Objective: The aim of this study was to assess the results of combined arthroscopically assisted posterior cruciate ligament reconstruction and open reconstruction of the posterolateral corner in patients with chronic (3 months or more) symptomatic instability and pain.

Patients & Methods: A retrospective analysis of all the patients who had a combined reconstruction of the posterior cruciate ligament and the posterolateral corner between 1996 and 2003 was carried out. Nineteen patients who had the combined reconstruction were identified from the database. All the patients were assessed pre and post-operatively by physical examination and three different ligament rating scores. All the patients also had weight bearing radiographs, MRI scans and an examination under anaesthesia and arthroscopy pre-operatively. The PCL reconstruction was performed using an arthroscopically assisted single anterolateral bundle technique and the posterolateral corner structures were reconstructed using an open Larson type of tenodesis.

Results: Pre-operatively all the patients had a grade III posterior sag and demonstrated more than 20 degrees of external rotation as compared to the opposite normal knee on the Dial test. The average follow up was 66.8 months (range 24–108). Post-operatively 7 patients had no residual posterior sag, 11 patients had a grade I posterior sag and 1 patient had a grade II posterior sag. Five of the 19 patients demonstrated minimal residual posterolateral laxity. The Lysholm score improved from a mean of 41.2 to 76.5 (P=0.0001) and the Tegner score from a mean of 2.6 to 6.4 (p=0.0001).

Conclusions: We conclude that while a combined reconstruction of chronic posterior cruciate ligament and pos-terolateral corner instability does not restore complete anatomical stability, improvement in symptoms and function demonstrate its value in these difficult injuries.

Aim: This is a report on outcome of Complete Trans-physeal ACL reconstruction in a group of 24 children with open physes of whom 6 were under 12 years (Pre-pubertal).

Materials & Methods: A group of twenty-four children with an average age of 13 years were reviewed. Six children were aged 12 or under at the time of operation. There were 21 boys and 3 girls. The follow-up ranged from 12 to 72 months (mean 37.8 months).

ACL Reconstruction was done by a standard 4-strand hamstring technique using an endobutton proximally and a spiked washer and screw distally in the tibia.

The IKDC, Lysholm and Tegner scores were used to assess the knees pre and post-operatively. Stability was measured using the KT-1000 arthrometer.

Results: Common modes of injury were football, rugby, skiing and squash. The left side was involved in 13 patients, and the right side in 11 patients. Interval between injury and surgery ranged from 3 to 22 months with an average of 8 months. Meniscal repair was carried out in 9 out of 14 patients with meniscal tears. The average Tegner score before injury was 7.7, before operation was 4 and at the last follow-up was 7.6. The average pre-operative Lysholm score was 54.6 compared to the post-operative score of 93. There was no incidence of angular deformity or a limb length discrepancy. There has been 1 re-rupture in a child aged 11 years 11 months at operation but no meniscal injuries. The outcome in the 5 other children aged 12 or less at the time of operation has been as good as the older children.

Conclusion: Reconstruction of the anterior cruciate ligament using a trans-physeal technique gives good results in pre-pubertal children and in adolescents.