In 28 patients with a solitary diagnosis of instability of the trapeziometacarpal joint because of a rupture of the anterior oblique
In 100 consecutive patients with chronic deficiency of the anterior cruciate ligament we reconstructed the
We treated 12 patients with multilevel stenosis of the cervical canal after spondylosis or ossification of the posterior longitudinal
Hip arthrography was performed in 19 patients in the initial stage of Perthes' disease. Sphericity and subluxation were measured and it was found that subluxation was independent of the femoral head deformity. We therefore tried to identify the cause of early subluxation: in seven patients a swollen ligamentum teres was thought to be responsible, and was associated with medial pooling of the contrast medium. A swollen ligamentum teres was seen in another seven cases; the other five arthrograms were normal. These findings were further clarified by enhanced CT scans, which confirmed that
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
Sixty-five knees were subjected to a kinematic analysis using the instant-centre technique in order to determine the effect of deficiency of the anterior cruciate ligament on the biomechanics of active movement in the knee. The instant-centre pathway in acute ruptures of the anterior cruciate ligament was found to have a specific abnormality. This corresponded with a positive pivot-shift sign, but was present even when that sign was not clinically detectable. Primary repair using a transosseous wire suture did not usually abolish the biomechanical abnormality. The data provide a possible explanation for the doubtful prognosis of primary repair of this
A simple modification of Gallie's subtalar fusion is described as a salvage procedure in treating patients with pain from old fractures of the calcaneous involving the subtalar joint. Graft bone for the fusion is taken from the outer half of the calcaneus, thus avoiding disturbance of the tibia or iliac crest. Collapse of the donor site helps to narrow the widened heel present in these patients. The posterior approach allows the peroneal tendons to be freed from any adhesions, and at the same time release of the calcaneo-fibular
1. The spinal branches of the vertebral artery were injected with a suspension of barium sulphate and the blood supply of the vertebral bodies of the lower four or five cervical vertebrae investigated radiologically. 2. Beneath the posterior longitudinal
There have been few descriptions of the site of attachment onto the triquetrum, the so-called meniscal homologue, of the triangular fibrocartilage complex (TFCC). We have investigated the sites of attachment onto the triquetrum of 87 TFCCs collected from embalmed cadavers. All TFCCs were smoothly attached to the triquetrum. In 79 (46 cases, 90%) they were attached to the triquetrum and fifth metacarpal bone, and in eight (5 cases, 10%) they were attached widely on the articular surface of the triquetrum. It is necessary to have accurate positional information about the normal triquetrum and TFCC in order to perform arthroscopy. The meniscal homologue attached to the triquetrum is smooth in almost all cases. In about 10% of joints the TFCC is attached to the lunotriquetral
The physiological role of mechanoreceptors in the anterior cruciate ligament (ACL) was studied in unanaesthetised decerebrate-spinalised cats and dogs. Tonic activity in the quadriceps and the hamstring increased in response to physiological loading of the ACL. Evoked potentials in the posterior articular nerve (PAN) were elicited by electrical stimulation of the surface of the
The aims of this study were to evaluate the morphology of the ankle in patients with an osteochondral lesion of the talus using 3D CT, and to investigate factors that predispose to this condition. The study involved 19 patients (19 ankles) who underwent surgery for a medial osteochondral lesion (OLT group) and a control group of 19 healthy patients (19 ankles) without ankle pathology. The mean age was significantly lower in the OLT group than in the control group (27.0 Aims
Patients and Methods
The anteroposterior stability of cadaveric knees was investigated. There was a wide range of normal laxity; knees were more stable at 90 degrees than at 20 degrees flexion. Anterior cruciate ligament implants with different stiffnesses were inserted; normal stability could always be restored, and the stiffness or extensibility of implants did not affect knee behaviour significantly. The tightness of implants was critical--small tensioning errors caused subluxation, inhibited knee extension and allowed damagingly high implant tensions. It is concluded that the tension of
Four en-bloc resections for malignant tumours of the hip, the peri-acetabular region and the iliac wing were reconstructed using an irradiated hemipelvic allograft together with a total hip prosthesis. Technical aspects include the use of an anterior Enneking approach which excises the previous biopsy site, division and re-attachment of the iliac crest and fixation of the prosthesis using a modified acetabular cup and three polypropylene artificial
We studied the aetiology of vertebral slip in a long-term follow-up of 22 adult patients with isthmic spondylolysis or spondylolisthesis of L5. Of the 18 with spondylolysis without slip, 13 showed no slip after ten years, but five developed displacement of over 5%. All four patients with spondylolisthesis showed progression of the slip. We found that the vertical thickness of the transverse process of L5 was significantly greater (p <
0.01) in the 13 patients with no slip than in the other two groups. The relationship of vertebral slip to the shape of the transverse processes of L5 may be explained by differences in the bulk or physiological strength of the posterior bands of the iliolumbar
1. Isolated dislocation of the radius at the elbow occurs most commonly as a pronation injury, associated with slight elbow flexion and a varus strain. Disruption of the radio-ulnar articulation occurs primarily because of tearing of the annular
1. Seven cases of non-traumatic anterior atlanto-axial displacement in young people are recorded. 2. Four of the seven patients showed evidence of neurological compression. All cases improved symptomatically with treatment, but five still show persistent radiological displacement. 3. The mechanism of the displacement is thought to be due to acquired insufficiency of the transverse
The family we record draws attention to an association between recurrent dislocation of the patella and joint laxity, which is not confined to the knee. This may pass unrecognised if specific inquiry is not made. In this and other families reported, the joint laxity is inherited, as though due to a dominant gene, but some only of those affected suffer recurrent dislocation of the patella. It is probable that there are other genetically determined causes of recurrent patellar dislocation. In three other families we have seen more than one subject of patellar dislocation, but none had lax
1. Screw fixation of clavicle to coracoid process, with subsequent calcification and ossification along the conoid and trapezoid
1. It is suggested that replacement of the costo-clavicular