The aim of this study was to evaluate the efficacy of the anteromedial opening wedge osteotomy for PCL deficient varus knees with medial compartment degenerative changes

Twelve patients had undergone an anteromedial opening wedge high tibial osteotomy for the PCL deficient varus knee using a Puddu plate. All patients were followed for a minimum of one year. Patients were evaluated prospectively pre-operatively and at follow up by visual analogue pain and patellofemoral pain scores, IKDC II, WOMAC, SF-36 and a radiographic evaluation.

All patients improved from Grade III to Grade I PCL instability. Patients reported a significant improvement in visual analogue pain and patellofemoral pain scores, IKDC II, WOMAC and SF-36.

This technique shows encouraging early results for a complex problem.

Introduction: To evaluate the medium-term outcome of patients undergoing revision knee arthroplasty with structural allograft for uncontained defects.

Methods: We followed prospectively 50 patients undergoing 52 revision knee replacements with 66 structural grafts in three institutions. An independent investigator reviewed twenty-nine knees in 27 patients after a mean of 96.9 months.

Results: Twelve knees were re-revised at a mean of 70.7 months. Two of these patients retained their allografts. Eleven patients died with their structural allograft and implants intact and were not awaiting revision at a mean of 93 months.

Failure was defined as an increase of less than 20 points in the modified HSS knee score at the time of the review or the need for an additional operation related to the allograft. Thirteen knees were deemed to be failures giving a 75% success rate. Graft resorption occurred in five patients resulting in implant loosening. Four failed due to infection and non-union between the host bone and allograft was present in two. One patient with both knees grafted failed to gain a 20-point improvement. Survival analysis showed a 72% survival at 10 years. Clinically, the modified HSS score improved from a mean of 32.5 pre-operatively to 75.6 at the time of the review. Radiographic analysis of the surviving grafts showed no severe resorption, one moderate and two mild cases of resorption. Evaluation for loosening revealed one patient with a loose tibial component, while three patients had non-progressive tibial radiolucent lines. All four patients were asymptomatic.

Conclusions: Our results demonstrated encouraging medium-term survival of allografts utilised for revision knee replacement in a group of difficult patients with massive bone loss.

Introduction: Day-stay anterior cruciate ligament (ACL) reconstruction is commonly performed in North America. We report our experience in New Zealand.

Methods: One hundred and sixteen arthroscopic ACL reconstructions were performed by one surgeon with the same anaesthetist over a period of 14 months. One hundred and four were performed as day-stay procedures. Children and patients who had no social support stayed overnight. All patients underwent spinal anaesthesia with a femoral nerve block. Patients were discharged with oral analgesia, a brace and a cryocuff. One hundred and three patients were prospectively evaluated after two weeks by a visual analogue pain scores (0–10) and a self-administered patient satisfaction questionnaire.

Results: One hundred and two patients (99%) were happy to go home. One patient was admitted from the day-stay unit. One patient was re-admitted in the middle of the night. Ninety eight patients (93%) coped on the night of surgery and did not think they should have been in hospital. The mean visual analogue pain score at discharge was 1.0, in the middle of the first night was 1.8 and was 2.1 on the first day post op. Patients experienced significantly more pain the day after surgery than the night of surgery (p= 0.04).

Conclusion: Day-stay ACL reconstruction was well tolerated by most patients.

Introduction: It has been proposed that tunnel widening in ACL reconstructions is due to excessive graft tunnel motion secondary to elastic fixation.

Aim: To determine whether techniques which fix the graft closer to the joint (interference screws), eliminate the bungy cord and are stiffer will decrease tunnel widening. The clinical significance of tunnel widening is examined.

Method: Two hundred and fifty nine patients were evaluated prospectively. Four fixation methods were evaluated. Sixty-nine were reconstructed using Endobuttons and staples (elastic fixation). Forty-eight were subjects reconstructed with a bone mulch screw and staples, 55 patients were reconstructed with metal interference screws and 87 with bioabsorbable interference screws. Patients underwent a clinical examination, IKDC, Cincinnati knee score and KT-1000 testing one year post-operatively. These factors were correlated with tunnel widening. Tunnel widening was determined using magnification adjusted AP and lateral radiographs using Scion Image software.

Results: Tunnel widening occurred with all the fixation methods. Mean tunnel area increased 122% for the Bioscrew, 89% for the metal interference screw, 76% for the bone mulch screw and 36% for the Endobutton (ANOVA p=< 0.0001). Tunnel widening did not correlate with increased laxity, poor IKDC or Cincinnati knee scores.

Conclusions: Tunnel widening occurred with both elastic and rigid fixation methods. Tunnel widening could not be avoided by fixing the graft closer to the joint or eliminating the ‘bungy cord’. Graft tunnel motion was not the sole cause of tunnel widening in ACL reconstruction. Tunnel widening did not correlate with poor outcome in the short term.

Introduction: We report one surgeon’s experience with autologous chondrocyte implantation (ACI) for the treatment of large chondral knee defects

Method: Over a five-year period, 295 chondral knee defects in 169 patients were treated with ACI. Most patients were complex having failed other treatments. Only 4% of patients had simple condylar lesions. Patients were followed prospectively. Patients were independently evaluated by an history, clinical examination, WOMAC score, Cincinnati Knee Score (CKS), IKDC, SF-36 and patient satisfaction scores administered pre-operatively and at 12, 24, 36 and 48 months post-operatively.

Results: Two hundred and sixty seven grafts (89%) were functioning well. The common causes for graft failure were poor graft incorporation and delamination, non-compliant rehabilitation and progressive osteoarthritis. Periosteal hypertrophy was present in 20% requiring arthroscopic debridement. All outcome measures improved significantly with time.

Conclusion: In a complex group of patients ACI showed encouraging results in the short term.