Meniscal allograft transplantation: a review of the current literature.

INTRODUCTION: Patients who have previously undergone meniscectomy are known to potentially suffer subsequent knee problems including degenerative changes. Meniscal transplantation has been proposed as a possible solution to these problems. This article aims to review the current literature to consolidate the evidence surrounding the use of human meniscal allograft transplantation. MATERIALS AND METHODS: Three databases (PubMed, Embase and Medline) were searched to find English language articles pertaining to meniscal allograft transplantation. Each article was critiqued by two authors using a structured appraisal tool, and stratified according to the level of evidence. RESULTS: No Level I or II studies were identified. Many studies had small study groups with limited follow-up and patient selection and description of patient factors varied greatly. This made comparing data difficult. There were also very few papers concentrating on isolated meniscal transplantation. Four types of graft are used--fresh, fresh-frozen, cryopreserved and freeze-dried (lyophilised) graft. Cryopreserved and fresh-frozen allografts are deemed most suitable. Most authors advocate the use of non-irradiated grafts from screened donors to reduce transmission of infection. Best results occur when using bony anchors to fix the graft, although this requires accurate graft positioning. Patients have an improved outcome if they have less severe degenerative changes within the knee prior to transplantation. CONCLUSIONS: No statistically significant studies looking at isolated meniscal transplantations have been found. The evidence suggests that meniscal allograft transplantation provides improvement of pain and function in the short and intermediate term. The effect on future joint degeneration is still unknown. The ideal patient group includes patients less than 40 years of age with knee pain, proven meniscal injury and a normally aligned, stable joint without severe degenerative changes.

Early femoral loosening of the titanium 3M capital cemented hip: A lesson relearned.

A 4-year follow-up study is presented comparing 3M Capital cemented hip replacements with Charnley low friction arthroplasty controls. The mean radiological follow-up in the Capital and Charnley groups was 47 months (25 to 61) and 47 months (23 to 66) respectively. All cases were performed by the same surgical team over the same period (April 1991-October 1993). The operative technique including femoral preparation and cementing technique was identical in each group. Charnley broaches were used for femoral preparation in both groups and Charnley cups were used in all cases. In all of the 3m Capital cases cobalt-chrome femoral heads were used. There was no case selection for either group. Six of the 21 Capital femoral components were deemed to be loose on radiological criteria. None of the Charnley hips was loose. This represents an unacceptably high incidence of radiological femoral stem loosening in the Capital hip replacement. A previous uncontrolled study has attributed early failures to deficient femoral preparation and/or cementing technique. We suggest that early femoral stem loosening in the Capital hip occurs despite satisfactory operative technique in contrast with the results using the Charnley total hip replacement. (Hip International 2002; 1: 17-22).

Failure strengths of suture vs. biodegradable arrow and staple for meniscal repair: an in vitro study.

A study was performed to determine the in vitro biomechanical behaviour of two 'all inside' meniscal repair techniques (Meniscal Arrow [Bionx Implants Inc.] and Meniscal Staple [Surgical Dynamics Inc.]) and compare these directly with both a horizontal and vertical suture repair. Using 30 fresh bovine medial menisci, vertical 'bucket handle' tears were created 4 mm from the meniscus periphery. Repairs were subsequently performed, using four techniques, with 15 repairs in each group, a horizontally placed 3-metric Ethibond suture, a vertically placed 3-metric Ethibond suture, a single 13-mm arrow and a single 7-mm staple. A tensile test was performed to determine the force at failure for each technique. The mean force at failure of the horizontal and vertical suture groups was 63.2 and 73.9 N, respectively, 44.3 N for the arrow group and 17.8 N for the staple group. The mean forces at failure were significantly different (P < 0.005). The mean tensile strength of the meniscal staple was significantly lower than that of both suture and arrow groups. The 7-mm staple design may not allow adequate interdigitation between the barbed legs and the semicircular collagen fibres of the meniscus.

The Basingstoke Orthopaedic Database: a high quality accurate information system for audit.

The accuracy of a computerised audit system custom produced for the Orthopaedic Department has been validated by comparison with operating theatre records and patients' case notes. The study revealed only 2.5 per cent missed entries; of the recorded entries information regarding the nature of the operation was found to be 92.5 per cent complete and 98 per cent accurate. The high percentage accuracy reflects the high degree of medical input in operation of the system. The Basingstoke Orthopaedic Database is flexible, cheap and easy to maintain. Data is stored in a form that is readily applicable to standard software packages.

Reconstruction nailing for subtrochanteric fractures in the Pagetic femur.

Three cases of subtrochanteric fractures in patients with Paget's disease are presented which were treated by closed intramedullary nailing using the Russel-Taylor reconstruction nail. In one case with severe deformity of the femur, diaphyseal osteotomy was required to enable implant insertion. All fractures (including the osteotomy) united. There were no operative or long-term complications and no implant failures. The reconstruction nail is ideal for such cases and has technical and biomechanical advantages over other implants.

Primary bone tumours of the shoulder: an audit of the Leeds Regional Bone Tumour Registry.

An audit of the prospectively gathered data of the Leeds Regional Bone Tumour Registry found that primary bone tumours of the shoulder constituted 145 of 2039 cases (7%). Seventy-five per cent of these occurred in the proximal humerus, 20% in the scapula and 5% in the outer half of the clavicle. Malignant and benign tumours were of equal overall frequency (73 vs 72) but the malignant lesions tended to occur in an older population (mean ages 43 years and 17 years respectively). Simple bone cyst was the commonest diagnosis in children, chondrosarcoma in the middle age group and osteosarcoma in the over-60s. Presenting symptoms were a poor guide to whether the lesion was malignant or not and the correct preoperative diagnosis was made only in a minority of cases. In 134 cases the diagnosis made by the referring pathologist was confirmed by the Bone Tumour Registry but in 11 cases, the diagnosis was changed by the Tumour Registry and differed with important clinical implications. Bone tumour registries provide a valuable source of cumulative information about uncommon tumours and facilitate accurate diagnosis, teaching and research.

Controlled trial of cephradine versus cefuroxime in vascular surgery.

Two hundred and three consecutive patients undergoing acute or elective vascular reconstructions (N = 162) or amputations (N = 41) were randomized to receive either a single dose of cephradine 2 g intravenously or cefuroxime 1.5 g intravenously at induction of anaesthesia. Infective morbidity in both groups was assessed post-operatively as was therapeutic antibiotic prescribing. No significant differences in septic complications were found between patients receiving cefuroxime or cephradine. In addition, tissue penetration of each antibiotic was assessed by assay of serum and tissue specimens. Serum levels of cefuroxime were significantly less than cephradine 10 min after injection (median concentrations 115 micrograms/ml versus 182 micrograms/ml, p less than 0.01 Wilcoxon), but there were no differences in tissue penetration.