Introduction This study was conducted in order to evaluate the patterns of utilization of arthroscopic knee debridement for the treatment of degenerative arthritis and the five years outcome following an initial arthroscopic procedure at our institution.

Methods This is a retrospective study on all patients with degenerative arthritis of the knee who had their first arthroscopic debridement between 1992 and 1995, and had a follow-up of at least five years or ended up with total knee replacement (TKR). Patients with other prior surgery to the knee were excluded. The patients were divided into four groups based on the first arthroscopic finding using the Outerbridge grading system (Stage I: Softening, II: Fibrillation, III: Fragmentation, IV: Eburnation). The clinical status following the first arthroscopy and during the last follow-up were evaluated. The duration between the first arthroscopic debridement and TKR were also taken into account. Two hundred and two cases were included in the study which consists of 114 male and 88 female with mean age of 58.7 years. The mean follow-up was 5.4 years. There were 15 cases in stage I, 96 in stage II, 58 in stage III and 33 in stage IV.

Results Following the first arthroscopic debridement, 93.7% of patients in stage I and II became asymptomatic compared to 26.4% in stage III and in IV where 60.4% still presented with recurrent symptoms. On the last follow-up, 18.9% in stage I and II had total knee replacement done compared to 78.0% in stage III and IV. The mean duration between the first arthroscopic debridement and TKR was 8.6 years in stage II, 3.3 years in stage III and 1.5 years in stage IV.

Conclusions This study has shown that given the proper selection of patients and the correct stage of degenerative arthritis, arthroscopic debridement can still be a successful palliative, temporizing treatment for the osteoarthritic knee. It is of utmost importance that the patient’s pre-operative expectations have to be clearly objectified.

The effect of screw geometry on the pullout strength of Anterior Cruciate Ligament [ACL] reconstruction is well documented. Most research has looked at the effect of screw length and diameter, however other factors such as the degree of taper may also be important. Tapered screws should in theory be associated with increased pullout strength. This has not been demonstrated either clinically or in vitro before. The aim of this study was to compare the pullout strength of ACL reconstruction with a parallel against a tapered screw.

A parallel and tapered screw were manufactured which were identical in all other respects. Sixty superficial digital flexors from the hind legs of sheep were harvested. The tendons were paired and combined to form a quadruple tendon reconstruction of approximately 7mm diameter as measured with graft sizer. An ACL reconstruction was performed on the proximal tibia of 30 bovine knees, which had been harvested in right and left knee pairs, using the quadruple tendon. Fifteen reconstructions were fixed using tapered screws and fifteen with non-tapered screws. The insertion torque of both tapered and non tapered screws were recorded using an instrumented torque screwdriver. The reconstructions were mounted in an Instron materials testing machine with an x-ray bearing system to eliminate horizontal forces, to ensure that the forces were all directed along the line of the tibial tunnel. The maximum pullout strengths were recorded in each case. Five knee pairs were subjected to bone densitometry scanning to ensure that any difference in pull out strength was not due to changes in bone density between right and left knee pairs.

Results indicated that there was no difference between right and left knee pairs [p = 0.58] and that tapered screws were associated with significantly higher pull-out strengths [p=0.007] and insertion torques [p = 0.001].