关节镜下韧带重建治疗外伤性膝关节脱位合并多发韧带损伤

目的 探讨关节镜下韧带修复或重建治疗外伤性膝关节脱位合并多发韧带损伤的疗效。方法 回顾性分析2010年6月～2016年12月收治的14例关节镜下韧带修复或重建治疗的外伤性膝关节脱位病例,其中KD-Ⅰ型4例,KD-Ⅱ型6例,KD-Ⅲ型4例(改良Sehenck分型)。4例(KD-Ⅱ型2例,KD-Ⅲ型2例)合并腘动脉损伤者先行血管探查吻合及侧方结构修复术,6周后重建交叉韧带;10例(KD-Ⅰ型4例,KD-Ⅱ型4例,KD-Ⅲ型2例)行一期关节镜下交叉韧带重建术+侧副韧带重建或修复术。随访时行膝关节体格检查、VAS评分、Lysholm评分及关节活动度等,以评价临床疗效。结果 全部病例随访18～42个月,平均24个月。末次随访时VAS评分(1.6±0.3)分,Lysholm膝关节评分(81.6±12.2)分,关节活动度(120.5°±18.6°),与术前比较均有改善(P0.05)。3例(21.4%,3/14)残留膝关节不稳定:抽屉试验(+)3例,外翻应力试验(+)1例。2例出现关节僵硬。结论 KD-Ⅰ型、KD-Ⅱ型外伤性膝关节脱位,应待肿胀消退后,一期关节镜下重建交叉韧带;KD-Ⅲ型外伤性膝关节脱位应选择分期手术,肿胀消退后先修复或重建侧方结构,待炎症消退、关节囊及侧方结构愈合后,再行二期交叉韧带重建。     

Persistent morbidity after Medial Patellofemoral Ligament Reconstruction — A registry study with an eight-year follow-up on a nationwide cohort from 1996 to 2014

Background

To evaluate the trends in treatment of patellar dislocation in the Danish population as a whole from 1996 to 2014 and evaluate the incidence of persistent morbidity after Medial Patellofemoral Ligament Reconstruction (MPFL-R).

Does subtalar instability really exist? A systematic review

BackgroundSubtalar joint instability (STI) is considered as a potential source of chronic lateral hindfoot instability. However, clinical diagnosis of STI is still challenging. This systematic review was conducted to assess the consistency of the clinical entity “subtalar instability”, to investigate the reliability of available diagnostic tools and to provide a critical overview of related studies.MethodsA systematic review of the Medline, Web of Sciences and EMBASE databases was performed for studies reporting on tests to investigate subtalar instability or lesions of the subtalar ligaments. To investigate the relation with chronic STI, studies focusing on sinus tarsi syndrome (STS) or acute lesions of the subtalar ligaments were also included in the search strategy and were assessed separately.ResultsThis review identified 25 studies focusing on different topics: chronic STI (16), acute lesions of the subtalar ligaments (5) and STS (4). Twelve studies, assessing STI, demonstrated the existence of a subgroup with instability complaints related to abnormal increased subtalar motion (7) or abnormalities of the subtalar ligaments (6). We found insufficient evidence for measuring subtalar tilting using stress radiographs. MRI was able to assess abnormalities of the ligaments and stress-MRI detected abnormally increased motion.ConclusionComplaints of instability can be related to subtalar ligaments injuries and an abnormally increased motion of the subtalar joint. Stress radiographs should be interpreted with caution and should not have the status of a reference test. Clinical diagnosis should rely on several parameters including MRI.     

Anterior cruciate ligament‐ and hamstring tendon‐derived cells: in vitro differential properties of cells involved in ACL reconstruction

Anterior cruciate ligament (ACL) reconstruction involves the replacement of the torn ligament with a new graft, often a hamstring tendon (HT). Described as similar, the ACL and HT have intrinsic differences related to their distinct anatomical locations. From a cellular perspective, identifying these differences represents a step forward in the search for new cues that enhance recovery after the reconstruction. The purpose of this study was to characterize the phenotype and multilineage potential of ACL‐ and HT‐derived cells. ACL‐ and HT‐derived cells were isolated from tissue harvest from patients undergoing total knee arthroplasty (TKA) or ACL reconstruction. In total, three ACL and three HT donors were investigated. Cell morphology, self‐renewal potential (CFU‐F), surface marker profiling, expression of tendon/ligament‐related markers (PCR) and multilineage potential were analysed for both cell types; both had fibroblast‐like morphology and low self‐renewal potential. No differences in the expression of tendon/ligament‐related genes or a selected set of surface markers were observed between the two cell types. However, differences in their multilineage potential were observed: while ACL‐derived cells showed a high potential to differentiate into chondrocytes and adipocytes, but not osteoblasts, HT‐derived cells showed poor potential to form adipocytes, chondrocytes and osteoblasts. Our results demonstrated that HT‐derived cells have low multilineage potential compared to ACL‐derived cells, further highlighting the need for extrinsic signals to fully restore the function of the ACL upon reconstruction. Copyright © 2015 John Wiley & Sons, Ltd.     

Ligament balancing in the valgus knee

Total knee arthroplasty in the knee with valgus deformity is a challenge for surgeons. Making distal and posterior femoral and tibial bone cuts perpendicular to the mechanical axis are essential for obtaining alignment throughout the flexion–extension arc of motion. A well-balanced knee assures correct function, which is realized by a functional approach for releasing the ligaments that are found to be tight in flexion and/or extension while testing the knee after bone cuts have been made. Special attention to normalized tracking of the patella and quadriceps mechanism is crucial at the end of the surgical procedure.     

高屈曲状态下膝关节静力稳定结构的生物力学研究进展

膝关节高屈曲状态在亚洲国家和中东地区的日常生活及特殊职业中极为常见。膝关节静力稳定结构包括前、后交叉韧带,内、外侧副韧带及关节囊,其主要功能是维持关节稳定性,其生物力学和运动学特点对全膝置换术中软组织松解、膝关节韧带重建及损伤后的康复具有重要意义。本文对近年来膝关节生物力学的研究方法及静力稳定结构在膝关节由伸直到高屈曲运动过程中的生物力学特点进行了阐述;对今后全膝置换术中软组织平衡、膝关节韧带修复与重建及伤后与术后康复方面的研究方向进行了展望和预测。     

Comparison of outcome after ACL reconstruction in terms of subjective assessment of symptoms and function and clinical assessment of ligament stability

Background

The knee joint is frequently involved in sports and other injuries with Anterior cruciate ligament being a very common ligament to be injured. The Lachman test, pivot-shift test, and instrumented knee laxity examination are frequently used and reported for evaluation of ACL reconstruction. The aim of this study is to examine and evaluate the relationships between the clinical assessment of ligament stability and subjective assessment of symptoms and function after ACL reconstruction.