Reconstruction of the anterior cruciate ligament using the polyester ABC ligament scaffold: a minimum follow-up of four years.

We carried out a prospective study of 71 patients who had undergone reconstruction of the anterior cruciate ligament with the ABC scaffold. Their mean age was 28 years (18 to 50). All had either sub-acute or chronic traumatic deficiency of the ligament. The mean period of follow-up was five years (four to seven). Assessment included the use of the International Knee Documentation Committee score, the modified Lysholm score, the Tegner Activity score, the Knee Injury and Osteoarthritis Outcome score and measurement with the KT-1000 arthrometer. Two patients had mild recurrent synovitis. There were no infections and no failures of the ligament. During the period of study, two patients sustained a traumatic fracture of a femoral condyle. The implants retained their integrity in both cases. All patients returned to their previous or enhanced levels of daily activity by three months after operation and 56 (79%) achieved their pre-injury level of sporting activity by six months. The patients who were competing in National level sports returned to play at one level less after operation than before. The Lysholm score showed that 58% of the patients (41) were excellent, 34% (24) good, and 8% (6) fair, with a mean post-operative score of 93. According to the International Knee Documentation Committee score, 35% of knees (25) were 'normal', 52% (37) 'nearly normal' and 13% (9) 'abnormal'. Complete satisfaction was noted in 90% of patients (64). The development of osteoarthritis and the management of anterior cruciate deficiency associated with laxity of the medial collateral ligament remains uncertain. Our results indicate that in the medium-term, the ABC ligament scaffold is suitable and effective when early and safe return to unrestricted activities is demanded. We acknowledge the current general hostility towards reconstruction of the anterior cruciate ligament with artificial materials following reports of early failure and chronic synovitis associatiated with the production of particulate debris. We did not encounter these problems.

Medium-term results with a primary cemented rotating-hinge total knee replacement. A 7- to 15-year follow-up.

We reviewed 100 cemented Endo-model rotating-hinge (Waldemar Link GMBH & Co, Hamburg, Germany) total knee replacements in 80 patients with a mean age of 70 years (56 to 85) at a mean post-operative follow-up of 11 years (7 to 15). Good or excellent results were seen in 91% of knees and survival at 15 years was 96.1%. There were two deep infections, one dislocation and one supracondylar fracture. There were no peri-operative deaths and there was no loosening, malalignment, migration or wear. We consider this prosthesis to be ideally suited for the replacement of the deformed knee when the use of an unconstrained design may be questionable.

Replacement of the anterior cruciate ligament. Comparison between the endoscopic and mini-open technique in 56 and 100 patients, respectively.

56 patients with anterior cruciate ligament (ACL) rupture underwent an endoscopic procedure to replace the torn ligament with a bone-patellar tendon-bone autograft. Their mean age was 24 (18-35) years and 45 were men. Follow-up was mean 3 (1-5.5) years. The outcome of the endoscopic technique was compared to that of 100 patients, matched for age and activity level, who were operated on during the same period using the mini-open method. Patients operated on with endoscopic technique had considerably less postoperative pain and regained knee motion faster. Function and stability were similar in the two groups.

Uncemented total hip replacements and thigh pain.

We reviewed 51 uncemented total hip replacements (THRs) in 44 patients (mean age 62 years) and average postoperative follow-up period of 4 years. The evaluation system used was based on that of D'Aubigne-Postel-Charnley, and the excellent and very good results totalled over 90%. There were no revisions or aseptic loosenings, and only one late infection and one death due to cardiac infarction. Special attention was paid to the so-called thigh pain phenomenon which, despite current views, was found to be unexpectedly low (only one case) and also gone within 2 years. We feel that the design of the prosthesis used, its kind of alloy, the anatomic shape of the stem and the low modulus of the elasticity as well as the avoidance of the press fitting technique at the distal part of the stem are important factors in avoiding the stress shielding phenomenon and thigh pain.