Comparison of open and arthroscopic stabilization for recurrent shoulder dislocation in patients with a Bankart lesion.

We performed a prospective study of 117 patients (119 shoulders) with symptomatic, recurrent anterior posttraumatic shoulder instability to compare open versus arthroscopic reconstruction. Arthroscopic reconstructions (N = 66) were performed using bioabsorbable tacks (Suretac fixators), whereas open reconstructions (N = 53) were performed with suture anchors. All of the patients had a Bankart lesion. Independent observers examined 108 of the 119 shoulders (91%) at a median follow-up period of 28 months (range, 24 to 63) for the arthroscopic group and 36 months (range, 24 to 63) for the open group. The recurrence rate, including both dislocations and subluxations, was 9 of 60 (15%) in the arthroscopic group, compared with 5 of 48 (10%) in the open group. At follow-up, the Rowe score was 93 points (range, 39 to 100) and the Constant score was 91 points (range, 56 to 100) in the arthroscopic group, compared with 89 points (range, 53 to 100 and 57 to 100 for the Rowe and Constant scores, respectively) for both scores in the open group. The only significant difference was in external rotation in abduction, which was 90 degrees (range, 50 degrees to 135 degrees) in the arthroscopic group and 80 degrees (range, 25 degrees to 115 degrees) in the open group. Both methods produced stable and well-functioning shoulders in the majority of patients.

Unbiased evaluation of the arthroscopic extra-articular technique for Bankart repair: a clinical and radiographic study with a 2- to 5-year follow-up.

This study performed an unbiased reexamination of patients who at least 2 years previously had undergone an arthroscopic extra-articular Bankart repair and prospectively evaluated the development of degenerative changes in the shoulder. Two unbiased observers who had never seen the patients before and had in no way been involved in the treatment of the patients were given unlimited access to the patients' files, surgical reports, and radiographs. Of the 80 patients 72 (90%) attended the follow-up 42.5 months (24-66) after the index procedure. Failures in terms of stability (redislocations and subluxations) were recorded in 14% of the patients. The Rowe score was 97 points (51-100), the Constant score was 94 (56-100) in injured shoulders and 97 points (80-100) in noninjured shoulders (P = 0.002). A return to the preinjury level of activity was recorded in 73% of the patients. There was a significant increase in degenerative changes between the pre- and postoperative radiographic assessments (P < 0.0001). At 2- to 5-year follow-up therefore the extra-articular arthroscopic Bankart repair resulted in stable and well-functioning shoulders in a high percentage of patients. However, the signs of radiographic degenerative changes increased between the preoperative assessments and the 2- to 5-year follow-up.

Preconditioning patellar tendon autografts in arthroscopic anterior cruciate ligament reconstruction: a prospective randomized study.

This prospective randomized evaluated the effect of preconditioning patellar tendon autografts before implantation and fixation during anterior cruciate ligament (ACL) reconstruction. Fifty-three patients with a unilateral ACL rupture were included in the study. One group of patients had their patellar tendon autograft preconditioned by passive stretching at a constant load of 39 N for 10 min immediately prior to implantation (group P). The other group underwent no preconditioning before the implantation of the graft (group NP). The follow-up examination was performed by independent observers after 26 months (23-29) in group P and after 25 months (23-30) in group NP (n.s.). At follow-up the KT-1000 laxity test revealed a total side-to-side difference of 2.5 mm (-1.5 to +8.5) in group P and 3.0 mm (-7 to +6.5) in group NP (n.s.). The Lysholm score was 86 points (47-100) in group P and 94 points (44-100) in group NP (n.s.). The Tegner activity level was 6 (2-9) in group P and 7 (3-9) in group NP (n.s.). There was no significant difference between the study groups regarding IKDC classification. Patients who underwent ACL reconstruction using a preconditioned patellar tendon autograft had no advantages in terms of restoration of laxity or clinical outcome at 2-year follow-up.

Evaluation of the reproducibility of the KT-1000 arthrometer.

The aim of the study was to examine whether the KT-1000 arthrometer was reliable when it came to distinguishing between a group of patients with a chronic anterior cruciate ligament (ACL) rupture and a group of patients without an ACL rupture, and to examine the reproducibility of the examination between two experienced examiners. The aim was also to examine whether the KT-1000 measurements were dependent on whether the patients were awake or under anaesthesia. The study comprised 40 patients: Group A consisted of 20 patients who had a chronic unilateral ACL rupture and Group B consisted of 20 patients who were scheduled for arthroscopy due to knee problems other than an ACL rupture. The KT-1000 examination was performed before surgery by two experienced physiotherapists (PT I and PT II). PT II subsequently performed a retest of the patients under anaesthesia. The mean anterior side-to-side laxity difference between PT I and PT II was 0.2 mm in Group A and 1.8 mm in Group B (n.s., P=0.03). The anterior side-to-side measurements of knee laxity revealed significant differences between Group A and Group B, independent of who the measurements were made by when the patients were awake (PT I P=0.011, PT II P=0.001). However, no significant difference (P=0.063) was found when the patients were under anaesthesia. The interclass correlation coefficient (ICC) between PT I and PT II in Group A was 0.55 (P=0.005) for the anterior side-to-side laxity, while it was 0.60 (P=0.002) in Group B. There were no significant differences within Group A or Group B between the measurements made when people were awake compared with those under anaesthesia. The conclusions of the study were that the KT-1000 arthrometer was able to distinguish a group of patients with an ACL rupture from a group without one. The reproducibility of the KT-1000 measurements of anterior knee laxity between two experienced examiners was considered as fair. Furthermore, the measurements were not dependent on whether the patients were awake or under anaesthesia.

Functional outcome of anterior cruciate ligament reconstruction in recreational and competitive athletes.

The aim of this study was to compare the outcome after anterior cruciate ligament reconstruction in recreational and competitive athletes, with a minimum follow-up of two years. Forty-nine patients (24 males and 25 females) who, at the time of the index injury, were classified as recreational athletes (Tegner level 2-5) were compared with 226 patients (61 females and 165 males) who, at the time of the index injury, were classified as competitive athletes (Tegner level 9-10). At the follow-up, no significant differences were found between the study groups in terms of the Lysholm score, IKDC evaluation system, one-leg-hop test, KT-1000 laxity measurements, anterior knee pain and the patients' subjective evaluation of the results. However, the competitive athletes displayed a significantly higher reduction in Tegner activity level than the recreational athletes. The functional and objective results after anterior cruciate ligament reconstruction were comparable for the recreational and competitive athletes. We, therefore, conclude that anterior cruciate ligament reconstruction could be recommended for recreational athletes as well as competitive athletes.

Evaluation of harvested and normal patellar tendons: a reliability analyses of magnetic resonance imaging and ultrasonography.

This study compared the reliability (interchangeability) of magnetic resonance imaging (MRI) and ultrasonography (US) examinations of the patellar tendon after using central third patellar tendon autografts during anterior cruciate ligament reconstruction. Nineteen consecutive patients (7 women, 12 men) underwent bilateral MRI and US of the patellar tendons 27 (24-29) months after anterior cruciate ligament reconstruction using ipsilateral central third patellar tendon autografts. Two experienced radiologists blinded to one another evaluated the examinations. Measurements of the length of the noninjured patellar tendon showed the greatest reliability between MRI and US, with no systematic difference (P=0.48), a small mean difference (-0.1 mm), and an interclass correlation coefficient of 0.74. The measurements of the thickness and width of the noninjured side were also judged as reliable. However, on the injured side a lower reliability was found between MRI and US. We conclude that MRI and US are reliable (interchangeable) methods only for evaluating noninjured patellar tendons.

Comparison of traditional and subcutaneous patellar tendon harvest. A prospective study of donor site-related problems after anterior cruciate ligament reconstruction using different graft harvesting techniques.

Our goal was to compare the results after anterior cruciate ligament reconstruction using either the traditional one-incision or the subcutaneous two-incision technique to harvest the central third of the patellar tendon, particularly concerning disturbances in anterior knee sensitivity and the patient's ability to walk on his or her knees. One surgeon performed anterior cruciate ligament reconstruction on 124 patients with unilateral ruptures and no history of previous incisions in the anterior knee region. The traditional one-incision graft harvesting technique was used in 58 patients and the subcutaneous two-incision technique was used in 66 patients. At 2 years, the International Knee Documentation Committee classification, Lysholm score, arthrometry side-to-side difference, and single-legged hop test showed no significant differences between groups. The area of insensitivity was a median of 24 cm2 in the traditional harvest group and 0 cm2 in the subcutaneous harvest group. The patients with subcutaneous harvest had a tendency toward fewer problems during walking on their knees than did the patients with traditional harvest. Our conclusion is that the subcutaneous two-incision graft harvesting technique caused less disturbance in anterior knee sensitivity and a tendency of less discomfort during walking on one's knees than the traditional one-incision technique.

Absorbable implants for open shoulder stabilization: a clinical and serial radiographic evaluation.

PATIENTS AND METHODS: Eighteen consecutive patients who had recurrent, unidirectional, post-traumatic shoulder instability were included. All the patients underwent surgery with a standardized open Bankart technique involving absorbable suture anchors. CLINICAL RESULTS: No redislocations occurred during the study period of 31 months (range 25 to 38 months). The Rowe and Constant scores were 86 points (range 61 to 98 points) and 89 points (range 73 to 99 points), respectively. The strength measurements revealed 8.6 kg (range 3.8 to 15 kg) in 90 degrees abduction compared with 9.3 kg (range 2.2 to 16.5 kg) in the control shoulders (not significant). The external rotation in abduction was 65 degrees (range 20 degrees to 90 degrees) compared with 91 degrees (range 80 degrees to 105 degrees) in the control group (P < .001). RADIOGRAPHIC RESULTS: Signs of minor or moderate degeneration were found in 10 of 18 patients on the preoperative radiographs, in 15 of 18 at 7 months, and in 16 of 18 at 33 months (P < .05 before surgery vs 33 months). From the preoperative examination to the 7-month control, 7 of 18 patients had an increase in degenerative changes, and from the 7-month to the 33-month control, an increase was found in 8 of 18 (P = .008, before surgery vs 7 months; P = .005, 7 months vs 33 months). At the 7-month control, 8 of 18 patients had invisible or hardly visible drill holes, and 10 of 18 had visible or cystic drill holes at the site of implantation for the absorbable suture anchors. At the 33-month control, 10 of 18 patients had invisible or hardly visible drill holes, and 8 of 18 had visible or cystic drill holes (not significant, 7 months vs 33 months). CONCLUSION: The method resulted in stable shoulders in 17 of 18 patients. Degenerative changes were present on the radiographs in most of the patients and appeared to increase over time. Visible drill holes or drill holes with cystic changes were seen on the radiographs in a significant number of patients at the 7-month and the 33-month control and did not appear to heal during the follow-up period.

A clinical and radiographic comparison of absorbable and non-absorbable suture anchors in open shoulder stabilisation.

The aim of this study was to compare the clinical and radiographic results using either absorbable or non-absorbable suture anchors in patients with recurrent unidirectional, post-traumatic shoulder dislocations. All patients had a Bankart lesion. One surgeon operated on 33 consecutive patients, 27 males and six females. Group A comprised 15 shoulders and group B 18 shoulders, all of which underwent a standardised open Bankart reconstruction using 3.7-mm TAG suture anchors. In group A, absorbable anchors were used, while in group B, non-absorbable ones were used. There was one re-dislocation in each group. In group A, the Rowe and Constant scores were 89 (69-98) and 89 (76-99) points, respectively. The corresponding values in group B were 87 (44-98) (not significant; NS) and 90 (71-100) points (NS). The strength measurements revealed 8.1 (3.8-12.3) kg in 90 degrees abduction in group A and 10.0 (6.7-12.0) kg in group B. Healthy control shoulders revealed 10.2 (4.5-13.2) kg (NS A and B versus controls). The external rotation in abduction was 70 degrees (40-90) in group A and 80 degrees (40-100) in group B. The value for the controls was 90 degrees (80-120) [P < 0.001 (A versus controls), P < 0.05 (A versus B) and P < 0.001 (B versus controls)]. The radiographs revealed that 9/15 (60%) in group A and 10/15 (66%) in group B had visible drill holes or cystic formations in conjunction with the drill holes (NS). Furthermore, 11/15 (73%) in group A and 10/15 (66%) in group B had signs of minor degeneration (NS). We conclude that, in terms of stability and clinical results, no differences were found between the study groups. Both groups demonstrated a restriction in external rotation as compared with the healthy shoulders in the same cohort. On the radiographs, visible drill holes or cystic formations in conjunction with the drill holes were seen with equal frequency, regardless of whether absorbable or non-absorbable suture anchors were used.

The localization of the infrapatellar nerves in the anterior knee region with special emphasis on central third patellar tendon harvest: a dissection study on cadaver and amputated specimens.

The aim of this dissection study on cadaver and amputated specimens was to determine the position of the infrapatellar nerves in the anterior knee region, and to investigate whether it would be possible to harvest the patellar tendon through two small vertical incisions, leaving the infrapatellar nerves undamaged and the major part of the paratenon intact. The infrapatellar nerve did not pass through the area between the apex of the patella and the tibial tubercle in 1 of 60 specimens. The nerve passed through this area as one branch in 15 of 60 specimens, as two branches in 37 of 60, as three in 6 of 60, and as four in 1 of 60 specimens. The distance from the apex of the patella to the infrapatellar nerve or the uppermost branch of the nerve was 30 mm (+/- 27 mm [2 SD]). The distance from the tibial tubercle to the infrapatellar nerve or the lowermost branch of the nerve was 27 mm (+/- 27 mm [2 SD]). In one specimen, the infrapatellar nerve passed 10 mm distal to the tibial tubercle. In 4 of 60 specimens, a branch of the infrapatellar nerve passed just above the tibial tubercle, and in 2 of 60 a branch passed just above the apex of the patella. In 19 of 20 specimens in which the harvesting procedure was performed, the infrapatellar nerve or the nerve branches were undamaged. The length of the undamaged paratenon was 27 mm (+/- 23 mm [2 SD]). This study showed that it was possible to harvest consistent bone-patellar tendon-bone autografts through two vertical 25-mm incisions, leaving the infrapatellar nerve undamaged and the paratenon partially intact in the majority of the cadaver and amputated specimens.

Arthroscopic and open shoulder stabilization using absorbable implants. A clinical and radiographic comparison of two methods.

The aim of this study was to compare the clinical and radiographic results in patients with recurrent unidirectional, post-traumatic shoulder instability (dislocations/subluxations). All the patients had a Bankart lesion and underwent reconstruction using either an open or an arthroscopic technique and absorbable implants. Thirty-three consecutive patients (36 shoulders) were operated on by one surgeon. Group A comprised 18 shoulders which underwent an open Bankart reconstruction using absorbable 3.7-mm TAG suture anchors. Group B comprised 18 shoulders which underwent a combination of an intra- and extra-articular arthroscopic stabilization using 8-mm Suretac fixators. The median number of dislocations before the reconstruction was 5(0-45) in group A and 4 (0-30) in group B (NS). The follow-up examination was performed by an independent observer after a median of 31 (range 25-38) months in group A and 28 (range 18-46) months in group B (NS). An independent radiologist without any knowledge of the surgical procedure evaluated all the radiographs. There were no re-dislocations in either group. In group A, the Rowe and Constant scores were 86 (range 61-98) and 89 (range 73-99), respectively. The corresponding values in group B were 92 (range 83-98; P = 0.05) and 96 (range 75-100; NS). The external rotation in abduction was 65 degrees (range 20 degrees-90 degrees) in group A and 83 degrees (range 65 degrees-105 degrees) in group B (P = 0.0017). The radiographs revealed that 10/18 (56%) in group A and 4/18 (23%) in group B had visible drill-holes or cystic formations in conjunction with the drill-holes (P = 0.002). In this study the open procedure resulted in a restriction in external rotation more frequently than the arthroscopic procedure. The radiographs revealed visible drill-holes or cystic formations in conjunction with the drill-holes more frequently when TAG suture anchors were used than when Suretac fixators were used. The radiographic changes did, not appear to affect the clinical outcome, however.