Following the recognition of platelet rich plasma (PRP) as an interventional procedure by NICE, patients who had failed standard conservative treatment for chronic elbow tendinitis and referred for surgery were recruited prospectively into a PRP injection study.

52 patients at Torbay Hospital, Devon, UK received PRP injections in 18 months and 37 had a minimum of 6 months follow up. The outcomes in these patients are summarised.

There were 16 males and 21 females. 30 had tennis elbow and 7 had golfers elbow. All patients had their symptoms for a minimum of 6 months and had failed to improve with standard conservative treatment. 2 had a failed outcome from previous tennis elbow release surgery. The PRP injections were carried out under ultrasound guidance after correlating the tender spot with neovascularisation on flow Doppler. 31 patients had a single injection; the other 21 patients had 2 injections. Quick DASH score and patients own self-satisfaction was used to measure outcome. 18 patients (48%) were discharged by 6 months. DASH score worsened in 7 patients (19%) and 2 of these patients opted to have surgery, which had no benefit either. No complications were observed with the use of PRP.

Overall, by using PRP injections, surgery was avoided in 35 patients (95%) at 18 months and nearly half of the patients were discharged from follow up by 6 months.

The use of scoring systems for surveillance of post-operative outcomes is increasing. However, the methodology of this follow-up is not universal. We set out to assess whether a postal Oxford Shoulder Score (OSS) was sufficient to identify patients who were dissatisfied and wanted further treatment.

Of 88 patients who had undergone GlobalCap resurfacing in the previous 5 years, we received a completed postal OSS (Median score 33, Range 5–48) from 80 patients. Those with a score <24 (an agreed threshold for surgery pre-operatively) were brought to clinic for review.

The 16 recalled patients (2 males, 14 females; age 58–85) had their OSS repeated, supervised by a clinic nurse, and had a Constant Score and an American Shoulder and Elbow Surgeons (ASES) Score performed. Satisfaction was also questioned.

OSS correlated well with the Constant Score (r=0.79) and ASES (r=0.86). However, supervision increased the OSS by an average of 6 points (Mean 13.9 to 19.9) and only three of the patients proved dissatisfied with the outcome of their surgery.

Used alone, an unobserved OSS may have limited value for this purpose and the use of comparative pre-operative scores or additional patient-reported outcome measures may be necessary to detect poor outcomes.

Patients using a neutral rotation brace post proximal humerus fracture fixation have improved functional outcome and external rotation of the shoulder compared to patients using a standard polysling.

Patients who have proximal humerus fracture fixation with extramedullary plates and screws have a risk of reduced range of movement especially external rotation. Gerber et al showed that the average external rotation after fixation of proximal humeral fractures was 39 degrees in their patient cohort compared to a normal range of 80–100 degrees. This can lead to reduced function and poor patient related outcomes. Geiger et al showed that in a cohort of 28 patients, poor functional outcome was noted in 39.3% with an average Constant-Murley Score of 57.9.

Current practice is to utilise a polysling holding the shoulder in internal rotation post-shoulder fixation. Patients usually wear the sling for up to 6 weeks. We believe that this increases the risk of adhesion formation with the shoulder in internal rotation in the shoulder joint. Therefore this can cause loss of external rotation in the shoulder joint. We believe that holding the shoulder in a neutral alignment, with a neutral rotation brace post-fixation, will enable an increased rate of external rotation post-operatively thus improving external rotation and functional outcome

There is currently no literature comparing the different slings used post-operatively and we believe that this study would be the first of its kind. It would have a substantial change in the way clinicians manage proximal humeral fractures and will potentially reduce the numbers of re-operations to divide adhesions or perform capsular releases. Secondary benefits include a potential earlier return to full function and work and improved patient satisfaction.

Study proposal: Prospective Randomised Controlled Trial of the neutral rotation brace compared to the standard, currently used, polysling post proximal humerus fracture fixation. No blinding of either participants or clinicians. Three surgeons utilising similar fixation techniques via the deltopectoral approach and using Philos plate fixation (Synthes Ltd.). Standardised post-operative rehabilitation protocol for all patients.

Follow up: clinical review and postal outcomes for 1 year

Primary outcomes: Post operative functional outcome scores (Oxford, DASH, EQL) obtained at 6 weeks, 9 weeks, 3 months and 1 year). These will be compared to scores taken pre-operatively.

Secondary outcomes: Clinical review at 6 weeks, 3 months and 1 year with range of movement measurements. Radiographs also taken at 6 weeks and 3 months to assess union. Patient questionnaire at 1 year (with outcome scores) assessing patient return to work, complications and patient satisfaction

Inclusion criteria: Proximal humeral fractures requiring operative intervention with extramedullary plate fixation (i.e. fractures displaced by 1cm and/or angulated by 45 degrees or more). Age>18.

Exclusion Criteria: Patients having intra-operative findings of complete Pectoralis major rupture or if operative exposure requires complete Pectoralis major tenotomy. (These patients need to be held in internal rotation with a standard polysling to allow healing of the Pectoralis major tendon).

We assessed hyperextension of the knee and joint laxity in 169 consecutive patients who underwent an anterior cruciate ligament reconstruction between 2000 and 2002 and correlated this with a selected number of age- and gender-matched controls. In addition, the mechanism of injury in the majority of patients was documented. Joint laxity was present in 42.6% (72 of 169) of the patients and hyperextension of the knee in 78.7% (133 of 169). All patients with joint laxity had hyperextension of their knee. In the control group only 21.5% (14 of 65) had joint laxity and 37% (24 of 65) had hyperextension of the knee. Statistical analysis showed a significant correlation for these associations. We conclude that anterior cruciate ligament injury is more common in those with joint laxity and particularly so for those with hyperextension of the knee.

Purpose of the study A prospective observational study to ascertain any correlation between joint laxity and knee hyperextension to anterior cruciate ligament rupture.

Methods used Joint laxity as defined by Beighton’s method and hyperextension of uninjured knee in 169 patients with symptomatic isolated anterior cruciate ligament rupture was recorded in a prospective fashion. This was correlated to the scores obtained in a selected group of age and sex matched controls

Results 72 out of 169 of the patients had hyperlaxity in their joints and 133 out of 169 had knee hyperextension. In the control group 14 out of 65 had hyperlaxity in their joints and 24 out of 65 had knee hyperextension.

Statistical analysis showed that ACL injury was common in those with lax joints and with knee hyperextension with a p < 0.001

Conclusion ACL injury is common in patients with joint laxity especially in those with knee hyperextension.

Mechanical methods of deep vein thrombosis (DVT) prophylaxis rely on the prevention of venous stasis – one of Virchow’s triad of cause of DVT. Mechanical methods, such as the A-V Impulse System (Orthofix Vascular Novamedix, Andover, UK) are used widely in orthopaedic surgery for the prevention of DVT, especially after elective orthopaedics.

The evidence for the use of the A-V Impulse System in elective orthopaedics is widely accepted and is considered a Grade A Recommendation by the International Consensus Statement. These data are reviewed and critiqued.

More recent studies show how mechanical methods can offer benefits to the patient outside of hip and knee replacement surgery. Data are presented on how such devices can effectively reduce swelling, DVT, compartment pressure and pain associated with trauma, based on over 20 years of practical experience. The practical implications of using these devices is discussed.

Development of a novel technique of arthroscopic rotator cuff repair which adapts the proven strong open technique using the Arthrex Post (low profile screw) into an arthroscopic technique by using the Arthrex Biotenodesis screw technique. The theoretical advantages of this technique are the ability to use stronger suture material, with a simple, tolerant, knotless and adaptable technique

Prior to use of this technique on patients we required laboratory confirmation of its benefit over present techniques. We have previous experience with laboratory testing at Exeter University using a MONSANTO TEN-SIOMETER for the previous Arthrex Post system. A similar experimental model was used for this study comparing two methods of fixation:

standard arthroscopic technique with Corkscrew anchor to decorticated footprint area on fresh frozen porcine humerus.

Initial results show a significant advantage of the biotenodesis technique with failure at over 1,000 N compared to 113N for a 2cm bone tunnel and 180N–600N for anchors. This shows promise for use in patients.

Over-zealous release of the first dorsal compartment of the wrist for de Quervain’s disease or other lesions such as ganglia, may result in volar subluxation of the tendons of abductor pollicis longus and extensor pollicis brevis. This is usually asymptomatic, but may occasionally become disabling. We describe an operation using part of the extensor retinaculum to stabilise such a subluxation.