Background: Osteochondral lesions of the talus are uncommon in children and adolescents. Surgical procedures differ from those used for adults to avoid iatrogenic physeal injuries. This study aimed to evaluate the clinical and radiological outcomes of surgical treatment in pediatric patients with osteochondral lesions, specifically investigating the patient age and the status of distal tibial physis as factors associated with surgical success. Methods: We retrospectively reviewed 28 patients who had symptomatic osteochondral lesions of the talus that were treated surgically between 2003 and 2016. If the lesion was stable and articular cartilage was intact, retrograde drilling was performed under fluoroscopic guidance. Lesions with detached overlying cartilages were treated by debridement of the cartilage combined with microfracture and drilling. Radiographic outcomes, American Orthopaedic Foot & Ankle Society ankle-hindfoot score, and skeletal maturity were evaluated. Results: Radiological improvement was observed in 24 (24/28, 86%) patients and complete and incomplete healing in 8 and 16 patients, respectively. Changes in pain grades, American Orthopaedic Foot & Ankle Society scores, and radiological healing after surgery were significant (pain grade, p < 0.001; American Orthopaedic Foot & Ankle Society, p = 0.018; radiological healing, p < 0.001). In addition, patients in the younger age group (≤13 years) showed greater improvements in pain grades than older patients (p = 0.02). Improvement in pain grade after surgery was better in the skeletally immature group than in the skeletally mature group (p = 0.048). Conclusion: Clinical and radiological improvements were observed after surgical treatment. The younger age group and open physis group showed more pain improvement. Level of evidence: Therapeutic level IV.

Park J, et al. Clin Orthop Surg. 2025 Jun;17(3):408-416. https://doi.org/10.4055/cios24250

Purpose: The purposes of this study were threefold: (1) to evaluate the influence of femoral antecurvature on coronal alignment changes following supracondylar femoral derotational osteotomy (FDO); (2) to investigate the combined effects of derotation angle and osteotomy orientation in relation to femoral antecurvature and (3) to propose a practical strategy for minimising valgus deviation after FDO based sagittal femoral bowing. Materials and Methods: Sixty‐six cadaveric femoral computed tomography (CT) scans were analysed using three‐dimensional (3D) simulation. Femurs were classified into three groups based on the degree of antecurvature using the distal diaphyseal angle (DDA). Virtual surgery was simulated at 7 cm above the joint line using two osteotomy methods (shaft‐perpendicular and distal femur condylar line [DFC]‐parallel) and two derotation angles (10° and 20°). Mechanical lateral distal femoral angle (mLDFA) was measured before and after simulation. Multivariable and stratified regression analyses were performed. Results: Greater antecurvature led to larger mLDFA decrease, with more pronounced valgus shifts at higher derotation angles. Making DFC‐parallel osteotomy significantly reduced valgus change regardless of bowing ( β = −0.331, p = 0.005). A significant interaction was found between DDA and derotation angle ( β = 0.015, p < 0.001). The combination of DFC‐parallel osteotomy with 10° derotation provided the least valgus change ( R ² = 0.84). The allowable derotation angle to maintain <1° valgus shift decreased as DDA increased. Conclusion: Femoral antecurvature significantly affects coronal alignment after supracondylar FDO. Although the optimal target angle for derotation remains a surgical choice, understanding the relationship between sagittal bowing and coronal alignment can help tailor patient‐specific decisions. To minimise valgus shift after supracondylar FDO, aligning the osteotomy plane parallel to the distal femur condylar line can be effective. This method is simple and practical for standard surgical procedures. Level of Evidence: Level IV.

The purpose of this study was to evaluate whether intravenous (IV) dexamethasone, within the current multimodal pain management protocol, (1) could maintain postoperative pain at a comparable level without IV patient-controlled analgesia (PCA), (2) could reduce opioids-related side effects, and (3) whether an additional dose of dexamethasone on postoperative day (POD) 2 would offer further pain-relieving effect without increasing the risk of complications. A total of 178 patients (182 knees) who underwent total knee arthroplasty for osteoarthritis were included in the study. The patients were divided into Dexa 2 & PCA and Dexa 3 & NoPCA groups. From operative day to POD 5, pain visual analogue score (VAS), rescue opioids consumption, episodes of postoperative nausea and vomiting (PONV), antiemetics usage, and side effects of opioids such as postoperative urinary retention (POUR) and constipation were checked. For safety, wound complication and infection were checked. There was no difference in pain VAS between the two groups during all six perioperative days. Rescue opioids consumption was lower in Dexa 2 & PCA group. Total dosage of used opioids for six perioperative days was lower in Dexa 3 & NoPCA group. Dexa 3 & NoPCA group had less PONV and POUR. There was a marked increase in pain VAS and the use of rescue opioids from POD 1 to POD 2 in the Dexa 2 & PCA. There were no wound problems or infections in either group. Under the current multimodal pain management protocol, comparable level of postoperative pain could be achieved by dexamethasone without the need of IV PCA. By not using IV PCA, overall opioid usage was reduced, which could lead to a lower frequency of PONV and POUR. While there is still room for further research on the duration and frequency of administering dexamethasone, additional administration on POD 2 is believed to provide additional pain management benefits compared with administering only until POD 1.

Rationale: Distal femoral derotational osteotomy (DFDO) is widely performed to correct excessive femoral anteversion in patients with patellofemoral instability. However, unintended changes in coronal alignment can occur depending on the orientation of the cutting plane. We present a case of unintentional femoral valgization after DFDO in a patient with a recurrent patellar dislocation. Patient concerns: A 23-year-old female presented with multiple episodes of recurrent patellar dislocation of her right knee. Diagnoses: Physical examination revealed a positive apprehension test, positive J-sign, and generalized joint laxity. An effusion was observed in the right knee. Radiologic findings included increased femoral anteversion (30.3°), ruptured medial patellofemoral ligament (MPFL), mild varus alignment (hip-knee-ankle angle 0.4°), mechanical lateral distal femur angle (mLDFA) of 86.6°, patella alta, and increased tibial tuberosity–trochlear groove (TT–TG) distance. Interventions: The patient underwent MPFL reconstruction and DFDO with target correction of femoral anteversion of 15°. Osteotomy was performed perpendicular to the real anatomical shaft axis. Outcomes: Postoperative imaging revealed an unintended valgus malalignment (HKA angle −3.0°) and decrease of mLDFA (83.6°). Despite the altered alignment, no recurrence of dislocation was noted during the 18-month follow-up period, and the clinical outcome was satisfactory. Lessons: Unintentional valgus alignment may result from osteotomies oriented perpendicular to the real anatomical shaft axis. Surgeons should consider using the virtual anatomical shaft axis to determine the cutting plane and minimize the risk of iatrogenic malalignment during DFDO.