Aim

To find out the usefulness of knee arthroscopy with debridement in patients of 60 years or more.

Purpose: Correlation of the clinical outcome of X stop interspinous process decompression (IPD) in patients with symptomatic lumbar spinal stenosis (LSS) is made with their preoperative disc heights.

Method: 45 patients, who had clinical follow-up at 2 years, had pre-operative erect positional MRI scans. Clinical outcome was assessed by Zurich Claudication Questionnaire,ODI,SF36 and VAS scores.ZCQ is the most condition specific for LSS and was used. There is clinically significant improvement if two ZCQ domains improved > threshold (SS> 0.46, PF> 0.42, PS< 2.4) or patients were satisfied. Disc heights were measured in the standing erect posture. Osiris 4.17 software program was used for measurements. Statistics used was Chi-Square test with cross tabulation.

Results: There was clinical improvement in 33 and some or no improvement in 12 patients. Overall preoperative range of disc heights was 1.8 to 10.05 mm, median 5.93. Disc height was less than or equal to 5mm in 21 patients and it was > 5 mm in 24 patients.19 patients who had initial disc height of > 5 mm and 14 patients who had disc height of less than or equal to 5 mm had clinically significant improvement. In the group of patients who had some or no improvement the numbers were 5 and 7 respectively. We found a difference between the groups with bigger and smaller preoperative disc heights and a larger proportion of patients with bigger preoperative disc height had better clinical outcome. This difference was not statistically significant, P = 0.350.

Conclusions: The X stop device remains clinically effective at the end of 2 years in the majority of patients. Overall patients who had bigger preoperative disc heights 79% (i.e. 19/24 who had > 5mm initial disc height) had better clinical outcome compared to those with smaller preoperative disc heights.

Interest statement: Commercial/industry support: Medtronics

Aims: To investigate the clinical and radiological (MRI) effectiveness of Nuclear Magnetic Resonance Therapy (NMRT) on mild to moderate degenerative knee osteo-arthrosis (OA).

Methods: A double blind randomised control mono-centric study of 100 volunteer patients with mild to moderated knee OA. All patients underwent clinical examination, pain was recorded on visual analog scale (VAS) and Oxford knee score and WOMAC osteoarthritis index at baseline and at follow up intervals (1 week, 1 month, 3 months and 6 months). The treatment group (n=50) received five sessions of one hour NMRT on five consecutive days. Radiological assessment included baseline standing plain radiograph of the knee joint (AP and Lateral views) and positional MRI scan which was repeated at 3 months. Cartilage thickness in weight bearing areas and bone and cartilage MRI score (BAC-MS) were used to assess response of the cartilage to NMRT. Data was analysed using SPSS 16.0 software and non-parametric tests.

Results: Ninety six patients completed six months follow-up. The treatment and placebo groups were comparable except that the male: female ration was 1:1 and 1:2 respectively. No adverse effect was reported during the study. The treatment group showed mean increase of 4° in the range of movement at 6 six months, which was statistically significant (p=0.01). There was no difference in other outcome variables at any time interval between the two groups.

Radiologically, BAC-MS and cartilage thickness at three months had no significant difference between treatment and placebo groups (p-value = 0.81 and 0.88 respectively). The change in BAC-MS and cartilage thickness at 3 months was also not significant (p-value = 0.09 and 0.41 respectively).

Conclusion: Five 1 hour sessions of NMRT is a safe mode of treatment, but has no radiological (at 3 months) and clinical (6 months) beneficial effect on mild to moderate Knee Joint Osteoathrosis.

Purpose: To see if the symptoms of mild to moderate degenerative knee osteoarthrosis are improved clinically by magnetic resonance therapy (MRT).

Method: This a double blind randamised control mono-centric study involving 100 volunteer patients recruited form the outpatient clinics who met the set inclusion and exclusion criteria of mild to moderate Osteoarthrosis of the knee joint. AD Elektronik GmbH, Wetzlar, Germany supplied the devices for giving MRT, which involved five sessions of one hour each on five consecutive days. These devices work with a coded chip card and only half of the 100 cards were coded to provide MRT. Base line assessment and follow up at 1 week, 1 month, 3 month and 6 months included clinical examination and Oxford and WOMAC Knee scores. Radiological assessment included baseline plain radiographs of the knee joint in standing position (AP and Lateral views) and positional MRI scan. At three months MRI scan was repeated. Data was analysed using SPSS 16.0 software and Mann-Whitney and Chi–square Tests were used.

Results: No adverse effects were reported during the study. The treatment and the placebo groups were comparable except that the male: female ratio was 1: 2. Placebo group had statistically significant improvement in the WOMAC Pain OA index at 3 months (p=0.017). There was statistically significant improvement in the range of movements at 6 months (p=0.010), but this was clinically not significant as the mean increase in Range of Movement was 4°. At the end of 6 months there was not difference between the two groups.

Conclusion: This study has found that five 1 hour sessions of MRT is a safe mode of treatment, but fails to support that it has a beneficial effect on Knee Joint Osteoathrosis.

Introduction: Avulsion fractures of the anterior tibial spine are not so common. The best form of treatment for displaced fractures is still debatable.

Aims: We aimed to analyze the results of different forms of internal fixation for avulsion fractures of the anterior tibial spine.

Material and Methods: Twenty-five patients with avulsion fractures of the anterior tibial spine had open reduction and internal fixation with different implants (AO screw, Herbert screw, stainless steel wire loop and absorbable stitch) and techniques. The mean follow up period was 3.66 years. They were evaluated clinically and radiologically, using KT 1000 arthrometer for ACL laxity and goniometer for range of movements. The outcome was measured using Lysholm Knee Score.

Results: Significant residual anterior laxity despite adequate fracture union was a common finding. Maximum ACL laxity was seen in adults in whom absorbable stitches had been used and they had a corresponding lower Lysholm score. Significant migration of the Herbert screws was noted in two of five patients in which it was used. Five of the eight patients with higher Lysholm score had AO screw fixation. Three patients with steel wire loop for stabilization of the fracture also had better results comparatively. Three individuals who had their knee immobilised in 25°–50° of flexion developed fixed flexion deformities, which took 12–18 months to recover.

Conclusions: The use of absorbable stitches as the primary method of fixation for avulsion fractures of the tibial spine should be avoided in adults. Herbert screw in this situation has a tendency to migrate. AO screws and non-absorbable loop yields better functional outcome. Immobilization of the knee in excessive flexion leads to prolonged fixed flexion deformity. Early range of movements can be achieved by replacing cast with a brace allowing flexion up to 90 degrees.