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Purpose: The purpose of this study was to compare subjective, objective and radiographic outcome of the lateralized single-bundle bone-patellar tendon-bone autograft with a non-anatomical double-bundle hamstring tendons autograft anterior cruciate ligament (ACL) reconstruction technique at long-term follow-up. Methods: Seventy-nine non-consecutive randomized patients (42 men; 37 women) with unilateral ACL insufficiency were prospectively evaluated, before and after ACL reconstruction by means of the above-mentioned techniques, with a minimum follow-up of 8 years (range 8-10 years; mean 8.6 years). In the double-bundle hamstrings technique, we used one tibial and one femoral tunnel combined with one 'over-the-top' passage, cortical staple's fixation and we left intact hamstrings' tibial insertion. Patients were evaluated subjectively and objectively, using IKDC score, Tegner level, manual maximum displacement test with KT-2000™ arthrometer. Radiographic evaluation was performed according to IKDC grading system, and re-intervention rate for meniscal lesions was also recorded. Results: The subjective and objective IKDC were similar in both groups while double-bundle hamstrings group showed significantly higher Tegner level ( P = 0.0007), higher passive range of motion recovery ( P = 0.0014), faster sport resumption ( P = 0.0052), lower glide pivot-shift phenomenon ( P = 0.0302) and lower re-intervention rate ( P = 0.0116) compared with patellar tendon group. Radiographic evaluation showed significant lower objective degenerative changes in double-bundle hamstrings group at final follow-up ( P = 0.0056). Conclusion: Although both techniques provide satisfactory results, double-bundle ACL reconstruction shows better functional results, with a faster return to sport activity, a lower re-operation rate and lower degenerative knee changes. [ABSTRACT FROM AUTHOR]

Osteotomy is one of the more ancient orthopaedic procedures still used today. Today, new knowledge and technology about bone healing and better fixations to accelerate postoperative management have allowed high tibial osteotomy to become a useful procedure for active patients younger than 60 years of age with symptomatic unicompartmental disease and osseous deformity of the knee. An important advantage of this procedure is the possibility of combining with it the articular cartilage procedure (osteochondral grafts, autologous chondrocyte implantation), meniscus transplantation, or ligament reconstruction. The 2 main techniques to produce valgus realignment of the knee are lateral closing wedge osteotomy and medial opening wedge osteotomy. We also can perform elevation osteotomy in posttraumatic cases and procurvation osteotomy to correct genu recurvatum. Most complications resulting from osteotomy can be avoided by careful patient selection and accurate preoperative planning. Therefore, the role of high tibial osteotomy is not only curative as in treating cartilage damage and posttraumatic axial deviation in patients older than 50 years but also preventive in degenerative joint diseases of young patients with congenital or posttraumatic axial deviation or anatomical deformation of the knee joint. [Copyright &y& Elsevier]