This study compares the positioning of femoral AM and PL tunnels obtained with specific ancillary instruments during anatomic double-bundle ACL reconstruction with the native ACL footprint using three-dimensional computed tomography (3-D CT). In 35 consecutive patients, anatomic double-bundle ACL reconstruction was performed with specific ancillary instruments. Three-dimensional CT reconstruction of both knees was performed using the volume rendering technique. In the controls (contralateral knee, with intact ACL), the angle between the longitudinal axis of the footprint and the axis of the femur, the "footprint angle" (FA) was measured. On the involved side, using the axis passing through the tunnel centers, FA was also measured. In both the groups, footprint's length and width, and distances to cartilage margins were measured. FA was 28.1 degrees +/- 5.0 degrees in the controls and 32.9 degrees +/- 15.8 degrees on the involved side (n.s.). There was no statistical difference between the two groups for the other morphometric parameters: footprint's length and width, and distances to cartilage margins. Using specific ancillary instruments the morphometric parameters of the reconstructed femoral ACL footprint were similar to the native ACL.

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The purpose of the study is to investigate whether the oxygen uptake and heart rate at rest, in Greek professional soccer players, are affected by recent injuries, as well as how sleep quality is affected. Forty-two male professional soccer players were included in the study and divided into two groups: injurygroup (n = 22, age: 21.6 ± 5.4 years, body fat: 11.0 ± 3.9%, total body water: 64.0 ± 2.5%) and no-injurygroup (n = 20, age: 24.2 ± 5.6 years, body fat: 10.1 ± 2.8%, total body water: 64.3 ± 1.8%). The oxygen uptake at rest (VO2resting, mL/min/kg) and heart rate (HR, bpm) were recorded in the upright position for 3 min, and the predicted values were calculated. One hour before, the athletes answered the Pittsburgh Sleep Quality Index (PSQI) questionnaire. The results showed a difference between groups (injurygroup vs. no-injurygroup) in VO2resting (7.5 ± 1.4 vs. 5.5 ± 1.2 mL/min/kg, p < 0.001) and percent of predicted values (92.5 ± 17.2 vs. 68.3 ± 14.6%, p < 0.001) and HR, such as beats per min (100.6 ± 12.8 vs. 93.1 ± 4.6 bpm, p = 0.001), percent of predicted values (50.7 ± 6.4 vs. 47.6 ± 2.8%, p = 0.003) and sleep quality score (PSQI: 4.9 ± 2.2 vs. 3.1 ± 0.9, p = 0.005). Anthropometric characteristics were not different between groups. Oxygen consumption and heart rate at rest are affected by the systemic adaptations due to injury. These pathophysiological changes probably relate to increased blood flow in an attempt to restore the injury area.

A 24-year-old patient with a history of juvenile rheumatoid arthritis underwent a primary cementless left total hip arthroplasty (THA). The original THA consisted of an Optifix 54 cup with a 3-mm thick polyethylene liner, an Optifix size 4 stem (Smith & Nephew Richards, Memphis, Tennessee) and a Biolox aluminum 32-mm femoral head. Fourteen years later, radiographs demonstrated extensive wear of the polyethylene liner resulting in direct articulation and abrasion wear of the ceramic femoral head on the cup and a bubble sign. This article presents a case of a catastrophic failure of a ceramic/polyethylene bearing with destruction of the polyethylene liner and the metallic shell and protrusio of the nonfractured ceramic head through the metallic shell. To our knowledge this is the first description of extensive metallosis and subsequent radiograph bubble sign not presenting as a result of wear of a metal-on-metal articulation. At the time of revision surgery–Hydrocel TNT Monoblock 58 cup (Zimmer, Warsaw, Indiana), Wagner 265/14 stem (Zimmer), and a Co/Cr 28-mm head–copious metallic debris was seen both macroscopically and histologically, with the ceramic head protruding behind the metallic shell. Multiple factors may have been responsible for this failure including a thin polyethylene shell, a suboptimal locking mechanism, gamma in air sterilization for polyethylene, multiple screw-holes that reduce the contact surface between shell and polyethylene, the rough surface on the inside of the shell and non-articular wear at the metal polyethylene interface within the acetabular component and the high demands of this active young patient.

BackgroundObturator nerve block plays an additive role on the quality of analgesia for knee surgery. Since the use of dual guidance increases the success rate of nerve blocks, we investigated the feasibility of performing anterior cruciate ligament reconstruction under dual-guided blockade of obturator with femoral and sciatic nerves. Furthermore, we propose a novel method for the assessment of obturator nerve block.MethodsFifty-seven patients undergoing anterior cruciate ligament repair were studied. Neurostimulating needles were guided out-of-plane by ultrasound. To induce the obturator nerve block, 10 ml of ropivacaine 0.5% were injected after eliciting contractions of adductor longus, brevis and magnus followed by block assessment for 30 minutes by examining the patient lift and left down the leg.ResultsThe sonographic recognition of obturator nerve was easy and quick in all cases. Time for applying the block was 119.9 ± 79.2 sec. Assessing this block with lifting-leaving down the leg gave satisfactory results in 24.0 ± 5.07 min. After performing femoral-sciatic blocks, the inflation of tourniquet resulted in VAS score of > 0 in 2/57 patients and operation in 12/57. Total dose of fentanyl was 120.1 ± 64.6 µg and of midazolam 1.86 ± 0.8 mg. In 6 patients propofol was administered for sedation and 1 of them required ventilation with laryngeal mask airway, converting the anesthesia technique to general anesthesia.ConclusionsOur data suggest that anterior cruciate ligament reconstruction can be performed under obturator-femoral-sciatic blocks. Identification of obturator nerve with ultrasound is easy and the block can be assessed by observing how the patient lifts and leaves down the leg.