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The aim of the study was to assess knee function after arthroscopic anterior cruciate ligament reconstruction and to analyse complications impeding rehabilitation, additional surgery until the final follow-up, as well as residual patellofemoral pain and donor-site problems. Between 1991 and 1994, 635 patients were operated on using patellar tendon autografts and interference screw fixation. Of these, 604 (95.1%) patients (403 male and 201 female) were re-examined by independent observers at the final follow-up 38 (range 21–68) months post-operatively. The Lysholm score was 85 (range 14–100) points and the Tegner activity level was 6 (range 1–10). Using the IKDC score, 206 patients (34.1%) were classified as normal, 244 (40.4%) as nearly normal, 122 (20.2%) as abnormal and 32 (5.3%) as severely abnormal. In patients with an uninjured contralateral knee ( n = 527), the KT-1000 revealed a total side-to-side difference of 1.5 (range –7–11) mm, and 384/527 (72.9%) had a side-to-side difference of ≤ 3 mm. The one-leg-hop test was 95% (range 0%–167%). One or more complications impeding rehabilitation were recorded in 184/604 patients (30.5%). The most common was an extension deficit (> 5°), in 81 patients (13.4%). During the period until the final follow-up, 196 re-operations were performed in 161/604 (26.7%) patients. More than one re-operation was required in 27 patients. Shaving and anterior scar resection due to extension deficit were the most common procedures performed (on 65 occasions). Moderate to severe subjective anterior knee pain related to activity, walking up and down stairs, and sitting with the knee flexed was found in 203/604 patients (33.6%). The median loss of anterior knee sensitivity was 16 (range 0–288) cm2. Patients with a full range of motion had less anterior knee pain than patients with isolated flexion or extension deficits, or combined flexion and extension deficits ( P < 0.05, P = 0.08 and P < 0.001, respectively). Patients with a full range of motion had less anterior knee pain than patients with extension deficits (with and without flexion deficits) ( P < 0.001). Patients with a full range of motion and a minimal loss (≤ 4 cm2) of anterior knee sensitivity had significantly ( P < 0.01) less subjective anterior knee pain than patients who did not fulfil these criteria. A considerable number of complications hindering the rehabilitation and conditions requiring additional surgery until the final follow-up were recorded. Anterior knee pain and problems with knee-walking were correlated with the loss of range of motion and anterior knee sensitivity. [ABSTRACT FROM AUTHOR]

Twenty-four patients who underwent anterior cruciate ligament revision surgery were studied postoperatively (12 with reharvested ipsilateral patellar tendon grafts and 12 with contralateral patellar tendon grafts). For comparison purposes, 12 matched patients with primary anterior cruciate ligament reconstruction, who had been operated on using the same technique by the same surgeons, were chosen. The median time since the first reconstruction was 57 months (range, 15 to 132) in the ipsilateral tendon group and 54 months (range, 20 to 108) in the contralateral tendon group. Follow-up examination showed that there were no significant differences in total KT-1000 arthrometer side-to-side measurements between the groups, but the Lysholm score was higher for patients with contralateral tendon grafts than for patients with ipsilateral grafts. Only two patients with ipsilateral grafts were classified as having excellent or good results. Functional testing outcomes were similar for all groups, and magnetic resonance imaging screening showed no differences between the reharvest and primary harvest groups in terms of length, width, thickness, or donor site gap of the patellar tendon. However, there were two major complications in the group with revision surgery with the ipsilateral reharvested patellar tendon. Reharvesting the ipsilateral patellar tendon resulted in lower functional scores and a higher rate of complications than revision with the contralateral patellar tendon or primary anterior cruciate ligament reconstruction. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess knee function after anterior cruciate ligament reconstruction focusing on residual donor-site problems. Ninety consecutive patients with chronic unilateral anterior cruciate ligament rupture were operated on by the same surgeon using patellar tendon autografts, the all-inside arthroscopic technique, and interference screw fixation. At the follow-up examination 24 (range 22– 32) months after the index operation, the median total anterior-posterior KT-1000 side-to-side difference was 2.5 (–7 to 11) mm. The median Lysholm score was 86 (range 37–100) points and the median Tegner activity level was 6 (range 1–9). Using the IKDC evaluation system, 62 of 90 (69%) were classified as normal or nearly normal. The median one-leg-hop quotient was 93 (range 0– 167)% of the uninjured leg. Of 90 patients, 44 (49%) had minor or no discomfort when asked to walk on their knees (kneewalkers) and 46 of 90 (51%) patients had severe problems or found it impossible to perform the test (non-kneewalkers). The ‘kneewalkers’ had a median loss of anterior knee sensitivity of 10 (range 0–120) cm2. The corresponding value for the ‘non-kneewalkers’ was 25 (range 0–200) cm2 ( P = 0.0001). Palpatory donor-site tenderness was registered in 19 of 44 (43%) of the ‘kneewalkers’ and 37 of 46 (80%) of the ‘non-kneewalkers’ ( P < 0.001). Full hyperextension was not regained by 9 of 44 (20%) of the ‘kneewalkers’ and 19 of 46 (41%) of the ‘non-kneewalkers’ ( P < 0.05). Additional surgery during the follow-up period was required by 6 of 44 (14%) of the ‘kneewalkers’ and 19 of 46 (41%) of the ‘non-kneewalkers’ ( P < 0.01). Magnetic resonance imaging focusing on the donor site was performed on 31 randomly selected patients and revealed no difference between the ‘kneewalkers’ and the ‘non-kneewalkers’ in terms of patellar tendon width, thickness, length, and residual donor-site gap size. The kneewalking test was found to be a functional and reliable test for detecting donor-site morbidity. It appears that donor-site morbidity was related to problems requiring additional surgery during the follow-up period, such as extension deficit and pain near the metal implant on the tibial side, as well as the loss of anterior knee sensitivity. It appears to be important to attempt to preserve the sensitivity in the operated area during surgery and to regain full hyperextension in the post-operative period to minimize donor-site morbidity. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to prospectively follow bone mineral areal mass (BMA) changes in the calcaneii, hips, and lumbar spine after anterior cruciate ligament (ACL) reconstruction using hamstring tendon autografts., Methods: Patients with a unilateral ACL injury scheduled for reconstruction were included in the study. The BMA mass was measured in both calcaneii, the hips, and the lumbar spine using the dual-energy x-ray absorptiometry (DEXA) technique. Quality of life was estimated using the EQ-5D questionnaire, and activity was measured using the Tegner activity score. The patients were assessed before surgery and after 6, 18, 36, and 60 months., Results: Forty-eight patients (21 female and 27 male patients), median age 31 years (17 to 64 years), participated in the study for 5 years. After 5 years, the female patients had lost 9.5% (P < .001) and 10.1% (P < .001) of their BMA in the calcaneus on the operated and nonoperated sides, respectively. Correspondingly, the male patients had lost 6.5% (P = .004) and 8.5% (P < .001) on the operated and nonoperated sides, respectively. In the hips, the female patients had lost 4.0% (P < .001) and 2.7% (P < .001) on the operated and the nonoperated sides, respectively. Among the male patients, the BMA loss was 3.4% (P = .002) and 4.8% (P < .001) in the hips on the operated and the nonoperated sides, respectively. The EQ-5D index was a mean (standard deviation [SD]) of 0.72 (0.23) before surgery and 0.86 (0.17) (P < .001) after 5 years. The preinjury Tegner activity level was a median (range) 7.5 (1 to 10). The preoperative Tegner activity level was 2.5 (0 to 9) and increased to 4 (1 to 9) (P = .002) after 5 years., Conclusions: Both female and male patients had a significant decrease in BMA in both calcaneii and both hips during the 5-year study period compared with a reference population of Swedish healthy women and men. The patients increased their Tegner activity level and improved their EQ-5D index during the 5-year follow-up period., Level of Evidence: Level II, prognostic prospective study., (Copyright © 2013 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: The aim of the present study was to make an in-depth clinical, radiographical, and histological evaluation of patients who underwent anterior cruciate ligament (ACL) revision surgery with reharvested central third patellar tendon autograft., Methods: Four patients (two women and two men) underwent ACL revision surgery with reharvested patellar tendon autograft 71 (66-120) months after the primary reconstruction. The patients were followed prospectively and underwent a clinical examination and magnetic resonance imaging (MRI) at two and 10 years. Furthermore, they underwent a second-look arthroscopy involving a biopsy procedure from the reconstructed ACL 3 years after revision surgery., Results: The clinical results were poor both at two and 10 years, but the knees were stable and had a firm endpoint in all four patients in the Lachman test. At the second-look arthroscopy, the graft appeared macroscopically normal in all four patients. Histologically two patients had a normal or close to normal appearance of the reconstructed ACL with no or slight increase in cellularity and vascularity. Two patients had a marked increase in cellularity and vascularity, and the findings revealed that ligamentization was present in all four patients., Conclusions: The clinical outcome 10 years after ACL revision surgery was poor in these four patients. In contrast, the reharvested patellar tendon appeared close to normal on MRI, and the second-look arthroscopy with the concomitant histological findings revealed that the grafts were viable 3 years after revision. Therefore, the reharvested patellar tendon seems to have the potential for ligamentization when used for ACL revision surgery., Level of Evidence: Case series, Level IV.

The K-edge photoelectron and KLL Auger–Meitner decay spectra of Argon have been investigated computationally at the restricted active space perturbation theory to the second order level using biorthonormally transformed orbital sets. Binding energies were computed for the Ar 1s primary ionization, as well as for satellite states originated from shake-up and shake-off processes. Based on our calculations, the contributions of shake-up and shake-off states to the KLL Auger–Meitner spectra of Argon have been completely elucidated. Our results are compared with recent state-of-the-art experimental measurements on Argon. [ABSTRACT FROM AUTHOR]

Purpose: We evaluated whether transrectal ultrasound guided ProACT system implantation in patients under local anesthesia and with stress urinary incontinence after radical prostatectomy is feasible in a day hospital setting, and is safe and well tolerated., Materials and Methods: The procedure was used in 11 consecutive patients (mean age 69.9 years) with stress urinary incontinence after undergoing radical prostatectomy between November 2006 and July 2007. The ProACT system was implanted with a transrectal ultrasound guided procedure after administration of local anesthesia (40 ml ropivacaine 7.5 mg/ml) in perineal skin, subcutaneous tissue, pelvic diaphragm and laterally to the anastomosis. During surgery any reason for discomfort was collected. Pain was evaluated with the visual analogue scale, Numeric Pain Intensity Scale and Simple Descriptive Pain Intensity Scale. Transrectal ultrasound was performed 7 days after surgery to exclude device migrations due to early patient mobilization., Results: The ProACT systems were successfully implanted in all patients under local anesthesia without any need for general anesthesia, and without perioperative surgical or anesthesia related complications. Subjective discomfort was minimal. Mean visual analogue scale was 13 mm (range 0 to 28). Mean Numeric Pain Intensity Scale was 1.4 points (range 0 to 4). On the Simple Descriptive Pain Intensity Scale 4 patients (36.3%) reported no pain, 5 (45.5%) reported mild pain and 2 (18.2%) reported moderate pain. Discharge from the hospital was possible for all patients after 6 hours. All transrectal ultrasound performed after 7 days excluded balloon migrations., Conclusions: Transrectal ultrasound guided ProACT system implantation with the patient under local anesthesia only is feasible, safe, well tolerated and may be performed as a day surgery procedure.

Aim of the Study: To evaluate the specific cost components in two similar groups of patients who underwent laparoscopic or open radical cystoprostatectomy with orthotopic ileal neobladder at our Institution., Methods: Between November 2000 and July 2004, 20 men with transitional cell carcinoma of the bladder underwent laparoscopic (group 1) or open (group 2) radical cystoprostatectomy with orthotopic ileal neobladder. We evaluated the costs of hospital stay, surgical consumables and operating room occupation. At our Institution one day of hospital stay costs Euro 625 while one hour of operating room costs Euro 520 (professional fees included)., Results: Hospital stay and operating room occupation in group 1 and 2 were statistically different (respectively 395.5 versus 275 min and 10.5 versus 18.9 days). Surgical consumables cost Euro 637 for patients in group 1 versus Euro 270 for patients in group 2. With the considered issues, at our Institution laparoscopic radical cystoprostatectomy costs Euro 10,626 whereas open radical cystoprostatectomy costs Euro 14,465., Conclusions: Laparoscopic radical cystoprostatectomy seems associated with a shorter hospital stay and with a reduction of costs if compared to the open approach.

Objectives: Urinary incontinence is one of the major drawbacks of radical retropubic prostatectomy (RRP). One of the possible reasons for this urinary incontinence is a postoperative deficiency of the rhabdosphincter (RS). It has been recently demonstrated that reconstruction of the posterior aspects of the RS allows a rapid recovery of continence after RRP. This study evaluated the application of this technique in videolaparoscopic radical prostatectomy (VLRP), assessing the percentage of continent patients at 3, 30, and 90 d after catheter removal., Methods: A two-arm prospective comparative trial was carried out with 31 patients recruited for each arm. Group A underwent standard VLRP and group B underwent VLRP with RS reconstruction (VLRP-R). Continence was defined as no pads or one diaper/24h and was assessed 3, 30, and 90 d after the procedure., Results: At catheter removal, 74.2% versus 25% (p=0.0004) of patients were continent with the VLRP-R technique versus VLRP, respectively. A statistically significant difference was present at 30 d (83.8% vs. 32.3%; p=0.0001) At 90 d the difference, although still present, was not statistically significant (92.3% vs. 76.9%; p=0.25)., Conclusions: In this preliminary report, the posterior reconstruction of the RS appears to be an easy and feasible technique even in a laparoscopic setting. Time to continence recovery was significantly shortened.

Anterior cruciate ligament reconstruction (ACLR) is one of the more common procedures performed worldwide and perhaps the most widely studied construct in orthopedic literature. Interference screws are reliable and frequently used for ligament reconstruction, providing rigid fixation and facilitates graft incorporation allowing for the physiologic loads of early rehabilitation. The purpose of this study was to determine the bio-integration profile and quality of soft tissue graft when using mineral fiber-reinforced screws in an ACLR interference model. Nine sheep underwent ACLR using harvested autologous tendon graft fixated with 4.75 mm screws made of continuous mineral fibers. Histopathology and imaging evaluation at 28, 52, 104, 132-weeks (W) demonstrated mesenchymal tissue ingrowth into implant wall at 28 W, which increased at 52 W and peaked at 104 W. At 132 W, implants fully replaced by newly remodeled bone. Graft cellularity was evident at 28 W and continued to increase through 132 W as the tendon ossified at sites of bone contact. Pro-healing M2-macrophages and giant cells remained infrequent, with minor increases between 52 W and 104 W, attributed to expected phagocytic response. Pro-inflammatory cells (i.e., M1-macrophages, polymorphonuclears) were absent through the entire study course. In conclusion, bio-integrative screws provide secure soft tissue fixation with replacement by bone demonstrating graft cellularization over time. [ABSTRACT FROM AUTHOR]