Both hamstring and patellar tendon autografts provided good subjective outcomes and objective stability at 11 years. Positive pivot-shift test (1+) was significantly more frequent in the PT group. No significant differences in the rate of graft failure were identified. Patients with patellar tendon graft had a greater prevalence of osteoarthritis at 11 years after surgery.
The open Bankart procedure is still considered the gold standard for patients with recurrent posttraumatic anterior shoulder instability. The purpose of this retrospective study was to analyze long-term results after open Bankart procedure in 83 patients that were operated between 1987 and 2000 and to evaluate the rate of recurrent instability, level of function and range of motion. The mean follow-up time was 9 (3-16) years. The postoperative recurrence rate including subluxations was 12%. The mean Constant score was 77 and the mean Rowe score was 63. Average loss of external rotation in 90 degrees of abduction was 19 degrees . The results were disappointing in terms of stability and function. In the absence of longterm prospective studies on newer arthroscopic techniques, the decision on the reconstruction method must still be based on the surgeon's experience and the patient's choice.
A prospective, randomised, 5-year follow-up study was designed to compare the functional results between patellar tendon and hamstring tendon autografts after anterior cruciate ligament reconstruction. Primary reconstruction was performed in 32 patients using the central third of the patellar ligament and in 32 patients using double-looped semitendinosus and gracilis tendons. All reconstructions were performed by a single surgeon, with identical surgical technique and rehabilitation protocol. Of the total 64 patients in the study, 54 (85%) were available for the 5-year follow-up. No statistically significant differences were seen with respect to Lysholm score, International Knee Documentation Committee (IKDC) classification, clinical and KT-2000 arthrometer laxity testing, single-legged hop test and anterior knee pain. Graft rupture occurred in two patients (8%) in the patellar tendon group and in two patients (7%) in the hamstring tendon group; 23 patients (88%) in the patellar tendon group and 23 patients (82%) in the hamstring tendon group returned to their pre-injury activity level. Good subjective outcome and stability can be obtained by using either graft; no statistically significant differences were found in functional outcome between the grafts.Résumé Une étude prospective randomisée avec un suivi moyen de 5 ans a été réalisée de façon à comparer les résultats de la reconstruction du ligament croisé antérieur par tendon rotulien ou tendon de la patte d'oie. Cette reconstruction a bénéficié à 32 patients, dans chaque type de traitement. Pour les patients traités par tendons de la patte d'oie on a utilisé à l'aide d'un double renfort le semitendineux et le gracilis. Toutes ces interventions ont été réalisées par le même chirurgien avec la même technique de rééducation. Sur les 64 patients de l'étude, 54 (85%) ont pu être suivis pendant 5 ans. Il n'y a pas de différence significative entre ces deux séries, après analyse selon le score de Lysholm, la classification IKDC, la laxité clinique et la laxité évaluée par le KT-2000. De même en ce qui concerne le sautillement et les douleurs antérieures du genou. Une rupture de la greffe est survenue chez deux patients (8%) du groupe tendon rotulien et chez deux patients (7%) du groupe tendon de la patte d'oie. 23 patients (88%) du groupe tendon rotulien et 23 patients (82%) du groupe patte d'oie ont pu reprendre leurs activités à un niveau identique à celui qu'ils avaient avant l'accident. Ces techniques permettent d'obtenir une bonne stabilité sur le plan résultats subjectifs sans différence significative quelle que soit la greffe utilisée.
Provided that a good implant position is achieved, comparable short-term results can be obtained using a bionic stem. Still, a decrease of bone mineral density in Gruen zone 7 occurred in both groups. Further studies are required to determine survivability of the bionic stem.
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