Delayed Management of Popliteal Artery Injury Following Knee Dislocation—A Case Report

Knee dislocations frequently involve vascular injuries that demand early diagnosis and timely intervention. Time of ischemia is pivotal in determining the outcome for the limb, delays in treatment beyond 8 hours significantly increase the risk of limb loss. Unfortunately, this critical window is often missed in resource-limited settings. Here we report a 25-year-old female sustained a left knee injury after falling into a trench. She was diagnosed with an open knee dislocation accompanied by a popliteal artery injury. However, revascularization was delayed for 18 hours due to limited resources, including the unavailability of a thrombectomy catheter. Postoperatively, the patient received anticoagulation therapy with serial limb assessments and after 3 weeks the laceration healed and the limb was still viable. Knee dislocations frequently result in vascular injury (popliteal artery most common), making prompt diagnosis and intervention essential for limb preservation. In settings with limited resources, like ours, delayed presentation and transfer to specialized centers contribute to prolonged ischemic times. Nonetheless, viable limbs should be revascularized in stable patients, even with prolonged ischemia. This case highlights the importance of limb revascularization despite delay. Efforts should be made to improve prompt diagnosis, timely referral, and availability of necessary equipment for vascular repair to optimize outcomes in similar cases.

Commentary on“The deterministic condition for the ground reaction force acting point on the combined knee valgus and tibial internal rotation moments in the early phase of cutting maneuvers in female athletes”

1.Introduction For decades,substantial disagreement has persisted as to whether dynamic knee valgus is the cause of the majority of anterior cruciate ligament(ACL)injuries or rather the result of the ACL rupture.1 Consequently,great effort and expense has gone into capturing 3-dimensional kinetics and kinematics from live athletes to drive in vitro and in silico models of ACL injury in order to elucidate the actual mechanism of injury,as these factors have been demonstrated to be surrogates of intraarticular structural loading on the ACL.2,3 The elucidation of injury mechanisms for non-contact ACL injuries is of great medical value as such knowledge consequently permits quantified examination and validation of interventions and their respective effectiveness in both prevention and rehabilitation of these traumatic knee injuries.

Multiligament knee injuries with associated tibial plateau fractures: A report of two cases

The management of a combination of fracture and multiligament knee injury(MKI) in traumatic knee injury remains controversial, and there are evolving treatment recommendations. Currently, there are no studies focusing on older adult patients with MKI's in combination with tibia fractures. As a result, there is no well-established treatment algorithm for older adult patients with these complex injuries. We report two cases of MKI's with concomitant fractures in patients fifty years of age or older. Both patients were treated surgically for their associated tibial plateau fractures, but were managed with conservative treatment of the multiligamentous knee injuries. We also provide a review of the literature and guidelines for older adult patients with these types of complex traumatic injuries. Early to mid term acceptable outcomes were achieved for both patients through surgical fixation of the tibial plateau fracture and conservative treatment of the ligament injuries. We propose a comprehensive treatment algorithm for management of these complex injuries.

Complex knee injuries treated in acute phase: Long-term results using Ligament Augmentation and Reconstruction System artificial ligament

AIM To present the long-term results of complex knee injuries, treated early using the Ligament Augmentation and Reconstruction System(LARS) artificial ligament to reconstruct posterior cruciate ligament(PCL).METHODS From September 1997 to June 2010, thirty-eight complex knee injuries were treated, where early arthroscopic PCL reconstructions were undergone, using the LARS(Surgical Implants and Devices, Arc-sur-Tille, France) artificial ligament. Exclusion criteria were: Late(> 4 wk) reconstruction, open technique, isolated PCL reconstruction, knee degenerative disease, combinedfracture or vascular injury and use of allograft or autograft for PCL reconstruction. Clinical and functional outcomes were assessed with IKDC Subjective Knee Form, KOS-ADLS questionnaire, Lysholm scale and SF-12 Health Survey. Posterior displacement(PD) was measured with the Telos Stress Device. RESULTS Seven patients were excluded; two because of coexisting knee osteoarthritis and the remaining five because of failure to attend the final follow-up. The sample consisted of 31 patients with mean age at the time of reconstruction 33.2 ± 12.5 years(range 17-61). The postoperative follow-up was on average 9.27 ± 4.27 years(range 5-18). The mean average IKDC and KOS scores were 79.32 ± 17.1 and 88.1 ± 12.47% respectively. Average PD was 3.61 ± 2.15 mm compared to 0.91 ± 1.17 mm in the uninjured knees(one with grade 1+ and two with grade 2 +). Dial test was found positive in one patient, whereas the quadriceps active drawer test was positive in three patients. None was tested positive on the reverse-pivot shift test. The range of motion(ROM) was normal in thirty knees, in comparison with the contralateral one. There was no extension deficit. Osteoarthritic changes were found in three knees(9.6%).CONCLUSION Early treatment of complex knee injuries, using LARS artificial ligament for PCL reconstruction sufficiently reduces posterior tibia displacement and provides satisfactory long-term functional outcomes.

Elevated levels of interleukin-1β, interleukin-6, tumor necrosis factor-α and vascular endothelial growth factor in patients with knee articular cartilage injury

BACKGROUND Inflammatory cytokines play a vital role in the occurrence of osteoarticular injury and inflammation. Whether inflammation-associated factors interleukin-1β(IL- 1β), IL-6, tumor necrosis factor-α(TNF-α) and vascular endothelial growth factor (VEGF) are involved in the pathogenesis of keen articular cartilage injury remains poorly understood. AIM To measure the levels of inflammatory factors [IL-1β, IL-6, TNF-α and VEGF] in patients with knee articular cartilage injury. METHODS Fifty-five patients with knee articular cartilage injury were selected as patient groups, who were divided into three grades [mild (n = 20), moderate (n = 19) and severe (n = 16)] according to disease severity and X-ray examinations. Meanwhile, 30 healthy individuals who underwent physical examination were selected as the control group. The levels of IL-1β, IL-6, TNF-α and VEGF were measured by ELISA and immunohistochemical staining. RESULTS Compared with the control group, patient groups displayed significantly higher levels of IL-1β, IL-6, TNF-α and VEGF, and the extent of increase was directly proportional to the severity of injury (P < 0.05). In addition, the number of cells with positive staining of IL-1β, IL-6, TNF-α and VEGF in the synovial membrane were significantly increased, along with increased disease severity (P < 0.05). After treatment, the scores of visual analogue scale and the Western Ontario and McMaster University of Orthopaedic Index in patient groups were 2.26 ± 1.13 and 15.56 ± 7.12 points, respectively, which were significantly lower than those before treatment (6.98 ± 1.32 and 49.48 ± 8.96). Correlation analysis suggested that IL-1β and TNF-α were positively correlated with VEGF. CONCLUSION IL-1β, IL-6, TNF-α and VEGF levels are increased in patients with knee articular cartilage injury, and are associated with the disease severity, indicating they might play an important role in the occurrence and development of knee articular cartilage injury. Furthermore, therapeutically targeting them might be a novel approach for the treatment of keen articular cartilage injury.

Establishing minimum clinically important difference values for the Patient-Reported Outcomes Measurement Information System Physical Function, hip disability and osteoarthritis outcome score for joint reconstruction, and knee injury and osteoarthritis out

AIM To establish minimum clinically important difference(MCID) for measurements in an orthopaedic patient population with joint disorders.METHODS Adult patients aged 18 years and older seeking care for joint conditions at an orthopaedic clinic took the Patient-Reported Outcomes Measurement Information System Physical Function(PROMIS~? PF) computerized adaptive test(CAT), hip disability and osteoarthritis outcome score for joint reconstruction(HOOS JR), and the knee injury and osteoarthritis outcome score for joint reconstruction(KOOS JR) from February 2014 to April 2017. MCIDs were calculated using anchorbased and distribution-based methods. Patient reports of meaningful change in function since their first clinic encounter were used as an anchor.RESULTS There were 2226 patients who participated with a mean age of 61.16(SD = 12.84) years, 41.6% male, and 89.7% Caucasian. Mean change ranged from 7.29 to 8.41 for the PROMIS~? PF CAT, from 14.81 to 19.68 for the HOOS JR, and from 14.51 to 18.85 for the KOOS JR. ROC cut-offs ranged from 1.97-8.18 for the PF CAT, 6.33-43.36 for the HOOS JR, and 2.21-8.16 for the KOOS JR. Distribution-based methods estimated MCID values ranging from 2.45 to 21.55 for the PROMIS~? PF CAT; from 3.90 to 43.61 for the HOOS JR, and from 3.98 to 40.67 for the KOOS JR. The median MCID value in the range was similar to the mean change score for each measure and was 7.9 for the PF CAT, 18.0 for the HOOS JR, and 15.1 for the KOOS JR.CONCLUSION This is the first comprehensive study providing a wide range of MCIDs for the PROMIS? PF, HOOS JR, and KOOS JR in orthopaedic patients with joint ailments.

Evidence for a Potential “Knee-Eye-Brain Axis” Involved in Mobility and Navigation Control: Knee Injury and Obesity May Disrupt Axis Integrity

Humans depend on the coordinated activity of their lower extremities for mobility, an essential feature of Homo sapiens. In addition, they use vision to use this mobility to successfully navigate through their environment. During development, mobility appears to mature first, and then it is coordinated with navigation. Thus, the two, mobility and navigation are likely interdependent in function. Recent studies have indicated that compromising the integrity of the knee, a central element of the lower extremity motion segment, can lead to molecular alterations in both the cornea including the central cornea where light passes, as well as the interior of the eye (the vitreous humor). Not all insults to the knee lead to reproducible alterations in the eye, indicating some specificity in the response. In addition, it was recently reported that alterations to the cells in the vitreous humor occur following dietary induction of obesity in a rat model. As humans with obesity, as well as arthritis of the knee are at risk for ocular involvement and exhibit altered gait characteristics, the clinical and preclinical data raise the possibility of a “knee-eye-brain axis” to control or regulate mobility and navigation. Better delineation of such an axis could have implications for variations in control during maturation, and well as during aging when vision and mobility can be compromised, with increased risk for serious falls and failure to successfully navigate the environment.

Treatment of Floating Knee Injury in Children

The necessity and superiority of the surgical operation on children with floating knee injury and the fracture union and complications were investigated. Twenty-eight children with floating knee injury were subjected to open reduction and internal fixation or external fixator. The patients were followed up for 18 months to 7 years. The curative effectiveness was scored by Karlstrom criteria. The results showed that no nonunion or deformity was found. The affected limb was 1.2 cm to 1.5 cm longer in 2 cases, 0.8 to 1.2 cm shorter in 3 cases than the contralateral. No severe dysfunction of knee joint occurred. The excellent-good rate was 92.8 % and the curative rate 71.4 respectively. So for children whose age is older than 5 years, it＇s a good way to treat the fractures of femur and tibia with open reduction and internal fixation or external fixator. The method can be advantageous for the nursing care, early function recovery, shortening of the hospital stay and avoidance of severe complications.

Perspectives on endogenous and exogenous tissue engineering following injury to tissues of the knee

The knee is a multi-component organ system comprised of several tissues which function coordinately to provide mobility. Injury to any one component compromises the integrity of the system and leads to adaptation of the other components. Over time, such events often lead to dysfunction and degeneration of the knee. Therefore, there has been considerable research emphasis to repair injured components in the knee including cartilage, menisci, and ligaments. Approaches to improving healing and repair/regeneration of knee tissues have included surgery, anti-sense gene therapy, injection of growth factors and inflammatory cytokine antagonists, transplantation of in vitro expanded chondrocytes, enhancement of endogenous cells via microfracture, injection of mesenchymal stem cells, and implantation of in vitro tissue engineered constructs. Some of these approaches have lead to temporary improvement in knee functioning, while others offer the potential to restore function and tissue integrity for longer periods of time. This article will review the status of many of these approaches, and provide a perspective on their limitations and potential to contribute to restoration of knee function across the lifespan.

A Mesh Meta-Analysis of the Effectiveness of Different Warm-Up Exercises to Prevent Knee Injuries in Young Child Soccer Players

Objective: A mesh Meta-analysis was used to evaluate the effectiveness of four warm-up exercises to prevent knee injuries in juvenile soccer players. Method: They are a randomized controlled trial (RCT) on FIFA 11+ integrated warm-up, FIFA 11+ Kids integrated warm-up, and neuromuscular training (NMT) warm-up for the prevention of knee joint in juvenile soccer players by a computer search of CNKI, CBMdisc, WanFangdata, Pubmed, Web of science, and SPORTDicus database. The search period was from the establishment of each database to February 2022. Two investigators screened the literature, extracted data, and assessed risk bias for the included studies according to the pre-defined inclusion and exclusion criteria, and finally analyzed the data using Stata 14.0 software and OpenBUGS software. Results: A total of 10 RCT studies with 17,143 subjects, spanning the age range of 7 to 19 years, were included. The results of the reticulated Meta-analysis showed that all three warm-up modalities were effective in reducing the incidence of knee injuries in junior soccer players compared to conventional warm-up, with the optimality in descending order of FIFA 11+ Kids comprehensive warm-up (SUCRA = 85.3), neuromuscular training warm-up (SUCRA = 66.7), and FIFA 11+ combined warm-up (SUCRA = 44). Conclusion: The FIFA 11+ Kids comprehensive warm-up is the most effective warm-up exercise for the prevention of knee injuries in junior and child soccer players, but the above findings need further validation due to the quantity and quality of the literature and the quality of the evidence.

Functional Outcomes for Combined Acute Anterior and Posterior Cruciate Knee Injuries Treated Non-Operatively

Introduction: results after non-operative management for knees sustaining combined acute anterior and posterior cruciate ligament tears were presented. Subjects: 13 patients, 10 with medial, and 3 with lateral ligament injury. Methods: non-operative management consisted of employing a brace to prevent sagittal translation of the tibia. Quadriceps muscle and early passive knee motion exercises in the brace was encouraged immediately after arthroscopy. Weight-bearing was forbidden for 3 weeks. The brace was not removed for 3 months. Follow-up periods ranged from 2 to 6 years (mean, 3 years 2 months). Results: none, but one patient had a slight restriction of knee flexion. Quadriceps muscle strength revealed an average of 89.0% of normal side. The knee score indicated 2 patients rated good, 3 rated fair, and 8 rated poor. The score correlated with measurements of anterior and posterior translation on the stress radiograph significantly. Stress radiography revealed that anterior laxity was reduced better than posterior laxity significantly. Conclusion: non-operative brace therapy can be considered for this combined injury as the initial treatment. A late reconstruction would be performed when the result was not satisfactory. Preserved range of motion and muscle strength after brace therapy had a great advantage to the late reconstructive surgery.

Study on the relationship between knee injury recovery and traditional Chinese medicine constitution of young male amateur cyclist in Hainan island cycling league

Objective:To study the relationship between the recovery of knee joint injury and traditional Chinese medicine constitution of young male amateur cyclist in Hainan.Methods:720 young male amateur cyclists were selected from the tour nanli lake national wetland park cycling race and Hainan international tourism island cycling league(ding'an station)in 2019.According to the classification criteria of TCM constitutions in classification and determination of TCM constitutions revised by the Chinese association of traditional Chinese medicine in April 2009,the TCM constitutions were divided into mild constitution group and Yin deficiency constitution group.Standard Kujala knee pain questionnaire was used to evaluate knee joint function in pinyin and Yin deficiency groups.To observe the relationship between TCM constitution and functional injury and recovery degree of knee joint.Results:Body mass index(BMI)of Yin deficiency quality was lower than that of pinyin deficiency quality(P<0.01).Score of knee flexion and extension degree was higher in Yin deficiency quality 30 minutes before the race(P<0.05).The score of Yin deficiency quality was lower after 30 minutes of squatting(P<0.01)and jumping(P<0.05).The total score of knee joint was higher 5 days after the race(P<0.01).The knee flexion and extension(P<0.05)and jump(P<0.05)were higher in the pre-race and post-race scores.Conclusion:There is a high correlation between the constitution of traditional Chinese medicine and the degree of functional injury and recovery of knee joint.The degree of post-game sports injury is higher and the recovery of post-game sports injury is faster.Therefore,different sports protection schemes can be formulated for different constitutions in bicycle RACES to reduce the occurrence of sports injuries and accelerate the recovery time of sports injuries.

3D Finite Element Model of Human Knee Injuries in the Traffic Accident

Objective To explore the injury mechanism of the human knee in a traffic accident by establishing a 3D finite element(FE) model. Methods The FE model, composed of femur, tibia, fibula, patella, meniscus, knee ligaments and surrounding soft tissues, was reconstructed by CT scanning data from a male volunteer. Validation was performed by the lateral impact simulation, and the stress and strain results were obtained to be compared with those previously reported for injury prediction. Results The results derived from the FE model were found to be similar with those previously reported, most of the ligaments and meniscus wounded at 40 m/s collision, which was readily observed. Conclusion The simulation results generated by FE model can be effectively used for the injury mechanism analysis of initial contact.

Creating Prep to Play PRO for women playing elite Australian football:A how-to guide for developing injury-prevention programs

Background:Developing context-specific,evidence-informed,and implementable injury-prevention programs is challenging.Women playing in the elite Australian Football League for Women are at high risk of serious knee injuries,and no specific injury-prevention program exists.The objective of the study was to describe the collaborative process used to create a context-specific injury-prevention program.Methods:A previously used intervention-development process was modified to incorporate a partnership with the sport’s governing organization and focus on engaging program implementers.The Reach Effectiveness Adoption Implementation and Maintenance(RE-AIM)Sports Setting Matrix guided program development and implementation strategies.Results:The 7-step process,aligned with the RE-AIM Sports Setting Matrix,was applied to develop the injury-prevention program and was titled Prep to Play PRO.The steps were:(Step 1)gaining organizational support and establishing a project partnership;(Step 2)using research evidence and clinical experience;(Step 3)consulting content and context experts;(Step 4)engaging the organization,experts,program implementers,and end-users to concreate the intervention and develop implementation strategies;(Step 5)testing the intervention acceptability and feasibility;(Step 6)evaluating the intervention and implementation strategies against theory;and(Step 7)obtaining feedback from early implementers and end-users.Conclusion:Engaging critical stakeholders at multiple ecological levels(organization,team,and athlete)throughout program development and implementation planning support real-world use.The processes and activities described can guide future sports injury-prevention program development and implementation.

Chondroitin sulfate and glucosamine combination in patients with knee and hip osteoarthritis:A long-term observational study in Russia

BACKGROUND Oral treatment of glucosamine(GA) combined with chondroitin sulfate(CS) was reportedly effective for pain relief and function improvement in osteoarthritis patients with moderate to severe knee pain in clinical trials. While the effectiveness of GA and CS on both clinical and radiological findings has been demonstrated, only a few high-quality trials exist. Therefore, controversy regarding their effectiveness in real-world clinical practice remains.AIM To investigate the impact of GA + CS on clinical outcomes of patients with knee and hip osteoarthritis in routine clinical practice.METHODS A multicenter prospective observational cohort study included 1102 patients of both genders with knee or hip osteoarthritis(Kellgren & Lawrence grades Ⅰ-Ⅲ) in 51 clinical centers in the Russian Federation from November 20, 2017, to March 20,2020, who had started to receive oral capsules of glucosamine hydrochloride 500 mg and CS 400mg according to the approved patient information leaflet starting from 3 capsules daily for 3 wk,followed by a reduced dosage of 2 capsules daily before study inclusion(minimal recommended treatment duration is 3-6 mo). Changes in subscale scores [Pain, Symptoms, Function, and Quality of Life(QOL)] of the Knee Injury and Osteoarthritis Outcome Score(KOOS)/Hip Disability and Osteoarthritis Outcome Score(HOOS) questionnaires during the observational period(up to 54-64wk with a total of 4 visits). Patients’ treatment satisfaction, data on the combined oral use of glucosamine hydrochloride and CS, concomitant use of non-steroidal anti-inflammatory drugs(NSAIDs), and adverse events(AEs) were also evaluated.RESULTS A total of 1102 patients with knee and hip osteoarthritis were included in the study. The mean patient age was 60.4 years, most patients were women(87.8%), and their average body mass index was 29.49 kg/m2. All subscale scores(Pain, Symptoms, Function, and QOL) of the KOOS and HOOS demonstrated clinically and statistically significant improvements. In patients with knee osteoarthritis, the mean score increases from baseline to the end of Week 64 were 22.87, 20.78,16.60, and 24.87 on Pain, Symptoms, Physical Function(KOOS-PS), and QOL subscales(P < 0.001for all), respectively. In patients with hip osteoarthritis, the mean score increases were 22.81, 19.93,18.77, and 22.71 on Pain, Symptoms, Physical Function(HOOS-PS), and QOL subscales(P < 0.001for all), respectively. The number of patients using any NSAIDs decreased from 43.1% to 13.5%(P < 0.001) at the end of the observation period. Treatment-related AEs occurred in 2.8% of the patients and mainly included gastrointestinal disorders [25 AEs in 24(2.2%) patients]. Most patients(78.1%) were satisfied with the treatment.CONCLUSION Long-term oral GA + CS was associated with decreased pain, reduced concomitant NSAID therapy, improved joint function and QOL in patients with knee and hip osteoarthritis in routine clinical practice.

关节镜下自体骨软骨移植对膝关节局限性软骨损伤的临床疗效评价

目的探讨关节镜下自体骨软骨移植术对膝关节局限性软骨损伤的临床疗效,并以磁共振成像(MRI)检查对疗效进行评价。方法选取2018年6月至2021年6月诊治的100例膝关节局限性软骨损伤患者,按随机数字表法分为研究组和对照组,每组各50例。研究组采取关节镜下自体骨软骨移植术,对照组采取微骨折术治疗。采用MRI评估其手术疗效,并记录其术后膝关节软骨愈合时间;采用Lysholm膝关节功能评分表、国际膝关节文献委员会(IKDC)膝关节评估表,评估患者治疗前后膝关节功能变化;统计患者术后并发症发生率。结果研究组关节软骨愈合优良率98.00%,高于对照组84.00%(P<0.05)。两组术前和术后3个月的Lysholm评分、IKDC评分比较差异无统计学意义(P>0.05);术后6、12、24个月,研究组Lysholm评分、IKDC评分均高于对照组(P<0.05)。两组患者术后均无严重并发症,且并发症发生率差异无统计学意义(P>0.05)。研究组术后膝关节软骨愈合时间短于对照组(P<0.05)。结论关节镜下自体骨软骨移植术对膝关节局限性软骨损伤的远期治疗效果显著,可有效改善患者术后膝关节功能,缩短膝关节软骨愈合时间,安全性高。

MRI检查指标、血清骨钙素、MMP-1及IL-1对膝骨关节炎合并软骨损伤的预测价值

目的探讨磁共振成像(MRI)及血清骨钙素、基质金属蛋白酶(MMP-1)及白细胞介素-1(IL-1)对膝骨关节炎合并软骨损伤的预测价值。方法回顾性分析2021年8月至2023年5月广西贵港市人民医院收治的84例膝骨关节炎患者的临床资料。入院后均行关节镜检查,依据检查结果是否合并软骨损伤分组,分为合并组(n=40)与未合并组(n=44)。比较两组资料[性别、年龄、体重指数、合并疾病(高血压、高脂血症、糖尿病)、病变部位(左膝、右膝)、饮酒史、吸烟史]、MRI不同区域软骨T_(2)值[股骨外侧(LF)、股骨内侧(MF)、胫骨外侧(LT)、胫骨内侧(MT)、髌骨区(P)]以及血清骨钙素、MMP-1、IL-1水平。通过多因素采取非条件Logistic逐步回归分析明确膝骨关节炎合并软骨损伤的危险因素。通过受试者操作特征(ROC)曲线分析MRI不同区域软骨T_(2)值、血清骨钙素、MMP-1、IL-1预测膝骨关节炎合并软骨损伤的价值。结果两组性别构成比、年龄、体重指数、病变部位、合并高血压、高脂血症、糖尿病、饮酒史、吸烟史比较,差异均无统计学意义(P>0.05);合并组MRI不同区域软骨T_(2)值以及血清骨钙素、MMP-1、IL-1水平均显著高于未合并组,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,MRI不同区域软骨T_(2)值、骨钙素、MMP-1、IL-1是膝骨关节炎患者合并软骨损伤的危险因素(P<0.05)。经ROC分析证实,LF软骨T_(2)值、MF软骨T_(2)值、LT软骨T_(2)值、MT软骨T_(2)值、P软骨T_(2)值、骨钙素、MMP-1、IL-1最佳截断值分别为39.705 ms、44.250 ms、36.855 ms、35.715 ms、38.005 ms、6.655μg/L、7.335μg/L、389.340 pg/mL,曲线下面积分别为0.796、0.840、0.859、0.882、0.728、0.705、0.763、0.721,均有较高预测价值(P<0.05)。结论MRI不同区域软骨T_(2)值、血清骨钙素、MMP-1、IL-1是膝骨关节炎合并软骨损伤的危险因素;同时LF软骨T_(2)值≥39.705 ms、MF软骨T_(2)值≥44.250 ms、LT软骨T_(2)值≥36.855 ms、MT软骨T_(2)值≥35.715 ms、P软骨T_(2)值≥38.005 ms、骨钙素≥6.655μg/L、MMP-1≥7.335μg/L、IL-1≥389.340 pg/mL可用于预测此类患者合并风险。

对国防学院篮球队学生膝关节运动损伤调查与分析

本文通过文献资料法、问卷调查法探讨校篮球队学生运动训练中膝关节损伤的主要原因及其预防。结果:揭示了篮球运动膝关节损伤的特点,规律及损伤原因。结论:技术动作上的缺点和错误,准备活动不充分;场地,器材;关节局部负荷量过大;缺乏保护和自我保护,安全意识。

膝关节股骨内侧髁自发性骨坏死的阶梯治疗策略

背景:目前临床上对于膝关节自发性骨坏死已经有多种保守治疗和手术的方案,并取得了优良的效果,但在手术指征和具体手术方案选择方面尚未形成广泛的共识,临床中仍存在一发现膝关节自发性骨坏死就行单髁置换或全膝关节置换的误区,亟需普及阶梯治疗的理念。目的:从文献和临床病例中总结发现导致膝关节股骨内侧髁自发性骨坏死保守治疗效果欠佳的因素,同时与Koshino分期结合,提出膝关节股骨内侧髁自发性骨坏死阶梯治疗的策略。方法:系统检索文献数据库,总结发现导致膝关节股骨内侧髁自发性骨坏死保守治疗效果欠佳的因素。同时检索住院电子病例系统回顾性分析2017年1月至2023年1月在广东省中医院骨科因膝关节股骨内侧髁自发性骨坏死行保守和手术治疗的病例,对典型病例治疗成功和失败的原因进行总结分析。结果与结论:①膝关节自发性骨坏死的早诊断和早治疗,对预后有着非常重要的意义。临床上对突发的膝关节疼痛,X射线片检查未见明显异常时,如症状持续不能缓解大于1周,建议行MRI检查,可以发现早期的膝关节自发性骨坏死。②膝关节股骨内侧髁自发性骨坏死的Koshino1期和2期的影像在X射线片下较难区分,需借助MR进行区分,Koshino 1期MR图像主要以骨髓水肿为主,尚未形成边界清晰的骨坏死区,而Koshino 2期MR上可见边界清晰的坏死区。③总结出5个导致膝关节股骨内侧髁自发性骨坏死保守治疗效果欠佳的因素:a.坏死区面积>5 cm^(2);b.坏死区占比超过髁的40%;c.内侧半月板相对挤压百分比≥33%(伴或不伴随内侧半月板损伤、软骨下骨髓水肿);d.MRI上坏死区深度(矢状位坏死区域前后径)>20 mm;e.下肢力线内翻>6°。④Koshino 1期的膝关节自发性骨坏死保守治疗效果良好。Koshino 2期的膝关节自发性骨坏死,优先选择保守治疗方案;或在保守治疗方案的基础上配合行钻孔减压治疗;如果保守治疗3个月后症状没有减轻或MR上没有改善时,患者同时存在5个因素中的任一个,则应考虑行保膝手术治疗。Koshino 3期和4期的膝关节自发性骨坏死,需在考虑5个因素的基础上,同时兼顾患者年龄、性别和活跃程度,选择保膝手术治疗。对于合并症状性髌股关节炎、外翻畸形、坏死区范围大影响单髁假体稳定性等的Koshino 4期膝关节股骨内侧髁自发性骨坏死,采用全膝关节置换治疗。

全膝关节置换中的缺血再灌注损伤

背景:以往针对缺血再灌注损伤的相关机制、表现、防治已有报道。但对全膝关节置换引起的下肢骨骼肌缺血再灌注损伤研究较少,此文重点对全膝关节置换引起下肢缺血再灌注损伤的发病机制、临床影响及防治方法进行综述。目的:通过对全膝关节置换引起下肢缺血再灌注损伤的相关文献进行归纳总结,分析其机制、意义,为进一步研究骨骼肌缺血再灌注损伤给出提示。方法:应用计算机检索PubMed数据库、CNKI、万方数据库及维普数据库2000-01-01/2022-04-30发表的相关文章,英文检索词为“ischemia-reperfusion injury,total knee arthroplasty,tourniquet,mechanism,pathophysiology,skeletal muscle,treatment”;中文检索词为“缺血再灌注损伤,全膝人工关节置换术,止血带,机制,病理生理,骨骼肌,治疗”。排除重复性研究及部分相关性较低的基础类文章。最终纳入68篇文献进行综述。结果与结论:(1)缺血再灌注损伤的发病机制与氧自由基、细胞内钙超载、中性粒细胞活化相关,还和高浓度一氧化氮、无复流现象以及细胞凋亡等机制相关,更详尽的机制研究能为将来的防治提供依据;(2)下肢缺血再灌注损伤会造成局部骨骼肌损伤,这可能由手术本身的创伤引起,也可能是缺血再灌注损伤的作用,还需要更有针对性的研究区别二者关系;(3)下肢缺血再灌注损伤甚至会影响远端器官,造成肾脏、肺脏损伤,还会影响局部及全身循环;(4)明确缺血再灌注损伤的影响能为将来的防治指明方向,目前的防治措施主要包括缺血预处理,麻醉药物、抗氧化剂等药物预防;(5)针对全膝关节置换手术引起的下肢骨骼肌缺血再灌注损伤的详细综述,能为将来的诊疗决策提供依据。