Specialist Knee Research Articles

Exploration of adverse consequences of total knee arthroplasty by patients and knee specialists: a qualitative study.

A successful outcome according to the knee specialist is not a guarantee for treatment success as perceived by patients. In this study, we aimed to explore outcome expectations and experiences of patients with OA before and after total knee arthroplasty (TKA) surgery and knee specialists that might contribute to the negative appraisal of its effect, and differences in views between patients and knee specialists. Semi-structured interviews were held in Belgium and the Netherlands. Twenty-five patients (2 without indications for TKA, 11 on the waiting list for TKA and 12 postoperative TKA) and 15 knee specialists (9 orthopaedic surgeons, 1 physician assistant, 1 nurse practitioner and 4 physiotherapists) were interviewed. Conversations were audio recorded, transcribed verbatim, and analysed using thematic analysis following the grounded theory approach. Separate analyses were conducted for patients and knee specialists. Patients were focused on the arduous process of getting used to the prosthesis, lingering pain, awareness of the artificial knee and limitations they experience during valued and daily activities, whereas knee specialists put emphasis on surgical failure, unexplained pain, limited walking ability and impairments that limit the physical functioning of patients. This study provides a comprehensive overview of potential adverse consequences from the perspective of both patients and knee specialists. Improving patients' awareness and expectations of adaptation to the knee prosthesis needs to be considered.

Navigating ACL Injuries Amid the COVID-19 Pandemic: A Retrospective Analysis.

Introduction In the United Kingdom, musculoskeletal injuries represent a substantial proportion of primary care appointments, and within this category, acute knee injuries are prominent in accident and emergency department cases. Notably, diagnosing anterior cruciate ligament (ACL) injuries is a recognized challenge, often leading to extended diagnostic delays. The COVID-19 pandemic has significantly affected the management of musculoskeletal disorders, driven by reduced surgical capacities, creating a backlog of patients awaiting necessary surgical interventions. Delayed ACL reconstruction poses risks of prolonged knee instability and secondary injuries. To address these concerns, this study evaluates the impact of COVID-19 on the timeline from ACL injury diagnosis to MRI and surgical intervention, with a specific focus on an internal acute knee clinic pathway designed to expedite the evaluation, diagnosis, and management of soft tissue knee injuries. Methods In this cross-sectional study, we retrospectively reviewed all the patients who underwent primary ACL reconstruction from January 2019 to November 2022 in a district general teaching hospital (DGH). Besides demographic data of the patients, we recorded the dates of injury, primary presentation, first knee specialist review, knee MRI, and ACL reconstruction surgery, as well as the injury-to-surgery, injury-to-MRI, and MRI-to-surgery periods. Patients were divided based on the date of operation to pre- and post-COVID, and outcomes were compared to see the possible effects of COVID-19. Data were analyzed using a quantitative and qualitative test with a P < 0.05 significance level. Results Our cohort included 97 patients, and the mean age of patients was 30.6 years (17-53 years). The median time of injury-to-MRI was 46.5 days during the pre-COVID period, which decreased to 44 days in the post-COVID period (P = 0.596). The median time of injury-to-surgery was 287.5 days during the pre-COVID period, which increased to 289 days in the post-COVID period (P = 0.019). The median MRI-to-surgery duration was 200 days during the pre-COVID period, which increased to 225 days in the post-COVID period (P = 0.006). Around 35% of patients had an MRI prior to getting evaluated by a specialist. Conclusion The COVID-19 pandemic had a significant impact on the management of ACL injuries, with delays in elective knee clinics and surgery potentially leading to delays in the diagnosis and management of such injuries. However, our study showed that the delay from ACL injury to subsequent surgery actually reduced post-pandemic due to hospital-based acute knee pathway, which is particularly important in the context of associated meniscal injury that can worsen while patients wait for surgery.

Patterns of Associated Knee Ligament and Chondral Injuries in First-Time Traumatic Patellar Dislocation: A Retrospective Magnetic Resonance Imaging (MRI) -Based Study.

Introduction First-time acute traumatic patellar dislocation, when managed without a knee magnetic resonance imaging (MRI) scan, may lead to missed diagnoses of important associated knee injuries. The aim of this study was to ascertain the incidence of associated ligamentous and cartilaginous injuries in first-time traumatic patella dislocation. Methods This was a five-year retrospective study on patients aged 16-45 who had knee MRI scans showing the characteristic bone bruise patterns seen in traumatic lateral patellar dislocation. Anonymized data from the hospital picture archiving and communication system (PACS) was obtained with each scan reviewed by a consultant radiologist, a fellowship-trained orthopaedic knee specialist, and an orthopaedic registrar or resident. Results A total of 200 knee MRI scans were screened. 61 eligible knee MRI scans were included in the study. The patients' ages ranged from 16 to 42 years old, with a mean of 25 years. 73.8% were male. A medial patellofemoral ligament (MPFL) tear or rupture occurred in 58 of 61 knees (95%) with MPFL attenuation in three (5%) injured knees. Meniscal injuries were identified in 5 of 61 knees (8.2%), medial collateral ligament (MCL) injuries in 11 of 61 knees (18%), osteochondral injuries and loose bodies in 17 of 61 knees (27.9%), and anterior cruciate ligament (ACL) injury in one knee (1.6%). Conclusions This single-centre MRI-based study has provided information on the incidence of associated chondral and ligamentous injuries in patients with first-time acute traumatic patellar dislocation. This information will be useful for clinicians when counselling patients and will add to the available literature on this injury. An MRI scan should be obtained in cases of suspected first-time traumatic patellar dislocations, especially in active young patients, due to the incidence of other associated traumatic knee lesions that might need surgical treatment and lead to persisting knee symptoms if neglected.

Inter- and intra-rater reliability of knee flexion angle measurements on X-ray and MRI.

Range of motion (ROM) is an important aspect of orthopaedic patient assessment. It can be measured at the knee joint by determining the knee flexion angle (KFA) a patient can achieve at extremes of flexion and extension. As with any measurement, the accuracy and reliability of the method used determine its validity. The consistency of magnetic resonance imaging (MRI) scans as compared to the current gold standard of X-ray remains unknown in terms of KFA evaluation. The aim of this study was to assess and compare the reliability of measuring KFA between X-ray and MRI scans. This study included 80 patients (94 knees) who had attended a specialist knee clinic due to varying knee pathologies and undergone both X-ray and MRI scans. Lateral and T1-weighted sagittal imaging views (respectively) were used to measure KFA by two trained observers independently at two separate time points, 8 weeks apart. The data was then statistically analysed and intra- and inter-observer reliability calculated using the intraclass correlation coefficient (ICC). The intra-observer reliability for X-ray was 0.96 (P<0.001) and that for MRI was 0.83 (P<0.001). The inter-observer reliability for X-ray was 0.99 (P<0.001) and that for MRI was 0.81 (P<0.001). All the intra-class correlation coefficients were graded as excellent in both the intra- and inter-observer reliability analysis. Overall, the mean KFA was notably higher on X-ray measurements than that on MRI scans. There was a statistically significant difference between Time 1 and Time 2 measurements (17.7° vs. 16.8°) for MRI data (P=0.022). No significant difference was found for X-ray measurements (46.4° vs. 45.6°) in this regard (P=0.182). Both X-ray and MRI allow KFA to be measured with an excellent degree of reliability. However, X-ray measurements were overall superior to that of MRI mainly due to the larger field of view of the visible on-screen image which more readily identifies the anatomical landmarks required to measure KFA.

A 2021 consensus statement on osteotomies around the knee by the UK Knee Osteotomy consensus Group (KOG)

BackgroundThere are significant deficiencies in the evidence base of modern-day osteotomy which result in significant variation in practice between surgeons. The purpose of this statement was to develop a consensus statement on the practice of osteotomy so that a more standardized approach to the indications, surgical technique, and postoperative care could be outlined. The article is also intended to educate and inform the practice of individuals who are early in their experience and/or clinical practice. MethodA group of 29 specialist knee surgeons who regularly perform osteotomy was convened to form the Knee Osteotomy consensus Group (KOG). Consensus was determined utilizing the consensus group technique described by List. A total of 37 questions were asked covering all aspects of clinical practice. Results20 statements were generated and debated until a criterion level of 70% was met. ConclusionsConsensus was achieved regarding 20 statements concerning Indications for surgery, decision making, surgical planning, technique, post-operative assessment and recovery.

P60 Impact of Acute Knee Clinic in the West of Scotland

IntroductionSoft tissue knee injuries are a common presentation among the young and adult population, thus, we have performed this audit to investigate the impact of introducing a new acute knee clinic in the West of Scotland with regards to delay in treatment of such injuries and potential clinical outcomes.MethodsWe have collected data from over 100 random patients with anterior cruciate ligament (ACL) injuries pre and post- the introduction of acute knee clinic in the West of Scotland and calculated the median time taken for them to see a knee specialist following their initial injury. The data was collected using a standardised proforma and analysed using Microsoft Excel. All patients included were 18-years-old and above.ResultsThe introduction of an acute knee clinic has led to over 65% reduction in waiting time to see a knee specialist following a knee injury. In addition, soft tissue co-injuries such as meniscal tears were more likely to occur in patients who waited longer to be treated and thus the introduction of the knee clinic had also led to a reduction in waiting time for a definitive treatment (i.e. surgery) of patients and subsequent reduction in associated co-injuries.ConclusionAcute knee clinics are effective in reducing patient waiting time to be seen by a knee specialist following an ACL tear. This is particularly important as the earlier intervention is more likely to prevent subsequent meniscal and chondral injuries which in turn can provide patients with better clinical outcomes and quality of life.

Reliability of two techniques and training level of the observer in measuring the correction angle when planning a high tibial osteotomy

BackgroundIn high tibial osteotomy, planning is critical for achieving successful realignment. Any method selected needs to be reliable, with inter-observer and intra-observer correlation. A literature review demonstrated two distinct methods of planning for high tibial osteotomy.Hypothesis: Both methods are precise and show excellent inter and intra-observer correlation. MethodFifty consecutive weight-bearing long leg alignment antero-posterior (AP) radiographs were identified and planning undertaken on suitable radiographs using the methods of Puddu (method 1) and Miniaci (method 2). Two observers, one junior trainee and one Specialist Knee Fellow, recorded measurements to calculate inter and intra-observer correlation. ResultsThirty-two radiographs were included. Inter-observer and intra-observer correlation, and correlation between the two methods were all greater than 0.97 (p<0.0001). ConclusionOur results show excellent correlation between both methods and both observers. Both methods are reliable for planning and can be performed by both junior trainees and subspecialists. Further work should consider how planning can ensure adequate intraoperative correction.

Closed Tibial shaft fractures treated with the Ilizarov method: A ten year case series

ObjectivesTo review the outcomes of patients treated with the Ilizarov method for an isolated, closed, simple diaphyseal, Tibial fracture at our institution over the last decade. MethodsThe Ilizarov frame database was used to identify 76 skeletally mature patients who sustained an isolated, closed, extra-articular, simple, diaphyseal Tibial fracture; the injury also known as a “nail-able Tibial fracture.” ResultsThe average age of the patient was 38 (17–70). All 76 patients progressed to union. The average time until union was 148 (55–398) days. The coronal and sagittal alignment was 3° (0−17°) and 4° (0−14°) respectively. No patient suffered from compartment syndrome. No patient developed septic arthritis. No patient had documented anterior knee pain or secondary knee specialist input post frame removal.On average, there were 9(4–29) follow up appointments and 10(5–26) radiographs post frame application.There is a 59% chance of a patient having a difficulty post frame application.The malunion rate was 5%.Persisting pinsite infection post frame removal occurred in 5 patients (6.5%).Drilling of the pinsite sequestrum resolved the infection in four of these patients, giving a deep infection rate of 1.3%. ConclusionsThe Ilizarov method has a role to play in the treatment of simple closed Tibial shaft fractures in patients who need to kneel. Patient education is a priority however; the patient must be made aware of the difficulty rate associated with the Ilizarov method when compared to the complication profile of alternative treatments.

Anterior cruciate ligament injury: A persistently difficult diagnosis

BackgroundHistorically anterior cruciate ligament (ACL) injuries have been diagnosed poorly. A paper published in Injury in 1996 showed that less than 10% of patients with an ACL injury had the diagnosis made by the first physician to see them and that the average delay from first presentation to diagnosis was 21 months. The aim of our study was to investigate whether an improvement has been made over the last two decades in diagnosing ACL injuries. MethodsWe identified 160 patients who had an ACL reconstruction performed by a single surgeon between October 2004 and December 2011 and for whom a complete data set was available. Data was extracted retrospectively from the hospital notes and a dedicated patient database. We performed a sub-group analysis comparing patients seen prior to the introduction of an acute knee injury clinic in April 2007 and patients seen after the introduction of the clinic. Results75.1% (120/160) of patients presented first to an emergency department (ED) or to their general practitioner (GP), but only 14.4% (23/160) were diagnosed on initial presentation. The median number of healthcare professionals a patient saw prior to a diagnosis of ACL injury was 3. The median delay from injury to presentation was 0 weeks (range 0-885), injury to diagnosis 13 weeks (0-926), presentation to diagnosis 10 weeks (0-924), presentation to a specialist knee clinic 24 weeks (0-1006), and specialist knee clinic to surgery 13 weeks (0-102). The median total time from injury to surgery was 42 weeks (0-1047). Following the implementation of an acute knee injury clinic in 2007, the median delay from presentation to surgery dropped from 59 weeks to 36 weeks (p = 0.050) and there was a significant decrease in the median delay from specialist knee clinic to surgery from 23 to 11 weeks (p=0.002). ConclusionOver the past two decades there appears to have been little improvement in the early diagnosis of ACL injuries, with only 14.4% of patients being diagnosed correctly at initial presentation. We recommend further education of emergency and primary care clinicians in the diagnosis of ACL injuries, emphasising the importance of the typical history of an ACL injury. The implementation of an acute knee injury clinic may help minimise delays to surgery, which should result in better patient outcomes.

Surgical treatment of recurrent proximal tibio-fibular joint ganglion cysts

BackgroundComplex symptomatic ganglion cysts arising from the proximal tibio-fibular joint (PTJ) are not an uncommon presentation in specialist knee clinics and can be managed by aspiration or excision. There is, however, a high rate of recurrence and often there is progressive involvement of the common peroneal nerve (CPN) and its branches, and permanent nerve damage may result. MethodsThis study is a review of the outcome of recalcitrant and recurrent cyst disease with CPN involvement treated by proximal fibulectomy. Nine patients with clinical and radiological diagnosis of a ganglion cyst involving the proximal tibio-fibular joint were treated by proximal fibulectomy. Average age was 47.2years (19 to 75). Patients were followed up clinically and radiologically. Medical notes were reviewed to assess clinical/pathological characteristics, surgical outcome, recurrence rate and the symptoms of instability and nerve function. ResultsNone of the patients were lost to follow-up. After an average follow-up of 83months (15 to 150), none of the patients had clinical or radiological evidence of recurrence. All patients were pain-free and had a complete resolution of nerve symptoms and no evidence of CPN injury. None of the patients complained of localised pain or knee instability and there were no wound healing problems. ConclusionsMRI now confirms TFJ-ganglion cysts to be more common than previously recognised. Where there is refractory disease with progressive nerve symptoms and evidence of nerve sheath involvement, joint excision by proximal fibulectomy gives a satisfactory functional result in controlling disease and preventing further nerve damage. Level of evidenceIV

Prevalence and consequences of delayed diagnosis of anterior cruciate ligament ruptures

Rupture of the anterior cruciate ligament (ACL) is a common injury, often presenting with a typical injury pattern. Historically, the literature indicates that the accuracy of diagnosis of ACL ruptures is poor at the initial medical consultation. The aims of this study were to determine: the mechanism of injury; changes in accuracy of diagnosis of ACL ruptures at initial presentation over the last decade; and the effect of subsequent delay in diagnosis and definitive treatment. A prospective cohort of one hundred and thirty-two consecutive patients who underwent ACL reconstruction between 2005 and 2009 were analysed. The median age of the patients was 18years (12-57). Sixteen patients were excluded due to chronic ACL injury. One hundred and sixteen patients (117 ACL ruptures) were included in the analysis. A typical injury pattern was documented in 87 (74.4%) of cases. The most common sporting activities associated with an ACL injury were football (35.3%), skiing (21.6%) and rugby (10.3%). The majority of patients (67.5%) sought medical attention within 1week from time of injury. The correct diagnosis of an ACL rupture was made in 33 cases (28.2%) at the initial medical consultation. The diagnosis was made following medical consultation in 13 (11.1%) of cases with the use of magnetic resonance imaging and 6 (5.1%) cases at arthroscopy. The median time to diagnosis was 6weeks (0-192), and the median time to ACL reconstruction was 24weeks (1-240). A delay in diagnosis of >6months was associated with a medial meniscal tear rate of 72.2% compared to 23.1% if the diagnosis was made within 4months of the injury (p<0.05). Despite a 'typical' mechanism of injury leading to ACL rupture, the rate of initial diagnosis in the UK still remains poor. This often leads to an unnecessary delay in the diagnosis and subsequent treatment and increases the risk of secondary injury to the knee. A delay in diagnosis of >6months was associated with an increased medial meniscal tear rate. Patients who present with a 'typical' injury pattern should therefore be referred for further assessment by a knee specialist within 6weeks. IV.

Anterior cruciate ligament rupture: Delay to diagnosis

Anterior cruciate ligament (ACL) tears are common injuries. Despite the diagnosis being in essence a clinical one, this has often proved unreliable. The objective of this study was to ascertain the delay to diagnosis of ACL injury from initial presentation and subsequent delay to review by a knee specialist. The study involved a retrospective review of 130 patient case notes in a consecutive series of patients undergoing primary ACL reconstruction. Details regarding mechanism of injury, dates of initial and subsequent clinic attendances and the treating health-care professional were recorded. Other information included dates of magnetic resonance imaging (MRI) scans and when a patient first saw a knee specialist. From this, delays to clinical or radiological diagnosis were calculated. There were 82 acute and 48 chronic ACL injuries. Overall, the initial treating practitioner made the diagnosis in only 25 patients, yielding a diagnostic rate of 19.2%. Diagnoses made on MRI scan accounted for 38.5% of cases, the remainder being diagnosed clinically. The mean delay to diagnosis of ACL rupture was 65 days, and only 53 patients were diagnosed within 30 days of initial presentation. A total of 15 patients had undergone arthroscopy, eight of which were diagnostic. The mean delay to consulting a soft-tissue knee surgeon was 165 days. In the acute group, the initial diagnostic rate was only 7.3% and the mean delay to diagnosis was 82 days, with 29 patients diagnosed within 30 days. Despite 78% of the patients having a typical mechanism of ACL injury, and most attending acutely via the Emergency Department (ED), diagnosis of this common injury remains tardy. There has been at best only minor improvement in the diagnostic rate and delays, certainly of acute ACL injury, since a study in 1996. The overall clinical diagnostic rate remains disconcertingly low as does the delay to consulting a soft-tissue knee specialist.

Paper # 1: Patient Reported Outcome Measure of Innovative Bicompartmental (Segmental) Knee Resurfacing in a University Hospital Setting

We present the short-term patient reported outcome measures (PROMS) for a large series of bicompartmental (segmental) knee resurfacing involving combined medial unicompartmental and patellofemoral joint resurfacing performed in a Specialist Knee Surgical Unit in a University Hospital setting.

Posterolateral corner injuries of the knee

We retrospectively reviewed the hospital records of 68 patients who had been referred with an injury to the posterolateral corner of the knee to a specialist knee surgeon between 2005 and 2009. These injuries were diagnosed based on a combination of clinical testing and imaging and arthroscopy when available. In all, 51 patients (75%) presented within 24 hours of their injury with a mean presentation at eight days (0 to 20) after the injury. A total of 63 patients (93%) had instability of the knee at presentation. There was a mean delay to the diagnosis of injury to the posterolateral corner of 30 months (0 to 420) from the time of injury. In all, the injuries in 49 patients (72%) were not identified at the time of the initial presentation, with the injury to the posterolateral corner only recognised in those patients who had severe multiple ligamentous injuries. The correct diagnosis, including injury to the posterolateral corner, had only been made in 34 patients (50%) at time of referral to a specialist knee clinic. MRI correctly identified 14 of 15 injuries when performed acutely (within 12 weeks of injury), but this was the case in only four of 15 patients in whom it was performed more than 12 weeks after the injury. Our study highlights a need for greater diligence in the examination and investigation of acute ligamentous injuries at the knee with symptoms of instability, in order to avoid failure to identify the true extent of the injury at the time when anatomical repair is most straightforward.

The Accuracy of Magnetic Resonance Imaging Scanning and Its Influence on Management Decisions in Knee Surgery

The purpose of our study was to evaluate the impact of preoperative magnetic resonance imaging (MRI) assessment of articular knee pathology on the clinical management of patients presenting with joint line pain. A preliminary study on 100 patients was performed to assess the accuracy of specific MRI sequences, using arthroscopy as a gold standard. Six hundred and eighteen consecutive patients with knee symptoms presenting to 2 specialist knee surgeons were then recruited. A clinical diagnosis of an arthroscopically treatable lesion was made in all cases. Clinical assessment data were correlated to subsequent MRI findings, recording any discrepancy and in particular whether or not MRI findings influenced management decisions. In the preliminary study, MRI sequences had an overall sensitivity of 83.2% and a specificity of 94.3% for the detection of chondral lesions. However, when considering arthroscopic grade III and IV lesions, MRI sensitivity and specificity were improved to 84.5% and 97.1%. In the second phase of the study, 141 (22.8%) of the 618 patients presenting with knee symptoms had an altered clinical management subsequent to MRI. The presence of unexpected chondral lesions was found in 77 of these patients. Conversely, 22 patients with clinical symptoms suspicious for simple chondral degeneration had unstable meniscal tears. We suggest that preoperative MRI scanning identifies a group of patients who have more advanced degenerative joint disease than the clinical assessment and the plain radiographs suggest. This would expedite definitive surgery in patients with advanced osteoarthritis on MRI scans. Level II, development of diagnostic criteria on basis of consecutive patients with universally applied gold standard.

Health technology assessment of magnetic resonance imaging of the knee

A search of the available literature was performed and the role of MR imaging of the knee is discussed. Based on this search the authors concluded that MR has a high sensitivity in detecting any abnormalities in the knee but it does not have the same diagnostic accuracy as a clinical investigation performed by a trained knee specialist when all knee injuries are taken together. It does lead to a decrease in the number of surgical interventions due to its high negative predictive value. For the detection of meniscal injury, MR has the same accuracy as arthroscopy and should be performed in order to avoid unnecessary surgical interventions. A negative MR also obviates further investigation in suspected cartilage damage. This is not true for anterior and posterior cruciate ligament problems where MRI is less accurate than clinical investigation.

Development and efficiency of an acute knee trauma list

Following acute knee trauma some patients will require urgent arthroscopy. Traditionally surgery is undertaken as in-patient on the general trauma list. This system leads to blockage of beds, repeated starving of the patient and out-of-hour's surgery in many cases. We introduced a dedicated Day Surgery knee trauma list (KTL) to reduce in-patient admissions, waiting time and cost. The typical indications for urgent knee arthroscopy are locked knees secondary to meniscal tears, loose bodies or cruciate ligament ruptures; acute osteochondral fractures; and children with acute meniscal tears. This retrospective review compares the study group: patients on the knee trauma list during the first 8 months following introduction, and the control group: patients on the general in-patient trauma list over a similar period immediately prior to implementation of the new list. There were 49 patients in the control group with an average stay in hospital of 2.5 days. Out-of-hour's operations were performed in 13 patients and 3 patients required a repeat arthroscopy. Fifty-three patients were treated in the knee study group. The significant operations were meniscal repair in 7, fixation of osteochondral fragments in 3. None of the patients required overnight stay. Control group patients were more likely to have surgery performed by inexperienced non-specialist knee surgeons, whereas specialist knee surgeons staffed the knee trauma list. Specialist surgeons were available to staff the knee trauma list. As the majority of the control group had spent an average of 2.2 nights in hospital, there has been considerable savings to the hospital. Introduction of the Day Surgical Knee trauma list has reduced unnecessary admissions per week; episodes of prolonged starving, cost and have improved patient satisfaction and management.

Automated techniques for visualization and mapping of articular cartilage in MR images of the osteoarthritic knee: a base technique for the assessment of microdamage and submicro damage

The purpose of this paper is to describe automated techniques for the visualization and mapping of articular cartilage in magnetic resonance (MR) images of the osteoarthritic knee. The MR sequences and analysis software which will be described allow the assessment of cartilage damage using a range of standard scanners. With high field strength systems it would be possible, using these techniques, to assess micro-damage. The specific aim of the paper is to develop and validate software for automated segmentation and thickness mapping of articular cartilage from three-dimensional (3-D) gradient-echo MR images of the knee. The method can also be used for MR-based assessment of tissue engineered grafts. Typical values of cartilage thickness over seven defined regions can be obtained in patients with osteoarthritis (OA) and control subjects without OA. Three groups of patients were studied. The first group comprised patients with moderate OA in the age range 45-73 years. The second group comprised asymptomatic volunteers of 50-65 years; the third group, younger volunteers selected by clinical interview, history and X-ray. In this paper, sagittal 3-D spoiled-gradient steady-state acquisition images were obtained using a 1.5-T GE whole-body scanner with a specialist knee coil. For validation bovine and porcine cadaveric knees were given artificial cartilage lesions and then imaged. The animal validations showed close agreement between direct lesion measurements and those obtained from the MR images. The feasibility of semi-automated segmentation is demonstrated. Regional cartilage thickness values are seen as having practical application for fully automated detection of OA lesions even down to the submicrometer level.

Pro-sports medicine from the inside.

Pro-sports medicine from the inside.

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

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.