Treatment of recurrent patellar instability with a modification of the Roux-Goldthwait technique.

Recurrent instability of the patella may be a significant disability in the childhood and adolescent population. Numerous surgical procedures to address this instability have been described, with variable outcome. This has led to considerable confusion in the literature as to how to treat patellofemoral problems in children. This study retrospectively reviews 30 knees in 20 patients with chronic recurrent patellar instability who were treated with a modified Roux-Goldthwait technique including the release of contracted lateral structures by a single surgeon over a 13-year period, with an average of 6.2 years follow-up. By Insall's criteria, 26 knees had an excellent result, 3 good result, and 1 fair result. Ten patients evaluated using a dynamometer showed that strength achieved in the operated leg was greater than 90% in 8 patients and greater than 80% in 2 patients. Here, we report upon a single operation to treat patellar instability performed in the pediatric population with consistently excellent results.

Treatment of ankle instability in children and adolescents with a modified Chrisman-Snook repair: a clinical and patient-based outcome study.

Ligamentous injuries to the lateral ankle complex, although rare in the child with open physes, increase with age and are seen with considerable frequency in late childhood and adolescence. In athletic, ligamentously lax individuals, recurrent sprains may lead to ligament attenuation and instability. When instability becomes chronic and interferes with everyday activity, reconstruction is indicated. The literature on reconstruction addresses primarily the adult population, with minimal guidance in treating the child and adolescent. The authors report their experience with 48 reconstructions performed in patients aged 8 to 17 years (mean 14.5 years) over a 12-year period. Mean follow-up was 6.5 years. All patients failed to respond to conservative treatment, including casting or bracing and physical therapy. All had disabling instability. All had a positive drawer sign clinically, and all but one had significant talar tilt on preoperative stress radiographs. A modification of the Chrisman-Snook procedure was used. Forty-four ankles in 38 patients were available for clinical and radiographic re-evaluation. One patient with generalized systemic ligamentous laxity required bilateral repair for failure of previous Evans procedures 8 years earlier; the remaining patients had primary repairs and remain asymptomatic. Each has a negative drawer sign and a reduction of talar tilt from a preoperative average of 14.5 degrees to a postoperative average of 4 degrees, based on stress radiographs. An outcomes questionnaire was administered to all patients, who subjectively rated their pain and instability at extremely low levels (1/10) and their function at a high level (8/10). All patients had their expectations met regarding the results of surgery. There was no radiographic evidence of degenerative arthritis at follow-up. The authors recommend this as an excellent means of treating children with chronic ankle instability who have failed to respond to conservative treatment. The authors have modified Chrisman's procedure by using a much smaller incision and improved graft isometry.

Radiofrequency probe treatment for subfailure ligament injury: a biomechanical study of rabbit ACL.

OBJECTIVE: Utilizing a rabbit anterior cruciate ligament model of ligamentous subfailure injury, biomechanical properties of injured ligament treated with radiofrequency energy were evaluated. It was hypothesized that an injured ligament treated with radiofrequency probe would demonstrate restoration of biomechanical properties lost through injury. BACKGROUND: Radiofrequency probe, thermal treatment has been utilized in the clinical setting to address joint instability caused by ligamentous laxity from injury or repetitive microtrauma. The biomechanical effects of radiofrequency probe thermal treatment on injured ligamentous tissues have not been studied in the laboratory. DESIGN: Three groups of specimens: Control, Sham, and Treatment, 10 each, were tested under identical conditions. METHODS: Viscoelastic behavior was analyzed using a relaxation test (6% strain, up to 180 s) performed before injury, after injury, and after injury plus sham or injury plus radiofrequency probe treatment. RESULTS: After injury the normalized forces in the relaxation test decreased by approximately 50%. The post-treatment relaxation test revealed significant ( P < 0.01 ) restoration of the average relaxation force in the Treatment group to that of the Control group (0.79, SD 0.11 vs. 0.80, SD 0.10). Both of these groups were significantly different from the Sham group (0.44, SD 0.11). Additionally, stretch-to-failure test showed partial restoration of the toe region of the load-deformation curve by the radiofrequency treatment. CONCLUSIONS: The radiofrequency probe treatment is shown to be an effective mechanism for restoring initial ligament tensile stiffness and viscoelastic characteristics lost by the subfailure injury in vitro.