Anterior cruciate ligament reconstruction with a single hamstring tendon graft and tape locking screw (TLS) fixation leads to good clinical outcome in two years of follow-up.

Background: There are many fixation methods for hamstring tendon autograft available for anterior cruciate ligament (ACL) reconstruction. The intention of this study was to report clinical follow-up data of the Tape Locking Screw (TLS) reconstruction technique. Hypothesis: Does TLS method give good long term results in patient satisfaction and in clinical knee tests. Patients and methods: We selected 119 prospectively collected patients with a two-year follow-up who had an ACL reconstruction using TLS technique. A total of 114 cases were available for follow-up two years postoperatively. The evaluation methods were instrumented laxity measurements, clinical examination and knee scores. Results: The Lysholm and IKDC scores improved from preoperative 76 and 50 to 95 and 90, respectively. Tegner activity level before surgery was 3 and improved to 6 at 2 years postoperatively. Discussion: ACL reconstruction with TLS technique showed good objective outcome at the 2-year follow-up. We confirmed improvement in all evaluation method variables. Level of evidence: Case series; level of evidence, 4. Trial registration: ISRCTN registry, study ID ISRCTN34011837. Registered retrospectively April 29, 2020.

Patient injury claims for posterior cruciate ligament injury: a nationwide registry study in Finland.

BACKGROUND AND PURPOSE: Posterior cruciate ligament (PCL) injuries usually occur in combination with other ligamentous knee injuries. The outcome varies and may be poor due to suboptimal treatment. We investigated claims following PCL injury treatment on a nationwide scale. PATIENTS AND METHODS: All patient PCL injury claims filed in Finland from 1997 to 2015 were collected from the Patient Insurance Centre (PIC) register. We reviewed and analyzed all records to determine the causes of claims. General background data were obtained from the National Care Register for Social Welfare and Health Care (HILMO). RESULTS: We found out from HILMO background data that, during the 19-year study period, 1,891 PCL and 1,380 multiligament reconstructions were performed in 99 different hospitals. The number of PCL injuries treated conservatively is unknown. During this same period, 49 claims arrived at the PIC, and 39/49 of these patients were operated on. 12/49 claims were compensated. Of these 12 claims, 6 were compensated for technical errors and 4 were compensated for diagnostic delays. CONCLUSION: The number of patient injury claims was few, and compensated claims were even fewer. Technical errors and diagnostic delays were the most common reasons for reimbursement.

A prospective comparison of 3 hamstring ACL fixation devices-rigidfix, bioscrew, and intrafix-randomized into 4 groups with a minimum follow-up of 5 years.

BACKGROUND: ACL (anterior cruciate ligament) reconstruction remains the gold standard surgical option for patients with ACL tears. There are many fixation devices available for ACL reconstruction. Recent ACL reconstruction strategies are aiming to reproduce the native anatomy and normal kinematics of the knee. This is a five years follow-up report of some of the new devices for graft fixation. A two years follow-up data was published previously. METHODS: 120 patients were randomized into four different groups (30 each) for ACL reconstruction with hamstring tendons: group I femoral Rigidfix cross-pin and Intrafix tibial extension sheath with a tapered expansion screw; group II Rigidfix femoral and BioScrew interference screw tibial fixation; group III BioScrew femoral and Intrafix tibial fixation; group IV BioScrew fixation into both tunnels. The evaluation methods were clinical examination, knee scores, and instrumented laxity measurements. RESULTS: In this 5 years follow-up there were 102/120 (85%) patients available, but only 77 (64,2%) attended the clinical examinations. No significant difference between the groups in the clinical results was detected. Between the 2 and 5 years follow-up there were 6 additional procedures in group I and one in group II. There was a significant difference in additional procedures between group I and the other groups (P = .041). CONCLUSION: There was a statistically significant difference in the additional procedures, most in group I (six). The ACL grafts were intact. Other statistically or clinically significant differences in the 5 years follow-up results were not found. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. Trial registration ISRCTN registry with study ID ISRCTN34011837. Retrospectively registered 17.4.2020.

Comparison of clinical results of anteromedial and transtibial femoral tunnel drilling in ACL reconstruction.

BACKGROUND: A femoral bone tunnel in ACL reconstruction can be constructed from the outside in or from the inside out. When doing it inside out, the approach can be via the anteromedial (AM) portal or through the tibial bone tunnel. It has been suggested that better results might be expected by doing it anteromedially. Clinical results after femoral tunnel drilling via the AM or transtibial (TT) techniques in reconstruction of anterior cruciate ligament (ACL) are presented. METHODS: Three hundred patients with ACL injuries were chosen for this study from previously collected data on ACL reconstructions. They were divided into two groups: 150 patients treated with AM drilling and 150 treated with TT drilling. In the AM group, the reconstructions were performed using a semitendinosus graft with the Tape Locking Screw (TLS™) technique (n = 87) or Retrobutton™ femoral and BioScrew™ tibial fixation with a semitendinosus-gracilis graft (n = 63). In the TT group, the fixation method used was Rigidfix™ femoral and Intrafix tibial fixation with a semitendinosus-gracilis graft. The evaluation methods were clinical examination, knee scores (Lysholm, Tegner and IKDC) and instrumented laxity measurements (KT-2000™). Our aim was to evaluate if there was better rotational stability and therefore better clinical results when using AM drilling compared to TT drilling. RESULTS: After excluding revision ACL reconstructions, there were 132 patients in the AM group and 133 in the TT group for evaluation. At the 2-year follow-up, there were 60 patients in the AM group (45.5%) and 58 in the TT group (43.6%). There were no statistically significant differences between the groups in any of the evaluation methods used. CONCLUSION: Both drilling techniques resulted in improved patient performance and satisfaction. We found no data supporting the hypothesis that the AM drilling technique provides better rotational stability to the knee. TRIAL REGISTRATION: ISRCTN registry with study ID ISRCTN16407730. Retrospectively registered Jan 9th 2020.

Anterior cruciate ligament reconstruction-related patient injuries: a nationwide registry study in Finland.

Background and purpose - Treatment outcomes of anterior cruciate ligament (ACL) injuries are generally good, but complications after ACL reconstruction (ACLR) can result in long-lasting problems. Patient injury claims usually fall on the more severe end of the complication spectrum. They are important to investigate because they may reveal the root causes of adverse events, which are often similar regardless of the complication's severity. Therefore, we analyzed ACL-related patient injuries in Finland, the reasons for these claims, causes of complications, and grounds for compensation.Patients and methods - We analyzed all claims filed at the Patient Insurance Centre (PIC) between 2005 and 2013 in which the suspected patient injury occurred between 2005 and 2010. This study also reviewed all original patient records and available imaging studies. General background data were obtained from the National Care Register for Social Welfare and Health Care (HILMO).Results - There were 248 patient injury claims, and 100 of these were compensated. Compensated claims were divided into 4 main categories: skill-based errors (n = 46), infections (n = 34), knowledge-based errors (n = 6), and others (n = 14). Of the compensated skill-based errors, 34 involved graft malposition, 26 of them involved the femoral-side tunnel. All compensated infections were deep surgical site infections (DSSI).Interpretation - This is the first nationwide study of patient injuries concerning ACLRs in Finland. The most common reasons for compensation were DSSI and malposition of the drill tunnel. Therefore, it would be possible to decrease the number of serious complications by concentrating on infection prevention and optimal surgical technique.

Toll-like receptors and their soluble forms differ in the knee and thumb basal osteoarthritic joints.

Background and purpose - Although the pathogenesis of osteoarthritis (OA) is not well understood, chondrocyte-mediated inflammatory responses (triggered by the activation of innate immune receptors by damage-associated molecules) are thought to be involved. We examined the relationship between Toll-like receptors (TLRs) and OA in cartilage from 2 joints differing in size and mechanical loading: the first carpometacarpal (CMC-I) and the knee. Patients and methods - Samples of human cartilage obtained from OA CMC-I and knee joints were immunostained for TLRs (1-9) and analyzed using histomorphometry and principal component analysis (PCA). mRNA expression levels were analyzed with RT-PCR. Collected synovial fluid (SF) samples were screened for the presence of soluble forms of TLR2 and TLR4 by enzyme-linked immunosorbent assay (ELISA). Results - In contrast to knee OA, TLR expression in CMC-I OA did not show grade-dependent overall profile changes, but PCA revealed that TLR expression profiles clustered according to their cellular compartment organization. Protein levels of TLR4 were substantially higher in knee OA than in CMC-I OA, while the opposite was the case at the mRNA level. ELISA assays confirmed the presence of soluble forms of TLR2 and TLR4 in SF, with sTLR4 being considerably higher in CMC-I OA than in knee OA. Interpretation - We observed that TLRs are differentially expressed in OA cartilage, depending on the joint. Soluble forms of TLR2 and TLR4 were detected for the first time in SF of osteoarthritic joints, with soluble TLR4 being differentially expressed. Together, our results suggest that negative regulatory mechanisms of innate immunity may be involved in the pathomolecular mechanisms of osteoarthritis.

Soluble biglycan: a potential mediator of cartilage degradation in osteoarthritis.

BACKGROUND: Soluble biglycan (sBGN) and soluble decorin (sDCN), are two closely related essential components of extracellular matrix which both have been shown to possess proinflammatory properties. We studied whether sBGN or sDCN were present in synovial fluid (SF) of osteoarthritis (OA) or rheumatoid arthritis (RA) patients and studied sBGN or sDCN potential role in the degradation of OA cartilage. METHODS: SF obtained from meniscus tear, OA, and RA patients were analysed for sBGN and sDCN using enzyme-linked immunosorbent assays. OA chondrocytes and cartilage explants were stimulated for 48 h with 5 µg/ml sBGN or 1 µg/ml lipopolysaccharide. Messenger RNA (mRNA) levels of Toll-like receptors (TLRs), proteinases and cartilage matrix molecules were determined using quantitative real-time polymerase chain reaction. Protein levels of matrix metalloproteinases (MMPs) and cytokines were measured using Luminex xMap technology. Production of nitric oxide (NO), release of proteoglycans and soluble collagen were measured from conditioned culture media using biochemical assays. OA cartilage explant proteoglycans were stained for Safranin O and quantified using image analysis. TLR4 activation by sBGN and sDCN was studied in engineered HEK-293 cells with TLR4 signalling genes inserted together with a reporter gene. RESULTS: sBGN was found in meniscus tear SF (14 ± 2 ng/ml), OA SF (582 ± 307 ng/ml) and RA SF (1191 ± 482 ng/ml). Low levels of sDCN could also be detected in SF of meniscus tear (51 ± 4) ng/ml, OA (52 ± 3 ng/ml), and RA (49 ± 4 ng/ml). Stimulation of chondrocytes with sBGN increased significantly the mRNA and protein expression of catabolic MMPs, including MMP1, MMP9 and MMP13, and of inflammatory cytokines interleukin (IL)-6 and IL-8, whereas the expression of anabolic markers aggrecan and collagen type II was decreased. sBGN induced release of proteoglycans, collagen and NO from chondrocytes and cartilage explants. The catabolic response in explants was dependent of OA cartilage degradation stage. The mechanism of action of sBGN was mainly mediated through the TLR4-nuclear factor-κB pathway. CONCLUSIONS: High levels of sBGN was found in advanced OA and RA SF. sBGN activates chondrocytes mainly via TLR4, which results in net loss of cartilage. Thus, sBGN can be a mediator of OA cartilage degradation and also a potential biomarker for arthritis.

A randomized prospective controlled study with 5-year follow-up of cross-pin femoral fixation versus metal interference screw fixation in anterior cruciate ligament reconstruction.

PURPOSE: The purpose of this study was to determine and compare mid- to long-term results of cross-pin versus metal interference screw fixation of ACL graft. METHODS: In a prospective trial, 62 patients were randomized into two groups based on method of fixation. Transtibial drilling technique was used in the cross-pin and outside-in femoral drilling in the interference screw fixation group. Clinical and radiographical outcomes were assessed 2 and 5 years postoperatively. RESULTS: The study showed no clinically significant difference with respect to method of graft fixation. Mean anteroposterior side-to-side instrumented laxity difference was 2.4 mm in the cross-pin group and 2.5 mm in the screw group (n.s.). Median Tegner and mean Lysholm scores at 5 years were 6 (range 3-9) and 92.2 (range 69-100) in the screw group and 7 (3-10) and 93.3 (82-100), respectively, in the cross-pin group. Radiographical osteoarthritis increased in both groups from 2 to 5 years after reconstruction (p < 0.05), especially in the medial and patellofemoral joint spaces. Widening of the drill tunnels continued from 2 to 5 years without clinical significance. CONCLUSIONS AND CLINICAL RELEVANCE: The method of graft fixation did not yield a difference in clinical or radiographical outcome at 5 years. Results were excellent in both groups. LEVEL OF EVIDENCE: I.

Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: 5-year follow-up.

OBJECTIVE: To study the long-term outcome of arthroscopy in patients with chronic patellofemoral pain syndrome (PFPS), the authors conducted a randomised controlled trial. The authors also investigated factors predicting the outcome in patients with PFPS. METHODS: Fifty-six patients with PFPS were randomised into two groups: an arthroscopy group (N=28), treated with knee arthroscopy and an 8-week home exercise programme, and a control group (N=28), treated with a similar 8-week home exercise programme only. The primary outcome was the Kujala score on pain and function at 5-year. Secondary outcomes were visual analogue scales (VASs) to assess activity-related symptoms. RESULTS: According to the Kujala score, both groups showed a marked improvement during the 5-year follow-up: a mean improvement of 14.7 (95% CI 9.9 to 19.4) in the arthroscopy group and 13.5 (95% CI 8.1 to 18.8) in the controls. No differences between the groups in mean improvement in the Kujala score (group difference 1.2 (95% CI -8.4 to 6.1)) or in the VAS scores were found. None of the investigated factors predicted the long-term outcome, but in most of the cases the treatment result immediately after the exercise programme remained similar also after the 5-year follow-up. CONCLUSION: Our RCT, being the first of its kind, indicates that the 5-year outcome in most of the patients with chronic PFPS treated with knee arthroscopy and home exercise programme or with the home exercise programme only is equally good in both groups. Some of the patients in both groups do have long-term symptoms.

Results of total knee replacement with a cruciate-retaining model for severe valgus deformity--a study of 48 patients followed for an average of 9 years.

The objectives of the present study were to find out the results and the factors affecting survival after primary knee arthroplasty with a cruciate-retaining prosthesis in severe valgus deformity. Forty-eight patients (52 knees) participated in the current follow-up study. All patients were followed at least 5 years or to first revision. Mean follow-up time was 9 years (range, 1 to 17 years).The Kaplan-Meier analysis revealed 79% (95% CI 68% to 91%) survival rate with revision for any reason and 81% (95% CI 70% to 93%) survival rate with revision for instability as an endpoint at 10 years. Preoperatively TFA was 23° (range, 15°-51°) in valgus and 7° (range, 21° valgus-4° varus) in valgus postoperatively. Of the 14 re-operated patients, eight were revised because of progressive postoperative medial collateral ligament instability. All re-operations were performed during the first 4 years of the follow-up. The mean TFA was 15.5° valgus postoperatively for those eight and the odds ratio for a revision was 2 (95% CI 1-3, p = 0.025) when compared to the rest of the study population. The residual valgus deformity increases the risk of re-operation and it should be avoided. If proper soft-tissue balance cannot be achieved or there is no functional medial collateral ligament present more constrained implants should be used. In selected cases where both bony correction and ligament balancing have properly been achieved the use of a cruciate-retaining type of prosthesis is justified.

A prospective comparison of 3 hamstring ACL fixation devices--Rigidfix, BioScrew, and Intrafix--randomized into 4 groups with 2 years of follow-up.

BACKGROUND: New devices for graft fixation in anterior cruciate ligament reconstruction are released to clinical use without clinical follow-up data. HYPOTHESIS: There is similar clinical outcome after either cross-pin or absorbable interference screw fixation in anterior cruciate ligament reconstruction with hamstring tendons. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. METHODS: A total of 120 patients were randomized into 4 different groups (30 each) for anterior cruciate ligament reconstruction with hamstring tendons: femoral Rigidfix cross-pin and Intrafix tibial expansion sheath with a tapered expansion screw; Rigidfix femoral and BioScrew interference screw tibial fixation, BioScrew femoral and Intrafix tibial fixation; or BioScrew fixation into both tunnels. The evaluation methods were clinical examination, knee scores, and instrumented laxity measurements. RESULTS: Ten patients were completely lost to follow-up and 3 revisions were done before the 2-year follow-up, leaving 107 of 120 (89%) patients for analysis. No statistically significant differences between the groups were seen 2 years postoperatively, and all but 2 patients in the Rigidfix/Intrafix and Rigidfix/BioScrew groups, respectively, were classified into International Knee Documentation Committee A or B categories. A revision reconstruction was performed before the 2-year follow-up in 2 cases after a high-energy injury caused a rerupture (1 in Rigidfix/Intrafix and 1 in BioScrew/BioScrew groups). In addition, there were 4 nontraumatic failures revised before the 2-year follow-up (2 in Rigidfix/Intrafix and 1 each in Rigidfix/BioScrew and BioScrew/BioScrew). CONCLUSION: There were no statistically or clinically relevant differences in the results 2 years postoperatively, and all 4 techniques improved patient performance.

Medial unicompartmental knee arthroplasty with Miller-Galante II prosthesis: mid-term clinical and radiographic results.

AIM: The purpose of our study was to evaluate retrospectively the mid-term results of the Miller-Galante II (Zimmer, Warsaw, USA) unicondylar knee arthoplasty (UKA). METHOD: The study included 46 patients with medial UKAs. Mean follow-up time was 7.0 years (range 2.7-13.1 years). RESULTS: Survival rate of the prosthesis was 86.6% (95% CI 73.7-99.6) at 7 years. The mean clinical and functional Knee Society Scores had increased from 51 and 62 points preoperatively to 76 and 93 points (P < 0.001) postoperatively. Five of the 46 knees were revised because of excessive wear of the polyethylene liner, and three due to progression of the osteoarthritis in the lateral compartment of the knee. CONCLUSION: Survival of this fixed-bearing UKA was not as good as previously reported and polyethylene wear seems to be a more common problem than previously assumed.

Isokinetic quadriceps and hamstring muscle strength and knee function 5 years after anterior cruciate ligament reconstruction: comparison between bone-patellar tendon-bone and hamstring tendon autografts.

Existing clinical studies have not proven which graft is to be preferred in anterior cruciate ligament (ACL) reconstruction. In recent years, bone-patellar tendon-bone and hamstring tendons have been the most frequently used graft types. Muscle strength deficit is one of the consequences after ACL reconstruction. The aim of this study was to evaluate possible differences in hamstring and quadriceps muscle strength and knee function 5 years after ACL reconstruction between the BPTB and the STG groups. The study group consisted of 288 patients (132 women, 156 men) with a unilateral ACL rupture who had received a BPTB (175 patients) or STG (113 patients) ACL reconstruction. Lower extremity concentric isokinetic peak extension and flexion torques were assessed at the angular velocities of 60 degrees /s and 180 degrees /s. The International Knee Documentation Committee (IKDC), the Tegner activity level, the Lysholm knee and the Kujala patellofemoral scores were also collected. Isokinetic quadriceps peak torque (percentage of the contralateral side) was 3.9% higher in the STG group than in the BPTB group at the velocity of 60 degrees /s and 3.2% higher at the velocity of 180 degrees /s and the isokinetic hamstring peak torque 2% higher in the BPTB group than in the STG group at the velocity of 60 degrees /s and 2.5% higher at the velocity of 180 degrees /s. In both groups the subjects had weaker quadriceps and hamstring muscle strength in the injured extremity compared with the uninjured one. In the single-leg hop test (according to the IKDC recommendations) there was a statistically significant difference (P = 0.040) between the groups. In the STG group, 68% of the patients had the single-leg hop ratio (injured vs. uninjured extremity) > or =90%, 31% of the patients 75-89% and 1% of the patients <75%, while in the BPTB group the corresponding percentages were 72, 21 and 7%. However, no statistically significant differences in clinical outcome were found between the groups as determined by the IKDC, Tegner activity level, Lysholm knee and Kujala patellofemoral scores.

Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized controlled trial.

BACKGROUND: Arthroscopy is often used to treat patients with chronic patellofemoral pain syndrome (PFPS). As there is a lack of evidence, we conducted a randomized controlled trial to study the efficacy of arthroscopy in patients with chronic PFPS. METHODS: A total of 56 patients with chronic PFPS were randomized into two treatment groups: an arthroscopy group (N = 28), treated with knee arthroscopy and an 8-week home exercise program, and a control group (N = 28), treated with the 8-week home exercise program only. The arthroscopy included finding-specific surgical procedures according to current recommendations. The primary outcome was the Kujala score on patellofemoral pain and function at 9 months following randomization. Secondary outcomes were visual analog scales (VASs) to assess activity-related symptoms. We also estimated the direct healthcare costs. RESULTS: Both groups showed marked improvement during the follow-up. The mean improvement in the Kujala score was 12.9 (95% confidence interval (CI) 8.2-17.6) in the arthroscopy group and 11.4 (95% CI 6.9-15.8) in the control group. However, there was no difference between the groups in mean improvement in the Kujala score (group difference 1.1 (95% CI -7.4 - 5.2)) or in any of the VAS scores. Total direct healthcare costs in the arthroscopy group were estimated to exceed on average those of the control group by euro901 per patient (p < 0.001). CONCLUSION: In this controlled trial involving patients with chronic PFPS, the outcome when arthroscopy was used in addition to a home exercise program was no better than when the home exercise program was used alone. TRIAL REGISTRATION: Current Controlled Trials ISRCTN 41800323.

The effect of graft placement on the clinical outcome of the anterior cruciate ligament reconstruction: a prospective study.

The effect of the graft placement on the clinical outcome of patients after anterior cruciate ligament (ACL) reconstruction has been studied sparsely. We conducted a prospective follow-up of 140 patients who underwent an arthroscopic ACL reconstruction with a hamstring graft. One hundred and four of them (74%) could be examined at the 2-year follow-up. Clinical examination included Lysholm, Tegner, and International Knee Documentation Committee rating scores, arthrometric anterior-posterior knee laxity assessment, and muscle strength assessments. The graft placement was measured from lateral radiographs using a system recommended for measuring the attachment positions of the cruciate ligaments as well as a method called 'the sumscore of the graft placement', which takes into account both the femoral and the tibial graft placements simultaneously. The sumscore was smaller in knees with normal anterior-posterior knee laxity in the Lachman test (P = 0.002) and normal rotational knee laxity in the pivot shift test (P = 0.01) than in those with abnormal laxity. The tibial graft placement was more anterior when the Lachman test was normal (P = 0.04). The Lysholm score was better when the femoral graft placement was more posterior (r = -0.20, P = 0.04). The optimal femoral graft placement was between 25 and 29% of length of the femoral condyle along the Blumensaat's line from posterior to anterior. The optimal tibial graft placement was between 32 and 37% of the length of the tibial plateau from the anterior corner, and the optimal sumscore was between 61 and 66. The sumscore and its components (the femoral and tibial graft placements) showed a clear association with the clinical outcome of the patients. The best outcome was achieved when the sumscore was small; that is the graft placement showed posterior enough in the femur, and anterior enough in the tibia.

Randomized prospective study of ACL reconstruction with interference screw fixation in patellar tendon autografts versus femoral metal plate suspension and tibial post fixation in hamstring tendon autografts: 5-year clinical and radiological follow-up results.

Patellar tendon graft has been the most frequently used material in anterior cruciate ligament (ACL) reconstruction, but the hamstring tendons have been increasingly used as well; however, which graft is to be preferred is not adequately supported by existing clinical studies. In this prospective randomized clinical trial, the study hypothesis was that the hamstring tendons are equally good graft material as the patellar tendon in ACL reconstruction. Ninety-nine patients with laxity due to a torn ACL underwent arthroscopically assisted reconstruction with graft randomization according to their birth year to either patellar tendon with metal interference screw fixation or double looped semitendinosus and gracilis tendons with fixation similar to the Endobutton technique using a titanium metal plate suspension proximally and screw-washer postdistally. Excluding preoperative Lysholm knee score, there were no significant differences between the two groups in the preoperative and operative data. A standard rehabilitation regimen was used for all the patients, including immediate postoperative mobilization without a knee brace, protected weight bearing for 2 weeks, and return to full activity at 6-12 months postoperatively. Forty patients in the patellar tendon group and 39 patients in the hamstring tendon group were available for clinical evaluation at median 5 years after surgery (ranges 3 years 11 months-6 years 7 months). The results revealed no statistically significant differences with respect to clinical and instrumented laxity testing, isokinetic muscle torque measurements, International Knee Documentation Committee ratings, Lysholm (knee score), Tegner (activity level) and Kujala patellofemoral knee scores. There was an enlargement of the drill tunnels, statistically more in the hamstring tendon group, but no increase from 2 to 5 years in either group. Narrowing of the joint spaces (IKDC measurement method) from 2 to 5 years postoperatively was seen in both the groups, however, without difference between the two groups.

Primary cartilage lesions and outcome among subjects with patellofemoral pain syndrome.

We investigated the association between cartilage lesion and future symptoms in two groups of subjects with patellofemoral pain syndrome (PFPS). Group A consisted of 31 men (mean age 20.9 years, range 19-32) and group B of 28 consecutive patients (12 men and 16 women; mean age 27.8 years, range 15-50) operated on for PFPS. The mean follow-up time was 3.4 (range 1-7) years in group A and 4.9 (range 1-6) years in group B. At follow-up the subjects in group A with severe cartilage lesion (n = 10) reported more knee symptoms as measured by their Kujala score (mean 75.1, SE 3.6 vs. 88.5, SE 2.4) than those with minor cartilage lesion (n = 21) (age and follow-up time-adjusted P < 0.01). In group B the subjects with severe cartilage lesion tended to report more knee symptoms according to their Kujala score (mean 71.0, SE 7.0 vs. 86.1, SE 5.9; age, sex and follow-up time-adjusted P = 0.15) and VAS score (mean 51.8, SE 11.8 vs. 12.7, SE 10.4; adjusted P = 0.04) than the subjects without cartilage lesion. Our study shows that among the patients with PFPS, the subjects with severe cartilage lesion of the patella or femoral trochlea reported more subjective symptoms and functional limitations at follow-up than those without or with small cartilage lesion of the patella or femoral trochlea.

Cross-pin femoral fixation versus metal interference screw fixation in anterior cruciate ligament reconstruction with hamstring tendons: results of a controlled prospective randomized study with 2-year follow-up.

PURPOSE: To determine if there is a different clinical outcome after cross-pin versus interference screw fixation in anterior cruciate ligament (ACL) reconstruction with hamstring tendons. TYPE OF STUDY: Prospective randomized clinical follow-up study. METHODS: Sixty-two patients were randomized into either TransFix cross-pin (Arthrex, Naples, FL) (TransFix group, n = 31) or metal interference screw femoral fixation (screw group, n = 31) in ACL reconstruction with hamstring tendons. The distal fixations were an AO screw with spiked washer post and metal interference screw. The evaluation methods were clinical examination, CA 4000 laxity (OSI, Hayward, CA), and Lido isokinetic muscle torque measurements (Lido MultiJoint II; Loredon, West Sacramento, CA) as well as International Knee Documentation Committee (IKDC), Tegner activity level, Lysholm knee, and Kujala patellofemoral scores. RESULTS: There were no differences between the study groups preoperatively. For the 2-year follow-up, 26 patients of the TransFix group and 30 patients of the screw group were available (90%). The evaluation methods disclosed no statistical differences between the groups at the 1- or 2-year follow-up examinations. At the 2-year follow-up, 22 (85%) of the TransFix and 22 (73%) of the screw group patients were in the IKDC A or B categories. There were significantly more additional procedures postoperatively in the TransFix group owing to the removal of the tibial fixation post hardware in 15 (48%) cases. CONCLUSIONS: There were no statistically or clinically relevant differences in the results 1 or 2 years postoperatively and both techniques seemed to improve patients' performance. LEVEL OF EVIDENCE: Level I.

Failed regrowth of the harvested semitendinosus tendon: a rare complication of tendon harvest after anterior cruciate ligament reconstruction.

Harvested hamstring tendons were recently shown to possess the ability to regrow and regain their function in flexing the knee joint. In this study, we report a case of failed regrowth of previously harvested semitendinosus tendon to its original insertion site in a 24-year-old professional soccer player. The disturbance resulted in the formation of a clearly visible Popeye-type muscular prominence in the proximal thigh and a notable gap in the midthigh distal to the muscular prominence in knee flexion. Furthermore, 6 months after surgery, in the second full-speed soccer practice, the patient experienced a sudden sharp pain in his hamstring muscles, which was later diagnosed as being from a strain of the semitendinosus muscle.