Traditional medial soft tissue release for balancing of the varus knee in total knee arthroplasty can lead to an inconsistent reduction in medial tension. The purpose of this study is to establish whether sequential needle puncturing of the medial collateral ligament (MCL) can be a safe and predictable method for medial release.

Total knee prostheses were implanted in 14 cadaveric specimens by a single surgeon. Medial tension was measured in flexion and extension by a pressure sensor with implants in place, and calipers after removal of implants and gap distraction under constant tension. Measurements were performed after each of 5 sets of 5 punctures of the MCL with an 18-gauge needle and following 5 transverse perforations with an 11-blade. A consistent valgus force was applied after each set of MCL punctures with a pneumatic cylinder. Pearson's correlation was used to compare pressure sensor measurement with gap distance measurement under tension. The pressure as detected by the sensor after each set of 5 punctures was analyzed by a repeated measures two-way ANOVA and a Tukey multiple comparisons test to determine a significant decreases between puncture sets.

The pressure sensor device correlated more closely with systematic tissue release (r=0.59 for % change from baseline) than did measurements of gap increase under tension (r= −0.22). All knees had ≤5mm of medial opening with up to 25 needle punctures. Two knees had <5mm of medial opening in flexion after blade perforation. The mean pressure decreases in 90 degrees flexion, mid-flexion and extension were 11.2, 9.4 and 9.9 lbs respectively after 5 needle punctures and 8.1, 11.5 and 9.6 lbs between 5 and 15. Significant pressure decreases were seen after 5 and 10 needle punctures and again after blade perforation (p<0.05)

Needle puncture of the deep and superficial MCL leads to a significant and reliable decrease in medial tension over the first 15, with diminishing effect up to 25 punctures. This method may be employed when up to 20 lbs reduction in medial pressure is desired. Blade perforation after needle puncture should be approached with caution.

Lateral Epicondylitis is a common condition caused by angiofibroblastic hyperplasia of the tendinous insertion. Its treatment is varied and includes rest, physiotherapy, corticosteroid injection and surgical release. Of late, the role of Platelet Rich Plasma (PRP) injections have been explored, with positive results.

We prospectively assessed the outcomes of lateral epicondylitis treated with PRP injections and compared the outcomes of ultrasound guided and ‘blind’ injection.

This was a single centre prospective cohort study. Patient were assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) Score. PRP was injected into and around the common extensor origin either with or without ultrasound guidance. The primary outcome measure was DASH score at 3 months.

45 (23F:22M) patients were recruited. The mean age was 50 years (range 35 to 79). The mean duration of follow-up was 106 days. The average pre-injection DASH score for both groups combined was 45.5 (11.7–87.5). The mean DASH score at 3 months follow-up was 27.7. The ultrasound guided injection group had a mean improvement in DASH score from 45.5 to 31.2. The “blind” injection group had a mean improvement in DASH from 44.4 to 27.7. No complications were noted. There was no statistically significant difference in improvement in DASH score between the two groups.

Our study provides further evidence to support of the use of PRP injections in the treatment of epicondylitis of the elbow. Interestingly, however, we found that the use of Ultrasound guidance does not appear to improve patient outcomes.

Purpose: Presently, tension band figure-of-eight fixation of olecranon fractures is usually performed with stainless steel wire. A polyethylene cable cerclage has been proposed as an alternative to lessen the complications associated with wire. This study compared the stability of tension band constructs for olecranon fracture fixation using a polyethylene cable cerclage or a stainless steel wire cerclage.

Methods: Ten matched pairs of fresh-frozen cadaveric elbows, without radiographic abnormality, were selected for the study. In each specimen, a transverse fracture was created by an osteotomy at the middle of the sigmoid notch of the olecranon. One elbow of each pair was randomized for tension band fixation with a figure-of-eight construct while the other was fixed by tension banding with a loop cerclage. Two different materials, stainless steel wire and isoelastic polyethylene cable, were randomly selected to create the cerclage constructs in each elbow. The triceps tendon was controlled and cyclic loads were applied to the dorsal cortex of the ulna 8 cm distal to the fracture site to create a bending moment. The elbow was initially preconditioned at 45 N for 100 cycles, followed by four periods of 300 cycles each, from 45 N to 120 N in 25 N increments. Dynamic and static fracture gap for the different configurations and materials were recorded.

Results: No difference in static gap was found between the metal figure-of-eight, cable figure-of-eight and cable loop constructs (p> 0.05). The metal loop was found to have significantly greater gap (p=0.0013) than the other 3 constructs. No difference was observed in dynamic gap at the peak loads for any of the constructs (p=0.3379).

Conclusion: This study demonstrated that the biomechanical performance of tension band fixation in an olecranon fracture model using a polyethylene cable in either figure-of-eight or loop construct is similar to that of the stainless steel wire figure-of-eight construct and should be considered as an option to the traditional stainless steel wire. This type of soft and tissue tolerant fixation may lessen the known clinical complications of wire fixation while providing equivalent stability under physiologic loads which would permit early rehabilitation.

We studied the effect of 'dynamisation' on tibial fractures in six patients treated by the Dynamic Axial Fixator. In the early stages, peak cyclic movement at two to four weeks averaged 0.75 mm (0.19 to 1.02) on the medial side of the bone and 0.86 mm (0.21 to 1.25) on the lateral side. The amount of movement correlated with the applied load and the fracture stiffness. After unlocking the fixator column at six weeks, progressive closure of the gap averaged 1.3 mm (0.1 to 3.5). Cyclic movement is produced by early weight-bearing with the fixator column locked. Progressive closure occurs after unlocking the column, and is often associated with a reduction in cyclic movements. The effects of dynamisation on movement at the fracture site should be defined separately, in terms of cyclic movement and of progressive closure.