Background, Osteochondral lesions are a common clinical problem and the management has been historically challenging. Mesenchymal stem cells have the potential to differentiate into chrondrocytes thus restore hyaline cartilage to the defect theoretically improving clinical outcomes in these patients. Purpose,To assess the clinical and functional outcomes of mesenchymal stem cell implantation to treat isolated osteochondral defects of the knee. A secondary purpose is to assess the quality of the current available evidence as well as the radiological and histological outcomes. We also reviewed the cellular preparation and operative techniques for implantation.
Methods, A comprehensive literature search of 4 databases was carried out. We searched for clinical studies reporting the outcomes with at least 12 months of follow-up. Clinical, radiological, and histological outcomes were recorded. We also recorded demographics, stem cell source, culture technique, and operative technique. Methodological quality of each study was assessed using the modified Coleman methodology score, and risk of bias for the randomised controlled studies was assessed using the Cochrane Collaboration tool. Results, Seventeen studies were found encompassing 367 patients. The mean patient age was 35.1 years. Bone marrow was the most common source of stem cells utilized. Mesenchymal stem cell therapy consistently demonstrated good short- to medium-term outcomes in the studies reviewed with no serious adverse events being recorded. There was significant heterogeneity in cell harvesting and preparation as well as in the reporting of outcomes. Conclusion, Mesenchymal stem cells demonstrated a clinically relevant improvement in outcomes in patients with osteochondral defects of the knee.

Introduction: We changed the VTE prophylaxis regime at Salisbury District Hospital as per the updated NICE guidance in April 2019 in patients undergoing elective total hip and knee arthroplasty procedures. We conducted this study to see if the change to the clinical practice is safe and to estimate any financial savings to the Trust. Methods: A retrospective review of the incidence of thrombosis and embolism in patients undergoing elective arthroplasty procedures was undertaken from the regular audit records collected by the haematology department. We compared this incidence against the yearly number of hip and knee arthroplasty procedures undertaken at this hospital from April 2017-March 2020. This information was collected from the National Joint Registry data set for the Salisbury District Hospital. The updated NICE guidance(March, 2018)recommends the usage of Low Molecular Weight Heparin(LMWH) for 10 days and Aspirin for another four weeks for patients after THR and Aspirin for 14 days for patients undergoing TKR. Results: We noticed the rate of VTE in patients undergoing THR and TKR from April 2017-March 2018 was 1.83%(n=10/546), from April 2018- March2019 was 0.82%(n=6/726).The updated NICE guidance was introduced into the clinical practice at our hospital from 1 st April 2019 and the rate of VTE noted from April 2019- March 2020 was found to be 1.97%(n=12/607).Conclusion: This change in the VTE prophylaxis per the updated NICE guidance led to the huge financial savings of about £10,000 to our Trust in one year with improved patient compliance and without any increased incidence of thromboembolism.

Tibial plateau fractures are difficult to treat and, although rare, representing about 1% of all fractures, the consequences of inadequate treatment can be serious.
Associated intra-articular injuries are not uncommonThe approach via open reduction has a high rate of complications, which has led to the development of alternative techniques, namely percutaneous. Arthroscopy is particularly useful as it allows a good visualization of the joint surface and other intra-articular injuries, keeping the soft tissue injury to a minimum.
The combined treatment of tibial plateau fractures using arthroscopy and radioscopy has numerous advantages over conventional methods. The aim of this study is to retrospectively assess the functional and radiographic results and the value of the combined approach. Good results are reported in the literature in the short term. Our aim is to determine whether the good results are maintained in the medium and long term.
Between January 2013 and December 2019, by the same surgical team, 24 patients with fractures of the tibial plateau were operated using the combined arthroscopic and radioscopic approach. A clinical and radiological review of the patients was performed.
The combined arthroscopic and radioscopic approach to fractures of the tibial plateau is a safe but demanding technique. Based on this study and on the good results obtained, this technique proved to be highly recommended and with several advantages compared to other treatment methods. We can therefore conclude that the medium and long term results of the combined approach, both in clinical and radiographic terms, were quite favorable.

Introduction: Reconstruction of the medial patellofemoral ligament (MPFL) remains the gold-standard procedure for patellofemoral instability (PFI) in young adults. Recent studies report worse results in cases with trochlear dysplasia, so the use of adjuvant techniques (e.g., trochleoplasty) may be indicated. Methods: Retrospective and single-center study, including patients who underwent MPFL reconstruction with hamstring graft between June 2012 and April 2020. Clinical and radiological parameters were analyzed. The grade of trochlear dysplasia was standardized according to the Dejour Classification (low - A; high - B, C and D) and the functional outcomes determined using the Tegner Lysholm Knee Scoring Scale (TLKSS). Results: 48 patients were included, 37 female, with a median age of 18 [16-21] years. The median follow-up time was 9 [6-16.8] months. The median TLKSS at the end of the follow-up was 80 [66.3-86]. Functional outcomes were superior in patients without dysplasia (p=0.045). In patients with dysplasia, the results were statistically superior in patients with high grade (p=0.006). In view of the type of surgical procedure used, there were worse functional results in patients undergoing isolated reconstruction of the MPFL compared to those undergoing combined surgery for anterior tibial tuberosity medialization and/or distalization (p=0.011). Conclusion: The trochlear dysplasia negatively influenced the functional outcomes of patients undergoing MPFL reconstruction by PFI. The simultaneous surgical correction of an increased TT-GT distance or high patella seems to be more important factor, presenting better functional outcomes comparatively to the isolated reconstruction of the MPFL. Prospective studies will be necessary to confirm these data.

Introduction: Osteochondral allograft transplantation is a biological resurfacing option for massive osteochondral lesions of the knee. According to the literature long term chondrocyte survival is limited to a maximum of 50-80%. Based on previous reports decreased time between graft harvest and implantation may improve survival rate. Methods: Authors treated 16 massive osteochondral defects on femoral and tibial condyles by osteochondral allografts harvested 24-36 hours before the implantations. Surgical procedures were supported in 7 cases MegaOATS technique, while in 9 cases free hand technique was used. Follow up by clinical scores, X-ray and MR images was performed between 1 to 12 years. In 3 cases control arthroscopies were performed and in 1 cases histological evaluation of biopsy was also used to check chondrocyte survival. Results: Based on poor clinical outcome allograft revision was needed in 3 cases and total knee replacement had to be performed for 1 patient. The remaining 12 cases represented good to excellent clinical outcome according to ICRS and Cincinnati scores, X-ray and MR follow ups. Histological evaluation has shown preserved hyaline cartilage surface, and confocal microscopy represented over 90 % chondrocyte survival in biopsy material. Conclusion: Transplantation of ultra-fresh, 24-36 hours old osteochondral allografts may provide better chondrocyte survival than 14-28 days, old fresh osteochondral blocks. Sizing and congruency remain critical technical points, but long term outcome can be improved by decreasing time between graft harvest and implantation.

Background: The anatomic distal femoral locking plate (DF-LCP) has simplified the management of supracondylar femoral fractures with stable knee prostheses. Osteoporosis and comminution seem manageable, but at times, the construct does not permit early mobilization. Considerable soft tissue stripping during open reduction and internal fixation (ORIF) may delay union. Biological plating offsets this disadvantage, minimizing morbidity.

Materials: Thirty comminuted periprosthetic supracondylar fractures were operated from October 2010 to August 2016. Fifteen (group A) were treated with ORIF, and fifteen (group B) with closed (biological) plating using the anatomical DF-LCP. Post-operatively, standard rehabilitation protocol was followed in all, with hinged-knee-brace supported physiotherapy. Clinico-radiological follow-up was done at 3 months, 6 months, and then yearly (average duration, 30 months), and time to union, complications, failure rates and function were evaluated.

Results: Average time to union was 4.5 months (range, 3-6 months) in group A, and 3.5 months (range, 2.5-5 months) in group B. Primary bone grafting was done in twelve patients (all group A). At final follow-up, all fractures had healed, and all (but two) patients were walking unsupported, with no pain or deformity, with average knee range of motion (ROM) of 90 (range, 55 to 100). Two patients had superficial infection (group A), two had knee stiffness (group A), one had shortening of 1.5cm (group B) and one had valgus malalignment of 10 degrees (group B).

Conclusion: Biological plating in comminuted supracondylar fractures about stable TKA prostheses is an excellent option, may obviate need for bone grafting, and reducing complications.

Introduction: We studied the outcome of 200 Knees with primary Osteoarthritis associated with Varus deformity, for which High Tibial Osteotomy (HTO) was performed and followed up for 10 years. 160 were open wedged and closed wedge made up the remaining. The primary aim was to study the long-term outcome of this procedure in Indian population. Materials & Methods: 190 patients (200 knees) were operated by a senior Orthopaedic surgeon between January 2000 and October 2010. The main criteria for patient selection were that the patients who are having Osteoarthritis with Varus deformity irrespective of their age. They were followed up regularly for a period of 10 years from the date of surgery and The Knee Society Score (KSS) was used to determine the outcome. Results: 178 Patients were satisfied with the procedure. The KSS improved from a pre-operative score of 43.34 to 90.73 at 10 years post-operative follow-up. Only 2 cases had the recurrence of the deformity. One of them had a successful revision HTO, while the other needed a Total Knee Arthroplasty. Conclusion: HTO can provide permanent pain relief if it is done at right time. Contrary to the criticism HTO has received, in terms of losing its effectiveness very quickly and also for causing Patella Baja, it is still the gold standard for treating Primary Osteoarthritis, with far fewer complications rates than reported. We recommend HTO in patients with knee osteoarthritis and varus deformity irrespective of the age.

High Tibial Osteotomy (HTO) is a well-established surgical procedure for the treatment of varus knee, associated with cartilage defects or arthrosis of the medial compartment. The purpose of HTO is to allow a transfer of axial load to the preserved lateral compartment. The aim of this study was to evaluate the complications associated with HTO performed in our Intitution.
A retrospective descriptive study was performed in which all patients undergoing HTO for varus knee in the last nine years were evaluated and the main direct complications resulting from the surgery performed were identified and analyzed.
60 HTO in 55 patients, 33 females and 22 males, with a mean age of 55,9 years (38-68). 41 lateral closing wedge and 19 medial opening oteotomies. Mean followp-up time was 27,4 months. Overall 14 complications (23%) were identified (12 patients). 3 cases of surgical site infection, in which one needed surgery for debridment. 3 cases of intra-operative fractures treated with osteosynthesis. 3 cases of consolidation delay and 1 of pseudarthrosis, the latter treated with decortication, autologous bone graft and fixation review. 1 case of overcorrection treated with corrective osteotomy. One patient had 3 complications: a posterior tibial artery psedoaneurism that compressed the common perenal nerve which developed permanent deficits, a deep infection followed the multiple surgeries needed to address the mentioned complications.
HTO is a safe procedure with an acceptable complication rate. Most complications can be solved with conservative treatment. An adequate surgical technique is essential to prevent serious complications that compromise patient prognosis.