Background

Performing lateral extra-articular tenodesis (LET) with ACL reconstruction may conflict with the ACLR femoral tunnel.

Methods

12 fresh-frozen cadaveric knees were used: at 120 flexion, an 8mm ACLR femoral tunnel was drilled in the anteromedial bundle position via the anteromedial portal. A modified Lemaire LET was performed using a 1 cm-wide iliotibial band strip left attached to Gerdy's tubercle. The LET femoral fixation point was identified 10mm proximal / 5 mm posterior to the LCL femoral attachment, and a 2.4-mm guide wire was drilled, aiming at 0, 10, 20, or 30 degrees anteriorly in the axial plane, and at 0, 10, or 20 degrees proximally in the coronal plane. The relationship between the LET drilling guide wire and the ACLR femoral tunnel reamer was recorded for each combination. When collision with the femoral tunnel was recorded, the LET wire depth was measured.

Background

Little scientific evidence is available regarding the effect of knee joint line obliquity (JLO).

Methods

10 fresh-frozen human cadaveric knees were axially loaded to 1500 N in a materials testing machine with the joint line tilted 0, 4, 8, and 12 degrees varus and valgus, at 0, and 20 degrees of knee flexion. The mechanical compression axis was aligned to the centre of the tibial plateau. Contact pressures / areas were recorded by sensors inserted between the tibia and femur below the menisci. Changes in relative femoral and tibial position in the coronal plane were obtained by an optical tracking system.

Introduction

Our aim was to investigate trends in the incidence rate and main indication for revision knee replacement (rKR) over the past 15 years in the UK.

Methodology

Cross-sectional study from 2006 - 2020 using data from the National Joint Registry (NJR). Crude incidence rates were calculated using population statistics from the Office for National Statistics.

Background

Meniscal tears affect 222 per 100,000 of the population and can be managed non-operatively or operatively with an arthroscopic partial meniscectomy (APM), meniscal repair or meniscal transplantation. The purpose of this review is to summarise the outcomes following treatment with a meniscal tear and explore correlations between outcomes.

Methodology

A systematic review was performed of MEDLINE, EMBASE, AMED and the Cochrane Central Register of Controlled Trials to identify prospective studies describing the outcomes of patients with a meniscal tear. Comparisons were made of outcomes between APM and non-operative groups. Outcomes were graphically presented over time for all treatment interventions. Pearson's correlations were calculated between outcome timepoints.

Introduction

Recent research has questioned the role of arthroscopic meniscectomy in patients with a meniscal tear leading to the development of treatment recommendations for these patients. There is a clear need to understand patient perceptions of living with a meniscal tear in order to plan future research and treatment guidelines.

Aims

To explore the experiences and expectations of treatment of young patients with a meniscal tear of the knee

Introduction

In cementless UKR, early post-operative tibial fractures are 7x more common in very small tibias. A smaller keel has been shown to reduce this fracture risk, but its effect on fixation is unassessed. This mechanical study assesses the effect of keel interference and size on sagittal micromotion of the tibial component in physiological loading positions.

Method

A high-resolution Digital Image Correlation setup was developed and validated to an accuracy of 50 micrometres. Variants of tibial components were 3D-printed: standard, no-interference, no-keel, and a new small keel. Components were implanted into bone-analogue foam which was machined to a CT-reconstructed small tibia, using surgical technique. Tibias were loaded to 200N in physiological loading positions: 8mm (step-up) and 15mm (lunge) posterior to midpoint, and micromotion was assessed.

Background

The incidence of periprosthetic fractures of the femur around a total knee arthroplasty (TKA) is rising and this is owed to the increased longevity that today's TKA implants allow for, as well as an aging population. These injuries are significant as they are related to increased morbidity and mortality.

Methods

We retrospectively reviewed all periprosthetic fractures around a TKA that presented to our NHS Trust between 2011 to 2020. Medical records were reviewed. Treatment, complications and mortality were noted.

Introduction

Adverse reactions to pain medication and pain can delay discharge after outpatient knee arthroplasty (TKA). Pharmacogenomics is an emerging tool that might help reduce adverse events by tailoring medication use based on known genetic variations in the CYP genes determining drug metabolism. This study was undertaken to evaluate whether pre-operative pharmacogenomic testing could optimize peri-operative pain management in patients undergoing total knee arthroplasty (TKA).

Methods

This prospective, randomized study was performed in adults undergoing primary TKA. Patients in the experimental group underwent pre-operative pharmacogenomic evaluation and medication adjustments. Medications were not optimized for control patients. The Overall Benefit of Analgesic Score (OBAS) at 24 hours post-op was the primary outcome. Postoperative pain scores (VAS scale), total opioid use, time in recovery, and time to discharge were also compared.

Introduction

Knee replacement surgery can greatly improve pain, disability, quality of life and ability to work. Socioeconomic deprivation is associated with multiple poor health outcomes, partly due to reduced access to services, including surgery. We investigated whether deprivation was associated with characteristics at presentation, and outcomes following knee arthroplasty.

Methodology

We linked data from 2358 knee arthroplasty cases with the Index of Multiple Deprivation, and mortality data after mean 7.6 years follow up. A locally developed scoring system was used prospectively to categorise case complexity.

Introduction

The outcome of revision anterior cruciate ligament reconstruction (ACL-R) is guarded, particularly their return to sports activities. It is important to know the factors affecting the functional outcomes following a revision ACL-R.

Methods

We analysed results from 39 patients, who underwent a revision ACL reconstruction by a single surgeon and was followed up over a year. Some of them were treated in 2-stage revision while the rest were single-stage revision, depending upon their size of bone tunnel or osteolysis as assessed by pre-operative CT scan.

Introduction

There is growing interest in the use of robotic Total Knee Arthroplasty (TKA) to improve accuracy of component positioning. This is the first study to investigate the radiological accuracy of implant component position using the ROSA® knee system with specific reference to Joint Line Height, Tibial Slope, Patella Height and Posterior Condylar Offset. As secondary aims we compared accuracy between image-based and imageless navigation, and between implant designs (Persona versus Vanguard TKA).

Methodology

This was a retrospective review of a prospectively-maintained database of the initial 100 consecutive TKAs performed by a high volume surgeon using the ROSA® knee system. To determine the accuracy of component positioning, the immediate post-operative radiograph was reviewed and compared with the immediate pre-operative radiograph with regards to Joint Line Height, Tibial Slope, Patella Height (using the Insall-Salvati ratio) and Posterior Condylar Offset.

Introduction

There is a longstanding presumed association between obesity, complications, and revision surgery in primary knee arthroplasty. This has more recently been called into question, particularly in centres where a high volume of arthroplasty is performed. We investigated the correlation between Body Mass Index (BMI), mortality, and revision surgery.

Method

This was a cohort study of at least 10 years following primary knee arthroplasty from a single high volume arthroplasty unit. Mortality and revision rates were collected from all patients who underwent primary knee arthroplasty between 2009 and 2010. Kaplan Meier analysis was performed.

Introduction

The Syn-VAR RCT is the first of its kind comparing hamstrings autograft v synthetic neoligament for MPFL reconstruction.

Our aim is to evaluate short and long term patient related outcomes measures (PROMs) following synthetic / autologous MPFL reconstruction in a heterogenous cohort of patients with recurrent patellar instability.

Method

20 patients meeting inclusion criteria were recruited and randomised. Standardised surgery was performed by a single surgeon in Altnagelvin Hospital with data collected over 3 years from 2016. Kujala score was the primary outcome measure with data captured preoperatively and 12 weeks/2 years postoperatively. Secondary outcomes included four other validated scores and complications including Norwich Patellar Instability, Lysholm, IKDC and Banff

Introduction

Total knee replacement (TKR) aims to reduce pain and functional limitations. Despite a good outcome for many, 15–20% patients report chronic pain three months after TKR.

The STAR Care Pathway is a clinically important and cost effective treatment to improve pain outcomes over 1 year for people with chronic pain at 3 months after total knee replacement surgery. The care pathway is delivered by specially trained Extended Scope Practitioners (ESPs).

There is a gap between research findings and translation into practice. This work shows how the STAR trial findings were implemented into NHS practice at a single centre and the further work required to enable national implementation.

Methodology

Trial findings were presented to NHS managers with a business case for an implementation pilot. Trial documentation was adapted for use in usual care using the COM-B model for behaviour change and evidence-based approaches to increase the return of postal questionnaires. Trial sites were contacted to understand their capacity to implement the intervention locally.

Introduction

Autologous chondrocyte implantation (ACI) is a common procedure, primarily performed in active, young patients to treat knee pain and functional limitations resulting from cartilage injury. Nevertheless, the functional outcomes of ACI remain poorly understood. Thus, the aim of this systematic review was to evaluate the biomechanical outcomes of ACI.

Methodology

Ovid MEDLINE, Embase, and Web of Science were systematically searched using the terms ‘Knee OR Knee joint AND Autologous chondrocyte implantation OR ACI’. Strict inclusion and exclusion criteria were used to screen publications by title, abstract, and full text. Study quality and bias were assessed by two reviewers. PROSPERO ID: CRD42021238768.

Introduction

Persistent medial laxity increases the risk of failure for ACL reconstruction. To address this, multiple reconstruction techniques have been created. To date, no single strand reconstruction constructs have been able to restore both valgus and rotational stability. In response to this, a novel single strand Short Isometric Construct (SIC) MCL reconstruction was developed.

Methods

Eight fresh-frozen cadaveric specimens were tested in three states: 1) intact 2) after sMCL and dMCL transection, and 3) after SIC MCL reconstruction. In each state, four loading conditions were applied at varying flexion angles: 90N anterior drawer, 5Nm tibial external rotation torque, 8Nm valgus torque, and combined 90N anterior drawer plus 5Nm tibial external rotation torque.

Introduction

Total joint arthroplasty (TJA) is one of the commonest and most successful orthopaedic procedures, used for the management of end-stage arthritis. With the recent introduction of robotic assisted joint replacement, Computed Tomography (CT) has become part of required pre-operative planning.

The aim of this study is to quantify and characterise incidental CT findings, their clinical significance, and their effect on planned joint arthroplasty.

Methodology

All consecutive patients undergoing an elective TJR (hip or knee arthroplasty) were retrospectively identified, over a 3-year period (December 2019 and December 2022). Data documented and analysed included patient demographics, type of joint arthroplasty, CT findings, their clinical significance, as well as potential delays to the planned arthroplasty because of these findings and subsequent further investigation.

Introduction

There is little published literature to support the claim that a successful total knee replacement (TKR) is predictive of future good outcomes on the contralateral side. The objective was to identify whether outcome from the first of staged TKRs could be used to predict the outcome of the contralateral TKR.

Methodology

This was a retrospective cohort study of 1687 patients over a 25-year period undergoing staged bilateral TKRs in a UK arthroplasty centre. A control group of 1687 patients undergoing unilateral TKR with matched characteristics was identified.

Primary outcomes: satisfaction and Knee Society Score (KSS) at one year.