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【Abstract】Objective: To evaluate the anatomy of femoral tunnels created by simulated transtibial technique in double-bundle anterior cruciate ligament (ACL) reconstruction. Methods: Two tibial tunnels, anteromedial (AM) and posterolateral (PL), were drilled 45° and 55° to tibial plateau respectively. On the femoral side, the AM and PL tunnels were drilled through anteriomedial portal. Af ter the four tunnels were established, the shaft of a reamer was introduced into the joint through tibial tunnel and reached gainst the lateral wall of intercondylar notch. The position that the reamer shaf t can reach was marked and recorded. Results: Neither femoral AM nor PL tunnel opening can be fully or partially reached by the reamer shaft through the tibial AM tunnel in all cases. The evaluation thr ough the tibial PL tunnel showed that only in 8 of 50 cases (16%) the femoral AM tunnel opening and in 4 cases (8%) the PL opening can be fully reached. On the other hand, in 12 cases (24 %) the femoral AM tunnel opening and in 0 cases ( 20%) the PL opening can be partially reached by the shafts through the tibial PL tunnel. Conclusion: The result strongly suggests that transtibial technique is not well competent for femoral tunnel drilling in anatomic double-bundle ACL reconstruction as we have hypothesized. Key words: Anterior cruciate ligament reconstr uction; Arthroscopy; Anatomy; Knee

Objective: To analyze the histopathology of, surgery for, and prognosis (survival rate, local recurrence rate, metastases rate, function) of epithelioid angiosarcoma (EA)., Methods: Seven patients diagnosed as EA were received treatment in our department from May 2001 to May 2011. According Enneking staging, 3 patients were classified as IIA, 3 for IIB, and 1 for III. Wide excision was performed in 3 patients and amputation in 4 patients. Seven patients were followed up from 3 to 20 months., Results: One patient had local recurrence 3 months after wide excision. Five patients had metastases at 4 to 20 months postoperatively. The cumulative survival rate at 0.5, 1 and 2 years postoperatively were 67%, 22% and 0. The function of 3 patients after limb salvage operation was good in 2 cases and poor in 1 case. The tumor site, surgical staging, and safe margin were crucial factors affecting survival rate., Conclusions: The prognosis of EA in deep soft tissue was poor. Customized, multimodality treatment and safe margin in operation may increase the survival rate as well as decrease recurrence and metastasis.

Aim: To poly ADP ribose polymerase inhibitors PJ34 on glutamate neurotoxicity induced protective effect, as PJ34 in ischemic cerebrovascular disease provide a reference for clinical applications., Methods: After the cultured HT-22 cells were treated with 5 mmol/L Glu induction treatment, divided into the PJ34 group subsequently given 50 micromol/L PARP inhibitor PJ34 protection effects processing. Inhibition rate of each group and the PARP activity of changes., Results: PJ34 group after 24 h, inhibition rate of HT-22 cells were markedly decreased (P<0.05). PJ34 PARP activity than the control group was significantly lower (P<0.05)., Conclusion: PJ34 PARP activity by reducing increased glutamate-induced HT-22 cell viability, and thus play a protective effect on cells.

Objective: To introduce a novel technique in which meniscal stitching needle is used as a puller to induct steel wire to secure the tibial eminence avulsion under arthroscopic visualization, and evaluate the clinical results., Methods: From 1999 to 2005, fifteen cases of tibial eminence avulsion were treated with this new technique. Lysholm scoring scale system was used to assess knee function before and after surgery. Regular plain anteroposterior and lateral X-ray films were undertaken to detect the bony healing of avulsed fragment., Results: The operating time could be controlled within 30 minutes. No complications such as intraarticular infection, iatrogenic injury, fibroarthritis or nonunion of fracture occurred in this group. X-ray film revealed that bony healing in all 15 cases was achieved from 6 weeks to 12 weeks postoperatively. Lysholm score was improved from 19.1+/-15.2 (ranging from 10 to 56) preoperatively to 97.5+/-3.7 (ranging from 91 to 100) postoperatively on average in 12-54 months follow up (mean 23 months). The statistically significant difference was shown in Student's t test (t equal to 18.483, P equal to 3.100 x 10(-11), P < 0.01). Wire breakage was found in two patients whose wires were removed 8 months and 14 months after initial operation, respectively., Conclusion: This technique has many advantages, such as simplicity, wide indications from type II to type IV fractures, minimal invasion, short operating time and predictable satisfactory results.

Objective: To analyze the histological results and the biological remodeling of ligamentous insertion after the reconstruction of anterior cruciate ligament (ACL) with autograft or allograft tendon., Methods: Extensor digitorum tendon was harvested from hind limb as graft material and transplanted to reconstruct the resected ACL in 12 mongrel dogs. Each free tendon end was secured by holding sutures and then the sutures were tied to the post screw at the femoral and tibial bony tunnel outlet after transplantation respectively. Autograft was randomly performed on one side of knee while allograft on the other side of knee. After transplantation, the histological analysis was undertaken at the 6th, 12th weeks and the 6th month using hematoxylin-eosin (HE) stain under light microscope., Results: The insertion structure of normal ACL typically consisted of four layers, i.e., dense connective tissue, fibrocartilage, mineralized fibrocartilage and bone. There was a distinct regular tidemark line between fibrocartilage and mineralized fibrocartilage. At the 6th week postoperatively, loose connective tissue presented in the interspace between graft and bony tunnel wall in both autograft and allograft groups. At the 12th week postoperatively, the collagenous fibers between autograft and tunnel wall became well organized and the four layers of insertion with discontinuous tidemark line were demonstrated indistinctly in autograft group but not in allograft group. At the 6th month postoperatively, both of a clear and continuous tidemark line and distinct four layers could be seen in autograft group. In allograft group, only a waved discontinuous tidemark line was shown and either the anatomic morphology or the maturity of insertion was inferior to that of autograft group., Conclusions: At the 6th month postoperatively, although the ligament-cartilage insertion is primarily formed after ACL reconstruction with autograft or allograft tendon, the histological morphology and the maturation of insertion of autograft tendon are better than those of allograft group, which suggests that postoperative rehabilitation should be paid more attention and could be safer if little delayed during ACL reconstruction with allograft tendon.