We have an aggressive approach to meniscal repair, including repairing tears other than those classically suited to repair. Elite athletes represent the subgroup of patients who place the most demand on the menisci and as a result, place maximum stress on any meniscal repair. Here we present the medium to long-term outcome of meniscal repair (inside-out) in the elite athlete.

42 elite athletes underwent 45 meniscal repairs between January 1990 and July 1997 were identified from a prospective database. All repairs were performed using an arthroscopically assisted inside-out technique. All patients returned a completed questionnaire (Lysholm and IKDC) to determine their current function and any symptoms or interventions that we were unaware of. 67% medial and 33% lateral menisci were repaired (3 patients had both medial and lateral menisci repaired). 83.3% of these repairs were associated with simultaneous ACL reconstruction. The average time from injury to surgery was 11 months (range 0–45 months). Follow-up time was a mean of 8.5 years (range 5.4 to 12.6 years).

In general, function was good with an average Lysholm and subjective IKDC scores of 89.6 and 85.4 respectively. 81% of patients returned to their main sport and most to a similar level at a mean time of 10.4 months post-repair. We identified 11 definite failures, 10 medial and 1 lateral meniscus that ultimately required arthroscopic excision, this represents a 24% failure rate. We identified one further patient who had possible failed repairs, giving a worse case failure rate of 26.7% at a mean of 42 months post surgery. However, 7 of these failures were associated with a further injury, and 2 of the 7 failures ruptured their ACL reconstruction. Therefore the repairs had healed and were torn with reinjury. In this series medial meniscal repairs were Significantly more likely to fail than lateral meniscal repairs, with a failure rate of 36.4% and 5.6% respectively (p< 0.05).

This series reflects an aggressive approach to meniscal repair with repair of tears in a high demand elite group of patients. Despite this, on a worst case analysis 73% were intact at a mean of 8.5 years post repair. We conclude that meniscal repair and healing is possible and that most patients can return to preinjury level of activity.

Introduction and Aims: To assess the tibiofemoral kinematics of the PCL deficient knee using vertical open-access ‘dynamic’ MRI.

Method: Tibiofemoral motion was assessed using open-access MRI, weight-bearing in a squat, through the arc of flexion from zero to 90 degrees in six patients with isolated rupture of the PCL in one knee [diagnosed from conventional MRI scanning and clinical assessment] and a normal contralateral knee. Mid-medial and mid-lateral sagittal images were analysed in all chosen positions of flexion in both knees to assess the relative tibiofemoral relationships. Passive sagittal laxity was assessed by performing the posterior and anterior drawer tests, while the knees were scanned, again using the same MRI scanner. The tibiofemoral positions during this stress MRI examination was measured from mid-medial and mid-lateral sagittal images of the knees.

Results: Rupture of the PCL leads to an increase in passive sagittal laxity in the medial compartment of the knee [P< 0.006]. In the weight-bearing scans, PCL rupture alters the kinematics of the knee with persistent posterior subluxation of the medial tibia so that the femoral condyle rides up the anterior upslope of the medial tibial plateau. This ‘fixed’ subluxation was observed throughout the extension-flexion arc being statistically significant at all flexion angles (P< 0.018 at 0°, P< 0.013 at 20°, P< 0.014 at 45°, P< 0.004 at 90°). The kinematics of the lateral compartment were not altered by PCL rupture to a statistically significant degree. The posterior drawer test showed increased laxity in the medial compartment.

Conclusion: PCL rupture alters the kinematics of the medial compartment of the knee resulting in ‘fixed’ anterior subluxation of the medial femoral condyle [posterior subluxation of the medial tibial condyle]. This study helps to explain the observation of increased incidence of osteoarthritis in the medial compartment and specifically femoral condyle, in PCL deficient knees.

Purpose: To assess if ACL reconstruction restores normal knee kinematics.

Methods: Tibiofemoral motion was assessed weight-bearing through the arc of flexion from 0 to 90° in ten patients who were at least 6 months following successful hamstring graft ACL reconstruction. Lachman’s test was also performed using dynamic MRI. Mid-medial and mid-lateral images were analysed in all positions to assess the tibiofemoral relationship.

Results: The laxity of the reconstructed knees was reduced to within normal limits. However the normal tibiofemoral relationship was not restored after ACL reconstruction with persistent anterior subluxation of the lateral tibial plateau throughout the arc of flexion 0–90°(p< 0.001).

Conclusion: Successful ACL reconstruction reduces joint laxity and improves stability but it does not restore normal knee kinematics.