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Abstract Background Up to date, no information exists about the intra-articular temperature changes of the knee related to activity and ambient temperature. Methods In 6 healthy males, a probe for intra-articular measurement was inserted into the notch of the right knee. Each subject was jogging on a treadmill in a closed room at 19°C room temperature and skiing in a ski resort at -3°C outside temperature for 60 minutes. In both conditions, temperatures were measured every fifteen minutes intra-articulary and at the skin surface of the knee. A possible influence on joint function and laxity was evaluated before and after activity. Statistical analysis of intra-articular and skin temperatures was done using nonparametric Wilcoxon's sign rank sum test and Mann-Whitney's-U-Test. Results Median intra-articular temperatures increased from 31.4°C before activity by 2.1°C, 4°C, 5.8°C and 6.1°C after 15, 30, 45 and 60 min of jogging (all p ≤ 0.05). Median intra-articular temperatures dropped from 32.2°C before activity by 0.5°C, 1.9°C, 3.6°C and 1.1°C after 15, 30, 45 and 60 min of skiing (all n.s.). After 60 minutes of skiing (jogging), the median intra-articular temperature was 19.6% (8.7%) higher than the skin surface temperature at the knee. Joint function and laxity appeared not to be different before and after activity within both groups. Conclusion This study demonstrates different changes of intra-articular and skin temperatures during sports in jogging and alpine skiing and suggests that changes are related to activity and ambient temperature.

Background: No scientific study has addressed the effects of the routine use of postoperative drains in the donor site after arthroscopic anterior cruciate ligament reconstruction using hamstring tendons. Hypothesis: Patients who have drains placed in their donor sites have less lower extremity edema, more motion, and more comfort in the early postoperative period. Study Design: Randomized controlled clinical trial; Level of evidence, 1. Methods: Thirty-four patients undergoing arthroscopically assisted quadruple hamstring tendon anterior cruciate ligament reconstruction were randomly assigned to either receive a drain for 24 hours placed at the donor site (17 patients) or have no drain at the donor site (17 patients). Data were collected on postoperative days 1, 3, 5, and 7 regarding knee flexion, knee extension, thigh circumference, leg circumference, and visual analog scale (measuring pain). Results: In the study group versus the control group, there were increased knee flexion measurements on postoperative day 7 (84° vs 69°, P < .05); smaller thigh circumference measurements on postoperative day 7 (36.8 vs 40.1 cm, P < .05); smaller leg circumference measurements on postoperative days 3 (33.2 vs 36.4 cm, P c .05), 5 (32.7 vs 36.0 cm, P c .05), and 7 (31.8 vs 35.7 cm, P c .001); and a lower visual analog scale score on postoperative days 3 (40.38 vs 57.50, p .001), 5 (38.46 vs 60.35, P = .001), and 7 (38.07 vs 61.43, P = .001). Conclusion: Drain placement at the donor site after anterior cruciate ligament reconstruction gives more comfort to the patient and provides better flexion within the first week. [ABSTRACT FROM AUTHOR]

Background: A variety of fixation devices are used for anterior cruciate ligament reconstruction with hamstring tendon grafts. These devices increase costs and can present artifacts in magnetic resonance imaging as well as complications in revision sur- gery. Therefore, a novel knot/press-fit technique that requires no implantable devices has been introduced. Null Hypothesis: The knot/press-fit technique restores knee kinematics as well as the more commonly used EndoButton CL f ixation and has similar biomechanical properties as other devices published in the literature. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric knees (52 ± 7 years) were tested using a robotic/universal force-moment sensor testing system. The knee kinematics of the intact, anterior cruciate ligament-deficient, EndoButton-reconstructed, and knot/press- fit-reconstructed knee in response to both a 134-N anterior tibial load and a combined rotatory load at multiple knee flexion angles was determined. Differences between the 4 knee states were evaluated with a 2-factor repeated-measures analysis of variance (P > .05). To determine the stiffness and strength of the knot/press-fit fixatIon, the femur-graft-tibia complex was tested in uniaxial tension. Results: In response to an anterior tibial load, the anterior tibial translation for the knot/press-fit reconstruction was found to be not significantly different from that of the intact anterior cruciate ligament as well as that of the EndoButton reconstruction (P> .05). In response to a combined rotatory load, neither reconstruction procedure could effectively reduce the coupled anterior tib- ial translation to that of the intact knee, and no significant difference between the 2 reconstructions could be detected (P> .05). The stiffness of the knot/press-fit complex was found to be 37.8 ± 9.6 N/mm, and the load at failure was 540 ± 97.7 N, which is equal to other devices published in the literature. Clinical Relevance: The experiment suggests that the knot/press-fit technique may be a reliable alternative for the femoral fixation of hamstring tendon grafts. [ABSTRACT FROM AUTHOR]

Neuromuscular electrical stimulation (NMES) is defined as the application of an electric current to neuromuscular tissue to elicit a muscle contraction. It is typically applied in a clinical setting to strengthen muscle, particularly the quadriceps femoris, through repetitive contractions. Most studies to date involving NMES have been conducted using conventional lead-wired, or "single path" devices, and while effective, these devices have inherent limitations around comfort and incomplete muscle recruitment. In a prospective, randomized, controlled, single-blind trial, investigators found that using a novel "Multipath" device was effective when combined with standard rehabilitation in accelerating recovery after anterior cruciate ligament reconstruction. Additional research is warranted to explore whether this effect also occurs after other types of knee surgery.

We report a case of a systemic allergic reaction to biodegradable poly-L-lactic acid (PLLA) interference screws after anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone graft. A 30-year-old patient complained of certain symptoms, such as an inability to focus mentally, rash on the right femur, chronic fatigue, decreased sex drive, and localized alopecia, 3 months after ACL reconstruction in the right knee. Two biodegradable PLLA interference screws had been used for proximal and distal graft fixation. Allergy testing showed a value of 7 in PLLA antigen. After removal of 1 screw in August 2000, the patient reported marked improvement, but some symptoms remained. In July 2001 he underwent arthroscopic revision ACL reconstruction with hamstrings via an implant-free technique with intensive debridement of the tunnels and removal of all scar tissue and screw rests. All symptoms disappeared, and the PLLA antigen number fell from 3 to "concentrate" 2 months postoperatively.

Background: It has been demonstrated that bone tunnel widening could appear after knee anterior cruciate ligament (ACL) reconstruction, especially for those patients whose ruptured ACL were reconstructed with semitendinosus and gracilis tendons. Many factors can influence the extent of tunnel widening. Few studies have investigated the relationship between bone tunnel widening and rehabilitation procedures. This research was carried out to find the rehabilitation procedures' influence on the tibial bone tunnel widening after ACL reconstruction., Methods: Sixty-five cases, whose ACL reconstructions were done using quadrupled semitendinosus and gracilis tendons, were divided into two groups. Group A had 33 cases, 19 men, 14 women, averaged (31.2 +/- 12.4) years old, only ACL reconstruction was done using Paessler's technique, and aggressive rehabilitation procedure was used for function recovery post operation. Group B had 32 cases, 20 men, 12 women, averaged (30.3 +/- 10.3) years old. Except for ACL reconstruction, every patient in group B accepted meniscus repair using re-fixation methods or cartilage repair using microfracture technique, conservative rehabilitation procedure was used post operation. Six months post operation, standard posterior-anterior radiographic plates were taken for each case, CorelDRAW 8.0 software was used to digitize all X-ray plates and measure the upper, middle and lower parts of the tibial tunnel. Magnification effect of X-ray plates was taken out after measurement., Results: Six months after ACL reconstruction the tibial tunnel widening of the upper, middle and lower parts on both the posterior-anterior and lateral X-ray plates in Group A with aggressive rehabilitation procedure was much more serious than in Group B with conservative rehabilitation. KT-1000 knee stability measurement and clinical manifestation showed no difference between the two groups., Conclusions: Rehabilitation procedure after ACL reconstruction is one of the reasons for tunnel widening. It not only can directly influence the function recovery of ACL reconstructed knee, but also perhaps indirectly influence the function recovery and long-term clinical result of the operated knee by influencing the tunnel widening.

Objective: To find out the relationship between different rehabilitation procedures and the tibial tunnel widening after ACL reconstruction., Methods: Sixty-five patients undergone ACL reconstructions by using quadrupled semitendinosus and gracilis tendons were divided into two groups. Group A had 33 patients, 19 male, 14 female, average age (31.2 +/- 12.4) years, only ACL reconstruction was performed with Germanic Professor Paessler's technique, and aggressive rehabilitation procedure was used for functional recovery. Group B had 32 patients, 20 male, 12 female, average age (30.3 +/- 10.3) years. Besides ACL reconstruction, every patient in Group B accepted meniscus repair or cartilage repair with microfracture technique, then postoperative conservative rehabilitation procedure was used. Six months after operation, standard posterior-anterior radiographic plates were taken for each patient, CorelDRAW 8.0 software was used to digitize all X-ray plates and measure the upper, middle and lower parts of the tibial tunnel. Magnification of X-ray plates was taken out after measurement. Statistic analysis was done by t-test., Results: Six months after ACL reconstruction, on both the posterior-anterior and lateral X-ray plates the tibial tunnel widening of the upper, middle and lower parts in Group B with aggressive rehabilitation procedure was significantly serious than in Group A with conservative rehabilitation., Conclusions: Rehabilitation procedure after ACL reconstruction is one of the reasons for tunnel widening. It perhaps influences the functional recovery and long-term clinical result of the operated knee by affecting the tunnel widening.