Introduction. Habitual dislocation of the patella is rare in children. Several procedures have been described to stabilise the patella by lateral release and medial check-reins. The results are unpredictable. The failure is probably due to passive stretching of the static stabilisers of the patella ie. tendons and capsule. The aim of this paper is to describe the outcome of Pes Anserinus transfer for habitual dislocation of the patella in children. Methods. Eleven children (13 knees) were reviewed retrospectively between 1990 and 2008 following surgical realignment. The age ranged between 5-13 years. Two had ligamentous laxity. Nine dislocated in flexion and 2 in extension. Through a lateral incision the iliotibial band, vastus lateralis and lateral capsule were released. Through a medial incision the capsule was reefed and the pes anserinus insertion was transferred to the medial side of the patella and its tendon. The vastus lateralis was reattached more proximally to the rectus. Quadriceps rehabilitation was started 4 weeks following plaster immobilisation. Results. The wounds healed well. Scar thickening was seen in 2 children. Extensor lag of 20°-30° improved by 4-6 months. Squatting was possible in all at 1-8 year follow-up. One recurrence occurred following a fall. The results were graded satisfactory in 12 knees and poor in 1. Conclusion. Static stabilisers have been shown to stretch when used as check reins in habitual dislocations of the patella. The pes anserinus transposition is a broad base anchorage providing dynamic stability. It acts as a physiological, non-stretchable sling as its neurovascular supply is intact compared to severed tendon or capsules used as medial check reins

This paper reports the results of pes anserinus insertion as a dynamic transfer for habitual dislocation of the patella.

From 1995 to 2001 five patients were seen, ranging in age from 5 to 13 years. Follow-up ranged from nine months to three years. Through a long lateral incision, the iliotibial band and abnormal superolateral insertion of the vastus lateralis were divided. The lateral capsule down to the lateral border of the patellar tendon was released. Finally the vastus intermedius tendon was divided.

The rectus femoris was lengthened in one patient. Through a medial parapatellar incision, the pes anserinus insertion was detached with a sleeve of periosteum and sutured to the anteromedial aspect of the patella and patellar tendon to act as a dynamic check rein. The relaxed medial capsule was reefed before the transfer. The child was immobilised in an above-knee cast for four weeks after wound closure and later had physiotherapy.

In all patients the results were good. Movement was from 0° to 130° and there were no complications or redislocations. Skyline views showed the patella located in the groove.

Dynamic stabilisation of the patella in habitual dislocations yields more successful results. Preserving the vastus medialis helps prevent the extensor lag that usually occurs after these procedures. Abnormal insertion of the vastus lateralis and a tight iliotibial band were identified as the main causes of the dislocation. The failure of reconstructive procedures is perhaps due to the inadequate strength of the soft tissue used as a static medial stabiliser of the patella.

Introduction: Recent clinical, morphological and MRI studies have evidenced a potential for regeneration of the tendons of the semitendinous and medial rectus muscles. This is the first article in the world literature describing how these two tendons have been obtained for the second time and have been used for reconstruction of the ACL.

Materials and methods: The study included two men aged 30 and 38 in whom the ACL had been reconstructed (6 and 9 years before, respectively) using the semitendinous (ST) and medial rectus (MR) tendons. The full length and width of the tendons were harvested using a tenotome. The ACL reconstruction was subsequently broken in both patients in a sporting accident. Preoperative MRI was performed in both patients and confirmed the rupture of the ACL and regeneration of the ST and MR. Both tendons were harvested, the macroscopic findings were noted and samples of the tendons were taken for histological study. The regenerated tendons were used to reconstruct the ACL, maintaining their distal attachment and fixing them proximally with a staple.

Results: Macroscopically the regenerated tendons looked nearly normal. Both had regenerated to their normal thickness and length (the diameter of the tunnels in the ACL revision surgery was the same as in the primary surgery).

The histological study showed normal tendinous tissue with a few areas of disorganised collagen bundles, increased proliferation of fibroblasts and formation of capillaries.

After a follow-up of 14 and 17 months, both patients recovered their prior level of sports activity and their knees were stable.

Conclusions: Harvesting the tendons of the semitendinous and medial rectus muscles leads to regeneration of both tendons. Although the biomechanical properties of this regenerated tissue are unknown, clinically it appears to be an appropriate tissue for ACL reconstruction.

Background

Medial open wedge high tibial osteotomy (MOWHTO) has been accepted as a highly effective option for the treatment of medial unicompartmental osteoarthritis of the knee. Although pain in the medial joint line is significantly relieved after MOWHTO, some patients complain of pain over pes anserinus after the osteotomy, necessitating implant removal for pain relief.