DOS BULLETIN - Dansk Ortopædisk Selskab
DOS BULLETIN - Dansk Ortopædisk Selskab DOS BULLETIN - Dansk Ortopædisk Selskab
2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 96 Serial Dilation reduces Graft Slippage compared to Extraction Drilling in Anterior Cruciate Ligament Reconstruction: A Randomized Controlled Trial using Radiostereometric Analysis OG Sørensen, K Larsen, BW Jakobsen, TB Hansen, M Lind, K Søballe University Hospital of Aarhus; Hospital Unit West; Hamlet Private Hospital Background: The hamstring tendon graft has become increasingly popular in anterior cruciate ligament reconstruction because of low donorsite morbidity. However, the tibial fixation is considered problematic, partly because of low tibial mineral bone density. Purpose: This study tested the hypothesis that serial dilation of the tibial tunnel could provide a stronger anchorage of the graft-fixation-device complex compared to traditional extraction drilling. Methods: Forty patients (22 males and 18 females) undergoing ACL reconstruction were randomized to either extraction drilling (group ED) or compaction by serial dilation (group SD) of the tibial tunnel. Tantalum beads were placed in the tibia, femur, and in the hamstring graft. Radiostereometric analysis (RSA) were performed postoperatively and again after 6, 12, and 24 weeks. Migration of graft in the bone tunnels as well as knee laxity was assessed using RSA and a TELOS stress device. Findings: Six patients (3 males and 3 females) were excluded during follow-up, which resulted in 17 patients in group ED (median age: 30 years (range: 20 – 50)) and 17 patients in group SD (median age: 32 years (range: 20 – 49)). The mean migration of the graft at in the tibial bone canal after 3 months was 1.3 (SD 0.6) mm, in group ED and 0.8 (SD 0.5) mm in group SD (P = 0.02). The overall knee laxity after 3 months was 13.0 (SD 4.0) mm in group ED and 10.9 (SD 3.1) mm in group SD. Conclusion: This study found significantly less slippage of the hamstring graft in the tibial bone canal in the serial dilated group compared to the extraction drilling group. The clinical relevance of the difference is unknown. No difference in stress radiographic knee laxity was found between the 2 groups. 96
2010-378_DOS nr. 3 2010 29/09/10 10:08 Side 97 Bone density in relation to failure in patients with osteosynthesized femoral neck fractures Bjarke Viberg, Jesper Ryg, Jens Lauritsen, Søren Overgaard, Ole Ovesen Department of Orthopaedic Surgery and Traumatology, Odense University Hospital and Institute of Clinical Research, University of Southern Denmark; Department of Geriatrics, Odense University Hospital Background: The treatment of femoral neck fracture with internal fixation (IF) is recommended in younger patients and has compared to arthroplasty the advantage of retaining the femoral head. A big problem with osteosynthesis is though failure. Finding predictors for fixation failure is still an ongoing process and osteoporosis has been suggested as a predictor. Purpose: To correlate bone mineral density (BMD) in regard to failure of IF in osteosynthesized femoral neck fractures. Methods: In a health technology assessment study from 2005-2006 at Odense University Hospital, Department of Orthopaedic Surgery and Traumatology, 177 patients with femoral neck fractures accepted DEXA –scanning of the hip and lumbar spine assessing BMD. Final follow-up were 01.08.2010 and 142 patients with IF comprised the final cohort. The cohort consisted of 106 females and 36 males with a mean (CI) age of 77,1 (75,3-78,9). Failure is defined as revision surgery or new fracture. Findings: 69 patients had a t-score (total hip) below -2,5 SD as defined for osteoporosis. At 1 year the overall (dislocated) failure rate was 34,3 % (44,2 %), at 2 years 45,1 % (59,4 %) and at end of follow-up 49,2 % (62,1 %). In the cox regression analysis the following factors for failure were significant: dislocated fracture, osteosynthesis placement and prior fracture. There were no association for total hip BMD, neck BMD, age, sex, quality of fracture reduction, walking disability, independent living, alcohol or smoking. A cox regression sub analysis of the undisplaced fractures showed significant result only for osteosynthesis placement. Conclusion: There is no association between BMD and failure of internal fixation in osteosynthesized femoral neck fractures. 97
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2010-378_<strong>DOS</strong> nr. 3 2010 29/09/10 10:08 Side 96<br />
Serial Dilation reduces Graft Slippage compared to<br />
Extraction Drilling in Anterior Cruciate Ligament<br />
Reconstruction:<br />
A Randomized Controlled Trial using<br />
Radiostereometric Analysis<br />
OG Sørensen, K Larsen, BW Jakobsen, TB Hansen, M Lind, K Søballe<br />
University Hospital of Aarhus; Hospital Unit West;<br />
Hamlet Private Hospital<br />
Background: The hamstring tendon graft has become increasingly popular<br />
in anterior cruciate ligament reconstruction because of low donorsite<br />
morbidity. However, the tibial fixation is considered problematic,<br />
partly because of low tibial mineral bone density.<br />
Purpose: This study tested the hypothesis that serial dilation of the tibial<br />
tunnel could provide a stronger anchorage of the graft-fixation-device<br />
complex compared to traditional extraction drilling.<br />
Methods: Forty patients (22 males and 18 females) undergoing ACL<br />
reconstruction were randomized to either extraction drilling (group ED)<br />
or compaction by serial dilation (group SD) of the tibial tunnel. Tantalum<br />
beads were placed in the tibia, femur, and in the hamstring graft.<br />
Radiostereometric analysis (RSA) were performed postoperatively and<br />
again after 6, 12, and 24 weeks. Migration of graft in the bone tunnels as<br />
well as knee laxity was assessed using RSA and a TELOS stress device.<br />
Findings: Six patients (3 males and 3 females) were excluded during<br />
follow-up, which resulted in 17 patients in group ED (median age: 30<br />
years (range: 20 – 50)) and 17 patients in group SD (median age: 32<br />
years (range: 20 – 49)). The mean migration of the graft at in the tibial<br />
bone canal after 3 months was 1.3 (SD 0.6) mm, in group ED and 0.8<br />
(SD 0.5) mm in group SD (P = 0.02). The overall knee laxity after 3<br />
months was 13.0 (SD 4.0) mm in group ED and 10.9 (SD 3.1) mm in<br />
group SD.<br />
Conclusion: This study found significantly less slippage of the hamstring<br />
graft in the tibial bone canal in the serial dilated group compared<br />
to the extraction drilling group. The clinical relevance of the difference<br />
is unknown. No difference in stress radiographic knee laxity was found<br />
between the 2 groups.<br />
96