Recurrent patella dislocation is a well-recognized complication after primary dislocation of the patellofemoral joint. We propose that acute surgical management of the injury minimizes this risk.

Between February 2006 and August 2010 47 patients (49 knees) with a mean age of 17.9 (range 12–31) at the time of surgery who sustained a patellofemoral joint dislocation for the first time were treated with an acute repair of the medial patellofemoral ligament.

Patients presenting to our fracture clinic following a primary lateral dislocation of the patella were investigated with an MRI scan and with consent, proceeded to have an examination under anaesthesia and arthroscopy of the injured knee. An easily dislocatable patella in the presence of a confirmed medial patellofemoral ligament rupture was the indication for open repair.

All patients treated surgically were followed up for a period of 24–72 months where the primary outcome measure was further dislocation. An evaluation of symptoms, functional recovery, restoration of range of movement and patient satisfaction was made supported by the Lysholm knee score.

Our results confirm that acute repair of the medial patella femoral ligament in selected patients reduces the risk of further dislocations and results in a overall good functional outcome and patient satisfaction with minimal complications.

Aim

To correlate the surgical and MRI findings in acute lateral patellar dislocation and to determine the accuracy of MRI in identifying location of MFPL injury.

This is a study of 24 patients (28 Knees) who underwent acute repair for quadriceps and patellar tendon ruptures using Leeds Keio ligament. Four patients had bilateral quadriceps tendon rupture.

The mean age of patients was 57.4 years (range from 20 to 85 years) with mean follow-up of 20 months (range from 2 months to 3 years). Four patients (6 knees) were lost in follow-up. Knee injury and Osteoarthritis and Outcome Score (KOOS) and Tegner Lysholm Knee Score were used to evaluate the outcome. Sixteen patients had scores of 80 and above in both scoring systems. The mean flexion was 125° and extension lag of 6.6°. The knees were not immobilised after surgery and patients were encouraged to fully weight bear.

One patient had patella fracture secondary to fall although technical error played a part in this. Two patients had bilateral ruptures secondary to fall and one patient had ectopic bone formation. There was no wound infection.

This technique permits immediate mobilisation and full weight bearing of the limb. The early results are promising but long term results are yet to be evaluated.

Objective: To evaluate the results of cannulated screw fixation for subcapital neck of femur fractures in our unit.

Materials and Methods: 104 patients underwent the above procedure in our unit over a two year period (Jan 2006 – Dec 2007). The case notes and xrays of these patients were reviewed retrospectively. The age group varied between 31 and 100 years.

Results: There was 20% incidence of complications. There were 9 cases of AVN and 10 cases of screws backing out and I case of subtrochanteric fracture. Of the 9 cases of AVN 3 were below 73 years of age and the rest had a mean age of 90.3 years.

Conclusion: There is a high incidence of AVN in geriatric group requiring further surgery and cannulated screws fixation is not the optimal choice in geriatric group for varied reasons. Further review is to be carried out looking for the specific reasons of failure.

Purpose: To evaluate the patients who underwent acute surgical repair of medial patellofemoral ligament following first lateral dislocation of patella

Methods: Twenty four patients with mean age 19 yrs (12–41) who underwent acute repair of MPFL were reviewed. The mean follow-up was 14 months (2–35 months). All patients had MRI scan preoperatively and most of them were operated within two weeks of injury. Patients were evaluated clinically and Kujala and modified Lysholm were recorded. None of these patients had further dislocations and all had negative patellar apprehension tests. The mean Kujala and modified Lysholm scores were above 85.

Conclusion: Our results strongly support that in selected patients acute repair of MPFL prevents further dislocations and early return to sporting activities. The long term results are to be evaluated.

Recent literature suggests MPFL is the primary medial restraint in lateral patellar dislocation and supports acute repair in first lateral dislocations.

Objective: To evaluate the results of patients who underwent acute surgical repair of MPFL in our unit.

Materials and Methods: Nine patients with mean age of 25(12–41) were evaluated in a dedicated clinic. The mean follow-up was 15.7 months (6–22). All patients had MRI scan preoperatively and were operated within two weeks of injury. Patients were evaluated clinically and Kujala and Lysholm scores were recorded.

Results: None of these patients had further dislocations of patella and patellar apprehension test was negative on examination. The mean Kujala score was 78(74–100) and mean Lysholm score was 92(85–100). All patients had returned to sporting activities at clinic review. All but one mentioned that they would choose surgical repair if the injury occurred in the other knee.

Conclusion: Our results confirm in selective patients acute repair of MPFL is the ideal treatment to prevent recurrent dislocations and early return to sports.

Introduction: The long term results of a previously published (J Shoulder Elbow Surg. 2002 Sep–Oct; 11(5):486–492) series of 44 primary Souter-Strathcyde total elbow arthroplasties performed on 36 patients with rheumatoid arthritis by a single surgeon in a district general hospital are presented.

Methods: Of the 36 patients 14 patients had died leaving 22 patients or 28 elbows that could be followed up with a mean follow up of 11 years (range 9.7–17.8 years). Patients were followed up in research clinics. They underwent plain radiographs and clinical examination. The notes of the deceased patients were reviewed.

Results: In the surviving patients 60% reported complete freedom of pain, 28% mild intermittent pain and 11% moderate pain. The mean range of motion at follow up was 91 degrees (range 30–130 degrees). This represented a mean gain of 15 degrees of flexion, but only a 1 degree gain in extension. Fourteen elbows had a range of motion of 100 degrees or greater compared with 9 before surgery.

In the deceased patients 2 patients had undergone revision and the remaining patients had died of causes unrelated to the surgery with the prosthesis intact. There was 1 permanent ulnar nerve palsy and two deep infections one requiring debridement. Eight of the original 44 primaries required revision, 3 for fractures and 5 for loosening.

Discussion: In patients with rheumatoid arthritis and low functional demand, the Souter-Strathclyde total elbow arthroplasty performs well in abolishing pain and increasing independence in carrying out the activities of daily living.