Introduction

Circular frames in the lower limbs have been removed by Specialist nurses in our clinics for the past 20 years using Entonox. This standard of care has helped reduce the burden of health care cost by avoiding removal of frames in theatres. We have recently started using Penthrox and present our encouraging initial data suggestive of superior efficacy when compared to Entonox.

This prospective case-controlled study evaluates the outcome of chronic combined anterior cruciate ligament (ACL) & posterolateral corner (PLC) knee reconstruction.

Twenty-six patients (23 male) underwent combined ACL & PLC reconstruction between October 2001 and October 2006 (Group ACL/PLC). Mean age 30.2 years (range 17–44). Mean follow-up 51 months (range 27–109). The commonest mode of injury was football. Seven patients had concomitant lateral, and 9 medial meniscal procedures, 1 osteochondral defect was micro-fractured. All procedures were performed at the same operation. Prospective scoring was done pre-operatively and 3,6,12, and 24 months post-op using Lysholm, IKDC 2000 and KOOS scoring systems. These scores were compared to an age, sex and injury matched control group of patients who also underwent ACL reconstruction without posterolateral corners injury (Group ACL).

Functional scores showed a significant improvement in all patients in both ACL/PLC and ACL groups postop (p< 0.05). Pre-op scores for Lysholm (p=0.005), IKDC (p=0.03), KOOS sports (p=0.03) and quality of life (QOL) (p=0.03) were significantly lower in Group ACL/PLC compared to Group ACL. Other significantly reduced KOOS scores were - sports 12 (p=0.04) & 24 months (p=0.004); and QOL 12 (p=0.01) & 24 months (p=0.006).

Conclusions: Injury to the posterolateral stabilizing structures of the knee usually occurs in association with other ligamentous injuries. The recognition and adequate management of this injury is crucial. Knees with combined ACL & PLC injuries have reduced function compared to ACL injuries alone. Patients undergoing combined ACL & PLC reconstruction should be made aware that the nature of their injury is such that postoperatively they may have ongoing functional limitations with respect to return to sport and quality of life.

The purpose of this study was to evaluate the outcome of posterior cruciate ligament (PCL) reconstruction with a double tunnel technique, using prospective pre & post-operative functional scoring and clinical evaluation.

We reviewed those patients who underwent PCL reconstruction between October 2001 and October 2006. 24 patients were identified, 23 male and 1 female. Mean age 30.1 years (range 17–43). Mean follow up 56 months (range 29–86). The commonest mode of injury was football. 3 patients had isolated PCL injuries, 21 had concomitant knee ligament injuries which were treated surgically at the same operation. Patients were prospectively scored pre-operatively and at 3, 6, 12 & 24 months post-op using the Lysholm, IKDC 2000 & KOOS scoring systems. These scores were compared to an injury matched control group who underwent comparable knee ligament reconstructions, but who had intact PCL’s.

The knee scores showed a significant improvement in all PCL reconstructed patients post-op (p< 0.05). However, significant differences were found between the PCL reconstructed and PCL intact groups. Both groups had high return to employment and return to sports rates. We describe our method of double tunnel reconstruction.

Conclusions: PCL injury is usually associated with concomitant soft tissue knee injuries. PCL deficiency contributes significantly to the morbidity of the multiple ligament injured knee. Reconstruction with the double tunnel technique described gives excellent functional improvement and high rates of return to employment and sports.