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The Journal of Bone & Joint Surgery British Volume
Vol. 60-B, Issue 1 | Pages 74 - 81
1 Feb 1978
Bentley G

Four methods of surgical treatment of chondromalacia patellae have been evaluated after periods ranging from two to thirty years (average seven years), to discover the success rate, complications and indications for each. A total of 140 operations had been performed in 98 patients. Overall, satisfactory results were achieved in 25 per cent after forty shavings of the patellar cartilage, 35 per cent after twenty cartilage excisions and drilling of the subchondral bone, 60 per cent after twenty medial transfers of the patellar tendon and 77 per cent after sixty patellectomies. Thirty-four primary patellectomies gave 82 per cent satisfactory results compared with 62 per cent after twenty-six patellectomies performed after a previously unsuccessful operation. The results were worst in patients below twenty years of age especially women and in those with Grade IV changes in the patellar cartilage. Weakness of the quadriceps after any procedure predisposed to an unsatisfactory result. Extensive late radiological degenerative changes in the knee were not seen. On the basis of the results in this report, patellar tendon transfer is recommended in adolescents and athletes with Grade I, II or III changes in the patellar cartilage. In adults over twenty years of age with Grade I and II changes cartilage excision and drilling is satisfactory. In adults with Grade III and adults or adolescents with Grade IV changes patellectomy is the treatment of choice.


The Journal of Bone & Joint Surgery British Volume
Vol. 60-B, Issue 1 | Pages 71 - 73
1 Feb 1978
Marks K Bentley G

The Insall-Salvati method of determining the position of the patella by radiography was employed in fifty-one patients with chondromalacia patellae that had been proved at arthrotomy. There was no definite relationship between chondromalacia patellae and patella alta. There was, however, a highly significant statistical difference between the ratio of the length of the patella to that of the patellar tendon in normal men and women.


The Journal of Bone & Joint Surgery British Volume
Vol. 59-B, Issue 1 | Pages 58 - 63
1 Feb 1977
Edwards D Bentley G

Six cases of osteochondritis dissecans patellae have been studied in five patients in an attempt to clarify the aetiology and prognosis. Assessment of the results of treatment was performed using a standard protocol. The thirty-four previous case reports in the literature are reviewed. In four of the five patients symptoms began after flexing the knee under load and three showed patellar subluxation on tangential radiographs. Thus, repetitive shearing stress on the patellar surface is thought to be an important aetiological factor. The indication for operation is a loose osteochondral fragment either wholly or partly detached from the articular surface of the patella. Vertical excision of the affected area of articular cartilage with drilling of the underlying bone gave two "good" and two "excellent" results. Healing of the drilled area and maintenance of the cartilage space was seen in radiographs of all four cases so treated. This simple method of treatment, which probably causes filling of the defect in the surface by fibrocartilage, is recommended.


The Journal of Bone & Joint Surgery British Volume
Vol. 58-B, Issue 2 | Pages 227 - 229
1 May 1976
Dickson R Stein H Bentley G

The results of ten excision arthroplasties of the elbow for rheumatoid disease are described. The operation may afford good relief of pain and a useful increase both of hinge motion and of forearm rotation. Instability is not a serious problem unless the patient has to bear weight on crutches. To increase stability after arthroplasty it appears that Kirschner wire fixation is advisable as well as a plaster cast. For advanced rheumatoid disease unilateral excision arthroplasty has a definite value, especially for patients confined to a wheelchair.


The Journal of Bone & Joint Surgery British Volume
Vol. 57-B, Issue 4 | Pages 454 - 462
1 Nov 1975
Bentley G Kreutner A Ferguson AB

Little is known of the effects of synovectomy on articular cartilage. In order to investigate this matter, anterior synovectomy of the knee was performed in thirty-five normal adult rabbits and in thirty-five which were given 25 milligrams of hydrocortisone intramuscularly each week afterwards. The animals were killed at intervals from four to 110 days after synovectomy. Histological examination of the regenerating synovium in both groups showed complete structural and functional regeneration by eighty days in the first group and a delay in regeneration in the steroid group. 35Sulphur autoradiographs of the articular cartilage of femoral and tibial condyles revealed surface fibrillation and chondrocyte death in 23 per cent of normal knees after eighty days but only 1·8 per cent of knees of animals receiving hydrocortisone. Thus synovectomy in a healthy joint may have an unfavourable effect on the physiology of cartilage by alteration of synovial composition and hyaluronate content in normal joints. Systemically-administered hydrocortisone may reduce this harmful effect in normal cartilage.


The Journal of Bone & Joint Surgery British Volume
Vol. 57-B, Issue 3 | Pages 407 - 407
1 Aug 1975
Bentley G


The Journal of Bone & Joint Surgery British Volume
Vol. 56-B, Issue 4 | Pages 643 - 649
1 Nov 1974
Feil E Bentley G Rizza CR

1. The management of fractures in five patients with haemophilia is described: two patients had antibodies to antihaemophilic globulin.

2. The principles of management of injured haemophilia patients are described, as are the special problems in patients with antibodies to AHG.

3. Stability of the fragments must be achieved to prevent the hazards of displacement of the fracture, recurrent bleeding and pseudotumour formation which may threaten viability of the limb.

4. Stabilisation of potentially unstable fractures can be achieved at the onset by internal fixation. Plaster casts should be reserved for stable fractures or fractures occurring in young children.


The Journal of Bone & Joint Surgery British Volume
Vol. 56-B, Issue 4 | Pages 768 - 778
1 Nov 1974
Souter WA Aichroth PM Bates EH Bentley G Holden CEA Jeffery AK


The Journal of Bone & Joint Surgery British Volume
Vol. 55-B, Issue 3 | Pages 588 - 594
1 Aug 1973
Rothwell AG Bentley G

1. Twelve trephine specimens of articular cartilage and subchondral bone taken from six fresh osteoarthritic femoral heads were incubated in a medium containing tritiated thymidine, and autoradiographs were prepared from serial sections five microns thick.

2. Scattered labelling of chondrocytes in sections from four of the six femoral heads was demonstrated. No more than four labelled cells were seen in any one section. About half were found in typical chondrocyte clusters.

3. The implications of this evidence of chondrocyte multiplication with regard to the repair of damaged articular cartilage are discussed.


The Journal of Bone & Joint Surgery British Volume
Vol. 53-B, Issue 2 | Pages 324 - 337
1 May 1971
Bentley G

1. Degenerative arthritis has been produced consistently in adult rabbits by the injection of the proteolytic plant enzyme papain into the hip joint. Arthritic changes were recognisable radiographically after six weeks.

2. A progression of changes occurred, from loss of acid mucopolysaccharide staining in the matrix, fibrillation, fissuring and erosion of articular cartilage with death of chondrocytes in the weight-bearing areas, to secondary bony changes of subchondral sclerosis, occasional cysts and osteophyte formation.

3. Synovial inflammation occurred with accumulation of cartilage and bone debris in the inferior capsule and later capsular thickening.

4. It is suggested that this arthritis is sufficiently similar to human osteoarthritis to be useful as a model for further studies of the pathogenesis of the disease and the effects of different methods of treatment.


The Journal of Bone & Joint Surgery British Volume
Vol. 52-B, Issue 3 | Pages 571 - 577
1 Aug 1970
Bentley G Greer RB

1. The epiphyses of the metatarsal heads of 250-gramme rabbits were separated at the zone of cell columns, stripped of perichondrium, labelled with tritiated thymidine and transplanted into the back muscles of the same animals.

2. Endochondral ossification started in the grafts at four days, was well established by seven days and progressed until fourteen days, the end of the study.

3. Progressive passage of the label down the zone of cell columns and into the hypertrophic zone was observed.

4. The tritiated-3H thymidine label had disappeared from the cartilage cells by ten days. No labelling was observed in the bone cells at any stage.

5. It was not possible to demonstrate from the experiment that growth plate chondrocytes are precursors of osteoblasts in the process of endochondral ossification in rabbits.


The Journal of Bone & Joint Surgery British Volume
Vol. 51-B, Issue 3 | Pages 498 - 502
1 Aug 1969
Bentley G Goodfellow JW


The Journal of Bone & Joint Surgery British Volume
Vol. 50-B, Issue 3 | Pages 588 - 594
1 Aug 1968
Bentley G Jeffreys TE

1. Three cases of traumatic anuria following muscle ischaemia ("crush syndrome") are reported.

2. The pathogenesis and treatment of the condition are discussed.

3. A scheme of management directed to the prevention of renal failure is proposed.


The Journal of Bone & Joint Surgery British Volume
Vol. 50-B, Issue 3 | Pages 551 - 561
1 Aug 1968
Bentley G

1. Seventy patients with impacted fractures of the femoral neck treated from 1953 to 1965 have been reviewed. Forty-seven were treated conservatively and twenty-three by primary internal fixation.

2. The complications of both methods of treatment are recorded.

3. The prognosis following impacted femoral neck fractures is good. Seventy-nine per cent treated conservatively and 96 per cent treated by primary internal fixation had excellent or good results.

4. Primary internal fixation is the treatment of choice.