The Clinical Efficacy and Risk Factors after Revision and Reconstruction of Anterior Cruciate Ligament

The aim of this study was to study the clinical efficacy and prognostic factors after revision and reconstruction of anterior cruciate ligament. All the patients who underwent the first revision of anterior cruciate ligament (ACL) reconstruction in the department of sports medicine from January 2001 to December 2015 were collected. The demographic information, the first revision and reconstruction information of ACL, and the information during the first ACL reconstruction were collected. A total of 335 cases were included. Lysholm score, Tegner activity score, and IKDC subjective score at the last follow-up were significantly higher than those before operation. Compared with graft failure caused by sports injury, the postoperative scores of patients with revision due to life accidents or initial reconstruction techniques were significantly lower ( P < 0.05 ). The postoperative Lysholm score of patients with femoral canal drilling through the tibial canal was lower than that of patients with anterior internal approach. The postoperative IKDC score of patients who underwent medial meniscus suture at the same time was higher than that of patients without meniscus combined injury. ACL revision can improve the stability and function of knee joint. Compared with the revision caused by life accident or technical reasons of primary reconstruction surgery, the patients with graft failure caused by sports injury have better postoperative recovery. Medial meniscus suture and anterior internal approach drilling of the femoral bone canal have a statistically protective effect on the clinical function after ACL revision.

NON-INVASIVE METHODS FOR DAMAGE DIAGNOSIS OF MENISUS OF THE KNEE JOINT

Цель исследования: оптимизация результатов хирургического лечения пациентов с повреждениями менисков коленного суставас использованием малоинвазивной органосохраняющей технологии «сшивания мениска». В статье приведены результаты хирургического лечения 70 больных с повреждениями менисков коленного сустава, лечившийся ГКП на ПХВ ГКБ № 7 г. Алматы за период с 2017 по 2020 гг. Все больные были распределены на контрольную и основную гроуппу. В контрольную группу вошли 40 (57,2%) больных. Им выполнена артроскопическая резекция мениска. Коленный сустав не иммобилизовали, больные получали физиолечение, ЛФК и массаж. 30 (42,8%) больных отнесены к основной группе, которым выполнен шов менисков под астроскопом по новому способу (свидетельство на авторское право № 9602 от 04.05.2020.). Коленный сустав иммобилизовали на 4 недель, больтные получали также физиолечение, ЛФК и массаж конечности. Комплексное лечение больных с использованием нового способа артроскопического сшивание мениска (свидетельство на авторское право № 9602 от 04.05.2020.), ранние активные движения в здоровых суставах нижней конечности (голеностопных и тазобедренных со второго дня) и ранние пассивные и активные движения в оперированном коленном суставе (со второго дня), поздняя нагрузка на оперированную конечность (через 4 недель), способствовало в 96,7% случаях получить хороших и удовлетворительных результатов лечения у пациентов основной группы. Частота неудовлетворительных исходов лечения в основной группе встречается на 6,2% реже в сравнении с пациентами контрольной группы. Objective of the study: to optimize the results of surgical treatment of patients with injuries of the knee menisci using the minimally invasive organ-preserving technology of "stitching the meniscus". The article presents the results of surgical treatment of 70 patients with injuries of the knee menisci, who were treated by the MCP at the PCV City Clinical Hospital № 7 in Almaty for the period from 2017 to 2020. All patients were divided into control and main groups. The control group included 40 (57.2%) patients. He performed arthroscopic resection of the meniscus. The knee joint was not immobilized, the patients received physiotherapy, exercise therapy and massage. Thirty (42.8%) patients were referred to the main group, who had meniscus suture performed under an astroscopic technique using a new method (copyright certificate № 9602 dated 05/04/2020). The knee joint was immobilized for 4 weeks, the patients also received physiotherapy, exercise therapy and limb massage. Complex treatment of patients using a new method of arthroscopic suturing of the meniscus (copyright certificate № 9602 dated 05/04/2020), early active movements in healthy joints of the lower limb (ankle and hip from the second day) and early passive and active movements in the operated knee joint (from the second day), late loading on the operated limb (after 4 weeks), contributed in 96.7% of cases to obtain good and satisfactory treatment results in patients of the main group. The incidence of unsatisfactory treatment outcomes in the main group is 6.2% less common in comparison with patients in the control group.

Deep Learning-Based Image Feature with Arthroscopy-Aided Early Diagnosis and Treatment of Meniscus Injury of Knee Joint

The aim of this study is to explore the clinical effect of deep learning-based MRI-assisted arthroscopy in the early treatment of knee meniscus sports injury. Based on convolutional neural network algorithm, Adam algorithm was introduced to optimize it, and the magnetic resonance imaging (MRI) image super-resolution reconstruction model (SRCNN) was established. Peak signal-to-noise ratio (PSNR) and structural similarity (SSIM) were compared between SRCNN and other algorithms. Sixty patients with meniscus injury of knee joint were studied. Arthroscopic surgery was performed according to the patients’ actual type of injury, and knee scores were evaluated for all patients. Then, postoperative scores and MRI results were analyzed. The results showed that the PSNR and SSIM values of the SRCNN algorithm were (42.19 ± 4.37) dB and 0.9951, respectively, which were significantly higher than those of other algorithms ( P < 0.05). Among patients with meniscus injury, 17 cases (28.33%) were treated with meniscus suture, 39 cases (65.00%) underwent secondary resection, 3 cases (5.00%) underwent partial resection, and 1 case (1.67%) underwent full resection. After meniscus suture, secondary resection, partial resection, and total resection, the knee function scores of patients after treatment were (83.17 ± 8.63), (80.06 ± 7.96), (84.34 ± 7.74), and (85.52 ± 5.97), respectively. There was no great difference in knee function scores after different methods of treatment ( P > 0.05), and there were considerable differences compared with those before treatment ( P < 0.01). Compared with the results of arthroscopy, there was no significant difference in the grading of meniscus injury by MRI ( P > 0.05). To sum up, the SRCNN algorithm based on the deep convolutional network algorithm improved the MRI image quality and the diagnosis of knee meniscus injuries. Arthroscopic knee surgery had good results and had great clinical application and promotion value.

Knee meniscus suturing techniques in children and indications for their use

Relevance The problem of meniscus injuries in children has acquired a particular relevance. The growth in their incidence has been caused not only by an active sports- and lifestyle of pediatric patients but also by improved diagnosis due to magnetic resonance and arthroscopic techniques. Aim To formulate indications for the use of various methods of meniscus suturing in children and to evaluate the results of treatment of meniscus injuries in children, depending on the location of the tears. Materials and methods Our study included 74 patients who underwent meniscus suturing from March 2018 to December 2020. The age of the children ranged from 10 to 17 years. Time since the injury ranged from one day to 3 years. Before surgery, they underwent instrumental examination; knee joint radiography was performed in all patients, knee MRI was performed in 66 patients. Results Meniscus sutures were evaluated clinically and instrumentally at 6 months after the operation (MRI). One year after the meniscus repair, X-rays of the knee were taken to assess osteoarthritis. There was no pain after surgery in 68 children (91.9 %). There were no blocks of the knee joint after surgery in all children. Full recovery of the range of motion in the knee joint was observed in 69 children (93.2 %). Complications were noted in five children. Conclusion Poor results after meniscectomy has led to the emergence of several methods that allow meniscus repair and avoid meniscectomy that impairs knee functions. In children, the potential for restoration of menisci after their reconstruction is higher than in adults. It is possible to repair lesions not only in the white zone but after periods of more than three months since the injury. The choice of the meniscus suture technique used is determined by the location of the tear, taking into account possible complications. The use of a combination of methods allows reconstruction of the damaged meniscus regardless of the location of the tear and the complexity of the injury. Good clinical results, absence of complaints and return to usual physical activities in the immediate postoperative period should be regarded as positive outcomes subjected to further study.

Clinical practice and postoperative rehabilitation after knee arthroscopy vary according to surgeons’ expertise: a survey among polish arthroscopy society members

Background Meniscus repair is a challenging task in knee arthroscopy. Currently, there are a variety of arthroscopic methods available for meniscus repair. The purpose of this study was to determine a consensus in meniscus tear treatment in the environment of Polish orthopaedists. Methods A total of 205 registered orthopaedic surgeons participated in the surveys. The survey consisted of 35 questions regarding general arthroscopy and postoperative management, including physicians’ level of expertise, anaesthesia, postoperative treatment, rehabilitation and procedures performed. Comparisons were made between knee arthroscopy experts (> 100 arthroscopies performed per year) and non-experts (≤ 100 cases) on aspects of patient care. Results The most important finding of this study was the agreement among almost all aspects of the knee arthroscopy approach. Consensus among Polish surgeons was noticed in choosing regional anaesthesia for knee arthroscopy, the lack of need for knee braces and knee medications, the of use of LMW heparin for thromboprophylaxis, 1–2 days of hospitalization, the recommendation of rehabilitation and the use of magnetic resonance as a diagnostic test for meniscus damage. Surgical expertise was significantly associated with the performance of meniscus suture procedures (p = 0.009). Experts recommended starting rehabilitation on the day of surgery (p = 0.007) and were more likely to use objective physical tests (p = 0.003). Non-expert surgeons recommended a longer period from meniscus suture to full-range knee motion (p = 0.001) and admitted that patient age does matter for meniscus repair qualification (p = 0.002). Conclusions There is consensus among almost all issues of meniscus tear treatment in the environment of Polish orthopaedists; however, the issues of rehabilitation and the use of advanced meniscus repair techniques are associated with surgical expertise.

Clinical practice and postoperative rehabilitation after knee arthroscopy vary according to surgeons’ expertise: a survey among Polish Arthroscopy Society members.

Background: Meniscus repair is a challenging task in knee arthroscopy. Currently, there are a variety of arthroscopic methods available for meniscus repair. The purpose of this study was to determine a consensus in meniscus tear treatment in the environment of Polish orthopaedists.Methods: A total of 205 registered orthopaedic surgeons participated in the surveys. The survey consisted of 35 questions regarding general arthroscopy and postoperative management, including physicians’ level of expertise, anaesthesia, postoperative treatment, rehabilitation and procedures performed. Comparisons were made between knee arthroscopy experts (> 100 arthroscopies performed per year) and non-experts (≤ 100 cases) on aspects of patient care.Results: The most important finding of this study was the agreement among almost all aspects of the knee arthroscopy approach. Consensus among Polish surgeons was noticed in choosing regional anaesthesia for knee arthroscopy, the lack of need for knee braces and knee medications, the of use of LMW heparin for thromboprophylaxis, 1-2 days of hospitalization, the recommendation of rehabilitation and the use of magnetic resonance as a diagnostic test for meniscus damage. Surgical expertise was significantly associated with the performance of meniscus suture procedures (p = 0.009). Experts recommended starting rehabilitation on the day of surgery (p=0.007) and were more likely to use objective physical tests (p=0.003). Non-expert surgeons recommended a longer period from meniscus suture to full-range knee motion (p=0.001) and admitted that patient age does matter for meniscus repair qualification (p=0.002).Conclusions: There is consensus among almost all issues of meniscus tear treatment in the environment of Polish orthopaedists; however, the issues of rehabilitation and the use of advanced meniscus repair techniques are associated with surgical expertise.

Clinical practice and post-operative rehabilitation after knee arthroscopy varies according to surgeon's expertise: a survey among Polish Arthroscopy Society members.

Background: Meniscal repair has received increasing attention. Currently, there is a variety of arthroscopic methods of meniscus repair available. The purpose of this study was to determine a consensus in meniscus tear treatment in the environment of Polish orthopedists.Methods: 205 registered orthopedic surgeons took part in surveys. The survey consisted of 35 questions regarding general arthroscopy and postoperative management, including physician’s level of expertise, arthroscopy anesthesia, postoperative treatment, rehabilitation and procedures performed. Comparisons were made between knee arthroscopy experts (> 100 arthroscopies performed per year) and non-experts (≤ 100 cases) on aspects of patient care.Results: The most important finding of this study is an agreement in almost all aspects of knee arthroscopy approach. A consensus between polish surgeons was noticed in choosing regional anesthesia for knee arthroscopy, no need for knee braces nor knee medications, using LMW heparin as thromboprophylaxis, 1-2 days hospitalization, recommendation of rehabilitation and magnetic resonance as a diagnostic test for meniscus damage. Surgical expertise was significantly associated with the performance of meniscus sewing procedures (p = 0.009). Experts recommended starting rehabilitation already on the day of surgery (p=0.007) and more likely used objective physical tests (p=0.003). Non-expert surgeons recommended longer period from meniscus suture to a full range knee motion (p=0.001) and admitted that patient’s age does matter for meniscus repair qualification (p=0.002).Conclusions: There is a consensus in almost all issues of meniscus tear treatment in the environment of the Polish orthopedists, however the rehabilitation issues and the use of advanced meniscus repair techniques is associated with surgical expertise.

Clinical Practice and Post-Operative Rehabilitation After Knee Arthroscopy: Comparison Between Polish Experts and Non-Experts.

Background: The purpose of this study was to compare the clinical practices between polish expert and non-expert arthroscopy knee surgeons.Methods: 205 registered orthopedic surgeons took part in surveys. The survey included 35 questions regarding general arthroscopy and postoperative management, including physician’s level of expertise, arthroscopy anesthesia, postoperative treatment, rehabilitation and procedures performed. Comparisons were made between knee arthroscopy experts (> 100 arthroscopies performed per year) and non-experts (≤ 100 cases) on aspects of patient care.Results: The most important finding of this study is an agreement in almost all aspects of knee arthroscopy approach. A consensus between polish surgeons was noticed in choosing regional anesthesia for knee arthroscopy, no need for knee braces nor knee medications, using LMW heparin as thromboprophylaxis, 1-2 days hospitalization, recommendation of rehabilitation and magnetic resonance as a diagnostic test for meniscus damage. Surgical expertise was significantly associated with the performance of meniscus sewing procedures (p = 0.009). Experts recommended starting rehabilitation already on the day of surgery (p=0.007) and more likely used objective physical tests (p=0.003). Nonexpert surgeons recommended longer period from meniscus suture to a full range knee motion (p=0.001) and admitted that patient’s age does matter for meniscus repair qualification (0.002).Conclusions: Clinical practice varies among orthopeadists performing knee arthroscopy procedures, based on their level of expertise. Polish knee arthroscopy experts agreed with non-experts in the type of anesthesia during knee arthroscopy and numerous aspects of postoperative treatment. Surgical expertise was associated with the performance of advanced meniscus suturing techniques.