Purpose of the study: There remains some debate on the proper treatment of congenital dislocation of the patella in children and adolescents. Ligament-periosteum transfer (green-stick method) is a technique adapted for pediatric patients which realigns the distal extensor system.

Material and methods: Between 1979 and 2000, 36 children (51 knees) were treated with this method described by Grammont. Section of the lateral wing and medial capsulomyoplasty were associated in all procedures. Other complementary procedures used as needed included lengthening of the quadriceps, trochleoplasty, and quadriceps release. Mean age at surgery was 11 years (range 5–15 years). All patients were reviewed at bone maturity with a mean follow-up of 7.5 years for functional (IKC criteria) and radiographic assessment. A computed tomography and/or magnetic resonance imaging was obtained preoperatively and at last follow-up to assess TAGT, patellar height, trochlear angle, femoral anteversion, external tibial torsion, and knee rotation. Tibial slope was specifically studied to assess the possible epiphysiodesis effect.

Results: Two groups of patients were distinguished: congenital dislocation of the patella (persistent or usual) and objective patellar instability. Functional outcome was good in 74% and 87% of the knees. There were eight cases of recurrent dislocation: five knees were operated on with good outcome. The trochlear angle was improved in both groups, more significantly in the congenital dislocation group. There was one case of an inverted tibial slope (−2°) and two cases of cancelled slope.

Discussion: Our functional results are in agreement with earlier reports (Grammont, Bensahel, Langeskiold) but comparison is hindered by the heterogeneous nature of the different cohorts. Radiographically, we observed that trochlear remodeling, a sign of good stability, is better if the operation is performed early (before the age of ten years). On the contrary, in adolescents with major patellar instability, complementary trocheloplasty should be performed in addition to the recentering procedure. We observed that a small tibial slope became smaller in eleven knees in comparison with the nonoperated knee and in comparison with the preoperative slope for the bilateral cases. There appears to be a discrete epiphysiodesis effect but with no functional consequence.

Conclusion: We propose a classification of congenital dislocation of the patella in children. The ligament-periosteum transfer technique, associated with other procedures as needed, enables stabilizing the extensor system and a normal trochlear angle if surgery is performed at a young age. Remodeling of the tibial tubercle may result from transient disruption of the vascular supply.

Introduction: Osteoid osteoma is a benign tumour that usually requires surgical excision as it commonly presents with severe and debilitating pain. Treatment by percutaneous drill resection with CTscan control was developed by Doyle, Voto & Kohler 15 years ago as an alternative to the classical “en bloc resection”. A series of 62 cases using this method is reported.

Method: The procedure is performed by an orthopaedic surgeon in the CT Scan room with the radiologist participation. The lesion (nidus) is localized on an appropriate CT slice. A special set of instruments (drill, trephine, reamer) are introduced in succession along a guide wire through a short skin incision. A small cylinder of bone is removed for histopathology analysis.

Between June 1987 and July 2003, 62 cases were so far treated. There were 13 adults (19 – 35 years) and 49 children and adolescents (2.5 years – 18 years). All patients had a clinical and radiological evidence for osteoid osteoma (hyperfixation on scintigraphy, visible nidus on CT scan). The nidus was mostly localized in the lower limb (53 cases) especially femoral neck (23), femoral shaft (13), tibial shaft (14).

Results: No severe complications were observed (delayed union after skin necrosis of the tibia in 3 cases, transitory palsy of extensor hallucis longus in one case. Clinical healing after a 1 year follow up was observed in all but 2 cases. In these 2 cases the lack of healing was considered as a failure of treatment and not true “recurrence”; a second attempt was successful. The nidus was confirmed in the specimen in half cases.

Discussion: This method has now clearly demonstrated its effectiveness and security. Benefits for patients are evident: thanks to minimal bone resection, quick recovery and immediate weight bearing are possible. This technique is now indicated in most cases, versus “en bloc resection” which should be considered only for some vertebral or superficial localizations of the nidus. Concurrently, other techniques have been recently developed : destruction by thermo coagulation or photocoagulation, which are similar to resection ; all are non invasive interventional procedure.

Purpose of the study: Advances in chemotherapy protocols over the last 20 years have considerably improved the prognosis and functional outcome in patients with osteogenic sarcoma. We report here the results of a cooperative study conducted under the auspices of the French Society of Pediatric Oncology (SFOP). Twenty-nine oncology centers participated in this retrospective national multicentric study.

Materials and methods: The study included 15 .3 patients with osteogenic sarcoma of the limb who were treated by the OS87 protocol with conservative surgery between 1987 and 1994. The OS87 protocol consisted in conservative or nonconservative surgery combined with pre- and postoperative chemotherapy. The following inclusion criteria were used: age under 20 years, tumor localization in a limb (pelvis and spine excluded), no metastasis at diagnosis, biopsy proven osteogenic sarcoma.

Results: Mean age at diagnosis was 13 years. The knee localization predominated (80 p. 100). 82.5 p. 100 of the patients had grade IIB disease (Enneking classification). For the 187 patients included in the protocol surgery was nonconservative in 20 p. 100 of the cases and conservative in 80 p. 100. The choice of the surgical technique (arthroplasty, allograft, autograft, resection without reconstruction) depended on the patient’s age and school situation. Data analyzed here concerned only those patients who had conservative treatment. Mean follow-up was 64 months. The actuarial survival curve plateaued at 71 p. 100 at more than 6 years. Early and late complications were numerous and variable (mechanical, infectious, local recurrence). Secondary amputation was required in 10 p. 100 of the patients. The overall functional outcome of the preserved limbs was nevertheless good with rapid restoration of self-sufficiency despite major surgery and a high number of reoperations (about 65 p. 100 of cases).

Discussion: In light of the frequency and the seriousness of the complications, these results are modest. Patients and family should be advised of the risk, particularly the risk of secondary amputation which may be required early due to contaminated excision or at mid term due to major non-cancerological complications. As survival has been improved, functional capacity must be preserved for several years. This orients surgery towards more “biological” reconstruction which can provide greater longevity than arthroplasty.