Erratum to: Poor outcome at 7.5years after Stanisavljevic quadriceps transposition for patello-femoral instability

Introduction: Congenital dislocation of the patella and recurrent symptomatic dislocation in adolescents are difficult pathologies to treat. Stanisavljevic described an extensive release procedure essentially involving medializing the entire lateral quadriceps and medial soft tissue stabilization. There are no significant series reporting the success of this method. This procedure has been performed in our institution over several years and we report our results. Method: Retrospective case series. Between 1990 and 2007, 20 knees in 13 children and adolescents (mean age 12.8years; 4-17, 7 female) with recurrent or congenital dislocation of the patella (8 knees) underwent this procedure after failed conservative treatment (mean follow-up 7.5years; 4-16). All were immobilized in a long leg cast for 6weeks. Results: Five knees in five patients (20%, 1 congenital dislocation) reported their knees as improved without further dislocations. Out of the 15 knees with failures (80%) 12 in six patients (60%) were revised due to redislocation. Three knees in two patients (15%) still had dislocations or subluxations, but any revision was refused. Three knees in three patients caused pain and discomfort during daily activity. Redislocation first developed after a mean of 21.3months (4-72) postoperatively. Only one patient had returned to sport at the 12-month follow-up. Discussion: The Stanisavljevic procedure produces a mediocre success rate with our long-term follow-up series showing a failure rate up to 80%. We therefore recommend more specific procedures dealing with the anatomical deformity such as trochleaplasty to produce superior success rates

Long-Term Evolution of the Hip and Proximal Femur after Hip Reconstruction in Non-Ambulatory Children with Cerebral Palsy: A Retrospective Radiographic Review

Background: Hip displacement in children with cerebral palsy (CP) has a higher prevalence in non-ambulatory children. Progression can lead to pain, pelvic obliquity and difficulty with sitting. This can be addressed with hip reconstruction. Our study aims to report the long-term radiological outcomes after hip reconstruction, in particular the evolution of femoral head deformity. Methods: A total of 58 hips of non-ambulatory children with CP were evaluated retrospectively using pre-operative, early (median 120 days) and late post-operative (median 8.6 years) anteroposterior standardised radiographs. All the hips were treated with femoral shortening varus derotation osteotomy (VDRO), pelvic osteotomy and an open reduction, if indicated. The radiographical indices measured included the migration percentage (MP), sharp angle, acetabular index, centre-edge angle, neck shaft angle, head shaft angle, pelvic obliquity, femoral head sphericity, femoral head deformity (FHD) and growth plate orientation. Results: Improvements in hip congruency and morphology were evident after reconstructive hip surgery. These were maintained at the late post-operative time point. Median MP improved from 56% (IQR 46–85%) to 0% (IQR 0–15%) at early follow-up. This increased to 12% (IQR 0–20%) at late follow-up. Pre-operatively, FHDs of 14 hips (24%) were classified as grade A (spherical femoral head). This increased to 22 hips (38%) at early follow-up and increased further to 44 hips (76%) at late follow-up. Conclusions: Our study shows that hip reconstruction reduces hip displacement in the long term, indicated by decreased post-operative MP maintained at long-term follow-up. Although non-ambulatory children lack weight-bearing forces promoting bone remodelling, improved femoral head morphology after surgery alters the forces between the acetabulum and the femoral head. Mild femoral head deformity (grades A and B) remained stable and even improved after surgery, postulated to be due to severe osteoporosis allowing remodelling

Single-Event Multi-Level Surgery in Cerebral Palsy: A Bibliometric Analysis

Background and Objectives: Single-Event Multi-Level Surgery (SEMLS) is a complex surgical programme in which soft tissue contractures and bony torsional deformities at the ankle, knee and hip, in both lower limbs are surgically corrected during a single operative session, requiring one hospital admission and one period of rehabilitation. The aim of SEMLS is to improve gait and function in ambulant children with cerebral palsy. Utilisation of the SEMLS concept can reduce the number of surgical events, hospital inpatient stays and reduce rehabilitation requirements to a single intensive episode. Three-dimensional gait analysis is a pre-requisite to plan intervention at multiple anatomic levels to correct fixed deformities and to improve gait and function. Materials and Methods: This study was a bibliometric analysis of SEMLS in cerebral palsy using the Clarivate Web of Science Core Collection database from 1900 to 29 May 2023. Results: A total of 84 studies met the inclusion criteria. The most highly cited article was “Correction of severe crouch gait in patients with spastic diplegia with use of multilevel orthopaedic surgery” by Rodda et al. (2006) with 141 citations. The most productive institutions by number of articles were the Royal Children’s Hospital Melbourne (Australia), Murdoch Children’s Research Institute (Australia) and University of Melbourne (Australia). The most productive author by number of citations was HK Graham (Australia). Conclusions: The literature base for SEMLS consists largely of retrospective cohort studies. The aforementioned three institutes in Melbourne, Australia, which frequently collaborate together, have contributed the greatest number of studies in this field

The effect of knee flexion and rotation on the tibial tuberosity-trochlear groove distance

PURPOSE: The purpose was to measure the effect of flexion and additional rotation of the femur relative to the tibia on the tuberosity-trochlear groove distance (TT-TG) in the same subject in 20 cadaveric knees joint. METHODS: In 20 human adult cadavers, formal fixed knees (age: 81.9 years, SD 12.3; 10 female) CT scans were performed in extension and 30 degrees of flexion as well as in neutral, maximal possible internal (IR), and external rotation (ER). On superimposed CT scan images, TT-TG was measured in each position. TT-TG measurements were correlated in all knee positions. RESULTS: TT-TG in full extension/neutral rotation was 7.8 mm (SD 3.4, range, 2.4-15.3). TT-TG in full extension and IR was significantly lower, and TT-TG in full extension and ER was significantly higher than in neutral rotation (5.4 +/- 2.3 vs. 10.9 +/- 4.8 mm; P > 0.001). IR and ER varied between 1.0 degrees -7.6 degrees and 0.2 degrees -9.2 degrees , respectively. TT-TG in 30 degrees flexion/neutral rotation was 3.9 mm (SD 1.8, range, 1.3-7.8), which was significantly lower than in full extension and neutral rotation (P > 0.001). TT-TG in 30 degrees flexion and IR was significantly lower, and TT-TG in 30 degrees flexion and ER was significantly higher than values obtained in neutral rotation (2.7 +/- 1.2 vs. 6.5 +/- 3.4 mm; P > 0.001). IR and ER in 30 degrees flexion varied between 0.6 degrees -10.7 degrees and 1.9 degrees -13.0 degrees , respectively. CONCLUSION: Flexion as well as rotation of the knee joint significantly alters the TT-TG. These results may have wider clinical relevance in assessing TT-TG and further decisions based on it

Joint-Preserving Surgery in Varus Ankle Osteoarthritis.

Ankle deformity is a disabling condition especially if concomitant with osteoarthritis (OA). Varus ankle OA is one of the most common ankle OA deformities. This deformity usually leads to unequal load distribution in the ankle joint and decreases joint contact surface area, leading to a progressive degenerative arthritic situation. Varus ankle OA might have multiple causative factors, which might present as a single isolated factor or encompassed together in a single patient. The etiologies can be classified as post-traumatic (e.g., after fractures and lateral ligament instability), degenerative, systemic, neuromuscular, congenital, and others. Treatment options are determined by the degree of the deformity and analyzing the pathology, which range from the conservative treatments up to surgical interventions. Surgical treatment of the varus ankle OA can be classified into two categories, joint-preserving surgery (JPS) and joint-sacrificing surgery (JSS) as total ankle arthroplasty and ankle arthrodesis. JPS is a valuable treatment option in varus ankle OA, which should not be neglected since it has showed a promising result, optimizing biomechanics and improving the survivorship of the ankle joint