INTRODUCTION: The authors present the results of a surgical technique for lateral ankle chronic instability, derived from Castaing and Duquennoy procedures. It uses a half peroneus brevis with a tightening of the antero- lateral capsule. A Plasty with the extensorum digitorum brevis was used in the event of associated subtalar instability.

MATERIAL AND METHODS: Between 2001 and 2005, 38 cases of ligamentoplasties have been performed for chronic instability of the ankle. 32 (25 men and 7 women) of them have been reviewed with a mean delay of 26 months (extremes of 10 months to 5 years). They were middle-aged of 28,5 years. All the patients have been reviewed with stress X-Ray in varus of the both ankles (measure of tibio talar angle, arthritis) and had a strength measure in eversion by the same examiner. The functional evaluation was performed with Molander and Olerud ankle score.

RESULTS: There were 20% of complications, especially cutaneous cicatrisation problems and algodystrophy. After surgery, no patient had instability; only one, had apprehension of the ankle. 90 % retrieved the same sport with the same level. No body changed of job. 3 patients were disappointed because of pain in sports and stiffness. At revision, the functional score was 90 against 59 at the pre operative time. The difference of strength in eversion between the two ankles was about 7%. Laxity had a good correction seeing the average tibio talar angle between the both ankle is 0,5°.

DISCUSSION: The results of this procedure show a distinct improvement of stability, radiological laxity and functional activity. The arthrotomy performed in Duquennoy procedure, is useful for diagnosis and treatment. It shows the cartilage and allows the removal of impingement and foreign bodies. A plasty that uses the single evertor deprives the ankle of a part of active and proprioceptive control. However, the patients didn’t feel a difference or a discomfort. The patients who had the surgery on the jump foot side had no significative difference of strength in eversion between the both ankles.

CONCLUSION: This anatomical procedure gives 91% of satisfaction, for these active young people. The postoperative physiotherapy allows the complete recovery of activities from the sixth month after surgery.

Purpose: From 1985 to 2001, 31 total knee arthroplasties were performed for 17 adolescents or young adults with idiopathic juvenile osteoarthritis. The purpose of this work was to evaluate functional and radiological outcome.

Material and methods: Overall functional outcome was assessed with the Steinbrocker classification. Knee function was evaluated with the IKS score. Several types of prostheses were implanted: constrained GSB (n=14), cemented semi-constrained tri-CCC tri-compartment with a rotatory platform (n=10), non-cemented semi-constrained ROCC (n=1), LCS (n=2) including non-cemented, and FINN (n=2) (two custom-made rotation hinge prostheses implanted in the same patient). Fourteen prostheses involved bilateral implants, including three dual implantation procedures.

Results: Mean age at implantation was 20 years five months (14–29). There were fourteen girls and three boys. Eight had systemic idiopathic juvenile osteoarthritis and nine a polyarticular form. The Steinbrocker staging was: II (n=5,) III (n=6), IV or bedridden (n=4). Ten patients had two hip prostheses before bilateral knee arthroplasty. Mean follow-up was 4.5 years (1–12). Among the 31 operated knees, 16 were pain free, 14 minimally painful, and one painful due to loosening. The joint score was very good (n=18), good (n=4), and poor (n=5). Radiographically, normal alignment was found for 29 knees. Lucent lines were observed for 10 of the 14 GSB constrained prostheses. We did not observe any evidence of lucent lines for the non-cemented tri-compartment prostheses. Complications were: limited skin necrosis (n=1), bilateral supracondylar fracture one year after implantation (n=1).

Discussion: Outcome has been encouraging for total knee prostheses in patients with idiopathic juvenile osteoarthritis. These arthroplasties allow spectacular functional improvement. The few series reported have also reported very good results. Cemented tri-compartment semi-constrained implants appear to provide better stability at five years. Biologically sealed tri-compartment prostheses would be a very satisfactory solution due to the preservation of bone stock.

Purpose: We expose technical problems encountered for prosthesis replacement in osteoarthrosis juvenilis (OJ). The characteristic feature of this disease is early joint destruction during growth.

Material and methods: Total knee arthoplasty (TKA) was performed in 17 severely disabled patients (31 knees): Steinbrocker stage II=30%, stage III=30%, stage IV=40%. Mean age at operation was twenty years (14–29). Technical difficulties were related to the following combinations: 1) multidirectional malformations, generally in valgus (mean 16°, range 5–30°) in 30% of the knees associated with external rotation (mean 20°, range 5–50) and sagittal deformation with permanent flexion (mean 31°, range 5–60°) with external or posterior tibia dislocation; 2) limited joint motion: 71° (0–115°); 3) extraarticular deformations with permanent flexion or vicious hip rotation, tibial or femoral callus; 4) major condyle dysplasia due to growth deficiency (3/31 or necrosis (3/31); 5) low patella (100%) and subluxation; 6) weak bone and fragile skin related to corticosteroid therapy; 7) persistent growth cartilage in four patients. We tried to implant the most adapted prosthesis in each individual situation, favouring the least constrained implant possible.

Results: We used fifteen mobile plateau prostheses including five pure gliding TKA and ten posterostabilised TKA with a mobile plateau and 16 hinge prostheses with two rotators. Thirty of the 31 TKA were custom-made.

Discussion: Our different approaches enabled us to propose the following: correction of extra-articular deformations by TKA, after tenotomy and traction, or after concomitant osteotomy; primary approach after checking the vasculonervous bundle (popliteal sciatic); sub-periosteal dissection preserving the lateral ligaments searching to achieve ligament balance when possible in order to implant the least constrained implant possible; non-cemented implants, especially for “soft” or “fatty” bone; no patellar resurfacing when there is a risk of an overly thick low and subluxed patella.