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.

Ski injury statistics, 1982 to 1993, Jackson Hole Ski Resort.

A retrospective analysis was conducted on injury statistics compiled over 12 seasons, from 1982 to 1993 (2.55 million skier-days), at a Wyoming ski resort. The population at risk was determined by ticket sales per year. A total of 9749 skiing injuries was indexed by anatomic region and severity according to diagnosis on initial evaluation. Injury rates were then analyzed as a function of time. The injury rate remained constant at 3.7 injuries per 1000 skier-days during the 12 seasons. The rate of lower extremity to upper extremity injury decreased from 4:1 to 2:1 during the study period (P < 0.03). The ankle injury rate also decreased with time (P < 0.04). Ulnar collateral ligament sprains make up 7% of all injuries. Knee sprains in general account for 30% of all injuries. The incidence of anterior cruciate ligament tears increased as a function of time (P < 0.04) and accounted for 16% of all skiing injuries during the study period. The medial collateral ligament sprain was the most common injury, making up 18% of skiing injuries. Forty-seven snowboard injuries from the 1992 to 1993 season are also presented. Our injury statistics mirror those currently reported in North America, except our data reflect a higher incidence of knee sprains.

Consideration of the anterior cruciate ligament injury in skiing.

The anterior cruciate ligament (ACL) injury of the knee is a common ski injury. At a typical ski area clinic in Wyoming, an average of one per day is diagnosed over the 120-day ski season. Other ski clinics report a similar incidence of ACL injuries. In view of the 570 registered ski slopes in the United States, the ACL injuries occur at epidemic proportions. Under consideration are causal factors involved in the typical skier's ACL injury, such as recent evolutions in skiing techniques, boot styles, the skier's environment, and the anatomic considerations relating to body mechanics that place the ACL in a position of compromise in the intercondylar notch. Clear identification of the mechanism of ski injury of the ACL is difficult. As the significant causative factors become identified, and with the stimulation of further interest and research, there is some promise for prevention in the future.