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Background: Physiotherapists are often key decision‐makers on when to refer patients with recurrent patellar dislocation for surgical opinion. Limited guidance exists to aid this decision. Differences in orthopaedic surgeons' and physiotherapists' views on which patients and when to refer people for surgical consideration or non‐operative care may affect outcome. This study aimed to explore orthopaedic surgeons and physiotherapists decision‐making surrounding treatment opinions for patients with recurrent patellar dislocation. Methods: An online survey performed. UK registered and practicing orthopaedic surgeons and physiotherapists were invited to participate. The survey utilised two vignettes and a series of related questions to ascertain respondents' views on decision‐making to surgical referral for people with recurrent patellar dislocation. Data were analysed using descriptive statistics and inferential statistical tests to explore factors related to responses. Results: Eighty four respondent surveys were analysed (38 surgeons, 46 physiotherapists). Overall, there was a low level of agreement amongst respondents for the management of the vignettes (k = 0.215, p = < 0.0005). Some disparity existed between the professions on the definition of recurrent patellar dislocations and the clinical features which may require an early surgical assessment. Physiotherapists were three times more likely to delay a surgical opinion for the vignettes presented in this study than the surgeons. Conclusion: This is the first study to investigate orthopaedic surgeons' and physiotherapists' views on decision‐making around surgical or non‐operative management for recurrent patellar dislocations. High‐quality research is required to underpin explicit guidance on decision‐making regarding management of recurrent patellar dislocation. [ABSTRACT FROM AUTHOR]

Purpose: The position of the osseous tunnels and graft during anterior cruciate ligament (ACL) reconstruction has been the subject of multiple studies aiming for either anatomical placement or an alternative. The assessment of these positions, using post-operative imaging, is therefore of interest to the surgeon in both the evaluation of surgical performance and surveillance of potential complications. The purpose of this review is to identify the optimal use of imaging in both the surveillance of clinical practice and in planning revision surgery.Methods: A comprehensive systematic review was performed using Medline and Pubmed searches to identify radiological methods used to assess ACL reconstruction tunnel position. Commonly used methods were identified with correlation to either native anatomy or clinical results.Results: The findings suggest that plain radiographs can be used to assess tunnel position and identify grafts that are positioned non-anatomically and may be at increased risk of complications. Computer tomography (CT) offers additional information about the tunnel aperture shape and size that is of importance for revision surgery and research projects whilst magnetic resonance imaging (MRI) provides further assessment of both graft integrity and associated soft tissue damage.Conclusion: In the surveillance of routine clinical practice, plain radiographs are sufficient to define tunnel position. The additional information provided by three-dimensional imaging is only required in revision surgery or research studies.Level Of Evidence: IV. [ABSTRACT FROM AUTHOR]

Purpose: The aim of the study was to determine the in vitro effects of plasma-mediated bipolar radiofrequency ablation on human chondrocyte compensatory proliferation and inflammatory mediator expression., Methods: Human articular cartilage biopsy specimens, from total knee replacement, and human chondrocytes in alginate culture, from patients undergoing autologous chondrocyte implantation, were exposed to plasma ablation with a Paragon T2 probe (ArthroCare, Austin, TX). Instantaneous chondrocyte death was investigated with live/dead assays of biopsy specimens and cell cultures. Chondrocyte proliferation was determined by Hoechst staining of DNA on days 3 and 6. Messenger RNA expression of IL-1β, IL-6, IL-8, tumor necrosis factor α, high-mobility group protein B1, matrix metalloproteinase 13, type IIA collagen, and versican was determined on days 3 and 6., Results: Live/dead imaging showed a well-defined local margin of cell death ranging from 150 to 200 μm deep, both in the alginate gel and in the biopsy specimens exposed to plasma ablation. The ablation-exposed group showed a significant proliferation increase compared with control on day 3 (P < .043). There were significant increases compared with control in IL-6 expression on day 3 (P < .020) and day 6 (P < .045) and in IL-8 expression on day 3 (P < .048). No differences were seen for IL-1β, tumor necrosis factor α, high-mobility group protein B1, matrix metalloproteinase 13, type II collagen, or versican., Conclusions: This study has shown that exposure to plasma-mediated ablation induces a well-defined area of immediate cell death and a short-term increase in proliferation with human articular chondrocytes in vitro. The exposure also alters cytokine expression for the same period, causing upregulation of IL-6 and IL-8., Clinical Relevance: The results show the potential of plasma-mediated ablation to cause the onset of a tissue regeneration response with human articular cartilage., (Copyright © 2012 Arthroscopy Association of North America. All rights reserved.)

We present a review of the current literature surrounding the use of radiofrequency energy for arthroscopic chondroplasty in the knee. This review article summarizes basic science, clinical efficacy, and recent advances in the understanding of radiofrequency energy use for the treatment of chondral lesions. Laboratory evidence of increased mechanical stability and decreased release of inflammatory mediators associated with the use of radiofrequency energy chondroplasty is described with clinical evidence of decreased pain and increased functional scores when compared with mechanical chondroplasty. We re-examine concerns about the immediate side effects of radiofrequency energy use, including damage to local structures, in light of new potentially contradictory results, as well as the progression of techniques and probe design. However, although reported complications are few, because the quality of clinical evidence about safety and efficacy remains low, we suggest cautious and judicious use of this technology until future research has clearly defined the long-term clinical outcomes and risks., (Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Musculoskeletal complications following chickenpox are rare among immunologically normal children. Septic arthritis after varicella is caused by group A Streptococcus and affects the knee most frequently. We present a case of septic arthritis of the elbow caused by Staphylococcus aureus. We review the English language literature on septic arthritis complicating chickenpox. We conclude that diagnosis and treatment should be carried out according to guidelines on de novo septic arthritis including the early use of magnetic resonance imaging.

Dupuytren's disease commonly affects men over the age of 40 years. It is very rare to find it in the paediatric age group. We describe a case of histologically proven Dupuytren's disease in a 10-year-old boy who presented with a nodule in his palm. Dupuytren's disease should be considered in the differential diagnosis of a nodule in hand or contracture of a finger joint in the paediatric age group.