Book Review

Knee Surgery: Current Practice

N Engl J Med 1993; 329:367-368July 29, 1993

Article

Knee Surgery: Current Practice
Edited by Paul M. Aichroth and W. Dilworth Cannon, Jr. 802 pp., illustrated. New York, Martin Dunitz/Raven Press, 1992. $250. ISBN: 0-88167-934-8

Knee surgery has evolved over the past decade into a major part of orthopedic surgical practice. Currently, the definitive postgraduate textbook is that by John Insall (Surgery of the Knee. New York: Churchill Livingstone, 1984), which has not since been revised since 1984 and therefore has fallen a little out of date, particularly the sections on arthroscopic surgery and ligament reconstruction. The authors of Knee Surgery have made an effort to fill the need for an updated postgraduate knee-surgery textbook, with particular emphasis on rapidly changing areas. The book has 21 major sections comprising 96 chapters, contains 788 pages of text, and has 95 authors.

The book is generally well written, with some excellent chapters by respected experts in their fields. Numerous high-quality illustrations complement the text. Included at the back of the book are several appendixes presenting the various knee-assessment scoring systems, which the postgraduate student will find very useful.

Although written as a postgraduate textbook, this book falls short of achieving its aims primarily because of its unusual structure. It is divided into sections, each beginning with a brief overview. In some sections there are good chapters on surgical techniques for certain operative procedures, but not all sections have such a chapter. The authors describe their own techniques, but they do not discuss variations and alternatives. The book therefore has many deficiencies as a textbook of surgical techniques.

Many of the authors have been given the same brief. This is particularly evident in the sections covering the more controversial aspects of knee surgery, such as ligament reconstruction. This material will be of interest to the experienced reader who may have attempted several different methods for a certain surgical procedure and wishes to know about alternatives and contrasting views. To the postgraduate student, however, this variety of approaches may be confusing. It is left to the reader to decide which chapters describe the method of choice and which reflect an outdated and discredited mode of treatment. The chapter on the use of carbon fiber-containing prostheses for cruciate-ligament reconstruction is particularly misleading. The author argues strongly for their use in place of other procedures such as the autogenous patellar-tendon graft -- a view contrary to that held by the majority of knee surgeons. The chapter and section summaries by the editors include no qualifying statements to guide the reader, who may not be aware of the clinical and biomechanical research of independent workers not quoted in the book, which contrasts with the results presented.

The several chapters on the retrospective audit of knee surgery at the Westminster Hospital appear out of place, since there are no contrasting data from other centers. The research reflects the overall tendency toward retrospective rather than prospective controlled trials to justify certain surgical procedures. To gain a wider understanding of the research literature, I would hope that the postgraduate student would read the relevant research journals.

The book does contain some very good chapters, notably on imaging of the knee, acute anterior cruciate-ligament injuries, chondral and osteochondral lesions, and documentation and evaluation in disorders of the knee. Though arthroscopic surgery and ligament reconstruction are covered in depth (238 pages), other topics are covered fairly briefly. These include the biomechanics of the knee (14 pages), patellofemoral joint disorders (60 pages), and fractures around the knee (15 pages).

The undergraduate student will find this book too detailed, but the postgraduate student will find the factual information necessary for higher surgical examinations. In addition, the reader will gain a good understanding of the current practice of knee surgery in selected centers. Unfortunately, the information is fragmented, often repeated in sequential chapters, lengthy, and lacking in easily remembered key points.

In summary, this book is not a textbook essential for postgraduate students in knee surgery. The most useful textbook for this purpose remains Surgery of the Knee. However, this new book would be a valuable addition to an orthopedic library and may be very useful for the postgraduate student in orthopedic surgery who wishes to gain a detailed understanding of knee surgery before higher surgical examinations.

David P. Johnson, M.B., Ch.B., F.R.C.S., F.R.C.S.(Orth.), M.D.
The Glen Hospital, Bristol BS6 7JJ, United Kingdom