Aims. The aim of the British Association for Surgery of the Knee (BASK) Meniscal Consensus Project was to develop an evidence-based treatment guideline for patients with meniscal lesions of the knee. Materials and Methods. A formal consensus process was undertaken applying nominal group, Delphi, and appropriateness methods. Consensus was first reached on the terminology relating to the definition, investigation, and classification of meniscal lesions. A series of simulated clinical scenarios was then created and the appropriateness of arthroscopic
Aims. The aim of this study was to compare patient-reported outcomes (PROMs) following isolated anterior cruciate ligament reconstruction (ACLR), with those following ACLR and concomitant meniscal resection or repair. Methods. We reviewed prospectively collected data from the UK National Ligament Registry for patients who underwent primary ACLR between January 2013 and December 2022. Patients were categorized into five groups: isolated ACLR, ACLR with medial meniscus (MM) repair, ACLR with MM resection, ACLR with lateral meniscus (LM) repair, and ACLR with LM resection. Linear regression analysis, with isolated ACLR as the reference, was performed after adjusting for confounders. Results. From 14,895 ACLR patients, 4,400 had two- or five-year Knee injury and Osteoarthritis Outcome Scores (KOOS) available. At two years postoperatively, the MM repair group demonstrated inferior scores in KOOS pain (β = −3.63, p < 0.001), symptoms (β = − 4.88, p < 0.001), ADL (β = − 2.43, p = 0.002), sport and recreation (β = − 5.23, p < 0.001), quality of life (QoL) (β = − 5.73, p < 0.001), and International Knee Documentation Committee (β = − 4.1, p < 0.001) compared with the isolated ACLR group. The LM repair group was associated with worse KOOS sports and recreation scores at two years (β = − 4.264, p < 0.001). At five years, PROMs were comparable between the groups. At five years, PROMs were comparable between the groups. Participants undergoing ACLR surgery within 12 weeks from index injury demonstrated superior PROMs at two and five years. Conclusion. Our study showed that MM repair, and to a lesser extent LM repairs in combination with ACLR, were associated with inferior patient-reported outcome measures (PROMs) compared to isolated ACLR at two years postoperatively, while meniscal resection groups exhibited comparable outcomes. However, by five years postoperation, no significant differences in PROMs were evident. Further longer-term, cross-sectional studies are warranted to investigate the outcomes of ACLR and concomitant
Introduction. Anterior cruciate ligament reconstruction (ACLr) is the most widely published operation in the orthopaedic literature. Over recent years there has been increased interest in the surgical technique and role of concomitant procedures performed during ACLr. The National Ligament Registry (NLR) collects robust data on ACLr performed in the UK. In this registry analysis we explore trends in ACLr surgery and how they relate to published literature and the growing industry portfolio available to surgeons. Methods. Using data from the NLR, 14,352 ACLr performed between 2013–2021 were analysed. High impact papers on ACLr were then cross referenced against this data to see if surgical practice was influenced by literature or whether surgical practice dictated publication. Common trends were also compared to key surgical industry portfolios (Arthrex, Smith and Nephew) to see how new technology influenced surgical practice. Results. The number of ACLr performed in isolation is decreasing. The number of ACL reconstructions involving
Aims. Circular RNA (circRNA) is involved in the regulation of articular cartilage degeneration induced by inflammatory factors or oxidative stress. In a previous study, we found that the expression of circStrn3 was significantly reduced in chondrocytes of osteoarthritis (OA) patients and OA mice. Therefore, the aim of this paper was to explore the role and mechanism of circStrn3 in osteoarthritis. Methods. Minus RNA sequencing, fluorescence in situ hybridization, and quantitative real-time polymerase chain reaction (qRT-PCR) were used to detect the expression of circStrn3 in human and mouse OA cartilage tissues and chondrocytes. Chondrocytes were then stimulated to secrete exosomal miR-9-5p by cyclic tensile strain. Intra-articular injection of exosomal miR-9-5p into the model induced by destabilized medial meniscus (DMM) surgery was conducted to alleviate OA progression. Results. Tensile strain could decrease the expression of circStrn3 in chondrocytes. CircStrn3 expression was significantly decreased in human and mouse OA cartilage tissues and chondrocytes. CircStrn3 could inhibit matrix metabolism of chondrocytes through competitively ‘sponging’ miRNA-9-5p targeting Kruppel-like factor 5 (KLF5), indicating that the decrease in circStrn3 might be a protective factor in mechanical instability-induced OA. The tensile strain stimulated chondrocytes to secrete exosomal miR-9-5p. Exosomes with high miR-9-5p expression from chondrocytes could inhibit osteoblast differentiation by targeting KLF5. Intra-articular injection of exosomal miR-9-5p alleviated the progression of OA induced by destabilized medial
Abstract. Introduction. The aim of this study was to determine the factors affecting return to sport (RTS) and career longevity of elite athletes after microfracture of the knee. Methods. A retrospective review of a consecutive series of elite athletes with chondral injuries in the knee treated with microfracture was undertaken. RTS was defined as competing in at least one event at professional level or national/ international level in amateur sport. Demographic, pre, intra and post operative factors affecting RTS were analysed. Results. Fifty six athletes, including 35 (62.5%) footballers and 14 (25.0 %) rugby players, with a mean age 24.8 (+/− 3.9) years, were included. 18 (32.1 %) of chondral injuries were secondary to trauma, 20 (35.7 %) post meniscectomy, 9 (16.1%) post anterior cruciate ligament (ACL) reconstruction and 9 (16.1%) idiopathic. Fifty (89.3%) of athletes RTS at a mean time of 10.0 (+/−5.8) months. 43 (86.0%) athletes were still playing at 2 years. At 5 years 25 (59.5%) of the players who had RTS and had surgery more than 5 years ago were still playing professional sport. Factors associated with not playing at 5 years were cartilage lesions >1.5cm2(52.4% vs 66.7%), more than 1 lesion (35.7% vs74.1%), lateral
We examined the relationship between waiting times for ACL surgery and the need for
Abstract. Introduction. The use of MCL “pie-crusting” (selective release of the superficial MCL) to improve arthroscopic access to the posteromedial compartment of the knee for isolated
Anterior cruciate ligament (ACL) reconstruction is a commonly performed operation. A variety of graft options are used with the most popular being bone-patellar-tendon-bone and hamstring autograft. There has been an increase in the popularity of hamstring autograft over the past decade. The aim of the study was to assess the ten year subjective knee function and activity level following four-strand semitendinosis and gracilis (STG) anterior cruciate ligament reconstruction. 86 patients underwent anterior cruciate reconstruction by two knee surgeons over a 12 month period (January 1999 to December 1999). 80 patients meet the inclusion criteria of arthroscopic ACL reconstruction. The same surgical technique was used by both surgeons involving four-strand STG autograft, single femoral and tibial tunnels and aperture graft fixation with the Round headed Cannulated Interference (RCI) screw. Patient evaluation was by completion of a Lysholm Knee Score and Tegner Activity Level Scale at a minimum of ten years from reconstructive surgery. This was by initial postal questionnaire and subsequent telephone follow-up. 80 patients underwent anterior cruciate reconstruction with average age 30.9 years (15 to 58 years). There was a 77.5% (62 patients) response at ten years to the questionnaire. The median Lysholm Knee Score at ten years was 94 (52 to 100). The median activity level had decreased from 9 to 5 at ten years according to the Tegner Activity Scale. 73% of patients reported a good or excellent outcome on the Lysholm score. The group of patients was further divided into those that required
We reviewed 5086 patients with a mean age of
30 years (9 to 69) undergoing primary reconstruction of the anterior cruciate
ligament (ACL) in order to determine the incidence of secondary
pathology with respect to the time between injury and reconstruction.
There was an increasing incidence of medial meniscal tears and chondral damage,
but not lateral meniscal tears, with increasing intervals before
surgery. The chances of requiring medial
Arthroscopy of the knee is one of the most commonly
performed orthopaedic procedures worldwide. Large-volume outcome
data have not previously been available for English NHS patients.
Prospectively collected admissions data, routinely collected on
every English NHS patient, were analysed to determine the rates
of complications within 30 days (including re-operation and re-admission),
90-day symptomatic venous thromboembolism and all-cause mortality.
There were 301 701 operations performed between 2005 and 2010 –
an annual incidence of 9.9 per 10 000 English population. Of these,
16 552 (6%) underwent ligament reconstruction and 106 793 (35%)
underwent
Objectives. Meniscal injuries are often associated with an active lifestyle. The damage of meniscal tissue puts young patients at higher risk of undergoing
This study examined windswept deformity (WSD) of the knee, comparing prevalence and contributing factors in healthy and osteoarthritic (OA) cohorts. A case-control radiological study was undertaken comparing 500 healthy knees (250 adults) with a consecutive sample of 710 OA knees (355 adults) undergoing bilateral total knee arthroplasty. The mechanical hip-knee-ankle angle (mHKA), medial proximal tibial angle (MPTA), and lateral distal femoral angle (LDFA) were determined for each knee, and the arithmetic hip-knee-ankle angle (aHKA), joint line obliquity, and Coronal Plane Alignment of the Knee (CPAK) types were calculated. WSD was defined as a varus mHKA of < -2° in one limb and a valgus mHKA of > 2° in the contralateral limb. The primary outcome was the proportional difference in WSD prevalence between healthy and OA groups. Secondary outcomes were the proportional difference in WSD prevalence between constitutional varus and valgus CPAK types, and to explore associations between predefined variables and WSD within the OA group.Aims
Methods
Introduction. Partial meniscectomy, a surgical treatment for meniscal lesions, allows athletes to return to sporting activities within two weeks. However, this increases knee joint shear stress, which is reported to cause osteoarthritis. The volumes and locations of partial meniscectomy that would result in a substantial increase in knee joint stress is not known. This information could inform surgeons when a meniscus reconstruction is required. Aim. Our aim was to use a previously validated knee finite element (FE) model to predict the effects of different volumes and locations of partial meniscectomy on cartilage shear stress. The functional point of interest was at the end of weight acceptance in walking and running, when the knee is subjected to maximum loading. Method. An FE model of the knee joint was used to simulate walking and running, two of the most common functional activities. Forces and moments, obtained from the gait cycle of a 76.4 kg male subject, were applied at the tibia. Different sizes (0%, 10%, 30%, 60%) and locations (anterior, medial and posterior) of partial meniscectomies were simulated (Figure 1). Maximum cartilage shear stress was determined for the different meniscectomies. Graphs were plotted of the cumulative tibial cartilage volume subjected to stress values above specific thresholds. Results and analysis. Maximum shear stress values for the intact knee during walking were 2.00 MPa medially and 1.71 MPa laterally. During running these magnitudes rose to 3.48 MPa medially and 4.70 MPa laterally. For a 30% anterior, central and posterior meniscectomy during walking shear stress increased by 25.9%, 44.9% and 32.5% medially, and 12.4%, 25.7% and 17.8% laterally. During running shear stress increased by 9.6%, 8.3% and 7.1%, medially and 31.6%, 37.5% and 43.6% laterally. For a 60% meniscectomy, during walking shear stress increased by 47.2% medially and 31.8%, laterally. During running shear stress increased by 10.0%, medially and 51.8%, laterally. The percentage of cartilage volume exposed to shear stress levels above a specified threshold is illustrated in Figure 2 for different volumes and locations of partial meniscectomy. Discussion and conclusions. This is first study that has estimated the volume of cartilage exposed to specific stress thresholds in walking and running as a function of the amount and location of meniscectomy. Maximum shear stress was 100% higher at the end of weight acceptance in running compared to walking. Stress was higher in the lateral compartment during running while higher in the medial compartment during walking. This is because a valgus moment acts at the knee at the end of weight acceptance in running while a varus moment acts at the joint in walking. Clinical significance. The model developed from this research has potential for applications in planning
AIM. Failure of a primary anterior cruciate ligament (ACL) reconstruction is associated with poor functional outcomes even after revision surgery. The aim of this study is to identify early predictors for failure, so that it may aid in recognition of at-risk patients. METHOD. An observational study was conducted of 623 patients undergoing primary ACL reconstruction by a single surgeon over a 72 month period. Patient and procedure related parameters including age, gender, BMI, time to surgery, graft size, fixation methods, meniscal and chondral injuries,
Aim: The purpose of this study was to evaluate the results of transphyseal ACL reconstruction technique in skeletally immature patients. Material &
Methods: Between 2002 and 2008, twenty knees in twenty skeletally immature patients with a mean chronological age of 13.2 years (range, 7 to 16.2 years) underwent transphyseal reconstruction of the anterior cruciate ligament with use of an autogenous quadrupled hamstrings-tendon graft with metaphyseal fixation. Ten knees had additional
The operative treatment of lesions of the anterior cruciate ligament (ACL) in athletes has been widely advocated and performed. We have investigated the outcome of non-operative management in a lower-demand, general population. We reviewed a consecutive group of 228 patients, which excluded professional and high-level athletes, for two to 12 years after an ACL lesion had been diagnosed by arthroscopy. There was a low incidence of secondary ACL and
The best surgical strategy for the management of displaced bucket-handle (BH) meniscal tears in an anterior cruciate ligament (ACL)-deficient knee is unclear. Combining meniscal repair with ACL reconstruction (ACLR) is thought to improve meniscal healing rates; however, patients with displaced BH meniscal tears may lack extension. This leads some to advocate staged surgery to avoid postoperative stiffness and loss of range of motion (ROM) following ACLR. We reviewed the data for a consecutive series of 88 patients (mean age 27.1 years (15 to 49); 65 male (74%) and 23 female (26%)) who underwent single-stage repair of a displaced BH meniscal tear (67 medial (76%) and 21 lateral (24%)) with concomitant hamstring autograft ACLR. The patient-reported outcome measures (PROMs) EuroQol visual analogue scale (EQ-VAS), EuroQol five-dimension health questionnaire (EQ-5D), Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee score (IKDC), and Tegner score were recorded at final follow-up. A Kaplan-Meier survival analysis was performed to estimate meniscal repair survivorship. Analyses were performed with different cut-offs for meniscal and ACL injury-to-surgery time (within three weeks, three to ten weeks, and more than ten weeks).Aims
Methods
Background: Unfortunately ACL injuries are not uncommon in the young: the majority however occurring after skeletal maturity. Aim: To perform an internal audit of the demand, methods and results of ACL reconstruction in young patients at a tertiary referral centre. Methods: Patients were identified through electronic patient records, and all operation notes and follow up records were scrutinised. Results: 84 cases under 20 years of age (range 14–19) were reviewed from 2000–2004 with a minimum follow-up of 6 months. Over 10% had undergone previous surgery or had documented articular injury. 42 cases required further