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.

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 a slight reduction in Lysholm scoring in the LK group, as well as reduced Tegner activity level. Pivot shift and laxity were significantly greater in the LK group.

Compared with earlier results, which showed little subjective difference between the groups, the autogenous PTG group show more sustainable long-term results than the synthetic (LK) group. There is no significant difference in anterior knee symptoms between the groups.

The purpose of this study was to assess if the use of sterile stockings in lower limb surgery results in the contamination of the operative site with skin commensals from unprepared skin.

Twenty-five consecutive patients under going elective single knee arthroscopy were included in our study. All patients were operated on in the same laminar airflow theatre, by the same surgeon using the same method of skin preparation and operative technique.

Skin swabs were taken from each patient’s foot prior to the commencement of surgery. The limb was then prepared as follows;

An unscrubbed assistant holds up the leg, the leg is then prepared with betadine, by the surgeon from ankle to thigh, sparing the foot.

Two samples were also cut from the cuff of the stocking, one prior to its use to act as a control and the other once it had been unrolled up the leg. The three samples were then sent to microbiology. The swabs were plated out on blood (x2), chocolate and Maconkey agar. One blood plate was incubated anaerobically at 37°c and the others in air at the same temperature. The stocking sample was cultured in nutrient broth. After 48 hours isolates were identified using standard techniques.

The results showed that none of the stocking samples yielded positive microbiology, however all of the foot swab samples did. They all grew coagulase negative Staphylococcus (CNS), five also grew conforms and one grew Pseudomonas, as well.

We can conclude from this, that this method of skin preparation using the sterile stocking is safe. It appears in this study, that the action of unrolling the stocking over the unprepared foot and then up the prepared leg does not contaminate the prepared operative site with commensals from the foot. However concern is raised by the high incidence of CNS on the foot, and may be a source of potential infection.

Aim: We conducted a prospective, randomised study of 50 patients, 40 (80%) male and 10 (20%) female, with anterior cruciate ligament (ACL) rupture to compare the results of ligament reconstruction by middle third patellar tendon graft (M) or synthetic Leeds-Keio (LK) ligament.

Method: The patients were randomised into two groups. 26 (52%) underwent PTG repair and 24 (48%) LK repair. Subjective knee function was classified using the Lysholm score, Tegner activity score and IKDC grading. Laxity was tested by clinical examination including anterior draw, pivot shift and arthrometric measurements using the Stryker Laxometer (Stryker Corporation, Kalamazoo, Michigan, USA).

Results: We present the early (two to five-year follow-up) results of this on-going trial. There was no statistical difference between the two groups in activity levels, both pre-injury and current. However, both pivot shift and anterior laxity were significantly greater in the LK group at two years and greater.

Discussion: While the LK group did develop significantly greater laxity, it is demonstrated that the functional outcome is not affected. We conclude therefore that if the results of surgery were to be based on a functional outcome rather than objective measurements of laxity, it would seem logical that the LK is an acceptable alternative to autogenous PTG.

However whilst function appears to be as good the less successful objective criteria do suggest reservations for the long term results of the Leeds-keio graft.