Refixation of femoral anterior cruciate ligament tears combined with a semitendinosus tendon augmentation. Technique and results.

As part of a retrospective study, 76 patients with acute tears of the anterior cruciate ligament who underwent reinsertion and augmentation with the semitendinosus tendon were examined. The follow-up took place on average 4.5 years (range 3-7 years) after surgery. A decreased range of motion upon comparison with the uninjured opposite side was seen in 43 patients. The Lachman test revealed a grade 1 instability in 42 patients, grade 2 in 17 and grade 3 in 2, while 15 patients had a negative test result. The average Lysholm score was 92 points and the Tegner activity score had an average of 7.1 points. KT-1000 measurements showed an identical degree of anterior translation for both knees at 89 N in 25 individuals. The analysis revealed a difference of 2 mm in 15 patients, 4 mm in 19,6 mm in 15 and greater than 6 mm in 2. The radiographic follow-up examination revealed a deterioration of the degenerative change of 1 deg in 17 patients and 2 deg in 4 patients. Isometric testing showed no loss in flexion strength of the operated knee joints compared to the healthy opposite side. The ratio between flexion and extension strength was also identical for both knees. The reinsertion and augmentation with a single strand of semi-tendinosus tendon is not, as this study demonstrates, the appropriate reconstructive technique for the majority of ACL tears.

Surgical treatment of ruptures of the Achilles tendon: a review of long-term results.

The rupture of the Achilles tendon is frequently sports-related. In the time from 1 January, 1978 until 31 December, 1988, we treated 358 men and 54 women with such an injury at the Staatliche Orthopaedische Klinik in Munich. The average age of these patients was 43 years. The site of the rupture was generally located between 3-5 cm proximal of the distal insertion of the tendon. In the follow-up examination of 122 patients with surgical treatment of tendo calcaneus ruptures 85% showed 'good' to 'very good' subjective results. Of the operated patients 97% would choose the same treatment under similar circumstances. The isokinetic studies demonstrated a loss of static and dynamic strength in plantar flexion of the ankle joint of 9.1%, and 16.7% respectively, when compared to the healthy contralateral side. The ultrasound examination revealed a thickening of the tendon and of the dorsal paratenon with changes in the internal structure of the injured Achilles tendon. In spite of these favourable results, the high complication rate of 15.1% shows the need for new and extensive studies regarding the various alternative treatment forms, such as functional, non-operative options, to finally resolve the debate about the optimal treatment of Achilles tendon ruptures.

Surgical treatment of dislocations of the acromioclavicular joint in the athlete.

The treatment of the sports related dislocation of the acromioclavicular joint remains controversial. This study was carried out to determine whether or not a combined surgical procedure consisting of repair and polydioxanone (PDS)-cord augmentation of the coracoclavicular ligaments, fixation of the acromioclavicular joint with a single Kirschner wire as well as the repair of the acromioclavicular ligament permitted return to athletic activity. Athletes were examined with regard to their range of motion, pain and their ability to return to the performance level achieved before the injury. During the period 1986-1989, 21 athletes were treated. Follow-up averaged 22 months. Return of athletes to previous performance level was related to their original degree of activity. Two recreational once-a-week athletes did not return to this level, 19 patients, including five competitive athletes, continued their previous activities. There was no correlation between coracoclavicular ossification or post-traumatic arthritis and a good or excellent result. We recommend the operative treatment of acromioclavicular separations in athletes.

Sports-related epiphyseal injuries of the lower extremity. An epidemiologic study.

Sports-related epiphyseal injuries in children and adolescents have been becoming more prevalent during recent years. We report 85 patients with epiphyseal fractures of the lower extremity treated in our hospital during the last twenty years, of which 60 were males and 25 females with an average age of 12.6 years (range 4 to 17 years of age). The injuries were sustained during soccer in 28% and during alpine skiing in 26% of the cases, of which the former was responsible for most of the injuries reported in males and the latter for those in females. The most frequently seen localizations were in the distal tibial epiphysis (31 cases), followed by the distal fibula (17) and the proximal tibial epiphysis (15). Of the reported 85 epiphyseal fractures 30 were Salter-Harris type I injuries, 25 type II, 8 type III and 11 were type IV fractures, while 11 were avulsion fractures. Of these patients, 56% were treated surgically, while conservative treatment was chosen for 44% of the patients. Of the 49 patients available for follow-up, complications were documented in 9 instances, including 3 leg length discrepancies, 4 axis deviations, one avascular necrosis of the femoral head and one case of osteomyelitis, of which 6 required corrective surgery.

Tumoral calcinosis of the ischium.

The authors report on a case of tumoral calcinosis of the ischium in a 63-year-old female. By means of this particular case a general review of the literature on pathogenesis, histological characteristics, the possible way of treatment and the prognosis of tumoral calcinosis is presented.

Sports-related two-plane fractures of the distal tibia. Report of two cases.

Two cases of sports-related two-plane fractures of the distal tibia, their operative treatment and the result of therapy after hardware removal are reported. The incidence and mechanism of this type of fracture in adolescents are shown as well as the indication for surgical reconstruction depending on the gap in the joint surface of the distal tibia.