Tibial and femoral bone tunnel widening (TW) has been observed following anterior cruciate ligament (ACL) reconstruction. We developed a χ12 mm cannulated cancellous screw (Intercondylar Ligament Screw, ICLS) for femoral fixation to reduce TW. The purpose of this study is to introduce our surgical method and its results. We employed an original ICLS system developed to reduce the needed distance between the tibial and femoral-fixation points (distance between fixation points, DbF) in ACL reconstruction. Five-strand (sometimes four or six-strand) hamstring grafts are connected to the ICLS. Tibial fixation is achieved with a Ligament Tension Screw, which had been developed by Murase et al. rom 2001 to 2008, 169 knees underwent ACL reconstruction at our hospitals using our ICLS system. TW was evaluated by radiographs at least three months postoperatively. An enlargement of more than 2 mm was considered TW. The following was also evaluated: range of motion, the limb symmetry index (LSI, injured leg divided by uninjured and multiplied by 100), value of knee extension power in OKC, anterior knee laxity, Lysholm score, and DbF. The average length of DbF was 38.1 mm (n=132). Only 6.7% (n=104) of cases showed more than 2 mm of TW. Mean LSI was 83.3%(n=77) four months postoperatively. The mean Lysholm score was 96.2(n=68) at three months after ACL reconstruction. The mean side-to-side difference in anterior tibial translation, measured with use of a KT-2000 or Knee Lax, was 1.60 mmï1/4N=57ï1/4‰. We were able to reduce TW after ACL reconstruction using our ICLS system with good results.
The purpose of this study was to describe a clinical evaluation of the etiological factors in osteochondritis dissecans (OCD) of the knee from radiographic and arthroscopic findings. Twenty-two knees of 20 patients (16 male and 4 female, 16.1 years old in average at surgery) with symptomatic OCD of the femoral condyle were studied. The medial femoral condyles were affected in 16 knees of 14 patients (medial group) and the lateral femoral condyle in 6 knees of 6 patients (lateral group). These two groups were compared using radiological location and arthroscopic findings. In radiography, the location of OCD was classified in accordance with Cahill et al. (1989). On the anteroposterior view, five zones were numbered 1 to 5 from medial to lateral. On the lateral view, three zones were labeled A,B and C from anterior to posterior. In the medial group, the locations of OCD were 23BC(12), 2BC(1), 23ABC(1) and 23C(2); 14(88%) of 16 knees involved in non-meniscal area. In the lateral group, the locations of OCD were 45C(4), 5C(1) and 4BC(1); 5(83%) of 6 knees involved in meniscal area. In arthroscopy the medial group did not have medial meniscal tear, while the lateral group had 5 lateral meniscal lesions of 6 knees; 3 discoid meniscus (2 with tear and 1 without tear), 2 bucket-handle type tear and one no meniscal lesion. Lateral meniscal lesions (with or without discoid) might cause OCD of the lateral femoral condyle. In the medial femoral condyle, we thought that OCD did not relate to meniscal lesions.
The purpose of this study is to describe a surgical procedure for unstable osteochondritis dissecans (OCD) of the capitellum and its results. Between 1992 and 1997, 11 elbows of 11 patients with OCD of the capitellum were treated in our institution. The average age at surgery was 14.7 years and the ages ranged from 12 to 16 years. All patients were male baseball players affected in the throwing side. The follow-up period was from 31 to 95 months (average: 57 months). All patients underwent internal fixation using the pull out wiring method and bone graft (this procedure was established by Kondo in 1989). All lesions of OCD were not only softening or cracked but also unstable with early separation or partially detached fragment. After surgery, a long arm cast was applied for 3 weeks. After confirming bony union of OCD by X-ray, the wires were removed ranged from 15 to 21 weeks (average 17 weeks) postoperatively. Throwing activity was allowed 6 months after surgery. At the follow-up, all patients were relieved pain and all except one returned to previous throwing levels. Radiographs showed good healing of OCD and minimum degenerative changes were found in only a few joints. We concluded that this surgical procedure was an effective treatment for adolescent baseball players with unstable OCD of the capitellum.
