Objective To investigate the short-term effectiveness of high tibial osteotomy (HTO) for treatment of middle aged and older populations with varus knee combined with medial meniscus posterior root tear (MMPRT), and to evaluate the biomechanical changes in the knee joint after operation based on finite element analysis. Methods A retrospective analysis of clinical data was conducted on 35 patients (35 knees) admitted between June 2021 and October 2023, who met the inclusion criteria for varus knee combined with MMPRT. There were 17 males and 18 females with a mean age of 59.2 years (range, 48-65 years). Open wedge HTO was performed to correct the alignment in all patients. X-ray films and MRI were conducted before operation and at 3, 6, and 12 months after operation to assess changes in lower limb alignment and joint structure. And the femorotibial angle, medial proximal tibial angle (MPTA), posterior tibial slope angle (PTSA), weight-bearing line ratio (WBLR), as well as the Lysholm score, Hospital for Special Surgery (HSS) score, and visual analogue scale (VAS) score for pain were compared between pre- and post-operation. Finite element models were reconstructed based on knee CT data from a healthy volunteer to simulate changes in stress distribution at the knee joint before and after HTO, and to analyze postoperative mechanical improvement characteristics. Results All 35 patients underwent successful operations. Postoperatively, 3 cases of incisional fat liquefaction and 2 cases of mild superficial wound infection occurred; no complication such as deep vein thrombosis of the lower extremities, severe infection, or neurovascular injury was observed. All patients were followed up 12-14 months (mean, 13.0 months). Imaging reexamination revealed that all osteotomies had achieved radiographic union, with no complication such as osteotomy loss, significant collapse, or plate fracture. At 12 months after operation, the femorotibial angle, MPTA, WBLR, and PTSA were all significantly higher than preoperative levels (P<0.05). Compared with preoperative values, the Lysholm score and HSS score gradually increased, while the VAS score decreased at 3, 6, and 12 months, with significant differences between different time points (P<0.05). Finite element analysis showed that the stress distribution in the medial and lateral compartments of the knee joint tended toward equilibrium after HTO. Medial cartilage contact stress decreased by approximately 40% compared to preoperative levels, and stress concentration in the medial meniscus was significantly reduced. Conclusion HTO can significantly alleviate knee pain in middle aged and older populations with varus knee combined with MMPRT, improve the distribution of knee joint forces, and promote the recovery of joint function.
Objective To explore the effectiveness of arthroscopic binding fixation using suture through single bone tunnel for posterior cruciate ligament (PCL) tibial insertion fractures in adults. Methods Between October 2019 and October 2021, 16 patients with PCL tibial insertion fractures were treated with arthroscopic binding fixation using suture through single bone tunnel. There were 11 males and 5 females with an average age of 41.1 years (range, 26-58 years). The fractures were caused by traffic accident in 12 cases and sports in 4 cases. The time from injury to operation ranged from 2 to 10 days with an average of 6.0 days. The fractures were classified as Meyers-McKeever type Ⅱ in 4 cases and type Ⅲ in 9 cases, and Zaricznyi type Ⅳ in 3 cases. There were 2 cases of grade Ⅰ, 7 cases of grade Ⅱ, and 7 cases of grade Ⅲ in the posterior drawer test. There were 3 cases combined with lateral collateral ligament injury and 2 cases with meniscus injury. The visual analogue scale (VAS) score, Lysholm score, International Knee Documentation Committee (IKDC) score, and knee range of motion were used to evaluate knee joint function. The posterior drawer test and knee stability tester (Kneelax 3) were used to evaluate knee joint stability. The X-ray films were used to evaluate fracture reduction and healing. Results All incisions healed by first intention after operation. There was no incision infection, popliteal neurovascular injury, or deep venous thrombosis of lower limbs. All patients were followed up 6-12 months, with an average of 10 months. X-ray films at 6 months after operation showed the fractures obtained bone union. There were 11 cases of grade 0, 4 cases of gradeⅠ, and 1 case of grade Ⅱin posterior drawer test, showing significant difference when compared with preoperative results (Z=23.167, P<0.001). The VAS score, Lysholm score, IKDC score, knee range of motion, and the results of Kneelax3 examination all significantly improved when compared with preoperative results (P<0.05). Conclusion For adult patients with PCL tibial insertion fractures, the arthroscopic binding fixation using suture through single bone tunnel has the advantages of minimal trauma, good fracture reduction, reliable fixation, and fewer complications. The patient’s knee joint function recovers well.
Objective To investigate the effectiveness of proximal humerus internal locking system (PHILOS) plate combined with rotator cuff reinforcement suture in the treatment of Neer type Ⅳ proximal humerus fracture. MethodsThe clinical data of 48 patients with proximal humeral fractures admitted between January 2016 and December 2020 were retrospectively analyzed, including 18 males and 30 females. The age ranged from 28 to 69 years (mean, 56.3 years). The causes of injury included falling in 39 cases and traffic accident in 9 cases. The time from injury to operation was 2-5 days (mean, 2.8 days). All of them were Neer type Ⅳ proximal humerus fractures, including 11 patients with dislocation. All patients underwent internal fixation with a PHILOS plate after anatomical reduction of the greater nodule, and the rotator cuff was sutured to the plate to reinforce fixation. The operation time was recorded, the wound healing, fracture healing, and complications were observed. The visual analogue scale (VAS) score, Constant-Murley shoulder score, University of California Los Angeles (UCLA) score, and American Shoulder and Elbow Surgeons (ASES) score were used to evaluate shoulder function before operation, at 3 months after operation, and at last follow-up. Results The operation time ranged from 65 to 90 minutes (mean, 76.9 minutes). All incisions healed by first intention. All patients were followed up 9-16 months (mean, 12 months). Fracture reduction was good and all fractures healed, the healing time was 2-6 months (mean, 4.6 months). There was no complication such as subacromial impingement, fracture redisplacement, and screw removal during follow-up. One patient had humeral head necrosis, but the basic function of the shoulder joint was acceptable, the symptoms were mild, and no treatment was performed. At 3 months after operation, the upper limb function of the patients basically recovered. The VAS score, Constant-Murley score, UCLA score, and ASES score significantly improved at 3 months after operation and at last follow-up when compared with preoperative, and further improved at last follow-up than at 3 months after operation (P<0.05). ConclusionPHILOS plate combined with rotator cuff reinforcement suture in the treatment of Neer type Ⅳ proximal humerus fracture has the advantages of promoting early postoperative rehabilitation exercise, improving postoperative function of shoulder joint, and reducing complications.