Abstract. Introduction. Symptomatic osteochondritis dissecans (OCD) and traumatic osteochondral fractures (OCF) are treated with fixation with either metal or bioabsorbable device. We performed a comparative review of patients with OCD and traumatic OCF stabilised with Bio-Compression screws which are headless absorbable compression screws. Our aim was to determine whether there was a difference in outcomes between presentations. Methods. Retrospective single-centre cohort study of all patients with OCD and OCF treated with Bio-Compression screw between July 2017 and September 2022. All patients followed up until discharge with satisfactory clinical outcome. Primary outcome was return to theatre for ongoing pain or mechanical symptoms. Secondary outcome was evidence of fixation failure on follow-up MRI scan. Results. 20 patients included; 8 OCF and 12 OCD. Average age 21 (OCF), 24 (OCD). The most common location was patella (58%) in OCF or the medial femoral condyle (75%) in OCD. Traumatic defects were smaller (2.6cm2 vs 3.3cm2) although this was not statistically significant (p=0.28). In the OCF group one patient went on to have further surgery. There were no re-operations in the OCD group. Both groups had good outcomes and similar times to discharge. There was no evidence of fixation failure of Bio-Compression screws on MRI scans. Conclusions. Within the limits of this relatively small cohort there is no significant difference between outcomes for OCD or traumatic OCF fixation with Bio-Compression screws. Both groups demonstrate good outcomes irrespective of the location or the aetiology of the fragment

A total of 218 patients with unilateral anterior cruciate ligament deficiency were randomly assigned to one of four groups. In group A an anatomical double bundle anterior cruciate ligament reconstruction was performed; group B were treated by a single bundle using an Endobutton for femoral fixation; in group C by a single bundle using RigidFix cross pins for femoral fixation; and in group D by a single bundle using a bioabsorbable TransFix II screw for femoral fixation. For tibial fixation a bioabsorbable Intrafix interference screw was used for all the groups and the graft was fashioned from the semitendinosus and gracilis tendons in all patients. In all, 18 patients were lost to follow-up. The remaining 200 were subjected to a clinical evaluation, with assessment of the anterior drawer, Lachman’s and the pivot-shift tests, and KT-1000 arthrometer measurement. They also completed the International Knee Documentation Committee, Lysholm knee and Tegner activity scores. At a mean of 29 months (25 to 38) follow-up there were no significant differences concerning time between injury and range of movement and Lysholm knee scores among the four groups. However, the double bundle method showed significantly better results for the pivot-shift test (p = 0.002). The KT 1000 measurements showed a mean difference between the reconstructed knee and the patients’ normal knee of 1.4 mm in the double bundle group and 2.4 mm in the single bundle group; which was statistically significant. The Lachman and anterior drawer tests also showed superior results for the double bundle method. The International Knee Documentation Committee scale showed no significant difference among the groups (p < 0.001). On clinical evaluation the double bundle group showed less laxity than the single bundle groups. However, regardless of the technique, all knees were improved by anterior cruciate ligament reconstruction compared with their pre-operative status

A total of 11 patients (12 knees) with stable lesions of osteochondritis dissecans of the knee underwent arthroscopic fixation of the fragments using polylactide bioabsorbable pins. The site of the lesion was the medial femoral condyle in ten knees and the lateral femoral condyle in two. The mean age of the patients was 14.8 years (12 to 16). At a mean follow-up of 32.4 months (13 to 38 months) all fragments had MRI evidence of union. One patient developed early transient synovitis, which resolved with non-steroidal anti-inflammatory medication. All patients returned to sporting activities within eight months of operation and did not require a period of immobilisation

Purpose. The purpose of this study was to assess radiologically the absorption of a poly L-lactide bioabsorbable interference screw used in anterior ligament reconstruction. Methods. A case series of ten sequential patients undergoing anterior ligament reconstruction with a four-strand hamstrings technique were assessed with MRI scans at one, two, four, seven and ten years postoperatively. The scans were reported by an independent radiologist, with respect to resorption of the screw and post resorption changes in the bone. Fixation of the graft in ACL surgery is varied from metal interference screw, resorbable screws made of PLLA, and staple fixation. The advantage of resorbable screws allow imaging of the knee postoperatively, and the perceive benefit of screw resorption and replacement with host bone. Results. No resorption had occurred after 4 years in any of the patients. By seven years screw absorption was complete in seven patients and progressive in three. Five patients displayed new bone formation within the tibial tunnel. Of the five patients with no demonstrable new bone formation, a fluid collection was present within the tibial tunnel. In one of these patients, MRI revealed formation of a ganglion beyond the limit of the tunnel. We will present the final data after ten years. Conclusions. This study has shown that the bioabsorbable screws take longer to resorb than initial in vitro data. It is unclear as to whether any ganglion formation is related to the resorption, or the presence of the hamstring graft in the tunnel. The theoretical advantages of bio-absorbable screws must be weighed against these findings

Aims

The Oswestry-Bristol Classification (OBC) is an MRI-specific assessment tool to grade trochlear dysplasia. The aim of this study is to validate clinically the OBC by demonstrating its use in selecting treatments that are safe and effective.

Aims

Our purpose was to describe an unusual series of 21 patients with fungal osteomyelitis after an anterior cruciate ligament reconstruction (ACL-R).

The tensile strength of the medial patellofemoral ligament (MPFL), and of surgical procedures which reconstitute it, are unknown. Ten fresh cadaver knees were prepared by isolating the patella, leaving only the MPFL as its attachment to the medial femoral condyle. The MPFL was either repaired by using a Kessler suture or reconstructed using either bone anchors or one of two tendon grafting techniques. The tensile strength and the displacement to peak force of the MPFL were then measured using an Instron materials-testing machine.

The MPFL was found to have a mean tensile strength of 208 N (SD 90) at 26 mm (SD 7) of displacement. The strengths of the other techniques were: sutures alone, 37 N (SD 27); bone anchors plus sutures, 142 N (SD 39); blind-tunnel tendon graft, 126 N (SD 21); and through-tunnel tendon graft, 195 N (SD 66). The last was not significantly weaker than the MPFL itself.

This prospective study used magnetic resonance imaging to record sagittal plane tibiofemoral kinematics before and after anterior cruciate ligament reconstruction using autologous hamstring graft. Twenty patients with anterior cruciate ligament injuries, performed a closed-chain leg-press while relaxed and against a 150 N load. The tibiofemoral contact patterns between 0° to 90° of knee flexion were recorded by magnetic resonance scans. All measurements were performed pre-operatively and repeated at 12 weeks and two years.

Following reconstruction there was a mean passive anterior laxity of 2.1 mm (sd 2.3), as measured using a KT 1000 arthrometer, and the mean Cincinnati score was 90 (sd 11) of 100. Pre-operatively, the medial and lateral contact patterns of the injured knees were located posteriorly on the tibial plateau compared with the healthy contralateral knees (p = 0.014), but were no longer different at 12 weeks (p = 0.117) or two years postoperatively (p = 0.909). However, both reconstructed and healthy contralateral knees showed altered kinematics over time. At two years, the contact pattern showed less posterior translation of the lateral femoral condyle during flexion (p < 0.01).