The middle third of quadriceps tendon is an autograft of sufficient size and strength and is stronger than the patellar tendon autograft with the same dimensions. We present the results from the use of a quadriceps autograft for the reconstruction of the chronically ACL deficient knee. Between March 1999 and March 2000 we treated 36 patients with chronic ACL deficiency using a quadriceps tendon autograft, harvested from the middle third of the tendon with and without a patellar bone block. The tendinous side of the graft was stabilized using the Mark II and Patella Soffix fixation systems (Surgicraft, UK). In the tibia the graft was passed through a tunnel and in the femur it was passed over the top. In those cases where the graft was harvested with a bone block, his was fixed to the tibia using interference screw fixation. The mean postoperative follow up was 21 months. The results have been evaluated using the IKDC, the Lysholm and the Tegner scales. According to the International Knee Documentation Committee rating system most of the patients had normal or nearly normal ratings. Knee laxity was evaluated using the arthrometers KT-2000 and Rolilmeter. There were no significant complications related to the harvesting site and there was no significant differences between the two groups regarding stability and function. MRI evaluation and second look arthroscopies in 7 patients revealed graft survival The quadriceps tendon-patellar autograft is a reasonable alternative ACL reconstruction in primary and probably revision ACL reconstruction with minimal donor site morbidity and restoration of knee stability.
Purpose of this report is to present a surgeons group experience in shoulder arthroscopy step by step from a diagnostic status to a therapeutic one, in cases of recurrent instability, impingement syndrome and rotator cuff pathology. There is focus on technique tips, learning curve period, complications and solutions. We evaluated 250 shoulder arthroscopies from May 99 to Apr.03. 155 cases of them were recurrent instability reconstructions in young patients (16–34 years old, ave.24,3) while the rest of them were rotator cuff pathology patients (22–69 years old ave.44,3). Lateral decubitus position was elected as the standard position in all cases. Patients were operated from a group of two surgeons each time. We analyzed parameters as, EUA, learning curve, technique tips concerning labrum mobilization, anchors and shuttle relay insertion and capsule plication. We describe the intra-op complications and the way out of them. There is also a detection where arthroscopic shoulder instability reconstruction was contraindicated and open technique was preferred. Our experience in arthroscopic shoulder instability reconstruction and rotator cuff pathology showed that, is a minimally invasive technique. The learning curve period is high, better results can be anticipated when there is a surgical group and when there is a carefully elected sample of patients as it was in our cases.