Mechanical Symptoms of Osteoarthritis in the Knee and Arthroscopy.

The potential benefit of arthroscopy as a treatment for knee osteoarthritis is contentious, with National Institute for Health and Care Excellence stating that, "There is uncertainty regarding the efficacy of the procedure." This is a study of a consecutive series of patients with osteoarthritis of the knee, suffering from mechanical symptoms, such as giving way, catching, and locking, and undergoing arthroscopic debridement, including chondroplasty and meniscectomy where appropriate. A total of 33 patients were reviewed at a mean period of 24 months (standard deviation 3 months) and follow-up data were obtained for 28 of these patients. Primary outcomes measured were: number of mechanical symptom episodes per week and visual analog scores for pain. Secondary outcomes measured were: Oxford, Lysholm, and Tegner knee scores together with arc of motion of the joint. Seven patients went on to have a knee replacement within 2 years. In the patient subgroup who did not require further surgery, there was statistically significant improvement in giving way (p = 0.0184) and marginally significant improvement in catching and locking (p = 0.1105 and p = 0.087, respectively). There were statistically significant improvements found in the Oxford and Lysholm scores (p < 0.0001). An average decrease of 1.9 in the VAS pain score was observed that was also statistically significant (p < 0.0007) and an average improvement of 10 degrees in the arc of motion was noted, which was marginally significant (p = 0.0687). To our knowledge, this is the first study with a primary outcome measure of mechanical symptoms experienced by patients. The results overall suggest that patient symptoms improved following arthroscopic treatment. As a result, episodes of mechanical symptoms should be important criteria for clinicians in determining the patient suitability for arthroscopic debridement.

Simultaneous bilateral anterior cruciate ligament reconstruction: a safe option.

When patients present with bilateral anterior cruciate ligament (ACL) deficiency and require reconstruction in both knees, a single setting or staged approach can be adopted. Although single-setting reconstruction has been described, there are no published case series that describe simultaneous bilateral ACL reconstruction. We report a case series of eight patients who underwent simultaneous bilateral ACL reconstruction. We used two-camera stack systems to allow for truly simultaneous bilateral surgery by two surgical teams. At 2 weeks, all patients were independent in mobility. There was no difference in pivot shift, Lysholm and Tegner scores at 1 year when compared to published outcomes for unilateral ACL reconstruction. The median duration of follow-up was 28 months (range 12-50 months). Based on these small numbers, our results demonstrate that simultaneous bilateral ACL reconstruction is a safe and clinically effective option when using either hamstring or patella tendon graft.

Total hip arthroplasty and the golfer: a study of participation and performance before and after surgery for osteoarthritis.

Many patients who undergo total hip arthroplasty still have a high level of activity. A popular low-intensity exercise in this patient group is golf. This study sought to investigate the group of patients who have had a hip arthroplasty procedure and who list golf as one of their pastimes, assessing the impact of surgery on their ability to participate in and perform at the game. Seven hundred fifty consecutive patients who had undergone total hip arthroplasty were sent questionnaires relating to their golfing habits. There was no significant change from their predisease state to their 1-year postoperative golf performance and level of participation. Harris hip scores were significantly higher for the golfing population both preoperatively and at all stages of follow-up.

An investigation to examine the inter-tester and intra-tester reliability of the Rolimeter knee tester, and its sensitivity in identifying knee joint laxity.

PURPOSE: The purpose of this study is to evaluate the Rolimeter knee tester (Aircast, Europe) as reliable and clinically sensitive tool for identifying and quantifying knee joint laxity utilising a sample of both known ACLD and normal knees. METHODS: Thirty matched subjects (15 known ACLD and 15 normal subjects) were tested for knee joint laxity using the Rolimeter. Each subject was measured at both 90 degrees and 30 degrees of knee flexion, by each of the six investigators. This was then repeated again by all six investigators so that inter-tester and intra-tester reliability could be examined. RESULTS: Results showed that there was good reliability between testers, and intra-tester reliability was good for both left and right knees in both 90 degrees and 30 degrees of flexion. Results also demonstrated a high level of sensitivity for determining knee joint laxity in ACLD compared to normal knees. CONCLUSION: The Rolimeter knee tester is a reliable device for quantifying knee joint laxity, and is sensitive enough to identify anterior cruciate ligament deficiency.