Aims: To assess the outcome of biological resurfacing combined with osteotomy for knee osteoarthritis [OA] in young individuals.

Methods: Between January 2001 and March 2006, 25 active patients with unicompartmental OA were treated with a combination of cartilage resurfacing and tibial or femoral osteotomy. The cartilage resurfacing procedure was microfracture on both surfaces in 20 patients, Matrix Autologous Chondrocyte Implantation in 3, Autologous Chondrocyte Transplantation in 1 and Meniscal transplantation in 1. For limb realignment, an open wedge High Tibial Osteotomy was performed in 23 patients and Distal Femoral Osteotomy in 2 patients, using either the Puddu plate (Arthrex) or the Tomofix plate (Synthes).

There were 23 male and 2 female patients with a mean age of 45 years (range 27 to 60). The median follow-up period was 22.5 months (range 6 to 60). At follow-up patients were assessed radiographically and clinically using the knee society clinical score [KSS] and the Tegner activity scale.

Results: The outcome was satisfactory in 20 patients who had improvement in pain and function. The median Tegner activity level was 5.5 and the median KSS was 164. Poor results in five patients were due to delayed union in 1, nonunion in 2 and persistent severe pain in 2 who subsequently underwent unicompartmental or total knee replacement.

Discussion and conclusion: Management of the young active individual with grade 4 bare bone arthritis in the knee is challenging, and arthroplasty may not provide the ideal solution. Our series has shown that combining opening wedge osteotomy with cartilage repair results in improvement in a high proportion of patients. Such salvage surgery or ‘biological resurfacing’ may therefore have a place in the management of active young patients with bare bone osteoarthritis.

Aims: Patellar instability and painful patellar mal-tracking are common challenging conditions faced by a knee surgeon. Our purpose was to describe an arthroscopy assisted method of medial patellofemoral ligament reconstruction to address these conditions present our results using this modified technique.

Materials & Method: Between April 2001 and December 2003, 22 knees in 20 consecutive patients underwent arthroscopically assisted MPFL reconstruction using an autologous hamstring tendon. There were 12 female and 8 male patients passed with a mean age of 29.9 years. The knees were assessed using Fulkerson’s and Kujala’s scoring systems and the mean follow-up period was 20.8 months (range 12–35).

The technique uses a single hamstring tendon with undisturbed biological distal attachment, where the free end is routed through a longitudinal tunnel in the dorso-medial aspect of the patella and fixed to an isometric point near the medial femoral epicondyle using an interference screw. The position of femoral attachment is the most important factor in achieving an isometric graft.

Results: There was a significant increase (p=< 0.0001) in mean Fulkerson score of 35.4 from a pre-operative value of 47.4 to a post-operative value of 82.9. Sixteen patients rated their knees as good or excellent and there was only one complication of complex regional pain syndrome. 11 of 13 patients who were keen on sports returned to their sports at a mean of 3.9 months (range 1–10).

Conclusion: We report good results with this technique of medial patello femoral ligament reconstruction and would advocate it as an effective surgical option for patients with recurrent lateral instability as well as those with painful lateral mal-tracking.

Aims: To assess the results of Anterior Cruciate Ligament (ACL) reconstruction at a minimum of two years follow-up, using the Rolimeter [AIRCAST, Europe] as an adjunct to routine knee examination and subjective scoring systems.

Methods: The Warrington Knee Injury database was initiated in June 2001 and data from all knee ligament injuries has been collected prospectively, from preoperative status through to all follow up assessments. Inclusion criteria for our study were, all ACL reconstructions performed by the senior author with minimum 24 months follow up; other ligaments being intact and presence of a normal contralateral knee.

50 patients satisfied the inclusion criteria. There were 41 males and 9 females in ages ranging from 17 to 51 (mean 30.6 years), with no significant difference in age between sexes. Hamstring grafts were used in 29 knees and Bone-Patellar tendon – Bone (BPTB) grafts in 21. Knee laxity was measured using the Rolimeter with IKDC knee examination and functional assessments using the Lysholm, IKDC and KOOS scoring systems.

Results: 20/21 of patients with BPTB grafts (95.2%) and 26/29 of patients with Hamstring grafts (89.7%) achieved normal or near normal knee laxity compared to their opposite knee. The Range of movement in 48 of 50 knees (96%) fell within normal or near normal limits according to IKDC description (Lack of extension < 3 degrees and lack of flexion < 10 degrees). Two patients with abnormal range of movement had a similar lack of movement preoperatively. Though none of the knees were abnormally tight (AP laxity difference < -3), there was a relationship between knee tightness and lack of extension, but this was not statistically significant. There was no association between age or sex of patient and lack of movement. The mean IKDC, Lysholm and KOOS symptom scores were 80.45, 87.3 and 81.3 respectively.

Conclusions: We have achieved a normal or near normal AP laxity in 92% of our ACL reconstructions on assessment at 2 years postoperatively. We report no signifi-cant difference in outcome between use of Hamstring or BPTB grafts. The functional outcome has been optimal as revealed by subjective evaluation.

Purpose: To subjectively assess and present the outcome after ACL reconstruction with minimum follow-up of 24 months.

Methods: Our knee injury database was established in June 2001. Data were collected prospectively for all knee ligament reconstructions carried out by a single surgeon. The database has a prospectively studied consecutive series where all the patients surveyed completed the Lysholm, KOOS and IKDC 2000 questionnaires preoperatively and at 3, 6, 12 and 24 months postoperatively. Our knee injury database comprises of 163 patients who had ACL reconstruction in which Hamstrings were used in 120 cases and Bone Patella-Tendon Bone (BPTB) grafts in 43. This includes 27 complex reconstructions and 12 revisions (11 from other centres).

Results: Fifty-six of the 79 patients (70.8%) who were at least 2 years post ACL reconstruction attended for their 2 year review. Majority were male patients(90%) and both attendees and non- attendees were of a similar age (30.5 /30 respectively) and did not exhibit a statistically significant difference in their pre op or early post op scores. In the non-attendee group 2 were students, 1 emigrated, 1 registered as unemployed, 7 no employment status and 3 did not consent to such follow-up. The mechanism of injury was, 62 as sporting injury (24 contact/38 non-contact sport), 3 road traffic accidents and 8 activities of daily living and 2 not recorded. The mean scores were, IKDC – 77.14, Lysholm – 83.96 and KOOS symptom – 81.6.

Conclusions: All subjective evaluation questionnaires (KOOS, Lysholm and IKDC) revealed a progressive trend in our patients. We found that in the KOOS, a multidimensional patient completed aggregated score, the Quality of Life (QoL) dimension exhibited results which were interestingly not correlating with the other dimensions of the questionnaire, with patients who scored < 50% occupying manual or non-administrative positions at work

Purpose: To assess the results of ACL reconstructions carried out at our institution in a non-elite cohort of patients with regards to return to active sports post reconstruction.

Materials & Methods: Seventy-five (71%) of 106 patients who underwent reconstruction of isolated ACL tears between June 2001 and August 2004 performed by the senior author completed a newly designed questionnaire (incorporating Cincinnati Sports Activity Scale [CSAS]) to help us fully assess their return to sports and to elucidate reasons if not returning to pre-injury level. 55 were completed at follow up, with objective clinical assessment and other subjective questionnaires [KOOS, IKDC and Lysholm] and 20 were done through telephone interview.

Results: All 75 patients were involved in sports at CSAS Levels 1 & 2 prior to their injury and 39 (52%) had to drop to level 4 after injury. Following reconstruction 61 patients (81.3%) returned to CSAS 1 & 2 levels. 28 of 30 patients (93.3%) operated within 2 years from injury achieved pre-injury CSAS levels compared to 33 of 45 (73.3%) with a longer interval. The mean Lysholm, IKDC and KOOS Sports scores at 12 to 24 months follow up revealed a progressive trend and were 84.9, 76.3 and 73.6 respectively.

One reason for not returning to pre–injury intensity of sports was that many (71.7%) expressed fears of instability though most (70%) had no instability on playing. 77.8% of non-returners who were more than 30 years age reasoned not wanting to risk re-injury compared to 36.8% in the under 30 group. More significantly, 44.4% of over 30s said they were planning to drop their sporting level anyway compared to 5.5% in the younger group.

Conclusion: ACL reconstruction is best done as early as possible after injury for persons intending to return to competitive sports. The results are even better after early intervention in younger patients. Psychosocial issues play a significant role in return to active sports.

Introduction: This prospective study is designed to evaluate PCL reconstruction using the arthroscopic ‘double bundle technique’ in a consecutive series of patients with multiple ligament instability.

Methods: 12 consecutive patients who underwent arthroscopic posterior cruciate ligament reconstruction at Warrington Hospital for a combined ligament injury with PCL tear between 2001 and 2004 were included in the study. The indication for surgery was functional disability of the knee due to pain and instability. All were male patients with an average age 33 years (range 18 to 44). Average time from injury to surgery was 31.5 months (range 1 day to 96 months). The evaluation parameters included functional assessment, clinical examination, and functional score. All data was collected prospectively. The average period of follow up was 23months (range 9 to 50 months)

Results: Using the IKDC subjective assessment 63% of the patients had normal/near normal knee function (range 16 to 94). On Lysholm scoring 71% reported good or excellent results. On objective examination 83% had abolition of reverse pivot with 91% showing no evidence of PLC instability.

Conclusions: Arthroscopic double bundle PCL reconstruction in this study produced a satisfactory clinical outcome in terms of return to function objective assessment and symptom improvement. The technique has improved results in terms of outcome than previous reports in the literature would suggest.

This is a prospective study looking at 116 consecutive total hip replacements in 110 patients using the C-Stem total hip replacement system (Depuy International, Leeds, UK) between March 2000 and October 2002. This is the first documented study of results of the C-Stem outside Wrightington Hospital where it was developed.

There were 69 females and 41 male patients. Average age was 66 years (Range 32 – 89 years). 64 patients had a right hip replacement, 52 patients had a left hip replacement and 6 were bilateral. The duration of follow up was from 24 to 55 months, with an average of 38.75 months.

All patients had a cemented C-stem via a posterior approach. 107 with a metal head and 9 with a ceramic head. Cemented, all polyethylene cups were used. 82 hips had an Opera cup inserted and 34 had an Ogee cup inserted. Palacos R with Gentamicin was used for the cement.

103 femoral stems were neutral.12 stems were in varus (5–10 degrees) and 1 stem was in valgus (5–10degrees). No stems were greater than 10 degrees in either direction. There were no lucencies in any of the zones described by Gruen. The average amount of subsidence of the stem was 0.86mm (range 0–4mm).

The average cup angle was 44.29 degrees (SD = +/− 4.85). 8 acetabular components had a 0.5mm lucent area in zone 1 and 2 acetabular components had 1mm lucent area in zone 1. All of these lucencies were present on the immediate postoperative x-ray and none were progressive.

There were no lucencies in the other zones. There have been no incidences of deep infection, fatal P.E, dislocation or revision.

We conclude that the C-Stem has produced excellent results in the short term in keeping with the criteria of the NICE guidelines.