We reviewed 87 patients who underwent revision anterior cruciate ligament (ACL) reconstruction. The incidence of meniscal tears and degenerative change was assessed and related to the timing from primary ACL graft failure to revision ACL reconstruction. Patients were divided into either an early group (revision surgery within 6 months of graft failure) or a delayed group. Degenerative change was scored using the French Society of Arthroscopy system. There was a significantly higher incidence of articular cartilage degeneration in the delayed group compared to the early group (53.2% vs 24%, p < 0.01, Mann- Whitney U test). No patients in the early group had advanced degenerative change (SFA grades 3 or 4), compared with 12.9% of patients in the delayed group. There was no significant difference in the incidence of meniscal tears between the two groups. In conclusion, the findings of the study support the view that patients with a failed ACL reconstruction and symptomatic instability should have an early revision reconstruction procedure carried out to minimise the risk of articular degenerative change.
Clinical examination was used to assess the ligament laxity using the Beighton score. Laxity is scored on a 0–9 scale. Scores of 4 or above are indicative of generalized ligament laxity. Brighton criteria is used to diagnose Benign Joint Hypermobility Syndrome (BJHS) and use signs and symptoms along with Beighton score. The most common graft used was a quadruple hamstring in 23 patients (57%). The causes of graft failure were trauma in 22 patients (55%), biological in 17 patients (42%) and infection in 1 patient (2.5%). The revision ACL graft was patella tendon in 23 patients (57%), allograft tendon was used in 11 patients (28%) and quadruple hamstring was used in 4 patients (10%). The average Beighton score for these patients was 3 with a range from 0–9. 20 patients (50%) in this group had a Beighton score of 4 or more. Only 6 patients (15%) fulfilled the Brighton criteria for BJHS.
Twenty two percent of the non operatively managed knees developed symptomatic instability and 10% of knees treated with tibial spine fixation developed instability (p=0.22). Stiffness was more common in knees treated with tibial spine fixation than in knees managed nonoperatively (60% vs 19%, p <
0.0005). There was a tendency for increased stiffness in older patients treated with surgical fixation of the tibial spine.
Participants: Eighteen people (>
18 years) who could speak, read and understand English and who had participated in an exercise program for NSCLBP. Design: Participants were guided with a set of pre-determined questions and encouraged to give personal opinions freely. Data were transcribed verbatim, read independently by 2 researchers and analysed thematically using grounded theory.
At 2 weeks the average range of motion (ROM) difference from the normal side was 31%. Twenty-five patients (66%) restored a functional range of motion (5–120 degrees) by 6 weeks. Thirty-five patients (92%) had a normal ROM by 3 months. Peak torque, average power and total work of quadriceps and hamstring muscle groups were normal in 4 patients (11%) at 6 weeks. At 3 months 11 patients (29%) had restored normal muscle function. At 6 months 46% of patients had normal muscle function. At 1 year 11 patients (29%) still had abnormalities of muscle function on isokinetic testing.
Traumatic knee dislocations are rare but devastating injuries. We have evaluated the clinical results of ligament repair and reconstruction. Knee dislocation was defined as an acute event that produced multidirectional instability with at least 2 of the 4 major ligaments disrupted. Twenty-one patients with 22 knee dislocations presented between 1994 and 2001. There was one vascular and one common peroneal nerve injury. Eight (38%) patients were treated in the acute period (<
14 days), 5 (24%) had reconstructions within 1 year of injury. The remainder were late reconstructions. The patients were evaluated at mean follow-up of 32 months (11 to 77). This included ROM measurement, clinical and instrumented ligament laxity testing. Posterior stress view with 10kg weight was used to evaluate the PCL reconstruction. Function was evaluated using the IKDC chart, the Lysholm Score, the Tegner Activity Level, the Knee Outcome Survey and WOMAC. The mean extension deficit was 6.8 degrees (0–25) and mean flexion deficit was 8.6 degrees (0–20). Of the ACL reconstructions, 4 knees had 0–3mm side-to-side difference, 15 knees had 3–5mm and 1 knee had 6–10mm. Of the PCL reconstructions, 2 were within 3–5mm of side-to-side difference, 9 knees were 6-10mm and 4 were more than 10mm. Posterolateral corner repair/reconstructions appeared durable. None of the knees were IKDC Grade A, 8 knees were Grade B, 9 were as Grade C and 5 were Grade D. The mean Lysholm Score was 81 (66–100) and the mean Tegner Activity Level was 4.9 (1–7). The mean Knee Outcome Survey score was 75 (41–99). Acutely treated knees had better scores than late reconstructions. Our study has demonstrated good function in the operatively treated knee dislocations at 1–7 years. Nearly all had few problems with daily activities. The ability to return to high-demand sports and heavy manual labour was less predictable.
A carbonated apatite cement with a high compressive strength was used in the treatment of tibial plateau fractures. There were 41 patients (20 male; 21 female; mean age 59 years). All patients had isolated tibial plateau fractures. There were 15 B2.2, 23 B3.1 and 3 B2.3 fractures. Fractures were fixed with limited internal fixation using a short anterior parapatellar incision. Reduction and fixation were initially achieved. Once this was carried out the void under the elevated plateau was filled using calcium phosphate cement. A buttress plate was used in one case, screws or K-wires in 33 cases and calcium phosphate cement alone in 7 cases. Patients were mobilised partially weight bearing in a hinged knee brace and allowed full weight bearing at 6 weeks. Reductions were anatomic (<
2mm displacement in 32 (78%) cases, satisfactory (3-5mm displacement) in 7 (17%) cases and imperfect (>
5mm) in 2 (5%) patients. Extrusion of some calcium phosphate cement into surrounding soft tissue occurred in one case. This material resorbed with no adverse effects. Loss of reduction was observed in 6 (15%) cases. There were no other significant complications. Thirty-seven patients (90%) had more than 120 degrees of knee flexion at 6 months. Calcium phosphate cement is an alternative to the use of bone grafting in any area of cancellous subject to compressive load. It is ideal for use in tibial plateau fractures with compressed subchondral bone after elevation. It obviates the need for buttress plating and bone grafting and there is no bone graft donor site morbidity. Patients are able to mobilise more rapidly and early discharge is facilitated. Calcium phosphate cement is a promising development in the management of tibial plateau fractures and initial results suggest it may be more effective in maintaining reduction that standard methods of fixation and grafting.