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Insall & Scott Surgery of the Knee (Fifth ed)

W. Norman Scott pp. 1463 Philadelphia: Elsevier – Churchill Livingstone, 2012 ISBN: 1463 ISBN 978-1-4377-1503-3


Insall & Scott Surgery of the Knee has become such a household name within the orthopaedic fraternity that a formal introduction barely seems required. The first edition was released in 1984 when John Insall engaged 24 contributors to create a single-volume textbook that encompassed the entire knowledge of knee surgery of its day. The book became an instant success and following editions grew in size necessitating the creation of two volumes. The year 2000 saw the amalgamation with W. Norman Scott’s textbook The Knee, and after Insall’s untimely death, Scott took over as sole editor.

The all new fifth edition, which rather unusually for a commercial textbook has received its seal of approval from the American Knee Society, has been condensed into a single volume of approximately 1500 pages. Although the overall number of pages appears to have been reduced compared to the fourth edition, the introduction of 40 chapters available exclusively online indicates that the amount of information provided has continued to grow almost exponentially. The reviewer however regrets that the publisher, probably for economic reasons, has moved away from the two volume format, as this has resulted in a single volume of somewhat cumbersome proportions. Online registration is for the first time offered free with the purchase of the printed version. This will allow the reader access to the fully searchable content of all chapters, an online downloadable image library, a collection of 160 instructional videos, and a glossary of TKR designs with images and text from various device manufacturers. The publisher has indicated that it will provide quarterly updates to the online content, designed to overcome the perpetual lag in providing information on current developments, an intrinsic problem with which textbooks are commonly associated.

Almost all chapters have been updated and the great majority of them have seen a complete re-write, which is mainly due to the introduction of new contributors. Hence very little has remained unchanged compared with the previous edition, with the exception of Insall’s chapter on the history of knee arthroplasty, which still demonstrates Insall’s fascination with this subject matter and which should be compulsory reading for any arthroplasty surgeon. There are many new chapters and most sections have been extended significantly to take account of new developments. More emphasis has been placed on imaging of internal knee derangements with particular focus on cartilage, menisci and ligaments. Rather surprisingly however, the chapter on ‘Imaging of Osseous Knee Trauma’ has been removed from the printed edition and is only accessible online. Sections on basic science, which had been partially excluded from the previous edition, have been re-established, and include wide-ranging discussions of the effects of total knee arthroplasty on knee kinematics and biomechanics. This section however, remains reserved for online access and is not available in print.

The section on Sports Medicine has been enlarged to comprise 40 chapters on the various aspects in the treatment of cartilage, ligament and meniscal injuries, highlighting its importance in a society affected by an increasing desire to maintain a high level of sporting activity beyond the age of retirement. Despite the excellence of individual chapters dealing with the various technological advances available to date, a generalised ‘current concept style’ review is sometimes missing. A case in point is the section on cartilage repair, which appears to lack a chapter that would help the clinician to reflect on the pros and cons of the available cartilage repair techniques, and function as an aid in the decision making process. The section on the treatment of ligament injuries is well structured and written by the leading figures in their respective fields. It is a pleasure to read and even covers aspects like ‘Osteotomy and the cruciate deficient knee’ and ‘Unicompartmental knee arthroplasty in ACL deficient knees’, which provide evidence that the long term consequences of ligament insufficiency and the need for potential remedies have not been ignored. Both chapters are pertinent to the problems most of us are facing already, as the baby boomer generation is heading toward their fifth decade. The section on disorders of the patellar and extensor mechanism has also seen the addition of chapters dealing with distal and proximal re-alignment procedures, MPFL reconstruction and trochleoplasty.

Five additional chapters provide medical background information on the different types of knee arthropathies including gout, crystalline disease, osteo-, rheumatoid and psoriatic arthritis, a subject matter of great importance which is all too often omitted from most surgical text books. The section entitled ‘Joint replacement and its alternatives’ contains a total of 43 chapters covering a diverse spectrum of issues and almost represents a textbook in its own right. Discussed topics include the validity of scoring systems, the place of osteotomy for the arthritic knee, pros and cons of cruciate retention versus substitution, treatment options in uni-, bi- and tricompartmental OA, computer navigation and robotics to name but a few. Aspects on revision and the treatment of complex problems like the management of bone defects, patellar fracture, instability and infection have been given appropriate exposure and will not disappoint.

Some sections have been further enhanced with ‘round table discussions’ between experts emphasising the editor’s ambition in trying to provide a balanced view especially on more controversial subject matters. An entirely new section has been created for this edition focusing predominately on pain management and the prevention of venous thromboembolism in knee surgery. The latter covers the various treatment modalities pertaining to mechanical devices and chemical agents, which are discussed in significant detail and even include a chapter on the European approach to VTE prophylaxis.

Although written by over 300 contributors, the book appears surprisingly homogenous. Chapters are well illustrated with multicolour images and photographs and presented topics are meticulously researched to incorporate the most up-to-date information. Insall may have strived to be a complete knee surgeon when he presented his first edition some 28 years ago but such aspirations are clearly out of the realm of anyone practicing knee surgery today. Access to a regularly updated electronic version will help those who prefer to search the content with the convenience of the computer, and will represent a welcome expansion to the knowledgebase of this traditional textbook, allowing us to keep abreast with new developments. Sections are well structured and chapters are logically organised making it a pleasure to browse through the contents. It is one of a dying breed of major textbooks, which against all odds has stood the test of time by continually evolving and by meeting the demands of the 21st century. Despite its title, the book has succeeded in covering the whole spectrum of surgical and non-surgical treatment, without neglecting basic scientific backgrounds. Overall Insall & Scott Surgery of the Knee is an outstanding publication providing a breadth of information which is hard to find elsewhere making it the ideal source book which will appeal not only to the orthopaedic clinician interested in knee surgery but also to the non-specialist who seeks a deeper understanding on this subject matter.

O. S. Schindler

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