Changes of mechanoreceptors in different-state remnants of ruptured anterior cruciate ligament.

OBJECTIVE: To observe the changes in the quantity and morphology of mechanoreceptors in different-state remnant stumps of ruptured anterior cruciate ligaments (ACLs). METHODS: Specimens of completely ruptured ACL remnants were collected from 57 patients. The injury time from injury to surgery was recorded. According to the degree of pre-operative anterior displacement of knee joint, these patients were divided into two groups: group 1 (≤ 6 mm) and group 2 (> 6 mm). The morphology type of ligament remnant in each patient was identified. The correlations of mechanoreceptor number in the remnant stumps with the morphology of ligament stump, injured knee stability, and injury time were analyzed. Subsequently, based on ACL lesion type, patients were divided into four groups including groups A, B, C, and D, and then, the items above were compared among the four groups. RESULTS: Group 1 contained 20 specimens including three with type B and 17 with type C. Group 2 contained 37 specimens including 20 with type A, 1 with type B, 2 with type C, and 14 with type D. The distributions of four-type remnant morphologies (X2 = 49.406, P = 0.000) and mechanoreceptors (X2 = 13.84, P = 0.002) were all significantly different between the two groups. The number of mechanoreceptors was positively correlated with the injured knee stability (r = 0.63,P = 0.018). The number of the mechanoreceptors was not obviously correlated with the injury time in group 1 (r = - 0.37,P = 0.136), while it was negatively correlated with the injury time in group 2 (r = - 0.51,P = 0.022). There was a significant difference in pre-operative anterior displacement of knee joint among groups A, B, C, and D (F = 85.59, P = 0.000), and the pre-operative anterior displacement of knee joint was less in groups B and C than in groups A and D. There was a significant difference in the distribution of typical and atypical mechanoreceptors among groups A, B, C, and D (X2 = 68.16, P = 0.032). CONCLUSIONS: The ruptured ACL remnants connecting the femur to tibia can still play a role in maintaining knee stability; thus, the mechanoreceptors can persist in these remnants for a long time.

Comparison of hamstring tendon autograft and tibialis anterior allograft in arthroscopic transtibial single-bundle posterior cruciate ligament reconstruction.

PURPOSE: To compare the outcomes between hamstring tendon autograft and tibialis anterior allograft in arthroscopic transtibial single-bundle posterior cruciate ligament (PCL) reconstruction. METHODS: Thirty-seven patients undergoing isolated single-bundle PCL reconstruction were enrolled in this study, and their data were retrospectively analyzed. They were divided into group A [4-strand hamstring tendon autograft (4SHG), n = 18] and group B [2-strand tibialis anterior allograft (2STAG), n = 19] and followed up for 2 years at least. Several parameters including the International Knee Documentation Committee score, Lysholm knee score, Tegner activity rating and knee laxity arthrometer were evaluated, and physical examination was performed preoperatively and postoperatively, and postoperative complications were also observed in all patients. Meanwhile, the postoperative posterior instability was compared between the affected knee and the contra-lateral knee. RESULTS: Compared with preoperative knee laxity and function, both groups had significant improvement postoperatively (P < 0.01). However, there were no significant differences in knee laxity and function between both groups (n.s.). Compared with contra-lateral knee, the posterior stability was worse in the affected knee (P < 0.01). CONCLUSIONS: The outcomes were similar between 4SHG or 2STAG in PCL reconstruction. Compared with contra-lateral knees, the affected knees have slight residual knee laxity in both groups. LEVEL OF EVIDENCE: Retrospective comparative study, Level III.

Surgical treatment of popliteal cyst: a systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis of the clinical efficacy of different surgical methods in the therapy of popliteal cysts may provide evidence about effective surgical treatments. METHODS: PubMed, EMBASE, and OVID were searched with the following terms: (popliteal cyst* OR baker's cyst*) AND (arthroscopic OR excision OR operative OR treat* OR surgery). Inclusion criteria included the following: studies reported the efficacy of different surgical methods in popliteal cyst patients; patients were ≥ 16 years; and studies must have involved a minimum of 10 patients. Studies were grouped according to the surgical methods, and a meta-analysis was employed to identify the success rate based on the pooled data. RESULTS: A total of 11 studies were included: The communication between the cyst and the articular cavity was enlarged in 7 studies; this communication was closed in 3 studies; and only intra-articular lesions were managed in 1 study. After the data were pooled, the success rates were 96.7 and 84.6 % in the communication-enlargement group and communication-closure group, respectively. Studies with communication enlargement were subgrouped into the cyst wall resection group and the non-cyst wall resection group, for which the success rates were 98.2 and 94.7 %, respectively. CONCLUSIONS: Based on the current available evidence, at present, any how arthroscopic excision of the cyst wall, arthroscopic management of intra-articular lesions, and enlarging the communication between the cyst and the articular cavity is an ideal strategy for the popliteal cyst. The current literature on the treatment of popliteal cysts is limited to retrospective case series. Future prospective studies with high-quality methodology and uniform scoring system are required to directly compare communication-enlargement surgery and communication-closure surgery and determine the optimal treatment of popliteal cysts. Cyst wall resection may improve the therapeutic efficacy, to draw definitive conclusions, and high-level clinical researches with a large number of patients and long-term follow-up should be initiated.

Comparison of therapeutic effects between drainage blood reinfusion and temporary clamping drainage after total knee arthroplasty in patients with rheumatoid arthritis.

OBJECTIVE: To compare the therapeutic effects between drainage blood reinfusion and temporary clamping drainage after total knee arthroplasty in patients with rheumatoid arthritis to provide a basis for clinical practice. METHODS: Data from 83 patients with rheumatoid arthritis undergoing total knee arthroplasty were retrospectively analyzed. The 83 patients were divided into a drainage blood reinfusion group (DR group, n = 45) and a temporary clamping drainage group (CD group, n = 38). In the DR group, postoperative drainage blood was used for autotransfusion. In the CD group, closed drainage was adopted, and the drainage tube was clamped for 2 h postoperatively followed by patency. The postoperative drainage amount, hemoglobin level, rate and average volume of allogeneic blood transfusion, swelling and ecchymosis of the affected knee joint, time to straight-leg raising and range of active knee flexion were compared between the two groups. RESULTS: The total drainage volume was higher in the DR group than in the CD group (P = 0.000). The average volume of postoperative allogeneic blood transfusion (P = 0.000) and the decrease in the hemoglobin level 24 h after total knee arthroplasty (P = 0.012) were lower in the DR group than in the CD group. Swelling and ecchymosis of the affected knee joint, time to straight-leg raising and the range of active knee flexion were improved in the DR group compared with the CD group (all P<0.05). CONCLUSION: Compared with temporary clamping drainage, drainage blood reinfusion after total knee arthroplasty can reduce the allogeneic blood transfusion volume and is conducive to early rehabilitation in patients with rheumatoid arthritis.

Comparison of therapeutic effects between drainage blood reinfusion and temporary clamping drainage after total knee arthroplasty in patients with rheumatoid arthritis

OBJECTIVE: To compare the therapeutic effects between drainage blood reinfusion and temporary clamping drainage after total knee arthroplasty in patients with rheumatoid arthritis to provide a basis for clinical practice. METHODS: Data from 83 patients with rheumatoid arthritis undergoing total knee arthroplasty were retrospectively analyzed. The 83 patients were divided into a drainage blood reinfusion group (DR group, n = 45) and a temporary clamping drainage group (CD group, n = 38). In the DR group, postoperative drainage blood was used for autotransfusion. In the CD group, closed drainage was adopted, and the drainage tube was clamped for 2 h postoperatively followed by patency. The postoperative drainage amount, hemoglobin level, rate and average volume of allogeneic blood transfusion, swelling and ecchymosis of the affected knee joint, time to straight-leg raising and range of active knee flexion were compared between the two groups. RESULTS: The total drainage volume was higher in the DR group than in the CD group (P = 0.000). The average volume of postoperative allogeneic blood transfusion (P = 0.000) and the decrease in the hemoglobin level 24 h after total knee arthroplasty (P = 0.012) were lower in the DR group than in the CD group. Swelling and ecchymosis of the affected knee joint, time to straight-leg raising and the range of active knee flexion were improved in the DR group compared with the CD group (all P<0.05). CONCLUSION: Compared with temporary clamping drainage, drainage blood reinfusion after total knee arthroplasty can reduce the allogeneic blood transfusion volume and is conducive to early rehabilitation in patients with rheumatoid arthritis. .