Replacement of the anterior cruciate ligament of the knee with deep frozen bone-tendon-bone allografts.

Surgical treatment of the torn anterior cruciate ligament (ACL) and consequent knee instability showed great development over the last decade. Arthroscopic techniques and the use of different allogenic tissues became a routine. Between 1995 and 1998, 31 knees in 30 patients underwent ACL reconstruction of the knee with fresh-frozen allografts at the Department of Orthopedics, Medical University of Pécs, Hungary. The operations were performed with arthroscopic technique. This paper retrospectively assesses the outcomes with an average follow up of 28 months, which showed good results in most of the cases. The authors reviewed the literature emphasizing advantages and disadvantages of the method with special interest to possible complications resulting from the use of allografts: graft rejection, graft re-rupture, transmission of infection and synovitis evoked by immune response.

Long-term results of the operative treatment of clubfoot: a representative study.

This study reports the long-term results of operative treatment of clubfoot. Of the patients who underwent posteromedial release for congenital clubfoot between 1972 and 1975 at the Medical University in Pécs, Hungary, 41 feet of 30 patients have been under control examination. Control consisted of the distribution of questionnaires, physical examination, and in some cases, radiologic analysis. At an average of 20 years postsurgery, good clinical results were observed in 31 (75%) feet. In these patients, satisfying foot form and good function were achieved, yet the characteristic atrophy of the calf and shortening of the foot were visible. Abnormal conditions were found in 10 feet, consisting of overcorrection in 6 and undercorrection in 4 cases. Subjective judgment of the patients was considerably better; only 5 (12%) feet had no satisfying results. Data of feet in an incorrect position were analyzed and compared with other cases. In cases of feet operated on in patients aged > or = 1 year and in patients who underwent multiple operations, abnormalities were found in a significantly higher percentage.

[The scapula: rare localization of osteochondroma]. / Osteochondroma ritka lokalizációja: a scapula.

The authors demonstrate their 6 cases of scapular exostoses which were operated on between 1973 and 1993 at the Orthopaedic Department of the Medical University of Pécs. Results of the surgery with a mean five year follow up are discussed, and the literature data of incidence, diagnosis and treatment are reviewed. With resection of the osteochondroma good results were achieved in all of the cases.

Reconstruction of the patellar tendon using a Y-shaped flap folded back from the vastus lateralis fascia.

BACKGROUND: Neglected and repeated ruptures of the patellar tendon are fortunately an uncommon event. These ruptures are often difficult to repair because they are generally accompanied by contractures of the quadriceps muscle and extensive scar tissue formation, and clinical findings are similar regardless of whether the rupture occurred during or after total knee arthroplasty. In both cases, reconstruction is the treatment. METHODS: Here, we present data on reconstruction of the patellar tendon using our own method, which is performed in the following manner: the fascia flap shafted in the distal direction is separated from the vastus lateralis fascia of the quadriceps muscle, then folded back and fixed to the tibial tuberosity enclosing the patella in a Y shape. We used this new method in sixteen cases. All of the patients were examined clinically for an average of twenty-eight months. The Knee Society score was determined prior to surgery and on follow up. RESULTS: Both the physical and ultrasound monitoring showed that all sixteen tendons healed properly, indicating that there was no need for any further surgical interventions. The mean Knee Society pain and function scores as well as the average range of motion of the knee increased significantly after the operations. CONCLUSION: We believe that the presented method is an acceptable option for functional and biomechanical repair of the patellar tendon for the following reasons: the static balance of the knee joint remains unaltered, the quadriceps muscle is not damaged, and the central pulling direction remains steady.

Prevalence of degenerative joint complaints of the lower extremity: a representative study.

As part of the international campaign of the bone and joint decade, we aimed to present epidemiological data on the prevalence of major joint complaints in a Central European region. Ten thousand subjects aged between 14 and 65, selected randomly by the Hungarian central office of statistics from three counties in southern Hungary, were surveyed using our own questionnaire based on widely accepted scoring systems in the literature, focusing on major degenerative joint complaints, and using the short form 36 (SF-36) questionnaire. We found that the prevalence of hip pain in the observed group was 22.2%, the prevalence of knee pain 30.3%, and frequent ankle pain occurred in 9.7%. The results of the SF-36 questionnaire showed that with the exception of social function, neither of the values of the examined health dimensions reached levels of other international surveys. Details of the survey and the possible causes of the higher prevalence are discussed, along with the results of the SF-36 questionnaire.

[Significance of postoperative fever after hip prosthesis implantation]. / Bedeutung des postoperativen Fiebers nach Hüftendoprothesen-Implantation.

INTRODUCTION: Postoperative fever is a phenomenon well-known by every orthopedic surgeon, yet its etiological background and its relation to wound infections is still unclear. The number of publications related to this topics in general and in the special field of orthopedics is quite limited. METHOD: The incidence of postoperative fever in 177 patients who underwent total hip replacement was investigated; its nature and connections to possible bacterial wound infections are described. Moreover, the effectiveness of antibiotic therapy was also taken into consideration. RESULTS: In 39% of the sample, fever exceeding 38 degrees C was noted in the immediate postoperative period; in 87% of these cases, the fever was of unknown etiology, its background could not be specified by clinical tests and examinations. In four cases of the total 177 patients, microbiologically proven wound infection occurred during the period of hospital stay, but only three of these patients had fever. The results of patients treated with antibiotics because of fever did not differ significantly from those of patients who did not receive antibiotics. This was true from the aspect of both the disappearance of fever and the frequency of complications. CONCLUSION: The results emphasise that postoperative fever is only a minor predictive factor of wound infections; at the same time absence of fever does not mean absence of septic complications. In the case of immediate postoperative fever of unknown etiology and without clinical symptoms, it is inexpedient to start antibiotic treatment or to increase the prophylactic antibiotic dosage.

[Management of calcaneonavicular coalition and results]. / A calcaneonavicularis coalitio kezelésének eredményei.

26 cases of calcanconavicular coalitions were treated by resection of the calcanconavicular bar. The endresults were markedly influenced by the age at surgery, while there was no difference between the "bone" and "cartilage" group. The coalition must be recognised if someone examinates a rigid flatfoot.

Comparative study of autograft or allograft in primary anterior cruciate ligament reconstruction.

Between December 1996 and December 2002, we treated 79 patients with arthroscopy-assisted anterior cruciate ligament (ACL) reconstructions. In 53 patients we used autografts and in 26 patients allografts. Patients were followed up for 38 (12-72) months. The two groups did not differ in preoperative sport activity level. The postoperative Lysholm score was 89.9+/-8.1 in the autograft group and 84.1+/-18.6 in the allograft group. Comparing the patients' Lysholm score according to whether they had a low (1-5) or a high (6-10) postoperative Tegner score, we found no statistically significant difference between the groups. On one occasion, the allograft ruptured during the implantation procedure just prior to the fixation. Postoperatively, we performed three revisions-two in the allograft group and one in the autograft group-and three second-look arthroscopies. There were no bacterial infections and no cases of viral transmission. No immune rejection, resorption, or immunsynovitis occurred during the follow-up.

31,781 cases of non-surgical female sterilisation with quinacrine pellets in Vietnam.

The quinacrine method of non-surgical female sterilisation involves transcervical intrauterine insertion of 252 mg quinacrine as pellets during the proliferative phase of the menstrual cycle; the drug causes inflammation and fibrosis of the proximal fallopian tube. We have carried out a field trial of 31,781 cases in twenty-four provinces of Vietnam from Jan 2, 1989, until October, 1992. There were 818 pregnancies after the procedure, of which 80 were carried to term. Some women received only one dose of quinacrine; the majority received two doses with an interval of one month. Cumulative life-table pregnancy rates per 100 women at 1 year (for studies of at least 50 cases followed for 12 months) were 2.63 (SE 0.17) among 9461 women who received two doses and 5.15 (0.48) among 2225 who received only one dose. Failure rates (pregnancies) were strongly affected by the skill of the doctor or midwife. There were no deaths and only 8 serious complications were reported (0.03%); by contrast, in a similar series of women undergoing surgical sterilisation, 30 deaths and between 540 and 1812 serious complications would be expected. All reported side-effects were minor and of short duration. There were 19 ectopic pregnancies and the incidence was 0.89 per 1000 woman-years of use. There was one birth defect (anencephaly), in a fetus conceived 2.5 months after quinacrine insertions; however, we believe it is not related to the procedure. An estimated 242 maternal deaths will be averted by these 31,781 sterilizations. This method is safe and acceptably effective for female sterilisation.