Adductor longus ruptures in elite sportsmen--pitfalls of surgical repair: a report of two cases.

Insertional tendinopathy of the adductor longus is a common and problematic condition in elite athletes and may lead to rupture. Previous literature has reported good outcomes in these patients when these ruptures are treated with both surgical and non-operative management. This paper will discuss the available literature on management of adductor tears and describe two case reports of deep infection following surgical repair of ruptures in soccer players and the effects this had on their profession. We conclude that, given the overall evidence of conservative management of adductor tears and possible complications associated with the surgery that these cases highlight, acute adductor tears in the majority should be treated conservatively.

Delayed repair of the quadriceps using the Mitek anchor system: a case report and review of the literature.

Extensor mechanism disruptions are relatively uncommon knee injuries. Within this group, delayed treatment is an infrequent but difficult clinical situation. Fibrous degeneration, muscle contraction and subsequent hiatus present a challenge to the orthopaedic surgeon. We present an unusual case of a successful delayed repair using the Mitek anchors system (Mitek Products Inc., a division of Ethicon Inc., Westwood, Massachusetts).

Subungual exostosis following toe nail removal--case report.

Removal of toe nail is a minor procedure that can be under ring block with no significant complications. We report the case of a young lady who developed a rapidly growing subungual exostosis on her right great toe following nail removal. Inadvertent iatrogenic injury to the nail bed and underlying phalangeal periosteum during nail removal might have triggered off rapid bone growth resulting in the large exostosis. To our knowledge, this aetiology for subungual exostosis formation has not been reported before.

The Lubinus patellofemoral arthroplasty: a series of 17 cases.

INTRODUCTION: The Lubinus patellofemoral arthroplasty was introduced in our institution in 1994. The first 17 patients were followed-up in order to identify the short-term outcome for this prosthesis. MATERIALS AND METHODS: The average age at surgery was 66 years (range 37-82 years). The mean follow-up was 19 months. The indications for surgery were strictly limited to radiographically proven primary osteoarthritis affecting only the patellofemoral joint (13) and secondary arthritis due to maltracking, subluxation (3) or trauma to the patella (1). At review, the range of movement and Lysholm and Tegner scores were recorded and radiographs obtained. Patients were also asked if their outcome was satisfactory or unsatisfactory. RESULTS: At review, only 9 (53%) knees were classified as satisfactory by the patients. Further surgery had been carried out in 6 cases (35%) including revision to total knee arthroplasty in 4 (24%). Other complications included clicking and subluxation in 3 cases (18%), extension block in 3 (18%) and infection in 1 (6%). Progression of osteoarthritis to involve other compartments occurred in 2 cases (12%). CONCLUSIONS: Many of these early problems are related to the unforgiving nature of the prosthesis on insertion. These poor early results have led us to stop using the prosthesis.

Do we practice evidence based medicine with regard to drain usage in knee arthroplasty? Results of a questionnaire of BASK members.

Clinical governance requires our clinical practice to be evidence based. We wished to see if British Orthopaedic surgeons are using the current evidence with regards to the use of drains in knee arthroplasty. A questionnaire was faxed to all UK members of BASK to ascertain their current practice regarding the use of drains in knee arthroplasty and the rationale for their drain policy. The study suggests that the majority of practising members of BASK do not practice evidence based medicine with regard to the use of drains in knee arthroplasty.

Ex-professional association footballers have an increased prevalence of osteoarthritis of the hip compared with age matched controls despite not having sustained notable hip injuries.

OBJECTIVE: To compare the prevalence of self reported, physician diagnosed osteoarthritis (OA) of the hip in ex-professional footballers with that in age matched controls in the general public. METHOD: A questionnaire was sent to the 92 football league and premiership managers to assess the prevalence of OA of various joints. The prevalence of OA of the hip in those managers that were ex-professional footballers was assessed. Radiographic controls were obtained and used to assess the prevalence of OA of the hip in the general population. The results of the two groups were compared statistically using chi(2) tabulation. RESULTS: Seventy four (80%) of the managers responded to the questionnaire. Nine of the 68 ex-professional footballers who replied had OA of the hip, and six of these had undergone a total of eight total hip replacements. Of the 18 managers who did not respond, 12 were known to be ex-professionals. In the control group of 136, two had OA of the hip. The two groups differed significantly (p<0.001). The odds ratio for OA of the hip was 10.2 (95% confidence interval 2.1 to 48.8). CONCLUSION: The ex-professional footballers had a significantly higher prevalence of OA of the hip than an age matched group of radiographic controls.

Arthroscopically guided Kirschner wire fixation for fractures of the intercondylar eminence of the tibia.

Eight children with type II and III fractures of the intercondylar eminence of the tibia were treated. The osteochondral fragments were reduced arthroscopically and held with Kirschner wires with the knee in extension. The wires were then incorporated into a long leg plaster. There was no associated significant collateral ligament or meniscal damage in any of the knees requiring operative intervention. At follow-up all the fragments had healed. None had symptoms of ligamentous laxity. One knee showed increased antero-posterior laxity compared with his normal knee associated with a 20 degree block to extension. Arthroscopic reduction and Kirschner wire fixation provides an accurate and effective treatment of these fractures, helping to avoid chronic ligamentous laxity and decreasing the morbidity associated with open procedures.

A failure mechanism of Leeds-Keio ligaments.

From our experience with the Leeds-Keio artificial ligament at Bolton Hospitals we report the histology from three cases in which the new ligament was demonstrated to have failed in response to trivial injury, after an initially successful anterior cruciate replacement. The histology showed fragmentation of graft material associated with a chronic inflammatory response in the new ligament. A chronic inflammatory response occurs as a result of fragmentation of the Dacron fibres; and once established, inhibits production of the neoligament, thus dooming it to failure.

Stabilisation of the infected spine.

A metal stabilising rod was inserted at the time of surgical drainage of the abscess in six patients with spinal instability secondary to vertebral osteomyelitis. The procedure enabled early postoperative mobilisation to be undertaken in five patients. All cases obtained immediate relief of pain. One case of delayed wound healing occurred but not late recurrent infections were encountered after discontinuing antibiotic therapy. The technique was employed in cases of pyogenic as well as tuberculous spinal osteomyelitis.

Stabilisation of the spine affected by malignancy.

A technique for securely stabilising the spine affected by malignancy has been developed. It provides excellent pain relief and some improvement of neurological deficit, and allows of laminectomy and radiotherapy. Although the technique is relatively simple, and the materials used are commonplace and inexpensive, it needs to be learnt which may mean that surgery for spinal malignancy will need the service of a trained surgeon, rather than that of an initiate.

University of Manchester sports injury clinic.

This paper reviews the work of the sports injury clinic based at the Student Health Centre, University of Manchester during its first eighteen months. A total of 852 patients including 46 Centre of Excellence athletes were treated. The results indicate that the establishment of such a specialised clinic is worthwhile, that the injured sportsmen should be treated by individuals trained and interested in the treatment of injured patients in general and that the commonest injuries are soft tissue injuries to the knee of ankle joint. A record card, designed for future computer analysis, is illustrated. It includes details of the sport, training, mechanism of injury, pathology and treatment.

Hydroxyproline excretion in the detection of occult bone metastases from breast cancer.

When surgery fails to cure breast cancer it is due to disseminated micrometastases present at the time of operation. The measurement of urinary hydroxyproline (OHP) is a possible screening test for such metastases in bone. This study compared both a single and serial urinary OHP estimation with the axillary node status, the bone scan status and the subsequent clinical course. A single measurement did not correlate with the axillary node or bone scan status, neither was there a relationship with the subsequent clinical course. Serial OHP estimations, every 3 months for a year, increased the accuracy of the test such that node-positive patients had higher excretions than node-negative patients (p less than 0.05). Patients who subsequently died with bone metastases tended to have a higher excretion than those who remained disease free, although this did not reach statistical significance. No relationship existed between serial OHP estimations and bone scan status. We consider the measurement of urinary OHP to be insufficiently sensitive to detect bone micrometastases and it is only raised when a substantial amount of bone is involved.

Management of leukaemic infiltration of the testis.

Of 95 boys treated for acute lymphoblastic leukaemia 25 have developed leukaemic infiltration of the testes. In 15 children relapse was apparently confined to the testes, and since treatment 7 of these boys remain in remission. The median duration of remission after testicular relapse was 72 weeks, considerably longer than that reported after other forms of leukaemic relapse.