The pathogenesis of rotator cuff degeneration is important in determining the management and prognosis.

During surgery, the pathological area was excised and sent for histological examination. This paper describes the histological features of 229 biopsies taken from patients with various stages of rotator cuff pathology.

Clarification of the pathology can assist in determining the nature of any additional procedure to be performed.

Acquired pes planus is a common problem that develops spontaneously over time in the elderly. Initial diagnosis is difficult. Treatment is also difficult, as minor procedures are ineffective and major procedures not necessarily indicated.

This paper presents a new approach in which a simple sinutarsi arthrorexis with flat foot prosthesis is combined with various medial procedures, depending on the pathology of the tibialis posterior. No osteotomies or fusions are required. The paper considers indications for surgery and additional medial procedures.

This approach differs from present techniques. Because the surgery is of a minor nature, it can be performed earlier to retard progression of the disease.

This paper introduces a new biological material for the treatment and augmentation of ligament and tendon deficiencies, and presents a variety of uses in orthopaedic conditions. The membrane was originally tested and used in cardiac valve replacement, where it is still in use.

Manufactured from bovine pericardial tissue, the collagen biolink membrane is treated chemically by cross-linking with gluteraldehyde. Aldehydes are chemically capped to prevent inflammatory response. The result is a strong collagenous material that provides a non-stretch bio-integrate for ligament replacement/augmentation. The membrane is fashioned to meet the particular ligament/tendon requirement.

This material is well suited for use in foot and ankle surgery, as well as in other situations, especially rotator cuff surgery. It may revolutionise ligament and tendon surgery.

Total ankle replacement (TAR) is a relatively new addition to the arthroplasty family. The uniform belief that the learning curve for this procedure is steep seems to have retarded the advancement of TAR as a substitute for arthrodesis. This presentation highlights the problems of TAR, exploring the reasons for the high initial complication rate and discussing ways of overcoming the difficulties.

The most common problems are correcting the deformities and creating a ligamentous balance. Because of the unique ankle and subtalar configuration, a paradigm shift is required to realign and balance the joint properly.

It is hoped this talk will make TAR user-friendlier and help it take its rightful place in arthroplasty surgery.

This paper introduces a relatively new treatment of pes planus.

Over three years we have treated 21 patients with idiopathic or acquired pes planus by inserting a cylindrical polyethylene prosthesis in the subtalar sinus tarsi to limit subtalar movements. After a two to four-week period in postoperative surgical plaster, patients become fully weight-bearing, with immediate correction of alignment of the pes planus.

The polyethylene has excellent wear properties and we have encountered no wear or particular reactions. We have had no bone resorption or infections, and few and minor complications. Correction of the deformity is maintained even after removal of the prosthesis.

The advantages of immediate correction of the deformity and early full weight-bearing make this simple and effective procedure an attractive alternative to conservative treatment, osteotomy and subtalar fusion in selected cases.

Increasingly often diagnosed by sophisticated investigation, rotator cuff disease may be treated conservatively or surgically. Surgical options are decompression alone, decompression and debridement, partial rotator cuff repair, full reconstruction, tendon transfer and prosthetic replacement.

Emphasising the quality of the repair rather than the classification of the injury, this paper details the criteria used in reaching a decision about the type of surgical treatment. Clinical, radiological, ultrasonographic and arthroscopic findings are used. The prognosis is directly related to the repair.

During the last four years the author has used extracorporeal shock wave therapy (ESWT) to treat tendonoses, including 82 cases of tennis elbow, 108 cases of plantar fasciitis and 42 cases of related conditions. Treatment is administered in the consulting room without analgesia. This paper discusses the protocol used in selected cases.

In 78% of cases, overall subjective and objective results were good to excellent, in 15% fair. In only 17% was the result poor, with no improvement. No cases of degeneration were encountered. There were few complications and these were minor. Because of the obvious clinical benefits in selected cases, this new modality of orthopaedic treatment is still being used daily after four years.

Total ankle replacement, a relatively controversial procedure, is technically demanding.

Over the past four years, the author has performed 52 total ankle replacements for osteoarthritis. Patients have attained a 30% to 70% increase in the range of movement. Results have been rated good to excellent in 90% of cases, although 20% of ankles took a year to settle. Immediate benefits were relief of pain and correction of deformity. The procedure required a shorter period of convalescence than arthrodesis, and the rate of morbidity was notably lower. Subsequent conversion to arthrodesis was performed in 3% of patients, and eight prostheses required revision.

The overall results prove this procedure superior to ankle arthrodesis. Once the surgical technique has been mastered, this procedure is likely to become the treatment of choice in arthritis of the ankle.

The author describes a new soft tissue reconstruction of hallux valgus.

This method reduces the intermetatarsal angle as well as the sesamoid metatarsal relationship. The procedure can be used in conjunction with various metatarsal osteotomies.