Correlations of high molecular weight adiponectin, tumor necrosis factor-alpha and vascular endothelial growth factors with occurrence of colonic polyps in the prediabetic population.

We aimed to explore the correlations of high molecular weight adiponectin (HMW-ADP), tumor necrosis factor-alpha (TNF-α) and vascular endothelial growth factors (VEGFs) with the occurrence of colonic polyps in the prediabetic population. Two hundred patients with prediabetes were enrolled, and their clinical data were retrospectively analyzed. They were divided into group A (75 patients with colonic polyps) and group B (125 patients without colonic polyps). Eighty patients with normal glucose tolerance in the same period were divided into group C (32 patients with normal glucose tolerance and colonic polyps) and group D (48 patients with normal glucose tolerance but no colonic polyps). The correlations of serum HMW-ADP, TNF-α and VEGF levels with plasma glucose and insulin levels were explored by Pearson's analysis. The factors influencing the occurrence of colonic polyps were determined by logistic regression analysis. Serum HMW-ADP was negatively correlated with TNF-α, VEGFs, FPG, 2hPG, FI and HOMA-IR (r<0, P<0.05), whereas serum TNF-α and VEGFs were positively correlated with FPG, 2hPG, FI and HOMA-IR (r>0, P<0.05). Age, body mass index, waist-to-hip ratio, history of smoking, history of drinking, family history of colon cancer, TNF-α and VEGF were independent risk factors [odds ratio (OR)>1, P<0.05], and HMW-ADP was a protective factor (OR<1, P<0.05). The areas under the curves of serum HMW-ADP, TNF-α, VEGFs and their combination for predicting the occurrence of colonic polyps were 0.899, 0.787, 0.908 and 0.922, respectively. The combination of HMW-ADP, TNF-α and VEGFs can effectively predict the occurrence of colonic polyps in prediabetic patients.

Potassium ameliorates cotton (Gossypium hirsutum L.) fiber length by regulating osmotic and K+ /Na+ homeostasis under salt stress.

Potassium (K) application can alleviate cotton salt stress, but the regulatory mechanisms affecting cotton fiber elongation and ion homeostasis are still unclear. A two-year field experiment was conducted to explore the effects of K on the osmolyte contents (soluble sugar, K+ content, and malate) and related enzyme activities during the fiber elongation of two cotton cultivars with contrasting salt sensitivity (CCRI-79; salt tolerant cultivar, and Simian 3; salt-sensitive cultivar). Three K application treatments (0, 150, and 300 kg K2 O ha-1 ) were applied at three soil salinity levels (low salinity, EC = 1.73 ± 0.05 dS m-1 ; medium salinity, EC = 6.32 ± 0.10 dS m-1 ; high salinity, EC = 10.84 ± 0.24 dS m-1 ). K application improved fiber length and alleviated salt stress by increasing the maximum velocity of fiber elongation (Vmax ). The increase rate of K on fiber length decreased with elevating salt stress, and the increase rate of K on Vmax of CCRI-79 was greater than that of Simian3. K application can increase the enzyme activities (phosphoenolpyruvate carboxylase, PEPC, E.C. 4.1.1.31; pyrophosphatase, PPase, E.C. 3.6.1.1; and plasma membrane H+ -ATPase, PM H+ -ATPase, E.C. 3.6.3.14) as well as the content of osmolytes associated with the enzymes mentioned above. K increased the osmolyte contents under salt stress, and the increase in the K+ content of the fibers was much higher than that of soluble sugar and malate. The results of this study indicated K fertilizer application rates regulate the metabolism of osmolytes in cotton fiber development under salt stress, K+ is more critical to fiber elongation.

Analgesic Efficacy of Transverse Abdominis Plane Block and Quadratus Lumborum Block in Laparoscopic Sleeve Gastrectomy: A Randomized Double-Blinded Clinical Trial.

INTRODUCTION: The analgesic effect and safety of transversus abdominis plane block (TAPB) is still controversial in various abdominal procedures. Quadratus lumborum block (QLB) has been considered to provide a widespread and long-lasting analgesic effect in gynecological surgeries. However, the analgesic effects of these two techniques in patients with extreme obesity undergoing laparoscopic sleeve gastrectomy (LSG) are still unknown. METHODS: A total of 225 patients with obesity were randomly assigned to group TAPB (n = 76, 30 ml 0.33% ropivacaine with dexmedetomidine 1 µg kg-1), group QLB (n = 76, 30 ml 0.33% ropivacaine with dexmedetomidine 1 µg kg-1), or general anesthesia alone (GA, n = 73, 30 ml 0.9% saline). During the 48-h postoperative period, patients received continuous intravenous patient-controlled analgesia (PCA) containing sufentanil 2 µg kg-1, dexmedetomidine 2 µg kg-1, and granisetron 3 mg. The scores of visual analogue scale (VAS) in surgical incision and viscera, considering as the primary outcomes, were continuously recorded at postoperative 0, 0.5, 1, 2, 6, 12, 24, 48 h and discharge. RESULTS: Comparing with patients in the GA group, VAS scores of incision and viscera were consistently reduced during the initial 6-12 h after LSG in TAPB and QLB groups, and they received less propofol and remifentanil (P < 0.001) as well. In the QLB group, patients had longer duration for the first rescue analgesia, and fewer requirements of the rescue analgesia within 24 h than the GA group (P < 0.05). In addition, there were fewer PCA requirements in QLB group than GA and TAPB groups (P < 0.05). CONCLUSIONS: Ultrasound-guided transversus abdominis plane block and quadratus lumborum block could provide comparable analgesic effects for a laparoscopic sleeve gastrectomy in obese patients. TRIAL REGISTRATION: Chinese Clinical Trial Registry; ChiCTR1800019236.

ACL graft with extra-cortical fixation rotates around the femoral tunnel aperture during knee flexion.

PURPOSE: An understanding of the behavior of a new ACL graft in the femoral tunnel during knee motion and external loading can provide information pertinent to graft healing, tunnel enlargement, and graft failure. The purpose of the study was to measure the percentage of the tunnel filled by the graft and determine the amount and location of the graft-tunnel contact with knee motion and under external knee loads. METHODS: Single bundle anatomical ACL reconstruction was performed on six cadaveric knees. Specimens were positioned with a robotic testing system under: (1) passive flexion-extension, (2) 89-N anterior and posterior tibial loads, (3) 5-N m internal and external torques, and (4) 7-N m valgus moment. The knees were then dissected, repositioned by the robot and the geometry of the femoral tunnel and graft were digitized by laser scanning. The percentage of tunnel filled and the contact region between graft and tunnel at the femoral tunnel aperture were calculated. RESULTS: The graft occupies approximately 70% of the femoral tunnel aperture and anterior tibial loading tended to reduce this value. The graft contacted about 60% of the tunnel circumference and the location of the graft-tunnel contact changed significantly with knee flexion. CONCLUSION: This study found that the graft tends to rotate around the tunnel circumference during knee flexion-extension and contract under knee loading. The "windshield-wiper" and "bungee cord" effect may contribute to femoral tunnel enlargement, affect graft healing, and lead to graft failure. There can be a considerable motion of the graft in the tunnel after surgery and appropriate rehabilitation time should be allowed for graft-tunnel healing to occur. To reduce graft motion, consideration should be given to interference screw fixation or a graft with bone blocks, which may allow an earlier return to activity.

Pathological changes of frozen shoulder in rat model and the therapeutic effect of PPAR-γ agonist.

Frozen shoulder is a common shoulder disorder characterized by a gradual increase of pain and a limited range of motion. However, its pathophysiologic mechanisms remain unclear and there is no consensus as to the most effective treatment. The purpose of the study was to investigate the effect of transforming growth factor-ß (TGF-ß) on fibrosis and inflammatory response of the shoulder joint of rat models and to explore the therapeutic effect of the peroxisome proliferator-activated receptor-γ (PPAR-γ) agonist. In the study, the effect of PPAR-γ agonist CDDO-IM treatment on cell proliferation, migration, and extracellular matrix proteins synthesis (vimentin, α-smooth muscle actin, collagen I, and collagen III) were tested by cell proliferation test, scratches test, real-time quantitative polymerase chain reaction, and Western blot analysis. The frozen shoulder was also established on the rat model by injecting adenovirus-TGF-ß1 into rats' shoulder capsule. Pathological changes of the frozen shoulder tissue of the experimental group and PPAR-γ agonist treatment group were evaluated. The stiffness of joints of the three groups was tested. Inflammatory mediators' expression including cyclooxygenase-1, interleukin-1ß, and tumor necrosis factor-α of the shoulder was tested by enzyme-linked immunosorbent assay, and the expression of extracellular matrix proteins was evaluated by hematoxylin and eosin staining and immunohistochemistry. The results showed that pathological changes of the frozen shoulder in the rat model include an abnormal proliferation of fibroblasts, infiltration of inflammatory cells, and disorder of fibrous structure, while rosiglitazone reduced the severity of the frozen shoulder in the treatment group. Clinically, PPAR-γ agonists may be a promising target for the treatment of the frozen shoulder.

Partial meniscectomy does not affect the biomechanics of anterior cruciate ligament reconstructed knee with a lateral posterior meniscal root tear.

PURPOSE: The purpose of this study was to determine the effects of a lateral meniscus posterior root tear, partial meniscectomy, and total meniscectomy on knee biomechanics in the setting of anterior cruciate ligament (ACL) reconstruction. METHODS: Thirteen fresh-frozen cadaver knees were tested with a robotic testing system under an 89.0-N anterior tibial load at full extension (FE), 15°, 30°, 60° and 90° of knee flexion and a simulated pivot-shift loading (7.0 Nm valgus and 5.0 Nm internal tibial rotation) at FE, 15° and 30° of knee flexion. Anterior tibial translation (ATT) and the in-situ force of ACL graft under the different loadings were measured in four knee states: (1) ACL reconstruction with intact lateral meniscus (Intact meniscus), (2) ACL reconstruction with lateral meniscal posterior root tear (Root tear), (3) ACL reconstruction with lateral posterior partial meniscectomy (Partial meniscectomy) and (4) ACL reconstruction with total lateral meniscectomy (Total meniscectomy). RESULTS: Under anterior tibial loading, compared with an intact meniscus, root tear significantly increased ATT at 15° and 30° of knee flexion (p < 0.05) and partial meniscectomy had almost same increased ATT as with root tear at any knee flexion between FE and 90°. Under simulated pivot-shift loading, total meniscectomy increased ATT compared with intact meniscus, root tear, partial meniscectomy at FE (p < 0.05). CONCLUSION: Under anterior tibial and simulated pivot-shift loading, partial meniscectomy has no significant effect on the stability of ACL-reconstructed knee with lateral meniscal posterior root tear, while total meniscectomy increased laxity at less than 30° of knee flexion. Clinically, in cases of irreparable meniscal root tears or persistent pain a partial meniscectomy can be considered in the setting of ACL reconstruction.

Single-bundle MCL reconstruction with anatomic single-bundle ACL reconstruction does not restore knee kinematics.

PURPOSE: The purpose of this study was to evaluate and compare knee kinematics and kinetics following either single bundle, modified triangular or double-bundle reconstruction of the superficial medial collateral ligament (sMCL) with single bundle anatomic ACL reconstruction. METHODS: Using a cadaveric model (n = 10), the knee kinematics and kinetics following three MCL reconstructions (single-bundle (SB), double-bundle (DB), modified triangular) with single bundle anatomic ACL reconstruction were compared with the intact and deficient knee state. The knees were tested under (1) an 89-N anterior tibial load, (2) 5 N-m internal and external rotational tibial torques, and (3) a 7 N-m valgus torque. RESULTS: Anatomic ACL reconstruction with SB MCL reconstruction was able to restore anterior tibial translation and external rotation to intact knee values but failed to the internal and valgus rotatory stability. Anatomical DB MCL reconstruction (with SB ACL reconstruction) and the modified triangular MCL reconstruction (with SB ACL reconstruction) restored all knee kinematics to the intact value. CONCLUSION: This study shows that clinical presentation with combined ACL and severe sMCL injury, single-bundle MCL with single-bundle ACL reconstruction does not restore knee kinematics. Anatomical double-bundle MCL reconstruction may produce slightly better biomechanical stability than the modified triangular MCL reconstruction, but the modified triangular reconstruction might be more clinically practical with the advantages of being less invasive and technically simpler while at the same time can restore a nearly normal knee joint.

The femoral posterior fan-like extension of the ACL insertion increases the failure load.

PURPOSE: To examine the role of the posterior fan-like extension of the ACL's femoral footprint on the ACL failure load. METHODS: Sixteen (n = 16) fresh frozen, mature porcine knees were used in this study and randomized into two groups (n = 8): intact femoral ACL insertion (ACL intact group) and cut posterior fan-like extension of the ACL (ACL cut group). In the ACL cut group, flexing the knees to 90°, created a folded border between the posterior fan-like extension and the midsubstance insertion of the femoral ACL footprint and the posterior fan-like extension was dissected and both areas were measured. Specimens were placed in a testing machine at 30° of flexion and subjected to anterior tibial loading (60 mm/min) until ACL failure. RESULTS: The intact ACL group had a femoral insertion area of 182.1 ± 17.1 mm2. In the ACL cut group, the midsubstance insertion area was 113.3 ± 16.6 mm2, and the cut posterior fan-like extension portion area was 67.1 ± 8.3 mm2. The failure load of the ACL intact group was 3599 ± 457 N and was significantly higher (p < 0.001) than the failure load of the ACL cut group 392 ± 83 N. CONCLUSION: Transection of the posterior fan-like extension of the ACL femoral footprint has a significant effect on the failure load of the ligament during anterior loading at full extension. Regarding clinical relevance, this study suggests the importance of the posterior fan-like extension of the ACL footprint which potentially may be retained with remnant preservation during ACL reconstruction. Femoral insertion remnant preservation may allow incorporation of the fan-like structure into the graft increasing graft strength.

Safety and feasibility analysis of combination therapy of laparoscopic left hepatectomy and choledochoscopy for calculus of the left intrahepatic duct.

BACKGROUND: The aim of this paper was to observe the efficacy of combination therapy of laparoscopic left hepatectomy and choledochoscopy for calculus of left intrahepatic duct. METHODS: We retrospectively analyzed the clinical data of 76 patients with calculus of left intrahepatic duct who were admitted and diagnosed in this hospital between August 2014 and August 2015. Patients who received the laparotomy for treatment were enrolled into the control group (N.=32), and those who received the combination therapy of laparoscopic left hepatectomy and choledochoscopy were enrolled into the study group (N.=44). The surgical efficacy and the occurrence of surgery complications were compared between the two groups, and the recurrence of calculus was observed in follow-up after the operation. RESULTS: Comparison of the surgical duration showed no statistically significant difference between the two groups (P>0.05); bleeding amount, evacuation time and length of stay in the study group were less or shorter than those in the control group (P<0.05); the overall incidence rate of surgery complications in the study group was 9.10%, which was lower than the overall incidence rate of surgery complications, 43.75%, in the control group (P<0.05). No statistically significant differences were identified in the comparisons of the levels of albumin (ALB), alanine aminotransferase (ALT) and aspartate aminotransferase (AST) at 1d before and 10d after operation, hospitalization expenses, and operation fee between the two groups (P>0.05). The average duration of follow-up after operation was 12 months, during which 2 patients in the control group were found with a calculus in a diameter of 0.4 cm in the left intrahepatic duct which was later removed using choledochoscopy followed by the extraction of T duct, and the conditions of patient were well-controlled; no recurrence of calculus was observed in the study group. CONCLUSIONS: Combination therapy of laparoscopic left hepatectomy and choledochoscopy is worth being promoted in clinical practice of treatment for calculus of intrahepatic duct with various advantages, such as significant effect, small trauma, high safety and reliability, rapid recovery after operation and few recurrences.

Anterior cruciate ligament graft fixation first in anterior and posterior cruciate ligament reconstruction best restores knee kinematics.

PURPOSE: To evaluate the effect of different graft fixation sequences in one-stage anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction on (1) knee biomechanics and (2) tibiofemoral alignment. METHODS: Twelve porcine knees were used in this study. Five fixation sequences were performed (angle indicating knee flexion): (a) PCL at 30° and ACL at 30°, (b) PCL at 90° and ACL at 30°, (c) ACL at 30° and PCL at 30°, (d) ACL at 30° and PCL at 90°, and (e) ACL and PCL simultaneous fixation at 30°. Anterior and posterior tibial translation was measured under an 89 N load. A 3-D digitizer was used to measure the change in anteroposterior (AP) tibiofemoral position. RESULTS: None of the graft fixation sequences restored the AP laxity of the intact knee, and there are minimal differences in the in situ tissue forces in the ACL and PCL grafts. The reconstructions with fixation of the PCL graft first resulted in a significantly larger change in AP tibiofemoral position from the intact knee at 60° and 90° of knee flexion than the reconstructions with fixation of the ACL graft first (p < 0.05). CONCLUSION: Fixation of the ACL graft at 30° of knee flexion followed by fixation of the PCL graft can best restore the tibiofemoral position of the intact knee. This study has clinical relevance in regard to the effect of graft fixation sequence on the position of the tibia relative to the femur in one-stage ACL and PCL reconstruction.

Medial collateral ligament reconstruction is necessary to restore anterior stability with anterior cruciate and medial collateral ligament injury.

PURPOSE: The purpose of this study was to compare knee kinematics and graft forces in anterior cruciate ligament (ACL) reconstruction combined with one of two superficial medial collateral ligament (sMCL) reconstruction techniques (parallel or triangular vector sMCL reconstruction). METHODS: Twenty porcine knees were divided into two groups (n = 20), parallel or triangular vector sMCL reconstruction, with both groups having anatomic single-bundle ACL reconstruction. The knees were tested under (1) an 89-N anterior tibial load, (2) 4 Nm internal and external rotational tibial torques, and (3) a 7 Nm valgus torque. RESULTS: With ACL/sMCL co-injuries, single-bundle ACL reconstruction alone does not restore anterior, valgus, and internal stability. Triangular vector sMCL reconstruction better restored anterior stability, and parallel sMCL reconstruction better restored valgus stability. CONCLUSION: This study showed that single-bundle ACL reconstruction alone was not able to restore anterior tibial translation, valgus rotation, and external rotation of the intact knee with combined ACL and sMCL injuries and sMCL reconstruction was also required. The combined ACL and parallel sMCL reconstruction better restored valgus and external rotation stability, while the combined ACL and triangular vector method better restored anterior tibial translation. With combined ACL and severe sMCL injury, both ligaments should be reconstructed. The two sMCL reconstruction techniques exhibited slightly different kinematics and graft force; however, there was not enough difference to recommend one over the other.

NEDD4 promotes cell growth and migration via PTEN/PI3K/AKT signaling in hepatocellular carcinoma.

The novel E3 ubiquitin-protein ligase neural precursor cell-expressed developmentally downregulated protein 4 (NEDD4) has been implicated as a crucial factor promoting the tumorigenesis of several types of cancer. The present study investigated the oncogenic role of NEDD4 in hepatocellular carcinoma (HCC) by targeted small interfering RNA silencing of the tumor suppressor phosphatase and tensin homolog (PTEN). Using normal hepatocyte and HCC cell lines, the influence of NEDD4 depletion on proliferation and migration as well as on the PTEN/phosphatidylinositol-3-kinase/protein kinase B signaling pathway was assessed. Additionally, the expression of NEDD4 was assessed in HCC specimens from 78 patients. The in vitro immunohistochemistry results indicated that NEDD4 protein expression was higher, but PTEN expression was lower, in HCC cells compared with normal hepatocytes. The results from the MTT assay, wound healing experiment and Transwell assays demonstrated that NEDD4 depletion lead to decreased proliferation and migration ability of HCC cells. Results from western blotting and immunofluorescence demonstrated that silencing of NEDD4 disrupted the PTEN/phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway in HCC cells. A total of 55 (70.5%) of the HCC specimens stained positive for NEDD4 and expression significantly correlated with tumor size (P=0.047), differentiation degree (P=0.032), vascular invasion (P<0.001), and lymph node metastasis (P=0.005). Thus, NEDD4 appears to perform a critical role in promoting the proliferation and metastasis of HCC via activation of the PTEN/PI3K/AKT signaling pathway; as such, NEDD4 may be a promising target for novel treatments of HCC.

Structural and mechanistic insights into regulation of HBO1 histone acetyltransferase activity by BRPF2.

HBO1, a member of the MYST family of histone acetyltransferases (HATs), is required for global acetylation of histone H3K14 and embryonic development. It functions as a catalytic subunit in multisubunit complexes comprising a BRPF1/2/3 or JADE1/2/3 scaffold protein, and two accessory proteins. BRPF2 has been shown to be important for the HAT activity of HBO1 toward H3K14. Here we demonstrated that BRPF2 can regulate the HAT activity of HBO1 toward free H3 and H4, and nucleosomal H3. Particularly, a short N-terminal region of BRPF2 is sufficient for binding to HBO1 and can potentiate its activity toward H3K14. The crystal structure of the HBO1 MYST domain in complex with this segment of BRPF2 together with the biochemical and cell biological data revealed the key residues responsible for the HBO1-BRPF2 interaction. Our structural and functional data together indicate that the N-terminal region of BRPF2 plays an important role in the binding of HBO1 and a minor role in the binding of nucleosomes, which provide new mechanistic insights into the regulation of the HAT activity of HBO1 by BRPF2.

The effect of anterior cruciate ligament graft rotation on knee biomechanics.

PURPOSE: The purpose of this study was to evaluate the effects on knee biomechanics of rotating the distal end of the bone-patellar tendon graft 90° in anatomic single-bundle (SB) anterior cruciate ligament (ACL) reconstruction with a porcine model. METHODS: Twenty (n = 20) porcine knees were evaluated using a robotic testing system. Two groups and three knee states were compared: (1) intact ACL, (2) deficient ACL and (3) anatomic SB ACL reconstruction with (a) non-rotated graft or (b) rotated graft (anatomic external fibre rotation). Anterior tibial translation (ATT), internal (IR) and external rotation (ER) and the in situ tissue force were measured under an 89-N anterior tibial (AT) load and 4-N m internal and external tibial torques. RESULTS: A significant difference from the intact ACL was found in ATT at 60° and 90° of knee flexion for rotated and non-rotated graft reconstructions (p < 0.05). There was a significant difference in the in situ force from the intact ACL with AT loading for rotated and non-rotated graft reconstructions at 60° and 90° of knee flexion (p < 0.05). Under IR loading, the in situ force was significantly different from the intact ACL at 30° and 60° of knee flexion for rotated and non-rotated graft reconstructions (p < 0.05). There were no significant differences in ATT, IR, ER and the in situ force between rotated and non-rotated reconstructions. CONCLUSION: Graft rotation can be used with anatomic SB ACL reconstruction and not have a deleterious effect on knee anterior and rotational biomechanics. This study has clinical relevance in regard to the use of graft rotation to better reproduce the native ACL fibre orientation in ACL reconstruction.

Effect of fixation angle and graft tension in double-bundle anterior cruciate ligament reconstruction on knee biomechanics.

PURPOSE: To compare the effect of graft fixation angle and tension in double-bundle anterior cruciate ligament (ACL) reconstruction on knee biomechanics. METHODS: Fourteen cadaver knees were tested using a robotic system under two loadings: (1) an 89-N anterior tibial load (ATL) at full extension (FE), 15°, 30°, 45°, 60°, and 90°, and (2) combined 7 N m valgus and 5 N m internal tibial torques (simulated pivot-shift test) at FE, 15° and 30°. Four graft fixation angles and tensions were used for the anteromedial (AM) and posterolateral (PL) bundles, respectively: (Recon 1) 30°/20N and FE/20N, (Recon 2) 30°/30N and FE/10N, (Recon 3) 45°/20N and 15°/20N, and (Recon 4) 45°/30N and 15°/10N. RESULTS: All fixation protocols closely restored the intact knee kinematics under ATL and simulated pivot-shift loading. For the AM bundle under ATL, the in situ force (ISF) with Recon 3 at the FE was significantly lower than that of the intact knee. For the PL bundle under ATL, the ISF with Recon 3 at the FE, 15° and 30° was significantly higher than that of the intact knee. In PL bundle under simulated pivot-shift loading, the ISF with Recon 1 and Recon 2 at FE was lower and the ISF of the PL bundle with Recon 3 at the 15° was higher than that of the intact knee. CONCLUSION: The AM-45°/30N and PL-15°/10N fixation most closely matched intact knee kinematics; however, stabilizing the knee during anterior tibial translation may risk an imbalance of the AM and the PL bundle loading. The results indicate that ACL bundle forces may not be restored even if the clinical assessment shows good results with the Lachman test and pivot-shift test. This may alter the loading on other structures of the knee.

Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction.

PURPOSE: The purpose of this study was to evaluate the clinical results of medial collateral ligament (MCL) anatomic ligament repair (ALR) and triangular ligament reconstruction (TLR) in treating acute grade III MCL injury with respect to imaging and functional results. METHODS: Between January 2009 and October 2011, a total of 69 patients with an acute grade III MCL tear combined with an anterior cruciate ligament tear were divided into 2 groups: those who underwent ALR and those who underwent TLR. Single-bundle anterior cruciate ligament reconstruction was also performed in all patients. A radiographic stress-position imaging test was performed to evaluate excessive medial opening of the knee. In addition, the Slocum test was carried out to assess anteromedial rotatory instability before surgery and at follow-up. The subjective symptoms and functional outcomes were evaluated preoperatively and postoperatively with International Knee Documentation Committee (IKDC) assessment. RESULTS: Sixty-four patients with a mean follow-up period of 34 months were included in the final analysis. The measurement results for medial opening at the last follow-up appointment decreased significantly from the pretreatment measurements and fell within the normal range, without a statistically significant difference between the 2 groups (P > .05). The overall incidence of anteromedial rotatory instability was reduced to 21.9% compared with 62.5% preoperatively. However, the incidence of anteromedial rotatory instability in the TLR group (9.4%) decreased significantly compared with that in the ALR group (34.4%) (P < .05). All patients' IKDC subjective scores significantly improved after surgery. No statistically significant difference was found between the 2 groups at the last follow-up (P > .05). The comparison of IKDC extension and flexion deficit scores between the 2 groups showed no significant differences. Eleven patients in the ALR group and 4 in the TLR group complained of medial knee pain. The comparison between the 2 groups showed no significant difference (P > .05). CONCLUSIONS: The clinical outcomes of this study showed that no major difference existed in the ALR and TLR groups based on IKDC scores and medial opening evaluations in the short-term. However, TLR offered better rotatory stability than ALR at final follow-up. LEVEL OF EVIDENCE: Level II, lesser-quality randomized controlled trial.