Aims. This study compared patients who underwent arthroscopic repair of large to massive rotator cuff tears (LMRCTs) with isolated incomplete repair of the tear and patients with incomplete repair with biceps tendon
Aims. To develop and internally validate a preoperative clinical prediction model for acute adjacent vertebral fracture (AVF) after vertebral
We report the clinical outcome and findings at
second-look arthroscopy of 216 patients (mean age 25 years (11 to 58))
who underwent anterior cruciate ligament (ACL) reconstruction or
augmentation. There were 73 single-bundle ACL
Rotator cuff tears are common in middle-aged and elderly patients. Despite advances in the surgical repair of rotator cuff tears, the rates of recurrent tear remain high. This may be due to the complexity of the tendons of the rotator cuff, which contributes to an inherently hostile healing environment. During the past 20 years, there has been an increased interest in the use of biologics to complement the healing environment in the shoulder, in order to improve rotator cuff healing and reduce the rate of recurrent tears. The aim of this review is to provide a summary of the current evidence for the use of forms of biological
Anterior cruciate ligament (ACL) graft failure from rupture, attenuation, or malposition may cause recurrent subjective instability and objective laxity, and occurs in 3% to 22% of ACL reconstruction (ACLr) procedures. Revision ACLr is often indicated to restore knee stability, improve knee function, and facilitate return to cutting and pivoting activities. Prior to reconstruction, a thorough clinical and diagnostic evaluation is required to identify factors that may have predisposed an individual to recurrent ACL injury, appreciate concurrent intra-articular pathology, and select the optimal graft for revision reconstruction. Single-stage revision can be successful, although a staged approach may be used when optimal tunnel placement is not possible due to the position and/or widening of previous tunnels. Revision ACLr often involves concomitant procedures such as meniscal/chondral treatment, lateral extra-articular
In developmental dysplasia of the hip, a deficient acetabulum may be augmented by placing local autogenous iliac osseous graft, or the ilium itself, over the head of the femur with the expectation that the added bone will function as a bearing surface. We analysed this bone obtained en bloc during subsequent surgery which was performed for degenerative osteoarthritis in three patients at 6, 25 and 30 years after the initial
Bone defects are occasionally encountered during
primary total knee replacement (TKR) and cause difficulty in establishing
a stable well-aligned bone-implant interface. Between March 1999
and November 2005, 59 knees in 43 patients underwent primary TKR
with a metal block
Aims. The success of anterior cruciate ligament reconstruction (ACLR)
depends on osseointegration at the graft-tunnel interface and intra-articular
ligamentization. Our aim was to conduct a systematic review of clinical
and preclinical studies that evaluated biological
We used an in vivo model to assess the use of an autogenous cancellous bone block and marrow graft for augmenting tendon reattachment to metallic implants. We hypothesised that
Dislocation following total hip arthroplasty (THA) is a well-known and potentially devastating complication. Clinicians have used many strategies in attempts to prevent dislocation since the introduction of THA. While the importance of postoperative care cannot be ignored, particular emphasis has been placed on preoperative planning in the prevention of dislocation. The strategies have progressed from more traditional approaches, including modular implants, the size of the femoral head, and
We undertook a multicentre, prospective study of a series of 112 unstable trochanteric fractures in order to evaluate if internal fixation with a sliding screw device combined with
We describe the clinical outcome of a technique of surgical
Aims. The purpose of this study was to evaluate whether an innovative
templating technique could predict the need for acetabular augmentation
during primary total hip arthroplasty for patients with dysplastic
hips. Patients and Methods. We developed a simple templating technique to estimate acetabular
component coverage at total hip arthroplasty, the True Cup: False
Cup (TC:FC) ratio. We reviewed all patients with dysplastic hips
who underwent primary total hip arthroplasty between 2005 and 2012.
Traditional radiological methods of assessing the degree of acetabular dysplasia
(Sharp’s angle, Tönnis angle, centre-edge angle) as well as the
TC:FC ratio were measured from the pre-operative radiographs. A
comparison of augmented and non-augmented hips was undertaken to
determine any difference in pre-operative radiological indices between
the two cohorts. The intra- and inter-observer reliability for all
radiological indices used in the study were also calculated. Results. Of the 128 cases reviewed, 33 (26%) needed acetabular
Aims. The purpose of the study was to investigate whether closed intramedullary
(IM) nailing with percutaneous cement augmentation is better than
conventional closed nailing at relieving pain and suppressing tumours
in patients with metastases of the femur and humerus. Patients and Methods. A total of 43 patients (27 men, 16 women, mean age 63.7 years,
standard deviation (. sd. ) 12.2; 21 to 84) underwent closed
IM nailing with cement augmentation for long bone metastases. A
further 27 patients, who underwent conventional closed IM nailing,
served as controls. Pain was assessed using a visual analogue scale
(VAS) score pre-operatively (pre-operative VAS), one week post-operatively
(immediate post-operative VAS), and at six weeks post-operatively
(follow-up post-operative VAS). Progression of the tumour was evaluated
in subgroups of patients using F-18-fludeoxyglucose (F-18-FDG) positron
emission tomography (PET)/computed tomography (CT) and/or bone scintigraphy
(BS), at a mean of 8.8 and 7.2 months post-operatively, respectively. Results. The mean pain scores of patients who underwent closed nailing
with cement augmentation were significantly lower than those of
the control patients post-operatively (immediate post-operative
VAS: 3.8, . sd. 0.9 versus 6.0, . sd. 0.9;
follow-up post-operative VAS: 3.3, . sd. 2.5 versus 6.6, . sd. 2.2;
all p <
0.001). The progression of the metastasis was suppressed
in 50% (10/20) of patients who underwent closed nailing with
Between April 1992 and July 2005, 310 posterior lip
The Chiari osteotomy and various shelf procedures are used to augment the weight-bearing area in dysplastic acetabula. The new articular surface derives by metaplasia from the acetabular rim and joint capsule, and is therefore of poorer quality than congruous hyaline cartilage. We reviewed 32 patients after
The healing of a hamstring graft to bone is the weak link in the reconstruction of a cruciate ligament using this donor material. We therefore investigated the
We evaluated the biomechanical properties of two different methods of fixation for unstable fractures of the proximal humerus. Biomechanical testing of the two groups, locking plate alone (LP), and locking plate with a fibular strut graft (LPSG), was performed using seven pairs of human cadaveric humeri. Cyclical loads between 10 N and 80 N at 5 Hz were applied for 1 000 000 cycles. Immediately after cycling, an increasing axial load was applied at a rate of displacement of 5 mm/min. The displacement of the construct, maximum failure load, stiffness and mode of failure were compared. The displacement was significantly less in the LPSG group than in the LP group (p = 0.031). All maximum failure loads and measures of stiffness in the LPSG group were significantly higher than those in the LP group (p = 0.024 and p = 0.035, respectively). In the LP group, varus collapse and plate bending were seen. In the LPSG group, the humeral head cut out and the fibular strut grafts fractured. No broken plates or screws were seen in either group. We conclude that strut graft
In a single-blind, randomised series of knee replacements in 116 patients, we used radiostereometric analysis (RSA) to measure micromotion in three types of tibial implant fixation for two years after knee replacement. We compared hydroxyapatite-augmented porous coating, porous coating, and cemented fixation of the same design of tibial component. At one to two years, porous-coated implants migrated at a statistically significantly higher rate than hydroxyapatite-augmented or cemented implants. There was no significant difference between hydroxyapatite-coated and cemented implants. We conclude that hydroxyapatite
The aim of this study was to evaluate the clinical and radiological outcomes of locking plate fixation, with and without an associated fibular strut allograft, for the treatment of displaced proximal humeral fractures in elderly osteoporotic patients. We undertook a retrospective comparison of two methods of fixation, using a locking plate without an associated fibular strut allograft (LP group) and with a fibular allograft (FA group) for the treatment of these fractures. The outcome was assessed for 52 patients in the LP group and 45 in the FA group, with a mean age of 74.3 years (52 to 89), at a mean follow-up of 14.2 months (12 to 19). The clinical results were evaluated using a visual analogue scale (VAS) score for pain, the Constant score, the American Shoulder and Elbow Surgeons (ASES) score, and the range of movement. Radiological results were evaluated using the neck-shaft angle (NSA) and humeral head height (HHH).Aims
Patients and Methods