Reconstruction of the anterior cruciate ligament with the iliotibial band autograft in patients with chronic knee instability.

We performed combined internal and external anterior cruciate ligament (ACL) reconstruction with the iliotibial band autograft in 169 consecutive patients with chronic ACL insufficiency who were followed up for 24-61 months. Of these, 155 (91%) agreed to an additional independent observer follow-up after 24-92 months. Eight patients (5%) had sustained a rerupture/elongation of the graft and were operated on again; nine (6%) had sustained a tear of the contralateral ACL. Knee function and activity increased after the reconstruction. Lysholm scores improved from median 81 preoperatively to 99 at follow-up and Tegner scores from median 4 to 7. At follow-up 97 (71%) were active at the same level as prior to injury. In 17 of the 40 patients (12%) dropping to a lower activity level this was due to knee problems. The side-to-side difference in anterior-posterior knee laxity was more than 3 mm in 18 knees (13%) and more than 5 mm in 3 knees (2%). Including eight reruptures, this results in a "stability" failure rate of 8.8%. The overall IKCD rating showed normal knee function in 88 (73%) and nearly normal knee function in 30 (25%). Anterior knee pain was present in 14 (10%) of the patients at follow-up. Patients with isolated ACL injury had higher Lysholm scores and Tegner scores than patients with associated injuries. No clinical signs of varus knee development were seen. Of the 155 patients 94% would have the procedure repeated if necessary with the knowledge that they have today. The combined internal and external iliotibial band procedure can restore knee stability and function in the majority of chronic ACL-insufficient knees.

Reconstruction of anterior cruciate ligament deficient knees in soccer players with an iliotibial band autograft. A prospective study of 132 reconstructed knees followed for 4 (2-7) years.

One hundred and thirty-two consecutive soccer players (117 males and 15 females, median age 23, range 16-39 years) underwent primary reconstruction of the anterior cruciate ligament (ACL) with an iliotibial band (ITB) autograft. All patients were followed prospectively for a minimum of 2 years. One hundred and eighteen patients (89%) attended an independent observer follow-up after a median of 47 (24-92) months. The time before participating in soccer was a median of 7 (5-24) months. At a median of 4 years, 80 (68%) were still active soccer players, while 38 had changed activity to a lower level. Twenty-five gave up soccer playing for reasons unrelated to the knee, and 13 (11%) gave up due to problems from the reconstructed knee. The Lysholm score improved from a median of 82 (range 42-99, mean [SD] 80.5 [+/-11.9]) points prior to the operation to a median of 99 (range 57-100, mean [SD] 94.6 [+/-8.5]) at follow-up. The Tegner score improved from a median of 3.5 (0-7) preoperatively to 9 (1-10). Four patients (3%) sustained a rupture of the graft: three ruptures occurred among the 15 females (20%), and one was seen among the 117 males (0.8%) (P=0.01). Eight per cent had predominantly minor cosmetic complaints from the donor-site hernia, while 51% had temporary discomfort from the staples used for graft fixation. Using the ITB autograft for ACL reconstruction, we found excellent and good results in soccer players with ACL deficiency and high demands for optimal knee function. The failure rate in general was comparable with other methods, and the majority was still active in soccer sports at a median of 4 years after surgery. An unacceptably high rerupture rate was registered in female players.

Epidemiologic, bacteriologic, and long-term follow-up data of children with acute hematogenous osteomyelitis and septic arthritis: a ten-year review.

A total of 69 children with acute hematogenous osteomyelitis and 48 with septic arthritis admitted in the period 1978 through 1987 were included in a retrospective review. Epidemiologic and bacteriologic data were analyzed and compared with those of an earlier study (1965 through 1975), confined to the same geographic area. Long-term outcome was evaluated by a questionnaire and clinical and radiographic follow-up. A significant increase in the admission rate for both disorders was observed. The long-term outcome was favorable: major sequelae were found in three patients (3%), minor sequelae in two patients (2%). The benign long-term outcome may well be related to rapid hospital admission and appropriate long-lasting antibiotic treatment.

Results of reconstruction of acute ruptures of the anterior cruciate ligament with an iliotibial band autograft.

Forty patients with an acute complete tear of the anterior cruciate ligament (ACL) underwent primary reconstruction with an iliotibial band autograft after median 15 (range 0-90) days. Objective and functional evaluation was performed after median 37 (range 24-87) months by two independent observers using the International Knee Documentation Committee (IKDC) knee evaluation form, the Lysholm knee function score, and the Tegner activity score. During the observation period 5 patients sustained an ACL tear in the contralateral knee, and 1 patient (2.5%) sustained a graft rupture and underwent re-reconstruction. For the remaining 34 knees the Lysholm score at follow-up was median 100 (range 84-100, mean 97 [+/- 4]), all patients scoring excellent (n = 28) or good (n = 6). Three patients (9%) had more than 3 mm side-to-side difference in anteroposterior laxity. All 4 ligament failures occurred in patients operated on within the first 2 weeks after the injury. Twenty-six patients (76%) returned to the same level of activity as prior to the injury. Of 8 who dropped to a lower activity level, only one ascribed this to problems with the operated knee, meaning that 26 of 27 (96%) returned to their desired level of activity. According to the overall IKDC evaluation, 14 patients (40%) had a normal knee (A), 13 (37%) had a nearly normal knee (B), 5 (14%) had an abnormal knee (C), and 2 (9%) had a severely abnormal knee (D). Ten patients (25%) had the staples removed due to local irritation, and further 6 (15%) had local symptoms from the tibial staples. The harvest site gave 8 (20%) patients cosmetic complaints, but all graded this as slight, and 3 (8%) had slight pain during activity from the lateral muscular hernia. In selected individuals performing vigorous knee activities, autologous reconstruction of acute ACL disrupted knees with a combined internal and external iliotibial band transfer demonstrates excellent results after median 3 years. The failure rate is comparable to other techniques.

Isolated total ruptures of the anterior cruciate ligament--a clinical study with long-term follow-up of 7 years.

Seventy patients met our inclusion criteria in this retrospective study, all with an arthroscopic/arthrotomic-verified isolated total anterior cruciate ligament (ACL)-rupture and a minimum follow-up period of 3 years and no associated lesions. Due to emigration/death, 3 patients were not available for follow-up. Of the remaining 67, 25 patients underwent secondary ACL-reconstruction, equivalent to a failure rate of the initial non-operative treatment of 37%. All patients were initially treated conservatively. This left 42 patients for follow-up--9 answered a questionnare and 33 went through follow-up examination after a median of 7.1 years (range 3.3 14.6) including IKDC-evaluation form, Lysholm & Tegner score, ES-SKA-score, clinical examination and Stryker Laxity test. In the present study all values represent the 33 patients available for follow-up. Soccer, handball and alpine skiing were most frequently responsible for the injury. We observed in the 33 patients a decline in median Lysholm score from 100 (90-100) pretraumatic to 86 (42-100) at follow-up, and a decrease in median Tegner values from 7 (3-9) pretraumatic to 5 (2-7) at follow-up. All but 2 patients demonstrated a decline in Lysholm score, and only 3 patients returned to their preinjury level. According to the ESSKA-classification, the number of "cutting-sports performers" declined dramatically from 24 to 2. All but one patient ascribed their decline in activity to their knee status. The Stryker-measured AP-translocations were significantly higher on the injured knee (7.27) compared to the healthy knee (4.80) (P < 0.05). Intermittant rest pain was suffered by 63% of the patients. During the time from inclusion until follow-up, 13 (39%) patients sustained an additional ipsilateral knee lesion, most commonly a tear of the medial meniscus. The overall outcome was expressed in a low frequency of return to unrestricted preinjury level of function, and a high level of instability complaints resulting in many secondary ACL-reconstructions. Naturally some have adapted to their ultimate functional disability, but only through modification of activities, and the overall outcome after conservative therapy of these ACL-ruptures was not satisfactory.

An epidemiological analysis of the injury pattern in indoor and in beach volleyball.

This study was designed to evaluate the injuries in indoor and in beach volleyball, and to compare the injury pattern in the two different types of volleyball. Injuries in 295 volleyball players were recorded during the beach volleyball season 1993 and during the following indoor volleyball season 1993 to 1994. The method of enquiry was two identical questionnaires. Equal numbers of men and women, elite and recreational players were represented. In beach volleyball 24 injuries were reported and 286 in indoor volleyball, representing an incidence of 4.9 injuries per 1000 volleyball hours in beach volleyball and 4.2 in indoor volleyball. The most frequent injuries were acute injuries located in the ankle and finger and overuse injuries in the knee and shoulder. The injury pattern was different in indoor and in beach volleyball. In beach volleyball most injuries occurred in field defence and in spiking, with overuse injuries in the shoulder as the major site. In indoor volleyball most injuries occurred during blocking and spiking, resulting most frequently in acute finger and ankle injuries, respectively.

Isolated partial rupture of the anterior cruciate ligament. Long-term follow-up of 56 cases.

The majority of previous studies on partial ruptures of the anterior cruciate ligament (ACL) include a relatively large proportion of knees with associated intra-articular injury or collateral ligament tear that contributes to an increase in the symptoms of instability and further deterioration of knee function. In the present study only patients with isolated, partial ruptures of the ACL were evaluated. Fifty-six patients with one injured knee were examined after a median of 5.3 (range 2.0-12.7) years using the IKDC evaluation form, Lysholm knee function score and Tegner activity score. Of the 56 knees, 6 underwent autologous reconstruction due to early progression to complete rupture. Of 34 knees evaluated for laxity, 25 had a negative Lachman test and 7 a positive (+) Lachman. In 2 knees a Lachman ++ result and a positive pivot shift were found. With instrumented laxity testing 24 knees had 2 mm or less difference in laxity compared with the contralateral uninjured knee. The largest side-to-side difference in knee laxity was 4.5 mm. Lysholm score was median 86 (range 52-100) points, and 62% had good or excellent knee function. A significant decline in activity was seen. Only 10 patients (30%) resumed their preinjury activities. We find that the majority of patients with an isolated, partial rupture of the ACL have an acceptable knee function and a stable knee after a median 5 years follow-up. There is, however, a marked reduction in activity.

Fractures of the scapula.

This paper presents a review of all patients admitted to the orthopedic department of Frederiksberg University Hospital during a period of 10 years with a diagnosis of fracture of the scapula-a total of 18. All medical records and roentgenograms were reviewed retrospectively. We found, in agreement with the literature reviewed, an extremely high frequency-88% in our study-of high-energy trauma as a cause of scapular fractures. In 88% of the cases the scapular fracture was associated with other lesions; fractures of the ipsilateral humerus or ribs were seen with the highest incidences (44%). All patients were treated conservatively, resulting in satisfactory conditions of their scapula and shoulder girdles.

Formation of impacted fractures of the femoral neck: an experimental study.

Nine femoral-neck specimens were exposed to a fracturing force applied to the femoral head, perpendicular to the axis of the femur, simulating a fall onto the greater trochanter. The mechanical strength and fracture type were investigated in a universal testing machine. In all nine specimens, the superior (cranial) cortex of the femoral neck fractured first, followed by some compression and fracture of the inferior cortex, whereby impacted fractures had been formed. After application of additional force, dislocated fractures occurred. This method may be of value in experimental studies of impacted fractures of the femoral neck. RELEVANCE: This study describes an experimental procedure for formation of impacted femoral neck fractures. Hopefully this technique may be employed in further examining the nature and biomechanics of impacted hip fractures. The ultimate aim would seem to be a classification with regard to which fractures require surgery and which may be treated conservatively.

Computer registration of infections used to measure the effect of prophylactic antibiotics on postoperative infections following osteosynthesis in hip fractures.

Continuous registration of operations and wound infections was used to demonstrate the effect of prophylactic antibiotics in hip fracture osteosynthesis. In order to monitor wound infections and other postoperative complications in an orthopaedic department, 2 years' data on 688 patients with hip fractures, were entered into a personal computer program. During 1990, there was no formal policy for antibiotic prophylaxis; during 1991 prophylactic cefuroxime was recommended for osteosynthesis of hip fractures. In 1990 56% of patients were given prophylaxis and in 1991 this rose to 79%. Overall, 68% of patients had prophylaxis. The overall rate of deep wound infections (DWI) was significantly lower in patients treated with prophylactic antibiotics (0.6%), compared with those without prophylaxis (4.6%). Patients with DWI were admitted to the hospital for an average of 43.7 days, compared with 14.6 days for patients without complications. We recommend the use of prophylactic cefuroxime in hip fracture osteosynthesis. Computer registration of complications is a useful method for clinical quality control in an orthopaedic department.

Nontraumatic clavicular osteolysis in weight lifters.

In a previous study, we found an overrepresentation of weight lifters in patients who had a resection of the lateral end of the clavicle. To further investigate a possible association between competitive weight lifting and the development of nontraumatic osteolysis of the lateral end of the clavicle, we studied a group of 25 Danish weight lifters. This group was compared to an age-matched control group of 25 men who had never engaged in weight training procedures. None of the subjects had any history of trauma to the shoulder girdle. All 50 subjects underwent radiographic examination of both shoulder joints. In the weight lifter group, seven cases (28%) demonstrated classical radiographic findings of clavicular osteolysis, with loss of subchondral bone detail, translucency, and cystic changes, while four subjects (16%) had subjective symptoms but no radiographic changes. None of the individuals from the control group revealed similar symptoms or radiographic signs. Thus, based on this limited material, the prevalence of the disorder is about 27%.

[Acute poisoning in childhood. 607 admissions during a 5-year period to a Danish pediatric department]. / Akutte forgiftninger i barnealderen. 607 indlaeggelser over en 5-årig periode på en dansk paediatrisk afdeling.

This article presents a review and an analysis of the 607 patients admitted to the Paediatric Department in Gentofte University Hospital, Copenhagen, on account of all kinds of poisoning during the period of five years from 1980 to 1985. We observed that the number of inpatients on account of poisoning constituted 4.5% of the total number of inpatients. The female to male ratio was registered as 0.84. No significant differences in admission of patients in each of the five years were found. 97.5% of the children were hospitalized only for two days or even less. Of the total number of patients, 75% were observed in the age groups up to four years and 53% in the interval between one and three years. Concerning the type of poisoning agents: we found that 29% were poisoned with solid substances, 24% with chemical-technical agents, 23% with botanical agents, 22% with various kinds of medicine and finally 2% with gaseous agents. A possible coherence between the different categories of poisoning agents and the age intervals was reviewed. 31% of the admitted children developed symptoms, of which the most frequently observed were gastrointestinal, cerebral and respiratory. The poison categories with the highest frequency of complications were the chemical-technical agents and those determined by ingestion of medicine.

Resection of the lateral end of the clavicle following osteolysis, with emphasis on non-traumatic osteolysis of the acromial end of the clavicle in athletes.

Preoperative radiographs of 38 patients who had undergone resection of the lateral end of the clavicle were reviewed. Seven cases of osteolysis of the lateral end of the clavicle were found, of which four followed severe injury of the shoulder girdle. Three of the cases were young male athletes, with nontraumatic osteolysis. One additional patient with this disorder, in whom resection has not yet been performed, was also included. All four had practised weightlifting and benchpressing as part of their training. Hence, a feasible explanation for the osteolytic process seems to be repeated microfractures due to stresses imposed by these activities. Several conservative regimens provided only temporary relief. After resection, the symptoms ceased and the patients were able to return to competitive sport. With the increasing interest in bodybuilding, non-traumatic osteolysis of the acromial end of the clavicle should be borne in mind in cases of pain in the shoulder in athletes.

A quantitative Allen's test.

Allen's test has been performed quantitatively by measuring digital systolic pressure during compression of the radial or ulnar artery at the wrist. The reduction of pressure in normal subjects was less than 25 per cent. Insufficiency of the arterial supply to the hand from the radial artery, the ulnar artery or the palmar arcades can easily be diagnosed from an abnormal reduction in digital systolic pressure during arterial compression.