Purpose: To quantify the amount of agreement among UK orthopaedic surgeons regarding the natural history and treatment including surgery and rehabilitation of the ACL deficient knee.

Methods: Following from Marx et al (Arthroscopy. 2003 Sep;19(7):762–70) a surgeon mail survey was performed to 360 members of the British Association for Surgery of the Knee. Surgeons who had treated ACL deficient patients in the last year were asked to complete the survey. Thirty questions were included to determine the surgeons’ opinions regarding the natural history of the ACL deficient knee, indications for surgery and patient selection, surgical treatment and rehabilitation. Clinical agreement was present when 80% or more agreed on the same response option.

Results: 150 surgeons in total responded to the survey; 121 had treated ACL deficient patients in the past year. The mean age was 48.9 years and 83% considered their practice to be a subspecialty in knee surgery. The mean number of ACL reconstructions performed in the past year was 41 (range 1–210). Clinical agreement was present for 12 (40%) of the 30 questions; surgeons disagreed on 18 (60%) of the questions.

Conclusions: Similar significant variation regarding the management of ACL injuries is seen among members of BASK as among members of the American Academy of Orthopaedic Surgeons (AAOS). Clinical disagreement included whether ACL deficient patients can participate in all recreational sporting activities, that ACL reconstruction reduces the rate of arthrosis in the ACL deficient knee, and the use of bracing in non-surgically treated ACL deficient knees. Surgeons also disagreed about age, open growth plates, radiographic evidence of osteoarthrosis, pain, and, repairable and unrepairable meniscal tears in ACL deficient patients.

Introduction To evaluate the Fast-Fix meniscal repair system, which is a disposable, pre knotted ‘all-inside’ suture with similar pull out strength to vertical mattress suture.

Materials and Methods Between September 2001 and May 2002, we performed 39 meniscal repairs in 38 patients, 1 patient had bilateral injury. The average age was 24(16–37). The cause of the meniscal injury was sports related in 70%, unrelated to sports in 16% and with no history of trauma in 14%. The average time from injury to repair was 2–3 weeks. The majority had associated Anterior Cruciate Ligament Rupture 73% (28 patients). 23 patients had medial meniscal and 16 had lateral meniscal repair. All cases were done as a day case by the senior author. The meniscus was repaired, if the tear was vertically oriented and in the periphery. Two Fast-Fix sutures were used for each repair. Concomitant ACL injury was reconstructed 6 weeks post meniscal repair.

Meniscus was considered to have healed if a) confirmed at arthroscopy or b) No mechanical symptoms after repair. 31 patients had repeat arthroscopy, 28 for ACL reconstruction, 2 for persistent mechanical symptoms and 1 following re-injury.

Results The range of clinical follow up was between 3 to 20 months. In 26 patients healing of the meniscus was confirmed during arthroscopy. 7 patients had no mechanical symptoms following repair. The healing rate was 86% (33 patients). 5 repairs were considered as failures and were excised subsequently. The healing rate was higher in patients with associated ACL injury (92%) compared to isolated meniscal tear healing rate of 70%.

Discussion We feel early results show the Fast-Fix to be safe, simple to use all- inside meniscal repair technique and has the advantage of vertical mattress sutures and no separate incision. Healing rates with combined ACL injuries are better than isolated meniscal tears.