Diagnoses and Treatment Recommendations-Interrater Reliability of Uroflowmetry in People with Multiple Sclerosis.

Background: Uroflowmetry (UF) is an established procedure in urology and is recommended before further investigations of neurogenic lower urinary tract dysfunction (NLUTD). Some authors even consider using UF instead of urodynamics (UD). Studies on the interrater reliability of UF regarding treatment recommendations are rare, and there are no relevant data on people with multiple sclerosis (PwMS).

'The Sneaky Plica' revisited: morphology, pathophysiology and treatment of synovial plicae of the knee.

Purpose: To comprise current knowledge on morphology, embryology and pathophysiology of synovial plicae as well as on clinical and therapeutic aspects of the plica syndrome.

Methods: Review of the literature combined with a meta-analysis of studies assessing the outcome of open or arthroscopic plica excision including the author's own series.

Results: The term synovial plica has been devised to describe a number of intra-capsular folds thought to represent remnants of a membranous knee joint partition present during foetal development.

The story of anterior cruciate ligament reconstruction--part 2.

The first part of The story of anterior cruciate ligament reconstruction, was published in the previous issue of this journal, and the reader is encouraged to study both parts in order to become better acquainted with the subject. Those who have read the first part will remember that it concerned the historical developments surrounding the ligament's discovery, the acknowledgement of its function and the appreciation of the detrimental effects once it becomes damaged. It also described the efforts of the early pioneers who recognised the need to reestablish ligament function by ways of ligament repair or reconstruction with autologous tissue.

The story of anterior cruciate ligament reconstruction--Part 1.

Once upon a time the anterior cruciate ligament (ACL) enjoyed a relatively unchartered existence, when only a fall from a jousting horse or chariot might have sent a knight or gladiator into early retirement due to an unstable knee. In today's world of high speed travel and an ever increasing number of sports enthusiasts, injuries of the ACL are almost common place with a yearly incidence of about 35 per 100,000 of the population. Although we have known about the existence of the cruciate ligaments since they were first described by Galen over 2000 years ago, awareness of their function and the consequences of their loss were not appreciated until much later.

Basic kinematics and biomechanics of the patellofemoral joint part 2: the patella in total knee arthroplasty.

Patellar and femoral component in total knee arthroplasty are inextricably linked as a functional unit. The configuration of this unit has been a matter of ongoing debate, and the myriad of different patellar and femoral components currently available reflect the lack of consensus with respect to the ideal design. One of the major challenges is to overcome the biomechanical disadvantages of a small contact area through which high contact pressures are transferred, making this mechanical construct the weakest part of the prosthetic knee.

The controversy of patellar resurfacing in total knee arthroplasty: Ibisne in medio tutissimus?

Early arthroplasty designs were associated with a high level of anterior knee pain as they failed to cater for the patello-femoral joint. Patellar resurfacing was heralded as the saviour safeguarding patient satisfaction and success but opinion on its necessity has since deeply divided the scientific community and has become synonymous to topics of religion or politics. Opponents of resurfacing contend that the native patella provides better patellar tracking, improved clinical function, and avoids implant-related complications, whilst proponents argue that patients have less pain, are overall more satisfied, and avert the need for secondary resurfacing.

Current concepts of articular cartilage repair.

Articular cartilage provides a vital function in the homeostasis of the joint environment. It possesses unique mechanical properties, allowing for the maintenance of almost frictionless motion over a lifetime. However, cartilage is vulnerable to traumatic injury and due to its poor vascularity and inability to access mesenchymal stem cells, unable to facilitate a satisfactory healing response.

Surgery for anterior cruciate ligament deficiency: a historical perspective.

The anterior cruciate ligament (ACL) has entertained scientific minds since the Weber brothers provided biomechanical insight into the importance of the ACL in maintaining normal knee kinematics. Robert Adams described the first clinical case of ACL rupture in 1837 some 175 years to date, followed by Mayo-Robson of Leeds who performed the first ACL repair in 1895. At that time, most patients presented late and clinicians started to appreciate signs and symptoms and disabilities associated with such injuries.

Basic kinematics and biomechanics of the patello-femoral joint. Part 1: The native patella.

The patello-femoral joint (PFJ) enhances our ability of knee flexion and extension and is assumed to have evolved through men's ability of having adopted a bipedal gait. This articulation between patella and femur is relatively complex and displays intricate biomechanical behaviour. Forces in the patello-femoral joint are a function of the quadriceps force, and the angle of flexion of the knee.

The practice of unicompartmental knee arthroplasty in the United Kingdom.

Purpose: To survey the current practice of unicompartmental knee arthroplasty (UKA) in the United Kingdom.

Methods: Questionnaires were sent to all 341 local members of the British Association for Surgery of the Knee to inquire into their practice of UKA, including clinical indications, preoperative investigations, surgical approach, preferences in implant design, and the role of UKA in relation to high tibial osteotomy.

Results: 56% of respondents performed less than 16 UKAs per year, whereas 16.

Cartilage repair using autologous chondrocyte implantation techniques.

Articular cartilage in adults has a poor ability to self-repair after injury. A variety of cartilage resurfacing techniques have the potential to improve the repair of cartilage defects and reduce the patient's disability. The most advanced of these techniques is autologous chondrocyte implantation.

Minimally invasive surgery of the knee.

Minimally invasive knee replacement surgery has been developed in an attempt to lessen the impact of operations on the patient's quality of life, in the same way as arthroscopy, the forefather of minimally invasive surgery (MIS), revolutionised cartilage and ligament surgery three decades earlier. The technique is based on minimising soft tissue and muscle trauma, skin incision length, and capsular disruption while trying to maintain the ultimate goal of a well-aligned, well-fixed knee replacement. Short-term advantages including accelerated recovery and reduction in blood loss have been demonstrated, but it remains to be investigated whether MIS is able to provide sustainable benefits and long-term outcome equivalent to conventional surgery.

Use of a novel bone graft substitute in peri-articular bone tumours of the knee.

We treated three patients with aneurysmal bone cysts and seven with giant cell tumours who presented with a large osteolytic lesion in peri-articular areas of the knee. The patients age ranged from 8 to 49 years (mean 25 years). The average tumour volume was measured at 39.

Retroperitoneal giant schwannomas: report on two cases and review of the literature.

The occurrence of massive retroperitoneal schwannomas is extremely rare and their presence may only be expressed by insidious onset of non-specific and misleading symptoms with a predominance of lower back pain. MRI scan as the imaging procedure of choice will demonstrate the tumour location and its relation to the surrounding structures, but due to heterogeneity and degeneration in some tumours, it may mimic malignancy. Hence tissue sampling through needle biopsies are essential to verify the diagnosis prior to surgery.