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简介：Background:Apreviousstudyhasreporteda50%reductionindisuseatrophyofthequadricepsduringthefirst14daysafteranteriorcruciateligament(ACL)reconstruction.Afollow-uptrialisneededtoconfirmthesepromisingresults.ThepresentstudyaimstoinvestigatetheeffectofanocclusionstimulusonquadricepsatrophyafterACLreconstruction.Methods:Atotalof24subjectsparticipatedinthestudy.Theywererandomizedintotwogroups.Startingthe2nddayaftersurgery,theocclusiongroupreceivedanocclusionstimulusfor5min,followedbyremovaloftheocclusivepressurefor3min.Thiswasrepeatedfivetimesinonetrainingsession,twicedaily.Duringtheperiodofocclusivestimulus,thesubjectsperformed20lowloadexercisesforthequadriceps.Thecontrolgroupfollowedthesameexerciseprotocol,butwithouttheocclusionstimulus.Changesinquadricepsanatomicalcrosssectionarea(ACSA)weremeasuredusingaxialmagneticresonance(MR)imagesat40%and50%ofthelengthofthefemur.Results:BothgroupshadasignificantreductionofquadricepsACSAfrom2daysbeforesurgeryto16daysaftersurgery.Duringtheinterventionperiod,theocclusiongrouplost13.8%±1.1%(mean±SEM)andthecontrolgrouplost13.1%±1.0%oftheirquadricepsACSA,respectively.Therewasnosignificantdifferencebetweentheocclusionandcontrolgroupswithregardstoatrophyofthequadricepsmuscles.Conclusion:Inconflictwithotherstudiesusingasimilarprotocol,applicationofbloodflowrestrictionthefirst14daysafterACLreconstructiondidnotreducequadricepsACSAmuscleatrophymeasuredbyMRinapopulationofathletes.

简介：客观：为了介绍posteromedial，从胫骨为以后的十字形的系带(打印机控制语言)的多骨的撕裂的减小和附件通过gastrocnemius的中间的头的中间的边阶来临。方法：通过posteromedial的起作用的减小和内部固定从1998年2月在我们的部门gastrocnemius走近到2000年3月的有PCL的胫骨的附件经历了的avulsed的十一个病人。皮切口被颠倒沿着gastrocnemius和以后的囊的中间的头的中间的边阶塑造L被把暴露中间的边阶和侧面的收回，避免腿弯部的神经与血管的结构的损坏。在那以后，以后的囊垂直地有点中间地被把到以后的intercondylarsulcus并且就在手指触诊放的以后的中间的胫骨的著名上。当时，PCL和它的胫骨的附件是容易温和的。在推迟的盒子中，打印机控制语言外设释放是必要的克服系带收回并且为最佳的减小并且多骨的愈合使破裂床清醒。最后，一或二个可被细菌破坏的螺丝钉被用来修理avulsed骨头片断和30°屈曲膝灰浆在创伤被关上以后，演员组固定定期被使用。评估包括了X光检查，以后下垂符号和以后的抽屉与相反地侧面的方面相比测试。因为伴随物损害，对低手足的功能的评价不是可得到的。结果：在PCL的胫骨的附件avulsed损害的修理使用的gastrocnemius的Theposteromedial途径能提供清楚的解剖暴露的利益，很少血损失(20ml平均)，对任何结构的分开或附件的没有需要。病人被跟随在上面为一般水准上的11个月(从6个月到2年)。它证明多骨的愈合在推迟的损害的情况下在新鲜损害和7-9星期的情况下在4-6星期以内被完成。六从8fresh盒子出现了完全否定以后下垂符号或以后的抽屉测试但是为1-2公里的2有的额外的松弛。在3个推迟的盒子中，为3-4公里的额外的松弛与thecontralateral膝相比被介绍。结论；gastrocnemius的pos

简介：AbstractPurpose:To retrospectively analyze the clinical outcomes of meniscus repair with simultaneous anterior cruciate ligament (ACL) reconstruction and explore the causes of failure of meniscus repair.Methods:From May 2013 to July 2018, the clinical data of 165 patients who were treated with meniscus surgery and simultaneous ACL reconstruction, including 69 cases of meniscus repair (repair group) and 96 cases of partial meniscectomy (partial meniscectomy group) were retrospectively analyzed. The exclusion criteria were as follows: (1) ACL rupture associated with fracture, collateral ligament injury, or complex ligament injury; (2) a history of knee surgery; or (3) a significant degree of osteoarthritis. The 69 patients in the repair group were divided into the non-failure group (62 cases) and the failure group (7 cases) depending on the repair effect. Postoperative outcomes of the repair group and the partial meniscectomy group were compared. General conditions and postoperative outcomes of the failure group and the non-failure group were compared. During the median follow-up period of 28 months (range, 4 - 65 months) after the second arthroscopy, postoperative outcomes of seven patients in the failure group were summarized. SPSS 25.0 statistical software was used for statistical analysis. A p value less than 0.05 was considered statistically significant.Results:Seven patients in the failure group who underwent the second arthroscopy were followed up for (30 ± 17.4) months and their postoperative outcomes were summarized. Compared with the partial meniscectomy group, the International Knee Documentation Committee scores of patients in the repair group improved significantly (p = 0.031). Compared with the non-failure group, more patients in the failure group were younger than 24 years (p = 0.030). The median follow-up period was 39.5 months. All patients recovered well after subsequent partial meniscectomy and relieved clinical symptoms. Visual analog scale scores decreased significantly (p = 0.026), and the International Knee Documentation Committee and Lysholm scores improved significantly (p = 0.046 for both).Conclusion:The failure rate of meniscus repair in this study was 10.1% (7/69), all of which were medial meniscus tears. However, the surgical outcomes of ACL reconstruction were not affected, and there might be a role for graft protection. Therefore, meniscus retears can be successful treated by performing subsequent partial meniscectomy in patients with repair failure.

简介：AbstractPurpose:To avoid potential problems of double-bundle anterior cruciate ligament reconstruction (ACLR), various modifications have been reported. This study analyzed a novel technique of modified double-bundle (MDB) ACLR without implant on tibial side in comparison to single-bundle (SB) ACLR.Methods:Eighty cases of isolated anterior cruciate ligament tear (40 each in SB group or MDB group) were included. SB ACLR was performed by outside in technique with quadrupled hamstring graft fixed with interference screws. In MDB group, ACLR harvested tendons were looped over each other at the center and free ends whipstitched. Femoral tunnel was created by outside in technique. Anteromedial tibial tunnel was created with tibial guide at 55°. The anatomic posterolateral aiming guide (Smith-Nephew) was used to create posterolateral tunnel. With the help of shuttle sutures, the free end of gracillis was passed through posterolateral tunnel to femoral tunnel followed by semitendinosus graft through anteromedial tunnel to femoral tunnel. On tibial side the graft was looped over bone-bridge between external apertures of anteromedial and posterolateral tunnel. Graft was fixed with interference screw on femoral side in 10° knee flexion. International Knee Documentation Committee (IKDC), Tegner score, Pivot shift and knee laxity test (KLT, Karl-Storz) were recorded pre- and post-surgery. At one year magnetic resonance imaging (MRI) was done. Statistical analysis was done by SPSS software.Results:Mean preoperative KLT reading of (10.00 ± 1.17) mm in MDB group improved to (4.10 ± 0.56) mm and in SB group it improved from (10.00 ± 0.91) mm to (4.80 ± 0.46) mm. The mean preoperative IKDC score in MDB group improved from (49.49 ± 8.00) to (92.5 ± 1.5) at one year and that in SB group improved from (52.5 ± 6.9) to (88.4 ± 2.6). At one-year 92.5% cases in MDB group achieved their preinjury Tegner activity level as compared to 60% in SB group. The improvement in IKDC, KLT and Tegner scale of MDB group was superior to SB group. MRI confirmed graft integrity at one year and clinically at 2 years.Conclusion:MDB ACLR has shown better outcome than SB ACLR. It is a simple technique that does not require fixation on tibial side and resultant graft is close to native ACL.

简介：Objective:Toanalyzethehistologicalresultsandthebiologicalremodelingofligamentousinsertionafterthereconstructionofanteriorcruciateligament(ACL)withautograftorallografttendon.Methods:ExtensordigitorumtendonwasharvestedfromhindlimbasgraftmaterialandtransplantedtoreconstructtheresectedACLin12mongreldogs.Eachfreetendonendwassecuredbyholdingsuturesandthenthesuturesweretiedtothepostscrewatthefemoralandtibialbonytunneloutletaftertransplantationrespectively.Autograftwasrandomlyperformedononesideofkneewhileallograftontheothersideofknee.Aftertransplantation,thehistologicalanalysiswasundertakenatthe6th,12thweeksandthe6thmonthusinghematoxylin-eosin(HE)stainunderlightmicroscope.Results:TheinsertionstructureofnormalACLtypicallyconsistedoffourlayers,i.e.,denseconnectivetissue,fibrocartilage,mineralizedfibrocartilageandbone.Therewasadistinctregulartidemarklinebetweenfibrocartilageandmineralizedfibrocartilage.Atthe6thweekpostoperativcly,looseconnectivetissuepresentedintheinterspacebetweengraftandbonytunnelwallinbothautograftandallograftgroups.Atthe12thweekpostoperatively,thecollagenousfibersbetweenautograftandtunnelwallbecamewellorganizedandthefourlayersofinsertionwithdiscontinuoustidemarklineweredemonstratedindistinctlyinautograftgroupbutnotinallograftgroup.Atthe6thmonthpostoperatively,bothofaclearandcontinuoustidemarklineanddistinctfourlayerscouldbeseeninautograftgroup.Inallograftgroup,onlyawaveddiscontinuoustidemarklinewasshownandeithertheanatomicmorphologyorthematurityofinsertionwasinferiortothatofautograftgroup.Conclusions:Atthe6thmonthpostoperatively,althoughtheligament-cartilageinsertionisprimarilyformedafterACLreconstructionwithautograftorallografttendon,thehistologicalmorphologyandthematurationofinsertionofautografttendonar

简介：AbstractBackground:Recently, adjustable-loop devices (ALDs) have been widely used, and their reliability has always been the focus of attention. This study compared loop length changes under pull stress caused by flexion and extension of the cadaver knee between ALDs and fixed-loop devices (FLDs) in terms of femoral fixation after anterior cruciate ligament (ACL) reconstruction.Methods:ACL reconstruction in cadaveric knee joints was performed under arthroscopy with femoral suspension devices and tibial fixation by tying sutures on staples. The knee joint was repeatedly flexed and extended 30 times after fixation. According to the femoral fixation device used (Endobutton or Ultrabutton), the knee joints were divided into two groups: the ALD group (12 specimens) and the FLD group (ten specimens). The length of the loop before and after fixation was measured, and the loop length of the ALD group was re-measured 1 day after reconstruction.Results:There was no significant difference in the length of the loop between the two groups (t = 0.579, P = 0.569). One day later, the loop length of the ALDs retracted by 0.29 ± 0.33 (0-1.1) mm, and there was no retraction in three specimens.Conclusion:There was no significant difference in the loop length under flexion and extension stress after ACL reconstruction between ALDs and FLDs.

简介：AbstractBackground:Multiple techniques are commonly used for posterior cruciate ligament (PCL) reconstruction. However, the optimum method regarding the fixation of PCL reconstruction after PCL tears remains debatable. The purpose of this study was to compare the biomechanical properties among three different tibial fixation procedures for transtibial single-bundle PCL reconstruction.Methods:Thirty-six porcine tibias and porcine extensor tendons were randomized into three fixation study groups: the interference screw fixation (IS) group, the transtibial tubercle fixation (TTF) group, and TTF + IS group (n = 12 in each group). The structural properties of the three fixation groups were tested under cyclic loading and load-to-failure. The slippage after the cyclic loading test and the stiffness and ultimate failure load after load-to-failure testing were recorded.Results:After 1000 cycles of cyclic testing, no significant difference was observed in graft slippage among the three groups. For load-to-failure testing, the TTF + IS group showed a higher ultimate failure load than the TTF group and the IS group (876.34 ± 58.78 N vs. 660.92 ± 77.74 N [P < 0.001] vs. 556.49 ± 65.33 N [P < 0.001]). The stiffness in the TTF group was significantly lower than that in the IS group and the TTF + IS group (92.77 ± 20.16 N/mm in the TTF group vs. 120.27 ± 15.66 N/m in the IS group [P = 0.001] and 131.79 ± 17.95 N/mm in the TTF + IS group [P < 0.001]). No significant difference in the mean stiffness was found between the IS group and the TTF + IS group (P = 0.127).Conclusions:In this biomechanical study, supplementary fixation with transtibial tubercle sutures increased the ultimate failure load during load-to-failure testing for PCL reconstruction.