Lars Dahlstedt

Goretex prosthetic ligament vs. Kennedy ligament augmentation device in anterior cruciate ligament reconstruction. A prospective randomized 3-year follow-up of 41 cases.

In a prospective randomized study on patients with functional instability due to old anterior cruciate ligament tears, 18 were randomized to a Goretex reconstruction and 23 to augmentation with the Kennedy Ligament Augmentation Device (LAD). All operations were performed with use of a modified over-the-top technique. At follow-up (median 36 months), improvements in Lysholm scores, activity scores, and arthrometry values were recorded in both groups as compared with preoperative levels. The LAD group had better Lysholm scores than the Goretex group. Among Goretex-reconstructed knees, effusion and pain occurred, and major effusions in two knees caused by the Goretex artificial ligament were indications for graft explant after 4 years. Our short-term results with the Goretex prosthetic ligament are not acceptable because of effusions and of pain. Our short-term results of the LAD polypropylene braid as an augmentation to an autologous graft seem promising.

Knee laxity in cruciate ligament injury Value of examination under anesthesia

Arthrometry was performed before and during anesthesia in 41 patients with acute or old anterior cruciate ligament injuries and only minor signs of valgus or varus instability. The uninjured contralateral knee served as a control. The influence of anesthesia on the anterior stability was distinct in acute knee injuries. There was also a small, but definite, increase in anterior laxity in uninjured knees. Knees with old injuries were more lax, and the injured-uninjured difference in anterior laxity was more pronounced. Stability examination under anesthesia is of great value for acutely injured knees.

Poor results of bovine xenograft for knee cruciate ligament repair

In 28 patients the anterior cruciate ligament of the knee was substituted with a bovine bioprosthesis (Xenograft). Five patients underwent reoperations due to synovitis and graft rupture during the first postoperative year; and 2 patients, due to graft rupture after 3 years. After 3 years, 11/21 patients with a remaining graft had a rupture. Totally, 18/28 implanted grafts were considered to be ruptured. Our results indicate that the Xenograft in its present form should not be used.

Cryotherapy after cruciate knee surgery Skin, subcutaneous and articular temperatures in 8 patients

We recorded temperature changes on the skin surface, subcutaneously and intra-articularly during cryotherapy after knee surgery by using Cryo-cuff compression dressings. Subcutaneous recordings on the contralateral knee were used as reference. 8 patients were examined. There was a reproducible decrease in skin temperature and subcutaneous temperature. Skin temperature had to be lowered to about 20 degrees C to obtain demonstrable intraarticular temperature changes.

Gross osteolytic tibia tunnel widening with the use of Gore-Tex anterior cruciate ligament prosthesis: a radiological, arthrometric and clinical evaluation of 17 patients 13-15 years after surgery.

Background Postoperative widening of the bone tunnels have been found after anterior cruciate ligament reconstruction using autologus bone-patellar tendon-bone or hamstring tendon grafts. These changes seem to be of no clinical significance in a short to midterm follow-up. We investigated if a synthetic graft evokes the same bone tunnel widening and if it is of clinical significance in a longterm follow-up. Methods We examined 17 patients, 13–15 years after their anterior cruciate ligament reconstruction using a Gore-Tex ligament prosthesis. The follow-up consisted of clinical examination, K-1000 arthrometric measurement, Tegner, Lysholm and IKDC scores, and CT examination of their tibia bone tunnels. 6 patients had been reoperated before follow-up, 3 because of graft rupture and 3 because of effusion and/or pain. Results 5 patients were graded as normal (n = 2) or nearly normal according to the IKDC score, and 4 of these patients still had their Gore-Tex prosthesis intact. 15 of the patients had a tibia bone tunnel wider than the drilled 7.9 mm diameter, ranging from 9.6 to 26 mm. These changes in the bone tunnels were in some cases without symptoms and could not be detected with arthroscopy, clinical examination, arthrometry or evaluation scores. We do not know whether they are progressive. Interpretation Based on our findings, we recommend that patients who have had a Gore-Tex anterior cruciate ligament reconstruction should be examined not only clinically or by questionnaire, but also with CT.

Reconstruction of old anterior cruciate ligament injuries: No difference between the Kennedy LAD-method and traditional patellar tendon graft in a prospective randomized study of 40 patients with 4-year follow-up

In a prospective randomized study we investigated 40 patients with functional instability due to old anterior cruciate ligament tears by using two different techniques for reconstruction of the ligament. 20 patients were randomized to reconstruction with use of a traditional medial bone-patellar tendon graft and 20 patients to a half-thickness patellar tendon graft augmented with the Kennedy Ligament Augmentation Device (LAD). At follow-up after 4 years, both groups were still improved concerning function scores and arthrometry. The use of the Kennedy LAD method, however, gave no more subjective or objective benefits than did the traditional method.

Value of intercondylar notch plasty : CT studies and peroperative measurements of 127 knees

The intercondylar notch diameter was measured in six knees on CT scans before and after anterior cruciate ligament reconstruction. During the operation, direct measurements of the anterior notch diameter was also performed before and after notch plasty. There was good agreement between CT and peroperative measurements, showing that the enlargement of the intercondylar notch can be measured on the CT scan. Twenty-one patients previously reconstructed because of old anterior cruciate ligament injuries were reexamined after a median of 4 years, and their notch diameters were measured by CT or at reoperation. The notch remained open in stable knees, but was narrowed in unstable knees. The notch diameter before notch plasty was assessed with a calliper at operation on 45 patients with acute and 60 patients with old injuries. Both groups had a mean intercondylar diameter of 16 mm. The conclusion that the notch plasty stays open in stable knees emphasizes the importance of this step in the reconstruction procedure.

Extraarticular repair of the unstable knee: Disappointing 6-year results of the Slocum and Ellison operations

Thirty-nine clinically unstable knees caused by anterior cruciate ligament rupture were evaluated 5-8 years after medial and lateral extraarticular stabilization according to Slocum and Ellison. At the follow-up, 10 knees had been subjected to an intraarticular anterior cruciate ligament reconstruction, and one knee was not available for follow-up. The mean Lysholm score for the 28 reexamined knees was 84 out of a maximum of 100 points. Activity scores were generally low, and all the knees had increased anterior drawer instability. The combination of the pes anserinus and lateral extraarticular repair did not give acceptable long-term results.

Cruciate ligament prosthesis vs. augmentation: A randomized, prospective 5-year follow-up of 41 cases

In a prospective study, 18 patients were randomized to a prosthesis and 23 patients to the Kennedy Ligament Augmentation Device (LAD) because of functional instability due to old anterior cruciate ligament injuries. The operations were performed with use of a modified over-the-top technique. At the last follow-up (5 years), postoperative improvements in scores were maintained for both groups, but LAD-reconstructed patients had better Lysholm and activity scores than the Goretex group. The achieved postoperative improvement in anterior stability (KT-1000) did not deteriorate for either of the groups during the 5-year follow-up. The Goretex patients had more effusion and pain and more secondary operations.

No bone ingrowth into the tibia tunnel in anterior cruciate ligament-reconstructed patients: a 1-year prospective quantified CT study of 10 patients reconstructed with an autologous bone-patellar tendon-bone graft.

10 patients with major instability symptoms due to an acute anterior cruciate ligament injury were operated on with a bone-patellar tendon-bone reconstruction. Tibial condyle bone mineral density (BMD), bone ingrowth and changes in diameter in the tibia bone tunnel were studied with quantified computed tomography (QCT) postoperatively and after 1, 3, 6 and 12 months. We found no sign of bone ingrowth in the form of increased bone mineral density (BMD) in the bone tunnels in any of the patients. The tunnel diameter increased in all patients during the first postoperative months. After 1 year, 5 patients had a smaller diameter than at the first postoperative examination, 2 had the same diameter as immediately after surgery and 2 patients had a larger diameter. A sclerotic zone developed in all patients along the perimeter of the tunnel during the 3-6 months of follow-up. The BMD in the tibial condyle decreased at 3 months; it then increased, but between 6 and 12 months, it levelled out and was slightly lower than postoperatively. In conclusion, we found no growth of bone into the tunnel and tendinous part of the graft during the first postoperative year.