We studied the outcomes following arthroscopic primary repair of bucket handle meniscus tears to determine the incidence of re-tears and the functional outcomes of these patients. Prospective cohort study. Over a 4-year period (2016 to 2020), 35 adult patients presented with a bucket handle tear of the meniscus. Arthroscopic meniscal repair was performed using either the all inside technique or a combination of all-inside and inside-out techniques. 15 patients also underwent simultaneous arthroscopic anterior cruciate ligament reconstruction. Functional knee scores were assessed using IKDC and Lysholm scores.Aims
Methodology
Anterior cruciate ligament (ACL) injuries represent a significant burden of disease to the orthopaedic surgeon and often necessitate surgical reconstruction in the presence of instability. The hamstring graft has traditionally been used to reconstruct the ACL but the quadriceps tendon (QT) graft has gained popularity due to its relatively low donor site morbidity. This is a single centre comparative retrospective analysis of prospectively collected data of patients who had an ACL reconstruction (either with single tendon quadrupled hamstring graft or soft tissue quadriceps tendon graft). All surgeries were performed by a single surgeon using the All-inside technique. For this study, there were 20 patients in each group. All patients received the same post-operative rehabilitation protocol and were added to the National Ligament Registry to monitor their patient related outcome scores (PROM).Introduction
Methods
We studied the outcomes following arthroscopic primary repair of bucket handle meniscus tears to determine the incidence of re-tears and the functional outcomes of these patients. Prospective cohort study. Over a 4-year period (2016 to 2020), 35 adult patients presented with a bucket handle tear of the meniscus. Arthroscopic meniscal repair was performed using either the all inside technique or a combination of all-inside and inside-out techniques. 15 patients also underwent simultaneous arthroscopic anterior cruciate ligament reconstruction. Functional knee scores were assessed using IKDC and Lysholm scores.Abstract
Aims
Methodology
There has been a significant increase in the demand for arthroplasty as a result of the Covid 19 pandemic and lack of beds on the green pathway. The average length of in-hospital stay following knee replacements has been successfully reduced over the years following introduction and adoption of enhanced recovery protocols. Day case arthroplasty has the potential to be efficient as well as cost-effective. We present our day case pathway for elective knee arthroplasty and early results of its adoption at a district general hospital. Our pathway was developed through a multidisciplinary input from surgeons, anaesthetists, physiotherapists, nursing staff, administrative staff, surgical care practitioners and pharmacists. Inclusion criteria were defined to identify patients suitable for cay case arthroplasty. Results of 32 patients who underwent day case partial and total knee replacement at our institution between 2018 to 2022 are presented. 31 out of 32 (97%) were discharged safely on the day of surgery. Patients were discharged at a mean of 7 hours following surgery. There were no re-admissions following discharge. There were no surgical complications at a mean follow-up of 2 years. Patient feedback revealed high levels of satisfaction and that they would recommend the pathway to others. Cost analysis revealed savings towards bed costs. Our early results demonstrate day case knee arthroplasty to be safe and cost effective. With limited resources to tackle the enormous backlog of arthroplasty, it offers the potential to make theatre utilization efficient.
Prospective single-surgeon case-series evaluating patients undergoing surgery by this technique. 76 cases (mean age of 33.2 years) who had primary ACL reconstruction with BTB or quadriceps tendon with bone block, were divided into 2 matched groups (age, sex and type of graft) of 38 each based on the method of femoral fixation used (interference screw or adjustable cortical suspension). Patients were followed up clinically and using PROMS from NLR with EQ-5D, KOOS, IKDC and Tegner scores. Complications and return to theatre were noted. Paired two-tailed student t-tests and Chi-square tests were employed for statistical analysis. At a mean follow-up of 82 months, peri-operative mean EQ-5D VAS, EQ-5D Index, KOOS, IKDC and Tegner activity scores showed significant improvement (p<0.05), but no significant difference between the two groups (p>0.05). Mean graft length and diameter was 77mm and 9.3 respectively. Mean interval from injury to surgery was 10.5 months. 18(23.7%) patients had associated meniscal tear with 73.3 % undergoing repair. 10 cases (13.2 %) returned to theatre including, MUA for arthrofibrosis (n=2) and intra-substance graft failure (n=2). 3 cases had to be converted to interference screw fixation due to the tightrope cutting through from the femoral bone block as a result of a technical pitfall.Abstract
Methodology
Results
Recurrent patellar dislocation in combination with cartilage injures are difficult injuries to treat with confounding pathways of treatment. The aim of this study is to compare the clinical and functional outcomes of patients operated for patellofemoral instability with and without cartilage defects. 82 patients (mean age-28.8 years) with recurrent patellar dislocations, who underwent soft-tissue or bony procedures, were divided into 2 matched groups (age, sex, follow-up and type of procedure) of 41 each based on the presence or absence of cartilage defects in patella. Chondroplasty, microfracture, osteochondral fixation or AMIC-type procedures were done depending on the nature of cartilage injury. Lysholm, Kujala, Tegner and Subjective Knee scores of both groups were compared and analysed. Complications and return to theatre were noted.Abstract
Background
Methods
Recurrent patellar dislocation in combination with cartilage injures are difficult injuries to treat with confounding pathways of treatment. The aim of this study is to compare the clinical and functional outcomes of patients operated for patellofemoral instability with and without cartilage defects. 82 patients (mean age-28.8 years) with recurrent patellar dislocations, who underwent soft-tissue or bony procedures, were divided into 2 matched groups (age, sex, follow-up and type of procedure) of 41 each based on the presence or absence of cartilage defects in patella. Chondroplasty, microfracture, osteochondral fixation or Autologous Matrix-Induced Chondrogenesis(AMIC)-type procedures were done depending on the nature of cartilage injury. Lysholm, Kujala, Tegner and Subjective Knee scores of both groups were compared and analysed. Complications and return to theatre were noted.Background
Methods
Recurrent patellar dislocation is often reported in bilateral knees in young active individuals. The medial patellofemoral ligament (MPFL) tear is the attributable cause behind many of them and warrants reconstruction of the ligament to stabilize the patellofemoral joint. Besides, trochleoplasty and Fulkerson's osteotomy are some other procedures that are performed to treat this problem. This study aimed to compare the clinical and functional outcomes in a cohort of patients with single-stage bilateral realignment procedures vs staged procedures. It was a retrospective matched cohort study with prospectively collected data. A total of 36 patients (mean age-26.9 years, range 13 years to 47 years) with recurrent patellar dislocations, who underwent a surgical correction in both the knees, were divided into two matched groups (age, sex, follow-up, and type of procedure). Among them, 18 patients had surgeries in one knee done at least six months later than the other knee. The remaining 18 patients had surgical interventions for both knees done in a single stage. Lysholm, Kujala, Tegner, and subjective knee scores of both groups were compared and analyzed. The rate of complications and return to the theatre were noted in both groups.Introduction
Methods
Anatomic all-inside ACL reconstruction using TransLateral technique is a relatively new technique that reduces surgical invasion and pain leading to early recovery. We evaluated clinical outcomes of patients undergoing primary anatomic all-inside ACL reconstruction using TransLateral technique. Retrospective case-series evaluating patients undergoing surgery from June 2013 – December 2017. Patients were followed up clinically and using PROMS including EQ-5D, KOOS, IKDC and Tegner scores. Paired two-tailed student t-tests were used to assess clinical significance. 138 patients were included (115 males, 23 females). Mean age was 30 years (range 16.0 – 60.2). Graft choice included isolated semitendinosus (n=115) or both semitendinosus and gracilis (n=26). Mean graft length and diameter were 62.1mm and 8.7mm. Sixteen cases (11.3%) returned to theatre; MUA for arthrofibrosis (n=4), infection (n=2), haemarthrosis (n=1) and metalwork failure (n=1). Incidence of graft re-rupture was 5.7% (n=8); 7 cases were in the mid-bundle femoral tunnel placement. 52.5% (n=74) had complete peri-operative PROMS scores. Mean peri-operative EQ-5D VAS scores were 69.8 and 78.2 (p=0.02). Mean peri-operative KOOS scores for all domains demonstrated significant improvements (p<0.001). Mean peri-operative IKDC scores were 46.1 and 72.5 (p<0.05) and peri-operative Tegner activity scores were 3.3 and 5.3 (p<0.001). Anatomic all-inside ACL reconstruction using TransLateral technique demonstrates favourable clinical and biomechanical advantages including independent anatomic femoral tunnel placement, bone preservation and use of single tendon graft. Patients report significant improvements in pain, functional outcome, quality of life and return to sports. Mid-bundle femoral tunnel placement has been abandoned due to higher failure rate.
Oxford Medial Unicompartmental Knee Replacement (OMUKR) is a well-established treatment option for isolated medial compartment arthritis, with good patient reported outcome measures (PROMs). We present our results of the Oxford Domed Lateral Unicompartmental Knee Replacement (ODLUKR) to establish if patients benefit as much as with OMUKR. Retrospective review of prospectively collected data of a single surgeon series of consecutive UKR from 2007 to 2014 were collated with a minimum 2 years follow-up. PROMs data were collected using pre- and post-operative Oxford Knee Scores (OKS) (best score of 48). One hundred and twenty-eight OMUKR and 27 ODLUKR were performed in the study period. There was no significant difference in the age at time of surgery, but there were significantly more women in the ODLUKR group (74% vs 53%). There was no significant difference in pre-op OKS between the groups (OMUKR = 16/48; ODLUKR = 20/48), or the improvement in OKS post-op (OMUKR = 19 points; ODLUKR = 17 points). One ODLUKR was revised to Total Knee Replacement (TKR) for pain. There were three (11.1%) bearing dislocations, which were treated with thicker bearing exchange, with no subsequent problems. There were no bearing dislocations in the OMUKR. Four OMUKR were revised to TKR due to pain. The overall implant survivorship was 96.3% for ODLUKR and 96.9% for OMUKR. ODLUKR is a good treatment option for isolated lateral compartment arthritis and gives results equivalent to OMUKR. There is, however, an increased risk of bearing dislocation so should be performed by a high volume UKR surgeon.
Wales in collaboration with the Welsh Assembly Government, has attempted to start a national ligament register. Norway is the lead in Europe for running a successful national quality knee ligament registry. As yet there is no UK wide registry encompassing all forms of knee ligament surgery. The issue has been discussed at previous society meetings, but no consensus has been reached.Aims
Introduction
