Aim: To review the outcomes for avulsion fractures of the tibial spine in children managed by arthroscopic internal fixation using a canulated screw.

Materials & Methods: A retrospective review was performed of 8 tibial spine avulsion fractures in children managed operatively by arthroscopic canulated screw fixation over a 4 year period. All fractures were graded grade III or IV (Meyer and McKeevers) in severity. Notes and radiographs were reviewed and Lysholm scores were obtained. The average age of our patients was 10.6 years and the average duration of follow up was 23.6 months (Range: 3–52 months). The average Lysholm score achieved was 88.9 (median 94.5, range 61–100) with the score demonstrably improving after the first year from injury. Bony healing was seen in all cases. One patient needed manipulation under anaesthesia to realize full movement.

Conclusions: On the basis of these results, we recommend arthroscopic canulated screw fixation as the treatment of choice for tibial spine avulsions. It takes over a year, however, to achieve optimal results. This series represents the largest collection of these uncommon injuries hitherto reported from the UK.

We studied 40 patients in whom the patella was not severely deformed and who were undergoing primary total knee arthroplasty (TKA) for osteoarthritis by one surgeon using one type of prosthesis. They were randomly allocated either to have the patella retained or resurfaced with a cemented, all-polyethylene component regardless of the state of the patellar articular cartilage. Apart from removal of osteophytes, no surgery was undertaken on the retained patellae. All 38 surviving patients were evaluated at three years using the HSS knee score and a new, specifically designed Patellar score (maximum score of 30). No TKA was revised, but two patients in the resurfacing group had a further unrelated procedure.

The mean HSS and Patellar scores at follow-up were 89 and 28 in the patellar retention group and 83 and 26 in the patellar resurfacing group. Statistically significant lower scores for both were recorded in women and in heavier patients. Stair-climbing ability was significantly better in the retention group. Although there were no complications related to patellar resurfacing, in the medium term we did not find any significant benefit from resurfacing the patella during TKA for osteoarthritis if it was not severely deformed.