ENLARGEMENT PLASTY OF THE ACETABULUM BY V ASCULARIZED ILIAC CREST CARTILAGE TRANSFER IN CHILDREN

Introduction Following an experimental study with rabbits published in 1983, the authors report the results of a surgical technique for the enlargement plasty of the acetabulum in children, This study was prece eded by an anatomical study of the vascularization of foetal iliac cre st epiphysis. Material 10 children were operated on at an average of 8 years old. The indications were 5 dysplastic hips (short acetabulum), and 5 Perthes deseases. The results were evaluated by the acetabular index of the weight-bearing zone. Wilberg center-edge angle and joint congruence. The comparison with the non operated side estimated the gr owth due to the graft. Methods An iliac crest cartilaginous fragment 4 to 5 cm long is harvested from the endopelvic side. This graft is ped iculized on the deep circonflex iliac vessels. The hip joint is opened and the labrum is partially resected. The graft is correctly oriented , placed at the periphery of the acetabulum in an intra-articular posi tion and fastened with two trans osseous stiches. The length of the va scular pedicle allows to place the graft without any microanastomosis. Results At maximum follow-up (range 3,3 to 8 years), in average value s, the coverage Wilberg angle increased of 4 degrees on the non operat ed side and of 23 degrees on the operated side (increase uf 19 degrees due to the graf). The acetabular index decreased of 2 degrees on the non operated side and of 10 degrees on the operated side (decrease of 8 degrees due to the graft). The joint congruence showed that the graf t molds itself on the femoral head and ensured harmonius coverage, it seemed that it favoured growth remolding of the femoral head. Discussi on The results showed the growth pursuit of an iliac crest cartilage v ascularized graft placed intra-articularly. This graft increases the a cetabulum size by adjusting itself to the femoral head. The hyalin car tilage cells of the graft which are in contact with the femoral head, are likely to transform themselves into articular cartilage cells. Thi s surgical technique seems to have its place with the enlargement tech niques of the acetabulum as long as remolding of the head and acetabul um is required.