Repair of ruptured quadriceps tendon with Leeds-Keio ligament following revision knee surgery.

We describe the use of the Leeds-Keio ligament to reconstruct a neglected quadriceps tendon rupture following revision knee arthroplasty. The Leeds-Keio ligament has been used in the treatment of patellar tendon ruptures complicating primary knee arthroplasty with good result--but may, as this report shows, also be successfully applied to address deficiencies of the quadriceps tendon in the revision setting, with continued good function for 2 years.

Simultaneous dislocations of the radiocapitellar and distal radioulnar joints.

Posttraumatic instability of the distal radioulnar joint (DRUJ), occurring in isolation or in association with fractures of the radius, is well-documented. Few reports have identified simultaneous ipsilateral DRUJ instability and elbow dislocation. The authors of the present study describe a case of persistent radiocapitellar subluxation after closed reduction of an elbow dislocation, secondary to irreducible volar subluxation of the DRUJ.

Range of motion after arthroplasty for the stiff osteoarthritic knee.

In 28 of 1656 total knee arthroplasties (TKAs) (1.7%) performed for osteoarthritis at this institution, the preoperative arc of motion was 60 degrees or less (average 47.5 degrees; range, 20-60 degrees). The outcome of 22 of the 28 TKAs (21 patients) is reported at a mean follow-up of 52.9 months (range, 24-144 months). Eighty-two percent of the cases were managed with standard soft-tissue releases and posterior cruciate-retaining implants and 18% with a cruciate-substituting design. The joint score rose from 28.8 to 82.2 and the Knee Society Score from 24.6 to 77 points. The mean postoperative arc of motion improved by 46 degrees-93.5 degrees. At latest follow-up, 68.2% of knees achieved maximal flexion of 90 degrees or more. Manipulation was performed in 22.7%. Complications were minimal. A functionally useful range of motion is possible after total knee arthroplasty in the majority of stiff osteoarthritic knees, often without the need for posterior cruciate substitution.

Body mass index as a predictor of outcome in total knee replacement.

The clinical and radiographic outcomes of 326 total knee replacements (TKR) in 285 osteoarthritic patients with body mass index (BMI) greater than 30 kg/m2 were compared with the results of a matched group of 425 TKR in 371 patients with BMI less than 30 kg/m2. At an average follow-up of 75.9 (48-144) months the Knee Society score (KSS) in the obese patients had increased by 41.9 points, and the joint score by 43.7. In the non-obese group the KSS rose by 40.2 points and the joint score by 42.6 points. Although patients with BMI greater than 40 kg/m2 achieved a lower final KSS the 'absolute improvement' appeared to be independent of BMI. Of the obese patient group 4.9% underwent a revision of their TKR, compared with 3.1% of the non-obese group. Although linear osteolysis (radiolucency) rates were comparable, focal osteolysis rates were 5 times those of control subjects when the BMI exceeded 40 kg/m2. Ten-year survivorship figures were similar for both obese and non-obese patients.

Cementless cup fixation in total hip arthroplasty after 5-8 years.

A series of 199 total hip arthroplasties was performed using a porous-coated, hemispherical press-fit acetabular cup. At a mean follow-up of 91.5 months 158 cups were available for clinical and radiological review. The mean age of the patients at the time of the index arthroplasty was 62.5 years. The mean Harris Hip score at final follow-up was 87.3. No shells were revised although eccentric polyethylene wear prompted liner replacement in two cases. Osteolysis was noted in six cases but predominantly in relation to the femoral stem. Focal pelvic osteolytic lesions were rare. All the cups were classified as stable on radiography.

Anterior knee symptoms after four-strand hamstring tendon anterior cruciate ligament reconstruction.

Proponents of hamstring anterior cruciate ligament (ACL) reconstruction suggest that anterior knee symptoms (AKS) may be less than following the use of bone-patella-bone autograft. Our aim was to assess the incidence of AKS in a cohort of patients who had undergone hamstring reconstructions. Forty-four of 50 consecutive patients who had undergone arthroscopically assisted four-strand gracilis/semitendinosus hamstring ACL reconstructions were reviewed at a minimum follow-up of 24 months. The frequency and severity of anterior knee pain experienced during activities of daily living, sports, prolonged sitting, stair-climbing and kneeling was recorded by means of the Shelboume and Trumper anterior knee pain questionnaire. The location of both pain and any perceived sensory change was recorded using patient-drawn diagrams. Although mild or moderate symptoms occurred in a proportion of patients, only 2% experienced significant symptoms that caused limitation with daily activity, 7% with strenuous work or sport, 12% with kneeling, 5% with stairs and none with prolonged sitting. The pain was not specifically related to the incision for tendon harvest and drilling of the tibial tunnel. Areas of sensory change over the front of the knee were identifiable in 50% of patients, and of these, 86% demonstrated sensory change in the distribution of the infragenicular branch of the saphenous nerve. Although rarely a cause of limitation of activity, AKS can be a problem after hamstring ACL reconstruction and patients should be counselled accordingly.

Roller-blades: should they carry a government health warning?

Rollerblading is increasingly popular in the UK. Over 12 weeks, we treated 29 patients of whom 34 per cent required operative intervention. There was a wide range of injuries, those of the radius being most common, and some (e.g. femoral and pelvic fractures) being quite severe. The value of protective equipment is discussed.