Paediatric intrasubstance posterior cruciate ligament rupture.

The authors present the case of a 4-year-old boy who sustained an intrasubstance posterior cruciate ligament (PCL) tear whist trampolining. He was managed non-operatively with return to full function by 8 months. A high index of suspicion is required when assessing paediatric hyperflexion/extension injuries at the knee as ligamentous injury may occur without osteochondral fracture and may be missed on routine radiographs. Early MRI can identify such injuries in addition to osteochondral avulsions which are often amenable to acute internal fixation. In the case of paediatric intrasubstance PCL tears, it appears that non-operative management yields a good functional outcome in the short term in the skeletally immature.

Do children who in-toe need to be referred to an orthopaedic clinic?

The objective of this study was to investigate the outcome of in-toeing referrals to a paediatric orthopaedic department. Two hundred and two patients referred to the Royal Hospital for Sick Children, Edinburgh between July 2005 and March 2008 were retrospectively reviewed. Increased femoral anteversion and internal tibial torsion formed the majority of diagnoses. The median age of referral was 4 years. No patient in the audit period required surgery. Eighty-six percent of children were discharged after their first visit. No significant pathology was identified in the 14% reviewed. Management and outcome for these children were not affected by referral to the orthopaedic clinic.

Pretibial subcutaneous soft tissue lesions presenting to a paediatric orthopaedic clinic.

Pretibial swellings in children usually represent erythema nodosum which exhibits characteristic skin changes. Three cases of pretibial subcutaneous lesions are presented which had no skin involvement or bony abnormalities on plain radiographs. At initial presentation, concerns of malignancy were raised but these lesions were ultimately diagnosed as granuloma annulare, fat necrosis and subcutaneous infection. In combination with clinical assessment and plain radiographs, MRI proved invaluable in reaching diagnosis and excluding neoplasia. Biopsy was only required in one case in this series after MRI. A tissue diagnosis, however, remains mandatory if there is any doubt over the nature of such lesions.

10-16 year results of Leeds-Keio anterior cruciate ligament reconstruction.

Following initial enthusiasm in the late 1980s, the use of artificial ligament substitutes for anterior cruciate ligament (ACL) reconstruction has declined. However, the disadvantages of donor site morbidity for autologous graft and concerns about cross-infection from allogenic material have resulted in a maintained interest in prosthetic ligament substitutes. This study presents the outcome of ACL substitution using the Leeds-Keio (LK) polyester ligament at a mean of 13.3 years (range 10-16 years). Outcome was assessed using the International Knee Documentation Committee score, the Lysholm knee score, Tegner activity scale and American Knee Society Score and laxity by clinical examination and the Stryker Knee Laxity Tester. Standardized radiographs were taken to assess for evidence of degenerative change. The objective scoring tests showed that all patients experienced some degree of symptoms from their knee but functional impairment varied widely. Of the group, 28% were known to have ruptured their LK ligament and 56% had increased laxity compared with their opposite knee but no correlation could be shown between rupture, increased laxity and poor function. Of particular concern, all post-operative knees had radiographic signs of degenerative change compared with a rate of 39% in the contralateral knees.