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.
To compare the current practice of ACL reconstruction in a District General Hospital against the recently produced BOA best practice guidelines, we have reviewed all ACL reconstructions performed at our institute from 1997 – 2001. We have assessed the interval from injury to reconstruction and the role of pre-operative assessment and education. We have assessed the standard of documentation regarding the in-patient stay and the surgery itself, including the grade of operating surgeon. Post-operatively, we have assessed the position of the grafts radiologically, and whether original levels of sporting activity were regained. The average time from injury to first consultation in an orthopaedic clinic was 23.6 months. In respect of the admission notes, 77% had the history of injury and symptoms documented, and although all had a general pre-operative cardio-respiratory examination documented, none had evidence of examination of the relevant knee joint. Furthermore, none of the patients had the risks and benefits of the procedure documented at admission, and only one patient had been consented by the operating surgeon. Peri-operatively, all patients received both antibiotics and thromboprophylaxis, although only 21% had daily entries in the notes. The average post-operative follow-up was 9.1 months. From this audit of our current practice, we have highlighted the following points :-
There is still an unacceptable delay in the diagnosis of ACL rupture. Documentation must be improved, with regard to admission examination, daily note entries and recording the findings at EUA. The specific risks and benefits of surgery must be documented either at out-patient assessment or at the time of consent. Consent is not obtained by the operating surgeon.
