Medial patellofemoral ligament reconstruction in children: A comparative randomized short-term study of fascia lata allograft and gracilis tendon autograft reconstruction.

BACKGROUND: Many surgical procedures have been described to treat recurrent patellar dislocation, but none of these techniques has been successful in all patients. The goal of the study was to evaluate the results of medial patellofemoral ligament reconstruction in children. Two operative procedures were evaluated; a fascia lata allograft and an autologous gracilis graft. METHODS: Forty-four children (27 girls and 17 boys) between 13 and 17 years of age with unilateral recurrent patellar dislocation underwent medial patellofemoral ligament (MPFL) reconstruction. Patients were operated in two orthopedic centers. The 1st group contained 22 patients and surgery was performed using a fascia lata allograft. In the 2nd group of patients which also contained 22 children and autologous gracilis graft was used. The mean age of the patients was 14.9 years and the mean follow-up was 24 months. Preoperatively, all patients were evaluated clinically (Kujala score questionnaire) and radiologically. The same evaluation was used 18 to 30 months postoperatively to estimate the results of our treatment. RESULTS: In 1st group of children operated with cadaver allografts, the Kujala score significantly improved from 73.91 points preoperatively to 94.50 points postoperatively (P < .001). The average duration of operating procedure was 1 hour and 35 minutes. As shown by subjective symptoms, the results in 95% of patients were rated as good or very good. All children returned to full activity. Similar results were obtained in patients in 2nd group, where MPFL was reconstructed with ipsilateral gracilis tendon. Kujala score increased from 70.77 points preoperatively to 94.32 postoperatively (P < .001). Our results were estimated as good or very good in 93% of patients. All patients that were operated returned to full activity. However, median duration of operation was longer and lasted 1 hour and 55 minutes. CONCLUSIONS: Both techniques were effective in the short-term (18-30 months) in treatment of recurrent patellar dislocation. The use of cadaver allograft spares the hamstring muscles and reduces the time of surgery. Therefore, such study appears to be useful because it provides valuable information that would help to guide treatment of this condition in children. Level of evidence II-2.

Postural defects in children with cystic fibrosis - preliminary report.

UNLABELLED: Postural disturbances may cause the worsening of cardiopulmonary function in cystic fibrosis children and adolescents, as well as adversely affect their somatic and psychological development. THE AIM: Evaluation of postural defects in the population of cystic fibrosis children and adolescents. MATERIAL AND METHODS: Physical orthopedic examination of 41 cystic fibrosis patients (20 girls, 21 boys), aged 2-17 years (mean 8.1). The patients were divided into age groups: I under 5 y.o - 8 patients., II 5-9 y.o.- 6 patients, III 9-13 y.o - 11 patients, IV 13 y.o. and older - 16 patients. Postural disorders were divided into two groups. The first group included defects with a possible influence on the respiratory function of a cystic fibrosis patient: scoliosis, spine defects and chest deformities. The second group included lower extremities defects without influence on the function of the respiratory system. RESULTS: Postural as well as chest disorders were observed in 36 (87.8%) of the patients who were examined. Disorders with possible influence on respiratory system function, were observed in 13 (31.7%) of the 41 patients. Increased thoracic kyphosis (round back) was most frequent. In the group of patients aged 5 years and younger neither spinal nor chest abnormalities were observed. In the group of patients aged 5-9 years 1 (16.6%) case of congenital scoliosis and 1 (16.6%) case of plane back were found. In the group of children aged 9-13 years increased thoracic kyphosis was observed in 2 (18.1%) cases, plane back was observed in 2 (18.1%) children as well, while in 1 (9.0%) case increased lumbar lordosis was diagnosed. Barrell chest was observed in 2 (18.1%) cases. In the group of adolescents aged 13 years and more, 4 (25.0%) cases of scoliosis, 16 (100%) cases of increased thoracic kyphosis and 6 (37.5%) cases of barrel chest were observed. Because of the different methods of examination among posture studies of the healthy population, obtaining a control population is difficult. CONCLUSIONS: The number of postural defects in children with cystic fibrosis increases with age, and is becoming a significant health problem. It seems that there is a need of a deeper study on a greater population. .