We describe a novel physeal sparing arthroscopic technique for anatomic suture refixation of tibial eminence fractures and assess the mid-term results of six consecutive patients (McKeever type II n = 2, III n = 3 and IV n = 1). The mean follow-up was 5 +/- 2 years. Five of six patients were painfree. All patients returned to their preinjury sport level. Mean passive ipsilateral and contralateral flexion was 143 degrees +/- 5 degrees. The IKDC score was A in five and B in one patients. The mean Lysholm score was 97 +/- 3%. The median Tegner score was 8 (range 6-9) preinjury and at follow-up. The mean Total Knee Society score was 197 +/- 4 points. ACL laxity (KT-1000 134 N) showed a side-to-side difference of 2 +/- 2 mm. Two of six patients underwent a tibial screw removal under local anaesthesia. No loss of reduction or grossly physeal disturbance was observed. The reported surgical technique showed excellent to good clinical and radiological results and may be a physeal sparing alternative to previously described procedures.

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Tibial osteotomy is a well-established procedure for treatment of the varus osteoarthritic knee. A special new technique of oblique tibial osteotomy at the level of the tibial tubercle, preserving the medial cortex and iliotibial band, is presented which allows partial weight bearing the first postoperative day. Postoperatively the femorotibial alignment should be 5° to 7° of valgus in elderly patients. Because in younger individuals the intact iliotibial band is a strong restraint against varus deformity, we seek to correct to 3° to 5° of valgus in these patients. Of 172 cases treated with this technique between 1982 and 1986, 50 patients were retrospectively reviewed. After a follow-up period of 6 months to 3 years, pain was relieved in 46 patients. Complications consisted of 5 secondary wound healings, including 2 superficial infections, 1 tibial plateau fracture, and 3 varus recurrences.

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It is well known that a loss of motion occurs after ACL reconstruction, particularly after anterior placement of the femoral insertion of the graft. The problem, however, is related to the nonanatomical placement of the graft and not a consequence of an abnormal healing process. This situation can usually be improved by total graft resection. In our consideration the proximal transplant shift is probably a better treatment for patients with a structurally intact graft. This study was undertaken to illustrate our clinical findings. We examined 4 women and 7 men with a mean age of 28 years; the average follow-up period was 18 months. Preoperatively all patients complained of pain related to activity. The range of motion was 123 degrees -9.5 degrees -0 degrees flexion-extension. Eight patients were unable to participate in sports, and three were unable to work. The IKDC scores were: one B, four C, and six D. The Lachman test was negative or slide positive (1+). Postoperatively all patients improved and reported no or slight pain with a free range of motion (140 degrees -0 degrees -0 degrees ). All patients returned to work, and eight patients were able to practice sports again. The IKDC scores were two A, seven B, and two C. The average Lysholm score was 86 points. The clinical Lachman test was slide positive (1+). The radiological Lachman test and the KT-1000 test had a side-to-side difference of 2 mm. Based on these results, the proximal transplant shift seems to be a good alternative treatment for us at the present time.