Traditionally, sports Injuries have been sub-optimally managed through Emergency Departments (ED) in the public health system due to a lack of adequate referral processes. Fractures are ruled out through plain radiographs followed by a reactive process involving patient initiated further follow up and investigation. Consequently, significant soft tissue and chondral injuries can go undiagnosed during periods in which early intervention can significantly affect natural progression. The purpose of this quality improvement project was to assess the efficacy of an innovative Sports Injury Pathway introduced to detect and treat significant soft tissue injuries. A Sports Injury Pathway was introduced at Fiona Stanley Hospital (WA, Australia) in April 2019 as a collaboration between the ED, Physiotherapy and Orthopaedic Departments. ED practitioners were advised to have a low threshold for referral, especially in the presence of a history of a twisting knee injury, shoulder dislocation or any suggestion of a hip tendon injury. All referrals were triaged by the Perth Sports Surgery Fellow with early follow-up in our Sports Trauma Clinics with additional investigations if required. A detailed database of all referrals was maintained, and relevant data was extracted for analysis over the first 3 years of this pathway. 570 patients were included in the final analysis. 54% of injuries occurred while playing sport, with AFL injuries constituting the most common contact-sports injury (13%). Advanced Scope Physiotherapists were the largest source of referrals (60%). A total of 460 MRI scans were eventually ordered comprising 81% of total referrals. Regarding Knee MRIs, 86% identified a significant structural injury with ACL injuries being the most common (33%) followed by isolated meniscal tears (16%) and multi-ligament knee injuries (11%). 95% of Shoulder MRI scans showed significant pathology. 39% of patients required surgical management, and of these 50% were performed within 3 months from injury. The Fiona Stanley Hospital Sports Injury Pathway has demonstrated its clear value in successfully diagnosing and treating an important cohort of patients who present to our Emergency Department. This low threshold/streamlined referral pathway has found that the vast majority of these patients suffer significant structural injuries that may have been otherwise missed, while providing referring practitioners and patients access to prompt imaging and high-quality Orthopaedic sports trauma services. We recommend the implementation of a similar Sports Injury Pathway at all secondary and tertiary Orthopaedic Centres

Osteoarthritis (OA) is a disabling disease depriving the quality of life of patients. Mesenchymal stem cells (MSCs) are recently used to modify the inflammatory and degenerative cascade of the disease. Source of MSCs could change the progression and symptoms of OA due to their different metabolomic activities. We asked whether MSCs derived from the infrapatellar fat (IPF), synovium (Sy) and subcutaneous (SC) tissues will decrease inflammatory and degenerative markers of normal and OA chondrocytes and improve regeneration in culture. Tissues were obtained from three male patients undergoing arthroscopic knee surgery due to sports injuries after ethical board approval. TNFa concentration decreased in all MSC groups (Sy=156,6±79, SC=42,1±6 and IPF=35,5±3 pg/ml; p=0,036) on day 14 in culture. On day seven (Sy=87,4±43,7, SC=23±8,9 and IPF=14,7±3,3 pg/ml, p=0,043) and 14 (Sy=29,1±11,2, SC=28,3±18,5 and IPF=20,3±16,2 pg/ml, p=0,043), MMP3 concentration decreased in all groups. COMP concentration changes however were not significant. Plot scores of tissues for PC2-13,4% were significantly different. Based on the results of liquid chromatography-mass spectrometry (LC-MS) metabolomics coupled with recent data processing strategies, clinically relevant seven metabolites (L-fructose, a-tocotrienol, coproporphyrin, nicotinamide, bilirubin, tauro-deoxycholic acid and galactose-sphingosine) were found statistically different (p<0.05 and fold change>1.5) ratios in tissue samples. Focusing on these metabolites as potential therapeutics could enhance MSC therapies. Acknowledgment: Hacettepe University, Scientific Research Projects Coordination Unit (#THD-2020-18692) and Turkish Society of Orthopedics and Traumatology (#TOTBID-89) funded this project. Feza Korkusuz MD is a member of the Turkish Academy of Sciences (TÜBA)

In response to the COVID-19 pandemic public health measures were implemented to limit virus spread. After initial implementation of a province-wide lockdown (Stage 1), there followed a sequential ease of restrictions through Stages 2 and 3 over a 6-month period from March to September 2020 (Table 1). We aimed to determine the impact of COVID-19 public health measures on the epidemiology of operative paediatric orthopaedic trauma and to determine differential effects of each stage of lockdown. A retrospective cohort study was performed comparing all emergency department (ED) visits for musculoskeletal trauma and operatively treated orthopaedic trauma cases at a Level-1 paediatric trauma center during Mar-Sep 2020 (pandemic), compared with Mar-Sep 2019 (pre-pandemic). All operative cases were analyzed based on injury severity, mechanism of injury (MOI) and anatomic location (AL). Comparisons between groups were assessed using chi-square testing for categorical variables, and student t-tests and Fisher's exact tests for continuous variables. During the pandemic period, ED visits for orthopaedic trauma decreased compared to pre-pandemic levels by 23% (1370 vs 1790 patients) and operative treatment decreased by 28% (283 vs 391 patients). There was a significant decrease in the number of operative cases per day in lockdown Stage 1 (1.25 pandemic vs 1.90 pre- pandemic; p < 0 .001) and Stage 2 (1.65 pandemic vs 3.03 pre-pandemic; p< 0.001) but no difference in operative case number during Stage 3 (2.18 pandemic vs 2.45 pre-pandemic; p=0.35). Significant differences were found in MOI and AL during Stage 1 (p < 0 .001) and Stage 2 (p < 0 .001) compared to pre-pandemic. During Stage 1 and 2, playground injuries decreased by 95% and 82%, respectively; sports injuries decreased by 79% and 13%, and trampoline injuries decreased 44% and 43%, compared to pre-pandemic. However, self-propelled transit injuries (bicycles/skateboards) increased during Stage 1 and Stage 2 by 67% and 28%, respectively compared to pre- pandemic. During lockdown Stage 3 there were no differences in MOI nor AL. There were no significant differences in injury severity in any lockdown stage compared to pre-pandemic. COVID-19 lockdown measures significantly reduced the burden of operative paediatric orthopaedic trauma. Differences in volume, mechanism and pattern of injuries varied by lockdown stage offering evidence of the burden of operative trauma related to specific childhood activities. These findings will assist health systems planning for future pandemics and suggest that improvements in safety of playgrounds and self-propelled transit are important in reducing severe childhood injury requiring operative intervention. For any figures or tables, please contact the authors directly

Introduction: The health benefits of physical exercise are well recognised. In recent years the department of health has been encouraging the UK population to exercise more. We aimed to determine if there was any change in the number and pattern of sport and exercise related injuries attending a city Emergency Department (ED) over the past two decades. Methods: We undertook a prospective comparative study of patients attending an ED over two time periods: Aug 85 – April 86 and Aug 04 – April 05. All identified patients had a standardised proforma inserted into their notes which was prospectively completed by the attending clinician at the time of consultation. Results: We observed a 35% increase in sporting injuries over the 19 year period (1000 injuries out of 37036 new patients vs 1351 out of 37526, p< 0.0001). The total number of new patients attending the ED remained unchanged during this time. Males remain the majority of patients with sports injuries (86%). We noted a change in age distribution with a relative increase in patients under 16 yrs (p< 0.0001), a decrease in 16–24 yrs (p=0.0002) and an increase in patients over 40yrs (p< 0.001). There was a significant reduction in patients presenting out of hours and a significant increase in the delay to presenting at ED with the majority of patients presenting over 4 hours after the injury. Football remains the commonest cause of sports injury accounting for half of all sports injuries, followed by rugby but there has been a relative decline in skiing, martial arts jogging and squash as a cause of injury and a significant increase in injuries due to snowboarding, skateboarding and basketball. Conclusion: There has been an increase in the number of sports injuries attending hospital, which may represent a general increase in sport and exercise participation among our population

Introduction and Objective. The rupture of the anterior cruciate ligament is a common sports injury and surgical reconstruction is often required to restore full function of the knee. Hamstring tendons are usually used as autografts. In addition to knee pain and stiffness, infections are feared complications after surgery. Incubation of the autograft in a vancomycin solution until implantation reduced the infection rate by about ten-fold. Recent studies showed no negative effect of vancomycin on the biomechanical properties of porcine tendons. A negative effect of high vancomycin concentrations on chondrocytes and osteoblast is reported, but the effect on tendon and tenocytes is not known. Materials and Methods. Rat Achilles tendons or isolated tenocytes were incubated with an increasing concentration of vancomycin (0 – 10 mg). Tendons were incubated for 0 – 40 minutes, while tenoyctes were incubated for 20 minutes followed by culturing for up to 7 days. Cell viability was assessed with PrestoBlue Assay and live/dead stain. The potential effect of vancomycin on the expression of tendon specific genes and extracellular matrix (ECM) genes was quantified. Possible structural changes of the tendon are analyzed. Results. Incubation of the tendons or tenocytes with 5 mg vancomycin for 20 minutes (clinical use) had no negative effects on the cell viability in the tendons or the isolated tenocytes, while incubation with the toxic control (ethanol) significantly reduced cell viability. Even twice the concentration and a longer incubation time had no negative effect on the cells in the tendons or the isolated cells. Vancyomycin did not affect the expression of Col1a1, Col3a1, and the tenocyte markers mohawk, scleraxis and tenomodulin. Conclusions. The results showed that clinical practice of wrapping the autograft in vancomycin did not impair the tenocyte viability. The expression of collagens and tenocyte markers was also not affected, neither in the incubated tendons nor in the isolated cells. This indicates that vancomycin had no effect on cell phenotype and the formation of the extracellular matrix, which, in addition to cell viability, is important for the performance of the autograft

Aims. To determine the impact of COVID-19 on orthopaediatric admissions and fracture clinics within a regional integrated care system (ICS). Methods. A retrospective review was performed for all paediatric orthopaedic patients admitted across the region during the recent lockdown period (24 March 2020 to 10 May 2020) and the same period in 2019. Age, sex, mechanism, anatomical region, and treatment modality were compared, as were fracture clinic attendances within the receiving regional major trauma centre (MTC) between the two periods. Results. Paediatric trauma admissions across the region fell by 33% (197 vs 132) with a proportional increase to 59% (n = 78) of admissions to the MTC during lockdown compared with 28.4% in 2019 (N = 56). There was a reduction in manipulation under anaesthetic (p = 0.015) and the use of Kirschner wires (K-wires) (p = 0.040) between the two time periods. The median time to surgery remained one day in both (2019 IQR 0 to 2; 2020 IQR 1 to 1). Supracondylar fractures were the most common reason for fracture clinic attendance (17.3%, n = 19) with a proportional increase of 108.4% vs 2019 (2019 n = 20; 2020 n = 19) (p = 0.007). While upper limb injuries and falls from play apparatus, equipment, or height remained the most common indications for admission, there was a reduction in sports injuries (p < 0.001) but an increase in lacerations (p = 0.031). Fracture clinic management changed with 67% (n = 40) of follow-up appointments via telephone and 69% (n = 65) of patients requiring cast immobilization treated with a 3M Soft Cast, enabling self-removal. The safeguarding team saw a 22% reduction in referrals (2019: n = 41, 2020: n = 32). Conclusion. During this viral pandemic, the number of trauma cases decreased with a change in the mechanism of injury, median age of presentation, and an increase in referrals to the regional MTC. Adaptions in standard practice led to fewer MUA, and K-wire procedures being performed, more supracondylar fractures managed through clinic and an increase in the use of removable cast. Cite this article: Bone Joint Open 2020;1-7:424–430

Anterior cruciate ligament (ACL) injuries are one of the most common ligament injury occurring in young and active individuals. Reconstruction of the torn ligament is the current standard of care. Of the many factors which determine the surgical outcome, fixation of the graft in the bony tunnels has significant role. This study compared the clinical and functional outcome in patients who underwent ACL reconstruction by standard anteromedial portal technique with single bundle hamstring graft anchored in the femoral tunnel using rigidfix and cortical button with adjustable loops. The tibial fixation and rehabilitation protocol were same in both groups. 107 patients underwent ACL reconstruction over a two-year period (87 males, 20 females, 44 after motor vehicle accident, 34 after sports injuries, 79 isolated ACL tear, 21 associated medial meniscus tear, 16 lateral meniscus tear and 11 both menisci). Rigid fix group had 47 patients and adjustable loop 60 patients. Clinical evaluation at end of one year showed better stability in rigid fix group regarding Lachman, anterior drawer, pivot shift tests, KT 1000 arthrometer side to side difference and hop limb symmetry index. However, the differences were not statistically significant. Functional evaluation using IKDC 2000 subjective score and Lysholm score showed better results in rigidfix group than variable loop, but was not statistically significant. However, lower scores were noted in patients with concomitant meniscal injury than in isolated acl tear patients and this was statistically significant in both groups. Rigidfix seems to give better graft fixation on femoral side than variable loop, but by the end of one year the functional outcome is comparable in isolated acl reconstructions

This project determines the numbers of UK service personnel with sports related injuries requiring physiotherapy or admission to Bastion Role 3 facility. We identified the trend of the injuries and how they were sustained during. The outcomes were recorded to determine the cost to the mission. Data was collected from April to September 2013. Results included 123 (29% of the deployed contingent in BSN catchment) were unfit for role whilst receiving treatment and 27 personnel (6%) were unable to return to their role in theatre due to their injury. 19 personnel were evacuated to UK, 7 to RCDM and 12 DAH to RRU. The mean length of hospital stay was 2.5 days, the total number of overnight stays was 58. The cost of an overnight stay in a Role 3 hospital bed is £200 and the cost of an escorted Aeromed £8,020. Incidence of sports injuries of UK personnel during H18, requiring role 1 or role 3 interventions was 6.3%. Individual PT accounted for 84% of injuries and 16% due to duty PT. 50% were lower limb injuries (UL – 25%, spine – 25%). Following treatment 94% patients remained in BSN in role, 4% Aeromed to UK. The potential cost was estimated at a minimum of £163,980

A retrospective review of all patients presenting to the multinational integrated medical unit at Sipovo in Bosnia-Herzegovina during the period 1 June 2000 to 30 November 2000 was carried out. During this 6-month period, 203 new patients presented to the orthopaedic surgeon; these patients form the basis of this study. Of the 203 patients, 54 (26.6%) presented with chronic problems, but of these 18 (33.3%) had been exacerbated by sporting activities during the tour. The remaining 149 (73.4%) presented with acute problems, and of these sports injury was the most common cause. Traffic accidents, military training injuries, non-specific trauma (falls, crush injures etc) and acute orthopaedic problems such as sciatica accounted for the remainder of the causes. These data are presented in table 1. Football was again the most common cause of injury accounting for 34.4% of all sporting injuries, and the lower limb, particularly the ankle, was the most common site of injury. The wisdom of allowing this sport, during operational tours, must be questioned. Only 5 (8.2%) of the patients presenting with sports injuries were discharged straight back to full duties. The majority (70.5%) received light duties (mean 14.4 days), but 13 patients (21.3%) required admission to hospital of which 9 were subsequently evacuated out of theatre. The total number of patients used for this review was 203 of which 13 were trauma from traffic accidents, 61 were sporting injuries, 7 from military training, 52 were non specific trauma, 11, the cause was not recorded, 5 were acute non traumatic orthopedic problems, 18 were chronic and exacerbated by sport and 36 were not related to sport at all

The prevalence of knee osteoarthritis (OA) in The United States is approximately 40 million cases, and this number is expected to rise to 60 million by the year 2020. Multiple non-operative treatment options are available for patients, including bracing. Braces can also be used for “pre-habitation” prior to total knee arthroplasty (TKA), after TKA, after traumatic sports injuries, and in neurologic patients. Although, the AAOS recommendations for brace use for treatment of knee osteoarthritis (OA) are “inconclusive”, recent studies have shown improved functional outcomes with the use of off-loader braces for the treatment of uni-compartmental knee OA. In addition, supplemental modalities such as transcutaneous electrical nerve stimulation (TENS) and neuromuscular electrical stimulation (NMES) have demonstrated improved subjective and functional outcomes. These off-loader braces and supplemental modalities are easy to use, may decrease pain, delay TKA, and improve clinical outcomes following surgery. In addition, they may decrease the use of other costly knee OA treatment options such as pain medications and intra-articular injections

Background. To complement subjective patient-reported outcome measures, objective assessments are needed. Activity is an objective clinical outcome which can be measured with wearable activity monitors (AM). AM's have been validated and used in joint arthroplasty patients to count postures, walking or transfers. However, for demanding patients such as after sports injury, running is an important activity to quantify. A new AM algorithm to distinguish walking from running is trialed in this validation study. Methods. Test subjects (n=9) performed walking and running bouts of 30s duration on a treadmill at fixed speeds (walking: 3, 4, 5, 7km/h, running: 5, 7, 9, 12, 15km/h) and individually preferred speeds (slow, normal, fast, maximum, walk/run transition). Flat and inclined surfaces (8%, 16%), different footwear (soft, hard, barefoot) and running styles (hind/fore-foot) were tested. An AM (3D accelerometer) was worn on the lateral thigh. Previously validated algorithms to classify all gait as walking were adapted to differentiate running from walking, the main criterium being vertical acceleration peaks exceeding 2g within each subsequent 2s-interval. Independently annotated video observation served as reference. Results. A total of 312 events had to be classified. Walking bouts (162) were correctly identified in 158 cases resulting in 97.5% detection accuracy. Running bouts (150) were correctly identified in 146 cases (97.3%). In 8 walking bouts (5.0%), an additional running event was falsely detected. These happened at 7km/h and maximum (>8.6km/h) walking speed and during continuous walk/run transitions at individual transition speeds. In 12 running bouts (8.2%), an additional walking event was falsely detected. These happened during slow running (<7km/h). Timing event duration and step counts were >95% accurate. Conclusions. Thigh-worn AM and a simple algorithm can distinguish walking from running at high accuracy and thus can serve doctors, therapists or coaches to objectify outcomes, decisions about effective and safe exercise intensities or return-to-play

Introduction. Hip and groin injuries are common in athletes participating in high level sports. Adductor muscle tendon injuries represent a small but important number of these injuries. Avulsion injuries involving tendons attaching to the symphysis pubis have previously been described and can be managed both operatively and non-operatively. The aim is to describe a rare variant of this injury; complete avulsion of the adductor sleeve complex including adductor longus, pectineus and rectus abdominus. A surgical technique is then outlined which promotes a full return to pre-injury level of sporting activity. Patients/Materials & Methods. Fifteen high level athletes with an MRI confirmed acute adductor complex avulsion injury (6–34 days) were identified from the institution's sports injury database over a 10 year period. All underwent surgical repair. The operative procedure comprised anatomical attachment of the avulsed tissues in all cases (plus mesh reinforcement of the inguinal wall in 7 patients). All underwent a standard format of rehabilitation which was then individualised to be sport specific. Results. One patient developed a superficial wound infection which was successfully treated with antibiotics. 12 out of 15 patients complained of transient local numbness which resolved in all cases. All patients (including 7 elite athletes) returned to their previous level of participation in sport. Discussion. Injury to the triad of adductor longus, pectineus and rectus abdominus should be considered in athletes presenting with groin pain following forced adduction. All athletes underwent early surgical exploration, previous studies have shown prolonged symptoms in early conservative management. Adductor tenotomy has shown previously acceptable results but may be less suitable in elite athletes with higher functional demands when operative repair has been shown to be successful. Conclusion. Operative repair of acute sleeve avulsion of the adductor complex in high level athletes, followed by sport specific rehabilitation promotes return to previous level of participation in sport

Aim:. Ankle sprains are one of the most common sports injuries. Around 10–20 % of the acute ankle sprains may lead to the sequelae of chronic ankle instability. Around 15–35% of the patients have residual pain following successful lateral ligament reconstruction. One of the reasons suggested for the persistent symptoms following lateral ligament reconstruction has been the presence of intra-articular pathology. Methods and materials:. We performed ankle arthroscopy on all patients undergoing the modified Brostrom repair and compared patients with associated intra-articular pathology to those without any intra-articular pathology. Results:. A total of 35 patients underwent the modified Brostrom procedure during the study period. 11/25 patients were found to have associated intra-articular pathology. The average age for both the groups was 33 years. The average follow-up duration was 75 months and 71 months for the intra-articular pathology group and the normal articular groups respectively. The difference in the SAFAS (Sports athlete foot and ankle score) was statistically better in the group without any intra-articular pathology (93.7 compared to 71.6, p-value < 0.05). Conclusions:. The patients who have an associated intra-articular pathology whilst undergoing the stabilisation of lateral ligament instability of the ankle have a slightly poorer outcome compared to those without any intra-articular pathology. Secondly, the SAFAS scoring system seems to overcome the ceiling effect seen in other scoring systems when used for the athletic population

Aims

To report the outcomes of patients with a fracture of the distal tibia who were treated with intramedullary nail versus locking plate in the five years after participating in the Fixation of Distal Tibia fracture (FixDT) trial.

With associated snow sports injury risks being well documented, the scope for preventative medicine is clear. This article focuses on potential precautions taken by skiers/snowboarders and how they vary between different snow sport groups. A total of 181 randomly selected individuals from the Whistler/Blackcomb Medical Centre, Canada, took part in this questionnaire-based cohort study, examining snow sports activity, preventive measures, and protective equipment use. Most individuals were ski area residents of advanced expertise, with 50% having had a previous snow-riding injury. The most commonly reported significant ski injury was anterior cruciate ligament (ACL) rupture, while in snowboarders, it was wrist fracture. Skiers were more likely to improve fitness levels before going onto the slopes, whereas crossover riders (both skiing and snowboarding) were more likely to take lessons. Most individuals used eye and sun protection and had adequately warm clothing. Beyond basic precautions, protective equipment and preventive measures are used infrequently. It is suggested that by increasing awareness and use of such equipment, injury rates may be reduced

Aims

The aim of this study was to compare the longer-term outcomes of operatively and nonoperatively managed patients treated with a removable brace (fixed-angle removable orthosis) or a plaster cast immobilization for an acute ankle fracture.

During the period 2004–2009, 35 children were admitted to the emergency department,(24 males:11 females), aged 3–14 years old,(MEAN 8,45 years), with supracondylar humeral fractures (33 extension type and 2 flexion type). All fractures were closed and result of sports injuries or games and were treated with closed reduction under general anesthesia and percutaneous k-w fixation. The postoperative follow-up lasted from 6 months to 4 years. The Bauman’s angle was evaluated postoperatively on the operated and normal elbow and was 76, 6 ±1° and 74, 7 ±0, 6°. According to Flynn’s criteria the functional outcome was excellent in 29 cases. In 6 cases where the Bauman’s angle was greater than 10–15° there has been observed varus deformity (4 cases), valgus deformity (1 case), and flexion deficit (1 case). The percutaneous k-w fixation and preservation of Bauman’s angle with carrying angle too, on supracondylar humeral fractures on children is a safe solution to avoid future complications

Pelvic fractures in children are rare and potentially disastrous injuries. Using medical records and radiographs over a three year period from January 2008 to March 2011 at an academic hospital we retrospectively analysed the incidence, the associated data and management of these injuries. Results. During this time period 633 paediatric patients where admitted with trauma related injuries; only 19 had pelvic fractures, an incidence of 0.03%. The majority of these patients (13) were involved in PVA's; while MVA (3), fall from height (1) and sports injuries (1) made up the rest. Males (13) were injured more commonly and the average age of the patients was 9 years (3–14). There is debate of over the ideal paediatric pelvic fracture classification system in the literature. However, 13 pelvic fractures were classified stable; 3 were unstable fractures with disruption of the pelvic ring. In addition 2 iliac wing fractures and 1 avulsion (apophyseal) fracture were found. 58% of the patients had associated injuries, however, only 2 of the 19 had associated abdominal viscus injuries. Neither of these required exploratory laparotomy and were managed conservatively. The treatment of these pelvic fractures in our unit was patient specific and largely conservative. 17 patients' pelvic fractures were treated with bed rest, analgesia and mobilisation as pain allowed while the remaining 2 had pelvic external fixators. No ORIF's were performed. Associated orthopaedic injuries were managed accordingly. The average hospital stay of a patient with a pelvic fracture was 15 days (3–48 days). There were no mortalities during this time period

Background. Adductor muscle and tendon injuries are commonly seen in sport. Complete adductor avulsions have been described and can be managed non-operatively or operatively. A rare variant of this injury is the complete avulsion of the adductor complex with the pectineus and rectus abdominus amounting to a complete sleeve avulsion from the pubis. This is a severe injury that is increasingly recognised due to improved imaging and lower diagnostic threshold. Purpose. We describe the surgical management of twelve athletes with this severe injury. Study design. Prospective case series - Level of evidence, 4. Methods. All the injuries were prospectively collected onto our institutional pelvic sports injury database. This series summarises the outcome in twelve consecutive cases where surgery was undertaken after presentation with an acute avulsion (6–34 days) in athletes. The procedure comprised anatomical reattachment of the avulsed tissues with mesh reinforcement of the inguinal wall in seven patients. An independent physiotherapist reviewed all patients. Results. One patient developed a superficial wound infection treated with antibiotics. Transient complaints of local numbness were common but all twelve sportsmen returned to high-level sport (five elite) at an average of thirteen weeks (10–21 weeks). Conclusion. Awareness of the possibility of this complex injury is important and there should be a low threshold for investigation. In elite athletes operative intervention is associated with good clinical outcomes and successful return to sport

Aims

The effects of remnant preservation on the anterior cruciate ligament (ACL) and its relationship with the tendon graft remain unclear. We hypothesized that the co-culture of remnant cells and bone marrow stromal cells (BMSCs) decreases apoptosis and enhances the activity of the hamstring tendons and tenocytes, thus aiding ACL reconstruction.