Introduction

The dysplastic trochlear is a developmental condition characterized by an abnormally flat or dome-shaped trochlea and it is recognized as a significant cause of patella instability. Surgical correction of the shape of the Trochlear Groove is frequently performed. The described methods in the literature involve open arthrotomy to normalize and maintain the trochlear morphology achieving normal alignment and tracking of the patella.

The dysplastic Trochlear is a developmental condition characterised by an abnormally flat or dome-shaped trochlea and it is recognised as a significant cause of patella instability, with the increased sulcus angle being is the most common finding. Surgical correction of the shape of the Trochlear Groove is frequently performed. The described methods in the literature involve open arthrotomy to normalise and maintain the trochlear morphology achieving normal alignment and tracking of the patella.

Open procedures carries a significant risk of arthrofibrosis. The technique was developed in human cadaveric knees at the Donjoy Clinical Education and Research Facility (CERF) in Vista California. We describe an arthroscopic procedure to create a neo-trochlea using gouges, spherical and conical hooded burrs. We studied prospectively a series of 4 consecutive patients with patello-femoral instability secondary to trochlear dysplasia, who were treated by an Arthroscopic trochleoplasty by a single surgeon between 2007 and 2008. Postoperatively the patients were rehabilitated in accordance with our routine Patello-Femoral microfracture Protocol, allowing weight bearing and ROM 0-20 degrees in a long lever brace for 6 weeks. CT scanning at one year showed a complete neo-cortex and cartilage sequenced MRI at 12 months showed complete fill with fibro cartilage.

Pre- and post-operative scores (KOOS, Kujala) were assessed by the patients and a satisfaction questionnaire was completed. The results showed a statistical improvement in the outcome at the 2 year follow up.

Overall, patients (100%) were satisfied with the outcome of their procedure and there have been no adverse events. To our knowledge this technique has not been described before in the English literature and the early results of arthroscopic trochleoplasty are encouraging and offer an alternative to open approaches. Larger numbers and longer follow ups are needed to confirm the long term benefit.

This prospective case-controlled study evaluates the outcome of chronic combined anterior cruciate ligament (ACL) & posterolateral corner (PLC) knee reconstruction.

Twenty-six patients (23 male) underwent combined ACL & PLC reconstruction between October 2001 and October 2006 (Group ACL/PLC). Mean age 30.2 years (range 17–44). Mean follow-up 51 months (range 27–109). The commonest mode of injury was football. Seven patients had concomitant lateral, and 9 medial meniscal procedures, 1 osteochondral defect was micro-fractured. All procedures were performed at the same operation. Prospective scoring was done pre-operatively and 3,6,12, and 24 months post-op using Lysholm, IKDC 2000 and KOOS scoring systems. These scores were compared to an age, sex and injury matched control group of patients who also underwent ACL reconstruction without posterolateral corners injury (Group ACL).

Functional scores showed a significant improvement in all patients in both ACL/PLC and ACL groups postop (p< 0.05). Pre-op scores for Lysholm (p=0.005), IKDC (p=0.03), KOOS sports (p=0.03) and quality of life (QOL) (p=0.03) were significantly lower in Group ACL/PLC compared to Group ACL. Other significantly reduced KOOS scores were - sports 12 (p=0.04) & 24 months (p=0.004); and QOL 12 (p=0.01) & 24 months (p=0.006).

Conclusions: Injury to the posterolateral stabilizing structures of the knee usually occurs in association with other ligamentous injuries. The recognition and adequate management of this injury is crucial. Knees with combined ACL & PLC injuries have reduced function compared to ACL injuries alone. Patients undergoing combined ACL & PLC reconstruction should be made aware that the nature of their injury is such that postoperatively they may have ongoing functional limitations with respect to return to sport and quality of life.

The purpose of this study was to evaluate the outcome of posterior cruciate ligament (PCL) reconstruction with a double tunnel technique, using prospective pre & post-operative functional scoring and clinical evaluation.

We reviewed those patients who underwent PCL reconstruction between October 2001 and October 2006. 24 patients were identified, 23 male and 1 female. Mean age 30.1 years (range 17–43). Mean follow up 56 months (range 29–86). The commonest mode of injury was football. 3 patients had isolated PCL injuries, 21 had concomitant knee ligament injuries which were treated surgically at the same operation. Patients were prospectively scored pre-operatively and at 3, 6, 12 & 24 months post-op using the Lysholm, IKDC 2000 & KOOS scoring systems. These scores were compared to an injury matched control group who underwent comparable knee ligament reconstructions, but who had intact PCL’s.

The knee scores showed a significant improvement in all PCL reconstructed patients post-op (p< 0.05). However, significant differences were found between the PCL reconstructed and PCL intact groups. Both groups had high return to employment and return to sports rates. We describe our method of double tunnel reconstruction.

Conclusions: PCL injury is usually associated with concomitant soft tissue knee injuries. PCL deficiency contributes significantly to the morbidity of the multiple ligament injured knee. Reconstruction with the double tunnel technique described gives excellent functional improvement and high rates of return to employment and sports.

Purpose: To subjectively assess and present the outcome after ACL reconstruction with minimum follow-up of 24 months.

Methods: Our knee injury database was established in June 2001. Data were collected prospectively for all knee ligament reconstructions carried out by a single surgeon. The database has a prospectively studied consecutive series where all the patients surveyed completed the Lysholm, KOOS and IKDC 2000 questionnaires preoperatively and at 3, 6, 12 and 24 months postoperatively. Our knee injury database comprises of 163 patients who had ACL reconstruction in which Hamstrings were used in 120 cases and Bone Patella-Tendon Bone (BPTB) grafts in 43. This includes 27 complex reconstructions and 12 revisions (11 from other centres).

Results: Fifty-six of the 79 patients (70.8%) who were at least 2 years post ACL reconstruction attended for their 2 year review. Majority were male patients(90%) and both attendees and non- attendees were of a similar age (30.5 /30 respectively) and did not exhibit a statistically significant difference in their pre op or early post op scores. In the non-attendee group 2 were students, 1 emigrated, 1 registered as unemployed, 7 no employment status and 3 did not consent to such follow-up. The mechanism of injury was, 62 as sporting injury (24 contact/38 non-contact sport), 3 road traffic accidents and 8 activities of daily living and 2 not recorded. The mean scores were, IKDC – 77.14, Lysholm – 83.96 and KOOS symptom – 81.6.

Conclusions: All subjective evaluation questionnaires (KOOS, Lysholm and IKDC) revealed a progressive trend in our patients. We found that in the KOOS, a multidimensional patient completed aggregated score, the Quality of Life (QoL) dimension exhibited results which were interestingly not correlating with the other dimensions of the questionnaire, with patients who scored < 50% occupying manual or non-administrative positions at work

Aims: To assess the results of Anterior Cruciate Ligament (ACL) reconstruction at a minimum of two years follow-up, using the Rolimeter [AIRCAST, Europe] as an adjunct to routine knee examination and subjective scoring systems.

Methods: The Warrington Knee Injury database was initiated in June 2001 and data from all knee ligament injuries has been collected prospectively, from preoperative status through to all follow up assessments. Inclusion criteria for our study were, all ACL reconstructions performed by the senior author with minimum 24 months follow up; other ligaments being intact and presence of a normal contralateral knee.

50 patients satisfied the inclusion criteria. There were 41 males and 9 females in ages ranging from 17 to 51 (mean 30.6 years), with no significant difference in age between sexes. Hamstring grafts were used in 29 knees and Bone-Patellar tendon – Bone (BPTB) grafts in 21. Knee laxity was measured using the Rolimeter with IKDC knee examination and functional assessments using the Lysholm, IKDC and KOOS scoring systems.

Results: 20/21 of patients with BPTB grafts (95.2%) and 26/29 of patients with Hamstring grafts (89.7%) achieved normal or near normal knee laxity compared to their opposite knee. The Range of movement in 48 of 50 knees (96%) fell within normal or near normal limits according to IKDC description (Lack of extension < 3 degrees and lack of flexion < 10 degrees). Two patients with abnormal range of movement had a similar lack of movement preoperatively. Though none of the knees were abnormally tight (AP laxity difference < -3), there was a relationship between knee tightness and lack of extension, but this was not statistically significant. There was no association between age or sex of patient and lack of movement. The mean IKDC, Lysholm and KOOS symptom scores were 80.45, 87.3 and 81.3 respectively.

Conclusions: We have achieved a normal or near normal AP laxity in 92% of our ACL reconstructions on assessment at 2 years postoperatively. We report no signifi-cant difference in outcome between use of Hamstring or BPTB grafts. The functional outcome has been optimal as revealed by subjective evaluation.

Purpose: To assess the results of ACL reconstructions carried out at our institution in a non-elite cohort of patients with regards to return to active sports post reconstruction.

Materials & Methods: Seventy-five (71%) of 106 patients who underwent reconstruction of isolated ACL tears between June 2001 and August 2004 performed by the senior author completed a newly designed questionnaire (incorporating Cincinnati Sports Activity Scale [CSAS]) to help us fully assess their return to sports and to elucidate reasons if not returning to pre-injury level. 55 were completed at follow up, with objective clinical assessment and other subjective questionnaires [KOOS, IKDC and Lysholm] and 20 were done through telephone interview.

Results: All 75 patients were involved in sports at CSAS Levels 1 & 2 prior to their injury and 39 (52%) had to drop to level 4 after injury. Following reconstruction 61 patients (81.3%) returned to CSAS 1 & 2 levels. 28 of 30 patients (93.3%) operated within 2 years from injury achieved pre-injury CSAS levels compared to 33 of 45 (73.3%) with a longer interval. The mean Lysholm, IKDC and KOOS Sports scores at 12 to 24 months follow up revealed a progressive trend and were 84.9, 76.3 and 73.6 respectively.

One reason for not returning to pre–injury intensity of sports was that many (71.7%) expressed fears of instability though most (70%) had no instability on playing. 77.8% of non-returners who were more than 30 years age reasoned not wanting to risk re-injury compared to 36.8% in the under 30 group. More significantly, 44.4% of over 30s said they were planning to drop their sporting level anyway compared to 5.5% in the younger group.

Conclusion: ACL reconstruction is best done as early as possible after injury for persons intending to return to competitive sports. The results are even better after early intervention in younger patients. Psychosocial issues play a significant role in return to active sports.

Introduction: This prospective study is designed to evaluate PCL reconstruction using the arthroscopic ‘double bundle technique’ in a consecutive series of patients with multiple ligament instability.

Methods: 12 consecutive patients who underwent arthroscopic posterior cruciate ligament reconstruction at Warrington Hospital for a combined ligament injury with PCL tear between 2001 and 2004 were included in the study. The indication for surgery was functional disability of the knee due to pain and instability. All were male patients with an average age 33 years (range 18 to 44). Average time from injury to surgery was 31.5 months (range 1 day to 96 months). The evaluation parameters included functional assessment, clinical examination, and functional score. All data was collected prospectively. The average period of follow up was 23months (range 9 to 50 months)

Results: Using the IKDC subjective assessment 63% of the patients had normal/near normal knee function (range 16 to 94). On Lysholm scoring 71% reported good or excellent results. On objective examination 83% had abolition of reverse pivot with 91% showing no evidence of PLC instability.

Conclusions: Arthroscopic double bundle PCL reconstruction in this study produced a satisfactory clinical outcome in terms of return to function objective assessment and symptom improvement. The technique has improved results in terms of outcome than previous reports in the literature would suggest.