Biomedical subjects

J Kartus

Publications and source records attributed to J Kartus.

At least 19 recordsLinked to original sources

PubMed2002

Comparison of functional outcome after anterior cruciate ligament reconstruction resulting in low, normal and increased laxity.

The aim of the study was to analyse and compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction using patellar tendon autografts in three groups of patients. The groups were determined by knee laxity as measured with the KT-1000 arthrometer at the follow-up two to five years after the reconstruction. Group A (n=15) had an anterior side-to-side laxity difference of <-3 mm (i.e. the reconstructed knee was less lax than the contralateral non-injured knee), Group B (n=376) had a difference of > or = -1, but < or = +2 mm and Group C (n=38) had a difference of > or g=6 mm. All the patients had a normal contralateral knee. In Group A, 7/15 (47%) patients and, in Group B, 82/375 (22%) patients had an extension deficit of > or =5 degrees (P=0.052). The corresponding values in terms of flexion deficit were 8/15 (53%) and 99/375 (26%) respectively (P=0.04) (one missing value in Group B). In Group C, 14/38 (37%) had an extension deficit (P=0.04; Group B vs Group C). Group C displayed worse results than Group B in terms of the Lysholm score and the one-leg-hop test (P=0.001 and P=0.011 respectively). The corresponding comparison between Group A and Group B revealed no significant differences. We conclude that a considerable number of patients showed persisting deficits in range of motion (ROM) after an ACL reconstruction. No major differences were found if they were analysed in subgroups with decreased, near normal or with increased knee laxity. The worst residual functional impairment, as measured with the Lysholm score and one-leg-hop test, was found in the group with increased knee laxity and most ROM deficits in the knees with decreased laxity.

Adolescent↗

PubMed2001

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.

Adolescent↗

PubMed2001

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.

Arthroscopy↗

PubMed2001

A prospective four- to seven-year follow-up after arthroscopic anterior cruciate ligament reconstruction.

The aim of this study was to evaluate the results after arthroscopic anterior cruciate ligament reconstruction using a bone-patellar tendon-bone graft in 99 patients, who were followed up prospectively for four to seven years. The pre-injury Tegner activity level was 7 compared with 5 at the four- to seven-year follow-up (P<0.0001). The preoperative Lysholm score was 74.5 points. At the two-year follow-up, the Lysholm score was 95 points, while it was 90 points at the four- to seven-year follow-up (P<0.0001 preoperative vs two years and preoperative vs four to seven years and P<0.0005 two years vs four to seven years). Using the IKDC evaluation system, 80% of the patients were classified as normal or nearly normal and 20% as abnormal or severely abnormal at the final follow-up. The KT-1000 laxity measurements revealed a side-to-side difference of 2.9 mm preoperatively, 0.6 at two years and 1.0 mm at four to seven years. Twenty-six patients underwent additional surgery during the follow-up period. The results after arthroscopic reconstruction of the anterior cruciate ligament appear to be satisfactory both at the short- and the medium-term follow-ups, but there appears to be some deterioration between the two-year and the four- to seven-year follow-up.

Adolescent↗

PubMed2001

Is a knee brace advantageous after anterior cruciate ligament surgery? A prospective, randomised study with a two-year follow-up.

The aim of this study was to evaluate the use of a knee brace after arthroscopic anterior cruciate ligament reconstruction using central third patellar tendon autografts. Fifty patients were randomly allocated to two groups. The patients in Group A wore a brace for three weeks postoperatively, while the patients in Group B were rehabilitated without the use of a brace. Pre-operatively, the groups were comparable in terms of age, sex, activity level, knee laxity and muscle strength. The follow-up examination was performed by one independent observer. All the patients were followed up for a minimum of two years. At the follow-up, there were no significant differences between the study groups in terms of the Tegner activity level, Lysholm score, IKDC evaluation system, one-leg-hop quotient, KT-1000 measurements and isokinetic torque. Using the visual analogue scale, the patients in Group A evaluated their pain during the first two post-operative weeks as 1.0 (0-7), compared with 2.3 (0-9) in Group B (P= 0.04). Furthermore, the patients in Group A had a tendency towards fewer problems with swelling, haemathrosis and wound leakage during the early post-operative period (P=0.08). We conclude that the patients who were rehabilitated with the use of a brace had less pain and a tendency towards fewer complications during the early post-operative period than the patients who were rehabilitated without the use of a brace. However, there were no differences in terms of function or knee laxity at the two-year follow-up.

Adolescent↗

PubMed2001

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.

Adolescent↗

PubMed2001

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.

Adolescent↗

PubMed2000

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.

Adolescent↗

PubMed2000

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.

Absorbable Implants↗

PubMed2000

A comparison of results in middle-aged and young patients after anterior cruciate ligament reconstruction.

The aim of this retrospective study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction in middle-aged and young patients. From our database (including 604 patients with a follow-up rate of 95%), we extracted all the patients over 40 years of age (group A, n = 30) and compared them with a group of patients from the same material, aged between 20 and 24 years (group B, n = 37). The groups were comparable in terms of the male:female ratio and surgical techniques. The follow-up was performed by independent observers. The median follow-up period was 31 months (range, 22 to 60 months) in group A and 38 months (24 to 60 months) in group B (P =.014). Before injury, the Tegner activity level was 6 (4-9) in group A and 9 (4-9) in group B (P <.001). At follow-up, the Tegner activity level was 5 (3-9) in group A and 6 (3-9) in group B (P =.032). At the follow-up, there was no difference in terms of the Lysholm score, which was 91 (37-100) and 89 (38-100) points in group A and group B, respectively. Using the IKDC evaluation system, 10 patients (33%) were classified as normal, 12 (40%) as nearly normal, 6 (20%) as abnormal, and 2 (7%) as severely abnormal in group A, compared with 8 (22%) normal, 18 (48%) nearly normal, 10 (27%) abnormal, and 1 (3%) severely abnormal in group B (NS). The 1-leg hop quotient was 90% (52-167) in group A and 93% (70-118) in group B (P =.056). The KT-1000 measurement showed an anterior side-to-side laxity difference of 2.0 mm (-4 to 8.5 mm) in group A and 2.0 mm (-2.5 to 8.0 mm) in group B (not significant). The middle-aged patients were subjectively more pleased with the results than the younger patients. There were no differences in either early or late complications between the groups. At the index operation, 11 of 30 patients (37%) in group A and 1 of 37 (3%) in group B had cartilage lesions or degenerative changes (P <.001). Age does not appear to disqualify middle-aged patients with symptomatic ACL tears from undergoing reconstruction.

Adult↗

PubMed1999

Complications following arthroscopic anterior cruciate ligament reconstruction. A 2-5-year follow-up of 604 patients with special emphasis on anterior knee pain.

The aim of the study was to assess knee function after arthroscopic anterior cruciate ligament reconstruction and to analyse complications impeding rehabilitation, additional surgery until the final follow-up, as well as residual patellofemoral pain and donor-site problems. Between 1991 and 1994, 635 patients were operated on using patellar tendon autografts and interference screw fixation. Of these, 604 (95.1%) patients (403 male and 201 female) were re-examined by independent observers at the final follow-up 38 (range 21-68) months post-operatively. The Lysholm score was 85 (range 14-100) points and the Tegner activity level was 6 (range 1-10). Using the IKDC score, 206 patients (34.1%) were classified as normal, 244 (40.4%) as nearly normal, 122 (20.2%) as abnormal and 32 (5.3%) as severely abnormal. In patients with an uninjured contralateral knee (n = 527), the KT-1000 revealed a total side-to-side difference of 1.5 (range -7-11) mm, and 384/527 (72.9%) had a side-to-side difference of < or = 3 mm. The one-leg-hop test was 95% (range 0%-167%). One or more complications impeding rehabilitation were recorded in 184/604 patients (30.5%). The most common was an extension deficit (> 5 degrees), in 81 patients (13.4%). During the period until the final follow-up, 196 re-operations were performed in 161/604 (26.7%) patients. More than one re-operation was required in 27 patients. Shaving and anterior scar resection due to extension deficit were the most common procedures performed (on 65 occasions). Moderate to severe subjective anterior knee pain related to activity, walking up and down stairs, and sitting with the knee flexed was found in 203/604 patients (33.6%). The median loss of anterior knee sensitivity was 16 (range 0-288) cm2. Patients with a full range of motion had less anterior knee pain than patients with isolated flexion or extension deficits, or combined flexion and extension deficits (P < 0.05, P = 0.08 and P < 0.001, respectively). Patients with a full range of motion had less anterior knee pain than patients with extension deficits (with and without flexion deficits) (P < 0.001). Patients with a full range of motion and a minimal loss (< or = 4 cm2) of anterior knee sensitivity had significantly (P < 0.01) less subjective anterior knee pain than patients who did not fulfil these criteria. A considerable number of complications hindering the rehabilitation and conditions requiring additional surgery until the final follow-up were recorded. Anterior knee pain and problems with knee-walking were correlated with the loss of range of motion and anterior knee sensitivity.

Adolescent↗

PubMed1999

Serial magnetic resonance imaging of the donor site after harvesting the central third of the patellar tendon. A prospective study of 37 patients after arthroscopic anterior cruciate ligament reconstruction.

The aim of this prospective study was to follow the development of repair tissue in the donor-site area using serial magnetic resonance imaging (MRI) evaluation and to assess whether the MRI findings were correlated with donor-site morbidity. Thirty-seven consecutive patients with unilateral anterior cruciate ligament injuries undergoing elective reconstruction of the ligament were included in the study. They were aged 27 (range 14-50) years. The graft was harvested through two 25-mm vertical incisions with the aim of protecting the infrapatellar nerve and sparing the paratenon. The tendon defect was left open. The patients underwent MRI evaluation at 6 weeks, 6 months and 27 months postoperatively. A final clinical follow-up was made 25 (range 23-29) months postoperatively. MRI demonstrated that the donor-site gap, i.e. the area corresponding to a pathological non-tendinous-like tissue signal, was 9 (range 4-18) mm at 6 weeks, 5 (range 2-14) mm at 6 months and 2 (range 0-5) mm at 27 months. The size of the donor-site gap had significantly decreased at 6 months compared with 6 weeks (P = 0.0001), as well as at 27 months compared with 6 months (P = 0.0001). We conclude that the patellar tendon at the donor site healed gradually, as expressed by a decrease in the area of non-tendinous-like tissue signal on the serial MRI evaluations.

Adolescent↗

PubMed1999

Subacute versus delayed reconstruction of the anterior cruciate ligament in the competitive athlete.

The objective of this study was to compare the function and activity level in patients with anterior cruciate ligament injuries, who participated in competitive sports (Tegner activity level > or = 7) and underwent a reconstruction of the anterior cruciate ligament, either subacute (2-12 weeks, group I) or late (12-24 months, group II) after the injury. The patients in group I (n = 97) were comparable with those in group II (n = 103) in terms of gender, age, preinjury activity level, and the reconstruction technique. At the final follow-up (2-5.5 years after the operation), the Lysholm score, the IKDC evaluation system and the one-leg-hop test revealed no differences between the groups. There were also no differences between the groups in terms of the patients' subjective evaluation or expectations. The Tegner activity level at follow-up was 8 (range 2-10) in group I and 6 (range 2-9) in group II (P = 0.0001). The same thing was found in terms of the desired Tegner activity level, which was 9 (range 4-9) in group I and 7 (range 3-10) in group II (P = 0.0002). The KT-1000 laxity meter revealed a total side-to-side difference of 1.5 mm (-3.5-8.5) in group I and 1.5 mm (-3.5-7) in group II (NS). Associated meniscal surgery between the index injury and the reconstruction, or during the reconstruction, was performed in 37/97 (38%) of the patients in group I and 59/103 (57%) of the patients in group II (P < 0.01). This study revealed that competitive athletes who underwent reconstruction at a subacute stage after the anterior cruciate ligament injury had a higher activity level 2-5.5 years after the index operation, as well as a higher desired level of activity compared to athletes who had the reconstruction delayed by 12-24 months. Furthermore, meniscal injuries were significantly more frequent if the reconstruction was delayed.

Adolescent↗

PubMed1999

Analysis of subjective, objective and functional examination tests after anterior cruciate ligament reconstruction. A follow-up of 527 patients.

This study included 527 patients (178 female and 349 male) with unilateral anterior cruciate ligament (ACL) rupture who underwent arthroscopic ACL reconstruction using bone-patellar tendon-bone autograft and interference screw fixation. The follow-up examination was performed by independent observers at a median of 38 (21-68) months after the index operation. At the follow-up, the Lysholm score was 86 (14-100) points, the Lysholm instability subscore was 22 (0-25) points and the Lysholm pain subscore was 19 (0-25) points. The Tegner activity level was 6 (1-10). The one-leg-hop test was 91 (0-167)% of the non-injured knee. The difference in the anterior side-to-side laxity as measured with the KT-1000 arthrometer at 89 Newton (N) was 1.5 (-5-13) mm and the total KT-1000 side-to-side difference at 89 N was 2 (-7-11) mm. Using the International Knee Documentation Committee (IKDC) evaluation system, 177 (33.6%) patients were classified as normal (group A), 211 (40%) as nearly normal (group B), 109 (20.7%) as abnormal (group C) and 30 (5.7%) as severely abnormal (group D). The highest correlation coefficients were recorded between the IKDC evaluation system and the Lysholm score (p = 0.66), the patients' subjective evaluation (p = 0.53), the Tegner activity level (p = 0.34), all the laxity tests (p > or = 0.34) and the one-leg-hop test (p = 0.28). The resumption of sporting activities and work as evaluated by the Tegner activity level correlated with the patients' subjective evaluation (p = 0.34) but did not correlate with the laxity tests, i.e., the manual Lachman test (p = -0.06) and the total and anterior KT-1000 tests (p = -0.06). Furthermore, none of the laxity tests correlated with the functional tests or the patients' subjective evaluation. We conclude that the IKDC evaluation system is a reliable and useful tool for evaluating the post-operative outcome after an ACL reconstruction.

Adolescent↗

PubMed1999

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.

Aged↗

PubMed1999

Magnetic resonance imaging of the patellar tendon after harvesting its central third: a comparison between traditional and subcutaneous harvesting techniques.

The aim of this study was to compare the 2-year results after anterior cruciate ligament reconstruction using patellar tendon autografts harvested through a paratenon-splitting, traditional technique (group A) with the results of a subcutaneous technique aiming at protecting the infrapatellar nerves and the paratenon (group B). Special emphasis was placed on evaluating the donor site. Magnetic resonance imaging (MRI) of the patellar tendon was performed to evaluate the reconstitution after harvesting its central third. Examinations of knee-walking ability and assessments of anterior knee sensitivity were made in order to evaluate donor-site discomfort and the function of infrapatellar nerves. Seventy-two consecutive patients were included in the study; group A comprised 35 patients and group B, 37 patients. At the 2-year follow-up, the Tegner activity level, the Lysholm score, and the IKDC evaluation system showed no significant differences between groups A and B. The median loss of normal anterior knee sensitivity was 16 cm2 (range, 0 to 200 cm2) in group A and 0 cm2 (range, 0 to 285 cm2) in group B (P = .20). In group A 20% of the patients and in group B 58% had normal sensitivity (P < .01). MRI showed that the donor-site gap (area corresponding to non-tendinous-like tissue signal) was 5 mm (range, 0 to 9 mm) in group A and 2 mm (range, 0 to 5 mm) in group B (P < .0001). At 2-year follow-up, the subcutaneous graft-harvesting technique resulted in less disturbance of anterior knee sensitivity and a smaller donor-site gap than the traditional technique.

Adolescent↗

PubMed1999

Comparison of arthroscopic one-incision and two-incision techniques for reconstruction of the anterior cruciate ligament.

The purpose of this study was to assess the outcome of arthroscopic anterior cruciate ligament reconstruction performed using either the 'one-incision' technique or the rear-entry 'two-incision' technique. A series of 221 consecutive patients who underwent anterior cruciate ligament reconstruction was reviewed retrospectively. In the study population, two subgroups were defined. Group A consisted of 118 patients who underwent reconstruction using the one-incision transtibial endoscopic technique and Group B consisted of 103 patients who underwent reconstruction using the two-incision technique. The groups were comparable in terms of age, sex and activity level. The follow-up was performed after 47 (40-68) months in Group A and 55 (40-68) months in Group B. The Lysholm score at the final follow-up was significantly lower in Group A (90, 38-100) than in Group B (94, 34-100) (P = 0.002). The median KT-1000 total side-to-side difference was 1.5 (-6 to 7.5) mm in Group A, and 2.0 (-3.5 to 9) mm in Group B (n.s.). No significant difference between the groups was found when the IKDC evaluation system was used. Four intra-operative complications were registered in Group A and none in Group B (P = 0.06). No significant difference was found in terms of anterior knee pain, the one-leg-hop quotient or the activity level at the final follow-up. In this study the two methods gave similar and satisfactory results. Serious intraoperative complications were, however, recorded in four cases when the one-incision technique was used.

Adolescent↗

PubMed1999

A comparison of results after arthroscopic anterior cruciate ligament reconstruction in female and male competitive athletes. A two- to five-year follow-up of 429 patients.

The aim of this study was to compare the results after arthroscopic anterior cruciate ligament reconstruction in female and male competitive athletes who had a pre-injury Tegner activity level of > or =7 and a non-injured contralateral anterior cruciate ligament. One hundred and thirty-three female and 296 male patients were followed at 38 (21-68) months after the index operation. All the patients were operated on by experienced knee surgeons using patellar tendon autografts and interference screw fixation. At the index operation the median age of the female patients was 23 (1645) years and the median age of the male patients was 26 (16-47) years. The reconstruction was performed a median of 10 (0-141) and 10 (0-203) months after the injury in women and men respectively. The patients were re-examined by independent observers. At the follow-up, the median Lysholm score was 89 (38-100) points in the female group and 90 (22-100) points in the male group (P=0.015). The IKDC evaluation system, subjective anterior knee pain, subjective evaluation of the results, the knee-walking test and the KT-1000 tests revealed no differences between the groups. The mean (+/-2 SD) pre-injury Tegner activity level was 8.1 (+/-1.9) (median 8 (7-10)) in the female group and 8.4 (+/-1.8) (median 9 (7-10)) in the male group (P=0.003). At the follow-up, the Tegner activity level was 6.2 (+/-3.8) in the female group and 6.8 (+/-3.6) in the male group (P=0.012). At the follow-up, the Tegner activity level had decreased by 1.9 (+/-3.8) for the women and 1.6 (+/-3.3) for the men, as compared with the pre-injury level (n.s.). The difference between the performed and the desired activity level at the follow-up was 1.1 (+/-3.2) in the female group and 0.9 (+/-3.0) in the male group (n.s.). In the female group 53/133 (40%) and in the male group 115/296 (39%) returned to the pre-injury activity level (n.s.). The median one-leg-hop quotient was 93 (0-116)% in the female group and 96 (0-130)% in the male group (P=0.006). Concomitant meniscal injuries prior to the index operation, at the index operation or during the follow-up period were found in 64/133 (48%) women and in 185/ 296 (62%) men (P<0.01). The main conclusion was that the overall results in female and male athletes were comparable two to five years after the anterior cruciate ligament reconstruction. However, concomitant meniscal injuries were more common in male than females athletes after anterior cruciate ligament injuries.

Adolescent↗