Introduction We performed an audit of tunnel position in primary anterior cruciate ligament reconstructions performed by two surgeons at a single centre. The audit cycle was opened with a retrospective review of a cohort of patients in order to establish existing surgical practice. Following this review our practice changed with the use of intra-operative image intensifier to confirm tunnel positions. The audit loop was closed with a prospective study of a second cohort of patients undergoing surgery using the new technique.

Results Twenty five patients were reviewed in each group. The case-mix for the two groups were similar with regard to age, sex, side, graft selection and surgical technique. The first cohort of patients had optimal tibial tunnel placement in 56% (sagittal) and 88% (coronal) of cases. The femoral tunnel was correctly positioned in the sagittal plane in 52% of patients. The second cohort, in which an intra-operative image-intensifier was used, had optimal tunnel position for the femur in 100% of cases and for the tibia (sagittal) in 48% of patients.

Conclusion In this study we have shown that the use of an image intensifier, intra-operatively, greatly improved femoral tunnel position but had no significant effect on tibial tunnel placement. We have also demonstrated that audit is effective in improving clinical practice.

The risk of venous thromboembolism following surgery, with its associated morbidity and mortality, means it forms an important part of informed consent for a surgical procedure. The risk of thrombo embolic complications extends beyond the post-operative hospital stay. Patients suffering such a complication after discharge are generally not re-admitted under the care of the operating surgeon.

A retrospective opening loop audit was undertaken to investigate the communication of post-operative thrombo embolic complications between specialities in a large district general hospital. The operating surgeon was unaware of 87% of cases of pulmonary embolism and 20% of cases of deep vein thrombosis affecting patients in their post-operative period. The inter-specialty communication of post-operative complications is important to maintain a high standard of patient care and allow surgeons to make informed decisions about clinical practice.