Arthroscopy is now well established as a method of diagnosing meniscal lesions, and its advantages have been pointed out in several reports. Arthroscopic surgery, however, is difficult to master, so that for
Aims. The best surgical strategy for the management of displaced bucket-handle (BH) meniscal tears in an anterior cruciate ligament (ACL)-deficient knee is unclear. Combining meniscal repair with ACL reconstruction (ACLR) is thought to improve meniscal healing rates; however, patients with displaced BH meniscal tears may lack extension. This leads some to advocate staged surgery to avoid postoperative stiffness and loss of range of motion (ROM) following ACLR. Methods. We reviewed the data for a consecutive series of 88 patients (mean age 27.1 years (15 to 49); 65 male (74%) and 23 female (26%)) who underwent single-stage repair of a displaced BH meniscal tear (67 medial (76%) and 21 lateral (24%)) with concomitant hamstring autograft ACLR. The patient-reported outcome measures (PROMs) EuroQol visual analogue scale (EQ-VAS), EuroQol five-dimension health questionnaire (EQ-5D), Knee injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee score (IKDC), and Tegner score were recorded at final follow-up. A Kaplan-Meier survival analysis was performed to estimate meniscal repair survivorship. Analyses were performed with different cut-offs for meniscal and ACL injury-to-surgery time (within three weeks, three to ten weeks, and more than ten weeks). Results. Meniscal repair survivorship at a median final follow-up of 55 months (interquartile range (IQR) 24 to 91) was 82% (95% confidence interval 70 to 89). A total of 13 meniscus repairs failed (12 requiring
The menisci of the knee have an important role in load-bearing and shock absorption within the joint. They may also function as secondary stabilisers, have a proprioceptive role, and aid the lubrication and nutrition of the articular cartilage. Complete or partial loss of a meniscus can have damaging effects on a knee, leading to serious long-term sequelae. This paper reviews the consequences of
We continued a prospective longitudinal follow-up
study of 53 remaining patients who underwent open total meniscectomy
as adolescents and who at that time had no other intra-articular
pathology of the knee. Their clinical, radiological and patient-reported
outcomes are described at a mean follow-up of 40 years (33 to 50).
The cohort of patients who had undergone radiological evaluation
previously after 30 years were invited for clinical examination,
radiological evaluation and review using two patient-reported outcome
measures. . A total of seven patients (13.2%) had already undergone total
knee replacement at the time of follow-up. A significant difference
was observed between the operated and non-operated knee in terms
of range of movement and osteoarthritis of the tibiofemoral joint,
indicating a greater than fourfold relative risk of osteoarthritis
at 40 years post-operatively. All patients were symptomatic as defined
by the Knee Injury and Osteoarthritis Outcome Score. This study represents the longest follow-up to date and it can
be concluded that
We reviewed 230 patients an average of 34 months after they had undergone partial or total
We reviewed 74 partial medial
We have carried out a prospective, longitudinal 30-year review of 95 adolescents who underwent total
Late degenerative changes are known to follow
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
1. Four cases of arterial injury complicating
The results of three different types of
Changes in the knee joint after
A prospective trial has been carried out to determine the value of suction drainage in the operation of
The role of arthroscopic
We report the results of a prospective longitudinal study of 147 athletes who had had a
Two hundred patients with a meniscal lesion were peroperatively allocated to partial or total
The causes of persistent symptoms after
We evaluated the outcome of partial lateral
1. A case of traumatic aneurysm in the popliteal fossa after a lateral
Of 250 patients scheduled for
In a double-blind, randomised, prospective study of 139 patients undergoing arthroscopic
1. In the course of 2,668 operations for suspected cartilage lesions 119 errors of diagnosis were revealed. 2. These errors are analysed and certain conclusions are drawn.
The medial meniscus was resected from the right knees of twelve young grivet monkeys that were killed at intervals of twenty-one to 252 days after operation. The knees operated upon and the control knees were investigated radiologically and histologically. Degenerative changes occurred in the medial femoral and tibial condyles. At first there was loss of cells from the superficial layer of the articular cartilage, with a marked decrease in the acid mucopolysaccharide content of the matrix. The chondrocytes in the deeper layer of the non-calcified zone proliferated to form clones before finally degenerating. The acellular cartilage showed splitting, and with progress of the degenerative process there was thinning and erosion of the cartilage. Eventually there was complete loss of articular cartilage with thickening and exposure of the subchondral bone. These degenerative changes were confined to a small area of the articular cartilage and had occurred despite regeneration of the meniscus. The rest of the cartilage looked normal. It is concluded that articular cartilage deprived of the protection of a meniscus may undergo arthritic changes.
The suppression of the immediate postmeniscectomy synovial reaction by a potent prostaglandin inhibitor (flurbiprofen 400 mg daily) resulted in significantly less knee pain and swelling in 50 patients compared to 50 age-matched controls taking a simple analgesic (paracetamol 4 g daily) (P less than 0.001), thus enhancing recovery by three to four weeks. In the patients undergoing partial meniscectomy knee function was restored by 27 days, a figure comparable with endoscopic methods.
Aims. Patients with osteoarthritis of the knee commonly have degenerative
meniscal tears. Arthroscopic
Aims. To investigate the risk factors for progression of articular
cartilage damage after anatomical anterior cruciate ligament (ACL)
reconstruction. Patients and Methods. A total of 174 patients who underwent second-look arthroscopic
evaluation after anatomical ACL reconstruction were enrolled in
this study. The graded condition of the articular cartilage at the
time of ACL reconstruction was compared with that at second-look
arthroscopy. Age, gender, body mass index (BMI), ACL reconstruction
technique, meniscal conditions, and other variables were assessed
by regression analysis as risk factors for progression of damage
to the articular cartilage. Results. In the medial compartment, multivariable logistic regression
analysis indicated that partial medial
Aims. Meniscal allograft transplantation is undertaken to improve pain
and function in patients with a symptomatic meniscal deficient knee
compartment. While case series have shown improvements in patient
reported outcome measures (PROMs), its efficacy has not been rigorously
evaluated. This study aimed to compare PROMs in patients having
meniscal transplantation with those having personalized physiotherapy
at 12 months. Patients and Methods. A single-centre assessor-blinded, comprehensive cohort study,
incorporating a pilot randomized controlled trial (RCT) was performed
on patients with a symptomatic compartment of the knee in which
a (sub)total
The anatomy and microstructure of the menisci
allow the effective distribution of load across the knee. Meniscectomy
alters the biomechanical environment and is a potent risk factor
for osteoarthritis. Despite a trend towards meniscus-preserving
surgery, many tears are irreparable, and many repairs fail. . Meniscal allograft transplantation has principally been carried
out for pain in patients who have had a
We reviewed 195 knees in 167 patients at least 20 years after a rim-preserving
Of 34 consecutive proximal tibial osteotomies for secondary degenerative arthritis in patients under 40 years of age, 33 were evaluated at least three years (mean 7.5 years) after operation. In all 73% were satisfactory, with four failures in 21 procedures in men and five failures in 12 procedures in women. The primary abnormalities were medial
Aims. Risk of revision following total knee arthroplasty (TKA) is higher
in patients under 55 years, but little data are reported regarding
non-revision outcomes. This study aims to identify predictors of
dissatisfaction in these patients. Patients and Methods. We prospectively assessed 177 TKAs (157 consecutive patients,
99 women, mean age 50 years; 17 to 54) from 2008 to 2013. Age, gender,
implant, indication, body mass index (BMI), social deprivation,
range of movement, Kellgren-Lawrence (KL) grade of osteoarthritis
(OA) and prior knee surgery were recorded. Pre- and post-operative
Oxford Knee Score (OKS) as well as Short Form-12 physical (PCS)
and mental component scores were obtained. Post-operative range
of movement, complications and satisfaction were measured at one
year. Results . Overall, 44 patients with 44 TKAs (24.9%) under 55 years of age
were unsure or dissatisfied with their knee. Significant predictors
of dissatisfaction on univariate analysis included: KL grade 1/2
OA (59% dissatisfied), poor pre-operative OKS, complications, poor
improvements in PCS and OKS and indication (primary OA 19% dissatisfied,
previous
The aim of this study was to evaluate the cost-effectiveness of arthroscopic partial meniscectomy versus physical therapy plus optional delayed arthroscopic partial meniscectomy in young patients aged under 45 years with traumatic meniscal tears. We conducted a multicentre, open-labelled, randomized controlled trial in patients aged 18 to 45 years, with a recent onset, traumatic, MRI-verified, isolated meniscal tear without knee osteoarthritis. Patients were randomized to arthroscopic partial meniscectomy or standardized physical therapy with an optional delayed arthroscopic partial meniscectomy after three months of follow-up. We performed a cost-utility analysis on the randomization groups to compare both treatments over a 24-month follow-up period. Cost utility was calculated as incremental costs per quality-adjusted life year (QALY) gained of arthroscopic partial meniscectomy compared to physical therapy. Calculations were performed from a healthcare system perspective and a societal perspective.Aims
Methods
Meniscal allograft transplantation (MAT) for patients with symptomatic meniscal loss has demonstrated good clinical results and survivorship. Factors that affect both functional outcome and survivorship have been reported in the literature. These are typically single-centre case series with relatively small numbers and conflicting results. Our aim was to describe an international, two-centre case series, and identify factors that affect both functional outcome and survival. We report factors that affect outcome on 526 patients undergoing MAT across two sites (one in the UK and one in Italy). Outcomes of interest were the Knee injury and Osteoarthritis Outcome Score four (KOOS4) at two years and failure rates. We performed multiple regression analysis to examine for factors affecting KOOS, and Cox proportional hazards models for survivorship.Aims
Methods
Cite this article:
1. It is suggested that slow recovery and post-operative effusion after
We evaluated the long-term results of 109 tibial plateau fractures, 61 treated by skeletal traction and early knee movement and 48 treated by surgery, at an average follow-up of 70 months. The functional results were much the same, though
In 20 skeletally mature female merino sheep, divided into four groups, we performed total medial
Anterior cruciate ligament (ACL) graft failure from rupture, attenuation, or malposition may cause recurrent subjective instability and objective laxity, and occurs in 3% to 22% of ACL reconstruction (ACLr) procedures. Revision ACLr is often indicated to restore knee stability, improve knee function, and facilitate return to cutting and pivoting activities. Prior to reconstruction, a thorough clinical and diagnostic evaluation is required to identify factors that may have predisposed an individual to recurrent ACL injury, appreciate concurrent intra-articular pathology, and select the optimal graft for revision reconstruction. Single-stage revision can be successful, although a staged approach may be used when optimal tunnel placement is not possible due to the position and/or widening of previous tunnels. Revision ACLr often involves concomitant procedures such as meniscal/chondral treatment, lateral extra-articular augmentation, and/or osteotomy. Although revision ACLr reliably restores knee stability and function, clinical outcomes and reoperation rates are worse than for primary ACLr. Cite this article:
We report the clinical and arthroscopic findings in 20 cases of medial meniscal cyst with a mean follow-up of 20 months. These were studied prospectively from a series of 7435 knee arthroscopies in which there were 1246 stable non-arthritic knees with medial meniscal tears. The diagnosis on referral was incorrect in seven, and incomplete in seven. There was coexistent meniscal injury in 17 (85%), but in the other three no tear was visible at arthroscopy. Ten knees had additional intra-articular abnormalities. Treatment of the cyst was by open resection in 12 and arthroscopic evaluation at
Fifty-two children with 62 discoid lateral menisci were reviewed at an average follow-up of 5.5 years. Their average age at operation was 10.5 years and the mean delay in diagnosis was 24 months. Most of the children had vague and intermittent symptoms and the classical clunk was demonstrable in only 39% of the knees. An associated osteochondritis dissecans of the lateral femoral condyle was seen in seven knees. Forty-eight knees with symptomatic torn discoid menisci underwent open total lateral
In a 41-year-old man, right-sided infraspinatus muscle weakness was associated with compression of the suprascapular nerve caused by a spinoglenoid ganglion cyst. The lesion was confirmed using electromyography and MRI. In addition, arthroscopy showed an incomplete discoid labrum. The free inner edge of the labrum was removed as in a
A review is presented of early results of a consecutive series of 45 bucket-handle or flap tears of a meniscus treated by closed partial meniscectomy over a two-year period. The mean operating time was 45 minutes. All patients were treated in hospital and 39 of 41 assessable patients were discharged within 24 hours of operation. The mean time to return to work was 12.9 days. One patient later required arthrotomy to excise a residual nubbin of meniscal tissue which had been incompletely removed and caused pain. At follow-up at a mean of eight months after operation only one patient had temporary mechanical symptoms not explained by further injury or degenerative change. Seven patients who had undergone previous open
To determine the relationship between articular cartilage status and clinical outcomes after medial opening-wedge high tibial osteotomy (MOHTO) for medial compartmental knee osteoarthritis at intermediate follow-up. We reviewed 155 patients (155 knees) who underwent MOHTO from January 2008 to December 2016 followed by second-look arthroscopy with a mean 5.3-year follow-up (2.0 to 11.7). Arthroscopic findings were assessed according to the International Cartilage Repair Society (ICRS) Cartilage Repair Assessment (CRA) grading system. Patients were divided into two groups based on the presence of normal or nearly normal quality cartilage in the medial femoral condyle: good (second-look arthroscopic) status (ICRS grade I or II; n = 70), and poor (second-look arthroscopic) status (ICRS grade III or IV; n = 85) groups at the time of second-look arthroscopy. Clinical outcomes were assessed using the International Knee Documentation Committee (IKDC) score, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short Form survey.Aims
Methods
Pengas IP, Assiotis A, Nash W, Hatcher J, Banks J, McNicholas MJ. Total
Uncemented mobile bearing designs in medial unicompartmental knee arthroplasty (UKA) have seen an increase over the last decade. However, there are a lack of large-scale studies comparing survivorship of these specific designs to commonly used cemented mobile and fixed bearing designs. The aim of this study was to evaluate the survivorship of these designs. A total of 21,610 medial UKAs from 2007 to 2018 were selected from the Dutch Arthroplasty Register. Multivariate Cox regression analyses were used to compare uncemented mobile bearings with cemented mobile and fixed bearings. Adjustments were made for patient and surgical factors, with their interactions being considered. Reasons and type of revision in the first two years after surgery were assessed.Aims
Methods