Cyclops lesion is a fibrous nodule on the tibial side of the knee and it is one of the common complications that arises after anterior cruciate ligament (ACL) reconstruction, causing loss of knee extension. A presenta...Cyclops lesion is a fibrous nodule on the tibial side of the knee and it is one of the common complications that arises after anterior cruciate ligament (ACL) reconstruction, causing loss of knee extension. A presentation dominated by recurrent hemarthrosis is a rare presentation of this lesion. In this case report, we have discussed about a male patient who presented with recurrent hemarthrosis and inability to extend the knee joint fully 8 months after ACL reconstruction. Cyclops lesion was identified by clinical examination and magnetic resonance imaging (MRI). Recurrence after initial excision of the lesion occurred and complete resolution happened during the second operation when cauterization was done. It is imperative that treatment should include coagulation of the vascularized stump to avoid any recurrence.展开更多
After reconstructing the anterior cruciate ligament(ACL),unsatisfactory bone tendon interface healing may often induce tunnel enlargement at the early healing stage.With good biological features and high formability,M...After reconstructing the anterior cruciate ligament(ACL),unsatisfactory bone tendon interface healing may often induce tunnel enlargement at the early healing stage.With good biological features and high formability,Magnesium-Zinc-Gadolinium(ZG21)wires are developed to bunch the tendon graft for matching the bone tunnel during transplantation.Microstructure,tensile strength,degradation,and cytotoxicity of ZG21 wire are evaluated.The rabbit model is used for assessing the biological effects of ZG21 wire by Micro-CT,histology,and mechanical test.The SEM/EDS,immunochemistry,and in vitro assessments are performed to investigate the underlying mechanism.Material tests demonstrate the high formability of ZG21 wire as surgical suture.Micro-CT shows ZG21 wire degradation accelerates tunnel bone formation,and histologically with earlier and more fibrocartilage regeneration at the healing interface.The mechanical test shows higher ultimate load in the ZG21 group.The SEM/EDS presents ZG21 wire degradation triggered calcium phosphate(Ca-P)deposition.IHC results demonstrate upregulation of Wnt3a,BMP2,and VEGF at the early phase and TGFβ3 and Type II collagen at the late phase of healing.In vitro tests also confirmed the Ca-P in the metal extract could elevate the expression of Wnt3a,βcatenin,ocn and opn to stimulate osteogenesis.Ex vivo tests of clinical samples indicated suturing with ZG21 wire did not weaken the ultimate loading of human tendon tissue.In conclusion,the ZG21 wire is feasible for tendon graft bunching.Its degradation products accelerated intra-tunnel endochondral ossification at the early healing stage and therefore enhanced bone-tendon interface healing in ACL reconstruction.展开更多
Objective: to study the postoperative rehabilitation effect of proprioceptive training in patients with arthroscopic antilogous tendon ACL reconstruction. Methods: 35 patients with autologous ACL reconstruction from J...Objective: to study the postoperative rehabilitation effect of proprioceptive training in patients with arthroscopic antilogous tendon ACL reconstruction. Methods: 35 patients with autologous ACL reconstruction from June 2020 to June 2021. 16 patients in the control group received routine rehabilitation training, and 19 patients in the proprioception training group performed routine rehabilitation training and proprioception training. Comparing pain level, depression, anxiety, knee lysholm score, holden walking function score, and satisfaction before and after rehabilitation training. Results: comparison of pain degree, depression, anxiety, knee Lysholm score, holden walking function score, P> 0.05, pain degree, depression, anxiety, knee lysholm score, and holden walking function score were significantly better than the control group, P <0.05. Satisfaction in the proprioceptive training group was higher than in the control group (P <0.05).The satisfaction of the proprioceptive training group was 100.00%, compared to 80.00% in the control group. Conclusion: the effect of routine rehabilitation training and proprioception training is accurate, which can relieve depression and anxiety, and improve knee function, pain, walking function and satisfaction, which is worth promoting.展开更多
Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation o...Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.展开更多
As one of the most promising fixators developed for anterior cruciate ligament(ACL)reconstruction,biodegradable magnesium(Mg)-based interference screws have gained increasing attention attributed to their appropriate ...As one of the most promising fixators developed for anterior cruciate ligament(ACL)reconstruction,biodegradable magnesium(Mg)-based interference screws have gained increasing attention attributed to their appropriate modulus and favorable biological properties during degradation after surgical insertion.However,its fast degradation and insufficient mechanical strength have also been recognized as one of the major causes to limit their further application clinically.This review focused on the following four parts.Firstly,the advantages of Mg or its alloys over their counterparts as orthopaedic implants in the fixation of tendon grafts in ACL reconstruction were discussed.Subsequently,the underlying mechanisms behind the contributions of Mg ions to the tendon-bone healing were introduced.Thirdly,the technical challenges of Mg-based interference screws towards clinical trials were discussed,which was followed by the introduction of currently used modification methods for gaining improved corrosion resistance and mechanical properties.Finally,novel strategies including development of Mg/Titanium(Ti)hybrid fixators and Mg-based screws with innovative structure for achieving clinically customized therapies were proposed.Collectively,the advancements in the basic and translational research on the Mg-based interference screws may lay the foundation for exploring a new era in the treatment of the tendon-bone insertion(TBI)and related disorders.展开更多
Background:A previous study has reported a 50% reduction in disuse atrophy of the quadriceps during the first 14 days after anterior cruciate ligament(ACL) reconstruction.A follow-up trial is needed to confirm these p...Background:A previous study has reported a 50% reduction in disuse atrophy of the quadriceps during the first 14 days after anterior cruciate ligament(ACL) reconstruction.A follow-up trial is needed to confirm these promising results.The present study aims to investigate the effect of an occlusion stimulus on quadriceps atrophy after ACL reconstruction.Methods:A total of 24 subjects participated in the study.They were randomized into two groups.Starting the 2nd day after surgery,the occlusion group received an occlusion stimulus for 5 min,followed by removal of the occlusive pressure for 3 min.This was repeated five times in one training session,twice daily.During the period of occlusive stimulus,the subjects performed 20 low load exercises for the quadriceps.The control group followed the same exercise protocol,but without the occlusion stimulus.Changes in quadriceps anatomical cross section area(ACSA) were measured using axial magnetic resonance(MR) images at 40% and 50% of the length of the femur.Results:Both groups had a significant reduction of quadriceps ACSA from 2 days before surgery to 16 days after surgery.During the intervention period,the occlusion group lost 13.8% ± 1.1%(mean ± SEM) and the control group lost 13.1% ± 1.0% of their quadriceps ACSA,respectively.There was no significant difference between the occlusion and control groups with regards to atrophy of the quadriceps muscles.Conclusion:In conflict with other studies using a similar protocol,application of blood flow restriction the first 14 days after ACL reconstruction did not reduce quadriceps ACSA muscle atrophy measured by MR in a population of athletes.展开更多
A surgical simulation and evaluation method in the anterior cruciate ligament(ACL)reconstructionwith image-free navigation was presented.Firstly,video tracking module,bone surface reconstructionmodule and virtual simu...A surgical simulation and evaluation method in the anterior cruciate ligament(ACL)reconstructionwith image-free navigation was presented.Firstly,video tracking module,bone surface reconstructionmodule and virtual simulation module of this system were discussed.Secondly,the coordinate relations ofseveral surgery objects(including surgical instrument,anatomical,camera and screen)in the surgicalenvironment,the tracking based on MicronTracker with two cameras and the bone surface real-time recon-struction based on the Delaunay algorithm were introduced in detail.Finally,experiments of anisometrymeasurement and virtual simulation on two plastics were carried out to verify the validity of the proposedmethod.The anisometry value of reconstructed ACL was 8.970039mm.The effectiveness of ACL recon-struction has been proved by preliminary evaluation trials.展开更多
Incorporation of a tendon graft within the bone tunnel represents a challenging clinical problem. Successfulanterior cruciate ligament (ACL) reconstruction requires solid healing of the tendon graft in the bone tunnel...Incorporation of a tendon graft within the bone tunnel represents a challenging clinical problem. Successfulanterior cruciate ligament (ACL) reconstruction requires solid healing of the tendon graft in the bone tunnel. En-hancement of graft healing to bone is important to facilitate early aggressive rehabilitation and a rapid return topre-injury activity levels. No convenient, effective or inexpensive procedures exist to enhance tendon-bone (T-B)healing after surgery. Low-intensity pulsed ultrasound (LIPUS) improves local blood perfusion and angiogenesis,stimulates cartilage maturation, enhances differentiation and proliferation of osteoblasts, and motivates osteogenic differentiation of mesenchymal stem cells (MSCs), and therefore, appears to be a potential non-invasive tool for T-Bhealing in early stage of rehabilitation of ACL reconstruction. It is conceivable that LIPUS could be used to stimulateT-B tunnel healing in the home, with the aim of accelerating rehabilitation and an earlier return to normal activities inthe near future. The purpose of this review is to demonstrate how LIPUS stimulates T-B healing at the cellular andmolecular levels, describe studies in animal models, and provide a future direction for research.展开更多
Biodegradable magnesium(Mg)or its alloys are desirable materials for development into new-generation internal fixation devices or implants with high biocompatibility,adequate mechanical modulus,and osteopromotive prop...Biodegradable magnesium(Mg)or its alloys are desirable materials for development into new-generation internal fixation devices or implants with high biocompatibility,adequate mechanical modulus,and osteopromotive properties,which may overcome some of the drawbacks of the existing permanent orthopaedic implants with regard to stress-shielding of bone and beam-hardening effects on radiographic images.This review summarises the current research status of Mg-based orthopaedic implants in animals and clinical trials.First,detailed information of animal studies including bone fracture repair and anterior cruciate ligament reconstruction with the use of Mg-based orthopaedic devices is introduced.Second,the repair mechanisms of the Mg-based orthopaedic implants are also reviewed.Afterwards,reports of recent clinical cases treated using Mg-based implants in orthopaedics are summarised.Finally,the challenges and the strategies of the use of Mg-based orthopaedic implants are discussed.Taken together,the collected efforts in basic research,translational work,and clinical applications of Mg-based orthopaedic implants over the last decades greatly contribute to the development of a new generation of biodegradable metals used for the design of innovative implants for better treatment of orthopaedic conditions in patients with challenging skeletal disorders or injuries.展开更多
文摘Cyclops lesion is a fibrous nodule on the tibial side of the knee and it is one of the common complications that arises after anterior cruciate ligament (ACL) reconstruction, causing loss of knee extension. A presentation dominated by recurrent hemarthrosis is a rare presentation of this lesion. In this case report, we have discussed about a male patient who presented with recurrent hemarthrosis and inability to extend the knee joint fully 8 months after ACL reconstruction. Cyclops lesion was identified by clinical examination and magnetic resonance imaging (MRI). Recurrence after initial excision of the lesion occurred and complete resolution happened during the second operation when cauterization was done. It is imperative that treatment should include coagulation of the vascularized stump to avoid any recurrence.
基金Theme-based research scheme of Hong Kong Research Grant Council(RGC Ref:T13-402/17-N)National Natural Science Foundation of China(No.U1804251)。
文摘After reconstructing the anterior cruciate ligament(ACL),unsatisfactory bone tendon interface healing may often induce tunnel enlargement at the early healing stage.With good biological features and high formability,Magnesium-Zinc-Gadolinium(ZG21)wires are developed to bunch the tendon graft for matching the bone tunnel during transplantation.Microstructure,tensile strength,degradation,and cytotoxicity of ZG21 wire are evaluated.The rabbit model is used for assessing the biological effects of ZG21 wire by Micro-CT,histology,and mechanical test.The SEM/EDS,immunochemistry,and in vitro assessments are performed to investigate the underlying mechanism.Material tests demonstrate the high formability of ZG21 wire as surgical suture.Micro-CT shows ZG21 wire degradation accelerates tunnel bone formation,and histologically with earlier and more fibrocartilage regeneration at the healing interface.The mechanical test shows higher ultimate load in the ZG21 group.The SEM/EDS presents ZG21 wire degradation triggered calcium phosphate(Ca-P)deposition.IHC results demonstrate upregulation of Wnt3a,BMP2,and VEGF at the early phase and TGFβ3 and Type II collagen at the late phase of healing.In vitro tests also confirmed the Ca-P in the metal extract could elevate the expression of Wnt3a,βcatenin,ocn and opn to stimulate osteogenesis.Ex vivo tests of clinical samples indicated suturing with ZG21 wire did not weaken the ultimate loading of human tendon tissue.In conclusion,the ZG21 wire is feasible for tendon graft bunching.Its degradation products accelerated intra-tunnel endochondral ossification at the early healing stage and therefore enhanced bone-tendon interface healing in ACL reconstruction.
文摘Objective: to study the postoperative rehabilitation effect of proprioceptive training in patients with arthroscopic antilogous tendon ACL reconstruction. Methods: 35 patients with autologous ACL reconstruction from June 2020 to June 2021. 16 patients in the control group received routine rehabilitation training, and 19 patients in the proprioception training group performed routine rehabilitation training and proprioception training. Comparing pain level, depression, anxiety, knee lysholm score, holden walking function score, and satisfaction before and after rehabilitation training. Results: comparison of pain degree, depression, anxiety, knee Lysholm score, holden walking function score, P> 0.05, pain degree, depression, anxiety, knee lysholm score, and holden walking function score were significantly better than the control group, P <0.05. Satisfaction in the proprioceptive training group was higher than in the control group (P <0.05).The satisfaction of the proprioceptive training group was 100.00%, compared to 80.00% in the control group. Conclusion: the effect of routine rehabilitation training and proprioception training is accurate, which can relieve depression and anxiety, and improve knee function, pain, walking function and satisfaction, which is worth promoting.
文摘Background: The size of Hamstring autograft of less than 8.0 mm in ACL re-construction is one of the key factors that may contribute to the failure of the graft. In this study, we are going to assess the correlation of pre-operative MRI measurement of Hamstring tendons with the intra-operative ACL graft. Thus, it may help surgeons to anticipate the needs for graft augmentation should the final graft size be smaller than expected. Methods: We retrospectively re-viewed 41 cases of ACL reconstructions in which MRI were done pre-operatively, in Hospital Pakar Sultanah Fatimah (HPSF), Muar between January 2019 until December 2022. MRI measurements of Hamstring tendon (semitendinosus: ST, and gracilis) were done by a radiologist, and the in-tra-operative notes were reviewed for the final graft size. Pearson’s correlation coefficients were calculated to determine the relationship between graft size and tendon cross-sectional area. The intraclass correlation (ICC) by using two-way mixed model with type consistency, the reliability based on average measure was 0.41 (95% CI: ?0.10, 0.69). A p-value < 0.05 was considered sig-nificant. Results: Of 105 patients with primary ACL reconstruction done be-tween January 2019 to December 2022, only 41 patients were included in this study. There was fair correlation (p = 0.048) between pre-operative MRI measurement and the graft diameter intra-operatively. The mean of 17.0 mm of combined diameter of ST and gracilis tendon in MRI may results in graft diameter of 8.3 mm. There was also positive correlation between patients’ height and the intra-operative graft size. Conclusion: These results showed good correlation between pre-operative MRI measurement of Hamstring ten-don size with the intra-operative graft size, hence it is a reliable tool to predict the Hamstring autograft size in ACL reconstruction.
基金This work was supported by the National Natural Science Foundation of China(Ref No.81702165)Guangdong Natural Science Fund(Ref.No.2019A1515011404)+1 种基金Key-Area Research and Development Program of Guangdong Province(Ref.No.2020B090924004)Theme-based Research Scheme(Ref No.T13-402/17-N).
文摘As one of the most promising fixators developed for anterior cruciate ligament(ACL)reconstruction,biodegradable magnesium(Mg)-based interference screws have gained increasing attention attributed to their appropriate modulus and favorable biological properties during degradation after surgical insertion.However,its fast degradation and insufficient mechanical strength have also been recognized as one of the major causes to limit their further application clinically.This review focused on the following four parts.Firstly,the advantages of Mg or its alloys over their counterparts as orthopaedic implants in the fixation of tendon grafts in ACL reconstruction were discussed.Subsequently,the underlying mechanisms behind the contributions of Mg ions to the tendon-bone healing were introduced.Thirdly,the technical challenges of Mg-based interference screws towards clinical trials were discussed,which was followed by the introduction of currently used modification methods for gaining improved corrosion resistance and mechanical properties.Finally,novel strategies including development of Mg/Titanium(Ti)hybrid fixators and Mg-based screws with innovative structure for achieving clinically customized therapies were proposed.Collectively,the advancements in the basic and translational research on the Mg-based interference screws may lay the foundation for exploring a new era in the treatment of the tendon-bone insertion(TBI)and related disorders.
文摘Background:A previous study has reported a 50% reduction in disuse atrophy of the quadriceps during the first 14 days after anterior cruciate ligament(ACL) reconstruction.A follow-up trial is needed to confirm these promising results.The present study aims to investigate the effect of an occlusion stimulus on quadriceps atrophy after ACL reconstruction.Methods:A total of 24 subjects participated in the study.They were randomized into two groups.Starting the 2nd day after surgery,the occlusion group received an occlusion stimulus for 5 min,followed by removal of the occlusive pressure for 3 min.This was repeated five times in one training session,twice daily.During the period of occlusive stimulus,the subjects performed 20 low load exercises for the quadriceps.The control group followed the same exercise protocol,but without the occlusion stimulus.Changes in quadriceps anatomical cross section area(ACSA) were measured using axial magnetic resonance(MR) images at 40% and 50% of the length of the femur.Results:Both groups had a significant reduction of quadriceps ACSA from 2 days before surgery to 16 days after surgery.During the intervention period,the occlusion group lost 13.8% ± 1.1%(mean ± SEM) and the control group lost 13.1% ± 1.0% of their quadriceps ACSA,respectively.There was no significant difference between the occlusion and control groups with regards to atrophy of the quadriceps muscles.Conclusion:In conflict with other studies using a similar protocol,application of blood flow restriction the first 14 days after ACL reconstruction did not reduce quadriceps ACSA muscle atrophy measured by MR in a population of athletes.
基金Supported by the National High Technology Research and Development Programme of China (No. 2004AA421022)National Science Fund for Distinguished Young Scholars of P. R. China (No. 60525314)National Science & Technology Pillar Program in the Eleventh Five-year Plan ( No.2006BAI03A16)
文摘A surgical simulation and evaluation method in the anterior cruciate ligament(ACL)reconstructionwith image-free navigation was presented.Firstly,video tracking module,bone surface reconstructionmodule and virtual simulation module of this system were discussed.Secondly,the coordinate relations ofseveral surgery objects(including surgical instrument,anatomical,camera and screen)in the surgicalenvironment,the tracking based on MicronTracker with two cameras and the bone surface real-time recon-struction based on the Delaunay algorithm were introduced in detail.Finally,experiments of anisometrymeasurement and virtual simulation on two plastics were carried out to verify the validity of the proposedmethod.The anisometry value of reconstructed ACL was 8.970039mm.The effectiveness of ACL recon-struction has been proved by preliminary evaluation trials.
基金Project (No. 81171687/H0604) supported by the National Natural Science Foundation of China
文摘Incorporation of a tendon graft within the bone tunnel represents a challenging clinical problem. Successfulanterior cruciate ligament (ACL) reconstruction requires solid healing of the tendon graft in the bone tunnel. En-hancement of graft healing to bone is important to facilitate early aggressive rehabilitation and a rapid return topre-injury activity levels. No convenient, effective or inexpensive procedures exist to enhance tendon-bone (T-B)healing after surgery. Low-intensity pulsed ultrasound (LIPUS) improves local blood perfusion and angiogenesis,stimulates cartilage maturation, enhances differentiation and proliferation of osteoblasts, and motivates osteogenic differentiation of mesenchymal stem cells (MSCs), and therefore, appears to be a potential non-invasive tool for T-Bhealing in early stage of rehabilitation of ACL reconstruction. It is conceivable that LIPUS could be used to stimulateT-B tunnel healing in the home, with the aim of accelerating rehabilitation and an earlier return to normal activities inthe near future. The purpose of this review is to demonstrate how LIPUS stimulates T-B healing at the cellular andmolecular levels, describe studies in animal models, and provide a future direction for research.
基金supported by Guangdong Natural Science Fund of China(No.2019A1515011404)Key-Area Research and Development Program of Guangdong Province of China(No.2020B090924004)Area of Excellences Scheme of Hong Kong Research Grants Council of China(No.AoE/M-402/20).
文摘Biodegradable magnesium(Mg)or its alloys are desirable materials for development into new-generation internal fixation devices or implants with high biocompatibility,adequate mechanical modulus,and osteopromotive properties,which may overcome some of the drawbacks of the existing permanent orthopaedic implants with regard to stress-shielding of bone and beam-hardening effects on radiographic images.This review summarises the current research status of Mg-based orthopaedic implants in animals and clinical trials.First,detailed information of animal studies including bone fracture repair and anterior cruciate ligament reconstruction with the use of Mg-based orthopaedic devices is introduced.Second,the repair mechanisms of the Mg-based orthopaedic implants are also reviewed.Afterwards,reports of recent clinical cases treated using Mg-based implants in orthopaedics are summarised.Finally,the challenges and the strategies of the use of Mg-based orthopaedic implants are discussed.Taken together,the collected efforts in basic research,translational work,and clinical applications of Mg-based orthopaedic implants over the last decades greatly contribute to the development of a new generation of biodegradable metals used for the design of innovative implants for better treatment of orthopaedic conditions in patients with challenging skeletal disorders or injuries.
