Case: A 13-year-old adolescent boy and a 12-year-old girl, with torn anterior cruciate ligament (ACL) and increased posterior tibial slopes (PTS) of 17° and 19°, underwent transphyseal anterior tibial hemiepiphysiodesis and ACL reconstruction using a quadriceps autograft. Epiphysiodesis plates were removed after epiphyseal closure in the girl and after 12 months in the boy. Follow-up at 12 and 15 months showed Tegner and Lysholm scores of 4 and 100, with PTS reduced to 8° and 9°. Both resumed sports without further instability. Conclusion: Anterior tibial hemiepiphysiodesis effectively reduced the increased PTS to physiological levels in both cases.

Background: Less experienced surgeons have an increased risk for tunnel malpositioning as a predominant risk factor for failure of anterior cruciate ligament reconstruction (ACLR). Fluoroscopic guidance can improve the precision of tunnel positioning. Purpose: To investigate whether low-volume surgeons can achieve precise femoral tunnel placement in ACLR under fluoroscopic control comparable to that of experienced mid- and high-volume surgeons. Study Design: Cohort study; Level of evidence, 3. Methods: This study retrospectively included 150 patients who underwent primary ACLR between January 2021 and March 2023 and were prospectively enrolled in an in-clinic registry. Three groups were defined: high-volume surgeon (1 surgeon with >100 ACLRs per year; 50 images), mid-volume surgeon (1 surgeon with >10 to F = 0.332; height relation: Pr > F = 0.081; P < .05). The precision of the high-volume surgeon (depth relation: SD, 3.29%; height relation: SD, 4.92%) was comparable to that of the mid-volume surgeon (depth relation: SD, 2.98%; height relation: SD, 5.9%) and low-volume surgeon (depth relation: SD, 3.58%; height relation: SD, 4.62%). Conclusion: In this study, fluoroscopically guided tunnel placement allowed low-volume surgeons to achieve a level of precision comparable to that of the experienced surgeons. Fluoroscopy might especially help low-volume surgeons to achieve a standardized and highly reproducible femoral tunnel position and thus avoid tunnel malpositioning.

Aim: Aim of this study was to establish the first clinical results after implantation of ultrathin silver-polysiloxane-coated₁ plates in the treatment of infected non-union of the femoral shaft.Method: As part of the REFECT study, a prospective, non-interventional analysis was conducted encompassing all patients who received internal stabilization with a silver-coated₁ plate from 01/2023 to 09/2024 as part of the treatment for infected non-union of the femur. Standardized clinical follow-ups including PROMs (WOMAC-Index, LEF-S, EQ-5D, VAS) and X-rays were performed 3, 6, 12 (and 24) months postoperatively.For comparison, a retrospective analysis of 76 patients with infected femoral non-union, who had received a stabilization with an uncoated plate in the past 10 years, was performed.Results: The mean follow-up of the 8 included patients (mean bone defect: 3.6 cm) was 9 months (as of 04/24). Multiresistant bacteria were found in the intraoperative samples of 5 patients. The concentration of silver ions in blood serum reached a maximum of 0.014 mg/l in the laboratory controls. All patients showed a positive healing process with no sign of re-infection and no adverse procedure-associated events. Full weight bearing was achieved after an average of 4 months (n=6) with improved WOMAC-, LEF-S-, EQ-5D and VAS-score at 1-year FU. In the reference group (uncoated, mean FU: 3.5 years), there was a re-infection rate of 25 %, mostly in the first 2 years. Difficult-to-treat bacteria were detected in 22%, multiresistant Staph. epidermidis in 28% of cases.Conclusions: The silver-coated₁ implants showed good biocompatibility with no evidence of procedure-associated complications.The use of silver-coated₁ implants could reduce the risk of re-infection.Further clinical data with longer follow-up are needed to assess the long-term value of the procedure.