Purpose of study: To assess the effect of 18-month waiting list, on the subsequent requirement of knee arthros-copy.

Materials and methods: Medical records of 310 patients with knee pain, who had been placed on the non-urgent arthroscopy waiting list in 2003, were assessed. Diagnoses and the grade of doctor placing the patients on the list were also noted. The percentages of patients undergoing surgery as planned, as well as of those being cancelled were looked at.

Results: 61% of patients underwent knee arthroscopy as planned. 12% considered their symptoms insignificant as to require operation. 11% wanted a later operation date because of personal reasons, 7% had their surgery privately or had been expedited through the waiting list scheme because of deterioration in their condition but remained on NHS waiting list, and 9% patients had their surgeries postponed because of other medical reasons.

Conclusion: For a group of patients having been placed on an 18-month waiting list for knee arthroscopy, 40% did not subsequently have surgery within the NHS setting, as planned initially.

We present an unusual cause of anterior tibial pain in a 24-year-old professional international football player who was found to have a synostosis of the middle-third of the diaphysis of the tibia and fibula.

This is a rarely described phenomenon. Conservative treatment is the recommended treatment of choice, but this failed in our patient. Resection produced resolution of symptoms; he remained symptom-free three years later.

A radiological and histological analysis of five knee joints after a minimum of 15 years following the implanting of carbon fibre which had been used as a treatment for knee instability was undertaken. All patients underwent Total Knee replacement for secondary osteoarthritis. Histological analysis demonstrated a variable amount of macroscopically visible carbon particles in the synovium, hyaline cartilage and menisci showed . At microscopy these particles were found enveloped by giant cells and lying quiescent with no active inflammatory changes. No intact carbon fibre ligament was noted within the joint, small portion of the old ligament were covered with a thin fibrous layer but there was no evidence of any structure resembling neo-ligament.

Extra articularly the carbon fibre was covered with a thick fibrous sheath with no active inflammatory changes inflammation. In the bone tunnels the carbon fibre- bone interface showed an apposition of the bone to the carbon fibre without any interposing fibrous sheath.

The histology suggests that carbon fibre bonds directly with the bone without fibrous interposition and that there is no evidence of synovitis changes related to the carbon fibre material.

The study suggest that although carbon fibre failed structurally as a ligament replacement it did not cause any significant long term inflammatory pathology.