Orthopaedics and Trauma RSS feed: Current Issue. Orthopaedics and Trauma presents a unique collection of International review articles summarizing the current state of knowledge and research in orthopaedics. Each issue focuses on a specific topic, discussed in depth in a mini-symposium; other articles cover the areas of basic science, medicine, children/adults, trauma, imaging and historical review. There is also an annotation, self-assessment questions and a 'second opinion' section. In this way the entire postgraduate syllabus will be covered in a 4-year cycle.http://www.orthopaedicsandtraumajournal.co.uk/?rss=yesElsevier Inc.en © 2010 Published by Elsevier Inc. All rights reserved. Orthopaedics and Trauma1877-1327242April 2010 © 2010 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132710000540/abstract?rss=yesEditorial Board10.1016/S1877-1327(10)00054-0Orthopaedics and Trauma 24, 2 (2010)2010-04-01Orthopaedics and Trauma2010-04-01242S1877-1327(10)X0003-3iihttp://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132710000400/abstract?rss=yesThis edition of Orthopaedics and Trauma contains a mini-symposium on ‘Soft Tissue Surgery in the Knee’. The mini-symposium has aimed to cover some of the most important and most common areas of soft tissue knee surgery, but naturally cannot be comprehensive or exhaustive.EditorialIan McDermott10.1016/j.mporth.2010.03.015Orthopaedics and Trauma 24, 2 (2010)2010-04-01Orthopaedics and Trauma2010-04-01242S1877-1327(10)X0003-3Mini-Symposium: Soft Tissue Surgery in the Knee8383http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132710000308/abstract?rss=yesAbstract: The knee joint has biomechanical roles in allowing gait, flexing and rotating yet remaining stable during the activities of daily life, and transmitting forces across it. Geometrical, anatomical and structural considerations allow the knee joint to accomplish these biomechanical roles. These are addressed and discussed in this article.(i) Biomechanics of the knee jointS.D. Masouros, A.M.J. Bull, A.A. Amis10.1016/j.mporth.2010.03.005Orthopaedics and Trauma 24, 2 (2010)2010-04-01Orthopaedics and Trauma2010-04-01242S1877-1327(10)X0003-3Mini-Symposium: Soft Tissue Surgery in the Knee8491http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132710000278/abstract?rss=yesAbstract: There are various surgical approaches to the knee joint and its surrounding structures, and such approaches are generally designed to allow the best access to an area of pathology whilst safeguarding important surrounding structures. In this article we provide a concise account of the commonly used approaches to the knee joint. Many knee procedures nowadays are routinely performed via arthroscopic or arthroscopic assisted methods. However, knowledge of open surgical access to the knee remains vital for knee arthroplasty surgery and cases where arthroscopy is not possible or practical.(ii) Surgical approaches to the knee jointJeremy E.S. Stanton, Chinmay M. Gupte, Vishy Mahadevan10.1016/j.mporth.2010.03.002Orthopaedics and Trauma 24, 2 (2010)2010-04-01Orthopaedics and Trauma2010-04-01242S1877-1327(10)X0003-3Mini-Symposium: Soft Tissue Surgery in the Knee9299http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132710000266/abstract?rss=yesAbstract: Anterior cruciate ligament (ACL) injury is relatively common. There is increasing awareness of the normal anatomy of the ACL and the need for reconstruction to replicate the normal anatomy. The ACL may be reconstructed as a single bundle or as a double bundle with restoration of the antero-medial and postero-lateral bundles. The postero-lateral bundle is most effective in providing stability of knee rotation.ACL injury is more common in females and there are preventative programmes attempting to reduce the frequency of ACL injury in high risk groups.The mainstay of diagnosis of ACL injury is clinical, with supportive evidence provided by MRI scanning. Rehabilitation, as conservative treatment or in association with ACL reconstruction is paramount, with restoration of symmetry essential prior to ACL reconstruction.Graft choice and fixation methods are of importance with respect to the rehabilitation regimes employed but are not necessarily the most important factors in providing a successful ACL reconstruction. Restoration of the natural degree of hyperextension is crucial to a good outcome.Meniscal pathology is different in the ACL-deficient knee to the ACL-intact knee and many tears heal without intervention after stabilization of the knee.(iii) What's new in anterior cruciate ligament surgery?Andrew Unwin10.1016/j.mporth.2010.03.001Orthopaedics and Trauma 24, 2 (2010)2010-04-01Orthopaedics and Trauma2010-04-01242S1877-1327(10)X0003-3Mini-Symposium: Soft Tissue Surgery in the Knee100106http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS187713271000028X/abstract?rss=yesAbstract: Although articular cartilage has extraordinary mechanical properties, able to maintain almost frictionless motion over a lifetime, it is vulnerable to traumatic injury and subsequent degeneration. Poor vascularity and inability to access undifferentiated cell populations that would facilitate a response to injury, are responsible for articular cartilage's limited ability to self-repair. The creation of cartilage repair tissue hence relies on the implantation or neosynthesis of cartilage matrix elements. This goal is achievable through a variety of repair techniques including marrow stimulation, the use of autologous or synthetic structural grafts or chondrocyte implantation. Although there are substantial differences in the complexity and technical application of each method, they are all united in the endeavour to restore joint function and prevent joint degeneration. The surgeon attempting to treat cartilage defects is required to possess not only a basic understanding of the physiology of cartilage growth, healing and repair, but also of biomechanics and kinematics of the knee, in order to appreciate the forces acting on the joint surfaces. Clinical success or failure will depend on appropriate patient selection, accurate clinical assessment, definition of the root cause and application of the right choice of treatment modality. Any therapy plan must include subsequent treatment options, which may become necessary should the first-line management fail to ameliorate symptoms.(iv) Articular cartilage surgery in the kneeOliver S. Schindler10.1016/j.mporth.2010.03.003Orthopaedics and Trauma 24, 2 (2010)2010-04-01Orthopaedics and Trauma2010-04-01242S1877-1327(10)X0003-3Mini-Symposium: Soft Tissue Surgery in the Knee107120http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132710000369/abstract?rss=yesAbstract: The menisci play a key role in knee function. Maintaining meniscal function should therefore be one of the key goals of any surgeon performing arthroscopic surgery in the knee. This article aims to explore current concepts in meniscal surgery, including a review of the structure and function of the menisci with particular emphasis on the part they play in the biomechanics of load bearing, shock absorption and stability in the knee. The implications of meniscal injury are discussed and current strategies of meniscal resection, repair and replacement are reviewed.(v) Meniscal tears, repairs and replacement – a current concepts reviewAlan Getgood, Angus Robertson10.1016/j.mporth.2010.03.011Orthopaedics and Trauma 24, 2 (2010)2010-04-01Orthopaedics and Trauma2010-04-01242S1877-1327(10)X0003-3Mini-Symposium: Soft Tissue Surgery in the Knee121128http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS187713271000031X/abstract?rss=yesAbstract: Soft-tissue knee surgery is performed for a multitude of conditions and encompasses a large number of procedures. The post-operative management of these conditions is constantly evolving as a result of advances in technology and a better understanding of human physiology, however, there remains no consensus on the ideal timeframe over which loading can be progressed. Rehabilitation protocols provide basic guidelines through which effective outcomes can be achieved. However, the rate and extent of recovery will depend on many patient and external factors, and it is questionable whether full recovery or a return to normality is ever complete.The complex neuromuscular motor patterning, strength and control which are affected by injury and surgery are very difficult to gauge, and difficult to recreate. Isokinetic testing affords a validated, reliable and reproducible method of evaluating muscle strength, endurance and antagonist/agonist balance. It may be utilized at the earliest safe opportunity to establish the efficacy of any functional rehabilitation programme and can allow adjustments to be made to optimize outcomes. Future studies into the use of Pilates programmes and their effects on earlier muscle pattern retraining may also allow for safer and earlier returns to sporting activity.This review establishes an evidence-based approach to the post-operative rehabilitation of the knee following anterior cruciate ligament reconstruction, arthroscopic meniscectomy, and meniscal repair surgery.(vi) Physiotherapy and rehabilitation following soft-tissue surgery of the kneeHenry D.E. Atkinson, Jennifer Michelle Laver, Elizabeth Sharp10.1016/j.mporth.2010.03.006Orthopaedics and Trauma 24, 2 (2010)2010-04-01Orthopaedics and Trauma2010-04-01242S1877-1327(10)X0003-3Mini-Symposium: Soft Tissue Surgery in the Knee129138http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132710000345/abstract?rss=yesAbstract: The accurate assessment and management of the unstable patellofemoral joint depends on knowledge of the anatomy and stabilizing structures. Surgery should not be considered until non-operative interventions have failed and the recurrent nature of the disease has resulted in functional impairment. The surgical strategy should, whenever possible, aim to restore normal anatomy rather than introduce new abnormalities. Often a combination of surgical techniques is required.(vii) Patellofemoral instabilityNeil Upadhyay, Charles Wakeley, Jonathan D.J. Eldridge10.1016/j.mporth.2010.03.009Orthopaedics and Trauma 24, 2 (2010)2010-04-01Orthopaedics and Trauma2010-04-01242S1877-1327(10)X0003-3Mini-Symposium: Soft Tissue Surgery in the Knee139148http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132709001705/abstract?rss=yesAbstract: Large segmental defects of long bones comprise a complex pathology resulting from a variety of aetiologies. Their prolonged, painful and uncertain treatment is usually beset with a range of consequences for the patient, varying from the psychological to the socioeconomic. Trauma, osteomyelitis, bone tumour resections or treatment of congenital deformities are main causes of bone deficiency. Their treatment has been thoroughly studied for the last 35 years and both vascularized bone grafting and distraction osteogenesis with the Ilizarov technique have emerged as gold standards. Novel techniques have arisen during the last 10 years, giving new perspectives to the management of this problem. Intramedullary lengthening devices, bioactive membranes, osteogenic proteins and tissue engineering are the new weapons in the armamentarium of orthopaedic surgeons. This study describes the aforementioned treatment techniques (classic and novel) and elaborates on their indications, advantages/disadvantages and complications. Algorithms for the assessment and treatment of critically size long-bone segmental defects are also proposed.Current management of long bone large segmental defectsNikolaos G. Lasanianos, Nikolaos K. Kanakaris, Peter V. Giannoudis10.1016/j.mporth.2009.10.003Orthopaedics and Trauma 24, 2 (2010)2010-04-01Orthopaedics and Trauma2010-04-01242S1877-1327(10)X0003-3Trauma149163http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132709001742/abstract?rss=yesAbstract: Cri du Chat syndrome is a rare genetic condition affecting the short arm of chromosome 5. A range of clinical features, including the characteristic “cat-like” cry and developmental delay, is recognized in children with the syndrome. A higher incidence of certain paediatric orthopaedic conditions such as scoliosis, developmental dysplasia of the hip and pes planus and varus has also been observed.Cri du Chat syndromeLyndsay Cuming, Donna Diamond, Rouin Amirfeyz, Martin Gargan10.1016/j.mporth.2009.11.002Orthopaedics and Trauma 24, 2 (2010)2010-04-01Orthopaedics and Trauma2010-04-01242S1877-1327(10)X0003-3Syndrome164166http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132710000436/abstract?rss=yesCME questions based on the Mini-Symposium on “Soft Tissue Surgery in the Knee”10.1016/j.mporth.2010.03.018Orthopaedics and Trauma 24, 2 (2010)2010-04-01Orthopaedics and Trauma2010-04-01242S1877-1327(10)X0003-3CME Section167168http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132709001547/abstract?rss=yesAnswers to CME questions based on the Mini-Symposium on “Foot and Ankle Problems”10.1016/j.mporth.2009.10.002Orthopaedics and Trauma 24, 2 (2010)2010-04-01Orthopaedics and Trauma2010-04-01242S1877-1327(10)X0003-3CME Section169169http://www.orthopaedicsandtraumajournal.co.uk/article/PIIS1877132709000505/abstract?rss=yesThe Authors regret that some errors appeared in the published version of the above article. The paragraph on page 28 of the article entitled “Varus/valgus positioning and lift-off” should read as follows.Erratum to “Basic biomechanics of human joints: Hips, knees and the spine” [Current Orthopaedics (2006) 20, 23–31]T.D. Stewart, R.M. Hall10.1016/j.mporth.2009.03.002Orthopaedics and Trauma 24, 2 (2010)2010-04-01Orthopaedics and Trauma2010-04-01242S1877-1327(10)X0003-3Erratum170170