Level IV.

Prior to ACL revision surgery, bone tunnel measurements can be done using a 3D T1-MRI sequence in low-field MRI. MRI measurements show the same accuracy as CT scans. Preoperative radiation exposure in mainly young patients could be reduced. Also the costs of an additional CT scan could be saved.

No abstract

Aims and Objectives: Local infiltration analgesia (LIA) is meanwhile worldwide established and scientifically proven in perioperative treatment of TKA. Single-shot is the mostly used option. However, after the local analgesia has subsided, at the latest after the day of surgery, the pain is usually present and affects rapid mobilization and rehabilitation. Long-acting medications for LIA have not proved to be effective and there are barely data on intra-articular continuous analgesia. We present a randomized controlled trial which compares the LIA with and without additional continuous analgesia using an intraarticular catheter. Materials and Methods: 50 patients with TKA were randomized and included in the study. All patients received the same implant system without patellar resurfacing, without tourniquet or drains. The operation was performed by the same surgeon and postoperative treatment was identical. Both groups received a general anesthesia with laryngeal mask. A group of 25 patients received a single-shot LIA containing 150 ml bupivacaine (0.2%) and morphine (20 mg). The other group, also 25 patients, received the same single-shot LIA and an intraarticular catheter (350 ml) for 3 days with continuous infiltration (8ml/h) of bupivacaine (0.2%) and morphine (20 mg per 200 ml bupivacaine) . The following parameters were recorded preoperatively and postoperatively: VAS, additionally analgetics / opioids. Also included were complications such as infections, postoperative falls and DVT. Results: The average operating time was 46 min. There were no complications or reinterventions. The results were not significantly different during the first day, but for day 2 to 4 VAS was significantly better and additional analgetics / opioids were significantly less (p <0.05) in the group with additional catheters. On days 5 and 6, the results again were comparable. Conclusion: There was a superiority of the additional intra-articular catheter for some days in the perioperative treatment of TKA.

Aims and Objectives: Based on a large quantity of CT data, variations in distal femoral geometry was examined and evaluated for TKA. Materials and Methods: A retrospective study was performed on 24,042 data sets generated during the process of designing individual knee implants. Following parameters were recorded for the distal femur: Femoral absolute anterior-posterior (AP) and medial-lateral (ML) extent, lateral and medial condyle and trochlea size, distal condylar offset (DCO) between lateral and medial condyle, and the difference between medial and lateral posterior condylar offset (PCO) measured in AP direction. Results: Variable patient geometry was found with analysis of the AP and ML extent. Approximately one-third of the patients would experience size conflicts of +/- 3 mm with standard arthroplasty systems. 62% of the knees had a DCO> 1 mm. 83% of the distal femur had a mediolateral difference in PCO> 2 mm, which corresponds to about 3° external rotation and does not correlate with the femoral size. Conclusion: There is a distinct variability of femoral AP and ML extent as well as offsets / asymmetries. Medial and lateral PCOs are different and do not correlate with femoral size. This first results in mismatches between size of implant and individual knee anatomy and secondly in possible softtissue release and different femoral external rotations to adapt systems with fixed distal geometry to the individual situation.