We retrospectively reviewed the hospital records of 68 patients who had been referred with an injury to the posterolateral corner of the knee to a specialist knee surgeon between 2005 and 2009. These injuries were diagnosed based on a combination of clinical testing and imaging and arthroscopy when available. In all, 51 patients (75%) presented within 24 hours of their injury with a mean presentation at eight days (0 to 20) after the injury. A total of 63 patients (93%) had instability of the knee at presentation. There was a mean delay to the diagnosis of injury to the posterolateral corner of 30 months (0 to 420) from the time of injury. In all, the injuries in 49 patients (72%) were not identified at the time of the initial presentation, with the injury to the posterolateral corner only recognised in those patients who had severe multiple ligamentous injuries. The correct diagnosis, including injury to the posterolateral corner, had only been made in 34 patients (50%) at time of referral to a specialist knee clinic. MRI correctly identified 14 of 15 injuries when performed acutely (within 12 weeks of injury), but this was the case in only four of 15 patients in whom it was performed more than 12 weeks after the injury.

Our study highlights a need for greater diligence in the examination and investigation of acute ligamentous injuries at the knee with symptoms of instability, in order to avoid failure to identify the true extent of the injury at the time when anatomical repair is most straightforward.

While injury to the posterolateral corner is accepted as a relatively common occurrence associated with rupture of the anterior cruciate ligament, posteromedial meniscocapsular injury has not previously been recognised as such. In a prospective assessment of 183 consecutive reconstructions of the anterior cruciate ligament this injury was observed in 17 cases, giving it an incidence of 9.3%. Clinically, it was associated with a mild anteromedial rotatory subluxation and it is important not to confuse this with posterolateral rotatory subluxation. In no case was this injury identified by MRI. The possible long-term clinical relevance is discussed.

Aims: To identify any changes in the demographics of ACL injured patients over the last decade.

Methods: Over a twelve month period, the demographic data from 117 consecutive new patients with ACL injuries attending one consultant’s clinic in 1994 was prospectively recorded. This was then compared with data from a similar cohort of 103 consecutive new ACL injured patients attending the same clinic some twelve years later.

Results:

Since 1994, the proportion of women seen with ACL injury doubled from 12% to 25%

Conclusion: The population of patients with new ACL injuries has changed significantly over the last twelve years. The average age, proportion of women and number of skiing related injuries have all increased significantly. We speculate that the most likely cause of these changes is the skiing population, which has enlarged and, due to retention of participants, has aged over the period of this study (1). Most skiing injuries are sustained abroad and the vast majority of skiers buy holiday insurance to cover themselves against injury. Yet it is the NHS that ends up footing the bill for any reconstructive surgery and rehabilitation. We propose that if the insurance companies maintained responsibility for their clients’ injuries until a full recovery had been made, the NHS would save millions of pounds.

Purpose:- to examine changing demographics in ACL Injury

Methods:- the data from a cohort of 117 consecutive patients with ACL injury from a study performed in 1994 was compared with the data from a cohort of 103 consecutive patients with ACL injury collected in 1994/95.

Results:- In 1994, 12% of the patients were female, in 2004 25%.

In 1994, 62% of the injuries were sustained during soccer and rugby, in 2004 58%. In 1994, 9% of injuries were sustained during skiing, in 2004 28% – a 300% increase.

In 1994 the average age was 26.5, in 2004 33. When this increase was examined in detail the average age of the skiers was 41, the soccer players 31 and the rugby players 27.

Clearly there has been a change in the demographics of ACL injury which may have a significant impact in providing NHS services for the ACL injured patient in the UK.

Purpose: The aim of the study was to evaluate whether the recognition rates of ACL injuries had improved in the decade following the original paper published by the senior author.

Methods: Prospective data collection using a standard questionnaire on all patients presenting to a dedicated soft tissue knee injury clinic. There were 103 patients with a median age of 31.

Results: 94 out of the 103 patients gave a typical history of an ACL injury. The mean time to referral to this specialist clinic was 92 weeks. The commonest mechanism of ACL injuries was sports (88/103), with soccer making up the vast majority. The correct diagnosis was made by 13% of A& E staff, 30% of GPs and 57% of Orthopaedic surgeons.

Of the 11 patients who had an arthroscopy, 4 were told that they had an ACL injury. None of the 15 who had an MRI scan were told that they had an ACL injury.

Conclusion: Despite the increasing incidence and changes in management, there appears to have been very little improvement in the detection of the ACL injured knee in the last 10 years.

We present a series of four patients with what we have termed the snapping pes syndrome. This is a painful clicking and catching experienced at the posteromedial corner of the knee when moving from flexion to extension. Clinical examination and real time ultrasound are the most useful diagnostic tools. If medical treatment is unsuccessful surgical excision of both the semitendinous and gracilis tendons is indicated for relief of persistent symptoms.