Aims

We aimed to determine hip-related quality of life and clinical findings following treatment for neonatal hip instability (NHI) compared with age- and sex-matched controls. We hypothesized that NHI would predispose to hip discomfort in long-term follow-up.

We prospectively assessed the diagnostic accuracy of the gravity stress test and clinical findings to evaluate the stability of the ankle mortise in patients with supination–external rotation-type fractures of the lateral malleolus without widening of the medial clear space. The cohort included 79 patients with a mean age of 44 years (16 to 82). Two surgeons assessed medial tenderness, swelling and ecchymosis and performed the external rotation (ER) stress test (a reference standard). A diagnostic radiographer performed the gravity stress test.

For the gravity stress test, the positive likelihood ratio (LR) was 5.80 with a 95% confidence interval (CI) of 2.75 to 12.27, and the negative LR was 0.15 (95% CI 0.07 to 0.35), suggesting a moderate change from the pre-test probability. Medial tenderness, both alone and in combination with swelling and/or ecchymosis, indicated a small change (positive LR, 2.74 to 3.25; negative LR, 0.38 to 0.47), whereas swelling and ecchymosis indicated only minimal changes (positive LR, 1.41 to 1.65; negative LR, 0.38 to 0.47).

In conclusion, when gravity stress test results are in agreement with clinical findings, the result is likely to predict stability of the ankle mortise with an accuracy equivalent to ER stress test results. When clinical examination suggests a medial-side injury, however, the gravity stress test may give a false negative result.

Cite this article: Bone Joint J 2015; 97-B:1126–31.

Previous studies from single centres or single-surgeon series report good early and mid-term results for high tibial osteotomy (HTO) in the treatment of osteoarthritis of the knee. However, the survivorship of HTO at a national level is unknown. This registry-based study included 3195 high HTOs performed between 1987 and 2008. Kaplan-Meier analysis revealed an overall survivorship of 89% (95% confidence interval (CI) 88 to 90) at five years and 73% (95% CI 72 to 75) at ten years, when conversion to total knee replacement was taken as the endpoint. Females and patients aged > 50 years had worse survivorship than males or patients aged ≤ 50 years (hazard ratio (HR) 1.26 (95% CI 1.11 to 1.43) and HR 1.41 (95% CI 1.23 to 1.64), respectively). The survivorship of HTOs performed between 1998 to 2008 was worse than for those performed between 1987 and 1997.

Background: The aim of our prospective, randomized study was to compare two operative techniques for the treatment of acute Achilles tendon rupture and question the necessity of augmented repair. Null hypothesis: Augmentation with a down-turned gastrocnemius fascia flap does not give any better result than end-to-end suturation by the Krackow locking loop surgical technique.

Study Design: A prospective, randomized clinical trial.

Methods: Sixty patients with acute Achilles tendon rupture were randomized preoperatively to receive end-to-end suturation by the Krackow locking loop technique either without augmentation (Group I) or with one down-turned gastrocnemius fascia flap, as described by Silfverskiöld (Group II). A dorsal brace allowed free active plantar flexion of the ankle postoperatively, whereas dorsiflexion was restricted to neutral for the first three weeks. Weight bearing was limited for six weeks. The follow-up period was one year, and evaluation was performed in terms of clinical measurements, an outcome score, isokinetic calf muscle performance tests and tendon elongation measurements.

Results: The mean operation time was 25 minutes longer in the augmentation group and the incision 7 cm longer (p< 0.001 both). The overall ankle scores were excellent in 70% of cases and good in 30% in both groups. The isokinetic calf muscle strength scores were excellent in 41% of cases, good in 52%, and fair in 7% in group I, whereas those in the group II were excellent in 45% of cases, good in 35%, fair in 15% and poor in 5%. Achilles tendon elongation occurred in both groups and elongation correlated significantly with previous AT problems (ρ= 0.47, p=0.040), isokinetic peak torque deficits (ρ= 0.64, p=0.001) and isometric strength deficits (ρ= 0.48, p=0.026) in the nonaugmentation group. No significant differences were seen between the two groups at the 3-month and 12-month check-ups with regard to pain, stiffness, subjective calf muscle weakness, footwear restrictions, range of ankle motion, overall outcome, iso-kinetic calf muscle strength, mean peak work-displacement relationships or tendon elongation. Six re-ruptures (three in each group) and two deep infections in group II were regarded as treatment failures and were excluded. The final results in all the rerupture cases were good.

Conclusions: Routine use of augmentation does not seem to be necessary in surgery for fresh total Achilles tendon ruptures.