Purpose. The aim of the present study was to investigate the relationship between generalised ligament laxity and requirement for revision ACL reconstruction. Materials and methods. 126 patients undergoing primary ACL reconstruction were included in the study along with 35 patients undergoing revision ACL surgery. 62 patients without any knee ligament injury formed an age and sex matched the control group. The Beighton score was used to quantify the ligamentous laxity in all cases with a score more than 4 classified as having generalised ligamentous laxity. The revision ACL patients were evaluated to identify technical errors at the time of the primary procedure or subsequent traumatic injury that could have contributed to primary graft failure. Results. The primary ACL surgery group was associated with an increased generalised ligamentous laxity compared to the control group and this was statistically significant (p < 0.05). Similarly the revision surgery group was also associated with increased generalised ligamentous laxity compared to the control group (p < 0.05). The revision ACL surgery group was also associated with increased generalised ligamentous laxity when compared to the primary ACL surgery group but this did not quite achieve statistical significance (p = 0.058). There was a subgroup within the revision cohort, who had a failure of the original surgery due to biological failure of the primary graft. The incidence of generalised ligament laxity in this group was significantly higher than the primary surgery group (p < 0.05). Conclusion. The findings of the study suggest a clear relationship between generalised ligamentous laxity and ACL injury. The study also highlights a link between generalised ligamentous laxity and requirement for revision ACL surgery. Based on the results of our study we feel that in the presence of GLL an autogenous graft may not be the best mode of reconstruction for either primary of revision ACL reconstruction. A case could be made for preferring allografts over autografts for these patients to reduce the rate of graft failure. Further prospective studies comparing allograft and autorgraft failure rates in patients undergoing primary and revision ACL are required to confirm our observations

Structural allografts may be used to manage uncontained bone defects in revision total knee replacement (TKR). However, the availability of cadaver grafts is limited in some areas of Asia. The aim of this study was to evaluate the mid-term outcome of the use of femoral head allografts for the reconstruction of uncontained defects in revision TKR, focusing on complications related to the graft.

We retrospectively reviewed 28 patients (30 TKRs) with Anderson Orthopaedic Research Institute (AORI) type 3 bone defects, who underwent revision using femoral head allografts and stemmed components. The mean number of femoral heads used was 1.7 (1 to 3). The allograft–host junctions were packed with cancellous autograft.

At a mean follow-up of 76 months (38 to 136) the mean American Knee Society knee score improved from 37.2 (17 to 60) pre-operatively to 90 (83 to 100) (p < 0.001). The mean function score improved from 26.5 (0 to 50) pre-operatively to 81 (60 to 100) (p < 0.001). All the grafts healed to the host bone. The mean time to healing of the graft was 6.6 months (4 to 16). There have been no complications of collapse of the graft, nonunion, infection or implant loosening. No revision surgery was required.

The use of femoral head allografts in conjunction with a stemmed component and autogenous bone graft in revision TKR in patients with uncontained bone defects resulted in a high rate of healing of the graft with minimal complications and a satisfactory outcome. Longer follow-up is needed to observe the evolution of the graft.

Cite this article: Bone Joint J 2013;95-B:643–8.

We present the operative technique and clinical results of concomitant reconstruction of the medial collateral ligament (MCL) and the posterior oblique ligament for medial instability of the knee using autogenous semitendinosus tendon with preservation of the tibial attachment. The semitendinosus tendon graft between the screw on the medial epicondyle and the tibial attachment of the graft was overlapped by the MCL, while the graft between the screw and the insertion of the direct head of the semimembranosus tendon was overlapped by the central arm of the posterior oblique ligament. Assessment was by stress radiograph and the Lysholm knee scoring scale. After a mean follow-up of 52.6 months (25 to 92), the medial joint opening of the knee was within 2 mm in 22 of 24 patients. The mean Lysholm score was 91.9 (80 to 100).

Concomitant reconstruction of the MCL and posterior oblique ligament using autogenous semitendinosus tendon provides a good solution to medial instability.

We have investigated the changes in anterior laxity of the knee in response to direct electrical stimulation of eight normal and 45 reconstructed anterior cruciate ligaments (ACLs). In the latter, the mean time from reconstruction was 26.7 months (24 to 32). The ACL was stimulated electrically using a bipolar electrode probe during arthroscopy. Anterior laxity was examined with the knee flexed at 20° under a force of 134 N applied anteriorly to the tibia using the KT-2000 knee arthrometer before, during and after electrical stimulation.

Anterior tibial translation in eight normal and 17 ACL-reconstructed knees was significantly decreased during stimulation, compared with that before stimulation. In 28 knees with reconstruction of the ACL, in 22 of which the grafts were found to have detectable somatosensory evoked potentials during stimulation, anterior tibial translation was not decreased. These findings suggest that the ACL-hamstring reflex arc in normal knees may contribute to the functional stability and that this may not be fully restored after some reconstructions of the ACL.