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Meniscal substitution is a fundamental procedure to prevent osteoarthritis of the knee after massive meniscectomy. Stone, Steadman and Rodkey have developed a bioreadsorbable collagen matrix (CMI) which acts as a scaffold to restore the original medial meniscal. The objective of this study was to prospectively evaluate the results of CMI implantation at a follow up from a minimum of 6 to a maximum of 8 years. Eight patients (mean age 25) were evaluated at a final observation point from 6 to 8 years after CMI implantation. Inclusion criteria were an irreparable meniscal tear or a previous meniscectomy involving the medial meniscus. Follow up evaluation included Cincinnati Knee Rating Scale (CKRS), IKDC, subjective evaluation and X-ray and MRI control. There were no complications related to the device. All patients were able to return to day activities without limitations 3 months after surgery. Both subjective CKRS score and objective IKDC score showed improvement in all cases except one patient with an ACL re-injury. In two cases scores were slightly worse from 2 years after surgery to the final observation point. The other five cases obtained maximum score at final follow-up. In four cases the absence of pain remained until the final observation point, while in four cases a low entity of pain was described at long term follow-up. MRI showed in five cases mixoid degeneration signal, two had normal signal with reduced size, while one patient had no recognizable implant. Six patients had preserved cartilage and articular space, with no changes respect to pre-op control. Arthroscopic second look evaluation has been performed in three cases, revealing in two cases the presence of the implant, although with a reduced size respect to the original one, while in one case the CMI was almost disappeared. Our small series of eight patients prospectively followed from 6 to 8 years of follow-up has shown highly satisfactory results. Although the aspect of the implant was mostly abnormal, the implant may have helped reduce the deterioration of the knee joint at final observation time.

This prospective study examined 50 patients who underwent ACL surgery using hamstring tendons with a modification including intra- and extra-articular reconstruction. All patients were athletes competing at a high level in various sports. Full return to sports was allowed at 4 months. IKDC score and KT-2000 were used for assessing clinical outcome at a mean of 6.4 years (5-7 years) Resumption of sport, Tegner activity score, and isokinetic test were also used. The IKDC score showed 92% of normal or nearly normal knees. Of the 50 patients 48 regained full extension, and only two had extension deficit between 0 degrees and 3 degrees. KT evaluation was less than 3 mm in 38 cases (76%), 3-5 mm in 9 (18%), and more than 5 mm in 3 (6%). In 90% of cases the patient resumed sport at the same level. The mean Tegner activity score was 8.1 (5-10). The isokinetic test showed no deficit for hamstring and quadriceps muscles. Removal of staples was necessary in eight cases (16%) due to femoral lateral bursitis. Acute reconstruction had significantly better clinical assessment of abnormal laxity and KT value. Men had significantly better results then women. This technique demonstrated a high reliability, low morbidity, low functional deficit and fast recovery using hamstring grafts.

The technique described tries to achieve a dynamic stability of the patella throughout the full range of motion in severe patellar instability where the Elmslie-Trillat procedure is insufficient. No recurrence of patellar instability has been observed. The stability must be obtained with dynamic control in the initial degrees of flexion, trying to avoid an excessive patellar medialization.