Introduction: The technique of double bundle anterior cruciate ligament (ACL) reconstruction has been proposed to be more anatomical but technically more demanding. We are presenting a simple technique using autogenous hamstring graft and Rigid-Fix pins (Mitek, Johnson & Johnson).

Materials and Methods: 2 tibial and 2 femoral tunnels are prepared using 6mm reamer for the posterolateral (PL) and 7 mm reamer for the anteromedial (AM) bundles. Trans-tibial approach was used for preparing the femoral tunnels. Double or triple gracellis graft is used for the PL and double semitendinoses for the AM bundles. On the femoral side single Rigid-Fix pin was used to fix each graft separately. 7 mm and 8 mm biodegradable screws were used for graft fixation on the tibial side for the PL and AM tunnels in sequence. The AM bundle was stabilised with the knee in 60° flexion and the leg internally rotated while the PL bundle was fixed whiles the knee in 15° flexion and external rotation. 43 patients were randomized between two groups (A), 21 patients for whom single bundle ACL reconstruction using hamstring autogenous graft, Rigid-Fix pins and interference screws and group (B) 22 patients who had double bundle ACL reconstruction using the above mentioned technique. IKDC scoring system was used for evaluation.

Results: At 18 months post-operative there was no significant difference between the two groups in the IKDC score but the return to sport and heavy manual work was higher in group B 95% compared to only 60 % in group A.

Discussion: and Conclusion: A simple and reproducible technique is described for double bundle ACL reconstruction and shown to provide better outcome for the patients who perform highly demanding physical activity.

A reduced femoral offset in total hip replacement has been thought to be disadvantageous. We reviewed the results of 54 consecutive primary total hip replacements in 49 patients (mean age of 68 years) performed between August 1990 and December 1994, with a mean follow-up of 8.8 years (sd 2.1). The mean pre-operative femoral offset for these hips was 41 mm (sd 7.4). All patients received a low-offset Charnley stem and a polyethylene cup inserted by a single surgeon.

At their latest follow-up, surviving patients had a significant improvement in the performance of their hip. Three had undergone revision, one each for deep infection, recurrent dislocation and late pain with subluxation. No hips had been revised, or were at risk of revision, for aseptic loosening. The mean annual linear rate of wear was 0.2 mm (sd 0.08) for the whole group. There was no correlation between the pre-operative femoral offset and the post-operative rate of wear. Our survivorship estimate was 91% when revision for any reason was taken as an end-point, but 100% if aseptic loosening was considered as the end-point. Our study demonstrates that a low-offset femoral stem can produce good, medium-term results.

Hip prostheses that do not reproduce the patients’ preoperative femoral offset have been correlated with increased wear rate, instability, abductor weakness and reduced range of motion. We have reviewed the results of 54 primary low friction arthroplasties with low offset stem commonly called “¾ neck Charnley” in 49 patients (47 females and 2 males). There has been no publication in literature on the results of this stem. Mean age was 68 years (range 30 to 83). The operations were performed by one of us, (VR) as an orthopaedic trainee, with a mean follow up of 8.7 ± 2 years. The preoperative diagnosis was 40 OA, 8 protrusio, 2 DDH, 2 post-traumatic, 1 SUFE and 1 RA. The preoperative offset was 41.9 ± 7.1 mm (mean ± STD), weight 65 ± 8.4 kg, height 156.4 ± 8 cm.

At their latest review 3 cases had been revised for infection or recurrent instability with a survivorship of 93.5% using Kaplan Meyer’s analysis. None of the femoral or acetabular components were loose or at risk of loosening. 16 cups showed demarcation in 1 zone of ≤ 1mm, and 2 cups had a 2 mm demarcation in 2 zones that was not progressive. 7 stems had ≤ 1mm demarcation in 1 zone, and 5 stems at 2 zones. Condensation at the tip of the stem was noted in 2 hips. The linear wear rate was 0.2 ± 0.08mm/year. Using Pearson’s correlation coefficient with P< 0.05, no statistically significant correlation was found between the preoperative offset and the linear wear rate.

We believe that the surgeon should try to reproduce the patient’s femoral offset aiming for the best intra-operative soft tissue balance. The linear wear rate in this series is higher than previously reported in cases that survived for over 20 years from this unit. However, at this stage of analysis low offset Charnley stems produce good medium term results.