The purpose of this study was to define the topography of the articular surface of the femoral condyles and to develop a method for computerized topographic matching of donor and recipient sites for osteochondral transplantation. The condyles of seven fresh cadaveric femurs were mounted on the rotating stage of a laser-based coordinate measuring machine. An anatomic coordinate system defining the articular surface of the condyles was created. Customized software was developed to allow selection and topographic matching of osteochondral graft donor and recipient sites from any location on the surface of the condyles. For cartilage defects within the weightbearing portions of the medial or lateral femoral condyles, grafts taken from sites from the most medial or lateral portions of the patellar groove provided a significantly better topographic match than did grafts taken from the central intercondylar notch.

The purpose of this study was to evaluate the results and complications of anterior cruciate ligament surgery in middle-aged patients. Forty-five consecutive pa tients over 40 years old (average age, 44.6 years) who had arthroscopically assisted anterior cruciate liga ment reconstructions with midthird patellar tendon au tografts were evaluated. The patients returned for in terviews, physical examinations, radiographs, Biodex dynamometer strength testing, and KT-1000 arthrom eter testing at an average of 37 months after their surgeries (range, 24 to 96 months). The mean Lysholm and Gillquist score was 91, which corresponds to symptoms only with vigorous activity. The overall scores from the International Knee Documentation Committee form were 29 (64%) normal or nearly nor mal and 2 (4%) severely abnormal. Side-to-side differ ences as determined by the KT-1 000 arthrometer were ≤3 mm in 31 of 40 patients (78%), between 3 and 5 mm in 4 patients (10%), and >5 mm in 5 patients at 30 pounds of anterior displacement. Seventy-six percent of the patients (N = 34) returned to their preoperative activity levels. Three patients required repeat arthro scopic surgery for persistent knee pain and two pa tients had graft ruptures. This study shows that when middle-aged patients undergo surgery, their results can be successful and satisfying to a degree similar to those of younger patients.

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The effect of dilation of the tibial tunnel on the strength of hamstring graft fixation using interference screws was evaluated. In all, 28 RCI screws were tested in male human tibia-hamstring constructs with tibial tunnels reamed or dilated to the respective size of the graft diameter. Dilation of the tibial tunnel failed to significantly enhance hamstring fixation. Grafts secured in dilated tunnels displayed an 11% greater resistance to the initiation of graft slippage (174+/-112 N) compared to their undilated controls (156+/-77 N, P=0.63). Dilation of the tibial tunnel increased the failure load by an average of 4%, independent of screw diameter (dilated specimens: 360+/-120 N, controls: 345+/-88 N, P=0.74). Biomechanical research on the effect of tibial tunnel dilation in hamstring fixation has not provided satisfactory evidence as to the benefits of this additional surgical step during anterior cruciate ligament (ACL) reconstruction.

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