Anterior cruciate ligament reconstruction and physiological joint laxity: earliest changes in joint stability and stiffness after reconstruction

Physiological joint laxity is an important element of normal knee joint function, providing smooth joint movement. However, the objective evaluation of post-operative results after knee ligament surgery is usually based primarily on stability and range of motion, and joint laxity has been ignored. In this study, we measured the joint stiffness of 82 knees undergoing anterior cruciate ligament (ACL) reconstruction with the Leeds-Keio artificial ligament, before the operation, immediately after the operation, and finally when the full range of motion was achieved postoperatively; changes in joint laxity after the ACL reconstruction were investigated. Before the operation, joint laxity was greater than that of the normal side (P < 0.01), but immediately after the operation it diminished compared not only with that observed preoperatively, but also with that of the normal side. When the full range of motion was achieved, joint laxity was lower than that observed immediately after the operation (P < 0.01), but still remained higher than that of the normal side (P < 0.01). In other words, stability was achieved, but joint laxity was diminished through the operation. In this series, a stiffer artificial ligament than the natural ACL was used, and maximum tension was applied during the operation, aiming at better stability, but this may cause diminution of joint laxity. Received for publication on Sept. 1998; accepted on Dec. 2, 1998     

Measurement of varus-valgus and internal-external rotational knee laxities in vivo--Part II: relationship with anterior-posterior and general joint laxity in males and females.

We examined sex differences in general joint laxity (GJL), and anterior-posterior displacement (ANT-POST), varus-valgus rotation (VR-VL), and internal-external rotation (INT-EXT) knee laxities, and determined whether greater ANT and GJL predicted greater VR-VL and INT-EXT. Twenty subjects were measured for GJL, and scored on a scale of 0-9. ANT and POST were measured using a standard knee arthrometer at 133 N. VR-VL and INT-EXT were measured using a custom joint laxity testing device, defined as the angular displacements (deg) of the tibia relative to the femur produced by 0-10 Nm of varus-valgus torques, and 0-5 Nm of internal-external torques, respectively. INT-EXT were measured during both non-weight-bearing (NWB) and weight-bearing (WB = 40% body weight) conditions while VR-VL were measured NWB. All laxity measures were greater for females compared to males except for POST. ANT and GJL positively predicted 62.5% of the variance in VR-VL and 41.8% of the variance in WB INT-EXT. ANT was the sole predictor of INT-EXT in NWB, explaining 42.3% of the variance. These findings suggest that subjects who score higher on clinical measures of GJL and ANT are also likely to have greater VR-VL and INT-EXT knee laxities.     

喙肩韧带内侧半转位重建喙锁韧带治疗肩锁关节完全脱位

目的 :探讨喙肩韧带内侧半转位重建喙锁韧带治疗肩锁关节完全脱位的手术方法和疗效。方法 :2006年1月至2012年6月,采用喙肩韧带内侧半转位重建喙锁韧带,同时辅以锁骨钩钢板和克氏针内固定治疗肩锁关节完全脱位26例,男18例,女8例;年龄25~51岁,平均36.7岁;手术时间为伤后3~12 d,平均5 d。按照Rockwood分型:Ⅲ型4例,Ⅴ型22例。临床表现为局部肿胀、压痛伴弹跳感,肩关节活动受限,术前拍摄双侧肩关节标准应力位X线片,测量患侧喙锁间隙为(16.2±5.0)mm,较健侧(7.6±1.0)mm明显增宽。术后通过X线片检查和Constant-Murley评分对手术疗效进行评价。结果:术后切口均Ⅰ期愈合,无感染、内固定断裂、再脱位的发生。所有患者获得随访,时间12~30个月,平均18个月。于术后1个月拔除克氏针、8~10个月取出内固定钢板。到末次随访时肩关节活动均基本恢复正常,而且获得了一个无痛的关节。按Constant-Murley评分,优24例,良2例。喙锁间隙距离患侧为(7.7±1.2)mm,健侧为(7.6±1.0)mm,两侧比较差异无统计学意义(P>0.05)。结论:采用喙肩韧带内侧半转位重建喙锁韧带,加喙锁韧带缝合、锁骨钩钢板和克氏针内固定综合治疗,效果良好。     

TightRope重建喙锁韧带联合锚钉治疗肩锁关节脱位的临床疗效

目的：探讨TightRope重建喙锁韧带联合锚钉修复肩锁关节治疗肩锁关节脱位的疗效。方法回顾性分析2013年5月至2015年5月于我院采用TightRope重建喙锁韧带联合锚钉修复肩锁关节治疗的13例肩锁关节脱位病人（TightRope+锚钉组）及采用肩锁钩钢板治疗的21例肩锁关节脱位病人（肩锁钩钢板组）的临床资料,比较两组的手术时间、术中出血量、术后及末次随访时的X线片及术后3、6个月及末次随访时的Neer肩关节功能评分。结果两组的手术时间、术中出血量比较,差异均无统计学意义（均P＞0.05）。在术后3、6个月及末次随访时,TightRope+锚钉组的Neer肩关节功能评分分别为（84.5±8.1）分、（91.8±9.4）分、（96.1±11.1）分,而肩锁钩钢板组的相应得分分别为（72.4±7.5）分、（86.9±9.6）分、（89.2±9.8）分,TightRope+锚钉组明显优于肩锁钩钢板组,差异均有统计学意义（均P＜0.05）。末次随访时的X线片提示TightRope+锚钉组病人无复位丢失、创伤性关节炎等出现;肩锁钩钢板组出现4例肩峰下撞击征,1例肩峰骨溶解,所有病人均在8~10个月后取出内固定,2例病人取出钢板后出现复位丢失。结论采用TightRope重建喙锁韧带联合锚钉修复肩锁关节治疗肩锁关节脱位,可获得更符合生物力学的复位,肩锁关节稳定,肩关节功能恢复满意,无需二次手术取出内固定。     

关节镜下喙锁和肩锁韧带重建治疗陈旧性Rockwood III型肩锁关节脱位

目的探讨关节镜下喙锁+肩锁韧带重建治疗陈旧性Rockwood III型肩锁关节脱位的疗效。 方法选取2016年1月至2020年12月北京大学人民医院收治的14例确诊为陈旧性肩锁关节脱位患者,其中男8例、女6例,平均年龄（37.2±10.1）岁,平均受伤时间（13.4±3.5）个月,累及优势侧肩关节7例,均行关节镜下喙锁+肩锁韧带重建手术。术后所有患者分别于不同时间点随访（术后1、3、6、12个月）,进行视觉模拟评分（visual analogue scale,VAS）和美国加州大学洛杉矶分校（University of California, Los Angeles,UCLA）评分。 结果14例确诊为陈旧性肩锁关节脱位患者（均为Rockwood III型）进入研究并完成手术,12例获得完全随访,平均随访（26.3±8.6）个月（12~36个月）。患者术前和术后1个月、3个月、6个月、12个月VAS评分分别为（5.667±0.414）分、（5.583±0.288）分、（4.583±0.229）分、（2.833±0.271）分、（0.538±0.193）分,与术前相比,所有患者在术后3个月、6个月和12个月随访时均显示疼痛减轻,术后6个月和12个月疼痛减轻的程度与术前相比（VAS评分变化）差异有统计学意义（P<0.001）。患者术前和术后1个月、3个月、6个月、12个月UCLA评分分别为（19.083±0.468）分、（18.583±0.434）分、（21.000±0.628）分、（25.750±0.579）分、（32.750±0.509）分,与术前相比,所有患者在术后3个月、6个月和12个月随访时UCLA评分与术前相比均有提高,术后6个月、12个月随访时UCLA评分改善的程度与术前相比,差异有统计学意义（P<0.001）。 结论关节镜下喙锁+肩锁韧带重建可以用较小的创伤达到帮助陈旧性肩锁关节脱位患者减轻疼痛和改善肩关节功能的目的。     

A comparison of cyclic variations in anterior knee laxity,genu recurvatum,and general joint laxity across the menstrual cycle

Changes in anterior knee laxity (AKL), genu recurvatum (GR) and general joint laxity (GJL) were quantified across days of the early follicular and early luteal phases of the menstrual cycle in 66 females, and the similarity in their pattern of cyclic variations examined. Laxity was measured on each of the first 6 days of menses (M1–M6) and the first 8 days following ovulation (L1–L8) over two cycles. The largest mean differences were observed between L5 and L8 for AKL (0.32 mm), and between L5 and M1 for GR (0.56°) and GJL (0.26) (p < 0.013). At the individual level, mean absolute cyclic changes in AKL (1.8 ± 0.7 mm, 1.6 ± 0.7 mm), GR (2.8 ± 1.0°, 2.4 ± 1.0°), and GJL (1.1 ± 1.1, 0.7 ± 1.0) were more apparent, with minimum, maximum and delta values being quite consistent from month to month (ICC_2,3 = 0.51–0.98). Although the average daily pattern of change in laxity was quite similar between variables (Spearman correlation range 0.61 and 0.90), correlations between laxity measures at the individual level were much lower (range ?0.07 to 0.43). Substantial, similar, and reproducible cyclic changes in AKL, GR, and GJL were observed across the menstrual cycle, with the magnitude and pattern of cyclic changes varying considerably among females. © 2010 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:1411–1417, 2010     

Ligamentous restraints of the second tarsometatarsal joint: a biomechanical evaluation.

Ligamentous injury of the tarsometatarsal joint complex is an uncommon, but disabling condition that frequently occurs in elite athletes. There are few options for managing these injuries, in part because the relative mechanical contribution of the ligaments of the tarsometatarsal joint is unknown, complicating decisions regarding which ligaments need reconstruction. In the current study, strength and stiffness of the dorsal, plantar, and Lisfranc ligaments of 20 paired cadaver feet were measured and compared. The plantar and Lisfranc ligaments were significantly stiffer and stronger than the dorsal ligament, and the Lisfranc ligament was significantly stronger and stiffer than the plantar ligament.     

三Endobutton钢板解剖重建喙锁韧带治疗肩锁关节脱位

目的探讨三Endobutton钢板解剖重建喙锁韧带治疗肩锁关节脱位的初步临床疗效。方法对25例肩锁关节脱位患者应用三Endobutton钢板解剖重建喙锁韧带治疗的临床疗效进行分析。结果 25例均获随访,时间14～29个月。X线检查证实肩锁关节脱位均完全复位。肩关节外展活动范围术前为40°～80°,术后为140°～150°。肩关节功能按Constant标准,评分术前为(66.5±3.2)分,术后3个月为(90.5±2.3)分,术后6个月为(93.5±3.1)分。结论三Endobutton钢板解剖重建喙锁韧带治疗肩锁关节脱位固定确实,不损伤关节面,术后患者可以早期功能锻炼,无需二次手术,疗效满意。     

自制导向器引导下双股钛缆与锁骨钩钢板治疗严重肩锁关节脱位

目的:比较钛缆仿生重建喙锁韧带与锁骨钩钢板治疗肩锁关节脱位的临床疗效.方法:回顾分析2017年1月至2018年12月39例严重急性肩锁关节脱位患者的临床资料,其中双股钛缆组19例,其中男13例,女6例;年龄26～67;RockwoodⅢ型10例,Ⅳ型4,Ⅴ型5例;交通伤8例,摔伤11例;受伤至手术时间3～6 d.钢板组...     

重视肩锁关节复合体修复以提高不稳定肩锁关节脱位疗效

正肩锁关节脱位作为肩部的常见损伤,随着交通发达和建筑的发展,交通事故和高处坠落使本病有逐年上升趋势。在诊断和分型方面,逐渐趋向统一:通过病史、体格检查、结合影像学检查使诊断得以明确。从早期的3度分类到目前广泛被认可的Rockwood[1]6型分类:1度和2度与Ⅰ型和Ⅱ型相对应;而3度包含了Ⅲ、Ⅳ、Ⅴ、Ⅵ型。在治疗方面:1度和2度即Ⅰ型和Ⅱ型临床上普遍认可通过保守治疗可以获得满意的疗效;而3度中Ⅲ、Ⅳ、Ⅴ、Ⅵ型的治疗:Ⅲ型损伤仍存有争议,而Ⅳ、Ⅴ、Ⅵ型采用手术复位和稳定治     

Endobutton钢板与锁骨钩钢板治疗肩锁关节脱位的疗效分析

目的比较双Endobutton袢钢板与钩钢板治疗RockwoodIII型肩锁关节脱位的临床疗效。方法回顾分析2008年5月至2011年5月收治的73例RockwoodllI型肩锁关节脱位患者,分为双Endobutton钢板组（A组,n=39）和锁骨钩钢板组（B组,n=34）,比较两组手术时间、术中出血量、住院时间及疗效。两组术后均随访8～20个月,平均12．8个月。结果A组的术中出血量、手术时间及总住院时间均低于B组,差异有统计学意义（P〈0．05）;术后按Karlsson标准进行疗效评定：优良率A组100％,B组88．2％,差异有统计学意义（P=0．0174）。结论双Endobutton袢钢板在治疗Rockwoodm型肩锁关节脱位有明显优势。     

单、双束喙锁韧带重建治疗肩锁关节脱位62例报道

目的讨论应用单、双束喙锁韧带重建治疗肩锁关节脱位（AJC）的临床疗效。 方法自2009~2016年应用Endobutton、Arthrex AC Joint Tight Rope等替代物,通过建立喙突与锁骨间隧道,进行单、双束喙锁韧带重建,共治疗AJC 62例。 结果62例患者都接受了随访,随访时间最短1年,最长7年。根据Constant-Murley肩关节功能评分标准:优57例、良2例,可3例,优良率达95%。 结论应用单、双束喙锁韧带重建治疗AJC的临床疗效满意。     

带线铆钉结合克氏针多轴固定治疗肩锁关节脱位

<正>2012年3月~2014年1月,我院采用带线铆钉重建喙锁韧带结合克氏针固定治疗16例TossyⅢ型肩锁关节脱位患者,短期疗效满意,报道如下。1材料与方法1.1病例资料本组16例,男11例,女5例,年龄27~55岁。左侧6例,右侧10例,均为闭合损伤。受伤至手术时间1~6 d。1.2手术方法臂丛+颈丛麻醉。沿     

胸锁关节脱位合并肩锁关节脱位伴肩胛骨喙突骨折漏诊1例

<正>患者,女,55岁,因跌伤致右肩疼痛活动受限2 h收住入院。患者2 h前骑车时跌倒,右侧头面部及右肩着地,急诊摄X线片示右胸锁关节脱位。入院查体:右锁骨胸骨端局部隆起、压痛,可及弹性固定,平卧时隆起变小,坐起时明显,右手各指感觉活     

带肩峰骨瓣喙肩韧带转移修复喙锁韧带治疗Ⅲ度肩锁关节脱位

目的：探讨手术治疗Ⅲ度肩锁关节脱位的新方法。方法：2000年8月-2004年3月收治TossyⅢ度肩锁关节脱位14例，男10例，女4例；年龄17～54岁，平均42．5岁；新鲜脱位9例，陈旧脱位5例。采用带肩峰骨瓣喙肩韧带转移修复喙锁韧带加内固定治疗，其中采用锁骨钩钢板固定6例，骨片钉固定8例。结果：所有患者经过3个月～3年（平均2．4年）随访，根据Karlsson评定标准：A级9例，B级5例。结论：喙肩韧带替代喙锁韧带确保肩锁关节的稳定，骨瓣与锁骨固定愈合较韧带与骨愈合更可靠，手术操作简单，功能恢复快。     

Triple-Endobutton钢板置入治疗Rochwood Ⅲ-Ⅴ型肩锁关节脱位

目的：探讨Triple-Endobutton 钢板置入治疗Rochwood分型Ⅲ-Ⅴ型肩锁关节脱位的临床疗效。方法：2008年3月至2010年6月,对28例Rochwood Ⅲ-Ⅴ型肩锁关节脱位的患者进行Triple-Endobutton 钢板置入治疗,男18例,女10例;年龄20～60岁,平均38岁;左侧20例,右侧8例;均为闭合性损伤。肩关节功能按Constant标准进行疗效分析。结果：28例获随访,时间18～24个月,平均20个月。所有患者肩关节活动良好,未出现再脱位及疼痛等症状。X线检查肩锁关节均完全复位。肩关节功能按Constant标准,术前评分25.4±2.0,术后1个月65.9±3.0,术后3个月87.2±3.2,术后6个月95.7±1.6.结论：利用Triple-Endobutton 钢板置入治疗Rochwood Ⅲ-Ⅴ型肩锁关节脱位固定牢靠,操作简单,并发症少,无须二次取出,术后可早期进行功能锻炼,疗效满意。