The study was established to assess the long-term results and differences between autogenous and synthetic anterior cruciate ligament (ACL) reconstruction.

We randomised 50 patients into 2 groups: 26 (52%) underwent reconstruction with middle third patellar tendon graft (PTG) harvested using the ‘Graftologer’ (Neoligaments) and 24 (48%) underwent reconstruction with the Leeds-Keio ligament (LK).

Subjective knee function was assessed using the Lysholm score, Tegner activity score, IKDC grading, and clinical assessment of anterior knee pain. Laxity was tested clinically, including anterior draw at 20° (Lachman), pivot shift, and arthrometric measurements using the Stryker laxometer.

At five years we have noted no significant difference in Lysholm scoring and Pivot shift between the LK group and patellar tendon group. But there was a significant difference in Tegner activity level and IKDC activity scores with PTG faring better at five years. There is no significance difference in anterior knee symptoms between the groups.

Conclusion: Due to the success of PTG/Hamstring in routine primary ACL reconstruction there does not seem to be a role for artificial ligaments. However, if we just look at functional outcome and patient satisfaction, LK patients seem to be doing as well as PTG at five years. So, there may be a place for the Leeds Keio graft where autologous tissue is unavailable.

Purpose: We carried out a questionnaire survey amongst all the members of the British Association for surgery of the Knee (BASK) to provide us with a guide to the current practice and opinions on cementing techniques in Knee replacement.

Materials & Methods: Between January and February 2003, all the three hundred members of the BASk were mailed a thirteen-question survey regarding the current practice of TKR with specific emphasis on the cementing techniques.

Conclusion: Our study shows the wide variation in current practice and attitudes towards cementing in Total Knee replacement amongst the specialist Knee surgeons of Britain, but the practice of the majority is in accordance with the guidelines issued by the BOA & BASK.

The study was established to assess the long-term results and differences between autogenous and synthetic anterior cruciate ligament (ACL) reconstruction.

We randomised 50 patients into 2 groups: 26 (52%) underwent reconstruction with middle third patellar tendon graft (PTG) harvested using the ‘ Graftologer ‘ (Neoligaments), and 24 (48%) underwent reconstruction with the Leeds-Keio ligament (LK).

Subjective knee function was assessed using the Lysholm score, Tegner activity score, IKDC grading, and clinical assessment of anterior knee pain. Laxity was tested clinically, including anterior draw at 20° (Lachman), pivot shift, and arthrometric measurements using the Stryker laxometer.

At five years we have noted a slight reduction in Lysholm scoring in the LK group, as well as reduced Tegner activity level. Pivot shift and laxity were significantly greater in the LK group.

Compared with earlier results, which showed little subjective difference between the groups, the autogenous PTG group show more sustainable long-term results than the synthetic (LK) group. There is no significant difference in anterior knee symptoms between the groups.

Aim: We conducted a prospective, randomised study of 50 patients, 40 (80%) male and 10 (20%) female, with anterior cruciate ligament (ACL) rupture to compare the results of ligament reconstruction by middle third patellar tendon graft (M) or synthetic Leeds-Keio (LK) ligament.

Method: The patients were randomised into two groups. 26 (52%) underwent PTG repair and 24 (48%) LK repair. Subjective knee function was classified using the Lysholm score, Tegner activity score and IKDC grading. Laxity was tested by clinical examination including anterior draw, pivot shift and arthrometric measurements using the Stryker Laxometer (Stryker Corporation, Kalamazoo, Michigan, USA).

Results: We present the early (two to five-year follow-up) results of this on-going trial. There was no statistical difference between the two groups in activity levels, both pre-injury and current. However, both pivot shift and anterior laxity were significantly greater in the LK group at two years and greater.

Discussion: While the LK group did develop significantly greater laxity, it is demonstrated that the functional outcome is not affected. We conclude therefore that if the results of surgery were to be based on a functional outcome rather than objective measurements of laxity, it would seem logical that the LK is an acceptable alternative to autogenous PTG.

However whilst function appears to be as good the less successful objective criteria do suggest reservations for the long term results of the Leeds-keio graft.

The aim of this trial was to assess the clinical examination findings commonly used for the ACL deficient knee.

For reliability testing and criterion validation 102 patients with ACL injuries were assessed by a single observer, 35 by a second observer and 47 again by the initial observer. For construct and criterion validation 30 patients were assessed pre-operatively and a mean of 1.7 years after ACL reconstruction. The Lysholm 11, Tegner and Cincinnati outcome measures were assessed along with instrumented knee laxity (Stryker test), the one hop test (OHT) and graded tests (including anterior draw, Lachman test, quality of end point, and pivot shift test).

The outcome measures were found to be reliable except the Cincinnati system. All examination findings were of unsatisfactory reliability, with the exception of the OHT and the Stryker test. Construct validation revealed a significant improvement in all outcome measure scores and examination findings following ACL reconstruction. Criterion validation revealed that of the examination findings only the OHT had a satisfactory correlation with the symptom of giving way and the Lysholm/Tegner measures. Comparison of the difference between the desired and actual Tegner activity levels with the examination findings revealed an improvement in all levels of correlation.

With the exception of the OHT, the clinical examination findings used for the ACL deficient knee are unreliable and correlate poorly with the functional outcome of the patient. They may, however, have some benefit in assessment of deficiency of the anatomical structures and the findings should be presented individually, rather than forming part of the functional assessment of the patient.