Bart Stuyts

Trochleoplasty in dysplastic knee trochlea

In patients complaining of recurrent patellar dislocations or persistent retropatellar pain due to a dysplastic femoral trochlea, we perform a Henri Dejour trochleoplasty. In this technique the femoral trochlea is deepened by removing the subchondral trochlear bone followed by incision, impaction and fixation of the cartilage flange along the trochlear groove. Between 1996 and 1999, 13 procedures were performed in 12 patients. Strictly lateral X-rays showed dysplasia of the trochlea, as defined by the “crossing sign”, whether or not in combination with patella alta. Patients were assessed using the Larsen–Lauridsen score considering pain, stiffness, osteopatellar crepitus, flexion and loss of function. Although the majority of patients scored fair and poor on an objective scoring system, we achieved 77% good to very good subjective results. Although the result was not perfect, the patients were satisfied with the procedure. This technique might be a valuable alternative in cases of frank trochlear dysplasia associated with persistent retropatellar pain or recurrent patellar dislocations.

Missed diagnosis of false aneurysm of the superficial femoral artery after closed complex fracture of the distal femur.

This case report presents a 38-year-old male patient who developed a false aneurysm of the superficial femoral artery after minimally invasive plate internal fixation of a comminuted articular distal femoral fracture sustained in a motor vehicle accident. Two days after surgery, the patient developed pain, non-pulsatile swelling on the medial side of the knee and anemia. After about six weeks, diagnosis of false aneurysm of the superficial femoral artery was confirmed by duplex ultrasound and computed tomographic angiography. A percutaneous endovascular procedure was performed to treat the false aneurysm without evacuating the blood collection.

Custom-made lateral femoral hemiarthroplasty for traumatic bone loss: A case report

We report the case of a 32-year-old male patient involved in a road traffic accident in which he sustained a grade II open supra- and intercondylar fracture of the left distal femur with substantial bone loss of the lateral femoral condyle and trochlea (AO classification type 33 C3). Normal knee function was no longer possible, as the patella was trapped within the bony defect. Existing reconstructive options such as unicondylar osteoarticular allograft, arthrodesis, and arthroplasty were considered. However, as all these techniques present significant disadvantages, particularly in young and active patients, a custom-made lateral hemiarthroplasty was designed and implanted as an alternative treatment. Follow-up at 24 months revealed an excellent, pain-free level of function and radiographs showed no signs of implant loosening or migration. This technique offers the most anatomical means of reconstruction with maximal preservation of the bone stock, thereby better facilitating any revisions that may be necessary in the future. This is an experimental technique reserved for rare indications, and currently has no long-term follow-up results associated with its use. Additional research is therefore needed before widespread adoption of this technique can take place.

A New Reconstructive Technique of the Anterolateral Ligament with Iliotibial Band-Strip

Background: Anterior cruciate ligament (ACL) reconstruction is a well-established surgical procedure for the correction of ACL ruptures. However, the incidence of instability following ACL reconstruction is substantial. Recent studies have led to greater insight into the anatomy and the radiographic characteristics of the native anterolateral ligament (ALL), along with its possible role in residual instability after ACL reconstruction. Method: The current paper describes a lateral extra-articular tenodesis to reconstruct the ALL during ACL procedures, using a short iliotibial band strip. The distal insertion of this strip is left intact on the anterolateral side of the proximal tibia, and the proximal part is fixed at the anatomic femoral insertion of the ALL. Results: Our technique avoids the sacrifice of one of the hamstring tendons for the ALL reconstruction. Additionally, there is no interference with the anatomical location or function of the LCL. Conclusion: Our technique offers a minimally invasive and nearly complete anatomical reconstruction of the ALL with minimal additional operative time.