Mid-term results of arthroscopic reconstruction in chronic posterior cruciate ligament instability.

The purpose of this study was to evaluate the clinical results of arthroscopic single bundle posterior cruciate ligament (PCL) reconstruction in patients with chronic PCL instability not responding to conservative treatment. 18 patients were available for follow-up with an average elapsed time of 3 years between onset of injury and surgery and an average duration of 3.3 years between reconstruction and evaluation. The clinical results were investigated using the IKDC form, the Tegner rating system, a subjective evaluation, and the VAS for pain rating. The presence of femoral degenerative changes correlated strongly to the elapsed time between injury and operation (P<0.05). Before surgery all patients were graded D (severely abnormal) using the IKDC evaluation form. The final IKDC score at follow-up resulted in grade A (normal) in five patients (28%), grade B (nearly normal) in eight patients (44%), grade C (abnormal) in four patients (22%) and grade D (severely abnormal) in one patient (6%). The VAS score for pain rating revealed very few complaints of pain and it demonstrated a strong correlation between the subjective evaluation and the Tegner rating score (P<0.01). Evaluation of the Tegner score resulted in a significant improvement after surgery when compared to the situation prior to operation (P<0.01). Although there still is some controversy on the indication for treatment of PCL injury, we conclude on the basis of our findings that arthroscopic reconstruction of symptomatic chronic PCL instability, not responding to conservative therapy, can be greatly beneficial.

Abnormal bone scans in anterior cruciate ligament deficiency indicate structural and functional abnormalities.

Many patients with anterior cruciate ligament (ACL) deficiency have an abnormal bone scan. This finding has not yet been explained. Suggested explanations include intra-articular (structural) or kinematic (functional) abnormalities. We examined the relationship between bone scintigraphy and cartilage degeneration or meniscal lesions in the ACL-deficient knee in 95 consecutive patients who had bone scintigraphy 1-3 days prior to arthroscopic ACL reconstruction. Intra-articular abnormalities of the knee did not explain all scintigraphic patterns of this study. We did not find clinically useful positive predictive values for scintigraphic patterns considered to indicate cartilage degeneration or a lateral meniscus lesion. A clinically useful positive predictive value was found only for medial meniscus lesions when time since ACL rupture was more than 18 months, and for local cartilage degeneration when markedly increased uptake was seen when time since ACL rupture was more than 4 months. Considering these findings, alternative explanations are discussed, based on specific aspects of abnormal kinematics and adaptive bone metabolism of the ACL-deficient knee.

Abnormal bone scans of the tibial tunnel 2 years after patella ligament anterior cruciate ligament reconstruction: correlation with tunnel enlargement and tibial graft length.

Tibial bone tunnels were examined with bone scans 2 years after patella ligament ACL reconstruction in 68 patients. At 2 years, scan uptake at the tibial tunnel was increased in 29% of patients. Marked increase of scintigraphic uptake was associated with tibial tunnel enlargement of more than 35% and a graft length in the tibial tunnel over 14 mm. Scan uptake was correlated to tunnel enlargement (r = 0.64, P < 0.01) and tunnel enlargement was correlated to graft length inside the tibial tunnel (r = 0.59 P < 0.001). No correlation was found between scan uptake or tunnel enlargement and anterior laxity, sagittal tunnel position and subjective outcome. Scintigraphy indicates the enlarged tibial tunnels are filled with remodelling bone. Tibial fixation location influences ligament healing inside the tunnel: Return of osseous homeostasis at the tibial tunnel can take more than 2 years when fixation is more than 14 mm below the joint.

Operative treatment for delayed union and nonunion of midshaft clavicular fractures: AO reconstruction plate fixation and early mobilization.

Fourteen patients were treated operatively for delayed union and nonunion of midshaft clavicular fractures from 1986 to 1994. Radiographically, nine nonunions were atrophic and five hypertrophic. The operative technique included opening the medullary canal, bone grafting, and fixation with an AO reconstruction plate. Postoperative mobilization started within one week. The mean follow-up was 60 months (range, 16 to 101 months). Consolidation was observed radiologically after 10 to 30 weeks. All patients were asymptomatic after 10 weeks and had a normal range of shoulder motion. One patient sustained a fractured clavicle following adequate trauma. Operative treatment for delayed union and nonunion of clavicular fractures with AO reconstruction plate fixation, bone grafting, and early postoperative mobilization yields excellent results.