Moiss Cohen 1980 REMEMBER... The children are not a miniature adult - PowerPoint PPT Presentation

FIFA MEDICAL CENTRE UNIVERSIDADE FEDERAL ISAKOS EDUCATION TRAINING Medical Director OF EXCELLENCE DIRECTOR DE SAO PAULO - BRASIL CENTER Chairman Chairman Medical Director Medical Board Moisés Cohen

1980

REMEMBER... The children are not a miniature adult Children  Body changes  Muscles hypertrophied  Bones grow  Ligaments are more requested Lausanne – Oct. 2017

2016 GRAFT BEHAVIOUR Quadruple hamstring graft decreases a mean 25.3 % • (range from 12.9 to 33.3 %) in diameter from time of ACL reconstruction surgery until reassessment period after surgery in skeletally immature patients Astur,D. ........Cohen M.,KSSTA 2016

2017 Astur DC, Cachoeira CM, Vieira TS, Debieux P, Kaleka CC, Cohen M.

< 16 years old 16 and 18 years old 24.6 % > 18 years old 17.5 % 9.2 % Astur DC, Cohen M. KSSTA. 2017

TANNER STAGE GUIDELINES Type 1 Type 2 Type 3 e 4 Tanner III and IV Tanner I, II, III Tanner I > 15-16 years-old < 12-13 years-old < 8-9 years-old Phyisis in closing Open physis Totally open physis Medium graft Small graft Tiny graft Developed epiphysis Eminent epiphysis Minimal epiphysis thickness Viable femoral Viable femoral Symptomatic Asymptomatic epiphysis and tibial Transphyseal reconstruction epiphysis Totall trans Partial trans Unstable Stable Type Type ephyseal ephyseal 3 4 reconstruction reconstruction Anatomical + vertical t Extra-articular Non surgical tunnel tunnel Surgery treatment t

JWL, male, 4 y.o. Frequent falls and Left Knee instability since 1 year

February, 2011 • Cabinet fall on left knee • Emergency Room – “Left Tibia fracture with no displacement . Cast Immobilization for 25 days”. • During 1 year the mother said the patient didn’t complaint but he dropped down many times and he couldn’t run and play soccer with the collegues at the school.

April, 2012 • The mother says that she saw the “boy's knee dislocating” • He usually dislocated the knee by himself just kidding to show to his friends December 2012 • The patient came to visit us.

Lachman +++/3+ • • Anterior Drawer +++/3+ • Pivot Shift +++/3+ • No articular swelling No pain • Spontaneous subluxation of the left knee • Tanner I •

ANTEROPOSTERIOR LATERAL OBLÍQUE Immature skeleton with no bone changes

NORMAL

Sagital T2

?

Surgical technique 2015 Kocher, M.S.,JBJS, 2006

LATERAL ANTEROPOSTERIOR

Superior  M L M L M L M L 1 2 3 4 Fixação tibial M L M L M L M L Inferior 5 6 7 8  GRAFT TRAJETORY Axial T2 fat Sat

Sagital T2 fat Sat Lateral  1 2 3 Fixação tibial Medial 4 5 6

Posterior  M L M L M L 1 2 3  GRAFT TRAJETORY M L M L M L Anterior Fixação Coronal 4 5 6 tibial T2 fat Sat

2017 – P.O 56 months – 9 years old Good Evolution, Very happy Normal activities together with the school colleagues

SUMMARY  FUTURE ?????  More Normal Childhood  We need to know better about the evolution and the complications  Clarify and Share the problem with the family

Thank You