Introduction. Anterior cruciate ligament (ACL) reconstructive surgery is one of the most commonly performed surgical procedures. Synthetic ACL repair surgery with the Lars ligament is designed to repair, rather than replace, the torn ACL. Once the ACL is repaired, the level of function, biomechanical attributes and proprioception should be similar to the pre-injury state. All patients in this cohort have undergone surgical repair of the torn ACL with synthetic Lars ligament augmentation. The indications and surgical technique will be outlined. Patients have been assessed at follow-up with KOOS and Marx scores, which reflect the surgical outcome. The preliminary results with a six-month minimum follow-up will be presented. The results reflect previous published studies that show that surgical repair of the torn ACL with Lars ligament augmentation, can reliably and reproducibly stabilise the knee and allow an early return to sport. Complications include one septic arthritis, superficial wound infections and improperly placed bone tunnels. Synthetic ACL repair using the Lars ligament is a reprodicible technique that allows a rapid post-operative rehabilitation and avoids all complications relating to graft harvesting. The indications and the surgical technique are quite specific and must be adhered to in order to achieve the best results

Objectives

Surgical marking during tendon surgery is often used for technical and teaching purposes. This study investigates the effect of a gentian violet ink marker pen, a common surgical marker, on the viability of the tissue and cells of tendon.

Excessive postoperative opioid prescribing is a significant contributor to the opioid crisis. Prescribing in orthopaedic surgery is often further complicated by high use of opioid-based preoperative analgesia. ‘Opioid PrEscRiptions and usage After Surgery’ (OPERAS) is an international multicentre prospective student- and trainee-led collaborative study which aims to quantify the amount of opioids prescribed at discharge after common orthopaedic surgeries against what is consumed by patients at 7-days, and assess the impact of opioids on patient-reported outcomes. Data is being collected over 6 14-day periods on consecutive adult patients undergoing shoulder arthroplasty, rotator cuff repair, shoulder labral repair, anterior cruciate ligament repair, hip arthroplasty, and knee arthroplasty, with follow-up via telephone call at 7-days after discharge. The primary outcome is the proportion of oral morphine equivalents (OME) of prescribed opioids versus consumed opioids at 7-days post-discharge. This ongoing study is actively recruiting in over 20 countries. Globally, 65 centres are collecting orthopaedic, including 10 New Zealand centres and 17 Australian centres. To date, 284 orthopaedic patients have been prospectively enrolled with complete data (mean age 59.6 ± 16.7 years; 51.6% female). Overall, 77% and 89% of patients were prescribed opioids on discharge in New Zealand and Australia respectively. On average, 60% of prescribed opioids were consumed at 7-days post-discharge globally (150 OME (75-500) vs. 90 OME (15-200); p<0.01). In New Zealand and Australia, 42.1% (285 OME (150-584) vs. 120 OME (6-210); p<0.01) and 63.3% (150 OME (86-503) vs. 95 OME (28-221); p<0.01) of prescribed opioids were consumed at 7-days, respectively. OPERAS will provide the first high-quality global data on opioid prescription and consumption patterns with patient perspectives. These data can inform prescribing practice and inform guidelines. The growing interest in New Zealand and Australia in student- and trainee-led orthopaedic collaborative research, as evidenced by this study should be actively encouraged and fostered

An important aspect of the governance of surgical services within a Healthcare Trust is the correct coding of elective procedures performed. Within the Trust, treatment codes are banded into specific healthcare resource groups (HRGs), which generate a predetermined income. Accurate coding and grouping of the treatments provided for patients is consequently vital to Trusts to ensure that they receive appropriate financial reward for the care provided, so ensuring they remain economically viable as a department. We present a retrospective study investigating the accuracy of procedure coding, code allocation to HRGs, and the resultant cost consequences for all elective arthroscopic anterior cruciate ligament (ACL) repairs completed by one consultant over one financial year (01/01/2010-31/03/2011). In this period a total of 55 ACL repairs were undertaken by the consultant. Data was available for 43 of these cases, all of which were repairs of traumatic ACL ruptures. The patients had an average age of 26.7 (17–55) years, all were ASA 1 and had no significant comorbidities. They were all booked for identical procedures, except one patient who required an allograft; 12 required meniscectomies. All 43 had an operation note completed by the operating consultant. Within this trust patient and procedural codes were generated from electronic discharge letters (EDLs). We found that all 43 EDLs were completed accurately, contained full details of the procedures undertaken, and included relevant information such as complications, patient comorbidities, length of stay and the prescription of analgesics. These 43 EDLs generated 15 different diagnostic codes and 10 different procedure codes, with a total of 35 different combinations of codes. These were then grouped into six different HRGs. These six HRGs generated income for the Trust, varying from £1880 to £3554 (mean £2670) for the procedures, with a total income of £114,823. We found that patient and procedure details, and the level of doctor completing the EDL did not significantly influence the HRG generated (P = 0.4). Currently within the Trust, and nationally the HRG tariff for a routine ACL repair has not been agreed upon. The maximum possible tariff from an HRG for this procedure for a patient with no significant comorbidities is described as – ‘Reconstruction of intraarticular ligament – Major knee procedure for trauma’, generating an income of £5183 per case. Application of this tariff would have resulted in a total income of £222,869 for the 43 patients included in the present study a potential increase of earnings for the Trust of £108,046, for one elective procedure in one financial year. The findings of this study reveal the potential for limitations in the governance of surgical services through inaccuracies in HRG coding, despite the availability of suitably detailed EDLs. It is suggested that Trusts should audit and, where indicated, ensure effective quality assurance of HRG coding in the interests of the governance of secondary care services

Previous Anterior Cruciate Ligament (ACL) reconstruction is currently a bar from entry to the Royal Marines and Royal Navy, whilst the British Army allows recruits to join if asymptomatic 18 months post ACL reconstruction. However current Royal Marines policy is to rehabilitate recruits who sustain an ACL disruption in training. We retrospectively analysed the rehabilitation times and pass out rate of Royal Marines who had an ACL disruption during recruit training over an 8 year period. 12 recruits sustained an ACL disruption during recruit training in the study period, giving an incidence of around 1.5/1000 recruits. 9 Patients underwent ACL repairs in training, with 1 patient leaving and rejoining post repair and later successfully passed out. 2 patients were treated conservatively. Of the 12 ACL sustained in training 8/12 (67%) passed out. None of the patients treated conservatively passed out. The mean time out of training for successful recruits was 51.6 weeks (95% CI 13.1) mean rehabilitation time post ACL reconstruction for successful recruits was 36.7 weeks (95% CI 12.5). Mean time to discharge for unsuccessful recruits 63.2 weeks (95% CI 42.4). In the operative group 1/10 left due to failure to return to training and 1/10 left through unrelated reasons. Current costing for recruit training is £1800 per week per recruit. ACL injuries are not common in Royal Marine Training, and reconstruction is not a bar to completing Royal Marine basic training. We estimate that it costs around £100,000 per-injured recruit, to maintain a policy of rehabilitating ACL injured recruits in Royal Marines training. Further research into the long-term employability or Royal Marines sustaining an ACL injury in training is required