Severe Ligament Injuries Research Articles

Magnetic Resonance Imaging-Based Morphometric Analyses of the Bicruciate Injury of the Knee: Is There a Clue in the Distal Femur?

The morphology of the distal femur's intercondylar notch has been implicated in the susceptibility to and severity of cruciate ligament injuries. While previous research has primarily focused on isolated anteriorcruciate ligament (ACL) or posterior cruciate ligament (PCL) injuries, the relationship between notch morphology and combined cruciate injuries remains less understood. This study aimed to explore the association between femoral notch morphology and the severity of combined cruciate ligament injuries in adult males. In this retrospective cohort study, MRI scans from 118 adult male participants with and without knee dislocations (60 cases with Schenk classification Type II or higher knee dislocations and 58 controls) were analyzed. The study period ranged from 2015 to 2023. Femoral notch width, notch width index (NWI), and notch shape (U shape, A shape) were assessed using a Philips Multiva 1.5 Tesla system (Philips, Amsterdam, Netherlands). The statistical significance of differences in measurements between cases and controls was evaluated using independent sample t-tests performed with IBM SPSS Statistics, version 26 (IBM Corp., Armonk, NY). The case group exhibited a significantly smaller mean femoral notch width (15.88 mm ± 2.7 mm) and NWI (0.238 ± 0.58) compared to the control group (notch width 18.29 mm ± 3.4 mm, NWI 0.25 ± 0.31), with p-values of 0.004 for both measurements. The notch shape was predominantly A-shaped in the case group (n = 49) as opposed to U-shaped in the control group (n = 41). The study identifies a significant association between reduced femoral notch dimensions and the severity of complex cruciate ligament injuries. These findings support the notion that specific femoral notch morphologies may predispose individuals to more severe ligamentous injuries.

Total Wrist Arthrodesis: An Update on Indications, Technique and Outcomes.

Painful end-stage wrist osteoarthritis (OA) unresponsive to conservative treatment is frequently managed with total wrist arthrodesis (TWA), which might render pain alleviation and ameliorate function, pain, and grip strength. Usual indications for TWA include inflammatory arthritis, idiopathic degenerative OA and posttraumatic OA, Kienböck's illness, brachial plexus palsy, cerebral paralysis, infraclavicular brachial plexus blocks and other spastic and contracture base illnesses, scapholunate advanced collapse, scaphoid nonunion advanced collapse, and failure of other surgical techniques such as after failed total wrist arthroplasty, four-corner fusion, proximal row carpectomy and severe ligament injuries (this procedure iscarried out when all other treatment alternatives have failed to control the individual's symptoms). TWA is commonly carried out with a dorsal plate fixed from the distal radius to the third metacarpal. However, other surgical procedures have been reported, including intramedullary fixation and new implants that do not cross the third carpometacarpal joint or some procedures without utilizing hardware for example using a vascularized fibular grafting In individuals with rheumatoid arthritis. TWA has been shown to give persistent and painless stability for 20 years or more. The rate of adverse events for TWA ranges from 0.1% to 6.1%, though some authors have published that it can be as high as 27%. The most common adverse events are tendon ruptures, peri-implant fractures of the third metacarpal, the need for hardware removal, and constant pain at the third carpometacarpal joint. In idiopathic degenerative OA, the reoperation rate following TWA has been reported as high as 63%. While TWA can render foreseeable pain alleviation and ameliorate function, orthopedic surgeons should remember that this surgical technique is not without its risks and that the accessibility of many surgical procedures requires orthopedic surgeons to scrupulously contemplate the risks and benefits of each alternative for the individual in front of them.

A new mouse model of ankle instability induced by multiple mechanical sprains with controlled inversion angle and speed.

Ankle sprain occurs by a sudden and extreme inversion and plantarflexion at the ankle joint to cause ligamentous injuries. A portion of ankle sprain patients experience recurrent ankle sprains and develop chronic ankle instability (CAI). The present CAI animal models are single events with severe ligamentous injury using surgical transection of ligaments or manually overextending the ankle. Purpose: To simulate the mechanical and recurrent sprain injuries in CAI patients, we established a new ankle instability model with multiple ankle injuries using a self-designed machine to sprain the ankle with a controlled inversion angle and speed. Methods: Male C57BL/6J mice were used and respectively subjected to a sham operation, calcaneofibular ligament (CFL) transection, and mechanical ankle sprains. Three mechanical sprains were performed on the 13th and 185th day after the initial mechanical ankle sprain. Results: The first mechanical sprain and CFL transection induced ankle injury as indicated by an average of a 62% decrease in ankle pressure pain threshold and a 114% increase in the ankle thickness compared with the contralateral untreated ankle. The second and third mechanical sprains induced recurrent ankle injuries. The foot slips during beam tests were increased after mechanical ankle sprains but not after CFL transection, indicating the induction of motor balance deficits. Multiple mechanical ankle sprains induced significant gait changes in longer duration of stance (an average of 194% increase), swing (134%), and step cycle (147%) compared with CFL transection or sham operation, and slower walking speed (78% reduction) and shorter step distance (91%) after the third sprain. Conclusion: These results elucidate that multiple mechanical sprains, which induce recurrent ankle injuries, balance deficits, and gait changes, are a good model for investigating the mechanisms of CAI induced by recurrent sprain injuries.

Bone marrow edema of the medioplantar talar head is associated with severe ligamentous injury in ankle sprain

PurposeTo investigate the predictive value of talar head edema (THE) in acute ankle sprain for the presence of concomitant ligament injuries.MethodsThis retrospective study was approved by the ethics committee and informed consent was obtained. One hundred patients (mean age: 37 years ± 14 [standard deviation], range 13–77 years) with MRI of the ankle after acute trauma were included. The cohort in this matched-pair study consisted of 50 patients with THE (group 1) and 50 patients without THE (group 2). Two readers independently evaluated presence and size of bone marrow edema of the talus head and injuries of the lateral, medial, talonavicular, and spring ligament complex. Statistics included intraclass correlation coefficient (ICC) and Kappa statistics as well as parametric and non-parametric tests.ResultsOn average, patients with THE demonstrated significantly more ligament injuries in comparison to patients without THE (3.7 vs. 1.3, p ≤ 0.01). Also, in patients with THE, the number of injured ligaments was significantly higher at the lateral (p = 0.03), medial (p ≤ 0.01), and talonavicular (p ≤ 0.01) compartment in comparison to patients without THE. The most frequently injured ligaments in patients with THE were the anterior talofibular ligament (60%) and the anterior tibiotalar ligament (42%). There was no significant correlation between edema size and the number of injured ligaments or compartments (p = 0.5).ConclusionTHE is associated with more extensive ligamentous ankle injury, in particular to the medial and lateral collateral ligament complex, and therefore indicative of severe ankle trauma.

Characteristics and predictors of muscle strength deficit in mechanical ankle instability

PurposeMuscle strength training is a common strategy for treating chronic ankle instability (CAI), but the effectiveness decreases for mechanical ankle instability (MAI) patients with initial severe ligament injuries. The purpose of this study was to investigate the characteristics and the potential predictors of muscle strength deficit in MAI patients, with a view to proposing a more targeted muscle strength training strategy.MethodsA total of 220 MAI patients with confirmed initial lateral ankle ligament rupture and a postinjury duration of more than 6 months were included. All patients underwent a Biodex isokinetic examination of the ankle joints of both the affected and unaffected sides. Then, the associations between the limb symmetry index (LSI) (mean peak torque of the injury side divided by that of the healthy side) and the patients’ sex, body mass index, postinjury duration, presence of intra-articular osteochondral lesions, presence of osteophytes and ligament injury pattern (i.e., isolated anterior talofibular ligament (ATFL) injury or combined with calcaneofibular ligament injury) were analysed.ResultsThere was significantly weaker muscle strength on the affected side than on the unaffected side in all directions (p < 0.05). The LSI in plantar flexion was significantly lower than that in dorsiflexion at 60°/s (0.87 vs 0.98, p < 0.001). A lower LSI in eversion was significantly correlated with female sex (0.82 vs 0.94, p = 0.016) and isolated ATFL injury (0.86 vs 0.95, p = 0.012). No other factors were found to be associated with muscle strength deficits.ConclusionMAI patients showed significant muscle strength deficits on the affected side, especially in plantar flexion. There were greater strength deficits in eversion in females and individuals with an isolated ATFL injury. Thus, a muscle strength training programme for MAI patients was proposed that focused more on plantar flexion training and eversion training for females and those with an isolated ATFL injury.

Correlation of damage score in PTOA with changes in stress on cartilage in an ovine model

There is a high risk of developing osteoarthritis (OA) following traumatic injury to the knee. Severe ligament injuries can disrupt the integrity of the multicomponent knee at both biological and biomechanical levels. We hypothesize changes in cartilages stresses could lead to tissue damage and development of OA. The in-vivo gait kinematics of the stifle (knee) joint of four adult female ovine subjects were recorded prior to and at ten-and-twenty weeks following partial ACL-MCL transection. The subjects were sacrificed and the experimental joint from each subject was mounted on a parallel robotic system programmed with the kinematic findings. Ten custom-built Fibre Bragg Grating optic sensors were arranged to measure contact stresses on the surface of the tibial plateau articular cartilage. These sensors provide the first accurate stress measurements in a joint during gait replication using the previously recorded in-vivo kinematics. The relationship between the results obtained and observed focal damage was assessed. The locations on the tibial plateaus that experienced the greatest change in contact stresses corresponded with the locations of focal damage development. No direct link was detected between individual animal differences in kinematics and variations in stress magnitudes or the development of focal cartilage damage. The findings highlight the importance of mechanical stress determinants in the integrated set point for the knee (with individual variation), and how injury-related stress changes correlate with development of PTOA.

Radiographic and ultrasonographic imaging of a dystrophic mineralization on the oblique sesamoidean ligament in a jumping horse. Twenty months follow-up

Mineralization of the anatomical structures involved in the limb movement of horses has been reported to induce lameness and interfere with athletic performance. A 4-year-old jumping horse in sport activity was reported at Veterinary Hospital of University of São Paulo, with mild lameness and a mineralized oblique distal sesamoidean ligament (ODSL) of the left forelimb, revealed by a purchase radiographic and ultrasound examination. Mineralization is more common in tendons than ligaments. This report calls for attention to these structures when performing image exams, even in mild lameness. Long-term favorable follow-up by ultrasonographic and radiographic examination showed that the severe ligament injury in this case did not decrease the athletic activity until the present day.

Operative versus Non-Operative Management of Traumatic Thoracolumbar Injuries according to the AO Spine Thoracolumbar Spine Injury Classification System

AbstractIntroduction The AOSpine Thoracolumbar Spine Injury Classification (AOSTSIC) system has been proposed to better characterize injury morphologies and improve the classification of thoracolumbar (TL) spine trauma. However, the indications for surgical treatment according to the AOSTSIC system are still debated. Additionally, the proposed Thoracolumbar AOSpine Injury Score (AOSIS) is quite complex, which may preclude its use in daily practice. The objective of this review is to discuss the AOSTSIC system and its indications for initial nonoperative versus surgical management of acute TL spine trauma.Methods We analyzed the literature for each injury type (and subtype, when pertinent) according to the AOSTSIC system as well as their potential treatment options.Results Patients with AOSTSIC subtypes A0, A1, and A2 are neurologically intact in the vast majority of the cases and initially managed nonoperatively. The treatment of A3- and A4-subtype injuries (burst fractures) in neurologically-intact patients is still debated with great controversy, with initially nonoperative management being considered an option in select patients. Surgery is recommended when there are neurological deficits or failure of nonoperative management, with the role of magnetic resonance findings in the Posterior Ligamentous Complex (PLC) evaluation still being considered controversial. Injuries classified as type B1 in neurologically-intact patients may be treated, initially, with nonoperative management, provided that there are no ligamentous injury and non-displacing fragments. Due to severe ligamentous injury, type-B and type-C injuries should be considered as unstable injuries that must be surgically treated, regardless of the neurological status of the patient.Conclusions Until further evidence, we provided an easy algorithm-based guide on the spinal trauma literature to help surgeons in the decision-making process for the treatment of TL spine injuries classified according to the new AOSTSIC system.

MRI of ankle sprain: the association between joint effusion and structural injury severity in a large cohort of athletes.

To test the hypothesis if presence and amount of effusion in the tibiotalar and talocalcaneal joints are associated with an increased risk for severe structural injury in ankle sprains. A total of 261 athletes sustaining acute ankle sprains were assessed on MRI for the presence and the amount of joint effusion in the tibiotalar and talocalcaneal joints, as well as for ligamentous and osteochondral injury. Specific patterns of injury severity were defined based on lateral collateral ligament, syndesmotic, and talar osteochondral involvement. The presence and the amount effusion (grades 1 and 2) were considered as risk factors for severe injury, while physiological amount of fluid (grade 0) was considered as the referent. Conditional logistic regression was used to assess the risk for associated severe injuries (syndesmotic ligament rupture and talar osteochondral lesions) based on the presence and amount of tibiotalar and talocalcaneal effusions. For ankles exhibiting large (grade 2) effusion in the tibiotalar joint (without concomitant grade 2 effusion in the talocalcaneal joint), the risk for partial or complete syndesmotic ligament rupture was increased more than eightfold (adjusted odds ratio 8.7 (95% confidence intervals 3.7-20.7); p < 0.001). The presence of any degree of effusion in any of the joints was associated with an increased risk for severe talar osteochondral involvement (several odds ratio values reported; p < 0.001), including large subchondral contusions and any acute osteochondral lesion. The presence of tibiotalar and talocalcaneal effusions is associated with an increased risk for severe concomitant structural injury in acute ankle sprains. • For ankles exhibiting severe (grade 2) effusion in the tibiotalar joint after sprain, the risk for partial or complete syndesmotic ligament rupture increases more than eightfold. • The presence of effusion in both tibiotalar and talocalcaneal joints is associated with an increased risk for severe ligament injury such as complete ATFL rupture as well as partial or complete syndesmotic ligament rupture. • The presence of effusion in the tibiotalar or talocalcaneal joints after sprain is associated with an increased risk for severe talar osteochondral involvement.

Elastin: a possible genetic biomarker for more severe ligament injuries in elite soccer. A pilot study

Elastin: a possible genetic biomarker for more severe ligament injuries in elite soccer. A pilot study

Arthroscopic scapholunate dorsal capsulodesis: A 30-patient case series comparing postoperative splint immobilization versus immobilization and connected K-wiring

The aim of this retrospective study was to compare the results of arthroscopic dorsal capsulodesis performed with or without temporary K-wiring to treat patients who had sustained scapholunate ligament injuries. Our case series included 30 patients with an average age of 37 years (range: 19–55) of whom 12 were female. Dorsal scapholunate capsulodesis was carried out in all patients. In 15 patients, splint immobilization only was used (group I). For the remaining 15 patients, supplementary scapholunate and scaphocapitate K-wiring was performed (group II). The outcomes, whether K-wiring was used or not, were not as good as the outcomes of other published studies. In our study, the reported QuickDASH score was on average higher than 20/100, pain score was higher than 2/10, grip strength was less than 70% of the contralateral side. There was one postoperative complication in the first group and three complications in the second group; five cases of DISI were reported in the first group and three in the second group. There were no significant differences between the two groups. Based on our findings, supplementary K-wiring is not necessary when a dorsal scapholunate capsulodesis is performed. The outcomes of our study were not as good as those of other published series, potentially due to a shorter follow-up and the more severe ligament injuries in our case series.

Treatment results in severe lateral ligament injury of the ankle based on talar tilt angle

Treatment results in severe lateral ligament injury of the ankle based on talar tilt angle

Elastin: a possible genetic biomarker for more severe ligament injuries in elite soccer. A pilot study.

The study of new genetic biomarkers in genes related to connective tissue repair and regeneration may help to identify individuals with greater predisposition to injury, who may benefit from targeted preventive measures, and those who require longer recovery time following a muscle, ligament or tendon injury. The present study investigated whether single nucleotide polymorphisms of the Elastin gene could be related to MCL injury. 60 top class football players were studied to identify single nucleotide polymorphisms for the Elastin (ELN) gene using Allelic Discrimination analysis. Each player was followed for 7 seasons, and each MCL injury was noted. Ligament injury rate, severity and recovery time are related to specific genotypes observed in the elastin gene, especially the ELN-AA (16 MCL) and the ELN-AG (3 MCL). Players with the ELN-GG genotype sustained no MCL injury during the 7 seasons of the study. The identification of polymorphisms in the ELN gene may be used as a novel tool to better define an athlete's genotype, and help to plan training and rehabilitation programmes to prevent or minimize MCL ligament injuries, and optimize the therapeutic and rehabilitation process after soft tissue injuries, and manage the workloads during trainings and matches.

Palmar dislocation of the thumb metacarpophalangeal joint: report of four cases and a review of the literature

We report four cases of palmar dislocation of the thumb metacarpophalangeal joint and review of an additional 22 cases in the literature. Our four cases were associated with ligamentous injuries that prevented stable closed reduction. The patients were treated with open reduction and ligament repair and ultimately had a decreased range of motion. Our four cases and the 22 cases from literature fall into three types: Type A - stable joint (the metacarpophalangeal joint is stable, without severe ligament injury); Type B - tendon block (palmar displaced extensor tendons within the metacarpophalangeal joint prevents reduction); and Type C - joint instability (the metacarpophalangeal joint is unstable because of severe collateral ligament disruption). Type B is the most commonly reported type of palmar dislocation of the thumb metacarpophalangeal joint, with distinct features of the involvement of the collateral ligaments and failure of attempted manual reduction. The patients without severe collateral ligament disruption were managed with conservative treatment. The patients with interposition of extensor tendons and the patients with instability resulting from severe ligamentous injuries require surgical treatment.

Mice with global deletion of mitogen inducible gene 6 display rapid and severe cartilage and subchondral bone damage after ligament and meniscus injury

s / Osteoarthritis and Cartilage 21 (2013) S9–S62 S13 protein subunits was investigated in growth plates of 6 week old mice by immunohistochemistry. Expression of RMRP, its protein subunits and important chondrogenic differentiation markers (Col2a1, Acan, Col10a1, Sox9, Runx2) was also determined by RT-qPCR and immunoblotting in chondrogenically differentiating ATDC5 cells and human bone marrow stem cells (hBMSCs). In addition, RMRP was functionally investigated during chondrogenic differentiation by targeting RMRP expression using a specific siRNA duplex and analysing the outcome on chondrogenic gene expression. Furthermore, chondrogenic induction of dermal fibroblasts was used as a model to test the effect of CHH-associated mutations in RMRP on chondrogenic differentiation of CHH patient-derived fibroblasts. Results: To determine expression of RNase MRP during chondrogenic differentiation in vivo, mouse growth plate sections were immunohistochemically stained for RNaseMRP protein subunits.Without exception, all proteins showed identical growth plate distribution patterns: Resting zone chondrocytes express RNaseMRPproteins,whereas nooronlyweak expression levelswere observed inproliferative chondrocytes. In contrast, expression of RNase MRP proteins was clearly detectable in hypertrophic chondrocytes in the growth plate. This differentiation phase-specific expression of RNase MRP protein subunits was confirmed for Rpp25, Rpp30 and Rpp40 on ATDC5 and hBMSC differentiation models (mRNA); their expressionwas upregulated from day 14 in differentiation onwards, simultaneously with hypertrophic genes. Knockdown of RMRP expression by RNAi resulted in upregulation of RNase MRP mRNA substrates Clb2 and viperin and decreased chondrogenic marker expression (Sox9, Col2a1, Runx2, Col10a1), suggesting a role for RMRP in chondrogenic differentiation. In addition, knockdown of RMRP also resulted in altered Bapx1/Nkx3.2 expression, further substantiating a role in chondrocyte hypertrophy. To verify our results we transdifferentiated CHH patientderived fibroblasts and matched controls to acquire a chondrocyte-like phenotype. Chondrogenic capacity of the CHH patients was clearly disrupted and showed a more than 50% reduced Col10a1 expression as compared to matched control cultures. Conclusions: Our data show that expression of RNase MRP and its subunits is regulated during chondrogenic differentiation, is predominantly associated with chondrocyte hypertrophy and shows functional cross-talk with chondrogenic pathways. These data are the first to show the association of RNase MRP with skeletal development and may provide an explanation for the CHH-associated skeletal phenotype as well as unveiling a potential novel regulator of chondrocyte hypertrophic differentiation in skeletal development. 10 MICE WITH GLOBAL DELETION OF MITOGEN INDUCIBLE GENE 6 DISPLAY RAPID AND SEVERE CARTILAGE AND SUBCHONDRAL BONE DAMAGE AFTER LIGAMENT AND MENISCUS INJURY D.M. Joiner, K.D. Less, E. VanWieren, B.O. Williams. Van Andel Res. Inst., Grand Rapids, MI, USA Purpose: The Epidermal Growth Factor Receptor (EGFR) Signaling pathway plays important roles in osteochondral metabolism and joint disease, which can be triggered by damage to ligaments andmenisci. The goal of this study was to examine the early effect of global deletion of mitogen inducible gene 6 (MIG6), a negative regulator of EGFR, on cartilage and subchondral bone in mice after ligament and meniscus injury. Methods: Global loss of function MIG6 knock-out mice (MIG6-/-) and wild-type (WT) littermates were anesthetized and ligament transections and meniscus removal were performed on the right knee using an established surgical destabilization method. Subchondral bone from surgery knees and untouched contralateral control knees was assessed with x-ray. HE arrows point to bone erosion). Bone damage in surgery knees was greater for MIG6-/animals compared to the control knee and to surgery knees from WT littermates (Figure 2). Ectopic cartilaginous growth pockets were present inMIG6-/mice 4 weeks after ligament and meniscus damage (Figure 1). MIG6-/mice also had increased EGFR expression 4 weeks after surgery (Figure 3) and increased osteoclasts (Figure 4; arrows point to osteoclasts) in the knee joint compared to WT animals. Conclusions: MIG6-/mice displayed rapid and more severe bone and cartilage damage after knee injury compared to WT mice. MIG6 and EGFR could be potential therapeutic targets for preventing cartilage and bone damage and subsequent joint disease development after ligament and meniscus injury.

Ligament regeneration using an absorbable stent-shaped poly-l-lactic acid scaffold in a rabbit model

Ligaments are frequently damaged in sports activities and trauma, and severe ligament injury can lead to joint instability and osteoarthritis. In this study, we aimed to regenerate the medial collateral ligament (MCL) using an absorbable stent-shaped poly-L-lactic acid (PLLA) scaffold in a rabbit model to examine the biocompatibility and mechanical properties. Twenty-three Japanese white rabbits were used in this study. MCL defects were surgically created in the knee joints and then reconstructed using stent-shaped PLLA scaffolds. As controls, flexor digitorum longus (FDL) tendons were implanted into the contralateral knees. Seven rabbits were sacrificed at three time points, conducted four, eight and 16 weeks after the operation. The regenerated tissues were histologically evaluated using fibre alignment scoring, morphology of fibroblast scoring and immunohistochemical analysis of types I and III collagen. The regenerated tissues were also biomechanically evaluated by measuring the ultimate failure load and stiffness. At four weeks post-operation, spindle-shaped cells were observed on the inside of the scaffolds. At eight weeks, maturation of the regenerated tissues and collagen fibre alignment parallel to the ligaments was observed. At 16 weeks, the fibre alignment had become denser. The fibre alignment and morphology of fibroblast scores significantly increased in a time-dependent manner. Expression of type I collagen was more strongly observed in the scaffold group at eight and 16 weeks post-operation than at four weeks. Type III collagen was also observed at four, eight and 16 weeks post-operation. A thin layer of fibrocartilage was observed at the ligament-bone junction at eight and 16 weeks. The ultimate failure load of the scaffold group was 46.7 ± 20.7 N, 66.5 ± 11.0 N and 74.3 ± 11.5 N at four, eight and 16 weeks post-operation, respectively. There was no statistical difference between the normal MCL and the scaffold group at 16 weeks post-operation. The stent-shaped PLLA scaffold allowed for MCL regeneration with type I collagen expression and fibrocartilage formation and resulted in sufficient mechanical function.

Paper 161: Protective Balancing for Prevention of Severe Muscle Injuries and Anterior Cruciate Ligament Injuries in Elite Female Soccer Players

Paper 161: Protective Balancing for Prevention of Severe Muscle Injuries and Anterior Cruciate Ligament Injuries in Elite Female Soccer Players

Cervical spine injury in the young child

This Grand Rounds is about the clinical and radiological presentation, treatment and outcome of pediatric cervical spine injury. A 15-month-old girl suffers from a motor vehicle accident and is intubated on-site because of progressive agitation. Whole body trauma CT was read as normal. When sedation was discontinued after 24 h she was found to be tetraplegic below C6 level. MRI shows a total disruption between C6 and C7 that in hindsight was also visible on the initial trauma CT. She was treated surgically by an anterior and posterior reconstruction and was post-operatively treated with a halo vest. Clearing the cervical spine in young children is deceptively difficult. Meticulous review and interpretation of conventional radiographs and CT are important yet MRI should be considered in uncertain cases. Severe ligamentous injury without concomitant bony injury occurs more frequently than in older children and adults, with sometimes devastating consequences.

关节镜辅助与切开复位内固定治疗髌骨骨折的疗效对比分析

目的：探讨关节镜辅助微创与切开复位内固定治疗髌骨骨折临床效果。方法：2007年6月~2011年10月，关节镜辅助与切开复位Cable-pin固定治疗髌骨骨折病例，选择骨折类型相似的两组各30例进行疗效对比分析。两组患者受伤至手术时间为2~5天，平均3.5天。均为新鲜闭合骨折。关节镜手术组常规膝关节镜检查，伴有半月板损伤4例，股骨髁软骨面损伤5例均I期处理，严重韧带损伤予二期处理。在关节镜监视下进行复位和Cable-pin微创固定，损伤的股四头肌扩张部予镜下修补。切开组常规行切开整复骨折，Cable-pin固定。结果：1) 用T检验比较两组患者手术时间及术后第3天疼痛评分情况，均有统计学差异。关节镜组手术时间较切开组长，而术中出血量及术后疼痛评分均有所减低。2) 两组患者术后3个月X线片示骨折均愈合。关节镜组：均无切口及关节感染、皮肤坏死或创口延迟愈合。2例后期出现关节面塌陷1 mm~1.5 mm，均为伴有冠状面骨折的Rockwood V型。1例出现髌骨关节面1 mm分离，Rockwood V型。术后3个月Bostman评分：优24例，良5例，差1例。此期主要表现为股四头肌萎缩，肌力不够及膝关节主动伸屈功能较差。术后6个月Bostman评分：优26例，良4例。此期不适表现为劳累后疼痛及肿胀，上下楼及深蹲不适。切开组：2例在院期间切口愈合不良，1例3周后切口感染，再次清创引流后3周痊愈，未影响骨折愈合。术后3个月Ｘ线片示骨折均愈合。1例后期出现关节面塌陷2 mm，伴有冠状面骨折的Rockwood V型。1例钢缆松动，关节面轻度分离1 mm。术后3个月Bostman评分：优19例，良8例，差3例。此期不适表现为手术疤痕牵拉不适，股四头肌萎缩，肌力不够及膝关节僵硬。术后6个月Bostman评分：优24例，良5例，差1例。此期不适表现为深蹲时髌前疤痕牵拉感，关节活动弹响，打软腿，关节僵硬，劳累后疼痛及肿胀，上下楼及深蹲不适等。3) 用X2检验比较两组患者术后3个月膝关节屈伸活动范围，显示关节镜组与切开组活动范围有显著差异，关节镜组优于切开组。4) 两组患者正常工作生活平均时间，镜下组和切开组分别为(75 ± 15) d和(110 ± 15) d。结论：两种手术方式均能较好治疗髌骨骨折，中长期疗效相似。与传统切开复位手术相比关节镜辅助下治疗髌骨骨折，可以微创进行骨折的精确复位和固定，早期发现和处理关节内其他结构损害，应用多种镜下技术相结合能较好修复扩张部。术后局部疼痛轻，在早期功能康复方面具有一定优势。但应按骨折类型慎重选择病例。 Objective: Comparative analysis curative effect of arthroscopy and open reduction in treatment of patellar fracture. Method: We’ve treated closed patellar fractures with Cable-pin in arthroscopy and open reduction since July 2007 till October 2011. Divide the cases into two groups with classification of fracture, and 30 cases every group. The patients were operated 2 - 5 days after injury (3.5 days in average). Arthroscopy group: we routinely exam the joint under arthroscopy and find 4 meniscus injury and 5 femoral condyle cartilage injury, and then proceed reduction and internal fixation closely inspected under arthroscopy were operated with MIPO technique using Cable-pin. Patellar tears were also treated under arthroscopy, so did the meniscus injury and femoral condyle cartilage injury. A severe ligament injury requires secondary intervention. Result: 1) Compared average operation time and grading the wound ached NO. 3 day after operation with variance. Arthroscopy group have longer time, fewer amount of bleeding and grading the wound ached. 2) All X rays showed healed fracture 3 months after operation. Arthroscopy group: there was no evidence of infection, necrosis or delayed healing. Bostman Score after 3 month counted for 24 excellent, 5 good and 1 bad. Major situation were atrophy of quadriceps femoris, weak, and compromised active extension of keen joint. Bostman Score after 6 month counted for 26 excellent, 4 good. Major situation in this period were pain and swelling after exercises and irritation of subcutaneous internal fixation device. Open reduction group: There was 2 cases poor wound healing and 1 cases wound infection. Bostman Score after 3 month counted for 19 excellent, 8 good and 3 bad. Major situation were atrophy of quadriceps femoris, weak, and compromised active extension of keen joint. Bostman Score after 6 month counted for 24 excellent, 5 good and 1 bad. Major situation in this period were pain and swelling after exercises and irritation of subcutaneous internal fixation device. 3) With X2 test compared between the two groups were 3 months after knee flexion range of activity, display arthroscopy group and open reduction group activity area have significant differences, arthroscopy group is better than the open reduction group. 4) Two groups of patients with normal work and life average time, arthroscopy group is (75 ± 15) d and open reduction group is (110 ± 15) d. Conclusion: Long term of curative effect is good of arthroscopy and open reduction in treatment of patellar fracture. Arthroscopy can achieve precise reduction and internal fixation of fracture, early discovery and treatment of other joint structure injury. Various type of patellar fracture can be well handled by different internal fixation instrument. The variety of technology with arthroscopy can treat retinaculum tear cutaneously. But key is cautious select cases with fracture type.

Effect of cyclic three-dimensional strain on cell proliferation and collagen synthesis of fibroblast-seeded chitosan-hyaluronan hybrid polymer fiber

BackgroundTissue engineering techniques using biodegradable three-dimensional (3D) scaffolds with cultured cells offer more potential alternatives for the treatment of severe ligament and tendon injuries. In tissue engineering, one of the crucial roles of 3D scaffolds is to provide a temporary template with the biomechanical characteristics of the native extracellular matrix (ECM) until the regenerated tissue matures. The purpose of the present study was to assess the effect of various cyclic mechanical stresses on cell proliferation and ECM production in a 3D scaffold made from chitosan and hyaluronan for ligament and tendon tissue engineering. MethodsThree-dimensional scaffolds seeded with rabbit patella tendon fibroblasts were attached to a bioreactor under various conditions: static group, no strain; stretch group, tensile strain; rotational group, rotational strain; combined group, rotational and tensile strain. In the Static group, 3 weeks of stationary culture was performed. In the remaining three groups, a loading regimen of 0.5Hz for 18h and then 6h rest was carried out for 2 weeks after 1 week of static culture. The DNA content was determined to quantify cell proliferation. Real-time reverse transcription polymerase chain reaction analysis was performed to assess the mRNA levels of the ECM products. ResultsDNA content of the combined group was significantly higher than that of the static and stretch groups, and that of the rotational group was significant higher than that of the static and stretch groups at 21 days after cultivation. The mRNA level of types I and III collagen and fibromodulin in the combined group was significantly higher than that in the other three groups. The amount of collagen synthesis in the combined group was higher than that in the static group, but the difference was not significant. ConclusionsMultidimensional cyclic mechanical strain to mimic the physiological condition in vivo has the potential to improve or accelerate tissue regeneration in ligament and tendon tissue engineering using 3D scaffolds in vitro.