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Background: The management of combined anterior cruciate ligament (ACL) and medial collateral ligament (MCL) injuries remains contentious. Clinical outcomes of surgical, conservative, and combined approaches have been described in a range of prospective and retrospective studies. The aim of the current systematic review was to evaluate these outcomes and assess the study methodologies. Methods: A comprehensive literature search of the following databases was performed: PubMed, OVID, Cochrane Database of Systematic Reviews and Google Scholar. Studies were assessed using the Coleman Methodology Score. Results: 52 articles were included (3 randomised controlled trials, 8 prospective comparative studies, 17 retrospective comparative studies and 24 case series). Outcome measures were heterogeneous amongst articles. The most common outcomes assessed were AP laxity, Lysholm score and medial/valgus laxity. Complications at varying follow-up times with differing grades of MCL injury were reported in 25 (48%) studies. Evidence was conflicting, with no consensus from the available published literature regarding the best method of treatment for a combined ACL and MCL injury. Conclusions: Heterogeneous outcome measures and limited randomised controlled trials prevent advocacy of a single treatment option. Good outcomes have been reported from repair, reconstruction and conservative management of the MCL together with ACL reconstruction. Further prospective comparative data is required to evaluate MCL management choice and prognostic signs for successful nonsurgical MCL treatment.

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BACKGROUND: To optimise sprint performance, one needs to understand how motor control affects motor performance. Researchers have proposed that the Dynamic Systems Theory be adopted for explaining motor performance, skill acquisition and the development of pedagogical methods. Within this theory, the individual is seen as a complex system that functions as the interaction of many sub-systems. Entrained movements would be characterised by optimal sequencing, timing and grading of muscle activation. One of the identified control parameters for running is the rhythm in the coordination pattern. OBJECTIVES: The objectives of this study were twofold: firstly to investigate whether 6 weeks of timing and rhythmicity training using the computer-based Interactive Metronome™ (IM™) system improves motor timing and rhythmicity, and secondly to investigate whether such effects of IM™ influence the kinematic variables of a sprint. METHODS: This study followed a semi-quantitative analysis case study approach using a Paralympic sprinter with a single below knee amputation participated in this study. Data for acceleration and maximal running velocity phases were collected using video recorders. RESULTS AND CONCLUSIONS: As found by previous research, the IM™ programme improved the motor timing and rhythmicity of the athlete. However, in contrast to previous research, only minimal improvements, non-significant improvements, were seen in the actual motor performance. This athlete was an older more established athlete and it is therefore recommended that these types of programmes should be followed by young participants in the more fundamental phases of their movement development, to show best results.

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BACKGROUND: The technical reliability demonstrated by semi active robots in implant placement could render unicompartmental knee arthroplasties (UKAs) more favourable than they are currently. The relatively untested method using patient specific instrumentation (PSI), however, has the potential to match the accuracy produced by robots but without the barriers that have prevented them from being used more widely in clinical practice, namely operative time. Therefore this study took a step towards comparing the accuracy and time taken between the two technologies. METHODS: Thirty-six UKAs were carried out on identical knee models, 12 with the Sculptor, 12 with PSI and 12 conventionally under timed conditions. Implant placement in these knees was then judged against that in a pre-operative plan. RESULTS: Tibial implant orientations and femoral implant positions and orientations were significantly more accurate in the PSI group with mean errors of 6°, 2 mm and 4° respectively, than the conventional group which had means of 9°, 4 mm and 10°. There was no significant difference between the robot and PSI generally except in tibial implant orientation (mean robotic error 3°) and tibial implant position did not vary significantly across all three groups. It was also found that use of PSI and conventional methods took half the time taken by the robot (p<0.001). CONCLUSIONS: With further development, PSI can match and possibly surpass the accuracy of the robot, as it does with the conventional method, and achieve planned surgery in less time. CLINICAL RELEVANCE: This work sets the foundation for clinical trials involving PSI.

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Robotic systems have been shown to improve unicompartmental knee arthroplasty (UKA) component placement accuracy compared to conventional methods when used by experienced surgeons. We aimed to determine whether inexperienced UKA surgeons can position components accurately using robotic assistance when compared to conventional methods and to demonstrate the effect repetition has on accuracy. Sixteen surgeons were randomised to an active constraint robot or conventional group performing three UKAs over three weeks. Implanted component positions and orientations were compared to planned component positions in six degrees of freedom for both femoral and tibial components. Mean procedure time decreased for both robot (37.5 mins to 25.7 mins) (P = 0.002) and conventional (33.8 mins to 21.0 mins) (P = 0.002) groups by attempt three indicating the presence of a learning curve; however, neither group demonstrated changes in accuracy. Mean compound rotational and translational errors were lower in the robot group compared to the conventional group for both components at all attempts for which rotational error differences were significant at every attempt. The conventional group's positioning remained inaccurate even with repeated attempts although procedure time improved. In comparison, by limiting inaccuracies inherent in conventional equipment, robotic assistance enabled surgeons to achieve precision and accuracy when positioning UKA components irrespective of their experience.

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PURPOSES: Post arthroplasty gait analysis has up till now been performed on subjects walking slowly on flat ground rather than challenging them at faster speeds or walking uphill. We therefore asked: (1) Is there a measurable difference in the performance of hip resurfacing arthroplasty (HRA) and total hip arthroplasty (THA) limbs at patients' self-determined fastest walking speeds and steepest inclines? and (2) Is there a relationship between the observed differences between the gait of HRA and THA implanted limbs and patient walking speeds and inclines. METHODS: In an ethically approved study we recruited patients with bilateral hip arthroplasties: one HRA and one THA. Nine subjects were assessed using an instrumented treadmill at a range of speeds and inclines by a blinded observer. The ground reaction forces of subjects were recorded and an age, sex and BMI matched control group was used for comparison. RESULTS: Increasing walking speed correlated strongly with between leg differences in weight acceptance (r = 0.9, p = 0.000) and push-off force (r = 0.79, p = 0.002). HRA implanted limbs accepted significantly more weight at top walking speeds (1208 N ± 320 versus 1279 N ± 370, p = 0.026) and pushed off with greater force when walking uphill (818 N ± 163 versus 855 ± 166, p = 0.012). HRA limbs more closely approximated to the gait of the normal control group. CONCLUSIONS: Arthroplasty implants do have an impact on the gait characteristics of patients. Differences in gait are more likely to be evident when assessment is made at fast speeds and walking uphill. This study suggests that HRA may enable a more normal gait.

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