Neglected patella tendon ruptures require reconstruction using tendon grafts. The LARS ligament has been successfully used in cruciate and collateral knee ligament reconstruction. We present a technique using LARS ligament for the reconstruction of a chronic patella tendon rupture in a low-demand patient. The result after 1-year follow-up was deemed successful.

Cobb described a method of reconstruction in Johnson and Strom Type II tibialis posterior dysfunction (TPD) using a split tibialis anterior musculotendinous graft. We assessed patient function and satisfaction after a modified Cobb reconstruction in a group of patients with a narrow spectrum of dysfunction, examined a modification of the Johnson and Strom classification to emphasize severity of deformity, and assessed the ability of the technique to prevent subsequent fixed deformity. We prospectively followed 32 patients managed by this technique and a translational os calcis osteotomy with early flexible deformity after failed conservative treatment. There were 28 women and four men with unilateral disease. The average followup was 5.1 years. Staging was confirmed clinically and with imaging. The modified surgery involved a bone tunnel in the navicular rather than the medial cuneiform with plaster for 8 weeks followed by orthotics and physiotherapy.

The use of the 70 arthroscope in knee surgery is not a new concept, and it is frequently used in posterior cruciate ligament reconstruction. There are previous reports of its use in anterior cruciate ligament surgery, but it has not achieved routine use. With the move toward anatomic anterior cruciate ligament reconstruction, it is recognized that accurate tunnel placement is vital for a good clinical outcome. Visualization of the femoral and tibial footprints can be variable with the use of only an anterolateral viewing portal, and it may be necessary to create accessory anteromedial portals, which can cause problems with instrument crowding. Overall, the 70 arthroscope provides an excellent view of the femoral and tibial footprints and a view of the full length of the femoral and tibial tunnels through a single anterolateral viewing portal.

INTRODUCTIONWe sought to validate radiographic measurements of range of motion of the knee after arthroplasty as part of a new system of virtual clinics.METHODSThe range of motion of 52 knees in 45 patients was obtained by 2 clinicians using standardised techniques and goniometers. Inter-rater reliability and intraclass correlation coefficients (ICCs) were calculated. Radiographs of these patients’ knees in full active flexion and extension were also used to calculate intra and inter-rater reliability compared with clinical measurements using four different methods for plotting angles on the radiographs.RESULTSThe ICC for inter-rater reliability using the goniometer was very high. The ICC was 0.91 in extension and 0.85 in flexion while repeatability was 8.49° (-8.03–8.99°) in extension and 5.23° (-4.54–5.74°) in flexion. The best ICC for radiographic measurement in extension was 0.86, indicating ‘near perfect’ agreement, and repeatability was 5.43° (-4.04–6.12°). The best ICC in flexion was 0.95 and repeatability was 5.82° (-3.38–6.55°). The ICC for intrarater reliability was 0.98 for extension and 0.99 for flexion on radiographic measurements.CONCLUSIONSValidating the use of radiographs to reliably measure range of motion following knee arthroplasty has allowed us to set up a ‘virtual knee clinic’. Combining validated questionnaires and radiographic measurement of range of motion, we aim to maintain high quality patient surveillance following knee arthroplasty, reduce our ratio for new to follow-up patients in line with Department of Health guidelines and improve patient satisfaction through reduced travel to hospital outpatients.