Recent reports have suggested an increase in the number of anterior cruciate ligament (ACL) injuries in children, although their true incidence is unknown. The prognosis of the ACL-deficient knee in young active individuals is poor because of secondary meniscal tears, persistent instability and early-onset osteoarthritis. The aim of surgical reconstruction is to provide stability while avoiding physeal injury. Techniques of reconstruction include transphyseal, extraphyseal or partial physeal sparing procedures. In this paper we review the management of ACL tears in skeletally immature patients. . Cite this article: Bone Joint J 2013;95-B:1562–9

We have treated 69 patients with 72 cystic lateral menisci by arthroscopic surgery. Meniscal tears were observed in all cases, and 69 of these had a horizontal cleavage component. Three types of tear were identified and may be progressive. Treatment was by arthroscopic resection of the meniscal tear, and decompression of the cyst through the substance of the meniscus. After a mean follow-up of 34 months the results were good or excellent in 64 knees (89%) and there were few complications. We recommend this technique as the treatment of choice for cysts of the lateral meniscus

A group of 40 patients with unstable knees due to a combination of a meniscal tear with a rupture of the anterior cruciate ligament was studied to assess the effects of treatment by meniscectomy alone. The results were assessed both subjectively and objectively, but emphasis was placed on the symptoms rather than the physical signs of instability. Meniscectomy alone cured the symptoms of instability in 22 of the patients and a further eight required no further surgical treatment; bucket-handle tears were associated with a good result and posterior-horn tears with a poor result. The remaining 10 patients later underwent an additional procedure to reconstruct the ligament because of persisting symptoms. It was concluded that in patients with this combined lesion the torn meniscus should be dealt with first. In young patients with a posterior-horn tear it would be justifiable to perform a ligamentous reconstruction at the same time as the meniscectomy

Cite this article: Bone Joint J 2023;105-B(11):1133–1134.

Economic evaluation provides a framework for assessing the costs and consequences of alternative programmes or interventions. One common vehicle for economic evaluations in the healthcare context is the decision-analytic model, which synthesizes information on parameter inputs (for example, probabilities or costs of clinical events or health states) from multiple sources and requires application of mathematical techniques, usually within a software program. A plethora of decision-analytic modelling-based economic evaluations of orthopaedic interventions have been published in recent years. This annotation outlines a number of issues that can help readers, reviewers, and decision-makers interpret evidence from decision-analytic modelling-based economic evaluations of orthopaedic interventions.

Cite this article: Bone Joint J 2023;105-B(1):17–20.

The February 2023 Knee Roundup³⁶⁰ looks at: Machine-learning models: are all complications predictable?; Positive cultures can be safely ignored in revision arthroplasty patients that do not meet the 2018 International Consensus Meeting Criteria; Spinal versus general anaesthesia in contemporary primary total knee arthroplasty; Preoperative pain and early arthritis are associated with poor outcomes in total knee arthroplasty; Risk factors for infection and revision surgery following patellar tendon and quadriceps tendon repairs; Supervised versus unsupervised rehabilitation following total knee arthroplasty; Kinematic alignment has similar outcomes to mechanical alignment: a systematic review and meta-analysis; Lifetime risk of revision after knee arthroplasty influenced by age, sex, and indication; Risk factors for knee osteoarthritis after traumatic knee injury.

Aims

This study aims to identify the top unanswered research priorities in the field of knee surgery using consensus-based methodology.

This study evaluated the results of a physeal-sparing technique of intra-articular anterior cruciate ligament (ACL) reconstruction in skeletally immature patients, with particular reference to growth disturbance. Between 1992 and 2007, 57 children with a mean age of 12.2 years (6.8 to 14.5) underwent ACL reconstruction using the same technique. At a mean of 5.5 years (2 to 14) after surgery, 56 patients underwent clinical and radiological evaluation. At that time, 49 patients (87.5%) had reached bony maturity and 53 (95%) achieved A or B according to the IKDC 2000 classification. Four patients had stopped participation in sports because of knee symptoms, and three patients (5.4%) had a subsequent recurrent ACL injury. There was no clinical or radiological evidence of growth disturbance after a mean growth in stature of 20.0 cm (3 to 38). This study demonstrates that ACL reconstruction sparing the physes in children is a safe technique protecting against meniscal tears and giving better results than reconstruction in adults, without causing significant growth disturbance

Aims

To identify unanswered questions about the prevention, diagnosis, treatment, and rehabilitation and delivery of care of first-time soft-tissue knee injuries (ligament injuries, patella dislocations, meniscal injuries, and articular cartilage) in children (aged 12 years and older) and adults.

Aims

This study aimed to investigate the role and mechanism of meniscal cell lysate (MCL) in fibroblast-like synoviocytes (FLSs) and osteoarthritis (OA).

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

Aims

To evaluate inducing osteoarthritis (OA) by surgical destabilization of the medial meniscus (DMM) in mice with and without a stereomicroscope.

The relationship between meniscal tearing and degenerative joint disease was studied by macroscopic examination of 115 knees at necropsy. The incidence of meniscal pathology was 57 per cent. There was no overall difference in the severity and distribution of tibiofemoral degeneration, whether the meniscus was torn or normal. We found little evidence that degenerative meniscal tears cause osteoarthritis or vice versa

Nine pedunculated benign synoviomata causing mechanical symptoms similar to those of a torn meniscus are described. The average age of the patients was 34.4 years. During the period of study, 2254 meniscal lesions causing mechanical symptoms were identified, giving an incidence of one benign synovioma for every 250 meniscal lesions. All the lesions were removed arthroscopically with relief of symptoms