Knee injuries are common and account in various sports for 15-50% of all sports injuries. The cost of knee injuries is therefore a large part of the cost for medical care of sports injuries. Furthermore, the risk of acquiring a knee injury during sports is considered higher for females than for males. The nationwide organization "Youth and Sports" represents the major source of organized sports and recreation for Swiss youth and engages annually around 370000 participants in the age group of 14 to 20 years. The purpose of this study was to combine data on knee injuries from two sources, the first being data on the exposure to risk found in the activity registration in "Youth and Sports" and the second injuries with their associated costs resulting from the activities and filed at the Swiss Military Insurance. This allowed calculation of knee injury incidences, to compare risks between males and females and to estimate the costs of medical treatment. The study comprises 3864 knee injuries from 12 sports during 7 years. Females were significantly more at risk in six sports: alpinism, downhill skiing, gymnastics, volleyball, basketball and team handball. The incidences of knee injuries and of cruciate ligament injuries in particular, together with the costs per hour of participation, all displayed the same sports as the top five for both females and males: ice hockey, team handball, soccer, downhill skiing and basketball. Female alpinism and gymnastics had also high rankings. Knee injuries comprised 10% of all injuries in males and 13% in females, but their proportional contribution to the costs per hour of participation was 27% and 33%, respectively. From this study it can be concluded that females were significantly more at risk for knee injuries than males in six sports and that knee injuries accounted for a high proportion of the costs of medical treatment.
Arthrometry was performed before and during anesthesia in 41 patients with acute or old anterior cruciate ligament injuries and only minor signs of valgus or varus instability. The uninjured contralateral knee served as a control. The influence of anesthesia on the anterior stability was distinct in acute knee injuries. There was also a small, but definite, increase in anterior laxity in uninjured knees. Knees with old injuries were more lax, and the injured-uninjured difference in anterior laxity was more pronounced. Stability examination under anesthesia is of great value for acutely injured knees.
At last follow-up we found no statistical difference in stability tests, functional or activity scores; both groups showed stable improvement concerning scores and arthrometry compared with the preoperative values. No advantages were associated with the use of the Kennedy LAD, and we do not recommend it or a similar device for uncomplicated cases. New augmentation devices are simply launched onto the market, and we recommend caution and thorough evaluation in prospective, randomised studies before they are adopted into use.
In a prospective randomized study on patients with functional instability due to old anterior cruciate ligament tears, 18 were randomized to a Goretex reconstruction and 23 to augmentation with the Kennedy Ligament Augmentation Device (LAD). All operations were performed with use of a modified over-the-top technique. At follow-up (median 36 months), improvements in Lysholm scores, activity scores, and arthrometry values were recorded in both groups as compared with preoperative levels. The LAD group had better Lysholm scores than the Goretex group. Among Goretex-reconstructed knees, effusion and pain occurred, and major effusions in two knees caused by the Goretex artificial ligament were indications for graft explant after 4 years. Our short-term results with the Goretex prosthetic ligament are not acceptable because of effusions and of pain. Our short-term results of the LAD polypropylene braid as an augmentation to an autologous graft seem promising.
We recorded temperature changes on the skin surface, subcutaneously and intra-articularly during cryotherapy after knee surgery by using Cryo-cuff compression dressings. Subcutaneous recordings on the contralateral knee were used as reference. 8 patients were examined. There was a reproducible decrease in skin temperature and subcutaneous temperature. Skin temperature had to be lowered to about 20 degrees C to obtain demonstrable intraarticular temperature changes.
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