We report the clinical results of seven consecutive allograft knee ligament reconstructions using Achilles tendon prepared using a chemical treatment process. Results have been disappointing with six clinical failures at short durations of follow-up. All allografts are not the same and the method of tissue preparation may have important consequences for clinical outcomes. Debate regarding the use of allograft or autograft tissue for knee ligament reconstruction continues. A variety of allograft tissues are available from commercial and NHS sources: fresh frozen, freeze dried, irradiated or chemically prepared. There are gaps in the literature with respect to clinical outcomes for these various methods of graft preparation. A recent systematic review indicated similar short-term clinical outcomes for fresh frozen allografts and autografts. The senior author began using allograft Achilles tendon for revision ACL reconstruction or primary multiple ligament reconstruction in 2007. Tissues were obtained from a commercial supplier. These tissues had been harvested in Eastern Europe, transported to the USA and sterilised using a patented “Biocleanse” chemical treatment process. This involves sequential ultrasonic baths of detergent, peroxide and alcohol for fixed periods of time along with pressure and vacuum cycles. Between April 2007 and April 2009, 7 allograft ligament reconstructions were performed in 5 knees. These comprised 5 ACL and 2 LCL reconstructions. At follow up of between 4 months and 2 years, clinical failure of 6 grafts has been observed. We are aware of one previous series of results for ACL reconstructions using chemically sterilised and irradiated allograft tissues. A 45% graft failure rate was reported. We have not been able to identify any clinical outcome studies for grafts prepared using the “Biocleanse” process. Our results have prompted us to change to UK sourced, donor screened allografts, which are fresh frozen after decontamination with 70% ethanol

Although the vast majority of patients that undergo total knee replacement have satisfactory outcomes with a generally low complication rate, occasionally a patient will be encountered that has had multiple failed surgeries, and now reaches a crossroad as to whether limb salvage will be acceptable or not.

Cite this article: Bone Joint J 2014;96-B(11 Suppl A):122–4.

Structural allografts may be used to manage uncontained bone defects in revision total knee replacement (TKR). However, the availability of cadaver grafts is limited in some areas of Asia. The aim of this study was to evaluate the mid-term outcome of the use of femoral head allografts for the reconstruction of uncontained defects in revision TKR, focusing on complications related to the graft.

We retrospectively reviewed 28 patients (30 TKRs) with Anderson Orthopaedic Research Institute (AORI) type 3 bone defects, who underwent revision using femoral head allografts and stemmed components. The mean number of femoral heads used was 1.7 (1 to 3). The allograft–host junctions were packed with cancellous autograft.

At a mean follow-up of 76 months (38 to 136) the mean American Knee Society knee score improved from 37.2 (17 to 60) pre-operatively to 90 (83 to 100) (p < 0.001). The mean function score improved from 26.5 (0 to 50) pre-operatively to 81 (60 to 100) (p < 0.001). All the grafts healed to the host bone. The mean time to healing of the graft was 6.6 months (4 to 16). There have been no complications of collapse of the graft, nonunion, infection or implant loosening. No revision surgery was required.

The use of femoral head allografts in conjunction with a stemmed component and autogenous bone graft in revision TKR in patients with uncontained bone defects resulted in a high rate of healing of the graft with minimal complications and a satisfactory outcome. Longer follow-up is needed to observe the evolution of the graft.

Cite this article: Bone Joint J 2013;95-B:643–8.

Disruption of the extensor mechanism in total knee arthroplasty may occur by tubercle avulsion, patellar or quadriceps tendon rupture, or patella fracture, and whether occurring intra-operatively or post-operatively can be difficult to manage and is associated with a significant rate of failure and associated complications. This surgery is frequently performed in compromised tissues, and repairs must frequently be protected with cerclage wiring and/or augmentation with local tendon (semi-tendinosis, gracilis) which may also be used to treat soft-tissue loss in the face of chronic disruption. Quadriceps rupture may be treated with conservative therapy if the patient retains active extension. Component loosening or loss of active extension of 20° or greater are clear indications for surgical treatment of patellar fracture. Acute patellar tendon disruption may be treated by primary repair. Chronic extensor failure is often complicated by tissue loss and retraction can be treated with medial gastrocnemius flaps, achilles tendon allografts, and complete extensor mechanism allografts. Attention to fixing the graft in full extension is mandatory to prevent severe extensor lag as the graft stretches out over time.

Most patients (95%) with fibular hemimelia have an absent anterior cruciate ligament (ACL). The purpose of this study was to assess the long-term outcome of such patients with respect to pain and knee function. We performed a retrospective review of patients with fibular hemimelia and associated ACL deficiency previously treated at our institution. Of a possible 66 patients, 23 were sent the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) questionnaire and Lysholm knee score to complete. In all, 11 patients completed the MODEMS and nine completed the Lysholm score questionnaire. Their mean age was 37 years (27 to 57) at review. Five patients had undergone an ipsilateral Symes amputation. There was no significant difference in any subsections of the Short-Form 36 scores of our patients compared with age-matched controls. The mean Lysholm knee score was 90.2 (82 to 100). A slight limp was reported in six patients. No patients had episodes of locking of the knee or required a supportive device for walking. Four had occasional instability with sporting activities.

These results suggest that patients with fibular hemimelia and ACL deficiency can live active lives with a similar health status to age-matched controls.