Chris Servant

Ipswich Hospital NHS Trust · Department of Trauma & Orthopaedics

Purpose: To compare the incidence of postoperative anterior knee pain at rest and during "knee walking" in patients who had anterior cruciate ligament reconstruction (ACLR) surgery with hamstring tendon (HT) grafts versus bone-patellar tendon-bone (BPTB) grafts harvested using a minimally invasive double-incision technique with autografting of the...

Recently, there has been renewed interest in performing a lateral extra-articular procedure (LEAP), either an anterolateral ligament (ALL) reconstruction or a LET (lateral extra-articular tenodesis) to address a deficiency of the anterolateral complex (ALC) of the knee during anterior cruciate ligament (ACL) reconstruction. The ALC consists of the...

High tibial osteotomy (HTO) is enjoying somewhat of a resurgence as a treatment for medial compartment arthritis with a varus deformity. An inverted V-shaped high tibial osteotomy (IVHTO), which is essentially a combined lateral closing-wedge high tibial osteotomy (CWHTO) and medial opening-wedge high tibial osteotomy (OWHTO), has some theoretical...

A medial opening wedge high tibial osteotomy is a cost-effective procedure for younger patients with symptomatic medial compartment knee arthritis. A high rate of success can be expected, but excessive postoperative joint line obliquity is associated with inferior clinical outcomes. If preoperative planning predicts that the postoperative medial pr...

An excessively lateral tibial tubercle is a well-accepted risk factor for recurrent patellar dislocation. Generally, it is measured on magnetic resonance imaging as the TT-TG distance (tibial tubercle–trochlear groove distance), and recent meta-analyses have suggested that a value as low as 12.5 mm can be used as the threshold for deciding when to...

Background: Late-stage isolated medial knee osteoarthritis can be treated with total knee replacement (TKR) or partial knee replacement (PKR). There is high variation in treatment choice and little robust evidence to guide selection. The Total or Partial Knee Arthroplasty Trial (TOPKAT) therefore aims to assess the clinical effectiveness and cost-...

We need ambitious pioneers to explore the frontiers of surgical technique, but the surgeons that follow are wise to wait for independent and robust evidence of clinical benefit. Double-bundle anterior cruciate ligament reconstruction has struggled to establish its role, and triple-bundle reconstruction is perhaps even less likely to gain widespread...

Correspondence to: sseewoonarain@gmail.com A 27 year old man stumbled down a step and twisted his left knee. He felt immediate severe pain in the knee and was unable to weight bear. On examination he had a swollen knee with a limited, painful range of movement. There was no obvious neurovascular deficit. Plain radiographs of the left knee were tak...

Purpose: Here we present the unusual case report of where a woman sustained a traumatic injury causing an open right subtrochanteric hip fracture which damaged the femoral nerve.

This retrospective analysis of 182 consecutive patients who underwent anterior cruciate ligament (ACL) re-construction aimed to assess the clinical examination under anaesthetic and the MRI diagnostic accuracy of arthroscopically-proven, complete ACL ruptures, depending on the morphology of the torn ligament. Patients were then assigned to Group 1...

Purpose: The aim of this meta-analysis was to compare the risk of stiffness between early and delayed anterior cruciate ligament (ACL) surgery in studies that use a modern accelerated rehabilitation protocol. Methods: Medline, Embase, and the Cochrane library were searched for studies that compared outcomes for early and delayed ACL reconstructi...

This volume is a practical, procedure-by-procedure guide to patient positioning for about 50 of the most common surgical procedures, written by a multidisciplinary team of surgeons, nurses, ODAs and anaesthetists. Positioning for each procedure is described in detail and points of interest or potential hazards discussed where appropriate. Each proc...

Benign ganglion (synovial) cysts within the knee are uncommon and especially so when located in the infrapatellar fad pad. They cause many non-specific symptoms but usually present as a swelling. We report the case of a young gentleman with multiple benign synovial cysts within the fat pad causing a locked knee, which was treated with arthroscopica...

We reviewed a series of 39 patients (40 cases) receiving the Link MP stem in revision hip arthroplasty. Average follow-up was 68 months (range 60-115 months). Proximal femoral defects were classified using the Endo-Klinik and Paprosky classifications. Indications included: osteolysis 13 cases; septic loosening 8 cases; periprosthetic fractures 18 c...

We reviewed a series of 39 patients (40 cases) receiving the Link MP stem in revision hip arthroplasty. Average follow-up was 68 months (range 60–115 months). Proximal femoral defects were classified using the Endo-Klinik and Paprosky classifications. Indications included: osteolysis 13 cases; septic loosening 8 cases; periprosthetic fractures 18 c...

Magnetic resonance imaging (MRI) is widely believed to be highly accurate in diagnosing injuries of the posterior cruciate ligament (PCL). The aim of this study was to determine the accuracy of MRI in diagnosing chronic PCL injury. MRI was performed on 10 knees with a clinical and arthroscopic diagnosis of a PCL injury sustained at least 6 months p...

Dysfunction of the patellofemoral mechanism presents in many ways. Results from different realignment procedures show great variability in patient outcome. A surgical technique is presented that attempts to correct all the abnormalities of patellofemoral maltracking. The procedure consists of a lateral release, a vastus medialis (obliquus) tendon a...

Dysfunction of the patellofemoral mechanism presents in many ways. Results from different realignment procedures show great variability in patient outcome. A surgical technique is presented that attempts to correct all the abnormalities of patellofemoral mal-tracking. The procedure consists of a lateral release, a vastus medialis (obliquus) tendon...

We have investigated the ability to kneel after total knee replacement. We asked 75 patients (100 knees) at least six months after routine uncemented primary total knee replacement, to comment on and to demonstrate their ability to kneel. Differences between the perceived and actual ability to kneel were noted. In 32 knees patients stated that they...

We have investigated the ability to kneel after total knee replacement. We asked 75 patients (100 knees) at least six months after routine uncemented primary total knee replacement, to comment on and to demonstrate their ability to kneel. Differences between the perceived and actual ability to kneel were noted. In 32 knees patients stated that they...

This case report illustrates the need to be aware of extraspinal causes of sciatica. A patient with a strangulated sciatic hernia showed the clinical features of sciatic leg pain, intestinal obstruction, and a left gluteal abscess. To highlight the need to examine the course of the sciatic nerve for local pathology when the cause of sciatica is not...

A case is reported of an adolescent sprinter who was chronically disabled by pain after non-operative management for an acute hamstring injury. He had sustained an avulsion fracture of the ischial apophysis with displacement of 2.5 cm. Avulsion fractures of the ischial apophysis with displacement of 2 cm or more are unusual, but they frequently res...

Study design. This case report illustrates the need to be aware of extraspinal causes of sciatica. A patient with a strangulated sciatic hernia showed the clinical features of sciatic leg pain, intestinal obstruction, and a left gluteal abscess. Objective. To highlight the need to examine the course of the sciatic nerve for local pathology when the...

The performance of senior house officers (SHOs) and their advisers in accident and emergency departments was compared in the diagnosis of abdominal pain in 711 patients. Accuracy of diagnosis was 63 per cent for advisers and 54 per cent for SHOs. Overall, the adviser improves the diagnosis of the SHO in only 6 per cent of cases. The SHOs refer accu...