Purpose of the study: The isometric position of the femoral tunnel is a critical element for successful anterior cruciate ligament (ACL) repair. An overly wide tunnel can compromise long-term results, requiring revision. The purpose of this prospective study was to evaluate the incidence of femoral tunnel widening on two fixation systems and to determine its impact on clinical outcome.

Material and methods: This prospective study included 80 four-strand hamstring ACL reconstructions. In group A, the titanium cross pinning method was used for fixation (Arthrex, Transfix) 30 mm from the Blumensaat line. In group B, two bioabsorble crossed pins (Mitek, Rigid Fix) were used 13 mm from the «anatomic» fixation. The two groups were similar for age, gender, degenerative disease and type of tibial fixation. Radiographic findings were noted at postop, and 6, 12 and 24 months follow-up. The diameter of the femoral tunnel was measured on the ap and lateral views. The diameter of the tunnel was compared with the drilled diameter. Outcome was assessed with the IKDC score and KT1000 arthrometry.

Results: Two-year follow-up data was available for 66 patients (34 in group A and 32 in group B). Postoperatively, tunnel widening was not significant in either group. At six months, the diameter of the tunnel had increased 62% in group A and 49% in group B. At one year, tunnel diameter decreased 24% in group A and 21% in group B. No significant difference was noted at 24 months. At two years, the tunnel diameter was not correlated with clinical outcome.

Discussion and conclusion: Widening of the femoral fixation tunnel does not alter long-term outcome of ACL reconstructions. While no significant difference was observed for the fixation systems studied in the present analysis, radiographic widening appears to be less for fixations closer to the «anatomic» fixation.

Purpose of the study: The rate of recurrence after conventional manipulation procedures and arthroscopic debridement for idiopathic adhesive capsulitis of the shoulder is rather high. Arthroscopic release using a radiofrequency method might improve results. The purpose of this prospective study was to compare results of two athroscopic methods: manipulation and debridement versus radiofrequency release.

Material and methods: Thirty patients underwent arthroscopic treatment for shoulder pain six months after a conventional treatment for idiopathic adhesive capsulitis. In group A (n=15 patients), manipulation under anesthesia was followed by arthroscopic joint debridement. In group B (n=15 patients) arthroscopic section of the contracted structures was followed by radiofrequency section of the rotator interval and the anterior and posterior capsule. The coracohumeral ligament was sectioned in all cases. Subacromial decompression was achieved arthroscopically in four of the cases in group A and in two in group B. Age, gender and preoperative joint motion were similar in the two groups.

Results: Follow-up data at six weeks and at 3, 6, and 12 months were assessed in 27 patients (12 group A and 14 group B). Pain, joint stiffness, and function (UCLA and Constant) were assessed. Recurrence required revision in two patients in group A. There was no significant difference for pain (VAS) but there was an improvement in joint motion at three and six months for patients in group B. The outcome was satisfactory in all patients except one.

Discussion and conclusion: Radiofrequency release appears to yield better results than manipulation and arthroscopic debridement. The radiofrequency technique enables section of the rotator interval, the coracohumeral ligament and the capsule to prevent early adhesions and allow more rapid recovery of function.

Purpose of the study: The debate continues on the appropriate tendon to use for anterior cruciate ligament (ACL) reconstruction. There are few comparative data on the different types of grafting material. We propose a retrospective analysis of bilateral ACL reconstruction where a patellar tendon (PT) and hamstring tendons were used in the same patient.

Material and methods: This was a phase IV trial. From December 1992 through March 2003, ACL reconstructions of both knees were performed in 46 consecutive patients using the PT for one side and hamstring grafts for the other. Follow-up was at least two years for 38 patients. There was no difference between the knees prior to reconstruction. The postoperative protocol was the same for both knees. The Lysholm Knee Score and the IKDC scores as well as KT1000 arthrometry were recorded.

Results: There was no difference between the two sides for laxity (KT1000) or resumed sports activity. Postoperative pain, loss of extension, joint stiffness, and anterior pain were greater on the PT reconstruction side. All patients except two preferred the hamstring reconstruction.

Conclusion: The results of this study show that the two types of reconstruction are equivalent in terms of objective outcome but that the subjective assessment favors hamstring reconstruction.