Isolated medial patellofemoral ligament reconstruction significantly improved quality of life in patients with recurrent patella dislocation.

PURPOSE: The purpose of this study was to measure the improvement in quality of life (QoL) following isolated anatomical double-bundle medial patellofemoral ligament reconstruction. METHODS: This is a single-centre, prospective study of 56 consecutive patients (57 knees) who underwent isolated MPFL reconstruction between 2014 and 2017. Functional outcome and QoL were assessed with the Kujala score and the EQ-5D-3L questionnaire, respectively. Objective outcomes were obtained through clinical examination at the latest follow-up assessing redislocation rate, patella apprehension test, patellar tilt, pain and range of motion. RESULTS: The median Kujala score increased from 60 (range 31-96) to 92 (range 34-100) at latest follow-up (p < 0.001). The median EQ-5D index also increased, from 0.69 (range 0.10-1) at baseline to 1 (range 0.16-1) at latest follow-up (p < 0.001), as well as the median EQ-5D VAS from 75 (range 20-95) to 92 (range 40-100) (p < 0.001). Four dimensions of the EQ-5D were significantly improved except for the anxiety/depression scores. Female patients reported lower scores at baseline and at latest follow-up, for all three outcomes (Kujala, EQ-5D index, EQ-5D VAS), however there was no evidence that gender negatively impacted on the benefit of surgery. The re-dislocation rate was 0%. Apprehension and patellar tilt test were negative in all patients and no flexion deficit was identified at latest follow-up. Two patients had tenderness along the reconstruction requiring femoral screw removal in one of them. CONCLUSIONS: Isolated anatomical double-bundle aperture MPFL reconstruction, offered significantly improved short-term QoL along with excellent functional outcome. Female patients scored lower, but this did not affect the overall outcome. Including QoL tools in the assessment of ligament reconstruction operations, such as the MPFL, can provide more accurate understanding of the overall patient benefit. LEVEL OF EVIDENCE: II.

Outcomes in the elderly patient following enhanced recovery pathways for elective lower-limb arthroplasty surgery.

INTRODUCTION: Enhanced recovery pathways (ERPs) have been shown to reduce both morbidity and mortality, as well as length of stay, in very elderly patients undergoing joint replacement surgery. However, their impact on patient-reported outcome measures (PROMs) in this vulnerable cohort of patients has not previously been investigated. METHODS: Oxford Hip and Knee Scores were collected pre- and postoperatively for patients undergoing joint replacement surgery at Wrexham Maelor Hospital, along with data on patient demographics. RESULTS: Of the 646 who had total hip replacements, 32 (4.95%) were aged 85 years or over, and of the 875 who had total knee replacements, 39 (4.46%) were aged 85 years or over. Similarly to younger patients, those over the age of 85 years saw a benefit in the outcome at 6 months and 24 months following elective hip and knee arthroplasty on an ERP. This was reflected by a significant increase in the outcome scores at 6 months postoperatively in both age groups undergoing either a total hip replacement or total knee replacement. CONCLUSIONS: We found no detrimental effect of ERPs on PROMs data in older patients. In fact, these patients saw a similar benefit in outcome following elective hip and knee arthroplasty as the younger cohort.

An observation of massive lumbar disc prolapse.

BACKGROUND: The aim of this study was to investigate whether massive lumbar disc herniations (LDH) can be managed safely with non-operative treatment. Whilst most LDH are treated successfully with analgesia and physiotherapy, there is little literature regarding the treatment of massive LDH. Their impressive size raises the suspicion that they may cause cauda equina syndrome and are therefore often treated surgically. METHODS: Patients were referred to our tertiary unit by either their general practitioner or the musculoskeletal service. To be included in the study, patients had to have a diagnosis of massive LDH on their initial magnetic resonance imaging (MRI) and opt for non-operative treatment. Seventeen patients with a diagnosis of massive LDH with an average follow-up of 209 days (0 to 1,005 days) were reviewed. RESULTS: One patient was listed for surgery due to persisting radicular pain only. However, they were deemed unfit for surgery and this was therefore cancelled. One patient developed impending cauda equina syndrome and underwent urgent discectomy with no complications. All remaining patients were managed safely non-operatively with no complications. CONCLUSIONS: We conclude that the massive LDH can be safely managed non-operatively, providing patients are examined for cauda equina syndrome and are fully educated on the need to represent urgently should red-flag symptoms develop.

Mycobacterium chelonae hand infection: a review.

Six cases of culture-proven Mycobacterium chelonae tenosynovitis were identified through retrospective chart review. Fifteen cases were identified using computerised Medline search. Clinical features, treatment and outcome were described. Infection control was achieved in our patients with an average of 3.2 surgeries each and antibiotic treatment for six months to one year. Eleven published cases were managed by combined surgery and systemic antibiotics, with an average of 1.73 surgeries per patient and seven weeks to 24 months of antibiotics. All our patients were disease free on final follow-up. Thirteen cases were resolved. Functional outcomes were reported for eight cases. Comparison of functional outcome was not possible because different parameters were used in different reports. Aggressive debridement, susceptibility-guided antibiotics, and supervised rehabilitation resulted in infection control and acceptable hand function for our patients. Standardised data collection on subsequent cases would facilitate outcome monitoring and formulation of a treatment guideline for this disease.