Introduction: The usual surgical treatment of valgus knee in Ellis van Creveld Syndrom (EVC), is high tibial osteotomy. However, this approach failed to achieve the expected goal of lasting correction. Based on Dr. Paley’s observations, and our previous unsuccessful treatment of valgus knee in EVC syndrome, we changed the surgical approach. The aim of the surgical treatment is to eradicate all the elements causing sever valgus knee: 1) dysplasic lateral tibial condyle, 2) progressive depression of the lateral tibial plateau, 3) short fibula, 4) short and contracted fascia lata, 5) short lateral collateral ligament and biceps femoris, 6) short lateral head of gastrocnemius, and 7) contracted lateral knee capsule and lateral retinaculum. In many aspects the pathology of Blount’s disease grade 5 or 6 is similar, but located at the medial tibia causing genu vara.

Materials and Methods: Three valgus knees of EVC syndrome and two varus knees of Blount’s disease grade 5 & 6 underwent surgical treatment by a unique surgical approach to address all pathologies which contribute to the deformity. In the cases of EVC syndrome the first stage operation included: 1) peroneal nerve release and soft tissue release including T.F.L., B.F., L.C.L., capsule and gastrocnemius, 2) arthrogram, 3) fibulectomy, 4) elevation of lateral tibial plateau with bone graft, 5) reconstruction of L.C.L. and B.F., 6) lateral release of retinacula and rerouting of patella, and 7)cast application. In the second stage operation of these cases a corrective high tibial osteotomy was performed. In the Blount’s disease knees the operative treatment was performed in one stage and included: 1) arthrogram, 2) elevation of the medial tibial plateau, 3) fibulotomy, 4) closing wedge tibial osteotomy based laterally, 5) transfer of the bony wedge under the elevated plateau and fixation.

Results: All deformities were corrected with no recurrence, and stability of the knees persisted. We had one common peroneal nerve neuropraxia that recovered and one wound dehiscence.

Conclusions: In both conditions, EVC syndrome and Blount’s disease, corrective high tibial osteotomy does not address the pathology, and recurrence is to be expected. The described surgical technique fulfills that target – eradication of the pathologic elements that lead to valgus or varus.

Background: The Achilles tendon is the strongest and thickest tendon in the human body, it is very commonly injured with significant clinical implications. The treatment of Achilles tendon rupture is a matter of controversy in orthopedics and sports medicine. Surgical repair compared with conservative treatment is debated constantly in the literature, without a conclusive decision. The diagnosis of Achilles tendon rupture is based usually on clinical examination, and may be reinforced by ultrasound or magnetic resonance imaging. The present study has been conducted in order to determine whether an ultrasound examination performed at the time of injury could be useful in deciding how to treat the patient.

Patients: Over a period of 5 years we treated 26 patients who had a clinical presentation of ruptured Achilles tendon with ultrasound diagnosis of either a partial tear or a full tear. Patients who were diagnosed by ultrasound as having a full tendon tear were operated on, and were not included in this study. Eight patients had partial tear of the tendon, six had a tear of the musculotendinous region, and twelve had a proximal tear. All patients were treated by means of a cast or a dressing, with limitation of weight bearing. The follow-up period ranged between six months to three years after the injury, and included up-to-date functional evaluation.

Results: Eighteen patients were available for evaluation. Excellent functional results were reported by five patients, twelve patients reported good results, and one patient complained of a bad result. None of our patients needed delayed surgery, and only one suffered from re-rupture of the tendon during his rehabilitation, and was treated conservatively with good results. No correlation was found between the location of the tear and the functional results.

Conclusions: 1. Ultrasound is an important and accurate tool in the diagnosis of Achilles tendon tear and is helpful in choosing the appropriate treatment. 2. Partial tear of Achilles tendon is not an indication for operative treatment, even when the clinical examination (Thompson test) is positive. The outcome of conservative treatment in this situation is as good or even better than surgical treatment.