In this community-based sample followed from primary ACLR to revision ACLR, the prevalence of articular cartilage injuries increased, while the prevalence of meniscus injuries decreased. The higher prevalence of articular cartilage injuries at revision ACLR may represent new injuries. The lower prevalence of meniscus tears at revision ACLR may be caused by susceptible menisci being injured and treated at primary surgery or by changes in knee kinematics or injury exposure patterns.

The introduction of totally implantable venous access devices (TIVAD) has provided a solution to difficult venous access in patients with cystic fibrosis. Early reports have, however, recognized a number of complications with their use. We report our experience with five devices used over 8 yrs with regard to complications and patient attitudes. Patients' notes were reviewed to record the details of TIVAD insertion, duration of function, and complications. In January 1996 the surviving 30 patients were surveyed on their attitudes to TIVAD and complications by written questionnaire. Sixty one ports were implanted in 42 patients (aged 16-47 yrs) between June 1988 and January 1996, giving a total of 1,510 patient-months' experience. The duration of function ranged from 2 weeks to 6 yrs. Survival analysis showed that the median survival of ports was 53 months, 42 out of 61 (69%) had not failed in service at the end of follow-up or patient death. Twenty-three complications occurred in 19 patients. These included: line occlusion (10 patients), venous thrombosis (4), difficult access (3), infection (2), cellulitis (1), inversion of port chamber (2) and pneumothorax (1). The questionnaire showed that patients had strong views on the positioning of their port. Lifestyle issues included interference with seatbelts (8 patients), sport (4), clothing (2), sexual relations (2) and cosmetic appearance (15). Complication rates were similar to those in other studies, although infection rates and salvage of an occluded port were lower. The survey highlighted a number of lifestyle issues, with cosmetic appearance deemed unsatisfactory by half of the patients. However, the majority (28 out of 30) believed their totally implantable venous access devices to be a better alternative to cannulae or long lines.

PECS was developed in Delaware, USA over 10 years ago by Bondy and Frost (1994a). Over the last two years PECS has been introduced to this country and has raised a great deal of interest in people working in the field of autistic spectrum disorders (ASD). This paper will address some of the issues that arose during the establishment of PECS in one special school. Changes seen in 21 children with severe learning difficulties who have been taught to use PECS are reported and the use of PECS with children who do not have an ASD is discussed.

Type 31-A2 fractures become increasingly unstable with increased medial comminution (or fragment size). SHS-P constructs were more load sharing than SHS-IMN constructs. These findings may help guide the surgeon in choice of implant for a 31-A2 intertrochanteric fracture, leaning toward SHS-IMN for the more unstable fracture patterns.