To evaluate in-vivo the effectiveness of the double bundle technique for Anterior Cruciate ligament (ACL) reconstruction in restoring knee rotational stability under varying dynamic loading conditions.

The study group included 10 patients who underwent double-bundle ACL reconstruction with hamstrings tendon autograft, 12 patients with single-bundle reconstruction, 10 ACL deficient subjects and 12 healthy control individuals. Kinematic and kinetic data were collected using an 8-camera optoelectronic motion analysis system and one force plate. Knee rotational stability was examined during two maneuvers: a combined 60o pivoting turn and immediate stairs ascend and a combined stairs descend and immediate 60o pivoting maneuver. The two factors evaluated were the maximum

There were no significant differences in tibial rotation between the four groups in the examined maneuvers. Tibial rotation in the single- and the double-bundle groups were even lower than the control group. Rotational moments did not differ significantly between the four groups in any of the examined maneuvers. In general, rotational moments in the affected side of the ACL reconstructed and deficient groups were found reduced compared to the unaffected side.

Double-bundle reconstruction does not reduce knee rotation further compared to the single-bundle technique during dynamic stability testing under varying conditions. The injured side of ACL reconstructed or deficient individuals is exposed to substantially lower rotational moment compared to the intact side.

Patella recurrent dislocation and patellofemoral pain syndrome instability many young people and especially athletes. In the present study we present the results of the extension mechanism realignment through the Fulkerson oblique osteotomy of the tibial tuberosity and soft tissue balancing.

During the last two years 10 patients (7 men, 3 women, mean age 29.3/ range 20–39) were treated operatively for recurrent dislocation of the patella using the Fulkerson procedure. All patients underwent knee arthroscopy for the treatment of potential chondral damage or loose bodies and for lateral retinacular release. After that we performed oblique tibial tuberosity osteotomy, medialization and internal fixation with 2 cortical screws. This oblique osteotomy allows also the anteriorization of tibial tuberosity as we move it medially. In addition, we performed medial placation. All the patients used functional knee brace locked to 0° right after the operation and with gradual ROM increase till the 8th p.o. week.

The patients had no initial or long term complication. During their last follow up examination had a painless knee with full ROM and marked improvement of the patella tracking. The mean Lysholm score was 90.5. No patella dislocation was referred.

Our findings show that the Fulkerson osteotomy procedure, with an additional intervention on the lateral and medial patella retinacular, is an excellent option for the treatment of recurrent patella instability and relief of the patellofemoral pain.

Failure of a TKA is caused many times from the polyethylene debris or the mechanical forces which lead to loosening mostly to tibial component. The mobile meniscal knee prosthesis could provide solution as it simulates better normal knee function.

The aim of our study is to present the midterm results of TKA using mobile bearing platform Rotaglide.

During the period 2000–2004 we performed 261 TKA with the Rotaglide mobile polyethylene prosthesis (Corin Medical, UK). They are 235 women and 26 men, mean age 76.33 years, and the 93.7% of them (N=245) with primary osteoarthritis. The tibial component was cemented for all them, and for the femur was cementless for 146 cases (hybrid) and cemented for 115. None of them had patella replacement. One hundred five patients (59 hybrid and 46 cemented) were examined clinically and radiologically and the minimum follow-up time was 5 years (mean 6,6 /range 5–8 years). We use the Knee injury and Osteoarthritis Outcome Score (KOOS- range of scale for each subscore 0–100).

There was significant improvement of knee function and the majority of our patients were satisfied from the result. Specifically, the score for general symptoms and joint stiffness was 89.1, for pain was 83.3, for daily activities was 75.6 and for the quality of life was 72.5. One patient had revision TKA for femur component aseptic loosening.

Our results indicate that the Rotaglide total knee arthroplasty is a great choice for primary knee OA with excellent functional result.

The bead EndoPearl is bioabsorbable material which placed in the ACL graft edge, and augment the stabilization in the femoral tunnel when an interference screw is used. Our aim was to recorded the operative characteristics of this technique and the clinical results after using EndoPearl in ACL reconstruction with hamstrings graft.

In 36 of our patients who had ACL reconstruction with hamstrings we used EndoPearl bead. They were 23 men and 13 women mean age 27.8 years (17–46). The graft was fixed in the femur side with interference screw. All patients followed the same p.o. rehabilitation regime. We followed them up the 1st, 2nd, 3rd, 6th and 8th p.o. month. During the last follow-up we checked the anterior drawer test, Noulis-Lachman test and in some cases pivot shift test, and in parallel Lysholm score was recorded pre-operatively and in the last examination.

In this last F.U. check none of them had positive Noulis-Lachman test or pivot shift test. The anterior drawer test was negative to 32 patients and in 4 we found slight laxity in comparison with the health leg. Lysholm score showed significant improvement (mean 90.2 p.o.), and nobody had “giving way”.

The application of the EndoPearl in conjunction with a bioscrew in the femoral tunnel in autogenous ACL reconstruction using semitendinosus and gracilis tendon grafts provides a significantly decreased in p.o. laxity.

The aim of this study is to present the early results of our department’s experience, about cementless fixation of femoral component in total knee replacement.

During the period 1997–2002 from the patients who treated surgically for knee osteoarthratis, 285 were followed up p.o. from 6 months up to 5 years (mean 30 months). They were 246 women and 39 men (mean age 69,4 years), to whom we used unconstrained total knee arthroplasty. For all of them, we didn’t use orthopaedic cement to fix the femoral component and there were no case of patella replacement. All the patients were examined clinically and with x-rays (Knee Society Roentgenographic Evaluation and Scoring System).

The answer to the question about the use or not of orthopaedic cement for femoral component fixation is not clear in the international literature. There is the attitude of using cement every time or depending the use of cement on patient’s age and bone quality. On the other hand, many orthopaedic surgeons, like us, never use cement (except for the very osteoporotic bone). There were no cases of femoral component’s loosening in our data.

In conclusion, we believe that the cementless fixation of femoral component in total knee replacement offers satisfactory stabilization of the component, the same as the cemented fixation offers, according to the international literature.

The purpose of this paper is to present the results of the comparative study about the use of autologous transfusion system for drainage of surgical trauma after total knee arthroplasty, aiming to decrease the p.o. homologous blood transfusion need.

During the period between Nov 2001 and Apr 2003 we studied 110 patients (80 women and 15 men, mean age 70,5 years) who underwent TKR. We used autologous transfusion system in 55 patients (group A) and for the rest 55 (group B) a plain negative pressure drainage system.

From the group B patients, 35 (63,63%) were transfused with 2–4 blood units, while only 17 (30,9%) patients from group A had the need for homologous blood transfusion (2–5 units). But, we should mark that in 8 patients autologous transfusion system failed and 7 of them were transfused (2 units each). This means that from group A patients to whom autologous transfusion system was used successfully (47) only for 10 (21,27%) there was need for homologous blood transfusion. The autologous transfusion system gave 200–1650cc (mean 619cc) of blood. None of group A patients and 2 of group B had allergic reaction.

In conclusion, the autologous transfusion system contributes to decreasing the homologous blood transfusion after TKR and in addition it decreases the transfusion’s complications.

Last decade intramedullary nailing is the choice method for the treatment of lower extremity’s long bone fractures. This method matches much better the biomechanics of bones and therefore it leads to faster and better fracture porosis. The aim of our study is to record our experience of using intramedullary nailing and other methods of osteosynthesis for femur and tibia fractures and pseudarthrosis.

During the last 6 years we treated 264 with long bone fractures. One hundred ninety two of them are available at least for 2 years postoperatively. Patients with major health problems or tumors were excluded. From this group of patients 116 were men and 76 women with mean age 42 years (16 up to 75). They had 107 tibial fractures, 81 femoral fractures, 12 tibial pseudarthrosis and 3 femoral pseudarthrosis. We used reamed or undreamed intramedullary nails for 64 tibial and 52 femoral fractures and we used other methods (internal fixation with plates, external fixation) for 43 tibial and 29 femoral fractures. All the cases of pseudarthrosis were after surgical treatment and they were treated only with intramedullary nails. All the nails were dynamized depending on fracture type and the healing procedure. The follow up of our patients included clinical examination (pain, length, torsion etc) and x-rays at 1st, 3rd and 6th month postoperatively and after that every year.

Our data (clinical examination and x-rays) were enriched with objective estimation of patients physical condition at specific time intervals from the operation. We recorded also their one opinion about their health standard.

The analysis of our results shows that intramedullary nailing, and especially after reaming, provides more rigid and secure stabilization. It also leads to faster porosis. This method allows immediate mobilization of nearby joints and better rehabilitation. It has fewer complications and we found completely valuable for the pseudrathrosis cases. Regarding only patients general health condition and return in preinjury functional level and professional activities, intramedullary nailing becomes a statistically more useful method for treatment of long bone fractures of lower extremity.

Introduction: Patellar tendon is one of the main donor sites for graft. Postoperatively, during the healing procedure there are changes, which we recorded and combined them with the clinical image respectively.

Material and Methods: During the period 1998–2001 in Sports Injury Unit, we operated for Anterior Cruciate Ligament insufficiency with autologous Bone Patellar Tendon Bone (BPTB) graft 265 patients. We used autologous BPTB graft from the middle third. We got near the two parts after taking the graft and we sewed very well the peritendon fascia. All patients, with few differentiations, followed the same rehabilitation program.

Seventy -seven of them (44 men and 33 women ranging from 17 to 44 years -mean: 24,3 years), were imaged postoperative with MRI at specific intervals from the operation between 3–36 months. In the same time we checked the patients clinically.

Results: No one study can answer which is the exact time of satisfying or complete healing. Our study shows elements of scar tissue in the middle third of patellar tendon which is decreasing given time. After the 12th month, the proportion between healthy and scar tissue changes and healthy tissue become dominant. But in some cases scar is still existing even after 36 months. The clinical problems such as anterior knee pain are not existed after the 8th postoperative month.

Conclusion: In conclusion, we can say that “regeneration” and healing of patellar tendon occurs mainly during the first postoperative year, but it doesn’t stop after this time. So, we couldn’t recommend this donor site for revision reconstruction before the completion of one year postoperatively.

Purpose: The purpose of our study is to record the composition and the viability of the cells from reaming products during intramedullary nailing of tibia or femur.

Material and Methods: We studied 21 fractures (13 tibia and 8 femur). The patients had mean age 27 years {1 9–67) and they didn’t face any systemic disease. The operation was done during the first 3 days from the injury and there was pro-operative x-ray check for measuring the medullar cavity. For 16 fractures we used reamers with diameter smaller or equal to the medullar cavity and for the rest 5 for biomechanical reasons we used bigger reamer. We take the products in aseptic condition in the operating room and after the proper elaboration they were been analyzed histo logically. The patients were followed up until the complete healing of the fractures.

Results: Our first observation was that in the very small reamers, which didn’t “touch” the endosteum there were non-viable marrow cells. After that with reamers till 1mm less than the intramedullary diameter there was viable bone mass 35–70% more than the non-viable. When the reaming exceeded this border microscopic analysis showed pieces (1–1, 5mm) of bone mass with few viable elements in the center of them and more compressed dead cells in the perimeter. From the p.o. follow-up it was remarkable that the patients whose bone was reamed didn’t exceed the intramedullary diameter showed primary callus formation in x-rays after 4–5 weeks, but the others after 5–7 weeks.

Conclusions: In conclusion, although our sample is not big enough, we can say that there are sighs that the reaming products cells are more viable when the reaming does not exceed the intramedullary diameter. This fact seems to have positive influence in the callus formation procedure.