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In this multi-center study involving 412 patients, we assessed the influence of concomitant partial meniscal resection on the medium-term clinical results after anterior cruciate ligament reconstruction. We performed a resection of minimum one-third of the medial or lateral menisci in 137 patients (group M) and found intact menisci in 275 patients (group NM). Those who had undergone previous meniscal surgery, subsequent meniscal surgery or a re-rupture of the anterior cruciate ligament graft during the follow-up were not included. After a median of 3 (2-6) years, the patients were reexamined by independent observers. Group M patients had more pain, swelling and laxity than those in group NM; they also had a worse classification according to the IKDC system, lower Lysholm scores and a greater proportion of patients with loss of motion.

We studied the validity and reliability of the Foot and Ankle Outcome Score (FAOS) when used to evaluate the outcome of 213 patients (mean age 40 years, 85 females) who underwent anatomical reconstruction of the lateral ankle ligaments with an average postoperative follow-up of 12 years (range, three to 24 years). The FAOS is a 42-item questionnaire assessing patient-relevant outcomes in five separate subscales (Pain, Other Symptoms, Activities of Daily Living, Sport and Recreation Function, Foot- and Ankle-Related Quality of Life). The FAOS met set criteria of validity and reliability. The FAOS appears to be useful for the evaluation of patient-relevant outcomes related to ankle reconstruction.

The aim of this study was to evaluate the use of a knee brace after arthroscopic anterior cruciate ligament reconstruction using central third patellar tendon autografts. Fifty patients were randomly allocated to two groups. The patients in Group A wore a brace for three weeks postoperatively, while the patients in Group B were rehabilitated without the use of a brace. Pre-operatively, the groups were comparable in terms of age, sex, activity level, knee laxity and muscle strength. The follow-up examination was performed by one independent observer. All the patients were followed up for a minimum of two years. At the follow-up, there were no significant differences between the study groups in terms of the Tegner activity level, Lysholm score, IKDC evaluation system, one-leg-hop quotient, KT-1000 measurements and isokinetic torque. Using the visual analogue scale, the patients in Group A evaluated their pain during the first two post-operative weeks as 1.0 (0-7), compared with 2.3 (0-9) in Group B (P= 0.04). Furthermore, the patients in Group A had a tendency towards fewer problems with swelling, haemathrosis and wound leakage during the early post-operative period (P=0.08). We conclude that the patients who were rehabilitated with the use of a brace had less pain and a tendency towards fewer complications during the early post-operative period than the patients who were rehabilitated without the use of a brace. However, there were no differences in terms of function or knee laxity at the two-year follow-up.

We studied the kinematics of both knees using radiostereometry in 11 patients with unilateral injury of the anterior cruciate ligament and normal contralateral knee. Continuous radiostereometric exposures at a speed of 2-4 exposures a second were performed, when the patients ascended an 8 cm high platform. The tibial center was more dorsally displaced and the tibia more externally rotated on the injured side. This increasing external tibial rotation was associated with increased anterior displacement of the lateral femoral condyle. The latter also displayed less anterior-posterior translations during continuous extension. The anterior-posterior translation of the medial condyle was about the same as on the uninjured side. Changes in the kinematics of the knee joint due to rupture of the anterior cruciate ligament can result in an abnormal joint load, which may increase the risk of damage to the cartilage and the menisci.

The objective of this study was to compare the function and activity level in patients with anterior cruciate ligament injuries, who participated in competitive sports (Tegner activity level > or = 7) and underwent a reconstruction of the anterior cruciate ligament, either subacute (2-12 weeks, group I) or late (12-24 months, group II) after the injury. The patients in group I (n = 97) were comparable with those in group II (n = 103) in terms of gender, age, preinjury activity level, and the reconstruction technique. At the final follow-up (2-5.5 years after the operation), the Lysholm score, the IKDC evaluation system and the one-leg-hop test revealed no differences between the groups. There were also no differences between the groups in terms of the patients' subjective evaluation or expectations. The Tegner activity level at follow-up was 8 (range 2-10) in group I and 6 (range 2-9) in group II (P = 0.0001). The same thing was found in terms of the desired Tegner activity level, which was 9 (range 4-9) in group I and 7 (range 3-10) in group II (P = 0.0002). The KT-1000 laxity meter revealed a total side-to-side difference of 1.5 mm (-3.5-8.5) in group I and 1.5 mm (-3.5-7) in group II (NS). Associated meniscal surgery between the index injury and the reconstruction, or during the reconstruction, was performed in 37/97 (38%) of the patients in group I and 59/103 (57%) of the patients in group II (P < 0.01). This study revealed that competitive athletes who underwent reconstruction at a subacute stage after the anterior cruciate ligament injury had a higher activity level 2-5.5 years after the index operation, as well as a higher desired level of activity compared to athletes who had the reconstruction delayed by 12-24 months. Furthermore, meniscal injuries were significantly more frequent if the reconstruction was delayed.

The aim of this prospective study was to compare two arthroscopic techniques for reconstructing the anterior cruciate ligament, the "outside-in" (two incisions) and the "all-inside" (one incision) techniques. The results obtained for 30 patients operated on using the "outside-in" technique (group I) were compared with those for 29 patients operated on using the "all-inside" technique (group II). Before surgery, there were no significant differences between the groups in terms of Lysholm score, Tegner activity level, patellofemoral pain score, or knee laxity. Both groups displayed significant improvements in Lysholm score after 24 months, from 69 (16) to 91 (9) in group I and from 70 (17) to 90 (15) in group II (means (SD)). There were also significant improvements in patellofemoral pain scores in both groups, from 13 (6) to 18 (5) in group I and from 14 (6) to 18 (4) in group II after 24 months. No difference was found between the groups in knee stability at the 24 month follow up. The IKDC score was identical in both groups at follow up. The operation took significantly longer for patients in group I (mean 94 (15)) than for those in group II (mean 86 (20)) (p = 0.03). The mean sick leave was 7.7 (6.2) weeks in group I and 12.3 (9.7) weeks in group II (p = 0.026), indicating that there may be a higher morbidity associated with the "all-inside" technique. It can be concluded that there were no significant differences between the two different techniques in terms of functional results, knee laxity, or postoperative complications. The results were satisfactory and the outcome was similar in both treatment groups.

If permission of full active and passive extension immediately after an anterior cruciate ligament (ACL) reconstruction will increase the post-operative laxity of the knee has been a subject of discussion. We investigated whether a post-operative rehabilitation protocol including active and passive extension without any restrictions in extension immediately after an ACL reconstruction would increase the post-operative anterior-posterior knee laxity (A-P laxity). Our hypothesis was that full active and passive extension immediately after an ACL reconstruction would have no effect on the A-P laxity and clinical results up to 2 years after the operation. Twenty-two consecutive patients (14 men, 8 women, median age 21 years, range 17-41) were included. All the patients had a unilateral ACL rupture and no other ligament injuries or any other history of previous knee injuries. The surgical procedure was identical in all patients and one experienced surgeon operated on all the patients, using the bone-patellar tendon-bone autograft. The post-operative rehabilitation programme was identical in both groups, except for extension training during the first 4 weeks post-operatively. The patients were randomly allocated to post-operative rehabilitation programmes either allowing (Group A, n=11) or not allowing [Group B (30 to -10 degrees ), n=11] full active and passive extension immediately after the operation. They were evaluated pre-operatively and at 6 months and 2 years after the reconstruction. To evaluate the A-P knee laxity, radiostereometric analysis (RSA) and KT-1000 arthrometer (KT-1000) measurements were used, range of motion, Lysholm score, Tegner activity level, the International Knee Documentation Committee (IKDC) evaluation system and one-leg-hop test quotient were used. Pre-operatively, the RSA measurements revealed side-to-side differences in Group A of 8.6 mm (2.3-15.4), median (range) and in Group B of 7.2 mm (2.2-17.4) (n.s.). The corresponding KT-1000 values were for Group A, 2.0 mm (0-8.0) and Group B, 4.0 mm (0-10.0) (n.s.). At 2 years, the differences between the two groups were minimal, regardless of the method that had been used. The RSA measurements in Group A were 2.7 mm (0-10.7) and in Group B 2.8 (-1.8 to 9.5). The KT-1000 values were for Group A, 1.0 mm (-1.5 to 3.5), and for Group B, 0.5 mm (-1.0 to 4.0), without any significant differences between the groups. Nor did the Lysholm score, Tegner activity level, IKDC or one-leg-hop test differ. Early active and passive extension training, without any restrictions in extension, immediately after an ACL reconstruction using bone-patellar tendon-bone graft did not increase post-operative knee laxity up to 2 years after the ACL reconstruction.

The KT-1000 and similar non-invasive arthrometers are used as a complement to clinical examination in the diagnosis of anterior cruciate ligament (ACL) rupture and during the follow-up after surgery. We compared the two methods, KT-1000 and Radiostereometric analysis (RSA), when used to measure anterior-posterior knee laxity (A-P laxity) in patients with ACL rupture, before and after the reconstruction of this ligament, in a prospective, comparative study. Twenty-two consecutive patients (14 men, 8 women) with a median age of 24 years (range 16–41) were studied. All the patients had a unilateral ACL rupture and an intact contralateral knee. The patients were operated on by one experienced surgeon using the bone-patellar tendon-bone (BTB) autograft. Preoperatively and 2 years after the reconstruction, all the patients were evaluated using KT-1000 and RSA measurements of A-P laxity. The side-to-side differences between the injured and the intact knees, that is, total A-P laxity for both knees, are presented. Preoperatively, the median side-to-side differences using the two methods (KT-1000/RSA) were 4.0 (0–10)/7.4 mm (2.2–17.4) (P

BackgroundInjury of the anterior cruciate ligament changes the kinematics of the knee joint. In studies of cadaveric knees, investigators have examined the effect of anterior cruciate ligament reconstruction on knee kinematics, but the effect on dynamic knee motion is not known.HypothesisReconstruction of the anterior cruciate ligament restores knee kinematics to normal.Study DesignProspective cohort study.MethodsNine patients were examined preoperatively and 1 year after reconstruction. Continuous radiostereometric exposures were performed at a speed of two to four exposures per second while the patients ascended an 8-cm high platform. Tibial rotation and tibial and femoral translation were measured with radiostereometric analysis.ResultsTibial rotation and tibial and femoral translation were not significantly different after anterior cruciate ligament reconstruction compared with preoperative measurements. A radiostereometric evaluation of anterior knee laxity revealed restoration to within 1 mm of that on the uninjured side. Further evaluation of knee function using the Lysholm score, the Tegner activity level score, the International Knee Documentation Committee evaluation system score, and measurements of laxity using the KT-1000 arthrometer revealed significant improvements after reconstruction.ConclusionKinematics of the anterior cruciate ligament injured knee did not change significantly after ligament reconstruction, but the functional results were satisfactory and knee laxity was diminished.

This prospective randomized evaluated the effect of preconditioning patellar tendon autografts before implantation and fixation during anterior cruciate ligament (ACL) reconstruction. Fifty-three patients with a unilateral ACL rupture were included in the study. One group of patients had their patellar tendon autograft preconditioned by passive stretching at a constant load of 39 N for 10 min immediately prior to implantation (group P). The other group underwent no preconditioning before the implantation of the graft (group NP). The follow-up examination was performed by independent observers after 26 months (23-29) in group P and after 25 months (23-30) in group NP (n.s.). At follow-up the KT-1000 laxity test revealed a total side-to-side difference of 2.5 mm (-1.5 to +8.5) in group P and 3.0 mm (-7 to +6.5) in group NP (n.s.). The Lysholm score was 86 points (47-100) in group P and 94 points (44-100) in group NP (n.s.). The Tegner activity level was 6 (2-9) in group P and 7 (3-9) in group NP (n.s.). There was no significant difference between the study groups regarding IKDC classification. Patients who underwent ACL reconstruction using a preconditioned patellar tendon autograft had no advantages in terms of restoration of laxity or clinical outcome at 2-year follow-up.

Our goal was to compare the results after anterior cruciate ligament reconstruction using either the traditional one-incision or the subcutaneous two-incision technique to harvest the central third of the patellar tendon, particularly concerning disturbances in anterior knee sensitivity and the patient's ability to walk on his or her knees. One surgeon performed anterior cruciate ligament reconstruction on 124 patients with unilateral ruptures and no history of previous incisions in the anterior knee region. The traditional one-incision graft harvesting technique was used in 58 patients and the subcutaneous two-incision technique was used in 66 patients. At 2 years, the International Knee Documentation Committee classification, Lysholm score, arthrometry side-to-side difference, and single-legged hop test showed no significant differences between groups. The area of insensitivity was a median of 24 cm2 in the traditional harvest group and 0 cm2 in the subcutaneous harvest group. The patients with subcutaneous harvest had a tendency toward fewer problems during walking on their knees than did the patients with traditional harvest. Our conclusion is that the subcutaneous two-incision graft harvesting technique caused less disturbance in anterior knee sensitivity and a tendency of less discomfort during walking on one's knees than the traditional one-incision technique.

The aim of this retrospective study was to compare the results after arthroscopic anterior cruciate ligament (ACL) reconstruction in middle-aged and young patients. From our database (including 604 patients with a follow-up rate of 95%), we extracted all the patients over 40 years of age (group A, n = 30) and compared them with a group of patients from the same material, aged between 20 and 24 years (group B, n = 37). The groups were comparable in terms of the male:female ratio and surgical techniques. The follow-up was performed by independent observers. The median follow-up period was 31 months (range, 22 to 60 months) in group A and 38 months (24 to 60 months) in group B (P =.014). Before injury, the Tegner activity level was 6 (4-9) in group A and 9 (4-9) in group B (P

The most common graft in anterior cruciate ligament (ACL) surgery involves using the central one-third of the patellar tendon. Knowledge concerning the postoperative disability after harvesting the patellar tendon is, however, limited. The aim of this study was to evaluate the impact patellar tendon suture and bone grafting of the patellar bone defect might have in terms of functional outcome and patellofemoral pain after harvesting the bone-tendon-bone graft, compared with leaving the harvested site non-sutured and non-grafted. Sixty patients, scheduled for arthroscopically assisted ACL reconstruction, were randomly allocated to two groups. In group I, suture of the patellar tendon and bone grafting of the patellar defect were performed. In group II, the tendon gap and the patellar defect were left open. Preoperatively, there was no significant difference between the groups when comparing objective knee stability, as measured with a KT-1000 laxity meter, Lysholm score, Tegner activity level, IKDC score, or patello-femoral pain score. Both groups had a significantly improved Lysholm score at the 2-year follow-up, without any difference between them. Tegner's activity level was significantly lower at follow-up, compared with the pre-injury level in both groups. The patellofemoral pain score improved significantly after the reconstruction, without any difference between the groups. Ultrasonography did not reveal any difference between the groups in terms of healing of the tendon gap. This study revealed no differences in donor site morbidity, functional outcome, patellofemoral pain score or knee joint stability between the two treatment groups. The conclusion is that suture of the patellar tendon and bone grafting of the patellar defect do not improve the functional results or reduce donor site morbidity after arthroscopically assisted ACL.

Chronic lateral ankle instability can be associated with a longitudinal rupture of the peroneus brevis tendon. Patients with these problems have atypical posterolateral or retromalleolar pain, as well as clinical signs of ligamentous instability. This injury is frequently concomitant with lateral ligament injuries and the injury mechanism is similar; however, the tendon rupture is often missed. Laxity or insufficiency of the superior peroneal retinaculum allows the anterior part of the peroneus brevis tendon to ride upon the sharp posterior fibular edge, resulting in a longitudinal rupture of the tendon. We report on the results after surgical treatment in nine patients (10 ankles) with combined instability of the lateral ankle ligaments and longitudinal rupture of the peroneus brevis tendon. All these patients underwent surgical repair of the peroneus tendon, reconstruction of the superior peroneal retinaculum, removal of the sharp posterior edge of the fibula and correction of the ligamentous instability of the anterior talofibular and calcaneofibular ligaments. One constant finding at surgery was a longitudinal intratendineal rupture of the peroneus brevis tendon combined with insufficiency of the superior peroneal retinaculum and insufficiency of the lateral ligaments. At follow-up 3 (2-5) years post-operatively, the functional results were excellent or good in nine ankles and fair in one. All the patients with excellent or good results had resumed their preinjury activity level. We conclude that this lesion should be suspected in patients with lateral ligamentous instability, combined with retromalleolar pain. In these cases, it is important to address both the tendon rupture and the ligamentous insufficiency.

The purpose of this study was to assess the outcome of arthroscopic anterior cruciate ligament reconstruction performed using either the 'one-incision' technique or the rear-entry 'two-incision' technique. A series of 221 consecutive patients who underwent anterior cruciate ligament reconstruction was reviewed retrospectively. In the study population, two subgroups were defined. Group A consisted of 118 patients who underwent reconstruction using the one-incision transtibial endoscopic technique and Group B consisted of 103 patients who underwent reconstruction using the two-incision technique. The groups were comparable in terms of age, sex and activity level. The follow-up was performed after 47 (40-68) months in Group A and 55 (40-68) months in Group B. The Lysholm score at the final follow-up was significantly lower in Group A (90, 38-100) than in Group B (94, 34-100) (P = 0.002). The median KT-1000 total side-to-side difference was 1.5 (-6 to 7.5) mm in Group A, and 2.0 (-3.5 to 9) mm in Group B (n.s.). No significant difference between the groups was found when the IKDC evaluation system was used. Four intra-operative complications were registered in Group A and none in Group B (P = 0.06). No significant difference was found in terms of anterior knee pain, the one-leg-hop quotient or the activity level at the final follow-up. In this study the two methods gave similar and satisfactory results. Serious intraoperative complications were, however, recorded in four cases when the one-incision technique was used.

The aim of this study was to compare the results after arthroscopic anterior cruciate ligament reconstruction in female and male competitive athletes who had a pre-injury Tegner activity level of > or =7 and a non-injured contralateral anterior cruciate ligament. One hundred and thirty-three female and 296 male patients were followed at 38 (21-68) months after the index operation. All the patients were operated on by experienced knee surgeons using patellar tendon autografts and interference screw fixation. At the index operation the median age of the female patients was 23 (1645) years and the median age of the male patients was 26 (16-47) years. The reconstruction was performed a median of 10 (0-141) and 10 (0-203) months after the injury in women and men respectively. The patients were re-examined by independent observers. At the follow-up, the median Lysholm score was 89 (38-100) points in the female group and 90 (22-100) points in the male group (P=0.015). The IKDC evaluation system, subjective anterior knee pain, subjective evaluation of the results, the knee-walking test and the KT-1000 tests revealed no differences between the groups. The mean (+/-2 SD) pre-injury Tegner activity level was 8.1 (+/-1.9) (median 8 (7-10)) in the female group and 8.4 (+/-1.8) (median 9 (7-10)) in the male group (P=0.003). At the follow-up, the Tegner activity level was 6.2 (+/-3.8) in the female group and 6.8 (+/-3.6) in the male group (P=0.012). At the follow-up, the Tegner activity level had decreased by 1.9 (+/-3.8) for the women and 1.6 (+/-3.3) for the men, as compared with the pre-injury level (n.s.). The difference between the performed and the desired activity level at the follow-up was 1.1 (+/-3.2) in the female group and 0.9 (+/-3.0) in the male group (n.s.). In the female group 53/133 (40%) and in the male group 115/296 (39%) returned to the pre-injury activity level (n.s.). The median one-leg-hop quotient was 93 (0-116)% in the female group and 96 (0-130)% in the male group (P=0.006). Concomitant meniscal injuries prior to the index operation, at the index operation or during the follow-up period were found in 64/133 (48%) women and in 185/ 296 (62%) men (P