Femoroacetabular impingement causes groin pain and decreased athletic performance in active adults. This bony conflict may result in femoroacetabular subluxation if of sufficient magnitude. The ligamentum teres has recently been reported to be capable of withstanding tensile loads similar to that of the anterior cruciate ligament, and patents with early subluxation of the hip may become dependent on the secondary restraint that is potentially provided by the ligamentum teres. Rupture of the ligamentum may thus cause symptomatic hip instability during athletic activities. An arthroscopic reconstruction of the ligamentum teres using iliotibial band autograft was performed in an attempt to restore this static stabiliser in a series of four such patients. Early clinical results have been promising. The indications, technique and early outcomes of this procedure are discussed

Antegrade intramedullary nailing of fractures of the shaft of the humerus is reported to cause impairment of the shoulder joint. We have reviewed 33 patients with such fractures to assess how many had injuries to the ipsilateral shoulder. All had an MR scan of the shoulder within 11 days of injury. The unaffected shoulder was also scanned as a control. There was evidence of abnormality in 21 of the shoulders (63.6%) on the injured side; ten had bursitis of the subacromial space, five evidence of a partial tear of the rotator cuff, one a complete rupture of the supraspinatus tendon, four inflammatory changes in the acromioclavicular joint and one a fracture of the coracoid process. These injuries may contribute to pain and dysfunction of the shoulder following treatment, and their presence indicates that antegrade nailing is only partly, if at all, responsible for these symptoms

Acquired flatfoot deformity after injury is usually due to partial or complete tearing of the tendon of tibialis posterior, with secondary failure of the other structures which maintain the medial longitudinal arch. We describe a patient in whom the rupture of the plantar calcaneonavicular (spring) ligament resulted in a clinical picture similar to that of rupture of the tendon of tibialis posterior. Operative repair of the ligament and transfer of the tendon of flexor digitorum gave an excellent result at four years with the patient returning to full sporting activities

We report a case of an apparent avulsion fracture of the posteromedial margin of the medial plateau of the tibia. This was associated with a tear of the medial meniscus and rupture of the anterior cruciate ligament (ACL). This triad has been previously reported, and the plateau fracture was related to the insertion of the semimembranosus tendon. The detailed investigation of our case and some experiments on cadaver knees showed that the injury was not an avulsion fracture but was produced by varus and external rotation forces on a flexed knee. It was due to the anterior subluxation of the medial tibial plateau after rupture of the ACL

Aims

We wanted to evaluate the effects of a bone anabolic agent (bone morphogenetic protein 2 (BMP-2)) on an anti-catabolic background (systemic or local zoledronate) on fixation of allografted revision implants.

Operative fixation is the treatment of choice for a rupture of the distal tendon of biceps. A variety of techniques have been described including transosseous sutures and suture anchors. The poor quality of the bone of the radial tuberosity might affect the load to failure of the tendon repair in early rehabilitation. The aim of this study was to determine the loads to failure of different techniques of fixation and to investigate their association with the bone mineral density of the radial tuberosity. Peripheral quantitative computed tomography was carried out to measure the trabecular and cortical bone mineral density of the radial tuberosity in 40 cadaver specimens. The loads to failure in four different techniques of fixation were determined. The Endobutton-based method showed the highest failure load at 270 N (. sd. 22) (p < 0.05). The mean failure load of the transosseous suture technique was 210 N (. sd. 66) and that of the TwinFix-QuickT 5.0 mm was 57 N (. sd. 22), significantly lower than those of all other repairs (p < 0.05). No significant correlation was seen between bone mineral density and loads to failure. The transosseous technique is an easy and cost-saving procedure for fixation of the distal biceps tendon. TwinFix-QuickT 5.0 mm had significantly lower failure loads, which might affect early rehabilitation, particularly in older patients

One hundred patients with acute ruptures of the lateral ligaments of the ankle were randomly allocated either to conservative treatment in a plaster cast or to operative repair. With the aid of stress tenography, the extent of the injury was established. There were 30 patients with isolated anterior talofibular ruptures and 20 with additional calcaneofibular ligament ruptures in each treatment group. Operative repair was associated with a higher incidence of complications in the first weeks, and slightly delayed the patients' return to work. At an independent two-year review there was no evidence that operative repair offered improved symptomatic or functional benefit

Thirteen patients with ruptures of the calcaneal tendon diagnosed more than four weeks after injury were reviewed. Eleven patients had operative reconstruction with tendon shortening and the postoperative follow-up ranged from one to seven years. Isometric and isokinetic measurements, as well as the strength of the triceps surae, all compared favourably with the normal contralateral leg. Only one tendon re-ruptured. Eight of the eleven patients were satisfied with the results and the two patients who had refused reconstruction had worse functional results. Late reconstruction of a ruptured calcaneal tendon is thus a worthwhile procedure

Previous perfusion studies of the rotator cuff have demonstrated an area of hypovascularity in the distal part of the supraspinatus tendon. This has been implicated in the pathogenesis of its rupture. We performed a quantitative histological analysis of the vascularity of the tendons of supraspinatus and infraspinatus. Vessel number, size and the percentage of the tendon occupied by vessels were measured at 5 mm intervals from the humeral insertions to the muscle bellies. Both tendons were hypovascular in their distal 15 mm. No significant difference was demonstrated between the vascularity of supraspinatus and infraspinatus. We conclude that factors other than vascularity are important in the pathogenesis of supraspinatus rupture

Magnetic resonance imaging was performed on 28 patients with suspected calcaneal tendon injury prior to treatment. None of the patients were involved in competitive sports. All underwent clinical examination, some had had ultrasound or CT scans. We identified four types of lesions: type I, inflammatory reaction; type II, degenerative change; type III, incomplete rupture and type IV, complete rupture. Thirteen of the 28 patients underwent surgery and the diagnostic findings were verified. We recommend that type I, type II and type III lesions be managed conservatively, while type IV lesions should be operated in the young and active patient

Non-operative management has frequently been adopted for closed injuries of the infraclavicular brachial plexus and its branches in the belief that spontaneous recovery is likely to occur, and surgical exploration is performed only if recovery has not occurred in the expected time. This paper correlates the clinical and electrophysiological features with the operative findings in six patients with such injuries. The axillary nerve was ruptured in all six patients, the musculocutaneous nerve in two and the radial nerve in two. When the muscles supplied by a branch of the plexus were denervated, the differentiation between rupture of that branch and a lesion in continuity could only be made by surgical exploration, which should be performed as soon as other injuries permit

1. The results of operation in sixty-three patients with rupture of the rotator cuff of the shoulder have been reviewed. 2. In seventeen patients the classical delto-pectoral route was found to give poor access and mediocre results. 3. In forty-six patients a superior approach along the supraspinatus fossa and through the divided acromion process was found to give excellent access and to permit lateral advancement of the supraspinatus muscle in order to enable wide gaps to be closed. With this improved surgical access the proportion of good results has been doubled. 4. It is suggested that when a case of rupture of the cuff, confirmed by arthrography, fails to respond to physiotherapy, operative repair should be undertaken

Aims

It is important to understand the rate of complications associated with the increasing burden of revision shoulder arthroplasty. Currently, this has not been well quantified. This review aims to address that deficiency with a focus on complication and reoperation rates, shoulder outcome scores, and comparison of anatomical and reverse prostheses when used in revision surgery.

We treated surgically 16 shoulders with an isolated traumatic rupture of the subscapularis tendon over a six-year period. Nine patients had a total and seven a partial tear of the subscapularis tendon. Repair was undertaken through a small deltopectoral groove approach. The mean Constant score improved in total tears from 38.7 to 89.3 points (p = 0.003) and in partial tears from 50.7 to 87.9 points (p = 0.008). The total tears were significantly more improved by surgery than the partial tears (p = 0.001). The delay between trauma and surgery was inversely proportional to the improvement in the Constant score suggesting that early diagnosis and surgical repair improves outcome

Aims

Hip reconstruction after resection of a periacetabular chondrosarcoma is complex and associated with a high rate of complications. Previous reports have compared no reconstruction with historical techniques that are no longer used. The aim of this study was to compare the results of tantalum acetabular reconstruction to both historical techniques and no reconstruction.

Aims

The aim of this study was to prepare a scoping review to investigate the use of biologic therapies in the treatment of musculoskeletal injuries in professional and Olympic athletes.

Aims

The aim of this retrospective study was to determine if there are differences in short-term clinical outcomes among four different types of matrix-associated autologous chondrocyte transplantation (MACT).

1. Bony spurs resulting from erosion of the scaphoid bone and trapezium in rheumatoid arthritis can pierce the floor of the carpal tunnel and cause attrition rupture of flexor tendons–most often the flexor pollicis longus tendon. 2. It is difficult to show these spurs on conventional radiographs, but using a special tomographic technique we have been able to explore the floor of the carpal tunnel in three planes. Using this technique we have been able to guard the flexor pollicis longus against attrition rupture by early excision of a spur from the scaphoid bone. 3. Our findings support the recommendation of free division of the flexor retinaculum in rheumatoid arthritis. When doing this the surgeon should always look for a bony spur piercing the floor of the carpal tunnel

Many methods of reconstruction for ACL deficiency have been described, but little is known about their biomechanical properties. We examined extra-articular (EA), intra-articular (IA) and combined (EA+IA) reconstructions in ten cadaver knees after the ACL had been ruptured by the performance of a rapid anterior drawer movement. Stability at each stage before and after rupture and reconstruction was tested by anterior drawer, Lachman, varus-valgus and tibial rotation tests. Both IA and IA+EA reconstructions restored normal stability, while EA reconstructions improved stability but did not restore it to normal. The addition of an EA procedure to an IA procedure made no difference to knee stability. We conclude that in cases of isolated ACL deficiency there is no biomechanical basis for EA reconstruction, either alone or in addition to an IA reconstruction

Aims

To describe the risk of periprosthetic joint infection (PJI) and reoperation in patients who have an acute, traumatic wound dehiscence following total knee arthroplasty (TKA).