 6, 24, and 48 weeks after operation (P<0.05). There was no significant difference in graft tendon-bone node T2 value between 2 groups (P>0.05) at 48 weeks after operation, but difference was significant at 6 and 24 weeks (P<0.05).ConclusionAutologous fibrin clot can effectively enhance graft revascularization, and accelerate the process of tendon-bone healing after ACL reconstruction.
Objective To review the research progress regarding the over-the-top technique for anterior cruciate ligament (ACL) reconstruction. MethodsThe relevant literature on ACL reconstruction using the over-the-top technique was analyzed for its evolution, clinical application, advantages, and limitations. Results Over-the-top technique for ACL reconstruction is a combined intra- and extra-articular technique. Because it avoids drilling the femoral tunnel, its advantages are mainly highlighted in the protection of the femur. Therefore, it is widely used in children and adolescents with epiphyseal occlusion and in patients with revision reconstruction. In addition, significant improvements in postoperative joint stability, functional scores, and return to exercise rates are found in long-term follow-up studies of patients with primary ACL reconstruction and combined anterolateral tenodesis. However, the technique also has some limitations, such as poor stability of knee flexion after operation, high requirement for graft length, and easy impact of graft in the intercondylar fossa. Conclusion The current research results show the effectiveness and safety of the over-the-top technique for primary and revision ACL reconstruction, with the advantages of wide application, simple operation, and quick recovery; however, more researches are needed to further optimize the selection of grafts and femoral condyle management problems, and to clarify the long-term effectiveness.
Anterior cruciate ligament (ACL) injury is one of the most common and typical sports injuries. Neuromuscular proprioceptive training has been widely used in clinical practice in recent years due to its significant therapeutic effects, but the correlation between proprioception and ACL injury is still lacking in-depth exploration. ACL injury can result in the loss of mechanoreceptors, which in turn affects proprioceptive signal afferents, resulting in impaired neuromuscular control. Impaired neuromuscular control, in turn, can cause ligamentous structures to be overburdened beyond their stretch thresholds, leading to proprioceptive impairment, creating a vicious cycle. Based on neuromuscular control theory, this article further discusses the relationship between proprioception and ACL injury, aiming to provide new ideas for rehabilitation after ACL injury.
ObjectiveTo investigate the effectiveness of partial anterior cruciate ligament (ACL) suture repair with wide awake local anesthesia no tourniquet (WALANT) technique.MethodsBetween July 2017 and July 2019, 18 patients with partial ACL injury were admitted. There were 10 males and 8 females, with an average age of 40.5 years (range, 22-57 years). There were 5 cases on the left knee and 13 cases on the right knee. Forteen cases had a clear history of trauma or sports injury, and 4 cases had no obvious cause. The time from injury to operation was 1-6 months (median, 3 months). Partial ligament was sutured using WALANT technique under arthroscopy. The operation time, total hospital stay, and postoperative hospital stay were recorded. Lachman test and anterior drawer test were performed to evaluate the knee joint stability after treatment, and Lysholm and International Knee Documentation Committee (IKDC) scores were used to evaluate the knee function. Five-point Likert scaling were used to evaluate postoperative patient satisfaction.ResultsThe operation time was 30-100 minutes (mean, 64.2 minutes). The total hospital stay was 2-12 days (mean, 4.5 days). Postoperative hospital stay was 1-4 days (mean, 1.8 days). All incisions healed by first intention after operation, and no surgery-related complications occurred. All patients were followed up 12-36 months (mean, 19.1 months). Lachman test and anterior drawer test were negative after operation. Lysholm score and IKDC score at 6 and 12 months after operation were significantly higher than those before operation, and at 12 months after operation were higher than those at 6 months after operation, the differences were significant (P<0.05). At last follow-up, according to five-point Likert scaling of patient satisfaction, 7 cases were very satisfied, 10 cases were relatively satisfied, and 1 case was general. The total patient satisfaction rate was 94.4% (17/18). MRI scan showed the good ligament tension.ConclusionUsing WALANT technique to repair partial ACL injuries under arthroscopy can retain the patient’s own ligament tissue to the maximum extent and achieve satisfactory short-term effectiveness.