[A preliminary study on the surgical timing of spinal tuberculosis].

OBJECTIVE: To observe the changes of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and nerve function in patients with spinal tuberculosis before and after surgery, explore the timing of surgical intervention, and evaluate its influence on surgical safety. METHODS: A retrospective analysis was conducted on 387 patients with spinal tuberculosis who received surgical treatment from March 2012 to March 2017, including 278 males and 109 females, aged 12 to 86 years old with an average of (49.9±19.1) years. There were 64 cases of cervical tuberculosis, 86 cases of thoracic tuberculosis, 76 cases of thoracolumbar tuberculosis and 161 cases of lumbar tuberculosis. There were 297 patients with single segmental involvementand 90 patients with multiple segmental involvement. Among them, 62 cases presented neurological damage, and preoperative spinal cord neurological function depended on ASIA grade, 5 cases of grade A, 8 cases of grade B, 39 cases of grade C, and 10 cases of grade D. According to the duration of preoperative antituberculosis treatment, the patients were divided into group A (256 cases, receiving conventional quadruple antituberculosis treatment for 2-4 weeks before surgery) and group B (131 cases, receiving conventional quadruple antituberculosis treatment for more than 4 weeks before surgery). The two groups were compared in terms of gender, age, preoperative complicated pulmonary tuberculosis, lesion site, lesion scope, surgical approach, drug resistance and other general clinical characteristics. ESR, CRP, visual analogue scale(VAS), Oswestry Disability Index (ODI), Frankel grade and postoperative complications were observed. RESULTS: All 387 patients were followed up for 12 to 36 (18.3±4.5) months. There were no significant differences in gender, age, preoperative pulmonary tuberculosis, lesion site, lesion range, surgical approach, preoperative drug resistance and other characteristics between two groups. A total of 32 patients in two groups did not heal after surgery, with an incidence rate of 8.27%. The VAS and spinal cord dysfunction index of the two groups were significantly improved after surgery (P<0.05), but there was no significant difference between two groups at the same time point (P>0.05) . From 1 to 14 days after operation, the neurological function began to gradually recover, and the neurological function grade was increased by 1 to 3 grades. From 3 months after operation to the final follow up, 52 cases recovered completely, 8 cases partially recovered, and 2 cases did not improve. There was no significant difference in ESR and CRP between two groups before admission, 1 month after surgery, and final follow-up (P>0.05). CONCLUSION: After 2-4 weeks of anti tuberculosis treatment before operation, patients with spinal tuberculosis could be operated upon with ESR and CRP in a descending or stable period. In principle, patients with spinal tuberculosis and paraplegia should be treated as soon as possible after active preoperative management of the complication without emergency surgery.

[Treatment of tuberculosis of lumbar spine in elderly patients with percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation].

OBJECTIVE: To explore the clinical effects and advantages of percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation in the treatment of tuberculosis of lumbar spine in elderly. METHODS: The clinical data of 32 patients with tuberculosis of lumbar spine received percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation from May 2013 to May 2016 were retrospectively analyzed. There were 13 males and 19 females, aged from 62 to 85 years old with an average of 75 years. Lesion segmental Cobb angle was 13° to 21° with an average of (16.52±3.20)°. Tuberculosis focal involved L1-L2 of 1 case, L2-L3 of 4 cases, L3-L4 of 15 cases, L4-5 of 10 case, L5-S1 of 2 cases. Cobb angle, VAS score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) and ASIA grade were compared before and after operation. The stability of the spine and the recurrence of tuberculosis were evaluated. RESULTS: All patients were followed up for 12-36 months with the mean of 24 months. Three patients complicated with giant paravertebral psoas abscess occurred sinus tract in canal orifice of drainage tube after irrigation, and healed in 3 months after operation. Other 29 patients obtained healing of phase I without sinus tract formation. The clinical symptoms of all patients obvious improved at 2 weeks to 3 months after operation and no complications such as severe heart and lung, liver and kidney dyfunction were found. VAS scores and Cobb angles were improved from preoperative(6.77±1.23) points and(16.52±3.20)° to(4.71±0.69) points and (4.24±1.22)° at 1 week after operation. No infection and tuberculosis recurrence were found at follow-up period. ESR and CRP were normal at final follow-up and ASIA grade had obvious improved. CONCLUSIONS: Percataneous endoscopic focal cleaning and drainage combined with posterior internal fixation is a simple, effective and safe method for tuberculosis of lumbar spine in elderly, and is worthy to recommend its clinical use.

[Application of cortical bone trajectory screw in elderly patients with lumbar tuberculosis].

OBJECTIVE: To explore the clinical effect of cortical bone trajectory screw technology combined with anterior mini-open debridement and prop graft for lumbar tuberculosis in elderly. METHODS: The clinical data of 22 patients with lumbar tuberculosis treated by cortical bone trajectory screw technology combined with anterior mini-open debridement and prop graft from February 2015 to December 2016 were retrospectively analyzed. There were 13 males and 9 females with an average age of (73.3±7.1) years old. The pre-operative Frankel grading showed that 2 cases were grade B, 5 cases were grade C, 6 were grade D, and 9 were grade E. Pre- and post-operative kyphosis Cobb angle, visual analogue scale (VAS), erythrocyte sedimentation rate(ESR) and the Frankel grade were analyzed, the conditions of complication, stability of internal plants, graft fusion were observed. RESULTS: All 22 patients were follow-up for 12 to 24 months with an average of (18.7±4.6) years. Two patients with contralateral psoas major muscle abscess enlarged at 3 months after operation and were cured by drainage under the guidance of type-B ultrasonic. Other 20 cases got primary healing without sinus formation and recurrence of spinal tuberculosis. At the final follow-up, the Frankel grading showed that 3 cases was grade C, 5 cases were grade D, and 14 cases were grade E. The Cobb angle, visual analogue scale (VAS), ESR were respectively decreased from preoperative(17.68±3.86)°, (6.95±2.26) points, (47.14±20.85)mm/h to (4.77±2.47)°, (2.18±1.59) points, (16.77±11.42) mm/h at final follow-up. X-ray and CT scan showed bone union for 3 to 8 months after operation, with a mean time of(4.9±1.2) months. CONCLUSIONS: It is effective method to treat lumbar tuberculosis with cortical bone trajectory screw technology combined with anterior mini-open debridement and prop graft.

[Eearly clinical effects of percutaneous endoscopic focal cleaning and drainage in the treatment of single-level suppurative spondylitis].

OBJECTIVE: To evaluate the clinical value of percutaneous endoscopic focal cleaning and drainage in the treatment of single-level suppurative spondylitis. METHODS: The clinical data of 18 patients with single-level suppurative spondylitis treated by percutaneous endoscopic focal cleaning and drainage from June 2014 to December 2015 were retrospectively analyzed. There were 11 males and 7 females, aged from 46 to 75 years old with an average of (58.89±9.46) years. According to the patient's diagnosis and drug sensitivity results to anti-infection therapy after operation. All the patients were followed up for 12 to 24 months with an average of(15.50±3.45) months. Disease control status was evaluated by laboratory examination of erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) before and after operation. Relief of pain was evaluated using visual analogue scale(VAS). Nerve function was assessed by ASIA classification. Clinical effects were evaluated by Kirkaldy-Willis standard. Spinal stability and recurrence of infection were observed by imaging data. RESULTS: All the operations were successful, and no complication as hematoma, nerve injury, infection, cerebrospinal fluid leakage, sinus formation at the site of tube placement, or mixed infection were found. Postoperative bacteriological report was positive in 12 cases, while 6 cases showed no bacterial growth, and the infection status in 13 cases were confirmed by pathological examination. ESR, CRP, VAS at 2 weeks, 3 months after surgery and at the final follow-up were obviously improved(P<0.05). Clinical symptoms were improved significantly at 1 week to 3 months after operation. According to Kirkaldy-Willis standard to evaluate the clinical effect, 14 cases obtained excellent results, 3 good, and 1 fair. Nerve function recovery was based on ASIA grading at the final follow-up. The lost Cobb angles were (1.11±1.18)° on average, with no statistically significant difference before and after operation (P>0.05). During the follow-up, no recurrent infection has occurred. CONCLUSIONS: Percutaneous endoscopic focal cleaning and drainage is a minimally invasive, effective and safe surgical method, which serves as a new choice for surgical treatment of suppurative spondylitis.

The efficacy and safety of using a bipolar sealer to prevent blood loss in spine surgery: A meta-analysis.

OBJECTIVE: The purpose of this systematic review and meta-analysis of randomized controlled trials (RCTs) and non-RCTs was to evaluate the effect of using a bipolar sealer to prevent surgical bleeding in spine surgery. METHODS: In June 2017, the PubMed, Embase, Cochrane controlled trials register, Web of Science, Google, and Chinese Wanfang databases were used to identify RCTs and non-RCTs comparing the effects of intraoperative placement of a bipolar sealer versus standard electrocautery with regard to blood loss and blood transfusion. Stata 12.0 software was used to perform the meta-analysis. Weighted mean differences with 95% confidential intervals (CIs) were used for continuous outcomes, and relative risks with 95% CIs were used for discontinuous outcomes. After testing for publication bias and heterogeneity across studies, the data were aggregated and assessed with a random effects model when necessary. RESULTS: In total, 6 clinical trials with 560 patients were included in this meta-analysis. The pooled results indicated that the use of a bipolar sealer decreased the estimated blood loss (MD = -165.06, 95% CI -236.73 to -93.40, P < 0.001), the need for a blood transfusion (RR = 0.46, 95% CI 0.31 to 0.68, P < 0.001), the transfusion units used (MD = -0.41, 95% CI -0.60 to -0.21, P < 0.001), the operative time (MD = -12.98, 95% CI -21.82 to -4.15, P = 0.004) and the length of hospital stay (MD = -2.77, 95% CI -5.45 to -0.10, P = 0.042). No significant difference was observed for the occurrence of infection (RR = 0.52, 95% CI 0.19 to 1.39, P = 0.192). CONCLUSION: Based on the current meta-analysis, the use of a bipolar sealer is superior to standard electrocautery for reducing intraoperative blood loss and is therefore recommend for use during spine surgery.

Treatment of Lumbar Tuberculosis by Mini-Open Anterior Approach Focal Cleaning Combined with Posterior Internal Fixation.

BACKGROUND The aim of this study was to evaluate the efficiency and clinical outcomes of mini-open anterior approach focal cleaning combined with posterior internal fixation compared to conventional anterior extraperitoneal approach focal cleaning combined with posterior internal fixation in the treatment of lumbar tuberculosis (TB). MATERIAL AND METHODS Medical records from 124 patients were collected from February 2010 to April 2015; patients were divided into two groups: group A (mini-open anterior approach focal cleaning combined with posterior internal fixation) and group B (conventional anterior extraperitoneal approach focal cleaning combined with posterior internal fixation in period I). The data on postoperative mechanical ventilation time, preoperative, postoperative, and last follow-up Cobb angle, visual analog scale (VAS), erythrocyte sedimentation rate (ESR), and Frankel classification were collected and analyzed. Operative complications, internal stability, and bone graft fusion were also observed. RESULTS All patients were followed-up for 12 to 36 months (average 22.5 months). Seven cases (five in group A and two in group B) had side psoas abscess and were cured after secondary drainage surgery. The rest of the cases were all cured after primary surgery, with no formation of sinus, incisional hernia, cerebrospinal fluid leakage, or recurrence of spinal TB, with no TB symptoms. Bone graft fusion ranged from 3 to 8 months (average 4.7 months). Compared to group B, group A, which had less time on postoperative mechanical ventilation, had a higher VAS score. Both groups had distinct improvements in Cobb angle, ESR, and Frankel classification after surgery. CONCLUSIONS Treating lumbar TB by mini-open anterior approach focal cleaning combined with posterior internal fixation was safe and effective.

[Application value of Xpert MTB/RIF in diagnosis of spinal tuberculosis and detection of rifampin resistance].

OBJECTIVE: To investigate the application value of Xpert MTB/RIF in diagnosis of spinal tuberculosis and detection of rifampin resistance. METHODS: The 109 pus specimens were obtained from patients who were primaryly diagnosed as spinal tuberculosis. All of the pus specimens were detected by acid-fast stain, liquid fast culturing by BACTEC MGIT 960 and Xpert MTB/RIF assay to definite the differences in sensitivity and specificity of mycobacterium tuberculosis among detecting methods. Pus specimens obtained by different methods were deteceded by MTB/RIF test to analyze the self-influence on Xpert MTB/RIF test. The result of liquid fast culturing by BACTEC MGIT 960 was used as the gold standard; and the value of Xpert MTB/RIF assay in detecting rifampin resistance was analyzed. RESULTS: The sensitivity of acid-fast stain, liquid fast culturing by BACTEC MGIT 960 and Xpert MTB/RIF assay were 25.92%, 48.15%, 77.78%, respectively. The sensitivity of pus specimens obtained from open surgery, ultrasound positioning puncture and biopsy the sensitivity were 83.78%, 76.47%, 44.68% respectively deteceded by MTB/RIF test. According to the gold standard of the results of liquid fast culturing by BACTEC MGIT 960 assay, the sensitivity and specificity of Xpert MTB/RIF assay in detecting rifampin resistance were 80%(4/5) and 90.70%(39/43), respectively. CONCLUSIONS: Xpert MTB/RIF assay has higher value in diagnosis of spinal tuberculosi, and also can detect rifampin resistance. The number of mycobacterium tuberculosis in pus specimens has a great influence in the sensitivity of Xpert MTB/RIF assay.

Progress in function of HDL-eNOS signaling pathway in cardiovascular system and it' s influencing factors / 中国病理生理杂志

High-density lipoprotein ( HDL) is negatively related to the risk of cardiovascular diseases such as atherosclerosis .Recent studies have shown that HDL activates a variety of target cells , such as vascular endothelial cells and macrophages , and activates the related cell signaling pathway to exert an anti-atherosclerosis role .HDL is a complex substance which composes of multiple particles .The changes of many factors affect the characteristics and functions of HDL, and then affect the activation of endothelial nitric oxide synthase ( eNOS) .This paper summarizes the recent correla-tion studies, and expounds the related factors that affect the HDL-eNOS signaling pathway .

Analysis of the effect of amiodarone combined with psychological intervention on arrhythmia and its effects on serum high sensitive C reactive protein / 中国生化药物杂志

Objective To investigate the clinical effect of amiodarone combined with psychological intervention on the treatment of the patients with arrhythmia and its influence on the serum high sensitive C reactive protein. Methods The control group were treated with amiodarone on the basis of routine treatment, the study group was given amiodarone combined with psychological intervention on the basis of routine treatment. The effect in the two groups before and after treatment and the hs-CRP level changes in the two groups were recorded. Results The total efficiency in the study group was 89.13%, which was higher than 71.74% in the control group(P<0.05). There was no significant difference in the level of hs-CRP between the two groups before treatment. After treatment, the hs-CRP in study group was better than that in control group (P<0.05). Conclusion On the basis of routine treatment, amiodarone combined with psychological intervention can significantly improve the clinical efficacy of arrhythmia patients, and significantly reduce the level of hs-CRP.

Therapeutic Observation of Scalp Acupuncture plus Rehabilitation for Children Epilepsy / 上海针灸杂志

Objective To compare the therapeutic efficacy between scalp acupuncture plus rehabilitation and rehabilitation in treating children epilepsy.Method Sixty children with epilepsy were enrolled and randomized into two groups, 30 cases in the treatment group and 30 cases in the control group. The treatment group was intervened by scalp acupuncture plus rehabilitation, while the control group was treated with rehabilitation. After the intervention, the changes of Comprehensive Function Assessment for Disabled Children (CFADC) and electroencephalogram (EEG) waves were observed, and the therapeutic efficacies of the two groups were compared and analyzed.Result The comprehensive function scores were changed significantly in both groups after the treatment (P<0.05). After the treatment, the comprehensive function score was (61.15±2.65) in the treatment group versus (58.60±2.81) in the control group, and the between-group difference was statistically significant (P<0.05). There was a significant difference in comparing the EEG waves between the two groups (P<0.05). In the control group, no case was recovered, 4 cases showed marked efficacy, 21 showed effective, and 5 failed in the treatment; in the treatment group, 2 cases were recovered, 10 showed marked efficacy, 16 showed effective, and 2 failed in the treatment. There was a significant difference in comparing the therapeutic efficacy between the two groups (P<0.05), and the treatment group was superior to the control group.Conclusion Scalp acupuncture plus rehabilitation can produce a satisfactory clinical efficacy in treating children epilepsy and is thus feasible.

Analysis of the effect of amiodarone combined with psychological intervention on arrhythmia and its effects on serum high sensitive C reactive protein / 中国生化药物杂志

Objective To investigate the clinical effect of amiodarone combined with psychological intervention on the treatment of the patients with arrhythmia and its influence on the serum high sensitive C reactive protein. Methods The control group were treated with amiodarone on the basis of routine treatment, the study group was given amiodarone combined with psychological intervention on the basis of routine treatment. The effect in the two groups before and after treatment and the hs-CRP level changes in the two groups were recorded. Results The total efficiency in the study group was 89.13%, which was higher than 71.74% in the control group(P<0.05). There was no significant difference in the level of hs-CRP between the two groups before treatment. After treatment, the hs-CRP in study group was better than that in control group (P<0.05). Conclusion On the basis of routine treatment, amiodarone combined with psychological intervention can significantly improve the clinical efficacy of arrhythmia patients, and significantly reduce the level of hs-CRP.

Therapeutic Observation of Scalp Acupuncture plus Rehabilitation for Children Epilepsy / 上海针灸杂志

Objective To compare the therapeutic efficacy between scalp acupuncture plus rehabilitation and rehabilitation in treating children epilepsy.Method Sixty children with epilepsy were enrolled and randomized into two groups, 30 cases in the treatment group and 30 cases in the control group. The treatment group was intervened by scalp acupuncture plus rehabilitation, while the control group was treated with rehabilitation. After the intervention, the changes of Comprehensive Function Assessment for Disabled Children (CFADC) and electroencephalogram (EEG) waves were observed, and the therapeutic efficacies of the two groups were compared and analyzed.Result The comprehensive function scores were changed significantly in both groups after the treatment (P<0.05). After the treatment, the comprehensive function score was (61.15±2.65) in the treatment group versus (58.60±2.81) in the control group, and the between-group difference was statistically significant (P<0.05). There was a significant difference in comparing the EEG waves between the two groups (P<0.05). In the control group, no case was recovered, 4 cases showed marked efficacy, 21 showed effective, and 5 failed in the treatment; in the treatment group, 2 cases were recovered, 10 showed marked efficacy, 16 showed effective, and 2 failed in the treatment. There was a significant difference in comparing the therapeutic efficacy between the two groups (P<0.05), and the treatment group was superior to the control group.Conclusion Scalp acupuncture plus rehabilitation can produce a satisfactory clinical efficacy in treating children epilepsy and is thus feasible.

[Anterior small-incision focus debridement with posterior internal fixation for the treatment of lumbar spinal tuberculosis].

OBJECTIVE: To explore clinical outcomes and advantages of anterior small-incision focus debridement with posterior internal fixation through muscle spa ring in treating patients with lumbar spinal tuberculosis. METHODS: From February 2010 to February 2014, totally 82 patients with lumbar spinal tuberculosis were treated by posterior individual fixation with small-incision focus debridement,including 50 males and 32 females with an average of 50.5 years old. All patients were divided into two groups according to different procedures. Forty-nine patients in group A were treated with anterior small-incision focus debridement with posterior internal fixation through muscle spa ring at stage I ; and 33 patients in group B were treated with focus debridement with posterior internal fixation by extraperitoneal approach at stage I . Postoperative mechanical ventilation time, preoperative and postoperative Cobb angle, visual analogue scale (VAS), erythrocyte sedimentation rate (ESR) and Frankel grading were observed and compared. Postoperative complications, stability of internal fixation and bone union were compared. RESULTS: All patients were followed-up from 15 to 36 months with an average of 23.7 months. Psoas abscess of three patients in group A and 1 patient in group B on the opposite side increased and were healed by the secondary apocenosis. The other 78 cases were healed at stage I, and no sinus tract formation, incisional hernia, leakage of cerebrospinal and occurrence of spinal tuberculosis were occurred. Fracture healing time ranged from 3 to 7 months with an average of 4.6 months. Postoperative mechanical ventilation time and VAS score in group A was better than group B. There were no statistical differences in Cobb angle, ESR and Frankel grading at the final following-up between two groups. CONCLUSION: Anterior small-incision focus debridement with posterior internal fixation through muscle spa ring in treating patients with lumbar spinal according to degree of damage is a safe and effective method.

[Percutaneous intervertebral foramina endoscopic lumbar discectomy decompression for elder patients with lumbar spinal stenosis syndrome].

OBJECTIVE: To evaluate the clinical outcomes of percutaneous intervertebral foramina endoscopic lumbar discectomy for elder patients with lumbar spinal stenosis syndrome. METHODS: From July 2006 to July 2011, 60 elder patients with lumbar spinal stenosis syndrome were treated with surgical operation, including 32 males and 28 females with an average age of (66.7 +/- 2.5) years old ranging from 72 to 83 years. These patients were divided into the traditional surgery group and percutaneous intervertebral foramina endoscopic discectomy groups (PTED group), 30 cases in each group. The index of the preoperative and postoperative, operative incision visual analogue scale (VAS) of two groups were compared. The Oswestry disability index (ODI) of two groups at 6, 24 months of the follow-up were also evaluated on activity of daily living. RESULTS: The average operative time, the average blood loss, the number of cases using analgesic drug, hospitalization time of PTED group were better than those of the traditional surgery group (P < 0.05). The improvement of incision VAS in PTED group was better than that in the traditional surgery group (P < 0.05). All patients were followed up for 24 months at least. The ODI at 1, 24 month after operation were better than that of preoperative in two group respectively (P < 0.05), but the improvement of PTED group was better than that of the traditional surgery group (P < 0.05). CONCLUSION: PTED has the advantages of smaller incision, less bleeding, less postoperative stay and hospitalization time, tissue trauma and quicker recovery. It is a safe and efficacious minimally invasive surgical technique for elder patients with lumbar spinal stenosis syndrome.

[Experiment on articular cartilage defect repaired with autologous cancellous bone or cancellous bone enriching bone marrow stem cell].

OBJECTIVE: To compare and evaluate the effect of autologous cancellous bone and cancellous bone enriching bone marrow stem cell for the repairing the defects of articular cartilage, and purpose the experimental basis for clinical application. METHODS: By using the completely random design, 16 adult rabbits were divided into two groups randomly. Autologous cancellous bone and cancellous bone enriching bone marrow stem cells were applied for repairing size-matched, full-thickness articular cartilage defects on the femoral condyle of the knees. The reconstructed tissues were observed by gross, optical and microscopy view and Wakitani score at 12 weeks respectively. RESULTS: In cancellous bone enriching bone marrow stem cells group, articular surface was ivory white and relative evenness, the regenerated tissues integrated well with the surrounding normal cartilage with obscure boundary between them. The thickness of regenerated tissues was two-third of normal cartilage, the Wakitani score was 4.44 +/- 1.41. In autologous cancellous bone group, articular surface was gray and introcession, the regenerated tissues was very thin, the thickness of regenerated tissues was one thirds or one half of normal cartilage, the Wakitani score was 8.93 +/- 1.18. The differences between two groups were significant (P < 0.01). CONCLUSION: Cancellous bone enriching bone marrow stem cells are feasible for repairing of large articular cartilage defects with hyaline cartilage. The repairing ability of autologous cancellous bone is inferior.

Isometric reconstruction of the posterolateral corner of the knee.

To date, there is no consensus on the best technique to repair injured posterolateral structures of the knee. We evaluated the effects of a fibular head based isometric reconstruction of the posterolateral knee corner with a double bundle semitendinosus tendon. From February 2001 to February 2005, 18 isometric reconstructions of a chronic posterolateral corner (PLC) injury of the knee were performed using the semitendinosus tendon. The average age of the patients was 39 years, ranging from 19 to 52 years. Twelve were male and 6 female. The time interval between injury and treatment ranged from 1.5 to 14 months. Three patients had simple PLC injuries, 10 had combined PLC-posterior cruciate ligament (PCL) injuries and two of them had undergone a PCL reconstruction elsewhere 6.5 months prior to referral. Three other patients had an associated anterior cruciate ligament (ACL) injury and two had a combination of PLC with ACL and PCL injury. A doubled semitendinosus tendon was threaded through bony tunnels in the fibular head running from the insertion of the lateral collateral ligament (LCL) to the fibular insertion of the popliteo-fibular ligament and both ends were fixed proximally into bony tunnels of the lateral femoral condyle at their respective isometric point. The varus stress test and the posterolateral rotation test were used to evaluate stability of the posterolateral structures. Isometry was optimal between the femoral attachment site of the popliteal tendon to the anatomical insertion of the popliteofibular ligament at the fibular head. The fibular insertion of the LCL is isometric to the anterior or antero-inferior 8-10 mm of the femoral insertion of the LCL. The average follow-up period was 32 months (30-42 months). There was no varus knee instability in full extension. At 30 degrees of flexion two cases demonstrated a grade I varus instability. A fibular head based isometric reconstruction is a reproducible and reliable technique for reconstruction of the posterolateral corner of the knee.