The potential benefit of arthroscopy as a treatment for knee osteoarthritis is contentious, with National Institute for Health and Care Excellence stating that, "There is uncertainty regarding the efficacy of the procedure." This is a study of a consecutive series of patients with osteoarthritis of the knee, suffering from mechanical symptoms, such as giving way, catching, and locking, and undergoing arthroscopic debridement, including chondroplasty and meniscectomy where appropriate. A total of 33 patients were reviewed at a mean period of 24 months (standard deviation 3 months) and follow-up data were obtained for 28 of these patients. Primary outcomes measured were: number of mechanical symptom episodes per week and visual analog scores for pain. Secondary outcomes measured were: Oxford, Lysholm, and Tegner knee scores together with arc of motion of the joint. Seven patients went on to have a knee replacement within 2 years. In the patient subgroup who did not require further surgery, there was statistically significant improvement in giving way (p = 0.0184) and marginally significant improvement in catching and locking (p = 0.1105 and p = 0.087, respectively). There were statistically significant improvements found in the Oxford and Lysholm scores (p < 0.0001). An average decrease of 1.9 in the VAS pain score was observed that was also statistically significant (p < 0.0007) and an average improvement of 10 degrees in the arc of motion was noted, which was marginally significant (p = 0.0687). To our knowledge, this is the first study with a primary outcome measure of mechanical symptoms experienced by patients. The results overall suggest that patient symptoms improved following arthroscopic treatment. As a result, episodes of mechanical symptoms should be important criteria for clinicians in determining the patient suitability for arthroscopic debridement.

IV.

Background: Survivors of primary malignant musculoskeletal tumors often face long-term disability. Clinicians at present are unable to provide evidence-based advice about returning to sports, which is important for active patients. Purposes:1. Identify patients returning to sports.2. Describe the sporting activities in which patients participate.3. Identify the outcome measures used to assess return to sport. 4. Identify barriers preventing return to sports. Study design: Systematic review. Methods: A comprehensive search strategy was used to identify relevant studies combining the following concepts: (1) Bone/Soft tissue tumor, (2) Lower limb, (3) Surgical interventions, and (4) Sports. Studies were selected according to eligibility criteria with the consensus of three authors (MTB, FS, and CG).Results: Twenty-two studies were selected, published between 1985 and 2020, including 1005 patients. Fifteen of the 22 studies had valid data on return to sports, with 705 participants, of which 412 (58.4%) returned to some form of sport such as swimming and cycling, at a mean follow-up period of 7.6 years. Four studies directly compared limb sparing surgery and amputation; none of these were able to identify a difference in sports participation or ability. Conclusion:There is insufficient published research to provide guidance for patients with respect to return to sports following musculoskeletal tumors. Future prospective studies are needed to collect better pre-and post-treatment data at multiple time intervals. Validated clinical and patient sports participation outcomes such as type of sports, level, frequency, and validated sports-specific outcome scores should be recorded. In particular, more comparison between limb sparing surgery and amputation would be welcome.

Primary malignant bone and soft tissue tumours often occur in the lower extremities of active individuals including children, teenagers and young adults. Survivors routinely face long-term physical disability. Participation in sports is particularly important for active young people but the impact of sarcoma treatment is not widely recognised and clinicians may be unable to provide objective advice about returning to sports. We aimed to identify and summarise the current evidence for involvement in sports following treatment of lower limb primary malignant bone and soft tissue tumours.A comprehensive search strategy was used to identify relevant studies combining the main concepts of interest: (1) Bone/Soft Tissue Tumour, (2) Lower Limb, (3) Surgical Interventions and (4) Sports. Studies were selected according to eligibility criteria with the consensus of three authors. Customised data extraction and quality assessment tools were used.22 studies were selected, published between 1985 – 2020, and comprising 1005 patients. Fifteen studies with data on return to sports including 705 participants of which 412 (58.4%) returned to some form of sport at a mean follow-up period of 7.6 years. Four studies directly compared limb sparing and amputation; none of these were able to identify a difference in sports participation or ability.Return to sports is important for patients treated for musculoskeletal tumours, however, there is insufficient published research to provide good information and support for patients. Future prospective studies are needed to collect better pre and post-treatment data at multiple time intervals and validated clinical and patient sports participation outcomes such as type of sports participation, level and frequency and a validated sports specific outcome score, such as UCLA assessment. In particular, more comparison between limb sparing and amputation would be welcome.

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