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The Bone & Joint Journal
Vol. 105-B, Issue 12 | Pages 1244 - 1251
1 Dec 2023
Plastow R Raj RD Fontalis A Haddad FS

Injuries to the quadriceps muscle group are common in athletes performing high-speed running and kicking sports. The complex anatomy of the rectus femoris puts it at greatest risk of injury. There is variability in prognosis in the literature, with reinjury rates as high as 67% in the severe graded proximal tear. Studies have highlighted that athletes can reinjure after nonoperative management, and some benefit may be derived from surgical repair to restore function and return to sport (RTS). This injury is potentially career-threatening in the elite-level athlete, and we aim to highlight the key recent literature on interventions to restore strength and function to allow early RTS while reducing the risk of injury recurrence. This article reviews the optimal diagnostic strategies and classification of quadriceps injuries. We highlight the unique anatomy of each injury on MRI and the outcomes of both nonoperative and operative treatment, providing an evidence-based management framework for athletes.

Cite this article: Bone Joint J 2023;105-B(12):1244–1251.


The Bone & Joint Journal
Vol. 104-B, Issue 8 | Pages 915 - 921
1 Aug 2022
Marya S Tambe AD Millner PA Tsirikos AI

Adolescent idiopathic scoliosis (AIS), defined by an age at presentation of 11 to 18 years, has a prevalence of 0.47% and accounts for approximately 90% of all cases of idiopathic scoliosis. Despite decades of research, the exact aetiology of AIS remains unknown. It is becoming evident that it is the result of a complex interplay of genetic, internal, and environmental factors. It has been hypothesized that genetic variants act as the initial trigger that allow epigenetic factors to propagate AIS, which could also explain the wide phenotypic variation in the presentation of the disorder. A better understanding of the underlying aetiological mechanisms could help to establish the diagnosis earlier and allow a more accurate prediction of deformity progression. This, in turn, would prompt imaging and therapeutic intervention at the appropriate time, thereby achieving the best clinical outcome for this group of patients.

Cite this article: Bone Joint J 2022;104-B(8):915–921.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 2 | Pages 127 - 132
1 Feb 2008
Warwick D Dahl OE Fisher WD

Thromboprophylaxis remains a controversial subject. A vast amount of epidemiological and trial data about venous thromboembolism has been published over the past 40 years. These data have been distilled and synthesised into guidelines designed to help the practitioner translate this extensive research into ‘evidence-based’ advice. Guidelines should, in theory, benefit patient care by ensuring that every patient routinely receives the best prophylaxis; without guidelines, it is argued, patients may fail to receive treatment or be exposed to protocols which are ineffective, dangerous or expensive. Guidelines, however, have not been welcomed or applied universally. In the United States, orthopaedic surgeons have published their concerns about the thromboprophylaxis guidelines prepared by the American College of Chest Physicians. In Britain, controversy persists with many surgeons unconvinced of the risk/benefit, cost/benefit or practicality of thromboprophylaxis. The extended remit of the recent National Institute of Clinical Excellence thromboprophylaxis guidelines has been challenged. The reasons for this disquiet are addressed in this paper and particular emphasis is placed on how clinically-acceptable guidelines could be developed and applied


The Journal of Bone & Joint Surgery British Volume
Vol. 89-B, Issue 1 | Pages 1 - 4
1 Jan 2007
Robertsson O

This article considers the establishment, purpose and conduct of knee arthroplasty registers using the Swedish register as an example. The methods of collection of appropriate data, the cost, and the ways in which this information may be used are considered


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 11 | Pages 1401 - 1406
1 Nov 2008
Patel A Calfee RP Plante M Fischer SA Arcand N Born C

Methicillin-resistant Staphylococcus aureus (MRSA) has become a ubiquitous bacterium in both the hospital and community setting. There are two major subclassifications of MRSA, community-acquired and healthcare-acquired, each with differing pathogenicity and management. MRSA is increasingly responsible for infections in otherwise healthy, active adults. Local outbreaks affect both professional and amateur athletes and there is increasing public awareness of the issue. Health-acquired MRSA has major cost and outcome implications for patients and hospitals. The increasing prevalence and severity of MRSA means that the orthopaedic community should have a basic knowledge of the bacterium, its presentation and options for treatment. This paper examines the evolution of MRSA, analyses the spectrum of diseases produced by this bacterium and presents current prevention and treatment strategies for orthopaedic infections from MRSA


The Bone & Joint Journal
Vol. 96-B, Issue 11_Supple_A | Pages 7 - 9
1 Nov 2014
Berend ME Berend KR Lombardi Jr AV

Over the past 30 years there have been many improvements in implant fixation, correction of deformity, improved polyethylene wear, and survival after knee replacement. The work over the last decade has focused on less invasive surgical techniques, multimodal pain management protocols, more rapid functional recovery and reduced length of stay, aiming to minimise the side effects of treatment while maintaining function and implant durability. When combined and standardised these pre-, intra- and post-operative factors have now facilitated outpatient knee replacement procedures for unicompartmental replacement, patella femoral arthroplasty and total knee replacement (TKR).

We have found liposomal bupivacaine, with potential for longer therapeutic action, to be a helpful adjunct and describe our current pain management program. The next step in our multimodal program is to improve the duration of patient satisfaction and reduce cost and length of stay after TKR.

Cite this article: Bone Joint J 2014;96-B(11 Suppl A):7–9.


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 11_Supple_A | Pages 8 - 10
1 Nov 2012
Watts CD Pagnano MW

Despite advances in contemporary hip and knee arthroplasty, blood loss continues to be an issue. Though blood transfusion has long been used to treat post-operative anemia, the associated risks are well established. The objective of this article is to present two practical and effective approaches to minimising blood loss and transfusion rates in hip and knee arthroplasty: the use of antifibrinolytic medications such as tranexamic acid and the adoption of more conservative transfusion indications.


The Journal of Bone & Joint Surgery British Volume
Vol. 94-B, Issue 11_Supple_A | Pages 3 - 7
1 Nov 2012
Barrack RL

Venous thromboembolism (VTE) remains an immediate threat to patients following total hip and knee replacement. While there is a strong consensus that steps should be taken to minimise the risk to patients by utilising some forms of prophylaxis for the vast majority of patients, the methods utilised have been extremely variable. Clinical practice guidelines (CPGs) have been published by various professional organisations for over 25 years to provide recommendations to standardise VTE prophylaxis. Historically, these recommendations have varied widely depending in underlying assumptions, goals, and methodology of the various groups. This effort has previously been exemplified by the American College of Chest Physicians (ACCP) and the American Academy of Orthopaedic Surgeons (AAOS). The former group of medical specialists targeted minimising venographically proven deep vein thrombosis (DVT) (the vast majority of which are asymptomatic) as their primary goal prior to 2012. The latter group of surgeons targeted minimising symptomatic VTE. As a result prior to 2012, the recommendations of the two groups were widely divergent. In the past year, both groups have reassessed the current literature with the principal goals of minimising symptomatic VTE events and bleeding complications. As a result, for the first time the CPGs of these two major subspecialty organisations are in close agreement.


The Journal of Bone & Joint Surgery British Volume
Vol. 87-B, Issue 6 | Pages 749 - 754
1 Jun 2005
Giannoudis PV Parker J Wilcox MH


The Journal of Bone & Joint Surgery British Volume
Vol. 88-B, Issue 6 | Pages 701 - 705
1 Jun 2006
Simpson AHRW Mills L Noble B


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 6 | Pages 685 - 696
1 Jun 2008
Robinson CM Jenkins PJ Markham PE Beggs I

The sternoclavicular joint is vulnerable to the same disease processes as other synovial joints, the most common of which are instability from injury, osteoarthritis, infection and rheumatoid disease. Patients may also present with other conditions, which are unique to the joint, or are manifestations of a systemic disease process. The surgeon should be aware of these possibilities when assessing a patient with a painful, swollen sternoclavicular joint.


The Journal of Bone & Joint Surgery British Volume
Vol. 93-B, Issue 4 | Pages 427 - 434
1 Apr 2011
Griffin M Iqbal SA Bayat A

Failure of bone repair is a challenging problem in the management of fractures. There is a limited supply of autologous bone grafts for treating nonunions, with associated morbidity after harvesting. There is need for a better source of cells for repair. Mesenchymal stem cells (MSCs) hold promise for healing of bone because of their capacity to differentiate into osteoblasts and their availability from a wide variety of sources. Our review aims to evaluate the available clinical evidence and recent progress in strategies which attempt to use autologous and heterologous MSCs in clinical practice, including genetically-modified MSCs and those grown on scaffolds. We have compared various procedures for isolating and expanding a sufficient number of MSCs for use in a clinical setting.

There are now a number of clinical studies which have shown that implantation of MSCs is an effective, safe and durable method for aiding the repair and regeneration of bone.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 5 | Pages 545 - 549
1 May 2008
Ashby E Grocott MPW Haddad FS

Orthopaedic outcome measures are used to evaluate the effect of operative interventions. They are used for audit and research. Knowledge of these measures is becoming increasingly important with league tables comparing surgeons and hospitals being made accessible to the profession and the general public.

Several types of tool are available to describe outcome after hip surgery such as generic quality-of-life questionnaires, disease-specific quality-of-life questionnaires, hip-specific outcome measures and general short-term clinical measures. We provide an overview of the outcome measures commonly used to evaluate hip interventions.


The Journal of Bone & Joint Surgery British Volume
Vol. 91-B, Issue 7 | Pages 845 - 850
1 Jul 2009
Bannister G Amirfeyz R Kelley S Gargan M

This review discusses the causes, outcome and prevention of whiplash injury, which costs the economy of the United Kingdom approximately £3.64 billion per annum. Most cases occur as the result of rear-end vehicle collisions at speeds of less than 14 mph. Patients present with neck pain and stiffness, occipital headache, thoracolumbar back pain and upper-limb pain and paraesthesia. Over 66% make a full recovery and 2% are permanently disabled. The outcome can be predicted in 70% after three months.


The Journal of Bone & Joint Surgery British Volume
Vol. 91-B, Issue 1 | Pages 1 - 7
1 Jan 2009
Robinson AHN Pasapula C Brodsky JW

A comprehensive review of the literature relating to the pathology and management of the diabetic foot is presented. This should provide a guide for the treatment of ulcers, Charcot neuro-arthropathy and fractures involving the foot and ankle in diabetic patients.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 7 | Pages 827 - 832
1 Jul 2008
Rees JL

This review discusses the pathogenesis and surgical treatment of tears of the rotator cuff.


The Journal of Bone & Joint Surgery British Volume
Vol. 88-B, Issue 1 | Pages 2 - 7
1 Jan 2006
Lemaire R


The Journal of Bone & Joint Surgery British Volume
Vol. 88-B, Issue 7 | Pages 841 - 851
1 Jul 2006
Lee EH Hui JHP


The Journal of Bone & Joint Surgery British Volume
Vol. 87-B, Issue 12 | Pages 1595 - 1604
1 Dec 2005
Hadjipavlou AG Tzermiadianos MN Katonis PG Szpalski M