Many radiographic techniques have been described for measuring patellar height. They can be divided into two groups: those that relate the position of the patella to the femur (direct) and those that relate it to the tibia (indirect). This article looks at the methods that have been described, the logic behind their conception and the critical analyses that have been performed to test them.

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.

We wish to report our observations on a prospective series of 22 patients with high energy posterolateral corner injuries undergoing surgery at our Unit.

Since 1997, all patients presenting to our Unit with posterolateral corner injuries were analysed prospectively. Twenty two patients are presented with a mean follow-up of two years. Thirteen patients underwent acute exploratory surgery within two weeks of injury. The majority of patients had four or more injured structures identified at operation. The surgery involved reattachment of the injured structures together with selective staged intra-articular reconstruction in high demand individuals. Nine patients were referred to our unit a number of years after their original accident. The majority of these chronic cases underwent popliteofibular reconstruction using semitendinosus. All patients from both groups returned to activities of daily living after surgery. Ten patients returned to sport after reconstruction. Eight out of ten of these had undergone acute reconstruction.

Posterolateral corner injuries are high-energy multiple ligament injuries. Acute repair with staged selective intra-articular reconstruction in our series led to 61% of the acute patients returning to sport. Only 22% of the patients presenting late, returned to sport after reconstruction. This suggests that patients are more likely to return to sport if their knees are reconstructed early and we would encourage an assertive approach to these high-energy injuries.

Acute fractures of the scaphoid were randomly allocated for conservative treatment in a Colles’-type plaster cast with the wrist immobilised in either 20° flexion or 20° extension. The position of the wrist did not influence the rate of union of the fracture (89%) but when reviewed after six months the wrists which had been immobilised in flexion had a greater restriction of extension. We recommend that acute fractures of the scaphoid should be treated in a Colles’-type cast with the wrist in slight extension.