Introduction: Initial results for the management of osteochondral defects with both ACI-C and MACI have been encouraging, showing significant clinical improvement. This single-centre study set out to determine any significant difference in outcomes between ACI-C and MACI.

Aim: Reporting three year follow up of clinical and arthroscopic assessment of prospective analysis of ACI-C and MACI used in the management of symptomatic, full-thickness chondral and osteochondral defects in the knee.

Method: Following assessment arthroscopy and harvesting of chondrocytes for culture, patients were randomised into the ACI-C or MACI arm and underwent their respective procedures one month later. In ACI-C a covered technique is employed using a porcine-derived type I/III collagen membrane sutured in place; MACI requires cultured autologous chondrocytes to be seeded in a bi-layered type I/III collagen membrane which is glued into position. An arthroscopy was performed at 12 and 24 months postprocedure to assess graft coverage and biopsies taken to determine extent of hyaline, mixed and fibro-cartilage proliferation.

Results: 102 patients underwent either ACI-C (44) or MACI (58) with an average age of 33.6 (14–52). Mean Cincinnati knee rating scores recorded prior to assessment arthroscopy for ACI-C: 45.2 (10 – 94) and MACI: 45.5 (10 – 90) showed improvement at follow up with 63% of patients in the ACI-C group scoring good or excellent at three years, and 60% in the MACI group. ICRS arthroscopy scores were good or excellent in 91.4% of ACI-C and 76.1% of MACI patients at 24 months. Biopsies of the transplants at 24 months revealed proliferation of hyaline and mixed cartilage (hyaline and fibro-cartilage) in 48.6% of the ACI-C and 30.5% of the MACI patients.

Conclusion: Results to date suggest significant clinical and arthroscopic improvement following ACI-C and MACI, with evidence of proliferation of hyaline cartilage at the transplant site. Limited differences are noted between the outcomes of the two techniques.

Aims: he purpose of this study was to determine whether autologous chondrocyte implantation (ACI) in patients with articular cartilage defects of the knee resulted in patients returning to pre-injury levels of work and physical activities.

Methods: 133 consecutive patients from January 2001 to December 2002 underwent ACI at our institution. A telephone and postal questionnaire was conducted to ascertain a detailed occupational and leisure activity profile in this cohort of patients. For each job held for at least 2 months, we asked whether an average working day had involved any of the ten specified physical activities. Similarly, for each sport that had been played more than 5 times a year, we asked the age the sporting activities had began and whether they were able to return to these sports after surgery. Occupation for each patient was given a 3 digit code according to the Standard Occupational Classification System 2000 and hence determined whether the work performed was manual or non-manual.

Results: 97 patients responded to the questionnaire. There were 53 females and 44 males and the mean age at the time of operation was 34.5 (range 14 to 49). Category 6 (Personal Services Occupations) was the most common occupation pre-operatively, whereas category 4 (Administrative and Secretarial Occupations) was the most common post-operatively. 7% of patients’ work involved kneeling or squatting and this figure rose to 12%, 4 years following surgery. 42% of patients had to make some form of modification to their work (usually less physical or more office based). 47% of patients were able to return to at least one of the sports they played pre-injury.

Conclusion: This is the first study to demonstrate that patients are able to return to work and resume sporting activity following autologous chondrocyte implantation.

Aims: To compare the clinical and functional outcomes of autologous chondrocyte implantation for treatment of osteochondral defects of the knee performed in overweight, obese and patients of ‘ideal weight’as defined by their BMI.

Methods: We analysed the data on all our patients that have been followed up for a minimum of 2 years and had their height and weight recorded initially in our database. Functional assessment consisted of the Modified Cincinatti Scores (collected prospectively at 6 months, 1 year, 2 years and 3 years following surgery). Patients were placed into 3 groups according to their body mass index (BMI). Group A consisted of patients with BMI of 20 to 24.9, group B patients with BMI of 25 to 29.9 and Group C are patients with BMI of 30 to 39.9.

Results: There were 80 patients (41 males and 39 females) with a mean age of 35.4 (range 18 to 49). The mean BMI for the entire group was 26.6. The pre-operative, 6 month, 1 year, 2 year, and 3 year Modified Cin-cinatti Score in Group A (32 patients) was 54.4, 80.3, 82.7, 74.7 and 72.6. Similarly in Group B, the scores were 53, 41, 54, 56, 49.5 and in Group C the scores were 36.3, 36.3, 49.6, 36, and 35.7. The wound infection rate in Group A was 6.25%, in Group B was17.6% and Group C was 14.3%.

Conclusions: Initial results from this study suggest that BMI is an important predictor of outcome after chon-drocyte implantation. The group of patients that would gain most benefit from ACI are patients that are not overweight (defined by BMI in the range of 20 to 24.9). Further work is being carried out to support the hypothesis that surgeons should strongly consider not operating on patients unless the BMI is less than 25.

Introduction: Hypothesis:- Posterior lumbar interbody fusion (PLIF) produces improvement in the MOS Short Form 36 (SF36) scores comparable to that seen in total hip replacement.

Current consensus holds the surgical treatment of lower back pain as less effective or predictable than interventions performed in most other orthopaedic subspecialties. Detailed clinical and economic outcome studies are vital to justify its use in routine practice. This prospective study presents medium to long-term clinical outcome scores for PLIF which are compared with those of an operation that might be considered a modern orthopaedic gold-standard: total hip arthroplasty.

Methods: The authors present 100 consecutive PLIF operations performed by the senior author between 1997 and 2004. SF36, Oswestry Disability Index (ODI), Visual Analogue Scores (VAS) and walking distances were prospectively collected and analysed in the post-operative period. Results were compared to the SF36 healthy population norms and with the outcome scores of standard total hip replacement available in the literature.

Results: The mean pre-operative ODI was 49. 12 months following surgery this improved to 22. All outcomes as measured by SF36 improved following surgery. The VAS for back pain improved from 8.5 pre-operatively to 3.21 post-operatively. Leg pain improved from 6.98 to 2.85. Improvements in the SF36 scores were similar to those seen in hip arthroplasty.

Discussion: The hypothesis has been proven. The gains in function following spinal fusion are comparable with those seen in hip arthroplasty. In the authors’ opinion PLIF is an effective procedure in an appropriately selected patient population.