Abstract. Objectives. This study aims to evaluate the functional outcomes of early weight-bearing in a functional orthosis for conservatively managed, complete AT ruptures. Also we tried to evaluate the patient reported outcome with this form of treatment. Design. In this prospective study, we have analysed data from 41 patients with ultrasound diagnosed compete AT ruptures, with a gap of less than 5 cm. Every patient was treated in a functional weight-bearing orthosis (VACOped®) for 8 weeks with early weight-bearing following a specific treatment protocol, followed by rehabilitation with a trained physiotherapist. Methods. Patients were followed up with foot and ankle trained physiotherapist for at least 1 year post-injury. At final follow up, the followings were measured: calf girth, single-leg heel raise height and repetitions. Furthermore, ATRS score and a patient feedback were taken on this final visit. Result. The mean ATRS score was 82.1, with a re-rupture rate of only 2% as compared to 5% in normal orthosis. The average calf bulk difference was 1.6 cm, the average heel raise height difference was 1.8cm and a heel raise repetition difference of 6. There was a statistically significant correlation between ATRS score and calf muscle girth (p=0.02). However, there was no significant correlation between ATRS and heel raise height or heel raise repetitions. Conclusion. Early weight-bearing in a functional orthosis provides excellent functional outcomes for conservatively managed, complete AT ruptures, and is associated with very low re-rupture rates. A multidisciplinary approach with a guided rehabilitation programme is essential for optimising functional outcome

Isolated rupture of short head of biceps is a rare injury. There have been no published reports of rupture at the musculotendinous junction. We report two cases of complete rupture of the musculotendinous junction of the short head of biceps in young males both occurring during water skiing. Two males sustained water skiing injuries where the handle was forced against the flexor region of the arm. Whilst trying to adduct and flex the extended arm, they both sustained complete musculotendinous ruptured of their short head of biceps. Both underwent pre-operative magnetic resonance imaging and one underwent isokinetic strength testing of elbow flexion and supination. Surgical repair was performed using absorbable sutures. One patient had the short head muscle belly flipped distally to lie in a subcutaneous plane in front of the elbow. Post-operative management included cast immobilisation for three weeks then gentle range of motion exercises. Both patients recovered their full range of motion in the arm. There were no complications. Post-operative strength testing was performed and will be presented. This is a unique series of complete musculotendinous rupture of the short head of biceps. The mechanism of injury was resisted adduction and flexion against the towrope handle with the arm in extension. These ruptures occurred in high impact high velocity accidents. Surgical repair lead to an excellent outcome

Hamstring muscle strain is a common sports related injury. It has been reported in a variety of sports, following acceleration or deceleration while running or jumping. Injury may vary from simple muscle strains to partial or complete rupture of the hamstring origin. Avulsion fracture of the ischial tuberosity has also been described. Simple hamstring muscle strains are treated conservatively. Surgical exploration and repair is currently advocated for partial or complete rupture of the hamstring origin. A few case series exists in literature suggesting the benefits of early intervention. We report a series of 8 athletes who presented between 2002 and 2006 with complete tear of their hamstring origin. Avulsion of the ischial tuberosity was excluded in these cases. After confirming the diagnosis, early surgical exploration and repair or reattachment was performed. The patients were braced for 8 weeks. This was followed by specialist physiotherapy and a supervised rehabilitation programme over 6 months. All patients were followed up to monitor return to normal activities and sports. The sciatic nerve was scarred to the avulsed tendon in three cases. Neurolysis led to a rapid relief of symptoms. Cases where the hamstring origin had retracted more than 3 cm required a figure 7 incision. There were no major complications including nerve palsies. An excellent functional outcome was noted by 12 months in all 8 patients. 7 of them returned to their previous level within 6-9 months of injury. One person despite a very good recovery, opted out of sports. No other complications were seen as a result of the surgical procedure. In conclusion, a tear of the origin of hamstring muscles is a significant injury. Early surgical repair and physiotherapy is associated with a good outcome and enables an early return to high level sports

Knee dislocation is a rare injury in high energy trauma, but it is even rarer in low energy injuries. We present, to our knowledge, the only case in the world literature of knee dislocation following a cricketing injury. The patient was a 46 year old recreational fast bowler who, whilst bowling, slipped on the pitch on the follow through. He sustained an anteromedial knee dislocation which was reduced under intravenous sedation. He also sustained a neuropraxia of the common peroneal nerve with grade 2 weakness of ankle and toe dorsiflexion. Magnetic Resonance Imaging (MRI) confirmed a complete rupture of anterior cruciate ligament (ACL), lateral collateral ligament (LCL) and postero-lateral corner (PLC). Patient underwent surgical reconstruction and repair of his PLC along with repair of LCL with combination of anchor sutures and metal staple within 72 hours of the injury. He was treated in a cast brace. The ACL insufficiency was treated conservatively. Patient made an uneventful recovery and follow up at 3 months revealed a full range of knee movements with asymptomatic ACL laxity

Introduction. The Segond's fracture is described as a cortical avulsion of the lateral tibial plateau at the site of insertion of the middle third of the lateral capsular ligament. The Segond's fracture is usually associated with a tear of the Anterior Cruciate Ligament (ACL) and it is considered as an indirect radiological sign of complete rupture of the ACL. However there are no studies investigating the effect of a Segond's fracture on the kinematic of the knee especially on the rotatory instability and Pivot Shift (PS) phenomenon. The purpose of this study is to investigate the effect of a Segond's fracture on the kinematic of the knee with the use of navigation and the PS test. Methods. Ten whole fresh-frozen cadavers were used. A navigator (2.0 Orthopilot Navigation System, BBraun Aesculap, Tuttlingen, Germany) was used to measure maximum manual Anterior Tibial Translation (ATT) at 30°, 60° and 90° of flexion, maximum manual Internal Rotation (IR) and maximum manual External Rotation (ER) at 0°, 15°, 30°, 45° and 90° of flexion. All procedures were performed three times and the mean value taken as the final result in each case. Moreover a PS test was performed by the senior, most experienced, surgeon, and graded as mild (gliding), moderate (jerk) and severe (subluxation). Navigation measurements and PS tests were performed in each knee with ACL intact, after arthroscopic cutting of the entire ACL and after a Segond's fracure was produced by exposing the antero lateral compartment of the knee underneath the ileo-tibial tract. Statistical analysis was performed using ANOVA 1-way and MANOVA tests and value for statistical analysis was set at p<0.05. Results. Navigation procedure: Cutting the whole ACL resulted in a significant increase of ATT at 30° and 60° of flexion, with no significant effect on IR and ER. Producing the Segond's fracure resulted in a significant increase of ATT at 60° and 90° of flexion, in a significant increase of IR at 30°, 45° and 60° of flexion with no significant effect on ER. PS: The PS was clinically undetectable in all knees with ACL intact. After cutting the ACL it continued to be undetectable in two cases, mild positive in six cases and moderate in two. The addition of the Segond's fracture resulted in an increase of the PS in all cases with a moderate grade detected in three and severe in seven. Conclusions. Despite the limitations of this study, which include manual loads applied to the knee during navigation measurements and subjective evaluation of the PS, the results of this cadaver study indicate that the Segond's fracture has a significant effect on knee stability especially on rotational stability, which is functionally the most important in case of ACL tear. Therefore, in case of an acute ACL tear, when a Segond's fracture is radiologically detected and an ACL reconstruction is performed, an inspection of the lateral compartment with repair of capsule and fixation of the fracture could be advisable in order to better restore knee stability

Aims

Despite the increase in the surgical repair of proximal hamstring tears, there exists a lack of consensus in the optimal timing for surgery. There is also disagreement on how partial tears managed surgically compare with complete tears repaired surgically. This study aims to compare the mid-term functional outcomes in, and operating time required for, complete and partial proximal hamstring avulsions, that are repaired both acutely and chronically.