Evaluation of driving skills after anterior cruciate ligament reconstruction with hamstring autograft.

BACKGROUND: There are no well-established guidelines for safe driving after injury or surgical treatment. The purpose of this study was to assess the aptitude to regain driving skills and brake reaction abilities after anterior cruciate ligament (ACL) surgery. METHODS: This study compared the driving abilities and skills at four to six weeks after surgery of 31 patients who underwent ACL reconstruction with hamstring autograft with 31 healthy volunteers. Multiple variables, including pedestrian impact, car crash, red traffic light violations, visual reaction time, and other driving abilities were measured with a validated driving simulator. RESULTS: There was no statistically significant between-group difference with respect to skill, driving ability, and brake reaction times (P > 0.05). The differences between right and left knees were also not statistically significant (P > 0.05). However, patients with a right ACL reconstruction had a higher number of collisions with fixed objects (2.82 vs. 1.84, P = 0.239) and pedestrian impacts (0.23 vs. 0.00 P = 0.221), and had slower brake reaction times (585.69 vs. 456.02 ms, P = 0.069). The Tegner score was similar in each group (7.19 in ACL reconstruction group vs. 6.8 in control group, P = 0.092) and the Lysholm score improved as compared with the presurgical measurement (53.48 vs. 89.61, P < 0.001). CONCLUSIONS: Anterior cruciate ligament surgery with hamstring autograft did not result in a decrease in driving performance and safety at four to six weeks after surgery with respect to skill, ability to drive, and brake response time.

The effects of previous meniscus and anterior cruciate ligament injuries in patients with total knee arthroplasty.

BACKGROUND: Patients undergoing total knee replacements constitute a suitable population to study the natural history of traumatic joint injuries. MATERIAL AND METHODS: We studied all the patients who received a TKA (Total knee arthroplasty) over the course of one year, in five different centers. The study included 474 patients who had undergone primary TKA for knee OA over a one-year period. In each patient, we analyzed age, sex, side of operation, weight, height and body mass index (BMI, kg/m2). BMI were stratified into four groups according to the WHO classification: normal (<25), overweight (>25 and <30), obese (>30 and <40), and morbidly obese (>40). RESULTS: In the TKA group, 74% of the patients were women, while in the THA group the percentage of men and women was similar. No differences were found in the sides operated on. Differences between both groups were found in knee alignment. Women were operated on more frequently for TKA, as there was a higher incidence of OA of the knee joints in women aged over 65. CONCLUSIONS: Patients who required a total knee arthroplasty are likely to have previously undergone surgery or trauma to the knee joints.

Catastrophic wear in a metal-on-ceramic total hip arthroplasty.

A 51-year-old woman came to our clinic 6 months after a right total hip arthroplasty. She had noticed a slowly growing mass in the proximal thigh and referred progressive pain in the right groin. Plain radiography revealed premature acetabular cup aseptic loosening, and in the computed tomography study, a 14-cm-diameter mass was observed. Revision surgery was performed, showing a metal-on-ceramic bearing surface. The histologic analysis of surrounding tissues was reported as massive metallosis. Although occasionally chosen for primary or revision hip arthroplasty, there is little information available about the in vivo wear behavior of this combination. This important fact should be taken into account before considering such a surface alternative.