One reason why NICE (National Institute for Clinical Excellence) does not support operations by the NHS to heal hyaline cartilage lesions using a patients own cells is because there is no clear evidence to show that these operations are beneficial and cost-effective in the long term. Specifically, NICE identified a deficiency of high quality cartilage being produced in repaired joints. The presence of high quality cartilage is linked to long-lasting and functional repair of cartilage. The benchmark for quality, NICE stipulate, is repair cartilage that is stiff and strong and looks similar to the normal tissue surrounding it, i.e. mature hyaline articular cartilage.

Biopsy material from autologous cartilage implantation surgical procedures has the appearance of immature articular cartilage and is frequently a mixture of hyaline and fibrocartilage. Osteoarthritic cartilage, in its early stages, also exhibits characteristics of immature articular cartilage in that it expresses proteins found in embryonic and foetal developmental stages, and is highly cellular as evidenced through the presence of chondrocyte clusters. Therefore, an ability to modulate the phenotype and the structure of the extracellular matrix of articular cartilage could positively affect the course of repair and regeneration of articular cartilage lesions. In order to do this, the biochemical stimuli that induce the transition of an essentially unstructured amorphous cartilage mass (immature articular cartilage) to one that is highly structured and ordered, and biomechanically adapted to its particular function (mature articular cartilage) has to be identified.

We show for the first time, that fibroblast growth factor-2 and transforming growth factor beta-1 induce precocious maturation of immature articular cartilage. Our data demonstrates that it is possible to significantly enhance maturation of cartilage tissue using growth factor stimulation; consequently this may have applications in transplantation therapy, or through phenotypic modulation of osteoarthritic chondrocytes in diseased cartilage in order to stimulate growth and maturation of repair tissue.

To review our practice of requesting nerve root blocks, to see how effective our therapeutic blocks are and how many of our diagnostic blocks confirm clinical suspicion and help decision making.

Retrospective cohort analysis

120 fluoroscopically guided nerve root blocks were performed between 20/08/2008 and 29/12/2008. There were 100 patients who had pain diary data available, 42 males (mean age 52.02 range 20-76) 58 females (mean age 60.03, range 22-88).

We recorded: clinical diagnosis, reason for block, result of block on a 10 point visual analogue pain diary on days 0, 2, 14 and at review. A successful block was defined as an improvement of at least 2 points. For the diagnostic blocks we also recorded whether the block result influenced surgical decision making.

Block methods will be illustrated in diagram. Results will be displayed graphically and in text. 18 blocks were cervical (1 purely diagnostic, 6 therapeutic, and 10 mixed, 1 data unavailable). 71 blocks were lumbar (1 purely diagnostic, 28 purely therapeutic, and 37 mixed, 5 data unavailable). 28% of all blocks were successful immediately (2 unavailable data) and 22% at two weeks (1 unavailable data). By 3 months the success rate for therapeutic blocks was 26%. Of the blocks done for diagnostic reasons, 86% influenced a clinical decision at the next outpatient appointment.

Our results justify the continuance of this service. Increased care should be taken that patients' outcome data is collected.

The posterior compartments of the knee are not routinely visualised during arthroscopy. However, considerable pathology can occur here and be overlooked. The purpose of this study was to assess both the use of posterior knee joint inspection and the use of posterior portals. The operative technique of posterior portal placement is described.

A retrospective audit of all knee arthroscopies performed by a single surgeon from August 2004 to March 2006 was carried out.

108 arthroscopies were performed and posterior portals were used in 20 patients. The posterior portal was used predominately for instrumentation rather than visualisation. The main indication for use of a posterior portal was for meniscal preparation during meniscal repair. Loose bodies were removed from the posterior compartment in six cases. A posterior portal was used to inspect the PCL stump for debridement and possible PCL reconstruction in one patient. There were no specific complications attributable to portal placement.

Posterior portals were utilised in over fifteen percent of cases. These portals are easy to create and are particularly useful in meniscal repair and loose body removal. Specific complications of posterior knee portals have been