No abstract

Anterior cruciate ligament (ACL) reconstruction, using an ipsilateral hamstring graft, may necessitate an alternative graft source if the obtained graft is insufficient with regards to length or diameter. The study aims to determine the rate of insufficient ipsilateral hamstring graft harvesting in primary ACL reconstruction. Retrospective review of 50 consecutive primary ACL reconstructions performed by a single surgeon in the United Kingdom. In 3 of 50 cases, there was insufficient ipsilateral hamstring graft harvesting and a contralateral hamstring graft was used. In two cases, this was due to premature division of the ipsilateral hamstring tendons (3/100 harvested tendons). In one case, an adequate length of semitendinosus was obtained, but its central portion was too thin. Retrospective review of preoperative magnetic resonance imaging identified the thin part of the tendon in the latter case. Insufficient ipsilateral hamstring graft harvesting is a recognized, yet unusual intraoperative complication in primary ACL reconstruction. Presurgical planning as to how to manage such complications is essential.

Patients who had arthroscopic shoulder surgery with the provision of an inter-scalene nerve block (ISB) at Blackpool Teaching Hospitals, were previously required to remain in hospital overnight. We introduced a new protocol that allowed same day discharge following arthroscopic shoulder surgery under general anaesthesia and ISB. The aim of this study was to review the outcome of this change in practice. Our results indicated that providing a discharge protocol for patients having arthroscopic shoulder surgery with the inclusion of ISB can avoid unnecessary overnight stay and enable significant cost savings, without detriment to patient safety or satisfaction.

AimsFrozen shoulder is a common, painful condition that results in impairment of function. Corticosteroid injections are commonly used for frozen shoulder and can be given as glenohumeral joint (GHJ) injection or suprascapular nerve block (SSNB). Both injection types have been shown to significantly improve shoulder pain and range of motion. It is not currently known which is superior in terms of relieving patients’ symptoms. This is the protocol for a randomized clinical trial to investigate the clinical effectiveness of corticosteroid injection given as either a GHJ injection or SSNB.MethodsThe Therapeutic Injections For Frozen Shoulder (TIFFS) study is a single centre, parallel, two-arm, randomized clinical trial. Participants will be allocated on a 1:1 basis to either a GHJ corticosteroid injection or SSNB. Participants in both trial arms will then receive physiotherapy as normal for frozen shoulder. The primary analysis will compare the Oxford Shoulder Score (OSS) at three months after injection. Secondary outcomes include OSS at six and 12 months, range of shoulder movement at three months, and Numeric Pain Rating Scale, abbreviated Disabilities of Arm, Shoulder and Hand score, and EuroQol five-level five-dimension health index at three months, six months, and one year after injection. A minimum of 40 patients will be recruited to obtain 80% power to detect a minimally important difference of ten points on the OSS between the groups at three months after injection. The study is registered under ClinicalTrials.gov with the identifier NCT04965376.ConclusionThe results of this trial will demonstrate if there is a difference in shoulder pain and function after GHJ injection or SSNB in patients with frozen shoulder. This will help provide effective treatment to patients with frozen shoulder.Cite this article: Bone Jt Open 2023;4(3):205–209.

We report a case of pulmonary embolism occurring transiently during impaction of morsellized bone graft in the femoral medullary canal as a part of revision hip arthroplasty. To our knowledge this complication has not yet been reported during impaction bone grafting. Increased awareness would lead to use of monitoring devices and early intervention during revision hip surgery. (Hip International 2004; 14: 48-50).