Purpose: To evaluate knee proprioception following Anterior Cruciate Ligament (ACL) reconstruction using two different autografts.

Materials and methods: Forty patients, (34 male, 6 female), aged between 17–54 years old (mean: 31), with complete ACL tears were subjected to ligamentous reconstruction. Group A (20 patients) underwent reconstruction with 4 strand hamstrings graft whilst in the remaining 20 patients (group B) bone-patellar tendon-bone graft was used. Proprioception was assessed by the Joint Position Sense (JPS) of the knee for predetermined angles (15°, 45° and 75°) as well as by the threshold to detection of passive movement (TTDPM) at 15° and 45° in flexion and extension using an isokinetic dynamometer (Con-Trex, MJ, Switzerland). The examination was performed pre-operatively and 3, 6 and 12 months after surgery, on both knees of all patients.

The t-test was utilised for statistical analysis.

Results: ACL deficient knees presented with significantly poor TTDPM values at a starting angle of 15° moving into flexion and extension. The JPS findings were statistically different between injured and uninjured knees (p< 0.05).

The TTDPM at 15° and JPS findings of the injured leg, before and 6, 12 months after reconstructive surgery, were statistically different (p< 0.05) for both groups.

There was no statistically significant difference for both JPS and TTDPM at 15° in flexion and extension between the findings in reconstructed and uninjured knees, at 6 and 12 months post-operatively in both groups.

No difference was found when comparing proprioceptive improvement following ACL reconstruction between the two different autograft groups.

Conclusions: Both JPS at 15°, 45°, and 75° and TTDPM at 15° in flexion and extension are impaired in ACL deficient knees. There is improvement of these proprioceptive parameters following operative reconstruction of the ACL using both hamstrings and patellar tendon grafts. No particular graft seems to be preferable in terms of proprioceptive improvement as assessed by JPS and TTDPM.

The aim of our study was to examine the outcome of ACL reconstruction by using four strand hamstring tendon autografts.

Material and Methods: the study included 44 patients (29 males,15 females;mean age 26;18–45 years). The diagnosis was based on clinical examination and imaging techniques. The operation was performed arthroscopically 4–62 weeks after the injury. The tendon was fixed in the tibia with an interference screw and in the femur with three different methods cross pin in 16 cases, transfix pin in 11 cases and Endo button in 17 cases.

Results: The mean follow up was 28 months (12–42). The mean Lysholm score was improved from 35–65 (mean 49) preoperativelly to 55–100 postoperativelly (mean 88).

5 patients had laxity > 3mm when compared to the healthy knee by using the KT-1000 arhthrometric testing. 2 of the latter patients complained of a feeling of knee joint instability which occurred due to inaccurate positioning of the femoral tunnel. In 2 cases the transfix pins were displaced and removed on the 4th and 15th post-operative month.

The tunnel expansion was measured by an X-Ray or a CT scan. The tibial tunnel expansion was 0–2.5mm (mean 1.2) or 18% and the femoral tunnel expansion was 0–3 mm (mean 1.4) or 26%. 8 patients reported mild pain which did not restrict their activities. A 5 degree loss of extension was noticed in one patient who continues physiotherapy.

28 of the above patients suffered also from a meniscal injury that was managed arthroscopically.

Conclusion: ACL reconstruction by using four strand hamstring tendon autografts is safe, highly successful with very few complications when proper graft preparation and accurate tunnel placement is achieved.

Purpose: To present/evaluate the results of ‘intramedullary hip screw’ (IMHS) for treatment of subtrochanteric fractures of the hip.

Materials and Methods: Between 2003–2005 fifty four (54) patients aged 62–92 years old (average: 77,3 yrs) with subtrochanteric fractures of the hip were treated in our department with intramedullary hip screw (IMHS). Thirty one (31) patients were women and twenty three (23) were men. Thirty (30) fractures were located in the right hip and the remaining twenty four (24) in the left one. All patients were operated by the same surgical team –within 3 days from injury in the 86% of the cases. The duration of the procedure was between 55–75 minutes. Post-op, the patients were mobilized early with -at least–partial weight bearing and they were followed-up -clinically and radiologicallly for 7–30 months.

Results: 85% of the fractures were united within 14 weeks uneventfully. In seven cases, bone grafts were used. Three (3) cases of superficial wound inflammation and two case of haematoma were noticed. All above cases were treated successfully. Neither femur’s fractures (near or distal to the tip of IMHS) nor failure of implants were noticed. The 75% of patients achieved the pre-op status of rehabilitation.

Conclusions: The results of this study show that ‘intramedullary hip screw’ (IMHS) seems to be a reliable treatment for the subtrochanteric fractures of the hip; and it could be considered as one of treatment of choice for them.

Purpose: To present the results of the tibial tuberosity osteotomy as part of the surgical approach for total knee replacement. Material and Methods: Tibial tuberosity osteotomy was performed during TKR for better exposure in 19 knees corresponding to 19m patients (9 male, 10 female), with average age 76 years (68–80). Four of the procedures were revisions. Fifteen were primary TKR, ten of which had been subjected to high tibial osteotomy previously. The rest þve patients had excessive valgus deformity (over 20 degrees), and they were approached through a lateral parapatelar incision. In two cases screws only were used to stabilize the osteotomised tubercle, and wire loops in the rest of them. Patients were instructed for partial weight bearing for six weeks postoperatively. Results: All osteotomies united in less than four months. In three cases (including the two with only screw þxation), proximal migration of the tuberosity was noted, but less than 2cm. No skin problems were encountered. Three patients,(22%), complained for anterior knee pain. Preoperative mean range of movement was 75 degrees, and improved to 90 degrees postoperatively. Average blood loss was 850 cc. Conclusions: The tibial tuberosity osteotomy offers excellent exposure in the revision and difþcult primary TKR, but it lengthens the operative time, and the blood loss is higher.

Purpose: To present the results of the use of shoulder prosthesis in multifragmented displaced humeral head fractures. Material-methods: 19 patients with comminuted and severely displaced fractures of the upper humeral epiphysis were treated with shoulder hemiar-throplasty. Their age varied from40 to 81 years (av:71). Seven patients had severely displaced four-part fracture; eight patients had four- part fracture-dislocation and four patients, three-part fracture dislocation with extended damage to humeral head articular surface. In 16 cases the arthroplasty was performed within 10 days, and in three, 6 weeks or more after the injury. The glenoid was not replaced in any of the cases. Results: The follow-up period was 16–84 months (av: 51). None of the patients had been reoperated, and none of the prosthesis was regarded ÒlooseÒ. The clinical assessment was done using the Constant-Murley scale. The score varied from 50 to 89 points, (av: 79). The average score for ÒpainÒ was 13(max 15) and for ÒmobilityÒ29(max 40). Average abduction reached 100 degrees and forward ßexion 110 degrees. At the last examination, 15 out of the 19 patients had returned to the previous social and occupational activities. Conclusions: The shoulder replacement offers satisfactory results in cases with comminuted and badly displaced fractures, but is a technically demanding procedure, and the time interval between injury and operation, strongly affects the result. Long lasting physiotherapy, patient compliance and cooperation are necessary for a satisfactory outcome.