Purpose We describe a simple method of dressing pin sites, based on the principles developed in the Ilizarov Institute, that can be easily used in British operating theatres.

Method There are a wide variety of protocols for pin site care but infection rates of up to 80% are reported. The Russian Ilizarov Institute claim low infection rates which may be influenced by their dressing technique. Pin sites are dressed with gauze sponges held against the skin with specifically manufactured rubber stoppers passed over the wires. These provide pressure at the pin site. Plastic syringes consist of a barrel and a plunger with a rubber bung. The rubber bung from a 5ml syringe plunger can be easily removed and slid over the end of a half-pin or both ends of a fine wire. This must be done before the frame is attached and we recommend applying the bungs each time a pin is inserted. At the end of the procedure a cut piece of gauze is applied around the pin site and held in place by the rubber bung, providing a secure non-bulky dressing. A dressing protocol developed by the senior author, based on “The Russian Protocol”, was audited and found to have made a significant impact on the incidence on pin track infection. The bungs can be slid back up the pin when the dressings are changed and left up if the pin site is to remain uncovered. Should the pin site begin to discharge the bung can again be used to hold the dressings securely.

Conclusion We have found this to be a simple, quick, inexpensive and reliable method of pin site dressing that can be readily used in everyday practice, and, reduces the pin track infection incidence.

Aim: This investigation compares the tibial tunnel appearances at 1 year and again at 8 years post-operatively in 49 patients and reports on the clinical significance of these appearances. Materials and Methods:49 consecutive patients who underwent isolated central anterior cruciate ligament reconstruction using a four stranded hamstring tendon technique comprised the study group. The patients were reviewed clinically and with weight bearing AP and Lateral radiographs at one year and eight years (range 5–9years) from reconstruction. Two blinded observers measured the tunnel diameters using a digital caliper on the 1year and 8 year radiographs. Tunnel enlargement was calculated from the known drill size with correction for magnification. The findings were correlated with clinical outcome and various associations were studied. Results: At one year postoperatively tunnels had increased in diameter by a mean of 26% at the proximal end, and by 19% at the distal end. By 8 years both measurements had reduced to 20% and to 13% respectively and this decrease in tunnel enlargement was significant (p< 0.05). Tunnel enlargement was significantly greater in those knees with persistent effusion at one year. (P< 0.05). 10 patients (26%) had distal tibial tunnel diameters which were less than the original drill size and of these ten patients only one had a positive Lachman (side to side difference> 3mm) compared to 9 in the rest. (P< 0.05). Conclusion: Tunnel enlargement that occurs at 1yr reduces by 8 years from reconstruction. Decrease in tunnel enlargement at the distal end is associated with an improved and lasting stability.