Our aim was to examine the potential of autologous perichondral tissue to form a meniscal replacement. In 18 mature sheep we performed a complete medial meniscectomy. The animals were then divided into two groups: 12 had a meniscal replacement using strips of autologous perichondral tissue explanted from the lower rib (group G) and six (group C) served as a control group without a meniscal replacement. In all animals restriction from weight-bearing was achieved by means of transection and partial resection of tendo Achillis. Six animals (four from group G and two from group C) were each killed at 3, 6 and 12 months. The grafts and the underlying articular cartilage were removed and studied by gross macroscopic examination, light microscopy, SEM, polarised light examination, and by biomechanical tests. In all the transplanted animals a new perichondral meniscus developed. After three months the transplants resembled normal menisci in size and thickness, while in the control animals only small rims of spontaneously grown tissue were seen. Microscopically, the perichondral menisci showed a normal orientation of collagen fibres and normal cellular characteristics, but in the central region, areas of calcification disturbed the regular tissue differentiation. Healing tissue in control animals lacked the normal fibre orientation and cellularity. SEM of perichondral menisci showed surface characteristics similar to those of normal sheep menisci without fissures and lacerations; the control specimens had these defects. The femoral and tibial cartilage in contact with the new menisci had normal surface characteristics apart from one animal with slight surface irregularities. Control animals showed superficial lesions after three months which increased at six to 12 months postoperatively. Microangiography of the newly grown tissue demonstrated a less intense vascularisation after three months when compared with normal menisci. The failure stress and tensile modulus of perichondral menisci were significantly lower than those of normal contralateral menisci, and spontaneously regenerated tissue in meniscectomised animals had even lower values. There were no significant differences in values between newly grown perichondral menisci and spontaneously grown tissue

Aims

The aims of this study were to compare the mid-term outcomes of patients with late-stage arthritis of the wrist treated with proximal row carpectomy (PRC) and dorsal capsular interposition (DCI) arthroplasty with a matched cohort treated with routine PRC alone.

Aims

The aim of this study was to investigate the long-term clinical and radiological outcome of patients who suffer recurrent injuries to the anterior cruciate ligament (ACL) after reconstruction and require revision surgery.

Objectives

Pulsed electromagnetic field (PEMF) stimulation was evaluated after anterior cervical discectomy and fusion (ACDF) procedures in a randomized, controlled clinical study performed for United States Food and Drug Administration (FDA) approval. PEMF significantly increased fusion rates at six months, but 12-month fusion outcomes for subjects at elevated risk for pseudoarthrosis were not thoroughly reported. The objective of the current study was to evaluate the effect of PEMF treatment on subjects at increased risk for pseudoarthrosis after ACDF procedures.

Aims

Reconstruction of the acetabulum after resection of a periacetabular malignancy is technically challenging and many different techniques have been used with varying success. Our aim was to prepare a systematic review of the literature dealing with these techniques in order to clarify the management, the rate of complications and the outcomes.

Aims

The aim of this study was to examine the association between postoperative glycaemic variability and adverse outcomes following orthopaedic surgery.

Aims

The aim of this study was to determine how the short- and medium- to long-term outcome measures after total disc replacement (TDR) compare with those of anterior cervical discectomy and fusion (ACDF), using a systematic review and meta-analysis.

Aims

This study aimed to investigate the role of quantitative histological analysis in the diagnosis of fracture-related infection (FRI).

1. The antigenicity of homologous cortical and cancellous bone has been investigated in eighty-four rabbits. 2. The primary immune responses which occur in lymph nodes draining homografts of fresh tissues (Burwell and Gowland 1961, 1962) have been used as a histological indicator of the antigenicity of fresh homologous cortical bone freed from soft tissues. 3. The secondary immune responses which occur in lymph nodes draining homografts of fresh marrow-containing iliac bone (Burwell 1962a, b) have been used also as a histological indicator of the antigenicity of homografts of 1) fresh cortical bone freed from soft tissues, 2) fresh marrow-free iliac bone, and 3) mairow-containing iliac bone treated by boiling, freezi ng, freeze-drying and merthiolate solution. 4. It is found that whereas fresh homologous cortical bone fails usually to produce cytological evidence of a primary response in the regional lymph nodes, fresh homologous cortical bone chips inserted into the drainage areas of lymph nodes sensitised previously to donor ..tissue evoke constantly cytological evidence of a secondary response. 5. Fresh homologous marrow-free iliac bone inserted into the drainage areas of lymph nodes sensitised previously to donor tissue does not produce detectable evidence of a secondary response. 6. Homografts of boiled marrow-containing iliac bone do not elicit a secondary response in lymph nodes previously sensitised to donor tissue. 7. Previous work has shown that homografts of frozen (–20 degrees Centigrade) marrow-containing iliac bone do not evoke a primary response in lymph nodes draining such grafts. In the present work it is shown that similar frozen homografts inserted into the drainage areas of lymph nodes previously sensitised to donor tissue evoked a secondary response in three of six lymph nodes. 8. Homografts offreeze-dried marrow-containing iliac bone fail usually to evoke a secondary response in lymph nodes sensitised to donor tissue. 9. Homografts of marrow-containing iliac bone treated by immersion in merthiolate solution before being inserted into the drainage areas of lymph nodes previously sensitised to tissue from the donor elicited a secondary response in three of five lymph nodes. 10. Knowledge concerning the antigenicity offresh and treated homologous bone is discussed in the light of recent work

1. The results of repair of the sciatic nerve and of its main divisions have been analysed in a series of 118 cases, the patients having been under observation for three to eighteen years (average 11·7 years). 2. A result was satisfactory if there was some return of sensibility throughout the autonomous zone (the area of skin supplied exclusively by the damaged nerve) and if the more important muscles of the leg were capable of contraction against gravity and resistance. 3. When the whole of the sciatic nerve is damaged it is necessary to present the results separately for the lateral and medial popliteal divisions. 4. Of forty-seven cases of repair of the medial popliteal nerve 79 per cent showed useful motor and 62 per cent useful sensory recovery. In three out of four cases the correspondence between the degree of motor and of sensory recovery was fairly close. 5. Of seventy-two cases of repair of the lateral popliteal nerve 36 per cent showed useful motor and 74 per cent useful sensory recovery. The latter figure must be regarded with some reserve because sensory "recovery" in the lateral popliteal zone may be due to the ingrowth of nerve fibres from contiguous normally innervated skin. Thus it is not possible to correlate motor and sensory recovery. 6. In eighteen cases of repair of the posterior tibial nerve, there was useful sensory recovery in the sole in twelve. But although there was evidence of recovery in the plantar muscles in eleven cases it was functionally valueless. 7. In repair of the medial popliteal nerve the result was better if suture had been carried out early. In repair of the lateral popliteal nerve there was no evidence that delay was harmful; but the proportion of good results was so low (as judged by motor function alone, sensory recovery being often extraneous) that this exception to a general rule cannot be taken very seriously. 8. Gaps of up to twelve centimetres–estimated after resection of the damaged nerve ends–could be closed without difficulty by the usual technique, and the extent of the gap up to that limit had no influence on the prognosis. The closure of larger gaps, when the knee must be flexed beyond a right angle, is not compatible with good recovery because the post-operative stretching of the nerve causes serious intraneural damage. 9. Nerve grafting has given poor results in repair of the sciatic nerve

Aims

This study describes the use of the Masquelet technique to treat segmental tibial bone loss in 12 patients.

Aims

The management of a significant bony defect following excision of a diaphyseal atrophic femoral nonunion remains a challenge. We present the outcomes using a combined technique of acute femoral shortening, stabilized with a long retrograde intramedullary nail, accompanied by bifocal osteotomy compression and distraction osteogenesis with a temporary monolateral fixator.

Patellar instability most frequently presents during adolescence. Congenital and infantile dislocation of the patella is a distinct entity from adolescent instability and measurable abnormalities may be present at birth. In the normal patellofemoral joint an increase in quadriceps angle and patellar height are matched by an increase in trochlear depth as the joint matures. Adolescent instability may herald a lifelong condition leading to chronic disability and arthritis.

Restoring normal anatomy by trochleoplasty, tibial tubercle transfer or medial patellofemoral ligament (MPFL) reconstruction in the young adult prevents further instability. Although these techniques are proven in the young adult, they may cause growth arrest and deformity where the physis is open. A vigorous non-operative strategy may permit delay of surgery until growth is complete. Where non-operative treatment has failed a modified MPFL reconstruction may be performed to maintain stability until physeal closure permits anatomical reconstruction. If significant growth remains an extraosseous reconstruction of the MPFL may impart the lowest risk to the physis. If minor growth remains image intensifier guided placement of femoral intraosseous fixation may impart a small, but acceptable, risk to the physis.

This paper presents and discusses the literature relating to adolescent instability and provides a framework for management of these patients.

Cite this article: Bone Joint J 2017;99-B:159–70.

Non-traumatic osteonecrosis of the femoral head is a potentially devastating condition, the prevalence of which is increasing. Many joint-preserving forms of treatment, both medical and surgical, have been developed in an attempt to slow or reverse its progression, as it usually affects young patients.

However, it is important to evaluate the best evidence that is available for the many forms of treatment considering the variation in the demographics of the patients, the methodology and the outcomes in the studies that have been published, so that it can be used effectively.

The purpose of this review, therefore, was to provide an up-to-date, evidence-based guide to the management, both non-operative and operative, of non-traumatic osteonecrosis of the femoral head.

Cite this article: Bone Joint J 2017;99-B:1267–79.

1. This is a simple clinical study of the end-results of arthrodesis of the hip joint in patients followed up and re-examined five to twenty-five years after operation. 2. The study was stimulated by our astonishment at recent reports which suggested that arthrodesis of the hip caused serious operative mortality, a high rate of wound infection, and failure of sound fusion in one of every two cases; and that even when sound fusion was gained there was always pain in the back and usually stiffness of the knee. To say that we were astonished puts it mildly. 3. This review includes 120 patients aged from ten to seventy years, treated for osteoarthritis of the hip joint by intra-articular arthrodesis with the internal fixation of a nail, usually with an iliac graft, and with immobilisation in plaster for not less than four months. 4. Of these 120 patients there was sound fusion of the joint, proved radiographically, in 94 per cent; a mortality of nil; and recovery of free movement of the knee joint to the right angle or far beyond in 91·5 per cent. Almost half of the patients regained normal movement, the heel touching the buttock. Only in eight patients was there less than right-angled flexion. 5. There was no pain in the back—none whatever—in 64 per cent of the patients. In 36 per cent there was some pain or discomfort. One alone said that the low back pain was worse than before the operation. Many others said that pain in the back had been relieved by the operation. 6. It is emphasised that these results were gained only from sound fixation of the joint in the mid-position with neutral rotation, no more abduction than is needed to correct true shortening, and no more flexion of the joint than that with which the patient lies on the table. The limb was immobilised in plaster for at least four months after operation. The stiff knee was mobilised by the patient's own exercise without passive stretching, force or manipulation. 7. Two other groups of patients are considered. There are fourteen treated by fixation of the joint with nail alone, an operation that was never intended to arthrodese the joint and which has long since been abandoned. The other small group is that of patients with old unreduced traumatic dislocation of the hip, a procedure in which the risks of operation are so great and the number of successful results so small as to dissuade us from attempting operative reduction. 8. After successful arthrodesis of the hip joint patients can return to every household activity and every recreation including ski-ing, mountaineering, rock climbing, or whatever else they want

Aims

The aim of this study was to evaluate near-infrared spectroscopy (NIRS) as a continuous, non-invasive monitor for acute compartment syndrome (ACS).

Objectives

The objective of this study was to investigate the therapeutic effect of peripheral blood mononuclear cells (PBMNCs) treated with quality and quantity control culture (QQ-culture) to expand and fortify angiogenic cells on the acceleration of fracture healing.