Artikel
Division of the transverse acetabular ligament and non-weightbearing in perthes' disease: 4 year results
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Autoren
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A. Meiss
- Altonaer KinderKrankenhaus, Kinderorthopädie, Hamburg
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L. Clarfeld
- Genf
| Veröffentlicht: | 13. Juni 2005 |
|---|
Gliederung
Text
Introduction
There is an early cartilaginous enlargement of the femoral head in Perthes' disease. Lack of concomitant acetabular growth or widening will lead to loss of containment. We divided the transverse acetabular ligament (TAL) to promote widening of the acetabulum and maintain containment.
Material and Methods
We report 14 patients belonging to Catterall group III or IV. Division of the TAL was performed when MR imaging showed containment-at-risk-signs (labrum lift, flattening of the epiphysis, beginning epiphyseal protrusion). The TAL was divided but not removed. Strict non-weightbearing was imposed postoperatively.
Results
Evaluation was performed by a modified Stulberg classification. The result was excellent in 2 cases, good in 8 (71% excellent and good), satisfactory in 3 (22%), and poor in 1 case (7%). Three cases with an unfavorable course were associated with poor compliance for non-weightbearing. After additional bony procedures (Salter's osteotomy and /or intertrochanteric varus osteotomy) the outcome was satisfactory in 2 and poor in 1 case.
Conclusions
The combination of division of the TAL and strict non-weightbearing lead to 71% excellent and good results.
Three patients with poor compliance for non-weightbearing had an unfavorable course. Containment could be improved by bony procedures.
We suspect that our good results are related to the overall good compliance for non-weightbearing. Bony procedures are superior to division of the transverse acetabular ligament for maintainment of containment.
