Eight patients who underwent reconstruction of anterior cruciate ligament (ACL) using the Leeds-Keio artificial ligament were reviewed to investigate the failure mechanism of reconstruct-ed ACL. There were 7 males and one female, with an average age of 27 years (range, 17 to 40 years) . The average time from primary to revision ACL surgery was 49 months (range, 18 to 96 months) . The mean follow-up period was 42 monts (range, 24 to 60 months) . Six cases showed early slackness of reconstructed ACL and the two other cases had reoperation due to injury. Seven cases showed bone tunnels on the anterior of the tibia, and three cases showed bone tunnels on the anterior of the femur. All cases had poor tissue induction around the Leeds-Keio artificial ligament. All patients underwent revision ACL surgery with autogenous bone-patellar tendon-bone graft. The side to side difference in the anterior laxity was 3.9 mm, measured with Telos SE after revision ACL reconstruction. The Lysholm Knee Score averaged 84.1 after revision ACL recostruction. Accurate surgical technique seems of critical importance in ACL reconstruction, especially using the Leeds-Keio artificial ligament.

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Although early aggressive rehabilitation after anterior cruciate ligament (ACL) reconstruc-tion is advocated clinically, the early remodeling process of the reconstructed ACL has not been fully investigated. The purpose of this study was to examine the biological and biomechanical properties of the reconstructed ACL in the early postoperative period. In an animal model, the ACLs of 21 canine knees were excised and reconstructed using the patellar tendon. Seven dogs were sacrificed at each of the three designated time periods (l, 3 and 6 weeks), and the reconst-ructed ACL was examined. Microangiographic and histological study showed early ischemic ne-crosis, with subsequent revascularization and repopulation of cells by 6 weeks. In mechanical testing, the measured maximum load of the reconstructed ACL corresponded to 63% of that of the control patellar tendon graft (31% of the strength compared with the control ACL) at one week after surgery. The strength of the reconstructed ACL remained at a similar level at 3 and 6 weeks. The relative strength of the patellar tendon graft compared with that of the ACL is dif-ferent between the human and canine knee (170% and 50%, respectively) . If this difference is taken into account, the strength of the reconstructed ACL in the early postoperative period mea-sured in this study (55-63% of that of the control patellar tendon graft) is thought to be sufficient to withstand a load applied in the aggressive rehabilitation now generally practiced.

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We studied Intramedullary nailing for treatment of distal tibial fractures between 1997-1999. The fractures were classified as 5 AO-type, 43-A fractures and one 43-B fracture. Four cases were open fractures : one Gustilo grade-I and 3 grade-II. Overall results were judged according to the JOA score and Burwell's evaluation system. In all cases, the clinical results were good. We consider that technical check point is stability of fibula fractures, so we treated fibula fractures using plating, as much as possible. Distal tibial fractures are often associated with soft tissue damage. For such a condition, open reduction and plating occasionally resulted in difficulty in skin suture. Clinically, this Intramedullary nailing technique seems a safe effective treatment.

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We evaluated 6 cases of total hip arthroplasty using a constrained acetabular component (constrained THA) . The mean age of patients at operation was 75 years (range, 68 to 83 years) . Patients' original diseases were coxarthrosis (2), rapidly destructive coxarthropathy (2), osteonecrosis of femoral head (1) and rheumatoid arthritis (1) . All hips were followed up from one year 2 months to 3 years (mean, 2 years 2 months) . The average Japanese Orthopaedic Association score (JOA score) improved from 22.8 to 72.5 points. No dislocation and loosening were observed in the cases except for that of an 83-year-old woman who had marked obesity and dementia. Constrained THA can decrease the incidence of recurrent dislocation and provide good stability for the hip joint, although the indications must be carefully assessed.

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Since 1984 we have chiefly been performing either spherical acetabular osteotomy (SAO) or intertrochanteric femoral osteotomy as joint preserving operations to treat coxarthrosis. If necessary, these procedures were carried out in combination with acetabular edge resection to improve the localized incongruity, modified Lance-Spitzy's shelf operation to enlarge the weight bearing surface, and transfer of the greater trochanter to reduce the resultant force of the hip joint. For this study, 63 joint preserving operations for coxarthrosis in 56 patients over 50 years of age with a follow-up period of more than 10 years were reviewed. The mean age at time of operation was 54.3 years (range from 50 to 65 years) . Clinically satisfactory results were achieved in 22 (95.7%) of 23 hips, which consisted of 5 hips in the early stage and 18 in the advanced stage of osteoarthrosis at the time of the operation. These were treated by SAO, but only 29 (74.4%) of 39 hips, 16 in the advanced stage and 23 in the terminal stage, required femoral osteotomy alone or in conjunction with other surgical procedures. Radiologically significant improvement has been obtained in 17 hips (73.9%) managed by SAO, compared to 24 hips (61.5%) treated with femoral osteotomy.
It is concluded that these procedures are very useful and effective as time-saving operations to treat coxarthrosis in patients over 50 years of age.

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We studied the surgical results (1-7 years) of cementless total hip arthroplasty (THA) with bone grafting for hip joints with rheumatoid arthritis (RA) accompanying protrusio acetabuli. Of the 154 hips that underwent THA for RA, 36 hips among 31 patients were protrusio acetabuli types whereby the non-loaded site of the resected femoral head was sliced, bone was grafted at the acetabular fossa, and the cup was fixed without bone cement. Except for one case, all were late stage RA, and in most cases surgery was performed as part of multiple replacement arthroplasty. Clinical findings during follow-up showed that the mean JOA score before surgery of 32.1 improved to a mean of 84.3 during the survey period, which indicated good improvement in hip joint function. Practical walking was not possible in half of the cases before surgery, but all patients except one during the survey period were able to maintain practical walking ability. Protrusion distance plus at least 1 mm was determined by X-ray as protrusio acetabuli, but during the survey period minus 8 mm was the mean, and good cup positioning was maintained. The grafted bone took hold without any large changes noted in the cup setting angle. Clear loosening was noted in only one hip in which there was insufficient impact of the grafted bone during surgery, and a radiolucent line of no more than 1 mm was seen in only four hips.Although these are interim results, they indicate the safety and effectiveness of this procedure over the long term. It is not rare in cases of RA for THA to be unavoidable even in young persons. Considering the probability of re-implantation in future, the selection of cementless THA is thought to be appropriate. If adequate bone grafting is performed in combination in the RA hip joint with protrusio acetabuli, it is possible to position a cementless cup, and this is considered a useful method.

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Seventeen hands of 16 patients with rheumatoid arthritis who had spontaneous rupture of the extensor tendon were surgically treated. Eight of 17 hands had an isolated rupture of the extensor policis longs tendon, and the others had a combined rupture of the index to small finger. Surgical procedures included tendon transfer using extensor indicis proprius or flexor digitorum superficialis of the ring finger in 15 cases, and tendon graft using palmaris longus in 2 cases. Synovectomy was performed in all cases, and the Darrach procedure was performed in 9 cases which did not have an isolated rupture of the extensor policis longs tendon. Good results were achieved in cases with rupture of the extensor policis longs tendon, though there was some slight extension lag remaining in some of the other cases.

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We present three cases of osteoid osteoma with arthritis of the adjacent joint. Two lesions were in the ankle and one in the elbow. All cases presented specific nocturnal joint pain and all showed joint swelling and limb atrophy. Delay in diagnosis was a feature in all cases and ranged from 5 to 12 months. Lack of familiarity with the radiologic and histologic features of intra-articular osteoid osteoma caused diagnostic errors. CT scanning has proven to be a valuable method of revealing a small nidus, especially for those lesions located in bones with complex anatomy.

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