Anterior cruciate ligament reconstruction with a single hamstring tendon graft and tape locking screw (TLS) fixation leads to good clinical outcome in two years of follow-up.

Background: There are many fixation methods for hamstring tendon autograft available for anterior cruciate ligament (ACL) reconstruction. The intention of this study was to report clinical follow-up data of the Tape Locking Screw (TLS) reconstruction technique. Hypothesis: Does TLS method give good long term results in patient satisfaction and in clinical knee tests. Patients and methods: We selected 119 prospectively collected patients with a two-year follow-up who had an ACL reconstruction using TLS technique. A total of 114 cases were available for follow-up two years postoperatively. The evaluation methods were instrumented laxity measurements, clinical examination and knee scores. Results: The Lysholm and IKDC scores improved from preoperative 76 and 50 to 95 and 90, respectively. Tegner activity level before surgery was 3 and improved to 6 at 2 years postoperatively. Discussion: ACL reconstruction with TLS technique showed good objective outcome at the 2-year follow-up. We confirmed improvement in all evaluation method variables. Level of evidence: Case series; level of evidence, 4. Trial registration: ISRCTN registry, study ID ISRCTN34011837. Registered retrospectively April 29, 2020.

A prospective comparison of 3 hamstring ACL fixation devices-rigidfix, bioscrew, and intrafix-randomized into 4 groups with a minimum follow-up of 5 years.

BACKGROUND: ACL (anterior cruciate ligament) reconstruction remains the gold standard surgical option for patients with ACL tears. There are many fixation devices available for ACL reconstruction. Recent ACL reconstruction strategies are aiming to reproduce the native anatomy and normal kinematics of the knee. This is a five years follow-up report of some of the new devices for graft fixation. A two years follow-up data was published previously. METHODS: 120 patients were randomized into four different groups (30 each) for ACL reconstruction with hamstring tendons: group I femoral Rigidfix cross-pin and Intrafix tibial extension sheath with a tapered expansion screw; group II Rigidfix femoral and BioScrew interference screw tibial fixation; group III BioScrew femoral and Intrafix tibial fixation; group IV BioScrew fixation into both tunnels. The evaluation methods were clinical examination, knee scores, and instrumented laxity measurements. RESULTS: In this 5 years follow-up there were 102/120 (85%) patients available, but only 77 (64,2%) attended the clinical examinations. No significant difference between the groups in the clinical results was detected. Between the 2 and 5 years follow-up there were 6 additional procedures in group I and one in group II. There was a significant difference in additional procedures between group I and the other groups (P = .041). CONCLUSION: There was a statistically significant difference in the additional procedures, most in group I (six). The ACL grafts were intact. Other statistically or clinically significant differences in the 5 years follow-up results were not found. STUDY DESIGN: Randomized controlled clinical trial; Level of evidence, 1. Trial registration ISRCTN registry with study ID ISRCTN34011837. Retrospectively registered 17.4.2020.

Comparison of clinical results of anteromedial and transtibial femoral tunnel drilling in ACL reconstruction.

BACKGROUND: A femoral bone tunnel in ACL reconstruction can be constructed from the outside in or from the inside out. When doing it inside out, the approach can be via the anteromedial (AM) portal or through the tibial bone tunnel. It has been suggested that better results might be expected by doing it anteromedially. Clinical results after femoral tunnel drilling via the AM or transtibial (TT) techniques in reconstruction of anterior cruciate ligament (ACL) are presented. METHODS: Three hundred patients with ACL injuries were chosen for this study from previously collected data on ACL reconstructions. They were divided into two groups: 150 patients treated with AM drilling and 150 treated with TT drilling. In the AM group, the reconstructions were performed using a semitendinosus graft with the Tape Locking Screw (TLS™) technique (n = 87) or Retrobutton™ femoral and BioScrew™ tibial fixation with a semitendinosus-gracilis graft (n = 63). In the TT group, the fixation method used was Rigidfix™ femoral and Intrafix tibial fixation with a semitendinosus-gracilis graft. The evaluation methods were clinical examination, knee scores (Lysholm, Tegner and IKDC) and instrumented laxity measurements (KT-2000™). Our aim was to evaluate if there was better rotational stability and therefore better clinical results when using AM drilling compared to TT drilling. RESULTS: After excluding revision ACL reconstructions, there were 132 patients in the AM group and 133 in the TT group for evaluation. At the 2-year follow-up, there were 60 patients in the AM group (45.5%) and 58 in the TT group (43.6%). There were no statistically significant differences between the groups in any of the evaluation methods used. CONCLUSION: Both drilling techniques resulted in improved patient performance and satisfaction. We found no data supporting the hypothesis that the AM drilling technique provides better rotational stability to the knee. TRIAL REGISTRATION: ISRCTN registry with study ID ISRCTN16407730. Retrospectively registered Jan 9th 2020.

Efficacy of a novel PCR- and microarray-based method in diagnosis of a prosthetic joint infection.

BACKGROUND AND PURPOSE: Polymerase chain reaction (PCR) methods enable detection and species identification of many pathogens. We assessed the efficacy of a new PCR and microarray-based platform for detection of bacteria in prosthetic joint infections (PJIs). METHODS: This prospective study involved 61 suspected PJIs in hip and knee prostheses and 20 negative controls. 142 samples were analyzed by Prove-it Bone and Joint assay. The laboratory staff conducting the Prove-it analysis were not aware of the results of microbiological culture and clinical findings. The results of the analysis were compared with diagnosis of PJIs defined according to the Musculoskeletal Infection Society (MSIS) criteria and with the results of microbiological culture. RESULTS: 38 of 61 suspected PJIs met the definition of PJI according to the MSIS criteria. Of the 38 patients, the PCR detected bacteria in 31 whereas bacterial culture was positive in 28 patients. 15 of the PJI patients were undergoing antimicrobial treatment as the samples for analysis were obtained. When antimicrobial treatment had lasted 4 days or more, PCR detected bacteria in 6 of the 9 patients, but positive cultures were noted in only 2 of the 9 patients. All PCR results for the controls were negative. Of the 61 suspected PJIs, there were false-positive PCR results in 6 cases. INTERPRETATION: The Prove-it assay was helpful in PJI diagnostics during ongoing antimicrobial treatment. Without preceding treatment with antimicrobials, PCR and microarray-based assay did not appear to give any additional information over culture.

Joint use of drugs and alcohol.

AIMS: To determine the relationships between the different patterns of drinking and drug use in the general population. DESIGN: The data from three nationwide surveys conducted in Finland in 1998, 2002 and 2004 were pooled into one dataset (n = 7,227). PARTICIPANTS: Population aged 15-69. MEASUREMENTS: Use of illicit drugs was analyzed in relation to annual alcohol consumption, heavy episodic drinking, frequenting of pubs and restaurants, and the misuse of prescribed drugs. Respondents were divided into five different groups according to their involvement in drug cultures, i.e. 'no contact with drug cultures', 'some contact with drug cultures', 'drug experimenters and ex-users', 'cannabis users' and 'multidrug users'. FINDINGS: The prevalence of drug use increased along with the annual alcohol consumption, and polysubstance use was most prevalent among heavy drinkers. Heavy episodic drinking and frequenting of pubs and restaurants increased in parallel with involvement in drug cultures. Misuse of prescribed drugs was most prevalent among multidrug users. CONCLUSIONS: Polysubstance use patterns reveal an interlacing of alcohol and drug cultures. However, standard measures employed in alcohol and drug research are insufficient to capture the phenomenon in detail, and more research and the development of new approaches are needed.

Relationship between negative experiences and drinking experience among 15- to 16-year-old adolescents in Finland.

AIMS: To assess the relationship between negative experiences and frequency of alcohol drinking and drunkenness among 15- to 16-year-old adolescents in Finland. METHODS: A school-based survey as part of the European School Project on Alcohol and Other Drugs (ESPAD) conducted in Finland in 2003. Nationally representative sample of Finnish adolescents, aged 15-16 (n = 3,321). Response rate 92%. Negative experiences, alcohol use and drunkenness were assessed using a self-administered questionnaire. Logistic regression analysis was used to examine the relationship between negative experiences and drinking experience. RESULTS: Prevalence of negative experiences increased with increased frequency of drinking and drunkenness. Certain harms (troubles with the police, engaging in regretted and unprotected sexual intercourse) were experienced primarily with frequent drinking and drunkenness (>20 occasions). Logistic regression analysis indicated that only the drunkenness-related drinking style was significantly related to troubles with the police and engaging in sexual intercourse regretted the next day. CONCLUSIONS: While under-aged youths experience many problems in relationship to their alcohol use, certain problems are highly associated with frequent and heavy drinking, especially with drunkenness-related drinking style. These findings should be acknowledged when implementing effective alcohol education and alcohol-related policies to reduce under-aged alcohol use and related harms.

The reliability of self-reported drinking in adolescence.

AIMS: To study the reliability of adolescents' self-reported drinking and perceived drunkenness in surveys. METHODS: The data from two cross-sectional school-based questionnaire surveys with representative cluster samples (the European School Survey Project on Alcohol and Other Drugs, ESPAD) in Finland were used; there were 2161 (1995) and 3109 (1999) 15-year-old respondents. The response rates were 94% and 90% respectively. The measurements analysed were an open-ended and a set of closed-category questions concerning the latest drinking occasion. RESULTS: The set of three closed questions used in 1995 yielded mean amounts of 6.6 (girls) and 8.7 (boys) centilitres of pure alcohol whereas the figures obtained from the open question were 8.5 (girls) and 11.8 (boys) centilitres. With the closed set extended in 1999 into five questions, the two figures among girls were 7.7 (closed) and 7.7 (open) centilitres; the corresponding figures among boys were 11.3 (closed) and 11.7 (open) centilitres. Individual level correlations between the two measures among girls were 0.69 in 1995 and 0.69 in 1999; and 0.69 (1995) and 0.65 (1999) among boys. The numbers of students reporting specific beverage type use were higher when using closed questions compared with an open question. Drunkenness self-reports related logically to amounts of alcohol drunk. CONCLUSIONS: The adolescent drinking amount self-reports seem reasonably reliable and valid both on a population and individual level. A set of closed questions may capture the amount drunk even better than an open question.