IKDC Subjective Knee Evaluation Form Research Articles

Comparison between Outcomes of Open and Arthroscopic Fixation of Tibial Spine Avulsion Fractures

OBJECTIVES This study aimed to compare the functional outcomes of fragment reduction and to measure the rate of postoperative complications between arthrotomy (ORIF) and arthroscopy(ARIF) pediatric tibial spine avulsion fractures using the Lysholm knee scoring system (limp, pain swelling, climbing stairs) and IKDC subjective knee evaluation form. METHODS: This Comparative Study was conducted at the Department of Orthopedic Surgery, Jinnah Hospital Lahore, between 2021-2022. A total of 42 patients who had tibial spine avulsion fracture with follow-up of 6 months were included. Twenty-one patients were treated with ORIF, and 21 were treated with ARIF. Functional outcomes were assessed using the IKDC score and LYSHOLM score (Follow-up rate was 95 %). Radiographic findings of patients were recorded, and a statistical study was done. The level of significance was set at <0.05. RESULTS: The study revealed that out of 42 Participants, 36(85.71%) males and 6 (14.29 %) females participated in the survey with the age range of 8-16 years with a mean age of 12.02± (2.53) years. Out of 42 Participants, 22 (52.4%) had motor vehicle accidents with type 3(38.1%) and 4(54.8%) modified Meyers and Mckeever fracture classification. At the end of the follow-up period, the mean IKDC score was 90.52 + 1.50 (p = 0.00, CI = 95%). The Lysholm score was 90.676.11 compared to the last follow-up (p=0.20, CI = 95%). Compared to ORIF, only 5(11.9%) patients complained of post-op infection or vascular injury. CONCLUSION: This study observed better functional outcomes in arthroscopic reduction and immobilization than in open reduction internal fixation. Arthroscopy for TSAF decreases the risk of arthrofibrosis and minimizes morbidities and better management of symptoms. Compared to OIRF, ARIF showed good content validity for the IKDC and Lysholm scales.

Long-Term Minimum 15-Year Follow Up After Lateral Discoid Meniscal Preservation Surgery in Children and Adolescents

Background:Discoid meniscus is a congenital variant typically affecting the lateral meniscus of the knee. Historically, surgical intervention when symptomatic consisted of total meniscectomy; however, after degenerative changes were observed, current treatments now focus on rim preservation with arthroscopic saucerization and meniscal repair for instability, when indicated.Purpose:The aim of this study was to examine long-term patient-reported outcomes of lateral discoid menisci (LDM) treated with meniscal-preserving techniques.Methods:Ninety-eight patients treated arthroscopically for LDM at a single institution at a minimum of 15 years ago were retrospectively identified and contacted by mailers and telephone to participate. Subjective functional outcomes and patient satisfaction data were collected using a questionnaire that included the validated IKDC Subjective Knee Evaluation Form, Lysholm Score, Marx Activity Rating Scale, Tegner Activity Score, and WOMAC Osteoarthritis Index. Patient and surgical characteristics and patient-reported outcomes were summarized by mean and standard deviation (SD), median and interquartile range (IQR), or frequency and percent, as appropriate.Results:Of the 46 patients contacted (response rate of 46/98 eligible), 25 (54%) completed the questionnaires. The mean (± SD) age at initial surgery was 10.8 (± 3.4) years and 30.3 (± 3.7) years at final follow-up. The mean (± SD) follow-up time from initial surgery was 19.5 (± 2.8) years (range, 16–27). Patient-reported outcomes included: IKDC 77.4 ± 17.2, Lysholm 78.6 ± 21, WOMAC 7.6 ± 11.3, Tegner Activity 7 (out of 10), and Marx Activity Rating Scale 8 (out of 10) (Table 1). Eleven (44%) cases underwent subsequent LDM-related surgery on the ipsilateral knee(s). There were no cases of total knee replacement (Table 2).Conclusions:Overall, patient-reported outcomes were favorable at a minimum of 15-year follow-up after rim-preserving saucerization of lateral discoid meniscus. While two-thirds of patients were satisfied with their surgical outcomes, nearly half of patients underwent revision saucerization with or without meniscal repair. Subsequent long-term follow-up studies with radiographs will be important to determine how meniscus-preserving procedures may curb the development of arthritis.Table 1.Overall Postoperative Outcomes (N=25 patients)a Table 2.Postoperative Outcomes by Discoid Type and Surgery (N=26)a

Augmentation of Primary ACL Reconstruction With a Modified Ellison Lateral Extra-articular Tenodesis in High-Risk Patients: A Pilot Study.

Background:Lateral extra-articular tenodesis (LET) has been used to augment primary anterior cruciate ligament (ACL) reconstruction to reduce the risk of reinjury. Most LET procedures result in a construct that is fixed to both the femur and the tibia. In a modified Ellison procedure, the construct is only fixed distally, reducing the risk of inadvertently overconstraining the lateral compartment.Purpose:To evaluate the use of the modified Ellison procedure in a cohort of patients deemed to be at a high risk of further ACL injury after primary ACL reconstruction.Study Design:Case series; Level of evidence, 4.Methods:Included were 25 consecutive patients with at least 2 of the following risk factors: age <20 years at the time of surgery, previous contralateral ACL reconstruction, positive family history of ACL rupture (parent or sibling), generalized ligamentous laxity (Beighton ≥4), grade 3 pivot shift in the consulting room, a desire to return to a pivoting sport, and an elite or professional status. All patients underwent primary ACL reconstruction with an additional modified Ellison procedure. Postoperatively, patients completed the IKDC subjective knee evaluation form (International Knee Documentation Committee), KOOS Quality of Life subscale (Knee injury and Osteoarthritis Outcome Score), ACL–Return to Sport After Injury Scale, Marx Activity Rating Scale, and SANE score (Single Assessment Numeric Evaluation).Results:At 12-month follow-up, the mean outcome scores were as follows: SANE, 94/100; IKDC, 92/100; Marx, 13/16; ACL–Return to Sport, 85/100; and KOOS, 77/100. At 24 months, return-to-sport data were available for 23 of 25 patients; 17 (74%) were playing at the same level or higher than preinjury and 2 at a lower level. One patient (4%) sustained a contact mechanism graft rupture at 12 months. There were 2 (9%) contralateral ACL injuries, including 1 ACL graft rupture, at 11 and 22 months postoperatively. There was a further contralateral ACL graft rupture at 26 months.Conclusion:The use of the modified Ellison procedure as a LET augmentation of a primary ACL reconstruction to produce a low graft rupture rate appeared to be safe in a cohort considered to be at a high risk of reinjury. The procedure showed promise in terms of reducing further graft injuries.

Клиническая эффективность анатомической пластики передней крестообразной связки коленного сустава

Purpose Evaluate clinical effectiveness of anatomical reconstruction of the anterior cruciate ligament (ACL) and determine the perspectives for practical health care. Material and methods The review included 706 patients who underwent arthroscopic reconstruction of the ACL and graft interference screw fixation between 2010 and 2018. ACL reconstruction was performed using either anteromedial portal (n = 396, Group I) or an isometric transtibial tunnel technique (n = 310, Group II). Outcomes were evaluated clinically and radiographically using the 2000 International Knee Documentation Committee (2000 IKDC) Subjective Knee Evaluation Form, the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Lysholm scoring scale. Clinical and economic outcome measures included surgical time, rehabilitation and disability periods and period of recovery for sports performance. Results The knee anterior drawer test was equally negative and showed no significant differences in the groups. The Lachman test and the pivot shift test showed better results in Group I (p &lt; 0.001). Contractures, atrophic femoral muscles (p &lt; 0.05), synovitis (p &lt; 0.01), vertical position of the femoral graft channels and pathologically extended bone channels with wind-wiper effect (p &lt; 0.001) were more common among patients of Group II. Although knee function returned to normal, as rated with the 2000 IKDC Subjective Knee Evaluation Form, in 91.3 % of cases pathological changes in the knee (C) and severely impaired function (D) were 2.5 and 5 times less common in group I than in Group II (p &lt; 0.05). Pain, symptoms and sport scores were significantly higher on the KOSS scale for Group I (p &lt; 0.05). Surgical time was longer in patients of Group I (p &lt; 0.05) who had shorter rehabilitation period (p &lt; 0.05). Conclusion Anatomical reconstruction of ACL using anteromedial portal was shown to be a more reliable technique as compared to transtibial approach to ensure overall knee stability arranging adequate bone channels. The technique is capable to protect the graft from injury, reduce the likelihood of pain, synovitis, contractures, muscle atrophy, providing shorter rehabilitation, disability period and recovery for sport performance.

Clinical and radiological outcome after anterior cruciate ligament reconstruction using the T-lock Osteotrans resorbable tendon anchor: early experience and midterm follow-up

PurposeReconstruction of the Anterior cruciate ligament (ACL) using tendon grafting is an established method for restoring knee function and stability. Multiple methods are established for graft fixation. Several involve anchoring the autograft distant to the joint with hardware that remains implanted. This study reports the first early to midterm results in patients who received ACL reconstruction (ACLR) using the T-Lock Osteotrans femoral near joint fixation method with a tibial fixation using the BioactIF Osteotrans interference screw.MethodsThis consecutive prospective series included 20 Patients (14 Male, 6 Female) with a primary ACL rupture. All patients were treated with an ACLR using a semitendinosus autograft fixated with the T-Lock Osteotrans and were followed-up postoperatively. The following parameters were assessed: Side-to-side difference of the posterior-anterior translation measured using the KT-1000 arthrometer, Tegner activity score, Lysholm score, IKDC subjective knee evaluation form. Magnetic resonance imaging (MRI) was done to assess tunnel enlargement and integrity of the anchoring device.ResultsThe average follow-up duration was 2 years (range 1–4.2 years). One patient was lost to follow-up. Two Patients suffered a traumatic ACL re-rupture 2 years postoperatively and received a 2-stage revision ACLR. Difference in the posterior-anterior translation was 1.8 mm (range 0–5). The median Tegner score was 6 (range 4–10) and 9 patients (45%) returned to their preinjury level of activity. The mean IKDC subjective knee evaluation form scored 91 points (range 77–100). The mean Lysholm score was 86 points (74–96). All mentioned scores were significantly better compared to preoperative values. No relevant tunnel enlargement was seen on MRI. The anchoring device was evaluated to be intact in all patients.ConclusionACLR with the aforementioned procedure leads to good clinical and radiological outcome.

Long term results after transepiphysal ACL reconstruction in children and adolescent

Aims and Objectives: The aim of our study was to review the long term clinical and radiological (MRI) outcomes of adult patients who underwent ACL reconstruction as children or adolescent with emphasize to the features of growth disturbance, angular deformity, meniscal and cartilage damage and revision rate Materials and Methods: We retrospectively evaluated patient who underwent ACL reconstruction in our clinic with arthroscopic transepiphyseal technique using hamstrings graft in childhood or adolescence between the years 1997 and 2009. A total of 43 Patients were assessed. 25 male and 18 female. The average age at time of surgery was 13,5 years (8 - 16 y.), at time of assessement 22,4 years (18 - 30 y.) . The mean follow up was 10 years (4 - 16 years).The physical development of the patients was assessed with the Lysholm score and the Cincinnati Knee score scale, their satisfaction was recorded on the basis of the IKDC subjective knee evaluation form and the Tegner activity score . Leg deformity or leg length discrepancy was evaluated clinically by the observers. The instrumented Lachman test using KT1000 and manual Pivot shift test was performed to assess knee stability. MRI was used to detect graft integrity, cartilage and meniscal damages. Results: No significant leg deformities or leg length discrepancy had been detected. The average Lysholm score was 91 points (83 - 100), the Cincinnati Knee Score was 90,4 (79 - 100) points on average . The mean IKDC score was 92 points (82 -100). The Tegner-Activity-Score changed from preop 6,8 (2-10) to post op 5,8 (2-9).2 Patient underwent revision ACL reconstruction due to rerupture (3 and 9 years post op). 2 Patients underwent meniscal surgery during follow up (1 resection and one refixation). KT1000 evaluation showed 67% excellent, 21% good and in 12% bad results. The MRI scan showed 42 intact grafts and one unverifiable graft. One patient with cartilage damage up to 3° (ICRS), 3 patients with meniscal degeneration up to grade 2. Each patient showed a free range of motion Conclusion: Our data underlines that transepiphyseal ACL reconstruction in children and adolescent with hamstrings is a save procedure leading to good long term results without causing angular deformity or growth disturbance

Return to sport activity after anterior cruciate ligament reconstruction in skeletally immature athletes with manual drilling original all inside reconstruction at 8 years follow-up

ObjectiveAnterior cruciate ligament (ACL) tears are common injuries in adolescent athletes, especially in those who bear high stress on their knees due to shearing forces. The goal of the surgical procedures in skeletally immature patients is to restore joint stability avoiding the adverse effects on the growth process.The aim of this study was to verify the return of the skeletally immature professional athletes to sports in the long-term, following ACL reconstruction with the original all-inside technique and with manual drilling. MethodsThis study included 24 athletes (14 boys, 10 girls; mean age: 13.15 years, range: 9–14 years) who had radiographic evidence of open physes, were less than 14 years of age at the time of surgery and those with a minimum follow-up of eight years. All patients completed a questionnaire, the IKDC subjective knee evaluation form, and Tegner Activity Scale. Biomechanical outcomes of the KT-1000 arthrometer, gait analysis, and stabilometric and isokinetic results were also evaluated. A plain radiograph of both lower limbs was taken to obtain a precise measurement of the limb length and mechanical axis angles. ResultsThe patients returned to sport activities in a mean time of 6.43 months. No rerupture or resurgery due to growth abnormalities was observed. The mean difference in length between the operated and contralateral legs was 0.4 (range: −0.2 to 0.7) cm. The mean side-to-side difference measured with the KT-1000 arthrometer was 5.2 (range: 3.5 to 7) mm in the preoperative and 0.8 (range: 0 to 2.5) mm in the postoperative measurements. ConclusionIn conclusion, the original all-inside technique with manual drilling with a half tunnel and short graft seems to be a very effective technique for the surgical management of ACL injuries in pediatric/adolescent athletes. A good rate of return to sports at pre-injury levels or higher, high patient satisfaction and a decent motor and proprioceptive function is possible as shown by our analysis. Level of evidenceLevel IV, Therapeutic study.

Autologous osteochondral mosaicplasty in osteochondritis dissecans of the patella in adolescents.

Osteochondritis dissecans of the patella (OCDP) is rare in adolescents. The objective of this study was to evaluate functional results of OCDP management in adolescents with mosaicplasty and to analyze proper integration of osteochondral grafts via MRI. This is a retrospective series of eight cases of OCDP treated by mosaicplasty. Mean age at the surgery was 15years (range 12-17). Clinical features were represented by retropatellar pain, hydarthrosis, locking and crepitus. All patients benefited from knee radiographs as well as pre-operative MRI. Six OCDP were evaluated International Cartilage Repair Society (ICRS) grade III and two were ICRS grade IV. Mean surface of the lesion was 97.5mm2. The pre- and post-operative assessments were conducted with scores obtained on the IKDC subjective knee evaluation form, Lysholm knee score, and Tegner activity scale. These assessments were completed by post-operative MRI. The magnetic resonance observation of cartilage repair tissue (MOCART) score was calculated from the latest MRI examination conducted after surgery. Mean follow-up was 28.6months. At the latest follow-up, the mean IKDC score was 86.5, Lysholm score was 89, and Tegner activity scale score was 6.2 (pre-operative scores were respectively 49.9, 53.8, and 4.5). Radiographs and MRI showed a complete integration of grafts at the latest follow-up with a satisfactory reconstruction of the joint surface. Mean MOCART score was 75/100. Autologous osteochondral mosaicplasty to manage OCDP in adolescents appears to be a reliable technique on the short term to restore patellar joint surface and obtain satisfactory functional results.

Randomized Controlled Trial Comparing All-Inside Anterior Cruciate Ligament Reconstruction Technique With Anterior Cruciate Ligament Reconstruction With a Full Tibial Tunnel

The purpose of this investigation was to compare the clinical effectiveness of full-tunnel anterior cruciate ligament (ACL) reconstructive surgery with all-inside ACL reconstruction. After statistical power analysis was performed and institutional review board approval and patient informed consent were obtained, 150 patients having ACL reconstruction were prospectively randomized to an all-inside or full-tibial tunnel technique. Outcome (International Knee Documentation Committee [IKDC] Knee Examination Form, IKDC Subjective Knee Evaluation Form, Knee Society Score [KSS], Short Form 12 [SF-12] score, femoral or tibial tunnel or socket widening, narcotic consumption, and visual analog scale [VAS] pain score compared with baseline) was measured and recorded preoperatively and at various postoperative time points with a minimum follow-up of 2 years. There were no differences between groups with regard to IKDC Knee Examination Form, IKDC Subjective Knee Evaluation Form, KSS score, SF-12 score, or femoral socket or tibial tunnel or socket widening, or narcotic consumption. The VAS pain score compared with baseline was significantly lower for the all-inside technique on day 1, on day 7, at 1.5 weeks, and at 24 months. The null hypothesis (no difference between all-inside ACL reconstruction and ACL reconstruction with a full tibial tunnel) is supported for IKDC scores, KSS score, SF-12 score, narcotic consumption, and tibial and femoral widening, whereas all-inside ACL reconstruction results in a lower VAS pain score compared with baseline. Level I, randomized controlled clinical trial with greater than 80% patient follow-up 2 years postoperatively.

Osteochondral autologous graft transfer system in the knee; mid-term results

IntroductionThe purpose of this study was to determine the effectiveness of the osteochondral autologous graft transfer system in the treatment of chondral and osteochondral lesions of the knee. MethodsSixty five knees of sixty four patients who underwent autologous osteochondral graft transfer were evaluated with clinical scores and imaging techniques. ResultsThe average follow up was 82.2 (51–145) months. The patients were evaluated according to Tegner activity scale, Lysholm scale and IKDC subjective knee evaluation form. According to all these scales, all patients showed increasing results in various rates in the last follow up. Accordingly, mean increases of 59.2±15.9 points, 3.6±1.4 points, and 42.6±11.5 points were achieved in Lysholm knee scores, Tegner activity scale scores, and IKDC subjective knee evaluation form, respectively (p≤.0001). Moreover, we found no significant correlation between functional results and age, functional results and localization of osteochondral defect, functional results and additional knee pathologies. ConclusionIn our study we achieved significant increases in all the scales in the last follow up. Furthermore, we found no significant correlation between functional results and age, defect localization and additional knee pathologies.

Influence du type d’orthèse de genou sur l’évolution clinique postopératoire d’une chirurgie du ligament croisé antérieur chez le sportif

Objectives To establish the influence of the type of brace on the postoperative clinical evolution after anterior cruciate ligament (ACL) surgery in competitive sportspeople. Methods The authors prospectively followed the evolution of three populations of ACL reconstruction: one who received a functional brace, the other a rigid brace and last no brace. The three groups followed the same rehabilitation program. The clinical parameters of evaluation were pain, perimeter patellar joint, range of motion, muscular atrophy, locking the quadriceps, and the quality of walking. We also used the IKDC subjective Knee Evaluation Form and PPLP scoring scale. Results There is no clinically significant difference at about a month of surgery between the three groups (407 patients). There is no difference with the PPLP scoring scale. No repeat rupture is occurred postoperatively. There is a significant difference in the IKDC subjective ( P = 0.03) between the group with functional brace and rigid brace. Conclusion With the same active rehabilitation program, the clinical evolution is identical with or without brace. The only difference is subjective (IKDC subjective Knee Evaluation Form).

Validity and reproducibility of the PPLP scoring scale in the follow-up of athletes after anterior cruciate ligament reconstruction

Objectives Validate the use of the PPLP scoring scale in the follow-up of athletes after anterior cruciate ligament (ACL) reconstruction. Patient and method We conducted a prospective follow-up study on athletes with ACL reconstruction during several time periods between 2003 and 2009, we analyzed the score validity, its reproducibility, its responsiveness to change and its relevance in the follow-up and monitoring of ACL reconstructive surgeries. Results The PPLP scoring scale was defined for the monitoring of ACL reconstruction in athletes. The PPLP tool is made of two parts: the first one (PPLP1) with a total of 100 points for postoperative follow-up and the second one also with a total of 100 points (PPLP2) adding up to the first score for determining a final post-op monitoring score of 200 points. The PPLP2 scoring scale is administered at a distance from the initial ACL reconstruction. For construct validity, we showed the differences in items’ characteristics (coefficient r of 0.20 in 763 patients), and adequate correlation of the PPLP score to other scoring scales found in the literature (OAK, Lysholm, Tegner, Knee injury and Osteoarthritis Outcome Score [KOOS], Arpege, IKDC Subjective Knee Evaluation Form and Psychovitality Test). The intra/interexaminer reproducibility is excellent going from 0.92 to 1. The PPLP scoring scale shows a statistically significant responsiveness to change during the hospital stay, according to the postoperative delay but with great variations. Complicated clinical evolutions (among 3296 ACL reconstructions with postoperative follow-up) are well identified by a low PPLP score, mainly for complex regional pain syndrome Type 1 (CRPS1: 1.9%) with a mean PPLP1 score of 80.33 whereas uncomplicated clinical evolutions (80.8%) have a mean score of 94.28 with a significant difference ( p < 0.0001). PPL2 scoring scale is significantly correlated to the possibility of getting back to competition ( p = 0.012) and a high score is linked to a faster return to competition (follow-up of 258 patients). The optimal threshold score is 176, and not 170/200, as previously suggested. However, this score remains poorly discriminating in regards to sensitivity (79.7%), specificity (49.3%) and the percentage of athletes returning to competition 2.5 months after completing the PPL2 scoring tool (37.9%). Conclusion The PPLP scoring scale was validated in the French language in terms of construct validity, reproducibility and sensitivity. This scoring scale is used for the follow-up and monitoring of ACL reconstruction in athletes, providing useful information on the quality of their recovery particularly during the postoperative phase and the possibilities of getting back to competition.

Knee flexor strength after ACL reconstruction: comparison between hamstring autograft, tibialis anterior allograft, and non-injured controls

Hamstring muscle group dysfunction following anterior cruciate ligament reconstruction (ACL) using a semitendinosus-gracilis autograft is a growing concern. This study compared the mean peak isometric knee flexor torque of the following three groups: subjects 2 years following ACL reconstruction using semitendinosus-gracilis autografts (Group 1), subjects 2 years following ACL reconstruction using tibialis anterior allografts (Group 2), and a non-injured, activity-level-matched control group (Group 3). We hypothesized that Group 1 would have greater mean involved lower extremity peak isometric knee flexor torque deficits than the other groups. Handheld dynamometry with subjects in prone and the test knee at 90 degrees flexion was used to determine bilateral peak isometric knee flexor torque. Group 1 (86.4 +/- 11) and Group 2 (80.5 +/- 13) had similar 2000 IKDC Subjective Knee Evaluation Form scores (P = NS). Group 1 had a mean involved lower extremity peak isometric knee flexor torque deficit of -17.0 +/- 14 Nm. Group 2 had a mean involved lower extremity peak isometric knee flexor torque deficit of -0.8 +/- 9 Nm. Group 3 (control) had a mean left and right lower extremity peak isometric knee flexor torque difference of -0.7 +/- 14 Nm. Group 1 had decreased involved lower extremity peak isometric knee flexor torque compared to Groups 2 and 3 (two-way ANOVA; group x side interaction P < 0.05, Tukey HSD = 0.008). Long-term knee flexor strength deficits exist following hamstring autograft use for ACL reconstruction that does not occur when a tibialis anterior allograft is used. Early identification of impaired knee flexor strength among this group and modified rehabilitation may reduce these deficits. Adding quantitative biomechanical testing of sprinting and sudden directional change movements to the standard physical therapy evaluation will better elucidate the clinical and functional significance of the observed knee flexor strength impairments and aid in determining sport specific activity training readiness.

Double-bundle versus single-bundle ACL reconstruction using the horizontal femoral position: a prospective, randomized study

The aim of this study was to evaluate whether anterior cruciate ligament (ACL) reconstruction using the double bundle technique (DB) improves stability in the knee compared with the single bundle technique (SB) with the femoral tunnel in a more horizontal position (2 or 10 o'clock). We conducted a randomized, prospective study. Forty patients were randomized to the DB group (20 patients) and the SB group (20 patients). Four-stranded semitendinosus and gracilis autologous grafts were used in the SB group and in the DB group the conventional four tunnel technique was carried out using the same tendons. The IKDC complete form was used for the preoperative evaluation, and in the follow-up the IKDC subjective knee evaluation form, IKDC current health assessment form and IKDC knee examination form were used. Anteroposterior (AP) laxity was evaluated by standardised and forced radiology in all patients. No significant preoperative between-group differences were found. During the follow-up, no differences were found between groups, except for significant between-group differences (P < 0.05) between the preoperative and postoperative evaluations. The IKDC index also showed significant differences in the 2-year follow-up. Median scores increased from 48 (range 41-54) to 81 (range 75-87) (P = 0.01) in the SB group and from 52 (range 46-58) to 80 (range 72-88) (P = 0.02) in the DB group. There were no significant differences between the groups in terms of functional scores. In conclusion, the 2 and 10 o'clock placements showed no significant differences between SB and DB techniques in the pivot-shift test, manual and radiological anterior posterior laxity and IKDC scores. However, significant between-group differences were found between the preoperative and postoperative evaluations.

Two-bundle anterior cruciate ligament reconstruction with eight-stranded hamstring tendons: Four-tunnel technique

The purpose of this study was to evaluate the clinical results of two bundle anterior cruciate ligament reconstruction with eight strands of hamstring tendons. Forty three cases of chronic anterior cruciate ligament ruptures were reconstructed arthroscopically with eight strands of hamstring tendons in way of two-bundle and four-tunnel reconstruction. Quadruple-stranded semitendinosus tendon was used to reconstruct the anterior bundle, and quadruple-stranded gracilis tendon was used to reconstruct the posterior bundle. The grafts were fixed with a suspension technique by mini-plates and mini-buttons. The patients were followed up for more than one year. Forty one patients (95.3%) had negative Lachman test, and on KT-1000 examination (25° flexion and 30 lb) the side-to-side difference in anterior laxity was <3 mm. One patient had a one plus clinical Lachman's test and another two plus (KT-1000 side-to-side difference of 4 mm and 6 mm respectively). The pivot shift was negative in all but two cases which were one plus. According to the IKDC knee examination form, 42 cases (97.7%) were graded normal or nearly normal. According to the IKDC subjective knee evaluation form, the results increased from 41.4±6.3 preoperatively to 95.7±3.1 at the last follow-up (P<0.01). The Lysholm score increased from 48.2±6.4 to 94.1±2.5 (P<0.01). The average Tegner score was 6.9 before injury, 3.5 before surgery and 6.5 at the last follow-up. In conclusion, arthroscopic two-bundle anterior cruciate ligament reconstruction with eight strands of hamstring tendon can reliably restore knee stability.