Session 2: Sportstrauma
Ondag den 22. oktober
09:00 – 10:30
Lokale: Stockholm/Copenhagen
Chairmen: Morten Boesen Morten / Michael Rindom Krogsgaard
13. Is the use of oral contraceptives associated with operatively treated anterior cruciate ligament injury? A case-control study from the Danish Registry of Knee Ligament Reconstruction
Lene Rahr-Wagner, Theis Thillemann, Frank Menhert, Alma Pedersen, Martin Lind
department of ortopaedic surgery, Aalborg University Hospital; department of clinical epidemiology, Aarhus University Hospital; department of ortopaedic surgery, sports medicine, Aarhus University Hospital
Background: The incidence of anterior cruciate
ligament (ACL) injuries is 2-9 times
higher in women than in men.
Additionally, in vitro studies have
demonstrated that ACL is an estrogen
target tissue, and some studies have
therefore suggested a protective
association between oral
contraceptives (OC) and the likelihood
of sustaining ACL injury.
Purpose / Aim of Study: The aim was to test the hypothesis of a
protective association between OC use
and the likelihood of sustaining
operatively treated ACL injury.
Materials and Methods: The study population included 4,497
female cases with an operatively
treated ACL injury registered in the
Danish Registry of Knee Ligament
Reconstruction for the 2005-2011
period and 8,858 age-matched
controls with no ACL injury.
The study evaluated exposure to OC
use at the time of ACL injury and in the
five previous years (ever user) or no
OC use (never user). Ever users were
further classified as either new users,
long-term users or recent users.
Finally, a dose-response analysis of
OC use was performed.
We used conditional logistic regression
to calculate the relative risk (RR) with a
95% confidence interval (CI) of
sustaining operatively treated ACL
injury according to OC use.
Findings / Results: The adjusted RR associating OC with
ACL injury was 0.82 (95% CI: 0.75 to
0.90) between ever users and never
users. Furthermore, we found a
decreased relative risk (RR) of
sustaining ACL injury of 0.80 (95% CI:
0.74 to 0.91) in long-term users and
0.81 (95% CI: 0.72 to 0.89) in recent
users. Additionally, we found a trend
towards a dose-response association.
Using OC for more than four years did
not seem to alter the likelihood of
sustaining operatively treated ACL
injury.
Conclusions: This indicates a protective association
between OC use and the likelihood of
sustaining operatively treated ACL
injury.
14. Limited Osteochondral Repair by a Biomimetic Collagen Scaffold - One to Three Years Clinical and Radiological Follow-Up
Bjørn Christensen, Casper Foldager, Niels Christian Jensen, Cody Bünger, Martin Lind
Orthopedic Research Laboratory, Aarhus University Hospital; Department of Orthopedic Surgery, Aarhus University Hospital; Division of Sports trauma, Aarhus University Hospital
Background: Osteochondral injuries are therapeutically
challenging and no gold standard treatment
has been established. Cell-free, layered
scaffolds are a new treatment option for
these defects.
Purpose / Aim of Study: The aim of this study was to evaluate the
osteochondral repair in patients treated with
The MaioRegen® scaffold, a cell-free
biomimetic scaffold. It has previously been
shown to induce clinical subchondral bone
and articular cartilage regeneration.
Materials and Methods: Eleven patients with osteochondral defects in the knee (n=7) or in
the talus (n=4) were enrolled. Patients filled out clinical evaluation
questionnaires pre-OP and at the final follow-up (2,5 years, range
1,9-3,1 years). The patients underwent pre-OP MRI, and CT and
MRI 1 (range 1-1,2 years) and 2,5 years post-OP (range 1,9-3,1
years). The knee patients were evaluated using KOOS, IKDC and
Tegner, the ankle patients using AOFAS Hindfoot and Tegners
score. The cartilage and bone formation was evaluated using the
MOCART score.
Findings / Results: Three patients were re-operated and
excluded due to treatment failure. CT: None
of the patients had complete regeneration of
the bone. 6/8 patients had no or very limited
(<10%) bone formation. 1/8 had 20-30%
bone filling and 1/8 had 40-50% bone filling.
MRI: No improvement was found in the
MOCART score at any time point.
5/6 patients experienced a clinical
improvement, and one patient a worsening.
The results were insignificant.
Conclusions: Treatment of osteochondral defects with the
MaioRegen scaffold resulted in incomplete
cartilage- and limited subchondral bone
repair at 1 and 2,5 year’s follow-up. Three
patients were excluded due to treatment
failure.
This study raises concerns about the
biological repair potential of the MaioRegen®
implant. Long-term studies are needed to
investigate if the clinical improvements are
permanent.
15. One-year follow-up after ACL reconstruction – surgeon or physical therapist ?
Ina Wieland Nielsen, Kirsten Bettina Jensen, Jonathan Jetsmark Bjerre, Peder Klement Jensen, Michael R. Krogsgaard
Ergo- and Physical Therapy, Bispebjerg Hospital; Section for Sportstraumatology M51, Bispebjerg Hospital; Dept. of Orthopadic Surgery, Bispebjerg Hospital
Background: One year follow-up after ACL
reconstruction is traditionally done by
orthopaedic surgeons, often the
person who operated, which could lead
to bias in the results. One year is also
time for return to sports, and patients
often request instruction for further
rehabilitation.
Purpose / Aim of Study: To replace surgeons with physical
therapists (PTs) at one-year follow-up
and evaluate if stability measures
changed.
Materials and Methods: Between 1.5.13 and 30.4.14 (P2) one-
year follow-up of patients after ACL
reconstruction were done by one of
two specially trained PTs and only by a
surgeon if problems were reported.
Stability measures including
Lachman-, drawer- and pivot-tests and
anterior laxity with Rolimeter in both
knees were performed. In addition 4
functional tests were done. The same
stability measurements were
performed by the surgeons in a
previous period: 1.5.12 – 30.4.13 (P1),
and results for the two periods were
compared.
Findings / Results: Rolimeter measures right/left were
5,63/5,79 mm in P1 and 6,96/7,07 mm
in P2. Measures were significantly
higher for both knees in P2 (t-test: p <
0,001). The difference between
operated and non-operated knee in
P1/P2 was 1,38/1,98 mm (p = 0,008).
There were more positive drawer tests
(p = 0,005) during P1, but no
difference for Lachman and pivot-tests
(p > 0,05). Standard rehabilitation
plans (GOPs) had been sent to the
local therapists following
reconstruction, but the content of the
actual rehabilitation varied and many
patients asked for further instruction.
Conclusions: Absolute measures and differences in
Rolimeter measurements were higher
during the period when PTs tested,
indicating that PTs and surgeons might
test differently. An advantage of PT
follow-up is the possibility for further
instructions, functional testing results
and release of surgeons’ time.
16. The association between patient-reported outcomes and physical outcome measures in Danish patients one year after anterior cruciate ligament reconstruction
Jonathan Comins, Bettina Jensen, Ina Wieland Nielsen, Volkert Siersma, Michael Krogsgaard
Section for Sports Traumatology M51, Bispebjerg Hospital; 3Department of Occupational and Physical Therapy, Bispebjerg Hospital; Research Unit and Section of General Practice, Department of Public Health, University of Copenhagen
Background: Patient-reported outcome measures
(PROMs) fail to correlate with anterior
laxity and functional performance tests
in patients with anterior cruciate
ligament (ACL) deficiency. A recent
Korean study found that the IKDC PROM
correlates significantly with laxity and
functional performance in patients with
ACL reconstruction.
Purpose / Aim of Study: We assessed the degree of association
between two different PROMs (KNEES-ACL
and IKDC) and anterior laxity and
standard functional performance tests in
Danish patients one year post ACL
reconstruction.
Materials and Methods: Eighty-six patients who had undergone
ACL reconstruction one year previously
were retrospectively included. Patients
completed KNEES-ACL and IKDC and a
physical therapist applied tests of knee
ligament laxity and a battery of
standardized functional performance
tests. Between-knee differences were
computed and Spearmans rho correlations
were assessed between the seven
subscales of KNEES, the IKDC total
score, between-knee laxity values, and
functional performance tests.
Findings / Results: All KNEES subscores correlated highly
significantly with the IKDC total score.
KNEES ADL, Symptoms, and Slackness
correlated highest with IKDC at between
0.67 and 0.78. Correlations between the
other KNEES subscales and IKDC ranged
from 0.36 to 0.57. There were low
associations between laxity and
functional performance. All KNEES
subscales correlated highly
significantly with one another.
Conclusions: The IKDC and the KNEES-ACL do not
correlate highly with physical outcome
measures in Danish patients one year
post ACL reconstruction. The IKDC
correlates best with the constructs of
ADL, Symptoms, and sensation of
instability (Slackness) in the
KNEES-ACL. This supports the notion that
both PROMs and physical measures are
necessary to assess surgical outcome in
patients treated for ACL deficiency.
17. PREVIOUS KNEE-INJURY AND LOW KNEE FUNCTION SCORE INCREASE THE RISK OF FUTURE KNEE INJURY IN ADOLESCENT FEMALE FOOTBALL
Mikkel Bek Clausen, Lars Tang, Mette Kreutzfeldt Zebis, Peter Krustrup, Per Hölmich, Kristian Thorborg
School of Physiotherapy, Institute of Rehabilitation and Nutrition, Faculty of Health and Technology, Metropolitan University; Arthroscopic Centre Amager, SORC-C, Copenhagen University Hospital, Amager-Hvidovre, Denmark; Gait Analysis Laboratory, Copenhagen University Hospital, Hvidovre, Denmark; Department of Nutrition, Exercise and Sports (NEXS), Section of Human Physiology, Copenhagen Centre for Team Sport and Health, University of Copenhagen, Copenhagen, Denmark
Background: Knee-injuries are common in adolescent
female football. Severe knee-injuries
can cause persistent symptoms,
potentially forcing female players to
retire from contact sport. Previous
knee-injury is recognized as a risk
factor for future knee-injuries in adult
football, but evidence regarding
adolescent female football is scarce and
contains important methodological flaws.
Purpose / Aim of Study: The primary aim of this study was to
investigate the risk of sustaining
future knee-injury in relation to
previous knee-injuries. Secondly, low
Knee Osteaoarthritis Outcome Score
(KOOS) was investigated as a potential
risk factor for future knee injuries.
Materials and Methods: A population based sample of 326 girls
(15-18 years) without knee-injury at
baseline, participating in a Danish
Football Association series during the
spring 2012 season, was included.
Self-reported data on previous
knee-injury and KOOS- score were
collected at baseline. Football-injuries
and football-exposures were reported
weekly by answers to standardised
text-message questions followed by
individual injury-interviews. A priori,
previous knee-injury and low KOOS-scores
(< 80 points) were chosen as independent
variables of interest in the primary and
secondary risk-factor analyses.
Findings / Results: 29 players sustained 34 time-loss
knee-injuries. Adjusted for match/total
ratio and playing-level, baseline report
of previous knee-injury significantly
increased the risk of time-loss
knee-injury (RR: 3.65 95%CI 1.73-7.68;
p<0.001). Low baseline-score in three
KOOS sub-scales (ADL, Sport/rec and QOL)
significantly increased the risk of
time-loss knee-injury (RR: 2-5, p=
0.008-0.046).
Conclusions: Previous knee-injury and KOOS subscale
scores lower than 80 points in ADL,
Sport/rec and QOL significantly
increases the risk of sustaining a
knee-injury in adolescent female
football players.
18. Significant role on rotatory stability of the anterolateral ligament in ACL insufficient knees
Mette Tavlo, Salameh Eljaja, Jørgen Tranum-Jensen, Volkert Siersma, Michael Rindom Krogsgaard
Institut for Cellulær og Molekylær Medicin, Københavns Universitet; Afdeling for Idrætskirurgi, Bispebjerg Hospital; Forskningsenheden for Almen Praksis, Center for Sundhed og Samfund
Background: Recent studies have described the anatomy
of an anterolateral ligament (ALL) of the
knee. This ligament has been linked to the
Segond fracture that is patognomonic for
tear of the anterior cruciate ligament (ACL).
ALL is hypothesised to be important for the
internal rotatory stability of the knee, but its
mechanical effect has yet to be clarified.
Purpose / Aim of Study: Our aim was to test the function of the ALL
for rotatory and anterior-posterior (AP)
stability in ACL insufficient and
reconstructed knees and the effect of
anatomical ALL reconstruction with a
tendon.
Materials and Methods: In 18 cadaver legs ALL was dissected.
Function of ALL (+/- ALL) and of ALL
reconstruction (reALL) was tested with
the ACL removed (-ACL) and
reconstructed (+ACL) with following
combinations: +ACL-ALL, +ACL+ALL, -
ACL+ALL, -ACL-ALL, -ACL+reALL and
+ACL+re-ALL. All combinations were
tested with the knees in 0, 30, 60 and 90
degrees of flexion. AP stability was
tested with a Rolimeter. Rotation of tibia
was applied with 50 N internal and
external and measured photographically
from K-wires inserted in tibia and femur.
Findings / Results: The ALL did not appear uniform, but was
well defined in 78 %. ACL (+/-) had a
significant effect on the AP stability but not
on rotation. ALL (+/-) had significant effect
on the rotatory stability (p = 0.0006),
regardless of the condition of ACL, and on
the AP stability in ACL insufficient knees (p =
0.023). The lost stability of ALL was
regained when ALL was reconstructed.
Conclusions: ALL is a major rotational stabilizer. If ALL is
torn in connection with ACL rupture,
reconstruction of ACL is not re-establishing
rotatory stability. When ALL is reconstructed
anatomically, rotatory instability is re-
established. ALL reconstruction as
supplement to ACL reconstruction might be
considered in patients with a Segond
fracture.
19. Redislocation after conservative treatment of primary patellar dislocations
Bo Kaewkongnok, Anders Bøvling, Celia Møllenborg, Bjarke Viberg, Lars Blønd
Orthopaedic Surgery , Køge; Orthopaedic Surgery and Traumatology , Odense University Hospital; Orthopaedic Surgery, Køge
Background: Primary patellar dislocation should be
treated conservatively using either a
immobilizing brace or a plaster splint,
except for cases with osteochondral
fracture. No studies have yet focused on
various treatment regimens in relation
to the duration of immobilization.
Purpose / Aim of Study: This study compares different
conservative treatment regimes after
primary patella dislocation measuring
the rate of redislocation.
Materials and Methods: Retrospective study comparing two
cohorts from two hospitals, having two
different conservative treatment
protocols. The first regime consist of 2
weeks 30 degree locked brace and the
second regime consist of 6 weeks brace
with gradually increasing range of
movements after two weeks. Patients
under 30 years having first-time
patellar dislocations were included.
Redislocations, treatment regimens, type
of rehabilitation and trochlea dysplasia
and patella alta on radiographs were
recorded.
Findings / Results: 458 patients having 475 primary patella
dislocations (230 females) with a median
age of 17.0 years (IQR 14.9-20.5) were
included. Re-dislocations (or surgery)
were recorded for 132 patients with a
median re-dislocation time of 347 days
(IQR 170-704). X-ray images suited for
measurement showed a dysplasia
proportion of 72.9%. A logistic
regression analysis showed that
increasing age (OR 0.82, p<0.0001),
instruction in VMO exercises (OR 0.31,
p<0.048), and increasing Insall-Salvati
index (OR 0.047,p<0.009) all were
preventive of re-dislocations. None of
the treatment regimes showed any
statistical significant difference for
preventing re-dislocations.
Conclusions: We found no difference between the two
conservative treatment protocols in
respect to the rate of re-dislocation.
Increasing age, instructions in VMO
exercises and increasing Insall-Salvati
index was found to be preventive for
re-dislocation.
20. Do ACL patients suffer from comorbidity and is there any association between comorbidity and the risk of ACL revision surgery? A nationwide population-based case-cohort study of 13,443 ACL reconstructed patients
Lene Rahr-Wagner, Theis Thillemann, Martin Lind, Alma Pedersen
Department of Orthopaedic surgery, Aalborg University Hospital; Department of Clinical Epidemiology, Aarhus University Hospital
Background: Anterior cruciate ligament (ACL)
reconstructed patients are considered
healthy individuals. However,
information on comorbid disease is
lacking.
Purpose / Aim of Study: The aim of this study was to describe
and compare comorbid conditions
among ACL reconstructed patients and
a matched cohort without ACL injury.
Further, to evaluate the impact of
comorbid diseases on the risk of ACL
revision surgery.
Materials and Methods: This case-cohort study included
13,443 unilateral primary ACL
reconstructed patients from the Danish
Knee Ligament Reconstruction
Register (DKRR) matched on gender
and age with a comparison cohort
without ACL injury. Information on
medical comorbid conditions was
obtained from the Danish National
Registry of Patient. The prevalence of
all comorbid conditions was described
for ACL reconstructed patients and the
comparison cohort in terms of: 1)
Charlson Comorbidity Index (CCI) 2)
ICD-10 disease chapters, 3) more
common chronic diseases in a younger
population.
Finally we assessed the risk of ACL
revision surgery according to the
comorbid conditions, using Cox
regression analysis.
Findings / Results: ACL reconstructed patients had
generally a slightly lower prevalence of
almost all ICD-10 classified comorbid
disease groups compared to the
comparison cohort without ACL injury.
The percentage of CCI=0 was high in
both groups. As expected most
diseases increased slightly with rising
age. Most of the comorbid conditions
did not affect the risk of revision
surgery.
Conclusions: This study provides new information on
comorbid conditions in ACL
reconstructed patients, which has not
previously been described. This study
supports the hypothesis that ACL
patients are generally healthy
individuals. A large variety of diseases
are present in the ACL reconstructed
group, but with very low prevalence
and a low CCI indicating a healthy
cohort.
21. Autologous Dual Tissue Transplantation for Osteochondral repair - One Year Clinical and Radiological Follow-Up
Bjørn Christensen, Casper Foldager, Martin Lind
Orthopedic Research Laboratory, Aarhus University Hospital; Division of Sports trauma, Aarhus University Hospital
Background: Articular cartilage has a very limited potential
for spontaneous regeneration, due to the
avascular nature of the tissue. Numerous
treatment methods have been implemented,
among them microfracture, ACI and
mosaicplasty, but no Gold standard
treatment has been established.
Purpose / Aim of Study: To evaluate the use of Autologous Dual-
Tissue Transplantation (ADTT): An easily
applicable, low cost treatment option for
articular cartilage repair.
Materials and Methods: Eight patients (age 33 years, range: 24-45)
suffering from osteochondral defects of the
medial femoral condyle were enrolled. The
injury area was debrided and the
osteochondral defect was filled with
autologous bone from the tibial tuberosity, to
the level of the adjacent cartilage. Cartilage
biopsies from the intercondylar notch, was
chipped, and the cartilage chips were
embedded in fibrin glue in the defect. The
stability of the treatment was tested with 40
full range motions, and the incision was
closed. The patients were evaluated pre-
operatively and one year post-operatively
using MRI, CT, and clinical scores (KOOS,
IKDC and Tegner)
Findings / Results: A significant improvement was found in the
IKDC score (from 40,2 – 67,5, p=0,02), the
Tegner score (2,8 – 4,6, p=0,01) and KOOS
pain, symptoms, sport/rec and quality of life.
The MOCART MRI score improved from 30
to 62,5 (p=0,0003). CT imaging showed very
good defect filling, with an uneven bone
surface.
Conclusions: Treatment of osteochondral injuries in the
knee with ADTT resulted in significant
clinical and radiological improvements at one
year. Despite the limited number of patients
and the short-term follow-up, this study
highlights ADTT as a promising treatment
option for osteochondral injuries.
22. Posterior cruciate ligament reconstruction in skeletal immature children; a case series of six patients.
Ole Gade Sørensen, Peter Faunø, Svend Erik Christiansen, Martin Lind
Orthopedics, University Hospital of Århus
Background: Rupture of the posterior cruciate
ligament (PCL) is a rare knee injury in
childen with open growth plates. So far
only case studies have been reported in
the literature. We present follow-up
results of six patients with open physes
treated with PCL reconstruction.
Purpose / Aim of Study: To evaluate clinical outcome after PCL
reconstruction in six skeletal immature
patients.
Materials and Methods: Between August 2006 and October
2010 six skeletal immature patients (one
girl and five boys) were treated with
PCL reconstruction. In 5 cases
hamstring tendons autografts were
used. One patient was reconstructed
with use of a tibialis anterior tendon
allograft. At time of surgery median age
was 9 years (range 6 – 14). Median
follow-up time after surgery was 50
months (range 41 – 90). Outcome was
evaluated by KOOS and Tegner scores,
Instrumented knee laxity and radiologic
long axis leg length measurements.
Findings / Results: Median KOOS score at follow up
regarding symptoms, pain, ADL, Sport,
and QOL were 79 (range 43 – 100), 89
(range 41 – 100), 99 (range 66 – 100),
70 (range 5 – 100), and 81 (range 19 –
94) respectively. Median Tegner score
was 6 (range 4 – 7). Median side to side
difference in laxity using KT1000 was 2
mm (range 1 – 5) at 25 degrees of
flexion and 3 mm (range 3 – 6) at 70
degrees of flexion. No side to side
difference in knee extension was found.
In contrast a median difference of 8
degrees of flexion decrease was
found . All but one patient had returned
to sports at follow-up. One patient had a
leg length discrepancy of 16 mm, the
index knee being the longer.
Conclusions: PCL reconstruction resulted in fair to
good clinical outcome in skeletal
immature children.
23. Testing basic competency in knee arthroscopy using a virtual reality simulator: Exploring reliability and validity
Mads Emil Jacobsen, Morten Jon Andersen, Claus Ol Hansen, Lars Konge
Center of Clinical Education, Copenhagen University Hospital Rigshospitalet, Denmark; Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Denmark; Arthroscopic Center Amager, Copenhagen University Hospital Amager, Denmark
Background: Orthopedic residents are confronted with
diagnostic arthroscopies early in their
training. Arthroscopy differs from
traditional open surgery and many
residents feel less prepared for
arthroscopic procedures. Virtual reality
(VR) training and testing could ensure
basic competency before proceeding to
supervised operations in patients.
Purpose / Aim of Study: The aim of this study was to create a
reliable and valid simulation-based test
for diagnostic knee arthroscopy.
Materials and Methods: Twenty-six physicians (13 untrained
novices and 13 experienced surgeons)
performed a test consisting of five
procedures on a VR knee arthroscopy
simulator. Performance was evaluated by
obtaining predefined metrics from the
simulator for each procedure from which
z-scores, describing inappropriate
behavior, were calculated. Reliability
was explored by calculating an
Intra-class Correlation Coefficient.
Validity was explored by comparing the
performances of novices and experienced
surgeons using independent samples
t-tests. Using the contrasting groups
method a pass/fail standard was set and
its consequences explored.
Findings / Results: One procedure was excluded from the
final test due to lack of validity.
Z-scores showed an inter-case
reliability of 0.87 between the four
procedures in the final test. A total
z-score was 38.6 ± 27.3 for the novices
and 0.0 ± 9.1 for the experienced
surgeons (p < 0.0005). The pass/fail
standard was set at a total z-score of
15.5 resulting in two of the novices
passing the test and a single
experienced surgeon failing.
Conclusions: By combining four procedures on a VR
arthroscopy simulator we were able to
create a valid and reliable test of
basic arthroscopic competency, and
establish a credible pass/fail standard.
The test could help assess and ensure
basic competency of junior surgeons
before supervised operations in patients.
24. Treatment of posterior cruciate ligament tear combined with postero-lateral instability in skeletal immature children.
Ole Gade Sørensen, Peter Faunø, Svend Erik Christiansen, Martin Lind
Orthopedics, University hospital of Århus
Background: Tear of the posterior cruciate ligament
(PCL) in combination with instability of
the postero-lateral corner (PLC) is a
very uncommon finding in children with
open growth plates. We present follow-
up results of three patients with open
physes treated with PCL and PLC
reconstruction.
Purpose / Aim of Study: To evaluate clinical outcome after
combined PCL and PLC reconstruction in
three skeletal immature patients.
Materials and Methods: Between July 2004 and December 2010
three skeletal immature patients were
treated with combined PCL and PLC
reconstruction. Age at time of surgery
was 7, 7 and 9 years. At follow-up the
three patients were 16, 15 and 13 years
respectively. Outcome was evaluated
by KOOS and Tegner scores,
Instrumented knee laxity and radiologic
long axis leg length measurements.
Findings / Results: KOOS scores at follow up for patient# 1,
regarding symptoms, pain, ADL, Sport,
and QOL were 61, 64, 66, 15 and 38.
Patient# 2 scores were 86, 100, 100,
100 and 100, whereas patient#3 scored
96, 94, 100, 95 and 81 respectively.
Tegner score was 6, 9 and 6 for the
three patients. Laxity measurement was
only performed for patient#1 and
patient#2 at follow-up. Side to side
difference in laxity using KT1000 was 0
and 2 mm at 25 degrees of flexion and 1
and 8 mm at 70 degrees of flexion. Side
to side difference in knee flexion was
15, 5 and 5 degrees. No difference in
knee extension was found. At follow-up
all three patients had returned to sports
at a recreational level. Leg length
discrepancy was found to be 11, 16 and
5 mm, the index knee being the longer in
all three patients.
Conclusions: Combined PCL and PLC reconstruction
seems to result in variable clinical
outcome in skeletal immature children
and our data suggest a risk of growth
disorder in these patients.