Aim

Our collaborative study aims to demonstrate that acute partial Achilles Tendon Tears (ATTs) are not separate diagnostic entities from full ATTs. and should be thought of as a continuum rather than binary partial or full.

Patella resurfacing is becoming more routine in total knee replacements with recent reports indicating improved long term outcomes. Despite this, patella osteotomy relies heavily on how the cutting jig is applied rather than on fixed anatomical landmarks. Recognised complications of asymmetric patella resection are patella fractures, patella maltracking, bony impingement and pain. Accurate instruments have been developed for other aspects of total knee replacements. However cutting guides for the patella tend to be cumbersome with poor reproducibility.

Patella tilt is defined as the angle subtended by a line joining the medial and lateral edges of the patella and the horizontal. Keeping this angle to a minimum results in congruent alignment of the patella button within the trochlear groove. Current patella cutting jigs do not take this angle into consideration as they require full eversion of the patella laterally, not only making accurate placement of the jig difficult but also putting excessive strain on the surrounding soft tissue.

This study describes a new cutting technique for the patella osteotomy which is referenced off the distal femoral condyles ensuring a more accurate and reproducible cut without having to evert the patella.

With the femoral component trial in situ and the patella in its normal anatomical lie, the knee is flexed to 30°. The patella cutting jig is then applied in the usual manner making sure that adequate thickness of patella remains but it is placed parallel to a line joining the two condyles of the femoral component. By cutting the patella in this position parallel to the distal femoral condyles, patella tilt is minimised and the patella button will be aligned evenly within the trochlear groove.

Currently all patients requiring patella resurfacing at our institution are undergoing this technique and the short term results have been very promising.

This study presents a novel patella cutting technique that utilises a fixed landmark to ensure a more accurate and reproducible osteotomy. We are planning a large scale trial comparing pre- and post-operative knee scores and radiological assessment of patients having this new technique compared to standard cutting techniques. This will allow us to report on the longer term effects and pave the way for better patella resurfacing instrumentation.

Much debate exists over the value of exercise therapy for treating adolescent idiopathic scoliosis (AIS). This study aims to address the current evidence. An extensive search was carried out using the common medical databases, limiting results to clinical trials in English involving humans with defined outcome measures. 155 papers were identified and after applying strict inclusion criteria 12 papers remained for further analysis. These included 9 prospective cohort trials, 2 retrospective cohort trials and one case series. No randomised controlled trials were identified. Although all of the papers concluded an improvement in scoliotic curve after exercise therapy, not one of the papers had reliable methods or results to validate their conclusions. Identified shortcomings included, poor compliance with outpatient exercise regimes with no clear indication of who assessed for curve improvement, how it was assessed or what experience they had, nor was observer error for Cobb angle measurement taken into account. Additionally only a few of the studies had sound statistical analysis and no study could comment on whether the improvements seen were maintained after the exercise regime. Four previous systematic reviews have been performed finding favourable results for exercise therapy, but these were written by authors involved in the original research, adding significant reviewer bias. This systematic review has revealed only poor and low level evidence supporting the use of exercise therapy for treating AIS. Well designed controlled trials with randomisation are required to validate exercise therapy as an effective treatment option and as an appropriate use of NHS funds.