Red Blood Cell Membrane-Camouflaged Polydopamine and Bioactive Glass Composite Nanoformulation for Combined Chemo/Chemodynamic/Photothermal Therapy.

Combinations of different therapeutic strategies, including chemotherapy (CT), chemodynamic therapy (CDT), and photothermal therapy (PTT), are needed to effectively address evolving drug resistance and the adverse effects of traditional cancer treatment. Herein, a camouflage composite nanoformulation (TCBG@PR), an antitumor agent (tubercidin, Tub) loaded into Cu-doped bioactive glasses (CBGs) and subsequently camouflaged by polydopamine (PDA), and red blood cell membranes (RBCm), was successfully constructed for targeted and synergetic antitumor therapies by combining CT of Tub, CDT of doped copper ions, and PTT of PDA. In addition, the TCBG@PRs composite nanoformulation was camouflaged with a red blood cell membrane (RBCm) to improve biocompatibility, longer blood retention times, and excellent cellular uptake properties. It integrated with long circulation and multimodal synergistic treatment (CT, CDT, and PTT) with the benefit of RBCms to avoid immune clearance for efficient targeted delivery to tumor locations, producing an "all-in-one" nanoplatform. In vivo results showed that the TCBG@PRs composite nanoformulation prolonged blood circulation and improved tumor accumulation. The combination of CT, CDT, and PTT therapies enhanced the antitumor therapeutic activity, and light-triggered drug release reduced systematic toxicity and increased synergistic antitumor effects.

Injectable Zn2+ and Paeoniflorin Release Hydrogel for Promoting Wound Healing.

As more and more superbugs emerge, wounds are struggling to heal due to the inflammation that accompanies infection. Therefore, there is an urgent need to reduce the abuse of antibiotics and find nonantibiotic antimicrobial methods to counter infections to accelerate wound healing. In addition, common wound dressings struggle to cover irregular wounds, causing bacterial invasion or poor drug release, which reduces the wound healing rate. In this study, Chinese medicinal monomer paeoniflorin which can inhibit inflammation is loaded in mesoporous zinc oxide nanoparticles (mZnO), while Zn2+ released from mZnO degradation can kill bacteria and facilitate wound healing. The drug-loaded mZnO was encapsulated by a hydrogel formed from oxidized konjac glucomannan and carboxymethyl chitosan via rapid Schiff base reaction to obtain an injectable drug-releasing hydrogel wound dressing. The immediate-formation hydrogel allows the dressing to cover any wound shape. In vitro and in vivo studies have demonstrated that the dressing has good biocompatibility and superior antibacterial properties, which can promote wound healing and tissue regeneration by promoting angiogenesis and collagen production, providing a promising perspective for the further development of multifunctional wound dressings.

A New Arthroscopic Tightrope Suture-Button Fixation Procedure for Tibial Eminence Avulsion Fracture.

This case-series outcome study presents a new arthroscopic technique for tibial eminence avulsion fracture (TEAF) with double-tunnel using two tightrope suture buttons. From May 2017 to July 2020, we performed a new arthroscopic technique for TEAF with double tunnels, using two tightrope suture buttons on 13 patients. Clinical assessments included anterior drawer, Lachman, and pivot shift tests, the International Knee Documentation Committee (IKDC), Lysholm knee scores, visual analog scale (VAS) scores, and range of motion (ROM). An independent observer noted conditions before surgery and during the last follow-up. The patients had an average follow-up of 26.2 months, ranging from 15 to 37 months. During the last postsurgical follow-up, the anterior drawer, Lachman, and pivot shift tests were negative in all the cases. According to the IKDC, Lysholm, and VAS final scores, all patients presented a significant knee function improvement at last follow-ups compared with preoperatively. The study shows that satisfactory results about an anatomic reduction of the fragment, knee stability, function, and strength can be achieved with the new arthroscopic technique for TEAF with double tunnels using two tightrope suture buttons. This study is a therapeutic case series and its level of evidence is IV.

Diagnostic value of the lateral femoral notch sign and kissing contusion in patients with anterior cruciate ligament injuries: a case-control study.

INTRODUCTION: The lateral femoral notch sign (LFNS) and the kissing contusion (KC) are two indirect signs of anterior cruciate ligament (ACL) injuries. They can be used to diagnose ACL injuries. MATERIALS AND METHODS: A total of 1000 patients were enrolled in this study, including 500 patients with ACL injuries who assigned to experimental group and 500 patients with meniscal tear (MT) who allocated to control group. All the patients underwent magnetic resonance imaging (MRI) preoperatively, and the diagnosis was confirmed with the aid of arthroscopy. The depth of LFNS and the presence of KC were determined on MRI findings. The relationship and characteristics between these two indicators was explored. RESULTS: The notch depth of lateral femoral condyle in the experimental group (0.99 ± 0.56 mm) was significantly greater than that in the control group (0.49 ± 0.28 mm) (P < 0.05). The positive rate of KC in the experimental group (183/500) was markedly higher than that in the control group (3/500) (P < 0.05). The values of notch depth in patients who had ACL rupture concomitant lateral MT injuries and medial collateral ligament (MCL) injuries were 1.12 ± 0.64 and 1.23 ± 0.74 mm, respectively, which were significantly higher than those in patients with only ACL injury (0.89 ± 0.49 mm) (P < 0.05). It also was revealed that when the optimal cut-off point of LFNS was 0.72 mm (area under the curve (AUC) = 81%), the values of specificity and sensitivity were 67% and 84%, respectively. For KC, the corresponding values were 36.6% and 99.4%, respectively. The diagnostic outcome of LFNS was not in agreement with that of KC, as there was a poor coincidence according to the Kappa coefficient (Kappa = 0.155 < 0.4, P = 0.035). CONCLUSION: The LFNS and KC have strong clinical significance in the diagnosis of ACL injuries. A deeper notch often indicates a more complex knee injury. Notch depth equal to 0.72 mm can be basically considered as the optimal cut-off point for LFNS in statistics.

Clinical Use of Platelet-Rich Plasma to Promote Tendon-Bone Healing and Graft Maturation in Anterior Cruciate Ligament Reconstruction-A Randomized Controlled Study.

Background: We investigated the effect of platelet-rich plasma (PRP) on tendon-bone healing and intra-articular graft (IAG) maturation after anterior cruciate ligament (ACL) reconstruction. Methods: In this prospective randomized controlled study, 60 patients with ruptured ACLs were divided one-to-one into two groups (study and control). Patients were treated using single-bundle autologous hamstring autografts. Only patients in the study group were administered PRP. Knee function (pre-operative and three-, six-, and 12-month post-operative Lysholm activity, Tegner and International Knee Documentation Committee scores, femoral tunnel (FT) and tibial tunnel (TT) diameters measured with computed tomography (post-operative follow-up at 4 days and at 12 months), and magnetic resonance imaging signal/noise quotients of the IAG and graft in the FT (at 12 months) were used to evaluate tendon-bone healing and graft maturation. Results: Patients' knee function scores improved after ACL reconstruction, but there were no significant differences between groups. At 12 months, FT (study, 8.88 ± 1.46 mm; control, 8.42 ± 2.75 mm) and TT (study, 9.50 ± 1.07 mm; control, 9.99 ± 1.91 mm) diameters were larger than FT (study, 6.91 ± 0.74 mm; control, 7.30 ± 1.17 mm) and TT (study, 9.31 ± 0.83 mm; control, 9.36 ± 0.88 mm) diameters at 4 days; however, differences between groups were not significant (FT, P = 0.67; TT, P = 0.52). There were no significant differences between groups for signal/noise quotients of the IAG (study, 1.38 ± 0.70; control, 2.01 ± 0.62; P = 0.06) and FT-portion of the graft (study, 2.39 ± 1.22; control, 2.46 ± 0.83; P = 0.89). Conclusion: PRP had no significant effect on reducing bone tunnel widening, accelerating tendon-bone healing, or improving knee function; however, PRP may improve IAG maturation. Trial registration: Our study was first registered at Clinicaltrials.gov with registration No. NCT04659447 on 12/09/2020.

[Research progress of lateral femoral notch sign in diagnosis of anterior cruciate ligament rupture].

OBJECTIVE: To summarize the relationship between lateral femoral notch sign (LFNS) and anterior cruciate ligament (ACL) rupture. METHODS: The relevant literature of LFNS at home and abroad in recent years was retrospectively reviewed, and its mechanism, diagnostic criteria and influencing factors in diagnosis of ACL rupture were summarized and analyzed. RESULTS: The LFNS is associated with rotational stability of the knee. As an indirect sign of ACL rupture, the LFNS has high clinical diagnostic value, especially the diagnosis of ACL rupture with lateral meniscus injury. CONCLUSION: The diagnostic criteria and influencing factors of LFNS in diagnosis of ACL rupture are still unclear and controversial, which needs further study.

Effect of Integrative Neuromuscular Training for Injury Prevention and Sports Performance of Female Badminton Players.

OBJECTIVES: Investigate the effects of integrated neuromuscular training (INT) on injury prevention and the performance of professional female badminton athletes by comparing their preintervention and postintervention tests. The study hypothesized that integrated neuromuscular training can improve the asymmetry and improve the sport performance of female badminton players. METHODS: According to pretest value based on functional movement screening, 38 participants were divided into a high-risk group (HG) and a low-risk group (LG) with 22 and 16 people in each group. Two groups of athletes took part in an 8-week INT program consisting of four 90-min sessions each week. The asymmetries in movement, physical fitness, and special abilities were tested before and after the intervention. Independent sample t-test was used for the statistical analysis. RESULTS: This research found indicated that 8 weeks of INT influenced FMS scores in both groups (HG and LG). The change of inline lunge (ES H = 0.42, ES L = 0.21) and trunk stability push-up (ES H = -0.58, ES L = -0.20) showed significant differences (P < 0.05), and the change of the FMS scores (ES H = 0.81, ES L = 0.65), deep squat (ES H = 0.6, ES L = 0.3), and rotation stability (ES H = -0.65, ES L = -0.72) showed very significant differences (P < 0.01). Compared to the pretest, most of the physical fitness parameters improved significantly in the HG and LG groups except strength index, and special abilities of the HG and LG group women badminton athletes showed a substantial increase. CONCLUSION: Integrated neuromuscular training can effectively improve the asymmetry of female badminton athletes' limbs, prevent sports injury, and improve the athlete's performance ability. However, athletes in different risk groups have certain differences in the degree of improvement in their motor skills.

Comparison between single- and double-bundle anterior cruciate ligament reconstructions for knee with grade 2 medial collateral ligament injury.

ABSTRACT: This research discussed clinical outcomes of anterior cruciate ligament reconstruction accompanied by conservative treatment for grade 2 medial collateral ligament injury, and comparison was performed between double-bundle and single-bundle anterior cruciate ligament reconstruction.Clinical information was retrospectively collected for 41 cases suffering anterior cruciate ligament injuries accompanied by grade 2 medial collateral ligament injuries. Within 14 days after their injuries 22 cases received single-bundle anterior cruciate ligament reconstruction (SB group), while 19 were treated with double-bundle medial collateral ligament reconstruction (DB group). Physical statuses were estimated based on International Knee Documentation Committee (IKDC) and Lysholm scores, Lachman, pivot shift and manual valgus test, and range of motion (ROM), while side-to-side difference was estimated through KT 2000 arthometer.Anterior cruciate ligament reconstruction accompanied by conservative treatment showed significantly improved anteroposterior, rotational and valgus stability, and IKDC and Lysholm scores (in comparison to pre-operative status, P < .05). Incidence of pivot shift was dramatically lower in DB group (2/19) than in SB group (7/22 and 2/22; P = .028). No substantial dissimilarity existed between DB and SB groups either in Lachman and valgus tests, KT 2000, ROM, IKDC, or Lysholm scores.Anterior cruciate ligament reconstruction accompanied by conservative treatment could achieve outstanding stability and functional manifestations for cases facing anterior cruciate ligament injury accompanied by grade 2 medial collateral ligament injury. Moreover, double-bundle anterior cruciate ligament reconstruction is superior to single-bundle operation in treating rotational instability of the knee.Level of evidence: Retrospective comparative study, Level III.

Barbed Sutures in Total Knee Arthroplasty: A Meta-analysis of Randomized-Controlled Trials.

Newer methods of wound closure such as barbed sutures hold the potential to reduce closure time and equivalent wound complications in various surgeries. However, few studies have compared barbed suture and conventional wound closure techniques in total knee arthroplasty (TKA). The purpose of this review was to appraise the efficacy and safety of the barbed suture in closure of TKA. We conducted a meta-analysis to identify relevant randomized-controlled trials involving barbed sutures and conventional sutures in TKA in electronic databases, including Web of Science, Embase, PubMed, Cochrane Controlled Trials Register, Cochrane Library, Highwire, CBM, CNKI, VIP, Wanfang database, up to August 2019. Finally, we identified 1,472 TKAs (1,270 patients) assessed in 13 randomized-controlled trials. Compared with conventional wound closure techniques, barbed sutures resulted in shorter total wound closure time (p < 0.001), fewer needle puncture injuries to members of the surgical team (p = 0.02). There were no significant differences in terms of blister formation (p = 1.0), superficial infection (p = 0.82), range of motion (p = 0.94), incisional exudate (p = 0.75), suture abscess (p = 0.26), or suture breakage (p = 0.11), wound-related complications (p = 0.10), ecchymosis (p = 0.08) between barbed and conventional wound closure. Based on the available level I evidence, we thus conclude that a knotless barbed suture is a safe and effective approach for wound closure in TKA. Given the relevant possible biases in our meta-analysis, more adequately powered and better-designed randomized-controlled trials studies with long-term follow-up are required to recommend barbed sutures for routine administration in TKA.

Comparison of oral versus intravenous tranexamic acid in total knee and hip arthroplasty: A GRADE analysis and meta-analysis.

BACKGROUND: The efficacy and safety of oral tranexamic acid (TXA) remain controversial because of the small number of clinical studies. The aim of the present study was to compare the efficacy and safety of oral TXA with intravenous TXA in patients undergoing total hip arthroplasty and total knee arthroplasty in a systematic review and meta-analysis. METHODS: We conducted a meta-analysis to identify randomized controlled trials (RCTs) involving oral and intravenous TXA in total hip arthroplasty and total knee arthroplasty up to December 2019 by searching databases including PubMed, Web of Science, Embase, the Cochrane Controlled Trials Register, the Cochrane Library China Biology Medicine, China National Knowledge Infrastructure, China Science and Technology Journal Database and Wanfang. The mean difference or standard mean difference was used to assess continuous outcomes such as hemoglobin (Hb) drop, total blood loss, drain blood loss, and length of hospital stay, with a 95% confidence interval. Relative risks with a 95% confidence interval were used to assess dichotomous outcomes such as transfusion rate and the incidence of deep venous thrombosis and calf muscular vein thrombosis. Review Manager was used for the meta-analysis. RESULTS: Ten RCTs containing 1080 participants met the inclusion criteria. We found no significant differences in terms of the average Hb drop (P = .60), total blood loss (P = .60), transfusion rate (P = .99), drain blood loss (P = .91), length of hospital stay (P = .95), and the incidence of deep venous thrombosis (P = .55) and calf muscular vein thrombosis (P = .19) between oral and IV TXA. CONCLUSIONS: Compared with the IV TXA, oral TXA has similar effects on reducing the Hb drop, total blood loss, transfusion rate, drain blood loss, and length of hospital stay without increasing the risk of calf muscular vein thrombosis and deep venous thrombosis. Furthermore, oral TXA is easy to access and administer, which decreases the workload of nurses and even delivers cost-saving benefits to the health care system. We thus conclude that oral TXA may be an optimal approach in total joint arthroplasty. However, more high-quality and multicenter RCTs are still needed to confirm our conclusions. REGISTRATION: The current meta-analysis was registered on PROSPERO (International Prospective Register of Systematic Reviews), and the registration number was CRD42018111291.

Static Low-Angle Squatting Reduces the Intra-Articular Inflammatory Cytokines and Improves the Performance of Patients with Knee Osteoarthritis.

Osteoarthritis (OA) is one of the major diseases leading to disability, and inflammation plays an important role in the pathogenesis of OA. However, inflammation of OA is multifactorial, chronic, and in low intensity, which makes drug-based immunotherapy difficult. Here, we have designed a novel method of exercise-static low angle squat (SLAS), which reduces the intra-articular inflammation of OA knee as well as strengthens the vastus medialis of quadriceps. A two-year follow-up trial of current exercise methods demonstrated long-term, significant improvement in pain relief, range of motion, muscle strength, and knee stability.

Age-related Changes of Posterior Tibial Slope and Its Roles in Anterior Cruciate Ligament Injury.

Nearly all previous studies in posterior tibial slope (PTS) and anterior cruciate ligament (ACL) injuries ignored age-related changes, and the published data are inconsistent. The objective of this study was to reveal age-related changes of PTS and its roles in ACL injury. Data for 2618 lower limbs were included initially based on the availability of lateral radiographs and a suitable femoro-tibial angle. The final 1431 subjects were analyzed according to age, gender, side, and injury status. Student's t-tests, one-way analysis of variance, and curve fitting were used to analyze data. The PTS in males was greater than that in females in the 0-9 and 30-39-year-old groups, but this pattern reversed in the 40-49, 60-69, 70-79, and 80-89-year-old groups. The PTS was greater on the left side than on the right side in the 0-9, 10-19, 50-59, 60-69, and 80-89-year-old groups. The curve fitting for PTS demonstrated a trend of first decreasing and then increasing with aging. The PTS values differed significantly between knees with an ACL injury and those without in the 20-29, 30-39, and 40-49-year-old groups but not in the 50-59-year-old group. The PTS follows a trend of first decreasing and then increasing, and its role in ACL injury changes with advancing age. The higher PTS is only unrelated to the risk of ACL injury in age groups with a lower mean PTS value.

The effect of medial meniscal horn injury on knee stability.

PURPOSE: This study investigated the effect of damage of the posterior and anterior horns of the medial meniscus on knee stability. METHODS: Twenty fresh-frozen porcine knees were divided into two groups (anterior horn and posterior horn injury). Each group was tested in three states: intact medial meniscus, posterior or anterior horn of medial meniscus resection and total medial meniscectomy. A robotic testing system was used to test anterior tibial translation (ATT) at 30° (full extension), 60° and 90° of knee flexion with an external anterior tibial load of 89 N, internal rotation (IR) and external rotation (ER) at 30° and 60° of knee flexion under a 4 N m tibial rotation torque. RESULTS: In response to an IR torque, there was a significant difference between the state of intact medial meniscus and anterior and posterior horn damage, except for anterior horn resection at 60° of knee flexion. In response to an ER torque, there were no significant differences between the state of intact meniscus and horn damage except for anterior horn resection at 30° of knee flexion. Meniscal damage had no significant effect on ATT. CONCLUSION: The results indicated that the posterior horn was more important in controlling the IR stability than the anterior horn with knee flexion, and the anterior horn was more important in controlling the ER stability than the posterior horn at full knee extension in the anterior cruciate ligament-intact knee. These findings further the understanding of the mechanisms, the prevention of injuries and rehabilitation of meniscal horn injury in clinical practice.

Intraoperative anthropometric measurements of tibial morphology: comparisons with the dimensions of current tibial implants.

PURPOSES: This study analyzed morphological differences in the resected proximal tibial surfaces of Chinese males and females undergoing total knee arthroplasty (TKA) and compared the measurements with the dimensions of five currently used tibial implants. METHODS: The mediolateral (ML), middle anteroposterior (AP), medial anteroposterior (MAP), and lateral anteroposterior (LAP) dimensions of the resected tibial surfaces of 976 Chinese TKA knees (177 male, 799 female) were measured. The ML/AP ratio of every knee was calculated. These morphological data were compared with the dimensions of five currently used tibial implants. RESULTS: The ML, AP, MAP, and LAP dimensions of the resected proximal tibias showed significant differences according to gender. Compared with currently used tibial implants, the smaller implants showed tibial ML undersizing and the larger implants showed tibial ML overhang. The ML/AP aspect ratio progressively decreased with increasing AP dimension in the resected proximal tibias, which contrasts with the relatively constant or increased (NexGen) aspect ratio in currently used tibial implants. Males showed a higher ML/AP aspect ratio than females for a given AP dimension. This indicates that for an implant with a given AP dimension, the tibial ML dimension tends to be undersized in males and to overhang in females. CONCLUSION: The results of this study may provide fundamental data for designing suitable tibial implants for use in the Chinese population, especially for design of gender-specific prostheses. LEVEL OF EVIDENCE: II.

[Predisposing factors of patellofemoral articular cartilage injury after anterior cruciate ligament reconstruction].

OBJECTIVE: To evaluate the effects of age, gender, tibial anterior laxity and time from surgery to follow-up on patellofemoral articular cartilage status after anterior cruciate ligament reconstruction by second-look arthroscopy. METHODS: A total of 102 patients undergoing arthroscopic anterior cruciate ligament reconstruction received second-look arthroscopy at least one year after operation. There were 71 males and 31 females with an average age of 27.1 (16-41) years. The average time from primary operation to second-look arthroscopy was 23 (12-51) months. Arthroscopic evaluations of patella and trochlea cartilage status for all patients were performed at initial anterior cruciate ligament reconstruction and second-look arthroscopy. The effects of age, gender, tibial anterior laxity and time from surgery to follow-up on patellofemoral articular cartilage status were retrospectively examined. RESULTS: Patellofemoral articular cartilage degeneration continued to aggravate after anterior cruciate ligament reconstruction. There was no significant gender difference in patella and trochlear cartilage status. The patellar cartilage of patients under 30 years was worse than that of patients aged 30 years and above. Even though there was no significant difference. However, no significant inter-group difference existed in trochlear cartilage damage. With regard to KT-2000 side-to-side differences (0-3 mm vs >3 mm), no significant difference existed in patella and trochlear cartilage status. No significant difference was also found in the status of patella and trochlear cartilage between patients with body mass index under 24 kg/m(2) and patients 24 kg/m(2) and higher. The patellar cartilage of patients within 24 months after operation was significantly worse than that of patients 24 months and longer. However it did not apply to trochlear cartilage. CONCLUSION: The degeneration of patellofemoral articular cartilage worsens after anterior cruciate ligament reconstruction. And significantly more severe lesions are found in patellar cartilage of patients within 24 months after operation.

Intraoperative study on anthropometry and gender differences of the proximal tibial plateau at the arthroplasty resection surface.

BACKGROUND: The tibial plateau is asymmetric with a larger medial plateau. We observed from clinical practice that the shape of the tibial plateau does not always present a larger medial plateau. Tibial plateau also showed other shapes. The purpose of this study was to analyze the anthropometric data of the proximal tibia in a large group of Chinese patients undergoing total knee arthroplasty and to investigate the morphology of the resected proximal tibial surface and its gender differences. METHODS: A total of 822 knees (164 males, 658 females) from the Chinese population were measured intraoperatively for medial anteroposterior (MAP) and lateral anteroposterior (LAP) dimensions of the resected proximal tibial surface. The difference of MAP and LAP (DML) was also calculated as MAP minus LAP. We then classified the data into three groups based on the DML (<-2, -2 to 2, and >2 mm) to analyze the morphology of the proximal tibia and its distribution between male and female. RESULTS: The shape of proximal tibial plateau was of three types: larger medial plateau type, symmetric type, and larger lateral plateau type. There were significant differences between males and females in relation to the shape distribution of the proximal tibial plateau (P < 0.05). Most of the proximal tibial plateau was asymmetric, with 517 of 822 (62.9%) tibia having a DML >2 mm and 120 of 822 (14.6%) tibia having a DML<-2 mm. Only 185 of 822 (22.5%) tibia had a DML between -2 and 2 mm. CONCLUSION: The results of this study can be used as a guideline to design tibial components with different DMLs to better match the different anthropometry of the resected tibial surface.

Clinical features and prognosis of discoid medial meniscus.

PURPOSE: To evaluate the clinical manifestations and the outcome of surgical treatment of discoid medial meniscus. METHODS: Records of 13 patients with discoid medial meniscus were retrospectively reviewed for their epidemiology, clinical manifestations, operation methods, treatment outcome and radiographic characteristics. RESULTS: The 13 cases of discoid medial meniscal injury took up 1.5 ‰ of the overall meniscal injuries treated at our institute during the 44-year period. Patients presented with knee pain (13 patients), giving away (10 patients), swelling (9 patients) and snapping (9 patients). The most common physical signs were medial joint line tenderness (13 patients) and positive McMurray test (11 patients). Ten patients required total meniscectomy. There were excellent short-term results: the median Tegner score was 7, and the mean Lysholm score was 94.8 ± 2.4 at two-year follow-up. However, the long-term outcome was not as good with degenerative changes in the medial compartment of all the involved knees. CONCLUSION: The discoid medial meniscus is extremely rare. The clinical signs and symptoms of discoid medial meniscal injuries are similar to those of any other meniscal injury. No Wrisberg-ligament type abnormality was found. Meniscectomy for discoid medial meniscus produced promising short-term results and deteriorating long-term results with secondary degeneration of cartilage in the medial compartment. LEVEL OF EVIDENCE: Retrospective case series, Level IV.

[Measurement of bone tunnel width with computed tomography versus plain radiography after anterior cruciate ligament single-bundle reconstruction].

OBJECTIVE: To compare the measurements of bone tunnel width with computed tomography (CT) and plain radiography two years after anterior cruciate ligament single-bundle reconstruction. METHODS: Twenty patients underwent primary anterior cruciate ligament single-bundle reconstruction with hamstring autografts. There were 10 females and 10 males. Tibial and femoral bone tunnel widths were measured with CT and plain radiography at least two years post-operation. The average follow-up period was 26 months (range, 24-31). The tunnel measurements were taken at the widest point of tibial and femoral tunnels on sagittal and coronal CT and plain radiography perpendicularly to the longitudinal axis of tunnels. All data were statistically analyzed. RESULTS: The tibial tunnel width of one case decreased on CT while all others increased. The average tibial tunnel width on coronal plain radiography was 0.9 ± 0.6 mm (range, 0.3-2.2) larger than that on CT. And the average width on sagittal plain radiography was 0.9 ± 0.5 mm (range, 0.1-2.1) larger than that on CT. Both were statistically significant. All femoral tunnel widths increased, except in 2 cases. The average femoral tunnel widths on coronal and sagittal plain radiography were both significantly larger than those on CT. And the difference were 0.7 ± 0.6 mm (range, 0-1.7) and 0.9 ± 0.7 mm (range, 0.1-2.7) respectively. CONCLUSION: Bone tunnel measurements on plain radiography are significantly larger than those on CT after anterior cruciate ligament reconstruction.

Sex, age, and annual incidence of primary total knee arthroplasty: a university affiliated hospital survey of 3118 Chinese patients.

BACKGROUND: In recent years, the number of patients undergoing primary total knee arthroplasty in China has rapidly increased. However, the incidence of primary total knee arthroplasty is unknown. The purpose of this study was to investigate the sex, age and, annual incidence of primary total knee arthroplasty based on 3118 Chinese patients who underwent the procedure during the period of 2000 - 2011. METHODS: Total knee arthroplasties were performed on 511 males and 2607 females in our hospital during the period of 2000 - 2011. The sex, age, and annual incidence of primary total knee arthroplasty were evaluated. RESULTS: The annual incidence of primary total knee arthroplasty increased from 35 knees in 2000 to 681 knees in 2011. The average annual percentage increase in incidence was 33.2%. Females accounted for 83.2% of the patients who underwent primary total knee arthroplasty. In both males and females, the highest incidence was observed in the group aged 65 - 74 years. CONCLUSIONS: This study demonstrated a rapid increase in the incidence of primary total knee arthroplasty in our Chinese study population. The sex and age incidence of primary total knee arthroplasty in our study population differed from those reported in Western populations.

Double-bundle anterior cruciate ligament reconstruction using bone-patellar tendon-bone allograft: technique and 2- to 5-year follow-up.

BACKGROUND: Nonanatomic transtibial single-bundle anterior cruciate ligament reconstruction (SB-ACLR) with a bone-patellar tendon-bone (BPTB) allograft has been used for a long time and has shown the same satisfactory clinical results as an autograft; however, it has not been reported if a double-bundle ACLR (DB-ACLR) could be performed with a BPTB allograft and achieve even better results. HYPOTHESIS: The DB-ACLR with a BPTB allograft is technically feasible and will be superior to the SB technique in restoring better anterior and rotating stability. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: The study was performed with 56 patients, and 52 (25 in the DB group and 27 in the SB group) of them were followed up at 2 to 5 years. With an irradiated deep-frozen BPTB allograft, a standard single-incision arthroscopic technique was used, and the graft was fixed with bioabsorbable interference screws on both the femoral and tibial sides. Outcome assessment at final follow-up included International Knee Documentation Committee (IKDC), Tegner, and Lysholm scores; side-to-side difference by conventional KT-2000 arthrometer; total anteroposterior (AP) laxity by the back-pushing KT-2000 arthrometer; pivot shift (0, +, ++); range of motion (ROM); and isokinetic muscle strength evaluation. RESULTS: Mean follow-up was 47.3 ± 11.5 and 58.2 ± 6.6 months for the DB group and SB group, respectively. A statistically significant difference in favor of the DB group was found with the total AP laxity at 30° (P < .05). The overall incidence of pivot shift in the DB group (4% ++) was significantly lower than that in the SB group (26%: 19% + and 7% ++; P = .029). No significant differences were found between the 2 groups in terms of IKDC score, Lysholm score, Tegner score, conventional KT-2000 arthrometer anterior laxity, ROM, and muscle strength. CONCLUSION: A DB-ACLR with a BPTB allograft is feasible and achieved more satisfactory results than the transtibial SB technique in terms of total AP stability and rotational stability in spite of no significant differences among other clinical parameters.