Aim of our study was to find an association of additional intra-artricular derangements due to the delay in referring a patient with Anterior Cruciate Ligament (ACL) injury to a consultant orthopaedic clinic. We carried out a retrospective review of 50 patients who underwent ACL reconstruction (performed arthroscopically taking semitendinosis tendon graft) between July 2007 and November 2008. Orthopaedic referrals were grouped into A&E-group (48%) and GP-group (52%). Average time span between initial injury and patient's first contact with an orthopaedic surgeon was 10 days in the AE-group and 30 months in the GP-group. On analysing the MRI scans we found a significant difference regarding the presence of additional injuries: A&E-group had less medial meniscus injuries (43.75%) compared to the GP-group (65%). Lateral meniscus injuries were present in 18.75% in A&E-group and in 35% in GP-group. Findings during arthroscopic ACL reconstruction revealed following differences: A&E-group had less medial meniscus injuries (30.43%) compared to the GP-group (46.15%). Lateral meniscus injuries were 43.48 % and 30.77 % in A&E-group and GP-group respectively. Lysholm Knee Scoring system was used in both the groups pre- and postoperatively. The A&E-group had better results preoperatively (average 56.7) and postoperatively (average 95.5) when compared to the GP group which had shown scores to be 50.4 (pre-op) and 90.7 (post-op).Introduction
Methods and results
Plantar fibromatosis is a relatively rare disease compared to its counterpart in the hand. Though it is considered to be a part of Dupuytrens diathesis it has been less exhaustively studied to enable evidence based management strategies. We followed up all patients presenting with plantar fibromatosis to our institute between 1980 and 2006, identifying 41 patients. 6 patients were lost to followup. Thirty-five patients with 60 involved feet were included in the study. There were 22 males and 13 females, all white Caucasians. The median age at presentation was 45 (19–63 years), and the median follow up was 10 years (2–25 years) Twenty-one of our patients had palmar Dupuytren’s disease, six had knuckle pads, four had Peyronie’s disease, four had other superficial fibomatoses and two keloids. Six were diabetic, four had epilepsy of whom two took valproate and one phenobarbitone. Eight patients had a family history of fibromatoses. The most common presentation was a painful lump (20); 13 patients had a painless lump (13) and two had only pain. All patients reported a proliferative phase of enlarging nodule size, often with pain, which lasted 1–4 years (median 2 years). Thereafter most patients reported improvement in symptoms (size of lump and pain) as well as function. As we came to recognise this, we treated most patients with symptomatic measures and observation only. At review, 17 patients considered their symptoms were improving, 14 were stable and only four had noticed deterioration. Seven patients, mostly early in the series, were treated by wide excision; six had recurrence at review although only one was symptomatic. Plantar fibromatosis is a benign condition which stabilises and may improve after an initial proliferative phase lasting about two years Most patients require no intervention.
