This prospective, randomized clinical comparison of tibial fixation in 4-bundle hamstring ACL reconstruction, evaluated mechanical results (laxity) between BioScrew XtraLok® (Linvatec) and Intrafix® (Mitek Products) at six months. One hundred and three sequential patients undergoing ACL reconstruction by three surgeons with identical technique were recruited. KT-1000 arthrometer manual maximum measurements were taken at six weeks, six and six months post-operatively.

At six weeks and three months, KT-1000 side-to-side differences between the groups are not statistically significant (student-t test, p=0.87 and p=0.34, respectively). In clinical results at six months, tibial fixation with Bioscrew XtraLok has significantly decreased laxity compared to the Intrafix device (p=0.017).

This prospective, randomized clinical comparison of tibial fixation in hamstring ACL reconstruction evaluated mechanical results (laxity) between BioScrew XtraLok® (Linvatec, Largo, FL) and Intrafix® (Mitek Products, Norwood, MA) at six months.

After Ethics Review Board approval and sample-size calculation, one hundred and three sequential patients undergoing ACL reconstruction were recruited. Inclusion criteria were: absence of other ligamentous injury or previous knee surgery, and a normal contralateral knee.

After drilling tunnels, patients were allocated to a study arm (XtraLok® or Intrafix®) by a computer-generated randomization table. In all patients, EndoButton® (Smith & Nephew, Andover, MA) was used for femoral fixation and the Mitek tensioner was employed.

The patients were assessed with KT-1000 arthrometer manual maximum measurements taken at six weeks, three and six months post-operatively by independent clinicians. Mean measurements between the two groups were compared using the student-t test at the above intervals.

At six months, eighty-seven of one hundred and three (84%) patients were available for follow-up; 43 XtraLok (XL), and forty-four Intrafix (IF). There was no significant difference between groups in mean age and gender. KT-1000 arthrometer side-to-side differences at six weeks were 1.04mm (XL) versus 1.14mm (IF), and 0.96mm (XL) versus 1.38mm (IF) at three months. At these intervals, differences between the groups are not statistically significant (p=0.87 and p=0.34, respectively). At six months, KT-1000 side-to-side difference was 1.26mm (XL) versus 2.41mm (IF), which is statistically significant (p=0.017).

In clinical results at six months, ACL fixation with Bioscrew XtraLok shows decreased laxity compared to the Intrafix device.

Purpose: Resurgence in mobile bearing unicompartmental arthroplasty o the knee has come to Canada in last 3 years. This has been attributed to the popularity of minimally invasive surgery, improved instrumentation, and encouraging outcome results from the developers and others. A prospective study was undertaken at an academic institution to evaluate the initial experience with the first 400 Oxford knees.

Methods: Oxford unicompartmental knees have been implanted since Feb 2001 at our institution. A majority of these were entered into the Ontario Joint Registry. All others were retrieved from hospital records to capture 100% of all cases done form our institution. All surgeons attended an Oxford training course. The main outcome of interest was repeat surgery revision for any cause, including revision.

Results: Three hundred and fifty Oxford knees with minimum 1 year follow up were available for study. Three surgeons have implanted 90 % of the implants. Fourteen patients have come to revision surgery as of October 1, 2005 for an incidence of 3,7 %. Causes include rapid lateral compartment deterioration (6), persisting medial pain (6), and medial collateral ligament disruption (1). Ten were revised to ttoal knee arthroplasty (8 cruciate retaining and 2 posterior stabilized), except the ligament disruption, which was reconstructed with Achilles allograft. Two others had open debridement for medial pain. This rate of revision is higher than reported in literature. Severe obesity (BMI > 35) was a factor in 4 failures.

Conclusions: Our experience was not as successful as reported in the literature from the prosthesis designers. Causes include poor technique and inappropriate indications when scrutinized closely. The temptation to stretch indications must be tempered by acceptance of higher revision rate than reported in literature and should be part of informed consent. Survivorship should be institution specific and not that of original published data from the developers.

Purpose: The objective of this project is to determine the suitability of modified fibrin hydrogels as scaffolds for articular cartilage tissue engineering. The attractive feature of the fibrin system is that the gel precursors are available in autologous form. We have previously demonstrated that genipin, a naturally occurring cross-linking agent, stabilizes the fibrin gel.

Methods: Human articular chondrocytes were isolated from articular cartilage harvested from consenting patients undergoing total knee arthroplasty. The human cells were encapsulated into fibrin gels where gelation was induced by combining fibrinogen, thrombin, and genipin. The resulting gels were evaluated for extracellular matrix (ECM) production, mechanical properties, cell viability, and biodegradation.

Results: No breakdown of the gels was detected during 5 weeks of cell culture. After several weeks in culture, histology indicates significant proteoglycan production by encapsulated cells, and collagen II and aggrecan were detected in this ECM by immunostaining. There was a greater accumulation of cartilage-like ECM in the gels cross-linked with genipin. Dynamic compression tests performed at 0.1 Hz for 10 cycles using an MTS machine indicate that accumulation of ECM was associated with increased stiffness of the material. Cell viability was assessed using live/dead staining, and was found to be > 50% after 24 hours and at 1 week in culture. The presence of genipin cross-linking did not significantly affect cell viability. Real-Time RT-PCR indicated that encapsulated chondrocytes show an increase in Sox9, collagen II and aggrecan expression over 5 weeks and that this is further increased in the presence of genipin. The gene expression results agreed with the enhanced ECM seen under these conditions by histology and immunostaining. The fibrin material was also implanted subcutaneously into rats and after 30 days the material was removed, sectioned and evaluated. Immunostaining indicated that while there was evidence of biodegradation, the material did not appear to cause an inflammatory response.

Conclusions: Modified fibrin hydrogels show potential as cellular scaffolds for articular cartilage tissue engineering. An in vivo orthopaedic model must now be developed to fully evaluate the potential of the fibrin gel. Funding: Other Education Grant