膝关节镜下自体髌韧带重建前交叉韧带手术探讨

目的报告关节镜下采用中1/3骨-髌韧带-骨(BPTB)等长重建前交叉韧带手术10例,并对临床疗效进行分析讨论.方法经临床及关节镜检查确诊的前交叉韧带(ACL)损伤患者10例,平均年龄22.3岁(17～26岁),取自体BPTB中1/3,关节镜下重建其ACL.术后随访时间16个月(12～20个月),参照敖英芳临床判断标准及lysholm评分评价疗效.结果临床效果优者3例,良5例,中1例,差1例.Lysholm评分术前(23.8±8.53)分,术后(88±7.48)分(P＜0.01).术后3例合并膝前疼痛,其中2例接受再次关节镜手术,再次镜检证实为脂肪垫挤压综合征,均于手术后恢复.结论膝关节镜下自体髌韧带重建前交叉韧带,近期疗效肯定,术后恢复快,但膝前疼痛并发症的防治值得探讨.     

关节镜下膝关节前交叉韧带重建术的护理

目的:探讨关节镜下前交叉韧带重建术的护理。方法:对36例应用膝关节镜下前交叉韧带重建术的患者,术后按照预先制订的锻炼方法进行康复训练。康复重点是对患肢肌肉萎缩的预防,肌力的恢复,关节主动活动范围,患肢负重及平衡功能训练等。结果:36例患者患侧膝关节活动范围均恢复良好,可正常生活和参加体育活动,患膝无不适感和感染现象发生。结论:充分的术前准备,术后细心的观察及正确的功能锻炼是保证其成功康复的关键。     

关节镜下前交叉韧带重建术的护理配合

对94例前交叉韧带断裂病人关节镜下实施前交叉韧带重建术,给予充分的术前准备,术中密切配合,效果显著。认为对于关节镜下的手术,护士必须术前熟悉手术器械,术中要有娴熟的配合技巧,且要做好腔镜器械的维护。     

关节镜下前交叉韧带重建术的护理配合

对94例前交叉韧带断裂病人关节镜下实施前交叉韧带重建术,给予充分的术前准备,术中密切配合,效果显著.认为对于关节镜下的手术,护士必须术前熟悉手术器械,术中要有娴熟的配合技巧,且要做好腔镜器械的维护.     

关节镜下前交叉韧带损伤下自体肌腱重建前交叉韧带的手术配合

［ ］ 目的：探讨关节镜下前交叉韧带损伤自体肌腱重建的护理配合。方法：选择300例关节镜下行交叉韧带损伤自体肌腱重建的患者,做好充分的术前准备,认真评估患者身心健康,术中密切观察病情,积极手术配和。结果：在良好的护理配合下,关节镜下前交叉韧带损伤自体肌腱重建取得较好的临床效果,手术时间逐渐缩短,未发生于手术相关的并发症。结论：手术室护士术前认真评估患者情况,并对病人的心理护理,精心准备器械,良好的手术配合是保证手术质量和手术安全的关键,并是提高手术效率不可缺少的部分。手术室护理人员必须不断学习,掌握新知识,才能更好的完成手术期护理配合。     

自体富血小板血浆联合关节镜下重建术治疗前交叉韧带损伤的临床研究

目的：研究富血小板血浆联合关节镜下自体腘绳肌腱重建前交叉韧带的临床疗效。方法：选取2018年1月~2019年1月在娄底市中心医院行膝关节前交叉韧带重建术患者30例患者,根据随机数字表法分为对照组和试验组各15例。对照组采用关节镜下自体腘绳肌腱重建前交叉韧带,试验组采用自体富血小板血浆联合关节镜下自体腘绳肌腱重建前交叉韧带。比较两组患者在不同时间段内的IKDC检查评分,并使用Lysholm量表判断膝关节功能恢复情况,比较并发症发生情况。结果：术前两组IKDC评分、Lysholm评分比较,差异无统计学意义（P＞0.05）;术后两组IKDC评分、Lysholm评分均较术前上升,且试验组各项评分均明显高于对照组,差异有统计学意义（P＜0.05）。两组治疗及随访期末发生并发症。结论：自体富血小板联合关节镜下自体腘绳肌腱重建前交叉韧带,可以缓解疼痛并改善膝关节功能。     

关节镜下采用自体现髌韧带重建前交叉韧带

目的：研究和评估关节镜下采用自体髌韧带重建交叉韧带在前交叉韧带损伤病人中的应用价值。方法：对36例前交叉韧带损伤病人行镜视下自体髌韧带重建前叉韧带术,结果：36例均获随诊,时间6－11个月,平均8．6个月,根据40分量化评定标准,随诊结果优10例（27．8％）,良19例（52．8％）,可7例（19．4％）。结论：关节镜视下行前交叉韧带重建术具有损伤少,术后固定时间短,功能恢复快的特点,是值得推荐的治疗方法。     

关节镜下LARS人工韧带重建前交叉韧带42例

回顾性分析2006 08/2007-03解放军广州军区广州总医院骨科收治的前交叉韧带损伤患者42例,男27例,女15例.均采用LARS人工韧带进行关节镜下前交叉韧带重建.等距点建立胫骨和股骨骨道.置入韧带后游离纤维位于关节腔内,挤压螺钉固定.本组42.例患者均获得随访,术后抽屈试验,Lachman试验及轴移试验全部阴性.术前IKDC评分为D级28例,C级14例;术后早期为A级35例,B级7例,差异有显著性惫义(x 2=7.243,P＜0.05).术前及术后Lysholm膝关节功能评分为(66.8±7.1)分和(94.2±4.6)分,差异有显著性意义(t=10.769,P＜0.05).所有患者均未出现滑膜炎、韧带断裂、活动明显受限等并发症.术后X射线示螺钉位置止确.     

关节镜下保留残端重建前交叉韧带对前交叉韧带损伤患者膝关节功能恢复的影响

目的：探讨关节镜下保留残端重建前交叉韧带（ACL）对ACL损伤患者膝关节功能恢复的影响。方法：选择2018年3月~2020年5月收治的90例ACL损伤患者,根据随机数字表法分为干预组（45例）和对照组（45例）。两组患者均行ACL重建,干预组术中保留胫骨端ACL残端,对照组术中不保留胫骨端ACL残端。比较两组术前及术后3、6、12个月本体感觉和膝关节功能。结果：干预组术后3、6个月膝关节Lysholm评分高于对照组,被动角度再生试验结果、被动活动察觉阈值低于对照组,差异有统计学意义（P＜0.05）;两组术前、术后12个月被动角度再生试验结果、膝关节Lysholm评分、被动活动察觉阈值比较,差异无统计学意义（P＞0.05）。结论：关节镜下保留残端重建ACL治疗ACL损伤患者能够加快本体感觉恢复速度,促进膝关节功能恢复。     

关节镜下前交叉韧带重建术的康复训练护理

[目的]探讨关节镜下前交叉韧带(ACL)重建术后康复训练的护理措施及效果。[方法]对153例 ACL 断裂的病人行关节镜下前交叉韧带重建术,53例未进行康复或规范康复护理病人为对照组,100例进行康复护理为康复组。分别在术后6个月、12个月、24个月对两组术后抽屉实验阳性率进行了评价。[结果]康复组术后12个月、24个月抽屉实验阳性率明显低于对照组(P <0.01)。[结论]早期正确的锻炼是关节镜下 ACL 重建术后康复的关键,有利于恢复膝关节的稳定性和提高手术成功率。     

关节镜下前交叉韧带重建的术后康复

目的探讨关节镜下自体半腱肌、股薄肌肌腱双束重建前交叉韧带手术的康复治疗方法。方法前交叉韧带断裂病人46例,关节镜下重建前交叉韧带,术后给予系统康复治疗,应用等速测评指导训练,锻炼采取循序渐进的方式实施,并采用LYSHOLM评分标准进行膝关节功能评分。结果 46例中43例恢复正常的关节活动度,LANCHMAN前抽屈试验均转为阴性,LYSHOLM评分优良率为91.3%,等速肌力测试术后峰力矩较术前平均提高35%。结论恰当的术后康复治疗能安全、有效地促进前交叉韧带重建术后患肢的功能恢复。     

关节镜下三股半腱肌肌腱重建后十字韧带

目的：在关节镜下利用三股半腱肌肌腱和界面螺钉重建后十字韧带。方法：关节镜下移植半腱肌肌腱重建膝关节后十字韧带，用于治疗后十字韧带损伤后关节不稳定。结果：10例患者平均随访8．2个月。Larson评分由术前58分提高到92分。所有患膝术前后抽屉试验及Lachman试验均阳性，术后仅1例后抽屉试验弱阳性，1例Lachman试验弱阳性。结论：关节镜下利用三股半肌肌腱和界面挤压螺钉重建后十字韧带是一种可恢复膝关节功能的可靠方法。该技术具有不切开关节囊，损伤小，关节粘连率低优点。     

INCREASED SATELLITE CELL APOPTOSIS IN VASTUS LATERALIS MUSCLE AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

ObjectiveRecovery of the quadriceps femoris muscle after anterior ligament reconstruction is impaired. The aim of this study was to investigate satellite cell content and function of the vastus lateralis muscle after anterior ligament reconstruction.MethodsBiopsies were obtained from the vastus lateralis muscle of 16 recreational athletes immediately before and again 12 weeks after anterior ligament reconstruction. Total satellite cell number (Pax7⁺), activated (Pax7⁺/MyoD⁺), differentiating (Pax7^–/MyoD⁺), and apoptotic (Pax7⁺/TUNEL⁺) satellite cells, myofibers expressing myosin heavy chain (MHC) I and II, and neonatal MHC (MHCneo) were determined immunohistochemically.ResultsAfter anterior ligament reconstruction, the number of apoptotic satellite cells was significantly (p = 0.019) increased, concomitant with a significant (p < 0.001) decrease in total satellite cell number, with no change in activated and differentiating satellite cell number. MHCneo⁺ myofibers tended towards an increase.CONCLUSIONSatellite cell apoptosis and the reduction in the satellite cell pool might provide an explanation for prolonged quadriceps muscle atrophy after anterior ligament reconstruction.LAY ABSTRACTProtracted muscle atrophy is common after anterior ligament reconstruction, even if athletes adhere to a structured rehabilitation programme. Satellite cells, the stem cells of skeletal muscle, play an important role in recovery of an atrophied muscle. Exercise can activate satellite cells, induce their proliferation, and probably also differentiation of these stem cells. The current study evaluated satellite cell content and function in biopsies from the vastus lateralis muscle of 16 recreational athletes immediately before and 12 weeks after anterior ligament reconstruction. After anterior ligament reconstruction, an increased number of satellite cells showed signs of apoptosis (cell death). Furthermore, total satellite cell number was decreased, with no change in the numbers of activated and differentiating satellite cells. The number of regenerating myofibers expressing neonatal myosin tended to increase. In conclusion, satellite cell apoptosis and the reduced satellite cell number might provide an explanation for the impaired muscle recovery after anterior ligament reconstruction.Key words: satellite cells, apoptosis, muscle regeneration, developmental myosin heavy chain, muscular atrophy, quadriceps muscle

Protracted atrophy and weakness of the quadriceps muscle are common after anterior cruciate ligament (ACL) injury and/or anterior cruciate ligament reconstruction (ACL-R), even if the patients undergo guided rehabilitation programmes (1–4). Muscle recovery is compromised due to negative changes in the knee extensor muscles, most likely due to impaired neuromuscular function (5), post-surgery inflammation (6) and immobilization (7). After ACL injury, fibrogenic alterations were observed in biopsies obtained from the vastus lateralis muscle of the injured leg (8, 9). Satellite cell (SC) abundance was also reduced compared with biopsies taken from the vastus lateralis muscle of the uninjured leg (8, 10). Furthermore, there was a surprising lack of increase in SC number after regular rehabilitation training (10), as well as after 12 weeks of supervised quadriceps strength training during rehabilitation after ACL-R (3).SCs play an important role in skeletal muscle growth and regeneration (11, 12). Increases in SC number occur after 11–12 weeks of quadriceps strength training in healthy subjects (13–15). The role of SCs in atrophy of human skeletal muscle, however, has scarcely been investigated. In the very few studies on the role of SCs in atrophy of human skeletal muscle (8, 10, 16), loss of SCs with atrophy is not a consistent finding. However, there is some evidence that a particularly severe atrophic environment, as is found, for example, after severe burn injury, has a negative impact on SC number and SC function and can induce SC apoptosis (17). With regard to findings in animal studies, it has been hypothesized that muscle wasting in old age (sarcopaenia) could at least partly be explained by SC dysfunction with increased SC apoptosis due to chronic low-grade systemic inflammation (18). The significantly reduced SC number in biopsies from the vastus lateralis muscle after ACL injury (8, 10) and the lack of increase in SC number after resumption of muscular training after ACL-R (3, 10) suggest that ACL injury and/or ACL-R with quadriceps tendon or semitendinosus tendon autografts, respectively, might generate a severe atrophic environment with negative effects on SC number and function.The primary aim of this study was to further investigate the effects of ACL-R on SCs and to determine whether the previously described reduction in SC number might be due to SC apoptosis. The study analysed muscle biopsies from the vastus lateralis muscle of recreational athletes immediately before ACL surgery and again after 12 weeks of early rehabilitation.     

ANTERIOR CRUCIATE LIGAMENT INJURY DIAGNOSIS AND MANAGEMENT IN A PEDIATRIC PATIENT: A CASE REPORT

The management of the skeletally immature athlete sustaining injury to the anterior cruciate ligament and other knee structures provides multiple challenges for both the treating clinicians and parents of the injured child. The diagnostic process and subsequent decision making present additional complexities because of the developmental anatomy and the potential for disturbance of normal growth patterns by some surgical interventions. In the following case report, the course to appropriate management of a young athlete is detailed, including the contributions of imaging results. The reconstructive options available to orthopedic surgeons and the patient''s post‐operative progression are also briefly discussed. Rehabilitation practitioners require an understanding of the unique issues present when providing care for pediatric and adolescent athletes with knee injuries in order to assist in optimal decision making in the phases during which they are involved.

Level of Evidence:

5 (Single Case Report)     

DUAL-TASK ASSESSMENT IMPLICATIONS FOR ANTERIOR CRUCIATE LIGAMENT INJURY: A SYSTEMATIC REVIEW

Background:Several systematic reviews have evaluated the role of dual-task assessment in individuals with concussion. However, no systematic reviews to date have investigated dual-task protocols with implications for individuals with anterior cruciate ligament (ACL) injury or ACL reconstruction (ACLR).Purpose:To systematically review the evidence on dual-task assessment practices applicable to those with ACL deficiency/ACLR, specifically with the aim to identify motor-cognitive performance costs.Study Design:Systematic reviewMethods:A systematic literature review was undertaken on those with ACL-deficient or ACL-reconstructed knees performing dual-task activities. The following databases were searched from inception to June 8, 2018 including CINAHL, PsychInfo, PubMed, SPORTDiscus, Web of Science, and gray literature. Three primary search categories (knee, cognition, and motor task) were included. Only one reviewer independently performed the database search, data extraction, and scored each article for quality. All studies were assessed for quality and pertinent data were extracted, examined and synthesized.Results:Ten studies were included for analysis, all of which were published within the prior ten years. Performance deficits were identified in those with either ACL deficiency or ACLR while dual-tasking, such as prioritization of postural control at the expense of cognitive performance, impaired postural control in single limb stance, greater number of cognitive errors, and increased step width coefficient of variation while walking. No studies examined those with prior ACL injury or ACLR during tasks that mimicked ACL injury mechanisms such as jump-landing or single-leg cutting.Conclusion:The results of the current systematic review suggests that postural control, gait, and/or cognitive deficits exist when evaluated under a dual-task paradigm in those with ACL deficiency or ACLR. This systematic review highlights the need for future research on dual-task assessment for individuals who have sustained an ACL injury or undergone ACLR, specifically utilizing more difficult athletic movements.Level of Evidence:Level 3a