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2025,33(12):1057-1062, DOI: 10.20184/j.cnki.Issn1005-8478.11102A
Abstract:
With the development of arthroscopic knee surgery techniques and instruments, the diagnosis and treatment level of knee joint injuries has improved. However, the undesirable phenomenon of emphasizing surgical operations while neglecting diagnostic capabilities has emerged, resulting in misdiagnosis and mistreatment. This issue of the Orthopedic Journal of China features key content related to the diagnosis and treatment of knee injuries: First, pay attention to clinical basic work to avoid misdiagnosis and missed diagnosis. It is necessary to attach importance to basic work such as medical history collection, and reduce misdiagnosis and missed diagnosis caused by weak basic knowledge and blind confidence. Taking multiple ligament injuries of the knee as an example, this paper analyzes the progress and misunderstandings in diagnosis and treatment, and emphasizes the importance of strengthening the training of young doctors, the mentorship and guidance of experts at all levels, and the meticulous work of clinical doctors close to clinical practice. Combined with the difficulty in diagnosing posterior cruciate ligament injury, this paper introduces the application of MRI at 90° flexion position to change the "?"- shaped PCL sign in conventional examination into a "straight lines", making the diagnosis more intuitive and accurate. Second, pay attention to surgical indications and standardized operations to avoid intraoperative and postoperative complications. Continuously study standardized procedures such as surgical indications for knee injuries. This issue analyzes and summarizes hot and controversial events, such as nerve and blood vessel injury during lateral meniscus suture and how to reduce postoperative recurrence during arthroscopic popliteal cyst surgery. Third, pay attention to innovation and the development of new technologies to avoid surgical misunderstandings. Correctly understand the connotation of innovation. The development of new technologies should comply with multiple principles. Considering serious complications, such as intraoperative injury to the popliteal vessels and nerves during lateral meniscus suture, and posterior cruciate ligament surgery, emphasize the risks of blindly developing new technologies without carefully assessing surgical capabilities, and remind doc-tors to carry out surgeries step by step based on their own conditions. Fourth, focus on clinical basic research to improve the diagnosis and treatment level of knee diseases, with an emphasis on basic research in biomechanics, anatomical pathology, imaging, new materials, and new surgical methods. This issue publishes some surgical approach options for hot and difficult issues, such as revision of re-injured anterior cruciate ligament after repair and reconstruction, and emphasizes strengthening the research on perioperative rehabilitation nursing.
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HUANG Chang-ming, ZHU Tian-hao, FU Yang-pan, ZHANG Ya-qing
2025,33(12):1063-1068, DOI: 10.20184/j.cnki.Issn1005-8478.11083A
Abstract:
There are many complications in posterior cruciate ligament reconstruction surgery, among which the most serious and the most harmful is the accidental popliteal artery injury during the operation. Once this happens, if it is not diagnosed and treated in time, it will have disastrous consequences and bring irreversible impact on the life and health of the patient. Therefore, to prevent this from happening, it is necessary for us to deeply understand and study the causes and clinical manifestations of it, so as to achieve early prevention, early detection and early treatment in actual operation. Based on this background, this paper attempts to elaborate the causes of accidental popliteal artery injury during posterior cruciate ligament reconstruction surgery and the clinical characteristics of this complication by combining the analysis of relevant cases, and further explore relevant preventive measures and countermeasures, in order to effectively reduce or avoid this serious complication in future medical practice.
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HUANG Chang-ming, FU Yangpan, DONG Hui-xiang, ZHU Tian-hao
2025,33(12):1069-1074, DOI: 10.20184/j.cnki.Issn1005-8478.11082A
Abstract:
Popliteal cyst is a common disease, and there are many surgical methods. Previously, open resection to remove the cyst was the common treatment method, whereas with high postoperative recurrence rate. How to reduce the recurrence after arthroscopic resection remains the focus of current research. The recurrence of popliteal cyst after operation is often affected by many factors such as anatomy, primary cause, surgery and patient's own factors. Arthroscopic intraarticular disease management and cyst drainage are effective. Reasonable selection of arthroscopic approach is the key to successful operation. The cyst wall resection during the operation can further reduce the chance of the postoperative recurrent cyst, but attention should be paid to prevent the serious complications of the vascular and nerve injury of the posterior knee. In combination with relevant literature and a case, this paper focuses on the pathogenesis of popliteal cyst, the postoperative recurrence related anatomical factors and intra-articular diseases, diagnostic issue, arthroscopic surgical skills, key points and intraoperative pitfall, so as to improve the diagnosis and treatment and reduce postoperative recurrent cyst.
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ZHU Tian-haoa, LIN Jian-kunb, HUANG Chang-minga, FAN Hua-qianga, FU Yang-pana, GAN Zhi-yonga, LIU Zhen-huanga
2025,33(12):1075-1082, DOI: 10.20184/j.cnki.Issn1005-8478.11085A
Abstract:
[Objective] To evaluate the pitfalls and postoperative complications in one-stage repair and reconstruction for multiple ligament injuries of the knee, and to analyze the countermeasures. [Methods] A retrospective study was conducted on 50 patients who had knee multiple ligament injuries treated surgically in our hospital from 2011 to 2024. The incidence of intraoperative traps and postoperative complications and their treatment were hierarchically analyzed. [Results] A total of 18 patients were included into this study after the patients who lose the follow-up were excluded. The patients were compared in stratifications based on time interval between injury and surgery, number of ligaments involved, whether the knee was dislocated at hospital admission, and artificial or autogenous grafts used. There were no significantly differences in terms of Lysholm, IKDC and VAS scores between the early operation group and delayed operation group, two ligaments involved group and three ligaments involved group, dislocation group and non-dislocation group, artificial ligament graft group and tendon autograft group (P＞0.05). Complications occurred in 6 of 18 cases (33.3%), including 5 cases of knee stiffness after operation, which resolved without adverse consequences after manual release in 1 case, and rehabilitation exercise in 4 cases. In term of stratified comparison, the artificial ligament group had significantly ankylosis ratio and the tendon autograft group (66.7% vs 8.3% , P= 0.022), whereas the two ligament involved group had significantly less ankylosis ratio than the three ligaments involved group (0 vs 35.7%, P＜0.001). [Conclusion] Ankylosis is the most common complication after one-stage repair and reconstruction for the multiple ligament injuries of the knee, which is more likely to occur after one-stage reconstruction with artificial ligament graft, or for three ligaments involved. There was no significant difference in clinical outcomes between early and delayed surgery and with or without dislocation at hospital admission
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FU Yang-pan, YANG Lin-gen, HUANG Chang-ming, LIN Huai-xiong, FAN Hua-qiang, GAN Zhi-yong, HU Xi-chun, DONG Hui-xiang, ZHU Tianhao
2025,33(12):1083-1089, DOI: 10.20184/j.cnki.Issn1005-8478.11087A
Abstract:
[Objective] To evaluate the significance of magnetic resonance imaging (MRI) examination at 90° knee flexion for the diagnosis of old posterior cruciate ligament (PCL) rupture. [Methods] A retrospective study was conducted on 32 patients who had unilateral PCL tear treated surgically in our hospital from January 2018 to December 2023. All patients were screened for PCL injury by drawer test, underwent MRI examination in extension position and 90° knee flexion, and got old PCL rupture confirmed by arthroscopic surgery. The MRI images were evaluated by two radiologists and a consensus was reached. The MRI measurments were compared and analyzed with those of arthroscopic surgery. [Results] The MRI at 90° knee flexion showed that the normal PCL was of (43.6±1.2) mm in length, (7.5±0.8) in mm width and (77.9±1.2)° in sagittal angle, while the old torn PCL was of (46.8±2.5) mm in length, (9.4±0.9) mm in width and (74.3± 1.3)° in sagittal angle. By comparison, the MRI at knee extension measured the old torn PCL (37.3±1.1) mm in length, (10.1±0.9) mm in width and (70.2±1.4)° in sagittal angle. There were statistical significant differences in the old torn PCL in width, length and sagittal angle between the knee extension and 90° knee flexion position (P＜0.001). The length variation ratio between the normal PCL and torn PCL increased from 3.6% at knee extension position to 7.3% at 90° knee flexion, while the length variation ratio between the knee extension and 90° knee flexion was 21.1% for normal PCL, while 25.5% for the old torn PCL. [Conclusion] MRI examination at 90° knee flexion can significantly expand the length variation ratio of the PCL, which is conducive to improving the accuracy of diagnosis of old PCL injury.
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FU Yang, KANG Kai, XIA Yan, JING Yuan-hai, LI Jia
2025,33(12):1090-1095, DOI: 10.20184/j.cnki.Issn1005-8478.11068A
Abstract:
[Objective] To compare the clinical outcome of arthroscopic anterior cruciate ligament (ACL) reconstruction with two kinds of femoral side suspension fixation. [Methods] A retrospective research was done on 106 patients who received unilateral arthroscopic single-bundle ACL reconstruction with hamstring tendon autograft from June 2021 to June 2023. According to doctor-patient communication preoperatively, 46 patients had ACL reconstructed by using EndoButton fixed loop for femur side fixation, while other 60 patients were by using Rigidloop adjustable loop for femoral side fixation. The perioperative period, follow-up and imaging documents were compared between the two groups. [Results] There were no statistically significant differences in operation time, intraoperative blood loss, first time to ambulation, hospital stay, incision healing quality, incision healing time, and incidence of complications between the two groups (P＞0.05). All patients in both groups were followed up for more than 12 months, and there was no a significant difference in the time for recovery exercise between the two groups (P＞0.05). The IKDC score, Lysholm score and KT-1000 side to side difference were significantly improved over time in both groups (P＜0.05), whereas which proved not statistically significant between the two groups at any corresponding time points (P＞0.05). In terms of image, the anterior tibial displacement under anterior drawer stress was significantly declined with time in both groups (P＜0.05), which was no statistical significance between the two groups at any time points accordingly (P＞0.05). However, the EndoButton group had significantly greater inner diameter of the tibial tunnel than the Rigidloop group at 12 months after operation [(8.4±0.8) mm vs (7.9±0.6) mm, P＜0.05]. [Conclusion] Both the fixed loop and the adjustable loop fixation of the tendon graft femoral side in arthroscopic ACL reconstruction do achieve good and consistent short-term consequence, but the EndoButtonthe fixed loop for femoral side fixation has more obvious tibial tunnel enlargement than the Rigidloop adjustable loop.
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ZHU Tian-hao, HUANG Chang-ming, FAN Huaqiang, LIU Zhen- huang
2025,33(12):1096-1099, DOI: 10.20184/j.cnki.Issn1005-8478.11080A
Abstract:
Arthroscopic meniscus suture is a common operation, but improper operation can still damage blood vessels and nerves cause serious consequences. By reviewing the literature, this paper studied and summarized the risk factors, clinical manifestations, treatment and prevention methods of common neurovascular injuries in lateral meniscus suture. Although neurovascular injuries complicated in lateral meniscus suture are rarely seen, the operators should pay attention to preoperative planning, intraoperative prevention, and timely diagnosis and treatment after surgery to achieve a satisfactory prognosis, otherwise catastrophic consequences may result. In order to improve the understanding of neurovascular injury in lateral meniscus suture, this article summarizes the above contents.
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DING Xuan, NIE Yi-qiong, Lü Pai-yun, HU Chong, YAN Fang, DENG Nan-ling, XU Zhao-le, LI Qian
2025,33(12):1100-1105, DOI: 10.20184/j.cnki.Issn1005-8478.110424
Abstract:
[Objective] To introduce the surgical technique and preliminary clinical consequence of concurrent arthroscopic anterior cruciate ligament (ACL) reconstruction and posterolateral lateral tibial plateau fracture reduction. [Methods] From January 2019 to July 2021, 53 patients received abovesaid arthroscopic procedures for ACL tear complicated with posterolateral tibial plateau impacted fractures. Based on preoperative MRI classification, the arthroscopic ACL reconstruction and tibial plateau fracture reduction were performed. After the hamstring tendons were harvested to prepare a quadruple tendon graft, the femoral tunnel was established through the inferomedial portal, then ACL tibial tunnel was established, and the remaining ACL reconstruction procedure was finished in routine manner. Under the arthroscopy, the anterior cruciate ligament reconstruction tibial guide was located the collapsed fracture site, and the tibial tunnel was created to the subchondral bone with caution to avoid interference of previous tibial tunnel for ACL reconstruction. As proper articular surface reduction was observed under arthroscopy, bone autografts harvest from the ipsilateral ilium were filled and impacted into the bone tunnel to support and fixed the fracture. [Results] All the 53 patients had operation performed successfully without complications, whereas with the average operation time of (58.3±33.7) min, and were followed up for (14.3±2.8) months. All patients had the posterolateral tibial plateau fractures and reconstructed ACL healed well, with VAS score [(6.7±1.5), (1.3±0.7), P＜0.001], IKDC score [(52.6±6.3), (87.5±7.2), P＜0.001], as well as knee range of motion (ROM) and pivot shift phenomena improved significantly at the latest follow-up compared with those before surgery (P＜0.05). [Conclusion] The simultaneous arthroscopic posterolateral tibial plateau fracture reductionfixation and ACL reconstruction are simple and feasible techniques to treat the combined knee injury, do achieve satisfactory short-term clinical outcome.
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FU Yang- pan, LI Yu, HUANG Chang- ming, ZHANG Shao- zhan, FAN Hua-qiang, GAN Zhi-yong, HU Xi-chun, DONG Hui-xiang, ZHU Tian-hao, ZHANG Ya-qing
2025,33(12):1106-1110, DOI: 10.20184/j.cnki.Issn1005-8478.11090A
Abstract:
[Objective] To introduce the surgical technique and preliminary clinical results of surgical treatment for the irreducible knee dislocation (IKD). [Methods] From January 2015 to December 2023, 3 patients received first stage open reduction and second stage arthroscopic cruciate ligament reconstruction for IKD. In the first stage of surgery, manual reduction was initially attempted. If manual reduction failed, the medial side of the knee was incised to expose the medial collateral ligament, medial retinaculum, and Stieda fracture. After releasing the locked medial structures, the knee was reduced properly. As two anchors were placed on the medial femoral condyle, and the medial collateral ligament, medial retinaculum, and Stieda fracture were fixed to the medial femoral condyle. The ipsilateral semitendinosus tendon autograft could be used to reconstruct or augment the medial structures if necessary. After rehabilitation during the interval between the two-stage operations, arthroscopic ACL and PCL reconstructions were conducted in the second stage. The bone tunnels for PCL were created first, followed by those for ACL. Finally, the ACL was reconstructed by using contralateral hamstring tendons, while the PCL was reconstructed by an artificial ligament graft (LARS). [Results] All three patients had two-stage operations performed successfully without severe complications. Follow-up periods ranged from 12 to 20 months, with an average of (15.5 ± 3.3) months. Lysholm score increased from (47.0±1.3) preoperatively to (86.3±1.8) at the last follow-up (P＜0.05), IKDC2000 score increased from (48.1±1.8) to (85.0±1.2) (P＜ 0.05), KSS score from (45.0±1.5) to (88.0±1.1) (P＜0.05), and medial joint space width from (12.3±2.2) mm to (1.7±0.8) mm accordingly (P＜ 0.05). At the last follow-up, all 3 patients had mild anterior-posterior instability with axial shift test (-), anterio drawer test (-) and posterio drawer test (+). MRI confirmed the proper location of the bone tunnels. [Conclusion] The staged surgical treatment for IKD demonstrates satisfactory outcomes in terms of knee stability and functional recovery.
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LIU Chao, DAI Zhu, CHEN Dan, YANG Zhi-jun, LIU Jiang-hua, WU Biao, FAN Wei-jie
2025,33(12):1111-1115, DOI: 10.20184/j.cnki.Issn1005-8478.110328
Abstract:
[Objective] To present the surgical technique and preliminary outcomes of arthroscopic suture with double-tunnel suspension fixation of acute anterior cruciate ligament (ACL) rupture. [Methods] From January 2022 to January 2024, 12 patients with acute ACL injury were treated with the abovesaid technique. After successful anesthesia, arthroscopic examination was routinely performed. The ACL stump was knitted and sutured, and double bone tunnels were created from the anatomical sites the anteromedial and posterolateral bundles of the ACL on the lateral femoral condyle. The sutures were introduced through both tunnels to the outer cortex of the lateral condyle of the femur, the plate suture holes. Subsequently, the an Ethibond suture was introduced, which was passed through the anteromedial bone tunnel into the joint cavity, one end passes through the stump. At posterior drawer stress position with knee flexion of 30 degrees, the sutures were tighten over the suspension plate, until proper tensing on the ACL, finally the sutures were tied and secured. [Results] All patients had operation performed successfully without complications, and followed up for 12~24 months. The Lysholm [(49.7±6.7), (93.5±2.9), P＜ 0.001], IKDC [(50.8±5.2), (89.1±3.3), P＜0.001] and Tegner scores [(1.0±0.7), (5.3±1.1), P＜0.001] were significantly improved at the last follow-up compared with those before surgery. The MRI showed grade 1 ACL continuity in the12 patients, with grade 2 or above fibrosis signal intensity. [Conclusion] This arthroscopic suture with double-tunnel suspension fixation for acute ACL rupture is feasible technique with satisfactory preliminary consequence, however, the long-term outcomes need to observed further.
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DONG Hui- xiang, HUANG Chang-ming, ZHUANG Ao, FAN Hua- qiang, HU Xi- chun, FU Yang- pan, GAN Zhi-yong, LIU Zhen-huang, ZHU Tian-hao
2025,33(12):1116-1121, DOI: 10.20184/j.cnki.Issn1005-8478.11086A
Abstract:
[Objective] To investigate the surgical technique for treatment of re-ruptured anterior cruciate ligament (ACL) after primary reconstruction. [Methods] A total of 5 patients underwent revised ACL reconstruction combined with modified Lemaire surgery for reruptured ACL after primary reconstruction. The patient was placed in supine position, underwent arthroscopic examination to confirm the re-rupture of the reconstructed ACL. After the location and diameter of the inner apertures of the tunnels were investigated, the femoral and tibial bone tunnels were debrided. The hamstring tendon harvested contralaterally or peroneal longus tendon ipsilaterally was folded, and inserted into the hollow LARS ligament to prepare the graft with diameter at least 1~2 mm larger than the previous graft. The graft was introduced into the tunnels and the joint cavity and fixed with metal interference screws respectively in proper tension. Subsequently, the modified Lemaire surgery is performed. A 6-8cm skin incision was made along the line between Gerdy's tubercle and the lateral epicondyle of the femur, and the iliotibial band (ITB) was cut to form a bundle 8-10cm in length and 1cm in width with intact attachment on Gerdy tubercle at the distal end, while the free proximal end stitched. The free end of ITB bundle was passed under the lateral collateral ligament, introduced into the bone tunnel on femoral insertion of anterolateral ligament (ALL) and fastened with interference screw in proper tension. [Results] All the 5 patients were operated on successfully with operation time of (90.2±30.1) min, intraoperative bleeding of (50.2±30.1) mL, and got incision healed well, without serious complications, such as infection, vascular and nerve injury. Twelve months after revision surgery, 3 patients returned to sports activity, and 2 patients did not regain the sports capacity, and 1 patient had a slight knee snap. According to the modified HSS score, the clinical results were marked as excellent in 4 and good in 1 patient 12 months after surgery. After operation, Kneelax 3 measured the bilateral difference of anteriorposterior displacement ≤2 mm. [Conclusion] ACL revision reconstruction combined with modified Lemaire surgery does effectively restore knee anteroposterior stability, improve rotational stability, reduce graft re-failure chance, and achieve satisfactory function for failed ACL reconstruction with high risk.
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WANG Yu, YANG Jiu- shan, JING Li- zhong, WANG Shao-shan, LI Shu-xin
2025,33(12):1122-1125, DOI: 10.20184/j.cnki.Issn1005-8478.110341
Abstract:
[Objective] To introduce the surgical technique and preliminary clinical results of collagen protein cartilage scaffold for repairing knee cartilage injuries. [Methods] Two patients underwent abovesaid surgical operation. As routine anteromedial and anterolateral portals were created, arthroscopic examination was conducted with debridement of hyperplastic synovial around the lesion, and microfracture was performed in the grade IV cartilage defect area under arthroscopy. After drying the joint cavity by suctioning intra-articular fluid, the prepared collagen protein cartilage scaffold was injected and filled into the cartilage defect area. [Results] Both patients recovered normal activities 3 months postoperatively, with maximum flexion of 130°, Lysholm scores of 83~85, the IKDC 2000 scores of 79~83 and pain VAS score of 0. [Conclusion] The cartilage defect in the two patients are repaired effectively, with improved limb function and symptom relief, achieve satisfactory preliminary outcomes.
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GAN Zhi-yong, HUANG Chang-ming, FAN Hua-qiang, FU Yang-pan, DONG Hui-xiang, HU Xi-chun, LIU Zhen-huang, ZHU Tian-hao, ZHANG Ya-qing
2025,33(12):1126-1130, DOI: 10.20184/j.cnki.Issn1005-8478.11092A
Abstract:
[Objective] To introduce the surgical technique and preliminary clinical outcome of remnant-preservation posterior cruciate ligament (PCL) reconstruction with Ligament Augmentation and Reconstruction System (LARS) under arthroscopy. [Methods] The patient was placed in a supine position after combined lumbar and epidural anesthesia, and then the anteromedial (AM), anterolateral (AL) and transpatellar (TP) portals were established for arthroscopic observation and instrument operation. The proliferative synovial tissue posterior to the PCL were debrided, whereas the PCL remnant was preserved properly, and the PCL tibial insertion and posterior meniscofemoral ligament in the posterior compartment were exposed. The PCL tibial locator was inserted into the posterior compartment by medial side of the ACL through the anteromedial portal. Its tip was fitted 2cm below the tibial platform, on the anatomic PCL attachment. After the tibial bone tunnel was created, a wire loop was introduced into the tunnel and pulled out through the anteromedial porta for next step use. The femoral bone tunnel was made outside-in at 8 mm above the articular cartilage and 12 mm away from the femoral intercondylar line. Another wire loop was introduced into the femoral tunnel and pulled out through the anteromedial portal. The two ends of the LARS graft were pulled into the joint cavity with both wire loops, and then pulled both ends out external apertures of the femoral and tibial tunnel, respectively. Under proper tension, the graft was fastened on the femoral and tibial sides with interference screws to accomplish PCL reconstruction. [Results] All the 21 patients were operated on successfully and followed up from 12 months to 25 months. The Lysholm score [(35.2±6.0), (88.7±4.2), P＜0.001] and IKDC score [(33.1±7.1), (89.4±4.1), P＜0.001] were significantly improved 12 months after surgery compared with those preoperatively. [Conclusion] Arthroscopic remnant-preservation reconstruction of posterior cruciate ligament with LARS graft via intercondylar fossa is a feasible technique and has good clinical consequence.
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ZHU Tian-haoa, LIN Jiankunb, HUANG Chang- minga, FAN Hua- qianga, FU Yang- pana, GAN Zhi- yonga, LIU Zhen- huanga
2025,33(12):1131-1135, DOI: 10.20184/j.cnki.Issn1005-8478.11091A
Abstract:
[Objective] To introduce the surgical technique and preliminary clinical results of reconstruction of posterior cruciate ligament after tibial intramedullary nail fixation. [Methods] A patients underwent abovesaid surgical operation. Before operation, the type of tibial fracture and the degree of PCL fracture were determined by CT 3D and MRI, and the PCL tibial tunnel was measured and per-performed on CT 3D images. During the operation, PCL tibial tunnel was drilled according to the preoperative measurement data. After the tunnel was drilled, it was examined whether there was a convergence between the two. If there was a convergence, a locking screw was placed in another position, if not the screw was re-inserted. Attention should be paid to locking tail cap of the intramedullary nail during the operation to avoid leakage of lavage fluid. [Results] The patient had PCL reconstructed successfully without significant complications during and after operation. IKDC score increased from 43 before surgery to 59 at 4 months after surgery, Lysholm score increased from 27 before surgery to 87 at 4 months after surgery, and VAS score decreased from 7 before surgery to 2 at 4 months after surgery. [Conclusion] When tibia fracture is combined with ipsilateral PCL rupture, PCL can be reconstructed early according to the above surgical methods, which is a safe and effective surgical method.
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WANG He-yun, LUO Liu-ning, LING Fei-qun, WANG Yi-qing, LIANG Ming, XU Xiao-yong, QIN Xi-huan, Lü Tian
2025,33(12):1136-1139, DOI: 10.20184/j.cnki.Issn1005-8478.110136
Abstract:
[Objective] To evaluate the clinical outcome of arthroscopic single-bundle reconstruction of anterior cruciate ligament (ACL) and meniscus suture in the treatment of ACL rupture complicated with medial meniscus buck-handle tear (BHT). [Methods] A retrospective research was done on 38 patients had ACL rupture combined with medial meniscus BHT treated surgically by abovementioned technique from May 2017 to May 2020. The clinical and imaging data were evaluated. [Results] All the patients had operation performed successfully without any serious complications such as vascular and nerve injury, whereas with the average operation time of (93.0±35.6) min, and were followed up for (2.0±0.4) years in a mean. Compared with those preoperatively, the VAS score [(6.4±1.8), (0.4±0.6), P＜ 0.001], and 2000 IKDC score [(37.0±20.3), (94.3±4.8), P＜0.001], Lysholm score [(41.7±23.8), (95.0±3.9), P＜0.001], knee extension-flexion range of motion (ROM) [(97.7±28.5)°, (130.8±11.0)°, P＜0.001] were significantly improved at the latest follow-up. In addition, the anterior drawer test [1+/2+/3+, (0/0/21/17), (38/0/0/0), P＜0.001], Lachman tests [1+/2+/3+, (0/0/21/17), (38/0/0/0), P＜0.001], pivot shift test [negative/weakly positive/positive, (21/9/8), (0/38/0), P＜0.001] were significantly improved correspondingly. The second arthroscopic look 2 years after operation revealed the meniscus completely healed in 18 cases (47.3%), partially healed in 12 cases (31.6%), and not healed in 8 cases (21.1%). [Conclusion] The arthroscopic single-bundle ACL reconstruction and meniscus suture do alleviate knee pain and improve knee function for ACL rupture complicated with medial meniscus buck-handle tear, with meniscus healed completely or partially in 30 of 38 cases.
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WANG Zhixianga, LAI Jian-hongb, LIN Yong-feia, ZHONG Hong-faa, HE Xiang-zhonga, ZHONG Liang-yua, LI Bing
2025,33(12):1140-1144, DOI: 10.20184/j.cnki.Issn1005-8478.11073A
Abstract:
[Objective] To evaluate the clinical efficacy of arthroscopic suture combined with Tightrope fixation for posterior cruciate ligament (PCL) tibial avulsion fracture. [Methods] A retrospective study was conducted on 26 patients who had PCL tibial avulsion fracture fixed with arthroscopic suture combined with Tightrope from January 2020 to June 2023. The clinical and imaging data were evaluated. [Results] All the 26 patients were operated on successfully with operation time of (68.3±10.2) min, the blood loss of (26.0±7.4) mL, the incision length of (5.1±0.5) cm, and the hospital stay of (4.2±0.4) days. All of them were followed up for more than 12 months, with an average of (14.8±1.9) months. Compared with those preoperatively, the IKDC, Lysholm, VAS scores and knee range of motion significantly improved at the last follow-up (P＜0.05). As for imaging, the tibial posterior displacement under posterior drawer stress was significantly reduced [(8.7± 1.1) mm, (1.3±0.3) mm, P＜0.001]. [Conclusion] Arthroscopic suture combined with Tightrope fixation for PCL tibial avulsion fracture has advantages of minimal invasive surgery and better functional recovery, and achieves satisfactory short-term clinical consequence.
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ZHANG Ya-qing, FU Yang-pan, ZHU Tian-hao, WAN Xiao-mei, ZHANG Ya-zhen, LIN Xue-jin, PENG Hong, HUANG Chang-ming
2025,33(12):1145-1148, DOI: 10.20184/j.cnki.Issn1005-8478.11088A
Abstract:
[Objective] To review the consequence of arthroscopic release and progressive rehabilitation for knee ankylosis secondary to cruciate ligament reconstruction. [Methods] From January 2020 to December 2023, 201 patients received arthroscopic knee cruciate ligament reconstruction in our hospital. Among them, 16 patients developed knee stiffness, underwent revision arthroscopic release, and progressive rehabilitation, involving continuous passive motion (CPM), active closed chain and open chain knee excises on the basis of adequate analgesia. The clinical data of the 16 patients were evaluated. [Results] All the 16 patients underwent arthroscopic release smoothly without iatrogenic fracture, whereas with operative time of (60.5±10.5) min and blood loss of (50.0±8.8) mL. As time elapsed preoperatively, 1 month postoperatively and last follow-up lasted for (15.0±3.5) months, the knee ROM [(102.0±1.2), (120.4±4.4), (134.0±1.5), P＜0.001], VAS score [(4.0±0.5), (3.6±0.6), (1.2±0.2), P＜0.001], Lysholm score [(43.0±1.6), (73.4±1.8), (88.3±1.9), P＜0.001], IKDC scores [(47.5± 1.8), (69.3±2.0), (86.2±1.4), P＜0.001] and KSS score [(44.0±1.8), (73.7±1.8), (88.0±1.5), P＜0.001] were significantly improved. [Conclusion] Arthroscopic release and progressive rehabilitation exercise do effectively treat knee adhesion after cruciate ligament reconstruction and achieve satisfactory functional recovery.
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ZHANG Ya- zhen, ZHANG Ya-qing, FU Yang-pan, WAN Xiao-mei, ZHU Sha, HUANG Chang-ming
2025,33(12):1149-1152, DOI: 10.20184/j.cnki.Issn1005-8478.11089A
Abstract:
[Objective] To evaluate the clinical outcome of individualized phased rehabilitation for one-stage repair and reconstruction of multi-ligamentous knee injuries (MLKI). [Methods] A retrospective study was performed on 20 patients who admitted into our department for MLKI from January 2016 to December 2023. All of whom received one-stage surgical repair and reconstruction, followed by personalized phased rehabilitation. The clinical data of the patients were evaluated. [Results] All patients were operated on successfully. Among 20 patients, 10 patients were of ACL/PCL/MCL combined injuries, 6 of ACL/PCL/PLC combined injuries, 3 of ACL/MCL combined injuries and 1 of PCL/PLC injuries. Regarding surgical treatment, ACL repair was performed in 1 case, ACL reconstruction in 18, PCL repair in 1, PCL reconstruction in 16, PMC repair in 11, PMC reconstruction in 2, PLC repair in 1 and PLC reconstruction in 6 cases. As time elapsed preoperatively, 1 month after operation and the last follow-up, knee ROM [(76.0±2.6)°, (79.2±2.2)°, (130.0±2.5)°, P＜0.001], VAS score [(5.0±0.5), (4.2±0.4), (1.1±0.2), P＜0.001], Lysholm score [(38.0±1.8), (42.0±2.3), (87.2±2.9), P＜0.001], IKDC scores [(42.2±1.9), (45.3±2.4), (87.4±1.8), P＜0.001] and KSS score [(40.0±1.9), (43.3±1.7), (87.0±1.8), P＜0.001] were significantly improved. During the followup, none of the patients had revision surgery. [Conclusion] After the onestage repair and reconstruction of MLKI, individualized stage rehabilitation according to the actual situation of patients does effectively improve the consequence and reduce the occurrence of postoperative knee dysfunction.
