Kenneth L. Lambert

Vascularized patellar tendon graft with rigid internal fixation for anterior cruciate ligament insufficiency.

After diagnosing the anterior cruciate ligament (ACL) rupture by manual and arthroscopic examination with the patient under anesthesia, the decision to augment or substitute depends on the patients requirements. In a community of athletically motivated patients, a method of strong, durable stabilization is achieved using a pedicled patellar tendon graft with a 90 degrees twist and bone-to-bone fixation. The intercondylar notch is surgically enlarged; holes are drilled from without into the tibia and femur, the graft is harvested with bone plugs at each end, pulled into place, and transfixed with screws. Knee function is tested before closure. After operation, the emphasis is on joint ranging exercises. Quadriceps exercises are not initiated until three months after operation. Participation in a sport is not advised for approximately one year. The patellar tendon graft has all of the advantages of an autologous tissue, either for augmentation or substitution of the ACL. It has strength, durability, and elasticity; it can be transplanted with bone plugs; with the infrapatellar fat pad preserved, it retains its paratendinous vascularity. The method has been employed for five years. No graft failures have occurred, and no patient has reinjured the reconstructed ligament. Not one patient has had to give up the sport that caused the injury due to recurrent instability.

Ski injury statistics, 1982 to 1993, Jackson hole ski resort

A retrospective analysis was conducted on injury statistics compiled over 12 seasons, from 1982 to 1993 (2.55 million skier-days), at a Wyoming ski resort. The population at risk was determined by ticket sales per year. A total of 9749 skiing injuries was indexed by anatomic region and se verity according to diagnosis on initial evaluation. Injury rates were then analyzed as a function of time. The injury rate remained constant at 3.7 injuries per 1000 skier-days during the 12 seasons. The rate of lower extremity to up per extremity injury decreased from 4:1 to 2:1 during the study period (P < 0.03). The ankle injury rate also de creased with time (P < 0.04). Ulnar collateral ligament sprains make up 7% of all injuries. Knee sprains in general account for 30% of all injuries. The incidence of anterior cruciate ligament tears increased as a function of time (P < 0.04) and accounted for 16% of all skiing injuries during the study period. The medial collateral ligament sprain was the most common injury, making up 18% of skiing injuries. Forty-seven snowboard injuries from the 1992 to 1993 season are also presented. Our injury statistics mir ror those currently reported in North America, except our data reflect a higher incidence of knee sprains.

Consideration of the anterior cruciate ligament injury in skiing

The anterior cruciate ligament (ACL) injury of the knee is a common ski injury. At a typical ski area clinic in Wyoming, an average of one per day is diagnosed over the 120-day ski season. Other ski clinics report a similar incidence of ACL injuries. In view of the 570 registered ski slopes in the United States, the ACL injuries occur at epidemic proportions. Under consideration are causal factors involved in the typical skiers ACL injury, such as recent evolutions in skiing techniques, boot styles, the skiers environment, and the anatomic considerations relating to body mechanics that place the ACL in a position of compromise in the intercondylar notch. Clear identification of the mechanism of ski injury of the ACL is difficult. As the significant causative factors become identified, and with the stimulation of further interest and research, there is some promise for prevention in the future.

Anterior Cruciate Ligament Reconstruction; Bone-Patella Tendon-Bone Versus Semitendinosus Anatomic Reconstruction

In this article, the long term (2–10 years; mean, 4.8 years) followup results of two reconstructive procedures for the anterior cruciate ligament are compared. The bone-patella tendon-bone (with interference fit fixation) was performed on 69 knees, and the semitendinosus anatomic reconstruction was performed on 68 knees, in a population of 76 men and 52 women (age range, 15–60 years; average, 31 years). The patients in the two groups showed no difference in subjective results or activity level and no significant difference to manual testing. The semitendinosus procedure group had a slightly higher KT manual maximum failure rate than the patella tendon group (17% versus 11%). Arthrometric stability did not show deterioration, but patient satisfaction decreased in those patients who had meniscectomies. Both procedures showed satisfactory results during the long term followup. However, if the secondary restraints are compromised, the stiffer bone-patella tendon-bone construct is preferred for reconstruction of the chronic anterior cruciate ligament deficient knee.

Current trends in repair and rehabilitation of complete (acute) anterior cruciate ligament injuries Analysis of 1984 questionnaire completed by ACL Study Group

Results of a 21 question survey, taken at the ACL Study Group meeting in 1984, present a composite picture of current practices in ACL reconstruction and rehabilitation. Forty-four of the 50 questionnaires were returned. Responses represented views from knee sur geons in the United States, Canada, Australia, Sweden, and Switzerland. These results were compared with a report of a 1980 international survey in which views of 40 knee experts from the United States, Canada, Eng land, France, and Sweden were summarized. Ques tions on the two surveys were similar, particularly about rehabilitation. Although the time span between the two surveys was only 4 years, we can see both consisten cies and changes. Responses about length of time between ACL repair and full range of motion (by 6 months) were essentially the same (88% in 1980, and 86.4% in 1984). However, changes were evident in length of immobilization (longer in 1980) and prescribing isometric contractions of quadriceps 1 st week postop eratively (more frequently in 1980). Surgeons allowed patients to return to full activity sooner in 1980 than in 1984. Electrical stimulation was being used more fre quently in 1984, and apparently the practice of simul taneous hamstring and quadriceps contraction has come into prominence since 1980 as it was not men tioned in the first survey. In 1984, 50% of the respond ents indicated they prescribed it. Since standardized reporting systems are not established, we cannot do reliable statistical analyses on large samples. At the present time, making surveys with responses from similar groups every few years is the best available way to capture trends in treatment of ACL injuries.

Ulnar collateral ligament injury of the thumb: Treatment with glove spica cast

The doctor will likely order an X-ray of the thumb to rule out a broken bone. The doctor will also test the stability of the thumb with gentle pressure from each side, and compare this to the other thumb. If there is a sprain to the UCL of the thumb, the physician may prescribe a custom orthosis to rest the joint and ligament for a period of time. If the ligament is torn or ruptured, the doctor may recommend surgery to repair the ligament.