Traditional dogma states that anterior knee pain in adolescence does not lead to patello-femoral arthritis. However analysis of 642 new knee referrals seen in one year showed that over 25% had anterior knee pain and that patients were of all ages. This lead to us questioning whether anterior knee pain or adolescent chondromalacia patellae is in fact a benign self limiting condition.

Method: A postal questionnaire was sent to 150 patients who had undergone isolated patello femoral replacement (PFR) enquiring about patella problems earlier in life. The same questionnaire was sent to a matched group of patients who had undergone unicompartmental replacement; because of the selection policy of the unit, these would not have had changes of patellofemoral arthritis.

Results: 118 patients who had undergone PFR retumed the form. 107 were female; the average age at surgery was 66 years. 26 (22%) reported adolescent anterior knee pain at an average age of 18. 112 forms were returned form the UKR group in which females predominated and who had an average age at surgery of 67 years. Only 7 (6%) reported adolescent anterior knee pain, at an average age of 19. 16 (14%) of the PFR group reported adolescent patella instability as opposed to 1 on the UKR group.

Discussion: The finding that significantly more patients with isolated patello-femoral arthritis had suffered from adolescent anterior knee pain suggests a possible causal relationship. Further long-term studies are needed to determine whether adolescent anterior knee pain is benign, as traditionally believed, or whether certain subsets are precursors of patello-femoral arthritis.

Purpose: This study analyses the kneeling ability of patients following Unicompartmental knee replacement (UKR), Patellofemoral replacement (PFR) and Total knee replacement (TKR).

Method: Data was prospectively collected on 272 knees (254 patients) that had undergone various forms of arthroplasty procedures for osteoarthritis of the knee. All patients completed the Oxford Knee Questionnaire preoperatively and 1 year postoperatively, thus graded their kneeling ability into one of 5 categories. Absolute values and change following arthroplasty were recorded. In addition the reported kneeling ability of 75 patients was checked by clinical examination.

Results: Preoperatively only 2% of all patients could kneel with PFR group being more able than the others (UKR 0%, TKR 0% and PFR 6%). In all groups the kneeling ability was better one year following replacement than preoperatively (23% of UKR, 18% of TKR and 9% of PFR) being able to kneel with little or no difficulty.

Conclusions: No form of arthroplasty used resulted in good kneeling ability, though this function was always improved particularly by UKR. Good range of movement and younger age appeared to correlate with better kneeling ability but many patients thought they had been told not to kneel and reported less ability than they demonstrated on examination. Instruction to avoid kneeling seems unnecessary.

Aim: MRI examination of tibial tunnel enlargement after hamstring ACL surgery.

Methods and Results: 101 primary hamstring ACL reconstructions were carried out employing a transtibial over-the-top route with fixation provided by the Soffix buttonhole polyester double loop device (1186 N mean UTL to failure with young human cadaveric STG tendons). 24 were reviewed and bony tunnel enlargement was evaluated. 18 prospective reconstructions at 4 months and 6 randomly selected cases at a mean of 14 months were subjected to MRI scanning performed perpendicular to the tibial tunnel axis and the cross sectional area (CSA) was calculated with a computer programme.

In 7 cases there was no enlargement, in 5 cases there was cylindrical enlargement, in 12 cases there was conical enlargement but no cavitation was noted. A maximum mean CSA of 33% ± 38.84 sd was noted at the upper tibial tunnel exit whilst the CSA increase at the distal tibial tunnel entrance was 13% ± 16.77 sd.

In addition the MRI scan showed no evidence of excessive granulation tissue ingrowth or synovial fluid between the graft and the tunnel wall. It would appear that micro-motion which is a major factor in tunnel enlargement is eliminated by the combination of a tight fitting graft, the strength and stiffness of the fixation device and highly accurate, low stress placement of the tibial tunnel. Post operative KT 2000 arthrometric testing of the mean side to side difference (SSD) was 1.71 mm ± 1.82 sd confirming that the graft remained stiff in vivo.

Conclusion: We concluded that our technique avoids excessive tunnel enlargement and leads to greater post-operative graft stiffness than that reported in other series, where hamstring reconstruction has been employed.