Correlations between age, Charlson score and outcome in clinical unilateral T3a prostate cancer

According to the European Association of Urology （EAU） guidelines, a life expectancy of〉 10 years is considered an important factor in the treatment of prostate cancer. The Charlson score is used to predict mortality based on comorbidities. The purpose of this study was to investigate the relationship between age, Charlson score and outcome in patients with cT3a prostate cancer. Between 1987 and 2004, 200 patients, who were with clinical T3a prostate cancer and who underwent radical prostatectomy （RP）, were previously detected by digital rectal examination （DRE）. Patients were categorized into two age groups （〈 65 and≥65 years old）. Patients were also divided into two groups according to Charlson score （ = 0 and ≥ 1）. Both age and Charlson score were analyzed regarding their predictive power of patients＇ outcomes. The mean follow-up period was 70.6 months, and the mean age of patients was 63.3 years. In all, 106 patients were 〈 65 years old and 94 patients were ≥65 years old. Age was a significant predictor of overall survival （OS）. A Charlson score of 0 was found in 110 patients, and of ≥ 1 in 90 patients. Charlson score was not a significant predictor of biochemical progression-free survival （BPFS）, clinical progression-free survival （CPFS） or OS. Cox multivariate analysis showed that margin status was a significant independent factor in BPFS, and cancer volume was a significant independent factor in CPFS. Charlson score does not influence the outcome in patients with clinical locally advanced prostate cancer. Age may influence OS. RP can be performed in motivated healthy older patients. However, the patients need to be counseled regarding possible surgery-related side effects, such as urinary incontinence and erectile dysfunction, which are age- and comorbidity-dependent.     

Prevalence of incidental prostate cancer in patients undergoing radical cystoprostatectomy： data from China and other Asian countries

The purpose of this study is to investigate the frequency of prostate cancer （Pca） discovered incidentally in radical cystoprostatectomy specimens in Asia and to determine the feasibility of prostate-sparing cystectomy （PSC） for Asian patients. Ninety-two male bladder cancer patients who underwent radical cystoprostatectomy at our center between January 2003 and January 2008 were included in this study. The mean age of patients was 67.1 years （range： 32-75 years）. Prostate-specific antigen （PSA） levels and digital rectal examination （DRE） results before surgery were obtained retrospectively. Prostates of all patients were embedded and sectioned at 5-mm intervals. The same pathologist examined the prostatic tissues from radical cystoprostatectomy specimens. Finally, a structured literature review was performed using MEDLINE and PUBMED to estimate the occurrence of incidental Pca in Asia. Of the 92 patients, 3 （3.3%） were found to have Pca; in one out of three （33.3%） patients the disease was clinically significant due to a Gleason grade 4 carcinoma. Eight articles were included in our review. The overall incidence of Pca discovered incidentally in radical cystoprostatectomy specimens in Asia was 9.9% （64/642）. When age was restricted to 〈 60 years, only 7 out of 222 （3.2%） patients were found to have synchronous Pca, and none of the cases was clinically significant. The occurrence of Pca in radical cystoprostatectorny specimens in Asia is much lower than that in Western countries. PSC might be feasible for Asian patients under a strict preoperative selection.     

Pattern of ocular trauma among the elderly in Kashan,Iran

Objective：Ocular trauma is a common cause of visual impairment and accounts for 38% to 52% of all patients presenting as ophthalmic accident and emergency cases to the hospital.The purpose of this study is to describe the pattern of ocular injuries that leads to hospitalization in the elderly in Kashan,Iran.Methods：In the retrospective consecutive case series,a total of 94 geriatric patients （≥ 65 years） who admitted and underwent management for ocular trauma from April 2001 to March 2011 at Matini Hospital of Kashan,the only center of eye surgery in the region of Kashan,were reviewed.The items include age,sex,injury mechanism,site and extent of damage,presenting and final best corrected visual acuity at least 3 months after trauma,which were reviewed and analyzed with SPSS software.Results：During the 10 years,94 eyes of 94 patients with ocular trauma were included.Mean age of patients was （77.5±5.1） years （range 65 to 102 years）.Male to female ratio was 2.76.The mechanism of ocular injury included sharp trauma in 56 patients （59.6%） and blunt in 38 patients （40.4%）.Trauma occurred mostly in males （69 patients,73.4%） and at the work place （38 patients,40.4%）.On admission the visual acuity in 50 patients （53.2%） with damaged eyes was light perception to hand motion.While the final best corrected visual acuity in 36 patients （38.3%） was better than hand motion.Conclusion：Ocular trauma is a serious cause of visual impairment in the elderly.Appropriate and timely management may improve their visual prognosis.     

Allograft tissue irradiation and failure rate after anterior cruciate ligament reconstruction:A systematic review

AIM:To evaluate whether anterior cruciate ligament(ACL) allograft irradiation is effective for sterility without compromising graft integrity and increasing failure rate.METHODS:A literature search was conducted using Pub Med,Cochrane,and Google.The following search terms were used:"Gamma irradiation AND anterior cruciate ligament AND allograft" with a return of 30 items.Filters used included:English language,years 1990-2015.There were 6 hits that were not reviewed,as there were only abstracts available.Another 5 hits were discarded,as they did not pertain to the topic of interest.There were 9 more articles that were excluded:Three studies were performed on animals and 6 studies were meta-analyses.Therefore,a total of 10 articles were applicable to review.RESULTS:There is a delicate dosing crossover where gamma irradiation is both effective for sterility without catastrophically compromising the structural integrity of the graft.Of note,low dose irradiation is considered less than 2.0 Mrad,moderate dose is between 2.1-2.4 Mrad,and high dose is greater than or equal to 2.5 Mrad.Based upon the results of the literature search,the optimal threshold for sterilization was found to be sterilization at less than 2.2 Mrad of gamma irradiation with the important caveat of being performed at low temperatures.The graft selection process also must include thorough donor screening and testing as well as harvesting the tissue in a sterile fashion.Utilization of higher dose(≥ 2.5 Mrad) of irradiation causes greater allograft tissue laxity that results in greater graft failure rate clinically in patients after ACL reconstruction.CONCLUSION:Allograft ACL graft gamma irradiatedwith less than 2.2 Mrad appears to be a reasonable alternative to autograft for patients above 25 years of age.     

Clinical observation of particulate cancellous bone impaction grafting in combination with total hip arthroplasty for acetabular reconstruction

Objective： To investigate the effect of particulate cancellous bone impaction grafting in combination with total hip arthroplasty （THA） for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fractures.
Methods： Totally 15 consecutive cases with unilateral acetabular fracture were treated with bone impaction grafting in combination with THA in our department. There were 10 males and 5 females with mean age of 48.2 years （ranging from 36 to 73 years）. Eight cases had the fracture at left hips, 7 at right hips. The average age at injury was 28 years （ranging from 18 to 68 years）. The mean follow-up period was 4.3 years （ranging from 2 to 7 years）. Results： Compared with mean 42 points （ranging from 10 to 62） of the preoperative Harris score, the survival cases at the final follow-up had mean 84 points （ranging from 58 to 98）. One patient had mild pain in the hip. No revision of the acetabular or femoral component was undertaken during the follow-up. Normal rotational centre of most hips was recovered except 2 cases in which it was 0.8 mm higher than that in opposite side. All of them had a stable radiographic appearance. Progressive radiolucent lines were observed in Ⅰ,Ⅲ zones in 2 cases. One patient had a nonprogressive radiolucent line in zone Ⅲ. The cup prosthesis was obviously displaced （6 mm） in one patient, but had not been revised.
Conclusion： Particulate cancellous bone impaction grafting in combination with THA as a biological solution is an attractive procedure for acetabular reconstruction in patients with posttraumatic arthritis and bone loss after acetabular fracture, which can not only restore acetabular bone stock but also repair normal hip anatomy and its function.     

Significance of age and comorbidity as prognostic indicators for patients with bladder cancer

The aim of this study was to determine the impact that age and comorbidity status have on both overall and bladder cancer-specific survival of bladder cancer patients. We obtained medical information pertaining to a population of 528 patients with newly diagnosed bladder cancer from Chung-Ang University Hospital cancer registry. The Adult Comorbidity Evaluation-27 （ACE-27） test, which has been previously validated in adult cancer patients, was used to assess comorbidity. We evaluated differences in the demographic and clinical characteristics of included patients, as well as differences in the treatments they received after categorizing them by age. The median age at the time of bladder cancer diagnosis of the entire cohort was 63 years, and the median follow-up time was 97 months. Of the 528 patients who were included in our study, 303 had at least one comorbid condition and 249 died during the follow-up period. When patients were stratified by age, we found that older patients had a higher proportion of severe comorbidities （P 〈 0.01） than younger patients, and that a lower proportion of them underwent radical cystec- tomy for invasive bladder cancer （IBC） （P 〈 0.01）. By multivariate analysis, we found that older age was predictive of lower overall survival （OS） and bladder cancer-specific survival （BCSS） rates among patients with superficial bladder cancer （SBC） and of lower OS rates among patients with IBC. We also found that moderate-severe comorbidity status and treatment through a bladder-conserving approach were predictive of lower OS and cancer-specific survival rates among patients with IBC. The disparity between overall deaths and bladder cancer deaths was shown in SBC and increased along with age and higher comorbidity. Age and comorbidity were found to be independent predictive factors of OS and BCSS among bladder cancer patients, and explained the disparity that we observed between overall bladder cancer-specific mortality rates.     

Clinical study of a new approach to thoracolumbar surgery

Objective： The conventional approaches for treatment of thoracolumbar diseases require extensive surgical exposure, often leading to postoperative pain and morbidity. Thoracoscopic-assisted surgery in these regions usually requires an extended recovery period due to the placement of drainage. We developed an innovative retroperitoneal-extrapleural approach to thoracolumbar involvement by an extra-diaphragmatic technique using dedicated instruments. Neither incision nor reconstruction of the diaphragm was necessary. Exposure to the lateral part of the thoracolumbar vertebrae could be achieved without crus resection. This study is aimed to evaluate the clinical outcomes of this new surgical procedure.
Methods： A total of 9 cases （5 cases of thoracolumbar fracture-dislocation, 1 each of spinal infection, tumor, thoracolumbar scoliosis and ossification of posterior longitudinal ligament） were subjected to the study. The average age of the patients was 52.3 years. The results were compared with the control group consisting of thoracoscopic surgery subgroup （5 patients, mean age 52.1 years） and conventional surgery subgroup （12 patients, mean age 61.3 years）.
Results： Compared with the control group, the average period of bed confinement and mean intra- and postoperative blood loss decreased significantly. Pulmonary complications were avoided in all cases. The surgical time was shortened, postoperative pain was reduced, and early postoperative ambulation became possible. Conclusion： The diaphragm-preserving retroperitoneal-extrapleural approach that we developed is a valid minimally invasive alternative for the treatment of thoracolumbar diseases.     

关节镜下个体化前交叉韧带单束与双束解剖重建的近期疗效比较

Objective To compare clinical outcomes of double-bundle and single-bundle in individualized arthroscopic anatomical reconstruction of anterior cruciate ligament (ACL) . Methods The clinical data of 117 patients were reviewed who had received double-bundle or single-bundle arthroscopic ACL reconstruction from March 2007 through September 2009 in our hospital and had undergone complete follow-up. Of them, 35 cases had single-bundle ACL reconstruction and 82 double-bundle reconstruction. In the single-bundle group(group A), there were 31 men and 4 women, aged 28. 6 ±5. 1 years. In the double-bundle group(group B), there were 73 men and 9 women, aged 27. 6 ±5. 4 years. The 2 groups were comparable in the preoperative demographic data ( P > 0. 05). To evaluate the outcomes, Lachman and Pivot Shift exams , KT-2000, Lysholm and IKDC (International Knee Documentation Committee) scores, were adopted. Results The 117 patients received a mean follow-up of 15 months (from 11 to 25 months). The Lachman test showed 88. 6% (31/35) were normal in group A and 95. 1% (78/82) were normal in group B.The pivot-shift test showed 88. 6%(31/35) were normal in group A and 96. 3% (79/82) were normal in group B. Group A had a mean Lysholm score of 93. 4 ± 8. 2 and group B a mean Lysholm score of 93. 7 ±7. 0. There were no significant differences between the 2 groups in the above indexes ( P > 0. 05). By IKDC score, 71. 4% (25/135) were normal in group A and 93. 9% (77/82) were normal in group B. The KT-2000 test showed a mean of 1. 4 ± 0. 6 mm in group A and a mean of 1. 1 ± 0. 5 mm in group B. These 2 values were significantly different between the 2 groups ( P < 0. 05). Conclusions The individualized arthroscopic double-bundle anatomical reconstruction of ACL can maximally restore the anteroposterior and rotational stability. Arrangement of the ACL insertion site on the femoral and tibial side, three-portal technique and ruler application are keys for individualized anatomical double-bundle ACL reconstruction.     

Sexual and reproductive function in end-stage renal disease and effect of kidney transplantation

Advanced chronic kidney disease is associated with impaired spermatogenesis and testicular damage. Semen analysis typically shows a decreased volume of ejaculate, oligo-or complete azoospermia, and a low percentage of motile sperm. Erectile dysfunction （ED） is also common in patients with chronic renal failure （CRF） and is observed in excess of 50% of these patients. There have been ongoing improvements in survival and quality of life after renal transplantation. One of the most impressive aspects of successful renal transplantation in the young people is the ability of the male patient to father a child. In this article we first review pathophysiology of reproductive failure in end-stage renal disease （ESRD）, then ED in ESRD and its management are discussed, finally sexual function in renal transplant patients and management of ED in these patients are reviewed.     

Penile fracture and its treatment： Is retrograde urethrograghy necessary for management of penile fracture？

[Abstract] Objective： Penile fracture, being defined as rupture of the tunica albuginea of the corpus cavernosum, is uncommon. Here, we analyze findings on our patients during a 10-year period and evaluate the role of retrograde urethrography. Methods： From February 2002 to April 2012, 116 patients were admitted with penile fracture at Ghaem Medical Center. Patient history and physical examination were taken at their admittance to detect probable urethral injury. Before surgery, retrograde urethrography was performed in all patients. The size and site of the tunical rupture were recorded. Then the rupture of tunica albuginea was sutured with nonabsorbable （3-0 nylon） sutures and the ties were placed on the internal surface （continuous method）. All patients were followed up for 12 months. Results： Patients＇ mean age was （32.78±10.61） years and ranged （16-62） years. The mechanism of trauma was sexual intercourse in 103 patients （89%） and masturbation in 13 patients （11%）. The most common site of injury found after exploration was right （55%） and lateral （74%） of the corpus cavernosum. The size of the tunical rupture was from 0.5 to 3.0 cm （mean 1.88±0.72）. Three of the patients had Marphan＇s syndrome. Urethral injury was detected by retrograde urethrography in 4 patients （3%） who had macroscopic hematuria and urethrorrhagia. During 12 months follow-up, no complication was seen. Conclusion： There is no need to perform retrograde urethrography unless the patients have gross hematuria or urethrorrhagia. The key to success in treatment of penile fracture is to achieve a rapid diagnosis based on history and a physical examination, avoid unnecessary imaging tests and perform immediate surgery to reconstruct the site of injury.     

Anterior cruciate ligament reconstruction in adolescents: a survivorship analysis

There are few reports on the longevity of anterior cruciate ligament (ACL) reconstruction in adolescents. In the study reported here, we performed a survivorship analysis of our experience with ACL reconstructions in adolescents. We retrospectively reviewed the cases of 276 consecutive patients (girls' bone age, > 13 years; boys' bone age, > 14 years; chronological age, < 18 years) who underwent primary ACL reconstruction. All patients underwent transphyseal ACL reconstruction with Achilles tendon soft-tissue allograft using the same technique. Twenty-nine patients (10.5%) were excluded or lost to follow-up. Mean follow-up of the remaining 247 patients was 6.3 years (range, 2-10 years). Data were collected from charts and telephone interviews. Failure was defined as the report of symptomatic knee instability and/or revision ACL surgery. The Kaplan-Meier method showed that 1-year survivorship of ACL reconstruction was 96.4% and 5-year survivorship was 93.1%.     

Anterior cruciate ligament reconstruction in an 84-year-old man

Anterior cruciate ligament (ACL) reconstruction is typically reserved for younger patients. Several recent articles have reported expanding traditional age barriers for ACL reconstruction in patients up to 62 years old. We report a case of a successful ACL reconstruction in an active 84-year-old rancher. Physiologic age is more important than chronologic age when considering ACL reconstruction.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 17, No 1 (January), 2001: pp 70–72     

Editorial Commentary: Age-Appropriate Expectations Are Critical When Analyzing Knee Anterior Cruciate Ligament Reconstruction Outcomes: Age Is More Than Just a Number

In patients undergoing anterior cruciate ligament (ACL) reconstruction, age affects treatment and postoperative recovery decisions, as well as failure rates and outcomes. However, how age affects postoperative patient-reported outcomes and the appropriateness of using the International Knee Documentation Committee patient acceptable symptoms state score in the >40-year-old patient population has received little attention. This study assesses commonly used patient-reported outcomes in older patients undergoing ACL reconstruction and aims to redefine a more suitable patient acceptable symptoms state score for this patient population. As our understanding of both the importance of ACL reconstruction on knee biomechanics and joint stability, as well as the increased rate of ACL reconstruction in older patients grows, having age-appropriate outcomes expectations is critical to both counseling patients and developing future research aims. Future application of outcomes scores in clinical practice and in the research, arena must take into account patient age and function after ACL reconstruction.     

Assessment of osteoarthritis after reconstruction of the anterior cruciate ligament: a study using single-photon emission computed tomography at ten years

We used single-photon emission computed tomography (SPECT) to determine the long-term risk of degenerative change after reconstruction of the anterior cruciate ligament (ACL). Our study population was a prospective series of 31 patients with a mean age at injury of 27.8 years (18 to 47) and a mean follow-up of ten years (9 to 13) after bone-patellar tendon-bone reconstruction of the ACL. The contralateral normal knee was used as a control. All knees were clinically stable with high clinical scores (mean Lysholm score, 93; mean Tegner activity score, 6). Fifteen patients had undergone a partial meniscectomy and ACL reconstruction at or before reconstruction of their ACL. In the group with an intact meniscus, clinical symptoms of osteoarthritis (OA) were found in only one patient (7%), who was also the only patient with marked isotope uptake on the SPECT scan compatible with OA. In the group which underwent a partial meniscectomy, clinical symptoms of OA were found in two patients (13%), who were among five (31%) with isotope uptake compatible with OA. Only one patient (7%) in this group had evidence of advanced OA on plain radiographs. The risk of developing OA after ACL reconstruction in this series is very low and lower than published figures for untreated ACL-deficient knees. There is a significant increase (p < 0.05) in degenerative change in patients who had a reconstruction of their ACL and a partial meniscectomy compared with those who had a reconstruction of their ACL alone.     

前交叉韧带解剖位单束重建与传统过顶位单束重建的疗效比较

目的比较解剖位单束重建(anatomical single-bundle,ASB)与传统过顶位单束重建(over-the-top single-bundle,OSB)前交叉韧带(anterior cruciate ligament,ACL)的临床疗效。方法回顾分析2008年1月-6月收治的64例单膝ACL损伤患者临床资料。其中28例采用ASB治疗(ASB组),36例采用OSB治疗(OSB组)。两组患者性别、年龄、病程、国际膝关节文献委员会(IKDC)评分、Lysholm评分及膝关节前方松弛度等一般资料比较,差异均无统计学意义(P>0.05),具有可比性。结果两组术后切口均Ⅰ期愈合,无感染及其他并发症发生。患者均获随访,随访时间20～24个月,平均21.5个月。末次随访时,两组IKDC评分、Lysholm评分及前方松弛度与术前比较,差异均有统计学意义(P<0.05);两组间比较差异均无统计学意义(P>0.05)。末次随访时,ASB组轴移试验阴性率与术前比较,差异有统计学意义(P<0.05);OSB组与术前比较差异无统计学意义(P>0.05);两组间比较差异亦有统计学意义(P<0.05)。结论关节镜下采用ASB重建ACL疗效优于传统OSB,尤其在控制旋转稳定性方面。     

Revision anterior cruciate ligament reconstruction using the lateral third of the ipsilateral patellar tendon after failure of a central-third graft: a preliminary report on 10 patients

Long-term outcomes were reported for 10 (77%) of 13 cases of revision anterior cruciate ligament (ACL) reconstruction using the lateral third of the ipsilateral patellar tendon as a graft. All primary ACL reconstructions were ipsilateral central-third bone-patellar tendon-bone graft procedures. Mean age at follow-up was 30.7 years, and mean time from revision ACL surgery to follow-up was 42.9 months. At follow-up, average KT-1000 difference between knees was 2.4 mm. All patients had a negative pivot shift, extension within 5 degrees of the contralateral knee, and flexion within 15 degrees. Mean bilateral comparison ratios for isokinetic strength and hop testing were: extension, 83.5%; flexion, 96%; and single-leg hop 96.9%. No patella fractures or tendon ruptures had occurred. All patients had returned to their previous work level, and 8 of the 10 patients could participate in at least "moderate" sports activities (e.g., skiing and tennis). The results were comparable to published outcome reports for both primary and revision ACL reconstruction. The lateral third of the ipsilateral patellar tendon is a good graft option for revision ACL reconstruction.     

Allograft Use in Anterior Cruciate Ligament Reconstruction

Anterior cruciate ligament (ACL) reconstruction is one of the most common procedures performed by orthopedic surgeons. While autograft reconstruction remains the gold standard, allograft tissues have become a controversial option for ACL reconstruction. No data currently exist regarding recent trends in graft choices, and no consensus exists over which graft type is most appropriate for which patient. In this article, we examine trends in ACL graft choice at our institution, and review the pertinent information a surgeon must consider when making this decision. We reviewed operating room records from 2002 to 2008 to determine trends in graft choice for primary single bundle ACL reconstruction. Total number of procedures performed, graft choices, and patient ages were recorded. Patients were divided into the following age groups: less than 16, 16 to 20, 21 to 30, 31 to 40, 41 to 50, and over 50. Percent of ACL reconstructions using allograft was calculated for each year, as well as for each age group. Data were analyzed for trends in ACL graft choice over this time period as well as for trends in graft choice by age. We hypothesized that the rate of allograft use in primary ACL reconstruction had increased over time and that allograft use was associated with higher patient age. We also review the risks, safety, and standards for tissue procurement. Allograft use increased significantly (p < 0.001) from 2002 (17%) to 2008 (46%). There was also a significant difference (p < 0.001) in average age of patients receiving allografts (40.4 years) and autografts (26.4 years). Allograft use was significantly associated with higher patient age (p < 0.05) and increased with each successive age group from a rate of 9.9% in patients under 16 to 79.9% in patients over 50. Our study found that allograft use in primary ACL reconstruction has significantly increased from 2002 to 2008 and is significantly more common in older patients.     

Revision ACL reconstruction outcomes: MOON cohort

Many clinicians believe that the results of revision anterior cruciate ligament (ACL) reconstruction compare unfavorably with primary ACL reconstruction. However, few prospective studies have evaluated revision ACL reconstruction using validated patient-based metrics. This study was performed to evaluate and compare the results of revision ACL reconstruction and primary ACL reconstruction. The Multicenter Orthopaedic Outcomes Network consortium is an NIH-funded, hypothesis-driven, multicenter prospective cohort study of patients undergoing ACL reconstruction. All patients preoperatively complete a series of validated patient-oriented questionnaires. At scheduled 2-year follow-up all patients are given the same series of questionnaires to complete. The study evaluated the results of 2-year follow-up of revision ACL reconstruction performed in 2001. Parameters evaluated included Marx activity level, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) scores. For this study 446 subjects met inclusion criteria; 2-year follow-up was obtained on 393 (88%). The study group consisted of 55% males with median age of 22 years. There were 33 revision ACL reconstruction cases, for which follow-up was available for 29 (88%). Median baseline Marx (interquartile range) was 12 (8 to 16) and 12 (6 to 16) for the primary ACL reconstruction and revision ACL reconstruction groups, respectively (p= 0.81). At 2 years, median Marx was 9 (4 to 13) and 5 (0 to 10) for the primary ACL reconstruction and revision ACL reconstruction groups, respectively (p= 0.03). Median 2-year IKDC was 75.9 (revision) versus 83.9 (primary) (p=0.003). Median KOOS subscale Knee Related Quality of Life (KRQOL) at 2 years was 62.5 (revision) versus 75 (primary) (p < 0.001), subscale Sports and Recreation was 75 (revision) and 85 (primary) (p = 0.005), subscale Pain was 83.3 (revision) and 91.7 (primary) (p= 0.002). Marx activity score declined at 2-year follow-up in revision ACL reconstruction compared with primary ACL reconstruction. IKDC and KRQOL were significantly decreased in revision ACL reconstruction compared with primary ACL reconstruction at 2-year followup. Revision ACL reconstruction resulted in a significantly worse outcome as measured by these patient-based measures at 2 years.     

关节镜下同种异体骨-前交叉韧带-骨移植重建前交叉韧带的疗效分析

目的前交叉韧带(anterior cruciate ligament,ACL)是膝关节重要的稳定结构,探讨关节镜下应用深低温冻存同种异体骨-ACL-骨移植重建ACL的方法及疗效。方法 2007年10月-2010年2月,对22例ACL损伤患者于关节镜下采用深低温冻存的同种异体骨-ACL-骨移植重建ACL。男15例,女7例;年龄19～55岁,平均27.6岁。损伤原因:运动伤12例,摔伤1例,重物压伤2例,交通事故伤7例。左膝14例,右膝8例。病程7 d～12个月,中位病程65 d。前抽屉试验阳性19例,轴移试验阳性19例,Lachman试验阳性21例。术前根据国际膝关节评分委员会(IKDC)分级评定标准,异常5例,严重异常17例;IKDC主观评分为(49.6±6.9)分,Lysholm评分为(48.5±5.3)分,Tegner膝关节运动功能评分受伤前为(6.8±1.2)分,受伤后术前为(2.1±0.5)分。20例行MRI检查,其中18例提示ACL损伤。结果手术时间65～85 min,平均75 min;出血量80～150 mL,平均110 mL。术后切口均Ⅰ期愈合,均无免疫排斥反应及下肢深静脉血栓形成等并发症发生。患者术后均获随访,随访时间7～34个月,平均18个月。末次随访时无伸膝受限;屈膝活动度为125～135°,平均130.5°。前抽屉试验阳性2例,轴移试验阳性1例,Lachman试验阳性3例。根据IKDC分级评定标准:正常10例,接近正常11例,异常1例;IKDC主观评分为(90.0±5.8)分,与术前比较差异有统计学意义(t=4.653,P=0.021)。Lysholm评分为(91.6±7.1)分,与术前比较差异有统计学意义(t=4.231,P=0.028)。Tegner评分为(6.1±1.5)分,与受伤前比较差异无统计学意义(t=1.321,P=0.070),与受伤后术前比较差异有统计学意义(t=3.815,P=0.033)。术后6个月19例关节镜复查示无移植韧带断裂,17例移植物张力正常,2例稍松弛。结论关节镜下应用深低温冻存的同种异体骨-ACL-骨移植重建ACL,可达到ACL解剖重建,术后膝关节功能恢复良好。     

Bilateral simultaneous anterior cruciate ligament reconstruction: A case series and review of the literature

Bilateral ACL rupture is a relatively uncommon injury with an incidence of 2–4%. Most bilateral ACL rupture occurs at two different times, but few cases of single-staged bilateral ACL ruptures have also been reported. There have been reports of both single-staged, and two-staged reconstruction of bilateral ACL ruptures in the literature but without a clear consensus. We present a series of five bilateral ACL rupture cases managed by single-staged arthroscopic ACL reconstruction, using quadrupled hamstring grafts. All of them were young males, with an average age of 26.8 years (Range: 19–39 years). Three out of five of these cases (60%) had sustained the injury to both the knees simultaneously while playing sports. All the five patients had generalized joint laxity with significant hyperextension of their knees. All the ten knees (in five patients) were clinically stable, at their last follow-ups. None of the knees had any early or late complications. A single-staged bilateral ACL reconstruction is a safe, reproducible, and cost-effective procedure for patients with a bilateral ACL deficient knee, in experienced hands.