Background Female patients undergoing arthroscopic anterior cruciate ligament reconstruction with hamstring tendon graft developed increased post-operative laxity compared to male and female patients who had been reconstructed using patellar tendon graft.

Hypothesis Supplementary tibial fixation in female patients will reduce laxity.

Study Design Prospective, randomized, double-blinded clinical trial.

Methods Fifty-six female patients divided into two groups (standard tibial fixation versus supplementary staple fixation) were followed for 2 years.

Results After 2 years the mean side-to-side difference utilizing KT-1000 arthrometer manual maximum measurements was 1.8 mm (standard group) and 1.1 mm (staple group) (p=0.05). A Grade 0 Lachman test was present in 63% of the standard group and 86% of the staple group (p=0.04). Kneeling pain was experienced by 7% of the standard group and 29% of the staple group (p=0.05).

Conclusions Supplementary tibial fixation in female patients undergoing ACL reconstruction with hamstring tendon graft and interference screw fixation with a single screw size significantly improves laxity measurements and clinical stability assessment 2 years postoperatively. However, this is at the cost of increased kneeling pain.

In 13 unloaded living knees we confirmed the findings previously obtained in the unloaded cadaver knee during flexion and external rotation/internal rotation using MRI. In seven loaded living knees with the subjects squatting, the relative tibiofemoral movements were similar to those in the unloaded knee except that the medial femoral condyle tended to move about 4 mm forwards with flexion. Four of the seven loaded knees were studied during flexion in external and internal rotation. As predicted, flexion (squatting) with the tibia in external rotation suppressed the internal rotation of the tibia which had been observed during unloaded flexion.

During a four-month period we observed 12 stress fractures of the inferior pubic ramus in 11 military recruits undergoing basic training. Eleven of these were in women. This high number was considered to be caused by the introduction of mixed training of male and female recruits; this forces women to increase their stride length when marching.

The presenting symptom was chronic groin pain which failed to settle with rest, and the clinical diagnoses were confirmed by radiographs in all but one patient who was diagnosed by ^99mTc bone scanning. Since the required stride length has been reduced there have been no new cases of stress fracture of the pelvis.