A new technique in double-bundle anterior cruciate ligament reconstruction with implant-free tibial fixation.

PURPOSE: This case-series outcome study presents a surgical technique for anatomic double-bundle anterior cruciate ligament (ACL) reconstruction with 4-tunnel using two interference screws. There was a 2-year minimum follow-up. METHODS: From January to December 2009, an ACL 4-tunnel, anatomic, double-bundle reconstruction was performed on 27 patients. Double-strand hamstring tendon grafts were used in each femoral tunnel as well as two interference screws. Tibial fixation was insured through manual tension, by tying non-absorbable sutures on the bone bridge between the two tunnels at 20° of knee flexion. Clinical assessments included the International Knee Documentation Committee (IKDC) and Lysholm knee scores, range of motion (ROM), pivot-shift test, single-leg hop, and quadriceps-hamstrings strength tests using a hand-held dynamometer. Anterior knee laxity was also assessed using a rolimeter. A single examiner performed all testing pre-operatively at 6 months and during the 2-year follow-up. RESULTS: All patients were assessed during the 2-year follow-up. At that time, 92 % of the patients presented normal anterior laxity (average, 1.3 ± 0.5 mm) and rotational knee stability. No statistical side-to-side difference was found for ROM, muscle strength, single-leg hop, and function (n.s.). All patients presented a normal knee function according to the IKDC and the Lysholm score. In addition, no infection, graft failure, or pain were observed at the harvesting site. CONCLUSION: The study shows that satisfactory results in relation to knee laxity, function, and strength can be achieved with the implant-free tibial fixation in the ACL double-bundle reconstruction with two interference screws. LEVEL OF EVIDENCE: Therapeutic case series, Level IV.

A comparison of hip strength between sedentary females with and without patellofemoral pain syndrome.

STUDY DESIGN: Cross-sectional study. OBJECTIVE: To compare the hip strength of sedentary females with either unilateral or bilateral patellofemoral pain syndrome (PFPS) to a control group of sedentary females of similar demographics without PFPS. BACKGROUND: It has been suggested that hip muscle weakness may be an important factor in the etiology of young female athletes with PFPS. This syndrome is also common in sedentary females and it is unclear if similar findings of hip weakness would be present in this population. METHODS: Females between 15 and 40 years of age (control group, n = 50; unilateral PFPS, n = 21; bilateral PFPS, n = 29) participated in the study. Strength for all 6 hip muscle groups was measured bilaterally on all subjects using a handheld dynamometer. RESULTS: The hip musculature of sedentary females with bilateral PFPS was statistically weaker (range, 12%-36%; P<.05) than that of the control group for all muscle groups. The hip abductors, lateral rotators, flexors, and extensors of the injured side of those with unilateral PFPS group were statistically weaker (range, 15%-20%; P<.05)than that of the control group, but only the hip abductors were significantly weaker when compared to their uninjured side (20%; P<.05). CONCLUSION: This study demonstrates that hip weakness is a common finding in sedentary females with PFPS.