The purpose of this study is to evaluate the relationship between the clinical results and the angle of the reconstructed ligament measured radiographically. We also describe the comparison of the results by the fixation technique of the femoral tunnel. We retrospectively evaluated 90 patients who had arthroscopy assisted ACL reconstruction using middle-third middle-third bone patellar tendon autograft. There were 67 men and 23 women. Their average age at surgery was 23.9 years. The average follow up periods was 28.0 months. We used interference fit screw for grafted ligament fixation of the femoral and tibial tunnel. 71 patients received inside out technique and on 19 patients outside in technique as for the fixation of the femoral funnel. The lateral angle and A-P angle of the reconstructed ligament were measured roentgenographically. Data from KT-2000 arthrometer testing with side to side difference and Lachman test were used to assess postoperative anterior knee laxity. Pivot shift tests were also used for rotational knee laxity. Data from roentgenograms reflected the correlation with clinical testing. Mean value of the side to side difference was 1.3mm. In pivot shift test, the average lateral angle of the reconstructed ligament of negative group was 73.2o , while positive group was 77.2 o , it was statistically significant. The average lateral angel and A-P angle of the reconstructed ligament with inside out technique group was larger than those of outside in technique group. Recent recommendations placing the tibial tunnel more posterior results in a lower incidence of graft impingement, but we found a relationship between the angle of the reconstructed ligament and rotational stability of the knee. Anterior-posterior stability can be obtained by achieving posterior placement of the reconstructed ligament. More vertical graft angle caused by posterior placement of tibial tunnel should affect rotational stability. Inside out as the way of fixation technique for the femoral tunnel showed a tendency of more vertical graft angle.
We assessed the Japanese specific bone age standard with Tanner-Whitehouse 2 (TW2) method for the evaluation of skeletal maturity in adolescent scoliosis. TW2 bone age was investigated by the left hand-wrist X-rays of 120 girls with adolescent scoliosis. Their chronological age ranged from 10.2 to 19.0 years. Because Risser’s sign is uncertain between Risser IV and V, for comparison of TW2 bone age with Risser’s sign, we classified apophyses that with an apparent narrowing of cartilage and that with a partial fusion as the later of Risser IV. In addition, clinical courses of the skeletal matured cases (adult bones) in 6 months before investigation were reviewed retrospectively. Even or less than 5 degrees change of Cobb’s angle was evaluated as unchanged. Furthermore, bone age distribution of immature cases was also reviewed for comparision of the unchanged group with the progressive group. None was evaluated as adult bone in the stage from Risser 0 to III. The rate of adult bone which was shown in Risser IV was 43.5%, but 88.9% was in the later of IV. 95.8% of Risser V was already adult bone. Moreover, 93.1% of adult bone was unchanged in their clinical courses. Remaining 4 cases (6.9%) was progressive, but had not progressed in the following 6 months. Bone ages of the progressive immature group distributed in the range from 11.7 to 13.9 years. Those of the unchanged immature group distributed mainly over 13.1 years. Although it is necessary to follow the immature longitudinally, adult bone appeared almost in the later of Risser IV, and appeared earlier than Risser V. And Cobb’s angle may become unchanged before adult bone. At least adult bone would be an indicator between Risser IV and V.
Between 1986 and 1990, we carried out 55 rotational acetabular osteotomies in 54 patients with acetabular dysplasia. Five hips were lost to follow-up. Of the 50 remaining, the degenerative changes were classified according to the criteria of Tönnis as grade 0 in 23, grade 1 in 16 and grade 2 in 11. The mean age of the three men and 46 women at the time of operation was 31.8 years (13 to 53). The mean follow-up was 137 months (120 to 174). At the most recent follow-up, 48 patients had satisfactory relief from pain. There was a slight decrease in the range of movement, particularly of flexion, in 18 hips. Radiologically, all osteotomies had united satisfactorily. There was radiological evidence of improvement in degenerative changes in 13 hips (5 grade 1 and 8 grade 2). Ten deteriorated (5 grade 0, 3 grade 1, and 2 grade 2) and one required total hip arthroplasty ten years after osteotomy. The osteoarthritis in the two hips with an associated valgus osteotomy progressed. The changes in radiological indices such as the centre-edge angle, acetabular femoral head index, acetabular root obliquity and horizontal or vertical displacement of the femoral head showed no statistical difference (unpaired Student’s
