Requests for reprints should be sent to Mr J. Ireland. We are indebted to the Photographic Department of the Institute of Orthopaedics and to Miss Kathleen Ockendon for the illustrations and to Mrs Elisabeth Scott for her invaluable administrative and secretarial work.

A series of 135 knee arthroscopies has been reviewed to determine the accuracy of detection of meniscal lesions. Arthroscopy and double-contrast arthography achieved similar accuracy (84 per cent and 86 per cent) in the diagnostically more difficult knees of the series. The combined accuracy of both examinations was 98 per cent. Arthroscopic difficulty in seeing the posterior third ofthe medial meniscus, and consequently tears in this region, is emphasised and discussed. Arthroscopy and arthrography are complementary in the diagnosis of difficult meniscal problems.

We have reviewed 40 patients after replacement of a ruptured anterior cruciate ligament with a free graft of the medial third of the patellar tendon, combining this in 17 of the cases with a MacIntosh extra-articular tenodesis. The average age of the patients at operation was 25.4 years; instability of the knee had been present for 1.5 to 9 years, and the mean follow-up was 2.9 years. The results, assessed on subjective stability, were good in 29 patients, over half being able to return to their original sport, and fair in eight. The technique of operation for free patellar tendon grafting is described in detail and the indications for this and for an additional MacIntosh tenodesis are discussed.

A simple technique for screw fixation of the carpal scaphoid in cases of delayed union and non-union is described.

No abstract