Background

The mechanical disadvantage and detrimental effect to articular cartilage following meniscectomy has been well documented in the literature. Meniscal repair in the avascular (white on white zone) is controversial and would be deemed inappropriate by many.

We reviewed professional sportsmen who had undertaken Anterior Cruciate Ligament reconstruction to determine their actual and perceived sporting performance and long term outcome. The specific aim was to determine whether the players returned to the same standard of play, following reconstructive surgery. After IRAS approval, a questionnaire survey was distributed to 55 professional players on the Sports Injury Surgery ACL database. 24players returned questionnaires (response rate of 43.6%). Dates of surgery ranged from January 1998-February 2006. The mean elapsed time following surgery was 48 months (range 13-120 months). 12 patients had injured their left knee, 8 their right and 4 both knees. The respondents played rugby league 37% (9), soccer 33.3% (8), rugby union 21% (5) and netball 8.3% (2). 12 respondents were playing in the top leagues in their sports. 15 were regular first team players and 6 were squad players.

62.5% (15) thought they had returned to their previous standard of play, 29% (7) said that they had not and 2 did not know. 71% (17) of respondents thoughts their knee returned to normal however 25% (6) did not. The mean time for RTP was 10 months (5-21 months). Those that returned to the same standard were younger (21yrs) compared to those who did not (25yrs) (P=0.108). 4 players had torn the ACL in the opposite knee or ruptured their reconstruction. Additional meniscal injuries did not influence outcome and at 4 years most players had no or only slight symptoms with sport or activities of daily living. The rupture of the ACL is no longer a career ending injury for the professional sportsman. The majority (62.5%) of players will return to their pre-injury standard of play following reconstruction. The age at injury and additional meniscal injuries were not shown to be significant factors in this series.

Hypothesis

Avascular meniscal tears can be repaired with good clinical outcomes.

The details of 320 consecutive patients undergoing knee microfracture, with a minimum follow up of 6 months, were taken from the Sports Injury Database at the Robert Jones and Agnes Hunt Orthopaedic Hospital, Oswestry. All had same phsyiotherapy regime post operatively. Two rounds of postal questionnaires were administered to assess patient satisfaction along with Lysholm, Tegner, VAS for pain and a modified IKDC scores. 196 patients responded (61.25%).

The mean age of our patients was 40.64 years and the mean follow up 37.02 months (range 6–78 months). There were 35 smokers and 161 non-smokers. 64 patients had surgery in the medial compartment, 35 in lateral, 50 in patella-femoral and 47 belonged to the combined category. 93 patients had other surgeries (partial meniscectomies, ACL reconstruction etc) along with microfracture(47.45%).

Seventy two percent of patients were satisfied with their outcome and 18.95% weren’t. 51.43% of smokers were satisfied with their outcome and 76.88% of non smokers (p=0.021). Patients more than 50 years of age were less satisfied (p=0.023) than younger patients. Having concomitant knee surgery, including ACL reconstruction, made no difference to patient satisfaction or functional scores.

The location of the lesion in the knee did not affect patient satisfaction. However, all five post op score levels were statistically different among them. The Lysholm post op scores were significantly better in lateral and PFJ compartments than medial. Lateral and combined groups were significantly better than medial for Tegner post op scores. Lateral and PFJ groups were significantly better than medial for VAS and modified IKDC scores.

Smoking and age significantly affect patient satisfaction after knee microfracture. Having concomitant knee surgeries doesn’t make a difference to either satisfaction or functional outcome. Our results suggest that the medial compartment doesn’t do as well in functional scores as previously thought.

Radiofrequency thermal shrinkage of anterior cruciate ligament (ACL) laxity or partial injury is a relatively recent treatment. Studies have shown varied results with this technique but have had small study numbers and mixtures of both primary and reconstructed ACLs. We present our series of 109 patients.

Between 1999 and 2008 our department performed radiofrequency thermal tightening on 109 patients with partial native ACL injury or ACL laxity. Fifty three patients completed both pre and post-operative evaluations at a mean follow-up of 20.5 months. Evaluation consisted of visual analogue pain scores, Tegner activity and Lysholm scoring.

From the 110 patients that underwent thermal shrinkage for ACL instability 21 (19%) went on to require full ACL reconstruction. The decision to convert to full ACL reconstruction was made at a mean of 13 months (sd=12) following thermal shrinkage surgery. Comparing those who required ACL reconstruction with those who did not, we found those requiring reconstruction to be significantly younger. Mean = 25yrs vs. 31.5yrs. (p≤ 0.002)

Fifty three patients completed both pre and post-operative evaluations at a mean follow-up of 20.5 months. Following treatment there was a significant improvement in mean Lysholm scores from 64.4 to 79.5 (p< 8.42x10-7) and pain scores 3.7 to 2.0 (p< 3.06x10-6); however there was a reduction in patients’ activity levels as assessed by Tegner score, from 6.65 to 6.0 (p< 0.019).

Comparing those who required ACL reconstruction with those who did not, we found those requiring reconstruction to be have higher pre-operative level of activity (mean Tegner score = 7.3 vs. 6.5. (p< 0.047)).

Radiofrequency thermal shrinkage of anterior cruciate ligament significantly improves knee function but may not be appropriate for younger patients or patients with high activity levels.

Background: Unfortunately ACL injuries are not uncommon in the young: the majority however occurring after skeletal maturity.

Aim: To perform an internal audit of the demand, methods and results of ACL reconstruction in young patients at a tertiary referral centre.

Methods: Patients were identified through electronic patient records, and all operation notes and follow up records were scrutinised.

Results: 84 cases under 20 years of age (range 14–19) were reviewed from 2000–2004 with a minimum follow-up of 6 months. Over 10% had undergone previous surgery or had documented articular injury. 42 cases required further meniscal surgery at the time of reconstruction: 12% repairs (20/168 menisci), 18% partial menisectomy (30/168). The median time to reconstruction from injury was 9 months (range 1–72). No case was delayed for growth plate maturation. Reconstruction methods were partly surgeon dependent, following adult themes. Occasionally tibial fixation was away from the growth plate with low profile screws and washers. We are only aware of 1 failure during this short follow-up.

Conclusion: We believe that the use of techniques similar to those used on adults is appropriate for adolescents. However the high comorbidity is of some concern, demonstrating that this age range is as challenging as their older counterparts.

There is a high incidence of spinal deformity in children with the Prader-Willi syndrome. We have encountered major complications following spinal surgery in this condition. We report our experience and conclude that spinal surgery is a formidable undertaking and the risks should be appreciated by the surgeon and the parents.