Introduction. Recurrent patellar dislocation is often reported in bilateral knees in young active individuals. The medial patellofemoral ligament (MPFL) tear is the attributable cause behind many of them and warrants reconstruction of the ligament to stabilize the patellofemoral joint. Besides, trochleoplasty and Fulkerson's osteotomy are some other procedures that are performed to treat this problem. This study aimed to compare the clinical and functional outcomes in a cohort of patients with single-stage bilateral realignment procedures vs staged procedures. Methods. It was a retrospective matched cohort study with prospectively collected data. A total of 36 patients (mean age-26.9 years, range 13 years to 47 years) with recurrent patellar dislocations, who underwent a surgical correction in both the knees, were divided into two matched groups (age, sex, follow-up, and type of procedure). Among them, 18 patients had surgeries in one knee done at least six months later than the other knee. The remaining 18 patients had surgical interventions for both knees done in a single stage. Lysholm, Kujala, Tegner, and subjective knee scores of both groups were compared and analyzed. The rate of complications and return to the theatre were noted in both groups. Results. With a mean follow-up of 7.3 years (2.0 years to 12.3 years), there was a significant improvement in PROMS observed in both the groups (p<0.05). No significant difference could be found between the two groups in terms of the Lysholm, Kujala, and subjective knee scores (p> 0.05). The rate of complication and the re-operation rate was comparable in both the groups (p>0.05). Conclusion. The outcomes of staged vs simultaneous surgeries for bilateral patellofemoral instability are comparable. Our results indicate that simultaneous bilateral surgical correction is safe. This can potentially be an option to reduce the surgical cost and perioperative morbidity. However, careful selection of cases, choice of the patient, and the scope of rehabilitation facilities are some of the other factors that should be considered

The purpose of this study was to compare the outcomes of arthroscopic unilateral surgery and simultaneous bilateral surgery for posterior ankle impingement syndrome (PAIS) in athletes and to evaluate the usefulness of simultaneous bilateral surgery. A total 48 hindfeet of 41 athletes (14 hindfeet of 14 males, 34 hindfeet of 27 females) who underwent arthroscopic surgery for PAIS were studied. Japanese society for surgery of the foot (JSSF) score and visual analogue scale (VAS) were compared before and after surgery, using Wilcoxon signed-rank test. The operation time and the time to return to sports activity were compared in 10 hindfeet of 5 patients who underwent simultaneous bilateral surgery and 38 hindfeet of 36 patients who underwent unilateral surgery, using Wilcoxon rank sum test. Classic ballet was the most common type of sport that caused PAIS (59%, 24/41 athletes). Soccer (10%, 4/41 athletes), baseball (10%, 4/41 athletes), badminton (5%, 2/41 athletes), volleyball (5%, 2/41 athletes), and athletics (5%, 2/41 athletes) followed. The JSSF score improved significantly from 72.7 preoperatively to 98.9 postoperatively in unilateral surgery, and significantly improved from 75.2 preoperatively to 99.0 postoperatively in simultaneous bilateral surgery. VAS significantly decreased from 64.7 preoperatively to 4.8 postoperatively in unilateral surgery, and significantly decreased from 72.7 preoperatively to 1.0 postoperatively in simultaneous bilateral surgery. The operating time was 53.7 minutes on average for unilateral surgery and 101.0 minutes for simultaneous bilateral surgery, significantly longer in bilateral simultaneous surgery. The mean time to return to sports activity was 4.8 weeks for unilateral surgery and 9.6 weeks for simultaneous bilateral surgery, significantly longer in simultaneous bilateral surgery. Both unilateral and simultaneous bilateral surgeries for PAIS in athletes were useful. It should be noted that the operating time and the time to return to sports will be longer. However, considering the 2 times hospitalizations and 2 times surgeries, simultaneous bilateral surgery is one of the treatment options for PAIS

Background. Post-operative acute kidney injury is significant complication following surgery. Patients who develop AKI have an increased risk for progression into chronic kidney disease, end-stage renal failure and increased mortality risk. The patient outcomes following total knee replacement (TKR), who develop AKI has been a topic of interest in recent years as it may have patient and medicolegal implications. Nevertheless, there are no studies looking at the incidence, risk factors and outcomes of AKI following bilateral TKRs at the same sitting. Objectives. To determine the incidence, risk factors and outcomes of post-operative AKI following bilateral TKRs surgery at the same sitting. Methods. This was a retrospective single-centre study performed at the Princess Royal Hospital, which performed a total of 25 BTKR. The incidence, Surgical and patient risk factors were recorded and analysed. Results. The incidence of AKI as defined by NICE guidelines following bilateral TKRs was 20%. 16% (4 patients) had stage 1 and 4% (1 patient) had stage 2 AKI. The mean change in Creatinine between pre- and post-operative blood tests was +19μmol/L. There was a strong significant correlation between CKD and AKI (r=0.75, P<0.05). Furthermore, a moderate correlation was found between higher BMI and pre-operative Charlson index and AKI. AKI did not have an effect on the length of inpatient stay with the mean inpatient length of stay for patients who had an AKI of 10 days compared to 11days for those who did not. All AKIs were resolved within 72 hours. There were no associated mortalities with AKI. Conclusion. The incidence of AKI following bilateral TKR was 20%. Pre-operative chronic kidney disease as well as having a higher BMI were identified as risk factors for developing AKI. Pre-operative CKD optimisation and careful adequate hydration intra-operatively should be considered in these patients. AKI was not associated with an increased length of stay or mortality in our study

Rebound growth after hemiepiphysiodesis may be a normal event, but little is known about its causes, incidence or factors related to its intensity. The aim of this study was to evaluate rebound growth under controlled experimental conditions.

A total of 22 six-week-old rabbits underwent a medial proximal tibial hemiepiphysiodesis using a two-hole plate and screws. Temporal growth plate arrest was maintained for three weeks, and animals were killed at intervals ranging between three days and three weeks after removal of the device. The radiological angulation of the proximal tibia was studied at weekly intervals during and after hemiepiphysiodesis. A histological study of the retrieved proximal physis of the tibia was performed.

The mean angulation achieved at three weeks was 34.7° (standard deviation (sd) 3.4), and this remained unchanged for the study period of up to two weeks. By three weeks after removal of the implant the mean angulation had dropped to 28.2° (sd 1.8) (p < 0.001). Histologically, widening of the medial side was noted during the first two weeks. By three weeks this widening had substantially disappeared and the normal columnar structure was virtually re-established.

In our rabbit model, rebound was an event of variable incidence and intensity and, when present, did not appear immediately after restoration of growth, but took some time to appear.

Cite this article: Bone Joint J 2015;97-B:862–8.