The Knee and the Cruciate Ligaments Anatomy Biomechanics Clinical Aspects Reconstruction Complications Rehabilitation

Edited by R.P.Jakob and H.-U.SHiubli of the Orthopedic Study Group for the Knee

Translated by T. C. Telger

With 519 Figures in 1071 Separate Illustrations and 91 Tables

Springer-Verlag Berlin Heidelberg New York London Paris Tokyo Hong Kong Barcelona Budapest

Prof. Dr. RP.Jakob Department for Orthopedic Surgery, University of Bern Inselspital, 3010 Bern, Switzerland

PO Dr. H.-U.Staubli Orthopedicsrrraumatology, Tiefenau Hospital of the City of Bern Tiefenaustrasse 112, 3004 Bern, Switzerland

Title of the original German edition: Kniegelenk und Kreuzbander © Springer-Verlag Berlin Heidelberg 1990

ISBN-13: 978-3-642-84465-2 e- ISBN-13: 978-3-642-84463-8 001: 10.1007/978-3-642-84463-8

Library of Congress Cataloging-in-Publication Data Kniegelenk und Kreuzbander. English. The Knee and the cruciate ligaments: anatomy. biomechanics. clinical as­pects, reconstruction, complications, rehabilitation 1 edited by R.P.Jakob and H.-U. Staubli of the Orthopedic Study Group for the Knee; translated by R. C. Telger. p. cm. Includes bibliographical references and index. ISBN-I3:978-3-642-84465-2 1. Anterior cruciate ligament-Surgery. 2. Knee-Surgery. 3. Knee-Anatomy. I. Jakob, Roland. II. Staubli, H.-U. III. Schweizerische Gesellschaft fur Orthopadie. Orthopedic Study Group for the Knee. IV. Title. [DNML: 1. Knee Injuries-therapy. 2. Knee Joint-anatomy & histology. 3. Ligaments-physiopathology. 4. Ligaments­Surgery. WE 870 K685j RD561.K5913 1992 617.5'82059-dc20 DNLM/DLC 92-49767

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© Springer-Verlag Berlin Heidelberg 1992 Softcover reprint of the hardcover 1st edition 1992

The use of general descriptive names, registered names. trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regula­tions and therefore free for general use. Product liability: The publishers cannot guarantee the accuracy of any information about dosage and application contained in this book. In every individual case the user must check such information by consulting the relevant literature.

24/3130-543210 - Printed on acid-free paper

To our families, for their understanding, sacrifice, and encouragement

"All in all you're just another brick in the wall." Pink Floyd, The Wall

Foreword

This book summarizes the experience gained by the Orthopedic Study Group for the Knee (OAK) of the Swiss Orthopedic Society in dealing with knee problems relating to deficiencies of the cruciate ligaments. The editors, R.P. Jakob and H.-U.Staubli, have collaborated with international authorities to produce this ex­cellent work dealing with a great many aspects of knee surgery and especially the problems of the cruciate ligaments. For clarity, the book begins with definitions and explanations of basic biomechan­ical terms. The chapters on Anatomy and Biomechanics present up-to-date scien­tific information based on anatomic and biomechanical principles as they are ap­plied in modern knee surgery. The second part of the book focuses on the OAK-sanctioned approach to knee documentation and evaluation, which is a valuable supplement to other knee evaluation schemes. The European Society for Knee Surgery (ESKA) and the American Orthopedic Society for Sports Medicine (AOSSM) are currently at­tempting to combine the advantages of the OAK system with an internationally valid evaluation scheme to create a standard evaluation and documentation sys­tem that will be acceptable to all physicians. Next, Noesberger, Jakob, Staubli and others take a comprehensive look at clinical diagnosis, pathomechanics, and pathomorphology. Arthroscopic and radiologic methods are described for documenting anterior subluxation of the tibia in pa­tients with anterior cruciate ligament insufficiency. The authors use various methods to convey the techniques of knee stability testing in the position of near extension to medical students and younger clinical colleagues. Werner MUller de­scribes in detail the various types of meniscus lesion that can develop in the ante­rior cruciate ligament-deficient knee. The natural history of untreated cruciate li­gament insufficiency is reviewed by the editors and by Jean Yves Dupont, who gives us the perspective of the "French school." A long chapter is devoted to the treatment of acute anterior cruciate ligament insufficiency and associated injuries of the medial capsuloligamentous complex including meniscal tears. Various auto­logous, alloplastic, and synthetic ligament reconstructions are described in the chapter on Chronic Anterior Cruciate Ligament Insufficiency, which reflects state-of-the-art techniques practiced in Europe. Arthroscopically assisted tech­niques of cruciate ligament reconstruction - European modifications of American techniques and original innovations - are described in detail. A separate chapter is devoted to significant posterolateral injuries that can accompany lesions of the anterior and posterior cruciate ligaments, and another to synthetic cruciate liga­ment substitutes and their problems. Additionally, there are several chapters on late degenerative changes resulting from chronic cruciate ligament instability and on the complications that can follow specific reconstructive procedures. This book is comprehensive enough to meet the needs and interests of a very wide readership. It is an excellent sourcebook on the status of reconstructive knee surgery as it is successfully practiced in Europe today.

Stockholm, Summer, 1992 Ejnar Eriksson

Introduction

In 1981 the Orthopedic Study Group for the Knee (OAK) held its first advanced training course on the anatomy and biomechanics of the knee. The course, in which anatomic specimens were used to demonstrate ligament reconstruction techniques, was quickly filled. It was repeated in 1982 and 1983, and in 1984 the OAK was officially established as a professional working group of the Swiss Or­thopedic Society (SGO). At the first congress of the European Society of Knee Surgery and Arthroscopy (ESKA) in 1984, the preliminary course on anatomy and biomechanics was again conducted chiefly by the OAK. This course, too, was highly successful. More than 20 years ago, outstanding successes in the treatment of bone fractures and degenerative joint disease prompted a number of foreign scientists to visit Swiss orthopedic hospitals. While praising our methods of treating the spine, hip, knee and foot, these visitors also pointed out that newer methods had been de­vised for managing the soft tissues about the knee. This led me, in April of 1971, to join several hundred colleagues from France, Bel­gium, Spain, and Italy in a visit to the Journes de Chirurgie du Genou in Lyon. To the credit of the great teacher Albert Trillat and his school, which is still active today, this was the first time that I truly appreciated the importance of the essen­tial "third dimension" in knee surgery. Present-day exponents of the French school such as Henri Dejour, Pierre Chambat, Bernhard Myoen, Jean-Luc Lerat, and J ean-Yves Dupont, together with other OAK -affilitated European knee spe­cialists such as Carl J. Wirth and Michael Wagner, are among the key contributors to this book. Although the insights received at Lyon were important, the riddle of the knee was far from solved. Too many therapeutic outcomes appeared to be random in na­ture. There had to be hidden principles at work. Why, for example, was a pivot shift possible? Biomechanics and kinematics, as elucidated by Alfred Menschik, provided the key that guided us to the explanation while deepening our knowledge of soft­tissue biodynamics and biomechanical dynamics. The definitive step from the "bone age" to the "soft-tissue age" has already been taken in orthopedic surgery. One factor driving this development was sports medicine, which already had a significant head start in the USA. The four-bar linkage of Menschik and the Weber brothers led us through coup­ling curves and envelope curves to the concept of isometry as a new quality in the healthy functioning of collagenous soft tissues like the ligaments. But isome­try is too narrow and rigid a concept. We must adopt a broader functional view so that we can better grasp the new concepts of anatomometry and normo­metry. W. Muller's book The Knee - Form, Function, and Ligament Reconstruction, pub­lished nearly a decade ago, offered the first comprehensive review of the problems of anatomy and function as they were understood at that time. Further basic re­search has confirmed older hypotheses and added new knowledge. Isometry, yes, but only in a limited sense and supported by tissue fibers that become tense when

X Introduction

the laws of biomechanics demand a greater fiber potential to supply the necessary mechanical strength. One lesson that can be drawn from these insights is that none of us can accomplish much by ourselves, and that only through cooperation in groups and across na­tional boundaries can we achieve real progress in terms of improved patient care. Implicit in this awareness is the need to develop a common language for the com­plex nomenclature of the phenomena, and also for the documentation and quali­tative evaluation of traumatic lesions and therapeutic outcomes. In response to this need, the ESKA and the AOSSM (American Organization for Surgery in Sports Medicine) have founded the IKDC (International Knee Do­cumentation Committee), in which 10 members each from the USA and Europe focus their professional efforts on solving the problems that are so familiar to us all. Rik Huiskes from the team of Theo VanRens, the Cincinnati school of Frank Noyes and Ed Grood, and Russel Warren and Peter Torzilli and their colleagues at the Hospital for Special Surgery in New York have contributed much to the new discoveries in soft-tissue biomechanics. This research has laid vital foundations for the work of the IKDC. Fritz Hefti, Roland P. Jakob, Hans-Ulrich Staubli, and Werner MUller of the OAK also have become members of the IKDC. The knee continues to be of central importance in many respects:

- Anatomically, as the joint uniting the two longest lever arms of the musculo-skeletal system, the femur and tibia

- In sports traumatology, as the most commonly injured critical joint - In an actuarial sense, as an object of contention in disability judgments - In the treatment of degenerative joint disorders (e. g., after meniscectomy),

ranking second only to the hip - In individual cases where it is important to consider the possible effect of psy­

chological factors on the knee joint and, conversely. the difficulty some patients may have in coping with a chronically painful "problem knee"

For the future, much remains to be improved, and basic research needs to be fur­ther refined. The evolutionary path will probably take us past the ligaments and menisci to the cartilage, to the functions of the synovial membrane including its eutrophic function in maintaining articular homeostasis and the destructive cata­bolic effects that occur in synovitis (e.g., due to abrasion of artificial ligaments), and finally to the still little-researched processes involved in proprioception. With its comprehehsive. up-to-date summary of our knowledge of the knee and cruciate ligaments, this book will be a valuable aid in furthering our under­standing and management of structures "about the knee."

Basel. Summer, 1992 Werner MUller

Preface

Members of the Orthopedic Research Group for the Knee (OAK) of the Swiss Orthopedic Society and experienced European knee specialists have pooled their authoritative knowledge to create The Knee and the Cruciate Ligaments, whose major emphasis is on diagnostic and therapeutic problems. Though a compilation, the work still manages to reflect the individual interpretive freedom of its con­tributors. An introductory chapter on nomenclature is followed by numerous chapters, grouped by common themes, dealing with anatomy and biomechanics, diagnosis, pathomechanics, and pathomorphology of acute tears of the anterior cruciate liga­ment (ACL) and chronic knee instability. Special attention has been given to the description of concomitant injuries of the collateral ligaments and menisci and to the various techniques of open and arth­roscopically assisted ACL reconstruction. We have placed special emphasis on the treatment of posterolateral and posterior knee instability. Problems relating to the synthetic replacement of the ACL, chronic cruciate ligament insufficiency with osteoarthritis, and intra- and postoperative complications of reconstructions and their management are explored with the help of illustrative case materials. There is also a chapter on rehabilitation and evaluation in which therapeutic results, complications and their management are discussed on the basis of clinical series. The editors of this volume - members of the International Knee Documentation Committee - have succeeded in incorporating the knowledge of that body into the documentation and evaluation of knee instabilities. Our main purpose, and that of the book as a whole, is to help young surgeons and orthopedists to define indications while providing them with practical tools and precise details on operative and instrumental techniques.

Acknowledgments

We are sincerely grateful to all those who have contributed to the creation of this book: our secretaries Mrs. Charlotte Neuenschwander, Department of Ortho­pedic Surgery, Inselspital, and Mrs. Verena Oppliger, Orthopedics and Traumatol­ogy, Department of Surgery, Tiefenauspital, Bern; our illustrators Hans Holzherr, Christian Langenegger, and Willi ,Hess, Department of Instructional Media (AUM), University of Bern, Inselspital; and our photographers Mrs. Boa (Tie­fenauspital), Mrs. Steiner (Inselspital), Mrs. Widmer (Inselspital), Mr. Huber (Inselspital), and Mr. Zimmermann (AUM). Finally, we thank the staff at Springer-Verlag for their very high-quality produc­tion work.

Bern, Summer, 1992 R. P. Jakob H-U.Staubli

Table of Contents

Terms, Definitions, and Glossaries H.-v. Stiiubli, R. P. Jakob ..... .

Historical and Current Perspectives in the Treatment of Anterior Cruciate Ligament Insufficiency R. P. Jakob,J. P. Warner ................ .

Anatomy and Biomechanics

Surgical Anatomy of the Knee Joint E. B. Hunziker, H.-v. Stiiubli, R. P. Jakob

The Popliteus Muscle C. Fabbriciani, M. Oransky

Structural Molecules in Articular Cartilage, Tendons and Ligaments

1

22

31

48

E. B. Hunziker ............................... 62

Functional Anatomy of the Cruciate Ligaments N. F. Friederich, W.R. O'Brien .......... . 78

Anatomy and Biomechanics of the Anterior Cruciate Ligament: A Three-Dimensional Problem R. Huiskes, L. Blankevoort ..... ..... 92

Significance of Anatomy and Biomechanics W. Hackenbruch .................................. 110

OAK Knee Documentation and Evaluation

OAK Knee Evaluation: A New Way to Assess Knee Ligament Injuries We. Milller, R. Biedert, F. Hefti, R. P. Jakob, U. Munzinger, H.-v. Stiiubli ... 123

Evaluation of Knee Ligament Injuries: The OAK and IKDC Forms F. Hefti, T. Drobny, W. Hackenbruch, W. C. Kipfer, P. Holzach, R. P. Jakob, We. Muller, H.-v. Stiiubli ............................. 134

XIV Table of Contents

Diagnosis, Pathomechanics, and Pathomorphology of Anterior Crnciate Ligament Insufficiency

Diagnosis of Acute Tears of the Anterior Cruciate Ligament, and the Clinical Features of Chronic Anterior Instability B. Noesberger . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Pathomechanical and Clinical Concepts of the Pivot Shift Phenomenon

. 143

R. P. Jakob, H-U. StiiubU ........................... . 157

Anterior Subluxation in Knees with Chronic Anterior Cruciate Ligament Insufficiency: A Comparison of Arthrometry and Stressradiography H.-U.Stiiubli, R.P.Jakob, B.Noesberger ..................... 169

Our Current Technique of Stressradiography Near Extension H-U.Stiiub/i,R.P.Jakob ................... . ....... 177

Anterior Subluxation in the Chronically Anterior Cruciate Ligament-Deficient Knee: Comparison of Simultaneous Arthrometry and Stressradiography Using the KT 1000 H-U.StiiubU, R.P.Jakob ............................. 184

The Various Faces of Anterior Cruciate Ligament Tears During Arthroscopic Examination A. Giichter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190

New Imaging Techniques A. Giichter . . . . . . . . . . ....... 193

The Drawer Simulator: A Practice-Oriented Training Device for Anteroposterior Stability Testing in the Knee M. H Oswald, S. Christen, R. P. Jakob ...................... 196

Morphology and Function of the Cruciate Ligaments in a Computer Simulation Model B. Schneider, P. Wirz, R. P. Jakob ......................... 201

Production of Mechanical Knee Models for Training P. Wirz, B. Schneider, R. P. Jakob ........... .

Femoropatellar Problems Associated with Anterior Cruciate Ligament Insufficiency

. . 215

C. Gerber ...................................... 225

Classification of Meniscal Tears Associated with Lesions of the Anterior Cruciate Ligament We. Maller .......................... .

Natural History of Untreated Tears of the Anterior Cruciate Ligament

. .. 230

H-U.Stiiubli, R.P.Jakob ............................. 237

Natural History of Associated Intraarticular Pathology in the Chronic Anterior Cruciate Ligament-Deficient Knee J. Y. Dupont, C. Scellier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246

Table of Contents XV

Aplasia of the Cruciate Ligaments H. -U. Staubli, R. P. Jakob, P. Witschger, R. Ganz . . . . . . . . . . . . . . . . . 250

Concepts and Experience in the Treatment of Anterior Cmciate Ligament Disorders

Healing Processes RHefti ...... . ... 257

Morphologic Ultrastructure of Repaired and Reconstructed Ligaments WHackenbruch, H.Amold-Schmiebusch .................... 262

Indications for the Operative and Conservative Treatment of Cruciate Ligament Injuries C.J. Wirth ............................ .

Indications for Cruciate Ligament Reconstruction: A Recapitulation

. .. 266

R. P. Jakob . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 270

Acute Tears of the Anterior Cmciate Ligament

Treatment of Acute Tears We. Maller ........ . ....................... 279

Primary Repair of Acute Ruptures G. Blatter, R B. Sprenger, P. Burkart ....................... 289

Late Results after Primary Repair P. M. Ballmer, W C. Kipfer, B. Griinig, H.-u. SWubli, R. Zehnder, R. P.Jakob . 293

Avulsion Fractures of the Intercondylar Eminence in Adolescents: Pathophysiology, Case Material, and Late Results P. Bachelin ..................................... 299

Dislocation of the Knee R. J ohner, P. M. Ballmer, D. Rogge, H. B. Burch, R. P. Jakob, H. Tscheme . . . 307

Injuries of the Collateral Ligaments and Menisci

Instability of the Medial Collateral Ligament: Operative or Nonoperative Treatment? P.M.Ballmer, R.P.Jakob ........... .

Treatment of Combined Injuries of the Anterior ('ruciate Ligament and Medial Collateral Ligament Complex

. ... 321

P. M. Ballmer, R T. Ballmer, R. P.Jakob . . . . . . . . . . . . . . . . . . . . . . 325

XVI Table of Contents

Meniscus Repairs B. Moyen, J. L. Lerat, H. Muller .... 329

Meniscus Repair with Special Reference to Arthroscopic Technique R. P. Jakob, P. M. Ballmer, K. Zuber, H.-U. Stliubli ........... . · 333

Open Meniscus Repair: Technique, Postoperative Treatment, and Results M. Rodriguez . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343

Chronic Insufficieucy of the Anterior Cruciate Ligament

Autologous or Allogeneic Reconstruction? A. Giichter . . . . . . . . . . . . . . . . . . . . .... 357

Arthroscopically Assisted Reconstruction of the Anterior Cruciate Ligament. Preoperative Planning: Two-Tunnel Technique H.-u. Stliubli, S. Sporri . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 363

Reconstruction of the ACL with a Patellar Tendon Graft Based on the Infrapatellar Fat Pad: An Experimental Study in Animals T. Drobny, We. Muller, U. Munzinger, S. M. Perren ......... . . .. 370

Use of the Semitendinosus Tendon for Anterior Cruciate Ligament Reconstruction J.-L. Meystre

Anterior Cruciate Reconstruction Through a Transligamentous Approach A. Glichter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Modification of the Clancy Patellar Tendon Reconstruction of the ACL: Analysis of Three-Year Results W. C. Kipfer, P. M. Ballmer, H.-u. Stiiubli, B. Grunig, R. Zehnder, R. P.Jakob

Surgical Treatment of Anterior Cruciate Ligament Insufficiency: Comparison of Results of Repair, Primary Augmentation, and Reconstruction R. Biedert, We. Muller, W. Hackenbruch, R. Baumgartner

Late Results after ACL Reconstruction with an Autologous Free Patellar Tendon Graft W. Hackenbruch, W. Hey, H. R. Henche .

Extraarticular Lateral Reconstructions

· 376

· 384

· 389

· 401

· 412

D. Fritschy, C. Freuler ............................... 416

Arthroscopic Techniques of Anterior Cruciate Ligament Reconstruction

Kenneth Jones Technique of Arthroscopic Cruciate Reconstruction J. D. Demottaz ................................... 427

Table of Contents XVII

Arthroscopically Assisted Cruciate Ligament Reconstruction Using a Free Patellar Tendon Graft P. M. Ballmer, R. P.Jakob ............................. 437

Arthroscopically Assisted ACL Reconstruction Using Autologous Quadriceps Tendon H.-V.Staubli ................... . . ........... 443

Cruciate Reconstruction under Arthroscopic Control: Technique and Preliminary Results P. Chambat, E. Pradat ............................... 452

Injuries of Posterolateral Structures and the Posterior eruciate Ligament

Lateral and Posterolateral Rotatory Instability of the Knee R. P. Jakob, J. P. Warner .................... . . ...... 463

The Popliteus Tendon and Its Fascicles in the Popliteal Hiatus: Arthroscopic Functional Anatomy with and without ACL Insufficiency H.-V. Staubli, St. Birrer .............................. 495

Synthetic Materials for Ligament Reconstruction

Biomechanical Considerations S. N. Freudiger ........ . . ............ 505

Current Status of Synthetic Ligament Reconstruction U. Munzinger . . . . . . . . . . . . . . . . . . . . . . .

Synthetic Augmentation of Anterior Cruciate Ligament Repairs and Reconstructions

...... 518

M. Wagner, R. Schabus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 532

Instability and Osteoarthritis

Instability-Related Osteoarthritis: Special Indications for Osteotomies in the Treatment of the Unstable Knee R.P.Jakob .............. '. . . . . . . . . . . . . . . . . . . . . 543

Monopodal Weight-Bearing Radiography ofthe Chronically Unstable Knee H. Dejour, P. Neyret, M. Bonnin . . . . . . . . . . . . . . . . . . . . . . . . 568

Role of Unicompartmental Arthroplasty in Femorotibial Osteoarthritis with a Deficient Central Pivot P. Cartier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 577

XVIII Table of Contents

Complications of Anterior Cruciate Ligament Reconstruction

Intra- and Postoperative Complications H.-U.Stiiub/i, R.P.Jakob ...... ~ .

Role of Arthroscopy in the Diagnosis and Treatment of Complications of ACL Reconstruction

. .. 589

A. Giichter . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 601

Rehabilitation and Evaluation

Aspects of Rehabilitation in the Anterior Cruciate Ligament-Deficient Knee C. Gerber ................................... 607

Functional Rehabilitation after Anterior Cruciate Ligament Reconstruction B. Fandrey, B. Griinig, R. P. Jakob .................... 613

Isokinetic Testing to Evaluate Quadriceps and Hamstring Strength after a Primary Anterior Cruciate Ligament Repair or Reconstruction W. C. Kipfer, B. Griinig, P. M. Ballmer, R. Zehnder, R. P. Jakob . . . . . . . . . 619

Concluding Remarks

Rationale and Benefit of Treating Cruciate Ligament Lesions: The Payer's Perspective E. W. Ramseier ................................... 627

Future Outlook A. Giichter . . .

Subject Index .

630

633

List of Contributors

Arnold-Schmiebusch, H., Dr. Anatomisches Institut, Abt. Anatomie II, Albert-Ludwigs-Universitat, Albertstrasse 17,7800 Freiburg i. Br., FRG

Bachelin, P., Dr. Medecin-Chef Orthopedie, Hopital de Zone, Saint-Loup Orbe, 1350 Orbe, Switzerland

Ballmer, F. T., Dr. Klinik und Poliklinik fUr Orthopadische Chirurgie der Universitat Bern, Inselspital, 3010 Bern, Switzerland

Ballmer, P. M., Dr. Orthopadische Chirurgie, Grabenstr. 4,3600 Thun, Switzerland

Baumgartner, R., Dr. Orthopadie/Traumatologie, Kantonsspital, 4101 Bruderholz, ~witzerland

Biedert, R., Dr. Eidg. Turn- und Sportschule Magglingen, Hauptstrasse 243-245, 2532 Magglingen, Switzerland

Birrer, St., Dr. Tiefenauspital der Stadt Bern, Tiefenaustrasse 112,3004 Bern, Switzerland

Blankevoort, L., Dr. Sectie Biomechanica, Institut voor Orthopaedie, KU-Nijmegen/St. Radboud Ziekenhuis, P.B. 9101, 6500 Nijmegen, The Netherlands

Blatter, G., Dr. Orthopadische Abteilung, Kantonsspital, 9007 St. Gallen, Switzerland

Bonnin, M., Dr. Clinique de Chirurgie, Orthopedie et Traumatologie, Universite Lyon 1, Centre Hospitalier Lyon-Sud, 69310 Pierre-Benite, France

Burch, H.B., Dr. Ferpicloz, 1700 Fribourg, Switzerland

Burkart, P., Dr. Orthopadische Chirurgie FMH, Obergrundstrasse 44, 6003 Luzern, Switzerland

Cartier, P., Dr. Centre de Chirurgie du Genou, Clinique des Lilas, 41-49, Av. du Marechal Juin, 9360 Les Lilas, France

xx List of Contributors

Chambat, P., Dr. Chirurgie Orthopedique, Traumatologie du Sport, Clinique Emilie de Vialar, 116, rue Antoine Charial, 69003 Lyon, France

Christen, S., Dr. Turmstrasse 5, 3613 Steffisburg, Switzerland

Dejour, H., Prof. Dr. Clinique de Chirurgie, Orthopedie et Traumatologie, Universite Lyon 1, Centre Hospitalier Lyon-Sud, Pavillon 3 A, 69310 Pierre-Benite, France

Demottaz, J.D., Dr. FMH flir Orthopadische Chirurgie, 64, rue de Lyon, 1203 Geneva, Switzerland

Drobny, T., Dr. Orthopadische Klinik, Wilhelm-Schulthess-Klinik, Neumiinsterallee 3, 8008 Ziirich, Switzerland

Dupont, J. Y., Prof. Dr. Clinique St. Michael & St. Anne, 51, rue de Kerjestin, B. P. 517, 29107 Quimper-Cedex, France

Fabbriciani, c., Prof. Dr. Clinica Ortopedica della Universita Cattolica, Largo A. Gemelli 8, 00168 Roma, Italy

Fandrey,B. Physiotherapie, Inselspital, 3010 Bern, Switzerland

Fasel, A., Dr. Institut d' Anatomie de l'Universite, 1700 Fribourg, Switzerland

Freudiger, S. N., Dipl. Ing. ETH 'Protek AG, Stadtbachstrasse 64, 3012 Bern, Switzerland

Freuler, C., Dr. H6pital Cantonal Universitaire, Policlinique de Chirurgie, 24, rue Micheli-du­Crest, 1211 Geneva 4, Switzerland

Friederich, N.F., Dr. Orthopadische Abteilung, Kantonsspital Bruderholz, 4101 Bruderholz, Switzerland

Fritschy, D., PO Dr. H6pital Cantonal Universitaire, Policlinique de Chirurgie, 24, rue Micheli-du­Crest, 1211 Geneva 4, Switzerland

Gachter, A., Prof. Dr. Orthopadische Abteilung, Kantonsspital Basel, 4000 Basel, Switzerland

Ganz, R., Prof. Dr. Klinik und Poliklinik flir Orthopadische Chirurgie der Universitat Bern, Inselspital, 3010 Bern, Switzerland

List of Contributors XXI

Gerber, c., Prof. Dr. Orthopadische Klinik, Kantonsspital, 1700 Fribourg, Switzerland

Griinig,B. Spiezbergstrasse 22, 3700 Spiez, Switzerland

Hackenbruch, W., Dr. Orthopadie, Regionalspital, 4900 Langenthal, Switzerland

Hefti, E, PD Dr. Kinderorthopadische Abteilung, Kinderspital, Romergasse 8,4005 Basel, Switzerland

Henche, H. R, PD Dr. Kreiskrankenhaus Rheinfelden, Ortsteil Nollingen, 7888 Rheinfelden, FRG

Hey, W.,Dr. Kreiskrankenhaus Rheinfelden, Ortsteil Nollingen, 7888 Rheinfelden, FRG

Holzach, P., Dr. Chirurgie, Spital, 7270 Davos, Switzerland

Huiskes, R, Prof. Dr. Sectie Biomechanica, Instituut voor Orthopaedie, KU-Nijmegen/St. Radboud Ziekenhuis, p.B. 9101, 6500 HB Nijmegen, The Netherlands

Hunziker, E. B., Prof. Dr. M. E. Miiller-Institut fiir Biomechanik, Universitat Bern, Murtenstrasse 35, 3008 Bern, Switzerland

Jakob, R. P., Prof. Dr. Klinik und Poliklinik fUr Orthopadische Chirurgie der Universitat Bern, Inselspital, 3010 Bern, Switzerland

Johner, R, Dr. Chirurgien Orthopedique FMH, Av. Marc-Dufour 4, 1004 Lausanne, Switzerland

Kipfer, W. C., Dr. Grafenriedstrasse 1,3074 Muri, Switzerland

Lerat, J.L., Prof. Dr. Hopital Edouard Herriot, Pavillon I, Place d'Arsonval, 69374 Lyon Cedex 08, France

Meystre, J.-L., Dr. Orthopadische Klinik, Kantonsspital, 1000 Lausanne, Switzerland

Moyen, B., Prof. Dr. Hopital Edouard Herriot, Chirurgie Orthopedique, Medecine du Sport, 69374 Lyon Cedex 08, France

Miiller, We., Prof. Dr. Orthopadie/Traumatologie, Kantonsspital Bruderholz, 4101 Bruderholz, Switzerland

XXII List of Contributors

Muller, H., Dr. Hopital Edouard Herriot, Chirurgie Orthopedique, 69374 Lyon Cedex 08, France

Munzinger, U., Dr. Orthopadische Abteilung, Wilhelm-Schulthess-Klinik, Neumunsterallee 3, 8008 Zurich, Switzerland

Neyret, P., Dr. Clinique de Chirurgie, Orthopedie et Traumatologie, Universite Lyon 1, Centre Hospitalier Lyon-Sud, 69310 Pierre-Benite, France

Noesberger, B., Dr. Orthopadie, Regionalspital Interlaken, 3800 Interlaken, Switzerland

O'Brien, W. R., Dr. The Blazina Orthopaedic Clinic and Sherman Oaks Community Hospital, Sherman Oaks, CA 91403, USA

Oransky, M., Dr. Clipica Ortopedica della Universita Cattolica, Largo A. Gemelli 8, 00168 Roma, Italy

Oswald, M. H., Dr. Chirurgische Klinik, Kantonsspital, 8200 Schaffhausen, Switzerland

Perren, S. M., Prof. Dr. Schweizerisches Forschungsinstitut, Laboratorium fOr Experimentelle Chirurgie, 7270 Davos-Platz, Switzerland

Pradat, E., Dr. Chirurgie Orthopedique, Traumatologie du Sport, Clinique Emilie de Vi alar, 116, rue Antoine Charial, 69003 Lyon, France

Ramseier, E. W., Dr. SUVA Direktion, Postfach, 6002 Luzern, Switzerland

Rodriguez, M., Dr. Orthopadische Universitatsklinik Balgrist, Forchstrasse 340,8008 Zurich, Switzerland

Rogge, D., Dr. t formerly: Unfallchirurgische Klinik, Medizinische Hochschule, Konstanty­Gutschow-Strasse 8,3000 Hannover 61, FRG

Scellier, c., Dr. Clinique du Marais, llbis, rue Barbette, 75003 Paris, France

Schabus, R., Dr. Unfallchirurgische Universitatsklinik, Alser Strasse 4,1097 Vienna, Austria

Schneider, B., Lic. phil. nat. Seidenberggasschen 1,3073 Gumligen, Switzerland

Sporri, S., Dr. Tiefenauspital der Stadt und der Region Bern, Tiefenaustrasse 112,3004 Bern, Switzerland

List of Contributors XXIn

Sprenger, F. B., Dr. Orthopadische Chirurgie, Arztehaus, Rorschacherstrasse 19,9000 St. Gallen, Switzerland

SUiubli, H.-v., PO Dr. Orthopadie/Traumatologie, Tiefenauspital der Stadt und der Region Bern, Tiefenaustrasse 112, 3004 Bern, Switzerland

Tscherne, H., Prof. Dr. Unfallchirurgische Klinik, Medizinische Hochschule, Konstanty-Gutschow­Strasse 8,3000 Hannover 61, FRG

Wagner, M., Prof. Dr. Landeskrankenhaus Salzburg, Unfallchirurgie, MillIner Hauptstrasse 48, 5020 Salzburg, Austria

Warner, J.P., Dr. Center for Sports Medicine and Rehabilitation, Baum Boulevard at Craig, Street, Pittsburgh, PA 15213, USA

Wirth, C. J., Prof. Dr. Medizinische Hochschule, Heimchenstrasse 1-7,3000 Hannover 61, FRG

Wirz, P., Dr. Milhlenstrasse 30, 3076 Worb, Switzerland

Witschger, P., Dr. M. E. Milller-Institut fUr Biomechanik, Universitat Bern, Murtenstrasse 35, 3008 Bern, Switzerland

Zehnder, R., PO Dr. t formerly: AO-Dokumentation, Murtenstrasse 35, 3008 Bern, Switzerland

Zuber, K., Dr. Klinik und Poliklinik fUr Orthopadische Chirurgie der Universitat Bern, Inselspital, 3010 Bern, Switzerland