Arne Ekeland

Articular Cartilage Lesions in 993 Consecutive Knee Arthroscopies

Background Traumatic articular cartilage injuries heal poorly and may lead to development of osteoarthritis at a young age. This study estimates the number of patients who may benefit from one of the surgical methods of cartilage repair. Methods All patients undergoing knee arthroscopy during a 6-month period at three collaborating hospitals were consecutively evaluated according to the International Cartilage Repair Society (ICRS) knee form. The material consists of 993 consecutive knee arthroscopies in patients with median age of 35 years. Results Preoperative radiographs demonstrated degenerative changes in 13% of the knees. Articular cartilage pathology was found in 66% and a localized cartilage defect was found in 20% of the knees. A localized full-thickness cartilage lesion (ICRS grade 3 and 4) was observed in 11% of the knees. Of the localized full-thickness lesions, 55% (6% of all knees) had a size above 2 cm2. Conclusion Eleven percent of all knee arthroscopies show cartilage defects that may be suitable for cartilage repair procedures. However, the natural history of these lesions and the number of patients that will benefit from a cartilage repair procedure are so far unknown.

Dynamic hip screw with trochanteric stabilizing plate in the treatment of unstable proximal femoral fractures: a comparative study with the Gamma nail and compression hip screw.

OBJECTIVE To compare the results after operative treatment of unstable per- and subtrochanteric fractures with the Gamma nail, compression hip screw (CHS), or dynamic hip screw with a laterally mounted trochanteric stabilizing plate (DHS/TSP). DESIGN Prospective. PATIENTS One hundred seventy patients with unstable trochanteric femoral fractures surviving six months after operation. Eighty-five patients were randomized to treatment with the Gamma nail (n = 50, Gamma group) or the compression hip screw (n = 35, CHS group) and compared with a consecutive series of eighty-five patients operated with the dynamic hip screw with a laterally mounted trochanteric stabilizing plate (DHS/TSP group) MAIN OUTCOME MEASUREMENTS Radiographs were analyzed for fracture classification, evaluation of fracture reduction, implant positioning, later fracture dislocation, and other complications. Pre- and postoperative functional status of the patients were recorded, with a minimum of six months follow-up. RESULTS Eighteen percent of the patients in the Gamma group, 34 percent in the CHS group, and 9 percent in the DHS/TSP group suffered significant secondary fracture dislocation during the six months follow-up, leading to a varus malunion, lag screw cutout, or excessive lag screw sliding with medialization of the distal fracture fragment. Two patients (4.0 percent) in the Gamma group suffered an implant-related femoral fracture below the nail, and one had a deep infection. The reoperation rates were 8.0 percent in the Gamma group, 2.9 percent in the CHS group, and 5.9 percent in the DHS/TSP group. All but one fracture in the Gamma and CHS groups and two fractures in the DHS/TSP group healed within six months. Approximately three-fourths of the patients had returned to their preoperative walking ability after six months, with a trend toward better functional outcome in the DHS/TSP group. Use of a TSP reduced the secondary lag screw sliding as compared with the conventional CHS, without affecting fracture healing. CONCLUSION The TSP may be an aid in the treatment of these difficult fractures because the problem with femoral shaft fractures using the Gamma nail is avoided and the medialization of the distal fracture fragment frequently associated with the CHS is prevented.

Focal Cartilage Defects in the Knee Impair Quality of Life as Much as Severe Osteoarthritis A Comparison of Knee Injury and Osteoarthritis Outcome Score in 4 Patient Categories Scheduled for Knee Surgery

Background Patients with focal cartilage defects in the knee may suffer from both pain and functional impairment. Treatment options are often insufficient. It is not known, however, to what extent their complaints affect quality of life, compared with other knee disorders. Knee Injury and Osteoarthritis Outcome Score (KOOS) is a validated global knee score suitable for comparison of patients with knee complaints attributable to different causes. Hypothesis Complaints because of localized cartilage defects in the knee reduce quality of life measured by KOOS to a different extent than those due to anterior cruciate ligament deficiency and osteoarthritis, when comparing patients within the working population scheduled for surgery. Study Design Cross-sectional study; Level of evidence, 3. Methods Previously registered KOOS baseline data on patients enrolled in different knee treatment studies were included in the present study; the patients were 18 to 67 years of age (working population) at data registration. The different patient categories were (1) patients with knee osteoarthritis enrolled for knee arthroplasty, (2) patients with knee osteoarthritis enrolled for osteotomies around the knee, (3) patients with focal cartilage lesions enrolled for cartilage repair, and (4) patients with anterior cruciate ligament—deficient knees enrolled for anterior cruciate ligament reconstruction. The KOOS subscale quality of life was the main parameter for comparison of complaints. Results At preoperative baseline, patients with focal cartilage defects in the knee scored 27.5 on the KOOS subscale quality of life, not significantly different from the 28.8 and 27.2 in the patients with osteoarthritis enrolled for knee osteotomies and arthroplasties, respectively. For all the subscales of KOOS, the cartilage patients scored significantly lower than the patients with anterior cruciate ligament deficiency. Conclusion Patients with focal cartilage lesions have major problems with pain and functional impairment. Their complaints are worse than those of patients with anterior cruciate ligament—deficient knees, and quality of life is affected to the same extent as in patients scheduled for knee replacement.

Methods for Testing the Mechanical Properties of the Rat Femur

A modular apparatus to measure the bending and torsional properties of the rat femur is presented. Both intact femur diaphyses and diaphyseal fractures in different phases of healing can be tested. It is also possible to measure the bending-strength of the distal femur metaphysis and the epiphyseal plate. The apparatus can be used to investigate the effect of drugs and hormones on the remodelling of the rat femur.

The Effect of Knee Bracing After Anterior Cruciate Ligament Reconstruction A Prospective, Randomized Study with Two Years’ Follow-up

The purpose of this prospective, randomized, clinical trial was to evaluate the effect of knee bracing after anterior cruciate ligament reconstruction. Sixty patients were randomized into one of two groups: Patients in the braced group wore rehabilitative braces for 2 weeks, followed by functional braces for 10 weeks, and patients in the nonbraced group did not wear braces. Data were recorded preoperatively, and postoperatively after 6 weeks, 3 and 6 months, and 1 and 2 years. The following outcome measures were used: KT-1000 arthrometry, the Cincinnati knee score, goniometry to record range of motion, computed tomography to determine thigh atrophy, Cybex 6000 isokinetic testing to evaluate muscle strength, three functional knee tests, and a visual analog scale to evaluate pain. At all follow-up times there were no significant differences between the two groups with regard to knee joint laxity, range of motion, muscle strength, functional knee tests, or pain. However, the Cincinnati knee score showed that patients in the braced group had significantly improved knee function compared with patients in the nonbraced group at the 3-month follow-up, even though the braced group showed significantly increased thigh atrophy compared with the nonbraced group at 3 months.

Gamma nail vs compression screw for trochanteric femoral fractures: 15 reoperations in a prospective, randomized study of 378 patients

A total of 378 trochanteric and subtrochanteric femoral fractures were randomized to treatment with Gamma nail (177) or Hip Compression Screw (HCS) (201). After a median follow-up time of 17 (10-27) months, 15 patients needed reoperations; 13 had been treated with Gamma nail and 2 with HCS. 10 patients, all treated with Gamma nail, were reoperated because of a femoral shaft fracture. 5 of these fractures occurred 8 (4-10) days postoperatively and were related to intraoperative complications. The other 5 shaft fractures occurred a median of 2 (1-3) months postoperatively after falls, and may be related to stress concentration at the tip of the solid nail. The lag screw cut out or penetrated the femoral head in 5 patients, 3 of them treated with Gamma nail and 2 with HCS.

Locked intramedullary nailing for displaced tibial shaft fractures

We analysed the results of 93 tibial shaft fractures treated with the Grosse-Kempf locked nail. Twenty-six fractures were comminuted, 19 were open grade I to II, and 54 were located outside the middle third of the tibia. The deep infection rate was 3.2%. There were only two poor results. The use of this method is recommended and discussed.

Mechanical Properties of Fractured and Intact Rat Femora Evaluated by Bending, Torsional and Tensile Tests

Mechanical properties of healing fractures and growing, intact bones were studied in male rats aged 8 weeks at the beginning of the study period. A standardized, closed fracture was produced in the middle of the left femur. The fracture was not immobilized. At various intervals after the fracture, the healing fractured femora and the contralateral, intact femora were subjected to bending, torsional and tensile tests. The fractured femora regained the strength and the ultimate deformation of the contralateral, intact femora after about 8 weeks when tested in bending, and after about 13 weeks when tested in torsion. In the first phases of fracture repair, the healing fractures could resist more torsional moments increased with increase in age and weight of the animals, whereas the ultimate angular deformation remained constant. The ultimate bending and torsional stresses (bone material strength) increased to reach a plateau when the rats were about 14 weeks old. No significant differences were observed between the bending, torsional and tensile application.

INFLUENCE OF AGE ON MECHANICAL PROPERTIES OF HEALING FRACTURES AND INTACT BONES IN RATS

Mechanical properties of fractured and intact femora have been studied in young and adult, male rats. A standardized, closed, mid-diaphyseal fracture was produced in the left femur, the right femur serving as control. The fracture was left to heal without immobilization. At various intervals, both fractured and intact femora were loaded in torsion until failure. The fractured femora regained the mechanical properties of the contralateral, intact bones after about 4 weeks in young and after about 12 weeks in adult rats. For intact bones, both the ultimate torsional moment (strength) and the torsional stiffness increased with age of the animals, whereas the ultimate torsional angle remained unchanged. For bone as a material, however, the ultimate torsional stress (strength) and the modulus of rigidity (stiffness) increased with age only in young rats, being almost constant in the adult animals. The various biomechanical parameters of the healing fractures did not reach those of the contralateral, intact bones simultaneously. The torsional moment required to twist a healing femoral fracture 20 degrees (0.35 radians), a deformation close to what an intact femur can resist, proved to be a functional and simple measure of the degree of fracture repair in rats.

Interference screw fixation of hamstring vs patellar tendon grafts for anterior cruciate ligament reconstruction.

Abstract The present study was designed to investigate the fixation strength of a quadruple semitendinosus-gracilis graft compared with a middle-third bone-patellar tendon-bone graft using a new interference screw developed to fix hamstrings grafts for ACL reconstructions (RCI, Smith & Nephew Donjoy). Five pairs of human cadaveric knees from donors with a mean age of 43 (range 33–52) years were used. One knee of each pair was randomly allocated to be reconstructed on the femoral side with a semitendinosus-gracilis graft from the same donor using RCI screw fixation. As the control, the contralateral knee was correspondingly reconstructed with a bone-patellar tendon-bone graft using the same interference screw. The grafts were pulled out at a velocity of 30 mm/s by an axially applied load using a MTS machine. The mean (SD) failure load for the bone-patellar tendon-bone graft fixations was 505 (25) N, 110% stronger than the mean failure load for the semitendinosus-gracilis graft fixations, which was 240 (47) N (P = 0.003). The stiffness for the patellar tendon-bone graft fixations was 46 (11) N/mm, 120% stiffer than the semitendinosus-gracilis graft fixations, which was 22 (11) N/mm (P = 0.01). This study shows that the interference screw principle used for ACL reconstructions with hamstrings tendons is inferior to that for bone-patellar tendon-bone reconstructions although the screw was developed especially for soft-tissue fixation in bone tunnels.