Derotational distal femur osteotomy with medial patellofemoral ligament reconstruction can get good outcomes in the treatment of recurrent patellar dislocation with excessive TT-TG and increased femoral anteversion.

Background: Surgery is the main treatment for recurrent patellar dislocation (PD). However, due to the complexity of anatomical factors, there is still a lack of consensus on the choice of combined surgical methods. This study aimed to compare the clinical and radiological outcomes of medial patellofemoral ligament reconstruction combined with derotational distal femur osteotomies (MPFLR + DDFO) and combined with tibial tubercle osteotomies (MPFLR + TTO) for recurrent PD with increased femoral anteversion angles (FAA) and excessive tibial tubercle-trochlear groove (TT-TG) distance. Methods: In this retrospective analysis, MPFLR + DDFO and MPFLR + TTO patients from 2015 to 2020 were included. Group A (MPFLR + DDFO, n = 42) and B (MPFLR + TTO, n = 46) were formed. Clinical outcomes included physical examinations, functional outcomes (Kujala, Lysholm, International Knee Documentation Committee (IKDC), visual analog scale (VAS) and intermittent and persistent osteoarthritis pain scale (ICOAP), Tegner scores), and complications. The Caton-Deschamps index (CD-I), patellar title angle, patellar congruence angle, patella-trochlear groove distance, TT-TG distance, and FAA were used to assess radiological outcomes. Results: All clinical outcomes improved significantly in both groups, but Group A had significantly better postoperative scores than Group B (Kujala: 89.8 ± 6.4 vs. 82.9 ± 7.4, P < 0.01; Lysholm: 90.9 ± 5.1 vs. 81.3 ± 6.3, P = 0.02; IKDC: 87.3 ± 9.0 vs. 82.7 ± 8.0, P < 0.01; Tegner: 6.0 (5.0, 9.0) vs. 5.0 (4.0, 8.0), P = 0.01). However, there was no significant difference in the VAS and ICOAP scores between the two groups. No dislocation recurrences occurred. Radiological outcomes improved significantly in both groups, but Group A had better outcomes. After surgery, the patellar height of 88.5% (23/26) patients in Group A and 82.8% (24/29) patients in Group B was restored to normal (the Caton-Deschamps index <1.2). Conclusions: Both MPFLR + TTO and MPFLR + DDFO obtained satisfactory clinical and radiological outcomes in the treatment of recurrent PD with increased FAA and excessive TT-TG. However, the outcomes of MPFLR + DDFO were better and should be considered a priority. MPFLR + TTO may be not necessary for such patients.

Arthroscopic Linear Chain Fixation for the Treatment of Medial Meniscus Posterior Root Tear: A Case Study.

BACKGROUND: The repair and reconstruction of medial meniscus posterior root tears (MMPRTs) is an important issue in the field of orthopedic sports medicine. This study reports the first application of arthroscopic linear chain fixation for the treatment of MMPRTs. CASE PRESENTATION: A 78-year-old female patient presented with a 1.5-month history of right knee pain accompanied by a locked facet joint. The patient underwent surgery with the new linear chain fixation method. In this method, the suture and the loop part of the buckle-strap titanium plate were combined into a linear chain mechanical complex, and the tension of the posterior root stump was gradually increased by pulling on the two attachment lines at the external mouth of the tibial tunnel. The postoperative Lysholm score was 89, and the visual analogue scale score was 0.9, indicating a significant improvement in knee joint function. At the 7-month and 1-year post-surgery follow-up, physical and MRI examinations confirmed satisfactory healing of the MMPRTs. CONCLUSION: This surgical approach offers several benefits, including a simplified instrumentation setup, preservation of natural anatomical structures, and reliable residual stump fixation. It has the potential for clinical implementation.

Medial Plication Using an Arthroscopic All-Inside Technique for Treatment of Patellar Instability in Adolescents.

The purpose of this study was to present a medial plication using an arthroscopic all-inside technique for the treatment of patellar instability in adolescents. From July 2009 to June 2012, 19 patients with acute patellar dislocation were operated by this technique. Of these patients, follow-up was available in 17 patients at an average of 3 years (range: 1.5-4 years). At the follow-up, we evaluated the patients with physical examinations, radiographs, computed tomography scan, as well as the Lysholm and Kujala scoring scales. No recurrence of patellar instability has been found. The recovery of knee mobilization resulted to be good. We think this could be a valid technique to treat patellar instability in adolescents with less associated morbidity and good cosmetic results.

[Effects of tillage rotation and fertilization on soil aggregates and organic carbon content in corn field in Weibei Highland].

A field experiment on effects of tillage rotation and fertilization on corn continuous cropping-practiced lands was carried out in Heyang of Shaanxi in 2007-2012. The tillage types included annual rotation of no-tillage and subsoiling (NT-ST), subsoiling and conventional tillage (ST-CT), or conventional tillage and no-tillage (CT-NT), and yearly practice of no tillage (NT-NT), subsoiling (ST-ST) or conventional tillage (CT-CT). The fertilization treatments included balanced fertilization, low-rate fertilization and conventional fertilization, which were separately practiced against the different tillage types. The experiment investigated compositions, mean mass diameters (MWD), geometrical mean diameters (GMD) and fraction dimension numbers (D) of soil aggregates in 0-40 cm soil and contents of organic carbon in 0-60 cm soil. The results indicated that: 1) The increased tillage intensity caused the reduced mechanical stability and content of soil aggregates and increased soil organic carbon loss. No-tillage or tillage rotation increased the MWD, GMD and contents of soil organic carbon and soil aggregates with diameters of more than 0.25 mm, but decreased D. Under the same fertilization treatment, the contents of soil aggregates with diameters of more than 0.25 mm were ranked in the order of NT-NT>NT-ST>NT-CT>ST-ST>CT-ST>CT-CT, and under the same tillage rotations, the soil aggregates were more stable with the balanced or low- rate fertilization than with the conventional fertilization. 2) Mathematical fractal dimension fitting of soil aggregates indicated that the fractal dimension numbers of soil aggregates ranged within 2.247-2.681 by dry sieving and 2.897-2.976 by wet sieving. In 0-30 cm soil, the fractal dimension numbers of soil aggregates were significantly lower under no-tillage or tillage rotation than under conventional tillage, and in 0-40 cm soil, the fractal dimensions of soil aggregates increased with soil depth, and tended to stabilize at the soil depth of 40 cm. 3) The different fertilization treatments exerted significantly different influences on the contents of soil organic carbon (P < 0.05), which tended to decline with soil depth. Compared to the conventional fertilization, the balanced fertilization increased the content of soil organic carbon by 6.9%, and the contents of soil organic carbon increased as the diameters of soil aggregates increased. The correlation analysis showed that the contents of soil aggregates with diameters of 0.25-2 mm significantly affected the content of soil organic carbon, with the coefficient of determination being 0.848 (P < 0.01).