2 stage revisions of infected knee replacements using a static spacer are complicated by poor patient mobility between stages and the need for extensive soft tissue releases at the second stage. In this study we hypothesised that the use of the resterilsed components as temporary functional spacers, maintains patient function, and reduces soft tissue releases at second stage without reducing the rate of septic failure and obviating the need for expensive purpose made spacers.

Method We report our series of seven two-stage revisions of infected total knee replacements using the resterilised femoral and tibial components as a temporary articulating spacers. This was compared to a second cohort of 6 patients in which the standard “hamburger” static spacer was used. Outcomes measured include reinfection rates, interval mobility, final range of movement, and bone loss.

Results The articulating spacer allowed more comfortable function between stages and obviated the need for rectus snips and tibial tubercle osteotomies for exposure at the second stage. There was less bone loss in the articulating group requiring less stems or augments. The range of movement averaged 88 degrees at 9.3 months compared to 80 degrees at 9.2 months in the “static” cohort. There were no reinfections in either group.

Discussion We have shown that this is a safe and effective way of treating infected knee arthroplasties with significant advantages for the surgeon and patient over more traditional methods.

The rehabilitative phase of ankle injury management often involves the use of an ankle brace. The aim of this study was to ascertain the effects of such braces on the forces through the foot and the timing of peak loads in the gait cycle, in the recovering ankle and the uninjured ankle, in order to understand better the mechanism by which such braces enhance ankle stability.

Twenty four adults with recurrent ankle injuries and an aspiration to return to sporting activity were studied. Each was in the rehabilitation phase of recovery from ankle injury. Controls were 17 adults who regularly took part in sporting activity, without ankle injury. Assessment of peak force in three orthogonal axes (% body weight) during walking was carried out using the Kistler foot plate; the times taken to reach the maxima were recorded. Subjects were assessed in bare feet, training shoes and wearing one of two types of commonly available stirrup-type ankle braces.

Results showed that the ankle braces did not alter peak loads compared to training shoes alone (one-way analysis of variance, p< 0.05) and were consistent in both the injured and un-injured subjects. There were no significant differences between the two braces tested (p< 0.05). The time to reach peak load was not significantly different between the braced or non-braced ankles in either the injured or control groups.

Conclusions are that stirrup type ankle braces do not alter the peak forces through the foot during walking. The effectiveness of stirrup-type ankle braces appears not to depend on their modification of medial forces during gait.

The rehabilitative phase of ankle injury management often involves braces. Our aim was to ascertain the effect of both a brace on both ankle range of movement and the timing of peak loads in the gait cycle, to understand better the mechanisms by which such braces enhance ankle stability.

We recruited 24 adults who were in the rehabilitation stage following ankle injuries, and in whom there was an aspiration to return to sport.

Controls were 17 adults who regularly played sport, but had no recent history of injury.

Assessment of range of movement was carried out using the Biodex isokinetic dynamometer to measure inversion, eversion, flexion and extension of the foot, with the subject in training shoes, and wearing one of two common stirrup-type ankle braces. Assessment of peak force in three orthogonal axes (% body weight) was performed using the Kistler footplate. The subjects were observed in bare feet, trainers and stirrup braces.

Results showed that the ankle braces restricted inversion (mean reduction 9 degrees, SD 8 degrees) compared to training shoes alone in both the injured and non-injured sunjects, but the restriction in range of movement in inversion /eversion was not significantly different between the braced injured and un-injured ankles (t test p< 0.05).The ankle braces did not alter peak loads compared to training shoes alone (one way analysis of variance, p< 0.05);these findings were consistent in both groups. The time to reach peak load was not significantly different between the braced or un-braced ankles in either the injured or control groups.

We conclude that stirrup type braces reduce the range of inversion/eversion in the normal and injured ankle, reducing the movement by a similar amount in both of these groups, but they do not alter peak forces through the foot during walking.

It is not clear to what extent the normal active stabilisers of the ankle, primarily the peroneii, are affected by fatigue, during or after sporting activity. The aim of this study was to ascertain the effects of fatigue on ankle stability in the active sportsman.

20 adults who regularly took part in sporting activity, and who had no recent history of ankle injury were recruited. Assessment of ankle stability and function consisted of a static test (one legged stance, ‘stork test’) and dynamic tests (time taken to hop 6-limbed star), testing each leg. Test time were recorded (3 attempts with the best result counting) before and after exercise which consisted of a 2km treadmill run, run at the subject’s best pace.

Our results showed an overall improvement in both static and dynamic stability after exercise. The differences reached statistical significance (one-tailed analysis of variance, p< 0.05).

We therefore conclude that moderate exercise improves static and dynamic ankle stability in the normal ankle; this demonstrates a beneficial warm up effect, rather than a fatigue effect.

The functionally unstable ankle with giving way or with lack of confidence in the ankle, without major ligamentous laxity, is a common problem in sportsmen and women. The aim of this study was to record the arthroscopic findings in patients with ankle problems, a history of ankle injury, and continuing functional instability.

We reviewed the findings of 90 consecutive ankle arthroscopies in patients suffering from ankle problems interfering with sport. All complained of a combination of pain on sporting activity (38%), a lack of trust in the ankle (30%), or the ankle letting them down when running or turning (22%).

Results showed that isolated lesions identified at arthroscopy were uncommon (7%). 40% had synovitis, often associated with scarring or thickening around the anterior talo-fibular ligament (ATFL). Anterior tibial osteophytes were found in 45% and chondral or osteochondral talar lesions were present in 53%. The majority (80%) also had a lesion in the inferior tibiofibular joint (ITFJ). The ITFJ lesions were often firm, impinging within the ankle joint, and were associated with synovitis. All ankle lesions were arthroscopically resected.

The importance of ATFL impingement lesions, sometimes called meniscoid lesions, has previously been described. We would draw attention to the IFTJ lesions, which were common in our series of unstable ankles, and which we believe are part of the pathology of this condition.