objective IKDC protocols. The subjective ... - Arthroscopy Journal

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We prospectively compared the outcome of anterior cruciate ligament reconstruction using patellar tendon autograft with outcome using hamstring tendon au-.
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ABSTRACTS

objective IKDC protocols. The subjective satisfaction and the level of sports return were considered. Results: After ten fifteen year follow up, the Lysholm score was 23 (37,1%) patients excellent (95-100), 26 (41,9%) good (84-94), 11 (17,7%) fair (63-83) and 2 (3,2%) bad ( ⬍ 64). The relation between the satisfaction level and the SF-36 score showed just 5 (8,1%) patients unsatisfied. Even the high level of subjective satisfaction (91,9%) the final evaluation of the objective IKDC was, no patient as normal (A), 31 (50%) almost normal (B),23 (37,1%) abnormal (C) and 8 (12,9%) severely abnormal. In general the range of motion was decreased in the operated knees. The Lachman test was negative in 27,4%, (⫹)in 40,3%, (⫹⫹) in 20,9% and (⫹⫹⫹) in 11,3%. The Pivot Shift was considered normal in 33,9%, (⫹) in 56,3% and (⫹⫹) in 9,7%. The KT-1000 showed 32,3% of abnormal results compartment (⬎3mm). Degenerative changes were detected in the medial compartment of 41 (66,2%) patients, lateral compartment in 36 (58%) and femoropatellar in 46 (74,2%) patients. It was found a strong relation between degenerative arthritis and previous meniscectomy. The Caton-Deschamps index was normal in 54(87,1%) patients and low patella was found in 8 (12,9%) with no significant relation with femoropatellar arthritis. The sports return occurred in 66,1%; change of the sports in 16,1% and no return in 17,7%. The worst results of Lachman test and pivot shift corresponded to the worst levels of sports return activities. Conclusions: 1. The general and knee specific score were less rigid than the IKDC objective; 2. The best interpretation of the results occurred in the subjective and objective protocols associations; 3. The degenerations champs were predominant in the femoropatellar joint; 4. The meniscectomy determined the degenerative change on the lateral and medial compartment; 5. The ACL reconstruction was not enough to avoid the degenerative changes in the articular surface. Paper #69 Anterior Cruciate Ligament Reconstruction. A Prospective Randomized Study Of Patellar And Hamstring Tendon Autografts. Arsi Harilainen, Helsinki, Finland, Eric Linko, Helsinki, Finland, Jerker Sandelin, MD, Presenter, Invalidisaatio, Orton Hospital, Helsinki, Finland We prospectively compared the outcome of anterior cruciate ligament reconstruction using patellar tendon autograft with outcome using hamstring tendon autograft. Ninety-nine patients with laxity due to a torn anterior cruciate ligament underwent arthroscopically assisted reconstruction with graft randomization according

to birth year. Excluding preoperative Lysholm score there were no significant differences between the 2 groups in preoperative and operative data. A standard rehabilitation regimen was used for all patients including immediate mobilization without a knee brace, protected weight bearing for 2 weeks, and return to full activity at 6 to 12 months postoperatively. Forty-three patients in the patellar tendon group and 46 patients in the hamstring tendon group were available for clinical evaluation at a minimum of 21 months after surgery (range 21 to 38 months). The results revealed no statistically significant differences with respect to clinical and instrumented laxity testing, International Knee Documentation Committee ratings, isokinetic muscle torque measurements, Lysholm (knee score), Tegner (activity level) and Kujala patellofemoral knee score. The patellar and hamstring tendon autograft anterior cruciate ligament reconstructions showed equal results 2 years after surgery. Both techniques seem to improve patients’ performance. Paper #70 The Effect Of Knee Flexion Angle At The Time Of Graft Fixation In ACL Reconstruction With A Patellar Tendon Graft. Julian A. Feller, Presenter, La Trobe University Musculoskeletal Research Center, Melbourne, Australia, Kate E. Webster, Melbourne, Australia Background: There are a number of surgical variables during anterior cruciate ligament (ACL) reconstruction which can potentially affect graft tension and function. Aim: To determine whether the angle of knee flexion at the time of graft fixation affects the clinical outcome following ACL reconstruction using a patellar tendon (PT) graft. Methods: Using a prospectively created database of patients undergoing ACL reconstruction by a single surgeon, 50 eligible patients were identified who had undergone a reconstruction for an isolated ACL rupture between 3 weeks and 12 months following injury. A PT graft was fixed proximally with an Endobutton and distally with a bioabsorbable interference screw. At the time of distal fixation the knee was flexed to 70 degrees in 33 patients and was at 0 degrees extension in 17 patients. An independent research assistant reviewed all patients at 12 months. Variables recorded included extension and flexion deficits, KT-1000 measured anterior knee laxity, anterior and kneeling pain severity, Cincinnati score and IKDC rating. Results: There was a trend towards increased extension deficit in the group fixed at 70 degrees (0 : mean

ABSTRACTS 0.04 deficit, 70 : mean 1.3 deficit, p ⫽ 0.055). No other difference was identified between the two groups. There was no correlation between extension deficit and anterior knee laxity. Conclusion: Fixation of a PT graft with the knee at 0 rather than 70 appears to result in less extension deficit without compromise of stability or function. Paper #71 The Prevalence Of Anterior Knee Pain After ACL Reconstruction — A Controlled Clinical Trial. Amer Khan, Presenter, The Royal Free Hospital, London, United Kingdom, Chrish Thakkar, London, United Kingdom, Jonathan Emberson, London, United Kingdom, George S. E. Dowd, Herts, United Kingdom Aim: We determined prospectively the incidence and prevalence of anterior knee pain following ACL reconstruction using autogenous ipsilateral bone-patella-tendon-bone graft in a cohort of 60 patients. Methods: Sixty operations were performed consecutively in 60 knees by the same surgeon and all patients underwent the same rehabilitation protocol. The frequency and severity of anterior knee pain experienced during activities of daily living, sports, prolonged sitting, stair climbing and kneeling was recorded using the Shelbourne and Trumper anterior knee pain questionnaire, the patellofemoral study group anterior knee pain questionnaire and a pain visual analogue scoring system. The location of pain and any perceived sensory change was recorded using patient-drawn diagrams. The minimum post-operative follow-up was 2 years. All results were compared with a healthy control group of 50 subjects with no history of knee surgery. Results: The average age of the control and treated groups were 22.8 and 35.6 years respectively (p ⬍ 0.0001). 74% of the control group experienced no pain compared to 22.2% of the treated group at 2 years following surgery. However we noted a significant improvement in both anterior knee symptoms and sensory change in the treated group with time from 2 years to 5 years post operation (p ⫽ 0.04). At 4-5 years the pain experienced in the treated group was less than that before operation and similar to that in the control group (p ⫽ 0.07). Conclusion: We postulate that in our series of patients anterior knee pain following ACL reconstruction with autogenous bone-patella tendon-bone graft diminishes within 5 years to that found in a young and healthy population. Paper #72 Tunnel Widening After ACL Reconstruction Is Dependent On Type Of Fixation Used. A

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Prospective Randomized Study Comparing Two Different Fixation Methods For Hamstring Grafts. Peter Faunoe, Presenter, Dept Orthop Surg, Randers, Denmark, Soeren Kaalund, Randers, Denmark Purpose: To compare the incidence of tunnel widening (TW) in patients undergoing ACL reconstruction with hamstring graft using either A) transfixation implant, (Transfix, Arthrex) in femur and interference screw (Arthrex) in tibial tunnel or B) endobutton in femur and bicortical screw and washer distally to the tibial tunnel. Material and Method: 100 patients were included and randomized. 87 patients was assessed at a one year follow-up. The evaluation included standardized X-rays. KT-1000, IKDC and Lysholm score. The diameter of the tunnel at one year follow-up was, after correction for magnification, compared to the original reamed diameter. A more than 2mm enlargement was considered TW. Results: In the group where transfixation in femur and interference screw in tibia was used, 7/41 had developed femoral TW and 5/41 in tibia. In the endobutton group 20/46 had TW in femur and 16/46 in tibia. (Fishers exact test p ⬍ 0,05) No difference was found with respect to Lysholm score, IKDC or athrometric evaluation. Conclusion: There was a significant reduction of TW in both femur and tibia using fixation points close to the joint comparing to the system where the distance between the fixation points is long. We conclude that the position of the fixation site and the quality of the fixation device are major factors in the development of TW after ACL surgery. Paper #73 Assessment Of The Patello-femoral Joint Following ACL Reconstruction, Using Patellar Tendon Graft Versus Hamstring Quadrupled Graft. Mohamed Hossam Elshafie, Presenter, Alexandria University, Alexandria, Egypt, Mohamed Emad Eid, Alexandria, Egypt Objectives: The aim of this prospective study was to evaluate the effect of ACL reconstruction on Patellofemoral joint, comparing between the BPTB graft and doubled STG graft. Material and Methods: Seventy-seven patients which underwent ACL reconstruction using BPTB graft and doubled STG graft were studied, 40 in the BPTB group and 37 in the STG group. The procedure was standard in both groups. In the BPTB group, the patellar tendon defect was not closed and the graft was fixed with metal interference screws, for the STG group the graft