Clinical Improvement Is Achieved Following Tibial Tubercle Distomedialization for Patellar Maltracking and Patella Alta Without Instability.

PURPOSE: To determine short-term patient-reported outcomes following distomedial tibial tubercle transfer (TTT) in patients with patellar maltracking and patella alta without instability. METHODS: A single-surgeon case series study was performed on patients receiving distomedial TTT for the indication of patellar maltracking and patella alta without instability, after nonresponse to conservative treatment. Patient-reported outcomes were assessed preoperatively and at 3-, 6-, 12-, and 24-month follow-up using Kujala, Knee injury and Osteoarthritis Outcome Score (KOOS), and visual analog scale (VAS) pain scores. Generalized estimating equations analyses were performed to study improvement over time. Minimal clinically important differences obtained from literature were used to determine clinical relevance. RESULTS: A total of 40 patients were included. Eight patients were lost to follow-up; thus, outcomes of 32 patients were analyzed. Mean follow-up was 22 months, median age was 21 years, and 75% were female. Mean Kujala score increased pre- to postoperatively from 55 ± 12 to 79 ± 16 (P < .001), KOOS from 48 ± 14 to 79 ± 15 (P < .001), and VAS from 64 ± 17 to 25 ± 21 (P < .001), respectively. Eighty-four percent had clinical improvement of Kujala score, 91% of KOOS, and 78% of VAS score. A plateau phase in pain reduction was reached at 3 months, and in functional improvement at 6 months follow-up, after which no further significant improvement was observed. Complication rate was 3% and removal of hardware rate was 72%. Conclusions: In this case series study, distomedial TTT led to clinically relevant functional improvement and pain reduction in patients with patellar maltracking and patella alta without instability. However, the removal of hardware rate was high (72%). LEVEL OF EVIDENCE: Level IV, therapeutic case series.

The successful treatment of genu recurvatum as a complication following eight-Plate epiphysiodesis in a 10-year-old girl: a case report with a 3.5-year follow-up.

We report a case of genu recurvatum following eight-Plate epiphysiodesis and the successful treatment of this complication. A 10-year-old patient underwent epiphysiodesis of the knee with eight-Plates. She was followed up and genu recurvatum developed as a complication. At the 12-month follow-up after epiphysiodesis, the treated knee showed a flexion of 135° and an extension of 35°. Lateral radiograph evaluation showed an extension change of the femur. During reoperation, the eight-Plates were repositioned more posterior, which resulted in successful treatment of the hyperextension. Eight-Plates can lead to (treatable) articular surface angle changes in the sagittal plane.

Intersurgeon variance in computer-assisted planning of anterior cruciate ligament reconstruction.

PURPOSE: To test the hypothesis that computer-controlled virtual planning will prohibit tunnel malpositioning and minimize variance in tunnel placement in anterior cruciate ligament (ACL) reconstruction, thereby providing us with a more accurate and reproducible procedure. TYPE OF STUDY: In vitro cadaver study. METHODS: Three orthopaedic surgeons with different levels of experience in ACL reconstruction were asked to position tunnel placement K-wires in a predefined "optimal" position using both computer-assisted surgery (CAS) and conventional techniques in 12 fresh-frozen cadaver knees. Virtual cylindrical 8-mm grafts were virtualized as the computer system outlined an impingement area and visualized graft elongation. CAS positioning and conventional techniques were compared between surgeons and correlated to experience level. RESULTS: The difference in virtual planning was 5.02 mm (SD, 2.40; range, 1.77 to 9.64 mm) between the tibial tunnels and 4.61 mm (SD, 2.13; range, 2.06 to 8.42 mm) between the femoral tunnels. The mean difference between the CAS and conventional procedures was 6.20 mm (SD, 2.49; range, 3.00 to 10.39 mm) for the femoral tunnel and 6.46 mm (SD, 2.27; range, 2.65 to 10.47 mm) for the tibia tunnel. The 2 less-experienced surgeons were responsible for 3 cases of impingement when using a conventional procedure. No elongation or impingement was seen when using CAS. CONCLUSIONS: This cadaver study shows that computer assisted planning may reduce intersurgical variance. CLINICAL RELEVANCE: Computer navigation and virtual ligament reconstruction constitute a good arthroscopic surgery teaching tool. This technique enables residents and less experienced surgeons to control positioning and limit complications caused by tunnel misplacement.