Aim: The purpose of this study was to evaluate the results of transphyseal ACL reconstruction technique in skeletally immature patients.

Material & Methods: Between 2002 and 2008, twenty knees in twenty skeletally immature patients with a mean chronological age of 13.2 years (range, 7 to 16.2 years) underwent transphyseal reconstruction of the anterior cruciate ligament with use of an autogenous quadrupled hamstrings-tendon graft with metaphyseal fixation. Ten knees had additional meniscal surgery. The functional outcome, graft survival, radiographic outcome, and any growth disturbance were evaluated at a mean of 2.2 years (range, 1.0 to 5.9 years) after the surgery.

Results: No patient underwent revision anterior cruciate ligament reconstruction. The mean International Knee Documentation Committee subjective knee score (SD) was 90.5 (10.0) points and the mean Lysholm knee score was 92.2 (10.0) points. The result of the Lachman examination was normal in 18 knees and nearly normal in two; it was not abnormal or severely abnormal in any knee. The mean increase in total height was 7.2 cm (range, 1.2 to 20.4 cm) from the time of surgery to the time of final follow-up. No angular deformities of the lower extremity were measured radiographically, and no lower-extremity length discrepancies were measured clinically. Complications included one case of knee stiffness requiring physiotherapy, one case of persistent pain leading to medial menisectomy for tear and one case of re-injury five months post ACL reconstruction requiring medial meniscus repair.

Conclusion: Excellent functional outcome was noted in skeletally immature patients after transphyseal reconstruction of the anterior cruciate ligament with use of an autogenous quadrupled hamstrings-tendon graft with metaphyseal fixation. There were very few complications and no growth disturbance.

Purpose: To quantify the amount of agreement among UK orthopaedic surgeons regarding the natural history and treatment including surgery and rehabilitation of the ACL deficient knee.

Methods: Following from Marx et al (Arthroscopy. 2003 Sep;19(7):762–70) a surgeon mail survey was performed to 360 members of the British Association for Surgery of the Knee. Surgeons who had treated ACL deficient patients in the last year were asked to complete the survey. Thirty questions were included to determine the surgeons’ opinions regarding the natural history of the ACL deficient knee, indications for surgery and patient selection, surgical treatment and rehabilitation. Clinical agreement was present when 80% or more agreed on the same response option.

Results: 150 surgeons in total responded to the survey; 121 had treated ACL deficient patients in the past year. The mean age was 48.9 years and 83% considered their practice to be a subspecialty in knee surgery. The mean number of ACL reconstructions performed in the past year was 41 (range 1–210). Clinical agreement was present for 12 (40%) of the 30 questions; surgeons disagreed on 18 (60%) of the questions.

Conclusions: Similar significant variation regarding the management of ACL injuries is seen among members of BASK as among members of the American Academy of Orthopaedic Surgeons (AAOS). Clinical disagreement included whether ACL deficient patients can participate in all recreational sporting activities, that ACL reconstruction reduces the rate of arthrosis in the ACL deficient knee, and the use of bracing in non-surgically treated ACL deficient knees. Surgeons also disagreed about age, open growth plates, radiographic evidence of osteoarthrosis, pain, and, repairable and unrepairable meniscal tears in ACL deficient patients.

Background: In an effort to reduce the waiting times for outpatient appointments and surgery ‘Direct Access Arthroscopy Services’ have been set up in some centres whereby GP’s assess patients with acute knee injuries.

The value of a physiotherapist in the Back Pain clinic is well known, however their effectiveness in an Acute Knee Injury Clinic has not been documented despite the fact that they have already been used in some centres to triage these injuries.

Purpose of study: This study was therefore set up to determine if an experienced physiotherapist can accurately diagnose an acute knee injury and formulate a treatment plan.

Methods: 50 consecutive patients with acute knee injuries were seen in the fracture clinic. They were each assessed and a diagnosis made and treatment plan formulated by the consultant, an orthopaedic SHO and two experienced physiotherapists in random order. Evaluation was by history, examination and X Rays. Final diagnosis was based on arthroscopic findings, further investigations or response to conservative treatment.

Results: We found no statistically significant difference in the clinical diagnosis and treatment plans made by the consultant and the orthopaedic physiotherapist p> 0.05 (Mc Nemar’s Test). In addition the physiotherapist had a higher proportion of correct diagnoses compared to the SHO. Again this difference was not statistically significant.

Conclusion: The results suggest that an experienced physiotherapist can safely and effectively be used to assess patients with an acute knee injury in the outpatient clinic setting.

Background: The decision on how to manage a patient with an acute ACL tear diagnosed at arthroscopy is still very subjective. Since 1995 all such patients in a single surgeon practice were managed either surgically or conservatively based on a modification of criteria described by Daniel. This essentially takes into consideration the presence of associated injuries and the activity level of the patient.

Purpose: This study was conducted to determine if these criteria used were effective in selecting our patients for surgery or conservative treatment.

Methods: We randomly selected 100 patients treated with at least 2 years follow up. The operatively and conservatively treated groups were compared based on the Tegner activity scale, the Lysholm-II1 score before and after treatment and the IKDC score after treatment. These scores were calculated using information from case notes, X Rays, patient questionnaires and outpatient clinic assessments.

Results: There were 42 patients treated conservatively and 58 treated by ACL reconstruction. The average age was 32 years for the operative group and 34 years for the conservative group.

We found no statistically significant difference between the Lysholm-11 scores and the IKDC scores between the two groups.

Conclusion: The criteria used to determine the management of our patients with acute ACL injuries is effective and as such we recommend its use.

We report the results in the first 16 patients treated in Sheffield using bifocal techniques for diaphyseal bone loss and deformity secondary to trauma. Eight patients had bone-transport and eight had compression-distraction methods. At a mean follow-up of 24 months all 16 had excellent or good results with union of the fracture, correction of deformity and normal or near normal leg length. There were no major complications. Mean treatment times were 16 months for bone transport and 9.8 months for compression-distraction. Bone transport was more complicated requiring an average of 2.2 additional operations compared with only one for compression-distraction. Femoral cases had shorter treatment indices than tibial cases but had less favourable outcomes.