Relation of the Sural Nerve and Medial Neurovascular Bundle With the Achilles Tendon in Children With Cerebral Palsy Treated by Percutaneous Achilles Tendon Lengthening.

BACKGROUND: One of the most common treatment options for a short Achilles tendon (AT) in cerebral palsy is percutaneous AT lengthening using 3 hemisections. Because of proximity of neurovascular structures around the tendon, iatrogenic injury to them have been a concern about this technique. The sural nerve (SN) is under risk of injury at the site of the lateral incomplete cut, especially if it is done proximally. The medial neurovascular bundle is under injury risk at medial cuts. The aim of the article was to study the anatomical relations of the SN and medial neurovascular bundle to the AT, and define dangerous levels for injury with the help of magnetic resonance imaging (MRI). METHODS: Patients operated for percutaneous Achilles lengthening were called for MRI investigation of the SN and medial neruvascular bundle integrity and their anatomical relation with the AT. The distance of 5 mm was taken as the threshold for increased risk of injury. Measurements were done on MRI at each cm from the insertion of the tendon on both medial and lateral sides, and at the level of the middle cut. RESULTS: Thirty ankles operated and followed at least 1 year were included to the study. On the medial side, the tibial nerve, and the posterior tibial artery lied more than 5 mm away from the tendon at all levels in all patient. On the lateral side, the first 4 cm were relatively safe for the middle lateral cut, while increased risk of SN damage was detected in more proximal levels. Overall, 6 of 30 ankles had radiographically detectable SN injury. CONCLUSIONS: The first 4 cm of the AT on the lateral side was detected to be safe for the middle lateral directed cut, while whole tendon length were found to be safe for the first and the third cuts of the percutaneous Achilles lengthening surgery using 3 hemisections in children with cerebral palsy. LEVEL OF EVIDENCE: Level III.

High-Riding Congenital Hip Dislocation: THA With Unilateral vs Bilateral Transverse Femoral Shortening Osteotomy.

BACKGROUND: We argue that 1-stage bilaterally total hip arthroplasty (THA) could be acceptable in bilateral coxarthrosis because of high-riding developmental dysplasia of the hip (DDH). METHODS: Sixty-nine cases (51 patients) of high-riding DDH in patients who underwent THA from 2010 to 2013 were reviewed. Patients were divided into 2 groups: unilateral (group 1) and 1-stage bilateral surgery (group 2). The clinical measurements were the visual analog scale and Harris Hip Score. RESULTS: The average follow-up was 37.3 months for group 1 and 38.8 months for group 2. The hospital stay time was 5.2 days in group 1 and 6.2 days in group 2 (P = .334). The mean Harris Hip Score and visual analog scale score were improved significantly after surgery for both groups, and there was no statistically significant difference (P = .988). There was no difference between groups 1 and 2 in terms of complications (P = .137). CONCLUSION: Our data confirm that 1-stage bilateral transverse osteotomy with THA is an effective method as unilateral and it does not increase the length of patients' hospital stays and features a low risk of postoperative complications in the treatment of patients with high-riding DDH.

Endoscopic calcaneoplasty: 5-year results.

OBJECTIVE: The aim of this study was to evaluate the results of the endoscopic calcaneoplasty technique for the treatment of retrocalcaneal bursitis and Haglund's disease. METHODS: This study included 30 feet of 28 patients who underwent endoscopic surgery for Haglund's disease between 2003 and 2011. The inflamed bursa and posterosuperior surface of the calcaneus were removed with a shaver and bone resection performed until there was no friction on the Achilles tendon with the ankle in dorsiflexion. All patients were discharged on the same day and allowed full weight-bearing at the second postoperative week. American Orthopedic Foot and Ankle Society (AOFAS) scores and patient satisfaction were recorded. RESULTS: Average follow-up was 58.4 months. AOFAS scores significantly improved from a postoperative average of 52.6 points to 98.6 points at the final evaluation (p<0.005). All patients were satisfied with the result of the operation. CONCLUSION: Endoscopic calcaneoplasty with the patient in the prone or supine position appears to be a safe and effective surgical procedure for the treatment of retrocalcaneal bursitis and Haglund's disease.