Reconstruction of the anterior cruciate ligament with carbon fibres: unsatisfactory results after 8 years.

A total of 37 patients were operated on for anterior cruciate ligament (ACL) insufficiency between 1980 and 1989 using two types of carbon fibre ligament substitutes. The average age of the population was 23.6 years. The carbon fibre prostheses were covered with either a strip of medial joint capsule or lyophilized dura. Follow-up averaged 8.1 years (range 4-13 years), most of the operations being done from 1983 to 1985. Evaluation included a questionnaire, physical examination, Lysholm scoring, radiographs and cruciometer testing. The operated ACLs were looser than those in the contralateral healthy knees. The Lysholm scoring system gave acceptable results (excellent and good) in 43.5%, fair in 31.4% and poor in 24.1% of cases. Acceptable results provided better stability and muscle strength. During the follow-up there was an evident deterioration in stability as well as in Lysholm score. The results between the two types of ligaments did not become statistically different. Osteoarthrosis increased in all the knees examined radiographically (28/37). The results indicate that the ACL reconstructions using these types of carbon fibre prostheses lead to unacceptable results in the long-term follow-up.

Long-term results of Smillie pin fixation of osteochondritis dissecans in the femoral condyles.

The purpose of this study was to determine the extent of secondary osteoarthritis after fixation of an osteochondritis dissecans fragment in the knee using Smillie pins as well as to assess the final outcome of the procedure. Eighteen patients treated for osteochondritis dissecans of the knee 10-34 years previously were re-evaluated clinically and radiologically. Moderate secondary osteoarthritis was noted in 35% of the patients, and clinically unsatisfactory result was seen in 44%. The remaining patients showed good or excellent clinical and radiological results at the follow-up.

The angle-measuring device, a practical resource in high tibial osteotomy.

Thirty-two patients with medial gonarthrosis were subjected to high tibial osteotomy. In 16 knees the base of the osteotomy wedge was measured in mm using a caliper and in another 16 knees the angle-measuring device was used. The miscorrection in correlation to the aimed angle was in the first case 0.2 +/- 4.7 degrees, and in the second case 2.4 +/- 4.1 degrees varus undercorrection. The possible sources of error according to measurement of mechanical axis deviation angle of the knee, angle-measuring device and wedge measuring technique during surgery as well as laxity of knee and age-correlated need of overcorrection are pointed out. The angle-measuring device is an important tool especially in high tibial osteotomy of the knee.

Management of the fibula in high tibial osteotomy for arthritis of the knee. Union times and complications.

An evaluation of 300 high tibial osteotomies in 285 patients showed that the more distal the fibular osteotomy the longer the union time. The union time of the tibial osteotomy was unaffected by the site of the fibular osteotomy, but union was most rapid in both when staples were used. Most complications in curved osteotomy occurred when the fibular osteotomy was performed 15 cm below the fibular head. In wedge osteotomy loosening of the staples used for fixation was the most frequent complication.

Medial and lateral gonarthrosis treated with high tibial osteotomy. A prospective study.

A prospective series comprising 52 knees in 48 patients suffering from medial or lateral unicompartmental gonarthrosis and treated by means of high tibial osteotomy shows, by comparing mechanical axis (MA) 0 degrees corrected knees, how important is the overcorrection of the MA into valgus in medial osteoarthritis. The clinical results were significantly correlated to overcorrection, the results 2 years postoperatively being better than those obtained at a follow-up 1 year after the operation. Of the results, 82% were good within a limit of +/- 3 degrees after 2 years, while only 77% were correspondingly good 1 year postoperatively. In lateral gonarthrosis overcorrection was not as good, but there was a mean overcorrection of +2 degrees, and with respect to this overcorrection, the results were quite acceptable. The results were directly correlated to the opening up of the joint space affected (80%) and diminution or disappearance of subluxation, 1/3 being 0 degrees preoperatively, 1/2 postoperatively in medial gonarthrosis. In lateral gonarthrosis, subluxation was increased, with 2/3 being 0 degrees preoperatively, 1/3 being 0 degrees postoperatively. The extension deficit in varus knees significantly diminished after valgus osteotomy; the change in valgus knees was also evident but not significant. The mean value of extension deficit was below 5 degrees in all cases at the 2 years' follow-up examination. However, 95% of all patients showed good or fair results after a follow-up period of 2 years.

Tibial torsion measured by computed tomography.

The clinical methods for measuring tibial torsion are based on the assumption that the proximal tibial tilt invariably is 0 degrees, an assumption which proved to be false in 38 legs examined using computed tomography. The conventional radiologic methods have not gained general acceptance. The various CT methods available for measurement of tibial torsion were investigated and have indicated too wide a variation to be clinically useful. At present, no reliable method for measuring tibial torsion seems to be available.