The use of Proficiency-based VR training, under supervision with prompt instructions and feedback, and the use of haptic feedback, has proven to be the most effective way of delivering the virtual reality training. The incorporation of virtual reality training into surgical training curricula is now necessary. A unified platform of training needs to be established. Further studies to assess the impact on patient outcomes and on hospital costs are necessary. (PROSPERO Registration number: CRD42014010030).

Is financing adequate for these complex cases?

identified as having had revision ACL reconstruction at a single stage under a single surgeon. The case notes were retrospectively reviewed and patients were contacted by telephone interview where patient reported outcome measures were recorded in the form of Tegner Activity Scale, Tegner Lysholm Knee Scoring Scale, Cardiff ACL Satisfaction Index and EQ5D Euroqol. Results: 20 patients were contactable (59%), with the average follow-up of 3.8 years [range 1-10 years]. None of the revisions had failed. The mean Tegner score was 84.4 [range 45-100], which correlated well with the EQ5D Euroqol. One patient had proceeded to TKR at 6 years but the graft was functioning at the time of surgery. Eight of the revisions used bone patella tendon bone (BPTB) as a graft material. Fixation was possible in all but one case where a femoral post and suspensory fixation was required. Tegner score was higher in revisions using hamstrings [n¼8, mean 83.4] than BPTB [n¼11, mean 82.6]. Conclusions: Single stage revision ACL reconstruction can yield good results, where hamstring and BPTB grafts yield similar results on functional outcome scores.

Internal hernias are rare, constituting 5.8% of all intestinal obstruction cases. Congenital transverse mesocolon hernias in adults are specifically rare. We hereby present a case of an adult female presenting with acute intestinal obstruction. Her CT scan showed classic signs of internal herniations: 'Whirlpool sign', crowding of bowel loops in the upper compartment and the absence of caecum from the Right Iliac Fossa. At operation, she was found to have a congenital defect in the transverse mesocolon, through which have herniated the terminal ileum, caecum and the proximal half of the ascending colon. They have furthermore rotated 360° about the axis of the pedicle forming a volvulus. The bowel was viable. The herniated bowel was derotated, and reduced through the defect, the defect was closed with polydioxanone sutures, and the caecum and ascending colon was fixed to the lateral abdominal wall.

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