Purposes of study

Evaluation of the pre-operative documentation of neurovascular status in children presenting with Gartland Grades 2 and 3 supracondylar fractures and the development of an Emergency Department Proforma.

Background

A large number of Tendo-Achilles (TA) injuries occur during sporting activity. Typically occurring in males aged 30–50, whom occasionally undertake sporting activities, the so called ‘weekend warriors’.

Purpose: To subjectively assess and present the outcome after ACL reconstruction with minimum follow-up of 24 months.

Methods: Our knee injury database was established in June 2001. Data were collected prospectively for all knee ligament reconstructions carried out by a single surgeon. The database has a prospectively studied consecutive series where all the patients surveyed completed the Lysholm, KOOS and IKDC 2000 questionnaires preoperatively and at 3, 6, 12 and 24 months postoperatively. Our knee injury database comprises of 163 patients who had ACL reconstruction in which Hamstrings were used in 120 cases and Bone Patella-Tendon Bone (BPTB) grafts in 43. This includes 27 complex reconstructions and 12 revisions (11 from other centres).

Results: Fifty-six of the 79 patients (70.8%) who were at least 2 years post ACL reconstruction attended for their 2 year review. Majority were male patients(90%) and both attendees and non- attendees were of a similar age (30.5 /30 respectively) and did not exhibit a statistically significant difference in their pre op or early post op scores. In the non-attendee group 2 were students, 1 emigrated, 1 registered as unemployed, 7 no employment status and 3 did not consent to such follow-up. The mechanism of injury was, 62 as sporting injury (24 contact/38 non-contact sport), 3 road traffic accidents and 8 activities of daily living and 2 not recorded. The mean scores were, IKDC – 77.14, Lysholm – 83.96 and KOOS symptom – 81.6.

Conclusions: All subjective evaluation questionnaires (KOOS, Lysholm and IKDC) revealed a progressive trend in our patients. We found that in the KOOS, a multidimensional patient completed aggregated score, the Quality of Life (QoL) dimension exhibited results which were interestingly not correlating with the other dimensions of the questionnaire, with patients who scored < 50% occupying manual or non-administrative positions at work

Aim: To study the effect intra-operative image guidance has on the position of both femoral and tibial tunnel placement in primary anterior cruciate ligament reconstruction surgery

Methods: Prospective study of 2 consecutive series of 10 patients undergoing ACL reconstruction surgery all operated on by the same surgeon (the senior author). In the first group intra-operative image guidance in the form of a standard image intensifier was used to guide the surgeon in the positioning of the tibial and femoral tunnels. In the second group no image guidance was used. The position of the femoral and tibial tunnels were assessed on AP and lateral radiographs post operatively and recorded. The two groups were compared.

Conclusion: There was no significant difference in the position of the femoral tunnel position between the 2 groups (p=0.23). There was no significant difference in the position of the tibial tunnel between the 2 groups, in either the AP (p=0.37) or lateral (p=> 0.5) plane. There appears to be no benefit to using an image intensifier to aid in tunnel preparation in ACL reconstruction surgery.

Introduction: Instrumented arthrometry is a widely used technique for the quantification of cruciate ligament laxity. It is used both before and after surgery. The Rolimeter(Aircast, Europe) is used in such scenarios. It has several advantages over its cousins; it is more compact, lighter, less expensive and amenable to sterilization techniques. The other leading arthrometers have however had over 15 years of clinical use and their reliability has been thoroughly assessed. Muellner et al found no significant difference in the intra-tester and inter-tester results obtained on Rolimeter assessment of the knees of un-injured healthy subjects. Our study assessed the inter-tester and intra-tester variability when the Rolimeter is applied to patients with unilateral ACL-deficient knees. It also examines whether the level of experience of the examiner influences the results in this group of patients.

Materials and Methods: Six examiners each examined thirty-three subjects on two occasions. One examiner was medically qualified but had never performed a Lachman or anterior drawer test. Two examiners were qualified physiotherapists who routinely examined knees, but had never used a Rolimeter. One medically qualified examiner was considered to be of intermediate experience.Two examiners were regarded as expert Rolimeter users.For each examination a Rolimeter reading was taken three times with the knee at 30 degrees of flexion and three times at 90 degrees of flexion for both knees.The interval between examinations was at least thirty minutes. All the readings were acquired on the same day. The examiners were blinded to whether the subject was known to be ACL deficient or not. The results of the examinations were entered onto a data-base.Repeated measures analysis of variance was used to test for the effects of the following factors, difference between examiners, reproduction of results between examinations.

Results: There was no significant difference between each set of measures for each subject between examinations (p=0.767), indicating that the measurement procedure was reliable. Measurements were significantly higher in patients with ACL-deficient knees compared to the control group (p< 0.001) confirming the sensitivity of the Rolimeter to help diagnose ACL-deficient knees. The in-experienced examiner’s measurements were lowest and were more reliable. The examiner with the intermediate experience was the most un-reliable. Both experienced examiners were in close agreement.

Conclusion: We have demonstrated that the rolimeter is reliable in the assesment of ACL deficient patients regardless of the experience of the examiner.