Introduction: Anatomical observation and biomechanical studies have shown that the anterior cruciate ligament (ACL) mainly consists of two distinct bundles, the anteromedial (AM) bundle and posterolateral (PL) bundle. Conventional single-bundle ACL reconstruction techniques have focused on the restoration of the AM bundle while giving limited attention to the PL bundle. The purpose of this prospective, randomize clinical study is to compare the outcomes of ACL reconstruction when using either double-bundle or single-bundle technique and bioabsorbable interference screw fixation, and similar rehabilitation, with both techniques.

Methods: Sixty-five patients were randomized into either double-bundle (n = 35) or single-bundle (n=30) ACL reconstruction with hamstring tendons and bio-absorbable screw (Hexalon, Inion Company, Finland) fixation in both group. The evaluation methods were clinical examination, KT-1000 arthrometer measurements, radiographic evaluation, as well as International Knee Documentation Committee (IKDC), and Lysholm knee scores. There were no differences between the study groups preoperatively. For an average of 14 months of follow-up (range, 12 to 20 months), 30 patients of the double-bundle group and 29 patients of the single-bundle group were available (91%).

Results: At the follow-up, the rotational stability, as evaluated by pivot shift test, was significantly better in the double-bundle group than in the single-bundle group. Also, the early anterior stability tended to be better with double-bundle technique, although at the 14-month follow-up, no significant difference between the groups was found anymore. In addition, none of the patients in the double-bundle group had graft failure, while four patients in the single-bundle group had. However, knee scores were equal at the follow-up, and all the results were significantly better at the follow-up than preoperatively, in both groups.

Conclusions: Rotational stability and early anterior stability were better with double-bundle technique than with single-bundle technique in ACL reconstruction with hamstring autografts and bioabsorbable screw fixation. However, both fixation techniques improved patients’ performance.

Introduction: Shoulder pain, caused by subacromial impingement or rotator cuff tear, is common for the middle-aged and elderly people. It can cause diminished ability to work and prolonged sick-leaves. The purpose of this study was to evaluate the effect of the operative treatment of this pain (arthroscopic subacromial decompression, rotator cuff repair) when the patients returned home the same day (outpatient) from the day-surgery unit or stayed 1–3 nights at the ward (hospitalized).

Methods: Ninety-three patients were included in this prospective, comparative study. The inclusion criteria were:

1) shoulder pain more than 6 months with no response for conservative treatment,

The minimum of the follow-up was 2 years (range 24 to 32 months), and 76 patients (82%) participated to the evaluation at this point. In the outpatient group were 37 patients (24 subacromial impingements, 13 rotator cuff tears), and in the hospitalized group 39 patients (23 subacromial impingements, 16 rotator cuff tears). Evaluation methods were clinical examination, radiographic evaluation, isometric elevation strength measurements, as well as the University of California Los Angeles (UCLA) and Constant shoulder scores. All operations were done by one experienced orthopaedic surgeon, and all evaluations at the follow-up by one independent examiner.

Results: At the follow-up, both shoulder scores (UCLA, Constant) were significantly better than the preoperative scores in every patient group (p< 0.001). In the patients with subacromial impingement, muscle strengths of the operated shoulders improved to the level of non-operated, contralateral shoulders, while in the patients with rotator cuff tear, the strength was still diminished (the mean difference in elevation strengths when comparing to the contralateral side was 1.8 kg). However, no significant differences in the shoulder scores or muscle strengths were found when the outpatient group and hospitalized group were compared.

Conclusions: Operative treatment of subacromial impingement and rotator cuff tear after failed conservative treatment led to good results at 2-year follow-up. The patients in the outpatient-group had similar results than the patients in the hospitalized patient-group. However, because the hospitalization is more expensive, the outpatient surgery is recommended.