Surgical Techniques for the Knee

The ideal book of surgical techniques for the knee is one in which all the procedures that the reader would personally wish to see are present and where the content and detail in each chapter confirm his own prejudices. Each topic should provide enough detail to make the procedures understandable and logical, and the illustrations should compliment the description in the text. Pitfalls and complications of the procedures based on the personal experience of the writer would be invaluable. In many of these chapters, written by surgeons with great experience, the aims are attained. The initial review of the content of the book showed it to be comprehensive, but it was disappointing to note the exclusion of several areas, such as unicompartmental knee replacement, patellofemoral arthroplasty and new areas in the management of arthritis which have become standard procedures. The majority of PCL reconstructions nowadays are performed using the anterolateral single bundle, but the only reference to PCL reconstruction is using the double-bundle technique which has yet to be proved to be superior. The indications for isolated PCL reconstruction are at present few; nearly all are associated with reconstruction of the posterolateral corner of the knee which is still under critical review. ACL reconstruction is the most common soft-tissue ligament procedure worldwide, and bone-patellar tendon-bone is still the most common technique. Unfortunately, this very important chapter on ACL reconstruction lacks illustration, and this must increase the risk of misunderstanding when carried out by less experienced surgeons. The illustrations for reconstruction using the hamstrings also make the procedure difficult to follow, which is increased by the incorrect orientation of some of the illustrations. However the written description is excellent. While many methods for repairing meniscal tears are described, including the simple and effective Fast-Fix, alternatives for ACL reconstruction, both with hamstrings and bone-patellar tendon, are not included. The Endo-button technique for ACL reconstruction for example, is in frequent use but is not mentioned. The chapters on articular cartilage repair provide up-to-date information on the various techniques available, although the chapter on abrasion arthroplasty, excellent in itself, is perhaps too long and generalised for a book on surgical techniques. Microfracture, surely now a more frequently-used technique, is notable for its absence. The many chapters on approaches to the knee and the various techniques in total knee replacement are well planned and presented with superb illustrations. Certainly the chapters on replacement should be read by all junior staff, and as a refresher for experienced surgeons (they certainly confirm this reviewer’s prejudices!). It would be difficult to obtain sufficient knowledge from many of the trauma chapters to be guided through an internal fixation of a fracture in the knee, simply because the illustrations are so few and the possible methods of internal fixation are so varied. Puddu’s method of opening wedge osteotomy does not include the use of the more up-to-date method of locking screws, which have improved the technique considerably and increased the strength of the fixation. I am not convinced that there is a place for the older device here described. Overall the book provides a current yet incomplete description of procedures available. I must judge it to be uneven, showing great promise for future editions if the illustrations of every chapter were as good as of some.