To fix the ligaments, tendons or other transplantation materials by passing through bone channels was commonly used and a relialde method in the reconstruction of joint stability. Usually an additional incision was necessary on the side of the outlet of the bone channel, that the screws, plates or U-shaped staple could be applied. An instrument was designed that the steel miniplate could be fixed to the bone by noninvasive method. This technique was applied in 20 cases in which anterior cruciate ligament in 14, posterior cruciate ligament in 4, and collateral ligaments in 2 with carbon fibers. The result was successful in all patients. It was shown that it gave simple manipulation, reliable fixation and no need to have an additional incision, and it could lessen patients’ suffering and lead to satisfactory clinical result.
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.
Objective To investigate the method and short-term effectiveness of arthroscopic reconstruction of anterior cruciate l igament (ACL) using RetroButton-allogeneic tendon-interference screw. Methods Between June 2009 and October 2009, 23 patients with ACL rupture were treated by arthroscopic reconstruction with RetroButton-allogeneic tendon-interference screw. There were 15 males and 8 females with an average age of 32.5 years (range, 19-46 years), including 17 left knees and 6 right knees. The injury causes were sport trauma (13 cases), traffic accident (8 cases), and fall ing injury(2 cases). There were 7 acute cases (lt; 6 weeks) and 16 chronic cases (gt; 6 weeks). Among the cases, 11 cases compl icated by medial meniscus injury, 6 by lateral meniscus injury, 3 by the both injuries, and 5 by articular cartilage injury. All cases had no injuries of posterior cruciate l igament, medial or lateral collateral l igament, or posterolateral structure. The time from injury to operation ranged from 3 weeks to 32 months. Lysholm and International Knee Documentation Committee (IKDC) scores were used for subjective evaluation, while Lachman test and KT-1000 measurement for objective evaluation. Results All wounds healed by first intention. The symptoms of unstable knee were improved obviously. No high fever, infection, or immunologic rejection were observed. Refractoriness synovitis and joint effusion occurred in 1 case after operation, and was improved after articular cavity flushing for 7 times within 3 weeks. All cases were followed up 10-17 months (mean, 14.7 months). There were significant differences in Lysholm score, IKDC score, Lachman test, and KT-1000 measurement between pre-operation and last follow-up (P lt; 0.05). Conclusion Arthroscopic reconstruction of ACL with RetroButton-allogeneic tendon-interferencescrew is simple and safe, and its short-term effectiveness is satisfactory.
ObjectiveTo discuss whether human amniotic mesenchymal stem cells (hAMSCs) possesses the characteristic of mesenchymal stem cells, and could differentiate into ligament cells in vitro after induction. MethodsThe hAMSCs were separated through enzyme digestion, and the phenotypic characteristics of hAMSCs were tested through flow cytometry. The cells at passage 3 were cultured with L-DMEM/F12 medium containing transforming growth factor β1 (TGF-β1)+basic fibroblast growth factor (bFGF) (group A), containing hyaluronic acid (HA) (group B), containing TGF-β1+bFGF+HA (group C), and simple L-DMEM/F12 medium (group D) as control group. The morphology changes of cells in each group were observed by inverted phase contrast microscope at 21 days after induction; the cellular activities and proliferation were examined by sulforhodamine (SRB) colorimetric method; and specific mRNA and protein expressions of ligament including collagen type I, collagen type III, and tenascin C (TNC) were measured by real-time fluorescence quantitative PCR and immunohistochemical staining. ResultsThe flow cytometry result indicated that hAMSCs expressed mesenchymal stem cell phenotype. After 21 days of induction, the cells in groups A, B, and C grew like spindle-shaped fibroblasts under inverted phase contrast microscope, and cells showed single shape, obvious directivity, and compact arrangement in group C. The SRB result indicated that the cells in each group reached the peak of growth curve at 6 days; the cellular activities of groups A, B, and C were significantly higher than that of group D at 6 days after induction. Also, the immunohistochemical staining results showed that no expressions of TNC were detected in 4 groups at 7 days; expressions of collagen type I in groups A, B, and C were significantly higher than that in group D at 7, 14, and 21 days (P<0.001); the expressions of collagen type III in groups A, B, and C were significantly higher than that in group D at 14 and 21 days (P<0.001). There was an increasing tendency with time in collagen type I of group B, in collagen type III and TNC of groups A and C, showing significant difference among different time points (P<0.001). The real-time fluorescence quantitative PCR results revealed that the mRNA expressions of collagen type I and TNC in group C were significantly higher than those in groups A and B (P<0.05), and the mRNA expression of collagen type III in group B were significantly higher than that in groups A and C at 21 days (P<0.05). The mRNA expressions of collagen type I and TNC in groups A and C and mRNA expression of collagen type III in group C had an increasing tendency with time, showing significant difference among different time points (P<0.001). ConclusionThe hAMSCs possesses the characteristics of mesenchymal stem cells and excellent proliferation capacity. After in vitro induction, the expressions of ligament specific genes can be up-regulated and the synthesis of ligament specific proteins can be also strengthened. As a result, it can be used as one of ligament tissue engineering seed cell sources.
ObjectiveTo explore the feasibility of Lisfranc ligament reconstruction with autogenous tendon through biomechanical testing. MethodsTwelve fresh-frozen cadaveric lower limbs were prepared three sequential testing conditions:intact Lisfranc ligament (intact group), disrupted Lisfranc ligament (disrupted group), and Lisfranc ligament reconstruction (reconstruction group). Under fixing on the Bose mechanical test machine, three models were given 0-600 N axial loading in the neutral position and the plantar flexion of 30° according to the speed of 10 N/s, every 100 N load with a 1-minute interval. The medial cuneiform (C1) and the second metatarsal (M2) base displacement and the foot transverse arch height were recorded under different loads. ResultsIn the neutral position and the plantar flexion of 30°, C1-M2 displacement and foot transverse arch height showed an increasing trend with increased load under 0-600 N axial loading. There were significant differences in C1-M2 displacement variation in 2 positions among groups (P＜0.05). In disrupted group, the C1-M2 displacement variation in neutral position was significantly lower than that in plantar flexion of 30° (t=7.392,P=0.000). In the neutral position, the foot transverse arch height variation in the disrupted group and the reconstruction group was significantly higher than that in the intact group (P＜0.05), but there was no significant difference between the disrupted group and reconstruction group (P>0.05). ConclusionLisfranc ligament reconstruction with autogenous tendon can reduce the C1-M2 displacement variation and stabilize Lisfranc joint to a certain degree. Reconstruction of both dorsal ligament and Lisfranc ligament will not improve the buffering capacity. The C1-M2 displacement variation in the plantar flexion of 30° is more obvious than that in neutral position, so it is helpful to improve clinical diagnosis of occult Lisfranc damage.
Objective To evaluate the clinical results of bioabsorbable interference screw in knee ligament reconstruction. Methods From April 2002 to August 2004, 39 patients with knee ligament injury were treated, including 33 males and6 females with a median age of 25 years (15 to 65 years). The involved ligament included 29 anterior cruciate ligament of knee(ACL), 6 posterior cruciate ligament of knee(PCL)，4 combined ACL and PCL, 3 medial collateral or lateral collateral ligaments of knee point and 1 posterolateral complex injury of knee. All of patients underwent anatomic ligament reconstructions under arthroscopy or open surgery by autografts and fixation with bioabsorbable interference screw. Results All 34 patients were followed up 6 to 28 months (mean 13.7months). The patients were evaluated by Lysholm knee functional scales, the knee scores were 43.6±13.4 before operation and 85.4±16.3 after operation, showing significant difference (Plt;0.05). There was no limitation of rangeof motion and loosening of the screw. However, one case suffered from infection, and 3 cases suffered from effusion and synovitis after surgery and recovered after management. Conclusion Bioabsorbable interference screw fixation is a reliable method in knee ligament reconstruction and is effective to restore knee joint stability.
【Abstract】 Objective To investigate the effect of the volar capsular l igament complex on stabil ity of the wrist jointand to provide basic biomechanical theoretical criteria for cl inic appl ication of the external fixator. Methods Nine upperl imbs specimens (left 6, right 3) were taken from fresh adult cadavers to make wrist joint-bone capsular l igament complex specimens. Firstly, soft tissues of forearms and hands were resected and capsular membranes and l igaments were reserved to make the bone-articular l igament complex (normal specimen). Secondly, the volar capsular l igament complex was cut off from radial malleolus to ulnar malleolus (impaired specimen). Thirdly, the impaired volar capsular l igament complex was interruptedly sutured by the use of 4# suture silk (repaired specimen). To simulate cl inical operation with external fixator, the biomechanical test was done according to the sequence (normal, impaired, repaired, repaired and fixed, impaired and fixed). Statistical significance was analyzed through selected loads at the three different shifts (1.5, 2.0, 2.5 cm). Results According to the sequence (normal, impaired, repaired, repaired and fixed, impaired and fixed), when the shift was 1.5 cm, the different respective loads were (60.74 ± 20.60), (35.23 ± 13.88), (44.36 ± 20.78), (168.40 ± 29.21) and (139.00 ± 33.18) N, respectively. When the shift was 2.0 cm, the different loads were (138.46 ± 12.93), (87.17 ± 24.22), (97.52 ± 23.29), (289.00 ± 54.29) and (257.98 ± 55.74) N, respectively. When the shift was 2.5 cm, the different loads were (312.87 ± 37.15), (198.16 ± 37.14), (225.66 ± 30.96), (543.15 ± 74.33) and (450.35 ± 29.38) N, respectively. There was no statistically significant difference between the impaired and repaired specimens (P gt; 0.05). Similarly, there was statistically significant difference among the rest specimens (P lt; 0.05). The same statistical results were obtained when the two different shifts were compared. There was statistically significant difference at the three different shifts for the same specimen (P lt; 0.05). Conclusion Volar capsular l igament complex is an important anatomic structure to keep stabil ity of the wrist joint. The carpal instabil ity arises out of the injured complex. Repairing the injured complex only can not immediately restore stabil ity of the wrist joint. The external fixator can effectively help to diminish the relative shift of the impaired capsular l igament complex, to reduce the load of the repaired complex and to protect the complex accordingly. The device plays an important role in maintaining stabil ity of the wrist joint.
Objective The anterior cruciate l igament (ACL) is the important stable structure of the knee. To evaluate the method and outcome of bone-ACL-bone (B-ACL-B) allograft under arthroscope in reconstruction of ACL. Methods Between October 2007 and February 2010, arthroscopic ACL reconstruction with deep-freezing B-ACL-B allograft was performed on 22 patients with ACL ruptures. There were 15 males and 7 females with an average age of 27.6 years (range, 19-55 years). The causes of ACL rupture were sport trauma in 12 cases, fall ing injury in 1 case, heavy crush in 2 cases, and traffic accident in 7 cases. The locations were the left knee in 14 cases and the right knee in 8 cases. The disease durationwas 7 days to 12 months (median, 65 days). Nineteen patients showed the positive results of anterior drawer test and pivot shift test, and 21 patients showed the positive results of Lachman test. According to International Knee Documentation Committee (IKDC) criteria, there were 5 abnormal and 17 severely abnormal. The subjective IKDC score was 49.6 ± 6.9. The Lysholm score was 48.5 ± 5.3. The Tegner scale scores were 6.8 ± 1.2 before injury and 2.1 ± 0.5 before operation. The MRI showed the ACL injuries in 18 of 20 patients. Results The mean operative time was 75 minutes (range, 65-85 minutes); the mean blood loss was 110 mL (range, 80-150 mL). All incisions healed by first intention. No immunologic rejection and deep vein thrombosis of lower l imbs occurred. All patients were followed up 7-34 months (mean, 18 months). At last follow-up, the flexion of the knee ranged from 125 to 135° (mean, 130.5°). Two patients showed the positive results of anterior drawer test, 1 patient showed the positive result of pivot shift test, and 3 patients showed the positive results of Lachman test. According to the IKDC criteria, 10 patients rated as normal, 11 patients as nearly normal, 1 patient as abnormal. The subjective IKDC score was 90.0 ± 5.8, showing significant difference when compared with preoperative one (t=4.653, P=0.021). The Lysholm score was 91.6 ± 7.1, showing significant difference when compared with preoperative one (t=4.231, P=0.028). The Tegner scale score was 6.1 ± 1.5, showing no significant difference when compared with one before injury (t=1.321, P=0.070) and showing significant difference when compared preoperative one (t=3.815, P=0.033). The arthroscopic examination showed no rupture of grafts in 19 patients, 17 grafts showed normal tension, and 2 showed sl ight relaxation at 6 months after operation. Conclusion Reconstruction of the ACL with B-ACL-B allograft under arthroscope is a safe and effective method, which can anatomically reconstruct ACL and obtain a good recovery of the knee function after operation.
Objective To investigate the cl inical outcome of treating dorsal wrist gangl ion with an improved surgical strategy by excising the gangl ion completely along their stalk and repairing the dorsal carpal l igaments under brachial anesthesia. Methods From March 2005 to January 2007, 34 patients with dorsal wrist gangl ion were treated and studied retrospectively. There were 14 males and 20 females, aged 25-65 years (43 years on average). The left sides were involved in 22 cases and right sides in 12 cases. Thirteen cases of relapse received excision for 1 to 4 times under local anesthesia, with amean period of 17 months (14 days to 7 years) from excision to recurrence. Twenty-one patients were first attack cases with a mean period of 11 months (15 days to 8 years) from diagnosis to excision. The size of the gangl ion ranged from 1.5 cm × 1.2 cm to 4.5 cm × 4.0 cm. Now, each surgical process was performed under brachial anesthesia, and a pneumathode tourniquet was used. In 6 patients, the stalks of gangl ion did not invade the carpal l igaments, and gangl ion was removed completely without immobil ization after operation. In 28 patients, the stalks of gangl ion invaded the carpal l igaments, gangl ion was excised completely along its stalk to the dorsal carpal structure; the l igaments were sutured directly in 16 cases and were repaired with adjacent tissue such as the wall of sheathing canal of extensor tendon in 12 cases. The wrists were immobil ised for 3 weeks. Results Primary wound heal ing was achieved in all incisions. All patients were followed up for 26-36 months with an average of 31.5 months. Only 2 cases (5.9%) recurred. The range of motion of the wrist remained normal and the symptom of the dorsal wrist was rel ieved sl ightly. Patients’ satisfaction score ranged from 60 to 100, with an average of 83.8. Conclusion The gangl ion should be excised completely together with defect repair of dorsal carpal l igament under brachial anesthesia and the wrist immobil ised for 3 weeks, the recurrence rate will be reduced greatly.