Avascular Changes Research Articles

Role of platelet-rich plasma in the treatment of rotator cuff tendinopathy.

Shoulder pain is a common musculoskeletal complaint, and rotator cuff (RC) pathologies are one of the main causes. The RC undergoes various tendinopathic and avascular changes during the aging process. Other degenerative changes affecting its healing potential make it an appealing target for biological agents. Platelet-rich plasma (PRP) has demonstrated the potential to deliver a high concentration of several growth factors and anti-inflammatory mediators, and its clinical use is mainly supported by experiments that demonstrated its positive effect on muscle, ligaments, and tendinous cells. This review aimed to specify the role of PRP and its future applications in RC tendinopathies based on the current clinical evidence. Due to the different characteristics and conflicting outcomes, clinicians should use PRP with moderate expectations until more consistent evidence is available. However, it is reasonable to consider PRP in patients with contraindications to corticosteroid injections or those with risk factors for inadequate healing. Its autologous origin makes it a safe treatment, and its characteristics make it a promising option for treating RC tendinopathy, but the efficacy has yet to be established.

Retinal microvascular changes in white matter hyperintensities investigated by swept source optical coherence tomography angiography

BackgroTo assess the microvascular changes in the macular region and the foveal avascular zone (FAZ) area in participants with white matter hyperintensities (WMHs) using swept source optical coherence tomography angiography (SS OCTA).MethodsThis cross-sectional study included a total of 23 WMH participants (45 eyes) and 20 age-matched healthy participants (40 eyes). SS OCTA (VG200; SVision Imaging, Ltd., Luoyang, China) was used to assess the retinal vessel density (VD) and the FAZ area. VD was measured in the superficial vascular plexus (SVP), intermediate capillary plexus (ICP) and deep capillary plexus (DCP) within a 6 × 6-mm scan centred on the macula using a 5-mm Macula circle. The FAZ area was automatically measured on the inner retina layer within a 3 × 3-mm scan in the macular region.ResultsThere was no significant difference in VD in the SVP between the two groups. However, VD in both the ICP and DCP was significantly decreased in WMH participants (P = 0.028, P = 0.016). The FAZ area was significantly enlarged in WMH participants (P = 0.030). The signal quality was significantly lower in WMH participants (P < 0.001).ConclusionsThis study suggested that WMH participants have retinal microvascular and foveal avascular zone area changes compared with healthy controls. Further longitudinal studies with larger sample sizes are warranted to identify the value of our findings in the early evaluation of WMHs.

Simultaneous asymmetrical bilateral hip dislocations – A report of three cases with different presentations and management

BackgroundSimultaneous traumatic dislocation of both the hips in an individual is an uncommon injury. It accounts for only 1–2% of all traumatic hip dislocations. Simultaneous traumatic dislocation of both the hips in opposite directions i.e., anterior dislocation of one hip and posterior of the other is even rarer. These asymmetric dislocations need prompt identification for appropriate management. While their management should proceed in a manner commensurate with the accepted management of isolated dislocations to avoid complications, it is the timely identification which is essential. Study detailsRetrospectively the details of three patients with asymmetric bilateral hip dislocations were collected. The article describes the clinical presentation of each patient and the management offered to them. The follow up duration ranged from 15 months to 24 months. ResultsIn the short term, the outcomes in terms of hip pain, movements at the hips and radiological parameters like absence of arthritic or avascular changes were found to be satisfactory in each patient. ConclusionEarly diagnosis and prompt reduction is the essential first step in the appropriate management of these patients to prevent the possible complications. The associated fractures must be managed as per the established principles of trauma care. Long term follow up is essential for identifying if complications like avascular necrosis and secondary osteoarthritis develop after this uncommon injury.

Treatment of Navicular Stress Fractures With an Algorithmic Approach.

Navicular stress fractures are becoming increasingly more common. There is no universal consensus on treatment. We provide an algorithm that we feel will be useful in determining treatment. A retrospective study was performed on all patients having operative treatment of navicular stress fractures during a 10-year period. Acute fractures were treated with open reduction internal fixation. Chronic fractures greater than 3 months were treated with open reduction and internal fixation (ORIF) and iliac crest bone grafting. Chronic fractures with evidence of sclerosis, avascular changes, or those who failed previous surgery were treated with ORIF, iliac crest bone grafting, as well as vascular bone grafting. Patients' pain scores were recorded and a return-to-sports scale was used. Radiographic union was compared among the 3 groups using computed tomographic (CT) scans or radiographs. Forty-three patients were identified. Fifteen received ORIF alone, 12 were treated with ORIF and bone graft, and 16 had ORIF with vascularized bone grafting. No difference was found among the median age of the 3 groups. In terms of radiographic healing, 3 patients in the ORIF group received radiographs alone. All other patients had follow-up CT scans. ORIF alone group had 80% union, ORIF with bone graft had 75% union, and ORIF with vascularized bone grafting had 100% union. Return to sports did not show any difference among the 3 groups. The algorithm dividing navicular stress fractures into 3 distinct groups with different operative techniques helped us address these difficult cases. Vascularized bone grafting certainly appeared to be beneficial for the more difficult cases. Level IV, case series.

Outcomes of Revision Ankle Arthroplasty using a Fixed-bearing, Stemmed Intramedullary Prosthesis

Category: Ankle, Ankle Arthritis Introduction/Purpose: As in all total joint arthroplasty, longevity is finite, and the need for predictable revision surgery is mandatory. Literature is sparse describing revision total ankle arthroplasty (TAA) feasibility and outcomes. Revision total ankle arthroplasty involving implant exchange remains in its infancy, making critical assessment of outcomes necessary to guide future treatment options. The purpose of this study was to analyze the clinical outcomes of revision TAA using a minimum 2-year follow-up to evaluate for early failure and outcomes. Methods: Retrospective chart review identified 18 patients that underwent revision of their TAA to a third generation FDA approved fixed-bearing, intramedullary stemmed implant with a minimum 2 year follow up. Once identified, all patients were contacted for an in-office outcomes questionnaire, examination, and radiographic follow up. Outcomes included the Foot &amp; Ankle Disability Index (FADI) Score, Foot Function Index (FFI), Visual Analog Scale (VAS) used for pain, and ankle range of motion. Results: The mean age of patients at the time of revision was 59.6±9.7years and the mean follow up was 4.2±2.1 years. The mean FADI score was 69.9±17.9, the mean FFI was 49.1±15.2, and the mean VAS score was 33.3±25.8. Mean ankle dorsiflexion was 19.6±7.8 degrees and mean ankle plantar flexion was 18.6±7.5degrees. Postoperative complications included one infection requiring irrigation and debridement with hardware removal for a medial ankle soft tissue abscess, and one medial malleolus fracture that underwent open reduction and internal fixation. Three revision prostheses failed during the follow-up period, requiring additional surgery. Reasons for failure included talar subsidence in 2 patients secondary to osteolysis and/or avascular changes to the talus, and medial/lateral gutter impingement due to an oversized talar component in 1 patient. Conclusion: Revision of ankle arthroplasty requires significant planning in extraction of the failed prosthesis, implantation of the revision prosthesis, and alignment of the foot. Major complications are potentially avoidable through careful bone assessment prior to revision surgery, and results are acceptable in this early follow-up study using a fixed-bearing intramedullary stemmed implant system.

An isolated capitellum fracture of the humerus in adult: A rare case report

Introduction: Isolated capitellum fractures are rare and represent only 1% of all elbow fractures and 6% of distal humeral fractures.Case description: A 45-year-old right hand dominant female presented to us with pain and stiffness in her left elbow following a fall onto the outstretched hand that occurred 6 months prior. She had capitellum fracture with avascular changes and excision of the fractured fragment was done. Physiotherapy was initiated with outcome of nearly normal elbow function. At the time of injury, she was unable to move her elbow actively due to pain and she was misdiagnosed as soft tissue injury earlier in a local hospital.Conclusion: Possibility of rare diagnosis such as capitellum fracture should also be kept in mind while treating elbow injuries. Health Renaissance 2015; 13 (1): 112-116

Functional Outcome of Isolated Hoffa Fractures Treated with Cannulated Cancellous Screw.

Introduction: Isolated Hoffa fracture is an infrequent injury and little research has been done on this subject. The purpose of this study was to evaluate the functional outcome and complications of surgically managed Hoffa fractures with cannulated cancellous screw.Materials and Methods: Between 2011 and 2014, eight isolated Hoffa fractures in seven adult patients with mean age 39.8±11.9 years (range 25-60 years) were managed with cannulated cancellous screw of 6.5mm diameter applied in anterior to posterior direction using swashbuckler and medial parapatellar approach for lateral and medial Hoffa fractures respectively. All patients were evaluated using knee evaluation score after two years or longer. Mean follow up was 28±3.8 months (range 24-36 months).Results: All fractures in the eight patients healed clinicoradiologically by the 16th week with excellent result in 87.5% cases and good in 12.5% cases. By the end of union, the range of motion (ROM) of the knee was 0° to 110° except in two patients. One patient had ROM 10°-100° and other had 15°-90°. Mean knee evaluation score was 87.5±10.4. There was no incidence of non-union, infection or avascular changes in the patients or loss of reduction till final follow up.Conclusion: Open reduction and fixation with two 6.5 mm cannulated cancellous screws with early mobilization yielded good functional outcome in isolated Hoffa fractures.

Avascular necrosis of femoral head presenting as pathological subcapital neck of femur fracture: An unclassified presentation

Avascular necrosis of femoral head is not an uncommon chronic disorder of hip in adults. The patient presents to the health facility with varied range of symptoms based on the degree of collapse of the head and arthritic changes at hip. Avascular necrosis of hip presenting as sub-acute condition with pathological sub capital neck of femur fracture has not yet been reported. The commonly used Ficat and Arlet, university of Pennsylvania, association research circulation osseous and the Japanese Investigation Committee on Osteonecrosis do not include such a presentation in the classification nor is management. We report this in an Indian patient aged 42, tailor by occupation presenting with pain and worsening of limp following a squatting event. MRI revealed avascular changes on both hips and sub capital neck of femur fracture on the left. We managed him with an uncemented total hip arthroplasty. The other side was managed conservatively as he was asymptomatic. He had a good result with a Harris hip score of 97 at 7th month follow up.

Optical coherence tomography angiography in retinal vein occlusion

Objective To observe the characteristics of optical coherence tomography (OCT) angiography (OCTA) in retinal vein occlusion (RVO). Methods Prospective and observational study. Clinical examination of 81 consecutive patients (86 eyes) diagnosed with RVO were included in the study, in which the branch retinal vein occlusion in 47 eyes, central retinal vein occlusion in 39 eyes. Forty-five patients were male and 36 patients were female. Aged from 28 to 76 years old, the mean age was (55.36±10.01) years old. Comprehensive optical and imaging examination were performed, including fundus photography, fundus fluorescein angiography (FFA), spectral domain OCT, en face OCT and OCTA. The retinal blood flow imaging scan mode and the optic disc blood flow imaging scan mode were performed, the scanning region in the macular area were 3 mm × 3 mm, 6 mm × 6 mm, 8 mm × 8 mm respectively, around the optic disc were 3 mm × 3 mm and 4.5 mm × 4.5 mm. Each region scans 2 times. The characteristics of foveal avascular zone change, macular edema, non-perfusion and optical disc edema in OCTA and their corresponding FFA and en face OCT were observed. Results By OCTA, 67 eyes (77.9%) for foveal avascular zone change, 23 eyes (26.7%) for macular edema, 40 eyes (46.5%) for non-perfusion, and 33 eyes (38.4%) for optical disc edema can be detected. The foveal avascular zone change can be indentified as the tranformation, destruction and even vanish of the arch in superfacial layer of retinal macular area, acompanied with the dilatation and thickening of capillary vessels, the occlusion and expanding of capillary vessels arounded the foveal avascular zone in the deep layer of macular area. Those performances were more clear than FFA. The main expression of macular edema was low signal and was not as clear as en face OCT. The tortuosity and expansion of retinal vessels, density decreasing and even occlusion or abnormal traffic branch of capillary vessels can be observed in non-perfusion. These observations were similar to FFA. However, pieces of highly signal identical with non-perfusion area can be detected in chroid capillary. The representation of optical disc edema was the brush-like expanding of capillary vessels aroud optical disc. Conclusions OCTA can help for observing the abnormal changing of capillary vessels in foveal avascular zone and macular edema, non-perfusion and optical disc edema. Foveal avascular zone change showed occlusion and expanding of capillary vessels around the foveal avascular zone in the deep layer of macular area. Macular edema showed the weak signal. Non-perfusion showed tortuosity and expansion of retinal vessels, density decreasing and even occlusion or abnormal traffic branch of capillary vessels. Optical disc edema showed brush-like expanding of capillary vessels around optical disc. Key words: Retinal vein occlusion/diagnosis; Tomography, optical coherence

Chronic Scapholunate Instability Treated With Temporary Screw Fixation

To determine the efficacy of scapholunate (SL) temporary screw fixation to maintain the reduction of SL interval after ligament debridement, repair, or reconstruction. A total of 36 patients who had chronic SL instability were included. Arthroscopic debridement was performed for dynamic instability, and primary repair or reconstruction of the SL ligament was performed for static instability. We then used SL screw fixation for the protection of the repair or reconstruction. Screws were removed when loosening was noted on x-ray. The average patient age was 43 years. Eleven had dynamic instability, and 25 had static instability. The average follow-up was 7.9 years. Nearly 95% of the patients had no more than mild pain. The average ranges of movement of the wrist were 55° extension, 51° flexion, 26° ulnar deviation, and 15° radial deviation. Postoperative x-ray revealed an average SL angle of 56°. The average SL gap was 2.5 mm. Both of these radiographic parameters were maintained at final follow-up. Dorsal intercalated segmental instability (DISI) deformity was not corrected in 2 patients. One patient had avascular changes in the proximal scaphoid and lunate but remained asymptomatic at 7 years postoperatively. There was no further intercarpal and radiocarpal degeneration. Temporary SL screw fixation together with arthroscopic debridement, ligament repair, or reconstruction provided a stable closure of the SL interval and satisfactory clinical and functional results along with a low incidence of complication. Therapeutic IV.

Simultaneous Bilateral Femoral Neck Stress Fracture in a Young Stone Mason.

Unilateral stress fractures of the femoral neck are very uncommon and bilateral involvement is even rarer. They commonly occur in athletes, military recruits, older persons, or individuals with underlying metabolic disorders and very seldom in normal individuals. We present a rare case of simultaneous bilateral fracture neck of femur in a 25-year-old man who came with complaints of pain in bilateral groin for 1 month. There was no history of trauma or history suggestive of excessive activity prior to the onset of pain, but there was history of lifting heavy weights daily. On evaluation with MRI scan bilateral fracture of the femur neck was diagnosed and patient was operated on bilaterally with internal fixation done using dynamic hip screw. Patient then regained his routine activity over a period of 6 months and on follow-up at 1 year no avascular necrosis changes were seen in the femur head. We presented this case because of its unusual presentation and the diagnostic challenge it poses.

English

Neglected fracture neck of femur is a common presentation in developing countries like India. We report a case of 58years old male patient which was successfully managed at our institute. Treatment options vary from arthroplasty and osteotomy (with or without graft) to osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularized, and non-vascularised fibular graft). We performed a non vascularised fibular graft with cancellous screw fixation. Patient had a satisfactory bony union without any avascular changes. We emphasize that Non vascularised fibular graft is a treatment option for surgical management of fracture neck of femur.

Herbert screw fixation of capitellar fractures

Background Capitellar fractures are rare injuries. Controversy regarding the management of these injuries still continues. If anatomy is not reconstructed accurately, elbow function is suboptimal. The most accepted treatment of capitellar fractures is by open reduction and internal fixation. Recently, Herbert screw system has been recommended for fixation of osteochondral fractures. Objective The aim of this study was to evaluate the outcome of Herbert screw fixation in the treatment of capitellar fractures. Patients and methods Between May 2007 and July 2010, 10 patients with displaced fractures of the humeral capitellum were treated by open reduction and internal fixation of the capitellar fragments with Herbert screws in Benha University Hospital and Benha insurance hospitals. The mean follow-up period was 14 months (range 6-24 months) and the mean age was 37 years (range 20-48 years). Results All patients were evaluated according to the Mayo elbow performance score. Overall, six patients' results were found to be excellent and that of four were good. All patients were satisfied with the operative outcome and had a stable pain-free elbow with good range of motion at follow-up without any avascular necrosis or arthritic changes. The mean extension of the elbow was 7.5° (range 0-20°) and the mean flexion was 132° (range 128-135°). They all had full pronation and supination and had good stability; however, none of them had residual pain. Conclusion Treatment of capitellar fractures by Herbert screw leads to minimal articular damage and rigid fixation with solid union and excellent compression as well as early mobilization. Encountering a free capitellar fragment and nonunion should not discourage the use of internal fixation, as avascular necrosis is less likely to occur with good fixation and early mobilization.

Simplified scaphoid reconstruction technique with Zaidemberg's vascularized radial graft

For more than 10 years, we have been using a simplified reconstruction technique for scaphoid non-unions that involves the use of a graft first described by Zaidemberg et al. [1]. This approach requires that an island bone graft harvested from the radial styloid and pedicled on the 1,2-intercompartmental supraretinacular artery be embedded into the site of the non-union. The objective of our technical modifications was to simplify the harvesting and handling of the graft and the internal fixation. This technique is only used for cases of scaphoid non-union with avascular changes in the proximal fragment, repeated non-union after bone grafting and internal fixation, chronic non-union with osteophyte formation in the dorso-radial aspect and fracture secondary to Preiser disease.

Non-vascularized bone graft with Herbert-type screw fixation for proximal pole scaphoid nonunion

BackgroundSince proximal pole fractures of the scaphoid are frequently overlooked, the poor vascularity in the proximal pole fragment often leads to nonunion. Vascularized bone grafts have been recently tested in cases with scaphoid proximal pole nonunion, but the indication for this treatment has not been well established. Alternatively, we have been treating such patients with a non-vascularized iliac bone graft and Herbert-type screw fixation with considerable success. The purpose of this investigation is to evaluate these cases retrospectively and clarify the surgical efficacy of our procedure. MethodsBetween 1996 and 2009, 11 consecutive patients with proximal pole scaphoid nonunion were treated with a non-vascularized corticocancellous iliac bone graft and Herbert-type screw fixation. They were all male aged from 12 to 26 years. In two patients, avascular changes were recognized in the proximal pole in preoperative radiographs or MRI. Follow-up ranged from 12 to 76 months. ResultsBone union was radiographically confirmed in all patients, who returned to their former activities without any complications. The period from operation to union ranged from 12 to 24 weeks. The mean Mayo modified wrist score was 76.4 points preoperatively and 91.4 points postoperatively, and was improved in all cases. ConclusionsA non-vascularized iliac bone graft with Herbert-type screw fixation obtained satisfactory clinical and radiographic results in cases with scaphoid proximal pole nonunion, regardless of the vascularity in the proximal fragment.

Le greffon vascularisé radial de Zaidemberg. Bases anatomiques et expérience clinique

In 1991, Carlos Zaidemberg described a new technique to repair scaphoid non-unions with a vascularized bone graft harvested from the radial styloid process. An anatomic study based on 30 dissections after colorized latex injection established the constancy of the radial styloid process's artery, while showing that its origin, course and length were subject to variations. In a retrospective series of 38 cases over a period of 10 years, the vascularized bone graft was indicated for: (1) scaphoid non-union with the presence of avascular changes of the proximal fragment (23 cases); (2) failed prior reconstruction with bone graft and internal fixation (nine cases); (3) degenerative styloid-scaphoid arthritis (three cases); (4) fracture on Preiser dystrophy (three cases). The five steps of the simplified operative technique without dissection of the vascular pedicle include: (1) longitudinal dorso-radial approach, identification of the periosteal portion of the radial styloid process artery; (2) incision of the first and second compartments, longitudinal arthrotomy under the second compartment; (3) styloidectomy and transversal resection of the scaphoid non-union and sclerotic bone; (4) elevation of the vascularized bone graft; (5) transversal and radial insertion of the vascularized bone graft, osteosynthesis by two or three K-wire touching the scaphoid's radial edge. Scaphoid union was obtained in 33 cases out of 38. The only postoperative complications were two transient radial paresthesia. The standardized surgical procedure using vascularized bone graft harvested from the radial styloid process provides an efficient scaphoid reconstruction.

Scaphoid reconstruction by a free vascularized osteochondral graft from the rib: A case report

Nonunion and avascular necrosis of the proximal pole of the scaphoid remain one of the most difficult problems in wrist reconstructive surgery. A number of interpositional vascularized bone grafts have been proposed for scaphoid nonunion, in order to promote faster union at the contact site with both fragments. However, once the proximal pole has undergone avascular changes and is completely necrotic, there is no alternative other than to remove it. At present, more radical operations have been advocated in these cases, such as proximal row carpectomy or intercarpal arthrodesis. We present a case where the necrotic proximal pole of the scaphoid was removed and replaced with a remodeled osteochondral-free vascularized graft from the rib based on the inferior and superior intercostal arteries, branches of the internal mammary artery.

Phenotypic Overlap of Familial Exudative Vitreoretinopathy (FEVR) with Persistent Fetal Vasculature (PFV) Caused by FZD4 Mutations in two Distinct Pedigrees

Purpose: To describe a severe familial exudative vitreoretinopathy (FEVR) phenotype seen in infancy that resembles persistent fetal vasculature (PFV) caused by mutations in the FZD4 gene in two pedigrees with high intrafamilial variability. Methods: Three infants presented with features compatible with bilateral PFV. Eye examinations from the affected children and their relatives were reviewed retrospectively (follow-up:18 months-9 years). Mutation screening was performed using direct sequencing of the FZD4, LRP5 and NDP genes. Results: Bilateral retinal folds extending from the optic nerve to the inferotemporal aspect of the lens mimicing PFV were observed in two of the three affected children before the age of two months. The third child was examined at birth, and the avascular peripheral retina treated with diode laser within one week of age, with subsequent arrest of the disease process. A FZD4 mutation, M493_W494del, was identified in one affected child in pedigree 1, and a novel missense mutation, I114T, was detected in 2 affected children in pedigree 2; while no mutations were found in NDP or LRP5 genes in the 3 affected children. In both pedigrees, at least one affected relative was asymptomatic and failed to show the characteristic avascular changes of FEVR. Conclusions: The clinical features in the three children and their relatives with a documented FZD4 mutation support the previous reports of a high degree of intrafamilial and interfamilial variability in FEVR. In extreme cases with very early onset, the development of a retinal fold can mimic PFV, a non-hereditary condition with rare exception.

Effect of Needle Revision of Failed Filtering Blebs with Different Concentrations of Mitomycin C

Purpose: To investigate the efficacy and the risk factors for failure and complications of mitomycin C (MMC)-augmented needle revision (NR) of failed filtering blebs. Methods: Thirty eyes whose intraocular pressure (IOP) did not decrease after the cutting of scleral flap sutures were recruited. NR was performed with a 26-gauge needle under a slit-lamp. Immediately following NR, all eyes received a subconjunctival injection of 0.1 ml of 0.02 mg/ml (group A) or 0.1 mg/ml (group B) MMC at the adjacent conjunctiva. The mean follow-up period after the last needle revision was 13.2±4.2 months. Results: The mean IOP decreased from 25.7±10.6 mmHg before surgery to 13.7±2.5 mmHg at the last follow-up in group A and from 24.1±6.8 mmHg to 17.7±8.6 mmHg in group B (group A: p=0.001, group B: p=0.065). Subconjunctival hemorrhage, hyphema, and a shallow anterior chamber appeared in most cases. However, choridal detachment and avascular changes of the conjunctiva were observed in group B. Conclusions: IOP decreased in both groups A and B, but severe complications appeared only in group B. NR followed by a subconjunctival injection of 0.02 rather than 0.1 mg/ml is a safe and effective method. J Korean Ophthalmol Soc 49(6):951-957, 2008

The Salter innominate osteotomy: should it be combined with concurrent open reduction?

The timing of surgical realignment of the acetabulum after reduction of the dysplastic hip is controversial since a delay in correction may allow the joint to sublux again. The radiographic outcome after 188 Salter osteotomies was reviewed 5-25 years postoperatively using a comprehensive rating scale; 139 hips (69%) developed satisfactorily, 49 hips (26%) remained dysplastic but stable and nine hips (5%) were unsatisfactory. The best results occurred in children under the age of 30 months treated by combined open reduction and Salter osteotomy, when no further operation was required. The staged procedure yielded a slightly smaller proportion of satisfactory results, which were independent of the age of the child (and the incidence of redisplacement and avascular change was reduced). If the innominate osteotomy reduced the acetabular inclination by approximately 15 degrees the hip joint usually stabilized and a normal acetabular (Sharp) angle was present at maturity. When 132 patients were assessed clinically at maturity (between the ages of 16 and 35 years), clinical, functional and radiographic review revealed that 121 of 148 hips were graded in Severin groups I and II. The clinical outcome was determined by the degree to which the acetabular dysplasia was corrected.