Range of motion, degree of hemarthrosis and leg circumference was prospectively recorded in one hundred and eighteen consecutive isolated ACL reconstructions. A higher grade of hemarthrosis at one week was associated with a flexion deficit at eight weeks (P=0.002, relative risk 1.93). Increased leg circumference at one week was also associated with a flexion deficit at eight weeks (P=0.007, relative risk 1.37). An extension deficit was not associated with a hemarthrosis (P=0.47) or increased circumference (P=0.07). This prospective review identifies a risk factor for clinicians to be aware of after ACL Reconstruction. These patients merit closer observation and possibly a modified rehabilitation protocol.

To determine if increased swelling in the early post operative period is predictive of difficulty in regaining full range of motion after ACL reconstruction.

Increased swelling, at one-week post op (presence of a large hemarthrosis or a measured circumference greater than 1.5cm more than the control limb) is associated with flexion loss at eight weeks post surgery. These patients merit closer observation and possibly a modified rehabilitation protocol.

Patients with a higher grade of hemarthrosis at one week were more likely to have a flexion deficit at eight weeks (P=0.002, relative risk 1.93). Increased circumference was also associated with a flexion deficit at eight weeks (P=0.007, relative risk 1.37). The presence of a large hemarthrosis was not associated with an extension deficit at (P=0.47) although there was a trend for increased circumference to be associated with extension deficit (P=0.07).

One hundred and eighteen consecutive patients were prospectively assessed post ACL reconstruction. Range of motion was measured by goniometer at week one, four and eight. A deficit greater than 10° of flexion or 5° of extension (compared to normal leg) at the eight-week mark was defined as significant. The grade of hemarthrosis and circumference of the leg at the level of the patella were recorded at the same intervals. All patients underwent endoscopic, primary, ACL reconstruction with a standardized post op physio protocol. Exclusion criteria included previous surgery on either knee, significant effusion at the time of surgery or associated ligament injuries.

This paper outlines a valid and reliable, clinical method of assessing the amount of deformity in the congenital clubfoot. Clinical & MRI clubfoot scoring systems were developed to score the amount of deformity clinically & to image & score osteochondral pathology of the club-foot -MRI Total Score (MTS), MRI Hindfoot Contracture Score (MHCS), & MRI Midfoot Contracture Score (MMCS), Clinical Total Score (CTS), Clinical Hindfoot Contracture Score (CHCS), Clinical Midfoot Contracture Score (CMCS). Three independent observers tested the Clinical scoring systems Inter-observer reliability (Kappa Statistic) over one hundred consecutive clubfeet. Kappa values were CTS-0.92, CMCS-0.91, and CHCS-0.86- (almost perfect inter-observer reliability). Nineteen clubfeet were scored clinically and by thirty-eight MRI evaluations during treatment. Validity was evaluated by correlating the MRI and clinical scores (Pearson Correlation). The Pearson Correlations between clinical & MRI scores were CTS: MTS = 0.786 (P< 0.01), CHCS: MHCS = 0.712 (P< 0.01) & CMCS: MMCS = 0.651 (P< 0.01). All correlations were highly significant confirming validity.

There is neither reliability nor validity in current methods of clubfoot assessment. This paper outlines a method of assessing the amount of deformity in the congenital clubfoot deformity using six well-described simple clinical signs that has been tested & found to be both valid and reliable. A clinical clubfoot scoring system was created- Clinical Total Score (CTS)- comprised of a Clinical Hind-foot Contracture Score (CHCS) & a Clinical Midfoot Contracture Score (CMCS). One hundred consecutive congenital clubfeet were scored for clinical deformity each week during cast treatment by three independent observers. Inter-observer reliability (Kappa Statistic) of this clinical scoring system was evaluated. A clubfoot MRI protocol & scoring system were developed to visualise & score osteochondral pathology of the clubfoot -MRI Total Score (MTS)- comprised of a MRI Hindfoot Contracture Score (MHCS) and a MRI Midfoot Contracture Score (MMCS). Nineteen clubfeet were scored clinically and by thirty-eight MRI evaluations during treatment. All MRI films were scored for amount of osteochondral pathology. Validity of this clinical scoring system was evaluated by correlating the MRI and clinical scores (Pearson Correlation).

The Kappa values for inter-observer reliability were CTS-0.92, CMCS-0.91, and CHCS-0.86. All scores showed almost perfect inter-observer reliability. The Pearson Correlations between clinical & MRI scores were CTS: MTS = 0.786 (P< 0.01), CHCS: MHCS = 0.712 (P< 0.01) & CMCS: MMCS = 0.651 (P< 0.01). All correlations were highly significant confirming validity of the clinical scores.

We have developed a clinical scoring system for club-feet that is reliable and valid.

Introduction and Aims: A variety of factors have been associated with difficulty in regaining normal knee motion following anterior cruciate ligament surgery. The purpose of this study was to determine if increased swelling in the early post-operative period is predictive of difficulty in regaining full range of motion after ACL reconstruction.

Method: 118 consecutive patients were prospectively assessed post-ACL reconstruction. Range of motion was measured by goniometer at week one, four and eight. A deficit greater than 10 degrees of flexion or five degrees of extension (compared to normal leg) at the eight-week mark were defined as significant. The grade of hemarthrosis and circumference of the leg at the level of the patella were recorded at the same intervals. All patients underwent endoscopic, primary, ACL reconstruction with a standardised post-op physio protocol. Exclusion criteria included previous surgery on either knee, significant effusion at the time of surgery or associated ligament injuries.

Results: Patients with a higher grade of hemarthrosis at one week were more likely to have a flexion deficit at eight weeks (P=0.002, relative risk 1.93). Increased circumference was also associated with a flexion deficit at eight weeks (P=0.007, relative risk 1.37). The presence of a large hemarthrosis was not associated with an extension deficit at (P=0.47), although there was a trend for increased circumference to be associated with extension deficit (P=0.07). The patients that had difficulty in regaining full range of motion were similar to the rest of the cohort with regards to patient age, sex, time to surgery, graft type, incidence and treatment of meniscal pathology.

Conclusions: Increased swelling, at one-week post-op (presence of a large hemarthrosis or a measured circumference greater than 1.5cm more than the control limb) is associated with flexion loss at eight weeks post-surgery. These patients merit closer observation and possibly a modified rehabilitation protocol.