Niels Hejgaard

The course of differently treated isolated ruptures of the anterior cruciate ligament as observed by prospective stress radiography.

In a prospective stress radiographic study of the course of 21 isolated anterior cruciate ligament (ACL) injuries, primary suture was performed in eight patients and reconstruction due to chronic instability was performed in six patients. Seven patients were treated by exploratory arthrotomy only. After a follow-up period of seven years the anterior drawer sign had disappeared in five of the 14 patients who had shown this sign prior to operation, but in some of these patients progressive rotatory instabilities developed, so that the total abnormal instability did not improve in any of the three therapeutic groups. Only ten patients obtained a completely symptom-free knee. A well performed Jones procedure could reduce a chronic anterior drawer instability, but in several of the patients troublesome patellofemoral pain developed later. Acute suture of isolated anterior cruciate ligament injuries afforded the best results in this series and is recommended.

The effect of anterior displacement of the tibial tuberosity in idiopathic chondromalacia patellae: a prospective randomized study.

In 42 patients with idiopathic chondromalacia patellae, the effect of anterior displacement of the tibial tuberosity was evaluated in a prospective and randomized study. The operation performed was a modified Bandi procedure, and it resulted in significant relief of the patellofemoral pains, compared with the effect of a standard shaving procedure. Shaving alone was done in 22 patients of whom 6 (27 per cent) were classified as good, a result which may have been due to the placebo effect. In another 20 patients shaving was combined with anterior displacement of the tibial tuberosity resulting in pain relief in 18 (9 degrees per cent). The lack of unambiguously good results may be due to the fact that, although an anterior displacement reduces the retropatellar pressure, it cannot by itself compensate for an abnormal, dynamic tracking pattern of the patella.

PROSPECTIVE STRESS RADIOGRAPHY IN 38 OLD INJURIES OF THE LIGAMENTS OF THE KNEE JOINT

In a prospective clinical and stress radiographic study comprising 38 patients, the course of chronic ligament injuries in the knee joint was evaluated. All but five patients had isolated ligament injuries, 16 of which affected the anterior cruciate ligament. The operations were performed from 18 days to 20 years after the injury had occurred. In 13 patients primary suture could be carried out, 12 patients underwent exploratory arthrotomy, and the remainder had relevant ligament repair. After a follow-up period of 7 years the instability had been cured in all patients with medial laxity and in one of two patients with lateral laxity. Nineteen patients had a drawer sign preoperatively. The anterior drawer sign disappeared in practically all patients, while a posterior drawer sign was a constant sequel to injury affecting the posterior cruciate ligament. It was difficult to prevent the development of rotatory instability--which was present in six preoperatively and in 14 at follow-up--and the rotatory instabilities were predominantly marked (greater than 6 mm). Nevertheless, only a few patients had an annoying sensation of instability. By means of ligament reconstruction, it was possible to reduce the preoperative instability appreciably. Passive instability had completely subsided in 40 per cent (15/38). The subjective result was good, only 16 per cent (6/38) having troublesome loss of function.

Chondromalacia Patellae: A Radiographic Study of the Femoropatellar Joint

X-rays of 71 patients operated on for chondromalacia patellae were examined in order to obtain a comprehensive picture of the radiographic changes in this disease. Ninety-seven patients with a normal patellofemoral joint - found at operation - were used as a control group. We found a significantly higher frequency of patella alta and the presence of Haglunds excavation in patients with chondromalacia but had to conclude that ordinary X-rays cannot be used to confirm the diagnosis chondromalacia patellae.

Prospective Stress Radiographic Study of Knee Ligament Injuries in 62 Patients Treated by Acute Repair

A prospective clinical and stress radiographic study comprising 62 patients was performed to assess the value of acute repair of 35 isolated collateral ligament injuries and 27 major injuries. After a follow-up period of 6 years there was no lateral or medical instability in 42 out of 46 patients. This included 31 out of 33 patients in the group with medial collateral ligament injuries. Among the patients with major injuries 16 (60 per cent) had drawer signs, but in only 6 was there significant instability (greater than 6 mm). In the total material it proved difficult to prevent the development of rotatory instability. This was present in 10 patients preoperatively and in 19 at follow-up. However, this instability was on the whole slight and was experienced as annoying by only 4 patients. Measurement of passive instability showed that 55 per cent (34/62) had become completely stable, but this applied to only 30 per cent (8/27) of patients with major injuries. The functional end result was unsatisfactory in 8 patients (13 per cent). Although several patients could compensate muscularly for a marked passive instability, there was a significant correlation between instability and functional loss.

Value of early attention to spinal compression syndromes

In a consecutive series of 125 patients with spinal compression syndromes, neurological regression was evaluated in relation to the time interval from (a) initial symptoms (patient delay), (b) diagnostic recognition (diagnostic delay), and (c) decision on treatment (therapeutic delay) until the time of definitive treatment. Patients with benign lesions showed a statistically significant negative correlation between the duration of (a) + (b) + (c) and the therapeutic result. In cancer patients there was a tendency for rapid progression of the disease to give a poorer result than in patients in whom the course was more insidious. In all, 77 patients improved after a short therapeutic delay (14 h), while in the remaining 48 the status was unchanged or worse after a long delay (34 h); this is a highly significant difference.