Different methods of anterior cruciate ligament (ACL) reconstruction
have been described for skeletally immature patients before closure
of the growth plates. However, the outcome and complications following
this treatment remain unclear. The aim of this systematic review
was to analyse the outcome and complications of different techniques
which may be used for reconstruction of the ACL in these patients. We performed a systematic review of the literature according
to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines. This involved a comprehensive search of PubMed, Medline,
CINAHL, Cochrane, Embase and Google Scholar databases using the
following combinations of keywords, “knee”, “anterior cruciate ligament”,
“reconstruction”, “injury”, “children”, “adolescent”, “skeletally
immature”, “open physis” and “surgery”.Aims
Materials and Methods
Initial stability of tibial trays is crucial for long-term success of total knee arthroplasty (TKA) in both primary and revision settings. Rotating platform (RP) designs reduce torque transfer at the tibiofemoral interface. We asked if this reduced torque transfer in RP designs resulted in subsequently reduced micromotion at the cemented fixation interface between the prosthesis component and the adjacent bone. Composite tibias were implanted with fixed and RP primary and revision tibial trays and biomechanically tested under up to 2.5 kN of axial compression and 10° of external femoral component rotation. Relative micromotion between the implanted tibial tray and the neighbouring bone was quantified using high-precision digital image correlation techniques.Objectives
Methods
The aim of this study was to analyse the effect of altered viewing
perspectives on the measurement of the glenopolar angle (GPA) and
the differences between these measurements made on 3D CT reconstructions
and anteroposterior (AP) scapular view radiographs. The influence of the viewing perspective on the GPA was assessed,
as were the differences in the measurements of the GPA between 3D
CT reconstructions and AP scapular view radiographs in 68 cadaveric
scapulae.Aims
Materials and Methods
Throughout the 20th Century, it has been postulated that the knee moves on the basis of a four-bar link mechanism composed of the cruciate ligaments, the femur and the tibia. As a consequence, the femur has been thought to roll back with flexion, and total knee arthroplasty (TKA) prostheses have been designed on this basis. Recent work, however, has proposed that at a position of between 0° and 120° the medial femoral condyle does not move anteroposteriorly whereas the lateral femoral condyle tends, but is not obliged, to roll back – a combination of movements which equates to tibial internal/ femoral external rotation with flexion. The aim of this paper was to assess if the articular geometry of the GMK Sphere TKA could recreate the natural knee movements The pattern of knee movement was studied in 15 patients (six male: nine female; one male with bilateral TKAs) with 16 GMK Sphere implants, at a mean age of 66 years (53 to 76) with a mean BMI of 30 kg/m2 (20 to 35). The motions of all 16 knees were observed using pulsed fluoroscopy during a number of weight-bearing and non-weight-bearing static and dynamic activities.Objectives
Methods
The aim of this study was to compare the biomechanical stability and clinical outcome of external fixator combined with limited internal fixation (EFLIF) and open reduction and internal fixation (ORIF) in treating Sanders type 2 calcaneal fractures. Two types of fixation systems were selected for finite element analysis and a dual cohort study. Two fixation systems were simulated to fix the fracture in a finite element model. The relative displacement and stress distribution were analysed and compared. A total of 71 consecutive patients with closed Sanders type 2 calcaneal fractures were enrolled and divided into two groups according to the treatment to which they chose: the EFLIF group and the ORIF group. The radiological and clinical outcomes were evaluated and compared.Objectives
Methods
Periprosthetic femoral fractures (PFF) following total hip arthroplasty
(THA) are devastating complications that are associated with functional
limitations and increased overall mortality. Although cementless
implants have been associated with an increased risk of PFF, the
precise contribution of implant geometry and design on the risk
of both intra-operative and post-operative PFF remains poorly investigated.
A systematic review was performed to aggregate all of the PFF literature
with specific attention to the femoral implant used. A systematic search strategy of several journal databases and
recent proceedings from the American Academy of Orthopaedic Surgeons
was performed. Clinical articles were included for analysis if sufficient
implant description was provided. All articles were reviewed by
two reviewers. A review of fundamental investigations of implant
load-to-failure was performed, with the intent of identifying similar
conclusions from the clinical and fundamental literature.Aims
Patients and Methods
The aim of this study was to report the outcome of the non-operative
treatment of high-grade posterior cruciate ligament (PCL) injuries,
particularly Hughston grade III injuries, which have not previously
been described. This was a prospective study involving 46 consecutive patients
who were athletes with MRI-confirmed isolated PCL injuries presenting
within four weeks of injury. All had Hughston grade II (25 athletes)
or III (21 athletes) injuries. Our non-operative treatment regimen
involved initial bracing, followed by an individualised rehabilitation
programme determined by the symptoms and physical signs. The patients
were reviewed until they had returned to sports-specific training,
and were reviewed again at a mean of 5.2 years (3 to 9).Aims
Patients and Methods
Favourable results for collarless polished tapered stems have been reported, and cement creep due to taper slip may be a contributing factor. However, the ideal cement thickness around polished stems remains unknown. We investigated the influence of cement thickness on stem subsidence and cement creep. We cemented six collarless polished tapered (CPT) stems (two stems each of small, medium and large sizes) into composite femurs that had been reamed with a large CPT rasp to achieve various thicknesses of the cement mantle. Two or three tantalum balls were implanted in the proximal cement in each femur. A cyclic loading test was then performed for each stem. The migration of the balls was measured three-dimensionally, using a micro-computed tomography (CT) scanner, before and after loading. A digital displacement gauge was positioned at the stem shoulder, and stem subsidence was measured continuously by the gauge. Final stem subsidence was measured at the balls at the end of each stem.Objectives
Methods
The most effective surgical approach for total hip arthroplasty
(THA) remains controversial. The direct anterior approach may be
associated with a reduced risk of dislocation, faster recovery,
reduced pain and fewer surgical complications. This systematic review
aims to evaluate the current evidence for the use of this approach
in THA. Following the Cochrane collaboration, an extensive literature
search of PubMed, Medline, Embase and OvidSP was conducted. Randomised
controlled trials, comparative studies, and cohort studies were
included. Outcomes included the length of the incision, blood loss,
operating time, length of stay, complications, and gait analysis.Aims
Materials and Methods
Morton’s neuroma is common condition of the forefoot, but its
aetiology remains unclear. Our aim was to evaluate the relationship
between the width of the forefoot and the development of a Morton’s
neuroma. Between January 2013 and May 2016, a total of 84 consecutive
patients (17 men, 67 women) with a unilateral Morton’s neuroma were
enrolled into the study. The involved and uninvolved feet of each
patient were compared. A control group of patients with symptoms
from the foot, but without a neuroma who were matched for age, gender, affected
side, and web space location, were enrolled. The first to fifth
intermetatarsal distance, intermetatarsal angle and intermetatarsal
distance of involved web space on standing radiographs were assessed.Aims
Patients and Methods
We aimed to evaluate the temperature around the nerve root during drilling of the lamina and to
determine whether irrigation during drilling can reduce the chance of nerve root injury. Lumbar nerve roots were exposed to frictional heat by high-speed drilling of the lamina in a live
rabbit model, with saline (room temperature (RT) or chilled saline) or without saline (control)
irrigation. We measured temperatures surrounding the nerve root and made histological
evaluations.Aims
Materials and Methods
The use of robots in orthopaedic surgery is an
emerging field that is gaining momentum. It has the potential for significant
improvements in surgical planning, accuracy of component implantation
and patient safety. Advocates of robot-assisted systems describe
better patient outcomes through improved pre-operative planning
and enhanced execution of surgery. However, costs, limited availability,
a lack of evidence regarding the efficiency and safety of such systems
and an absence of long-term high-impact studies have restricted
the widespread implementation of these systems. We have reviewed
the literature on the efficacy, safety and current understanding of
the use of robotics in orthopaedics. Cite this article:
The modified Smith–Petersen and Kocher–Langenbeck
approaches were used to expose the lateral cutaneous nerve of the
thigh and the femoral, obturator and sciatic nerves in order to
study the risk of injury to these structures during the dissection,
osteotomy, and acetabular reorientation stages of a Bernese peri-acetabular
osteotomy. Injury of the lateral cutaneous nerve of thigh was less likely
to occur if an osteotomy of the anterior superior iliac spine had
been carried out before exposing the hip. The obturator nerve was likely to be injured during unprotected
osteotomy of the pubis if the far cortex was penetrated by >
5 mm.
This could be avoided by inclining the osteotome 45° medially and
performing the osteotomy at least 2 cm medial to the iliopectineal
eminence. The sciatic nerve could be injured during the first and last
stages of the osteotomy if the osteotome perforated the lateral
cortex of ischium and the ilio-ischial junction by >
10 mm. The femoral nerve could be stretched or entrapped during osteotomy
of the pubis if there was significant rotational or linear displacement
of the acetabulum. Anterior or medial displacement of <
2 cm
and lateral tilt (retroversion) of <
30° were safe margins. The
combination of retroversion and anterior displacement could increase tension
on the nerve. Strict observation of anatomical details, proper handling of
the osteotomes and careful manipulation of the acetabular fragment
reduce the neurological complications of Bernese peri-acetabular
osteotomy. Cite this article:
