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Abstract: The aims of this study were to determine survival rate, the clinical performance, and radiologic results of an Anatomic Graduated Component (AGC) total knee arthroplasty (TKA). Survival analysis was assessed by analyzing all hospital records of 211 AGC TKAs in 177 patients after 15 to 20 years. The survival rate was 87%, with failure defined as revision for any reason including infection. The main reasons for failure were infection and failure of the metal-backed patellar component. Clinical evaluation of 30 patients (33 TKAs) and questionnaires of 20 patients (23 TKAs) were taken, showing moderate to good results (mean Knee Society Score, 51; mean Western Ontario and McMaster Universities Osteoarthritis index, 82; mean University of California Los Angeles score, 4). Radiologic evaluation of 13 TKAs in 12 patients showed that none was suspect for loosening. Three knees showed significant medial wear but no clinical complaints. In conclusion, this is one of the first studies showing that AGC total knee prosthesis has good results 15 to 20 years after surgery. [Copyright &y& Elsevier]

Abstract: Os vesalianum pedis is an uncommon accessory bone. It is located proximal to the fifth metatarsal and found within the peroneus brevis tendon. The incidence is very low, and as with other accessory bones of the foot, it is rarely symptomatic. When symptomatic, the main objective in diagnosis is to differentiate from an ossifying apophysis of the fifth metatarsal base, an apophysitis of the fifth metatarsal base (Iselin’s disease), a fracture of the tuberosity of the fifth metatarsal, nonunion of a tuberosity fracture of the fifth metatarsal, an ununited apophysis of the fifth metatarsal base, and an os perineum. We present a very rare case of a bilateral symptomatic os vesalianum pedis. The clinical presentation and course are described, as well as its treatment. This case showed that both conservative and operative treatment can be effective for pain reduction. Operative treatment of course has the risk of complications, a lesion of a branch of the sural nerve occurring in this case. On the other hand, conservative treatment can take a long time to reduce pain, and there is always the risk of recurrence. [Copyright &y& Elsevier]

In a double-bundle posterior cruciate ligament reconstruction, several surgical techniques are available. Compared with other techniques, the advantages of the all-inside technique and cortical suspension devices with variable loop length are that shorter grafts can be used, tendons can be quadrupled, and a double-bundle posterior cruciate ligament reconstruction can be performed with autologous grafts. Furthermore, the all-inside technique provides independent outside-in socket reaming and is soft tissue, cortex, and bone sparing because no full diameter tunnels but sockets are created with a small diameter guide pin, which can transform into a retrograde drill. Sockets could however lead to bottoming out of the grafts at the femoral side and subsequent residual laxity. This can be avoided by using 2 separate grafts that are fixed in 2 femoral sockets before they are independently fixed and tensioned in 1 tibial socket in their corresponding flexion angle. In this technical note, we present a double-bundle, all-inside posterior cruciate ligament reconstruction using 2 separate autologous grafts. [ABSTRACT FROM AUTHOR]

Purpose: To study the value of tourniquet use during routine arthroscopy of the knee. Methods: In this randomized, double-blind controlled trial, 245 patients were included from April 2005 until March 2007 and randomized into an inflated tourniquet group (n = 137) or a deflated tourniquet group (n = 108). The primary outcome was intraoperative visibility. Secondary outcomes were the need to intraoperatively inflate the tourniquet because impaired vision impeded the procedure, the number of times and reason (impaired vision or debris) for flushing the knee, the duration of the procedure (in minutes), and the surgeon''s impression of whether the tourniquet was inflated during the procedure. Results: Intraoperative visibility was statistically significantly better in the group with the inflated tourniquet. In 11 of the 16 cases in which visibility was rated fair/poor (unsatisfactory), the surgeon felt the need to inflate the tourniquet. In all of the cases the tourniquet had not been previously inflated. In all but 1 case the visibility improved to at least to a rating of good. The frequency of flushing the knee intraoperatively was significantly higher in the deflated tourniquet group. The operative time was not significantly different statistically. Conclusions: The results of this study support our hypothesis that routine arthroscopy of the knee with an inflated tourniquet significantly improves visibility, but it does not shorten operative time. Level of Evidence: Level I, therapeutic randomized controlled trial. [Copyright &y& Elsevier]