POSTER ABSTRACTS

ANKLE/FOOT/CALF Poster #1 Morfologic Study of the Feet in Long Distance Runners ...... Jose Felipe Alloza, Sao Paulo, BRAZIL Poster #2 Post Traumatic Osteoarthrosis Role of Fibular Length and Width of Ankle Mortise After Malleolar Fracture...... Saqib Amin, Sharjah, UNITED ARAB EMIRATES Poster #3 Arthroscopic Arthrodesis of Subtalar Joint: The New Technique and Short Term Results ...... Eiichirou Asou, Tagawasi, JAPAN Poster #4 Calcaneo-Fibular Ligament Plasty in Ankle Instability: A Miniinvasive Day Surgery Technique ...... Gian Luigi Canata, Torino, ITALY Poster #5 Arthroscopic Treatment of Osteochondritis Dissecans in the Talus ...... Chong-Hyuk Choi, Seoul, KOREA Poster #6 Semirigid Contra Plaster Cast Fixation of the Ankle Sprain in Athletes ...... Milan Handl, Prague, CZECH REPUBLIC Poster #7 Do I Have a Flatfoot – The Runner’s Impression, the Doctor's Findings ...... Erik Hohmann, Rockhampton, AUSTRALIA Poster #8 The Long-Term Patient-Relevant Outcomes Are Worse in Women Than in Men After Anatomical Lateral Ankle Reconstruction ...... Jon Karlsson, Gothenburg, SWEDEN Poster #9 Oral Hydrolytic Enzymes in Patients With Acute Ankle Sprain: Efficacy and Safety Aspects ...... Gino M.M.J. Kerkhoffs, Amsterdam, NETHERLANDS Poster #10 Arthroscopic Ankle Arthrodesis with Arthrex ACL Guide ...... Myung Ku Kim, Incheon, SOUTH KOREA Poster #11 Clinical Result of Cortical Bone Peg Autograft for Osteochondral Lesion of the Talus ...... Hideji Kura, Sapporo, JAPAN Poster #12 Post Traumatic Lateral Ankle Pain Resulting from Intra-articular Soft Tissue ...... Gideon Mann, Givat Shaul, ISRAEL Poster #13 Clinical Result of Arthroscopic Reduction for Trimalleolar Fracture of the Ankle ...... Kohei Naito, Ohdashi, JAPAN Poster #14 Foot Pressure Distribution During Gait in Athletes With Functional Instability of the Ankle Joint ...... Koji Nawata, Yonago, JAPAN Poster #15 Diagnostic Value of Magnetic Resonance Imaging for Injury of the Anterior Talofibular Ligament ...... Kazunori Oae, Izumo, JAPAN Poster #16 Arthroscopic Osteochondral Autograft Transplantation for Osteochondritis Dissecans of the Talus ...... Satoshi Ochiai, Yamanashi, JAPAN Poster #17 Ultrasound-Guided Sclerosing of Neovessels in Tendinosis. A New Treatment in Painful Chronic Achilles Tendinosis ...... Lars Öhberg, Umeå, SWEDEN Poster #18 Arthroscopic Treatment of Anterior Ankle Friction ...... Alberto Pienovi, San Isidro, ARGENTINA Poster #19 Osteochondral Lesions of the Talar Dome Associated With Trauma ...... Masato Takao, Izumo, JAPAN

BASIC SCIENCE Poster #20 Vasculo-neural Origin to Chronic Achilles Tendon Pain ...... Håkan Kjell, Bertil Alfredson, Umeå, SWEDEN Poster #21 Positional Variation in In Vivo Tibial Strains During Jumping Exercises ...... Anton Arndt, Huddinge, SWEDEN Poster #22 Frozen Shoulder: Effects of Superior and Anterior Capsular Release. A Cadaveric Study...... Philippe Beaufils, Le Chesnay, FRANCE

Poster #23 Bone Marrow Perfusion in Healthy Subjects Assessed by Scintigraphy After POSTER ABSTRACTS Application of a Tourniquet ...... Lars Blond, Solrod, DENMARK Poster #24 Exsanguination of Limbs in Elderly Subjects Before Sugery ...... Lars Blond, Solrod, DENMARK Poster #25 Time-dependent Modulation of Collagen Type I and III Gene Expression in Human Fibroblasts Under Cyclic Strain ...... Ulrich Bosch, Hannover, GERMANY Poster #26 Insertion Torque, Pullout Strength Relationship During Bioabsorbable Interference Screw Fixation of a Soft Tissue Tendon Graft: A Synthetic and Human Cadaveric Bone Biomechanical Study with Operative Correlates ...... David N.M. Caborn, Louisville, KY, USA Poster #27 Morphological Study of Rabbits Knee with an Open Eiphysial Cartilage After Anterior Cruciate Ligament Resection ...... Moises Cohen, Sao Paulo, BRAZIL Poster #28 Histologic Evaluation of Autologous Chondrocytes Transplantation ...... Antonio Delcogliano, Rome, ITALY Poster #29 Time-Dependant Mechanical and Histological Changes of Ligaments After Thermal Shrinkage: Effect of Immobilization ...... Onder Kilicoglu, Istanbul, TURKEY Poster #30 Failure Strengths of In Vivo Degraded Bioabsorbable Interference Screws ...... Mehmet Demirhan, Istanbul, TURKEY Poster #31 Immunohistochemical Analysis of Mechanoreceptors in the Human Inferior Glenohumeral Ligament...... Benno Ejnisman, Sao Paulo, BRAZIL Poster #32 Influence of the Bone Tunnel Angle on the Graft-Bone Healing Process ...... Kensaku Hashiba, Kanazawa, JAPAN Poster #33 Metabolic Changes in Knee Joint Synovia During Reperfusion After Arthroscopy - An In Vivo Study Using the Microdialysis Technique ...... Erland Högberg, Stjärnhov, SWEDEN Poster #34 The Mechanism of the Development in Rat Knee Joint...... Masaaki Ito, Urakawa, JAPAN Poster #35 •Calcitonine Gene-Related Peptide and Neuropeptide Y After Eccentric Exercise ...... Sven Jonhagen, Bromma, SWEDEN Poster #36 Chondrocyte Transplantation Against the Full Thickness Cartilage Defect Has the Protective Effect for Surrounding Normal Cartilage ...... Kenichi Kajitani, Izumo-shi, JAPAN

5.1 Poster #37 Correlation Between Chondroitin-6 sulfotransferase mRNA Expression and the Composition Ratio of Chondroitin Sulfate Isomers in Osteoarthritic and Regenerative Cartilage Tissue of the Rabbit Knee Joint ...... Kenzo Kawasaki, Izumo, JAPAN Poster #38 Regional Differences in the Healing Potential of the Meniscus – An Organ Culture Model to Eliminate the Influence of Microvasculature and Synovium ...... Kenji Kobayashi, Hiroshima, JAPAN Poster #39 Efficient Transduction of Meniscal Fibrochondrocytes in vitro and in vivo by Recombinant Adeno-Associated Virus Vectors ...... Dieter M Kohn, Homburg-Saar, GERMANY Poster #40 Chondrocytes Induce Chondrogenic Differentiation of Synoviocytes Under the Coculture Condition ...... Sokichi Maniwa, Izumo, JAPAN Poster #41 The Effects of Mechanical Compressive Strain on the Articular Chondrocytes. A Study Using mRNA Expression of Cultured Chondrocytes Agarose Gel...... Kensuke Mio, Ota-city, JAPAN Poster #42 AG-041R, a Cholecyctokinin-B/Gastrin Receptor Antagonist, Stimulates the Repair of Osteochondral Defect in Rabbit Model...... Toru Nakanishi, Izumo, JAPAN Poster #43 Clinical and Immunological Evaluation of Patients with Symptomatic Metal Hypersensitivity Following Knee Arthroplasty. Is Metal Hypersensitivity a Cause of Prosthetic Loosening? ...... Yasuo Niki, Tokyo, JAPAN Poster #44 Bioabsorbable Fixation Comparison of a Semitensinosis-Bone Composite Allograft versus Bone-Patella Tendon-Bone Graft ...... John Nyland, Louisville, Kentucky, USA Poster #45 The Meniscofemoral Ligaments: An Anatomic Study ...... Maximiliano Ranalletta, Buenos Aires, ARGENTINA Poster #46 Tissue Engineered Cartilage by In vivo Culturing of Chondrocytes in a PLLA- Collagen Hybrid Sponge ...... Takashi Sato, Tsukuba, JAPAN Poster #47 IGF-I Gene Transfer by Electroporation Promotes Regeneration in a Muscle Injury Model ...... Toshiaki Takahashi, Kochi, JAPAN Poster #48 Angiogenic Response to Bipolar Radiofrequency Treatment of Normal Rabbit Achilles Tendon ...... James P Tasto, San Diego, CA, USA Poster #49 Long-term Skeletal Unloading Induces A Full-Thickness Patellar Cartilage Defect in Growing Rats ...... Masato Tomiya, Tokorozawa, JAPAN Poster #50 The Effect of Extracellular Matrix on ACL Cell ...... Satoshi Tsukazaki, Tokorozawa, JAPAN Poster #51 Tendon Graft Incorporation in a Bony Tunnel by Fracture Callus Formation ...... Ido Zion, Jerusalem, ISRAEL Poster #456 "The Glass Knee" – A New Method of Anatomic Preparation and Preservation of Human Joints...... Scott F. Dye, San Francisco, CA, USA

ELBOW/WRIST/HAND Poster #52 Arthroscopic Treatment for Lateral Epicondylitis: An Outcome Assessment ...... Craig Michael Ball, Auckland, NEW ZEALAND

POSTER ABSTRACTS Poster #53 Elbow Arthroscopy: A Comparison Between Different Outcome Measures ...... Philippe P Hardy, Boulogne, FRANCE Poster #54 Correlation of Preoperative MRI and Arthroscopically Proven Chondral Lesions in the Elbow ...... Amos Kidron, Herzliya, ISRAEL Poster #55 Advances in Elbow Arthroscopy – Utilizing Leverage for Visualization ...... Ronald M Selby, New York, NY, USA Poster #440 The Role of Valgus Stress Radiography in the Evaluation of Partial Tears of the Ulnar Collateral Ligament ...... Keith Sheldon Hechtman, Coral Gables, FL, USA Poster #454 Arthroscopic Treatment of Combined TFCC Lesions: A New Clinical Entity ...... Michael R. Redler, Trumbull, CT, USA

KNEE - ACL Poster #56 Contribution of Mechanoreceptors in the Anterior Cruciate Ligament to the Joint Position Sense of the Knee ...... Nobuo Adachi, Hiroshima, JAPAN Poster #57 Comparison of Two Biodegradable Interference Screws for Tendon-to-Bone Fixation in ACL Reconstruction. Experimental Study with Roentgen- Stereometric-Analysis (RSA)...... Frank Adam, Homburg/Saar, GERMANY Poster #58 Central Third Bone-Patellar Tendon-Bone Arthroscopic Anterior Cruciate Ligament Reconstruction: A 5-Year Follow-up ...... Isik Karli Akgun, Istanbul, TURKEY Poster #59 A Large Intra-Articular Ganglion Blocking Flexion of the Knee ...... SOFIA ANDRIKOULA, IOANNINA, GREECE Poster #60 ACL Reconstruction Using the Quadriceps Tendon Autograft With and Without Patellar Bone Plug: Comparison of Results ...... Emmanuel M Antonogiannakis, Athens-Cholargos, GREECE Poster #61 ACL Reconstruction Using Quadrupled Hamstring Tendon Graft: Comparison of Two Types of Soft Tissue Fixation ...... Emmanuel M Antonogiannakis, Athens-Cholargos, GREECE Poster #62 Evaluation of the EndoPearl of Femoral Fixation in Hamstring ACL Reconstruction: A Blind Prospective Randomized Clinical Trial ...... Shalinder Arneja, Winnipeg, CANADA Poster #63 Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction ...... Hiroshi Asano, Tino, JAPAN Poster #64 Partial Anterior Cruciate Ligament Tears ...... Denis R Atkinson, Havelock North, NEW ZEALAND Poster #65 Revision of Failed Anterior Cruciate Ligament Reconstruction ...... Georgios Anastasios Babalis, N. Iraklio Attikis, GREECE Poster #66 Hour-Glass (Bargash) Technique in Arthroscopic ACL Reconstruction ...... Nael Abdou Bargash, Damanhour, EGYPT Poster #67 Anterior Cruciate Ligament Reconstruction in Professional Ballet Dancers. A Retrospective Case Series...... Mario Bizzini, Zürich, SWITZERLAND

5.2 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Poster #68 Anterior Cruciate Reconstruction Combined with Valgus Tibial Osteotomy – Long Term Result ...... Nicolas Bonin, Besancon, FRANCE Poster #69 Anterior Cruciate Ligament Reconstruction – A New Press-fit Technique ...... Aristidis Bordokas, Athens, GREECE Poster #70 Rehabilitation After Day Surgery ACL Reconstruction: A Prospective, Randomized Study ...... Gian Luigi Canata, Torino, ITALY Poster #71 Prevention of Venous Thromboembolism After ACL Reconstruction: A Prospective, Randomzed Study ...... Gian Luigi Canata, Torino, ITALY Poster #72 Would ACL Deficient Patient Have More Problems in Single Leg Hop Incorporated With an Element of Rotation? ...... Eric Ping Chien, Hong Kong, HONG KONG Poster #73 Five-Year Prospective Classification of Patients With Acute ACL Rupture ...... Terese Chmielewski, Alachua, FL, USA Poster #74 Knee Stiffening During Unilateral Standing in Individuals With Instability After Acute ACL Rupture ...... Terese Chmielewski, Alachua, FL, USA Poster #75 The Cases of the Rerupture of Reconstructed ACL Using Multi-Strand Hamstring Tendon ...... Sadahiro Cho, Kawaguchi, JAPAN Poster #76 Anterior Cruciate Ligament Reconstruction in Children and Skeletal Immature Adolescents ...... Svend Erik Christiansen, Aarhus, DENMARK Poster #77 Specific Questionnaire for Knee Symptoms: Lysholm Knee Scoring – Translation and Validation for Portuguese Language ...... Moises Cohen, Sao Paulo, BRAZIL Poster #78 A New Technique of Preparation and Fixation of an ACL Semi-Tendinosus Graft (Mechanical Evaluation by Pull-out and Cyclic Loading Tests) ...... Michel Collette, Bruxelles, BELGIUM Poster #79 ACL Reconstruction with Doubled Hamstring Tendons Fixed With 2 Bio-absorbable Interference Screws in Competitive Athletes ...... Daniel Comba, La Loggia-TO, ITALY Poster #80 Posterolateral Chondral Injury in Anterior Cruciate Ligament Rupture ...... Adam Dalgleish, Auckland, NEW ZEALAND Poster #81 Arthroscopic ACL Reconstruction With No Torniquet Use in Routine Bone-Patellar Tendon-Bone ...... Roberto Jose Batista Dorea, Salvador, BRAZIL Poster #82 MRSA Toxic Shock Syndrome After Arthroscopic Anterior Cruciate Ligament Reconstruction ...... Kosuke Ebina, Toyohaka-city, JAPAN Poster #83 The Effect of ACL Surgery on Bone Mineral in the Calcaneus ...... Lars Ejerhed, Uddevalla, SWEDEN Poster #84 •A Degradable Polyurethaneurea Augmentation Device for ACL Reconstruction ...... Ingrid Ekenman, Stockholm, SWEDEN Poster #85 Rehabilitation Using an Active Motion Device After Anterior Cruciate Ligament Reconstruction ...... Sven Feil, Heidelberg, GERMANY Poster #86 The Effect of Physiotherapy Following Anterior Cruciate Ligament Reconstruction ...... Julian A Feller, Melbourne, AUSTRALIA Poster #87 The Evolgate: A New Method for Anatomic Tibial Fixation of Quadrupled Hamstring Graft in ACL Reconstruction: A Biomechanical Study ...... Andrea Ferretti, ROME, ITALY Poster #88 3-D Gait Analysis of ACL Deficient Patients Using the Chaos Theory ...... Anastasios Georgoulis, Ioannina, GREECE Poster #89 Changes in Single Step Balance of ACL Deficient Patients Before and After Low Demand Exercise ...... Anastasios Georgoulis, Ioannina, GREECE Poster #90 Two-Year Comparative Study After ACL Reconstruction: BPTB vs D-STG ...... Francesco Giron, Firenze, ITALY Poster #91 ACL Reconstruction with D-STG Fixed to the Femur With a Mitek Anchor: 5 Year Results ...... Francesco Giron, Firenze, ITALY Poster #92 Injury to the ACL in Alpine Skiing:

A Biomechanical Analysis of Tibial Torque and Knee Flexion Angle ...... Sharon L. Hame, Los Angeles, CA, USA POSTER ABSTRACTS Poster #93 Hyaluronic Acid; Additional Therapy After ACL Reconstruction ...... Milan Handl, Prague, CZECH REPUBLIC Poster #94 Effect of 80N Initial Graft Tension on Anterior Tibial Translation With Time After ACL Reconstruction ...... Kazuhisa Hatayama, Maebasi, JAPAN Poster #95 Monopolar Electrothermal Tightening of Chronic, Interstial Partial ACL Tears . .Stephen W. Houseworth, Colorado Springs, CO, USA Poster #96 Clinical Results of Two-Stage ACL Revision ...... Sadafumi Ichinohe, Morioka, JAPAN Poster #97 In Vivo Simultaneous Measurement of Length Changes of the Anteromedial and Posterolateral Bundles of the Anterior Cruciate Ligament Reconstructed With The Four-Tunnel Two-Route Procedure With Hamstring Tendon Grafts ...... Hiroki Ichiyama, Sapporo, JAPAN Poster #98 Evaluation of Graft After ACL Reconstruction ...... Michael Ilias Iosifidis, Thessaloniki, GREECE Poster #99 ACL Reconstruction With Hamstrings and Bioabsorbable ...... Don H Johnson, Ottawa, CANADA Poster #100 Effect of Axial Rotation of the Tibia on Activation of the Extensor Mechanism: Implication for Non-Contact ACL Injury ...... Akihiro Kanamori, Tsukuba, JAPAN Poster #101 Serial Changes in the MRI of Anterior Cruciate Ligament Graft in Tibial Bone Tunnel ...... Izumi Kanisawa, Chiba, JAPAN Poster #102 A Comparison of Three Methods of ACL Reconstructions With Minimum 30 Months Follow-up ...... Sinan Karaoglu, Kayseri, TURKEY Poster #103 When to Inject Analgesic Agents Intra-articularly in ACL Reconstructions – Before or After Tourniquet Releasing ...... Sinan Karaoglu, Kayseri, TURKEY Poster #104 A Long-term MRI Study after Harvesting Patellar Tendon Autografts ...... Jüri Toomas Kartus, Trollhättan, SWEDEN Poster #105 Return to Sports Activities after Anterior Cruciate Ligament Reconstruction ...... Masayoshi Katayama, Maebashi City, JAPAN Poster #106 Effects of ACL-Reconstruction on Joint Surface Pressure Pattern ...... Richard K Kdolsky, Vienna, AUSTRIA Poster #107 Arthroscopic ACL Reconstruction Using Patellar Tendon-Bone Autograft and Bioabsorbable Interference Screw ...... Myung Ku Kim, Incheon, SOUTH KOREA

5.3 Poster #108 Anterior Cruciate Injuries in Children with Open Physes ...... Tatsuo Kobayashi, Tokorozawa, JAPAN Poster #109 Thermal Shrinkage Method Using Holmium; YAG Laser on ACL Deficient Knee ...... Akihiro Kotani, Mitaka-shi, JAPAN Poster #110 Antero-lateral Rotatory Instability of the Knee ...... Andreas K. Kreutz, Homburg Saar, GERMANY Poster #111 •Bone-Mulch-Screw/WasherLoc Fixation of Doubled Flexor Tendon Graft in Anterior Cruciate Ligament Reconstruction – Biomechanical Evaluation on the Effect of Initial Graft Tension Using Cyclic Elongation ...... Toshiharu Kudoh, Sapporo, JAPAN Poster #112 Intraoperative Measurement of Graft Isometry by Graft Fixation of One of the Two Bundles in Two-Route ACL Reconstruction ...... Yoshiaki Kurihara, Minami-Saku Gun, JAPAN Poster #113 Simultaneous Bilateral ACL Reconstruction ...... Pablo Lacroze, Buenos Aires, ARGENTINA Poster #114 Augmented Arthroscopic Repair of Acute Ruptures of the Anterior Cruciate Ligament ...... Franz Landsiedl, Vienna, AUSTRIA Poster #115 Allograft ACL Revision Reconstruction – 3 Years Follow-up ...... Dan Laptoiu, Bucharest, ROMANIA Poster #116 Hamstring Anterior Cruciate Ligament Reconstruction Using Three Surgical Techniques and Secure Fixation: An Outcome Analysis Comparing Women and Men ...... Keith W. Lawhorn, Clarksville, MD, USA Poster #117 Arthroscopic Anterior Cruciate Ligament Reconstruction Using Central Quadriceps Tendon Autograft ...... Myung-Chul Lee, Seoul, KOREA Poster #118 Donor-Site Morbidity in ACL Reconstruction Using Quadriceps Tendon Autograft ...... Myung Chul Lee, Seoul , KOREA Poster #119 The Anatomy of Tibial Eminence Fractures: Arthroscopic Observations Following Failed Closed Reduction ...... Joseph Lowe, Jerusalem, ISRAEL Poster #120 Transphyseal ACL Repair in the Skeletally Immature Athlete ...... Peter Benjamin MacDonald, Winnipeg, CANADA Poster #121 Anatomic Double Bundle ACL Reconstruction With Hamstrings. Technical Note...... Maurilio Marcacci, Bologna, ITALY Poster #122 The Relationship Between Anterior Cruciate Ligament Laxity and Patient Function ...... Robert G Marx, New York, NY, USA Poster #123 Donor Site Morbidity After ACL Reconstruction Using Ipsilateral vs. Contralateral BPT Graft ...... Dimitrios Stylianos Mastrokalos, Leimen, GERMANY Poster #124 Sports and All-Day-Life Ability Following ACL Reconstruction Using the Hamstrings vs BPT-graft in an Implant-Free Pressfit Technique ...... Dimitrios Stylianos Mastrokalos, Leimen, GERMANY Poster #125 Tibial Tunnel Enlargement After ACL Reconstruction with Hamstrings. A Comparison of Single and Double Point Tibial Graft Fixation...... Dimitrios Stylianos Mastrokalos, Leimen, GERMANY Poster #126 Knee Function After Anterior Cruciate Ligament Injury in Elite Collegiate Athletes ...... David R. McAllister, Los Angeles, CA, USA Poster #127 Primary ACL Reconstruction With B-T-B Allograft: Two to Nine Year POSTER ABSTRACTS Outcomes and MRI Assessments ...... Eric C McCarty, Nashville, Tennessee, USA Poster #128 Differences Between Bioabsorbable Femoral Fixation and Interference Screw Fixation During Reconstruction of the Anterior Cruciate Ligament ...... Mladen MIskulin, Zagreb, CROATIA Poster #129 Bone Tunnel Changes Following Anterior Cruciate Ligament Reconstruction Fixed at the Tibial Anatomic Position: Computed Tomographic Evaluation ...... Akihiko Nagao, Mutsu City, JAPAN Poster #130 The Effect of Tendon Harvest on the Clinical Results after Endoscopic ACL Reconstruction: Two-tendons (St & G) vs One-Tendon (St) ...... Shinya Nagasaki, Hakodate, JAPAN Poster #131 Use of Radiofrequency Energy to Control Notch Regrowth in ACL Reconstruction ...... Kazuhiko Nakano, Sapporo, JAPAN Poster #132 How to Reduce Patellar Tendon Graft Harvesting Morbidity? Cadaverous Study of a New Technique ...... Nicolas Bonin, Besancon, FRANCE Poster #133 Anterior Cruciate Ligament Reconstruction in Competitive Soccer Players ...... Hiroyuki Nose, Kawaguchi, JAPAN Poster #134 Gluteus Maximus Provides a Greater Contribution to Dynamic Frontal and Transverse Plane Knee Control Among Females with Increased Femoral Anteversion ...... John Nyland, Louisville, Kentucky, USA Poster #135 The Clinical Evaluation of Reconstructed ACL Compared with Arthroscopy and MRI ...... Hiroyuki Obata, Urakawa, Hokkaido, USA Poster #136 Anterior Cruciate Ligament Reconstruction in the Skeletally Immature Patient ...... James E Owen, Brisbane, AUSTRALIA Poster #137 Short and Long Term ACL Deficiency: The Role of Hamstrings ...... Christos Dimitrios Papageorgiou, Ioannina, GREECE Poster #138 The Effect of ACL Reconstruction of the Internal-External Rotation of the Knee Joint ...... Christos Dimitrios Papageorgiou, Ioannina, GREECE Poster #139 ACL Reconstruction With Patellar Tendon. The Effect of Using a Graft Without a Patellar Bone Plug ...... Uwe Pietzner, Altentreptow, GERMANY Poster #140 Donor Site Problems After ACL BTB Autograft Reconstruction: Long Term Results ...... Madis Rahu, Tallinn, ESTONIA Poster #141 A Minimally Invasive Technique ("Healing Response") to Treat Acute ACL Injuries in Patients 40 Years and Older ...... William G Rodkey, Vail, CO, USA Poster #142 Anteromedial vs. Transtibial Femoral Tunnel Placement in ACL Reconstruction. An in vivo Study...... Julian Rossis, Heidelberg, GERMANY

5.4 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Poster #143 Arthroscopic ACL Reconstruction Utilizing a Quadruple Semitendinosus and Bioabsorbable Screws: Early Result ...... Suriyapong Saowaprut, Bangkok, THAILAND Poster #144 Biomechanical Comparison of Contact Pressure of the Graft in Bone Tunnels of Single and Two Incision ACL Reconstruction ...... Hiroyuki Segawa, Niigata City, JAPAN Poster #145 The Relation Between Anterior-Posterior Knee Laxity and Degenerative Chondral Lesions After ACL Replacement. An Experimental Roentgenstereometric (RSA) Analysis...... Romain Seil, Homburg/Saar, GERMANY Poster #146 The Influence of Graft-tunnel Motion and Initial Synovial Fluid Leakage Into the Tibial Tunnel on Tibial Tunnel Enlargement After ACL Replacement...... Romain Seil, Homburg/Saar, GERMANY Poster #147 Locked Knee Masking Exam of Anterior Cruciate Ligament ...... Ronald M Selby, New York, NY, USA Poster #148 Notchplasty: Description of Technique ...... Ronald M Selby, New York, NY, USA Poster #149 The Case for Acute Anterior Cruciate Ligament Reconstruction ...... Christopher Terence Servant, Bath, UNITED KINGDOM Poster #150 Mid-Term Results of the Reconstruction of Chronic Anterior Cruciate Ligament Lesions with Polyester Prosthesis ...... Nilson R. Severino, Sao Paulo, BRAZIL Poster #151 Patellar Fracture Associated to Rupture of the Patellar Tendon Presenting as a Complication of Arthroscopic Reconstruction of the Anterior Cruciate Ligament With the Patellar Tendon...... Nilson R. Severino, Sao Paulo, BRAZIL Poster #152 Primary and Revision ACL-Reconstruction With Patellar ...... Rainer Siebold, Walldorf, GERMANY Poster #153 Changes of Sagittal Obliquity in Reconstructed Anterior Cruciate Ligament Measures on Magnetic Resonance Images ...... Masaki Sonoda, Chiba, JAPAN Poster #154 Female Athletes Have Fewer Intraarticular Injuries than Males: A Prospective Comparison by Sport and Competition Level ...... Kurt P. Spindler, Nashville, TN, USA Poster #155 Impact of Tendon Graft Suturing Technique on Interference Fixation Strength of Quadrupled Hamstring Tendon Grafts in Cruciate Ligament Reconstruction ...... Eric S. Steenlage, Berlin, GERMANY Poster #156 Bilateral Anterior Cruciate Ligament (ACL) Reconstruction With Autologus Patellar Tendon 1 to 9 Years Follow Up ...... Edilson Schwansee Thiele, Curitiba, BRAZIL Poster #157 Evaluation of the Return to Sports After Bilateral Anterior Cruciate Ligament Reconstruction ...... Edilson Schwansee Thiele, Curitiba, BRAZIL Poster #158 Isocinetic Evaluation of Patients Submitted to ACL Reconstruction With Patellar Tendon. An Analysis of 30 Cases ...... Edilson Schwansee Thiele, Curitiba, BRAZIL Poster #159 Arthroscopic Versus Mini-Arthrotomy ACL Reconstruction. An Initial Comparison of Results ...... Edilson Schwansee Thiele, Curitiba, BRAZIL Poster #160 Anterior Cruciate Ligament Injury Mechanism in Snowboarders and Skateboarders ...... Barry R Tietjens, Auckland, NEW ZEALAND Poster #161 Outcome of Bi-socket ACL Reconstruction Using Multiplied Hamstring Tendons ...... Yukiyoshi Toritsuka, Osaka, JAPAN Poster #162 Arthroscopic ACL Reconstruction Using Multi-Stranded Hamstring Tendon Autograft: 2 vs. 7 Year Results ...... Yukiyoshi Toritsuka, Osaka, JAPAN Poster #163 A Comparison of Two Different Methods for Anterior Cruciate Ligament Reconstruction Using the Semitendinosus Tendon ...... Gen Tsuchiya, Koriyama-city, JAPAN Poster #164 Knee Muscle Function in Patients Free of Anterior Knee Pain After Anterior Cruciate Ligament Reconstruction Using Bone-Patellar Tendon-Bone Graft ...... Eiichi Tsuda, Hirosaki, JAPAN Poster #165 Two-Bundle Reconstruction of the Anterior Cruciate Ligament ...... Takashi Tsukahara, Gifu, JAPAN POSTER ABSTRACTS Poster #166 Biological Fixation after Anterior Cruciate Ligament Reconstruction With Hamstring Tendons Using an Endobutton on the Femoral Side ...... Yuji Uchio, Izumo, JAPAN Poster #167 A Biodelivery Interference Screw and Growth Factors for Augmentation of Tendon-Bone Healing ...... William R. Walsh, Randwick, AUSTRALIA Poster #168 Computational Analysis Reveals the Significance of Anatomical ACL Reconstruction ...... Masayoshi Yagi, Kobe, JAPAN Poster #169 Advantages of Computer Assisted Navigation System Using Magnetic Tracking Technology in Anatomical ACL Reconstruction ...... Masayoshi Yagi, Kobe, JAPAN Poster #170 Subjective Evaluation of Patients After Anterior Cruciate Ligament Reconstruction Using Visual Analog Scale ...... Junya Yamazaki, Mitaka-City, JAPAN Poster #171 Prospective Study of Knee Stability by a KT-2000 A ...... Masanori Yasumoto, Hiroshima, JAPAN Poster #172 Clinical Results of ACL Reconstruction Using Leeds-Keio Artificial Ligament in High Level Athletes of American Football and Rugby ...... Tsukimura Yasunori, Tokyo, JAPAN Poster #173 Donor Side Morbidity After ACL Reconstruction Using the Quadriceps Tendon Graft With and Without Patellar Bone Plug ...... Christos K Yiannakopoulos, Athens, GREECE Poster #437 Is the Successful Treatment of the ACL Sufficient to Return Athletes Back to Sport? ...... Alberto Gobbi, Milan, ITALY Poster #438 Quadrupled Bone-Semitendinosus ACL Reconstruction: A Clinical Investigation in a Group of Athletes ...... Alberto Gobbi, Milan, ITALY

KNEE - ARTHRITIS Poster #174 Windswept Deformity as a Result of Seronegative Knee Arthritis ...... Tomoyuki Abe, Utsunomiya, JAPAN Poster #175 Mid-term Results of the AGC Total Knee Replacement ...... Jose Alemparte, Santiago, CHILE

5.5 Poster #176 Is Routine Prophylaxis of Deep Vein Thrombosis After Total Knee Arthroplasty Needed? A Report from an Eastern Mediterranean Country ...... Semih Aydogdu, Izmir, TURKEY Poster #177 Total Knee Arthroplasty for Gonarthrosis with Pre Op Patellar Subluxation. Interest of the Lateral Approach on Patellar Tracking...... Philippe Beaufils, Le Chesnay, FRANCE Poster #178 Use of an Interpositional Spacer for Treatment of Medial Compartment Arthritis ...... Alan H Beyer, Newport Beach, CA, USA Poster #179 Valgus TKA. Results of 255 LCS Mobile-Bearing TKA With 5 to 15 Year Follow-up ...... Jens Boldt, Zurich, SWITZERLAND Poster #180 Long-Term Results of LCS Mobile Bearing TKA. Evaluation of 457 TKA with 10 to 13 Year Follow-Up...... Jens Boldt, Zurich, SWITZERLAND Poster #181 Physical Activity and Occupational Status in Patients Younger Than 55 Years with LCS Mobile Bearing TKA. Evaluation of 228 Cases ...... Jens Boldt, Zurich, SWITZERLAND Poster #182 Arthrofibrosus in TKA. Is There a Correlation With Femoral Component Mal-rotation? ...... Jens Boldt, Zurich, SWITZERLAND Poster #183 Quadruple Arthroplasty in the Lower Extremity ...... Jens Boldt, Zurich, SWITZERLAND Poster #184 Arthroscopic Debridement and High Tibial Osteotomy for Knee Osteoarthritis in Aging Athletes ...... Jesus Ignacio Cardona, Zapopan, MEXICO Poster #185 The Role of the Orthopaedic Nurse Practioner in ...... Paul Carter, Wirral, ENGLAND Poster #186 Unicompartmental Knee Replacement Revision Surgery: Is it Really an Easy Job? ...... Enzo Cenna, Torino, ITALY Poster #187 The Often Poor Clinical Outcome of Infected Total Knee Arthroplasty ...... Wang Ching-Jen, Kaohsiung Hsien, TAIWAN Poster #188 Change of the Patellofemoral Alignment by Technique Modification in Total Knee Arthroplasty Using LCS Prosthesis ...... Jaehoon Chung, Kwangju, SOUTH KOREA Poster #189 The Management of Degenerative Knee Arthritis in the Active Middle Aged Arthroscopic Approach ...... Moises Cohen, Sao Paulo, BRAZIL Poster #190 Autologous Ostheochondral Graft in Chondral Lesion Treatment – Experimental Study in Goats ...... Antonio Delcogliano, Rome, ITALY Poster #191 Lateral Condylar Release for High Valgus Knee Replacement ...... James K DeOrio, Jacksonville, FL, USA Poster #192 Axial Parameters Influencing Lower Limb Realignment in High Tibial Osteotomy ...... Mehmet Rifat Erginer, Istanbul, TURKEY Poster #193 Coronal Tibial Osteotomy for Unicompartmental Arthrosis of the Knee ...... Stephen Fealy, New York, NY, USA Poster #194 Quantitative Gait Analysis After Medial Unicompartmental Knee Replacement for Osteoarthritis ...... Julian A Feller, Melbourne, AUSTRALIA Poster #195 Arthroscopic Surgery With HTO Effect for Osteo-Arthritic Patients With Knee Flexion Contractures and Genu-Vara ...... Alex Finsterbush, Jerusalem, ISRAEL

POSTER ABSTRACTS Poster #196 Indications for Arthroscopy in Elderly Patients ...... Alex Finsterbush, Jerusalem, ISRAEL Poster #197 Post-operative Results of Mobile Bearing TKA for Osteoarthritis of the Knee ...... Kazumasa Fukushima, Tokyo, JAPAN Poster #198 The Significance of Preliminary Arthroscopy in Proximal Tibial Osteotomy for the Correction of Varus Knee ...... Danilo Gervasoni, Niardo, ITALY Poster #199 Total Knee Arthroplasty Bilateral Sequential in One Stage. Clinical Results and Complications...... Hugo González, Santiago, CHILE Poster #200 Early Patient Outcomes Following Primary and Revision Total Knee Arthroplasty: A Prospective Study ...... Richard C Hartley, Lower Heswall, UNITED KINGDOM Poster #201 Does A Patient's Pre-operative Mental State Influence Post-operative Physical Outcomes in Total Knee Arthroplasty? A Prospective Study...... Richard C Hartley, Lower Heswall, UNITED KINGDOM Poster #202 Measurement of the Soft Tissue Tension in Total Knee Arthroplasty ...... Akiho Hoshino, Saitama, JAPAN Poster #203 Restricting Postoperative Weightbearing in Mobile Bearing Cementless Total Knee Arthroplasty Is Innecessary ...... Yoshinori Ishii, Gyoda, JAPAN Poster #204 Post-operative Functional Status of Mobile Bearing and Fixed Bearing Total Knee Arthroplasty in Patients With Osteoarthritis and Rheumatoid Arthritis (Cochrane Review) ...... Wilco Jacobs, Nijmegen, THE NETHERLANDS Poster #205 •Reproducibility of the Peroperative Measurement of the Transepicondylar Axis During Total Knee Replacement by a Non Image Based Navigation System ...... Jean-Yves Jenny, Illkirch, FRANCE Poster #206 Arthroscopy or Total Knee Replacement for Old Patients With Serious Osteoarthritis, Our Experience ...... Yu Jiakuo, Beijing, CHINA Poster #207 Analysis of Initial Fixation Strength of Press-Fit Fixation Technique in Anterior Cruciate Ligament Reconstruction ...... Hyunchul Jo, Seoul, KOREA Poster #208 Drilling from the Intercondylar Area for Treatment of Osteochondritis Dissecans of the Knee Joint ...... Kenzo Kawasaki, Izumo, JAPAN Poster #209 Standardised Mortality Ratios and Fatal Pulmonary Embolism Rates Following Primary Total Knee Arthroplasty – A Cohort of 1018 Consecutive Cases...... Amer Khan, London, UNITED KINGDOM Poster #210 Balanced Placement of the Femoral Component in Revision Total Knee Arthroplasty ...... Katsuhiko Kitaoka, Kanazawa, JAPAN Poster #211 A Three Dimensional Evaluation for Positioning of Total Knee Arthroplasty and its Application for Osteotomy Control by the System of the Three Dimensional Leg Alignment Assessment With Digital X-ray ...... Yoshio Koga, Niigata City, JAPAN

5.6 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Poster #212 Result of Posterior Cruciate Retaining Total Knee Arthroplasty ...... Dong Chul Lee, Taegu, SOUTH KOREA Poster #213 Limitations of the MODEMS Knee Core Instrument in Detecting Improvement Following Total Knee Arthroplasty ...... Robert G Marx, New York, NY, USA Poster #214 •The Role of Long-term Weekly Intra-articular Injections of Sodium Hyaluronate for Osteoarthritis of the Knee ...... Shin Miyatake, Kagawa, JAPAN Poster #215 The Unix Unicompartmental Knee Arthroplasty ...... Hayden Morris, East Melbourne, AUSTRALIA Poster #216 Does Pain Severity Correlate with Bone Marrow Lesion Pattern Detected With MR Imaging in Knee Osteoarthritis? ...... Yoshihiro Nagaosa, Fukushima City, JAPAN Poster #217 The Result of Osteochondral Graft and High Tibial Osteotomy in the Osteonecrosis of Medial Femoral Condyle ...... Yasuaki Nakagawa, Kyoto, JAPAN Poster #218 •Loss of Correction Following High Tibial Osteotomy ...... Dietrich Pape, Homburg/Saar, GERMANY Poster #219 Is Polyethylene Wear a Problem in Total Knee Arthroplasty? A Review at 12 Years Follow Up. 113 Cases...... Philippe Piriou, Garches, FRANCE Poster #220 Primary Total Condylar Arthroplasty of the Knee – PFC nd PFC Sigma Knee ...... Zoran Zdravko Popovic, Belgrade, YUGOSLAVIA Poster #221 The Oxford Unicompartmental Knee Prosthesis: An Independent 10-Year Follow-up...... Nicole Pouliart, Antwerp, BELGIUM Poster #222 Measurement of the Valgus Angle of the Femur on Computerised Axial Tomography Scans ...... Arvind Rawal, Warrington, UNITED KINGDOM Poster #223 Correlating the Outcome of Knee Intraarticular Visco-Supplementation With Radiological Changes of Osteoarthritis ...... Arvind Rawal, Warrington, UNITED KINGDOM Poster #224 Comparing the Efficacy of Two Hyaluronic Acid Derivatives: Is There a Difference? ...... Arvind Rawal, Warrington, UNITED KINGDOM Poster #225 Primary Total Knee Arthroplasty with Intramedullary Nail Fixation for Supracondylar Femoral Fracture in Rheumatoid Arthritis of the Knee ...... Keinosuke Ryu, Shinjukuku, JAPAN Poster #226 The Patello-Femoral Joint (PFJ) Status in Revision Knee Arthroplasty; A New Classification System & Its Reliability...... Vishal Sahni, Liverpool, UNITED KINGDOM Poster #227 Clinical and Radiological Evaluation at Five Years Follow-up of 177 PFC Total Knee Arthroplasty ...... Giulia Sandrucci, Torino, ITALY Poster #228 Hinged Total Knee Replacement in Severe Knee Revision Surgery ...... Giulia Sandrucci, Torino, ITALY Poster #229 Standing Knee Radiographs: AP vs PA Prospective Evaluation Arthroscopically Confirmed Arthritis ...... Kurt P. Spindler, Nashville, TN, USA Poster #230 New Method for Bone-grafting for the Huge Bone Defect in TKA – Bone Scintimetric Evaluation and Clinical Outcomes ...... Takehiko Sugita, Sendai, JAPAN Poster #231 Total Knee Arthroplasty Preserving or Not the PCL: Gait Analysis ...... Lais Turqueto Veiga, Rio de Janeiro, BRAZIL Poster #232 •Five Year Review of the Rotaglide Total Knee Arthroplasty ...... Christopher J Wilson, Glasgow, UNITED KINGDOM Poster #233 Extensor Mechanism Recovery After Medial Parapatellar and Tri-Vector Retaining Approaches for Total Knee Arthroplasty: A Prospective, Randomised, Double Blind Study ...... Edward V Wood, Liverpool, UNITED KINGDOM Poster #234 Posterior-Anterior Weight-Bearing Radiograph in Fifteen Degree Knee Flexion in Medial Osteoarthritis ...... Norio Yamanaka, Kochi, JAPAN Poster #235 The Blood Management in Total Knee Replacement.

The Effectiveness of Postoperative Reinfusion...... Athanasios N. Zacharopoulos, Kirra Fokidas, GREECE POSTER ABSTRACTS Poster #441 TKA Using the ESKA Semiconstrained Prosthesis in Severe Knee Desaxations ...... Jose Maria Cavanilles, Barcelona, SPAIN

KNEE - LIGAMENT/PATELLA Poster #236 Proprioception in Patients with Anterior Knee Pain: Description of a New Measurement Method ...... Devrim Akseki, Izmir, TURKEY Poster #237 Does Proximal Tibio-Fibular Arthrolysis Produce Posterolateral Instability? ...... Guillermo R. Arce, Buenos Aires, ARGENTINA Poster #238 The Long-term Results of Maquet – Type Tibial Tubercle Elevation for Patellofemoral Arthrosis ...... Semih Aydogdu, Izmir, TURKEY Poster #239 Isolated Posterior Cruciate Ligament Reconstruction in Chronic Posterior Instability. A Retrospective Study With a 2 to 15 Years Follow Up...... Mario Bizzini, Zürich, SWITZERLAND Poster #240 Periosteum-Enveloped Hamstring Tendon Graft in Anterior Cruciate Ligament Reconstruction ...... Chih-Hwa Chen, Kweishan, TAIWAN Poster #241 Comparison of Quadruple Hamstring Tendon Graft and Quadriceps Tendon Graft in Anterior Cruciate Ligament Reconstruction ...... Chih-Hwa Chen, Kweishan, TAIWAN Poster #242 Arthroscopic PCL Reconstruction With Quadriceps Tendon Autograft ...... Chih-Hwa Chen, Kweishan, TAIWAN Poster #243 The Effects of Knee Position, Graft Tension and Mode of Fixation in Posterior Cruciate Ligament Reconstruction ...... Wang Ching-Jen, Kaohsiung Hsien, TAIWAN Poster #244 Outcome study of the surgical treatment of 48 chro ...... Pascal Christel, Paris, FRANCE Poster #245 Anatomical and Histological Study in Knees of Rabbits with Epifisial Cartilage, After the Section of Posterior Cruciate Ligament...... Moises Cohen, Sao Paulo, BRAZIL Poster #246 Medial Patello-Femoral Ligament Reconstruction ...... Masataka Deie, Hiroshima, JAPAN Poster #247 Long Term Results of Arthroscopic Posterior Cruciate Ligament Reconstruction With Bone Patellar Tendon Bone Autograft ...... Antonio Delcogliano, Rome, ITALY

5.7 Poster #248 Surgical Treatment of Combined ACL-PCL Injuries of the Knee. A Clinical Study ...... Andreas Panagiotis Diamantopoulos, Athens, GREECE Poster #249 The Multiple Ligament Injured Knee. Outcomes of Surgical Treatment...... Andreas Panagiotis Diamantopoulos, Athens, GREECE Poster #250 Comparison of Two Differents Grafts for the Treatment of 48 Chronic Posterior Instabilities with Two Years Follow-up ...... Patrick Djian, Paris, FRANCE Poster #251 Patellar Tenoplasty With Gracilis and Semitendinosus: A Case Presentation ...... Roberto Jose Batista Dorea, Salvador, BRAZIL Poster #252 Patellar Distal Realigment With Mini-incision in Recidivating Luxation of the Patella ...... Roberto Jose Batista Dorea, Salvador, BRAZIL Poster #253 Management of Knee Dislocations – Experience of 67 ...... Lars Engebretsen, Oslo, NORWAY Poster #254 International Patellofemoral Study Group (IPSG) Lateral Release Survey Results ...... Donald C Fithian, San Diego, CA, USA Poster #255 One versus Two Incision PCL Reconstruction Using Multiplied Hamstring Tendons...... Masayuki Hamada, Hirakata, JAPAN Poster #256 Biomechanical Comparison of Trans-Tibial Versus Tibial Inlay PCL Reconstructions ...... Christopher D Harner, Pittsburgh, PA, USA Poster #257 Reconstruction of the Posterolateral Corner. A New Surgical Procedure ...... Bent Wulff Jakobsen, Aarhus, DENMARK Poster #258 Dynamic Patellar Tracking in Pathological Conditions ...... Ryosuke Kuroda, Pittsburgh, PA, USA Poster #259 Arthroscopic PCL and Combined Ligament Reconstruction in the Athlete ...... Mario Victor Larrain, Buenos Aires, ARGENTINA Poster #260 Posterior Cruciate Ligament Reconstruction Using Hamstring Tendon With Preservation of Posterior Cruciate Ligament Remnant ...... Beom Koo Lee, Seoul, KOREA Poster #261 Comparative Analysis of Delayed Laxity Developing After Arthroscopic PCL Reconstruction in Isolated and Combined Injury of Posterior Cruciate Ligament ...... Kwang-Won Lee, Daejeon, KOREA Poster #262 Analysis of Relationships Between Subjective and Objective Groups of IKDC Score ...... Abbas Madani, Tehran, IRAN Poster #263 Reconstruction of the ACL-PCL Deficient Knee: A Biomechanical Study of Graft Pretension and Knee Laxity ...... Keith L Markolf, Los Angeles, CA, USA Poster #264 Medial Soft Tissue Restraints to the Dynamic Patellar Tracking ...... Kiyonori Mizuno, Kobe, JAPAN Poster #265 •Bioabsorbable versus Metal Screw in Anteromedial Tibial Tubercle Transfer – A Biomechanical Study ...... Janne T Nurmi, Tampere, FINLAND Poster #266 Trochleaplasty – An Effective Surgical Option in Recurrent Patellar Dislocation Due to Dysplastic Patellofemoral Groove ...... Rolf F Oetiker, Cham, SWITZERLAND Poster #267 Comparison of Endoscopic and 2-Incision PCL Reconstruction Using Autogenous Hamstring Tendons ...... Yasumitsu Ohkoshi, Hakodate, JAPAN

POSTER ABSTRACTS Poster #268 Posterolateral Knee Instability. Surgical Treatment and Clinical Results...... Iraklis Ioannis Patsopoulos, Athens, GREECE Poster #269 The Treatment of Combined Injuries of the Posterior Cruciate and Medial Collateral Ligament. MCL Stability Depends on PCL Status ...... Seung-Suk Seo, Pusan, SOUTH KOREA Poster #270 Subjective Evaluation of the Medical Transfert of the Antreior Tibial Tuberosity in Objective Patellar Instability ...... Elvire Servien, Caluire et Cuire, FRANCE Poster #271 Surgical Treatment Inveterate Dislocation of the Knee...... Nilson R. Severino, Sao Paulo, BRAZIL Poster #272 Anatomical Advancement of the Medial Collateral Ligament Combined With Anterior Cruciate Ligament Reconstruction: Series Long-Term Follow-up ...... Takashi Soejima, Kurume, JAPAN Poster #273 Does the Arthroscopic Release of the External Patellar Retinacula Represent a Valuable Method in the Treatment Recurrent Dislocation of Patella? ...... Cristian Ioan Stoica, Bucharest, ROMANIA Poster #274 Serial Evaluation of the Restored Stability After Posterior Cruciate Ligament Reconstruction ...... Atsushi Sugita, Ibaragi, JAPAN Poster #275 Comparison of the Magnetic Resonance Imaging of Acute Grade III Medial Collateral Ligament Injury With the Surgical Pathology ...... Yasuhiro Tagawa, Amagasaki, JAPAN Poster #276 Delayed Medial Collateral Ligament Reconstruction Using Looped Semitendinosus Tendon Graft for Combined Anterior Cruciate Ligament/Posterior Cruciate Ligament/Medial Collateral Ligament Injuries of the Knee ...... Harukazu Tohyama, Sapporo, JAPAN Poster #277 Patella Fractures: A New Classification System for Postoperative Outcome Evaluation ...... Anastasios V Tokis, Anatoli- Ioannina, GREECE Poster #278 Ligament Referencing to Determine Femoral Component Rotation and Effect on Patella Tracking in Total Knee Arthroplasty ...... Ate Binne Wymenga, Nijmegen, NETHERLANDS Poster #279 Tightening and Augmentation of Posterior Cruciate Ligament (Using Modified Tibial Inlay Technique) ...... Jung Yong Bok, Seoul, REPUBLIC OF KOREA Poster #442 Operative Management of Multiligament Injuries in Athletes ...... Luis A Vargas, Coral Gables, FL, USA Poster #453 Arthroscopic Repair of Medial Retinacular Ruptures Associated With Acute Patella Dislocations: Report of a New Technique ...... Michael R. Redler, Trumbull, CT, USA

KNEE - MUSCLE/TENDON/BONE Poster #280 Arthroscopic Assisted Reduction and Minimal Osteosynthesis in Tibial Plateau Fractures ...... Georgios Anastasios Babalis, N. Iraklio Attikis, GREECE

5.8 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Poster #281 Infra Patellar Tendonitis in Professional Volleyball Player ...... Alvaro Chamecki, Curitiba, BRAZIL Poster #282 High Tibial Osteotomy and Alteration of the Tibial Slope ...... Erik Hohmann, Rockhampton, AUSTRALIA Poster #283 Transient Osteoporosis of the Knee. Diagnosis and Aetiology ...... Makoto Kawakubo, Ichikawa-shi, JAPAN Poster #284 The Histological Pathology of Chronic Tendon Lesions ...... John B King, London, UNITED KINGDOM Poster #285 Treatment of Chronic Patellar Dislocation With a Modified Elmslie-Trillat Procedure ...... Maurilio Marcacci, Bologna, ITALY Poster #286 Ileotibial Band Syndrome in Triathletes ...... Sergio Migliorini, Cameri, ITALY Poster #287 Development of an Intra-operative Automatic Apparatus for Calcium Phosphate Coating in the Human Anterior Cruciate Ligament Graft ...... Hirotaka Mutsuzaki, Tsukuba, JAPAN Poster #288 Plica Syndrome After the Injury of the Rectus Femoris Muscle – A Case Report ...... Toshiro Otani, Shinjuku-ku, JAPAN Poster #289 Original Technique for the Treatment of Ligament Related Genu Recurvatum. Preliminary Results...... Philippe Piriou, Garches, FRANCE Poster #290 The Relationships Between Torque of the Knee Extensors and Flexors and Limping Gait ...... Kenji Sato, Funabashi, JAPAN Poster #291 High Tibial Osteotomy: Fixation with a Double-Eight Tie ...... Nilson R. Severino, Sao Paulo, BRAZIL Poster #292 Arthroscopic Reduction and Fixation of Avulsion Fracture of the Posterior Cruciate Ligament (PCL) at the Tibial Insertion ...... Etsuo Shoda, Hikami-gun, JAPAN Poster #293 Evaluation of the Patellar Tendon by Magnetic Resonance Imaging (MRI) ...... Edilson Schwansee Thiele, Curitiba, BRAZIL

KNEE OTHER Poster #294 Anterior Cruciate Ligament Reconstruction Using a New Femoral Fixation Device. 1 Year Experience ...... Ralph Wischatta, Kiel, GERMANY

KNEE/CARTILAGE/MENISCUS Poster #295 Microfracture Technique in the Treatment of Osteonecrosis ...... Isik Karli Akgun, Istanbul, TURKEY Poster #296 •Pre-emptive Analgesic Effect of Intrarticular Tenoxicam After Arthroscopic Knee Surgery ...... Devrim Akseki, Izmir, TURKEY Poster #297 Description of a New Meniscus Test and Its Comparison With the McMurray's Test and Joint Line Tenderness ...... Devrim Akseki, Izmir, TURKEY Poster #298 The Meniscal "Pseudocyst" ...... Saqib Amin, Sharjah, UNITED ARAB EMIRATES Poster #299 Bone Spect Imaging for Differential Diagnosis of Atraumatic Medial Joint Space Knee Pain...... Ron Arbel, Hod Hasharon, ISRAEL Poster #300 Vascular Endothelial Growth Factor Expression After Bucket Handle Meniscus Tears in Relation to the Site of the Lesion in a Rabbit Model ...... Roland Becker, Magdeburg, GERMANY Poster #301 Discoid Lateral Meniscus: Case Report of a Symptomatic Wrisberg-Ligament ...... Klaus Buckup, Dortmund, GERMANY Poster #302 Meniscus Refixation Using The FasT-Fix ...... Jens-Ulrich Buelow, East Fremantle, AUSTRALIA Poster #303 •Arthroscopic Autologous Chondrocyte Implantation for the Treatment of a Chondral Defect in the Tibial Plateau. A Case Report ...... Paolo Bulgheroni, Varese, ITALY Poster #304 •Treatment of Deep Articular Cartilage Defects of Knee and Ankle With

Autologous Implantation (MACI®): Early Results ...... Paolo Bulgheroni, Varese, ITALY POSTER ABSTRACTS Poster #305 Collagen Meniscus Implant (CMI): Early Results and Histological Analysis of the Implant ...... Paolo Bulgheroni, Varese, ITALY Poster #306 Postarthroscopic Meniscus Repair Analgesia With Intraarticular Ketorolac, Morphine or Bupivacaine ...... Jaume Calmet, Tarragona, SPAIN Poster #307 Reproducibility and Reliability of the Outerbridge Classification ...... Michelle Cameron-Donaldson, Cheyenne, WY, USA Poster #308 Diagnostic Correlation Between Magnetic Ressonance Imaging With Arthroscopy in the Intra-articular Lesion of the Knee...... Alvaro Chamecki, Curitiba, BRAZIL Poster #309 Treatment of Focal Articular Cartilage Lesions of the Knee With Autogenous Osteochondral Graft: A 2 to 4 Year Follow-up Study ...... Wang Ching-Jen, Kaohsiung Hsien, TAIWAN Poster #310 Prospective Randomized Study on Unicompartmental K ...... Norberto Confalonieri, Seregno, ITALY Poster #311 Meniscus Allograft Transplantation: An Experimental Study in Rabbits...... Ricardo Paula Cury, Sao Paulo, BRAZIL Poster #312 Arthroscopic Findings in Sport and Non-Sport Injuries in Young Patients of the General Population ...... Georgios I. Drosos, Athens, GREECE Poster #313 Arthroscopic Partial Meniscectomy for Degenerative Tear of the Medial Meniscus in Patients Over 50 years – 10 Year Follow Up ...... Alex Finsterbush, Jerusalem, ISRAEL Poster #314 Etiology of Post-meniscectomy Osteonecrosis ...... Hiroshi Higuchi, Maebashi-shi, JAPAN Poster #315 Meniscal Repair with Bioabsorbable Devices ...... Don H Johnson, Ottawa, CANADA Poster #316 A Study on Discoid Lateral Menisci in Japanese Cadaver Knees ...... Yuki Kato, Tokyo, JAPAN Poster #317 Clinical and Radiological Results of the Arthroscopic Partial Meniscectomy ...... Hayrettin Kesmezacar, Istanbul, TURKEY Poster #318 Evaluation of the Water Content in Articular Cartilage Using Near Infrared Spectroscopy ...... Tatsuya Kikuchi, Niigata, JAPAN Poster #319 Biomechanical Effect of Autogenous Osteochondral Graft on Articular Cartilage ...... Hiroshi Kuroki, Kyoto, JAPAN Poster #320 Clinical Results of Arthroscopic Meniscal Repair According to the Joint Stability ...... Hee-Soo Kyung, Daegu, KOREA

5.9 Poster #321 Allograft ACL/Meniscus Transplantation in Patients With Prior Meniscectomy, ACL Deficiency and Early Degenerative Arthritis ...... Steven D. Levin, Wilmette, IL, USA Poster #322 Healing of Osteochondral Defects in the Rat Patella After Periosteum Transplantation – Evaluation of Cartilage Repair and Nerve Fiber Sprouting ...... Magnus Lundberg, Stockholm, SWEDEN Poster #323 Outside-In Meniscus Suture Technique; 5 Years Follow-Up ...... Rodica Marinescu, Bucharest, ROMANIA Poster #324 Inter-observer Agreement for the Assessment of Intra-articular Pathology in Knee Arthroscopy ...... Robert G Marx, New York, NY, USA Poster #325 A Prospective Outcome Analysis of Patients Treated with Microfracture Abrasion for Chondral Lesions of the Knee: A Preliminary Review ...... Robert G Marx, New York, NY, USA Poster #326 Choice of Operative Methods for Osteochondritis Dissecans of the Femoral Condyles ...... Hideo Matsumoto, Tokyo, JAPAN Poster #327 Autogenous Osteochondral Grafting for Osteonecrosis of the Knee ...... Yoshitaka Matsusue, Otsu, JAPAN Poster #328 •Matrix Associated Autologous Chondrocyte Transplantation (MACT) in Clinical Practice ...... Johann Georg Meinhart, Wels, AUSTRIA Poster #329 All Inside Meniscal Repair: A Cadaveric Study Comparing the FasT-Fix to the Rapid Loc Device ...... Mark David Miller, Charlottesville, VA, USA Poster #330 Postoperative Results in the Donor Site of the Mosaicplasty ...... Yasuaki Nakagawa, Kyoto, JAPAN Poster #331 Reduced Plantar Force-Time Integral During Partial Weight Bearing Gait Using the Easy Strutter Functional Orthosis System ...... John Nyland, Louisville, Kentucky, USA Poster #332 Syndrome of the Anterior Synovial Impingement: Classification, Diagnosis and Treatment ...... Paulo Roberto Rockett, Porto Alegre, BRAZIL Poster #333 Consumer Meniscal Lesion ...... Paulo Roberto Rockett, Porto Alegre, BRAZIL Poster #334 Short-term Results of Treatments for Meniscal Tears in Anterior Cruciate Ligament Reconstructed Knees ...... Hideki Sato, Hirosaki, JAPAN Poster #335 Osteonecrosis of the Medial Femoral Condyle Following Arthroscopy – Is it a Complication of the Surgical Intervention? ...... Stefan Seitz, Herne, GERMANY Poster #336 All-Inside Suture Meniscus Repair ...... Ronald M Selby, New York, NY, USA Poster #337 Arthroscopic Meniscal Repair with Suture and Fibrin Clot of Horizontal Meniscal Tear in Young Adult ...... Seung-Suk Seo, Pusan, SOUTH KOREA Poster #338 Bucket-Handle Medial Meniscus Tears in the ACL Reconstructed Knee: Long-Term Outcome ...... K. Donald Shelbourne, Indianapolis, IN, USA Poster #339 Clinical Evaluation of Meniscus Repair With a Bioa ...... Rainer Siebold, Walldorf, GERMANY Poster #340 Prospective Comparison of Arthroscopic Medial Meniscus Repair Technique: Inside-Out Sutures vs Entirely Arthroscopic Arrows ...... Kurt P. Spindler, Nashville, TN, USA

POSTER ABSTRACTS Poster #341 Hyaluronan Matrix-Associated Chondrocyte Transplantation for the Treatment of Posttraumatic Chondromalacia Patella – Early Clinical Results of a Pilot Study ...... Gabriele Striessnig, Vienna, AUSTRIA Poster #342 Matrix Associated Chondrocyte Transplantation (MACI) for the Repair of Cartilage Defects – Early Clinical Results After 12 Months ...... Gabriele Striessnig, Vienna, AUSTRIA Poster #343 Arthroscopic Subtotal Meniscectomy for Discoid Meniscus in Student Athletes ...... Hideaki Takeda, Tokyo, JAPAN Poster #344 Tibial Erosions Associated With Radial Cleavage Tears of the Lateral Meniscus ...... Barry R Tietjens, Auckland, NEW ZEALAND Poster #345 Evaluation of Hyaluronan Synthesis by Retrovirus-Mediated Gene Transfer of Hyaluronan Synthase 2 ...... Kan Tsuchiya, Chiba, JAPAN Poster #346 Arthroscopic Assessment of Human Cartilage Stiffness of the Femoral Condyles and the Patella With a New Tactile Sensor ...... Yuji Uchio, Izumo, JAPAN Poster #347 Ultrasound and MRI Evaluation of Knee Meniscal Extrusion ...... Rene E Verdonk, Gent, BELGIUM Poster #348 Articular Cartilage Defect Healing Using Paste Gra ...... William R. Walsh, Randwick, AUSTRALIA Poster #349 Biomechanical Testing of Meniscal Devices ...... William R. Walsh, Randwick, AUSTRALIA Poster #350 1.0 Tesla Magnetic Resonance Imaging Accuracy Correlated With Clinical Symptoms and Arthroscopic Findings ...... Yuichi Yoshii, Tsukuba, JAPAN Poster #443 Autologous Chondrocyte Transplantation for Articular Cartilage Defects in the Knee Histological Evaluation ...... Sabreena Mahroof, London, UNITED KINGDOM Poster #444 Arthroscopic Treatment of Osteochondritis Dissecans of the Knee With Autologous "Bone Sticks" ...... Rogerio Teixeira Da Silva, Perdizes, BRAZIL Poster #452 Bioabsorbable Pin Fixation of Osteochondral Lesions of the Knee ...... Matthias Rolf Schurhoff, Coral Gables, FL, USA

OTHER Poster #351 The Value of MRI to Diagnose Meniscal and ACL Tears: Sensitivity, Specificity and Likelihood Ratio...... Graeme Campbell Brown, Geelong, AUSTRALIA Poster #352 Intraarticular Opioid Injections After Knee Arthroscopy ...... Artur Gadek, Krakow, POLAND Poster #353 A Simple and Safe Method to Confirm Accuracy of Intraarticular Knee Injection ...... Rudolph C. Glattes, Nashville, TN, USA

5.10 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Poster #354 Proximal Tibiofibular Joint Ganglion Cysts: Excision, Recurrence and Joint Arthrodesis ...... Christopher C. Kaeding, Columbus, OH, USA Poster #355 Biomechanical Analysis of Distal Biceps Tendon Repair Methods ...... Christopher C. Kaeding, Columbus, OH, USA Poster #356 The Introduction of the Simple Body Conditioning Equipment for Patients at Home ...... Tamiko Kamimura, Saitama, JAPAN Poster #357 Posterior "Back and Forth" Arthroscopic Approaches on the Posterior Knee Compartments ...... Stephane Louisia, Kenthurst, AUSTRIA Poster #358 Surgical Approach to the Achilles Tendon and a Programme of Physiotherapy After Surgical Treatment of Achilles Tendinosis ...... Mihkel Mardna, Tallinn, ESTONIA Poster #359 Ruptured Baker's Cyst Mimicking Compartment Syndrome ...... Sefa Muezzinoglu, Kocaeli, TURKEY Poster #360 Perioperative Autotransfusion in Total Knee Arthroplasty ...... Raj K Reddy, Midland, TX, USA Poster #361 Anterior Knee Pain After Tibial Intramedullary Nailing ...... Christos K Yiannakopoulos, Athens, GREECE Poster #362 The Incidence of Vascular Complications in Patients Submitted to Knee Arthroscopy Based on Collor Flow Duplex Scanning Findings...... Emerson K. Zanoni, Curitiba, BRAZIL

SHOULDER INSTABILITY Poster #363 Arthroscopic Findings in Chronic Anterior Shoulder Instability in Males 18 to 30 Years old ...... Emmanuel M Antonogiannakis, Athens-Cholargos, GREECE Poster #364 The Prevalence of Glenohumeral Osteoarthritis in Patients with Chronic Shoulder Instability ...... Michelle Cameron-Donaldson, Cheyenne, WY, USA Poster #365 Thermal Capsulorraphy for the Treatment of Multi-Directional Shoulder Instability in Female Volley Players ...... Daniel Comba, La Loggia-TO, ITALY Poster #366 Arthroscopic Labroplasty for Instability Due to Ligamentous Laxity ...... Joe De Beer, Oranjezicht, SOUTH AFRICA Poster #367 The Modified Latarjet Procedure for Instability With Bone Loss ...... Joe De Beer, Oranjezicht, SOUTH AFRICA Poster #368 Monopolar Electrothermal Shoulder Repair for Instability ...... Stephen W. Houseworth, Colorado Springs, CO, USA Poster #369 Long Term Follow-up of Radiofrequency Heat Probe Use During Arthroscopic Stabilization of the Shoulder ...... Peter Benjamin MacDonald, Winnipeg, CANADA Poster #370 Some Original Techniques and Simple Devices for Performing the Arthroscopic Bankart Repair Securely With Two Portals ...... Yasumoto Matsui, Obu, JAPAN Poster #371 Athroscopic Stabilization of Collision Athletes ...... Augustus D. Mazzocca, Farmington, CT, USA Poster #372 Thermal Capsular Shrinking in the Treatment of Unstable Shoulders in Athletes – An Alternative Method? ...... Hans-Gerd Pieper, Essen, GERMANY Poster #373 Role of the Latissimus Dorsi in Antero-Inferior Shoulder Dislocation in Cadavers ...... Nicole Pouliart, Antwerp, BELGIUM Poster #374 Mid-substance Tear of Glenohumeral Ligament as a Cause of Recurrent Anterior Dislocation of the Shoulder: Evaluation With Abduction and External Rotation MR Imaging ...... Minoru Yoneda, Osaka, JAPAN Poster #445 Clinical Outcome of Arthroscopic Anterior Shoulder Stabilization: Two-to-Six Year Follow-up ...... Seung-Ho Kim, Seoul, KOREA Poster #446 Arthroscopic Treatment of Posterior Instability of the Shoulder. Mid-Term Results: Evaluation of 16 Patients with Posterior Instability of the Shoulder Operated With Arthroscopic Capsular Shift...... Daniel Adolfo Slullitel, Rosario, ARGENTINA POSTER ABSTRACTS Poster #447 Subacromial Instability Syndrome: Laxity as a Late Cause of Rotator Cuff Failure ...... Miguel Slullitel, Santa Fe, ARGENTINA Poster #448 Correct Diagnosis and Augmented Transglenoid Repair. A Key to Success in Shoulder Instability on Young Rugby Players...... Daniel Adolfo Slullitel, Rosario, ARGENTINA Shoulder Other Poster #375 The Use of Kinematic MRI in the Diagnosis of Shoulder Injury in Throwing Athletes ...... Toshio Aihara, Tokyo, JAPAN Poster #376 Arthroscopic Management of the Impingement Syndrome of the Shoulder ...... Sercan Akpinar, Adana, TURKEY Poster #377 Arthroscopic-Assisted Shoulder Arthrodesis: A Modified Technique...... Juan Diego Ayala, Coslada, SPAIN Poster #378 Arthroscopic Biceps Tenodesis Using Bioabsorbable Interference Screw Fixation ...... Pascal Boileau, Nice, FRANCE Poster #379 Modified Weaver-Dunn Procedure in the Treatment of Complete Acromioclavicular Disruption ...... Yu-Sing Francis Chan, Manchester, UNITED KINGDOM Poster #380 Arthroscopic Rotator Cuff Repair by Footprint Reconstruction: Short Term Results ...... Joe De Beer, Oranjezicht, SOUTH AFRICA Poster #381 Major Pectoralis Muscle Rupture in the Athletes ...... Benno Ejnisman, Sao Paulo, BRAZIL Poster #382 Muskuloskeletal Injuries on 320 Athletes' Shoulders: Mechanism of Injury, Diagnosis, and Return to Sports Practice ...... Benno Ejnisman, Sao Paulo, BRAZIL Poster #383 Medium-term Results After Arthroscopic Therapy of the Frozen Shoulder ...... Roderich Heikenfeld, Herne, GERMANY Poster #384 Repair of Type-2 Slap Lesions Using Corkscrew Anchors. A Clinical Follow-up Study ...... Jüri Toomas Kartus, Trollhättan, SWEDEN Poster #385 The Surgical Outcome of the Arthroscopic Treatment for Overhead Athletic Injuries ...... Toshiro Kotake, Kyoto, JAPAN Poster #386 The Surgical Outcome of the Arthroscopic Treatment for an Overhead Athletic Injuries ...... Toshiro Kotake, Kyoto, JAPAN

5.11 Poster #387 Arthroscopic Rotator Cuff Repair – The Preliminary Results Compared With Mini-Open Repair ...... Hsiao-Li Ma, Taipei, TAIWAN Poster #388 Case Report of Spontaneous Dissolution of Ganglion Cyst Following Arthroscopic Stabilisation of a Type 2 SLAP Lesion • Literature Review of the Treatment of Ganglion Cyst Causing Suprascapular Nerve Entrapment ...... Wing Yuk Mok, Hong Kong, CHINA Poster #389 Rotator Cuff Repair Using a Screw and Washer Technique: Analysis of Outcome at One Year Follow-up...... Cary R. Motz, Aurora, CO, USA Poster #390 Posterior Shoulder Pain in Throwing Athletes With Bennett Lesion ...... Shigeto Nakagawa, Osaka, JAPAN Poster #391 Arthroscopic Acromioplasty and Rotator Cuff Repair Using Anchors Through a Mini Open Approach ...... Pericles P. Papadopoulos, Thessaloniki, GREECE Poster #392 Follow-Up After Shoulder Stabilization Procedures – A Comparison of Patient Self-Assessment and Clinical Examination ...... Hans-Gerd Pieper, Essen, GERMANY Poster #393 Calcific Tendonitis: A Systematic Technique for Arthroscopic Localization and Debridement ...... Ronald M Selby, New York, NY, USA Poster #394 The Infraspinatus Insertion – An Anatomic Study for Arthroscopists ...... Robert Allen Sellards, New Orleans, LA, USA Poster #395 Early Results of Third-Generation Humeral Prosthetic Replacement ...... Robert Allen Sellards, New Orleans, LA, USA Poster #396 Comparison of the Load to Failure of a Cannulated Tack (Suretac II) and a Suture Anchor (Mitek) in Rotator Cuff Repair ...... Graham Tytherleigh-Strong, Cambridge, UNITED KINGDOM Poster #397 All Arthroscopic Versus Mini Open Repair in the Management of Complete Tears of the Rotator Cuff ...... Stephen C Weber, Sacramento, CA, USA Poster #398 Mini Open Sub Pectoral Biceps Tenodesis for Management of Ruptures of the Ling Head of the Biceps ...... Stephen C Weber, Sacramento, CA, USA Poster #399 All Arthroscopic Versus Mini Open Repair of Partial Thickness Rotator Cuff Tears: The Safety of Completing the Tear ...... Stephen C Weber, Sacramento, CA, USA Poster #400 The Glenolabrum Injury of the Shoulder: MRI an MR Arthrography With Arthroscopic Correlation ...... Kazuhiro Yamaguchi, Sasebo, JAPAN Poster #401 The Importance of the Injected Volume of Corticosteroids and Xylocaine in the Treatment of Subacromial Impingement Syndrome ...... Christos K Yiannakopoulos, Athens, GREECE Poster #402 Isolated Rupture of the Subscapularis Tendon During Throwing Motion ...... Gen-itsu Yoshikawa, Otsu, JAPAN Poster #403 Isokinetic Profile and Suggestion for the Recovery of Throwing Shoulder Injuries of High School Baseball Players ...... Toshinori Yoshimatsu, Tokyo, JAPAN Poster #404 Isokinetic Profile and Suggestion for the Recovery of Throwing Shoulder Injuries of High School Baseball Players ...... Toshinori Yoshimatsu, Tokyo, JAPAN Poster #405 Subacromial Arthroscopic Decompression of the Shoulder With the Caspari Technique. Long-Term Follow-up ...... Benigno C. Zenteno, Mexico DF, MEXICO POSTER ABSTRACTS Poster #439 Interest of Arthroscopy in the Diagnosis and the Treatment of a Painful Shoulder Arthroplasty ...... Kempf Jean-François, Strasbourg, FRANCE Poster #449 Outcome of Mini-Open Salvage of Technically Unsuccessful Arthroscopic Rotator Cuff Repair ...... Seung-Ho Kim, Seoul, KOREA

SPINE/HIP/THIGH Poster #406 Exposure of the Adolescent Porcine Spine to Mechanical Flexion-Compression and Extension-Compression...... Adad Baranto, Göteborg, SWEDEN Poster #407 Surgical Treatment of Athletes Spinal Diseases ...... Moises Cohen, Sao Paulo, BRAZIL Poster #408 Acute Injury of an Intervertebral Disc in an Elite Tennis Player ...... Olof Lundin, Göteborg, SWEDEN Poster #409 Psoas Rupture Without a Predisposing Factor. A Case Report ...... Sefa Muezzinoglu, Kocaeli, TURKEY Poster #410 Psoriatic Arthritis of Hip Joint...... Takashi Ono, Nakakomagun, JAPAN Poster #411 A Technique for Arthroscopic Removal of a Bullet From the Acetabulum ...... Steven B Singleton, Fort Worth, TX, USA Poster #412 Arthroscopic Acetabular Labral Repair ...... Akihiro Tsuchiya, Ichikawa, JAPAN Poster #413 Snapping Hip Caused by Joint Cartilage Avulsion – A Case Report ...... Yasuhiro Yamamoto, Nakakoma-gun, JAPAN

SPORTS MEDICINE Poster #414 The Outcome and Findings of Arthroscopic Surgery in Swimmer's Shoulder ...... Klaus Bak, Charlottenlund, DENMARK Poster #415 Percutaneous vs. Open Surgical Achilles Tendon Repair ...... Andrej Cretnik, Celje, SLOVENIA Poster #416 New Sports Bandage for Ankle Support – Its Clinical Application and Functional Results ...... Toru Fukubayashi, Tokyo, JAPAN Poster #417 Rofecoxib in the Treatment of Painful Knee Joint in Ice-Hockey Players ...... Milan Handl, Prague, CZECH REPUBLIC Poster #418 SmartNail – A Biodegradable Nail for Treatment of Osteochondral Lesions ...... Gert Kristensen, Aalborg, DENMARK Poster #419 Endoscopic Treatment of Osgood-Schlatter's Disease ...... Gert Kristensen, Aalborg, DENMARK Poster #420 The Relationship Between Bone Bruise in MRI and Associated Injuries After Knee Joint Trauma ...... Hee-Soo Kyung, Daegu, KOREA Poster #421 Musculoskeletal Injuries in Track and Field. A Two-year Follow-up of Competitive Athletes...... Cristiano F S Laurino, Sao Paulo, BRAZIL

5.12 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Poster #422 Skateboard Injuries ...... Cristiano F S Laurino, Sao Paulo, BRAZIL Poster #423 Male Pelvic Straddle-Typed Stress Fracture ...... Hao-Chin Liao, Changhua, TAIWAN Poster #424 Surgical Management of Tennis Elbow: A Comparative Study of Two Techniques ...... Nicola Maffulli, Stoke on Trent, UNITED KINGDOM Poster #425 Incomplete Tears of the Anterior Cruciate Ligament ...... Nicola Maffulli, Stoke on Trent, UNITED KINGDOM Poster #426 Clinical and Functional Results of Open Operative Repair for Achilles Tendon Rupture in a Non-specialist Surgical Unit: A Long-Term Outcome Study ...... Nicola Maffulli, Stoke on Trent, UNITED KINGDOM Poster #427 Local Flap Coverage for Soft Tissue Defects Follow ...... Nicola Maffulli, Stoke on Trent, UNITED KINGDOM Poster #428 Ruptured Achilles Tendons Show Increased Lectin Stainability ...... Nicola Maffulli, Stoke on Trent, UNITED KINGDOM Poster #429 Quantitative Review of Operative and Non-Operative Management for Subcutaneous Rupture of the Achilles Tendon ...... Nicola Maffulli, Stoke on Trent, UNITED KINGDOM Poster #430 Long Term Outcome of Macintosh Reconstruction of Chronic Anterior Cruciate Ligament Insufficiency Using Fascia Lata ...... Nicola Maffulli, Stoke on Trent, UNITED KINGDOM Poster #431 The Study of Effect of Verbascoside on Oxidative Stress in Muscles During Immobilization and Remobilization in Rabbits ...... Liu Mingju, Hong Kong, CHINA Poster #432 Five Cases with Atlantal Fracture by Sumo Wrestling ...... Yusuke Morimoto, Chiyoda-ku, JAPAN Poster #433 Adolescent Females and Males Differ in the Perceived Importance of Static Hamstring Stretching ...... John Nyland, Louisville, Kentucky, USA Poster #434 Muscle Activity During Dash Shown by 18F- FDG PET...... Masahiro Ohnuma, Sendai, JAPAN Poster #435 Analysis of Poor Condition in J-League Professional Football Players ...... Minoru Shiraishi, Toyota, JAPAN Poster #436 Mechanical Properties of Suture Eyelet – Suture Interactions ...... William R. Walsh, Randwick, AUSTRALIA Poster #450 Surgical Treatment Tibial Eminence of a Shank Bone in Young Sportsmen ...... Vitaly F. Kuksov, Samara, RUSSIA Poster #451 The Clinical Diagnosis of Achilles Tendinopathy With Tendinosis ...... Nicola Maffulli, Stoke on Trent, UNITED KINGDOM Poster #455 Prevalence of Orthopaedic Injuries Among 160 Brazilian Competitive Tennis Players ...... Rogerio Teixeira Da Silva, Perdizes, BRAZIL POSTER ABSTRACTS

5.13 Ankle/Foot/Calf ingly. Type A fracture lay below syndesmosis. Type fracture at the level of syndesmosis. And type C above this site. Poster #1 MORFOLOGIC STUDY OF THE FEET IN LONG DISTANCE Result: of 40 patients, 15 (37.5%) had type A fracture 18 patient RUNNERS (49%) type B, 7 patient (17.5%) type C. After either open or Rogerio Teixeira Da Silva, Perdizes, BRAZIL closed reduction, a shortened fibular was observed in 22 Caio Augusto Nery, Sao Paulo, BRAZIL patients (55%) and an elongated fibular in 15 patient (37.5%), Milton Luiz Miszputen, Sao Paulo, BRAZIL and a fibular of normal length in 3 patient (7.5%). The mortise Moises Cohen, Sao Paulo, BRAZIL was widened in 28 patients (70.5%), narrowed in 7 patients Jose Felipe Alloza, Sao Paulo, BRAZIL, Presenter (17.5%), an of normal length 5 patients (12.5%). Radiological UNIFESP/EPM, Sao Paulo, BRAZIL finding shows of fibular malleolar, and wide ankle mortise.

Participating in sporting and physical activities has played a Discussion: previous measurement using other methods have vital role in our society. However, greater duration and intensity confirm the relationship of a short fibula and widened ankle in the practice of sports has increased the number of injuries. mortise with radiological osteoarthrosis, especially in type B Running, which is seen as a therapeutic, recreational and com- fracture, clinically osteoarthrosis was not associated with petitive activity available to all as well as not requiring much in reduced joint immobility, which has been noted before. Painful terms of equipment and expenditure may, however, lead to joint was noted in all type of class. Our study suggest a relation injuries and overloading of the lower limbs in particular, a between poor late results in the treatment of malleolar frac- result both of continuous and prolonged impact as well as indi- tures, with bone incongruity (a shortened fibula), and joints vidual propensities. Once an important correlation was instability (irrespective of mode of management). observed between lower limb injuries and postural foot varia- tions, a study was designed of the morphology and identifica- tion of deviations or misalignments of the distal end of the Poster #3 lower limbs. To this end, 94 feet of 47 medium and long dis- ARTHROSCOPIC ARTHRODESIS OF SUBTALAR JOINT: tance male runner were analysed. Their ages ranged between 18 THE NEW TECHNIQUE AND SHORT TERM RESULTS and 51 and all had been regular runners for a period of at least Eiichirou Asou, Sasebo, JAPAN, Presenter 6 months. The runners were assessed both clinically and radio- Kazuhiro Yamaguchi, Sasebo, JAPAN logically. From the podographic classification of the different Hiroyuki Kitahara, Sasebo, JAPAN foot types (12% flat, 9,6% cavus and the other 77% normal or Nagasaki Rosai Hospital, Sasebo, JAPAN neutral) statical similarities and relationships of clinical and radiological parameters were analysed. No significant anom- (PURPOSE) The purpose of this study was to describe a new alies were observed in the runner, however, considerable varia- technique of arthroscopic arthrodesis of subtalar joint and to tions in the physical relation of one bone with another in the know the short term results of this surgery. (MATERIALS AND adults became evident which, in turn, alerted to the impossi- METHOD) Six patients were treated with arthroscopic arthrode- bility of taking one radiological variable alone as absolute in sis. Four patients were male and two patients were female. The POSTER ABSTRACTS determining the nature of the bone architecture or the classifi- age of patients were 24-63 years old (mean 39.3 years old). cation of different types of feet. It was clear that the Talus-1 Diagnosis of the patients were subtalar osteoarthritis after cal- metatarsal angle (±4°), Talonavicular Congruence angle (4°- caneal fracture and ankle sprain. Lidocaine test for the subtalar 27°) and Articular Congruence Measure (3-9 mm) are radiolog- joint was very effective for all six patients. We did not use any ical parameters which may be used to analyse foot types as they external fixation devices or joint widening instruments at sur- demonstrate sound statistical similarities and relationships. gery. At first, we inserted 3.5mm arthroscope in 1-2 cm above to From anatomical, biomechanical and image considerations, it subtalar joint from lateral side, and remove soft tissues includ- became clear that the assessment of complex articular move- ing interosseous ligament. Secondly, articular cartilage and ments such as pronation or hyperpronation in walking or run- bone were cut by chisel and electronic shaver. We could con- ning call for joint analyses of structural static and dynamic tinue to gain the space for the view after bone resection. Medial aspects. facet was clearly viewed by the arthroscopy. After enough resec- tion of all articular surface of subtalar joint, fixation of the joint was performed by two cannulated screw. (RESULTS) Plain radi- Poster #2 ograph of the joint showed the bone union at ten weeks after POST TRAUMATIC OSTEOARTHROSIS ROLE OF FIBULAR surgery in all six patients, and the patients did not complain of LENGTH AND WIDTH OF ANKLE MORTISE AFTER subtalar pain. MALLEOLAR FRACTURE. Saqib Amin, Sharjah, UNITED ARAB EMIRATES, Presenter Poster #4 Introduction: Conservative and inappropriate operative treat- CALCANEO-FIBULAR LIGAMENT PLASTY IN ANKLE ment of melleolar fractures often results in post traumatic INSTABILITY: A MINIINVASIVE DAY SURGERY TECHNIQUE osteoarthrosis. The aim of this study was to analyse the role of Gian Luigi Canata, Torino, ITALY, Presenter abnormal length of the fibula, and the width in development of Centro di Traumatologia dello Sport e Chirurgia Ar, Torino, ITALY osteoarthrosis. Only a minority of ankle sprains develop a chronic instability. Method & Material: 40 patients, 30 male and 10 female. (18-55 We evaluated retrospectively a mini invasive calcaneofibular yrs age). 25 were treated from 1998-2001 for the fracture of the ligament plasty to treat anterolateral posttraumatic chronic melleolus by open reduction and internal fixation, 15 were ankle instability. treated by closed reduction and immobilse with the cast for 6 weeks. Anterio-posterior X-ray of the both ankle joints were Material and methods taken after 2 years, shortening of fibular malleolus and widen- 26 patients, all practicing sports activities, 20 females and 6 ing of the ankle was measured. Fractures were classified accord- males (mean age 25,3 years, 17-62) were operated on with a miniinvasive technique for instability due to chronic posttrau-

5.14 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). matic calcaneofibular ligament laxity. The calcaneofibular liga- ment was retensed to the fibula with reabsorbable stitches. Mean time between injury and surgery 52 months. All cases Poster #6 showed painful ankle instability with a pathologic talar tilt. All SEMIRIGID CONTRA PLASTER CAST FIXATION OF THE cases were treated in Day Surgery. An arthroscopic synovec- ANKLE SPRAIN IN ATHLETES tomy or chondroplasty was associated in 5 cases. Milan Handl, Prague, CZECH REPUBLIC, Presenter After surgery a rigid bendage was prescribed. Full weight bear- Tomas TRC, Prague, CZECH REPUBLIC ing was allowed after 15 days. Results were evaluated with the Orthopaedic Clinic, University Hospital Motol, Prague, CZECH REPUBLIC Ogilvie Harris Scale and the Kaikkonen scale. A proprioceptive side to side evaluation was made with Delos board. Mean fol- Summary: low up 43 months (18-67). Statistical analysis was performed The ankle sprain is very common injury in athletes. Author eval- with the Student’s t test uated 2 parallel groups of total 46 patients treated after the severe ankle sprain by plaster cast or semirigid synthetic cast. Results The evaluation was based on clinical tests and X ray findings. Ogilvie Harris Scale showed 21 excellent and 5 good results. Both testing were performed in 3 periods after the casts were Kaikkonen scale : 26 excellent results. Proprioceptive evalua- removed. The results show a positive effect of early semirigid tion did not show a significative side to side difference (p> treatment than in classic plaster cast treatment. 0,005). All subject resumed their previous sports activities in the third month after surgery. Purpose The aim of the study was to evaluate the effect of a early semi- Conclusions rigid fixation of the ankle sprain in the comparison to conser- This simple technique aimed to an anatomic repair is effective vative plaster cast therapy in high level athletes. and can be performed in Day Surgery with excellent results. Calcaneofibular ligament plasty alone can restore stability in Methods chronic anterolateral ankle instabilities. Two groups of patients - high level athletes were treated imme- diately after the severe ankle sprain (hematoma, swelling, sta- ble ankle, X ray negative) immediately within 24 hours after the Poster #5 injury by the cast immobilisation. The first group (25 pts) used ARTHROSCOPIC TREATMENT OF OSTEOCHONDRITIS a semirigid synthetic cast, the other one used typical plaster DISSECANS IN THE TALUS cast. The former were released the heel by partially cutting the Chong-Hyuk Choi, Seoul, SOUTH KOREA, Presenter cast after ten days. In both groups was cast removed after four Yong-Min Cheon, Seoul, SOUTH KOREA weeks. The following rehab procedure were the same. The clin- Dept. of Orthopaedic Surgery, Yongdong Severance H, Seoul, SOUTH KOREA ical testing were performed in 6, 9 and 12 weeks after removing the cast. Early load, early mobility, pain-free gait and stability Purpose : To evaluate the long term results of arthroscopic sim- were observed. ple excision for osteochondritis dissecans in the talus clinically, and to investigate the gross change and histologic findings in Results the defect area through second look arthroscopy and biopsy. Semirigid fixation group appear better early load, early mobil- ity and pain-free gait than in plaster cast group. Stability of the Materials and Methods: This study included twenty two ankle remained the same as it was before the injury. (See table). patients who were treated with osteochondritis dissecans in no f-u 12 w load % ROM % painfree % stability % the talus. After arthroscopic excision of loose fragment, G 1-semirigid fixation 25 25 100 96 92 96 G 2 - plaster cast 21 21 90,5 80,9 76,2 95,2 debridement for underlying necrotic tissue was done. Active bleeding bed was confirmed in all cases when tourniquet was Discussion POSTER ABSTRACTS released. The average follow up was 3.5yrs (25month-8yr). In The early possible come-back in high level athletes is still dis- nine cases, second look arthroscopy was done (post op 7 cussed. In case of non-operative treatment of the ankle sprain months - 8yrs). The final results were evaluated with ankle- there are two basic ways for recovering. The risk of early semi- hindfoot scale (maximum 100 points) and functional scale rigid fixation from the worse stability of the joint is suspected. (maximum 90 points). Conclusion: Results: According to Berndt and Harty classification, 8 cases Results show the semirigid fixation preferably than plaster cast were stage IV, 12 in stage III and 2 in stage II. The average size is worth to perform in ankle sprains where no ligaments dam- 2 2 of lesion was 1.6cm (3.75 - 0.75cm ) and depth was 0.8cm (0.5- age occurs. The recovery to full athletic load was better in the 1.1cm). In seven cases, cartilage lesions were found in the tib- semirigid group. ial plafond contacting with the lesion. In final evaluation, ankle-hindfoot scale was improved from 67 (pre-op) to 81 (p<0.01). The average of ankle functional score was 72. In sec- Poster #7 ond look arthroscopy, no associated pathological changes was DO I HAVE A FLATFOOT – THE RUNNER’S IMPRESSION, found in the ankle joint except two cases who had degenerative THE DOCTOR’S FINDINGS arthritis due to chronic ankle instability. With lapse of time, the Erik Hohmann, Rockhampton, AUSTRALIA, Presenter defects had a tendency to fill up with fibrous tissue. A serial Andreas B Imhoff, Munich, GERMANY change of microscopic findings also showed a progression of Department of Orthopaedic Sportsmedicine Munich, Munich, GERMANY fibrous tissue to mature fibrocartilage. Introduction: It is suggested that there is a link between arch Conclusion: The arthroscopic simple excision and debridement type of the foot and overuse injuries. The use of individual were effective for the treatment of osteochondritis dissecans in selected running shoes can reduce running injuries substan- the talus in terms of clinical and functional outcome. The defect tially. To select the correct shoe the runner needs to have did not influence the development of secondary changes and showed a tendency of filling up with fibrocartilage.

5.15 appropriate knowledge of his own foot anatomy and biome- p=0.001). 43% of the women experienced pain from their ankle chanics. at least weekly as opposed to 25% of the men. 44% of the women experienced at least moderate difficulty with twist- Methods: The feet of runners were examined. A questionnaire ing/pivoting on the operated ankle as opposed to 34% of the was used to assess the runner’s knowledge about his arch men. 65% of the women were aware of their ankle at least height and biomechanics of running. The clinical examination weekly as opposed to 35% of the men. was performed by 5 Orthopaedic Surgeon and experienced orthopaedic technicians. Weight-bearing podograms were Conclusion: The long-term outcome after anatomical ligament taken to further delineate the arch. reconstruction is worse in women than in men. On average 11 years after operation, nearly half of the women had ankle pain Results: We examined 92 volunteers with a mean age of 35,4 at least weekly and two-thirds of the women were aware of their (12-63) years, a mean height of 176 cm (154-195) with a mean ankle at least weekly. body weight of 70,38 kg (45-95). 18 out of 47 runners with a flat- foot deformity identified their deformity correctly. 25 out of 43 Reference: with a normal arch were correct in identifying their foot 1. Roos EM, Brandsson S, Karlsson J. Validation of the Foot anatomy. 2 runners with a cavus foot were correct in identifying and Ankle Outcome Score (FAOS) for ankle ligament recon- their deformity. Only 4 out of 38 runners that diagnosed them- struction. Foot Ankle Int 22; 788-794: 2001 selves as being pronators have been found to be pronators. 4 runners with a self-diagnosed non pronating foot were classi- fied as being pronators. 3 runners that could not classify them- Poster #9 selves were diagnosed as pronators. ORAL HYDROLYTIC ENZYMES IN PATIENTS WITH ACUTE ANKLE SPRAIN: EFFICACY AND SAFETY ASPECTS Conclusion: This study demonstrates the poor knowledge of Gino M.M.J. Kerkhoffs, Amsterdam, THE NETHERLANDS, Presenter foot deformities in the running community. Peter Struijs, Amsterdam, THE NETHERLANDS Herman Zwipp, Dresden, GERMANY Volker Rahlfs, Gauting, GERMANY Poster #8 Niek CN van Dijk, Amsterdam, THE NETHERLANDS THE LONG-TERM PATIENT-RELEVANT OUTCOMES ARE Orthopaedic Research Center Amsterdam, Dept of Ort, Amsterdam, THE WORSE IN WOMEN THAN IN MEN AFTER ANATOMICAL NETHERLANDS LATERAL ANKLE RECONSTRUCTION Jon Karlsson, Gothenburg, SWEDEN, Presenter Objective Sveinbjôrn Brandsson, Gothenburg, SWEDEN To compare the effectiveness and acceptable safety of the triple Ewa Roos, Lund, SWEDEN combination Phlogenzym (rutoside, bromelain and trypsin) Department of Orthopaedics, Sahlgrenska University, Gothenburg, SWEDEN with double combinations, single substances and placebo.

Introduction: Ligament injuries of the ankle joint are the most Design POSTER ABSTRACTS common sports-related injuries. Although most patients with Multinational, multicenter, double masked, randomised, paral- these injuries are managed non-surgically, some will develop lel group design with 8 groups (factorial). recurrent ligament instability. The common treatment in such cases is ligament reconstruction. In several recent studies Setting anatomical reconstruction is recommended as the best choice. Departments of orthopaedic surgery and emergency depart- The long-term results of anatomical reconstructions of the lat- ments in 27 European hospitals. eral ankle ligaments are, relatively unknown. Further, the assessment methods previously used, have probably not been Participants sensitive or specific enough to evaluate patient-relevant out- Patients aged between 16 and 53 years presenting with acute comes and changes over time. Recently a new, patient-relevant one-sided sprain of the lateral ankle joint. assessment scale, assigned to be used for patients with foot and ankle problems (FAOS) has been validated and published.1 Main outcome measures The aim of this study was to evaluate the long-term results after Pain on walking 1 or 2 steps, as defined by the patient on a anatomical reconstruction for recurrent ankle instability, using visual analogue scale (VAS). The range of motion, as measured the FAOS evaluation tool and especially to compare the out- by the investigator and expressed as a sum of flexion and exten- come parameters in women and men. sion. The volume of the injured foot with the “Volometer”.

Material and method: 213 patients (85 women) operated on Results with anatomical reconstruction due to recurrent ankle instabil- A total of 721 patients were randomised, 674 were analysed on ity were evaluated on average 12 (range, 3-24) years postopera- an intention to treat bases. At the primary endpoint at 7 days, tively using clinical and radiological (standardized stress the highest reduction of pain was observed in the bromelain- radiographs) assessments. Patient-relevant outcomes were trypsin group (-73.7%). The Phlogenzym group showed a assessed using the FAOS-scales (pain, other symptoms, activi- median reduction by -60.3%, while the placebo group showed a ties of daily living, sport & recreation function, foot & ankle- median reduction by -73.3%. The highest increase of the range related quality of life) scored on a 0-100, worst-best, scale. of motion with regard to the medians is seen in the placebo group (percent change from baseline 60.0%). The Phlogenzym Results: The mean ages and years to follow-up were similar in group showed a median increase of 42.9%.The highest decrease men and women. There was no difference in the relevance of of swelling was observed in the trypsin group (change from each item with regard to gender. Women reported worse out- baseline -3.9%). The Phlogenzym group showed a percentage comes in all five FAOS subscales, the differences being signifi- change from baseline of -2.3% and the placebo group of -2.9%. cant for pain (81 v 86 points; p=0.005), other symptoms (74 v 81 The safety population included 692 patients. The vast majority points; p=0.009), sport and recreation function (65 v 75 points; of physicians and patients rated the tolerability of all tested p=0.004), and foot & ankle-related quality of life (62 v 72 points; treatments either as very good or at least as good.

5.16 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Poster #12 Conclusions POST TRAUMATIC LATERAL ANKLE PAIN RESULTING Superiority of Phlogenzym in treatment of patients with acute FROM INTRA-ARTICULAR SOFT TISSUE one-sided sprain of the lateral ankle joint could not be demon- Gideon Mann, Givat Shaul, ISRAEL, Presenter strated in comparison to the three 2-drug combinations, or in Shay Shabat, Kfar Saba, ISRAEL comparison to placebo. No additional benefit was revealed David Morgenstern, Kfar Saba, ISRAEL from the three single substances. Naama Constantini, Netanya, ISRAEL Joseph Lowe, Jerusalem, ISRAEL Meir Nyska, Kfar Saba, ISRAEL Poster #10 Wingate Institute, Netanya, ISRAEL ARTHROSCOPIC ANKLE ARTHRODESIS WITH ARTHREX ACL GUIDE Introduction: Myung Ku Kim, Inchon, SOUTH KOREA, Presenter Continuous pain on the lateral aspect of the ankle after acute Inha University, Inchon, SOUTH KOREA ankle sprain is often a troublesome phenomena, yet under diagnosed and unexplained. Bony injures as fracture of the lat- Arthroscopic ankle arthrodesis has advantages of small skin eral process of the talus, Osteochondritis or minor displaced incision, faster recovery time, short hospitalization and short avulsion fracture of the lateral maleolus impacted under the union time. But, for the successful result, it requires well-expe- maleolus should be excluded as should fractures of the anterior rienced skill and accurate screw insertion. For them, fluorosco- process of the calcaneum or calcaneal fracture causing per- phy or repetitive radiography are needed during operation. So, oneal tendon impingement on the fibula. Injury to the sinus the surgical time may be extended and surgeon may has a risk tarsi structures should be excluded by using local anesthesia. of radiation. Here, the author used Arthrex ACL guide during Partial or full tears of the peroneal tendon would occasionally arthroscopic ankle arthrodesis. We could inserted cannulated comprise an extra articular cause for continuous pain. screws accurately and precisely without helping of fluoroscophy or repetitive radiography. We could get solid bony union within In this presentation, we shall observe the intra-articular soft tis- 3 months after operation in all cases. The application of Arthrex sue impingement as a yet under-diagnosed cause of pain. Post ACL guide is successful method on arthroscopic ankle traumatic synovitis after ankle sprain or following chronic bony arthrodesis. This can minimizes the risk of radiation and surgi- impingement and osteophyte formation will not be included in cal time. the scope of this presentation.

Bony Anatomy and Bony Impingement: Poster #11 The talus side saddles the calcaneum so that its axis is directed CLINICAL RESULT OF CORTICAL BONE PEG AUTOGRAFT to the first web space while the calcaneal axis is directed to the FOR OSTEOCHONDRAL LESION OF THE TALUS fourth web space. Thus bony impingement would usually be Hideji Kura, Sapporo, JAPAN, Presenter antero-medial in dorsiflexion between the neck of the talus and Seiichi Ishii, Sapporo, JAPAN the tibia or the postero-lateral between the calcaneum and the Shinsuke Mera, Sapporo, JAPAN tibia in plantarflexion. Antero-lateral and postero-medial pain Dept. Orthopedic Surgery Sapporo Medical University, Sapporo, JAPAN is usually from soft tissue in origin as a bony impingement does not occur in these areas (Hamilton, 1995). Purpose: The purpose of this study was to evaluate the clinical results of cortical bone peg autograft for osteochondral lesion Antero-Lateral Pain Caused by Soft Tissue: of the talus. The following entities are described: 1. Basset’s Ligament: In 1990, Basset described a distal exten-

Materials and Methods: From 1993 to 2000, thirty four feet of 34 sion of the anterior tibiofibular ligament impinging during POSTER ABSTRACTS patients who had ostreochondral lesion of the talus were plantarflexion on the lateral shoulder of the talus. treated by cortical bone peg autograft. Ten were male and 24 2. Ferkel’s Phenomena: In 1991, Ferkel described the accumula- were female. Twenty five were medial type and 9 were lateral tion of scar tissue and inflamed synovium in the antero-lateral type. The average age at surgery was 31 years old (15 - 70 yrs.). gutter usually post-traumatic. The average follow up period was 4.5 years (2 - 9 yrs.). The eval- 3. Syndesmotic Pathology: Syndesmotic sprain or partial dis- uation was performed as follows: AOFAS hindfoot score, ROM ruption could be painful for a long time, felt especially in dor- of ankle joint, arthroscopic findings (postsurgery 1 year). siflexion. This could be exaggerated by avulsion of a bony chip form the tibia (Tillot’s Fracture) or rarely form the fibula or exag- Result: Flap tear of full thickness articular cartilage without gerated by synovial hernia into rents in the tibiofibular liga- subchondral bone was found in 11 ankles. Remaining 23 ankle ment (McLaughlin, 1960). had osteochondral bone fragment. AOFAS score was averaged 4. “Meniscoid Ankle”: First described by Wolin in 1950 and fur- 74 points at presurgery and 97 points at final follow up. ther developed by Tomasen in 1982 this interesting pathology Dorsiflexion of the ankles averaged 17.5 at presurgery and 14.3 evolves from soft tissue being trapped between the lateral at final follow up. Plantarflexion of the ankles averaged 47.2 at shoulder of the talus and the lateral maleolus. This could presurgery and 45.6 at final follow up. In arthroscopic investi- assume a classic “meniscoid” shape or could seem more like gation, Mild local synovitis in 13 ankles, mild fibrilation in 5 scar and synovial unorganized tissue rather similar to Ferkel’s ankles, and partial defect of articular cartilage in 2 ankle. phenomenon.

Conclusions: These results suggested that the cortical bone Diagnosis: peg autograft kept strong fixation for the chondral or osteo- Clinical examination would be assisted by imaging modalities: chondral lesion to achieve biological heeling. Mild synovitis x-ray, bone scan, CT or MRI. It seems the best imaging modal- was found in about one third of the ankles after 1 year of the ity for soft tissue intra-articular impingement syndromes is the surgery. These might be limitation of this procedure. CT-Arthrography.

Treatment:

5.17 When conservative methods fail, inclusive of rest, activity mod- If the trimalleolar ankle fractures were treated non-anatomi- ification, NSA and occasionally taping, bracing and orthotics, cally, the cartilage at the fracture site will degenerate and even- surgical methods would be used, mainly arthroscopy both for tually cause osteoarthritis. We regard that there are two diagnosis and for definitive and final treatment. advantage of arthroscopy assisted treatment of intra-articular trimalleolar fractures. The first advantage is that chondral sur- Summary: face was reducted accurately. The second advantage is that Lateral pain after an acute ankle sprain is often hard to diag- ankle arthroscopy can confirm the associated lesions such as nose. It may be a result of a minor fracture or bony impinge- osteochondral lesion and the instability of the distal tibiofibu- ment of extra-articular origin, tendon injury or soft tissue lar joint. intra-articular pathology typical to the antera-lateral pain syn- drome. Diagnosis by clinical and imaging methods should be attempted prior to treatment which would be conservative, Poster #14 arthroscopic or occasionally by open surgery. FOOT PRESSURE DISTRIBUTION DURING GAIT IN ATHLETES WITH FUNCTIONAL INSTABILITY OF THE ANKLE JOINT Poster #13 Koji Nawata, Yonago, JAPAN, Presenter CLINICAL RESULT OF ARTHROSCOPIC REDUCTION FOR Ikuta Hayashi, Yonago, JAPAN TRIMALLEOLAR FRACTURE OF THE ANKLE Shinji Nishihara, Yonaga, JAPAN Kohei naito, Oda, JAPAN, Presenter Department of Orthopedic Surgery, Sanin Rosai Hosp, Yonago, JAPAN Fumito Komatsu, Oda, JAPAN Masatoshi Tobita, Izumo-shi, JAPAN Objective: Functional instability of the ankle joint is one of the Hidetoshi Yamaguchi, Oda, JAPAN most common residual disabilities after an acute ankle sprain. Masato Takao, Izumo, JAPAN It is defined by Freeman as a condition characterized by a ten- Kazunori Oae, Izumo, JAPAN dency of the ankle repeatedly sprain or the subjective feeling of Mitsuo Ochi, Izumo-shi, JAPAN the ankle giving way. The aim of this study was to investigate Yuji Uchio, Izumo, JAPAN the foot pressure distribution during gait in athletes with func- Department of Orthopaedic Surgery, Shimane Medical, Izumo, JAPAN tional instability of the ankle joint.

Introduction Methods: Two groups were examined. FI group comprised 8 col- When we treat the trimalleolar fractures, anatomical reduction lege athletes with functional instability of the ankle joint. of the articular cartilage and rigid fixation of the fracture site Control group comprised 10 healthy college students. Pressure, are important for good postoperative results. We have utilized area and force during gait were measured using a pressure an ankle arthroscopy to assist the anatomical reduction of the measuring system (MP-4800, Anima, Japan). The dynamic foot articular cartilage in osteosynthesis. The purpose of this study angle and the pronation-spination (PS) index were calculated . is to evaluate the results of the arthroscopic reduction and internal fixation with trimalleolar fractures of the ankle. Results: FI group demonstrated significantly lower (p<0.05) POSTER ABSTRACTS dynamic foot angle and greater (p<0.01) PS index at the push- Materials and Methods off phase of gait than those in control group. Between 1999 and 2001, 26 patients with trimalleolar fractures were treated surgically at our institution. There were 16 males Conclusions: The results showed the increase in adduction- and 10 females with the mean age at surgery 36 years old spination of the foot at the push-off phase of gait with func- (range,19-77 years). They were followed up 6 to 25 months tional instability of the ankle joint. (mean; 18 months). Anteroposterior, lateral and mortise radi- ographs were made preoperatively in order to classify the frac- ture types. According to the Lauge-Hansen classification Poster #15 system, 21 cases were supination-external rotation type, 3 DIAGNOSTIC VALUE OF MAGNETIC RESONANCE cases were pronation-eversion type, 2 cases were supination- IMAGING FOR INJURY OF THE ANTERIOR adduction type. In operation, before osteosynthesis, we per- TALOFIBULAR LIGAMENT formed ankle arthroscopy to make sure the condition of the Kazunori Oae, Izumo, JAPAN, Presenter cartilage at the fracture site. And we reduce the cartilage Masato Takao, Izumo, JAPAN anatomically as far as possible. If there were any other lesions, Yuji Uchio, Izumo, JAPAN they were treated respectively in operation. After that, all Kohei Naito, Oda, JAPAN patients were undergone screw and/or plate fixation of the frac- Taisuke Kono, Izumo, JAPAN ture site. At the latest follow-up, we evaluated all patients using Mitsuo Ochi, Izumo-shi, JAPAN the Burwell’s evaluation system . 89-1, Enya, Izumo, JAPAN

Results PURPOSE: To evaluate the diagnostic value of Magnetic reso- At the time of osteosynthesis, there were 10 cases of osteo- nance (MR) imaging in comparison with that of operative find- chondral lesion. In these cases, 5 cases had been performed ings for clarifying the portion of the anterior talofibular arthroscopic drilling, and one case had been removed the ligament disruption. chondral fragment and performed abrasion. In 13 cases with the instability of the tibiofibular syndesmosis, we stabilized the METHOD: This study involved 22 patients with anterior distal tibiofubular joint using a syndesmosis screw. There were talofibular ligament disruptions who had a surgery at Shimane all good results in radiographic evaluation, and in subjective Medical University Hospital. All of these patients were exam- clinical evaluation. 24 cases were good, and 2 cases were fair in ined with MR imaging to diagnose the portion of the anterior objective evaluation. talofibular ligament disruption. When imaging revealed discon- tinuity (criterion 1) and a high intensity area in the ligament Discussion (criterion 2), the injury was considered to be a ligament disrup- tion. The portion of the ligament tear was classified in three

5.18 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). types to 1) At the attachment of fibula, 2) Substance, 3) At the Ronny Lorentzon, Umea, SWEDEN attachment of talus. Håkan Kjell, Umea, SWEDEN Bertil Alfredson, Umea, SWEDEN RESULTS: On the basis of operative findings, in 4 cases, the lig- Dpt of Diag Radiology/Dpt of Surgical and Perioper, Umea, SWEDEN ament was disrupted at the attachment of fibula. In 12 cases, the ligament was disrupted at the substance. In 6 cases, the lig- Objective- The mechanism that causes pain in chronic Achilles ament was disrupted at the attachment of talus. On the basis of tendinosis is not known. However, recently, using high resolu- MR imaging findings, in 4 cases, the ligament was seemed to be tion ultrasound and colour doppler technique, we showed that disrupted at the attachment of fibula. In 11 cases, the ligament neovascularisation was associated with painful chronic Achilles was seemed to be disrupted at the substance. In 5 cases, the tendinosis. Therefore, we investigated whether sclerosing the ligament was seemed to be disrupted at the attachment of neovessels would affect the level of tendon pain. talus. These cases were correctly diagnosed. On the other hand, in one case, the ligament was seemed to be disrupted at both Material and Methods- In this pilot study, we describe the effect the attachment of fibula and talus. In another one case, the lig- of injecting (ultrasound and colour doppler-guided) a scleros- ament was not clearly demonstrated and it could not be diag- ing agent, polidocanol, against neovessels in 10 patients (7 nosed the lesion of ligament tear. These two cases were not men and 3 women, mean age 55 years) with painful chronic correctly diagnosed. A diagnostic value to clarify the portion of mid-portion Achilles tendinosis. the ligament tear is made with a rate 90.9% (20/22). Results- Eight of ten patients were satisfied with the results of CONCLUSION: When we repaired the acute anterior talofibular treatment. There was a significantly reduced pain during activ- ligament disruption, we decide the operative methods properly ity (reported on a VAS-scale), and no remaining neovasculari- such as pull-out suture technique, intra-tendinous suture tech- sation, after an average of two injections (treatments). Two nique, and suture anchor technique according to the portion of patients were not satisfied, and neo-vascularisation remained the ligament tear. Our study showed that MRI is one of the use- present in these cases. At follow-up, an average of six months ful tools to clarify the portion of the ligament tear preopera- after treatment, the same eight patients remained satisfied and tively. performed Achilles tendon- loading activities as desired. Their VAS-score had decreased from 74 before treatment to 8 (p<0.01). Poster #16 ARTHROSCOPIC OSTEOCHONDRAL AUTOGRAFT Conclusions- Sclerosing of neovessels in patients with painful TRANSPLANTATION FOR OSTEOCHONDRITIS chronic Achilles tendinosis rapidly reduced activity-related ten- DISSECANS OF THE TALUS don pain and the benefits remained at 6 months. These find- Satoshi Ochiai, Yamanashi, JAPAN, Presenter ings suggest that neovessels may play a key role in causing Yoshiki Hamada, Nakakoma-gun, JAPAN chronic tendon pain. Takatoshi Ide, Nakakoma-gun, JAPAN Takashi Ono, Nakakomagunn, JAPAN Jirou Ichikawa, Yamanashi, JAPAN Poster #18 Department of Orthopaedic Surgery,Yamanashi Medica, Tamaho, JAPAN ARTHROSCOPIC TREATMENT OF ANTERIOR ANKLE FRICTION SYNDROME IN HIGH LEVEL ATHLETES We present the case of a patient with osteochondritis dissecans Alberto Pienovi, San Isidro, ARGENTINA, Presenter of the talus, in whom favorable outcomes were obtained by Sergio Oscar Massetti, Buenos Aires, ARGENTINA arthroscopic osteochondral autograft transplantation. The Ruben Calafell, City Bell, ARGENTINA patient was a 27-year-old female who sprained her left ankle CTO, San Isidro, ARGENTINA while playing tennis. Since pain in the ankle persisted, plain POSTER ABSTRACTS radiography, computed tomography scan and magnetic reso- Objective: This prospective study evaluates the results of the nance imaging were performed. The results suggested stage III arthroscopic treatment of the anterior ankle friction syndrome. osteochondritis dissecans of the talus, according to the four- The group studied was of highly active young athletes. 107 stage classification of Berndt and Harty. The patient subse- patients who presented anterior ankle friction syndrome were quently underwent surgery. Arthroscopy revealed lesions over a studied. relatively broad area, from the central to posterior regions on the medial side of the talus. Drilling or restorative fixation Method: The group studied was comprised of 83 men (77.5%) would have proven insufficient for repairing bone defects and and 19 women (17.7%) with an average age of 25.2 (from 18 to irregular surfaces of the articular cartilage. Autograft transplan- 35) The follow-up was made over 52 months (12 months to 8 tation was therefore performed under arthroscopic guidance years). The pathology was classified into 4 types, all receiving using OATS (Arthrex Inc.). At time of writing (eight months arthroscopic treatment. In all cases a RMN preoperative was postoperatively), the patient had experienced no pain and performed. The patients were evaluated objectively and subjec- range of motion was not limited. In addition, radiolucency of tively, and sports activity was especially considered in the the talus was restored. Treating osteochondritis dissecans of results. The surgical technique was described. the talus accompanied by a large osteochondral defect is some- times difficult. The present method is useful as it is less inva- Results: 92 (85.98%) of the patients obtained an excellent or sive and use of autologous osteochondral graft ensures very good result while 11 (10.28%) were regular and 4 (3.74%) physiologically proper repair. poor, respectively. Ninety-one percent of the patients were sat- isfied with the method used and the results obtained. 81 patients (75.7 %) of the athletes returned to their previous level Poster #17 of activity in sports. This result declined in time. ULTRASOUND-GUIDED SCLEROSING OF NEOVESSELS IN TENDINOSIS. A NEW TREATMENT Conclusions: The anterior friction syndrome is a frequent IN PAINFUL CHRONIC ACHILLES TENDINOSIS pathology in contact and high level athletes. The arthroscopic Lars Öhberg, Umea, SWEDEN, Presenter

5.19 treatment is an effective procedure and the results are accept- (polidocanol) was injected in the area with neovascularisation able, but they decrease with time in the long-term evaluations. outside the ventral part of the tendon. Biopsies taken from tendinosis tissue and normal tendon tissue in 6 patients were used for immunohistochemical and gene expression studies. Poster #19 OSTEOCHONDRAL LESIONS OF THE TALAR DOME Results: In all 32 tendons, structural tendon changes and neo- ASSOCIATED WITH TRAUMA vascularisation was demonstrated on the painful (injured), but Masato Takao, Izumo, JAPAN, Presenter not on the non-painful (non-injured) side. Twelve patients with Mitsuo Ochi, Izumo-shi, JAPAN demonstrated neovessels before treatment, were treated with Yuji Uchio, Izumo, JAPAN eccentric calf-muscle training for 12 weeks. At follow-up, 10 Department of Orthopaedics, Shimane Medical Univer, Izumo, JAPAN patients were satisfied with treatment (no tendon pain during activity). In 9/10 satisfied patients there were no remaining Purpose: We investigated differences in the cause of chondral neovessels. After injection of the local anaestetic, all patients (C), subchondral (S), and combined chondral-subchondral (CS) experienced a significantly diminished level of pain during ten- lesions of the talar dome based on the presence of distal fibu- don-loading activity (heel-raises). The VAS-score (mean) lar fractures and anterior talofibular ligament (ATFL) disrup- decreased from 81 before injection, to 6 after injection. In biop- tions. sies, enzyme histochemistry showed nerve structures in close relation to blood vessels. cDNA-arrays demonstrated signifi- Materials and Methods: There were 92 cases of distal fibular cantly higher expression levels for vasculoendothelial growth fractures and 86 cases of ATFL disruptions, including 36 feet factor (VEG-F) in tendinosis tissue compared to normal tendon with subacute ATFL and 50 feet with chronic ATFL disruptions. tissue. In diagnosing C, S, or CS lesions, we used a combination of magnetic resonance imaging to evaluate the subchondral con- Conclusions: We demonstrate that there seems to be a signifi- ditions and ankle arthroscopy to evaluate the chondral condi- cant relationship between vessel ingrowth (neovascularisation) tions. and chronic Achilles tendinosis pain, and that nerve structures are accompanying the vessels. Furthermore, by using a local Results: Out of a total of 92 distal fibular fractures, 65 cases anaestetic it was determined that the tendon pain originated (70.7%) had C, S, or CS lesions at the time of osteosynthesis, from the area with neovascularisation at the ventral part of the and 27 did not (29.3%); among the latter group, 2 developed C, tendon. These findings might have implications for treatment. S, or CS lesions about one year after the operation. Out of a total of 86 ATFL disruptions, 35 (40.7%) had C, S, or CS lesions. Among the subacute cases, 7 of 36 (19.4%) had C, S, or CS Poster #21 lesions, versus 28 of 50 cases (56.0%) with chronic ATFL disrup- POSITIONAL VARIATION IN IN VIVO TIBIAL STRAINS tions. DURING JUMPING EXERCISES Carin Olin, Huddinge, SWEDEN Discussion: There have been several reports regarding the eti- Anton Arndt, Huddinge, SWEDEN, Presenter POSTER ABSTRACTS ology of OCL of the ankle joint. Many investigators have con- Charles Milgrom, Jerusalem, ISRAEL cluded that OCL of the ankle is primarily traumatic in origin. Ingrid Ekenman, Stockholm, SWEDEN However, it remains to be clarified whether OCL is usually ini- Dept. Orthopaedic Surgery, Huddinge University Hos, Huddinge, SWEDEN tiated by a single acute trauma or develops gradually after repeated microtraumas. Our study shows that almost all of the Introduction C, S, or CS lesions occurred at the time of initial trauma in dis- Stress fractures are a common overuse injury in athletes in a tal fibular fractures. In the cases of ATFL disruption, repetitive variety of sports and the most frequent localisation is the tibial microtrauma with remaining lateral instability was the major shaft. The two major types are the postero-medial and the ante- cause of C, S, or CS lesions of the talar dome. rior stress fracture and these types have a different etiology, patho-anatomy and natural course. Stress fractures at the ante- rior location are regarded as more difficult to treat and are a Basic Science problem for athletes performing frequent jumps such as in bal- let dancing, long jump and basketball (Ekenman, 1998). The purpose of this study was to use a strain gauge instrumented Poster #20 staple system to measure local bone deformation at two VASCULO-NEURAL ORIGIN TO CHRONIC ACHILLES defined sites during various jumping exercises. TENDON PAIN Håkan Kjell, Bertil Alfredson, Umeå, SWEDEN, Presenter Materials and Methods Lars Öhberg, Umeå, SWEDEN Ten physically fit male patients (mean(SD) age: 33(4.5), weight: Sture Forsgren, Umeå, SWEDEN 84(9.3) kg, height: 185(4.8) cm) participated in the study. Strain Mattias Lorentzon, Umeå, SWEDEN gauge problems were encounter for three subjects and the pre- Ronny Lorentzon, Umeå, SWEDEN sented results are therefore, for seven subjects. Strain gauges Sports Medicine Unit, University of Umeå, Umeå, SWEDEN were attached to surgical staples, which were inserted under local anaesthetic in predrilled holes in the postero-medial and Purpose: The purpose of this study was to investigate were the anterior tibial sites. Subjects performed zig zag hopping, verti- pain comes from in chronic Achilles tendinosis, by using ultra- cal hopping and forefoot landings. All landings were on a sonography and colour doppler, enzyme histochemistry, gene Kistler force platform for definition of ground contact. technology, and diagnostic injections. Results Methods: All patients had the diagnosis chronic Achilles tendi- Peak tension strains were greater than compression for all three nosis. In 32 patients (mean age 47 years), ultrasonography and exercises at the more proximal, anterior location. The highest colour doppler was used to study tendon structure and occur- strains at this location were for zig zag hopping (tension: 1242 rence of neovascularisation. In 20 patients, a local anaestetic ± 1828 me, compression: -646 ± 958 me). The absolute highest

5.20 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). tension strain was, however, measured at the postero-medial - intraarticular part of m. subscapularis: poor increase of location during zig zag hopping (tension: 1768 ± 2214 me, com- RE1 (10°), but associated with a risk of shoulder dislocation (1 pression: -1078 ± 1491 me). Compression was greater than ten- case) sion at the postero-medial site for vertical hopping and forefoot landing. Discussion: Our frozen shoulder model was reproducible. Arthroscopically superior and anterior capsular release seemed Discussion to be secure in our experimental study (no vascular or nervous All results showed high standard deviations resulting from high damage). Our study emphasized on the importance of rotator intersubject differences. The strains recorded were not greater interval release to retrieve external rotation. Combined release than those in running (Milgrom et al., 2000). Variations were of rotator interval and inferior glenohumeral ligament leaded to found between the two locations with tension strain being a better results on mobility. Lack of posterior shoulder capsule greater factor at the anterior site as indicated for a single sub- study was a limit of our work. ject by Ekenman (1998). Greater anterior tension may be the result of plantarflexor contraction when landing on the fore- foot. Tension at the anterior location is suggested as a possible Poster #23 mechanism in stress fracture etiology in athletes engaged in BONE MARROW PERFUSION IN HEALTHY SUBJECTS frequent jumping activity. ASSESSED BY SCINTIGRAPHY AFTER APPLICATION OF A TOURNIQUET References Lars Blond, Solrod, DENMARK, Presenter Ekenman, I. 1998. Tibia stress fractures in athletes – an investi- Jan LysgÂrd Madsen, Frederiksberg, DENMARK gation of possible predisposing factors. PhD thesis, Karolinska Dept. of Orthop. Surg., Amager Hospital and Dept., Copenhagen, DENMARK Institute, Stockholm, Sweden. Milgrom, C. et al. 2000. Do high impact exercises produce Introduction higher tibial strains than running. Br J Sports Med., 34,195-199. So far, only few studies have dealt with bone marrow perfusion distally to a tourniquet. This study addressed the topic.

Poster #22 Material and methods FROZEN SHOULDER: EFFECTS OF SUPERIOR AND Eighteen male and six female healthy volunteers of mean age ANTERIOR CAPSULAR RELEASE. A CADAVERIC STUDY. 50 years (range 20-86) had a tourniquet inflated on either upper Philippe Boisrenoult, Le Chesnay, FRANCE arm (14 subjects) or thigh (10 subjects). After bolus injection of Pascal Gaudin, Le Chesnay, FRANCE autologue 99mTc-labeled erythrocytes, dynamic imaging of arm Fabrice Duparc, Rouen, FRANCE or leg was performed as 1-sec frames for 15 min with a gamma Philippe Beaufils, Le Chesnay, FRANCE, Presenter camera. The time for arrival of the labeled erythrocytes to the Department of Orthopaedics Surgery, Andre Mignot H, Le Chesnay, FRANCE condyles was recorded and the velocity of the progression of erythrocytes was calculated. All subjects had a DXA-scan in Introduction: The aim of this study was to determine the effects order to evaluate body composition. of arthroscopically assisted superior and anterior capsule release, on motion in an experimental model of frozen shoul- Results der. In all subjects we observed labeled erythrocytes to ooze beneath the cuff through the bone marrow and reach the Material and methods: 12 cadavers shoulders were used. condyles. The erythrocytes passed on via periarticular vessels Passive range of motion (ROM) was initially normal. Capsular to reach soft tissue distally to the joint. The median velocity for shrinkage was performed to simulate a frozen shoulder the progression was 4.0 cm/min (quartile 3.1-5.3) in the upper

(Arthrocare®, energy 2). Then, 12 selective cuttings sequences limb and 3.7 cm/min (quartile 2.7-4.4) in the lower limb. POSTER ABSTRACTS under arthroscopically control were done (Arthrocare®, energy Kendall rank test did not reveal any correlation between gender, 9). Following structures were studied: rotator interval, medium age, body composition or blood pressure and velocity for the glenohumeral ligament, inferior glenohumeral ligament, and progression. the intraarticular part of m. subscapularis. Posterior capsule was not studied. After each section, two independent examina- Conclusions tors measured ROM. An open approach was finally performed This study shows that while the use of a tourniquet can effec- to confirm cuttings and to look for potential nervous or vascu- tively occlude the extra-osseous blood supply, some intra- lar damage. osseous blood supply is retained, making it difficult to obtain a bloodless field in some patients, despite the use of a tourni- Results: Measures were reproducible (+/- 5°). In all shoulders, quet. The present scintigraphic technique might be valuable for cuttings were satisfying. There was no vascular or nervous dam- visualisation of osteonecrosis of the condyles, for evaluation of age. The role of each studied structure could be resumed as the intra-osseous blood supply in long bone fracture sites or well as: aseptic loosening of knee prothesis. - rotator interval: external rotation increase in 0° of eleva- tion (ER1) (mean 40°), and 90° of elevation (ER2) (mean 35°). This increase was superior to the decrease during shrinkage. Poster #24 - inferior glenohumeral ligament: increase of elevation EXSANGUINATION OF LIMBS IN ELDERLY SUBJECTS (mean 33°) BEFORE SURGERY - rotator interval and inferior glenohumeral ligament: more Lars Blond, Solrod, DENMARK, Presenter important increase of elevation and ER2, than after each iso- Jan LysgÂrd Masen, Hvidore, DENMARK lated cutting (synergy). Dept. of Orthop. Surg., Amager Hospital and Dept., Copenhagen, DENMARK - medium glenohumeral ligament: poor increase of external rotation at 45° of elevation and flexion. Introduction Until now, no study have compared the efficacy of different methods for exanguination of limbs in elderly subjects before

5.21 surgery. This was done in the present study by means of a new sion. The changes in col III mRNA after 15’ of stretching were scintigraphic technique. more moderate than observed for col I (30’: 43%, 60’:48%).

Materials and methods Conclusion: Collagen gene transcription is revealed to be rap- Gamma camera scintigraphy after autologue injection of idly responsive to cyclic stretching of fibroblasts. Dependent on 99mTc-labeled erythrocytes was used to evaluate the percent- stress time, fibroblasts respond differentially to cyclic stretch- age reduction of blood volumes in both lower and upper limbs ing. This may have implication for the healing process in ten- after different exsanguination procedures in 10 healthy individ- don/ligament injuries. Cyclic stretching of engineered uals with a mean age of 82 years (range 76-86). The exsan- tendon/ligament tissues may also affect the mechanical prop- guination methods were elevation for various time periods or erties of cell/collagen composites used to repair/reconstruct Esmarch bandage. tendons and ligaments. With different stretch time periods, the quality and thus the mechanical properties of in vitro generated Results tissues could be modulated. The different exsanguination procedures gave rise to the fol- lowing median percentage reduction of blood volumes. In the lower limbs: Elevation 5 sec 42 %, 15 sec 46 %, 30 sec 45 %, 60 Poster #26 sec 46 %, 120 sec 47 %, and Esmarch bandage 61 %. In the upper INSERTION TORQUE, PULLOUT STRENGTH RELATIONSHIP limbs: Elevation 5 sec 31 %, 15 sec 33 %, 30 sec 35 %, 60 sec 34 DURING BIOABSORBABLE INTERFERENCE SCREW %, 120 sec 32 %, and Esmarch bandage 53 %. Elevation of the FIXATION OF A SOFT TISSUE TENDON GRAFT: lower limbs for 15 sec was significantly more effective than ele- A SYNTHETIC AND HUMAN CADAVERIC BONE vation for 5 sec (p<0.02). For the upper limbs no significant dif- BIOMECHANICAL STUDY WITH OPERATIVE CORRELATES ferences were found between the effects of elevation for the David N.M. Caborn, Louisville, KY, USA, Presenter various time periods. Esmarch bandage was significantly more John Nyland, Louisville, KY, USA efficient than elevation in both upper limbs (p<0.001) and Peter Hester, Louisville, KY, USA lower limbs (p<0.001). University of Louisville, Louisville, Kentucky, USA

Conclusions Purpose: This study attempted to determine the relationship When using elevation alone 15 sec is needed for the lower limb between the insertion torque of bioabsorbable interference and 5 sec is needed for the upper limb. Esmarch bandage are screws used for soft tissue tendon graft fixation in synthetic and significantly more effective the elevation alone. human cadaveric bone and the biomechanical characteristics of pullout strength including load to failure, stiffness and dis- placement. A secondary objective was to determine the opera- Poster #25 tive efficacy of using an insertion torque-measuring device TIME-DEPENDENT MODULATION OF COLLAGEN TYPE I during ACL reconstruction with a soft tissue tendon graft. AND III GENE EXPRESSION IN HUMAN FIBROBLASTS UNDER CYCLIC STRAIN Materials and Methods: POSTER ABSTRACTS Ulrich Bosch, Hannover, GERMANY, Presenter Twelve doubled, 100 mm long tibialis anterior allografts of sim- Johannes Zeichen, Hannover, GERMANY ilar size (length = 100 mm, diameter = 9 mm) prepared for ACL Michael Skutek, Hannover, GERMANY reconstruction were randomly divided into 2 equal groups (n = Martijn van Griensven, Hannover, GERMANY 6). Group 1 was distally fixed in tunnels created in 10 lb/ft3 Laboratory of Histology and Cell Biology, Departme, Hannover, GERMANY dense synthetic bone and group 2 were distally fixed in tunnels created in 20 lb/ft3 dense synthetic bone (FR-6700, General Objective: Mechanical strains have the capacity to modulate Plastics, Tacoma, WA). Tunnels of 7.5-mm diameter were drilled cell behavior through several different signaling pathways. in 5 cm3 synthetic bone blocks and then dilated to 9.5 mm. The Understanding the response of ligament and tendon fibroblasts soft tissue tendon grafts for both groups were fixed in their to mechanically induced strains may provide useful knowledge respective tunnels with a single 10-mm diameter, 35-mm long, for treating injuries, improving rehabilitation regimens and for bioabsorbable Delta interference screw using the Torque engineering functional grafts for tissue repair. The aim of the in Measuring Device (Arthrex Inc., Naples, FL) to record maximum vitro study was to determine collagen (col) I and III gene insertion torque. Following fixation, the proximal end of each expression in human patellar tendon derived fibroblasts under graft was secured with clamps in a servo hydraulic-testing cyclic strain. machine (Model# 1331, Instron Corp., Canton, MA) with the displacement force vector aligned directly with the tibial tunnel Methods: Human patellar tendon fibroblasts were obtained (“worst case scenario”). The graft was then preloaded to 25 N, from specimens of 5 donors (18-40 years) undergoing surgical cycled from 0-50 N, and was then subjected to a 20-mm/min treatment of knee joint instability. Fibroblasts were cultured traction force. Identical procedures were used to test the fixa- and 500 000 2nd passage cells from each donor were plated on tion characteristics of 8 tibialis anterior allografts in human flexible silicon dishes. Monolayers of these subconfluently cadaveric tibias (BMD = 0.84 g/cm2). Interference screw inser- grown cells were then stretched along their longitudinal axes by tion torque was measured during operative efficacy testing with an electromechanical device. Cyclic strain (5%, 1Hz) was the Torque Measuring Device by the same surgeon during the applied for 15’ and 60’, respectively. Col I and III mRNA was primary ACL reconstruction of 14 otherwise nonimpaired measured by RT-PCR: 0’, 15’, 30’ and 60’ after stretching, respec- patients (age = 27.6 +/- 8.6 yrs of age, 8 female, 6 male) using tively. Fibroblasts from each donor without any mechanical similar sized allograft tibialis anterior tendons. All patients stimulation served as individual control. The paired t-test was were non-smokers. Pearson product moment correlations were used for statistical analysis (p<0.05). used to determine relationships between biomechanical graft fixation characteristics with bioabsorbable interference screws Results: 15’ of stretching results in a significant increase in col and the densities of synthetic and human cadaveric bone. I mRNA 30’ (67%) and 60’ (69%) after stretching, respectively. Insertion torque and subject age relationships were determined After 60’ of stretching, no significant increase in col I mRNA was during operative efficacy testing. observed. Similar results were observed in col III mRNA expres-

5.22 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Results: All grafts failed by tunnel pullout. Biomechanical test- AIM: in our study we evaluated two patients, of our series of ing of synthetic bone revealed strong relationships between autolugous cartilage implantation, to check with a biopsy, at insertion torque and material density (r = 0.97) and between two years, the type and organization of cartilage tissue and its insertion torque and load to failure (r = 0.80). A moderate rela- attachment to the bone. tionship was observed between insertion torque and stiffness (r = 0.70), and no relationship was observed between insertion Material and method : In two patients (age 29 and 31 years) we torque and displacement (r = 0.07). Using human cadaveric tib- performed autolugous condrocyte transplantation, the patients ias a strong relationship (r = 0.86) was observed between inser- had severe chondral lesion, 3 and 4 cm2, on medial femoral tion torque and BMD, and moderate relationships were condyle. We harvested small cartilage fragments on non weight observed between insertion torque and load to failure (r = 0.70) bearing surface of the affected knee, then condrocytes were iso- and between insertion torque and stiffness (r = 0.72). An lated and cultured. After five weeks the cells were implanted on insignificant relationship (r = 0.23) was observed between the lesions using a proteoglycane substrate (Hyalograf). At two insertion torque and displacement. Operative efficacy testing years we performed an arthroscopy with a biopsy of the treated revealed a strong inverse relationship between tibial insertion lesion; the specimens were observed by routine and polarized torque and subject age (r = -0.74) and a similar, but weaker rela- light microscopy. The patients were also evaluated clinically tionship between femoral insertion torque and subject age (r = (ICRS score) and subjected by standard x-ray and MR of the -0.47). knee.

Conclusions and Significance: Results display the close rela- Results: Both patients had symptomatic improvement, MR tionship between insertion torque, load to failure and stiffness imaging showed a well appearing cartilage layer; arthroscopi- for bioabsorbable interference screw fixation of soft tissue ten- cally the lesions were completely healed, but they were soft don grafts. The close relationship observed between insertion when evaluated by probe. The lower part of biopsy showed a torque and subject age during operative efficacy testing sug- hyaline cartilage while in the upper side there was fibrocarti- gests a close association with BMD. The Torque Measuring lagineous tissue. The transplanted tissue was inserted into Device may be a useful tool in determining the need for hybrid bone, but no tidemark was observed. Polarized light fixation, particularly at the tibia. microscopy showed fibrous bundles in the superficial and mid- dle part of biopsy.

Poster #27 Discussion and Conclusion: We obtained excellent clinical MORPHOLOGICAL STUDY OF RABBITS KNEE WITH AN results (confirmed also by MR) with autolugous condrocytes OPEN EPIPHYSIAL CARTILAGE AFTER ANTERIOR transplant, the patients were free of pain with a complete CRUCIATE LIGAMENT RESECTION R.O.M., histology showed, at two years, that new cartilage was Moises Cohen, Sao Paulo, BRAZIL, Presenter inserted into bone but condrocytes were non arranged in layer Fernando Luiz de Arruda, Sao Paulo, BRAZIL like normal articular cartilage, there was a significant part Rene Jorge Abdalla, Sao Paulo, BRAZIL (almost 50%) constituted by fibrocartilagineous tissue. We con- Federal University of Sao Paulo, Sao Paulo, BRAZIL clude that the new-formed cartilage seems firmly attached to the bone, but many concerns still remain regarding the function Abstract: The objective of this study was to analyze the mor- of this disorganized cells in the long period. phology of the rabbit knee joint with an open epiphysial carti- lage after the anterior cruciate ligament resection. Sixty young male rabbits were distributed into two groups, denominated Poster #29 control and experimental groups with 30 left and 30 right knee TIME-DEPENDENT MECHANICAL AND HISTOLOGICAL joints. The anterior cruciate ligament resection was performed CHANGES OF LIGAMENTS AFTER THERMAL SHRINKAGE: on the knee joints of the experimental group and an arthrotomy EFFECT OF IMMOBILIZATION POSTER ABSTRACTS in the 60 remainders keen joints, denominated the control Mehmet Demirhan, Istanbul, TURKEY group. The animals were submitted to a reoperation in 3, 6 and Mustafa Uysal, Istanbul, TURKEY 12 weeks. Macroscopic and histological alterations in the carti- Onder Kilicoglu, Istanbul, TURKEY, Presenter lage were observed in 6 weeks. These alterations were deter- Istanbul University, Istanbul Faculty of Medicine, Istanbul, TURKEY mined by the laterality. Evidence was confirmed in 12 weeks. Aim To investigate the possible effects of immobilization on biome- Poster #28 chanical and histological properties of collagenous tissue HISTOLOGIC EVALUATION OF AUTOLOGOUS treated with thermal shrinkage in an in-vivo rabbit model. CHONDROCYTES TRANSPLANTATION Antonio Delcogliano, Rome, ITALY, Presenter Material and methods Salvatore Franzese, Rome, ITALY 52 medial collateral ligaments in 26 mature New Zeland rabbit Silvio Chiossi, Roma, ITALY knees were divided into 8 groups. Monopolar radiofrequency- Amerigo Menghi, Roma, ITALY assisted thermal shrinkage procedure was performed on all lig- Giuseppe Rinonapoli, Roma, ITALY aments, except 5. In half of the knees, joints were immobilized. Ernesto de Santis, Roma, ITALY Animals were sacrificed at 0, 3, 6, 9 weeks postoperatively. All Antonio Caporaso, Roma, ITALY ligaments were tested biomechanically using a material testing Universita Cattolica - Clinica Ortopedica, Roma, ITALY machine. Histological changes were evaluated using electron microscopy. Autologous chondrocyte implantation now is very popular technique, however many concerns there are about the type of Results this cartilagineous layer and the ability of this new tissue to Average ultimate failure load in the unshrunken control group bond to subsiding bone. was 56.40±11.05 N. Failure loads of the shrunken ligaments were 54.92±9.63 N after 3 weeks, 31.45±14.03 N after 6 weeks, 24.28±5.30 N after 9 weeks in immobilized knees and

5.23 38.14±12.79 N on week 0, 53.12±17.15 N after 3 weeks, Carlos Vicente Andreoli, Sao Paulo, BRAZIL 32.08±11.57 N after 6 weeks, 45.20±18.20 N after 9 weeks in Flavio Faloppa, Sao Paulo, BRAZIL unrestricted knees. The failure loads of shrunken ligaments Maria Thereza Alves Seixas, Sao Paulo, BRAZIL were significantly lower than the control group on the day of Alexandre Odashiro, Sao Paulo, BRAZIL operation (p<0,10). Although the immobilized ligaments Moises Cohen, Sao Paulo, BRAZIL remained weaker than the unrestricted group, this difference Federal University of Sao Paulo, Sao Paulo, BRAZIL was statistically significant only on the 9th week (p<0.10). The neural histology of the human shoulder ligament were Conclusion studyed using anti-protein S100 (immunohistochemical analy- Shrinkage causes an acute loss in the tensile strength of tis- sis of mechanoreceptors). The inferior glenohumeral ligament sues. Although immobilization within the first 6 weeks follow- were obtained at autopsy from 18 fresh cadavers (36 shoulders), ing operation might be helpful for protecting the ligament, age average of 37 years and 10 months. The purpose of this prolonged immobilization seems to have negative effects on sutdy was described the sensory innervation, number and types tissue healing after shrinkage. of mechanoreceptors according to side and age. The ligaments were splitted in two section, one more medial and another lat- eral to the labrum. We classified the neural structures using Poster #30 morfological studies (freeman and Wyke, 1967) and size (Del FAILURE STRENGTHS OF IN VIVO DEGRADED Valle et al, 1998). The immunohistochemical analysis showed BIOABSORBABLE INTERFERENCE SCREWS 1197 neural elements in the inferior glenohumeral ligament, Onder Kilicoglu, IStanbul, TURKEY mainly near the attachment in the glenoid. There was no statis- Mehmet Demirhan, Istanbul, TURKEY, Presenter tical difference in the right and left shoulder. The cadavers older Senol Akman, Istanbul, TURKEY than 30 years old showed more Ruffini like receptors in the Ata Can Atalar, Istanbul, TURKEY medial portion of the ligament, and in the younger cadavers we Serhat Ozsoy, Istanbul, TURKEY found more free nerve endings. Umit Ince, Istanbul, TURKEY Istanbul University, Istanbul Faculty of Medicine, Istanbul, TURKEY Poster #32 Aim: To investigate the effect of in vivo degradation on the fail- INFLUENCE OF THE BONE TUNNEL ANGLE ure strengths of polylactide bioabsorbable interference screws. ON THE GRAFT-BONE HEALING PROCESS Study design: Animal model experiment. Kensaku Hashiba, Kanazawa, JAPAN, Presenter Katsuhiko Kitaoka, Kanazawa, JAPAN Method: Ten bioabsorbable (poly-L-lactide) interference screws Department of Orthopaedic Surgery, Kanazawa Univer, Kanazawa, JAPAN (BioInterference, Arthrex) were used to fix ipsilateral patellar tendon grafts in 10 live sheep knees. The animals were sacrified [INTRODUCTION] Implantation of an autogenous tendon graft in the 6th and 12th postoperative weeks. The screws were into the bone tunnel is a common procedure in soft tissue retrieved and re-implanted using the same technique in 10 reconstruction surgery, and many studies have been reported POSTER ABSTRACTS cadaveric sheep knees. Fixation strength of the screws were on this. However, no study has been conducted in which a vari- determined by pulling on the patellar tendon. Results were ety of mechanical stresses were exerted in the same model. compared to a control group consisting of 4 screws, placed in cadaveric knees. The mechanical tests were followed by macro- [PURPOSE] The purpose of this study was to assess the graft- scopic and microscopic examination of the specimens. bone healing process in the light of the time, location and bone-tunnel angle. Results: Mode of failure was tendon pull-out in all tested screws. Tendons pulled out with an average force of 357±30 N [MATERIALS & METHODS] Sixty-five rabbits were used. Under in the control group consisting of cadaveric knees. The screws, general anesthesia, the extensor digitorum longus tendon was retrieved after a degradation period of 6 weeks, failed with a dissected and inserted into the bone tunnel made in the proxi- mean load of 399±119 N, and 12-week screws at 447±72 N, mal tibia. The bone tunnel was drilled at 30, 45 and 60 degrees while the nondegraded screws (control group) failed at 465±118 to the lateral cortex of the tibia with custom-made drill guides. N after their second implantation. The differences between The inserted tendon was fixed on the medial cortex with suture these groups were not significant. No signs of degradation and washer. The rabbits were sacrificed at 2, 4, 6, 8 and 12 weeks could be observed on the retrieved screws. Histological exami- after operation, and eight areas were observed in each speci- nation of the 6 week specimens showed necrotic changes in the men. Each specimen was evaluated and scored according to tendon around screw contact areas. Healing with granulation our evaluation criteria. tissue was present in the same area in the 12th week. Foreign body reaction or an inflammatory response was not observed. [RESULTS & CONSIDERATIONS] There were obvious differ- ences in the healing process of the graft-bone junction in terms Conclusion: In vivo degradation of poly-L-lactide interference of time, location and bone-tunnel angle, and these were found screws causes neither a loss in the fixation strength of the to be interactive. The biological bond was finally established at screws for at least 12 weeks nor an obvious inflammatory reac- the entrance of the bone tunnel which appeared to be due to tion. PLLA interference screw can safely be used as an alterna- stress shielding. When the bone-tunnel angle was closed in the tive to metallic screws. direction of the load, the continuity appeared early. It seems that the shearing force accelerates the healing process. We are currently performing mechanical testing, and hope to show the Poster #31 results of this in the near future. IMMUNOHISTOCHEMICAL ANALYSIS OF MECHANORECEPTORS IN THE HUMAN INFERIOR GLENOHUMERAL LIGAMENT. Poster #33 Benno Ejnisman, Sao Paulo, BRAZIL, Presenter Eduardo Da Frota Carrera, Sao Paulo, BRAZIL

5.24 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). METABOLIC CHANGES IN KNEE JOINT SYNOVIA DURING REPERFUSION AFTER ARTHROSCOPY – AN IN VIVO (Results) Mesenchymal cells gradually showed elongation, STUDY USING THE MICRODIALYSIS TECHNIQUE cytoplasmic vacuolization and pyknosis in the intermediate Torsten Wredmark, Stockholm, SWEDEN zone where the elongated cells were parallelized in some strata. Erland Hˆgberg, Stockholm, SWEDEN, Presenter Some of these cells were further flattened into spindle cells and Center for Surgical Science, Karolinska Institute, Stockholm, SWEDEN the number of strata decreased to two. Concerning cavitation, the initial separation was detected between the elongated cells Background: The aim of this study was to quantify how a mild in the intermediate zone in paraffin sections at E16.5 and the surgical trauma such as arthroscopy alters synovial metabolism spindle cells in epoxy sections at E18.5. No positive cells were and local blood flow. We used the microdialysis technique to detected in the knee joint at any stage from E16 to E18.5 with monitor synovial physiology in vivo. TUNEL methods. A ladder pattern showing the occurrence of DNA fragmentation due to apoptosis was obtained from the Methods: Basic carbohydrate metabolism and blood flow was samples of forelimbs at E16. But the pattern was not found in monitored in the synovial membrane with in vivo microdialysis the samples from the knee joint at all stages. following knee joint trauma using arthroscopy as trauma model. Arthroscopy was performed with or without a tourni- (Discussion) The micro- and ultracellular alterations in the quet in order to differentiate the grade of ischemic trauma. interzone seemed to reflect the differences in the arrangement and density of collagen fibers and developmental condition of Results: Lactate levels were higher in the synovial membrane extracellular matrix between layers, and these alterations also than in reference tissue (subcutaneous fat). There was a signif- did not seem to be likely inhibit the synthesis of hyaluronan at icant increase in lactate postoperatively. Blood flow, measured the presumptive joint line because this synthesis is performed as ethanol ratio was stable in both tissues. These findings indi- at the plasma membrane. Conclusions Separation between cate an increase in local lactate production since the levels of spindle cells should be the developmentally programmed cavi- lactate in blood and reference tissue were comparable and did tation, and it is probably natural that the rationalization of the not show a significant increase. There was a consumption of milieu of extracellular matrix for cavitation accords with cellu- glucose in the synovial membrane which was not observed in lar metamorphoses in the interzone. the reference tissue. Pyruvate levels were higher in the synovial membrane. Poster #35 Conclusion: A state of reperfusion occurs in the synovial mem- •CALCITONINE GENE-RELATED PEPTIDE AND brane following a moderate trauma such as standard NEUROPEPTIDE Y AFTER ECCENTRIC EXERCISE arthroscopy of the knee joint. Microdialysis should be further Sven Jonhagen, Bromma, SWEDEN, Presenter evaluated in the study of in vivo physiology in the synovial Paul W Ackermann, Stockholm, SWEDEN membrane. Tonu Saartok, Visby, SWEDEN Per A Renstrom, Stockholm, SWEDEN Karolinska Hospital, Stockholm, SWEDEN Poster #34 THE MECHANISM OF THE DEVELOPMENT Microdialysis followed by radioimmunoassay was used in an IN RAT KNEE JOINT. attempt to detect neuropeptides in human skeletal muscle and Masaaki Ito, Urakawa, JAPAN, Presenter also to study the effect of eccentric exercise. Eight healthy sub- Japanese Red Cross Urakawa General Hospital, Urakawa, JAPAN jects participated in the study. Microdialysis of the distal part of vastus lateralis of the quadriceps was performed at rest, imme- (Introduction) The findings of some researchers suggested the diately after eccentric exercise and two days after the exercise. dense accumulation of blastemal mesenchymal cells is appar- The microdialysate was analysed by radioimmunoassay focus- POSTER ABSTRACTS ently distinguishable between two osseous primordia of the ing on detection of Calcitonine Gene-Related Peptide (CGRP) pre-chondral mesenchyme at an early stage in the development and Neuropeptide Y (NPY) as peptides representing the sen- of a synovial joint. The joint develops within this accumulation, sory and autonomic nervous system. Over all, the measured which is generally called, the interzone, and consists of three concentrations were low, some even below the detection limit. layers. The middle layer of the interzone is also called the inter- At rest, CGRP was detected in 2 of 8 subjects (20%), directly mediate zone. As far as the developmental mechanism of the after exercise in 6 of 8 (75%) and two days after exercise in 6 of synovial joint is concerned, hypotheses can in principle be clus- 8 (75%). At rest, NPY was detected in 0 of 8 subjects (0%), tered into two groups. The classical one is that a partial cavity directly after exercise in 4 of 8 (50%) and two days after exercise emerges somewhere within the interzone and becomes in 1 of 8 (13%). The study shows that measurable levels of CGRP enlarged by mechanical stimulation due to movement. In other, and NPY can be detected in skeletal muscle after eccentric exer- there is a revival in terms of cell disappearance in the interzone, cise. The results indicate a short lasting increase in NPY levels including cell degeneration and cell death. We could not find and long lasting increase in CGRP levels after eccentric exer- out any report clearly indicating no contribution of apoptosis to cise. Both CGRP and NPY may be involved in vasoregulation cavitation by means of both immunochemistry and morphol- after exercise, whereas CGRP also might be involved in the reg- ogy. Thus, we investigated the development of the rat knee joint ulation of pain that is seen after eccentric exercise. using light and electron microscopy, using immunological and biochemical methods to show precise structural cellular changes (morphological differentiation) in the interzone. Poster #36 CHONDROCYTE TRANSPLANTATION AGAINST THE FULL (Material & Methods) We used 126 hindlimbs and 12 forelimbs THICKNESS CARTILAGE DEFECT HAS THE PROTECTIVE of 63 white Wistar rat embryos of the stages from E14 to P1, and EFFECT FOR SURROUNDING NORMAL CARTILAGE investigated the development of the rat knee joint by light and Kenichi Kajitani, Izumo-shi, JAPAN, Presenter electron microscopy. TUNEL methods and electrophoresis of Mitsuo Ochi, Izumo-shi, JAPAN DNA fragments were examined to detect apoptosis in this Yuji Uchio, Izumo, JAPAN study. Kenzo Kawasaki, Izumo, JAPAN

5.25 Sokichi Maniwa, Izumo, JAPAN and C6ST mRNA expression gradually decreased after opera- Seiji Furukawa, Izumo-shi, JAPAN tion. The amount of CS and the ratio of C6S to C4S and C6ST Department of Orthopaedics, Shimane Medical Univer, Izumo-shi, JAPAN mRNA expression in the regenerative cartilage tissue gradually increased after operation although these scores were signifi- Introduction: Cartilage, once destroyed, doesn’t recover but cantly lower than those of the control group. In the control degenerates, with the surrounding and facing cartilage further group, there were no significant changes in the amount of CS, deteriorating into osteoarthritis. Transplantation of cartilage- ratio of CS isomers or C6ST mRNA expression. like tissue by tissue engineering is promising for repairing car- tilage defect with hyaline cartilage-like tissue. However, it is Conclusion: C6ST was correlated with the ratio of CS isomers in obscure whether this procedure would prevent deterioration of articular cartilage. Moreover, C6ST may play important roles in the surrounding and facing cartilage. The purpose of this study maintaining or improving the quality of CS in articular cartilage. was to investigate its protective effects for progressing to osteoarthritis. Poster #38 Materials and Methods: 36 rabbits were divided into three REGIONAL DIFFERENCES IN THE HEALING POTENTIAL groups. A cartilage defect (size: 6mm x 4 mm in width and 3 mm OF THE MENISCUS - AN ORGAN CULTURE MODEL TO in depth) was created on the patellar groove of the knee. The ELIMINATE THE INFLUENCE OF MICROVASCULATURE defects were filled with allogeneic chondrocytes which were AND SYNOVIUM isolated from joints, embedded in atelocollagen gel, and cul- Kenji Kobayashi, Hiroshima, JAPAN, Presenter tured for 3 weeks (G group). As controls, the same defect was Eisaku Fujimoto, Hiroshima, JAPAN left empty (D group), and a sham operation was performed (S Yoshio Sumen, Hiroshima, JAPAN group). At 12 and 24 weeks after operation, the cartilage in the Mitsuo Ochi, Izumo-shi, JAPAN surrounding area and the patella was assessed macroscopi- Yoshikazu Ikuta, Hiroshima, JAPAN cally, histologically, biochemically,and biomechanically. Department of Orthopedic Surgery, Hiroshima Univer, Hiroshima, JAPAN

Results: Macroscopically, many osteophytes were observed in Introduction the surrounding cartilage in the D group. Mankin’s score of the Many studies about meniscal healing have concluded that D group was significantly higher than that of the G and S groups peripheral vascularity into the meniscus plays the principal role at 12 and 24 weeks (p<0.05). The stiffness and the concentra- on its healing. Recently, regional differences of biochemical tion of chondroitin sulfate in the D group were significantly property of meniscal cells have been reported. To our knowl- lower than those in the other two groups at 24 weeks. edge, there have been no histological studies of the regional differences of the healing potential without influence of blood Conclusion: Transplantation of cartilage-like tissue may pre- supply. The purpose of this study was to examine the regional vent progression to osteoarthritis without deteriorating the sur- healing response of meniscus using an organ culture. rounding and facing cartilage after chondral injury. Materials and Methods POSTER ABSTRACTS A full-thickness circular defect, 1.5 mm in diameter, was placed Poster #37 in the avascular zone of the meniscal specimens harvested from CORRELATION BETWEEN CHONDROITIN-6 both knees of rabbits. The menisci were divided into two groups SULFOTRANSFERASE MRNA EXPRESSION AND THE by following treatment. In Group T, the defects were filled with COMPOSITION RATIO OF CHONDROITIN SULFATE meniscal grafts, 1.5 mm in diameter, from the peripheral zone ISOMERS IN OSTEOARTHRITIC AND REGENERATIVE of the same specimens after resection of the femoral surface to CARTILAGE TISSUE OF THE RABBIT KNEE JOINT match the recipient. In Group C, the tissue removed for creat- Kenzo Kawasaki, Izumo, JAPAN, Presenter ing the circular defect in the avascular zone were implanted in Mitsuo Ochi, Izumo-shi, JAPAN the defects after cutting the femoral end of the tissue as menis- Yuji Uchio, Izumo, JAPAN cal grafts. Menisci of both groups were cultured in multiwell Sokichi Maniwa, Izumo, JAPAN culture plate (one meniscus per one well). Atfter the incubation Toru Nakanishi, Izumo, JAPAN for 2, 4 or 6 weeks, each of the meniscal explants was evaluated Shimane-Medical University, Izumo, JAPAN grossly and histologically using the semiquantative scorings. The association between the graft and the recipient tissue was Object: The composition ratio of two chondroitin sulfate (CS) rated with a 3-point scale for gross evaluation, and was rated isomers (C6S, C4S) is known to increase in the skeletal matured with a 4-point scale for histological evaluation. The high score stage and decreased in osteoarthritic cartilage. In this study we was assigned to the good association. The differences between examined the correlation between Chondroitin-6 sulfotrans- the 2 groups were analyzed by the means of unpaired Mann- ferase (C6ST) mRNA expression and the composition ratio of Whitney test. Immunohistochemical analysis with anti-prolifer- chondroitin sulfate isomers in osteoarthritic (OA) and regener- ating cell nuclear antigen (PCNA) were also carried out to ative cartilage of the rabbit knee joint. assess the healing reaction.

Materials and Methods: In this study we employed the ACL Results transaction method for the OA model and creation of an osteo- The morphological difference was not detected after incubation chondral defect for the regenerative cartilage model. The for 2 and 4 weeks. After the incubation for 6 weeks, the score of amounts of C6S and C4S in the normal, osteoarthritic and Group T was significantly higher than that of Group C (p regenerative cartilage were measured by HPLC methods and =.0152). Histologically, healing reactions in the interface C6ST mRNA expression was observed by semi-quantitative PCR between the graft and the recipient tissue occurred in 7 (16%) at 1 and 3 months after operation. of 37 explants in Group C. In contrast in Group T, healing reac- tions such as the cross-link formation and fibrous continuity Results: In the OA model, while the amount of CS was were observed in 27 (59%) of 37 explants. The histological score increased at 1 month after operation, it was significantly of Group T was higher than that of Gour C after incubation for decreased at 3 months after operation. The ratio of C6S to C4S each periods, and there were siginificant differences between

5.26 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). two groups after 4 and 6 weeks incubation (p=.0237, p=.0281). in human meniscal fibroblasts adjacent either to the surface or The PCNA-positive cells were detected in the interface between to the injection site, depending on the application method. the two components in Group T. When rAAV-lacZ was applied in vivo to medial meniscal tears, reporter gene expression was achieved for at least twenty days Discussion following transduction. Our group previously reported that meniscus has slow-cycling cells (implication for precursor cells) at peripheral region. We Conclusion: These data suggest that AAV-based vectors can used an organ culture to evaluate whether peripheral region efficiently transduce and stably express foreign genes in human containg slow cycling cells has superior reparative potential, meniscal fibrochondrocytes. The reported efficiencies are com- without the influence of blood supply and synovial tissue. More parable to the previously reported data using adenoviruses or reparative reactions were observed in implanting the grafts retroviruses in vivo. The data further indicate direct application from peripheral region (Group T). These results suggest that of rAAV vectors results in successful transduction of human meniscal tissue of the peripheral region have higher healing menisci in explant culture. Finally, the data demonstrate that potential than that of the inner region. The difference of the these rAAV vectors are capable of effectively delivering recom- regional healing response of the meniscus in vivo may be due binant genes to meniscal lesions in vivo. This approach may to not only the vascularity but also the healing potential of the form the basis for novel treatments of meniscal lesions. cells in the meniscus.

Poster #40 Poster #39 CHONDROCYTES INDUCE CHONDROGENIC EFFICIENT TRANSDUCTION OF MENISCAL DIFFERENTIATION OF SYNOVIOCYTES UNDER THE FIBROCHONDROCYTES IN VITRO AND IN VIVO BY COCULTURE CONDITION RECOMBINANT ADENO-ASSOCIATED VIRUS VECTORS Sokichi Maniwa, Izumo, JAPAN, Presenter Henning Madry, Homburg, GERMANY Tetsuya Nishikori, Izumo, JAPAN Magali Cucchiarini, Homburg, GERMANY Kenichi Kajitani, Izumo-shi, JAPAN Ernest Terwilliger, Boston, MA, USA Mitsuo Ochi, Izumo-shi, JAPAN Stephen Trippel, Indianapolis, IN, USA Shimane Medical University, Izumo, JAPAN Dieter M Kohn, Homburg-Saar, GERMANY, Presenter Laboratory for Experimental Orthopaedics, Departme, Homburg, GERMANY Purpose: To evaluate the chondrogenic differentiation of syn- oviocytes (Sys) cocultured with chondrocytes (Chs). Introduction: Successful gene transfer into menisci is a prereq- uisite for gene therapy of meniscal lesions. In the present study Methods: Sys were obtained by explant culture of the synovial we tested the hypothesis that recombinant adeno-associated membrane of the knee joint of a young rabbit. Chs were pre- virus (rAAV) vectors are capable of effecting gene transfer in iso- pared from articular cartilage by enzymatic digestion with 0.25% lated human meniscal fibrochondrocytes in vitro, human trypsin and 0.25% collagenase. Sys were seeded at a concentra- meniscal tissue in vitro and sites of meniscal damage in vivo. tion of 25000 cells/cm2 and cocultured with Chs at a 1:1 ratio. Locomotion of the cells was monitored using a phase contrast Methods: Recombinant AAV vectors expressing the E. coli fl- microscope and a time-lapse video. Immunocytochemistry was galactosidase (lacZ) gene under the control of the CMV-IE pro- performed using anti-S-100 protein and anti-collagen type II moter/enhancer were packaged, purified, and titrated by antibodies. Indirect coculture was also performed using a real-time PCR. Human meniscal fibrochondrocytes were enzy- membrane separated trans-well culture chamber (MSTC). matically isolated from menisci obtained at the time of total knee arthroplasty and transduced in monolayer culture with Results: Migration velocity of Sys decreased from 13.7um/h to graded doses of rAAV-lacZ. Human meniscal explants obtained 7.4um/h 4 hours after coculture and the spindle-shaped mor- POSTER ABSTRACTS at the time of total knee arthroplasty were transduced with phology of Sys became polygonal similar to Chs. Positive rAAV at a dose of 8 µl of virus stock per sample either onto the immunostaining of S-100 protein was observed in Chs (72%), surface of untreated human menisci or injected into meniscal cocultured cells (53%), but was not in Sys (0%) (p<0.01). tears that were created using a scalpel. In vivo, 2.5 µl of rAAV- Collagen type II was detected in Chs and cocultured cells. S-100 lacZ were applied to medial meniscal tears in the knee joints of protein was not detected in Sys when cocultured using a MSTC Chinchilla bastard rabbits using a Hamilton syringe. LacZ gene (indirect coculture). expression was assessed by X-Gal-staining. Histological sec- tions were stained with eosin and examined by light Discussion and Conclusion: Under the coculture condition, Chs microscopy. Differences between groups were compared using induced chondrogenic differentiation of Sys, which have the ANOVA. Data are expressed as mean ± standard deviation (SD). nature of mesenchymal stem cells (MSC). Our results suggest that cell-to-cell interaction rather than soluble factors may play Results: Isolated human meniscal fibrochondrocytes were a role in chondrogenic differentiation of Sys. MSCs in the syn- transduced with an efficiency of 14.4 ± 9.5% when 0.1 µl virus ovial tissue are promising cell source for articular cartilage stock were applied. Increasing the amount of rAAV-lacZ induced repair. a dose-dependent increase in efficiency. Maximal transduction efficiency was 87.2 ± 14.8% with 16 µl virus stock (n = 3). ANOVA revealed significant differences between all treatment groups (P Poster #41 < 0.05; n = 3), except when the dosis of 8 µl was compared with THE EFFECTS OF MECHANICAL COMPRESSIVE STRAIN 16 µl 0.05; (P > 0.05; n = 3). When rAAV-lacZ was applied to the ON THE ARTICULAR CHONDROCYTES. A STUDY USING surface of human meniscal explants or injected into meniscal MRNA EXPRESSION OF CULTURED CHONDROCYTES tears in vitro, X-Gal staining was observed over the entire sur- AGAROSE GEL. face of the explants or in the tissue surrounding the injection Kensuke Mio, Tokyo, JAPAN, Presenter site (n = 7). Gene expression persisted until day 28 post-trans- Seiji Saito, Tokyo, JAPAN duction, the longest time point analyzed. On histological analy- Taisuke Tomatsu, Tokyo, JAPAN sis of transduced human menisci, X-Gal staining was observed Hideo Matsumoto, Tokyo, JAPAN

5.27 Yoshiaki Toyama, Tokyo, JAPAN the articular cartilage. Following this unexpected discovery, Institute Rheumatology, Tokyo Women’s Medical Univ, Tokyo, JAPAN daily intraarticular injections of a high dose of AG-041R for 3 weeks into the normal knee joints of rats have induced cartilage [Objective]: To investigate the effects of cyclic compressive hyperplasia in marginal regions of the femoral condyle without strain on articular chondrocytes cultured in agarose gel. other tissues being affected. In this study, we examined the effect of AG-041R on the repair of osteochondral defects in the [Methods]: Bovine articular chondrocytes were cultured in rabbit knee joints. Materials and Methods: Osteochondral agarose gel supplemented with or without IL-1 beta. After the defects (cylindrical, 4-mm diameter) was created in the patellar application of 15% compressive strain at 1Hz for 24h, total RNA groove of the rabbit knee joint. At the time of operation, 100~l was extracted and reverse transcribed into cDNA. Then, mRNA of 1~M of AG-041R was administered, followed by 200~l with an levels of aggrecan, type II collagen, aggrecanase1, 2 and MMP3 osmotic pump for 14 days. Histological and biochemical evalu- were assayed by semi-quantitative RT-PCR. ations were performed at 12 and 24 weeks after surgery.

[Results]: In unstrained constructs, IL-1 beta caused a signifi- Results: The histological score of the AG-041R-treated group, cant decrease in the mRNA levels of anabolic factors such as the quantity of glycosaminoglycan and the ratio of chondroitin aggrecan and type II collagen compared to the constructs with- sulfate in the AG-041R-treated tissue were significantly higher out IL-1 beta. On the other hand, it caused a significant than in the untreated group. Moreover, the degeneration of car- increase of catabolic factors such as aggrecanase 1, 2 and tilage around the defect was suppressed in the AG-041R- MMP3. In the absence of IL-1 beta, strain caused an increase in treated group. mRNA levels of aggrecan and type II collagen compared to unstrained constructs, but statistically not of aggrecanase 1, 2 Conclusion: These findings suggest that AG-041R is effective for and MMP3. In the presence of IL-1 beta, strain reduced mRNA the repair of osteochondral defects. levels of aggrecanase 1, 2 and type II collagen, but statistically not of aggrecan and MMP3. Poster #43 [Discussion]: In the absence of IL-1 beta, when strain was CLINICAL AND IMMUNOLOGICAL EVALUATION OF applied, chondrocytes expressed higher mRNA levels of ana- PATIENTS WITH SYMPTOMATIC METAL HYPERSENSITIVITY bolic factors than unstrained chondrocytes. This result is com- FOLLOWING KNEE ARTHROPLASTY. IS METAL patible with those written in many reports (Buschmann MD, HYPERSENSITIVITY A CAUSE OF PROSTHETIC LOOSENING? Lee DA), and suggests that physiological compressive stress is Yasuo Niki, Tokyo, JAPAN, Presenter an essential factor for normal cartilage. IL-1 beta is a powerful Hideo Matsumoto, Tokyo, JAPAN catabolic agent. In unstrained constructs, IL-1 beta caused a Toshiro Otani, Shinjuku-ku, JAPAN decrease in the mRNA levels of anabolic factors and an Yasunori Suda, Tokyo, JAPAN increase of catabolic factors. However, when strain was applied Takashi Toyoda, Tokyo, JAPAN in the presence of IL-1 beta, we could find that the strain Department of Orthopaedic Surgery, Keio University, Tokyo, JAPAN reduced mRNA levels of aggrecanase1 and 2 significantly. POSTER ABSTRACTS Aggrecanase 1 and 2 are recently thought to be the major Introduction: Although metal hypersensitivity can undoubtedly enzymes responsible for cleaving the core protein of aggrecan occur after prosthetic implantation, the role of metal hypersen- and then mediating cartilage breakdown. So, this result may sitivity in prosthetic loosening has yet to be established. beneficial for protecting articular cartilage. Physiological Several reports have documented prosthesis-induced metal mechanical stress may essential for the chondrocytes of not sensitization as assessed by skin-patch test. However, the inter- only normal joints but also abnormal joints such as OA or RA. pretation of skin-patch test is not exactly straightforward in sit- Recently, many authors suggest that physiological cyclic com- uations with prosthetic implantation, and most pression is important for articular cartilage. Lee DA et al metal-sensitized patients are in fact asymptomatic. In the pres- demonstrated that cyclic compression might counteract the ent study, we performed radiographical and biological analyses effects of IL-1 beta on chondrocytes by suppressing both nitric on 10 patients with symptomatic metal hypersensitivity such as oxide and PGE2 synthesis. Our study also suggests that a phys- severe dermatitis or urticaria following knee arthroplasty. In iological cyclic compressive strain may counteract the effects of addition, we discussed potential diagnostic factors for sympto- IL-1 beta on articular chondrocytes by suppressing the expres- matic metal hypersensitivity and relationships between metal sion of aggrecanase 1 and 2. hypersensitivity and subsequent loosening.

Methods: The subject population comprised 10 patients who Poster #42 developed eczematous dermatitis after knee arthroplasty (9 AG-041R, A CHOLECYCTOKININ-B/GASTRIN RECEPTOR TKAs and 1 UKA) Continuous joint effusion co-existed to vari- ANTAGONIST, STIMULATES THE REPAIR OF ous degrees in all patients. Peripheral blood and joint fluid OSTEOCHONDRAL DEFECT IN RABBIT MODEL. samples were obtained from each patient. Mononuclear leuko- Toru Nakanishi, Izumo, JAPAN, Presenter cyte fractions were obtained from heparinized whole blood, fol- Kenzo Kawasaki, Izumo, JAPAN lowed by a modified lymphocyte stimulation test in which T-cell Yuji Uchio, Izumo, JAPAN proliferative activity in response to metal ions such as nickel, Mitsuo Ochi, Izumo-shi, JAPAN cobalt, and chromium was measured. Phenotypic characteris- Shimane Medical University, Izumo, JAPAN tics of joint fluid cells were also determined using flow cytom- etry (FCM). Samples from patients without any evidence of Purpose: AG-041R, 3R-1-(2, 2 Diethoxyethyl) - ((4 methylphenyl) metal hypersensitivity following knee arthroplasty were used as amino-carbonyl methyl) -3- ((4 methylphenyl) ureido-indoline- controls. 2-one), is a cholecyctokinin-B /gastrin receptor antagonist, which was originally developed to treat gastric ulcers. In a pre- Results: Of the 10 patients, 7 displayed localized eczema clinical toxicological study on rats, oral administration of a high around operative scars and 3 demonstrated generalized dose of AG-041R was found to stimulate systemic cartilage eczema. Eczematous reactions started at a mean of 3 weeks hyperplasia, including the trachea, the intervertebral disk and after implantation. The 7 patients with localized eczema and 1

5.28 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). patient with generalized eczema reached immunological toler- secured to a clamp and positioned in a servo hydraulic device ance and eczema subsequently settled within 4 months, while during pullout testing. Grafts were cycled ten times from 10-50 the remaining two still displayed generalized eczema after 4 N prior to pull to failure at a rate of 20 mm/min with the force months postoperatively. Radiographical evaluation found no vector aligned with the tibial tunnel (“worst case scenario”). evidences of prosthetic loosening in any patients. In our modi- Paired t-tests were used to evaluate biomechanical differences fied T-cell proliferation test, which is able to exclude nonspe- between graft types (p < 0.05). cific responses induced by metal antigens, all 10 patients demonstrated positive responses to nickel, or cobalt or Results: Bone mineral densities were statistically equivalent chrome, and the 7 patients with localized eczema changed from between graft types (BPTB = 0.86 +/- 0.16 g/cm2 vs. SBC = 0.85 negative to positive results following development of immuno- +/- 0.14 g/cm2, p = 0.49). Significant differences were not logical tolerance. FCM revealed that percentages of CD3+ T- observed between graft types for load to failure strength (BPTB cells in joint fluid were significantly higher in patients with = 620.8 +/- 209 N vs. SBC = 601.2 +/- 140 N, p = 0.80) or stiff- eczema than in control subjects. Interestingly, after tolerance ness (BPTB = 4.9 +/- 3.7 N/mm vs. SBC = 4.1 +/- 3.7 N/mm, p = was established, percentages of CD3+ T cells gradually 0.74). The SBC allograft yielded significantly more displace- decreased. Importantly, the implantation of prostheses lacking ment prior to failure than the BPTB graft (15.1 +/- 4.9 mm vs. 9.2 surface modifications (i.e., ion implantation) was strongly asso- +/- 1.3 mm). ciated with development of metal hypersensitivity-related eczema. Conclusions and Significance: In this limited sample, the SBC allograft displayed statistically equivalent load to failure Discussion: Metal hypersensitivity reactions are currently esti- strength and stiffness compared to the BPTB graft. This finding mated to affect <1% of patients with orthopaedic implants. in combination with avoidance of tissue morbidity from graft However, based on our study, most cases lose sensitivity due to harvest suggests that the SBC allograft may be an effective immunological tolerance within 3 months after implantation, alternative for ACL reconstruction. Further studies are being and the actual incidence of metal hypersensitivity is likely to be designed to determine if the displacement difference observed higher than reported in past studies. According to the present prior to failure is due to the suture configuration connecting results, the presence of joint effusion and high percentages of bone to soft tissue and whether this difference has any clinical CD3+ T-cells in joint fluid represent potential diagnostic fac- significance. tors. In addition, implantation of prostheses lacking surface modifications was strongly associated with the development of symptomatic metal hypersensitivity. Although a direct causal Poster #45 relationship between metal sensitivity and subsequent pros- THE MENISCOFEMORAL LIGAMENTS: thetic loosening is very difficult to clarify, our study of patients AN ANATOMIC STUDY with symptomatic metal hypersensitivity indicated that metal Maximiliano Ranalletta, Bs As, ARGENTINA, Presenter hypersensitivity may not be associated with prosthetic loosen- Nestor Abel Brigatti, Tolosa, ARGENTINA ing. However, it is possible that associations may be seen in Walter O. Rossi, Capital, ARGENTINA cases where joint effusion persists for a long time. Maximiliano Ranalletta, Bs As, ARGENTINA Medicina del Deporte SA, Bs As, ARGENTINA

Poster #44 Introduction: The menisco femoral ligaments are accesory liga- BIOABSORBABLE FIXATION COMPARISON OF A ments of the knee. They extend from the posterior horn of the SEMITENSINOSIS-BONE COMPOSITE ALLOGRAFT lateral meniscus to the lateral aspect of the medial condile VERSUS BONE-PATELLA TENDON-BONE GRAFT close to the femoral attachment of the posterior cruciate liga- John Nyland, Louisville, KY, USA, Presenter ment (PCL). The fibers running along the anterior surface of the

Scott Klein, Louisville, KY, USA PCL are called anterior meniscofemoral ligament or POSTER ABSTRACTS Peter Hester, Louisville, KY, USA Humphrey’s ligament and those passing along the posterior David N.M. Caborn, Louisville, KY, USA surface are called posterior meniscofemoral ligament or University of Louisville, Louisville, Kentucky, USA Wrisberg’s ligament. The purpose of this study was to evaluate the incidence of the menisco femoral ligaments in cadaverics Purpose: To compare the biomechanical properties of tibial fix- knees. ation for a bone-patellar tendon- bone (BPTB) graft and a novel semitendinosis/bone composite (SBC) allograft. Tibial fixation Materials and methods: Forty cadaverics knees were dissected. remains the most compromised component of ACL reconstruc- There were 20 female and 20 male specimens. All the soft tis- tion in the first eight to twelve weeks postoperatively. Although sues except the cruciate ligaments and the meniscus were the BPTB graft has demonstrated efficacy when used for ACL removed and the distal femur was cut sagittally at the inter- reconstruction, the morbidity associated with its harvest condilar notch. These technique permitted the observation of remains problematic. This study investigated the biomechani- the ligaments and their insertion site. cal properties of the SBC allograft, which is comprised of a quadrupled semitendinosus tendon with cortical bone struts at Results: In all 40 knees, the posterior horn of the lateral menis- each end. The SBC allograft is designed to provide comparable cus was connected to the femur. The anterior meniscofemoral stability to the BPTB graft, but without the adverse sequelae ligament was present in the forty knees (100%) dissected and associated with harvestation. the posterior meniscofemoral ligament in 28 (70%).

Materials and Methods: Seven paired, fresh frozen cadaveric Discussion: The incidence of the meniscofemoral ligaments knees (20-45 years) were stripped of all soft tissue attachments reported in the literature is dispaired. We found both ligaments and randomly assigned to receive either the BPTB graft or SBC present in the 70% of the knees and the anterior or Humphrey’s allograft. After each specimen was DEXA scanned with a thresh- ligament as a constant structure. old of 0.7 g/cm2 for study inclusion, the grafts were placed into tibial tunnels via a standard protocol and secured with 28 mm bioabsorbable screws. The proximal end of each graft was Poster #46

5.29 TISSUE ENGINEERED CARTILAGE BY IN VIVO structs preserved their original rectangular shapes for all CULTURING OF CHONDROCYTES IN A implantation periods. Hematoxylin and eosin stains revealed PLLA-COLLAGEN HYBRID SPONGE an increase of chondrocytes in their natural round morphology Takashi Sato, Tsukuba, JAPAN, Presenter and a decrease of vascularization with increased implantation Guoping Chen, Tsukuba, JAPAN time. A greater number of round morphological chondrocytes Takashi Ushida, Tsukuba, JAPAN were observed in the PLLA-collagen hybrid sponge than in the Tomoo Ishii, Tsukuba, JAPAN PLLA sponge. Safranin O/fast green stains revealed that more Naoyuki Ochiai, Tsukuba, JAPAN GAGs were detected in the PLLA-collagen hybrid sponge than Tetsuya Tateishi, Tsukuba, JAPAN in the PLLA sponge. The amount of GAGs also increased with Tissue Engineering Research Center, National Insti, Tsukuba, JAPAN increased implantation time. Collagen type II was detected in all the implants seeded with chondrocytes. The PLLA-collagen Introduction hybrid sponge seeded with chondrocytes showed a more Tissue engineering of cartilage has been proved to be one of the homogeneous distribution of collagen type II than in the PLLA most promising approaches for cartilage repair. Temporary sponge seeded with chondrocytes. In sponges without chon- biodegradable porous scaffolds play an important role in this drocytes, only fibroblasts and a high degree of neovasculariza- approach. Many different scaffolds have been constructed from tion were observed. Neither GAGs nor collagen type II was a variety of biomaterials. Biodegradable synthetic polymers detected. such as poly(glycolic acid) (PGA), poly(lactic acid) (PLA), their copolymer of poly(DL-lactic-co-glycolic acid) (PLGA), and Discussion biodegradable naturally derived polymers such as collagen Tissue engineered cartilage grafts should meet certain criteria have been most frequently used. Because each of these poly- to enable surgical handling and mechanical loading. Because mers has their respective advantages, hybrid scaffolds have biodegradable synthetic polymers can easily be processed into been developed to combine these advantages[1~5]. In our pre- intended shapes with good mechanical strength, they have vious study, we developed a novel kind of hybrid scaffold by been used as skeletons to hybridize with other more mechani- introducing a collagen sponge into the pores of a synthetic cally weak biomaterials. In this study, we hybridized PLLA polymer sponge [1,2]. In the present study, the PLLA-collagen sponge with collagen sponge and used it as a scaffold for in hybrid sponge was used as a scaffold for in vivo tissue engi- vivo tissue engineering of bovine articular cartilage. The PLLA- neering of bovine articular cartilage. collagen hybrid sponge maintained its original shape, as did the PLLA sponge, whereas the collagen sponge collapsed as we Materials and methods previously reported [5]. The mechanically strong PLLA sponge PLLA sponge and PLLA-collagen hybrid sponge were prepared worked as a skeleton, preventing collapse of the embedded col- as follows. Sieved NaCl particulates ranging in diameter from lagen sponge, and thus would provide easy surgical handling. 600 to 710 micron were mixed with a PLLA solution in chloro- Histological examination the implants revealed that more form at a concentration of 20% (w/v). The mixture was air-dried chondrocytes maintained their original morphology and the and the NaCl particulates were leached out by washing with cartilaginous matrices were more homogeneously distributed deionized water to form the PLLA sponge. The PLLA sponge in the PLLA-collagen hybrid sponge than in the PLLA sponge. POSTER ABSTRACTS was immersed in bovine collagen type I acidic solution (0.3%) The PLLA sponge needed to be prewetted for cell seeding, under a vacuum, frozen, and freeze-dried to form PLLA-collagen while the PLLA-collagen hybrid sponge did not require such hybrid sponge. The hybrid sponge was cross-linked with glu- treatment. Hybridization of the PLLA sponge with the collagen taraldehyde vapor, subsequently treated with 0.1 M glycine sponge facilitated cell seeding, perhaps because of the aqueous solution, and washed with deionized water. The increased hydrophilicity after hybridization. The increase of car- sponges were cut into 8 x 8 x 2.2 mm-sized cubes and sterilized tilaginous extracellular matrices and the decrease of vascular- with ethylene oxide gas. Bovine articular chondrocytes were ization with a longer implantation period in the PLLA-collagen isolated from shoulder and elbow joints of a two-week old calf hybrid sponge suggest the progression of cartilaginous tissue by collagenase digestion. After being subcultured in flasks in formation. The PLLA-collagen hybrid sponge retained the DMEM containing 10% FBS for two weeks with two passages, advantages of both PLLA and collagen, and facilitated the for- the chondrocytes were collected with trypsin treatment and mation of cartilaginous tissue, suggesting that it would be a suspended in culture medium at densities of 5x10E7 cells/mL useful scaffold for cartilage tissue engineering. for seeding. The cell suspension was seeded in the PLLA and PLLA-collagen sponge (140 micro L/sponge) twice. The con- References structs were cultured statically in the medium under a 5% CO2 [1] Chen, G. et al., Chem. Lett. 561-562, 1999. atmosphere at 37 degree C for one week. Subsequently, the [2] Chen, G. et al., J. Biomed. Mater. Res. 51:273-279, 2000. constructs were implanted subcutaneously in the dorsum of [3] Dunn, M.G. et al., J. Appl. Polym. Sci. 63:1423-1428, 1997. athymic nude mice. Each mouse carried four different con- [4] Thomson, B.C. et al., J. Biomater. Sci. Polymer. Edn. 7:23-38, 1995. structs (PLLA sponge with cells, PLLA-collagen sponge with [5] Sato, T. et al., Mater. Sci. Eng. C 17:83-89, 2001. cells, PLLA sponge without cells, and PLGA-collagen sponge without cells). The implants were harvested after in vivo incu- bation of 2, 4, 6, and 8 weeks. The implants were fixed in neu- Poster #47 tral buffered formalin, embedded in paraffin, and sectioned (10 IGF-I GENE TRANSFER BY ELECTROPORATION micron thick). Histological analyses were performed using PROMOTES REGENERATION IN A MUSCLE INJURY hematoxylin and eosin, safranin O/fast green staining and MODEL immunohistochemistry of collagen type II. Toshiaki Takahashi, Kochi, JAPAN, Presenter Kenji Ishida, Kochi, JAPAN Results Ken Ito, Kochi, JAPAN The cell seeding in PLLA-collagen hybrid sponge was easier Akira Tominaga, Kochi, JAPAN than PLLA sponge which required prewetting with the medium. Hiroshi Yamamoto, Kochi, JAPAN No evidence of superficial infection or fistula formation was Department of Orthopaedic Surgery, Kochi Medical S, Nankoku, JAPAN observed. In sponges seeded with chondrocytes, all constructs were easily dissected from the subcutaneous tissue. These con-

5.30 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Purpose: The goal of this study was to determine whether IGF-I and to determine if bipolar RF treatment can stimulate an gene delivery by electroporation promotes repair after muscle angiogenic response. injury. Materials and Methods: Following animal subjects committee Materials and methods: An injury-repair model was created approval, the achilles tendons of seventeen New Zealand White using mice in which a hamstring muscle was cut and sutured. rabbits underwent bipolar radiofrequency coblation with a Fifty micro gram of IGF-I DNA or GFP DNA (both in pCAGGS) Topaz WandTM (Arthrocare, Sunnyvale, CA) model Perc D at a were injected into the lesion and introduced into muscle cells probe setting of 4 (175 V RMS). Under general anesthesia the by electrostimulation using an electric pulse generator. Injured left and right tendons were surgically exposed using a posterior muscles from mice injected with IGF-I DNA group were com- midline incision from heel to mid-calf. Under cooling condi- pared to those from mice injected with GFP DNA group or those tions (continuous infusion of sterile Ringer’s solution), leftside from uninjected mice (sham operated group). Experimental tendons received RF over a 2 cm length at intervals of 0.5 cm at muscles were compared with respect to histologic analysis, durations of 500 milliseconds each touch. Rightside tendons IGF-I concentration at 1, 2 and 4 weeks after injection, and elec- received no RF and served as sham controls. Following the pro- tromyographic examination at 4 weeks after injection. cedure, incisions were closed with a 3-O vicryl suture for the paratenon layer and a 4-O vicryl subcuticular suture for skin Results: The mean number of regenerated muscle fibers in the closure. Eight animals were sacrificed at 9 days, three at 28 days IGF-I DNA injected group was significantly more than that in and six at 90 days. At sacrifice all tendons were examined the GFP-DNA injected and control groups at 2 weeks after injec- grossly and histological evaluation (H&E) was performed using tion. The mean diameter of regenerated muscle fibers from the non-polarized and polarized light microscopy (n=3 at each time IGF-I DNA injected group was larger than that of the GFP-DNA point). Analysis of the angiogenetic markers, alphav integrin injected group at 4 weeks after injection. There was no signifi- subunit and vascular endothelial growth factor (VEGF) by semi- cant difference in the serum IGF-I concentration between the quantitative reverse transcription polymerase chain reaction IGF-I DNA group and the GFP DNA group at 1, 2, and 4 weeks (RT-PCR) was carried out to determine evidence of angiogene- after injection. However, the ratio of injected/non-injected sis. RT-PCR analysis was performed at 9 days (n=5) and 90 days (contralateral) hamstring muscle IGF-I concentration was sig- (n=3). Statistical analysis was performed using paired T-test nificantly greater in mice injected with IGF-I DNA than the ratio and a priority level of significance was set at p<0.1 for those injected with GFP DNA at 1, 2 and 4 weeks. The ratio (injected/uninjected, contralateral) of the amplitude of com- Results: At nine days tendons treated with bipolar radiofre- pound muscle action potentials (CMAP) in the IGF-I DNA quency showed severe inflammation with mild adherence to injected group was greater than that of the GFP DNA injected adjacent tissue and no effusion. Control tendons appeared group after 4 weeks. macroscopically normal. Histological assessment of RF-treated tendons showed thickening of the sheath, inflammatory cells Conclusions: This study also demonstrated that IGF-I gene within the tendon and a slightly disorganized collagen fiber transfer by electroporation increased the number and diameter crimp pattern. Control tendons exhibited normal collagen fiber of regenerated myofibers. These results demonstrated that the organization and structure along with normal appearing fibrob- effects of enhanced IGF-I production were local and limited to lasts, i.e. no inflammatory cells present. RT-PCR analysis at this the injected area. IGF-I gene transfer by electroporation proved time point revealed an increase (p=0.1) in the alphav and VEGF to be a simple, safe, inexpensive and effective method to pro- mRNA levels relative to controls. At 28 days RF-treated tendons mote the regeneration of injured muscles in our injury model. exhibited minimal inflammation, no edema or effusion and mild scarring with adherence to adjacent tissue. Histologically, RF-treated tendons contained fewer inflammatory-like cells Poster #48 than was observed at 9 days but had a sheath, which continued

ANGIOGENIC RESPONSE TO BIPOLAR RADIOFREQUENCY to exhibit hypercellularity relative to sham controls. Control POSTER ABSTRACTS TREATMENT OF NORMAL RABBIT ACHILLES TENDON tendons continued to show a normal appearance grossly and at Virgil B Medlock, Dallas, TX, USA the microscopic level. By 90 days post-treatment the macro- David Amiel, La Jolla, CA, USA scopic appearance of the treated tendons was normal with no Frederick Harwood, La Jolla, CA, USA inflammation, edema or effusion in evidence. Histologically, Scott Ball, La Jolla, CA, USA collagen fiber organization and cellularity appeared normal. James P Tasto, San Diego, CA, USA, Presenter Control tendons continued to show no changes. RT-PCR analy- San Diego Sports Medicine and Arthroscopy Fellowsh, San Diego, CA, USA sis at 90 days demonstrated no differences in alphav or VEGF expression in RF-treated tendons compared to sham controls. Introduction: Normal tendons are characterized by a well- organized collagenous fibrillar network sparsely interspersed Discussion: A common goal in treatment options to combat with fibroblastic cells and vascular structures. Alfredson and tendinosis is to limit tissue injury and stimulate a healing Lorentzon showed that tendons experiencing tendinosis con- response of which angiogenesis is a vital part. Importantly, the tained no inflammatory cells but exhibited changes in the col- present study has demonstrated histological evidence for new lagen fiber ultrastructure. Ahmed et al theorized that poor blood vessel formation and an increase in angiogenetic mark- vascularity may be a factor and may prevent adequate tissue ers in tendons treated with bipolar radiofrequency coblation. repair leading to further weakening of the tendon and potential While the results revealed macroscopic and microscopic rupture. Currently, operative treatment of tendinosis has been changes in the early term, bipolar RF-treated tendons resumed limited to debridement of the abnormal degenerative tissue to a normal appearance by 90 days. These results suggest that stimulate a healing response. CoblationR devices are bipolar bipolar radiofrequency coblation may provide a viable option radiofrequency (RF) probes which use accelerated particles to for the surgical treatment of tendinosis. cause molecular disintegration to effect a controlled ablation of tissue. The purpose of the present study was to evaluate the effects of bipolar RF on the macroscopic and microscopic struc- Poster #49 tural and cellular characteristics of the rabbit achilles tendon

5.31 LONG-TERM SKELETAL UNLOADING cartilage nor details of pathological changes due to unloading INDUCES A FULL-THICKNESS PATELLAR have been reported. This study, in which unloading was applied CARTILAGE DEFECT IN GROWING RATS for 12 weeks by modification of a standard method, revealed Masato Tomiya, Tokorozawa, JAPAN, Presenter that skeletal unloading accelerated the advancement of not Shoichi Ichimura, Tokorozawa, JAPAN only tidemark but also subchondral ossification front. Also Toshiyuki Kikuchi, Tokorozawa, JAPAN revealed was a full-thickness cartilage defect of the patella in Yasuo Yoshihara, Tokorozawa, JAPAN the medial facet without any surface fibrillation of the remain- Tatsuo Kobayashi, Nishitokyo city, JAPAN ing articular cartilage. These results suggest that long-term Kyosuke Fujikawa, Tokorozawa, JAPAN skeletal unloading in children could cause so-called chondro- Department of Orthopaedic Surgery, National Defens, Tokorozawa, JAPAN malacia patellae described by Goodfellow.

Introduction: Much effort has been made to clarify the effects of Conclusion: This study suggested that skeletal unloading as overloading on articular cartilage and bone. However, little is well as overloading cause destruction of articular cartilage. known about the effects of reduced loading, despite its possi- Patellar bone atrophy, particularly in the medial part, was rap- ble contribution to the pathogenesis of certain clinical dis- idly induced by skeletal unloading in the first 3 weeks and eases, such as so-called chondromalacia patellae. In addition, slowly progressed thereafter. although skeletal response to long-term space flight will become more crucial in the near future, such effects have not been elucidated, especially with regard to articular cartilage. Poster #50 The purpose of this study is to investigate the effect of long- THE EFFECT OF EXTRACELLULAR MATRIX ON ACL CELL term skeletal unloading on patellar cartilage and bone using Satoshi Tsukazaki, Tokorozawa, JAPAN, Presenter the tail suspension model of growing rats. Toshiyuki Kikuchi, Tokorozawa, JAPAN Tatsuo Kobayashi, Nishitokyo city, JAPAN Materials and Methods: Fourty 9-week-old male F344/N rats Kyosuke Fujikawa, Tokorozawa, JAPAN were randomly divided into two groups: caged control (C) and Dept. of Orthopaedic Surgery, National Defense Med, Tokorozawa, JAPAN tail suspended (TS). Hindlimbs of the TS rats were subjected to unloading for up to 12 weeks by the Morey-Holton method of [Purpose] tail suspension with some modification. The rats were sacri- The extracellular matrix (ECM) acts not merely as a scaffold for ficed at 3, 6, 9, and 12 weeks. Sequential changes of the patella cells but also regulates their functions. The importance of the in the TS group compared with the C group were analysed ECM is recognized especially in tissue engineering. We have macroscopically and by pathology using hematoxylin-eosin explored the utilization of ECM to promote the regeneration of stain. Total cartilage area (TCA), calcified cartilage area to TCA anterior cruciate ligament (ACL) by tissue engineering meth- (CCA/TCA), and bone volume/tissue volume (BV/TV) correspon- ods. In this study, the effect of type I and type III collagens, ding to the cancellous and cortical spaces in the medial and which are the main ECM of ACL, on proliferation of ACL cells is lateral facets, respectively, of the patella were analysed by per- reported. sonal computer using NIH image 1.62. POSTER ABSTRACTS [Materials and Methods] Results: Macroscopic findings revealed that in the TS group the ACL cells were isolated by digestion with 0.025% collagenase surface of the distal patellar cartilage became purplish, partic- from ACL obtained aseptically from Japanese white rabbits (6 ularly in the medial margin at 3 weeks, suggesting a decrease in weeks of age). The cells in this study were used after the first cartilage thickness. The purple color became more intense at 6 passage in culture. To examine morphological changes and cell weeks, and after 9 weeks a partial defect of cartilage was found. proliferation induced by type I and type III collagens, cells were Pathological findings demonstrated that in the TS group a sig- inoculated at a density of 1 x 104 cells/0.5ml/well onto type I, or nificant decrease in thickness of the entire articular cartilage type III collagen-coated dishes prepared by coating with each was found. On the other hand, the remaining articular surface collagen solution (Nitta Gelatin, Japan). Cells were cultured in did not show any fibrillation. A partial defect of patellar carti- Dulbecco’s modified Eagle’s medium (DMEM) containing 10% lage at the margin of the medial facet was found in 94% of the FBS at 37°C in a humidified atmosphere of 95% air and 5% CO2. TS animals after 9 weeks or more of tail suspension. In the Controls were uncoated dishes. Morphological changes of the medial facet of the patella, at 3 and 6 weeks, most of the sub- cells in each dish were observed by phase contrast microscopy chondral bone marrow was directly in contact with the calcified and scanning electron microscopy (SEM). At 2, 4 and 6 days cartilage where more hypertrophic chondrocytes were fonnd; a after starting incubation, cell proliferation was measured using decrease in thickness of the calcified cartilage was the result. WST-1. TCA in the medial facet in the TS group was significantly decreased compared with the C group at 3, 6, 9, and 12 weeks [Results] (p<0.01), but no such significant differences were found in the Cells cultured on collagen-coated dishes had a markedly differ- lateral facet. CCA/TCA in the TS group significantly increased at ent morphology compared to those in uncoated dishes. The 3, 6, 9, and 12 weeks compared with the C group. Bone atrophy cells on type I collagen extended more processes, whereas was observed in the TS group, with significant decreases in some cells on type III collagen elongated and had more slender BV/TV in the TS group compared with the C group at 3, 6, 9, and shapes.Cell proliferation on type I collagen had a tendency to 12 weeks. This was more marked in the medial than in the lat- be decreased, but in contrast, culture on type III collagen sig- eral facet. nificantly increased proliferation compared to controls or type I collagen. Discussion: O’Connor reported that unloading by tail suspen- sion accelerated the advancement of the tidemark toward the [Discussion and Conclusion] articular surface of the femoral and tibial cartilage, but not Type I and type III collagen affected cell morphology and prolif- advancement of the subchondral ossification front. That is, the eration. These results suggest that both collagens may be thickness of the calcified articular cartilage increased, although important factors for tissue engineering of ACL regeneration. total thickness of articular cartilage did not change. However, neither the effect of longer-term skeletal unloading on articular

5.32 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Poster #51 TENDON GRAFT INCORPORATION IN A BONY TUNNEL BY Methods: Fifteen elbows in 14 consecutive patients were FRACTURE CALLUS FORMATION treated with arthroscopic release of the ECRB tendon for recal- Ido Zion, Jerusalem, ISRAEL, Presenter citrant lateral epicondylitis. All patients had undergone non- Gershon Chaimsky, Jerusalem, ISRAEL operative treatment for an average of 16 months prior to Adi Freedman, Jerusalem, ISRAEL surgery. Standardized pre and post-operative examinations Joseph Lowe, Jereusalem, ISRAEL were performed which included goniometric measurements of Hadassah Hospital, Jerusalem, ISRAEL range of motion and an assessment of strength. The ASES Elbow Assessment Form was completed in all patients both Introduction: The use of hamstring tendons instead of the gold pre-operatively and at final review. standard bone-patellar tendon-bone as ACL autografts has become more frequent. The weak link in early hamstring graft Results: All patients reported significant pain and functional healing and rehabilitation remains the graft fixation technique. limitations pre-operatively, with an average pain score of 7.5 The biological and biomechanical attributes of tendon-bone and ASES score of 46.5. Five patients had a pending Workers healing are not well defined and may be inferior to those of Compensation Claim. At an average follow-up of 18 months all bone to bone healing. Supplementation of the fixation by but 2 patients were satisfied with the procedure, with 86.7 % manipulation of the healing process may be desirable. Our reporting minimal or no pain (average pain score 1.1). study was aimed at improving double staple tibial fixation of Significant pain relief had usually occurred by the first post- tendon grafts in ACL reconstruction by impaction of bone graft operative visit. Two elbows in 2 patients (13.4 %) did not into the tibial tunnel. improve and subsequently underwent further surgery. At final follow-up all patients had a full range of motion with no signif- Materials and Methods: The study utilized a dog model, in icant difference in measured strength between operated and which the long digital extensor tendon was transplanted into non-operated sides. The average ASES score had improved to an extra-articular tunnel in the proximal tibia and fixed with a 85.7. There were no complications. periosteal suture and, in the experimental group with an addi- tional staple impacted into the tunnel roof. Discussion: Arthroscopic release of the ECRB tendon provides excellent pain relief and satisfactory return of elbow function Results: We showed that the maximal load to failure as well as and strength in patients who have failed an extensive period of the stiffness of a tendon graft in a bony tunnel, increased sig- non-operative treatment for lateral epicondylitis. Patient satis- nificantly with time in those animals in which the graft fixation faction is high and the average ASES Elbow Score can be sig- was supplemented by fracturing the tunnel roof by staple nificantly improved. Improvements in pain are seen early and impaction. complications are rare, making this an attractive alternative to more traditional open techniques. Histological and radiographic parameters were however equiv- ocal: The tunnel was not obliterated by callus at any stage - Apparent tunnel obliteration on X-ray was shown to be an arti- Poster #53 fact on CT scan. There was no bony ingrowth into the graft, and ELBOW ARTHROSCOPY: A COMPARISON BETWEEN the presence of healing callus did not change histological pic- DIFFERENT OUTCOME MEASURES ture of tendon-bone healing by fibrous tissue interzone, as Luca Capuano, Parma, ITALY demonstrated in the literature. Philippe P Hardy, Boulogne, FRANCE, Presenter Samuel Poulain, Boulogne, FRANCE Conclusions: We concluded on the basis of biomechanical data Hopital Ambroise Pare, Boulogne, FRANCE that tendon graft incorporation in the surrounding bony tibial tunnel in ACL reconstruction may have been enhanced by frac- Introduction: The results of orthopaedic procedures as POSTER ABSTRACTS ture callus formation in the vicinity of the tunnel. This tech- described by commonly used scoring systems are difficult to nique may lead to a more rapid and secure fixation of the graft evaluate since they may not necessarily correlate with patients’ at the tibial site. The method we propose may provide a simple satisfaction. and inexpensive method of supplementing early double staple tibial fixation strength when utilizing tendon grafts for ACL Material and methods: This is a clinical outcome analysis on a reconstruction. group of patients treated with elbow arthroscopy. We reviewed 14 patients of 22 patients managed with elbow arthroscopy at our institution between march 1995 and march 2001 with a Elbow/Wrist/Hand mean follow up of 24 months (range 1-64 months). Only 2 patients claimed for workers compensation. Two independent orthopaedic surgeon evaluated all patients using 3 elbow scor- Poster #52 ing systems (Mayo Clinic Elbow Scoring System, Hospital for ARTHROSCOPIC TREATMENT FOR LATERAL Special Surgery, and American Sport Medicine Institute of EPICONDYLITIS: AN OUTCOME ASSESSMENT Alabama scoring systems). A simple satisfaction question and Craig Michael Ball, Auckland, NEW ZEALAND, Presenter a visual analogue scale (V.A.S.) for pain and satisfaction were Leesa M Galatz, St Louis, MO, USA also administered. Spearman’s non-parametric correlation Ken Yamaguchi, St Louis, MO, USA coefficients were calculated for estimating correlation between Washington University in St Louis, St Louis, MO, USA the three scoring systems and the patient satisfaction. The Wilcoxon signed-rank test was used to compare the statistical Introduction: Arthroscopic release of the ECRB tendon has association between the three scoring systems. The Friedman recently generated considerable interest as an alternative treat- test was used to confirm the results at the Wilcoxon test. ment option for refractory lateral epicondylitis. The purpose of this study was to evaluate patient reported outcome and objec- Results: the three scoring systems showed significant correla- tive measures of elbow function following this procedure with a tion with each other (p< 0.05) but failed to correlate to patients’ minimum follow-up of 12 months. satisfaction as expressed by a simple satisfaction question

5.33 which relate to the pre-operative status and to a global visual age was 46 years (range 14 to 69 years). Four patients were left analogue scale which considers both pain and satisfaction handed and 10 right handed, 5 patients were operated at their (V.A.S.). Patients with the same level of satisfaction can perform non-dominant side and 9 at their dominant side. There were 2 differently at the scoring systems. recreational and 1 competitive basketballers, 1 recreational tennis player, 1 competitive judoka and 1 competitive gymnast Discussion and conclusions: Clinical outcome measures at national level. The mean time to return to practice sport was should be more detailed and reliable in describing the efficacy 2.6 months (range 1-6 months), only the competitive gymnast of orthopaedic procedures. The aim of this preliminary study went back to the same preoperative level when practising sport. was not to criticise well-established elbow scoring systems but All the other patients either did not perform sports at all or did to evaluate the relationship between those and the patients’ not practice sports involving the upper limbs. The mean time to subjective perception of satisfaction that seems to be one of return to work was 16,5 days (range 0-60 days). The 2 patients the most important indicator of treatment success. This who claimed for worker compensation were the only two who assumption is at present leading the investigators to utilise as necessitated respectively 30 and 60 days to go back to work. The an integration of traditionally accepted scoring systems, gen- mean duration of symptoms before surgery was 31,4 months eral health and disease-specific quality of life measurement (range 0-240 months), the mean duration of conservative treat- tools that have showed to be very sensible at detecting minimal ment was 3,4 months (range 0-24 months). Only one patient differences of the health status. Another comparison between had previous surgery for a supracondylar elbow fracture the results at the scoring systems and V.A.S. and those occurred two years before the date of arthroscopy. One patient obtained using health-related quality of life (MOS-SF36) and had a diagnostic arthroscopy followed by an arthrotomy to disease-specific measures (Disability of Arm and Shoulder and excise fragments of a radial head fracture. All patients had an x- Hand) is at present under investigation. ray follow up, in 9 cases a TDM or arthro-TDM was performed. All procedures except 3 were performed by the senior Author. Introduction: The arthroscopic procedure consisted in 1 case of the excision Diagnostic and operative elbow arthroscopy has come a long of an articular fragment from a Hahn Steinthal fracture of the way from its early beginnings and is now an accepted treatment humeral condyle, in another patient a similar fracture with a modality for numerous conditions about the elbow although larger fragment was fixed with a canulated screw, in 7 cases of initially deemed unsuitable because of small joint capacity and an anterior and posterior synovectomy, in 3 cases of an dangerous proximity to neuro-vascular structures. Initially indi- osteotomy of an impinging olecranon osteophyte, in 1 patient cations included diagnosis of pain of undetermined cause, the excision of the pseudoarthrotic fragment of the apex of the removal of loose bodies, evaluation and /or debridement of olecranon was performed, in 8 cases multiple loose bodies osteochondritis dissecans lesions of the capitellum and chon- were excided, in 1 case an anterior capsulotomy was carried out dromalacia of the radial head, excision of olecranon osteo- and in 2 patients an anterior and posterior arthrolysis was per- phytes, synovectomy and synovial biopsy, lysis of adhesions. formed. All patients were reviewed from two independent Recently indications have been expanded to include release of orthopaedic surgeon who evaluated all charts and x-ray follow- elbow contractures caused by trauma or degenerative arthrytis, up. At the physical examination, the range of motion, valgus tennis elbow release, olecranon bursectomy, radial head exci- instability at 0 and 30°, postero-lateral rotatory instability (O’ POSTER ABSTRACTS sion and selected fracture treatment. (1) O’ Driscoll and Morrey Driscoll test)(4), palpation of all the components of the elbow in 1992 reviewed 71 patients to critically analyse the diagnostic joint and of the “soft spot”(1) to check for synovitis or synovial and therapeutic benefit of the procedure and reported a 10% of effusion were carried out. A neurological examination was per- complication rate (2). Reddy and Jobe review of 172 patients formed as well. All patients were evaluated with 3 commonly and 187 elbows in 2000 is, to our knowledge the largest group used elbow scoring systems: Mayo Clinic Elbow Scoring System of patients yet reported in the literature. In their study they (referred hereafter as Morrey’s scoring system), Hospital for report a very high success rate with only a 1,6% complication Special Surgery of New York, (referred hereafter as Figgie’s), and rate(3). Other smaller series report complication rates between American Sport Medicine Institute of Alabama scoring system 0 and 15% (3). The purpose of the study was initially just to (referred hereafter as ASMIA). To achieve a homogeneous sta- review the patients operated with elbow arthroscopy to obtain tistical comparison the latter was normalized to 100 points. The surgical results data. The analysis of this group of patients structure of the different domains and relative weight of the using different outcome measures made us understand that the objective and subjective component on the total score was dif- results of elbow arthroscopy as described by commonly used ferent in the three utilised scoring systems (40% subjective scoring systems may not necessarily correlate with patients’ component in Morrey’s system, 50% subjective component in satisfaction, therefore, we decided to evaluate the statistical both Figgie’s and ASMIA’s Scoring systems). A simple satisfac- correlation between 3 widely accepted elbow scoring systems tion question (S.S.Q.) and a visual analogue scale (V.A.S.) for and the patients’ subjective perception of satisfaction as pain and satisfaction were also administered. The simple satis- expressed by a simple satisfaction test and by a global visual faction question relates to the pre-operative status asking analogue scale which investigate both pain and satisfaction. whether the patient feels worse, the same, better or much bet- ter as compared to his pre-operative condition (0-3 range). A Material and methods: Visual Analogue Scale of 100 mm was presented to all patients We reviewed 14 of 22 patients managed with elbow arthroscopy asking to quantify both the residual pain and satisfaction fol- at our institution between march 1995 and march 2001 with a lowing the surgical procedure. As usual the 0 point was referred mean follow up of 24 months (range 1-64 months). One to no pain and/or complete function/satisfaction, while 100 was patients had a diagnostic of osteochondritis dissecans, 1 associated with the most excruciating pain and/or complete patient of post-traumatic osteochondritis of humeral condyle, 4 disability/dissatisfaction. For an easier visualisation of scatter patients of primitive osteochondromatosis, 1 patient of non plots the complement to 100 for the VAS was utilised. specific synovitis, 1 patient of RA, 1 patient of post-traumatic Spearman’s non-parametric correlation coefficients were calcu- pseudoarthrosis of the apex of the olecranon, 3 patient of post- lated for estimating correlation between the three scoring sys- traumatic arthrofibrosis and 2 patient of fracture of capitulum- tems and the patient satisfaction. The Wilcoxon signed-rank humeri. Four patients had loose bodies as concurrent test was used to evaluate the statistical association between diagnosis. Only 2 patients claimed for workers compensation. the three scoring systems. The Friedman test was used to con- Three patients were women and eleven were men. The mean firm the results at the Wilcoxon test.

5.34 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). relevance, health questionnaires need to be used in a longitu- Results: dinal manner, such a way that the patients act as their own con- Even considering the total of 22 patients there were neither trols (5). Unfortunately health questionnaires can be minor nor major complications in this study group. When asked cumbersome, and it is known that for self-administered postal if they would have repeated the arthroscopy if necessary 10 survey’s the higher the patients burden the lower the response patients over 14 answered positively (71%). With reference to rate (8,9,10). When extensive questionnaires cannot be used for the simple satisfaction question, 7 patients affirmed to feel practical reasons other simpler tools such as a simple question much better, 4 better, 2 the same end 1 worse than pre-opera- on satisfaction that refers to the pre-operative status and a tively. Only 2 patients reported an excellent result at the Visual Analogue Scale for pain and satisfaction can provide Morrey’s scoring system, 11 patients were classified as having a useful information regarding the effect of the intervention. good result and 1 patient a poor result. The mean Morrey’s Previous studies have highlighted the importance of patients’ scoring system was 89.6/100 points (median 92.5, mode 88). perception of results when evaluating the outcome of an index The same group reported 7 excellent, 2 goods and 4 fairs results procedure (5,6,7). These findings are confirmed in our prelimi- when analysed with the Figgie’s scoring system. The mean nary study. Figgie’s score was 85.6/100 points (median 90, mode 71). Finally, 6 excellent, 2 goods, 5 fairs and 1 poor results were Commonly used rating systems should be more detailed and reported at the ASMIA scoring system. The mean ASMIA scor- reliable in describing the efficacy of orthopaedic procedures. ing system was 79.4/100 points (median 81.2, mode 97.5). The The aim of this preliminary study was not to criticise well- mean V.A.S. for pain and satisfaction was 25mm (median 23 established elbow scoring systems but to evaluate the relation- mm, mode 20 mm). Despite the initial impression when look- ship between those and the patients’ subjective perception of ing at the data distribution, the three scoring systems showed satisfaction that seems to be one of the most important indi- significant correlation with each other(p <0.05), but they failed cator of treatment success. This assumption is at present lead- to correlate to patients’ satisfaction as expressed by the simple ing several investigators to utilise as an integration of satisfaction question which relate to the pre-operative status traditionally accepted scoring systems, general health and dis- and to a global visual analogue scale which considers both pain ease-specific quality of life measurement tools that have and satisfaction (V.A.S.) when analysed with Spearman’s non- showed to be very sensible at detecting minimal differences of parametric correlation coefficients. Patients with very similar the health status. Another comparison between the results at level of satisfaction can perform differently at the scoring sys- the scoring systems and V.A.S. and those obtained using tems and vice-versa (Morrey’s, Figgie’s and ASMIA/100 scoring health-related quality of life (MOS-SF36)(11) and disease-spe- systems reported respectively p= 0.21; p=0.11 and p=0.17 when cific measures (Disability of Arm and Shoulder and Hand) (12) correlated with the VAS). No statistically significant association is at present under investigation. Apparently we are still far between the three scoring systems was found at the Wilcoxon away from our “target” of a single outcome evaluation system signed-rank test and confirmed with the Friedman test that is under all condition, reliable, valid and sensitive to (p>0,05). The lack of statistical significance of the last tests is changes of clinical importance, that takes into account both probably due to the small size of the sample. patients’ and physicians perspective and that is short and prac- tical to use. Discussion and conclusions: This preliminary study with a sample of 14 patients examined References: on one single occasion providing no information on repro- 1) Baker C.L., Jones G.L. Arthroscopy of the elbow. Am J Sp Med ducibility of data, is certainly not exhaustive. Further studies 1999;27:251-264. with larger groups and a deeper statistical analyse are needed. 2) O’ Driscoll S W, Morrey B F. Arthroscopy of the elbow, diag- In our patients we found no significant correlation between nostic and therapeutic benefits and hazard, J Bone Joint Surg physicians administered rating systems and the patients per- (Am) 1992; 74-A:84-94. ceptions of results, in agreement to the findings of other 3) Reddy A S, Kvitne R S, Yocum L A, ElAttrache N S, Glousman POSTER ABSTRACTS Authors (5,6). Outcomes evaluation should include both physi- R E, Jobe F W. Arthroscopy of the elbow: a long term clinical cian’s and patient’s perspectives (7). Different measures of out- review. Arthroscopy.2000;16-6:588-594. come seem to be needed when a complete assessment of 4) O’ Driscoll S W, Bell D F, Morrey B F. Postero-lateral rotatory results has to be achieved. Scoring systems have been widely instability of the elbow. J Bone Joint Surg (Am) 1991; 73-A:440-446. used to assess results in all domains of orthopaedics since they 5) Callaghan J J, Dysart S H Carlton F. Savory, Hopkinson W J. are usually good at detecting differences in pain and function. Assessing the results of hip replacement, a comparison of five Current elbow-scoring systems are based on the observer- different rating systems. J Bone Joint Surg (Br) 1990; 72-B:1008-9. derived assessment of a variety of clinical and functional crite- 6) Turchin DC, Beaton DE, Richards RR.Validity of observer- ria, which are scored separately and then aggregated. The based aggregate scoring systems as descriptors of elbow pain, aggregate score then is assigned a categorical ranking that function, and disability. J Bone Joint Surg Am 1998 Feb; 80(2):154-62 ranges from excellent to poor. The developers of different 7) Lieberman J R, Dorey F, Shekelle P, Shumaker L, Thomas B J, elbow-scoring systems have chosen different outcome criteria, Kilgus D J, Finerman G A. Differences between patients’ and assigned different weights to each criterion, and accorded dif- physicians Evaluation of outcome after total hip arthroplasty. J ferent ranges of values to each categorical ranking (6). These Bone Joint Surg (Am) 1996; 78-A:835-838. observations and the small size of the sample can probably 8) Robertsson O, Dumbar M J. Patient satisfaction compared account for the lack of statistically significant association found with general health and disease -specific questionnaires in at the Wilcoxon and Friedman tests. The results at the scoring knee arthroplasty patients. J Arthroplasty.2001; 16 systems are usually expressed by arbitrary numbers that are 9) Soderman P, Malchau H, Herberts, P, Zugner R, RegnÈr and often difficult to interpret in a quantitative way. The association Garellick G.Outcome after total hip arthroplasty (part II). Acta of descriptive categories to score ranges does not improve Orthop Scand 2001; 72-2:113-119. things significantly. Health questionnaires have been subjected 10) Dumbar M J, Robertsson O, Ryd L., Lidgren L.Results of a to severe psychometric validation. General health and disease- survey of 3600 patients from the Swedish knee arthroplasty reg- specific quality of life measurement tools have showed to be istry. J Bone Joint Surg (Br) 2001; 83-B:339-344. very sensitive and reliable and therefore, they have been employed increasingly in medical research. To increase their

5.35 11) Ware JE Jr, Sherbourne CD. The MOS 36-item short-form magnetic resonance imaging (MRI) findings in the treatment of health survey (SF-36). I. Conceptual framework and item selec- partial tears of the ulnar collateral ligament (UCL). In addition, tion. Med Care 1992 Jun; 30(6): 473-83. we describe a consistent, reproducible, and reliable method for 12) Hudak PL, Amadio PC, Bombardier C. Development of an performing proper stress radiography. upper extremity outcome measure: the DASH (disabilities of the arm, shoulder and hand). The Upper Extremity METHODS: Over a 3-year period 174 patients were diagnosed Collaborative Group (UECG). Am J Ind Med 1996 Jun;29(6):602-8. with UCL injuries based on history and the presence of pain on valgus stress testing. Of this group, 25 athletes (14.4%) were diagnosed with partial tears of the UCL by MRI read by one Poster #54 radiologist. All patients had plain and stress anteroposterior CORRELATION OF PREOPERATIVE MRI AND radiographs taken of both the affected and unaffected sides. ARTHROSCOPICALLY PROVEN CHONDRAL LESIONS IN The valgus stress was applied by a single physician to all THE ELBOW patients with the shoulder in 65° of abduction, maximal exter- Amos Kidron, Herzliya, ISRAEL, Presenter nal rotation, forearm pronated, and the elbow flexed to 30°. The Preston M. Wolin, Chicago, IL, USA ulno-humeral distance in the plain radiograph was measured Martin L Lazarus, Evanston, IL, USA and subtracted from the measured distance in the stress view. Center for Athletic Medicine, Chicago, IL, USA The difference in opening between the affected and unaffected side was calculated. All patients underwent conservative ther- Purpose: MRI has proved useful in detecting lesions of the knee apy for the symptomatic elbow including avoidance of valgus and shoulder joints .The purpose of this study was to evaluate stress, physical therapy, and range of motion bracing. its usefulness in detecting elbow articular surface injuries by comparing the findings of preoperative MRI with the findings RESULTS: The 25 patients were separated into two groups on arthroscopy. Type of Study: Outcome study and retrospec- based on the calculated side-to-side difference in radiographic tive analysis. Method: Preoperative MRI evaluations of articular ulno-humeral distance. Thirteen patients were found to have a chondral injuries of the elbow were compared with arthroscopic 0.5mm difference or less. In 12 (92.3%), symptoms resolved findings in 31 consecutive patients. Results: The accuracy of with conservative treatment and the patients returned to their MRI in predicting lesions was 45% for the radial head, 65% for baseline level of activity. One out of 13 (7.7%) failed conserva- the capitellum, 20% for ulnar lesions, and 30% for the trochlea. tive treatment and required reconstruction. Twelve patients had MRI arthrography did not significantly increase the predictive a 0.5mm difference or greater, 8 (75.0%) of which failed conser- accuracy. Conclusions: MRI is less useful for detecting isolated vative therapy and underwent UCL reconstruction. Four (25.0%) articular surface injuries in the elbow than in other joints, such of these patients had complete resolution of their symptoms as the knee. The accuracy of the MRI findings does not justify after conservative treatment. its substitution for arthroscopic evaluation. CONCLUSION: Stress radiography is a useful adjunct to physi- cal exam and MRI when evaluating treatment options for partial Poster #55 UCL tears. Since the majority of these patients are high-level POSTER ABSTRACTS ADVANCES IN ELBOW ARTHROSCOPY – athletes whose careers are performance-dependent, it is impor- UTILIZING LEVERAGE FOR VISUALIZATION tant to offer them treatment that permits their return to play as Ronald M Selby, New York, NY, USA, Presenter soon as possible. Our results show that overhead athletes with Stephen J O’Brien, New York, NY, USA partial tears of the UCL who have a 0.5mm or less side-to-side Anne M. Kelly, New York, NY, USA difference with valgus stress radiography will likely resolve with Mark C. Drakos, New York, NY, USA conservative therapy. Those patients exhibiting a more than Samuel A. Taylor, New York, NY, USA 0.5mm difference in laxity will likely not benefit from non-oper- The Hospital for Special Surgery, New York, NY, USA ative management.

Visualization and access are of fundamental importance in arthroscopy including arthroscopy of the elbow. A new tech- Poster #454 nique in elbow arthroscopy utilizes the application of gentle ARTHROSCOPIC TREATMENT OF COMBINED TFCC leverage to pry apart the surfaces of the ulnohumeral joint to LESIONS: A NEW CLINICAL ENTITY gain an improved arthroscopic visualization and access for Michael R. Redler, Trumbull, CT, USA, Presenter instrumentation to work within these confined spaces. A thor- Steven P Fries, Trumbull, CT, USA ough knowledge of anatomy combined with techniques of Beth A Roros, Trumbull, CT, USA retraction and leverage are expanding our ability to operate The Orthopaedic and Sports Medicine Center, Trumbull, CT, USA safely in even narrow confines of the elbow. In recent years, appreciation for the role of triangular fibrocar- tilage complex tears in ulnar sided wrist pain has significantly Poster #440 increased (TFCC - triangular fibrocartilage complex) The TFCC THE ROLE OF VALGUS STRESS RADIOGRAPHY functions as a major stabilizer of the distal radioulnar joint. It IN THE EVALUATION OF PARTIAL TEARS OF THE is the focal point that allows the carpus to rotate with the ULNAR COLLATERAL LIGAMENT radius around the ulna. As a stabilizer of the ulnar carpus, the Keith Sheldon Hechtman, Coral Gables, FL, USA, Presenter TFCC transmits 20% of an axially applied load from the ulnar John E Zvijac, Coral Gables, FL, USA carpus to the distal ulna. Severe twisting and loading injuries of Matthias Rolf Schurhoff, Coral Gables, FL, USA the wrist are commonly responsible for tears of the TFCC. These Jeremy Blair Green, Coral Gables, FL, USA patients will not only present with ulnar sided wrist pain, but John William Uribe, Coral Gables, FL, USA pain with the extremes of supination and pronation as well as UHZ Sports Medicine Institute, Coral Gables, FL, USA repetitive activity. Injuries to the TFCC have presented a chal- lenge in regards to treatment. We have previously reported on OBJECTIVES: The purpose of this study is to examine the value a successful technique for arthroscopic repair of peripheral of stress radiographs in conjunction with physical exam and TFCC tears. The technique involves the use of spinal needles

5.36 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). placed percutaneously through the safe zone and the use of a PURPOSE: The purpose of this study was to clarify the correla- Shuttle relay (Linvatec) and Panacryl suture to create a mat- tion between the number of mechanoreceptors in ACL rem- tress type repair. Follow up for a minimum of 24 months has nants and proprioceptive ability of the patients. produced excellent results when evaluated using the Mayo Modified wrist score. As our series of patients has grown, we METHOD: We studied 29 knees in 29 patients who underwent have noted an interesting subset of patients that have had not ACL reconstruction due to insufficiency of their ligament. There only peripheral TFCC tears, but central tears as well. To the best were 12 males and 17 females with an average age of 27 years of our knowledge, lesions of the TFCC involving both central (range: 14 to 47 years). Joint position sense test evaluated the and peripheral tears have not previously been described. Past ability of patients to reposition their knee to a previously studies have demonstrated successful outcomes with debride- placed angle according to Skinner’s method. The test was per- ment of central lesions and repair of peripheral lesions. Both formed 3 days before the ACL reconstruction. The total number arthroscopic as well as open techniques have been described. of mechanoreceptors in ACL remnants that had been obtained However, when we first encountered a TFCC tear with both a intraoperatively was examined histologically, using the Gairns central and a peripheral component; what we have termed a gold chloride method. Spearman’s correlation coefficient was Combined TFCC lesion, we were perplexed as to how to used for statistical analysis. approach the problem. We ultimately did a thorough debride- ment of the central component and a secure arthroscopic repair RESULTS: The average final inaccuracy of the joint position of the peripheral component and then treated the patient post- sense was 1.3 (0-5.4) degrees. The average number of operatively as we would any other peripheral repair. This first mechanoreceptors in an ACL remnant was 18 (8-30). There was patient post operatively had and excellent outcome with a a significant inverse correlation between the number of Modified Mayo wrist score of 100. Since this first patient, review mechanoreceptors and the inaccuracy of the joint position of our series of TFCC repairs has yielded five additional patients sense of the knee (p=0.032, r=-0.41). with Combined Lesions of the TFCC for a total of six patients. This report is an evaluation of these six patients with combined CONCLUSION: This study clearly demonstrated that a higher TFCC lesions. There were four males and two female patients. number of mechanoreceptors in the ACL remnants was corre- Their average age was thirty-three years old. There were four lated with lower final inaccuracy of joint position sense, sug- right wrist injuries and two left wrist injuries. The dominant gesting that mechanoreceptors in ACL remnant contribute to wrist was injured 5/6 times. Mechanism of injuries included the proprioceptive function of the knee. In ACL reconstructions, three sports related injuries (baseball, hockey and tennis), two surgeons should consider preserving ACL remnants to preserve MVA’s and one assault. Associated pathology involved one proprioceptive function, if possible. In any event, ACL recon- scapholunate ligament rupture and one ECU sling rupture. structions should aim to restore the proprioceptive function of the ligament as well as its mechanical function. Results: Follow up ranged from ten to 48 months and averaged 22 months. Average Mayo Modified wrist score was 90. This SIGNIFICANCE: This is the first study that investigated the cor- compared favorable with our previous series of peripheral TFCC relation between histological status of mechanoreceptors in repairs where the average score was 92.5. ACL remnants and the proprioceptive function of the knee in a same patient. Conclusions: We believe that debridement of the central por- tion of a Combined TFCC lesion in conjunction with repair of the peripheral portion can lead to good and excellent results. Poster #57 Without repair of the peripheral portion of the combined COMPARISON OF TWO BIODEGRADABLE INTERFERENCE lesion, the laxity caused by the tear of the central portion would SCREWS FOR TENDON-TO-BONE FIXATION IN ACL lead to biomechanical instability. Despite the lack of continuity RECONSTRUCTION. EXPERIMENTAL STUDY WITH of the central portion of the TFCC, repair of the peripheral por- ROENTGEN-STEREOMETRIC-ANALYSIS (RSA). POSTER ABSTRACTS tion leads to increased stability by creating a suspension bridge Frank Adam, Homburg/Saar, GERMANY, Presenter type configuration. Burkhart popularized this concept in Dietrich Pape, Homburg/Saar, GERMANY regards to partial repair of massive rotator cuff tears and we Sascha Brombach, Homburg/Saar, GERMANY believe this biomechanical theory is applicable for Combined Stefan Rupp, Homburg/Saar, GERMANY Lesions of the TFCC as well. Debridement of the central portion Dieter M Kohn, Homburg-Saar, GERMANY in conjunction with repair of the peripheral portion of a com- University of Homburg/Saar, Orthopaedic Department, Homburg/Saar, bined TFCC lesion gives the surgeon a viable surgical option GERMANY when faced with this difficult variant of TFCC pathology. Introduction Biodegradable interference screws are frequently applied Knee - ACL devices for Hamstring graft fixation in ACL reconstruction. Some doubt exists about the primary stability that can be achieved. This experimental RSA study was performed to meas- Poster #56 ure micromotion between tendon graft and bone under increas- CONTRIBUTION OF MECHANORECEPTORS IN THE ing load with different screw designs. In addition maximum ANTERIOR CRUCIATE LIGAMENT TO THE JOINT load at failure and linear stiffness were evaluated and the fail- POSITION SENSE OF THE KNEE ure mode was recorded. Nobuo Adachi, Izumo, JAPAN, Presenter Mitsuo Ochi, Izumo-shi, JAPAN Materials and Method Yuji Uchio, Izumo, JAPAN We used 20 porcine specimen for the study. The extensor hallu- Junji Iwasa, Izumo, JAPAN cis longus tendon of the front leg was folded to a four-stranded Masakazu Kuriwaka, Izumo, JAPAN graft and sutured with a baseball stitch. Graft diameter was Department of Orthopaedics, Shimane Medical Univer, Izumo, JAPAN 9mm in all samples. The graft was anchored within a tibial tun- nel of the same diameter and 40mm length either with a stan- dard 7x25mm Polylactid screw (BioScrew, Linvatec) or a special

5.37 designed biodegradable screw for soft tendon graft fixation RESULTS: Fourteen patients (%25) scored poorly (severe abnor- with maximum diameter of 8mm and 23mm length (Sysorb, mal, IKDC grade D), and fortytwo patients (%75) scored abnor- Sulzer). The tibial bone, the tendon-graft and the interference mal (grade C) preoperatively. Fiftyfour patients had improved screw were marked with tantalum beads. After fixation preload- on their prereconstruction IKDC scores. Postoperatively 41 ing with 100N was performed over 2 minutes. The grafts were patients (%73,21) were rated as normal (grade A), 12 patients then loaded axially under RSA control increasing the force in (%21,43) nearly normal (grade B) and 2 patients (%3,57) were steps of 50N. Micromotion between tendon graft, screw and tib- rated as abnormal (grade C) on the assessment of IKDC. Only ial bone was measured with RSA. one case (%1,79) scored poorly (grade D), who demonstrated graft lysis one year postoperatively. Fiftyfour patients (%96,43) Results obtained full range of motion. One (%1,79) patellar fissure, and Accuracy of RSA for the in vitro study was evaluated 0.03mm. one (%1,79) deep venous thrombosis were noted. Three Placement of the slightly thicker Sysorb screw with a blunt patients sustained anterior knee pain during one year postop- thread was technically difficult compared to the sharper eratively. BioScrew. Load at failure was significantly higher for the Sysorb screw (730±145) compared to the BioScrew (445±37N). Linear CONCLUSION: These results suggest that arthroscopic recon- stiffness of the Sysorb screw fixation was about 3 times higher struction using a central third bone-patellar tendon-bone free compared to the standard screw (1687±728N/mm versus autologous graft compares favorably with other alternatives 517±218N/mm, p<0.01). Graft slippage of more than 0.5mm was and provides still gold-standart in the intermediate-term treat- observed at lower loads for the BioScrew (250N versus 461N, ment of ACL rupture. The long-term follow-up results will be p<0.05). Slippage of the graft at 200N was 0.09±0.04mm for the seen in time. Sysorb screw compared to 0.38±0.15mm for the BioScrew in average (p<0.05). Poster #59 Conclusions A LARGE INTRA-ARTICULAR GANGLION BLOCKING Compared to the standard interference screw we found a higher FLEXION OF THE KNEE ultimate failure load, less graft slippage and increased stiffness Sofia Andrikoula, Ioannina, GREECE, Presenter for the specially designed Sysorb screw. Placement of the rela- Vasilis Chouliaras, Ioannina, GREECE tive thick blunt threaded Sysorb screw may be difficult in real Vasilios Kontogeorgakos, Ioannina, GREECE ACL reconstruction. Graft slippage was observed for the Christos Papageorgiou, Ioannina, GREECE BioScrew fixation at loads that may occur during rehabilitation. Anastasios Georgoulis, Ioannina, GREECE University of Ioannina, Ioannina, GREECE

Poster #58 Introduction: Few cases have been reported concerning gan- CENTRAL THIRD BONE-PATELLAR TENDON-BONE glion cysts arising from the anterior cruciate ligament (ACL). ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT However, these ganglion cysts may produce knee discomfort RECONSTRUCTION: A 5-YEAR FOLLOW-UP without a clear etiology. They should be suspected in patients POSTER ABSTRACTS Isik Karli Akgun, Istanbul, TURKEY, Presenter having pain and clicking sensation during terminal knee exten- Tahir Ogut, Istanbul, TURKEY sion or painful limitation of the range of motion. Hayrettin Kesmezacar, Istanbul, TURKEY Istemi Yucel, Istanbul, TURKEY Case report: A 53-year old male gradually developed uncom- University of Istanbul, Cerrahpasa Faculty of Medi, Istanbul, TURKEY fortable restriction to full extension of the right knee for a dura- tion of 9 months. On examination he had 10 degrees loss of PURPOSE: In this retrospective study, we report on the five-year extension and 40-45 degrees flexion. The results of the tests for follow-up results of 56 patients, who had had arthroscopic Lachman’s sign, anterior drawer, pivot shift, posterior drawer reconstruction of the anterior cruciate ligament (ACL) using a were negative. The pain in the anterior aspect of the knee was central third bone-patellar tendon-bone free autologous graft, aggrevated during forced flexion of the joint. to assess the intermediate-term effectiveness of this technique. Imaging results: Radiographs were negative. Magnetic reso- MATERIALS and METHOD: 56 patients underwent arthroscopic nance (MR) imaging of the right knee was performed. It showed ACL reconstruction using bone-patellar tendon-bone autograft a ‘cystic’ mass 2 x 1,5 x 1,5 cm in size in the femoral insertion of by the same surgeon. The mean follow-up was 62.4 months the ACL. (range, 31-99 months). There were 44 males and 12 females with a mean age of 30,17 years (range, 17-44 years). Sport injury Treatment: Based on the above findings, the patient was was the primary cause of the ACL deficiency by almost all of the brought to arthroscopy for further evaluation and proper treat- patients (52, %92,86). We used cannulated interference screws ment. The meniscal and articular surfaces were found to be (kurosaga) for bone-patellar tendon-bone graft fixation. The intact. This intra-articular ganglion was the result of mucinous day after the operation, an intensiv rehabilitation program is degeneration of the ligament. This mass was spread in the begun to perform under the supervision of a physical therapist. medial intra-articular space and posterior horn of the medial We assessed the flexor-extensor balance of the knees with a meniscus. The evacuation of the mass by arthroscopically Cybex 6000 model isokinetic apparatus. The average interval guided needle aspiration was impossible. We performed an between operation and assessment was 5 months. We allowed extended debridement of the ligamentum mucosum using a the patients to return to sports, when the difference between shaver in order to remove all the mass avoiding the fear of the injured and uninjured sides was less than %15 on the recurrent formation of the cyst. Then, we tested the laxity of the assessment. Isokinetic rehabilitation program was applied to remained ACL fibers with a probe. As the mechanical role of the patients, who demonstrated a difference more than %15. them was insignificant, we decided to remove them all. The patients were evaluated according to International Knee Subsequent histologic examination confirmed a ganglion cyst. Documentation Committee’s (IKDC) grading system preopera- At 3 months follow-up patient was symptom free, with no com- tively and postoperatively. plaints of instability and knee pain.

5.38 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Discussion: A ganglion cyst of the anterior cruciate ligament is system (Surgicraft, UK). The graft was passed in the tibia a rare disorder. In our case, it has been related to the femoral through a tunnel and in the femur it was passed over the top. insertion of the anterior cruciate ligament. When this lesion is This group of patients was compared to a group of 59 patients discovered early it can be treated successfully with an arthro- where the Endobutton fixation system (Smith & Nephew) was scopic debridement. Late discovery makes the total resection of used. The two groups were compared using subjective and the ganglion impossible and may result in the weakening of the objective evaluation, and isokinetic and functional strength ACL due to extensive debridement. tests. Assessment using the IKDC knee scoring as well as the Tegner and the Lysholm scores revealed no significant differ- ences between the two groups. Isokinetic evaluation revealed Poster #60 also similar results. Both techniques proved to be safe, effec- ACL RECONSTRUCTION USING THE QUADRICEPS tive and reproducible restoring knee function. TENDON AUTOGRAFT WITH AND WITHOUT PATELLAR BONE PLUG: COMPARISON OF RESULTS Emmanuel Antonogiannakis, Athens-Cholargos, GREECE, Presenter Poster #62 Christos K Yiannakopoulos, Athens, GREECE EVALUATION OF THE ENDOPEARL OF FEMORAL Kostas Karliaftis, Athens, GREECE FIXATION IN HAMSTRING ACL RECONSTRUCTION: Georgios Anastasios Babalis, N. iraklio Attikis, GREECE A BLIND PROSPECTIVE RANDOMIZED CLINICAL TRIAL Christos Karabalis, Athens, GREECE Shalinder Arneja, Winnipeg, CANADA, Presenter Labros Papoulias, Athens, GREECE Warren Froese, Winnipeg, CANADA Antonios Iliadis, Athens, GREECE Peter Benjamin MacDonald, Winnipeg, CANADA Panos Efstathiou, Athens, GREECE University of Manitoba, Winnipeg, CANADA 401 General Army Hospital, Athens, GREECE Purpose: An adjunct to bio-interference screw fixation in the We present the results from the use of a quadriceps autograft femoral tunnel in ACL reconstruction using autogenous semi- for the reconstruction of an ACL deficient knee. Between March tendinosus and gracilis tendons is available called the 1999 and December 2000 we treated 13 patients with chronic EndoPearl (Linvatec, Largo, FL). The EndoPearl, biodegradable ACL deficiency using a quadriceps tendon autograft, harvested poly-(L-lactide) in composition, is sutured to the leading end of from the middle third of the tendon without patellar bone block the graft and placed proximally in the femoral tunnel. The and 14 patients using quadriceps tendon autograft harvested EndoPearl and bioabsorbable interference screw interact to with a patellar bone block. The tendinous side of the graft was form an interlocking system which may provide greater femoral stabilized using the Mark II and Patella Soffix fixation systems fixation strength in vivo. The purpose of the study was to assess (Surgicraft, UK). In the tibia the graft was passed through a tun- the clinical relevance of the EndoPearl using the KT-1000 Knee nel and in the femur it was passed over the top. The graft side Arthrometer and the Mohtadi ACL Quality of Life (ACL-QOL) with the bone block was stabilized in the tibia using interfer- Questionnaire. ence screw fixation. Postoperatively an accelerated rehabilita- tion program was followed. The results were evaluated at a Study Design: Prospective Randomized Clinical Trial. mean follow-up of 25 months. The results have been evaluated using the IKDC, the Lysholm and the Tegner scales. Most Methods: ACL reconstruction with autogenous semitendinosus patients returned to their preinjury level of sports activity. and gracilis tendons was performed on 37 patients. Pre-opera- According to the International Knee Documentation tively, three months, six months and one year post-operatively, Committee rating system, 24 of the 27 patients had normal or patients were evaluated using the KT-1000 Knee Arthrometer nearly normal ratings. Knee laxity was evaluated using the and the ACL-QOL questionnaire. arthrometer Rolilmeter. There were no significant complica- tions related to the use of the autograft. There was no signifi- Results: In comparing side-to-side differences in KT-1000 out- POSTER ABSTRACTS cant differences between the two groups regarding stability and comes pre-operatively, the study group (EndoPearl) showed no function. A quadriceps tendon-patellar autograft is a reason- difference statistically from the control group. Three months able alternative to ACL reconstruction in primary and probably post-operatively, the difference between the study group (1.93 revision ACL reconstruction. ± 1.28 mm) and the control group (3.07 ± 2.15mm) approaches significance (p=0.09). Six months post-operatively, the differ- ence between the study group (1.58 ± 1.12 mm) and the control Poster #61 group (2.64 ± 1.40 mm) is statistically significant (p=0.024). ACL RECONSTRUCTION USING QUADRUPLED Statistically significant differences could not be detected when HAMSTRING TENDON GRAFT: COMPARISON OF TWO comparing the ACL-QOL questionnaire between the two TYPES OF SOFT TISSUE FIXATION groups. Post-operative 1 year follow-up results are pending. Emmanuel Antonogiannakis, Athens-Cholargos, GREECE, Presenter Kostas Karliaftis, Athens, GREECE Conclusion: The application of the EndoPearl in conjunction Christos K Yiannakopoulos, Athens, GREECE with a bioabsorbable interference screw in the femoral tunnel Vassilios Tzortzakis, Athens, GREECE in autogenous ACL reconstruction using semitendinosus and Georgios Anastasios Babalis, N. iraklio Attikis, GREECE gracilis tendon grafts provides a significantly decreased laxity Kostas Kotsiopoulos, Athens, GREECE six months post-operatively in terms of KT-1000 side-to-side Christos Karabalis, Athens, GREECE differences. Clinical Relevance: In an accelerated post-opera- Panos Efstathiou, Athens, GREECE tive rehabilitation program, patients and doctors have 401 General Army Hospital, Athens, GREECE increased confidence in terms of graft stability with the appli- cation of the EndoPearl. We present the results from the use of a quadrupled hamstring tendon graft in the over the top position using a novel soft tis- sue fixation system. Between March 1999 and December 2000 Poster #63 we treated 87 patients with chronic ACL deficiency using a ANTERIOR KNEE PAIN AFTER ANTERIOR CRUCIATE quadrupled hamstring tendon graft using the Mark II fixation LIGAMENT RECONSTRUCTION

5.39 Hiroshi Asano, Tino, JAPAN, Presenter arthroscopy- assisted ligamentplasty of the anterior cruciate Sadao Niga, Kawaguchi, JAPAN ligament through Ian 97 to Nov 99. Full range of knee joint Suwa Central Hospital, Chino, JAPAN motion was standard before revision surgery. A patellar tendon graft was used in 15 of them at the primary ligamentplasty, in 3 PURPOSE: Anterior knee pain is a major complication after ACL hamstrings, in 3 iliotibial band and in 14 others synthetic. 2 reconstruction and this complication causes limitation of daily patients from the last subgroup were undergoing a 2nd revi- and sports activity. To improve results with respect to postop- sion. In all, 32 patients were revised because they suffered the erative pain, we evaluated factors affecting anterior knee pain consequences of instability, 6 others because of synovitis due after ACL reconstruction. to synthetic graft, while 3 patients suffered both. The revision procedure was performed arthroscopically using an autologous METHODS: Four hundred forty-one patients who underwent tendon graft in 22 cases (14 hamstrings, 8 patellar tendon, 4 ACL reconstruction with hamstring tendon were evaluated to quadriceps tendon)and patellar tendon allograft in 9 cases. determine the incidence of anterior knee pain and the associ- Mean follow up was 3 years, while the outcome was accessed ated affecting factors (gender, age, preoperative knee extension using the IKDC score at 2 years after the revision reconstruc- strength). We defined anterior knee pain as a pain occurred in tion. patello-femoral joint or patellar tendon and lasting more than one month. RESULTS: In 7 patients we recognized a misdiagnosed antero- lateral ligament insufficiency, in 25 technical error, in 8 narrow RESULTS: Forty-seven patients (10.7%) indicated anterior knee notch, 8 patients were not collaborated to rehabilitation proto- pain after operation. The major cause of pain is patellar ten- col while 5 others sustained a true re-injury. According to the dinitis. These pains occurred averaged 2.4 months after opera- last follow-up IKDC score, we had: A 7 patients (20%), B 19 tion and lasting averaged 10.6 months. The incidence of (54,3%), C 5 (14,3%) and D 4 (11,4%) patients. 20 out of 35 anterior knee pain was 14.4% in female, 7.4% in male, 9.3% in patients regained their sport activity, 10 in the pre-injury level, aged less than 30 and 20% in aged 30 and over. As regard to 9 patients were satisfied while refused to enable in sports with preoperative knee extension strength, the incidence was 18.6% pivoting activity. We had 2 patients with superficially wound in patients with less than 60% of contralateral limb and 10.4% donor site infection without compromising the graft and one in patients with 60% and over. case with deep-vein thrombosis. Factors of poor prognosis were associated with medial meniscectomy (p=0,03), damaged CONCLUSION: The incidence of anterior knee pain was 10.7% articular cartilage (p=0,02) and a longstanding misdiagnosis of after ACL reconstruction with hamstring tendon. Female, aged the initially ruptured ACL. (p=0,02). over thirty and weak preoperative knee extension strength are risk factors of anterior knee pain after ACL reconstruction. CONCLUSIONS: Despite the usage of arthroscopic technique, the success rate of revision anterior cruciate ligament recon- struction, is lower than the primary surgery. The deleterious Poster #64 effect of previous meniscectomy, articular cartilage lesions and PARTIAL ANTERIOR CRUCIATE LIGAMENT TEARS delayed primary reconstruction lowers even more the success POSTER ABSTRACTS Denis Atkinson, Havelock North, NEW ZEALAND, Presenter rate of the revision procedure. Royston Centre, Hastings, NEW ZEALAND

25 partial ACL tears are reviewed. In 21 cases the diagnosis was Poster #66 confirmed by EUA and arthroscopy. Despite a vigorous rehabil- HOUR-GLASS (BARGASH) TECHNIQUE IN itation protocol the prognosis in the active athelete was poor. 8 ARTHROSCOPIC ACL RECONSTRUCTION cases could not return to sport and were troubled by everyday Nael Abdou Bargash, Jeddah, SAUDIA ARABIA, Presenter instability. All went on to ACL reconstruction. 17 cases returned Khalid Baterjjee, Jeddah, SAUDIA ARABIA to sport but suffered a further major giving way event on aver- Saudi German Hospital, Jeddah, SAUDIA ARABIA age 12 months after diagnosis. 14 of these cases went on to ACL reconstruction. Partial ACL tears in the active athlete have A new technique for ACL reconstruction was implemented in a prognosis similar to complete ACL tears. The extent and type Saudi German hospital – Jeddah-Kingdom of Saudia Arabia 36 of tear did not influence outcome. Diagnosis and management month ago. of the condition is discussed. Forty three patients with clinically and radiologically proven ACL tears were operated by arthroscopic ACL reconstruction Poster #65 using an autogenous bone-patellar tendon-bone graft. All REVISION OF FAILED ANTERIOR CRUCIATE patients are active male athletes with mean age of 27 years. The LIGAMENT RECONSTRUCTION new technique, which was implemented in all patients, was fix- Georgios Anastasios Babalis, N. Iraklio Attikis, GREECE, Presenter ation of the femoral component of the graft using an hour-glass Grigorios Papadopoulos, Athens, GREECE technique without interference screw. All patients were evalu- Kostas Karliaftis, Athens, GREECE ated postoperatively for a mean period of 24 month both clini- Emmanuel Antonogiannakis, Athens-Cholargos, GREECE cally and radiologically. The results of this new technique was Christos K Yiannakopoulos, Athens, GREECE superior to that obtained with the classical technique of using Panos Efstathiou, Athens, GREECE interference screw presented in the literature everywhere after Orthopaedic Department 401 Athens General Military, Athens, GREECE eliminating the well-known and sometimes disastrous compli- cations of interference screws. PURPOSE: Purpose of this retrospective study is the outcome (mid-term) of revision anterior cruciate ligament reconstruction due to recurrence of instability in young soldiers. Poster #67 ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION PATIENTS AND METHOD: 35 young patients (military person- IN PROFESSIONAL BALLET DANCERS. nel, all male), mean age 24,6y (19-31y) underwent a revision A RETROSPECTIVE CASE SERIES.

5.40 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Tomas Drobny, Zurich, SWITZERLAND cal findings in 34 of the 35 knees. Long leg films were available Mario Bizzini, Zurich, SWITZERLAND, Presenter in 30 patients. The mean age at operation was 32 years (18-49). Schulthess Clinic, Zurich, SWITZERLAND Delay between injury and surgery averaged 8 years (range, 1-33 years). Sixty-six percent of the patients (N=23) had previously Background: Ballet dancers perform at highest level, exposing lost the medial meniscus at time of surgery. their knee joints to tremendous loads. Anterior cruciate liga- ment (ACL) injury in professional ballet dancers represent a Results – What were the results? potential career-ending injury. Very little knowledge is available Data in the literature concerning injury and management of the ACL At review, 93% of the patients were very satisfied or satisfied in this specific population. with their operated knee. Subjective score including knee func- tion, symptoms and activity level average 78/100 (range, 46-96). Purpose: To describe the mechanisms, surgical/rehabilitation 48% of the patients could regularly practice leisure sports like management and the functional outcome in 5 professional bal- tennis or skiing. let dancers. Statistical analysis Methods: From 1990 to 1999, 5 professional ballet dancers sus- The overall IKDC objective score was normal (A) for 5 knees tained an acute ACL injury (two of them during a particular (14%) and nearly normal (B) for 16 knees (46%). It was abnormal jump), that required surgical intervention. The surgical proce- (C) for 12 knees (34%) and severely abnormal (D) for 2 knees dure was performed by the same surgeon (TD). The used auto- (6%). The IKDC score was correlated with monopodal weight graft was the Bone Patellar tendon Bone of the ipsilateral knee. bearing translation pre and post operatively. One patient had an open-, the other four had an arthroscopic- In medial compartment, radiological progression of assisted reconstruction. After an intensive rehabilitation, all osteoarthrosis was seen in 5 knees (15%): 3 of 14 knees have the 5 dancers returned to perform at pre-injury level. Follow up evolved from grade B to C and 2 of 20 knees from grade C to D. evaluation included: the complete IKDC 2000 (with clinical Axial femoro-tibial correction was 6.8 degrees at follow up in examination, questionnaires, X-rays), instrumented laxity, iso- group B and 4.7 degrees in group C. kinetic strength and balance measurements. The activity level In lateral compartment, remodelling changes occurred in 18 was also carefully documented. knees (53%) and pre osteoarthritic changes in 2 knees (6%) without correlation with axial correction. Results: The results of this ongoing study will be first presented at the ISAKOS Knee Committee Workshop in Florence Conclusions (November 28th-December 1st, 2002). Performing a valgus tibial osteotomy combined with an ACL reconstruction stabilizes the knee and stop the early progres- sion of osteoarthitis. It has to be considered in chronic ACL Poster #68 deficient knees when radiological pre-arthritis is noticed partic- ANTERIOR CRUCIATE RECONSTRUCTION ularly in case of previous medial meniscectomy or acquired COMBINED WITH VALGUS TIBIAL OSTEOTOMY – malalignment. LONG TERM RESULT Philippe Neyret, Caluire, FRANCE N. Bonin, Lyon, FRANCE, Presenter Poster #69 T. Ait Si Selmi, Lyon, FRANCE ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION – Henri Dejour, Lyon, FRANCE A NEW PRESS-FIT TECHNIQUE Hopital de la Criox Rousse, Caluire, FRANCE Matheos Tzurbakis, Athens, GREECE Aristidis Bordokas, Athens, GREECE, Presenter

The Hypothesis – What is the question? Andreas Panagiotis Diamantopoulos, Athens, GREECE POSTER ABSTRACTS Untreated ACL deficient knee in active individual will predis- Anastasios Smyrnis, Athens, GREECE pose them to instabilities, meniscal tears, and radiographic Iraklis Ioannis Patsopoulos, Athens, GREECE changes. ACL reconstruction itself may increase the onset of 2nd Orthopaedic Department, Evangelismos General H, Athens, GREECE osteoarthritis. The goal is to precise subjective, objective, func- tional, and radiological results of patients that underwent ante- Purpose: The aim of this study is to present a new press-fit rior cruciate ligament (ACL) reconstruction combined with a technique for ACL reconstruction and our clinical results of valgus tibial osteotomy. patients operated with this technique.

Method – How was the question investigated? Methods: From 1995 until now we apply our arthoscopically From 1983 to 1999, we treated 66 knees by this combined pro- assisted press-fit technique for ACL reconstruction using autol- cedure. We only studied the 47 ACL deficient knees that pre- ogous bone-patellar-tendon-bone graft (BPTB). Stable bone fix- sented abnormal radiological findings in the medial ation on the femoral tunnel without using any hardware tibiofemoral joint (remodelling changes (Grade B: 35%), (press-fit fixation), is considered as the main feature of this prearthritic changes (Grade C: 65%)).We excluded 3 knees with technique. Appropriate instruments have been developed evolved osteoarthritis (Grade D), 11 knees with asymmetrical therefore. The technique involves the harvesting of the middle- opening of the lateral compartment and 5 knees with excessive third patellar-tendon with two bone blocks. The bone block constitutional genu varum without medial radiological com- from the tibial tubercle is cut and removed in a trapezoid shape partmental changes. 35 (74.5%) of the 47 knees were retrospec- with the short edge on the tendon side. Femoral and tibial tun- tively reviewed at 11 years mean follow-up (range, 1-16 years). nel are then drilled. The femoral tunnel is prepared in connical A free bone-patellar tendon-bone graft was harvested to recon- shape, using the appropriate instruments. The graft is pulled struct the ACL. Often a Lemaire type extra articular procedure from laterally first into the femur tunnel until a sudden jolt was performed (24 knees). The tibial osteotomy was a lateral indicates that the trapezoid femoral bone block is stabilized in closing wedge in 25 cases and a medial opening wedge in 10 the conical shaped tunnel, while for tibial graft fixation sutures cases. IKDC score was used. Radiologically we checked axis, over a distal bone bridge, is used. 127 patients underwent ACL anterior tibial translation in monopodal stance and radiologi- reconstruction with this technique (acute:47, subacute:15,

5.41 chronical 65). The average age was 26.2 years (range, 17 to 45). There are few data on the incidence of venous thromboem- All patients were operated by the same team of doctors. bolism after knee arthroscopic surgery. This prospective study Postoperatively an aggressive rehabilitation programm was fol- was aimed to evaluate the risk of venous thromboembolism lowed. The patients have been evaluated with the IKDC, Tegner and the clinical results after ACL arthroscopic reconstruction and Lysholm scoring systems. with or without prophylaxis with low-molecular weight heparin (LMWH). Results: 113 patients (88.9%) were reexamined. The average fol- low up period was 42.4 months. Average Lysholm-score was Methods 94,2%; IKDC score was A in 43%, B in 46,5%, C in 8% and D in Between January and December 1999, 36 patients with sympto- 2,5%; Average Tegner-score was before injury 6,6 and in reex- matic ACL deficient knees were randomly allocated to receive amination 6. either no treatment or enoxaparin sodium once daily subcuta- neously for 6 days. Group A, 18 patients, 13 males, 5 females Conclusions: This study indicates that this press-fit technique mean age 32,5 (16-59) no treatment, Group B:18 patients, 12 offers stable graft fixation with very good clinical results, with- males 6 females mean age 29,6 (22-59) receiving LMWH. Both out any of disadvantages associated with “hard-ware”. It not groups were comparable regarding demographics and baseline only reduces significantly the overall cost, but it facilitates revi- characteristics. The reconstructions,with patellar tendon-bone sion surgery and postoperative MRI. autografts, were carried out by a single surgeon using a single technique, and the same rehabilitation protocol was used in all cases. Immediate free RoM and full weight bearing were Poster #70 allowed after surgery. Results were evaluated with the 2000 REHABILITATION AFTER DAY SURGERY ACL IKDC form and major or minor bleedings, were also evaluated. RECONSTRUCTION: A PROSPECTIVE, RANDOMIZED Compression color-coded sonography in case of clinical sus- STUDY pect of venous thrombosis. Statistical analysis was performed Gian Luigi Canata, Torino, ITALY, Presenter with the Student’s t test. Alasdair Sutherland, Mentone, AUSTRALIA Ozgur Ahmet Atay, Ankara, TURKEY Results Onur Tetik, Ankara, TURKEY No differences could be demonstrated between the two groups. Gursel Leblebicioglu, Ankara, TURKEY No case of venous thrombosis was detected in either group. Centro di Traumatologia dello Sport e Chirurgia Ar, Torino, ITALY Group A 3 minor bleedings Group B 2 minor bleedings (p > 0,005) Day surgery reduces costs and lowers the risk of hospital IKDC subjective evaluation : mean score group A 80,7 (45,9- acquired infection. This prospective study evaluates the effect 95,4) group B 75,5 (45,9-88,5) (p>0,05) of day surgery on post-operative rehabilitation time. IKDC knee examination form: Group A 16 A 1 B 1 C Group B 11 A 5 B 2 C (p>0,05) Material and Methods. Between July 1996 and December 1997, 122 patients with symp- Conclusions POSTER ABSTRACTS tomatic ACL deficient knees were randomly allocated to Day Thromboprophylaxis with LMWH is not necessary in patients Surgery reconstruction (Group A: 62 patients, mean age 28 immediately mobilized after arthroscopic ACL reconstruction. years) or In Patient reconstruction (Group B: 60 patients, mean age 30 years). Cases were carried out under regional anaesthe- sia. The reconstructions, with patellar tendon-bone autografts, Poster #72 were carried out by a single surgeon using a single technique, WOULD ACL DEFICIENT PATIENT HAVE MORE and the same rehabilitation protocol was used in all cases. PROBLEMS IN SINGLE LEG HOP INCORPORATED Results were evaluated with the IKDC form, and time to walking WITH AN ELEMENT OF ROTATION? without support, time to recover complete RoM and the time Eric Ping Chien, Hong Kong, HONG KONG, Presenter from surgery to resuming running and sports activities were Candace YH Wong, Hong Kong, HONG KONG also evaluated. Statistical analysis was performed with the Dept Ortho Surgery, Hong Kong, HONG KONG Student’s t test. ACL deficient (ACLD) patients always complain that they have Results. difficulty in sports with cutting and turning action. They noticed There were no statistical differences in IKDC scores, time to fewer problems in running in straight line. While single leg hop walking without crutches, time to full RoM, time to running or is a common functional test of ACL deficiency performed in time to return to sports. 97% in group A declared that they were straight line, it did not incorporate element of cutting and turn- satisfied with the day surgery. ing. In this study, we studied the kinematic pattern of knee dur- ing single leg hop with and without knee rotation. The subjects Conclusions. were requested to hop with single leg in straight line, single leg Day surgery ACL reconstruction is well tolerated and allows the hop with pre-internal rotated leg, single leg hop with pre-exter- same rapid rehabilitation of sportsmen as In Patient surgery. nal rotated leg, single leg hop and land with internal rotated leg and single leg hop and land with external rotated leg. Penny and Giles Electrogoniometer, Biomed Ltd (P&G Poster #71 Electrogoniometer) was used to document the kinematic pat- PREVENTION OF VENOUS THROMBOEMBOLISM tern of knee rotation during these single leg hop tests. The AFTER ACL RECONSTRUCTION: validity of P&G Electrogoniometer in assessing knee rotation A PROSPECTIVE, RANDOMZED STUDY was tested by a specially designed jig with a traditional Gian Luigi Canata, Torino, ITALY, Presenter goniometer attached. Significant correlation was found Alfredo Chiey, Torino, ITALY between them at level of 0.001. Kinematics of 15 ACLD knees Centro di Traumatologia dello Sport e Chirurgia Ar, Torino, ITALY and 15 normal knees during functional tests were recruited. Rotation patterns of knees during functional tests were ranked into 3 groups according to the smoothness of the change of

5.42 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). angle of rotation by an observer who was blind to which group KNEE STIFFENING DURING UNILATERAL of subject the graph belonged to. STANDING IN INDIVIDUALS WITH INSTABILITY Results showed that there was no significant difference AFTER ACUTE ACL RUPTURE (p<0.05) between ACLD and normal knee during takeoff phase Lynn Snyder-Mackler, Newark, DE, USA of most of the tests except in the single leg hop with pre-exter- Terese L. Chmielewski, Newark, DE, USA, Presenter nal rotated leg test. At landing phase, there were significant dif- University of Delaware, Newark, DE, USA ferences (p<0.05) between two groups in most of the tests except in single leg hop (straight line) and in single leg hop and Introduction: Anterior cruciate ligament (ACL) injury is preva- landing with internal rotated leg. The results suggested that the lent and often leads to instability, quadriceps muscle weakness ACL deficient patient have more problems in single leg hop and osteoarthritis (OA). Most individual with chronic ACL defi- incorporated with an element of rotation. Perhaps this specific ciency have evidence of knee OA years after ACL rupture. single leg hop test can reveal the rotational instability more Weakness and instability experienced by ACL deficient persons specifically and be used as a reference of the assessment of the who do not compensate well for the injury (non-copers) inde- knee function. pendently lead to compensation strategies that could precipi- tate or worsen knee OA.

Poster #73 Objective: Determine strategies for controlling tibial position in FIVE-YEAR PROSPECTIVE CLASSIFICATION OF PATIENTS subjects with ACL rupture and uninjured subjects using knee WITH ACUTE ACL RUPTURE kinematics and muscle activity during disturbed unilateral Terese L. Chmielewski, Newark, DE, USA, Presenter standing. Lynn Snyder-Mackler, Newark, DE, USA Michael Axe, Newark, DE, USA Methods: Seven subjects with an acute unilateral ACL rupture, University of Delaware, Newark, DE, USA who were active in high level sports prior to injury and were classified as non-copers, participated in the study. Ten highly INTRODUCTION: A classification algorithm for acute anterior active, uninjured subjects were recruited as control subjects. cruciate ligament (ACL) rupture soon after injury (Fitzgerald et All subjects participated in motion analysis (6 dof rigid body al. 2000) was used to prospectively categorize the entire popu- analysis) and muscle activity (EMG) testing consisting of ten lation of highly active individuals diagnosed with acute, ACL trials of undisturbed unilateral standing, followed by 10 trials rupture in the practice of a single orthopedic surgeon during each of unilateral standing during which the support surface the five-year period from May 1996-April 2001. translated horizontally in an anterior, posterior or lateral direc- tion (disturbed condition). Translation direction order was ran- METHODS Concomitant injury, unresolved impairments and a domly assigned. Translations in the anterior and posterior screening examination including clinical measures (number of direction were applied at 40 cm/s for a distance of 5.8 cm. episodes of giving way, hop tests) and patient self-report were Lateral translations were applied at 25 cm/s for a distance of 3 used to classify individual as non-copers or potential copers. cm. Sagittal plane knee angle and sagittal plane tibial position with respect to the femur were averaged over a 2 second inter- RESULTS: 395 highly active patients presented with complete, val in the undisturbed condition and over the interval of surface acute ACL rupture during the 5-year period. 76 subjects had translation in each disturbed condition. Knee angle and tibial repairable meniscal tears or full-thickness articular cartilage position in all trials were referenced to the position in a cali- damage on MRI, 81 had concomitant ligamentous injury, bilat- bration trial (hip, knee and ankle in a neutral position) taken in eral injury or concomitant fracture and 20 patients had unre- bilateral stance. Analysis of Variance (ANOVA) was used to solved impairments (quadriceps weakness n=5, knee flexion determine differences between groups. Statistical significance contracture n=2, effusion n=6, pain n=6, other n=1). This group was set at p < 0.05. EMG activity was normalized to EMG dur- had the same age and sex distribution as the entire sample. ing an MVC. EMG timing and magnitude were used to describe POSTER ABSTRACTS 43/395 did not participate in the classification algorithm cocontraction as described by Rudolph et al (2001). because of immediate surgery, distance, missed appointments or declining to participate in the research study. This group also Results: Non-copers stand with greater knee flexion than unin- had the same age and sex distribution as the entire sample. The jured subjects in all conditions (p < 0.01). Compared to the cal- remaining 185 patients participated in the screening examina- ibration trial, non-copers’ tibias moved posteriorly in relation tion an average of 1.5 months after injury. The population to the femur during every unilateral standing condition (undis- included 117 men and 68 women. 131/185 (71%) were injured in turbed: -0.9 mm; disturbed: anterior = -1.8 mm, posterior = -3.0 a non-contact manner. 60 (51%) men and 39 (57%) women mm, lateral = -3.0 mm), while the tibial position of uninjured failed the screening examination criteria and were classified as subjects moved anteriorly (undisturbed: 1.4 mm; disturbed: non-copers. 57 (49%) men and 29 (43%) women passed the anterior = 2.1 mm, posterior = 1.7 mm, lateral = 1.9 mm). Non- screening examination to identify those with better dynamic copers’ tibial position differed significantly from uninjured sub- knee stability. jects in every condition (undisturbed: p < 0.05; disturbed: p < 0.01). EMG analysis provides evidence for a muscular compo- DISCUSSION AND CONCLUSION: Most “isolated” acute ACL nent to the differing stabilization strategies between the non- ruptures result from non-contact mechanisms of injury. More copers and uninjured subjects. than half of the patients are non-copers. 57% of women failed the screening examination and were classified as non-copers Conclusion: Non-copers appear to over-constrain the knee, compared to 51% of men. Perhaps early neuromuscular com- keeping the tibia in a posterior position, compared to uninjured pensation strategies in women are not as successful as those in subjects. This stiffening strategy reflects an unsophisticated men with acute isolated ACL rupture. adaptation to the ACL rupture for which appropriate muscle activation strategies to stabilize the knee have not yet devel- oped. This compensation strategy, which may reduce anterior Poster #74 tibial translation at the knee, may also lead to less shock absorption and excessive joint compression that exacerbate joint destruction.

5.43 In the period from 010197 - 311201 45 children and adolescents (mean age 13 y, range 8 - 15) with ACL rupture were treated Poster #75 operatively. Mechanism of injury was nearly exclusively sport- THE CASES OF THE RERUPTURE OF RECONSTRUCTED related trauma (soccer, handball, basketball and skiing). Sex- ACL USING MULTI-STRAND HAMSTRING TENDON ratio were 27 girls/18 boys. 40% had concomitant lesions, Sadahiro Cho, Kawaguchi, JAPAN, Presenter (meniscal tears, medial collateral ligament and chondral frac- Sadao Niga, Kawaguchi, JAPAN tures). One child were excluded due to multiple ligament injury Hiroshi Asano, Tino, JAPAN (ACL, PCL and MCL). Akiho Hoshino, Saitama, JAPAN Kawaguchi Kohgyo General Hospital, Kawaguchi, JAPAN Method: Group 1: Of special interest were 10 skeletally immature PURPOSE: The purpose of this study is to investigate the rerup- patients (age 8 - 13y, mean 11y, Tanner I+II) with radiographi- ture case of reconstructed anterior cruciate ligament (ACL) cally “wide” open growth plates treated with intra-articular using multi-strand hamstring tendon (M-ST). reconstruction using a soft-tissue autograft (hamstrings with femoral endo-button fixation and screw/spiked washer fixation MATERIALS AND METHODS: Five hundred ninety-seven on the tibia-side). Trans-epiphyseal technique was used in both patients who underwent reconstruction of ACL using M-ST from tibia and femur. 1995 through 2001 were reviewed. There were 343 male and 254 Group 2: 21 adolescents (age 14 -15y, mean 14,5, Tanner III) female patients, with an average 22.2 years (range, 13 to 50 with open physes were treated operatively with softtissue auto- years). Femoral tunnel was made by inside-out technique. To grafts whereas the remaining (group 3) 7 patients (Tanner IV) the cases of rerupture of reconstructed ACL, we searched terms: approaching skeletal maturity were reconstructed with patellar length difference at operation, trauma history, tibial tunnel bone-tendon-bone technique. placement, anterior stability, knee extensor muscle strength Group 4: 6 children had avulsion fractures at the tibiaplateau. 4 and arthroscopic observation. We also compared the rate of of these patients had displacement with > 2 mm and were rerupture cases of reconstructed ACL using patella tendon treated operatively with reduction and fixation with cerclage- (BTB) from 1990 through 1994 with M-ST. wire fixation through 2 drill-holes in the tibia epiphysis.

RESULTS: There were 7 patients (1.2%) who had sustained a Results: Mean FU was 28 month. No growth plate disturbances rerupture of the reconstructed ACL in M-ST group. An average were seen in any groups. Mean Lysholm score improved from time from primary surgery to rerupture was 20 months (range, 4 61 preop. to 92 postop. The KT-1000 analysis improved from 7 to 36 months). There were clearly traumatic episodes in all mm to 1 mm laxity (Lachman, 25 flex, 30 lbs). The overall func- seven patients. Length differences using Isometric Positioner at tional outcome was good except in one girl (Tanner group IV) operation were average 3.2mm (1-5mm). Length pattern in all who sustained of instability grade I - II and Pivot shift grade I. seven patients was over-the-top pattern. The tibial tunnel In group I one 10 years old boy had an excellent result and placements were posterior to the Blumensaat’s line in X-ray returned to sport (soccer and skiing) but 11 month after primary findings of the lateral view at full extension knee position in all reconstruction he had a new injury resulting in graft-rupture. A POSTER ABSTRACTS seven patients. Before rerupture, no statistically significant dif- revision has been performed (Feb. 2002). Accurate graft-sizing ference in postoperative Lachman test, Pivot shift test, KT-1000 and equivalent drilling (min 0,5 mm interval) is optional. side to side difference, knee extensor muscle strength and range of motion of the knee between rerupture group and the Ref. others. There were no graft impingements at second-look 1. Aichroth PM, Patel DV, Zorrilla P., 3: J Bone Joint Surg Br 2002 arthroscopy before rerupture. In BTB group, eighty-six patients Jan;84(1):38-41; The natural history and treatment of rupture of were reviewed. There were 4 patients (4.7%) who had sustained the anterior cruciate ligament in children and adolescents. A a rerupture of the reconstructed ACL. To compare the rate of prospective review. rerupture cases, the rate in M-ST group was significantly lower 2. Pressman AE, Letts RM, Jarvis JG: J Pediatr Orthop 1997 Jul- than that in BTB group. Aug;17(4):505-11: Anterior cruciate ligament tears in children: an analysis of operative versus nonoperative treatment. CONCLUSION: There were 7 patients (1.2%) who had sustained 3. Fehnel DJ, Johnson R.; Sports Med 2000 Jan;29(1):51-63: a rerupture of the reconstructed ACL using M-ST. Anterior cruciate injuries in the skeletally immature athlete: a review of treatment outcomes. 4. Lo IK, Bell DM, Fowler PJ.; Instr Course Lect 1998;47:351-9: Poster #76 Anterior cruciate ligament injuries in the skeletally immature ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN patient. CHILDREN AND SKELETAL IMMATURE ADOLESCENTS 5. McCarroll JR, Shelbourne KD, Patel DV.; Sports Med 1995 Svend Erik Christiansen, Aarhus, DENMARK, Presenter Aug;20(2):117-27: Anterior cruciate ligament injuries in young S¯ren Kjeldsen, Aarhus, DENMARK athletes. Recommendations for treatment and rehabilitation. Bent Lund, Aarhus C., DENMARK Bent Wulff Jakobsen, Aarhus, DENMARK Division of Sports Trauma, Aarhus, DENMARK Poster #77 SPECIFIC QUESTIONNAIRE FOR KNEE SYMPTOMS: Reconstruction of the anterior cruciate ligament in skeletal LYSHOLM KNEE SCORING – TRANSLATION AND immature adolescents using soft tissue autograft crossing the VALIDATION FOR PORTUGUESE LANGUAGE physes seems to be a recommendable treatment (ref.1-3). Moises Cohen, Sao Paulo, BRAZIL, Presenter However the treatment of ACL lesions in younger children Maria Stella Peccin, Sao Paulo, BRAZIL (Tanner I-II) with significant growth potential is controversial Rozana Ciconelli, Sao Paulo, BRAZIL due to risk of disturbance of the epiphysis resulting in bony UNIFESP (CETE), Sao Paulo, BRAZIL bridging, angular deformity or leg length discrepancy (ref.4). Introduction: Knee disorders have various consequences for Material: the individual’s quality of life and functional capacity.

5.44 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Prior to these experiments,a bone densitometry was performed Objective: To translate, validate and verify the measurement on each bone specimen. properties of the Lysholm Knee Scoring Scale for the Portuguese language. Poster #79 Methods: Fifty patients with knee lesions (meniscal, anterior ACL RECONSTRUCTION WITH DOUBLED HAMSTRING cruciate ligament lesions, chondromalacia and arthrosis) were TENDONS FIXED WITH 2 BIO-ABSORBABLE selected. INTERFERENCE SCREWS IN COMPETITIVE ATHLETES Daniel Comba, La Loggia-TO, ITALY, Presenter Results: Patients characteristics included 29 male, 21 female, Enzo Cenna, Torino, ITALY average age = 38,7 years, graduated at high school (16 patients) Mauricio Xavier Motta-Navas, Torino, ITALY and at university (34 patients). Ordinal concordance and inter Fisio&Sport, Torino, ITALY and intra-interviewer reproducibility were excellent (a = 0.9). Inter-interviewer nominal concordance was good (Kappa = 0.7) PURPOSE OF THE STUDY: to evaluate the results with a and intra- interviewer was excellent (Kappa=0.8). In the valida- prospective study in 54 selected competitive athletes following tion process Lysholm’s questionnaire was correlated to the ACL reconstruction with compacted hamstring tendons fixed numerical scale for pain (r = -0.6; p=0.001) and to Lequesne’s with 2 interference bio-absorbable screws + a metallic staple index (r = -0.8; p=0.001). The correlation between Lysholm’s on the tibia. and the overall health evaluation by the patient and therapist was poor and non-significant. The correlation between Lysholm METHODS: between March 1997 and February 2001 a series of questionnaire and the SF-36 was significant in relation to phys- 54 competitive athletes (ranging from amatorial to professional ical aspects (r = 0.4, p = 0.04), pain aspects (r= 0.5, p = 0.001) level) with isolated ACL tears were operated upon using an and functional capacity (r= 0.7; p= 0.001). hamstring autograft (DLSTG) fixed with 1 femoral and 1 tibial bio-absorbable interference screws (BioScrew) and 1 metallic Conclusions: We concluded that the Lysholm knee scoring staple on the tibia. Preparation of all the grafts was extremely scale version for the Brazilian culture showed reproducibility accurate, requiring compacted ends of the tendons (35-45 mm) and validity for patients with meniscal, anterior cruciate liga- with absorbable threads. A high density of the bony wall of the ment lesions, chondromalacia and arthrosis of the knee. tunnels was achieved using cannulated compacters. A rehabili- tation program including immediate motion and weight bear- ing followed surgery. Return to sport activities was allowed after Poster #78 6 months. Final evaluation at 2 years follow-up was performed A NEW TECHNIQUE OF PREPARATION AND FIXATION OF according the IKDC and Tegner score and arthrometric KT1000 AN ACL SEMI-TENDINOSUS GRAFT (MECHANICAL measurements. EVALUATION BY PULL-OUT AND CYCLIC LOADING TESTS) Michel Collette, Bruxelles, BELGIUM, Presenter RESULTS: KT1000 (man.max.) 0-2mm 45 athletes (83%); 3-4mm Yvan de Meeus d’Argenteuil, Tervuren, BELGIUM 7 (13%); >5mm 2 (3%). Tegner activity level: pre-injury 8,2 (7- Clinique Edith Cavell, Bruxelles, BELGIUM 10); follow-up 7,8 (6-9). IKDC: 51 normal and nearly normal (94%), 3 abnormal (5,5%), no severe abnormal. For more than six years, we have been routinely and satisfacto- rily using an original method of preparing an isolated semi- CONCLUSIONS: Our overall results in competitive athletes tendinosous graft in our ACL reconstructions. The using an ACL hamstring graft fixed with bio-absorbable inter- semi-tendinosous tendon is harvested in isolation. Each graft’s ference screw plus a tibial metallic staple indicate that this end is then sewn to each other to make a closed ligament ring. technique is a valid choice even for a high-performance popu-

By twisting it and folding it back on itself, we then get a four lation. We think it is essential to achieve a strong fixation of the POSTER ABSTRACTS strand tendon loop with one single suture. As proximal and dis- graft, with an extremely accurate preparation of the tendons tal fixation bands can pass and slide freely through the loop, and tunnels, in order to obtain good results, comparable to any tension on the graft will automatically be divided equally others graft-fixation methods. into each of the four graft’s strands unlike conventional meth- ods where each free tendon graft’s end should be equally ten- sioned before fixation. However, our ligament loop has implied Poster #80 so far the use of synthetic suspension bands whose mechanical POSTEROLATERAL CHONDRAL INJURY IN drawbacks have now been very well documented. Therefore, a ANTERIOR CRUCIATE LIGAMENT RUPTURE new method of fixation was developed in order to address Adam Dalgleish, Auckland, NEW ZEALAND, Presenter these problems. It consists of a fully endo-tunnel device,fixing Hayden Morris, East Melbourne, AUSTRALIA the graft close to its extremity and, suitable for both femoral East Melbourne Orthopaedic Surgeons, Melbourne, AUSTRALIA and tibial fixation. It provides a very strong primary fixation (up to three times the interference screw-type fixation strength) Arthroscopic examination of forty-three consecutive patients and also an excellent stiffness. with Anterior Cruciate Ligament Rupture was performed by a single experienced knee surgeon. Nine patients (21%) had a This paper reports the results of the mechanical study per- chondral lesion of the posterolateral tibia beneath the poste- formed on 45 specimens using human tissue (femoral heads rior horn of the lateral meniscus, not seen unless the meniscus collected from hip arthroplasties and semi-tendinosous ten- was elevated with the arthroscopic probe. On four occasions a dons from cadaver donors).It includes single pull-out strength chondral loose body was identified and removed. Seven of the tests and cyclic loading tests to 250 N and 500 N (by 1500 nine (78%) patients had an associated lateral meniscal tear. cycles).These tests were applied selectively to the isolated graft Magnetic Resonance Imaging identified bone bruising in the loop first, then to the isolated fixation in bone and, finally to posterolateral tibia but was not accurate in predicting the pres- the complex bone-ligament after fixation. ence of a posterolateral chondral lesion. We report a new arthroscopic finding not previously mentioned in the literature.

5.45 Poster #81 Discussions: Only one case of toxic shock syndrome after ARTHROSCOPIC ACL RECONSTRUCTION WITH NO arthroscopic surgery has been reported. Considering this case, TORNIQUET USE IN ROUTINE BONE-PATELLAR TENDON- we must take care of 1) dermatitis such as atopy, 2) presence of BONE MRSA toxic shock syndrome. Roberto Jose Batista Dorea, Salvador, BRAZIL, Presenter Centro Medico AlianÁa, Salvador, BRAZIL Poster #83 Purpose: This presentation demonstates a new method to con- THE EFFECT OF ACL SURGERY ON BONE MINERAL IN trol bleeding during the ACL arthroscopic reconstruction sur- THE CALCANEUS gery, intending to dimish the risk of the development of a Lars Ejerhed, Uddevalla, SWEDEN, Presenter deep-vein thrombosis or of a lesion of the peripheral nervous Jüri Toomas Kartus, Trollhättan, SWEDEN system or muscle fibers. Jon Karlsson, Gothenburg, SWEDEN Department of Orthopaedics, Norra ƒlvsborg/Uddeval, Method: The procedure is performed with 0.5 ml of adrenaline Trollhättan/Uddevalla, Gôteborg, SWEDEN diluted in 100 ml of isotonic solution; 20 ml of this solution is injected into the entering portals. At the supero-medial portal Purpose: The aim of the study was to evaluate the effect of ante- 10 ml of the solution is injected, and at the infero-lateral and rior cruciate ligament (ACL) reconstruction on the bone min- infero-medial portals 5 ml are injected into each one. During eral areal mass (BMA) in the calcaneus on the injured and the following 5 minutes flexion-extension movements are made non-injured side. to spread the solution thoughout the knee articulation. After this the knee is ready for the arthroscopic part of the surgery. Type of study: Prospective cohort study of bone mineral in the Eventually, if a strong bleeding persists, one can inject 20-30 ml calcaneus before and after ACL reconstruction. more of the solution, wait 5 minutes to let it take effect and afterwards the structures will be able to be visualized with clar- Methods: Thirty-four consecutive patients with a unilateral ACL ity. Next, a central incision is made and the strengthener ten- rupture underwent arthroscopic reconstruction using patellar don is removed from the Bone-patellar tendon-bone. The tendon autografts. The BMA was assessed bilaterally in the cal- hemostasis must be done with care because the tourniquet is caneus using a gamma-camera according to the Dual-energy not used. After this procedure, we restart the arthroscopic part Photon Absorptiometry technique, before the operation and of the surgery to perform the tendinosus transposition with fix- after six and 26 months. ation. P.S.: The same procedure of ACL reconstruction is also used with the semitendinosus and gracilis. Results: Thirty-one of thirty-four patients (20 men and 11 women) underwent all the BMA measurements. The median Results: During a period of 42 months, we have performed 180 age at the index operation was 27 (16-50) years and the recon- operative arthroscopic ACL reconstructions and have had only struction was performed 12 (2-192) months after the injury. The one case of deep-vein thrombosis and no problems with median preoperative Tegner activity level increased from 3 (2-8) POSTER ABSTRACTS lesions on the peripheral nervous system or muscle fibers. The to 7 (2-9) at 26 months (p<0.0001). The BMA in the calcaneus age of the patients varied from 17 to 50 years. on both the injured and non-injured side decreased by 16% and 17% respectively from the preoperative measurement to the 26- Conclusion: This procedure renders good visability during the month control (p=0.0014, p=0.0006). On all occasions, the BMA arthroscopic part of the surgery and is a technically safer was lower on the injured side than on the non-injured side method, thus avoiding and lowering the possibility of post- (p=0.012). operative problems. Conclusions: Patients with a unilateral ACL rupture had a lower BMA in the calcaneus on the injured side compared with the Poster #82 non-injured side. Although the patients increased their activity MRSA TOXIC SHOCK SYNDROME AFTER ARTHROSCOPIC level after the reconstruction, the BMA in the calcaneus ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION decreased on both the injured and the non-injured side in the Kosuke Ebina, Suita, JAPAN, Presenter perspective of two years after the operation. Norinao Matsumoto, Toyonaka, Osaka, JAPAN Tatsuo Mae, Osaka, JAPAN Dept.of Orthop.Surgery,Osaka Kouseinenkin Hospital, Osaka, JAPAN Poster #84 •A DEGRADABLE POLYURETHANEUREA AUGMENTATION We report a rare case of MRSA toxic shock syndrome after DEVICE FOR ACL RECONSTRUCTION arthroscopic anterior cruciate ligament reconstruction. Ingrid Ekenman, Stockholm, SWEDEN, Presenter Ulf Eklund, V. Frolunda, SWEDEN Case report: A 25-year-old man who had atopy in past history Elisabeth Liljensten, Gothenburg, SWEDEN underwent arthroscopic anterior cruciate ligament reconstruc- Barbro Danielson, Gothenburg, SWEDEN tion. At 10 days after surgery, he suddenly presented extreme Lars Peterson, Billdal, SWEDEN leg pain, fever (>39°C), hypotension, renal and liver disfunc- Gothenburg Medical Center, Gothenburg, SWEDEN tion; nevertheless operated knee presented little infectious sign. Shock treatment procedures including broad spectrum The objective of a degradable ACL augmentation device is to antibiotics therapy and debridement of the knee joint were improve the knee-stability by protecting the ACL-autograft dur- ineffective, and then we suspected MRSA toxic shock syndrome ing remodeling and allow early rehabilitation during healing and tried to treat with vancomycin at 14 days after surgery. without worries about the graft. The mechanical properties of MRSA was detected from synovium at 15 days, and so we added the device gradually decreases, and the autograft increases in continuous irrigation. Although therapies above were per- strength. The purpose of the present investigation was to eval- formed for 3 weeks, removal of graft and hardwares was neces- uate the surgical technique, the long-term stability and the tis- sary in order to clear infection completely.

5.46 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). sue response to a bone-patella tendon-bone autograft and a patients (average age ±37.1 years) only completed the stan- degradable polyurethane urea -ACL augmentation device. dardised rehabilitation journal (Group CO). The following tests were carried out: One-leg-hop test, isokinetic muscle strength Method measurement by angle speeds of 60, 90, 180°/sec., and a coor- Patients with an isolated ACL instability have been recon- dination test on the Kinestetic Ability Trainer “KAT 2000”, static structed with a BPTB autograft augmented with a degradable on one leg and static on two legs. Both the injured and unin- (PUUR) ACL augmentation device. In two pilot studies includ- jured legs were tested. The test periods were 1 day before sur- ing 20+10 patients, the aim was to elaborate the surgical tech- gery (V.U.), then 6 (6 postop.) and 12 (12 postop.) weeks after nique and to evaluate the knee-joint stability after ACL surgery. reconstruction and accelerated rehabilitation. In these prospective, single center studies the patients have been oper- Results: For the one-leg hop, the results for both measurement ated on and followed-up at 3, 6 months, and then every 6th periods of the check-up in the CAM group (6 postop.: 56.44 ± month up to four years. Arthroscopies and MRI were performed 21.73; 12 postop.: 74.56 ± 21.72) were significantly better than in 5 patients and biopsies for histological analysis were har- in the control group (6 postop.: 33.75 ± 23.82; 12 postop.: 62.66 vested. In addition, the second pilot study with 10 patients, ± 19.53) (6 postop.: p = 0.006; 12 postop.: p = 0.043). The isoki- operated on with BPTB-autograft and ACL-augmentation with a netic strength measurement gave a significantly better result at polyurethanurea-band was started, and accelerated rehabilita- both an angle speed of 60°/sec. (p = 0.028) and 90°/sec. (p = tion was performed. MRI in all patients were made after six 0.040) in the CAM group (60°/sec.: 1.19 ± 0.51; 90°/sec.: 1.20 ± month. 0.41) compared to the control group (60°/sec.: 0.82 ± 0.46; 90°/sec.: 0.89 ± 0.45). After 12 weeks no more significant differ- Results ences could be determined, but even here there tends to be a All 30 patients, in both pilot studies, had a side-to-side differ- better result (60°/sec.: p = 0.228; 90°/sec.: p = 0.126) for the ence (KT1000, max manual) of less than 3 mm. In three CAM group (60°/sec.: 1.61 ± 0.59; 90°/sec.: 1.64 ± 0.49) com- patients, the bands had to be explanted (all within one year) pared to the control group (60°/sec.: 1.38 ± 0.54; 90°/sec.: 1.37 due to postoperative complications related to the surgical tech- ± 0.51). At an angle speed of 180°/sec. there was a trend to bet- nique. Although the bands had to be explanted, the stability ter values in the CAM group (6 postop.: 1.00 ± 0.36; 12 postop.: was still good. MRI showed ingrowth of bone in the femoral and 1.34 ± 0.39) compared to the control group (6 postop.: 0.84 ± the tibial tunnel. Histological observations showed ingrowth of 0.41; 12 postop.: 1.21 ± 0.39) without significance being organized connective tissue parallel with the PUUR fibers. achieved (6 postop.: p = 0.261; 12 postop.: p = 0.331). For the Blood vessels and collagen type I was identified using immuno- coordination test, a better but not significant result was histochemical methods. achieved in the first check-up with measurement of the injured leg (CAM: 350.25 ± 147.16; CO: 413.40 ± 113.74) for the CAM Conclusions group (p = 0.155). With the second check-up, the CAM group (p In the two pilot studies, the first of 20 patients with follow up = 0.035) achieved a significantly better result (CAM: 275.44 ± for four years and the second with accelerated rehabilitation 136.49; CO: 363.25 ± 104.07). The static test for both legs and a follow up time for one year, the combination of a BPTB showed a significantly better result for both measuring periods autograft and the PUUR augmentation device allowed early (6 postop.: p = 0.022; 12 postop.: p = 0.025) for the CAM group ROM-training, and functional training with preserved stability. (6 postop.: CAM: 269.00 ±177.95; CO: 407.75 ± 168.91; 12 MRI showed ingrowth of bone in the femoral and tibial tunnels. postop.: CAM: 236.18 ± 136.48; CO: 340.15 ± 127.40). The complications that occurred were related to the surgical technique, which resulted in modifications of the procedure. Discussion and Summary: The significant improvement of mus- No signs of severe inflammatory reactions or foreign body reac- cle strength and coordination after using this new type of active tion were detected in the patient biopsies. Ingrowth of vascu- motion device for 4 weeks can be explained by a reduction of larized organized connective tissue parallel with the PUUR neural blockage of the extensor mechanism. The contralateral POSTER ABSTRACTS fibers containing collagen type I was demonstrated. transfer of muscle activation might also play a role. The active motion device CAMOPED® seems to us to be a sensible addi- tion to the standard rehabilitation programme after ACL recon- Poster #85 struction. REHABILITATION USING AN ACTIVE MOTION DEVICE AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION Poster #86 Sven Feil, Heidelberg, GERMANY, Presenter THE EFFECT OF PHYSIOTHERAPY FOLLOWING Hans H Paessler, Heidelberg, GERMANY ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION Atos clinic center, Heidelberg, GERMANY Julian A Feller, Melbourne, AUSTRALIA, Presenter Rebecca Payne, Melbourne, AUSTRALIA Aim: The aim of this prospective and randomised study is to Nicholas Taylor, Melbourne, AUSTRALIA evaluate an early functional follow-up treatment with an active Kate E Webster, Melbourne, AUSTRALIA knee motion device, CAMOPED®, after reconstruction of the Tania Pizzari, Melbourne, AUSTRALIA anterior cruciate ligament (ACL). We put forward as a hypothe- La Trobe University Musculoskeletal Research Center, Melbourne, AUS- sis that a low postoperative loss of muscular strength and coor- TRALIA dination can be achieved after a muscle-activating therapeutic exercise. Background: Following anterior cruciate ligament (ACL) recon- struction it is common practice for patients to undertake a pro- Material and Method: 36 patients with an isolated cruciate lig- gressive program of physiotherapy, with the aim of regaining ament injury took part in the study. 12 men and 4 women (aver- function by restoring range of movement, strength and propri- age age ±30.7 years) use an active motion device 4-7 days after oception. surgery in addition to a standardised rehabilitation journal (Group CAM). With this, the patients exercised for half an hour four times a day, every day for 4 weeks. An additional 20

5.47 Aim: To establish whether there is any difference in outcome gate resisted to 1100 cycles at 150 N with an ultimate strength between patients who have attended physiotherapy frequently of 671 N (SD 174) as only one case fixed with interference screw following ACL reconstruction and those who have not. resisted to 1100 cycles with an ultimate strength of 448 N; the other cases failed after less than 300 cycles. Cyclic test to 50 N Methods: Through an interview process involving 143 patients, increments load: the ultimate load was 1032 N (SD 126) for the 10 patients were identified who had attended physiotherapy on evolgate and 400 N (SD 94) for the interference screw as the three or fewer occasions during the first six months after ACL slippage at 250 N was 0,376 mm (SD 0,06) for the evolgate and reconstructive surgery. The patients in this ‘minimal physio- 0,702 mm (SD0,12) for the interference screw; the mean stiff- therapy’ group were matched for age, gender, graft type, prein- ness of the fixation method was 358 N/mm (SD 77) for the evol- jury activity level and occupation with 10 patients (from the gate and 177 N/mm (SD 27,4) for the interference screw. same cohort of 143 patients) who had attended physiotherapy on 12 or more occasions - the ‘regular physiotherapy’ group. At CONCLUSIONS: in all the test performed the evolgate was 12 months following surgery participants were assessed using demonstrated to significantly improve the strength and reduce the International Knee Documentation Committee (IKDC) form, the construct slippage of hamstring tendon grafts fixed to tibia the Cincinnati form, and hop tests. with interference screw.

Results: Compared with the regular physiotherapy group, patients in the minimal physiotherapy group achieved better Poster #88 outcomes at 12 months in terms of Cincinnati symptoms (mean 3-D GAIT ANALYSIS OF ACL DEFICIENT PATIENTS USING 46 v 43, p = 0.03), overall Cincinnati score (mean 94 v 87, p = THE CHAOS THEORY 0.02) and triple hop symmetry (mean 102% v 93%, p = 0.03). Tina Moraiti, Ioannina, GREECE Giannis Giakas, Ioannina, GREECE Conclusion: Patients who had attended physiotherapy infre- Nick Stergiou, Omaha, NE, USA quently achieved better outcomes than patients who attended Christos Papageorgiou, Ioannina, GREECE more than 12 times. These results demonstrate that patients Elias Tsepis, Ioannina, GREECE who choose not to attend physiotherapy regularly after ACL Stavros Ristanis, Ioannina, GREECE reconstructive surgery can still achieve satisfactory outcomes. Anastasios Georgoulis, Ioannina, GREECE, Presenter University of Ioannina, Ioannina, GREECE

Poster #87 Introduction THE EVOLGATE: A NEW METHOD FOR ANATOMIC TIBIAL Numerous studies have been conducted regarding gait analysis FIXATION OF QUADRUPLED HAMSTRING GRAFT IN ACL in anterior cruciate ligament deficient (ACLD) patients. RECONSTRUCTION: A BIOMECHANICAL STUDY Although several of these studies have shown that ACLD Andrea Ferretti, Rome, ITALY, Presenter patients develop protective mechanisms (i.e., quadriceps Fabio Conteduca, Rome, ITALY avoidance) to increase knee stability, it seems that these adap- Edoardo Monaco, Rome, ITALY tations fail to protect the knee from future pathology. It seems POSTER ABSTRACTS Luca Labianca, Taranto, ITALY that further in-vivo biomechanical investigation is required to Dept. Orthopedics, II School of Medicine, S. Andre, Rome, ITALY understand the mechanisms of pathological knee joint motions and develop rehabilitation programs, which would delay the PURPOSE. The Evolgate (Citieffe, Bologna, Italy) is a low profile development of future degenerative diseases. One of the ways titanium alloy device developed to augment the tibial interfer- to enhance our understanding of these mechanisms is to exam- ence screw fixation of hamstring tendon in ACL recontruction. ine the stride-to-stride variability. Stride-to-stride variability The first objective of this study was to compare the initial fixa- has been related with changes in sensory feedback and has tion strength of the Evolgate with interference screw’s one. The been associated with locomotor stability. In addition, this vari- second objective was to determine the fatigue behaviour of the ability has been described as a “healthy flexibility” within the Evolgate and interference screw under cyclic loading in both neuromuscular system. Severe injury can possibly result in a constant (150 N) and incremental loading (50 N increments per loss of this flexibility that may not be regained despite surgical cycle). treatment. Conventional methods to examine the variability of human movement include the analysis of standard deviation TYPE OF STUDY: Biomechanical Study. METHODS: Pull out and coefficient of variation. Recently the theory of chaos and test: This study compares the initial pull-out strength, stiffness non-linear dynamic methods were used to investigate various and failure modes of five pairs of four strand human semi- complex phenomena in the areas of immune system, genetics, tendinosus and gracilis grafts fixed to porcine tibias using etc. We used one of these techniques to examine the effect of either the evolgate or one round threaded titanium interference ACL deficiency on the complexity of gait patterns during walk- screw. Structural test of the graft-fixation method-tibia com- ing. Specifically, we hypothesized that the ACL deficient knee plexes were administered using a materials testing machine at will be less complex (which means less flexible to external a strain rate of 50 mm/sec. Cyclic loading: two paired tests were influences) when compared with the healthy knee. performed using, for each test, five pairs of common digital extensor bovine tendons fixed to porcine tibias: critical graft fix- Methods ation conditions were simulated by applying to the graft 1100 A six-camera Peak Performance system (50 Hz) was used to subsequent cycles with a constant load of 150 N and by pro- record 3D kinematics from 11 ACL deficient patients (mean age gressively loading the graft in increments of 50 N until failure. 34, mean mass 78 kg). Knee joint laxity was tested with KT-1000 in all patients and side to side differences were at least 3mm. RESULTS. Pull out test: The mean failure load was 1207N The Lysholm score for all patients was between 40 and 89. The (SD259) for the evolgate and 561N (SD70) for the interference subjects had approximately 10 minutes to familiarize with the screw (p< 0.05) as the mean stiffness of the graft-fixation experimental setup. The subjects walked at their self selected method-tibia complex was 160 N/mm (SD 47) for the evolgate speed on a motorized treadmill. Fifteen markers set were posi- and 106 N/mm (SD 23) for the interference screws (p<0.05). tioned at specific bony landmarks of the lower limbs to indicate Cyclic test to constant load: All the cases fixed with the evol- the movements of the lower segments. Segmental angular data

5.48 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). of the foot, the tibia, and the thigh were calculated from The exercise decreased the balance ability of all healthy sub- approximately 120 continuous footfalls. Subsequently, the knee jects for both legs (p<0.05). In the deficient group the balance joint data were analyzed for complexity using the Approximate ability of the healthy leg was also decreased (p<0.05), however Entropy (ApEn). Smaller ApEn values will indicate decreases in in the deficient side five of the patients similarly decreased but complexity and lack of flexibility and variability (more periodic the other four of them were able to sustain their score as before move patterns). ApEn group mean differences between the the exercise. Further analysis on MRI scans and concentric knee affected and unaffected sides were examined with a paired t- flexion extension peak torque values revealed that there this test at a 95% level of significance. result was not related to meniscus lesion or hamstrings and quadriceps isokinetic torque. These results indicate that some Results and Discussion patients possibly adapt to use other mechanisms or that they Our findings of 11 ACL deficient patients showed that the ApEn avoided using their injured leg equally with the healthy side values for the deficient knee were lower than the ApEn of the during the exercise. Data are still collected to increase the healthy knee (p<0.05). These results are in agreement with pre- power of our analysis. vious studies which examined patients after reconstruction and found that the reconstructed knee is less complex than the healthy knee. It is therefore indicated that the deficient knee Poster #90 moves along more periodical patterns (known patterns). This TWO-YEAR COMPARATIVE STUDY AFTER ACL decreased variability creates smaller adaptations and increases RECONSTRUCTION: BPTB VS D-STG the risk of injury in possible unexpected movements. Francesco Giron, Firenze, ITALY, Presenter Paolo Aglietti, Florence, ITALY Flavio Biddau, Florence, ITALY Poster #89 Francesco Sasso, Florence, ITALY CHANGES IN SINGLE STEP BALANCE OF ACL DEFICIENT First Orthopaedic Clinic - University of Florence, Florence, ITALY PATIENTS BEFORE AND AFTER LOW DEMAND EXERCISE Giannis Giakas, Ioannina, GREECE Purpose: To prospectively assess differences in clinical and Tina Moraiti, Ioannina, GREECE radiographic results at 2-year minimum F.U. after ACL recon- Stavros Ristanis, Ioannina, GREECE struction performed using either a BPTB or a D-STG autograft. Elias Tsepis, Ioannina, GREECE Christos Papageorgiou, Ioannina, GREECE Material and Methods: 100 knees with a chronic isolated ACL Nick Stergiou, Omaha, NE, USA lesion were randomly assigned to one of the two graft choices. Anastasios Georgoulis, Ioannina, GREECE, Presenter Both groups were comparable in terms of age at surgery, injury- University of Ioannina, Ioannina, GREECE surgery interval, activity level, gender, surgical technique and rehabilitation. All patients were evaluated by an independent Introduction and blind oberver using the IKDC form, the patient self-admin- Previous research indicated that degenerative joint changes are istered Knee Injury and Osteoarthritis Outcome Score (KOOS), not only due to joint instability but also due to a disruption of the Functional Score for Anterior Knee Pain (FSAKP, by S. proprioceptive function. The ACL contains mechanoreceptors Werner), the KT-1000 dynamometer, and Cybex NORM testing and it has been suggested that it also functions as a sensory for concentric isokinetic strength. A radiographic study using organ. The injury of ACL would result in deterioration of pro- standard image amplifier controlled views was performed. prioception and changes in body balance. This hypothesis how- ever is still under discussion. Moreover, non-fatiguing exercise Results: induces no significant changes or a decrease in sway in healthy Average D-STG BPTB subjects. Therefore the purpose of this study was to examine KOOS(0-100 Normal)Pain 94 90 Symptoms 90 87 the effect of low demanding exercise on the balance of ACL ADL 97 96 POSTER ABSTRACTS deficient patients. We hypothesised that fatigue will decrease Sport 87 81 balance especially at the leg with ACL deficiency. It has been Quality of life 83 74 shown that running deteriorates balance more than walking IKDC A B A B and a possible explanation is the more excessive head move- ROM 98% 2% 98% 2% ment and disturbance of vestibular and visual information cen- Stability 52% 48% 64% 36% tres of running compared to walking. In our study we eliminated Final 57% 43% 58% 42% this factor and used cycling instead. KT-1000 ssd 30 lbs (mm) 2.3 2.2

Methods Cybex test: Extensor strength deficit 60°/sec 6% 10% Flexor strength deficit 60°/sec 3% 1% Ten healthy and nine ACL deficient patients were recruited. At Internal rotation deficit 30°/sec 13% 7% the beginning of each test each subject had as many trials as required in order to get familiar with the one-leg static balance FSKA (0-50 Normal) 47 44 procedure. The KAT2000 system was used to examine the single Kneeling discomfort 44% 76% p=.02 Femoral Tunnel Widening Frontal plane 42% 10% p<.001 stance ability (Hansen et al., 2000). Then three trials for each Tibial Tunnel Widening Frontal plane 30% 18% leg were recorded and the best was used as the representative. Sagittal plane 54% 45% The low-demand exercise was the same for all subjects. Each subject cycled on a Tunturi cycle ergometer for 10 minutes at 50 Conclusions: The subjective evaluation showed slightly less rounds per minute (50W). The subjects were tested for balance pain and symptoms (not statistically significant) in the D-STG immediately after. In both tests (before and after exercise) the group. The objective evaluation showed no significant differ- leg examined was randomly selected by the examiner. ences between groups in all the analysed parameters except for Statistical differences were examined using a two-way ANOVA kneeling discomfort (higher in the BPTB group) and femoral test (group x exercise). tunnel widening (higher in the D-STG group).

Results and Discussion Poster #91

5.49 ACL RECONSTRUCTION WITH D-STG FIXED TO THE University of California-Los Angeles, Los Angeles, CA, USA FEMUR WITH A MITEK ANCHOR: 5 YEAR RESULTS Francesco Giron, Firenze, ITALY, Presenter INTRODUCTION: The anterior cruciate ligament (ACL) has been Paolo Aglietti, Florence, ITALY shown to be particularly susceptible to injury during alpine ski- Pierluigi Cuomo, Firenze, ITALY ing. Tibial torque is thought to be an important mechanism for Antonio Ciardullo, Florence, ITALY injury, especially when applied to a knee which is fully extended First Orthopaedic Clinic - University of Florence, Florence, ITALY or fully flexed. The purpose of this study was to directly record forces generated in the ACL during application of tibial torque Purpose: To prospectively evaluate the 5-year results of ACL at four knee flexion angles representing four mechanisms of reconstruction using a double semitendinosus and gracilis ACL injury during skiing. graft (D-STG) rigidly fixed to the femur with a Mitek anchor. METHODS: Thirty-seven fresh-frozen cadaver knees were Material: 46 patients with an isolated complete subacute or instrumented with a tibial load cell which measured resultant chronic ACL injury (injury-surgery interval 19 months, range 1- force in the ACL as internal and external tibial torques were 156) were included. The average age at surgery was 28 years applied to the tibia at full extension, 90 degrees of flexion, full (range 17-48). We were able to personally review 42 patients at flexion, and forced hyperflexion. 5-year minimum follow-up. Two patients were lost, one had had a rerupture in the mid-substance at 3 months while playing RESULTS: At each flexion position, mean ACL force generated soccer and the fourth had had a knee fracture in an accident. by 10 N-m of internal tibial torque was significantly higher than the mean generated by 10 N-m of external tibial torque. Mean Technique: The femoral tunnel was drilled first with the knee in ACL forces generated by tibial torque at 90 degrees of flexion 120° - 130° of flexion through the antero-medial portal. The were relatively low. During flexion-extension, mean ACL forces position of the K wire was checked fluoroscopically with intra- were highest (193N) in hyperflexion. Addition of 10 N-m inter- operative lateral views with condylar superimposition and only nal tibial torque to a fully flexed or hyperflexed knee signifi- positions less than 30% from the back of the condyles were cantly increased mean ACL force (p<0.05). The highest mean accepted or the K wire was repositioned. The tibial K wire was ACL forces were recorded with 10 N-m internal torque applied introduced using the One Step tibial guide (Arthrotek) which to the tibia in full extension (239N) and hyperflexion (243N). references off the roof of the notch in extension to avoid impingement. The fixation of the graft was achieved with a CONCLUSIONS: Based upon these findings, application of Mitek anchor in the femur, with the 2 tendons directly passed in internal tibial torque to a fully extended or fully flexed knee the slot of the anchor, and an RCI screw, supplemented with a would represent the most dangerous loading conditions in spiked washer and bicortical screw, in the tibia. The 4 strands of terms of potential ACL injury from twisting falls during skiing. the graft were individually tensioned and fixed at 25° after cycling. Rehabilitation was aggressive controlled and without braces. Poster #93 HYALURONIC ACID; ADDITIONAL THERAPY AFTER ACL POSTER ABSTRACTS Methods: IKDC form, KT-1000 dynamometer, and Cybex testing RECONSTRUCTION (concentric isokinetic strength) were employed. An X-ray study Milan Handl, Prague, CZECH REPUBLIC, Presenter using standard image amplifier controlled views was per- Tomas TRC, Prague, CZECH REPUBLIC formed. Orthopaedic Clinic, University Hospital Motol, Prague, CZECH REPUBLIC

Results: At 5 years one patient (2.3%) revealed a lack of Summary: extension of 3° and another (2.3%) complained of some pain ACL reconstruction is a frequent knee procedure. Sometimes during sports activities. Two patients had giving way. The KT ssd the chronic effusion after the surgery can be observed, esp. in was 1.8 mm at 30 lbs (range 0-7 mm) and 76% of the knees were the knee with cartilagenous defects before the ACL reconstruc- within 2 mm. Final IKDC score showed 95% satisfactory results. tion. The additional therapy by hyaluronic acid (HA) was per- Extensor and flexor deficits were 4.6% and 1.1% on average at formed in this study. Author evaluated 2 parallel groups of total 60°/s. Radiographic study confirmed the position of the tibial 79 patients treated by ACL reconstruction and having difficul- and femoral tunnels within accepted limits in both planes. ties from chondropathy before the surgery. The former group Tunnel widening was found in 39% of the femurs and 47% of the was treated by HA, the latter not. The evaluation was based on tibias. The amount of tunnel widening did not change between clinical tests and X ray findings. The results show a positive 2- and 5-year follow-up. As to the tibial tunnel a correlation was effect of early postoperative additional treatment by HA. found between the incidence of widening and distance of the RCI screw from the joint (the closer the screw, the lower the Purpose incidence). No statistically significant difference was found The aim of the study was to evaluate the effect of an early addi- between the stability at 2-year and at 5-year results. tional treatment by HA in cases when chronic effusion in the knee after ACL reconstruction can be expected. Conclusion: We believe that the D-STG graft, with strong fixa- tion to bone, can give excellent results similar to the so called Methods gold standard patellar tendon. Two groups of pacients (79 pts., age 18 - 43 yrs., chronic effu- sion, chondropathy or OA I grade) - treated by ACL reconstruc- tion were observed. The treatment in the first group (43 pts.) - Poster #92 HA was delivered intraarticular after 4,5 and 6 weeks after sur- INJURY TO THE ACL IN ALPINE SKIING: A gery. The other group (36 pts.) remained without any special BIOMECHANICAL ANALYSIS OF TIBIAL TORQUE AND treatment, esp. without any intraarticular shots. Both groups KNEE FLEXION ANGLE were tested clinical and X-ray. before surgery and after 4, 6 and Sharon L. Hame, Los Angeles, CA, USA, Presenter 9 weeks (clinical) and 12 weeks (clinical and X-ray). Presence of Daniel Oakes, Los Angeles, USA effusion, ROM and muscle strenght were evaluated. Keith L Markolf, Los Angeles, CA, USA

5.50 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Results PURPOSE: To assess the results of monopolar electrothermal The HA group showed less effusion, better early ROM and ear- tightening of chronic, partial interstitial ACL tears performed by lier onset of muscle strenght esp. in 6 and 9 weeks check-up. a single surgeon.

no f-u 12 w effusion % ROM % muscle strength % METHODS: This study began in January 1998 and continues. 28 G 1- hyaluronic acid 43 43 6,9 95,3 88,4 G 2 - none 36 36 30,5 80,6 74,9 patients underwent arthroscopic tightening of their native ACL or ACL graft at a minimum of 3 months after injury. All patients Discussion had failed a physical therapy program and were unwilling to The chronic effusion slowing down the rehab therapy, ROM and modify their activities or use a brace. Each patient underwent a muscle strenght is suspected from being caused by cartilage- pre-operative MRI that reported the ACL to be “normal” or as a nous defects prior the LCA reconstrution. The possible positive “minor sprain”. All patients underwent a postoperative, care- influence of HA in the postoperative treatment is observed. fully followed physical therapy program including the use of a brace allowing range of motion 15 to 90 degrees for the first 6 Conclusion: weeks after surgery. The physical therapy program lasted a min- Results show HA has a positive effect on lowering chronic effu- imum of 4 months after surgery and stressed the same rever- sion, improving ROM and better muscle strenght after the ACL ence for soft tissue healing as our program for formal reconstrution in the comprision to group without any addi- arthroscopic assisted ACL reconstructions. tional treatment. RESULTS: 25 of 28 patients experienced excellent or good results from this procedure. There were 3 failures. 24 patients Poster #94 had “Normal” or “Nearly normal” IKDC Standard Form ratings at EFFECT OF 80N INITIAL GRAFT TENSION ON ANTERIOR a minimum of 6 months after surgery (range 6-47 months, aver- TIBIAL TRANSLATION WITH TIME AFTER ACL age 22 months). Lysholm Scale ratings improved from an aver- RECONSTRUCTION age of 59.7 to 88.1. The average Tegner Activity scale was 3 Kazuhisa Hatayama, Maebashi, JAPAN, Presenter preoperative and 7 postoperative. The pre/post KT-2000 data Hiroshi Higuchi, Maebashi-shi, JAPAN was not statistically significant. Additional procedures were Atsushi Kobayashi, Maebashi-shi, JAPAN performed on 26 patients at the time of the ACL tightening. Masashi Kimura, Maebashi, JAPAN Fumiaki Kobayashi, Maebashi, JAPAN CONCLUSIONS: Monopolar tightening of chronic, interstitial Masanori Terauchi, Maebashi-shi, JAPAN partial ACL tears is effective in a very carefully selected group of Kenji Shirakura, Maebashi-shi, JAPAN patients. Patients must have an intact ACL or ACL graft on both Kenji Takagishi, Maebashi-shi, JAPAN preoperative MRI and during evaluation at the time of Department of Orthopaedic Surgery, Gunma University, Maebashi, JAPAN arthroscopy. The postoperative physical therapy program is critical to the success of this procedure. The author believes [Purpose] We evaluated a time series analysis on changes of that this technique will be seldom used for ACL instability as anterior tibial translation (ATT) after anterior cruciate ligament few patients meet the stringent preoperative selection criteria. (ACL) reconstruction with 80N initial graft tension. #96 [Material & Methods] Twenty-five patients (male 9, female 16) Poster were enrolled in this study. ACL-Reconstruction was performed CLINICAL RESULTS OF TWO-STAGE ACL REVISION using autogenous semitendinosus tendon in all cases. ATT was Sadafumi Ichinohe, Morioka, JAPAN, Presenter evaluated at side to side difference (STSD) before surgery, 3, 6, Yoichi Kamei, Morioka, JAPAN 12 months postoperatively. Tomohiko Onodera, Hanamaki, JAPAN

Yoshihiro Shirakura, Morioka, JAPAN POSTER ABSTRACTS [Results] Average STSD of ATT were 6.8?3.9mm, 0.8?3.8mm, Masaaki Yoshida, Morioka, JAPAN 1.7?4.1mm and 2.6mm?3.6mm; at before surgery, 3Mo, 6Mo, Tadashi Shimamura, Morioka, JAPAN 12Mo after surgery, respectively. In chronic ACL-torn cases, Iwate Medical University, Morioka, JAPAN STSD of ATT was significantly larger than subacute cases at 12Mo postoperatively. In addition, STSD of ATT was signifi- Purpose: The rates of ACL revision cases were increased due to cantly large at before surgery and 12Mo postoperatively in increasing numbers of primary ACL reconstruction. The authors cases with medial meniscal tear. Preoperative ATT was corre- performed two-stage ACL revision for six knees. The purpose of lated with that of 6 and 12Mo postoperatively. However, Age this paper is to evaluate clinical results and to clarify the indi- and gender did not effect on postoperative ATT. cations of two-stage ACL reconstruction.

[Conclusions] This study suggested that ACL-Reconstruction Materials and methods: Current study included six cases of with 80N initial graft tension reduced the postoperative ante- revised ACL injuries. There were two males and four females, rior laxity of the knee joint. However, postoperative stability of three left knees and three right knees. Grafts of primary ACL knee joint are worse in chronic cases and combined medial reconstruction were four Leeds-Keio artificial ligaments, one meniscal tear cases than the others. BTB, and one STG. Mean time interval between primary surgery to revision was 70 months (48 to 108), and mean follow-up peri- ods after revision surgery was 16 months (2 to 31). Graft Poster #95 removal with bone graft for tibial tunnel was performed first MONOPOLAR ELECTROTHERMAL TIGHTENING OF stage. After 3 or more months of bone graft, revised ACL recon- CHRONIC, INTERSTIAL PARTIAL ACL TEARS struction was performed using contra lateral or ipsi lateral dou- Stephen W. Houseworth, Colorado Springs, CO, USA, Presenter ble folded semitendinosus and gracilis. Graft fixation was Premier Health Plaza, Colorado Springs, Colorado, USA performed at over the top position by one or two titanium sta- ples. Cause of graft failure, complication of revised surgery, and clinical results of revised surgery were studied.

5.51 Results: Causes of graft failure were unknown three and trauma ter of the insertion of the normal AM bundle in the standard three. However, all of traumas were classified light ones. There manner. For the PL bundle reconstruction, a Kirschner wire was were no obvious complications in our two-stage ACL revision. drilled at the femoral aiming point, which was located at the 4 There were no obvious progressive OA changes but one or 8 o’clock orientation using the trans-tunnel technique. For between graft removal to ACL revision. Clinical results were the AM bundle reconstruction, another wire was drilled at the evaluated five cases that had half years or more follow-up peri- point located at the 2 or 10 o’clock orientation. Then, the com- ods. There were no positive anterior drawer and no positive mercially available isometer system (Smith & Nephew) was pivot shift test. The mean JOA score was 97 and the mean used to measure the length between the two intraarticular out- Lysholm score was 95. lets for the AM and PL bundles. In addition, we used specially designed cylindrical devices to fill the vacant space of the tibial Discussion: Several papers recommended two-stage ACL revi- tunnels so that a suture for measurement was passed through sion. One paper recommended that two stages ACL revision is the center of each outlet. After a metal tags was attached to good procedure in theoretically but it is not realistic because of each femoral aiming point, an isometer was set at the end of increases patient’s inconvenience and cost. Brown reported each suture attached the tag. Thus, the length changes for the that indications for two-stage ACL revision include decreased AM and PL bundles were simultaneously determined during ROM and large bone defects. Our indications for two-stages passive knee motion, the angle of which was measured with an ACL revision at this moment are that pre-revised MRI demon- electrogoniometer. After the measurement was repeated 10 strated a large tibial tunnel or misplacement of the tibial tun- times, each femoral tunnel was created through each aiming nel expected to cause a large bone defect. point with the Endobutton technique. The doubled tendon graft was transplanted in each pair of tunnels, and fixed with an Conclusions: 1. Clinical results were studied in six knees that Endobutton and polyester tapes. The standard postoperative received two-stage ACL revision. 2. Our indications for two- management was applied after surgery. The patients were fol- stages ACL revision at this moment are that pre-revised MRI lowed up for 1 year. Objective evaluation was performed with a demonstrated a large tibial tunnel or misplacement of the tib- range of motion, the side-to-side anterior laxity measured with ial tunnel expected to cause a large bone defect. KT2000, and IKDC evaluation. Statistical analysis was made with the two-way ANOVA with a post-hoc test for multiple com- parisons. Poster #97 IN VIVO SIMULTANEOUS MEASUREMENT OF LENGTH Results: When the knee was flexed from zero degree of exten- CHANGES OF THE ANTEROMEDIAL AND sion to 15, 30, 60, 90, and 120 degrees of knee flexion, the aver- POSTEROLATERAL BUNDLES OF THE ANTERIOR age length between the tunnel outlets for the AM bundle CRUCIATE LIGAMENT RECONSTRUCTED WITH THE decreased by 2.1, 3.3, 4.3, 4.5, and 3.6 mm, respectively, while FOUR-TUNNEL TWO-ROUTE PROCEDURE WITH that for the PL bundle decreased by 2.8, 4.8, 6.9, 8.3, and 8.1 HAMSTRING TENDON GRAFTS mm, respectively. The two-way ANOVA demonstrated signifi- Kazunori Yasuda, Sapporo, JAPAN cant differences between the two bundles and the knee flexion Hiroki Ichiyama, Sapporo, JAPAN, Presenter angles (p<0.0001). The post-hoc test showed that the degree of POSTER ABSTRACTS Eiji Kondo, Sapporo, JAPAN the decrease was significantly greater for the PL bundle than for Nobuto Kitamura, Sapporo, JAPAN the AM bundle at 60, 90, and 120 degrees (p=0.0346, 0.0146, Yasunari Ikema, Sapporo, JAPAN and 0.0039, respectively). Concerning the 1-year follow-up Toshikazu Yoshikawa, Sapporo, JAPAN results, each patient restored the full range of knee motion. The Harukazu Tohyama, Sapporo, JAPAN IKDC Evaluation showed ‘Normal’ in 12 out of the 15 patients Department of Medical Bioengineering & Sports Medi, Sapporo, JAPAN and ‘Nearly normal’ in the remaining 3 patients.

Introduction: The normal ACL is composed of the anteromedial Discussion: This in vivo simultaneous measurement study (AM) and posterolateral (PM) bundles. In the single-route ACL clearly demonstrated that the length change pattern between reconstruction procedures, it is impossible to reconstruct these the tunnel outlets is significantly different between the AM and two bundles. The four-tunnel two-route ACL reconstruction PL bundles. The PL bundle is considered to be more tensioned procedure has been developed to anatomically reconstruct the than the AM bundle in near extension position. The present AM and PM bundles of the ACL. However, no in vivo studies length patterns were similar to those for the normal AM and PL have been conducted to clarify functional differences of the two bundles that were measured in our previous in vitro study bundles reconstructed in this procedure. The purpose of this in (CORR, 1987). The postoperative results of our patients were vivo study is to compare the length change patterns during excellent. This study suggested that the four-tunnel two-route knee motion for the AM and PL bundles reconstructed with the ACL reconstruction procedure may be able to create the AM four-tunnel two-route ACL reconstruction procedure using and PL bundles that have different functions. hamstring tendon grafts.

Materials and Methods: An in vivo study was conducted using Poster #98 15 patients (8 men and 7 women) with chronic isolated ACL EVALUATION OF GRAFT AFTER ACL RECONSTRUCTION tear. An average age was 22.7 years. The patients underwent Michael Ilias Iosifidis, Thessaloniki, GREECE, Presenter arthroscopy-assisted ACL reconstruction with doubled ham- Stergios Papastergiou, Triandria, GREECE string tendon autografts. All surgeries were performed by the Ioannis Tsitouridis, Thessaloniki, GREECE first author using the four-tunnel two-route procedure. The roof Christos Papageorgiou, Ioannina, GREECE or wall plasty was not performed. A tibial tunnel for the PL bun- Ioannis Giannakopoulos, Thessaloniki, GREECE dle was created with a canulated drill (6- or 7-mm diameter). Kostas Parissis, Athens, GREECE The extraarticular outlet was located at the point 15mm distal Dep.of Sports Injuries “Saint Paul” Gen.Hospital, Thessaloniki, GREECE from the joint line and just anterior to the medial collateral lig- ament, while the intraarticular outlet was located at the center The question about the ligamentization of the graft is still exist- of the insertion of the normal PL bundle. A tibial tunnel for the ing without a clear answer, and the postoperative behavior of a AM bundle (7- or 8-mm diameter) was drilled through the cen- ligament graft is still a matter of debate. The purpose of this

5.52 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). study is to record the tissue changes of an autologous bone minimize the observed side-to-side laxity. On the femoral side, patellar-central third patellar tendon- bone tibial (BPTB) graft Endopearl™ fixation was added and the proximal 3cm of the after surgical ACL reconstruction, using MRI and to combine graft sutured to improve screw-graft fixation. We performed them with the clinical image respectively. tunnel dilation, advancement of the BioscrewTM to the proxi- mal tunnel aperture and supplementary fixation on the tibial During the period 1998-2001 we operated 265 patients for ACL side with a periosteal button. The results of ACL reconstruction insufficiency with autologous BPTB graft. Seventy nine of them with double-looped semitendinosus and gracilis graft with (45 men and 34 women, ranging from 17 to 44 years -mean: 25,3 improved fixation were compared to those with Bioscrew™ fix- years), were imaged with MRI postoperatively at specific inter- ation only. vals from the operation, ranging from 3-36 months. We used interference screws of poly-L-lactic acid (PLLA) in 34 patients and titanium screws for the rest of them. We examined the graft Poster #100 and the surgically created bone tunnels. EFFECT OF AXIAL ROTATION OF THE TIBIA ON ACTIVATION OF THE EXTENSOR MECHANISM: All grafts were intact except for one with complete tear and one IMPLICATION FOR NON-CONTACT ACL INJURY with partial tear. The orientation of the grafts on sagittal images Akihiro Kanamori, Tsukuba, JAPAN, Presenter was straight at about 80%. There was a gradually change of the Shizuka Michigami, Tsukuba, JAPAN graft’s signal during the pass of time. A homogenous “high” sig- Toru Okuwaki, Tokyo, JAPAN nal after the 3rd p.o. month indicated the inflammatory reac- Yutaka Miyanaga, Tsukuba, JAPAN tion to the graft’s embodiment procedure. After the 1st p.o. year Naoyuki Ochiai, Tsukuba, JAPAN a “low” signal such as the normal ACL was dominant. Toru Fukubayashi, Tokyo, JAPAN Spontaneously, we recorded ingrowth of periligamentous con- University of Tsukuba, Tsukuba, JAPAN nective tissue- an evidence of graft maturity. The critical time was about 18 months postoperatively. There was a slight widen- [Purpose] The exact mechanism of a non-contact anterior cru- ing of both femoral and tibial tunnels, more remarkable on the ciate ligament (ACL) injury remains unknown. Historically, the tibia, whose peak time was in the same period (for the femur potential for an ACL tear occurs when the knee is subjected to 11mm to 12,1mm at the critical time and then back to 10mm, a valgus and external rotational torque. However, cadaveric and for the tibia 11,7mm to 12,9mm and finally 11mm). It was studies have shown little increase in the force in the ACL in mainly “pear” shaped, but without any correlation with knee response to such a torque, which suggests that the application stability. of the torque alone is not a risk factor. Dynamic factors are also implicated in ACL injury; specifically the extensor mechanism Rehabilitation is matched to the presumed load that the graft of the knee pulls the tibia anteriorly and increases the force in is considered to tolerate. That is, any information about graft the ACL. The objective of this study was to determine the acti- healing or “maturation” is quite useful. There are few studies of vation of the quadriceps muscles upon landing from a jump bone tunnel enlargement, but clinical significance and etiology with the tibia in three different positions of axial rotation. It was of this phenomenon remains unclear. hypothesized that positioning the tibia in axial rotation would increase the activation of the quadriceps muscles.

Poster #99 [Material and Method] Three female collegiate basketball play- ACL RECONSTRUCTION WITH HAMSTRINGS AND ers with no previous report of knee injury participated in this BIOABSORBABLE study. Surface electrodes were placed over the vastus lateralis Ben J Bessette, Ottawa, CANADA (VL) and vastus medialis obliquus (VMO) muscles of the sub- Ari E Pressman, Ottawa, CANADA jects’ right limb. Reflective markers were also placed on the hip,

Don H Johnson, Ottawa, CANADA, Presenter knee, and ankle. Subjects were then asked to mimic basketball POSTER ABSTRACTS The Ottawa Hospital, Ottawa, CANADA maneuvers by jumping and landing on their right foot with three different positions of the tibia: neutral, internally rotated, In an initial study, a prospective evaluation of 49 patients and externally rotated. The two dimensional (coronal and sagit- treated between December 1996 and May 1998 with a double- tal view) kinematics were collected using two high-speed digi- looped semitendinosus and gracilis graft for anterior cruciate tal cameras. The EMG data obtained during the landing activity ligament reconstruction was undertaken. Grafts were secured were normalized to those obtained during a maximum volun- with bioabsorbable interference soft tissue screws (Bioscrew; tary contraction of the quadriceps muscles (%EMG). Linvatec, Largo, FL) made of poly L-lactic acid. Patients were followed for a minimum of two years (average 2.31 ±0.27 years). [Results and Discussion] The flexion angle of the knee upon Tenger and Lysholm scores were used to determine pre and landing for all positions of tibial rotation ranged from 22 to 30 post-operative knee function and IKDC scores were calculated degrees. Upon landing with neutral tibial rotation, the %EMG of at the two-year follow up. The average IKDC score was 84.8± the VL and VMO were 131 and 165, respectively. When the foot 14.3 at the final follow up. A pivot shift was absent in all but two was rotated either internally or externally, the %EMG of the VL patients at the final follow up. Despite the clinical success as increased up to 240, while those of the VMO did not change sig- determined by patient based subjective outcome and the IKDC nificantly. The results of this study show that the activation of score, the KT scores showed a 4-5 mm side-to- side difference the extensor mechanism increases according to the position of in 20.8%. Although this degree of laxity has been experienced in axial rotation of the tibia upon landing. The increased activa- some series with other methods of fixation such as the tion of the vatus lateralis, as well as the lower knee flexion Endobutton™ (Acufex microsurgical, Mansfield MA), we felt angle may be an important factor in non-contact ACL injuries that this represented substantially more laxity than had been that occur upon landing from a jump. experienced with our bone-patellar tendon-bone cohort of ACL reconstruction fixed in the same manner during the same period of time. It is possible that this laxity represents differ- Poster #101 ences in graft material or in bone fixation. In the second part of SERIAL CHANGES IN THE MRI OF ANTERIOR CRUCIATE our study, improvements in fixation were made in an attempt to LIGAMENT GRAFT IN TIBIAL BONE TUNNEL

5.53 Izumi Kanisawa, Chiba, JAPAN, Presenter BPTB, 18 patients (90%) with allograft BPTB and 22 patients Hideshige Moriya, Chiba, JAPAN (88%) with autograft ST. There was a significant difference on Akihiro Tsuchiya, Ichikawa, JAPAN the Lachman test between group 1 and group 3, and on effusion International Budo University, Katsuura city, JAPAN between group 1 and group 2 (p<0.05). However no significant differences were found between the three groups on the IKDC Objective: Although maturation of the graft in the bone tunnel and Lysolm scores (p>0.05). following the anterior cruciate ligament (ACL) reconstruction is very important factor affecting results of the surgery, there are not many clinical study examining intra-tunnel graft changes. Poster #103 The purpose of this study was to examine intra-tunnel graft WHEN TO INJECT ANALGESIC AGENTS maturation by serial MRI following ACL reconstruction. INTRA-ARTICULARLY IN ACL RECONSTRUCTIONS – BEFORE OR AFTER TOURNIQUET RELEASING Methods: Twenty-five patients who received three-times of Gulen Guler, Kayseri, TURKEY postoperative MRI examination were included in this study. Sinan Karaoglu, Kayseri, TURKEY, Presenter Twelve patients received ACL reconstruction using the multiply Aynur Akin, Kayseri, TURKEY folded hamstring tendon graft (Group 1), and 13 patients Kudret Dogru, Kayseri, TURKEY received ACL reconstruction using the rolled iliotibial tract Levent Demir, Kayseri, TURKEY graft (Group 2). MRI examinations were performed within four Mehmet Halici, Kayseri, TURKEY weeks, at three months, and at 12 months after the surgery Erciyes University, Kayseri, TURKEY using 1.5T MRI unit (Signa, GE) with intravenous administra- tion of gadolinium. Axial views of the tibial bone tunnel were The purpose of this study was to prospectively evaluate two dif- evaluated. ferent applications of intra-articular (i.a.) mixture composed of 40 ml 0.25% bupivacaine, and 2 mg morphine in anterior cruci- Results: Within four weeks, ring-shaped enhancement around ate ligament (ACL) reconstructions - before and after tourni- the graft which showed almost homogeneous low signal inten- quet release. The study was a prospective, double blind, sity bundle were observed in all subjects. At three months and randomised, clinical trial. 12 months after the surgery, the grafts in group 1 were sepa- rated into several segments by enhancement, and the grafts in Forty patients who underwent ACL reconstruction were group 2 showed ring-shaped enhancement inside the graft. prospectively randomised into two groups. Group 1was Ring-shaped enhancement around the graft were also observed injected with i.a. morphine with bupivacaine 10 min. before in the both group. tourniquet release group 2 was injected with i.a. morphine with bupivacaine injection after tourniquet release, following 30 min Conclusions and Significance: Differences were found between waiting with closed drainage. Visual analog scale (VAS) scores MRI taken within four weeks and later than three months after were recorded 10 and 30 min, 1, 2, 4, 8, 12, and 24 h. after the the surgery, which seems to represent graft maturation process operation. Detailed records were kept of the amount of anal- during this period. Differences were also found between the two gesic drug required. POSTER ABSTRACTS groups. Enhancement inside the graft observed later than three months looks like invading between folded tendons in group 1, In pain scores, there was no difference between the two groups and between rolled iliotibial tract layers in group 2. The graft themselves except 30 min. postoperatively (P = 0.005). First maturation in the bone tunnel seems to be influenced by the analgesic requirement time was significantly lower in group 2 form of the graft, and the graft in the bone tunnel does not (P < 0.001) and total amount of opioid used was lower in group seem to become homogeneous at least within one year after 2 (P = 0.037) than those in group 1. There was no difference these two types of surgery. between the two groups in terms of operation time (P = 0.484), although there was a significant difference between groups in terms of tourniquet time (P = 0.024). Poster #102 A COMPARISON OF THREE METHODS OF ACL We concluded that i.a. analgesic injection after tourniquet RECONSTRUCTIONS WITH MINIMUM 30 MONTHS release is more beneficial to obtain postoperative analgesia in FOLLOW-UP ACL reconstructions when comparing same injection before Sinan Karaoglu, Kayseri, TURKEY, Presenter tourniquet release. Mustafa Altuner, Kayseri, TURKEY Mehmet Halici, Kayseri, TURKEY Erciyes University, Kayseri, TURKEY Poster #104 A LONG-TERM MRI STUDY AFTER HARVESTING This study was performed in order to compare the results of PATELLAR TENDON AUTOGRAFTS patients that were treated by arthroscopic anterior cruciate lig- Jüri Toomas Kartus, Trollhättan, SWEDEN, Presenter ament (ACL) reconstructions using autogenous Bone patellar Michael Svensson, Trollhättan, SWEDEN Tendon Bone (BTB) (25 patients, mean age 26), solvent-dehy- Lars Ejerhed, Uddevalla, SWEDEN drated allogenous BTB (20 patients, mean age 27) and autoge- Sven Lindahl, Trollhättan, SWEDEN nous quadrupled Semitendinosus Tendon (ST) (25 patients, Jon Karlsson, Gothenburg, SWEDEN mean age 26) for chronic ACL rupture. The results were evalu- Orthopaedic Department NƒL-Hospital, Trollhättan, SWEDEN ated according to the Lysholm and IKDC scores. Mean follow- up periods (30-59 months) were 40 months, 40 months and 42 Purpose of the study: To make a long-term MRI study of the months in autograft BPTB, allograft BPTB and autograft ST, donor site after ACL reconstruction using ipsilateral, central respectively. Excellent or good results according to the Lysholm third patellar tendon autografts. scores were achieved in 23 patients, 18 patients and 20 patients in autograft BPTB, allograft BPTB and autograft ST, respectively. Materials and methods: Nineteen consecutive patients aged 27 Similarly, normal or nearly normal patients according to the (16-43) years were included in the study. MRI examinations of IKDC scale accounted for 23 patients (92%) with autograft

5.54 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). the donor site were performed 6 (5-10) weeks (n=19), 6 (6-8) Dep. of Traumatology, University of Vienna Medical, Vienna, AUSTRIA months (n=18), 27 (24-29) (n=19) months and 71 (68-73) (n=17) months postoperatively. The contralateral normal side (n=19) Aim of the study was to compare the preinjury knee joint pres- was only examined at the first occasion. sure pattern with the pattern after ACL-resection and after reconstruction using a BTB-graft without preloading and with Results: The size of the donor site gap decreased significantly 25N and 50N preload. In 6 cadaver knee joints the pressure (p=0.0001) between 6 weeks and 6 years after the harvesting probes were simultanously applied into the medial and lateral procedure. The thickness of the patellar tendon at the donor joint space. The knee was flexed and hanging - imitating the site was increased compared with the contralateral healthy side position in a leg holder. Then the knee was extended to 0¬° and until 2 years after the index operation (p=0.0004). However, the again brought to hanging position. Then the ACL was resected thickness decreased over time and was normalised at 6 years. and the measurement repeated. After implantation of a BTB- The width of the patellar tendon at the donor site was increased graft again the pressure relation was measured as well as after compared with the contralateral side regardless of when the preloading of the BTB-graft with 25N and 50N. The relative examination was performed (p<0.01), (Table 1). pressure values between the medial and lateral compartment were used. The curve in the injured joint served as basic curve Conclusions: Prospective MRI examinations revealed that the for determing the correct pressure curves after reconstructions. patellar tendon at the donor site was not completely nor- After resection of the ACL the pressure curve showed rather malised 6 years after harvesting its central third. similarity to the injured joint; after BTB-grafting an almost identical curve compared to the uninjured knee was recorded. The similarity disapperaed the more preloading was put onto Poster #105 the BTB-graft. RETURN TO SPORTS ACTIVITIES AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION The pressure relation between the medial and lateral knee com- Masayoshi Katayama, Maebashi City, JAPAN, Presenter partment was recorded before and after ACL-resection and with Masashi Kimura, Maebashi, JAPAN BTB-graft loaded and unloaded. Almost similar curves to the Hiroshi Higuchi, Maebashi-shi, JAPAN uninjured knee were recorded when an unloaded BTB-graft was Yasukazu Kobayashi, Maebashi, JAPAN implanted. Quality of ligament reconstructions can be defined Fumiaki Kobayashi, Maebashi, JAPAN intraoperatively by restoration of normal pressure relation Junta Kuwabara, Maebashi, JAPAN curve. Kenji Shirakura, Maebashi-shi, JAPAN Kenji Takagishi, Maebashi-shi, JAPAN Masanori Terauchi, Maebashi-shi, JAPAN Poster #107 Gunma University Faculty of Medicine, Maebashi, JAPAN ARTHROSCOPIC ACL RECONSTRUCTION USING PATELLAR TENDON-BONE AUTOGRAFT AND [PURPOSE] The purpose of this study is finding out of factors BIOABSORBABLE INTERFERENCE SCREW for missing to play the previous sports after anterior cruciate Myung Ku Kim, Inchon, SOUTH KOREA, Presenter ligament (ACL) reconstruction. In Suk Oh, Inchon, KOREA Inha University, Inchon, SOUTH KOREA [METHODS AND MATERIALS] One hundred and thirty-nine athletes who had undergone ACL reconstruction were studied. Purpose: Authors reported the results of arthroscopic ACL They applied if they could return to the previous sports activi- reconstruction using patellar tendon-bone autograft and ties or not, and retrospectively checked by manual tests, X-ray bioabsorbable interference screw (Bioscrew: poly-L Lactic stress view, and IKDC score. acid). POSTER ABSTRACTS [RESULT] One hundred and eleven athletes were able to play Materials and methods : From Jan. 1998 to Dec. 1998, we per- their previous sports (84.2%){group ABLE}. The other who were formed 39 cases of arthroscopic ACL reconstruction using PTB unable to play their previous sports is 22 athletes {group autograft and Bioscrew. An average 3 years and 2 months fol- UNABLE}. In Lachman test 96 athletes of ABLE (86.5%) and 17 low-up was available. We measured KT-200 test, IKDC score, of UNABLE (77.3%) were negative, and in knee jerk test simi- Tenger score and Lysholm score at preoperative evaluation and larly 90 (81.1%) of ABLE and 15 (68.1%) of UNABLE were nega- compared with the results of final evaluation. We performed re- tive. In X-ray stress view the instability for the contra lateral arthroscopy on 4 cases and observed the degree of degradation side were 3.2mm in ABLE and 3.6mm in UNABLE. IKDC score of Bioscrews. showed A:14 B:79 C:19 D:5 in ABLE and A:1 B:15 C:4 D:2 in UNABLE. Results : At preoperative evaluation, an average KT-2000 test was 8.1, Lysholm score 66.2, IKDC score below C on all cases [DISCUSSION] There were no significant differences between and Tenger score 3.7, but, at final evaluation, KT-2000 test was the ABLE and the UNABLE, but it tended to less instability in 2.8, Lysholm score 91.7, IKDC score above B on all cases and ABLE. It could be one of factors for missing to play the previous Tegner score 6.9. Re-arthroscopic finding at 3 and 12 months sports to remain instability after the ACL reconstruction. after implantation showed that there was no degradation of PLLA screws, but 21 and 33 months, there was partial degrada- tion of PLLA screws. Poster #106 EFFECTS OF ACL-RECONSTRUCTION ON JOINT SURFACE Conclusion : Bioabsorbable interference screw is a reasonable PRESSURE PATTERN alternative to metallic screw during ACL reconstruction. But, Richard Kdolsky, Vienna, AUSTRIA, Presenter bioabsorbable screw implanted in human takes a much longer Basil AlArabid, Vienna, AUSTRIA degradation time than had been anticipated. Martin Fuchs, St. Poelten, AUSTRIA Rudolf Schabus, Vienna, AUSTRIA Vilmos Vecsei, Vienna, AUSTRIA Poster #108

5.55 ANTERIOR CRUCIATE INJURIES IN CHILDREN WITH and each group of 10 pieces was heated for 10 minutes. The OPEN PHYSES thermal shrinkage in the length of the tissue samples at each Tatsuo Kobayashi, Nishitokyo city, JAPAN, Presenter temperature and the histological findings were examined. Kyosuke Fujikawa, Tokorozawa, JAPAN Experiment 2: The ACL tibia connective region of adult pig rear Satoshi Tsukazaki, Tokorozawa, JAPAN knees was separated and a ligament was fixed at 10mm behind Atsushi Sugihara, Tokorozawa, JAPAN the region using a pin or an instant adhesive to prepare 8 Masato Tomiya, Tokorozawa, JAPAN pieces of ACL knee instability models. The TS method using a Yoshihiro Aoki, Tokorozawa, JAPAN holmium: YAG laser was applied to the loosened ACL in a Takeo Kawakubo, Tokorozawa, JAPAN saline solution. The laser conditions employed were 5, 10, 15 National Defense Medical College, Tokorozawa, JAPAN and 20W at 15Hz with a total energy of 500mmJ, two models per group. Before and after the TS method, the forward sliding [INTRODUCTION] In these days sporting activities such as foot- improvement rates were measured on the X-ray lateral images. ball, baseball and so on have been spreading into young gen- Subsequently, the ligaments were extracted and histological eration. Furthermore, diagnosis of ACL injury has became findings were examined. precise owing to prevalence of MRI and arthroscopy. The inci- dence of ACL injuries in children with open physes seems to Results have increased. However the treatment of ACL injuries with Experiment 1: The thermal shrinkage rates were 4% at 50C, 8.5% open physes is still controversial. We will report the results of at 55C, 35.3% at 60C, 56.2% at 65C and 63.4% at 70C. Therefore, conservative treatment of ACL injuries with open physes. the shrinkage rate increased significantly with heating. From the histological findings, no shrinkage was found in collagen [CASES] This study includes 38 fresh ACL injuries in children fiber at 50C, but the shrinkage became clear at 55C. The shrink- with open physes. There are 32 boys and 5 girls, and one boy age became most remarkable at 60C, and thermal denaturation had bilateral ACL injuries. occurred at 65C, showing unclear fibrous structure. Therefore, 60C was assumed to be an optimal temperature giving an effec- [TREATMENT] All of cases were treated conservatively by tive thermal shrinkage and minimal structural denaturation. immobilization at 30 degree of knee flexion with cast for 3 Experiment 2: The forward sliding mean improvement rates weeks and ACL-grip brace afterwards. For 4 - 5 months after were 44.0% at 5W, 58.5% at 10W, 83.0% at 15W and 79.0% at 20W. their injuries any kinds of sporting activities were prohibited. Significant improvements were found at 15W and 20W. From After that light sport with ACL-grip was allowed. the histological findings, shrinkage of the collagen fiber, which was detected at 60C in Experiment 1, was found at 15W. On the [RESULTS] At 5 years or longer follow-up, Lachman test was other hand, thermal denaturation progressed into the deeper positive in 71%, anterior drawer test in 76.3% and jerk test in layers of the tissue at 20W. Therefore, the TS method at 15W 60.5%. However subjective complaints of children such as pain was found to show significant improvements in forward sliding and giving way were not so remarkable as in adults cases. The without causing strong thermal denaturation. Therefore, opti- typical secondary OA change was spike formation of the tibial mal conditions for lasers were 15Hz and 15W. spine. Meniscal tears were noted in cases continuing sporting POSTER ABSTRACTS activities. Advance OA change was observed in the elder boys. Discussion In 1994, Thabit tried a laser-assisted capsular shift and reported [CONCLUSION] The results of conservative treatment of ACL 80% satisfactory results. In 1996, Garcia performed an internal injuries with open physes were not satisfactory at over 5 years knee joint capsular shift for kneecap instability and reported follow-up. that functions and adaptability were regained at an early stage. In 1998, Thabit tried the thermal shrinkage method on damaged ACLs containing large amounts of Type I collagen as in the case Poster #109 of capsules. From the results after an average of 1 year and 6 THERMAL SHRINKAGE METHOD USING HOLMIUM; YAG months after the operation, KT-1000 was found to be 2mm or LASER ON ACL DEFICIENT KNEE less in 23 cases out of 25 cases, reporting satisfactory results. Akihiro Kotani, Mitaka-shi, JAPAN, Presenter However, in 1999, Carondelet reported cases of failure within 6 Kyorin University School of Medicine, Mitaka, JAPAN months after the operation in 4 cases out of 12, indicating unstable results. In 1997, Schaefer et al. applied a laser to rab- Purposes bit knee tendons and the length of the tendons was observed Recently, thermal surgery using heat energy such as lasers has without external fixing. The shrinkage immediately after laser been tried primarily in arthroscopic surgery. Thabit reported in irradiation was 6.6%, but the length of the tendons extended in 1994 that satisfactory results were obtained when the laser- contrast to that before irradiation due to tension of the quadri- assisted capsular shift was tried for capsular instability. In 1998, ceps femoris muscle after 4 weeks and 8 weeks. Thus, the diffi- a thermal shrinkage procedure that causes ligament shrinkage culty of after-care was pointed out. In the present study, we in the instability of the knee anterior cruciate ligament (ACL), caused shrinkage in the loosened anterior cruciate ligament to which contains Type I collagen, repeatedly tightened ligaments achieve tightening when using heat energy from lasers. to obtain successful results. For the purpose of performing the Although it is important to thoroughly investigate case selec- “Thermal Shrinkage Method” using a holmium: yttrium-alu- tion, surgical techniques and after-care in the future, it may minum-garnet (Ho: YAG) laser for cases of ACL capsular insta- become one of the treatments for anterior cruciate ligament bility, we conducted basic experiments to determine laser instability. irradiation conditions and the results are reported. Conclusions Materials and Methods 1] Thermal shrinkage was tried using a holmium: YAG laser for Experiment 1: Knee ACL was extracted from adult pig rear ACL knee instability. knees and frozen for storage. After defrosting at room tempera- 2] The optimal condition for laser energy was 15W. ture, fifty pieces of tissue samples (length: 5mm, height: 5mm, 3] Knee forward sliding was reduced so that the; Thermal width: 3mm) were prepared from the ligaments. These tissue Shrinkage; may become one of the treatments for anterior cru- samples were placed in saline solution at 50, 55, 60, 65 and 70C, ciate ligament instability.

5.56 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Kazunori Yasuda, Sapporo, JAPAN Department of Medical Bioengineering & Sports Medi, Sapporo, JAPAN Poster #110 ANTERO-LATERAL ROTATORY INSTABILITY OF THE KNEE [Introduction] Anterior cruciate ligament (ACL) reconstruction Andreas K. Kreutz, Homburg-Saar, GERMANY, Presenter using the hamstring tendon graft has some disadvantages Dietrich S. Hammer, Homburg/Saar, GERMANY compared to that using the bone-patellar tendon-bone graft. Jochen Duchow, Homburg/Saar, GERMANY One of the disadvantages is that the stiffness of the femur-graft- Dieter M Kohn, Homburg-Saar, GERMANY tibia (FGT) complex is low, when the graft is fixed with sutures. Orthopeadic Department University Hospital Hombur, Homburg-Saar, In order to increase the stiffness of the FGT complex with the GERMANY hamstring tendon graft, Bone-Mulch-Screw/WasherLoc fixation system has recently been developed. However, biomechanical Introduction behaviors of the FGT complex reconstructed using this system Acute or chronic antero-lateral capsulo-ligamentous laxity of have not been clarified during and after cyclic loading. In order the knee is not always detected on clinical examination and is to understand these biomechanical behaviors, it is important therefore wrongly thought to be uncommon. However, even in to know the effect of the initial graft tension on the behaviors. moderately mild lesions, the functional deficit is often quite The purpose of this study is to clarify the effect of initial graft severe, particularly in athletes. An accurate diagnosis following tension on biomechanical behaviors of the FGT complex recon- the acute injury is the basis of effective treatment. structed using the double-looped flexor tendon graft with Bone-Mulch-Screw/WasherLoc fixation system, during and after Method cyclic elongation. We have measured anterior and rotatory displacement in 20 knees with chronic deficiency of the anterior cruciate ligament [Methods] In the present study, a porcine ACL reconstruction (ACL). We performed stress radiography and stress MRI using a model was used. In this model, a pair of digital flexor tendon simple apparatus which maintained the knee in Lachman test was trimmed so that their cross-sectional area became the position (20° of flexion) while a 9 kg load was applied to the dis- average value of human hamstring tendons (Noyes et al. 1984; tal femur the tibia fixated. Associated lesions were evaluated the gracilis: 7 mm2; the semitendinosus: 14 mm2). Twenty-one clinically and via MRI. Knee instability was evaluated clinically porcine knees were used. In each knee, ACL reconstruction was using different knee scores. performed with the double-looped flexor tendon graft, which was fixed using Bone-Mulch-Screw/WasherLoc fixation system Results (Arthrotek, Naples, FL). Then, the FGT specimens were ran- None of the knees showed secondary lesions like meniscal tear, domly divided into 20-N, 80-N, and 140-N groups (n=7 in each injured collateral ligaments or damage to the postero-lateral group). For 20-N, 80-N, and 140-N groups, a tensile load of 20 corner (PLC) but twelve knees showed degenerative changes of N, 80 N, and 140 N, respectively, was applied to the graft for 2 the medial meniscus according to clinical and MRI data. minutes as an initial graft tension. Then, cyclic elongation of 2 Thirteen knees showed 10mm or more (grade III) anterior trans- mm was applied 5000 times to the FGT complex at 0.2 Hz. lation of the tibia, six knees had a tibia translation between 5 Finally, each FGT specimen underwent the tensile failure test. and 10mm (grade II) and one knee showed less than 5mm Statistical comparisons were made using a one-way ANOVA (Grade I) without significant difference between radiological and Fischer PLSD tests. and MRI findings. In nine knees a lateral rotation displacement was found according to MRI scan while five knees showed lat- [Results] The peak load values at the first cycle were signifi- eral and two knees medial rotation instability according to radi- cantly different among 20-N, 80-N, and 140-N groups. The peak ological data. The tibia head size differs from 6,8cm to 9,8cm load rapidly decreased during the first 1000 cycles in each (mean 8,1cm) in medio-lateral direction. All patients showed group. At the 5000th cycle, the mean peak load value was 57N, clinical signs for ACL deficiency but none of them were clini- 105N and 126N in 20-N, 80-N, and 140-N groups, respectively. POSTER ABSTRACTS cally rated as rotatory unstable. However, none of the patients We found a significant difference in the peak load between 20- got back to the same level of sport. N and 80-N groups, while there were no significant differences between 80-N and 140-N groups. After cyclic elongation, the Conclusion initial stiffness (the slope in the toe-region of the load-dis- Stress radiological evaluation of anterior - posterior displace- placement curve) of the FGT complex in 20-N group was signif- ment of the knee in Lachman position correlates well with icantly lower than that in 80-N and 140-N groups, while there stress MRI findings but differ in the amount of rotation dis- were no significant differences between 80-N and 140-N groups. placement. The tibia head size and the distance between the There were no significant effects of the initial graft tension on femur condyles might influence the amount of inaccuracy. the linear stiffness or the ultimate failure load of the FGT com- However, regarding antero-lateral rotatory instability neither plex after cyclic elongation. radiological findings nor MRI measurements correlate well to clinical results. [Discussion and Conclusion] The present study demonstrated, first, that cyclic elongation significantly affected biomechanical behaviors of the FGT complex reconstructed using the double- Poster #111 looped flexor tendon graft and Bone-Mulch-Screw/WasherLoc •BONE-MULCH-SCREW/WASHERLOC FIXATION OF system under each initial tension. Secondly, an increase of ini- DOUBLED FLEXOR TENDON GRAFT IN ANTERIOR tial tension from 80 N to 140 N did not significantly increase the CRUCIATE LIGAMENT RECONSTRUCTION - initial stiffness of the complex after cyclic elongation. Based on BIOMECHANICAL EVALUATION ON THE EFFECT OF previously reported data of the normal ACL force at the full- INITIAL GRAFT TENSION USING CYCLIC ELONGATION extension, 16 to 87 N (Markolf et al. 1990), the mean peak load Toshiharu Kudoh, Sapporo, JAPAN, Presenter of 105 N at 5000th cycle in 80-N group is considered to be too Harukazu Tohyama, Sapporo, JAPAN high. Therefore, this study implied that the optimal initial ten- Nobuto Kitamura, Sapporo, JAPAN sion for Bone-Mulch-Screw/WasherLoc fixation system should Yoshimitsu Aoki, Sapporo, JAPAN be less than 80 N. Akio Minami, Sapporo, JAPAN

5.57 Purpose: Poster #112 Evaluate the clinical outcome of simultaneous bilateral ACL INTRAOPERATIVE MEASUREMENT OF GRAFT ISOMETRY autograft reconstruction. BY GRAFT FIXATION OF ONE OF THE TWO BUNDLES IN TWO-ROUTE ACL RECONSTRUCTION Methods: Yoshiaki Kurihara, Nagano, JAPAN, Presenter From March 1991 to February 2000, eighteen patients were Takeshi Muneta, JAPAN operated on by two of us due to bilateral ACL insufficiency on Hiroo Ikeda, JAPAN a single operation basis. Fifteen patients were available at a Dept. of Orthopaedic Surgery, Saku General Hospita, Usuda-town, mean follow up of 38,4 months. The central third of the patellar Nagano, JAPAN tendon was used as an autograft in 7 cases and a quadrupled hamstring reconstruction was performed in the other 8 cases. PURPOSE: to measure each bundle length change by fixing the The rehabilitation program was similar to that adopted for the other bundle in two-route ACL reconstruction to clarify the corresponding unilateral operation during the same period. effects of stress sharing among multi-strand bundle in multi- The perioperative morbility and the IKDC SCORE were evalu- strand graft ligament reconstruction ated.

METHOD: Graft length changes were measured with the Results: Isometric Positioner (Acufex) in 43 endoscopic two-route ACL Perioperative morbility was higher than in unilateral surgery, reconstructions using hamstring tendons. Measurements for but significantly lower than for the same operation performed anteromedial(AM) and posterolateral(PL) bundles were per- consecutively. Four patients with joint effusions due to full formed in following three ways; First, with the Isotac and a weight bearing the day after surgery, needed to be drained. suture, secondly, with the graft itself passed through bone tun- None of them developed infections. Resumption of work and nels and locked to femoral cortex with Endobuttons, and then, physical activity times were 30 % longer than after a unilateral with the graft itself after the other bundle was fixed with a No.5 operation, whereas the short and mid-term results were similar. suture to tibia. Length changes from in full extension to 30, 60, Twenty seven knees (90 %) got a normal or nearly normal IKDC 90, 120 degrees of knee flexion were plotted and compared at Score. each angle. Discussion & Conclusions: RESULTS: In anteromedial(AM) bundles, mean length changes In the presence of bilateral ACL insufficiency the arthroscopic from in full extension to each angle were -2.5mm, -3.4mm, - simultaneous autograft reconstruction seems to be a reliable 3.2mm, -2.4mm with the Isotac, -1.3mm, -1.3mm, -1.1mm, - option. With an aggressive rehabilitation protocol, excellent 0.6mm with the AM graft when PL bundle was not fixed, results could be expected in this group of individuals. -0.9mm, -1.0mm, -0.8mm, -0.2mm when PL was fixed. There were slight but significant differences at 30 and at 60 degrees of flexion between PL not fixed and fixed. In posterolateral(PL) Poster #114 bundles, mean length changes at each angle were -3.1mm, - AUGMENTED ARTHROSCOPIC REPAIR OF ACUTE POSTER ABSTRACTS 4.3mm, -4.7mm, -4.2mm with the Isotac, -1.7mm, -2.1mm, - RUPTURES OF THE ANTERIOR CRUCIATE LIGAMENT 2.1mm, -1.8mm with the PL graft when AM bundle was not Franz Landsiedl, Vienna, AUSTRIA, Presenter fixed, -1.7mm, -2.0mm, -2.1mm, -1.9mm when AM was fixed. Siegfried Schenk, Vienna, AUSTRIA There was not significant difference at each angle between Nicolas Aigner, Vienna, AUSTRIA before and after AM fixation. Thomas Motycka, Vienna, AUSTRIA Orthopädisches Spital Wien-Speising, Vienna, AUSTRIA CONCLUSION: In our measurements, differences of graft length change after fixation of the other bundles were generally Aim of the study: smaller than differences between with the Isotac and with the Acute repair of ACL ruptures is rarely used as it is considered to grafts. However, in anteromedial bundles, length changes at give worse results than reconstruction using bone tendon bone smaller flexion angle became slightly shorter after fixation of PL patellar ligament or hamstrings. We started augmented arthro- bundles probably due to more tight “over the top pattern” of PL scopic acute repair of ACL ruptures in selected cases in 1988 bundles. In posterolateral bundles, changes of patterns after and wanted to find out if the objective follow up done by an AM fixation had no tendency. independent examiner could confirm the subjective high patient satisfaction and if any difference between semitendi- SIGNIFICANCE: These results may show the possibility of nosus (ST) and PDS band augmentation could be found. stress sharing in two-route ACL reconstruction. Our methods might be useful to predict tension pattern after fixation and to Material and methods: decide the sequence of fixation. Between December 1988 and January 1997 28 patients with acute ACL ruptures were operated on. In 12 patients the ST and in 16 the PDS band was used for augmentation. Only patients Poster #113 between the second and tenth day post injury with ruptures of SIMULTANEOUS BILATERAL ACL RECONSTRUCTION the femoral attachment and a solid long stump of the ACL were Guillermo R. Arce, Buenos Aires, ARGENTINA included in the study. Routine diagnostic arthroscopy was per- Pablo Lacroze, Buenos Aires, ARGENTINA, Presenter formed using a tourniquet. If primary repair was considered to Santiago Butler, Buenos Aires, ARGENTINA be possible a transcondylar 5mm tunnel was drilled in the 1 or Eduardo Diego Abalo, Capital, ARGENTINA 11 o’clock position using an inside out technique. The notch Juan Pablo Previgliano, Capital, ARGENTINA was debrided carefully. A 4,9mm working cannula was inserted Enrique Pereira, Capital, ARGENTINA through the drill hole into the joint to facilitate the passage of Roberto Valentini, Capital, ARGENTINA the sutures and the augmentation. Using 25cm long flexible Gabriel Pinazo, Buenos Aires, ARGENTINA needles 3-4 U-sutures were applied to the stump of the ACL IADT, Buenos Aires, ARGENTINA using # O PDS or Maxon threads. The sutures were delivered through the working cannula to exit at the distal lateral femur.

5.58 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). After sufficient fixation of the ACL stump a tibial tunnel was 51 ligamentoplasties of the ACL were carried out under drilled from the anteromedial tibia to the most posterior tibial arthroscopy by the same operational team between 1997 and foot print of the ACL. A double loop of 10mm woven PDS band 2001 (21 patellar bone-tendon-bone autografts and 30 achilles or the ST of which the tibial attachment was left intact were and patellar tendon allografts). All these ligaments were re- used for augmentation. Femoral fixation was achieved using a examined with 3 years of average follow-up, and a minimum of post screw for the PDS band and a screw and a small Burri-plate 1 year follow-up. Arthroscopy second-look was routinely per- for the ST. For tibial fixation of the PDS band we used staples, formed at 12 months in order to remove the screws, clinical the semitendinosus tibial attachment was left intact. examination (Lysholm score) and radiologic laximetry being performed every 6 months. 70% of cases had had previous sur- Results: gery, for meniscal lesions or traumatic cartilage lesions. 10 of the 12 ST patients and 13 of the 16 PDS patients could be Rehabilitation protocol was the same in both groups. The revi- reevaluated clinically and radiologically by performing an sion was necessary in 4 cases, average aged 26 years, three after instrumented Lachman X-ray with 8 years follow up (range 4- a post-traumatic event, a case of persistent laxity of a sports- 12). One patient of the PDS group sustained a traumatic rerup- man operated in another service. The revision technique was ture of the ACL after 5 years of excellent clinical follow up. An completely arthroscopic by using allografts. The follow-up for ACL reconstruction was performed in our institution. 1 patient revision cases (follow-up1 year 1) was favorable with the refused the follow up examination, 3 patients were lost. resumption of sport activity at 6 months.

No significant differences were found in the results of the two CONCLUSIONS groups (ST and PDS), therefore the results of the two groups are Main advantage of allograft reconstruction is the less invasive, presented together. A radiological Lachman (load 15 kp) differ- completely arthroscopic technique. Rehabilitation is easier, ence to the uninjured knee of 0-2mm was found in 10 patients, cosmetics are improved. At 3 years follow-up, functional results 3-5mm in 10 patients and 6-10mm in two patients. Two patients are similar in both groups (allograft versus autograft). For the were in IKDC group A, 18 in group B and 3 in group C. revision cases, the most usual clinical situation is that of a per- Evaluating the average OAK score resulted in 90 points (range sistent laxity or repeated trauma following the first intervention 60-11). The range of motion was excellent with all but one by failure of the transplant which is autograft or allograft. patients having > 135° of flexion and only one patient with 3° Tendinitis or partial rupture was found at the level of the of extension loss. There were three + (gliding) pivot shifts. The remaining tendon. The use of the old tunnels is generally not patients’ satisfaction was very high with an average of 1,35 possible either for the femur or for the tibia or for both, and a (range 1-3) points on a scale from 1 (excellent) to 5 (failure). In new drilling is essential. The osteolysis located into preopera- 3 patients (2 of the PDS and 1 of the ST group) arthroscopic tive and confirmed intra-operative is such as the drilling of a adhesiolysis had to be performed 6 to 9 months postopera- new isometric tunnel is not technically possible,so frequently it tively because of severely restricted range of motion. Additional is necessary to apply a bone graft. Utilisation of allografts make diagnoses of these patients: 2 ruptures of the posteromedial the surgical gestures much simpler and the rehabilitation eas- capsule and medial collateral ligament treated by open recon- ier, due to minimal host complications. The protocols of reha- struction and long leg cast for 4 weeks. Since 1995 a more bilitation were personalized according to the preoperative aggressive postoperative regimen with partial weight bearing functional state. for 4 weeks and protected range of motion exercises between 0- 15-90° is used. Using this aftertreatment has completely elimi- nated range of motion problems. Poster #116 HAMSTRING ANTERIOR CRUCIATE LIGAMENT Conclusions: RECONSTRUCTION USING THREE SURGICAL The long time results of this study are similar to results of tra- TECHNIQUES AND SECURE FIXATION: AN OUTCOME ditional ACL reconstructions with hamstrings or patella tendon ANALYSIS COMPARING WOMEN AND MEN POSTER ABSTRACTS with 83 % excellent and good results in the OAK score. Other Stephen M. Howell, Sacramento, CA, USA advantages of the procedure are the good long term stability, Keith W. Lawhorn, Clarksville, MD, USA, Presenter the excellent range of motion in most patients and the high Steven M. Traina, Denver, CO, USA patients’ satisfaction. If range of motion exercises are initiated University of California at Davis, Davis, California, USA very early the problem of postoperative adhesions can be avoided. Though there are no significant differences between Background: Females reconstructed with a double-looped the ST and PDS group there was a trend to better results in the semitendinosus and gracilis (DLSTG) graft and interference ST group. We still use the ST technique in carefully selected screw and suture fixation have poorer anterior laxity and clini- compliant patients with acute femoral ruptures of the ACL if cal outcome than males. The effect of gender on clinical out- there is a reattachable stump of good quality. come has not been reported with other surgical techniques that use a DLSTG graft.

Poster #115 Hypothesis: Females have the same stability and clinical out- ALLOGRAFT ACL REVISION RECONSTRUCTION – come as males with three surgical techniques that use a DLSTG 3 YEARS FOLLOW-UP graft and secure fixation. Dan Laptoiu, Bucharest, ROMANIA, Presenter Orthopaedics and Trauma Department, Colentina Clin, Bucharest, Study Design: Retrospective review of prospectively collected ROMANIA data.

PURPOSE Methods: The surgical technique for the Multicenter 2001 treat- We report the results of a study evaluating our arthroscopic ment group (61 F, 58 M) included drilling the femoral tunnel technique for ligamentoplasties (primary and revision) of the through the tibial tunnel, looping the graft around a post in the anterior cruciate ligament (ACL) of the knee. femur (Bone Mulch Screw), and fixing the DLSTG graft to the tibia using a WasherLoc. The technique for the One-Incision METHOD 1999 treatment group (20 F, 47 M) included drilling the femoral

5.59 tunnel through the tibial tunnel, looping the DLSTG graft Introduction: This study evaluated the donor site change after around a post in the femur, and fixing the graft to the tibia with arthroscopic ACL reconstruction using central quadriceps ten- two soft tissue staples. The technique for the Two-Incision 1996 don-patellar bone autograft. treatment group (13 F, 28 M) included drilling the femoral tun- nel through a second incision, fixing the DLSTG graft to the Materials and Methods: Sixty-six knees that had had ACL femur with either one or two ligament washers, and looping the reconstruction using quadriceps tendon were investigated with graft around a post in the tibia. mean follow up period of 1 year 6 months (12 to 41 months).

Results: We observed no clinically significant differences in the Results: Quadriceps strength measured by Cybex II recovered to final IKDC score, activity level, anterior laxity, single-leg hop 80% of unaffected side at 1 year after surgery and patellar posi- test, flexion, and extension between females and males when a tion, in terms of Insall-salvati ratio and congruence angle, did DLSTG graft is used with the three surgical techniques. not show any change postoperatively. No anterior knee pain was observed at all. On MRI, wide intermediate signal intensity, Conclusions: Females with a DLSTG graft have the same out- higher than that of quadriceps tendon before harvest, was come as males with the three surgical techniques and the observed at donor sites in 13 out of 16 knees until 6 months secure fixation methods evaluated in this study. The outcome after reconstruction, but after 12 months, much lower intensity in females treated with a DLSTG graft is dependent on the sur- signal was observed at donor sites suggesting some regenera- gical technique and type of fixation. The DLSTG graft is not the tion of quadriceps tendon in harvest site. The thickness of cause of the poor outcome in females with interference screw quadriceps defect was found to be increased to 9.7mm at 6 and suture fixation that was reported in other studies. months and decreased to 7.7mm at 1 year postoperatively. Positive anterior drawer, pivot shift, and Lachman test over grade II was not found at final follow up in all knees. Anterior Poster #117 translation measured by KT-2000 arthrometer diminished from ARTHROSCOPIC ANTERIOR CRUCIATE LIGAMENT mean preoperative value of 4.8mm to 2.3mm. Lysholm score RECONSTRUCTION USING CENTRAL QUADRICEPS improved from 72 to 90. TENDON AUTOGRAFT Myung-Chul Lee, Seoul, KOREA, Presenter Conclusion: Central quadriceps tendon grafted in ACL recon- Sang Hoon Lee, Seoul, KOREA struction showed satisfactory results without any significant Hyunchul Jo, Seoul, KOREA morbidity of donor sites in the present study. Furthermore, MRI Sang Cheol Seong, Seoul, KOREA analysis suggests the evidence of postoperative remodeling in Department of Orthopedic Surgery, Seoul National U, Seoul, KOREA the donor sites.

Background : Patellar tendon bone autograft is widely used for ACL reconstruction because of good mechanical property, but Poster #119 donor site morbidity including anterior knee pain have been THE ANATOMY OF TIBIAL EMINENCE FRACTURES: reported by many orthopaedic surgeons. The purpose of this ARTHROSCOPIC OBSERVATIONS FOLLOWING FAILED POSTER ABSTRACTS study is to evaluate the clinical results of anterior cruciate liga- CLOSED REDUCTION ment reconstruction using central quadriceps tendon autograft. Joseph Lowe, Jereusalem, ISRAEL, Presenter Materials and Methods : From November 1997 to January 2000, Gershon Chaimsky, Jereusalem, ISRAEL 46 patients who received primary ACL reconstruction using Adi Freedman, Jereusalem, ISRAEL central quadriceps tendon were followed up for more than two Ido Zion, Jereusalem, ISRAEL years. We analyzed the clinical results, Lysholm score, KT-2000 Charles Howard, Jereusalem, ISRAEL score and quadriceps strength using Cybex II dynamometer. Hadassah Hospital, Jereusalem, ISRAEL

Results : At late follow-up, one patient demonstrated grade 2 Background: Failed manipulative reduction of avulsion frac- pivot shift test, and No patient demonstrated grade 3 pivot shift tures of the anterior cruciate ligament tibial insertion is attrib- test. Average KT-2000 maximum manual side to side difference uted in the literature to interposition of soft tissues. The reduced significantly from 4.7mm to 2.7mm(P<0.01). Mean objective of the presentation is (a) to show that failure to Lysholm score improved significantly from 70 to 90 (P<0.01). reduce McKeever type 3 fractures of the tibial eminence was not Quadriceps strength improved from preoperative value of 68% due to interposition of soft tissues, and (b) to discuss the sig- of unaffected knee to postoperative value of 80% of unaffected nificance of the observed attachment of the anterior third of the knee. No one had donor site tenderness. lateral meniscus to the avulsed anterior cruciate ligament insertion site in all the cases studied. Conclusion : Central quadriceps tendon-patellar bone autograft in ACL reconstruction showed satisfactory clinical results, and Method: A series of twelve cases of type 3 anterior cruciate lig- recommended as an excellent graft alternative in ACL recon- ament tibial eminence avulsions after failed attempts at manip- struction. ulative reduction underwent arthroscopic reduction and fixation of the avulsed fragment.

Poster #118 Results: The following findings were consistent: The avulsed DONOR-SITE MORBIDITY IN ACL RECONSTRUCTION intercondylar eminence was displaced superiorly into the inter- USING QUADRICEPS TENDON AUTOGRAFT condylar notch. Attached to this fragment was no only the ante- Myung Chul Lee, Seoul, KOREA, Presenter rior cruciate ligament, but also in all cases the anterior horn of Hyunchul Jo, Seoul, KOREA the lateral meniscus. The anterior third of the lateral meniscus Sang Hoon Lee, Seoul, KOREA was tom from its tibial attachment and displaced together with Sang Cheol Seong, Seoul, KOREA the bony fragment into the intercondylar notch. No interposi- Department of Orthopedic Surgery, Seoul National U, Seoul, KOREA tion of soft tissues was observed. Reduction of the bony frag- ment was facilitated by traction on sutures passed around the

5.60 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). anterior horn of the lateral meniscus. Standard fixation meth- ods were utilized. Poster #121 Conclusions: The concept that anterior cruciate ligament tibial ANATOMIC DOUBLE BUNDLE ACL RECONSTRUCTION avulsion irreducible by manipulation is caused by soft tissue WITH HAMSTRINGS. TECHNICAL NOTE. interposition was not observed in the 12 cases reported. The Maurilio Marcacci, Bologna, ITALY, Presenter attachment of the anterior horn of the lateral meniscus to the Alessandro Paladini Molgora, Angera (VA), ITALY avulsed tibial insertion of the anterior cruciate ligament may Stefano Zaffagnini, Bologna, ITALY not be an irrelevant incidental finding. The observation that the Alberto Vascellari, Bologna, ITALY displaced bony fragment is attached simultaneously to the Francesco Iacono, Bologna, ITALY anterior cruciate ligament and to the anterior horn of the lateral Istituto Ortopedico Rizzoli, Bologna, ITALY meniscus, both pulling in different directions, may explain the irreducibility of type 3 tibial eminence fractures by manipula- OBJECTIVE tion. Various surgical procedures and graft selections have been pro- posed for ACL reconstruction, with the goal to restore stability and normal knee kinematic. The variables that influence the Poster #120 final outcome are exact graft location, orientation, tension and TRANSPHYSEAL ACL REPAIR IN THE SKELETALLY biomechanical implant features close to normal ACL. With the IMMATURE ATHLETE aim to guarantee a good stability and restoration of normal Peter Benjamin MacDonald, Winnipeg, CANADA, Presenter kinematic we have developed a double bundle gracilis and Brian Black, Winnipeg, CANADA semitendinosus technique, trying to reproduce the mechanical Michael Davidson, Winnipeg, CANADA effect of both anteromedial and posterolateral bundle of ACL. David Dillon, Winnipeg, CANADA University of Manitoba, Winnipeg, CANADA MATERIAL AND METHODS The semitendinosus and gracilis tendons are harvested pre- Objective: serving their tibial insertion to maintain their neurovascular The purpose of this retrospective project is to study the effects supply and sutured together at the free proximal tendons end. of the conventional ACL repair using intra-articular transphy- Tibial and femoral tunnel are performed using guide pins posi- seal techniques on young adolescent patients. tioned under arthroscopic visualization. The diameter of the femoral tunnel is smaller than tibial one. After execution of a Design: Retrospective Follow-up Study lateral incision and dissection of muscle fascia the prepared tendons are passed over the top to reproduce the posterolat- Setting: Outpatient Sport Medicine Clinic eral bundle of ACL, and reinserted in the femoral tunnel previ- ously prepared and pulled down in the tibial tunnel again to Patients: 19 adolescents (average age at surgery = 15.2) who reconstruct the anteromedial bundle. After pretensioning of the had their ACL repaired through their femoral physes. tendons, they are fixed to the anteromedial aspect of the tibia with a transosseus suture knot. Interventions: Two year follow-up appointments were conducted with 19 ado- DISCUSSION lescents (average age at surgery = 15.2) who had their ACL The technical features of this technique are high mechanical repaired through their femoral physes. KT measurements were resistance by the use of a four bundle grafts, reproduction of taken, ACL “Quality of Life” questionnaires completed, the two anatomical bundles of ACL and avoidance of any hard- scanograms and MRI images of their femoral physes were col- ware implant. lected. IKDC scores were assessed. Results were tabulated and POSTER ABSTRACTS studied using descriptive statistics. Poster #122 Outcome Measures: THE RELATIONSHIP BETWEEN ANTERIOR CRUCIATE All patients were seen by their operative surgeon for post-oper- LIGAMENT LAXITY AND PATIENT FUNCTION ative follow-up (as well as the research nurse for further assess- Robert G Marx, New York, NY, USA, Presenter ment). Functional outcomes were documented. Timothy Stump, New York, NY, USA Self-administered “Quality of Life Assessment in ACL-defi- Edward C. Jones, New York, NY, USA ciency” (Dr. N. Mohtadi, Calgary, AB) questionnaires were com- John T. Cavanaugh, New York, NY, USA pleted at the patients’ two-year anniversary date. IKDC scores Thomas L. Wickiewicz, New York, NY, USA were calculated based on subjective and objective patient data. Russell F Warren, New York, NY, USA Hospital for Special Surgery, New York, NY, USA Results: None of the patients who participated experienced any leg INTRODUCTION: length discrepancies as supported by pre and post surgical Laxity of the knee in the antero-posterior plane has long been heights and scanograms. Of the patients who were able to par- considered to be a reliable, valid and objective measure for the ticipate in physical assessments, most had functioning ACLs at evaluation of ACL deficient or reconstructed patients. The aim least two years after their surgeries. MRIs showed that the phy- of this study was to determine whether there is a relationship ses were now closed and bony development had occurred nor- between laxity of the ACL (as documented by instrumented lax- mally. ity testing) and the stated functional ability of patients.

Conclusions: METHODS: Current transphyseal ACL repair techniques when used in the Patients who were ACL insufficient as well as patients who had young adolescent population prior to physeal closure did not undergone ACL reconstruction were evaluated. Patients with result in long term negative results. This technique has its place previous contralateral ACL injuries were excluded to avoid error in the ACL repair in young adolescents. calculating the difference in side to side laxity. Patients under-

5.61 went KT-1000 testing (side to side difference, maximum manual All major postoperative complaints concerning the harvesting at 30 degrees) by experienced sports therapists and were asked site are shifted from the injured knee into the healthy knee if to rate their ability to run, cut, pivot and decelerate on a four the graft is taken from the contralateral knee. This may be an point scale. They also completed the Lysholm and Tegner argument for favoring alternative grafts like semitendinosus scales to measure their level of symptoms and disability, as and gracilis, or quadriceps tendons. well as their level of activity.

RESULTS: Poster #124 Eighty-two patients were evaluated: 48 had undergone ACL SPORTS AND ALL-DAY-LIFE ABILITY FOLLOWING ACL reconstruction and 34 were ACL deficient. The mean KT-1000 RECONSTRUCTION USING THE HAMSTRINGS VS BPT- scores in the non-operative group was 3.9 mm side to side dif- GRAFT IN AN IMPLANT-FREE PRESSFIT TECHNIQUE ference compared to 2.7 mm in the post-surgical group (p 0.05). Jan Springer, Heidelberg, GERMANY The mean Lysholm and Tegner scores were 87.7 and 5.8, respec- Robert Kilger, Heidelberg, GERMANY tively. There was no statistically significant correlation between Dimitrios Stylianos Mastrokalos, Leimen, GERMANY, Presenter the patients’ stated ability to run, cut, pivot or decelerate and Hajo Thermann, Heidelberg, GERMANY their KT-1000 side to side differences. Hans H Paessler, Heidelberg, GERMANY Center for Knee and Foot Surgery. Atos Clinc Cente, Heidelberg, GERMANY DISCUSSION and CONCLUSION: Patient function following ACL injury or reconstruction is mul- The goal of this prospective, randomized study is the functional tifactorial and KT-1000 measurements in isolation do not nec- evaluation of two different techniques of ACL reconstruction by essarily reflect patients’ ability to perform athletic maneuvers using the bone-patella tendon (BPT) vs. hamstrings (ST/G). such as running, cutting, pivoting and deceleration. Material/Methods: 62 ACL-insufficient patients without any concommitent sport injuries took part in a prospective ran- Poster #123 domized study. 18 men and 13 women underwent an ACL- DONOR SITE MORBIDITY AFTER ACL RECONSTRUCTION reconstruction with BPT graft (Group I) with average age 29,87 USING IPSILATERAL VS. CONTRALATERAL BPT GRAFT (16-46) years. 31 patients (16 women and 15 men) with average Dimitrios Stylianos Mastrokalos, Leimen, GERMANY, Presenter age 34,23 (16-55) years underwent ACL-reconstruction using a Sebastian Mueller, Heidelberg, GERMANY quadrupeled hamstrings graft (Group II). Both techniques were Hans H Paessler, Heidelberg, GERMANY performed by using a press-fit and implant-free technique. We ATOS - Clinic Heidelberg Centre for Knee and Foot, Heidelberg, GERMANY used the same rehabilitation protocol for both groups (acceler- ated rehabilitation).The patients were evaluated by IKDC, Aim: The aim of this study is the evaluation of the activity level Lysholm and Tegner scoring systems, KT 1000, one leg hop, iso- and the remaining symptoms concerning the graft donor site in kinetics, internal torque, kneeling and knee walking test, 1 day patients having anterior cruciate ligament (ACL) reconstruction preoperatively (VU), and 3 (NU I), 6 (NU II) and 12 months (NU with either ipsilateral or contralatral bone-patellar-tendon III) postoperatively. POSTER ABSTRACTS (BPT) graft. Results: One year postop.the results of Group II (30 patients Method: 100 patients aged from 18 to 49 years (mean 34) hav- classified as A and B) were according to IKDC scoring system ing an ACL reconstruction with BPT-graft from 1997 to 1999 better than those in Group I (Group I: 24 patients classified as were included in this study. In 52 of them a BPT-graft (central A and B). We had similar results according to Lysholm-scoring third) from the ipsilateral side was used (group I). In 48 patients evaluation (Group II: 95,61 points vs. 90,87 in Group I the contralateral BPT was used (group II). The BPT graft with a (p=0.017)) and Tegner-score (Group II: 7,07 vs. 6,61 in Group I bone plug only from the tuberositas for femoral pressfit fixation (p=0.00)). According to the KT 1000 stability evaluation there was choosen to diminish additional morbidity from harvesting was no statistical significant difference between injured and a second bone plug from the patella. All patients were followed uninjured knees in both groups. The evaluation of the strength up by questionaire at an average of 35 months (25-53 months) of the hamstrings by isokinetics showed statistical significant postoperative. The questionaire included the Cincinnati score differences between both groups (Group II: 90,34 Nm vs. 99,19 the Tegner activity score and special questions concerning per- Nm in Group I, (p=0.008)). However our results concerning sisting symptoms at the donor site such as tenderness, numb- internal torque evaluation were not statistical significant. ness, kneeling pain and pain while walking on the knees. For Concerning the evaluation of the one leg hop comparing statistical analysis the paired t-test was used. injured and non-injured leg there was a significant difference between group II and group I (Group II: 96% vs. 91% in Group I, Results: The time from surgery to uptake of sport acitivities was (p=0.012)). We had worse results in Group I vs. Group II at in both groups similiar. The average Cincinnati Scoring was 85,2 kneelling and kneewalking-testings ((p=0.00)(p=0.00)), con- in Group I and 86,3 in Group II. There was no statistical signifi- cerning the anterior knee pain. cance in the Tegner score between the two groups. Impressive was that 88% of all the patients had complaints at the donor Conclusion: From our results concerning IKDC, Lysholm, site such as paraesthesias and pain, when walking on their Tegner, kneeling and knee walking tests it seems that the har- knees. Within group II there were 3 major complications con- vesting of both semitendinosus and gracilis tendon can be rec- cerning the donor knee: 1 rupture of the patellar tendon, 1 ommended for ACL reconstruction. Only the isokinetic severe tendinitis, resolved only by surgery, 1 chronic severe ten- evaluation of hamstrings showed a statistical significant defi- dinitis which continued for more than 3 years postoperative. No ciency of the hamstrings-group compaired to the BPT-group. similiar complications were observed in group I. But this result could not be confirmed with the methods of the internal torque evaluation and “one leg hop”. Conclusion: Donor site problems after harvesting the central third of the patellar tendon even with only one bone plug seems to be an underestimated problem. This study showed Poster #125 that there are no benefits if the contralateral BPT graft is used.

5.62 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). TIBIAL TUNNEL ENLARGEMENT AFTER ACL Albert M Tsai, Fontana, CA, USA RECONSTRUCTION WITH HAMSTRINGS. UCLA Department of Orthopedic Surgery, Los Angeles, California, USA A COMPARISON OF SINGLE AND DOUBLE POINT TIBIAL GRAFT FIXATION. Introduction: Few studies have examined long-term results Julian Rossis, Heidelberg, GERMANY after ACL reconstruction in elite athletes. This study retrospec- Yu Jiakuo, Beijing, CHINA tively evaluated knee function and quality of life at a minimum Hans H Paessler, Heidelberg, GERMANY of two years follow-up in elite collegiate athletes who had sus- Dimitrios Stylianos Mastrokalos, Leimen, GERMANY, Presenter tained an ACL injury, and compared them to a matched cohort Atos Clinic, Center for Knee Surgery, Foot Surgery, Heidelberg, GERMANY of their uninjured teammates.

Introduction : Radiographic tibial bone tunnel enlargement has Methods: 42 Division I-A collegiate athletes who had sustained been observed following ACL reconstruction with hamstrings. It an ACL injury over a ten year period were identified. Of these, has been hypothesized that mechanical factors such as graft 33 were contacted, as well as 33 uninjured control athletes from tunnel motion and stiffness of the fixation technique contribute the same team who played a similar position. Knee function to tunnel enlargement.The purpose of this study was to evalu- was evaluated with the modified Lysholm, Tegner, and subjec- ate whether additional aperture fixation to distal fixation (two- tive portion of the IKDC forms. Quality of life was assessed with point fixation or 2P) may diminish tibial tunnel widening the SF-36 questionnaire. Athletes were further questioned on compared to distal fixation alone (one-point fixation or 1P). their mechanism of injury, time until return to sport, and self- assessment of performance level compared to pre-injury status. Methods: Two groups of patients were evaluated. In group 1P Appropriate statistical analysis was used. (44 pts, 20 female and 24 male, mean age 33.4±10.2) the grafts were fixed using a press fit technique plus two 4 mm Mersilene Results: The sports involved during ACL injury were football tapes passed and tied over a 10 mm bone bridge created in the (14), basketball (7), soccer (3), gymnastics (3), track and field anterior cortex 1cm distal to the exit of the tibial tunnel as a (2), skiing (2), baseball (1), and tennis (1). 29 of the 33 ACL post (one-point fixation). In group 2P (51 pts, 19 female and 32 injured athletes underwent ACL reconstruction surgery. 3 of the male, mean age 33.9±10.4) the same technique was used as in 33 control athletes subsequently sustained ACL injury after group 1P, except for an additional fixation using 1 absorbable leaving college. Mean Tegner score was 6.0 in the ACL injury cross pin in 27 pts. and 2 absorbable cross pins (Rigid fix, group and 7.1 in the control group (p=.054). Modified Lysholm Mitek) in 24 pts., which were inserted through the graft parallel score was 85.9 in the ACL injury group and 89.9 in the control and close to the tibial plateau in the coronar plane (double group (p=.25). All component and summary scores of the SF-36 point fixation). All patients in both groups were operated on by were not significantly different between the groups. In the ACL the senior surgeon (HP) and followed the same rehabilitation injury group, 16 patients scored A or B in the subjective portion protocol. AP and lateral radiographs with a 10mm reference ball of the IKDC; 17 patients scored C or D. In the control group, 24 as well as patients evaluation were performed 3, 6 and 12 patients scored A or B; 9 patients scored C or D. A chi-squared months post-op. After scanning and correcting for radiographic analysis revealed differences between these two groups to be magnification, tibial tunnel size was measured at the widest significant (p=0.04). Self-assessment of current performance dimension on both AP and lateral radiographs using the Scion level was 77.6% in the ACL injury group and 77.9% in the con- Image software and changes in tunnel width were recorded rel- trol group. After college, five of the ACL injured athletes con- ative to the diameters drilled at surgery. Statistical analysis was tinued their sport at a professional or national team level vs. done using t-test (significance p < 0.05) nine of the control athletes.

Results: Tunnel enlargement occurred in both groups. On AP Discussion: Quality of life in elite collegiate athletes who sus- radiographs the mean enlargement in group 1P was 30.2±13.6 tained an ACL injury was not significantly different from their

% while in group 2P it was 31.07±12.08 % (p=0.5). On the lateral uninjured teammates. Knee function between these groups was POSTER ABSTRACTS radiographs the mean enlargement in group 1P was not significantly different with the exception of the subjective 25.61±13.99 % and in group 2P, 19.63 ±10.92 % (p<0.05). portion of the IKDC. Significant increase in tibial tunnel width was observed in both groups at 3 months post - op (p<0.05) but not thereafter (6m and 12 m). No statistical relationship was found between tun- Poster #127 nel enlargement and gender, age, IKDC, and KT 1000 side-to- PRIMARY ACL RECONSTRUCTION WITH B-T-B side difference in both groups. ALLOGRAFT: TWO TO NINE YEAR OUTCOMES AND MRI ASSESSMENTS Conclusion : This study shows that suspensory tibial graft fixa- Eric C. McCarty, Nashville, TN, USA, Presenter tion with cross-pins results in less tibial tunnel enlargement in Airron Richardson, Nashville, USA the sagital plane. This may be explained by the fact that the Russell F Warren, New York, NY, USA cross pins are inserted in the coronar plane thus reducing tib- Thomas L. Wickiewicz, New York, NY, USA ial graft movements mainly in the sagital plane. The study sup- David W Altchek, New York, NY, USA ports the hypothesis that tibial graft micro-movement during Josh Stein, New York City, USA the period of tendon healing to bone (up to 3m) plays a role in Hollis G. Potter, New York, NY, USA tibial tunnel enlargement after ACL reconstruction using ham- John Thomas, New York, USA strings. Additional cross-pin fixation may reduce tunnel Hospital for Special Surgery, New York, NY, USA enlargement to a certain degree. Introduction: Despite widespread use of allograft tissue for ACL reconstruction, there are very few series with long-term follow- Poster #126 up and none with complete MRI follow-up for primary recon- KNEE FUNCTION AFTER ANTERIOR CRUCIATE LIGAMENT structions. INJURY IN ELITE COLLEGIATE ATHLETES David R. McAllister, Los Angeles, CA, USA, Presenter Methods: Thirty patients underwent a follow-up assessment a Sharon L. Hame, Los Angeles, CA, USA minimum of two years (avg. 4.6) after undergoing an ACL recon-

5.63 struction procedure with fresh frozen Bone-Patellar tendon- Mutsu General Hospital, Mutsu City, JAPAN Bone Allograft tissue. Outcome measures included: physical examination, arthrometric testing (KT-1000), plain radiographs, MRI, and functional testing (one-leg hop test). Standard out- The goal of anterior cruciate ligament (ACL) reconstruction is come scales included the International Knee Documentation to reestablish normal joint stability and to maintain it with Committee scale, Lysholm II scale, and a visual analog scale. sports activity. Though fixation of the graft should be ideally as close to the joint lines as possible, attaining anatomic graft fix- Results: The average age of the patients at the time of the ACL ation on both the femoral and tibial sides is difficult indeed in reconstruction was 40.2 years (range 27-52). KT-1000 (max any graft. We have done bone grafting to the proximal end of manual) side-to-side differences revealed 11 patients with val- the tibial bone plug in bone-patellar tendon-bone (BPTB) to ues > 3.0 mm and 19 with values < 3.0 mm. MRI revealed par- avoid tibial tunnel enlargement. Fink reported the utility of tial to full disruption in 5 grafts and an inhomogeneous signal computed tomography in additional 9 grafts. 17 knees demonstrated poor to fair incor- poration of the tibial bone block. Twelve knees demonstrated (CT) to detect the bone tunnel enlargement. The purpose of this tibia tunnel widening. Functionally, only two patient experi- study was to precisely evaluate with CT scans the tibial tunnel enced episodes of instability, one with activities of daily living changes following ACL reconstruction with BPTB graft fixed at and one with moderate to strenuous athletic activity. The aver- the tibial anatomic position. age Lysholm score was 89.2, and the average Tegner score was 4.9. Thirteen consecutive patients who had undergone ACL recon- Conclusions: Primary ACL Reconstruction using allograft B-T-B struction with BPTB were retrospectively reviewed at one year tissue provides the patient with satisfactory knee stability and postoperatively. We routinely use the 10mm diameter coring a high rate of return to functional activities, but objective knee reamer to create the tibial bone tunnel, harvesting a cored can- stability is of concern. Tunnel widening and poor graft incorpo- cellous bone plug. We add it to the proximal end of the tibial ration is evident on MRI but does not correlate with increased bone plug to secure the graft closer to the articular surface with laxity. interference screws. To evaluate the tibial tunnel changes, CT was performed consecutively. Multidetector-row herical CT (LightSpeed QX/I; GE Yokogawa Medical Systems, Milwaukee, Poster #128 WI, USA) was used of the tibial metaphysis with following the DIFFERENCES BETWEEN BIOABSORBABLE FEMORAL protocol: the section thickness was 5mm and the table speed FIXATION AND INTERFERENCE SCREW FIXATION was 5mm/sec, resulting in a pitch of 1. Secondary sagittal and DURING RECONSTRUCTION OF THE ANTERIOR coronal reconstructed images were obtained. Digital measure- CRUCIATE LIGAMENT ment was done at the tibial tunnel aperture (level I), at the mid- Mladen MIskulin, Zagreb, CROATIA, Presenter point of the tunnel length (level II) and at the proximal end of General Hospital “Zabok”, Zabok, CROATIA the bone plug (level III) in both sagittal and coronal planes. To assess the effectiveness of bone graft added to the BPTB, seven POSTER ABSTRACTS The purpose of this paper is to present a study of the differ- other cases who had undergone endoscopic ACL reconstruc- ences between two systems for the femoral fixation of the tion without bone graft were reviewed with CT as a control. bone-tendon-bone graft (patellar ligament) during ACL recon- Statistical analysis was performed using Unpaired t-test (p < struction. Since May 2001, for the femoral graft fixation during .05). procedure of the ACL reconstruction in General Hospital “Zabok”, Croatia, we are using the Mitek RIGIDFix cross pin Bone-Tendon-Bone System. On the other hand, we didn’t stop The mean tunnel size in CT sagittal plane was 11.7mm at level using a “traditional” interference screw. I, 11.5mm at level II and 10.2mm at level III at 12 months post- operatively. In the control group the average was 11.4mm at To check the difference between two types of the fixation device level I, 11.1mm at level II and 10.2mm at leveL III. The mean size we formed two groups of patients (experimental and control in CT coronal plane was 10.3mm at level I, 10.1mm at level II group) with 30 and more patients in each group. It has to be and 9.6mm at level III. In the control group the average was mentioned that all ACL reconstruction has been performed in 10.0mm at level I, 10.9mm at level II and 11.4mm at level III. The day surgery. The hypothesis of the study is that a new fixation differences in enlargement between the groups was not signifi- device offers better fixation, faster rehabilitation and faster cant (p > .05). The tunnel expansion was largest at level I in return to the sport activities. During study we are searching for both saggital and coronal planes, but it was not significant sta- the difference between two groups of patients according to the tistically (p > .05). IKDC Standard Knee evaluation score. We expect to find a sta- tistically significant difference between two methods that will justify employment of the suggested fixation. All procedures Fink reported that CT was a reliable measure to evaluate bone were, and still are performed in day surgery with 1 day hospi- tunnel changes, especially in the early postoperative phase talization. when absence of sclerotic margin on radiographs. He found the expansion was largest at the midpoint of the tunnel and sug- gested one of the etiology of tunnel enlargement was synovial Poster #129 fluid leakage into the tunnel. On the contrary our results BONE TUNNEL CHANGES FOLLOWING ANTERIOR showed that bone-grafting to BPTB would reduce the motion of CRUCIATE LIGAMENT RECONSTRUCTION FIXED the graft and avoid the enlargement of the middle of the tibial AT THE TIBIAL ANATOMIC POSITION: tunnel. Another explanation could be the fact that cancellous COMPUTED TOMOGRAPHIC EVALUATION bone-grafting had the advantage of early bony fusion and pre- Akihiko Nagao, Mutsu City, JAPAN, Presenter vented the inflow of joint fluid to the tunnel. We also believe Satoshi Toh, Hirosaki, JAPAN that bone-grafting increased the stiffness of BPTB biomechani- Yasuyuki Ishibashi, Aomori, JAPAN cally, and anatomical fixation minimized functional length and Koichi Shibutani, Hirosaki, JAPAN maximized the stiffness of the graft. We concluded that less

5.64 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). tunnel enlargement could be detected where the bone graft was through the medial parapatellar incision, and the lateral edge placed in a more anatomical position close to the joint line. of the opening of the intercondylar notch including crescent shape of subchondral bone was performed (notchplasty). Thereafter, in the right knee the RF treatment of 15 watts was Poster #130 applied to the notch with the electro-surgical device (VAPR) for THE EFFECT OF TENDON HARVEST ON THE CLINICAL 2 seconds. The left knee was served as a control without any RESULTS AFTER ENDOSCOPIC ACL RECONSTRUCTION: treatment after the notchplasty. At 12 weeks after surgery, all TWO-TENDONS (ST & G) VS ONE-TENDON (ST) the animals were sacrificed to observe the state of notch Shinya Nagasaki, Hakodate, JAPAN, Presenter regrowth, the surrounding cartilage and the synovium. The Yasumitsu Ohkoshi, Hakodate, JAPAN regrowth was classified into the following three grades: grade I, Kazuki Yamamoto, Hakodate, JAPAN regrowth less than 1/2; grade II, regrowth of more than 1/2; tomoyuki hashimoto, Hakodate, JAPAN grade III, full regrowth in the notch defect. The data were sta- Shigeru Yamane, Hakodate, JAPAN tistically analyzed with c-square test. Hakodate Central General Hospital, Hakodate, JAPAN (Results)In the control group, 22% was grade I; 33%, grade II; Purpose The purpose of this study is to clarify the effect of har- 45%, grade III. In the RF-treated group, 84% was grade I; 8%, vesting of two-tendons (semitendinosus tendon;St and gracilis grade II; 8%, grade III. The two groups were significantly differ- tendon;G) on the clinical results after ACL reconstruction com- ent in notch regrowth with a p-value of < 0.05. In the RF-treated pared with harvesting of one-tendon(St). group, the minimum cartilage damage was found in the sur- rounding area, and only one knee showed effusion and synovi- Materials and Methods Between 1995 and 1998, 224 patients tis. underwent one-incision ACL reconstruction. Cases were speci- fied according to the inclusion criteria of this study. As a result, (Discussion) There have been few experimental and clinical 50 patients who underwent two-tendons harvest (group StG) reports on the prevention of the notch regrowth following and 40 patients who underwent one-tendon harvest (group St) notchplasty. This study has clearly shown that RF treatment is were included in this study. Rosenberg’s procedure was per- effective on the suppression of the regrowth. Therefore, the formed in every case. The graft size, the clinical evaluation thermal treatment is recommendable, once the notchplasty is (IKDC form), the muscle strength (Biodex II), the period for added in ACL reconstruction. achieving full extension after surgery and active flexion angle were compared between the two groups. Poster #132 Results The average diameter of the graft was significantly HOW TO REDUCE PATELLAR TENDON GRAFT larger in group St and length of the grafts was significantly HARVESTING MORBIDITY – CADAVEROUS STUDY OF A longer in group StG. The average period for achieving full exten- NEW TECHNIQUE sion after surgery were 11.4 ?12.6 days in group StG, and 5.8 N. Bonin, Lyon, FRANCE, Presenter ?4.5 days in group St (p<0.05). There were no significant differ- Jeunet Laurent, Besancon, FRANCE ences between the two groups tested with respect to the over- Garbuio Patrick, Besancon, FRANCE all IKDC rating score. Side to side differences of anterior laxity Obert Laurent, Besancon, FRANCE (KT 1000, manual max.) was 1.8?1.8mm in group StG, and Service d’Orthopedie Traumatologie Plastique - chu, Besancon, FRANCE 1.8?1.4mm in group St. Loss of active flexion angle was observed more frequently in group StG. Introduction : To reduce donor-site morbidity, the authors performed a Conclusion Quicker and better postoperative recovery of ROM new device and tested a new surgical technique of patellar ten- and muscle strength was advantages of the one-tendons har- don graft procurement employing one small vertical incision POSTER ABSTRACTS vest. taking care of the paratenon and the infrapatellar nerves. They report the results of 27 bone-patellar tendon-bone autograft harvesting on fresh frozen cadaver. Poster #131 USE OF RADIOFREQUENCY ENERGY TO CONTROL Material and Method : NOTCH REGROWTH IN ACL RECONSTRUCTION Conception, realization and optimization of an instrument Kazuhiko Nakano, Sapporo, JAPAN, Presenter and its surgical technique was preliminary performed on sev- Mitsuhiro Aoki, Sapporo, JAPAN eral dissections. The instrument and the technique were then Konsei Shino, Habikino, Osaka, JAPAN evaluated on a consecutive series of 27 fresh frozen cadaver Toshiaki Yamamura, Sapporo, JAPAN knees. Harvesting procedure last, graft and incision size were Seiichi Ishii, Sapporo, JAPAN measured. Infrapatellar nerve or its branches, and paratenon Nishioka Daiichi Hospital, Sapporo, JAPAN were examined for injury. Harvesting problems were analyzed.

(Purpose) In anterior cruciate ligament (ACL) reconstruction, Results : notchplasty is occasionally performed to avoid graft impinge- Time of harvesting procedure was 15 minutes (9-22). ment against the notch. However, the regrowth of fibrous tissue Incision length measured 29 millimeters (24-33). Infrapatellar in the notch (notch regrowth) may take place to cause loss of nerve or its branches were undamaged in 21/27 graft procure- full extension, or to partially damage the graft. The prevention ments. It was partially damaged above the apex of the patella of this tissue regrowth in the notch is desirable, once the notch- in 5 graft procurements. Paratenon was safe in 23/27 harvesting plasty is added. The purpose of this study was to investigate the procedure. Harvesting complications were : effect of radiofrequency (RF) treatment on the notch regrowth - Rupture of traction suture : 3/27 following notchplasty and the surrounding cartilage. - Tibial bone block fracture without discontinuity : 2/27 - Distal patellar ligament insertion avulsion : 3/27 (Methods) Twelve Japanese white rabbits with an average age of 26 weeks were used. The bilateral knee joints were opened Discussion - Conclusion :

5.65 Patellar tendon autograft is a commonly used graft for Purpose: Females are at particular risk for sustaining non-con- anterior cruciate ligament reconstruction. However, persistent tact ACL injury, particularly during jump landings, and sudden donor-site complications such as unsightly scar, tenderness, deceleration during running directional changes. Frontal and disturbance in anterior knee sensitivity are still a problem. transverse plane femoral control through the hip joint is essen- The principal finding in this study was that it was possible tial to the prevention of ACL injury. The muscles of the pelvic to harvest a consistent bone-patellar tendon-bone graft deltoid (tensor fascia lata, gluteus medius and gluteus max- through 30 mm vertical incision using a new instrument. This imus) provide dynamic three-dimensional control of the femur. technique gives cosmetic and probably functional benefit, leav- This study evaluated the influence of femoral anteversion on ing the infrapatellar nerve or its branches intact and the pelvic deltoid muscle EMG amplitudes during the performance paratenon closed in most of the specimens. However, this tech- of a non-weight bearing combined hip abduction-external rota- nique can have complications. Surgical progress and computer tion movement. assisted surgery should lower the risks. A prospective clinical study is started. Materials and Methods: Twenty-one nonimpaired, athletic female college students (age = 20.5 +/- 2.4 yrs, height = 161 +/- 8.6 cm, weight = 60.3 +/- 11 kg) participated in this study. The Poster #133 hip anteversion angle of the preferred jump landing leg was ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN estimated by measuring passive medial hip rotation with a COMPETITIVE SOCCER PLAYERS handheld goniometer with subjects positioned prone on a Hiroyuki Nose, Kawaguchi, JAPAN, Presenter plinth. Bipolar surface electrodes were placed over the tensor Sadao Niga, Kawaguchi, JAPAN fascia lata, gluteus medius, and gluteus maximus muscles and Akiho Hoshino, Saitama, JAPAN a ground electrode was placed over the superior iliac spine of Kawaguchi Kogyo General Hospital, Kawaguchi, JAPAN the opposite lower extremity. Subjects were positioned in side lying with bilateral hips and knees flexed 45 deg and 90 deg, Purpose: In ACL reconstruction, the bone-patellar tendon-bone respectively, and the preferred jump landing leg placed superi- (BTB) and the semitendinosus and gracilis (STG) are used for orly. A padded 10.2 cm wide non-extendable belt was applied the grafts. In this study, for competitive soccer players, we com- distally around the thighs. Following practice, subjects per- pared BTB with STG concerning the time to return to the game. formed maximal volitional effort isometric hip abduction-exter- nal rotation against the belt. A 30 sec rest interval was provided Materials: 59 competitive soccer players who underwent surgi- between each of 6 total repetitions. EMG signal amplitudes cal reconstruction of ACL with BTB or STG from 1992 to 2000 were analyzed with a peak averaging function (Norquest 96 ver- were followed up over one year (21 BTB, 38 STG). In the patients sion 4.03, Noraxon, Scottsdale, AZ) and compared between reconstructed with BTB, there were 18 males and 3 females with subject groups based on hip anteversion angle (group 1 < 42 an average age of 19.8 years at the time of surgery. In the deg, n = 11 or group 2 > 42 deg, n = 10). Pearson product patients reconstructed with STG, there were 29 males and 9 moment correlations were used to delineate the individual con- females with an average age of 21.7 years at the time. tributions of tensor fascia lata, gluteus medius and gluteus maximus muscle activity to average pelvic deltoid muscle POSTER ABSTRACTS Methods: The postoperative period until jogging and competi- group function. tive level were assessed, also overall percentage for retuning to competitive level players were noted. Knee extensor muscle Results: Mean medial hip rotation was 34.7 +/- 6 deg and 51.2 strength, anterior knee pain and anterior laxity (KT-1000 +/- 7 deg for group 1 and group 2, respectively. Group 1 dis- arthrometer) were evaluated. played greater gluteus medius muscle activation amplitude (686 +/- 452 mV vs. 370 +/- 212 mV, p < 0.0001) and average Results: All 21 cases with BTB and 33 cases (87%) with STG pelvic deltoid muscle activation (707 +/- 215 mV vs. 602 +/- 246 returned to the game. There was no difference between BTB and mV, p = 0.01) than group 2. Significant differences were not STG in the time to restart jogging (4.2+/-1.9 months in BTB, observed between group 1 and group 2 for gluteus maximus 4.2+/-1.8 months in STG). It took more time to return to the (600 +/- 226 mV vs. 644 +/- 331 mV), or tensor fascia lata (836 game in BTB than in STG (10.6+/-3.8 months versus 8.3+/-3.8 +/- 358 mV vs. 791 +/- 424 mV) muscle activation amplitudes (p months). There was no difference concerning knee extensor > 0.05). Group 1 displayed a strong relationship between aver- muscle strength. Anterior knee pain was more frequent in BTB age pelvic deltoid and gluteus medius (r = 0.85) and tensor fas- (33.3% in BTB versus 15.7% in STG) and the patients with ante- cia lata (r = 0.82) muscle activation amplitudes, but an rior knee pain needed more time to return to the game. There insignificant relationship between average pelvic deltoid and was no difference in KT-1000 arthrometer. gluteus maximus (r = -0.15) muscle activation amplitudes. Group 2 subjects displayed strong relationships between aver- Discussion: There was no difference between BTB and STG in age pelvic deltoid and gluteus maximus (r = 0.80) and tensor knee extensor muscle strength. However, BTB group had more fascia lata (r = 0.83) muscle activation amplitudes, and a fair anterior knee pain and took more time to return to the game. It relationship between average pelvic deltoid and gluteus may be considered that anterior knee pain affected the return medius muscle activation amplitude (r = 0.61). to the game. Conclusions and Significance: Subjects with increased femoral anteversion displayed EMG muscle activation amplitude rela- Poster #134 tionships that suggested a greater use of the gluteus maximus GLUTEUS MAXIMUS PROVIDES A GREATER muscle for frontal and transverse plane control of the femur CONTRIBUTION TO DYNAMIC FRONTAL AND through the hip joint. Athletically active subjects with this pos- TRANSVERSE PLANE KNEE CONTROL AMONG FEMALES ture may particularly benefit from a knee injury prevention pro- WITH INCREASED FEMORAL ANTEVERSION gram that focuses on gluteus maximus muscle training for John Nyland, Louisville, KY, USA, Presenter three-dimensional long axis control of the femur through the David N.M. Caborn, Louisville, KY, USA hip joint. University of Louisville, Louisville, Kentucky, USA

5.66 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Poster #135 THE CLINICAL EVALUATION OF RECONSTRUCTED ACL Conclusions: Modification of a standard intra-articular ACL COMPARED WITH ARTHROSCOPY AND MRI reconstruction technique would seem an option for the skele- Hiroyuki Obata, Urakawa, JAPAN, Presenter tally immature athlete without significant risks of growth dis- Ken-ichi Murase, Ichihara City, Chiba, JAPAN turbance. Results are generally good but may not be as Kojirou Maeno, Ichihara, JAPAN successful as surgical reconstruction in the adult. Tamio Takahei, Ichihara, JAPAN Department of Orthopaedic Surgery, Teikyo Universi, Ichihara, JAPAN Poster #137 We analyzed the relationship between knee stability and arthro- SHORT AND LONG TERM ACL DEFICIENCY: scopic findings, MRI of reconstructed ACL using autogenous THE ROLE OF HAMSTRINGS hamstring tendons. 27 patients (16 male, 11 female; mean age Elias Tsepis, Ioannina, GREECE 26) were included in this study and evaluated clinical stability George Vagenas, Athens, GREECE (KT-2000 arthrometer side to side difference measuring), Giannis Giakas, Ioannina, GREECE arthroscopic findings and MRI at mean 22 months postopera- Christos Papageorgiou, Ioannina, GREECE, Presenter tively. KT-2000 difference were 22 normal, 4 nearly normal and Anastasios Georgoulis, Ioannina, GREECE 1 abnormal according to IKDC classification. Arthroscopic find- University of Ioannina, Ioannina, GREECE ings were 13 excellent, 10 good and 4 fair according to modified Sakai classification. MRI were 13 well-defined, 11 intermediate Introduction and 3 indiscernible according to Rak classification. The cases of ACL rupture leads to a mechanical deficit that may be compen- arthroscopic findings excellent and MRI well-defined tended to sated through functional and proprioceptive adaptations. The small at KT-2000 difference. There were cases which didn’t cor- force deficit of the thigh muscles as a consequence of the ACL related with arthroscopic findings and MRI. Our results showed rupture is well established. Although the quadriceps (QUADS) that the cases assessed good at arthroscopic findings and MRI suffer the greatest deficit, the hamstrings (HAMS) have restored A-P translation of reconstructed ACL using autoge- attracted attention in many studies because of their possible nous hamstring tendons, but MRI more contributed the knee stabilizing effect on the tibia. The first aim of this study was to stability than arthroscopic findings. investigate if the torque of QUADS and HAMS can be a dis- criminating factor between patients who adapt well to the prob- lem and the non-adapters. The second aim was to investigate Poster #136 how the dynamic profile of the thigh muscles evolves with time ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION IN since injury. THE SKELETALLY IMMATURE PATIENT Kevin T Boyd, Brisbane, AUSTRALIA Methods James E Owen, Brisbane, AUSTRALIA, Presenter A homogenous group of twenty-eight physically active men Peter T Myers, Brisbane, AUSTRALIA (soccer players) with unilateral ACL deficiency and twelve Brisbane Orthopaedic and Sports Medicine Centre, Brisbane, AUSTRALIA healthy controls were examined on a Biodex isokinetic dynamometer. Knee laxity was measured with the KT-1000, Background: Anterior cruciate ligament (ACL) rupture in the knee function was assessed with the Lysholm questionnaire juvenile athlete poses a management dilemma. Recent evi- and the level of activity was estimated with the Tegner scale. dence has suggested that non-operative treatment in this The patients were split into three groups according to the group results in high rates of symptomatic giving way, meniscal chronicity of the injury: the short term group (T1), the interme- damage and the spectre of premature osteoarthrosis. A variety diate group (T2) and the long term group (T3). The time after surgical reconstruction methods have been described to the ACL injury was about 3, 9 and 62 months for the three address this problem without adversely affecting remaining groups respectively. The Lysholm score was used to discrimi- POSTER ABSTRACTS growth. nate the patients who adapted well (group F1, 86.2 mean score) from the poorly adapted ones (group F2, 62.4 mean score). A Method: From 1995-2001, twenty-two skeletally immature ath- one-way Anova was used to examine differences between short letes less than 16 years of age (17 male, 5 female: average age term, intermediate and long term groups and an independent 14 yrs 8 mths, range 11-15 yrs) with wide open epiphyses have t-test to compare the groups of the different Lysholm scores. undergone anterior cruciate ligament reconstruction by a single Differences were tested at a 95% level of significance. surgeon using an anatomical, trans-epiphyseal, four-strand hamstring graft technique. Graft fixation was achieved distant Results and Discussion to the epiphyses. The subgroups formed to test the hypotheses were similar in age, weight and height as well as knee laxity. In the control Results: The average delay from injury to surgery was 10.4 mths group there was no significant asymmetry, either between left (range 1 - 42 mths). Initial surgery revealed 13 meniscal injuries and right or between dominant and non-dominant side. The (30%) of which 10 were repaired. Mean femoral and tibial tun- long-term group was significantly better than the T1 group in nel diameters were 7.4 and 7.6 mm respectively. Post-operative peak torque production (p<0.05). It is remarkable that espe- complications included two low-grade, tibial wound infections cially for the hamstrings the asymmetry between the two legs treated by debridement and removal of the tibial screw. There vanished in the long-term group (- 0.07% vs ?17.7%). Regarding has been no evidence of growth disturbance. Three patients the level of knee function, the only parameter which was signif- (14%) re-ruptured their grafts at 11-19 months in new injuries, icantly different between groups F1 and F2 was the hamstring 2 of whom have since undergone revision reconstruction. peak torque (p<0.05). There was a minimal deficit in peak Nineteen patients were available for current follow-up at a min- torque production during active knee flexion in the compen- imum 6 months (mean 38 mths, range 6-80 mths). Mean sators (- 2.3%), while in the non-compensators the injured side Lysholm score was 92.4 (range 81-100; 7 excellent, 11 good, and was 16.6% weaker. According to our findings the hamstrings 1 fair). The mean IKDC subjective score was 89.9 (range 72.4- muscle group is very important for the stability of the ACL defi- 100). Overall function was a mean of 8.9 on a visual analogue cient knee. The compensators tend to balance the injured leg scale. with the healthy leg regarding the HAMS while the QUADS of

5.67 the injured leg remained weaker then the healthy leg. It is pos- sible that this enhanced capacity of the HAMS provides ade- Results and Discussion quate stabilization of the tibia while the QUADS are not as The reconstructed knee had a greater internal-external rotation important for this role. Additionally, the improved function of than the healthy side (p<0.04) confirming our hypothesis. This these muscles might have been evident from the start in certain finding is in agreement with in-vitro studies and indicates that patients and these are the ones who are more competent of ACL reconstruction may not fully restore normal movement using their knee in a more satisfactory way. The symmetry in especially during loading and extreme rotation conditions. HAMS performance is also a characteristic of the long-term Future research needs to be undertaken on ACL reconstruction deficient patients. Again, the enhanced ability the hamstrings not only to prevent anterior translation of the tibial but also to might have been the reason why these patients did not seek prevent excessive internal-external rotation. ACL reconstruction. Based on these results, it is prudent to assume that poor performance of the hamstrings in the ACL deficient knee is a contributing factor to the demand and deci- Poster #139 sion for ACL reconstruction. On the other hand, intensive exer- ACL RECONSTRUCTION WITH PATELLAR TENDON. cise of the hamstrings must be an issue to focus on, during THE EFFECT OF USING A GRAFT either on ACL deficiency or after ACL reconstruction. WITHOUT A PATELLAR BONE PLUG Uwe Pietzner, Neubrandenburg, GERMANY, Presenter Brita Schmidt, Greifswald, GERMANY Poster #138 Niels Follak, Greifswald, GERMANY THE EFFECT OF ACL RECONSTRUCTION OF THE Harry Merk, Greifswald, GERMANY INTERNAL-EXTERNAL ROTATION OF THE KNEE JOINT Dirk Ganzer, Neubrandenburg, GERMANY Stavros Ristanis, Ioannina, GREECE Orthopedic clinic of EMA-university, Greifswald, GERMANY Giannis Giakas, Ioannina, GREECE Tina Moraiti, Ioannina, GREECE PURPOSE: To determine the effect of taking a patellar tendon Eleftheria Siavara, Ioannina, GREECE graft for ACL reconstruction without harvesting a patellar bone Christos Papageorgiou, Ioannina, GREECE, Presenter plug on postoperative patellar problems. Nick Stergiou, Omaha, USA Vasilis Chouliaras, Ioannina, GREECE METHOD: Fifty patients with a traumatic rupture of the anterior Anastasios Georgoulis, Ioannina, GREECE cruciate ligament (ACL) underwent an arthroscopically assisted University of Ioannina, Ioannina, GREECE reconstruction. We performed this ACL reconstruction in two different techniques with 25 patients each group: Introduction I transtibial technique with a bone patellar tendon bone The success of ACL reconstruction is widely evaluated with graft (BPTB) and arthrometers (i.e., KT-1000). However, such an evaluation is II all-inside technique with bone patellar tendon graft with- actually a measure of joint laxity and not a measure of dynamic out a patellar bone plug (BPT). joint stability during an activity. Thus, it is possible that the dif- A standard rehabilitation program was used for all patients POSTER ABSTRACTS ferences observed in gait biomechanics between individuals after surgery. The patients were evaluated 3, 6 and 12 month with ACL reconstructions and healthy controls are the result of postoperatively measuring subjective complaints (pain!), range differences in dynamic knee stability. Previous in-vitro studies of motion and patellofemoral crepitation. Additionally we per- showed that the ACL reconstructed knee still has a wider range formed the one leg hop test. The results were assessed in con- of internal-external rotation compared to the intact knee. The nection with the IKDC. purpose of this study was to examine the internal-external rota- tion range of movement in-vivo in a high demanding activity. In RESULTS: The results of both groups differ especially in patel- order to simulate this condition we selected the descending- lar pain. With the IKDC score for pain the results were graded steps-and-turn movement. We hypothesised that the recon- normal in only 30% in group I and 50% in group II three month structed knee will have greater internal-external rotation than postoperatively and 60% group I and 70% group II one year the healthy knee. postoperatively. There was a similar situation for the range of motion of the operated knee three and six month postopera- Methods tively. After one year there was no difference in ROM between Ten patients (mean age 23 years; mean mass 73 Kgr) with ACL the BPTB and BTP group. The patellofemoral crepitation was reconstruction participated in this study. The period between always less in group II. Also was the one leg hop test better in the time of the reconstruction and the examination was ranged the group using a graft without a patellar bone plug. between 6 to 40 months. Knee joint laxity was tested wit ha KT- 2000 in all patients and side to side differences were less than CONCLUSION: Patellar problems like pain and crepitation are 3mm. The Lysholm score for all patients was higher than 85. At known after ACL reconstruction with BPTB grafts. They are less the time of the examination they reported no functional prob- using Hamstrings. This study showed that there is an other lems. A six camera optoelectronic system (Peak Performance) possibility to reduce patellar problems. The use of patellar ten- was used to capture the kinematic data of the movement. The don grafts without a patellar bone plug decreases the patella subjects were asked to descent three steps with their own pace associated problems but it needs of course a reconstruction and depending on the final step on the ground to turn at 90 technique which doesn’t afford a second bone plug. degrees towards the side to that leg e.g. if the final step was the right they had to turn towards the right side. Fifteen markers set SIGNIFICANCE: ACL reconstruction with patellar tendon grafts were positioned at specific bony landmarks of the lower limbs may cause patellar problems postoperatively. Considerations to indicate the movements of the lower segments. Segmental on decreasing these problems should be done. angular data of the tibia, and the thigh were calculated from 5 trials for each side. This study only focused only at the internal- external rotation of the knee. Group mean differences between Poster #140 the affected and unaffected sides were examined with a paired DONOR SITE PROBLEMS AFTER ACL BTB AUTOGRAFT t-test at a 95% level of significance. RECONSTRUCTION: LONG TERM RESULTS

5.68 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Madis Rahu, Tallinn, ESTONIA, Presenter METHODS: The healing response procedure was performed on Ene Kääpa, Tallinn, ESTONIA 198 patients, average age 50 years (range 40 to 74yrs), between North Estonia Regional Hospital, Tallinn, ESTONIA 1991 and 1998. Average time from injury to surgery was 13 days (range 1 to 42 days). Complete mid-substance ACL tears were Objective: to analyse the influece of donor site problems to excluded. Healing response was performed only on complete sports and normal life activity 5 - 6 years after ACL BTB auto- proximal one-third ACL tears. Six to ten microfracture holes graft reconstruction. were made into the cortical bone at the origin of the disrupted ligament, and multiple perforations were made into the liga- Materials and methods: Between 1996 and 1997 54 patients (9 ment itself. No other ligament fixation was used. Postoperative female, 45 male, mean age 25,4 years) with chronic instability rehabilitation was similar to that used following ACL recon- (3-216 months) underwent arthroscopic ACL BTB autograft struction. reconstruction from central part of patellar tendon harvesting with longitudinal scin incision. 21 of 54 patients had associated RESULTS: Five patients (2.5%) re-injured their involved ACL intraarticular injuries. Clinical results were evaluated by means and underwent full ACL reconstruction. Two patients died of of the Tegner activity scale, Lysholme score, IKDC form, kneel- unrelated causes. Of the remaining 191 patients, 169 (88%) had ing ability, disturbance of donor site sensitivity and patients a minimum 2-year subjective follow-up. Average follow-up was subjective assessment of donor site morbidity to their sports 41 months (range 24 to 116 months) after the healing response and normal life activity. To compare objective and subjective procedure. At the most recent follow-up, 155 patients (92%) donor site problems, patients were divided: Group A (18 experienced no or minimal pain, 165 (98%) had no or minimal patients): with normal kneeling and normal sensitivity; Group B swelling, and 161 (95%) had no giving way. Average Lysholm (9): with normal kneeling, abnormal sensitivity; Group C (8): scores improved from 63 to 94. ADL scores improved from 4.6 with unpleasant kneeling, normal sensitivity; Group D (19): with to 8.7 (10=normal function). One hundred fifty-nine patients unpleasant kneeling, abnormal sensitivity. (94%) considered their knee function to be normal or nearly normal using IKDC criteria. Average patient satisfaction at final Results: 88,9% (48/54) of patients returned to their preinjury follow-up was 9.1 (1-10 scale). Clinical examinations were per- sports activity level (Tegner activity scale 4 - 10), Lysholme formed at 2 or more years post-healing response on 122 of 191 score was 92 (78 - 100), using IKDC score 66,1% were as normal, patients (64%). Average clinical follow-up was done at 45 31,5%-as nearly normal, 5.5%- as abnormal and 1,9%- as months (range 24 to 116 months). The clinical examinations severely abnormal. 51,9% (28/54) of patients were with donor revealed that 85 site sensitivity problems (loss of sensitivity 6,6 - 106,5 cm2) and patients (70%) had a negative pivot shift, 30 (25%) had a 1+ and 50% (27/54) - with kneeling problems. Patients in Group A nd B 7 (5%) had a 2+. KT-1000 MMD testing improved from an aver- did not have any problems from donor site to returning to age of 5.0mm preoperatively to 1.9mm postoperatively, a mean sports and normal life activity.In Group C 50% of patients had difference of 3.1mm (p<0.05). none significant problems in their sports activities, 37,5% - in normal life activity and 12,5% - significant problem in normal CONCLUSIONS: We believe that the surgically induced marrow life activity.In Group D: 31,6% of patients were found donor site clot that results from the healing response procedure supports problem as none significant, 5,3% - as significant to their sports progressive development of healing tissue at the site of the lig- activity and 42,1% - as none significant, 5,3%. as significant to ament injury. The marrow clot appears to provide an enriched their normal life activity(table) milieu conducive to ligament healing. The healing response technique restored stability and knee function in patients over Conclusion: In long term results abnormality of kneeling and age 40 years with torn proximal ACLs. These data show that the disturbancy of donor site sensitivity were correlated with healing response technique is an effective alternative to restore patients subjective assessment, making more problems in nor- structural integrity to the proximally torn ACL. mal life, but did not affect significantly their returning to previ- POSTER ABSTRACTS ous sports activity level. Poster #142 ANTEROMEDIAL VS. TRANSTIBIAL FEMORAL TUNNEL Poster #141 PLACEMENT IN ACL RECONSTRUCTION. AN IN VIVO STUDY. A MINIMALLY INVASIVE TECHNIQUE (“HEALING Julian Rossis, Heidelberg, GERMANY, Presenter RESPONSE”) TO TREAT ACUTE ACL INJURIES IN Hans H Paessler, Heidelberg, GERMANY PATIENTS 40 YEARS AND OLDER Atos Clinic, Centre for Knee Surgery, Foot Surgery, Heidelberg, GER- Karen K Briggs, Vail, CO, USA MANY William G Rodkey, Vail, CO, USA, Presenter Michelle Cameron, Cheyenne, WY, USA Introduction : The proper graft placement during ACL recon- Steadman Hawkins Sports Medicine Foundation, Vail, Colorado, USA struction is essential for achieving successful results. It is widely accepted that an ACL graft should be positioned at the OBJECTIVE: The “healing response” technique, a direct exten- original anatomic position at 10 resp. 2 o’clock. The purpose of sion of the microfracture procedure used to treat chondral this study was to evaluate whether a guiding pin for a femoral defects, may be useful as an alternative to ligament reconstruc- tunnel could be positioned through the tibial tunnel into the tion in the knee. Microfracture holes are made into the cortical center of the anatomical ACL attachment. bone at the origin of the disrupted ligament and into the liga- ment itself. The surgically induced marrow clot captures the Methods : We studied 77 knees (36 left and 41 right, 44 male ends of the ligament and provides healing proteins and regen- and 33 female, mean age 34.8 ±11.1) who underwented arthro- erative cells and, hence, an enriched environment for tissue scopic ACL reconstruction with hamstrings. Femoral tunnel regeneration. The ligament ends reunite without other fixation. was drilled through an antero-medial portal at the center of the The senior author developed the healing response technique to anatomic insertion at about 10 resp. 2 o, clock position at 125 promote healing of proximal ACL tears. This study examines degrees of flexion under fluoroscopic control. The tibial tunnel the outcome of healing response in patients over 40 years old. (mean diameter 7.55±0.54 mm) was drilled using a guide inserted at 90 degree of knee flexion. The position of the guide

5.69 was documented with AP and lateral radiographs in full exten- Conclusions: The ACL reconstruction using quadruple semi- sion. Mean inclination angle of the tibial tunnel in the coronar tendinosus and bioabsorbable screws fixation provided satis- plane was 27,53±3,13° and in the sagital plane 25,84±3,19°. factory rersult with minimal donorsite morbidity but caused Then, through the tibial tunnel, a 4mm offset femoral drill some tissue reaction. guide was positioned as close as possible to the femoral tunnel and a 2.5 mm guide wire was drilled. The position of the guide wire was photographed arthroscopically in each knee with the Poster #144 scope in the anteromedial porta. After scanning and correction BIOMECHANICAL COMPARISON OF CONTACT PRESSURE for magnification the deviation was measured as distance OF THE GRAFT IN BONE TUNNELS OF SINGLE AND TWO between the center of the femoral tunnel and guide wire in each INCISION ACL RECONSTRUCTION knee using a Scion Image Software. For statistical analyses the Hiroyuki Segawa, Niigata City, JAPAN, Presenter t-test (significance p<0.05) was used. Go Omori, Niigata City, JAPAN Yoshio Koga, Niigata City, JAPAN Results : The mean deviation between the center of the femoral Toshiaki Hara, Niigata City, JAPAN tunnel and the transtibial guiding pin was 4.50±1.54 mm. This Kensaku Kawakami, Niigata City, JAPAN was statistical highly significant (p=0.00000004). In 74 knees Niigata Cancer Center Hospital, Niigata City, JAPAN (96.1 %) the guidewire did not reach the femoral tunnel. Only in 3 knees it reached the superomedial edge of the femoral tunnel. This study compared the contact pressure of In the coronar plane, for inclination tibial tunnel angles 22°-26° grafts in bone tunnels of the single- and the two-incision tech- the mean deviation was 4.8±1.4mm, while for angles 27°-32° niques employed in ACL reconstruction. was 4.1±1.7mm. In the sagital plane, for inclination tibial tun- nel angles 22°-26° the mean deviation was 4.39±1.6 mm while Four fresh-frozen cadaver knees were for angles 27°-32° was 4.52±1.2mm. These differences in both tested. A femoral tunnel was generated through the tibial tun- planes were not statistically significant (p=0.3 and p=0.7 resp.) nel (single-incision technique). Another femoral tunnel was When tibial tunnel diameter of 7.0 or 7.5mm were used, the created using a rear-entry guide in the same exit to the joint mean deviation was 4.64 ±1.5mm. For tibial tunnel diameter of (two-incision technique). Aluminum cylinders contained four- 8.0 or 8.5 mm the mean deviation was 4.01±1.6 mm. This dif- way (anterior, posterior, medial and lateral) conductive rubber ference was not statistically significant (p = 0.4). pressure sensors at the entrance of the joint were inserted into the tibial and femoral tunnels. Dynamic changes in contact Conclusion : This study shows that transtibial femoral tunnel pressure of grafts in the femoral and tibial tunnels during 0 to drilling does not reach the anatomic side of the ACL insertion, 130 degrees of knee flexion were measured. even with larger tibial tunnels (for hamstring grafts up to 8.5 mm) and confirms the results of a recent cadaveric study by Significantly higher contact pressure was observed Arnold et al. This may explain why in many studies comparing at the anterior wall of the femoral tunnel in the case of the sin- hamstring to patellar tendon grafts, in which transtibial tunnel gle-incision technique in comparison to the two-incision tech- drilling was used, an increase in laxity s is observed. Transtibial nique at 0 degree (1.2 MPa vs. 0.5 MPa) and 30 degrees (0.7 MPa POSTER ABSTRACTS tunnel drilling should be replaced by drilling through the vs. 0.1 MPa) of knee flexion. Consistent contact pressure was anteromedial portal at least for tunnels with diameters < 9 mm. observed in the medial wall (0.2-0.4 MPa) with the single-inci- sion technique and in the lateral wall (0.1-0.5 MPa) with the two-incision technique. Pressure changes of the tibial tunnel Poster #143 were small; moreover, changes were not influenced by femoral ARTHROSCOPIC ACL RECONSTRUCTION UTILIZING A tunnel direction under all conditions. QUADRUPLE SEMITENDINOSUS AND BIOABSORBABLE SCREWS: EARLY RESULT This study demonstrated that the contact pres- Suriyapong Saowaprut, Bangkok, THAILAND, Presenter sure in the femoral tunnel was influenced by the direction of Wichan Kanchanatawan, Bangkok, THAILAND the femoral tunnel. The high contact pressure at the anterior Charlee Sumettavanich, Bangkok, THAILAND wall of the femoral tunnel in the case of the single-incision Insitute of Orthopaedics, Bangkok, THAILAND technique may erode the anterior wall of the femoral tunnel, leading to bone tunnel enlargement. Purpose: To evaluate the early result [mininum 2 years] of ante- rior cruciate ligament reconstruction using quadruple semi- tendinosus and fixation with bioabsorbable screws. Poster #145 THE RELATION BETWEEN ANTERIOR-POSTERIOR KNEE Type of Study: Case series. LAXITY AND DEGENERATIVE CHONDRAL LESIONS AFTER ACL REPLACEMENT. AN EXPERIMENTAL Methods: 154 primary ACL reconstruction with quadruple semi- ROENTGENSTEREOMETRIC (RSA) ANALYSIS. tendinosus and fixation with bioabsorbable screws [polygly- Romain Seil, Homburg/Saar, GERMANY, Presenter colic] without association with other ligament injury were Dietrich Pape, Homburg/Saar, GERMANY evaluate of minimum 2 years follow-up. All patients underwent Frank Adam, Homburg/Saar, GERMANY the same postoperative rehabilitation protocol. Dieter M Kohn, Homburg/Saar, GERMANY Dept. of Orthopaedic Surgery, University of Saarla, Homburg/Saar, GERMANY Results: 95% of the meniscal intact group showed anterior lax- ity differences of 3 mm or less [KT-2000] .Tegner scale was Objective: maintained at the pre injury level in 70%. IKDC grading form The objective of the study was to quantify anterior-posterior showed 89% in normal and near normal group. 2 patients had (AP) knee laxity after ACL replacement in a sheep model and to screw reaction and had drainage through skin without intraar- correlate it with the amount of secondary chondral lesions. ticular reaction. Method:

5.70 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Unilateral ACL reconstruction using an autologous Achilles laxity measurements were performed using RSA stress x-rays. tendon graft and rigid button fixation was performed in the MRI was used to analyze changes in tibial tunnel volume. right knees of 12 of 18 Merino sheep. (Gruppe 2: Durchmesser Transplantat = Tunnel (5 mm); Gruppe 3: Transplantat = 3 mm, Results: Tunnel = 5 mm). In the remaining 6 animals the original ACL Postoperative radiography revealed fluid leakage from the joint was resected (group 1). All animals were euthanized after 6 into the tibial tunnel only in group 2. Macroscopic evaluation months. Both knees were marked using 9 Tantalum beads. RSA revealed stable grafts and no abnormal graft positioning. The was performed using a calibration cage in 30° of knee flexion initial volume of the tibial tunnel was 412 mm≤ in all animals. before and after manual maximum AP translation. The amount After 6 months it was significantly higher in group 1 (841 (+/- of degenerative chondral lesions were macroscopically 206) mm≥ vs. 597 (+/-124) mm≥ in group 2 (p<0.05). Significant assessed and quantified on the distal femur and proximal tibia differences in tunnel diameter were found until a depth of 9 mm of both knees. from the articular surface. RSA revealed decreasing graft-tunnel micromotions over time (0-3 weeks: 1.57 mm; 3-6 weeks: 1.05 Results: mm; 6-12 weeks: 0.85 mm; 12-24 weeks: 0.78 mm). Graft-tunnel Macroscopic evaluation revealed intact ACL grafts in all ani- motions were higher in group 2 during the first 6 weeks after mals. The amount of chondral lesions were 90.7 (+/- 66.7) mm≤ surgery. There was no correlation between tunnel volume and in group 1; 116.3 (+/- 35.4) mm≤ in group 2 and 161.8 (+/- 68.4) ap knee laxity (correlation coefficient r=-0.2). mm≤ in group 3. RSA allowed for a highly precise measurement of AP knee laxity: mean side-to-side differences: 1.3 (+/- 0.8) Conclusions: mm in group 1; 1.0 (+/- 0.8) mm in group 2 and 2.0 (+/- 0.5) mm Our data showed that synovial fluid leakage from the joint into in group 3. There was a positive correlation between AP-laxity the tibial tunnel does not seem to be the major determinant of and the amount of chondral lesions (correlation coefficient r = tibial tunnel enlargement after ACL replacement. The initially 0.6 in group 1 and 0.7 in groups 2 and 3). In those animals with higher graft-tunnel motion and the smaller amount of increase a mean side-to-side difference of less than 1 mm (N = 6) the in tunnel volume in group 2 indicate that biomechanical factors amount of chondral lesions was 76.7 (+/- 50.8) mm≤. In animals might be the main cause of tunnel widening. with a mean side-to-side difference of more than 1 mm (N = 12) the surface of the chondral lesions was 156.3 (+/- 65.9) mm≤ (p< 0.05). Poster #147 LOCKED KNEE MASKING EXAM OF ANTERIOR CRUCIATE Conclusions: LIGAMENT 1. RSA allowed for highly precise measurements of AP knee Ronald M Selby, New York, NY, USA, Presenter laxity. Brian C. Halpern, New York, NY, USA 2. There was a positive correlation between the amount of Steve Weintraub, Marlboro, NJ, USA chondral lesions and AP knee laxity. Robert Wood Johnson University Hospital, New Brunswick, NJ, USA 3. The data indicate that the goal of ACL surgery should be to minimize AP laxity in order to prevent secondary osteoarthritic This is a case report of an entity felt by the authors to be useful changes in the long-term. to keep in mind as anexamination “pearl.” Essentially this young, athletic patient presented a few months after an episode of repelling while mountain climbing. He had felt his knee shift Poster #146 and “pop” and detected swelling. He was unable to fully extend THE INFLUENCE OF GRAFT-TUNNEL MOTION AND his knee following that event. Physical examination was, of INITIAL SYNOVIAL FLUID LEAKAGE INTO THE TIBIAL course, affected by this. Excursion and endpoint were both TUNNEL ON TIBIAL TUNNEL ENLARGEMENT AFTER ACL notably affected on Lachman examination. The MRI showed a

REPLACEMENT. bucket-handle meiscus tear but was unclear regarding the ante- POSTER ABSTRACTS Romain Seil, Homburg/Saar, GERMANY, Presenter rior cruciate ligament. A high index of suspicion from the his- Dietrich Pape, Homburg/Saar, GERMANY tory was helpful in this case. As a rule a torn ACL should not be Frank Adam, Homburg/Saar, GERMANY excluded with a locked knee even when not evident on an MRI. Dieter M Kohn, Homburg-Saar, GERMANY Dept. of Orthopaedic Surgery, University of Saarla, Homburg/Saar, GERMANY Poster #148 Objective: NOTCHPLASTY: DESCRIPTION OF TECHNIQUE To determine the effect of graft-tunnel motion and synovial Ronald M Selby, New York, NY, USA, Presenter fluid leakage into the tibial tunnel on tibial tunnel enlargement Stephen J O’Brien, New York, NY, USA after ACL replacement using Achilles tendon autografts in a The Hospital for Special Surgery, New York, NY, USA sheep model. Lateral notchplasty is a commonly performed step in anterior Methods: cruciate ligament reconstruction. In this paper we describe a Unilateral ACL reconstruction using an autologous Achilles systematic and reproducible technique for performing a notch- tendon graft and rigid button fixation was performed in 12 four- plasty that allows satisfactory visualization in the crucial poste- months-old Merino sheep. In group 1 (N=6) a double stranded rior aspect of the intercondylar notch, resection to avoid graft with a diameter of 5 mm was used. In group 2 (N=6) a sin- impingement either laterally or on the roof, and effectively aid gle-stranded graft with a diameter of 3 mm was used. All grafts in positioning the femoral insertion of the graft. were tensioned at 40 N. In both groups the bone tunnel diam- eter was 5 mm. For RSA measurements tantalum beads were inserted in the grafts, the femur and the tibia. Conventional Poster #149 postoperative arthrograpy was performed to analyze fluid leak- THE CASE FOR ACUTE ANTERIOR CRUCIATE LIGAMENT age from the joint into the tibial tunnel. Graft-tunnel micromo- RECONSTRUCTION tions were evaluated at 3, 6, 12 and 24 weeks using RSA. Six Christopher Terence Servant, Bath, UNITED KINGDOM, Presenter months after the procedure, the animals were euthanized. Knee Neil Bradbury, Bath, UK

5.71 Mark Holt, Bridgend, UK Mervyn J Cross, Crows Nest, AUSTRALIA Australian Institute of Musculoskeletal Research, Sydney, AUSTRALIA Poster #151 PATELLAR FRACTURE ASSOCIATED TO RUPTURE OF THE Our aim was to determine whether acute ACL reconstruction PATELLAR TENDON PRESENTING AS A COMPLICATION (performed within 3 weeks of injury) is associated with an OF ARTHROSCOPIC RECONSTRUCTION OF THE increased risk of knee stiffness due to arthrofibrosis, when com- ANTERIOR CRUCIATE LIGAMENT WITH THE PATELLAR pared with chronic reconstruction (performed more than 8 TENDON. weeks after injury). Nilson R. Severino, Sao Paulo-SP, BRAZIL, Presenter Ricardo Paula Cury, Sao Paulo, BRAZIL METHODS Osmar Pedro Camargo, Sao Paulo, BRAZIL We performed a prospective study of 114 patients who under- Aihara Tatsuo, Sao Paulo, BRAZIL went a patellar tendon ACL reconstruction and who returned Victor Marques Oliveira, Sao Paulo, BRAZIL for formal independent assessment at an average of 7 months Santa Casa Medical School, Sao Paulo, BRAZIL post-operatively. 62 patients underwent acute reconstruction and 52 patients underwent chronic reconstruction. All patients One of the most commonly used techniques of reconstruction were operated on by a single surgeon using a standardised of the Anterior Cruciate Ligament of the knee is the use of the arthroscopic technique and accelerated rehabilitation pro- central third of the patellar tendon as a graft. Even though this gramme. graft offers many advantages, there may be problems related to the donor site. The authors report an uncommon post-opera- RESULTS tive complication using this technique, where fracture of the There was no significant difference in the incidence of arthrofi- patella was associated to partial rupture of the patellar tendon. brosis between the acute and chronic groups. Flexion of less The authors have only found 3 other such cases reported in lit- than 125° or a loss of extension of more than 10° occurred in 8 erature to date. (12.9%) of the acute group and in 9 (17.3%) of the chronic group. All knees were clinically stable, but the mean KT1000 dif- ference was 1.21mm in the acute group and 1.89mm in the Poster #152 chronic group (p<0.05). There were also significantly more PRIMARY AND REVISION ACL-RECONSTRUCTION meniscal injuries (65% versus 31%) and chondral lesions (31% WITH PATELLAR versus 18%) in the chronic group. There were no significant dif- Rainer Siebold, Heidelberg, GERMANY, Presenter ferences in muscle strength or functional scores between the Jens-Ulrich Buelow, East Fremantle, AUSTRALIA two groups. Ludwig Boes, Neulingen, GERMANY Andree Ellermann, Pforzheim, GERMANY CONCLUSION ARCUS-Sportklinik, Pforzheim, GERMANY Acute ACL reconstruction is not associated with an increased risk of arthrofibrosis. However, it is associated with increased At our institution we have used fresh-frozen allografts for the POSTER ABSTRACTS stability and less meniscal and chondral pathology. This study reconstruction of the anterior cruciate ligament in over 400 suggests that the optimum time for ACL reconstruction is cases since 1993. within the first 3 weeks after injury. Method: In this retrospective study we evaluated the clinical outcome of 365 allografts (bone-patellar-tendon-bone allo- Poster #150 grafts and achilles-tendon-bone allografts) for primary and revi- MID-TERM RESULTS OF THE RECONSTRUCTION OF sion ACL-reconstruction. Patients (average age 38 years) were CHRONIC ANTERIOR CRUCIATE LIGAMENT LESIONS operated between May 1993 and February 1998 and mean fol- WITH POLYESTER PROSTHESIS low-up was 38 (range 24 to 71) months. Clinical evaluation con- Osmar Pedro Camargo, Sao Paulo, BRAZIL sisted of a history, an examination, IKDC, Cincinnati knee score Nilson R. Severino, Sao Paulo-SP, BRAZIL, Presenter (CKS), KT 1000 testing and standardized X-rays. Victor Marques Oliveira, Sao Paulo, BRAZIL Ricardo Paula Oliveira, Sao Paulo, BRAZIL Results: According to the IKDC the outcome was normal or Tatsuo Aihara, Sao Paulo, BRAZIL nearly normal in 75,6% in primary- and 67,0% in revision-ACL Santa Casa Medical School, Sao Paulo, BRAZIL reconstruction. Overall rating according to the CKS was more than 82 points for both groups. The objective stability meas- The objective of this study was to evaluate the results of the ured with the KT-1000 showed an average side to side differ- surgical reconstruction of chronic ACL lesions with artificial ence of 2,1mm for primary ACL reconstruction and 2,3mm for polyester ligament. Twenty-nine patients were treated with this revisioners. The total failure-rate was 13,7% for primary- and technique from January, 1992 to February, 1994. Twenty five of 15,0% for revision ACL reconstruction. the 29 patients returned for re-evaluation presenting a mean follow-up period of 4 years and 5 months. Twenty-two patients Conclusion: Given the increased failure-rate, autograft tissue were males and 3 were females. The mean age was 29 years remains our graft of first choice for primary ACL-reconstruction. (ranging from 19 to 46 years). Re-evaluation was carried out We advise, to reserve allografts for revision procedures where using clinical examination (Lachman test and pivot shift) and suitable autogenous tissues have been previously compro- Lysholm criteria. Fourteen patients were found to have insta- mised, where a contraindication for autogenous tissue harvest bility, and eight of these presented confirmation of the clinical exists or for multiple ligament surgery. No specific complica- suspicion of rupture through a repeat arthroscopy. Histological tions were observed with the use of allograft tissue. analysis of these ruptured ligaments revealed disorganized fibrous tissue and foreign body inflammatory reaction, baring no resemblance to the ACL. Results suggest that the current Poster #153 artificial ligament is not an effective graft for the reconstruction of chronic ACL lesions.

5.72 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). CHANGES OF SAGITTAL OBLIQUITY IN RECONSTRUCTED included side, contact, jumping, pop, ability to continue to ANTERIOR CRUCIATE LIGAMENT MEASURES ON play, and degree and timing of swelling. IA findings were MAGNETIC RESONANCE IMAGES recorded in surgery including meniscus, articular cartilage, pos- Masaki Sonoda, Chiba, JAPAN, Presenter terior cruciate ligament and collateral ligament injuries. Takeshi Yamashita, Chiba, JAPAN Statistical evaluation was chi square for categorical variables Takeyuki Okazaki, Chiba, JAPAN and student’s t-test for continuous variables with p=0.05 for Hideshige Moriya, Chiba, JAPAN significance. Kawatetsu Hospital, Chiba, JAPAN RESULTS: At the HS level females had significantly fewer Introduction: The purpose of this study was to analyze sagittal medial meniscus (MM) tears in soccer (p=0.02) and medial obliquity and divergence angle of reconstructed anterior cruci- femoral condyle (MFC) articular cartilage injuries in basketball. ate ligament (ACL) using magnetic resonance (MR) scans. There were no significant differences in mechanism of injury with approximately 2/3 noncontact and jumping mechanism. In Materials and Methods: ACL reconstruction through use of amateur and recreational level basketball, females had signifi- hamstring tendons and endobutton technique were performed cantly more contact injuries (62% vs 23%, p=0.02), onset of and MR images were taken 2 weeks and 6, 12, 18, 24 months fol- swelling (p=0.03), and fewer lateral meniscus tears (p=0.01). As lowing surgery on 12 knees (7 male, 5 female, average age 21.3). anticipated, females were lighter and smaller. ACL tibia plateau (ACLTP) angle, ACL divergence (ACLDV) angle at femoral tunnel and long axis of femorotibial (FT) angle CONCLUSIONS: We hypothesize the reduced frequency of IA were measured on sagittal images. Twenty normal ACL (10 injuries observed at high school level in females in soccer (MM) male, 10 female, average age 23.7) were also analyzed as nor- and basketball could lead to better long-term functional out- mal control. comes after ACL reconstruction given equal stability. Long- term evaluation for activity level, function, and arthritis is Results: ACLTP angle of reconstructed ACL at 2 weeks (58.5 currently being evaluated. Since there are significant differ- degrees) was significantly larger than normal ACLTP angle (47.7 ences in articular cartilage injuries and meniscus tears, further degrees, p<0.05). ACLTP angle increase, observed between 6 detailed investigation into mechanism of injury, anatomic knee and 12 months, was greater than 5 degrees in 3 cases (25.0%) differences, and arthropometric measurements is needed. and less than 5 degrees in 9 cases (75.0%). ACLDV angle was also observed to increase during this period. Anterior laxity side-to-side difference (KT-2000) was 2.7 mm in the angle- Poster #155 increased group and 1.3 mm in the non-increased group with IMPACT OF TENDON GRAFT SUTURING TECHNIQUE ON no significant difference. INTERFERENCE FIXATION STRENGTH OF QUADRUPLED HAMSTRING TENDON GRAFTS IN CRUCIATE LIGAMENT Conclusions: Although tibial and femoral tunnels were created RECONSTRUCTION at the ideal place, ACLTP angle was larger than normal ACL. Eric S. Steenlage, Berlin, GERMANY, Presenter Full return of patient’s ADL was observed between 6 and 12 Sven U Scheffler, Berlin, GERMANY months, with concurrent increase of ACLTP angle. Anterior lax- Andreas Weiler, Berlin, GERMANY ity of the angle-increased group was not significantly larger; David N.M. Caborn, Louisville, KY, USA however biological remodeling of the graft may be continuous Juergen Hoeher, Cologne, GERMANY during this time period. CharitÈ, Campus Virchow Klinikum, Berlin, GERMANY

Introduction Poster #154 Interference fixation of soft tissue grafts has become a widely

FEMALE ATHLETES HAVE FEWER INTRAARTICULAR used technique for cruciate ligament reconstruction. Stable fix- POSTER ABSTRACTS INJURIES THAN MALES: A PROSPECTIVE COMPARISON ation of the graft in the bone tunnel is necesarry for developing BY SPORT AND COMPETITION LEVEL a stable tendon-to-bone interface. Adequate graft fixation Kurt P. Spindler, Nashville, TN, USA, Presenter strength remains a concern, but reported graft fixation strength Dana P. Piasecki, Nashville, TN, USA has gradually increased with technique improvements such as Jack T Andrish, Cleveland, OH, USA improved screw materials and design, better graft / tunnel fit, Richard D Parker, Cleveland, OH, USA and tunnel compaction. Various and often inconsistent tendon Todd A. Warren, Nashville, TN, USA preparation techniques have been used to prepare the ham- Vanderbilt Sports Medicine Center, Nashville, Tennessee, USA string tendon graft. The impact of the tendon graft suturing technique on both ultimate fixation strength and tendon OBJECTIVE: Intraarticular (IA) injuries to articular cartilage and motion in the bone tunnel has not been well defined. The goal meniscus are presumed risk factors for long-term outcome after of this study was to determine whether uniform suturing of the ACL tears. No study has investigated whether gender differ- tendon graft affects 1) ultimate fixation strength of the ham- ences in IA injuries exist in athletes within same sport and string tendon graft and 2) motion of the tendon in the bone competition level. We investigated IA injuries and mechanism tunnel when comparing sutured grafts vs. unsutured grafts. of a singular acute ACL tear between males and females in the same sport at the same level of competition. Materials and methods Ten pairs of matched mature porcine tibias (age < 2 years) were METHODS: Athletes who were enrolled in a prospective ACL utilized. Ten paired human hamstring tendons were used, database were evaluated based on the following inclusion cri- specifically fresh-frozen quadrupled Semi-tendinosus and teria: participation at similar levels of competition (high school Gracilis (QSTG) tendon grafts. One quadrupled graft from each [HS] vs amateur or recreational), same sports (basketball [BB], pair was placed into one of two groups. In the first group two soccer, skiing), and normal bilateral knee histories before sus- cerclage sutures were placed 3 cm and 6 cm from the doubled taining acute ACL tear as a singular event. Two hundred twenty end of the graft to join the four tendon strands; no other suture athletes fit these criteria. Age, sex, weight, and height were doc- material was utilized. In the second group, in addition to the umented. Information related to the mechanism of injury cerclage sutures, heavy suture was used in a running, baseball/

5.73 whip stitch fashion between the two cerclage sutures to tightly Henrique Carvalho, Curitiba, BRAZIL unite the four strands of tendon graft and provide a possibly Clinica do Joelho, Curitiba, BRAZIL improved interface for the interference screw. The tendons grafts were fixed in individually sized bone tunnels with 28 mm The anterior knee instability secondary to an ACL lesion leads bioresorbable screws with a diameter that matched the graft to a physical and sports activities reduction observed in all size. The looped end of the graft and the attached tibia were ages. The purpose of this retrospective study is to evaluate the fixed in a materials testing machine and pre-conditioned with functional results, objectives and complications of the ACL 10 cycles of 5-20 N. This was followed by 100 cycles of 20-250 N, reconstruction with autologus graft of the central third of the followed by pullout to failure. Tendon motion in relation to the patellar tendon. Between May 1990 and March 2001, 1276 bone was measured with an infrared motion analysis system patients were operated with the isolated autologus patellar during cycling. tendon. For the objective, subjective, and sports/activities analyses was used the Lysholm, Tegner, IKDC criteria; the dif- Results ference between double-incision versus single-incision recon- Ultimate fixation strength for the grafts without the interlocking struction, open or arthroscopic ACL reconstruction, graft sutures averaged 597 N (range 476 - 697 N); grafts with the fixation, degenerative radiologic changes associated with sutures averaged 1023 N (range 870 - 1176 N); the average meniscus lesions and the rehabilitation program were also ana- increase in strength was 436 N. Ultimate stiffness in the non- lyzed. suture group was 250 N/mm and in the suture group 305 N/mm. Total graft motion during cyclic loading averaged 5.4 mm in the non-suture group, and 3.2 mm in the suture group. Poster #158 ISOCINETIC EVALUATION OF PATIENTS SUBMITTED Summary TO ACL RECONSTRUCTION WITH PATELLAR TENDON. Uniform suturing of human quadrupled hamstring grafts prior AN ANALYSIS OF 30 CASES to interference fixation improved the ultimate graft fixation Alvaro Chamecki, Curitiba, BRAZIL strength. Uniform suturing also decreased graft motion relative Edilson Schwansee Thiele, Curitiba, BRAZIL, Presenter to the bone tunnel during cycling at force levels assumed to be Luciene Bittencourt, Curitiba, BRAZIL similar to those encountered by the tendon graft construct in Murilo Bredt, Curitiba, BRAZIL vivo during activities of daily living. These results suggest that Clinica do Joelho, Curitiba, BRAZIL uniform suture preparation of the tendon graft may increase fix- ation strength of the graft during cruciate ligament reconstruc- The objective of this study is to evaluate the muscular deficit in tion, and contribute to a successful clinical outcome. 30 patients submitted to an n ACL reconstruction using the autologous central third of the patellar tendon. We used the cybex norm equipment with isocinetic test pre-op, and with 2, Poster #156 and 4 months pos-op. We analyzed the data regarding flex- BILATERAL ANTERIOR CRUCIATE LIGAMENT (ACL) ors/extensors muscles, agonist/antagonist relation, RECONSTRUCTION WITH AUTOLOGUS PATELLAR eccentric/concentric deficit and the mixed functional relation POSTER ABSTRACTS TENDON 1 TO 9 YEARS FOLLOW UP between agonists and antagonists. Edilson Schwansee Thiele, Curitiba, BRAZIL, Presenter Alvaro Chamecki, Curitiba, BRAZIL Emerson K. Zanoni, Curitiba, BRAZIL Poster #159 Murilo Cesar Santos, Curitiba Parana, BRAZIL ARTHROSCOPIC VERSUS MINI-ARTHROTOMY ACL Henrique Carvalho, Curitiba, BRAZIL RECONSTRUCTION. AN INITIAL COMPARISON OF Clinica do Joelho, Curitiba, BRAZIL RESULTS Henrique Carvalho, Curitiba, BRAZIL The ACL lesion is an incapacitating lesion for the sports active Edilson Schwansee Thiele, Curitiba, BRAZIL, Presenter person, and its incidence is increasing with more people every- Alvaro Chamecki, Curitiba, BRAZIL day participating in sports. Between 1990 and 1999, 905 ACL Murilo Cesar Santos, Curitiba Parana, BRAZIL lesions were operated in our clinic, and in the same period 28 Emerson K. Zanoni, Curitiba, BRAZIL patients with bilateral ACL lesion were diagnosed. 18 patients Clinica do Joelho, Curitiba, BRAZIL were operated on both knees (not simultaneously), and 15 of them (30 knees) were reviewed in this retrospective study. The ACL reconstruction surgery can be considered one of the These knees were analyzed subjectively according to a modified more versatile surgery, since even if we vary the type of graft, Cincinnati knee scoring questionnaires. For objective evalua- the fixation device, and the incision, generally we have a satis- tion we evaluated the mobility, swelling, Lachmann test, ante- factory result. The objective of this study is to compare the ini- rior drawer in neutral rotation, pivot shift test and degenerative tial results between these reconstructions done changes. We concluded that our incidence is lower than the arthroscopically assisted and with a mini arthrotomy. There American literature, and despite the surgical technique, the were evaluated as parameters: a- Intra articular effusion. b- result was better in patients with less time between the lesion Thigh hipotrophy at the end of the third month post-op. c- and the reconstruction. Muscle strength measured with a dynamometer d- range of motion. In the period from June 98 to March 99 were evaluated 60 patients who had been submitted to an ACL reconstruction. Poster #157 44 arthroscopically assisted and 16 with mini arthrotomy. The EVALUATION OF THE RETURN TO SPORTS AFTER average age was 31,3 years old, 88% were males and 58% had BILATERAL ANTERIOR CRUCIATE LIGAMENT their right knee operated. All patients followed the same proto- RECONSTRUCTION col, preconized by Shelbourne. The results we obtained showed Edilson Schwansee Thiele, Curitiba, BRAZIL, Presenter that despite 31% of the patients from the arhroscopically Murilo Cesar Santos, Curitiba Parana, BRAZIL assisted group had effusion in post op, and necessitated to Alvaro Chamecki, Curitiba, BRAZIL drain the fluid, and in the same group there was a bigger mus- Emerson K. Zanoni, Curitiba, BRAZIL

5.74 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). cular deficit in the first month, there were no significant differ- mal; 1(1%), severely abnormal. Loss of extension and flexion of ence in the final results (p< 0,005). more than five degrees was observed in five and three patients, respectively. Lachman test showed negative in 167 patients (91%) and trace in 15 (8%) and mildly positive in one (1%) with Poster #160 a firm end point. Pivot shift was negative in 170 patients (92%) ANTERIOR CRUCIATE LIGAMENT INJURY MECHANISM IN and trace in 14 (8%). The average side-to-side difference in SNOWBOARDERS AND SKATEBOARDERS anterior laxity @ man. max. force with KT-1000 was 1.0 + 1.4 mm Barry R Tietjens, Auckland, NEW ZEALAND, Presenter (- 4 to 6 mm). Ninety patients (94 %) showed the side-to-side Andrew Meighan, Glasgow, UNITED KINGDOM difference of less than 3 mm. Eastwood Orthopaedic Clinic, Auckland, NEW ZEALAND Conclusion) The bi-socket ACL reconstruction provides satis- The purpose of this study was to investigate the mechanism of factory outcome at short-term follow-up. injury causing anterior cruciate ligament ruptures in snow- boarders and skateboarders. Knee injuries occuring when snowboarding and skateboarding are rare. We reviewed 22 Poster #162 anterior cruciate ligament ruptures with an identical injury ARTHROSCOPIC ACL RECONSTRUCTION USING mechanism that has not been previously described. 15 injuries MULTI-STRANDED HAMSTRING TENDON AUTOGRAFT: occurred in snowboarders and 7 in skateboarders. All were 2 VS. 7 YEAR RESULTS advanced or expert boarders. All injuries occurred on landing a Norimasa Nakamura, Sakai, JAPAN high jump,which resulted in significant knee compression. All Shuji Horibe, Sakai, JAPAN described a flat landing on a flexed knee with no twisting com- Tomoki Mitsuoka, Kashiba, JAPAN ponent. The front leg knee was the one injured in every case. Yukiyoshi Toritsuka, Osaka, JAPAN, Presenter Masayuki Hamada, Hirakata, JAPAN We postulate that anterior cruciate rupture in these patients is Yoshiki Shiozaki, Sakai, JAPAN due to explosive eccentric quadriceps contraction when landing Konsei Shino, Habikino, Osaka, JAPAN from a jump. The injury mechanism is not boot-induced as has Osaka Rosai Hospital, Sakai, JAPAN been described in downhill skiers landing from a jump. Purpose: To assess changes in the subjective patient outcomes, knee laxity, and knee radiographic indicators of arthrosis Poster #161 between 2 and 7 years following arthroscopic ACL reconstruc- OUTCOME OF BI-SOCKET ACL RECONSTRUCTION tion using multi-strand hamstring tendon autograft. USING MULTIPLIED HAMSTRING TENDONS Yukiyoshi Toritsuka, Osaka, JAPAN, Presenter Method: One hundred and three patients (53 men and 50 Konsei Shino, Habikino, Osaka, JAPAN women; 23 years of mean age) with isolated ACL rupture had Yasukazu Yonetani, Suita, Osaka, JAPAN undergone arthroscopic ACL reconstruction with multi- Shigeto Nakagawa, Osaka, JAPAN stranded hamstring tendon autograft using drill hole tech- Norinao Matsumoto, Toyonaka, Osaka, JAPAN nique. Meniscal repair and/or meniscectomy were added in 65 Takahide Miyama, Suita, Osaka, JAPAN patients. Follow-up time points were 2 and mean 7 years (5 to Hideo Kawakami, Mino, Osaka, JAPAN 10 years) after surgery. The assessments included IKDC subjec- Shuji Horibe, Sakai, JAPAN tive evaluation, side-to side difference in anterior laxity by KT- Department of Orthopaedic Surgery, Osaka Universit, Suita, JAPAN 2000, and IKDC radiographic evaluation of the patello-femoral (PF) and femoral-tibial (FT) joint using skyline and Rosenberg Purpose) To clarify short-term results of bi-socket ACL recon- views. Chi-squared test, paired t-test, and Mann-Whitney-U test struction. were used for statistical analysis. POSTER ABSTRACTS

Patients and Methods) The subjects were 184 patients (94 Results: Ninety-eight % of patients graded their index knee female, 90 male; average age 25 yo) out of 481 patients who had function as normal or nearly normal at 2 years, while 96% of undergone endoscopic ACL reconstruction using mutistranded them were graded as normal or nearly normal at 7 years. Eighty- autogenous hamstring tendons via twin femoral sockets (bi- nine % of the cases were identically graded at both evaluation socket technique) from 1994 to 1999 and consented to have fol- points. low-up evaluation at 24 mos. or later postoperatively. Nine patients had received revision surgery due to re-injury before The mean side-to-side differences in anterior laxity at manual the 2-year-follow-up. The mean follow-up period was 26 mos. maximum force at 2 and 7 years were 1.5±1.4mm and ranging from 24 to 49 mos. Follow-up evaluation was performed 1.6±1.8mm, respectively. There was joint space narrowing evi- based on the IKDC Knee Ligament Evaluation Form. The har- dent on the radiographs in 6% of PF-, 10% of medial FT-, and vested semitendinosus tendon was cut in half and doubled 21% of lateral FT-joints at 2 years. While, that was evident in 6% respectively to separately prepare anteromedial and postero- of PF-, 13% of medial FT-, and 27% of lateral FT joint at 7 years lateral grafts. If necessary, the gracilis tendon was additionally post-surgery. Its severity was less than 50% in all cases except harvested to reinforce the graft. Through the single tibial tunnel one. All cases that showed progression in medial FT joint space of 7-9 mm created in the center of the footprint, the two femoral narrowing were accompanied by meniscal injury, whereas lat- sockets were created at 1:00 and 2:30 in the left knee or at 11:00 eral FT joint space narrowing progressed in 9% of the cases with and 9:30 in the right. Endobuttons were used for the femoral intact menisci at the time of surgery. The statistical analyses fixation and a post screw was used for the tibial side. showed that there was no significant difference in subjective Postoperative rehab was performed according to the non-accel- grading, KT measurement or joint space narrowing on radi- erated standard protocol. ographs between the two time points.

Results) One hundred six out of 184 patients (58%) rated the Discussion & Conclusion: This study demonstrates that subjec- index knees as normal; 72 (39%), nearly normal; 5 (3%), abnor- tively-assessed outcomes, anterior-posterior stability, and radi- ographic evidence of arthrosis generally do not deteriorate

5.75 between 2 and 7 years after arthroscopic ACL reconstruction using multi-stranded hamstring tendon graft. On the other RESULTS: Preoperative isokinetic peak torque of the hamstring hand, as previously reported, the observed arthritic change was and that of the quadriceps were significantly lower in the ACL- associated with meniscal injury at the time of surgery in most deficient knees compared to the contralateral uninjured knees. cases. However, some did show deterioration in the lateral FT At 3 and 6 months postoperatively, the concentric peak torque joint narrowing over time without associated meniscal pathol- of hamstrings in the ACL-reconstructed knees reached to 95 ± ogy. Longer-term follow-up is required to verify the effective- 25% and 94 ± 22% of the contralateral side, representing no sig- ness of ACL reconstruction in preventing knee arthrosis. nificant side-to-side difference, while those of the quadriceps were 68 ± 19% and 84 ± 23%, representing significant reduction. In contrast, the eccentric peak torque of hamstrings and that of Poster #163 quadriceps in the ACL-reconstructed knees were 81 ± 23% and A COMPARISON OF TWO DIFFERENT METHODS FOR 84 ± 23%, and significantly lower than in the contralateral side. ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING THE SEMITENDINOSUS TENDON CONCLUSIONS: The results suggest that the successful recov- Gen Tsuchiya, Koriyama, JAPAN, Presenter ery of the quadriceps function within the early period after ACL Masashi Kimura, Maebashi, JAPAN reconstruction with BPTB is a challenge even in patients free of Yasukazu Kobayashi, Maebashi, JAPAN anterior knee pain. Additionally, the reduction in eccentric peak Dept.of Orthopaedic Surgery Southurn Tohoku Genera, Koriyama, torque of the hamstring indicates that the functional recovery JAPAN of the hamstring is not complete at 6 months postoperatively, even though the ACL reconstruction is performed without sur- Sixty patients with unilateral instability of the anterior cruciate gical intervention to the hamstring tendon. ligament were prospectively randomized to anterior cruciate ligament reconstruction with either the” bilateral sockets Poster #165 method” (two tunnels in the femur) and “the two routes TWO-BUNDLE RECONSTRUCTION method” (two tunnels in femur and tibia) using the semitendi- OF THE ANTERIOR CRUCIATE LIGAMENT nosus tendon with an endobutton fixation technique. The same Takashi Tsukahara, Gifu, JAPAN, Presenter postoperative rehabilitation protocol was used for all patients Takehiko Suginoshita, Gifu, JAPAN and the follow-up was performed by an independent observer Yoshiaki Kusaka, Gifu, JAPAN (median 13 months, range 10 to 14). We evaluated the Lysholm Dept. of Orthopaedic Sports Medicine, Murakami Mem, Gifu, JAPAN score and side to side difference of stress X-p (Teros-SE). No significant differences were found between the groups regard- Introduction: A normal ACL can be morphologically divided ing Lysholm score and stress X-p. We conclude that the “bilat- into the anteromedial and posterolateral portions, each of eral sockets method” and the “two routes method” have similar which shows different tension patterns. We carried out two- outcomes in early term. We assume, however, that since the bundle anterior cruciate ligament (ACL) reconstruction using shape of the bone tunnel for the “two routes method” is more multiple strands of semitendinous and gracilis tendon. The anatomically correct than for the “bilateral sockets method” the purpose of this study is to assess the advantages for the stabil- POSTER ABSTRACTS long-term outcome may be more favorable for the “two routes ity of the knee using this method. method”. Materials and Method: 33 patients (17 men, 16 women; average age 24) who had two-bundle ACL reconstruction prospectively Poster #164 followed-up at a minimum of 18 months (range 18-24). The KNEE MUSCLE FUNCTION IN PATIENTS FREE OF fourth fold semitendinous tendon was used for anteromedial - ANTERIOR KNEE PAIN AFTER ANTERIOR CRUCIATE bundle and the fourth fold gracilis for posterolateral -bundle. LIGAMENT RECONSTRUCTION USING BONE-PATELLAR The following parameters were investigated: Range of motion TENDON-BONE GRAFT manual knee laxity test, anterior laxity measured with the KT- Eiichi Tsuda, Hirosaki, JAPAN, Presenter 1000 arthrometer and anterior shift rate (anterior drawer stress Kazutomo Miura, Hirosaki, JAPAN radiograph). Yasuharu Hiraga, Hirosaki, JAPAN Hiroshi Katano, Hirosaki, JAPAN Results: The average maximum knee extension was -0.5 degrees Yasuyuki Ishibashi, Aomori, JAPAN (SD: 4.2) and flexion was 146 degrees (SD: 8.8). No patients Satoshi Toh, Hirosaki, JAPAN showed positive Lachman test. Three patients (9.1%) showed Hirosaki Memorial Hospital, Hirosaki, JAPAN positive anterior drawer test (all were +), and no patients showed positive pivot-shift test. The side-to-side difference of INTRODUCTION: Preventing anterior knee pain after anterior anterior laxity measured with the KT-1000 arthrometer at man- cruciate ligament (ACL) reconstruction using bone-patellar ten- ual maximum stress was -0.8 mm (SD: 1.00). The side-to-side don-bone graft (BPTB) is the key to facilitate early recovery from difference of anterior shift rate was 2.2% (SD: 8.6). muscle weakness of the knee extensor and flexor. The objective of this study was to evaluate the knee muscle function in the Conclusion: This method can reconstruct anteromedial and early postoperative period in patients who experienced no posterolateral bundles of ACL separately, and these recon- anterior knee pain after the ACL reconstruction using BPTB. structed ligaments are more similar to normal ACL form than single bundle reconstructed ligaments. Our results suggest that MATERIALS AND METHODS: Forty-two patients who did not this method shows a better trend with respect to anterior sta- complain of anterior knee pain after ACL reconstruction using bility than single bundle reconstruction. BPTB were studied. Hamstring and quadriceps isokinetic strength were evaluated preoperatively and at 3 and 6 months postoperatively. The parameters examined were concentric and Poster #166 eccentric peak torque at 120 deg/sec. The statistical analysis was performed using the paired t-test and significance was set at p<0.05.

5.76 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). BIOLOGICAL FIXATION AFTER ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION WITH HAMSTRING TENDONS There was no evidence of infection or adverse effects in either USING AN ENDOBUTTON ON THE FEMORAL SIDE group. The AGF treated samples demonstrated a more mature Yuji Uchio, Izumo, JAPAN, Presenter tendon-bone interface compared to controls at both time Kenzo Kawasaki, Izumo, JAPAN points. CT scans presented an increased signal intensity in the Junji Iwasa, Izumo, JAPAN tunnel margins with AGF treatment compared to controls. Masakazu Kuriwaka, Izumo, JAPAN Sharpey’s fibres were noted by 4 weeks with AGF treatment. A Mitsuo Ochi, Izumo-shi, JAPAN generalised improvement in vascularity was also observed in Nobuo Adachi, Izumo, JAPAN the treated group based on presence of new blood vessels. Department of Orthopaedics, Shimane Medical Univer, Izumo, JAPAN The bio-delivery interference screw provides a novel method for To investigate whether a hamstring tendon graft would be bio- delivery of factors at the tendon-bone interface without com- logically fixed in the femoral bone tunnel after anterior cruciate promising the fixation concept of an interface screw. Initial ligament reconstruction, 64 patients were evaluated by serial experience using this device and growth factors from autolo- biomechanical testing and magnetic resonance images (MRI) gous platelets (AGF) demonstrated accelerated healing com- during 2 years after surgery. At the second-look arthroscopy at pared to controls. 2 years postoperatively, biological fixation of the graft was con- firmed by probing and injecting a contrast medium within the femoral bone tunnel. In 56 stable knees at 2 years postopera- Poster #168 tively, 42 grafts were biologically fixed in the femoral tunnel COMPUTATIONAL ANALYSIS REVEALS THE with a well-covered synovium, excepting one. This group main- SIGNIFICANCE OF ANATOMICAL ACL RECONSTRUCTION tained a high stiffness (120% of normal), and showed low signal Masayoshi Yagi, Kobe, JAPAN, Presenter intensity in an early postoperative MRI (12+/-8 months). Kiyonori Mizuno, Kobe, JAPAN Fourteen stable knees without graft fixation in the femoral tun- Naohiro Oku, Kobe, JAPAN nel had gradually increased anterior displacement with nearly Mitsumasa Matsuda, Kobe, JAPAN normal stiffness. Five unstable knees with graft fixation Tkuzo Iwatsubo, Kobe, JAPAN retained low stiffness (70%), and showed low signal intensity Shinichi Yoshiya, Kobe, JAPAN late in the postoperative period (20+/-9 months). Three unsta- Masahiro Kurosaka, Kobe, JAPAN ble knees without biological fixation rapidly increased anterior Department of Orthopedic Surgery, Kobe University, Kobe, JAPAN displacement, with half the stiffness of a normal knee. These results suggested that postoperative low stiffness of the recon- Objective: Recently, it has been suggested that anatomical ACL structed knee might indicate late biological fixation of the reconstruction, which reproduces AM and PL bundles of the grafts in the femoral tunnel, predicting a possibility of postop- ACL, improves functional outcomes. The objective of our study erative anterior knee instability. was firstly to assess the change in length of both AM and PL bundles during active knee motion, and secondly to evaluate the effect of the graft placement on stabilization in the ACL Poster #167 reconstructed knee joint using computational analysis. A BIODELIVERY INTERFERENCE SCREW AND GROWTH FACTORS FOR AUGMENTATION OF TENDON-BONE Methods: An intact fresh-frozen human cadaveric knee was HEALING used in this study. Before the experiment, extra-articular soft Richard Evans, Randwick, AUSTRALIA tissue was removed while keeping the ligaments and joint cap- Peter Hughes, Randwick, AUSTRALIA sule intact. The femur and tibia were potted into plastic tubes, Jim Iliopoulos, Randwick, AUSTRALIA and a magnetic position sensor (3 SPACE FASTRAK, Polhemus

Yan Yu, Randwick, AUSTRALIA Inc., Colchester, VT) was mounted on both the femur and tibia. POSTER ABSTRACTS Craig Waller, Randwick, AUSTRALIA The femur was then fixed to a non-metal test stand in a hori- Warwick JM Bruce, Randwick, AUSTRALIA zontal orientation and the tibia was allowed to hang freely with William R. Walsh, Randwick, AUSTRALIA, Presenter a weight corresponding to that of the lower leg. The knee was University of New South Wales, Sydney, AUSTRALIA extended from 90 degrees of flexion to full extension by exert- ing a quadriceps force with a constant loading speed A number of biological agents are available for use in (500mm/min). Six-degrees of freedom of knee kinematics were orthopaedics to augment healing (growth factors, BMPs etc). A calculated from the data obtained by the sensors. A bony sur- potential application is at the healing tendon-bone interface in face contour of the knee was reconstructed from the CT scan an ACL reconstruction. An interference screw was designed images. For the first objective of the study, the change in length which allows delivery of any biological agent to the tendon between both femoral and tibial anatomical insertions of AM bone interface. This study evaluated the use of a new bio-deliv- and PL bundles during active knee extension was assessed ery interference screw and autologous growth factors (AGF) at using the computational knee model. For the second objective, the tendon-bone interface in a sheep knee model. constraining forces in response to anterior tibial loading and rotational torque were calculated for the ACL graft routed An open intra-articular reconstruction was performed in 20 between various combinations of the insertions. adult sheep using an extensor tendon model following ethical approval. A titanium bio-delivery interference screw was used Results: The length of the PL bundle increased as the knee was for fixation in the tibial and femoral tunnels. Animals were allo- flexed, while that of AM bundle was relatively constant through- cated to 2 groups (control or AGF treated) and killed at 4 and 12 out the range of motion. The optimal graft placement which weeks (n=5 per group). Concentrated platelets (AGF) were har- exhibited a stabilizing effect for both anterior tibial loading and vested at the time of surgery using a cell separator and con- rotational torque was different in orientation. centrating unit. AGF was introduced into the screw and infiltrated to the interface at the time of surgery. Endpoints Discussion: The significance of anatomical ACL reconstruction included computed tomography (CT), serial histology and was assessed using a mathematical model. First, the results immunohistochemistry. showed that the AM and PL bundles each have different roles

5.77 to play during knee motion. Secondly, it is suggested that sin- Kenichi Shinomiya, Tokyo, JAPAN gle bundle ACL reconstruction cannot provide an effective con- Tokyo Medical and Dental University, Tokyo, JAPAN straint in response to complex loading. The Purpose of this study is to evaluate the relationship between objective evaluation and subjective evaluation using Poster #169 the visal analog scale (VAS) after ACL reconstruction. ADVANTAGES OF COMPUTER ASSISTED NAVIGATION SYSTEM USING MAGNETIC TRACKING TECHNOLOGY IN This study involved 99 patients (50 male, 99 female) over a one ANATOMICAL ACL RECONSTRUCTION year period after 2 bundle ACL reconstruction.The follow up Masayoshi Yagi, Kobe, JAPAN, Presenter examination was performed at a median of 2.7 years (range: Mahiro Saito, Kobe, JAPAN 1.0year-7.5years) after the operation. VAS we developed had 26 Kiyonori Mizuno, Kobe, JAPAN items including 3 items for general evaluation, 12 items such as Nobuzo Matsui, Kobe, JAPAN intensity and frequency of pain and instability,giving way at Shinichi Yoshiya, Kobe, JAPAN both ADL and sports, and 11 items such as sports and ADL Masahiro Kurosaka, Kobe, JAPAN activities. We studied the relationship between subjective eval- Department of Orthopaedic Surgery, Kobe University, Kobe, JAPAN uation using VAS and objective evaluation of the knee. The patients were divided into two groups according to objective Objective: Recently, anatomical ACL reconstruction, which facters: anterior laxity as measured with KT-1000 (the difference reproduces the AM and PL bundles of ACL, has been proposed at manual maximum pull), one-legged hop test (% of non- as achieving better functional results. However, a surgical tech- injured knee), and sports activity level of patients (competitive nique, which is both accurate and meticulous, is required to or recreational athletes). The value of VAS in 26 items were anatomically reproduce both bundles in the procedure. The compared between each of the two groups. objective of our study was to compare the accuracy of tunnel placement in anatomical ACL reconstruction using two tech- As for the relationship between VAS and the one-legged hop niques: 1) navigation system (Shimadzu Inc., Japan) in combi- test, the values for 14 items in VAS were significantly lower in nation with a magnetic tracking system, and 2) arthoroscopic the group with less than 75% (of the non-injured knee) than in surgery by an experienced surgeon using a conventional ACL the group with more than 90%. Therefore, it was thought that drill guide. the one-legged hop test had a high correlation with the value of VAS. With regard to anterior laxity as measured with KT-1000, Material and Methods: Sixteen knees (Sawbones, Inc., U.S.A) the values of 4 laxity items in VAS were significantly lower in the from the same mold were used in this study. The targeting point group with more than 4mm (the difference at manual maximum was determined as the center of an anatomically appropriate pull) than in the group with less than 4mm. Subjective evalua- insertion point of the AM and PL bundles of the ACL. The tion using VAS was suggested to be highly sensitive to objective femoral and tibial tunnels (pilot holes) for both bundles for knee laxity. For patients of different level of sports activity, no two-route ACL reconstruction were then drilled using either the significant differences were found in items regarding sporting navigation system (n=8) or conventional drill guide (n=8) in activities. POSTER ABSTRACTS random order. Femoral tunnels were drilled using a transtibial technique. In the case of the navigation system (Group I), refer- VAS we developed was a reliable and useful method to evaluate ence points were placed in the femur and tibia and a CT scan in detail the subjective feeling in patients after ACL reconstruc- was performed for image data acquisition. Pilot holes were then tion. created under the guidance of the navigation system. In the case of the conventional technique (Group II), an experienced surgeon drilled pilot holes under arthroscopic control. The dis- Poster #171 tance between the target point and the pilot hole was meas- PROSPECTIVE STUDY OF KNEE STABILITY BY A KT-2000 ured by a caliper. Unpaired t-test was used for statistical A analysis. Masanori Yasumoto, Hiroshima, JAPAN, Presenter Masataka Deie, Hiroshima, JAPAN Results: When deviation from the target point for the tibia tun- Kenji Kobayashi, Hiroshima, JAPAN nel was compared, no significant differences were found Yoshio Sumen, Hiroshima, JAPAN between Group I (AM: 1.6mm, PL: 1.5mm) and Group II (AM: Mitsuo Ochi, Izumo-shi, JAPAN 1.6mm, PL: 1.5mm). However, in the case of the femoral tunnel, Hiroshima Univ. Dept of Orthopaedic Surgery, Hiroshima, JAPAN significant differences (p<0.05) were observed between GrouP I (AM: 1.6mm, PL: 1.6mm) and Group II (AM: 4.3mm, PL: 3.6mm). The purpose of this study is to evaluate knee stability after anterior cruciate ligament (ACL) reconstruction using an auto- Conclusion: A computer assisted navigation system using a genous multistrand hamstring tendon, and to compare the sin- magnetic tracking system appears to achieve accurate and con- gle- socket technique (SS) and bi-socket technique (BS). sistent tunnel placement in anatomical ACL reconstruction. Single- or bi-socket reconstruction with EndoButton femoral fixation and double staple tibial fixation was performed for uni- lateral ACL injuries in 30 patients (SS: 13,BS: 17). In the SS Poster #170 group, the femoral socket was made at a position of 11 or 1 SUBJECTIVE EVALUATION OF PATIENTS AFTER o’clock relative to the femoral ACL attachment site, while in the ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION BS group the additional socket was created at 9-10 or 2-3 USING VISUAL ANALOG SCALE o’clock position. The tibial side was fixed under 50N initial graft Junya Yamazaki, Tokyo, JAPAN, Presenter tension. At five phases (before operation, immediate after Takeshi Muneta, JAPAN operation, 3, 6, and 12months after operation), anterior dis- Yoshiaki Kurihara, Nagano, JAPAN placement at 133 N, anterior terminal stiffness at 133 N and ini- Hiroo Ikeda, JAPAN tial stiffness were evaluated using a KT-2000 arthrometer. At Kazuyoshi Yagishita, Tokyo, JAPAN 12months after surgery, there were no significant differences in Ichiro Sekiya, Tokyo, JAPAN range of motion, Anterior drawer test, Lachman test and Pivot

5.78 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). shift test between the two groups. Immediately after surgery the through March of 2000, a quadriceps tendon autograft was used mean side-to-side difference in anterior displacement was -1.2 in 27 patients with ACL injuries with a patellar bone block (13 ± 2.9mm for the SS group and -5.2 ± 2.4mm for cases) or without bone block (14 cases). The follow - up ragned the BS group (p<0.01). But 3 months after the operation, there between 15 and 31 months. The presence of effusion, pain on were no significant differences between the two groups. There kneeling, local tenderness was especially evaluated. Most were no significant differences in stiffness throughout the post patients could return to the same level of preinjury sports activ- surgical period. The results of this study suggest that adequate ity. Anterior knee pain was noted in 5 patients (18.51%) but was initial force on the grafted tendon differed between patient severe in only 1 (3.7%). No patient reported pain on kneeling treated using the single- socket technique and those treated and no effusion was present in any of our patients. Local scar using the bi-socket technique for anterior cruciate ligament tenderness was present during the first 3 months but disap- reconstruction using an autogenous hamstring tendons. peared later. There were no significant complications related to the graft-harvesting site. The use of quadriceps tendon auto- graft appears to cause little postoperative donor-site morbidity Poster #172 and anterior knee pain compared to other autografts. CLINICAL RESULTS OF ACL RECONSTRUCTION USING LEEDS-KEIO ARTIFICIAL LIGAMENT IN HIGH LEVEL ATHLETES OF AMERICAN FOOTBALL AND RUGBY Poster #437 Tsukimura Yasunori, Tokyo, JAPAN, Presenter IS THE SUCCESSFUL TREATMENT OF THE ACL Matsumoto Hideo, Tokyp, JAPAN SUFFICIENT TO RETURN ATHLETES BACK TO SPORT? Kitasato Institute Hospital, Tokyo, JAPAN Alberto Gobbi, Milan, ITALY, Presenter Benjamin Tuy, Milano, ITALY [OBJECTIVES] Activities in top level American-football and Orthopaedic Arthroscopic Surgery International, Milano, ITALY rugby players after ACL reconstruction were investigated Leeds-Keio artificial ligament was used as the substitute for all INTRODUCTION: The risk of ACL injury is significantly greater the athletes and benefits to use an artificial ligament were ana- in individuals doing pivoting and cutting sports. Today, ACL lyzed. reconstruction is the gold standard after ACL injury in the youn athlete angaged in high-risk sports. Evaluation of success is [MATERIALS AND METHODS] Seventy-nine top level usually based on measurable parameters such as strength, sta- American-football and rugby players were studies. All of them bililty, subjective assessment, and functional level. Our goal were men and their mean age was 21.6. Left knee was involved was to determine whether the commonly utilized knee rating in 33, right in 32, and bilateral in 7 cases. The period from the systems could predict the successful return of athltes to their injury to the ACL reconstruction was 6.2 months on average. previous sports participation level. The mean follow-up period was 25.3 months. METHODS: We reviewed one hundred athletes who underwent [RESULTS AND DISCUSSION] Satisfactory stability was ACL reconstruction using either a bone-patellar tendon-bone obtained after the surgery, and the side to side difference in the graft (n=50)or a quadrupled semitendinosus graft (n=50)and anterior laxity measured with KT-2000 knee arthrometer was 1.7 followed an aggressive rehabilitation protocol. The average age mm on average at 12 months after the operation. Re-injury of was 28.3 years; there were 61 males and 39 females. At an aver- the ACL occurred in 6 cases within two years. All the athletes age follow-up of 3 years (range, 2-5 years), the patients were had returned to their pre-injuried level of sporting activities at assessed using the following rating systems: IKDC, Lysholm, least once. The average peroiod to the return was 6.5 months. Tegner, and Noyes scales. Clinical evaluation, isokinetic The period to the return was found to have a negative correla- strength tests, computerized knee laxity anlysis and functional tion with recovery of the extensor muscle strength and a posi- strength tests were also done. More than 60% of athletes were tive correlation with presence of bilateral meniscal tear. It was engaged in high-risk sports. POSTER ABSTRACTS also found that the longer the period from injury to the recon- struction, the more frequently present the meniscal tear. These RESULTS: The average scores were: Lysholm, 90; Noyes, 88; results suggested that using the artificial ligament has an subjective evaluation, 85%; pre-injury Tegner, 7.6; final Tegner, advantage for early return to the sporting activities and that an 6.0. There were 89 normal or nearly normal knees by IKDC scor- early ACL reconstruction after the injury is desirable to prevent ing. Only 65% were able to return to their previous level of secondary meniscal damages. sports participation.

DISCUSSION: Normalization of structural and biomechanical Poster #173 parameters of the ACL-injured knee did not always mean recov- DONOR SIDE MORBIDITY AFTER ACL RECONSTRUCTION ery of optimal athletic function. Other factors such as restora- USING THE QUADRICEPS TENDON GRAFT WITH AND tion of neuromuscular control mechanisms may play a role. WITHOUT PATELLAR BONE PLUG Psychological factors and patient motivation also contribute Christos K Yiannakopoulos, Athens, GREECE, Presenter but are difficult to quantify. Emmanuel Antonogiannakis, Athens-Cholargos, GREECE Kostas Karliaftis, Athens, GREECE CONCLUSION: Successful ACL reconstruction based on Christos Karabalis, Athens, GREECE presently established knee scores does not accurately predict Christos Thanasas, Athens, GREECE the return of the athlete to the same pre-injury level of sports Panos Efstathiou, Athens, GREECE participation. Antonios Iliadis, Athens, GREECE 401 General Army Hospital, Athens, GREECE Poster #438 Following ACL surgery significant donor site morbidity may QUADRUPLED BONE-SEMITENDINOSUS ACL result in substantial impairment. We present the results from RECONSTRUCTION: A CLINICAL INVESTIGATION 27 patients who underwent surgery for chronic ACL deficiency IN A GROUP OF ATHLETES using a quadriceps tendon autograft. From March of 1999 Alberto Gobbi, Milan, ITALY, Presenter

5.79 Benjamin Tuy, Milano, ITALY and the medial plateau of the left knee. The laboratory tests for Sanjeev Mahajan, Milano, ITALY diabetes mellitus, rheumatoid factor, and TPHA were negative, Orthopaedic Arthroscopic Surgery International, Milano, ITALY but CRP and ESR were positive. X-ray examinations of other joints were normal, except for Heberden nodules in both INTRODUCTION: The hypothesis of our study was that a hands. Two years after the initial examination, total knee quadrupled bone-semitendinosus (STB) graft could combine arthroplasty was performed on both knees, and a synovia and the advantage of bone-to-bone healing with the high cross-sec- an articular cartilage of the surgical specimens showed histo- tional area of a quadrupled hamstring graft in ACL reconstruc- logical characteristics resembling those of rheumatoid arthritis. tion. Ten months postoperatively, there was no pain or deformity, and the CRP value had decreased. MATERIALS AND METHODS: ACL reconstruction with an STB graft was performed on 80 athletes with isolated ACL injury Discussion: Most of windswept deformity is seen in osteoarthri- from January 1996 to December 1999: femoral fixation was sis, and its progression is slow. In our patient, relatively rapid obtained with Endobutton and tibial fixation with Fastlok. At a destruction occurred, but the typical rheumatoid arthritis and mean follow-up of 36 months, they were evaluated with the fol- neuroarthropathy were absent. Histological findings resem- lowing: standard knee scores and functional strength tests; bling those of rheumatoid arthritis were observed. This seems post-operative pain rating; knee x-rays taken post-surgery and to have been a case of an atypical seronegative arthritis. And, at final follow-up; MRI at 3-6 months; isokinetic flexion-exten- since she continued to complain of knee pain and swelling after sion and internal-external rotation tests at 3, 6, and 12 months; both knee bruises, it seems to have occurred insufficiency frac- and computerized laxity analysis at 6 months and final evalua- tures. We speculate that atypical seronegative arthritis and tion. Parametric and non-parametric tests were used for statis- insufficiency fractures after both knee bruises caused this tical analysis. windswept deformity.

RESULTS: Average surgical time was 85 minutes, including 13 minutes graft preparation. Ninety percent were discharged Poster #175 within 24 hours. Subjective knee rating was 87%; kneeling test MID-TERM RESULTS OF THE AGC TOTAL KNEE was positive in 7% and average Werner score was 44/50. REPLACEMENT Lachmann test was negative in 90% at final evaluation. Sensory Jose Alemparte, Santiago, CHILE, Presenter changes were present in 30% at 3 months and 10% had definite Rodrigo Hernandez Hernandez Tagle, Santiago, CHILE hyposthesia. MRI showed graft incorporation at 3 months. Jose Marcelo Mardones Acevedo, San Miguel, CHILE Computerized laxity analysis revealed 90% with less than 3mm Hospital DIPRECA, Santiago, CHILE side-to-side difference. Isokinetic testing showed normal ham- string and quadriceps peak torques at 12 months. The one-leg A total of 148 total knee arthroplasties were performed in hop test and vertical jump were normal by 6 months. Average DIPRECA hospital between 1993 and 1999. Ninety-four of them Noyes score was 88, Lysholm score 91, and Tegner activity rat- were AGC total knee replacements and these are included in ing 6.5 (pre-op, 7.5). IKDC score showed 72 knees normal or the report. All patients had implantation with a cemented pos- POSTER ABSTRACTS nearly normal, 7 abnormal, and one severely abnormal. Sixty- terior cruciate-substituing design, with resurfacing of three five percent returned to the same pre-injury sports level. components in all cases. Mean age at surgery was 69 years and the patients were followed for a minimum of 2 years (range 2 - CONCLUSION: Quadrupled bone-semitendinosus is a viable 8). The survival analysis at 8 years was 96.65%, with revision for graft for ACL reconstruction and should be considered specially any reason as the endpoint. Lost to follow-up was 3.19%. The in patients with extensor mechanism problems. mean knee score for pain and function were 89 and 64 out of 100. The scores were analyzed by categories also. This knee arthroplasty shows excellent results in mid-term follow up in Knee - Arthritis the population we report. Key words: Anatomic Graduated Components, total knee arthroplasty, cruciate-substituing, sur- vival analysis. Poster #174 WINDSWEPT DEFORMITY AS A RESULT OF SERONEGATIVE KNEE ARTHRITIS Poster #176 Tomoyuki Abe, Utsunomiya, JAPAN, Presenter IS ROUTINE PROPHYLAXIS OF DEEP VEIN THROMBOSIS Hideo Matsumoto, Tokyo, JAPAN AFTER TOTAL KNEE ARTHROPLASTY NEEDED? Tateru Shiraishi, Utsunomiya, JAPAN A REPORT FROM AN EASTERN MEDITERRANEAN Toshiro Otani, Shinjuku-ku, JAPAN COUNTRY Yasunori Suda, Tokyo, JAPAN Semih Aydogdu, Izmir, TURKEY, Presenter Michikazu Nakamura, Utsunomiya, JAPAN Umur Aydogan, Izmir, TURKEY Saiseikai Utsunomiya Hospital, Utsunomiya, JAPAN Mustafa Parildar, Izmir, TURKEY Ahmet Memis, Izmir, TURKEY We report a case of atypical arthritis that rapidly progressed to Hakki Sur, Izmir, TURKEY joint destruction as in the windswept deformity. Ege University Hospital, Izmir, TURKEY

Case: A 72-year-old woman. She complained of bilateral knee Introduction: There are conflicting reports about the relative pain after bruising her knees. On the initial examination, she infrequency of deep vein thrombosis (DVT) seen after total knee was diagnosed as osteoarthrisis and had a conservative treat- arthroplasty (TKA) in oriental people, questioning routine use ment. However, she continued to complain of knee swelling and of pharmacological prophylaxis (PP). pain. When examined 1.5 years later, she had developed a val- gus deformity of the right knee and a varus deformity of the left Materials and methods: The purpose of this prospective clinical knee. The X-rays showed knee joint destructions involved with study was to test our clinical observations on the low the large bone defects on the lateral plateau of the right knee prevalance of DVT after TKA in the absence of any form of PP.

5.80 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). 184 patients who had undergone unilateral TKA were assessed Alan H Beyer, Newport Beach, CA, USA, Presenter by ascending venography (AV) in post-operative 6 to 10 days Hoag Hospital, Newport Beach, CA, USA period. No prophylaxis other than early active mobilization was used. If AV has detected DVT, its localization, uni or multi-focal- A significant number of 45 to 65 year old patients suffer from ity, degree of occlusion and clinical importance were examined. the early onset of medial compartment degenerative arthritis. The possible interactions between AV findings and clinical Traditional treatments for these patients include Total Knee parameters like sex, clinical diagnosis, type of surgical Arthroplasty (TKA), Unicompartmental Arthroplasty (UKA), or approach (standart or subvastus) and use of tourniquet were High Tibial Osteotomy (HTO). Many surgeons are reluctant to searched statistically (tested using Chi Square test, perform TKA on these younger patients because of the activity alpha=0,05). restrictions placed upon TKA patients and because of the potential mechanical failure of the implants over time. UKA and Results: The overall DVT prevalance was found to be 54/184 HTO are often utilized to gain these patients several years of (2.9%); but only 9 cases of DVT (4.9%) were considered to be pain free activity before they must undergo TKA. While many clinically important (popliteal and above levels). In the first 3 authors report excellent results utilizing these procedures, months post-operative period no cases of clinically diagnosed these operations require bone resections that can complicate pulmonary embolism and mortality was observed. The effect of future conversion to TKA. two different surgical approaches, use of tourniquet and sex on the prevalance of DVT was not found to be statistically signifi- A new treatment option is under investigation that utilizes a cant. CoCr spacer to restore the mechanical alignment of the knee and retention of the medial soft tissues without requiring bone Conclusions: Results we obtained do not encourage us the rou- resection or fixation of the implant. The spacer is a self-center- tine use of pharmacological DVT prophylaxis in the absence of ing bearing that replaces the cartilage lost from both the tibial risk factors in our TKA cases, as the percentage of clinically and femoral articulating surfaces. This presentation will discuss important DVT cases are identical to those obtained with pro- the treatment rational, surgical steps, and early patient results phylaxis in Western studies. utilizing a CoCr interpositional spacer for the treatment of iso- lated medial compartment osteoarthritis.

Poster #177 TOTAL KNEE ARTHROPLASTY FOR GONARTHROSIS WITH Poster #179 PRE OP PATELLAR SUBLUXATION. INTEREST OF THE VALGUS TKA. RESULTS OF 255 LCS MOBILE-BEARING LATERAL APPROACH ON PATELLAR TRACKING. TKA WITH 5 TO 15 YEAR FOLLOW-UP Zniber Boubker, Le Chesnay, FRANCE Jens Boldt, Zurich, SWITZERLAND, Presenter Jean Brilhaut, Chambray-les-Tours, FRANCE Peter Keblish, Allentown, USA Philippe Boisrenoult, Le Chesnay, FRANCE Urs Munzinger, Zurich, SWITZERLAND Philippe Beaufils, Le Chesnay, FRANCE, Presenter Schulthess Klinik, Zurich, SWITZERLAND Department of Orthopaedics Surgery, Andre Mignot H, Le Chesnay, FRANCE Introduction: Correction of fixed valgus is a challenge in pri- Introduction:The purpose of this study was to compare the mary TKA. Achieving patello-femoral and femoral-tibial stabil- results of lateral versus medial approach on patellar tracking of ity requires superficial/deep lateral side releases if total knee arthroplasty (TKA) with lateral patellar subluxation. non-constrained prostheses are utilized. The medial approach has disadvantages with more reported complications. The Material and methods: Two groups of 13 patients with patellar direct lateral approach, with/without tubercle osteotomy, is an subluxation (patellar shift > 5 mm) underwent TKA with patel- approach option utilized in two reporting centers. lar component using CEDIOR posterior-stabilized prosthesis POSTER ABSTRACTS (Sulzer®). Both groups were similar for angular deformities and Methods: 255 valgus TKAs with 5- to15-year follow-up were patellar measurements. In the A group patellar imbalance were reviewed. Demographics included 91% females, 15% rheuma- performed using a lateral approach with tibial tuberosity toid, mean age 69. Prostheses utilized were LCS mobile-bearing osteotomy whereas medial approach with lateral retinacular (meniscal PCL-retaining/rotating PCL-sacrificing). Patella was release were used in the B group. A comparison of the clinical non-resurfaced in 90%; cementless fixation in 86%. The direct and radiological results was done. lateral approach with similar lengthening techniques was used with tubercle osteotomy in one center and osteo-periosteal Results: One knee required femoral revision for patellar dislo- joint exposure in another. cation in the B group. There was no specific complications after tibial tuberosity osteotomy. Patellar tilt were significantly dif- Results: Good/excellent 91%, modified HSS score improvement ferent (p=0,006): medial in group A (mean - 3.3°) and lateral in 57 to 85. Deformity (12) improved <8 to 12 points (>15° valgus group B (mean + 3.8°). Patellar were centered in both groups to <5° valgus). ROM improved from mean 11°/97° to 1/110° lat- (mean 0.3 mm). est. Technical/prosthetic-related complications included: 7 bearing failures (5 meniscal, 2 rotating platform), 2 aseptic Conclusion: Using two groups of similar knees, our data loosenings (tibial), 1 patella ligament rupture and 2 screw loos- demonstrated that the lateral approach with tibial tuberosity enings in the osteotomy group, 1 patella re-dislocation in a 75- osteotomy was more efficient to cure patellar lateral tilt than year-old female with dislocation since age 15 (non-osteotomy the medial approach even with lateral retinacular release. group), 2 infections, and 1 re-operation for arthrofibrosis. Therefore we recommend this approach to perform TKA in osteoarthritic knees with lateral subluxation of the patella. Discussion/Conclusion: Valgus TKA using LCS moveable bear- ings implanted via a direct lateral approach are highly success- ful regarding stability and patella tracking. Failures correlate Poster #178 with inadequate/de-stabilizing releases and meniscal PCL- USE OF AN INTERPOSITIONAL SPACER FOR retaining prostheses. Rotating bearings allow for better stabil- TREATMENT OF MEDIAL COMPARTMENT ARTHRITIS ity and self-adjustment of common mal-rotation variables. The

5.81 lateral approach allows for direct (step-wise) lengthening CONCLUSION: releases, improved patellar tracking, and precise gap balancing. Patients younger than 55 perform well in general physical activ- ity, work performance, and sports activities. Better quality of life after mobile bearing TKA can be expected in younger patient. Poster #180 Young age should not be a contraindication for TKA. LONG-TERM RESULTS OF LCS MOBILE BEARING TKA. EVALUATION OF 457 TKA WITH 10 TO 13 YEAR FOLLOW-UP. Jens Boldt, Zurich, SWITZERLAND, Presenter Poster #182 Urs Munzinger, Zurich, SWITZERLAND ARTHROFIBROSUS IN TKA. IS THERE A CORRELATION Schulthess Klinik, Zurich, SWITZERLAND WITH FEMORAL COMPONENT MAL-ROTATION? Jens Boldt, Zurich, SWITZERLAND, Presenter Purpose: Evaluate of clinical outcome of 457 LCS mobile bear- Urs Munzinger, Zurich, SWITZERLAND ing TKA from one centre. Schulthess Klinik, Zurich, SWITZERLAND

Materials and Methods: From a cohort of over 3.5000 mobile Background: The purpose of this study was to determine bearing TKA in one large center, 457 cases were performed whether internal mal-rotation of the femoral component is more than 10 years ago (mean 11 years). Drop-out were 63 associated with arthrofibrosis in TKA. Multiple etiological fac- (13.8%) cases, 128 patients were known to have died and 63 tors have been suggested, but specific causes have not been (13.2%) cases could not be included leaving 86.2% that entered identified. We hypothesized arthrofibrosis may be triggered by the study. Patient demographics included 76% females and 8% a combination of non-physiological kinematics (femoral com- rheumatoids. There were 275 (60%) meniscal bearing and 182 ponent internal rotation) and a tight medial compartment. rotating platform design components. The patella was resur- faced in 95 (21%) cases. Methods: From a consecutive cohort of 3058 mobile bearing TKA forty-four (1.4%) cases were diagnosed as having arthrofi- Results: Preoperative KSS scores improved from a mean of 84 brosis, of which thirty-eight (86%) cases could be recruited. to 157 points and range of motion from 97 to 110 degrees post- Thirty-eight patients with a well functioning TKA served as operatively. Clinical scores were excellent or good in 88%, mod- matched controls. Evaluation included CT investigation to erate in 10% and poor in 2%. Kaplan Meier survival analysis was determine femoral component rotation with reference to the 96.9% after a mean of 11 years taking any revision into account. transepicondylar axis (TEA). Worst track record were polyethylene meniscal bearings with 91.2% and best the femoral component with 99.8% after a mean Results: Femoral components in the AF group were significantly of 11 years. Other complications will be listed in depth. (p<0.00001) internally mal-rotated by a mean of 4.7 degrees ranging from ten degrees internal rotation (IR) to one degree Conclusions: The data of this study with a survival rate of 96.7% external rotation (ER). Mean femoral rotational in the control after a mean of 11 years support the use of this mobile bearing group was parallel (0.3 degrees IR) to the TEA (six degrees IR to device. Best track record was noted with the all cruciate sacri- four degrees ER). Arthrofibrosis was not associated with age, POSTER ABSTRACTS ficing rotating bearing device and worst with the ACL and PCL gender, body-mass-index, or preoperative diagnosis. retaining meniscal bearing device. Conclusions: There is a highly significant association between arthrofibrosis in TKA and internal mal-rotation of the femoral Poster #181 component. On the base of these results it was hypothesized PHYSICAL ACTIVITY AND OCCUPATIONAL STATUS IN that non-physiological kinematics in TKA with mal-aligned PATIENTS YOUNGER THAN 55 YEARS WITH LCS MOBILE femoral components influence and/or trigger arthrofibrosis in BEARING TKA. EVALUATION OF 228 CASES TKA. Jens Boldt, Zurich, SWITZERLAND, Presenter Urs Munzinger, Zurich, SWITZERLAND Clinical Relevance: In TKA with arthrofibrosis, we now consider Schulthess Klinik, Zurich, SWITZERLAND femoral CT evaluation with the view to surgically rebalancing the flexion gap and realigning the femoral component, when PURPOSE: Evaluation of TKA in a younger population with spe- internal mal-rotation is confirmed. cial regards to: patient’s general activity level pre- and postop- eratively, sports activities, work related changes, relationship of BMI and activity. Poster #183 QUADRUPLE ARTHROPLASTY IN THE LOWER EXTREMITY METHOD: From 3300 mobile bearing TKA performed in non- Jens Boldt, Zurich, SWITZERLAND, Presenter inflammatory knee arthritis from 1988 - 2000, a total of 228 LCS Urs Munzinger, Zurich, SWITZERLAND TKA entered the study. A questionnaire was send out, of which Schulthess Klinik, Zurich, SWITZERLAND 86% were received. PURPOSE: Outcome of bilateral hip and knee arthroplasty in RESULTS: Follow-up time was 2 to 11 years, mean total score the same patient with special regards to schedule planning, was 95.2 points (out of 100). Currently in occupation were 61%, postoperative complications and follow-up. and retired 39%. There were 2% complications that will be dis- cussed in depth. Of the group 89% participated in active exer- METHOD: Since 1985 more than 6000 THA and 5500 TKA were cises with a mean of 475 min / week on 2.5 days. Average implanted at Schulthess Klinik, of which 8% were rheumatoid walking distance / day ranged from less than 1 km in 8% to more patients. Quadruple THA and TKA were performed in a total of than 10 in 10% of the group. Sports activities included: swim- 58 (0.1%) of which 88% were RA. Mean follow-up knees was 8.5 ming 36%, fitness 18%, hiking 14%, cycling 11%, tennis 7%, years (1-17), of hips 9.5 years (1-18). On average 67% of alpine skiing 7%, and jogging 7%. Daily gardening and house- implants were uncemented. In 21% of the cases all four pros- work was noted in 51%. theses were implanted within one year and over 50% within five years.

5.82 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). operative assessment, health advice, informed consent, clinical RESULTS: Taking revision of components as failure there were follow up and maintainance of a database for research and three infections (CLS hip, GSB and LCS knee), two aseptic loos- audit. Follow up radiographs are reviewed regularly by the enings (Endler cup, GSB knee), two recurrent hip dislocations, entire medical team in a teaching environment. Relative costs three knee bearing exchanges (LCS, INNEX), and four patella of this service were calculated using outpatient charging data. component removal (GSB, PCA). 100 postal questionnaires were used to assess patient satisfac- tion. Patients answered 13 questions relating to the service CONCLUSION: Quadruple arthroplasty in the lower extremity they received. Knee arthroplasty follow up through the nurse did not show an increased failure rate compared with single lead clinic was half the cost of follow up through the consultant arthroplasty in this center. The results of this study support the lead clinic. 80 patients returned the postal questionnaire. indication for quadruple procedure with early postoperative Responses were very supportive of the ANP service. 79 (95%) of rehabilitation and full weight bearing. Data suggest a proce- patients were happy to be assessed by the ANP and felt that dure with hips before knees and at least two weeks between their problems were dealt with appropriately. 17 (21%) of arthroplasty operations. patients felt they should be seen by a surgeon at some stage during their routine follow up. Overall, 75 (94%) of patients were very satisfied or satisfied with the service, 1 (1%) was dis- Poster #184 satisfied and 4 (5%) did not answer this question. Increasing ARTHROSCOPIC DEBRIDEMENT AND HIGH TIBIAL patient numbers and demand for high quality care combined OSTEOTOMY FOR KNEE OSTEOARTHRITIS IN AGING with a decrease in doctors hours worked has lead to a shortage ATHLETES of time for discussion of ‘prehabilitation’ and post-operative Jesus Ignacio Cardona, Zapopan, MEXICO, Presenter care. Long term clinical and radiological follow up leading to Jorge Alfredo Mojarro, Zapopan, MEXICO adequate research and audit must not be compromised. A Joaquin A. Torres, Zapopan, MEXICO trained nurse practitioner working in conjunction with the sur- Centro de Ortopedia y Medicina del Deporte, Zapopan, MEXICO gical team is a cost effective way of improving total patient care, audit and research within a department. We have found a high OBJECTIVE: To evaluate the functional results of arthroscopic degree of patient satisfaction with this approach. debridement plus high tibial realignment osteotomy in the osteoarthritic knee in active aging athletes Poster #186 METHODS: Records from 121 active elder recreational and UNICOMPARTMENTAL KNEE REPLACEMENT REVISION competitive athletes underwent arthroscopic debridement plus SURGERY: IS IT REALLY AN EASY JOB? high tibial osteotomy for moderate an severe knee osteoarthri- Enzo Cenna, Torino, ITALY, Presenter tis from 1992 through 2000 were retrospectively rewiewed. 103 Giulia Sandrucci, Torino, ITALY patients were interviewed to compare the pre-operative vs real Daniel Comba, La Loggia-TO, ITALY functional and sports activities. The results were analyzed using Alessandro Bistolfi, Ttorino, ITALY non parametric tests. Maurizio Crova, Pecetto, ITALY II Orthopaedic Clinic, Turin, ITALY RESULTS: The results were evaluated a minimum of one year, with an average of 4.7 years of follow-up. 68.4% back to sports, Despite almost 30 years of controversy the status of unicom- 31.6% left sports but kept active and exercising regularly. All partmental knee replacement (UNI) remains uncertain. It would patients were completelly satisfied with the results of surgery appear to offer a good alternative to osteotomy or total knee and would recomend the procedure. No one have needed other replacement (TKR). Compared to osteotomy there is a higher treatments than analgesic and physical therapy eventually. initial success rate and also compared to TKR the UNI knee

replacement offers better results with faster recovery and POSTER ABSTRACTS CONCLUSIONS & SIGNIFICANCE: Our results determine that improved function, with mini-open surgical approach, too. arthroscopic debridement plus high tibial osteotomy is an acceptable an valuable procedure for the treatment of The UNI failures percentage in the long period (ten to twenty osteoarthritic aging athlete`s knee. The time required for symp- years follow-up) seems to be higher than in TKR and with some toms reliefe is not consistently predectable but finally a high differences as regarding causes. The UNI failures are more average of patients recover a desired daily and sports activities commonly due to: level. The high significative improvement of pain and other - femoral or tibial loosening: condylar osteonecrosis, cement symptoms of knee osteoarthritis in active aging athletes, make loosening. this procedure a secure option in suchs patientes who not - instability: anterior cruciate or medial collateral ligament failure accept to change their style of life becouse a total knee replace- - high correction with valgus deformity: rapid evolution of the ment. arthritis to the opposite side - persistent deformity in varus: severe polyethylene wear - lack of motion: wrong rehabilitation protocol, wrong compo- Poster #185 nents position. THE ROLE OF THE ORTHOPAEDIC NURSE PRACTIONER - inadequate selection of the patient: obesity, total knee arthri- IN tis, anterior laxity. Paul Carter, Wirral, ENGLAND, Presenter Rose Finley, Upton, UK The more important steps in revision surgery are discussed: Richard W Parkinson, Upton, UK - ligament balancing: how to choose among posterior sta- Wirral Hospitals NHS Trust, Wirral, ENGLAND bilised tibial component, CCK or hinged replacements. - bone loss management: when to use bone graft from the lat- We report the role of our advanced nurse practitioner (ANP) eral side, wedges, spacers, or cement. with particular relevance to cost effectiveness, patient satisfac- - component selection and modularity: where to provide tion and data collection. Our nurse practitioner has been mobile bearing devices and stemmed components involved in arthroplasty care since 1996. Her duties include pre-

5.83 Furthermore every orthopaedic surgeon should remember what graphic scan. The patellofemoral alignment was checked with Insall wrote in 1991: “the unicondylar arthroplasty is not a con- the congrunce angle on Merchant’s view. servative procedure that allows a total knee arthroplasty to be done easily after”. UNI as TKR should be considered definitive Results: The internal rotation of the femoral component was replacement surgery. 6.60 degrees (3.88 SD) in group A and 3.40 degrees (2.39 SD) in group B (P<0.001). The congruence angle was 27.79 degrees For communications: (15.29 SD) in group A and 17.60 degrees (14.47 SD) in group B G. Sandrucci, MD (P<0.001). II Orthopaedic Clinic, University of Turin Trauma Centre Conclusion: Making the femoral anteroposterior cutting paral- Via Zuretti 29, 10126 Torino - Italy lel to the transepicondylar axis without using the femoral guide Tel 0039116933573 posioner rather than parallel to the proximal tibial cut surface Fax 0039116933760 using femoral guide posioner may give a better patellofemoral Email [email protected] alignment by decreasing the risk of the internal rotation of the femoral component.

Poster #187 THE OFTEN POOR CLINICAL OUTCOME OF INFECTED Poster #189 TOTAL KNEE ARTHROPLASTY THE MANAGEMENT OF DEGENERATIVE KNEE ARTHRITIS Ching-Jen Jen Wang, Kaohsiung Hsien, TAIWAN, Presenter IN THE ACTIVE MIDDLE AGED – ARTHROSCOPIC Ting-Wen Huang, Kaohsiung Hsien, TAIWAN APPROACH Jun-Wen Wang, Kaohsiung Hsien, TAIWAN Moises Cohen, Sao Paulo, BRAZIL, Presenter Han-Shiang Chen, Kaohsiung Hsien, TAIWAN Rene Jorge Abdalla, Sao Paulo, BRAZIL Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung Hsien, TAIWAN Federal University of Sao Paulo, Sao Paulo, BRAZIL

This study compared the clinical outcomes of various options In the last past years the improvement of sports practice of treatment in 26 infected TKA with successful eradication and contributed to increase the number of active middle aged no recurrence of infection for at least two years. There were 20 patients with degenerative arthritis in the knee. The goals of the women and 6 men with an average age of 77 years. The average surgical treatment are to relief the symptoms, maintain the follow-up time was 48 (range 24, 83) months. The evaluation patient’s active lifestyle and delay the need for arthroplasty, by: parameters included pain score, knee score functional score minimal morbidity, cost effective, arthroscopically procedure, and radiograph of the knee. The knees with acute infection early rehabilitation, outcomes measurable and good long term showed significantly better outcome, and the clinical results results. Arthroscopic Lavage and Debridement - The effect of were comparable to non-infected TKA. The clinical outcome of lavage of degenerative joints was first noted by Bircher in 1921, chronic infection was less favorable. Arthrodesis achieved bet- followed by Burman et al in 1935 and Watanabe et al in1964, ter pain relief, while reimplantation TKA showed better func- since when an extensive clinical study has been conducted and POSTER ABSTRACTS tion. However, no significant difference in knee scores was extended to other joints. This procedure has been advocated as observed between reimplantation TKA and arthrodesis. a treatment for degenerative joint processes of the knee to Approximately 50% of reimplantation TKA had mild to moder- effect removal of loosie bodies, proinflammatory mediators ate knee pain. and cartilaginous degradation products. The debridement of degenerated and partial thickness articular cartilage defects has been shown to provide a short term symptomatic pain Poster #188 relief but does not stimulate regeneration of articular cartilage. CHANGE OF THE PATELLOFEMORAL ALIGNMENT BY TECHNIQUE MODIFICATION IN TOTAL KNEE PERSONAL EXPERIENCE: study design- single center, random- ARTHROPLASTY USING LCS PROSTHESIS ized, prospective; preop VAS > 60 for pain and ADL; Jaehoon Chung, Kwangju, SOUTH KOREA, Presenter Patients:116 (M 77, F 39); Age: 38 - 58 yr (mean age 48.4 yr) ; Dong-A Hospital, Kwangju, SOUTH KOREA Follow up 26, 52 and 104 weeks; Outcomes measures - Pain and ADL VAS. Results: Improvement rate 26 wk - 63%, 52wk - 54%, Background: It is well known that the internal rotation of the 104 wk - 20%. CONSIDERATIONS: Arthroscopic lavage and femoral component may be the cause of the patellar maltrack- debridement provide a positive, but often short lived reduction ing in total knee arthroplasty. The purpose of this study was to in the severity of symptoms. It may be indicated as a minor pro- evaluate the change of the patellofemoral alignment and the cedure to reduce symptoms before the major procedure indica- femoral component rotation by modifying the femoral antero- tion. posterior cutting references in total knee arthroplasty using LCS prosthesis without patellar resurfacing. Abrasion, Drilling and Microfracture - After the loss of the artic- ular cartilage in progressive degeneration arthritis of the knee, Materials and Methods: We performed 206 total knee arthro- the sclerotic lesion occurs. The question is how to stimulate the plasties and classified them into two groups based on the repair in that area. The concept is that an abrasion, drill hole or femoral anteroposterior cutting reference during the operation. microfractures, made into the cancelous bone reach the blood Group A was 102 knees which femoral anteroposterior cutting supply and the pluripotential cells for healing. The second look was done parallel to the proximal tibial cut surface using the arthroscopy in drilling or microfractures procedures usually femoral guide posioner, as recommended originally. Group B shows the healing of each dumple, but no coalescence of repair was 104 knees which femoral anteroposterior cutting was per- tissue between the defects. In abrasion procedure the healing formed parallel to the transepicondylar axis without using the is continue but many papers show less long time improvement femoral guide posioner. The degree of femoral component rora- than drilling or microfractures. In all those procedures the ear- tion was defined by the angle between the transepicondylar liest repair tissue is fibrocartilage. The indications are: pain, axis and posterior femoral cutting line on computed tomo- swelling, crepitus, loss of function due to degenerative arthritis and in active middle aged patients before knee arthroplasties.

5.84 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Some contraindications are: morbid obesity, ankylosis, insta- lesions were completely covered by chondral tissue, slight bility, deformity and inflammatory arthritis. The surgical tech- depression was always present between graft and adjacent bor- nique involves 1 to 4 mm. deep, depending on the procedure. ders of native cartilage. Histology at 3 months showed in mid- The intraoperative observation when the inflow is decreased or dle of the implant the four layers of articular cartilage while the tourniquet is released, is necessary to make sure that the peripherically we observed clusters of cells with many hyper- surface vessels bleed and blood clots form on drilled or trophic condrocytes. Between the transplanted cartilage and abraded areas, filling the defects. In the postoperative manage- surrounding tissue there was in all animals a fibrocartilagi- ment is necessary about four to six weeks for healing and mat- neous tissue. A well appearing tidemark was observed at 3-6-9 uration of the regenerative tissue. and 12 months. Histologic appearance was similar at 6-9 and 12 months; the fibrocartilagineous tissue seems to be more dense PERSONAL EXPERIENCE: Study design - single center, retro- at 12 months. We observed also peripherically a modification of spective; preop VAS > 60 for pain and ADL; Patients- 513, knees colourability of intercellular matrix. The donor sites were full of 532 (M 385, F 128); Procedures- 213 abrasion, 251 drilling and fibrocartilageous tissue. 68 microfractures ; Age: 36 to 59 yr (mean age 49,6 yr); Follow up: 2 to 16 yr (mean 9,3 yr) Outcomes measures - Pain and ADL Discussion: Clinically we had good results with AOG, but when VAS. Results: analysed in three groups of patients’ follow-up, checked artroscopically in our patients always we observed a two to five years- 63% of improvement, more than five to ten fibrous layer between implant and cartilage and a softening of years- 38% of improvement and more than ten years- 9% of transplanted cartilage evaluated with a probe. The results of improvement. We didn’t find significant differences between our experimental study confirm this macroscopic appearance, drilling and microfrature procedures results, but the abrasion also after 12 months the graft is viable but is not integrated procedures were associated to the worst results after five years. with surrounding cartilage; a fibrocartilagineous tissue is We performed the second look arthroscopy and biopsy in 28 always present. patients, all associated to some new procedure, 6 between 2 to 5 yr f.u, 14 between 5 and 10 yr f.u, and 8 with more than 10 yr. Conclusion: Multiple osthechondral autograft seems to be clin- We didn’t see any hyaline cartilage tissue, even in longer fol- ically a good alternative in young chondral lesion treatment, low-up patients; in all cases the biopsy showed fibrocartilage but there is always a fibrocartilagineous layer between cartilage tissue. CONSIDERATIONS: The procedures showed a temporary and transplant and matrix alteration is clearly present. benefit but remains a reasonable alternative before knee replacement in middle aged active patients. CONCLUSIONS: The arthroscopic procedures to treat the degenerative arthritis Poster #191 in active middle aged patients can provide a reduction in the LATERAL CONDYLAR RELEASE FOR HIGH VALGUS KNEE severity symptoms and improve the activities of daily living, but REPLACEMENT not for a long time, in general, is disappointing to the patient James K DeOrio, Jacksonville, FL, USA, Presenter as well to the surgeon. Mayo Clinic, Jacksonville, Florida, USA

Objective: To obtain a balanced knee in the face of a high val- Poster #190 gus knee without damaging the peroneal nerve when perform- AUTOLOGOUS OSTHEOCHONDRAL GRAFT IN CHONDRAL ing total knee arthroplasty. LESION TREATMENT – EXPERIMENTAL STUDY IN GOATS Antonio Delcogliano, Rome, ITALY, Presenter Material and Methods: Six patients with genu valgum over 20 Silvio Chiossi, Roma, ITALY degrees were treated with a standard total knee cruciate sacri- Salvatore Franzese, Rome, ITALY ficing knee arthroplasty. These six knees represented 2% of the Giuseppe Rinonapoli, Roma, ITALY total knees done in our institution from ‘94-’01. In order to

Amerigo Menghi, Roma, ITALY obtain ligamentous balancing, in lieu of sequential release of POSTER ABSTRACTS Mario Cillo, Roma, ITALY soft tissues, a large osteotome was taken and the entire lateral Ernesto de Santis, Roma, ITALY condyle is split off the femur. Antonio Caporaso, Roma, ITALY Universita Cattolica - Clinica Ortopedica, Roma, ITALY Results: The single event of the lateral condylar release was suf- ficient to obtain balancing in all the knees without additional Autologous ostheochondral graft (AOG) has begun in recent soft tissue release. One patient with a 45 degree valgus knee years the treatment of choice for many surgeons; however the still developed a peroneal nerve palsy. All patients were satis- fate of trasplantented tissue and its ability to bind with sur- fied (including the patient with the postoperative peronal rounding cartilage still remains unclear. palsy). The Hospital for Special Surgery Knee score was 92 and Aim: to evaluate experimentally osteochondral autograft trans- 91 for the subjective and functional scores respectively. plant in goats Conclusions: Lateral condylar boney release is effective for bal- Material and Methods : We performed AOG in 10 adult goats; a ancing high valgus total knee arthroplasty. However, when the chondral lesion of 0,5 cm was created on weight bearing surface valgus knee exceeds 30 degrees, increased femoral shortening on medial condyle. Multiple small graft were harvested on lat- with advancement of the medial collateral ligament may still be eral troclea using commercial arthoscopic tools (OATS), osthe- necessary. chondral plugs were then press-fit in to prepared recipient site on medial condyle without using any fixation device. The ani- mals were sacrificed at 3-6 (4 animals) - 9 and 12 months (6 ani- Poster #192 mals). The specimens were observed with light microscopy and AXIAL PARAMETERS INFLUENCING LOWER LIMB polarized light microscopy. REALIGNMENT IN HIGH TIBIAL OSTEOTOMY Mehmet Rifat Erginer, Istanbul, TURKEY, Presenter Results: The animals were able to walk without limitation, the Hayrettin Kesmezacar, Istanbul, TURKEY joint were free of infection. Range of motion was completely Tahir Ogut, Istanbul, TURKEY restored. At macroscopic evaluation (in all cases) chondral Richard Nyman, Uppsala, SWEDEN

5.85 University of Istanbul, Cerrahpasa Faculty of Medi, Istanbul, TURKEY Valgus Cut Valgus Achieved IR / ER Flexion / Extension PURPOSE: To investigate axial parameters affecting lower limb 5 deg 4.2 deg 3.9 deg ER 3.7 deg flexion alignment after high tibial osteotomy; to find a method for 10 8.4 7.8 ER 7.2 flexion determining the appropriate correction angle. 15 12.7 11.6 ER 10.7 flexion

METHOD: Between 1990 and 2001 118 knees of 91 patients Varus Cut Varus Achieved IR / ER Flexion / Extension underwent HTO with a closing-wedge technique. The same 5 deg 3.6 deg 2.7deg ER 2.3deg extension author performed all of the procedures. Three staples were use 10 6.8 7.1 ER 6.4 extension for internal fixation in most cases. Clinical and radiological 15 9.5 10.4 ER 9.5 extension details have been evaluated retrospectively for 61 knees of 47 patients. The average duration of follow-up was 91 months. The Average patient pain scores went from 7.8/10 to 2.6/10. Avg Hip-Knee-Ankle Angle (femorotibial mechanical angle), the Lysholm score post-op was 84.3. There was an average of a 10 femorotibial angle, the femoral condylar - femoral shaft angle degree correction per patient. (lateral distal femoral angle), the femoral condylar - tibial plateau angle (joint line convergence angle), the tibial plateau Discussion/Conclusion: CTO is an effective surgical option for - tibial shaft angle (medial proximal tibial angle) were meas- patients with unicompartmental arthrosis of the knee. The ured from preoperative and postoperative standing anteropos- coronal osteotomy affords the surgeon the ability to correct terior radiographs for all the patients. Statistical differences multiplanar deformities through one osteotomy. Results in a among the preoperative and postoperative averages were ana- small cohort of patients are encouraging. lyzed using the Student’s t-test. The strength of the linear rela- tionship between the variables had been measured with Pearson’s correlation coefficients. The significance of the coef- Poster #194 ficients was evaluated using the t-test. QUANTITATIVE GAIT ANALYSIS AFTER MEDIAL UNICOMPARTMENTAL KNEE REPLACEMENT FOR RESULTS AND CONCLUSIONS: Before and after the operations OSTEOARTHRITIS the femorotibial angle correlated significantly (p 0.001) with the Kate E Webster, Melbourne, AUSTRALIA tibial plateau - tibial shaft angle. The regression line of the cor- Julian A Feller, Melbourne, AUSTRALIA, Presenter relation (Y = - 0.95 X + 260.42) revealed that a correction result- Jo Wittwer, Melbourne, AUSTRALIA ing in a tibial plateau - tibial shaft angle of 95° should be La Trobe University Musculoskeletal Research Centr, Melbourne, AUS- achieved intraoperatively in order to obtain a final femorotibial TRALIA angle of 170°. A statistically significant (p 0.001) difference was observed between preoperative and postoperative averages of Purpose: To characterise the footstep pattern and knee kine- femoral condylar - tibial plateau angles, suggesting thinking on matics during walking after unilateral medial unicompartmen- the reliability of the standing radiographs in preoperative plan- tal knee replacement. ning of the osteotomy. POSTER ABSTRACTS Method: Five females and seven males (mean age 69 +/- 8 yrs) who had undergone unicompartmental replacement for unilat- Poster #193 eral medial compartment osteoarthritis of the knee partici- CORONAL TIBIAL OSTEOTOMY FOR pated in the study. Each patient was tested at least 12 months UNICOMPARTMENTAL ARTHROSIS OF THE KNEE after surgery (mean follow up: 22 months), and had achieved a Stephen Fealy, New York, NY, USA, Presenter successful recovery (return to normal daily activities, no ongo- Xeng-Hua Deng, New York, NY, USA ing joint pain and a Knee Society Score of 80 or greater). For Thomas L. Wickiewicz, New York, NY, USA gait analysis six cameras were connected to a Vicon 3-dimen- Hospital for Special Surgery, New York, New York, USA sional motion analysis system to provide kinematic data. In addition, an 8.2m long GaitRITE electronic walkway was used to Introduction: Unicompartmental gonarthrosis in properly calculate spatial and temporal parameters. Patients completed selected patients is often treated with high tibial osteotomy. four walks at both self-selected comfortable and fast speeds. HTO corrects varus/valgus, but doesn’t address flexion and rotation of tibia. We sought to mechanically evaluate a coronal- Results: The mean self-selected comfortable walking speed plane tibial osteotomy (CTO) that addresses varus/valgus, rota- (1.36 m/sec, SD: 0.2), cadence (117.6 steps/min, SD: 7.5) and tion, and flexion of tibia. We also sought to assess short-term stride length (1.41 m, SD: 0.2) fell within the range of published clinical outcome in a cohort who had undergone the procedure norms for a healthy adult sample. Patients were able to increase their walking speed by 30% during the fast pace mode. Methods: 5 standard tibial sawbones were used. 3-D coordi- There was no significant difference between operated and con- nates of the distal tibia relative to plateau were taken using the tralateral limbs for stance time, step length, or single support Polhemus tracking device. CTO performed on specimens. Distal time. All but one patient showed a normal biphasic pattern of segment was rotated around an instant center of rotation at flexion-extension motion about the operated knee. In 8 of the osteotomy, calculated for each specimen. Specimens rotated by 12 patients there was, however, a significant increase in knee 5° intervals into varus/valgus. Corresponding change of distal flexion on the operated limb throughout the gait cycle com- tibia relative to proximal tibia regarding varus/valgus, pared to the contralateral limb. This pattern of increased knee flexion/extension, and rotational correction measured. 11 knees flexion was most marked during stance. (9pts; avg age 33.6yrs) were evaluated at a minimum of 2 yrs post-op. All patients had varus gonarthrosis pre-op. Conclusions: Following medial unicompartmental knee replacement spatio-temporal gait parameters were within nor- Results: mal limits and patients had the ability to vary their walking There was a surprising linear correlation between correction at speed, indicating a good functional outcome based on these the osteotomy site and degree of correction achieved distally. two measures. A significant increase in flexion in the operated (Tables) knee was observed in 67% of patients. The cause of this

5.86 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). increased flexion and its ramifications in terms of function are osteo-arhritic knee condition. ACL impingmentt in the inter- yet to be determined. condylar notch or patellar fixation due to osteophytes should be suspected. Arthroscopic notchplasty, or removal of osteo- phytes around the patella, followed by physiotherapy, can pro- Poster #195 duce full or improved knee extension and produce HTO-like ARTHROSCOPIC SURGERY WITH HTO EFFECT FOR effect. OSTEO-ARTHRITIC PATIENTS WITH KNEE FLEXION 4. Patients with a recurrent swelling of the knee with effusion, CONTRACTURES AND GENU-VARA with or without X-Ray evidence of osteoarthritis. Suspect joint Alex Finsterbush, Jerusalem, ISRAEL, Presenter polution by debries or loose bodies. Synovitis can be elimi- Joseph Lowe, Jereusalem, ISRAEL nated by removal of debries. Gershon Chaimsky, Jerusalem, ISRAEL 5. Patients with unicompartmental (mostly median) joint nar- Gideon Mann, Givat Shaul, ISRAEL rowing and x-ray evidence of osteo-arthritis for evaluation of James D. O’Holleran, Boston, MA, USA other compartments, before diciding on a definite surgery (HTO Jon JP Warner, Boston, MA, USA or TKR). The secondary goal is “house cleaning”. Hadassah University Hospital, Jerusalem, ISRAEL 6. Patients after intra-articular joint injury with continuous complaints after a rehabilitation period. Joint incongruity in 107 patients over 50 years old underwent arthroscopic surgery weight bearing surface and or loose bodies. for a veriety of indications between 1989 and 1991. 36 patient Relative indications for arthroscopiy in the treament of elderly presented genu-vara with knee flexion cpntracture on top of patients : osteo-arthritis. 32 of 36 patients had on grade 4 arthritic 1. Cristaline synovitis withrecurrent effusions. changes on arthroscopy; 4 patients had grade 3 changes. 19 2. Synovial chondromatosis with recurrent effusion and/or lock- patients had additional tear of the posterior horn of the medial ing of the knee. meniscus. On arthroscopy 26 were found to have obliterated 3. Sudden knee pain at night, with normal x-ray, with evidence intercondylar notch, mostly by soft tissue; 14 had osteophytes of AVN by scan of MRI for evaluation of cartilage congruity and in the notch and 12 had large osteophytes blocking the patella. integrity. Arthroscopy-guided drilling procedure can be per- Knee flexion contracture, as measured before surgery, was as formed. following : 20 degrees or more - twenty one patients; 10-20 When is Arthroscopy NOT indicated in ghe treatment of elderly degrees - eleven patients; less than 10 degrees - four patients. patients with knee problems: Following surgery and intensive physiotherapy, knee flexion 1. Chronic pain on activity, without knee effusion. contracture was reduced to 10-20 degrees in six patients; in six- 2. Multiple joint involvement. teen patients - less than 10 degrees; the rest had straight knees. 3. Advanced multicompartmental osteo-arthritis. Only nineteen patients from this group were located for evalu- ation ten years later. Three patients had 10-20 degrees of flex- tion; nine patients had less than 10 degrees of flextion and Poster #197 seven patients maintained straight knees. Patients that had POST-OPERATIVE RESULTS OF MOBILE BEARING TKA residual knee flexion contracture after surgery deteriorated dur- FOR OSTEOARTHRITIS OF THE KNEE ing the time. Analyzing the good results we found that these Kazumasa Fukushima, Tokyo, JAPAN, Presenter patients had normal or nearly normal articular cartilage in the Atsuhiko Sakamoto, Tokyo, JAPAN front part of the femoral condyles and achieved full correction Toshinori Yoshimatsu, Tokyo, JAPAN of their contractures. At present, we recommend MRI examina- Yuki Kato, Tokyo, JAPAN tions for evaluation of articular cartilage before suggesting this Akiyoshi Saito, Tokyo, JAPAN procedure. However, even partial reduction of knee flexion con- Keinosuke Ryu, Tokyo, JAPAN tracture resulted in temporary improvement in pain and func- Department of Orthopaedic Surgery, Nihon Universit, Itabashiku, JAPAN tion in most cases. POSTER ABSTRACTS Purpose A short-term clinical result of mobile bearing TKA, which had Poster #196 been used by since 1996, was evaluated and compared with INDICATIONS FOR ARTHROSCOPY IN ELDERLY PATIENTS standard type TKA. Alex Finsterbush, Jerusalem, ISRAEL, Presenter Joseph Lowe, Jereusalem, ISRAEL Object and Method gershon chaimsky, jerusalem, ISRAEL 41 cases (51 joints), where mobile bearing TKA was performed Gideon Mann, Givat Shaul, ISRAEL on osteoarthritis of the knee(OA) from June 1996 through Hadassah, Jerusalem, ISRAEL December 2001, involved 8 male and 33 female, aging from 64 to 90 (mean age 71.3). 6 months to 4 years follow-up (mean 2 During our fifteen years experience of arthroscopic surgery, we years) was the period of study. In Mobile group, 27 cases (31 have noted the increasing number of elderly patients udergoing joints) used Rotaglide mobile bearing TKA and 14 cases (20 Arthroscopic surgry. Following about 12 years of follow-up, we joints) used that of Kneeopus. In Control group, using standard have concluded the following indicaitons for surgery in this type TKA, 24 cases (28 joints) used Axiom, 8 cases (10 joints) group of patients: used PFC, 5 cases (10 joints) used Nexgen and 6 joints used 1. As with young patients, sport trauma or any trauma followed others. Both groups were evaluated by JOA scorebased on their by typical signs of meniscal, ligamentous or other injury, improvement in Range of Motion (ROM) and contamination should be treated. levels. 2. In cases of a sudden deterioration in knee condition, acute pain on full flexion with or without knee effusion, in patients Results without previous knee problems or who suffered from chronic JOA score was 49.5 points before and 76.3 points after surgery aches on activity - suspect a degenerative tear of the posterior in the Mobile group, 46.1 points before and 73.5 points after horn of the medial meniscus. surgery in the Control group, respectively. There was no signif- 3. Patients with a progressive development of genu vara, with icant difference between the 2 groups in JOA score. ROM was lack of full extension of the knee, who suffer from a chronic 15.5-108.4 degrees pre-operatively and improved to 5.2-119.5

5.87 degrees post-operatively in the Mobile group. In Control group, - Osteochondral autograft transfer: 4 cases pre-operative ROM was 2-106.5 degrees, and 5.9-111 degrees post-operatively. We observed a significant difference in the In 10 cases we have treated both the meniscal and the chondral increase of ROM between the two groups statistically. No con- damages. taminations were observed in both groups in a short time fol- low-up. DISCUSSION AND CONCLUSION: The association of prelimi- nary arthroscopy to tibial osteotomy in varus knee considerably Conclusion improves the clinical and anatomical results. The contempora- Results of mobile bearing TKA were compared with standard neous treatment of articular lesions and the direct arthroscop- type TKA. The Mobile group had an advantage of gain in ROM. ical inspection of the lateral knee compartment permit to There was no problem in a short-term result and also an excel- decide on more accurate surgical procedures. Moreover, a sec- lent result was obtained. But the generation of contaminations ond look one year after surgery, has shown an important such as Polyethylene wear is necessary to consider in a long- improvement of the medial condyle cartilage. term follow-up.

Poster #199 Poster #198 TOTAL KNEE ARTHROPLASTY BILATERAL SEQUENTIAL THE SIGNIFICANCE OF PRELIMINARY ARTHROSCOPY IN IN ONE STAGE. CLINICAL RESULTS AND COMPLICATIONS. PROXIMAL TIBIAL OSTEOTOMY FOR THE CORRECTION Hugo Gonzalez, Santiago, CHILE, Presenter OF VARUS KNEE Jaime Duboy, Santiago, CHILE Danilo Gervasoni, Niardo, ITALY, Presenter Alvaro Ferrer, Santiago de Chile, CHILE Antonio Medeghini, Esine, ITALY Giovani Carcuro, Santiago, CHILE Gianpaolo Chitoni, Esine, ITALY Instituto Traumatologico y ClÌnica Santa MarÌa, Santiago, CHILE Mauro Ballerini, Esine, ITALY Augusto Trombini, Esine, ITALY Purpose: The goal of this study is to evaluate clinical results Andrea Salvini, Esine, ITALY and complications in total knee arthroplasty bilateral sequen- Vallecamonica Hospital, Esine, ITALY tial in one stage.

PURPOSE: Evaluate the real condition of the medial and lateral Patients and methods: We performed a prospective and proto- varus knee compartment before the valgus osteotomy and treat colized study of patients with bilateral gonarthrosis.From April the associated damages. 1994 to November 2000, 38 patients underwent 76 cemented posteriorly stabilized TKA bilateral sequential in one stage. We MATERIALS AND METHODS: Since 1994 we have employed tib- excluded patients with severe systemic disease. The evaluation ial proximal osteotomy in varus knee or in medial symptomatic was made using HSS score and alignment measured by overload of any origin in patients under 65 years by means of monopodal weigthbearing x-rays. emicallotasis correction thanks to unilateral external fixator. POSTER ABSTRACTS We have treated 87 cases in total. In the last 37 cases we have Results: The mean age of the patients was 60 years (range,28 to associated a preliminary arthroscopy to evaluate endoarticular 84),the mean follow-up period was 62 months (range,25 to 104). damages. This has allowed us to treat possible meniscal or The etiology was degenerative joint disease in 53% and chondral lesions (shaving, chondral abrasions, perforations rheumatoid arthritis in 47%. 88% of patients had angular defor- according to Pridie, microfractures or osteochondral auto- mity (varus knee 58%,range:176 to 190 degrees and valgus knee grafts). The treatment of chondral or meniscal lesions in varus 42%,range:152 to 170 degrees).97% had excellent or good clini- knee without associating a valgus osteotomy is going to fail. cal results. The incidence of systemic complications was 13% (5 The patients have been evaluated using standard and tele-radi- patients) all resolved with specific treatment. The rate of infec- ographs under load and by means of TC and MRI. After arthro- tion was 2.7% (2 knees). scopical time and possible treatment of articular damages we have performed an incomplete proximal tibial osteotomy, and Conclusions: The bilateral sequential surgical procedure in one thanks to external unilateral fixator, a progressive emicallotasis stage is a safe option of treatment in selected patients, with with 2° overcorrection. In corrections over 7° we have per- functional results and complications similar to previous formed distal peroneal osteotomy. reports. We believe it’s important point out that the results depend in large part on the expertise of the surgeon and the RESULTS: Since 1998 we have associated arthroscopy to valgus protocolized management of these patients. tibial osteotomy in 37 patients, male 28, female 9, average age 49.4 years (min.21 max.65). The medium correction has been 8° (min.7 max.9). The origin of the medial overload has been: Poster #200 EARLY PATIENT OUTCOMES FOLLOWING PRIMARY - Previous medial total meniscectomy AND REVISION TOTAL KNEE ARTHROPLASTY: - Previous medial condylar tibial fractures A PROSPECTIVE STUDY - Osteochondral traumas Richard Hartley, Wirral, UNITED KINGDOM, Presenter - Medial condylar femoral necrosis Nicholas G Barton Hanson, Liverpool, UK - Previous arthroscopical chondral treatment without osteotomy Rose Finley, Upton, UK Richard W Parkinson, Upton, UK The osteotomy is restored in 100% of the cases, in an average Department of Orthopaedics, Arrowe Park Hospital, Upton, UNITED of 53 days (min.45 max.55). KINGDOM

Associated arthoscopical surgery has been: There has been speculation as to whether the outcome of revi- - Subtotal medial meniscectomy: 9 cases sion total knee arthroplasty (TKA) is as successful as primary - Treatment of chondral damages in medial femoral condyle: 11 TKA, this study was designed to compare the outcomes of pri- cases mary and revision TKA in order to address this question.

5.88 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). as assessed using the SF-12 and WOMAC outcome measures, Methods in primary and revision TKA. The study collected data prospectively from patients operated upon by one surgeon using one prosthesis design in each Methods group. All patients undergoing revision TKA between 1997 and 100 primary TKA and 60 revision TKA patients were prospec- 2000 were included in the study. 100 consecutive patients tively assessed using the validated SF-12 and WOMAC outcome undergoing primary TKA between 1997 and 1999 were included measures. They were assessed pre-operatively and at six and in the study. All surgery was performed by the senior author. twelve months post-operatively. All surgery was performed by a Patients completed SF-12 and WOMAC questionnaires pre- single surgeon (the senior author) using one prosthesis design operatively and at six and twelve months post-operatively. in each group. Mean scores were calculated for the different areas within both outcome measures (WOMAC pain, stiffness and function; SF- Mean scores were calculated for the different areas within both 12, physical constant score [PCS] and mental constant score outcome measures (WOMAC pain, stiffness and function; SF-12 [MCS]) The results were entered into a database and analysed - physical constant score [PCS] and mental constant score using a combination of two way and simple repeated measures [MCS]) analysis of variance (ANOVA) and t-tests. Only if the result of the ANOVA was significant were post-hoc adjusted t-tests per- The information was entered into a database and assessed for formed on the data values. any correlation between the pre-operative MCS and post-oper- ative PCS, pain, stiffness and function scores using Spearman’s Results Rank Correlation. WOMAC scores did not differ between the two groups pre-oper- atively. Both patient groups showed a significant improvement Results in WOMAC scores at six months (P<0.0005). In the primary The results reveal a significant positive correlation between group the pain and function scores improved significantly pre-operative MCS and post-operative PCS scores at six and between six and twelve months (P=0.0258 and P=0.0019 twelve months (P=0.01 and P=0.031 respectively) in the primary respectively). This was not the case in revision patients. SF-12 patients. There was no correlation in the revision patients. PCS scores were significantly better in the primary patients pre- There was a statistically significant negative correlation operatively (P<0.0005). Both groups showed a significant between pre-operative MCS and six month WOMAC pain, stiff- improvement at six months assessment (P<0.0005). Neither ness and function scores (P=0.025, P=0.019 and P=0.011 group demonstrated an improvement between six and twelve respectively) in the primary patients. There was no significant months. SF-12 MCS scores did not show any difference between correlation with twelve months WOMAC scores. There was no the two groups pre-operatively. No significant change in MCS significant correlation in terms of pre-operative MCS and six score occurred during the study in either the primary or revision months WOMAC scores in the revision patients, but there was patients. a statistically significant negative correlation between pre- operative MCS and the twelve months pain score (P=0.039). Conclusion The SF-12 and WOMAC health questionnaires are valid, reliable Conclusion and responsive outcome measures. The study has collected The SF-12 and WOMAC health questionnaires are valid, reliable data prospectively from patients operated upon by one surgeon and responsive outcome measures. The study has collected using one prosthesis design in each group. These findings sup- data prospectively from patients operated upon by one surgeon port the concept that revision TKA leads to a comparable using one prosthesis design in each group. The results of this improvement in patient perceived outcomes of physical param- study support the concept that high generic mental health eters as does primary TKA in both generic health outcome scores in patients prior to primary TKA are associated with measures and disease specific outcome measures. good physical outcomes in terms of both generic health out- POSTER ABSTRACTS come measures and disease-specific outcome measures.

Poster #201 DOES A PATIENT’S PRE-OPERATIVE MENTAL STATE Poster #202 INFLUENCE POST-OPERATIVE PHYSICAL OUTCOMES IN MEASUREMENT OF THE SOFT TISSUE TENSION IN TOTAL KNEE ARTHROPLASTY? A PROSPECTIVE STUDY. TOTAL KNEE ARTHROPLASTY Richard Hartley, Wirral, UNITED KINGDOM, Presenter Akiho Hoshino, Saitama, JAPAN, Presenter Edward V Wood, Upton, UK Hiroshi Asano, Tino, JAPAN Nicholas G Barton Hanson, Liverpool, UK Tim J. Wilton, Derby, UK Rose Finley, Upton, UK Kawaguchi Kogyo General Hospital, Kawaguchi, JAPAN Richard W Parkinson, Upton, UK Wirral Hospitals NHS Trust, Upton, UK Soft tissue balancing is the major concern in the surgical pro- cedure of TKA, however, proper value of the soft tissue tension Introduction strength has been decided by the surgeons’ hands and judged There have been many studies concerned with the outcomes of by their own experiences. Soft tissue tension in the past was total knee arthroplasty (TKA). A number of outcome predictors created by surgeons’ feeling as “just enough”. New instruments have been identified, however, no study has been published to were developped by the authors, which indicate varus/valgus date that specifically assesses the influence of patients’ pre- balancing and gap difference at both extension and flexion. operative mental state on the post-operative physical out- Also, this balancer shows absolute value of the soft tissue ten- comes of TKA. sion from the torque driver attached to the instruments. This balancer was used in 77 consecutive knee arthroplasties and Aims proper soft tissue tension for TKA was investigated. In our sur- This study aims to identify any correlation between patients’ gical procedure, proper soft tissue tension was noted as 126+/- pre-operative mental status and post-operative physical scores, 24N in extension and 121+/-23N in flexion. There was no significant correlation between soft tissue tension and postop-

5.89 erative flexion angle (ave. 117 degrees). The results suggested Methods: We searched the Cochrane Library (issue 2000-3), that the tension strength ranging from 80 to 160N (not too Current contents (1996 to July 2000), and Medline (1966 to July loose, not too tight) could achieve enough postoperative flex- 2000). Reference lists of selected articles were also included. ion angle and it might not affect the flexion angle. Articles were selected with the aid of a checklist. When content was regarded as being relevant and internal validity was accept- able, the article was selected for the review. Data was collected Poster #203 on relevant demographic data and functional outcome meas- RESTRICTING POSTOPERATIVE WEIGHTBEARING IN ures like Range of Motion, specific measures of activities with MOBILE BEARING CEMENTLESS TOTAL KNEE daily tasks, and composite knee scores such as Knee Society ARTHROPLASTY IS UNNECESSARY Score, and Hospital for Special Surgery score. Controlled stud- Yoshinori Ishii, Gyoda, JAPAN, Presenter ies were considered primary studies and cohort and cross-sec- Yoshikazu Matsuda, Gyoda, JAPAN tional studies were considered secondary studies to allow a Ishii Orthop & Rehab Clinic, Gyoda, JAPAN best evidence synthesis.

Purpose: Generally the protocol for cementless prosthesis calls Main results: No primary studies were encountered evaluating for weightbearing to be restricted for 6 weeks. The purpose of the difference in functional outcome of the two prosthesis this study is to evaluate prospectively the necessity of postop- types. Best evidence synthesis could only be performed with erative weightbearing restriction in mobile bearing cementless secondary studies. total knee arthroplasty (TKA) with respect to the occurrence of component loosening. Conclusions: We could find no evidence on the basis of best evidence synthesis for the superiority for one of the two pros- Materials and Methods: Eighty LCS (Low Contact Stress) knee thesis types with regard to ROM or functional performance of systems were analyzed. PCL-retaining (PCLR) (meniscal bear- the patients. ing type) and PCL-sacrificing (PCLS) (rotating platform type) consisted of 40 knees in 40 patients respectively. Full weight- bearing under the supervision of a therapist was allowed on the Poster #205 first postoperative day. Anteroposterior and abduction/ adduc- •REPRODUCIBILITY OF THE PEROPERATIVE tion stress view were measured at six months postoperatively MEASUREMENT OF THE TRANSEPICONDYLAR AXIS with Telos arthrometer (GmbH, Griesheim, Germany) applying DURING TOTAL KNEE REPLACEMENT BY A NON IMAGE 150 N. BASED NAVIGATION SYSTEM Jean-Yves Jenny, Illkirch, FRANCE, Presenter Results; All patients had no clinical complication and could flex Cyril Boeri, Illkirch, FRANCE minimum 90°. No patients in PCLR and PCLS showed compo- Centre de Traumatologie et d’Orthopedie, Illkirch, FRANCE nent loosening in both femur and tibia. In anteroposterior lax- ity on average, PCLR and PCLS revealed 10.8 mm and 10.0 mm INTRODUCTION : The transepicondylar axis is an accepted ref- at 30° flexion, and 9.4mm and 9.7mm at 90° flexion respectively. erence for the rotational positioning of the femoral component POSTER ABSTRACTS In abduction/ adduction laxity on average, 4° were observed of a total knee prosthesis. Navigation systems should allow a respectively in both PCLR and PCLS. higher precision of the localization of this axis. The authors studied the reproducibility of the peroperative measurement of Discussion and Conclusion; Reasonable anteroposterior laxity this axis with a non image based infrared navigation system. (approximate 10mm) to absorb the shear stress and balanced abduction/ adduction laxity (4°) to minimize micromotion MATERIAL - METHODS : The authors analyzed a consecutive between the implant and bone might contribute to the result. series of 20 total knee prostheses (SEARCH® prosthesis, The result suggests that postoperative restriction of weight- Aesculap, Tuttlingen, FRG) implanted by the same surgical bearing may not be necessary in mobile bearing cementless team of two senior orthopaedic surgeons. They used the TKA, thereby decreasing hospital stay and costs as well as ORTHOPILOT® non image based navigation system (Aesculap, cemented TKA. Tuttlingen, FRG), which allows to define with a kinematic analy- sis the mechanical axes of the femur and the tibia, and to track relevant anatomical points with a stylus. The mechanical femur Poster #204 axis was defined first by tracking the respective movements of POST-OPERATIVE FUNCTIONAL STATUS OF MOBILE the pelvis, the femur and the tibia and calculation of the cen- BEARING AND FIXED BEARING TOTAL KNEE ters of rotation of the hip and knee joints. The coronal reference ARTHROPLASTY IN PATIENTS WITH OSTEOARTHRITIS plane was defined by palpation with the stylus of the most pos- AND RHEUMATOID ARTHRITIS (COCHRANE REVIEW) terior point of both femoral condyles : this plane included the Wilco Jacobs, Nijmegen, THE NETHERLANDS, Presenter mechanical axis of the femur and was parallel to the posterior Ate Wymenga, Nijmegen, THE NETHERLANDS bicondylar femoral line. The highest point of both medial and Sint Maartenskliniek, Nijmegen, THE NETHERLANDS lateral epicondyles was then palpated with the stylus. These two points defined the transepicondylar plane, which was par- Background: The polyethylene insert in total knee arthroplasty allel to the mechanical femur axis. The angle between the ref- can be fixed to the tibial plateau or it can have freedom of rota- erence plane and the transepicondylar plane was directly tion and/or translation. It is not yet clear what the differences calculated by the dedicated software. Three measurements of are in functional results between the two prosthesis types. the transepicondylar plane were done during the same proce- dure by each surgeon, without changing the reference plane. Objectives: To assess if a mobile bearing total knee prosthesis The intra- and inter-observer variations of the localization of provides a better range of motion (ROM) and a better func- the transepicondylar axis were studied with a paired Wilcoxon tional outcome than a fixed bearing prosthesis in patients with t-test and a Spearman correlation test with a 0.05 level of sig- rheumatoid arthritis and osteoarthritis after total knee arthro- nificance. plasty.

5.90 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). RESULTS : The mean intra-observer variation of the localization arthroscopy should be done at first for all of the osteoarthritis of the transepicondylar axis was 4° in comparison to the refer- patients, even serious patients. ence axis, with a maximum of 11° for the first surgeon and 9° for the second one, in either internal or external rotation. The mean inter-observer variation of the localization of the Poster #207 transepicondylar axis was 4° in comparison to the reference ANALYSIS OF INITIAL FIXATION STRENGTH OF PRESS- axis, with a maximum of 14°, in either internal or external rota- FIT FIXATION TECHNIQUE IN ANTERIOR CRUCIATE tion. There were significant differences in both intra- and inter- LIGAMENT RECONSTRUCTION observer measurements. Hyunchul Jo, Seoul, KOREA, Presenter Myung Chul Lee, Seoul, KOREA CONCLUSION : The peroperative measurement of the localiza- Sang Cheol Seong, Seoul, KOREA tion of the transepicondylar axis involves a high intra- and Department of Orthopedic Surgery, Seoul National U, Seoul, KOREA inter-observer variation, with mean values about 5° and maxi- mum value over 10°. This variation can be explained by the Purpose: We performed a controlled laboratory study to evalu- anatomical, smooth shape of both femoral epicondyles. The ate the initial fixation strength of press-fit technique. exact influence of this variation on the clinical, functional and long-term outcomes after total knee prosthesis has to be stud- Methods: Fifty porcine lower limbs were used and divided into ied. 5 groups according to the method of fixation and the diameter difference between the bone plug and the femoral tunnel in cases of press-fit fixation; group 1, 2, 5 were press-fit fixation Poster #206 group with diameter difference 1.0mm, 1.4mm, and 1.4mm, ARTHROSCOPY OR TOTAL KNEE REPLACEMENT FOR respectively; group 3, titanium interference fixation; group 4, OLD PATIENTS WITH SERIOUS OSTEOARTHRITIS, OUR bioabsorbable interference fixation. The grafts in the press-fit EXPERIENCE group were harvested with a hollow oscillating saw with inner Yu Jiakuo, Beijing, CHINA, Presenter diameter of 9.4 mm to obtain a consistent and complete circu- Institute of Sports Medicine of Beijing University, Beijing, CHINA lar shape. The diameter of the femoral tunnel was 8 mm. The specimens underwent 250 loading cycles between 0-2 mm of Now the number of total knee replacement operation is displacement. Thereafter, the specimens were loaded to failure. increasing year by year, the composing of patients is also changing. During early period, most of the patients for total Results: The average ultimate failure loads of the group 2 knee replacement suffered from rheumatoid arthritis, now it (press-fit+1.4mm) and group 5 (press-fit+1.4mm & 30 degrees) has been changed into osteoarthritis. Is it necessary to do were 571.40 N and 605.40 N, respectively, which were not sig- arthroscopy before total knee replacement? Our research told nificantly different from those of the group 3 (titanium interfer- us we should do arthroscopy at first for 85% percent of serious ence screw), 691.10 N and group 4 (bioabsorbable interference osteoarthritis. screw), 707.40 N, respectively.

Material and Method: Conclusion: The complete circular shape and increased diame- From 1985-2001, 85 patients included 90 knees with serious ter difference between the bone plug and the femoral tunnel osteoarthritis were treated with arthroscopy. Male 31, female seemed to contribute to the stronger fixation. 54. Age: 56.6?.18 years old. Mean follow up time 4 years. During operation, Cartilage debridement, synovial membrane shaving, taking out of lose bodies and cartilage fragments, partial and Poster #208 total meniscectomy and subchondral bone decompression for DRILLING FROM THE INTERCONDYLAR AREA FOR patellar, femur and tibia plateau has been used to different TREATMENT OF OSTEOCHONDRITIS DISSECANS OF THE POSTER ABSTRACTS patients. All of the operations has been done by one surgeon. KNEE JOINT Knee Society Clinical Rating System and Lysholm score was Kenzo Kawasaki, Izumo, JAPAN, Presenter used. Mitsuo Ochi, Izumo-shi, JAPAN Yuji Uchio, Izumo, JAPAN Result: Nobuo Adachi, Izumo, JAPAN 1. Knee Society Clinical Rating System result: Knee pathology Junji Iwasa, Izumo, JAPAN score before operation19.61?.96, post operation 41.12 ?.17, Shimane Medical University, Izumo, JAPAN p=0.0000. Knee function score before operation 44.38?.30, post operation 69.69 ?.17, p=0.0000. Total score pre-operation: Purpose: To demonstrate a new method in which drilling is 64.5?.26, post-operation: 110.80?.73. p=0.0000. made from the intercondylar space and its efficacy in treating 2.Comparing Lysholm score pre- and post- operation, osteochondritis dissecans (OCD) of the knee in skeletally p=0.0000. immature patients with relatively stable lesions with an intact 3. According to the Knee Society Clinical Rating System and articular surface in cases where there was failure of initial non- Lysholm, excellent, good, improvement and fail clinical results operative management. Methods: The lesions of 16 knees of 12 were as: excellent 53.13%, good 31.25%, improvement 9.37% patients with OCD of the femoral condyles failed to heal by con- and fail 6.25%. servative treatment for more than 3 months (average 5.6 months) and thereafter were arthroscopically treated with Conclusion: drilling from not transarticular but intercondylar bare area with- Considering the result of 3-6 years follow up, 85% arthroscopy out damaging articular surface. Eight lesions involved the results has excellent and good result, only 15% with improve- medial femoral condyle, and 8 involved the lateral femoral ment and fail result. Attention should be paid that before oper- condyle. The average follow-up was 16 months. Results: All ation the total Knee Society Clinical Rating System score was lesions healed after drilling, and the average time of healing only 64.5. No relationship between pathology degree, varus and was 4 months by x-p and 7 months by MRI. The average valgus degree and clinical result was found. It was suggested Lysholm score improved from an average of 70.4 points at pre- operation to an average of 97.8 points after operation. The

5.91 results of the Hughston Rating Scale were similar: 10 of the 12 Purpose: To introduce a method for revision total knee arthro- patients showed excellent results and the remaining 2 patients plasty (Re-TKA) with the concept of the balanced placement of good results. Conclusion: We advocate our new and less inva- the femoral component. sive procedure of drilling from the bare area of the intercondy- lar space for OCD without damaging the articular cartilage in Surgical technique & subjects: The first step consists of releas- the knee joint of skeletally immature patients who have had ing soft-tissue and cutting the proximal tibia. The second step failure of initial nonoperative management. involves the decision of the femoral component rotation refer- ring to the joint gap in 90 degrees of flexion. The third step involves the decision of the joint line referring to the joint gap Poster #209 in 0 and 90 degrees of flexion. Finally, tibial and femoral com- STANDARDISED MORTALITY RATIOS AND FATAL ponents are placed with or without stems and augmented PULMONARY EMBOLISM RATES FOLLOWING blocks. Since 1998, we have performed Re-TKA using this tech- PRIMARY TOTAL KNEE ARTHROPLASTY – nique on 20 knees. Thirteen knees were followed more than 2 A COHORT OF 1018 CONSECUTIVE CASES. years. There were 3 men and 10 women with an average age of Amer Khan, London, UNITED KINGDOM, Presenter 73 years. The average follow-up was 30 months. Jonathan Emberson, London, UNITED KINGDOM George S E Dowd, Herts, UNITED KINGDOM Results and conclusion: All patients using this technique had The Royal Free Hospital, London, UNITED KINGDOM excellent results at the time of follow-up. Re-TKA contains dif- ficult problems such as bone defects and soft tissue scaring. AIM Therefore, common soft-tissue balancing after independent-cut To determine retrospectively the post-operative mortality and technique is not fit for Re-TKA. Furthermore, the decision of the fatal pulmonary embolism (PE) rates in 1018 consecutive pri- properly rotating of the femoral component and the properly mary total knee replacements (TKR) in the three month period joint line is very hard comparing to primary TKA. This technique after surgery where chemical thromboprophylaxis was not rou- of the balanced placement of the femoral component is very tinely used. simple and essential to create better clinical results in Re-TKA.

METHODS Operations were performed over a period of twelve years by Poster #211 eight different senior orthopaedic surgeons on 280 men and A THREE DIMENSIONAL EVALUATION FOR POSITIONING 566 women. One hundred and seventy-two patients had bilat- OF TOTAL KNEE ARTHROPLASTY AND ITS APPLICATION eral TKRs and the mean age at the time of operation for men FOR OSTEOTOMY CONTROL BY THE SYSTEM OF THE and women was similar (69.4 and 72.2 years respectively). THREE DIMENSIONAL LEG ALIGNMENT ASSESSMENT Patients were traced by out-patient appointments, telephone WITH DIGITAL X-RAY and through their general practitioners (GPs). Post-mortem Yoshio Koga, Niigata City, JAPAN, Presenter examinations were used to verify the cause of death in all save Go Omori, Niigata City, JAPAN three of the cases. All but one of the patients were followed-up. Katsutoshi Nishino, Niigata, JAPAN POSTER ABSTRACTS Niigata Kobari Hospital, Niigata, JAPAN RESULTS At post-mortem examination there were no deaths from PE. Objectives: By three dimensional leg alignment assessment Since three patients were certified dead without post-mortem system, a computer assisted Total Knee Arthroplasy can be con- examination and one patient could not be traced this meant trolled by routine X-ray with digital X-ray system. The method that, at worst, our fatal PE rate was 0.39% (4/1018; CI 0.13% - and its accuracy are presented. 1.08%). However we suspect our fatal PE rate to be 0.2% (2/1018; 0.03% - 0.79%).At worst the all-cause mortality rate was Background: We developed the system of three-dimensional leg 0.69% (7/1018; CI 0.3% - 1.48%). The patient mortality was com- alignment assessment using biplanar (simultaneous, AP and pared with the population mortality for England and Wales 60-degrees oblique) computed radiography (Fuji Film Co., using standardised mortality ratios (SMRs). The SMR for both Japan) in standing position. The anatomical coordinates sys- sexes combined was 0.74 (CI 0.29 - 1.52). We observed a lower tem which is determined by the reference points (femoral side: mortality in females SMR = 0.67 and males SMR = 0.84 during femoral head and bilateral posterior condyles of femur as a the first three post-operative months than compared to the spherical shape, tibial side : proximal and distal joint surface general population. and line of mid-points of tibia and fibula shaft) is established in biplanar X-ray image by fitting technique with the computed CONCLUSION tomography model. After this fitting the anatomical coordi- Fatal pulmonary embolism after total knee replacement with- nates can be re-established. in any 0-90 degrees biplanar X-ray out routine chemical thromboprophylaxis is uncommon. The projection with more than a half length of femur and tibia. overall death rate in patients undergoing total knee replace- ment in our series appears to be lower than that in the general Design/Methods: By this system and the projection matrix of population. the component, a three dimensional image of the component can be introduced to the biplanar X ray image. After the fitting of the shadow of the components to the femoral and tibial joint Poster #210 geometry, a suitable size and a three dimensional position BALANCED PLACEMENT OF THE FEMORAL COMPONENT assessment of component to anatomical coordinates system IN REVISION TOTAL KNEE ARTHROPLASTY can be evaluated in the personal computer (Pre-operarive plan- Katsuhiko Kitaoka, Kanazawa, JAPAN, Presenter ning). For the intra-operative registration, by use of this system, Kensaku Hashiba, Kanazawa, JAPAN the osteotomy can be controlled with digital X-ray which is Ryuichi Nakamura, Kanazawa, JAPAN taken in order to fit the intraoperative X-ray image to the image Orthopaedic Surgery, Kanazawa Univ., Kanazawa, JAPAN data of pre-operative planning. The position of the image of the X-ray maker connected to the intra-medullary rod in the coor- dinates system is also determined. The osteotomy levels of the

5.92 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). pre-operative planning related to X-ray marker of the intra- 4. Tibiofemoral angle was corrected from preoperative average medullary rod is calculated, and the special osteotomy jigs that 5.7° varus to post-operative average 6.9° valgus. consisted of a small rod connected by universal joint (a central 5. α, β, γ, δ and ε angles in postoperative radiologic assessment point of the joint is the same as the poison of a central point of were respectively 97.3°, 89.6°, 7.0°, 6.3° and 85.8°. X-ray marker) are attached to the inramedullary rod. The direc- tion and distance of the small rod is set to control flexion, < Conclusion > abduction, rotation, and anterior and proximal translation of There was statistical significance(P<0.05) in postoperative knee the osteotomy surface. Post-operative evaluation of three rating scale and functional score in all case compared to pre- dimensional positioning of the components can be assessed by operative states. In comparing the subgroups of limitation of biplanar X-ray with the same technique as the pre-operative motion, there was statistical significance(P<0.05) of functional planning. scale in group III which had more severe limitation of motion. The more preoperative limitation of motion, the more increas- Results: A three dimensional positioning of component can be ing in functional scores at last follow up. If appropriate tech- determined within 1 degrees or 1 mm variation. Osteotomies of nique of maintaining adequate balance in the deformed knee total knee replacement can be controlled within 5 minutes with the preoperative motion limitation and soft tissue defor- within 1 degree and 1 mm accuracy. mity can make good clinical results and solve the problems of deformity and motion limitation. Conclusions: This computer assisted surgery can be performed in any hospital by a routine X-ray in shorter time by assessment of three dimensional leg alignment assessment to detect the Poster #213 anatomical coordinates system. LIMITATIONS OF THE MODEMS KNEE CORE INSTRUMENT IN DETECTING IMPROVEMENT FOLLOWING TOTAL KNEE ARTHROPLASTY Poster #212 Edward C. Jones, New York, NY, USA RESULT OF POSTERIOR CRUCIATE RETAINING TOTAL Robert G Marx, New York, NY, USA, Presenter KNEE ARTHROPLASTY Nawal Atwan, New York, NY, USA Dong Chul Lee, Taegu, SOUTH KOREA, Presenter Margaret G. E. Peterson, New York, NY, USA Wook Jin Shon, Taegu, KOREA Eduardo A. Salvati, New York, NY, USA Byung Won Park, Taegu, KOREA Thomas P. Sculco, New York, NY, USA Yeung Nam University Hospital, Taegu, KOREA Hospital for Special Surgery, New York, NY, USA

< Purpose > Introduction: The posterior cruciate ligament retaining design in the total The use of patient-derived outcome scales to measure knee arthroplasty had a good clinical results in the long term improvement following orthopaedic surgery has gained impor- follow up and its results can be affected by the preoperative tance in the last decade. A MODEMS Knee Core instrument was deformity, degree of limitation of motion and flexion contrac- developed by the American Academy of Orthopedic Surgeons ture. The purpose of study was to evaluate clinical result of pos- to measure improvement following treatments for disorders of terior cruciate retaining TKA (PRTKA) according to the degree of the knee. The goal of this study was to evaluate the ability of deformity and range of motion. this instrument to measure early functional recovery at six months after total knee arthroplasty. < Materials and Method > From January 1993 to March 1999, seventy-seven cases in 46 Methods: patients were followed up more than 3 years. Average follow up Prior to total knee arthroplasty, 266 knee patients completed period was 44 months and average age was 68 year old. They the MODEMS Knee Core instrument and the SF-36 General POSTER ABSTRACTS were divided to three groups according to degree of varus Health Scale. They also completed these questionnaires at six deformity (group I: ≤5 group II: 6~10 group III: ≥11, and degree months following surgery. Sixty-two percent of the patients of range of motion (groupI: ≤90 group II: 90~110 groupIII: ≥110. were female and the age range was 28 to 90 years with a mean The clinical results according to the presence of flexion con- age of 70 years. The ability of these tools to measure improve- tracture were evaluated. Evaluation systems were used with ment was assessed with the standardized response mean. Hospital for special surgery criteria and radiographic evaluation of American knee society for radiologic assessment Results: The MODEMS Knee instrument did not detect increased < Result > improvement for the patients when compared to the SF-36 PCS 1. Knee rating scales of HSS in group I, II, III according to degree (standardized response means : 1.50 for MODEMS Knee Core, of preoperative deformity were improved from preoperative 1.51 for PCS of the SF-36 and 1.21 for MCS of SF-36). The mean average 40.8, 30.7, and 18.0 to postoperative average 73.2, 81.0, baseline scores were as follows: Knee score 58.32±15.72; SF-36 and 90.0 and functional scores were improved from preopera- PCS 29.92±8.24. The mean six month post-operative scores tive average 40.8, 30.7 and 18.0 to postoperative average 73.2, were: Knee score 79.91±15.22; SF-36 PCS 41.71±10.79. At six 81.0, and 90.0. months post-op, nine percent of the knee replacement patients 2. Range of motion in group I, II, III according to ROM were were rated at 100 points on the MODEMS Knee Core instru- improved from preoperative average 81.9°, 100.8°, and 121.7°, ment and nineteen percent scored 95 points or greater at six to postoperative average 99°, 109°, and 117°, and knee rating months. scales were improved from preoperative average 24.0, 41.0 and 49.0 to postoperative average 84.3, 86.1, and 85.8. Conclusion: 3. The changes of flexion contracture in group I (absence of The MODEMS Knee Core instrument exhibits a significant ceil- knee contracture) and group II (presence of knee contracture) ing effect and has a limited capacity to detect a wide range of were changed from preoperative 0° and 13° to 0.5° and 1.1° and improvement following total knee replacement at six months knee rating scale were improved from preoperative average 45.0 post-operatively. and 31.0° to postoperative 86.6 and 84.6°.

5.93 These results showed that the effect of HA injections were Poster #214 maintained for one week in group 1, however, those in group 2 •THE ROLE OF LONG-TERM WEEKLY INTRA-ARTICULAR were not maintained. From these results, it was thought that INJECTIONS OF SODIUM HYALURONATE FOR weekly intra-articular HA injections are effective for patients OSTEOARTHRITIS OF THE KNEE with moderate OA. However, patients with severe OA need Shin Miyatake, Kagawa, JAPAN, Presenter shorter interval intra-articular HA injections. HA has lubricat- Naohito Hibino, Mitoyo, JAPAN ing, anti-inflammatory and analgesic effects, and the half-life of Kiminori Yukata, Mitoyo, JAPAN extrinsic HA has been reported to be 10 to 20 hours. In this Akihiro Nagamachi, Mitoyo, JAPAN study, the minimum VAS was observed 2.7 days after injection Toru Endo, Mitoyo, JAPAN on average in group 1 and 1.1 days in group 2. This result indi- Mitoyo General Hospital, Mitoyo, JAPAN cates that volume decrease of extrinsic HA aggravated symp- toms more directly in patients with severe OA. It was thought Introduction that a larger volume of HA is necessary to manage patients with Some clinical studies demonstrated that five weekly intra-artic- severe OA. ular injections of sodium hyaluronic acid (HA) were superior to placebos and well tolerated in patients with moderate Conclusion osteoarthritis (OA) of the knee. The mid-term effects of this Long-term weekly intra-articular HA injections are effective for therapy for moderate OA of the knee have been reported to be patients with moderate OA. However, patients with severe OA favorable. In Japan, it is not rare to continue intra-articular need shorter interval or larger volume intra-articular HA injec- injections of HA for six weeks or more to treat moderate and tions. severe OA patients who decide against surgery. At our hospital, approximate 70% of the patients who were injected with HA continued to undergo injections for six months or more. Poster #215 However, it is unclear whether long-term weekly intra-articular THE UNIX UNICOMPARTMENTAL KNEE ARTHROPLASTY HA injection is effective for patients with OA of the knee. The Hayden Morris, East Melbourne, AUSTRALIA, Presenter purpose of this prospective study was to evaluate the effects of Ismail Zulkharnain, Kuala Lumpur, MALAYSIA long-term weekly intra-articular injections of HA for patients Mercy Private Hospital, Melbourne, AUSTRALIA with OA of the knee. Unicompartmental knee replacement, although controversial, Materials and Method has become more popular in recent years. Debate continues Twenty-three patients who underwent weekly intra-articular HA with regards to long term results, minimally invasive tech- injections for six months or more participated in this study. The niques, cemented or press fit prostheses and mobile or fixed average age was 73.2 years (range 50 to 82 years). Patients bearing articulations. The Unix unicompartmental knee pros- treated with steroids or topical anesthetics were excluded. thesis is a unique design comprising a press fit femoral com- ponent, a tibial base plate with ‘horizontal keel’ and screw Patients were divided into two groups according to the grading fixation. The components are hydroxyapatite coated. The POSTER ABSTRACTS system of Kellgren and Lawrence (grade I-IV); group 1: grade I authors experience using this prosthesis is presented. and II (n=11), group 2: grade III and IV (n=12). One hundred mm visual analog scale (VAS) was used to evaluate the effects of 18 patients with 19 knees were studied consecutively. Followup intra-articular HA injections for knee pain. VAS of patients were 2-5 years. 10 males, 9 females. Age 34-83 years. Medial 16, lat- recorded prior to administration, at 20:00 on the day of injec- eral 3 knees. Surgical technique was with a ‘medium invasive’ tion and every night for one week. We selected the following technique. A medial parapatellar approach without patellar four points. They were VAS prior to administration, VAS at 20:00 eversion. Femoral jigs allow accurate alignment and cutting. on the day of injection, minimum VAS value and VAS of the final day. The changes of VAS in both groups were evaluated. Followup was 100%. The average Knee Society Score was 94.1 at Statistical analysis was performed using one-way ANOVA and followup. 11 of 18 patients scored 100. There were no failures. Fisher’s PLSD for post hoc test. For all statistical analyses, the Survival was 100% Radiologically, reactive lines tibia zone I, II, P<0.05 level of significance was used. III in 1 patient, zone I and III in 1 patient.

Results These early results for unicompartmental knee replacement In group 1, average VAS decreased from 52 mm prior to admin- using the Unix prsothesis in the authors hands are encouraging istration to 38 mm at 20:00 on the day of injection. The average and confirm Epinette’s excellent results reported at 10 year fol- minimum VAS was 28 mm and was observed at 2.7 days after lowup. New minimally invasive surgical techniques have further HA injection on average. On the final day, average VAS was 31 improved early results. mm. There were statistically significant differences between the average VAS prior to administration and the average minimum VAS and between the average VAS prior to administration and Poster #216 VAS of the final day. In group 2, average VAS decreased from 49 DOES PAIN SEVERITY CORRELATE WITH BONE MARROW mm prior to administration to 37 mm at 20:00 on the day of LESION PATTERN DETECTED WITH MR IMAGING IN injection. The average minimum VAS was 28 mm and was KNEE OSTEOARTHRITIS? observed at 1.1 days after HA injection on average. On the final Yoshihiro Nagaosa, Fukushima City, JAPAN, Presenter day, average VAS was 36 mm. There was a significant difference Shin-ichi Kikuchi, Fukushima City, JAPAN between the average VAS prior to administration and the aver- Hironori Numazaki, Fukushima City, JAPAN age minimum VAS, however, significant difference between the Yasunobu Konnai, Fukushima City, JAPAN average VAS prior to administration and VAS of the final day Fukushima Medical University of Medicine, Fukushima City, JAPAN was not observed. Bone marrow lesion (BML) is frequently noted in knee Discussion osteoarthritis (OA). Pain-related nerve fibers are abundant in subchondral bone of OA. The hypothesis is that BML is associ-

5.94 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). ated with pain in knee OA. To investigate this hypothesis, 58 a broken MCT can lead to lateral displacement of the distal tib- patients with symptomatic knee OA, fulfilling the ACR criteria, ial segment and early revarisation. Roentgen Stereometric were enrolled in the study. MR imaging of the knee was per- Analysis (RSA) studies on HTO patients with an intact MCT formed in all patients. On MR imaging, T1-, T2-weithed, proton- show persisting translations between the tibial segments when density fast spin-echo and STIR sequences were used. A single COVENTRY staples were used. In this study, serial RSA was observer who classified the size of BML into 3 grades and who used to determine the in vivo stability of rigid internal fixation detected subchondral bone cyst and low intensity lesion sug- after HTO over time in patients with varying degree of varus gesting abnormal trabeculae performed a retrospective review. malalignment and correction. Severity of knee pain was evaluated with the English version of WOMAC pain subscale. BML on MRI was noted in 43 patients Methods: (74%) with knee OA: localized type 55%; intermediate type 24%; Fifteen patients with varus gonarthrosis stage I-III (AHLBACK) wide type 21%. Pain score was not associated with BML size, were treated with HTO and internal fixation with an L-shaped the presence of bone cyst, or low intensity lesions. On the other rigid plate. Patients were followed by serial RSA, conventional hand, varus malalignment on the radiograph was significantly radiographs and clinical evaluation over a 12 months period. correlated with BML size in a group of varus knee OA (p<0.01). In conclusion BML of knee OA was not associated with pain Results: severity whereas it strongly associated with radiographic varus In 9 of 15 succeeding patients, the MCT could be preserved dur- malalignment. ing surgery (group 1). The average wedge size was 7.1° in this group. In 6 of 15 of patients, the MCT was unintentionally fis- sured intraoperatively either during approximation of the tibial Poster #217 segments or during internal fixation. In these patients, an aver- THE RESULT OF OSTEOCHONDRAL GRAFT AND HIGH age 10.7° wedge was resected (group 2). In group 2, RSA TIBIAL OSTEOTOMY IN THE OSTEONECROSIS OF revealed a 1.3 mm increase in lateral displacement of the distal MEDIAL FEMORAL CONDYLE in relation to the proximal tibial fragment within three weeks Yasuaki Nakagawa, Kyoto, JAPAN, Presenter after surgery. Between six to twelve weeks after HTO, RSA data Takashi Suzuki, Kyoto, JAPAN were comparable between both groups and the translations Yoshitaka Matsusue, Otsu, JAPAN between tibial segments were below the accuracy of the RSA Takashi Nakamura, Kyoto, JAPAN set-up. Department of Orthopaedic Surgery, Faculty of Medi, Kyoto, JAPAN Conclusion: [Purpose] Mosaicplasty is also indicated to the osteochondral Resecting larger wedge sizes (≥ 10°) was frequently followed by defect. We reported 6 cases performed osteochondral graft and a fissure of the MCT leading to an early lateral displacement of high tibial osteotomy in the osteonecrosis of medial femoral the distal tibial segment after HTO. A rigid plate fixation could condyle. [Materials and Methods] We experienced 6 cases 6 not prevent a loss of correction in cases with a fissure of the knees from 1998 to 2001 in our hospital. Two men and 4 women, MCT. Six weeks after surgery, the osteotomy was stable accord- 2 right knees and 4 left ones, and the mean operative age was ing to RSA and weight bearing was allowed without a further 62-years-old. According to the Koshino classification, stage 3 loss of correction. was 3 cases and stage 4 was 3 ones. The mean follow-up period was 19 months. We evaluated the area of osteochondral defect, the number of implanted plugs, femorotibial angle, IKDC eval- Poster #219 uation form and range of motion. [Results] The mean area was IS POLYETHYLENE WEAR A PROBLEM IN TOTAL KNEE 404 mm2, and the mean number of plugs was 3.2. The mean ARTHROPLASTY? A REVIEW AT 12 YEARS FOLLOW UP. osteotomy angle was 11.7 degrees, and the mean femorotibial 113 CASES. angle changed from 180.5 degrees to 168.7 degrees. In the pre- POSTER ABSTRACTS operative IKDC, all cases were abnormal, and 4 cases were nor- Philippe Piriou, Garches, FRANCE, Presenter mal and 2 cases were nearly normal in follow-up IKDC. All cases Thierry Judet, Paris, FRANCE except one could sit straight. [Discussion] Soucacos recom- Hopital Raymond PoincarÈ, Garches, FRANCE mended total knee arthroplasty in such cases as ours. However, the patients who were performed total knee arthroplasty could Premature wear and osteolysis in TKA, is a frequent problem in not sit straight. In our operative technique, almost cases could literature. The authors use the HLS Total Knee Arthroplasty sit straight. [Conclusion] The result of osteochondral graft and (TKA) (Ste TORNIER) since year 1985. The results of 113 TKA high tibial osteotomy in the osteonecrosis of medial femoral implanted between 1985 and 1989 are presented here. 4 condyle was good, especially in the range of motion. patients are lost of follow-up. 41 died. 2 prosthesis were removed (1 for infection and 1 for mechanical failure because of malalignment). Poster #218 •LOSS OF CORRECTION FOLLOWING Mean follow up is 12 years and maximum 16 years. HIGH TIBIAL OSTEOTOMY Dietrich Pape, Homburg/Saar, GERMANY, Presenter Survival analyse of this serial using Kaplan meier method is Frank Adam, Homburg/Saar, GERMANY 98% at 16 years with a confidence interval at 95% using green- Dieter M Kohn, Homburg-Saar, GERMANY wood formula equal to [92%, 99%]. Department of Orthopaedic Surgery, University of S, Homburg/Saar, GERMANY We studied the wear looking at front standing X-rays. We found Background: 8 cases of wear (4 lateral side, 4 on medial side), all related to In high tibial closing wedge osteotomies (HTO), closure of an slight malalignement. Wear appeared at 10 years, with no clin- osteotomy gap after resection of a bony wedge can be associ- ical signs at 12 years of follow-up. Carreful examination of X- ated with a fissure of the medial cortex of the tibial head (MCT). rays showed no sign of osteolysis except decalcification of the Clinically, the integrity of the MCT is crucial for the mainte- medial femoral condyle. nance of correction during the healing period. Biomechanically,

5.95 We did no revision for wear or osteolysis. All tibial plateau had difference between the score of patients older and patients a minimal thickness of 10 mm. There is a correlation between younger than 65 years of age. wear and femoro-tibial alignement. Conclusions: Because this type of prosthesis preserves a maxi- In conclusion, our experience with the postero-stabilized TKA, mum of bone stock and is revised to a total prosthesis without HLS, wear was not a problem at all. much difficulty it is the first choice prosthesis for medial uni- compartmental osteoarthritis in the relatively young patient. In the light of other, very scarce long-term follow-up series, and Poster #220 compared to follow-up of total knee prostheses, the revision PRIMARY TOTAL CONDYLAR ARTHROPLASTY OF THE rate is high. Therefore, in spite of the very good and lasting HSS KNEE • PFC ND PFC SIGMA KNEE score in this group, this prosthesis is not the first choice in the Zoran Zdravko Popovic, Belgrade, YUGOSLAVIA, Presenter elderly. Dragan Nikoli, Belgrade, YUGOSLAVIA Milimir Kosutic, YUGOSLAVIA Jovo Rajovic, YUGOSLAVIA Poster #222 Military Medical Academy, Belgrade, YUGOSLAVIA MEASUREMENT OF THE VALGUS ANGLE OF THE FEMUR ON COMPUTERISED AXIAL TOMOGRAPHY SCANS At the department for orthopaedics and traumatology of Arvind Rawal, Bolton, UNITED KINGDOM, Presenter Military Medical Academy in Belgrade, Yugoslavia, from K R Ratnam, Macclesfield, UNITED KINGDOM 01.01.1998.year till 31.12.2001.year it was performed 137 total- Graham W Keys, Macclesfield, UNITED KINGDOM condylar arthroplasties of the knee on 100 patients. At 37 (37%) Graham J Kemp, Liverpool, UNITED KINGDOM of patients the surgery was done bilaterally in one procedure. Macclesfield General Hospital, Macclesfield, UNITED KINGDOM There were 33 (33%) of male and 67 (67%) of female patients. Average age was 67 years (from 20-78). Average period of follow Purpose up was 1,5 years (from 6 months to 2 years). The frequency of The aim of knee replacement surgery is to restore physiological deep infection in this period was 9 (6,56%) at 8 (5,83%) patients. alignment. For reasons of radiation safety and cost most sur- At 8 (5,83%) of those patients infection happened in second geons simply cut the distal femur at 5° valgus angle. However, half of year 2000 and 1 (0,72%) during 2001. There is possibility this is specific to an individual, and the replaced knee should that such a frequency of infection in this particular period was reproduce that angle. We set out to evaluate the accuracy and caused by technical insufficiency in preparation for performing reproducibility of measuring the valgus angle on a preoperative of surgeries. At 6 (4,3%) of infected patients the procedure of CT scannogram, and to ask whether this permits restoration of bilateral totalcondylar arthroplasty performed at once. In one individual knee alignment postoperatively. case, with patient who was in dialyse, both endoprosthesis implanted in at once caused the infection. It is all about Subjects & Methods orthopaedics – surgical procedure that requires excellent tech- Preoperative CT scannograms were performed on 94 patients nical conditions for its performance, right choice of total condy- (188 knees) for measurement of valgus angle. The anatomical POSTER ABSTRACTS lar endoprosthesis of knee and competent surgical team. and mechanical axes were drawn and the angle subtended by these axes at intercondylar notch gave the Hip Knee Shaft (HKS) or valgus angle for the femur. This angle was transferred Poster #221 onto the femoral jig system in order to perform the distal cut. THE OXFORD UNICOMPARTMENTAL KNEE PROSTHESIS: Two persons measured this angle to analyse intra- and inter- AN INDEPENDENT 10-YEAR FOLLOW-UP. observer variation. Twenty sets of pre- and post-operative Nicole Pouliart, Antwerp, BELGIUM, Presenter scannograms were used to validate the practice of making the Van Isacker Tom, Brussels, BELGIUM distal femoral cut based on HKS angle. Cottenie Dominique, Gent, BELGIUM Vorlat Peter, Brussels, BELGIUM Results Verdonk Rene, Gent, BELGIUM The overall standard deviation of intra-observer variation was Handelberg Frank, Brussels, BELGIUM 0.40°, while the coefficient of determination (R2) was 0.86; for Casteleyn Pierre-Paul, Brussels, BELGIUM inter-observer variation the coefficient of determination (R2) Gent University Hospital/University Hospital VUB, Gent/Brussels, BELGIUM was 0.83. Thus reproducibility was good. The pre- and the post- operative HKS angles were not significantly different (P = 0.2 by Purpose: To assess the long-term results of the Oxford unicom- paired t-test). Thus the physiological knee alignment was partmental knee prosthesis for unicompartmental osteoarthri- restored. tis and to discuss these results in comparison to other, scarce, long-term follow-up data. Conclusion Measurement of the knee axes on the CT scannogram is safe, Methods: Sixty-five medial and 6 lateral prostheses were placed feasible and permits accurate realignment of the knee, thus in 67 patients. After an average of 10 years, they were evaluated minimising prosthetic failure. with the Hospital for Special Surgery (HSS) knee score.

Results: Eight prostheses were lost to follow-up. Fifteen Poster #223 patients passed away after a mean of 7 years, all of them with CORRELATING THE OUTCOME OF KNEE their prostheses in place. Ten (16%) revisions were noted: in 4 INTRAARTICULAR VISCO-SUPPLEMENTATION WITH cases (6%) this was associated with an initially poor operative RADIOLOGICAL CHANGES OF OSTEOARTHRITIS indication or a postoperative malalignment. The mean HSS Pidikiti S Prasad, Liverpool, UNITED KINGDOM score in 35 medial and 3 lateral prostheses was 164 (79% excel- D Teanby, Prescot, UNITED KINGDOM lent or good, 10.5% moderate and 10.5% poor results) com- E M Toh, Liverpool, UNITED KINGDOM pared to 168 at 4.5-years of follow-up. There is no significant Arvind Rawal, Bolton, UNITED KINGDOM, Presenter

5.96 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Department of Orthopaedic and Trauma Surgery, Whis, Prescot, UNITED KINGDOM Results The group injected with hyluronan was noted to have a better Purpose: outcome compared to the group injected with hylan in all cate- This study was designed to correlate the radiological changes gories measured. However this result lacked absolute statisti- of the knee with a favorable outcome when treated with an cal significance due to the small number of patients involved in intraarticular knee viscoelastic supplementation. the study.

Material and Methods Conclusion A prospective cohort of 60 patients receiving a standard course We conclude that the efficacy of action may be more signifi- of intraarticular knee viscoelastic supplementation with a com- cantly related to the biochemical property of hyaluronic acid mercial uncrosslinked hyaluronic acid derivative of an interme- derivatives compared to its molecular weight. We also postu- diate molecular weight. Follow up was for 12 weeks post late that this biochemical property may be affected by the treatment with clinical improvement measured using the attempt at increasing the molecular weight by crosslinking the Western Ontario and McMasters Universities Osteoarthritis hyaluronic acid derivative. A randomised control trial with a Index. X-rays of the relevant knee were viewed and graded for greater number of candidates would be able to provide a the severity of joint space, osteophyte, tibial spine, sclerosis, clearer understanding of this issue. cyst formation, alignment and general severity by an observer blinded to the outcome of the treatment. There were no appre- ciable differences noted in the age, sex, length of follow up and Poster #225 number of intraarticular injections given per course in each x- PRIMARY TOTAL KNEE ARTHROPLASTY WITH ray category. INTRAMEDULLARY NAIL FIXATION FOR SUPRACONDYLAR FEMORAL FRACTURE IN RHEUMATOID ARTHRITIS OF Results THE KNEE There is a significant correlation between a significant improve- Keinosuke Ryu, Tokyo, JAPAN, Presenter ment in stiffness with mild changes in the tibial spine as well as Kazumasa Fukushima, Tokyo, JAPAN lateral and medial joint space and general x-ray changes. Syu Saito, Tokyo, JAPAN Improvement in pain correlated with changes in joint space, Ichiro Shimizu, Tokyo, JAPAN tibial spine and general x-ray changes whilst improvement in Takao Ishi, Tokyo, JAPAN function correlated with changes in joint space only. Overall Kaichiro Saigo, Tokyo, JAPAN improvement correlated with joint space changes, tibial spine Keinosuke Ryu, Tokyo, JAPAN and general x-ray changes Department of Orthopaedic Surgery, Nihon Universit, Itabashi, JAPAN

Conclusion (Introduction) Operative treatment is usually chosen for the We conclude that patients with severe osteoarthritic changes in treatment of supracondylar femoral fracture to restore knee joint space on x-ray will not significantly benefit from intraar- function. However, it is very difficult, when supracondylar ticular knee viscoelastic supplementation. In particular mino femoral fracture occurs in patients who plan to undergo total knee arthoroplasty (TKA) due to osteoarthritis or rheumatoid arthritis of the knee. In these cases, we have to consider treat- Poster #224 ment options, which are including 1-stage surgery and 2-stage COMPARING THE EFFICACY OF TWO HYALURONIC ACID surgery. 1-stage surgery is primary TKA with additional fracture DERIVATIVES: IS THERE A DIFFERENCE? fixation. 2-stage surgery consists of fracture fixation performed Pidikiti S Prasad, Liverpool, UNITED KINGDOM at first, and then after bone union, TKA is performed. We report

Arvind Rawal, Bolton, UNITED KINGDOM, Presenter 2 cases with supracondylar femoral fractures in patients with POSTER ABSTRACTS E M Toh, Liverpool, UNITED KINGDOM rheumatoid arthritis of the knee, which were treated with a 1- D Teanby, Prescot, UNITED KINGDOM stage procedure. We present our 1-stage technique with using Department of Orthopaedic and Trauma Surgery, Whis, Prescott, TKA with retrograde intramedullary nail. UNITED KINGDOM (Case 1) A 59-year-old woman fell while walking and sustained Purpose a right supracondylar femoral fracture. Previously, she under- This study was designed to check the clinical validity of a previ- went conservative treatment for rheumatoid arthritis of the ous study that had concluded that the clinical efficacy of intrar- knee, and TKA has been scheduled. 12 days following the injury, ticular knee viscoelastic supplementation was directly related she was treated surgically by a primary TKA with retrograde to the molecular weight of the hyaluronic acid derivative. intramedullary nail fixation additionally. 12 weeks after surgery, the range of motion of the knee was 0 to 110 degree, and the Material and methods patient had no complaints. A prospective cohort of 92 patients receiving a standard course of intrarticular knee viscoelastic supplementation with two (Case 2) An 80-year-old woman fell while walking and sustained commercial hyaluronic acid derivatives of differing molecular a supracondylar femoral fracture on the left side. She has been weights were studied. There were no appreciable differences in treated as a rheumatoid arthritis for 30 years. 25 years ago, she the age, sex, length of follow up, number of intraarticular injec- was treated due to a left femoral neck fracture with hip endo- tions given per course and x-ray changes between the two prosthesis. Currently, her rheumatoid knee arthritis was treated groups. 32 were given a crosslinked hyaluronic acid derivative conservatively, and TKA has been scheduled. 14 days following (hylan) with an average molecular weight of 6.0x106D. The the injury, she was treated surgically by a primary TKA with ret- remaining 60 received an uncrosslinked hyaluronic acid deriva- rograde intramedullary nail fixation additionally. 6 weeks after tive (hyluronan) with an average molecular weight of surgery, she started full weight bearing. 8 weeks following sur- 1.55x106D. Follow up was for 12 weeks post treatment with clin- gery, the range of motion of the knee was 0 to 110 degree, and ical improvement measured using the Western Ontario and patient had no complaints. McMasters Universities Osteoarthritis Index.

5.97 (Discussion) There are advantages for both 1-stage and 2-stage surgery for the supracondylar femoral fracture in patients with Total knee replacement (TKR) is world wide recognised as the rheumatoid arthritis of the knee. Elderly patients with rheuma- treatment of choice for knee arthritis. At the II Orthopaedic toid arthritis usually have not only poor systemic conditions Clinic of Turin, from September 1993 and July 1998 we but also osteoporosis. 2-stage surgery takes a long period for implanted 243 PFC TKR which is a posterior stabilised cruciate bone union, especially in osteoporotic cases. Additionally, the substituting prosthesis. We evaluated 177 TKR in 143 patients patients dealing with poor systemic conditions would not allow (144 F, 33 M, mean age 69,5 years), the average follow up period the necessary long time rehabilitation. According to these rea- was 5 years (range 35-84 months), the pathology was arthritis in sons, 1-stage surgery is better than 2-stage surgery in those 87%, rheumatoid arthritis in 11,3%, for post-traumatic arthritis patients. In 1-stage surgery, primary TKA with fracture fixation in 1,7%. The patella was resurfaced in 60.5% of the knees, using is technically demanding, due to the quite difficult correction of an all polyethylene component. Scoring was carried out accord- the alignment by the displaced distal femoral fragment and cut- ing to the Hospital for Special Surgery (HSS). Survivorship ting of the femoral joint surface. In our cases, both patients’ analysis was done to determine the cumulative rate of survival systemic condition was improved before this challenging oper- of the implant during the period of the study(16). The end point ation, and we achieved good results. for the analysis was a revision operation for any reason. Radiographs were evaluated for overall alignment and radiolu- cent lines using the Knee Society TKA radiographic evaluation Poster #226 and scoring system. Preoperatively the mean HSS score was THE PATELLO-FEMORAL JOINT (PFJ) STATUS IN 61.26 points (range 35 to 88 points). At the time of the most REVISION KNEE ARTHROPLASTY; A NEW recent follow up, the mean HSS score was 90.56 (range 60 to CLASSIFICATION SYSTEM & ITS RELIABILITY. 100 points), p < 0.001. The clinical result was excellent in 87.6%, Vishal Sahni, Liverpool, ENGLAND, Presenter good in 19.2%, fair in 8.5%, and poor in 3.9%. Radiolucencies Paul Carter, Wirral, ENGLAND were found around the femoral component in nine knees (8%), Sanjay Sureen, Manchester, ENGLAND and in the views of the tibial tray in 33% knees. One prosthesis Richard W Parkinson, Upton, UK had aseptic loosening by the time of the most recent follow up Wirral Hospitals NHS Trust, Wirral, ENGLAND examination. The rate of survival of the implant was 95% at five years and nine revision was carried out (5%). In the present We sought to develop and validate a classification system for series, patients had relief of pain, an excellent range of move- assessing patello-femoral joint (PFJ) status prior to revision ment, and restoration of function with improvement in quality knee arthroplasty. of life. These good results could be related to the technique of Many factors influence the outcome of revision knee surgery. alignment and soft tissue balance, which was performed after The importance of bone stock and stability with regard to the the distal femoral cut and before the tibial resection and to the femur and tibia has been documented. The importance of the femoral locating device orientation, that is placed in slight extensor mechanism has not been addressed. Our classifica- external rotation with reference to the epicondylic axis. tion system grades the condition of the PFJ by describing both the patella bone stock and the patello-femoral tracking. Four For communications: POSTER ABSTRACTS grades ranging from ‘normal’ to ‘disrupted extensor mecha- G. Sandrucci, MD nism’ describe patella bone status. Four grades ranging from II Orthopaedic Clinic, University of Turin ‘normal’ to ‘complete dislocation’ describe patello-femoral Trauma Centre tracking. Via Zuretti 29, 10126 Torino - Italy 145 sets of pre- and post-operative radiographs, each set con- Tel 0039116933573 sisting of an AP, lateral and skyline patella view, were studied. Fax 0039116933760 Three clinicians graded all radiographs according to the classi- Email [email protected] fication system on two separate occasions. These assessments were performed at least six weeks apart. The results were analysed by an independent observer who was blinded. Both Poster #228 intra- and inter-observer agreement was quantified using kappa HINGED TOTAL KNEE REPLACEMENT values. IN SEVERE KNEE REVISION SURGERY Intra-observer kappa values were 0.89, 0.96 and 0.82. Inter- Francesco Lagalla, Torino, ITALY observer kappa values were 0.94, 0.87 and 0.97 between the Giulia Sandrucci, Torino, ITALY, Presenter three clinicians. This indicates excellent levels of agreement. Marco Fiammengo, Torino, ITALY We conclude that this classification system provides a conven- Pier Franco Triolo, Torino, ITALY ient, specific, descriptive and reproducible method of denoting Maurizio Crova, Pecetto, ITALY PFJ status. Our system may be used to accurately communicate II Ortopaedic Clinic, Turin, ITALY and compare PFJ characteristics. This will aid planning of surgi- cal intervention and allow comparison of results and tech- Total knee arthroplasty revision surgery is a complex procedure niques in revision knee arthroplasty. and it is increasing in the last ten years. It usually requires implants with particular technical features. The difficulty and complexity of this kind of surgery is due to the Poster #227 great meta-epiphiseal bone loss, both femoral and tibial, and CLINICAL AND RADIOLOGICAL EVALUATION AT FIVE to the severe capsular-ligamentous instability. YEARS FOLLOW-UP OF 177 PFC TOTAL KNEE We choose the Endomodel arthroplasty, this implant has tibial ARTHROPLASTY and femoral stems and it allows to fill large tibial bone loss Giulia Sandrucci, Torino, ITALY, Presenter using specific polyethylene inserts. Between 1993 and 2001 41 Enzo Cenna, Torino, ITALY complex knee revisions were performed in 39 patients (30 F, 9 Alessandro Bistolfi, Torino, ITALY M, mean age 70,3 years). We evaluated the patients clinically Pier Franco Triolo, Torino, ITALY with the HSS scoring system and radiologically with the Knee Maurizio Crova, Pecetto, ITALY Society TKA radiografic evaluation and scoring system, with a II Orthopaedic Clinic, Turin, ITALY mean follow up of 5 years (min 24, max 109 months). The revi-

5.98 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). sion was performed for aseptic loosening in 21 cases, for septic ues were extremely low in the 3-16% range (AP 3% vs. PA 6% loosening in 16 cases (we used the “two stages” technique in 11 medial; AP 16% vs. 6% PA lateral). However, the specificity was cases and the “one stage” in 5, always associated with antibi- very high in the 92-98% range with PA significantly better otic-addicted cement) and for instability in 2, 1 case for fracture (p<0.05) at 96% vs. 92% AP for lateral compartment only. For and 1 for other reasons. None of these cases presented signs of Group B comparison, where Grade 2 chondromalacia is consid- loosening; all the cases mantained the correct alignment of 7° ered disease, the sensitivity is still low but the AP was signifi- valgus given by the prostheses design. Two cases required a cantly more sensitive (p<0.05) than PA (11% vs. 2%) for the revision surgery with the substitution of the femoral compo- lateral compartment only. No statistical differences were nent for the rupture of its PE component. According to the clin- observed for very high values for specificity in the range 92-99%. ical results, the range of motion and degree of satisfaction, in Both results are probably of little clinical significance with the our opinion the righ answer in salvage revision total knee magnitude of change of 4% for specificity values over 90% and arthroplasty is the use of a hinged total knee arthroplasty like 9% for the extremely poor values (<2%) for sensitivity. the “Endomodel”. CONCLUSIONS: Both radiography techniques (AP vs. PA) For communications: demonstrated extremely low sensitivity but high specificity for G. Sandrucci M.D arthritis whether analyzed by Rosenberg definition CM 1-2 vs. II Orthopaedic Clinic, University of Turin CM 3-4 (Group A) or CM 1 vs. CM 2, 3, 4 (Group B). Thus radi- Trauma Centre ographs are poor screening tests for arthritis (CM Grades 2-4) Via Zuretti 29, 10126 Torino - Italy (poor sensitivity) but are good diagnostic tests for chondroma- Tel 0039116933573 lacia with >90% specificity. No clinical difference or consistent Fax 0039116933760 statistical difference was observed between standing PA vs. AP; Email [email protected] therefore, either could be ordered with similar accuracy. Clearly, a more sensitive screening tool is required for detection of early knee arthritis detected arthroscopically. Poster #229 STANDING KNEE RADIOGRAPHS: AP VS PA PROSPECTIVE EVALUATION ARTHROSCOPICALLY Poster #230 CONFIRMED ARTHRITIS NEW METHOD FOR BONE-GRAFTING FOR THE HUGE Kurt P. Spindler, Nashville, TN, USA, Presenter BONE DEFECT IN TKA - BONE SCINTIMETRIC Robert H. Boyce, Nashville, TN, USA EVALUATION AND CLINICAL OUTCOMES Eric C. McCarty, Nashville, TN, USA Takehiko Sugita, Sendai, JAPAN, Presenter Todd Michener, Nashville, TN, USA Tomomaro Kawamata, Sendai, JAPAN Yu Shyr, Nashville, TN, USA Masahiro Ohnuma, Sendai, JAPAN Vanderbilt Sports Medicine Center, Nashville, Tennessee, USA Dept. of Ortho. Surgery Tohoku University Graduate, Sendai, JAPAN

OBJECTIVE: Despite the near universal use of radiographs (XR) New method for bone-grafting for the huge bone defect (more used for screening and diagnostic purpose of detecting knee than 10 mm in depth) in total knee arthroplasty (TKA) is pre- arthritis, no prospective studies have investigated their routine sented. There were five osteoarthritic knees (in three patients) use in general sports medicine practice. Prior investigations and five rheumatoid arthritic knees (in four patients). They were have a selection bias to a high-risk population, then compared followed for at least two years. The status of the grafted bone XR to arthroscopic evaluation of arthritis. Since the detection of was evaluated using three-phase bone scintimetry. Bone scinti- early osteoarthritis has both prognostic and treatment implica- metric findings showed that revascularization to the grafted tions, we initiated a prospective comparison of standing AP and bone began four weeks after TKA and the activity of bone

Rosenberg PA films in all patients presenting to a sports medi- remodeling continued for one year after TKA and gradually sub- POSTER ABSTRACTS cine practice who had subsequent arthroscopic surgery. We sided. Radiographic findings showed neither loosening of com- compared the sensitivity and specificity between radiographic ponents nor collapse of the grafted bone. No patients techniques and for both medial and lateral compartments. Our complained of knee pain in daily living. Average range of hypothesis was there was no difference between radiographic motion of the knee was from 0 to 114 degrees. techniques for either compartment.

METHODS: As part of a prospective protocol, all new patients Poster #231 with indications for knee radiographs had bilateral AP and TOTAL KNEE ARTHROPLASTY PRESERVING Rosenberg PA x-rays. Over a two-year time period, 349 patients OR NOT THE PCL: GAIT ANALYSIS subsequently had arthroscopic surgery where grading of arthri- Alfredo Marques Villardi, Rio de Janeiro, BRAZIL tis by chondromalacia (CM) Grades 1-4 (Modified Outerbridge) Lais Turqueto Veiga, Rio de Janeiro, BRAZIL, Presenter on scale diagrams was performed by a single surgeon (KPS). All JosÈ Sergio Franco, Rio de Janeiro, BRAZIL x-rays had articular cartilage interval measured independently, MaurÌcio Cagy, Rio de Janeiro, BRAZIL by an observer blinded to side, in millimeters (mm) by com- Paulo J. Guimaraes Silva, Rio de Janeiro, BRAZIL partments in both knees. In Group A, comparison was identical Luciano Raptopoulos, Rio de Janeiro, BRAZIL to Rosenberg with a positive radiograph defined as a 2-mm dif- M·rio Donato D’Angelo, Rio de Janeiro, BRAZIL ference side to side (by compartment) for CM 0, 1, 2 vs. 3, 4. In CPMH (Human Movement Research Center)- Hospital, Rio de Janeiro, Group B, only the definition of disease was changed, with BRAZIL Grade 2 CM now grouped with CM Grades 3 and 4. The statisti- cal evaluation compared sensitivity and specificity between x- Objective: The study of gait analysis parameters in pacients ray procedures with p<0.05 as significant. who had had a primary total knee arthroplasty, preserving or sacrificing the posterior cruciate ligament. RESULTS: For Group A comparison (Rosenberg Method Analysis), the sensitivity was not significantly different between Patients and Method: From April 7th, 2000 to November 11th, AP vs. PA for either the medial or lateral compartment. The val- 2000, 60 patients who underwent total knee arthroplasty (70

5.99 cases) were submitted to Gait Analysis (kinematic parameters learing curve. In a series of over 300 knees to date there have and dynamic eletromiography), at the Centro de Pesquisa do been no further meniscal complications. Movimento Humano (CPMH: Human Movement Research Center).From the total number of patients, 21 were male and 39 We feel this prosthesis offer a safe and effective treatment for female, with age ranging from 45 to 85 years (average 68.3 osteo arthritis with a good clinical outcome at five years with a years). The indication for total knee arthroplasty was due to low level of complications. ostheoarthrits in 66 cases, and to rheumathoid kneein the remaining. The cases were further divided into three groups according to the type of prosthesis as follows: Group I: Poster #233 Prothesis with posterior cruciate ligament (PCL) preservation EXTENSOR MECHANISM RECOVERY AFTER MEDIAL (24 cases); Group II: Osteonics prothesis; 7000 series PARAPATELLAR AND TRI-VECTOR RETAINING (Osteonics, Allendale, NJ) with PCL sacrifice (22 cases); Group APPROACHES FOR TOTAL KNEE ARTHROPLASTY: III:LCS prothesis (DePuy, Warsaw, IN), platform type, with PCL A PROSPECTIVE, RANDOMISED, DOUBLE BLIND STUDY sacrifice (24 cases). A Vicon 140 system, with three infrared Nigel J Donnachie, Upton, UK cameras, two bertec force platforms and a Motion Lab dynami- Edward V Wood, Upton, UK, Presenter cal EMG system compose the Gait Laboratory in CPMH (Rio de Richard Hartley, Wirral, UNITED KINGDOM Janeiro). Richard W Parkinson, Upton, UK Wirral Hospitals NHS Trust, Upton, UK Results: The angular flexion values of the knee during the phase of stance (initial contact, load acceptance, mid-stance and pre- Introduction swing) were submitted to the Anderson-Darling test to evaluate In order to perform daily activities the knee must fully extend if the data could be seen as originated from a gaussian popula- and flex through to 95 degrees. Several studies have shown that tion, which was satisfied for a significance level (a) of 5%. knee flexion after total knee arthroplasty (TKA) continues to Hence, one could use the t Student test to compare the average improve after discharge from hospital. However, extension does of the knee flexion values with values assumed as normal in not, and therefore early post-operative rehabilitation must con- CPMH. The patients from Group I showed a gait pattern more centrate on achieving full or near-full extension. Therefore if a physiological for a = 5%, i.e, exhibited a gait pattern more close specific type of surgical approach causes less damage to the to normal. Based on the graphical analysis of the 70 cases, we extensor mechanism, but still allows adequate exposure, this could note a great inter-individual variability of the gait pat- could be of significant benefit to the patient by improving the terns. No case could reproduce the normal gait pattern. The co- outcome of surgery. The tri-vector retaining arthrotomy (TVRA) contraction phenomenon occurred more pronouncedly in the was described by Bramlett as a hybrid between the medial patients from group II (81.8%), followed by the ones from group parapatellar arthrotomy (MPPA) and the subvastus arthrotomy. III (66.6%). The least frequent cases of such phenomenon were seen in group I (54.1%). Aims The aim of the study was to examine whether the TVRA facili- Conclusion: Changes in gait (specifically regarding to knee flex- tates the faster recovery of the extensor mechanism following POSTER ABSTRACTS ion) occurred in some level depending on the kind of implant TKA. used in the total arthroplasties. In group where the PCL was preserved, the best results were shown, regarding to both Gait Methods Analysis and Dynamical EMG. Patients undergoing primary TKA for osteoarthritis were ran- domised into MPPA and TVRA groups (15 and 17 patients respectively). All surgery was performed by one surgeon using a Poster #232 single implant design. The patients and assessors were blinded •FIVE YEAR REVIEW OF THE ROTAGLIDE TOTAL KNEE as to which approach was used. ARTHROPLASTY The patients were assessed pre-operatively and at three and six Christopher J Wilson, Glasgow, UNITED KINGDOM, Presenter weeks post-operatively. The Hospital for Special Surgery Score Gavin Tait, Kilmarnock, SCOTLAND UK (HSS) was used for clinical assessment. Extensor mechanism Glasgow Royal Infirmary, Glasgow, SCOTLAND UK strength was assessed using isokinetic dynamometry in terms of peak torque generated, torque at 30 and 60 degrees flexion, In this study we present the outcomes of patients with the total work generated and average power generated. Muscle Rotaglide mobile meniscal knee prosthesis implanted for damage was assessed by electromyography of the following osteoarthritis. All patients reviewed had this prosthesis muscle areas - vastus medialis obliquus (VMO), vastus medialis implanted in Crosshouse Hospital Scotland by two Surgeons. longus (VML), distal rectus femoris (DRF), proximal rectus The minimum follow up period was 5 years (Range 5 -8.2) femoris (PRF) and vastus lateralis (VL). The results were Patients were assessed clinically and the results were stan- analysed statistically. dardised using the Hospital for Specialist Surgery (HSS) knee score. Standard radiographs were taken in AP and Lateral Results planes to assess for evidence of loosening. Case note were then The HSS scores showed no significant differences between the examined for evidence of complications. two groups pre-operatively and post-operatively (P=0.161 and P=0.495 respectively). The isokinetic dynamometer results Sixty Seven patients (73 Knees) were reviewed. 97% of patients revealed a statistically faster recovery of extensor mechanism had an exellent clinical outcome with HSS scores of 85 or more. power in the TVRA group in all domains (P=0.0188, 0.0303, Two Knees (2.7%) were revised one for meniscal fracture and 0.0254, 0.0285 and 0.0374 respectively). Electromyographic one for meniscal dislocation. Both knees were found to be lax testing revealed less post-operative inhibition of muscles close in flexion due to problems with soft tissue balancing. To date to the knee in the TVRA group. The MPPA group demonstrated there have been no failures due to loosening and no deep infec- significant drops in activity in VMO, DRF and VL (P=0.0080, tions. Both meniscal revisions may have been caused by prob- 0.0415 and 0.0051 respectively). The TVRA group did not lems with balncing the flexion and extention gaps early in our demonstrate significant decreases in activity in any muscle area tested.

5.100 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). they supplemented postoperatively with banked blood transfu- Conclusion sions when required. A control group of 30 patients (group B), The results of this study support the concept that the TVRA in whom standard suction drains were used, received one unit causes less damage to the extensor mechanism than MPPA, of homologous banked blood transfusion intraoperatively and allowing faster recovery of the extensor mechanism on both additional blood transfusions postoperatively when required. isokinetic dynamometry and EMG testing. The admission of banked blood transfusion determined by haemoglobin value (<9mg/dL) and/or clinical signs (blood pressure, pulses, etc). The value of haemoglobin, haematocrite Poster #234 and platelets recorded preoperatively and the 1st, 5th and 15th POSTERIOR-ANTERIOR WEIGHT-BEARING day after operation. RADIOGRAPH IN FIFTEEN DEGREE KNEE FLEXION IN MEDIAL OSTEOARTHRITIS Results: 5 patients of group A required postoperatively 9 units Norio Yamanaka, Kochi, JAPAN, Presenter of homologous blood (0.3 units/patient). 10 patients of group B Toshiaki Takahashi, Kochi, JAPAN required additional 15 banked blood units postoperatively Hiroshi Yamamoto, Kochi, JAPAN (totally 45 banked blood units for group B, 1.5 units/patient). In Norikazu Ichikawa, Aki, JAPAN the study group the total homologous blood requirements Department of Orthopaedic Surgery, Kochi Medical S, Nankoku, JAPAN reduced by 80%, while the postoperative blood requirements reduced by 60%. There was no significant difference in the post- Purpose: The aim of this study is to evaluate what angles of operative haematocrite and haemoglobin values between the flexion in the coronal radiographic view are useful for assessing two groups. None of the patients developed any adverse reac- medial osteoarthritis of the knee. tions after reinfusion.

Methods: We compared four views of conventionally extended, Conclusions: The use of an autologous blood reinfusion system 15 degrees, 30 degrees, and 45 degrees flexion of the knee with reduces highly effectively the demands of homologous banked respect to joint space narrowing, and medial tibial plateau blood transfusion in total knee arthroplasty. (MTP) and tibiofemoral angles in 113 knees from 95 patients with medial osteoarthritis of the knee (22 male, 73 female patients, mean age: 67 years,). Poster #441 TKA USING THE ESKA SEMICONSTRAINED PROSTHESIS Results: At the midpoint and the narrowest point of the medial IN SEVERE KNEE DESAXATIONS compartment, joint space narrowing values at 15 degrees, 30 Jose maria Cavanilles, Barcelona, SPAIN, Presenter degrees, and 45 degrees flexion of the knee were smaller than Xavier Granero, Badalona, SPAIN that of the conventional extended view. Satisfactory data of Ruiz Juan Antonio, Badalona, SPAIN superimposition of the medial tibial plateau (MTP) was 12% at Soler Minoves Jose maria, Badalona, SPAIN the extended conventional, 36% at 15 degrees, 20% at 30 Laura Torrededia, Badalona, SPAIN degrees, and 19% at 45 degrees of flexion of the knee. A view of Jaume Roca, Badalona, SPAIN 15° flexion of the knee revealed a smaller difference of the Hospital Universitari Germans Trias i Pujol, Badalona, SPAIN tibiofemoral angle with the knee extended than did that at 30 degrees and 45 degrees flexion of the knee in cases of medial The use of tricompartimental prostheses is not recommended osteoarthritis. in patients with a varus or valgus deformity greater than 20° nor in those patients with a flexum or recurvatum contracture. This Conclusions A postero-anterior new view of a 15 degrees flexed is because the impairment of the capsula articularis and knee was able to accurately detect joint space narrowing, good insuffiency of the collateral ligaments might lead to the appear- alignment of the MTP in the medial compartment, and less dif- ance of postoperative instability. In our opinion the best option POSTER ABSTRACTS ference of tibiofemoral angle with a view of extended knee for for these patients is a semi constrained prosthesis, since the cases of medial osteoarthritis of the knee. stability of this type of implant is not provided by the capsu- loligamentous structures but by the prosthesis design itself.

Poster #235 Material and methods THE BLOOD MANAGEMENT IN TOTAL KNEE The aim of this study was to review the results obtained in a REPLACEMENT. THE EFFECTIVENESS OF series of 32 patients who had an ESKA semi constrained pros- POSTOPERATIVE REINFUSION. thesis inserted. All patients were operated by the same surgeon Athanasios N. Zacharopoulos, Kirra Fokidas, GREECE, Presenter and the indication for TKA was either degenerative or rheu- Georgios Xenos, Amfissa, GREECE matic. The mean follow-up period was 5 years. This series Nikolaos Tzanakakis, Amfissa, GREECE include 15 cases of dynamic genu valgum in patients affected Spyros Moscachlaidis, Amfissa, GREECE with Charcot-like arthropathy which is not rare among our General Hospital of Amfissa, Amfissa, GREECE patient population.

Purpose of the study: To determine the effectiveness of a post- Results operative autologous blood reinfusion system, as an alterna- Data have been evaluated according to the Knee Society Knee tive to homologous, banked blood transfusions in total knee Score with the following results: arthroplasty. -excellent (90-100 points) in 14 cases (43.7%) -good (80-90 points) in 9 patients (28.1%) Material and Methods: We have carried out a prospective ran- -fair (60-79 points) in 7 patients (21.8%) domized, controlled study on 60 patients having unilateral total -poor (less than 60 points) in 2 patients (6.2%). knee replacement. In all these patients the same surgical team applied the same surgical technique and they follow the same Conclusions rehabilitation program. In 30 of these patients (group A) a rein- The ESKA semi constrained prosthesis is designed with fusion system of unwashed blood salvaged was applied and cemented intramedullary stems on both femoral and tibial

5.101 components and two articular. Its insertion is not technically right knees of asymptomatic individuals for both JPS and vibra- demanding and it provides good joint stability, alignment and tion sense (p>0.05). The mean perception time of vibration was range motion being very useful in patients with severe knee 9.03 and 7.31 seconds for right; 8.55 and 6,82 for left knees of desaxations. asymptomatic individuals in extension and in flexion respec- tively. Mean perception time of vibration sense in asympto- matic knees of patients (in extension and in flexion) were also Knee - Ligament/Patella compared with perception times of right and left knees of asymptomatic individuals and found no differences (p>0.05).

Poster #236 Conclusion: Decreased patellar vibration sense in extension is PROPRIOCEPTION IN PATIENTS WITH ANTERIOR KNEE a good indicator of decreased proprioception in anterior knee PAIN: DESCRIPTION OF A NEW MEASUREMENT METHOD pain. Increased contact pressure on the patellar chondral sur- Devrim Akseki, Izmir, TURKEY, Presenter face in flexion is tought to eliminate the proprioceptive differ- Ugur Ozic, Izmir, TURKEY ence between the symptomatic and normal knees. According to Aziz Vatansever, Manisa, TURKEY the results of this study JPS is not a recommendable method to Celal Bayar University, School of Medicine, Dept., Izmir, TURKEY. measure the knee proprioception in patients with unilateral patellofemoral pain. Purpose: Deterioration of the proprioceptive capability has been shown in patients with anterior knee pain in a limited number of studies. Although joint position sense (JPS) has Poster #237 been used in most of these studies, its reliability, however has DOES PROXIMAL TIBIO-FIBULAR ARTHROLYSIS been found to be questionable in patients with patellar com- PRODUCE POSTEROLATERAL INSTABILITY? pression syndrome. To our knowledge, vibration sense has not Guillermo R. Arce, Buenos Aires, ARGENTINA, Presenter been used for measurement of proprioceptive capability in Pablo Lacroze, Buenos Aires, ARGENTINA patients with anterior knee pain. Purpose of the study was: 1. To Santiago Butler, Buenos Aires, ARGENTINA introduce a new and simple method to measure proprioceptive Eduardo Diego Abalo, Capital, ARGENTINA capability of the knee, 2. To compare it with the method of joint Juan Pablo Previgliano, Capital, ARGENTINA position sense, 3. to test the reliability of joint position sense; Enrique Pereira, Capital, ARGENTINA in patients with unilateral anterior knee pain syndrome. Roberto Valentini, Capital, ARGENTINA Jorge Macias, Buenos Aires, ARGENTINA Materials and Methods: Ten patients with clinically diagnosed IADT, Buenos Aires, ARGENTINA unilateral anterior knee pain syndrome (2 male, 8 female) whose ages ranged between 25 to 48 years (av. 38.3 years) were Introduction: included in the study. The left knee was involved in 6, and right Proximal tibio-fibular joint arthrolysis (PTFA) performed during one was involved in 4. Average duration of symptoms was 10.7 high tibial osteotomy (HTO), relaxes the posterolateral struc- months (range, 1 to 32 months). Cinema finding was positive in tures of the knee due to proximal migration of the fibular head POSTER ABSTRACTS all, Lysholm score was average 66.6 (range, 44 to 89). On clini- and the tibial attachment of the popliteus muscle. cal examination, positive patellar crepitus and positive patellar compression and friction tests were accepted as diagnostic cri- Purpose: teria for anterior knee pain syndrome. Exclusion criteria were as To evaluate the influence of proximal tibio-fibular joint arthrol- follows: 1. All the patients with findings of a torn meniscus, 2. ysis (PTFA) over the posterolateral corner, in the simultaneous Knee ligament injuries on history and/or clinical examination, high tibial osteotomy and ACL reconstructions. 3. Demonstrated tibiofemoral arthrosis in any grade on x-rays, 4. A history of knee pain also in the past on contralateral knee. Type of Study: Case series To test the JPS, the patient attempted to replicate four target angles (15°, 30°, 45°, 60°), actively. Vibration sense was meas- Methods: ured by a diaposone (Riesta-128F) with the knee in extension Eleven patients were retrospectively evaluated to asses the and in flexion. It was seated to the center of the patella and the influence of the proximal tibio-fibular arthrolysis in the pos- patients were told to inform when the vibration sense disap- terolateral corner stability. The varus alignment was corrected peared. The time period between the first oscilation of the dia- performing a wedge resection osteotomy of the proximal tibia. posone and the loss of vibration sense was measured by a A soft tissue release and rongeur resection of the proximal chronometer. All the measurements related to the JPS and tibio-fibular joint was performed in all cases for wedge closure. vibration sense were repeated six times by the same author In the same surgical procedure an ACL reconstruction was (D.A.). Same measurements were done on the contralateral done. The lateral collateral ligament and popliteo-fibular liga- (normal) knees of the patients and the results were compared. ment status were evaluated with the Tibial External Rotation Additional ten normal subjects also underwent the same (dial) Test in prone position and the Posterolateral External measurements to assess any possible left and right side differ- Rotation Test. Both tests were done in 30 degrees of flexion, ences. Mann-Whitney U test was used for statistical analysis. and the side to side differences in the thigh-foot angle were recorded. Results: The vibration sense was significantly diminished in symptomatic knees in extension (p<0.001); the mean percep- Results: tion time of vibration was 7.16 seconds on the symptomatic A side to side differences of 15 degrees or more was considered knees and was 9.18 seconds on the contralateral normal knees. as an increase in posterolateral corner instability. All cases The difference was not significant (p>0.05) when the knee was except one had normal posterolateral corner examination. flexed to 90° (6.38 seconds versus 6.37 seconds for sympto- matic and normal knees, respectively). No statistically signifi- Discussion and Conclusions: cant differences were found in JPS between the symptomatic In a simultaneous varus alignment and ACL reconstruction pro- and normal knees at any of the four target angles. Results of the cedure, a closed wedge HTO with PTFA seems to be safe and measurements showed no differences between the left and effective. Even though the PTFA produces a proximal slide of

5.102 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). the fibular head, the findings of this study suggest that the knowledge about the long-term outcome after PCL reconstruc- PTFA does not jeopardized the posterolateral stability in these tion. group of patients. Purpose: To evaluate and compare the long-term functional outcome after isolated reconstruction (with two different auto- Poster #238 grafts) in a recreational sport population. THE LONG-TERM RESULTS OF MAQUET – TYPE TIBIAL TUBERCLE ELEVATION FOR Methods: From 1985 to 2000, 35 patients had an isolated PCL PATELLOFEMORAL ARTHROSIS reconstruction, with a 2 to 15 years follow up. All the patients Emrah Kizilboga, Bornova- Izmir, TURKEY had a chronic posterior instability, with an average time injury Semih Aydogdu, Izmir, TURKEY, Presenter to surgery of 1,1 year. Excluded were patients with combined Hakki Sur, Izmir, TURKEY reconstructions, PCL/ACL, and PCL with high tibial osteotomy. Ege Universitesi Tip Fakultesi Ortopedi Klinigi, Izmir, TURKEY All open procedures were performed by the same two surgeons (UM, TD). The utilized autografts were the Bone Patellar Tendon The aim of the study: Bone (single tunnel technique) and Semitendinosus/Gracilis Evaluating the long-term durability of and the changes seen Tendons (double tunnell technique). The patients were evalu- after Maquet procedure in both patellofemoral and ated by an independent experienced clinician (MB). Follow up tibiofemoral compartments of the knee joint. examination included: the complete IKDC 2000 (including clin- ical examination, questionnaires and X-rays), instrumented lax- Material and Method: ity, isokinetic strength and balance measurements. 21 patients (5 males, 16 females, mean age at the time of oper- ation 59.3) treated by Maquet tibial tubercle elevation with Results: The results of this ongoing study will be first presented minimum follow-up of 8 years (average 11.5 years) were at the ISAKOS Knee Committee Workshop in Florence reviewed both clinically and radiologically. A detailed ques- (November 28th-December 1st, 2002). tionaire was used to assess the functional impairment during daily activities. An evaluation score was used based on both subjective and objective assessment of the knee joint.The Poster #240 changes in the geometry of the extensor mechanism of the knee PERIOSTEUM-ENVELOPED HAMSTRING TENDON GRAFT joint which could interfere subsequent knee arthroplasty were IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION analysed by scanning tomography Chih-Hwa Chen, Kweishan, TAIWAN, Presenter Wen-Jer Chen, Taoyuan, TAIWAN Results: Chun-Hsiung Shih, Taoyuan, TAIWAN Maquet-type osteotomy yielded an average 7.5 years of pain- Chang Gung Memorial Hospital, Kweishan, TAIWAN free period but objectively only 3 of 21 cases (%15) was graded as good or excellent. The complication rate was %19 (4 of 21 Introduction: Tendon-bone incorporation of a tendon graft procedures). All indices for the length of patellar tendon dis- within the bone tunnel is a major concern when performing for played significant shortening of the tendon. An average tibial ligament reconstruction. The periosteum consists of multipo- tubercle elevation of 1,59 cm remained unchanged with some tent steml cells to form osteogenic and chondrogenic tissues. medial displacement. Q angle calculated by CT scans, was sig- Our histological and biomechanical studies in animal had nificantly lowered in comparison to the control side. CT param- shown superior healing process and stronger healing strength eters displayed a significant improvement in CT parameters for within a bone tunnel when wrapping the periosteum on the patello-femoral congruence was still present on the operated tendon graft. This concept was applied on the ACL reconstruc- side even after long-term follow-up. tion to enhance tendon-bone healing when using the ham-

string tendon graft. POSTER ABSTRACTS Discussion and conclusions: Maquet-type tibial tubercle elevation has the capability of long- Materials and methods: A 4-stranded semitendinosus and gra- term pain relief and functional improvement for patellofemoral cilis tendon is used as the graft. A piece of periosteum, 3 cm x arthrosis. The most important factor which defines the status of 3 cm, harvested from the anterior cortex of proximal tibia, is the knee joint in long-term is the progresion of the arthrosis in split into two rectangle flaps with size of 1.5 cm x 3 cm each. medial tibio-femoral compartment. The improvement in the The periosteum flaps are wrapped and sutured around the ten- parameters of patellofemoral congruence obtained by the don graft at the portions near the femoral and tibial tunnel osteotomy is durable. openings. The cambium layer is faced outside to the bone tun- nel.

Poster #239 Results: From 2000, this technique has been used in 21 patients ISOLATED POSTERIOR CRUCIATE LIGAMENT with follow-up for 12 to 18 months. 18 of 21 patients (92%) RECONSTRUCTION IN CHRONIC POSTERIOR INSTABILITY. could return to the same or higher level of pre-injury sports A RETROSPECTIVE STUDY WITH A 2 TO 15 YEARS activity. Average Lysholm knee scores were 94 points. Overall FOLLOW UP. outcome of IKDC rating was normal or nearly normal in 19 Urs Munzinger, Zurich, SWITZERLAND patients (90%). Bone tunnels enlargement of 1 mm was identi- Tomas Drobny, Zurich, SWITZERLAND fied in 1 femoral tunnel (5%) and in 1 tibial tunnel (5%). Mario Bizzini, Zurich, SWITZERLAND, Presenter Schulthess Clinic, Zurich, SWITZERLAND Conclusion: Periosteum is easy to harvest from proximal tibia where has a routine incision for hamstring tendons harvesting. Background: Injuries of the posterior cruciate ligament can rep- Besides the potential for enhancement of tendon-bone healing, resent an invalidating knee condition for the patients. The sur- enveloped-periosteum may aid in sealing off the intra-articular gical management of PCL injury is controversial, and often only tunnel opening in a early period to avoid synovial fluid reflux short-term results are published. In the literature there is little into the tunnel. Bone tunnel enlargement could be decreased. This clinical results showed that arthroscopic ACL reconstruc-

5.103 tion with periosteum-enveloping hamstring tendon graft is graft (Achilles tendon, patellar tendon) has been generally encouraging and can be considered to be a reasonable choice. used. Allograft tendon are not always available in most coun- tries. Patellar tendon autograft is difficult to pass due to the ori- entation of tunnel and associated with anterior knee pain. The Poster #241 purpose of this study is to describe the technique of arthro- COMPARISON OF QUADRUPLE HAMSTRING TENDON scopic PCL reconstruction with an alternative autograft, patel- GRAFT AND QUADRICEPS TENDON GRAFT IN ANTERIOR lar bone- quadriceps tendon graft. We presented a 3 years CRUCIATE LIGAMENT RECONSTRUCTION outcome report. Chih-Hwa Chen, Kweishan, TAIWAN, Presenter Wen-Jer Chen, Taoyuan, TAIWAN Materials and methods: The graft is harvested as a 20x10x8 Chun-Hsiung Shih, Taoyuan, TAIWAN mm3 bone plug of upper patellar bone and 75x10x6 mm3 of Chang Gung Memorial Hospital, Taoyuan, TAIWAN central quadriceps tendon, including rectus femoris and partial thickness of vastus intermedius. Arthroscopic PCL reconstruc- Introduction: Quadruple hamstring tendon graft and quadri- tion is performed using two-incision method. The graft is ceps tendon autograft are two of the graft using in the ACL passed from femoral to tibial tunnels with bone plug fixation reconstruction. The purpose of this study is to compare, at min- with interference screw at femoral tunnel and free tendon end imal two-year follow-up, the outcomes of ACL reconstruction fixation with suture and bicortical screw at tibia. when using quadruple hamstring tendon autograft versus quadriceps tendon autograft. Results: Between 1996 and 1998, this graft has been used in 24 patients. 21 patients with at least 3 years complete follow-up Materials and methods: A Hamstring tendons graft consisted of data were included in this study. 19 (90%) patients demon- a 10 cm of 4-stranded semitendinosus tendon and gracilis ten- strated good or excellent results by the Lysholm knee rating. In don graft. A quadriceps tendon graft consisted of a 20x10x8 mm the IKDC rating, 12 (57%) patients revealed a 3 to 5 millimeter bone plug and 80x10x6 mm tendon portion. During 1996-1997, ligament laxity. Two (10%) patients revealed grade II laxity. At 3 there were 32 patients with hamstring tendon autograft and 29 years after surgery, 18 (86%) patients had less than a 10 mm dif- patients done with quadriceps tendon autograft. 28 of ham- ference in thigh girth between their reconstructed and opposite string tendon autograft group and 26 of quadriceps tendon limbs. 17 (81%) patients were assessed as normal or nearly nor- group with complete follow-up data for at least 3 years were mal rating by IKDC guideline. included for final analyses. Clinical assessments included Lysholm knee scores, IKDC scores, thigh muscle girth and Conclusion: Arthroscopic reconstruction for PCL appears with strength, and radiographic evaluation. this graft could produce satisfactory results at 3 more years postoperatively. Quadriceps tendon autograft has the advan- Results: In the Lysholm knee rating, 93% of patients demon- tage of self-available, easier arthroscopic technique, and com- strated good or excellent results in the hamstring tendon parable graft size. It is a reasonable alternative choice of group, as did 92% of patients in the quadriceps tendon group. autograft used for PCL reconstruction. The IKDC rating revealed no difference between two groups in POSTER ABSTRACTS terms of activity level, symptoms, and range of motion. 5 patients (18%) in the hamstring tendon group and 4 patients Poster #243 (15%) in the quadriceps tendon group revealed a 3-5 mm liga- THE EFFECTS OF KNEE POSITION, GRAFT TENSION AND ment laxity. 2 patients (7%) with hamstring tendon grafts and 2 MODE OF FIXATION IN POSTERIOR CRUCIATE LIGAMENT patients (8%) with quadriceps tendon grafts revealed grade II RECONSTRUCTION laxity. There was no difference in the IKDC final rating of normal Ching-Jen Jen Wang, Kaohsiung Hsien, TAIWAN, Presenter and nearly normal grading between two groups. There is no sig- Hsiang-Ho Chen, Kaohsiung Hsien, TAIWAN nificant difference in flexor or extensor muscle deficit between Han-Shiang Chen, Kaohsiung Hsien, TAIWAN two groups. Ting-Wen Huang, Kaohsiung Hsien, TAIWAN Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung Hsien, TAIWAN Conclusions: Comparable satisfactory results between the two surgical groups were demonstrated at a minimal 3 years follow- Background and Purpose: Many knees exhibit residual ligament up. The four-stranded hamstring tendon graft is a strong graft laxity after PCL reconstruction which was believed technique and associated with minimal harvesting morbidity. The quadri- related. The purpose of this study was to investigate the opti- ceps tendon autograft had one side bone plug and adequate mal graft tension, the best angle of knee flexion and the mode graft size. We regard that both grafts could afford good ligament of fixation in posterior cruciate ligament (PCL) reconstruction. reconstruction likelihood and are reasonably acceptable graft choices for ACL reconstruction. Type of Study: Anatomic biomechanical study

Design and Method: A testing apparatus with frictionless bear- Poster #242 ing that allows other degrees of freedom except for flexion and ARTHROSCOPIC PCL RECONSTRUCTION WITH extension of the knee joint was designed. The normal PCL ten- QUADRICEPS TENDON AUTOGRAFT sion at different angles of knee flexion was measured with a Chih-Hwa Chen, Kweishan, TAIWAN, Presenter force transducer, and the optimal tension of the PCL graft that Wen-Jer Chen, Taoyuan, TAIWAN allows full range of knee motion was studied with a tensiome- Chang Gung Memorial Hospital, Taoyuan, TAIWAN ter in 12 cadaver knees. The modes of fixation failure between interference fixation and postfixation were studied with Instron Introduction: Indications for surgical reconstruction of PCL machine in 8 cadaver knees each. include a grade III or IV injury, combined ligaments injuries, symptomatic posterior instability. Surgical treatment for PCL Results: The lowest PCL tension in normal knees was noted at injury with arthroscopic technique has been developed. But 200 to 300 of knee flexion, and the highest at 900. The optimal considerable controversy continues in regard to the choice of tension of PCL graft, that allows full range of knee motion, was graft tissues. Autograft (patellar tendon, hamstrings) or allo- 15 lbs (68 N). The average load of graft failure was 417 (179?30)

5.104 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). N with interference fixation, and 367 (149?01) N with postfixa- Full series : subjective evaluation: 9A, 27B,12C. Symptoms : 6A, tion when the patellar bone-tendon-bone graft was tested. 28B, 14C. Final score : 1A, 25B, 21C, 1D. Laxity : 5.0 ± 3.0 mm, There was no statistical difference in the failure load between gain : 62 %. interference fixation and postfixation (P = 0.753), however the PI : subjective evaluation: 6A, 8B,3C. Symptoms : 5A, 10B, 2C. modes of failure differ. The sites of failure for interference fixa- Final score : 1A, 10B, 6C. Laxity : 4.0 ± 2.0 mm, gain : 62 %. tion were 25% due to rupture of ligament substance, and 75% PPLI : subjective evaluation: 2A, 11B, 14C. Symptoms : 3A, 10B, bone plug pullout; and those of postfixation were 25% due to 4C. Final score : 4B, 12C, 1D. Laxity : 5.7 ± 3.5 mm., gain : 54 %. rupture of ligament substance, 37.5% due to fracture, and 37.5% PPMI : subjective evaluation: 6B. Symptoms : 6B. Final score : as a result of suture breakage. 5B, 1C. Laxity : 5.9 ± 3.0 mm, gain : 61 %.

Conclusion: The results of this study suggested that a 15 pound Whatever the parameter, the D category has almost disap- tension to the graft at 200 to 300 of knee flexion is optimal in peared at the last follow-up. This improvement was statistically PCL reconstruction. There was no statistical difference in the significant (p<0.001). failure load between interference fixation and postfixation despite different modes of fixation failure. Discussion and conclusion PCL reconstruction with a two-bundle autograft combined with secondary restraints repair, augmentation or reconstruction or Poster #244 limb alignment, when needed, leads to a laxity gain similar to OUTCOME STUDY OF THE SURGICAL ACL surgery. However, the combination of a postero-lateral TREATMENT OF 48 CHRO instability to PCL insufficiency has a lower prognosis on the Pascal Christel, Paris, FRANCE, Presenter final outcome (p=0.01). Patrick Djian, Paris, FRANCE Marc Branfaux, LYON, FRANCE Clinique Nollet, PARIS, FRANCE Poster #245 ANATOMICALAND HISTOLOGICAL STUDY IN KNEES OF This is a prospective and continuous study of 48 posterior RABBITS WITH EPIFISIAL CARTILAGE, AFTER THE chronic instabilities operated between 1995 and 2000. In this SECTION OF POSTERIOR CRUCIATE LIGAMENT. series, the PCL was always reconstructed with a 2-bundle tech- Moises Cohen, Sao Paulo, BRAZIL, Presenter nique. Fernando Luiz de Arruda, Sao Paulo, BRAZIL Rene Jorge Abdalla, Sao Paulo, BRAZIL Material and Methods : the series includes 33 males and 15 UNIFESP (CETE), Sao Paulo, BRAZIL females, 29 y.o. average at injury. The average disability time was 32 months ; 26 patients had sustained previous surgery Summary without PCL reconstruction. The pre-operative clinical exami- The aim of this experiment was to study morphology of rabbit nation showed 17 isolated posterior instabilities (PI), 17 com- knees with the epiphyses opened after section of the posterior bined postero-postero-lateral instabilities (PPLI), 6 combined cruciate ligament. Young and male rabbits were divided into postero-postero-medial instabilities (PPMI), 1 PPMI + PPL two groups: control group and experimental group with 60 instability, and 7 complex antero-posterior instabilities (PCL + knees in each group. Section of the posterior ligament was per- ACL + 2ndary restraints). In the current series the PCL has formed in the knees of the experimental group and only an always been arthroscopically reconstructed with a tibial tunnel arthrotomy was made in the control group. The animals were technique using two-bundle autograft either made of bone- re-operated after 3, 6 and 12 weeks being submitted to patellar tendon-bone for the 22 first cases, or quadriceps ten- euthanasia immediately after re-operation. A statistically sig- don (26 cases). Depending on the lesions, combined secondary nificant result in the experimental group was found in the fol- restraints insufficiency was always treated by reefing, autolo- lowing items of macroscopic evaluation: knee diameter, POSTER ABSTRACTS gous augmentation or reconstruction. In case of a varus knee bicondylar diameter, increase in synovial liquid, osteophite in associated to a PPLI, a HTO was performed prior to ligament the femur and lesion in the articular cartilage. No significant reconstruction. Outcome was evaluated by using the IKDC 93 values were found regarding lesion of the medial meniscus. In scoring system and the posterior laxity was measured with relation to histological evaluation, all the subgroups of the con- stress X rays. trol group did not present alterations and were considered as normal. In the experimental group, the items synovitis, hyper- Results plasia of chodrocyte, penetration of subchondrals vessels in The average follow-up was two years. All the patients have been the patellar cartilage and alteration in the anterior cruciate lig- followed at least for one year. No post-operative complication aments of the experiment showed significant results in the sta- was noticed. We will focus on the results of the 3 first groups : tistical analysis. These alterations had similar intensity and PI, PPLI, PPMI. location no matter if it was the right or left experimental knee. The anterior cruciate ligament of the experimental group pre- Pre-operative status sented significant alterations in the three subgroups. Full series : subjective evaluation: 12C, 36D. Symptoms : 6B, 10C, 32D. Final score : 9C, 39D. Laxity : 11.4 ± 4.3 mm. PI : subjective evaluation: 4C, 13D. Symptoms : 2B, 2C, 12D. Poster #246 Final score : 4C, 14D. Laxity : 9.9 ± 3.3 mm. MEDIAL PATELLO-FEMORAL LIGAMENT PPLI : subjective evaluation: 7C, 10D. Symptoms : 2B, 6C, 9D. RECONSTRUCTION Final score : 3C, 14D. Laxity : 11.7 ± 4.6 mm. Masataka Deie, Hiroshima, JAPAN, Presenter PPMI : subjective evaluation: 6D. Symptoms : 1B, 5D. Final Yoshio Sumen, Hiroshima, JAPAN score : 6D. Laxity : 13.0 ± 3.7 mm. Mitsuo Ochi, Izumo-shi, JAPAN Kenji Kobayashi, Hiroshima, JAPAN Last follow-up Masanori Yasumoto, Hiroshima, JAPAN Hiroshima University, Hiroshima, JAPAN

5.105 The Medial patello-femoral ligament (MPFL) functions to stabi- SURGICAL TREATMENT OF COMBINED ACL-PCL lize the patella preventing lateral dislocation. This study fol- INJURIES OF THE KNEE. A CLINICAL STUDY lowed 3 cases (4 knees) of recurrent dislocation patellae and 2 Andreas Panagiotis Diamantopoulos, Athens, GREECE, Presenter cases (4 knees) of habitual dislocation patellae after MPFL Iraklis Ioannis Patsopoulos, Athens, GREECE reconstruction. The average at time of surgery was 8.5 years Aristidis Bordokas, Athens, GREECE (range 6-10 years). The follow-up terms averaged 5.5 years (2-10 Emanouel Papadakis, Athens, GREECE years). None of the cases were complicated by other syn- Matheos Tzurbakis, Athens, GREECE dromes. Our MPFL reconstruction method involved transfer of 2nd Orthopaedic Department, Evangelismos General H, Athens, GREECE the semitendinosus tendon to the patella via the pulley of the posterior one-third part of proximal medial collateral ligament. Purpose: The aim of this paper is to study the knee injuries with The transferred tendon was then sutured on the surface of the simultaneous ACL and PCL rupture and the results of their patella. There were no patella dislocations after surgery and the reconstruction. average Kujala’s score was 96 points. X-ray evaluations revealed the average values of the congruence angle, the tilting angle, Material and method: The last eight years 24 patients were and the lateral shift ratio, were to be normal. However, the val- treated, during the acute phase, by the same team of doctors. ues of the lateral stress shift ratio, the medial stress shift ratio, The average age was 33,1 years (range, 20 to 61); 22 males and and Insall-Salvati ratio remained abnormal. We concluded that 2 females. In 12 incidents accompanied rupture of lateral struc- our MPFL reconstruction method might be considered a suit- tures was seen and in 6 rupture of medial structures, while in 20 able method for the treatment of recurrent and habitual patel- cases participation of posterior structures was observed. lar dislocation of children, although hyper-mobility of patellae Isolated injury of the central structure (ACL and PCL) was and the high position of the patellae remained. observed only in 2 patients. 3 Segond fractures were seen, 2 chondral lesions, 2 neurogical events while no vascular injury was observed. In all cases the damaged ligaments were Poster #247 anatomically exposed and reconstructed. The autologous grafts LONG TERM RESULTS OF ARTHROSCOPIC POSTERIOR mostly used for reconstruction, are BPTB for PCL and quadri- CRUCIATE LIGAMENT RECONSTRUCTION WITH BONE ceps tendon for ACL reconstruction. Postoperatively, an accel- PATELLAR TENDON BONE AUTOGRAFT erated program of rehabilitation was introduced, aiming in Antonio Delcogliano, Rome, ITALY, Presenter progressive mobilization of the joint and muscle endurance. 3 Amerigo Menghi, Roma, ITALY patients were reoperated because of inadequate movement of Silvio Chiossi, Roma, ITALY the knee joint. Giuseppe Rinonapoli, Roma, ITALY Salvatore Franzese, Rome, ITALY Results: 23 patients (95,8%) were reexamined. The average fol- Antonio Caporaso, Roma, ITALY low up period was 54,7 months. The evaluation of the results Universita Cattolica - Clinica Ortopedica, Roma, ITALY was performed with IKDC, Lysholm and Tegner score and KT- 1000. Average Lysholm-score was 86,78% (range, 53 to 100); Aim: The goal of this paper is to evaluate the results of our IKDC score was A in 5 cases, B in 10, C in 5 and D in 3; Average POSTER ABSTRACTS patients who underwent an arthroscopically assisted PCL Tegner-score was before accident 4,69 and in reexamination reconstruction using patellar tendon graft. 4,04. The mean anterior translation on KT-1000 testing was 7,1 mm (20° flexion - 89 Newton’s), the mean posterior translation Material and method: In this paper we report results obtained 5,0 mm (70° flexion - 89 Newton’s) and the mean differences in surgical treatment of 16 cases of chronic injury of the PCL. from the uninvolved side was 1,8 mm and 2,3 mm, accordingly. (The average age of patients was 26 years). All patients under- went an arthroscopically assisted bone-patellar tendon-bone Conclusion: Surgical treatment of combined ruptures of PCL autograft reconstruction. All patients were examined clinically and ACL must be immediate. The aim is to obtain anatomical and radiographically with an average follow-up of 38 months. restoration of all knee compartments. The rehabilitation pro- All patients were evaluated according to IKDC scoring system, gram must be aggressive. If the knee joint mobilization is not KT-1000 arthrometer, standard radiographic views and mag- accomplished within 4-6 weeks, arthroscopical adhesion’s netic resonance imaging. 13 patients (81,2%) graded normal (A) release must take place. or near normal (B) with IKDC scoring system.

Results: Posterior traslation measured by KT-1000 arthrometer Poster #249 improved from 10,8 mm preoperatively to 4,9 mm postopera- THE MULTIPLE LIGAMENT INJURED KNEE. OUTCOMES tively. X-rays excluded any sign of arthrosis. MRI has shown a OF SURGICAL TREATMENT. correct placement and alignment of tibial and femoral tunnel in Andreas Panagiotis Diamantopoulos, Athens, GREECE, Presenter 15 of 16 patients. Iraklis Ioannis Patsopoulos, Athens, GREECE Christina Neila, Athens, GREECE Discussion and conclusion: Posterior cruciate ligament (PCL) Ioannis Georgilas, Athens, GREECE injuries are more common than once believed and may repre- Matheos Tzurbakis, Athens, GREECE sent up to 30% of all knee ligament tears. Recent advances have 2nd Orthpaedic Department, Evangelismos General Ho, Athens, GREECE increased our knowledge of the anatomy and mechanical char- acteristics of the PCL, but current treatment of injuries involv- Purpose: The aim of this paper is to study the complex ligament ing the PCL remains a controversial issue in the field of sports knee injuries and to evaluate the results of surgical treatment. medicine. Our results confirm that BPTB arthroscopic tech- Material and method: Between 1993 and 2001, 51 patients with nique of PCL reconstruction allows a precise location of the 52 injured knees were treated. The average age was 32,9 years graft and achieves good clinical and functional results at mid (range, 18 to 68); 45 males and 6 females. Our material was and long term follow up. classified according to Strobel’s classification (1995): isolated injury of central structure (ACL and PCL) was found in 2 patients, injury of 2 anatomical structures in 22 patients, 3 Poster #248 structures in 23 and more than 3 in 5. In 10 incidents accompa-

5.106 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). nied fractures were seen, in 5 chondral lesions, in 3 neurogical The average follow-up is two years. All the patients have been damage while no vascular injury was observed. All patients followed at least one year. No post-operative complication was were operated, during the acute phase, by the same team of noticed. We will focus on the results of the 3 first groups: PI, doctors. All the damaged structures were anatomically exposed PPLI, PPMI. and restored (first capsular tears, then meniscal lesions and collateral ruptures and finally ACL and PCL ruptures). All grafts Pre-op status Pre-op for ligament reconstruction were autologus. Postoperatively Subjective Symptoms Global Score the knee was placed in a brace, set in 10°-60° and isometric GrI /GrII A B C D A B C D A B C D Laxity mm quadriceps exercises were began followed by progressive mobi- Full serie 12 36 6 10 32 9 39 11.4 ± 4.3 PI 2 /2 7/6 1/2 1/1 7/5 3/0 6/8 9.3 ± 3.1/ 9,5±3,6 lization of the joint. After 3 weeks full extension was permitted PPLI 4/3 6/4 2/3 3/3 5/4 1/2 9/5 10 ± 4.3 / 11± 5 and weight bearing was permitted after 6 weeks. Full activity PPMI 3/3 0/1 3/2 3/3 11.0 ± 3.2 /11,6±5 was achieved after 6 months. Follow-up Post-op Results: 46 patients/47 knees (90,2%) were reexamined. The Subjective Symptoms Global Score Gain average follow up period was 52 months. The evaluation of the GrpI/GrpII A B C D A B C D A B C D Laxity mm % results was performed with IKDC, Lysholm and Tegner score Full serie 9 27 12 6 28 14 1 25 21 1 5.0 ± 3.0 62 LPD 3/3 4/4 1/2 4/1 4/6 1/1 1/0 7/3 1/5 4.0 ± 2.0/3.8±1.7 54/62 and KT-1000. Average Lysholm-score was 86,6% (range, 53 to LPPE 1/1 0/1 9/5 2/1 6/5 2/2 1/3 8/4 1/0 5.7 ± 3.5/5±3.2 50/54 100); IKDC score was A in 9 cases, B in 23, C in 8 and D in 6; LPPI 3/3 3/3 2/3 1/05.9 ±3.0/4.9±3.3 61/61 Average Tegner-score was before accident 4,82 and in reexami- nation 4,1. The mean anterior translation on KT-1000 testing Discussion and conclusion was 6,9 mm (20° flexion-89 Newton’s), the mean posterior PCL reconstruction with a two-bundle autograft combined with translation 4,6 mm (70° flexion-89 Newton’s) and the mean dif- secondary restraints repair, show better result with QT graft ferences from the uninvolved side was 1,5 mm and 2,2 mm, (p=0.02). The gain with QT is significantly better (p=0.03). The accordingly. combination of a postero-lateral instability to the PCL insuffi- ciency has a lower prognosis on the final outcome (p=0,01). Conclusion: Immediate surgical reconstruction of the complex knee injuries must be obtained with great care and all the rup- tured anatomical structures must be restored. The rehabilita- Poster #251 tion program must be aggressive, aiming in progressive PATELLAR TENOPLASTY WITH GRACILIS AND mobilization of the joint and muscle endurance. The surgeon SEMITENDINOSUS: A CASE PRESENTATION must know all the alternative methods of reconstructing the Roberto Jose Batista Dorea, Salvador, BRAZIL, Presenter main knee ligaments and adjust them according to cases. Centro Medico AlianÁa, Salvador, BRAZIL

Purpose: This presentation demonstrates a new thecnique to Poster #250 give support to the recovery of the lesioned patellar tendon, COMPARISON OF TWO DIFFERENTS GRAFTS FOR THE maintaining the original strength and function, with the return TREATMENT OF 48 CHRONIC POSTERIOR INSTABILITIES to normal activities, permiting the blood supply of the strength- WITH TWO YEARS FOLLOW-UP ener tendon (gracilis and semitendineous). Patrick Djian, Paris, FRANCE, Presenter Pascal Christel, Paris, FRANCE Method: A central incision from the patella to tile tibial Clinique Nollet, Paris, FRANCE tuberosity is made, the tendon lesion is identified and the debridement of the injured edges of the patellar tendon is per- This is a prospective and continuous study of 48 posterior formed. The approximation of the edges with sutute is realized, chronic instabilities operated between 1995 and 2000. using Ethibond no2. Another incision is made on a level with POSTER ABSTRACTS gracilis and semitendineous tendons, holding the distal inser- Material and Methods : Two different graft were used to recon- tation of both, leaving their blood supply intact. The trans- struct the PCL. In group I, the PCL has been arthroscopically portation to the patellar tendon is realized, where it will be reconstructed with a two-bundle autograft of bone-patellar ten- fixed with a zig-zag suture, strengthening the previous patellar don-bone in 22 cases and in group II there were 26 cases in tendon’s suture. which the PCL has been reconstructed arthroscopically with a two-bundle quadriceps tendon. Results: On the 48th day after surgery the patient presented full extension of the knee, with 180° and flexion degree of 140°. He The two groups do not show any difference in term of sex ratio, returned to his atheletic activities, partially, after 4 months and average at injury and number of previous surgery. The pre-oper- completely, after 6 months, in combination with an intensive ative clinical examination showed in group I, 9 isolated poste- physiotherapy support. rior instabilities (PI) and 8 in group II, 10 combined postero-postero-lateral instabilities (PPLI) and 7 in group II, 3 Conclusion: This procedure has been demonstrated to be an combined postero-postero-medial instabilities (PPMI) and 3 in effective method in correcting the patellar tendon lesion, while group II, 1 PPMI + PPL instability in groupI, and 7 complex maintaining the original strength and function, thus permitting antero-posterior instabilities (PCL + ACL + 2ndary restraints). the return to atheletic activities with the same intensity. Combined secondary restraints insufficiency has always been treated either by reefing, autologous augmentation or recon- struction. In case of varus knee associated to a PPLI, a HTO was Poster #252 performed prior to ligament reconstruction. Outcome was eval- PATELLAR DISTAL REALIGMENT WITH MINI-INCISION IN uated by using the IKDC 93 scoring system and the posterior RECIDIVATING LUXATION OF THE PATELLA laxity was measured with stress radiography. Roberto Jose Batista Dorea, Salvador, BRAZIL, Presenter Centro Medico AlianÁa, Salvador, BRAZIL Results

5.107 Introduction: This technique originally appeared in 1888 when terolateral corner. The patients were the placed in a brace and it was described by Roux, and consisted of performing, by on a CPM 2 hours 2 times a day for 7 days, and the vascular sta- means of a large incision, the transplatation of the tuberosity of tus was monitored closely. After 7-10 days the patients under- the tibia, medially, and lowering it when necessary. The tech- went surgery including arthroscopic reconstruction of the ACL nique was improved by Hauser in 1938 and in 1989 Roberto and PCL with auto or preferably, if available, allograft. Results Dorea attempted to improve on the technique once again by for patient with a followup for more than 6 months are pre- markedly diminishing the size of the incision and fixing the sented including IKDS, Cincinatti, Tegner and a clinical exam tuberosity of the tibia with two small fragment screws which with KT1000. provided greater stability and dispensed with post-operatory immobilization. Results:. No serious complication occurred in conjuntion with surgery or the hospital stay. Two infections with staf aureus Purpose: This presentation demonstrates the realigment with occurred and was successfully treated. Three patients under- mini-incision technique which provided greater stability and went secondary arthroscopic debridement for arthrofibrosis > dispensed with post-operatory immobilization. 90 % of the patients have returned to work, but the majority have had to reduce or change their sports activities. The Technique: An incision measuring aproximately 3.5 cm is made Cincinatti score was 69 (36-99). on the distal portion of the patellar tendon. The tendon is sep- arated from the subcutaneous cellular tissue without the use of Conclusion:. We have designed a treatment protocol for this a cutting instrument, extending to the patella. The lateral part difficult patient group. Short term (6-60 months) follow up sug- of the tendon is carried out. After partially disengaging of the gest promising results. distal insertion of semitendineous, gracilis and semimen- graneius muscles, a new bone attachment is formed. The removal of the patellar tendon with the bone block centralized Poster #254 and temporarily attached onto the new site is then completed. INTERNATIONAL PATELLOFEMORAL STUDY GROUP After verifying if the patella centralization is stisfactory it can be (IPSG) LATERAL RELEASE SURVEY RESULTS fastened in a definitive manner. The distal portion of semi- Donald C Fithian, San Diego, CA, USA, Presenter tendineous, gracilis and semimembraneius muscles is then Liz W. Paxton, El Cajon, CA, USA reinserted. The closing is done by planes and after that a com- William R. Post, Morgantown, WV, USA pressive bandage is used. Southern California Permanente Medical Group, San Diego, CA, USA

Results: In the period comprised of December 1989 to The aim of this study was to identify consensus and disagree- December 2001, 38 surgeries were performed with this tech- ment on lateral release (LR) indications and techniques. A sur- nique, 34 with good results (89,5%), 03 with satisfactory results vey was sent to all members of an international group of (7,8%) and 01 with an unsatisfactory result (2,6%). orthopedic surgeons with interest in knee extensor mechanism disorders. The survey asked about indications, procedure vol- Conclusion: This procedure is a technically easier and more ume, and LR mechanisms. Twenty-seven surgeons completed POSTER ABSTRACTS effective method for recidivating luxation of the patella, with the survey (60% response rate). The median number of opera- and excellent post-operatory recovery and great aesthetic tive procedures performed per year was 300. Few surgeons appearance. (15%) performed more than 10 LR cases per year. The median number of LR was 1-5 per year (<2% of surgical volume). The majority performed at least one LR per year as primary or sec- Poster #253 ondary surgery (70%). The preferred technique for isolated LR MANAGEMENT OF KNEE DISLOCATIONS – was open or mini-open (59%). Fewer than 40% used LR in treat- EXPERIENCE OF 67 ing patellar dislocation. Fewer than 20% used LR in patellar Lars Engebretsen, Oslo, NORWAY, Presenter subluxation or dislocation. Over 50% identified lateral tilt by Steinar Johansen, Stabekk, NORWAY examination as a requirement to justify LR. Most respondents Tom Clement Ludvigsen, Oslo, NORWAY (70%) identified systematic hypermobility as a contraindication Steinar Johansen, Stabekk, NORWAY to LR. Over 70% obtained informed consent for LR during rou- Oslo Orthopaedic University Clinic, Oslo, NORWAY tine arthroscopy. Most respondents (78%) identified relief of tension in the retinaculum as the mechanism for how LR works. As a level I trauma hospital, OOU receives an increasing num- Conclusions: There is strong consensus that objective evidence ber of knee dislocations. This report is based on the treatment is needed to support lateral release. That is, few surgeons of acute knee dislocations seen at OOU from May 1. 1996 would perform LR on basis of history alone. There is little through July 2001. agreement as to what physical or imaging evidence provides the best indication for LR. Isolated lateral release is performed Patients and methods: infrequently even among surgeons with specific interest in dis- 66 patients with 67 dislocated knees were admitted in the peri- orders of the patellofemoral joint. ode. All patients were students or working prior to the injury and all had a high functional level. 50% of the dislocations occured in conjunction with major traffic accidents- the major- Poster #255 ity of which were motorbikecyklists, while the remaining ONE VERSUS TWO INCISION PCL RECONSTRUCTION injuries were sustained during sports. 4 patients had a com- USING MULTIPLIED HAMSTRING TENDONS. plete injury of the peroneal nerve on admittance, while an addi- Masayuki Hamada, Hirakata, JAPAN, Presenter tional 4 had decreased motor strength and \or sensory Konsei Shino, Habikino, Osaka, JAPAN dysfunction. In addition one patient had a ruptur of the patel- Shuji Horibe, Sakai, JAPAN lar tendon and one a patella dislocation. Two of the patients in Tomoki Mitsuoka, Kashiba, JAPAN this group had a vascular injury. On admittance the patients Ken Nakata, Amagasaki, JAPAN underwent a diagnostic exam in the emergency room.. All the Norimasa Nakamura, Sakai, JAPAN patients then had a MRI with a special protocol for the pos- Yukiyoshi Toritsuka, Osaka, JAPAN

5.108 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Atsushi Sugita, Ibaragi, JAPAN tibial reconstruction, and single bundle tibial inlay reconstruc- Osaka Univ. Medical School, Suita, Osaka, JAPAN tion. The same 10 mm fresh frozen Achilles tendon graft was used for both reconstructions in a given specimen. The graft (Objective) was preconditioned for 15 cycles with 10 lbs (44 N) and fixed at Recent innovation in arthroscopic surgery has made it possible 90° of knee flexion with a tension of 20 lbs (88 N). The kine- to perform one-incision technique PCL reconstruction without matics for each of the four knee conditions and the in situ femoral skin incision. The purpose of this study was to clarify forces in the intact PCL and the PCL grafts were determined. difference in clinical outcome between the conventional two- Statistical analysis was performed using repeated measures incision and the newer one-incision PCL reconstruction. ANOVA (p<0.05).

(Materials and Methods) RESULTS: Posterior tibial translation with each reconstruction There were 30 patients (male 26, female 4) with a mean age of was significantly greater than that in the intact knee at all flex- 26 suffering from unilateral chronic PCL insufficiency. The tibial ion angles by 1.7 to 2.1 mm (p<0.05). There were no significant tunnel was created from anterior cortex to the center of the PCL differences in posterior tibial translation between the two tech- footprint, while the femoral drill hole was positioned at the niques at any flexion angles (p>0.05). The in situ forces in the center of the footprint of the anterolateral bundle. In the former PCL grafts with both techniques were significantly lower than 15 patients, the femoral drill hole was created in outside-in those of the intact PCL at 30°, 60°, 90°, and 120° by 7 to 39 N fashion using a drill guide (two-incision group), while it was (p<0.05). There were no differences in in situ forces in the PCL created inside-out fashion through the far lateral anterior por- grafts between the trans-tibial and tibial inlay techniques tal in the latter 15 patients (one-incision group). After the graft (p>0.05). of 3-4 stranded hamstring tendons was introduced into the joint, it was first fixed to the femur with a button or screw post CONCLUSION: These data suggest that either technique may in the two-incision group or with Endo-button in the one-inci- be performed with similar biomechanical results. The finding sion group. Then, it was fixed to the tibia under manual maxi- that neither technique was able to restore intact knee kinemat- mum tension at 0° with a screw post in both groups. ics or in situ forces in the PCL suggests that the single bundle Postoperatively, all the patients were rehabilitated according to graft used in both techniques was inadequate in resisting a the same protocol. At 2 years post operation, they were evalu- posterior tibial load when compared to the intact PCL. ated with IKDC Knee Ligament Standard Evaluation Form, However, this study evaluated the efficacy of PCL graft con- quantitative laxity measurement using plain radiography (grav- structs at initial fixation. Biological healing studies are needed ity sag view) and isokinetic thigh muscle power analysis. to address issues such as graft elongation and remodeling over time, and only a randomized controlled clinical study will truly (Results) determine if there is any clear advantage of either technique. While 22 of the patients (74 %) regained full ROM, 8 of them (26 %) showed flexion loss of 5° to 10°. According to the IKDC sub- jective assessment, 53 % of the two-incision group patients Poster #257 were graded as normal; 33 %, nearly normal; 13 %, abnormal, RECONSTRUCTION OF THE POSTEROLATERAL CORNER. while 53 % of the one-incision group were graded as normal; 47 A NEW SURGICAL PROCEDURE %, nearly abnormal; 0 %, abnormal. The mean side-to-side pos- Bent Wulff Jakobsen, Aarhus, DENMARK, Presenter terior laxity difference of 4.2 + 2.9 mm for the two-incision Bent Lund, Aarhus C., DENMARK group was significantly greater than the value of 2.4 + 2.0 mm S¯ren Kjeldsen, Aarhus, DENMARK for the one-incision group (p < 0.05). There was no difference in Svend Erik Christiansen, Aarhus, DENMARK thigh muscle strength between the two groups. Division of Sports Trauma, University Hospital of, Aarhus, DENMARK

(Conclusion) Lesion of the popliteus fibular ligament and the popliteus ten- POSTER ABSTRACTS One-incision technique provides better outcome than two-inci- don with or without rupture of the lateral collateral ligament is sion one in restored stability. often referred to as lesion of the postero-lateral corner of the knee. The postero-lateral corner is involved in 4% of all knee- ligament injuries giving an incidence of less than 0.1 per 1.000 Poster #256 per year. Lesion of the postero-lateral corner is often related to BIOMECHANICAL COMPARISON OF TRANS-TIBIAL lesion of either rupture of the anterior or posterior cruciate lig- VERSUS TIBIAL INLAY PCL RECONSTRUCTIONS ament. Untreated lesion of the postero-lateral corner will lead Fabrizio Margheritini, Rome, ITALY to rotatory instability. Undiagnosed lesion can lead to failure of Craig S Mauro, Pittsburgh, PA, USA primary anterior cruciate ligament reconstruction. Primary Jeffrey Rihn, Pittsburgh, PA, USA repair with or without augmentation is recommended. In Kathryne J Stabile, Pittsburgh, PA, USA chronic cases stability should be established using an Savio L-Y Woo, Pittsburgh, PA, USA anatomic reconstruction. Christopher D Harner, Pittsburgh, PA, USA, Presenter University of Pittsburgh, Pittsburgh, PA, USA Material: In the period from May 1887 to Jan 2001 51 patients with posterolateral instability were treated with primary repair PURPOSE: The objective of this study was to determine the bio- with augmentation or reconstruction. Median age were 30 mechanical efficacy of the tibial inlay and trans-tibial tech- years, 29 were males. Chronic cases constituted 72,5% and niques of PCL reconstruction in restoring knee kinematics and 31.4% had previous surgery. Cause of injury were RTA in 35% in situ forces of the intact knee. and sport in 41%. The concomitant ligament lesions were: Isolated PLC/LCL 6 METHODS: Ten human cadaveric knees (34-80 years) were PLC & ACL 20 tested. Using a robotic/universal force-moment sensor testing PLC & PCL 15 system, a 134 N anterior-posterior load was applied at 0°, 30°, PLC & ACL & PCL 9 60°, 90° and 120° of knee flexion. Each knee was tested under PLC & ACL & PCL & MCL 1 four conditions: intact, PCL-deficient, and single bundle trans-

5.109 Method: All had reconstruction of the lateral structures with a was 30.2 mm. Patellar tracking was not changed by the femoral new procedure using hamstring grafts. Through a lateral hockey rotation. stick approach the proximal tibia and fibula were exposed as well as the anatomical insertion points of the lateral collateral Discussion: Our study demonstrated that patellar tracking was ligament and the popliteus tendon at the femoral epicondyle. affected significantly by MPFL deficiency. Studies of the surgi- Drill-holes through head of fibula, proximal tibia and femur cal findings in acute patellar dislocation indicated that the were done and a reconstruction of the lateral collateral and the MPFL was torn as the patella dislocates. Our study indicated popliteus tendon with semitendinosus and gracilis graft were that the MPFL deficiency caused recurrent lateral patellar dis- performed. Concomitant ligament instability were treated with location in patients with abnormal Q-angle. reconstrucion using either autografts or allografts. All were evaluated with subjective assessment and objectively using KT1000 according to the IKDC form >12 months post-op. Poster #259 Results: Preop 93% had > 10° lateral rotatory instability at 90° ARTHROSCOPIC PCL AND COMBINED LIGAMENT prone examination; postop all were stable (74% grade A, <5°; RECONSTRUCTION IN THE ATHLETE 26% grade B, 6-10°). Mario Victor Larrain, Buenos Aires, ARGENTINA, Presenter Hugo Montenegro, Buenos Aires, ARGENTINA Conclusion: It can be concluded that significant PCL instability David M. Mauas, Cap Fed, ARGENTINA often is combined with PLC instability and non-diagnosed PLC Cristian Collazo, Capital, ARGENTINA instability concomitant to ACL instability may lead to ACL Nicolas Carrasco, Buenos Aires, ARGENTINA reconstruction failure. A 2 double bundle reconstruction of the Argentine Rugby Union and Arthroscopy Sport Injuri, Buenos Aires, LCL and PLC result in good objective stability with low compli- ARGENTINA cation risk. Purpose The purpose of this study is to analyze our surgical indication Poster #258 and results in the PCL and associated ligament reconstructions DYNAMIC PATELLAR TRACKING IN PATHOLOGICAL in sports injuries. CONDITIONS Ryosuke Kuroda, Pittsburgh, PA, USA, Presenter Material and method Kiyonori Mizuno, Kobe, JAPAN Between November ‘89 to October ‘00 we performed a retro- Masahiro Kurosaka, Kobe, JAPAN spective study in 46 patients operated with PCL reconstruction, Shinichi Yoshiya, Kobe, JAPAN excluding: bone avulsions, vascular and neurological lesions. Nobuzo Matsui, Kobe, JAPAN The most frequent sport was rugby 18 cases (39%) followed by Hirotsugu Muratsu, Kakogawa, JAPAN soccer 13 cases (28%). Only 4 cases (9%) suffered crash car acci- Masayoshi Yagi, Kobe, JAPAN dent (high energy). 37 patients had multiple ligament lesions Department of Orthopaedic Surgery, Kobe University, Kobe, JAPAN (80%). 42 cases were male (91.3%), Average age 25 years (range 18 - 37). All patients were evaluated with standard x-ray, we POSTER ABSTRACTS Objective: Symptoms of patellar instability may be caused by measure the posterior translation in the lateral stress view per- various abnormalities, such as patellofemoral dysplasia and formed at 90° of flexion, grade I: 5mm, grade II: 10mm, grade III: malalignment, dysfunction of medial soft tissue restraints, more than 10mm. The M.R.I. was useful to confirm the PCL articular surface injury. However, the pathogenesis of the patel- injure and to evaluate associated lesions. lar instability is still unknown. The purpose of this study was to know the dynamic patellar tracking under the pathological con- Surgical indications ditions and investigate the pathogenesis of the patellar insta- 1. Active young patients with acute grade III lesions or grade bility. II lesions with associated posterolateral injuries. 2. Symptomatic chronic grade II and III lesions Methods: Six fresh-frozen human cadaveric knees were used. Cases: The knees were extended using a material testing machine. Isolated PCL;...... 9 (19.5%) Magnetic position sensors (3 SPACE FASTRAK, Polhemus Inc., PCL + Posterolateral...... 19 (41.3%) Colchester, VT) were mounted on the femur, tibia and patella. PCL + ACL...... 12 (26.1%) The dynamic patellar tracking was measured using position PCL + ACL + Posterolateral...... 4 (8.7%) sensors from the angle of 90 to 0 degree of the knee joint with PCL + ACL + Posteromedial...... 1 (2.2%) the following conditions; 1) Medial patellofemoral ligament PCL + ACL + Posterolateral + medial...... 1 (2.2%) (MPFL) dysfunction, 2) lateralization of tibial tuberosity (10mm lateral), 3) realignment of the direction of the extensor mecha- Surgical Technique nism muscle force (10 degrees lateral), 4) the abnormal internal We performed an arthroscopic transtibial reconstruction of the rotation (10 degrees) of the femur. The lateral shift of the anterolateral bundle with a strong 11 mm. diameter graft. patella and the lateral tilt angle of the patella with respect to Although we had used the patellar tendon in our first 11 cases, the femur were calculated. we prefer the cuadripital tendon as a first choice for the PCL reconstruction, because of some intrinsic characteristics Results: In the intact knees, the maximum patellar tilt was 4.4 (length, thickness, one bone side, etc.). 22 reconstructions were degrees and the maximum patellar shift was 4.9 mm. The patel- performed with cuadricipital auto graft. In multiple ligament lar shift was affected by lateralization of tibial tuberosity and reconstructions, Achilles tendon allo graft is very useful if it’s abnormal direction of the extensor mechanism muscle force available. (increased Q-angle). The lateral patellar tilt and shift were sig- nificantly affected by loss of MPFL. The average of the maxi- Results mum tilt angle changed from 4.4 to 8.1 degrees. Furthermore, We evaluated 46 cases, mean follow up 4 years and 10 months MPFL deficiency combined with increased Q-angle significantly (range 18 month to 12 years and 4 months) using subjective increased the patellar tilt and shift. The average of maximum and objective methods. According to Lisholm score we tilting angle was 35.4 degrees and the maximum patella shift obtained 42 cases (91.3%) of excellent and good results, 3 cases

5.110 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). (6.5%) fair, and only 1 case (2.1%) poor. With the stress x-ray evaluation comparing to the contra lateral side, we found: Poster #261 Grade 0: posterior translation negative: 6 cases (13%) COMPARATIVE ANALYSIS OF DELAYED LAXITY Grade 1 (< = 5 mm.): 30 cases (65.2%) DEVELOPING AFTER ARTHROSCOPIC PCL Grade 2 (6 - 10 mm.): 7 cases (15.2%) RECONSTRUCTION IN ISOLATED AND COMBINED INJURY Grade 3 (> 10 mm.): 3 cases (6.5%) OF POSTERIOR CRUCIATE LIGAMENT Kwang-Won Lee, Daejeon, SOUTH KOREA, Presenter Conclusions Dept. of Orthopaedic Surgery, Eulji University Hos, Daejeon, SOUTH KOREA The isolated PCL reconstruction is not very frequent (19%) because of it’s good healing potential and his good tolerance. Purpose: To analyze the clinical and radiological results of the Using the arthroscopic transtibial one single bundle technique delayed laxity developing after arthroscopic PCL reconstruction is difficult to obtain similar objective results comparing with of isolated and combined PCL-deficient knees. the non injured contralateral side (6 cases -13%- with negative posterior translation). Most of the cases had grade I posterior Materials and Method: From June 1994 to June 2000, we retro- translation (30 cases -65.2%-). 80% of the cases (37 patients) spectively evaluated 45 subjects with PCL-deficient knees who required multiple ligament reconstruction. The simultaneous were treated by arthroscopic PCL reconstruction using Achilles repair was possible in our hands with this technique. On the tendons (allograft). At a mean follow-up of 49 months (range: other hand, the Lisholm score showed in 42 cases (91.3%) 12-72), the functional results were evaluated according to the excellent and good results, with a high percentage of return to IKDC knee ligament evaluation form and Lysholm knee score sport. We know is very difficult to restore all the biomechanical and KT-2000 arthrometer. The postoperative posterior laxity of PCL, but with an adequate diagnosis and a correct recon- was measured with difference of posterior translation between struction of the PCL and the associated lesions, we obtained the injured and uninjured knee. satisfactory results. Results: Preoperative mean side to side differences of the pos- terior translation were 11.83mm in 18 isolated PCL-deficient Poster #260 knees and 12.7mm in 27 combined PCL-deficient knees, respec- POSTERIOR CRUCIATE LIGAMENT RECONSTRUCTION tively. Postoperative mean differences of the posterior transla- USING HAMSTRING TENDON WITH PRESERVATION OF tion were 6.38mm in isolated PCL-deficient knees and 6.7mm in POSTERIOR CRUCIATE LIGAMENT REMNANT combined PCL-deficient knees, respectively (P>0.05). The Beom Koo Lee, Seoul, KOREA, Presenter Lysholm mean score was 87.4 points in isolated PCL-deficient Gachon Medical College, Gil Medical Center, Inchon, KOREA knees and 81.2 points in combined PCL-deficient knees at last follow up postoperatively. Purpose : The purpose of study is to evaluate the clinical results of PCL (posterior cruciate ligament) reconstruction using the Conclusion: The functional results were no relationship to the quadruple hamstring tendon with preservation of the PCL rem- degree of laxity. Tendency of posterior laxity may be influenced nant. by associated injury of the knee.

Type of Study : Case series. Poster #262 Methods : Twenty PCL reconstructions have been performed by ANALYSIS OF RELATIONSHIPS BETWEEN SUBJECTIVE one surgeon. The average follow-up period were at 31 months. AND OBJECTIVE GROUPS OF IKDC SCORE Isolated injuries were eleven cases and associated injuries were Abbas Madani, Tehran, IRAN, Presenter nine cases. Arthroscopic findings, preoperative and postopera- Iran University of Medical Sciences, Tehran, IRAN tive posterior displacement at stress radiograph, Lysholm knee POSTER ABSTRACTS score and complications were evaluated. INTRODUCTION Recent analyses of knee ligament surgeries have attempted to Results : As a functional result, the average postoperative quantify the functional outcome after surgery. Among accepted Lysholm knee score was 92, showing more than good in eight- outcome measures used to evaluate knees following ligament een cases (90%). The average preoperative posterior displace- injury are the IKDC knee rating scale . Although outcome stud- ment with stress radiograph was 14 and the postoperative one ies using IKDC have documented the positive impact of ACL was 3.2. Postoperatively in isolated injuries, the average poste- reconstruction, variations in the functional outcome after Lig rior displacement at stress radiograph was 2.6. In associated reconstructions have not clearly correlated with objective injuries, the average posterior displacement at stress radi- measures of stability. The purpose of this study was 1) to deter- ograph was 3.7. In case of reconstruction within three weeks, mine if guidelines established by the International Knee the average laxity was 2.6. And in case of reconstruction after Documentation Committee (IKDC) could distinguish differ- three weeks, average posterior laxity was 3.7. ences in outcome, as indicated by the patients’ subjective rat- ing of knee function and The resumption of sporting activities Conclusions : Good stability and function of knee could be following ACL reconstruction, and 2) to determine which sub- obtained by PCL reconstruction using Hamstring tendon with groups included in the IKDC rating system contribute to the preserving the PCL remnant and slow rehabilitation. prediction of the outcome result.

Publishing and Reprint Information MATERIAL & METHOD - from Department of Orthopaedic Surgery, Gil Medical Center, Sixty-six patients were studied prospectively following four Gachon Medical College,Inchon, Korea. strands hamstring ACL reconstruction by a single surgeon. - Address correspondence and requests to Beom Koo Lee, Average follow up was 15.92 months. the graft fixed by A.O M.D., Department of Orthopaedic Surgery, Gil Medical Center, screw and spiked washer to supracondyle of femur. after com- Gachon Medical College, 1198 Kuwol-dong, Namdong-gu, pletion of a brace free, intensive rehabilitation program, results Inchon, Korea. E-mail : [email protected] were recorded using the IKDC knee score, Objective measures of stability included Lachman, anterior drawer and pivot-shift

5.111 tests. we named the; patient subjective assessment box of the which resulted from applying nominal pretensions at 30° were form as “ patient’s satisfaction” and the combined results of the also recorded. An ANOVA with repeated measures was used to lachman, the pivot-shift, and the anterior drawer test as “lig determine differences in knee laxities at each flexion angle for tests” in this study .Improvement of activity level and patient’s the various test conditions. satisfaction was our two criteria for the outcome result. Results: The ACL and PCL graft pretensions were found to be RESULTS: interrelated; applying tension to one graft produced a change in 63 patients (%99.5) considered their knee function normal or the pretension in the other (fixed) graft. This was due to the near normal. one leg hope were >%90 of opposite side in 35 tendency of the tibia to sublux posteriorly from applied ACL patients (%53) and >%76 in 18 patients (%27.3). in ligament pretension, and anteriorly from applied PCL pretension. The examination group of IKDC 18 patients (%27.3) were graded A PCL graft had to be pretensioned first to consistently restore and 44 patients (%66.7) B. an overall IKDC assessment 59 (%89) near-normal knee laxities. When the ACL graft was preten- were considered normal or nearly normal. patient satisfaction sioned first, in most cases the graft had to be slackened or pre- were A in 24 patients (%36.4) and B in 36 (%54.5), 52 patients tensioned to a very low level to achieve the final nominal mix of (%78.8) had improvement in their activity level but only 41 ACL and PCL force; this was an inconsistent and non-reprodu- patients (%62.1) could return to preinjury activity level patient’s cable pretensioning strategy. The nominal graft pretensions satisfaction correlated with one leg hop (p=0.024), final result applied at 30° degrees of flexion were 23.7 N for the PCL and 9.8 (p<0.001) and with the pivot shift test (p=0.019). The resump- for the ACL. The corresponding graft forces which developed tion of sporting activities and work mostly correlated with the when the knee was subsequently extended to 0° were 76.8 N for one leg hop (p<0.001)and med meniscus tear(P=0.031) but did the PCL and 30.4 for the ACL. When the knee was lexed to 90° not correlate with the lig tests. Furthermore, none of the laxity the graft forces were 68.8 for the PCL and 17.3 for the ACL. It tests correlated with the return to preinjury activity level. final was not possible to match laxity of the intact knee at 0° flexion result had significant relationship with presents activity level in all specimens: mean laxity at full extension with nominal (P<0.001), ant drawer test (P=0.032), patient’s satisfaction graft pretensions was 1.6mm greater than the intact knee. (p<0.001) and one leg hop (P<0.001). Overtensioning the PCL by 40N (at 30° flexion) significantly reduced knee laxity at all flexion angles, while overtensioning Conclusion : the ACL did not. At 0, 30 and 90 degrees the mean laxities were Although lig exams is commonly used for evaluation of the 9.4, 14.4, and 13.0 for the intact knee; 11.0*, 14.6, and 13.2 when results in ACL reconstruction in the clinics and had relation- the nominal pretensions were used; 9.7 +, 13.0 +, and 10.4 + ship with patient’s satisfaction, but as the results of this study when nominal PCL pretension + 40 N was used; 10.1, 13.3, and one leg hop could be the most sensitive predictor of postoper- 14.0†; when nominal ACL pretension + 40 N was used. ative outcome result and highly correlated with the patient’s satisfaction and resumption of activities . * sign. diff. from Intact (p < .05); + sign. diff. from nominal (p < .05); † sign. diff. from PCL (nom. +40N) (p > .05)

Poster #263 Conclusions: Pretensioning both grafts at 30° degrees of flexion POSTER ABSTRACTS RECONSTRUCTION OF THE ACL-PCL DEFICIENT KNEE: (PCL pretensioned first) generated the most consistent knee A BIOMECHANICAL STUDY OF GRAFT PRETENSION AND laxity patterns. The mean PCL pretension was 2.4 times that for KNEE LAXITY the ACL. The graft pretensions determined in this study were Keith L Markolf, Los Angeles, CA, USA, Presenter somewhat lower than those believed to be used in clinical prac- Geoffry O’Neill, Los Angeles, CA, USA tice. Steven Jackson, Los Angeles, CA, USA David R. McAllister, Los Angeles, CA, USA University of California, Los Angeles, California, USA Poster #264 MEDIAL SOFT TISSUE RESTRAINTS Introduction: Reconstruction of the ACL-PCL deficient knee TO THE DYNAMIC PATELLAR TRACKING remains a significant orthopaedic challenge. Clinical results Kiyonori Mizuno, Kobe, JAPAN, Presenter from these procedures are often poor, with a failure to restore Ryosuke Kuroda, Pittsburgh, PA, USA normal knee laxity. Various graft pretensioning protocols have Shinichi Yoshiya, Kobe, JAPAN been previously described but none have been studied biome- Masahiro Kurosaka, Kobe, JAPAN chanically. The purpose of this study was to determine the lev- Hirotsugu Muratsu, Kakogawa, JAPAN els of ACL and PCL graft pretension necessary to restore a Nobuzo Matsui, Kobe, JAPAN near-normal knee laxity profile between 0° to 90° of flexion, and Masayoshi Yagi, Kobe, JAPAN to determine the best graft pretensioning sequence. Department of Orthopaedic Surgery, Kobe University, Kobe, JAPAN

Methods: Laxity testing at 200N of applied AP force was per- Objective: Previous studies of the pathoanatomy of acute patel- formed on twelve fresh-frozen knee specimens at 0°, 30°, and lar dislocation indicated that the medial retinaculum is torn as 90° of knee flexion. After resection of both cruciates, load cells the patellar dislocates and can lead to the chronic lateral insta- were installed to record forces at the tibial insertion of an ACL bility and recurrent dislocation. Anatomic studies have identi- graft replacement and at the femoral origin of a PCL graft fied that the medial patellofemoral ligament (MPFL) was the replacement; both grafts were fashioned from B-PT-B prepara- primary stabilizer against the lateral patellar displacement. tions. Both grafts were pretensioned at 30° of knee flexion. However, the importance of the MPFL on dynamic patellar Through trial and error, levels of graft pretensions were found instability has been still unknown. The purpose of this study which best restored AP laxity and also generated reasonable was to investigate the role of MPFL and the effectiveness of graft force profiles over a 90° degree range of passive knee flex- MPFL reconstruction on dynamic patellar tracking. Methods: ion; these were referred to as the nominal ACL and PCL pre- Five freshfrozen human cadaveric knees were used. The knees tensions. Knee laxities were also measured while first applying were extended using a material testing machine. Magnetic the nominal pretension to one graft, and then overtensioning position sensors (3 SPACE FASTRAK, Polhemus Inc., the other graft by 40N. Graft forces at 0° and 90° of flexion Colchester, VT) were mounted on the femur, tibia and patella.

5.112 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). The dynamic patellar tracking was measured using position TROCHLEAPLASTY – AN EFFECTIVE SURGICAL OPTION sensors from 90 to 0 degree of the knee joint with the following IN RECURRENT PATELLAR DISLOCATION DUE TO conditions; 1) the medial restraints intact and then cut to deter- DYSPLASTIC PATELLOFEMORAL GROOVE mine their contribution to lateral translation of the patella, 2) Rolf F Oetiker, Cham, SWITZERLAND, Presenter MPFL reconstruction using hamstrings tendon. The lateral shift Heinz Bereiter, Chur, SWITZERLAND of the patella and the lateral tilt angle of the patella with Department of Orthopaedic Surgery, Kantonsspital, Chur, SWITZERLAND respect to the femur were calculated. Results: In the intact knees, the maximum patellar tilt was 7.3 degrees and the max- Purpose: Numerous pathologies are known to be a possible imum patellar shift was 5.6 mm. Patellar tracking was not sig- cause of chronic recurrent patellar dislocation. Among these nificantly affected by loss of medial restraints except MPFL. the dysplasia of the trochlea is considered to be most impor- Patellar tracking was changed significantly by loss of the MPLF tant. According to Dejour the dysplasia of the patellofemoral at 40 - 0 degree of the knee flexion angle. The maximum patel- groove can be recognized in strictly lateral x-rays (crossing lar shift was 11.5 degrees and the maximum tilt was 7.9 mm. sign). The surgical goal in patients with recurrent dislocations These were significantly different from the intact knees. Normal due to dysplasia of the patellofemoral groove (trochlea) should dynamic patellar tracking was substantially restored after therefore be the reconstruction of the patellofemoral groove. reconstruction of the MPFL. Discussion: Recently the impor- tance of MPFL has been described in the literature. However, Patients and Methods: From 1990 to 2001 73 Patients - mainly only a few papers of the dynamic patellar tracking have been previously operated ineffectively - with recurrent patellar dislo- published. Our study demonstrated that MPFL played an cation due to dysplasia of the trochlea have been reconstructed important role to stabilize the patella at knee flexion angle of by an osteotomy with formation of a new, deepened less than 40 degrees and that the reconstruction of MPFL patellofemoral groove (trochleaplasty): A distally connected restored normal patellar tracking. osteochondral flake is removed from the distal and ventral part of the dysplastic trochlea and is then refixed after having deep- ened the osseous groove in a v-shaped manner. Surgical strat- Poster #265 egy was determined by preoperative X-ray and CT. •BIOABSORBABLE VERSUS METAL SCREW IN Postoperative results were verified clinically with additional ANTEROMEDIAL TIBIAL TUBERCLE TRANSFER – Visual Analog Scale (VAS) and conventional X-rays. CT-Scan, A BIOMECHANICAL STUDY MRI and arthroscopy were performed in selected patients in the Teppo L.N. Järvinen, Tampere, FINLAND earlier series as well as histologic examinations in three cases. Janne T Nurmi, Tampere, FINLAND, Presenter Pekka Kannus, Tampere, FINLAND Results: Preliminary results of our 1 to 10 year follow-up show Harri Sievänen, Tampere, FINLAND a marked subjective and objective functional improvement in Markku Järvinen, Tampere, FINLAND over 90% of the patients. No relevant cartilage damage due to Department of Surgery, University of Tampere; and, Tampere, FINLAND the surgical technique was found in post MRI and arthroscopy examinations. The longterm success seems to depend highly Anteromedial tibial tubercle transfer has been proven success- on the correct diagnosis of a dysplastic patellofemoral groove ful in the treatment of patellar malalignment. In this operation causing recurrent patellar dislocation and a precise technique the osteotomized and transferred tibial tubercle is fixed with of this demanding surgical procedure. screws, commonly with 1-2 bicortical or cancellous metal screws. In this study, twenty-two pairs of human cadaver tibiae (44 tibiae in total) were used to compare the initial fixation Poster #267 strength of 4.5-mm bicortical bioabsorbable and metal screw. COMPARISON OF ENDOSCOPIC AND 2-INCISION PCL The volymetric bone mineral density of the knee pairs was RECONSTRUCTION USING AUTOGENOUS HAMSTRING determined at the proximal tibia using peripheral quantitative TENDONS POSTER ABSTRACTS computed tomography (pQCT) and no significant difference Yasumitsu Ohkoshi, Hakodate, JAPAN, Presenter was found in the bone densities between the bioabsorbable Shinya Nagasaki, Hakodate, JAPAN screw group (total: 215 +/- 30 mg/cm3, trabecular bone: 174 +/- Ryosuke Ishida, Hakodate, JAPAN 31 mg/cm3) and the metal screw group (total: 217 +/- 34 mg/cm3, Tomoyuki Hashimoto, Hakodate, JAPAN trabecular bone: 178 +/- 40 mg/cm3). In our two-phase biome- Shigeru Yamane, Hakodate, JAPAN chanical testing protocol, the specimens were first subjected to Kazuki Yamamoto, Hakodate, JAPAN a cyclic loading test (1500 loading cycles between 50 and 300 N Hakodate Central General Hospital, Hakodate, JAPAN at 0.5 Hz frequency), after which they were loaded to failure at a rate of 1.0 m/min (single cycle load-to-failure test). No signif- Purpose: The purpose of this study is to determine the advan- icant displacement differences were observed between the two tages of our endoscopic technique (a new single running route groups in the cyclic loading test. In the subsequent single cycle of the graft) over the conventional two-incision technique in load-to-failure test, the average yield load was 566 +/- 234 N in PCL reconstruction. the bioabsorbable screw group and 984 +/- 630 N in the metal screw group (p=0.002). However, no significant group differ- Surgical technique: The concept of our surgical technique is to ences were found between the two screws with regards to stiff- minimize the graft angulation at the inner edge of the bone tun- ness. The mode of failure was screw breakage and/or bending in nel. The tibial entry point of the guide pin is under the tibial lat- the bioabsorbable screw group, and screw bending and/or pull- eral subcondylar flare approximately 1-2 cm anterior to the out in the metal screw group. In conclusion, considering the posterior cortex. This creates less graft angulation on the pos- average maximum quadriceps pull measured in humans (390 terior aspect of the tibia. A new drill system has been devised +/- 76 N, Rupp et al. Arthroscopy 15: 179-184, 1999), even a single to allow antegrade femoral drilling starting from inside the bioabsorbable bicortical screw seems to provide a sufficient notch. This method also allows better femoral tunnel orienta- strength of fixation for the anteromedial tibial tubercle transfer. tion. As a substitute graft material, we employ autogenous hamstring tendons, and we secure them with an Endobutton and Post-screw. Poster #266

5.113 Materials & Methods: From 1992 to 1995, 43 two-incision PCL reconstructions with autogenous hamstring tendons were per- Conclusion: Posterolateral instability of the knee is a complex formed. And from 1995 to 2001, 90 endoscopic PCL reconstruc- injury, mainly treated surgically. Surgical failure leads to great tions with looped autogenous hamstring tendons using an functional disability, not easily treated. That is why rehabilita- Endobutton were performed. Cases were specified according to tion must be achieved in terms of tremendous care. the inclusion criteria of this study. As a result, fifty-one patients were included in this study. The two-incision group comprised 22 patients (group I) and the endoscopic reconstruction group Poster #269 comprised 29 patients (group II). The clinical evaluation was THE TREATMENT OF COMBINED INJURIES OF THE performed using the IKDC form. The quadriceps strength was POSTERIOR CRUCIATE AND MEDIAL COLLATERAL measured using Biodex II. The period for achieving 90 degrees LIGAMENT. MCL STABILITY DEPENDS ON PCL STATUS of flexion after surgery was also compared. Seung-Suk Seo, Pusan, SOUTH KOREA, Presenter Paik Hospital, Pusan, SOUTH KOREA Results: There were no significant differences between the two groups tested with respect to the overall IKDC rating score. The Purpose: There are many reports on the management of com- mean value of side to side differences of AP total laxity (KT bined injuries of the anterior cruciate ligament (ACL) and MCL. 1000, manual max.) was 3.95mm in group I, 2.38mm in group II Reports on the treatment of combined posterior cruciate liga- (p<0.05). The average period for achieving 90 degrees of flexion ment(PCL) and MCL injuries are rare. The purpose of this study after surgery was 16.6 days in groupI, 12.1 days in group II. is to evaluate the results of the treatment of combined PCL and Achievement of ROM in group II was significantly shorter. The MCL injuries and factors effecting on the MCL stability. peak torque of isokinetic contraction in group II was signifi- cantly greater than group I at one year after surgery. Materials and Methods: we retrospectively studied 10 patients with combined PCL and MCL injuries. The mean age of patients Discussion & Conclusion: Better posterior stability and quicker was 33.6 years. The causes of injury were sports trauma in 2 and postoperative recovery of ROM and muscle strength were traffic accidents in 8 cases. 4 PCL were repaired or augumented advantages of the endoscopic technique over the two-incision with autogenous hamstring tendons and 6 PCL were recon- technique in PCL reconstruction. structed. 2 MCL were conservatively treated and 8 MCL were repaired. The results were evaluated with Lysholm score, IKDC form, Telos stress radiograph at mean follow up 3.9 years. Poster #268 POSTEROLATERAL KNEE INSTABILITY. SURGICAL Results: According to Lysholm score 2 were execellant, 2 good, TREATMENT AND CLINICAL RESULTS. 3 fair, 3 poor. Using the IKDC grade 2 were A, 2 B, 4 C, 2 D. Iraklis Ioannis Patsopoulos, Athens, GREECE, Presenter According to stress X-ray the PCL laxity were classified with Andreas Panagiotis Diamantopoulos, Athens, GREECE group 1 (less than 5 mm posterior laxity) and group 2 (more Emanouel Papadakis, Athens, GREECE than 6 mm posterior laxity). Group 1 were 4 and group 2 were 6 Ioannis Georgilas, Athens, GREECE cases. Group 1 showed mean 1.7 mm valgus laxity and group 2 POSTER ABSTRACTS Matheos Tzurbakis, Athens, GREECE showed mean 3.2 mm valgus laxity at the stress radiograph. 2nd Orthopaedic Department, Evangelismos General H, Athens, GREECE Conclusions: The results of the treatment of combined PCL and Purpose: The aim of this paper is to study the posterolateral MCL injuries were less satisfactory. MCL stability depended on knee instability and to evaluate the results of surgical treat- the PCL status. This study showed that a more sophisticated ment. PCL reconstruction was needed to obtain the secure medial stability. Material and method: Between 1995 and 2001, 20 patients were treated, by the same team of doctors. The average age was 29,4 years (range, 20 to 61); 19 males and 1 female. Eight patients Poster #270 suffered from acute injury, while the rest (12) were chronic. In SUBJECTIVE EVALUATION OF THE MEDICAL TRANSFERT 14 incidents accompanied rupture of PCL was seen, while in 12 OF THE ANTREIOR TIBIAL TUBEROSITY IN OBJECTIVE cases an ACL rupture was observed. The aim of treating chronic PATELLAR INSTABILITY cases, was to make an augmentation of posterolateral struc- E. Servien, Caluire, FRANCE, Presenter tures by using reconstruction techniques and to correct the T. Ait Si Selmi, Lyon, FRANCE joint alignment. In acute cases ruptures of posterolateral cor- Philippe Neyret, Caluire, FRANCE ner were identified and repaired, or an augmentation of pos- Centre Livet, Caluire, FRANCE terolateral corner with autologus graft (iliotibial band-popliteus bypass) took place, if it was necessary. Introduction Postoperatively the knee was immobilized in plaster for 6 The aim of this study is to analyse the functional results of weeks, followed by intensive physiotherapeutic program. recurrent patellar dislocations operated between 1998 and 1999. Objective evaluation is difficult. Rate of recurrent dislo- Results: 16 patients (80%) were reexamined. The average follow cation after surgery is one criteria of assessment. Subjective up period was 34,8 months. The evaluation of the results was evaluation seems to be an interesting criteria. performed with IKDC, Lysholm and Tegner score and KT-1000. Average Lysholm-score was 86,3% (range, 57 to 100); IKDC Material and methods score was A in 3 cases, B in 8, C in 3 and D in 2; Average Tegner- 190 knees (140 patients) were included in this study. Mean fol- score was before accident 5,87 and in reexamination 4,5. The low-up was 5 years (2 years - 12 years). Knees subjective evalu- mean anterior translation on KT-1000 testing was 6,1 mm (20° ation of IKDC 99 was used in post-operative.This evaluation has flexion-89 Newton’s), the mean posterior translation 5,2 mm 18 items for estimate the sport activities level and the func- (70° flexion-89 Newton’s) and the mean differences from the tional level of the knee. 118 patients (83%) have answered to uninvolved side was 1,4 mm and 2,6 mm, accordingly. All the questionnaire. patients returned to their previous activities in 8 months time.

5.114 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Results Takashi Kawada, Kurume, JAPAN 88 patients (63%) have been reviewed by questionnaire and Akira Maeda, Fukuoka, JAPAN clinically, and 29 patients (20%) by questionnaire only. 68 Kurume University School of Medicine & Narita Orth, Kurume, JAPAN patients (58%) were very satisfied and 43 (36%) were satisfied. One patient (0.86%) was disappointed and 5 (4.27%) were dis- [Purpose] Although MCL injury is usually treated conserva- satisfied.We have evaluated our results for the pain (37.6% of tively, it has not yet been agreed how to treat complete MCL discomfort), the swelling, the clamping, the instability, the daily injury associated with ACL insufficiency. For a series of such activities living (68% of discomfort in the kneeling), the sportive cases, we have performed anatomical advancement of the MCL, level. The mean subjective score was 77.2 (45.9 - 95.4). between 1990 and 1993. Here, we present the outcome after long-term follow-up. Discussion Some authors (Insall) disagree with the surgical treatment in [Materials and Methods] Anatomical advancement of the MCL recurrent patellar dislocation due to the onset of secondary combined with ACL reconstruction was performed for eight femoro-patellar arthrosis. But for us, the surgical treatment is male cases. Of these, four cases have been followed for a mean indicated when there was at least one dislocation with mor- period of 10 years (range: 9-11) after the operation. In all cases, phologic anomalies (trochlear dysplasia, patella alta, TT-TG). ACL reconstruction was performed by a traditional two-incision We didn’t found patello-femoral arthritis. It’s the patient him- technique. For the MCL injury, the remnant was pulled and self who appreciate the results of surgery and it shows the fixed at the center of the femoral insertion. The mean age at treatment by tibial tubercle transfer is efficient with good satis- operation was 33 years old (range: 20-43). The average period factory score. The quality of results depends on good analysis from the time of injury to the time of the operation was 10 of patellar pathology and factors of patellar instability weeks. A final assessment was based on the IKDC form. Stress (trochlear dysplasia, patella alta, AT-TG value, quadriceps dys- X-P and MRI were also performed. plasia, patellar tendon length). Our revision score is not very important because the young age of the series but the other [Results] Although the mean side-to-side difference on abduc- series of litterature are similar. tion stress test when the knee was extended was 0.25mm (range: 0-1), it was 1.6mm (range: 1-3) when the knee was bent Conclusion at 30 degrees. Only one case that had venue valgus knees was The surgery of recurrent patellar dislocation gives good results over 2mm. All cases revealed marginal osteoarthritic change on in long range (10 years). The subjective evaluation score IKDC X-P, and MRI revealed hypertrophy in the repaired MCL. allowed a precise appreciation by the patient. This study is the first that presents an subjective evaluation of the result of [Conclusion] At least, our procedure revealed relatively good medial transfer of the anterior tibial tuberosity in patellar dis- stability against abduction stress after a minimum 9-years fol- location. Finally, we need to know subjective score in different low-up period. However, our other findings have indicated the group of age in a control group. It would make possible to cre- necessity of a more certain reconstruction technique by a ate a ponderation score. strong graft.

Poster #271 Poster #273 SURGICAL TREATMENT INVETERATE DISLOCATION OF DOES THE ARTHROSCOPIC RELEASE OF THE EXTERNAL THE KNEE. PATELLAR RETINACULA REPRESENT A VALUABLE Nilson R. Severino, Sao Paulo, BRAZIL, Presenter METHOD IN THE TREATMENT RECURRENT Osmar Pedro Camargo, Sao Paulo, BRAZIL DISLOCATION OF PATELLA? Ricardo Paula Cury, Sao Paulo, BRAZIL Cristian Ioan Stoica, Bucharest, ROMANIA, Presenter

Aihara Tatsuo, Sao Paulo, BRAZIL Laurentiu Ciprian Nicolae, Bucharest, ROMANIA POSTER ABSTRACTS Victor Marques Oliveira, Sao Paulo, BRAZIL Golia Teodor, Bucharest, ROMANIA Santa Casa Medical School, Sao Paulo, BRAZIL Karakoutas Theodoros, Bucharest, ROMANIA Dinu Antonescu, Bucharest, ROMANIA The authors relate a rare case in the literature, of a 58 year old Foisor Orthopaedic Hospital, Bucharest, ROMANIA female patient, with complete inveterate dislocation of the left knee treated 11 months after the initial lesion with open reduc- The paper, based on a study group of 41 cases of arthroscopic tion, longitudinal incision, articular debridement, realignment release of the external patellar retinacula, shows the main clin- of the patella, lateral release and capsular reinforced medial ical, paraclinical and arthroscopic steps in diagnosis of recur- suture. rent dislocation of the patella. The result of arthroscopic evaluation and treatment were: quick functional recovery and The authors describe a literature revision, the history and the low hospitalization costs, due to the “one day surgery”. accomplished treatment, as well as the good result obtained Nevertheless classical arthrotomic surgery, combining sev- after four years of the surgery. eral complex techniques malalignment of the extensor mecha- nism still has a well-defined role in the treatment of the cases of recurrent dislocation of patella in which arthroscopic surgery Poster #272 is not suitable. ANATOMICAL ADVANCEMENT OF THE MEDIAL COLLATERAL LIGAMENT COMBINED WITH ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION: SERIES LONG- Poster #274 TERM FOLLOW-UP SERIAL EVALUATION OF THE RESTORED STABILITY Takashi Soejima, Kurume, JAPAN, Presenter AFTER POSTERIOR CRUCIATE LIGAMENT Hidetaka Murakami, Kurume, JAPAN RECONSTRUCTION Nobuhiro Tanaka, Kurume, JAPAN Atsushi Sugita, Ibaragi, JAPAN, Presenter Kensei Nagata, Kurume, JAPAN Osaka University, Suita, JAPAN Takanobu Abe, Kurume, JAPAN

5.115 [Purpose] at the tibial insertion site type C: diffuse damage of the super- It is generally known that restored stability obtained by poste- ficial layer over the whole length) and also into three types by rior cruciate ligament (PCL) reconstruction is inferior to that the location of deep layer damage (type I: at the menisco- obtained by anterior cruciate ligament (ACL) reconstruction. As femoral ligament, type II: at the menisco-tibial ligament, type it is important to learn when posterior laxity recurs after opera- III: neither type I nor II). Each MRI type was contrasted with the tion, this study was conducted to determine when posterior lax- operative pathology of the superficial and deep MCL. ity increases after PCL reconstruction. Results: Superficial layer: Four cases were classified as type A [Materials and Methods] by the MRI. As predicted by the MRI, intra-operative observa- Eighteen chronic isolated PCL-injured patients underwent tion revealed that the superficial fibers were ruptured or endoscopic PCL reconstruction (single-socket: 8 patients, bi- detached at the femoral attachment in all these cases. Seven socket: 10 patients) using multi-stranded autogeneous ham- cases were type C injury. Surgical exposure revealed that the string tendons. There were 13 male and 5 female patients with superficial fibers were ruptured in the midsubstance. Both the mean age of 28. Postoperatively, the knee was immobilized stumps were folded back from each other and there was a big for 2 weeks. Range of motion exercise was started at 2 weeks. gap between them in all cases. Contrary to the MR imaging Partial weight bearing was allowed at 3 weeks, followed by full which suggested extensive damage over the whole length, the weight bearing at 5 weeks. Jogging was recommended at 4 superficial fiber damage was localized to the disruption site. months and full sports activity was allowed at 8-9 months. There were no type B cases. Deep layer: Eight cases were clas- Lateral plain radiographs with the knee kept in upright position sified as type I by the MRI and surgical exposure verified the at 90 degrees (gravity sag view) were used to quantify the tibia- disruption of the menisco-femoral ligaments in all cases. One femur step-off before operation, immediately after operation, 1, case was a type II injury and the intra-operative findings con- 2, 3, 6, 12 and 24 months postoperatively. Side-to-side differ- firmed the rupture of the menisco-tibial ligament. Two cases ences of the tibia-femur step-off in the radiograph were used as were classified as type III. One case had a rupture of the an indicator of the posterior laxity. menisco-femoral ligament and the other case involved the dis- ruption of both the menisco-femoral and menisco-tibial liga- [Results] ments at the time of surgery. While all patients showed more than 2+ posterior laxity preop- eratively (Ave. +8.7 +/- 5.8 mm), their knees were overcon- Discussion & Conclusion: This study shows that, in most cases, strained immediately after the reconstruction (Ave. -5.1 +/- 3.3 the MRI accurately reveals disruption of the superficial fibers of mm). Ten (56 %) out of 18 patients maintained less than 3 mm the femoral attachment of the MCL, and also those of the deep laxity throughout the follow up periods, while the remaining 8 fibers. On the other-hand, MRI less reliably predicted the status (44 %) showed more than 3 mm laxity. Seven of the latter 8 of midsubstance tears in the superficial layer. However, the patients already showed abnormal posterior laxity at 1 month. results in this study support that the presence of diffuse abnor- mality in the signal intensity within the superficial fibers of the [Conclusion and significance] MCL is suggestive of the presence of a large gap between the This study has demonstrated that most of the patients who stumps of the torn MCL. This information could be helpful to POSTER ABSTRACTS showed abnormal posterior laxity (> 3 mm) at 12 months after surgeons in deciding whether to surgically repair or to conserv- PCL reconstruction showed that at 1 month postoperatively. In atively treat MCL injuries. order to improve the outcome of the PCL reconstruction, the rehabilitation program should be strictly controlled in early postoperative period, while the surgical procedure itself should Poster #276 be more sophisticated. DELAYED MEDIAL COLLATERAL LIGAMENT RECONSTRUCTION USING LOOPED SEMITENDINOSUS TENDON GRAFT FOR COMBINED ANTERIOR CRUCIATE Poster #275 LIGAMENT/POSTERIOR CRUCIATE LIGAMENT/MEDIAL COMPARISON OF THE MAGNETIC RESONANCE COLLATERAL LIGAMENT INJURIES OF THE KNEE IMAGING OF ACUTE GRADE III MEDIAL COLLATERAL Harukazu Tohyama, Sapporo, JAPAN, Presenter LIGAMENT INJURY WITH THE SURGICAL PATHOLOGY Kazunori Yasuda, Sapporo, JAPAN Yasuhiro Tagawa, Sakai,Osaka, JAPAN, Presenter Nobuto Kitamura, Sapporo, JAPAN Norimasa Nakamura, Sakai, JAPAN Yuko Anaguchi, Sapporo, JAPAN Tomoki Mitsuoka, Kashiba, JAPAN Yoshimitsu Aoki, Sapporo, JAPAN Yoshiki Shiozaki, Sakai, JAPAN Tokifumi Majima, Sapporo, JAPAN Masayuki Hamada, Hirakata, JAPAN Akio Minami, Sapporo, JAPAN Konsei Shino, Habikino, Osaka, JAPAN Department of Medical Bioengineeing & Sports Medic, Sapporo, JAPAN Shuji Horibe, Sakai, JAPAN Osaka Rosai Hospital, Sakai,Osaka, JAPAN Combined injuries to the anterior cruciate ligament (ACL)/ pos- terior cruciate ligament (PCL)/ medial collateral ligament Introduction: To contrast the preoperative magnetic resonance (MCL) result in multiplanar instability of the knee. Previous imaging (MRI) with the surgical pathology of the acute grade III studies have reported that surgical repair of the MCL associ- medial collateral ligament (MCL) injury of the knee. ated with cruciate ligament reconstruction in an acute phase has a high risk for the development of postoperative arthrofi- Methods: Eleven consecutive cases with acute grade III MCL brosis. Therefore, delayed MCL reconstruction after an acute injury combined with torn ACL and/or PCL were studied. All inflammatory phase is one of options to restore valgus stabili- cases underwent primary MCL repair in addition to ACL and/or ties and minimize a risk of postoperative arthrofibrosis for com- PCL reconstruction. The interval from the injury to the surgery bined ACL/PCL/MCL injuries. However, there were few studies ranged from 5 to 14 days (mean, 8.7 days). Using the MRI (three on clinical outcomes of delayed MCL reconstruction for com- successive T2-weighted coronal images), MCL injury was classi- bined ACL/PCL/MCL injuries. The purpose of the present study fied into three types according to the location of the damaged was to evaluate delayed MCL reconstruction using looped superficial layer (type A : at the femoral attachment site, type B:

5.116 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). semitendinosus tendon graft for combined ACL/PCL/MCL tion. Sixteen patients had an associated ipsilateral injury. There injuries of the knee. were nine open fractures. We classified the patella fractures in 10 patterns according to their radiographic configuration: A1 [Methods] Between 1995 and 1999, 12 patients (8 males and 4 (transverse), A2 (vertical), B1 (transverse upper pole), B2 (trans- females) with combined ACL/PCL/MCL injuries underwent verse lower pole), C1 (comminuted upper pole), C2 (commin- delayed MCL reconstruction using looped semitendinosus ten- uted lower pole), D1 (fractures with 3 fragments), D2 (fractures don graft with the following procedures for cruciate ligament with 4 fragments), D3 (comminuted inferior half) and D4 (com- injuries. In all acute cases (n=5), PCL reconstruction using minuted). The management was based on the pattern of the hamstring tendon graft had been performed within 3 weeks injury. The frequencies were: 1. A1+A2 fractures (25%). Most of after the injuries. At 3 months after the acute PCL reconstruc- them were treated with 2 Kirschner wires (KW) and anterior ten- tion or later, the patients underwent MCL reconstruction with sion band (21 fractures). 2. B1+B2 (16%) were treated, with the contralateral semitendinosus tendon in combination with equal proportion, partial excision (6 fractures), fixation via ACL reconstruction using the bone-patellar tendon-bone graft. sutures (5 fractures) or using tension band and 2 KW (5 frac- In all chronic cases (n=7), ACL and PCL reconstructions were tures). 3. C1+C2 fractures (15%) were treated with partial exci- simultaneously performed with the MCL reconstruction using sion (5), suturing (3) and tension band combined with 2 KW (5) autogenous grafts from the same sources to the acute ones. All or with screws (2 fractures). Most variable was the treatment of patients were available for a detailed evaluation that included type D (44%) fractures. a physical examination, the IKDC Knee Ligament Evaluation, and stress radiographs. Their mean age at the time of operation Results: Seventy-two out of the 100 patients were retrospec- was 23.8 years (16 to 41 years) and the mean follow-up was 3.6 tively evaluated (fifteen could not be contacted, eleven had years (2.0 to 6.0 years). died) during a mean follow-up period of 68.8 months (5 to 151 months). Postoperative radiographic evaluation showed corti- [Results] No patients underwent postoperative manipulation cal separation less than 4mm and step-off less than 3 mm or additional surgical procedures for the limitation in knee related to the fracture configuration. Patients were graded motion. At latest follow-up, none of the patients had flexion according to a functional scale which included assessment of: contracture of 3 degrees or more. The lack of flexion was 5 range of motion, pain, limitation of activity, atrophy of thigh, degrees or less in 10 knees (83%); and 6 to 15 degrees in the use of assistive devices during walking, swelling, giving-way remaining 2 knees (17%). Valgus stress radiographs showed and stair climbing. Results were scored as excellent: 28-30 that the side-to-side difference in the medial joint opening at points, good: 20-27 and poor: <20points. The mean postopera- 20 degrees of flexion was 0 to 2 mm in 8 knees (67%); and 3 to tive score for type A, B, C, D1, D2, D3, D4 was 28.8, 28.9, 29.4, 5 mm in the remaining 4 knees (33%). Final IKDC evaluation 28, 27.8, 28.5, 25.3, respectively. was grade B in 7 knees, grade C in 4 knees, and grade D in a knee, in which the side-to-side difference in the anterior-poste- Discussion: We introduce a new classification system for rior translation was more than 10 mm. patella fractures, which is based on preoperative radiographic evaluation. This system can be utilized for the optimal choice of [Conclusion] The results of the current study reveal that operative technique based on the fracture type as well as for delayed MCL reconstruction using looped semitendinosus ten- detailed postoperative outcome evaluation. don graft allows a satisfactory valgus stability for chronically MCL-deficient knees. Additionally, the present delayed MCL reconstruction procedure after an acute inflammatory phase Poster #278 has a low risk for the development of postoperative arthrofi- LIGAMENT REFERENCING TO DETERMINE FEMORAL brosis, even if the ACL or/and PCL reconstruction is simultane- COMPONENT ROTATION AND EFFECT ON PATELLA ously performed. Therefore, our approach including delayed TRACKING IN TOTAL KNEE ARTHROPLASTY

MCL reconstruction provides predictable outcomes for com- Ate Wymenga, Nijmegen, THE NETHERLANDS, Presenter POSTER ABSTRACTS bined ACL/PCL/MCL injuries, in spite of a prolonged treatment- Wilco Jacobs, Nijmegen, THE NETHERLANDS period and potential donor site morbidity. Sint Maartenskliniek, Nijmegen, THE NETHERLANDS

Introduction: Internal rotation of the femoral component in Poster #277 total knee arthroplasty can cause patella subluxation or dislo- PATELLA FRACTURES: A NEW CLASSIFICATION SYSTEM cation. Therefore many knee systems are ‘bone referenced’ and FOR POSTOPERATIVE OUTCOME EVALUATION use 3 degrees external rotation for the femoral component. Vasilios Kostopoulos, Ioannina, GREECE When ligament referenced systems are used, (lamina spreader Anastasios V Tokis, Anatoli-Ioannina, GREECE, Presenter or tensioner in flexion), the amount of rotation will vary, but is Christos Charitos, Ioannina, GREECE assumed to be within a safe range. Christos Papageorgiou, Ioannina, GREECE Anastasios Georgoulis, Ioannina, GREECE Goal: The goal of this study was to measure the rotation University of Ioannina, Ioannina, GREECE applied to the femoral component with a ligament tensioner in flexion and relate this rotation to patella tracking on axial radi- Purpose: To introduce a quantitative classification system for ographs. patella fractures. Methods: Subjects for this study were 47 patients undergoing Material-Methods: One hundred patella fractures had been primary total knee arthroplasty by one surgeon. After the treated surgically at our institution during a 10 year follow - up releases in extension, a tensioner (150 N) was used to deter- period. There were 67 men and 33 women from 15 to 82 years mine the femoral component rotation. Intraoperatively, the old (average age 43.8 years). Fifty-seven fractures resulted from rotation of the posterior bone cut was measured relative to the a fall or from a bumper direct blow; twenty-eight, from a dash- posterior condylar line. A custom-made goniometer was used. board injury; eleven were involved in a motorcycle accident and During follow-up, the patella position from the center of the direct blow; three, from a forced quadriceps contraction and trochlear groove was measured on standardized axial radi- one large osteochondral fracture due to lateral patella disloca- ographs with the leg relaxed.

5.117 Results: Average external rotation of the femoral component Poster #442 with the ligament balancing technique was 2.0 degrees (from 4° OPERATIVE MANAGEMENT OF MULTILIGAMENT internal to 10° external rotation; SD 3.3°). Ten components INJURIES IN ATHLETES were placed in slight internal rotation. Average position of the Matthias Rolf Schurhoff, Coral Gables, FL, USA patella was 1.7 mm lateral (from 9 mm medial to 6 mm lateral, Luis A Vargas, Coral Gables, FL, USA, Presenter SD 3.2 mm). The correlation between component rotation and John William Uribe, Coral Gables, FL, USA patella position was not significant (p=0.47). Two patients John E Zvijac, Coral Gables, FL, USA needed a lateralization of the tuberosity. Keith Sheldon Hechtman, Coral Gables, FL, USA UHZ Sports Medicine Institute, Coral Gables, Florida, USA Conclusion: The ligament balancing technique places the femoral component in an average of 2.0 degrees external rota- Introduction: The purpose of this study was to evaluate the out- tion, with a large inter-individual variation. There was no corre- come of surgical treatment of patients who suffered a knee dis- lation with patella tracking. Therefore, applying the ligament location. referencing technique should not lead to patella subluxation or dislocation. Materials and Methods: 22 patients with sports related injuries were identified over a ten year period, 17 were available for evaluation. The average follow-up was 51.5 months. All patients Poster #279 were male with a mean age of 29.5 years. 12 patients (70%) had TIGHTENING AND AUGMENTATION OF POSTERIOR concomitant meniscal injury, two (12%) had popliteal artery CRUCIATE LIGAMENT (USING MODIFIED TIBIAL INLAY injury, and three (18%) peroneal nerve injury. The outcome was TECHNIQUE) measured utilizing the IKDC scale, KT-1000 testing, and Biodex Jung Yong Bok, Seoul, REPUBLIC OF KOREA, Presenter isokinetic testing. Jin Soo Kim, Seoul, REPUBLIC OF SOUTH KOREA Dept of Orthopaedic Surgery, Yong-San Hospital, Seoul, REPUBLIC OF Results: All patients rated their knee normal preinjury and KOREA severely abnormal after injury and preoperative. At last follow- up, 5 patients rated their knee as normal, 8 nearly normal, 3 Tightening and Augmentation of Posterior Cruciate Ligament abnormal, and 1 severely abnormal. Range of motion was nor- - Using modified Tibial Inlay Technique - mal in 10 and nearly normal in 7. Stability was normal in 6, Young Bok Jung, M.D., Suk Kee Tae, M.D., Ho Joong Jung, M.D., nearly normal in 11. Functional level was nearly normal in 12, abnormal in 4, and severely abnormal in 1. KT-1000 testing for Jae Sung Lee, M.D., Tae Ho Kim, M.D. anterior instability found no patients with greater than 3 mm Department of Orthopaedic Surgery, Yong-san Hospital, difference, and 3 patients with 4 mm side to side difference Chung-Ang University, Seoul, Korea posteriorly. Biodex testing for extension deficits was 17.4% for peak torque, and 16.8% for total work. For flexion the peak Purpose : To introduce a new surgical method in chronic PCL torque was - 6.8%, and the total work -7.1%. There were 5 com- POSTER ABSTRACTS injury and to evaluate the outcome of the tightening and aug- plications which included arthrofibrosis, cellulitis, heterotopic mentation of posterior cruciate ligament (PCL) in chronic PCL ossification, posterior laxity, and loose body formation. deficient knees. Discussion: Early surgical intervention, with repair or recon- Materials and Methods : Eighteen patients who underwent struction of all involved structures, followed by a rehabilitation tightening and augmentation of PCL were evaluated at average program can yield good to excellent results in the majority of 36.7 months (24-49) after operation. Tightening of remnant cases. fiber of PCL by distally transferring tibial bony attachment and augmentation with one among 4 bundles of semitendinosus and gracilis tendons, autologous patellar tendon or allograft Poster #453 tendon were performed through a posterior approach in supine ARTHROSCOPIC REPAIR OF MEDIAL RETINACULAR position. The results were assessed by stress radiographs using RUPTURES ASSOCIATED WITH ACUTE PATELLA Telos stress device (Telos stress device; Austin & Associates, DISLOCATIONS: REPORT OF A NEW TECHNIQUE Inc., G. Scheuda, MD), maximal manual test with KT-1000 Lauren E Redler, Trumbull, CT, USA arthrometer (MED metric, USA), IKDC and OAK knee scores Michael R. Redler, Trumbull, CT, USA, Presenter before operation and at final follow-up. Steven P Fries, Trumbull, CT, USA The Orthopaedic and Sports Medicine Center, Trumbull, CT, USA Results : Average side to side difference in posterior stress radiograghs using Telos stress device improved from 9.9mm (6- Purpose: Acute patellar dislocation in athletes is a well-recog- 20) to 2.2mm (0-8). Average side to side difference in maximal nized entity that can cause significant impairment both acutely manual test with KT-1000 arthrometer also improved from as well as long term. Treatment options for an initial patella 6.9mm (5-10) to 1.9mm (0-5). Final IKDC score was A in three dislocation include immobilization, functional treatment or patients, B in eleven and C in four, which was C in 9 and D in 9 surgical repair. The rationale for each treatment choice is preoperatively. At last follow-up OAK score was excellent in 7 dependent on the nature of the injury; including the associated patients, good in 10 and fair in 1, which was fair in 7 and poor intra-articular damage, predisposing extensor mechanism in 11 preoperatively. Average OAK score improved from 67.5 malalignment as well the individual surgeon’s preference. In (42-79) to 87.0 (79-97). instances when pre-operative evaluation suggests a complete rupture or detachment of the medial retinaculum, surgical Conclusion : The above results show favorable outcome after repair becomes a viable option. The purpose of this study was tightening and augmentation of PCL without sacrificing the to do a preliminary report of a new technique for arthroscopic remaining fibers in reconstructive surgery for chronic PCL repair of the medial retinaculum associated with acute patella injury. dislocation using absorbable suture and anchors.

5.118 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Materials and Methods: Three patients with acute patella ARTHROSCOPIC ASSISTED REDUCTION AND MINIMAL dislocations presented to our sports medicine clinic within OSTEOSYNTHESIS IN TIBIAL PLATEAU FRACTURES hours of their dislocation. None of the patients had a previous Georgios Anastasios Babalis, N. Iraklio Attikis, GREECE, Presenter history of patella dislocation or significant patella-femoral mal- Gregory A Papadopoulos, Athens, GREECE tracking. Each injury occurred with the foot firmly planted on Emmanuel Antonogiannakis, Athens-Cholargos, GREECE the ground and then a violent twisting episode to the affected Kostas Karliaftis, Athens, GREECE knee. Each patient reported obvious visual evidence of patella Christos K Yiannakopoulos, Athens, GREECE dislocation with immediate onset of swelling. Evaluation in the Panos Efstathiou, Athens, GREECE office revealed a large hemarthrosis and lateral patella tilt with Orthopaedic Department Athens General Military Hos, Athens, GREECE the knee in an extended position. A palpable rent in the medial retinaculum could be appreciated. Plain x-rays revealed a lat- PURPOSE: The mid term outcome of selected tibial plateau eral patella tilt without evidence of bony damage. Each patient fractures and intra-articular associated lesions under arthro- underwent an MRI, which showed a complete rupture of the scopic control using cannulated screws or in combination with medial retinaculum. The decision was made to treat both hybrid external fixator. patients who were college and high school athletes operatively. Operative technique involved a diagnostic arthroscopy METHOD - PATIENTS: 28 patients 18-42 years old (ave. 24,2 y) done with standard anterior-medial and anterior lateral portals. that sustained a tibial plateau fracture from Ian ’98 to Jun ’01 Assessment of associated damage was done. Intra-articular underwent an arthroscopic assisted reduction using minimal evaluation of both patients revealed a significant hemarthrosis, osteosynthesis with percutaneous cannulated screws (types B1, traumatic chondromalacia of the articular surface of the patella B2, B3 to AO classification) or in combination with hybrid exter- and complete rupture of the medial retinaculum off the inser- nal fixator (Sheffield external fixator, Orthofix) (types C1, C3). tion into the medial non-articular portion of the patella. The Fractures were classified as 13 B1, 6B2, 4B3, 3C1 & 2C3. hemarthrosis was flushed using copious amounts of Postoperatively aggressive physical therapy and mobilization arthroscopy fluid. Mechanical chondroplasty of patella was was performed All patients were examined for follow up after 8- done using a shaver. Arthroscopic lateral release was accom- 52 months. (mean 32,4m). plished using a Mitek VAPR (Mitek Products, Westwood, MA). Care was taken to leave all fibres of the vastus lateralis intact. RESULTS: Accordind to HSS Knee Score, 75% of the results A shallow bony trough was then created along the medial were excellent, 17% were good while 8% were fair. We noticed 31 aspect of the non-articular surface of the patella using a round associated intraarticular lesions, while we repaired 19 of them arthroscopic burr. A medial para-patella portal was created and at the same time. There was anatomic reduction in all patients, after creating pilot holes, two to three Panalock anchors ((Mitek while one had secondary displacement that required a correc- Products, Westwood, MA). were placed proximally to distally tive osteotomy. Deep-venous thrombosis occurred in two cases along the previously created bony trough. Using a suture while one case with loss of flexion 6 months post-op was passer, one arm of the Panacryl suture was passed through the manipulated. We didn’t notice any compartment syndrome or medial retinaculum. This procedure was repeated to create a infection in our patients. Our mid-term results are as good as mattress suture configuration. Arthroscopy fluid inflow was the multiple short-term referred in literature. turned off and manual pressure was placed on the lateral aspect of the patella allowing for medial translation. CONCLUSIONS: Intra-articular tibial plateau fractures in Arthroscopic knot tying was then done through the medial elected cases (type B1, B2, B3, C1, C3) can be treated with min- para-patella portal. Excellent re-approximation of the medial imal osteosynthesis under arthroscopic technique. This tech- retinaculum was noted through a gentle range of motion. Post- nique has advantages as: minimal invasive procedure, better operatively the knee was placed into a post-op range of motion reduction of the articular surface, direct visualization and repair brace locked into full extension. Immediate weight bearing was of associated intraarticular lesions, lower complications rate encouraged and limited progressive motion was dialed into the and accelerated rehabilitation protocol. POSTER ABSTRACTS brace starting at post-op week number three. The brace was dis- continued at six weeks and aggressive therapy ensued. Results: At 24-month follow-up all three patients demon- Poster #281 strate full range of motion and strength, as well as normal sun- INFRA PATELLAR TENDONITIS IN PROFESSIONAL rise view x-rays. They deny any anterior knee pain or feeling of VOLLEYBALL PLAYER patella subluxation. There have been no recurrent episodes and Alvaro Chamecki, Curitiba, BRAZIL, Presenter all three patients have returned to full pre-injury level of sports Edilson Schwansee Thiele, Curitiba, BRAZIL participation. Luciene Bittencourt, Curitiba, BRAZIL Conclusion: This study represents only preliminary case Ana Maria Rebelo, Curitiba, BRAZIL reports on arthroscopic treatment of acute patella dislocations. Murilo Cesar Santos, Curitiba Parana, BRAZIL Limitations of this report include the fact that it is a retrospec- Emerson K. Zanoni, Curitiba, BRAZIL tive evaluation of a new technique and not a double-blinded Henrique Carvalho, Curitiba, BRAZIL prospective study. We believe, however, that the technique Clinica do Joelho, Curitiba, BRAZIL described is easy to perform and has the potential to provide excellent clinical results. It provides the surgeon with a mini- The extensor mechanism of the knee lesions are extremely mally invasive arthroscopic option when encountering the ath- common in sports with repetitive jumping, like volleyball, bas- lete with an acute patella dislocation associated with complete ketball and athletics. There are few study analyzing the predict- rupture of the medial retinaculum. ing factors, as well as how to prevent them. With this objective we analyzed 64 knees, 32 in high-level professional players (National volleyball team) and 32 recreational athletes (control Knee - Muscle/Tendon/Bone group). There were analyzed by magnetic Ressonance Imaging, the width, thickness, length and height of the infra patellar ten- don, and presence or not of inflammatory signs. We concluded Poster #280 that:

5.119 a- The professional athletes tendon length was bigger than images and increased signal intensity on T2-weghted images. the control group. (p< 0,05) This MR imaging pattern has known as bone marrow edema b- The relation p:as (articular facet/extra articular) was signif- (BME) pattern. Biopsy results showed that bone marrow edema icant bigger in the athletes group than the control group. without any ischemic necrosis. The symptoms resolved sponta- neously in all cases within four months. The nine patients were followed up for 12-36 months, and one case had relapsed in the Poster #282 opposite knee, which took on the regional migratory osteo- HIGH TIBIAL OSTEOTOMY AND ALTERATION OF THE porosis. TIBIAL SLOPE Erik Hohmann, Rockhampton, AUSTRALIA, Presenter DISCUSSION AND CONCLUSION: Transient osteoporosis typi- Andreas B Imhoff, Munich, GERMANY cally occurs in middle-aged men or in women in the third Department of Orthopaedic Sportsmedicine, Munich, GERMANY trimester of pregnancy, especially observed in the hip joint. However, there are few definite reports about the transient Introduction: High tibial osteotomies are commonly performed osteoporosis of the knee. The BME pattern on MR images is for varus/valgus malalignment of the knee. In the past we have useful for diagnosis of the transient osteoporosis of the knee. been well aware of correcting the coronal plane but did not In other words, familiarity with the distinct features of transient consider the sagittal plane when planning our osteotomies. osteoporosis on MR imaging is extremely important in the dif- Altering the sagittal plane might have an impact on the in situ ferential diagnosis in the patients with knee pain. forces of the cruciate ligaments and influence the stability of the knee. The purpose of this study was to investigate the amount of alteration of the tibial slope by closed wedge Poster #284 osteotomy. THE HISTOLOGICAL PATHOLOGY OF CHRONIC TENDON LESIONS Material/Methods: The study was conducted retrospective. John B King, London, UNITED KINGDOM, Presenter From 1/01 to 9/01 we reviewed all Xrays of patients that under- Sporte Medicine at the Royal London Hospital and Q, London, UK went a high tibial osteotomy or were admitted for removal of hardware. A total of 80 patients were operated. 67 patients The chronic tendon lesion remains confusing as evidenced by could be followed up. There were 41 males with an average age the variety of names used to describe the condition. This paper of 36,6 years (17-67) and 26 females aged on average 39,4 years describes the consistent histological change seen in the tendon (19-62). in which the term tendonosis has been applied on clinical grounds. Results:The slope of the preoperative Xrays was measured 6,1 degrees (0-12).The frontal plane was changed by a mean of 7,93 Method degrees. A closed wedge osteotomy decreased the slope by a The histological data of tendons explored within the last 18 mean of 4,88 degrees. Alteration of the coronal plane by six months are presented. Over this period 30 tendon lesions in degrees decreased the slope by 4,92 degrees, eight degrees by active athletes have been explored by the author. All have had POSTER ABSTRACTS 7 degrees, ten degrees by 4,75 and twelve degrees by 6,5 extensive non surgical treatment including exclusion of meta- degrees. Discussion: a closed wedge osteotomy decreases the bolic lesions, stretching and physiotherapeutic modalities, tibial slope. This causes an anterior shift in the starting posi- orthotic correction and where appropriate, injection. All have tion of the tibia potentially decreasing in situ forces acting on had scanning by MRI, CT or Ultrasound. Although the site of the the ACL. There was no correlation between the correction of the lesion varies the surgical technique has been consistent, coronal plane and alteration of the sagittal plane. namely stripping of the paratenon and excision of the central core lesion. The tendons involved have been the patella ten- don, the achilles tendon and the tibialis posterior. Poster #283 TRANSIENT OSTEOPOROSIS OF THE KNEE. Results DIAGNOSIS AND AETIOLOGY All specimens were reviewed in the Professorial Department of Makoto Kawakubo, Ichikawa-shi, JAPAN, Presenter a Teaching Hospital. The invariable finding was neovascularisa- Takahiro Koyanagi, Ichikawa, JAPAN tion. In addition there was variable myxoid degeneration, cleft Masanori Takahashi, Ichikawa, JAPAN formation and calcific deposition. In no specimen was there an Tatsuo Kobayashi, Nishitokyo city, JAPAN inflammatory cell response. Where the paratenon had been Kyosuke Fujikawa, Tokorozawa, JAPAN sent to the lab there were inflammatory cells. Tokyo Dental College Ichikawa General Hospital, Ichikawa, JAPAN Conclusion PURPOSE: To represent nine cases of transient osteoporosis of The lesion within the tendon of an athlete is not inflammatory. the knee. Under light microscopy it shows degeneration with repair. The clinical result. which is not the thrust of this paper showed a MATERIALS AND METHODS: Nine patients (Three women and return to previous activity in 26 of these patients within the six men) aged 35-84 years with debilitating knee pain were study window. The mechanism whereby surgical manipulation examined. All Patients underwent physical examination, clini- of this lesion is effective needs to be reviewed. It is a justifiable cal testing, radiography, scintigraphy, and magnetic resonance hypothesis that the major surgical insult simply starts a new (MR) imaging. Two patients underwent biopsy. genuine inflammatory process which may be the effect of eccentric muscle exercises (proven in muscle but not tendon) RESULTS: All patients had conventional radiographs that were or needling. rather normal or showed nonspecific osteopenia. Eight patients had bone scangrams that showed focal increased radionuclide uptake in the region of the painful joints. In each Poster #285 case, MR imaging of the affected joint showed regional TREATMENT OF CHRONIC PATELLAR DISLOCATION WITH decreased signal intensity of the bone marrow on T1-weighted A MODIFIED ELMSLIE-TRILLAT PROCEDURE

5.120 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Maurilio Marcacci, Bologna, ITALY, Presenter across the lateral femoral epicondyle. Once considered an Stefano Zaffagnini, Bologna, ITALY injury indigenous to runners, ITBS is also the most frequent Mirco Lo Presti, Bologna, ITALIA injury in triathletes. The purpose of this study is to identify ITBS Alberto Vascellari, Bologna, ITALY as a significant problem in triathletes and to propose both Elizaveta Kon operative and non operative measures for treating triathletes. Alessandro Russo, Bologna, ITALY The development of ITBS is usually caused by a combination of Istituti Ortopedici Rizzoli, Bologna, ITALY factors as training errors, anatomic factors, biomechanics of running, sport shoes and training surfaces; in triathlon we have PURPOSE OF THE STUDY to consider also the combination of the anatomical variants of The paper describe a modification of Elmslie Trillat procedure the lower extremity with improper cycle fit. For example, varus that usually is performed in severe cases of habitual or recur- knee or external rotation of greather than 20°, place a signifi- rent patellar instability. cant stretch on distal ITB when riding with internally rotated cleats. Infact abnormal lateral knee stress is most often the MATERIAL AND METHODS result of incorrect cleat pedal alignements. In triathlon the 18 knees (7 men and 8 women) treated for recurrent or habitual transition cycling-running with the change from concentric patellar dislocation evaluated clinically and radiographically at muscular contractions of cycling to eccentric contraction of mean follow-up of 5 years (range 24 months- 9 years). The mean running, and from unloaded cycling fase to the load state of age at the follow-up was 26,3 years (range 17-44 years). IKDC running, is an extremely delicate phase in witch some kilome- and the Kujala’s score, were used for clinical evaluation. At pre- tres are required to regain neuromuscular efficiency and elas- operative X ray all cases had patella “alta” (mean ratio 1.49). ticity indispensable for proper running style. In this phase the Nine cases showed severely abnormal congruence angle with a inability to dissipate the load forces of the locomotor appara- mean value of + 35° (min +8° max +54°) while 9 cases pre- tus by the lower limbs can favour the transmission of stress to sented a dislocated patella. Mean preoperative sulcus angle the knee. Consequently the triathletes (particularly those that was 141° (min 134° max 160°) and trochlea Bump [18] was in 5 have sporting backgrounds in swimming) normally tend to have cases grade III and in 13 cases grade II. Anteroposterior, lateral very little strength in the hip abductor (gluteus medius) and the and Merchants views for X-ray control triathletes fatigued after cycling fraction, are prone to increased thigh adduction and internal rotation at midstance, leading to SURGICAL TECHNIQUE an increased valgus vector at the knee. This situation increases When patella is still unstable during dynamic evaluation after tension on the ITB, making it more prone to impingement on execution of Elmslie Trillat procedure the medial third of the the lateral epicondyle of the femur, expecially during foot con- patellar tendon is isolated and harvested with corresponding of tact, when maximal deceleration absorbs ground reaction 1 cm length and 0,5 cm bone plug maintaining its insertion to forces. Furthermore the triathletes that have sporting back- the inferior medial side of the patella. This ligament is medial- grounds in cycling tend to be too tight in hip flexors and tensor ized and put in tension, trying to found a medial insertion that fascia lata and ileotibial band. guarantee. Patellar stability through the all range of motion. Weight bearing as tolerated is allowed after 3 days with full Clinical examination included a knee examination, assessment extension brace. Unrestricted activity including sports, by 8 to of lower extremity alignement, evaluation of biomechanics of 12 weeks postoperatively. running and of triathletes on their bicycles. All the athletes where examined with magnetic resonance to confirm the diag- RESULTS nosis. Treatment meseaures consist of training modifications, IKDC showed 11 knees A (normal) 4 knees B (most normal) 2 bicycle adjustements, stretching of TFL and ITB, strengthening knees C (abnormal) and 1 knee D (severely abnormal). Kujala of gluteus medius, rest or decreasing training distance, shoes score, showed excellent results in 16 knees, 1 fair and bad knee changes, physiotherapy and deep tissue massages. Indication respectively. The bad case presented at X-ray an overcorrection for cortisone injections was considered for those triathletes not POSTER ABSTRACTS of congruence angle. At follow- up X rays, the congruence angle responding to initial therapy. Surgery is indicated only after had a mean value of -6° (min -13°- max +4°). The mean Insall extensive nonoperative meseaures have failed to relieve symp- Salvati ratio at follow up was 1,19 toms. The surgical release excision of ITB was performed under local anaesthesia and was preceded in some case by an arthro- DISCUSSION scopic evaluation of the knee joint to rule out possible causes The technique described try to achieve a dynamic stability of of their symptoms. Triathletes underwent surgical release in the the patella through the all range of motion in severe patellar last 5 years excision of ITB where 15 among a group of 200 instability where Elmslie Trillat procedure is insufficient. No triathletes with ITBS and they return to preoperative sport lev- recurrence of patellar instability has been observed. Kujala and els in two months. IKDC score have shown 88% of satisfactory results with only two cases of minor discomfort. All patient regained full range of motion and in most cases were able to perform strenous activ- Poster #287 ity with no discomfort. The stability must be obtained with DEVELOPMENT OF AN INTRA-OPERATIVE AUTOMATIC dynamic control in the first degrees of flexion trying to avoid an APPARATUS FOR CALCIUM PHOSPHATE COATING IN THE excessive patellar medialization. HUMAN ANTERIOR CRUCIATE LIGAMENT GRAFT Hirotaka Mutsuzaki, Tsukuba, JAPAN, Presenter Masataka Sakane, Tsukuba, JAPAN Poster #286 Yutaka Miyanaga, Tsukuba, JAPAN ILEOTIBIAL BAND SYNDROME IN TRIATHLETES Yasuhiko Watanabe, Tsukuba, JAPAN Sergio Migliorini, Cameri, ITALY, Presenter Shinobu Tanaka, Tsukuba, JAPAN Marco Merlo, Busto Arsizio, ITALY Junzo Tanaka, Tsukuba, JAPAN Italian Triathlon Federation - Medical Committee, Rome, ITALY Hitoshi Shimojo, Tsukuba, JAPAN Kotaro Ikeda, Tsukuba, JAPAN Ileotibial band syndrome (ITBS) is an overuse injury caused by Savio L-Y Woo, Pittsburgh, PA, USA repetitive friction of the ileotibial band and underlying burse Naoyuki Ochiai, Tsukuba, JAPAN

5.121 Dept. of Orthop. Surg., Institute of Clinical Medi, Tsukuba, JAPAN time and cycle to seek the appropriate setting for clinical appli- cation. Although Ca-P depositions in group A and B were Purpose: greater than that in group C, it took more time for coating the One of the popular treatments for anterior cruciate ligament graft when compared with that in group C. Further study will be injuries is reconstruction using the semitendinosus and gracilis needed to find the appropriate amount of Ca-P deposit on/in (ST/G) tendon graft. However, many studies have suggested the graft to increase the initial strength in the bone-graft inter- that the initial bonding strength between a graft and bone sur- face. Another concerning, regarding Ca-P deposition in the face is insufficient for preventing graft motion within the bone intra-articular portion of the graft may cause joint inflamma- tunnel. We developed a novel apparatus to coat calcium phos- tion. Our data showed that covering the intra-articular part with phate (Ca-P) on/in living-tendon to augment initial bonding the rubber sheet had the effect on preventing Ca-P deposition. strength. The purposes of this study were to evaluate the effi- The greater amount of Ca-P deposit in the tibial end was cacy of our novel apparatus and to quantitatively and histolog- occurred because suture holes increased the total contact area ically access deposit on/in human ST/G tendon graft. with the solution.

Materials and methods: Twenty-five sets of fresh frozen human ST/G tendons were used Poster #288 for this study. A 6cm-long quadruple-strand ST/G graft was pre- PLICA SYNDROME AFTER THE INJURY OF THE pared. The tibial end was secured using the Krackow technique RECTUS FEMORIS MUSCLE – A CASE REPORT with No. 2 non-absorbable sutures. The Endobutton-CL (Smith Toshiro Otani, Shinjuku-ku, JAPAN, Presenter & Nephew, USA) was passed through the looped femoral end. Hideo Matsumoto, Tokyo, JAPAN Central one third of the graft, as an intra-articular (IA) portion, Yasunori Suda, Tokyo, JAPAN was covered with sleeve of a rubber glove. Each end of the Takashi Toyoda, Tokyo, JAPAN sheet was secured with a tie gun to prevent Ca-P deposit on/in Taku Yatabe, Tokyo, JAPAN the IA portion of the graft. After these procedures, graft went Shinnichi Maeno, Tokyo, JAPAN through the alternate soaking method using the custom made Department of Orthopaedic Surgery, Keio University, Shinjuku, JAPAN automatic Ca-P coating apparatus. The alternate soaking method was reported by Taguchi et al. in 1999. The cycle of the This is the report of a case of the plica syndrome after the injury alternate soaking is consisted of four steps. First, the graft was of the rectus femoris muscle. soaked in CaCl2 (200mM)/Tris-HCl (pH 7.4). Then it was washed with saline solution. After washing the graft, it was soaked in Case: A 20-year-old male was involved in a motorcycle accident Na2HPO4 +NaH2PO4 (128.7 mM, pH 7.4). Then it was washed in May 1999, and suffered from the incomplete rupture of the with saline solution again. Three different sets of soaking time right rectus femoris muscle. After the conservative treatment and cycle were applied. In group A, the graft was soaked with for four months, he complained medial para-patellar pain on each solution in 30 seconds and went through twenty cycles. In motion when he returned to work. He came to our department group B, one-minute of soaking time and fifteen cycles was on January 2000, complaining recurrent pain with tenderness applied. In group C, soaking time was three minutes and cycle on the just medial area of the right patella, particularly when he POSTER ABSTRACTS was five times. Total time for coating Ca-P on/in the tendon was suddenly stand up from chair. There was a dele on the rectus timed in each group. The tibial end (TE), central one third (IA), femoris muscle, but there was no loss of quadriceps muscle and the femoral end (FE) of the graft were transversely sec- power. We diagnosed as a plica syndrome combined with the tioned. Inorganic material in the each portion of the graft was partial rupture of the rectus femoris muscle, and performed analyzed using a thermogravimetric analysis. Histological eval- arthroscopy (AS). AS findings and procedure: We confirmed the uation of the specimen was performed using von Kossa stain- impingement of the large plica during knee flexion and exten- ing. Statistical analysis was performed using analysis of sion, without using saline, and resected it under AS procedure. variance, followed by Fisher’s PLSD test as a post-hoc test. Results: The pain disappeared immediately after the surgery. Results: He returned to the work a month after the procedure. Inorganic material contained in femoral end in the group A and B were significantly larger than that in the group C. In the tibial Discussion: We evaluate this case as a plica syndrome after the end, there was significantly greater amount of inorganic mate- incomplete rupture of the rectus femoris muscle. Although this rial deposited in the group A and B, when comparing to that in patient did not have any loss of muscle power in the knee the group C. However, there was no statistical difference in extensor mechanisms, subsequent dysfunction of the articu- intra-articular portion among three groups. Ca-P deposit in tib- laris genu muscles and/or imbalance between quadriceps and ial end was statistically greater than that in femoral end in all hamstring muscles might be caused the impingement of the groups. Histological analysis showed von Kossa staining from plica. This case also suggests that the plica itself is not the the surface area though 250 ?m inside of the graft. However, cause of the plica syndrome. intra-articular potion was not stained with von Kossa. When using our novel automatic coating apparatus (ESCOM Corp, Tokyo), total working time was reduced from 90 to 45 miniutes Poster #289 in group A, from 70 to 47 minutes in group B, and from 50 to 35 ORIGINAL TECHNIQUE FOR THE TREATMENT OF minutes in group C, respectively. LIGAMENT RELATED GENU RECURVATUM. PRELIMINARY RESULTS. Discussion: Philippe Piriou, Garches, FRANCE, Presenter Ca-P coating on/in the graft has capability of increasing the ini- Thierry Judet, Paris, FRANCE tial strength in bone-graft interface. In clinical setting, total Hopital Raymon PoincarÈ, Garches, FRANCE time for coating procedure should be short enough to prevent patients’ mobidity. Our novel apparatus was able to reduce the The authors report an original technique for the treatment of total working time. In our previous study, more soaking cycle the genu recurvatum of ligamentous origin. made greater deposition in the graft when the soaking time was the same. In this study, we altered combinations of soaking

5.122 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Therapeutic modalities for genu recurvatum are complex and Ricardo Paula Cury, Sao Paulo, BRAZIL vary specifically for each type of etiology. Moreover, the opera- Victor Marques Oliveira, Sao Paulo, BRAZIL tions that are designed to correct posterior capsuloligamen- Santa Casa Medical School, Sao Paulo, BRAZIL tous laxity in the knee by exclusively non-osseous procedures, are frequently subjected to secondary distension or, conversely, This retrospective study was carried out with the objective of to limitation of knee extension by excessive tightness. evaluating the results obtained in a series of 23 patients (27 knees) submitted to supra-tuberosity valgus tibia osteotomy The authors propose a technique of tightening the posterior fixed with a double-eight tie for the treatment of medial com- capsule without altering its integrity as would section followed partment arthrosis. Patients were evaluated subjectively using by suturing. The technique, which consists in rolling the bony Lysholm’s criteria, with a final mean score of 82 points (45 to insertions of the posterior capsule, is described along with pre- 100). There was a significant increase in the number of patients liminary results in 11 patients. who were assymptomatic after walking 500 meters, going from 9% pre-op to 78% upon final analysis. There was no statistical difference between pre and post-op joint amplitude, going from Poster #290 122 degrees pre to 123 degrees post-op. Four knees (15%) pre- THE RELATIONSHIPS BETWEEN TORQUE OF THE KNEE sented complications: one non-union, two suture tears and one EXTENSORS AND FLEXORS AND LIMPING GAIT neuropraxy of the common fibular nerve. Results show that this Kenji Sato, Funabashi, JAPAN, Presenter is an effective method of treatment capable of preserving the Koichi Wakimoto, Funabashi, JAPAN anatomical axis achieved during surgical repair (about 10 Akihiro Tsuchiya, Ichikawa, JAPAN degrees of valgus), and with a statistically significant improve- Kouji Michinaga, Funabashi, JAPAN ment in pain. Hideaki Shiratsuchi, Funabashi, JAPAN Funabashi Orthopedics, Funabashi, JAPAN Poster #292 Purpose: Limping gait for knee disorder has a great influence ARTHROSCOPIC REDUCTION AND FIXATION OF on an everyday life and return to sports. Patients who had knee AVULSION FRACTURE OF THE POSTERIOR CRUCIATE disorder were divided into limping group and non-limping LIGAMENT (PCL) AT THE TIBIAL INSERTION group. We examined the point for a limping improvement Etsuo Shoda, Hikami-gun, JAPAN, Presenter through analyzing knee extensors and flexors torque. Mitsuaki Noda, Osaka-fu, JAPAN Yasutaka Tomita, Kaibara-cho, JAPAN Method: Gait Training System (Biodex Medical Systems, USA) Keisuke Ohe, Kaibara-cho, JAPAN was used to measure the time of stance phase. It was defined, Atsushi Sakurai, Sumoto, JAPAN in this study, that 10% or more differences between right and Kouji Okamoto, Kaibara-cho, JAPAN left is limping group, and less than 10% differences is non-limp- Hiroshi Maeda, Kaibara-cho, JAPAN ing group. Furthermore, as for the non-limping group, it was Hyogo Prefectural Kaibara Hospital, Kaibara, JAPAN decided that the deficit of peak torque about the knee exten- sors or flexors is 30% or more. 63 patients who had knee disor- INTRODUCTION: Avulsion fracture of the PCL have commonly der were divided into the limping group (26 patients) and the been repaired with open reduction and internal fixation using non-limping group (37 patients). The patients of both groups the posterior approach. However, this approach dose not lend performed isokinetic muscle strength test at 60 deg/sec using itself to detection and repair of associated injuries. Biodex System 3 Isokinetic Dynamometer (Biodex Medical Furthermore the view is limited inspite of the invasion. We Systems, U.S.A) to both groups. We examined 4 items: 1) peak report six cases of the PCL avulsion that were arthroscopically torque/weight 2) total work/weight 3) deficit of peak torque 4) reduced and fixed with cannulated screw. torque starting after 0.2 seconds, and compared both groups. POSTER ABSTRACTS MATERIALS & METHODS: Six patients (5 male and 1 female) Results: Significant reductions in the knee flexors for the limp- with tibial avulsion fracture of the PCL were included in our ing group were found in the results 1, 2, and 4, and no signifi- study. The average age of the patients was 53 years-old (37-69 cant difference was found between the limping and the years). Arthroscopic reduction of bony fragment was performed non-limping groups in the knee extensors. using tibial antreior cruciate ligament drill guide under the con- trol of an image intensifier. Through this guide, K-wire was Conclusion: The knee flexors start contracting from the later placed from the anterior side of the tibia and replaced with a half of the swing phase to the first half of the stance phase in a cannulated screw. gait cycle, and produce the maximum contraction immediately after heel contact. At this time, momentary muscle strength of RESULTS: Bony union was obtaied in all cases except one with the knee flexors is needed for the stability of the knee joint. It relatively small fragment. However, the IKDC result was either A is considered that the function of the hamstrings responsibility or B and all cases rated their activity as almost the same as is reduced in the limping group because the results indicated preinjury activity in final follow-up(average 24 months; 6-46 reductions of peak torque, total work, and torque after 0.2 sec- months). onds in the knee flexors. It is important to consider the reactant contraction function of the knee flexors as well as the function CONCLUSIONS: The results seem to indicate that this opera- of the knee extensors in the improvement of limping gait. tion may be considered a valid option in the treatment of the relatively large avulsion fracture of the PCL. In contrast to the conventional posterior approach, arthroscopic examination of Poster #291 intraarticular pathology can be conducted without changing the HIGH TIBIAL OSTEOTOMY: patient's position and removal of the screw is much easier. FIXATION WITH A DOUBLE-EIGHT TIE Nilson R. Severino, Sao Paulo-SP, BRAZIL, Presenter Osmar Pedro Camargo, Sao Paulo, BRAZIL Poster #293 Tatsuo Aihara, Sao Paulo, BRAZIL

5.123 EVALUATION OF THE PATELLAR TENDON BY MAGNETIC postoperatvely. In the side- to- side laxity testing we observed RESONANCE IMAGING(MRI) a slightly higher difference in the hamstring group 1,55 mm Murilo Cesar Santos, Curitiba Parana, BRAZIL compared to the BPTB group with 1,15 mm. No patient showed Edilson Schwansee Thiele, Curitiba, BRAZIL, Presenter a side to side laxity difference bigger than 3mm in both groups. Alvaro Chamecki, Curitiba, BRAZIL However this had no influence on the functional outcome Emerson K. Zanoni, Curitiba, BRAZIL according to the Tegner activity scale and the IKDC subjective Henrique Carvalho, Curitiba, BRAZIL questionnaire. Clinica do Joelho, Curitiba, BRAZIL Conclusion: We found the rigid-fix™ crosspin femoral fixation The patellar tendinitis is a pathology that affects sports players device to be an easy to handle tool for ACL graft fixation with that require sudden knee extension or repetitive straining of no intraoperative complications. The results are comparable to the patellar tendon. These activities include runners, but other fixation techniques. Further investigations and studies mainly sports that require jumping, like volleyball, basketball will be necessary to show the long term fate of the pins and the among others. grafts.

The diagnosis of infrapatellar tendinitis is typical, but the radi- ologic criteria are not so good. The width, length, thickness and Knee/Cartilage/Meniscus extra articular surface of the patella in randomized 1300 MRI, with the objective of having normative data to analyze the structures involved in patellar tendinitis. Poster #295 MICROFRACTURE TECHNIQUE IN THE TREATMENT OF OSTEONECROSIS Knee - Other Isik Karli Akgun, Istanbul, TURKEY, Presenter Hayrettin Kesmezacar, Istanbul, TURKEY Tahir Ogut, Istanbul, TURKEY Poster #294 Alper Kebudi, Istanbul, TURKEY ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION Kaya Kanberoglu, Istanbul, TURKEY USING A NEW FEMORAL FIXATION DEVICE. 1 YEAR University of Istanbul, Cerrahpasa Faculty of Medi, Istanbul, TURKEY EXPERIENCE Heinz Laprell, Kiel, GERMANY OBJECTIVE: Our objective was to evaluate the results of arthro- Ralph Wischatta, Kiel, GERMANY, Presenter scopic subchondral bone plate microfracture technique per- V. Stein formed to the patients with osteonecrosis in the knee joint due to a variety of etiology including inflammatory diseases, vas- Purpose: To assess the one year functional results after ACL culitis, steroid therapy, trauma and idiopathic. reconstruction using a new femoral fixation device. PATIENTS AND METHODS: 28 patients with various degrees of POSTER ABSTRACTS Material and Methods: 92 patients (64 men, 28 women) with an chondral defects in the knee joint underwent arthroscopic sub- average age of 31,8 years (16-58) underwent ACL reconstruction chondral bone plate microfracture technique between 1997- between November 1999 and October 2000. 62 patients were 2000. Ten of these (Group 1) were with inflammatory disease reconstructed using the central 1/3 of the BPTB (group I). 30 association including systemic lupus erythematosus, vasculitis, patients were reconstructed using the 4-strand Hamstrings inflammatory arthritis or had received steroid therapy in the (group II) both in arthroscopic transtibial technique. All ACL past for several reasons. The mean age of the group was 28 grafts from both groups were fixed at the femoral site with a (range 20-34) and the distribution of sex was 4 male and 6 new, fully absorbable crosspin device (Mitek Corp.) Tibial fixa- female. tion was performed with fully absorbable interference screws in group I and with a hybrid fixation with additional staples in Group 2 included 18 patients who had idiopathic osteonecrosis group II. Postoperative rehab programme was the same in both or osteonecrosis due to the trauma, osteoarthritis. The mean groups with full weightbearing and CPM, careful physiotherapy age was 47 (range 16 - 67). Grade IV chondral lesions were with muscle strengthening exercises. Sports like jogging,swim- located in the medial femoral condyle in 5 (50%) patients in ming and biking were allowed as part of the rehabilitation 6 group 1 and in 17 (94%) in group 2; The remaining lesions were weeks after surgery. Return to strenuous sports was allowed 9 in the lateral femoral condyle. In three knee of the group 1, the months postoperatively. 4 months after surgery 42 patients had lesions were larger than 400 mm2 and the average defect size a MRI of their operated knee to assess the situation of the graft was 350 mm2. The second group had 180 mm2 average lesion and the biological degradation of the crosspins. At an average size. Multiple perforations were placed 3 to 4 mm apart and 4 of 16 months after surgery (min. 12, max. 23) 48 patients came mm deep into the subchondral bone to obtain the revascular- to our hospital for a standard clinical and subjective assess- ization. Early passive and active range of motion exercise was ment. For clinical evaluation we used the Tegner activity scale, begun at the day of procedure but weight bearing was protected the Lysholm score and the IKDC score. Objective assessment for 6 weeks. For 2 cases in group 2 anterior cruciate ligament included side-to-side laxity testing with the Rolimeter™ reconstruction was performed using bone-patellar tendon- (Aircast corp. Europe) bone graft due to the chronic instability.

Results: According to the MR Images no pin-breakage or sli- RESULTS AND DISCUSSION: The patients of the two groups page was noted. No cystic formations around the pins were were evaluated clinically and radiologically. The chondral observed 4 months after surgery. According to the Lysholm defects with inflammatory disorders or with previous steroid score patients had moved from an average of 98,55 points therapy for the chronic disease were larger. The average scores preinjury to 52,58 preoperatively and increased to 83,01 points of group 1 showed significant improvement and satisfaction of one year postoperatively. According to the IKDC score we saw patient after surgery (Preoperative and follow-up average an improvement by two categories in 16 cases, by 1 category in Lysholm scores were 39 and 80 respectively with mean follow- 25 cases and no change in 7 cases between preop and 1 year up of 34 months). This group included young patients with

5.124 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). chronic disorders and the preoperative functional status according to the ICRS Subjective Rating System was grade IV in Results: There were no statistically significant differences all cases. After microfracture technique performed that is not between the groups in age, body-weight, operation time and indicated classically in such a patient group, we observed the tourniquet time. Pain scores were significantly lower in group A improvement of the function level: grade I in one case, grade II than in group B at 1 and 2 hours; than in group C at 1, 2 and 4 in 7 and grade III in 2. These results showed that the microfrac- hours postoperatively, at rest (p<0.05). Lower pain scores were ture could be simple and cost-effective procedure in obtained in Group A compared to group B during active and osteonecrosis secondary to such chronic diseases to gain time passive knee flexion at 2 and 3 hours; and compared to group C for arthroplasty. Regarding the group 2 eight patients (44%) at 1, 2, 3, and 4 hours postoperatively (p<0.05). Significantly rated their knee as feeling normal and 9 (50%) stated better more analgesics were required in significantly more patients than before the microfracture. No improvement was seen in within the first six hours of arthroscopy in groups B and C than one case that had spontaneous osteonecrosis 1 month after in group A (p<0.05). arthroscopic partial meniscectomy. An increase of the average Lysholm scores from 57.8 to 89 was detected. Sixty six percent Conclusion: Preoperative intraarticular administration of of patients could partake in strenuous sports with no or mini- tenoxicam provides better pain relief and less analgesic use mal limitation. Functional status of this group according to the than its postoperative administration in active male patients. ICRS Subjective Rating System was grade III or IV in 16 (89%) Pain is also regressed during the active and passive movements cases before treatment. This rate was 6% at follow-up. For the of the knee with the pre-emptive use of intraarticular tenoxi- posttraumatic lesion, the time between the injury and the sur- cam. gery was seen important prognostic factor in outcome. In our series three patients who were treated by microfracture within 12 weeks of injury had excellent results with Lysholm score 100 Poster #297 all three. The control MRI of the cases revealed the continuity DESCRIPTION OF A NEW MENISCUS TEST AND ITS of normal cartilage with the fibrous-hyaline cartilage of the COMPARISON WITH THE MCMURRAY’S TEST AND JOINT treated areas. However an increase of the size of osteonecrosis LINE TENDERNESS in the subchondral bone was detected in 20% of the large Devrim Akseki, Izmir, TURKEY, Presenter lesions. Ozal Ozcan, Izmir, TURKEY Hakan Boya, Izmir, TURKEY CONCLUSIONS: Microfracture technique, being safe and less Halit Pinar, Ynciralty, TURKEY demanding for the treatment of full thickness chondral defects, Celal Bayar and Dokuz Eyl¸l Universities, Manisa-Izmir, TURKEY may be an alternative of the replacement surgery in young patients with large lesions. Clinical results, even in cases with Purpose: Clinical diagnosis of meniscal tears may be difficult associated inflammatory or chronic disease, were positive and even for the experienced knee surgeon. Most of the meniscus encouraging. tests are performed with the patient supine and non-weight- bearing, whereas most of the symptoms of a torn meniscus occur during weight-bearing activities. The purpose of this Poster #296 study is to describe a new meniscus test performed under •PRE-EMPTIVE ANALGESIC EFFECT OF INTRARTICULAR weight-bearing conditions; and then to compare its diagnostic TENOXICAM AFTER ARTHROSCOPIC KNEE SURGERY value with the two commonly used meniscus tests. Devrim Akseki, Izmir, TURKEY, Presenter I. Ozkan Akinci, Istanbul, TURKEY Materials and Methods: A prospective study was undertaken on Umit Atman, Manisa, TURKEY 150 consecutive patients (110 male, 40 female) whose ages Celal Bayar University, School of Medicine, Dept., Manisa, TURKEY ranged between 17 and 73 years (av. 35,7 years). All the patients

had had symptoms related to an intraarticular knee pathology, POSTER ABSTRACTS Purpose: Postoperative, intraarticular injections of nons- and 89 of them had had a history of trauma. Minimum six weeks teroidal antiinflamatory (NSAI) drugs have been documented of conservative treatment including non-steroidal antiinflama- to be effective in pain relief after day-case arthroscopy. Pre- tory drugs, rest and physical therapy had failed in all of the emptive analgesia using intraarticular pubivacaine and mor- patients, and the average Lysholm score was 65.9%±15.01 phine have also resulted in lower pain scores. The effectiveness (range 25 to 98). After a detailed history, physical examination of preoperative intraarticular NSAI drug injections have not and standard x-ray evaluation, patients underwent arthroscopy. been studied previously. The purpose of this study was to inves- The arthroscopic findings were accepted as the gold standard tigate the analgesic effect of administering intraarticular and final diagnoses were correlated to the results of meniscus tenoxicam preoperatively. tests. To detect a meniscal tear, McMurray’s test, joint line ten- derness and the new test, that is the weight-bearing McMurray’s Materials and Methods: A prospoctive-randomized study was test (Ege’s test-Ridvan Ege M.D.) were performed. In Ege’s test, conducted in 30 patients undergoing arthroscopic partial the patient squats while both lower extremities are in internal meniscectomy in Siirt Military Hospital. All the patients were and then in external rotation. Interpretation of the test is the male whose ages ranged between 20 to 26 years (av. same as the McMurray’s test. The diagnostic values of the three 21.9±0.268). The patients received a standard general anes- tests were calculated and compared. thetic and were operated by the same surgeon (D.A.). 20 mg tenoxicam in 20 ml normal saline was administered into the Results: A meniscus tear was found in 127 of the 150 patients. knee joint preoperatively in group A (n=10), and postopera- Medial and lateral meniscal tears were found in 90 and 28 tively in group B (n=10). Patients in group C (n=10) were patients, respectively, and nine had tears of both menisci. received 20 ml of intraarticular saline postoperatively. Verbal Additionally, an ACL tear was found in 32, patellar chondroma- rating and visual analogue pain scores (at rest, on active knee lasia in 17, suprapatellar plica in 9, tibiofemoral arthrosis in 22, flexion and on passive knee flexion) were recorded for the next generalized synovitis in 2 and loose body in 2 patients. 48 hours. Total analgesic requirements and the time for first Accuracy of JLT was 71% for medial meniscus tears. The sensi- analgesic requirement were measured. Mann-Whitney U and tivity was 88% and the spesificity was 44%. McMurray’s test was Wilcoxon-T tests were used for statistical analysis. accurate in 66%, sensitive in 67% and spesific in 69% for medial

5.125 meniscus tears. The accuracy of Ege’s test was 71%, the sensi- of the knee joint should routinely include inspection, palpation tivity was 67% and the spesificity was 81% for medial meniscal with side-to-side comparison of the medial and lateral joint- tears. Highest positive predictive value (PPV) was obtained with lines. This should be performed with the knee in varying deg- the new test (86%) and the highest negative predictive value grees of flexion, particularly 45 degree short of full extension. (NPV) was obtained with JLT (67%), for medial meniscus tears. The pseudocyst sign elicited in thia manner is of considerable Accuracies of JLT, McMurray’s test and Ege’s tests for the diag- clinical importance because of the frequency of its occurrence nosis of a lateral meniscus tear were 77%, 82% and 84%, respec- and complete correlation with meniscal tears requiring surgical tively. JLT was the most sensitive (67%), but the new test was intervention. the most spesific (88%) for lateral meniscus tears.

Conclusion: Any of the tests used in the study were predictive Poster #299 for the diagnosis of a meniscus tear. The newly described test BONE SPECT IMAGING FOR DIFFERENTIAL DIAGNOSIS seems to be more spesific and more accurate than the others in OF ATRAUMATIC MEDIAL JOINT SPACE KNEE PAIN. detecting both medial and lateral meniscus tears. According to Ron Arbel, Hod Hasharon, ISRAEL, Presenter our results, we believe that the new test reflects the symptoms Tali Becker, Tel Aviv, ISRAEL of a torn meniscus more accurately than the tests performed Moshe Yaniv, Ramat Gan, ISRAEL with the patient supine, because of it is performed in a func- Einat Even-Sapir, Tel Aviv, ISRAEL tional position. As the patient performs the test by himself, Tel Aviv Surasky Medical Center, Tel Aviv, ISRAEL misinterpretations depending on the experience of the exam- iner are eliminated with the new test. Introduction Chronic pain in the medial aspect of the knee without any his- tory of trauma is a common complaint in the adult population. Poster #298 In most cases X-Rays will be normal. Plane bone scan may THE MENISCAL “PSEUDOCYST” reveal increase uptake in the medial joint space. The main Saqib Amin, Sharjah, UNITED ARAB EMIRATES, Presenter problem is diagnostic, to differentiate the patients suffering from curable meniscal tears from those with osteoarthritis. MRI ABSTRACT: 30 patients requiring knee surgery underwnt is an excellent diagnostic tool, but is expensive and sometimes detailed preoperative assessment. All had clinical sign of a unavailable. According to our experience, SPECT bone scintig- lump on the joint line when the knee was examined at 45 raphy is a reliable and accessible diagnostic tool for diagnosis degree of flexion, which has been thought to indicate meniscal of degenerative meniscal tears and allows the pre selection of cyst. Of these 30 patients 14 had a meniscal cyst. The remain- the patients that will be treated successfully arthroscopicaly. ing 16 had a meniscal tear withpout a cyst. In these 16 cases, the clinical sign of a lump protruding from the joint line was Material and Methods: termed a “pseudocyst“. Ths new clinical sign is important Forty patients above 45 years old with pain in the medial joint because of its frequency of occurrence and the complete corre- space of their knee, without history of trauma were evaluated. lation with mwniscal tears requiring surgical intervention. All underwent SPECT bone scintigraphy followed by POSTER ABSTRACTS Arthroscopy. Twenty-eight patients were included in the final METHOD & MATERIAL: 30 patients were operated for meniscal statistical analysis. The other fourteen patients were eventually cyst over a period of one year. All these patients had pain in a excluded because only printed results of their SPECT were small area on the joint line,usually worse at night and radiating available and not our interpretation of the exam. (Although up and down the ipsilateral aspect of the leg. There was a pal- their results showed the same trend as the other group). pable or visible swelling on the joint line on examination of the all patients. At operation out of 30 patients 14 had cyst, in Results: remaining 16 there was swelling which was termed “pseudo- Sixteen patients showed typical crescent-like increase uptake cyst”. on SPECT and classified as “sure” diagnosis of a meniscal tear, all had a treatable meniscal tear proved by arthroscopy. Five RESULT: The meniscal pseudocyst was defined as a lump patients were diagnosed by SPECT as “suspected” to have ptotruding on the lateral joint line, tender in palpation, and meniscal tear and only three patients had a meniscal tear. varies in prominence on flexion of knee and appeared promi- Seven patients were suspected to have pathologies other than nent at 45 degree of flexion and disappears at 90 degree of flex- meniscal tears on SPECT like osteoarthritis or synovitis and ion and full extension. Patients with pseudocyst usally these findings were also confirmed by arthroscopy. complains of pain in lateral joint line, radiating of pain on the thigh and distally into the lower leg. All these 16 patients with Conclusions: the pseudocyst sign, 11 were male and 5 females with an aver- In our opinion, SPECT bone scintigraphy is a good diagnostic age age of 30. Pseudcyst occurred on the lateral aspect of the tool for differential diagnosis of degenerative meniscal tear joint in 12 patients and in 4 patient on the medial aspect out of from early osteoarthritis, especially when there is typical cres- 16 patients. All the 16 patient gave the history of trauma to cent-like increase uptake. These enable us to select the exclu- knee. At the time of operation all the 16 patients with pseudo- sive group of patients who will benefit from arthroscopy and cyst were found to have tear of the meniscus warranting partial avoid unnecessary surgery in the others. We recommend the meniscectomy. The majority of tear were cleavage type use of SPECT instead of plane bone scan as a routine in evalu- (87%).the remaining 13% were classic buckle handle tear. ation of chronic atraumatic medial joint space knee pain.

DISCUSSION: There are number of possible explanations for the appearance of joint-line pseudocysts associated with torn Poster #300 menisci, particularly in the lateral compartment of the knee. It VASCULAR ENDOTHELIAL GROWTH FACTOR appears evident that the tibiofemoral contact area changes at EXPRESSION AFTER BUCKET HANDLE MENISCUS TEARS about 45 degree of flexion, causing tension of the thickened IN RELATION TO THE SITE OF THE LESION IN A RABBIT portion of the meniscus and thus increasing the prominence of MODEL the joint-line swelling around this point. Clinical examination Roland Becker, Magdeburg, GERMANY, Presenter

5.126 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Thomas Pufe, Kiel, GERMANY tors during meniscus healing remains unclear and should be Roland Mentlein, Kiel, GERMANY investigated in further studies. Nicki Giessmann, Magdeburg, GERMANY Wolfram Neumann, Magdeburg, GERMANY 1. Arnoczky SP, Warren RF: The microvasculature of the menis- Wolf Petersen, Kiel, GERMANY cus and its response to injury. An experimental study in the Department of Orthopaedic Surgery/Anatomic Insti, Magdeburg/Kiel, dog. Am J Sports Med 11:131-141, 1983 GERMANY 2. Ferrara N, Keyt B: Vascular endothelial growth factor: basic biology and clinical implications. EXS 79:209-32.:209-232, 1997 INTRODUCTION: Only 20% of the meniscus periphery shows vascularisation which might explain the poor healing response of meniscus lesions (1). The formation of capillaries from pre- Poster #301 existing vessels (angiogenesis) is essential for tissue repair. DISCOID LATERAL MENISCUS: CASE REPORT OF A Angiogenesis is controlled by a variety of mitogenic and SYMPTOMATIC WRISBERG-LIGAMENT chemotactic peptides, that act on invading endothelial and Klaus Buckup, Dortmund, GERMANY, Presenter smooth muscle cells. One of the most important angiogenetic Michael Preuhs, Dortmund, GERMANY factor is the vascular endothelial growth factor (VEGF)(2).The Lars Linke, Dortmund, GERMANY purpose of the study was to find out, whether the expression of Klinikum Dortmund gGmbH, Dortmund, GERMANY VEGF is influenced by the site of the meniscus lesion. The symtomatic discoid lateral meniscus is a well-known con- MATERIAL & METHODS: A bucket handle lesion was created genital anomaly. Three different types are known: complete, either at the vascular periphery or the avascular inner zone of incomplete and Wrisberg-ligament type. The Wrisberg-ligament the medial meniscus using forty New Zealand White Rabbits. type has no meniscotibial attachment posteriorly. Total menis- The rabbits were sacrificed either after one, two, five or ten cectomy is the common treatment of the Wrisberg-ligament weeks. Immunohisto-chemistry, enzyme-linked immunosor- type. We discussed the management of a symptomatic discoid bent assay (ELISA) and reverse transcription-polymerase chain lateral meniscus (Wrisberg-ligament type) in a 16 year old reaction (RT-PCR) was performed for qualitative and quantita- young elite german soccer player. Pre-operative clinical and tive analysis of VEGF expression. The contralateral medial radiological features are presented. Our operative technique- meniscus of each animal served as the control. arthroscopic peripheral attachment after central partial menis- cectomy and postoperative course are described. We RESULTS: No healing was noticed of lesions at the inner zone documented the healing with the physical findings, the sport- after ten weeks. Four of the five lesions at the periphery were activity and radiological features after two years and review the healed after five weeks and all lesions were healed after ten literature, classification and current treatment options of each weeks. VEGF mRNA and protein was detected in all specimens type of discoid lateral meniscus. regardless of the site of the lesion and in the control group. VEGF expression was noticed in endothelial cells, but also in peripheral fibroblastic cells and fibrochondrocytes of both Poster #302 intact menisci and menisci with lesions. Significantly higher MENISCUS REFIXATION USING THE FAST-FIX VEGF-expression was found in specimens with meniscus Jens-Ulrich Buelow, East Fremantle, AUSTRALIA, Presenter lesions in comparison to the contralateral side up to ten weeks Andree Ellermann, Pforzheim, GERMANY (p<0.05). After seven days the highest VEGF-expression Guenter Koenig, Karlsruhe, GERMANY occurred at the inner zone of 1537+129pg/ml, which was twice Arcus Sportsclinic, Pforzheim, GERMANY as high in comparison to the periphery (727,2+129,2pg/ml; p<0,001). Similar VEGF-expression was noticed after two weeks a.purpose of the study: First experience using the FasT-Fix between the inner zone and the periphery of 709,4+343,4pg/ml meniscus refixation system POSTER ABSTRACTS and 600+70pg/ml respectively. VEGF expression declined at both the inner zone and the periphery after five and ten weeks. b.method: 73 patients were reviewed prospectively after menis- Immunostaining for the VEGF receptors VEGFR-1 and VEGFR-2 cus refixation. Minimum follow up was 1 year (52-68 weeks). was positive in all operated animals but not in the unoperated Average age was 27 years (16-48). There were 21 lateral and 52 ones. Immunostaining for VEGFR-1 was restricted to vascular medial meniscus tears with an average length of 2,4 cm. endothelial cells of capillaries. In larger vessels such as arteri- Inclusion criteria were: Meniscus tear in red or red white-zone oles or venuoles smooth muscle cells of the vessel wall were with a tear length >1,5 cm, in case of a Bucket-handle tear the also VEGFR-1 positive. The staining pattern of VEGFR-2 was FasT-Fix was combined with an outside in PDS suture, in case similar but single fibrochondrocytes and some of the fibroblas- of an ACL-tear (n=46) an ACL Reconstruction was performed. tic cells of the peripheral reparative tissue labeled positive for Patients with Cartilage damage > grade II (Outerbridge) were the VEGFR-2 too. excluded from the study. The evaluation consisted of a history, clinical examination, Lysholm and Cincinnati knee score. DISCUSSION: This study has shown that protein and mRNA of the vascular endothelial growth factor (VEGF) is expressed dur- c.Results: Two patients had to be revised. One patient, who had ing meniscus healing. Specimens with lesions at the avascular refixation of a lateral bucket handle tear, a partial medial region showed initially significantly higher VEGF-protein con- meniscectomy and an ACL reconstruction (quadruple ham- centration in comparison to lesion at the vascular periphery of string) at the same operation was revised for arthofibrosis at 7 the meniscus. One of the reason for higher VEGF-protein con- weeks postop. His lateral meniscus was healed and his sutures centration at the avascular region of the meniscus tissue might could still be seen in place. Another patient required a partial be caused due to hypoxia. Despite high VEGF concentration, meniscectomy 5 months after the meniscusrefixation, his FasT- lesions in the avascular inner zone failed to heal. VEGF seems Fix implants were loose and had to be removed. Otherwise no to be involved in meniscus healing only at the periphery, pro- reoperations were necessary and the rest of the meniscus refix- viding an environment which allows successful healing of a ations were healed clinically. Overall Lysholm score was 92 and tear. The effect of other angiogenetic or antiangiogenetic fac- Cincinnati knee score was 84. In total 117 FasT-Fix sutures were used for refixation. Eight of these sutures had to be removed

5.127 and replaced during the operation, because either the knot or DISCUSSION. In the ACI technique the need of suturing the both threads couldn’t be pushed tight or because of misplace- periosteal flap to the margin of the chondral lesion did not ment of the FasT-Fix. No other complications occured. allow to carry out the procedure arthroscopically. The use of fib- rin glue for fixating the seeded membrane has permitted to per- d. Conclusion: Meniscus repair with the FasT-Fix is a time sav- form the procedure arthroscopically in a simple and safe way. In ing and efficient fixation method. The all-inside technique the reported case, no specifically designed instruments were reduces operating time, avoids cartilage damage and reduces used and the posterior portion of the lateral tibial plate was the risk of serious neurovascular injuries and infection. approached according to a standard arthroscopic procedure. Even though the MACI® technique is mostly performed with an open procedure, the site of this lesion could not be reached Poster #303 without sacrifying tendinous and ligamentous structures of the •ARTHROSCOPIC AUTOLOGOUS CHONDROCYTE knee, and even in this case the sight and operating space could IMPLANTATION FOR THE TREATMENT OF A CHONDRAL not compare with an arthroscopic approach. There are several DEFECT IN THE TIBIAL PLATEAU. A CASE REPORT procedure that can be performed arthroscopically for treating Paolo Bulgheroni, Varese, ITALY, Presenter cartilage lesions, but the size of this defect was too large for Mario Ronga, Varese, ITALY bone marrow stimulation techniques and/or osteochondral Federico A. Grassi, Varese, ITALY grafts to be successful. Consequently, the arthroscopic MACI® Paolo Cherubino, Varese, ITALY technique appeared the best solution for this patient. Institute of Orthopaedics and Traumatology. Univer, Varese, ITALY

INTRODUCTION. An evolution of the traditional autologous Poster #304 chondrocyte implantation (ACI) technique is represented by •TREATMENT OF DEEP ARTICULAR CARTILAGE the matrix-induced autologous chondrocyte implantation DEFECTS OF KNEE AND ANKLE WITH MATRIX-INDUCED (MACI®). This method requires seeding of autologous chon- AUTOLOGOUS IMPLANTATION (MACI®): EARLY RESULTS drocytes on a type I-III collagene membrane, which is Paolo Cherubino, Varese, ITALY implanted in the chondral defect using exclusively fibrin glue. Federico A. Grassi, Varese, ITALY The authors report the arthroscopic MACI® technique, which Paolo Bulgheroni, Varese, ITALY, Presenter was adopted for the treatment of a chondral defect in the pos- Mario Ronga, Varese, ITALY terior part of the lateral tibial plateau. Institute of Orthopaedics and Traumatology. Univer, Varese, ITALY

SURGICAL TECHNIQUE. The chondral defect was studied pre- INTRODUCTION. Since 1999 the MACI® (Matrix-induced operatively by MRI (FSE Fat-Sat T2, GE T2) and accurately Autologous Chondrocyte Implantation) technique have been defined during arthroscopic harvesting of chondrocytes. The used for the treatment of deep articular cartilage defects at the patient was a 25-year old man presenting a deep chondral authors’ institution. This method requires seeding of autolo- lesion (2.5 mm x 10 mm in size) at the posterior portion of the gous chondrocytes on a type I-III collagene membrane, after lateral tibial plate of the left knee. A pneumatic tourniquet was their arthroscopic harvesting from the knee and subsequent in POSTER ABSTRACTS placed on the proximal thigh and a 30° oblique arthroscope vitro expansion of the cellular population using autologous was inserted through the standard anteromedial portal. serum. The seeded membrane is implanted in the chondral Operative instruments were inserted through the anterolateral defect using exclusively fibrin glue, through a limited exposure portal, in which a 7.0 mm arthroscopic cannula was placed. joint approach. After debridement with curettes and shaver (full radius blade 5.5 mm), haemostasis was carried out using an acromioplasty MATERIALS AND METHODS. Membrane structure and its cel- electrode. The chondral defect was sized with a measuring rod lular population were investigated by light microscopy, and the dimensions transferred onto the seeded collagen mem- immunohistochemistry, SEM, and electrophoresis (SDS PAGE brane, which was subsequently cut reproducing the shape of 7%) before implantation. There was evidence of chondroblasts the lesion. The membrane was folded and inserted into the and type II collagen inside the seeded membrane. The MACI® joint using atraumatic arthroscopic forceps. Saline solution technique was used for the treatment of 24 patients (17 males flow was stopped and fibrin glue was injected through a Tuohy and 7 females), with an average age of 35 years (range, 17 to 52 needle (17 G), inserted previously under the middle third of the years). As isolated lesions, the sites of the defects were the fol- lateral meniscus, in order to reach the chondral defect. lowing: 11 medial femoral condyle, 3 lateral femoral condyle, 1 Pressure on the membrane was applied with the probe in order femoral trochlea, 1 patella, 2 lateral tibial plate, 3 talar dome. to achieve optimal contact with the underlying bone. Saline As combined lesions, there were 1 medial femoral condyle + solution flow was restored and stability of the implant was patella, 1 lateral tibial plate + patella, 1 kissing lesion in the checked with repeated flexion/extension movements of the ankle. The average size of the defects was 3.5 cm2 (range, 2 to knee. 4.5 cm2). The treatment of 2 chondral defects in the lateral tib- ial plate was performed arthroscopically. MRIs (FSE FAT SAT T2, RESULTS. No complications were observed in the postopera- GE T2, SE T1) were taken before the operation as well as at 6, tive period. At 6 months, the ICRS score was normal from pre- 12 and 24 months post-operatively. operative severely abnormal; modified Cincinnati knee score was 7/10 points from preoperative 4/10 points. The implant was RESULTS. The average follow-up was 11.1 months (range, 3 to evaluated by MRI at 3 and 6 months postoperatively. At 3 25 months). No complications were observed in the postopera- months the graft filled the chondral defect and its signal was tive period. Among the eighteen patients with a minimum fol- hyperintense in T2-weighted fat-suppressed and gradient echo low-up of 6 months (15 knees, 3 ankles), 17 showed an scans. Subchondral bone showed reduction of the edema that improvement in the clinical and functional status after the was observed preoperatively. At 6 months, subchondral edema operation while the patient with a kissing lesion of the ankle was further reduced and the thickness of the implant appeared did not improve from his preoperative status. At the latest fol- increased with restoration of a regular articular surface. low up, the ICRS score was normal in all the knees; modified Cincinnati knee score averaged 8.25/10 points (range, 7-10) from preoperative 3.2/10 points (range, 2-4); Lysholm II and

5.128 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Tegner scales averaged respectively 92.5/100 and 6/10 (range, nique in 10 patients. Additional procedures included 6 ACL 81-100 and 5-8) from preoperative 54.8/100 and 2/10 (range, 18- reconstruction, 1 high tibial osteotomy and 1 matrix-induced 67 and 2-3). The AOFAS (American Orthopaedic Foot and Ankle autologous chondrocyte implantation (MACI®). The clinical- Society) score was used for the evaluation of the ankles and functional assessment was performed according to the Lysholm averaged 72/100 (range, 40-100) from preoperative 41.3/100 II and Tegner activity scales. All the knees were evaluated by X- (range, 23-63). In all the studied knees, MRIs showed filling of rays examination and CT-scan or MRI preoperatively. Patients the defect with decreased subchondral bone edema; at 6 with a longer follow up were studied by MRI (GE and FSE Fat months hyaline-like cartilage was evident at the site of implan- suppressed T2W scans) at 6 and 12 months post-op. A biopsy tation; remodelling of the implant persisted for 12 months after of the implant was performed in occasion of a second arthro- the operation. In two ankles, healing of the defects was evident scopic look in two patients, respectively 5 and 7 months after at MRI, while the failed case did not show any cartilage forma- surgery. The specimens, as well as the scaffold before implan- tion. A second arthroscopic look was performed in 1 knee and 1 tation, were studied by light microscopy (LM), TEM, SEM and ankle: recovery of the articular surface with wave-like hyaline EDAX microanalysis. tissue was demonstrated. RESULTS DISCUSSION. There are technical limits related to the tradi- Follow up averaged 5.4 months (range, 2 to 12 months). tional ACI technique: a non-homogeneous distribution of Postoperative complications included 2 cases of neurapraxia (1 chondrocytes in the recipient site and the risk of leaking out in saphenus, 1 infrapatellar) after inside-out sutures: in one case of inadequate sealing of the periosteal patch. Moreover, patient symptoms subsided spontaneously, while in the second complications related to the use of the periosteal patch and to one surgical neurolysis was required.All the patients with a the necessity of a wide exposure of the joint have been minimum follow up of 3 months showed an increase in the clin- reported. The MACI® technique is a tissue engineering tech- ical scores with respect to the preoperative status.A non homo- nique in which the principle of autologous cell culture is pre- geneous signal of the scaffold was observed at MRI after 6 served; a tridimensional collagen I-III scaffold is used for months, while a more uniform aspect was evident at 12 improving the structural and biological properties of the months. In the two second looks, a 10% bulk reduction of the implant. The collagen membrane offers some advantages from implant was noted; the newly formed menisci appeared healed the surgical point of view, too. It can be applied using exclu- to the parameniscus and to the residual meniscal stumps. sively fibrin glue through limited exposures of the affected Good consistency and stability was detected by probing. joints, allowing the surgeon to treat sites in which suturing Histological and ultrastructural analysis of the scaffold showed flaps to the cartilage is almost impossible (posterior femoral a parallel arrangement of collagen fibers connected by thinner condyles, ankle). The surgical procedure is quite simple, requir- fibrils (LM, TEM). Orthogonal views at SEM demonstrated at ing short operating times, and has also been performed arthro- the surface a dense collagen barrier, which prevents cellular scopically by the authors. The early results of MACI® are very invasion, and in the frontal sections a porous meshwork allow- promising, but the limited number of patients and the short fol- ing cellular migration. Microscopic observations on the two low up do not allow to draw conclusions on the long-term effec- implant biopsies were similar. Hyalin tissue infiltrated by cells tiveness of this method. and vessels, surrounded by the scaffold fibers, was evident at LM. Chondroblast-like cells, with newly synthesised collagen fibers, were observed inside the porous meshwork of the scaf- Poster #305 fold at SEM. Vitality and activity of these cells, as well as the COLLAGEN MENISCUS IMPLANT (CMI): EARLY RESULTS new matrix organization, were clearly shown by TEM. At EDAX AND HISTOLOGICAL ANALYSIS OF THE IMPLANT microanalysis no calcifications were detected inside the speci- Paolo Bulgheroni, Varese, ITALY, Presenter ments. Statistical analysis of the collagen fibers diameters indi- Mario Ronga, Varese, ITALY cates a trend to lower values in the biopsies, as would be

Alessandro Manelli, Varese, ITALY expected in human connective tissue. POSTER ABSTRACTS Federico A. Grassi, Varese, ITALY Paolo Cherubino, Varese, ITALY CONCLUSIONS Institute of Orthopaedics and Traumatology. Univer, Varese, ITALY According to this study, clinical results with CMI are promising. Pain relief cannot be attributed exclusively to the concomitant INTRODUCTION meniscectomy, since satisfactory outcomes were also achieved Collagen meniscus implant (CMI) is a tissue engineering tech- in symptomatic knees for previous meniscectomies. Follow up nique for the management of irreparable meniscal lesions. This is too short for drawing conclusions, but morphologic observa- method requires a collagen scaffold, derived from the bovine tions indicate that the scaffold is progressively infiltrated and Achilles tendon, which is shaped like the human menisci and remodeled by cells reconstituting a meniscal tissue. enriched with GAG in order to enhance cellular ingrowth, thus leading to gradual regeneration of meniscal tissue. Aims of this study were to assess the early clinical results achieved on 20 Poster #306 patients treated with CMI, and evaluate the evolution of the POSTARTHROSCOPIC MENISCUS REPAIR ANALGESIA implant by MRI imaging and histological analysis. WITH INTRAARTICULAR KETOROLAC, MORPHINE OR BUPIVACAINE MATERIALS AND METHODS Jaume Calmet, Tarragona, SPAIN, Presenter Twenty patients (16 male, 4 female), affected by irreparable Carles Steve, Tarragona, SPAIN meniscal lesions, were arthroscopically treated with CMI at the Segi Boada, Tarragona, SPAIN authors’ Institution since March 2001. The average age at the Josep GinÈ, Tarragona, SPAIN time of surgery was 37.6 years (range, 22 to 53 years). The main Hospital Universitari de Tarragona Joan XXIII, Tarragona, SPAIN indication for CMI was represented by primary meniscal lesions (16 cases), while 4 patients underwent the operation for per- Objective: A prospective study was designed and performed in sistent pain after a previous meniscectomy. The average size of order to assess the postoperative analgesic effect of intraartic- the lesion/defect was 3.8 cm (range, 2 to 4.6 cm). An inside-out ular ketorolac, morphine or bupivacaine during arthroscopic technique was adopted in 10 patients, and an all-inside tech- outpatient partial meniscectomy. Methods: 80 patients were

5.129 studied. Group 1 patients (n=20) received postoperative injec- tion of 10cc intraarticular bupivacaine 0,25%. Group 2 patients Poster #308 (n=20) received 60 mgr of intraarticular Ketorolac. Group 3 DIAGNOSTIC CORRELATION BETWEEN MAGNETIC patients (n=20) received intraarticular morphine, 1 mg diluted RESSONANCE IMAGING WITH ARTHROSCOPY IN THE in 10 cc saline. Group 4 patients (n=20) received only 10 cc INTRA- ARTICULAR LESION OF THE KNEE. saline and were considered the control group Several parame- Alvaro Chamecki, Curitiba, BRAZIL, Presenter ters were evaluated, including the postoperative analgesic Henrique Carvalho, Curitiba, BRAZIL effect (period measured from the end of the surgery until fur- Edilson Schwansee Thiele, Curitiba, BRAZIL ther analgesia was demanded), the level of postoperative pain Murilo Cesar Santos, Curitiba Parana, BRAZIL as calculated with the visual analog scale (VAS) 1, 2, 3, 12 and Emerson K. Zanoni, Curitiba, BRAZIL 24 hours after, and need for supplemental pain medication Clinica do Joelho, Curitiba, BRAZIL (during the first 24 hours following the surgical procedure). Results: No statistical differences were appreciated in demo- The objective of this study is to evaluate the role of Magnetic graphic data between groups. Patients treated with intraarticu- Ressonance Imaging (MRI) in the diagnosis of intra articular lar ketorolac got better analgesic effect that was statistical lesions of the knee. 312 patients, who had an MRI and posteri- significant in: postoperative analgesic effect (p=0,02), an need orly an arthroscopy, have their chart analyzed by the authors. for supplemental pain medication immediately after surgery The results regarding sensivity, specificity and accuracy were as (p=0,02), and after 24 hours (p=0,007). No complications were follows: found related to the intraarticular treatment. Conclusions: a 89%, 72% and 81% for medial meniscus dose of 60 mgr of intraarticular ketorolac has better analgesic 64%, 88% and 92% for lateral meniscus effect than bupivacaine or morphine. 90%, 93% and 92% for anterior cruciate ligament.

The authors concluded that the MRI is an adequate exam for Poster #307 the diagnosis of meniscus and ligament lesions of the knee, REPRODUCIBILITY AND RELIABILITY OF THE and is the exam we choose when the clinical exam is inconclu- OUTERBRIDGE CLASSIFICATION sive. Michelle Cameron, Cheyenne, WY, USA, Presenter Karen K Briggs, Vail, CO, USA J. Richard Steadman, Vail, CO, USA Poster #309 Steadman Hawkins Sports Medicine Foundation, Vail, CO, USA TREATMENT OF FOCAL ARTICULAR CARTILAGE LESIONS OF THE KNEE WITH AUTOGENOUS OSTEOCHONDRAL GRAFT: A 2 TO 4 YEAR FOLLOW-UP STUDY The purpose of this study was to determine the accuracy, relia- Ching-Jen Jen Wang, Kaohsiung Hsien, TAIWAN, Presenter bility, and reproducibility of the Outerbridge classification sys- Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung Hsien, TAIWAN tem. Six cadavaric knees underwent diagnostic arthroscopy. Following knee arthroscopy, an arthrotomy was performed. A retrospective study of 15 patients with 16 knees undergoing POSTER ABSTRACTS Arthroscopically identified lesions were measured using osteochondral autografts for focal full thickness articular carti- calipers. Nine individual orthopaedic surgeons (4 attendings lage defects of the knee with 2- to 4-year follow-up showed 80% and 5 sports medicine fellows) reviewed each video and graded good or excellent clinical results.There was no correlation of each chondral lesion 2 separate times. The accuracy of all the clinical results with the underlying diagnoses including observers was calculated based upon the percent of agreement osteonecrosis, osteochondritis dessicans and traumatic carti- between arthroscopy and the arthrotomy “gold standard”. The lage defect; or the size of the lesion smaller than 600 mm2. overall accuracy was 68%. The accuracy rate by lesion graded However, cartilage lesions larger than 600 mm2 were associated ranged from 22-100% with lower grade lesions being diagnosed with increasing fibrous tissue formation and fissuring between with less accuracy than higher-grade lesions. For those obser- the grafts and the host tissues and poor results. The improve- vations that did not agree with the gold standard, the observer ment in symptoms appeared time dependant ranging from 6 to graded the lesion higher than the standard 63% of the time and 16 weeks that postoperative protection of the graft is warranted. lower than the standard 37% of the time. The accuracy rate was There was no radiographic progression of degenerative changes highest for patella and trochlear groove lesions and lest accu- of the knee in medium term follow-up. Therefore, autogenous rate for lateral tibial plateau lesions.The kappa score between osteochondral graft is considered a good method in the treat- the arthrotomy grade and arthroscopy grade was calculated. ment of knees with moderate size articular cartilage defects. The kappa coefficient between the two scores was 0.602 indi- cating good agreement. The physician at arthroscopy graded the lesion higher than the arthrotomy grade 63% of the time. Poster #310 The intra-observer kappa coefficient was 0.80, indicating excel- PROSPECTIVE RANDOMIZED STUDY ON lent agreement. The inter-observer kappa coefficient was 0.52, UNICOMPARTMENTAL K indicating good agreement. The mean inter-observer kappa Norberto Confalonieri, Seregno, ITALY, Presenter between the 2 physicians in practice 5 years or greater was 0.72, Kouros Motavalli, Milan, ITALY compared to a kappa of 0.50 for the inter-observer reliability Pietro Cerea, Milan, ITALY between the physicians in practice less than 5 years and fel- Presidio Centro Ortopedico Traumatologico (CTO), Milan, ITALY lows. In this study, we found good agreement between the grades of cartilage lesions at arthrotomy and arthroscopy based INTRODUCTION on the Outerbridge classification. Arthroscopy grades tended to It is now a fact that unicompartimental knee replacement is not be more severe than arthrotomy grades. When the grade did merely “half a total knee arthroplasty”, rather it is a separate not agree with what was seen at arthrotomy, arthroscopy was world, characterised by a specific and well-established conser- more likely to assign a higher grade to the lesion. Inter-observer vative phylosophy. “Mini-incision”; “minimally invasive tech- and intra-observer reliability and reproducibility was good to nique”; sophisticated instruments that guide the insertion of excellent. the components; computer-assisted navigation and “one day surgery” are increasingly heard of. And even the strongest

5.130 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). opponents have now included unicompartimental arthroplasty transplantation. There were no histological findings suggesting among the treatment options for the arthritic knees. rejection of the graft.

MATERIALS AND METHOD Between 1996 and 1997 at the Orthopaedics Department of the Poster #312 Milan Trauma Center, a series of consecutive patients were ARTHROSCOPIC FINDINGS IN SPORT AND NON-SPORT assigned randomly to two groups receiving two different uni- INJURIES IN YOUNG PATIENTS OF THE GENERAL compartimental knee designs. 20 patients (Group A) were POPULATION implanted knees with a fixed plateau (Allegretto, Sulzer) and 20 Georgios Drosos, Athens, GREECE, Presenter (Group B) with mobile bearings. The implant used for Group B J Louis Pozo, Bath, UNITED KINGDOM was the AMC knee (Gleitlanger, G.) - which is similar to the I Vlachonikolis, Heraklion, GREECE Oxford meniscal knee (Biomet) - because of the wider range of Royal United Hospital, Bath, UK sizes available both for the femur and the tibia. The mean fol- low-up was 4 yrs.; patients’ mean age was 70 yrs., the knee Aim undergoing surgery was mainly the left knee and the medial The aim of this study was to analyse the arthroscopic findings compartment was the only compartment involved. following a significant soft tissue knee injury in the general population, and to evaluate the influence of Cause of injury, DISCUSSION Gender and Age upon Meniscal tear, ACL tears and Combined Considering the short follow-up, no definitive conclusions can Meniscal and ACL tears. be drawn about polyethilene wear or loosening of the compo- nents. However, the results achieved show that unicomparti- Patients and methods mental knees are a valid option to treat compartimental 215 patients (of a group of 1025 patients arthroscoped) with no osteoarthritis and deformities. The scores assigned to the vari- history of previous knee injury or surgery, no history of arthritis, ous parameters were in general much higher than the patients’ and normal X-rays who had undergone arthroscopy by the overall final score as patients were classified according to the same surgeon were studied. parameter that had recorded the worst score. Nonetheless, 90% of excellent and good results were achieved in both groups Statistical analysis using the GIUM Score Card which is much stricter than the one The data was analysed by an independent bio-statistitian using used to evaluate TKA patients. No total failures were recorded, Pearson’s chi square test or Fisher’s Exact test and uncondi- despite one revision case, which testifies that this technique is tional logistic regression analysis. more forgiving and associated with low morbidity, few compli- cations, early and full function recovery and absence of soma- Results toagnosia which is sometimes observed in TKA patients. No Sports related injuries (group 1) occurred in 62.8% and Non- statistically significant differences were observed between the sporting injuries (group 2) occurred in 37.2% of total patients. two groups, though mobile bearings knees required more Patients in group 1 were younger than patients in group 2 extensive femoral and tibial bone resection. To the best of the (p<0.001). More men than women underwent arthroscopy in authors’ knowledge, this is the only study of this kind ever pub- both groups. Patients in group 1 had greater likelihood than lished. patients in group 2 to have suffered: an ACL tear, a combined meniscal and ACL tear, or a lateral meniscal tear. Women had lower incidence than men to have sustained: a meniscal tear, a Poster #311 combined meniscal and ACL tear. MENISCUS ALLOGRAFT TRANSPLANTATION: AN EXPERIMENTAL STUDY IN RABBITS. Conclusion

Ricardo Paula Cury, Sao Paulo, BRAZIL, Presenter In the general population POSTER ABSTRACTS Nilson R. Severino, Sao Paulo-SP, BRAZIL a.more patients underwent arthroscopy after a sporting than Osmar Pedro Camargo, Sao Paulo, BRAZIL after a non-sporting injury Tatsuo Aihara, Sao Paulo, BRAZIL b.men had a higher representation than women in both groups Victor Marques Oliveira, Sao Paulo, BRAZIL c.the cause of injury was predictive for an ACL and combined Santa Casa Medical School, Sao Paulo, BRAZIL meniscal and ACL tears as well as the meniscus involved d.in both sporting and non-sporting injuries women had lower This experimental study was designed to evaluate the feasibil- incidence and hence lower risk of sustaining a meniscal or a ity of frozen meniscus allograft transplantations in rabbits. The combined meniscal and ACL tear. studied population consisted of twelve rabbits who underwent a unilateral medial meniscectomy. The material was frozen at -80°C for 30 days and then re-implanted into a different rabbit. Poster #313 Sixty days after re-implantation the meniscus was removed for ARTHROSCOPIC PARTIAL MENISCECTOMY FOR gross and microscopic analysis. Results were compared to the DEGENERATIVE TEAR OF THE MEDIAL MENISCUS IN opposite untouched knee (control group). Ten of the trans- PATIENTS OVER 50 YEARS - 10 YEAR FOLLOW UP planted menisci presented complete healing and 2 only partial Alex Finsterbush, Jerusalem, ISRAEL, Presenter healing of the area peripheral to the synovial membrane. The Joseph Lowe, Jereusalem, ISRAEL gross size and aspect of the meniscus were the same as those Gershon Chaimsky, Jerusalem, ISRAEL of the control group in 8 specimens. The 2 menisci with partial Gideon Mann, Givat Shaul, ISRAEL healing presented morphological changes, another meniscus Hadassah, Jerusalem, ISRAEL was smaller than its control, and a fourth meniscus was torn at the medial third. Histology showed collagenous fibers dis- During the years 1989-1991, 105 patients ages 50-82 underwent played in a random pattern and two types of cells, fibroblasts a veriety of arthroscopic procedures. 65 of the 105 were found and fibrochondrocytes. These findings were typical of the to have a degenerative tear, mostly of the posterior horn of the remodeling that takes place in the meniscus 3 or 4 months after medial meniscus; seven had additional damage to the lateral meniscus; two patients had a solitary tear of the lateral menis-

5.131 cus. Typical history was sudden pain, with or without swelling Conclusion: Our data suggested that postmeniscectomy or effusion in the knee, following squatting or a sudden change osteonecrosis would be caused by the result of subchondral in knee position, like standing from the sitting position on a bone fracture after arthroscopic meniscectomy. low sofa. 36 patients had previous knee pain on effort, related to osteoarthritic changes. Evaluation of patients following arthroscopic meniscectomy and occasional joint debridement Poster #315 was based on PAIN, FUNCTION and TIME (duration of the relief MENISCAL REPAIR WITH BIOABSORBABLE DEVICES after surgery) : 1 = worse than before arthroscopy; 2 = same as Ben J Bessette, Ottawa, CANADA before arthroscopy; 3 = better, but worse than pre-exacerbation Ari E Pressman, Ottawa, CANADA stage; 4 = same as pre-exacerbation; 5 = better than pre-exac- Don H Johnson, Ottawa, CANADA, Presenter erbation condition; 6 = no pain, almost normal function. The Ottawa Hospital, Ottawa, CANADA Results were calculated by pain score multiplied by function score and time (in years). Score of 40-60 points = failure; Intro: Meniscal knee pathology is a common cause of morbid- 61=120 points = fair result; 121-220 = good result; 221-330 = ity in the active adult population. In the past, such injuries were very good result; above 330 = excellent. Only 39 patients were managed by resection until it became evident that this resulted found for evaluation ten years after surgery. Results were as fol- in premature knee osteoarthritis. In order to facilitate preserva- lowing: 9 scored excellent; 17 scored good and very good; 10 tion of meniscal tissue, biodegradable fixation implants have scored fair (short term improvement); 3 failed (deteriorated recently been introduced. However, the impact on clinical and within a year after surgery). 2 patients from the “fair” and functional outcome of these devices remains to be clarified. “failed” groups (each) underwent knee replacement. Good The goals of this study were to determine: 1) the impact of results were directly correlated to articular cartilage condition biodegradable meniscal implants on meniscal repair rates at at time of surgery, but patients’ condition improved for a lim- the time of ACL reconstruction, and 2) the clinical outcome of ited period even in advanced stages of osteoarthritis. the meniscal fixation technique.

Methods: Of 2101 consecutive patients treated for ACL recon- Poster #314 struction over a ten-year period (1990-99), 251 had a concomi- ETIOLOGY OF POST-MENISCECTOMY OSTEONECROSIS tant meniscal repair. Patient charts were reviewed to determine Hiroshi Higuchi, Maebashi-shi, JAPAN, Presenter annual meniscal repair rates and repair techniques for the Masashi Kimura, Maebashi, JAPAN period described. Functional outcome was then determined Yasukazu Kobayashi, Maebashi, JAPAN with the aid of the Cincinnati Knee Questionnaire, Lysholm, Masanori Terauchi, Maebashi-shi, JAPAN and Tegner functional activity questionnaires. Scores were then Kenji Shirakura, Maebashi-shi, JAPAN compared as a function of the repair technique chosen (sutures Kentaro Tokuma, Maebashi-shi, JAPAN vs bioabsorbable vs hybrids). Kenji Takagishi, Maebashi-shi, JAPAN Department of Orthopaedic Surgery, Gunma Universit, Maebashi-shi, JAPAN Results: The annual meniscal repair rate for the period 1990-95 increased from 9.2 ± 1.6% to 20.8 ± 0.6% after the introduction POSTER ABSTRACTS Purpose: In the past decade, a number of authors reported that of biodegradable implants (1996-99). Failed repairs were noted juxta-articular bone marrow signal changes on magnetic reso- in 27 of 109 suture repairs, 2 of 17 hybrid repairs and 1 of 25 nance imaging (MRI) following arthroscopic meniscectomy with bioabsorbable devices. There were no complications in the meant postmeniscectomy osteonecrosis. However, since bone patients who received a repair with bioabsorbable devices, and marrow changes in those studies were only evident on MRI none required repeat surgery. without histological confirmation, we need to take care in draw- ing conclusions regarding real osteonecrosis with clinical fea- Discussion: The introduction of bioabsorbable implants has tures. The purpose of this study was to investigate an etiology stimulated an increase in annual meniscal repair rates. With of signal changes on MRI following meniscectomy. the judicious selection of meniscal tears appropriate for fixa- tion with bioabsorbable devices, a change in failure or func- Materials and Methods: We experienced 48 patients with juxta- tional outcome was not seen. articular bone marrow signal changes on MRI after arthroscopic meniscectomy. Conservative therapy was choused for these Conclusion: Bioabsorbable meniscal fixation devices are a safe patients; however, clinical symptoms and radiographic changes and viable alternative to conventional suture repair. were deteriorated with time in eight patients. These eight patients had not only clinical but also radiological osteonecrotic features. Of these eight, six patients (mean age, Poster #316 64.3) were performed a surgical treatment for osteonecrotic A STUDY ON DISCOID LATERAL MENISCI IN JAPANESE lesions. At the surgery, every six patients were applied both CADAVER KNEES arthroscopic and pathological examination to investigate an Yuki Kato, Tokyo, JAPAN, Presenter etiology of bone marrow signal changes on MRI. Midori Oshida, Tokyo, JAPAN Akiyoshi Saito, Tokyo, JAPAN Results: Three cases of articular cartilage fibrillation, one case Kazumasa Fukushima, Tokyo, JAPAN of segmentation and two cases of cartilage defect on the lesion Toshinori Yoshimatsu, Tokyo, JAPAN of bone marrow signal changes on MRI were detected from Keinosuke Ryu, Tokyo, JAPAN arthroscopic findings. Articular cartilage damages were corre- Shin Aizawa, Tokyo, JAPAN lated with radiological grade for osteonecrosis. Histological Dept. of Orthop. Surg. Nihon Univ. School of Med., Tokyo, JAPAN study confirmed that subchondral bone fracture on the lesion of bone marrow signal changes was recognized in all cases. Purpose: The purpose of this study was to determine the accu- However, osteonecrotic lesion was detected only in three cases rate incidence rate of the discoid lateral menisci and the rela- pathologically. These three patients were accompanied with tionship between the shape of the lateral meniscus and its deteriorated radiological grade for osteonecrosis. influence on causing a tear by observing the knees of Japanese cadavers.

5.132 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). (Preoperative and follow-up average Lysholm scores were 52 Method: Observations were made on anatomical materials dis- and 95 respectively). The result of the cases under 40 years old sected at Nihon University by its medical students and the or without articular cartilage damage was superior to the oth- authors from 1991 to 2002. 276 cadavers (145male, 131female) ers. The follow-up graphies of the patients revealed an average were dissected. The mean age of the cadavers was 77.41?11.29 of 0.88 degree of an increase to the varus, especially in the (ranging from 43 to 103). The investigation of 275 cadavers (542 medial meniscectomy group. Regarding the clear space, medial knees) was made according to their age and gender and the joint space narrowing was 0.41 mm and 1.12 mm for the knees shape and the tear of their lateral menisci. According to that underwent medial and lateral meniscectomy respectively. Ikeuchi’s classification, the lateral menisci of our cadaver’s dis- sections were classified into three different types (Normal type, CONCLUSION: Early functional and subjective results of N; Incomplete discoid type, ICD; Complete discoid type, CD). arthroscopic partial meniscectomy can be expected to be satis- factory with 94% good or excellent results. However radiologi- Results: Lateral menisci from 542 knees were classified as fol- cal findings reveal joint space narrowing and angulation to the lows; 350 N menisci (64.6%), 153 ICD menisci (28.2%), 14 CD varus with increasing time after surgery. menisci (2.58%). The rest (25 menisci) was not clear because their lateral menisci have either disappeared or priorly been removed. There were 266 cadavers who had bilateral knees. Poster #318 There were 161 who had bilateral normal menisci. There were EVALUATION OF THE WATER CONTENT IN ARTICULAR 14 who each had a N meniscus and an ICD meniscus. There CARTILAGE USING NEAR INFRARED SPECTROSCOPY were 65 who had bilateral ICD menisci. There were 5 who each Tatsuya Kikuchi, Niigata, JAPAN, Presenter had an ICD and a CD meniscus. There were 4 who had bilateral Yuji Tanabe, Niigata, JAPAN CD menisci. Lateral meniscal tears were seen in 12% of N, Makoto Sakamoto, Niigata, JAPAN 27.4% of ICD and 14.3% of CD. Evidently, an ICD meniscus sig- Naoto Endo, Niigata, JAPAN nificantly led to tears (p<0.05). Yoshio Koga, Niigata City, JAPAN Niigata Civil Hospital, Niigata, JAPAN Conclusion: Complete discoid menisci were more scarce in this study than in previous reports about Japanese people. This Introduction: Besides of histological investigation, there is no paper shows that the rate of complete discoid menisci in this method to evaluate biomaterial properties of the degenerated study is not significantly different comparing with reports in articural cartilage. A specific characteristic of near infrared Western countries, and that the incidence of a lateral meniscal spectroscopy to measure the internal water content of speci- tear and an incomplete discoid meniscus is closely related. mens can be utilized to evaluate the properties of articular car- tilage. In this basic study, the possibility of new arthroscopic Significance: In this major study on cadaver’s knees, the accu- technique is presented. rate incidence rate of discoid lateral menisci was determined. This study also showed the relationship between the shape of Materials and Methods: By the self-developed indicator and the lateral meniscus and its influence on causing a tear. sensor of near infrared spectroscopy, specimens were irradiated with 0.00146 mm. After partial absorption by hydroxyl, reflected spectroscopy was measured. The relation between the intensity Poster #317 of incident and reflected light is defined as; Absorbance: CLINICAL AND RADIOLOGICAL RESULTS OF THE A=log10 (Ii/Ir), where Ii is intensity of incident light and Ir is ARTHROSCOPIC PARTIAL MENISCECTOMY that of reflected light. The absorbance means the index of the Hayrettin Kesmezacar, Istanbul, TURKEY, Presenter internal water content in the specimen. Mehmet Rifat Erginer, Istanbul, TURKEY

Tahir Ogut, Istanbul, TURKEY Experimentations: 1) Change of absorbance by saline drop into POSTER ABSTRACTS Ali Uzpak, Istanbul, TURKEY the water absorbing materials. 2) Relation between thickness Turgut Dincal, Istanbul, TURKEY and absorbance of porcine articurlar cartilage and menisci. 3) University of Istanbul, Cerrahpasa Faculty of Medi, Istanbul, TURKEY Change of absorbance before and after indentation.

OBJECTIVE: The purpose of this study was to evaluate the Results: 1) Absorbance was directly proportionate to an results of 47 arthroscopic partial meniscectomy cases and to amount of drop within 5 drops. 2) From 1.5 mm to 0.2 mm in analyze the possible correlation between preoperative findings thickness, no change of absorbance was measured. 3) and the clinical and radiological results of the follow-up period. Absorbance was decreased temporally and recovered straightly by the indentation in all specimens. Recovery of absorbance PATIENTS AND METHODS: 229 patients with medial or lateral was much higher in an articular cartilage than in menisci. meniscus tears, underwent arthroscopic partial meniscectomy between 1993 - 1999. However only 47 of the patients (50 knees) Conclusion: The measurement of absorbance of near infrared could be found and thus formed the group for the present spectroscopy can detect the change of water content in a bipha- study. The mean age of the patients at operation was 42.53 sic specimen. This method can be utilized arthroscopically to (range 16 - 68) years. Of the 47 patients, 21 (%) were men and evaluate the biomechanical property of the cartilage. 26 (%) were women. Thirtynine medial meniscectomy and 10 lateral meniscectomy were performed. One case had both menisci partially removed. A Lysholm score was determined for Poster #319 each patient and standart graphies were assessed to compare BIOMECHANICAL EFFECT OF AUTOGENOUS with the axis and clear spaces of the uninvolved knees. OSTEOCHONDRAL GRAFT ON ARTICULAR CARTILAGE Hiroshi Kuroki, Kyoto, JAPAN, Presenter RESULTS: The average follow-up of the patients was 56.74 Yasuaki Nakagawa, Kyoto, JAPAN months (range 25 - 103 months). One patient underwent total Koji Mori, Kyoto, JAPAN knee arthroplasty and was excluded. Of the 48 knees, 29 (60%) Mao Ohba, Kyoto, JAPAN had excellent, 17 (34%) good and 2 (4%) had poor results Takashi Suzuki, Kyoto, JAPAN

5.133 Ken Ikeuchi, Kyoto, JAPAN CLINICAL RESULTS OF ARTHROSCOPIC MENISCAL Takashi Nakamura, Kyoto, JAPAN REPAIR ACCORDING TO THE JOINT STABILITY Dept. of Ortho. Surg., Faculty of Medicine, Kyoto, JAPAN Hee-Soo Kyung, Daegu, KOREA, Presenter Joo-Chul Ihn, Taegu, SOUTH KOREA Purpose Seung-Hoon Baek, Taegu, SOUTH KOREA In the procedures of surgical operation of the autogenous Department of Orthopaedic Surgery, Kyungpook Natio, Taegu, SOUTH osteochondral graft, the osteochondral plugs and surrounding KOREA cartilage are under the mechanical stress twice, i.e. when har- vesting and grafting. The purpose of this study is to analyze the Purpose: The purpose of this study was to evaluate the results biomechanical effect of autogenous osteochondral graft on of arthroscopic meniscal repair according to associated liga- articular cartilage. Using the ultrasonic system which was ment injury. developed for the measurement of stiffness, smoothness and thickness of the cartilage, we measured the biomechanical Materials and methods: Twenty cases were reviewed, which was properties of cartilage in human and in an animal model. done arthroscopic meniscal repair. The mean age was 32.3 years. The mean follow-up period was 39.7 months. Menisci Materials and methods that had underwent complete repair of associated ligament Clinical measurement: During surgical operation for two injuries (8 cases, Sa) and menisci that had no associated liga- human subjects of osteonecrosis, the stiffness, smoothness ment injury (9 cases, Sb) were classified as stable group (S), and thickness were measured using the ultrasonic measure- and the others (3 cases) as unstable group (U). Also stable ment system. Using Osteochondral Autograft Transfer System, group was divided to acute and chronic group. The result was 11 full-thickness osteochondral plugs were harvested from the evaluated with Lysholm score and IKDC method. The statistical donor site and grafted into the cylindrical holes of the recipient analysis was done using Wilcoxon rank sum test and Fishers site. The measurement just on the oseteochondral plugs was exact test (p<0.05). carried out at before harvesting and after grafting the plugs. Results: Group Sa had 87.5% satisfactory and Lysholm score Experimental measurement: Twelve frozen knee joints of was 90.9. Group U had 66.7% satisfactory, and Lysholm score mature pigs were used for the measurement. In each of 7 knees was 77.7 Group Sb had 89.9% satisfactory and Lysholm score defrosted overnight, three plugs (6-mm in diameter) were har- was 91.4. In acute group 91.7% was satisfactory, Lysholm score vested from the donor site of the femoral trochlea and grafted 92.5, in chronic group 80% was satisfactory, Lysholm score 88.6. into the holes (5-mm in diameter) in the recipient site of the femoral trochlea (the 6-mm model, n=21 plugs). In remaining 5 Conclusion: Joint stability was important factor for the outcome knees, total of 28 plugs (5-mm in diameter) were harvested of meniscal repairs. So, it is desirable to repair meniscus injury from the donor site and returned to its original site (the 5-mm early and the repair of associated ligament injuries should be model). The measurement was carried out three times, i.e. performed together. before and after harvesting and after grafting the plugs. The points of measurement were just on the plugs and surrounding POSTER ABSTRACTS 4 points (at approximately 5-mm proximal, distal, medial and Poster #321 lateral to the plugs). The data obtained were analyzed statisti- ALLOGRAFT ACL/MENISCUS TRANSPLANTATION IN cally using paired t-test and analysis of correlation. PATIENTS WITH PRIOR MENISCECTOMY, ACL DEFICIENCY AND EARLY DEGENERATIVE ARTHRITIS Results Steven D. Levin, Wilmette, IL, USA, Presenter In both of human and pigs, no differences in stiffness, smooth- Northwestern University, Evanston, Illinois, USA ness and thickness of articular cartilage between before har- vesting and after grafting the 6-mm plugs were observed. Post-traumatic arthritis is a well known sequela in patients with Stiffness and thickness of human plugs after grafting were sig- chronic ACL deficiency and prior meniscectomy. Few treatment nificantly correlated with those before harvesting. All of these options are available for patients with post-traumatic arthritis three parameters of 6-mm plugs of pigs after grafting were sig- and instability. The objective of this study was to evaluate the nificantly correlated with those before harvesting. In the 6-mm results of ACL/meniscus allograft transplantation in these model of pigs, there were no differences in the three parame- active patients. Nineteen of 20 patients who underwent ters of surrounding cartilage of the holes after harvesting the 6- ACL/meniscus allograft transplantation between 7/97 and 2/00 and 5-mm plugs. The parameters after harvesting the plugs were available for follow-up. All patients presented with pain, were significantly correlated with those before harvesting. instability, and had documented prior meniscectomy and ACL There were no differences in smoothness and thickness of sur- deficiency. The average age was 35(20-53), 16 males and 3 rounding cartilage between after harvesting the 5-mm plugs females. Thirteen cases were sports related and 6 trauma. Each and after grafting the 6-mm plugs. The three parameters after patient had an average of 1.6 prior surgical procedures (1-4). grafting were significantly correlated with those after harvest- Fourteen years on average transpired between the time of the ing. In the 5-mm model, no differences in the three parameters first surgery and the index procedure. Four patients required of articular cartilage between before harvesting and after graft- revision ACL surgery and 15 had a previously undiagnosed or ing the 5-mm plugs. The parameters after grafting were signifi- untreated ACL. Thirteen patients had prior medial meniscec- cantly correlated with those before harvesting. tomy, 3 lateral and 3 both. All patients underwent a combined medial or lateral cryopreserved meniscus allograft and endo- Conclusions scopic ACL allograft transplantation. Average follow-up was 2.6 During the operative technique of the osteochondral graft using yrs. All patients were evaluated by clinical exam, x-ray, MRI, Osteochondral Autogenous Transfer System, the biomechani- Lysholm and Tegner activity scores and KT-1000. Clinical results cal parameters on the osteochodral plugs did not change. yielded 8 excellent, 6 good, 1 fair, and 4 poor. Lysholm scores improved on average 23 points. Tegner activity level increased to 5.8. KT-1000 was less than 2.6mm maximum side to side dif- Poster #320 ference on average. Complications consisted of 2 patients with arthrofibrosis, 1 infection and 1 neuroma. The poor results were

5.134 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). in patients who initially presented with grade III arthritis. RESULTS Combined ACL/meniscus allograft transplantation is a good There were 4 failures in this study, consisted in re-rupture of the procedure for carefully selected patients who present with pain, meniscus. The clinical results were good in 91,4% with com- instability, documented prior meniscectomy, and ACL defi- plete recovery and return to physical and sportive activity; good ciency. Patients with post-traumatic arthritis beyond grade III in 2,8% with mild symptoms and failure in 5,8% consisting in tend to do more poorly than patients with less advanced arthri- meniscus re-rupture. Imaging and anatomopathological sam- tis. ples will be presented and discussed.

CONCLUSIONS Poster #322 The meniscus healing does occur. The healed meniscus has a HEALING OF OSTEOCHONDRAL DEFECTS IN THE RAT protective role towards articular cartilage. The cases selection PATELLA AFTER PERIOSTEUM TRANSPLANTATION – is important for success. The arthroscopical approach permits EVALUATION OF CARTILAGE REPAIR AND NERVE FIBER the identification and treatment of associated lessions. The SPROUTING outside -in technique is easy and does not require expensive Magnus Lundberg, Linkoping, SWEDEN, Presenter tools. Karin Edoff, Linkˆping, SWEDEN Hälsouniversitetet, Linkôping, SWEDEN Poster #324 Repair of articular cartilage is an important clinical problem. INTER-OBSERVER AGREEMENT FOR THE ASSESSMENT Availability of chondrogenic stem cells has been pointed out as OF INTRA-ARTICULAR PATHOLOGY IN KNEE one key factor in cartilage repair and application of periosteal ARTHROSCOPY autografts has been used clinically to improve healing. In addi- Robert G Marx, New York, NY, USA, Presenter tion, neuropeptide containing nerve fibers may contribute to Jason T. Connor, Cleveland, OH, USA healing by stimulating cell proliferation and/or differentiation. Annunziato Amendola, Iowa City, IA, USA In the rat, peptidergic nerve fibers invade the callus formation Jack T Andrish, Cleveland, OH, USA during fracture healing and peptidergic nerve fibers are abun- Christopher Keading, Columbus, OH, USA dant in cartilage related connective tissue during skeletal Eric C. McCarty, Nashville, TN, USA development in young mammals. The purposes of the present Richard D Parker, Cleveland, OH, USA study were to evaluate healing of an experimental full thickness Rick W. Wright, Saint Louis, MO, USA osteochondral defect in the rat patella with and without appli- Kurt P. Spindler, Nashville, TN, USA cation of a periosteal autograft, and to find out if a local nerve Hospital for Special Surgery, New York, NY, USA sprouting is part of the healing process. The periosteum flap was applied with the cambium layer facing the defect. INTRODUCTION: Osteochondral healing was evaluated with a histological score Acute and chronic cartilage injury of the knee have an impor- and the presence of nerve fiber profiles in relation to the defect tant impact on prognosis. The gold standard for the diagnosis was assessed by protein gene product 9.5 immunohistochem- of cartilage and meniscal injury of the knee is arthroscopic eval- istry. The results showed (i) that osteochondral defects in the uation. The presence and severity of such pathology may be the rat patella heal spontaneously but incompeletely, (ii) that heal- most important factor in the long-term prognosis of acute knee ing consistently is less satisfactory with the application of a injuries. Surgeons must be able to accurately grade meniscal periosteal autograft than without and (iii) that healing is not and chondral pathology at arthroscopic evaluation to allow accompanied by nerve fiber sprouting. Periosteum coverage prospective multi-center collaborative research trials. The goal alone does not provide sufficient healing conditions for osteo- of this study was to quantify inter-observer agreement among chondral repair in this model. fellowship trained sports medicine surgeons. POSTER ABSTRACTS METHODS: Poster #323 A single orthopedic surgeon with fellowship training in sports OUTSIDE-IN MENISCUS SUTURE TECHNIQUE; 5 YEARS medicine performed diagnostic arthroscopies on thirty knees in FOLLOW-UP thirty patients. Twenty patients had acute anterior cruciate lig- Rodica Marinescu, Bucharest, ROMANIA, Presenter ament (ACL) injury and ten had degenerative disease, to allow Dan Laptoiu, Bucharest, ROMANIA for a broad spectrum of knee pathology. Six sports medicine fel- Mihai Negrusoiu, Bucharest, ROMANIA lowship trained surgeons (mean: ten years in practice; range: 2- Orthopaedics and Trauma Department, Colentina Clin, Bucharest, 25) viewed the videos and rated each chondral surface as either: ROMANIA normal; grade 1 (softening); grade 2 (fissures and superficial changes); grade 3 (fragmentation and deep changes); and grade PURPOSE 4 (exposed bone). Meniscal pathology was graded as normal, We present the results of a prospective study evaluating the partial tear and complete tear. The Kappa statistic was used to arthroscopic technique of outside-in meniscal suture. quantify agreement among the surgeons.

MATERIAL AND METHOD RESULTS: Between January 1997- January 2001, 68 patients were enlisted For articular cartilage lesions, the Kappa statistic ranged from in this study. This group consisted in 57 men and 11 women. 0.51 to 0.80 with the exception of the medial tibial plateau, Average age was 27,6 years (range 17 to 45). There were 63 right which was 0.35. Medial meniscal pathology had a kappa value knees and 5 left knees. The types of tears suitable for suture of 0.63 and the lateral meniscus 0.53. This indicates moderate consisted in acute longitudinal tears, unique or in association to excellent agreement, with the exception of the medial tibial with radiar tear in middle third. The technique was always out- platform. side-in. The type of used suture was resorbable (2-0 PDS, 2-0 MAXON). The evaluations included clinical examination, radi- DISCUSSION and CONCLUSION: ographic exams and second look arthroscopies (6 cases). Agreement among surgeons with respect to articular cartilage and meniscus injury at arthroscopy is good, but not excellent.

5.135 The system used for scoring knee pathology has an impact on the level of agreement. Conclusion: The results of this prospective study suggest that patients with chondral and osteochondral lesions, who undergo the microfracture abrasion technique, experience sig- Poster #325 nificant clinical improvement at an approximate two-year fol- A PROSPECTIVE OUTCOME ANALYSIS OF PATIENTS lowup interval. TREATED WITH MICROFRACTURE ABRASION FOR CHONDRAL LESIONS OF THE KNEE: A PRELIMINARY REVIEW Poster #326 Riley J. Williams, New York, NY, USA CHOICE OF OPERATIVE METHODS FOR Robert G Marx, New York, NY, USA, Presenter OSTEOCHONDRITIS DISSECANS OF THE FEMORAL Edward C. Jones, New York, NY, USA CONDYLES Nawal Atwan, New York, NY, USA Hideo Matsumoto, Tokyo, JAPAN, Presenter Thomas L. Wickiewicz, New York, NY, USA Yasunori Suda, Tokyo, JAPAN Russell F Warren, New York, NY, USA Toshiro Otani, Shinjuku-ku, JAPAN Hospital for Special Surgery, New York, NY, USA Takashi Toyoda, Tokyo, JAPAN Yasuo Niki, Tokyo, JAPAN Introduction: Articular cartilage has a limited capacity for Keio University, Tokyo, JAPAN repair. As such, chondral and osteochondral lesions remain a serious clinical problem. Microfracture abrasion (pick proce- PURPOSE: The results of various operative methods for osteo- dure) remains one of the most commonly performed proce- chondritis dissecans of the femoral condyles were reviewed, dures indicated for the treatment of such lesions. To date, there and choice of these operative methods were discussed. exist no prospective analysis of the clinical outcomes of those patients treated with this surgical technique. METHODS: Thirty-six cases (26 males and 10 females) which underwent operative treatments were reviewed. The operative Purpose: The purpose of this study was to prospectively analyze methods included drilling, repositioning and fixation of the the clinical outcomes of patients treated with microfracture osteochodral fragment, and bone graft or osteochondral graft. abrasion for the treatment of isolated chondral defects of the The minimum follow-up period was two years. The medial knee.Methods: Following IRB approval, all patients who were femoral condyle was involved in 25 cases, and the lateral, in 11. pre-operatively indicated for microfracture abrasion of the Lateral discoid meniscus or meniscal injury was combined in femur, tibia or patella were included in the study. Patients with all the 11 cases in the lateral. The operative methods were concomitant diagnoses (ligament rupture) were excluded. At decided from the condition of the cartilage. Drilling was per- the time of surgical indication, all but one of the study patients formed in cases with no or minimal cartilage damages (12 completed baseline functional outcome questionnaires cases). Repositioning (if required) and fixation of the fragment (Activities of Daily Living Score, Short Form-36). At the time of using absorbable pins was carried out in cases with a partial or surgery, articular cartilage surfaces were graded according to total fragmentation (10 cases). Bone graft or osteochondral POSTER ABSTRACTS the classification of Outerbridge. The location of chondral graft was performed when the original site was already degen- lesions was noted and sized. The microfracture procedure was erated (14 cases). Partial meniscectomy was added when the performed by creating 3-4 perforations in the subchondral bone meniscal injury was combined. of the lesion approximately 5 mm apart. Postoperatively, the weightbearing status, use of continuous passive motion, and RESULTS: In patients who received drilling, the lesion healed bracing were recorded. Follow-up questionnaires were admin- radiographically in all the cases and they complained of no or istered to the patients at 6, 12, and 24 months postoperatively. minimal symptoms. In patients who received the fragment fixa- tion, re-union of the fragment was observed in 70% and the Results: 37 patients met the study criterion of preoperative clinical outcomes were satisfactory in most of the cases. In functional scoring and a minimum followup interval of 1 year. patients who received bone graft or osteochondral graft, The mean patient age was 39.2 years (range: 16-60 years); there although union of the graft was observed in all the cases radi- were 28 males and 9 females. The mean duration of symptoms ographically, 71% of the patients complained of residual pain. was 25 months (range: 1-324 months). CONCLUSIONS: From the results, drilling is sufficient if the car- Eighteen lesions were of traumatic origin; 19 lesions were tilage surface is not damaged. When the fragmentation chronic with no identifiable traumatic history. There were 29 occurred already, the fragment should be repositioned and chondral lesions, and 8 osteochondral lesions (osteochondritis fixed to the original site before degenerated, as its clinical dissecans). Chondral lesion location was as follows: lateral symptoms were much better than those with bone graft or femoral condyle (10), medial femoral condyle (17), trochlea (6), osteochondral graft. tibial plateau (1), patella (3). Thirty-five (94.6%) of the lesions were Grade IV; two (5.4%) lesions were Grade III. Mean chondral lesion size was 407 mm2 (range: 60 - 2000 mm2) Concomitant Poster #327 procedures included the following: partial meniscectomy (4), AUTOGENOUS OSTEOCHONDRAL GRAFTING FOR removal loose body (1), lateral release (2), none (30). OSTEONECROSIS OF THE KNEE Yoshitaka Matsusue, Otsu, JAPAN, Presenter The mean interval to followup was 13.1 months (range: 11.5 to Gen-itsu Yoshikawa, Otsu, JAPAN 18.3 months). The mean ADL score increased from a baseline Yasuaki Nakagawa, Kyoto, JAPAN score of 67.0+ 17.99 to 78.64 + 16.88 at followup (p=0.003). The Depatment of Orthopaedic Surgery, Shiga University, Otsu, JAPAN mean SF-36 Physical Component Score increased from 38.57 + 9.25 to 45.74 + 10.27 (p=0.001). The mean SF-36 Mental INTRODUCTION: Repair of the osteochondral lesion of Component Score decreased from 55.18 + 10.61 to 52.78 + 9.54 osteonecrosis of the knee is a difficult and controversial issue. (p=0.14). None of the 37 patients required further surgery of the In this paper, we present the clinical results of autogenous affected limb. osteochondral grafting for osteonecrosis of the knee.

5.136 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). ACT. Arthroscopic MACT additionally avoids open knee surgery MATERIALS AND METHOD: Ten patients with at least 6-monts and can be performed save and quick with the new device. follow-up periods were included in this study. The age ranged from 29 to 71 years of age, with a mean of 48. The follow-up period ranged from 6 to 66 months with a mean of 33. The Poster #329 cause of osteonecrosis was steroid-induced in 2 and idiopathic ALL INSIDE MENISCAL REPAIR: A CADAVERIC STUDY in 8. There was one knee with osteonecrosis of the medial tib- COMPARING THE FAST-FIX TO THE RAPID LOC DEVICE ial plateau. High tibial osteotomy was performed in 8 knees at Mark David Miller, Charlottesville, VA, USA, Presenter the same time of osteochondral grafting. The size of the osteo- Anikar Chhabra, Charlottesville, VA, USA chondral defect ranged from 180 to 1080 mm2 with a mean of Peter Blessey, Charlottesville, VA, USA 380. The number of transplanted grafts ranged from 1 to 5 with J Gonzales, Richmond, VA, USA a mean of 2.5. W R Beach, Richmond, VA, USA Alex Kline, Charlottesville, VA, USA RESULTS AND DISCUSSION: The clinical results by ICRS carti- David R Diduch, Charlottesville, VA, USA lage evaluation form were normal in 2, nearly normal in 7, and University of Virginia, Charlottesville, VA, USA abnormal in 1 knee. The range of motion was normal except in one knee with a flexion of 135 degrees. Second-look Purpose: There are several new devices currently available for arthroscopy revealed good fibrous cartilage regeneration in the All-Inside meniscal repair. Two of these devices, the Rapid Loc gap between the grafts and integration to the adjacent healthy (Mitek, Ethicon, Norwood, MA) and the FasT-Fix (Smith & cartilage in most of the cases. Satisfactory result was obtained Nephew, Endoscopic Division, Andover, MA), are attractive for the patient who had a large chondral lesion on the whole because they combine the advantages of traditional Inside-Out lateral femoral condyle. Abnormal result was obtained in the meniscal repair with an All-Inside technique. We chose to criti- patient who had high tibial osteotomy but lost the correction cally evaluate and compare these devices in a cadaver model. angle during the follow-up period. Resurfacing of osteochon- dral defect of the tibial plateau could be performed through an Type of Study: Cadaveric consecutive sample. arthroscopic technique. When a proper alignment (FTA: 170+/- 2 degrees) was obtained, autogenous osteochondral grafting Methods: Two groups of cadavers were evaluated. Group I eval- for osteonecrosis of the knee can provide a good knee function uated the FasT-Fix device, while Group II evaluated the Rapid including full flexion. Loc device. In each group, the devices were inserted arthro- scopically by two experienced Sports Medicine Fellowship CONCLUSION: Autogenous osteochondral grafting can give trained orthopaedic surgeons into eight fresh-frozen cadaveric satisfactory results for the osteonecrosis of the knee if a proper knees (age 73 to 96 for Group I, age 66 to 78 for Group II) into alignment is obtained. both the medial and lateral menisci. A total of 45 FasT-Fix devices were placed for Group I: 24 laterally and 21 medially. For Group II, a total of 48 Rapid Loc devices were placed: 24 lat- Poster #328 erally and 24 medially. For both groups, three devices were •MATRIX ASSOCIATED AUTOLOGOUS CHONDROCYTE inserted into each menisci. One device was inserted as far pos- TRANSPLANTATION (MACT) IN CLINICAL PRACTICE teriorly as possible (usually about 1 cm from the posterior Johann Georg Meinhart, Wels, AUSTRIA, Presenter horn), and two other devices were placed anterior to this at 5-7 Martin Fussenegger, Wels, AUSTRIA mm intervals extending into the body of each menisci. No Ernst Orthner, Wels, AUSTRIA devices were inserted into the anterior menisci. For purposes of Erwin Ploberger, Ried, AUSTRIA this study, the location of the devices were named posterior, Institute for Tissue and Organ Reconstruction, Wels, AUSTRIA middle, and anterior respectively. All of the knees were subse-

quently dissected to determine the location of the inserted POSTER ABSTRACTS Objective:Autologous chondrocyte transplantation has proven devices, and relation of the devices to the surrounding neu- its clinical feasibilty for the treatment of traumatic articular car- rovascular structures. tilage defects. The cells are applied to the defect in an aquaous solution. The defect then has to be sealed with a periostal flap. Results: The Rapid Loc device was correctly inserted 83.3% of In order to avoid periostal flap procurement and cell loss by time, compared with 60% correct placement with the FasT-Fix leaking, we used matrix associated autologous chondrocyte device. This difference was statistically significant (p<0.02) No transplantation (MACT). statistically significant difference was present when comparing locations of insertion of the devices due to our small sample Method: Chondrocytes were isolated from a small biopsie of an size, but trends support the Rapid Loc device. In Group I, sev- unloaded part of the articular cartilage. A sufficient cell number eral potential pitfalls were identified with the FasT-Fix device for transplantion was reached after 3-4 weeks in cell culture. On during the evaluation. When utilizing the depth penetration the day of operation, cells were harvested and chondrocyte-fib- limiter that comes preset with the device (to a depth of 22 mm), rin-collagen composite constructs were produced in the oper- superficial structures including the iliotibial tract and even the ating theater. This constructs were then grafted into the defect skin were at risk for penetration with the needle. Other poten- either by arthrotomy or arthroscopically by using a new device, tial pitfalls seen during the insertion of the FasT-Fix meniscal desinged especially for arthroscopic MACT. 15 patients were devices include suture tensioning issues (including failure of treated with MACT for traumatic articular cartilage defects. the suture during tightening), intraarticular deployment of the Patients were followed for up to 6 months. implants, premature deployment of both the first and second implants, difficulty in advancing the trigger for deployment of Results: All patients treated with MACT showed good two excel- the second implant, and difficulty in placing vertical-mattress lent results. No patients experienced locking or swelling. sutures. The technical problems encountered with the FasT-Fix device occurred much less frequently with the Rapid Loc Conclusion: MACT avoids periostal flap precurement and tech- device. Entrapment of the popliteus tendon (3/8) and superfi- nical difficulties of the cell solution application, as observed in cial medial collateral ligament (2/16) were the only major prob- lems with that device. There was no neurovascular risk

5.137 associated with proper use of the Rapid Loc device. Neither (ESFOS) (Orthotic Mobility Systems, Inc., Kensington, MD, device could be effectively inserted into the anterior meniscus USA). or extreme posterior horn. For both devices, we do remain con- cerned regarding the profile of the device on the meniscus and Materials and Methods: Twenty subjects (7 females, 13 males, the risk for chondral damage. age = 52.1 +/- 6.3 yrs) who were more than 1 year status-post unilateral total hip (n = 13) or total knee reconstruction (n = 7) Conclusions: The Rapid Loc can be placed more safely than the participated in this study. All subjects had used axillary FasT-Fix device, with less technical problems and with repro- crutches at least briefly during post-operative rehabilitation. ducible results. However, long term function and in vivo risks Following involved side instrumentation with a plantar force can not be evaluated in the cadaver model. sensor (Pedar, Novel, Munich), subjects were instructed in 50% involved side weight bearing using a digital scale and in appro- priate ambulatory assistive device use. During data collection Poster #330 subjects ambulated 15.2 m at a self-directed comfortable pace POSTOPERATIVE RESULTS IN THE DONOR SITE OF THE as plantar force data were sampled at 50 Hz. Subjects com- MOSAICPLASTY pleted the course with each assistive device, with alternating Yasuaki Nakagawa, Kyoto, JAPAN, Presenter device order between subjects. Mean peak plantar force-time Yoshitaka Matsusue, Otsu, JAPAN integral data were determined from the initial 3 steps taken Takashi Suzuki, Kyoto, JAPAN with each device. A series of one-way ANOVA were used to eval- Takashi Nakamura, Kyoto, JAPAN uate condition (device differences). Department of Orthopaedic Surgery, Faculty of Medi, Kyoto, JAPAN Results: The mean peak plantar force-time integral was reduced [Purpose] There are few reports of the postoperative results in during unilateral partial weight-bearing ambulation using the the donor site of the mosaicplasty. We examined the effect of ESFOS compared to axillary crutch use (394.6 +/- 169 N/sec vs. the donor site including second look arthroscopy. [Materials 526.8 +/- 209 N/sec, mean difference = 132.2 N/sec, p = 0. 03). and Methods] There were 23 patients and 24 knees we operated Statistically significant differences were not evident for mean mosaicplasty from 1997 to January in 2001. Fifteen men and 8 peak plantar forces during 50% unilateral weight bearing reduc- women, 11 right knees and 13 left ones, the mean operative age tion (crutches 326 +/- 155 N vs. ESFOS 339 +/- 114 N, p > 0.05) was 31.1 years old, and the mean follow up period was 24 or for mean peak plantar force onset timing following initial months. The assessment we used was the area of the donor foot-ground contact (crutches 0.68 +/- 0.29 sec vs. ESFOS 0.81 site, the number of the osteochondral plugs, how to fill up in +/- 0.37 sec, p > 0.05). the donor site, patella compression test, the symptom due to donor site and radiography. There were 16 patients and 17 Conclusions and Significance: Despite being unfamiliar with knees we performed second look arthroscopy. The mean period the ESFOS and having limited practice time, subjects who were from the mosaicplasty to the second look arthroscopy was 14.9 more than 1 year status post unilateral total knee or total hip months. [Results] The areas of the donor sites were 12 knees in replacement displayed a more controlled rate of loading at only lateral trochlea of the femur and 8 knees in the lateral and their involved lower extremity during flat surface ambulation POSTER ABSTRACTS medial trochleas. The mean number of the plugs was 3.9. How when using the device. The ability to effectively control weight to fill up in the donor site was 9 knees of autogenous bones, 7 bearing during both assisted ambulation and during closed ones of osteochondral composites in the lesions, 4 ones of arti- kinetic chain exercise tasks following articular cartilage preser- ficial bones and autogenous bone, and 4 ones of nothing. There vation or restoration procedures may enhance the self-lubrica- was only one patient who had symptoms due to the donor site. tion of articular cartilage during weight bearing thereby He continued his knee pain and swelling 5 months after his improving its elasto-hydrodynamic properties. The more physi- mosaicplasty, and had irregularity of the patellofemoral joint in ologically relevant loading provided by the ESFOS may help his radiography. We divided the donor sites into three types in improve patient functional outcomes following articular carti- second look arthroscopy: swelling 3 knees, flat 8 knees and lage surgery. depression 5 knees. [Discussion] The cause of the patient who had symptoms due to the donor site was supposed to be early returned to sport. [Conclusion] We divided the donor site into Poster #332 three types in second look arthroscopy: swelling, flat and SYNDROME OF THE ANTERIOR SYNOVIAL depression. There was only one patient who had the symptoms IMPINGEMENT: CLASSIFICATION, DIAGNOSIS AND due to the donor site. TREATMENT Paulo Roberto Rockett, Porto Alegre, BRAZIL, Presenter Jaime Mayer Wageck, Porto Alegre, BRAZIL Poster #331 Hospital Mãe de Deus, Porto Alegre, BRAZIL REDUCED PLANTAR FORCE-TIME INTEGRAL DURING PARTIAL WEIGHT BEARING GAIT USING THE EASY Objective: STRUTTER FUNCTIONAL ORTHOSIS SYSTEM The purpose of this study is to classify the lesions caused by the John Nyland, Louisville, KY, USA, Presenter syndrome of anterior sinovial impingement, the mechanism of David N.M. Caborn, Louisville, KY, USA injury and to evaluate the results obtained with the arthro- University of Louisville, Louisville, Kentucky, USA scopic treatment.

Purpose: With the evolution of surgical procedures designed to Method: preserve or restore hip, knee and ankle joint articular cartilage From September 1986 to May 1998, 36 resections of hyper- there is a greater need to provide more controllable, weight trophic synovitis causing anterior impingement were made bearing progressions during both assisted ambulation and from a total of 2032 knee arthroscopies. This represents only early rehabilitation. This study compared the mean peak plan- 1.77% of the patients undergoing knee arthroscopy. We tar force-time integrals during a modified 3-point gait pattern excluded cases of systemic diseases, widespread synovitis and with a 50% involved side weight bearing reduction using axillary other concomitant intra-articular diseases. Thirty-six patients crutches and the Easy Strutter Functional Orthosis System were included in this retrospective study. The average duration

5.138 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). of symptoms was 20,6 months with a range of 3 to 180 months. lesions - ICRS Classification), anterior horn of the meniscus Patients were 22 females and 14 males. Eighteen cases lesions and, less frequently, tibial cartilage injuries. Areas of occurred in the right knee and eighteen were in the left knee. chondromalacia changes in the adjacent articular surfaces were The mechanism of injury was noted in these cases. Eight of the usually present. These were probed, and any loose fragments patients had direct traumatic blows to the knee and two, indi- were removed. In the anterior horn were meniscal fraying and rect. Four of the patients reported twisting injuries to the knee. degenerative tears noted in superficial layer. Tears ranged from Seven patients reported repetitive minor trauma. The remain- discrete meniscal transverse tears to a true waste (consume) of ing fifteen patients had no trauma reported. inner margin. The lesion were arthroscopically classified in:

Clinical Signs: pain in the anterior joint line, pseudo-locking, Type I: alterations restricted to the synovial tissue: giving way, effusion, swelling and sensibility increase above the swelling, synovial hypertrophy, redness, vascular hypertrophy, anterior horn of the meniscus. They had no pain at rest, and ecchymosis, crushing of the synovial tissue and fibrosis. they had very localized symptoms, especially in the extension. Primary alterations that occur in the synovial tissue due to They stroll with painless attitude of discreet flexion of the knee repetitive minor trauma. (2.78%) and they avoid movements that need hyperextension (climbing or descending stairs). Type II: lesions in the femoral joint cartilage. Secondary alterations caused by the interpositions of synovial tissue caus- Physical Exam: Tests of strained hyperextension, causing acute ing lesions in the articular cartilage of the femur. (61.11%). pain, were accomplished and potentialized by the application of pressure above the anterosuperior border of the meniscus. Type III: lesions in the anterior horn of the meniscus and/or tibial cartilage. Secondary alterations caused by the interposi- Ultrasonography: Ultrasonography can show the site of synovi- tion of hypertrophic synovitis with lesions in the meniscus tis to evaluate the knee anterior soft tissue. Hipoechoic lesions and/or tibial cartilage. (2.78%). of synovial and volume increase in the comparative exam of the contralateral knee were found. On advanced phases we can Type IV: (Type II + Type III) Lesions in the femoral joint car- notice heterogeneous echo-pattern related to a chronic inflam- tilage and concomitant in the anterior horn of the meniscus matory change (fibrosis). Power Doppler Ultrasonography and/or tibial cartilage. Secondary alterations caused by the assessment showed an increase of the arterial and venous flow. interposition of synovial hypertrophic that provokes superior (femoral cartilage) and inferior (meniscus and/or tibial carti- Dynamic Ultrasonography: An interposition between the lage) injuries. (33.33%). femoral condyle and the superior surface of the anterior medial meniscus can be observed with the knee close to full extension. Results: With the knee fully extended, when the transducer is pressed on The average age was 36, 24 presented Type II lesions, 1 had Type the anterior horn of the meniscus, the patient experiences III and 11 had Type IV lesions. The average time to follow-up acute pain. was 95 months with a range of 17-155. Biopsies confirmed syn- ovial pathology in all cases. All the patients presented pain Treatment: It is conservative in the initial phase the treatment. recovery in the first 2 months of postoperative, 2 persisted with We suggest surgery when there is no symptoms improvement some limitation of the flexion and 3 had pain crisis after efforts. after 3 months. In all cases, the only common finding was the presence of a localized synovitis producing an impaction area Conclusion: approximately 2.5 X 2 cm on the anterior femoral condyle; this The anterior synovial impingement is characterized by a syn- was the main indication for partial synovectomy. The anterior ovial hypertrophy protruding into the join cavity. The patho- hypertrophy synovitis was excised with full radius blade (3.5 genesis of the pain is the entrapment of the hypertrophic mm) introduced through the anteromedial portal. Anterolateral synovium in the joint space. The removals of synovitis will relief POSTER ABSTRACTS portal was used for better arthroscopic visualization the symptoms and avoid further meniscal and cartilaginous (Visualization was possible through a standard anterolateral injuries on the anterior femoral condyle. The synovial impinge- portal). Special care was taken in order not to violate the ante- ment caused anterior pain in the knee mainly hurting the carti- rior capsule. In this series, the fat pad was not resected in all lage and medial meniscus. The arthroscopic surgical treatment cases. The cartilaginous surfaces lesions were treated with reached satisfactory clinical result, especially, in the relief of chondrectomy using full radius whisker blade (3.5 mm) and in the pain. We believe that the synovitis was the primary cause of one case abrasion was accomplished (1 cm2). The superficial symptoms, was not secondary to a cartilage injury and its etiol- meniscal lesions were treated with full radius whisker blade ogy was not necessarily related with trauma or other intra-artic- and partial meniscectomies were performed in larger lesions. ular pathologies. One case was sutured.

Pathologic Findings: Poster #333 Anterior synovial impingement medial was mostly found CONSUMER MENISCAL LESION (83.33%). The hypertrophic synovial was found reddish or Paulo Roberto Rockett, Porto Alegre, BRAZIL, Presenter whitish. It projects beyond the superior margins of the menis- Jaime Mayer Wageck, Porto Alegre, BRAZIL cus and it is interposed between the femur and the anterior Hospital Mãe de Deus, Porto Alegre, BRAZIL horn of the meniscus. In four cases, there was an exuberant growth of villous. Synovial bleeding secondary to mechanical Objective: damage was found. The purpose of this study is to describe the meniscal consumer lesion. It is a specific lesion, provoked by the anterior synovial Initially, we can observe the meniscus marked by hemosiderin impingement, which happens in the anterior horn of the menis- deposition originated from crushing of the synovial tissue cus with waste of your margin. This lesion can be confused with against articular cartilage of femoral condyle. In the most “Parrot-Beak Flap”, between the anterior horn and the body of advanced cases of synovial hypertrophic there were cartilagi- the meniscus. nous injuries of the anterior condyle (Central and Lateral site of

5.139 Method: The most advanced meniscal lesion caused by anterior synovial From a total of 2190 arthroscopies of the knee, accomplished impingement is the meniscal consumer lesion. It is character- from July 1986 to March 2000, we found 62 cases with meniscal ized by the disappearance of the free inner margin of the ante- lesion caused by the interposition of hypertrophic synovitis, rior horn of the medial meniscus. This disappearance occurs and of these, 10 cases were meniscal consumer lesion. In this because of the continuous and progressive waste of the menis- group of patients, cases of systemic diseases, widespread syn- cus caused by the interposition of the hypertrophic synovial tis- ovitis and degenerative osteoarthritis were excluded. sue between the articular surfaces. The treatment with partial meniscectomy should be made together with the resection of Lesion mechanism: the hypertrophic synovitis with the aim of solving the cause of The hypertrophic synovial projects beyond the superior margin the meniscal lesion. of the meniscus and it is interposed between the femur and the anterior horn of the meniscus. The pathogenesis of the menis- cal consumer lesion is the crushing of the synovial tissue against Poster #334 articular cartilage of femoral condyle. In the anterior horn, SHORT-TERM RESULTS OF TREATMENTS FOR meniscal fraying and degenerative tears have been observed in MENISCAL TEARS IN ANTERIOR CRUCIATE LIGAMENT superficial layer. Tears ranged from discrete meniscal transverse RECONSTRUCTED KNEES tears to the true waste (consume) of inner margin. Hideki Sato, Hirosaki, JAPAN, Presenter Yasuyuki Ishibashi, Aomori, JAPAN Clinical Signs: Kazuhiro Sasaki, Hirosaki, JAPAN They had very localized pain in the anterior join line especially Satoshi Toh, Hirosaki, JAPAN in the extension. They stroll with painless attitude of discreet Hirosaki University School of Medicine, Hirosaki, JAPAN flexion of the knee. Tests of strained hyperextension, causing acute pain, were accomplished and potencialized by the appli- The treatment of meniscal tears in anterior cruciate ligament cation of pressure above the anterosuperior border of the (ACL) reconstruction remains controversial. Some authors meniscus. reported that lateral meniscal tears were allowed to heal with- out surgery in acute ACL reconstruction. However, some rec- Pathologic Findings: ommended that meniscal repairs were useful in the presence of Classification of the lesions: ACL tears. The objective of this study was to investigate clinical Type I: crushing and degenerative tears restricted to the super- and magnetic resonance imaging (MRI) results after various ficial meniscal layer (74,3). arthroscopic treatment options for meniscal tears in ACL Type II: incomplete longitudinal tears (9,6). reconstructed knees. One hundred eighty-nine knees in 186 Type III: consumer lesion (16,1%). patients received primary arthroscopic ACL reconstruction between April 1997 and October 2000. Seventy-four knees were Treatment: retrospectively evaluated after a mean follow-up of 20 months Degenerative superficial meniscal lesions were treated with (range, 12 to 39). debridement with full radius whisker blade. Partial meniscec- POSTER ABSTRACTS tomies were performed in larger lesion and in all consumer Follow-up MRI was performed and evaluated at least one year lesions the flap tear has been removed in order to balance the after primary operation. In this study, we excluded the patients remaining tissue. Segmental resection of a torn meniscus who had retear of reconstructed ACL during follow-up periods, would leave this leading edge. These edges were trimmed to and those who could not have follow-up MRI. At primary ACL balance the remaining rim. reconstruction, there were 33 medial meniscal tears and 25 lat- eral ones. Of these cases, there were both medial and lateral Two cases (33,3%) of incomplete longitudinal tears were tears in 11 knees. For meniscal tears, 18 medial and 9 lateral sutured. The anterior hypertrophy synovitis was excised with menisci were treated by partial meniscectomy, 10 medial ones full radius blade in all cases. were treated by meniscal repairs (inside-out suture methods), and 5 medial and 16 lateral ones were arthroscopically evalu- Results: ated but not treated. Compared to MRI performed before pri- The average age of the patients that underwent to arthroscopy mary ACL reconstruction in follow-up MRI, high signals that treatment was 40 years old, ranged from 15 to 87. Thirty-four showed meniscal tears were obviously decreased at 18 of 33 were in the right knee and twenty-eight, in the left. Thirty medial menisci and 15 of 25 lateral ones. However, the change patients were male and thirty-two were female. The lesions of signal intensity in follow-up MRI was not significantly corre- were localized: 44 in the meniscus medial and 18 in the lateral lated with treatment options. In clinical results, 56 of 58 meniscus. We found 10 meniscal consumer lesions in 9 menisci remained asymptomatic except for two non-treated lat- patients. They were 31 years old of average age with minimum eral tears. These two patients had meniscal symptoms after of 15 and maximum of 58. Eight were in the left knee and 2 in reinjury. Although MRI was not adequate to evaluate treatment the right. Seven were female, and 2 male. All the 10 lesions options for meniscal tears, the clinical results suggested that were in the medial meniscus. The treatments of the meniscal the various methods were equivalently useful treatment lesions were accomplished together with the resection of the options. anterior hypertrophic synovitis. All the patients got relief of the pain within 2 months. Six patients had pain after some effort and 3 had limitation of the flexion comparatively. Concomitant Poster #335 lesions found in these 62 knees: 14 with medial pathologic plica OSTEONECROSIS OF THE MEDIAL FEMORAL CONDYLE causing cartilage lesions, 4 lesions in the other meniscus, 2 FOLLWING ARTHROSCOPY – IS IT A COMPLICATION OF with radial lesions in the posterior horn of the same meniscus, THE SURGICAL INTERVENTION? 2 ACL lesions, 1 cartilage erosion (Grade IV) in the trochlear Stefan Seitz, Herne, GERMANY, Presenter groove. Xenofon Baraliakos, Herne, GERMANY Martina Zielinski, Herne, GERMANY Conclusion: Georgios Godolias, Herne, GERMANY Klinik fuer Orthopaedie, St.-Anna-Hospital, Herne, GERMANY

5.140 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Introduction: The preservation of meniscus is crucial for main- Among the patients of our clinic, who underwent arthroscopic taining a normal knee joint function. A horizontal tear of menis- surgery since 1989 an osteonecrosis of the medial femoral cus is usually treated with a meniscectomy. Fibrin clot would condyle occured in 14 cases during the early postoperative promote a healing process in the avascular zone of horizontal period. The mean age of these patients was 61 years. While dur- tear of menscus. The purpose of this study is to evaluate the ing the operation a lesion of the medial meniscus could be effectiveness of the fibrin clot in the healing of horizontal found in 11 patients, in 3 cases the complaints could not be meniscal tear in the young adults. explained by the intraoperative findings. Chondromalacial resp. arthrotic changes did not exceed the usual age-related extent in Materials and Methods: 5 cases of horizontal meniscal tear any of the mentioned cases. During the opertion we only used were repaired with vertical mattress suture(2-0 Ethibond) and mechanical arthroscopy instruments. Retrospectively regarding the repair was enhanced with autogenous fibrin clot. Mean age the patients for their preoperative profile of pain we discovered, of cases was 21 years old. Cause of tear was 3 sports associated that the complaints had to be related to arthrotic disease rather injury, 1 traffic accident, 1 unknown. All patients had no associ- than to a meniscal tear due to degeneration, although x-rays ated intraarticular lesions. All cases had a horizontal tear at did not show major arthrotic development. posterior horn of medial meniscus. Mean length of tear was 21mm. During postoperative 6 weeks the knee was locked in full The postoperative occurence of osteonecrosis of the medial extension with a motion limited brace and was permitted a par- femoral condyle accompanied by generally unchanged prob- tial weight bearing with crutch. lems and complaints independent of the intraoperative find- ings has convinced us to delay arthroscopic intervention for a Results: All patients were followed at an average of 45.6months. group of 12 patients of the same age, who suffered from com- 5 cases was evaluated with MRI which showed 1 healed, 1 parable complaints. All of these patients were treated by non- incompletely healed, 1 not healed. On 2 cases of second look operative means within 2 to 5 months after initial occurence of arthroscopy 1 case showed the healed meniscus and 1 case the complaints. In 6 cases an osteonecrosis of the medial showed the reteared meniscus. 5 cases was evaluated with femoral condyle appeared during the above mentioned period Lysholm score which showed 3 excellent, 2 fair. Postoperative of time.For one of these patients an MRI had revealed first signs complication was 1 painful neuroma at the infrapatellar branch for this only 2 weeks after the clinical occurence of problems. of saphenous nerve. These findings suggest, that for patients of the mentioned age suffering from pain symptoms which are – despite of missing Conclusions: The use of fibrin clot in the repair of horizontal radiological changes – rather related to arthrosis than to a meniscal tear did not showed the satisfactory morphological meniscal lesion, the decision to do an arthroscopic interven- result. A more sophisticated methods were needed to obtain an tion should be made very carefully. A development of an complete meniscal healing. osteonecrosis due to the arthroscopic surgery is considered unlikely. Poster #338 BUCKET-HANDLE MEDIAL MENISCUS TEARS IN THE ACL RECONSTRUCTED KNEE: LONG-TERM OUTCOME Poster #336 K. Donald Shelbourne, Indianapolis, IN, USA, Presenter ALL-INSIDE SUTURE MENISCUS REPAIR Donald R. Carr, Indianapolis, IN, USA Ronald M Selby, New York, NY, USA, Presenter Francois Bonnomet, Strasbourg, FRANCE Stephen J O’Brien, New York, NY, USA Philippe Clavert, Strasbourg, FRANCE St. Vincent’s Hospital & Medical Center of New York, New York, NY, USA Jean Francois Kempf, Tremblay en France, FRANCE Methodist Sports Medicine Center, Indianapolis, IN, USA

An arthroscopic all inside technique for the repair of meniscus POSTER ABSTRACTS tears utilizing suture is presented. This is a modification of the We sought to determine the level of superiority meniscus repair Mulberry Knot Technique. Meniscus preparation, reduction, had above partial meniscectomy in patients undergoing ACL and the use of a spinal needle to introduce the suture is per- reconstruction with isolated, unstable, bucket handle medial formed the same way as with the Mulberry Knot Technique. meniscus tears with regard to subjective and objective out- After the first limb of the suture is brought through the knee, comes at greater than 2 years follow-up. Between 1982 and instead of tying the end of the suture, the spinal needle is 1995, 155 patients met the inclusion criteria. All patients under- slightly withdrawn from the meniscus and capsule but still kept went ACL reconstruction using patellar tendon autographs. under the skin. It is then re-inserted into the capsule, and Fifty-six patients underwent meniscal repair using inside-out meniscus and the second limb of the suture is retrieved technique. In 99 patients, the tear was felt to be non-salvage- through the same portal as the first suture limb. This allows the able and a partial meniscectomy was performed. Subjective fol- suture to be tied inside the knee with arthroscopic knot tying low-up was obtained with a modified Noyes questionnaire. techniques. We find that it gives a consistent, strong, and Patients were objectively evaluated using the IKDC knee exam- reproducible repair and can be used as a hybrid technique with ination criteria. The mean subjective score of 51 patients in the implants, other suture techniques, or as a stand alone tech- repair group was 90.9 +/- 11.6 points at a mean of 8.9 years after nique for meniscus repair or transplantation. surgery; the mean for 87 patients in the meniscectomy group was 90.9 +/- 16.7 points at a mean of 7.8 years after surgery (P=0.634). When repair group was subdivided into nondegener- Poster #337 ative tears (n=27) and degenerative tears (n=24) the mean ARTHROSCOPIC MENISCAL REPAIR WITH SUTURE AND Noyes score was 93.9 and 87.1 respectively (p=0.02). IKDC over- FIBRIN CLOT OF HORIZONTAL MENISCAL TEAR IN all grades on 25 patients in the repair group (mean time 7.1 YOUNG ADULT years) were normal in 13 (52%), nearly normal in 9 (36%), and Seung-Suk Seo, Pusan, SOUTH KOREA, Presenter abnormal in 3 (12%). IKDC overall grades on 56 patients in the Paik Hospital, Pusan, SOUTH KOREA removal group (mean time, 6.0 years) were normal in 26 (46%), nearly normal in 25 (45%), and abnormal in 5 (9%). IKDC radi- ographic sub-scores for the repair group were normal in 20,

5.141 nearly normal in 3, and abnormal in 1; the radiographic sub- Kurt P. Spindler, Nashville, TN, USA, Presenter scores for the removal group were normal in 41, nearly normal Todd A. Warren, Nashville, TN, USA in 8, and abnormal in 3. The distributions in grades were not Jason T. Connor, Cleveland, OH, USA statistically significant for a difference between groups Clinton J. Devin, Nashville, TN, USA (P=0.7467, overall grade; P=0.8977, radiographs). In patients Eric C. McCarty, Nashville, TN, USA with ACL reconstructed knees with unstable and isolated Vanderbilt Sports Medicine Center, Nashville, TN, USA bucket handle medial meniscus tears, the data at 7 years fol- low-up did not demonstrate superior subjective and objective OBJECTIVE: Entirely arthroscopic techniques of meniscus outcomes with meniscus repair verses partial removal. A subset repair have increasing popularity because they have reduced of repaired tears determined to be degenerative at the time of postoperative morbidity and easier insertion than traditional repair showed a statistically significant difference in subjective arthroscopically-guided inside-out repair with sutures. Despite scores at 8.9 years follow up. This difference is believed to be this shift in clinical practice technique, no prospective compar- due to the non-functioning of these menisci. These results rein- ative studies of clinical success have been published. This force the need to critically analyze the risks, benefits, and crite- comparative study on meniscus repair technique was initiated ria for meniscal repair in patients undergoing ACL when the senior author (KPS) prospectively switched in June reconstruction with unstable bucket handle medial meniscus 1996 from inside-out (PDS sutures) to entirely arthroscopic tears. (arrows) while keeping rehabilitation and weight-bearing con- stant. Our hypothesis was there would be no significant differ- ence in clinical success between repair techniques as defined Poster #339 by reoperation for meniscus repair failure. CLINICAL EVALUATION OF MENISCUS REPAIR WITH A BIOA METHODS: As the first component of the Multicenter Rainer Siebold, Heidelberg, GERMANY, Presenter Orthopaedic Outcomes Network (MOON) initiated in August Andree Ellermann, Pforzheim, GERMANY 1991, all ACL reconstructions were prospectively entered into a Jens-Ulrich Buelow, East Fremantle, AUSTRALIA database. A single surgeon’s posterior horn medial meniscus Ludwig Boes, Neulingen, GERMANY repairs with ACL reconstruction from 8/91-12/99 were evalu- Christian Sobau, Viernheim, GERMANY ated. Forty-seven consecutive patients (8/91-6/96) had arthro- ARCUS-Sportklinik, Pforzheim, GERMANY scopically assisted inside-out repair utilizing PDS sutures. Ninety-eight consecutive patients (6/96-12/99) had entirely Purpose of the study: Several new fixation devices for meniscus arthroscopic technique with bioabsorbable arrows. In both repair were developped in recent years. One of the most popu- time periods the percentage of menisci repaired were approxi- lar ones is the Bionx Meniscus Arrow. Short-term results are mately 20% of all ACL reconstructions. Clinical success was promising, but long-term clinical outcome is still in question. defined as no reoperation for medial meniscus debridement of We present a 2 to 3 year study of all-inside meniscus repair with failed repair site as previously documented on scale diagrams. the Bionx Arrow. Patient follow-up was by an 11-page Multi-Dimensional Health Assessment Questionnaire which included the validated KOOS, POSTER ABSTRACTS Material and Methods: 100 consecutive patients (100 menisci, WOMAC, SF-36, Lysholm, and IKDC-99, in addition to any pre- average age 29,5 [18-50] years) were evaluated prospectively vious operations on the knee. Statistical analysis consisted of following all-inside meniscus repair with the bioabsorbable Kaplan-Meier curves to investigate time to reoperation arrow. OP was performed between 9/1997 and 4/1999. F/u was between patients with these two techniques. A Cox propor- 33 [24 to 43] months and 96 patients were avaiable for f/u. tional hazards model was fit to compare times to reoperation Repairs were performed in either the medial (80%) or lateral and proportional hazards assumptions verified. (20%) posterior horn in the red-red or red-white meniscal zone. 70% of patients underwent concomitant ACL reconstruction. RESULTS: The inside-out suture technique had 85% follow-up F/u consisted of a history, clinical examination, Lysholm- and (40/47) with median 65 months. Follow-up in the entirely Cincinnati Knee Score. arthroscopic arrows group was 86% (84/98) with median 26 months. There were 6 failures for the inside-out group and 5 Results: 22 (22,9%) patients showed signs and symptoms con- failures in arrows. Kaplan-Meier curves demonstrate no differ- sistent with a meniscus tear (17 medial, 5 lateral) and under- ence and never differ by more than 2% in the first 5 years. The went partial meniscectomy. In 12 (55%) of revised patients Cox proportional hazards model shows no difference in time to concomitant ACL reconstruction was performed and 5 (22,7) of reoperation between techniques (p=0.88). The risk of reopera- patients were > 35 years. In the non-revisioners Lysholm Score tion is 0.90 times (95% CI 0.23-3.47) as high in the arrows group was 92,5 and Cincinnati Score was 89,9. We found 2 cases of than in the inside-out suture group at any point in time after distinct femoral cartilage damage. meniscus repair. Three-year success rates (proportions with no reoperations) were 90% (suture) vs 91% (arrows). While the Conclusions: Meniscus repair with the bioabsorbable arrow observed difference was just 1% at 3 years, the current sample leads to clinical results comparable to those of traditional sizes offer 80% power to detect a difference of 28% at 3 years. suture techniques. The simple and time saving all-inside inser- tion obviates the need for additional incisions and avoids knot CONCLUSIONS: Posterior horn medial meniscus repair with tying. A proper tear selection and arrow positioning is neces- concomitant ACL reconstruction (NWB 5-6 wks postop) has a sary and should avoid cartilage damage. Concomitant ACL clinical success of 90% at 3 years. No significant statistical or reconstruction and age had no significant influence on the revi- clinical differences were observed between techniques with our sion rate. protocol. However, this study did not include lateral meniscus repairs, large bucket-handle tears of the medial meniscus, or meniscus repair in the absence of ACL reconstruction; there- Poster #340 fore, no conclusions can be inferred from this study on these PROSPECTIVE COMPARISON OF ARTHROSCOPIC MEDIAL types of meniscus tears. MENISCUS REPAIR TECHNIQUE: INSIDE-OUT SUTURES VS ENTIRELY ARTHROSCOPIC ARROWS

5.142 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Poster #341 Christoph Resinger, Vienna, AUSTRIA HYALURONAN MATRIX-ASSOCIATED CHONDROCYTE Vilmos Vecsei, Vienna, AUSTRIA TRANSPLANTATION FOR THE TREATMENT OF Department for Traumatology, University of Vienna, Vienna, AUSTRIA POSTTRAUMATIC CHONDROMALACIA PATELLA - EARLY CLINICAL RESULTS OF A PILOT STUDY INTRODUCTION Stefan Marlovits, Vienna, AUSTRIA For the repair of cartilage defects the transplantation of cul- Gabriele Striessnig, Vienna, AUSTRIA, Presenter tured autologous chondrocytes is used. In the original tech- Christoph Resinger, Vienna, AUSTRIA nique a periostal flap is sutured over the defect site providing a Vilmos Vecsei, Vienna, AUSTRIA chamber for the transplanted cell suspension. As complica- Department for Traumatology, University of Vienna, Vienna, AUSTRIA tions of this method periostal hyperthrophy and delamination of the graft have been reported. As a further development the INTRODUCTION use of matrices as cell carriers reduce the periostal flap com- Chondromalacia of the patella in younger patients is still an plications and the operation time. We report the early clinical unsolved problem and can lead to significant pain and reduc- results of 10 patients after 12 months treated with autologous tion of quality of life. For the treatment of posttraumatic lesions matrix based chondrocyte transplantation. of the patellar cartilage the transplantation of cultured autolo- gous chondrocytes under a sutured periostal flap is not very MATERIALS AND METHODS effective. A possible successful method for the treatment of this Cartilage defects of 10 patients (mean age: 32 years; male 9 defects is the use of matrix associated cell transplantation [32,3], female: 1 [29,5]) were treated with an autologous chon- techniques. We report the early results of a pilot study for the drocyte transplantation using the MACI‚ technique (Verigen, treatment of posttraumatic cartilage defects of the patella with Copenhagen). The average defect size was 5.4 cm2 and the the transplantation of autologous chondrocytes cultured on a defects located on the medial femoral condyle (5), the patella hyaluronan matrix. (4) and the trochlea (1). After arthroscopy and cartilage biopsy chondrocytes were isolated and the number of cells increased PATIENTS AND METHODS in cell culture. Before implantation the cells were transferred on Ten patients (4 males and 6 females) with posttraumatic carti- a porcine collagen type I/III membrane. The implantation of the lage lesions of the patella were included in the pilot study. The membranes was performed during an arthrotomy and the con- mean age was 33.44 (male 32.79 and female 34.40). After inclu- structs were fixed with a fibrin glue (Tissucol‚). The postopera- sion in the study an arthroscopy was performed with hyaline tive care included CPM, non-weight-bearing for 4-6 weeks cartilage harvesting. The enzymatic isolation was followed by followed by partial weight-bearing for 4 weeks. For the clinical the expansion of the cell number. As a three-dimensional evaluation the patients were scored preoperative and 12, 24 matrix a non-woven hyaluronan polymer was used and the cells and 52 weeks postoperative. The subjective patient evaluation were cultivated for three weeks on this carrier (Fidia Advanced was performed with the KOOS and IKDC patient score. The Biopolymer, Abano, Italy). In a second step an arthrotomy was objective scores included the Lysholm, IKDC, Marshall, ICRS, performed followed by a debridement of the defect. The cell- Cincinnati, Larson and OAK score. hyaluronan matrix was transferred in the defect and fixed with fibrin glue (Baxter, Vienna, Austria). The postoperative rehabil- RESULTS itation was defined with non-weight bearing for 12 weeks, fol- In the postoperative period no infection was observed. In 5 lowed of partial weight bearing for 4 weeks and forced patients (50%) a diffuse swelling and effusion was present for mobilization of the knee. The clinical outcome was evaluated more than 10 days postoperatively. The major change after 6 with different knee scores including Lysholm-Score, Marshall- months compared to the preoperative clinical findings were the Score, IKDC, and KOOS. reduction of pain and crepitus. After 12 months most of the scores showed a significant improvement in all patients but a

RESULTS complete level of sport activities prior to the cartilage trauma POSTER ABSTRACTS In the postoperative period no infection was observed. In 6 was not reached. The Lysholm score showed preoperatively a patients (60%) a diffuse swelling and effusion was present for mean value of 49.8 (SD±3.34) and reached after 12 months 94 more than 14 days postoperatively. The major change after 6 (SD±2.23) of 100 possible points. The Marshall Score showed a months compared to the preoperative clinical findings were the similar result with significant improvement after 12 months reduction of pain and crepitus. The Lysholm score showed a after operation. mean value of 57 (SD±7.8) preoperative and reached after 6 months 73.25 (SD±19.3) of 100 possible points (figure 1). The CONCLUSION Marshall Score showed a similar result with significant The matrix associated techniques for the repair of cartilage improvement 6 months after operation (figure 2). defects with autologous chondrocyte transplantation are a fur- ther development with good clinical results after 12 months. CONCLUSION The matrix-associated techniques for the repair of cartilage defects with autologous chondrocyte transplantation and a Poster #343 hyaluronan matrix reveal promising short time results with sig- ARTHROSCOPIC SUBTOTAL MENISCECTOMY FOR nificant increase of the clinical outcome. Long-term prospec- DISCOID MENISCUS IN STUDENT ATHLETES tive studies are needed to prove the clinical and biological Hideaki Takeda, Tokyo, JAPAN, Presenter efficacy of this method. Yasuhito Samejima, Tokyo, JAPAN Takao Saito, Tokyo, JAPAN Yuitiro Terashima, Tokyo, JAPAN Poster #342 Koji Watarai, Tokyo, JAPAN MATRIX ASSOCIATED CHONDROCYTE TRANSPLANTATION Takashi Matsushita, Tokyo, JAPAN (MACI) FOR THE REPAIR OF CARTILAGE DEFECTS – Kenji Oguro, Tokyo, JAPAN EARLY CLINICAL RESULTS AFTER 12 MONTHS Teikyo University School of Medicine, Tokyo, JAPAN Stefan Marlovits, Vienna, AUSTRIA Gabriele Striessnig, Vienna, AUSTRIA, Presenter

5.143 The purpose of this study is to report the clinical results of And then GFP positive cells were collected by flow cytometry arthroscopic subtotal meniscectomy for lateral discoid menis- carried out on a FACStar. Transfected undifferenciated ATDC5 cus in student athletes. Between 1991 and 1996, 49 knees of 46 cells differentiated in the presence of insulin and we evaluated patients with discoid lateral meniscus were treated under visualization of pericellular coats which were composed of arthroscopy in our institution. Of these, 27 knees of 27 patients newly sinthesized hyaluronan using by immunofluorescent were selected for this study: student athletes from12 to 22 years staining and analysed hyaluronan concentration in culture of age at surgery, involved in athletic activities (more than 5 medium by high performance liquid chromatography. The sig- times per week) and without bilateral discoid meniscus, liga- nal of the cells transfected with HAS2 was visually much mentous instability and/or medial meniscal tear. The average stronger than that of control on 3 days and 14 days after differ- age at surgery was 15.3 years, ranged from 13 to 22 years. There entiation was started and also the hyaluronan concentration of were 19 males and 8 females. The follow-up period was from 69 the cells transfected with HAS2 in culture medium was much to 135 months (average: 95 months). All patients underwent higher than that of control for 21 days. By transfection of HAS2 arthroscopic subtotal meniscectomy: about 2 to 4 millimeters with retrovirus, we were able to expect the continuous synthe- of residual rim was left. According to Lysholm score, 15 patients sis of hyaluronan. Therefore this technique may be a great sig- (56%) were rated as excellent, 9 (33%) as good, 3 (11%) as fair nificance in case of autologous chondrocyte implantation. and none as poor. Twenty-three patients returned to active sport, 21 at their previous level. Arthroscopic subtortal menis- cectomy is an effective treatment for discoid lateral meniscus in Poster #346 young athletes.. ARTHROSCOPIC ASSESSMENT OF HUMAN CARTILAGE STIFFNESS OF THE FEMORAL CONDYLES AND THE Poster #344 PATELLA WITH A NEW TACTILE SENSOR TIBIAL EROSIONS ASSOCIATED WITH Yuji Uchio, Izumo, JAPAN, Presenter RADIAL CLEAVAGE TEARS OF THE LATERAL MENISCUS Mitsuo Ochi, Izumo-shi, JAPAN Barry R Tietjens, Auckland, NEW ZEALAND, Presenter Nobuo Adachi, Izumo, JAPAN Paul M Sutton, Auckland, NEW ZEALAND Kenzo Kawasaki, Izumo, JAPAN Neal Stewart, Auckland, NEW ZEALAND Junji Iwasa, Izumo, JAPAN Eastwood Orthopaedic Clinic, Auckland, NEW ZEALAND Masakazu Kuriwaka, Izumo, JAPAN Department of Orthopaedics, Shimane Medical Univer, Izumo, JAPAN The aim of this study was to determine the prevalence of Tibial bone erosions (a valuable radiographic sign) in patients with We measured the stiffness of the cartilage of the human radial cleavage tears of the lateral meniscus. Radial cleavage femoral condyles via an ultrasonic tactile sensor under arthro- tears of the lateral meniscus are uncommon and may be asso- scopic control. The stiffness and the degeneration of articular ciated with a lateral meniscal cyst. Erosion of the lateral tibial cartilage were assessed in 105 knees in 74 patients (39 men, 35 plateau has been described in association with lateral meniscal women, age: 9 - 72 years) who underwent arthroscopic obser- cysts but is reported to be rare. We believe this radiographic vation or surgery. Twenty-five knees suffered from traumatic POSTER ABSTRACTS feature is more common than previously reported and not cartilage injury, 14 from osteochondritis dissecans, 13 from widely recognised by Orthopaedic Surgeons. We identified 44 osteoarthritis, 11 from meniscal injury and 6 from ligamentous patients with arthroscopically proven radial cleavage tears of injury, bipartita patellae (3 knees), and symptomatic plica syn- the lateral meniscus. A Skeletal Radiologist (NS) independently ovialis (2 knees). The degeneration of cartilage was classified assessed the preoperative radiographs specifically looking for according to Outerbridge’s grading system. The relationships an erosion of the tibia just below the lateral joint margin. between the stiffness and the grade of cartilage degeneration, and gender were analyzed. The stiffness of grade I (softening) and II (fissuring less than 0.5 inches in length) was significantly Poster #345 lower than that of intact cartilage. In contrast, the stiffness of EVALUATION OF HYALURONAN SYNTHESIS BY grade IV (exposed subchondral bone) was significantly higher RETROVIRUS-MEDIATED GENE TRANSFER OF than that of any other group. The cartilage stiffness of the HYALURONAN SYNTHASE 2 patella in women was significantly lower than that in men. The Kan Tsuchiya, Chiba, JAPAN, Presenter tactile sensor was useful for determining the intraoperative Yuichi Wada, Chuou-Ku, JAPAN stiffness of healthy and diseased human cartilage in all grades. Kan Takase, Chiba, JAPAN Kouichi Nakagawa, Chiba, JAPAN Takeshi Yamashita, Chiba, JAPAN Poster #347 Hiroki Sakai, Chiba, JAPAN ULTRASOUND AND MRI EVALUATION OF KNEE Norimasa Takahashi, Chiba, JAPAN MENISCAL EXTRUSION Sakae Sano, Chiba, JAPAN Peter Verdonk, Gent, BELGIUM Atsuya Watanabe, Chiba, JAPAN Stefan Desmyter, Gent, BELGIUM Rie Koh, Chiba, JAPAN Yves Depaepe, Gent, BELGIUM Yoshikuni Kawaguchi, Chiba, JAPAN Karl Fredrik Almqvist, Gent, BELGIUM Hideshige Moriya, Chiba, JAPAN Martine De Muynck, Gent, BELGIUM Department of Orthopaedic Surgery School of Medici, 1-8-1 Inohana, Rene E Verdonk, Gent, BELGIUM, Presenter Chuo-Ku Chiba, JAPAN Ghent University Hospital, Gent, BELGIUM

In this study,we evaluated hyaluronan synthesis using gene Investigation of knee loading has shown that some 50% of the transfer of hyaluronan synthase 2(HAS2) with retrovirus into load is distributed through the tibial plateau surface. Some 50% the clonal chondrogenic cell line ATDC5. Plasmids containg goes through the normal meniscal bodies if intact. In case of HAS2 with the PMX-IRES-GFP vector which was the retrovirus partial meniscectomy the presence or the absence of the were transfected into undifferentiated ATDC5.As a control,cells meniscal wall is of the utmost importance to efficient sharing of transfected with the empty PMX-IRES-GFP vector were used. the knee load in the disturbed joint. The functional efficacy of

5.144 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). the meniscus in place under load can be assessed by MRI, but this cannot be routinely done as yet. We have studied meniscal ultrasound images in the normal knee joint and have compared Poster #349 extrusion profile versus meniscal allograft transplantation in BIOMECHANICAL TESTING OF MENISCAL DEVICES weightbearing and nonweightbearing conditions. Individual Richard Evans, Randwick, AUSTRALIA variation does not yet allow clear validation of results. Craig Waller, Randwick, AUSTRALIA Warwick JM Bruce, Randwick, AUSTRALIA Richard Harris, Randwick, AUSTRALIA Poster #348 Adam M Butler, Randwick, AUSTRALIA ARTICULAR CARTILAGE DEFECT William R. Walsh, Randwick, AUSTRALIA, Presenter HEALING USING PASTE GRA University of New South Wales, Sydney, AUSTRALIA Eva Korthagen, Randwick, AUSTRALIA Kevin R Stone, San Francisco, CA, USA Introduction Ivan Popoff, Randwick, AUSTRALIA The meniscus plays an important biomechanical role in knee Peter Hughes, Randwick, AUSTRALIA stability and load transmission. Arthroscopic repair of meniscal Richard Evans, Randwick, AUSTRALIA tears has been facilitated through a number of devices and Frank Vizesi, Randwick, AUSTRALIA techniques. This study examined the static tensile strength of 2 James Bliss, Randwick, AUSTRALIA new devices designed for use in the repair of meniscal tears. Tom Turek, San Francisco, UNITED STATES William R. Walsh, Randwick, AUSTRALIA, Presenter Methods University of New South Wales, Sydney, AUSTRALIA Five pairs of fresh frozen medial human menisci (mean age 42 years old) were harvested from cadaveric donor tissue. All Introduction Full thickness articular cartilage defects have diffi- menisci were macroscopically free of any pathology. A longitu- culty healing spontaneously and can lead to substantial degen- dinal full thickness tear was made 3 mm from the peripheral erative changes. Whilst a variety of surgical techniques have rim. The tears were repaired with 2 Fastfix (Smith & Nephew) or been described, no single technique has been shown to have 2 Rapidloc (Mitek) devices. The menisci were tested in uniaxial superior efficacy. The Microfracture technique, as described tension using and MTS 858 Bionix testing machine. The menisci Steadman, is proposed to release marrow elements (mes- were held in the testing machine by two sutures placed 7 mm enchymal stem cells, growth factors, etc.) to form a “super clot”. from the lesions. The tear was extended so that only the The Paste Graft technique, as described by Stone, utilises an repaired portion was allowed to resist loading. The holding osteochondral plug, which is hammered into a paste and sutures were fixed in pneumatic grips and distracted at 50 mm grafted into the defect. This study evaluated the biomechanic per minute until failure. The ultimate load and failure site were and histologic properties of full thickness articular cartilage recorded for all samples. Data was analysed using a paired defects in an osteoarthrosis model comparing the paste graft Student’s t-test using SPSS. technique, microfracture and a control untreated defect. Results and Discussion: Methods Bilateral anterolateral meniscectomies were pre- All samples failed at the fixation site. Both devices performed formed in 8 adult sheep following ethical approval, and housed similarly with mean ultimate loads of 53.0 N in the Fastfix for 3 months. Bilateral bicondylar defects (4.3 mm) were cre- group and 60.0 N in the Rapidloc group. ated on the femoral condyles. The defects allocated to three groups; control defect, Microfracture or Past graft technique. Arthroscopic repair of meniscal tears has progressed over the The animals were euthanised at 12 weeks. Three additional age past few years with a variety of fixation devices. Bellemans et matched control animals, that had not undergone meniscec- al., (The Knee, 9:11-14, 2002) recently reported the ultimate tomy, were also evaluated. The femoral condyles were har- load of 8 different repair techniques using the same protocol POSTER ABSTRACTS vested for macroscopic assessment, biomechanical testing and used in the current study. The Fastfix and Rapidloc devices histology. Unconfined compression was performed on the tested in the current study achieved greater ultimate loads defect sites (meniscectomy group only) and adjacent cartilage compared to horizontal mattress sutures PDS 1 (52.5 N), verti- using a Mach-1TM Micromechanical Tester (Biosyntech, cal loop sutures PDS 1 (46.3 N), T-fix device (47.5 N) as well as Canada). Four steps of 50 µm at a ramp rate of 50 µm/s was all types of Bionix arrow devices as reported by Bellemans and applied with a relaxation time between each step of 900 sec- co-workers. The Fastfix and Rapidloc devices are easy to use onds. Load versus time data was fitted to the biphasic theory. and provide similar static fixation strength for meniscal tears The defect sites were subsequently fixed in formalin, decalcified that are superior to other reported techniques. in formic acid-formalin, paraffin embedded and stained with H&E and Saffrin-O for light microscopic evaluations. Poster #350 Results and Discussions: The meniscectomy produced some 1.0 TESLA MAGNETIC RESONANCE IMAGING ACCURACY degenerative changes by 3 months observed at the time of the CORRELATED WITH CLINICAL SYMPTOMS AND defect surgery. Macroscopic assessment of the condyles at 12 ARTHROSCOPIC FINDINGS weeks post-treatment revealed further degenerative changes in Yuichi Yoshii, Tsukuba, JAPAN, Presenter the lateral and medial compartments. The control (empty Yasuhiko Watanabe, Tsukuba, JAPAN defects) did not heal by 12 weeks in this meniscectomy model. Kotaro Ikeda, Tsukuba, JAPAN In general, defect healing on the lateral condyle (which had sig- Naoyuki Ochiai, Tsukuba, JAPAN nificant degenerative changes) was inferior to the medial Ichihara Hospital,Tsukuba University Hospital, Tsukuba City, JAPAN condyle with both techniques. The defects treated with Microfracture or Paste Graft had tissue filling the defect, which Introduction: was mechanically inferior to the adjacent cartilage or normal Since the magnetic resonance (MR) imaging has no demon- control cartilage. Histology of the defects treated with strated adverse biological effects, it is widely used to assess a Microfracture or Paste Graft were filled with fibrocartilagenous wide spectrum of internal knee derangements. The MR imaging tissue in agreement with mechanical data. contrasting small pathological changes to normal structure has

5.145 capability to improve the clinical diagnosis and decrease the cost associated with arthroscopic examinations that yield neg- The purpose of this study is to analyse the short-term clinical ative results. Since the larger magnetic fields have more chance and histological results of the treatment of deep chondral to detect small abnormality, there is tendency to have an appa- defects with autologous chondrocyte transplantation. ratus to yield larger magnetic fields. However, the apparatus having higher magnetic field will be costly. This economical dis- This is a prospective study involving 34 consecutive patients advantage allows only the clinic that has massive demand for receiving autologous chondrocyte transplantation. Chondrocytes MR imaging to have such an apparatus. Although the 1.0-tesla from a non weight bearing area of the knee are harvested, then MR imaging apparatus is still expensive, it is affordable for isolated and cultured in vitro. Re-implantation involves injec- most of the clinic that is managing variable knee injuries. tion of the chondrocytes into the defect which is then sealed Therefore, the purpose of our study was to evaluate the effi- with a porcine 1/111 collagen membrane. Evaluation consists of ciency of the 1.0 teslaMR imaging and to find the limitation of clinical assessment, arthroscopy and histological examination. the apparatus. Histological evaluation consists of examination of a biopsy of the transplanted area one-year post-op. Staining techniques Materials and Methods: include the use of Erlich’s, H&E, Safranin 0 and S100. Using We reviewed eighty-three cases who had been diagnosed polarised light, the absence of the fibrillar nature of fibrocarti- meniscal or ligament injury, or both meniscal and ligament lage confirms the presence of hyaline cartilage. Further confir- injuries by the MR imaging before arthroscopic knee surgeries. mation can be gained by the examination of messenger RNA There were forty-seven males and thirty-six females. The age content, confirming the presence of type II collagen. range was nine to sixty-four years. We used the 1.0 tesla MR imaging equipment made by Toshiba Inc. A circumferential sur- The patients were treated between July 1998 and December face coil was positioned on the patient routinely. MR examina- 2000. The age range of the patients was 16-51 years (mean age tions were performed sagittal and coronal planes. The gradient 31 years). Of the 34 patients treated, 19 had right-sided lesions, echo method was used for echo formation. The founding from 17 had left-sided lesions with two patients receiving bilateral MR image that was read by a resident in our department was procedures. Solitary lesions were treated in 35 knees with two compared with that from arthroscopic knee surgery. Accuracy, defects being treated in one knee (37 defects in total). The sensitivity and specificity of MR images were calculated. defects were located on the medial femoral condyle in 22 cases, the lateral femoral condyle in 8, the trochlea in two and the Results: patella in 5 cases. The defect size ranged from 1- 7cm2 (mean Among 83 cases, medial meniscal tears, lateral meniscal tears, area 2.88cm2). The follow-up of the patients ranges from 1-39 and torn ACLs were found in thirty-seven, thirty-four, twenty- months (mean 19 months). 25 patients have at least one-year nine cases respectively. Eleven meniscal tears were detected as follow-up. Of these patients, using the Brittberg Rating, 6 false-positive study in the MR image. All of those cases showed patients have excellent results, with 11 good, 6 fair and 2 poor. high intensity change in T-2 weighted image. There were eight The mean Lysholm and Gillquist scores improved from 44.7 false-positive ACL tears. High intensity changes within the lig- pre-op to 76.2 one-year post-op and the mean Verbal ament in T-2 weighted image were found in those cases. Numerical Pain Scores improved from 7.1 to 1.1. Arthroscopy POSTER ABSTRACTS Accuracy, sensitivity, and specificity of meniscal tears in medial revealed that the transplants were level with the surrounding and lateral compartment and the torn ACL were as surface in most cases. Biopsy at one year confirmed the pres- follows.Tears of the medial meniscus:accurracy 86.7%,sensitiv- ence of hyaline cartilage in 13 out of 19 cases. ity 82.5%,specificity 90.7%.Tears of the lateral meniscus:accu- racy 81.9%,sensitivity 85.2%,specificity 80.4%.Tears of the Although the results are short-term, autologous chondrocyte anterior cruciate ligament:accuracy 89.2%, sensitivity 77.8%, transplantation can provide, with careful patient selection and specificity 97.9%. meticulous surgical technique, an effective treatment for carti- lage defects of the knee. The histological results are extremely Discussion: encouraging and chondrocyte transplantation may be the only The accuracy and sensitivity of our study was a little lower than procedure to allow regeneration of hyaline cartilage. that of the previous study. This result could be affected by the differences in the learning curves of an orthopaedic surgeon, and the equipment and protocols we used. It could also be Poster #444 possible that the high intensity change in the T-2 weighted ARTHROSCOPIC TREATMENT OF OSTEOCHONDRITIS image caused by degenerative change within the meniscus was DISSECANS OF THE KNEE WITH AUTOLOGOUS “BONE detected as the non-injured portion by arthroscopy. The inten- STICKS” sity change in the ACL is possibly affected by synovium fluid Rogerio Teixeira Da Silva, Perdizes, BRAZIL, Presenter around the ligament because of the accumulative effect during Moises Cohen, Sao Paulo, BRAZIL MR image processing. False-positive ACL tear in our study may Mario Carneiro Fo, Sao Paulo, BRAZIL be caused by this effect. Rogerio Teixeira Da Silva, Perdizes, BRAZIL Federal University of Sao Paulo, Sao Paulo, BRAZIL

Poster #443 Autologous bone sticks were taken from the ipsilateral tibial AUTOLOGOUS CHONDROCYTE TRANSPLANTATION FOR metaphysis and used in the arthroscopic fixation of unilateral ARTICULAR CARTILAGE DEFECTS IN THE KNEE osteochondritis dissecans of the knee in 11 patients; five of HISTOLOGICAL EVALUATION them were female and 6 male. Age varied from 11 to 20 years Sabreena Mahroof, London, UNITED KINGDOM, Presenter (mean age 16 years).All of them were involved in sports activi- Lee A David, London, UNITED KINGDOM ties and competitions. Follow-up varied from 15 to 108 months Jean Pringle, London, UNITED KINGDOM (mean follow-up 48 months). Based on Hughston et al (1984) Bayliss Mike, London, UNITED KINGDOM modified criteria results were satisfactory in 90,9% and unsatis- Timothy WR Briggs, London, UNITED KINGDOM factory in 9,1% of the cases. Arthroscopic fixation of the osteo- Bone Tumour Unit, Royal National Orthopaedic Hospi, London, UNITED chondritis dissecans of the knee with autologous bone sticks is KINGDOM technically simple and non-agressive and provides satisfactory

5.146 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). results in most cases. In press, Arthoscopy: The Journal of to operate. There were 13 papers found that met the criteria. Arthroscopic and Related Surgery The pooled results were: 1. For medial meniscus tear (MMT): True postive(TP)=332; False Postive(FP)=67; False Negative(FN)=47; True Poster #452 Negative(TN)=293; which gives a Sensitivity=87.6% & BIOABSORBABLE PIN FIXATION OF OSTEOCHONDRAL Specificity=81.4% LESIONS OF THE KNEE 2. For lateral meniscus tear (LMT): TP=144; FP=35; FN=75; Matthias Rolf Schurhoff, Coral Gables, FL, USA, Presenter TN=469; which gives a Sensitivity=65.8% & Specificity=93.1% Robin Fuchs, Coral Gables, FL, USA 3. For an ACL tear:TP=265; FP=23; FN=28; TN=480; which gives John E Zvijac, Coral Gables, FL, USA a Sensitivity=90.4% & Specificity=95.4% Keith Sheldon Hechtman, Coral Gables, FL, USA John William Uribe, Coral Gables, FL, USA The likelihood ratio (LR) expresses the odds that a given test UHZ Sports Medicine Institute, Coral Gables, Florida, USA result would be expected in a patient with (as opposed to one without) the target disorder. It is independent of the prevalence Purpose: Osteochondral lesions of the knee have been reported so has advantages over the use of the positive and the negative extensively in the orthopaedic literature. The purpose of this predictive value. Using the above tables: for a MMT the LR for a study is to report our experience of arthroscopic treatment of positive result (LR+)=4.7 while the likelihood ratio for a nega- completely separated osteochondral lesions of the knee with tive result (LR-)=0.15; for a LMT, LR+=9.5 & LR-=0.06; and for internal fixation using bioabsorbable pins. ACL, LR+ =19.8 & LR- =0.1. This implies, for example, that for an MRI that demonstrates a MMT, it 4.7 times as likely that the Type of Study: Retrospective Analysis patient has a MMT as opposed to not having a MMT. Alternatively, if the MRI is negative with respect to a MMT it is Materials and Methods: 35 patients with symptomatic osteo- about one seventh as likely that the patient has a MMT as chondral lesions were treated with arthroscopic currettage of against not having a MMT. the bone bed and fragment, followed by autogenous bone graft- ing when necessary, and pinning of the lesion with bioab- sorbable pins. The patients ranged from fourteen to forty-three Poster #352 years of age (mean age twenty-four). All lesions were com- INTRAARTICULAR OPIOID INJECTIONS AFTER KNEE pletely separated from subchondral bone and the average size ARTHROSCOPY was 4.5 square centimeters. The medial femoral condyle was Artur Gadek, Krakow, POLAND, Presenter affected in 25 patients, and the lateral femoral condyle was Jerzy Wordliczek, Krakow, POLAND affected in 10 patients. Clinical outcomes were measured using Wojciech Popiela, Krakow, POLAND the Lysholm and IKDC scoring systems, follow-up radiographs Jagiellonian University, Krakow, POLAND and MRI, and clinical examination. INTRODUCTION : Results: Mean follow-up was 48 months. Average Lysholm The discovery of the peripheral opioid receptors, the expression score was 95. On IKDC assessment 30 of 35 patients reported of which takes place mostly during the inflammation process in normal or nearly normal knee function. Radiographic and MRI the peripheral tissues, led to the modification of the analgesic evidence of incorporation and healing correlated with clinical management of the patients after knee arthroscopy. outcome. Four patients required re-arthroscopy for removal of loose fragments following partial union of osteochondral frag- AIM OF THE STUDY : ments. Only one patient experienced recurrent effusions and The study aimed at establishing the role of intra-articular fen- no patients experienced unremitting synovitis. tanyl or morphine injections to release pain after knee

arthroscopy. POSTER ABSTRACTS Conclusions: We have experienced good success with use of bioabsorbable pin fixation for completely separated osteo- MATERIAL AND METHODS : chondral lesions of the knee, and conclude bioabsorbable pins The study was carried out in a group of 360 patients (men and offer an effective method of internal fixation and may alleviate women) qualified for knee arthroscopy due to various reasons. the need for hardware removal. The procedure was performed under general anaesthesia. The patients were randomly assigned to 3 groups. Immediately before surgery the patients from group I received 1mg mor- Other phine in 10ml 0.9% NaCl, group II 25 mcg fentanyl in 10ml 0.9% NaCl, and group III 10ml 0.9% NaCl. To relieve pain postopera- tively the patients received additionally ketoprofen 100- Poster #351 300mg/24 h, and paracetamol 500mg - 2g/24 h. In all patients THE VALUE OF MRI TO DIAGNOSE MENISCAL AND ACL daily requirement of additional analgesics was monitored for TEARS: SENSITIVITY, SPECIFICITY AND LIKELIHOOD seven postoperative days, and pain intensity was measured RATIO. every 6 hours on VAS scale. Graeme Campbell Brown, Geelong, AUSTRALIA, Presenter Geelong Hospital, Geelong, AUSTRALIA RESULTS : Group I and II patients had significantly lower pain intensity MRI is widely used to image the knee for suspected meniscal measured on the VAS scale in the first 3 postoperative days and ACL injury. The purpose of this study was twofold: to per- which correlated with significantly lower requirement of addi- form a literature review of this diagnostic modality and to tional analgesics in these groups. report the “likelihood ratio” (an index of how good a test is). Strict inclusion criteria included: results presented so as to CONCLUSIONS : enable a “2x2” table construction and arthroscopy or open pro- Postoperative use of intra-articular opioid injections signifi- cedure as the diagnostic standard. Exclusion criteria included: cantly improved patients comfort after knee arthroscopy. the use of healthy controls and if the MRI affected the decision

5.147 CONCLUSION: An audible squishing sound after IA injection of Poster #353 1 to 2 cc air will provide a reliable method of confirming accu- A SIMPLE AND SAFE METHOD TO CONFIRM ACCURACY rate IA placement. This simple method is easily reproduced and OF INTRAARTICULAR KNEE INJECTION failure of clinical response to injection with audible confirma- Rudolph C. Glattes, Nashville, TN, USA, Presenter tion is, therefore, due to patient disease or another diagnosis, Gordon M. Blanchard, Nashville, TN, USA not failure of placement. Michael T. Rohmiller, Nashville, TN, USA Eric C. McCarty, Nashville, TN, USA Jake Block, Nashville, TN, USA Poster #354 Jason T. Connor, Cleveland, OH, USA PROXIMAL TIBIOFIBULAR JOINT GANGLION CYSTS: Kurt P. Spindler, Nashville, TN, USA EXCISION, RECURRENCE AND JOINT ARTHRODESIS Vanderbilt Sports Medicine Center, Nashville, TN, USA Shana Miskovsky, Columbus, OH, USA Christopher C. Kaeding, Columbus, OH, USA, Presenter OBJECTIVE: Intraarticular (IA) knee injections with or without Lawrence Weis, Columbus, OH, USA aspiration are routinely performed by both primary care and The Ohio State University, Columbus, OH, USA musculoskeletal specialists. In the office accuracy of placement is not confirmed, especially when no effusion is aspirated; Objective: therefore, failure of clinical response to injection could either In this paper, we will review the presentation, treatment and be due to patient disease or failed placement. We tested a sim- outcomes of 13 patients with proximal tibiofibular joint cysts. ple, no cost, reproducible method to confirm accurate place- We will also discuss an alternative treatment option: proximal ment of IA knee injections. Our hypothesis was that an audible tibiofibular joint (PTFJ) fusion. Ganglion cysts of the proximal “squishing” sound after placement of air with injection accu- tibiofibular joint are rare entities associated with significant rately confirmed IA placement of injection. patient disability. The mainstay of treatment is cyst excision however, several authors in the literature have noted recurrence METHODS: A total of 20 knees comprised the study group. as a significant problem. Our series of patients represents one Twenty patients presenting with clinical indications for corti- of the largest to date reported in the literature. No studies to costeroid injection with or without need for aspiration were date have evaluated the utility of proximal tibiofibular joint studied after IRB approval. Ten of these patients had aspiration fusion in relieving symptoms and preventing recurrence. Our of effusion from a superolateral location followed by injection. study includes four patients with successful PTFJ fusions using Ten of these patients had injection only in either an anterome- 6.5mm AO partially threaded cancellous screws. dial or anterolateral “portal” location in a sitting position with the knee flexed to 90 degrees. Five control patients (10 knees) Methods: had sham IA injections into subcutaneous skin at the supero- This is a retrospective review of thirteen patients who pre- lateral site in one knee and into the infrapatellar fat pad in the sented to our institution between 1987 and 1999. Two patients contralateral knee. A mixture of 4 cc of lidocaine, 1 cc of con- had prior surgery at an outside institution. Medical records and trast medium, and 1 to 2 cc of air was placed in a single injec- office charts were reviewed for each patient in the study. After POSTER ABSTRACTS tion into the study knees. A mixture of 4 cc of lidocaine, 1 cc of this review all patients were contacted and interviewed to com- contrast medium, and 2 cc of air was placed in a single injec- plete a phone survey describing their level of activity, any symp- tion in the control knees. Post-injection knees were immedi- tom or mass recurrence, current pain level, any additional knee ately flexed and extended and the presence of the “squishing” surgery and overall satisfaction. Average follow-up from surgery sound was recorded by a minimum of two observers in the to date of phone survey was 6.3 years (ranged from 1.3-12.9). room. A post-injection lateral radiograph was obtained for Average follow-up from surgery to last office visit and to date of viewing by a musculoskeletal radiologist blinded to the experi- detailed functional survey was 1.7 and 6.3 years respectively. mental versus control designation. A successful injection arthrogram was defined as a sharply defined rim of contrast Results: outlining the articular surfaces on plain film x-ray. A positive At presentation, most patients (75%) described a mass or “full- clinical test was defined as a clearly audible squishing sound in ness” of their lateral knee. Seven patients (54%) complained of the office post-injection. peroneal nerve dysesthesias. On MRI, cysts appeared dark on T1 and bright on T2-weighted images. Twelve patients elected RESULTS: Eighteen out of 20 knees with clearly audible squish- to undergo surgery. Eight patients underwent cyst excision and ing sounds had IA contrast confirmed by arthrogram. The sen- four underwent cyst excision combined with arthrodesis of the sitivity of a audible squishing sound confirming IA placement is proximal tibiofibular joint. There is no recurrence rate for this 100% with 95% confidence interval (CI) (80%-99.5%). Two out of type of cyst quoted in the literature due to the rarity of the dis- 20 knees with faint squishing sounds had IA contrast confirmed order, small patient samples and limited follow-up. However, by arthrogram. These two knees were injected in the “portal” over our post-operative follow-up period, we observed a recur- location with the knee flexed to 90 degrees. When these two rence rate of 25% following simple cyst excision. Our study patients were placed in a supine position with repeat flexion includes four patients (two with a history of recurrence) with and extension, the squishing sound was amplified. If we only successful PTFJ fusions using 6.5mm cancellous screws. All of include “easily audible” 18 of 20 positives, then sensitivity is these patients are without subsequent cyst recurrence and cur- 85% with CI 95% (61%-96%). Ten out of 10 knees without audi- rently have no activity restrictions. Morbidity of the procedure ble squishing sounds had extraarticular contrast confirmed by itself appears to be minor. One patient developed tenderness arthrogram. The specificity of no audible squishing sound is over the screw tip necessitating removal and another devel- 100% with CI of 95% (66%-99%). The location of injection did oped mild lateral ankle pain which did not significantly inter- not affect the presence of the clearly audible sound with statis- fere with her activity. tical significance in this number of patients. The use of 1 cc or 2 cc of air did not affect the presence of the clearly audible Conclusions: sound. Proximal tibiofibular cysts are rare entities that can cause sig- nificant disability in active patients. These cysts appear to have a high rate of recurrence after simple surgical excision. In the

5.148 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). setting of multiple recurrences, joint arthrodesis seems to have However home programs of body conditioning without tool and a valuable role. Due to its low morbidity, when used as a pri- machine like Yoga or Pilates’ matwork are beginning to spread mary procedure, arthrodesis may be more effective than tradi- among all age groups with orthopedic disorders. tional cyst excision. Additional studies are needed to further examine the role of PTFJ fusion in the treatment of these pecu- We focused on recent popular home programs of body condi- liar ganglion cysts. tioning and designed a simple tool which consists of 23.0 by 14.0 by 7.5cm E.V.A. block named FITBLOCK (Sports Medicine Institute for Life Enhancement, Tokyo, Japan) to assist home Poster #355 exercises of patients at low price, without disturbance of living BIOMECHANICAL ANALYSIS OF DISTAL BICEPS space. We designed this block for various home exercises TENDON REPAIR METHODS including stretches and we used its 7.5cm width mainly. This Jon Henry, Manitowoc, WI, USA width could fill the gap between popliteal region and floor of Grant L. Jones, Columbus, OH, USA hamstring stretch and fill the intercondylar gap of supine pelvic Christopher C. Kaeding, Columbus, OH, USA, Presenter tilt. For strengthening we placed it at innerthigh for buttock Alan Litsky, Columbus, OH, USA squeeze as a substitution for towels. Other cushion squeeze The Ohio State University, Columbus, Ohio, USA exercises could be done easier to make use of elasticity and resistance of E.V.A. And for squat exercise of the osteoarthritic Objective: knee, we placed it at intermalleolar gap for valgus deformity The distal biceps brachii tendon inserts on the posterior-ulnar and at intercondylar gap for varus deformity. We also used for aspect of the bicipital tuberosity, and its principal function is unsymmetrical squat. The material of this product has moder- forearm supination. We hypothesized that repair of the distal ate consistency which is comfortable for patients’ skins and biceps tendon to the anterior aspect of the tuberosity would muscles. We will introduce these exercises with this block using compromise forearm supination function. The purpose of this illustrations and photos. study was to compare the biomechanical properties of a distal biceps tendon repair to the anterior aspect of the bicipital tuberosity, typical of a single incision technique, with a repair Poster #357 to the posterior aspect of the tuberosity, as accomplished with POSTERIOR “BACK AND FORTH” ARTHROSCOPIC a two-incision technique. APPROACHES ON THE POSTERIOR KNEE COMPARTMENTS Methods: Stephane Louisia, Fresnes, FRANCE, Presenter Each of four matched pairs of fresh-frozen cadaveric upper Olivier Charrois, Le Chesnay, FRANCE extremity specimens were dissected and prepared for repair of Philippe Beaufils, Le Chesnay, FRANCE the distal biceps tendon using either an anterior or posterior Mignot Hospital, Le Chesnay, FRANCE reattachment with transosseous suture fixation. Specimens were tested on a MTS (Minneapolis, MN) with an intact distal Purpose: To evaluate the feasibility, indications, and usefulness biceps insertion and again following repair. A load cell at the of a new arthroscopic approach to the posterior knee compart- level of the DRUJ determined the resultant elbow flexion force ments. and forearm supination torque produced by a 100 N force applied to the proximal aspect of the tendon. Type of study: experimental in one cadaver and descriptive in six patients. Results: A Student’s T-test (p<0.05) was used to evaluate this data Methods: We developed an arthroscopic approach to the pos- among three groups: group A, anterior distal biceps tendon terior knee compartment involving use of a posteromedial por- repair versus intact tendon; group B, posterior repair versus tal and a posterolateral portal opposite each other. Each POSTER ABSTRACTS intact tendon; and group C, posterior repair versus anterior posterior portal is used in alternation for the arthroscope and repair. For both elbow flexion force and forearm supination instruments. The posterior portals are established using an torque no significant differences were found within any of the original “back and forth” technique. three groups. Conclusion: Results. The cadaver study showed that the technique was fea- This study supports our null-hypothesis demonstrating equiva- sible. It allowed us to define safety rules to protect the vessels lent biomechanical results for repair of the distal biceps tendon and nerves that course through the popliteal fossa. The to either the anterior or posterior aspect of the bicipital approach provided a broader field of view as compared to pre- tuberosity. viously described techniques. After removal of the septum dividing the posterior compartment, the synovial fold enclosing the posterior cruciate ligament and lining the upper and poste- Poster #356 rior parts of the posterior capsule was readily accessed, sug- THE INTRODUCTION OF THE SIMPLE BODY gesting that this approach may be particularly valuable for total CONDITIONING EQUIPMENT FOR PATIENTS AT HOME synovectomy. This was confirmed by results in six patients with Tamiko Kamimura, Saitama, JAPAN, Presenter villonodular synovitis, in whom the new approach was used in Kunihiko Andoh, Nagano, JAPAN combination with arthroscopic anterior synovectomy. Shin Sugiura, Tokyo, JAPAN Sports Medicine Institute for Life Enhancement, Itabashi, JAPAN Conclusions: This approach allows removal of parts of the syn- ovium that are difficult to access through conventional arthro- The muscle exercises around the joints especially knee at home scopic approaches. For total synovectomy, it can be used as an were described as one kind of the way of daily rehabilitation for alternative to open posterior synovectomy, in combination with orthopedic disorders. And a lot of tools and methods have been arthroscopic anterior synovectomy. developed and some of them had problems because of their complicated direction of use, higher prices as a personal prod- uct or unwelcome appearances for living space. Poster #358

5.149 SURGICAL APPROACH TO THE ACHILLES TENDON AND A was reinfused therby minimising the blood usage with no com- PROGRAMME OF PHYSIOTHERAPY AFTER SURGICAL plications reducing the strain on the present blood bank. TREATMENT OF ACHILLES TENDINOSIS Preoperative HB,HCT and post operative HB,HCT showed Mihkel Mardna, Tallinn, ESTONIA, Presenter acceptable drop. All transfusions were uneventful and well tol- Egle Seppo, Tallinn, ESTONIA erated. Tourniquet was utilised in all patients. Closed suction Eldur Annus, Tallinn, ESTONIA drainage was used as recommended by the manufacturer. Mustamäe Hospital, Tallinn, ESTONIA Average operative time was one hour and thirty minutes. Majority procedures were primaries and some revisions were We evaluated retrospectively a “S-type” scar after Achilleus ten- included in the study. With the increase in demand of blood don repair. 102 sportly active people, 13 females (17-55 yrs, and dwindling blood supplies this will be an alternative to uti- mean 36 yrs) and 89 males (17-62 yrs, mean 37 yrs) were oper- lize in all orthopedic procedures safely. ated because of Achilleus tendon rupture or Achilleus tendi- nosis, in all cases “ S-type “ skin incision was used. The incision starts proximally in the middle of the tendon and cruves later- Poster #361 ally making a figure of “S“ ending distally on the lateral edge of ANTERIOR KNEE PAIN AFTER TIBIAL the Achilleus tendon. All patients returned to their previous INTRAMEDULLARY NAILING activities during a year following the operation. There were no Christos K Yiannakopoulos, Athens, GREECE, Presenter cases of reruptures, nor any major problems with wound heal- Emmanuel Antonogiannakis, Athens-Cholargos, GREECE ing. All patients were satisfied with the cosmetic result of a scar. Georgios Anastasios Babalis, N. Iraklio Attikis, GREECE This incision gives a superb low-tension opening to the Kostas Karliaftis, Athens, GREECE Achilleus tendon and what we consider most important – a C. Karambalis, GREECE highly elastic scar for sportly active people and a good cosmetic Antonios Iliadis, Athens, GREECE result. Additionally we propose a physio-therapy programme 401 General Army Hospital, Athens, GREECE for athletes after surgical treatment of Achilleus tendinosis . Anterior knee pain is considered to be a common complication of tibial nailing. We studied the incidence of anterior knee pain Poster #359 in 49 patients with closed tibial diaphyseal nailing treated at RUPTURED BAKER’S CYST MIMICKING our institution between 1999 and 2001. In all cases the nail was COMPARTMENT SYNDROME inserted into the tibia without allowing any prominence. The Levent Buluc, Kocaeli, TURKEY length of follow-up was 14.6 months (9-36 months). The pres- Hakan Kurt, Kocaeli, TURKEY ence of spontaneous pain and pain on palpation and several Sefa Muezzinoglu, Kocaeli, TURKEY, Presenter activities was ascertained. In 22 patients the surgical trauma to Kocaeli University School of Medicine Dept of Orth, Izmit, TURKEY the knee was drained postoperatively and in 27 not. There was no difference between these two groups regarding wound com- We present two patients with ruptured Baker’s Cyst that had plications. The incidence of anterior knee pain of any intensity been referred to us with the diagnosis of compartment syn- at latest follow-up was 19.14 % (9 patients). Scar tenderness POSTER ABSTRACTS drome and thrombophlebitis. Both patients were middle-aged was noted in 19 patients (38.77%) but was significant in only 2 previously healthy males. On physical examination they both patients. The length of the incision was longer in the group of had a swollen and tender calves with minimal pain in passive patients with anterior knee pain (6.5 cm vs 4.2 cm). Anterior dorsiflexion of toes and feet. Laboratory tests were normal knee pain is common following tibial intramedullary nailing but including prothrombin and partial thromboplastin times. it severity is not incapacitating. Doppler venous ultrasonography was unremarkable. Magnetic resonance imaging showed popliteal cyst formation in both patients; one dissecting between gastrocnemius and soleus Poster #362 muscles in the proximal calf. Both patients had similiar treat- THE INCIDENCE OF VASCULAR COMPLICATIONS IN ment regime including immobilization and elevation of the PATIENTS SUBMITTED TO KNEE ARTHROSCOPY BASED involved extremity, cold dressing and non-steroidal antiinflam- ON COLLOR FLOW DUPLEX SCANNING FINDINGS. matory drugs. Their symptoms subsided on the second day. Emerson K. Zanoni, Curitiba, BRAZIL, Presenter Edilson Schwansee Thiele, Curitiba, BRAZIL In patients presenting with calf compartment sendrome symp- Murilo Cesar Santos, Curitiba Parana, BRAZIL toms, one has to consider knee internal derangements includ- Henrique Carvalho, Curitiba, BRAZIL ing the Baker’s Cyst. In almost all previously reported cases of Alvaro Chamecki, Curitiba, BRAZIL ruptured Baker’s Cyst and compartment pressure changes Clinica do Joelho, Curitiba, BRAZIL resulted in fasciotomies. In our cases, early diagnosis of the cyst rupture avoided us doing a fasciotomy. Thorough examina- Between November 1998 and May 1999, 35 patients previously tion including knee should be done in order to avoid overtreat- submitted to a knee arthroscopy were submitted to an colored ment of this rare disorder. eco-doppler exam, performed by the Siemens Elegra device, with a 5 mhz transductor. Examining the deep venous system and internal and external saphenous vein. We studied 37 legs Poster #360 (2 patients with bilateral arthroscopy), in 25 men and 10 PERIOPERATIVE AUTOTRANSFUSION IN TOTAL KNEE women, with an average age of 37,9 years old (18 to 67 years). ARTHROPLASTY All the patients were evaluated in the pre op period; being Raj K Reddy, Midland, TX, USA, Presenter excluded those with previous history of deep venous thrombo- Midland Memorial Hospital, Midland, TX, USA sis (DVT). All arthroscopies were performed with a pneumatic tourniquet, with an average duration of 66 minutes (55 to 80 Blood loss could be significant followed by total knee arthro- minutes) for treatment of ACL lesions and 23 minutes (15 to 30 plasty. 50 consecutive arthroplasties were performed. minutes) for meniscal lesions. None of the patients used any Transfusion was utilised by "ortho pat” processing system. medication as a prevention. 24 patients were considered as low Salvaged blood was recovered concentrated washed "PRBC" risk patients and 11 as medium risk patients. The eco-doppler

5.150 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). was repeated in the 5th and 10th post op day. 6 patients (4 men days in the group with arthritis and 802 days in those without and 2 women) had DVT in the post- op, 2 in the right knee and arthritis. There was no significant association between the 4 in the left knee. 4 cases occurred in the fibular vein, 1 in the presence of arthritis and the direction of instability (P=0.115). muscular vein of the calf and one in the posterior tibial vein. Patients with arthritis were significantly older than those with- One of them had pulmonary thrombo embolism. The main out arthritis (34.9 versus 29.6 years). Multivariate analysis iden- objective of this study was to evaluate the DVT incidence in oth- tified time from injury to surgery and age as independent erwise healthy patients submitted to a knee arthroscopy and predictors of arthritis. In this series of 422 patients with shoul- the eventual necessity of prevention. der instability, time from injury to surgery and older age showed significant associations with arthritis, whereas direc- tion of instability did not. Shoulder Instability

Poster #365 Poster #363 THERMAL CAPSULORRAPHY FOR THE TREATMENT OF ARTHROSCOPIC FINDINGS IN CHRONIC ANTERIOR MULTI-DIRECTIONAL SHOULDER INSTABILITY IN SHOULDER INSTABILITY IN MALES 18 TO 30 YEARS OLD FEMALE VOLLEY PLAYERS Emmanuel Antonogiannakis, Athens-Cholargos, GREECE, Presenter Daniel Comba, La Loggia-TO, ITALY, Presenter Christos K Yiannakopoulos, Athens, GREECE Mauricio Xavier Motta-Navas, Torino, ITALY Kostas Karliaftis, Athens, GREECE Ospedale Evangelico Valdese, Torino, ITALY Georgios Anastasios Babalis, N. iraklio Attikis, GREECE Christos Karabalis, Athens, GREECE PURPOSE OF THE STUDY: The aim of this prospective study Gerasimos Gialas, Athens, GREECE was to evaluate the Arthroscopic Thermal Shrinkage for the Panos Efstathiou, Athens, GREECE treatment of multi-directional shoulder instability in a selected Antonios Iliadis, Athens, GREECE population of female volley players (amatorial). 401 General Army Hospital, Athens, GREECE METHOD:Thermal capsulorraphy has controversial results in We report our results from the treatment of male patients with the previous published study. We performed a prospective chronic anterior shoulder instability who have been treated study of a population of 6 female athletes (amatorial) with cap- arthroscopically. Between 1999 and 2002 we treated 76 patients sular redundancy and multi-directional shoulder instability. All with anterior shoulder instability. All patients have been exam- patients failed at the non-operative rehabilitation program. The ined arthroscopically prior to the final treatment which was predominant direction of the instability was anterior/inferior arthroscopic reconstruction in 59 and open reconstruction in (4/6). None of the athletes had a complete or voluntary dislo- 17. Mean time between first dislocation and operation was 2-10 cation. Thermal Capsulorraphy was performed with the “grid” years. The number of dislocations and subluxation ranged technique. No shrinkage was done between 5.30 to 6.30 posi- between 9 and over 50. All patients were male soldiers, aged 18- tion to avoid damage to the axillary nerve. The treated shoul- 30 years. All intraoperative findings have been recorded. ders were maintained 5 weeks in a sling immobilization. Bankart lesion and its variants was noted in 71 patients Patients were reviewed at the follow-up at 12 and 24 months (93.42%), Hill-Sachs lesion in 42 patients (55.25%), HAGL with measurements of subjective and objective instability, lesion in 2 cases (2.6%), SLAP lesions in 16 patients (21.05 %) function, pain and range of motion. and loose bodies in 7 patients (9.21%). There was no case with rupture of the capsule. In all cases the labrum detachment was RESULTS: 1 patient had recurrence of the instability (posterior achieved using suture anchors. High incidence of labrum direction predominant). No axillary nerve disfunction were lesions was ascertained in our series of young males with found at the 12 months follow-up. 1 patient had a limited range chronic shoulder instability. This group of patients is amenable of motion at 12 months, recovered at 24 months. POSTER ABSTRACTS to arthroscopic reconstruction.

Poster #366 Poster #364 ARTHROSCOPIC LABROPLASTY FOR INSTABILITY DUE THE PREVALENCE OF GLENOHUMERAL TO LIGAMENTOUS LAXITY OSTEOARTHRITIS IN PATIENTS WITH CHRONIC Joe De Beer, Oranjezicht, SOUTH AFRICA, Presenter SHOULDER INSTABILITY Bart Berghs, Brugge, BELGIUM Michelle Cameron, Cheyenne, WY, USA, Presenter Karin van Rooyen, Cape Town, SOUTH AFRICA Karen K Briggs, Vail, CO, USA Cape Shoulder Institute, Cape Town, SOUTH AFRICA Mininder Kocher, Boston, MA, USA Marilee Horan, Vail, CO, USA Aim of the study: To evaluate the clinical outcome of arthro- Richard J Hawkins, Vail, CO, USA scopic labroplasty for shoulder instability. Steadman Hawkins Sports Medicine Foundation, Vail, CO, USA Material and Methods: 56 Patients were treated with arthro- The purpose of this study was to determine the prevalence of scopic labroplasty for shoulder instability due to ligamentous osteoarthrosis in patients with shoulder instability. From 1993 laxity. In our technique, the antero-inferior labral-capsular com- to 2000, a total of 422 patients were diagnosed with shoulder plex is detached and mobilized from the glenoid. It is advanced instability and underwent shoulder arthroscopy with concomi- superiorly and plicated, hereby re-creating a new labrum, re- tant shoulder stabilization. Clinical and arthroscopic data were tensioning the capsule and decreasing the articular volume. maintained prospectively. Data collected included grade of Usually, a rotator interval plication was added as well. chondrosis, the direction of instability, time from injury or Postoperatively, an adduction sling was applied for comfort onset of symptoms to surgery, and patient age. There was a sig- during the first 3 weeks, but patients were allowed to move nificant association between the grade of arthrosis and the within pain limits.. They were clinically reviewed and scored presence of arthritis(grade III-IV) with time from injury to sur- (Walch-Duplay) after 12 to 74 months (average: 26 months). gery (P<0.01). The mean time from injury to surgery was 1580

5.151 Results: No intra-operative complications or nerve injuries tation is advanced or delayed as indicated for a minimum of 4 were encountered. There was only 1 failure with frank re-dislo- months after surgery. cation. The mean Walch-Duplay score was 88/100 (range:10- 100). RESULTS: 148 of 160 patients have obtained stable shoulders (92.5%). Each patient with a stable shoulder has returned to Discussion: Redundant capsule and a hypoplastic labrum are within 91% of their preoperative range of motion. The failures common in unstable shoulders due to ligamentous laxity. The have occurred in patients who had multidirectional instability labroplasty creates a bumper and addresses the excess of cap- (included in the initial months of this study) and those who sule. In our short term experience, this arthroscopic technique were noncmpliant with postoperative instructions. The overall is superior to the open capsular shift and has become our sur- patient satisfaction with this procedure has been excellent. gical method of choice to deal with this type of shoulder insta- bility. CONCLUSIONS: Monopolar elctrothermal shoulder repair has been a very useful adjunct to the treatment of unidirectional shoulder instability when combined with repair of other shoul- Poster #367 der pathologic conditions. The author believes that the post- THE MODIFIED LATARJET PROCEDURE operative physical therapy program is equal to if not more FOR INSTABILITY WITH BONE LOSS important than the surgical techniques to insure the success of Bart Berghs, Brugge, BELGIUM this technique. Joe De Beer, Oranjezicht, SOUTH AFRICA, Presenter Hein De Jongh, Cape Town, SOUTH AFRICA Cape Shoulder Institute, Cape Town, SOUTH AFRICA Poster #369 LONG TERM FOLLOW-UP OF RADIOFREQUENCY HEAT Aim of the study: To evaluate the clinical outcome of our PROBE USE DURING ARTHROSCOPIC STABILIZATION OF method of the Latarjet procedure for instability with bony THE SHOULDER insufficiency of the glenoid Peter Benjamin MacDonald, Winnipeg, CANADA, Presenter Myrna Gwen Dyck, Winnipeg, CANADA Materials and Methods: 70 such patients were treated (1996- University of Manitoba, Winnipeg, CANADA 2001). Our modification of the Latarjet: 1.A long piece of cora- coid is detached. 2. It is rotated to match its concave inferior The purpose of this study was to follow results of arthroscopic surface with the surface of the glenoid 3.The capsule is repaired stabilization using a new technique either as an adjunct or as with bone anchors to the edge of the glenoid, placing the cora- the primary method of stabilization. Seventy-five (75) cases of coid graft extra-articular. Postoperatively no sling is applied arthroscopic stabilization using a radiofrequency heat probe and early rehabilitation is started. They were clinically reviewed were reviewed at a follow-up of 24 - 51 months. Of these cases, and scored (Walch-Du Play) after 9- 72 months (av.: 24) there were fifty-eight with a diagnosis of anterior instability (41 of those had a Bankart lesion which was also repaired), three Results:Excellent: 68%, Good: 25%, Moderate: 6%, Poor: 1% with a diagnosis of posterior instability, and fourteen with a POSTER ABSTRACTS There were no re-dislocations. diagnosis of multidirectional instability. In the anterior insta- bility patients with an associated Bankart lesion, the Bankart Discussion: The results of this procedure were most satisfactory repair was done with suture anchors and knot tying with sup- in this group of patients who were mostly contact sports per- plementary stabilization using the heat probe on the superior, sons, where soft tissue procedures (e.g., open and arthroscopic middle and inferior glenohumeral ligaments. In the other cases, Bankarts) are associated with unacceptable failure rates. the heat probe was used alone on either the posterior capsule in posterior instability or the anterior and posterior capsule in multidirectional instability patients. Poster #368 There were no complications of infection or nerve injury. MONOPOLAR ELECTROTHERMAL SHOULDER REPAIR There were seventeen cases of recurrent instability (22.67%). FOR INSTABILITY Four of the seventeen (23.5%) recurrences were revision cases Stephen W. Houseworth, Colorado Springs, CO, USA, Presenter of previous failed open stabilization. One of the cases of recur- Premier Health Plaza, Colorado Springs, CO, USA rent instability was in a patient with an ALPSA lesion, which had not been repaired. Of the remaining, two were in traumatic PURPOSE: This is an ongoing clinical study ro assess the effi- unidirectional instability with a Bankart lesion, one of, which cacy of monopolar electrothermal shoulder capsular repairs was later determined to be an inadequate repair. performed by a single surgeon. The heat probe was most successful in first time stabiliza- tion of traumatic unidirectional instability as an adjunct to a METHODS: This study began in July 1997 and continues. To this Bankart repair (recurrence rate 3/40, 7.5%). date, 160 shoulder stabilization pordedures have been per- Results seem to indicate some clinical situations in which formed. The indications for this procedure have evolved during this method of stabilization is not recommended. In particular, this time and now excludes those patients who have multidi- we do not recommend this technique in revision cases of pre- rectional instability. The causes of instabilty have been both vious failed open surgery. direct direct trauma such as from sports or motor vehicle acci- dents and/or from “cumulative micro-trauma” such as from weight lifting over many years. All other shoulder pathologic Poster #370 conditions such as SLAP lesions, Bankart lesions, rotator cuff SOME ORIGINAL TECHNIQUES AND SIMPLE DEVICES tears, and biceps tendon instbility have been addressed at the FOR PERFORMING THE ARTHROSCOPIC BANKART time of surgery. The monopolar electrothermal radio frequency REPAIR SECURELY WITH TWO PORTALS device from Oratec International (Menlo Park, CA, USA) has Yasumoto Matsui, Obu, JAPAN, Presenter been used for all procedures. Critical to the success of the Takaaki Omachi, Toyohashi, JAPAN technique is a physical therapy program customized for each Chubu National Hospital, Obu, JAPAN patient to weekly assess progress after surgery. Further rehbili-

5.152 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). [Purpose] One of the merits of the arthroscopic Bankart repair sule when indicated, and occasional rotator interval closure, all is its less invasiveness, and the less portal the more cosmetic performed in the beach-chair position. Average follow-up was advantage. We present our original techniques and simple 37 months (range 24-66). Results: Two of 13 (15%) collision ath- device for performing the arthroscopic Bankart repair securely letes experienced recurrent dislocations after the procedure. with two portals. One patient failed after 5 years when diving into a pool; he had played three years of high school football. One patient failed in [Operative techniques] Patients are laid in the lateral decubitus his second season after his stabilization (>2 years) when mak- position with the traction in 60 degree abduction and 20 degree ing a tackle. None of the contact athletes experienced a recur- flexion. View is got from the posterior portal. The anterior por- rent dislocation with all of them returning to high school or tal is made just above the superior tendon slip of the sub- college athletics. Discussion: 100% of all collision and contact scapularis, and 8 or 10 millimeter semi-transparent plastic athletes returned to organized high school or college sports. canula is inserted. The key for our Bankart repair technique is to Fifteen percent of those collision athletes had a recurrence make the best use of loop relays described as follows. First (subluxation not dislocation), which has not required treat- anterior labrum and glenoid edge are refreshed and a suture ment. Participation in collision and contact athletics is not a anchor (mini-revo screws) with No2 thread is inserted into the contraindication for arthroscopic anterior shoulder stabiliza- glenoid edge. Threads are pulled out of the posterior portal tion using suture anchors, proper suture placement, capsulor- once. Anterior tissues (labrum, IGHL or capsule) is pieced with rhaphy, and occasional rotator interval plication. suture hooks (Linvatec Co.), fixed with our original holder (made by Meira Co. Nagoya Japan). The holder is then detached and both ends of 75cm nylon folded thread are inserted into Poster #372 the suture hook hole and they are grasped by a small punch THERMAL CAPSULAR SHRINKING IN THE TREATMENT inside of the joint. Then the hook is retrieved, letting the thread OF UNSTABLE SHOULDERS IN ATHLETES – as it is with the loop remained outside of the joint. Crossing AN ALTERNATIVE METHOD? another thread with the loop, and by pulling the first thread, Hans-Gerd Pieper, Essen, GERMANY, Presenter the loop is exchanged (the direction of the loop is now for- Nicole Alexandra Hunger, Essen, GERMANY warded). The loop is once pulled out of the joint and hooked by Rene Tibussek, Essen, GERMANY a suture retriever and then pulled back into the joint together Sabine Sôrries, Essen, GERMANY with the retriever. The thread attached to the anchor is taken Dept. Orthop. Surg. & Sports Med., Alfried Krupp H, Essen, GERMANY with the retriever through the loop and is pulled anterior out of the joint.. By pulling the loop of nylon, the thread goes through Introduction the tissue. (For mattress suture, this procedure is repeated.) Arthroscopic thermal capsulorrhaphy either by laser or by And the knot is tied using knot pusher. radiofrequency has recently been considered an alternative in operative stabilization of the shoulder joint. It can be used to [Discussion] This procedure may appeared to be complicated, tighten elongated capsulo-ligamentous structures in multidi- but once you get accustomed, it is a safe and effective way. The rectional instabilities as well as recurrent shoulder dislocations third portal is not necessary because the shuttle relays are not if there is global capsular laxity without an injury of the cap- used. And it can be applied to the repair of the any types of sulo-labral insertion, a so-called Bankart lesion. Some authors Bankart lesions. describe the use of thermal capsuloplasty in addition to arthro- scopic Bankart repair.

Poster #371 Materials and Methods ATHROSCOPIC STABILIZATION OF COLLISION ATHLETES Between March 1999 and February 2001, arthroscopic thermal Augustus D. Mazzocca, West Hartford, CT, USA, Presenter capsulorrhaphy was performed as the only operative procedure

Dominic S. Carreira, Chicago, IL, USA in 35 patients (21 males, 14 females) with either recurrent POSTER ABSTRACTS Frederick M. Brown, Chicago, IL, USA shoulder dislocations (n = 14), subluxations (n = 4) or subacro- Jennifer Hayden, Chicago, IL, USA mial syndrome secondary to antero-inferior or multidirectional Anthony Romeo, Chicago, IL, USA instability (n = 17). In all of these patients the capsulo-labral Midwest Orthopaedics, Rush-Prebysterian-St. Luke’s, Chicago, IL, USA complex was intact at the time of surgery - none of them had a Bankart or HAGL lesion. The average age at surgery amounted Introduction: Repair of the anterior labrum (Bankart lesion) to 28,9 years (15 - 62). Of those 35 patients operated on, 29 (19 with tightening of the ligaments (capsulorrhaphy) is the recom- males, 10 females) could be examined at a follow-up time of mended treatment for recurrent anterior glenohumeral disloca- one year or more (average 22.1 months, 12 - 33) either person- tions. Current arthroscopic anterior stabilization results are ally (n = 18) or by use of a questionnaire (n = 11) specifically similar to open techniques. However, most surgeons still con- designed to get information on pain, function, strength, and sider future participation in collision or contact sports as a con- degree of activity exhibited in daily life, which are needed for traindication to arthroscopic stabilization. Purpose: The the Constant Score and the Rowe Score. Of these patients, 4 purpose of this study is to examine the long-term results of were professional athletes, 11 participated in competitive and arthroscopic anterior shoulder stabilization of high demand 10 in recreational sports. 4 patients were not active in sports at collision and contact athletes. Methods: Thirteen collision and all. 5 contact athletes were identified from the senior surgeons case registry. The analysis was limited to patients under the age Results of 20 that were involved in collision athletics (Football) or con- Mid-term results of this procedure are very encouraging. The tact athletics (Wrestling, Soccer). Objective testing included professional athletes had the best results (average Constant pre- and post-operative range of motion and stability. Outcome Score 102.7 %; average Rowe Score 98.5), followed by those measures included the ASES score, Simple Shoulder Test, SF- active in recreational sports (C.S. 93.5 %; R.S. 91.4) and the 36, visual analogue scale and Rowe scores. The surgical proce- competitive athletes (C.S. 89.9 %; R.S. 87.0). Those patients not dure was performed in a consistent manner: suture anchor active in any sports still had very good average results with a repair of the displaced labrum, capsulorrhaphy with suture mean of 90.2 % (C.S.) and 88.0 (R.S.) respectively. Only 2 placement, supplemented with thermal treatment of the cap-

5.153 patients in this study developed any recurrent instability within Results: The thinning of the capsule was detected in affected the time of follow-up. side of the 8 patients. Five patients with glenoid-side tear showed the signal change near the glenoid. Three patients with mid-portion tear showed severe thinning or disappearance of Poster #373 the capsule. In 2 patients with humeral-side tear showed nor- ROLE OF THE LATISSIMUS DORSI IN ANTERO-INFERIOR mal capsular appearance. All the unaffected sides showed the SHOULDER DISLOCATION IN CADAVERS low signal intensity of normal capsule without thinning, which Nicole Pouliart, Antwerp, BELGIUM, Presenter were clearly different from the abnormal findings in the eight Olivier Gagey, le Kremlin-BicÍtre, FRANCE affected shoulders. Comparison between findings in both sides Institut d’Anatomie, Paris, FRANCE of the shoulder was useful in evaluation of the thinning.

Purpose: To determine the possible role of the latissimus dorsi Conclusion: The ABER-MRI appears to be valuable in detection in preventing shoulder dislocation. of capsular tear at the glenoid-side and the mid-portion except for the humeral-side tear. Material and methods: In twenty fresh cadaver shoulders a cap- suloligamentous lesion from the inferior glenohumeral liga- ment complex up to and including the superior glenohumeral Poster #445 ligament was created through an axillary approach, leaving the CLINICAL OUTCOME OF ARTHROSCOPIC ANTERIOR surrounding muscles intact. In ten shoulders the section was SHOULDER STABILIZATION: TWO-TO-SIX YEAR FOLLOW-UP carried out on the glenoid side and in ten on the humeral side, Seung-Ho Kim, Seoul, KOREA, Presenter followed by a dislocation manoeuvre. If no locked antero-infe- Kwon-Ick Ha, Seoul, KOREA rior dislocation resulted, the latissimus dorsi (in 7 shoulders) Yang-Bum Cho, Seoul, SOUTH KOREA or the subscapularis (in 3 shoulders) were detached from their Byung-Dam Ryu, Seoul, SOUTH KOREA humeral insertion. The dislocation manoeuvre was then Irvin Oh, Seoul, KOREA repeated. Samsung Medical Center, Seoul, SOUTH KOREA

Results: With lesions on the glenoid side, a locked antero-infe- Background: The purpose of this study was to retrospectively rior dislocation always could be produced after section of only evaluate the surgical outcome of the arthroscopic repair of the the ligaments. Ligamentous lesions on the humeral side, how- capsulolabral lesion using suture anchors in a large series of ever, resulted only in a locked anterior dislocation in 7 shoul- patients who were followed-up for mid-term. ders and in a metastable dislocation in 3 shoulders. After sectioning the latissimus dorsi a locked antero-inferior disloca- Materials: We evaluated 167 patients with traumatic recurrent tion was possible in all 10 specimens. anterior shoulder instability after an arthroscopic Bankart repair using suture anchors. The mean age at the time of the Conclusion: In a cadaver model where the muscular enveloppe operation was 25.2 years (15-46 years). There were 149 male of the shoulder is left intact, the latissimus dorsi can prevent and 18 female patients. Before the index surgical procedure and POSTER ABSTRACTS inferior glenohumeral dislocation when the capsuloligamen- at the time of follow-up at a mean of 44 months (range, 24-75 tous lesions are situated on the humeral side. The latissimus months), we used three documented tools for the outcome dorsi plays no role when the lesions are situated on the glenoid measurement: The rating scale of the University of California at side. Los Angeles (UCLA), the America Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES), and the Rowe et al. We also utilized patients’ subjective assess- Poster #374 ment of their shoulder function compared to the preinjury level MID-SUBSTANCE TEAR OF GLENOHUMERAL LIGAMENT by a visual analogue scale. Examination of shoulder range-of- AS A CAUSE OF RECURRENT ANTERIOR DISLOCATION motion focused on the loss of external rotation with the arm at OF THE SHOULDER: EVALUATION WITH ABDUCTION AND the side and 90° abduction, compared to the opposite shoul- EXTERNAL ROTATION MR IMAGING der. We used paired sample T-test to assess the difference Minoru Yoneda, Osaka, JAPAN, Presenter between the preoperative and postoperative shoulder scores. Etsunobu Hayama, Osaka, JAPAN To evaluate preoperative risk factors that are associated with Kazutaka Izawa, Osaka, JAPAN the postoperative recurrence of the instability, we used survival Tatsuo Mae, Osaka, JAPAN analyses because the follow-up duration was not the same in Sunao Fukushima, Osaka, JAPAN all patients. The Gehan test was used for the survival analyses. Dept of Sports Medicine, Osaka Kosei-nenkin Hospit, Osaka, JAPAN Fisher exact test was used to evaluate the relationship between the return to activity and sports activity in patients with post- Purpose: To investigate the value of the abduction and external operative recurrent instability. rotation MR imaging (ABER-MRI) for detection of mid-sub- stance tear of glenohumeral ligament (capsular tear) in Results: Seven patients (4.2%) had recurrent instability, includ- patients with recurrent anterior dislocation of the shoulder ing 1 patient with frank dislocation, 2 patients with subluxation, and 4 patients with positive anterior apprehension test. At the Materials & methods: Both shoulders of the 10 patients (mean follow-up, the mean shoulder scores were improved (p<0.05). age; 30 years) with recurrent anterior shoulder dislocation According of the rating scale of Rowe et al., one hundred and caused by capsular tear were assessed. The tears were located thirty patients (77.8%) had excellent, 29 (17.4%) good, 6 (3.6%) at glenoid-side in 5, mid-portion in 3, and humeral-side in 2. fair, and 2 (1.2%) poor scores. The mean loss of range of motion MR imaging with the shoulder in abduction and external rota- was 2.2° for forward elevation, 2.0° for external rotation, and tion was performed with a permanent magnetic system (0.3-T less than one vertebral level for internal rotation. Patients’ Hitachi MRP 20, Hitachi Medical, Japan). Gradient-echo images activity increased significantly after the surgery (p<0.001). One (TR/TE=600/23, FA=40) in the axial plane were obtained. The hundred and fifty-eight patients (95%) returned satisfactory to assessments were compared with the arthroscopic findings. previous activities. Two patients had transient sensory change in the operated arm, which was relieved completely in a few

5.154 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). days. Three patients had postoperative adhesive capsulitis, plication very important since a significant acromial impinge- which eventually resolved. There was no infection, skin prob- ment might develop as a consequence of the ascent of the lem, or hardware problem. Within the follow-up periods, none humeral head; more frequently observed in relation to this con- of the patients showed sign of degenerative arthritis in the dition than in the cases of anterior instability. plane radiographs. The degree of glenoid defect was signifi- cantly related with the postoperative recurrence of the instabil- ity as a risk factor (p<0.0001). Survival analyses showed that Poster #447 patients with glenoid defect greater than 30% of the glenoid cir- SUBACROMIAL INSTABILITY SYNDROME: cumference showed higher risk of instability recurrence than LAXITY AS A LATE CAUSE OF ROTATOR CUFF FAILURE patients with less than 20% of the glenoid defect (p<0.003) In Miguel Slullitel, Santa Fe, ARGENTINA, Presenter patients with postoperative instability, the recurrent episode Daniel Adolfo Slullitel, Rosario, ARGENTINA was less frequent and shoulder function was related with the Miguel Angel Capomassi, Santa Fe, ARGENTINA activity level (Fisher Exact test, p=0.029). Revision arthroscopic Instituto Dr. Jaime Slullitel, Rosario, ARGENTINA Bankart repair stabilized 3 out of 4 patients. Introduction Conclusion: Unlike to the previous reports on the results of the From 1989 to 2002, ten families (father and son) were operated arthroscopic repair, arthroscopic capsulolabral repair using because of shoulder disease suture anchors provided satisfactory outcomes in terms of the recurrence, activity, and range of motion. Material and Method The ten sons whose ages ranged from 14 to 22 (mean 18 years old) were operated because of anterior glenohumeral instabil- Poster #446 ity. Among these patients the following symptoms were ARTHROSCOPIC TREATMENT OF POSTERIOR observed: six episodes of dislocation, 1 with pain, 3 with con- INSTABILITY OF THE SHOULDER. MID-TERM RESULTS: tinuous subluxations. 3 have bilateral symptoms when practis- EVALUATION OF 16 PATIENTS WITH POSTERIOR ing sports. Four were rugby players, 4 were soccer players and 2 INSTABILITY OF THE SHOULDER OPERATED WITH did not practice any sports at all. Upon physical examination, ARTHROSCOPIC CAPSULAR SHIFT. shoulders external rotation in 90° abduction was 125° in aver- Daniel Adolfo Slullitel, Rosario, ARGENTINA, Presenter age. During arthroscopy a loose capsule with a wide gap of the Miguel Slullitel, Santa Fe, ARGENTINA rotator cuffs was observed; 3 cases also had a Bankart lesion, Miguel Angel Capomassi, Santa Fe, ARGENTINA the remaining patients had a small labrum; the posterior cap- Instituto Dr. Jaime Slullitel, Rosario, ARGENTINA sule was redundant in 3 cases. All fathers were operated of rota- tor cuff disease. Their ages ranged from 45 to 70 (mean age 55 Introduction years old). Four of them had symptoms on the contralateral Between 1989 and 2001, 28 patients were treated because of shoulder, four were amateur tennis players and 6 practised no posterior instability of the shoulder. Four had a posttraumatic sports. X-Rays confirmed the presence of an inferior polar acute dislocation without relapse after reduction, 8 exhibited osteophyte in 5 cases. During arthroscopy, 6 advanced partial posterior locked dislocation of the shoulder that underwent tears of the rotator cuff were revealed on the supraspinatus. In open surgery and 16 suffered from posterior instability with four cases the tear was complete. In 6 cases there were degen- symptoms ranging from pain, voluntary and involuntary sub- erative disorders on the intraarticular portion of the biceps ten- luxation and dislocation of the shoulder that are part of this don. There were two additional cases where the patients sons report. had bilateral subluxation of shoulders that responded to con- servative treatments. One of the fathers had advanced unilat- Material and Method eral glenohumeral arthrosis while the other had bilateral

Patients age ranged from 13 to 22 (mean 19 years old). One involvement without prior symptoms. POSTER ABSTRACTS patient was female and 18 were male. One case have bilateral involvement. Follow up of patients treated arthroscopically Conclusion: In the literature there are no reports on family ranged from 36 to 12 months (mean 18 months). Six are ath- cases operated upon. We believe that in these families, laxity is letes - 3 rugby players and three tennis players - and 9 are not manifested in two different disorders: instability at younger age athletes. Concerning surgical findings, there were 4 posterior and tear of the rotator cuff in older maybe because of subacro- Bankart lesions, 2 of them also had a loose capsule; 10, had mial space instability. Minimum glenohumeral laxity can dam- loose capsules with a small, almost absent labrum. age the rotator cuff and the glenohumeral joint without prior instability symptoms. The family and personal history of laxity Labral anchorage was carried out as a single procedure or with should be taken into account as another factor to surgically latero medial plication on the glenoid aspect. Superior inferior approach the rotator cuff thus preventing deterioration from plication with free capsular sutures was the approach chosen in occurring. Further research should be carried out to detect lax- the case of significant residual laxity. When applying this tech- ity as a key factor in rotator cuff involvement and glenohumeral nique the capsule increases its thickness, due to the folding In arthrosis. 5 cases labral anchorage was associated with rotator interval plication due to posteroinferior laxity. Poster #448 Results CORRECT DIAGNOSIS AND AUGMENTED No relapses were observed so far. A frozen shoulder had to be TRANSGLENOID REPAIR. A KEY TO SUCCESS IN manipulated as well as a painful shoulder with persistent acro- SHOULDER INSTABILITY ON YOUNG RUGBY PLAYERS. mial impingement. This patient had a deficit of 30° of internal Daniel Adolfo Slullitel, Rosario, ARGENTINA, Presenter rotation. Patients lost an average of 10° of internal rotation. Miguel Slullitel, Santa Fe, ARGENTINA Miguel Angel Capomassi, Santa Fe, ARGENTINA Conclusion Instituto Dr. Jaime Slullitel, Rosario, ARGENTINA Results obtained as regards stability were satisfactory. It is dif- ficult to accurately determine the amount of posterior capsular

5.155 Evaluation of 30 arthroscopic surgeries in rugby players.min- Department of Orthopaedic Surgery, Nihon Universit, Tokyo, JAPAN imun follow up over one full season. Purpose Material and methods It is difficult to diagnose the shouder injury in preoperation.The From 1996 to 2001, 30 rugby players with shoulder instability purpose of this study is to compare the kinematic MRI findings were operated on. The age range was from16 to. 26.years (mean and arthroscopic findings focused on rotator cuff lesions or 20 years) Patients with first episode surgery were excluded. labral lesion, and determine the utility of kinematic MRI. (Minimun 2 maximun countless episodes), twenty percent of rugby players have a family history of shoulder dislocation and Materials and Methods thirty percent presented a loose contralateral shoulder.That We studied 10 cases (10 males; aged 16 to 33; mean age of 26.8 means that 50 % have some sort of multidireccional instability. years; 8 right shoulders and 2 left shoulder) who had undergone Glenoid bone defects (more than 20 %) was seen in 2 patientes kinematic MRI before surgery. Using an open magnetic MRI but engaging Hill Sach signs were not found in these patients. AIRIS (0.3T, permanent magnetic type, vertical magnetic field Follow up ranged from 5 rugby seasons to 1 rugby season. method, HITACHI MEDICAL Co.), sagittal and axial view by T2 (maximum 60, minimum 12 months). A transglenoid suture was weighted similar images were obtained. Both sagittal and axial used in all cases. A modified Caspary punch was used to pick images were obtained when the shoulder joint was positioned the capsule double on the joint side improving the capsule pli- with 0 degree flexion and moved by abduction from 0 to 180 cation, creating a neolabrum with the folded capsule without degree, and with 0 degree flexion and 90 degree abduction, repairing the dettached labrum, if present. Based on the extent moved by internal and external rotation from 90 to 90 degree. of the rotator cuff gap and the sulcus sign, the rotator cuff inter- The collected each static images transformed to dynamic val was aggressively plicated and the posterior branch of the images. These dynamic images obtained by kinematic MRI were glenohumeral inferior ligament was tightened in the posteroin- compared with the arthroscopic findings. ferior area of the labrum with anchors In case of associated posterior instability, the posteroinferior capsule was also pli- Results cated with on. In three cases radiofrequency was used since the Preoperative image diagnosis by kinematic MRI revealed 9 laxity was estimated not to be corrected. Anterior plication and shoulders with labral lesion(2 shoulders with SLAP lesion, 4 closure of the rotator cuff gap was performed in 30 out of the 30 shoulders with posterior tear, and 3 shoulders with inferior tear; patients. In 20 patients together with the plication of the pos- there was some overlap with each), and 7 shoulders with terior branch of the LGLHI. In five of these latter cases, poste- impingement syndrome. In the 9 shoulders with labral lesion, rior capsule was also tightened. we could confirm labrum slipping by kinematic MRI. In the two shoulders with SLAP lesion, the labrum was slipped by kine- Results matic MRI. In the 7 shoulders with impingement syndrome, we These patients recovered range of motion on 90° abduction could confirm that the rotator cuff attachment impinged under within an average of 190° between external and internal rota- the acromion during abduction .Arthroscopic findings revealed tion. The aim was not to get the same range of motion of the 9 shoulders with labral lesion (2 shoulders with SLAP shoulder given that in 50% of cases ROM was excessive and in lesion),and 7 shoulders partial rotator cuff tear of articular sur- POSTER ABSTRACTS average there was a 10° loss of shoulder forward flexion. No face. Thus, the kinematic MRI findings were matched the recurrences were observed, However there was a case of frozen arthroscopic findings in all cases. shoulder because of the use of radiofrequency and the removal of 5 posterior sutures Discussion and Conclusion Using the kinematic MRI, we could observe abnormal motion of Conclusion labrum (slipping) to the from dynamic images close to the posi- Contact athletes suffer from different subtypes of instability. In tion at which the clinical symptoms occur. In this study the our patients, 50 % had pre-existing laxities. If this defect is cor- kinematic MRI findings were simlar to arthroscopic findings. rected with the corresponding plications, better results can be Consequently, the kinematic MRI was highly useful to diagnose achieved. The shoulder should have an average of 190° of the shoulder injuries, suggesting that in future it may help in motion without relying on the opposite shoulder motion since elucidating the mechanism of the shoulder injury. it is often hyperloose. When having a decreased forward flexion as a result, stability to tackle is improved. However, the follow up has not been long enough to see whether limited ROM will Poster #376 eventually end in glenohumeral arthrosis. We believe that the ARTHROSCOPIC MANAGEMENT OF THE IMPINGEMENT modified transglenoid suture together with the aggressive clo- SYNDROME OF THE SHOULDER sure of rotator interval and the posterior retightening if needed Sercan Akpinar, Adana, TURKEY, Presenter is a valid alternative for the treatment of young contact ath- Metin Ozalay, Adana, TURKEY letes. Murat Hersekli, Adana, TURKEY Gurkan Ozkoc, Adana, TURKEY Reha N Tandogan, Ankara, TURKEY Shoulder Other Baskent University Hospital, Adana, TURKEY

Impingement syndrome of the shoulder is one of the most Poster #375 common causes of anterior shoulder pain and disability. We THE USE OF KINEMATIC MRI IN THE DIAGNOSIS OF studied the functional outcome of the patients who had been SHOULDER INJURY IN THROWING ATHLETES managed arthroscopically due to impingement syndrome of the Toshio Aihara, Tokyo, JAPAN, Presenter shoulder. 67 patients with impingement syndrome of the shoul- Akiyoshi Saito, Tokyo, JAPAN der underwent arthroscopic subacromial decompression. 24 Kenji Sato, Funabashi, JAPAN were males 43 were females. Average age was 57.2 (37-73 years). Takashi Horaguchi, Tokyo, JAPAN 29 mini-open rotator cuff repair, 6 biceps tenodesis, 1 biceps Shinichi Negishi, Saitama, JAPAN tenotomy, 2 removal of the calcific tendonitis, were done addi- Koh Hoteya, Chiyoda-ku, JAPAN tional to the index procedure. 10 patients had massive irrepara-

5.156 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). ble tear of the supraspinatus tendon. Dominant arms were operated in 58 patients. 22 were smoking patients. Night pain Results was positive in 60 patients. Average duration of symptoms were As a result, there were not surgery or postoperative complica- 8 months (3-24 months). The average preoperative forward flex- tions and radiological fusion was achieved at a mean time of 8 ion and external rotation in adduction were 109 and 24 degrees, weeks. All patients are painless with a good functional upper respectively. Internal rotation was gluteal in 34, lumbosacral in limb that let them to do all daily living activities without any 6, at L3 in 7, at T12 in 20 patients. 32 patients had interscalene problem. and 35 patients had general anesthesia. The average follow-up period was 19 months (6-40 months). The average postopera- Conclusions tive forward flexion and external rotation in adduction were 139 Although nowadays shoulder arthrodesis is becoming a low fre- and 35 degrees, respectively. Internal rotation was gluteal in 12, quent procedure, we present a new surgical technique of shoul- lumbosacral in 5, at L3 in 10, at T12 in 35 and interscapular in der fusion assisted by arthroscopy that has successfully been 5 patients. The average preoperative and postoperative used in three cases. Therefore, we recommend it whenever is Constant scores were 54 (40-67) and 86 (82-96), respectively. In indicated because it is a minimally invasive technique that conclusion, with meticulous surgical technique in selected minimizes complications of a high-risk open surgery. patients, arthroscopic management of the impingement syn- drome of the shoulder can be a safe and effective procedure. References 1. Brittain HA. Architectural Principles in Arthrodesis. 1952, 2nd Edition (E&S Livingstone: Edinburgh) Poster #377 2. Putti V. Arthrodesis for tuberculosis of the knee and the ARTHROSCOPIC-ASSISTED SHOULDER ARTHRODESIS: shoulder. Chir. Organi. Mov. 1933; 18: 217-225. A MODIFIED TECHNIQUE. 3. Watson-Jones R. Extra-articular arthrodesis of the shoul- Juan Diego Ayala, Coslada, SPAIN, Presenter der. J. Bone Joint Surg. 1933; 15: 862. Javier Guerrero, Madrid, SPAIN 4. Morgan CD and Casscells CD. Arthroscopic-assisted gleno- Asepeyo Hospital /Fraternidad Hospital, Madrid, SPAIN humeral arthrodesis. Arthroscopy 1992; 8(2): 262-266.

Fusion of the glenohumeral joint should be considered as an end-stage salvage procedure. Any other procedure that restores Poster #378 some of the glenohumeral motion and rotation has significant ARTHROSCOPIC BICEPS TENODESIS USING advantages over arthrodesis. Patients who are candidates for BIOABSORBABLE INTERFERENCE SCREW FIXATION shoulder arthrodesis require significant preoperative coun- Pascal Boileau, Nice, FRANCE, Presenter selling for a full understanding of their postoperative limita- Jean Sebastien Coste, Nice, FRANCE tions and functional capacities. Nevertheless, actual Nicolas Jacquot, Nice, FRANCE indications for glenohumeral fusion still have proven good Gilles Walch, Lyon, FRANCE functional results. These indications include chronic and Sumant G. Krishnan, Dallas, TX, USA irreparable comminute glenoid and/or glenoid fractures, neuro- Hopital Archet 2, Nice, FRANCE logical failure as complete brachial plexus injuries and paraly- sis of the deltoid muscle, previous history of deep surgical Aim of the study: infection, certain failed revision arthroplasties with a large We report the technique and the results of a new technique of amount of bone loss and for the treatment of intractable arthroscopic biceps tenodesis using bioabsorbable interfer- painful shoulder such as chronic irreparable rotator cuff ence screw fixation. injuries with articular arthropathy and multi-operated unstable shoulder. All open procedures (1,2,3) require a large exposure Material and methods: of the shoulder with all the subsequent complications specially Prospective study of 43 patients treated for a pathology of the POSTER ABSTRACTS infection and non-union. These complications can be mini- LHB between 1997 and 1999. The technique was used in 3 clin- mized with the arthroscopic techniques in a both intra and ical situations: 1) with arthroscopic cuff repair (3 cases); 2) iso- extraarticular arthrodesis as we describe it afterwards. To our lated pathology of the biceps tendon with an intact cuff (6 knowledge, this is the second description of an arthroscopic cases); 3) as an alternative to biceps tenotomy in patients with arthrodesis of the shoulder and represents a modified tech- massive, degenerative and irreparable cuff tears (34 cases). nique of that proposed by Morgan.(4) Biceps pathology included: tenosynovitis (4 cases), pre-rupture (15 cases), subluxation (11 cases), and dislocation (13 cases). Material and Method We present tree cases of shoulder arthrodesis assisted by Results: arthroscopic control. First patient was a 45 year old female with All patients were followed clinically for at least two years. The a chronic multidirectional instability of the left shoulder that Constant score improved from 43 points preoperatively to 79 required six failed open surgeries. Second patient was a 52- points at review (p<0,001). There was no loss of the elbow year-old male who sustained a fracture dislocation of the left movement and biceps strength was 90% of the strength of the shoulder that led to a chronic irreducible and irreparable pos- other side. Two patients, operated early in the series, presented terior dislocation of the glenohumeral joint. Third case was a 50 with a rupture of the tenodesis. In both cases the bicipital ten- year old male with four previous rotator cuff surgeries on his don was very friable and the diameter of the screw proved to be right shoulder and intractable pain. A two-part technique has insufficient (7 mm). No neurological or vascular complications been performed. First part includes arthroscopic cartilage occurred. debridement on both humeral and glenoid articular surfaces, and internal fixation with percutaneous canulated screws. Discussion/Conclusion: Second part consists on a subacromial arthrodesis with iliac Interference screws have been used successfully for several crest graft fixated with a screw, by a lateral mini-open approach. years in hamstring anterior cruciate ligament reconstruction of We performed the same operation technique in all tree cases. the knee. This technique uses the same principles of interfer- The patient was placed in a lateral decubitus position at 50° of ence screw fixation for performing biceps tenodesis using abduction, 15° of forward flexion and neutral rotation. bioabsorbable screws. Using interference screws of a larger

5.157 diameter than the humeral socket (usually a 9 mm screw for a 8 ARTHROSCOPIC ROTATOR CUFF REPAIR BY FOOTPRINT mm socket) we have not observed a failure of the fixation. RECONSTRUCTION: SHORT TERM RESULTS These results support continued use of arthroscopic biceps ten- Joe De Beer, Oranjezicht, SOUTH AFRICA, Presenter odesis with bioabsorbable screw fixation. Bart Berghs, Brugge, BELGIUM Karin van Rooyen, Cape Town, SOUTH AFRICA Cape Shoulder Institute, Cape Town, SOUTH AFRICA Poster #379 MODIFIED WEAVER-DUNN PROCEDURE IN THE Aim of the study: To evaluate the clinical and sonographic out- TREATMENT OF COMPLETE ACROMIOCLAVICULAR come of arthroscopic rotator cuff repair by “footprint recon- DISRUPTION struction”. Aaron Ng, Manchester, UNITED KINGDOM Stephen Bale, Preston, UNITED KINGDOM Material and Methods: Between 1998 and 2001, 260 sympto- Yu-Sing Francis Chan, Manchester, UNITED KINGDOM, Presenter matic acute and chronic rotator cuff tears were arthroscopically Royal Preston Hospital, Preston, UNITED KINGDOM repaired by medial and lateral anchorage of the tendons, referred to as “footprint reconstruction”. Postoperative regime Weaver-Dunn procedure has been a widely accepted treatment consisted of an adduction sling and passive mobilisation for 6 of complete acromioclavicular (AC) joint disruption (Rockwood weeks. Ultrasound examination was routinely performed on all type III- VI dislocations) since its introduction in 1972. It has shoulders 3 weeks postoperatively. All patients were invited for also been used in patients with fracture-dislocations at the AC a clinical review and an ultrasound examination after a mini- joint.The results of the operation have been very satisfactory. mum of 6 months. However, loss of reduction due to occasional pullout of the transferred coracoacromial (CA) ligament is not uncommon. Results: Preliminary results of the first 60 patients were very Over the years, there have been numerous modifications of this satisfactory with an average adjusted Constant score of 90%. No novel technique with good functional results. We present our major complications were encountered. The ultrasound at 3 technique, which is a modification of procedure described by weeks had a predictive value for healing: an intact cuff at 3 Weaver and Dunn. To our knowledge, this modified technique weeks corresponded with an intact cuff at follow up. In the has not been reported in the literature. sonographic cuff deficient shoulders, significant lower power was found at follow up, but this did not compromise the over- After exposing the acromion and distal clavicle, subperiosteal all favourable clinical score. flaps are raised from the distal 2-3 cm of clavicle. The distal end of clavicle, usually 1.0- 1.5 cm in length, is excised. The Discussion: Arthroscopic rotator cuff repair has distinct advan- medullary canal of the distal clavicle is drilled out and curetted tages over an open procedure and appears to be as reliable as to received the transferred CA ligament. Two small drill holes open repair, still the golden standard. We performed cadaver are made through the superior cortex of the distal clavicle. The dissections to map the normal footprint of the rotator cuff ten- CA ligament is carefully detached from the acromion process. dons, and developed the “footprint reconstruction” to create a One large (2mm) drill hole is made through both superior and more anatomic repair. We use this technique as the treatment POSTER ABSTRACTS inferior cortices of the clavicle 1.5cm proximal to the previous of choice in acute and chronic tears of all sizes. two small drill holes. Protection of the ligament transfer can be achieved by using a loop of absorbable PDS® cord (Ethicon Ltd., Edinburgh, UK) through this transosseous channel and Poster #381 passed carefully round the coracoid process (Figure1). The tip MAJOR PECTORALIS MUSCLE RUPTURE IN THE of the coracoid process is identified and drilled to allow inser- ATHLETES tion of Mitek® anchor (Ethicon Ltd., Edinburgh, UK) (Figures 2 Benno Ejnisman, Sao Paulo, BRAZIL, Presenter and 3). The Ethibond suture is then weaved into the CA liga- Moises Cohen, Sao Paulo, BRAZIL ment so that both ends of the suture exit through the acromial Carlos Vicente Andreoli, Sao Paulo, BRAZIL end. The ends of the suture are passed out through the small Alberto Pocchini, Sao Paulo, BRAZIL drill holes in the distal end of the clavicle. When the clavicle is Eduardo Da Frota Carrera, Sao Paulo, BRAZIL reduced the PDS® cord suture is tied to maintain reduction. Federal University of Sao Paulo, Sao Paulo, BRAZIL The CA ligament is then pulled up into the canal and the sutures tied. The authors presented seven cases of rupture of the major pectoralis muscle (MPM) in male athletes of which four under- Suture anchors have been widely used in reconstructive shoul- went surgery and three non-surgically, diagnosed by physical der surgery. This includes biceps tenodesis, capsular shift/ cap- examination and subsidiary tests. All athletes were at the com- sulolabral reconstruction, deltoid repair and rotator cuff repair. petitive level, five presenting lesion on the pectoralis muscle The use of Mitek® super anchor in this modified procedure when lifting weight (Bench press exercise) and two in the fight allow secure fixation of the suture into bone and helps prevent practice. The injury occurred during movements of abduction ‘cheese-wiring’ of the suture through the ligament. and neutral rotation of the humerous against a maximum resistance. Athletes presented pain and hematoma, of which The PDS® cord is used to protect the transferred CA ligament, six with deformity of the axilla and difficulty in the abduction of acting as a temporary reconstitution of the coraco-clavicular the injured limb. Among these cases, four presented total rup- (CC) ligament. The use of bioabsorbable PDS® cord obviates ture of the distal portion of the major pectoralis muscle in the the need for a second procedure to remove the screw. bony insertion at the proximal muscle, two partial rupture in the muscular portion and one partial rupture in the distal inser- We recommend the use of this surgical technique, as we believe tion to the humerous without total desinserction. One of the it provides better fixation and less chance of suture cutting athletes was submitted to surgical treatment in the acute phase through CA ligament, resulting in loss of reduction. (three days) and three in the chronic phase (23 days, 35 days and one year). The surgical technique used was the use of anchors or screw into the bones in order to reinsert the major Poster #380 pectoralis tendon. The authors concluded that complete dam-

5.158 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). age to the major pectoralis muscle of the athletes would be bet- complications did not occur. The praeoperative Constant-Score ter treated surgically than nonsurgically. resulted in an average value of 61 (44-73) points. These values improved on the average on 76 (59-88) points six weeks post- operative, 85 (61-96) points three months postoperative and 91 Poster #382 (63-100) points 1 year postoperative. One year after the opera- MUSKULOSKELETAL INJURIES ON 320 ATHLETES’ tion, 14 patients indicated the result as very good, 7 patients as SHOULDERS: MECHANISM OF INJURY, DIAGNOSIS, AND good, 5 patients as satisfying and 2 patients as bad. RETURN TO SPORTS PRACTICE Discussion: Benno Ejnisman, Sao Paulo, BRAZIL, Presenter The therapy of the frozen shoulder is the subject of a contro- Carlos Vicente Andreoli, Sao Paulo, BRAZIL versially led discussion. The described arthroscopic therapy is a Alberto Pocchini, Sao Paulo, BRAZIL complication-poor intervention, which leads to satisfying Eduardo Da Frota Carrera, Sao Paulo, BRAZIL medium-term results after success lacking of conservative. Moises Cohen, Sao Paulo, BRAZIL Federal University of Sao Paulo, Sao Paulo, BRAZIL Poster #384 The authors evaluated prospectively three hundred and twenty REPAIR OF TYPE-2 SLAP LESIONS USING CORKSCREW athlete with shoulder injuries, 216 (67,5%) being throwers, 256 ANCHORS. A CLINICAL FOLLOW-UP STUDY (76,8%) male athletes, 224 (70%) competitive athletes. The Juri Toomas Kartus, Trollhättan, SWEDEN, Presenter dominant side was affected in 221 (69%). Follow-up was over 1 Catarina Kartus, Trollhättan, SWEDEN year and eight months. The highest incidence of injury was in Harry Brownlow, Sydney, AUSTRALIA volleyball players with 52 (16%) athletes, followed by swimmers Greggory Burrow, Sydney, AUSTRALIA with 30 (9,3%). Atraumatic injury with 198 (61,8%) was most fre- Mark Perko, Sydney, AUSTRALIA quent than traumatic injury (122 / 61,8%). Pain complaint was North Sydney Orthopaedic and Sports Medicine Cente, Sydney, AUSTRALIA present in 215 (67%) athletes. Shoulder instability (140 / 43,7%) cases, were the most frequent, followed by rotator cuff lesions Purpose of the study: To make a clinical assessment of patients with 106 (33%) and by the achromialclavicular pathologies in 41 who had undergone arthroscopic repair of a type-2 SLAP lesion (12,8). The return to sports pratice was resumed within a mean using Corkscrew® anchors. period of six weeks; 254 (79,3%) athletes returned to the same level of competition, 49 (15,3%) athletes reduced their perform- Materials and methods: 17 consecutive patients who agreed to ance and 17 (5,3%) athletes did not return to sports pratice. In fill in a pre- and post-operative questionnaire were included in the sports orthopaedic practice the biomechanic, sports the study. The aetiology was traumatic in 12/17 patients and modality, level of activity, reabilitation and surgical treatment non-traumatic in 5/17. The time between the onset of the symp- are the basis to achieve a good result and return to sports activ- toms and the operation was 11 (3-120) months. At the index ities in the same level. operation five patients underwent a concomitant acromeo- plasty, while 4 patients underwent supplementary anterior labrum fixation using suture anchors. 13/17 (76%) of the Poster #383 patients were physically re-examined by independent observers MEDIUM-TERM RESULTS AFTER ARTHROSCOPIC after a follow-up period of 25 (11-32) months. The question- THERAPY OF THE FROZEN SHOULDER naires involved a patient administered assessment of pain and Xenofon Baraliakos, Herne, GERMANY instability using a VAS-scale from 0-10, where 0 indicates full Stefan Heidersdorf, Herne, GERMANY stability and no pain respectively. Stefan Seitz, Herne, GERMANY

Roderich Heikenfeld, Herne, GERMANY, Presenter Results: At follow-up the Rowe score was 84 (51-98) points and POSTER ABSTRACTS Georgios Godolias, Herne, GERMANY the Constant score was 83 (35-98) points. The Constant score Klinik fuer Orthopaedie am St. Anna Hospital, 44653 Herne, GERMANY on the non-operated side was 92 (66-100) points, (p=0.01). The external rotation in abduction was 85 (60-110) degrees on the Introduction: operated side and 90 (80-110) degrees on the non-operated In this prospective study we checked the short and medium- side (n.s.). The strength in abduction was 7.3 (0.8-14.4) kg on term results after arthroscopic therapy of the so-called frozen the operated side and 8.7 (2.7-15.5) kg on the non-operated shoulder. side (p=0.01). The pre-operative pain score decreased from 2.5 (0-8) to 0.75 (0-6) at follow-up (n.s). The corresponding values Methods: for the pre- and post-operative stability scores were 3.75 (0-8) 34 patients (20 women and 14 men) at the age of 52 years (41- and 2.25 (0-10) respectively (n.s). Three patients underwent or 62) with the diagnosis frozen shoulder were treated arthro- were scheduled for further surgery during the follow-up period. scopic. The painful movement restriction amounted praeoperativ 12.8 months (7-25): In the operation we shaved Conclusions: Based on the limited number of patients included accretions, performed synovectomy, notched the medial gleno- in the study it seems that the results are satisfactory and that humeral ligament with laser, dissected the subacromial bursa the subjective patient administered evaluations improve after and performed a subacromial decompression, depending on arthroscopic repair of type-2 SLAP lesions using Corkscrew® the findings. Finally, we did a moderate mobilisation in narco- anchors. sis. Postoperative, the patients were treated with intensive mobilisation therapy. The results were determined six weeks, three months and twelve months postoperative by the patient’s Poster #385 subjective opinion and by using the Constant Score. THE SURGICAL OUTCOME OF THE ARTHROSCOPIC TREATMENT FOR OVERHEAD ATHLETIC INJURIES Results: Toshiro Kotake, Kyoto, JAPAN, Presenter From 34 operated patients 28 patients (16 women and 12 men) Department of Orthopaedic Surgery, Mitsubishi Kyot, Kyoto, JAPAN appeared to the re-examination dates. Operation-conditioned

5.159 KOTAKE Toshiro 1), YAMAKAWA Tomoyuki 1), NAKAGAWA ARTHROSCOPIC ROTATOR CUFF REPAIR - Yasuaki2), NAKAMURA Takasi2), THE PRELIMINARY RESULTS COMPARED WITH 1) Department of Orthopaedic Surgery, Mitsubishi Kyoto MINI-OPEN REPAIR Hospital Hsiao-Li Ma, Taipei, TAIWAN, Presenter 2) Department of Orthopaedic Surgery, Faculty of Medicine, Taipei Veteran General Hospital, Taipei, TAIWAN Kyoto University Introduction The purpose of this study was to report our experience with an In order to decrease the significant ealy postoperative pain, and arthroscopic surgery in the treatment of a painful throwing to have an earlier and easier rehabilitation, the transition from shoulder. The study subjects consisted of patients with painful open or mini-open rotator cuff repair to all arthroscopic repair throwing shoulder and followed up for more than one year after was performed. We present 20 patients who underwent arthro- surgery. There were 12 males and 3 females. The age of the scopic rotator cuff repair and compare the preliminary results patients at operation ranged from 18 to 35 (average 24.2). The with patients who had mini-open repair. follow-up period ranged from 12 months to 52 months (average 310 months). Arthroscopic evaluation consisted of examination Material and Methods of the glenohumeral joint and subacromial space. Treatment All patients who failed non-operative treatment for chronic full consisted of debridement and repair of the rotator cuff, labral thickness rotator cuff tears and the tear size were documented tears and subacromial space. The results were evaluated by the from small to medium tear before or during the surgery were JSS Shoulder Sports score system. JSS Shoulder Sports score included. From December 1999, the first 15 consecutive improved from 49.6 points to 90.2 points. 22 patients revealed patients who received mini-open rotator cuff repair were undersurface tearing of the rotator cuff. 18 patients had lesions reviewed. Mean while, the initial 20 patients who received all of the subacromial space. 13 patients also had tearing of the arthroscopic repair since November 2000 were also reviewed. posterior labrum. Anterior labrum fraying was noted in all Arthroscopic acromioplasty were performed in all cases using patients. 33 of 41 (80%) throwers evaluated had returned to standard technique with patients in beach-chair position. All their preinjury level of throwing, but 8 throwers have changed the torn rotator cuff were repaired and fixed to the greater their positions. Arthroscopic surgery of the rotator cuff, labral tuberosity with either suture anchors or osseous tunnels lesions, and subacromial lesions are reasonable options for sutures in mini-open group; and only suture anchors in baseball players with symptomatic stable shoulders who wish arthrospic group. Postoperative care and rehabilitation were to return to sports. just the same way for both groups. Follow-up averaged 18 months for the mini-open and 10 months for the arthroscopic group. The follow-up was emphasized on perioperative morbid- Poster #386 ity and early stage of rehabilitation. THE SURGICAL OUTCOME OF THE ARTHROSCOPIC TREATMENT FOR AN OVERHEAD ATHLETIC INJURIES Results Toshiro Kotake, Kyoto, JAPAN, Presenter Age, gender, associated findings and duration of symptoms Department of Orthopaedic Suegery, Mitsubishi Kyot, Kyoto, JAPAN were not significantly different, but the arthroscopic repair is POSTER ABSTRACTS shown to offer a significant reduction in postoperative pain and KOTAKE Toshiro 1), YAMAKAWA Tomoyuki 1), NAKAGAWA shorter hospital stay over mini-open repair. For the arthro- Yasuaki2), NAKAMURA Takasi2), scopic repair group, recovery of either passive or active range of 1) Department of Orthopaedic Surgery, Mitsubishi Kyoto motion was easier and sooner during the first 2 months posop- Hospital eratively; returned to daily activity was also earlier within the 6 2) Department of Orthopaedic Surgery, Faculty of Medicine, months postoeratively. Kyoto University Discussion The purpose of this study was to report our experience with an The preliminary short term results revealed that when com- arthroscopic surgery in the treatment of a painful shoulder. The pared with mini-open repair, patients who underwent arthro- study subjects consisted of patients with painful shoulder of scopic repair of the small to medium rotator cuff tears had less overhead athlete and followed up for more than one year after scarring, shorter hospital stay, less postoperative pain, easier surgery. There were 12 males and 3 females. The age of the early rehabilitation and earlier returned to daily activity. patients at operation ranged from 18 to 35 (average 24.2). The follow-up period ranged from 12 months to 52 months (average 310 months). Arthroscopic evaluation consisted of examination Poster #388 of the glenohumeral joint and subacromial space. Treatment CASE REPORT OF SPONTANEOUS DISSOLUTION OF consisted of debridement and repair of the rotator cuff, labral GANGLION CYST FOLLOWING ARTHROSCOPIC tears and subacromial space. The results were evaluated by the STABILISATION OF A TYPE 2 SLAP LESION – LITERATURE JSS Shoulder Sports score system. JSS Shoulder Sports score REVIEW OF THE TREATMENT OF GANGLION CYST improved from 49.6 points to 90.2 points. 22 patients revealed CAUSING SUPRASCAPULAR NERVE ENTRAPMENT undersurface tearing of the rotator cuff. 18 patients had lesions Wing Yuk Mok, Hong Kong, CHINA, Presenter of the subacromial space. 13 patients also had tearing of the James J Lam, Chai Wan, CHINA posterior labrum. Anterior labrum fraying was noted in all Kai Chung Poon, Hong Kong, CHINA patients. 33 of 41 (80%) athletes evaluated had returned to their Joshua Ko, Hong Kong, CHINA preinjury level of sports, but 8 athletes have changed their posi- Gloria HK Wu, Hong Kong, CHINA tions. Arthroscopic surgery of the rotator cuff, labral lesions, TH Siu, Hong Kong, CHINA and subacromial lesions are reasonable options for overhead Department of Orthopaedics and Traumatology, Pamel, Hong Kong, CHINA athletes with symptomatic stable shoulders who wish to return to sports. Ganglion cyst compressing on suprascapular nerve, causing isloated infraspinatus or both supraspinatus and infraspinatus weakness, was an uncommon clinical condition. Recently, with Poster #387 the increasing awareness and availability of MRI arthrogram,

5.160 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). there were more reports on this condition. In the reviewed assess for osteolysis or a persistent screw tract. At six months series, the majority of the ganglion cysts were reported to be post-op the patients were again rated with a UCLA score and communicated with the shoulder joint, either through a labral SF-36 assessment. tear (e.g., SLAP lesion) or a capsular defect. Different kinds of sugeries were performed for this condition ranging from open Results: At one year follow-up, no patient reported any adverse decompression to all arthroscopic technique. None of the stud- reaction to the implant. Post-op UCLA scores increased from an ies has reported on the spontaneous dissolution of ganglion average of 16(range 9-22) pre-op to 32(range 23-35.(p<0.0001) cyst following arthroscopic stabilisation of a SLAP lesion. We SF-36 scores showed a statistically significant increase in phys- reported a case of supraglenoid cyst compressing the supras- ical function scores(p<0.005), physical role function scores capular nerve with a SLAP lesion. He was a 37-year-old con- (p<0.007), and bodily pain scores (p<0.0001). One patient struction site worker who had right shoulder pain after an injury developed mild adhesive capsulitis post-operatively but 4 months prior to presentation. Physical examination showed resolved. Two patients had persistent screw tracts without oste- isolated infraspinatus wasting and weakness together with olysis on their six month radiographs. No patient developed preservation of supraspinatus power and function. Speed test foreign body impingement. Continued follow-up for more than and O’Brien test were positive. MRI arthrogram showed a SLAP twelve months demonstrate no change in the results, in fact, lesion with supraglenoid cyst that was communicating with the some patients continue to show improvement long term. glenohumeral joint through the SLAP lesion. There was no rota- tor cuff tear. We performed shoulder arthroscopic repair of the Conclusions: The new bioabsorbable screw and washer is a safe type 2 SLAP lesion using Fastek suture anchors. We did not par- and effective alternative to traditional methods for the fixation ticular put the scope or any instrument into the cyst to decom- of the rotator cuff to bone. In addition, there seem to be no long press it. Postoperatively, he followed standard rehabilitation term disadvantages over these methods in patients objective programme for SLAP repair. There was good pain relief. The and subjective outcomes. This construct may have superior bio- power of the infraspinatus returned to grade 5. He again mechanical properties verses currently available fixation meth- engaged in heavy manual work. Follow-up MRI arthrogram ods. showed dissolution of the ganglion cyst. In this case, we showed that by repairing the SLAP lesion itself could cause dis- solution of the supraglenoid cyst with good clinical supras- Poster #390 capular nerve recovery. Direct drainage or decompression of the POSTERIOR SHOULDER PAIN IN THROWING ATHLETES ganglion cyst might not be necessary, if the cyst was associated WITH BENNETT LESION with a SLAP lesion. Shigeto Nakagawa, Osaka, JAPAN, Presenter Minoru Yoneda, Osaka, JAPAN Conclusion: Kenji Hayashida, Osaka, JAPAN 1. Ganglion cyst causing suprascapular nerve entrapment can Masanori Obata, Osaka, JAPAN happen in work-related injury. Sunao Fukushima, Osaka, JAPAN 2. MRI arthrogram is important in diagnosis and the planning Osaka Kosei-Nenkin Hospital, Osaka, JAPAN of treatment. 3. Suggested treatment strategy following literature review- a. PURPOSE: Bennett lesions are often observed in long-term Cyst with a SLAP lesion : stabilisation will lead to spontaneous throwing athletes and are usually non-symptomatic, suggesting dissolution, decompression may not be necessary. that there may be physiological ossifications. However, this b. Cyst without a SLAP lesion, but with a communication with lesion can sometimes become painful and disturb an athlete’s the glenohumeral joint: arthroscopic decompression through throwing ability. We have been treating symptomatic Bennett labral or capsular defects. lesions arthroscopically according to our criteria. As the reason c. Without SLAP lesion and no communication as shown on why some lesions become symptomatic is still unknown, we

MRI arthrogram : direct endoscopic drainage or open drainage investigated the factors inducing the pain on Bennett lesion. POSTER ABSTRACTS +/- release of superior transverse ligament. METHOD: Twenty-four baseball players with Bennett lesion, who underwent arthroscopic operation, were examined. Poster #389 According to our criteria, painful lesions in 11 players were ROTATOR CUFF REPAIR USING resected, and non-symptomatic ossifications in the other 11 A SCREW AND WASHER TECHNIQUE: players were left untreated and studied as control. Range of ANALYSIS OF OUTCOME AT ONE YEAR FOLLOW-UP. motion and joint laxity in bilateral shoulders under general Cary R. Motz, Aurora, CO, USA, Presenter anesthesia and arthroscopic findings were retrospectively stud- James P Tasto, San Diego, CA, USA ied. William J Ciccone II, Colorado Springs, CO, USA San Diego Sports Medicine and Orthopedic Center, San Diego, CA, USA RESULTS: We defined more than 10 degrees loss of internal rotation at 90-degrees abduction in injured shoulder compared Purpose: To report the results of our first twenty patients who with uninjured side as posterior capsular tightness. Though underwent repair of a rotator cuff tear using a new bioab- posterior capsular tightness was seen in 8 of 11 shoulders with sorbable screw and washer fixation device at minimum one non-symptomatic ossification, it was seen in only 4 of 13 shoul- year follow-up. ders with painful lesion (Mann-Whitney U analysis: p<0.05). Among 13 shoulders with painful lesion, avulsed ossification Methods: Twenty patients (16 male: 4 female) underwent a rota- from glenoid rim was seen in 4 shoulders and none of them tor cuff repair utilizing a bioabsorbabable screw and washer showed posterior capsular tightness. No avulsion was seen in (Bionx, Biocuff). The patients averaged 14 months follow-up 11 shoulders with non-symptomatic ossification (p<0.05). As (range 12-38 mos). The average age of the patients was 56 years for the other factors, there was no significant difference (range 43-70 years). Workmen’s compensation cases were between two groups. excluded from this series. The patients were rated pre-opera- tively with both a UCLA score and a SF-36 score for outcome CONCLUSION: While it was difficult to detect any intraopera- assessment. Radiographs were obtained at six months to tive findings specific to painful lesions, deficiency of posterior

5.161 joint tightness regardless of the formation of ossification In order to compare the results of a follow-up by patient self- appears to relate to their symptom. So, careful preoperative assessment and clinical examination, a printed questionnaire diagnosis should be done. was designed to get information on pain, function, strength, and degree of activity exhibited in daily life, which are needed SIGNIFICANCE: We clarified the character of Bennett lesion, for the Constant Score, the UCLA Score, and the Rowe Score. which induce throwing pain. This questionnaire was sent to and returned by 100 patients between 1 and 11 years after surgical treatment of shoulder instability. The same patients were examined clinically >2 Poster #391 weeks after they had returned the questionnaire. The scores ARTHROSCOPIC ACROMIOPLASTY AND ROTATOR CUFF resulting from the self-assessment of the patient by question- REPAIR USING ANCHORS THROUGH A MINI OPEN naire and those gained by clinical examination and questioning APPROACH of the patient were compared. Pericles P. Papadopoulos, Thessaloniki, GREECE, Presenter Ioannis Christoforides, Athens, GREECE Results Dimitrios Karataglis, Thessaloniki, GREECE There was no statistically significant difference between the Ippocratis Hatzokos, Thessaloniki, GREECE scores accumulated in the questionnaires and those resulting Ilias Fotiadis, Thesaloniki, GREECE from the clinical examination. The questionnaires exhibited a John Pournaras, Thessaloniki, GREECE tendency towards a slightly lower score primarily as concerns G. Papanikolaou Hospital, Thessaloniki, GREECE the assessment of strength, but this difference was not statisti- cally significant either. Purpose: Evaluation of the results of arthroscopic subacromial decompression and rotator cuff repair using anchors through a Conclusions mini-open approach. It seems reliable to carry out follow-up studies based on ques- tionnaires since their results are reasonably similiar to those of Material and methods: 25 shoulders in 24 patients were evalu- clinical examinations. Thus higher follow-up rates at lower cost ated for operative outcome using the Constant Score. 11 can be achieved. patients were male and 13 female. Average age at operation was 48.6 years (38-77 years). Follow-up ranged 12 to 26 months (average 15.5 months). Tears were classified according to size: Poster #393 10 were small-medium (<3cm), 12 were large (3-5cm) and 3 CALCIFIC TENDONITIS: A SYSTEMATIC TECHNIQUE FOR were massive (>5cm). Arthroscopic subacromial decompres- ARTHROSCOPIC LOCALIZATION AND DEBRIDEMENT sion was performed in all patients prior to rotator cuff repair Ronald M Selby, New York, NY, USA, Presenter using bone anchors through a mini-open approach. The cora- Stephen J O’Brien, New York, NY, USA coacromial ligament was preserved in all cases. Anne M. Kelly, New York, NY, USA Mark C. Drakos, New York, NY, USA Results: The average Constant Score improved from 38.5 pre- Samuel A. Taylor, New York, NY, USA POSTER ABSTRACTS operatively to 79.2 post-operatively. 13 results were evaluated The Hospital for Special Surgery, New York, NY, USA as excellent, 11 as good and 1 as fair; no poor results were recorded. One patient developed superficial infection which Precise localization and access are of fundamental importance was treated successfully with surgical debridement and antibi- in arthroscopy including arthroscopy of the shoulder. A tech- otics. nique is described which facilitates the ability to localize cal- cific deposits within the rotator cuff and makes their Conclusions: The results of our study suggest that arthroscopic subsequent debridement much easier. With a systematic subacromial decompression combined with rotator-cuff repair inside-out approach and the use of suture markers this often using bone anchors through a mini-open approach with preser- difficult arthroscopic procedure becomes systematic, repro- vation of the coracoacromial ligament is a good option for ducible, and easier to perform. We find this approach facilitates patients with rotator-cuff tear, especially when these are large what is often otherwise a frustrating and difficult procedure and or massive. can serve as a guide for orthopaedists facing this problem.

Poster #392 Poster #394 FOLLOW-UP AFTER SHOULDER STABILIZATION THE INFRASPINATUS INSERTION – PROCEDURES – A COMPARISON OF PATIENT SELF- AN ANATOMIC STUDY FOR ARTHROSCOPISTS ASSESSMENT AND CLINICAL EXAMINATION Robert Allen Sellards, New Orleans, LA, USA, Presenter Hans-Gerd Pieper, Essen, GERMANY, Presenter Ryan Coates, Chicago, IL, USA Rene Tibussek, Essen, GERMANY Anthony Romeo, Chicago, IL, USA Nicole Alexandra Hunger, Essen, GERMANY Rush-Presbyterian St. Luke’s Medical Center, Chicago, IL, USA Dept. Orthop. Surg. & Sports Med., Alfried Krupp H, Essen, GERMANY Arthroscopic rotator cuff repair restores the cuff anatomy with Introduction minimal disruption of the surrounding tissue. Success in Quality control has become an important part of any surgical dependent upon recognition of the tear pattern and the ten- procedure for medical as well as legal reasons. However, it is dons involved. Results have been promising and will most difficult to get a high follow-up rate on clinical examinations likely improve with new techniques and technology. In order to because many patients do not like to take the time to return for restore cuff anatomy, the arthroscopist must be able to identify them repeatedly, especially if they are satisfied with the result the torn tendons and determine the correct insertion point for of the operation. each on the humeral head. In this anatomic study, ten fresh frozen shoulders were dis- Methods sected and the precise location of the infraspinatus tendon insertion was identified. This location was compared to the

5.162 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). position of other recognizable intraarticular landmarks, includ- of the rotator cuff tendons rather than straight out in simulated ing the bare area and biceps tendon. The results indicate that rotator cuff repairs. the interval between the supraspinatus and the infraspinatus tendons is estimated at 6.3 mm anterior to the origin of the Materials & Methods: Rotator cuff lesions were created and bare area with a standard deviation of .82. The width of the repairs performed at the insertion of the supraspinatus tendon insertion is one centimeter. of matched disarticulated humeral heads of 11 cadavers using Knowledge of these relationships will enable the arthro- 2 Suretac devices spaced 1cm apart on one side and 2 Mitek scopist to correctly return the supraspinatus and infraspinatus anchors spaced 1cm apart on the opposite. The humerii were to their correct insertion points on the humeral head when per- then mounted in an Instron Test System with the supraspinatus forming arthroscopic rotator cuff repair. This results in better tendons clamped and pulled along their longitudinal axis. The post-operative function with correct anchor placement. structures were cyclically loaded for 200 cycles at 1Hz at 30N to assess compliance and then pulled to failure using a preload of 10N and a constant loading rate of 8.5 mm/sec to assess for Poster #395 mode and load to failure. EARLY RESULTS OF THIRD-GENERATION HUMERAL PROSTHETIC REPLACEMENT Results: There was an increase in compliance in both groups by Robert Allen Sellards, New Orleans, LA, USA, Presenter the 200th cycle but no statistical difference between groups. Anthony Romeo, Chicago, IL, USA The mean load to failure in the SureTac group 247.2N (+/-68.1) Rush Presbyterian St. Luke’s Medical Center, Chicago, IL, USA and the Mitek group 215.9 (+/-69.8) was not statistically signif- icant (p=0.213). The SureTac group failed by pull-out in 6 and INTRODUCTION: Shoulder replacement can predictably tendon “comb” through in 5, the Mitek group by pull-out in 2, improve patient comfort and passive range of motion. First and suture “pull” through in 3 and suture failure in 6. second generation designs fail to consistently match the three- dimensional anatomy of the proximal humerus. A third genera- Discusion: Although the failure mode of the devices differed, tion humeral prosthesis adapts to the patient’s normal the ultimate load to failure did not. Previous concerns about anatomy which should result in better motion and function the load to failure of tacks in rotator cuff repairs were not con- than a non-anatomic replacement. The purpose of this study is firmed in this study. to report the early results of third-generation humeral pros- thetic replacement. Conclusion: At time zero tack fixation for rotator cuff tears is comparable to that of cuff suture anchors. METHOD: A prospective outcome study was organized with patient evaluation performed preoperatively and after surgery at 3 months, 6 months, 1 year, then annually. Diagnoses Poster #397 included osteoarthritis, rheumatoid arthritis, avascular necro- ALL ARTHROSCOPIC VERSUS MINI OPEN REPAIR IN THE sis (AVN), cuff tear arthropathy, post-traumatic arthritis, and MANAGEMENT OF COMPLETE TEARS OF THE ROTATOR fractures. CUFF Stephen C Weber, Sacramento, CA, USA, Presenter RESULTS: The average follow-up for all patients was 10 months Rosana Sager, Sacramento, CA, USA (3 to 36 months). The analysis included pain scores, Simple Sacramento Knee and Sports Medicine, Sacramento, CA, USA Shoulder Test, ASES score, Constant score, range of motion, strength, and patient satisfaction. Patients with osteoarthritis Small series have shown all arthroscopic repair feasible, how- and AVN had the greatest increase in ROM. The non-adjusted ever, comparative series to document these reports’ assertions Constant score and ASES scores improved significantly with that these procedures provide improvement in perioperative the greatest increase noted in patients with osteoarthritis and morbidity or outcomes are limited. Presented here is a prospec- POSTER ABSTRACTS AVN. Patients with cuff tear arthropathy and rheumatoid arthri- tive report to compare all arthroscopic repairs with mini-open tis demonstrated limited improvements in active motion and rotator cuff repairs by a single surgeon. From 1/91 to 3/99 770 function. Of those that had glenoid replacements, the majority patients were taken to surgery for rotator cuff repair; 490 had had radiolucent lines with half being partial. There were some moderate or large tears or other diagnoses and were excluded, complications, including infection, glenoid revision, and sub- leaving 280 patients for review. 126 chose an all-arthroscopic scapularis rupture. repair versus 154 with an open repair. Follow-up averaged 36.3 months for the arthroscopic and 47.8 for open with a minimum CONCLUSION: Anatomic third-generation shoulder prostheses of two years. Age, gender, associated findings at surgery, and can alleviate pain, provide improved passive motion, active duration of surgery were not significantly different between the motion, and function. With an intact rotator cuff the active two groups. Perioperative morbidity was significantly motion and function of the shoulder will approach age- decreased with all arthroscopic repair, allowing 98% to be per- adjusted norms. formed outpatient versus 38% (p<0.01) and significantly less narcotic use. Recovery of motion was not significantly different at any time of follow-up. There were two manipulation and four Poster #396 reoperations for failed repair in the open group (4%). Four COMPARISON OF THE LOAD TO FAILURE OF A patients had loose anchors early in the arthroscopic group; this CANNULATED TACK (SURETAC II) AND A SUTURE complication ceased early using second-generation anchors. ANCHOR (MITEK) IN ROTATOR CUFF REPAIR Three failed repairs presented with a total reoperation rate of Graham Tytherleigh-Strong, Edinburgh, UK, Presenter 4.76% (p=ns). Final outcomes as measured by ASES, UCLA and Anthony Miniaci, Toronto, CANADA SST scores were not different. All arthroscopic repair is shown Alan Hirahara, Sacramento, CA, USA to offer a significant reduction in perioperative morbidity over Sports Medicine Programme, University of Toronto, Toronto, CANADA mini open repair. Final outcomes are not changed, and early complications indicate a steep learning curve. Aim: The load to failure of cannulated tacks (SureTac II) and cuff suture anchors (Mitek) were compared in the direction of pull

5.163 Poster #398 advancement of healthy tendon over the attachment site. MINI OPEN SUB PECTORAL BICEPS TENODESIS FOR Concerns over completing the tear in this situation appear MANAGEMENT OF RUPTURES OF THE LING HEAD OF unfounded. THE BICEPS Stephen C Weber, Sacramento, CA, USA, Presenter Sacramento Knee and Sports Medicine, Sacramento, CA, USA Poster #400 THE GLENOLABRUM INJURY OF THE SHOULDER: Recent articles have emphasized the role of the biceps as a sig- MRI AN MR ARTHROGRAPHY WITH ARTHROSCOPIC nificant pain generator in the shoulder. Treatment of these CORRELATION lesions however has varied widely. Open tenodesis is felt to Kazuhiro Yamaguchi, Sasebo, JAPAN, Presenter restores strength and cosmesis but has considerable morbidity. Hiroyuki Kitahara, Sasebo, JAPAN Arthroscopic tenotomy is simple but can result in significant Eiichirou Asou, Sasebo, JAPAN deformity and weakness postoperatively. Arthroscopic tenode- Nagasaki Rosai Hospital, Sasebo, JAPAN sis techniques have been described, but many are technically challenging, and some require transhumeral drilling, placing (PURPOSE) The purpose of this study was to know the correla- the axillary nerve at risk. Mini open biceps tenodesis using a tion of MRI and MR arthrography findings and arthroscopic subpectoral approach was presented as a technical note in findings of glenoid labrum injury of shoulder. 1993, offering simple, technically easy subcutaneous access to the retracted biceps through a 2 centimeter incision. This series (MATERIALS AND METHOD) Twenty six patients 16-49 years reviews long term follow-up of 81 patients treated over a 10 year old who had either signs and symptoms of shoulder pain or period, with a mean follow-up of 6.71 years. 56 were male, with instability were evaluated in this study. Each patient underwent the remainder female. Intraarticular pathology was corrected MR imaging and MR arthrography before surgery. Two senior arthroscopically; partial tears were tenotomized arthroscopi- radiologists analyzed the type of labrum injury and the area of cally and allowed to retract. With the patient lateral, the arm is injury. The type of injury were detachment, defecit, and fraying released from traction and abducted and externally rotated. A or degeneration. The results of MRI and MR arthrography and two centimeter mid axillary incision is made, and blunt dissec- arthroscopic findings were compared and scored. All data were tion carried down to the distal bicipital groove inferior to the calculated by the difference of MRI findings and arthroscopic pectoralis major tendon. The retracted tendon is then fixed to findings as follows. Rank 1: 0-1 hour difference; Rank 2: 1-2 hour the distal bicipital groove using a unicortical screw and washer. difference; Rank 3: 2-3 hours difference; Rank 4: over 3 hours No complications occurred. One patient was non-compliant diffrence. postoperatively, and reruptured the tendon; all other patients rated their arms as cosmetically normal. All procedures were (RESULTS AND DISCUSSION) The results of all type of labrum done outpatient. Post operative UCLA scores averaged 31.4. injury area were Rank 1: 3 cases; Rank 2: 5 cases; Rank 3: 7 Mini open biceps tenotomy is shown to have acceptable long cases; Rank 4: 12 cases. More false positive cases were seen in term outcome in the management of lesions of the biceps anterosuperior part of labrum than other areas. Labrum injury lesions. More complex arthroscopic techniques may signifi- in anterosuperior part was difficult to be diagnosed by MRI and POSTER ABSTRACTS cantly increase difficulty, cost, and risk without additional ben- MR arthrography. efit.

Poster #401 Poster #399 THE IMPORTANCE OF THE INJECTED VOLUME OF ALL ARTHROSCOPIC VERSUS MINI OPEN REPAIR OF CORTICOSTEROIDS AND XYLOCAINE IN THE TREATMENT PARTIAL THICKNESS ROTATOR CUFF TEARS: THE OF SUBACROMIAL IMPINGEMENT SYNDROME SAFETY OF COMPLETING THE TEAR Christos K Yiannakopoulos, Athens, GREECE, Presenter Stephen C Weber, Sacramento, CA, USA, Presenter Emmanuel Antonogiannakis, Athens-Cholargos, GREECE Sacramento Knee and Sports Medicine, Sacramento, CA, USA Kostas Karliaftis, Athens, GREECE Georgios Anastasios Babalis, N. Iraklio Attikis, GREECE Open repair of significant partial thickness rotator cuff tears has Christos Karabalis, Athens, GREECE been shown to offer superior results over debridement and Christos Thanasas, Athens, GREECE acromioplasty. The increased popularity of all arthroscopic 401 General Army Hospital, Athens, GREECE repair for full thickness tears wad felt to apply to repair of par- tial thickness tears as well. Controversy exists over the best The purpose of this study was to evaluate the significance of technique of repair of articular side defects, with some sur- the volume of injected corticosteroid and xylocaine in the treat- geons attempting to repair through the remaining attached ten- ment of subacromial impingement syndrome (SIS). The study don, and other completing the tear. 62 patients were identified was conducted between 1/1/2000 and 1/12/2001 and included with greater than 50% tears and followed prospectively over a 21 patients with SIS without the presence of other pathologic six year period with two year minimum follow-up. 33 patients lesions. The patients were separated randomly into 2 groups underwent all arthroscopic repair done by completing the tear following the positive clinical examination and the positive from the bursal side and then repairing with suture anchors and impingement test. Group A included 11 patients (6 males, 5 were compared to 29 patient managed with mini open tech- female of mean age 52.4 years) and group B included 10 nique. Follow-up averaged 31 months for the arthroscopic and patients (4 males, 7 females of mean age 57.6 years). In group 41 months for open. Perioperative morbidity was significantly A 12 mg of betamethasone (2 ml) and 1 ml xylocaine 2% have different between groups, with no patients admitted in the been injected, in contrast to group B where 12 mg betametha- arthroscopic group, and 48% admitted in the open group. sone (2 ml) and 8 ml xylocaine 2% have been injected. The Outcomes were similar (UCLA scores 30.67 arthroscopic 29.84 improvement of pain and function was evaluated at a mean of open p=N.S.). Arthroscopic repair of partial thickness tears 5.7 months (4-12 months). The results have been statistically offers significant improvement in morbidity over mini open evaluated using the t-test and the chi square test. The improve- repair, with similar outcomes. Completing the articular side ment in group B was more significant than in group A in terms tears allows a technically easier repair, and also allows of improvement of the functional results and relieving of the

5.164 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). pain. No significant difference in the range of motion was ascer- ISOKINETIC PROFILE AND SUGGESTION FOR THE tained. There were no significant local of systemic complica- RECOVERY OF THROWING SHOULDER INJURIES OF tions related to the use of corticosteroids or xylocaine. The HIGH SCHOOL BASEBALL PLAYERS injection of a minimum volume of steroids and xylocaine is pre- Toshinori Yoshimatsu, Tokyo, JAPAN, Presenter requisite for the improvement of the SIS. Shunichi Yoshimatsu, Nagano, JAPAN Keisuke Mashima, Tokyo, JAPAN Kazumasa Fukushima, Tokyo, JAPAN Poster #402 Akiyoshi Saito, Tokyo, JAPAN ISOLATED RUPTURE OF THE SUBSCAPULARIS TENDON Keinosuke Ryu, Tokyo, JAPAN DURING THROWING MOTION Dept.of Orthop. Surg., Nihon University School of M, Tokyo, JAPAN Gen-itsu Yoshikawa, Otsu, JAPAN, Presenter Yoshitaka Matsusue, Otsu, JAPAN Objective Mototsune Murakami, Otsu, JAPAN This report shows that the analysis of the isokinetic strength Katsuhiro Hori, Otsu, JAPAN test for throwing shoulder injuries can be used to determine Department of Orthopaedic Surgery, Shiga University, Otsu, JAPAN the appropriate time for the patient to return to pitching.

Chronic partial tears of the subscapularis tendon in patients Materials and Methods with baseball players are frequently described, while the acute During the last 6 years, among 265 players studied,150 high complete ruptures of this tendon are quite rare. We report the school baseball players were found to be uninjured while 115 case of a 50 years old amateur baseball player who suddenly players were found to be suffering from throwing shoulder injured his right shoulder during throwing. He drunk beer heav- injuries. The test was carried out using a CybexII Multi-Joint ily before playing baseball. The subscapularis muscle is highly Dynamometer. The patients were seated with their shoulders active during acceleration phase of throwing motion. We guess abducted at 90 degrees and their elbows flexed at 90 degrees. that autonomous muscular violence under the influence of The shoulders were tested for their rotational strength. We drink cause subscapularis tendon rupture. observed an imbalance of isokinetic strength of the shoulder by noticing a difference between the internal and external rota- tional strengths. In addition, we examined the data of concen- Poster #403 tric isokinetic endurance strength which was not reported ISOKINETIC PROFILE AND SUGGESTION FOR THE previously. RECOVERY OF THROWING SHOULDER INJURIES OF HIGH SCHOOL BASEBALL PLAYERS Results Toshinori Yoshimatsu, Tokyo, JAPAN, Presenter Returning to pitching was found to be highly possible when the Shunichi Yoshimatsu, Nagano, JAPAN patients corrected of the imbalance of internal and external Keisuke Mashima, Tokyo, JAPAN rotational strengths and their concentric isokinetic endurance Kazumasa Fukushima, Tokyo, JAPAN strength was above 80 measured by the concentric endurance Akiyoshi Saito, Tokyo, JAPAN strength test. Keinosuke Ryu, Tokyo, JAPAN Itabashiku, Tokyo, JAPAN Conclusion Correction of the imbalance of internal and external rotational shoulder injuries was performed as a sign of returning to throw strengths and the improvement of endurance strength are con- a pitch. sidered to be necessary to judge the appropriate time for returning to pitching. Materials and Methods

During the last 6 years, of the 265 players studied, 150 high POSTER ABSTRACTS school baseball players were normal and 115 were players suf- Poster #405 fering from throwing shoulder injuries. The testing was carried SUBACROMIAL ARTHROSCOPIC DECOMPRESSION OF out a CybexII Multi-Joint Dynamometer. The subject was seated THE SHOULDER WITH THE CASPARI TECHNIQUE. with his arm abducted 90° and the elbow flexed 90°. LONG-TERM FOLLOW-UP Benigno Ch Zenteno, Mexico DF, MEXICO, Presenter Results Sergio Martinez, Chihuahua, MEXICO We admitted the imbalance of isokinetic strength at the shoul- Nicolas Zarur, Mexico City, MEXICO der as a result of comparison of extension strength and inter- Cima Hospital, Chihuahua, MEXICO nal, external strength. In addition we present data for the previously unreported concentric isokinetic endurance Twenty patients were followed for a mean of 3 years, range 14 strength. Much of returning to throw a pitch was possible when months to 6 years, with diagnosis of impingement syndrome concentric isokinetic endurance strength was beyond the 80 by according to neer criteria, and failed conservative treatment for the concentric endurance strength test. Also there are many a long period of time. All operated by one surgeon with the cases of going beyond 85 point for JSS sports shoulder score. technique described by Richard B. Caspari. The age of the patients varied from 22 to 72, with a mean of 49.3 years. The Conclusion surgical mean time was 1.13 hrs. The aggregated injuries were:6 Correction of imbalance of internal, external rotation strength longitudinal incomplete injuries of the rotator cuff. Two com- and the improvement of endurance strength are considered to plete injuries of these tendons. Inferior clavicular osteophytes, be necessary for the decision of right timing for returning to two. Parcial lesions of the biceps tendon one. And arthritis of throw. the acromioclavicular joint one. We had no complications. The patients were evaluated with the UCLA shoulder parameters. Of the patients 85% resulted in good and excellent numbers. Poster #404 Pain was a parameter that improved from 2.3 to 9.3 postopera- tively with the UCLA classification. With the results mentioned above, we advise the utilization of this technique, as a simple

5.165 procedure, safe, effective and the results will not deteriorate Sung-Kyun Oh, Seoul, SOUTH KOREA with time. Irvin Oh, Seoul, KOREA Samsung Medical Center, Seoul, SOUTH KOREA

Poster #439 Purpose: The purpose of this study was to compare outcomes INTEREST OF ARTHROSCOPY IN THE DIAGNOSIS AND between arthroscopic repair of medium and large rotator cuff THE TREATMENT OF A PAINFUL SHOULDER tears to mini-open repair of similar tears in which arthroscopic ARTHROPLASTY repair was technically unsuccessful. Kempf Jean-FranÁois, Strasbourg, FRANCE, Presenter Torga Spak Roger, Strasbourg, FRANCE Methods: We evaluated 76 patients, who were treated for full- Lefebvre Yves, Strasbourg, FRANCE thickness rotator cuff tears either by all-arthroscopic (42 Lano Jerome, Strasbourg, FRANCE patients) or mini-open salvage of technically unsuccessful Bonnomet FranÁois, Strasbourg, FRANCE arthroscopic repair (34 patients). Patients who had acromio- Service d’Orthopedie Hopital de Hautepierre, Strasbourg, FRANCE clavicular arthritis, subscapularis tear, or instability were excluded. There were 39 males and 37 females with mean age Hemi or total shoulder arthroplasties (TSA) bring in a regular of 56 years (range, 42 to 75 years). Preoperative values includ- way an excellent analgesic and functional result. Some of these ing shoulder scores, tear size (arthroscopic group, 23 medium shoulders remain nevertheless painful and/or stiff and the and 19 large tears; mini-open salvage group, 21 medium and 13 cause of this unsatisfactory result is difficult to establish. We large tears) or patients’ activity were similar in both groups. The wanted to estimate the interest diagnosic and therapeutics of mini-open salvage procedure was performed after arthroscopic the arthroscopy in this context. acromioplasty, margin convergence when necessary and suture anchor insertion. At a mean follow-up of 39 months (range, 24 Of 1994 to 2000, 12 patients had an arthroscopy of the shoulder to 64 months), the results of both groups were compared with because of persevering pain. It was 11 times about a hÈmi- regard to the University of California Los Angeles and American arthroplastie and once about a TSA. The initial diagnosis was in Shoulder and Elbow Surgeons shoulder rating scales. 6 cases an osteoarthritis, in 3 cases a fracture of the upper part of the humerus, in 2 cases an osteonecrosis and in 1 case an Results: Shoulder scores improved in all ratings in both groups allograft for tumor. The revision of the patients contained a (p<0.05). Overall, sixty-six patients showed excellent or good Constant score (CS), a radiological evaluation (9 arthro-CT and ten patients showed fair or poor scores by the University of scan). Gestures were 5 arthrolysis, 5 tenotomies of the long California Los Angeles scale. Seventy-two patients satisfacto- head of Biceps (LHB), 2 removal of a fragment of cement. In 3 rily returned to prior activity and four showed unsatisfactory cases, an additional opened surgery was realized: 1 implanta- returns. The range of motion, strength, and patient satisfaction tion of a glenoid component for a painful hemiarthroplasty, were improved postoperatively. There were no difference in 1ablation of a fragment of cement and 1 rotator cuff repair. shoulder scores, pain, and activity return between the arthro- scopic and mini-open salvage groups (p>0.05). However, The interval between the prosthesis and the arthroscopy was on Patients with larger size tear showed lower shoulder scores and POSTER ABSTRACTS average of 28 months (6-96). The average follow-up was of 19 less predictive recovery of the strength and function (p<0.05). months (6-72 months). Globally, all the patients were Postoperative pain was not different with respect to the size of improved, the CS increased from 25 points to 43 points and the the tear (p=0.251). adjusted CS from 32% to 55%. 6 tenotomies of the LHB were realized, 5 times for an isolated pathology of the LPB and it is Conclusion: Arthroscopic repair of medium and large full-thick- in that case that the results were the best, increasing the CS ness rotator cuff tears had an equal outcome to technically from 28 points to 48 points. 5 arthroscopic releases were per- unsuccessful arthroscopic repairs, which were salvaged by con- formed for stiffness with less good results (pre-op CS: 23 version to a mini-open repair technique. Surgical outcome points, post-op CS: 39 points) because there was every time an depended on the size of the tear, rather than the method of important wear of the glenoid. For 3 patients, arthroscopy repair. allowed a surgical indication: 1 implantation of a glenoid com- ponent, 1 ablation of a fragment of cement and 1 rotator cuff repair. Spine/Hip/Thigh

Conclusions : • Arthroscopy of a shoulder arthroplasty remaining painful is Poster #406 useful for the diagnosis and for the treatment. EXPOSURE OF THE ADOLESCENT PORCINE SPINE TO • Hemiarthroplasties are more often painful than TSA. MECHANICAL FLEXION-COMPRESSION AND EXTENSION- • the most effective gesture is the tenotomy of a pathological COMPRESSION. LHB in an isolated way. Adad Baranto, Gôteborg, SWEDEN, Presenter • the arthrolysis of a painful and stiff shoulder arthroplasty is Lars Ekstrom, Gôteborg, SWEDEN less effective because of the associated glenoid wear. Mikael Hellstrom, Gôteborg, SWEDEN • the rarer indications are the ablation of foreign body or asso- Olof Lundin, Gôteborg, SWEDEN ciated rotator cuff desease. Sten Holm, Gôteborg, SWEDEN Leif Sward, Gôteborg, SWEDEN Sahlgrenska University Hospital, Department of Ort, Gôteborg, SWEDEN Poster #449 OUTCOME OF MINI-OPEN SALVAGE OF TECHNICALLY Study Design. Experimental, exposing functional spinal units UNSUCCESSFUL ARTHROSCOPIC ROTATOR CUFF REPAIR (FSU) from adolescent porcine to controlled mechanical flex- Seung-Ho Kim, Seoul, KOREA, Presenter ion-compression and extension-compression to failure. The Kwon-Ick Ha, Seoul, KOREA biomechanical, radiological, magnetic resonance imaging and Jong-Hyuk Park, Seoul, SOUTH KOREA histological characteristics are described. Jin-Seok Kang, Seoul, SOUTH KOREA

5.166 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Objectives. To try to explain the mechanism behind traumatic physical activities but one athlete who did not complete the displacement of the ring apophysis, disc degeneration and end postoperative recovery period. The purpose of this study was to plate injuries found in adolescent athletes by investigating the evaluate and discuss the pathologies treated on these patients, patterns of injury seen in FSU:s from adolescent porcine lum- the indication of the proposed treatment and its relationship bar spine exposed to traumatic flexion-compression and exten- with the patient’s sports activity. sion-compression forces.

Summary of Background Data. Several studies of the adoles- Poster #408 cent spine exposed to trauma have shown injuries affecting the ACUTE INJURY OF AN INTERVERTEBRAL DISC IN AN growth zone, in contrast to adults where the vertebral body is ELITE TENNIS PLAYER the weakest part. In athletes with high loads on the spine a high Leif Sward, Gôteborg, SWEDEN frequency of abnormalities in the vertebral discs, vertebral bod- Mikael Hellstrom, Gôteborg, SWEDEN ies, end plates and ring apophyses has been demonstrated. The Bjorn Rydevik, Gôteborg, SWEDEN aetiology of these abnormalities is however, still a controversial Olof Lundin, Gôteborg, SWEDEN, Presenter issue. Department of Orthopaedics and Radiology, Sahlgren, Gôteborg, SWEDEN

Methods. Eight functional lumbar spinal units (vertebra-disc- Study Design. A case report. vertebra) obtained from 4 adolescent male pigs were exposed to flexion-compression and another 8 FSU:s from 4 adolescent Objectives. To present a previously undescribed rare case of pigs were exposed to extension-compression forces to failure. intra-discal haematoma due to acute trauma in an elite tennis All FSU:s were examined with plain radiography and magnetic player with a literature review injury patterns. resonance imaging before and after flexion/extension compres- sion loading. After failure, the units were sagittally sawed into Summary of Background Data. Several studies have demon- 3-4 mm slices, photographed and prepared for histological strated a high frequency of radiological changes in the spine of examination. athletes, especially in sports with high loads on the back. In addition signs of disc degeneration without disc herniation Results. In all FSU:s exposed to flexion-compression there were have frequently been found in MRI studies of the spine of ath- identical traumatic avulsion fractures seen in the growth zone letes. The aetiology to these abnormalities is however obscure. posteriorly and similar injuries were seen in the extension- It has also been shown that radiological abnormalities of the compression units anteriorly. There were no changes in the spine in young athletes are correlated to back pain, which was discs. The avulsion fractures were not seen on plain radi- not found among former athletes where progressive disc ographs but were detected on magnetic resonance images and degeneration with time was the only factor that correlated with confirmed on macroscopic, microscopic and histological exam- back pain. ination. The flexion and extension angles at failure varied between 12° and 19°. The ultimate force at failure for all FSU Methods. In October 2000 an elite male tennis player experi- varied between 1607 N and 3138 N. enced pain in the right buttock after a backhand stroke. He was treated due to hip problems and started to play 2 weeks later. Conclusions. The weakest part of the lumbar spine in adoles- After a few games a backhand stroke again resulted in intense cent pigs, when compressed to failure in flexion or extension, is pain projected in the os coccyx region. At examination there the growth zone. This may explain the high frequency of disc was no neurological disturbances and the LasËgues test was degeneration and persisting ring apophyses seen in the spine negative. At palpation over the spinal processes (Springing of young athletes. test) of L1-L2 the patient experienced intense pain over the upper lumbar region, a pain with the same distribution as

described above. POSTER ABSTRACTS Poster #407 SURGICAL TREATMENT OF ATHLETES SPINAL DISEASES Results. MRI in November 2000 showed an injured L1-L2 disc Marcelo Wajchenberg, Sao Paulo-SP, BRAZIL with fluid inside the disc with a signal similar to blood. Another Moises Cohen, Sao Paulo, BRAZIL, Presenter three MRI examinations have been performed in the five to Eduardo B Puertas, Sao Paolo, BRAZIL eight weeks interval where a healing process has been recog- Francisco Prado Santos, Sao Paulo, BRAZIL nized with gradually increasing signal intensity in the nucleus Sheila Jean McNeill Ingham, Sao Paulo, BRAZIL pulposus. Luciano Miller Rodrigues, Sao Paulo, BRAZIL Paulo Satiro Souza, Sao Paulo, BRAZIL Conclusions. It may be concluded that MRI is sensitive in diag- Jose Carlos Melo Chagas, Sao Paulo, BRAZIL nosing acute intradiscal injuries and that the healing process Valdeci Manuel Oliveira, Sao Paulo, BRAZIL can be followed. UNIFESP/EPM, Sao Paulo, BRAZIL

The indication to perform a surgical treatment in patients with Poster #409 pathology in the spine varies according to the patient’s symp- PSOAS RUPTURE WITHOUT A PREDISPOSING FACTOR. tomatology without specific rules to its application. This fact is A CASE REPORT also observed in athletes but other variables must be consid- Kaya Memisoglu, Kocaeli, TURKEY ered such as the capacity to practice competitive physical activ- Baris Kurtgoz, Kocaeli, TURKEY ity after the surgery. In this study, 84 athletes were assisted Gur Akansel, Kocaeli, TURKEY during one year (from October 1999 to September 2000), of Sefa Muezzinoglu, Kocaeli, TURKEY, Presenter which 8 surgically treated. The diseases treated were: lumbar Kocaeli University School of Medicine Dept of Orth, Izmit, TURKEY disc herniation in 4 patients, spondylolysis in 1 patient, chor- doma in the cervical region in 1 patient, osteoid osteom in lum- Iliopsoas rupture is always a complication of anticogulation bar spine in 1 patient and fracture-luxation of the thoracic therapy, hemophilia, infection or very rarely following posterior spinal column in 1 patient. All the patients returned to their spinal decompresion. We report a isolated psoas muscle rup-

5.167 ture in a young female following an indirect minor trauma. A Hip arthroscopy was first described by Berman in 1931, but has thirty-one-year old woman who was admitted to orthopaedics been popularized only recently. Currently, arthroscopy of the department with a history of increasing right lower abdomen hip is used for the diagnosis and treatment of multiple disor- pain. Five days before she had a sudden deep abdomen pain ders about this joint. Proponents of hip arthroscopy assert that right after she was getting his son out of the car. The urogenital the indications for this procedure continue to evolve. Previous and internal examinations with laboratory tests were all nor- reports have demonstrated the use of arthroscopy for bullet mal. On physical eximination iliopsoas strechting tests were removal from the femoral head and hip joint. The authors positive, and all maneuvers activating iliopsoas muscle caused report a new, previously undescribed, method for removing a severe pain. MRI revealed a focal, fusiform area of increased T2 bullet lodged in the acetabulum. signal within the right psoas muscle along the medial aspect measuring 5 x 2 x 1 cm. No abnormal signal was noted on T1- CASE REPORT weighted images. The muscle was otherwise normal, with nor- A 38-year-old male presented with a bullet lodged in the right mal contours. These findings were consistent with a grade 1 acetabulum. After perforating the descending colon, the missile strain. Detailed examination showed any evidence for infection, had traversed the pelvis and became lodged within a non-dis- tumour or bleeding diathesis that may predispose iliopsoas placed acetabular fracture. He underwent arthroscopic I&D of rupture. She was put on conservative treatment with restriction the joint and extraction of the missile. The missile was engaged of physical activity and nonsteroidal antiinflamatory drugs, she in a longitudinal fashion using a 3.2 mm threaded-tipped guide was almost asymptomatic after two weeks. To our knowledge, pin through the nondisplaced acetabulum fracture. The psoas rupture without a predisposing factor, has not been pre- threaded pin advanced easily into the tip of the missile, and viously reported. when the pin was firmly seated, the bullet was then simply pulled out through the fracture line via the anterior hip portal. At one year follow up, this patient’s acetabulum fracture had Poster #410 healed, and he was ambulating without pain or crepitation. He PSORIATIC ARTHRITIS OF HIP JOINT. has had no evidence of hip sepsis or lead intoxication. Takashi Ono, Nakakomagunn, JAPAN, Presenter Takatoshi Ide, Nakakoma-gun, JAPAN Preop x-rays and CT scans, intraoperative fluoroscopic images, Yasuhiro Yamamoto, Nakakoma-gun, JAPAN and postop radiographs detail this report. Excellent intraoper- Satoshi Ochiai, Yamanashi, JAPAN ative arthroscopy photos also accompany the report. Yamanashi Medical University, 1110 Tamahomati Simokatou, JAPAN DISCUSSION Purpose: To report a case of psoriatic arthritis of hip joint who There are a number of existing reports detailing different tech- can be decreased the pain by arthroscopic synovectomy of the niques on arthroscopic bullet removal from the hip and femoral hip joint. head. Few detail removal of missiles or foreign bodies from the acetabulum, and we were unable to locate any that describe Case report: 38 year male. Chief complain: right coxalgia. this method of extraction. This case is illustrative of several per- Eczema of the whole body developed five years before first visit tinent topics for contaminated foreign bodies located adjacent POSTER ABSTRACTS of our hospital, and it was under medical treatment by diagno- to large joints: 1) the potential for joint infection; 2) the poten- sis of psoriasis. After time of 37 years-old the right coxalgia tial for lead intoxication; and 3) the potential for complications appeared and it had grown more severe. Although the anti- with arthroscopy following acute acetabulum fracture. inflammation drug medication was perfomed, sharp hip pain did not decrease. The right hip joint had pain on active motion and range of motion was restricted. With the plain X-rays view, Poster #412 narrowing of joint space, and enthesopathy were showed. ARTHROSCOPIC ACETABULAR LABRAL REPAIR Storage of joint liquid was revealed by MRI. We confirmed Akihiro Tsuchiya, Ichikawa, JAPAN, Presenter remarkable synovitis at the time of arthroscopic examination Yoshitada Harada, Chiba, JAPAN and arthroscopic synovectomy was performed. Coxalgia was Isao Abe, Chiba, JAPAN mitigated shortly after the operation. Until now, after five years Hiroyuki Sugaya, Funabashi, JAPAN post operatively, recurence has not occurred. Hideaki Shiratsuchi, Funabashi, JAPAN Kouji Michinaga, Funabashi, JAPAN Significance:Although the open surgical treatment of synovec- Funabashi Orthopedic Hospital, Funabashi, JAPAN tomy etc. is required for the hip joint which does not respond to the medical treatment, arthroscopic surgery suceeded in [Purpose] Two cases of arthroscopic acetabular labral repair are pain relief. This method is effective as minimum invasive sur- reported. The purpose of this study is to introduce our arthro- gery for the psoriatic arthritis. scopic technique of repairing torn acetabular labrum and to evaluate the results of this procedure.

Poster #411 [Material and method] In the supine position on a traction A TECHNIQUE FOR ARTHROSCOPIC REMOVAL OF A table, three portals, anterior, anterolateral and lateral, are BULLET FROM THE ACETABULUM inserted in the patient. The arthroscope is inserted into the Steven B Singleton, Fort Worth, TX, USA, Presenter anterior portal and other working instruments are inserted into Harris Methodist Hospital, Fort Worth, TX, USA the anterolateral and lateral portals. The torn acetabular labrum was repaired similarly to a torn labrum of the shoulder Arthroscopy of the hip offers minimally invasive access to the which is by use of an anchor system. The anchors were placed hip joint compared to standard open arthrotomy. The authors in the acetabulum and torn labra were sutured to the acetabu- describe an arthroscopically-assisted technique for the removal lum by the inside-in technique arthroscopically.Two female of a bullet lodged in the acetabulum of a young patient. cases were performed by our technique. The patient age at operation was 44 and 21, respectively. The second case was a INTRODUCTION judo player. Mild dysplasia acetabuli were revealed on X-ray in both cases. Symptoms were pain around the hip joint in daily

5.168 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). life and during sports. Follow-up was 43 months and 13 outcome of arthroscopic surgery in elite swimmers with shoul- months, respectively. der pain resistant to rehabilitation.

[Results] Postoperative swelling around the external genitalia Methods and materials: A retrospective analysis of 18 swim- was observed in one case, but improved naturally after several mers who underwent shoulder arthroscopy was undertaken. days without any complications. Pain around the hip joint dis- The median age was 18 years. The duration of symptoms before appeared after surgery in both cases. The second case was able operation was median 23 months. Patient records were to return to judo without any limitations. reviewed with respect to findings at preoperative clinical exam- ination and arthroscopical findings. Telephone interviews were [Conclusion] This is a first presentation of arthroscopic repair conducted in order to evaluate the functional outcome of the of torn acetabular labrum. We were able to obtain good results operation. Out of 18 people, 16 (89%) answered. in these two cases. Acetabular labral tear, especially ones which are detached from the acetabulum should be repaired arthro- Results: Eleven (61%) exhibited labral pathology: Three swim- scopically. mers had signs of posterior superior impingement (PSI), 2 had combined PSI and subacromial impingement, and 6 had labral tears, of which 2 had a SLAP lesion and 1 an incomplete Poster #413 Bankart. Three exhibited subacromial impingement alone, 2 SNAPPING HIP CAUSED BY JOINT CARTILAGE had inflammation of the long head of the biceps tendon, and 1 AVULSION – A CASE REPORT had diffuse synovitis. In one shoulder no pathological findings Yasuhiro Yamamoto, Nakakoma-gun, JAPAN, Presenter were seen. Seven (44%) returned to the same level without Takatoshi Ide, Nakakoma-gun, JAPAN pain, and two (12.5%) to the same level with moderate pain. Of Takashi Ono, Nakakomagunn, JAPAN 7 swimmers who had ceased activity, 6 (38%) stopped due to Yoshiki Hamada, Nakakoma-gun, JAPAN shoulder problems. Makoto Suma, JAPAN Yamanashi Medical University, Nakakoma-gun, JAPAN Conclusion: Only 56 percent return to competitive swimming at preinjury level after arthroscopic surgery of the shoulder. The Purpose: To report snapping hip caused by joint cartilage avul- most common finding in a swimmer’s shoulder is labral pathol- sion Case report: 24-year male. Chief complaint: right coxalgia. ogy. This may be an indication of wear of the stabilizing struc- He received conservative treatment for Perthes disease in child- tures in association with multidirectional hyperlaxity. hood. Six months before initial visiting of our hospital, sharp pain developed with click when he extended, with exteral rota- tion, his right hip joint from the full flexed position. Plain X-ray Poster #415 showed oval deformity of the femoral head without bone cyst or PERCUTANEOUS VS. OPEN SURGICAL ACHILLES sclerosis in the weight bearing area. CT detected impingement TENDON REPAIR of the anterior femoral head on the anterior acetabular rim Andrej Cretnik, Celje, SLOVENIA, Presenter without bony lesion. MRI revealed no intraarticular lesion. At Milos Kosanovic, Celje, SLOVENIA the time of arthroscopic examination, flap like avulsion of the Aleksander Frank, Maribor, SLOVENIA cartilage of the femoral head was recognized and it was shaved. Teaching Hospital, Maribor, SLOVENIA A day after the operation, sharp pain and click disappeared. 237 consecutive patients with a closed acute rupture of the Significance: Osteoarthritis, osteochondritis dissecans, and Achilles tendon were included in the multicentre study. There labral tear were reported as the cause of pain in the hip after were 132 prospectively followed patients in the first hospital, Perthes disease in childhood. Only 4 cases of hip pain with where all the patients were operated on with the percutaneous impingement of the anterior femoral head on the anterior suturing under local anesthesia and 105 patients in the second POSTER ABSTRACTS acetabular rim after Perthes disease were reported by Snow, et hospital where all the patients were treated with the open oper- al. in 1993. On the other hand, although labral tear and loose ative repair under general or spinal anesthesia. Functional out- body are recognized as the cause of intraarticular snapping hip, come and the complication rate were assessed with the detached joint cartilage were unrecognized. This pathology follow-up of minimally two years. should be recognized as the one of the cause of both coxalgia after Perthes disease and intraarticular snapping hip. The results showed significantly more major complications in the group of open operative repair in comparison with the group of percutaneous repair (12,4% versus 4,5%)(p=0,03), par- Sports Medicine ticularly necrosis (5,6% versus 0%)(p=0,019), as well as greater total number of the complications (23% versus 11%)(p=0,013). There were slightly more reruptures (3,7% versus 2,8%) and Poster #414 suralis nerve disturbances (4,5% versus 2,8%) in the group of THE OUTCOME AND FINDINGS OF ARTHROSCOPIC percutaneous repair with no statistical significance. Functional SURGERY IN SWIMMER’S SHOULDER score assessment showed no statistical significance with good Klaus Bak, Charlottenlund, DENMARK, Presenter result in 91% patients in the group of percutaneous repair and Christoffer Brush¯j, Copenhagen S, DENMARK in 88% patients in the group of open operative repair. Patients Hans Viggo Johannsen, ≈rhus, DENMARK in the group of open operative repair had finally significantly Peter Faunoe, Aabyhoej, DENMARK greater thickness of the operated Achilles tendon (p=0,0005) Department of Orthopaedic Surgery, Amager Hospital, Copenhagen, and greater loss of dorsiflexion of the ankle (p=0,003). Patients DENMARK in the group of percutaneous repair were more satisfied in their subjective assessment (p=0,024). The average costs in the Purpose: Among swimmers, shoulder pain is the most common group of percutaneous repair were about one third of those in injury. “Swimmer’s shoulder” can be examined and treated open operative group. arthroscopically. There are only few previous studies on this subject. The purpose of this study was to evaluate findings and

5.169 The results of the study support the choice of percutaneous Standard NSAIDs have a potential risk of causing GIT disease. suturing under local anesthesia as the method of comparable Despite this they are used in the treatment of sports injuries. functional results to the open repair with lower rate of compli- The aim of the study was to evaluate the effect and safety of a cations and lower costs. selective inhibitor COX-2 rofecoxib (with reduced risk of PUB) used as pain-killer in the knee difficulties.

Poster #416 Methods NEW SPORTS BANDAGE FOR ANKLE SUPPORT – Two groups of patients - high-level icehockey players (age 16 to ITS CLINICAL APPLICATION AND FUNCTIONAL RESULTS 38 yrs) were treated for the painfull knee (sprain, chondropathy, Toru Fukubayashi, Tokyo, JAPAN, Presenter chronic effusion, early OA). The treatment period was 1 week Kohji Wakayoshi, Nara, JAPAN since pain has been announced. No severe knee injury request- Shunpei Miyakawa, Ibaraki, JAPAN ing taking a rest was included in the study. The first group (21 Takanobu Aoyagi, Tokyo, JAPAN pts) used rofecoxib 25 mg daily, the other one (16 pts) used Takashi Miura, Tokyo, JAPAN paracetamol 500 mg daily. In both groups the therapy was fin- Nahoko Iwata, Tokyo, JAPAN ished after 7 days. The clinical testing were performed on 1,3 The University of Tsukuba and Nara Education, Tsukuba and Nara, JAPAN and 7 day. Early onset of pain-relief (in 2 hours) longterm effect of a single dose (1 day) and full effect (total pain relief) after 1 Purpose: There are certain complaints that conventional sports week dose were observed. bandages have not enough fixation strength. To increase the stability of the unstable ankle joint we developed new type Results bandages, which are much stiffer and more durable than the Rofecoxib group appear early onset after 2 hours with long term conventional ones. The objective of this study is to analyze the effect for the whole day. After one week therapy most of the effectiveness of these bandages from the point of durability, pain has gone. In paracetamol group there were shorter periods endurance ability, and sports performance. of the pain-killer effect. One dose was not sufficient as pain- killer in all cases. Paracetamol did not bring full recovery in Method: most cases. No GIT complications were observed in both - Stability and comfortability groups. Six male collage soccer players who had the experiences of pain full ankle sprains were used for this study. Their ankles were stabi- no relief % lontgerm % effect % GIT % lized with conventional bandage, new bandage, and taping. G 1- rofecoxib 21 80,9 - 90,5 95,3 95,3 0 G 2 - paracetamol 16 43,8 - 62,5 25 50 0 Stress X-rays were taken with Telos-SE before fixation, immedi- ately after fixation, and after thirty minutes soccer practice. Discussion Tilting angles of talus were measured, and statistically ana- The effective pain-killer can usually solve the reason of intraar- lyzed. Subjective evaluation of the fit feeling was also checked. ticular knee derangement. NSAID have potential risk of other - Running economy complication. The propper way of combination of both effects Endurance tests were performed with treadmill to seven male

POSTER ABSTRACTS is being searched among COX-2 inhibitors. collage athletes. VO2 and HR were monitored until the exhaus- tion. Running pitch and stride were measured from the video Conclusion: photography. The running economy (REco) was evaluated from The early possible outcome as an effective pain-killer among these points. drugs available on the market is discussed. Use of COX-2 inhibitors seems to be an adequate way in the effective treat- Results: New sports bandages showed better stability, durabil- ment of knee pain when the reduced risk of GIT complication as ity, and subjective feeling than the conventional ones. As far as well as sufficient effect of pain relief is demanded. the REco they showed no remarkable change.

Conclusion and Significance: This study demonstrated the #418 advantage of the new sports bandages. They may prevent the Poster SMARTNAIL – A BIODEGRADABLE NAIL FOR TREATMENT ankle sprain more effectively without decreasing sports per- OF OSTEOCHONDRAL LESIONS formances. Gert Kristensen, Aalborg, DENMARK, Presenter Preben Lass, Aalborg, DENMARK Steen Olesen, Aalborg, DENMARK Poster #417 Aalborg Hospital, Dept. of Orthopaedic Surgery O, Aalborg, DENMARK ROFECOXIB IN THE TREATMENT OF PAINFUL KNEE JOINT IN ICE-HOCKEY PLAYERS Introduction Milan Handl, Prague, CZECH REPUBLIC, Presenter Osteochondral fractures with a big cartilage component and a Orthopaedic Clinic, University Hospital Motol, Prague, CZECH REPUBLIC small bony component are difficult to fix properly. With Smartnail you can adress and fix these fractures from the chon- Summary: dral side. The knee pain after the hit, concussion and sprain is very com- mon at ice-hockey players in the high season. If no serious Material and method injury has been diagnosed the question of early ability to play 2 cases of osteochondral fractures of the talus, 2 cases of osteo- occurs. Author evaluated 2 parallel groups of total 37 players chondral fractures of patella after patella dislocations, 2 cases treated for the knee pain by rofecoxib or paracetamol in 2001 - of ACL-avulsion from the tibial eminence,one case of radial 2002. The evaluation was based on clinical tests. In both groups head fracture and one case with avulsion fracture of the proxi- the early ability to full load was observed and compared. The mal phalanx of the great toe - all repaired with Smartnails are results show a positive effect of rofecoxib in early full-sports presented. activity. Results Purpose

5.170 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). All osteochondral fractures healed in good position. No com- quent type was Costa-Paz type I (52.6 %). In group II more fre- plications were seen. quent locations were the middle portion of the lateral femoral condyle and the posterior portion of the lateral tibial condyle. Conclusion bone bruise associated with ACL injury, was upto 56.8 % and Smartnail is a new alternative in the treatment of osteochon- the frequent type were Costa-Paz type II (48 %), in order type dral fractures. It can be used arthroscopically as well as with (42 %). As a result, in the high-energy injury the bone bruise open procedures. had a various location in both condyle and less frequently asso- ciated injury, but in the low-energy injury there was particularly frequent location of bone bruise, associated injury and type. Poster #419 ENDOSCOPIC TREATMENT OF Conclusion: We could assess the associated injury by analysis OSGOOD-SCHLATTER’S DISEASE of the location and type of bone bruise, especially in the low- Gert Kristensen, Aalborg, DENMARK, Presenter energy injury, e.g. sports injury. But further study will be neces- Aalborg Hospital, Dept. of Orthopaedic Surgery O, Aalborg, DENMARK sary with more case analysis.

Introduction Osgood-Schlatter’s disease rearly needs operation, but when it Poster #421 does open surgery has been recommended. This paper MUSCULOSKELETAL INJURIES IN TRACK AND FIELD. describes an endoscopic technique with good results and with- A TWO-YEAR FOLLOW-UP OF COMPETITIVE ATHLETES. out complications. Cristiano Laurino, Sao Paulo, BRAZIL, Presenter Rogerio Takahashi, Sao Paulo, BRAZIL Material and method Patricia Guedes, Sao Paulo, BRAZIL 14 patients, age 22.4 years (range 14-35) all with failed conser- Rene Jorge Abdalla, Sao Paulo, BRAZIL ative treatment and all with X-ray changes were operated with Moises Cohen, Sao Paulo, BRAZIL endoscopic technique via standard anterolateral and antero- Centro de Traumato-Ortopedia do Esporte. Universid, Sao Paulo, BRAZIL medial portals. Procedures done were removal of ossicles in the tendon, resection of scar tissue in the infrapatellar bursa and Behavior of lesions among Track and Field athletes was evalu- removal of bony prominence of tibial tubercle - alone or in ated in this study, during a period of 2 years (season of 1998 combination. and 1999). Forty-six track and field athletes, of which 31 male (67.4%) and 15 (32.6%) were evaluated and followed-up, in the Results State of Sao Paulo. Incidence and characteristics of lesions in 11 out of 14 patients returned to the same sport within 3 relation to training, tournament, sports modality, level of per- months postop. 2 patients between 3 and 6 months. 1 patient formance, category (by age range) and individual characteris- developed patellar tendonitis after a symptomfree period. tics were studied. Forty-one athletes (89.1%) presented 107 Median operating time was 35 min. (25-45). No complications lesions, 29 (93.5%) were males and 12 (80.0%) females. A mean were observed. of 1.3 lesion/athlete/year was observed. Fifty-one (47.7%) severe lesions and 56 (52.3%) chronic lesions were found. Lower limbs Conclusion were involved in 86.0% of the lesions and the most common Endoscopic treatment of Osgood-Schlatter’s disease is a sim- affected areas were: thigh (31.8%) and knee (19.6%). ple and safe procedure allowing patients to return to sport very Tournaments caused 83.2% of the lesions. No statistical signif- fast. icant difference between the athlete’s level of performance or category and appearance of lesions among the studied groups was observed.

Poster #420 POSTER ABSTRACTS THE RELATIONSHIP BETWEEN BONE BRUISE IN MRI AND ASSOCIATED INJURIES AFTER KNEE JOINT TRAUMA Poster #422 Hee-Soo Kyung, Daegu, KOREA, Presenter SKATEBOARD INJURIES Joo-Chul Ihn, Taegu, SOUTH KOREA Cristiano Laurino, Sao Paulo, BRAZIL, Presenter Jun-Young Yeo, Taegu, SOUTH KOREA Luis Henrique Vieira, Sao Paulo, BRAZIL Department of Orthopaedic Surgery, Kyungpook Natio, Taegu, SOUTH Giovanna Cocco Parisse, Sao Paulo, BRAZIL KOREA Moises Cohen, Sao Paulo, BRAZIL Rene Jorge Abdalla, Sao Paulo, BRAZIL Purpose: The purpose is to analyze the relationship between Centro de Traumato-Ortopedia do Esporte. Universid, Sao Paulo, BRAZIL bone bruise in MRI and associated injuries after the knee joint trauma. This study evaluated 148 athletes, 135 (91.2%) were males and 13 (8.8%) females, 68 (45.9%) amateurs and 80 (54.1%) skate- Materials and Methods: Total 50 cases were reviewed, divided boarding professionals. The mean age was 22 years. Presence into two groups according to initial trauma energy. High-energy and characteristics of lesions caused by sports practice during group(group I), such as traffic accident was 13 cases, low- training and tournaments were evaluated in this study. The energy group (group II), such as sports trauma was 37 cases. number of reported lesions was 526. Amateurs presented 40.7% The type of the lesion was used the classification by Costa-Paz. of the lesions while professionals 59.3%. Among all the lesions, The site of lesion was analyzed according to femoral/tibial, 63.1% occurred due to the nonattendance of safety equipment. medial/lateral and anterior/middle/posterior site respectively. The most affected areas were: foot and ankle (27.5%), hands Associated injuries were confirmed by physical examination, (18.1%) followed by knee (17.1%). radiograph, MRI and arthroscopy.

Results: In group I there was a various distribution of the bone Poster #423 bruise in the knee joint according to mechanism of injury. The MALE PELVIC STRADDLE-TYPED STRESS FRACTURE bone bruise with ACL injury was 38% only and the most fre- Hao-Chin Liao, Changhua, TAIWAN, Presenter

5.171 Yu Chen-Tung, Changhua, TAIWAN mentous lesions. Patients were reviewed by a combination of Tung-Wu Lu, Taipei, TAIWAN questionnaire and clinical examination at a mean of 38 months Changhua Christian Hospital, Changhua, TAIWAN after the index injury (range 18 to 66).

Stress fracture is not an uncommon injury in sports medicine Results At review, 20 patients (77%) had developed some symp- clinics. It often occurs in joggers, runners, and recruits. It fre- toms of knee instability. The number of patients with a positive quently involves the metatarsals, tibia, fibula, os calcis, and Lachman’s test had increased from 17 to 18, and those with a femoral neck. Pelvic stress fracture contributes a low incidence positive pivot shift had increased from 9 to 13. Seven patients (1.25%) of all runners’ stress fractures. Stress fractures of the (27%) had undergone ACL reconstruction, 7 other patients pubic rami are even fewer. There is only one case report of (27%) had been unable to return to sport, and 6 patients (23%) female involving all four of the pubic rami in English literature. continued to participate in sport, but at a reduced level. Only 6 We present a male straddle-typed stress fracture and possible patients (23%) were able to continue in sport at their pre-injury mechanism discussed. level without reconstructive surgery. Patients with a tear of the anteromedial bundle of the ACL were more likely to have signs of instability at review and to require ACL reconstructive sur- Poster #424 gery than patients with a tear mainly affecting the posterolat- SURGICAL MANAGEMENT OF TENNIS ELBOW: A eral bundle. COMPARATIVE STUDY OF TWO TECHNIQUES Nicola Maffulli, Stoke on Trent, UNITED KINGDOM, Presenter Conclusions Partial lesions of the ACL, especially when involv- D Debashis, Stoke on Trent, ENGLAND ing the AM bundle, should not be regarded as benign injuries. Keele University, Stoke on Trent, ENGLAND They often result in symptomatic instability necessitating intra- articular reconstruction of the ACL, and, in the long run, in Background To ascertain whether there were any differences in marked decrease in the level of sports participation. the outcome of release of the common extensor origin and release of the common extensor origin and drilling of the lat- eral epicondyle in the management of recalcitrant tennis elbow. Poster #426 CLINICAL AND FUNCTIONAL RESULTS OF OPEN Methods 111 patients (125 elbows; 40 males, median age: 47 OPERATIVE REPAIR FOR ACHILLES TENDON RUPTURE IN years; 71 females, median age: 45 years) entered the study. The A NON-SPECIALIST SURGICAL UNIT: A LONG-TERM minimum follow up period was two years (average follow up: OUTCOME STUDY 52.8 months). Patients were reviewed at two and six or eight Nicola Maffulli, Stoke on Trent, UNITED KINGDOM, Presenter weeks, and three and six months after surgery. If a complication A Coutts, Aberdeen, SCOTLAND ensued, or if a patient did not report improvements, they were A MacGregor followed up for at least one year post-operatively. Two years J Gibson, Stoke on Trent, ENGLAND after the recruitment period had ended, telephone interviews Keele University, Stoke on Trent, ENGLAND were performed. We used a 1 to 10 scale when enquiring about POSTER ABSTRACTS pain, both pre-operative and post-operative, with 1 as the best We followed up 25 patients (average age 47.9 years, range 22 to score and 10 the worst. We also determined patient satisfac- 77) after open repair of their Achilles tendon rupture. All had tion, grip strength, and elbow function. been operated by a single general surgeon using an end to end reabsorbable suture, and immobilised in a plaster of Paris cast Results 75% of patients had excellent or good results, with 73% for 6 weeks. All patients had been discharged from follow up by of them being satisfied with the results of surgery. There was no 18 weeks from the operation. At an average of 3.4 years (range statistical significance in the outcome of the two procedures 6 months to 9.25 years), 18 had “excellent”, six (24%) “good”, (Chi square, p = 0.488). There were no statistically significant and one (4%) “satisfactory” results. All but one patient were differences between the two procedures regarding pain, satis- able to walk on tiptoes, and 20 of the 22 patients examined faction, elbow function, and grip strength. directly walked without a limp. At ultrasound, the injured ten- dons were on average 2.3 times thicker in antero-posterior Conclusions Release of the common extensor origin at the diameter, and 1.7 times thicker in transverse diameter. In the elbow is a relatively simple operation, and produces reliable hands of a single non-specialist fully trained general surgeon, long term relief of tennis elbow pain in at least 70% of patients. this management regime produces full return to pre-operative activities in the majority of patients, and a low rate of local complication. The macroscopic and ultrasonographic appear- Poster #425 ance of the operated tendon remains abnormal, but this is not INCOMPLETE TEARS OF THE ANTERIOR CRUCIATE associated with clinically evident pathology. LIGAMENT Nicola Maffulli, Stoke on Trent, UNITED KINGDOM, Presenter W J Leach, Stoke on Trent, ENGLAND Poster #427 Keele University, Stoke on Trent, ENGLAND LOCAL FLAP COVERAGE FOR SOFT TISSUE DEFECTS FOLLOW Background To report the long term outcome of patients with a Nicola Maffulli, Stoke on Trent, UNITED KINGDOM, Presenter partial tear of the anterior cruciate ligament (ACL). S M Kumta, Stoke on Trent, ENGLAND Keele University, Stoke on Trent, ENGLAND Methods We reviewed 26 of 31 athletes who had a diagnosis of acute, incomplete tear of the anterior cruciate ligament (ACL) We assessed the long term clinical and functional results fol- between November 1986 and December 1991. All patients had lowing local flap coverage in 11 patients (mean age: 40.7 years, arthroscopy and examination under anaesthesia within 8 weeks range 28 to 61 years) who developed wound complications after of acute knee injury, and were included in the study if there open repair of a ruptured Achilles tendon in the period 1990- were still ACL fibres remaining which resisted anterior tibial 1997. We used the medial plantar flap, the peroneal reverse translation. We excluded patients with associated major liga- flow island flap and he posterior tibial reverse flow flap, accord-

5.172 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). ing to the location of the skin incision for the open repair of the We reviewed 125 articles published in peer review journals on Achilles tendon and the location of the defect. In all cases, the the management of ruptured Achilles tendons to ascertain flap donor area was skin grafted from the ipsilateral thigh. At which regime was most popular and had the best results in the latest follow up, all but three patients had achieved an terms of complication rates and patient outcomes. Year of pub- excellent good result, having returned to their pre-injury activi- lication, patient numbers, sex, management method, follow up ties. All patients were able to stand on tiptoes unaided, and complications and patient satisfaction from each study were were able to walk without any aids. In all patients, the maxi- analysed. Each article was graded using a validated methodol- mum calf circumference was decreased, ranging from 2.5 to 1.3 ogy score. Methodology, patient satisfaction and complication cm less than the non-affected contralateral leg. However, none rate were then correlated with the year each paper was pub- reported a subjective sensation of weakness in their calf mus- lished. Skin healing complications were lowest in conservative cles. In our hands, local flaps are a reliable means of treating managed patients (3/578, 0.5%) and highest in open repair and skin defects following open repair of subcutaneous ruptures of immobilised patients (543/3718, 14.6%). General complication the Achilles tendon. rates were lowest in the open repair and early mobilisation group (16/238, 5.7%), and highest in the percutaneous and early mobilisation group (19/122, 15.6%). Re-rupture rates were high- Poster #428 est in the immobilised conservative management group RUPTURED ACHILLES TENDONS SHOW INCREASED (62/578, 10.7%) and lowest in the externally fixed group (0%). In LECTIN STAINABILITY general, the number of publications on ATRs are increasing Nicola Maffulli, Stoke on Trent, UNITED KINGDOM, Presenter with a trend for the number of reported complications to be S W Waterston, Aberdeen, SCOTLAND decreasing. The published articles had a low methodology S W B Ewen, Aberdeen, SCOTLAND score (mean 50.9 range 25-77), and show a trend towards ear- School of Post Graduate Medicine, Keele University, Stoke on Trent, ENG- lier mobilisation. Open repair and early mobilisation gives the LAND best functional recovery and an acceptable complication rate. The quality of publications into the management of Achilles Purpose To ascertain whether lectins could be a useful tool for Tendon ruptures is improving, and there is a trend for a lesser investigation of the extracellular matrix of degenerated and number of complications being reported. normal tendons.

Methods Haematoxylin-eosin stained slides were assessed Poster #430 blindly using a semi-quantitative grading scale for fibre struc- LONG TERM OUTCOME OF MACINTOSH ture; fibre arrangement; rounding of the nuclei; regional varia- RECONSTRUCTION OF CHRONIC ANTERIOR CRUCIATE tions in cellularity; increased vascularity; decreased collagen LIGAMENT INSUFFICIENCY USING FASCIA LATA stainability; hyalinisation; glycosaminoglycan, with a pathology Nicola Maffulli, Stoke on Trent, UNITED KINGDOM, Presenter score giving up to three marks per each of the above variables, D R Johnston, Aberdeen, SCOTLAND with 0 being normal, and 3 being maximally abnormal. For A Baker lectin staining with Aleuria aurantia, Canavalia ensiformis, R Christian Galanthus nivalis, Phaseolus vulgaris, Arachis hypogea, T R Scotland, Stoke on Trent, ENGLAND Sambucus nigra, Triticum vulgaris, assessment of staining on a Keele University, Stoke on Trent, ENGLAND scale from 0 (no staining) to 5 (strong staining) was performed blindly. We assessed the long-term outcome of the MacIntosh lateral- substitution over-the-top anterior cruciate ligament (ACL) Results The mean pathology sum-score of ruptured tendons (n reconstruction in 82 patients (84 knees) at an average follow up = 14; average age 46.5 years, range 29-61) was significantly of 9.8 years. Patients were evaluated with subjective question- greater than the mean pathology score of the control tendons naires and by clinical and radiographic examination. Using the POSTER ABSTRACTS of Achilles tendons from individuals with no known tendon Lysholm score, 17 knees were rated excellent, thirty-five good, pathology (n = 16; average age 62.5 years, range 49-73) (pathol- 19 fair, and 13 poor. The pivot shift test was negative in 74 ogy score: 18.5 ± 3.2 vs 6.1 ± 2.3). Four of the seven lectins used patients. Thirty knee radiographs were evaluated. The mean exhibited significantly positive results. Hospital for Special Surgery ACL radiographic score was 20.9. There was a non-significant association between the radi- Conclusions Ruptured tendons are histologically significantly ographic score and the Lysholm score, and between a worsen- more degenerated than control tendons. Ruptured tendons ing radiographic score and increasing time from injury. The show different lectin staining properties than non-ruptured MacIntosh lateral-substitution over-the-top ACL reconstruction ones. This difference may result from post-translational shows comparable results with previously published long-term changes in the extracellular matrix producing alterations in the studies. biochemistry of the tendon which MIGHT INTERFERE WITH THE INTERACTION WITH THE LATERAL SUGAR RESIDUES OF THE COLLAGEN MOLECULES, OR CAUSE STERIC BLOCKADE. Poster #431 THE STUDY OF EFFECT OF VERBASCOSIDE ON OXIDATIVE STRESS IN MUSCLES DURING Poster #429 IMMOBILIZATION AND REMOBILIZATION IN RABBITS QUANTITATIVE REVIEW OF OPERATIVE AND NON- Liu Mingju, HK, CHINA, Presenter OPERATIVE MANAGEMENT FOR SUBCUTANEOUS Li Jingxian, HK, CHINA RUPTURE OF THE ACHILLES TENDON Qin Ling, Shatin NT, HONG KONG Nicola Maffulli, Stoke on Trent, UNITED KINGDOM, Presenter Lee Kwongman, HK, CHINA J Wong, Aberdeen, SCOTLAND Chan Kaiming, HongKong, CHINA V Barrass, Aberdeen, SCOTLAND The Chinese University of Hong Kong, HK, CHINA University of Aberdeen, Aberdeen, SCOTLAND Immobilization is one of the most common clinical procedures for fractures on bones or ruptures of ligaments as well as

5.173 degenerative diseases of joints, it also frequently applied for patients displayed neurological symptoms. As far as the diag- injuries in sports. However, it is well known that immobilization nosis of atlantal fracture is concerned, CT is useful since plain results in dysfunction of the limb and obvious atrophy of radiography may miss these fractures. affected muscle. Moreover, recovery from muscle atrophy is The reason for the higher prevalence of atlantal fractures very slow. Resent study suggested that enhanced oxidative among sumo wrestlers could be the inherent nature of the stress occurred during the recovery from atrophic muscle, sport. In other words, no weight classes exist in sumo wrestling; which might aggravate muscle damage. In this study we evalu- sumo wrestlers do not wear protective gear; and in most bouts, ated the effect of Verbascoside, a purified extract of Chinese sumo wrestlers collide with each other and push the oppo- medicine, in reducing oxidative stress induced by remobiliza- nent’s head and neck region. As sumo wrestling is a very old tion. Male adult New Zealand White rabbits were divided into and traditional sport, a tendency exists among sumo wrestlers three groups: Control, Verbascoside and Placebo groups. After to ignore cervical pain, and a certain percentage of sumo 3 weeks one hindlimb in the casts, the rabbits of Verbascoside wrestlers with neck pain might unknowingly possess atlantal and Placebo groups attended remobilization treatment for 7 fractures. days. Five hours after the last remobilization training, the gas- tronemius muscles from all animals were harvested. The levels [Conclusions] We presented the cases of five patients with of thiobarbituric acid-reactive substance (TBARS) and reduced atlantal fracture caused by sumo wrestling. Although the sta- glutathione (GSH) were measured. The data showed that the bility of the atlantal axis has improved somewhat, bone fusion level of TBARS was increased significantly, while the level of has not yet been achieved in any of the patients. GSH was decreased significantly (P<0.05). Compared with Placebo group, significant decreased TBARS and increased GSH were observed in Verbascoside group (P<0.05). The results Poster #433 indicated remobilization enhanced oxidative stress, ADOLESCENT FEMALES AND MALES DIFFER IN THE Verbascoside could attenuate effectively increased oxidative PERCEIVED IMPORTANCE OF STATIC HAMSTRING stress during remobilization. STRETCHING John Nyland, Louisville, KY, USA, Presenter David N.M. Caborn, Louisville, KY, USA Poster #432 University of Louisville, Louisville, Kentucky, USA FIVE CASES WITH ATLANTAL FRACTURE BY SUMO WRESTLING Purpose: The hamstring muscles are dynamic biarticular ago- Yusuke Morimoto, Tokyo, JAPAN, Presenter nists that protect the ACL during jump landings and running Akiyoshi Saito, Tokyo, JAPAN directional changes. Nonimpaired musculotendinous extensi- Toshinori Yoshimatsu, Tokyo, JAPAN bility is an essential component of hamstring muscle group Takashi Horaguchi, Tokyo, JAPAN function. Increasing our understanding of the perceived rele- Kenji Sato, funabashi, JAPAN vance athletes place on hamstring stretching should increase Koh Hoteya, Chiyoda-ku, JAPAN our ability to achieve program adherence. This study evaluated Department of Orthopaedic Surgery Nihondaigaku Sur, Chiyoda-ku, JAPAN the opinions and practices of adolescent females and males in POSTER ABSTRACTS regard to static hamstring stretching. [introduction] Although bursting fractures of the atlas caused by automobile accidents or falling have been frequently Materials and Methods: One hundred twenty five nonimpaired reported, few reports of sports-induced atlantal fractures have athletes (64 males, 61 females) from two high schools partici- been made. We present the cases of five patients with atlantal pated in this study. Males participated in football, basketball, fractures caused by sumo wrestling: one patient was a univer- soccer, track and field, or wrestling. Females participated in sity sumo wrestler, while the other four were professional sumo basketball, soccer, track and field or gymnastics. Data were col- wrestlers. lected during pre-athletic participation physical exams. Active hamstring musculotendinous extensibility was measured using [report] Fractures were caused by hyperflexion in two patients a handheld goniometer with subjects positioned in supine at and hyperextension in two, with an unknown etiology in the 90 deg hip flexion. Subjects responded to written questions remaining patient. Although all patients reported spontaneous about the number of hamstring stretching repetitions and cervical pain and difficulty of mouth opening, none exhibited stretch duration that they commonly performed prior to ath- neurological symptoms. Plain radiography and computed letic participation. Subjects also completed a 3 question, 10 cm tomography (CT) confirmed a Jefferson fracture in four patients visual analogue scale survey (end range descriptors 1 = not and an anterior arch fracture in one. Each patient underwent important, 10 = very important) of perceived hamstring stretch- eight weeks of conservative therapy followed by neck muscle ing importance to injury prevention, athletic performance, and strengthening training. When fractures were severe, after four to their coach. weeks of skeletal traction of the skull, Philadelphia collars were used. Results: As expected females displayed greater active ham- These patients have been followed for a long period time, string musculotendinous extensibility than males (-13 +/- 13 but bone fusion has not been observed in any of the patients. deg knee extension vs. -23 +/- 13 deg knee extension, p > Nonetheless, the distance between the atlanto-dental distance 0.0001). Groups were similar for hamstring stretch repetition (ADD) has decreased during both flexion and extension, and (females = 3.1 +/- 2 repetitions vs. males = 3.8 +/- 5 repetitions), the stability of the atlantal axis has improved enough for four of and duration (females = 16 +/- 7 sec vs. males = 18 +/- 12 sec). the five patients to return to sumo wrestling. Rating differences did not exist between males (8.8 +/- 1.4 cm) and females (8.6 +/- 1.7 cm) for the perceived importance of [Discussion] Position of the neck at the time of injury varied hamstring stretching to injury prevention (p > 0.05). Males among the five patients. Since bursting fractures of the atlas are rated hamstring stretching to be more important to athletic caused by displacement eccentric to the nerves, patients are performance than females (8.9 +/- 1.2 cm vs. 8.3 +/- 1.4 cm, p = less likely to develop neurological symptoms. None of the five 0.009). Males rated hamstring stretching to be more important to their coach than females (8.5 +/- 1.6 cm vs. 7.6 +/- 2.2 cm, p = 0.001).

5.174 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Football Club (NGE) in 1999 season. Condition data were Conclusions and Significance: Although differences were not obtained daily by one full-time team doctor who performed observed regarding the importance of hamstring stretching to medical examination every pre- and post-training. The criteria injury prevention, males rated hamstring stretching to be more of poor condition include; 1) injury (trauma or disorder) needed important to both athletic performance and to their coaches some treatment by the team’s medical department, 2) can con- than females. Reduced perceptions of the importance of ham- tinue normal training for some days after injury occurred, 3) string stretching to athletic performance and to their coach performance level down. Poor condition was grouped into among female athletes may be associated with the tendency of Recover Group (RG; poor condition can continue training to the females to display increased joint laxity and a more erect, cap- last) and Deteriorate Group (DG; poor condition must stop suloligamentous dependent postural habitus during athletic training halfway). The statistical procedures were performed maneuvers. Modified hamstring stretching activities performed using Stat View (SAS Institute, Inc., North Carolina). The level in functionally relevant postures may improve musculotendi- of significance was 5%. nous extensibility among females without increasing knee cap- sulo-ligamentous laxity. As a component part of a comprehensive Results: knee injury prevention program these modifications may also A total of 72 poor condition injuries (RG; 52 cases, DG; 20 help reinforce postural behavior changes toward a greater cases) and 89 immediately training stop injuries occurred reliance on musculotendinous dependent postures. through one season. The average injury rate of poor condition per 1000 training hours per player was; 11.7 cases during game, 5.2 cases during camp, and 1.7 cases during training. About Poster #434 70% of the poor condition injuries were involving lower extrem- MUSCLE ACTIVITY DURING DASH SHOWN BY 18F-FDG PET. ities (ankle; 18%, knee; 11%, thigh; 11%, foot; 10%). In both Masahiro Ohnuma, Sendai, JAPAN, Presenter groups, many injuries occurred during game (RG; 48%, DG; Takehiko Sugita, Sendai, JAPAN 55%) and through non-contact mechanism (RG; 54%, DG; 60%). Tomomaro Kawamata, Sendai, JAPAN In Deteriorate Group, average 5.9 times of trainings could be Koshi N Kishimoto, Sendai, JAPAN continued from occurrence to discontinuance. Many injuries Akihito Tomiya, Sendai, JAPAN were caused by intrinsic factors; muscular problems (RG; 29%, Masatoshi Ito, Sendai, JAPAN DG; 40%), past injuries and inadequate rehabilitation (RG; 25%, Keiichiro Yamaguchi, Sendai, JAPAN DG; 35%) or by extrinsic factors; inappropriate training (RG; Shoichi Kokubun, Sendai, JAPAN 31%, DG; 30%), overuse (RG; 25%, DG; 20%), as well as by foul Hisashi Rikimaru, Sendai, JAPAN plays (RG; 29%, DG; 25%). In the Deteriorate Group, spine, Department of Orthopaedic Surgery, Tohoku Univers, Sendai, JAPAN thigh, lower leg, and foot injuries were more frequent than Recover Group. Muscular problems, past injuries and inade- Muscle activity during running at full speed was evaluated quate rehabilitation, and body mechanics such as malalign- using 18F-FDG PET and compared with that of a control group. ment influenced more strongly in the Deteriorate Group than 6 healthy males with an average age of 22.5 years were investi- Recover Group. gated during a dash for 10 minutes after intravenous injection of FDG (37 MBq). Another 5 healthy males with an average age Discussion and Conclusion: of 26.5 years were studied as controls. PET images were This study revealed that muscular problems, previous injuries, obtained 45 minutes after the FDG injection. In the control and body mechanics of players, inadequate rehabilitation of group, the mean SUVs of the anterior thigh, the posterior thigh, team physicians, and unsuitable training program of coaches the anterior leg, and the posterior leg were 0.48, 0.45, 0.46, and are the main deteriorate factors of player’s condition. Needless 0.46 respectively. In the dash group, the mean SUVs of the ante- to say about better medical support, we must make efforts in rior thigh, the posterior thigh, the anterior leg, and the poste- various fields to improve player’s condition. To do sufficient rior leg were 0.77, 0.83, 0.62, and 0.62 respectively. FDG daily medical care, to do adequate rehabilitation not affected POSTER ABSTRACTS accumulation in the posterior thigh in the dash group was sig- by head coach’s opinion, to advise proper training program to nificantly higher than in the control group (p<0.03). It was coaches from a medical standpoint, to educate players in a field observed from our investigation that the posterior thigh mus- of medicine (self-conditioning), and to do fair play are most cles were especially activated when running at full speed. important strategy to get better condition.

Poster #435 Poster #436 ANALYSIS OF POOR CONDITION IN J-LEAGUE MECHANICAL PROPERTIES OF SUTURE EYELET – PROFESSIONAL FOOTBALL PLAYERS SUTURE INTERACTIONS Minoru Shiraishi, Toyota, JAPAN, Presenter Andrew Perry, Randwick, AUSTRALIA Zdenko Verdenik, Toyota, JAPAN Adam M Butler, Randwick, AUSTRALIA Nagoya Grampus Eight Clinic, Toyota, JAPAN Danny Acton, Randwick, AUSTRALIA Richard Evans, Randwick, AUSTRALIA Objective: Peter Hughes, Randwick, AUSTRALIA To prevent injury and improve condition is very important to Jerome Goldberg, Randwick, AUSTRALIA achieve good results in professional sports. But the previous Warwick JM Bruce, Randwick, AUSTRALIA epidemiologic study did not clarified daily conditioning prob- David Sonnabend, Chatswood, AUSTRALIA lems in detail on that situation players can continue playing Ronald Mark Gillies, Randwick, AUSTRALIA but not show full performance. This study was designed to ana- William R. Walsh, Randwick, AUSTRALIA, Presenter lyze poor condition and discuss how to improve condition of University of New South Wales, Sydney, AUSTRALIA the professional football players in Japan (J-League). Introduction: Suture anchor and suture are commonly com- Materials and Methods: bined to repair tendon-bone interfaces. Traditionally, standard Poor condition was assessed for 31 professional football play- braided sutures, such as Ethibond, have been used based on ers (average 25.0 years; range 18-35) in Nagoya Grampus Eight historical use intransosseous repairs. The mechanical proper-

5.175 ties of the suture alone may play an important role in intraop- Objective To evaluate sensitivity, specificity, reproducibility and erative failure during repair. This study evaluated the in-vitro predictive value of palpation, of the painful arc sign, and of the failure strength of a new polyethylene based suture material ‘Royal London Hospital test’ in 10 patients with Achilles (Fibrewire, Arthrex) compared to #2 Ethibond over the eyelet of tendinopathy, and in 14 asymptomatic subjects. a standard suture anchor. Design Test-retest study.

Methods: The tensile strength of suture over an eyelet of a Setting University teaching hospital Mitek SuperAnchor was performed using an MTS Bionix Testing Machine. The anchor was fixed in a testing jig and 7 tests per- Participants Ten male athletes on the waiting list for explo- formed using #2 Ethibond (Ethicon) or #2 Fibrewire (Arthrex). ration of one of their Achilles tendons for tendinopathy of the Uniaxial tension was applied at 100 mm per minute and load main body of the tendon attended a special clinic. Each was versus displacement continuously recorded. The ultimate load, invited to bring at least one athletes of the same sex in the displacement at the ultimate load and stiffness were deter- same discipline aged within two years of themselves, with no mined for all samples. Data was analysed using an unpaired history and no symptoms of AT. A total of 14 controls were thus Student’s t-test using SPSS. recruited.

Results: Failure for all samples occurred at the eyelet suture Main outcome measures Pain and tenderness following per- interface for all samples. Differences between #2 Fibrewire and formance of palpation, the painful arc sign, and the ‘Royal #2 Ethibond in the current study were highly significant London Hospital test’.Results There were no statistically signif- (p<0.001). The ultimate strength (360.4 N vs. 193.0 N) and stiff- icant differences at the 5% level among the effects of investiga- ness (63.4 N/mm vs. 10.2 N/mm) of the Fibrewire were superior tor or between morning and afternoon measurements for any of to Ethibond. The displacement at the ultimate load for the three measurement methods. There was no evidence of a Fibrewire was less than Ethibond (6.7 mm vs. 18.1 mm). difference of the three assessment methods (p > 0.05). When the three methods were combined, the overall sensitivity was Discussion: Intraoperative failure of suture when using a suture 0.586 (CI 0.469 - 0.741) and the overall specificity was 0.833 (CI anchor can present a problem. The tensile strength of the 0.758 - 0.889). suture is one parameter that contributes to the overall biome- chanical properties. Many other factors (i.e. tendon and bone Conclusions In patients with tendinopathy of the Achilles ten- quality, knot etc.) also play an important role. When evaluated don with a tender area of intratendinous swelling which moves over the suture anchor eyelet, Fibrewire provided a much with the tendon and whose tenderness significantly decreases stronger and stiffer construct compared to Ethibond. or disappears when the tendon is put under tension, a clinical diagnosis of tendinopathy can be formulated, with a high posi- tive predictive chance that the tendon will show ultrasono- Poster #450 graphic and histological features of tendinopathy. SURGICAL TREATMENT TIBIAL EMINENCE OF A SHANK BONE IN YOUNG SPORTSMEN POSTER ABSTRACTS Vitaly F. Kuksov, Samara, RUSSIA, Presenter Poster #455 Pirogov City Hospital, Samara, RUSSIA PREVALENCE OF ORTHOPAEDIC INJURIES AMONG 160 BRAZILIAN COMPETITIVE TENNIS PLAYERS The choice of rational treatment is the basic.At displaced Rogerio Teixeira Da Silva, Perdizes, BRAZIL, Presenter Salter-Harris types II-III fractures the surgical treatment is Moises Cohen, Sao Paulo, BRAZIL shown.During 1994-2001 years surgical treatment was provided Marcelo Matsumoto, Sao Paulo, BRAZIL to 39 patients with cleavage fractures tibial eminence of a Center for Sports Medicine, Sao Paulo, BRAZIL shank bone /II type - 28 patients;III type - 11 patients/.Age of patients from 9 till 14 years.Artrotomia knee joint.Careful revi- One hundred and sixty competitive tennis players from Sao sion of it.Open osteosynthesis tibial eminence by Kirshner Paulo, Brazil were retrospectively studied. Of these, 64 (40%) wires with lavsan lasher;it was carried out through the sub- were females and 96 males (60%). Ages ranged from 9 to 78 chondral. The long term results of treatment are studied in all years with a mean of 27.6 years. The overall incidence was 0.15 39 patients at the period for 2 years till 5 years after opera- lesions per athlete per year of sports practice and 0.16 lesions tion.X-rayanatomic and fanctional results are good and excel- per athlete per year of competition. Two hundred and forty-four lent.The fragment adhesion in full; full congruence of joint lesions were reported by 122 athletes (38 athletes did not refer surface.The full volume of movements.The stable knee joint is any lesions), leading to an index of 1.53 lesions per athlete in presented.The sport forecast favorable - patients continue to go our population of tennis players. Regarding the affected part of in sports section. At cleavage fractures tibial eminence of a the body, the major lesion reported was muscle injury (58 ath- shank bone II-III types in young sportsmen only surgical treat- letes - 23.8%), followed by foot and ankle injury (48 athletes - ment is used,so favorable forecasts speak about it. 19.7%) and elbow injury (41 athletes - 16.8%). The most reported specific injuries were tennis elbow (38 athletes - 15.6%) and ankle sprain (36 athletes - 14.8%). The mean time of Poster #451 absence from the tennis courts, after the injuries was 39 days THE CLINICAL DIAGNOSIS OF ACHILLES TENDINOPATHY and the majority of the athletes returned after 7 to 28 days (90 WITH TENDINOSIS athletes - 36.9%). The younger players (up to the age of 16 Nicola Maffulli, Stoke on Trent, UNITED KINGDOM, Presenter years) reported a low incidence of lesions. Regarding tennis M G Kenward elbow, a direct relationship between the higher incidence of John B King, London, UNITED KINGDOM lesions and more years of tennis practice was observed. V Testa G Capasso, Stoke on Trent, ENGLAND R Regine Keele University, Stoke on Trent, ENGLAND

5.176 • The FDA has not cleared the drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off-label” use). Poster #456 "THE GLASS KNEE" – A NEW METHOD OF ANATOMIC PREPARATION AND PRESERVATION OF HUMAN JOINTS. Scott F. Dye, San Francisco, CA, USA, Presenter

Objective: Viewing the complex extra-articular anatomy of the knee through standard methods of preparation and dissection requires destruction of the more superficial layers to view the deeper ones. The purpose of this study is to report a new method of anatomic preparation and preservation (developed in the field of vertebrate biology/paleontology) which results in the muscles and other tissues becoming transparent - allowing visualization of deeper structures without extensive dissection.

Materials and Methods: Adult and embryonic (24 week) human knees were prepared using the following method: fixation of specimens in a 10% for- malin solution for 3 days. They were then washed in distilled H2O for 3 days. The specimens were then skinned and trans- ferred to decreasing changes of ethyl alcohol, from 95% to 15%. They were then transferred to distilled H2O for 3 hours. The specimens were then placed in a solution of saturated aqueous sodium borate solution with 1 gram of trypsin /30 ml of solu- tion for 3 weeks. They were then transferred to 0.5 grams of KOH solution for 24 hours. They were then transferred through 0.5% KOH - glycerin series (3:1, 1:1, 1:3) and ultimately to pure glycerin.

Results: The human knees prepared in this study show striking and exquisite details of extra-articular anatomy while remaining completely mobile and fully preserved.

Conclusion: This method of anatomic preparation and preservation of the human knee provides a novel technique to understand three- dimensional relationships of musculoskeletal macrostructures. This method can be easily applied to other human joints and musculoskeletal systems with probable similar benefits in anatomic understanding. POSTER ABSTRACTS

5.177 Abalo, Eduardo Diego ...... 4.55, 5.58, 5.102 Aydogdu, Semih ...... 5.80, 5.103 Bredt, Murilo ...... 5.74 Abdalla, Rene Jorge . .4.7, 5.23, 5.84, 5.105, 5.171 Azuma, Hirotaka ...... 4.67 Brettschneider, Olaf ...... 4.18 Abe, Isao ...... 5.168 Babalis, Georgios Anastasios . . .4.23, 5.39, 5.40, Brigatti, Nestor Abel ...... 5.29 Abe, Takanobu ...... 5.115 ...... 5.119, 5.150, 5.151, 5.164 Briggs, Karen K . . . .4.48, 4.60, 5.69, 5.130, 5.151 Abe, Tomoyuki ...... 5.80 Back, Di L ...... 4.85 Briggs, Timothy WR ...... 4.85, 5.146 Acevedo, Jose Marcelo Mardones ...... 5.80 Badet, Roger ...... 4.63 Brilhaut, Jean ...... 5.81 Ackermann, Paul W ...... 4.73, 5.25 Baek, Seung-Hoon ...... 5.134 Brombach, Sascha ...... 5.37 Acquaroli, Francesca ...... 4.5 Bahr, Roald ...... 4.32 Brown, Frederick M...... 4.25, 5.153 Acton, Danny ...... 5.175 Bailey, Shana ...... 4.38 Brown, Graeme Campbell ...... 5.147 Adachi, Nobuo . .4.8, 4.76, 5.37, 5.77, 5.91, 5.144 Bak, Charlottenlund, Klaus ...... 4.16 Browne, Jon E ...... 4.8, 4.59 Adam, Frank ...... 4.32, 4.34, 4.43, 4.74,Bak, Klaus ...... 5.169 Brownlow, Harry ...... 5.159 ...... 4.87, 5.37, 5.70, 5.71, 5.95 Baker Jr, Champ L ...... 4.42 Bruce, Warwick JM . . . . .4.83, 5.77, 5.145, 5.175 Adams, Doug ...... 4.47 Baker, A ...... 5.173 Brucker, Peter ...... 4.77 Adler, Ronald S...... 4.92 Baktir, Ali ...... 4.12 Brush¯j, Christoffer ...... 5.169 Adlington, Jay ...... 4.44 Baldini, Andrea ...... 4.68, 4.70 Buckup, Klaus ...... 5.127 Afendras, Gerasimos ...... 4.8 Bale, Reto ...... 4.57 Buelow, Jens-Ulrich ...... 5.72, 5.127, 5.142 Aglietti, Paolo ...... 4.68, 4.70, 5.49, 5.50 Bale, Stephen ...... 5.158 Bulgheroni, Paolo ...... 5.128, 5.129 Ahn, Hyun Jeong ...... 4.61 Balian, Gary ...... 4.8 Buluc, Levent ...... 5.150 Ahrens, Philip Michael ...... 4.17, 4.93, 4.94 Ball, Craig Michael ...... 5.33 Burkhart, Stephen S ...... 4.27 Aigner, Nicolas ...... 4.14, 5.58 Ball, Scott ...... 5.31 Burrow, Greggory ...... 5.159 Aihara, Tatsuo ...... 5.72, 5.123, 5.131 Ballerini, Mauro ...... 5.88 Butbul, Avivit ...... 4.85 Aihara, Toshio ...... 5.156 Barak, Y ...... 4.72, 4.79 Butler, Adam M ...... 4.13, 4.41, 5.145, 5.175 Ait Si Selmi, T...... 5.41, 5.114 Baraliakos, Xenofon ...... 4.17, 5.140, 5.159 Butler, Santiago ...... 4.14, 4.55, 5.58, 5.102 Aizawa, Shin ...... 5.132 Baranto, Adad ...... 4.16 Byn, Pieter ...... 4.64 Akansel, Gur ...... 5.167 Baranto, Adad ...... 5.166 Byrd, J.W. Thomas ...... 4.77, 4.79 Akgun, Isik Karli ...... 5.38, 5.124 Bargash, Nael Abdou ...... 5.40 Caborn, David N.M...... 4.2, 5.22, 5.29, 5.66, Akin, Aynur ...... 5.54 Barrass, V ...... 5.173 ...... 5.73, 5.138, 5.174 Akinci, I. Ozkan ...... 5.125 Barton Hanson, Nicholas G ...... 5.88, 5.89 Cagliero, Gabriel ...... 4.53 Akman, Senol ...... 5.24 Baterjjee, Khalid ...... 5.40 Cagy, MaurÌcio ...... 5.99 Akpinar, Sercan ...... 5.156 Battaglia, Todd C...... 4.8 Calafell, Ruben ...... 5.19 Akseki, Devrim ...... 5.102, 5.125 Bauer, Thomas ...... 4.48 Calmet, Jaume ...... 5.129 AlArabid, Basil ...... 5.55 Beach, W R ...... 5.137 Camanho, Gilberto ...... 4.7 Albuquerque, Roberto ...... 4.82 Beard, David ...... 4.64 Camargo, Osmar Pedro . .5.72, 5.115, 5.123, 5.131 Alemparte, Jose ...... 5.80 Beaufils, Philippe ...... 4.69, 5.21, 5.81, 5.149 Cameron, John Charles ...... 4.63 Alfredson, Bertil ...... 4.44, 5.19 Beccarini, Alessandro ...... 4.22 Cameron, Michelle ...... 4.48, 5.69, 5.130, 5.151 Allen, Answorth A...... 4.92 Becher, Christoph ...... 4.56 Canata, Gian Luigi ...... 5.14, 5.42 Alloza, Jose Felipe ...... 5.14 Becker, Roland ...... 4.18, 5.126 Canoz, Ozlem ...... 4.12 Almqvist, Karl Fredrik ...... 4.21, 5.144Becker, Tali ...... 5.126 Capasso, G ...... 5.176 Alonso, Daniel ...... 4.14 Bei, Giovanni ...... 4.7 Capomassi, Miguel Angel ...... 5.155 Altchek, David W ...... 4.53, 5.63 Bell, Simon Nicholas ...... 4.95 Caporaso, Antonio ...... 5.23, 5.85, 5.106 Altena, Mark ...... Bell,. . Todd. . D . . ..4.67 ...... 4.43 Capuano, Luca ...... 5.33 Altmeyer, Katrin ...... 4.33 Bereiter, Heinz ...... 5.113 Caputo, Guilherme Velho ...... 4.62 Altuner, Mustafa ...... 5.54 Bergfeld, John A ...... 4.51 Caracchini, Giuseppe ...... 4.7 Amado, Paulo ...... 4.42 Berghs, Bart ...... 5.151, 5.152, 5.158 Carcuro, Giovani ...... 5.88 Amatuzzi, Marco ...... 4.82 Berkson, Eric ...... 4.29 Cardona, Jesus Ignacio ...... 5.83 Amendola, Annunziato . . .4.44, 4.46, 4.87, 5.135 Bessette, Ben J ...... 5.53, 5.132 Carneiro Fo., Mario ...... 5.146 Amiel, David ...... 4.48, 5.31 Beyer, Alan H ...... 5.81 Carr, Donald R...... 5.141 Amin, Saqib ...... 5.14, 5.126 Beyerlein, Joerg ...... 4.77 Carrasco, Nicolas ...... 4.14, 5.110 Anaguchi, Yuko ...... 5.116 Bichler, Oliver ...... 4.57 Carreira, Dominic S...... 5.153 Andary, John ...... 4.75 Bicos, James ...... 4.47 Carrera, Eduardo Da Frota 4.13, 5.24, 5.158, 5.159 Anderson, Allen F ...... 4.8, 4.33, 4.59, 4.89 Biddau, Flavio ...... 5.49 Carter, Paul ...... 5.83, 5.98 Andoh, Kunihiko ...... 5.149 Birmingham, Trevor ...... 4.21 Carvalho, Henrique ...... 4.4, 5.74, 5.119, Andreoli, Carlos Vicente . .4.13, 5.24, 5.158, 5.159 Bistolfi, Alessandro ...... 5.83, 5.98 ...... 5.124, 5.130, 5.150 Andrikoula, Sofia ...... 5.38 Bittencourt, Luciene ...... 4.4, 5.74, 5.119 Cavanaugh, John T...... 5.61 Andrish, Jack T ...... 5.73, 5.135 Bizzini, Mario ...... 4.68, 4.84, 5.41, 5.103 Cavanilles, Jose Maria ...... 5.101 Angelini, Fabio ...... 4.82 Black, Brian ...... 5.61 Cecconi, Sergio ...... 4.22 Annus, Eldur ...... 5.150 Blanchard, Gordon M...... 5.148 Cenna, Enzo ...... 5.45, 5.83, 5.98 Antonescu, Dinu ...... 5.115 Blankevoort, Leendert ...... 4.42 Cerea, Pietro ...... 4.81, 5.130 Antonogiannakis, Emmanuel . . .4.23, 5.39, 5.40, Bleakney, Richard ...... 4.19 Chagas, Jose Carlos Melo ...... 5.167 ...... 5.79, 5.119, 5.150, 5.151, 5.164 Blessey, Peter ...... 5.137 Chaimsky, Gershon ...... 5.33, 5.60, 5.87, 5.131 Aoki, Mitsuhiro ...... 5.65 Bliss, James ...... 5.145 Chamecki, Alvaro ...... 4.4, 5.74, 5.119, 5.124,

INDEX Aoki, Yoshihiro ...... 5.56 Block, Jake ...... 5.148 ...... 5.130, 5.150 Aoki, Yoshimitsu . . .4.29, 4.45, 4.67, 5.57, 5.116 Blond, Lars ...... 5.21 Chan, Barbara P...... 4.71 Aoyagi, Takanobu ...... 5.170 Boada, Segi ...... 5.129 Chan, Kai-Ming ...... 4.71 Apreleva, Maria ...... 4.38 Boeri, Cyril ...... 4.65, 5.90 Chan, Otto ...... 4.31 Ara, Yuki ...... 4.63 Boes, Ludwig ...... 5.72, 5.142 Chan, Yu-Sing Francis ...... 5.158 Arbel, Ron ...... 4.57, 5.126 Boileau, Pascal ...... 4.17, 4.93, 4.94, 5.157 Charitos, Christos ...... 5.117 Arce, Guillermo R...... 4.14, 4.55, 5.58, 5.102 Boisrenoult, Philippe ...... 4.69, 5.21, 5.81 Charousset, Christophe ...... 4.27 Arciero, Robert A...... 4.8, 4.24, 4.59 Boland Jr, Arthur L ...... 4.89 Charrois, Olivier ...... 5.149 Armour, Tanya Alexandra ...... 4.47 Boldt, Jens ...... 4.66, 4.84, 5.81, 5.82 Chen, Chih-Hwa ...... 5.103, 5.104 Arndt, Anton ...... 4.1, 5.20 Bollom, Tim ...... 4.9 Chen, Guoping ...... 5.30 Arneja, Shalinder ...... 5.39 Bonin, N...... 5.41, 5.65 Chen, Han-Shiang ...... 5.84, 5.104 Arnold, William J ...... 4.64 Bonnomet, Francois ...... 4.25, 5.141 Chen, Hsiang-Ho ...... 5.104 Arora, Arvin ...... 4.78 Bordokas, Aristidis ...... 5.41, 5.106 Chen, Wen-Jer ...... 5.103, 5.104 Arruda, Fernando Luiz de ...... 5.23, 5.105 Börner, Thomas ...... 4.56 Chen-Tung, Yu ...... 5.172 Arya, Rakesh Chandra ...... 4.71 Borowski, Alex ...... 4.72, 4.79 Cheon, Yong-Min ...... 5.15 Asano, Hiroshi ...... 5.40, 5.44, 5.89 Bosch, Ulrich ...... 5.22 Cherubino, Paolo ...... 5.128, 5.129 Asou, Eiichirou ...... 5.14, 5.164 Boswell, Robert ...... 4.25 Cheuk, Yau-Chuk ...... 4.71 Atalar, Ata Can ...... 5.24 Bottoni, Craig R ...... 4.24 Chhabra, Anikar ...... 5.137 Atay, Ozgur Ahmet ...... 5.42 Bouattour, K ...... 4.63 Chien, Eric Ping ...... 5.42 Athanasiou, Kyriacos ...... 4.27 Boubker, Zniber ...... 5.81 Chiey, Alfredo ...... 5.42 Atkinson, Denis ...... 5.40 Boya, Hakan ...... 5.125 Chiossi, Silvio ...... 5.23, 5.85, 5.106 Atman, Umit ...... 5.125 Boyce, Robert H...... 5.99 Chitoni, Gianpaolo ...... 5.88 Atwan, Nawal ...... 5.93, 5.136 Boyd, Kevin T ...... 4.19, 5.67 Chmielewski, Terese L...... 5.43 Auda, Hiroko ...... 4.63 Bradbury, Neil ...... 5.71 Cho, Sadahiro ...... 5.44 Axe, Michael ...... 5.43 Brækken, Ingeborg ...... 4.32 Cho, Sung-Do ...... 4.75 Ayala, Juan Diego ...... 5.157 Brandsson, Sveinbjôrn ...... 5.16 Cho, Yang-Bum ...... 5.154 Aydogan, Umur ...... 5.80 Branfaux, Marc ...... 5.105 Choi, Chang-Hyuk ...... 4.23, 5.15 Choi, Nam-Hong ...... 4.88 Doral, M Nedim ...... 4.37 Garcia, Leopoldo ...... 4.5 Choi, Yohan ...... 4.83 Dorea, Roberto Jose Batista ...... 5.46, 5.107 Gaudin, Pascal ...... 5.21 Chouliaras, Vasilis ...... 5.38, 5.68 Dorey, Frederick ...... Gemas, . .4.9 Terry Keith ...... 4.3 Christel, Pascal ...... 5.105, 5.107 Dowd, George SE ...... 4.36, 5.92 Genoud, Patrick ...... 4.35 Christian, R ...... 5.173 Drakos, Mark C. . . . .4.52, 4.54, 4.92, 5.36, 5.162 Georg, Thomas ...... 4.33 Christiansen, Svend Erik ...... 5.44, 5.109 Drobny, Tomas ...... 5.41, 5.103 Georgilas, Ioannis ...... 5.106, 5.114 Christoforides, Ioannis ...... 5.162 Drogset, Jon Olav ...... 4.58 Georgoulis, Anastasios . . . .4.8, 5.38, 5.48, 5.49, Chung, Jaehoon ...... 5.84 Drosos, Georgios ...... 5.131 ...... 5.67, 5.68, 5.117 Chwastek, Heike ...... 4.44 du Toit, Don F...... 4.15 Gervasoni, Danilo ...... 5.88 Ciardullo, Antonio ...... 5.50 Duboy, Jaime ...... 5.88 Giakas, Giannis ...... 5.48, 5.49, 5.67, 5.68 Ciccone II, William J ...... 5.161 Duchow, Jochen ...... 5.57 Gialas, Gerasimos ...... 5.151 Ciconelli, Rozana ...... 5.44 Duparc, Fabrice ...... 5.21 Gianbalvo Del Ben, Giovanni ...... 4.68 Cillo, Mario ...... 5.85 Dyck, Myrna Gwen ...... 5.152 Giannakopoulos, Ioannis ...... 5.52 Cipolla, Massimo ...... 4.41 Dye, Scott F ...... 4.7 Gibson, J ...... 5.172 Clarke, Michael Thomas ...... 4.78 Ebina, Kosuke ...... 5.46 Giessmann, Nicki ...... 5.127 Clavert, Philippe ...... 4.25, 5.141 Edelson, Richard ...... 4.51 Giffin, J. Robert ...... 4.62 Clemens, Ulrich ...... 4.82 Edoff, Karin ...... 5.135 Gill, Sanjitpal S...... 4.8 Coates, Ryan ...... 5.162 Efstathiou, Panos ...... 4.23, 5.39, 5.40, Gillies, Ronald Mark ...... 4.83, 5.175 Cohen, Mark S...... 4.29 ...... 5.79, 5.119, 5.151 Giné, Josep ...... 5.129 Cohen, Moises ...... 4.13, 4.35, 5.14, 5.23, Eid, Mohamed Emad ...... 4.37 Giron, Francesco ...... 5.49, 5.50 ...... 5.24, 5.44, 5.84, 5.105, 5.146, Ejerhed, Lars ...... 4.22, 5.46, 5.54 Glattes, Rudolph C...... 5.148 ...... 5.158, 5.159, 5.167, 5.171, 5.176 Ejnisman, Benno . . .4.13, 4.70, 5.24, 5.158, 5.159 Gobbi, Alberto ...... 4.31, 4.34, 5.79 Collazo, Cristian ...... 4.14, 5.110 Ekenman, Ingrid ...... 4.1, 5.20, 5.46 Godolias, Georgios ...... 4.17, 5.140, 5.159 Collette, Michel ...... 5.45 Eklund, Ulf ...... 5.46 Goitz, Henry T ...... 4.55, 4.74 Comba, Daniel ...... 5.45, 5.83, 5.151 Ekstrom, Lars ...... 5.166 Goldberg, Jerome ...... 4.17, 5.175 Confalonieri, Norberto ...... 4.81, 5.130 Ellermann, Andree ...... 4.37, 5.72, 5.127, 5.142 Goldshmidt, R ...... 4.72, 4.79 Connor, Jason T...... 5.135, 5.142, 5.148 Elshafie, Mohamed Hossam ...... 4.37 Gomes, Joao Luiz Ellera ...... 4.62 Constantini, Naama ...... 4.71, 4.72, 4.79, 5.17 Emberson, Jonathan ...... 4.36, 5.92 Gonzales, J ...... 5.137 Conteduca, Fabio ...... 5.48 Endo, Naoto ...... 5.133 Gonzalez, Fernando Manuel ...... 4.41 Cordasco, Frank A...... 4.92 Endo, Toru ...... 5.94 Gonzalez, Hugo ...... 5.88 Corvelein, Ruby ...... 4.42 Engebretsen, Lars ...... 4.32, 4.58, 5.108 Goodfellow, J ...... 4.64 Costanza, Eduardo Humberto ...... 4.55 Erggelet, Christoph ...... 4.8, 4.59 Granero, Xavier ...... 5.101 Coste, Jean Sebastien ...... 4.17, 4.94, 5.157 Erginer, Mehmet Rifat ...... 5.85, 5.133 Grassi, Federico A...... 5.128, 5.129 Cottenie, Dominique ...... 4.64 Esposito, Marco ...... 4.55 Green, David ...... 4.8 Coutts, A ...... 5.172 Espregueira-Mendes, Joao ...... 4.42 Green, Jeremy Blair ...... 4.75, 4.92, 5.36 Cozma, Tudor ...... 4.72 Evans, Richard ...... 4.17, 5.77, 5.145, 5.175 Griensven, Martijn van ...... 5.22 Craig, Edward V...... 4.26 Even-Sapir, Einat ...... 5.126 Griffin, Sharon ...... 4.44 Cretnik, Andrej ...... 4.73, 5.169 Eves, William C...... 4.71 Grintal, Arnan ...... 4.85 Cross, Mervyn J ...... 5.72 Ewen, S W B ...... 5.173 Gröbel, Karl-Heinz ...... 4.18 Crova, Maurizio ...... 5.83, 5.98 Faloppa, Flavio ...... 5.24 Grontvedt, Torbjorn ...... 4.58 Cucchiarini, Magali ...... 5.27 Faunoe, Peter ...... 4.36, 5.169 Grover, Dustin ...... 4.38 Cuomo, Pierluigi ...... 5.50 Feagin, John A ...... 4.31 Gruen, Ulrich ...... 4.8 Curl, Walton W ...... 4.31, 4.86 Fealy, Stephen ...... 4.52, 4.76, 4.92, 5.86 Guedes, Patricia ...... 5.171 Cury, Ricardo Paula . . . . .5.72, 5.115, 5.123, 5.131 Feil, Sven ...... 5.47 Guerrero, Javier ...... 5.157 Da Silva, Rogerio Teixeira . . . . .5.14, 5.146, 5.176 Feller, Julian A ...... 4.36, 5.47, 5.86 Guler, Gulen ...... 5.54 Dagher, Elias ...... 4.25, 4.54 Felt, Jeff C ...... 4.64 Gutierrez, Vicente ...... 4.41 Dalgleish, Adam ...... 5.45 Ferrer, Alvaro ...... 5.88 Ha, Kwon-Ick ...... 4.23, 5.154, 5.166 D'Angelo, M·rio Donato ...... 5.99 Ferretti, Andrea ...... 5.48 Hairston, Gloria ...... 4.86 Danielson, Barbro ...... 5.46 Fiammengo, Marco ...... 5.98 Halici, Mehmet ...... 4.12, 5.54 David, Lee A ...... 5.146 Fink, Christian ...... 4.57 Halpern, Brian C...... 5.71 Davidson, Michael ...... 5.61 Finley, Rose ...... 5.83, 5.88, 5.89 Hamada, Masayuki ...... 5.75, 5.108, 5.116 Davies, Mark ...... Finsterbush,. . . .4.52 Alex ...... 4.72, 4.79, 5.87, 5.131 Hamada, Yoshiki ...... 5.19, 5.169 De Beer, Joe ...... 4.15, 5.151, 5.152, 5.158 Fithian, Donald C ...... 5.108 Hame, Sharon L...... 4.9, 5.50, 5.63 De Haven, Kenneth E ...... 4.20, 4.44 Flynn, Kevin ...... 4.21 Hammer, Dietrich S...... 4.28, 4.43, 4.74, 5.57 De Jongh, Hein ...... 5.152 Follak, Niels ...... 5.68 Handl, Milan ...... 5.15, 5.50, 5.170 de Meeus d' Argenteuil, Yvan ...... 5.45 Forsgren, Sture ...... 5.20 Hansen, Maria ...... 4.91 De Muynck, Martine ...... 5.144 Forwell, Lorie ...... 4.47, 4.87 Hara, Toshiaki ...... 5.70 De Santis, Ernesto ...... 5.23, 5.85 Fotiadis, Ilias ...... 5.162 Harada, Yoshitada ...... 5.168 Debashis, D ...... 5.172 Fourati, Elyes ...... 4.17 Hardy, Philippe P ...... 4.48, 5.33 DeBerardino, Thomas M ...... 4.24 Fowler, Peter J...... 4.21, 4.44, 4.46, 4.47, 4.87 Harilainen, Arsi ...... 4.36 Debski, Richard ...... 4.93 FranÁois, Bonnomet ...... 5.166 Harner, Christopher D ...... 4.62, 4.89, 5.109 Deie, Masataka ...... 5.78, 5.105 Franco, JosÈ Sergio ...... 5.99 Harper, Wade ...... 4.17 Dejour, Henri ...... 4.63, 5.41 Frank, Aleksander ...... 5.169 Harris, Richard ...... 5.145 Delcogliano, Antonio ...... 5.23, 5.85, 5.106 Frank, Handelberg ...... 5.96 Harrold, Fraser ...... 4.38 Demir, Levent ...... 5.54 Franzese, Salvatore ...... 5.23, 5.85, 5.106 Hart, John AL ...... 4.59 INDEX Demirhan, Mehmet ...... 5.23, 5.24 Freedman, Adi ...... 5.33, 5.60 Hartley, Richard ...... 5.88, 5.89, 5.100 Demurie, Alex ...... 4.21 Frey, Philipp ...... 4.68 Harwood, Frederick ...... 4.48, 5.31 Deng, Xeng-Hua ...... 4.26, 5.86 Fries, Steven P ...... 5.36, 5.118 Hashiba, Kensaku ...... 5.24, 5.92 DeOrio, James K ...... 5.85 Fritschy, Domizio ...... 4.35 Hashimoto, Tomoyuki ...... 4.84, 5.65, 5.113 Depaepe, Yves ...... 5.144 Froese, Warren ...... 5.39 Hatayama, Kazuhisa ...... 5.51 Desmyter, Stefan ...... 5.144 Frostick, Simon ...... 4.53 Hatzokos, Ippocratis ...... 5.162 Devin, Clinton J...... 5.142 Fu, Freddie H ...... 4.8, 4.59 Hawkins, Richard J ...... 4.48, 5.151 Dhert, W...... 4.11 Fu, Sai-Chuan ...... 4.71 Hayama, Etsunobu ...... 5.154 Di Feo, Daniele ...... 4.7 Fuchs, Martin ...... 5.55 Hayashi, Ikuta ...... 5.18 Diamantopoulos, Andreas Panagiotis ...... 5.41, Fuchs, Robin ...... 5.147 Hayashida, Kenji ...... 5.161 ...... 5.106, 5.114 Fujikawa, Kyosuke ...... 5.32, 5.56, 5.120 Hayden, Jennifer ...... 4.25, 5.153 Diaz, Roberto Yanez ...... 4.41 Fujimoto, Eisaku ...... 4.12, 5.26 Hechtman, Keith Sheldon . . . . .4.30, 4.75, 4.92, Diduch, David R ...... 5.137 Fujioka, Hiroyuki ...... 4.6 ...... 5.36, 5.118, 5.147 Dienst, Michael ...... 4.33, 4.80 Fujita, Hisao ...... 4.83 Heidersdorf, Stefan ...... 4.17 Dillon, David ...... 5.61 Fukubayashi, Toru ...... 5.53, 5.170 Heidersdorf, Stefan ...... 5.159 Dincal, Turgut ...... 5.133 Fukushima, Kazumasa . . .5.87, 5.97, 5.132, 5.165 Heikenfeld, Roderich ...... 4.17, 5.159 Dines, Joshua S...... 4.76 Fukushima, Sunao ...... 5.154, 5.161 Helliwell, TR ...... 4.53 Diop, Amadou ...... 4.69 Furukawa, Seiji ...... 5.26 Hellstrom, Mikael ...... 4.78, 5.166, 5.167 Djian, Patrick ...... 5.105, 5.107 Fussenegger, Martin ...... 5.137 Henche, Hans Rudolf ...... 4.9 Dodd, Chris ...... 4.64 Gadek, Artur ...... 5.147 Henderson, Ian ...... 4.61 Dogru, Kudret ...... 5.54 Gagey, Olivier ...... 4.22, 4.92, 5.154 Henry, Jon ...... 5.149 Dominique, Cottenie ...... 5.96 Galatz, Leesa M ...... 5.33 Hernandez Tagle, Rodrigo Hernandez ...... 5.80 Donnachie, Nigel J ...... 5.100 Ganzer, Dirk ...... 5.68Herrenbruck, Todd M ...... 4.51 Hersekli, Murat ...... 5.156 Jenny, Jean-Yves ...... 4.65, 4.82, 5.90 Kim, Sung-Jae ...... 4.77, 4.88 Herzoni, Y ...... 4.71, 4.72, 4.79 Jeong, Jae-Hoon ...... 4.77, 4.88 Kim, Young-Min ...... 4.23 Hester, Peter ...... 4.2, 5.22, 5.29 Jerome, Lano ...... 5.166 Kimura, Masashi ...... 5.51, 5.55, 5.76, 5.132 Hibino, Naohito ...... 5.94 Jiakuo, Yu ...... 5.63, 5.91 King, John B ...... 4.31, 4.80, 5.120, 5.176 Hideo, Matsumoto ...... 5.79 Jingxian, Li ...... 5.173 Kirkley, Alexandra ...... 4.21, 4.44, 4.47, 4.87 Higano, Yukimasa ...... 4.63 Jo, Hyunchul ...... 4.61, 5.60, 5.91 Kishimoto, Koshi N ...... 5.175 Higuchi, Hiroshi ...... 4.73, 5.51, 5.55, 5.132 Johannsen, Hans Viggo ...... 5.169 Kitahara, Hiroyuki ...... 5.14, 5.164 Hilton, Andrew ...... 4.85 Johansen, Oddmund ...... 4.58 Kitamura, Nobuto . . . .4.9, 4.50, 5.52, 5.57, 5.116 Hiraga, Yasuharu ...... 5.76 Johansen, Steinar ...... 5.108 Kitaoka, Katsuhiko ...... 5.24, 5.92 Hirahara, Alan ...... 5.163 Johnson, David P ...... 4.4 Kizilboga, Emrah ...... 5.103 Ho, Chi Lun ...... 4.71 Johnson, Don H ...... 5.53, 5.132 Kjeldsen, S¯ren ...... 5.44, 5.109 Hoeher, Juergen ...... 5.73 Johnston, D R ...... 5.173 Kjell, Håkan ...... 4.44, 5.19 Hoffmeyer, Pierre ...... 4.35 Jones, Edward C...... 5.61, 5.93, 5.136 Klein, Scott ...... 5.29 Hôgberg, Erland ...... 5.25 Jones, Grant L...... 5.149 Kline, Alex ...... 5.137 Hohmann, Erik ...... 4.77, 5.15, 5.120 Jones, Ian ...... 4.44 Knutsen, Gunnar ...... 4.58 Holden, Martha ...... 4.86 Jones, Kay S ...... 4.77, 4.79 Ko, Joshua ...... 5.160 Holm, Sten ...... 5.166 Jonhagen, Sven ...... 4.73, 5.25 Ko, Yong-Kon ...... 4.77 Holmes, M ...... 4.28 Jørgensen, Uffe ...... 4.16 Kobayashi, Atsushi ...... 5.51 Hölmich, Per ...... 4.91 Jose Maria, Soler Minoves ...... 5.101 Kobayashi, Fumiaki ...... 5.51, 5.55 Holt, Mark ...... Jouve,.5.72 Franck ...... Kobayashi, .4.48 Kenji ...... 5.26, 5.78, 5.105 Horaguchi, Takashi ...... 5.156, 5.174 Juan Antonio, Ruiz ...... 5.101 Kobayashi, Tatsuo ...... 5.32, 5.56, 5.120 Horan, Marilee ...... 4.48, 5.151 Judet, Thierry ...... 5.95, 5.122 Kobayashi, Yasukazu ...... 5.55, 5.76, 5.132 Hori, Katsuhiro ...... 5.165 Jung, Min-Wook ...... Kocher,. . . Mininder. .4.23 ...... 5.151 Horibe, Shuji . . . . .4.86, 4.88, 5.75, 5.108, 5.116 Kääpa, Ene ...... 5.69 Koehler, Christoph ...... 4.8 Hoser, Christian ...... 4.57 Kaalund, Soeren ...... 4.36 Koenig, Guenter ...... 5.127 Hoshino, Akiho ...... 5.44, 5.66, 5.89 Kabak, Sevki ...... 4.12 Koga, Yoshio ...... 4.63, 5.70, 5.92, 5.133 Hoteya, Koh ...... 5.156, 5.174 Kaeding, Christopher C...... 4.89, 5.148, 5.149 Kohler, Steffen ...... 4.82 Houseworth, Stephen W...... 5.51, 5.152 Kaiming, Chan ...... 5.173 Kohn, Dieter M . . . .4.28, 4.32, 4.33, 4.34, 4.43, Hovorka, Istvan ...... 4.93 Kajitani, Kenichi ...... 5.25, 5.27 ...... 4.74, 4.80, 4.87, 5.27, 5.37, Howard, Charles ...... 5.60 Kälebo, Peter ...... 4.16 ...... 5.57, 5.70, 5.71, 5.95 Howell, Stephen M...... 4.38, 5.59 Kamei, Yoichi ...... 5.51 Kohso, Kiyoyasu ...... 4.83 Huang, Ting-Wen ...... 5.84, 5.104 Kamimura, Tamiko ...... 5.149 Kokubun, Shoichi ...... 5.175 Huber, Martin ...... 4.68 Kanamori, Akihiro ...... 5.53 Kolker, Dov ...... 4.56 Hughes, Peter ...... 4.17, 5.77, 5.145, 5.175 Kanberoglu, Kaya ...... 5.124 Komatsu, Fumito ...... 5.18 Hull, Maury ...... 4.38 Kanchanatawan, Wichan ...... 5.70 Kon, Elizaveta ...... 5.121 Hultenheim, Ingrid ...... 4.22 Kang, Jin-Seok ...... Kondo, . . Eiji. . . ..5.166 ...... 4.9, 4.45, 5.52 Hunger, Nicole Alexandra ...... 5.153, 5.162 Kanisawa, Izumi ...... 5.54 Konermann, Werner ...... 4.82 Hunt, Patrick ...... Kannus,. . . . Pekka.4.44 ...... 4.34, 5.113 Konnai, Yasunobu ...... 5.94 Hurt, W. Grear ...... 4.65 Karabalis, Christos .4.23, 5.39, 5.79, 5.151, 5.164 Kono, Taisuke ...... 5.18 Hurtig, Mark ...... 4.46 Karambalis, C...... 5.150 Kontogeorgakos, Vasilios ...... 5.38 Huysmans, Pol E ...... 4.13 Karaoglu, Sinan ...... 4.12 Korthagen, Eva ...... 5.145 Iacono, Francesco ...... 4.5, 5.61 Karaoglu, Sinan ...... 5.54 Kosanovic, Milos ...... 4.73, 5.169 Ichikawa, Jirou ...... 5.19 Karataglis, Dimitrios ...... 5.162 Koshino, Tomihisa ...... 4.63 Ichikawa, Norikazu ...... 5.101 Karliaftis, Kostas ...... 4.23, 5.39, 5.40, 5.79, Kostopoulos, Vasilios ...... 5.117 Ichimura, Shoichi ...... 5.32 ...... 5.119, 5.150, 5.151, 5.164 Kosutic, Milimir ...... 5.96 Ichinohe, Sadafumi ...... 5.51 Karlsson, Jon ...... 4.16, 4.22, 5.16, 5.46, 5.54 Kotake, Toshiro ...... 5.159, 5.160 Ichiyama, Hiroki ...... 5.52 Kartus, Catarina ...... 5.159 Kotani, Akihiro ...... 5.56 Ide, Takatoshi ...... 5.19, 5.168, 5.169 Kartus, Jüri Toomas . . . . .4.22, 5.46, 5.54, 5.159 Kotsiopoulos, Kostas ...... 5.39 Ihn, Joo-Chul ...... 5.134, 5.171 Kashiwaguchi, Shinji ...... 4.75 Koyanagi, Takahiro ...... 5.120 Ikeda, Hiroo ...... 5.58, 5.78 Katano, Hiroshi ...... 5.76 Kramann, Bernhard ...... 4.33 Ikeda, Kotaro ...... 5.121, 5.145 Katayama, Masayoshi ...... 5.55 Krarup, Annabel Lee ...... 4.16 Ikema, Yasunari ...... 4.9, 5.52 Kato, Haruyasu ...... 4.12 Krasny, Christian ...... 4.14 Ikeuchi, Ken ...... 5.134 Kato, Yuki ...... 5.87, 5.132 Kreutz, Andreas K...... 4.28, 4.43, 4.74, 5.57 Ikuta, Yoshikazu ...... 5.26 Kawada, Takashi ...... 5.115 Krishnan, Sumant G...... 5.157 Iliadis, Antonios ...... 5.39, 5.79, 5.150, 5.151 Kawakami, Hideo ...... 5.75 Kristensen, Gert ...... 5.170, 5.171 Iliopoulos, Jim ...... 5.77 Kawakami, Kensaku ...... 5.70 Kudoh, Toshiharu ...... 4.45, 5.57 Imhoff, Andreas B ...... 4.77, 5.15, 5.120 Kawakubo, Makoto ...... 5.120 Kuksov, Vitaly F...... 4.89, 5.176 Ince, Umit ...... 5.24 Kawakubo, Takeo ...... 5.56 Kumta, S M ...... 5.172 Ingham , Sheila Jean McNeill ...... 5.167 Kawamata, Tomomaro ...... 5.99, 5.175 Kura, Hideji ...... 5.17 Iordache, Sorin ...... 4.85 Kawasaki, Kenzo ...... 4.8, 5.25, 5.26, 5.28, Kurihara, Yoshiaki ...... 5.58, 5.78 Iosifidis, Michael Ilias ...... 5.52 ...... 5.77, 5.91, 5.144 Kuriwaka, Masakazu . . . . .4.76, 5.37, 5.77, 5.144

INDEX Irrgang, James J ...... 4.89 Kdolsky, Richard ...... 5.55 Kuroda, Ryosuke ...... 5.110, 5.112 Isaksen, Vidar ...... 4.58 Keading, Christopher ...... 5.135 Kuroki, Hiroshi ...... 5.133 Ishi, Takao ...... 5.97 keblish, peter ...... 5.81 Kurosaka, Masahiro . . . . .4.60, 4.83, 5.77, 5.78, Ishibashi, Yasuyuki ...... 4.4, 5.64, 5.76, 5.140 Kebudi, Alper ...... 5.124 ...... 5.110, 5.112 Ishida, Kenji ...... 5.30 Kelly, Anne M...... 4.52, 4.54, 4.92, 5.36, 5.162 Kurt, Hakan ...... 5.150 Ishida, Ryosuke ...... 5.113 Kemp, Graham J ...... 5.96 Kurtgoz, Baris ...... 5.167 Ishii, Ryo ...... 4.84 Kempf, Jean-François ...... 4.25, 5.141 Kusaka, Yoshiaki ...... 5.76 Ishii, Seiichi ...... 5.17, 5.65 Kenward, M G ...... 5.176 Kuwabara, Junta ...... 5.55 Ishii, Tomoo ...... 5.30 Kerkhoffs, Gino M.M.J...... 4.42, 5.16 Kwongman, Lee ...... 5.173 Ishii, Yoshinori ...... 4.84, 5.90 Kerylidis, Michael ...... 4.11 Kwun, Koing-Woo ...... 4.23 Ito, Ken ...... 5.30 Kesmezacar, Hayrettin . . .5.38, 5.85, 5.124, 5.133 Kyung, Hee-Soo ...... 5.134, 5.171 Ito, Masaaki ...... 5.25 Keys, Graham W ...... 5.96 Labianca, Luca ...... 5.48 Ito, Masatoshi ...... 5.175 Khan, Amer ...... 4.36, 5.92 Labrinakos, Paul ...... 4.23 Iwasa, Junji ...... 4.8, 5.37, 5.77, 5.91, 5.144 Kidron, Amos ...... 5.36 Lacroze, Pablo ...... 4.14, 4.55, 5.58, 5.102 Iwata, Nahoko ...... 5.170 Kiefer, Hartmut ...... 4.82 LaFemina, Jennifer ...... 4.9 Iwatsubo, Tkuzo ...... 5.77 Kikuchi, Shin-ichi ...... 5.94 Lagalla, Francesco ...... 5.98 Izawa, Kazutaka ...... 5.154 Kikuchi, Tatsuya ...... 5.133 Lam, James J ...... 5.160 J‰rvinen, Markku ...... 5.113 Kikuchi, Toshiyuki ...... 5.32 Landreau, Philippe ...... 4.27 J‰rvinen, Teppo L.N...... 5.113 Kilger, Robert ...... 4.56, 5.62 Landsiedl, Franz ...... 4.14, 5.58 Jackson, Steven ...... 5.112 Kilicoglu, Onder ...... 5.23, 5.24 Lane, S ...... 4.31 Jacobs, Wilco ...... 4.66, 5.90, 5.117 Kim, Eun Mi ...... 4.61 LaPrade, Robert F ...... 4.9 Jacquot, Laurent ...... 4.69 Kim, Hee Junh ...... 4.61 Laprell, Heinz ...... 5.124 Jacquot, Nicolas ...... 5.157 Kim, Hyung-Gyu ...... 4.88 Laptoiu, Dan ...... 5.59, 5.135 Jakobsen, Bent Wulff ...... 5.44, 5.109 Kim, Jin Soo ...... 5.118 Larrain, Mario Victor ...... 4.14, 5.110 Järvinen, Markku ...... 4.34 Kim, Myung Ku ...... 5.17, 5.55 Lass, Preben ...... 5.170 Järvinen, Teppo L.N...... 4.34 Kim, Seung-Ho ...... 4.23, 5.154, 5.166 Laurent, Jeunet ...... 5.65 Jean-FranÁois , Kempf ...... 5.166 Kim, Shin-Kun ...... 4.23 Laurent, Obert ...... 5.65 Laurino, Cristiano ...... 5.171 Matan, Yonatan ...... 4.72, 4.79 Muller, Luis Marcelo ...... 4.62 Lawhorn, Keith W...... 5.59 Matsuda, Mitsumasa ...... 5.77 Muneta, Takeshi ...... 5.58, 5.78 Lazarus, Martin L ...... 5.36 Matsuda, Yoshikazu ...... 4.84, 5.90 Munzinger, Urs .4.66, 4.68, 4.84, 5.81, 5.82, 5.103 Leach, W J ...... 5.172 Matsui, Nobuzo ...... 4.6 Murakami, Hidetaka ...... 5.115 Leblebicioglu, Gursel ...... 5.42 Matsui, Nobuzo ...... 5.78, 5.110, 5.112 Murakami, Mototsune ...... 5.165 Lee, Beom Koo ...... 5.111 Matsui, Yasumoto ...... 5.152 Murase, Ken-ichi ...... 5.67 Lee, Dong Chul ...... 5.93 Matsumoto, Hideo .5.27, 5.28, 5.80, 5.122, 5.136 Muratsu, Hirotsugu ...... 5.110, 5.112 Lee, Kwang-won ...... 5.111 Matsumoto, Marcelo ...... 5.176 Murray, David ...... 4.64 Lee, Kwong-Man ...... 4.71 Matsumoto, Norinao ...... 5.46, 5.75 Musahl, Volker ...... 4.93 Lee, Myung Chul ...... 4.61, 5.60, 5.91 Matsushita, Takashi ...... 5.143 Mutsuzaki, Hirotaka ...... 5.121 Lee, Sang Hoon ...... 5.60 Matsusue, Yoshitaka . . .5.95, 5.136, 5.138, 5.165 Myers, Peter T ...... 4.19, 5.67 Lee, Sang-Wook ...... Matsuura, .4.23 Tetsuya ...... 4.75 Myklebust, Grethe ...... 4.32 Lee, Su-chan ...... 4.77, 4.88 Mauas, David M...... 4.14, 5.110 Nagamachi, Akihiro ...... 5.94 Lee, TQ ...... 4.28 Mauro, Craig S ...... 5.109 Nagamori, Jun ...... 4.19 Lee, Yong-Su ...... 4.77, 4.88 Mazzocca, Augustus D. . . .4.25, 4.29, 4.47, 5.153 Nagao, Akihiko ...... 5.64 Lehrberger, Klaus F ...... 4.64 McAllister, David R...... 5.63, 5.112 Nagaosa, Yoshihiro ...... 5.94 Levin, Steven D...... 5.134 McAllister, David R...... 4.52, 4.90 Nagasaki, Shinya ...... 4.84, 5.65, 5.113 Lewek, Michael ...... 4.68 McBryde, Angus M...... 4.43 Nagata, Kensei ...... 5.115 Liao, Hao-chin ...... 5.171 McCarty, Eric C...... 4.53, 4.73, 5.63, 5.99, Naito, Kohei ...... 5.18 Liljensten, Elisabeth ...... 5.46 ...... 5.135, 5.142, 5.148 Nakagawa, Shigeto ...... 5.75, 5.161 Lim, Moon-Sup ...... 4.23 Mclardy-Smith, P ...... 4.64 Nakagawa, Yasuaki . . . .5.95, 5.133, 5.136, 5.138 Lim, T.H...... 4.47 McMahon, Patrick ...... 4.93Nakajima, Hiroyoshi ...... 4.67 Lind, Bonnie K ...... 4.78 Medeghini, Antonio ...... 5.88 Nakamura, Michikazu ...... 5.80 Lindahl, Anders ...... 4.12 Medlock, Virgil B ...... 4.48, 5.31 Nakamura, Norimasa . . . .4.88, 5.75, 5.108, 5.116 Lindahl, Sven ...... 5.54 Mehalik, John N ...... 4.15 Nakamura, Ryuichi ...... 5.92 Lindblom, Per ...... 4.72 Meighan, Andrew ...... 5.75 Nakamura, Takashi ...... 5.138 Ling, Qin ...... 5.173 Meinhart, Johann Georg ...... 5.137 Nakanishi, Toru ...... 5.26, 5.28 Linke, Lars ...... 5.127 Memis, Ahmet ...... 5.80 Nakano, Kazuhiko ...... 5.65 Linko, Eric ...... 4.36 Memisoglu, Kaya ...... 5.167 Nakata, Ken ...... 4.86, 5.108 Litsky, Alan ...... 5.149 Menetrey, Jacques ...... 4.35 Naruse, Akira ...... 4.75 Lo Presti, Mirco ...... 5.121 Menghi, Amerigo ...... 5.23, 5.85, 5.106 Naughton, Michelle ...... 4.86 Lootens, Tom ...... 4.21 Mentlein, Roland ...... 5.127 Nawata, Koji ...... 5.18 Lorentzon, Mattias ...... 5.20 Mera, Shinsuke ...... 5.17 Negishi, Shinichi ...... 5.156 Lorentzon, Ronny ...... 4.44, 5.19, 5.20 Merk, Harry ...... 5.68 Negrine, John ...... 4.13, 4.41 Louisia, Stephane ...... 5.149 Merlo, Marco ...... 4.81, 5.121 Negrusoiu, Mihai ...... 5.135 Lowe, Joseph ...... 4.72, 4.79, 5.17, 5.33, Micheli, Lyle J ...... 4.8, 4.59 Neila, Christina ...... 5.106 ...... 5.60, 5.87, 5.131 Michener, Todd ...... 5.99 Nery, Caio Augusto ...... 5.14 Lu, Tung-wu ...... 5.172 Michigami, Shizuka ...... 5.53 Neumann, Wolfram ...... 4.18, 5.127 Lucania, Luciano ...... 4.22 Michinaga, Kouji ...... 5.123, 5.168 Newcomb, William A ...... 4.68 Ludvigsen, Tom Clement ...... 4.58, 5.108 Miehlke, Rolf ...... 4.82 Neyret, Philippe 4.39, 4.63, 4.69, 4.89, 5.41, 5.114 Lund, Bent ...... 5.44, 5.109 Miehlke, Wolfgang ...... 4.68 Ng, Aaron ...... 5.158 Lundberg, Magnus ...... 5.135 Migliorini, Sergio ...... 5.121 Nicholson, Gregory P...... 4.25, 4.29 Lundin, Olof ...... 4.16, 4.78, 5.166, 5.167 Mike, Bayliss ...... 5.146 Nicolae, Laurentiu Ciprian ...... 5.115 Lup, Domenico ...... 4.68 Milgrom, Charles ...... 4.1, 5.20 Niga, Sadao ...... 5.40, 5.44, 5.66 Lupparrelli, Stefano ...... 4.22 Miller, Bruce S ...... 4.6 Niki, Yasuo ...... 5.28, 5.136 Ma, Hsiao-Li ...... 5.160 Miller, Mark David ...... 4.8, 5.137 Nikoli, Dragan ...... 5.96 MacDonald, Peter Benjamin . . . .5.39, 5.61, 5.152 Millett, Peter J...... 4.29 Nishihara, Shinji ...... 5.18 MacGregor, A ...... 5.172 Minami, Akio ...... 4.29, 4.45, 4.67, 5.57, 5.116 Nishikori, Tetsuya ...... 5.27 Macias, Jorge ...... 5.102 Minato, Akira ...... 4.75 Nishino, Katsutoshi ...... 5.92 Madani, Abbas ...... 5.111 Mingju, Liu ...... 5.173 Noda, Mitsuaki ...... 5.123 Madry, Henning ...... 5.27 Miniaci, Anthony ...... 4.19, 4.46, 4.58, 5.163 Noerdlinger, Mayo A...... 4.25 Madsen, Jan Lysgrd ...... 5.21 Mio, Kensuke ...... 5.27 Nord, Keith D...... 4.26 Madsen, Michael ...... 4.29 Miskovsky, Shana ...... 5.148 Nose, Hiroyuki ...... 5.66 Mae, Tatsuo ...... 5.46, 5.154 MIskulin, Mladen ...... 5.64 Nottage, Wesley M ...... 4.91 Maeda, Akira ...... 4.88, 5.115 Miszputen, Milton Luiz ...... 5.14 Numazaki, Hironori ...... 5.94 Maeda, Hiroshi ...... 5.123 Mitsuoka, Tomoki ...... 4.88, 5.75, 5.108, 5.116 Nurmi, Janne T ...... 4.34, 5.113 Maeno, Kojirou ...... 5.67 Miura, Kazutomo ...... 5.76 Nygaard, Marianne ...... 4.16 Maeno, Shinnichi ...... 5.122 Miura, Takashi ...... 5.170 Nyland, John . .4.2, 5.22, 5.29, 5.66, 5.138, 5.174 Maerz, Deb ...... 4.53 Miyakawa, Shunpei ...... 5.170 Nyman, Richard ...... 4.78, 5.85 Maffulli, Nicola ...... 5.172, 5.173, 5.176 Miyama, Takahide ...... 5.75 Nyska, Meir ...... 4.71, 4.72, 4.79, 5.17 Magnusson, Lennart ...... 4.22 Miyanaga, Yutaka ...... 5.53, 5.121 O’Brien, Stephen J ...... 4.52, 4.54, 4.92 Mahajan, Sanjeev ...... 5.80 Miyatake, Shin ...... 5.94 O’Connor, J ...... 4.64 Mahar, Andrew ...... 4.25, 4.91 Mizuno, Kiyonori ...... 5.77, 5.78, 5.110, 5.112 O’Kane, John ...... 4.78 Mahroof, Sabreena ...... 5.146 Mohara, Shigeo ...... 4.73 O’Leary, Sean ...... 4.17 Majima, Tokifumi ...... 4.29, 4.67, 5.116 Mojarro, Jorge Alfredo ...... 5.83 Oae, Kazunori ...... 5.18 INDEX Mandelbaum, Bert R...... 4.8, 4.59 Mok, Wing Yuk ...... 5.160 Oakes, Daniel ...... 5.50 Manelli, Alessandro ...... 5.129 Molgora, Alessandro Paladini ...... 5.61 Obata, Hiroyuki ...... 5.67 Maniwa, Sokichi ...... 5.26, 5.27 Monaco, Edoardo ...... 5.48 Obata, Masanori ...... 5.161 Mann, Gideon . . . . .4.72, 4.79, 5.17, 5.87, 5.131 Monteiro, Gustavo ...... 4.13 O'Brien, Stephen J ...... 5.36, 5.71, 5.141, 5.162 Marcacci, Maurilio ...... 4.5, 5.61, 5.121 Montenegro, Hugo ...... 4.14, 5.110 Ochi, Mitsuo ...... 4.8, 4.76, 5.18, 5.20, 5.25, Marczyk, Luiz Roberto S ...... 4.62 Montgomery, Stuart M ...... 4.42 ...... 5.26, 5.27, 5.28, 5.37, 5.77, Mardna, Mihkel ...... 5.150 Moore, Susan ...... 4.93 ...... 5.78, 5.91, 5.105, 5.144 Margheritini, Fabrizio ...... 5.109 Moraiti, Tina ...... 5.48, 5.49, 5.68 Ochiai, Naoyuki ...... 5.30, 5.53, 5.121, 5.145 Marinescu, Rodica ...... 5.135 Morelli, Moreno ...... 4.19 Ochiai, Satoshi ...... 5.19, 5.168 Markolf, Keith L ...... 4.52, 5.50, 5.112 Morgenstern, David ...... 4.71, 5.17 Odashiro, Alexandre ...... 5.24 Marlovits, Stefan ...... 4.12, 5.143 Mori, Koji ...... 5.133 Oetiker, Rolf F ...... 5.113 Martelli, Sandra ...... 4.5 Morimoto, Yusuke ...... 5.174 Oguro, Kenji ...... 5.143 Martin, David F ...... 4.86 Moriya, Hideshige ...... 5.54, 5.73 Ogut, Tahir ...... 5.38, 5.85, 5.124, 5.133 Martinez, Alberto ...... 4.75 Morris, Hayden ...... 5.45, 5.94 Oh, In Suk ...... 5.55 Martinez, Sergio ...... 5.165 Moscachlaidis, Spyros ...... 5.101 Oh, Irvin ...... 5.154, 5.166 Marx, Robert G ...... 4.29, 4.53, 5.61, Moseley, Bruce ...... 4.8, 4.59 Oh, Sung-Kyun ...... 5.166 ...... 5.93, 5.135, 5.136 Motavalli, Kouros ...... 4.81, 5.130 Ohba, Mao ...... 5.133 Masen, Jan Lysgârd ...... 5.21 Motta-Navas, Mauricio Xavier ...... 5.45, 5.151 Ohberg, Lars ...... 5.19, 5.20 Mashima, Keisuke ...... 5.165 Motycka, Thomas ...... 4.14, 5.58 Öhberg, Lars ...... 4.44 Masi, Andrea ...... 4.7 Motz, Cary R...... 5.161 Ohe, Keisuke ...... 5.123 Massetti, Sergio Oscar ...... 5.19 Movin, Tomas ...... 4.72 Ohkoshi, Yasumitsu ...... 4.84, 5.65, 5.113 Mastrokalos, Dimitrios Stylianos . . . . .4.18, 4.56, Mueller, Sebastian ...... 5.62 Ohnuma, Masahiro ...... 5.99, 5.175 ...... 5.62, 5.63 Muezzinoglu, Sefa ...... 5.150, 5.167 O'Holleran, James D...... 5.87 Okamoto, Kouji ...... 5.123 Popoff, Ivan ...... 5.145 Saito, Syu ...... 5.97 Okazaki, Takeyuki ...... 5.73 Popovic, Zoran Zdravko ...... 5.96 Saito, Takao ...... 5.143 Oku, Naohiro ...... 5.77 Popp, Thomas ...... 4.57 Saito, Tomoyuki ...... 4.63 Okuwaki, Toru ...... 5.53 Posner, Matt ...... 4.31 Sakamoto, Atsuhiko ...... 5.87 Olesen, Steen ...... 5.170 Post, William R...... 5.108 Sakamoto, Makoto ...... 5.133 Olin, Carin ...... 5.20 Potter, Hollis G...... 5.63 Sakane, Masataka ...... 5.121 Oliveira, Ricardo Paula ...... 5.72 Poulain, Samuel ...... 5.33 Sakurai, Atsushi ...... 5.123 Oliveira, Valdeci Manuel ...... 5.167 Pouliart, Nicole ...... 4.22, 4.92, 5.96, 5.154 Salonen, David ...... 4.19 Oliveira, Victor Marques .5.72, 5.115, 5.123, 5.131 Pournaras, John ...... 5.162 Salvati, Eduardo A...... 5.93 Olsen, Odd Egil ...... 4.32 Pozo, J Louis ...... 5.131 Salvini, Andrea ...... 5.88 Omachi, Takaaki ...... 5.152 Prandini, Mauro ...... 4.55 Samejima, Yasuhito ...... 5.143 Omori, Go ...... 4.63, 5.70, 5.92 Prasad, Pidikiti S ...... 5.96, 5.97 Samnegård, Eva ...... 4.72 O'Neill, Geoffry ...... 5.112 Pressman, Ari E ...... 5.53, 5.132 Sandow, Michael J ...... 4.11 Ono, Takashi ...... 5.19, 5.168, 5.169 Presti, Mirco Lo ...... 4.5 Sandrucci, Giulia ...... 5.83, 5.98 Onodera, Tomohiko ...... 5.51 Preuhs, Michael ...... 5.127 Santos, Francisco Prado ...... 5.167 Orthner, Ernst ...... 5.137 Previgliano, Juan Pablo . . .4.14, 4.55, 5.58, 5.102 Santos, Murilo Cesar ...... 4.4, 5.74, 5.119, Oshida, Midori ...... 5.132 Price, Andrew ...... 4.64 ...... 5.124, 5.130, 5.150 Otani, Toshiro ...... 5.28, 5.80, 5.122, 5.136 Pringle, Jean ...... 5.146 Saowaprut, Suriyapong ...... 5.70 Ottolenghi, Eduardo Martin ...... 4.54 Puddu, Giancarlo ...... 4.41 Saris, D...... 4.11 Owen, James E ...... 5.67 Puertas, Eduardo B ...... 5.167 Sasaki, Kazuhiro ...... 4.4 Ozalay, Metin ...... 5.156 Pufe, Thomas ...... 5.127 Sasaki, Kazuhiro ...... 5.140 Ozcan, Ozal ...... 5.125 Quevedo, Luciano ...... 4.24 Sasso, Francesco ...... 5.49 Ozic, Ugur ...... 5.102 Radice Dieguez, Fernando ...... 4.41 Sato, Hideki ...... 4.4, 5.140 Ozkoc, Gurkan ...... 5.156 Rahlfs, Volker ...... 5.16 Sato, Kenji ...... 5.123, 5.156, 5.174 Ozsoy, Serhat ...... 5.24 Rahu, Madis ...... 5.69 Sato, Takashi ...... 5.30 Padhiar, Nat ...... 4.8 Rajovic, Jovo ...... 5.96 Schaadt, Geoffrey ...... 4.9 Paessler, Hans H . . . .4.18, 5.47, 5.62, 5.63, 5.69 Ramakrishnan, Prem ...... 4.47 Schabus, Rudolf ...... 5.55 Panuncialman, Ian S ...... 4.34 Ramappa, Arun ...... 4.38 Scheffler, Sven U ...... 4.44, 5.73 Papadakis, Emanouel ...... 5.106, 5.114 Ranalletta, Maximiliano ...... 5.29 Schenk, Siegfried ...... 5.58 Papadogiannakis, Nikos ...... 4.72 Raptopoulos, Luciano ...... 5.99 Schiel, Karin ...... 4.34 Papadopoulos, Gregory A ...... 5.119 Ratayski, Herta ...... 4.82 Schlegel, Jürgen ...... 4.12 Papadopoulos, Grigorios ...... 5.40 Ratnam, K R ...... 5.96 Schmidt, Brita ...... 5.68 Papadopoulos, Pericles P...... 5.162 Rawal, Arvind ...... 4.53, 5.96, 5.97 Schmitz, Miguel ...... 4.2 Papageorgiou, Christos . . . .4.8, 5.38, 5.48, 5.49, Rebelo, Ana Maria ...... 5.119 Schnabel, Michael ...... 4.12 ...... 5.52, 5.67, 5.68, 5.117 Reddy, Raj K ...... 5.150 Schneider, Guenther ...... 4.33 Papas, Sam ...... 4.11 Redler, Lauren E ...... 5.118 Schoenfelder, Veronika ...... 4.44 Papastergiou, Stergios ...... 5.52 Redler, Michael R...... 5.36, 5.118 Schurhoff, Matthias Rolf ...... 4.30, 4.75, 4.92, Pape, Dietrich ...... 4.28, 4.32, 4.34, 4.87, Rees, Jonathan ...... 4.64 ...... 5.36, 5.118, 5.147 ...... 5.37, 5.70, 5.71, 5.95 Regine, R ...... 5.176 Schweinfurth, Martin ...... 4.56 Papoulias, Labros ...... 5.39 René, Verdonk ...... Scotland,. . .5.96 T R ...... 5.173 Parildar, Mustafa ...... 5.80 Renstrom, Per A ...... 4.73, 5.25 Sculco, Thomas P...... 5.93 Parisse, Giovanna Cocco ...... 5.171 Resinger, Christoph ...... 5.143 Secic, Michelle ...... 4.65 Parissis, Kostas ...... 5.52 Richardson, Airron ...... 5.63 Segawa, Hiroyuki ...... 5.70 Park, Byung Won ...... 5.93 Richmond, John C ...... 4.89 Seil, Romain4.28, 4.32, 4.43, 4.74, 4.87, 5.70, 5.71 Park, Jong-Hyuk ...... 4.23, 5.166 Riepenhof, Helge ...... 4.9 Seitz, Stefan ...... 4.17, 5.140, 5.159 Park, Tae-Woo ...... 4.75 Riesle, J...... 4.11 Seixas, Maria Thereza Alves ...... 5.24 Parker, David A ...... 4.46 Rihn, Jeffrey ...... 5.109 Sekiya, Ichiro ...... 5.78 Parker, Richard D ...... 4.89, 5.73, 5.135 Rikimaru, Hisashi ...... 5.175 Selby, Ronald M . . .4.54, 5.36, 5.71, 5.141, 5.162 Parkinson, Richard W 5.83, 5.88, 5.89, 5.98, 5.100 Rinonapoli, Giuseppe ...... 5.23, 5.85, 5.106 Sellards, Robert Allen ...... 5.162, 5.163 Parner, Jan ...... 4.91 Ristanis, Stavros ...... 5.48, 5.49, 5.68 Seo, Seung-Suk ...... 5.114, 5.141 Patrick, Garbuio ...... 5.65 Robinson, B J ...... 4.64 Seong, Sang Cheol ...... 5.60, 5.91 Patsopoulos, Iraklis Ioannis . . .5.41, 5.106, 5.114 Roca, Jaume ...... 5.101 Seppo, Egle ...... 5.150 Pau, Hon-Man ...... 4.71 Rockett, Paulo Roberto ...... 5.138, 5.139 Sergio, Migliorini ...... 4.81 Pavlik, Attila ...... 4.95 Rodkey, William G ...... 4.20, 4.60, 5.69 Sernert, Ninni ...... 4.22 Paxton, Liz W...... 5.108 Rodrigo, Juan J ...... 4.6 Servant, Christopher Terence ...... 5.71 Payne, Rebecca ...... 5.47 Rodrigues, Luciano Miller ...... 5.167 Servien, E...... 4.39, 5.114 Peccin, Maria Stella ...... 5.44 Roebuck, Margaret ...... 4.53 Severino, Nilson R...... 5.72, 5.115, 5.123, 5.131 Pecora, Jose Ricardo ...... 4.82 Roger, Torga Spak ...... Shabat,.5.166 Shay ...... 4.71, 4.72, 4.79, 5.17 Pedersen, Cheryl ...... 4.21 Rohmiller, Michael T...... 5.148 Shelbourne, K. Donald ...... 4.89, 5.141 Pedersen, Søren Torp ...... 4.16 Rolf, Christer G ...... 4.72 Shibutani, Koichi ...... 5.64 Pederzini, Luigi ...... 4.55 Romeo, Anthony ...... 4.25, 4.29, 4.47, 5.153, Shih, Chun-Hsiung ...... 5.103, 5.104

INDEX Pedowitz, Robert A ...... 4.25, 4.91 ...... 5.162, 5.163 Shimamura, Tadashi ...... 5.51 Pereira, Enrique ...... 4.14, 4.55, 5.58, 5.102 Ronga, Mario ...... 5.128, 5.129 Shimizu, Ichiro ...... 5.97 Perez, M ...... 4.72, 4.79 Roos, Ewa ...... 5.16 Shimojo, Hitoshi ...... 5.121 Periotti, Gabriel ...... 4.53 Roros, Beth A ...... 5.36 Shin, Dong-Kyu ...... 4.23 Perko, Mark ...... 5.159 Rosenberger, Ralf ...... 4.57 Shino, Konsei .4.86, 4.88, 5.65, 5.75, 5.108, 5.116 Perry, Andrew ...... 5.175 Rossi, Marko ...... 4.53 Shinomiya, Kenichi ...... 5.78 Peter, Vorlat ...... 5.96 Rossi, Walter O...... 5.29 Shinomiya, Rikuo ...... 4.76 Petersen, Wolf ...... 5.127 Rossis, Julian ...... 5.63, 5.69 Shiozaki, Yoshiki ...... 4.88, 5.75, 5.116 Peterson, Lars ...... 4.12, 5.46 Rousselin, Benoit ...... 4.48 Shiraishi, Minoru ...... 5.175 Peterson, Margaret G. E...... 5.93 Rudolph, Katherine ...... 4.68 Shiraishi, Tateru ...... 5.80 Petit, Charles ...... 4.25 Ruotolo, Charles James ...... 4.91 Shirakura, Kenji ...... 4.73, 5.51, 5.55, 5.132 Pezzella, Giulio ...... 4.55 Rupp, Stefan ...... 4.34, 4.43, 4.74, 5.37 Shirakura, Yoshihiro ...... 5.51 Piasecki, Dana P...... 5.73 Rushing, Julia ...... 4.86 Shiratsuchi, Hideaki ...... 5.123, 5.168 Pienovi, Alberto ...... 4.24, 4.54, 5.19 Russo, Alessandro ...... 5.121 Shoda, Etsuo ...... 5.123 Pieper, Hans-Gerd ...... 5.153, 5.162 Ruthner, Roberto Pedersen ...... 4.62 Shon, Wook Jin ...... 5.93 Pierre-Paul, Casteleyn ...... 5.96 Rydevik, Bjorn ...... 5.167 Shyr, Yu ...... 5.99 Pietzner, Uwe ...... 5.68 Ryu, Byung-Dam ...... 5.154 Si Selmi, T. Aït ...... 4.39, 4.63, 4.69 Pinar, Halit ...... 5.125 Ryu, Keinosuke ...... 5.87, 5.97, 5.132, 5.165 Siavara, Eleftheria ...... 5.68 Pinazo, Gabriel ...... 5.58 Sˆrries, Sabine ...... 5.153 Siebold, Rainer ...... 5.72, 5.142 Piriou, Philippe ...... 5.95, 5.122 Saartok, Tonu ...... 4.73, 5.25 Sierevelt, Inger ...... 4.42 Pizzari, Tania ...... 5.47 Safran, Marc Raymond ...... 4.28, 4.93 Sievänen, Harri ...... 4.34, 5.113 Plancher, Kevin D ...... 4.49 Sager, Rosana ...... 5.163 Silva, Paulo J. Guimar„es ...... 5.99 Ploberger, Erwin ...... 5.137 Sahni, Vishal ...... 5.98 Singleton, Steven B ...... 5.168 Pocchini, Alberto ...... 4.13, 5.158, 5.159 Saigo, Kaichiro ...... 5.97 Siu, TH ...... 5.160 Poehling, Gary G...... 4.15, 4.86 Saito, Akiyoshi . . .5.87, 5.132, 5.156, 5.165, 5.174 Skjølberg, A ...... 4.32 Poon, Kai Chung ...... 5.160 Saito, Mahiro ...... 5.78 Skutek, Michael ...... 5.22 Popiela, Wojciech ...... 5.147 Saito, Seiji ...... 5.27 Sloth, Carsten ...... 4.16 Slullitel, Daniel Adolfo ...... 4.53, 5.155 Teodor, Golia ...... 5.115 Verdenik, Zdenko ...... 5.175 Slullitel, Miguel ...... 5.155 Terashima, Yuitiro ...... 5.143 Verdonk, Peter ...... 5.144 Smeulders, Mark ...... 4.42 Terauchi, Masanori ...... 4.73, 5.51, 5.55, 5.132 Verdonk, Rene E ...... 4.21, 4.64, 5.144 Smith, Beth P ...... 4.86 Terukina, Mitsunobu ...... 4.6 Vergara, Francisco Javier ...... 4.41 Smyrnis, Anastasios ...... 5.41 Terwilliger, Ernest ...... 5.27 Verma, S ...... 4.31 Snyder, Stephen J ...... 4.15 Testa, V ...... 5.176 Vezina, William C ...... 4.87 Snyder-Mackler, Lynn ...... 4.68, 5.43 Tetik, Onur ...... 5.42 Vieira, Luis Henrique ...... 5.171 Sobau, Christian ...... 4.37, 5.142 Thain, Lisa ...... 4.46 Villar, Richard N ...... 4.78 Soejima, Takashi ...... 5.115 Thakkar, Chrish ...... 4.36 Villardi, Alfredo Marques ...... 5.99 Solheim, Eirik ...... 4.58 Thanasas, Christos ...... 5.79, 5.164 Vizesi, Frank ...... 5.145 Sonnabend, David ...... 4.17, 5.175 Theodoros, Karakoutas ...... 5.115 Vlachonikolis, I ...... 5.131 Sonoda, Masaki ...... 5.73 Thermann, Hajo ...... 4.56, 5.62 Voelkering, Kristina ...... 4.33 Sørensen, Anne Kathrine Belling ...... 4.16 Thiele, Edilson Schwansee . . . . .4.4, 5.74, 5.119, Vogrin, Tracy ...... 4.62 Soucacos, Panagiotis ...... 4.8 ...... 5.124, 5.130, 5.150 Voloshin, Ilya ...... 4.2 Soudry, Michael ...... 4.85 Thomas, John ...... 5.63 Vorlat, Peter ...... 4.64 Souza, Paulo Satiro ...... 5.167 Tibesku, Carsten ...... 4.18 Vuillemin, Arnaud ...... 4.48 Speck, Matthias ...... 4.56 Tibussek, René ...... 5.153, 5.162 Wageck, Jaime Mayer ...... 5.138, 5.139 Sperling, John W...... 4.29 Tietjens, Barry R ...... 5.75, 5.144 Wajchenberg, Marcelo ...... 5.167 Spindler, Kurt P...... 4.65, 4.73, 4.89, 5.73, Tobita, Masatoshi ...... 5.18 Wakayoshi, Kohji ...... 5.170 ...... 5.99, 5.135, 5.142, 5.148 Toh, E M ...... 5.96, 5.97 Wakimoto, Koichi ...... 5.123 Spouge, Alison ...... 4.46 Toh, Satoshi ...... 4.4, 5.64, 5.76, 5.140 Walch, Gilles ...... 5.157 Springer, Jan ...... 4.18, 5.62 Tohyama, Harukazu ...... 4.9, 4.29, 4.45, 4.50, Walch, Gilles ...... 4.93 Stabile, Kathryne J ...... 4.62, 5.109 ...... 5.52, 5.57, 5.116 Waller, Craig ...... 5.77, 5.145 Staerke, Christian ...... 4.18 Tokis, Anastasios V ...... 5.117 Walsh, William R...... 4.13, 4.17, 4.41, 4.83, Stafilas, Kosmas ...... 4.8 Tokuma, Kentaro ...... 5.132 ...... 5.77, 5.145, 5.175 Steadman, J. Richard ...... 4.20, 4.60, 5.130 Tom, Van Isacker ...... 5.96 Wang, Ching-Jen Jen ...... 5.84, 5.104, 5.130 Steenlage, Eric S...... 5.73 Tomatsu, Taisuke ...... 5.27 Wang, Jun-Wen ...... 5.84 Stein, Josh ...... 5.63 Tominaga, Akira ...... 5.30 Warner, Jon JP ...... 5.87 Stein, V...... 5.124 Tomita, Fumihisa ...... 4.29 Warren, Russell F ...... 4.26, 4.29, 4.53, 4.76, Stergiou, Nick ...... 5.48, 5.49, 5.68 Tomita, Yasutaka ...... 5.123 ...... 5.61, 5.63, 5.136 Steve, Cannon ...... 4.85 Tomiya, Akihito ...... 5.175 Warren, Todd A...... 4.73, 5.73, 5.142 Steve, Carles ...... 5.129 Tomiya, Masato ...... 5.32, 5.56 Watanabe, Yasuhiko ...... 5.121, 5.145 Stewart, Neal ...... 5.144 Tong, Wai-Chung ...... 4.71 Watarai, Koji ...... 5.143 Stoica, Cristian Ioan ...... 5.115 Toritsuka, Yukiyoshi ...... 5.75, 5.108 Waterston, S W ...... 5.173 Stone, Kevin R ...... 5.145 Torrededia, Laura ...... 5.101 Watts, Mark C ...... 4.19 Strand, Torbjorn ...... 4.58 Torres, Joaquin A...... 5.83 Weber, Stephen C ...... 5.163, 5.164 Striessnig, Gabriele ...... 5.143 Tosi, Massimo ...... 4.55 Webster, Kate E ...... 4.36, 5.47, 5.86 Struijs, Peter ...... 5.16 Tossi, Rafael Jose ...... 4.24, 4.54 Weidemann, Pernille ...... 4.91 Stump, Timothy ...... 5.61 Toyama, Yoshiaki ...... 5.28 Weiler, Andreas ...... 4.44, 5.73 Suda, Yasunori ...... 5.28, 5.80, 5.122, 5.136 Toyoda, Takashi ...... 5.28, 5.122, 5.136 Weintraub, Steve ...... 5.71 Suedkamp, Norbert ...... 4.44 Traina, Steven M...... 5.59 Weis, Lawrence ...... 5.148 Sugaya, Hiroyuki ...... 5.168 TRC, Tomas ...... 5.15, 5.50 Wentorf, Fred A...... 4.9 Sugihara, Atsushi ...... 5.56 Triolo, Pier Franco ...... 5.98 White, Lawrence ...... 4.19 Suginoshita, Takehiko ...... 5.76 Trippel, Stephen ...... 5.27 Wickiewicz, ThomasL. . . . .5.61, 5.63, 5.86, 5.136 Sugita, Atsushi ...... 5.109, 5.115 Trivett, Adrian J ...... 4.46 Wiger, Per ...... 4.16 Sugita, Takehiko ...... 5.99, 5.175 Trojani, Christophe ...... 4.17, 4.94 Willems, J.W...... 4.11, 4.13 Sugiura, Shin ...... 5.149 Trombini, Augusto ...... 5.88 Williams, Riley J...... 5.136 Suma, Makoto ...... 5.169 Tsai, Albert M ...... 5.63 Wills, Nick ...... 4.9 Sumen, Yoshio ...... 5.26, 5.78, 5.105 Tsepis, Elias ...... 5.48, 5.49, 5.67 Wilson, Christopher J ...... 5.100 Sumettavanich, Charlee ...... 5.70 Tsitouridis, Ioannis ...... 5.52 Wilson, David R...... 4.38 Sur, Hakki ...... 5.80, 5.103 Tsuchiya, Akihiro ...... 5.54, 5.123, 5.168 Wilson, Michael ...... 4.56 Sureen, Sanjay ...... 5.98 Tsuchiya, Gen ...... 5.76 Wilton, Tim J...... 5.89 Sutherland, Alasdair ...... 5.42 Tsuda, Eiichi ...... 5.76 Winters, Wendy ...... 4.71 Sutton, Paul M ...... 5.144 Tsukahara, Takashi ...... 5.76 Wischatta, Ralph ...... 5.124 Suva, Domizio ...... 4.35 Tsukazaki, Satoshi ...... 5.32, 5.56 Wittwer, Jo ...... 5.86 Suzuki, Takashi ...... 5.95, 5.133, 5.138 Tsumura, Nobuhiro ...... 4.83 Wlk, Matthias ...... 4.14 Svensson, Michael ...... 5.54 Turek, Tom ...... 5.145 Wolde-Tsadik, G ...... 4.93 Sward, Leif ...... 4.78, 5.166, 5.167 Turner, Maria A...... 4.8 Wolin, Preston M...... 5.36 Tachibana, Keizo ...... 4.75 Turnipseed, Elizabeth ...... 4.65 Wong, Candace YH ...... 5.42 Tachikyan, Isabelle ...... 4.57 Tuy, Benjamin ...... 4.31, 4.34, 4.61, 5.79, 5.80 Wong, J ...... 5.173 Tagawa, Yasuhiro ...... 5.116 Tytherleigh-Strong, Graham . . .4.46, 4.58, 5.163 Wong, Yim-Ping ...... 4.71 Tait, Gavin ...... 5.100 Tzanakakis, Nikolaos ...... 5.101 Woo, Jong-Ken ...... 4.75 Takagishi, Kenji ...... 4.73, 5.51, 5.55, 5.132 Tzortzakis, Vassilios ...... 5.39 Woo, Savio L-Y ...... 4.62, 5.109, 5.121 Takahashi, Masanori ...... 5.120 Tzurbakis, Matheos ...... 5.41, 5.106, 5.114 Wood, Edward V ...... 5.89, 5.100 Takahashi, Rogerio ...... 5.171 Uchio, Yuji ...... 4.8, 4.76, 5.18, 5.20, 5.25, Wordliczek, Jerzy ...... 5.147 INDEX Takahashi, Toshiaki ...... 5.30, 5.101 ...... 5.26, 5.28, 5.37, 5.77, 5.91, 5.144 Wredmark, Torsten ...... 5.25 Takahei, Tamio ...... 5.67 Upasani, Vidyadhar V ...... 4.91 Wright, Rick W...... 5.135 Takao, Masato ...... 5.18, 5.20 Uribe, John William ...... 4.30, 4.75, 4.92, 5.36, Wu, Gloria HK ...... 5.160 Takeda, Hideaki ...... 5.143 ...... 5.118, 5.147 Wymenga, Ate ...... 4.66, 5.90, 5.117 Takeda, Mitsuhiro ...... 4.73 Ushida, Takashi ...... 5.30 Xenos, Georgios ...... 5.101 Takeda, Yoshitsugu ...... 4.75 Uysal, Mustafa ...... 5.23 Yagi, Masayoshi ...... 5.77, 5.78, 5.110, 5.112 Tanabe, Yuji ...... 5.133 Uzpak, Ali ...... 5.133 Yagishita, Kazuyoshi ...... 5.78 Tanaka, Junzo ...... 5.121 Vagenas, George ...... 5.67 Yamaguchi, Hidetoshi ...... 5.18 Tanaka, Nobuhiro ...... 5.115 Valentini, Roberto ...... 4.55, 5.58, 5.102 Yamaguchi, Kazuhiro ...... 5.14, 5.164 Tanaka, Shinobu ...... 5.121 Valeu, Renee ...... 4.71 Yamaguchi, Keiichiro ...... 5.175 Tandogan, Reha N ...... 4.39, 5.156 Van der Aa, Jan ...... 4.85 Yamaguchi, Ken ...... 5.33 Tang, Kanglai ...... 4.72 Van der Hulst, Victor ...... 4.13 Yamamoto, Hiroshi ...... 5.30, 5.101 Tasto, James P . . . . .4.25, 4.48, 4.71, 5.31, 5.161 Van der Woude, Henk-Jan ...... 4.13 Yamamoto, Kazuki ...... 4.84, 5.65, 5.113 Tateishi, Tetsuya ...... 5.30 Van Dijk, Niek CN ...... 4.42, 5.16 Yamamoto, Yasuhiro ...... 5.168, 5.169 Tatsuo, Aihara ...... 5.72, 5.115 Van Eijk, F...... 4.11 Yamamura, Toshiaki ...... 5.65 Taylor, Dean C ...... 4.24, 4.31 Van Rooyen, Karin ...... 4.15, 5.151, 5.158 Yamanaka, Masanori ...... 4.9, 4.50 Taylor, Nicholas ...... 5.47 Varela, Daniel ...... 4.24 Yamanaka, Norio ...... 5.101 Taylor, Samuel A...... 4.52, 5.36, 5.162 Vargas, Luis A ...... 5.118 Yamane, Shigeru ...... 4.84, 5.65, 5.113 Taylor, Stephen A...... 4.54 Vascellari, Alberto ...... 5.61, 5.121 Yamashita, Takeshi ...... 5.73 Teanby, D ...... 5.96, 5.97 Vatansever, Aziz ...... 5.102 Yamazaki, Junya ...... 5.78 Teitz, Carol C...... 4.78 Vecsei, Vilmos ...... 4.12, 5.55, 5.143 Yamazaki, Shuji ...... 4.29 Temme, Carsten ...... 4.9 Veiga, Lais Turqueto ...... 5.99 Yaniv, Moshe ...... 4.57, 5.126 Ten Ham, Arno M...... 4.66 Vena, Luca Maria ...... 4.68 Yasuda, Kazunori ...... 4.9, 4.29, 4.45, 4.50, ...... 4.67, 5.52, 5.57, 5.116 Yasumoto, Masanori ...... 5.78, 5.105 Yasunori, Tsukimura ...... 5.79 Yatabe, Taku ...... 5.122 Yeo, Jun-Young ...... 5.171 Yiannakopoulos, Christos K . . . .4.23, 5.39, 5.40, ...... 5.79, 5.119, 5.150, 5.151, 5.164 Yoneda, Minoru ...... 5.154, 5.161 Yonetani, Yasukazu ...... 5.75 Yong Bok, Jung ...... 5.118 Yoshida, Masaaki ...... 5.51 Yoshihara, Yasuo ...... 5.32 Yoshii, Yuichi ...... 5.145 Yoshikawa, Gen-itsu ...... 5.136, 5.165 Yoshikawa, Toshikazu ...... 5.52 Yoshimatsu, Shunichi ...... 5.165 Yoshimatsu, Toshinori . .5.87, 5.132, 5.165, 5.174 Yoshiya, Shinichi ...... 4.60, 4.83, 5.77, 5.78, ...... 5.110, 5.112 Yu, Yan ...... 5.77 Yucel, Istemi ...... 5.38 Yucra, Vladimir ...... 4.53 Yukata, Kiminori ...... 5.94 Yves, Lefebvre ...... 5.166 Zacharopoulos, Athanasios N...... 5.101 Zaffagnini, Stefano ...... 4.5, 5.61, 5.121 Zampetti, Piergiuseppe ...... 4.7 Zanoni, Emerson K...... 4.4, 5.74, 5.119, 5.124, ...... 5.130, 5.150 Zantop, Thore ...... 4.62 Zarur, Nicolas ...... 5.165 Zeichen, Johannes ...... 5.22 Zenteno, Benigno Ch ...... 5.165 Zielinski, Martina ...... 5.140 Zion, Ido ...... 5.33, 5.60 Zoric, Bojan ...... 4.52 Zulkharnain, Ismail ...... 5.94 Zvijac, John E ...... 4.30, 4.75, 4.92, ...... 5.36, 5.118, 5.147 Zwipp, Herman ...... 5.16 INDEX