Patellofemoral instability (PFI) is a common cause of knee pain and disability in the paediatric population. Patella alta, lateralised tibial tubercle, medial patellofemoral ligament (MPFL) deficiency, genu valgum and trochlear dysplasia are well known risk factors. A prospective database was created including patients referred through our physiotherapy pathway following first-time patella dislocation. Patella alta and lateralisation of the tibial tuberosity was treated with a Fulkerson-type tibial tubercle osteotomy(TTO). Medial patellofemoral ligament was reconstructed using quads tendon autograft pull-down technique. A modified Sheffield protocol was used postoperatively allowing weightbearing in a hinged knee brace. Forty patients were identified with 8 patients having bilateral presentations. Male to female ratio was 12:28 with an age range of 4–17 years. Eight patients had congenital PFI, five patients acquired PFI through traumatic patella dislocation and twenty-seven patients developed PFI from recurrent dislocations. Structural abnormalities were found in 38(95%) of patients. Patella alta (Caton-Deschamps index >1.2) was identified in 19(47%) patients, genu valgum in 12(30%) patients, increased tibial tubercle-trochlear groove distance(TT-TG>20mm) was present in 9(22.5%) patients and persistent femoral anteversion(> 20 deg) in 7(17%) patients. Eight patients were treated with TTO and MPFL reconstruction, three patients with MPFL reconstruction alone and five patients had guided growth for genu valgum correction. Ten patients are awaiting surgery. No postoperative patients had recurrence of PFI at their latest follow up. PFI is a common problem in the adolescent paediatric population with identifiable structural abnormalities. Correcting structural pathology with surgery leads to predictable and safe outcomes

Purpose. Angular deformity in the lower extremities can result in pain, gait disturbance, cosmetic deformity and joint degeneration. Up until the introduction of guided growth in 2007, which has since become the gold standard, treatment for correcting angular deformities in skeletally immature patients had been either an osteotomy, a hemiepiphysiodesis, or the use of staples. Methods. We reviewed the surgical records and diagnostic imaging in our childrens hospital to identify all patients who had guided growth surgery since 2007. All patients were followed until skeletal maturity or until their metalwork was removed. Results. 113 patients, with 147 legs were assessed for eligibility. Three were excluded for various reasons including inadequate follow-up or loss of records. Of the 144 treated legs which met the criteria for final assessment 32 (22.2%) were unsuccessful, the other 112 (77.8%) were deemed successful at final follow up. Complications were few, but included infection in one case and metal failure in another. Those with a pre-treatment diagnosis of idiopathic genu valgum/genu varum had a success rate of 83.6%. Conclusions. In our hands, guided growth had a seventy-eight percent success rate when all diagnosis were considered. Those procedures that were unlikely to be successful included growth disturbances due to mucopolysaccharide storage disease (28% failure rate), Blounts disease (66.6% failure rate) and achondroplasia (37.5% failure rate). If you exclude those three diagnoses, success rate for all other conditions was 81.4%. We continue to advocate the use of guided growth as a successful treatment option for skeletally immature patients with limb deformity

Introduction. Proper rotational alignment of the tibial component in total knee arthroplasty (TKA) could be achieved using several techniques. The self adjustment methodology allows the alignment of the tibial component under the femoral component after several flexion-extension movements. Our hypothesis was that this technique allowed a posterior tibial component alignment parallel to the femoral component posterior bicondylar axis. The aim of this study was to access this hypothesis using a post-operative CT-scan study. Materials and Methods. This prospective CT-scan study involved 94 TKA. Theses TKA were divided in two groups: group1: 50 knees with a pre-operative genu varum deformity (mean HKA: 172.2°), operated using a medial parapatellar approach, and group 2: 44 knees with a preoperative valgus deformity (mean HKA: 188.7°), operated using a lateral parapatellar approach. Four measures were done on each post-operative CT-scan: angle between anatomical transepicondylar axis and femoral component posterior bicondylar axis (FCPCA), angle between FCPCA and tibial component marginal posterior axis, angle between tibial component marginal posterior axis and bony tibial plateau marginal posterior axis (BTPMPA), angle between transepicondylar axis and tibial component marginal posterior axis. Each measure was repeated, after one month by the same independent observer. Statistical evaluation used non-parametric Wilcoxon–Mann–Whitney test to compare each group of measures, and intraobserver reproducibility was assessed using ANOVA test, with an error rate of 5%. Results. Intraobserver measurements were reproducible. Mean FCPCA was to 3,1° (SD:1,91) in group 1 and 4,7° (DS: 2,96) in group 2. Tibial component was positioned in external rotation in both groups, in relation to FCPCA: (group 1: mean angle: 0,7° (SD:4,45), group 2: mean angle: 0,9° (SD:4,53)) and in relation to BTPMPA: (group1: mean angle: 6,1° (SD: 5,85); group2: mean angle: 12,5° (SD: 8,6)). There was no statistical difference between these two groups. Tibial component was positioned in internal rotation in relation to anatomical transepicondylar axis: (Group1: mean angle: 1,9° (SD: 4,93); group 2: mean angle: 3° (SD: 4.38)). Discussion. By using the self adjustment technique, tibial component is aligned parallel to the femoral component regardless of the initial frontal deformity and the surgical approach. However, there was a difference in tibial component axis and BTPMPA, between the two groups. This difference should be explained by the difference in morphology of the tibial plateau bone in knee with genu valgum deformity. The self adjustment technique is a reliable method to obtain a proper rotational alignment of the tibial component in TKA