Joint surface incongruity and its maintenance: an experimental study.

The paper reports an experimental investigation into the mechanisms whereby the joints of living animals maintain their precise contours. The normal patter of joint incongruity in the rabbit's hip having first been established, three groups of experimental animals underwent operative procedures designed to reduce the joint pressure to a level unrealistic in normal life. In one group the hip was dislocated by manipulation; in a second group the muscles around the hip joint were divided; and in a third group the hind limb was disarticulated through the knee. When the animals were killed at intervals of a few weeks after the operations the experimental hip joint showed increased congruity in all cases. It is concluded that in immature animals there is a mechanism in joints to control the modelling of their shapes towards an ideal incongruity, and that that mechanisms is pressure sensitive.

Anterior cruciate ligament reconstruction by over-the-top repair combined with popliteus tendon plasty.

We used the MacIntosh over-the-top repair combined with a popliteal tendon plasty in 273 athletically active patients with chronic incapacitating functional instability due to anterior cruciate ligament rupture; 244 were reviewed at three to nine years after operation. We describe the technique and its results, with functional evaluation by the Tegner and Lysholm system. Excellent or good results were obtained in 71%; most of the 29% fair or poor results were due to extensive meniscal and degenerative changes. In a group of 11 patients with excellent results arthroscopic and histological findings were encouraging, showing good incorporation of the graft.

Cruciate ligament replacement using a meniscus. An experimental study.

In 30 rabbits, the medial meniscus was used to replace the anterior or posterior cruciate ligament. The changes that took place were followed in histological sections, obtained both from the area of insertion into bone and from the intra-articular part of the graft. There was a gradual differentiation to chondroid tissue, with subsequent calcific deposition and no appearance of normal ligamentous tissue. The strength of the graft after 52 weeks was only one-quarter of that of the normal ligament. Our results do not justify the use of the meniscus to replace a torn cruciate ligament.

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.

The Influence of lsokinetic Muscle Torque Exerted in Various Speeds on Soccer Ball Velocity.

Numerous variables influence soccer kick performance and among those initial soccer ball velocity is considered to be important. The purpose of this study was to investigate the correlation between initial ball velocity and two physical characteristics: relative isokinetic torque of the lower extremity and muscle contraction velocity. Eleven elite Greek soccer players age 25.5 +/- 3 years, weight 73.6 +/- 5.6 kg, height 176.5 +/- 5.5 cm, were tested on an isokinetic apparatus at different angular velocities to determine isokinetic muscle torque of the dominant lower extremity. To determine muscle contraction velocity and initial soccer ball velocity a cycling ergometer and a photocell apparatus were used, respectively. Relative isokinetic muscle torque values of the lower extremity were at 30 degrees /sec 3.29 +/- 0.32 Nm/kg, at 90 degrees /sec 2.49 +/- 0.28 Nm/kg, and at 180 degrees /sec 1.75 +/- 0.24 Nm/kg. Muscle contraction velocity was 3.69 +/- 0.27 c/s and initial ball velocity was 27.08 +/- 1.32 m/s. Initial ball velocity correlated significantly with relative isokinetic muscle torque at different angular velocities as follows: at 30 degrees /sec, r = 0.82, p < 0.01; at 90 degrees /sec, r = 0.73, p < 0.02; at 180 degrees /sec, r = 0.64, p < 0.05. Initial ball velocity was also significantly correlated with muscle contraction velocity (r = 0.77, p < 0.01). These results indicate that both physical qualities, i.e., relative isokinetic torque and muscle contraction velocity are significant variables related to soccer ball velocity which is considered to be an important factor of soccer kick performance.J Orthop Sports Phys Ther 1988;10(3):93-96.

An unusual case of subluxation of C.3-C.4.

A case is reported of spontaneous subluxation of C.3 on C.4 in a 6-year-old boy due to an upper respiratory infection after surgical treatment for muscular torticollis.

Reconstruction of the anterior cruciate ligament using a patellar tendon autograft. A long term follow up.

Three hundred and eighty-four athletes with chronic anterior cruciate instability were treated by a free autologous graft of the lateral third of the patellar tendon. Evaluation 5 to 9 years after operation was carried out in 334 cases by physical examination, the KT-1000 arthrometer and the Tegner and Lysholm scoring scale. There were 89.5% satisfactory results and 10.5% were unsatisfactory. Global instability, advanced osteoarthritis and restricted movement after operation were the reasons for a poor outcome. In 9 cases, histological examination showed good incorporation of the graft.

Clinical diagnosis of ruptures of the anterior cruciate ligament: a comparison between the Lachman test and the anterior drawer sign.

A comparative study of the diagnostic accuracy between the Lachman test and the anterior drawer test was performed by examining 144 knees with ruptured anterior cruciate ligaments. The diagnosis of anterior cruciate ligament rupture is often difficult to establish, especially in recent injuries with acute haemarthrosis. The diagnostic accuracy of the Lachman test in recent ruptures when the patient is examined without general anaesthetic is superior to that of the anterior drawer test, while in chronic cases with third-degree instability the two tests are equally reliable.

Meniscal injuries associated with rupture of the anterior cruciate ligament: a retrospective study.

The purpose of this study was to demonstrate the extent of meniscal involvement when the anterior cruciate ligament is torn. Data from 189 cases operated on for lesions of the anterior cruciate ligament form the basis of this report. The patients chosen for this study were all athletes forming two main groups. In one group, 82 patients were operated on immediately after their initial injury and in the other group 107 patients came for treatment because of persistent symptoms. It was recorded in the case notes whether there were any articular cartilage changes found at operation. Meniscal involvement was noted in 24.4 per cent of the patients of the first group. In particular, the meniscus was found to be torn in 20.6 per cent of the so-called 'isolated' tears and in 27.1 per cent of the combined cruciate injuries. No articular cartilage changes were noted in this group. In the second group meniscal injuries were seen in 61.6 per cent of the cases. More specifically, the menisci were involved in 26.7 per cent of the knees with first-degree instability, in 57.5 per cent with second-degree, rising to 75 per cent in knees with third-degree instability. Articular cartilage changes were seen in 20 per cent, 67.5 per cent and 78.8 per cent respectively. There is ample evidence in our study of the progressive meniscal involvement and degeneration in the knee of the athletically active individual after an anterior cruciate ligament rupture.

Acute rupture of anterior cruciate ligament: histological study of fifteen cases.

Rupture of the anterior cruciate ligament may lead to functional instability and premature degenerative changes of the knee or, if treatment and rehabilitation are carefully carried out, to a functionally stable knee. In this paper we histologically studied the torn ends of the anterior cruciate ligament from fifteen patients who underwent surgical treatment for acute rupture of the ligament. The interval between the rupture and surgery was 11-20 days. The purpose of this study was to evaluate the time of appearance and the degree of degenerative changes of the torn ends in cases of midsubstance rupture in order to determine 1) their biological value for restoring the anterior cruciate ligament and 2) the ideal time and the optimal technique for surgical treatment.

Obstetrical fracture-separation of the upper femoral epiphysis.

During the last 15 years we have treated six neonates with obstetrical fracture of the upper epiphysis of the femur. Two other cases have previously been reported by one of us (S.D.T.) in 1958. A common characteristic was a difficult and traumatic breech delivery, half the babies being "large-for-dates". The clinical and radiological signs of this injury are described. In two babies there were associated injuries of the same limb whilst two others had congenital dislocation of the contralateral hip. The prognosis appears to be excellent, in spite of the severity of the injury, and irrespective of treatment.