Journal of Clinical Medicine

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12 pages, 7072 KiB

Open AccessArticle

A Novel Technique of Arthroscopic Femoral Tunnel Placement during Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Dislocation

by Fengyi Hu, Weili Shi, Haijun Wang and Cheng Wang

J. Clin. Med. 2023, 12(2), 680; https://doi.org/10.3390/jcm12020680 - 15 Jan 2023

Cited by 1 | Viewed by 1729

Abstract

Recurrent patellar dislocation is a commonly encountered patellofemoral disease. Prompt surgical intervention is indicated for recurrent dislocation to restore patellofemoral stability. As one of the most preferred procedures, medial patellofemoral ligament (MPFL) reconstruction has been implemented on a large scale. Femoral tunnel placement [...] Read more.

Recurrent patellar dislocation is a commonly encountered patellofemoral disease. Prompt surgical intervention is indicated for recurrent dislocation to restore patellofemoral stability. As one of the most preferred procedures, medial patellofemoral ligament (MPFL) reconstruction has been implemented on a large scale. Femoral tunnel placement remains a crucial technical issue during MPFL reconstruction and is critical to ensure the isometry and proper tension of the graft. Currently, visual–palpatory anatomic landmarks and fluoroscopy-guided radiographic landmarks comprise the main approaches to intraoperative femoral tunnel positioning. However, the accuracy of both methods has been questioned. This article introduces an arthroscopic femoral tunnel placement technique. Apart from traditional anteromedial and anterolateral portals, two auxiliary arthroscopic portals are specially designed. The adductor tubercle, the medial epicondyle and the posterior edge are selected as main anatomic landmarks and are directly visualized in sequence under arthroscope. The relative position between the femoral attachment of the MPFL and the three landmarks is measured on preoperative three-dimensional computed tomography, providing semi-quantified reference for intraoperative localization. This technique achieves minimally invasive tunnel placement without X-ray exposure, and especially suits obese patients for whom palpatory methods are difficult to perform. Full article

(This article belongs to the Special Issue Minimally Invasive Treatment with Arthroscopy in Arthropathy)

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7 pages, 1844 KiB

Open AccessArticle

RETRACTED: Clinical Effect of Arthroscopic Resection of Extra-Articular Knee Osteochondroma

by Peng Chen, Li Shen, Qiong Long, Wei Dai, Xiaocheng Jiang, Canfeng Li, Jianwei Zuo, Jiang Guo and Xintao Zhang

J. Clin. Med. 2023, 12(1), 52; https://doi.org/10.3390/jcm12010052 - 21 Dec 2022

Cited by 2 | Viewed by 1612 | Retraction

Abstract

Objective: The aim of this study was to investigate clinical outcomes of arthroscopic resection of extraarticular knee osteochondroma. Methods: A retrospective analysis was performed in 74 patients with extra-articular knee osteochondroma treated by arthroscopic resection between August 2011 and August 2021, [...] Read more.

Objective: The aim of this study was to investigate clinical outcomes of arthroscopic resection of extraarticular knee osteochondroma. Methods: A retrospective analysis was performed in 74 patients with extra-articular knee osteochondroma treated by arthroscopic resection between August 2011 and August 2021, including 43 males and 31 females. Overall, 26 Distal femur cases and 48 proximal tibia cases were involved, with an average age of 31.7 ± 11.3 (11–57) years. Preoperative routine knee X-ray, CT, and MRI were performed before the operation. The Lysholm knee score, International Knee Documentation Committee (IKDC) score, Tegner knee motor function score, and visual analogue scale (VAS) were used to evaluate symptoms and functions before surgery and 3, 6, 12, and ≥24 months after surgery. Results: The average course of disease was (7.9 ± 3.7) months (range, 3–14 months) in 74 patients. The average follow-up was (22.6 ± 6.4) months (range, 10–37 months). There were no cases of vascular or nerve injury or wound infection. Compared with the preoperative function, the average scores of VAS, Lysholm, IKDC, and Tegner joint motor function decreased or increased significantly compared with the last follow-up (3.6 ± 1.1 vs. 0.1 ± 0.02, 44.5 ± 2.3 vs. 91.3 ± 4.9, 53.7 ± 2.6 vs. 94.2 ± 5.1, 4.6 ± 1.2 vs. 9.4 ± 1.4, p < 0.001). There was no recurrence or metastasis during the follow up. Conclusions: With the advantages of less trauma, high precision, less pain, and rapid recovery, arthroscopic resection of extra-articular knee osteochondroma can significantly improve the function of knee. It can be gradually extended to the treatment of other benign bone tumors. Full article

(This article belongs to the Special Issue Minimally Invasive Treatment with Arthroscopy in Arthropathy)

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11 pages, 1490 KiB

Open AccessArticle

The Prevalence and Characteristics of Chronic Ankle Instability in Elite Athletes of Different Sports: A Cross-Sectional Study

by Congda Zhang, Na Chen, Jingsong Wang, Zhengzheng Zhang, Chuan Jiang, Zhong Chen, Jianhui Fang, Juhua Peng, Weiping Li and Bin Song

J. Clin. Med. 2022, 11(24), 7478; https://doi.org/10.3390/jcm11247478 - 16 Dec 2022

Cited by 6 | Viewed by 1856

Abstract

Background: Ankle sprains are one of the most common injuries in athletic populations. Misdiagnosed and untreated ankle sprains will cause chronic ankle instability (CAI), which can significantly affect the performance of athletes. This study aimed to investigate the prevalence and characteristics of CAI [...] Read more.

Background: Ankle sprains are one of the most common injuries in athletic populations. Misdiagnosed and untreated ankle sprains will cause chronic ankle instability (CAI), which can significantly affect the performance of athletes. This study aimed to investigate the prevalence and characteristics of CAI in elite athletes of different sports. Method: This cross-sectional study included 198 elite athletes from Guangdong provincial sports teams. All participants answered a questionnaire about ankle sprains and ankle instability. The severity of their ankle instability was evaluated by the Cumberland Ankle Instability Tool (CAIT). Participants further underwent clinical examinations from sports medicine doctors to determine the presence and characteristics of ankle instability. The datasets were analyzed to determine the differences in prevalence between age, gender, sports teams, and sports categories. Results: In 198 athletes, 39.4% (n = 78) had bilateral CAI while 25.3% (n = 50) had unilateral CAI. Female athletes had a higher prevalence of CAI than male athletes in the study (p = 0.01). Prevalence showed differences between sports categories, and were significantly higher in acrobatic athletes than non-contact athletes (p = 0.03). Conclusions: CAI was highly prevalent among elite athletes in this study, with female athletes and athletes in acrobatic sports being associated with a higher risk of developing CAI in their professional careers. Therefore, extra precautions need to be taken into account when applying ankle protections for these athletes. Full article

(This article belongs to the Special Issue Minimally Invasive Treatment with Arthroscopy in Arthropathy)

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11 pages, 704 KiB

Open AccessArticle

Analysis of Visual Risk Factors of Anterior Cruciate Ligament Injury of Knee Joint

by Zhong Chen, Yuheng Li, Yichi Zhang, Zhengzheng Zhang, Jingsong Wang, Xinghao Deng, Chengxiao Liu, Na Chen, Chuan Jiang, Weiping Li and Bin Song

J. Clin. Med. 2022, 11(19), 5602; https://doi.org/10.3390/jcm11195602 - 23 Sep 2022

Cited by 1 | Viewed by 1723

Abstract

This study aimed to explore whether the defect of visual function is a risk factor of knee anterior cruciate ligament (ACL) sports injury and to provide a theoretical basis for the primary prevention of ACL sports injury. This cross-sectional study included 392 participants [...] Read more.

This study aimed to explore whether the defect of visual function is a risk factor of knee anterior cruciate ligament (ACL) sports injury and to provide a theoretical basis for the primary prevention of ACL sports injury. This cross-sectional study included 392 participants divided into two groups: the sports injury group (287 with sports injury of knee) and the control group (105 healthy volunteers). Participants in the sports injury group were further divided into the ACL-Intact group (133) and the ACL-Deficient group (154). Participants in the sports injury group received a questionnaire about the conditions of their injury (including injury action, site condition, weather, contact) and a visual examination by synoptophore (including binocular vision, subjective and objective oblique angle, visual fusion range, stereoacuity). Participants in the control group only received the visual examination. In the end, we found that low visual fusion range (p = 0.003) and injury action, especially quick turn (p = 0.001), sudden stop (p < 0.001) and jump (p = 0.001), are the major risk factors for ACL injury in the analysis of the integrated data. In addition, athletes with low vision fusion range have increased risk of ACL sports injury when they make a sudden stop on wooden floor, plastic floor or cement floor on cloudy days (OR = 13.208). Visual factors, especially low fusion range, significantly increase the risk of ACL sports injury. Full article

(This article belongs to the Special Issue Minimally Invasive Treatment with Arthroscopy in Arthropathy)

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12 pages, 1775 KiB

Open AccessArticle

Knee Kinematic Patterns and Early Cartilage Lesion Characteristics in Patients with Anterior Cruciate Ligament Reconstruction

by Xiaolong Zeng, Jiajun Zeng, Jinpeng Lin, Lingchuang Kong, Haobin Chen, Guoqing Zhong, Limin Ma, Yu Zhang and Wenhan Huang

J. Clin. Med. 2022, 11(18), 5457; https://doi.org/10.3390/jcm11185457 - 16 Sep 2022

Viewed by 1363

Abstract

Specific knee kinematic alterations have been theorized to correlate with the progression of cartilage degeneration, and therefore, post-traumatic osteoarthritis in patients with anterior cruciate ligament reconstruction (ACLR). However, how specific knee kinematic alterations contribute to knee joint cartilage degenerations remains to be unclear. [...] Read more.

Specific knee kinematic alterations have been theorized to correlate with the progression of cartilage degeneration, and therefore, post-traumatic osteoarthritis in patients with anterior cruciate ligament reconstruction (ACLR). However, how specific knee kinematic alterations contribute to knee joint cartilage degenerations remains to be unclear. To solve this problem, we hypothesized that there are specific cartilage-degenerating kinematic gait patterns that could be supported by the specific areas of cartilage lesions in ACLR knees. Thirty patients with unilateral ACLR knees and 30 healthy controls were recruited for the study. The kinematic differences between the ACLR knees and the healthy control knees during the stance phase were calculated to identify the kinematic patterns. Cartilage lesion distribution characteristics were acquired for patients with ACLR knees to validate the kinematic patterns using magnetic resonance images. Two kinematic patterns were modeled, i.e., sagittal (increased flexion angle and posterior tibial translation) and coronal (increased lateral tibial translation and abduction angle) kinematic patterns. For the sagittal pattern, the cartilage lesion distributions showed that there were more cartilage lesions (CLs) in the superoposterior regions than the posterior regions in the femoral condyles (p = 0.001), and more CLs in the posterior regions than the middle regions in the tibial plateau (p < 0.001). For the coronal pattern, the cartilage lesion distributions showed that there were more CLs in the lateral compartments near the tibial spine than the medial compartments near the tibial spine (tibial sides, p = 0.005 and femoral sides, p = 0.290). To conclude, the cartilage degeneration distribution evidence largely supports that the two kinematic patterns may contribute to cartilage degeneration in ACLR knees. These findings may provide a potential strategy of delaying early cartilage degeneration in ACLR knees by using motion (kinematic) pattern modification or training. However, investigations should be conducted on the actual effects of this potential strategy. Full article

(This article belongs to the Special Issue Minimally Invasive Treatment with Arthroscopy in Arthropathy)

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14 pages, 3790 KiB

Open AccessArticle

Biomechanical Study of Arthroscopic All-Inside Anterior Talofibular Ligament Suture Augmentation Repair, Plus Suture Augmentation Repair and Anterior Tibiofibular Ligament’s Distal Fascicle Transfer Augmentation Repair

by Lei Xiao, Boyuan Zheng, Yijuan Zhou, Dahai Hu, Jieruo Li, Xiaofei Zheng, Huige Hou and Huajun Wang

J. Clin. Med. 2022, 11(17), 5235; https://doi.org/10.3390/jcm11175235 - 5 Sep 2022

Cited by 3 | Viewed by 1568

Abstract

Objective: To explore the biomechanical efficacy of arthroscopic all-inside anterior talofibular ligament (ATFL) suture augmentation repair, plus suture augmentation repair and anterior tibiofibular ligament-distal fascicle (ATiFL-DF) transfer augmentation repair, so as to provide a basis for the accurate selection of ATFL repair in [...] Read more.

Objective: To explore the biomechanical efficacy of arthroscopic all-inside anterior talofibular ligament (ATFL) suture augmentation repair, plus suture augmentation repair and anterior tibiofibular ligament-distal fascicle (ATiFL-DF) transfer augmentation repair, so as to provide a basis for the accurate selection of ATFL repair in clinical practice. Methods: Twenty-four (12 pairs) fresh frozen human cadaver ankle specimens were used. Six of the ankle specimens were set as the normal group, and the other 18 ankle specimens were used to establish ATFL injury models. The ATFL was then repaired using arthroscopic all-inside ATFL suture augmentation repair (suture augmentation group), plus suture augmentation repair (plus suture augmentation group) and ATiFL-DF transfer augmentation repair (biological augmentation group), respectively. After the repaired ATFL was separated, the ankle specimens were fixed on an electronic universal testing machine with a customized fixture for the tensile test, and the ultimate failure load (N) and stiffness (N/mm) of the ankle specimens were compared. Results: The ultimate failure load of the plus suture augmentation group (229.3 ± 66.7 N) was significantly higher than that in the normal group (148.2 ± 39.4 N, p = 0.045) and the biological augmentation group (131.3 ± 38.8 N, p = 0.013). There was no statistical difference in ultimate failure load between the suture augmentation group (167.2 ± 47.2 N), the normal group and the biological augmentation group. The stiffness of the plus suture augmentation group (26.2 ± 8.2 N/mm) was significantly higher than that in the normal group (12.1 ± 3.8 N/mm, p = 0.005) and the biological augmentation group (12.7 ± 5.2 N/mm, p = 0.007). The stiffness of the suture augmentation group (23.6 ± 7.0 N/mm) was significantly higher than that in the normal group (p = 0.024) and the biological augmentation group (p = 0.033). There was no statistical difference in stiffness between the plus suture augmentation group and the suture augmentation group, and no statistical difference in stiffness between the normal group and the biological augmentation group. Conclusions: The tensile strength and rigidity of plus suture augmentation repair were significantly better than those of normal ATFL, suture augmentation repair and ATiFL-DF transfer augmentation repair. Suture augmentation repair can obtain tensile strength similar to normal ATFL and ATiFL-DF transfer augmentation repair, and suture augmentation repair can obtain rigidity significantly better than normal ATFL and ATiFL-DF transfer augmentation repair. ATiFL-DF transfer augmentation repair can obtain tensile strength and rigidity similar to normal ATFL. Full article

(This article belongs to the Special Issue Minimally Invasive Treatment with Arthroscopy in Arthropathy)

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Other

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5 pages, 13264 KiB

Open AccessTechnical Note

Crochet Hook Technique for Arthroscopic Anterior Talofibular Ligament Repair: Technique Note

by Zitao Liu, Jing Li, Gengxin Chen, Shihua Gao, Enhui Feng, Haitao Su, Haiyun Chen and Tao Jiang

J. Clin. Med. 2022, 11(23), 6922; https://doi.org/10.3390/jcm11236922 - 24 Nov 2022

Cited by 1 | Viewed by 1475

Abstract

Ankle sprains can lead to chronic lateral ankle instability caused by an injured anterior talofibular ligament (ATFL), and surgery is often required when conservative treatments fail. BROSTROM surgery is considered the gold standard and has a definite curative effect. Advancements in arthroscopic surgery [...] Read more.

Ankle sprains can lead to chronic lateral ankle instability caused by an injured anterior talofibular ligament (ATFL), and surgery is often required when conservative treatments fail. BROSTROM surgery is considered the gold standard and has a definite curative effect. Advancements in arthroscopic surgery and improvements in implanted anchors have led to an increase in ATFL repairs using arthroscopic surgery. Arthroscopic AFTL repair is less invasive, and patients could experience faster recovery compared to open AFTL repair. To simplify the complicated suture-passing processes in arthroscopic AFTL repair, we developed a crochet hook and loop wire technique, which is described in this paper. Full article

(This article belongs to the Special Issue Minimally Invasive Treatment with Arthroscopy in Arthropathy)

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14 pages, 1772 KiB

Open AccessSystematic Review

Efficacy and Safety of Tranexamic Acid in Shoulder Arthroscopic Surgery: A Systematic Review and Meta-Analysis

by Yiyuan Sun, Dan Xiao, Weili Fu, Wufeng Cai, Xihao Huang, Qi Li and Jian Li

J. Clin. Med. 2022, 11(23), 6886; https://doi.org/10.3390/jcm11236886 - 22 Nov 2022

Cited by 5 | Viewed by 2557

Abstract

Background: Visual clarity during shoulder arthroscopy can ensure an efficient and effective performance of the procedure, and it is highly related to bleeding without a tourniquet. Tranexamic acid (TXA) is widely used in adult reconstruction procedures; however, its use in shoulder arthroscopic operations [...] Read more.

Background: Visual clarity during shoulder arthroscopy can ensure an efficient and effective performance of the procedure, and it is highly related to bleeding without a tourniquet. Tranexamic acid (TXA) is widely used in adult reconstruction procedures; however, its use in shoulder arthroscopic operations is a relatively novel topic. Purpose: To analyze the available literature on visual clarity, blood loss, pain control, functional outcomes, and complications after the administration of tranexamic acid in shoulder arthroscopic surgery. Methods: A literature search was performed to retrieve randomized controlled trials examining the use of tranexamic acid at the time of shoulder arthroscopic surgery. The literature search included the MEDLINE, Embase, Web of Science, and Cochrane Library databases. The primary outcomes included visual clarity, blood loss, and visual analog scale scores for pain. Secondary outcomes were operative time, irrigation amount used, postoperative shoulder swelling, the need for pressure increase, mean arterial pressure (MAP), functional outcomes, postoperative adverse effects such as deep venous thrombosis, and pulmonary embolism. The outcomes were pooled to perform a meta-analysis. Results: Seven prospective randomized controlled trials met the inclusion criteria for analysis. All of the included studies performed arthroscopic rotator cuff repair. No significant difference in visual clarity was observed (SMD (standardized mean difference), 0.45 [95% CI(confidence interval), −0.68, 1.59]; p = 0.44) nor in pain score (MD (mean difference), −0.46 [95% CI, −0.97, 0.05]; p = 0.08) between the TXA group and the control group. Two studies found no significant difference in blood loss between the TXA group and the control group. The meta-analysis from five studies demonstrated no significant difference between the TXA and control groups in operative time (MD, −3.51 [95% CI, −15.82, 8.80]; p = 0.58) or irrigation amount used (MD, −2.53 [95% CI, −5.93, 0.87]; p = 0.14). Two trials reported different statistical results in postoperative shoulder swelling. No significant differences regarding the need for pressure increase and MAP were reported between groups. No wound complications or infections or cardiac, thrombotic, or thromboembolic complications were recorded in either group. Conclusion: The use of intravenous or local TXA in shoulder arthroscopic surgery did not increase complications or thromboembolic events, but TXA had no obviously effect of reducing bleeding to obtain a clear visual field or pain release in patients undergoing shoulder arthroscopic surgery. Full article

(This article belongs to the Special Issue Minimally Invasive Treatment with Arthroscopy in Arthropathy)

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