We have studied the mechanosensitive afferent units in the lateral ligament of the ankle of the cat, with reference to the causes of lateral instability after injury, using electrophysiological recording from the lumbar dorsal rootlets. We identified 30 mechanosensitive units in the lateral ligament; 28 (93%) were located near the attachment to the fibula and calcaneus, which included both low-threshold group-II units and low- and high-threshold group-III units. Our results indicate that there are both proprioceptors and nociceptors in the lateral ligament of the cat ankle, and confirm that afferent fibres from the lateral ligament may contribute to the stability of the joint by regulation of position and movement

We describe a technique for arthroscopy of the wrist which is carried out without traction and with the arm lying horizontally on the operating table. The wrist is not immobilised, which makes it possible to assess the extent of instability after a ligamentous tear. In a prospective study of 30 patients we compared this technique with conventional wrist arthroscopy, performing the new method first followed by conventional arthroscopy. The advantages are that the horizontal position of the arm allows the surgeon to proceed directly from arthroscopic diagnosis to treatment, and that no change of position is required for fluoroscopy. In terms of diagnostic sensitivity, we found our technique matched that of conventional arthroscopy. We had no difficulty in carrying out minor surgical procedures such as debridement and suturing

A retrospective review of 148 consecutive porous-coated hip arthroplasties (PCA) showed an incidence of thigh pain of 13% one year after surgery, and 22% at two years. Positive correlations were made with femoral stem subsidence (greater than 2 mm) and with distal periosteal and endosteal bone formation. No positive correlations were made with parameters of bone quality or component fit. Resolution of pain occurred in one-third and an anti-inflammatory agent produced partial relief in two-thirds of the patients. We conclude that thigh pain is secondary to stem instability with distal stress transfer in the absence of stable proximal fixation

We describe 74 patients with disabling instability of the knee due to isolated anterior cruciate deficiency. None responded to conservative measures or correction of internal derangements. All patients were treated by replacement of the anterior cruciate ligament with the medial third of the patellar tendon as a free graft, supplemented by an extra-articular MacIntosh lateral reconstruction. A satisfactory outcome was found in 93% of knees after an average of 70 months follow-up. Cast immobilisation after operation, the interval between injury and reconstruction, the age of the patient and the severity of symptoms before reconstruction had no significant effect on the final outcome

We used the MacIntosh over-the-top repair combined with a popliteal tendon plasty in 273 athletically active patients with chronic incapacitating functional instability due to anterior cruciate ligament rupture; 244 were reviewed at three to nine years after operation. We describe the technique and its results, with functional evaluation by the Tegner and Lysholm system. Excellent or good results were obtained in 71%; most of the 29% fair or poor results were due to extensive meniscal and degenerative changes. In a group of 11 patients with excellent results arthroscopic and histological findings were encouraging, showing good incorporation of the graft

A study of excision arthroplasty (Girdlestone's pseudarthrosis) for infected total hip replacements is presented. Twenty-two patients were reviewed with a minimum follow-up of one year. Reduction in pain was significant but the functional results were poor. Factors contributing to poor function were old age, poor medical condition and arthritis of the contralateral hip; these were in addition to the gross instability resulting from the pseudarthrosis. The patients were easily fatigued and dependent on external supports; calipers were found to be unacceptable. The symptoms after excision arthroplasty are compared with those before the original hip replacement

Chronic ankle instability after ligamentous injuries has been attributed to loss of proprioception, but there has been no previous study of the mechanoreceptors in human ligaments at this joint. We have examined the ligaments from five cadaver ankles for mechanoreceptors and classified them into the four types described by Wyke and Freeman in their study of feline ligaments. Type-II receptors, thought to provide the sensation of the beginning of joint motion, and type-III receptors, thought to be activated at the extremes of movement, were the most common. Our findings provide some neuroanatomical data to validate further research into the use of proprioceptive training after ligamentous injuries about the ankle

Dysfunction of the distal radio-ulnar joint caused by traumatic, congenital and inflammatory onditions is usually treated by excision of the head of the ulna. This operation can induce ulnar carpal shift, with complications such as instability with poor grip, pain and clumsiness of the wrist, if the lower articular surface of the radius is normally inclined, or overinclined towards the ulna. These complications can be avoided by use of an operation producing pseudarthrosis of the distal part of the ulna, with fusion of the radio-ulnar joint (Lauenstein) if there is dislocation, radio-ulnar discrepancy or arthritis, or without fusion (Baldwin) if the joint, in spite of keeping normal articular surfaces, has its movement blocked by malunion of a radial fracture

We compared the outcome of total knee arthroplasty in 19 patients who had had previous patellectomy with the results in a matched series of arthroplasties performed on knees in which the patella was intact. The mean follow-up was 63 months (21 to 114). In the study group, the outcome was poor in five patients. There was instability in the coronal plane in three patients and persistent pain in four. Three supracondylar fractures occurred. The overall complication rate was 36%. In the control group, pain was relieved in every case and there were no complications. Total knee arthroplasty has a higher complication rate and inferior results if the knee has undergone prior patellectomy

Total knee arthroplasty (TKR) using a medial capsular approach gives worse results in arthritic knees with valgus deformity than in those in varus, usually because of swelling, poor wound healing and stiffness, instability, recurrent valgus deformity and poor patellar tracking. A technique for replacement TKR of valgus knees using a lateral capsular approach was described several years ago, but was not routinely adopted because of the difficulties with and complexity of the procedure which included deliberate elevation of the tibial tubercle. In order to avoid this we have modified and simplified the procedure. Our preliminary results suggest that this lateral approach is safe and may give a better outcome than that through the medial capsule for the replacement of valgus knees

We have reviewed 40 patients after replacement of a ruptured anterior cruciate ligament with a free graft of the medial third of the patellar tendon, combining this in 17 of the cases with a MacIntosh extra-articular tenodesis. The average age of the patients at operation was 25.4 years; instability of the knee had been present for 1.5 to 9 years, and the mean follow-up was 2.9 years. The results, assessed on subjective stability, were good in 29 patients, over half being able to return to their original sport, and fair in eight. The technique of operation for free patellar tendon grafting is described in detail and the indications for this and for an additional MacIntosh tenodesis are discussed

1. The treatment is described of a consecutive series of fourteen patients suffering from rheumatoid arthritis causing a slip of the cervical vertebrae, mainly at the C.1-2 level, and a cord lesion. 2. The importance of a change of symptoms and signs in these patients, especially the occurrence of the so-called "alarm signs", is stressed. 3. In twelve patients the combination of this kind of cervical instability with a cord lesion was treated by fusion, most frequently of occiput to C.2 and 3. 4. In the eleven patients who survived the operation the results with a follow-up period of one to eight years are considered highly gratifying. 5. Technical details and various problems associated with treatment are discussed

Anteriorly displaced fractures of the wrist can be treated by the Kapandji technique of percutaneous intrafocal pinning with pins inserted through an anterior approach to give good reduction and stabilisation of the fracture. We have modified this technique by placing the pins through a posterior approach which decreases the risks of neurovascular damage. We have used this method to treat six children with distal radial fractures showing anterior displacement or instability. Good anterior stabilisation was achieved. The pins were removed at an average of eight weeks and the patients were then able to return to full activity. This simple technique can be used for unstable fractures after the failure of conservative treatment or in bilateral fractures in adolescents

Aims

Leucocyte esterase (LE) has been shown to be an accurate marker of prosthetic joint infection (PJI), and has been proposed as an alternative to frozen section (FS) histology for intraoperative diagnosis. In this study, the intraoperative assessment of LE was compared with FS histology for the diagnosis of prosthetic hip infection.

The movements of the carpal bones during the scaphoid shift test were evaluated radiographically in 60 wrists. The clinical results were graded according to the degree of subluxation of the scaphoid and pain on the dorsum of the wrist. Lateral radiographs at rest and under stress were taken and the relative movements of the scaphoid with respect to the radius and lunate, and the rotation of the scaphoid and lunate were calculated. Dorsal displacement of the scaphoid with respect to the radius was significantly associated with the clinical grade of subluxation. There was correlation between the amount of pain and the displacement of the scaphoid from the lunate, but not from the radius. The wrists with a painful shift test had greater relative displacement of the scaphoid from the lunate than those with painless subluxation. These observations support the view that pain associated with subluxation of the scaphoid during the shift test is a significant finding, and that radiographic analysis of the test may confirm a positive result when dynamic scaphoid instability is suspected