Purpose of the study:

The purpose of the study was to evaluate the possible causes or risk factors for the occurrence of venous thrombotic events (VTE) after shoulder arthroscopy.

Introduction: Studies have shown Near Infrared Spectroscopy (NIRS) as being an effective tool in measuring oxygenation non-invasively in tissues. More recently it has been used in clinical settings to assess circulatory and metabolic abnormalities, however, clinical studies in bone are lacking.

Materials and Methods: Ten able-bodied (AB) (5 men and 5 women; age, 23-40 years) and ten spinal cord injured (SCI) (complete cord transection above T10, 5 men and 5 women; age 19–38) participants were matched by age, gender, skin pigmentation and studied.

A spectrometer measured between 498-1000nm, at 0.2Hz , using glass optodes (2mm diameter). Five minutes of resting readings, followed by 3 minutes of below knee arterial occlusion and then 6 minutes post-occlusion were made. The second study, started with 5 minutes of resting readings, vibration loading for 3 minutes at 30 Hz with acceleration of 3g and 6 minutes post-vibration was then conducted.

Results: NIRS showed changes in blood parameters during the hyperemic response (avg. 97% increase in Hb from baseline, p< 0.0001). Able-bodied subjects had significantly quicker (p=0.01) capacity for Hb to return to baseline. There was a significant difference (p=0.001) in the time to peak for Hb following arterial occlusion in the SCI group, 16.6 seconds (sd 4.3), and 10.1 seconds (sd 1.7) in the able bodied.

Conclusion: Our findings suggest that there is a reduction in the bone’s ability to restore oxygenated blood in SCI participants compared to the AB participants. Future studies looking at changes in bone following a range of vibration amplitudes and frequencies in the SCI group should be considered using NIRS in order to optimize potential clinical benefits.

The goals of this study were to determine the outcome of surgical iliotibial band release in long-distance runners with iliotibial band friction syndrome (ITBFS).

A retrospective study of 66 patients (94 ITBFS) treated between 1995 and 1999 was performed. The diagnosis was made clinically by the presence of a positive Noble test. All other pathology was excluded. All patients had failed a trial of conservative therapy consisting of rest, physiotherapy, activity modification and corticosteroid injections.

Surgery was performed on an outpatient basis and patients were monitored postoperatively for at least two years. The outcome was assessed according to patient satisfaction, the time it took to return to running, level of activity and surgical complications.

Most patients were able to start running again within six weeks of surgery. Complications included three superficial infections and two cases of prolonged pain. The procedure was unsuccessful in three patients. Ninety-six percent of patients said that they would have this procedure again.

ITBFS is common in long-distance runners in this country. This is a safe, simple and effective surgical alternative for patients who do not respond to conservative treatment.

Introduction: The clinical effectiveness of spinal bracing for the conservative treatment of adolescent idiopathic scoliosis is still not fully understood. Cohort studies on clinical effectiveness fail to adequately measure and control for confounding variables including spine flexibility, curve type, magnitude and maturity, distribution of corrective forces and compliance. This paper presents intermediate findings from a longitudinal study to objectively measure brace wear patterns and compliance in users of custom fitted TLSOs in the UK. Braces are fitted with data logging devices to measure temperature and humidity at the skin/brace interface. Previously reported measures of compliance have been in adolescents wearing Boston Braces using questionnaires, strap tension, interface pressure and skin temperature. They have shown compliance reported by the user can significantly over estimate actual compliance.

Methods and results: 20 patients are being studied over 18 months. TLSOs are fitted with data logging devices to measure temperature and humidity at the skin/brace interface. They are discrete sensors inserted into a pocket formed on the posterior of the brace. Measurements are recorded at 16 minute intervals and data downloaded every three to four months. Results clearly demonstrate compliance and daily wear routines. Temperature and humidity at the skin/brace interface during periods of wear are 35°C and > 80%RH respectively. Compliance ranges from 60–98%. Users who stick rigidly to their regime only remove their brace in the evening. Where poorer compliance is evident, the brace is worn sporadically during the day and evening, and worn full time at night.

Conclusion: Measurement of temperature and humidity at the skin/brace interface clearly demonstrates compliance and daily wear routines. Compliance varies from 60–98%. Where poor compliance is an issue it is intended to re-interview these individuals and obtain more detailed information about the reasons why they failed to use the brace.

In a retrospective study of 100 cases treated between 1995 and 1999, we evaluated the outcome of surgical iliotibial band release in long-distance runners with ilio-tibial band friction syndrome (ITBFS).

All patients had a positive Noble test. All other pathology was excluded. Conservative therapy comprising rest, physiotherapy, activity modification and corticosteroid injection had proved ineffective.

Surgery was performed as an outpatient procedure and patients were followed up for at least two years postoperatively. The outcome was assessed by the time to return to running, the level of activity, patient satisfaction and the surgical technique.

Iliotibial band release offers an effective surgical alternative to patients with ITBFS who do not respond to conservative treatment.

Introduction: The advantages of arthroscopically assisted mini-open rotator cuff repairs have supported the evolution of all arthroscopic rotator cuff repairs. Careful analysis of these complex techniques is required to ensure that excellent or good surgical outcomes are achieved.

Methods: In each case a diagnostic arthroscopy preceded the repair. The configuration of the tear was noted and an assessment of the ease of repair was made. An arthroscopic acromioplasty was performed in all cases. Soft tissue releases were carried out. Bone and cuff preparation was required. The principles of margin convergence and balancing of force couples of the rotator cuff without tension mismatch were followed. Knot and loop security was required for cuff fixation. All patients who underwent arthroscopic rotator cuff repair from 1997 to 2001 were reviewed. Outcome scores were evaluated for pain, levels of activity, range of motion and strength.

Conclusions: Results comparable to mini-open repairs can be achieved. Complex arthroscopic skills must be mastered and the attraction of cosmesis and lower perioperative morbidity and stiffness must not compromise the long-term outcomes of the surgery.