Knee injuries in cyclists are often thought to result from an imbalance of load during the cycling motion as a consequence of inappropriate bike set-up. Recently, it has been postulated that incorrect foot positioning may be a significant factor in lower limb injury and poor cycling performance. The purpose of this study is to assess the effect of changing the foot position at the shoe-pedal interface on Vastus Medialis (VM) and Vastus Lateralis (VL) activity (mean and mean peak), knee angle and knee displacement.

Maximum power tests were completed on a first visit, with data collection on a second visit recorded at 60% of the subjects maximum. Video footage and surface electromyography (SEMG) from VM and VL muscles was obtained. Data was recorded over 10 crank cycles in 3 experimental conditions; neutral, 10 degrees inversion and 10 degrees eversion using Ethylene Vinyl Acetate (EVA) wedges fitted between the cyclists shoe and the shoe cleat. Raw data (mean SEMG, mean peak SEMG) was obtained using Noraxon and SiliconCOACH measured knee angle and knee displacement. Data was analyzed using Friedmans test with appropriate post hoc tests.

12 male subjects (range 26-45, mean 35.9 years) completed the study. Mean and mean peak SEMG data showed no significant differences between the 3 experimental conditions for VM and VL. VM:VL ratios from raw mean SEMG data demonstrated a decrease in synchronicity in inversion and eversion compared to neutral. Pronators demonstrated most synchronicity in inversion and least synchronicity in eversion. There were statistically significant differences in knee angle and knee displacement between neutral, inversion and eversion (p<0.05). Inversion promoted smaller knee valgus angles and greater knee displacement from the bike. Eversion promoted larger knee valgus angles and a smaller displacement from the bike.

By altering the foot position to either 10 degrees inversion or 10 degrees eversion, knee angle and knee displacement can be significantly influenced. Clinically, subjects who foot type is classified as pronating may benefit from some degree of forefoot inversion posting. Further research on subjects with knee pain needs to be undertaken.

Background and purpose: Back injury is a common complaint amongst rowers. With long training hours muscle fatigue is an inevitable consequence which may be a precursor to injury. This study aims to explore the effects of fatigue on iliocostalis lumborum (IL) and superficial multifidus (SM) whilst rowing on a Concept 2C rowing ergometer (C2CRE).

Method: Nineteen male athletes from Cardiff University Rowing Club were recruited fulfilling specific inclusion criteria (mean age 22yrs ± 3). Ethical approval was obtained from the institutions ethical committee. With bilateral EMG electrodes (IL and SM) attached Maximum Voluntary Contractions were collected followed by a 10 minute warm up on a C2CRE. Subjects subsequently performed a 7 stroke power test (pre fatigue condition) (Godfrey and Williams 2007). Subjects then rowed at a power rate of an average power rating from the 7 stroke power test. As soon as subjects power ratings fell below 85% of the average they stopped, and then immediately performed the 7 stroke power test whilst EMG data (IL and SM) was collected (post fatigue condition). Paired T tests reported differences between pre and post fatigue scores for IL and SM.

Results: A non significant trend in IL between pre and post fatigue conditions (p=0.065) was noted with no significant difference in SM activity (p=0.196)

Conclusion: This study has provided evidence that there is a difference in muscle activity between IL and SM following a fatiguing protocol, which may play an important role in the understanding of mechanisms leading to low back pain in rowers.

Introduction and Aims: The aim of this study is to identify specific risk factors for developing haemophilia-related orthopaedic complications and to provide a qualitative and quantitative analysis of the orthopaedic management of haemophilia complications.

Method: A postal survey was sent to 48 patients on the Wellington region haemophilia database. The questionnaire covered both qualitative and quantitative questions covering the participants’ current condition and treatment, past and present orthopaedic and non-orthopaedic management, support, education, employment and leisure activities.

Results: Twenty-five patients returned the questionnaire, a response rate of 52%. Most of the participants (68%; 17/25) felt that their education had been compromised as a result of haemophilia complications. Of those participants that were 16 years or older, 68.4% (13/19) felt that their working opportunities had been compromised as a result of haemophilia complications. Despite patients less than 18 years of age receiving prophylactic Factor VIII replacement (n=7) and all patients having Factor VIII available on demand, 18 patients had significant bleeds in the previous six months. Most bleeds were into joints, 13 knees, 13 ankles, 12 elbows, six shoulders and three hips, but a significant number of intra-muscular bleeds (n=22) also occurred. There were 62 painful joints reported by 19 patients, the ankle being most common (n=21), followed by hip (n=13), elbow (n=12), and knee (n=8). Twenty-five orthopaedic operations were described by eight patients, mainly knee (n=11) and hip (n=5) replacements, and synovectomies (n=9). In the last year, two patients who have factor VIII inhibitor had been successfully operated on, one for a large pseudotumor of the thigh, and the other for contralateral hip and knee joint replacement.

Conclusion: Despite good medical management, recurrent joint bleeds are a major problem in haemophilia. Many study patients commented that orthopaedic procedures were not performed readily enough, and that by the time they received their operation, their function had deteriorated significantly.

Between 1993 and 2002 7 allografts/joint replacement combinations have been used to treat massive bone loss at the elbow.

The original 4 procedures (2 humeral and 2 ulna allografts) used a standard Stanmore total elbow replacement. Of these the 2 humeral allografts failed and revision surgery was necessary. The 2 grafts on the ulna side of the joint remain in situ (average 6 years after surgery) with one of the patients subsequently having a primary joint replacement on the contra-lateral side.

More recently a further humeral and a further ulna allograft/joint replacement have been performed together with one patient having humeral and ulna allografts on both sides of the joint for extensive bone loss. In these cases the Coonrad-Morrey total elbow arthroplasty was used as the joint implant.

The philosophy behind the use of allografts is discussed and the management principles outlined. The possible reasons for failure of the early humerus allograft/joint replacement combinations is addressed and future developments considered.

Aim: To study the long term results of rotator cuff repair in patients over the age of 65.

Introduction: Although some patients with rotator cuff tears are asymptomatic, the majority have a combination of pain, weakness and restricted function. Whilst this affects the lifestyle of all patients, in the elderly these symptoms can make the difference between independent living and the need for assistance or sheltered accommodation.

Method: The present study has looked at a consecutive series of 24 patients all of them over 65 years, who underwent rotator cuff surgery between 1993 and 1997. Outcome has been assessed using two validated scoring systems – the Oxford Shoulder Score (OSS) and the DASH questionnaire. All patients had an open subacromial decompression of their shoulders at the time of cuff repair. Two patients could not be contacted for follow up and were therefore excluded. One patient who had a hemiarthroplasty of the shoulder 3 years after rotator cuff repair was excluded as well.

The average follow up period was 6 years (range 4.5 – 9 years). The Oxford Shoulder Score revealed that 72% had good to excellent results, 16% remained unchanged and 12% were worse than prior to surgery. The corresponding DASH scores were 28% excellent, 40% good, 16% fair and 16% poor respectively. In addition 81% of patients were independent with daily activities, with 48% of them living alone and the remaining 33% living with their partners. Only 19% of patients needed significant help with their activities of daily living. These results were irrespective of whether surgery was performed on the dominant or non-dominant shoulder.

Conclusion: We would suggest that age itself should not be considered a contraindication to rotator cuff repair.

The long term results of the ulnohumeral arthroplasty have not previously been reported using a recognised elbow scoring system.

Kashiwagi reported his results in 1986 but no validated scoring system was used in the publication. Morrey in 1992 evaluated his results using the Mayo Elbow Performance Score but the mean follow-up interval was only 33 months.

Between 1990 and 1996 twenty consecutive ulnohumeral arthroplasties were performed for primary degenerative disease of the elbow.

Outcome assessment using the DASH questionnaire and the Mayo Elbow Performance Score was taken at a mean follow-up of 75 months (range 58 to 132). Excellent or good results were identified in 85% (17/20) using the DASH questionnaire, and 65% (13/20) on assessment with the Mayo Elbow Performance Score (correlation coefficient 0.79).

Eighty percent (16/20) felt that the benefits of surgery had been maintained, and of those working at the time of surgery, 75% (12/16) were still employed in the same vocation.

There was no correlation between radiographic recurrence and the degree of fixed flexion deformity, flexion arc or elbow scores.