Purpose of the study: To evaluate the medium-term results of Valgus High tibial osteotomy using tomofix plate in patients with medial compartment arthritis with varus deformity.

Method: A total of 46 patients (50 knees) underwent Valgus High tibial osteotomy. The mean duration of follow-up was 60 months (36 – 72 months). The mean age was 39.5 (range 30–49) and all were male.

The patients were assessed on the basis of pre and post-operative Oxford and Knee society score, range of motion, radiological evidence of healing of the osteotomy site and alignment of the extremity.

Indication for the operation was medial compartment degeneration associated with varus malalignment.

The mean preoperative oxford knee score was 48 (range 38–54) and postoperative score was 22 (range 17–31). The knee score improved from the preoperative mean of 38 (range 30 – 55) to postoperative mean of 82 points (range 45 – 92). The mean preoperative functional score was 35 (range 25 – 55) and mean postoperative functional score was 75 points (range 50 – 95). The preoperative average knee flexion was 110 (Range 90 –130) which at the final follow-up remained unchanged. The mean preoperative Tibio-Femoral angle (mechanical) was 7 degrees varus (range 6–10) and mean postoperative Tibio-Femoral angle was 6.5 deg valgus (range 7–11).

There were no non-unions at the osteotomy site and the medial open-wedge filled-in without any need for bone graft or its substitutes

Conclusion: Our study shows that Valgus High tibial osteotomy for medial compartment arthritis using Tomofix plate gives good medium-term resutls. Longer-term follow-up is needed to establish its effectiveness in deferring joint replacement surgery.

Purpose Of The Study: Description of a new operative technique of trochleoplasty for patellar instability and its short-term results.

Method: we report a new technique of trochleoplasty for Trochlear dysplasia, using Mitek anchor sutures. The purpose of the procedure is to remove the anterior femoral boss associated with Femoral Trochlear dysplasia and make the floor of the trochlea level with the anterior femoral cortex. The operation entails undermining of the trochlear and lateral condylar articular cartilage to a new corrected level where it is held with the use of No 2 Ethibond Mitek anchor sutures. These anchors are placed in the subchondral bone, suture needle passed through the articular cartilage and the sutures tied over it. Approximately 4 -5 anchor sutures are placed to hold the trochlear cartilage down to the new corrected level. This procedure can be combined with proximal and distal patellar realignment.

So far, using this technique, we have operated on six patients with trochlear dysplasia and chronic patellar instability. The patients include 4 females and 2 male with an average age of 33 yrs (range 29 – 40). Average follow up is 16 months (range 8 – 24 months). There has not been any recurrence of patellar instability in the operated patients.

Conclusion: Short-term follow up of a new operative technique of troachleoplasty for patellar instability shows promising results.

Summary abstract The aim of this study was to clinically assess the outcome of arthroscopically assisted inside to outside meniscal repair. 75 meniscal repairs were carried out, the average age was 26yr 8 months, 14 patients ( 18.6% ) were lost to follow up. Average follow up was 6 yrs 4 months. The overall success rate was 86.9%, with 74.1% scoring clinically good or excellent on the Lysholm Score. There was a trend of improved results for patients over 30yrs, those with longer tears and lateral repairs did slightly better. Those with ACL laxity had a significantly better result. The time interval to repair following injury did not make a difference. The authors would recommend this traditional technique.

Full abstract

Purpose To clinically assess the mid to long-term outcome of arthroscopically assisted inside to outside meniscal repair.

Type of study Retrospective review

Method Patients were followed up by a combination of clinical review, mail and telephone questionnaires. The Lysholm knee (LS) and the Tegner activity (TA) scores were recorded.

Results From July 1991 until February 1999 75 meniscal repairs were carried out in 70 patients by a single surgeon (PJR). The average age of the patients was 26yr 8 months, there were 52 male and 18 female patients. 14 patients ( 18.6% ) were lost to formal follow up. Lysholm Score (LS) and Tegner Activity (TA) scores were available on 58 repairs for analysis. The average follow up was 6 yrs 4 months (range 3yrs 4 months to 10yrs 9 months ), Average scores were LS=89.2, TA before surgery=6.2, TA after surgery=5.7. 9 patients had menisectomy following re-tear due to further injury. The overall success rate was 86.9%, with 74.1% scoring clinically good or excellent on the Lysholm Score.

Conclusion There was a trend of improved results for patients over 30yrs, those with longer tears and lateral repairs did slightly better. Those with ACL laxity had a significantly better result. The time interval to repair following injury did not make a difference. With an overall success rate of 86.9% the authors would recommend this traditional technique in light of the more recent techniques presently in use.