Patients were followed up retrospectively by a combination of clinical review, mail and telephone questionnaires. The Lysholm knee (LS) and the Tegner activity (TA) scores were recorded.

From July 1991 until February 1999 75 meniscal repairs were carried out in 70 patients by a single surgeon (PJR). The average age of the patients was 26yrs 8 months, 52 male and 18 female. 14 patients (18.6%) were lost to formal follow-up. Lysholm Score (LS) and Tegner Activity (TA) scores were available on 58 repairs for analysis. The average follow-up was 6 yrs 4 months (range 3 yrs 4 months to 10 yrs 9 months), Average scores were LS=89.2, TA before surgery=6.2, TA after surgery=5.7. 9 patients had menisectomy following retear due to further injury. The overall success rate was 86.9%, with 74.1% scoring clinically good or excellent on the Lysholm Score.

There was a trend of improved results for patients over 30 yrs; those with longer tears and lateral repairs did slightly better. Those with ACL laxity had a significantly better result. The time interval to repair following injury did not make a difference. With an overall success rate of 86.9% the authors would recommend this traditional technique in light of the more recent techniques presently in use.

The aim of this study was to clinically assess the outcome of arthroscopically assisted inside to outside meniscal repair. Seventy-five meniscal repairs were carried out, the average age was twenty-six year eight months. Average follow up was six years four months, fourteen patients (18.6%) were lost to follow up. The overall success rate was 89.5%, with 78.1% scoring clinically good or excellent on the Lysholm Score. Improved results were shown for patients over thirty years, those with ACL laxity and with longer tears. Delay in repair did not make a difference. Clinically lateral repairs did better. With an overall success rate of 89.5% the authors would recommend this traditional technique.

The purpose of this study was to clinically assess the mid to long-term outcome of arthroscopically assisted inside to outside meniscal repair.

Patients were followed up retrospectively by a combination of clinical review, mail and telephone questionnaires. The Lysholm knee (LS) and the Tegner activity (TA) scores were recorded.

From July 1991 until February 1999 seventy-five meniscal repairs were carried out in seventy patients by a single surgeon (PJR). The average age of the patients was twenty-six year eight months, there were fifty-two male and eighteen female patients. Fourteen patients (18.6%) were lost to formal follow up. Of the seventyfive repairs carried out full data, Lysholm Score (LS) and Tegner Activity (TA) scores were available on fifty-five repairs for analysis. The average follow up was six years four months (range three years four months to ten years nine months), Average scores were LS=87.1, TA before surgery=6.1, TA after surgery=5.5. 9 patients had menisectomy following re-tear due to further injury.

The overall success rate was 89.5%, with 78.1% scoring clinically good or excellent on the Lysholm Score.

In contrast to previous studies improved results were shown for patients over thirty years, those with ACL laxity and those with longer tears. The time interval to repair following injury did not make a difference. In agreement with previous studies, clinically lateral repairs did better.

With an overall success rate of 89.5% the authors would recommend this traditional technique in light of the more recent techniques presently in use.

Introduction and Aims: Cold therapy is known to reduce pain and swelling after surgical procedures on the knee. We hypothesised that if cold therapy is started earlier, then there would be a reduction in pain and swelling in patients undergoing arthroscopic anterior cruciate ligament [ACL] reconstruction.

Method: We prospectively randomised 40 patients undergoing arthroscopic ACL reconstruction with hamstring autograft, to receive either room temperature [19° C] or cold [4° C] arthroscopy irrigation fluid. Patients were then assessed over the following seven days, with regard to pain [measured on a visual analogue scale], and swelling [measured with limb girth at four points around the knee].

Results: Pain scores were consistently reduced in the cold fluid group compared to the room temperature group throughout the post-operative period, and this difference was significant [p< =0.05] from six hours until seven days post-operatively. At day seven, the swelling measured at 5cm below the joint and 5cm above the joint were significantly lower in the cold group compared with the room temperature group. Drainage from the intra-articular drain was significantly lower in the cold group.

Conclusion: The use of cold irrigation fluid is a simple and safe measure by which pain and swelling (at day 7) can be reduced in the early post-operative period for arthroscopic ACL reconstruction.

Summary abstract The aim of this study was to clinically assess the outcome of arthroscopically assisted inside to outside meniscal repair. 75 meniscal repairs were carried out, the average age was 26yr 8 months, 14 patients ( 18.6% ) were lost to follow up. Average follow up was 6 yrs 4 months. The overall success rate was 86.9%, with 74.1% scoring clinically good or excellent on the Lysholm Score. There was a trend of improved results for patients over 30yrs, those with longer tears and lateral repairs did slightly better. Those with ACL laxity had a significantly better result. The time interval to repair following injury did not make a difference. The authors would recommend this traditional technique.

Full abstract

Purpose To clinically assess the mid to long-term outcome of arthroscopically assisted inside to outside meniscal repair.

Type of study Retrospective review

Method Patients were followed up by a combination of clinical review, mail and telephone questionnaires. The Lysholm knee (LS) and the Tegner activity (TA) scores were recorded.

Results From July 1991 until February 1999 75 meniscal repairs were carried out in 70 patients by a single surgeon (PJR). The average age of the patients was 26yr 8 months, there were 52 male and 18 female patients. 14 patients ( 18.6% ) were lost to formal follow up. Lysholm Score (LS) and Tegner Activity (TA) scores were available on 58 repairs for analysis. The average follow up was 6 yrs 4 months (range 3yrs 4 months to 10yrs 9 months ), Average scores were LS=89.2, TA before surgery=6.2, TA after surgery=5.7. 9 patients had menisectomy following re-tear due to further injury. The overall success rate was 86.9%, with 74.1% scoring clinically good or excellent on the Lysholm Score.

Conclusion There was a trend of improved results for patients over 30yrs, those with longer tears and lateral repairs did slightly better. Those with ACL laxity had a significantly better result. The time interval to repair following injury did not make a difference. With an overall success rate of 86.9% the authors would recommend this traditional technique in light of the more recent techniques presently in use.

A prospective study of the relationship of first day straight leg raise (SLR) to end range of movement took place. The ability to do SLR was used to measure patients’ motivation.

A standard medial parapatellar approach was used, all patients has osteoarthritis.

Responses from 100 patients were analyzed (divided into 3 groups)

Results: Group I: 47% of patients SLR at day one postoperatively,

-Flexion on discharge (mean) was 74°

Group II: 27% of patients SLR at day two postoperatively,

-Flexion on discharge (mean) was 66°

Group III: 26% of patients SLR at day 3 or more postoperatively,

-Flexion on discharge (mean) was 66°

Functional scores including WOMAC, SF-36 and pre-operative deformity did not vary even though Group I shows statistically significant increase in flexion at end follow up.

Conclusion: We feel that the time taken by patients to obtain SRL is multifactorial, but certainly includes motivation.

Numerous procedures have been described for degenerative arthritis of the carpometacarpal joint of the thumb. The sling procedure is technically demanding and involves sacrificing part of a healthy tendon. Silicon arthroplasty is associated with stem fracture and synovitis. We have successfully used external fixation for distraction and correction of adduction deformity following trapeziectomy with S-Quattro (Stockport Serpentine Spring System). Following trapeziectomy specially designed pins are inserted into the base of the 1^st metacarpal and radial styloid and distracted with 2 serpentine springs. The fixator is removed at six weeks and removable thermoplastic splint applied for further 6 weeks.

We reviewed the results of 39 trapeziectomy performed in 32 patients (3 male) with an average follow up of 53 months. ROM, power, pinch, pain score and patient satisfaction were reviewed by an independent hand therapist.

Average functional score was 28. 9 post-op (maximum 30) compared to 20. 7 pre operatively. Mean thumb abduction was 48. 9 and extension 49. 2 degrees which increased from 42. 9 and 43. 8 pre-operatively. Span was 19 centimetres and opposition 9. 26 on the Kapandji scale. Average grip strength was 40 lbs, pinch strength of 6 lbs and key lateral of 9. 5 lbs. Pain score improved from 7. 9 pre-op to 0. 9. There was statistically significant improvement of all functions except span. Long term follow up radiograph showed good maintenance of gap between base of 1^st metacarpal and scaphoid. Three cases had deep penetration of the pins, which required early removal. We now insert padding between the fixator and the spring to avoid deep penetration. One patient had mild RSD and another patient had pain in the distribution of the radial nerve, both of which improved following pin removal.

Application of S-Quattro following trapeziectomy is a simple and quick procedure. It is reasonably well tolerated by patients. Long-term follow-up showed improvement in hand function and good maintenance of gap between base of 1^st metacarpal and scaphoid.

The aim of this study was to ascertain if a correlation exists between the indication for revision and the clinical outcome in revision total knee replacement.

Methods: We analysed the data of 81 revision knee arthroplasty patients performed at Wrightington Hospital with an average follow-up of 31 months (1yr – 6yrs). All patients had semi-constrained prosthesis implanted (PS-PFC or TC3, Depuy). The indications for revising the total knee arthroplasty in each patient were noted and the clinical outcome was determined using a patient satisfaction questionnaire.

Results: Of the 81 patients, 18 were enthusiastic with the clinical outcome, 38 were satisfied, eight were non-committal and 17 were disappointed. Indications for revision in our series were aseptic loosening (31 patients), implant failure (21 patients), instability (14 patients), pain (eight patients) and infection (seven patients). Correlation between the indication for revision and the clinical outcome are detailed in the table below.

Sixteen per cent of patients revised for aseptic loosening were non-committal or disappointed with the outcome in comparison with 33.3% revised for implant failure, 21.4% revised for instability, 62.5% revised for pain and 71.4% revised for infection.

Conclusion: The indication for revision does affect the clinical outcome in revision knee arthroplasty. Patients undergoing revision knee arthroplasty for infection and pain are less likely to be satisfied with the clinical outcome of revision surgery.

It is usually assumed that there is a correlation between the number of previous operations and the clinical outcome of revision knee arthroplasty though it has not been studied and published. We reviewed our series of 81 revision knee arthroplasty patients to ascertain if a correlation exists. All patients had a semi-constrained prosthesis implanted.

Methods: We analysed the data of 81 revision knee arthroplasty patients performed at Wrightington Hospital with an average follow-up of 31 months (1yr – 6yrs). The number of previous operations on each knee were noted and the clinical outcome was determined using a patient satisfaction questionnaire.

Results: Of the 81 patients; 18 were enthusiastic with the clinical outcome; 38 were satisfied; eight were non-committal; 17 were disappointed. Seventy four per cent of patients with one previous operation were enthusiastic or satisfied with the revision surgery outcome in comparison to 55.5% and 0% of patients with two and three previous surgery respectively.

Conclusion: The trend from the above figures suggests that as the number of previous operations increases the likelihood of satisfactory clinical outcome decreases, in revision total knee replacement using semi-constrained prosthesis.

Background: Opinions about hinged knee prostheses vary a lot in different studies. We wanted to examine our series to ascertain their continued need in treating severely unstable knee joints and look at the early results.

Methods: 30 rotating hinged knee prostheses were implanted in Wrightington Hospital by the senior author. 4 patients deceased and the remaining knees were retrospectively followed up for an average of 16 months and examined for clinical or radiological factors indicating the overall outcome.

Results: Preoperative diagnosis: Gross instability associated with 12 – aseptic loosening; 18 – infection (15 pseudarthrosis, 1 failed arthrodesis) 19

Preoperatively, 16 patients were wheelchair bound and using a frame as a walking aid and 10 used two crutches for ambulation. 5 patients needed plastic surgical input and 5 needed a whiteside’s osteotomy for exposure. Previous surgery on the knee:

2 patients – 1 surgery

13 patients – 2 surgeries

8 patients – 3 surgeries

5 patients – 4 surgeries

2 patients – more than 4 surgeries

In the latest review, excluding the deceased patients, there were 24 patients (89%) regarded as having satisfactory and 3 patients (11%) unsatisfactory results. 89% of the patients were subjectively satisfied with the operation, mostly because of a stable, mobile knee with minimal pain, in comparison to their pre-operative debilitating condition.

Conclusions: Apart from clinical and radiological examination, preoperative diagnosis, pain, mobility, the number of previous surgeries and need for plastic surgery can be used as factors to assess the preoperative severity/morbidity of the case. Taking into account the very poor initial status of these patients, we recommend the rotating hinged prostheses still to be used in severely unstable knees.