Does anterior cruciate ligament reconstruction lead to degenerative disease?: Thirteen-year results after bone-patellar tendon-bone autograft.

BACKGROUND: Reporting of long-term outcome of anterior cruciate ligament (ACL) reconstruction with the patellar tendon (bone-patellar tendon-bone [BTB]) autograft is limited. There are concerns that degenerative joint disease is common in the long term, which may be associated with the procedure itself. HYPOTHESES: (1) ACL reconstruction with BTB provides good long-term outcome. (2) There are additional factors to surgical reconstruction that can be associated with the development of degenerative disease. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Of 161 patients, 114 were eligible. Patient-centered outcome was by Lysholm and subjective International Knee Documentation Committee (IKDC) score; objective outcome measures were clinical examination and IKDC radiological grade. RESULTS: Mean average follow-up was 13 years. The IKDC radiological grades in the worst compartment were A = 15%, B = 51%, C = 19%, and D = 14% (n = 83). There was a significant difference between the injured versus contralateral uninjured knee (n = 42, P = .003). In a subgroup with no meniscal or chondral injury the IKDC grades were A = 38%, B = 55%, C = 7%, and D = 0% (n = 29). The mean subjective scores were 89 ± 11 (Lysholm) and 83 ± 15 (IKDC) (n = 114). Poor IKDC subjective outcome was associated with chondral injury (P = .001), previous surgery (P = .022), return to sport (P = .013), and poor radiological grade in the ipsilateral medial compartment (P = .004). A poor IKDC radiological grade was associated with chondral injury (P = .002), meniscal injury (P = .010) and meniscectomy (P = .012), an IKDC subjective score of <85 (P = .01), and poor radiological grade in the contralateral medial compartment (P = .041). CONCLUSION: At 13 years, BTB ACL reconstruction provides a good outcome. Chondral and meniscal damage at surgery were associated with a poor radiological outcome, indicating that injuries sustained during ACL rupture may be the main predictors of degenerative bone disease.

Do Independent Sector Treatment Centres (ISTC) impact on specialist registrar training in primary hip and knee arthroplasty?

INTRODUCTION: The introduction of Modernising Medical Careers (MMC) is likely to reduce specialist registrar (SpR) operative experience during higher surgical training (HST). A further negative impact on training by local Independent Sector Treatment Centres (ISTCs) could reduce experience, and thus competence, in primary joint arthroplasty at completion of higher surgical training. PATIENTS AND METHODS: Retrospective case note and radiograph analysis of patients receiving primary hip and knee arthroplasty in a teaching hospital, before and after the establishment of a local ISTC. Patients and operative details were recorded from the selected case notes. Corresponding radiographs were assessed and the severity of the disease process assessed. RESULTS: Fewer primary hip and knee replacements were performed by SpRs in the time period after the establishment of an ISTC. CONCLUSIONS: ISTCs may adversely affect SpR training in primary joint arthroplasty.

Bioelectrical impedance: a new method for measuring post-traumatic swelling.

OBJECTIVES: The aim of this pilot study was to investigate whether measurement of the bioelectrical impedance of the lower limb could be used to measure the swelling resulting from acute ankle fracture. METHODS: The impedance of each ankle was measured in 14 patients with isolated acute ankle fracture. The degree of ankle swelling was also directly assessed by measurement of the ankle circumference and diameter and by the water displacement method. A control group of 17 healthy subjects with uninjured ankles was similarly assessed. RESULTS: The impedance of the ankle was significantly reduced in patients with ankle fracture, and there was a strong inverse relationship between the degree of this reduction and the amount of swelling as directly measured. The relationship was stronger using the impedance method than the circumference and diameter methods. CONCLUSIONS: We conclude that bioelectrical impedance can be used to measure ankle swelling in the presence of injury and could potentially be used both to monitor swelling clinically and as a research tool in studies of swelling management. More research is required to further define the potential role for this technique.