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Accuracy of the newly developed Zimmer Biomet Root Aiming guide in tibial tunnel creation compared with that of conventional guides 与传统导向器相比,新型Zimmer Biomet根部瞄准导向器在胫骨隧道创建中的准确性
IF 2.1 Q2 Medicine Pub Date : 2023-04-01 DOI: 10.1016/j.asmart.2023.03.001
Takaaki Hiranaka , Takayuki Furumatsu , Yuki Okazaki , Keisuke Kintaka , Naohiro Higashihara , Masanori Tamura , Eiji Nakata , Toshifumi Ozaki

Background/objective

Accurate tibial tunnel creation is crucial for successful transtibial pullout repair of medial meniscus (MM) posterior root tears (MMPRTs). This study aimed to evaluate the accuracy of the newly developed Zimmer Biomet Root Aiming (ZeBRA) guide for transtibial pullout repair of MMPRTs.

Methods

This study included 50 patients who underwent transtibial pullout repair using the Unicorn Meniscal Root (UMR) (n = 25) and ZeBRA (n = 25) guides. The expected anatomic centre (AC) and tibial tunnel centre (TC) were assessed using three-dimensional postoperative computed tomography (CT) images. The expected AC was defined as the centre of the circle tangent to the triangular footprint of the MM posterior root. The expected AC and TC on the tibial surface were assessed using the percentage-based posterolateral location on the tibial surface. The absolute distance between the AC and TC (mm) was evaluated.

Results

The mean AC location was 76.1% ± 3.1% posterior and 40.8% ± 2.1% lateral, whereas the mean TC location was 76.7% ± 5.3% posterior and 37.2% ± 3.6% lateral using the UMR guide and 75.8% ± 3.1% posterior and 36.5% ± 2.4% lateral using the ZeBRA guide. No significant difference was observed in the absolute distance between the UMR and ZeBRA guides (3.9 ± 1.4 and 3.8 ± 1.3 mm, respectively; p = 0.617).

Conclusions

The newly developed ZeBRA guide allows accurate tibial tunnel creation, and its accuracy is comparable to that of the conventional UMR guide. Tibial tunnels were created at optimal positions using both guides, and the choice of the guide would depend on the surgeon's preference.

背景/目的准确建立胫骨隧道对于成功经胫骨拔出修复内侧半月板(MM)后根撕裂(MMPRT)至关重要。本研究旨在评估最新开发的Zimmer Biomet Root Aiming(ZeBRA)引导器用于MMPRTs经胫骨拔出修复的准确性。方法本研究包括50名使用Unicorn半月板根(UMR)(n=25)和ZeBRA(n=25。使用三维术后计算机断层扫描(CT)图像评估预期解剖中心(AC)和胫骨隧道中心(TC)。预期的AC被定义为与MM后根的三角形足迹相切的圆心。使用基于百分比的胫骨表面后外侧位置来评估胫骨表面上的预期AC和TC。评估AC和TC之间的绝对距离(mm)。结果使用UMR引导的平均AC位置为76.1%±3.1%和40.8%±2.1%,而使用ZeBRA引导的平均TC位置为76.7%±5.3%和37.2%±3.6%,以及75.8%±3.1%和36.5%±2.4%。UMR和ZeBRA引导器之间的绝对距离没有显著差异(分别为3.9±1.4和3.8±1.3 mm;p=0.617)。使用两种引导器在最佳位置创建胫骨隧道,引导器的选择将取决于外科医生的偏好。
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引用次数: 0
Non-use of intra-articular drain after anterior cruciate ligament reconstruction does not affect postoperative knee pain and muscle strength on early period 前交叉韧带重建术后不使用关节内引流对术后早期膝关节疼痛和肌力无影响
IF 2.1 Q2 Medicine Pub Date : 2023-04-01 DOI: 10.1016/j.asmart.2023.04.002
Kengo Shimozaki, Junsuke Nakase, Rikuto Yoshimizu, Tomoyuki Kanayama, Yusuke Yanatori, Takuya Sengoku, Hiroyuki Tsuchiya

Introduction

This study aimed to determine the effect of using an intra-articular drain after anterior cruciate ligament (ACL) reconstruction on early postoperative pain, range of motion (ROM), muscle strength, and complications.

Materials and methods

Between 2017 and 2020, of the 200 consecutive patients who underwent anatomical single-bundle ACL reconstruction, 128 patients underwent primary ACL reconstruction with hamstring tendons and were evaluated for postoperative pain and muscle strength at 3 months postoperatively. Sixty-eight patients who received intra-articular drain before April 2019 were classified as group D and 60 patients without an intra-articular drain after ACL reconstruction after May 2019 were classified as group N. Patient background, operative time, postoperative pain, number of additional analgesics used, presence of intra-articular hematoma, ROM at 2, 4, and 12 weeks postoperatively, extensor and flexor muscle strength at 12 weeks postoperatively, and perioperative complications were compared between the two groups.

Results

The postoperative pain at 4 h after surgery was significantly greater in group D than in group N although no significant difference was found in the pain felt in the immediate postoperative period and at 1 day and 2 days postoperatively and in the number of additional analgesics used. No significant difference in the postoperative ROM and muscle strength was noted between the two groups. Six patients with intra-articular hematomas in group D and four patients in group N needed puncture by 2 weeks postoperatively, and no significant difference was found between the two groups.

Conclusion

Postoperative pain was greater at 4 h postoperatively in group D. Furthermore, the intra-articular drain did not affect muscle strength, ROM, and complications on the early postoperative period. The usefulness of intra-articular drain after ACL reconstruction was considered low.

Level of Evidence

Level IV.

引言本研究旨在确定前交叉韧带(ACL)重建后使用关节内引流管对术后早期疼痛、活动范围(ROM)、肌肉力量和并发症的影响。材料和方法2017年至2020年间,在连续200名接受解剖性单束前交叉韧带重建的患者中,128名患者接受了腘绳肌腱的前交叉韧带初次重建,并在术后3个月评估了术后疼痛和肌肉力量。在2019年4月之前接受关节内引流的68名患者被归类为D组,在2019年5月之后ACL重建后没有接受关节内排水的60名患者被分类为N组。患者背景、手术时间、术后疼痛、额外使用的止痛药数量、关节内血肿的存在、术后2、4和12周的ROM,比较两组患者术后12周的伸肌和屈肌力量以及围手术期并发症。结果D组术后4小时的疼痛明显大于N组,但术后即刻、术后1天和2天的疼痛感以及额外镇痛药的使用量没有显著差异。两组患者术后ROM和肌力无显著差异。D组6例关节内血肿患者和N组4例患者术后2周需要穿刺,两组之间无显著差异。结论D组术后4 h疼痛较大,关节内引流对术后早期肌力、ROM及并发症无影响。ACL重建后关节内引流的有效性被认为较低。证据级别IV级。
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引用次数: 0
Analyses of associated factors with concomitant meniscal injury and irreparable meniscal tear at primary anterior cruciate ligament reconstruction in young patients 青年原发性前交叉韧带重建术并发半月板损伤及不可修复半月板撕裂的相关因素分析
IF 2.1 Q2 Medicine Pub Date : 2023-04-01 DOI: 10.1016/j.asmart.2023.04.001
Tomohiro Tomihara , Yusuke Hashimoto , Shinji Takahashi , Masatoshi Taniuchi , Junsei Takigami , Shuko Tsumoto , Nagakazu Shimada

Purpose:

Although several factors related to the concomitant meniscal injury at anterior cruciate ligament reconstruction (ACL-R) have been investigated in a general population, few studies have identified the risk factors of meniscal tear severity in young patients in which the majority of ACL tears occur. The purpose of this study was to analyze the associated factors with meniscal injury and irreparable meniscal tear and the timeline for medial meniscal injury at ACL-R in young patients.

Methods:

A retrospective analysis of young patients (13 to 29 years of age) who underwent ACL-R by a single surgeon from 2005 to 2017 was conducted. Predictor variables (age, sex,body mass index [BMI], time from injury to surgery [TS], and pre-injury Tegner activity level) for meniscal injury and irreparable meniscal tear were analyzed with multivariate logistic

Results:

Four hundred and seventy-three consecutive patients with an average of 31.2 months post-operative follow-up were enrolled in this study. The risk factors for medial meniscus injury were TS (<= 3 months) (odds ratio [OR], 3.915; 95% CI, 2.630-5.827; P < .0001) and higher BMI (OR, 1.062; 95% CI, 1.002-1.125; P = 0.0439). The presence of irreparable medial meniscal tears correlated with higher BMI (OR, 1.104; 95% CI, 1.011-1.205; P = 0.0281)

Conclusion

An increased time from ACL tear to surgery of 3 months was strongly associated with an increased risk of medial meniscus injury, but not related to irreparable medial meniscal tear at primary ACL reconstruction in young patients.

Level of Evidence

Level IV.

目的:尽管在普通人群中研究了与前交叉韧带重建(ACL-R)时伴有半月板损伤相关的几个因素,但很少有研究确定年轻患者半月板撕裂严重程度的风险因素,其中大多数ACL撕裂发生在年轻患者中。本研究的目的是分析年轻患者半月板损伤和无法修复的半月板撕裂的相关因素,以及ACL-R时内侧半月板损伤的时间线。方法:对2005年至2017年由一名外科医生接受ACL-R的年轻患者(13至29岁)进行回顾性分析。采用多变量逻辑分析半月板损伤和无法修复的半月板撕裂的预测变量(年龄、性别、体重指数[BMI]、从损伤到手术的时间[TS]和损伤前Tegner活动水平)。内侧半月板损伤的危险因素是TS(<;=3个月)(比值比[OR],3.915;95%可信区间,2.630-5.827;P<;.0001)和较高的BMI(OR,1.062;95%置信区间,1.002-1.125;P=0.0439)。无法修复的内侧半月板撕裂的存在与较高的BMI相关(OR,1.104;95%可信范围,1.011-1.205;P=0.0281)结论ACL撕裂至手术时间增加3个月与与内侧半月板损伤的风险增加,但与年轻患者初次ACL重建时无法修复的内侧半月板撕裂无关。证据级别IV级。
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引用次数: 0
Bi-Cortical transhumeral drilling for biceps tenodesis – Is it safe? 双皮质经肱骨钻孔治疗肱二头肌肌腱固定术安全吗?
IF 2.1 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1016/j.asmart.2022.12.001
Bancha Chernchujit, Amolnat Chiarnpattanodom, Sumit Agrawal

Background

Biceps tenodesis is an effective procedure performed to treat shoulder pain originating from the long head biceps tendon. In arthroscopic biceps tenodesis unicortical drilling of the humerus is more commonly practiced as it is considered safe to the vital structures lying posterior to the proximal humerus. Many surgeons are wary of the bi-cortical approach as it poses a risk to these vital structures. The aim of this study was to establish whether bi-cortical drilling in proximal humerus is safe or not. Our second purpose was to find a safe zone (if any) for bi-cortical drilling if bi-cortical drilling is safe.

Methods

This study is a descriptive study conducted on cadaveric shoulders. Bilateral shoulders and arms of ten fresh-frozen cadavers (mean age 77.7 y) were dissected. Four landmarks in the dissected humerus were identified. They were superior margin of the bicipital groove, center of the bicipital groove, upper and lower border of pectoralis major insertion. Bi-cortical trans-humeral pinning was done in the humerus at all these points so that the pin exited through the posterior cortex of the humerus. The shortest distance between the pin and the nearest vital structure namely axillary nerve, radial nerve, articular surface of the humeral head, and cephalic vein was calculated from each fixed landmark.

Results

We established that bi-cortical drilling in proximal humerus was safe. The safe zone established for bi-cortical biceps tenodesis is at the middle of bicipital groove, which is 18.00 ± 4.02 mm inferior to the groove’s upper border. The boundaries of the safe zone lie 9.39 mm superiorly and 9.40 mm inferiorly to the middle of the bicipital groove.

Conclusion

The center of the established safe zone for bi-cortical trans-humeral pinning was 18 mm inferior to the bicipital groove’s upper border.

研究背景二头肌腱固定术是治疗由长头二头肌腱引起的肩部疼痛的有效方法。在关节镜下,肱骨二头肌腱单皮质钻孔更为常见,因为它被认为对肱骨近端后方的重要结构是安全的。许多外科医生对双皮质入路持谨慎态度,因为它会对这些重要结构构成风险。本研究的目的是确定肱骨近端双皮质钻孔是否安全。我们的第二个目的是找到一个安全区(如果有的话),如果双侧皮质钻孔是安全的。方法本研究是对尸体肩部进行描述性研究。解剖了10具新鲜冷冻尸体(平均年龄77.7岁)的双侧肩臂。解剖肱骨中的四个标志被确定。它们分别是肱二头肌沟的上缘、肱二头肌槽的中心、胸大肌插入的上下边界。在所有这些点对肱骨进行双皮质经肱骨钉扎,使钉穿过肱骨后皮质。根据每个固定标志计算销钉与最近的重要结构(即腋神经、桡神经、肱骨头关节面和头静脉)之间的最短距离。结果我们确定肱骨近端的双皮质钻孔是安全的。为双皮质二头肌肌腱固定建立的安全区位于二头肌沟的中间,该中间距离沟的上边界18.00±4.02mm。安全区的边界位于肱二头肌槽中部上方9.39mm和下方9.40mm处。结论经肱骨双皮质钉扎的安全区中心位于肱骨沟上缘下方18mm处。
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引用次数: 0
Reduction of perioperative blood loss and operating time for arthroscopic rotator cuff repair by intravenous administration of tranexamic acid 静脉注射氨甲环酸减少关节镜下肩袖修复术的围术期出血量和手术时间
IF 2.1 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1016/j.asmart.2023.01.001
Shinji Kawaguchi , Shoji Fukuta , Masashi Kano , Koichi Sairyo

Background

Tranexamic acid (TXA) is widely used in hip and knee arthroplasty to reduce perioperative bleeding. Recently, its use has been expanded to arthroscopic surgery. The purpose of this study was to evaluate the efficacy of preoperative use of TXA in arthroscopic rotator cuff repair (RCR).

Methods

A cohort comprising 129 consecutive patients who underwent arthroscopic primary RCR at our institution was retrospectively investigated according to whether they received TXA (April 2018 to December 2020, TXA group, n = 64) or did not receive TXA (April 2016 to March 2018, non-TXA group, n = 65). TXA was administered at a dose of 1 g intravenously. Rotator cuff tears were repaired by the suture bridge technique. Videos of the arthroscopic procedures were reviewed and rated for visual clarity using a 10-point numeric rating scale. Arthroscopic procedures were divided into glenohumeral, resection of bursal tissue and acromioplasty, and RCR steps. Each step was rated separately. Age, sex, body mass index, hemoglobin level before and on days 1 and 7 after surgery, operating time, mean arterial pressure, tear size, and number of anchors used for cuff repair were compared between the two groups.

Results

There were no statistically significant differences in the patient demographic data. The operating time was significantly shorter in the TXA group than in non-TXA group (97.8 ± 21.8 min vs 116.2 ± 26.0 min). The clarity of the visual field was similar between the two groups during the glenohumeral phase but was significantly higher in the TXA group during the resection of bursal tissue and acromioplasty and RCR phases. Hemoglobin level was not significantly different between the groups on postoperative day 1 but was significantly higher in the TXA group on day 7.

Conclusion

Administration of a single intravenous dose of TXA improved visual clarity in arthroscopic RCR, decreased the total operating time, and reduced hemoglobin loss on postoperative day 7.

背景氨甲环酸(TXA)广泛应用于髋关节和膝关节置换术以减少围手术期出血。最近,它的应用已经扩展到关节镜手术。本研究的目的是评估术前使用TXA进行关节镜下肩袖修复(RCR)的疗效(2016年4月至2018年3月,非TXA组,n=65)。TXA以1g的剂量静脉内给药。采用缝合桥技术修复旋转袖撕裂。对关节镜手术的视频进行了审查,并使用10分数字评分表对其视觉清晰度进行了评分。关节镜手术分为肩关节、囊组织切除和肩峰成形术以及RCR步骤。每一步都是单独评分的。比较两组患者的年龄、性别、体重指数、术前和术后第1天和第7天的血红蛋白水平、手术时间、平均动脉压、撕裂大小和用于袖带修复的锚钉数量。结果患者人口学数据无统计学意义差异。TXA组的手术时间明显短于非TXA组(97.8±21.8min vs 116.2±26.0min)。两组在肩关节期的视野清晰度相似,但TXA组在囊组织切除、肩峰成形术和RCR期的视野清晰度明显较高。术后第1天,两组之间的血红蛋白水平没有显著差异,但在第7天,TXA组的血红蛋白水平显著升高。结论单次静脉注射TXA可提高关节镜下RCR的视觉清晰度,缩短总手术时间,并在术后第7天减少血红蛋白损失。
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引用次数: 1
Femoral-varus tibial-valgus osteotomy (FVTVO) for neutrally-aligned knee osteoarthritis with severe joint line obliquity enables return to sports activities: A case series study 股骨内翻胫骨外翻截骨术(FVTVO)治疗伴有严重关节线倾斜的中性膝关节骨性关节炎,使其能够恢复体育活动:一个病例系列研究
IF 2.1 Q2 Medicine Pub Date : 2023-01-01 DOI: 10.1016/j.asmart.2023.01.002
Ryuichi Nakamura , Masaki Amemiya , Tomoyuki Shimakawa , Masaki Takahashi , Kazunari Kuroda , Yasuo Katsuki , Akira Okano

Background

Re-alignment surgeries for uni-compartmental knee osteoarthritis, such as high tibial osteotomy (HTO) for varus knees or distal femoral osteotomy (DFO) for valgus knees, are recognized as standard strategies. However, the treatment strategy has not been established for patients with a neutrally-aligned osteoarthritic knee with severe joint line obliquity (JLO) owing to the combination of a valgus femur and a varus tibia; i.e., type II coronal plane alignment of the knee (CPAK). total knee arthroplasty (TKA) can be an option for CPAK type II-aligned osteoarthritis in older inactive patients. Here, we hypothesized that joint line horizontalization by femoral-varus tibial-valgus osteotomy (FVTVO), which may reduce the shear stress induced by JLO, could be a treatment option for CPAK type II-aligned osteoarthritis in young active patients who wish to return to sports (RTS) activity. Our aim in this study was to evaluate the postoperative results of FVTVO with RTS.

Methods

Our indications for FVTVO are as follows: JLO >5°; mechanical medial proximal tibial angle (mMPTA) < 87°; mechanical lateral distal femoral angle (mLDFA) < 87°; typical osteoarthritis patterns for CPAK type II on magnetic resonance images, namely osteoarthritic change of the lateral tibial spine, medial slip of the femur, and/or lateral meniscal extrusion from the lateral femoral condyle; and flexion contracture <10°. We enrolled patients who wished to RTS and who had a pre-symptom Tegner score ≥5 and had completed at least a 1-year follow-up. For FVTVO, closed-wedge DFO was performed in all femurs; both closed-wedge HTO and open-wedge HTO were used in the tibia, depending on the situation. Range of motion exercises began on the first postoperative day, and full weight-bearing was permitted 6 weeks postoperatively. Jogging was permitted 3 months postoperatively after confirming bone union, and patients could gradually return to their sports activity 6–12 months’ postoperatively. The Japanese Orthopaedic Association (JOA) score and knee flexion range were assessed preoperatively and at the last follow-up. Tegner activity scale scores were assessed presymptom, preoperatively, and at the last follow-up. The hip-knee-ankle (HKA) angle, JLO, mMPTA, and mLDFA were evaluated radiologically, and meniscal extrusions, osteoarthritic change, and/or bone marrow edema were assessed on magnetic resonance images.

Results

One man and two women were included in this case series. Two were competitive athletes and one was a mountain climber. The patients' ages were 69, 46, and 57 years (Case 1, 2, and 3, respectively). All patients’ CPAK type was converted from type II to type V; i.e., neutral-aligned knee with a neutral joint line, postoperatively. All patients returned to their presymptom sports activity level by the final follow-up. The presymptom/preoperative/final follow-up Tegner scale in Case 1, 2, and 3 we

背景单室性膝关节骨性关节炎的重新定向手术,如膝内翻的胫骨高位截骨(HTO)或外翻膝的股骨远端截骨(DFO),被公认为标准策略。然而,由于股骨外翻和胫骨内翻的组合,中性排列的骨关节炎膝关节具有严重关节线倾斜(JLO)的患者的治疗策略尚未确定;即膝关节的II型冠状面对准(CPAK)。全膝关节置换术(TKA)可以作为治疗老年不活动患者CPAK II型骨关节炎的一种选择。在这里,我们假设通过股内翻-胫骨外翻截骨(FVTVO)进行关节线水平化,可以减少JLO引起的剪切应力,这可能是希望恢复运动(RTS)活动的年轻活跃患者中CPAK II型骨关节炎的治疗选择。我们在本研究中的目的是用RTS评估FVTVO的术后结果。方法我们的FVTVO适应症如下:JLO>;5°;机械性内侧近端胫骨角(mMTTA)<;87°;股骨远端机械外侧角(mLDFA)<;87°;磁共振图像上CPAK II型的典型骨关节炎模式,即胫骨外侧棘的骨关节炎改变、股骨内侧滑动和/或股骨外侧髁的外侧半月板挤出;以及屈曲挛缩<;10°。我们招募了希望RTS的患者,这些患者的症状前Tegner评分≥5,并完成了至少一年的随访。对于FVTVO,所有股骨均进行了闭合楔形DFO;根据情况在胫骨中同时使用闭合楔形HTO和开放楔形HTO。活动范围训练从术后第一天开始,术后6周允许完全负重。在确认骨愈合后3个月允许慢跑,患者可以在术后6-12个月逐渐恢复运动。术前和最后一次随访时评估了日本骨科协会(JOA)评分和膝关节屈曲范围。Tegner活动量表评分在症状前、术前和最后一次随访时进行评估。对髋膝踝(HKA)角、JLO、mMTTA和mLDFA进行放射学评估,并在磁共振图像上评估半月板挤压、骨关节炎变化和/或骨髓水肿。结果本病例系列包括1名男性和2名女性。两个是竞技运动员,一个是登山运动员。患者的年龄分别为69岁、46岁和57岁(分别为病例1、2和3)。所有患者的CPAK类型均由II型转为V型;即具有中性关节线的中性对齐的膝关节。所有患者在最后一次随访时都恢复到了症状前的运动活动水平。病例1、2和3的症状前/术前/最终随访Tegner量表分别为6/1/6、5/2/5和7/3/7。结论FVTVO关节线水平化治疗严重JLO的中立型膝关节提供了非常满意的临床结果,并成功地导致RTS。
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引用次数: 2
Utility of axial magnetic resonance images for detecting meniscal ramp lesions associated with anterior cruciate ligament injuries 轴向磁共振图像用于检测与前交叉韧带损伤相关的半月板斜坡病变的效用
IF 2.1 Q2 Medicine Pub Date : 2022-10-01 DOI: 10.1016/j.asmart.2022.09.001
Tomonori Kinugasa, Hirotaka Mutsuzaki, Yu Taniguchi, Yuki Sato, Arata Watanabe, Kotaro Ikeda

Background

Ramp lesions (RLs), associated with anterior cruciate ligament (ACL) injuries, should be repaired to ensure postoperative knee stability. However, it is difficult to identify all RLs before surgery using conventional sagittal magnetic resonance (MR) images and arthroscopy from the anterior, medial, and lateral portals that are usually used during ACL reconstruction. We report the effectiveness of axial images for detecting RL.

Methods

From January 2018, a total of 316 knees underwent primary ACL reconstruction with preoperative magnetic resonance imaging (MRI) examination at our hospital. Among these, 149 knees, which required meniscal suturing at the same time, were retrospectively investigated. This study evaluated 22 knees with confirmed RLs around the posterior horn of the medial meniscus. The effectiveness of the preoperative sagittal and axial MR images for detecting RL was assessed. With the MR image, a three-dimensional double-echo steady-state image with a flip angle of 25° was reconstructed into the sagittal and axial planes, respectively. Reconstructed images with 3-mm slices for sagittal slices and 1-mm slices for axial sections were used. The diagnosis was made based on the presence of RL (RL was present, RL may be present, and RL was not present) by four knee surgeons with more than 10 years of experience.

Results

Approximately 53% of knee cases were diagnosed with RLs using sagittal images. Meanwhile, a diagnosis was achieved using axial images in 89% of cases.

Conclusion

Axial MRI may be superior in detecting RLs.

背景:与前交叉韧带(ACL)损伤相关的髋关节损伤(RLs)应进行修复,以确保术后膝关节的稳定性。然而,在手术前使用常规矢状面磁共振(MR)图像和关节镜检查通常用于ACL重建的前、中、外侧门静脉很难识别所有的RLs。我们报告了轴向图像检测RL的有效性。方法自2018年1月起,我院共316例膝关节行原发性ACL重建,术前行MRI检查。其中149例膝关节同时需要半月板缝合。本研究评估了22个在内侧半月板后角周围确诊有RLs的膝关节。评估术前矢状面和轴向面mri图像检测RL的有效性。利用磁共振图像,将翻转角度为25°的三维双回波稳态图像分别重建为矢状面和轴向面。矢状面采用3mm切片重建,轴向面采用1mm切片重建。诊断是基于RL的存在(RL存在,RL可能存在,和RL不存在)由四位膝关节外科医生有超过10年的经验。结果约53%的膝关节病例通过矢状位成像诊断为RLs。同时,在89%的病例中,诊断是通过轴向图像实现的。结论轴向MRI对RLs有较好的诊断价值。
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引用次数: 2
Anterior cruciate ligament rupture and associated Segond fracture: Incidence and effect on associated ligamentous and meniscal injuries 前交叉韧带断裂及相关第二次骨折:对相关韧带及半月板损伤的发生率及影响
IF 2.1 Q2 Medicine Pub Date : 2022-10-01 DOI: 10.1016/j.asmart.2022.09.002
Ping Yen Yeo, Adriel Ming Jun Seah, Vivegan Visvalingam, Lester Teong Jin Tan, Jegathesan T, Keng Thiam Lee, Sean Wei Loong Ho

Introduction

The Segond fracture is an avulsion fracture of the lateral tibial plateau and is widely considered to be pathognomonic of anterior cruciate ligament (ACL) rupture. In addition to ACL rupture, Segond fractures have also been noted to be associated with significant intra-articular pathology such as meniscal injuries as well as extra-articular pathology such as collateral ligament injuries. This is likely due to the fact that the presence of a Segond fracture may represent increased rotatory instability. Whilst several studies have demonstrated the association of a Segond fracture with significant intra-articular pathology, there is a paucity of literature assessing if the combination of an ACL rupture and Segond fracture gives rise to higher rates of concomitant ligamentous and meniscal injuries. The primary objective of this study is to determine if patients with ACL ruptures associated with Segond fractures have higher rates of concomitant ligamentous and meniscal injury, when compared to patients with ACL ruptures without a Segond fracture.

Methods

A retrospective review of all patients who underwent ACL reconstruction in a single institution between 2014 to 2018 was conducted. A review of the patients’ demographics, operative notes, and radiographs was performed. X-rays and MRI scans were double-read by a board-certified radiologist and Orthopaedic surgeon.

Results

A total of 414 subjects were included. The incidence of Segond fracture was 2.4%. The mean age was 24.7±7.4 (range 16 to 60) years and 26.7±7.6 (range 16 to 38) years in patients with and without Segond fractures respectively. 89.9% of patients suffered a non-contact mechanism of injury, with sports injuries being most common (79.5%). There was a significantly higher rate of isolated lateral meniscus tears in patients with Segond fractures compared to those without (50% v.s. 20.8%) based on pre-operative MRI. (p<0.05) There were no other significant differences in associated ligamentous injuries.

Conclusion

The incidence of Segond fracture associated with ACL rupture is 2.4%. There is a significantly higher risk of a concomitant isolated lateral meniscus tear in ACL ruptures associated with a Segond fracture. There is no significantly higher risk of concomitant ligamentous injuries in ACL ruptures associated with a Segond fracture.

第二骨折是胫骨外侧平台的撕脱性骨折,被广泛认为是前交叉韧带(ACL)断裂的典型症状。除了前交叉韧带断裂外,第二骨折也被认为与严重的关节内病理(如半月板损伤)和关节外病理(如副韧带损伤)相关。这可能是由于第二次骨折的存在可能表明旋转不稳定性增加。虽然有几项研究表明第二段骨折与显著的关节内病理有关,但很少有文献评估前交叉韧带断裂和第二段骨折合并是否会导致更高的韧带和半月板损伤发生率。本研究的主要目的是确定与没有第二骨折的前交叉韧带破裂患者相比,前交叉韧带破裂合并第二骨折的患者是否有更高的伴随韧带和半月板损伤的发生率。方法回顾性分析2014 - 2018年在同一医院进行ACL重建的所有患者。回顾患者的人口统计资料、手术记录和x线片。x光片和核磁共振扫描由一名委员会认证的放射科医生和整形外科医生复读。结果共纳入受试者414例。第二次骨折发生率为2.4%。有和无二次骨折患者的平均年龄分别为24.7±7.4(16 ~ 60)岁和26.7±7.6(16 ~ 38)岁。89.9%的患者为非接触性损伤,其中以运动损伤最为常见(79.5%)。术前MRI显示,第二次骨折患者的外侧半月板撕裂率明显高于未骨折患者(50% vs . 20.8%)。(p<0.05)两组相关韧带损伤无显著性差异。结论第二次骨折合并前交叉韧带破裂发生率为2.4%。前交叉韧带骨折合并二次骨折并发孤立外侧半月板撕裂的风险明显增高。前交叉韧带骨折合并第二次骨折时,并发韧带损伤的风险没有明显增高。
{"title":"Anterior cruciate ligament rupture and associated Segond fracture: Incidence and effect on associated ligamentous and meniscal injuries","authors":"Ping Yen Yeo,&nbsp;Adriel Ming Jun Seah,&nbsp;Vivegan Visvalingam,&nbsp;Lester Teong Jin Tan,&nbsp;Jegathesan T,&nbsp;Keng Thiam Lee,&nbsp;Sean Wei Loong Ho","doi":"10.1016/j.asmart.2022.09.002","DOIUrl":"10.1016/j.asmart.2022.09.002","url":null,"abstract":"<div><h3>Introduction</h3><p>The Segond fracture is an avulsion fracture of the lateral tibial plateau and is widely considered to be pathognomonic of anterior cruciate ligament (ACL) rupture. In addition to ACL rupture, Segond fractures have also been noted to be associated with significant intra-articular pathology such as meniscal injuries as well as extra-articular pathology such as collateral ligament injuries. This is likely due to the fact that the presence of a Segond fracture may represent increased rotatory instability. Whilst several studies have demonstrated the association of a Segond fracture with significant intra-articular pathology, there is a paucity of literature assessing if the combination of an ACL rupture and Segond fracture gives rise to higher rates of concomitant ligamentous and meniscal injuries. The primary objective of this study is to determine if patients with ACL ruptures associated with Segond fractures have higher rates of concomitant ligamentous and meniscal injury, when compared to patients with ACL ruptures without a Segond fracture.</p></div><div><h3>Methods</h3><p>A retrospective review of all patients who underwent ACL reconstruction in a single institution between 2014 to 2018 was conducted. A review of the patients’ demographics, operative notes, and radiographs was performed. X-rays and MRI scans were double-read by a board-certified radiologist and Orthopaedic surgeon.</p></div><div><h3>Results</h3><p>A total of 414 subjects were included. The incidence of Segond fracture was 2.4%. The mean age was 24.7±7.4 (range 16 to 60) years and 26.7±7.6 (range 16 to 38) years in patients with and without Segond fractures respectively. 89.9% of patients suffered a non-contact mechanism of injury, with sports injuries being most common (79.5%). There was a significantly higher rate of isolated lateral meniscus tears in patients with Segond fractures compared to those without (50% v.s. 20.8%) based on pre-operative MRI. (p&lt;0.05) There were no other significant differences in associated ligamentous injuries.</p></div><div><h3>Conclusion</h3><p>The incidence of Segond fracture associated with ACL rupture is 2.4%. There is a significantly higher risk of a concomitant isolated lateral meniscus tear in ACL ruptures associated with a Segond fracture. There is no significantly higher risk of concomitant ligamentous injuries in ACL ruptures associated with a Segond fracture.</p></div>","PeriodicalId":44283,"journal":{"name":"Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/b8/56/main.PMC9578960.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40657261","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
The relationship between clinical outcomes of arthroscopic rotator cuff repair and hemoglobin A1c 关节镜下肩袖修复术临床疗效与糖化血红蛋白的关系
IF 2.1 Q2 Medicine Pub Date : 2022-10-01 DOI: 10.1016/j.asmart.2022.09.004
Ryosuke Takahashi , Yukihiro Kajita , Yusuke Iwahori , Yohei Harada

Background

The clinical outcomes of diabetic patients who underwent arthroscopic rotator cuff repair have been reported. However, few studies have focused on the relationship between these clinical outcomes and postoperative hemoglobin A1c. This study compared clinical outcomes of diabetic patients with a hemoglobin A1c < 7% to those with a hemoglobin A1c ≥ 7% at 12 months post-arthroscopic rotator cuff repair.

Methods

This retrospective study involved 51 consecutive patients who underwent arthroscopic rotator cuff repair from 2015 to 2020. Approximately 26 and 25 shoulders were assigned to a Low group (hemoglobin A1c < 7%) and High group (hemoglobin A1c ≥ 7%) at 12 months postoperatively, respectively. Patients with poorly controlled diabetes were preoperatively hospitalized for perioperative diabetic control. Clinical outcomes were shoulder range-of-motion, Constant Shoulder Score, and University of California, Los Angeles Score preoperatively and at 12 months postoperatively. Complications were also evaluated.

Results

Both groups showed significant improvement in their range-of-motion, Constant Shoulder Score, and University of California, Los Angeles score at 12 months post-arthroscopic rotator cuff repair (p < 0.05) except external rotation in High group. These improvements were significantly inferior in the High group compared to the Low group (Low/High group; 167.3 ± 7.7°/159.5 ± 16.3° for forward flexion; p = 0.013, 94.9 ± 7.6/90.1 ± 9.9 points for Constant Shoulder Score; p = 0.033, 32.6 ± 3.6/30.6 ± 4.1 points for University of California, Los Angeles score, p = 0.037). Hemoglobin A1c at 12 months postoperatively was also significantly inferior in the High group (Low/High group; 6.5 ± 0.3%/7.6 ± 0.8%; p < 0.05). The rate of rotator cuff retear was not significantly different between groups (Sugaya type4; p = 0.49, type5; p = 0.322) and there were no cases of infection or shoulder stiffness in either group.

Conclusion

Diabetic patients showed improvement of their range-of-motion and function after arthroscopic rotator cuff repair; however, patients with poorly controlled diabetes had significantly inferior improvement.

已有文献报道了接受关节镜下肩袖修复术的糖尿病患者的临床结果。然而,很少有研究关注这些临床结果与术后血红蛋白A1c之间的关系。本研究比较了糖化血红蛋白(A1c)和糖化血红蛋白(l1c)升高的糖尿病患者的临床结果。在关节镜下肩袖修复后12个月,血红蛋白A1c≥7%的患者为7%。方法回顾性研究纳入2015年至2020年51例连续接受关节镜下肩袖修复术的患者。大约26和25个肩胛被分配到低组(血红蛋白A1c和lt;7%)和高组(血红蛋白A1c≥7%)分别于术后12个月。糖尿病控制不佳的患者术前住院进行围手术期糖尿病控制。临床结果为术前和术后12个月的肩关节活动度、恒定肩关节评分和加州大学洛杉矶分校评分。并发症也进行了评估。结果两组患者在关节镜下肩袖修复后12个月的活动范围、恒定肩部评分和加州大学洛杉矶分校评分均有显著改善(p <0.05), High组除外。这些改善在高组明显低于低组(低/高组;前屈167.3±7.7°/159.5±16.3°;p = 0.013,恒肩评分94.9±7.6/90.1±9.9分;加州大学洛杉矶分校得分为32.6±3.6/30.6±4.1,p = 0.037)。高组患者术后12个月的糖化血红蛋白也明显低于对照组(低/高组;6.5±0.3%/7.6±0.8%;p & lt;0.05)。两组间肩袖再撕裂率无显著差异(Sugaya型4;P = 0.49, type5;P = 0.322),两组均无感染或肩关节僵硬病例。结论糖尿病患者经关节镜下肩袖修复后,关节活动范围和功能得到改善;然而,糖尿病控制不佳的患者改善明显较差。
{"title":"The relationship between clinical outcomes of arthroscopic rotator cuff repair and hemoglobin A1c","authors":"Ryosuke Takahashi ,&nbsp;Yukihiro Kajita ,&nbsp;Yusuke Iwahori ,&nbsp;Yohei Harada","doi":"10.1016/j.asmart.2022.09.004","DOIUrl":"10.1016/j.asmart.2022.09.004","url":null,"abstract":"<div><h3>Background</h3><p>The clinical outcomes of diabetic patients who underwent arthroscopic rotator cuff repair have been reported. However, few studies have focused on the relationship between these clinical outcomes and postoperative hemoglobin A1c. This study compared clinical outcomes of diabetic patients with a hemoglobin A1c &lt; 7% to those with a hemoglobin A1c ≥ 7% at 12 months post-arthroscopic rotator cuff repair.</p></div><div><h3>Methods</h3><p>This retrospective study involved 51 consecutive patients who underwent arthroscopic rotator cuff repair from 2015 to 2020. Approximately 26 and 25 shoulders were assigned to a Low group (hemoglobin A1c &lt; 7%) and High group (hemoglobin A1c ≥ 7%) at 12 months postoperatively, respectively. Patients with poorly controlled diabetes were preoperatively hospitalized for perioperative diabetic control. Clinical outcomes were shoulder range-of-motion, Constant Shoulder Score, and University of California, Los Angeles Score preoperatively and at 12 months postoperatively. Complications were also evaluated.</p></div><div><h3>Results</h3><p>Both groups showed significant improvement in their range-of-motion, Constant Shoulder Score, and University of California, Los Angeles score at 12 months post-arthroscopic rotator cuff repair (p &lt; 0.05) except external rotation in High group. These improvements were significantly inferior in the High group compared to the Low group (Low/High group; 167.3 ± 7.7°/159.5 ± 16.3° for forward flexion; p = 0.013, 94.9 ± 7.6/90.1 ± 9.9 points for Constant Shoulder Score; p = 0.033, 32.6 ± 3.6/30.6 ± 4.1 points for University of California, Los Angeles score, p = 0.037). Hemoglobin A1c at 12 months postoperatively was also significantly inferior in the High group (Low/High group; 6.5 ± 0.3%/7.6 ± 0.8%; p &lt; 0.05). The rate of rotator cuff retear was not significantly different between groups (Sugaya type4; p = 0.49, type5; p = 0.322) and there were no cases of infection or shoulder stiffness in either group.</p></div><div><h3>Conclusion</h3><p>Diabetic patients showed improvement of their range-of-motion and function after arthroscopic rotator cuff repair; however, patients with poorly controlled diabetes had significantly inferior improvement.</p></div>","PeriodicalId":44283,"journal":{"name":"Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9539623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40319184","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
Lateral posterior tibial slope does not affect femoral but does affect tibial tunnel widening following anatomic anterior cruciate ligament reconstruction using a Bone–Patellar Tendon–Bone graft 采用骨-髌腱-骨移植重建解剖前交叉韧带后,外侧胫骨后坡不影响股骨,但影响胫骨隧道拓宽
IF 2.1 Q2 Medicine Pub Date : 2022-10-01 DOI: 10.1016/j.asmart.2022.09.003
Shuji Taketomi, Hiroshi Inui, Ryota Yamagami, Keiu Nakazato, Kohei Kawaguchi, Kenichi Kono, Shin Sameshima, Tomofumi Kage, Sakae Tanaka

Background

Tunnel widening (TW) after anterior cruciate ligament (ACL) reconstruction has been a research area of interest in ACL reconstruction. In recent years, it has been noted that posterior tibial slope (PTS) affects several types of outcomes after ACL reconstruction including TW. However, the relationships between femoral and tibial TW and between PTS and TW following anatomical ACL reconstruction using a bone–patellar tendon–bone (BTB) graft are often not understood. Therefore, the purpose of this study was to retrospectively clarify the magnitude of femoral and tibial TW and the effect of PTS on TW following anatomical ACL reconstruction using a BTB graft.

Methods

A total of 111 patients who underwent isolated ACL reconstructions using BTB grafts were included in this study. Femoral and tibial tunnel aperture areas were measured using three-dimensional computed tomography (3D CT) at 1 week and 1 year postoperatively, and femoral and tibial TW (%) was calculated. Lateral and medial PTS was also measured using 3D CT.

Results

As compared with 1 week postoperatively, the mean tibial tunnel aperture areas increased by 30.6% ± 28.5%, and the mean femoral tunnel aperture areas increased by 28.3% ± 27.9% when measured at 1 year postoperatively. Although no significant difference was observed between femoral and tibial TW, a significant positive correlation was noted between femoral and tibial TW (r = 0.240, p = 0.011). A significant correlation was observed only between lateral PTS and tibial TW (r = 0.354, p < 0.001). There was no significant correlation between medial PTS and tibial TW, lateral PTS and femoral TW, or medial PTS and femoral TW.

Conclusion

Significant positive correlation was observed between femoral and tibial TW. Steeper lateral PTS correlated with greater tibial TW; on the other hand, medial PTS did not correlate with tibial TW. Although lateral PTS affected tibial TW, it did not affect femoral TW.

前交叉韧带(ACL)重建后的隧道扩宽(TW)一直是前交叉韧带(ACL)重建的研究热点。近年来,人们注意到胫骨后坡(PTS)会影响ACL重建后的几种结果,包括TW。然而,利用骨-髌骨肌腱-骨(BTB)移植术重建前交叉韧带后,股骨和胫骨TW之间的关系以及PTS和TW之间的关系通常尚不清楚。因此,本研究的目的是回顾性地阐明股骨和胫骨创伤的大小,以及使用BTB移植物重建解剖前交叉韧带后PTS对创伤的影响。方法对111例采用BTB移植物行孤立ACL重建的患者进行研究。术后1周和1年采用三维计算机断层扫描(3D CT)测量股骨和胫骨隧道孔径面积,计算股骨和胫骨的TW(%)。外侧和内侧PTS也使用3D CT测量。结果与术后1周比较,术后1年胫骨隧道平均开孔面积增加30.6%±28.5%,股骨隧道平均开孔面积增加28.3%±27.9%。股骨与胫骨TW无显著性差异,但股骨与胫骨TW有显著正相关(r = 0.240, p = 0.011)。仅外侧PTS与胫骨TW有显著相关性(r = 0.354, p <0.001)。内侧PTS与胫骨TW、外侧PTS与股骨TW、内侧PTS与股骨TW无显著相关性。结论股骨与胫骨TW呈显著正相关。更陡的外侧PTS与更大的胫骨TW相关;另一方面,内侧PTS与胫骨TW无关。虽然外侧PTS影响胫骨TW,但不影响股骨TW。
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引用次数: 1
期刊
Asia-Pacific Journal of Sport Medicine Arthroscopy Rehabilitation and Technology
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