The wrist is a complex joint involving many small bones and complicated kinematics. It has, therefore, been traditionally difficult to image and ascertain information about kinematics when making a diagnosis. Although MRI and fluoroscopy have been used, they both have limitations. Recently, there has been interest in the use of 4D-CT in imaging the wrist. This review examines the literature regarding the use of 4D-CT in imaging the wrist to assess kinematics and its ability to diagnose pathology. Some questions remain about the description of normal ranges, the most appropriate method of measuring intercarpal stability, the accuracy compared with established standards, and the place of 4D-CT in postoperative assessment.

Cite this article: Bone Joint J 2019;101-B:1325–1330.

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The aim of this study was to compare patient-reported outcome measures (PROMs), radiological measurements, and total hip arthroplasty (THA)-free survival in patients who underwent periacetabular osteotomy (PAO) for mild, moderate, or severe developmental dysplasia of the hip.

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The number of rotator cuff repairs that are undertaken is increasing. Reverse shoulder arthroplasty (RSA) is the procedure of choice for patients with rotator cuff arthropathy. We sought to determine whether patients who underwent rotator cuff repair and subsequent RSA had different outcomes compared with a matched control group who underwent RSA without a previous rotator cuff repair.

Nine pedunculated benign synoviomata causing mechanical symptoms similar to those of a torn meniscus are described. The average age of the patients was 34.4 years. During the period of study, 2254 meniscal lesions causing mechanical symptoms were identified, giving an incidence of one benign synovioma for every 250 meniscal lesions. All the lesions were removed arthroscopically with relief of symptoms

We report a patient with a subperiosteal ganglion cyst of the tibia which was imaged by radiography, arthrography, CT and MRI. The images were correlated with the arthroscopic surgical and histological findings. Spiculated formation of periosteal new bone on plain radiographs led to the initial suspicion of a malignant tumour. Demonstration of the cystic nature of the tumour using cross-sectional imaging was important for the precise diagnosis. Communication between the ganglion cyst and the knee was shown by a delayed arthrographic technique, and the presence of this communication was confirmed at arthroscopy and surgically

We report the arthroscopic drilling of classical lesions of osteochondritis dissecans in 11 knees in 10 children with at least six months history and no sign of clinical or radiological improvement. There were eight boys and two girls and the average age at operation was 12 years 11 months. Relief of pain was noticed within days of operation; radiological healing occurred within 12 months in nine of the 11 knees

Fractures of the anterior intercondylar eminence in children are relatively uncommon. There is considerable debate as to the best treatment of displaced fractures, but most methods described in the literature involve an open procedure combined with some form of fixation. Using human anatomical dissections, we have shown that the transverse meniscal ligament can become incarcerated within the fracture and act as a block to reduction. We describe an arthroscopic technique which requires no fixation device and report the results of its use in eight displaced fractures. This method gives reliable results and offers the advantage of less potential morbidity

Instability of the knee is frequently found in association with congenital leg-length discrepancy. We have studied six such patients clinically, radiologically and arthroscopically. Clinical signs of knee instability and significant radiological changes were present in all, and at arthroscopy the anterior cruciate ligament was completely absent in four patients and functionless in the other two. This deficiency appears to be a congenital condition which may predispose to meniscus injury or retropatellar pain; it may also lead to subluxation or dislocation of the knee during leg-lengthening procedures

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The aim of this study was to investigate the incidence, risk factors, and outcome of venous thromboembolism (VTE) following anterior cruciate ligament (ACL) reconstruction in a nationwide cohort.

A series of 135 knee arthroscopies has been reviewed to determine the accuracy of detection of meniscal lesions. Arthroscopy and double-contrast arthrography achieved similar accuracy (84 per cent and 86 per cent) in the diagnostically more difficult knees of the series. The combined accuracy of both examinations was 98 per cent. Arthroscopic difficulty in seeing the posterior third of the medial meniscus, and consequently tears in this region, is emphasised and discussed. Arthroscopy and arthrography are complementary in the diagnosis of difficult meniscal problems

We report the two- to four-year results following the insertion of the Leeds-Keio prosthetic ligament for chronic anterior cruciate deficiency. Virtually all the 20 patients were less disabled by instability, but objective results were good or excellent in only two-thirds and under anaesthesia the pivot shift sign was still positive in half. Arthroscopic and histological assessment in 16 patients failed to show the development of a functional neoligament, and the common appearance of a synovitic reaction to polyester particles gave concern

Seven children underwent partial meniscectomy for symptomatic discoid lateral meniscus. This procedure, modifying the discoid meniscus to the normal semilunar shape, was indicated only when degeneration or tear was minimal, when the meniscus was not abnormally thickened nor of Wrisberg type, when it was not hypermobile, when the capsular attachment was intact, and when the residual meniscus was free from abnormality. The results were excellent clinically, radiologically and arthroscopically, rehabilitation was shortened to half that required for total meniscectomy and the residual meniscus functioned entirely normally

A total of 108 patients with unilateral instability of the knee, associated with rupture of the anterior cruciate ligament, was prospectively randomised for arthroscopic single- or double-bundle reconstruction of the ligament using hamstring tendons. The same postoperative rehabilitation protocol was used for all. The patients were followed up for a mean of 32 months (24 to 36). We measured the anterior laxity and joint position sense at different angles of flexion of the knee to determine whether both bundles in the double-bundle reconstruction contributed to the stability of the joint and proprioception. No significant difference was found between the two groups with regard to anterior laxity measured by the KT-2000 arthrometer with the knee at 20° or 70° flexion nor with regard to proprioception. A notchplasty was required less often in the double- compared with the single-bundle reconstruction. We did not find any advantage in a double-bundle as opposed to a single-bundle reconstruction in terms of stability or proprioception

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The aim of this study was to evaluate health-related quality of life (HRQoL) and joint function in tenosynovial giant cell tumour (TGCT) patients before and after surgical treatment.

We used the MacIntosh over-the-top repair combined with a popliteal tendon plasty in 273 athletically active patients with chronic incapacitating functional instability due to anterior cruciate ligament rupture; 244 were reviewed at three to nine years after operation. We describe the technique and its results, with functional evaluation by the Tegner and Lysholm system. Excellent or good results were obtained in 71%; most of the 29% fair or poor results were due to extensive meniscal and degenerative changes. In a group of 11 patients with excellent results arthroscopic and histological findings were encouraging, showing good incorporation of the graft

We have investigated a prospective series of 100 acute traumatic haemarthroses of the knee in a general non-athletic population. All the patients had normal radiographs and an aspiration which confirmed the haemarthrosis, before undergoing ligament testing and an arthroscopic examination under anaesthesia. Only one patient had no serious pathology; in the other 99 a total of 193 lesions were recorded. Thirty knees had only one isolated lesion, 69 had combined lesions. This study confirms the serious nature of an acute traumatic haemarthrosis of the knee, even in non-athletic patients