Autologous osteochondral mosaicplasty in osteochondritis dissecans of the patella in adolescents.

PURPOSE: Osteochondritis dissecans of the patella (OCDP) is rare in adolescents. The objective of this study was to evaluate functional results of OCDP management in adolescents with mosaicplasty and to analyze proper integration of osteochondral grafts via MRI. METHODS: This is a retrospective series of eight cases of OCDP treated by mosaicplasty. Mean age at the surgery was 15 years (range 12-17). Clinical features were represented by retropatellar pain, hydarthrosis, locking and crepitus. All patients benefited from knee radiographs as well as pre-operative MRI. Six OCDP were evaluated International Cartilage Repair Society (ICRS) grade III and two were ICRS grade IV. Mean surface of the lesion was 97.5 mm2. The pre- and post-operative assessments were conducted with scores obtained on the IKDC subjective knee evaluation form, Lysholm knee score, and Tegner activity scale. These assessments were completed by post-operative MRI. The magnetic resonance observation of cartilage repair tissue (MOCART) score was calculated from the latest MRI examination conducted after surgery. RESULTS: Mean follow-up was 28.6 months. At the latest follow-up, the mean IKDC score was 86.5, Lysholm score was 89, and Tegner activity scale score was 6.2 (pre-operative scores were respectively 49.9, 53.8, and 4.5). Radiographs and MRI showed a complete integration of grafts at the latest follow-up with a satisfactory reconstruction of the joint surface. Mean MOCART score was 75/100. CONCLUSIONS: Autologous osteochondral mosaicplasty to manage OCDP in adolescents appears to be a reliable technique on the short term to restore patellar joint surface and obtain satisfactory functional results.

Displaced medial epicondyle fractures of the humerus: surgical treatment and results. A report of 139 cases.

BACKGROUND: Elbow instability is a common feature after medial epicondyle fractures, displaced or not, even in the absence of dislocation. Undisplaced or minimally displaced fractures often have an underestimated degree of instability secondary to unrecognised capsuloligamentous and muscular injuries. The purpose of this retrospective study was to analyze and to assess objectively the results of the surgical treatment of these acute injuries. METHODS: One hundred and thirty-nine displaced medial epicondyle fractures were surgically treated and reviewed. A valgus stress test was performed on each child under general anesthesia or sedation. Functional outcome was assessed using a scoring system based on a series of clinical and radiographic criteria. The mean age of patients at the time of accident was 11.9 years. Mean follow-up was 3.9 years. All fractures had associated with instability of the elbow. A posterolateral elbow dislocation was associated in 80 fractures. The medial epicondylar fragment was anatomically reduced and fixed in all cases. RESULTS: The final result was excellent in 130 cases and good in 9 cases. Elbow were stable and pain free in all patients. Normal elbow range of motion was reported in 133 cases. Union was achieved in all cases. Among these cases, nine had presented a <> union with no change on valgus stress views. No cases of cubitus valgus >/=10 degrees were observed. Anatomical abnormalities of the elbow were present in 28 cases: periarticular calcification in 18 cases, medial condyle groove formation in 4 cases, moderate hypertrophy and fragmentation of the medial epicondyle, respectively, in 3 cases. The positive valgus stress test performed at the time of surgery for all epicondyle fractures without associated dislocation regardless of there degree of displacement justified our operative approach. CONCLUSION: Operative intervention is a good management of these fractures and results in an anatomic reduction, a solid bone union and prevents valgus instability. Even with postoperative immobilization of the elbow (mean of 4 weeks), stiffness is rare. Damage to the medial stabilizing structure of the elbow rather than the extent of medial epicondyle displacement has a far greater influence on joint stability and outcome.

Satisfactory restoration of thoracic kyphosis in Lenke I AIS curves using bilateral vertebral coplanar alignment: an international multicenter experience.

STUDY DESIGN: Review of a prospective multicenter registry. OBJECTIVE: To report the correction of the thoracic sagittal profile in Lenke 1 curves using the bilateral vertebral coplanar alignment (BVCA) maneuver. All-pedicle-screw construtcs provide satisfactory coronal correction but fail to accurately restore the frequent thoracic hypokyphosis of Lenke 1 curves. BVCA is a recently described technique focused on restoration of the normal thoracic kyphosis alignment in AIS patients. METHODS: A non-consecutive series of 49 AIS patients underwent surgical correction of the deformity by only posterior pedicle screw construct. Coronal and sagittal curve correction was assessed by conventional standing X-rays at preoperative and 2-year follow-up visits. BVCA reduction maneuvers include the correction of the deformity, while descending an implantable rod within slotted tubes attached to the convex side screws. Restoration of physiologic kyphosis is achieved by spreading the distal ends of the tubes at the thoracic spine using different-sized spacers. RESULTS: Mean preoperative Cobb of the MT curves was 58.4° and was corrected at 70.9%. Preoperative apical vertebral rotation was 18.6° on average and was corrected at 52.9%. T5-T12 kyphosis showed a significant improvement from a mean angle of 18.8º (95% CI 13.3-24.8) to 23.5º (95% CI 20.1-26.1) at 2-year follow-up (a 25% increase) (p = 0.040). Patients with (-) sagittal modifier gained 13.9º on average; those with ( +) modifier decreased 24.0°, and patients with N sagittal modifier remained almost unchanged (2.9°). Differences in the changes of the thoracic sagittal profile between the three groups were statistically significant (p < 0.001). After surgical correction of scoliosis, 87.8% of the patients were considered normokyphotic. CONCLUSIONS: Clinical results have proven the ability of BVCA to obtain good correction of the deformity in the coronal plane, similar to other methods. However, this technique permits a more relevant restoration of thoracic kyphosis.

Complications of Albizzia femoral lengthening nail: an analysis of 36 cases.

Thirty-six cases of femoral lengthening using the Albizzia nail were performed. The indication for lengthening was a congenital malformation, sequellae of trauma, of infection, of radiation therapy, short stature, and vascular malformation. The mean age of the patients was 16 years, the average lengthening achieved was 4.7 cm, and the follow-up period averaged 5.8 years. We found that bone consolidation was achieved faster than with external fixation. The patient's comfort during lengthening as well as the speed of functional restoration also improved. In three cases, the program failed, in six the lengthening was achieved with a second procedure, and eight patients required one ratcheting or more under general anesthesia. In our experience, the Albizzia nail is a simple and effective solution for uncomplicated femoral lengthening.

Active aneurysmal bone cysts in children: possible evolution after biopsy.

PURPOSE: The active or aggressive character in certain localisations of aneurysmal bone cysts in children requires either curettage with a considerable recurrence rate or a radical segmental excision, raising complex reconstructive challenges. Cyst maturation with subsequent ossification may be observed either spontaneously or after incisional biopsy. PATIENTS: Five new cases of active aneurysmal bone cysts (ABCs) with healing of the cyst after biopsy alone are reported. All patients had no treatment of the cyst after the biopsy. RESULTS: In two cases, the lesion initially increases in size immediately after the biopsy, and it is only secondarily that the lesion decreases in size. Four out of five cases of the spontaneous healing occurred in pelvic bone. The cysts healed after, respectively, 36, 24, 12, 32 and 12 months. CONCLUSIONS: The emergence of these new cases of spontaneous healing encourages promoting clinical and radiological supervision after biopsy in selected cases. Unfortunately, it is impossible to predict a possible aggressive behaviour in ABCs. Then, if the lesion is quickly aggressive with clinically and radiologically increasing size after biopsy, it would be illogical and dangerous to let this ABC evolve. It would be necessary to treat it without delay. On the other hand, if the lesion moderately increased after the biopsy, it is possible to wait and observe the patient during a period of 5 months for a possible healing, if the ABC localisation is not dangerous. Of course, if the lesion does not increase in size after biopsy, there is no delay to treat it.