Progressive collapsing foot deformity (PCFD) is a complex foot deformity with varying degrees of hindfoot valgus, forefoot abduction, forefoot varus, and collapse or hypermobility of the medial column. In its management, muscle and tendon balancing are important to address the deformity. Peroneus brevis is the primary evertor of the foot, and the strongest antagonist to the tibialis posterior. Moreover, peroneus longus is an important stabilizer of the medial column. To our knowledge, the role of peroneus brevis to peroneus longus tendon transfer in cases of PCFD has not been reported. This study evaluates patient reported outcomes including pain scores and any associated surgical complications for patients with PCFD undergoing isolated peroneus brevis to longus tendon transfer and gastrocnemius recession. Patients with symptomatic PCFD who had failed non-operative treatment, and underwent isolated soft tissue correction with peroneus brevis to longus tendon transfer and gastrocnemius recession were included. Procedures were performed by a single surgeon at a large University affiliated teaching hospital between January 1 2016 to March 31 2021. Patients younger than 18 years old, or undergoing surgical correction for PCFD which included osseous correction were excluded. Patient demographics, medical comorbidities, procedures performed, and pre and post-operative patient related outcomes were collected via medical chart review and using the appropriate questionnaires. Outcomes assessed included Visual Analogue Scale (VAS) for foot and ankle pain as well as sinus tarsi pain (0-10), patient reported outcomes on EQ-5D, and documented complications. Statistical analysis was utilized to report change in VAS and EQ-5D outcomes using a paired t-test. Statistical significance was noted with p<0.05. We analysed 43 feet in 39 adults who fulfilled the inclusion criteria. Mean age was 55.4 ± 14.5 years old. The patient reported outcome mean results and statistical analysis are shown in Table one below. Mean pre and post-operative foot and ankle VAS pain was 6.73, and 3.13 respectively with a mean difference of 3.6 (p<0.001, 95% CI 2.6, 4.6). Mean pre and post-operative sinus tarsi VAS pain was 6.03 and 3.88, respectively with a mean difference of 2.1 (p<0.001, 95% CI 0.9, 3.4). Mean pre and post-operative EQ-5D Pain scores were 2.19 and 1.83 respectively with a mean difference of 0.4 (p=0.008, 95% CI 0.1, 0.6). Mean follow up time was 18.8 ± 18.4 months. Peroneus brevis to longus tendon transfer and gastrocnemius recession in the management of symptomatic progressive collapsing foot deformity significantly improved sinus tarsi and overall foot and ankle pain. Most EQ-5D scores improved, but did not reach statistically significant values with the exception of the pain score. This may have been limited by our cohort size. To our knowledge, this is the first report in the literature describing clinical results in the form of patient reported outcomes following treatment with this combination of isolated soft tissue procedures for the treatment of PCFD. For any figures or tables, please contact the authors directly

Objectives. The purpose of this study was to examine the effect of posterior cruciate ligament (PCL) retention, PCL recession, and PCL excision during cruciate-retaining total knee replacement. Methods. A total of 3018 anatomic graduated component total knee replacements were examined; 1846 of these retained the PCL, 455 PCLs were partially recessed, and in 717 the PCL was completely excised from the back of the tibia. Results. Clinical scores between PCL groups favored excision for flexion (p < 0.0001), and recession and retention for stairs (p < 0.0001). There was a mild difference in long-term all-cause aseptic survivorship between PCL-retained (96.4% at 15 years) combined with PCL-recessed groups (96.6% at 15 years) when compared with the PCL-excised group (95.0% at 15 years) (p = 0.0411, Wilcoxon; p = 0.0042, log-rank), as well as tibial or femoral loosening, which reported prosthesis survival of 97.8% at 15 years for PCL-retained knees, 98.2% for recessed knees, and 96.4% for excised knees (p = 0.0934, Wilcoxon; p = 0.0202, log-rank). Conclusions. Despite some trade-off in clinical performance, if the PCL is detached at the time of operation, conversion to a posterior-stabilised prosthesis may not be necessarily required as long as stability in the anteroposterior and coronal planes is achieved

The purpose of this study was to determine the incidence of graft-tunnel mismatch (GTM) when performing anatomic anterior cruciate ligament reconstruction (ACLR) using bone-patella tendon-bone (BPTB) grafts and anteromedial portal drilling. Beginning in November 2018, 100 consecutive patients who underwent ACLR by two sports fellowship-trained, orthopedic surgeons using BPTB autograft and anteromedial portal drilling were prospectively identified. The BPTB graft dimensions and the femoral tunnel distance, tibial tunnel distance, intra-articular distance, and total distance were measured. Surgeons determined the depth and angle of tunnels based on the patella tendon graft length dimensions in each case. After passage of the graft, the distance from the distal graft tip to the tibial cortex aperture was measured. GTM was defined as the need for additional measures to obtain satisfactory tibial graft fixation (< 1 5e20 mm of bone fixation). The incidence of mismatch was 6/100 (6%). Five cases involved the graft being too long, with the tibial bone plug protruding excessively from the tibial tunneld4/5 had a patella tendon length ? 50 mm. Three cases were managed with femoral tunnel recession, and two were treated with a free bone plug technique. One patient with a patella tendon length of 35 mm had a graft that was too short, with the tibial bone plug recessed in the tibial tunnel. Of patients whose tibial tunnel distance was within 5 mm of the patella tendon length, only 1/46 (2%) patients had mismatch, whereas 5/54 (9%) of patients who had >5 mm difference had mismatch. The incidence of grafttunnel mismatch after anatomic ACLR using BTPB and anteromedial portal drilling in this study is 6%. To limit the occurrence of GTM where the graft is too long, surgeons should drill tibial tunnel distances within 5 mm of the patella tendon length

Laboratory evidence has shown that tears within the substance of the triangular fibro-cartilaginous complex (TFCC) of the wrist are caused by shear and/or compressive forces rather that by distraction. They are commonly associated with ulnocarpal abutment syndrome (UCAS). A number of different methods of treatment have been advocated for UCAS but no satisfactory comparison of these has been reported. To compare the results of different forms of treatment for UCAS. The notes of 76 patients who had undergone wrist arthroscopy for UCAS were reviewed independently. The diagnoses made at the time of the arthroscopies and any surgical interventions (shaving the torn TFCC back to stable tissue, wafer resection of the ulnar head, repair of the TFCC) that were made at the same time were recorded. The results of these interventions were noted, as were any subsequent surgical procedures for persisting pain. These results were compared with those of a meta- analysis of the results for similar procedures published in the literature. All 76 patients had TFCC tears, four were repaired arthroscopically and the remainder underwent debridement. Nineteen of these had, in addition, arthroscopic wafer procedures carried out. Of the 53 who had only debridement 63% were graded as good or excellent. The remainder underwent formal ulnar recessions and 93% of these improved and were graded as good or excellent. Of the 19 who had wafer procedures 53% were graded as good or excellent. Seven (36%) of this group underwent ulnar recessions with five (66%) improving to be graded as good or excellent. There were no major complications such as infection, nonunion or failure of the internal fixation. Of the four cases in which the TFCCs were repaired arthroscopically, three were graded as good or excellent. One remained the same and underwent and ulnar recession and improved to be graded as good. From the meta-analysis 72% of patients who were treated by debridement alone were graded as good or excellent, while 66% were good or excellent after debridement combined with a wafer procedure. The patients who were treated by ulnar recession had a larger proportion of good or excellent results with 92% reaching this level of satisfaction. From these results it was concluded that arthroscopic debridement of tears of the TFCC was effective treatment in a majority of patients. The arthroscopic wafer procedure was effective as long as adequate bone was resected. Persisting symptoms of UCAS were very adequately treated by ulnar recession

The August 2012 Children’s orthopaedics Roundup. 360. looks at: whether 3D-CT gives a better idea of coverage than plain radiographs; forearm fractures after trampolining accidents; forearm fractures and the Rush pin; the fractured distal radius; elastic stable intramedullary nailing for long-bone fractures; aponeurotic recession for the equinus foot; the torn medial patellofemoral ligament and the adductor tubercle; slipped capital femoral epiphysis; paediatric wrist arthroscopy; and Pirani scores and clubfoot

Jimmy Craig had many talents and virtues. A keen sportsman, he played rugby for his school and university and in his younger days was an amateur boxer of note. Directly from medical school he joined the Medical Corps of the South African Forces fighting in the Western desert, and then went up the boot of Italy. On his return to Johannesburg, his home town, he developed expertise in cerebral palsy treatment and surgery. From about 1970 until the year before his death in 1992, he regularly visited Ikhwezi Lokusa School for the Orthopaedically Handicapped, just outside Umtata, once or twice a year. His visits lasted a week at a time. In those years he assessed approximately 1 500 children and operated on about 600. For the first 15 years, the operations were almost exclusively soft tissue surgery: tendon lengthening, tendon transfers and clubfoot releases. As the facilities in Umtata were upgraded, he performed an increasing amount of bone surgery. The operations he did were mainly on the lower limbs. They included lengthening of the triceps surae at the level of the gastrocnemius, lengthening of the tendo Achillis, release of hamstrings and hip adductors, recession of iliopsoas recession at the hips and Souter slides. On the upper limbs he fairly regularly performed surgical release of the first web space and release of flexor carpi ulnaris. He closely supervised the postoperative care provided by the school, which always had at least one expert Bobarth trained physiotherapist in residence

Aims

Posterior malleolar (PM) fractures are commonly associated with ankle fractures, pilon fractures, and to a lesser extent tibial shaft fractures. The tibialis posterior (TP) tendon entrapment is a rare complication associated with PM fractures. If undiagnosed, TP entrapment is associated with complications, ranging from reduced range of ankle movement to instability and pes planus deformities, which require further surgeries including radical treatments such as arthrodesis.

Aims

To systematically review the efficacy of split tendon transfer surgery on gait-related outcomes for children and adolescents with cerebral palsy (CP) and spastic equinovarus foot deformity.

Introduction. Traditional treatment of idiopathic flatfoot in the adult population include calcaneal neck lengthening or fusions. These surgical methods result in abnormal function with significant complication rates. Our prospective study aimed to quantify the functional and radiological outcome of a new technique for spring ligament reconstruction using a hamstring graft, calcaneal osteotomy and medial head of gastrocnemius recession if appropriate. Methods. 22 feet were identified from the senior authors flatfoot reconstructions over a 3 year period (Jan 2013 to Dec 2015). 9 feet underwent a spring ligament reconstruction. The control group were 13 feet treated with standard tibialis posterior reconstruction surgery. Follow up ranged from 8 to 49 months. Functional assessment comprised VAS heath and pain scales, EQ-5D and MOXFQ scores. Radiographic analysis was performed for standardised parameters. Results. Each group contained two bilateral procedures. The spring ligament patients had a mean age of 43, BMI of 29 and a male to female ratio of 4;1 There were no statistical differences between groups starting point functional scores or pre-operative radiological deformity. Post-operatively there was a statistically significant improvement of all domains and overall MOXFQ, EQ5d and VAS in the spring ligament patients. There was a statistically significant improvement in all radiological parameters with all patients being returned to normal. Functional scores were not significantly better than the control group [MOXFQ components, Control vs spring ligament group, Pain: 42 vs 45 (p=0.71), Walking: 50 vs 56 (p=0.43), Social: 35 vs 39 (p=0.72), EQ-5D: 0.64 vs 0.70 (p=0.72)]. Spring ligament reconstruction produced statistically better deformity correction for 4 of 5 measured radiological parameters (p< 0.05). Conclusion. Our new method of spring ligament reconstruction restores normal anatomy. In comparison to traditional procedures our method provides equivalent functional results and improved deformity correction

Aims

Research on hip biomechanics has analyzed femoroacetabular contact pressures and forces in distinct hip conditions, with different procedures, and used diverse loading and testing conditions. The aim of this scoping review was to identify and summarize the available evidence in the literature for hip contact pressures and force in cadaver and in vivo studies, and how joint loading, labral status, and femoral and acetabular morphology can affect these biomechanical parameters.

Laxity Differences in CR & PS TKA -Achieving Total Knee Balancing Using Bone Cut Adjustments and Correlation with Varus-Valgus Lift-Off. The Incidence and Mid Term Functional Effect of Partial PCL Recession in Fixed and Mobile Bearing PCL Retaining TKA. Clinical and Radiographic Results of a Modern Design, Onlay Patellofemoral Arthroplasty at a Minimum Two-Year Follow-Up. Custom Cutting Guides Do Not Improve Total Knee Arthroplasty Outcomes at 2 Years Follow-up. Tourniquet Use During TKA -Effect on Recovery of Strength and Function: a randomised, double-blind, control trial. Prospective, Randomised Trial of Standard vs Cross-linked Tibial Poly. Crosslink vs. Conventional TKA Poly Retrieval Analysis. Unplanned Readmissions after TKA Using a Statewide Database. Does Prior Cartilage Restoration Negatively Impact Outcomes of TKA. Periprosthetic Femur Fracture: Better to Revise than to Fix. Increased Non-stemmed Tibial Failures in Patients with a BMI ≥ 35. The Effect Of Canal Fit And Fill in Revision THA With Modular, Fluted, Tapered Stems. The Wagner Cone Stem For The Challenging Femur In Primary Total. Will Metal Heads Restore Integrity of Corroded Trunnions at Revision THR?. Influence of Head Size, Materials and Taper Design on Fretting and Corrosion of Metal on Polyethylene THR. Delta Ceramic on Ceramic THA – Midterm IDE Study Results. Refining Acetabular Safe Zone for Posterior Approach in THA. Comparison of a Pain Program for THA with and without Liposome Bupivacaine

Aims

This study uses prospective registry data to compare early patient outcomes following arthroscopic repair or debridement of the acetabular labrum.

Tarsometatarsal arthritis must be evaluated in conjunction with naviculocuneiform joint arthritis, as the two generally coexist. Primary osteoarthritis or systemic arthritis generally leads to uncomplicated non-deformity correction through arthrodesis. Challenges in correction become more pronounced following Lisfranc injury, where deformity and ligament instability introduce malalignment that mandates osteotomies to correct deformity. Diagnosis hinges on both CT scan data and selective diagnostic injections under fluoroscopy. The surgeon must simultaneously consider minimising bone resection to lessen the impact of metatarsal shortening. In addition, the three columns of the foot must be respected with reference to midfoot arthrodesis rules, introducing challenges in operative reconstruction as the lateral column mandates preserved flexibility. In addition, collapse at the midfoot often leads to a rigid pes planovalgus deformity, and the surgeon must consider when it is appropriate to add a medial slide calcaneal osteotomy and gastrocnemius recession. Finally, naviculocuneiform joint arthrodesis, if required, introduces significant technical challenges in both alignment and fixation that will be addressed

Aims

The aims of this study were: 1) to describe extended restricted kinematic alignment (E-rKA), a novel alignment strategy during robotic-assisted total knee arthroplasty (RA-TKA); 2) to compare residual medial compartment tightness following virtual surgical planning during RA-TKA using mechanical alignment (MA) and E-rKA, in the same set of osteoarthritic varus knees; 3) to assess the requirement of soft-tissue releases during RA-TKA using E-rKA; and 4) to compare the accuracy of surgical plan execution between knees managed with adjustments in component positioning alone, and those which require additional soft-tissue releases.

Aims

This is a multicentre, prospective assessment of a proportion of the overall orthopaedic trauma caseload of the UK. It investigates theatre capacity, cancellations, and time to surgery in a group of hospitals that is representative of the wider population. It identifies barriers to effective practice and will inform system improvements.

In this prospectively randomized study, we compared the changes in the range of motion (ROM) in posterior cruciate ligament-retaining (PCLR) (n=50) and -sacrificing (PCLS) (n=50) total knee arthroplasties during the perioperative period. The median ROM in PCLR prostheses was 122.5° preoperatively, 120.0° intraoperatively, and 100.0° at discharge, and 115.0°, 120.0°, and 95.0°, respectively, in PCLS. The designs did not differ statistically in each period (p> 0.05). Both designs showed significant correlations between the preoperative and intraoperative ROM, and between the preoperative and discharge ROM. Only the PCLS showed a significant correlation between the intraoperative and discharge ROM. Since the PCL tenses with flexion, the degree of preoperative degeneration, intraoperative recession, and postoperative tension of the PCL may have played a major role in the results. The PCLS design has an advantage in rehabilitation planning because of the predictable changes in the ROM during the perioperative period, although the acquired average ROM at discharge did not differ statistically

Purpose of Study. In children with spastic diplegia, surgery for equinus has a high incidence of both over and under correction. We wished to determine if conservative (mainly Zone 1) surgery for equinus gait, in the context of multilevel surgery, could result in the avoidance of calcaneus and crouch gait as well as an acceptable rate of recurrent equinus, at medium term follow-up. Description of Methods. This was a retrospective, consecutive cohort study of children with spastic diplegia, between 1996 and 2006. All children had distal gastrocnemius recession or differential gastrocsoleus lengthening, on one or both sides, as part of Single Event Multilevel Surgery. The primary outcome measures were the Gait Variable Scores (GVS) and Gait Profile Score (GPS) at two time points after surgery. Summary of Results. Forty children with spastic diplegia, GMFCS Level II and III were eligible for inclusion in this study. There were 25 boys and 15 girls, mean age 10 years at surgery. The mean age at final follow-up was 17 years and the mean postoperative follow-up period was seven years. The mean ankle GVS improved from 18.5° before surgery to 8.7° at short term follow-up (P<0.005) and 7.8° at medium term follow-up. Equinus gait was successfully corrected in the majority of children with a low rate of over-correction (2.5%) but a high rate of recurrent equinus (35.0%), as determined by sagittal ankle kinematics. Conclusion. Surgery for equinus gait, in children with spastic diplegia, was successful in the majority of children, at a mean follow-up of seven years, when combined with multilevel surgery, orthoses and rehabilitation. No patients developed crouch gait and the rate of revision surgery for recurrent equinus was 12.5%. NO DISCLOSURES

Purpose: Insertional calcific Achilles tendinosis is a painful, frequently disabling, condition. The longitudinal and radial alignment of the angiosomes of the posterior region of the leg makes a straight posterior midline approach logical. The safety of the posterior midline approach and the outcome of a central tendon splitting approach associated with a Strayer procedure to treat this condition was evaluated. Method: A retrospective review of a consecutive cohort of a single surgeon was performed. All patients had failed conservative treatment and all patients were primary cases. Forty-seven patients (48 heels) were treated over a 11-year period for chronic insertional Achilles tendinosis. All patients underwent a midline posterior splitting approach, debridment of the bursae, resection of the haglund deformity, partial Achilles detachment, debridement, reinsertion with bone anchor associated with a proximal gatrocnemius recession (strayer procedure) through a second midline incision. The average age was 59 years old (39–75), co-morbidities included four smokers and one diabetic patient. The average followup was 54 months (15–144). All patients answered pre-op and latest follow up AOFAS questionnaire, satisfaction rate and complications were reviewed. Results: Satisfaction rate was 100%. AOFAS score improved significantly from 59 (36–80) preop to 97 (90–100) at the latest follow-up. Complications included one superficial infection and one sural nerve paresthesia. There were no major complications. Conclusion: Achilles insertional tendinopathy treated by a posterior midline approach is a safe and reliable procedure. The procedure was associated with high patient satisfaction rate and excellent outcome

Introduction. Femoroacetabular impingement (FAI) causes anterior hip pain, labral tears and damage to the articular cartilage leading to early osteoarthritis of the hip. Surgical hip dislocation and osteoplasty of the femoral neck and acetabular rim is a technique pioneered by the Bernese group for the treatment of FAI. We present and discuss our results of this technique. Methods. Functional outcome was measured in hips with over 12 month follow-up using the Oxford hip and McCarthy non-arthritic hip scores pre- and post-operatively. Results. From March 2003 to December 2005, 79 hips underwent surgical hip dislocation for treatment of FAI. Ten were skeletally immature and excluded. In 16 hips, grade 4 osteoarthritis was present in greater than 10 × 10mm regions after reshaping of the abnormal anatomy. In these cases, hip resurfacing was performed. Of the 53 hips preserved (average age 37(17-65)), 35 had the labrum detached, debrided and reattached using bone anchors, 32 underwent recession of the acetabular rim at the site of impingement, 21 had chondral ‘carpet’ flaps debrided, 5 had removal of medial osteophytes, 7 had labral and/or bony cysts excised and grafted and 1 underwent an osteochondral graft. In 5 hips osteoarthritis progressed requiring hip resurfacing at an average of 8 months. Oxford Hip Score improved from an average 32 (range 13-59) to 23 (12-45) and McCarthy hip score from 50 (19-76) to 63 (28-79) in the preserved hips at an average 20 months following surgery (range 12-38 months). Conclusion. The early results of surgical hip dislocation are encouraging. The open procedure has distinct advantages compared to arthroscopy enabling a wider range of lesions to be treated. Careful patient selection is important in order to exclude patients with hip osteoarthritis. Long-term follow-up is required to see if this technique prevents the natural progression to osteoarthritis

Introduction: Femoroacetabular impingement (FAI) causes anterior hip pain, labral tears and damage to the articular cartilage leading to early osteoarthritis of the hip. Surgical hip dislocation and osteoplasty of the femoral neck and acetabular rim is a technique pioneered by the Bernese group for the treatment of FAI. We present and discuss our results of this technique. Methods: Functional outcome was measured using the Oxford hip and McCarthy non-arthritic hip scores pre and post-operatively. Results: Since January 2003, 36 hips in 34 patients (average age of 43 years (14–65)) underwent surgical hip dislocation for treatment of FAI. In 9 hips, grade 4 osteoarthritis was present in greater than 10 x 10mm regions after reshaping of the abnormal anatomy. In these cases, hip resurfacing was performed. Of the 27 hips preserved, 14 had chondral ‘carpet’ flaps debrided, 17 underwent recession of the acetabular rim at the site of impingement, 6 had removal of medial osteophytes, 6 had labral and/or bony cysts excised and grafted and 1 underwent an osteochondral graft. Oxford Hip Score improved from an average 36 (range 17–59) to 23 (12–45) and McCarthy hip score from 43 (9–74) to 62 (36–72) in the preserved hips at an average 15 months following surgery (range 6–33 months). Discussion: The early results of surgical hip dislocation are encouraging. Careful patient selection is important in order to exclude patients with hip osteoarthritis. Long-term follow-up is required to see if this technique prevents the natural progression to osteoarthritis