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In a prospective clinical study on 32 patients with Trevira ligament implants arthroscopic and histological findings were used to assess the articular effects of the synthetic ligament. In group 1 of patients with intact Trevira ligament no changes associated with foreign-body reactions were seen. In group 2 with abrased or frayed synthetic ligaments generalised foreign-body reactions in the suprapatellar recess as well as perivascular, round-cell infiltrates were seen in four out of six patients; four of the six cases also showed fibrotic signs indicative of prearthrotic changes. In group 3 with ruptured Trevira ligament no diffuse foreign-body reactions in the suprapatellar recess were seen in any of the 16 cases. In the intercondylar space foreign-body reactions correlating with the age of the implant were identified (p < 0.03). In 18% of cases with ruptured Trevira ligament generalised foreign-body reactions were seen; however, these changes were not accompanied by chronic inflammatory changes. Cases with technical shortcomings associated with a gradual fraying of the synthetic ligament invariably showed diffuse foreign-body reactions as well as chronic inflammatory infiltrates. In patients with spontaneous ligament rupture due to repeated trauma foreign-body reactions were restricted to the intercondylar space. In spite of the histological evidence of foreign-body granuloma no permanent clinical articular effects could be seen in our patients population within the follow-up time of up to 60 months.

In an experimental study of 14 cadaver knee joints, the pressure load on the joint surface after distal iliotibial band transfer was measured using Fuji Prescale foils. With an intact anterior cruciate ligament, increases of up to 153% for the average pressure load and of 225% for the total pressure in the lateral compartment were found in relation to the fixation point chosen. At point P3--slightly dorsal to the insertion of the lateral collateral ligament--the area loaded with maximum pressure increased to six-fold. Fixation at the transition of the lateral femoral condyle to the femoral shaft at the start of the linea aspera was associated with the least pressure increases in both the lateral and the medial compartments. Under all experimental conditions, lateral extra-articular stabilization with fixation at the insertion of the fibular collateral ligament was shown to be associated with significantly higher load increases. While a shift of pressure load to the dorsal third was seen in the lateral compartment, the mid-third remained the focus of the pressure load in the medial compartment. After transection of the anterior cruciate ligament and iliotibial band transfer at the "over-the-top" point, a significant shift of pressure towards the medial compartment was seen, while the lateral pressure load decreased. Medially, the area loaded with peak pressure remained constant, while the corresponding area in the lateral joint space showed a highly significant decrease to nearly one-third of normal. After additional bilateral meniscectomy this tendency was even more pronounced.(ABSTRACT TRUNCATED AT 250 WORDS)

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In a retrospective analysis of 70 patellar fractures the-long-term results after surgery were followed-up for periods of up to twelve years. Subjectively, excellent or satisfactory results were reported by 89% (n = 62) of patients. Clinical evaluation in the Lysholm score showed excellent or good results in 74.2% (n = 52) of cases. The results in the Lysholm score correlated well with the radiological evidence of arthrosis (p < 0.014) and with the clinical signs of chondropathy (p < 0.0005). Poor results (79.2 Lysholm points) were seen for comminuted fractures; however, the results for patients with distal transverse fractures were even lower (68.28 Lysholm points). Medial transverse fractures as well as distal patella pole ruptures were shown to have good prognostic results. In cases with comminuted fractures resection techniques are to be preferred to conservative procedures (p < 0.015). As regards long-term results in our patient population, partial patellectomy showed no obvious advantages over total patellectomy. In cases with multi-fragment fractures with questionable possibilities for reduction, cases with extensive cartilage damage as well as cases with distal transverse fractures partial or full patellectomy is recommended as the therapy of choice.