Osteoid osteoma of the acetabular fossa: Five cases treated with percutaneous resection

SummaryBackgroundOsteoid osteoma is a painful benign osteogenic tumour for which the treatment objective is surgical resection of the nidus. The acetabular fossa is an uncommon site of involvement where surgical access can prove challenging.Materials and methodsWe report a case-series composed of five patients with osteoid osteoma of the acetabular fossa treated with percutaneous bone resection and drilling under computed tomography guidance.ResultsAll five patients had an uneventful postoperative course with immediate pain relief that was sustained over time.DiscussionThe outcomes achieved using our percutaneous technique compare favourably with those of other percutaneous methods, most notably regarding pain relief and patient tolerance of the procedure.ConclusionPercutaneous bone resection and drilling under computed tomography guidance proved effective for the treatment of osteoid osteoma involving the acetabular fossa.Level of evidenceLevel IV

Return to sport and re-tears after anterior cruciate ligament reconstruction in children and adolescents

BACKGROUND: The primary objective of this study was to determine the time to and level of return to sports after anterior cruciate ligament (ACL) reconstruction in children and adolescents. The secondary objectives were to evaluate the risk of early ACL re-tear after return to sports and the risk of ACL tear in the contralateral knee. HYPOTHESIS: The time to return to sports in young patients is considerably longer than in adults. METHODS: A prospective multicentre study was conducted at 12 centres specialised in knee ligament surgery, in children and adolescents younger than 18 years, between 1 January 2015 and 31 October 2015. The patients were divided into a paediatric group with open physes and a skeletally mature group with closed physes. We recorded the time to return to sport, the type of sport resumed, and the occurrence of early re-tears on the same side. A poor outcome was defined as a re-tear or an objective IKDC score of C or D. A contralateral ACL tear was not considered a poor outcome. RESULTS: Of 278 included patients, 100 had open physes and 178 closed physes. In the open physes group, return to running occurred after 10.4±4.7 months, return to pivoting/contact sport training after 13.1±3.9 months, and return to pivoting/contact sport competitions after 13.8±3.8 months. Of the 100 patients, 80% returned to the same sport and 63.5% to pivoting/contact sport competitions. Re-tears occurred in 9% of patients, after 11.8±4.1 months, and contralateral tears in 6% of patients, after 17.2±4.4 months. In all, 19.4% of patients had a poor outcome, including 10.4% with an IKDC score of C or D and 9% with re-tears. In the group with closed physes, return to running occurred after 8.8±5.1 months, return to pivoting/contact sport training after 11.7±4.7 months, and return to pivoting/contact sport competitions after 12.3±4.2 months. Of the 178 patients, 76.9% returned to the same sport and 55.6% to pivoting/contact sport competitions. The re-tear rate was only 2.8% and the contralateral tear rate 5%. In all, 14.7% of patients had poor outcome, including 11.9% with an IKDC score of C or D and 2.8% with re-tears. No risk factors for re-tears were identified; the quadruple-bundle semitendinosus technique showed a non-significant association with re-tears. CONCLUSION: In young children, the return to sport time after ACL reconstruction is considerably longer than 1 year and the return to competitions occurs later and is more difficult. The results of this study indicate that reservations are in order when informing the family about return to sports prospects after ACL reconstruction. The return to pivoting/contact sport competitions should not be allowed until 14 months after surgery in young skeletally immature patients, and the risk of re-injury is high within the first 2 years. LEVEL OF EVIDENCE: IV, retrospective study

The value of early postoperative bone scan in slipped capital femoral epiphysis

The purpose of this study was to evaluate the sensitivity and predictive value of early postoperative bone scan for detection of avascular necrosis (AVN) of the femoral head after surgical treatment of slipped capital femoral epiphysis. We reviewed records of 49 patients (64 hips) operated on between 1980 and 1997 with a mean follow-up of 3 years. Sixty-one out of 64 hips went through an early postoperative bone scan. The three hips that developed AVN showed significant loss of radionuclide uptake. There were neither false-positive or false-negative cases in this series. Early postoperative bone scan has an excellent sensitivity and predictive value for detection of AVN after surgical treatment of slipped capital femoral epiphysis

Induced-membrane femur reconstruction after resection of bone malignancies: Three cases of massive graft resorption in children

SummaryBone reconstruction after surgical resection of bone malignancies in children remains a difficult challenge. Induced-membrane reconstruction as described by Masquelet et al. was originally reported in traumatic or septic bone defects and is now adapted to this field. We report here three cases of massive femoral graft resorption requiring surgical revision in two boys aged 3 and 6years and a 9-year-old girl. Hypotheses include the long delay between the two stages, nature of the bone graft, high varus loads specific to this location, and lack of stability of the fixation. This technique has recently provided promising preliminary results when applied to the field of bone tumours. However, reconstruction of the femur seems to be specifically associated with a risk of graft resorption. Identification of the origin of this major complication is needed to amend the technique or its indications

Voluntary femoro-tibial subluxations: a benign differential diagnosis in the snapping knee of a child

PURPOSE: Voluntary femoro-tibial subluxation is a rare entity predominantly found in pretoddlers. It presents as a dynamic phenomenon with uni- or bilateral audible snapping of the knee, often in a context of fatigue or irritation at the end of the day. The aim of the study was to observe the evolution and recovery in these patients. METHODS: Ten children were included. Other causes of dislocating joints and pathologies with snapping of the lateral meniscus were excluded from this study. Six-week immobilisation with a splint at 70° of knee flexion was primarily recommended to all patients. RESULTS: The mean age at onset of symptoms was 10months. Forty percent of the patients presented with bilateral symptoms. Clinically, four patients were hyperlax. In all patients, subluxations could be reproduced passively by rotating the foot externally and advancing the internal tibial plateau anteriorly. Three of the patients were treated with a dorsal splint and experienced significantly less or cessation of symptoms. Two patients underwent surgery, one for a concomitant anterior cruciate ligament (ACL) rupture and meniscus tear that worsened the symptoms, another for concomitant patella dislocation and a meniscus tear. One patient's parents refused treatment and four patients experienced less symptoms at the time of consultation and were not immobilized. Except for the two patients undergoing surgeries, no sequelae were observed. In general, the symptoms got less frequent when the patient began to walk. CONCLUSION: Voluntary femoro-tibial subluxation in children is a rare and benign condition that often resolves spontaneously without sequelae. The risk of meniscus tear should, however, be considered if subluxations do not cease. LEVEL OF EVIDENCE: IV