D.J.A. Learmonth

Natural progression of osteo-chondral defect in the femoral condyle.

We have tried to establish the course of an isolated osteochondral defect in a femoral condyle would take if it were not treated surgically. We studied 15 knees in 12 patients where a diagnosis of the condition had been made in the past and no surgical treatment instituted for it. Each patient was examined clinically and had an MRI scan. The average period of follow-up was 109 months, the range being 54-282 months. Six patients (seven knees) were under the age of 18 at the onset of symptoms. Of these, MRI of six knees showed either no abnormality or a healed lesion. Where the onset was after skeletal maturity, six of the eight knees showed features osteoarthritis on the MRI scan. Symptomatically, there was also a difference between the two groups.

Accuracy of needle placement in ACJ injections.

Localization of the Acromioclavicular joint (ACJ) even at arthroscopic surgery may be difficult because of its small size, osteophytes, variable anatomy of the joint and capsule. Therefore injection of the ACJ in the clinic may well be inaccurate. The aim of this study was to review the clinical accuracy of needle placement in ACJ injections, if performed without the aid of image intensification. Sixty patients with 66 shoulders were injected in the Day Unit in our department. The joint was palpated clinically, and the needle was placed in the site thought to be in the AC Joint. An image intensifier was then used to check the position of the needle in the AP and axillary views. The needle was considered correctly placed if between the bony boundaries of the acromion and clavicle. This was found in only 26 injections (39.4%). The remaining 40 injections (60.6%) were misplaced, either laterally in 21 injections (31.8%), medially in 13 (19.8%), anteriorly in 3 (4.5%) and inferiorly in 3 injections (4.5%). Theses were then reinserted under image intensifier guidance. The misplaced injections would have lead to inaccurate clinical outcomes, and decision making. This study is similar to other studies in that X-ray guidance improves the accuracy of injections and surgery. However the potential error rate for the small, anatomically variable AC joint is high. There is a 60% potential for ACJ injections to be out of the joint if performed by palpation alone, and we recommend the routine use of image intensification guidance.

A new computer-based triage tool for patients with knee disorders

The Birmingham Knee Interview (BKI) is a computer-based questionnaire that has been developed to triage patients with knee disorders in the 16-50 years age group. The BKI was developed as a triage tool by analysing the interview responses of 150 patients against their final diagnosis. The latter was determined by the findings at arthroscopy, clinical examination or special investigations (e.g. MRI). Based on the final diagnosis patients were divided into two groups. Group I contained those patients with pathologies that need assessment by a surgeon, while group II are those who do not. Twenty-five different questions showed statistical significance (P<0.05) in identifying a patient falling into one group or another. The weight of evidence of each chosen answer from these questions was calculated. The computer was then programmed to automatically sum these weights with a decision based on the score. A trial on a further 82 patients showed a correct decision of the computer software in 71 patients. In conclusion, the BKI provides an automated method for triaging patients with knee disorders that is 86.7% (S.E. 3.7%) accurate.

Unique combination of patellofemoral joint arthroplasty with Osteochondral Autograft Transfer System (OATS) - a case series of six knees in five patients.

Patellofemoral arthroplasty (PFA) is an accepted procedure for the treatment of isolated patellofemoral osteoarthritis. However its failure rate has been attributed to progressive femorotibial arthritis. Autologous osteochondral transplantation is an established procedure for the repair of focal cartilaginous defects on the medial and lateral femoral condyles. We present our case series of six knees in five patients where we combined the two procedures and extended the indication for PFA and delayed the need for total knee arthroplasty (TKA) in all but one patient over a mean follow up period of 3.8 years.

A comparison of a new computer-based interview for knee disorders with conventional history taking

Abstract A computer based questionnaire has been developed to record the history and analyse symptoms of patients with knee disorders. The programme produces a consistent database and a structured printed report. The printed reports from 100 patients were compared with their clinical notes recorded by two specialist knee surgeons from conventional history taking in out-patient clinics. The results show an overall agreement of 90.9% (kappa statistic=0.81) between the two methods with the information content of the computer record being much greater. The ability of the computer interview to produce a detailed history similar to and even more complete than a conventional out-patient record has the potential to considerably reduce the clinical and clerical time needed for some patients.

Bilateral patellar component dissociation in a patient with total knee arthroplasties

We present a case of bilateral patellar component dissociation 6 years after bilateral total knee arthroplasty. The patient had undergone arthroscopic lateral releases bilaterally for patellar maltracking. After repetitive trauma, the patient experienced patellar component dissociation, which was treated arthroscopically by removing the patellar components and leaving the patellae unresurfaced. The patients symptoms improved substantially. Our case highlights certain features of the etiology as well as the management of patellar component dissociation in the total knee arthroplasty, showing the important role of arthroscopy.