Anterior cruciate ligament reconstruction with a four-strand hamstring tendon autograft

BACKGROUND: In this study, we analyzed the clinical outcomes at a minimum of two years following reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft in patients who had presented with a symptomatic torn anterior cruciate ligament. METHODS: One hundred and twenty-two consecutive patients who had an isolated, symptomatic anterior tibial subluxation associated with rupture of the anterior cruciate ligament were treated with reconstruction of the anterior cruciate ligament with a four-strand autologous semitendinosus-gracilis tendon graft. One surgeon performed all of the operations. Prior to surgery and at the follow-up examination, physical findings and functional scores were recorded and knee radiographs were analyzed. Following surgery, a six-month rehabilitation regimen was implemented. RESULTS: Eighty-five patients (70%) were available for follow-up, which included physical examination, scoring of function, KT-1000 arthrometric testing, and radiographs, at a mean of twenty-eight months. Seventy-six (89%) of the patients had negative Lachman and pivot shift tests. The mean Lysholm score improved from 55 points preoperatively to 91 points at the time of follow-up (p < 0.01). The mean Tegner score improved from 5 to 6 points (p < 0.01). Sixty-five patients had <3 mm of knee translation on arthrometric testing, but six patients with marked laxity were not tested. Three patients (4%) had a positive pivot shift test but had no history of additional trauma to the knee. Six patients (7%) had a traumatic rupture of the graft, occurring at a mean of 10.7 months postoperatively. Assessment of the follow-up radiographs demonstrated no evidence of progressive degenerative change compared with the appearance on the preoperative radiographs. However, tunnel expansion was noted in all patients. The tibial tunnel expanded a mean of 17% (range, 0% to 32%), and the femoral tunnel expanded a mean of 29% (range, 0% to 40%). CONCLUSIONS: Reconstruction of the anterior cruciate ligament with use of a four-strand hamstring tendon autograft eliminated anterior tibial subluxation in 89% of patients who were examined at a minimum of two years postoperatively. The overall rate of failure was 11%. The functional knee scores were significantly increased at the time of follow-up, but these results did not correlate with the results of knee arthrometric testing.     

Arthroscopic reconstruction of the anterior cruciate ligament using allograft tendon

Treatment of the anterior cruciate ligament (ACL)-deficient knee using an arthroscopic technique and freeze-dried allograft tendons in 23 patients was studied prospectively. Accurate placement of drill holes and anchoring positions for the allografts was effected through a standard arthroscopic approach combined with a 3 cm incision on the medial tibial flare. Candidates for reconstruction were those who were unable to tolerate brace therapy and who had no degenerative arthritis. The 23 patients were drawn from a group of 60 treated patients because their follow-up had been greater than or equal to 1 year. Their knees were assessed preoperatively and postoperatively with a Lysholm knee rating scale, Lachman test with KT-1000 arthrometric quantitation, pivot shift, Biodex test, and radiographs. Knee rating values improved in all knees, and only one patient had a significant deterioration in the KT-1000 reading. All patients with at least 20 months follow-up have resumed their preinjury activity levels.     

Single versus two-incision arthroscopic anterior cruciate ligament reconstruction

The purpose of this study was to compare single (endoscopic) versus two-incision arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone in a population of young athletes. All patients followed a similar postoperative rehabilitation program. The Lysholm knee score, the International Knee Documentation Committee Score, KT-1000 arthrometric measurements, Lachman tests, pivot shift tests, isokinetic and functional testing, and perioperative complications were used to compare the two techniques. Anteroposterior and lateral radiographs were also evaluated and compared. Group I comprised 51 patients who underwent two-incision arthroscopic ACL reconstruction. The average age was 19.8 years, with a range of 18 to 22. The average follow-up in this group was 31 months (range, 24 to 43 months). Group II, the endoscopic group, consisted of 31 patients with an average age of 19.4 years (range, 18 to 22). The average follow-up was 25 months (range, 24 to 31 months). There were no significant differences between the two groups using subjective, objective, and functional criteria. There did appear to be a trend toward a residual pivot glide in the endoscopic group, but this did not achieve statistical significance. Radiographic analysis demonstrated an increased incidence of screw divergence in the endoscopic group. Intraoperative complications were more common with the endoscopic method.     

Association of KT-1000 measurements with clinical tests of knee stability 1 year following anterior cruciate ligament reconstruction.

STUDY DESIGN: Prospective, observational study. OBJECTIVES: To determine the association between KT-1000 measurements with an anterior translation force of 89 N and other measures of outcome (the Tegner activity score, the modified Lysholm score, subjective rating of instability, Lachman test, and pivot-shift test) 1 year following anterior cruciate ligament (ACL) reconstruction. BACKGROUND: Health care professionals often use the side-to-side difference measured with the KT-1000 arthrometer to determine ACL integrity during passive motion. It has been postulated that a 5-mm or greater difference between impaired and nonimpaired knees represents a procedural failure. METHODS AND MEASURES: Ninety patients (46 men, 44 women) with a mean age of 30 +/- 8 years were examined 1 year after surgery. Patients were classified in 1 of 3 groups depending on the amount of laxity between the impaired knee and the nonimpaired knee. Seventy percent of the subjects had a side-to-side difference less than or equal to 3 mm (tight), 13% had a difference of between 3 and 5 mm (moderate), and 17% had a difference greater than or equal to 5 mm (loose) on examination using the KT-1000. RESULTS: Mean Lysholm and Tegner scores did not differ significantly among groups. Side-to-side differences in KT-1000 measurements at 89 N were not associated with the Lysholm score (r = -0.09) or Tegner score (r = 0.02). Lachman tests were related to involved-knee KT-1000 measurements (r = 0.39) but not to side-to-side differences in KT-1000 measurements (r = 0.15). Similarly, pivot-shift tests were related to involved-knee KT-1000 measurements (r = 0.26) but not to side-to-side differences (r = -0.08). CONCLUSIONS: These results suggest that side-to-side KT-1000 measurements obtained with an anterior translation force of 89 N should not be used in isolation to determine ACL reconstruction success or failure 1 year following surgery.     

Long-term results of anterior cruciate ligament reconstruction using semitendinosus and gracilis tendons with Kennedy ligament augmentation device compared with patellar tendon autografts

ACL reconstructions were postoperatively evaluated in 102 patients who underwent surgery using an arthroscopically assisted double-incision technique. Augmentation of the distally based semitendinosus and gracilis tendons was done either with the Kennedy ligament augmentation device (LAD) (Group 1 patients, mean follow-up of 108 months) or bone-patellar-tendon-bone graft (Group 2 patients, mean follow-up of 109 months). At follow-up, serial KT-1000 measurements showed < or = 5 mm side-to-side differences in 70% of Group 1 and 90% of Group 2 patients. No differences were found among patients regarding postreconstruction complications such as loss in motion range, patellofemoral crepitus, osteoarthritis, and muscle disfunction.     

Arthroscopic treatment of type III tibial spine fractures using absorbable fixation

Over 2 years, five patients (average age 15 years) were diagnosed with a type III tibial spine fracture. All five fractures were treated with arthroscopic reduction and internal stabilization using absorbable fixation. At average 8.5-year follow-up, patients were interviewed and examined. Results were documented regarding function, KT-1000 testing, range of motion, and radiographic findings. All five patients reported no functional limitations despite participation in high-demand sports. Stability testing by KT-1000 revealed no objective instability. Range of motion was normal when the knee was immobilized in full extension postoperatively. No radiographic abnormality was noted at follow-up.     

Outcomes of anterior cruciate ligament reconstruction in patients with Workers' Compensation claims.

SUMMARY: A general perception exists that outcomes of orthopaedic procedures in patient's with Workers' Compensation claims fare worse than those of patients without such claims. We retrospectively reviewed the outcomes of anterior cruciate ligament (ACL) reconstruction in patients who have Workers' Compensation claims. This minimum 2-year follow-up study analyzed the occupational, functional, and objective results of patients who underwent arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction. Twenty-two patients with Workers' Compensation claims representing 5% of patients who underwent ACL reconstruction at our institution between 1987 and 1995 were included in the current study. All reconstructions were performed by the senior author (B.R.B.) using arthroscopic-assisted techniques (single and double-incision) with bone-patellar tendon-bone autografts followed by an accelerated rehabilitation protocol. Postoperative follow-up physical examinations revealed a negative anterior drawer in 19 patients (91%), a negative Lachman in 15 patients (68%), and a negative pivot shift in 21 patients (96%). The KT-1000 arthrometric evaluation at follow-up showed a mean maximum manual difference of 1. 9 mm with 15 patients (68%) having a maximum manual difference of 相似文献   

A minimally invasive technique ("healing response") to treat proximal ACL injuries in skeletally immature athletes

This study documents outcomes of athletically active, skeletally immature patients with proximal anterior cruciate ligament (ACL) tears treated with a non-reconstructive technique to promote healing ("healing response"). Between 1992 and 1998, 13 skeletally immature athletes with proximal ACL tears underwent a healing response procedure. Patients with previous ACL injury, other concurrent ligament pathology, and/or complete mid-substance ACL tears were excluded. Average preoperative KT-1000 arthrometer manual maximum difference for all patients was 5 mm (range: 3-10 mm). Preoperatively, all patients had a 1+ or 2+ pivot shift, and all patients reported knee function as abnormal or severely abnormal. Patients were followed prospectively with clinical examinations, KT-1000 testing, and subjective questionnaires. Three (23%) patients had a re-injury 30 to 55 months after the healing response and underwent subsequent ACL reconstruction. Subjective follow-up on the remaining 10 patients at an average of 69 months (range: 26-113 months) postoperatively indicated no patients experienced pain or giving way, and all considered their knee function normal. Average Lysholm score was 96, Tegner score was 8.5 (range: 7-10), and patient satisfaction at follow-up was 9.9 (1=very dissatisfied and 10=very satisfied). Clinical examination at least one year postoperatively was performed on 7 of 10 patients at 35 months (range: 12-63 months). Five patients had a negative pivot shift and 2 had a 1+ pivot shift. KT-1000 measurements improved to 2 mm (range: 0-3 mm). In the athletically active, skeletally immature patient, the healing response procedure can restore stability and knee function, with proper patient selection. In this study group, patients were very satisfied with the procedure and returned to a high level of sports and activities.     

Reconstruction of acute anterior cruciate ligament injuries: a prospective,randomised study of 40 patients with 7-year follow-up

BACKGROUND: In a prospective, randomised study, we compared the results of anterior cruciate ligament reconstruction using the conventional medial patellar tendon strip procedure with the Kennedy ligament augmentation device (LAD) over-the-top augmentation technique. The aim of the study was to see if the addition of this device, with its specific potential complications (infection, synovitis, mechanical failure) and increased costs, gave better functional stability and less donor site morbidity. METHODS: Forty patients ( n=20+20) with high physical demands, anterior cruciate ligament rupture less than 3 weeks old, and positive Lachman and pivot shift tests were included in the study. They were randomised by instructions in a sealed envelope that was randomly chosen. Postoperatively, they were immobilised in a plaster of Paris cast for 2 weeks. Full weight-bearing was not allowed until 6 weeks after the operation. Strength training on the operated side started when movement was restored to nearly normal, usually after 8-10 weeks. Return to full sport activity was allowed 1 year after the operation. Clinical and arthrometric follow-up was performed yearly using the Lysholm functional score, Tegner activity score, KT-1000 testing, Lachman and pivot shift tests. Follow-up lasted 3-9 years (mean 7 years). RESULTS AND CONCLUSIONS: At last follow-up we found no statistical difference in stability tests, functional or activity scores; both groups showed stable improvement concerning scores and arthrometry compared with the preoperative values. No advantages were associated with the use of the Kennedy LAD, and we do not recommend it or a similar device for uncomplicated cases. New augmentation devices are simply launched onto the market, and we recommend caution and thorough evaluation in prospective, randomised studies before they are adopted into use.     

Failure of clinical methods in assessing graft integrity after anterior cruciate ligament reconstruction: an arthroscopic evaluation.

We reviewed the findings of 24 patients who underwent knee arthroscopy following a bone-patellar tendon-bone autograft anterior cruciate ligament (ACL) reconstruction. Preoperative symptoms included pain, swelling, catching, and/or locking. Only one patient presented with subjective instability. The subjective and objective clinical findings as well as KT-1000 examination were compared with the arthroscopic findings. Thirteen of the 24 patients had an insufficient ACL graft by arthroscopic examination. In only 5 of these patients did the physical examination and/or KT-1000 results reliably detect an insufficient ACL graft. The remaining 8 patients had a stable knee by subjective and objective clinical criteria as well as strict KT-1000 criteria. No significant degenerative changes or lack of motion was present in this group. Also, 7 of the 8 patients had an excellent or good Orthop?dische Arbeitsgruppe Knie (OAK) score and maintained a high level of function. In the two patients who underwent preoperative magnetic resonance imaging the lack of an intact graft was confirmed. A subset of patients appear to have stable knees despite the lack of a functioning ACL graft. Therefore, standard clinical and KT-1000 criteria for ACL deficient knees have limitations in detecting graft integrity after ACL reconstruction. Arthroscopy or magnetic resonance imaging may be needed when graft integrity is in question.     

自体腘绳肌腱单束与双束重建前交叉韧带临床结果的Meta分析

目的 基于已发表的随机对照试验（randomized controlled trials, RCTs）,对关节镜下采用自体腘绳肌腱单束或双束重建前交叉韧带的整体疗效比较进行Meta分析。方法 计算机检索PubMed、Cochrane library、Springerlink数据库,收集自体腘绳肌键单束对比双束重建前交叉韧带的RCTs,检索时间及语种不限。两名研究人员按照指定的纳入标准及排除标准独立对文献进行筛选,提取有关数据资料,并采用Cochrane Collaboration工具表对文献质量进行评价。采用Revman 5.3软件进行Meta分析,比较两种重建方式术后国际膝关节评分委员会（International Knee Documentation Committee, IKDC）主观评分和客观评分、Lachman试验、轴移试验、Lysholm膝关节评分、Tegner膝关节评分、KT-1000或KT-2000关节活动度测量仪测量的数值,评价手术疗效。结果 纳入19篇RCTs,共1 190例研究对象,其中单束重建组580例,双束重建组610例。两组间在IKDC主观评分[MD=-0.90,95% CI（-3.07,1.27）,P=0.42]、IKDC客观评分[RR=0.98,95% CI（0.94,1.02）,P=0.38]、Lachman试验结果[RR=0.81,95% CI（0.63,1.05）,P=0.11]、Lysholm膝关节评分[MD=0.40,95% CI（-1.24,2.05）,P=0.63]、Tegner膝关节评分[MD=-0.08,95% CI（-0.47,0.33）,P=0.74]、KT-1000或KT-2000测量值[MD=0.30,95% CI（-0.05,0.64）,P=0.09]方面,差异均无统计学意义。轴移试验结果在两组间的差异具有统计学意义[RR=0.85,95% CI（0.74,0.97）,P=0.02]。结论 对于膝关节功能恢复和前直向稳定性,用自体腘绳肌腱单束或双束重建前交叉韧带的临床结果无明显差异;而对于恢复膝关节旋转稳定性,双束重建技术优于单束重建。     

Age and ACL reconstruction revisited

To determine the age limitations for indicating ACL reconstructions in patients with functional instability, this article reviews the results of anterior cruciate ligament (ACL) reconstructions in 23 patients with an average age of 54 years (range: 49-64 years). Patients were evaluated with the Lysholm and Gillquist knee questionairre, visual analog scale, satisfaction rating, physical examination, KT-1000 testing, and radiographs. Nineteen of the 23 patients were available for follow-up at an average of 24 months after the index procedure. Sixteen patients returned for physical examination and 3 agreed to telephone interviews. The mean Lysholm score was 92, visual analog score 0.5, satisfaction rating 100%, KT-1000 testing 2mm, range of motion 0 degrees to 135 degees. Sixteen of the 19 patients returned to acceptable activity levels. Fifteen patients had excellent or good results, while 4 patients had fair or poor results. Three of the 4 fair or poor results had significant moderate or severe knee arthrosis. Anterior cruciate ligament reconstruction with allograft in 49-64 year-old patients with minimal arthrosis is a safe, minimally invasive procedure that allows for return to a desired level of activity.     

Anterior cruciate ligament reconstruction in athletes with an ossicle associated with Osgood-Schlatter's disease

We report a series of 20 athletes with an ossicle associated with Osgood-Schlatter's disease (OSD) who underwent anterior cruciate ligament (ACL) reconstruction using autogenous, central-10-mm patellar-tendon graft. All patients had an Osgood-Schlatter's lesion with an ossicle as seen on a plain radiograph. The patients were reviewed at an average follow-up of 44 months (range, 24 to 108 months). The postoperative assessment included clinical examination, KT-1000 testing, isokinetic testing, and subjective score (using the modified Noyes' questionnaire). At the time of latest review, all 20 patients had a stable knee. The average side-to-side difference on manual maximum KT-1000 assessment was 1.9 mm (range, 0 to 5 mm). Average time to return to full sporting activities was 5.2 months (range, 2.6 to 8.9 months). All patients returned to their previous level of activity. The mean modified Noyes' knee score was 96 (range, 89 to 100). To date, no graft failure has occurred. Based on the results of this study, we believe that ACL reconstruction using the autogenous bone-patellar tendon-bone graft can be safely undertaken in athletes with an ossicle associated with OSD without compromising the final knee function.     

An institution-specific analysis of ACL reconstruction failure

The purpose of this study was to determine the most common causes of failed anterior cruciate ligament reconstruction (ACLR) using modern reconstructive techniques at a single, high-volume institution. In addition, the clinical outcomes of patients undergoing revision ACLR will be reported. The surgical logs of four senior knee surgeons were retrospectively reviewed for all patients who had undergone ACLR between 2002 and 2009. Patients were excluded if they did not have both the primary and revision surgery on the same knee with the same surgeon. Out of 1944 ACL reconstructions, 28 patients (56 reconstructions) were included in the study. Radiographic studies, operative reports, KT-1000 scores, and chart notes were used to identify all potential factors that may have led to failure. All patients were invited to return for a follow-up examination and survey. Of the 28 patients, the mean age at the index and revision procedure was 22 +/- 11 (range, 12 to 50) and 24 +/- 11 (range, 14 to 57), respectively. In 20 cases, the cause of failure was determined to be acute trauma (sports, work, or accident); in 1 case, the cause was biologic failure; while in 7 cases, the cause was technical error. During the study period the surgeons performed a combined total of 1944 procedures, for an overall failure rate of 1.8%. Twenty patients (71%) were available for follow-up at a mean 30.2 +/- 17.7 months. The overall postrevision outcomes were good to excellent for a majority of patients, with an average Lysholm score of 84 +/- 15.5 and International Knee Documentation Committee score of 77.2 +/- 13.8. The pre- and postoperative KT-1000 scores were 12.1 +/- 2.8 and 6.7 +/- 2.8, respectively. The results from this study suggest that traumatic re-injury, and not surgical/surgeon error, is the most common cause of ACLR failure using anatomic reconstructive principles and strong fixation. In addition, good to excellent outcomes following revision ACLR can be expected in the majority of patients.     

Kann das Ergebnis nach Kreuzbandoperationen arthrometrisch erfaßt werden?

In a long-term follow-up of 88 patients with complex ligament knee injuries we examined 70 of these who were operated upon between 1. 4. 1988 and 31. 3. 1990. We specifically looked at local complications, clinical results and knee stability, using subjective and arthrometrical (KT-1000) results 1 or 2 years after operation. The only parameters with a good correlation with stability were the clinical examination (Lachman-test) and the results with the arthrometer in the anterior-posterior translation. Stability after ACL-reconstruction with augmentation with a polydiaxonaon (PDS) augmentation band was physiological (2 mm under 89 N anterior-posterior traction) in 77% of all knees but only in 57% under maximal anterior-posterior manual stress. Neither the subjective outcome of Lysholm-Score correlated with arthrometry and clinical examination.     

Intrafix固定四股腘绳肌腱重建前交叉韧带的临床研究

目的 探讨采用Intrafix固定腘绳肌腱重建前交叉韧带的临床疗效.方法 2005年3月至12月采用Intrafix螺钉重建前交叉韧带患者35例,由同一术者完成,均采用4股半腱肌腱和股薄肌腱.前交叉韧带股骨端采用Endobutton袢固定.3例患者失访,术后随访时间为12～20个月,平均15个月.其中15例进行膝关节功能评分、KT-2000及X线检查,11例患者术后行MRI检查;其余17例患者仅进行了膝关节功能评分.结果 术后国际膝关节委员会(IKDC)膝关节主观功能评分平均91分(83～97分),15例膝关节检查IKDC分级为A级10例,B级5例(为术后膝关节伸屈角度略大所致).Lysholm评分83～93分,平均89分,其中优17例,良15例.术后优良率为100%.术后KT-2000结果 为30°133 N下平均1.2 mm(0～2.0 mm),90°133 N下平均0.5 mm(-0.5～2.0 mm).术后MRI可见重建韧带形态较好.术后X线片可见定位准确.结论 采用Intrafix固定四股腘绳肌腱重建前交叉韧带能够恢复膝关节前向稳定性,术后临床效果好.     

Anterior knee laxity in a healthy patient sample]

A prospective study investigates anterior knee laxity in 100 healthy subjects (mean age 24.5 years). Testing was performed by two examiners either clinically by Lachman test or by means of KT-1000 arthrometer. Mean anterior tibial translation was 4 mm for the right and 4.3 mm for the left knee when tested clinically. With use of KT-1000 at 89 Newton results were 4.6 mm and 4.0 mm, respectively. Clinical measurements revealed an inter-examiner difference of 0 to 1 mm in 77% of right and 80% of left knees. In the remainder difference was more than 1 mm. On apparative testing the two examiners obtained similar results at 67 Newton. Measurements differed increasingly, however, at 89 Newton and 134 Newton. In conclusion, the use of KT-1000 arthrometer in routine assessment of anterior knee laxity offers no advantage over clinical testing alone.     

Die arthroskopisch gestützte Rekonstruktion des vorderen Kreuzbands mittels autologer Patellarsehnenersatzplastik 5-Jahres-Ergebnisse

This study presents the five-year follow-up-results (range 56 to 63 months) of 76 of 119 patients who had had arthroscopically assisted reconstruction of the anterior cruciate ligament with use of the central third patellar tendon for acute rupture (19 patients = group A) or chronic ACL insufficiency (57 patients = group B) between may 1991 and october 1993 in the Department of Trauma Surgery University Hospital Ulm. The average Lysholm knee score was 94.6 points (group A = 97.1, group B = 93.8 points). The IKDC-score rated 21.1% of all patients as A (group A = 31.6%, group B = 17.5%), 57.9% as B (group A = 52.6%, group B = 59.6%), 19.7% as C (group A = 15.8%, group B 21.7%) and one patient of group B as level D. 9 patients (= 11.8%, group A = 21.1%, group B = 8.8%) showed up to 10 degree extension loss (compared with contralateral knee), one patient of group A (1.3%) more than 10 degree. A flexion loss up to 15 degree was seen in 12 patients (= 15.8%, group A = 21.1%, group B = 14.0%), of more than 15 degree in 3 patients (= 3.9%, group A = 5.3%, group B = 3.5%). The average KT-1000-side-to-side difference was 2.5 mm with 90 N (group A 2.4 mm, group B = 2.5 mm), 2.8 mm with 133 N (group A = 2.7 mm, group B = 2.8 mm) and 3.2 mm (both groups) for manual maximum. There was no statistically significant difference in quadriceps and hamstring isokinetic strength (Cybex) of operated vs. unaffected limb for 60/s as well as 240/s. X-ray analysis showed arthrotic signs of minimum one compartment in 22.3% of all patients (group A = 26.3%, group B = 21.1%). In summary, we found better long-term results of IKDC-score in patients with autogenous patellar tendon graft for acute ACL-rupture vs. chronic ACL insufficiency. In Lysholm knee score and KT-1000 arthrometric measurement we just saw little but not statistically significant differences between the two groups. The isokinetic strength of quadriceps and hamstring were similar between operated vs. unaffected limb as well as between group A and B.     

The incidence and significance of femoral tunnel widening after quadrupled hamstring anterior cruciate ligament reconstruction using femoral cross pin fixation

Purpose: The purpose of this study was to evaluate the amount of femoral tunnel widening that occurred after anterior cruciate ligament reconstruction using quadrupled hamstring autografts and to determine the clinical significance of any such tunnel enlargement. Type of Study: Retrospective clinical analysis. Methods: Twenty-nine patients who had undergone reconstruction of a torn anterior cruciate ligament with quadrupled hamstring autograft and cross pin femoral fixation were evaluated to determine the incidence and significance of postoperative femoral tunnel widening. A single surgeon performed all procedures, and average follow-up was 18.4 months (range, 12 to 31.5 months). All patients underwent flexion posteroanterior and lateral radiographs, an examination for determination of an International Knee Documentation Committee (IKDC) rating, had KT-1000 data collected, and completed Lysholm and Knee Outcome Survey functional questionnaires. Femoral tunnels were clearly seen in 27 patients. The tunnel diameters were measured at the opening of the tunnel, at the widest part of the tunnel, and just proximal to the cross pin. The amount of tunnel widening for each patient was then compared with the individual’s KT-1000 data, IKDC rating, and Lysholm and knee outcome survey scores to assess correlation. Results: Four different tunnel morphologies were noted, with the linear type being the most common. The widening at the greatest tunnel diameter was 65.5% on average. Side-to-side KT-1000 differences averaged 1.04 mm at 30 lb, and 1.10 mm at manual maximum. Eleven patients had IKDC overall ratings of normal, 13 had ratings that were nearly normal, and 2 had abnormal. Average Lysholm and knee outcome survey scores were 92.6 and 93.9, respectively. A significant correlation was found only between F2 and F3 widening with Lysholm scores. However, the significance was eliminated with removal of 2 outliers. Conclusions: The exact etiology of postoperative anterior cruciate ligament tunnel widening remains unknown. The present study reveals that significant tunnel widening occurs with quadrupled hamstring autografts and femoral cross pin fixation. However, the widening does not appear to have a significant effect on postoperative ligament laxity or functional knee scores, at least in the short term.Arthroscopy: The Journal of Arthroscopic and Related Surgery, Vol 19, No 5 (May-June), 2003: pp 470–476     

Osteolysis after unidirectional and multidirectional mobile-bearing total knee arthroplasty in young patients

We questioned whether a difference exists between multidirectional and unidirectional mobile-bearing total knee arthroplasties in terms of clinical results and the prevalence of polyethylene wear and periprosthetic osteolysis. We studied 62 patients who underwent simultaneous bilateral total knee arthroplasties, with a unidirectional prosthesis implanted in 1 knee and a multidirectional one in the other. Of the patients, 9 were men and 53 were women, with a mean age of 57.6 years (35-60 years). The minimum follow-up was 11 years (mean, 11.8 years; range, 11-13 years). Preoperative and postoperative knee and functional scores were not different between the 2 groups. No knee in either group had detectable tibial polyethylene liner wear or osteolysis on radiographs or on computed tomography scans. Two (3%) knees in each group were revised.