To document the incidence of intra-articular pathology resulting from delayed Anterior Cruciate Ligament (ACL) reconstruction

A prospective assessment of meniscal and chondral damage found at the time of primary ACL reconstruction, and the relationship of incidence of intra-articular pathology to time since original ACL injury.

We reviewed 1960 patients who had undergone a primary ACL reconstruction. There were 1443 Males and 517 females, with an average age of 28.3 years. The average age at injury was 25.4 years.

1136 patients (58%) had secondary intra-articular pathology, 621 (54.7%) had a medial meniscal tear, 594 (52.4%) had a lateral meniscal tear and 381 (33.5%) had chondral damage. The average time from injury to reconstruction was 2.9 years (34.8 months) Those with secondary intraarticular pathology presented for reconstruction later, average 3.9 years (46.8 months), compared to those without secondary pathology, average 1.5 years (18 months).

The incidence of secondary intra-articular pathology increased with delay between original ACL injury and reconstruction. 41% of those waiting 12 months; 60% of those waiting 3 years; 79% of those waiting 5 years and 88% of those waiting 10 years had secondary intra-articular pathology.

This study confirms the relationship between an unstable ACL deficient knee and the incidence of secondary intra-articular pathology. Furthermore, our study reveals the increasing incidence of meniscal and chondral pathology the greater the delay from injury to ACL reconstruction. To prevent unnecessary secondary intra-articular pathology we recommend ACL reconstruction is performed with minimal delay.

Introduction: The Motus (Osteo) total knee replacement design is an uncemented, stemless, hydroxyapatite-coated prosthesis designed as a low profile resurfacing implant.

Aim: To review the results after five to eight years of the use of this prosthesis by one surgeon and to discuss the perceived advantages of its design.

Methods: Between 1992 and 1996 the Motus (Osteo) prosthesis was used in 606 primary total knee replacements in 409 patients. The evaluation was undertaken using a clinical knee score based on the Knee Society Score and the Hospital for Special Surgery (HSS) score, which produces a maximum score of 200/200.

Results: The mean age was 69 years (range: 31 to 88 years) with 53% of the patients being female. Osteoarthritis was the underlying pathology in the majority of the cases. The minimum time to follow up was 60 months (mean: 79, range: 60 to 104 months). The mean pre-operative knee score was 98/200 with a range of movement from six degrees to 122 degrees. After five years, the mean knee score was 180/200 with a range of movement from one degree to 113 degrees. To date only two patients have required a revision procedure, both for deep infection. Twenty-six patients have died and six have been lost to follow-up as they are overseas.

Conclusion: At a minimum five-year review, the Motus (Osteo) total knee replacement prosthesis produced excellent functional and clinical results with a low rate of complications.