Paper #73 Assessment of the patello-femoral joint following ACL reconstruction, using patellar tendon graft versus hamstring quadrupled graft

ABSTRACTS 0.04 deficit, 70 : mean 1.3 deficit, p ⫽ 0.055). No other difference was identified between the two groups. There was no correlation between extension deficit and anterior knee laxity. Conclusion: Fixation of a PT graft with the knee at 0 rather than 70 appears to result in less extension deficit without compromise of stability or function. Paper #71 The Prevalence Of Anterior Knee Pain After ACL Reconstruction — A Controlled Clinical Trial. Amer Khan, Presenter, The Royal Free Hospital, London, United Kingdom, Chrish Thakkar, London, United Kingdom, Jonathan Emberson, London, United Kingdom, George S. E. Dowd, Herts, United Kingdom Aim: We determined prospectively the incidence and prevalence of anterior knee pain following ACL reconstruction using autogenous ipsilateral bone-patella-tendon-bone graft in a cohort of 60 patients. Methods: Sixty operations were performed consecutively in 60 knees by the same surgeon and all patients underwent the same rehabilitation protocol. The frequency and severity of anterior knee pain experienced during activities of daily living, sports, prolonged sitting, stair climbing and kneeling was recorded using the Shelbourne and Trumper anterior knee pain questionnaire, the patellofemoral study group anterior knee pain questionnaire and a pain visual analogue scoring system. The location of pain and any perceived sensory change was recorded using patient-drawn diagrams. The minimum post-operative follow-up was 2 years. All results were compared with a healthy control group of 50 subjects with no history of knee surgery. Results: The average age of the control and treated groups were 22.8 and 35.6 years respectively (p ⬍ 0.0001). 74% of the control group experienced no pain compared to 22.2% of the treated group at 2 years following surgery. However we noted a significant improvement in both anterior knee symptoms and sensory change in the treated group with time from 2 years to 5 years post operation (p ⫽ 0.04). At 4-5 years the pain experienced in the treated group was less than that before operation and similar to that in the control group (p ⫽ 0.07). Conclusion: We postulate that in our series of patients anterior knee pain following ACL reconstruction with autogenous bone-patella tendon-bone graft diminishes within 5 years to that found in a young and healthy population. Paper #72 Tunnel Widening After ACL Reconstruction Is Dependent On Type Of Fixation Used. A

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Prospective Randomized Study Comparing Two Different Fixation Methods For Hamstring Grafts. Peter Faunoe, Presenter, Dept Orthop Surg, Randers, Denmark, Soeren Kaalund, Randers, Denmark Purpose: To compare the incidence of tunnel widening (TW) in patients undergoing ACL reconstruction with hamstring graft using either A) transfixation implant, (Transfix, Arthrex) in femur and interference screw (Arthrex) in tibial tunnel or B) endobutton in femur and bicortical screw and washer distally to the tibial tunnel. Material and Method: 100 patients were included and randomized. 87 patients was assessed at a one year follow-up. The evaluation included standardized X-rays. KT-1000, IKDC and Lysholm score. The diameter of the tunnel at one year follow-up was, after correction for magnification, compared to the original reamed diameter. A more than 2mm enlargement was considered TW. Results: In the group where transfixation in femur and interference screw in tibia was used, 7/41 had developed femoral TW and 5/41 in tibia. In the endobutton group 20/46 had TW in femur and 16/46 in tibia. (Fishers exact test p ⬍ 0,05) No difference was found with respect to Lysholm score, IKDC or athrometric evaluation. Conclusion: There was a significant reduction of TW in both femur and tibia using fixation points close to the joint comparing to the system where the distance between the fixation points is long. We conclude that the position of the fixation site and the quality of the fixation device are major factors in the development of TW after ACL surgery. Paper #73 Assessment Of The Patello-femoral Joint Following ACL Reconstruction, Using Patellar Tendon Graft Versus Hamstring Quadrupled Graft. Mohamed Hossam Elshafie, Presenter, Alexandria University, Alexandria, Egypt, Mohamed Emad Eid, Alexandria, Egypt Objectives: The aim of this prospective study was to evaluate the effect of ACL reconstruction on Patellofemoral joint, comparing between the BPTB graft and doubled STG graft. Material and Methods: Seventy-seven patients which underwent ACL reconstruction using BPTB graft and doubled STG graft were studied, 40 in the BPTB group and 37 in the STG group. The procedure was standard in both groups. In the BPTB group, the patellar tendon defect was not closed and the graft was fixed with metal interference screws, for the STG group the graft

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ABSTRACTS

was fixed using the endobutton for the femoral side and spiked washer and screw for the tibial side. Postoperatively all patients had the same accelerated rehabilitation program. All patients were evaluated clinically and radiologically at 18 months postoperatively. The clinical examination includes, 1-Presence of PF pain. 2-Patellar crepitus. 3-Patellar irritability. 4-Range of motion. 5-thigh atrophy. The radiological examination was taken pre-operatively and at late follow-up, the following were recorded, 1- Patellar height (Insall/Salvatti ratio). 2- Sulcus angle. 3-Lateral PF angle. 4-Merchant congruence angle (CA). The pre-operative radiographic measurements were compared to the postoperative value and this was correlated to the clinical findings. Results: Anterior knee pain was present in 45% and 13.5% in both the BPTB group and STG group with a significant difference. Patellar irritability and patellar crepitus were higher in the BPTB group. Flexion contracture was present in 20% and 5.4% in both BPTB and STG group respectively. There was a positive correlation between the presence of PF pain as compared to patellar irritability, flexion contracture, and patellar crepitus in the BPTB group. Also there was a positive correlation between PF pain and thigh atrophy in both groups. Radiological investigation showed, a significant patellar tendon shortening (65%) in the BPTB group as compared to the preoperative values. There was a significant decrease in the Merchant congruence angle (CA) in the BPTB group as compared to the preoperative recorded value. Significant correlation was found between PF pain and patellar tendon shortening, but not to the postoperative recorded CA in the BPTB group. The STG group did not show significant changes in the PT length, or CA. The Lateral PF angle and the sulcus angle showed no significant changes postoperatively. Conclusions: In the BPTB group, there was a higher incidence of PF pain which correlated significantly with the PT shortening, patellar crepitus, patellar irritability, flexion contracture and thigh atrophy. In spite of significant changes in the Merchants congruence angle postoperatively in the BPTB group, it was not correlated to PF pain or PT shortening. In the STG group of ACL reconstruction, lower incidence of PF pain was found, with no significant changes in the PT length or Merchant angle. Paper #74 Hamstring-ACL-replacement In Children And Adolescents. Andree Ellermann, Presenter, ARCUS Sportklinik, Pforzheim, Germany, Christian Sobau, Viernheim, Germany Looking at the controversial Discussion about indica-

tion, transplant choice and fixation techniques in active ACL-injured patients with open physes we decided to operate even in childhood using a hamstring graft. 24 patients (14 female/10 male) operated at an age between 10 to 18 years (mean 14,3) were examined at mean f/u of 32 months (range 13-77) postoperatively. ACL-replacement was performed with a four strand hamstring graft using an Endobutton and a Suture Washer for fixation. The manually drilled tunnels were positioned transepiphyseal in the anatomic position. The mean diameter of the tunnels were 7,75 mm (range 6-10) on the femoral and 8,3 mm (range 6-11) on the tibial side. Measured with the IKDC-Score 79% were classified as normal or nearly normal. Mean Tegner Score was 7,1 (range 5-9). Three patients developed an instability within the first 12 months, two of them due to an adequate trauma. Clinical and radiological examinations did not show growth disturbances in any patient. The results did not correlate to gender. Presuming a bad progression in conservatively treated ACL- injured young patients and performing a careful operative treatment (small tunnel diameters, ligamentous graft, extracortical fixation, etc.) the above mentioned technique shows satisfying results and enables the young patient to return to every day activity and sports on a satisfying level. Paper #75 Arthroscopic Fixation Of The Fractures Of The Intercondylar Eminence Via New Portal. M. Nedim Doral, Presenter, Hacettepe University School of Medicine, Departmen, Ankara, Turkey, O. Ahmet Atay, Ankara, Turkey, Onur Tetik, Ankara, Turkey, Gu¨ rsel Leblebiciog˘ lu, Ankara, Turkey A new technique is described for arthroscopic reduction and internal fixation of fractures of the intercondylar eminence of the tibia. In this technique cannulated screws are placed through “Transquadricipital tendinous” portal. Avulsion fracture of the intercondylar eminence at the insertion of the anterior cruciate ligament (ACL) is the bony equivalent of a ligamentous rupture. This mode of ACL failure is mostly seen in children and adolescents. However, these fractures are also seen with increasing frequency in adults. Satisfactory reduction is essential to prevent nonunion or malunion of a fracture, which in turn can cause persistent problems such as knee pain, loss of extension and laxity of the ACL. The management of fractures is uncomplicated and straightforward when they are minimally displaced. However, the treatment of displaced and complete separation fractures has been controversial and there is no common