The possibility of reconstructing a massive rotator cuff rupture with a free graft of the triceps tendon or the coracoacromial ligament was tested experimentally in an anatomical and biophysical cadaver investigation. After dissection of the rotator cuff, a section of the supraspinatus tendon was removed to simulate a defect in the cuff. In dissection of the grafts, a bony squama was incorporated by osteotomy. The rotator cuff was reconstructed by suturing the free grafts into the defect. In addition, the bony squama was refixed in a prepared bone groove in the greater tuberosity of the humerus. The tensile strength and the elasticity of the grafts were compared with that of the supraspinatus tendon in rupture tests. The mean value of the maximum load determined (FRm) was greatest for the triceps tendon (706.451 N), while very much lower values were found for the coracoacromial ligament (395.836 N) and the supraspinatus tendon (496.792 N). The mean value of the maximum elasticity (LAm) was lowest for the coracoacromial ligament (4.701%); the supraspinatus tendon (7.047%) and the triceps tendon (8.250%) showed very much greater elasticity.

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In an in vitro study we collected data relating to three-dimensional kinematics and stability patterns in 40 knee joint specimens. The specimens were tested in an apparatus: the femur was flexed on a fixed transverse axis, while a freely mobile tibial assembly allowed measurement of all passive translational and rotational movements. Translational forces, torques and compression forces were introduced and the results compared with the measurements taken after implantation of different arthroplasty devices. This study compares the kinematics of a knee with mobile meniscal bearings (low contact stress, LCS) with the data relating to a more constrained system (Tricon M). The LCS knee showed the better kinematic behavior compared to the natural knee.

From 1983 to 1990, 82 knee arthroscopies (8.2%) carried out in our patients found nothing pathological. Sixty-four percent of these patients were active in sports, but trauma was noted in 32% of the cases only. Football and other ball games, skiing, and track and field athletics were the main causes. Twenty-six percent of the patients had undergone previous surgery in the affected knee. At a mean of 4.6 years postoperatively, clinical and radiological re-assessment was conducted so as to compare our pre- and intraoperative findings with the further course of events. We found that 48.2% of the patients were symptom-free after the diagnostic arthroscopy, 37.5% had persistent discomfort and 14.3% had a recurrence of discomfort after 6 months to 2 years. The objective measurement score (Zarins Rowe score), at 47.5 out of 50 points, was better than the subjective score, at 40 out of 50 points. Our diagnoses had to be changed retrospectively: meniscal lesions were diagnosed too frequently, while chondropathia patellae and instability were often missed. Additionally, complaints could be related to abnormal axis, limited range of motion of the hip or knee, leg length inequality and hypermobility. Being unable to verify a presumed intra-articular lesion arthroscopically is frustrating for both doctor and patient. Our data suggest that meniscal signs should be looked at more critically and emphasise the need for a complete evaluation of the whole locomotor system.

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