Anterior cruciate ligament reconstruction. Bone-patella tendon-bone versus semitendinosus anatomic reconstruction.

In this article, the long term (2-10 years; mean, 4.8 years) followup results of two reconstructive procedures for the anterior cruciate ligament are compared. The bone-patella tendon-bone (with interference fit fixation) was performed on 69 knees, and the semitendinosus anatomic reconstruction was performed on 68 knees, in a population of 76 men and 52 women (age range, 15-60 years; average, 31 years). The patients in the two groups showed no difference in subjective results or activity level and no significant difference to manual testing. The semitendinosus procedure group had a slightly higher KT manual maximum failure rate than the patella tendon group (17% versus 11%). Arthrometric stability did not show deterioration, but patient satisfaction decreased in those patients who had meniscectomies. Both procedures showed satisfactory results during the long term followup. However, if the secondary restraints are compromised, the stiffer bone-patella tendon-bone construct is preferred for reconstruction of the chronic anterior cruciate ligament deficient knee.

Spinal anesthesia for outpatients: appropriate agents and techniques.

With attention to appropriate selection of drugs, techniques, and needles, spinal anesthesia offers significant advantages in the outpatient setting. The combination of rapid onset, high reliability, and technical ease, along with the lower incidence of postoperative nausea and vomiting, allows for rapid turnover and discharge. The incidence of headache should not be a limiting factor if appropriate small, rounded bevel needles are used, and the technique is used primarily in the population aged over 40 years.

Capitellocondylar total elbow replacement. A long-term follow-up study.

The results of forty total elbow replacements in which a capitellocondylar prosthesis was implanted in thirty-five patients (five of whom had a bilateral procedure) were reviewed retrospectively. The average length of follow-up was 7.2 years (range, four to twelve years). Pronation, supination, and flexion of the elbow improved considerably, but extension did not change a great deal. The average rating of the elbow, according to the scoring system of Ewald et al., improved from 30 to 88 points, but the functional score, as defined by the American Rheumatism Association, improved in only four patients. Malarticulation or dislocation of the prosthesis occurred in ten patients (29 per cent). In two other patients, a deep infection developed, necessitating removal of the prosthesis. Ten prostheses (ten patients) had radiolucent lines on follow-up radiographs, but these lines were not associated with pain or loosening. Seven patients (seven elbows) had a transient ulnar-nerve palsy. The incidence of this complication was reduced from 30 per cent (five of seventeen patients) to 15 per cent (four of twenty-eight patients) when the lateral Kocher approach to the elbow was adopted.