Two-year postoperative MRI appearances of anterior cruciate ligament hamstrings autografts are not correlated with functional outcomes, anterior laxity, or patient age.

Aims: MRI has been suggested as an objective method of assessing anterior crucate ligament (ACL) graft "ligamentization" after reconstruction. It has been proposed that the MRI appearances could be used as an indicator of graft maturity and used as part of a return-to-sport assessment. The aim of this study was to evaluate the correlation between MRI graft signal and postoperative functional scores, anterior knee laxity, and patient age at operation.

Percutaneous Chevron and Akin (PECA) Osteotomies for Severe Hallux Valgus Deformity With Mean 3-Year Follow-up.

Background: Patients with severe hallux valgus deformity present technical and operative challenges with high rates of recurrence and residual deformity. The clinical and radiologic outcomes of percutaneous surgery for severe hallux valgus are not known.

Methods: A retrospective review of consecutive patients with a hallux valgus angle (HVA) >40 degrees or intermetatarsal angle (IMA) >20 degrees who underwent third-generation percutaneous chevron and Akin osteotomy (PECA) for hallux valgus deformity correction.

The influence of patellofemoral stabilisation surgery on joint congruity: an MRI surface mapping study.

Background: In the unstable patellofemoral joint (PFJ), the patella will articulate in an abnormal manner, producing an uneven distribution of forces. It is hypothesised that incongruency of the PFJ, even without clinical instability, may lead to degenerative changes. The aim of this study was to record the change in joint contact area of the PFJ after stabilisation surgery using an established and validated MRI mapping technique.

Lordosis Restoration With Midline Minimally Invasive Cortical Trajectory Screws (MidLF) and Transforaminal Interbody Fusion: A Safe Technique With a Short Stay.

Background: The minimally invasive cortical trajectory screw (MidLF) technique has been described accompanied with posterolateral interbody fusion (PLIF). We present our 2-year results of a hybrid technique to show that using transforaminal interbody fusion (TLIF) rather than PLIF in conjunction with MidLF is a less invasive and safe technique.

Methods: We retrospectively identified 25 patients who underwent MidLF with TLIF from July 2015 through September 2017.

infection after anterior cruciate ligament reconstruction: A case report.

Background: Infections after anterior cruciate ligament reconstruction (ACLR) are rare. No cases of infection have been described to our knowledge.

Case Summary: We describe a rare case of infection in a 23-year-old patient following an ACLR.

Randomized Controlled Trial of Topical Skin Adhesive vs Nylon Sutures for Incision Closure in Forefoot Surgery.

Background: There are many options for incision closure in forefoot surgery. The aim of this study was to compare topical skin adhesive (2-octyl-cyanoacrylate) to simple interrupted nylon sutures.

Methods: A prospective randomized controlled trial comparing topical skin adhesive (TSA) and nylon sutures (NSs) for elective open forefoot surgery.

The number of patients "worse than death" while waiting for a hip or knee arthroplasty has nearly doubled during the COVID-19 pandemic.

Aims: The aim of this study was to assess the quality of life of patients on the waiting list for a total hip (THA) or knee arthroplasty (KA) during the COVID-19 pandemic. Secondary aims were to assess whether length of time on the waiting list influenced quality of life and rate of deferral of surgery.

Methods: During the study period (August and September 2020) 843 patients (THA n = 394, KA n = 449) from ten centres in the UK reported their EuroQol five dimension (EQ-5D) scores and completed a waiting list questionnaire (2020 group).

A comparison of 2 cementing techniques in hip resurfacing using human femoral heads.

Introduction: Hip resurfacing remains a valid option in young male patients. The creation of the optimum cement mantle aids fixation of the femoral component. If the cement mantle is too thick the prosthesis can remain proud leading to early failure or if it penetrates too far into the femoral head, it may cause osteonecrosis.

Magnetic Resonance Imaging 1 Year After Hamstring Autograft Anterior Cruciate Ligament Reconstruction Can Identify Those at Higher Risk of Graft Failure: An Analysis of 250 Cases.

Background: There is currently no analysis of 1-year postoperative magnetic resonance imaging (MRI) that reproducibly evaluates the graft of a hamstring autograft anterior cruciate ligament reconstruction (ACLR) and helps to identify who is at a higher risk of graft rupture upon return to pivoting sports.

Purpose: To ascertain whether a novel MRI analysis of ACLR at 1 year postoperatively can be used to predict graft rupture, sporting level, and clinical outcome at a 1-year and minimum 2-year follow-up.

Study Design: Case-control study; Level of evidence, 3.

Remote Musculoskeletal Assessment Framework: A Guide for Primary Care.

Introduction Remote consulting has exploded into primary care following the initial COVID-19 surge as a measure to reduce potential cross-infection (staff-patient or patient-patient). Musculoskeletal (MSK) conditions comprise up to 21% of the annual primary care caseload in England. Established techniques for MSK examination, however, rely on face-to-face attendance.

Fixed bearing, all-polyethylene tibia, lateral unicompartmental arthroplasty - A final outcome study with up to 28 year follow-up of a single implant.

Background: Lateral unicompartmental arthroplasty (UKA) constitutes only 5-10% of all unicompartmental replacements performed. Whilst the short and medium term benefits are well documented, there remains concern regarding the higher revision rate when compared with total knee replacement. We report the long term clinical outcome and survivorship of a large series of lateral UKA.

Blood loss after revision knee arthroplasty is 1.38- to 2.17-fold higher than after primary knee arthroplasty: A retrospective analysis of 898 cases.

Background: There are a number of factors that influence blood loss during and after primary total knee arthroplasty (TKA) and revision TKA (rTKA). The purpose of this study was to provide a factorial assessment that would aid surgeons in managing expected blood loss in rTKA, when compared to TKA. The first question asked was the blood loss and transfusions between TKA and rTKA and the second question was risk factors for blood loss after rTKA.

Use of a Novel Variable Power Radiofrequency Ablation System Specific for Knee Chondroplasty: Surgical Experience and Two-Year Patient Results.

Introduction Although stabilisation of knee cartilage lesions (chondroplasty) may be performed with an arthroscopic shaver, more recently, radiofrequency (RF) ablation has gained in popularity. However, their remain some concerns about the avoidance of thermal injury, chondrolysis, and osteonecrosis with the use of RF devices. Methods We reviewed the outcomes of 85 knee chondroplasties performed with a new RF ablation wand designed for knee chondroplasty.

St Georg Sled medial unicompartmental arthroplasty: survivorship analysis and function at 20 years follow up.

Purpose: The peri-operative and short-term benefits of unicompartmental knee arthroplasty (UKA) are well supported in the literature. However, there remains concern regarding the higher revision rate when compared with total knee replacement. This manuscript reports the functional outcome and survivorship of a large series of fixed bearing, medial unicompartmental replacements (St Georg Sled), with a minimum of 20 years follow-up.

All-inside versus inside-out meniscal repair: A systematic review and meta-analysis.

Background: Meniscal repair using all-inside devices has garnered popularity compared to inside-out repair, yet few studies directly compare the two techniques in terms meniscal healing rates, surgical time, patient outcomes and incidence of complications.

Methods: A systematic literature review was performed using the Medline, Cochrane and Embase databases. English-language studies comparing all-inside and inside-out arthroscopic meniscal repair techniques directly were included.

Medial collateral ligament reconstruction graft isometry is effected by femoral position more than tibial position.

Purpose: The purpose of this study was to examine the length change patterns of the native medial structures of the knee and determine the effect on graft length change patterns for different tibial and femoral attachment points for previously described medial reconstructions.

Methods: Eight cadaveric knee specimens were prepared by removing the skin and subcutaneous fat. The sartorius fascia was divided to allow clear identification of the medial ligamentous structures.

The anatomy of Kaplan fibers.

Purpose: Kaplan fibers (KF) have been described as connections between the iliotibial band and the distal femur. They are divided into two distinct structures, proximal (PKF) and distal (DKF) fibers, which may participate in the control of the rotatory knee stability. Their anatomical characteristics have not been investigated completely, in particular with respect to reconstruction procedures.

Adjustable suspension versus hybrid fixation in hamstring autograft anterior cruciate ligament reconstruction.

Background: There has been increased use of adjustable suspensory fixation (ASF) for anterior cruciate ligament reconstruction (ACLR). Potential benefits are the ability to use a shorter graft and to prevent graft displacement and damage. The purpose of this study was to establish the efficacy of this fixation method and assess whether it leads to less tunnel widening, and avoids known complications of screw fixation.

Predictors of Functional Outcome After Microfracture Treatment of Cartilage Defects of the Knee.

Introduction: Microfracture (MFx) is a widely used technique in the treatment of articular cartilage defects of the knee. The objective of this study was to determine the prognostic factors of functional outcomes after MFx treatment of knee cartilage defects ≤ 4 cm2.

Materials And Methods: Forty-eight patients who were to be treated by MFx for knee cartilage defects ≤ 4 cm2 were prospectively included.

Ileus, Gastrointestinal Bleeding and Clostridium difficile Colitis after Hip and Knee Replacement - a Systematic Review.

Introduction: Major gastrointestinal complications after arthroplasty are rare, but can have detrimental effects on the patient and can substantially increase the overall cost of treatment. This systematic review provides an overview of ileus, gastrointestinal bleeding and C. difficile colitis after total hip and knee arthroplasty.

A systematic review and meta-analysis of survivorship and wear rates of metal and ceramic heads articulating with polyethylene liners in total hip arthroplasty.

Background: The major joint registries report better survivorship for ceramic on polyethylene over metal on polyethylene bearings in total hip arthroplasty and it is generally accepted that this is due to a lower polyethylene wear rate. We used evidence synthesis to compare survivorship, polyethylene wear rates and metal ion levels for metal-on-polyethylene (MoP) and ceramic-on-polyethylene (CoP) bearings. If wear rates are not dissimilar this difference in revision rate may have another cause.

Incidence and predictive factors of problems after fixation of trochanteric hip fractures with sliding hip screw or intramedullary devices.

Introduction: Hip fractures are common and disabling injuries, usually managed surgically. The most common type outside the joint capsule are trochanteric fractures, usually fixed with either sliding hip screw or intramedullary nail. Data are available in the National Hip Fracture Database (NHFD) on early failure and other major complications, but late or subtler complications may escape recording.

Exploring trends in admissions and treatment for ankle fractures: a longitudinal cohort study of routinely collected hospital data in England.

Background: Evidence on the most effective and cost-effective management of ankle fractures is sparse but evolving. A recent large RCT in older patients with unstable fractures found that management with close-contact-casting was functionally equivalent and more cost-effective than internal fixation. We describe temporal and geographic variation in ankle fracture management and estimate the potential savings if close-contact-casting was used more often in older patients.

How I do it: 1st stage revision TKA.

This article covers the key steps and decisions that we make when performing a 1st-stage revision Total Knee Arthroplasty (TKA) at the Avon Orthopaedic Centre and includes more detailed technique and tips regarding how we make our spacers. The first stage of a two-stage protocol should be done in a stable patient with information about the organism, and with the option of plastic surgery flap coverage if required. It should ideally be performed in the unit that is going to perform the second stage, and the operation note should document the soft-tissues, bone loss and extensor mechanism issues that will influence planning for the second stage.