ABSTRACT
BACKGROUND:Arthroscopic anterior cruciate ligament (ACL) reconstruction is the conventional surgical treatment at present for patients with severe anterior cruciate ligament injury or fracture. However, the opinions varies about whether the ACL remnant should be preserved, and its impact on the knee proprioception gets more and more attention. OBJECTIVE:To compare the influence of arthroscopic ACL reconstruction with remnant preservation or not on the proprioception of the knee joint using a meta-analysis. METHODS:We retrieved randomized control ed studies on arthroscopic ACL reconstruction with remnant preservation or not from 2001 to 2016. Meta-analysis was used to compare postoperative threshold to detection of passive motion (TTDPM), passive angle regeneration test, joint position sense and KT-1000/2000, IKDC, and Lysholm scores between remnant preservation or not. RESULTS AND CONCLUSION:(1) A total of 11 randomized control ed trials were included. (2) The meta-analysis results showed that postoperative TTDPM [OR=-0.50,95%CI(-0.74,-0.26), P<0.0001], passive angle reproduction [OR=-0.13, 95%CI(-0.26,-0.01), P=0.03<0.05] and Lysholm scores [OR=1.25, 95%CI(0.63, 2.06), P=0.0002], IKDC scores (OR=1.28, 95%CI([0.27, 2.28], P=0.01] in preserving-remnant were superior to removing-remnant for arthroscopic ACL reconstruction. However, there were no statistical y significant differences in KT1000/2000 scores [OR=-0.05, 95%CI(-0.13, 0.03), P=0.24] and joint position sense [OR=-0.30, 95%CI(-0.79, 0.18), P=0.22]. (3) In the arthroscopic ACL reconstruction, retained stump postoperative proprioception recovered wel and can obtain satisfactory clinical effect. However, prospective large-sample long-term randomized control ed trials are needed for verification.
ABSTRACT
BACKGROUND:Reconstruction with remnant preservation can enhance tendon-bone healing. However, the study limits on the histological level, and there is a lack of research based on the modular biological level. OBJECTIVE:To investigate whether anterior cruciate ligament reconstruction with remnant preservation can enhance tendon-bone healing. METHODS:Seventy-two New Zealand rabbits were randomly al ocated to three groups (n=24 per group), fol owed by cruciate ligament reconstruction without remnant (group A), with remnant preservation (femoral tensioning and augmented suture) (group B) and with remnant preservation (graft passing remnant anterior cruciate ligament sheath) (group C), respectively. RESULTS AND CONCLUSION:Hematoxylin-eosin staining showed that the tendon-bone healing in the groups B and C surpassed that in the group A, and group B was better than group C. Real-time PCR revealed that the expression level of osteoprotegrin mRNA and the osteoprotegrin/receptor activator of nuclear factor-κB ligand (RANKL) ratio were greater in the groups B and C than in the group A, and highest in the group C, while the expression levels of RANKL mRNA in the groups B and C were lower than that in the group A. In conclusion, these two kinds of anterior cruciate ligament reconstruction methods with remnant preservation can enhance tendon-bone healing, which have obtained most obvious achievements in the anterior cruciate ligament reconstruction in the graft passing anterior cruciate ligament remnant sheath that may be related to the up-regulation of osteoprotegrin mRNA and down-regulation of RANKL mRNA.
ABSTRACT
BACKGROUND:The unstable distal radius fractures are clinical y treated with external fixation, open reduction and internal fixation at present. These two methods have their advantages and disadvantages. OBJECTIVE:To compare the radiological, clinical and functional outcomes of two groups of patients treated by bridging external fixation combined with Kirschner wire fixation versus volar locked plate for a displaced fracture of the distal radius. METHODS:We col ected 68 cases of unstable distal radius fractures in the Department of Reparative and Reconstructive Surgery, First Affiliated Hospital of Xinjiang Medical University, China from October 2014 to April 2016. They were randomly assigned to two groups, with 34 in each group. Patients in the external fixation group received external fixator and Kirschner wire. Patients in the internal fixation group received volar locked plate. In the fol ow-up, outcomes were assessed by radiographic parameters, function parameters, and Cooney functional score between both groups. RESULTS AND CONCLUSION:(1) Al patients were fol owed up. External fixation group was fol owed up for 12-16 months. Internal fixation group was fol owed up for 13-15 months. X-rays showed al fractures healed. (2) At 3 months postoperatively, significant differences in pronation, supination, extension and radial deviation were detected between the two groups (P0.05). The range of motion of the wrist was better in the internal fixation group, but no significant difference in the grip strength was determined between the two groups at any time points in 1-year fol ow-up. (3) These results demonstrated that compared with the external fixation, volar locked plate fixation showed better early recovery postoperatively. With time prolonged, clinical outcomes of both repair methods tended to be consistent.