To identify unanswered questions about the prevention, diagnosis, treatment, and rehabilitation and delivery of care of first-time soft-tissue knee injuries (ligament injuries, patella dislocations, meniscal injuries, and articular cartilage) in children (aged 12 years and older) and adults. The James Lind Alliance (JLA) methodology for Priority Setting Partnerships was followed. An initial survey invited patients and healthcare professionals from the UK to submit any uncertainties regarding soft-tissue knee injury prevention, diagnosis, treatment, and rehabilitation and delivery of care. Over 1,000 questions were received. From these, 74 questions (identifying common concerns) were formulated and checked against the best available evidence. An interim survey was then conducted and 27 questions were taken forward to the final workshop, held in January 2023, where they were discussed, ranked, and scored in multiple rounds of prioritization. This was conducted by healthcare professionals, patients, and carers.Aims
Methods
Knee braces are limited to providing passive support. There is currently no brace available providing both continuous monitoring and active robot-assisted movements of the knee joint. This project aimed to develop a wearable intelligent motorised robotic knee brace to support and monitor rehabilitation for a range of knee conditions including post-surgical rehabilitation. This brace can be used at home providing ambulatory continuous passive movement obviating the need for hospital admissions. A wearable sensing system monitoring knee range of motion was developed to provide remote feedback to clinicians and real-time guidance for patients. A prototype of an exoskeleton providing dynamic motion assistance was developed to help patients complete their exercise goals and strengthen their muscles. The accuracy and reliability of those functions were validated in human participants during exercises including knee flexion/extension (FE) in bed and in chair, sit-to-stand and stand-to-sit.Abstract
Introduction
Methodology
The knee is the most commonly injured joint in sporting accidents. They cause substantial disability, time off work and long-term problems. There remains a limited number of high-quality randomised controlled trials assessing first time, acute soft tissue knee injuries. Key areas requiring answers include prevention, diagnosis, treatment, rehabilitation and delivery of care. In association with the James Lind Alliance, this BASK, BOSTAA and BOA supported prioritising exercise was undertaken over a year. The James Lind Alliance methodology was followed. An initial survey invited patients and healthcare professionals to submit their uncertainties regarding soft tissue knee injury prevention, diagnosis, treatment, rehabilitation and delivery of care. Over 1000 questions were submitted. Seventy-four questions were formulated to encompass common concerns. These were checked against best available evidence. Following the interim survey, 27 questions were taken forward to the final workshop in January 2023, where they were discussed, ranked and scored in multiple rounds of prioritisation by groups of healthcare professionals, patients and carers.Abstract
Introduction
Methodology
Fractures of the articular surface of the patella or the lateral femoral condyle usually occur following acute dislocation of the patella. This study looked at the radiological and functional outcomes of fixation of osteochondral fractures Twenty-nine patients (18 male, 11 female) sustained osteochondral fractures of the knee following patellar dislocation. All patients had detailed radiographic imaging and MRI scan of the knee preoperatively. An arthroscopic assessment was done, followed by fixation using bio-absorbable pins or headless screws either arthroscopically or mini-open arthrotomy. VMO plication or MPFL repair were done if necessary. MRI scan was done at follow-up to assess for healing of the fixed fragment prior to patient discharge.Abstract
Introduction
Methods
Fracture dislocation of the knee involves disruption of knee ligaments with associated tibial plateau fracture. If these injuries are not evaluated swiftly, can result in a limb-threatening injury. The aim of this study is to look at the clinical outcomes of a single surgeon case series at a major trauma centre. Prospectively collected data was analysed for a 5-year period. Primary outcome measures used were International Knee Documented Committee (IKDC) score and Knee Injury & Osteoarthritis Outcome Score (KOOS). The secondary outcome measures include Tegner activity scale, knee range of movements and complications.Abstract
Background
Methods
To determine the effectiveness of LIA compared to ACB in providing pain relief and reducing opiates usage in hamstring graft ACL reconstructions. In a consecutive series of hamstring graft ACL reconstructions, patients received three different regional and/or anaesthetic techniques for pain relief. Three groups were studied: group 1: general anaesthetic (GA)+ ACB (n=38); group 2: GA + ACB + LIA (n=31) and group 3: GA+LIA (n=36). ACB was given under ultrasound guidance. LIA involved infiltration at skin incision site, capsule, periosteum and in the hamstring harvest tunnel. Analgesic medications were similar between the three groups as per standard multimodal analgesia (MMA). Patients were similar in demographics distribution and surgical technique. The postoperative pain and total morphine requirements were evaluated and recorded. The postoperative pain was assessed using the visual analogue scores (VAS) at 0hrs, 2hrs, 4hrs, weight bearing (WB) and discharge (DC).Abstract
Objectives
Materials and Methods
Traumatic knee dislocations are devastating injuries and there is no single best accepted treatment. This study looked at functional outcome of a single surgeon case series of patients who underwent surgical management of their knee dislocation. Eighty-seven patients with knee dislocation were treated at a major trauma centre. Acute surgical repair and reconstruction with fracture fixation within 4 weeks was preferred unless the patient was too unstable (Injury severity score>16). The collaterals were repaired and augmented using a variety of autografts, allografts or synthetic grafts. PCL was primarily braced and reconstructed subsequently, if required. Outcome was collected prospectively using IKDC score, KOOS and Tegner score.Abstract
Introduction
Methods
We conducted a prospective study to investigate the role of the LARS ligament system to reconstruct the posterior cruciate ligament and the postero-lateral corner of the knee. We present a prospective single surgeon case series to evaluate early clinical and functional outcomes of postero-lateral corner and posterior cruciate ligament reconstruction in the knee using the LARS (ligament Augmentation and Reconstruction System) artificial ligament. 23 patients with multi-ligament knee injuries or isolated PCL injuries were treated with a mean follow up of 8 months (range: 2-37 months). Outcomes were assessed using the modified International Knee Documentation Committee score, and a modified Tegner- Lysholm score. 2 patients had acute reconstructive surgery within 7 days of injury, 5 patients within 3 months (semi-acute) and 16 were chronic cases that were operated on after three months from the date of injury. The LARS ligament reconstruction achieved a significant improvement between preoperative and postoperative assessment in relation to knee stability, function and patient satisfaction. The sooner the patients were treated the greater the improvements in functional scores were noted. Most patients achieved a full functional range of movement within six months. We had 2 complications, one superficial wound infection and one stiff knee requiring a manipulation. To date we have had no LARS ligament failures. In the short term the LARS functions well, with high clinical patient satisfaction, no signs of progressive laxity, synovitis or failure. We found no significant difference in functional score post reconstruction between the isolated PCL reconstructions and the multi ligament reconstructions. Our results show no early signs of the problems associated with synthetic grafts used in the past. Such grafts appear to be an attractive alternative to the use of autografts and allografts.Purpose
The aim of this study was to determine current practice in anterior cruciate ligament reconstruction amongst BASK members. This was an internet-based survey where members were invited to complete a questionnaire on ACL reconstruction. Of the 365 BASK surgeons performing ACL reconstruction, 241 completed the questionnaire (response rate 66%). 147(61%) of surgeons used both hamstring and patellar tendon grafts, 71(29%) used only hamstrings and 21(9%) used patellar tendon only. All surgeons used ipsilateral autograft. 157 (65%) used the transtibial technique for femoral tunnel placement with 80(33%) using the anteromedial portal technique. Of those using the anteromedial portal, the most common femoral fixation devices were the Endobutton (34%) and RCI screw (34%). Interference screw fixation (81%) was the most common tibial fixation in the same group of surgeons with the RCI screw being the most common (63%). 19% (45/241) of surgeons were performing double bundle ACL reconstructions in select cases. Hamstring femoral fixation was with a suspension device in 79% and interference screw in 18%. Of those using a suspension device the Endobutton was most common (48%) followed by Transfix (26%) and Rigidfix (19%). Tibial fixation was most commonly achieved by interference screw (57%) followed by Intrafix (30%). With patellar tendon graft the most popular femoral fixation was with an interference screw (66%) followed by suspension (34%). All surgeons used interference screw for tibial fixation. 90% of surgeons (217) allow immediate full weight-bearing as tolerated irrespective of fixation type with 8% delaying full weight bearing between 1 and 3 weeks. The results show the wide spread of variation in practice of ACL reconstruction. With recent renewed interest in a more anatomic placement of tunnels, the use of the anteromedial portal may continue to increase. With such a wide variation in techniques, grafts and fixation implants used, a register may help assess outcomes.
Delayed rather than early reconstruction of the anterior cruciate ligament is the current recommended treatment for injury to this ligament since it is thought to give a better functional outcome. We randomised 105 consecutive patients with injury associated with chondral lesions no more severe than grades 1 and 2 and/or meniscal tears which only required trimming, to early (<
two weeks) or delayed (>
four to six weeks) reconstruction of the anterior cruciate ligament using a quadrupled hamstring graft. All operations were performed by a single surgeon and a standard rehabilitation regime was followed in both groups. The outcomes were assessed using the Lysholm score, the Tegner score and measurement of the range of movement. Stability was assessed by clinical tests and measurements taken with the KT-1000 arthrometer, with all testing performed by a blinded uninvolved experienced observer. A total of six patients were lost to follow-up, with 48 patients assigned to the delayed group and 51 to the early group. None was a competitive athlete. The mean interval between injury and the surgery was seven days (2 to 14) in the early group and 32 days (29 to 42) in the delayed group. The mean follow-up was 32 months (26 to 36). The results did not show a statistically significant difference for the Lysholm score (p = 0.86), Tegner activity score (p = 0.913) or the range of movement (p = 1). Similarly, no distinction could be made for stability testing by clinical examination (p = 0.56) and measurements with the KT-1000 arthrometer (p = 0.93). Reconstruction of the anterior cruciate ligament gave a similar clinical and functional outcome whether performed early (<
two weeks) or late at four to six weeks after injury.
