Introduction. Superior Labral Anterior Posterior Tears are being treated surgically in increasing numbers. Stiffness is the most common complication. We reviewed 115 cases of SLAP repairs to try and identify preoperative risk factors if any for stiffness. Methods. Retrospective cohort study of 115 patients who underwent SLAP repair. All patients failed attempts at conservative therapy including NSAIDS, Physical Therapy and cortisone injections. Results. Age ranged from 16–71 years, with an average age of 46. Male 84, Female 31. patient charts and operative notes were examined from 2004–2009. We used an average of 1.64 anchors per case; we performed arthroscopic Mumford on 15 patients, subscap repair (4), 19 cases with concomitant SLAP repair and Arthroscopic rotator cuff repair Other procedures included Biceps tenotomy and tenodesis, chondroplasty, Microfracture, removal of loose bodies, synovectomy and lysis of adhesions. Twelve patients underwent revision surgery(10%) We had 5 cases of stiffness which required lysis of adhesions and synovectomy, 4 cases had previous SLAP and concomitant rotator cuff repair done at the index surgery, 4 cases had arthrosis noted at index surgery and underwent chondroplasty and 2 of them underwent micro fracture. During the revision surgery 4 had also a concomitant cuff tear (new) which required repair Average time from index surgery to revision was 11 months, the patients who developed adhesive Capsulitis and stiffness the average age was 56 years. We had 2 titanium metal anchors pull out and present as loose bodies with one of the anchor causing chondral damage, we stopped using metal anchors and we have not had this problem recur since.5 cases had Mumford procedure done during the revision surgery.5 cases needed repeat SLAP repairs and by increasing use of biceps tenotomy this incidence should decrease. Conclusions. Our large retrospective case series shows an acceptable complication rate. Stiffness (5%) is still the most common complication especially in patients older than 50, withpreexisting Glenohumeral arthritis and concomitant rotator cuff tears. Hopefully our early aggressive mobilization will decrease this incidence

We reviewed all patients that suffered a deep infection following anterior cruciate ligament (ACL) repair kept between January 2007 and April 2011 at our teaching hospital NHS trust, and the two local private hospitals. 18 patients were identified. All patients underwent at least 2 arthroscopic washouts, with limited synovectomy if required. Targeted antibiotics were commenced according to the culture results, and following microbiological advice. These patients were reviewed at a minimum of 1 year following eradication of infection (range 12–46 months). There were 7 surgeons performing the ACL reconstructions. The primary outcome measure was graft failure requiring revision. Our secondary outcome measures were a history of ongoing instability, KT 1000™ measurement, Tegner and Lysholm outcome scores. There were 18 patients identified as having suffered infection after ACL infection (mean age 24.3 years, range 15–38 years). Average C Reactive Protein (CRP) was 217 on admission (range 59–397). The most common organism isolated was coagulase negative staphylococcus in 47.3% of cases. There were 3 graft failures within the infection group. Of the remaining 15 patients there were no episodes of ongoing instability and mean pivot shift grade was 1.1, mean KT 1000™ side-to- side difference was +1.8mm. There was a reported drop on the Tegner activity score of 1.75 (range 0–6) and mean Lysholm score was 89 (range 56–100). The failure rate is slightly higher than that reported in the literature. Patient reported outcome measures in the patients are broadly consistent. We recommend an aggressive approach to the treatment of deep infection following ACL reconstruction, in order to achieve a satisfactory outcome

We aimed to investigate the effect of Seprafilm®, a synthetic biomembran, on the intra-articular adhesion formation in an experimental arthrofibrosis model. Twenty male white rabbits were randomly allocated into two groups of 10 animals in each. A standard surgical procedure aiming at the development of arthrofibrosis and including medial parapatellar arthrotomy, lateral eversion of the patella, partial synovectomy and debridement of anterior of supracondylar area and patella joint surface by scalpel was performed on all rabbits' right knees. Group 1 rabbits served as controls, and in Group 2 rabbits a Seprafilm®, barrier placed into the described area. In both groups, after surgery, knee joint was immobilized by a no.5 wire suture passing from the ankle and groin and keeping the joint in 140° of flexion. At 6th week, all animals were sacrificed and adhesion formation was evaluated both macroscopically and histo-pathologically. All data were semi-quantified and analyzed statistically by Fisher's exact test. While all rabbits in control group displayed different rates of adhesion macroscopically (62.5% severe, 25% moderate, 12.5% mild), none in the study group had it. The average macroscopic adhesion score was 2.5 ± 0.75 in control group, and 0 in Seprafilm® group. Histopathologic evaluation also revealed microscopic adhesion in all rabbits in control group, but none in Seprafilm® group. Fibroblast proliferation in Seprafilm® group (100% mild) was significantly lower than in control group (62.5% severe, 37.5% moderate) (p<0.05). In conclusion, use of Seprafilm® as a mechanical barrier may be of value against the formation of arthrofibrosis in risky knees such as septic and traumatic ones

INTRODUCTION. The purpose of this study is to report results from a prospective multicenter study of a bioresorbable type I collagen scaffold used to replace tissue loss following irreparable lateral meniscus injuries. METHODS. 49 non-consecutive patients (33M/16F; mean age 30.5 yrs, range 14.7–54.7 yrs) with irreparable lateral meniscus tears or loss requiring surgical treatment were prospectively enrolled at one of 7 EU centers. 11 patients (22%) had acute injuries of the lateral meniscus, while 38 (78%) had prior surgeries to the involved meniscus. Implantation of the LCMI (now Lateral Menaflex) was performed arthroscopically using an all-inside suturing technique (FASTFIX) combined with inside-out sutures in the more anterior meniscus aspect. Forty-three patients were evaluated with a 2 to 4-year follow-up (FU); mean FU duration was 45 months (range, 33–53 m). Patients were evaluated clinically and by self-assessment using Tegner activity and Lysholm function scores, as well as the Visual Analog Scales (VAS) for pain, and a satisfaction questionnaire. Evaluations were performed pre-operatively, 6 months, 1 year, 2 and 4 years after surgery. X-ray and/or MR-images were taken pre-operatively, and at 1 year and 2 years after surgery. RESULTS. At 3 months after surgery, all patients were able to return to activities of daily living without limitation. Post-op. mean values of all evaluated patients showed statistically significant improvement compared to the preoperative scores. Mean Tegner scores increased from 3.0 to 5.2 at 4 years (0.8 points less than the pre-injury “recall” value); mean Lysholm improved from 63 to 91; mean pain (VAS) decreased from 36 to 8. At the 4-year time point, 86% of the patients stated that they were satisfied with their results (compared to 78% at the one year FU time point). Function and pain scores improved continuously with the highest score at the latest FU evaluation. All data were statistically significant (p<0.001, except for Tegner with p=0.03). MRI examination revealed no changes to the articular cartilage and joint space; however, the newly formed tissue did not present a signal consistent with fully mature native meniscus tissue. Reoperations were necessary in 5 patients (10%) during the FU time period: 3 of the reoperations were for persistent swelling and pain, which were classified as related to the device (6%) and were treated by synovectomy and debridement. Patients recovered without sequelae. The re-op. rate in this series is comparable to re-op. rates reported after lateral meniscal repair. DISCUSSION. Based on available results with a minimum 2 year FU, 90% of the patients benefited from the Lateral Menaflex as evidenced by improved clinical outcomes associated with gains in activity and function. Longer-term FU continues to determine the extent and duration of the benefits observed