[Effect of electroacupuncture on rehabilitation of knee joint movement after anterior cruciate ligament reconstruction].

OBJECTIVE: To observe the effect of electroacupuncture (EA) on the rehabilitation of knee joint function after anterior cruciate ligament (ACL) reconstruction. METHODS: A total of 140 patients with ACL reconstruction were randomly divided into an observation group (58 cases recruited, 12 cases dropped out) and a control group (65 cases recruited, 5 cases dropped out). The patients in the control group were treated with routine rehabilitation treatment. The patients in the observation group, on the basis of the treatment in the control group, were treated with EA at Fengshi (GB 31), Futu (ST 32), Zusanli (ST 36), Shangjuxu (ST 37), Fenglong (ST 40), Xuanzhong (GB 39), Diji (SP 8) and Sanyinjiao (SP 6) on the affected side (2 Hz/100 Hz of dilatational wave, 2-5 mA). Each EA treatment lasted 20-30 min, twice a day for 7 days. The swelling degree (d), pain visual analogue scale (VAS), knee joint range of motion (ROM), scores of International Knee Documentation Committee (IKDC) subjective short form and scores of Lysholm were observed in the two groups 1 day, 1 month, 3 months, 6 months and 1 year after operation. RESULTS: One month and 3 months after operation, the swelling degree (d) and VAS scores in the observation group were lower than those in the control group (P<0.05); 6 months and 1 year after operation, there was no significant difference between the two groups on the swelling degree (d) and VAS scores (P>0.05). One month, 3 months, 6 months and 1 year after operation, the ROM of the knee joint in the observation group was higher than that in the control group (P<0.05), the IKDC score and Lysholm score were higher than those in the control group (P<0.05). Within one year, there were no relaxations, fractures and other related complications in the two groups. The pivot shift test, anterior drawer test and the Lachman test were all negative. CONCLUSION: EA combined with routine rehabilitation training could obviously reduce the pain of knee joint, improve the swelling degree, increase the ROM of knee joint, promote the functional recovery in patients with ACL reconstruction, which are superior to rehabilitation training alone.

Effect of tibial slope changes on femorotibial contact kinematics after cruciate-retaining total knee arthroplasty.

PURPOSE: The present study was undertaken to evaluate the effect of tibial slope (TS) changes on the femorotibial articular contact kinematics in subjects undergoing posterior cruciate-retaining total knee arthroplasty (CRTKA). METHODS: Eighteen knees in nine patients with medial osteoarthritis who underwent CRTKA using the same size prosthesis were analysed preoperatively and 2 years after TKA. TS changes were calculated on lateral radiographs taken before and after TKA. Knees were classified into two groups according to the change in TS obtained by subtracting the post-operative value from the preoperative value: group 1 (>3°) and group 2 (<3°). The femorotibial articular contact kinematics of knees during weight-bearing flexion were compared between the two groups by two-dimensional/three-dimensional registration. RESULTS: Group 1 showed a continuous posterior translation of the medial femoral condyle during the process of knee flexion, whereas in group 2 the medial femoral condyle experienced paradoxical anterior motion from 20° to 90° of knee flexion. The lateral femoral condyle continuously moved posteriorly in both groups. CONCLUSION: A greater reduction in TS after TKA compared with preoperative TS reduces paradoxical medial femoral condylar movement. This may contribute to improved patient satisfaction after CR TKA. LEVEL OF EVIDENCE: III.

[The role of posterolateral structure and posterior cruciate ligament in external rotatory stability of the knee].

OBJECTIVE: To investigate the changes of external rotation stability of the knee after the breaking and reconstruction of the posterolateral structure (PLS) of knee joint. METHODS: The femurs of 16 fresh cadaveric lower limbs were fixed to the base of rotating holders with the knee joints in full extension, or at an angle of 30 degrees , 60 degrees , or 90 degrees ; while the tibia was attached to a free rotary holder. The external rotation of the tibia was measured with a 5 kg x m x s(-2) tibial torque. The external rotation angle of the tibia was measured after the transectioning of the popliteus tendon (PT), popliteus muscle (PM), popliteofibular ligament (PFL), fibular collateral ligament (LCL), or popliteus tendon (PT). Autogenous hamstring tendon was used to reconstruct the PCL, and the Achilles tendon was used to reconstruct the PFL and PT, then the external rotation angle of the tibia was measured again. RESULTS: The isolated sectioning of PCL did not increase the tibial external rotation angle. When the knee was flexed the external rotation angle was 14.1 degrees in the intact knee and was 14.57 degrees in the PCL transectioning group (q = 0.47, P > 0.05). After the PFL was sectioned, when the knee joint was flexed at 60 degrees the external rotation angle was 16.94 degrees (q = 2.84, P < 0.05). After the PT was sectioned (PCL + PFL + PT), when the knee joint was flexed at 60 degrees the external rotation angle was 28.1 degrees (q = 14.01, P < 0.05). After isolated PCL reconstruction the external rotation angle was still bigger than that of the normal knee: for example, when the knee joint was at the angle of 60 degrees the external rotation angle was 27.67 degrees (q = 0.425, P < 0.05). There was a significant decrease in external rotation compared with PT section (P < 0.05). After the combined PCL + PLS reconstruction when the knee joint was at the angle of 60 degrees the external rotation angle of the knee was 14.51 degrees (q = 0.412, P < 0.05), however, the range of change was less than 1 degree. CONCLUSION: Isolated PCL section produces no change in external rotation. Complex injury of PCL and PSL can produce instability in external rotation. PT has the greatest important role to resist external rotation, then the greatest increase in external rotation can be found after PT is sectioned. Isolated PCL reconstruction can not completely restore the posterolateral stability of the knee. PCL reconstruction can partly restore the stability of the external tibial rotation. Only the combined PC + PLS reconstruction can reset the knee to physiological stability of external rotation.

[Application of bipolar radiofrequency energy in the treatmemt of elongated anterior cruciate ligament reconstruction].

OBJECTIVE: To introduce the application of bipolar radiofrequency energy in the treatment of elongated anterior cruciate ligament (ACL) reconstruction during arthroscopy. METHODS: From January 2002 to June 2003, 12 cases whose anterior cruciate ligament reconstruction were elongated accepted the therapy of bipolar radiofrequency energy during arthroscopy. The 12 patients included 11 men and 1 woman with an average age of 30 years ranging from 18 to 45 years old. The ACL grafts were composed of 5 patellar tendons and 7 semitendinosus tendons. The elongated reconstruction were treated by bipolar radiofrequency energy with an output of 284W. This was continued until the elongated reconstruction were tight. After the operation, the patients received unlimited orthosis and were conducted to do functional exercise of the knees. All the patients were followed up. The Lysholm-Tegner score and clinical examination of the knees were recorded and analyzed statistically with paired t text. RESULTS: The elongated ACL reconstruction became shrinkage and tighten after treated by bipolar radiofrequency energy. The palpation by hook and Lachman test showed negative results. The follow-up time was 5-13 months, averaged 8 months. The postoperative mean Lysholm-Tegner score of the knee was 88.5, which was significantly higher than that of preoperative score of 45.5 (P < 0.01). All the patients had no postoperative complications. CONCLUSION: By application of bipolar radiofrequency energy, the elongated ACL reconstruction can be shrunk and tightened to make the knees stabilize. The shrinkage procedure is simple, convenient and effective.