I n a two-centre study, 164 patients with unilateral instability of the anterior cruciate ligament were prospectively randomised to arthroscopic reconstruction with either a patellar tendon graft using interference screw fixation or a quadruple semitendinosus graft using an endobutton fixation technique. The same postoperative rehabilitation protocol was used for all patients and follow-up at a median of 31 months (24 to 59) was carried out by independent observers. Four patients (2%) were lost to follow-up.No significant differences were found between the groups regarding the Stryker laxity test, one-leg hop test, Tegner activity level, Lysholm score, patellofemoral pain score, International Knee Documentation Committee (IKDC) score or visual analogue scale, reflecting patient satisfaction and knee function. Slightly decreased extension, compared with the non-operated side, was found in the patellar tendon group (p < 0.05). Patients with associated meniscal injuries had lower IKDC, visual analogue (p < 0.01) and Lysholm scores (p < 0.05) than those without such injuries. Patients in whom reconstruction had been carried out less than five months after the injury had better final IKDC scores than the more chronic cases (p < 0.05).We conclude that patellar tendon and quadruple semitendinous tendon grafts have similar outcomes in the medium term. Associated meniscal pathology significantly affects the final outcome and early reconstruction seems to be beneficial. The bone-patellar tendon-bone graft has been regarded as the procedure of choice in reconstruction of the anterior cruciate ligament (ACL) for more than two decades. [1][2][3][4] Alternatives include semitendinosus or combined semitendinosus/gracilis tendon grafts. Few of the numerous studies reflecting the functional outcome after these different procedures are prospective investigations and even fewer are both prospective and randomised.5-7 Combined semitendinosus and gracilis grafts have been used in previous randomised studies. To the best of our knowledge, no prospective, randomised study comparing bone-patellar tendon-bone grafts with quadruple semitendinosus tendon grafts has been published. The particular clinical issues relate to possible elongation of hamstring tendon grafts over time, their possible lower donor site morbidity, especially reflecting patellofemoral problems, and optimal fixation technique.Our aim was to compare arthroscopically-assisted reconstruction of the ACL using bone-patellar tendon-bone graft and interference screw fixation with quadruple semitendinosus tendon graft using endobutton fixation proximally and screws distally. Patients and MethodsBetween 1995 and 1997, in a two-centre study, 180 patients were prospectively randomised to reconstruction of the ACL with either an ipsilateral bone-patellar tendon-bone graft or a quadruple semitendinosus graft. Inclusion criteria were single-leg insufficiency of the ACL with the trauma occurring at least two months before reconstruction, age between 15 and 45 years, no previous reco...

In a two-centre study, 164 patients with unilateral instability of the anterior cruciate ligament were prospectively randomised to arthroscopic reconstruction with either a patellar tendon graft using interference screw fixation or a quadruple semitendinosus graft using an endobutton fixation technique. The same postoperative rehabilitation protocol was used for all patients and follow-up at a median of 31 months (24 to 59) was carried out by independent observers. Four patients (2%) were lost to follow-up. No significant differences were found between the groups regarding the Stryker laxity test, one-leg hop test, Tegner activity level, Lysholm score, patellofemoral pain score, International Knee Documentation Committee (IKDC) score or visual analogue scale, reflecting patient satisfaction and knee function. Slightly decreased extension, compared with the non-operated side, was found in the patellar tendon group (p < 0.05). Patients with associated meniscal injuries had lower IKDC, visual analogue (p < 0.01) and Lysholm scores (p < 0.05) than those without such injuries. Patients in whom reconstruction had been carried out less than five months after the injury had better final IKDC scores than the more chronic cases (p < 0.05). We conclude that patellar tendon and quadruple semitendinous tendon grafts have similar outcomes in the medium term. Associated meniscal pathology significantly affects the final outcome and early reconstruction seems to be beneficial.

We report a case of long lasting respiratory depression after intravenous administration of morphine to a 7 year old girl with haemolytic uraemic syndrome. The plasma concentrations of the active metabolite M6G were more than 10 times those normally seen and the half-lives of M6G and morphine were prolonged.

The short-term effect of epidural anaesthesia (EDA) on the serum potassium (S-K) concentration was studied in 40 elderly men scheduled for minor urological surgery. In Group I, EDA was induced with mepivacaine 2% + adrenaline 1:200,000 (n = 20) and in Group II mepivacaine 2% was used (n = 20). When EDA had been induced, the mean plasma level of adrenaline was tripled in Group I, while it had decreased in Group II. In Group I there was a decrease in the arterial S-K concentration of up to 0.75 mmol.l-1 with a mean of 0.31 mmol.l-1, s.d. 0.20 (P less than 0.001). In Group II, a small but significant decrease of the S-K level was recorded in arterial (0.14 mmol.l-1, s.d. 0.14; P less than 0.001) but not in venous serum. Two-way analysis of variance showed that the addition of adrenaline to the local anaesthetic solution, but not the choice of using arterial or venous serum for analysis, significantly correlated to the lowering of the S-K concentration (P less than 0.001).

Epinephrine lowers the serum potassium level through an effect on the beta2-receptor. It is therefore difficult to evaluate whether depression of the ST level and the T wave on the electrocardiogram, during regional anaesthesia, is caused by a high plasma epinephrine level, a low serum potassium level, or both. For this purpose, we studied the relation between electrocardiogram and the plasma epinephrine and serum potassium concentrations during 20 intra-abdominal operations performed under combined epidural and general anaesthesia and in 18 subjects receiving intercostal nerve blockade. The results show that the hypokalaemic effect of epinephrine was reduced when the plasma epinephrine concentration exceeded 3 nmol L-1. A multiple regression analysis demonstrated that the ST level and the T-wave amplitude were most consistently affected by a low serum potassium level, while a high plasma epinephrine level correlated only to a depression in the T-wave amplitude. During surgery, only serum potassium correlated with these ECG variables.