To review the results of anterior cruciate ligament (ACL) reconstruction in the skeletally immature patient.

Methods and Results 13 skeletally immature patients average age 13.6 (range 11–16) who underwent intraarticular ACL reconstruction using hamstring autograft were followed up retrospectively, at an average of 23 months postoperatively (range 12–60). Patients were scored with International Knee Documentation Committee (IKDC) subjective knee score, IKDC objective knee score and KT-1000 arthrometer scores. They were also examined for leg length inequalities and angular deformities.

At follow up the average subjective knee score was 86.6 (range 51.7–97). On objective testing 5 knees were rated normal, 6 knees nearly normal, 1 knee abnormal and 1 knee greatly abnormal. KT-1000 testing at 30N of force showed an average side-to-side difference of 2.77mm (range1-7mm) at maximum force side to side difference was 3.62mm (range 1–13mm). No leg length discrepancy or angulation was detected. All patients had returned to a higher level of function than pre-operatively.

Statement Of Conclusion Our results show that intraarticular reconstruction of the ACL in skeletally immature patients is a safe and effective procedure. It does not carry a significant risk of damage to the growth plate of the femur or tibia. Objective results achieved are not as good as with the adult population as it would appear that in some cases there is a lengthening of the graft postoperatively. Subjective results are very good. Overall results are far superior to the alternative of conservative management, which risks further damage to the intraarticular structures of the knee.

Aim: This prospective study set out to establish whether a 10 mg dose of intra-articular morphine in combination with 0.5% Bupivicaine was more efficacious than a 5mg dose following therapeutic knee arthroscopy.

Methods: Sixty patients were randomised to receive either 5mg or 10mg intra-articular morphine in combination with Bupivicaine at the end of a therapeutic arthroscopy. Patients completed pain scores at regular intervals over 5 post operative days.

Results: There was no significant difference in both analgesic effect and side effect profile between the two different doses of intra-articular morphine.

Conclusion: 5mg intra-articular morphine in combination with 0.5% Bupivicaine provides effective post operative analgesia in patients having had a therapeutic knee arthroscopy. A 10 mg dose provides no added benefit.

We obtained samples of spinal accessory nerve from patients undergoing radical surgery for tumours or nerve grafting in the neck. These were analysed by light and electron microscopy for the type of fibre. All contained fibres consistent with non-proprioceptive sensory function including pain.