Objective: Prospective analysis of early clinical outcome in patients treated with medial patellofemoral ligament reconstruction using an autologous semitendinosus graft plus objective arthroscopic assessment of graft tension and subsequent patella tracking.

Method: 47 consecutive patients underwent 48 procedures between September 2005 and February 2008. All procedures were performed by the senior author using a standardised technique. A semitendinosus autograft is passed extrasynovially between the isometric attachments to the patella and femur and secured with an endobutton and interference screw. The technique includes arthroscopic assessment through a superolateral portal before and after graft placement ensuring correct graft tension and patella tracking before graft fixation. Patients received pre and post operative clinical evaluation, radiological assessment, outcome scoring systems and a satisfaction questionnaire.

Results: 47 patients were followed up with mean age 26 (range 16–49) and minimum follow up of 6 months (mean 13, range 6–35). 26 were male and 22 female. Indications were atraumatic recurrent patella dislocation in 30 patients, traumatic recurrent dislocation in 15 patients, instability in 2 and anterior knee pain in 1 patient. There have been no recurrent dislocations/ subluxations, 2 have had intermittent feelings of instability 6 have complained of medial knee pain and 3 have required further surgery. Kujala Scores improved from 53 (95%CI 28–78) to 78 (95%CI 70–85) and this was statistically significant (p< 0.05). This improvement is mirrored by the other scoring systems used. 94% of patients were satisfied with their operation.

Conclusions: This technique of medial patellofemoral ligament reconstruction is the first described which allows for objective intraoperative evaluation of the required graft tension to optimise patella tracking. The early results of this technique are encouraging.

Objective: To investigate the effect of lab based simulator training, on the ability of basic surgical trainees to perform diagnostic knee arthroscopy.

Method: 20 orthopaedic SHO’s with minimal arthroscopic experience were randomised to 2 groups. 10 received a fixed protocol of simulator based arthroscopic skills training. This consisted of 3 sessions of 6 simulated arthroscopies using a Sawbones bench-top knee model. Their learning curve was assessed objectively using motion analysis. Time taken, path length and number of movements were recorded. All 20 then spent an operating list with a blinded consultant trainer. They received instruction and demonstration of diagnostic knee arthroscopy before performing the procedure independently. Their performance was assessed using the intra- operative section of the Orthopaedic Competence Assessment Project (OCAP) procedure based assessment (PBA) protocol for diagnostic arthros-copy and further quantified with a global rating assessment scale.

Results: In theatre, simulator-trained SHO’s outscored all but one untrained SHO. The simulator trained group were scored as competent on more than 70% of occasions compared to less than 15% for the un-trained group (p< 0.05). The mean global rating score of the trained group was 24.4 out of 45 compared with 12.4 for the untrained group (p< 0.05). Motion analysis demonstrated objective and significant improvement in performance during simulator training.

Conclusion: The use of lab based arthroscopic skills training leads to subsequent significant improvement in operating theatre performance. This may suggest that formalised lab based training should be a standardised part of future surgical curricula. OCAP PBA’s appear to provide a useful framework for assessment however potential questions are raised about the ability of OCAP to truly distinguish levels of surgical competence.