Atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability

Objective To evaluate the clinical application of atlantoaxial joint fusion using anterior transarticular screw fixation and bone grafting for atlantoaxial joint instability. Methods Twenty-three cases of atlantoaxial joint instability were

Corticospinal activity during a single-leg stance in people with chronic ankle instability

Purpose:The aim of the study was to determine whether corticospinal excitability and inhibition of the tibialis anterior during single-leg standing differs among individuals with chronic ankle instability(CAI),lateral ankle sprain copers,and healthy controls.Methods:Twenty-three participants with CAI,23 lateral ankle sprain copers,and 24 healthy control participants volunteered.Active motor threshold(AMT),normalized motor-evoked potential(MEP),and cortical silent period(CSP)were evaluated by transcranial magnetic stimulation while participants performed a single-leg standing task.Results:Participants with CAI had significantly longer CSP at 100%of AMT and lower normalized MEP at 120%of AMT compared to lateral ankle sprain copers(CSP100%:p=0.003;MEP120%:p=0.044)and controls(CSP100%:p=0.041;MEP120%:p=0.006).Conclusion:This investigation demonstrate altered corticospinal excitability and inhibition of the tibialis anterior during single-leg standing in participants with CAI.Further research is needed to examine the effects of corticospinal maladaptations to motor control of the tibial anterior on postural control performance in those with CAI.

Patellofemoral MRI Alterations Following Single Bundle ACL Reconstruction with Hamstring Autografts Are Associated with Quadriceps Femoris Atrophy

High incidence of patellofemoral pain and patellofemoral joint osteoarthritis was found following anterior cruciate ligament(ACL)reconstruction.The unstability of patellofemoral joint might be an important contribution factor.This study was designed to define the relationship between the unstability of patellofemoral joint and quadriceps femoris atrophy.Twenty patients underwent MRI scan before ACL reconstruction and every two weeks after surgery,until 12 weeks.The merchant’s patellar congruence angle,lateral inclination angle,and quadriceps femoris muscle cross-sectional area were measured and the relationship between the changes of angles and the ratio of quadriceps femoris atrophy was studied by multiple regression analysis.Significant quadriceps femoris atrophy was observed after ACL reconstruction during the follow-up period of 12 weeks.The merchant’s patellar congruence angle and lateral inclination angle significantly changed after surgery.The alterations of the merchant’s patellar congruence angle were significantly correlated with the atrophy ratio of vastus medialis(coefficient=-5.76)and vastus lateralis(coefficient=8.35)during the follow-up period of 12 weeks.The alterations of lateral inclination angle were significantly correlated with the atrophy ratio of vastus medialis(coefficient=20.62),vastus lateralis(coefficient=-11.38)and rectus femoris(coefficient=-0.469)during the follow-up period 12 weeks.To sum up,ACL reconstruction can alleviate the dysfunction of patellofemoral joint to a certain extent.But,the unbalanced atrophy of quadriceps femoris once again destroyed the stability of patellofemoral joint following the operation,which might be one cause of patellofemoral joint pain and early onset of osteoarthritis after ACL reconstruction.So,rehabilitation training that focuses on quadriceps femoris especially the vastus medialis shortly following operation is suggested.

Anterolateral complex of the knee: State of the art

Rotatory instability of the knee represents the main reason for failure and poor clinical outcomes regarding anterior cruciate ligament(ACL)reconstruction techniques.It is now clear that the anterolateral complex(ALC)of the knee possesses a fundamental role,in association with the ACL,in controlling internal rotation.Over the past decade,ever since the anterolateral ligament has been identified and described as a distinct structure,there has been a renewed interest in the scientific community about the whole ALC:Lateral extra-articular tenodesis have made a comeback in association with ACL reconstructions to improve functional outcomes,reducing the risks of graft failure and associated injuries.Modern ACL reconstruction surgery must therefore investigate residual instability and proceed,when necessary,to extra-articular techniques,whether functional tenodesis or anatomical reconstruction.This review aims to investigate the latest anatomical and histological descriptions,and the role in rotational control and knee biomechanics of the ALC and its components.The diagnostic tools for its identification,different reconstruction techniques,and possible surgical indications are described..In addition,clinical and functional results available in the literature are reported.

Total Knee Arthroplasty:Patellar Replacement’s Influence in Patient Quality of Life Postoperatively

Objective: To study the influence of patellar resurfacing on quality of life under a standardised score. The chosen score was the Knee Society Score (KSS), which considers range of motion, pain, contractors, alignment and stability. Methods: Retrospective review of 60 patients submitted to total knee arthroplasty (TKA) was divided into two groups: with patellar resurfacing (PR) and without patellar resurfacing (NPR). We reviewed data from these patients containing the KSS, which are routinely used in our service. Data were analysed from 2013 to 2014, with a minimal patient follow-up of 18 months. Results: There were no unsatisfactory scores in our study. Total scores (KSS) were similar between the groups (mean KSS: PR = 88.36 ± 9.64;NPR = 84.26 ± 9.44 [p = 0.1]). While stratifying into groups (poor, fair, good, excellent), we found excellent results in 84.8% of PR versus 59.3% NPR (p = 0.056). These data did not reach statistical significance and can therefore be considered a coincidental result. Conclusion: Although these results did not show statistical significance (p = 0.056), patellar resurfacing patients tend to get more “excellent” results after 18 months of follow-up in quality of life when evaluated by KSS. Perhaps a larger amount of patients would suffice to acquire statistical significance in a future study.

Therapeutic efficacy of traditional Chinese exercises and massage treatment on lumbar instability:a randomized controlled trial

OBJECTIVE:To determine the effect of traditional Chinese exercises combined with traditional Chinese massage on lumbar instability.METHODS:Seventy patients with lumbar instability were randomly divided into experimental group and control group.The experimental group was treated with traditional Chinese exercises combined with traditional Chinese massage,while the control group was only treated with traditional Chinese exercises.The Japanese Orthopaedic Association(JOA)scores,Oswestry Disability Index(ODI)and dynamic imaging indexes were used to assess treatment outcomes.RESULTS:After 8 weeks of treatment,the JOA scores of both groups were significantly higher than those before treatment(P<0.05),while ODI was significantly lower(P<0.05).In addition,compared with the control group,the JOA score of the experimental group was significantly increased(P<0.05),and the ODI was significantly decreased(P<0.05).Besides,the dynamic imaging indexes of patients with lumbar instability significantly changed after treatment.The lumbar vertebral laxity was significantly decreased(P<0.05)than those before treatment.CONCLUSION:The traditional Chinese exercises and massage may improve the symptoms of lumbar instability,and traditional Chinese exercises combined with massage treatment may be better than exercises alone.

Management of post-traumatic elbow instability after failed radial head excision： A case report

Radial head excision has always been a safe commonly used surgical procedure with a satisfactory clinical outcome for isolated comminuted radial head fractures. However, diagnosis of elbow instability is still very challenging and often underestimated in routine orthopaedic evaluation. We present the case of a 21-years old female treated with excision after radial head fracture, resulting in elbow instability. The patient underwent revision surgery after four weeks. We believe that ligament reconstruction without radial head substitution is a safe alternative choice for Mason 1II radial head fractures accompanied by complex ligament lesions.

Posterolateral rotatory instability of the elbow： a case report and literature review

Posterolateral rotatory instability of the elbow describes a condition that radial head subluxation or dislocation occurs when forearm rotates externally in relation to humerus. It is difficult to diagnose and treat. We reported a typical case which was confirmed by physical examination and MR images. Ligamentous insufficiency was confirmed under direct vision, and was reconstructed with triceps fascia as described by Gong et al with slight modification. Regain of full function was achieved one year after surgery.

不稳定性下胫腓联合损伤的诊治研究进展

<正>下胫腓联合也称下胫腓关节,属于纤维连接关节,其关节面通过韧带相连~[1]。下胫腓联合是一个由多条韧带组成的复合结构,为下胫腓关节提供了一定的稳定性。它的组成包括下胫腓前韧带、下胫腓后韧带、下胫腓横韧带以及骨间韧带。虽然有学者认为下胫腓联合包括下胫腓横韧带,但多数情况下认为其是下胫腓后韧带的延续~[2]。下胫腓联合的损伤多由外旋应力所致,见于部分Weber

Proximal tibiofibular stabilization by anatomical ligamentoplasty and diaphyseal osteotomy of the fibula

Proximal tibiofibular instability is a rare condition for which treatment is poorly codified.A 21-year-old patient,a leisure sportswoman,presented a post-traumatic anterolateral instability of the proximal tibiofibular articulation without cartilage lesion.We propose an original surgical technique based on a review of the literature that combines an anatomical ligamentoplasty of the proximal tibiofibular joint and a proximal fibular diaphyseal osteotomy to reduce the distal tibiofibular mechanical stresses.This original technique allows a favorable evolution with recovery of professional and sports activities at 6 months.