Aim: The aim of this study was to assess the role of Hip Arthroscopy in the patient with a symptomatic Resurfacing arthroplasty of the hip.

Patients and Methods: Twelve consecutive patients who presented to our clinic with a painful resurfacing and indeterminate or normal investigations underwent an arthroscopy of their resurfacing were prospectively enrolled into the study following appropriate consent. The pre-operative investigations included haematological indices and acute phase reactants to rule out infection along with plain radiographs and an isotope bone scan.

Results: (table deleted)

Conclusions: Assessment of a symptomatic resurfacing is usually difficult and becomes more challenging in the background of normal or indeterminate investigations. However, in this situation, we found that in experienced hands, hip arthroscopy can be utilised as an effective tool for aiding diagnosis and offering therapeutic interventions in these patients.

Aim: The aim of this study was to study the course of the infra-patellar branch of the saphenous nerve (IPBSN) and describe its anatomical variations and relations.

Materials and Methods: Twenty-eight formalin-fixed cadaver lower extremity specimens were methodically dissected in the University Department of Anatomy. Dissection included identifying the saphenous nerve and tracing it distally till it pierced the deep fascia between the tendons of gracilis and sartorius. At this point, the saphenous nerve gave a branch that pierced the sartorius and became subcutaneous, known as the infrapatellar branch. The association of the nerve trunk with the sartorius muscle in terms of whether it originated above it, below it or pierced through it was studied. Following this the nerve was dissected along its course distally to the point of its termination where it gave one to three branches. The relationship of the point of termination of the IPBSN with bony surface landmarks like the medial border of the patella, the apex of the patella and the tibial tuberosity were also studied. The distance of the trunk from medial margin of patella was measured.

Conclusions: The anatomy of the IPBSN along with its branches is quite variable and a thorough knowledge of the same is essential to any knee surgeon to avoid injury to this structure.

Radiological measurements are an essential component of the assessment of outcome following knee arthroplasty. However, plain radiographic techniques can be associated with significant projectional errors because they are a two-dimensional (2D) representation of a three-dimensional (3D) structure. Angles that are considered within the target zone on one film may be outside that zone on other films. Moreover, these parameters can be subject to significant inter-observer differences when measured. The aim of our study therefore was to quantify the variability between observers evaluating plain radiographs following Unicompartmental knee arthroplasty.

Twenty-three observers, made up of Orthopaedic Consultants and trainees, were asked to measure the coronal and sagittal alignment of the tibial and femoral components from the post-operative long-leg plain radiograph of a Unicompartmental knee arthroplasty. A post-operative CT scan using the low dose Imperial knee protocol was obtained as well and analysed with 3D reconstruction software to measure the true values of these parameters. The accuracy and spread of the pain radiographic measurements were then compared with the values obtained on the CT.

On the femoral side, the mean angle in coronal alignment was 1.5° varus (Range 3.8, SD 1, min 0.1, max 3.9), whereas the mean angle in sagittal alignment was 8.6° of flexion (Range 7.5, SD 1.5, Min 3.7, Max 11.2). The true values measured with CT were 2.4° and 11.0° respectively. As for the tibial component, the mean coronal alignment angle was 89.7° (Range 11.6, SD 3.3, Min 83.8, Max 95.4), and the mean posterior slope was 2.4° (Range 8.7, SD 1.6, Min -2, Max 6.7). The CT values for these were 87.6° and 2.7° respectively.

We conclude that the plain radiographic measurements had a large scatter evidenced by the wide ranges in the values obtained by the different observers. If only the means are compared, the plain radiographic values were comparable with the true values obtained with CT (that is; accuracy was good) with differences ranging from 0.3° to 2.4°. The lack of precision can be avoided with the use of CT, particularly with the advent of low-dose scanning protocols.

Background: Arthroscopic visualisation of the postero-medial and posterolateral compartments of the knee through the intercondylar notch using the anterolateral and anteromedial portals respectively is not commonly practiced. The purpose of this study was to prospectively evaluate whether these views are useful either diagnostically, therapeutically or both in a routine knee arthroscopy.

Patients and Methods: It is a prospective study of two hundred consecutive patients who underwent a routine knee arthroscopy in our unit using the standard portals following an appropriate clinical and radiological evaluation. Posteromedial and posterolateral compartment visualisation through the intercondylar notch was undertaken in all the patients. An evaluation of the ease of the technique, the usefulness of visualisation and the morbidity associated with the procedure were recorded.

Results: The technique was deemed simple to perform in 91% of the patients. It was found to be more difficult in knees with degenerative joint disease. Posteromedial and posterolateral compartment visualisation was found to be useful for diagnosis or treatment in 15% and 6% of the diagnosed conditions respectively. The technique was most useful for tears of the posterior horn of the medial meniscus, most of which were not detected by visualisation from the anteromedial compartment alone. Visualisation of the compartments was deemed adequate in 98% of the patients. There was no morbidity associated with this procedure.

Conclusion: We believe that visualisation of the pos-teromedial and posterolateral compartment in a routine knee arthroscopy is beneficial; and an easy and safe procedure to perform.

Aim: The aim of this study was to determine if a correlation exists between the impingement test and the arthroscopic findings at the acetabular rim in non-dysplastic hips. Secondarily, we also wanted to establish if there was a correlation between the pain experienced on the impingement test and the pathology identified.

Patients and Methods: Sixty-two consecutive patients who were due to have an arthroscopy of the hip in our unit were prospectively recruited into the study. All the dysplastic hips were excluded from the study. One observer was involved in examining all the patients and another one in performing all the arthroscopies. The impingement test was considered positive if at 90 degrees of flexion, adduction and internal rotation, the patient complained of discomfort or pain. If the patient experienced pain this was described as a strongly positive test and if there was discomfort experienced it was considered as a weakly positive test. The test was performed on the morning of the arthroscopy and all the intra-articular findings recorded at arthroscopy. A tear of the acetabular labrum and chondral damage in the antero-superior margin of the acetabulum were considered as positive pathology at the acetabular rim.

Results : There were 40 males and 22 females in the study group. The impingement test was positive in 57 patients, strongly positive in 42 and weakly positive in 15. The arthroscopy revealed positive pathology in terms of an acetabular labrum tear and/or chondral damage at the acetabular rim in 55 patients. A negative test was recorded in 5 patients but there was positive rim pathology in two of these 5 patients.

Conclusion: The impingement test correlates positively with the pathology at the acetabular rim; the sensitivity of the test for diagnosing acetabular rim pathology is 96.4 % and the specificity is only 60 % in non-dysplastic hips. However, we did not identify any correlation between the level of pain and the pathology observed.

Objective: The aim of this study was to assess the results of combined arthroscopically assisted posterior cruciate ligament reconstruction and open reconstruction of the posterolateral corner in patients with chronic (3 months or more) symptomatic instability and pain.

Patients & Methods: A retrospective analysis of all the patients who had a combined reconstruction of the posterior cruciate ligament and the posterolateral corner between 1996 and 2003 was carried out. Nineteen patients who had the combined reconstruction were identified from the database. All the patients were assessed pre and post-operatively by physical examination and three different ligament rating scores. All the patients also had weight bearing radiographs, MRI scans and an examination under anaesthesia and arthroscopy pre-operatively. The PCL reconstruction was performed using an arthroscopically assisted single anterolateral bundle technique and the posterolateral corner structures were reconstructed using an open Larson type of tenodesis.

Results: Pre-operatively all the patients had a grade III posterior sag and demonstrated more than 20 degrees of external rotation as compared to the opposite normal knee on the Dial test. The average follow up was 66.8 months (range 24–108). Post-operatively 7 patients had no residual posterior sag, 11 patients had a grade I posterior sag and 1 patient had a grade II posterior sag. Five of the 19 patients demonstrated minimal residual posterolateral laxity. The Lysholm score improved from a mean of 41.2 to 76.5 (P=0.0001) and the Tegner score from a mean of 2.6 to 6.4 (p=0.0001).

Conclusions: We conclude that while a combined reconstruction of chronic posterior cruciate ligament and pos-terolateral corner instability does not restore complete anatomical stability, improvement in symptoms and function demonstrate its value in these difficult injuries.

Objective: To determine whether patient information leaflets improve patient recall during the process of informed consent.

Design: Prospective randomised controlled trial which compared a group of patients who were posted a patient information leaflet with those given verbal consent only.

Setting: Orthopaedic Unit of a District General Hospital

Patients: 110 patients were selected, of which 57 were randomly allocated to receive patient information leaflets through the post and 53 were given verbal consent only.

Outcome Measure: The recall of information given to the patient. This was tested using a questionnaire on admission. Each patient was allocated a score out of ten.

Results: There was a significant difference between the group who received patient information leaflets compared to those who did not (P< 0.0001, CI 2.0 to 3.1).

Conclusion: Patient information leaflets are a useful tool for the surgeon to improve the recall of the information given to the patient, in order to facilitate informed consent.

Objective: To determine whether patient information leaflets improve patient recall during the process of informed consent.

Design: Prospective randomised controlled trial which compared a group of patients who were posted a patient information leaflet with those given verbal consent only.

Setting: Orthopaedic Unit of a District General Hospital

Patients: 110 patients were selected, of which 57 were randomly allocated to receive patient information leaflets through the post and 53 were given verbal consent only.

Outcome Measure: The recall of information given to the patient. This was tested using a questionnaire on admission. Each patient was allocated a score out of ten.

Results: There was a significant difference between the group who received patient information leaflets compared to those who did not (P< 0.0001, CI 2.0 to 3.1).

Conclusion: Patient information leaflets are a useful tool for the surgeon to improve the recall of the information given to the patient, in order to facilitate informed consent.

This study investigates the efficacy of the AO Pi-plate in the treatment of complex, unstable, intra-articular fractures of the distal radius.

A retrospective study of 17 patients was carried out who underwent open reduction and internal fixation for dorsally displaced, intra-articular fractures of the distal radius using the AO Pi-plate. All patients were assessed clinically and radiologically post-operatively. The final functional outcome was assessed using the Gartland & Werley scoring system.

The average follow-up period was 34.3 months. 94% (16 patients) of the fractures were classified as AO type C fractures. The wrist movement was restored to a near normal range in all cases. The mean grip strength was 67% of the uninjured hand. The functional outcome as measured by the Gartland & Werley scoring system showed excellent and good results in 88% of the patients. Radiographic assessment revealed an average articular step-off of 0mm post-operatively. The implant removal rate was 29% (5 patients) and the main reason for that was extensor tenosynovitis.

Conclusion: Our study demonstrates that although the functional outcome after using the Pi-plate for complex distal radius fractures is good, there is a significant incidence of extensor tenosynovitis. We recommend that the implant is best used for Type C fractures and be removed electively after fracture union.

Complex regional pain syndrome is characterised by an exaggerated response to injury in a limb with intense prolonged pain, vasomotor disturbance, delayed functional recovery and trophic changes. This review describes the current knowledge of the condition and outlines the methods of treatment available with particular emphasis on the knee.

This review describes the development of arthroscopy of the hip over the past 15 years with reference to patient assessment and selection, the technique, the conditions for which it is likely to prove useful, the contraindications and complications related to the procedure and, finally, to discuss possible developments in the future.

We report a retrospective analysis of the results of combined arthroscopically-assisted posterior cruciate ligament reconstruction and open reconstruction of the posterolateral corner in 19 patients with chronic (three or more months) symptomatic instability and pain in the knee.

All the operations were performed between 1996 and 2003 and all the patients were assessed pre- and post-operatively by physical examination and by applying three different ligament rating scores. All also had weight-bearing radiographs, MR scans and an examination under anaesthesia and arthroscopy pre-operatively. The posterior cruciate ligament reconstruction was performed using an arthroscopically-assisted single anterolateral bundle technique and the posterolateral corner structures were reconstructed using an open Larson type of tenodesis.

The mean follow up was 66.8 months (24 to 110). Pre-operatively, all the patients had a grade III posterior sag according to Clancy and demonstrated more than 20° of external rotation compared with the opposite normal knee on the Dial test. Post-operatively, seven patients (37%) had no residual posterior sag, 11 (58%) had a grade I posterior sag and one (5%) had a grade II posterior sag. In five patients (26%) there was persistent minimal posterolateral laxity. The Lysholm score improved from a mean of 41.2 (28 to 53) to 76.5 (57 to 100) (p = 0.0001) and the Tegner score from a mean of 2.6 (1 to 4) to 6.4 (4 to 9) (p = 0.0001).

We conclude that while a combined reconstruction of chronic posterior cruciate ligament and posterolateral corner instability improves the function of the knee, it does not restore complete stability.

The aim of this study was to assess whether a femoral component which retained the neck reduced the incidence of leg-length inequality following total hip arthroplasty. A retrospective review was undertaken of 130 consecutive primary total hip arthroplasties performed between April 1996 and April 2004 using such an implant. There were 102 suitable patients for the study. Standardised pre- and post-operative pelvic radiographs were measured by an independent investigator to the nearest millimetre.

The leg-length inequality was reduced from a mean pre-operative value of −0.71 cm to a mean of 0.11 cm post-operatively. Of the 102 patients 24 (23.5%) had an equal leg-length post-operatively, and 95 (93.1%) had a leg-length inequality between −1 cm and 1 cm.

Introduction and Aims: The purpose of our study was to assess the efficacy of double osteotomy of the radius and ulna for correction of Madelung’s deformity. Made-lung’s deformity is a congenital alteration of the growth of the ulnar portion of the distal radius resulting in pain, decreased function of the wrist and hand and serious aesthetic disturbances.

Method: Four wrists in four patients with a mean age of 18.3 years were treated for symptomatic increased ulnar and volar inclination of the distal articular surface of the radius. All patients complained of wrist pain. In addition, two of them were dissatisfied with the aesthetic appearance of their wrist and the restricted range of movement. A double osteotomy of the radius and ulna was performed. The ulna was stabilised with a six-hole semi-tubular plate and the radius with a titanium T-plate.

Results: At one-year follow-up: pain relief and cosmetic appearance were satisfactory in all patients. Grip strength improved by 5.3 pounds. Average flexion improved from 63 to 67 degrees and pronation from 59 to 66 degrees. Abduction increased from three to six degrees and adduction from 16 to 21 degrees. Realignment of the wrist was shown radiographically by a change of ulnar inclination and volar inclination of the radius from 35.5 to 24 degrees and 15.5 to 10.5 degrees respectively. There was no evidence of recurrence of the deformity in any of the four wrists.

Conclusion: The initial results with the double osteotomy of the radius and ulna for Madelung’s deformity are promising but need longer follow-up.