Ligamentoplasty of the anterior cruciate ligament (ACL) has been associated with several complications. Their identification and management are crucial, as they could hinder functional status and patient’s quality of life. Our study aimed to analyze these complications after primary ACL reconstruction using two type of grafts. We conducted a retrospective study of 320 patients over a period of nine years. Our patients had an isolated ACL injury. They were divided into two groups according to the type of ACL reconstruction: bone–patellar tendon–bone (BPTB) or hamstring tendon (HT) graft. Data collected included pre- and post-operative clinical and radiological findings, and intra-operative findings. The Lysholm score and International Knee Documentation Committee (IKDC) evaluation system were used for pre- and post-operative assessment. The mean follow-up was 12 months. We observed statistically significant improvement after surgery in each group, as assessed by IKDC and Lysholm scores. There was no statistically significant difference between Lysholm and IKDC scores of two groups. The intraoperative incidents were observed in both groups, in relation to graft harvesting (n=3), tunnel placement (n=3), and graft fixation (n=4). Postoperative complications included infections (four cases in BPTB group), anterior knee pain only in BPTB group, stiffness (n=85), residual laxity (n=11), thromboembolic complications (n=1), Cyclops syndrome (n=1), calcification of the patellar tendon (n=2), and bone tunnel enlargement (n=5). In conclusion, anterior knee pain was higher in BTPB group, while HT graft technique is more likely to expose to graft harvesting incidents leading to conversion of the technique.

Background: Proximal femur osteochondromas are relatively rare, particularly in the femoral neck. These exostoses are linked with groin and lower extremity pain, bursal inflammation and compression on neurovascular structures. The choice of treatment poses difficulties to the surgeon.
Case Presentation: The authors report an unusual case of a 33-years-old male patient complaining of inguinal pain and internal snapping of the left hip joint. In the physical examination, the patient was presumed to be diagnosed with femoracetabular impingement. In radiologic evaluation, bony tumor associated with internal snapping was found on the posteromedial portion of the femoral neck. Despite of conservative treatment, there was no symptomatic improvement. Partial resection of bony tumor was performed arthroscopically. Total resection of the tumor was not possible due to the dimensions of it. The tumor was pathologically diagnosed as osteochondroma.
Clinical Outcomes: There was no recurrence, complication or abnormal finding during the follow up.
Discussion: Osteochondromas of the femoral neck are a challenging problem because of their distal location, which is difficult to access arthroscopically. Traditional methods of osteochondroma resection used invasive open approaches to manage these lesions. More recently, advances in hip arthroscopy have allowed expanded treatment of intra-articular hip conditions with a minimally invasive approach. The authors present their arthroscopic surgical technique to access the lesion and perform its resection.

Background: Painful, irreparable full-thickness rotator cuff tears in the absence of significant glenohumeral arthritis in active patients are challenging to manage. One surgical option is reconstruction of rotator cuff tendon using bridging dermal allograft (BDA) which is a biological acellular scaffold. BDA indications and implantation techniques continue to be refined and long-term results monitored. Objectives: To evaluate short-term outcomes of arthroscopic min-open rotator cuff reconstruction using BDA for the treatment of massive irreparable rotator cuff tears. To show this option results in improved shoulder function/comfort short term as a minimum. To describe the surgical technique. Study Design & Methods: Patient selection: full thickness supraspinatus tendon tear 2 to 5 cm with atrophied supraspinatus muscle on MRI scan. Intrusive pain. Failure of conservative measures. No glenohumeral degeneration. Surgical technique: arthroscopic-assisted mini-open technique using lateral or anterolateral deltoid split. BDA sutured to retracted tendon and spread over humeral head, tensioned, and anchored by double row repair to supraspinatus footprint. Retrospective review was conducted of patients managed by rotator cuff reconstruction using BDA by one surgeon in a single centre over 4 years. Outcome measurement: Oxford Shoulder Score questionnaire pre-operatively and 3 months post-operatively. Results: 15 patients average age 68 years (48 - 85 years), no early or delayed operative complications. 12 patients attended a minimum of 3 months follow-up. Outcomes: Improvement in OSS at 3 months from average 25 to average 40 (P<0.0001) Conclusion: Rotator cuff reconstruction using BDA is successful short term in increasing shoulder function and comfort.

Introduction: The frequency of anterior instabilities of the shoulder is quite high, due to the anatomical and functional features of the shoulder, frequent recurrences after orthopedic treatment of traumatic dislocations. The presence of the bone deficiency of the glenoid or Hill-Sachs type lesion, increase the recurrence rate after arthroscopic surgery. These injuries require surgeries with bone replacement techniques, or additional stabilization techniques. Methods: According to the own experience that includes the treatment of 62 patients in whom arthroscopic stabilization of the anterior shoulder instability was performed between 2010-2020. Confirmation of the diagnosis was based on clinical, radiological, ultrasound, CT and MRI examination. It has been practiced reinsertion of the anterio-inferior part of the labrum and the joint capsule to the glenoid by using anchors. The Hill-Sachs lesion - 21 cases, and in 8 cases arthroscopic resection was performed. In the bone deficiency of the glenoid, in 14 cases replacement of the defect with allograft was performed ,in other 3 cases Latarjet surgery and in another 3 cases osteochondral glenoid allograft. Results: Patients were evaluated postoperative using the Rowe score. From all study group only excellent or good results have been observed. Recurrences of instability were not found. Conclusions: Arthroscopic treatment of anterior instabilities with bone deficiency greater than 20% requires bone replacement by available procedures, either arthroscopy or another traditional methods. Hill-Sachs lesion in bones defects of the humeral head require defect coverage by filling or in major defects the operation Latarjet is indicated. Key-words: Shoulder arthroscopy, shoulder instability, Hill-Sachs.

Background
Primary traumatic dislocation is a major cause of chronic instability of shoulder joint. During the last few decades the search of the optimal treatment strategy for primary humeral head dislocations with labral tears remains the relevant topic.
Objectives
To assess the medium-term results of surgical treatment in patients with injuries of the articular labrum after primary and recurrent dislocation of humeral head.
Study Design & Methods
We analyzed surgical interventions of 71 patients from 2014 to 2017, who were aged 20 - 45 years, with traumatic dislocations of humeral head. All patients were divided into two groups: the first group included 34 patients with primary humeral head dislocation, the second group - 37 patients with recurrent dislocations. All patients had surgery in Orthopedic & Trauma Center - arthroscopy, refixation of joint labrum with bioabsorbable anchors.
Results
Assessing the upper extremity function using Constant and Oxford shoulder scores after 12, and 36 months after surgery, we observed a progressive increase in shoulder joint function. 3 years after surgery 85% of patients in the first group showed excellent results, 15% - satisfactory, poor results were not observed. In the second group 81% of patients had excellent results, 14% - satisfactory and 5% - poor.
Conclusions
In patients with rupture to the articular labrum, it is recommended to perform arthroscopy and refixation of labrum after primary dislocation. This tactics prevents complications, such as recurrent dislocations of shoulder and bone defects in the articular surface of the scapula and the humeral head.

Background: Treatment of injuries to the biceps-labral complex can be challenging, and often only diagnosed at arthroscopy. However it is important to make a preoperative plan based on physical examination and imaging studies, so as to inform patients about the planed procedure and length of rehabilitation. Materials and Methods: Eleven elite wrestlers who suffered their injury between 2008 and 2018 were investigated retrospectively. In this multicenter study we aimed to identify connection between mechanism, symptoms, treatment and outcome of the biceps-labral complex injury in elite wrestlers.Results: The injury was sustained at a mean age of 20.63 years, and most wrestlers were middle or light weight. All injuries occurred during shoulder movements in closed kinetic chain with the elbow extended, the forearm pronated and the shoulder slightly elevated. We found SLAP II diagnoses in 5, SLAP V in 3, LHBT tear in 2 and biceps tendinosis in 1 wrestler respectively. The surgical procedures performed were reinsertion in seven, tenodesis in three cases and one tenotomy. The postoperative rehabilitation was shorter in case of tenodesis or tenotomy (1-3 months), and took longer after reinsertion (6-9 months). Nine wrestlers returned to their previous level of sport. Conclusions: Injuries to the biceps-labral complex are relatively frequent in elite wrestlers, reflecting the high functional demands imposed on the upper limb. Though necessitating surgery, such injuries are not career ending, and most of our elite athletes returned to a high performance levels after surgery.

Introduction: The reconstructed hamstring graft Anterior cruciate ligament (ACL) is the weakest during the process of avascular necrosis, graft revascularisation and ligamentisation in the first 4-6 weeks. This cause early intrasubstance tear or graft pull out commonly from the tibial attachment. Tibial attachment preserving hamstring graft ACL reconstruction thus overcomes this stage and helps in early rehabilitation of the patient. Methodology: A total of 29 patients (mean age,29.75±7.36 years) with isolated ACL tear were included in this prospective observational study after the Institutional ethical clearance. All 29 patients underwent hamstring tibial attachment sparing modified double bundle arthroscopic ACL reconstruction(dbACL) during the course of study. Functional outcome was assessed using Lysholm’s knee scoring and Tegner activity level at regular intervals till 6 months. Anterior tibial translation was measured by Knee laxity tester (KLT, Karl-Storz). Result: All cases of this study could achieve stability in follow-up with no incidence of subjective or objective instability. The pre-operative Lysholm score(36.45) improved to excellent(>91) in 82.7% patients and good(77-91) in the remaining patients at 6month at six months of follow-up. The mean Tegner activity level at six months(4.79±0.94) neared the pre-injury level(5.34±1.11). The mean KLT pre-operative, 6.26±1.15 mm reduced to 2.55±0.74 mm at 6month follow-up(p<0.05). Conclusion: The study found a very promising, good functional outcome in patients underwent Hamstring tibial attachment sparing Modified dbACL Reconstruction. There was no case of early graft failure in this study depicting efficacy of tibial attachment sparing preparation of hamstring graft, thus imparting stability of a double bundle construct.

Purpose: This study aimed to evaluate the clinical outcomes of ASCR with mesh augmentation for the treatment of irreparable rotator cuff tears (IRCTs).
Methods: From 2013 to 2018, the data of 64 patients with IRCTs who underwent ASCR who met the inclusion criteria were retrospectively evaluated. Fascia lata grafts augmented with a polypropylene mesh were used for 30 patients (group M) and grafts without mesh augmentation were used for 34 patients (group C). Clinical outcomes were evaluated using ROM, the ASES questionnaire, and VAS for pain. Radiological outcomes were evaluated with based on AHD and stage of rotator cuff arthropathy. Outcomes were assessed preoperatively and at the final follow-up.
Results: Group M demonstrated a higher improvement in ASES score (29.1 ± 15.8) than group C (18.1 ± 15.9, p = 0.006). Forward flexion and external rotation improved in group M (40 ± 26 and 11 ± 5, respectively) and group C (28 ± 23 and 6 ± 3, respectively; p = 0.003 and 0.004, respectively). Graft healing rate was significantly higher in group M (83.3%) than in group C (58.8%, p = 0.039) and AHD was significantly higher in group M (9.1 ± 2.4 mm) than in group C (6.3 ± 1.8 mm) at the final follow-up (p = 0.001). Subgroup analysis revealed that patients with intact grafts demonstrated a more substantial improvement in functional outcomes (ASES score and forward flexion motion).
Conclusion: ASCR with mesh augmentation reduces graft failure rate as to restore superior shoulder joint stability.

Background: Superior capsular reconstruction is an alternative to reverse shoulder arthroplasty for irreparable rotator cuff tears (IRCTs). Traditional SCR uses a fascia lata autograft, which has shown greater failure rate at the greater tuberosity. Achilles tendon–bone allograft has been proposed to improve failure rate. This study evaluates the surgical outcomes of SCR using Achilles tendon–bone allograft for the treatment of IRCTs.
Study Design: Retrospective case series
Methods: We retrospectively evaluated 6 patients with massive IRCTs who underwent SCR using Achilles tendon–bone allograft from January 2017 to January 2018. We evaluated clinical outcomes using range of motion (ROM), the American Shoulder and Elbow Surgeons (ASES) score, and the Visual Analog Scale (VAS) for pain. We evaluated radiological outcomes for the AHD (acromiohumeral distance) and the status of graft integrity using serial magnetic resonance imaging. Second-look arthroscopy surgery was performed to evaluate graft integrity. We assessed outcomes pre-operatively and at final follow-up.
Results: ASES and VAS scores improved from 42.8 ± 11.9 and 4.0 ± 1.2 to 62.1 ± 14.7 and 2.8 ± 1.4, respectively. Forward flexion and external rotation improved from 98° ± 36° and 58° ± 4° to 123° ± 20° and 39° ± 8°, respectively. AHD improved from 3.9 ± 0.8 mm to 6.4 ± 2.2 mm at final follow-up. However, second-look arthroscopy examination at the average time of 7.6 months post operation confirmed a graft failure rate of 83.3%.
Conclusion: SCR using Achilles tendon–bone allograft for the treatment of IRCTs has a high graft failure rate.

Background: Arthroscopic superior capsular reconstruction (ASCR) is an option to treat the irreparable rotator cuff tears (IRCTs). However, the extent to which ASCR can be performed with regard to the patient’s age is yet to be determined. We aimed to compare the surgical outcomes in patients aged less than 65 years versus 65 years and older.
Methods: 73 Of 105 patients with IRCTs who underwent ASCR from 2013 to 2020 were enrolled. Polypropylene mesh augmentation to the graft was used in 18 patients (of the 36 patients) in group YOUNG and 20 patients (of the 37 patients) in group OLD. The clinical and radiological outcomes (graft integrity) were evaluated pre- and postoperatively.
Results: The mean age of the patients was 59.3 ± 3.6 years in group YOUNG and 71.0± 4.6 years in group OLD. Overall, the average preoperative ASES and VAS scores improved significantly at the final follow-up (p = 0.002 and 0.006, respectively). The graft healing rate was significantly greater in group YOUNG (81%) than in group OLD (65%) (p = 0.049). Subgroup analysis showed that after mesh augmentation, the healing rate in group YOUNG (84%) was similar to that of group OLD (85%) (p = 0.299).
Conclusions: ASCR resulted in a favorable surgical outcome for both young and elderly patients with IRCTs. The younger patients had lower graft failure rates and superior surgical outcomes. In elderly patients, ASCR with polypropylene mesh augmentation may reduce graft failure and result in surgical outcomes similar to that in young patients.

Purpose: To compare the surgical outcomes of arthroscopic superior capsular reconstruction (ASCR) for the treatment of irreparable rotator cuff tears (IRCTs) using fascia lata autograft versus allograft.
Methods: From March 2016 to October 2020, 38 patients met the inclusion criteria and enrolled in the study. ASCR was performed using fascia lata autograft (AUTOGRAFT group, 23 patients) and allograft (ALLOGRAFT group, 15 patients). Clinical outcomes were evaluated using ROM, the ASES score, and the VAS for pain. Radiological outcomes were evaluated using the AHD and fatty infiltration was assessed using the global fatty degeneration index (GFDI). The graft integrity status was evaluated using serial MRI and set as the primary endpoint. The surgical outcomes were compared between the two groups.
Results: Both groups showed improvement in clinical and radiological outcomes at the average follow-up of 30.7 ± 5.9 months. The ASES scores were significantly higher in the AUTOGRAFT group (87.2 ± 8.4) compared to those in the ALLOGRAFT group (70.7 ± 11.5; p = 0.045). The AHD was significantly greater in the AUTOGRAFT group (9.2 ± 2.3 mm) than in the ALLOGRAFT group (8.6 ± 1.5 mm; p = 0.042). The graft healing rate was significantly greater in the AUTOGRAFT group (87%) compared to the ALLOGRAFT group (80%; p = 0.033). The graft failure was found later than one year in the AUTOGRAFT group compared to the ALLOGRAFT group which occurred earlier than one year.
Conclusion: ASCR using fascia lata autograft is with better surgical outcome compare to allograft.

Introduction: A newly developed ultrasound procedure (AC-joint-index) for the quantitative measurement of AC joint instability is compared by with the standard X-ray procedure (panorama view with 10 kg weights).

Material and methods: 29 adult patients with acute AC joint instability (n = 10 TOSSY I, n = 11 TOSSY II and n = 8 TOSSY III) were examined both by ultrasound and X-ray measurement. The degree of AC joint separation was uniformly determined on the basis of a calculated index (AC-Index = AC-joint width of uninjured side / AC-joint width of injured side).

Results: The mean AC-index for TOSSY I instability was 1.0; 0.49 for TOSSY II instability and 0.21 for TOSSY III instability. The statistical analysis (Scheffe test) revealed significant differences between the mean AC-indices of all three groups (P < 0.0001), identical to the X-ray examinations and classification according to TOSSY.

Conclusions: We conclude that the reliability of ultrasound examination of AC joint instability is equal to that of radiographic measurement. Ultrasound measurement using the AC-index measurement is an easy to learn, reliable, side-effect-free and cost-effective method to measure AC-instability.

Introduction: Trochlear dysplasia is described as a condition where the femoral trochlea is shallow or flat in comparison with the normal V shape. This can contribute to recurrent patellar instability. Dejour classified trochlear dysplasia into four grades (Type A-D). Type C and D are considered high-grade dysplasia. Trochleoplasty is an option to treat severe trochlear dysplasia, where the aim is to provide bony stability by creating a deeper, more concave trochlear groove for the patella to track smoothly as the knee moves from flexion to extension.Objective: To assess early outcomes of Trochleoplasty with PROMs in patients diagnosed with Recurrent patellar instability and to identify significance of patient’s age and associated chondral injury in determining post operative outcome. Methods:
We evaluated the pre and post operative Norwich Patellar instability (NPI), Oxford knee score(OKS), Kujala score(KS) and pain catastrophising scale(PCS)of 16 patients who underwent trochleoplasty for high grade dysplasia and recurrent patellar instability. All patients underwent Trochleoplasty with Medial patellofemoral ligament reconstruction . Results: The average age of patients was 25 years. 7 out of 16 patients had no or grade 1 chondral injury, 4 patients had grade 4 and rest had grade 2 chondral injury. Early outcome measures showed improvement in NPI, OKS, KS and PCS. Younger patients and those with low grade chondral injury performed better. Conclusion: Trochleoplasty along with MPFL reconstruction provides good functional outcomes in patients diagnosed with recurrent patellar instability due to high-grade trochlear dyplasia. Early identification and management has proven to give better results.

Tibial spine fractures are chondroephyfiseal avulsions at the level of the ACL tibial insertion. These are infrequent fractures with a peak incidence in children and adolescents.
We present the case of a 15 year old boy who suffered a sports injury to his right knee. He was brought to the ER with significant pain and functional limitation. 80cc of hematic fluid were drained from the knee. He had anterior instability with no lateral instability associated. The x-ray diagnosed the a displaced tibial avulsion fracture, apparent on the tunnel view, and there were no associated lesions on the CT and MR scans.
Knee arthroscopy was performed 7 days after the trauma. The lesion was treated using a suture lever reduction technique - the fracture bed was prepared with a shaver. No 2 fiberwire sutures were passed near the base of the ACL insertion on the fragment. A single transtibial tunnel was drilled aiming for the posterior part of the fracture bed, avoiding the fragment. The sutures were then shuttled anterior to the fragment and into the tibial tunnel, levering down the fragment to an anatomical reduction. Tibial fixation was performed using a button.
Postoperatively, the knee was allowed active movement in a brace with ROM limitation of 0-90 in the first 3 weeks and the full weight bearing and ROM as tolerated from week 3-6. At 12 months of follow up, functional scores were VAS 0, Lysholm 96, IKDC 85,1. The patient reported no limitations on sportive activities.

Introduction: Controversy exists regarding the appropriate non-operative or surgical treatment of isolated posterior cruciate ligament (PCL) injuries, especially among high-performing athletes. We sought to assess the intervention type and time to return-to-play (RTP) in professional baseball athletes who sustained an isolated PCL injury. Methods: The MLB disability list was queried to identify professional MLB athletes with isolated PCL injuries between 2004 and 2013. Parameters included age, injury date, examination date, RTP date, and treatment intervention. A Student T-test assessed RTP time among athletes managed with non-operative or operative treatment. Results: 21 professional athletes had an isolated PCL injury, 3 of whom were excluded due to unidentified treatment. The average age at time of injury was 27.1 (95% CI [20.8 – 43.6]). Initial examination was performed 2.6 (95% CI [0.0 – 20.0]) days following injury. Of the remaining 18 injuries, 11 and 7 arose in the right and left knees, respectively. Injury type included strain/sprain (2 cases [11.1%]), PCL tear (2 cases [11.1%]), and other PCL injuries (14 cases [77.8%]). Three (16.7%) and 15 (83.3%) athletes received surgical and conservative management, respectively. The mean RTP time was 20.8 (7.0 – 66.0) days. No statistical difference was reported in RTP between intervention types (surgical: 14.0 days vs conservative: 16.0 days), p=0.17. Conclusion: There was no significant difference in RTP time among isolated PCL injuries requiring either non-surgical or surgical management.

Background: Rotator cuff injuries have traditionally been managed by either single-row or double-row arthroscopic repair techniques. Novel and more complex single-row methodologies have recently been proposed as biomechanically stronger alternative. However, no rigorous meta-analysis has evaluated the effectiveness of complex single-row against double-row repair. This meta-analysis aims to evaluate clinical outcomes in patients with full-thickness rotator cuff injuries treated with both simple and complex single-row, as well as transosseous-equivalent double-row procedures. Methods : An up-to-date literature search was performed using the pre-defined search strategy. All studies that met the inclusion criteria were assessed for methodological quality and included in the meta-analysis. Pain score, functional score, range-of-motion and Re-tear rate were all considered in the study.Results : The results of this meta-analysis suggest that there is no significant difference between complex single-row and TOE double-row in any of the observed outcomes. Similarly, the majority of included studies demonstrate equivalence of the TOE DR when compared to the simple single-row. However, the study suggests that there are significantly improved ASES functional scores and lower re-tear rates with TOE DR when compared to sSR.Conclusion : The available data in the literature would therefore advocate the use of transosseous-equivalent double-row fixation for the treatment of full thickness cuff tears. We appreciate other significant factors such as cost-effectiveness and operative-time are required in order to make informed treatment decisions. This paper has highlighted other significant limitations in the included studies where further, more extensive literature is required on the subject to draw more robust conclusions.

Introduction: Historically avulsion fractures of the tibial spine have been treated as an isolated injury. Meniscal injuries are seen in the MRI between 5% and 40% of cases, although these values are often underestimated. Case presentation: 14-year-old male child, admitted to the Emergency Department after falling from a skateboard with subsequent trauma to his left knee. He presented pain, swelling and limited active motion. X-ray and CT scan showed an avulsion fracture of the tibial spine (type III of Meyers and Mckeever classification). He underwent knee arthroscopy showing an entrapment of the anterior horn of the medial meniscus and the intermeniscal ligament. The meniscus was released, the bone fragment was reduced and reinserted with 2 suture tapes, and the limb was immobilized in extension with a cast for 3 weeks. The control X-ray showed a slight elevation of the tibial spine. After 6 months of physiotherapy, he presented 5º of knee extension deficit, performing sports without functional limitation. Discussion: Previous studies suggest an intraoperative meniscal injury rate higher than reported in the MRI assessment. Meniscal entrapment seems to be depending on the severity of the fracture and the degree of displacement. In the future, a prospective study correlating imaging and arthroscopic findings may provide additional information for clinical decision-making. Conclusion: The incidence of meniscal entrapment in the avulsion fracture of the tibial spine is underdiagnosed. The authors alert clinicians to the need of a high suspicion and individualized treatment of nonreducible type II and type III injuries.

Multi-ligament knee injuries often associated with direct high-energy trauma. Posterolateral corner (PLC) injury can be missed, predisposing to instability after cruciate ligament reconstruction. The aim is to review the literature presented in a case. A 63-year-old woman, obese, presented with knee pain and inability to walk after tripping on her dog. She objectively presented joint effusion, swelling in the fibular head, dial test with increased external rotation at 30º and 90º flexion, posterior drawer test and Lachman positive. Imaging studies demonstrated avulsion fracture of the fibula head (arcuate sign) and concomitant PLC injury with both anterior and posterior cruciate ligament injuries. She underwent PCL reconstruction using the “Versailles” technique (modified LaPrade) with ipsilateral hamstring autografts and reattachment of the biceps femoris tendon with suture anchor. One year postoperatively, she presented anteroposterior instability that compensated with the use of a fixed knee orthosis. Due to the persistence of instability, a total knee replacement was performed with a posterior stabilized prosthesis. There is no consensus regarding the order of reconstruction, although reconstruction of lateral/medial stabilizers is prioritized over cruciate ligaments and, in patients with low demand, reconstruction of the central pivot may be considered optional. There are different techniques for PLC reconstruction, the most commonly used are the Arciero and LaPrade techniques. There is controversy over which is the best technique and according to a recent biomechanics study, there is no statistically significant difference. In this case, due to low demand, personal history, and age of the patient, knee replacement was chosen.

Introduction: National Standards for Invasive Procedures guidelines (Nat SSIPs) were published by NHS England in 2015. We audited our clinical practice against recommended guidance. Methods: First cycle of the study was conducted in March 2020 on 25 patients. Results were analysed and the recommendations were published in the department. A second cycle of the study was completed in July 2020 on 16 patients during the Covid-19 outbreak. We collected the following data 1) Operation site marked prior to entry to the theatres 2) Marked on the correct side 3)If a permanent marker pen was used4) Appropriate arrow inserted 5)Marking done by the surgeon undertaking the procedure6)Marking done close to the operation site. Results: In the first cycle we noted that the first two parameters were followed in all 25 patients. In only 8/25 patients (32%) the marking was done by the surgical team who undertook the procedure and in 18/25 patients (72%) the marking was done close to the operation site. We presented the study results at the departmental clinical governance meeting & displayed educational posters. Repeat study conducted in July 2020 showed that 88% of patients had marking done by the appropriate surgical team compared to 32% in the initial study. It was noted that about 50% of patients were in plasters in the second loop hence only 38% patients had the marking done close the operation site. Conclusion: This local audit study demonstrated an improvement in the clinical practice for orthopaedic and trauma patients following the national guidelines.

Anterior cruciate ligament reconstruction using an autograft or an allograft is a routinely performed procedure. This operation is mostly done in younger individuals who lead an active lifestyle, with the aim of getting them back to their pre-injury levels of functioning. Sometimes the rehabilitation post surgery can be a very long process, because of disuse atrophy in the immediate post-operative period. Pre-habiliation physiotherapy is subjecting the patient to specific strengthening exercises in the six weeks before surgery. There have been studies which have proven the improvement with pre-habilitation physiotherapy. Our study was a randomized controlled trial of two cohorts of 20 individuals in each group ( non pre-habilitation and pre-habilitation ). We measured outcomes through patient reported outcome measures ( Lysholm knee score and Cincinnati knee score ) post operatively between the two groups and found that the group with the pre-habilitation had better scores ( statistically significant ) when compared to the control group.

Surgical treatment of acute high-grade acromioclavicular joint dislocation (Rockwood and Green III to V) remains controversial with multiple surgical techniques. The aim of this study was to evaluate the clinical and radiological outcomes of AC injury grade III to V who underwent arthroscopy-assisted double-button stabilization.
A retrospective review of patients with acute AC dislocation grade III-V submitted to stabilization with arthroscopy-assisted double button from 2013-2017, with follow-up of >6 months . Outcome was assessed by the Constant score at 6 months. The coracoclavicular distance was measured on bilateral Zanca view in the preoperative, immediate postoperative and 6 months.
19 patients, with a mean age of 34 years, with high grade AC dislocation- 7 grade III, 7 grade IV and 5 grade V. Time to surgery was in average of 12 days after injury (4-22 days). Average follow-up time was 8 months (6-14 months). Coracoclavicular distance in the immediate postoperative period was 11.5 (10.5-16mm), overlapping the contralateral, at 6 months there was an increase in the mean distance to 12.2 (10.8-17, 5). Average postoperative Constant score was 86. There was no record of infections or material intolerance, there was a case of partial reduction due to incorrect positioning of the clavicular button requiring re-operation.
The use of the double-button system allows the reduction of the acromio-clavicular joint and the coraco-clavicular space, with approximation of the injured ligament, allowing healing. Arthroscopic stabilization is less invasive, allows the assessment and treatment of associated intra-articular lesions and allows a better view of the coracoid.