Combined ACL re-revision with proximal tibial anterior closing wedge osteotomy restores knee stability and function with satisfactory clinical outcomes in patients who experience recurrent ACL ruptures with an associated increased PTS.

Minimally invasive total hip arthroplasty performed through a single-incision posterior approach by a high-volume hip surgeon with extensive experience in less invasive approaches to the hip is safe and reproducible. However, it offers no significant benefit in the early postoperative period compared with a standard incision of 16 cm. As it is not known whether lower-volume and less-experienced surgeons can achieve similar results, the mini-incision technique merits further study before wide dissemination and implementation of this family of surgical approaches can be recommended.

It has been suggested that an increased posterior tibial slope (PTS) and a narrow notch width index (NWI) increase the risk of anterior cruciate ligament (ACL) injury. The aim of this study was to establish why there are conflicting reports on their significance. A total of fifty patients with a ruptured ACL and 50 patients with an intact ACL were included in the study. The group with ACL rupture had a statistically significantly increased PTS (p < 0.001) and a smaller NWI (p < 0.001) than the control group. When a high PTS and/or a narrow NWI were defined as risk factors for an ACL rupture, 80% of patients had at least one risk factor present; only 24% had both factors present. In both groups the PTS was negatively correlated to the NWI (correlation coefficient = -0.28, p = 0.0052). Using a univariate model, PTS and NWI appear to be correlated to rupture of the ACL. Using a logistic regression model, the PTS (p = 0.006) and the NWI (p < 0.0001) remain significant risk factors. From these results, either a steep PTS or a narrow NWI predisposes an individual to ACL injury. Future studies should consider these factors in combination rather than in isolation.

Participation in professional sports and having a combined lateral tenodesis are risk factors for the development of infection after ACL reconstruction. We hypothesize that professional athletes may be part of a specific group of patients at higher risk of infection after ACL reconstruction.

Lateral ankle sprains are common; if conservative treatment fails and chronic instability develops, stabilization surgery is indicated. Numerous surgical procedures have been described, but those that most closely reproduce normal ankle lateral ligament anatomy and kinematics have been shown to have the best outcomes. Arthroscopy is a common adjunct to open ligament surgery, but it is traditionally only used to improve the diagnosis and the management of any associated intra-articular lesions. The stabilization itself is performed open because standard anterior ankle arthroscopy provides only partial visualization of the anterior talofibular ligament from above and the calcaneofibular ligament attachments cannot be seen at all. However, lateral ankle endoscopy can provide a view of this area that is superior to open surgery. We have developed a technique of ankle endoscopy that enables anatomic positioning of the repair or fixation of the graft. In this article we describe a safe and reproducible arthroscopic anatomic reconstruction of the lateral ligaments of the ankle using a gracilis autograft. The aim of this procedure is to obtain a more physiological reconstruction while maintaining all the advantages of an arthroscopic approach.

Acetabular offset (AO) is the distance between the centre of the femoral head and the true floor of the acetabulum. We quantified the AO in normal hips and compared the displacement of the centre of rotation of the hip (CRH) after conventional and anatomical cup implantation during THA. 100 CT-scans of normal hips were analysed before and after simulating implantation of the acetabular component. Mean AO was 30.8 mm ± 3.The medial shift of the CRH was 1.6 mm ± 1.2 with the anatomical and 4.8 mm ± 1.9 with the conventional technique (p<0.0001). Medialisation was greater than 5 mm in 44% of the cases when the conventional technique was used, but occurred in no case when using the anatomical technique. Differences between men and women were significant: 5.6 mm ± 1.6 and 3.5 mm ± 1.7 with the conventional technique; 2.0 mm ± 1.1 and 0.9 mm ± 0.9 with the anatomical technique (p<0.0001 for both measurements). The concept of hip offset cannot be limited to that of the femoral offset. AO widely varies and cannot be neglected. In patients with significant AO, surgeons should pay close attention to the preparation of the acetabulum. This should be done conservatively so that the acetabular cup can be placed anatomically in order to restore the native hip biomechanics.

AimsCA19.9 is a monosialoganglioside secreted by mucinous tumours of the gastrointestinal tract, including the pancreas and biliary tree. Limited studies have shown that this tumour marker may also be elevated in primary ovarian mucinous neoplasms, but no study has assessed whether serum CA19.9 levels can be used to predict if a primary ovarian mucinous tumour is benign, borderline or malignant. The aim of this study was to correlate the serum CA19.9 level with the histological features in a large series of primary ovarian mucinous neoplasms.Methods144 cases of primary ovarian mucinous neoplasm (79 benign, 45 borderline and 20 malignant) were identified in which a preoperative serum CA19.9 level had been performed. The association between the serum levels and the histological subtype and a variety of other parameters was investigated. In a subset of cases, immunohistochemical staining for CA19.9 was performed on tumour blocks.ResultsSerum CA19.9 levels were elevated in 27%, 38% and 40% of mucinous cystadenomas, borderline mucinous tumours and mucinous carcinomas, respectively. Markedly elevated levels of serum CA19.9 were observed in each group, with the highest serum CA19.9 measurements being noted in borderline mucinous tumours. There was no relationship between the serum CA19.9 level and whether the tumours were benign, borderline or malignant (Kruskal–Wallis test p value=0.32). A weak but statistically significant correlation was found between tumour maximum dimension and CA19.9 level (Spearman's rank correlation coefficient=0.17, p=0.04). In those cases in which CA19.9 immunohistochemistry was performed, all tumours showed positive staining for CA19.9, with 60% of these cases being associated with an elevated serum CA19.9 level.ConclusionPreoperative CA19.9 levels cannot be used to predict whether a suspected ovarian mucinous tumour is benign, borderline or malignant. Markedly elevated serum levels (>1000 U/ml) may be found in benign mucinous neoplasms as well as in borderline and malignant tumours.

Medialisation of the cup decreased stresses on the head-cup interface and on the abductor muscles, even when the global offset was not restored. Anatomical placement of the cup did not give the best results. The optimal outcome in terms of stress was observed when the cup was medialised but global offset restored. Any increase of global offset significantly increases the length and the tension in the anterior bundles of the abductor muscles.