The rectus femoris muscle is the most frequently involved quadriceps muscle in strain pathologies. The majority of quadriceps muscle belly injuries can be successfully treated conservatively and even significant tears in the less active and older population, non-operative management is a reasonable option. The authors report the delayed presentation of a 17-year-old male who sustained an injury to his rectus femoris muscle belly while playing football. This young patient did not recover the functional outcome required to get back to running and participating in sport despite 15 months of physiotherapy and non-operative management. Operative treatment using the ligament augmentation and reconstruction system ligament to augment Kessler repair allowed immediate full passive flexion of the knee and an early graduated physiotherapy programme. Our patient was able to return to running and his previous level of sport without any restrictions.

In this study the records of 45 patients with sickle cell disease involved in 63 presentations of acute chest syndrome at the Princess Margaret Hospital in Nassau, the Bahamas, between 1997 and 2001 were examined. Patients were divided into three groups on the basis of age (<13 years, 13–18 years, ⩾19 years) with a view to assessing clinical presentation. The incidence of symptoms, physical signs, and laboratory findings were enumerated and significant differences between age groups determined. The data were analysed using analysis of variance, t test, and χ2 test and compared with existing knowledge on the subject. This study proposed to evaluate the clinical presentation of acute chest syndrome with emphasis on historical and physical findings, and to encourage the physician to maintain a high index of suspicion for the condition in susceptible patients. It was found that presentation varied significantly with age groups, children presenting most classically with fever and cough and adults, with chest pain. The 13–18 age group emerged as the group which presented most frequently with the typical symptoms of chest infection, thus potentially making diagnosis easier. Of note, the most frequent finding was a normal examination, while the second commonest physical finding was crepitations on auscultation of the chest.

Aim-To quantify the exposure of very low birthweight neonates to ionising radiation from diagnostic x-rays. Methods-Retrospective analysis was made of all radiographs performed over 18 months in an integrated special care baby unit and regional neonatal surgical unit in a large teaching hospital of surviving inborn babies of very low birthweight (<1500 g) admitted to the unit. Results-Fifty five VLBW neonates were treated for a total of 3296 days and received 498 radiographs (median 5 per infant). The mean eVective radiation dose was 0.04 mSv and the maximum for one infant was 0.54 mSv. Conclusions-The radiation burden in this group of neonates is low and the benefits of diagnostic radiographs far outweigh any potential radiation risks. (Arch Dis Child Fetal Neonatal Ed 1998;78:F227-F229)

Impaction bone grafting for the reconstitution of bone stock in revision hip surgery has been used for nearly 30 years. Between 1995 and 2001 we used this technique in acetabular reconstruction, in combination with a cemented component, in 304 hips in 292 patients revised for aseptic loosening. The only additional supports used were stainless steel meshes placed against the medial wall or laterally around the acetabular rim to contain the graft. All Paprosky grades of defect were included. Clinical and radiographic outcomes were collected in surviving patients at a minimum of ten years after the index operation. Mean follow-up was 12.4 years (sd 1.5) (10.0 to 16.0). Kaplan-Meier survival with revision for aseptic loosening as the endpoint was 85.9% (95% CI 81.0 to 90.8) at 13.5 years. Clinical scores for pain relief remained satisfactory, and there was no difference in clinical scores between cups that appeared stable and those that appeared radiologically loose.

No abstract

Medium-term results appear to offer the benefits of being able to return to heavy manual labour as well as retaining a functional range of motion. It is difficult to predict long-term survival, but the outcome so far is encouraging, and conversion to midcarpal fusion remains a salvage option.

IntroductionAlthough stabilisation of knee cartilage lesions (chondroplasty) may be performed with an arthroscopic shaver, more recently, radiofrequency (RF) ablation has gained in popularity. However, their remain some concerns about the avoidance of thermal injury, chondrolysis, and osteonecrosis with the use of RF devices. MethodsWe reviewed the outcomes of 85 knee chondroplasties performed with a new RF ablation wand designed for knee chondroplasty. Lesion details and Chondropaenia Severity Score (CSS) were recorded for each patient. We evaluated the occurrence of adverse outcomes, post-operative complications, and the need for further surgery. Post-operative outcomes scores (Oxford Knee Score [OKS], Knee injury and Osteoarthritis Outcome Score [KOOS], and International Knee Documentation Committee [IKDC] subjective knee outcome) were recorded at a minimum of one-year follow-up. ResultsAt the final mean follow-up of 27.5 months (range: 12-46.6 months), 12 (14%) knees had undergone or were listed for further surgery. Four patients had corticosteroid injections for ongoing pain at a median 7.5 months (range: 5-20 months) post-operatively. There were no observed re-operations considered to be caused by complications related to thermal injury. Of the six patients listed for or undergoing knee arthroplasty, five (83%) had grade 4 lesions found at the arthroscopic chondroplasty. A negative correlation was noted between CCS, and post-operative IKDC subjective score (R=-0.35), KOOS Sports (R=-0.39), and KOOS QoL (R=-0.36). ConclusionsWe found that RF chondroplasty appeared safe, and there were no concerns with regard to thermal injury. Functional outcome appeared to be related to the quality of chondral and meniscal tissue throughout all knee compartments, with better results for isolated grade 2 and 3 cartilage lesions.

Background: A 2 mm–wide ultrahigh-molecular-weight polyethylene (UHMWPE) tape improves the contact pressure at root repair sites compared with high-strength suture and provides a stronger repair construct. UHMWPE tape is commonly used in rotator cuff repair, and fixation is often achieved with knotless suture anchors. The optimal method for tape fixation for meniscal root repair has not been established. Hypothesis: The use of suture anchors for the tibial fixation of 2-mm UHMWPE tape transosseous root repairs will lead to better biomechanical performance compared with other fixation methods. Methods: The medial meniscal posterior root attachment in 25 porcine knees was divided, and a standardized transtibial root repair was performed using 2-mm UHMWPE tape. The testing was performed by cyclic loading followed by load to failure. Tibial fixation was randomized to 5 tibial fixation types: (1) cortical fixation button, (2) pound-in suture anchor with screw-down interference suture locking, (3) tap-in suture anchor with inner locking plug, (4) postscrew, and (5) postscrew and washer. Results: There was no difference in displacement during cyclic loading between tibial fixation groups except for a highly significant difference in the maximum load at failure. Repairs in both suture anchor fixation groups all failed by tape slippage at relatively low loads (median, 145 and 116 N, respectively). Repairs tied over a cortical button, postscrew, or screw and washer failed by tape breakage at loads of 431, 405, and 528 N. Conclusion: For meniscal root repairs with 2-mm UHMWPE tape, use of suture anchors offers weaker fixation compared with tying over a button or postscrew/washer. While suture anchor fixation may be adequate for nonweightbearing postoperative protocols, it may not allow for more accelerated weightbearing.