Anterior cruciate ligament reconstruction in men and women: An outcome analysis comparing gender.

PURPOSE: Recent studies have shown that female athletes suffer a higher incidence of anterior cruciate ligament (ACL) tears than comparable male athletes. The purpose of this study was to evaluate the effect gender has on outcome in ACL reconstruction using bone-patellar tendon-bone autograft. TYPE OF STUDY: Retrospective case review and outcome study. METHODS: A retrospective review of a single surgeon's practice revealed 279 ACL reconstructions that met our criteria for inclusion. Two-hundred forty-nine of these patients (91%) were contacted. Two-hundred (72%) were evaluated with physical examination, KT-1000 testing, functional testing, and radiographic evaluation. Outcome was assessed with Tegner, Lysholm, modified HSS, and Cincinnati Knee rating scales, as well as the SF-36 health survey and a self-administered questionnaire. There were 137 men and 63 women. Data were evaluated with Wilcoxon rank sum testing, analysis of variance testing, chi-square analysis, and the Student t test. The level of significance was set at P <.05. RESULTS: Postoperatively, no differences were noted on Lachman, anterior drawer, pivot shift, or functional testing in either groups. Male patients had a significantly greater mean prone heel height difference (1.80 v 1.10 cm, P =.0018) and mean KT-1000 maximum manual side-to-side difference (0.76 v 1.73 mm, P =.014). However, no differences were noted in the percentage of patients with greater than 5-mm side-to-side difference, with 5 men (4%) and 2 women (3%) classified as arthrometric failures. No differences were noted in mean Tegner, Lysholm, Noyes Cincinnati, and modified HSS scores. Men had significantly lower HSS radiographic scores (24.98 v 26.22, P =.0016). Men and women were compared with gender-matched controls for SF-36 testing, and women scored higher compared with controls than did men in the Role Physical, Body Pain, and General Health categories. No differences were noted in either group regarding donor-site pain, patellofemoral crepitance, or problems with stair climbing. Ninety-six percent of men and 98% of women would have had the surgery over again given similar circumstances. CONCLUSIONS: Objective criteria failed to detect clinically significant differences in physical examination and arthrometric results between men and women. Knee rating scale scores were similar. Comparable outcome with high satisfaction and equal success can be expected in both men and women undergoing ACL reconstruction using bone-patellar tendon-bone autograft. No basis exists for the inclusion of gender as a determining factor regarding the decision to perform ACL reconstructive surgery with bone-patellar tendon-bone autograft.

Patellar tendon rupture 3 years after anterior cruciate ligament reconstruction with a central one third bone-patellar tendon-bone graft.

Use of the central one third bone-patellar tendon-bone autograft is an accepted technique for anterior cruciate ligament (ACL) reconstruction. Patellar tendon rupture following ACL reconstruction is an acknowledged, although rarely reported, complication of this procedure. Of the limited patellar tendon rupture cases reported in the literature, most are described early in the postoperative period. We present a case of late patellar tendon rupture more than 3 years after uneventful ACL reconstruction in a 32-year-old man.

Outcomes of anterior cruciate ligament reconstruction in patients with Workers' Compensation claims.

SUMMARY: A general perception exists that outcomes of orthopaedic procedures in patient's with Workers' Compensation claims fare worse than those of patients without such claims. We retrospectively reviewed the outcomes of anterior cruciate ligament (ACL) reconstruction in patients who have Workers' Compensation claims. This minimum 2-year follow-up study analyzed the occupational, functional, and objective results of patients who underwent arthroscopic-assisted anterior cruciate ligament (ACL) reconstruction. Twenty-two patients with Workers' Compensation claims representing 5% of patients who underwent ACL reconstruction at our institution between 1987 and 1995 were included in the current study. All reconstructions were performed by the senior author (B.R.B.) using arthroscopic-assisted techniques (single and double-incision) with bone-patellar tendon-bone autografts followed by an accelerated rehabilitation protocol. Postoperative follow-up physical examinations revealed a negative anterior drawer in 19 patients (91%), a negative Lachman in 15 patients (68%), and a negative pivot shift in 21 patients (96%). The KT-1000 arthrometric evaluation at follow-up showed a mean maximum manual difference of 1. 9 mm with 15 patients (68%) having a maximum manual difference of

Bone graft procurement for patellar defect grafting in anterior cruciate ligament reconstruction.

Bone grafting of the patellar defect from harvest of the central third bone-patellar tendon-bone autograft in anterior cruciate ligament (ACL) reconstruction has been advocated by some authors to decrease the risk of patellar fracture from the existing stress riser as well as decrease postoperative donor site pain. We present a method of harvesting bone reamings during ACL reconstruction that is simple, efficient, and maximizes the amount of bone that can be collected.

Posterolateral instability of the knee.

Posterolateral instability of the knee is difficult to diagnose and treat. It has been attributed to failure of ligament reconstruction and has been the cause of numerous knee operations. We present a small group of patients who complained of giving way of the knee and who had an increased range of external rotation of the tibia at 90 degrees knee flexion. The patients all had similar symptoms. We describe the standing apprehension test, which was positive in every case. Anterior subluxation of the lateral femoral condyle was detected manually in four patients and confirmed by radiography and MRI in one. The medial knee pain which is often associated with episodes of instability is probably due to stretching of the posteromedial soft tissues and perhaps the saphenous nerve.

Posterior ossification of the shoulder: the Bennett lesion. Etiology, diagnosis, and treatment.

We report a series of ossific lesions of the posterior inferior glenoid in a group of elite baseball players. We hope to clarify the etiology, diagnosis, and treatment of the Bennett lesion. From August 1985 to August 1991, we identified six professional baseball pitchers and one college pitcher with evidence of ossification of the shoulder on plain radiographs, computed tomography, or magnetic resonance imaging. Arthroscopic examination was performed in all cases. All seven players had identifiable posterior labral injury on arthroscopic examination; six of these seven also had varying degrees of undersurface posterior rotator cuff damage. No anterior tissue damage, anterior instability, or subacromial impingement was noted. No ossification was identified arthroscopically. Intraarticular labral and rotator cuff tears were debrided arthroscopically and patients underwent rehabilitation for 4 to 6 months after surgery. Six of the seven athletes returned to preinjury performance levels; however, one pitcher is no longer playing competitive baseball. The Bennett lesion is an extraarticular posterior ossification associated with posterior labral injury and posterior undersurface rotator cuff damage. It is not, however, a result of traction stresses in the region of the triceps insertion. Recognition is important for identification and treatment of the lesion and associated pathologic damage.

The semitendinosus: anatomic considerations in tendon harvesting.

The length and course of the semitendinosus tendon was studied in cadaveric specimens. The average length of the tendinous portion was 23 cm. The tendon separates from the other pes anserinus tendons as it passes beneath the semimembranosus muscle, where the deep fascia forms a sling for the tendon; the surgeon should be aware of this anatomy when using tendon strippers.

Seroepidemiology of bancroftian filariasis in the Seychelles Islands.

Wuchereria bancrofti is the only human filarioid present in the Seychelles archipelago. The last parasitological survey carried out in Mahé revealed a microfilaraemia rate of 3.6%. Serum samples from 417 native individuals living in Mahé were tested for the presence of filarial antibodies by ELISA method, using crude soluble extract of Brugia pahangi adult worm as antigen. The results seem to show a proportion of the population (17%) has been exposed to W. bancrofti (with OD values greater than 0.5) and 7% (with OD greater than 0.7) have specific filarial antibodies. The pattern of distribution of antibody levels in the sample population studied strongly suggest that filariasis is still endemic in Seychelles (Mahé).

Dengue in the Seychelles.

Epidemics of dengue-like illness occurred in the Seychelles from December 1976 to April 1977 and from December 1978 to January 1979. Dengue 2 virus was isolated from individuals who had been in the Seychelles in 1977. From February to April 1979, sera were collected from outpatients in Mahé, Seychelles, who had not previously been hospitalized with a dengue-like illness. Results of neutralization tests with these sera indicated that prevalence rates for the four dengue viruses were between 81% and 91.8% and that dengue 2 was the most probable etiological agent in the epidemics. In addition, antibodies to chikungunya (8.7%) and Sindbis (7.4%) viruses were found, providing, for the first time, evidence of the presence of these two alphaviruses in the Seychelles.