Introduction: During total knee arthroplasty (TKA), release of the medial structures is often required in the varus knee to obtain adequate ligamentous balancing. The aim of this study is to investigate the

clinical outcome,

Materials and Methods: Between January 2000 and December 2004, 359 patients underwent a cemented posterostabilized TKA with a third condylar design (HLS prosthesis, Tornier, Grenoble, France) for primary unilateral varus osteoarthritis. One hundred twenty eight male and 231 female patients patients wer operated on at a mean age of 71 years. All patients were evaluated preoperatively and at 3 months, 6 months and 12 months postoperative.

In 255 of the 359 (71%) primary TKA’s, symmetrical gaps could be achieved by releasing the capsula and the deep MCL (group 0). In 87 cases (24%), an additional piecrust of the superficial MCL was necessary (group 1). In 55 cases out of these 87 an additional release of the insertion of the semimembranosus was performed. In 17 out of the 359 (5%), the medial tightness necessitated a distal release of the superficial MCL (group 2).

Results: All knees improved significantly postoperatively both in pain and function. Overall mean flexion at 12 months was 122 degrees.

The mean preoperative mechanical femorotibial angle (MFTA) was 174.0, 172.1 and 169.5 and was corrected postoperatively to 179.1, 179.2 and 177.6 for group 0, 1 and 2 respectively.

At 12 months, mediolateral stability was clinically evaluated as normal in 97% for group 0, 95% for group 1 and 83% for group 2. Three percent (3%), 5% and 17% has a mediolateral laxity ranging from 6–9 degrees for group 0,1 and 2, respectively.

Conclusion: Based on these results, the authors propose the following rationale: the capsule and deep MCL should always be released. In varus knees < 8°, a pie crust of the superficial MCL can be associated. In a varus knee between 8 and 10°, a release of the MCL on the tibial side is indicated. A release of the semimembranosus tendon can be associated for fixed flexion contracture. Pie crust of the MCL is a safe and reliable release technique and is able to selectively address the posterior and/or anterior fibers of the superficial MCL.

Introduction: The degenerative changes in the patello-femoral joint after an autologous bone-tendon-bone anterior cruciate ligament reconstruction were studied using plain radiology more than 24 years after the surgical procedure.

Material and Methods: One hundred patients out of a total of 148 patients could be reviewed at 24.5 years follow-up. Radiological analysis included joint space width narrowing classification of the medial and lateral facet according to IKDC and patellar height according to Caton-Deschamps index (CDI).

Results: Fifty four percent of patients had medial femorotibial moderate or severe degenerative changes.

Medial patello-femoral degenerative changes were found more frequently and these lesions were more pronounced: 20% had narrowing < 50% (IKDC C) and 4% had narrowing > 50% (IKDC D). Onset of medial patellofemoral osteoarthritis was correlated with medial femorotibial osteoarthritis (p< 0,001).

Patellar height was statistically different between the operated and controlateral knee (CDI = 0.92 and 0.96, p< 0.001). Patella baja (CDI< 0.8, frequency 9.9%) was correlated with medial femoro-patellar osteoarthritis (< 0.001) and postoperative cast immobilisation (p=0.047).

Discussion: Patello-femoral degenerative changes observed 24.5 years after ACL reconstruction are part of the global degenerative changes of the knee joint. Harvesting of the patellar tendon for anterior cruciate ligament reconstruction results in a only 0.04 point decrease of the Caton-Deschamps index 24.5 years after surgery.

Objective: To evaluate the clinical and radiological outcome of an intra-articular bone-patellar tendon-bone (B-PT-B) anterior cruciate ligament reconstruction in combination with an extra-articular tenodesis (Lemaire procedure), at very long term follow-up.

Methods: Out of a total of 148 patients, 100 were available for clinical and/or radiological evaluation in 2006. The minimum follow-up is 21 years with a mean of 24.5 years. Outcome parameters included objective (IKDC) and subjective (KOOS) clinical scores, and radiographs (standing, TELOS).

Results: 84% of the patients were very satisfied or satisfied. The objective IKDC classification was: A=17%, B=41%, C=34%, D=8%. In 2006, 27% had narrowing < 50% (C) and 27% had narrowing > 50% (D). Onset of osteoarthritis correlated with medial meniscus status and medial femoral chondral defects. Knees with a preserved (healthy or sutured) medial meniscus had a significantly (p< 0.05) better radiological outcome. 24% had narrowing < 50% (C) and 12% had narrowing > 50% (D). Risk factors for osteoarthritis were: medial meniscectomy, residual laxity, age at intervention and femoral chondral defects.

Conclusion: The outcome of anterior cruciate ligament reconstruction using a B-PT-B in combination with extra-articular tenodesis is satisfactory in the very long term, in knees with a preserved medial meniscus and normal cartilage.

Autologous chondrocyte implantation is an established method of treatment for symptomatic articular defects of cartilage. CARTIPATCH is a monolayer-expanded cartilage cell product which is combined with a novel hydrogel to improve cell phenotypic stability and ease of surgical handling. Our aim in this prospective, multicentre study on 17 patients was to investigate the clinical, radiological, arthroscopic and histological outcome at a minimum follow-up of two years after the implantation of autologous chondrocytes embedded in a three-dimensional alginate-agarose hydrogel for the treatment of chondral and osteochondral defects.

Clinically, all the patients improved significantly. Patients with lesions larger than 3 cm² improved significantly more than those with smaller lesions. There was no correlation between the clinical outcome and the body mass index, age, duration of symptoms and location of the defects. The mean arthroscopic International Cartilage Repair Society score was 10 (5 to 12) of a maximum of 12. Predominantly hyaline cartilage was seen in eight of the 13 patients (62%) who had follow-up biopsies.

Our findings suggest that autologous chondrocyte implantation in combination with a novel hydrogel results in a significant clinical improvement at follow-up at two years, more so for larger and deeper lesions. The surgical procedure is uncomplicated, and predominantly hyaline cartilage-like repair tissue was observed in eight patients.