Advertisement for orthosearch.org.uk
Results 1 - 4 of 4
Results per page:
Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_13 | Pages 48 - 48
7 Aug 2023
Hampton M Reed D Ali F Nicolaou N Ajuied A
Full Access

Abstract

Introduction

There is currently very little evidence which can be used to guide surgeons treating skeletally immature patients with suspected meniscal injury. The aim of our modified Delphi study was to develop comprehensive recommendations for the management of isolated meniscal tears in skeletally immature children.

Methodology

An international, two round, modified Delphi consensus was completed. Included ‘experts’ were identified as having an established adult and/or paediatric knee practice and either: 1) Faculty at the international kid's knee meeting, 2) Active member of the complex national paediatric MDT group, or 3) faculty on recognised national course aimed at teaching knee surgeons regarding the management of meniscal lesions. A threshold of 70% was used to identify consensus.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_1 | Pages 213 - 213
1 Jan 2013
Ajuied A Norris M Wong F Clements J Back D Davies A
Full Access

Introduction

The advent of double bundle ACL (Anterior Cruciate Ligament) reconstruction had been hailed as potentially allowing for more anatomically and physiologically functioning graft, however until recently there had been little evidence of enhanced functional outcomes.

The aim of this study is to explore whether the dimensions of hamstring two strand single bundle grafts, are predictive of the combined four strand single bundle graft that results from combining the single bundle grafts, as well as the impact of double bundle grafts upon the available healing and attachment area within the bony tunnels.

Methods

Grafts of all likely two strand single bundle graft sizes, measured to the nearest 0.5mm in diameter using unslotted sizing block, were prepared using porcine flexor tendons,. These two strand single bundles were then systematically combined, and re-measured.

By geometrical calculation, the sum of the circumferences of the two, two strand double bundle grafts were compared to the combined four strand single bundle graft formed by combining the two smaller bundles.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 418 - 418
1 Sep 2009
Ajuied A Carlos A Kumar A
Full Access

Introduction: After adopting a new low suspensory bio-absorbable femoral fixation technique for single bundle, four strand, hamstring Anterior Crutiate Ligament (ACL) in conjunction with a rapid rehabilitation program, we observed at routine follow up that there was no evidence of femoral tunnel widening, as often observed with conventional high suspensory fixation systems.

Method: We conducted a retrospective observational cohort study to test the hypothesis that the Rigid-Fix (Mitek) system of femoral fixation, a low suspensory technique, is less prone to tunnel widening than traditional suspensory techniques.

14 subjects were recruited at routine follow up, and assessed by interview, clinical examination and plain digital raiodgraphs.

All radiographs were taken under clinical supervision, with a scale reference, hence allowing digital rescaling.

Results: All subjects had regained knee stability, and all but one had returned to their pre-injury level of sport. Clinically all knees were ligamentaly stable, exhibiting negative Luchman and pivot shift tests.

Examination of the radiographs demonstrated only a 1.1mm (+/− 0.9mm) mean femoral tunnel widening, which represents a 12% increase in diameter (21% increase in area), and compares very favourably to the observed tunnel widening in high suspensory techniques, as cited in the literature.

Conclusions: We conclude that the Rigid-Fix femoral ACL fixation system does not exhibit any evidence of clinically significant tunnel widening, even when used in conjunction with a rapid rehabilitation program.

Systems of low suspension benefit from the advantage of not relying on interference fit which risks posterior cortical ‘Blow Out’. A shorter graft working length within the tunnel lessens graft micro-movement, making early low biological fixation within the femoral tunnel more likely, and reduces the amount of tunnel widening. These micro-movement have been described as the ‘Windscreen Wiper’ and ‘Bungee Cord’ effects, and are well documented in traditional high suspensory fixation.


Orthopaedic Proceedings
Vol. 85-B, Issue SUPP_II | Pages 124 - 124
1 Feb 2003
Ajuied A Singh R Addison A Sait S
Full Access

To assess the incision used for routine primary Carpal Tunnel Decompression (CTD), preferred modes of division of the flexor retinaculum and the accuracy with which the motor branch of the median nerve could be identified.

A simple questionnaire was distributed at an orthopaedic regional meeting, which contained a list of simple questions, and a scale photocopy of the palm of a left hand. The surgeons were asked to indicate upon the hand the incision they would make and their prediction of the location of the motor branch of the Median nerve. The data was feed into a desk top spreadsheet program where it was analysed.

43 complete questionnaires were returned, comprising all grades from SHO to consultants. A great majority used a McDonald’s spatula during their division of the retinaculum, with an equal proportion cutting down onto the McDonald’s spatula as were cutting up from it. The shape of the incision was straight in a majority of cases, though some consultants and SpRs tended towards curved or S-shaped incisions. Length of incision varied, among all grades, from 2cm to 6cm, with Juniors tending towards shorter incisions. With respect to Ulna (Medial) or Radial (Lateral) position of the incision, the tendency was to place the incision Radially. 72% of surgeons located the position of the motor branch within 2cm of the actual position, as predicted by Kaplan’s lines.

The surgeons audited tended towards lateral incisions, and hence potentially placing the palmar cutaneous and the motor branches of the median nerve at greater risk.

Some juniors continue to have the preconception that smaller incisions for CTD are preferred.

The location of the motor branch was accurately predicted in a majority of cases.

The McDonald’s spatula is still widely used in CTD.