Difficulties posed in managing developmental dysplasia of the hip diagnosed late include a high-placed femoral head, contracted soft tissues and a dysplastic acetabulum. A combination of open reduction with femoral shortening of untreated congenital dislocations is a well-established practice. Femoral shortening prevents excessive pressure on the located femoral head which can cause avascular necrosis. Instability due to a coexisting dysplastic shallow acetabulum is common, and so a pelvic osteotomy is performed to achieve a stable and concentric hip reduction. We retrospectively reviewed 15 patients (18 hips) presenting with developmental dysplasia of the hip aged four years and above who were treated by a one-stage combined procedure performed by the senior author. The mean age at operation was five years and nine months (4 years to 11 years). The mean follow-up was six years ten months (2 years and 8 months to 8 years and 8 months). All patients were followed up clinically and radiologically in accordance with McKay's criteria and the modified Severin classification. According to the McKay criteria, 12 hips were rated excellent and six were good. All but one had a full range of movement. Eight had a limb-length discrepancy of about 1 cm. All were Trendelenburg negative. The modified Severin classification demonstrated four hips of grade IA, six of grade IB, and eight of grade II. One patient had avascular necrosis and one an early subluxation requiring revision. One-stage correction of congenital dislocation of the hip in an older child is a safe and effective treatment with good results in the short to medium term.

Tibial tuberosity transfer is a well-established procedure in the treatment of patellar instability and in selected cases of anterior knee pain. Several techniques have been advocated in the literature. Some of the common complications associated with this procedure have been pain and discomfort due to prominent screw heads, necessitating their removal; nonunion and delayed union of the osteotomy; and failure of fixation. Tibial fractures have also been reported in some case reports. We present our technique of tibial tuberosity transfer using two 4-mm cannulated screws for stabilization of the tuberosity fragment. We have used this technique either for isolated tibial tuberosity transfer or as part of a combined procedure along with medial patellofemoral ligament reconstruction in treating patellar instability. Using this technique, we have encountered no patients with wound problems, nonunion, delayed union, or loss of fixation and only 1 patient with a metal work problem needing a second procedure for its removal. We attribute our good outcomes to the preservation of the soft-tissue attachments to the tuberosity fragment; minimal softtissue dissection, which allows rapid bony consolidation of the osteotomy, which in turn allows accelerated rehabilitation; and the use of 4-mm cannulated screws for fixation of the osteotomy, minimizing the potential for metal work problems. P atellofemoral malalignment can manifest as patellofemoral pain or acute and recurrent instability.

The functional outcomes and complications after an endoscopically assisted percutaneous repair of Achilles tendon rupture were evaluated. An arthroscopically assisted percutaneous repair was performed in 20 patients between the ages of 28 and 47 years. Two patients were suffering from a long-standing rupture. Follow-up was 2.5 years. Evaluation entailed Merkel's scale for pain, functional load (weight) bearing capacity, and the heel raise test. For statistical analysis, a random effects Poisson regression model was used.All patients achieved good to excellent outcomes. The median score on Merkel's scale was 600. All patients were able to stand on the tiptoe of the operated leg and none had limitations placed on their daily activities. A 12% decrease in maximum torque and 16.5% decrease in work performance of the injured side were noted. There was no statistical significant difference in the heel raise test between the operated and non-operated leg. No wound problems, re-ruptures, or infections were reported. Two patients (10%) had sural neuralgia; in 1 case, it subsided without further treatment.Endoscopy in percutaneous Achilles tendon repair is useful in determining the initial gap and providing adequate apposition of the tendon ends. It is a safe technique with good outcomes and minimal complications. Despite its promising results, potential problems include sural neuralgia and some decrease in strength.

Background Management of patella instability remains a challenge particularly in the presence of trochlea dysplasia. The aim of this study is to assess the recurrence rates of those with patellar instability who have undergone a combined tibial tuberosity transfer (TTT) and medial patellofemoral ligament reconstruction (MPFLR) in the setting of trochlea dysplasia. Methods All skeletally mature patients who underwent combined TTT and MPFLR for recurrent patella instability were identified between January 2009 and December 2019. A retrospective review was conducted, with information regarding re-dislocation/subluxation and complications collected. Results Seventy patients with a mean age 25.3 years were identified and evaluated. Thirteen patients were found to have low-grade dysplasia (Dejour A), with 57 patients having high-grade dysplasia (Dejour B/C/D). No patients in the low,grade dysplasia group suffered a recurrence of their symptoms, with four in the high-grade group suffering episodes of re-dislocation/subluxation. Three patients subsequently underwent a trochleoplasty, with the other patient managed successfully non-operatively. There were a total of 13 complications in 11 patients. Conclusions A combined procedure of MPFLR and TTT can be used to manage patellofemoral instability even in the setting of trochlea dysplasia with a low rate of recurrence. Trochlea dysplasia, however, remains an anatomical risk factor for recurrence and patients should be counselled accordingly. The anatomical risk factors should be assessed in all patients to allow for the development of the most appropriate management plan, of which this combined procedure represents a potentially successful option. Level of Evidence IV (Case Series).