ACL reconstruction using bone-patellar tendon-bone press-fit fixation: 10-year clinical results.

Multiple techniques for anterior cruciate ligament (ACL) reconstruction are currently available, most of which use hardware or resorbable material for fixation of the graft inside or outside the bony tunnels. In this study, the long-term results of 95 patients at a mean follow-up of 10.7 years were assessed. The ACL was reconstructed using a patellar tendon autograft with a press-fit fixation. Between 1987 and 1991, 159 patients were operated by the senior author (PH), 95 could be seen for follow-up. Evaluation included detailed history, physical examination, functional knee ligament testing, KT-1000 arthrometer testing, the IKDC standard evaluation form, Lysholm, Flandry, and Tegner scoring systems. Radiographs were obtained preoperatively and at follow-up to assess the grade of osteoarthritis. Subjectively, none of the patients that were seen for follow-up complained of instability. Numbness of the skin was reported by 54% of the patients and pain during knee walking was described as mild in 25% and severe in 2%. The mean Flandry score was 243 (max: 280). The mean Lysholm score was 93.2 at follow-up and the Tegner activity level was 6.8 preinjury and 6.0 postoperatively. The average KT-1000 side-to-side difference was 1.8 mm on a manual maximum pull. The IKDC knee scoring revealed 84% of the patients with normal (A) or nearly normal (B) knee joints, 15% were (C), 1% was (D). Radiographically, joint space narrowing was found in 19%, 15%, and 25% for the patello-femoral, medial, and lateral compartments, respectively. Meniscus surgery was a determining factor. This study presents long-term clinical data on a press-fit fixation for ACL reconstruction. Results were excellent and good in more then 80% of the followed patients. The advantages of the press-fit fixation are direct bone-to-bone healing of the graft, decreased donor site morbidity, cost-effectiveness and ease for revision surgery.

Femoral insertion of the ACL. Radiographic quadrant method.

The optimal femoral insertion or footprint for an anterior cruciate ligament (ACL) graft is the anatomic site. This study was designed to determine the radiographic localization of the femoral insertion of the ACL on a lateral roentgenogram using a quadrant method. Ten human cadaveric knees with intact ACL were dissected. The most anterior, posterior, proximal, and distal borders of the femoral insertion of the ACL were marked with K-wires that were shortened at the bone level of the intercondylar fossa. A roentgenogram was obtained in the strictly lateral position. The end of the K-wires determined the projection of the femoral ACL insertion on the lateral roentgenogram. The center of the radiographically marked area was defined as point K, then four distances were measured on the lateral roentgenogram: distance t (representing the total sagittal diameter of the lateral condyle measured along Blumensaat's line), distance h (representing the maximum intercondylar notch height), distance a (representing the distance of point K from the most dorsal subchondral contour of the lateral femoral condyle), and distance b (representing the distance of point K from Blumensaat's line). Distance a is a partial distance of t and distance b is a partial distance of h, and distances a and b are expressed as length ratios of t and h. The center of the femoral insertion of the ACL was located at 24.8% of the distance t measured from the most posterior contour of the lateral femoral condyle and at 28.5% of the height h measured from Blumensaat's line. Based on these results, the ACL can be found just inferior to the most superoposterior quadrant, which means in anatomic terms it is localized from the dorsal border of the condyle at approximately a quarter of the whole sagittal diameter of the condyle and from the roof of the notch at approximately a quarter of the notch height. By using this radiographic quadrant method combined with fluoroscopic control during surgery, we were able to reinsert the ACL at its anatomic insertion site. This method is independent of variation in knee size or film-focus distance, easy to handle, and reproducible.

[Muscle and tendon injuries in the athlete]. / Muskel- und Sehnenverletzungen beim Sportler.

Muscle and tendon injuries are the most common injuries in sports; they are mostly caused by overuse and repetitive strain injuries and require special diagnosis and treatment. Selective examples are given of surgical therapy (when conservative treatment fails) for the most frequent sports injuries (like muscle ruptures, jumper's knee, Achilles tendon ruptures, rotator cuff tears, tendinitis, dislocation of tendons, compartment syndrome).