31 cases of high-energy proximal tibial fractures were retrospectively analysed. The series included 22 cases of Schatzker VI and 9 cases of proximal tibial extraarticular fractures. There were 7 females and 24 males, with average age being 45years(26–94). There were 12 open fractures ( 1 Gustilo grade1, 10 grade 3b and one 3c); while 19 cases had Tcherne’s grade 2–3 injury. 4 patients developed compartment syndromes requiring fasciotomy. All fractures were treated with preliminary ligamentotaxis using a unilateral external fixator. In addition, Open fractures underwent radical debridement with the one case of 3c requiring vascular reconstruction. CT scan was then done to assess the joint incongruity ,anatomy of the fracture, and to aid in decision making. The fractures were then fixed using percutaneous techniques and a circular external fixator. Minimal open reduction was resorted to in cases with significant joint depression. In all, 26 cases were managed using percutaneous techniques alone while 5 required minimal open reduction and screw fixation. Bone grafting was done in 6 cases and 11 required a plastics procedure for soft tissue reconstruction. The results were assessed using the radiological Rasmussen’s criteria and the clinically using he IKSS knee score. At a mean follow-up of 31mths, the mean time to metaphyseal union was 18weeks (6–25weeks);. 28 patients had good to excellent clinical scores, while 3 had a fair result. The radiologic assessment graded 12 cases as excellent and 19 as good. Complications included 2 cases with flap edge necrosis, 2 with severe pin tract sepsis, 1 with proximal DVT and one case with septic arthritis.

We conclude that the above treatment protocol yields promising results, preserving good knee function without prejudicing future need for arthroplasty.

Aim: The aim of our study was to evaluate the results of the Soffix Mark 1 and Mark 11 hamstring fixation device, placed transtibially with an “over the top” femoral route when applied to revision anterior cruciate ligament (ACL) surgery.

Method and results: Twenty nine ACL revisions performed between 1992 – 2000 were evaluated. Twenty six failed prosthetic ligaments, two failed semitendinosus/ gracilis (STG) and one BTB autografts were revised using hamstring grafts in 26, quadriceps in two, and patella bone tendon bone (BTB) in one patient. Mark 1 and 11 fixation devices were employed. Follow up included clinical examination, KT 2000 arthrometric assessment, Lysholm, Tegner and IKDC scoring. The average follow up time was 50 months ±22.4.

Arthrometric examination showed a mean side to side difference (SSD) of 1.66 mm ±1.5. The mean Lysholm score was 87.2 ±12.5 and 22 patients had a B rating (nearly normal) on IKDC scoring.

The Mark II Soffix group had a mean SSD of 1.23 mm ±1.3, a mean Lysholm score of 85.8 ±14.6 and IKDC B rating in 11/15. The lowest clinical scores were in 4 multiply operated knees but the SSDs were comparable with other groups. The Mark 1 Soffix group had a mean SSD of 2.0 mm ±1.6, Lysholm score of 84.6 ±14.3 and 13/16 had a B rating (IKDC). The smaller SSD in the Mark I Soffix was statistically significant (p< 0.05) when compared with the Mark I device. Multiply operated knees had worse IKDC and Lysholm scores (not statistically significant).

Conclusions: We concluded that a revision technique using the STG Soffix fixation device can restore stability with good functional outcomes following failed primary ACL reconstruction. Multiply re-operated knees had the worst functional results despite restoration of stability.