The purpose to prospectively compare two types of tibial fixation in a series of 160 anterior cruciate ligament (ACL) reconstructions. 160 ACL reconstructions were performed on 159 patients over a period of 3 years. These patients were prospectively and randomly divided into 2 groups based on the method of tibial fixation of the ACL graft. In one group, an Intrafix system was employed and in the other, Rigidfix crosspins. All ACL reconstructions were carried out arthroscopically, in the standard way, using a quadrupled hamstring tendon graft. In all cases the hamstring grafts were harvested through a single vertical incision over the pes anserinus insertion on the proximal tibia, 2cm medial to the midline. Number 2 Ethibond whip sutures were used to prepare the graft appropriately in each group. Patients were evaluated at the 6-month and the 1-year mark, by an independent observer who was blinded to the study. The assessments consisted of manual maximum KT1000 measurements, tegner and lysholm evaluations and single leg straight and crossed over tests. The clinical results between the two groups are similar with the cross-pin method of fixation on both sides of the joint providing satisfactory stability in the ACL reconstructed knee. The hypothesis was proven and both methods of fixation were found to be clinically satisfactory in providing an acceptable degree of stability following ACL reconstruction at 1 year post-op.
Osteoarthritis of the knee usually affects the medial compartment first and may later involve the lateral compartment. In its early stages, the options for operative treatment are valgus high tibial osteotomy, unicompartmental arthroplasty, and total knee arthroplasty. The general feeling is that UKR offers potential advantages over the more extensive total knee replacement (TKR) procedure for the management of unicompartmental disease: preservation of bone stock, retention of the anterior and posterior cruciate ligaments, and preservation of both the patellofemoral joint and half of the weight-bearing articulating surface of the knee joint. The purpose of this paper was to review all our cases of UKR and their early complication rate and to try and determine the factors that led to the individual complications as well as an assessment of the technical difficulties experienced in managing these cases. Over a period of 5 years, 206 UKR procedures were performed in one hundred and eighty-five patients. There were 21 bilateral cases. Eighty-three cases were left-sided and eighty-one were right-sided. There were sixty-nine female and one hundred and sixteen male patients. The age of the patients averaged 63.7 years (range, thirty-two to eighty-nine years) Five surgeons were involved in performing the surgery. There were thirty-five cases of lateral, and one hundred and seventy-one cases of medial compartment osteoarthritis. Due to the five-year period that this study spans, different prostheses were used
One patient sustained a tibial fracture intra-operatively Three cases of tibial fracture occurred within six weeks of the operation
- One case of proximal tibia stress fracture occurred within 6 months post UKR. - Ongoing pain past the one-year mark occurred in five patients - Superficial wound sepsis occurred in one patient
- 31 (15%) Patients underwent further surgery. - 13 (6.3%) Patients had their UKR revised to a TKR. - 9 (4.4%) Patients had at least one arthroscopic procedure. - 7 (3.4%) Patients had a procedure to remedy an illfitting polyethylene spacer.
Most of the failures that we had within the first year post-operatively occurred due to either surgical technical error or patient selection. We concur with previous studies indicating that revision UKR to TKR should not be undertaken lightly. Adequate revision instrumentation should be available and careful planning should be carried out prior to embarking on this procedure. One should be prepared for significant bone loss in the affected compartment. Arthroscopic debridement and adhesiolysis can be very successful in patients with distinct catching and clicking associated with an effusion, post UKR. Some patients have unexplained pain and failing to find a causative factor, the patients can be reassured that there will be a high probability of this pain diminishing, or even disappearing. Subsidence of the tibial component may occur in older patients with generalized osteopaenia, and if not severe, it can be observed. It may not cause a clinical problem. It appears that the more cases one does, the less likely the chance of failure and revision.
