OBJECTIVE: Extension stiffness of knee joint is always treated by the quadricepsplasty, but the main deficiency of this method is that patient feels weakness of lower limb and easily kneels down. The aim of this article is to explore the method to resolve the complications after quadricepsplasty. METHODS: Since 1978 to 1997, on the basis of traditional procedures of quadricepsplasty, sartorius muscle was used to reinforce the extension of knee joint. The lower 2/3 of sartorius muscle was fully dissociated only with its insertion intact. A tendon-periosteal-bone flap, about 2 cm in width, was managed on the anterior surface of patella, with its pedicle on the medial edge of patella. The tendon-periosteal-bone flap was used to fix the dissociated sartorious into patella to reinforce the extension of knee joint. The very lower part of sartorius was mainly aponeurosis, with the help of an aponeurosis bundle of iliotibial tract, it was fixed into the insertion of patellar ligament, through a bony tunnel chiseled adjacent to the insertion of patellar ligament. By now the movement of knee joint extension was strengthened by the transferred sartorius muscle. Postoperatively, every patient was required to extend and flex knee joint actively and/or passively. Altogether 12 patients were treated, 9 of them were followed up with an average of 14 months. RESULTS: The average movement was increased from 15 degrees to 102 degrees, and the average myodynamia was improved from grade II to grade IV. CONCLUSION: Traditional quadricepsplasty co-operated with transfer of sartorius muscle can strengthen the myodynamia of knee joint extension. It is simple method and can really achieve good function.
ObjectiveTo investigate the mid-term effectiveness of three‐dimensional (3D) printed osteotomy guide plate and personalized prosthesis in knee‐preserving tumor resection. Methods The clinical data of 12 patients who underwent knee‐preserving tumor resection and reconstruction with 3D printed osteotomy guide plate and personalized prosthesis between September 2016 and October 2018 were retrospectively analyzed. There were 7 males and 5 females. The age ranged from 7 to 59 years, with a median of 44.5 years. There were 11 cases of osteosarcoma and 1 case of fibrosarcoma, all of which were Enneking grade ⅡB. The distance from the tumor to the joint surface was 5.5-8.2 cm, with an average of 6.94 cm. Incision healing, tumor recurrence, periprosthetic fracture, and aseptic loosening were observed after operation. The Musculoskeletal Tumor Society (MSTS) scoring system was used to evaluate the function of the patients, and the knee flexion range of motion was measured. ResultsThe 12 patients were followed up 41-66 months, with an average of 54.5 months. The length of osteotomy ranged from 14 to 26 cm, with an average of 22.08 cm. Except for 2 patients with superficial infection of incision tissue, no deep infection involving the prosthesis occurred, no patient underwent revision surgery because of prosthesis infection. During the follow-up, local recurrence occurred in 2 cases and distant metastasis occurred in 3 cases. The overall disease-free survival rate was 58.3%. Two patients died of lung metastasis, and the overall survival rate was 83.3%. One patient underwent amputation due to local recurrence, and 1 patient underwent total knee arthroplasty due to prosthesis rupture. No aseptic loosening of the prosthesis and periprosthetic fracture occurred during the follow-up, and the overall prosthesis survival rate was 83.3%. At last follow-up, 10 patients obtained satisfactory knee flexion range of motion that ranged from 95° to 125°, with an average of 110°. Two children could not cooperate with early rehabilitation treatment due to pain, and the knee flexion range of motion was not ideal (50°, 75°). All patients achieved acceptable lower limb function with MSTS scores ranged from 26 to 30, with an average of 28. All patients walked without crutches. ConclusionThe treatment of malignant bone tumors around the knee joint with 3D printed osteotomy guide plate and personalized prosthesis can preserve the articular surface, obtain good limb function, reduce the risk of aseptic loosening of prosthesis, and achieve better mid-term effectiveness.
ObjectiveTo explore the correlation between the degree of bone marrow edema (BME) and the content change of tumor necrosis factor α (TNF-α) and matrix metalloproteinase 3 (MMP-3) and the knee pain symptoms in patients with bone contusion around the knee joint. MethodsThirty patients (30 knees) of bone contusion around the knee joint were chosen as the trial group between October 2009 and April 2012. According to visual analogue scale (VAS), 30 patients were divided into mild group (10 cases), moderate group (10 cases), and severe group (10 cases); according to MRI morphological changes, the patients were divided into type I group (12 cases), type Ⅱ group (11 cases), and type Ⅲ group (7 cases). Ten patients (10 knees) with soft tissue injury of the knee were chosen as control group. No significant difference was found (P>0.05) in gender, age, causes, side, and admission time after injury between 2 groups. The serum contents of MMP-3 and TNF-α were detected and statistically analysed between different degrees of pain groups and between different degrees of BME groups. Correlation was analysed between BME and inflammatory factor changes and VAS score. ResultsThe MMP-3 and TNF-α contents in trial group[(29.580±6.870) μg/L and (23.750±7.096) ng/L] were significantly higher than those in control group[(8.219±1.355) μg/L and (6.485±1.168) ng/L](t=9.686, P=0.000; t=7.596, P=0.000). The MMP-3 and TNF-α contents in patients with different degrees of pain and BME were significantly higher than those in patients of control group (P<0.05), and significant difference was found between patients with different degrees of pain (P<0.05), but no significant difference between patients with different degrees of BME (P>0.05). Multiple linear regression analysis showed that TNF-α content was significantly correlated with VAS score (P=0.000). ConclusionKnee pain symptoms are not related to the degree of BME in patients with bone contusion around the knee joint. Inflammatory factor TNF-α content is the main influence factor of knee joint pain symptoms.
Objective To summarize the clinical characteristics of foot and ankle deformities combined with knee and lower limb deformities and evaluate the advantages, clinical outcomes, and considerations of QIN Sihe’s surgical strategy for treating such complex deformities. Methods Between January 2022 and December 2024, 32 patients with foot and ankle deformities combined with knee and lower limb deformities were enrolled. The cohort included 23 males and 9 females, aged 10-67 years (mean, 41.1 years). The main etiologies included post-polio sequelae (20 cases) and congenital limb deformities (3 cases). Deformities were categorized as follows: equinovarus foot (12 cases), equinus foot (2 cases), equinovalgus foot (3 cases), equinus foot with swan-neck deformity (2 cases), calcaneus foot (5 cases), foot valgus (2 cases), knee flexion deformity (14 cases), genu recurvatum (4 cases), genu varum (3 cases), genu valgum (3 cases), lower limb shortening (3 cases), and lower limb external rotation (6 cases). QIN Sihe’s surgical strategies included osteotomies, tendon releases, and tendon transfers for deformity correction, followed by external fixation for residual deformity adjustment and stabilization. Outcomes were assessed using QIN Sihe’s Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction. Results All patients were followed up 8-32 months (mean, 16.5 months). Complications included pin tract infection (1 case, 1 site), ankle pain (2 cases), delayed healing at the proximal tibial osteotomy site (1 case), and anterior talar dislocation (1 case). At last follow-up, insufficient correction of foot deformity was observed in 1 case; both knee and lower limb deformities were corrected, with only mild recurrence of knee flexion deformity in 1 case. The foot/ankle and knee joint function improved. Based on QIN Sihe’s Postoperative Evaluation Criteria for Lower Limb (Foot and Ankle) Deformity Correction and Functional Reconstruction, outcomes were rated as excellent in 30 cases and good in 2 cases, with an excellent-good rate of 100%. Conclusion Foot and ankle deformities combined with knee and lower limb deformities are complex, QIN Sihe’s surgical strategy can achieve satisfactory clinical outcomes for simultaneous correction.
ObjectiveTo investigate the effect of body mass index (BMI) on the short- and medium-term effectiveness of unicompartmental knee arthroplasty (UKA) in the treatment of anterior medial compartmental osteoarthritis of knee joint.MethodsThe clinical data of 55 patients (61 knees) with anterior medial compartmental osteoarthritis of knee joint treated with minimally invasive UKA between May 2014 and May 2019 were retrospectively analyzed. According to BMI, the patients were divided into 3 groups: normal body mass group [group A, BMI 18.50-24.99 kg/m2, 23 cases (25 knees)], overweight group [group B, BMI 25.00-29.99 kg/m2, 23 cases (25 knees)], obesity group [group C, BMI 30.00-39.99 kg/m2, 9 cases (11 knees)]. There was no significant difference in gender, age, sides, disease duration, and preoperative American Special Surgery Hospital (HSS) score, pain visual analogue scale (VAS) score, and knee range of motion (ROM) among 3 groups (P>0.05). The operation time, intraoperative dominant blood loss, and the postoperative decreased amount of hemoglobin at 1 week were recorded and compared among 3 groups. The HSS score, VAS score, and ROM were used to evaluate the knee function and pain improvement.ResultsThere was no significant difference in the operation time, the intraoperative dominant blood loss, and the postoperative decreased amount of hemoglobin at 1 week among 3 groups (P>0.05). All the 55 patients were followed up 5-60 months, with an average of 24 months. No complication such as infection, fat embolism, or deep venous thrombosis of lower extremity occurred after operation. The anteroposterior and lateral X-ray films of the knee joint showed that no dislocation or loosening of the prosthesis occurred and the position of the prosthesis was good. At last follow-up, the HSS score, VAS score, and ROM of the 3 groups were significantly improved when compared with preoperative ones (P<0.05); but there was no significant difference among 3 groups (P>0.05).ConclusionFor obese and overweight patients with anterior medial compartmental osteoarthritis of the knee joint, the use of minimally invasive UKA can achieve satisfactory short- and medium-term effectiveness, and the long-term effectiveness needs further follow-up.
Objective To design a new custom-made artificial semi-knee joint based on rapid prototyping(RP) technique and to explore a method to solve necroses of allocartilage in hemi-joint allotransplantation. Methods Based on the extracted 3D contour image of the articular cartilage of femoral condyle, the custom-made artificial semi-knee joint was designed with Surfacer 9.0 image processingsoftware. The artificial semi-knee joint design used the femoral condylar 3D contour of the patient as the outer face and the subchondral bone 3D contour of allograft bone as inner face. One dado for medullary nailand two for special designing cages which were used to fix the cartilage into the allograft were added on the inner face. After being converted into RP data format, the computerassisted design was imported into the LPS600 rapid prototyping machine, and the prototype was achieved. Furthermore, the prototype could be modified by hand according to the design. Then the RP model was used as a positive mould to build up a silica gel negativemould, and the negative mould was sent to the factory to manufacture Ti-6Al-4V alloy articular cartilage through ordinary mould-melted founding process. Finally, the whole metal cartilage was completed after melting two special cages on it andpolishing it. Results A new custom-made artificial semi-knee joint was made ad used to treat a 14-year old patient. The custom-made artificial semi-knee joint and the subchondral bone were a perfect match. The operative result was satisfactory. The patient could walk 5 weeks after operation. The bone healing of the auto-bone and allo-bone was achieved 6 months later. A follow-up period lasting 1 yearshowed that the knee joint played a good function. Conclusion The artificial semi-knee joint is a good match for the allograft boneand a good idea to solve necroses of allocartilage in hemijoint allotransplantation.
A software and hardware platform for gait simulation and system evaluation for lower limb intelligent prosthesis is proposed and designed, in order that the wearable symmetry effect of the intelligent knee prosthesis can be quantitatively analyzed by machine test instead of human wear test. The whole-body three-dimensional gait and motion analysis system instrument, a device to collect gait data such as joint angle and stride of adults, was used for extracting simulated gait characteristic curve. Then, the gait curve was fitted based on the corresponding joint to verify the feasibility of the test platform in the experiment. Finally, the developed artificial knee prosthesis was worn on the prosthetic evaluation system to quantitatively analyze the gait symmetry effect. The results showed that there was no significant difference in gait symmetry between the developed knee joints at different speeds, which could reach more than 88%. The simulation and evaluation of the prosthetic gait have good effects on the functional simulation and evaluation of the lower limb intelligent prosthesis.
Objective To investigate the effectiveness of free latissimus dorsi myocutaneous flap transplantation combined with external fixation in the treatment of bone and soft tissue defects around the knee joint. Methods A retrospective analysis was conducted on the clinical data of 13 patients with high-energy trauma-induced bone and soft tissue defects around the knee joint admitted between January 2016 and July 2023. Among them, 11 were male and 2 were female, the age ranged from 23 to 61 years, with an average of 35.7 years. The causes of injury included 10 cases of traffic accident, 2 cases of machine entanglement injury, and 1 case of heavy object crush injury. According to the Gustilo-Anderson classification, 11 cases were type Ⅲ B and 2 cases were type Ⅲ C. Post-injury, 2 cases had wound infection and 2 cases had popliteal artery injury. The time from injury to flap repair was 40-49 days, with an average of 27.5 days. The wound size was 18 cm×13 cm to 32 cm×20 cm, all accompanied by distal femoral bone defects and quadriceps muscle defects. After primary debridement, vacuum sealing drainage combined with external fixation was used for treatment. In the second stage, free latissimus dorsi myocutaneous flaps were transplanted to repair soft tissue defects, with the flap size ranging from 20 cm×15 cm to 34 cm×22 cm. The donor sites of 9 flaps were directly sutured, and 4 cases with large tension were repaired with a keystone flap based on the posterior intercostal artery perforator. At 6-15 months postoperatively, with an average of 10.5 months, 11 patients underwent knee arthrodesis surgery; 2 patients with large bone defects at the distal femur and proximal tibia underwent multi-segment bone transport reconstruction of the bone defect. At last follow-up, the recovery of the flap and the donor site was recorded, and the function of the shoulder joint was evaluated by the American Shoulder and Elbow Surgeons (ASES) score, and the function of the affected knee joint was evaluated by the Knee Society Score (KSS). ResultsAll the flaps survived after operation, the wounds and donor site incisions healed by first intention. All 13 patients were followed up 15-55 months, with an average of 21.6 months. Four patients who underwent the restoration of the donor site with the thoracodorsal keystone perforator flap had obvious scar hyperplasia around the wound, but no contracture or symmetrical breasts on both sides. At last follow-up, the appearance and texture of the flaps were good; the bony fusion of the knee joint was good, and the range of motion and function recovered well; the shoulder joint function on the flap-harvested side was not significantly affected, and the range of motion was satisfactory. The ASES shoulder joint score of the latissimus dorsi muscle-harvested side was 85-95, with an average of 89.5. The knee joint function KSS score was 75-90, with an average of 81.2. ConclusionFree latissimus dorsi myocutaneous flap transplantation combined with external fixation for the treatment of bone and soft tissue defects around the knee joint caused by high-energy trauma can repair bone and soft tissue defects and reconstruct the stability of the knee joint, effectively preserve the integrity of the limb and soft tissues, and improve the patient’s ability of self-care.
ObjectiveTo study the effect of intraarticular injection of crosslinked-chitosan in the treatment of knee osteoarthritis in rabbits.MethodsThirty-two New Zealand white rabbits were randomly divided into 4 groups (groups A, B, C, and D; 8 rabbits in each group). The knee osteoarthritis models were prepared by anterior cruciate ligament transection in the left hind in groups A, B, and C. At 4 weeks after operation, the rabbits were received intraarticular injection of 0.6 mL crosslinked-chitosan in group A, 0.3 mL chitosan (once per 2 weeks, for twice) in group B, and 0.3 mL saline (once per 2 weeks, for twice) in group C. The rabbits in group D were treated with sham operation in the left hind, and received intraarticular injection of 0.3 mL saline (once per 2 weeks, for twice). At 8 weeks, the macroscopic observation, histological examination (HE staining, Safranin-fast green double staining, and Mankin score), scanning electron microscopy (SEM) observation, and immunohistochemical staining of collagen type Ⅱ were performed.ResultsMacroscopic and SEM observations showed that the cartilage in group D was basically the same as normal and better than that in groups A and B, and the abrasion of cartilage in group C was the most serious. The histological observation results in groups A and B were slightly similar and better than those in group C, but not up to the structure of group D. The macroscopic score and Mankin score of groups B and C were significantly higher than those of group D (P<0.05), and there was no significant difference between group A and group B (P>0.05). Immunohistochemical staining results showed that the collagen type Ⅱ positive percentage of chondrocytes was significantly higher in group D than that in groups B and C, and no significant difference was found between group A and group B (P>0.05). ConclusionThe crosslinked-chitosan can significantly improve the osteoarthritis of the rabbit knee, delay the pathological changes of osteoarthritis, and decrease the frequency of injection.
This article introduces the basic principles of finite element analysis in biomechanics, focusing on the basic principles of a variety of finite element analysis software, and their respective characteristics. In addition, it also describes the basic stress analysis of UGNX6.0 NASTRAN analysis for artificial knee process, i.e. the choice of the type, material definition, the set of constants, finite element mesh division and the finite element results of the analysis. Finite element analysis and evaluation of the design of personalized artificial knee were carried out, so that the rationality of the geometric design of the structure of the experimental design of artificial knee has been verified.