The best treatment for the active and lucid elderly patient with a displaced intracapsular fracture of the femoral neck is still controversial. Randomised controlled trials have shown that a primary total hip replacement is superior to internal fixation as regards the need for secondary surgery, hip function and health-related quality of life. Despite good results achieved with total hip replacement in this group, most orthopaedic surgeons still advocate hemiarthroplasty for this injury. We studied 120 patients with a mean age of 81 years (70 to 90) with an acute displaced intracapsular fracture of the femoral neck. They were randomly allocated to be treated with either a bipolar hemiarthroplasty or total hip replacement. Outcome measurements included peri-operative data, general and hip-specific complications, hip function and health-related quality of life. The patients were reviewed at four and 12 months. The duration of surgery was longer in the total hip replacement group (102 minutes (70 to 151)) versus 78 minutes (43 to 131) (p<0.001), and the intra-operative blood loss was increased 460 ml (100 to 1100) versus 320 ml (50 to 850) (p<0.001), but there were no differences between the groups regarding any complications or mortality. There were no dislocations in either group. Hip function measured by the Harris hip score was significantly better in the total hip replacement group at both follow-up periods (p=0.011 and p<0.001, respectively). The health-related quality of life measure was in favour of the total hip replacement group but did not reach statistical significance (p=0.818 at four months and p=0.636 at 12 months). These results indicate that a total hip replacement provides better function than a bipolar hemiarthroplasty as soon as one year post-operatively, without increasing the complication rate. We recommend total hip replacement as the primary treatment for this group of patients.

I n a two-centre study, 164 patients with unilateral instability of the anterior cruciate ligament were prospectively randomised to arthroscopic reconstruction with either a patellar tendon graft using interference screw fixation or a quadruple semitendinosus graft using an endobutton fixation technique. The same postoperative rehabilitation protocol was used for all patients and follow-up at a median of 31 months (24 to 59) was carried out by independent observers. Four patients (2%) were lost to follow-up.No significant differences were found between the groups regarding the Stryker laxity test, one-leg hop test, Tegner activity level, Lysholm score, patellofemoral pain score, International Knee Documentation Committee (IKDC) score or visual analogue scale, reflecting patient satisfaction and knee function. Slightly decreased extension, compared with the non-operated side, was found in the patellar tendon group (p < 0.05). Patients with associated meniscal injuries had lower IKDC, visual analogue (p < 0.01) and Lysholm scores (p < 0.05) than those without such injuries. Patients in whom reconstruction had been carried out less than five months after the injury had better final IKDC scores than the more chronic cases (p < 0.05).We conclude that patellar tendon and quadruple semitendinous tendon grafts have similar outcomes in the medium term. Associated meniscal pathology significantly affects the final outcome and early reconstruction seems to be beneficial. The bone-patellar tendon-bone graft has been regarded as the procedure of choice in reconstruction of the anterior cruciate ligament (ACL) for more than two decades. [1][2][3][4] Alternatives include semitendinosus or combined semitendinosus/gracilis tendon grafts. Few of the numerous studies reflecting the functional outcome after these different procedures are prospective investigations and even fewer are both prospective and randomised.5-7 Combined semitendinosus and gracilis grafts have been used in previous randomised studies. To the best of our knowledge, no prospective, randomised study comparing bone-patellar tendon-bone grafts with quadruple semitendinosus tendon grafts has been published. The particular clinical issues relate to possible elongation of hamstring tendon grafts over time, their possible lower donor site morbidity, especially reflecting patellofemoral problems, and optimal fixation technique.Our aim was to compare arthroscopically-assisted reconstruction of the ACL using bone-patellar tendon-bone graft and interference screw fixation with quadruple semitendinosus tendon graft using endobutton fixation proximally and screws distally. Patients and MethodsBetween 1995 and 1997, in a two-centre study, 180 patients were prospectively randomised to reconstruction of the ACL with either an ipsilateral bone-patellar tendon-bone graft or a quadruple semitendinosus graft. Inclusion criteria were single-leg insufficiency of the ACL with the trauma occurring at least two months before reconstruction, age between 15 and 45 years, no previous reco...

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A 3-fold increased prevalence of OA was found after an ACL injury treated with reconstruction compared with the contralateral healthy knee. No differences in the prevalence of OA between the BPTB and quadrupled ST reconstructions were found. An initial meniscus resection was a strong risk factor for OA; the time between injury and reconstruction was not.

Functional recovery after an ACL reconstruction can be achieved; gender and additional injuries are important predictors for a functional recovery. To time surgery early, that is, before recurring giving ways has occurred is essential to decrease additional injuries and increase the chance of functional recovery.

In the long term, the semitendinosus graft provided similar stability, knee function, and health-related quality of life but with less kneeling morbidity than did the bone-patellar tendon-bone graft.

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