Abstract. Introduction. The paediatric population present unique challenges to the knee surgeon, particularly when treating recurrent patellofemoral instability(PFI), the management of which is poorly standardised. Through the EPPIC BASK National Trainee Collaborative, we aimed to identify which procedures (and in which combination) are being used to surgically manage recurrent PFI in skeletally immature patients across the UK. Methods. A retrospective national service evaluation via a trainee collaborative analysing local trust data between 1st January 2014 and 31st December 2019. Data from institutions registered for EPPIC was compiled and compared to the national guidelines for adults. Results. A total of 333 patients were classified as skeletally immature(radiologically open physes) across 28 hospitals. Mean age was 14.1 years(+/- 4.5) with 64.9% being female. Mean number of procedures performed was 11.9 (+/-16.4). Isolated medial patellofemoral ligament reconstruction (MPFLR) was the most common procedure, performed in 65.8% of patients. Combined MPFLR and TTO was undertaken in 13.2% of patients. Proximal realignment surgery was performed in 5.1% of patients. Lateral releases were performed in 18.3% of patients with 8.4% performed in isolation. Conclusion. This study highlights the national variation in surgical treatment of PFI in skeletally immature patients. The guidance for adults cannot be applied universally to the skeletally immature, and it not always acceptable to delay treatment until physes close. This lack of standardisation within the UK in the management of recurrent PFI in skeletally immature patients highlights the need for a national consensus in appropriate surgical management of this patient population

Abstract. Introduction. National BOAST guidelines have been developed to coordinate and improve the standard of care for all patients with problems after knee replacement surgery. Since the inception of these guidelines we wanted to assess the impact of these guidelines on patients and their pathways following their discussions at our weekly revision MDT meetings. Methodology. Trust casenotes programs, PACS software and MDT notes were evaluated over the past 12 months (January 2022 to December 2022) to collect data for all patients with problematic knee replacements. Current in-patients discussed at MDT were excluded. Results. In total 52 patients with problematic knees were discussed. In terms of the SPECIFIC criteria described in BOAST guidelines, 39% met one or more of these criteria (component loosening, infection, instability, component wear) of which 90% are have had or planned for revision surgery. Of those (61%) not meeting this criteria, 77% have been deemed not to have a surgical cause after further investigations with the rest still pending further investigation. Conclusion. The publication of guidelines has aided in the ongoing management of patients with problematic knee replacements. From our MDT discussions over the last year, its clear that when appropriately investigated and a cause found from the SPECIFIC criteria, patients are offered appropriate revision surgery. Further work with longer-term outcomes from MDT discussions would help to evaluate the impact of these discussions on which problematic knees benefit most from revision surgery and the effect on knee revision networks

Deep joint infection is one of the most dreaded complications of total joint arthroplasty, and urinary tract infections (UTI) are generally believed to be a source for haematogenous seeding of the prosthetic joint. Although patients are often screened for UTI there appears to be minimal evidence on the management of asymptomatic bacteriuria, or for those patients who perform intermittent self-catheterisation prior to joint arthroplasty. This study aims to address this. We performed an online and postal survey of the British Association for the Surgery of the Knee membership to provide a consensus from a body of professionals. Of the respondents 75% performed 50 or more joint arthroplasty surgery over a 12 month period. For all surgeons, 71.4% provided antibiotic cover for the insertion and withdrawal of urinary catheters. However, only 19% were aware of National guidelines, compared to 76.2% for local guidelines which were more likely to be followed. Two thirds of surgeons would treat asymptomatic bacteriuria prior to surgery, yet 70% of these surgeons were unable to cite evidence for this decision. Similarly, the management of patients requiring intermittent self-catherisation produced a heterogenous response. Our study suggests there is a lack of consensus and/or awareness amongst specialist knee surgeons for the management of asymptomatic urinary bacteriuria in patients prior to knee surgery. We believe a minimum standard of care be defined by the society to protect both patient and surgeon

Aims

The aim of this study was to evaluate the cost-effectiveness of arthroscopic partial meniscectomy versus physical therapy plus optional delayed arthroscopic partial meniscectomy in young patients aged under 45 years with traumatic meniscal tears.

Aims

Periprosthetic fractures (PPFs) around the knee are challenging injuries. This study aims to describe the characteristics of knee PPFs and the impact of patient demographics, fracture types, and management modalities on in-hospital mortality.

Aims

In total knee arthroplasty (TKA), blood loss continues internally after surgery is complete. Typically, the total loss over 48 postoperative hours can be around 1,300 ml, with most occurring within the first 24 hours. We hypothesize that the full potential of tranexamic acid (TXA) to decrease TKA blood loss has not yet been harnessed because it is rarely used beyond the intraoperative period, and is usually withheld from ‘high-risk’ patients with a history of thromboembolic, cardiovascular, or cerebrovascular disease, a patient group who would benefit greatly from a reduced blood loss.

There is a large amount of evidence available about the relative merits of unicompartmental and total knee arthroplasty (UKA and TKA). Based on the same evidence, different people draw different conclusions and as a result, there is great variability in the usage of UKA.

The revision rate of UKA is much higher than TKA and so some surgeons conclude that UKA should not be performed. Other surgeons believe that the main reason for the high revision rate is that UKA is easy to revise and, therefore, the threshold for revision is low. They also believe that UKA has many advantages over TKA such as a faster recovery, lower morbidity and mortality and better function. They therefore conclude that UKA should be undertaken whenever appropriate.

The solution to this argument is to minimise the revision rate of UKA, thereby addressing the main disadvantage of UKA. The evidence suggests that this will be achieved if surgeons use UKA for at least 20% of their knee arthroplasties and use implants that are appropriate for these broad indications.

Cite this article: Bone Joint J 2015;97-B(10 Suppl A):3–8.

We prospectively studied the clinical, arthroscopic and histological results of collagen-covered autologous chondrocyte implantation (ACI-C) in patients with symptomatic osteochondritis dissecans of the knee. The study included 37 patients who were evaluated at a mean follow-up of 4.08 years.

Clinical results showed a mean improvement in the modified Cincinnati score from 46.1 to 68.4. Excellent and good clinical results were seen in 82.1% of those with juvenile-onset osteochondritis dissecans but in only 44.4% of those with adult-onset disease.

Arthroscopy at one year revealed International Cartilage Repair Society grades of 1 or 2 in 21 of 24 patients (87.5%). Of 23 biopsies, 11 (47.8%) showed either a hyaline-like or a mixture of hyaline-like and fibrocartilage, 12 (52.2%) showed fibrocartilage.

The age at the time of ACI-C determined the clinical outcome for juvenile-onset disease (p = 0.05), whereas the size of the defect was the major determinant of outcome in adult-onset disease (p = 0.01).

We investigated the prognostic indicators for collagen-covered autologous chondrocyte implantation (ACI-C) performed for symptomatic osteochondral defects of the knee.

We analysed prospectively 199 patients for up to four years after surgery using the modified Cincinnati score. Arthroscopic assessment and biopsy of the neocartilage was also performed whenever possible. The favourable factors for ACI-C include younger patients with higher pre-operative modified Cincinnati scores, a less than two-year history of symptoms, a single defect, a defect on the trochlea or lateral femoral condyle and patients with fewer than two previous procedures on the index knee. Revision ACI-C in patients with previous ACI and mosaicplasties which had failed produced significantly inferior clinical results. Gender (p = 0.20) and the size of the defect (p = 0.97) did not significantly influence the outcome.

Autologous chondrocyte implantation (ACI) is used widely as a treatment for symptomatic chondral and osteochondral defects of the knee. Variations of the original periosteum-cover technique include the use of porcine-derived type I/type III collagen as a cover (ACI-C) and matrix-induced autologous chondrocyte implantation (MACI) using a collagen bilayer seeded with chondrocytes. We have performed a prospective, randomised comparison of ACI-C and MACI for the treatment of symptomatic chondral defects of the knee in 91 patients, of whom 44 received ACI-C and 47 MACI grafts.

Both treatments resulted in improvement of the clinical score after one year. The mean modified Cincinnati knee score increased by 17.6 in the ACI-C group and 19.6 in the MACI group (p = 0.32). Arthroscopic assessments performed after one year showed a good to excellent International Cartilage Repair Society score in 79.2% of ACI-C and 66.6% of MACI grafts. Hyaline-like cartilage or hyaline-like cartilage with fibrocartilage was found in the biopsies of 43.9% of the ACI-C and 36.4% of the MACI grafts after one year. The rate of hypertrophy of the graft was 9% (4 of 44) in the ACI-C group and 6% (3 of 47) in the MACI group. The frequency of re-operation was 9% in each group.

We conclude that the clinical, arthroscopic and histological outcomes are comparable for both ACI-C and MACI. While MACI is technically attractive, further long-term studies are required before the technique is widely adopted.