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Year |
2001 |
|---|---|
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Question Number |
140. |
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Category |
Select |
Question
An asymptomatic 10-year-old boy is referred for evaluation of a limb-length discrepancy that measures less than 2cm. Examination reveals that the most lateral ray of the ipsilateral foot is absent, and the ipsilateral knee is unstable to Lachman and anterior drawer tests. Figure 43 shows an AP radiograph of the ankle. Management of the knee should consist of?
1- Anterior cruciate ligament reconstruction using a quadruple hamstring technique.
2- Anterior cruciate ligament reconstruction using an allograft in the over the top position.
3- Observation.
4- An aggressive physical therapy program that emphasizes open chain techniques.
5- Functional knee bracing until skeletal maturity, followed by anterior cruciate ligament reconstruction.
Figures
Answer (click for answer)
Answer 3, this child has fibular hemimelia (congenital deficiency of the fibula), which is also associated with other malformations. These include leg length inequalities of the thigh, the lower leg or both, ankle malformations and often the absence of one or several lateral rays of the foot. There has also been a high correlation of either aplasia or hypoplasia of the cruciate ligaments. Although there is a high incidence of these ligament deficiencies, most studies have shown that these patients rarely complain of any knee instability. As in the case of this patient, who is asymptomatic, the most appropriate management at this time would be observation.
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