Traumatic injuries to the sternoclavicular joint (SCJ) are uncommon representing only 3% of all injuries to the shoulder girdle. Acutely, the majority are managed non-operatively with physiotherapy rehabilitation. However, if there is evidence of neurovascular compromise emergency reduction is indicated. There is no consensus on treatment of SCJ dislocations and subluxations that remain symptomatic after conservative treatment. Multiple surgical techniques have been described to alleviate this problem. These include resection of the medial end of the clavicle and various stabilization techniques using Kirschner wires, muscle tendon (subclavius, sternocleidomastoid, semi-tendinosus and palmaris longus) and synthetic materials (Dacron). However, all techniques have reported problems in terms of pain, decreased range of movement and a relatively high complication rate.

We report a new technique using a LARS® ligament (Ligament Augmentation and Reconstruction System) with good early post-operative results. 5 symptomatic SCJ dislocations were repaired over a 3 year period. The operations were conducted by the same surgeon and at the same unit. The patients were on average 20 years old (17–22). Mean follow up time was 21 months (9–41). Functional assessment was made using the DASH (Disabilities of the Arm, Shoulder and Hand) and the OSS (Oxford Shoulder Score) outcome measures. An improvement between pre- and post-operative scoring was observed in both DASH median 51.7 (24.2–75.0) v 13.7 (8.3–20.8) (p=0.024) and OSS 20.6 (15–32) v 41.8 (39–47) (p<0.001). One patient had a pneumothorax intra-operatively but this resolved with conservative treatment. There were no long term complications experienced during follow up.

Aims

The aim of our study was to determine the prevalence of total knee arthroplasty in different ethnic groups and compare pre-operative and post-operative function using the Oxford Knee Score (OKS).

The purpose of the study was to investigate the outcome of Oxford medial unicompartmental knee replacement (UKR) in patients over 70 years old and also to assess their ability to kneel.

We identified from our prospectively collected knee database 90 patients (98 knees) undergoing Oxford medial UKR who were 70 years or older on the day of surgery.

Oxford Knee Scores (OKS) were collected pre-operatively and also post-operatively at the following intervals: 3 months, 6 months, 1 year, 2 years, 5 years and then annually after this.

The mean patient age at surgery was 73.2 years (range 70.2 – 84.3 years). The OKS pre-operatively had a mean of 35.8/60 (range 22-55) and improved to 23.6/60 post-operatively (range 14-34). Patient follow-up was 44.3 months and ranged from 12-111 months. Two patients were lost to follow-up, 1 was converted to a total knee replacement and 3 died of causes unrelated to the knee surgery. 91.7% of patients still had their original prostheses at last follow-up.

Forty percent of patients stated they were able to kneel pre-operatively which improved to 50.2% postoperatively. This was consistent throughout all the follow up intervals that were assessed. Specific kneeling score from the OKS showed no statistically significant change with a mean of 3.94/5 pre-operatively and a mean of 3.54 averaged over all the post-operative follow up intervals.

We conclude that medial Oxford UKR is a reliable operation in patients over 70 years old. Previous studies include a younger age group which potentially encourages the less familiar surgeon to use a UKR for the young active patient but continue with a total knee arthroplasty for the older patient. Our study suggests age should not be a factor when considering performing Oxford UKR. Ability to kneel is not altered significantly by UKR in this age group.

The aim of our study was to assess, for the first time in a large study, whether there are radiological features of the acromioclavicular joint (ACJ) which vary with age or between genders and side. Clinical experience suggested that there was no clear correlation between the radiological features and symptoms arising from the ACJ. Therefore we also aimed to test the null hypothesis that there are no consistent radiological features which correspond with the need for surgical excision of the ACJ.

We analysed 240 shoulder radiographs, divided into male and female, left and right shoulders, and decades from 20 to 80 years inclusive. At the ACJ the presence of sclerosis, osteophytes, cysts and lysis were recorded, and the width of the joint measured.

These same parameters were assessed on the pre-operative radiographs for a group of 100 patients by a blinded observer. Fifty had undergone ASD (arthroscopic subacromial decompression), and 50 ASD with ACJ excision. These two groups were age matched. Statistical analyses were performed.

There was no statistical difference between any of the parameters for gender or side however with increasing age there was a significantly increased incidence of joint space narrowing and increased features of osteoarthrosis. When comparing the matched ASD and the ACJ excision groups it was found that the presence of medial sclerosis (p = 0.016) and superior clavicular osteophytes (p = 0.016) were more common in the ACJ excision group.

We concluded that there is a change in the radiological features of the ACJ with increasing age but not between sides or gender. The null hypothesis is upheld. Only 2 parameters, namely medial acromial sclerosis and superior clavicular osteophytes, are radiological features which correlate with a symptomatic acromioclavicular joint. These have poor sensitivity and specificity and therefore should not be used as a test.

The aim of our study was to assess, for the first time in a large study, whether there are radiological features of the acromioclavicular joint (ACJ) which vary with age or between genders and side. Clinical experience suggested that there was no clear correlation between the radiological features and symptoms arising from the ACJ. Therefore we also aimed to test the null hypothesis that there are no consistent radiological features which correspond with the need for surgical excision of the ACJ. We analysed 240 shoulder radiographs, divided into male and female, left and right shoulders, and decades from 20 to 80 years inclusive. At the ACJ the presence of sclerosis, osteophytes and cysts were recorded, and the width and angle of the joint measured. These same parameters were assessed on the preoperative radiographs for a group of 100 patients by a blinded observer. Fifty had undergone ASD (arthroscopic subacromial decompression), and 50 ASD with ACJ excision. These two groups were age matched. Statistical analyses were performed. There was no statistical difference between any of the parameters for gender or side however with increasing age there was a significantly increased incidence of acromial sclerosis and joint space narrowing. When comparing the matched ASD and the ACJ excision groups it was found that the presence of medial sclerosis of the acromium (p = 0.016) and superior clavicular osteophytes (p = 0.016) were more common in the ACJ excision group. We concluded that there is a change in the radiological features of the ACJ with increasing age but not between sides or gender. The null hypothesis has been rejected. The presence of either medial sclerosis of the acromium, and superior clavicular osteophytes, are radiological features which correlate with a symptomatic acromioclavicular joint.