Background: The purpose of the study was to evaluate whether anteroposterior translation (APT) after ACL reconstruction with intraoperative balancing of the transplant tension to that of the contralateral ACL could be obtained at follow up. Additionally, differences of APT’s following ACL reconstruction using either autologous patella bonetendon–bone (BTB) or autologous quadriceps-tendon-bone (QTB) were assessed.

Methods: In a consecutive series of 44 patients (44 knees), ACL deficiency was treated in 30 patients (median age: 33, 16–58, 20 male, 22 right knee) with BTB–and in 14 patients (median age: 31, 17–50, 8 male, 10 right knee) with QTB-reconstruction. APT was evaluated in 20° knee flexion in the affected and healthy contralateral knee using the Rolimeter^®. Measurements were performed in both knees preoperative, during, and immediately after ACL-reconstrucion, as well as 3, 6 and 12 months postoperatively in triplates. For statistical analysis the non-parametrical Kruskal-Wallis Test (post test: Dunn’s Test) was used.

Results: Statistically significant decreases of APT were observed between pre–and intraoperative measurements in the BTB–and the QTB-group due to ACL reconstruction (11.1±2.0 to 6.3±0.7mm; p< 0.001 in the BTB and 11.1±2.3 to 6.8±1.2mm; p< 0.001 in QTB group). At the intraoperative measurements, there were no differences in APT between the contralateral healthy knee and the reconstructed knee in both groups. During the follow up, significant loss of APT in the balanced reconstructed knees were only observed in the BTB group after 12 months (6.3±0.7 to 7.5±1.2mm; p< 0.05).

Conclusion: After reconstruction of the ACL, BTB–and QTB-ACL reconstruction groups, yielded the same anteroposterior translation (APT) as contralateral healthy knees. This new intraoperative technique provides ACL reconstruction with balancing of the anteroposterior knee translation of the healthy contralateral knee. An increase in APT could be observed 12 months after ACL reconstruction only in the BTB group. Further research is necessary to assess whether QTB-ACL-reconstruction should be preferred regarding preservation of the initial ligament tension at follow up.

Aims : This prospective study investigated outcomes from TKA using the ligament balancing technique to implant a PCL-retaining knee prosthesis (balanSys^™ knee system). In addition we wanted to know if we can achieve stability in these knees and if there is a difference between mobile and fixed bearing prosthesis designs?

Methods: Between March 2001 and Mai 2005 143 patients (17 bilateral; n=160) with osteoarthritis received the balanSys^™ knee system with either a fixed or mobile polyethylene bearing. Objective assessments of the implant used Knee Society score (KSS) with the knee and functional score. Anterior-posterior translation was measured with the Rolimeter (Aircast) in 25° (Lachman) (mean of 3) and 90° of knee flexion (mean of 3), intraoperatively under anaesthesia and at follow up time. Subjective assessments used Visual Analogue Scale (VAS) data for pain, and patient satisfaction.

Results: The study population at follow up time (mean 4 years) contained 112 patients (31 males; 81 females) with 126 knee implants out of 160. Of these 126, 93 had fixed and 33 mobile bearings. Mean age at surgery was 70.6 years. The Rolimeter measurements for ap-translation showed an increase of stability from 8.3 preop to 4.6 mm at FU in 25° of flexion and 6.3 to 4.9 in 90° of flexion. The increase of stability for mobile bearings (7.8 to 5.8/6.1 to 6.0) is smaller than for fixed bearings (8.4 to 5.8/6.9 to 4.5). The t-test shows a clear cut significance Pr > [t] = 0.0038, the difference of the paired difference amounts to 1.4 mm. The t-test shows significant differences for both angles (25°/90°) Pr > [t] < 0.001. Mobile bearings have a higher laxity in ap direction compared to fixed bearings. ROM was similar for both genders (mean 118°). According to VAS, mean scores for pain and satisfaction were 1.5 (best 0) and 8.5 (best 10), respectively. The KSS (mean score 168; SD 31.1) was similar for both, fixed and mobile bearings. In 25° of flexion the subgroup of ‘tight’ knees (1–3.5 mm ap translation) and in 90° the subgroup of ‘loose’ knees (< 5.5 mm) performed best, with highest knee scores.

Conclusions: The TKA’s performed with a PCL-retaining prosthesis and a soft tissue oriented, ligament balancing, surgical technique were associated with good outcome (KSS mean score 168), a good range of motion (118°), good stability and with no significant differences between mobile bearing or fixed bearing implants at follow up (4 years). In addition patients reported little pain (1.5) and were very satisfied (8.5) with the outcome. Interesting was the fact that in 25° of flexion the subgroup of tight knees (1–3.5mm) and in 90° the subgroup of loose knees (< 5.5 mm) performed best, with highest knee scores.

Aims: Fractures of the distal radius are one of the most frequent fractures in older patients. For treatment this fractures conservative and operative procedures are accept. It was the aim of this retrospective study to point out, clinical and economical advantages of the treatment with the radioradial þxateur externe against the conservative therapy and other operative treatments. Methods: Between September 1999 und December 2000 58 patientens (53 women/5 men), older than 65 years (78,4±8,1), with fractures of the distal radius were treated in our hospital. 50 patients were clinically and radiologically controlled. Results: AO-Classiþcation: A84%, B4%, C12%. 11 patients were treated conservative (group1), 21 patients treated with radio-radial þxation (group2), 17 patients with other osteosynthesis (group3). There were signiþcant differences in the dorsal tilt of the articular plane, proceed from a post-traumatic Δtilt at 25,7¡±8,1¡. The fractures were corrected on a Δtilt at 16,3¡±4,3¡(group1) vs. a Δtilt at -1,0¡±7,2¡(group2) vs. a Δtilt at 9,7¡±6,9¡(group3) (p< 0,001). Also after 12 months this difference was signiþcantly higher: 21,5¡±9,9¡ vs. 1,7¡±7,6¡ vs. 10,5¡±8¡ (p< 0,001). Likewise signiþcant difference was the estimation of the postoperative pain with the visual-pain-analog-scale: 18,4±13,6 vs. 6,6±8,8 (p< 0,05). The costs for ambulant nursing and housekeeping amount to 3500e in group1, in group2 1500e. Conclusions: The treatment of fractures of the distal radius in older patients with poor bone-quality with radio-radial þxateur externe represents a alternative by clinical and radiological good results. Improved motion conducts a clear mean expenditure of ambulant after-treatment. Because of the developing savings-potential and the better clinical and radiological results the radio-radial þxateur externe can be recommended as a cost-lowering and quality-securing treatment.