Objective To review the injury mechanism and the treatment progress of terrible triad of the elbow, and to analyze the direction of further research. Methods Related literature concerning terrible triad of the elbow was extensively reviewed and comprehensively analyzed. Results The main treatment of terrible triad of the elbow is operation. The ultimate goal of treatment is to reconstruct sufficient stability of the elbow. The treatment includes fixation of the coronoid by suture, screw or plate; fixation of radial head by screw and plate, partial or complete replacement of the radial head; fixation of lateral collateral ligament and the medial collateral ligament by bone suture or anchors and the application of the external fixator. These surgical treatments have their own indications and advantages, most get satisfactory results. Conclusion Generally, surgery is needed to maintain the stability of the elbow for patients of terrible triad elbow. However, medial ligament repair or not, the choice of approach, and mechanism of injury still need further study.
Objective To explore the best flexion angle of the transplantation tendon for fixing joint in simultaneously reconstructing of the anterior cruciate l igament (ACL) and posterior cruciate l igament (PCL) using semitendinosus tendon as autologous graft. Methods Twenty-four clean level New Zealand White rabbits [(aged 6-8 months, male or female, and weighing (2.5 ± 0.2) kg] were selected and divided randomly into 3 groups (n=8) according to fixation angle of the reconstructed l igaments. The bilateral semitendinosus tendons of hind legs were used to reconstruct the PCL and ACL of right hind leg, and the reconstructed l igaments were fixed at knee flexion angles of 90° (group A), 60° (group B), and 30° (group A). The rabbit general situation was observed after operation, and the specimens of the knee joints (including 10 cmdistal end and 10 cm proximal end) were harvested for testing extension and flexion, displacement, and internal and external rotation at 3 months after operation. Results All the rabbits survived to the end of experiment. There was no significant difference in maximal displacements of ACL and PCL among 3 groups (P gt; 0.05). The anterior and posterior displacements of shift in 3 groups were less than 1 mm, suggesting good stabil ity. The anterior displacement and the posterior displacement at 30° flexion and 90° flexion in group A were significantly larger than those in group C (P lt; 0.05). There were significant differences in internal rotation angle and external rotation angle between group A and group C (P lt; 0.05), and there was no significant difference among other groups (P gt; 0.05). Conclusion When simultaneously reconstructing ACL and PCL, the knee flexion angle of 60° for fixing the reconstructed l igaments can achieve the best effect.
ObjectiveTo investigate the value of ligament remnant preservation during anterior cruciate ligament (ACL) reconstruction by observing the integrity, the tension, the synovial membrane covering, and the color of the reconstructed ligament under arthroscopy. MethodsBetween January 2011 and December 2013, 122 patients who underwent ACL reconstruction and arthroscopic internal fixation removal at 1 year after reconstruction were included in this study. Of these cases, 61 cases underwent ACL reconstruction using the remnant-preserved technique (preservation group);the other 61 cases underwent ACL reconstruction using non remnant-preserved technique (non preservation group). There was no significant difference in gender, age, injury side, body mass index, type of injury, the time from injury to reconstruction, and the result of KT-2000 examination between 2 groups (P<0.05). The reconstructed ACL were observed under arthroscopy when internal fixation was removed, and the effectiveness was evaluated according to the criteria of AO Yingfang. ResultsIn preservation group, the results were excellent in 34 cases, good in 22 cases, fair in 4 cases, and poor in 1 case;and in non preservation group, the results were excellent in 29 cases, good in 20 cases, fair in 10 cases, and poor in 2 cases;and there was no significant difference between 2 groups (Z=-1.320, P=0.187). ConclusionIn ACL reconstruction, the remnant-preserved technique is not obviously better than non remnant-preserved technique in the integrity, tension, membrane covering, and color.
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.
Objective To review the research and del ivery methods of growth factors in tendon injuries, and to point out the problems at present as well as to predict the trend of development in this field. Methods Domestic and international l iterature concerning growth factors to enhance tendon and l igament heal ing in recent years was extensively reviewed and thoroughly analyzed. Results Cell growth factor could promote tendon heal ing, improve the mechanical properties as well as reduce the adhesion postoperatively. The use of transgenic technology mediating cell factors to promote tendon repair shows its advantages in many ways. Conclusion The growth factors play a vital role in tendon heal ing. Reasonable treatment of growth factors through direct appl ication or gene transfer techniques is of great value for the heal ing process.
ObjectiveTo solve the fixation problem between ligament grafts and host bones in ligament reconstruction surgery by using ligament-bone composite scaffolds to repair the ligaments, to explore the fabrication method for ligament-bone composite scaffolds based on three-dimensional (3-D) printing technique, and to investigate their mechanical and biological properties in animal experiments. MethodsThe model of bone scaffolds was designed using CAD software, and the corresponding negative mould was created by boolean operation. 3-D printing techinique was employed to fabricate resin mold. Ceramic bone scaffolds were obtained by casting the ceramic slurry in the resin mould and sintering the dried ceramics-resin composites. Ligament scaffolds were obtained by weaving degummed silk fibers, and then assembled with bone scaffolds and bone anchors. The resultant ligament-bone composite scaffolds were implanted into 10 porcine left anterior cruciate ligament rupture models at the age of 4 months. Mechanical testing and histological examination were performed at 3 months postoperatively, and natural anterior cruciate ligaments of the right sides served as control. ResultsBiomechanical testing showed that the natural anterior cruciate ligament of control group can withstand maximum tensile force of (1 384±181) N and dynamic creep of (0.74±0.21) mm, while the regenerated ligament-bone scaffolds of experimental group can withstand maximum tensile force of (370±103) N and dynamic creep of (1.48±0.49) mm, showing significant differences (t=11.617,P=0.000; t=-2.991,P=0.020). In experimental group, histological examination showed that new bone formed in bone scaffolds. A hierarchical transition structure regenerated between ligament-bone scaffolds and the host bones, which was similar to the structural organizations of natural ligament-bone interface. ConclusionLigament-bone composite scaffolds based on 3-D printing technique facilitates the regeneration of biomimetic ligament-bone interface. It is expected to achieve physical fixation between ligament grafts and host bone.
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 investigate the surgical technique and short-term effectiveness of anterior cruciate l igament (ACL) reconstruction with LARS artificial l igament. Methods Between November 2008 and April 2010, eighty patients withACL injury were treated with LARS artificial l igament under arthroscope and successfully followed up. There were 51 males and 29 females, aged from 17 to 43 years with an average of 29.2 years. The injuries were caused by sport in 63 cases, traffic accident in 14 cases, and bruise in 3 cases. There were 43 left knees and 37 right knees. The disease duration ranged from 10 days to 11 months. The anterior drawer test, Lachman test, and pivot shift test for all cases were rated as positive. The preoperative Lysholm score was 55.4 ± 5.7, Irgang score was 48.3 ± 6.2, and Larson score was 54.8 ± 7.4; and the International Knee Documentation Committee (IKDC) score was lower than normal level in all cases. Obl ique coronal MRI showed ACL injury in all cases. Residual ACL and synovium were preserved during surgery. Results All incisions healed by first intention without compl ication of infection or deep venous thrombosis. All patients were followed up 7 to 24 months with an average of 16.8 months. There were 3 cases of screws exposure toward femoral cortical bone, 2 cases of loosening tibial screw, and 1 case of knee extension l imitation, and they were cured after symptomatic treatment. No LARS artificial l igament rupture and joint fibrosis occurred during followup. At last follow-up, the results of anterior drawer test, Lachman test, and pivot shift test were positive in 2, 3, and 3 patients,respectively. There were significant differences in Lysholm, Irgang, and Larson scores of affected knees between preoperation and 6 weeks postoperatively, last follow-up, respectively (P lt; 0.05). The normal rate of IKDC score were 43.75% (35/80) and 97.50% (78/80) at 6 weeks postoperatively and last follow-up, respectively. Conclusion The viscoelastic properties of LARS artificial l igament is different from that of biological materials. The graft should be fixed at a relatively extension position to avoid knee extension l imitation and sl ight loosening of graft tension is permitted at flexion position. Good cl inical result could be achieved if the technique is well appl ied.
ObjectiveTo investigate the operative method and short-term effectiveness in the surgical treatment of Maisonneuve fracture. MethodsBetween January 2010 and February 2013, 23 patients with Maisonneuve fracture were treated. There were 14 males and 9 females with an average age of 40.3 years (range, 30-68 years). The causes of injuries were falling injury in 11 patients, sports related injury in 5 patients, traffic accident injury in 4 patients, and falling injury from height in 3 patients. The interval between injury and operation was 7-10 days (mean, 8.5 days). All of fractures were closed. Three patients had combined injury of deltoid ligament. The surgical procedures included surgical reduction and fixation of medial malleolus fracture and posterior malleolus fracture, repair of the deltoid ligament with ground anchor suture, and fixation of the disrupted distal tibiofibular syndesmosis. ResultsAll incisions achieved primary healing, no postoperative complications such as infection occurred. Twenty-one patients were followed up 24-36 months (mean, 26.5 months). No patients complained of pain, tenderness, and obvious swelling of the ankle. At 3-6 months (mean, 4.6 months) after operation, X-ray films showed bony union of fractures and normal mortises in 21 patients. And no traumatic arthritis was observed with reliable fixation. The range of motion of ankle dorsi flexion and plantar flexion was 30-40° (mean, 34.5°). Baird-Jackson ankle functional score was 85-100 (mean, 94); 16 cases were rated as excellent, 4 as good, and 1 as fair with an excellent and good rate of 95.2%. ConclusionSurgical treatments of Maisonneuve fracture include surgical reduction and fixation of the medial malleolus and posterior malleolus, repair of the deltoid ligament and fixation of the disrupted distal tibiofibular syndesmosis, and good effectiveness can be achieved.
Objective To discuss the effectiveness of operation technique for antero-medial rotatory instability (AMRI) of the knee joint caused by motorcycle. Methods Between June 2007 and December 2009, 32 cases of AMRI caused by motorcycle were treated. There were 28 males and 4 females with an average age of 35.5 years (range, 20-50 years). The interval between injury and surgery was 5-10 days (mean, 7 days). The anterior cruciate ligament (ACL) was injured at the attachment point of the condyles crest; the medial collateral ligament (MCL) was injured at central site in 19 cases, at medial condyles of femur in 10 cases, and at medial condyles of tibia in 3 cases, which were all closed injuries. The bone avulsion of condyles crest was fixed by steel wire and MCL was repaired. Results Red swelling and a little effusion occurred at the incision in 1 case, and the other incisions healed by first intention. Traumatic arthritis of the knee occured in 5 cases. Thirty-two cases were followed up 16-22 months (mean, 18.5 months). The X-ray examination showed that the fracture union time was 5-8 weeks (mean, 6 weeks) after operation. At last follow-up, the extension of knee joint was 0° and the flexion of the knee joint was 110-170° (mean, 155°). According to the synthetic evaluating standard of International Knee Documentation Committee, 24 cases were rated as A level, 6 cases as B, 1 case as C, and 1 case as D at last follow-up. Lysholm knee score was 85.93 ± 3.76 at last follow-up, which was significantly higher (t=53.785, P=0.000) than preoperative score 37.54 ± 3.43. Conclusion In patients with AMRI caused by motorcycle, steel wire is used to fix the bone avulsion of condyles crest and MCL should be repaired simultaneously as far as possible. And associating with the early postoperative functional exercise, the short-term effectiveness is satisfactory, but long-term effectiveness still need further follow-up observation.