This study related mechanisms of gait compensations to the level of pain and to limitations in passive motion in patients with osteoarthritis of the hip. Joint motion, moments, and intersegmental forces were calculated for 19 patients with unilateral osteoarthritis of the hip (12 men and seven women) and for a group of normal subjects (12 men and seven women) with a similar age distribution. The patients who had osteoarthritis walked with a decreased dynamic range of motion (17 +/- 4 degrees) of the hip and with a hesitation or reversal in the direction of the sagittal plane motion as they extended the hip. The patients with a hesitation or reversal in motion had a greater loss in the range of motion of the hip during gait (p < 0.004) and a greater passive flexion contracture (p < 0.022) than those with a smooth pattern of hip motion. This alteration in the pattern of motion was interpreted as a mechanism to increase effective extension of the hip during stance through increased anterior pelvic tilt and lumbar lordosis. The patients who had osteoarthritis of the hip walked with significantly decreased external extension, adduction, and internal and external rotation moments (p < 0.008). The decreased extension moment was significantly correlated with an increased level of pain (R = 0.78; p < 0.001). This finding suggests that decreasing muscle forces (hip flexors) may be one mechanism used to adapt to pain.

The purpose of this multicenter retrospective study was to analyze the causes for failure of ACL reconstruction and the influence of meniscectomies after revision. This study was conducted over a 12-year period, from 1994 to 2005 with ten French orthopaedic centers participating. Assessment included the objective International Knee Documenting Committee (IKDC) 2000 scoring system evaluation. Two hundred and ninety-three patients were available for statistics. Untreated laxity, femoral and tibial tunnel malposition, impingement, failure of fixation were assessed, new traumatism and infection were recorded. Meniscus surgery was evaluated before, during or after primary ACL reconstruction, and then during or after revision ACL surgery. The main cause for failure of ACL reconstruction was femoral tunnel malposition in 36% of the cases. Forty-four percent of the patients with an anterior femoral tunnel as a cause for failure of the primary surgery were IKDC A after revision versus 24% if the cause of failure was not the femoral tunnel (P = 0.05). A 70% meniscectomy rate was found in revision ACL reconstruction. Comparison between patients with a total meniscectomy (n = 56) and patients with preserved menisci (n = 65) revealed a better functional result and knee stability in the non-meniscectomized group (P = 0.04). This study shows that the anterior femoral tunnel malposition is the main cause for failure in ACL reconstruction. This reason for failure should be considered as a predictive factor of good result of revision ACL reconstruction. Total meniscectomy jeopardizes functional result and knee stability at follow-up.

Mean follow-up was 11.6 +/- 0.8 years. Nine graft ruptures occurred. The satisfaction rate was excellent (90%). Seventy patients (74%) were still actively participating in sports. The mean subjective IKDC 2000 score was 90.5 +/- 8.8 points. The IKDC score was statistically correlated to laxity, time from injury, and osteoarthritis development at final follow-up. Ninety-one percent of patients were graded A or B according to the overall IKDC score. The radiological assessment reported osteoarthritis development in 17.8% of patients, and 39% showed radiological changes. Osteoarthritis was correlated with body mass index (P = .01) and age at follow-up (P = .006). In a selected population without meniscus and articular cartilage injury, an osteoarthritis rate of only 8% was found. Conclusion Arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft resulted in high patient satisfaction levels and good clinical results after 10 years. Moreover, a high percentage of patients remained involved in sports activities, and anterior cruciate ligament reconstruction protected their meniscus from a secondary tear. However, knee osteoarthritis developed in 17.8% of patients so treated.

Retrospective case series, Level IV.