High degree of consensus amongst an expert panel regarding focal resurfacing of chondral and osteochondral lesions of the femur with mini-implants.

INTRODUCTION: The rationale for the use of mini-implants for partial resurfacing in the treatment of femoral chondral and osteochondral lesions is still under debate. The evidence supporting best practise guidelines is based on studies with low-level evidence. A consensus group of experts was convened to collaboratively advance towards consensus opinions regarding the best available evidence. The purpose of this article is to report the resulting consensus statements. METHODS: Twenty-five experts participated in a process based on the Delphi method of achieving consensus. Questions and statements were drafted via an online survey of two rounds, for initial agreement and comments on the proposed statements. An in-person meeting between the panellists was organised during the 2022 ESSKA congress to further discuss and debate each of the statements. A final agreement was made via a final online survey a few days later. The strength of consensus was characterised as: consensus, 51-74% agreement; strong consensus, 75-99% agreement; unanimous, 100% agreement. RESULTS: Statements were developed in the fields of patient assessment and indications, surgical considerations and postoperative care. Between the 25 statements that were discussed by this working group, 18 achieved unanimous, whilst 7 strong consensus. CONCLUSION: The consensus statements, derived from experts in the field, represent guidelines to assist clinicians in decision-making for the appropriate use of mini-implants for partial resurfacing in the treatment of femoral chondral and osteochondral lesions. LEVEL OF EVIDENCE: Level V.

Improved data illustration in complex multi-ligament knee reconstruction surgery: using the historical principles of Florence Nightingale and John Venn.

BACKGROUND AND PURPOSE: The collection of multi-ligament knee reconstruction procedure data generates long tabulated lists of featureless abbreviations, which are often difficult to interpret and present. As demonstrated with the launch of the Scandinavian anterior cruciate ligament registries, such data are under increasing scrutiny. When developing a visual tool to improve the interpretation, presentation, and ongoing collection of data within this field, much can be learnt from the historical teachings of Florence Nightingale and John Venn. METHODS: Unknown to many, Florence Nightingale was a pioneer of graphic data illustration, becoming a Fellow of the Royal Statistical Society in 1858. Further advances in the visualization of complex data relations were made by John Venn, who introduced the Venn diagram in 1880. With this background in mind, the present work has been based upon the senior author's case series of 70 patients undergoing complex knee-ligament reconstruction at Warrington Hospital, from 2001 to the present time. RESULTS AND INTERPRETATION: Although obviously not negating the need for tabulated data, the graphic representation put forward here successfully supplements featureless tabulated lists of abbreviations and can be updated easily and regularly. Providing a clear, bright illustration that is free from patient identifiers, it can be used in presentations and publications, and freely accessed by a multidisciplinary team. It assists in the identification of injury patterns, can accommodate illustration of associated factors such as meniscal injury, and clearly demonstrates each hospital's multi-ligament knee reconstruction experience. This facilitates comparison and collaboration between hospitals and promotes research.

A new mechanical testing device for measuring anteroposterior knee laxity.

BACKGROUND: The authors assessed a new instrument, the Rolimeter, for the measurement of anteroposterior translation in the knee; it was compared to the KT-1000 arthrometer. PURPOSE: To determine if the Rolimeter offers a valid method for the measurement of anteroposterior translation that is as reproducible and reliable as the KT-1000 arthrometer. METHODS: Two of 3 observers examined 16 normal subjects (32 knees) and 36 patients (72 knees) with ligament ruptures twice, using both the Rolimeter and the KT-1000 arthrometers, 30 minutes apart. Total anteroposterior translation (manual maximal Lachman test) was recorded at 20 degrees and 80 degrees of knee flexion. RESULTS: On average, the Rolimeter measured approximately 1 mm less anteroposterior displacement than the KT-1000 arthrometer at manual maximum stress. Rolimeter measurements were more consistent than the KT-1000 measurements as measured by our observers. Specificity and sensitivity were equivalent between the Rolimeter and the KT-1000 arthrometer. CONCLUSIONS: The Rolimeter is as reproducible and reliable as the KT-1000 arthrometer. It offers a valid method for the measurement of anteroposterior translation in the knee. Higher accuracy was obtained at 20 degrees of flexion for the KT-1000 arthrometer and at 80 degrees of flexion for the Rolimeter.