Derby technique for posterolateral corner (PLC) reconstruction uses a doubled gracilis autograft to reconstruct the popliteo-fibular ligament (PFL) and a split biceps tendon transfer to reconstruct the lateral collateral ligament (LCL). We report midterm outcomes of a case series who underwent PLC reconstruction. A retrospective review of 27 patients who underwent PLC reconstruction from 2012 until 2018 was performed (6 females, 21 males, median age 26). Median time interval from injury to primary procedure was 10 months. Outcomes were recorded as per clinical assessment and outcome scores.Abstract
Introduction
Methodology
Alignment and soft tissue (ligament) balance are two variables that are under the control of a surgeon during replacement arthroplasty of the knee. Mobile bearing medial unicompartmental knee replacements have traditionally advocated sizing the prosthesis based on soft tissue balance while accepting the natural alignment of the knee, while fixed bearing prosthesis have tended to correct alignment to a pre planned value, while meticulously avoiding overcorrection. The dynamic loading parameters like peak adduction moment (PKAM) and angular adduction Impulse (Add Imp) have been studied extensively as proxies for medial compartment loading. In this investigation we tried to answer the question whether correcting static alignment, which is the only alignment variable under the control of the surgeon actually translates into improvement in dynamic loading during gait. We investigated the effect of correction of static alignment parameter Hip Knee Ankle (HKA) angle and dynamic alignment parameter in coronal plane, Mean Adduction angle (MAA) on 1st Peak Knee Adduction Moment (PKAM) and Angular Adduction Impulse (Add Imp) following medial unicompartmental knee replacements. Twenty four knees (20 patients) underwent instrumented gait analysis (BTS Milan, 12 cameras and single Kistler force platform measuring at 100 Hz) before and after medial uni compartmental knee replacement. The alignment was measured using long leg alignment views, to assess Hip Knee Ankle (HKA) angle. Coronal plane kinetics namely 1st Peak Knee Adduction Moment (PKAM) and angular adduction impulse (Add Imp)- which is the moment time integral of the adduction moment curve were calculated to assess medial compartment loading. Single and multiple regression analyses were done to assess the effect of static alignment parameters (HKA angle) and dynamic coronal plane alignment parameters (Mean Adduction Angle – MAA) on PKAM and Add Imp.Background
Methods
Septic Arthritis is an important life threatening condition affecting all age groups with a mortality of up to 11%. Our aim was to perform a study of the demographics, length of stay, complications and investigate if time delay of surgical treatment from the time of diagnosis has an impact on mortality and morbidity of the patients. We performed a retrospective study of all the patients presented to our Hospital between 2005 and 2009 with septic arthritis who underwent arthroscopic lavage as definitive intervention. We excluded the patients involving minor joints. Data collection was performed from case notes, microbiology and haematology laboratory results. We divided the patients into three groups based on the time from diagnosis to arthroscopic lavage as T1 (less than 12 hours), T2 (12–24 hours) and T3 (more than 24 hours). Our primary outcome measures were mortality and complications such as Intensive Care Admission. Secondary outcome measures included average length of stay in each group. A total of 57 patients were evaluated. The average age of the patients was 49.7 (10 months–94 years). 2 patients of T1 group died (5.4%) 3 patients of T1 group needed Intensive Care Unit (ICU) management (8.1%). There were no deaths or ICU admissions in the other groups. 40.3% of patients needed arthroscopic lavage more than once. The average length of stay of T1 was 19.8 days, T2–11.5 days and T3–27.5 days. Majority of the joints involved were knees (63.1%).23 patients (40.3%) had a preceding intervention performed in the same joint. Staphyloccus aureus was the most common organism isolated in 14 patients (26.3%).Methods
Results
The aim of this study was to evaluate the functional and clinical outcome following medial patello-femoral ligament reconstruction using autogenous hamstring tendon grafts for patellar instability. Over a 4 year period the senior author operated on 35 patients for lateral instability of the patella. The predominant initiating event was a sporting injury. Each patient had either failed conservative management including physiotherapy, or failed surgical management including tibial tuberosity transfer. Post-operatively, all patients were allowed full flexion and extension. Sporting activity was restricted until 4-6 months post-operatively. Patients were evaluated clinically and functionally. The Fulkerson score was utilised pre- and post-operatively. The minimum follow-up was 6 months, the mean follow-up was 20 months. There were 18 males and 17 females. The mean age was 24.6 years. The mean pre-operative Fulkerson score was 59.3 (range 6-100). The mean post-operative Fulkerson score was 83.6 (range 25-100), the mean improvement was 24.3. 24 patients returned to sporting activities. The main complications were one patient with a patella fracture that was stabilised with internal fixation, one patient requiring exploration and reinforcing the ligament which had attenuated. Both patients finally had a good clinical outcome. Our study has shown that symptomatic lateral instability of the patella can be effectively treated with a medial patello-femoral ligament reconstruction and result in overall good clinical and functional outcome. We would recommend this technique.
The aim of this study was to evaluate the functional and clinical outcome following medial patello-femoral ligament reconstruction using autogenous hamstring tendon grafts for patellar instability. Over a 4 year period the senior author operated on 35 patients for lateral instability of the patella. The predominant initiating event was a sporting injury. Patients were evaluated clinically and functionally. The Fulkerson score was utilised pre and post operatively. The minimum follow up was 6 months, the mean follow up was 20 months. There were 18 males and 17 females. The mean age was 24.6 years. The mean pre-operative Fulkerson score was 59.3(range 6–100). The mean post operative Fulkerson score was 83.6(range 25–100), the mean improvement was 24.3. 24 patients returned to sporting activities The main complications was one patient with a patella fracture that was stabilised with internal fixation, one patient requiring exploration and reinforcing the ligament which had attenuated. Both patients finally had a good clinical outcome. Our study has shown that symptomatic lateral instability of the patella can be effectively treated with a medial patello-femoral ligament reconstruction and result in overall good clinical and functional outcome. We would recommend this technique
Most obstetric brachial plexus palsies are due to rupture of the upper roots in babies whose delivery was complicated by shoulder dystocia. If treated by early exploration and grafting, they have a favourable prognosis. We reviewed 36 babies who had had an obstetric brachial plexus palsy after a breech delivery and found that they had a different pattern of injury; 81% had avulsion of the upper roots. This injury cannot be treated satisfactorily by exploration and microsurgical grafting and carries a considerably worse prognosis for shoulder function.
