The study was established to assess the long-term results and differences between autogenous and synthetic anterior cruciate ligament (ACL) reconstruction.

We randomised 50 patients into 2 groups: 26 (52%) underwent reconstruction with middle third patellar tendon graft (PTG) harvested using the ‘Graftologer’ (Neoligaments) and 24 (48%) underwent reconstruction with the Leeds-Keio ligament (LK).

Subjective knee function was assessed using the Lysholm score, Tegner activity score, IKDC grading, and clinical assessment of anterior knee pain. Laxity was tested clinically, including anterior draw at 20° (Lachman), pivot shift, and arthrometric measurements using the Stryker laxometer.

At five years we have noted no significant difference in Lysholm scoring and Pivot shift between the LK group and patellar tendon group. But there was a significant difference in Tegner activity level and IKDC activity scores with PTG faring better at five years. There is no significance difference in anterior knee symptoms between the groups.

Conclusion: Due to the success of PTG/Hamstring in routine primary ACL reconstruction there does not seem to be a role for artificial ligaments. However, if we just look at functional outcome and patient satisfaction, LK patients seem to be doing as well as PTG at five years. So, there may be a place for the Leeds Keio graft where autologous tissue is unavailable.

We describe a successful modified operative procedure at an average 19 months follow-up in 3 patients with congenital dislocation of the patella and compare its merits to the other procedures already reported in the literature.

Congenital dislocation of the patella may be associated with other congenital conditions or syndromes i.e. Down’s syndrome, congenital vertical talus and cerebral palsy. Numerous operative techniques have been described in the literature which may be divided into 3 basic groups. A modification of the Langenskiold & Ritsila procedure is described. The original procedure describes an extensive lateral release with detachment and medial transfer of the patellar tendon through a curved incision. The tendon is routed through a fold of synovium medially and fixed distally to bone with sutures through drill holes in the proximal tibia. We found at surgery this synovium was too fragile to hold the transferred tendon and the use of drill holes unnecessary. The main alterations include a limited and straight anterior skin incision, a fashioning of a ‘buckle’ of the transferred distal patellar tendon to a distally based flap which avoids drill holes in the growing bone. This modification of the Langenskiold procedure was used successfully in 3 cases, including a revision of a failed Goldthwaite- Roux procedure in a mentally handicapped child. The results at average 19 months follow-up are successful. The early results confirm that the patella remains located and tracks normally. The valgus and flexion deformities have significantly improved.

This modification of the Langenskiold & Ritsila procedure requires less dissection than other operations, with no bony surgery and a cosmetic scar. The Langen-skiold & Ritsila procedure has been successful and we feel that this modification simplifies and improves on the original technique.

Introduction: There are a number of classification systems for inter trochanteric fractures of the proximal femur but none that have been universally accepted. For a classification to be successful, it should have excellent reliability and reproducibility among all reviewers in the interpretation of the radiographs. Although the Tronzo classification system is used for inter trochanteric fractures, its reliability had not been tested yet.

Aims: The purpose of this paper is to present the interobserver and intraobserver reliability of the Tronzo classification for intertrochanteric fractures of the femur.

Methods: The radiographs of 50 patients with inter trochanteric fractures were classified by seven observers according to Tronzo’s classification. Three observers were consultant orthopaedic surgeons with a minimum 12 years orthopaedic experience and four were orthopaedic residents. All observers worked independently. The observers repeated the measurements three weeks later without reference to the previous assessments. Intra- and inter-observer agreement was evaluated using the weighted kappa (k) coefficient of Cohen as calculated by the Stata computer package.

Results: For time1, the inter-observer is 0.19 (95% CI 0.05 to 0.43) and for time 2 it is 0.20 (95% CI 0.06 to 0.44): jointly the kappa estimate is 0.20 (95% CI 0.09 to 0.36).

For the intra-observer reliability, the kappa is sightly higher, as one would expect, although it is still only 0.41 (95% CI 0.25 to 0.55).

Overall, the inter-observer reliability is slight (and at best, fair) and the intra-observer reliability is moderate. For clinical use a kappa of 0.8 is strongly recommended and clearly this was not achieved.

Discussion: Tronzo’s classification is simple, easy to use and is predictive of the method of reduction unlike the AO/ASIF classification that is more complicated with several groups and subgroups. However there is poor interobsever reliability as shown in our study. This suggests that comparison of results between studies using the Tronzo classification is not reliable enough to be of use. It should be stressed that reliability studies are not a measure of the accuracy of the classification. There is no right or wrong response in grading each radiograph. The analysis purely measures the reproducibility of the response between several observers.

Intraobserver reliability was moderate in our series, which suggest that individuals could use the Tronzo classification to document their results over a period of time to monitor long-term outcomes and to compare treatment modalities in the same studies.

The study was established to assess the long-term results and differences between autogenous and synthetic anterior cruciate ligament (ACL) reconstruction.

We randomised 50 patients into 2 groups: 26 (52%) underwent reconstruction with middle third patellar tendon graft (PTG) harvested using the ‘ Graftologer ‘ (Neoligaments), and 24 (48%) underwent reconstruction with the Leeds-Keio ligament (LK).

Subjective knee function was assessed using the Lysholm score, Tegner activity score, IKDC grading, and clinical assessment of anterior knee pain. Laxity was tested clinically, including anterior draw at 20° (Lachman), pivot shift, and arthrometric measurements using the Stryker laxometer.

At five years we have noted a slight reduction in Lysholm scoring in the LK group, as well as reduced Tegner activity level. Pivot shift and laxity were significantly greater in the LK group.

Compared with earlier results, which showed little subjective difference between the groups, the autogenous PTG group show more sustainable long-term results than the synthetic (LK) group. There is no significant difference in anterior knee symptoms between the groups.

Aims: Outside of specialist centres, follow up data on knee arthroplasties beyond 3 years is seldom available. We have devised a simple and cost effective tool to enable the average District general Orthopaedic department to assess their long-term outcomes following knee replacements. Methods: 130 patients underwent a total knee arthroplasty in 1997 at Bolton. A simple questionnaire (which could be completed in person or over the telephone) was dispatched to all of the 115 patients still alive. Questions referred to the patientñs satisfaction with their operation, their mobility, visual analogue score for their pain and any complications that had occurred. Results: Within two weeks there were 95(83%) meaningful returns and a further 8(7%) were completed over the telephone. 12(10%) were lost to follow up. Of the 103 questionnaires completed 80(78%) patients were completely satisþed with their joint. 23(22%) patients experienced problems Ð 13 had signiþcant pain (greater than 50% on VAS), 5 thromboembolisms, 4 infections (2 joint, 2 wound) and 1 complained of a shorter leg. Conclusions: With this questionnaire we have quickly and cheaply identiþed our 5-year status for knee arthroplasty. We thus propose it is a useful audit tool for a department such as ours. In addition it may have the potential to identify those patients who would beneþt from hospital review at þve years and thus could be recalled.