17-Year Results following Transepiphyseal Anterior Cruciate Ligament Reconstruction in Children and Adolescents. / 17-Jahres-Ergebnisse nach transepiphysärer Plastik des vorderen Kreuzbandes im Kindes- und Jugendalter.

OBJECTIVE: Rupture of the anterior cruciate ligament (ACL) in childhood and adolescence is a serious injury. It is now known that conservative therapy of an unstable knee joint in childhood or adolescence under can lead to poor subjective and objective results. The aim of this study is to record long-term results after transepiphyseal ACL reconstruction using autologous hamstring tendons and extracortical fixation in childhood and adolescence with open physes - at least 15 years after surgery. METHODS: Our internal registry was used to identify all patients who received surgical treatment of an acl tear during childhood and adolescence by transepiphyseal acl reconstruction more than 15 years previously. In these patients, the International Knee Documentation Committee for Subjective Knee Form (IKDCsubj.), Knee Injury and Osteoarthritis Outcome Score (KOOS), Tegner Activity Score (TAS) and Lysholm Score were collected, and clinical and magnetic resonance imaging (MRI) examinations were performed. RESULTS: A total of 22 patients were identified, 5 of whom could not be contacted. The mean age at the time of surgery was 13.1 years, and the mean follow-up time was 17.4 years. In 3 patients, a traumatic tear was observed with subsequent reconstruction of the ACL. None of the included patients showed a growth disorder during the course of the study. The IKDCsubj. was 92.4 ± 14.7 (48 - 100), the Lysholm score was 87.9 ± 16.9 (34 - 100), the TAS was 5.7 ± 2.3 (3 - 9) and the pain level based on VAS was 3.5 ± 2.6 (1 - 8) points. The values showed subjective and objective deterioration compared to the 10-year results, with no statistical significance. The following subscores were reported for the KOOS: KOOSpain 90.9 ± 17.6 (28 - 100); KOOSsymptom 82.9 ± 22.6 (11 - 100); KOOOSADL 94.3 ± 13.7 (44 - 100); KOOSSport 80.3 ± 26.4 (15 - 100); KOOSQOL 80.9 ± 25.8 (0 - 100). 13 of the 17 patients could also be clinically and radiologically examined. In 92% of patients, an intact acl reconstruction was found without evidence of cartilage or meniscus damage. The mean lateral difference in the KT-1000 measurement was 1.5 mm. CONCLUSION: ACL reconstruction in childhood and adolescence provides good functionality and stability of the knee joint over the long term. Secondary signs of osteoarthritis can only be detected in isolated cases by MRI. ACL reconstruction using the transepiphyseal technique can be considered the method of choice for open growth plate knee joints.

Experimental observations of Soret-driven convection in the transient diffusive boundary layer.

The onset of transient Soret-driven convection is investigated experimentally in a colloidal suspension of thermosensitive nanoparticles by the shadowgraph technique and by particle tracking observations. From the shadowgraph images, the concentration profile is reconstructed, giving evidence of a convective motion inside the transient boundary layer. Furthermore, the latency times for the convection onset are extracted from the measurements. The results point out that particle tracking is superior to the shadowgraph method for detecting the onset of convection. The onset latency times obtained from these experiments obey scaling laws which are in accordance with the predictions from theoretical treatments.

Gel formation in a mixture of a block copolymer and a nematic liquid crystal.

The viscoelastic properties of a binary mixture of a mesogenic side-chain block copolymer in a low molecular weight nematic liquid crystal are studied for mass concentrations ranging from the diluted regime up to a liquid crystalline gel state at about 3%. In the gel state, the system does not flow, exhibits a polydomain structure on a microscopic level, and strongly scatters light. Below the gelation point, the system is homogeneous and behaves like a usual nematic, so the continuum theory of liquid crystals can be applied for interpreting the experimental data. Using the dynamic Fréedericksz transition technique, the dependence of the splay elastic constant and the rotational viscosity on the polymer concentration have been obtained. Comparing the dynamic behavior of block copolymer solutions with the respective homopolymer solutions reveals that, above a mass concentration of 1%, self-assembling of the block copolymer chain segments in clusters occurred, resulting in a gel state at higher concentrations. The effective cluster size is estimated as a function of the concentration, and a scaling-law behavior near the sol-gel transition is confirmed. This technique may serve as an alternative method for determining the gelation point.

Transition from longitudinal to transversal patterns in an anisotropic system.

Periodic stripe patterns which form when an electric field is applied to a thin nematic liquid crystal layer with a very low conductivity are discussed. In this case the dielectric electroconvection mode persists down to very low frequencies of the driving voltage. A Lifschitz point, i.e., a transition from normal to oblique rolls is detected in the dielectric regime. A crossover from electroconvection to flexoelectric domains occurs for extremely low frequencies of about 0.1 Hz . The crossover scenario yields pattern morphologies characteristic for both mechanisms, i.e., electroconvection and flexoelectric domains which appear consecutively within one period of the driving voltage. A theoretical description of the onset characteristics of dielectric convection, which is based on an extended model including flexoelectricity, is also presented.

Experimental observation of a nonpitchfork acceleration instability in a nematic liquid crystal.

The velocity of domain walls caused by a symmetry-breaking instability is experimentally investigated for the case of electroconvection in a nematic liquid crystal. It turns out that the velocity increases linearly with the distance from the bifurcation creating the domains. This scaling behavior does not agree with the drift pitchfork bifurcation. It has, however, been predicted by a minimal model describing our scenario.

Fréedericksz transition in a thermoreversible nematic gel.

A thermoreversible (physical) gel of a nematic liquid crystal in its planar configuration is investigated. The transition temperatures of the gel are thermally and rheologically determined. The temperature for the nematic-isotropic transition is higher than that for the gel-sol transition, allowing the network to grow in the oriented nematic phase. The electrical Fréedericksz transition of the gel is investigated by using both an optical and an electrical detection method. The transition can be adjusted within a large voltage range by selecting the temperature of the sample. This behavior is determined by the thermal properties of the thermoreversible gel network.

Transformation from walls to disclination lines: statics and dynamics of the pincement transition.

We present an experimental and theoretical study of the pincement phenomenon-transformation of a wall associated with the Fréedericksz transition into a pair of disclination lines. We measure the velocity of the boundary (front) between the two states as a function of the voltage. Experimental results are recovered by numerical simulations based on the nematic tensor order parameter, which also reveal the detailed three-dimensional structure of the front. By introducing reduced models we obtain approximate expressions for the two-state coexistence voltage and the front velocity. We find a bifurcation scenario incorporating a pair of saddle nodes at which the wall and disclination solutions appear or disappear.

Planar-fingerprint transition in a thermoreversible liquid crystalline gel.

A thermoreversible (physical) gel consisting of a nematic liquid crystal mixed with a small quantity of a chiral organogelator is investigated in the planar configuration. The response of the system to an external electric field reveals multistability within a small hysteresis. The relaxation of the liquid crystal under this field is characterized by two different time scales: a fast one that is connected to the tilt of the director field, and a slow one that describes the reorientation of the chiral structure. In the first case, the relaxation is nonexponential and can be described by a Kohlrausch-Williams-Watts law with a stretching parameter of 0.5.