Aim: The purpose of this study is to evaluate the long term results of modified Elmslie-Trillat procedure. We have also reviewed the various modifications and its outcome seen in the literature to the original conventional Elmslie-Trillat procedure. Our modified surgical technique is described.

Materials and Methods: The patients were evaluated functionally using Kujala and Fulkerson scoring system. Clinical examination was performed to look for patella apprehension, tracking of patella, crepitus and range of movement. X rays were done to look for degenerative changes. The primary end point in our study was evidence of recurrent instability and the secondary end point was functional scoring and evidence of degenerative changes.

Results: Out of 38 patients and 42 knees available from our records from 1991 to 2005, 16 patients and 20 knees were available for functional and clinical review. The mean age at operation was 27 years. The average follow up was 9 years. 74% of the knees scored excellent to good with kujala and Fulkerson scoring. There was no episode of recurrent dislocation post-operatively in our series. Minimal degenerative changes were noted in 15% of knees. 37% of knees needed removal of screw. 58% of knee had some numbness around the scar. 80% of them returned back to original occupation. 60% of them went back to original sporting levels. All patients felt happy to recommend the operation.

Conclusion: We conclude that our modified Elmslie-Trillat surgical procedure is very successful in eliminating recurrent patellar dislocation and instability. We present the literature available on the various modifications of Elmslie-Trillat procedure and its outcome.

This study reports our long-term results of arthroscopically assisted meniscal suture using an inside-out technique.

Between January 1990 and July 1997, 112 patients underwent 121 meniscal repairs in 112 knees. The average follow up is 8.7 years (range 5.4 to 12.9 years). Repairs consisted of interrupted sutures using 2.0 PDS. Sutures were placed arthroscopically using a suture shuttle system and tied behind the capsule after making a small posteromedial or posterolateral incision. The meniscus and bed was prepared using a Rasp or hand-held instruments. Fibrin clot techniques were not used. 79% of patients had associated ACL reconstruction in addition to meniscal suture. All surgery was carried out by our senior author (PTM). Rehabilitation involved non-weight bearing in an extension splint for 3 weeks and partial weight bearing for a further 3 weeks followed by a progressive rehabilitation program.

The average age at surgery was 23.9 years (range 12.2 to 57.7 years). The average time from injury to surgery was 13.5 months (range 0 to 60 months). There were 74 males and 38 females. 51% of patients were professional or semi-professional athletes. Repair involved 79 medial menisci, 42 lateral menisci. The average number of sutures used was 3.8 (range 1 to 12). Operative findings and procedure were entered prospectively into a database. Patients were assessed clinically until recovery and long-term follow up consisted of a detailed postal questionnaire.

The average Lysholm scores were 86.4, with 59% excellent, 16% good, 17% fair and 8% poor. IKDC subjective scores averaged 82.0, with 40% excellent, 21% good, 27% fair and 12% poor. Confirmed failure of meniscal repair (as indicated by MRI or re-arthroscopy) has been identified in 11.8% of patients. A further 10.8% have a probable failure based on a recurrence of mechanical symptoms. Of the failures 73 % were professional or semi-professional sportsman. There average return to sport after surgery was 9.5 months (range 3 to 18 months). Failure was reported at an average of 29.3 months after surgery (range 0 to 84 months).

With an aggressive approach towards meniscal preservation we have achieved a success rate of 77.4% at an average follow-up of 8.7 years. The majority of these tears are vertical posterior horn or large bucket handle and associated with an ACL reconstruction. The majority of patients are young and involved in a high level of sporting activity.