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The Bone & Joint Journal
Vol. 101-B, Issue 6 | Pages 652 - 659
1 Jun 2019
Abram SGF Beard DJ Price AJ

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 meniscal surgery or nonoperative treatment in each scenario was rated by the group. The process was informed throughout by the latest published, and previously unpublished, clinical and epidemiological evidence. Scenarios were then grouped together based upon the similarity of clinical features and ratings to form the guideline for treatment. Feedback on the draft guideline was sought from the entire membership of BASK before final revisions and approval by the consensus group. Results. A total of 45 simulated clinical scenarios were refined to five common clinical presentations and six corresponding treatment recommendations. The final guideline stratifies patients based upon a new, standardized classification of symptoms, signs, radiological findings, duration of symptoms, and previous treatment. Conclusion. The 2018 BASK Arthroscopic Meniscal Surgery Treatment Guidance will facilitate the consistent identification and treatment of patients with meniscal lesions. It is hoped that this guidance will be adopted nationally by surgeons and help inform healthcare commissioning guidance. Validation in clinical practice is now required and several areas of uncertainty in relation to treatment should be a priority for future high-quality prospective studies. Cite this article: Bone Joint J 2019;101-B:652–659


Bone & Joint Open
Vol. 5, Issue 11 | Pages 1003 - 1012
8 Nov 2024
Gabr A Fontalis A Robinson J Hage W O'Leary S Spalding T Haddad FS

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 meniscal surgery


Bone & Joint 360
Vol. 11, Issue 3 | Pages 17 - 20
1 Jun 2022


Bone & Joint 360
Vol. 11, Issue 5 | Pages 18 - 19
1 Oct 2022


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_18 | Pages 9 - 9
1 Dec 2023
Garneti A Clark M Stoddard J Hancock G Hampton M
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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 meniscal surgery shows an increasing trend since 2013, with 57% of ACLr in 2021 now involving meniscus surgery. The number of ACLr with lateral extra-articular tenodesis (LET) has increased sharply since 2018, preceding the stability trial publication in 2020. Graft preference and size has remained static despite the introduction of new graft harvest and fixation devices. Additional procedures such as other ligament reconstruction and additional cartilage surgery have also remained static over time. Conclusion. In this analysis we looked at surgical trends in ACLr and their relation to literature and industry. Meniscal intervention is increasing, in keeping with the growing level of literature in this area. In the setting of LET, a high impact level 1 study appears to have significantly changed the practice of UK surgeons with a sharp increase in the number of LET procedures being performed. Industry appears to have little influence on the change in surgical trends, suggesting high quality evidence is what drives innovation in ACLr while industry supports rather than influences innovation. It will be interesting to see the impact of the stability 2 study, recent work on the medial structures of the knee and the commissioning of cartilage centres on future trends


Bone & Joint Research
Vol. 12, Issue 1 | Pages 33 - 45
16 Jan 2023
Li B Ding T Chen H Li C Chen B Xu X Huang P Hu F Guo L

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 meniscus surgery in mice. Conclusion. Taken together, these results demonstrate that reduction of circStrn3 causes an increase in miR-9-5p, which acts as a protective factor in mechanical instability-induced OA, and provides a novel mechanism of communication among joint components and a potential application for the treatment of OA. Cite this article: Bone Joint Res 2023;12(1):33–45


Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_13 | Pages 73 - 73
7 Aug 2023
Shatrov J Jones M Ball S Williams A
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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 meniscal surgery (42.1% vs 73.7%) and effusion on RTS (47.7% vs 72.2%). Conclusion. Over 89 % of elite athletes returned to professional sport after microfracture in the knee. However, the ability to continue playing is affected by several factors such as the extent of the chondral damage and recurrent effusions


Orthopaedic Proceedings
Vol. 90-B, Issue SUPP_I | Pages 61 - 61
1 Mar 2008
Guy P Kantor S Harvey E Reindl R
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We examined the relationship between waiting times for ACL surgery and the need for meniscal surgery at time of reconstruction. Using the Provincial Billing Database we identified 3812 ACL reconstructions between 1999–2001. Patients waited on average four hundred and twenty-two days from initial medical visit to reconstruction. 1722 patients (45%) required meniscal surgery with the ACL procedure. The delay to surgery was: two hundred and fifty-one days (no meniscal surgery required), four hundred and thirteen days (meniscal repair) and six hundred and seventy-six days (meniscectomies). This difference was significant, p< .01, ANOVA. The rate of meniscal surgery per time period was also significantly different: 17% if < 3months, 57% if > 6months. Our present Health Care policies place patients at risk of requiring avoidable meniscal surgery and developing osteoarthritis. The purpose of this study was to examine the relationship between waiting times for ACL surgery and outcome. The outcome measure was the need for meniscal surgery at the time of ACL reconstruction. The Provincial Data Base Billing information was reviewed for ACL reconstruction between 1999–2001. The simultaneous need for a meniscal procedure was noted. Tracking back in time, all demographic, diagnostic and interventional billing data (ICD & Visit billing code) preceding their ACL surgery was recorded. Between 1999–2001, 3812 ACL reconstructions were identified. Of these, 1722 patients required a meniscal procedure (45%). On average, patients waited over four hundred and twenty-two days from injury to reconstruction. Patients who did not require any meniscal procedure waited on average two hundred and fifty-one days, meniscal repairs waited four hundred and thirteen days, while meniscectomies waited six hundred and seventy-six days. More importantly, the need for a meniscal procedure correlated with the timing of surgery: 17% of those reconstructed < three months from injury had a significant meniscal injury, compared to 57% at > six months. Almost half of which (48%) required a meniscectomy for significant meniscal injury. These differences all attained statistical significance (p< 0.01). Previous reports suggest that the ACL-deficient knee increases the risk of meniscal injury and meniscal incompetence hastens OA. Our data show a progressive increase in the rate to meniscal surgery, and meniscal injury complexity with time. These delays and rates are higher than the ones proposed in the literature. It appears that the experience in our Province simply reproduces (rather than improves upon) the natural history of the ACL injury. We postulate restricting access to specialists and to surgery place the patient at risk for requiring avoidable surgery and developing osteoarthritis


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_7 | Pages 96 - 96
1 Jul 2022
Gabr A Robinson J
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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 meniscal surgery has been demonstrated. However, there are concerns that MCL pie-crusting with concomitant ACL reconstruction (ACLR) might affect knee stability and outcomes postoperatively. The aim of this study was to compare the functional outcomes between patients who underwent MCL pie-crusting at ACLR with those that did not. Methods. We performed a retrospective review of prospectively collected data from on the National Ligament Registry. 55 patients (33 male and 22 female) who had MCL pie-crusting(PC group) to address a meniscal lesion at the time of ACLR were compared with 65 patients (38 male and 27 female) who underwent isolated primary ACLR. All procedures were performed by a single surgeon at a tertiary centre between October 2013 and March 2019. Results. The mean Follow up was 4.2 years(range 2- 7 years). The mean EQ 5D- VAS scores were 82 and 81 in the PC group and ACLR only group respectively. The mean IKDC scores were 81 and 85 in the PC group and ACLR only group respectively. The mean KOOS scores in the PC group and ACLR only group were: Symptoms (81,87); Pain (89,92); ADLs (94,96), sports and recreation function (81,83), QoL (75,78) respectively. The differences in the scores were not statistically significant. Conclusions. This study demonstrates that pie-crusting of the MCL at the time of ACLR does not significantly affect the functional outcomes


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXIV | Pages 27 - 27
1 Jul 2012
Henderson L Johnston A Stokes M Corry I Nicholas R
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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 meniscal surgery and those that did not. The patients that did not require meniscal surgery had a median Lysholm score of 94 and those that required meniscal surgery had a similar median Lysholm score of 92.5. However it was noted that 8 patients required medial and lateral partial menisectomies at the time of original reconstruction. This group of patients had a median Lysholm Knee Score of 83.5 and Tegner Activity Scale of 4 at ten years following reconstruction. 17 of the 62 patients (27.4%) required re-operation because of further knee symptoms, with 4 patients requiring revision of the anterior cruciate following re-rupture. In conclusion anterior cruciate ligament reconstruction with four-strand STG hamstring autograft provides a reliable method of restoring knee function, with a 6% revision rate for re-rupture at ten years. Combined partial medial and lateral menisectomy at the time of the initial reconstruction is a poor prognostic indicator of function at ten years


The Bone & Joint Journal
Vol. 95-B, Issue 1 | Pages 59 - 64
1 Jan 2013
Sri-Ram K Salmon LJ Pinczewski LA Roe JP

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 meniscal surgery was increased by a factor of two if ACL reconstruction was delayed more than five months, and increased by a factor of six if surgery was delayed by > 12 months. The effect of delaying surgery on medial meniscal injury was also pronounced in the patients aged < 17 years, where a delay of five to 12 months doubled the odds of medial meniscal surgery (odds ratio (OR) 2.0, p = 0.001) and a delay of > 12 months quadrupled the odds (OR 4.3, p = 0.001). Increasing age was associated with a greater odds of chondral damage (OR 4.6, p = 0.001) and medial meniscal injury (OR 2.9, p = 0.001), but not lateral meniscal injury. The gender split (3251 men, 1835 women) revealed that males had a greater incidence of both lateral (34% (n = 1114) vs 20% (n = 364), p = 0.001) and medial meniscal tears (28% (n = 924) vs 25% (n = 457), p = 0.006), but not chondral damage (35% (n = 1152) vs 36% (n = 665), p = 0.565). We conclude that ideally, and particularly in younger patients, ACL reconstruction should not be delayed more than five months from injury. Cite this article: Bone Joint J 2013;95-B:59–64


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 10 | Pages 1327 - 1333
1 Oct 2011
Jameson SS Dowen D James P Serrano-Pedraza I Reed MR Deehan DJ

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 meniscal surgery. The 30-day re-admission rate was 0.64% (1662) and 30-day wound complication rate was 0.26% (677). The overall 30-day re-operation rate was 0.40% (1033) and the 90-day pulmonary embolism rate was 0.08% (230), of which six patients died. 90-day mortality was 0.02% (47). Age < 40 years, male gender and ligament reconstruction were significantly associated with an increased rate of 30-day re-admission and unplanned re-operation. In addition, a significant increase in 30-day admission rates were seen with Charlson comorbidity scores of 1 (p = 0.037) and ≥ 2 (p <  0.001) compared with scores of 0, and medium volume units compared with high volume units (p < 0.001). Complications following arthroscopy of the knee are rare. It is a safe procedure, which in the majority of cases is performed as day case surgery. These data can be used for quality benchmarking, in terms of consent, consultant re-validation and individual unit performance


Bone & Joint Research
Vol. 8, Issue 2 | Pages 101 - 106
1 Feb 2019
Filardo G Petretta M Cavallo C Roseti L Durante S Albisinni U Grigolo B

Objectives. Meniscal injuries are often associated with an active lifestyle. The damage of meniscal tissue puts young patients at higher risk of undergoing meniscal surgery and, therefore, at higher risk of osteoarthritis. In this study, we undertook proof-of-concept research to develop a cellularized human meniscus by using 3D bioprinting technology. Methods. A 3D model of bioengineered medial meniscus tissue was created, based on MRI scans of a human volunteer. The Digital Imaging and Communications in Medicine (DICOM) data from these MRI scans were processed using dedicated software, in order to obtain an STL model of the structure. The chosen 3D Discovery printing tool was a microvalve-based inkjet printhead. Primary mesenchymal stem cells (MSCs) were isolated from bone marrow and embedded in a collagen-based bio-ink before printing. LIVE/DEAD assay was performed on realized cell-laden constructs carrying MSCs in order to evaluate cell distribution and viability. Results. This study involved the realization of a human cell-laden collagen meniscus using 3D bioprinting. The meniscus prototype showed the biological potential of this technology to provide an anatomically shaped, patient-specific construct with viable cells on a biocompatible material. Conclusion. This paper reports the preliminary findings of the production of a custom-made, cell-laden, collagen-based human meniscus. The prototype described could act as the starting point for future developments of this collagen-based, tissue-engineered structure, which could aid the optimization of implants designed to replace damaged menisci. Cite this article: G. Filardo, M. Petretta, C. Cavallo, L. Roseti, S. Durante, U. Albisinni, B. Grigolo. Patient-specific meniscus prototype based on 3D bioprinting of human cell-laden scaffold. Bone Joint Res 2019;8:101–106. DOI: 10.1302/2046-3758.82.BJR-2018-0134.R1


Bone & Joint Open
Vol. 5, Issue 10 | Pages 879 - 885
14 Oct 2024
Moore J van de Graaf VA Wood JA Humburg P Colyn W Bellemans J Chen DB MacDessi SJ

Aims

This study examined windswept deformity (WSD) of the knee, comparing prevalence and contributing factors in healthy and osteoarthritic (OA) cohorts.

Methods

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.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_9 | Pages 54 - 54
1 May 2016
Carpanen D Hillstrom H Walker R Reisse F Cheah K Mootanah R
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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 meniscal surgeries and developing rehabilitation strategies for athletes. It could inform surgeons about the safe volume and location of partial meniscectomy that can be performed before meniscus reconstruction becomes necessary. Results of this study also highlight the importance of considering the effect of post-surgical outcomes following different common functional activities


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXXVII | Pages 439 - 439
1 Sep 2012
El-Husseiny M Patel S Hossain F Haddad F
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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, meniscal surgery, radiological parameters and post-operative IKDC scores. Logistic regression modeling was employed to identify those factors which were statistically significant for failure. RESULTS. We identified 14 patients who experienced failure of their ACL graft. The causes for failure included trauma (9), infection (2), arthrofibrosis (1), biological (1) and recurrent instability (1). Univariate analysis established a significant relationship between age at time of injury (p<0.001), BMI (p=0.001), time to index procedure (p<0.001), screw length (p=0.04) and early post-operative IKDC score (p<0.001). Multivariate analysis demonstrated all factors stated except screw length to be important for predicting failure for ACL reconstruction. CONCLUSIONS. The rate of graft failure is lower than has been those quoted in the literature. We have identified those patients who are at high risk of rupturing a reconstructed primary ACL graft. Careful monitoring and functional modification of high-risk patients may be indicated to prevent failure. This study identifies predictive factors of failed ACL reconstruction. Age at time of injury, BMI, time to surgery, post-operative IKDC scores were found to be associated with failure


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_III | Pages 287 - 287
1 Jul 2011
Rees A Gajjar S Tawfiq S Barton-Hanson N
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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 meniscal surgery. The functional outcome, graft survival, radiographic outcome, and any growth disturbance were evaluated at a mean of 2.2 years (range, 1.0 to 5.9 years) after the surgery. Results: No patient underwent revision anterior cruciate ligament reconstruction. The mean International Knee Documentation Committee subjective knee score (SD) was 90.5 (10.0) points and the mean Lysholm knee score was 92.2 (10.0) points. The result of the Lachman examination was normal in 18 knees and nearly normal in two; it was not abnormal or severely abnormal in any knee. The mean increase in total height was 7.2 cm (range, 1.2 to 20.4 cm) from the time of surgery to the time of final follow-up. No angular deformities of the lower extremity were measured radiographically, and no lower-extremity length discrepancies were measured clinically. Complications included one case of knee stiffness requiring physiotherapy, one case of persistent pain leading to medial menisectomy for tear and one case of re-injury five months post ACL reconstruction requiring medial meniscus repair. Conclusion: Excellent functional outcome was noted in skeletally immature patients after transphyseal reconstruction of the anterior cruciate ligament with use of an autogenous quadrupled hamstrings-tendon graft with metaphyseal fixation. There were very few complications and no growth disturbance


The Journal of Bone & Joint Surgery British Volume
Vol. 78-B, Issue 3 | Pages 446 - 451
1 May 1996
Casteleyn P Handelberg F

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 meniscal surgery, 5.4% and 3.5% respectively, and all these procedures were performed during the first three years after the ACL injury. We studied a subgroup of 109 patients with follow-up of at least five years (mean 8.5 years) and evaluated them using the IKDC score. The general outcome was reasonably satisfactory, with 23% in grade A, 50% in grade B, 21% in grade C and only 6.4% in grade D. We found no statistically significant prognostic effect within this group as regards age, activity levels, or the incidence of associated lesions


The Bone & Joint Journal
Vol. 104-B, Issue 6 | Pages 680 - 686
1 Jun 2022
Robinson JR Bruce D Davies H Porteous AJ Murray JRD Howells NR

Aims

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.

Methods

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).


Orthopaedic Proceedings
Vol. 88-B, Issue SUPP_II | Pages 252 - 252
1 May 2006
Roach R Banim R Rees D Roberts S White S
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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 meniscal surgery at the time of reconstruction: 12% repairs (20/168 menisci), 18% partial menisectomy (30/168). The median time to reconstruction from injury was 9 months (range 1–72). No case was delayed for growth plate maturation. Reconstruction methods were partly surgeon dependent, following adult themes. Occasionally tibial fixation was away from the growth plate with low profile screws and washers. We are only aware of 1 failure during this short follow-up. Conclusion: We believe that the use of techniques similar to those used on adults is appropriate for adolescents. However the high comorbidity is of some concern, demonstrating that this age range is as challenging as their older counterparts