We aim to determine the differences in lower limb joint kinematics during the golf swing of patients who had undergone Total Knee Arthroplasty (TKA) and a control group of native knee golfers. A case-control study was undertaken with ten golfers who had undergone TKA (cruciate retaining single radius implant) and five age and matched golfers with native knees. Each golfer performed five swings with a driver whilst being recorded at 200Hz by a ten-camera motion capture system. Knee and hip three-dimensional joint angles (JA) and joint angular velocities (JAV) were calculated and statistically compared between the groups at six swing events. The only significant differences in knee joint kinematics between TKA and control groups was a lower external rotation JA in the left knee during the backswing (p=0.010). There was no significant difference in knee JAV between the groups. Both hips demonstrated significantly (p=0.023 for left and p=0.037 for right) lower flexion in the TKA group during the takeaway swing event, and there was lower internal rotation in the backswing and greater external rotation in the downswing of the right hip. There was also slower left hip extension JAV in the downswing. Normal knee kinematics were observed during the golf swing following TKA, with the exception of reduced external rotation in the left knee during the back swing and the right during the down swing. The differences demonstrated in the hip motion indicate that they may make compensatory movements to adjust to the reduced external rotation demonstrated in the knee

Introduction. Debate remains which surgical technique should be used for ankle arthrodesis. Several open approaches have been described, as well as the arthroscopic method, using a variety of fixation devices. Both arthroscopic and open procedures have good results with union rates of 93–95%, 3% malunion rate and patient satisfaction of 70–90%, although some report complication rates as high as 40%. Aims. To identify union, complication and patient satisfaction rates with open ankle fusions (using the plane between EHL and tibialis anterior). Method. A retrospective review of all isolated primary fusions performed between 2005 and 2009. Patient records were reviewed and patients were recalled for clinical evaluation and AOFAS scoring. Follow up range was 7 months–8.3 years (mean 4 years). Results. 82 ankles were identified in 73 patients. Medical notes were reviewed for all patients. Fifty five patients were clinically reviewed (75% response rate), a further 3 contacted by telephone (79% response rate). Fifeteen were not contactable. Male 47: 35 female, age range at surgery 18–75 years (mean 56.1), left 37: 45 right, 8 were smokers. Causes leading to fusion were: Trauma 52 (63%), OA 17, Rh.A 7, CMT 3, CTEV 2, Talar AVN 1. All fusions were performed with 2 (78) or 3 (4) medial tibiotalar screws. Length of stay range: 1–12 days (mean 3.1). All patients were placed in plaster post operatively for a minimum 12 weeks. Time to union ranged from 8 to 39 weeks (mean 13.3) with a union rate of 100%. Major complications were 14.6%: 7 (8.5%) malalignment, 3 (3.7%) wound problems, 2 (2.4%) complex regional pain syndrome. There were no non unions, DVT, PE, stress fractures or deep infections. There were 2 (2.4%) delayed unions (> 6 months, both smokers), 6 (7%) asymptomatic superficial peroneal nerve injuries and one saphenous nerve injury. Four (4.8%) required screw removal. Subsequent fusions were performed in 7.3%, 4 subtalar, 1 triple and 1 chopart. The AOFAS range was 8–89 (mean 66). 79% were either ‘very satisfied’ or ‘satisfied’ and 8% were ‘very disatisfied’ or ‘disatisfied’. Patients played a variety of sports including golf, squash, badmington and sky diving. Conclusion. These results show excellent union rates (100%) in part related to the strong no smoking policy and meticulous surgical technique. Two delayed unions (union at 39 and 31 weeks) were smokers. There were high satisfaction rates, however varus malalignment and persistent pain (particularly CRPS) resulted in dissatisfaction. Many patients remained highly active. These results exceed the current reported union rates and compare favourable with complications and patient satisfaction and we therefore advocate this technique

The purpose of this study was to review the long-term outcomes of a previously reported prospective series of 46 type III acromioclavicular dislocations. These were treated surgically with temporary fixation of the acromioclavicular joint with wires, repair of the acromioclavicular ligaments, and overlapped suture of the deltoid and trapezius muscles. Of the 46 patients, one had died, four could not be traced, and three declined to return for follow-up, leaving 38 patients in the study. There were 36 men and two women, with a mean age at follow-up of 57.3 years (41 to 71). The mean follow-up was 24.2 years (21 to 26).

Patients were evaluated using the Imatani and University of California, Los Angeles (UCLA) scoring systems. Their subjective status was assessed using the Disabilities of the Arm, Shoulder and Hand and Simple Shoulder Test questionnaires, and a visual analogue scale for patient satisfaction. The examination included radiographs of the shoulder.

At a follow-up of 21 years, the results were satisfactory in 35 (92.1%) patients and unsatisfactory in three (7.9%). In total, 35 patients (92.1%) reported no pain, one slight pain, and two moderate pain. All except two patients had a full range of shoulder movement compared with the opposite side. Unsatisfactory results were the result of early redisplacement in two patients, and osteoarthritis without redisplacement in one. According to the Imatani and UCLA scores, there was no difference between the operated shoulder and the opposite shoulder (p > 0.05). Given the same situation, 35 (92.1%) patients would opt for the same surgical treatment again.

Operative treatment of type III acromioclavicular joint injuries produces satisfactory long-term results.

We retrospectively analysed the clinical results of 30 patients with injuries of the sternoclavicular joint at a minimum of 12 months’ follow-up. A closed reduction was attempted in 14 cases. It was successful in only five of ten dislocations, and failed in all four epiphyseal disruptions. A total of 25 patients underwent surgical reduction, in 18 cases in conjunction with a stabilisation procedure.

At a mean follow-up of 60 months, four patients were lost to follow-up. The functional results in the remainder were satisfactory, and 18 patients were able to resume their usual sports activity at the same level. There was no statistically significant difference between epiphyseal disruption and sternoclavicular dislocation (p > 0.05), but the functional scores (Simple Shoulder Test, Disability of Arm, Shoulder, Hand, and Constant scores) were better when an associated stabilisation procedure had been performed rather than reduction alone (p = 0.05, p = 0.04 and p = 0.07, respectively).

We recommend meticulous pre-operative clinical assessment with CT scans. In sternoclavicular dislocation managed within the first 48 hours and with no sign of mediastinal complication, a closed reduction can be attempted, although this was unsuccessful in half of our cases. A control CT scan is mandatory. In all other cases, and particularly if epiphyseal disruption is suspected, we recommend open reduction with a stabilisation procedure by costaclavicular cerclage or tenodesis. The use of a Kirschner wire should be avoided.