Deficiency of the anterior cruciate ligament (ACL) is a common disorder which can lead to changes in lifestyle. We followed 59 patients who had had arthroscopic reconstruction of the ACL using a central-third patellar-tendon autograft for seven years to assess the long-term effectiveness of recent advances in reconstruction of the ACL. The standard criteria for evaluation of the International Knee Documentation Committee, the Lysholm knee score and measurements using the KT 1000 arthrometer all showed satisfactory results. Deterioration in the clinical performance after seven years was associated with osteoarthritic changes and correlated with chronic ligament injuries and meniscectomy. There were three traumatic and three spontaneous ruptures. We believe that the procedure can be successful, but remain concerned about failure of the graft and osteoarthritis. The results raise questions about the best time to operate and suggest that
The aim of the British Association for Surgery of the Knee (BASK) Meniscal Consensus Project was to develop an evidence-based treatment guideline for patients with meniscal lesions of the knee. A formal consensus process was undertaken applying nominal group, Delphi, and appropriateness methods. Consensus was first reached on the terminology relating to the definition, investigation, and classification of meniscal lesions. A series of simulated clinical scenarios was then created and the appropriateness of arthroscopic meniscal surgery or nonoperative treatment in each scenario was rated by the group. The process was informed throughout by the latest published, and previously unpublished, clinical and epidemiological evidence. Scenarios were then grouped together based upon the similarity of clinical features and ratings to form the guideline for treatment. Feedback on the draft guideline was sought from the entire membership of BASK before final revisions and approval by the consensus group.Aims
Materials and Methods
We aimed to investigate factors related to the technique of medial
opening wedge high tibial osteotomy which might predispose to the
development of a lateral hinge fracture. A total of 71 patients with 82 osteotomies were included in the
study. Their mean age was 62.9 years (37 to 80). The classification
of the type of osteotomy was based on whether it extended beyond
the fibular head. The level of the osteotomy was classified according
to the height of its endpoint.Aims
Patients and Methods
The aim of this study was to report the outcome of the non-operative
treatment of high-grade posterior cruciate ligament (PCL) injuries,
particularly Hughston grade III injuries, which have not previously
been described. This was a prospective study involving 46 consecutive patients
who were athletes with MRI-confirmed isolated PCL injuries presenting
within four weeks of injury. All had Hughston grade II (25 athletes)
or III (21 athletes) injuries. Our non-operative treatment regimen
involved initial bracing, followed by an individualised rehabilitation
programme determined by the symptoms and physical signs. The patients
were reviewed until they had returned to sports-specific training,
and were reviewed again at a mean of 5.2 years (3 to 9).Aims
Patients and Methods
Delayed rather than early reconstruction of the anterior cruciate ligament is the current recommended treatment for injury to this ligament since it is thought to give a better functional outcome. We randomised 105 consecutive patients with injury associated with chondral lesions no more severe than grades 1 and 2 and/or meniscal tears which only required trimming, to early (<
two weeks) or delayed (>
four to six weeks) reconstruction of the anterior cruciate ligament using a quadrupled hamstring graft. All operations were performed by a single surgeon and a standard rehabilitation regime was followed in both groups. The outcomes were assessed using the Lysholm score, the Tegner score and measurement of the range of movement. Stability was assessed by clinical tests and measurements taken with the KT-1000 arthrometer, with all testing performed by a blinded uninvolved experienced observer. A total of six patients were lost to follow-up, with 48 patients assigned to the delayed group and 51 to the early group. None was a competitive athlete. The mean interval between injury and the surgery was seven days (2 to 14) in the early group and 32 days (29 to 42) in the delayed group. The mean follow-up was 32 months (26 to 36). The results did not show a statistically significant difference for the Lysholm score (p = 0.86), Tegner activity score (p = 0.913) or the range of movement (p = 1). Similarly, no distinction could be made for stability testing by clinical examination (p = 0.56) and measurements with the KT-1000 arthrometer (p = 0.93). Reconstruction of the anterior cruciate ligament gave a similar clinical and functional outcome whether performed early (<
two weeks) or late at four to six weeks after injury.
Most injuries to the medial collateral ligament (MCL) heal well after conservative treatment. We have identified a subgroup of injuries to the deep portion of the MCL which is refractory to conservative treatment and causes persistant symptoms. They usually occur in high-level football players and may require surgical repair. We describe a consecutive series of 17 men with a mean age of 29 years (18 to 44) who were all engaged in high levels of sport. Following a minor injury to the MCL there was persistent tenderness at the site of the proximal attachment of the deep MCL. It could be precipitated by rapid external rotation at the knee by clinical testing or during sport. The mean time from injury to presentation was 23.6 weeks (10 to 79) and none of the patients had responded to conservative treatment. The surgical finding was a failure of healing of a tear of the deep MCL at its femoral origin which could be repaired. After a period of postoperative protective bracing and subsequent rehabilitation the outcome was good. All the patients returned to their sports and remained asymptomatic at a mean of 48 weeks (28 to 60) post-operatively. Recognition of this subgroup is important since the clinical features, the course of recovery and surgical requirement differ from those of most injuries to the MCL.
We investigated the three-dimensional morphological differences of the articular surface of the femoral trochlea in patients with recurrent dislocation of the patella and a normal control group using three-dimensional computer models. There were 12 patients (12 knees) and ten control subjects (ten knees). Three-dimensional computer models of the femur, including the articular cartilage, were created. Evaluation was performed on the shape of the articular surface, focused on its convexity, and the proximal and mediolateral distribution of the articular cartilage of the femoral trochlea. The extent of any convexity, and the proximal distribution of the articular cartilage, expressed as the height, were shown by the angles about the transepicondylar axis. The mediolateral distribution of the articular cartilage was assessed by the location of the medial and lateral borders of the articular cartilage. The mean extent of convexity was 24.9° Our findings therefore quantitatively demonstrated differences in the shape and distribution of the articular cartilage on the femoral trochlea between patients with dislocation of the patella and normal subjects.
We reviewed 183 patients who had undergone reconstruction of the anterior cruciate ligament. The incidence of meniscal tears and degenerative change was assessed and related to the timing from injury to surgery. Degenerative change was scored using the French Society of Arthroscopy system. The patients were divided into an early (surgery within 12 months of injury) and a late group (surgery more than 12 months from injury). The late group was also subdivided into four groups of 12-month periods ranging from one year to more than four years after injury. There was a significantly higher incidence of meniscal tears in patients undergoing reconstruction after 12 months compared with those in the early group (71.2%
