Long-term data on the clinical outcome and the fate of the meniscus allograft after transplantation are scarce. In this study we present the clinical, radiological and MRI outcome of the meniscus graft and the articular cartilage after 42 meniscus allograft transplantations in 41 patients with a minimum follow-up of 10 years. A total of 27 medial and 15 lateral meniscal allografts were transplanted. Eleven of the medial allograft procedures were associated with a high tibial osteotomy. The patients were evaluated clinically at the time of transplantation and at the final follow-up using the modified HSS scoring system. The knee injury and osteoarthritis outcome score (KOOS) was used as an evaluation tool for patient-related outcome at the final follow-up. Joint space width narrowing and Fairbank changes were radiological outcome parameters, which were available for 32 patients. Femoral and tibial cartilage degeneration, graft extrusion and signal intensity were scored on MRI scans obtained in 17 patients approximately 1 year after transplantation and at the final follow-up (>10 years). For statistical analysis the patients were divided into three groups: lateral meniscal allograft (LMT), medial meniscal allograft transplantation with a high tibial osteotomy (MMT+HTO) and without (MMT). The modified HSS score revealed a significant improvement in pain and function at the final follow-up for all groups. Further analysis also revealed that an MMT+HTO procedure resulted in a greater improvement at the final follow-up when compared to MMT. Nonetheless, the KOOS scores obtained at the final follow-up revealed the presence of substantial disability and symptoms, in addition to a reduced quality of life. Radiographical analysis revealed no further joint space narrowing in 13/32 knees (41%). Fairbank changes remained stable in 9/32 knees (28%). MRI analysis showed no progression of cartilage degeneration in 6/17 knees (35%). An increased signal intensity of the allograft was present, as was partial graft extrusion in the majority of patients at the final follow-up. Seven cases had to be converted to a total knee arthroplasty during the follow-up; the overall failure rate was 18%. Long-term results after viable meniscus allograft transplantation are encouraging in terms of pain relief and improvement of function. Despite this significant improvement, substantial disability and symptoms were present in all investigated subgroups. Progression of further cartilage degeneration or joint space narrowing was absent in a considerable number of cases, indicating a potential chondroprotective effect. Level of evidence is therapeutic study, Level IV and retrospective analysis of prospectively collected data.

The aim of this study was to evaluate histological changes in torn (0.5-27 weeks after injury) and osteoarthritic (OA) knee menisci versus normal menisci after PAS-AB, SAF-O-FG, and immunostaining for CD34, CD31, and smooth muscle actin (SMA). Cell layers in the superficial zone and the cell density in the deep zone of the menisci were counted. In the superficial zone of normal menisci, cells expressing CD34 were demonstrated. CD34þ CD31 À cells were absent in OA menisci and disappeared in torn menisci as a function of time. In contrast, an increase of SMA þ cells combined with an increase of cell layers was observed in the superficial zone of torn menisci. SMA þ cells were absent in normal and OA menisci. The predominant tissue type in torn menisci evolved from fibrocartilage-like to fibrous-like tissue as a function of time, whereas in OA menisci it became cartilage-like. The response of the superficial zone was reflected by the decrease of CD34 þ and the increase of SMA þ cells in torn menisci and the transformation of a fibrous-like into a cartilage-like surface layer in OA menisci. These results potentially illustrate the contribution of CD34 þ cells to the homeostasis of meniscus tissue. ß

Objective:To evaluate the level of acceptability of the EULAR recommendations for the management of knee osteoarthritis (KOA) in practice. Methods: A questionnaire was sent to general practitioners, rheumatologists, rehabilitators, and orthopaedic surgeons in five European countries (France, Spain, Belgium, Switzerland, Italy). Practitioners were asked to give their opinion on the 10 EULAR recommendations and on 23 treatment modes for KOA. Practitioners' opinions were compared with those of the expert task force involved in the development of these recommendations. Results: The overall response rate was 10.4% (4204 replies). Results were similar across countries and specialties. Of the 23 treatment modes proposed, only joint lavage and intra-articular (IA) corticosteroid injections were more strongly recommended by the expert task force than by the responders as a whole, while the opposite was true for spa therapy. Principal component analysis showed: (1) some practitioners preferred ''hard line'' treatments (surgery, IA injections, or non-steroidal anti-inflammatory drugs (NSAIDs)); (2) there was a difference between those prescribing pharmacological (paracetamol) or nonpharmacological measures with low iatrogenicity (exercises, sticks, education), and those prescribing less well validated treatments closer to ''alternative'' medicine; (3) each specialist tended to advocate modes that they were most familiar with: rheumatologists were more likely to recommend IA injections and NSAIDs; orthopaedic surgeons, surgical procedures; rehabilitators, education and all non-pharmacological modes; general practitioners, spa therapy and opioids. Conclusions: A multidisciplinary approach is optimal in the management of this chronic disease with its variable course.

The effect of clopidogrel, a potent inhibitor of platelet aggregation, on naproxen-induced faecal blood loss was investigated in 30 healthy volunteers in a randomized, double-blind, placebo-controlled, two parallel treatment groups study. All subjects first received naproxen 250 mg b.i.d. during 7 days, after which they were randomly allocated to additionally receive either clopidogrel 75 mg once daily (n = 15) or matching placebo (n = 15) for 11 days. Faecal blood loss was measured by the 51Cr-labelled erythrocyte method during the last four days of each of the four study periods, i.e. baseline, treatment with naproxen alone, combined treatment and wash-out. Mean daily faecal blood loss was below 0.5 ml/day during the baseline period in both treatment groups and increased during treatment with naproxen alone to (mean +/- SD) 1.14 +/- 0.58 ml/day in the naproxen + placebo group and to 1.93 +/- 1.51 ml/day in the naproxen + clopidogrel group. Addition of clopidogrel to naproxen treatment was associated with an increase of the mean daily blood loss to 6.83 +/- 9.32 ml/day, which was statistically significantly higher than 1.75 +/- 1.40 ml/day observed during treatment with naproxen + placebo. During the wash-out period, mean daily blood loss decreased to 0.98 +/- 0.51 ml/day in the naproxen + placebo group and to 1.07 +/- 0.46 ml/day in the naproxen + clopidogrel group. Based on these results, it can be concluded that clopidogrel increases naproxen-induced gastrointestinal blood loss in healthy volunteers. Caution should therefore be called for when these drugs are coadministered.

HLA antigens have been identified in patients with juvenile chronic polyarthritis (J.C.P.) (n = 35). In J.C.P. the incidence of antigen B27 (57%) was found to be higher than in a normal population (n = 1,000). On recent evaluation of the clinical status, serology and x‐rays, the patients with juvenile chronic polyarthritis who have been followed up for many years, could be subdivided into four groups: Group 1: J.C.P. evolving to ankylosing spondylitis (n = 3); Group 2: J.C.P. with sacroiliitis (n = 17); Group 3: J.C.P. without sacroiliitis (n = 9); Group 4: juvenile rheumatoid arthritis characterised by a positive serology (n = 6). Groups 1 and 2 were characterised by a high incidence of antigen B27 (19/20). Only one subject of groups 3 and 4 had antigen B27. Sex distribution in groups 1 and 2 was found to be similar to that found in ankylosing spondylitis in adults and sex distribution in groups 3 and 4 was found to be similar to that found in rheumatoid arthritis in adults. It is concluded that if B27 positives develop juvenile chronic polyarthritis they have a high risk of developing sacroiliitis and acute uveitis. The authors propose to give the name Still's disease to the total group of children presenting initial symptoms corresponding to the criteria of Ansell & By waters (1959). Follow‐up of the cases permitted their further classification as juvenile ankylosing spondylitis, as juvenile chronic polyarthritis with or without sacroiliitis or as juvenile rheumatoid arthritis.