Purpose: The aim of the study is to show, on an MRI scan, that the posterior border of the anterior horn of the lateral meniscus (AHLM) could guide tibial tunnel position in the sagittal plane and provide anatomical graft position.Method:One hundred MRI scans were analysed with normal cruciate ligaments and no evidence of meniscal injury. We measured the distance between the posterior border of the AHLM and the midpoint of the ACL by superimposing sagittal images.Results:The mean distance between the posterior border of the AHLM and the ACL midpoint was -0.1mm (i.e. 0.1mm posterior to the ACL midpoint). The range was 5mm to -4.6mm. The median value was 0.0mm. 95% confidence interval was from -0.5 to 0.3mm. A normal, parametric distribution was observed and Intra- and inter-observer variability showed significant correlation (p<0.05) using Pearsons Correlation test (intra-observer) and Interclass correlation (inter-observer).Conclusion:Using the posterior border of the AHLM is a reproducible and anatomical marker for the midpoint of the ACL footprint in the majority of cases. It can be used intra-operatively as a guide for tibial tunnel insertion and graft placement allowing anatomical reconstruction. There will inevitably be some anatomical variation. Pre-operative MRI assessment of the relationship between AHLM and ACL footprint is advised to improve surgical planning.Level of Evidence:Level 4.

Aim: To determine whether radiological criteria can be used to guide the method of treatment of diaphyseal paediatric forearm fractures to MUA only or surgical intervention with either IMN or ORIF.Method: All cases of paediatric diaphyseal forearm fractures in children aged 5-12 presenting to our institution between 2006 and 2010 were reviewed (53 cases). Index radiographs were graded by AO classification, the presence of single or both bone injuries, apex dorsal or volar patterns, degree of cortical contact and fracture angulation. The duration of post-operative immobilisation, surgical complication and final clinical outcome and was also assessed.Results: The predominant fracture pattern was AO type 22-D/4.1. Both bones were involved in 87% of cases, and fractures occurred at the same level in 92%. 91% of fractures were apex volar, and the majority (87%) were complete. 32 fractures were treated with MUA, 16 with IMN, and 5 with ORIF. Sagittal plane deformity was not predictive of treatment method, this was maximal in the cohort treated with MUA only (34 • vs. 21 • with IMN and 19 • with ORIF). Cortical contact was not predictive of treatment method (83% with MUA vs. 49% with IMN and 73% with ORIF). Statistical analysis did not reveal any correlation between the radiographic indices of the fracture and the subsequent surgical treatment. All injuries went onto clinical and radiographic union with minimal complication.Conclusion: No single radiological criterion is predictive of fracture stability. Therefore the surgeon must be prepared to proceed to surgical intervention if MUA fails. This information will aid the planning of trauma lists where a shortfall exists between the ability of the surgeon to perform simple manipulation and the definitive surgical procedure.

Background: Femoral lengthening is associated with high complication rates often related to the type of surgical device used to perform the lengthening. The advent of intramedullary lengthening devices has promised a reduction in complications when compared with external fixation systems. The purpose of this study was to compare the clinical outcomes of femoral lengthening in children using a motorized intramedullary nail (Precice) versus an external fixation system (Taylor Spatial Frame—TSF; or Monolateral Rail System—MRS) at a single institution, single surgeon practice. Methods: This study is a retrospective comparison of pediatric patients who had previously undergone femoral lengthening (±deformity correction). Patients ages 8 to 18 years of age were included and grouped based on whether they had undergone Precice nailing or external fixation (TSF or MRS) between 2010 and 2019. Results: Twenty-seven patients (32 femurs) were included. Thirteen patients (15 femurs) had undergone Precice nailing and 14 patients (17 femurs) had undergone external fixation. The Precice group had significantly fewer problems, obstacles, and complications than the external fixation group, Precice 6.6%, 0%, 0%, respectively, and external fixation 47.1%, 29.4%, 0% respectively (P<0.01). Unplanned return to the operating room occurred in 4 cases, solely in the external fixation group. There were no differences in percentage of goal length achieved, Precice (mean 93.6%, range: 66.7% to 114.3%), external fixation (mean 96%, range: 76.9% to 117.5%) P=0.31 and total length achieved, Precice (mean: 44 mm, range: 20 to 80 mm), external fixation (mean: 46 mm, range: 10 to 70 mm) P=0.72. There was no difference in consolidation index, Precice (24.1 d/cm), external fixation (28.5 d/cm) P=0.36. The Precice group had a significantly shorter length of stay (mean: 2.2 d, range: 1 to 4 d), compared with the external fixation group (mean: 3.7 d, range: 2 to 8), P=0.01. Conclusions: Femoral lengthening in children using a motorized intramedullary nail was associated with a markedly reduced rate of complications and shorter length of stay compared with external fixation. Level of Evidence: Level III.