[Proximal avulsion of the tendon of the rectus femoris muscle : Case description and literature review]. / Proximaler Ausriss der Sehne des M. rectus femoris : Fallbeschreibung und Literaturübersicht.

Injuries of the thigh muscles are among the most common sports injuries. In soccer they represent nearly 30% of all injuries. The rectus femoris muscle in particular is often exposed to injuries due to its anatomical features. Versatile treatment strategies and posttreatment procedures are described in the literature, which take the type and duration of the injury and the physical constitution of the patient into consideration. This article presents the case of a 28-year-old hobby football player who suffered a proximal avulsion of a tendon of the rectus femoris muscle during a football match. After persistent complaints over 2 months operative treatment was performed by anchor refixation of the tendon. During the follow-up at 6 weeks postoperatively, there was a very good functional result with good mobility and only slightly reduced strength with early full load and movement. The anamnesis revealed no deficits in the side to side comparison 1.5 years after the trauma.

Long-term outcome of chevron-osteotomy in juvenile hallux valgus.

The long-term outcome of juvenile hallux valgus treated by a modified Austin procedure was investigated. The clinical (subjective, AOFA Scores) and radiological outcome (hallux valgus angles, intermetatarsal angles, position of the sesamoid bones and metatarsal index of 15 feet in 12 patients, aged 14 years and 2 months (SD +/- 1 year 10 months) were assessed pre- and postoperatively and after 7 years and 3 months (SD +/- 3 years). A significant improvement of the hallux valgus angle and of the intermetatarsal angle was obtained, persisting until final follow-up. The mean American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal and AOFA-Midfoot score were 94.5 points and 853 points, respectively. The modified Austin procedure appears to be an effective procedure to correct a juvenile hallux valgus deformity, with long lasting improvement, no growth disturbances and good functional outcome.

Patella re-alignment in children with a modified Grammont technique.

BACKGROUND AND PURPOSE: In skeletally immature patients, surgical options due to recurrent patella dislocation are limited, because bony procedures bear the risk of growth disturbances. In this retrospective study, we report the long-term functional and radiographic outcome in skeletally immature patients using the modified Grammont surgical technique. PATIENTS: Between 1999 and 2004, 65 skeletally immature knees (49 children) were treated with a modified Grammont procedure: an open lateral release and a shift of the patella tendon insertion below the growth plate on the tuberositas tibia, allowing the tendon to medialize. At mean 8 (5.6-11) years after surgery, 58 knees in 43 patients were evaluated by clinical examination, from functional scores (Lysholm, Tegner), and from radiographs of the knees. RESULTS: Mean Lysholm score was 82 postoperatively. Tegner score decreased from 6.2 to 5. Eight knees had a single dislocation within 3 months of surgery. 3 knees had repeated late dislocations, all with a high grade of trochlea dysplasia. 6 knees showed mild signs of osteoarthritis. No growth disturbances were observed. INTERPRETATION: The modified Grammont technique in skeletally immature patients allows restoration of the distal patella tendon alignment by dynamic positioning. Long-term results showed that there were no growth disturbances and that there was good functional outcome. However, patients with a high grade of trochlea dysplasia tended to re-dislocate.

Outcome of repaired unstable meniscal tears in children and adolescents.

BACKGROUND: Unstable meniscal tears are rare injuries in skeletally immature patients. Loss of a meniscus increases the risk of subsequent development of degenerative changes in the knee. This study deals with the outcome of intraarticular meniscal repair and factors that affect healing. Parameters of interest were type and location of the tear and also the influence of simultaneous reconstruction of a ruptured ACL. METHODS: We investigated the outcome of 25 patients (29 menisci) aged 15 (4-17) years who underwent surgery for full thickness meniscal tears, either as isolated lesions or in combination with ACL ruptures. Intraoperative documentation followed the IKDC 2000 standard. Outcome measurements were the Tegner score (pre- and postoperatively) and the Lysholm score (postoperatively) after an average follow-up period of 2.3 years, with postoperative arthroscopy and MRT in some cases. RESULTS: 24 of the 29 meniscal lesions healed (defined as giving an asymptomatic patient) regardless of location or type. 4 patients re-ruptured their menisci (all in the pars intermedia) at an average of 15 months after surgery following a new injury. Mean Lysholm score at follow-up was 95, the Tegner score deteriorated, mean preoperative score: 7.8 (4-10); mean postoperative score: 7.2 (4-10). Patients with simultaneous ACL reconstruction had a better outcome. INTERPRETATION: All meniscal tears in the skeletally immature patient are amenable to repair. All recurrent meniscal tears in our patients were located in the pars intermedia; the poorer blood supply in this region may give a higher risk of re-rupture. Simultaneous ACL reconstruction appears to benefit the results of meniscal repair.

Does gender influence the long-term outcome of single-event multilevel surgery in spastic cerebral palsy?

This study compared the long-term outcome of single-event multilevel surgery in spastic diplegic cerebral palsy (CP) on the basis of sex. We hypothesized that boys would have a worse outcome than girls. Thirty-four children (19 boys and 15 girls) with diplegic spastic CP and a minimal follow-up of 10 years were included. The Gillette Gait Index was the main outcome measure. We found no differences in surgical treatment, and both groups initially benefited from the surgery. However, although girls maintained the enhanced level of walking, walking ability in boys deteriorated constantly. Such a finding suggests that sex might have an important influence on treatment outcomes in children with CP.

Pathological gait in children with Legg-Calvé-Perthes disease and proposal for gait modification to decrease the hip joint loading.

PURPOSE: Legg-Calvé-Perthes disease (LCP) severely limits the range of hip motion and hinders a normal gait. Loading of the hip joint is a major consideration in LCP treatment. The aim of this study was to evaluate gait patterns in LCP and identify gait modifications to decrease the load on the affected hip. METHODS: Forty children with unilateral LCP were divided into three groups based on the time base integral of the hip abductor moments during single stance on the affected side acquired during instrumented 3D gait analysis. X-rays of the affected hip were classified according to Herring and Catterall. RESULTS: Children in the "unloading" group spontaneously adopted a Duchenne-like gait with pelvis elevation, hip abduction and external rotation during single support phase. The "normal-loading" group showed pelvis elevation with a neutral hip position in the frontal plane. In the "overloading" group the pelvis dropped to the swinging limb at the beginning of stance accompanied by prolonged hip adduction. The time base integral of the hip abductor moments during single stance correlated positively with the X-ray classifications of Herring and Catterall, hip abduction angle and age. Older children preferred to walk in hip adduction during single stance, had more impaired hips and tended to overload them. CONCLUSION: The hip overloading pattern should be avoided in children with LCP. Gait training to unload the hip might become an integral component of conservative treatment in children with LCP.

Lengthening of the midfoot in a case of lower-extremity hemimelia.

Hemimelia of the lower limb belongs to the group of congenital deficiency disorders. The clinical spectrum ranges from minimal shortening of the long bones to severe deficiencies of the extremities. Several etiologies, such as X-rays or drugs, have been implicated to be responsible for hemimelia. In the present report the clinical course and the long-term follow-up of a patient with transverse terminal hemimelia of the left foot at the level of the basis of the metatarsals is described. Due to frequent episodes of pain, development of pressure sores, and an increasing psychological burden, operative intervention consisting of a lengthening procedure using an Ilizarov fixator was indicated. Long-term outcome was good; the patient is now able to painlessly wear conventional shoes and displays a normal gait pattern.

The influence of age at single-event multilevel surgery on outcome in children with cerebral palsy who walk with flexed knee gait.

AIM: Information on the timing and long-term outcome of single-event multilevel surgery in children with bilateral spastic cerebral palsy (CP) walking with flexed knee gait is limited. Based on our clinical experience, we hypothesized that older children with bilateral spastic CP would benefit more from single-event multilevel surgery than younger children. Moreover, any improvement in older children could be maintained with fewer additional surgery events. METHOD: We performed a retrospective analysis of the long-term outcomes of single-event multilevel surgery. Thirty-two children (17 males, 15 females) who had received single-event multilevel surgery between 1995 and 2000 with a mean age at the time of surgery of 10 years 6 months (range 5y 8mo-15y 6mo; SD 3y 1mo) and in Gross Motor Function Classification System level II (n=12) or III (n=20) were included in the study. The inclusion criteria required that all children were ambulatory with spastic bilateral CP, had a flexed knee gait, had a full set of data for single-event multilevel surgery preoperatively and at 1 year and 10 years postoperatively, had not had previous surgery on their lower limbs, had not had any treatment with botulinum toxin A before gait assessment, and had not received intrathecal baclofen medication. The follow-up time lasted for over 10 years until the participants reached adulthood (mean age at the last follow-up 21 years 4 months, SD 3y 4mo). Data were collected on six separate occasions: preoperatively, at 1 year, at 2 to 3 years, at 5 years, at 7 to 8 years, and at 10 or more years postoperatively. The primary outcome was the Gait Deviation Index, and the secondary outcomes were the number and type of initial and additional surgeries. A linear mixed model and Spearman's rank correlation coefficient were used to prove the hypothesis. RESULTS: The older the child was at the time of the surgery, the better the long-term result ((Age,Time) =0.15; p=0.03). We did not find any correlation between age at the time of surgery and the number of bony or soft-tissue procedures performed initially as well as during the 10 years of follow-up. INTERPRETATION: Children with CP who require single-event multilevel surgery at an older age fare better in the long term than those who are younger at the time of surgery. The pubertal growth spurt is discussed as a contributing factor to gait deterioration.

Dynamic versus fixed equinus deformity in children with cerebral palsy: how does the triceps surae muscle work?

OBJECTIVES: To detect outcome measures that could help differentiate between dynamic and fixed equinus (FEQ) deformities in children with cerebral palsy, and secondary, to describe the function of the gastrocnemius and soleus (SOL) muscles when either dynamic triceps surae tightness or FEQ contracture is present. DESIGN: A group-comparison study. SETTING: Gait analysis laboratory. PARTICIPANTS: Children (N=23; 31 limbs) with cerebral palsy; 12 limbs showed a fixed contracture (FEQ group) and 19 limbs showed dynamic tightness of the triceps muscle (dynamic equinus group). Healthy children (N=12) without a neurologic or orthopedic disorder served as the control group. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Time-distance, kinematic and kinetic gait variables, muscle-tendon length, and velocity parameters. RESULTS: Maximal ankle dorsiflexion angles were decreased in both equinus groups compared with the control group. Ankle range of motion, maximal power generation of the plantar flexors, and its timing during the gait cycle were different among groups. The ankle slope parameter showed substantial differences among groups. Muscle-tendon length parameters for the SOL and the medial (MGAC) and lateral gastrocnemius muscles were abnormal in both equinus groups compared with the control group. Maximal muscle lengths of the MGAC and SOL were longer in the dynamic equinus than FEQ group. Peak lengthening velocity of the triceps surae muscle was significantly slower for all triceps surae muscles in the FEQ group than in the dynamic equinus group and occurred in the early swing phase. CONCLUSIONS: The presented results indicate that peak lengthening velocity of the triceps surae muscle might be one of the discriminating factors between FEQ and dynamic equinus deformity in children with cerebral palsy. This could help clinical decision making for treatment of an equinus gait pattern.

Genu recurvatum in cerebral palsy--part A: influence of dynamic and fixed equinus deformity on the timing of knee recurvatum in children with cerebral palsy.

The aim of the study was to confirm the hypothesis of the influence of the dynamic and fixed equinus deformity on the timing of knee recurvation (hyperextension). According to our hypothesis, dynamic equinus is linked to early and fixed equinus and to late knee hyperextension. A group 35 children with cerebral palsy (47 lower limbs) was divided into two subgroups according to the timing of maximum knee hyperextension. Clinical examination confirmed our hypothesis. Gait analysis and musculoskeletal modelling results were compared with 12 normally developing children. Both recurvatum groups had forefoot landing and neither achieved normal ankle dorsiflexion. Electromyographic examination revealed an abnormally high soleus activity in a single stance. Muscle length changes of medial gastrocnemius and soleus were in agreement with our hypothesis. Such a finding might simplify the decision as to which treatment to select for equinus deformity, present in patients with genu recurvatum.

Genu recurvatum in cerebral palsy--part B: hamstrings are abnormally long in children with cerebral palsy showing knee recurvatum.

Hyperextension of the knee in stance (knee recurvatum) is a common disorder in patients with spastic cerebral palsy (CP). A group 35 children with CP (47 lower limbs) was divided into two subgroups according to the timing of maximum knee extension during the stance phase of gait. Gait analysis and musculoskeletal modelling data were compared with a control group of 12 normally developing children. We observed no difference in kinematics between the CP groups who showed an equinus position of the foot at initial contact. Both groups showed increased external extensor moments across the knee. The muscle-tendon lengths of the hamstrings were abnormally long at initial contact, and in both recurvatum groups, contracted faster compared with the control group. Surface electromyography revealed prolonged activity of the hamstrings in stance and early activation in swing. Abnormally long hamstrings at initial contact together with equinus position of the foot are the main causes of genu recurvatum in children with CP.

Preliminary report: resection and interposition of a deepithelialized skin flap graft in tarsal coalition in children.

Six tarsal coalitions in children were managed surgically using a deepithelialized skin flap for interposition after resection of the bony, fibrous or cartilaginous coalition. The advantage of this technique is that due to positioning the skin flap, joint motion can be preserved. The clinical results using the Ankle Hindfoot Scale of the American Orthopedic Foot and Ankle Society were excellent in two and good in four cases. The radiographs at follow-up showed no recurrences of the resected coalitions. This study shows that the use of deepithelialized skin flap interposition is effective in providing pain relief for the patients in symptomatic coalitions.

Gait analysis in patients with Parkinson's disease off dopaminergic therapy.

OBJECTIVE: To compare time-distance, kinematic, and kinetic gait parameters in patients with idiopathic Parkinson's disease (PD) off dopaminergic therapy with a group of healthy control subjects. DESIGN: A group-comparison study. SETTING: Gait analysis laboratory. PARTICIPANTS: Patients with PD (n=20) and healthy age-matched controls (n=20). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Time-distance, kinematic, and kinetic gait variables. RESULTS: PD patients walked slower with shorter stride-length, comparable cadence, and longer double support times. Kinematics showed a reduction of the range of motion in the hip, knee, and ankle joints. Maximum hip extension and the ankle plantar flexion were significantly reduced. Kinetic gait parameters showed reduced push-off ankle power and lift-off hip power generation. Strong correlations between these important body advancement mechanisms and the walking velocity were observed. CONCLUSIONS: In addition to previously described dysfunctional kinematics, abnormal kinetic parameters play an important role in the characterization of gait in PD patients off therapy. Hence, these parameters could be used to document treatment effects of parkinsonian gait disorders.

Comparison of Ponseti versus surgical treatment for idiopathic clubfoot: a short-term preliminary report.

UNLABELLED: The Ponseti method of treatment for congenital clubfeet has gained widespread clinical acceptance. We have used manipulation, serial casting, and surgery to treat congenital clubfeet for almost 3 decades. Considering the Ponseti method of treatment to replace our traditional treatment method, we conducted a randomized, controlled trial evaluating the short-term outcome of the two treatment protocols. We evaluated foot function and applied a standardized measure of health status for children with orthopaedic problems. Nineteen patients (28 feet) were included in the trial. Nine infants (12 feet) were assigned to the Ponseti treatment group, and 10 (16 feet) were assigned to a group with initial casting and posteromedial release at the age of 6 to 8 months. The minimum followup was 3.3 years (mean, 3.5 years; range 3.3-3.8 years). Outcome measures included the Functional Rating System of Laaveg and Ponseti, the Pediatric Outcomes Data Collection Instrument (PODCI), and standardized radiographic measurements. At last followup the mean Functional Rating score was higher in the Ponseti group. Passive dorsiflexion and passive inversion-eversion were better in the Ponseti group. PODCI scales were comparable and radiographic outcome measures were similar in both groups. This trial has documented a favorable short-term outcome for the Ponseti method when compared with a traditional treatment protocol. LEVEL OF EVIDENCE: Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

Increased plasma kynurenine values and kynurenine-tryptophan ratios after major trauma are early indicators for the development of sepsis.

Kynurenine, the major degradation product of tryptophan has been shown to directly damage tissues, but its possible contribution to posttraumatic morbidity is unknown. Here, we studied the kinetics of kynurenine in patients after major trauma and whether this correlates with the development of posttraumatic sepsis. Kynurenine and tryptophan levels of 60 multiple-injured patients with Injury Severity Score of more than 16 were quantified prospectively by high-performance liquid chromatography. Blood samples were obtained daily from admission until day 10 after admission. Significantly increased kynurenine values were detectable already at day 1 after admission in blood from patients who later developed sepsis, regardless of injury pattern (P < 0.01). In contrast, kynurenine values of nonsepsis patients remained low throughout the observation period. However, all patients exhibited significantly decreased tryptophan values versus healthy controls (P < 0.01). Moreover, significantly increased kynurenine-tryptophan ratios rapidly predicted subsequent sepsis, multiple organ failure, and death (P < 0.01). Both increased kynurenine values and kynurenine-tryptophan ratios predicted posttraumatic development of sepsis and organ failure. This ought to be validated in subsequent studies.

Abdominal perforation after rupture of a diamond-studded wire: a case report.

INTRODUCTION: There are numerous cases of abdominal injuries due to bullets. Abdominal injuries due to bullets are a diagnostic and therapeutic challenge. Here, an unusual case of an abdominal perforation caused by a metal projectile, lead to confusion in the interpretation of the preoperative computer tomography. CASE PRESENTATION: We present an unusual case of a 32-year-old male worker who sustained a "shot" to the left upper abdominal quadrant, as a result of a work-related accident. The projectile derived from a special wire that tore during operation. One chain element happened to accelerate towards the patients belly and perforated the abdominal wall. Computer tomography located the radiopaque projectile to the cortex of the left kidney and showed a lesion of the tail of the pancreas. The presence of intraperitoneal free air suggested a gastrointestinal perforation. Immediate open exploration of the peritoneal cavity and the retroperitoneal space revealed perforating lesions of the anterior and posterior gastric wall, as well as the pancreatic tail. The projectile was finally retrieved in the upper pole of the left kidney. The patient had a good clinical course subsequent to surgery and was discharged in good general condition. CONCLUSION: This case represents a rare form of a retained bullet injury and corroborates the need of sufficient measures of worker-protection in area of diamond-studded wire cutting devices.

Axillary nerve palsy after retrograde humeral nailing: clinical confirmation of an anatomical fear.

INTRODUCTION: Locked antegrade or retrograde nailing of humeral shaft and proximal humerus fractures is a well established treatment option. Anatomic-morphological studies revealed a potential high risk of axillary nerve injury within proximal interlocking screw insertion. However, clinical experiences do not seem to confirm this, as there is a lack of interlocking screw insertion associated axillary lesions in literature. CASE REPORT: We report about a 69-year-old man with a humeral shaft fracture (AO-type 12-A3) stabilized by a retrograde implanted interlocking nail. Proximal interlocking screw insertion was performed in a posterior-to-anterior direction. The fracture healed uneventfully. In a follow-up examination 2 years later, an atrophy and paralysis of the deltoid muscle were visible. Electrophysiological evaluation confirmed an isolated axillary nerve injury. Nevertheless, the patient showed good functional recovery with almost free range of motion. CONCLUSION: Even for clinical practise proximal interlocking screw insertion is associated with a substantial risk of axillary nerve injury. Particularly for posterior-to-anterior screw insertion anatomic conditions should be considered. In spite of axillary nerve lesion, recovery of almost full shoulder function is possible by compensating the loss of deltoid function by rotator cuff muscles.

[Reconstruction of humeroradial joint]. / Korrekturosteotomien suprakondylärer Fehlstellungen am Humerus.

OBJECTIVE: Reconstruction of the anatomic axis of the upper extremity and preservation or improvement of elbow function. INDICATIONS: Supracondylar axial deviation (cubitus varus/valgus). Limitation of range of motion. Cosmetic impairment. Psychological problems due to deformity. CONTRAINDICATIONS: Degenerative changes of the elbow joint in adolescents and adults due to rheumatoid/anti-inflammatory disease. SURGICAL TECHNIQUE: Three-dimensional open deformity correction of the distal humerus without wedge resection and stabilization by external fixation. POSTOPERATIVE MANAGEMENT: Early postoperative mobilization of the elbow. Average treatment time by external fixator 10-12 weeks. RESULTS: Between 1998 and 2006, ten children underwent surgery for posttraumatic supracondylar deformity. Correction was achieved by means of three-planar reorientation of the distal end of the humerus. An external fixator was used for stabilization. Preoperatively, all patients showed cosmetic or functional impairment. Follow-up was performed between 1 and 9 years (7.4 years) postoperatively. Subjective, clinical and radiologic criteria were evaluated. Three patients showed excellent, six good and one poor results. Two pin tract infections and one irritation of the ulnar nerve were observed during treatment.

[Anterior cruciate ligament reconstruction with semitendinosus tendon in children]. / Vorderer Kreuzbandersatz mit der Semitendinosussehne bei Kindern.

OBJECTIVE: To present the technique of arthroscopy-assisted anterior cruciate ligament (ACL) reconstruction in children with complete ACL rupture. INDICATIONS: The indications for surgery are intraligamentous ruptures of the ACL with persistent signs and symptoms due to instability in spite of a minimum 6-month trial with conservative management and reduction of sports activities. Other decision-making factors for surgery include secondary injuries to the menisci or limitation of daily activities due to the instability produced by the ACL rupture. The indication for surgical intervention has to be judged individually and carefully in younger children. CONTRAINDICATIONS: Poor compliance on the part of the patient to participate in postoperative rehabilitation. Overexpectations regarding the surgical outcome (ability to participate in professional sports without limitations). Younger age of the patient (Tanner stage 2 or younger maturity), without trial of conservative treatment over a period of 6 months. ACL rupture at the bone-ligament region (tibial or femoral), partial rupture or lengthening of the ACL without rupture; in these instances, the instability may improve with growth. SURGICAL TECHNIQUE: Diagnostic arthroscopy to evaluate the knee joint and to identify associated or secondary injuries to the menisci and articular cartilage. If possible, these injuries should be addressed in the same surgical session. Preparation and stripping of the semitendinosus tendon using a tendon stripper. The technique used is transepiphyseal with extraosseous fixation. Depending on the thickness, the semitendinosus tendon is either tripled or quadrupled and prepared for transplantation. Single-canal technique. The diameter of the canal has to be selected depending on the size of the child's knee (usually between 6-8 mm). The tendon transplant is placed such that the canal is also filled with the tendon in the epiphyseal part (tendon transplant length usually 7 cm). Tibial canal entry medial to the tibial tuberosity, entering the joint at the level of the anterior horn of lateral meniscus in the intercondylar notch. Optimal positioning confirmed by an intraoperative negative impingement test of the guiding pin before drilling. Femoral canal entry placed at the 10:00-10:30 o'clock position on the right side, and 01:30-02:00 o'clock position on the left side. Care must be taken to avoid injury to the perichondral ring. In younger children (Tanner stage 3 or lower), avoidance of fixation material transfixing the epiphysis - femoral fixation performed using endobutton and tibial fixation with the Suture-disc. In older children (Tanner stage 4 or above) alternative fixation methods are possible (interference screw). The fixation of the ACL tendon transplant is such that reconstruction is in minimal tension in 30 degrees flexion. POSTOPERATIVE MANAGEMENT: Postoperative treatment regimen in the first 6 weeks after surgery depends on the extent of additive surgeries (menisci, chondral injuries) performed in the same sitting. In the absence of associated injuries, weight bearing is gradually increased with the aim of achieving full weight bearing at the end of the 1st postoperative week. In case of additional meniscal sutures, knee flexion is restricted to 60 degrees maximum and non-weight bearing for 4 weeks is advised. Postoperative mobilization is performed using an adjustable knee orthesis. Between 4-6 weeks postoperatively, the permitted flexion is gradually increased to a maximum of 90 degrees and partial weight bearing is started. Full weight bearing and free movements with muscle training are started after 6 weeks. Avoidance of weight transmission on the flexed and rotated knee until 12 weeks postoperatively. Start with sports activities under supervision after 6 months, trial with professional sports activities after 9 months. RESULTS: 57 children with remaining growth potential around the knee underwent ACL reconstruction using the semitendinosus tendon at the Pediatric Orthopedic Unit, Department of Pediatric Surgery, Graz, Austria, between 2002-2007. 45 patients received ACL reconstruction with associated meniscal injuries. The described endobutton technique for fixation of the transplant has been performed since 2006. As the patients are under follow-up, the long-term effects of this technique on growth around the knee are, to date, not known. 30 patients were operated before 2006 using the bioresorbable interference screw for fixation by ACL reconstruction with the semtendinosus tendon. All these patients were at Tanner stage 4 or older. 15 of these cases were evaluated after completion of growth, and all showed a good to excellent outcome in Tegner, Lysholm and IKDC (International Knee Documentation Committee) Scores without any growth disturbances.

K-wire Arthrodesis and Coracoclavicular Augmentation of Complete Acromioclavicular Separations: Functional and Subjective Results.

BACKGROUND: In recent years, there has been a trend from operative to conservative management of complete acromioclavicular separations. Despite this, surgical treatment is still recommended to manual workers and athletes, who account for a large part of the patients. The objective of this study was to evaluate the functional outcome of type III separations according to Tossy managed by temporary arthrodesis of the acromioclavicular joint combined with coracoclavicular augmentation. Special attention was paid to sport exercising patients. PATIENTS AND METHODS: In this study, 32 patients (mean age 39 years) with a complete acromioclavicular separation were investigated. All of them underwent a surgical treatment managed by temporary acromioclavicular arthrodesis with two parallel k-wires and augmentation of the coracoclavicular ligaments with a biodegradable cord (PDS). Functional outcome was assessed after an average follow-up of 36 months by using the Constant-Murley-, Neer- and DASH-score. Additionally, incidence of complications and subjective results were observed. RESULTS: Evaluation of the data, obtained from the scores, revealed an excellent result for the Constant-Murley- and DASH-score for 84% of the patients. Regarding the Neer-score, 78% had an excellent outcome. Eighty-four percent of the patients assessed revealed an excellent to fair subjective result. Cosmetic reasons were most frequently the cause for discontentedness. Minor complications occurred in three patients without severe sequelae. All patients returned back to former working and sport activity level. CONCLUSION: Surgical treatment of complete acromioclavicular separations by temporary arthrodesis with two k-wires and coracoclavicualar PDS-augmentation results in good to excellent function. It is associated with a low complication rate and a high patient contentedness. Particularly for athletes in non-contact sports this surgical technique can still be recommended.