Identifying risk factors for inferior outcomes after anterior cruciate ligament reconstruction (ACLR) is important for prognosis and patient information. This study aimed to ascertain if BMI, pre-operative scores, demographic data and concomitant injuries in patients undergoing ACLR affected patient-reported functional outcomes. A prospective review collected data from a single surgeon series of 278 patients who underwent arthroscopic ACLR. BMI, age, gender, graft choice, pre-op Lysholm score, meniscal and chondral injuries were recorded. The Lysholm score, hop test and KT1000 were used to measure post-op functional outcome at one year. Multiple regression analysis was used to determine factors that predicted Lysholm scores at one year.Abstract
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Methods
To describe the epidemiology, clinical features and outcomes of native joint septic arthritis in adults admitted to Middlemore Hospital in Auckland, New Zealand. Single-centre retrospective cohort study from 2009 to 2014. Patients ≥16 years of age were identified using ICD-10AM coding data. Electronic records were reviewed for demographic, clinical, laboratory, treatment and outcome data. Total and hemi-arthroplasty infections were excluded.Aim
Method
Following lumbar spine surgery patients with a high BMI appear to have increased post-operative complications including surgical site infections (SSI), urinary complications, increased anaesthetic/operative time and a greater need for post-operative blood transfusion. There is no current evidence, however, analysing the effect of BMI on functional outcome. We aimed to analyse the effect of BMI on functional outcome following lumbar spine surgery.Background:
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The aim of this study was to assess the risks and benefits of mini-incision TKR. The limited exposure afforded by the small skin incision in the new technique of mini-incision TKR has the potential for increasing the risk of mal-positioning of components. Minor mal-positioning of components has the potential to increase polyethylene wear and may lead to early loosening and poor functioning of the TKR. The literature supports the concept that alignment within +/- 3 degrees of neutral mechanical alignment in the coronal plane is associated with a better outcome. If the mechanical axis falls outside this range it may have up to a 30% failure rate at 10 years. We report the results of 166 mini-incision TKR that have been undertaken in 154 patients (96F; 58M; mean age 72; mean BMI 29; 96% OA) since November 2003. The pre-operative mechanical axis ranged from 8 degrees valgus to 15 degrees varus. Surgery was undertaken with a precise skin incision and a midvastus split approach. Specialised cutting blocks were used to facilitate a smaller incision. The prosthesis inserted was a cemented Zimmer NexGen TKR of either posterior stabilised or cruciate retaining form. Long leg weight bearing alignment radiographs were available in 52% of patients. The mechanical axis was measured in the coronal plane and found to lie within +/- 3 degrees of neutral in 86% of patients. This compares favourably with the current literature which reports the mechanical axis falling within this range in between 72% and 85% of cases. We believe the mini-incision TKR is a safe, reliable and reproducible technique offering substantial savings to the patient and health service without compromising accuracy.
The aim of this paper is to evaluate the Linvatec SE graft tensioner system in obtaining predictable initial tension during ACL reconstruction using hamstring grafts. The gracilis and semitendinosus grafts were tensioned individually prior to fixation distally to a combined tension of 80N. The knees were then cycled through full range of motion and the tension recorded at 90 degrees and in full flexion and extension. Experience on the first 22 patients indicated that 41% required 10 cycles of the knee to remove pre-conditioning and equalise tension at 80N combined, while the remaining 50% required 15 cycles. 90% reached stable tension after 15 cycles. In 54% the tension increased at full extension and graft tension was adjusted to 80N in extension to avoid overconstraining the graft. Twenty-two patients studied following this initial protocol underwent outcome assessment after minimum 6 months. Mean KT1000 arthrometry manual maximum side to side difference was 1.5mm. Femoral fixation was achieved using the Endobutton (Smith and Nephew) and Tibial fixation using the Extralok bioabsorbable screw (Linvatec). A subsequent shortened protocol of initial over-tensioning to 60N and 40N for the semitendinosus and gracilis double bundles respectively, followed by 15 cycles of the knee resulted in stable 80N combined tension with no further drop with more cycling. We conclude that the new tensioner system allows for accurate and predictable initial tension of hamstring reconstructed ACL grafts and that its use can be simplified by using the second technique protocol.
The results of the first 20 consecutive patients have been compared with 20 standard TKR procedures. The mean age of 73.5 and BMI of 29 was not significantly different to the standard Group. Mean hospital stay was approximately halved (5 days versus 9 days). 75% of patients were discharged on day 4 without needing extra home support. Mean incision length was 13.5cm and only one of 20 required blood transfusion. Mean operative time was 12 minutes longer and post-operative CT alignment showed no mal-position of the implants.
