Summary: The introduction of an acute knee trauma clinic dramatically reduced the waiting times for patients with ACL injury. There has been a statistically significant improvement in the numbers of meniscal tears deemed suitable for repair. Reduced waiting times has not impacted on the incidence or severity of chondral lesions.

Introduction

Anterior cruciate ligament (ACL) injury is one of the most common traumatic knee injuries, particularly in the young and active population, and rates are increasing (1,2). The BASK guidelines advocate that any patient presenting to the Emergency Department with acute knee trauma, haemarthrosis and suspected ligament instability, meniscal tear or osteochondral fracture should be seen and assessed within 2 weeks (3).

An Acute Knee Trauma (AKT) clinic was established within the Belfast Trust in 2018 to provide a consultant-led service for rapid triage of injuries and identification of patients who would benefit from timely reconstruction, The aim of this study was to establish if the introduction of this clinic resulted in improved time to surgery and, subsequently resulted in a reduction in the number of irreparable meniscal tears and preservation of articular cartilage. We hypothesised that patients waiting longer for surgery would experience more instability episodes with potential for additional intra-articular injury.

Methods

A matched cohort study of 89 consecutive patients undergoing ACL reconstruction pre (2016) and post (2023) the introduction of the AKT clinic was conducted using electronic records, imaging systems and theatre management records. Revision ACL procedures and skeletally immature patients were excluded. Patient demographics including age, sex, date and mechanism of injury were recorded. Initial review date by a consultant knee surgeon, time to MRI scan, and time to theatre were also assessed. Arthroscopic intervention for meniscal pathology and articular cartilage health on direct visualisation was recorded.

Results

There were no significant differences in the age and sex composition of the groups. Following the introduction of the AKT clinic the median days from injury to surgery reduced from 557 (range 38-5369) to 154 (range 16-295) a reduction of 72% (p=<0.001). There were similar, reductions in time from date of injury until MRI (p=<0.001) and specialised orthopaedic assessment (p = <0.001).
There were fewer medial meniscectomy surgeries performed in 2023 compared to 2016 (6.7% compared to 28.1%, OR = 0.18, 95% CI 0.07 to 0.48, p = <0.001). This finding was not seen for lateral meniscectomy (OR = 0.58, 95% CI 0.23 to 1.4, p = 0.353). Conversely the number of patients who underwent meniscal repair increased from 17 (19.2%) in 2016 to 39 (43.8%) in 2023 which was statistically significant (OR = 6.02, 95% CL 2.34 to 15.48), p = <0.001). Evaluation of chondral damage did not demonstrate any significant changes. ACL reconstruction with hamstring remains the mainstay of treatment, being carried out for 87 (98%) and 81 (91%) patients in 2016 and 2023 respectively.

Conclusion

The introduction of a consultant-led, dedicated, knee trauma clinic in the Belfast Trust has dramatically reduced the diagnostic and treatment waiting times for patients with ACL injury. While the suitability of a meniscal tear for repair is multifactorial, there has been a statistically significant improvement in the numbers of meniscal tears deemed suitable for repair. Reduced waiting times has not impacted on the incidence or severity of chondral lesions.

References
1. Luc B, Gribble PA, Pietrosimone BG. Osteoarthritis Prevalence Following Anterior Cruciate Ligament Reconstruction: A Systematic Review and Numbers-Needed-to-Treat Analysis. J Athl Train. 2014 Dec 1;49(6):806–19.
2. Harkey MS, Luc BA, Golightly YM, Thomas AC, Driban JB, Hackney AC, et al. Osteoarthritis-related biomarkers following anterior cruciate ligament injury and reconstruction: a systematic review. Osteoarthritis Cartilage. 2015 Jan;23(1):1–12.
3. BASK; BOSTAA. BOAST. 2020. Best Practice for Management of Anterior Cruciate Ligament (ACL) Injuries .

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Description Of A Novel Surgical Technique For Repairing Complete Radial Tears Of The Lateral Meniscus And Results Of Our Series ePoster Presentation Juan Pablo Zicaro, MD, ARGENTINA Mariano Manuel Zapata, MD, ARGENTINA Mariano Agustin Revah, MD, ARGENTINA Matias Costa-Paz, MD, PhD, ARGENTINA Carlos H. Yacuzzi, MD, ARGENTINA Oscar Alejandro Zicaro, MD, ARGENTINA
Improved Healing Rates Of Meniscal Repair With Concomitant Posterior Cruciate Ligament Reconstruction Compared To Meniscal Repair Alone ePoster Presentation Nathan Varady, MD, MBA, UNITED STATES Suhas Parise, BS, UNITED STATES Riley J. Williams, MD, UNITED STATES
Assessing the Risk of Iatrogenic Neurovascular Injury in All-Inside Medial Meniscal Repair Between Standard Versus Arthroscopic MRIs ePoster Presentation Chaiwat Chuaychoosakoon, MD, THAILAND Trisak Kingchan, MD, THAILAND Wachiraphan Parinyakhup, MD, THAILAND Tanarat Boonriong, Principal, THAILAND
Arthroscopic All-Inside Wrapping Repair of Lateral Meniscus Bucket-Handle Tears: Clinical and Imaging Outcomes ePoster Presentation Kun-Hui Chen, MD, TAIWAN En-Rung Chiang, MD, PhD, TAIWAN Hsuan‑Hsiao Ma, MD, TAIWAN
Clinical And MRI Outcomes Following Meniscal Repair: A Comparison Between Tear Types ePoster Presentation Elias Ammann, MD, SWITZERLAND Jay R. Ebert, PhD, AUSTRALIA Luke Rao, MD, AUSTRALIA Antony Liddell, FRACS(Orth), FAOrthA, AUSTRALIA Usman Najeeb Bhatty, FRCS, MB ChB, BSc, UNITED KINGDOM Ross Radic, MBBS FRACS (Ortho) FAOrthA, AUSTRALIA
Mid-Term Outcomes And Safety Of Medial Meniscus Allograft Transplantation Using A Bone-Bridge Technique: A Single-Center Experience ePoster Presentation Ilias Fanourgiakis, MD, MSc, FEBOT, GREECE Theodore Balfousias, MD, MSc, FEBOT, GREECE Rainer Siebold, Prof. Dr. med., GERMANY
Biomechanical Effect Of Location And Number Of Bone Tunnels In Transtibial Pull-Out Repair For Medial Meniscus Posterior Root Tear ePoster Presentation Toshitaka Tsunematsu, MD, JAPAN Tomoki Ohori, MD, PhD, JAPAN Akira Tsujii, MD, PhD, JAPAN Shuto Yamashita, MD, JAPAN Ayaka Tanaka, MD, JAPAN Syunya Otani, MD, PhD, JAPAN Seira Sato, MD, PhD, JAPAN Ken Nakata, MD, PhD, JAPAN Seiji Okada, MD, PhD, Prof., JAPAN
Joint Line Obliquity Can Increase Meniscus Root Tension ePoster Presentation Shuntaro Nejima, MD, PhD, JAPAN Andy Williams, MBBS, FRCS(Orth), FFSEM(UK), UNITED KINGDOM Andrew A. Amis, FREng, DSc, PhD, UNITED KINGDOM

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The Impact Of Introducing An Acute Knee Trauma Service In The Belfast Trust: Reduced Waiting Times And Improved Rates Of Meniscal Repair.

The Impact Of Introducing An Acute Knee Trauma Service In The Belfast Trust: Reduced Waiting Times And Improved Rates Of Meniscal Repair.

Introduction

Methods

Results

Conclusion

Knee Meniscus ePosters

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The Impact Of Introducing An Acute Knee Trauma Service In The Belfast Trust: Reduced Waiting Times And Improved Rates Of Meniscal Repair.

The Impact Of Introducing An Acute Knee Trauma Service In The Belfast Trust: Reduced Waiting Times And Improved Rates Of Meniscal Repair.

Introduction

Methods

Results

Conclusion