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Finite element analysis (FEA) is a fundamental tool that can be used in the orthopaedic world to simulate and analyze the behaviour of different surgical procedures. It is important to be aware that removing more than 20% of the meniscus could increase the shear stress in the cartilage and enlarge the risk of knee joint degeneration. In this fact, the maximal shear stress value in the medial cartilage increased up to 225% from 0.15 MPa to 0.5 MPa after medial meniscectomy. Also, meniscal root repair can improve meniscal biomechanics and potentially reduce the risk of osteoarthritis, even in cases of a loose repair. FEA has been used to better understand the biomechanical role of cruciate ligaments in the knee joint. ACLr with bone-patellar tendon-bone graft at 60 N of pretension and double-bundle PCLr were closer to that of a native knee in terms of biomechanics. The addition of a lateral extra-articular augmentation technique can reduce 50% of tibial translation and internal rotation, protecting the graft and minimizing the risk of re-rupture. Interestingly, anatomic and non-anatomic medial patellofemoral ligament reconstruction increased the pressure applied to the patellofemoral joint by increasing patellar contact pressure to 0.14 MPa at 30° of knee flexion using the semitendinosus as a graft. After all the advances in medical imaging technologies, future studies should take into consideration patient-specific data on both anatomy and mechanics, in order to better personalize the experimental model.

Ganglion cysts are commonly found in areas of constant mechanical stress such as the joints and tendons of the wrist or hand as well as the anterior aspect of the ankle. In the knee, parameniscal cysts are often encountered secondary to meniscal tears or articular degeneration. Intra-articular ganglion cysts are uncommon and often arise from the cruciate ligaments and are found in the intercondylar notch. However, ganglion cysts arising from collateral ligaments are very rare. We present a rare case of a boy in early childhood with non-specific medial joint line swelling and discomfort and was diagnosed with a medial collateral ligament ganglion cyst after multimodality imaging. To our knowledge, this is the first case documented in children., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Aims: The aim of this audit was to assess and improve the completeness and accuracy of the National Joint Registry (NJR) dataset for arthroplasty of the elbow., Methods: It was performed in two phases. In Phase 1, the completeness was assessed by comparing the NJR elbow dataset with the NHS England Hospital Episode Statistics (HES) data between April 2012 and April 2020. In order to assess the accuracy of the data, the components of each arthroplasty recorded in the NJR were compared to the type of arthroplasty which was recorded. In Phase 2, a national collaborative audit was undertaken to evaluate the reasons for unmatched data, add missing arthroplasties, and evaluate the reasons for the recording of inaccurate arthroplasties and correct them., Results: Phase 1 identified 5,539 arthroplasties in HES which did not match an arthroplasty on the NJR, and 448 inaccurate arthroplasties from 254 hospitals. Most mismatched procedures (3,960 procedures; 71%) were radial head arthroplasties (RHAs). In Phase 2, 142 NHS hospitals with 3,640 (66%) mismatched and 314 (69%) inaccurate arthroplasties volunteered to assess their records. A large proportion of the unmatched data (3,000 arthroplasties; 82%) were confirmed as being missing from the NJR. The overall rate of completeness of the NJR elbow dataset improved from 63% to 83% following phase 2, and the completeness of total elbow arthroplasty data improved to 93%. Missing RHAs had the biggest impact on the overall completeness, but through the audit the number of RHAs in the NJR nearly doubled and completeness increased from 35% to 70%. The accuracy of data was 94% and improved to 98% after correcting 212 of the 448 inaccurately recorded arthroplasties., Conclusion: The rate of completeness of the NJR total elbow arthroplasty dataset is currently 93% and the accuracy is 98%. This audit identified challenges of data capture with regard to RHAs. Collaboration with a trauma and orthopaedic trainees through the British Orthopaedic Trainee Association improved the completeness and accuracy of the NJR elbow dataset, which will improve the validity of the reports and of the associated research., Competing Interests: Z. Hamoodi reports research fellowship funding from Royal College of Surgeons, National Joint Registry, and The John Charnley Trust, related to this study. A. Sayers is senior statistician on the HQIP/NJR Lot 2 contract. M. R. Whitehouse is the principal investigator for the HQIP/NJR Lot 2 contract to provide statistical support, analysis and associated services to the NJR, related to this study, and reports multiple grants or contracts from the NIHR and Ceramtec, royalties or licenses from Taylor & Frances, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Heraeus, all of which are unrelated to this study. A. C. Watts reports royalties or licenses and patents planned, issued or pendingfrom Adler, consulting fees from Medartis, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Medartis, Stryker, and Arthrex, all of which are unrelated to this study, and is also a member of the editorial boards of the National Joint Registry and The Bone & Joint Journal., (© 2024 The British Editorial Society of Bone & Joint Surgery.)