The aim of this study was to determine whether the clinical outcome of autologous chondrocyte transplantation was dependent on the timing of a high tibial osteotomy in tibio-femoral mal-aligned knees. Between 2000 and 2005, forty-eight patients underwent autologous chondrocyte implantation with HTO performed at varying times relative to the second stage autologous chondrocyte implantation procedure. 24 patients had HTO performed simultaneously with their second stage cartilage transplantation, (the HTO Simultaneous Group). 5 patients had HTO prior to their cartilage procedure, (the HTO pre-ACI Group) and 19 had HTO performed between 1 to 4 years after their second stage cartilage implantation, (the HTO post-ACI Group). There were 29 men and 19 women with a mean age of 37 years (Range 28 to 50) at the time of their second stage procedure.

With average follow-up of 72 months we have demonstrated a significant functional benefit in performing the HTO either prior to or simultaneously with the ACI procedure in the mal-aligned knee. The failure rate in the Post-ACI group was 45% compared to the Pre-ACI and Simultaneous group, with failure rates of 20% and 25%, respectively.

An HTO performed prior to or simultaneously with an autologous chondrocyte implantation procedure in the mal-aligned knee, provides a significant protective effect by reducing the failure rate by approximately 50%.

Introduction: Autologous Chondrocyte Implantation (ACI) is a treatment option for symptomatic, full-thickness chondral/osteochondral injuries. Goals of surgery and rehabilitation include replacement of damaged cartilage with hyaline/hyaline-like cartilage, leading eventually to improved level of function. Intermediate and long-term results are promising in terms of functional improvement.

Purpose: To explore the hypothesis that non-hyaline cartilage repair tissue is associated with worse functional outcome and to assess whether the quality of the repair tissue formed following ACI improves with time post-surgery.

Methods and Results: Two hundred and forty eight patients who underwent ACI at our institution were studied, having had post-implantation biopsies of the repair tissue. Mean timing of biopsy was 14.8 months (range 3–55). 59 biopsies showed hyaline tissue (24%), 67 mixed hyaline and fibrocartilage (27%), 113 biopsies were fibrocartilage only (46%) and 9 patients had a fibrous tissue biopsy result (9%). 126 patients (51%) had hyaline tissue in the regenerate and demonstrated a mean Modified Cincinnati Rating Score (MCRS) of 84 and a mean Lysholm Score of 88 at last follow-up (Group 1). 122 patients (49%) had no hyaline tissue in the regenerate and scored a mean MCRS of 71 and a mean Lysholm Score of 73 (Group 2). Both Groups 1 and 2 demonstrated a statistically significant improvement in functional outcome between pre and post-operative scores (p< 0.0001). There was significant difference in post-operative scores between Groups 1 and 2 suggesting that presence of hyaline tissue in the regenerate is associated with improved functional outcome (p< 0.05). Finally, our statistical analysis suggested that if time post-implantation doubles, then the likelihood of a favourable histological outcome increases significantly.

Conclusion: ACI forms a durable repair tissue that remodels and continues to improve in quality with time. Poor functional outcome may reflect the presence of a non-hyaline cartilage repair tissue.

For any fracture classification, a high level of intraobserver reproducibility and interobserver reliability is desirable. We compare the consistency of the AO and Frykman classifications for distal radius fractures using digitised radiographs of 100 fractures by 15 orthopaedic surgeons and 5 radiologists using a Picture Archiving and Communications System (PACS). The process was repeated 1 month later. Reproducibility moderate for both the AO and Frykman systems, reliability only fair for both the AO and Frykman systems. In each case reproducibilty using the Frykman system was slightly greater. The assessor’s level of experience and specialty was not seen to influence accuracy. The ability to electronically manipulate images does not appear to improve reliability compared to the use of traditional hard copies, and their sole use in describing these injuries is not recommended.

These fractures are common, approximately one sixth of all fractures and the most commonly occurring fractures in adults. Their multitude of eponyms hint at the difficulty in formulating a comprehensive and useable system. The Frykman classification is most popular, but limited- does not quantify displacement, shortening or the extent of comminution. The more comprehensive AO system is limited in its complexity with 27 possible subdivisions. Computerised tomography shown to give only marginal improvement in consistency of classification.

Radiographs of 100 fractures selected. Anteroposterior and lateral view for each. 15 orthopaedic surgeons and 5 radiologists recruited as assessors, including 5 specialist registrars. Each given a printed description of Frykman and AO classifications. Radiographs could be manipulated digitally. Intra and inter-observer reproducibility analysed. A comparison made comparing reproducibility between radiologists and surgeons, consultant orthopaedic surgeons and trainees. Statistical methods; analysis involves adjustment of observed proportion of agreement between observers by correction for the proportion of agreement that could have occurred by chance. Kappa coefficients compared using the Student t test incorporating standard errors of kappa for these groups.

Median interobserver reliability was fair for both the AO (kappa = 0.31, range 0.2 to 0.38) and Frykman (kappa = 0.36, range 0.30 to 0.43) systems. Median intraobserver reproducibility was moderate for both the AO (kappa = 0.45, range 0.42 to 0.48) and Frykman (kappa = 0.55, range 0.51 to 0.57) systems. In each case the Frykman system was statistically (p< 0.01) more accurate. Level of experience, or specialty was not seen to influence accuracy (p< 0.01).

Our results demonstrate that using them in isolation in determining treatment and comparing results following treatment cannot be recommended