Reconstruction of the lateral ligaments of the ankle has been performed for many years, but few reports are available regarding the outcome after 10 years or longer, and there are no such reports on reconstruction with the more recently developed artificial ligaments. I report the clinical outcome and radiological findings. Materials and results: The subjects are 62 feet in 57 patients (male 28 feet, female 34 feet). All patients were followed up by direct examination and stress roentgenography for 10 years or longer. Mean follow-up period is 11 years and 9 months. On stress X-ray taken at the final examination, TTA improved preoperatively 19 degrees to 4 degrees postoperatively, and ADT improved from 12 to 5 mm. There was no marked development or progression of arthropathic changes. No allergic reaction to the artificial ligament material occurred in any patient. postoperatively and no patient had instability that became severe enough for reoperation to be required. As for arthropathic changes, in 3 patients with a TTA of 10 degrees or more postoperatively, progression of mild osteoarthritic changes was observed. Discussion: There have been few studies involving long-term follow-up for 10 years or more. This procedure is not happened OA changes and ADL limitation because reconstruction at anatomical position of ATFL and CFL. It has not been happened pathological rupture of artificial ligament because lateral ligaments are not intra-articular ligament but periarticular ligament. Conclusion: Reconstruction with artificial ligament is anatomical procedure and can be expected the prolonged effectiveness

Acromioclavicular joint injuries are one of the most common injuries in the shoulder girdle complex. Surgical management is considered based on patient profile, level of activity, pain, and classification of injury. To date, a vast array of surgical techniques have been proposed and described in the literature, a possible reason being that the optimal solution is still uncertain. The aim of this study is to determine the efficacy of an alternative surgical technique. This study is a retrospective case series of 80 patients that have been operated by a single surgeon over a period of 6 years. A novel surgical technique, the ‘BiPOD method’, was applied where a synthetic artificial ligament (LARS®) is used to reconstruct and reduce the acromioclavicular joint. The technique is done in a reproducible manner, where a single continuous artificial ligament is used to reduce and reconstruct both, the coracoclavicular and acromioclavicular ligament complexes to achieve bidirectional stability. Patients were followed-up postoperatively, either clinically where possible or telephonically. The Acromioclavicular Joint Instability Score (ACJI) and radiographic measurements were used to determine the clinical and surgical outcome of the surgery. Radiographic parameters, measuring the reduction of the coracoclavicular- and acromioclavicular joint, were analysed and documented. The results showed marked improvement in both, the coracoclavicular distance and acromioclavicular distance. Clinically, using the ACJI scoring system, the patients reported substantial improvement in pain and function. Complications were recorded but were insignificant. The BiPOD surgical technique, making use of an artificial LARS® ligament, has proven acceptable outcomes in the surgical management of acromioclavicular joint dislocations

Acute total knee dislocations are uncommon injuries for which some surgeons use artificial ligaments as their choice of graft for reconstruction. The goal of this study is to evaluate on a short and long term basis the stability and function of the LARS reconstructed knee. Flexion ROM was the only parameter which showed significant difference (p< 0.05) between subgroups. Therefore this treatment option for dislocated knee reconstruction seems to give good and lasting results even though patient’s quality of life may suffer. Although a variety of options have been proposed for the treatment of knee dislocations, the optimal one remains controversial. Allografts and autografts have both been used for reconstruction of the cruciate ligaments. The purpose of this study is to evaluate acute reconstruction of both cruciate ligaments using Ligament Advanced Reinforced System (LARS) artificial ligaments. We reviewed treatment of forty-eight acute knee dislocations. All patients had reconstruction of both cruciate ligaments with LARS ligaments. Patients were assed using SF-36, Lysholm and IKDC questionnaires as well as a physical exam. Stability of the reconstructed knee was evaluated radiologically using TELOS instrumentation. The controlateral knee was used as reference. The forty-eight patients were subdivided into four groups of post-operative intervals ranging from six months to seven years. The average ROM was 120°of flexion and −1.4° of extension. The differential average TELOS for LCA, LCP at 30° and LCP at 90° were respectively 2.9 mm, 2.8 mm, 6.9 mm. and their average Lysholm, SF-36 and IKDC scores were 72.0, 72.5, 53.5. Statistical results showed no significant difference (p> 0.05) between subgroups in terms function, laxity and extension but did in flexion. Our data show that patients treated by this method can regain a functional knee in terms of motion, stability and functional status and does not seem to deteriorate with time. Knee reconstruction with artificial ligaments shows promising results at short and longer term even though it seems to affect quality of life in this population. Financing: This study was partially financed by JK Orthomedic Inc

Between 1997 and 2005, 10 patients with chronic instability of the elbow underwent surgical stabilisation. There were 5 men and 6 women with a mean age of 41 years (16 to 58). All patients had initially dislocated the elbow at a mean of 5.6 years (6 months to 25 years) prior to surgical reconstruction. There were 8 chronic lateral and 2 medial reconstructions performed. The presenting symptoms, findings on clinical examination and methods of surgical reconstruction are defined. Two patients underwent reconstruction using an artificial ligament (Corin) as they had evidence of ligamentous laxity and at the time of assessment all the other patients had been treated using autografts. At a mean follow up of 3 years (1 to 6 years) all patients except one reported no symptoms of pain or instability and had been able to return to their normal work and social activity. The one patient with persisting elbow instability had Ehlers-Danlos syndrome and underwent a second revision procedure again using an artificial ligament (Corin). This review represents our surgical experience and functional outcomes with this rare form of ligamentous elbow injury

Aims:ACL revision surgery is a second-generation type of knee ligament surgery. The artificial ligaments, the imperfect mastering of arthoscopic assisted surgery and the absence of clinical and radiological analysis of peripheral laxities are among the main factors for failures. Methods:43 patients of a mean age of 29y were previously operated between 1 and 5 times.14 artificial ligaments, 23 patellar tendons and 4 hamstrings tendons failed as a first ACL reconstruction. The mean time between the first operation and the index revision was 44 months. In 6 cases an additional HTO was used. Different tendon grafts were used: quadriceps 11, patellar 19 and hamstrings 8. In 3 occasions an additional extra articular reefing was used. The patients were reviewed by one independent observer using KT 1000, Stress X rays, IKDC form (2000). The mean follow up is 35 months (11–123)Results:The IKDC score in pre operative time was 19 D, 21 C and 1B. At the review the score is 2A, 28 B, 9C, 2D. The functional IKDC form show 37.5% of remaining pain, 44% of stiffness sensation and 12.5% of instability. The mean functional improvement is 44%. The mean laxity improvement is 5.3mm for KT1000 and 4.5mm for stress X rays. Conclusions:Revision ACL surgery is not as good as primary surgery. The reconstruction is technically difficult and must be ‘à la carte’ in order to take in account several simultaneous problems: bone defect, cartilage abnormalities, skin and ligament insufficiencies

Purpose: Knee dislocation, although very rare, remains a devastating injury with many complications because of the complex nature of this trauma. The best treatment for knee dislocation is yet to be determined. The purposes of the study were to describe our surgical method, to report our results and to compare them with those of other surgical reconstruction techniques for knee dislocation. Method: Fifty-six (56) patients with knee dislocation underwent acute combined reparation and reconstruction using Ligament Advancement Reinforcement System (LARS) artificial ligament. Patients were divided in three different groups according to the follow-up period. Group 1 (G1) included patients with a follow-up between two and six months post-op, group 2 (G2) involved patients with a follow-up between six months and twenty-four (24) months and group 3 (G3) was composed of patients who had a follow-up between twenty-four (24) and ninety-one (91) months. Results: There was a significant difference between G1 and G3 for the Lysholm score and for the posterior stability at 90o of flexion measured with the Telos. Conclusion: The subjective and objective findings from our series are satisfactory and comparable to the results of other series of knee dislocations. Our findings suggest that with a follow-up at seven years, acute combined reparation and reconstruction with LARS ligaments is a valid alternative for the treatment of knee dislocation

Purpose. We conducted a prospective study to investigate the role of the LARS ligament system to reconstruct the posterior cruciate ligament and the postero-lateral corner of the knee. We present a prospective single surgeon case series to evaluate early clinical and functional outcomes of postero-lateral corner and posterior cruciate ligament reconstruction in the knee using the LARS (ligament Augmentation and Reconstruction System) artificial ligament. 23 patients with multi-ligament knee injuries or isolated PCL injuries were treated with a mean follow up of 8 months (range: 2-37 months). Outcomes were assessed using the modified International Knee Documentation Committee score, and a modified Tegner- Lysholm score. 2 patients had acute reconstructive surgery within 7 days of injury, 5 patients within 3 months (semi-acute) and 16 were chronic cases that were operated on after three months from the date of injury. The LARS ligament reconstruction achieved a significant improvement between preoperative and postoperative assessment in relation to knee stability, function and patient satisfaction. The sooner the patients were treated the greater the improvements in functional scores were noted. Most patients achieved a full functional range of movement within six months. We had 2 complications, one superficial wound infection and one stiff knee requiring a manipulation. To date we have had no LARS ligament failures. In the short term the LARS functions well, with high clinical patient satisfaction, no signs of progressive laxity, synovitis or failure. We found no significant difference in functional score post reconstruction between the isolated PCL reconstructions and the multi ligament reconstructions. Our results show no early signs of the problems associated with synthetic grafts used in the past. Such grafts appear to be an attractive alternative to the use of autografts and allografts

The study was established to assess the long-term results and differences between autogenous and synthetic anterior cruciate ligament (ACL) reconstruction. We randomised 50 patients into 2 groups: 26 (52%) underwent reconstruction with middle third patellar tendon graft (PTG) harvested using the ‘Graftologer’ (Neoligaments) and 24 (48%) underwent reconstruction with the Leeds-Keio ligament (LK). Subjective knee function was assessed using the Lysholm score, Tegner activity score, IKDC grading, and clinical assessment of anterior knee pain. Laxity was tested clinically, including anterior draw at 20° (Lachman), pivot shift, and arthrometric measurements using the Stryker laxometer. At five years we have noted no significant difference in Lysholm scoring and Pivot shift between the LK group and patellar tendon group. But there was a significant difference in Tegner activity level and IKDC activity scores with PTG faring better at five years. There is no significance difference in anterior knee symptoms between the groups. Conclusion: Due to the success of PTG/Hamstring in routine primary ACL reconstruction there does not seem to be a role for artificial ligaments. However, if we just look at functional outcome and patient satisfaction, LK patients seem to be doing as well as PTG at five years. So, there may be a place for the Leeds Keio graft where autologous tissue is unavailable

Reconstruction following internal hemipelvectomy for bone tumors remains a major surgical challenge. Most of the cases are considered not suitable for reconstruction because of high complication occurrence. Allografts coupled with standard prosthesis is a reliable method of reconstruction. 26 patients received a McMinn stemmed cup (Link, Germany) after periacetabular tumor resection from February 1999 to 2006. In 18 patients the reconstruction followed resection of the acetabular area while in other 8 an extrarticular resection of the proximal femur was performed. In 21 cases a stemmed acetabular cup were associated with massive bone allograft. There were 13 female and 13 male with a mean age of 41 years (13 to 70). Average follow-up was 45 months (7 to 105). Six patients were affected by local recurrence of the tumour and five underwent hindquarter amputation. In 4 of them the index surgery followed a previous recurrence of the tumour. Finally 6 patients died for related causes within 2 years. All the other 20 have been followed clinically and radiographically for a minimum of 24 months. Deep infection occurred in one case, there were no cases of dislocation. Radiolucency at the prosthesis-bone interface was observed in 3 cases, 2 patients had proximal migration < of 20 mm. Only one patient was treated for aseptic loosening because of incorrect initial position of the implant. The iliac osteotomy was consolidated in all cases, while a delayed union was frequently observed in the pubic osteotomy, however without compromise the stability of implant. Functional result were evaluated according to the MSTS system and this showed 65% of excellent or good clinical results. The procedure requires appropriate patient selection, accurate preoperative planning, meticulous selection and preparation of allograft. Usually artificial ligaments are applied to reduce hip instability, however, this type of reconstruction do not require complex fixation, thus reducing surgical time and early complications

INTRODUCTION: Intervertebral degeneration is characterised by instability due to permanent decrease in the stiffness of the intervertebral segment and concentration of stress upon the posterior portion of the disc, and by morphologic changes in the posterior elements due to posterior displacement of loading, notably enlargement of the lamina and zygapophyseal joints. These changes lead to reduction in the cross-sectional area of the vertebral canal. In order to counterbalance these changes, an implant has been developed with an interspinous blocker and an artificial ligament made of Dacron. This obviates the need for a permanent fixation in the vertebral bone, avoiding the risk of loosening. Inhibition of hyperextension limits narrowing of the posterior canal, resulting in an increase in its cross-sectional area of up to 40%. A first-generation implant for nonrigid stabilisation of lumbar segments was developed in 1986 with a titanium interspinous blocker. Following an initial observational study in 1988 and a prospective controlled study from 1988 to 1993, more than 300 patients have been treated for degenerative lesions with significant resolution of residual low back pain with no serious adverse effects. After careful analysis of the points that could be improved,a second-generation,improved implant called the ‘Wallis implant’ was developed with a redesigned blocker made of PEEK (polyetheretherketone), a more resilient material. METHODS: Biomechanical studies were used to verify the effectiveness of this implant in increasing intervertebral stiffness, reducing mobility, and unloading the facet joints and the posterior portion of the disc. A prospective multicenter international observational study was begun a year ago. RESULTS: Preliminary results confirm the clinical efficacy of this treatment on low back pain and nerve root symptoms, especially in recurrent disc herniation and canal stenosis. DISCUSSION: Nonrigid intervertebral fixation with the Wallis implant clearly appears to be a useful technique in the management of initial forms of degenerative intervertebral lumbar disc disease. The method should rapidly assume a specific role along with total disc prostheses in the new step-wise surgical strategy to obviate definitive fusion of degenerative intervertebral segments. Moreover, dynamic stabilisation with the Wallis system is totally reversible and leaves all other options open. Wallis is recommended for patients with lumbar disc disease who have: (i) discectomy for massive herniated disc leading to substantial loss of disc material, (ii) a second discectomy for recurrence of herniated disc, (iii) discectomy for herniation of a transitional disc with sacralization of L5, (iv) degenerative disc disease at a level adjacent to a previous fusion or prosthesis, (v) isolated disc resorption, notably with concomitant type-1 Modic changes, associated with low back pain, or (vi) symptomatic narrow canal treated by resection of the superior aspect of the laminae

Purpose: The procedure described in 1986 in the Revue de Chirurgie Orthopédique was used for 24 knees operated on since 1982. Operative technique: A single anterior incision measuring 18 cm and a 28-cm transplant using the patellear tendon, a slit of patellar bone, and the quadriceps tendon. The patellar bloc is fixed in the tunnel bored under the spinous process, using the patellar tendon to reconstruct the posterior cruciate ligament (PCL) and the quadriceps tendon to reconstruct the anterior cruciate ligament (ACL). It crosses the lateral condyle and prolonged to the Gerdy. The bone is blocked but can be fixed with a screw. Since the initial description, a second strand for a lateral plasty has been added from the condyle towards the posterior tibia (six cases). Two strands can be used for the PCL. The tunnel can run oblique upwardly to facilitate passage of the transplant behind the tibia (a 30 cm transplant is needed). Operative time 177±39 minutes. Material and methods: The series included 24 knees (75% men) (13 right and 3 bilateral procedures). The patients were aged 23±6 years at the time of the accident which was a sports accident in seven and an occupational accident in one. Time from the accident to surgery was 35±41 months. Prior surgery had been performed on fourteen knees (five sutures, five artificial ligaments, two ACL reconstructions). Three patients had fibular nerve palsy. Radiologically, the anterior drawer of the medial and lateral compartments was 124 and 185 mm; the posterior drawer was 174 and 126 mm. Lateral laxity predominated in 17 knees, medial laxity in seven and mixed laxity in eleven. The frontal axe was normal in five knees. Associated procedures depended on the laxity: three procedures to tighten the lateral popliteal ligament, three to tighten the posterior capsule of the femur, and seven to tighten the medial capsule of the femur. There was one meniscal suture and four regularisations. The knee was mobilised postoperatively and weight-bearing with assistance was allowed except in five cases with a weak reconstruction or associated osteotomy. Results: Mean follow-up was 4.5 years (1–20). Flexion was 130±11° and function was acceptable except for three patients who were able to resume their occupational activities but little sports activity. None of the patients was disappointed. Mean gain in anterior drawer was 5 mm for both compartments; gain for the posterior drawer was 6 mm medially and 3 mm laterally. Peripheral laxity was corrected best. Discussion: There are no data in the literature on cruciate reconstruction in patients with chronic laxity. This series is small but does have 20 years follow-up and provided precious information for improving results. It would be particularly interesting to use two strands for the PCL reconstruction, to use more peripheral procedures, especially with two lateral plasties and medial plasties, and to use osteotomy. Conclusion: Cases of double cruciate tears seen late are exceptional and appropriate treatment has not been standardised. Instead of using to distinct incisions with two transplants for the two cruciates, as would be possible with the classical techniques, we propose a single incision and a single transplant with peripheral plasties depending on the radiographic laxity

Aim: The purpose of the study was to assess the outcome results of an artificial bioprosthetic ligament used at Mayday University Hospital for ACL reconstruction in a cohort of patients after 1992 following the introduction of special instrumentation and to compare it with the results in an earlier cohort of patients. A high incidence of implant failure including rupture and stretching was noted in the early cohort with a 44% failure rate noted at three years following implantation. A mode of failure analysis led to the development of a modification of the implant, and introduction of new surgical instrumentation resulting in an improved implantation technique. Method: The Fresh cohort of patients was reviewed after the introduction of the new surgical instrumentation in 1992. 80 out of 111 operated patients were available for follow-up. There was 21.6 % failure rate and the following objective and subjective parameters were used: side to side difference measurements using the KT2000 arthrometer, average Lysholm score, average Tegner score and average Mohtadi score. The mean SSD was 3.14mm, the average Lysholm score was 74.93, the average Tegner score was 4.72 and the average Mohtadi score was 45.32. Conclusion: We were able to review 71% of patients operated on since 1992 using the above outcome measures. We concluded that the introduction of new surgical instrumentations and alterations in surgical technique since 1992 has improved the outcome following this type of surgery, although these results do not match the best reported for autologous ACL reconstruction

Background. Modular endoprostheses today represent a standard treatment option in the management of musculoskeletal tumors of the lower extremities. Long-term results of these reconstructions, however, are often limited by the course of the underlying disease. We therefore report our experiences in cancer patients with megaprostheses of the lower limb after a minimum of 15 years. Materials and Methods. 62 patients, 34 men and 28 women, with a mean age of 26 years (median, 20; range, 6–83) were included in this investigation with a mean follow-up of 230 months (median, 228; range, 180–342). Endoprosthetic reconstructions of the proximal femur (11), the distal femur (28), the total femur (2) or the proximal tibia (21) were indicated for osteosarcoma (43), chondrosarcoma (5), malignant fibrous histiocytoma (3) or other tumors (11). All patients have received either a KMFTR (22) or a HMRS (40) modular prosthesis; 23 patients had a muscle flap, 14 had a fibular transposition osteotomy and 4 have received an artificial LARS ligament for soft-tissue reconstruction. Results. 7 patients (11.3%) died throughout the follow-up period, but none succumbed to primary disease. One patient (1.6%) developed a local recurrence after 31 months that was resected. Overall, 56 patients (90.3%) underwent revision of their prosthesis; 50 (80.7%) had multiple revisions up to a maximum of 12 operations (mean, 3 per patient). The median overall prosthetic survival to first revision was 40 months; the corresponding 5-, 10- and 15-year survival rates were 35.5%, 14.5% and 12.9%, respectively. 3 patients (5.4%) had an infection, 8 (14.3%) had a soft-tissue related failure, 30 (53.6%) had a mechanical or structural failure and 15 (26.8%) had an aseptic loosening. The 15-year survival rates of these respective endpoints were 87.1% for infection, 79.0% for soft-tissue related failure, 32.3% for mechanical or structural failure and 56.5% for aseptic loosening. 59 patients (95.2%) have retained their prosthesis; 2 patients (3.2%) underwent secondary amputation due to an irresolvable complication, another one (1.6%) for a second malignancy. Conclusion. Modular prosthetic reconstructions of the lower extremities have a high revision rate in the long-term, primarily due to mechanical failures. Given that patients survive their malignant disease the rate of secondary implant removal, however, tends to be low, providing satisfactory function and body integrity. Further advances in implant design, soft tissue management and infection prophylaxis are required to reduce revision rates

In the UK we have many surgeon inventors – surgeons who innovate and create new ways of doing things, who invent operations, who design new instruments to facilitate surgery or design new implants for using in patients. However truly successful surgeon inventors are a rare breed and they need to develop additional knowledge and skills during their career in order to push forward their devices and innovations. This article reviews my own experiences as a surgeon inventor and the highs and lows over the whole of my surgical career.