Aims

This study assessed the association of classes of body mass index in kg/m² (classified as normal weight 18.5 kg/m² to 24.9 kg/m², overweight 25.0 kg/m² to 29.9 kg/m², and obese ≥ 30.0 kg/m²) with short-term complications and functional outcomes three to six years post-operatively for closed ankle fractures.

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. 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. There were 1161 female and 948 male patients with a mean age of 69 (21 to 97). All cause survivorship excluding mortality was 97.2% up to 13yrs with a minimum of 10 years. The revision rate in this series was 2.8% with no significant difference in revision rates after 10 year between patients with BMI above and below 40 (p=0.438). There was no significant difference in 10–year mortality between patients above and below a BMI of 40 (p=0.238). This study shows no significant difference in the long term survival of total knee replacement between patients with normal and high BMI. Careful consideration should be given before rationing surgery based on BMI alone

The aim of this study was to determine if patient reported outcome scores for arthroscopic meniscectomy are adversely affected by the degree of knee osteoarthritis or patient body mass index (BMI). All patients who underwent arthroscopic meniscectomy within the NHS in Scotland between 6th February and 29th April 2012 were audited as part of the Scottish Government Musculoskeletal Knee Arthroscopy Audit and were eligible for inclusion within this study. A total of 270 patients returned both their pre-operative and post-operative EuroQol 5Q5D5L descriptive questionnaire and Knee injury and Osteoarthritis Outcomes Scores. Patients were stratified according to BMI, degree of osteoarthritis, history of injury, and duration of knee symptoms. Pre-operative to post-operative EuroQol index scores [0.642±0.253 to 0.735±0.277, median±SD] and Knee injury and Osteoarthrtis Outcome Scores [44.63±18.78 to 62.28±24.94, median±SD] improved across all patients (p<0.0001). This was irrespective of degree of BMI, history of injury, or duration of symptoms. There was no such improvement in patients with moderate to severe osteoarthritis. Those patients with a BMI >35 kg/m2 had lower post-operative scores than the pre-operative scores of those of BMI <30 kg/m2. Arthroscopic meniscectomy is beneficial regardless of patient BMI, duration of symptoms, history of injury, or in the presence of mild arthritis

Introduction. Obesity has been associated with higher complication rates and poorer outcomes following joint replacement surgery. Body mass index (BMI) is a simple index of body composition and forms part of preoperative assessment. It does not take into account the proportion of lean mass and body fat and can give a false impression of body composition in healthy manual workers. A more accurate measure of body composition is available using non-invasive bioimpedance methods. This study aims to identify whether BMI provides an accurate measure of body fat composition in patients awaiting lower limb arthroplasty surgery. Methods. Consecutive patients attending for pre-assessment clinic prior to total knee and hip replacement surgery were examined. All patients had their BMI calculated and underwent bioimpedance testing using a bedside Bodystat 1500 scanner (Bodystat, UK). Results. 83 patients (28 male) were included. Mean age was 68 years (range 16 to 92). All were awaiting lower limb arthroplasty surgery (39 primary total hip replacement, 4 revision total hip replacement, 38 primary total knee replacement, one unicompartmental knee replacement and one patellofemoral joint replacement). Mean BMI was 30.8 (range 20.8 to 48.9). Mean body fat percentage was 37.4% (range 17% to 53.9%). A weak correlation was seen between the calculated BMI and the measured body fat percentage (r=0.42, Pearson's correlation coefficient). Mean body fat percentage in obese patients (BMI > 30; mean BMI 34.9; n=42) was 42% while in the non-obese patients (BMI < 30; mean BMI 26.6; n=41) was 32.8%. This difference was significant (p<0.001). Conclusion. In patients undergoing lower limb arthroplasty the calculated BMI has a weak correlation with the measured body fat percentage. Bedside, non-invasive bioimpedance analysis provides a quick and accurate measure of body composition and can be used during preoperative assessment. Future correlation of outcome against body composition and BMI will validate the use of body composition in these patients. Care should be taken when relying on BMI alone to assess body fat composition

Purpose. The purpose of this study were to investigate whether there is an association between the preoperative body mass index in total knee replacement patients and the effect three to five years postoperative. Method. 197 patients who had undergone primary total knee replacement in the period 1.1.2005–31.12.2006 participated in a three-five years of follow-up study. Outcome measures were self-rated health (SF-36), which consists of eight strands and two component scores, physical component score and mental component scores and the Knee Society rating system (KSS) (knee score and function scores), and improvement of the two KSS scores from baseline to follow-up. Results. With Ordinal logistic regression (adjusted for gender, age, basic disease and surgical procedure) were found statistically significant association between body mass index and nine of the fourteen outcome measures. For all outcome measures were found OR > 1. With a difference in body mass index of 1kg/m2 increases the risk of lower scores from a minimum of 2% OR 1.02 (0.97–1.07) p=0.5 (mental component score) to maximum 14% OR 1.14 (1.08–1.21) p <0.001 (KSS function score). With a difference in body mass index on 5kg/m2 increases the risk of lower scores from a minimum of 9% OR 1.09 (mental components scores) to a maximum of 96% OR 1.96 (KSS function scores). With a difference in body mass index of 10kg/m2 rises risk of worse score with minimum 19% OR 1.19 (mental component score) to a maximum of 284% OR 3.84 (KSS function score). Conclusion. There is a clear association between body mass index and efficacy 3–5 years following primary total knee replacement. More than half of the Outcome measures were statistically significant and the outcomes that were not statistically significant are clinically interesting. High body mass index increases the risk of poor outcome after total knee Arthroplasty

To compare the long-term outcomes of fibular nailing and plate fixation for unstable ankle fractures in a cohort of patients under the age of 65 years. Patients from a previously conducted randomized control trial comparing fibular nailing and plate fixation were contacted at a minimum of 10 years post intervention at a single study centre. Short term data were collected prospectively and long-term data were collected retrospectively using an electronic patient record software. Ninety-nine patients from one trauma centre were included (48 fibular nails and 51 plate fixations). Groups were matched for gender (p = 0.579), age (p = 0.811), body mass index (BMI)(p = 0.925), smoking status (p = 0.209), alcohol status (p = 0.679) and injury type (p = 0.674). Radiographically at an average of 2 years post-injury, there was no statistically significant difference between groups for development of osteoarthritis (p = 0.851). Both groups had 1 tibio-talar fusion (2% of both groups) secondary to osteoarthritis with no statistically significant difference in overall re-operation rate between groups identified (p = 0.518,). Forty-five percent (n=42) of patients had so far returned patient reported outcome measures at a minimum of 10 years (Fibular nail n=19, plate fixation n=23). No significant difference was found between groups at 10 years for the Olerud and Molander Ankle Score (p = 0.990), the Manchester-Oxford Foot Questionnaire (p = 0.288), Euroqol-5D Index (p = 0.828) and Euroqol-5D Visual Analogue Score (p = 0.769). The current study illustrates no difference between fibular nail fixation and plate fixation at a long-term follow up of 10 years in patients under 65 years old, although the study is currently under powered

Background. Injury to the ACL is a significant problem and can cause further damage to the internal structures of the knee. ACL injury is associated with injuries to other structures in the knee such as the meniscus and chondral cartilage. Such intra articular injuries pre-dispose the knee to develop arthritis. This injury is usually seen in young and active people usually related to sporting injuries. There is a paucity of literature on the influence of anthropometric features on the hamstring graft obtained in ACL reconstruction, although there are studies on the sex based differences affecting the hamstring graft. This study was undertaken to assess the influence of anthropometric measurements on the graft thickness obtained at ACL reconstruction surgery within the UK population. Objective. This study was undertaken to assess the influence of anthropometric measurements (body mass index (BMI), height and weight) on the graft thickness obtained at anterior cruciate ligament reconstruction surgery. Materials and methods. Data from 121 consecutive patients who had undergone ACL reconstruction by the same surgeon using quadrupled hamstring grafts were analysed. The body mass index, height and weight of these patients were correlated with the graft thickness obtained during surgery. Regression analysis was undertaken to assess the influence of individual anthropometric variables on the graft thickness. Results. Of the 121 patients there were 108 males and 13 females. Average age of the cohort was 32 years (14–55). There was a statistically significant positive correlation between the height and graft size (r=0.38, p < 0.01) as well as between the body weight and graft size (r=0.29, p < 0.01). However, when body mass index was calculated, the correlation was not statistically significant (r=0.08, p > 0.1). Regression analysis confirmed that BMI was not statistically significant as a predictor of hamstring graft diameter whereas height was statistically the most important predictor (F=20.1; p < 0.01) and yielded the predictive equation from regression analysis. Graft diameter=4.5 + 0.02 × Ht. (in cms) suggesting that people with height less than 125 cms (4′1″) are at greatest risk of a quadrupled graft size of less than 7 mm. Conclusion. Our findings suggest that although body mass index did not significantly correlate, individual anthropometric variables (height and weight) do influence the size of graft thickness in ACL reconstruction and give pre operative information. This may allow surgeons to plan for alternative graft options, if they could predict the possibility of inadequate graft size prior to ACL reconstruction surgery

Aims. The primary aim of this prognostic study was to identify baseline factors associated with physical health-related quality of life (HRQL) in patients after a femoral neck fracture. The secondary aims were to identify baseline factors associated with mental HRQL, hip function, and health utility. Patients and Methods. Patients who were enrolled in the Fixation using Alternative Implants for the Treatment of Hip Fractures (FAITH) trial completed the 12-item Short Form Health Survey (SF-12), Western Ontario and McMaster Universities Arthritis Index, and EuroQol 5-Dimension at regular intervals for 24 months. We conducted multilevel mixed models to identify factors potentially associated with HRQL. . Results. The following were associated with lower physical HRQL: older age (-1.42 for every ten-year increase, 95% confidence interval (CI) -2.17 to -0.67, p < 0.001); female gender (-1.52, 95% CI -3.00 to -0.05, p = 0.04); higher body mass index (-0.69 for every five-point increase, 95% CI -1.36 to -0.02, p = 0.04); American Society of Anesthesiologists class III (versus class I) (-3.19, 95% CI -5.73 to -0.66, p = 0.01); and sustaining a displaced fracture (-2.18, 95% CI -3.88 to -0.49, p = 0.01). Additional factors were associated with mental HRQL, hip function, and health utility. . Conclusion. We identified several baseline factors associated with lower HRQL, hip function, and utility after a femoral neck fracture. These findings may be used by clinicians to inform treatment and outcomes. Cite this article: Bone Joint J 2018;100-B:361–9

Radiation exposure is a hazard to orthopaedic surgeons, theatre staff and patients intra-operatively. Obesity is becoming a more prevalent problem worldwide and there is little evidence how a patient's body habitus correlates with the radiation doses required to penetrate the soft tissues for adequate imaging. We aimed to identify if there was a correlation between Body Mass Index (BMI) and radiation exposure intra-operatively. We performed a retrospective review of 75 patients who underwent sliding hip screw fixation for femoral neck fractures in one year. We recorded Body Mass Index (BMI), screening time, dose area product (DAP), American Society of Anesthesiologists (ASA) grade, seniority of surgeon and complexity of the fracture configuration. We analysed the data using statistical tests. We found that there was a statistically significant correlation between dose area product and patient's BMI. There was no statistically significant relationship between screening time and BMI. There was no statistical difference between ASA grade, seniority of surgeon, or complexity of fracture configuration and dose area product. Obese patients are exposed to increased doses of radiation regardless of length of screening time. Surgeons and theatre staff should be aware of the increased radiation exposure during fixation of fractures in obese patients and, along with radiographers, ensure steps are taken to minimise these risks

BACKGROUND & AIM. Most previous studies found that the rate of dislocation following primary THA was 2 to 3 % on average. It is expected that minimally invasive (MI) THA has fewer dislocations after surgery because it causes less muscle damage. To ascertain the risk factors of dislocation, we conducted a retrospective study of the occurrence of dislocation after MI-THA in Japanese patients. METHODS. From June 2003 when we began MI-THA to August 2010 primary MI-THAs were performed on 2,042 hips; 1,997 hips with mini-posterior approach (a mean incision of 7 cm) with the repair of posterior soft tissues and 45 hips with other approaches. The dislocation after MI-THA was studied with respect to age, sex, body mass index, the use of navigation system, femoral head size, cup size and approaches. The period of follow-up was from six weeks to seven years. RESULTS. The numbers of dislocation after MI-THA were 13 hips (0.6%). The numbers of posterior and anterior dislocation after MI-THA were nine and four hips, respectively. In the patients undergoing MI-THA, there was a significant difference between non-dislocated hips and dislocated hips, with respect to the average age (57 years vs. 66 years, p<0.017), the numbers of male patients (181 cases (9%) vs. 4 cases (31%), p<0.024), cup size (50 mm vs. 53 mm, p<0.007) and the numbers of cases which used navigation system (1,932 hips (95%) vs. 10 hips (77%), p<0.023). Whereas there was no significant difference between non-dislocated hips and dislocated hips with respect to the body mass index, femoral head size and approaches. DISCUSSION. Several risk factors of the dislocation after primary THA have been reported. In this study we found that MI-THA had fewer risk of dislocation as compared with historic controls. It is suggested that less soft tissue damage can decrease the risk of the dislocation after surgery. The incidence of dislocation was fewer in the younger and female patients undergoing MI-THA with the navigation system than in the older and male patients undergoing MI-THA without the navigation system. The posterior approach combined with the repair of posterior soft tissues did not increase the risk of dislocation after surgery as compared with other approaches. The position of implants is important to prevent dislocation after surgery, and the navigation system can help to obtain a good position of implants. CONCLUSIONS. We conclude that MI-THA can decrease the risk of dislocation after primary THA. Furthermore the combination of MI-THA and the navigation system is very useful to reduce the incidence of dislocation because the use of the navigation system during surgery can be helpful to acquire the precise position of implants

Osteoporosis and fragility fractures in men constitute a considerable burden in healthcare. We have reviewed 2035 men aged over 50 years with 2142 fractures to clarify the epidemiology of these injuries and their underlying risk factors. The prevalence of osteoporosis ranged between 17.5% in fractures of the ankle and 57.8% in those of the hip. The main risk factors associated with osteoporosis were smoking (47.4%), alcohol excess (36.2%), body mass index < 21 (12.8%) and a family history of osteoporosis (8.4%). Immobility, smoking, self-reported alcohol excess, a low body mass index, age ≥72 and loss in height were significantly more common among men with fractures of the hip than in those with fractures elsewhere

Laminar airflow systems are universal in current orthopaedic operating theatres and are assumed to be associated with a lower risk of contamination of the surgical wound and subsequent early infection. Evidence to support their use is limited and sometimes conflicting. We investigated whether there were any differences in infection rates (deep and superficial) between knee and hip arthroplasty cases performed in non-laminar and laminar flow theatres at 10 year follow-up. Between 2002 and 2006, 318 patients underwent knee and hip arthroplasty in a non-laminar flow theatre. Prospectively collected local arthroplasty audit data was collected including superficial and deep infection, revision for infection and functional outcomes. A cohort of patients from the same time period, who underwent knee and hip arthroplasty in a laminar flow theatre, were matched for age, sex, body mass index (BMI), operative approach, implant and experience of surgeon. Superficial infection rates were lower overall in the non-laminar flow theatre (2.2percnt; versus 4.7percnt;), with a significantly lower superficial infection rate for knee arthroplasty performed in the non-laminar flow theatre (2percnt; versus 6.9percnt;). The deep infection rates were similar (1.3percnt; vs 1.9percnt;) for both laminar and non-laminar flow theatre respectively. Revision rates for infection were similar between both groups (0.9percnt; in non-laminar flow theatre vs 0.3percnt; in laminar flow). Whilst the causes of post-operative surgical site infection are multifactorial, our results demonstrate that at long –term follow-up, there was no increased risk of infection without laminar flow use in our theatre

Many orthopaedic surgeons believe that obese patients have a higher rate of peri-operative complications and a worse functional outcome than non-obese patients. There is, however, inconsistency in the literature supporting this notion. This study was performed to evaluate the effect of body mass index (BMI) on injury characteristics, the incidence of complications, and the functional outcome after the operative management of unstable ankle fractures. We retrospectively reviewed 279 patients (99 obese (BMI ≥ 30) and 180 non-obese (BMI < 30) patients who underwent surgical fixation of an unstable fracture of the ankle. We found that obese patients had a higher number of medical co-morbidities, and more Orthopaedic Trauma Association type B and C fracture types than non-obese patients. At two years from the time of injury, however, the presence of obesity did not affect the incidence of complications, the time to fracture union or the level of function. These findings suggest that obese patients should be treated in line with standard procedures, keeping in mind any known associated medical co-morbidities

The incidence of deep-vein thrombosis and the need for thromboprophylaxis following isolated trauma below the knee is uncertain. We have investigated this with a prospective randomised double-blind controlled trial using low molecular weight heparin with saline injection as placebo in patients aged between 18 and 75 years who had sustained an isolated fracture below the knee which required operative fixation. All patients had surgery within 48 hours of injury and were randomised to receive either the placebo or low molecular weight heparin for 14 days, after which they underwent bilateral lower limb venography, interpreted by three independent radiologists. Further follow-up was undertaken at two, six, eight and 12 weeks. A total of 238 patients fulfilled all the inclusion criteria, with 127 in the low molecular weight heparin group and 111 in the placebo group, all of whom underwent bilateral venography. There was no statistically significant difference in the incidence of deep-vein thrombosis between those patients treated with low molecular weight heparin or the placebo (p = 0.22). The number of deep-vein thromboses in the two groups was 11 (8.7%) and 14 (12.6%), respectively. Age and the type of fracture were significantly associated with the rate of deep-vein thrombosis (p = 0.001 and p = 0.009, respectively) but gender, comorbidities and the body mass index were not. The overall incidence of deep-vein thrombosis in this series was 11%. There was no clinical or statistical significant reduction in the incidence of deep-vein thrombosis with the use of thromboprophylaxis. However, we accept that owing to a cessation of funding, recruitment to this trial had to be ended prior to establishing the necessary sample size. Our results cannot, therefore, categorically exclude the possibility that low molecular weight heparin treatment could be beneficial. We recommend a further multicentre trial be undertaken to resolve this matter

Introduction. Low total Mini-Mental State Examination (MMSE) score might significantly increase risk of hip fractures. This study was to investigate the effects of MMSE subdomains on the risk of hip fractures with a sex and age matched case control study. Materials & Methods. A total of 217 patients with first low-trauma hip fractures were matched with 215 hospitalised controls. Seven MMSE subdomains were analysed using conditional logistic regression with adjustment of five important clinical confounders: education level, ADL, physical activities, body mass index and bone mineral density. ROC curve analyses were further used to investigate the predictability of the independent subdomains. Results. In univariate analyses, low score of all MMSE subdomains significantly increased the risk of hip fracture. However, only time orientation and visual construction domain remained significant in multivariate analyses. In the ROC curve analyses, the AUC of these two independent subdomains along with five clinical confounders was significantly larger (p=0.008) than that of clinical confounders alone. The AUC of summed scores of these two subdomains were significantly higher than that of total MMSE score (p=0.009). Conclusions. Time orientation and visual construction subdomains were significant independent risk factors for hip fractures and could be effectively used to screen the patients with high fracture risk in the hospital. Preventive intervention can be given to these patients

Introduction. The risk factors for new adjacent vertebral compression fracture (NAVCF) after Vertebroplasty (VP) or Kyphoplasty (KP) for osteoporotic vertebral compression fractures (VCFs) were investigated. Materials and methods. The authors retrospectively analyzed the incidence of NAVCFs in 135 patients treated with VP or KP for osteoporotic VCFs. Study period was from 2004 to 2008 with minimum follow-up of 2 years. Possible risk factors were documented: age, gender, body mass index, bone mineral density (BMD), co-morbidities, location of treated vertebra, treatment modality and amount of bone cement injected. Anterior-posterior vertebral body height ratio, intra-discal cement leakage into the disc space and pattern of cement distribution of the initial VCF and adjacent vertebral bodies were assessed on lateral thoracolumbar radiographs by 2 independent assessors. Results. 21 patients (15.6%) had subsequent symptomatic NAVCFs with a median time to new fracture was of 125 days. There was no difference in incidence of NAVCF between VP and KP groups (P>0.05). Significant differences were found between patients with and without NAVCF in terms of age, BMD, and the proportion of cement leakage into the disc space (P < 0.05). Greater age, intra-discal cement leakage and low BMD were found in patients with NAVCF. Conclusion. The most important risk factors affecting NAVCFs were age, osteoporosis and intra-discal cement leakage

This paper describes an audit loop. We studied patients undergoing hip and knee surgery (arthroplasty and revision arthroplasty). All the patients were ‘complex elective’. I.e. they were either ASA grade 3 or 4, or had a body mass index in excess of 40. We collected data concerning postoperative admissions to HDU, ICU and PACU (planned and unplanned rates of admission, length of stay). We also noted mortality. In the first part of the study (April 2005 to March 2006) we studied 298 patients. All patients were assessed independently by an anaesthetist on the day of surgery. A multidisciplinary preoperative assessment clinic commenced in April 2006. After this date all patients were assessed preoperatively by a multidisciplinary anaesthetic lead team (anaesthetist, orthopaedic senior house officer, nurse practitioner). The need for an HDU or ICU bed was assessed and the bed was booked at part of the pre-operative plan. In the second part of the study (May 2006 to April 2009) a further 1147 arthroplasty patients were studied. Data was again collected regarding HDU, ICU, PACU and mortality as noted above. We found statistically significant (p=0.001) reductions in the admissions to PACU (22% down to 10%) and in mortality (6.1% down to 1.2%) after the introduction of the pre assessment clinic. There was also statistically significant (p=0.01) reduction in the HDU length of stay(2.1 days to 1.6 days), ITU unplanned admissions (1.3% to 0.4%) and the ITU length of stay in days (2.3 to 1.9 days). We also estimated cost savings of nearly £50 000 in the second limb of the study. This is based on the average decrease in HDU and ICU length of stay. We recommend the use of a multidisciplinary pre assessment clinic for complex orthopaedic surgery

Aim. The aim of this prospective comparative study was to evaluate the serum levels of different cytokines in patients underwent total knee replacement (TKR) and received allogeneic blood transfusion, post-operative auto-transfusion or not transfused. Material and Methods. This was a prospective non-randomized comparative study in 248 patients underwent TKR. Patient's demographic and clinical data including age, gender, body mass index (BMI), preoperative Hb value, complications were documented. The serum levels of IL-1b, IL-6, IL-8, IL-10, and TNF were measure pre-operatively, the 1st, 2nd, 3rd and 5th post-operative day. Patients were categorized in three groups; in Group 0 patients received no blood transfusion, in Group 1 patients received post-operative auto-transfusion and in Group 2 allogeneic blood transfusion was applied. Statistical analysis of the results was performed using repeated measures ANOVA. Results. Significant changes were observed in cytokines levels in Groups 1 and 2. In Group 1 (auto-transfusion) the levels of all cytokines significantly increased the 1st postoperative day, remaining above the pre-operative levels even the 5th post-operative day. In Group 2 (allogenic transfusion), although the levels of IL-6, IL-8 and IL-10 were also significantly increased the 1st postoperative day, they gradually returned to the per-operative levels by the 5th post-operative day. In Group 0 (no transfusion) the only significant increase was observed in IL-6 between pre-operative and 1st and 3rd day values. Furthermore, the area under the curve (AUC) of IL-1b, IL-6, IL-8 and IL-10 levels in Group 1 and AUC of IL-6, IL-8 and IL-10 levels in Group 2, were significantly higher compared to Group 0. There was no significant difference in post-operative patient's complications. Conclusion. According to the results of this study significant elevation of cytokine values were observed during the first five post-operative days in patients received blood transfusion after TKR. These changes were more pronounced in the auto-transfusion group

Background. The reported outcomes of unicompartmental knee replacement (UKR) for spontaneous osteonecrosis of the knee (SPONK) often derive from small series with an average followup of 5 years, enabling to generate meaningful conclusions. Therefore, we determined the long-term functional results and the 10-years survivorship of the implant in all patients with advanced SPONK of the medial tibio-femoral compartment treated with a unicompartmental knee arthroplasty at our institute. Methods. We retrospectively evaluated 84 consecutive patients with late stage SPONK. All patients received a pre-operative MRI to confirm the diagnosis, to exclude any metaphyseal involvement and to assess the absence of significative degenerative changes in the lateral and PF compartment. Mean age at surgery was 66 years and mean body mass index (BMI) was 28.9. In all cases, SPONK involved the medial compartment; in 77 cases the medial femoral condyle (MFC) was involved, while in 7 cases the pathology site was the medial tibial plateau (MTP). Radiological evaluation was conducted by 3 different radiologists and clinical evaluation according to KSS and WOMAC score was performed by 3 fellows from outside institutions, with no previous clinical contact with the patients, at a mean followup of 98 months. Results. We found a significant improvement in VAS score for residual pain self-assessment and maximum knee flexion (p<0.0001). The 10-year Kaplan-Meier survivorship with revision for any reason as endpoint was 89%. Mean results at final observation point for global KSS and WOMAC score were 87.1 (range 45–100; standard deviation 13.8) and 12 (range 0–44; standard deviation 10.3), respectively. No patient had significant radiographic signs of osteoarthritis progression in the lateral compartment or in the patello-femoral compartment at final evaluation. Conclusions. Our findings suggest that medial UKR performed for late stage SPONK of the medial tibio-femoral compartment in selected patients provides satisfactory long term clinical and radiographical results, with a 10-years Kaplan-Meier survivorship of the implant of 89%

INTRODUCTION. Patellar tendon (PT) autograft is an excellent choice repairing anterior cruciate ligament (ACL) ruptures. Published studies testing the biomechanical characteristics after plasty usually refer to grafts with 10mm wide. The thickness of PT and geometry of the patella have been overlooked. The purpose of this study was to understand the geometry of PT and patella in our population, regarding their use in Bone - Patellar Tendon - Bone (BTB) technique, in order to evaluate their biomechanical efficiency and study their relationship with anthropometric parameters. MATERIAL. 100 individuals (50/50) who underwent knee MRI (3-Tesla). Ages between 18–65years. METHODS. Retrospective study. Standardized protocol for measuring the PT and patella based in MRI images. Interview to obtain personal data. Statistical analysis using SPSS®. RESULTS. Sample (mean ±SD): age 41 ±14years, weight 73 ±12kg, height 167 ±10cm, BMI 26,04 ±4,13; length PT/patella −41,3 ±6,1mm/29,6 ±4,2 mm, width PT/patella −25,3 ±3,2mm/43,4 ±4,14mm; thickness PT −3,79 ±1,01mm/22,8 ±2,2mm; Men have thicker and wider patella and PT than women (p<0.001). The patella is also longer in males (p<0.001). There is statistical significant relationship between weight and height to width, thickness and length of PT and patella (p<0.01). Body Mass Index (BMI) doesn't have statistical correlation with geometry of the PT and patella. DISCUSSION. The PT remains as an excellent option in ACL repair. The anatomy and quality of the graft are essential to achieving good functional results. The choice of middle third tendon to the BTB plasty does not always correspond to the 10mm width, as used in most biomechanical tests. Also patellar integrity can be at risk (when collecting the bone block) if patella geometry is not considered. To our knowledge, there is only one similar study in literature, preformed in Asian individuals. CONCLUSION. Preoperatively accessing the geometry of Patella and PT can be crucial in obtaining efficient grafts and decreasing morbidity over the extensor mechanism