Aims

COVID-19 necessitated abrupt changes in trauma service delivery. We compare the demographics and outcomes of patients treated during lockdown to a matched period from 2019. Findings have important implications for service development.

We describe a new method for reconstructing the patellar tendon following combined injury to the patellar tendon and anterior cruciate ligament (ACL).

Combined injuries to the patellar tendon and the ACL represent a rare and potentially serious injury pattern. The injury to the patellar tendon can often go undiagnosed at primary presentation. Reconstructive options for the patellar tendon are described but can be technically difficult, particularly if ipsilateral hamstring has been used for anterior cruciate ligament reconstruction. Evidence suggests combined injuries generally lead to poor long term outcome.

We describe a case of a 26 year old male who presented with a reconstructed ACL and a patellar tendon deficient knee. Diagnosis was confirmed on Magnetic Resonance Imaging (MRI). Ipsilateral hamstrings had been used as donor for ACL reconstruction. An Achilles tendon allograft with distal bone block was used in combination with contralateral semitendinosus and gracilis autograft to reconstruct the three bundles of the patellar tendon. The patient experienced no postoperative complications and was followed up radiologically and clinically. Computer Topography imaging performed at 6 months post-operatively showed union of the bony Achilles tendon block. MRI performed 1 year post-operatively showed good incorporation of the tendinous grafts and no evidence of degeneration or tearing. Oxford knee score at 6 months post-operatively was 31/48. One year post-operatively full pre-injury activity level had been achieved.

We believe this method to provide adequate strength and integrity, enabling early rehabilitation following this rare injury. It has also been shown to give a good functional outcome.

We aimed to determine the reliability, accuracy and consequently the clinical role of digital templating in the pre-operative work up for total knee arthroplasty patients.

With the increasing use of digital radiology images, analogue templating may soon be defunct. Digital templating is a more recent development and its role is yet to be determined.

Ten pre-operative digital radiographs were templated by four independent observers. Inter-observer and intra-observer reliability was assessed using the kappa measure of concordance. Subsequently, 40 consecutive total knee arthroplasty patients underwent pre-operative digital templating. This was a blinded process by a consultant surgeon not involved with the operation. Each patient underwent TKR using the PFC Sigma System sized intra-operatively, without the operating surgeon having knowledge of the pre-operative templating result. Comparison was made between the pre-operative digital templates and the blinded intra-operative sizing.

For both the femoral and tibial templating there was good to very good inter- and intra-observer agreement. For the femoral component the templating was correct in 47.5% (± 1 size difference 97.5%). The tibial templating was correct in 55% (± 1 size difference 100%).

The inter- and intra-observer reliability of digital templating process has been shown to be acceptable but the correlation between digital templating and the actual size implanted is poor. Our series shows a similar accuracy to the published data on analogue templating for the same implant. Like analogue templating, its clinical role remains uncertain and its poor correlation to the actual implant sizes limits its usefulness.