One hundred eighteen patients, aged 40 or older, underwent partial meniscectomy and limited debridement of coexisting grade III or grade IV degenerative articular cartilage lesions. No curettage, abrasion arthroplasty, or subchondral drilling was performed. The average age of the patients was 57 years (range, 40 to 78). The mean followup was 3.3 years (range, 1 to 7). Sixty-three similar patients who also underwent partial meniscectomy but did not have the finding of significant coexisting articular surface erosion were studied for comparison. Of the 118 patients in the group with articular lesions (78 men and 40 women), 71 (60%) rated their improvement as significant, 22 (19%) as moderate, and 15 (13%) as mild; 10 (8%) noted no improvement. Although 98 (83%) were generally satisfied with their result, only 57 (48%) reported satisfaction for sports. However, 89 (75%) had resumed and continued recreational athletic activities. Results tended to be worse in women, in patients older than 60, in those with moderate or severe tibiofemoral radiographic changes, those who had a grade IV articular lesion, and those with longer followup time. Although results were poorer in patients with coexisting grade III or grade IV degenerative arthritis, arthroscopic partial meniscectomy and limited debridement was an acceptably effective procedure in patients over the age of 40.

Surgical management of the chronic ACL-deficient knee can present a difficult problem, even to the experienced surgeon. Although many procedures are commonly performed, they are not without specific risks.l2 Well-established complications of surgical reconstructions include patellar fracture,l8 patellar tendon rupture,' loss of motion,1O,l9 infection, and hardware failure.&dquo; We present a case of a 29-year-old man who had an ACL reconstruction using autogenous patellar tendon graft and an iliotibial band tenodesis. Six months postoperatively, he sustained a fracture at the level of the iliotibial band screw, requiring open reduction and internal fixation. To the authors' knowledge, this complication has not been previously reported. CASE REPORTA 29-year-old man was evaluated at our outpatient clinic for recurrent instability of the right knee. The patient was an avid recreational athlete who had injured his knee 4 years earlier while playing basketball. He noted that the injury was associated with an audible &dquo;pop,&dquo; immediate swelling, and inability to continue playing, but he did not seek medical attention at that time.At the initial evaluation, the patient complained of moderate medial knee pain and giving way with activities requiring running or pivoting. His medical history was otherwise unremarkable.Physical examination revealed a well-developed man with moderate right quadriceps atrophy, a mild joint effusion, and moderate medial joint line tenderness. Range of motion was 0° to 110°, with moderate discomfort at terminal flexion.Further examination revealed positive Lachman and anterior drawer tests, as well as a moderate pivot shift. There was no evidence of either a posterior sag or posterior drawer. Anteroposterior and lateral radiographs of the involved knee were unremarkable (Fig. 1).Initially, treatment was directed toward improving lower extremity strength and range of motion. Despite a wellsupervised trial of physical therapy, the patient's symptoms of instability did not improve. After some discussion, he agreed with our recommendation for an arthroscopic meniscal debridement and an intraarticular reconstruction using the central third of the patellar tendon (bone-tendon-bone). Diagnostic arthroscopy revealed an old complete tear of the ACL and a small radial tear within the substance of the medial meniscus. The posterior cruciate ligament and lateral meniscus were intact.A partial medial meniscectomy was performed, leaving a large stable rim. The patellar graft was harvested in the standard fashion with its bony attachments.' Isometrically determined bony tunnels were created in the femur and tibia using arthroscopic assistance and C-loop drill guides. The graft was then passed through the tunnels and was provisionally secured. At this point, examination of the knee revealed a full range of motion with only a trace positive Lachman test and elimination of the pivot shift. The graft was secured with interference screws and an extraarticular tenodesis of the iliotibial band was performed....