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The results of reconstructing the torn anterior cruciate ligament using the bone-block iliotibial-tract transfer in thirty-seven patients were reviewed. After the operation, only one patient considered the function of the knee to be normal, but most (all but four) could participate in moderately strenuous work activities and some sports activities. The athletes who were operated on rarely were able to return to their pre-injury level of activity. Most of the patients continued to have clinical evidence of deficiency of the anterior cruciate ligament. All but five had a positive Lachman test and most had a positive pivot-shift sign. Fifteen results were rated satisfactory and ten were rated poor. Because of these disappointing results we have discontinued using the procedure.

The anterior distal part of the iliotibial trace with attached bone block from Gerdy's tubercle was used as an intra-articular graft fixed by a screw to the tibia to control anterior instability (otherwise known as anterior, anteromedial, or anterolateral laxity) in twenty-four knees which were followed for two to four years. Concomitant single-plane 2+ to 4+ medial instability was present in eleven knees and was treated in five of them by simple immobilization, by imbrication of the medial collateral ligament, or by the Vigliani procedure. At follow-up, stability was improved and the result was rated good or excellent in twenty-one (88 per cent) of the twenty-four knees. The operation is applicable to the majority of chronic laxities of the knee and, because no immobilization is necessary, the postoperative care is much simplified and the rehabilitation time is much shorter. The procedure is contraindicated where there is posterior or single-plane lateral laxity.

An operation is described in which the medial head of the gastrocnemius is firmly fixed by a cancellous screw, through an attached bone block, to the medial femoral condyle to serve as an intraarticular graft for the control of chronic posterior instability of the knee. This procedure was done in eight patients, with a follow-up of twenty-nine to forty-eight months. The delay from injury to reconstruction averaged forty-two months (range, five to eighty-four months). At follow-up, stability was improved in all of the eight patients and the result was rated as good or excellent in six of them. One failure was due to unrelieved pain and in another patient a second injury led to reoperation. Because minimum immobilization is necessary, the postoperative care with this procedure is simplified and the period of rehabilitation is shorter.

Lumbosacral fusion must be considered in light of the newer concepts developed through surgical treatment of herniated intervertebral discs. Structural faults must be re-evaluated. Stabilization by fusion is still the treatment of choice in lumbosacral instability, irrespective of the spectacular results obtained after removal of the disc without fusion. Pseudarthrosis, especially of the fourth and fifth lumbar segments, has been found frequently after the regular types of fusion, and a special technique is necessary. The technique described for accurately impacting a mortised transfacet bone block under interlaminal distraction has the following advantages: 1. The period of confinement in bed is increased very little over that required for simple removal of a herniateti disc. 2. The fusion technique adds thirty minutes or less to the time involved in removing a herniated disc. 3. There is a minimum amount of mutilation of the spinal structures. 4. The articular facets are fused, which is of mechanical advantage. 5. The bone block rigidly stabilizes interlaminal motion, immediately after being countersunk into position. 6. Extension of the spine after operation locks the bone grafts firmly into position.

Actual recurrent dislocation of the hip unassociated with acetabular fracture, congenital dysplasia, sepsis, or paralysis is very rare. Before 1945 only seven such instances had been reported. In the eighth case, which has been presented in this paper, the condition was treated by surgical reinforcement of the posterior superior supports of the hip (with a bone block) and by fascial repair of the capsule.

This paper, as stated in the introduction, is presented to redirect attention to a primary orthopaedic problem; to describe techniques to correct triceps surae dysfunction; to emphasize the importance of correcting deformities caused by spasticity or tension in the tensor fasciae latae; to point out deformities in the foot which can be corrected and controlled by the Grice bone block; and to emphasize the importance of correcting all deformities before instituting rehabilitation in the cerebral palsy patient. The examination of 977 cerebral palsy patients at the North Carolina Cerebral Palsy Hospital and an uncalculated number in associated clinics from February 1950 to May 1954 has afforded an opportunity to evaluate many cerebral palsy problems. The opinions expressed are based on the results seen following 590 operative procedures carried out in 186 patients. The type of surgery performed is shown in Table II. With the present widespread and professional lay interest in cerebral palsy, it is hoped that these and other well established orthopaedic surgical procedures can be used to the benefit of the cerebral palsy patient, and that new procedures will be developed that will further advance surgery in this difficult field.

1. Posterior bone block of the ankle is productive of permanent satisfactory correction of drop-foot deformity in a high percentage of cases. 2. If possible, the operation should be performed when the patient is between ten and twenty years of age. 3. It should be done in conjunction with arthrodesis of the talonavicular, subtalar, and calcancocuboid joints. Care should be exercised to preserve the circulation of the talus. 4. Tendon transference should be done, when possible, after the principles laid down by Peabody and Crego and McCarroll. Better results are obtained when there is a balance of power between dorsiflexors and plantar flexors of the ankle. 5. We prefer an intra-articular block, placed immediately posterior to the talus, so that it will impinge on the posterior lip of the tibia. 6. This operation should be reserved for those patients who can be rendered bracefree thereby.