Clinical evaluation of arthroscopic-assisted allograft meniscal transplantation

<p><b>INTRODUCTION</b>A meniscal deficient knee is at risk of early degenerative osteoarthritis. Allograft meniscal transplantation has been used to treat the meniscus deficiency to alleviate pain symptoms and to delay progression to arthritis. This case series aims to assess the postoperative outcomes of patients who have undergone meniscal allograft transplantation in our hospital.</p><p><b>MATERIALS AND METHODS</b>This is a prospective clinical review of prospectively collected data of our Meniscal Transplantation Programme from 2004 to 2007. Twelve meniscal allografts were implanted in 12 males with symptomatic knees, using arthroscopically assisted techniques. Preoperative and postoperative assessments were conducted using the Visual Analogue Scale (VAS), Tegner Activity Level Scale, Lysholm Knee Scoring Scale, and 2000 International Knee Documentation Committee (IKDC) scoring systems.</p><p><b>RESULTS</b>The mean age was 26.7 years with a mean follow-up of 17 months (range, 5 to 37). The VAS score for pain improved from 5.5 (3- 10) to 1.4 (0-2) [P <0.05], Tegner from 3 (2-5) to 5.9 (3-9) [P <0.05], Lysholm from 62.5 (27-88) to 88.6 (70-100) [P <0.05], IKDC Subjective Score from 50 (24-79) to 79.5 (56-95) [P <0.05]. Overall IKDC Knee Examination Grades revealed 10 nearly normal and 2 abnormal scores.</p><p><b>CONCLUSIONS</b>This is the first series of allograft meniscal transplantation from Southeast Asia. Patient outcome evaluation via VAS, Tegner Activity Level Scale, Lysholm Knee Scoring Scale and 2000 IKDC Knee Evaluation Form showed improvement in symptoms and knee function after implantation.</p>

Return to sports after anterior cruciate ligament reconstruction - a review of patients with minimum 5-year follow-up

<p><b>INTRODUCTION</b>It is difficult to counsel the anterior cruciate ligament (ACL) deficient patient considering surgical reconstruction on the likelihood of eventual return to sports as information on this is lacking, especially in the Asian context. We wanted to determine how many of our patients who had ACL surgery returned to their previous levels of sports, 5 years after their surgery. For those that had not returned to their previous levels of sports, we wanted to identify their reasons for not doing so.</p><p><b>MATERIALS AND METHODS</b>Based on our inclusion criteria of a minimum 5-year follow-up after primary ACL reconstruction, 146 patients were identified for assessment. Sixty-four patients were successfully recalled. The mean age of our patients was 24.8 years (range, 18 to 40). The patients completed the Lysholm Knee, Tegner activity and the Subjective International Knee Documentation Committee (IKDC) questionnaires. Clinical examination of the operated knee was performed according to the Objective IKDC evaluation form and with a KT-1000 arthrometer.</p><p><b>RESULTS</b>The mean Lysholm score was 85.2 and the mean subjective IKDC score was 79.5. 81.2% of our patients had normal or nearly normal knees (IKDC A or B) with the remaining 18.8% at IKDC grade C. The mean side-side difference for anterior translation using the KT-1000 arthrometer was 1.2 mm. The median pre-injury Tegner activity level was 7 and the median 5-year post-surgery Tegner activity level was 6. Nineteen patients did not return to their pre-injury sports levels because of social reasons and were excluded. From the remaining 45 patients, 28 patients (62.2%) returned to their previous level of sports and 17 patients (28.8%) did not return to their previous level of sports. Of whom, 9 (20%) said that they did not return due to fear of re-injury and the remaining 8 (17.8%) said they had not returned because of knee instability and pain. At 5 years, the subgroup of patients who had returned to sport had the best scores: Lysholm (88.5), subjective IKDC (84.6) and IKDC Grade A&B (89.3%). When we compared this with the subgroups that did not return to sport because of fear of re-injury and because of an unstable knee, we found that the difference in knee outcome scores between these 3 groups were statistically significant.</p><p><b>CONCLUSION</b>Sixty-two per cent of our patients returned to their previous level of sport at 5 years after ACL reconstruction. Fear of reinjury is an important psychological factor for these patients not returning to sports. Our results would allow the attending surgeon to counsel the ACL deficient patient who is considering surgical reconstruction the likelihood of eventual return to sports.</p>

Recurrent patellar dislocation: reappraising our approach to surgery

<p><b>INTRODUCTION</b>The management of recurrent traumatic patellar dislocation includes surgical realignment. There is no clear distinction whether proximal soft tissue or distal procedures produce superior results. However, distal realignment procedures are commonly associated with greater morbidity. We advocate a distal procedure only for cases which are more severe, such as the presence of patellar maltracking.</p><p><b>MATERIALS AND METHODS</b>Between January 2002 and June 2007, all patients who had a history of traumatic patellar dislocation with recurrent symptoms and failed conservative management underwent surgical realignment. Patients who had evidence of lateral patellar subluxation on computed tomography (CT) scan were offered a distal realignment procedure using the Elmslie-Trillat or Roux Goldthwaite procedure. All other patients underwent proximal soft tissue medial patellofemoral ligament (MPFL) reconstruction. Pre and postoperative functional International Knee Documentation Committee (IKDC), Lysholm and Tegner score assessments were performed for a minimum follow-up period of 6 months. The mean scores for each group were analysed using the Wilcoxon Matched-Pairs Signed-Ranks test and the Mann-Whitney U test was used to evaluate the difference between the groups.</p><p><b>RESULTS</b>A total of 23 patients underwent surgery for patellar realignment. Of whom, 14 patients had a distal realignment procedure while 9 patients had a proximal procedure of MPFL reconstruction. There was greater morbidity reported with distal realignment procedures. Pre and postoperative IKDC, Lysholm and Tegner scores showed significant improvement for both treatment arms. However, there was no significant difference between the improvement scores for both groups.</p><p><b>CONCLUSION</b>Patients with significant patellar maltracking following traumatic patellar dislocation would benefit from distal realignment using the Elmslie-Trillat or Roux Goldthwaite procedure. Otherwise, a proximal soft tissue procedure involving MPFL reconstruction would be adequate. A management algorithm is proposed for clinical use.</p>