Different methods of anterior cruciate ligament (ACL) reconstruction
have been described for skeletally immature patients before closure
of the growth plates. However, the outcome and complications following
this treatment remain unclear. The aim of this systematic review
was to analyse the outcome and complications of different techniques
which may be used for reconstruction of the ACL in these patients. We performed a systematic review of the literature according
to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses
guidelines. This involved a comprehensive search of PubMed, Medline,
CINAHL, Cochrane, Embase and Google Scholar databases using the
following combinations of keywords, “knee”, “anterior cruciate ligament”,
“reconstruction”, “injury”, “children”, “adolescent”, “skeletally
immature”, “open physis” and “surgery”.Aims
Materials and Methods
The aim of this study was to report the outcome of the non-operative
treatment of high-grade posterior cruciate ligament (PCL) injuries,
particularly Hughston grade III injuries, which have not previously
been described. This was a prospective study involving 46 consecutive patients
who were athletes with MRI-confirmed isolated PCL injuries presenting
within four weeks of injury. All had Hughston grade II (25 athletes)
or III (21 athletes) injuries. Our non-operative treatment regimen
involved initial bracing, followed by an individualised rehabilitation
programme determined by the symptoms and physical signs. The patients
were reviewed until they had returned to sports-specific training,
and were reviewed again at a mean of 5.2 years (3 to 9).Aims
Patients and Methods
Our aim was to compare kinematic with mechanical alignment in
total knee arthroplasty (TKA). We performed a prospective blinded randomised controlled trial
to compare the functional outcome of patients undergoing TKA in
mechanical alignment (MA) with those in kinematic alignment (KA).
A total of 71 patients undergoing TKA were randomised to either
kinematic (n = 36) or mechanical alignment (n = 35). Pre- and post-operative
hip-knee-ankle radiographs were analysed. The knee injury and osteoarthritis
outcome score (KOOS), American Knee Society Score, Short Form-36,
Euro-Qol (EQ-5D), range of movement (ROM), two minute walk, and timed
up and go tests were assessed pre-operatively and at six weeks,
three and six months and one year post-operatively.Aims
Patients and Methods
Cortical and cancellous bone healing processes appear to be histologically different. They also respond differently to anti-inflammatory agents. We investigated whether the leucocyte composition on days 3 and 5 after cortical and cancellous injuries to bone was different, and compared changes over time using day 3 as the baseline. Ten-week-old male C56/Bl6J mice were randomized to either cancellous injury in the proximal tibia or cortical injury in the femoral diaphysis. Regenerating tissues were analyzed with flow cytometry at days 3 and 5, using panels with 15 antibodies for common macrophage and lymphocyte markers. The cellular response from day 3 to 5 was compared in order to identify differences in how cancellous and cortical bone healing develop.Objectives
Methods
Our aim was to evaluate the radiographic characteristics of patients
undergoing total hip arthroplasty (THA) for the potential of posterior
bony impingement using CT simulations. Virtual CT data from 112 patients who underwent THA were analysed.
There were 40 men and 72 women. Their mean age was 59.1 years (41
to 76). Associations between radiographic characteristics and posterior
bony impingement and the range of external rotation of the hip were
evaluated. In addition, we investigated the effects of pelvic tilt
and the neck/shaft angle and femoral offset on posterior bony impingement.Aims
Patients and Methods
Anterior cruciate ligament (ACL) reconstruction
is commonly performed and has been for many years. Despite this, the
technical details related to ACL anatomy, such as tunnel placement,
are still a topic for debate. In this paper, we introduce the flat
ribbon concept of the anatomy of the ACL, and its relevance to clinical
practice. Cite this article:
The purpose of this study was to evaluate the long-term outcome
of adolescents with cerebral palsy who have undergone single-event
multilevel surgery for a flexed-knee gait, followed into young adulthood
using 3D motion analysis. A total of 59 young adults with spastic cerebral palsy, with
a mean age of 26 years (Aims
Patients and Methods
Posterior condylar offset (PCO) and posterior tibial slope (PTS) are critical factors in total knee arthroplasty (TKA). A computational simulation was performed to evaluate the biomechanical effect of PCO and PTS on cruciate retaining TKA. We generated a subject-specific computational model followed by the development of ± 1 mm, ± 2 mm and ± 3 mm PCO models in the posterior direction, and -3°, 0°, 3° and 6° PTS models with each of the PCO models. Using a validated finite element (FE) model, we investigated the influence of the changes in PCO and PTS on the contact stress in the patellar button and the forces on the posterior cruciate ligament (PCL), patellar tendon and quadriceps muscles under the deep knee-bend loading conditions.Objectives
Methods
Patellar instability most frequently presents
during adolescence. Congenital and infantile dislocation of the
patella is a distinct entity from adolescent instability and measurable
abnormalities may be present at birth. In the normal patellofemoral
joint an increase in quadriceps angle and patellar height are matched
by an increase in trochlear depth as the joint matures. Adolescent
instability may herald a lifelong condition leading to chronic disability
and arthritis. Restoring normal anatomy by trochleoplasty, tibial tubercle transfer
or medial patellofemoral ligament (MPFL) reconstruction in the young
adult prevents further instability. Although these techniques are
proven in the young adult, they may cause growth arrest and deformity
where the physis is open. A vigorous non-operative strategy may
permit delay of surgery until growth is complete. Where non-operative
treatment has failed a modified MPFL reconstruction may be performed
to maintain stability until physeal closure permits anatomical reconstruction.
If significant growth remains an extraosseous reconstruction of
the MPFL may impart the lowest risk to the physis. If minor growth
remains image intensifier guided placement of femoral intraosseous
fixation may impart a small, but acceptable, risk to the physis. This paper presents and discusses the literature relating to
adolescent instability and provides a framework for management of
these patients. Cite this article:
We reviewed 34 consecutive patients (18 female-16 male) with
isthmic spondylolysis and grade I to II lumbosacral spondylolisthesis
who underwent in situ posterolateral arthodesis between the L5 transverse
processes and the sacral ala with the use of iliac crest autograft.
Ten patients had an associated scoliosis which required surgical correction
at a later stage only in two patients with idiopathic curves unrelated
to the spondylolisthesis. No patient underwent spinal decompression or instrumentation
placement. Mean surgical time was 1.5 hours (1 to 1.8) and intra-operative
blood loss 200 ml (150 to 340). There was one wound infection treated
with antibiotics but no other complication. Radiological assessment
included standing posteroanterior and lateral, Ferguson and lateral flexion/extension
views, as well as CT scans. Aims
Methods
Patients undergoing femoral lengthening by external fixation
tolerate treatment less well when compared to tibial lengthening.
Lengthening of the femur with an intramedullary device may have
advantages. We reviewed all cases of simple femoral lengthening performed
at our unit from 2009 to 2014. Cases of nonunions, concurrent deformities,
congenital limb deficiencies and lengthening with an unstable hip
were excluded, leaving 33 cases (in 22 patients; 11 patients had
bilateral procedures) for review. Healing index, implant tolerance
and complications were compared.Aims
Patients and Methods
The aim of this study was to evaluate the feasibility
of using the intact S1 nerve root as a donor nerve to repair an avulsion
of the contralateral lumbosacral plexus. Two cohorts of patients
were recruited. In cohort 1, the L4–S4 nerve roots of 15 patients
with a unilateral fracture of the sacrum and sacral nerve injury
were stimulated during surgery to establish the precise functional
distribution of the S1 nerve root and its proportional contribution
to individual muscles. In cohort 2, the contralateral uninjured
S1 nerve root of six patients with a unilateral lumbosacral plexus
avulsion was transected extradurally and used with a 25 cm segment
of the common peroneal nerve from the injured leg to reconstruct
the avulsed plexus. The results from cohort 1 showed that the innervation of S1 in
each muscle can be compensated for by L4, L5, S2 and S3. Numbness
in the toes and a reduction in strength were found after surgery
in cohort 2, but these symptoms gradually disappeared and strength
recovered. The results of electrophysiological studies of the donor
limb were generally normal. Severing the S1 nerve root does not appear to damage the healthy
limb as far as clinical assessment and electrophysiological testing
can determine. Consequently, the S1 nerve can be considered to be
a suitable donor nerve for reconstruction of an avulsed contralateral
lumbosacral plexus. Cite this article:
The purpose of this study was to report the experience of dynamic
intraligamentary stabilisation (DIS) using the Ligamys device for
the treatment of acute ruptures of the anterior cruciate ligament
(ACL). Between March 2011 and April 2012, 50 patients (34 men and 16
women) with an acute rupture of the ACL underwent primary repair
using this device. The mean age of the patients was 30 years (18
to 50). Patients were evaluated for laxity, stability, range of
movement (ROM), Tegner, Lysholm, International Knee Documentation Committee
(IKDC) and visual analogue scale (VAS) scores over a follow-up period
of two years.Aims
Patients and Methods
Recent reports have suggested an increase in
the number of anterior cruciate ligament (ACL) injuries in children, although
their true incidence is unknown. The prognosis of the ACL-deficient knee in young active individuals
is poor because of secondary meniscal tears, persistent instability
and early-onset osteoarthritis. The aim of surgical reconstruction
is to provide stability while avoiding physeal injury. Techniques
of reconstruction include transphyseal, extraphyseal or partial
physeal sparing procedures. In this paper we review the management of ACL tears in skeletally
immature patients. Cite this article:
