We sought to determine the degree of correlation between the condition of the patellar articular cartilage and patellofemoral symptoms and function in osteoarthritic patients undergoing total knee arthroplasty. The depth of the osteoarthritic lesion, as graded by the Outerbridge classification and its size and location were assessed to determine the condition of the patellar cartilage in 80 consecutive osteoarthritic knees undergoing total knee arthroplasty. The association between the condition of the cartilage and patellofemoral symptoms and function was investigated by correlation analysis. The depth and size of the lesion had a significant but weak correlation with anterior knee pain (r = −0.300 and −0.289; p = 0.007 and 0.009, respectively), whereas location had no significant association (p > 0.05). None had a significant association with patellofemoral functional parameters (chair-rising, stair-climbing, and quadriceps power) (p > 0.05). Our study indicates that patellofemoral symptoms and function are not completely determined by the condition of the cartilage. Caution should be taken when the symptoms and functional limitations are attributed to a lesion in the patellofemoral joint in making a decision regarding patellar resurfacing in total knee arthroplasty

Involvement of Patellofemoral joint (PFJ) has significant bearing in the management of osteoarthritis of the knee. The aim of this study is to assess the relationship between skyline radiographs, MRI and arthroscopic findings in the patellofemoral joint. Data was collected prospectively from fifty-three patients who underwent arthroscopy. There were 36 males and 17 females in the group with mean age of 48 years (range 18-71). Arthroscopically PFJ arthritis was classified based on Outerbridge grading system. Patients with Outerbridge grade III and IV lesions were considered to have significant arthritis of the PFJ. Kellgren-Lawrence grading system was used to assess the skyline radiographs. Radiographically patients with grade III and IV Kelgren-Lawrence changes were considered to have significant osteoarthritis of the PFJ. MRI scans were also studied to assess involvement of PFJ. Thirty-two patients had MRI scan and 20 patients had skyline views done as part of preoperative work up. Arthroscopic findings were considered as gold standard. MRI scan had specificity of 75%, sensitivity of 81%, positive predictive value of (PPV) 77 and negative predictive value of (NPV) 80% in diagnosing significant PFJ arthritis. Skyline radiographs had specificity of 100%, sensitivity of 50%, PPV of 100% and NPV of 57%. The overall accuracy of skyline radiographs in predicting significant PFJ arthritis was 70% and for MRI was 78%. We conclude that skyline radiographs has some value in he diagnosis of PFJ arthritis, however the sensitivity and negative predictive value is very is poor

Statement of purpose. To analyse the distribution of osteoarthritis of the knee, to determine what proportion of patients may be suitable for a partial knee replacement and finally to assess the risk of wear progression. Summary of methods used and results. The intra-operative articular surface mappings were collected for 250 consecutive patients undergoing knee arthroscopy. Patients were graded using the Outerbridge Classification. Radiographs including antero-posterior standing, postero-anterior flexion (Rosenberg), lateral and skyline views were graded (Kellgren and Lawrence) and compared with the arthroscopic findings. 13.3% of knees showed ‘isolated’ medial disease of Outerbridge Grade 3 or worse. Isolated lateral disease was noted in 1.4%, patello-femoral disease in 24.3%, bi-compartmental (Medial/PFJ) disease in 30.9% with tibio-femoral and tri-compartmental disease in 15.2%. The combination of lateral and patello-femoral disease was seen in 14.8%. The mean age of patients with tri-compartmental disease (60.9 years) was greater than the mean age of those suffering with osteoarthritis limited to one or two compartments (54 years). Radiological analysis revealed AP views had only 66% sensitivity and 73% specificity for the presence of Grade 3/4 lesions in the medial compartment. Rosenberg views had 73% sensitivity and 83% specificity. Skyline views had a sensitivity of 56% and 100% specificity. Statement of conclusion. The study suggests up to 85% of patients may be suitable for partial knee replacement. The study suggests the number of compartments affected by grade 3 and 4 disease increases with patient age. A large proportion of patients may be suitable for partial replacements. However, the presence of high levels of Grade 1 and 2 changes found in other compartments indicates a need for caution

Aims. Medial unicompartmental knee arthroplasty (UKA) is associated with successful outcomes in carefully selected patient cohorts. We hypothesised that severity and location of patellofemoral cartilage lesions significantly influences functional outcome after Oxford medial compartmental knee arthroplasty. Patients and Methods. We reviewed 100 consecutive UKAs at minimum eight-year follow-up (96 to 132). A single surgeon performed all procedures. Patients were selected based on clinical and plain radiographic assessment. All patients had end-stage medial compartment osteoarthritis (OA) with sparing of the lateral compartment and intact anterior cruciate ligaments. None of the patients had end-stage patellofemoral OA, but patients with anterior knee pain or partial thickness chondral loss were not excluded. There were 57 male and 43 female patients. The mean age at surgery was 69 years (41 to 82). At surgery the joint was carefully inspected for patellofemoral chondral loss and this was documented based on severity of cartilage loss (0 to 4 Outerbridge grading) and topographic location (medial, lateral, central, and superior or inferior). Functional scores collected included Oxford Knee Score (OKS), patient satisfaction scale and University College Hospital (UCH) knee score. Intraclass correlation was used to compare chondral damage to outcomes. Results. All patients documented significant improvement in pain and improved functional scores at mid-term follow-up. There were four revisions (mean 2.9 years, 2 to 4; standard deviation (. sd). 0.9) in this cohort, three for tibial loosening and one for femoral loosening. There was one infection that was treated with debridement and insert exchange. The mean OKS improved from 23.2 (. sd. 7.1) to 39.1 (. sd. 6.9); p < 0.001. The cohort with central and lateral grade 3 patellofemoral OA documented lower mean satisfaction with pain (90, . sd.  11.8) and function (87.5, . sd. 10.3) on the patient satisfaction scale. On the UCH scale, patients reported significantly decreased mean overall scores (7.3, . sd. 1.2 vs 9, . sd. 2.3) as well as stair climb task (3.5, . sd. 0.3 vs 5, . sd. 0.1) when cartilage lesions were located centrally or laterally on the PFJ. Patients with medial chondral PFJ lesions behave similar to patients with no chondral lesions. Conclusion. Topographical location and severity of cartilage damage of the patella can significantly influence function after successful Oxford medial UKA. Surgeons should factor this in when making their operative decision, and undertake to counsel patients appropriately. Cite this article: Bone Joint J 2016;98-B(10 Suppl B):11–15

Aims

This systematic review and meta-analysis aimed to compare the influence of patellar resurfacing following cruciate-retaining (CR) and posterior-stabilized (PS) total knee arthroplasty (TKA) on the incidence of anterior knee pain, knee-specific patient-reported outcome measures, complication rates, and reoperation rates.

Aims

The aim of this study was to compare any differences in the primary outcome (biphasic flexion knee moment during gait) of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) at one year post-surgery.

We studied 19 videotaped knee arthroscopies in 19 patients with mild to moderate osteoarthritis (OA) of the knee in order to compare the intraobserver and interobserver reliability and the patterns of disagreement between four orthopaedic surgeons. The classifications of OA of Collins, Outerbridge and the French Society of Arthroscopy were used. Intraobserver and interobserver agreements using kappa measures were 0.42 to 0.66 and 0.43 to 0.49, respectively. Only 6% to 8% of paired intraobserver classifications differed by more than one category. Observer-specific disagreement was evident both within and between observers. A small, but significant, occasional variation was also seen. Although reliability may improve by an analysis of disagreement, it appears that the arthroscopic grading of early osteoarthritic lesions is inexact

We report the results of a modified Fulkerson technique of antero-medialisation of the tibial tubercle, combined with microfracture or abrasion arthroplasty in patients under 60 with patello-femoral osteoarthritis. All patients operated on between September 1992 and October 2007 were reviewed by an independent observer in clinic or by postal questionnaire, using the Oxford Knee Score, Melbourne Patella Score and a Satisfaction Score. Only patients with Outerbridge Grade 3 – 4 osteoarthritis of the patello-femoral joint were included. They were assessed pre-operatively with plain x-rays, MRI scans (as well as tracking scans in the last 10 years) and arthroscopically. All patients with tracking scans showed lateral subluxation of the patella. The surgical procedure was a modification of Fulkerson's tibial tubercle osteotomy, with an advancement of 1-1.5 cms and a medialisation of 1.5 cms. The exposed bone of the patella and trochlea was drilled in the early cases and in the later cases an arthroscopic microfracture or abrasion using a power burr was carried out. Between September 1992 and October 2007, 103 procedures were carried out in 84 patients, 19 patients having staged bilateral procedures. The mean follow up was 84 months (range 24 – 204 months). The mean age was 45 (range 26 – 59) and the female to male ratio was 7.6:1. 70 patients were reviewed giving a follow up rate of 82%. The mean Oxford Knee Score was 18.5 pre-operatively (range 3- 32) and 34.3 post-operatively (range 11- 47). The Melbourne Patella Score was 9.6 pre-operatively (range 3- 30) and 20 post-operatively (range 11- 30). Patient Satisfaction Scores were excellent (54%), good (29%), fair (8.5%) and poor (8.5%). 4 knees in 3 patients were converted to a patello-femoral arthroplasty, giving a 10 year survival rate of 96.1%. This procedure offers an alternative to patello-femoral arthroplasty for younger patients with isolated patello-femoral arthritis

Introduction. Unicondylar knee replacements (UKR) may be more effective compared to Total knee replacements (TKR) in unicompartmental arthritis. We report patient outcomes & satisfaction data in an age matched cohort of patients with either a UKR or TKR. Method. A single unit and single surgeon series of patients were recruited. Data was retrospectively collated for 68 patients with more than 24 months follow-up. UKR was undertaken in patients with isolated medial compartment osteoarthritis; stable ACL and less than grade 3 lateral patellar changes of the Outerbridge classification. TKR was undertaken for the rest. The patients were assessed with validated knee scores including the Total Knee Function Questionnaire (TKFQ) which focuses on recreational & sporting outcomes as well as activities of daily living (ADL). Patient satisfaction and perception of knee normality was measured on a visual analogue scale. Results. 34 patients with a TKR and 34 patients with a UKR were analysed. The average ages in the TKR and UKR groups were 69.25 and 67.26 years respectively. The patients were well matched for demographics and had equivalent preoperative morbidities and scores. The UKR group had better WOMAC (p=0.003), SF36 (physical: p<0.001 mental: p=0.25), Oxford knee (p<0.001) and Knee Society scores (p=0.002, function: p<0.001). The UKR group showed better outcomes in the TKFQ including exercise and sport (p= 0.02), movement and lifestyle (p=0.02) and the ADL (p=0.002). There was however no difference in patient satisfaction scores (p=0.41) and perception of how normal the knee felt between the two groups (p=0.99). Conclusions. A UKR procedure confers better functional outcome in terms of recreation and sport compared to TKR procedures. While UKR is an appropriate choice in the elderly yet active patient with unicompartmental knee arthritis, satisfaction is similar to that of patients with a TKR reflecting higher preoperative expectations. Further work is needed to assess this

Aims

The aim of this study was to compare the clinical outcomes of robotic arm-assisted bi-unicompartmental knee arthroplasty (bi-UKA) with conventional mechanically aligned total knee arthroplasty (TKA) during the first six weeks and at one year postoperatively.

Aims

The patient-acceptable symptom state (PASS) is a level of wellbeing, which is measured by the patient. The aim of this study was to determine if the proportion of patients who achieved an acceptable level of function (PASS) after medial unicompartmental knee arthroplasty (UKA) was different based on the status of the anterior cruciate ligament (ACL) at the time of surgery.

Objectives

The use of the haptically bounded saw blades in robotic-assisted total knee arthroplasty (RTKA) can potentially help to limit surrounding soft-tissue injuries. However, there are limited data characterizing these injuries for cruciate-retaining (CR) TKA with the use of this technique. The objective of this cadaver study was to compare the extent of soft-tissue damage sustained through a robotic-assisted, haptically guided TKA (RATKA) versus a manual TKA (MTKA) approach.

Aims

Altered alignment and biomechanics are thought to contribute to the progression of osteoarthritis (OA) in the native compartments after medial unicompartmental knee arthroplasty (UKA). The aim of this study was to evaluate the bone activity and remodelling in the lateral tibiofemoral and patellofemoral compartment after medial mobile-bearing UKA.

We present the ten- to 15-year follow-up of 31 patients (34 knees), who underwent an Elmslie-Trillat tibial tubercle osteotomy for chronic, severe patellar instability, unresponsive to non-operative treatment. The mean age of the patients at the time of surgery was 31 years (18 to 46) and they were reviewed post-operatively, at four years (2 to 8) and then at 12 years (10 to 15). All patients had pre-operative knee radiographs and Cox and Insall knee scores. Superolateral portal arthroscopy was performed per-operatively to document chondral damage and after the osteotomy to assess the stability of the patellofemoral joint. A total of 28 knees (82%) had a varying degree of damage to the articular surface. At final follow-up 25 patients (28 knees) were available for review and underwent clinical examination, radiographs of the knee, and Cox and Insall scoring. Six patients who had no arthroscopic chondral abnormality showed no or only early signs of osteoarthritis on final radiographs; while 12 patients with lower grade chondral damage (grade 1 to 2) showed early to moderate signs of osteoarthritis and six out of ten knees with higher grade chondral damage (grade 3 to 4) showed marked evidence of osteoarthritis; four of these had undergone a knee replacement. In the 22 patients (24 knees) with complete follow-up, 19 knees (79.2%) were reported to have a good or excellent outcome at four years, while 15 knees (62.5%) were reported to have the same at long-term follow-up. The functional and radiological results show that the extent of pre-operatively sustained chondral damage is directly related to the subsequent development of patellofemoral osteoarthritis.

Cite this article: Bone Joint J 2013;95-B:478–85.

We describe 119 meniscal allograft transplantations performed concurrently with articular cartilage repair in 115 patients with severe articular cartilage damage. In all, 53 (46.1%) of the patients were over the age of 50 at the time of surgery. The mean follow-up was for 5.8 years (2 months to 12.3 years), with 25 procedures (20.1%) failing at a mean of 4.6 years (2 months to 10.4 years). Of these, 18 progressed to knee replacement at a mean of 5.1 years (1.3 to 10.4). The Kaplan-Meier estimated mean survival time for the whole series was 9.9 years (sd 0.4). Cox’s proportional hazards model was used to assess the effect of covariates on survival, with age at the time of surgery (p = 0.026) and number of previous operations (p = 0.006) found to be significant.

The survival of the transplant was not affected by gender, the severity of cartilage damage, axial alignment, the degree of narrowing of the joint space or medial versus lateral allograft transplantation. Patients experienced significant improvements at all periods of follow-up in subjective outcome measures of pain, activity and function (all p-values < 0.05), with the exception of the seven-year Tegner index score (p = 0.076).

Aims

The Bereiter trochleoplasty has been used in our unit for 12 years to manage recurrent patellar instability in patients with severe trochlea dysplasia. The aim of this study was to document the outcome of a large consecutive cohort of patients who have undergone this operation.

Objectives

To assess the effectiveness of a modified tibial tubercle osteotomy as a treatment for arthroscopically diagnosed chondromalacia patellae.

Aims

The purpose of this study was to report the experience of dynamic intraligamentary stabilisation (DIS) using the Ligamys device for the treatment of acute ruptures of the anterior cruciate ligament (ACL).

We studied whether the presence of lateral osteophytes on plain radiographs was a predictor for the quality of cartilage in the lateral compartment of patients with varus osteoarthritic of the knee (Kellgren and Lawrence grade 2 to 3).

The baseline MRIs of 344 patients from the Osteoarthritis Initiative (OAI) who had varus osteoarthritis (OA) of the knee on hip-knee-ankle radiographs were reviewed. Patients were categorised using the Osteoarthritis Research Society International (OARSI) osteophyte grading system into 174 patients with grade 0 (no osteophytes), 128 grade 1 (mild osteophytes), 28 grade 2 (moderate osteophytes) and 14 grade 3 (severe osteophytes) in the lateral compartment (tibia). All patients had Kellgren and Lawrence grade 2 or 3 arthritis of the medial compartment. The thickness and volume of the lateral cartilage and the percentage of full-thickness cartilage defects in the lateral compartment was analysed.

There was no difference in the cartilage thickness or cartilage volume between knees with osteophyte grades 0 to 3. The percentage of full-thickness cartilage defects on the tibial side increased from < 2% for grade 0 and 1 to 10% for grade 3.

The lateral compartment cartilage volume and thickness is not influenced by the presence of lateral compartment osteophytes in patients with varus OA of the knee. Large lateral compartment osteophytes (grade 3) increase the likelihood of full-thickness cartilage defects in the lateral compartment.

Cite this article: Bone Joint J 2015;97-B:1634–9.

The efficacy of circumpatellar electrocautery in reducing the incidence of post-operative anterior knee pain is unknown. We conducted a single-centre, outcome-assessor and patient-blinded, parallel-group, randomised, controlled trial to compare circumpatellar electrocautery with no electrocautery in total knee replacement in the absence of patellar resurfacing. Patients requiring knee replacement for primary osteoarthritis were randomly assigned circumpatellar electrocautery (intervention group) or no electrocautery (control group). The primary outcome measure was the incidence of anterior knee pain. A secondary measure was the standardised clinical and patient-reported outcomes determined by the American Knee Society scores and the Western Ontario and McMaster Universities (WOMAC) osteoarthritis index. A total of 131 knees received circumpatellar electrocautery and 131 had no electrocautery.

The overall incidence of anterior knee pain at follow-up at one year was 26% (20% to 31%), with 19% (12% to 26%) in the intervention group and 32% (24% to 40%) in the control group (p = 0.02). The relative risk reduction from electrocautery was 40% (9% to 61%) and the number needed to treat was 7.7 (4.3 to 41.4). The intervention group had a better mean total WOMAC score at follow-up at one year compared with the control group (16.3 (0 to 77.7) versus 21.6 (0 to 76.7), p = 0.04). The mean post-operative American Knee Society knee scores and function scores were similar in the intervention and control groups (knee score: 92.4 (55 to 100) versus 90.4 (51 to 100), respectively (p = 0.14); function score: 86.5 (15 to 100) versus 84.5 (30 to 100), respectively (p = 0.49)).

Our study suggests that in the absence of patellar resurfacing electrocautery around the margin of the patella improves the outcome of total knee replacement.