Reconstruction of chronic patellar tendon tear with allograft in a patient with Ehlers-Danlos syndrome.

Failure of repair of the patellar tendon is uncommon. It may occur in association with chronic systemic diseases or after administration of corticosteroid and quinolones. We report the reconstruction of the patellar tendon with allograft, after failed primary repair, of a 23-year-old young with Ehlers-Danlos syndrome.

[Southwick osteotomy in stable slipped capital femoral epiphysis: a long-term outcome study]. / Stabil femur basi epifiz kaymasinda Southwick osteotomisi: Uzun dönem sonuçlar.

OBJECTIVES: Moderate to severe chronic stable slipped capital femoral epiphysis (SCFE) produce permanent irregularities in the femoral head and acetabulum. We report a single centre long-term outcome study of Southwick's procedure for the management of moderate or severe stable chronic SCFE with irregularity of the femoral head. METHODS: In the period from January 1978 to January 1990, 20 patients (16 girls, 4 boys; mean age 13 years; range 11 to 15 years) underwent 22 Southwick osteotomies for chronic stable SCFE with closure or partial closure of the growth plate and a slip between 30 degrees and 70 degrees . All osteotomies were performed by the same surgeon. Patients were followed-up for an average of 22 years (range 16 to 28 years). RESULTS: External rotation deformity was corrected, and the Trendelenburg sign was hardly observable in any of the patients from six months of surgery. Radiographically, all patients showed full consolidation of the osteotomy within two months of surgery. There was no further epiphyseal slipping. We did not encounter any infection or avascular necrosis. Only one patient developed chondrolysis, which resolved fully in eight months. At the latest follow-up, no limb length discrepancy was seen in 18 patients, while two patients had a mean of 0.8 cm shortening. Eight patients (36.4%) showed radiographic evidence for degenerative joint disease, but none were symptomatic. CONCLUSION: The management of chronic stable (moderate to severe) SCFE by Southwick's osteotomy is safe, but technically demanding. It affords good predictable outcome with a low complication rate.

[Endo-arthroscopically assisted surgery of selected orthopaedic conditions: technique and results]. / Chirurgia mini-invasiva articolare ed extra-articolare assistita dall'endoscopia. Tecniche e risultati in patologia ortopedica.

The minimally invasive and arthroscopically assisted surgery is a new therapeutic resource in the surgical treatment of degenerative and prosthetic orthopaedic pathology; in the field of neoplastic one it is just dawning. In this work the AA. report the technique and results of the arthroscopically assisted percutaneous arthrodesis of the ankle and of the arthroscopically assisted percutaneous curettage of epiphyseal chondroblastoma (E.C.) and osteoid osteoma (O.O.) of skeleton. From 1992 to 2002 they treated 12 selected cases: 4 affected by E.C., 3 located at proximal tibia and 1 at proximal humerus, in patients aged from 13 to 16 years and evaluated at a follow-up ranging from 7 to 3 years, with a 75% of good results; 4 affected by osteoid osteoma of proximal femur (2) and tibia (2), in patients aged from 13 to 18 years, evaluated at a follow-up ranging from 12 to 3 years with very good results (75%); 4 cases of ankle'painful stiffness, with 1 case of severe weightbearing instability, in patients aged from 17 to 75 years, evaluated at final bone fusion, radiographically observed at a average of 3.2-month follow-up from operation. All cases were treated by MIS criteria under accurate radiographic and CT-3D pre-operative planning, endoscopic (trans-osseous tunnels) and/or arthroscopic (ankle arthrodesis) continuous assistance under fluoroscopy. Two cases received cortico-cancellous bone autografts. All neoplastic cases had histologic confirmation by excision biopsy. They report 2 cases of failure, 1 in the E.C. series (25%) and 1 among the O.O. (25%), respectively at 6 and 12 months from the operation. In conclusion the authors report good results in 75% of cases together with very good aestheticism, well accepted by patients, and with articular function not minimally altered by the technique.

Reconstruction of a chronic quadriceps tendon tear in a body builder.

Chronic quadriceps tendon tears are uncommon. We report about a body builder taking a cocktail of anabolic drugs for several years in whom reconstruction of a chronic quadriceps tendon tear was performed using ipsilateral hamstring tendons with good results despite the 7 month delay between injury and surgery. The use of hamstring tendons is a good option for the management of these lesions.