Evaluation of recurrent dislocation of the patella in children with MRI: Goldthwait technique combined with lateral release, and VMO advancement-a retrospective study of 85 knees.

PURPOSE: There are certain risk factors responsible for patella instability that should be identified before choosing the most appropriate treatment. METHODS: We evaluated 83 skeletally immature patients who, after two or more patellar dislocation episodes, underwent surgical treatment to address the condition of patellar instability. Each patient was evaluated for patellar instability risk factors using the Balcarek patellar instability severity score. Evaluation of patellar instability included knee MRI to systematically identify anatomical risk factors. The preoperative and postoperative clinical evaluation included the modified Cincinnati score and the Kujala score. The Roux-Goldthwait technique combined with lateral retinaculum release and the advancement of the vastus medialis oblique (VMO) was performed on all knees. RESULTS: The mean patient age at the time of surgery was 12.2 ± 1.59 years (range 8-14 years). The average follow-up was 4.72 ± 1.37 (range 3-8) years. Trochlear dysplasia (decreased trochlear depth), the most common anatomical risk factor, was identified in 71 knees (83.5%). The modified Cincinnati score increased from 58.46 ± 8.75 (range 49-76) points to 94.07 ± 2.88 (range 88-98) postoperatively. The mean Kujala scores increased from 58.51 ± 8.94 (range 49-76) points to 93.66 ± 2.65 (range 87-98) postoperatively. The two-tailed P value was less than 0.0001. The patients were followed until their skeletal maturation, without reporting any incidents of patella dislocation, except one. CONCLUSION: The Roux-Goldthwait technique combined with lateral retinaculum release, and the advancement of VMO, can restore patellar tracking and can decrease the probability of another dislocation. It was an effective treatment in skeletally immature patients who had two or more episodes of patellar dislocation. LEVEL OF EVIDENCE: IV.

Bioabsorbable pins for treatment of osteochondral fractures of the knee after acute patella dislocation in children and young adolescents.

A retrospective study was performed on the use of bioabsorbable pins in the fixation of osteochondral fractures (OCFs) after traumatic patellar dislocation in children. Eighteen children (13 females, 5 males) aged 11 to 15 years (mean age 13.1 years) with osteochondral fracture (OCF) of the knee joint were treated at the authors' institution. Followup ranged from 22 months to 5 years. Diagnosis was verified by X-ray and magnetic resonance imaging (MRI) of the knee and patella. In seven patients the osteochondral fragment was detached from the patella and in 11 it was detached from the lateral femoral condyle. All patients were subjected to open reduction and fixation of the lesion with bioabsorbable pins. Postoperatively, the knee was immobilized in a cast and all patients were mobilized applying a standardized protocol. Bone consolidation was successful in 17 of the 18 patients. Bioabsorbable pins reliably fix OCF in children and adolescents, demonstrating a high incidence of consolidation of the detached osteochondral fragment in short- and middle-term followup without requiring further operative procedures.

Characterization of albumin-acacia complex coacervation.

Complex coacervation between oppositely charged albumin and acacia mixtures has been studied, and the applicability of the various theoretical treatments of complex coacervation (the Voorn-Overbeek, Veis-Aranyi, Nakajima-Sato, and Tainaka theories) to this system has been assessed. Under optimum conditions where maximum coacervate yield occurred, the Voorn-Overbeek theory appeared to apply. However, away from the optimum coacervation conditions, coacervate sol formation was observed, which is in accordance with the Veis-Aranyi and Tainaka theories. Microelectrophoretic measurements were used to determine optimum pH and ionic strength conditions for maximum coacervation, based on the method of Burgess & Carless (1984). The effects of pH and ionic strength on coacervate yield are reported. Around the optimum conditions for maximum coacervation a viscous coacervate phase and a relatively clear equilibrium phase are formed.