Objectives

A variety of operative techniques have been described as under the term ‘Bristow-Latarjet’ procedure. This review aims to define the original procedure, and compare the variation in techniques described in the literature, assessing any effect on clinical outcomes.

Introduction: Traumatic knee dislocations are rare but devastating injuries. We have evaluated the clinical results of ligament repair and reconstruction. Knee dislocation was defined as an acute event that produced multidirectional instability with at least 2 of the 4 major ligaments disrupted.

Materials: Twenty-one patients with 22 knee dislocations presented between 1994 and 2001. There was one vascular and one common peroneal nerve injury. Eight (38%) patients were treated in the acute period (< 14 days), 5 (24%) had reconstructions within 1 year of injury. The remainder were late reconstructions. The patients were evaluated at mean follow-up of 32 months (11 to 77). This included ROM measurement, clinical and instrumented ligament laxity testing. Posterior stress view with 10kg weight was used to evaluate the PCL reconstruction. Function was evaluated using the IKDC chart, the Lysholm Score, the Tegner Activity Level, the Knee Outcome Survey and WOMAC.

Results: The mean extension deficit was 6.8 degrees (0–25) and mean flexion deficit was 8.6 degrees (0–20). Of the ACL reconstructions, 4 knees had 0–3mm side-to-side difference, 15 knees had 3–5mm and 1 knee had 6–10mm. Of the PCL reconstructions, 2 were within 3–5mm of side-to-side difference, 9 knees were 6–10mm and 4 were more than 10mm. Posterolateral corner repair/reconstructions appeared durable. None of the knees were IKDC Grade A, 8 knees were Grade B, 9 were as Grade C and 5 were Grade D. The mean Lysholm Score was 81 (66–100) and the mean Tegner Activity Level was 4.9 (1–7). The mean Knee Outcome Survey score was 75 (41–99). Acutely treated knees had better scores than late reconstructions.

Conclusion: Our study has demonstrated good function in the operatively treated knee dislocations at 1–7 years. Nearly all had few problems with daily activities. The ability to return to high-demand sports and heavy manual labour was less predictable.

We treated 21 patients with 22 dislocations of the knee by repair or reconstruction of all injured ligaments. Eight knees were treated in the acute phase (less than two weeks after injury); the remainder were treated more than six months after injury (6 to 72). Reconstructions were carried out with a combination of autograft and allograft tendons and by direct ligament repair where possible. At a mean follow-up of 32 months (11 to 77) the mean Lysholm score was 87 (81 to 91) in the acute group and 75 (53 to 100) in the delayed group. The mean Tegner activity rating was 5 in the acute group and 4.4 in the delayed group.

The International Knee Documentation Committee assessment revealed no differences between the two groups. Instrumented testing of knee stability indicated better results for anterior cruciate ligament reconstructions which had been undertaken in the acute phase, but no difference in the outcome of posterior cruciate ligament reconstructions. There was no difference in the loss of knee movement between the two groups. Although the differences were small, the outcome in terms of overall knee function, activity levels and anterior tibial translation were better in those knees which had been reconstructed within two weeks of injury.

Introduction: Nonunion of long bone fractures is rare in the skeletally immature. Many of these injuries threaten the survival of the limb and attempts to salvage the limb can only be justified if the ultimate limb function out performs that of a prosthesis. To our knowledge there has been no report of functional outcome following the treatment of such injuries. We report the outcome of a series of patients treated for tibial bone loss and nonunion at average follow-up of 52 months.

Patients and method: Nine children aged 18 months to 17 years were treated. Three patients had established nonunion ranging from 7 months to 6 years, three had bone loss (1–6cm) and three had fractures in which nonunion were anticipated (1 Gustilo IIIb and 2 Tcherne III’s). Five injuries involved the physeal growth plate (2 with partial physeal loss – Peterson VI).

Treatment involved wound excision for open fractures, debridement of devascularised bone and stabilisation with monolateral fixators (2 patients) and circular fixators (7 patients). Five patients had unifocal treatment, four had multifocal treatment (3 bone transports). Duration of non-union or bone loss ranged from 3 to 72 months, average 17 and median 12. Treatment time ranged from 3 to 12 months, and was not related to the complexity of treatment. The longest treatment times occurred when segments of devascularised bone had been left unexcised, a situation we termed “bone loss insitu”.

An independent observer assessed the patients. Functional outcome was measured using the Short Musculoskeletal Assessment Form, a validated outcome assessment tool (Swiontkowski et al. JBJS [A], 1999).

Results: At the latest follow-up (average 52 months), the mean range of knee motion was 3–125° and mean ankle range was 13° dorsiflexion, 35° plantarflexion. Physeal arrest was present in three children (limb length discrepancy 2–4 cm) but with no deformity. Functional outcome revealed a “Dysfunction Index” of 0–19% (ave. 7%) and a “Bother Index” of 0–16% (ave. 6%).

Conclusion: Limb salvage of severe tibial fractures in which nonunion were established or anticipated were worthwhile. Good function can be obtained. The duration of treatment was not related to the complexity of treatment but was increased by leaving sterile but avascular bone unexcised.