We describe 74 patients with disabling instability of the knee due to isolated anterior cruciate deficiency. None responded to conservative measures or correction of internal derangements. All patients were treated by replacement of the anterior cruciate ligament with the medial third of the patellar tendon as a free graft, supplemented by an extra-articular MacIntosh lateral
This retrospective study compared post-operative
epidural analgesia (E), continuous peripheral nerve blocks (CPNB) and
morphine infusion (M) in 68 children undergoing limb reconstruction
with circular frames. The data collected included episodes of severe
pain, post-operative duration of analgesia, requirement for top-up
analgesia, number of osteotomies, side effects and complications.
There was a significant difference between the number of episodes
of severe pain in patients receiving a morphine infusion and those
receiving epidurals or CPNB (M vs E, p <
0.0001;
M vs CPNB, p = 0.018). The CPNB group was associated
with the lowest incidence of episodes of severe pain and top-up
analgesia. Epidural analgesia was associated with significantly
more nausea and vomiting than morphine infusion (p = 0.053) and
CPNB (p = 0.023). It also had a significantly higher incidence of
motor blockade than CPNB (p <
0.01). We found that the most effective
method of post-operative analgesia for children undergoing lower
limb
We reviewed 32 deep-frozen irradiated allografts used for the
We reviewed retrospectively the results in 211 consecutive patients who had undergone limb salvage for bone neoplasia with endoprosthetic
We have treated 94 patients with chronic instability of the lateral side of the ankle by
We describe a retrospective review of 38 cases of
We retrospectively reviewed 44 consecutive patients
(50 hips) who underwent acetabular re-revision after a failed previous
revision that had been performed using structural or morcellised
allograft bone, with a cage or ring for uncontained defects. Of
the 50 previous revisions, 41 cages and nine rings were used with
allografts for 14 minor-column and 36Â major-column defects. We routinely
assessed the size of the acetabular bone defect at the time of revision
and re-revision surgery. This allowed us to assess whether host
bone stock was restored. We also assessed the outcome of re-revision
surgery in these circumstances by means of radiological characteristics,
rates of failure and modes of failure. We subsequently investigated
the factors that may affect the potential for the restoration of bone
stock and the durability of the re-revision
We retrospectively studied 14 patients with proximal and diaphyseal tumours and disappearing bone (Gorham’s) disease of the humerus treated with wide resection and
We examined the menisci in 47 patients at the time of anterior cruciate ligament reconstruction. Twenty-one patients had abnormal menisci at a mean of 34 months after injury, but there was no difference between the Lysholm scores of patients with intact or damaged menisci. Eleven patients had a new meniscal injury between
Deficiency of the anterior cruciate ligament (ACL) is a common disorder which can lead to changes in lifestyle. We followed 59 patients who had had arthroscopic
Between 1996 and 2003, 16 patients (nine female, seven male) were treated for a primary bone sarcoma of the femur by wide local excision of the tumour, extracorporeal irradiation and re-implantation. An additional vascularised fibular graft was used in 13 patients (81%). All patients were free from disease when reviewed at a minimum of two years postoperatively (mean 49.7 months (24 to 96). There were no cases of infection. Primary union was achieved after a median of nine months (interquartile range 7 to 11). Five host-donor junctions (16%) united only after a second procedure. Primary union recurred faster at metaphyseal junctions (94% (15) at a median of 7.5 months (interquartile range 4 to 12)) than at diaphyseal junctions (75% (12) at a median of 11.1 months (interquartile range 5 to 18)). Post-operatively, the median Musculoskeletal Tumour Society score was 85% (interquartile range 75 to 96) and the median Toronto Extremity Salvage score 94% (interquartile range 82 to 99). The Mankin score gave a good or excellent result in 14 patients (88%). The range of movement of the knee was significantly worse when the extracorporeally irradiated autografts were fixed by plates rather than by nails (p = 0.035). A total of 16 (62%) of the junctions of the vascularised fibular grafts underwent hypertrophy, indicating union and loading. Extracorporeal irradiation autografting with supplementary vascularised fibular grafting is a promising biological alternative for intercalary
Previous studies of the Ilizarov procedure have concentrated on musculoskeletal assessments rather than the opinions of patients. In a prospective trial of 25 consecutive patients, we evaluated the effect of Ilizarov
We developed an in vivo model of the attachment of a patellar tendon to a metal implant to simulate the
We treated four patients with periacetabular malignant tumours by pelvic
We report a retrospective study of 46 patients with continuing difficulties after anterior
We present a case of disruption of the posterolateral corner of the knee with avulsion of the tendon of biceps femoris. Repair and
We treated 90 patients with an isolated injury to the anterior cruciate ligament (ACL) by
Persistent dislocation of the elbow after a fracture of the coronoid process is a difficult problem. We have performed an open reduction with
Osteotomies are commonly carried out in orthopaedic surgery, particularly in limb
We reviewed the results of 13 adults of secondary