Good Long-term Functional Results Research Articles

Long-term results of slide laryngotracheoplasty for congenital subglottic stenosis in newborns and infants

ObjectivesSlide laryngotracheoplasty is an effective, single-step procedure without tracheostomy and stenting for treating high-grade congenital subglottic stenosis in neonates and infants. Long-term outcomes were evaluated to assess the reliability of the procedure performed in this age of rapid development of the laryngeal structures. MethodsWe report five children who underwent slide laryngotracheoplasty before the age of 4 months, each with >3 years follow-up. Increases of length and bodyweight were systematically assessed. Breathing, swallowing, voice, and overall satisfaction was assessed by a quality of life questionnaire. Voice quality was objectively evaluated by measuring shimmer, jitter, fundamental frequency, and the harmonics-to-noise ratio. ResultsAll patients had a stable and adequate airway during follow-up without any additional open airway surgery. The patients' voices were physiological, and the intervention had no negative impact on speech development. Swallowing function was optimally retained, and the patients’ bodyweight gain and length were satisfactory. During at least 3 years of observation, the anastomosis remained stable and grew dynamically with the patient. ConclusionsSlide laryngotracheoplasty (as a single-step procedure) provides an adequate airway without tracheostomy, grafting, or stenting with good long-term functional results in selected neonates and infants with congenital subglottic stenosis.

Long-term outcomes of talus osteochondral autologous transplantation in soccer players: 24 mosaicplasty with more than 10 years of follow-up

ObjectiveAround 17% to 40% of professional soccer players' joint injuries affect the ankle. Although their incidence rate is relatively low, it is necessary to treat the cartilage and osteochondral talus injury in most cases, particularly in athletes. According to the latest International Consensus Meeting on Cartilage Repair of the Ankle implicates that there is not enough evidence to make a proper guideline; therefore, the study aims to investigate the long-term outcomes of talar mosaicplasty. MathodsIn a single-center retrospective study, the long-term outcomes of talus mosaicplasty procedures in soccer players between 1997 and 2011 were investigated. A combination of scores was used: the FAOS (Foot and Ankle Outcome Score) and Bandi score in order to evaluate the ankle and donor site function, the Tegner scores to measure activity, and the MOCART 2.0 (Magnetic Resonance Observation of Cartilage Repair Tissue) score to describe cartilage surface. Players' skill level was divided into professional, competitive, and recreational groups. ResultsTwenty-four soccer players were included; 13 had MRI at the last follow-up control. The average follow-up time was 13.84 ± 3.65 (10.22-22.82) years. The mean FAOS score was 86.16 ± 16.05 (24-99), MOCART was 50.76 ± 12.55 (25-70), and 87% of the patients had a good to excellent Bandi score. The overall return to sport was 11.4 ± 4.8 (3.6-24) months. ConclusionMosaicplasty has a good long-term functional outcome score and proved to be a reliable treatment option for the athletic population.

Long-term functional outcomes following paediatric traumatic elbow dislocation, a clinical retrospective cohort study

BackgroundPaediatric traumatic elbow dislocation occurs in 6 per 100,000 children per year and if not treated promptly can result in a poor outcome. Despite this, the long-term clinical and functional outcome of these injuries has not been well described using modern patient-reported outcome tools. The aim of our study was present the outcome of these injuries in the long term. MethodsTwenty children with an acute traumatic elbow dislocation who presented between February 2007 to February 2016 were included in our study. Patient demographics, management and complications were recorded from the clinical notes. Ten children had associated fractures and were managed surgically, while the remaining were managed with closed reduction and immobilisation. Functional outcomes were assessed with Kim's elbow performance score. ResultsThe mean age was 12 years (7 –15) and follow-up was 8 years (4 – 13). There was one (5%) re-dislocation requiring surgery and one (5%) ulna nerve neurapraxia that resolved within one month. The average Kim's scores were 87.5 (65 – 100) and 77.5 (60 – 100) in the closed reduction and open reduction groups, respectively (P=0.08). 80% (16/20) reported good or excellent outcome with a Kim's score of greater than 75 points with no cases of poor functional outcome reported in our series. ConclusionsTraumatic elbow dislocations in children, with or without associated fracture, have a good long-term functional outcome with appropriate early management.

Correction of congenital macrostomia by double reversing Z-plasty: A technical note

Congenital macrostomia is a rare congenital deformity that consists of an enlargement of the commissure of the mouth. The malformation may be unilateral or bilateral and has a polymorphic presentation. Various surgical techniques have been described to correct macrostomia, with only a few cases illustrating the expected results. The surgical repair must consider both esthetic as well as functional impacts for the patient. We here propose a technical note to refine and provide additional information for good achievement of “Double Reversing Z-Plasty” for correction of macrostomia. Our case series also reports good long-term functional and esthetic results obtained with this technique, especially in case of a minor cleft.

Antiphospholipid syndrome-mediated acute cerebrovascular diseases and long-term outcomes.

The antiphospholipid syndrome (APS) is an autoimmune disease associated with thrombotic and non-thrombotic neurologic manifestations. APS is classified as primary (PAPS) or secondary (SAPS) when it co-exists with another autoimmune disease. We aim to describe the spectrum of acute cerebrovascular disease among patients with APS, their differences between stroke subtypes, and long-term functional outcomes. Retrospective cohort study including adult (≥18 years) patients with APS followed in the stroke clinic of a tertiary-care reference center for autoimmune diseases in Mexico from 2009 to 2019. We studied 120 cases; 99 (82.5%) women; median age 43 years (interquartile range 35-52); 63.3% with SAPS. Demographics, comorbidities, and antiphospholipid antibodies (aPL) positivity were similar between APS type and stroke subtypes. Amongst index events, we observed 84 (70%) acute ischemic strokes (AIS), 19 (15.8%) cerebral venous thromboses (CVT), 11 (9.2%) intracerebral hemorrhages (ICH), and six (5%) subarachnoid hemorrhages (SAH). Sixty-seven (55.8%) were known patients with APS; the median time from APS diagnosis to index stroke was 46 months (interquartile range 12-96); 64.7% of intracranial hemorrhages (ICH or SAH) occurred ≥4 years after APS was diagnosed (23.5% anticoagulation-related); 63.2% of CVT cases developed before APS was diagnosed or simultaneously. Recurrences occurred in 26 (22.8%) patients, AIS, in 18 (69.2%); intracranial hemorrhage, in eight (30.8%). Long-term functional outcomes were good (modified Rankin Scale ≤2) in 63.2% of cases, during follow-up, the all-cause mortality rate was 19.2%. We found no differences between stroke subtypes and APS types. aPL profiles were not associated with any of the acute cerebrovascular diseases described in this cohort. CVT may be an initial thrombotic manifestation of APS with low mortality and good long-term functional outcome.

“STUDY OF FUNCTIONAL OUTCOME IN DISPLACED BIMALLEOLAR FRACTURE TREATED WITH FIBULAR PLATING FOR LATERAL MALLEOLUS AND PINNING OR SCREW FOR MEDIAL MALLEOLUS “

Fractures of the ankle joint are among the commonest fractures in adults, with an incidence of up to 174 cases per 100 000 persons per year1. A study was conducted to learn the functional outcome of displaced bimalleolar fracture treated with bular plating for lateral malleolus and pinning or screw for medial malleolus. For a good long-term functional outcome to be achieved, reliable early evaluation is crucial so that it can be determined whether the problem is a distortion (sprain), ligament rupture, bony ligament avulsion, or fracture of the talocrural joint. The proper treatment is chosen on the basis of the mechanism of the accident and the correct classication of the injury and accompanying soft-tissue damage. The goal of treatment is to enable the patient to put his or her full weight on the joint once again without pain and to prevent permanent damage2. In this study, a total of 25 patients were included. Detailed history and clinical ndings are conrmed and noted. After surgery patients followed on at 1 month, 3 months & 6 months, and thereafter yearly for their radiological and functional outcome.

Could the vaginal wall sling still have a role after FDA's warning? the functional outcomes at 20 years.

Introduction:Aims of this study were to evaluate the functional outcomes of a vaginal wall sling technique in patients with stress urinary incontinence at 20 years after surgery and to evaluate the patient’s satisfaction after the surgical procedure.Material and Methods:This was a prospective single-center study on patients with stress urinary incontinence who underwent in situ vaginal sling surgery. Presurgery evaluation included history, pelvic examination, and urodynamic test. All patients completed Urogenital Distress Inventory–6 (UDI-6) questionnaire. They underwent checkups at 1, 3, 6, and 12 months postoperatively and then annually. The sling was created by making a rectangle (15–20 × 25 mm) on the anterior vaginal wall and it was reinforced by one roll of Marlex mesh on each side of the sling. The sutures were passed through the vagina at the suprapubic level after suprapubic incision, above the rectus fascia and tied without excessive tension.Results:From May 1996 to May 2002, 40 women underwent vaginal wall sling surgery for stress urinary incontinence. Last visit was performed on 20 women between March 2020 and April 2020. Median follow-up was 251.3 months (20.9 years) (range = 204.3–285.4 months). The success rate after 5 years of surgical procedure was 80%; over 5 years, the objective cure rate was 45%. Considering only the group of 13 patients with pure stress urinary incontinence, the objective cure rate decreased to 38%, in particular 7 years after surgery. Women who did not resolve their urinary incontinence needed to undergo a new treatment. At over 5 years after surgery, there was an increase in urgency (p = 0.001) and voiding symptoms (p = 0.008) and urgency urinary incontinence (UUI) (p = 0.04). Ninety-five percent were very much worse or much worse according to the Patient Global Impression of Improvement (PGI-I) scale.Conclusion:The in situ vaginal wall sling does not guarantee good long-term functional outcomes in women with stress urinary incontinence.

Surgical treatment of terrible triad of the elbow: Retrospective continuous 50-patient series at 2 years’ follow-up

IntroductionTerrible triad (TT) of the elbow is an association at high risk of instability. Treatment aims to restore joint stability. Lateral collateral ligament (LCL) repair is systematic, whereas medial collateral ligament (MCL) repair is only exceptionally necessary. The main aim of the present study was to assess clinical results in TT surgery. The secondary objective was to compare clinical progression with versus without MCL repair. Material and methodsA retrospective study included 50 TTs operated on via an isolated lateral or combined medial-lateral approach. Clinical assessment comprised MEPS, QuickDASH, VAS, flexion-extension and pronation-supination, and return to work and sport. Subgroup analysis was made according to associated MCL repair. ResultsFifty patients (19 female, 31 male) were operated on between January 2006 and January 2017. Mean follow-up was 24 months. At last follow-up, mean MEPS was 89.1, VAS 0.7, QuickDASH 16, flexion-extension 114°, and pronation-supination 137°. Only MEPS was significantly improved by MCL repair (p=0.02), with no significant difference in complications. DiscussionTT surgery with immediate mobilization gave good long-term functional results, not significantly improved by MCL repair. The lateral approach should be adopted in first line, with the medial approach in second line in case of persistent instability after lateral osteo-ligamentous repair. Level of evidenceIV; retrospective study.

Vaginal NOTES approach for risk-reducing salpingo-oophorectomy in BRCA mutation carriers: A video demonstration

Risk-reducing bilateral salpingo-oophorectomy (BSO) is an important option to prevent the development of ovarian and fallopian tube cancers in women with a BRCA1/2 mutation. Conventional laparoscopy is the current preferred technique since it is associated with less morbidity compared to laparotomy. Transvaginal Natural Orifice Transluminal Endoscopic Surgery (vNOTES) is a new minimally invasive technique that allows access to the peritoneal cavity through the vagina without skin incisions. The vNOTES technique for risk-reducing BSO is presented herein. This article includes a narrated, step-by-step video demonstration of the entire procedure.Risk-reducing BSO using the vNOTES approach is a feasible technique that appears to be simple, safe, and reproducible. This technique has the potential to improve patients’ surgical experience and provide good long-term functional and cosmetics outcomes. This technique needs to be further evaluated and compared to the conventional laparoscopic approach.

Time to Evacuation and Functional Outcome After Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation.

We present a retrospective analysis of patients who underwent minimally invasive endoscopic intracerebral hemorrhage (ICH) evacuation to identify variables that were associated with long-term outcome. Minimally invasive endoscopic ICH evacuation was performed on patients with supratentorial ICH who fit prespecified clinical inclusion and exclusion criteria. Demographic, clinical, and radiographic factors previously demonstrated to impact functional outcome in ICH were included in a univariate analysis to identify factors associated with favorable outcome (modified Rankin Scale score, 0-3) at 6 months. Factors associated with a favorable outcome in the univariate analysis (P≤0.20) were included in a multivariate logistic regression analysis with the same dependent variable. Ninety patients underwent MIS endoscopic ICH evacuation within 72 hours of ictus. In a multivariate analysis, factors associated with good long-term functional outcome included time to evacuation (per hour; OR, 0.95 [95% CI, 0.92-0.98], P=0.004), age (per decade, odds ratio [OR], 0.49 [95% CI, 0.28-0.77], P=0.005), presence of intraventricular hemorrhage (OR, 0.15 [95% CI, 0.04-0.47], P=0.002), and lobar location (OR, 18.5 [95% CI, 4.5-103], P=0.0005). Early evacuation was not associated with an increased risk of rebleeding. Young age, lack of intraventricular hemorrhage, lobar location, and time to evacuation were independently associated with good long-term functional outcome in patients undergoing minimally invasive endoscopic ICH evacuation. The OR for time to evacuation suggests that for each additional hour, there was a 5% reduction in the odds of achieving a favorable outcome.

Spondylolisthesis in young patients: postoperative functional outcomes at 22-year mean follow-up.

Previous short- and intermediate-term clinical and radiographic studies demonstrated good results in patients who underwent spine surgery for spondylolisthesis, long-term outcomes are lacking instead. Young patients are often involved in high-demanding and sport activities, therefore good/excellent functional outcomes are very important for their future quality of life. The aim of this study is to assess the long-term functional results in young patients surgically treated for developmental spondylolisthesis. Retrospective evaluation of consecutive patients who underwent lumbar surgery for spondylolisthesis. Inclusion criteria were: spondylolisthesis from grade 1 to spondyloptosis, age at surgery < 25years, follow-up > 15years. The following outcomes were assessed: VAS back, VAS leg, Oswestry disability index (ODI) score, Short Form 12 (SF-12), rate of revision surgery, postoperative recovery and sport activity. 113 patients were enrolled. Mean age at surgery was 19.8years and mean follow-up was 22.1years (16-32). 16 patients (14.2%) needed revision surgery. Functional outcomes at last follow-up were: VAS back = 1.6, VAS leg = 1.4, ODI = 9.2%, SF-12 physical component summary = 50, SF-12 mental component summary = 48.7. Significant differences were assessed in terms of ODI (p = 0.047) and SF-12 PCS (p = 0.015) between group treated with instrumented and non-instrumented techniques. Among the patients who practiced a sport, 87% returned to sport postoperatively (55% at medium-high-intensity level). This study shows good long-term functional outcomes in patients surgically treated for developmental spondylolisthesis. After surgery, there is a low incidence of back pain, the residual disability is mild and almost half of patients recover the same level of sport activity. Instrumented surgical techniques developed over the years seem to be related to high revision rate, but this does not affect long-term functional results.

MRI-based assessment of acetabular version and coverage after previous Pemberton osteotomy in skeletally mature patients.

PurposeIn hip dysplasia the Pemberton osteotomy can modify the shape of the acetabulum and is indicated for children aged between two and 12 when the triradiate cartilage is still open. However, there have been concerns about acetabular retroversion following this type of osteotomy. The studies, however, have been based on plain radiographs. The aim of our investigation was to assess the 3D acetabular orientation in patients with previous Pemberton osteotomy after skeletal maturation.MethodsTen patients with 12 operated hips were included who received Pemberton osteotomy for hip dysplasia between January 3, 2005 and March 25, 2011. Mean age at surgery and at follow-up were 7.2 years (sd 3.7) and 19.2 years (sd 3.7), respectively. MRIs were conducted with 1.5 T. Besides the measurement of acetabular version, the analysis included alpha angles, acetabular sector angles (ASAs) as well as modified ASAs (cartilage covered area angles). Furthermore, the presence of osteoarthritis (OA) as well as acetabular retroversion was determined on plain radiographs. Patient-related outcome measures included the international Hip Outcome Tool (iHOT) and EuroQol-5-Dimensions (EQ5D) scores.ResultsIn comparison with the contralateral native and healthy hips the operated hips showed similar version (19.5° (sd 4.6°) versus 18.6° (sd 7.0°); p = 0.974). Also, there were no differences in terms of femoral head sphericity (alpha angles) and acetabular coverage (ASA angles). Five of 12 Pemberton hips showed signs of beginning OA (Kellgren-Lawrence classification I or II) while none of the non-operated hips did. Patients who received surgery before the age of six years had similar functional and radiological results when compared with patients who were older than six years at surgery. Among all patients, iHOT was 91.9 (sd 10.0) and EQ5D was 90.3 (sd 7.3)).ConclusionThe Pemberton osteotomy provides good long-term radiographic and functional results without compromising acetabular version or coverage.Level of EvidenceLevel III: retrospective comparative study

Congenital knee dislocation. Therapeutic protocol and long-term functional results

Background and objectiveCongenital knee dislocation is a very rare entity, characterised by deformity in genuine recurvatum present at birth, and there is currently no consensus on the optimal treatment. The aim of the present study is to analyse the functional results and long-term complications after the application of a protocol of therapeutic action for the management of congenital knee dislocation (CKD) created in a reference centre for child orthopaedics. Materials and methodsRetrospective descriptive study of patients with congenital dislocation of the knee who followed CRPL between January 1997 and December 2010. Demographic variables, type of treatment, functional outcomes at the end of the follow-up, complications and relapses were studied. The conservative treatment consisted of serial casts, leaving the surgical treatment for cases in which passive flexion was not achieved above 30° or the conservative treatment failed. Results9 patients (11 knees) met the inclusion criteria. The 66.7% were girls and the average follow-up was 15 years (9-22). In all cases, conservative treatment was initiated. Of the 11 knees treated, less than half (36%) required surgery. The average Lysholm questionnaire was 90.3 points, the WOMAC pain 0.4 (0–1), WOMAC stiffness 1.8 (0–6) and WOMAC function 3.8 (1–12). ConclusionsThe existence and application of the PLCR protocol in a pathology as rare as congenital knee dislocation suggests good long-term functional results with few complications and no recurrences.

Robot-assisted transthoracic first rib resection for venous thoracic outlet syndrome.

Venous thoracic outlet syndrome (vTOS) is caused by external compression of the subclavian vein at the costoclavicular junction. It can be subdivided in McCleery Syndrome and Paget-Schroetter Syndrome (PSS). To improve the venous outflow of the arm and to prevent recurrent thrombosis, first rib resection with venolysis of the subclavian vein can be performed. Open transaxillary, supraclavicular, infraclavicular or combined paraclavicular approaches are well known, but more recent robot-assisted techniques are introduced. We report our short- and long-term results of a minimal invasive transthoracic approach for resection of the anteromedial part of the first rib using the DaVinci surgical robot, performed through three trocars. We analyzed all patients with vTOS who were scheduled to undergo robot-assisted transthoracic first rib resection in the period July 2012 to May 2016. Outcomes were: technical success, operation time, blood loss, hospital stay, 30-day complications and patency. Functional outcomes were assessed using the "Disability of the Arm, Shoulder and Hand" (DASH) questionnaire. Fifteen patients (8 male, 7 female; mean age 32.9 years, range 20-54 years) underwent robot-assisted transthoracic first rib resection. Conversion to transaxillary resection was necessary in three patients. Average operation time was 147.9 min (range 88-320 min) with a mean blood loss of 79.5 cc (range 10-550 cc). Mean hospital stay was 3.5 days (range 2-9). In three patients, complications were reported (Clavien-Dindo grade 2-3a). Patency was 91% at 15.5 months' follow-up. DASH scores at one and three years showed excellent functional outcomes (7.1 (SD= 6.9, range 0-20.8) and 6.0 (SD= 6.4, range 0-25)) and are comparable to the scores of the normative general population. Robot-assisted transthoracic first rib resection with only three trocars is a feasible minimal invasive approach for first rib resection in the management of vTOS. This technique enables the surgeon to perform venolysis under direct 3D vision with good patency and long-term functional outcome. Studies with larger cohort size are needed to compare the outcomes of this robot-assisted technique with other more established approaches.

Superficial Temporal Artery to Middle Cerebral Artery Cranial Bypass for Nonmoyamoya Steno-Occlusive Disease in Patients Who Failed Optimal Medical Treatment: A Case Series.

In the post-Carotid Occlusion Surgery Study (COSS) era, multiple reviews suggested subset groups of patients as potential candidates for superficial temporal artery to middle cerebral artery (STA-MCA) bypass. Among them are patients with recurrent strokes despite optimal medical therapy. There is a paucity of data on the outcome of bypass in these specific patients. To examine the safety and efficacy of direct STA-MCA bypass in patients with nonmoyamoya, symptomatic steno-occlusive disease with impaired distal perfusion, who failed optimal medical management or endovascular treatment. A retrospective review was performed to identify patients with cerebrovascular steno-occlusive disease who underwent bypass after symptomatic recurrent or rapidly progressive strokes, despite optimal conservative or endovascular treatment. A total of 8 patients (mean age 60±6 yr) underwent direct or combined direct/indirect STA-MCA bypass between 2016 and 2019. All anastomoses were patent. One bypass carried slow flow. There were no procedure-related permanent deficits. One patient developed seizures which were controlled by medications. A total of 7 out of 8 patients were stable or improved clinically at last follow-up (mean 27.3±13.8 mo) without recurrent strokes. One patient did not recover from their presenting stroke, experienced severe bilateral strokes 4 mo postoperatively, and subsequently expired. Modified Rankin Scale (mRS) improved in 6 patients (75%), remained stable in 1 patient (12.5%), and deteriorated in 1 (12.5%). Good long-term functional outcome was achieved in 5 patients (63%, mRS≤2). Patients with symptomatic, hypoperfused steno-occlusive disease who fail optimal medical or endovascular treatment may benefit from cerebral revascularization. Direct or combined STA-MCA bypass was safe and provided favorable outcomes in this small series.

Abstract P179: Impact of Transportation Mode on Outcome of Mechanical Thrombectomy

Introduction: It is well established that mechanical thrombectomy (MT) improves functional outcome in stroke patients with a large vessel occlusion and salvageable brain tissue. In this study, we evaluate the impact of transportation mode on outcomes of patients undergoing MT. Methods: The prospectively maintained data from medical charts of consecutive patients transferred to a single comprehensive stroke center (CSC) for thrombectomy from January 2017 to December 2019 was reviewed. Clinical outcome was measured at a 90-day follow up with National Institute of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS). Multivariate logistic regression analysis was used to assess the relationship between helicopter transportation and favorable 90-day outcome in MT patients. Results: A total of 135 MT patients underwent the procedure following interhospital transfer by helicopter or ground ambulance. 60/135 (44%) of the patients were transferred by air. On univariate analysis there was no significant differences in age (median of 66 vs. 68 years; p=0.23), sex (31% vs. 36% men; p=0.605) or race (31% vs. 44% white; p=0.344) between the air vs. ground groups. Also, baseline NIHSS did not differ (95% CI 12.0-15.69 vs. 14.06-17.31; p=0.136). Total of 56 (41.5%) patients received tissue plasminogen activator (tPA) (25 air vs. 31 ground; p=0.97) and the overall door to groin time was similar in both groups (85.17 vs. 83.96 minutes; p=0.86). NIHSS at 90-day follow up was significantly lower in those taken by helicopter compared to ground transit (95% CI 4.60-11.26 vs. 11.50-17.61; p=0.015). Air transportation was independently associated with good long-term functional outcome on multivariable logistic regression after controlling for age, sex, race, tPA and transportation time (OR 3.757 95% CI 1.23-11.4; p=0.02). Conclusions: Air transportation in MT patients was independently associated with better long-term functional outcome. The association between helicopter transit and long-term function is shown to be independent of transit time.

Clinical and Radiographic Outcomes Following Management of Benign Bone Lesions of the Hand With Calcium Phosphate Bone Cement

Background: Enchondromas are benign primary bone tumors that often occur in the hand. Surgical curettage is often indicated for symptomatic lesions, but controversy exists regarding whether and how best to fill the void. Autograft and allograft bone in addition to various types of plaster or cement are common means addressing the postexcision defect. This study reports long-term clinical and radiographic outcomes of excision with calcium phosphate bone cement (CPC) for benign bone lesions of the hand. Methods: This is a retrospective review of symptomatic benign bone lesions treated with curettage and CPC by a single surgeon with long-term follow-up. Following Institutional Review Board approval, consenting patients returned for postoperative research visits, during which radiographs were taken and functional outcome scores were measured. Results: Of the 7 patients who consented to participate, all initially presented with pain at the site of the tumor. Average follow-up time was over 6 years and overall functional outcome scores were good with early return to work. Cementation filled nearly the entire lesion on postoperative films and there were no postoperative fractures, infections, wound problems, or revision surgeries. Conclusions: This study reports good long-term radiographic and functional outcomes, without recurrences, in a series of patients with symptomatic benign bone lesions of the hand when treated with excision and CPC by a single surgeon.

Luxación congénita de rodilla. Protocolo terapéutico y resultados funcionales a largo plazo

Background and objectiveCongenital knee dislocation is a very rare entity, characterised by deformity in knee recurvatum present at birth, and there is currently no consensus on the optimal treatment. The aim of the present study is to analyse the functional results and long-term complications after the application of a protocol of therapeutic action for the management of congenital knee dislocation (CKD) created in a reference centre for child orthopaedics. Materials and methodsRetrospective descriptive study of patients with congenital dislocation of the knee who followed CRPL between January 1997 and December 2010. Demographic variables, type of treatment, functional outcomes at the end of the follow-up, complications and relapses were studied. The conservative treatment consisted of serial casts, leaving the surgical treatment for cases in which passive flexion was not achieved above 30° or the conservative treatment failed. Results9 patients (11 knees) met the inclusion criteria. The 66.7% were girls and the average follow-up was 15 years (9-22). In all cases, conservative treatment was initiated. Of the 11 knees treated, less than half (36%) required surgery. The average Lysholm questionnaire was 90.3 points, the WOMAC pain 0.4 (0-1), WOMAC stiffness 1.8 (0-6) and WOMAC function 3.8 (1-12). ConclusionsThe existence and application of the PLCR protocol in a pathology as rare as congenital knee dislocation suggests good long-term functional results with few complications and no recurrences.

Colonic interposition, a contemporary experience: technical aspects and outcomes.

Colonic interposition is rarely used as an oesophageal replacement after resection, as the preferred use of stomach involves less anastomoses and lower risks of major complications. The functional outcome from the colonic conduit is also unpredictable. This report documents the spectrum of experience of a high-volume oesophageal centre, highlighting indications, techniques and functional outcomes. A retrospective review was undertaken of a prospective database from 2012 to 2016. Four of 252 (1.5%) cases in this time period utilised colon interposition. Two cases were for gastric conduit necrosis following oesophageal cancer resections, one for caustic ingestion with both an oesophago-bronchial fistula and gastric injury, and one for a primary oesophageal malignancy in a patient whom previously had a total gastrectomy. All patients had either a retrosternal or posterior mediastinal isoperistaltic right colon conduit placed. Two of three cancer patients are alive and disease free at 3 and 5years, respectively. Surviving patients are weight stable and tolerating a normal diet. Both report excellent quality of life using validated assessment tools. Colonic interposition is rarely required in modern oesophageal practice, but with this technique good long-term nutritional and functional outcomes can be obtained. It is required in the armamentarium of a specialist centre, and training given its rarity may require novel approaches such as simulation and cadaveric-based training.

Five-years outcome of medial patellofemoral ligament reconstruction in isolated post-traumatic tear: A retrospective study

IntroductionMedial patellofemoral ligament (MPFL) reconstruction is the procedure of choice for lateral patellar dislocation. However, studies depicting the long terms results of this procedure is lacking. The present study was conducted to evaluate the functional outcomes after MPFL reconstruction at a minimum of five years follow-up. MethodsThis study was retrospective evaluations of patients who underwent MPFL reconstruction by basket weave method. A total of 35 patients (37 knees) with isolated MPFL tear who met the inclusion criteria were included in this study. These patients were assessed for functional outcome scores including Kujala score, International Knee Documentation Committee (IKDC) score, Lysholm score and Tegner activity score at a minimum follow-up of 5 years. ResultsThe mean follow-up was 81.57 ± 16.07 months and mean age of patients was 19.56 ± 8.02 years. There was no re-dislocation in any of the patients but 4 patients had apprehension test positive (10.81%). The mean Kujala score, IKDC score and Lysholm score preoperatively and postoperatively after MPFL reconstruction were 62.20 ± 16.86 and 90.32 ± 16.42 respectively (p < 0.0001); 58.62 ± 14.34 and 85.15 ± 7.65 respectively (p < 0.0001); 68.21 ± 10.72 and 95.30 ± 8.02 respectively (p < 0.0001) at the five-year follow-up. Mean Tegner score pre-injury and post-surgery was 6.23 ± 2.10 and 5.82 ± 1.90 respectively (p = 0.38) at a mean follow-up of five years. ConclusionsMPFL reconstruction surgery for isolated MPFL tears without any associated bony deformity, or soft tissue alterations has a good long-term functional outcome.