indication

Indications

Young patient

- previous total or near total meniscectomy

- developing joint line pain

- early chondral changes

- normal anatomic alignment

- stable or reconstructable knee

Contra-indications

> Grade 2 Chondral changes

Farr et al Am J Sports Med 2007

- combined mensical transplantation with ACI

Displaced Tibial Shaft Fractures

Acceptable reduction

- varus / valgus < 5^o

- anterior / posterior < 5^o

- rotation 5^o

- shortening 10 mm

Poor remodelling potential

- valgus 

- apex posterior angulation  / recurvatum

- rotational alignment does not remodel

- shortening / in 2-10 year old average overgrowth is only 5mm

Aim

Prevent head deformity & secondary OA

- interfere as little as possible with child's development

Goals

1. Restore & maintain ROM

- allow abduction which covers anterolateral extruded head 

- important range is abduction in extension

- aim 30^o abduction or 75% of contralateral side 

- can consider adductor tenotomy

Indication

Diagnostic

Pain / Stiffness / Locking

Instability

- exclude OCD

Assess syndesmosis

Therapeutic

Synovitis

Osseous lesions / Tibiotalar impingement spurs

Osteochondral defects