Yinghui Hua

Arthroscopic Repair of Lateral Ankle Ligament Complex by Suture Anchor

PURPOSEnArthroscopic repair of the lateral ligament complex with suture anchors is increasingly used to treat chronic ankle instability (CAI). Our aims are (1) to analyze and evaluate the literature on arthroscopic suture anchor repair of the anterior talofibular ligament and (2) to conduct a systematic review of the clinical evidence on the reported outcomes and complications of treating CAI with this technique.nnnMETHODSnWe performed a systematic review of the literature using PubMed, Ovid, Elsevier ScienceDirect, Web of Science-Conference Proceedings Citation Index, and the Cochrane Database of Systematic Reviews from 1987 to September 2013. Clinical studies using the arthroscopic suture anchor technique to treat CAI were included. Outcome measures consisted of clinical assessment of postoperative ligament stability and complications. In addition, the methodologic quality of the included studies was assessed by use of the modified Coleman Methodology Score.nnnRESULTSnAfter reviewing 371 studies, we identified 6 studies (5 retrospective case series and 1 prospective case series, all Level IV) that met the inclusion criteria, with a mean Coleman Methodology Score of 71.8 ± 7.52 (range, 63 to 82). In these studies 178 patients (179 ankles) underwent arthroscopic suture anchor repair of the anterior talofibular ligament with a mean follow-up period of 38.9 months (range, 6 to 117.6 months). All patients were reported to have subjective improvement of their ankle instability, with complications in 31 cases.nnnCONCLUSIONSnStudies of arthroscopic suture anchor technique to treat CAI are sparse, with moderate mean methodologic quality. The included studies suggest that the arthroscopic technique is a feasible procedure to restore ankle stability; however, on the basis of our review, this technique seems to be associated with a relatively high complication rate. Extensive cadaveric studies, clinical trials, and comparative studies comparing arthroscopic and open repair should be performed in the future.nnnLEVEL OF EVIDENCEnLevel IV, systematic review of Level IV studies.

Comparison of tendon–bone healing between autografts and allografts after anterior cruciate ligament reconstruction using magnetic resonance imaging

AbstractPurposenThe purpose of the study is to compare tendon–bone healing between autograft tendons and allograft tendons after anterior cruciate ligament (ACL) reconstruction using 3.0T magnetic resonance imaging.MethodsA total of 36 participants (18 with autograft and 18 with allograft reconstruction) underwent MRI scans at least 2xa0years after the ACL reconstruction operation. Oblique axial images were obtained on three-dimensional dual-echo steady-state images and imported into solid modelling software for three-dimensional model reconstruction of the bone tunnel. The graft signal intensity in the tunnel, tendon–bone interface, tunnel morphology, and tunnel area was analysed using the Siemens software packages to determine the tendon–bone healing between the groups.ResultsFor the tunnel morphology, both groups exhibited bone tunnel enlargement either at the femoral or tibial tunnel aperture. For the tendon–bone interface, one patient in the autograft group and two patients in the allograft group exhibited a significant fibrous scar tissue bands at the tendon–bone interface. The graft signal/noise quotient values of the allograft group were higher than the autograft group. However, there was no significant difference in the tunnel area between the allograft group and the autograft group.ConclusionsAlthough the autograft tendons exhibited a better remodelling effect than did the allograft tendons in the bone tunnel, there was no significant difference in the tendon–bone healing between the autograft tendons and the allograft tendons postoperatively. These findings indicate that the biomechanical effect of graft motion may play a significant role in the tunnel aperture.Level of evidenceIII.

Quantitative Magnetic Resonance Imaging Assessment of Cartilage Status: A Comparison Between Young Men With and Without Anterior Cruciate Ligament Reconstruction

PURPOSEnTo assess the cartilage status of the knee joints using magnetic resonance imaging at least 2 years after anterior cruciate ligament reconstruction (ACLR) in young adult men.nnnMETHODSnThirty young male patients with unilateral ACLR and 15 age-matched and body mass index--matched healthy men (controls) participated in this study. All participants underwent quantitative magnetic resonance imaging scans. Three-dimensional dual-echo steady-state sagittal images were segmented using solid model software to calculate the mean cartilage thickness, and multi-echo sagittal images were segmented with Siemens software (Siemens, Erlangen, Germany) to determine the T2 relaxation time of each cartilage plate.nnnRESULTSnThere was no statistically significant difference in the mean thickness of each cartilage plate between the ACLR and control groups (P = .9616 for lateral femoral cartilage, P = .5962 for lateral tibial cartilage, P = .9328 for patellar cartilage, P = .9712 for trochlear cartilage, P = .4408 for medial femoral cartilage, and P = .1933 for medial tibial cartilage). The ACLR group had significantly higher T2 values than the control group in the lateral femoral cartilage (P < .001), lateral tibia (P = .0011), trochlea (P = .0028), medial femur (P < .001), and medial tibia (P < .001). In addition, the patella showed no difference in T2 values between the 2 groups (P = .2152). The medial compartment cartilage showed a much higher percentage change in cartilage T2 values in the ACLR group.nnnCONCLUSIONSnAlthough no difference in cartilage thickness was detected between the ACLR group and the control group, the mean T2 relaxation time in the ACLR patients was significantly longer than that in control subjects.nnnLEVEL OF EVIDENCEnLevel III, retrospective comparative study.

Arthroscopic treatment for posterior tibial tendon lesions with a posterior approach

AbstractPurposenTo evaluate clinical results of arthroscopic treatment for posterior tibial tendon (PTT) lesions using a posterior approach.MethodsSixteen patients with PTT lesions underwent arthroscopic treatment using a posterior approach. After routine posterior arthroscopy to expose the posterior tibiotalar compartment, the posterior subtalar compartment, and the flexor hallucis longus tendon, the shaver was then moved through the flexor hallucis longus tendon to detect and treat the PTT lesion, including synovectomy, debridement, and repair of the PTT. American Orthopaedic Foot and Ankle Society Ankle-Hindfoot (AOFAS) scale and visual analog scale (VAS) for subjective satisfaction were used to evaluate pre- and post-operative clinical results.ResultsFifteen patients (94xa0%) (15 ankles) were followed for a mean of 26xa0±xa010xa0months. No patients experienced vascular or nerve complications during or after the operation. Mean AOFAS score improved from 49xa0±xa012 points preoperatively to 84xa0±xa08.5 points post-operatively (pxa0=xa00.000). Mean VAS improved from 6.2xa0±xa01.7 preoperatively to 2.4xa0±xa01.3 post-operatively (pxa0=xa00.000). There were three patients (20xa0%) with excellent outcomes, eight patients (53xa0%) with good outcomes, three patients (20xa0%) with fair outcomes, and one patient (7xa0%) with a poor outcome at follow-up.ConclusionsA posterior arthroscopic approach can provide a safe, reliable technique for detecting and treating PTT lesions and a satisfactory surgical outcome. The technique is an alternative to PTT tendoscopy.Level of evidenceIV.

Arthroscopic excision of juxtaarticular cancellous osteoid osteoma in the talar neck

AbstractCancellous osteoid osteoma of the talus near the subtalar joint is rare, and the treatment is very challenging. We present the first case of arthroscopic excision of juxtaarticular cancellous osteoid osteoma in the talar neck near the subtalar joint. After confirming the nidus of the osteoid osteoma with computer tomography, the lesion was completely removed with a motorized bur under arthroscopy, and the patient’s pain disappeared immediately after surgery. This case report demonstrates that a cancellous osteoid osteoma in the talar neck near the subtalar joint can be treated by arthroscopic excision and good results could be obtained. n Level of evidence IV.

Clinical and MRI outcomes of HA injection following arthroscopic microfracture for osteochondral lesions of the talus

PurposeThe purpose of this study was to compare the clinical and magnetic resonance imaging (MRI) outcomes of arthroscopic microfracture surgery alone or in combination with hyaluronic acid (HA) injection in the treatment of osteochondral lesions of the talus.MethodsThirty-five patients with osteochondral lesions of the talus who underwent arthroscopic microfracture were included and followed up for at least 9xa0months post-operatively. The patients were randomly divided into non-injection group (nxa0=xa017) who received treatment with microfracture surgery alone and injection group (nxa0=xa018) who also accepted intra-articular injection of HA post-operatively. Quantitative MRI was used to evaluate the cartilage repair after surgery. American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hind foot Scale scores and Visual Analogue Scale (VAS) scores were used to evaluate clinical outcomes.ResultsAfter operation, the MRI outcomes showed that the thickness index was higher (0.8xa0±xa00.1 vs. 0.7xa0±xa00.1) and the T2 index was lower (1.2xa0±xa00.1 vs. 1.4xa0±xa00.1) in the injection group than in the non-injection group (Pxa0<xa00.01). As for the volumes of subchondral bone marrow oedema, there are no significant differences between groups (n.s.). Compared with the non-injection group, the AOFAS score and the VAS score yielded a higher level of improvement in injection group at final follow-up post-operatively (Pxa0<xa00.05).ConclusionsArthroscopic microfracture is a safe and effective procedure for osteochondral lesions of the talus. Intra-articular HA injection as an adjunct to arthroscopic microfracture might offer better functional recovery than microfracture alone.Level of evidenceII.

Difference in Postural Control Between Patients With Functional and Mechanical Ankle Instability

Background: Lateral ankle sprain is one of the most common injuries. Since the structural and pathological differences in mechanical ankle instability (MAI) and functional ankle instability (FAI) may not be the same, it may be better to treat these as separate groups. The purpose of this study was to compare the difference in postural sway between MAI and FAI in patients with chronic ankle instability (CAI). Methods: Twenty-six patients with CAI and 14 healthy control participants were included in the study. The CAI patients were subdivided into MAI (15 patients) and FAI (11 patients) groups. Patients who were diagnosed with lateral ankle ligaments rupture by magnetic resonance imaging and ultrasonography were assigned to the MAI group. All participants performed single-limb postural sway tests 3 times on each leg with eyes closed and open. The average distances from the mean center of pressure position in the mediolateral and anteroposterior directions were recorded and compared among the 3 groups. Results: The unstable ankles in the MAI group showed significantly greater postural sway in the anterior, posterior, and medial directions compared with those in the control group with eyes closed. With eyes open, significantly greater postural sway was found in the anterior direction. In the FAI group, no difference was found in postural sway compared with those in the control group. The MAI group showed significantly greater postural sway in the anterior direction compared with the FAI group with eyes closed and open. No significant difference in postural sway was found between the unstable and stable ankles in the MAI or FAI groups, with or without vision. Conclusions: Patients with MAI have deficits in postural control, especially in anterior-posterior directions. However, no difference was found in postural sway in patients with FAI compared with healthy people. Clinical Relevance: As MAI patients suffer from deficits in postural control, balance training should be applied in those patients. In addition, special training should also include the contralateral side after a unilateral ankle ligament injured.

Sonoelastography shows that Achilles tendons with insertional tendinopathy are harder than asymptomatic tendons

PurposeTo seek differences of Achilles tendon hardness between insertional tendinopathy (IT) and asymptomatic controls by using computer-assisted quantification on axial-strain sonoelastography (ASE).MethodsThe study consisted of 37 non-athletic patients presenting with Achilles tendon pain in one or two tendons. Both tendons were examined clinically. Among the 74 tendons, 16 were diagnosed and categorized into an IT group and 29 into an asymptomatic group. The remaining 29 tendons were excluded due to non-insertional tendinopathy, ruptures, previous surgery or mixed disorders. The tendons in the IT and asymptomatic groups were examined with both ASE and conventional ultrasound. Computer-assisted quantification on ASE was conducted to extract parameters of tendon hardness, including the 20th percentile (H20), median (H50) and skewness (Hsk) of the hardness within tendon, as well as the ratio of the mean hardness within tendon to that outside tendon (Hratio).ResultsThe H20 (pxa0=xa00.003), H50 (pxa0=xa00.004) and Hratio (pxa0=xa00.002) were larger and Hsk (pxa0=xa00.001) was smaller at distal thirds of IT tendons than those of asymptomatic tendons. For differentiation between two groups, the Hsk achieved the best value (0.815) of area under the receiver operating characteristic curve, with a sensitivity of 81.3xa0%, a specificity of 86.2xa0% and an accuracy of 84.4xa0%.ConclusionsComputer-assisted quantification on ASE shows that IT tendons are harder than asymptomatic tendons. It might act as a potentially useful technique for identification and risk stratification of IT patients and thus be valuable in day-by-day clinical practice for monitoring IT progression and for evaluating therapeutic effects.Level of evidenceIII.

Biomechanical comparison of three methods for distal Achilles tendon reconstruction.

PurposeTo compare the load at failure and stiffness associated with three surgical techniques for distal Achilles tendon reconstruction (AT).MethodsNine matched pairs of fresh-frozen human cadaveric ATs were divided into three groups. Distal AT reconstruction was performed using suture anchors or one of two lengths of tendon overlap (10 or 5xa0mm). Each tendon was loaded to failure. The load at failure (N), stiffness (N/mm), and mode of failure were recorded. Differences in load at failure and stiffness were analysed.ResultsMean load at failure was significantly higher in the 10-mm group than in the 5-mm group (pxa0<xa00.05) or the suture-anchor group (pxa0<xa00.05). Load at failure did not differ significantly between the suture-anchor and 5-mm group, and stiffness did not differ significantly between any two groups. In the 10- and 5-mm groups, failure was caused by the grafts pulling out through the substance of the AT. Modes of failure varied in the suture-anchor group.ConclusionsThe load at failure was higher in the 10-mm group than in the 5-mm and suture-anchor groups. Although all three surgical techniques provide sufficient primary load-bearing ability, the 10-mm tendon-overlap technique may be more conducive to early post-operative rehabilitation.

The improvement of postural control in patients with mechanical ankle instability after lateral ankle ligaments reconstruction

PurposeLateral ankle sprain is the most common injury. A previous study demonstrated that patients with mechanical ankle instability suffered deficits in postural control, indicating that structural damage of the lateral ankle ligaments may produce a balance deficit. The purpose of this study was to confirm that lateral ligaments reconstruction could improve postural control in patients with mechanical ankle instability.MethodsA total of 15 patients were included in the study. Each patient had a history of an ankle sprain with persistent symptoms of ankle instability and a positive anterior drawer test and had been treated nonoperatively for at least 3xa0months. All patients were diagnosed with lateral ankle ligaments tear by ultrasonography and magnetic resonance imaging. They underwent arthroscopic debridement and open lateral ankle ligaments reconstruction with a modified Broström procedure. One day before and 6xa0months after the operation, all of the participants underwent single-limb postural sway tests. The anterior drawer test and the American Orthopedic Foot and Ankle Society scale score were used to evaluate the clinical results in these patients.ResultsAt 6xa0months after the operation, with the patients’ eyes closed, there was significantly decreased postural sway in the anteroposterior direction, the circumferential area, and the total path length on the operated ankles compared with those measurements before the operation. With eyes open, however, no difference was found in postural sway before and after the operation.ConclusionsPostural control was improved by reconstructing the lateral ligaments.Level of evidenceIV.