Dr MICICOI Grégoire
Chirurgie de la hanche
Chirurgie du genou
Chef de clinique
Assistant des Hôpitaux de Nice
Secrétariat:
Tel. : 04.92.03.38.94
Mail : persico.m2@chu-nice.fr
Mélina Persico
Pathologies traitées
- Arthrose et lésions dégénératives du genou
- Déformation du genou
- Lésions du genou liées à la pratique sportive
- Arthrose de la hanche
Principales interventions
- Ostéotomie du genou
- Prothèse de genou
- Reconstruction du ligament croisé antérieur & des ménisques
- Chirurgie personnalisée du genou
- Prothèse de hanche
Cursus professionnel
- 2016 – 2021 : Internat de chirurgie orthopédique, IULS, CHU Nice
- Depuis Nov. 2021 : Assistant spécialiste chirurgie orthopédique et traumatologique IULS, CHU Nice
Diplômes acquis
- Certificat diplômant des techniques de plastinations anatomiques (Sept. 2016)
- DIU Chirurgie de la Main et du Membre Supérieur (Juin 2018)
- DIU Pathologie locomotrice liée à la pratique du sport (Juin 2018)
- DU Microchirurgie (Juin 2018)
- DIU Pathologie Chirurgicale du Genou (Juin 2019 )
- DIU Échographie pour le chirurgien du Membre Supérieur (Juin 2019 )
- DU Pathologie de la Hanche (Sept. 2020 )
- DIU Arthroscopie (Sept. 2021)
- DIU Chirurgie de l’Épaule et du Coude (Nov. 2021)
Enseignement
- Monitorat de dissection (2012 à 2014)
- Enseignement universitaire d’anatomie locomoteur et chirurgie orthopédique dispensé aux infirmières – IFSI Nice (depuis 2017)
- Enseignement DIU Pathologie locomotrice liée à la pratique du sport (2020)
- Enseignement dispensé à l’école d’IBODE – Chirurgie orthopédique (depuis 2021)
- Enseignement dispensé à l’Institut de Formation en Masso-Kinésithérapie (depuis 2021)
Prix et distinctions
- Meilleure communication SFHG – Mars 2020
- Médaille d’Or des Hôpitaux de Nice – Université Côte d’Azur, CHU Nice – Sept. 2021
- Membre de la Société Française de Chirurgie Orthopédique et Traumatologique (SoFCOT)
- Membre de la Société Européenne de chirurgie du sport et d’arthroscopie (ESSKA)
- Membre du consortium Genou de la société Chirurgie assistée par Ordinateur (CAOS)
- Membre du Collège des jeunes orthopédistes (CJO) – Représentant Europe (FORTE)
Publications 2023 du Dr MICICOI Grégoire
Clinical and Radiological Outcomes of Double-Level Osteotomy Versus Open-Wedge High Tibial Osteotomy for Bifocal Varus Deformity
Alice Abs , Grégoire Micicoi, Raghbir Khakha, Jean-Charles Escudier, Christophe Jacquet, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/36814769/
Abstract
Background: In bifocal varus deformity, double-level osteotomy (DLO) is advocated to treat lower limb alignment to prevent an adverse increase in joint line obliquity.
Purpose/hypothesis: The purpose of this study was to compare the clinical and radiological results after DLO and open-wedge high tibial osteotomy (OWHTO) in patients with combined varus deformity. It was hypothesized that DLO would improve clinical results without increasing the complication rate compared with OWHTO.
Study design: Cohort study; Level of evidence, 3.
Methods: Inclusion criteria were medial tibiofemoral compartment pain, varus knee deformity with an abnormal medial proximal tibial angle <84° and a lateral distal femoral angle >90°, a functional anterior cruciate ligament, failure of nonoperative treatment, and a minimum 2-year follow-up with all clinical and radiological data. The rate of return to work or sports; the Knee injury and Osteoarthritis Outcome Score (KOOS); the University of California, Los Angeles (UCLA) activity score; and patient satisfaction were assessed at a minimum of 2 years of follow-up. Statistical comparison of the 2 groups was made using the chi-square or Student t test.
Results: A total of 69 consecutive patients were analyzed, of whom 38 underwent OWHTO and 31 underwent DLO surgery. A significant between-group difference was found for all radiological parameters; in particular, there was less joint line obliquity after DLO compared with OWHTO (1.7° vs 5.6°; P < .001). DLO provided better outcomes compared with OWHTO regarding the UCLA score (4.3 vs 6.7; P < .001) and patient satisfaction (2.6 vs 3.9; P < .001), but no significant difference in KOOS or return to work or sports was observed. The OWHTO group had more hinge fractures than the DLO group (34.2% vs 12.9%; P < .001).
Conclusion: For combined tibial and femoral varus deformity, DLO produced more physiologic joint line obliquity with slightly improved UCLA and patient satisfaction scores. A greater incidence of hinge fracture was observed after isolated OWHTO compared with DLO due to a larger tibial correction; however, this had little effect on clinical results at the 2-year follow-up.
Keywords: clinical outcome; complications; double-level osteotomy; joint line obliquity; open-wedge high tibial osteotomy.
© The Author(s) 2023.
Normo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomy
Axel Machado , Lolita Micicoi, Justin Ernat, Philipp Schippers, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37326635/
Abstract
Purpose: The objectives of this study were to evaluate functional results, revision-free survival, and the influence of postoperative alignment on outcomes after MCWHTO.
Methods: This retrospective study included 27 MCWHTO operated on from 2009 to 2021. Radiographic measurements were performed pre- and postoperatively. The HKA (Hip-Knee-Ankle angle), MPTA (Medial Proximal Tibial angle), LDFA (Lateral Distal Femoral Angle), JLO (Joint Line Obliquity), and JLCA (Joint Line Convergence Angle) were evaluated. The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee Score, and the Subjective Knee Value (SKV) as well as revision-free survival were evaluated. Postoperative alignment and its influence on clinical outcomes were also analysed.
Results: The mean follow-up was 61.9 months ± 31.4 (13-124). The HKA, MPTA, and JLCA angles were decreased post-operatively (respectively, Δ = 5.9° ± 2.6, p < 0.001; Δ = 6.1° ± 3.2, p < 0.001 and Δ = 2.5° ± 1.9, p < 0.001). LDFA and JLO were unchanged, post-operatively (respectively, Δ = 0.1° ± 2.2, p = 0.93 and Δ = 1.2° ± 3.3, p = 0.23). Postoperative HKA correlated with knee IKS (R = – 0.15, p = 0.04) and function IKS (R = – 0.44, p = 0.03). Postoperative LDFA correlated with knee IKS(R = 0.8, p < 0.01). Patients with postoperative HKA ≤ 180° had better KOOS (Δ = 12.3, p = 0.04) and IKS function (Δ = 28.1, p < 0.01) than those with HKA > 180°.
Conclusion: Functional results and revision-free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not significantly altered with small tibial correction and, obtaining an overall neutral or slightly varus alignment under the conditions of this study allowed an improvement in the postoperative clinical scores. The literature is still inconclusive on the ideal alignment for valgus deformities and larger series are needed to draw definitive conclusions.
Level of evidence: IV, case series.
Keywords: High tibia osteotomy; Joint line obliquity; Knee osteoarthritis; Medial closure; Valgus deformity.
© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
Publications 2022 du Dr MICICOI Grégoire
Comparative study of bilateral total hip arthroplasty in one or two stages
Comparative study of bilateral total hip arthroplasty in one or two stages
Grégoire Micicoi, Régis Bernard de Dompsure, Pascal Boileau, Christophe Trojani
https://pubmed.ncbi.nlm.nih.gov/35781050/
Abstract
Introduction: Bilateral total hip arthroplasty (Bi THA) for disabling bilateral hip osteoarthritis can be performed in one or two operative sessions. The objective of this study was to compare the complication rates of a group of patients who had bilateral THA in one operating session (Bi-1S THA) to a matched group of patients who had bilateral THA in two separate operating sessions (Bi-2S THA).
Materials and methods: This retrospective case-control study compared 84 Bi-1S THA matched to 84 Bi-2S THA by age, gender, diagnosis, ASA score (1-2) and surgical approach. The minimum follow-up was 12 months. Complication rates, total blood loss, number of blood transfusion units, and functional outcomes were assessed.
Results: Twelve patients (14.3%) in the Bi-1S THA group had minor or major complications, compared to twenty-one (25%) in the Bi-2S THA group (p=0.08): there were fewer minor complications in the Bi-1S THA group and a similar rate of major complications amongst the two groups. Total blood loss estimated using the OSTHEO formula was significantly lower in patients operated on by Bi-1S THA (1853±753mL versus 2804±1012mL, p <0.0001). The number of blood transfusion units was similar between the groups (0.5±0.8 versus 0.3±1.4 respectively, p=0.55). No significant difference was found regarding the functional results.
Conclusion: Under the conditions of this study, bilateral total hip arthroplasty in one operative session leads to fewer minor complications, and a similar rate of major complications, when compared to bilateral total hip arthroplasty in two separate sessions. This strategy can therefore be recommended for ASA 1 and 2 patients, under the age of 80 with disabling bilateral osteoarthritis.
Level of evidence: III, retrospective comparative study.
Keywords: Bilateral; Complications; One session; Total hip arthroplasty.
Copyright © 2022. Published by Elsevier Masson SAS.
Patient specific instrumentation allow precise derotational correction of femoral and tibial torsional deformities
Grégoire Micicoi, Boris Corin, Jean-Noël Argenson, Christophe Jacquet, Raghbir Khakha, Pierre Martz, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/36058123/
Abstract
Background: Rotational malalignment deformities of the lower limb in adults mostly arise from excessive femoral anteversion and/or excessive external tibial torsion. The aim of this study was to assess the correction accuracy of a patient specific cutting guides (PSCG) used in tibial and femoral correction for lower-limb torsional deformities.
Methods: Forty knees (32 patients) were included prospectively. All patients had patellofemoral pain or instability with torsional malalignment for which a proximal tibial (HTO) or distal femoral (DFO) or a double-level osteotomy (DLO) had been performed. Accuracy of the correction between the planned and the postoperative angular values including femoral anteversion, tibial torsion, coronal and sagittal alignment were assessed after tibial and/or femoral osteotomy.
Results: Forty knees were included in this study. In cases of HTO, the correction accuracy obtained with PSCG was 1.3 ± 1.1° for tibial torsion (axial plane), 0.8 ± 0.7° for MPTA (coronal plane) and 0.8 ± 0.6° for PPTA (sagittal plane). In cases of DFO, the correction accuracy obtained with PSCG was 1.5 ± 1.4° for femoral anteversion (axial plane), 0.9 ± 0.9° for LDFA (coronal plane) and 0.9 ± 0.9° for PDFA (sagittal plane). The IKSG was improved from 58.0 ± 13.2° to 71.4 ± 10.9 (p = 0.04) and the IKSF from 50.2 ± 14.3 to 87.0 ± 6.9 (p < 0.001).
Conclusions: Using the PSCG for derotational osteotomy allows excellent correction accuracy in all the three planes for femoral and tibial torsional deformities associated with patellofemoral instability. Level of clinical evidence II, prospective cohort study.
Keywords: Accuracy; Clinical outcomes; Derotational osteotomy; Patellofemoral instability; Patient-specific cutting guide; Torsional malalignment syndrome.
Copyright © 2022 Elsevier B.V. All rights reserved.
Slope-decreasing anterior closing wedge proximal tibial osteotomies using the freehand technique are accurate to within 2̊
Robin Rassat, Grégoire Micicoi, Christophe Jacquet, Sylvain Guy, Jean-Marie Fayard, Pierre Martz, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/36377059/
Abstract
Introduction: Anterior cruciate ligament (ACL) reconstruction requires a detailed analysis of the posterior tibial slope (PTS) as excessive values may cause the reconstruction to fail and require a slope-decreasing anterior closing wedge tibial osteotomy combined with revision of the failed ACL reconstruction. The main purpose of this study was to assess the accuracy of correction after slope-decreasing anterior closing wedge tibial osteotomy in cases of chronic anterior instability caused by ACL rerupture.
Materials and methods: This single-center retrospective study included 19 patients (20 knees) operated on by slope-decreasing anterior closing wedge tibial osteotomy combined with a second revision ACL reconstruction. The mean age was 22.4±3.3 years and the mean follow-up was 12.7±4.4 months. The preoperative planning was based on lateral calibrated X-rays of the entire tibia. The height of the closing wedge, which corresponded to the base of the osteotomy, was measured in millimeters. The procedure was performed using the freehand technique. The accuracy of the correction was defined as the difference between the desired preoperative PTS and the postoperative PTS achieved. An inter- and intraobserver analysis was performed.
Results: The mean preoperative PTS was 13.9±2̊ and the mean postoperative PTS was 4.0±1.7̊. The mean PTS correction was 10.1±2.1̊ with a planned target of 5.4±1.8̊. The accuracy obtained between the planned target and the postoperative corrections was 1.7±1.1̊. The regression analysis showed that the accuracy of the PTS correction was not influenced by the patient’s age, BMI, excessive preoperative PTS, or degree of correction achieved (p>0.05).
Conclusion: Slope-decreasing anterior closing wedge tibial osteotomies performed using the freehand technique for ACL graft rerupture can correct an excessive PTS within 2̊ of the planned slope correction. This accuracy is not determined by demographic factors, excessive preoperative PTS or degree of correction achieved.
Level of evidence: IV; retrospective cohort study.
Keywords: Closing wedge tibial osteotomy; Posterior tibial slope; Revision ACL reconstruction; Slope-decreasing tibial osteotomy.
Copyright © 2022 Elsevier Masson SAS. All rights reserved.
Publications 2021 du Dr MICICOI Grégoire
High tibial flexion osteotomy for symptomatic ligamentous genu recurvatum
High tibial flexion osteotomy for symptomatic ligamentous genu recurvatum
Christophe Trojani, Grégoire Micicoi, Pascal Boileau
https://pubmed.ncbi.nlm.nih.gov/34329759/
Abstract
Introduction: Symptomatic Ligamentous Genu Recurvatum (SLGR) is characterized by an asymmetrical hyperextension of the knee associated with pain and a feeling of instability occurring even during walking. The ligamentous origin of the recurvatum is linked to a sprain in hyperextension responsible for a rupture of the posterior structures that may be associated or not with a rupture of the cruciate ligaments.
Hypothesis: Tibial Flexion Osteotomy (TFO) allows control of a SLGR without rupture of the cruciate ligaments secondary to a sprain in hyperextension.
Material and methods: Ten patients (12 knees) including 8 women, aged 30.8 years on average (16-52) with asymmetrical SLGR secondary to a hyperextension sprain without rupture of the cruciate ligaments underwent TFO. An anterior tibial tuberosity (ATT) osteotomy was performed with an associated trans-tuberosity anterior opening wedge osteotomy of the tibia in the sagittal plane. The ATT was secured by two compression screws with lowering of the patella culminating from the opening wedge procedure. The genu recurvatum angle (GRA), tibial slope (TSangle) and patellar height according to the Caton-Deschamps index (CDI) were established. All patients were assessed using the IKDC and Lecuire scores (anatomical and functional scores).
Results: The average follow-up was 4.2 years (12-106 months). The GR angle was 7.3±3.2° preoperatively versus 22.7±4.1° postoperatively (p<0.01). The TS angle averaged 95.5±2.3° preoperatively versus 104.0±3.7° postoperatively (p<0.01). The CDI decreased from 1.17±0.21 preoperatively to 0.83±0.11 postoperatively (p<0.01). The IKDC and Lecuire scores improved.
Conclusion: Trans-tuberosity high tibial flexion osteotomy is an effective strategy in cases of Symptomatic Ligamentous Genu Recurvatum without rupture of the cruciate ligaments secondary to a hyperextension sprain, and with constitutional hyperlaxity. This procedure allows significant clinical improvement and correction of the recurvatum deformity in the medium term.
Level of evidence: IV, retrospective descriptive study.
Keywords: Genu recurvatum; High tibial flexion osteotomy; Opening wedge; Tibia; Tibial tuberosity.
Copyright © 2021. Published by Elsevier Masson SAS.
Lateral femoral closing wedge osteotomy in genu varum
Lateral femoral closing wedge osteotomy in genu varum
Matthieu Ollivier, Maxime Fabre-Aubrespy, Grégoire Micicoi, Matthieu Ehlinger, Lukas Hanak, Kristian Kley
https://pubmed.ncbi.nlm.nih.gov/34144255/
Abstract
The distal femoral valgisation osteotomy has a variety of indications due to enhanced understanding of segmental deformities of the lower limb. Historically, an overall varus deformity was corrected at the tibia, and a valgus deformity at the femur. This approach of performing an « all in the tibia » correction for an overall varus can nevertheless lead to abnormal postoperative morphology because it is non-anatomical; creating joint line obliquity, and potentially shear stress on the cartilage. An original lateral femoral closing wedge osteotomy technique is described, allowing the correction of a genu varum of femoral or mixed origin, in the event of an associated tibial valgisation osteotomy. The detailed technique minimizes the risk of a hinge fracture while improving post-operative outcomes.
Keywords: Biplanar; Distal femur osteotomy; Hinge; Knee; Osteoarthritis; Surgical technique.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
Global varus malalignment increase from double-leg to single-leg stance due to intra-articular changes
Léo-Pôhl Bardot, Grégoire Micicoi, Henri Favreau, Petr Zeman, Raghbir Khakha, Matthieu Ehlinger, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/33486561/
Abstract
Purpose: Preoperatively planned correction for tibial osteotomy surgery is usually based on weightbearing long-leg Xrays, while the surgery is performed in a supine non-weightbearing position. The purpose of this study was to assess the differences in lower limb alignment in three different weightbearing conditions: supine position, double-leg (DL) stance and single-sleg (SL) stance prior to performing a medial opening wedge high tibial osteotomy (MOWHTO) for varus malalignment. The hypothesis of this study was that progressive limb-loading would lead to an increased preoperative varus deformity.
Material and methods: This retrospective study included 89 patients (96 knees) with isolated medial knee osteoarthritis (Ahlbäck grade I or II) and significant metaphyseal tibial vara (> 6°). The differences between supine position, DL stance and SL stance were analysed for the hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), weight-bearing line ratio (WBL) and joint line convergence angle (JLCA).
Results: From a supine position to DL stance, the HKA angle slightly increased from 175.5° ± 1.1° to 176.3° ± 1.1° and JLCA changed from 2.0° ± 0.3° to 1.8° ± 0.3° without a statistically significant difference. From DL to SL stances, the HKA angle decreased from 176.3° ± 1.1° to 174.4° ± 1.1° (p < 0.05) and the JLCA increased from 1.8° ± 0.3° to 2.6° ± 0.3° (p < 0.05). A significant correlation was found between ΔHKA and ΔJLCA between the DL and the SL stances (R2 = 0.46; p = 0.01).
Conclusion: Varus malalignment increases with weight-bearing loading from double-leg to single-leg stances with an associated JLCA increase. Thus, single-leg stance radiographs may be useful to correct preoperative planning considering patient-specific changes in JLCA.
Level of clinical evidence: III, retrospective comparative study.
Keywords: Genu varum; Joint line convergence; Knee; Osteotomy; Weight-bearing; Weight-bearing radiographs.
© 2021. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
Osteotomy around the knee is planned toward an anatomical bone correction in less than half of patients
Grégoire Micicoi, Francesco Grasso, Kristian Kley, Henri Favreau, Raghbir Khakha, Matthieu Ehlinger, Christophe Jacquet, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/33753267/
Abstract
Introduction: In cases where the femur or tibial deformity is not correctly analysed, the corrective osteotomies may result in an oblique joint line. The aim of this study was to assess the preoperative deformity of patients due to undergo corrective osteotomy and the resulting abnormal tibial and femoral morphologies after the planned correction using 3D software.
Methods: CT scans of 327 patients undergoing corrective osteotomy were retrospectively included. Each patient was planned using a software application and the simulated correction was validated by the surgeon. Following the virtual osteotomy, tibial and femoral coronal angular values were considered abnormal if the values were outside 97.5% confidence intervals for non-osteoarthritis knees. After virtual osteotomy, morphological abnormalities were split into two types. Type 1 was an under/overcorrection at the site of the osteotomy resulting in abnormal bone morphology. A type 2 was defined as an error in the site of the correction, resulting in an uncorrected abnormal bone morphology.
Results: The global rate of planned abnormalities after tibial virtual osteotomy was 50.7% (166/327) with abnormalities type 1 in 44% and type 2 in 6.7%. After femoral virtual osteotomy the global rate was 6.7% (22/327) with only abnormalities type 1. A lower preoperative HKA was significantly associated with a non-anatomical correction (R2=0.12, p<0.001) for both femoral (R2=0.06, p<0.001) and tibial (R2=0.07, p<0.001) abnormalities.
Conclusion: Non-anatomical correction was found in more than half the cases analysed more frequently for preoperative global varus alignment. These results suggest that surgeons should considered anatomical angular values to avoid joint line obliquity.
Level of evidence: III; retrospective cohort study.
Keywords: Deformity; Knee; Osteoarthritis; Osteotomy.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
Patellar height is not modified after isolated open-wedge high tibial osteotomy without change in posterior tibial slope
Mathieu Carissimi, Pierre Sautet, Dimitri Charre, Lukas Hanak, Matthieu Ollivier, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/34358712/
Abstract
Introduction: Open-wedge high tibial osteotomy (OWHTO) corrects coronal deformity and can impact sagittal parameters such as posterior tibial slope and patellar height. The aim of the present study was to analyze change in patellar height after medial OWHTO with respect to tibial and femoral-referenced indices.
Material and method: This single-center retrospective study included 129 patients undergoing isolated posteromedial OWHTO, without change in tibial slope, using patient-specific cutting-guides. Patellar height was assessed on Caton-Deschamps (CD), Insall-Salvati (IS) and Schröter indices. Posterior tibial slope and coronal femoral and tibial angles were also measured. X-rays were taken preoperatively and at 12 months, and analyzed by 2 independent observers.
Results: OWHTO modified the global lower-limb alignment (Δ=6.3±0.95̊, p<0.0001) and the proximal tibial deformity (Δ=7±0.88̊, p<0.0001). Posterior tibial slope and tibial (CD and IS) and femoral (Schröter) patellar height indices were unchanged. Intra- and inter-observer reproducibility was excellent (ICC 0.79-0.91). There were no correlations between HKA or MPTA angles and change in patellar height.
Conclusion: The present clinical series showed that patellar height was unchanged by isolated posteromedial OWHTO without change in tibial slope, using patient-specific cutting-guides, with whichever femoral or tibial reference index. The Schröter patellar femoral height index was highly reliable and is independent of proximal tibial changes in assessing patellar height, and can thus be recommended in the follow-up of OWHTO.
Level of evidence: III; retrospective cohort study.
Keywords: Deformity; Knee; Open-wedge high tibial osteotomy; Patellar height; Posterior tibial slope.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
Patients with varus knee osteoarthritis undergoing high tibial osteotomy exhibit more femoral varus but similar tibial morphology compared to non-arthritic varus knees
Hamid Rahmatullah Bin Abd Razak, Grégoire Micicoi, Raghbir S Khakha, Matthieu Ehlinger, Ahmad Faizan, Sally LiArno, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/33423093/
Abstract
Purpose: The aim of this study was to compare alignment parameters between patients undergoing high tibial osteotomy (HTO) for knee osteoarthritis (OA) and non-arthritic controls.
Methods: Pre-operative computed tomography images from 194 patients undergoing HTO for medial knee OA and 118 non-arthritic controls were utilized. All patients had varus knee alignment (mean age: 57 ± 11 years; 45% female). The hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA) and non-weight-bearing joint line convergence angle (nwJLCA) were compared between « control group » and « HTO group ». Femoral and tibial phenotypes were also assessed and compared between groups. Variables found on univariate analysis to be different between the groups were entered into a binary logistic regression model.
Results: The mean age was lower (Δ = 4 ± 6 years, p = 0.024), body mass index (BMI) was higher (Δ = 1.1 ± 2.8 kg/m2, p = 0.032) and there were more females (Δ = 14%, p = 0.020) in the HTO group. The HTO group had more overall varus (7° ± 4.7° vs 4.8° ± 1.3°, p < 0.001). There was a significant difference in the mean mLDFA between the two groups with the HTO group having more femoral varus (88.7 ± 3.2° vs 87.3 ± 1.8°, p < 0.001). MPTA was similar between the groups (p = 0.881). Age was found to be a strong determinant for femoral varus (p = 0.03).
Conclusion: Patients undergoing HTO for medial knee OA have more femoral varus compared to non-arthritic controls while tibial morphology was similar. This will be an important consideration in pre-operating planning for realignment osteotomy in patients presenting with medial knee OA and warrants further investigation.
Level of evidence: III, retrospective comparative study.
Keywords: Femur; Joints; Knee; Morphology; Osteoarthritis; Osteotomy; Phenotype; Tibia.
© 2021. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
Double level knee osteotomy using patient-specific cutting guides is accurate and provides satisfactory clinical results: a prospective analysis of a cohort of twenty-two continuous patients
Francesco Grasso, Pierre Martz, Grégoire Micicoi, Raghbir Khakha, Kristian Kley, Lukas Hanak, Matthieu Ollivier, Christophe Jacquet
https://pubmed.ncbi.nlm.nih.gov/34536082/
Abstract
Purpose: Double level osteotomy (DLO) (femoral and tibial) is a technically demanding procedure for which pre-operative planning accuracy and intraoperative correction are key factors. The aim of this study was to assess the accuracy of the achieved correction using patient-specific cutting guides (PSCGs) compared to the planned correction, its ability to maintain joint line obliquity (JLO), and to evaluate clinical outcomes and level of patient satisfaction at a follow-up of two years.
Methods: A single-centre, prospective observational study including 22 patients who underwent DLO by PSCGs between 2014 and 2018 was performed. Post-operative alignment was evaluated and compared with the target angular values to define the accuracy of the correction for the hip-knee-ankle angle (ΔHKA), medial proximal tibial angle (ΔMPTA), lateral distal femoral angle (ΔLDFA), and posterior proximal tibial angle (ΔPPTA). Pre- and post-operative JLO was also evaluated. At two year follow-up, changes in the KOOS sub-scores and patient satisfaction were recorded. The Mann-Whitney U test with 95% confidence interval (95% CI) was used to evaluate the differences between two variables; the paired Student’s t test was used to estimate evolution of functional outcomes.
Results: The mean ΔHKA was 1.3 ± 0.5°; the mean ΔMPTA was 0.98 ± 0.3°; the mean ΔLDFA was 0.94 ± 0.2°; ΔPPTA was 0.45 ± 0.4°. The orientation of the joint line was preserved with a mean difference in the JLO of 0.4 ± 0.2. At last follow-up, it was recorded a significant improvement in all KOOS scores, and 19 patients were enthusiastic, two satisfied, and one moderately satisfied.
Conclusion: Performing a DLO using PSCGs produces an accurate correction, without modification of the joint line orientation and with good functional outcomes at two year follow-up.
Keywords: Accuracy; Clinical outcomes; Double level osteotomy; Joint line obliquity; Patient-specific cutting guide.
© 2021. The Author(s) under exclusive licence to SICOT aisbl.
Femoral and Tibial Bony Risk Factors for Anterior Cruciate Ligament Injuries Are Present in More Than 50% of Healthy Individuals
Grégoire Micicoi, Christophe Jacquet, Raghbir Khakha, Sally LiArno, Ahmad Faizan, Romain Seil, Baris Kocaoglu, Simone Cerciello, Pierre Martz, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/34710345/
Abstract
Background: Anterior cruciate ligament (ACL) injuries are multifactorial events that may be influenced by morphometric parameters. Associations between primary ACL injuries or graft ruptures and both femoral and tibial bony risk factors have been well described in the literature.
Purpose: To determine values of femoral and tibial bony morphology that have been associated with ACL injuries in a reference population. Further, to define interindividual variations according to participant demographics and to identify the proportion of participants presenting at least 1 morphological ACL injury risk factor.
Study design: Cross-sectional study; Level of evidence, 3.
Methods: Computed tomography scans of 382 healthy participants were examined. The following bony ACL risk factors were analyzed: notch width index (NWI), lateral femoral condylar index (LFCI), medial posterior plateau tibial angle (MPPTA), and lateral posterior plateau tibial angle (LPPTA). The proportion of this healthy population presenting with at least 1 pathological ACL injury risk factor was determined. A multivariable logistic regression model was constructed to determine the influence of demographic characteristics.
Results: According to published thresholds for ACL bony risk factors, 12% of the examined knees exhibited an intercondylar notch width <18.9 mm, 25% had NWI <0.292, 62% exhibited LFCI <0.67, 54% had MPPTA <83.6°, and 15% had LPPTA <81.6°. Only 14.4% of participants exhibited no ACL bony risk factors, whereas 84.5% had between 2 and 4 bony risk factors and 1.1% had all bony risk factors. The multivariate analysis demonstrated that only the intercondylar notch width (P < .0001) was an independent predictor according to both sex and ethnicity; the LFCI (P = .012) and MMPTA (P = .02) were independent predictors according to ethnicity.
Conclusion: The precise definition of bony anatomic risk factors for ACL injury remains unclear. Based on published thresholds, 15% to 62% of this reference population would have been considered as being at risk. Large cohort analyses are required to confirm the validity of previously described morphological risk factors and to define which participants may be at risk of primary ACL injury and reinjury after surgical reconstruction.
Keywords: ACL rupture; intercondylar notch width (NWI); lateral femoral condylar index (LFCI); morphological risk factors; posterior tibial slope.
Neutral alignment resulting from tibial vara and opposite femoral valgus is the main morphologic pattern in healthy middle-aged patients: an exploration of a 3D-CT database
Grégoire Micicoi, Christophe Jacquet, Akash Sharma, Sally LiArno, Ahmad Faizan, Kristian Kley, Sébastien Parratte, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/32372282/
Abstract
Purpose: Given the goal of achieving optimal correction and alignment after knee arthroplasty or high tibial osteotomy, literature focusing on the inter-individual variability of the native knee, tibia and femur with regards to the coronal or sagittal alignment is lacking. The aim of this study was to analyse normal angular values in the healthy middle-aged population and determine differences of angular values according to inter-individual features. The first hypothesis was that common morphological patterns may be identified in the healthy middle-aged non-osteoarthritic population. The second hypothesis was that high inter-individual variability exists with regards to gender, ethnicity and alignment phenotype.
Methods: A CT scan-based modelling and analysis system was used to examine the lower limb of 758 normal healthy patients (390 men, 368 women; mean age 58.5 ± 16.4 years) with available data concerning angular values and retrieved from the SOMA database. The hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA) and non weight-bearing joint line convergence angle (nwJLCA) were then measured for each patient. Results were analysed for the entire cohort and based on gender, ethnicity and phenotype.
Results: The mean HKA was 179.4° ± 2.6°, LDFA: 85.8° ± 2.0°, MPTA: 85.6° ± 2.4°, PDFA: 85.2° ± 1.5°, PPTA: 83.8° ± 2.9° and nwJLCA: 1.09° ± 0.9°. Gender was associated with higher LDFA and lower HKA for men. Ethnicity was associated with greater proximal tibial vara and distal femoral valgus for Asian patients. Patients with an overall global varus alignment had more tibia vara and less femoral valgus than patients with an overall valgus alignment.
Conclusion: Even if significant differences were found based on subgroup analysis (gender, ethnicity or phenotype), this study demonstrated that neutral alignment is the main morphological pattern in the healthy middle-aged population. This neutrality is the result from tibia vara compensated by an ipsilateral femoral valgus.
Level of clinical evidence: III, retrospective cohort study.
Keywords: Alignment; CT; HKA; HTO concepts; JLCA; Knee; LDFA; MPTA; Native; PPTA; Phenotypes.
Healthy middle-aged Asian and Caucasian populations present with large intra- and inter-individual variations of lower limb torsion
P Mathon, G Micicoi, R Seil, B Kacaoglu, S Cerciello, F Ahmad, S LiArno, R Teitge, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/32548676/
Abstract
Purpose: There is a lack of standardization in the measurement of lower limb torsional alignment. Normal values published in the literature are inconsistent. A 3D-CT-scan-based method was used in a healthy population to define the femoral neck version (FNV) and the tibial torsion (TT) and their relationship with demographic parameters. The study objectives were (1) to define normal values of lower limb torsional alignment, (2) to estimate inter- and intra-individual variations of torsional deformity of healthy individuals’ lower limbs. The hypothesis was that FNV and TT values would be influenced by patient characteristics such as gender, age, and ethnicity, and would have low side-to-side asymmetry.
Methods: Torsional landmarks of the lower limbs from 191 healthy subjects were automatically calculated with a 3D CT-scan-based program. The FNV was defined by the angle between the femoral neck axis and the femoral posterior condylar line. The TT angle was considered between the tibial plateau axis and the axis of the ankle. For the former, two alternatives were considered: the line connecting the more medial and lateral point of the medial and lateral plateau, respectively (method 1; TT1), or the line connecting the two more posterior points of the medial et lateral plateau (method 2; TT2). The ankle axis was defined as the line connecting the medial and lateral malleoli. These reference lines were automatically calculated. Age, gender, ethnic group, and BMI were recorded for every subject. A p value < 0.05 was considered as statistically significant.
Results: Overall, the mean FNV was 15.3 ± 9.5° and the mean TT was 31.6 ± 6.3°. Female hips were more anteverted than male hips. Caucasians had less anteverted hips than Asians, but more externally rotated tibias. Age and BMI were not correlated with any anatomical parameter. A substantial side-to-side asymmetry was found for FNV [absolute difference (AD) = 6.3°; percentage of asymmetry (%As) = 47%], TT1 (AD = 3°; %As = 12%), and TT2 (AD = 4.9°; %As = 9%) (p = 0.008).
Conclusion: The findings showed that lower limb torsional parameters were highly variable from patient to patient and from one leg to the other for the same patient. The understanding of normal values concerning femoral version and external tibial torsion in the present healthy population will help surgeons to define pathological values of FNV and TT, as well as corrections to perform in case of torsional deformities.
Level of evidence: Level III.
Keywords: Anteversion; Femoral neck version; Lower limb torsion; Tibial torsion; Torsional alignment.
Publications 2020 du Dr MICICOI Grégoire
Managing intra-articular deformity in high Tibial osteotomy: a narrative review
Managing intra-articular deformity in high Tibial osteotomy: a narrative review
Grégoire Micicoi, Raghbir Khakha, Kristian Kley, Adrian Wilson, Simone Cerciello, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/32902758/
Abstract
The joint line convergence angle (JLCA) has a normal range between 0° to 2°, which increases in magnitude depending on the severity and stage of osteoarthritis in the knee.The JLCA represents the interaction of the intra-articular deformity arising from the osteoarthritis and the surrounding soft tissue laxity. Therefore, the JLCA has become a vital parameter in analysing the long leg alignment views for corrective planning before osteotomy surgery. Recent studies have considered the influence on how the preoperative JLCA is measured and its influence on achieving accurate postoperative desired correction in high tibial osteotomy surgery.The JLCA also reflects the influence of soft tissue laxity in a lower limb malalignment and many surgeons encourage it to be taken into account to avoid non physiological correction and/or overcorrection with negatively impacted postoperative patient outcome.This present review addressed how to obtain an accurate preoperative measurement of the JLCA, its influence on postoperative deformity analysis and how to reduce errors arising from an elevated preoperative JLCA.We have proposed a formula to help determine the value to subtract from the planned correction in order to avoid an overcorrection when performing a corrective osteotomy.Level of clinical evidence IV, narrative review.
Keywords: Joint line convergence angle; Osteotomy; Overcorrection; Soft tissue correction.
Dorsal intercarpal ligament capsulodesis: a retrospective study of 120 patients according to types of chronic scapholunate instability
Grégoire Micicoi, Lolita Micicoi, Nicolas Dreant
https://pubmed.ncbi.nlm.nih.gov/32216521/
Abstract
The purpose of this study was to assess the results of dorsal intercarpal ligament capsulodesis (Mayo technique) for cases of chronic scapholunate instability and to specify the indications according to the severity of instability. A retrospective analysis was conducted and examined dorsal intercarpal ligament capsulodesis procedures performed for chronic scapholunate instability without intercarpal or radiocarpal arthritis. One-hundred and twenty patients were examined by an independent observer (48 predynamic, 48 dynamic and 24 static scapholunate instabilities). The follow-up period averaged 54 months (range 24-127). Mean final Mayo wrist score was 70, mean final Patient-Rated Wrist Evaluation was 27 and mean final QuickDASH score was 26. Functional, clinical and radiological data were improved for the operated patients. We concluded that dorsal intercarpal ligament capsulodesis is a good option for treating early stages of scapholunate instability.Level of evidence: IV.
Keywords: Scapholunate dissociation; capsulodesis; carpal instability; ligamentous repair; wrist; wrist instability.
Comments on: ``Is patient-specific instrumentation more precise than conventional techniques and navigation in achieving planned correction in high tibial osteotomy?`` by N. Tardy, C. Steltzlen, N. Bouguennec, J.-L. Cartier, P. Mertl, C. Bataillé, et al. published in Orthop Traumatol Surg Res 2020;8S:S231-S236
Grégoire Micicoi, Henri Favreau, Christophe Jacquet, Matthieu Ehlinger, Matthieu Ollivier
One-stage bilateral total hip arthroplasty versus unilateral total hip arthroplasty: A retrospective case-matched study
Grégoire Micicoi, Régis Bernard de Dompsure, Lolita Micicoi, Laurie Tran, Michel Carles, Pascal Boileau, Christophe Trojani
https://pubmed.ncbi.nlm.nih.gov/32265170/
Abstract
Background: One-stage bilateral hip replacement has the advantage of involving a single anesthesia, single hospital admission and single rehabilitation program. The theoretic drawback is increased surgical risk. Few French series have been reported, and none with comparison versus unilateral arthroplasty. We therefore conducted a comparative case-control study between 1-stage bilateral (1B-THA) and unilateral total hip arthroplasty (U-THA), assessing (1) morbidity/mortality, (2) survival, and (3) functional scores and forgotten hip rates.
Hypothesis: In a selected ASA 1 or 2 population, 1B-THA shows complications rates and implant survival comparable to U-THA.
Material and method: Between 2004 and 2018, 327 patients were included: 109 with 1B-THA, 218 with U-THA. One 1B-THA patient was matched to 2 U-THA patients on age, gender, diagnosis, ASA score 1 or 2, and anterior or posterior approach. Minimum follow-up was 12 months. Complications were collected for all patients in both groups. Early (≤90 days) or late (>90 days) morbidity/mortality and implant survival were recorded for both groups. Secondary endpoints concerned blood-sparing strategy and blood loss, functional scores, and patient satisfaction.
Results: Mortality was zero in both groups. There was no significant difference in complications rates (1B-THA 38.5%, U-THA 40.8%) (p=0.69), whether early (8.3% [9/109] and 7.8% [17/218] respectively [p=0.89]) or late (30.3% [33/109] and 33.0% [72/218] respectively [p=0.61]). Limb-length discrepancy was significantly less frequent in 1B-THA (5.5% [6/109] versus 13.3% [29/218] [p=0.03]). Forgotten hip rate was significantly more frequent in 1B-THA (86% [94/109] versus 70% [152/218] [p=0.01]). Five-year Kaplan-Meier implant survival was 97.2% (95% CI [91.9-99.1]) in 1B-THA and 96.6% (95% CI [93.0-98.4]) in U-THA (p=0.08).
Discussion: One-stage bilateral total hip arthroplasty gave acceptable results in disabling bilateral osteoarthritis of the hip with low surgical risk in selected patients (ASA 1 or 2). Mortality, complications and implant survival were unaffected, but the 1-stage bilateral procedure allowed better control of limb-length and provided a higher rate of forgotten hip.
Level of evidence: III, matched case-control study.
Keywords: 1-stage procedure; Bilateral total hip arthroplasty; Complications; Hip osteoarthritis; Outcome; Postoperative morbidity; Unilateral.
Copyright © 2020. Published by Elsevier Masson SAS.
Accuracy of the correction obtained after tibial valgus osteotomy. Comparison of the use of the Hernigou table and the so-called classical method
Xavier Nicolau, François Bonnomet, Grégoire Micicoi, David Eichler, Matthieu Ollivier, Henri Favreau, Matthieu Ehlinger
https://pubmed.ncbi.nlm.nih.gov/32820360/
Abstract
Introduction: Medial valgus-producing tibial osteotomy (MVTO) is classically used to treat early medial femorotibial osteoarthritis. Long-term results depend on the mechanical femorotibial angle (HKA) obtained at the end of the procedure. A correction goal between 3 and 6° valgus is commonly accepted. Several planning methods are described to achieve this goal, but none is superior to the other.
Objective: The main objective was to compare the accuracy of the correction obtained using either the Hernigou table (HT) or a so-called conventional method (CM) for which 1° of correction corresponds to 1° of osteotomy opening. The secondary objective was to analyze the variations observed in the sagittal plane on the tibial slope and on the patellar height. The working hypothesis was that the HT allowed a more accurate correction and that the tibial slope and patellar height were modified in both groups.
Material and method: In this monocentric and retrospective study, two senior surgeons operated on 39 knees (18 in the CM group, 21 in the HT group) between January 1, 2009 and December 31, 2014. The operator was unique for each group and expert in the technique used. The correction objective chosen for each patient, and written in the operative report, was considered as the one to be achieved. The surgical correction was the difference between the pre-operative and immediate post-operative data (< 5 J) for the mechanical tibial angle (MTA) and the hip-knee-ankle (HKA) angle. Surgical accuracy, where a value close to 0 is optimal, was the absolute value of the difference between the surgical correction performed and the goal set by the surgeon.
Results: The median surgical accuracy on the MTA was 3.5° [0.2-7.4] versus 1.4° [0-4.1] in the CM and HT groups, respectively (p = 0.006). In multivariate analysis, with the same objective, the CM had a significantly lower accuracy of 1.9° ± 0.8 (p = 0.02). For HKA, the median accuracy was 3.1° [0.3-7.3] versus 0.8° [0-5] in the CM and HT groups, respectively (p = 0.006). Five (5/18, 28%) and 16 (16/21, 76%) knees were within 3° of the target in the CM and HT groups, respectively (p = 0.004). The median tibial slope increased in both groups. This increase was significantly greater in the CM group compared with the HT group, with 5.5° [- 0.3-13] versus 0.5 [- 5.2-5.6], respectively (p < 0.001). The median Caton-Deschamps index decreased (patella lowered) in both groups after surgery, by – 0.21 [- 1.03; – 0.05] and – 0.14 [- 0.4-0.16], but without significant difference (p = 0.19). In univariate analysis, changes in tibial slope and patellar height were not significantly related to frontal surgical correction performed according to ΔMTA (R2 = 0.07; p = 0.055) and (R2 = – 0.02; p = 0.54) respectively.
Discussion: The correction set by the surgeons was achieved with greater accuracy and more frequently in the HT group, confirming the working hypothesis. The HT is therefore recommended as a simple way of achieving the set objective; the tibial slope and patellar height were modified unaffected by the frontal correction performed.
Keywords: Accuracy; Knee surgery; Navigation; Open wedge osteotomy; Tibial osteotomy.
Publications 2019 du Dr MICICOI Grégoire
Early morbidity and mortality after one-stage bilateral THA: Anterior versus posterior approach
Early morbidity and mortality after one-stage bilateral THA: Anterior versus posterior approach
Grégoire Micicoi, Régis Bernard de Dompsure, Laurie Tran, Michel Carles, Pascal Boileau, Nicolas Bronsard, Christophe Trojani
https://pubmed.ncbi.nlm.nih.gov/31591065/
Abstract
Background: Advantages of performing bilateral total hip arthroplasty (THA) in one stage include a single hospital stay, a single exposure to anaesthesia risks, and expedited rehabilitation. Controversy persists however, regarding safety, notably morbidity and mortality rates. Importantly, few studies have compared the anterior to the posterior approach for single-stage bilateral THA (1B-THA). The objective of this retrospective study in a uniform patient population was to compare the anterior and posterior approaches for 1B-THA in terms of: 1) early mortality rates, 2) early complications, 3) and 90-day re-admission rates, hospital stay lengths, and blood loss.
Hypothesis: 1B-THA in patients younger than 80 years who have an ASA score of 1 or 2 is associated with no early mortality and with low early morbidity rates regardless of whether the anterior or posterior approach is used.
Material and methods: A single-centre retrospective comparative design was used to assess 90-day mortality and morbidity rates in consecutive patients who underwent 1B-THA between 2004 and 2018. The groups managed with the anterior approach (AA) without traction table and posterior approach (PA) were compared. The ASA score was ≤2 and age ≤80 years in all patients. The groups were comparable for age, sex distribution, ASA score, pre-operative haemoglobin level, and reason for THA.
Results: We included 55 patients managed via the AA and 82 managed via the PA. No patients died in either group. Early complications occurred in 3 patients in the AA group and 6 in the AP group (p=0.74). No differences were noted between the two groups for each type of complication. In the AA group, 3 patients experienced major complications (p=0.06) (2 cerebrovascular events and 1 peri-prosthetic fracture). In the PA group, 6 patients experienced minor complications (1 case each of dislocation, piriformis syndrome, sacral pressure sore, and deep vein thrombosis and 2 cases of ilio-psoas irritation; p=0.08). Operative time was 144minutes (range, 110-195minutes) in the AA group and 171minutes (range, 108-255minutes) in the PA group (p<0.001). Mean hospital stay length was 7.6 days (range, 3-13 days) overall, 6.7 days (range, 5-11 days) in the AA group, and 8.2 days (range, 3-13 days) in the PA group (p<0.001). The early re-admission rate was 2.9% overall, with no difference between the AA group (3.6% [2/55]) and the PA group (2.4% [2/82]) A post-operative blood transfusion was required by 34/137 (24.8%) patients overall, 15/55(27.3%) patients in the AA group and 19/82 (23.2%) patients in the PA group (p=0.58).
Discussion: In selected patients (ASA score 1 or 2 and age ≤80 years), 1B-THA was not followed by any early deaths in the patients managed using the anterior or posterior approach. Total early morbidity rates were low. Neither the types of complications nor the early re-admission rates differed between the AA and PA groups. The shorter operative time in the AA group is ascribable to change in patient installation between the two arthroplasties when the PA is used.
Level of evidence: III, comparative study of consecutive patients.
Keywords: Bilateral total hip replacement; Early complications; Hip osteoarthritis; Mortality; One-stage surgery.
Copyright © 2019. Published by Elsevier Masson SAS.
″Caractérisation in vitro des effets des ciments chargés en bisphosphonates sur des cellules d’ostéosarcome ″
Master II en bio-ingénierie et physiopathologie ostéo-articulaire – Sept. 2016
« Stratégie et risques du remplacement prothétique bilatéral de hanche en une session opératoire«
Diplôme d’État de Docteur en médecine – Oct. 2018
« Anatomie et bases biomécaniques des ostéotomies autour du genou«
Diplôme d’État de Docteur ès sciences – Mars 2021
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Sociétés savantes
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- Membre de la Société Française de Chirurgie Orthopédique et Traumatologique (SoFCOT)
- Membre de la Société Européenne de chirurgie du sport et d’arthroscopie (ESSKA)
- Membre du consortium Genou de la société Chirurgie assistée par Ordinateur (CAOS)
- Membre du Collège des jeunes orthopédistes (CJO) – Représentant Europe (FORTE)
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Publications
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Publications 2023 du Dr MICICOI Grégoire
Clinical and Radiological Outcomes of Double-Level Osteotomy Versus Open-Wedge High Tibial Osteotomy for Bifocal Varus DeformityClinical and Radiological Outcomes of Double-Level Osteotomy Versus Open-Wedge High Tibial Osteotomy for Bifocal Varus Deformity
Alice Abs , Grégoire Micicoi, Raghbir Khakha, Jean-Charles Escudier, Christophe Jacquet, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/36814769/
Abstract
Background: In bifocal varus deformity, double-level osteotomy (DLO) is advocated to treat lower limb alignment to prevent an adverse increase in joint line obliquity.
Purpose/hypothesis: The purpose of this study was to compare the clinical and radiological results after DLO and open-wedge high tibial osteotomy (OWHTO) in patients with combined varus deformity. It was hypothesized that DLO would improve clinical results without increasing the complication rate compared with OWHTO.
Study design: Cohort study; Level of evidence, 3.
Methods: Inclusion criteria were medial tibiofemoral compartment pain, varus knee deformity with an abnormal medial proximal tibial angle <84° and a lateral distal femoral angle >90°, a functional anterior cruciate ligament, failure of nonoperative treatment, and a minimum 2-year follow-up with all clinical and radiological data. The rate of return to work or sports; the Knee injury and Osteoarthritis Outcome Score (KOOS); the University of California, Los Angeles (UCLA) activity score; and patient satisfaction were assessed at a minimum of 2 years of follow-up. Statistical comparison of the 2 groups was made using the chi-square or Student t test.
Results: A total of 69 consecutive patients were analyzed, of whom 38 underwent OWHTO and 31 underwent DLO surgery. A significant between-group difference was found for all radiological parameters; in particular, there was less joint line obliquity after DLO compared with OWHTO (1.7° vs 5.6°; P < .001). DLO provided better outcomes compared with OWHTO regarding the UCLA score (4.3 vs 6.7; P < .001) and patient satisfaction (2.6 vs 3.9; P < .001), but no significant difference in KOOS or return to work or sports was observed. The OWHTO group had more hinge fractures than the DLO group (34.2% vs 12.9%; P < .001).
Conclusion: For combined tibial and femoral varus deformity, DLO produced more physiologic joint line obliquity with slightly improved UCLA and patient satisfaction scores. A greater incidence of hinge fracture was observed after isolated OWHTO compared with DLO due to a larger tibial correction; however, this had little effect on clinical results at the 2-year follow-up.
Keywords: clinical outcome; complications; double-level osteotomy; joint line obliquity; open-wedge high tibial osteotomy.
© The Author(s) 2023.
CloseNormo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomyNormo-or slightly overcorrection show better results after medial closing wedge high tibial osteotomy
Axel Machado , Lolita Micicoi, Justin Ernat, Philipp Schippers, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/37326635/
Abstract
Purpose: The objectives of this study were to evaluate functional results, revision-free survival, and the influence of postoperative alignment on outcomes after MCWHTO.
Methods: This retrospective study included 27 MCWHTO operated on from 2009 to 2021. Radiographic measurements were performed pre- and postoperatively. The HKA (Hip-Knee-Ankle angle), MPTA (Medial Proximal Tibial angle), LDFA (Lateral Distal Femoral Angle), JLO (Joint Line Obliquity), and JLCA (Joint Line Convergence Angle) were evaluated. The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee Score, and the Subjective Knee Value (SKV) as well as revision-free survival were evaluated. Postoperative alignment and its influence on clinical outcomes were also analysed.
Results: The mean follow-up was 61.9 months ± 31.4 (13-124). The HKA, MPTA, and JLCA angles were decreased post-operatively (respectively, Δ = 5.9° ± 2.6, p < 0.001; Δ = 6.1° ± 3.2, p < 0.001 and Δ = 2.5° ± 1.9, p < 0.001). LDFA and JLO were unchanged, post-operatively (respectively, Δ = 0.1° ± 2.2, p = 0.93 and Δ = 1.2° ± 3.3, p = 0.23). Postoperative HKA correlated with knee IKS (R = – 0.15, p = 0.04) and function IKS (R = – 0.44, p = 0.03). Postoperative LDFA correlated with knee IKS(R = 0.8, p < 0.01). Patients with postoperative HKA ≤ 180° had better KOOS (Δ = 12.3, p = 0.04) and IKS function (Δ = 28.1, p < 0.01) than those with HKA > 180°.
Conclusion: Functional results and revision-free survival after MCWHTO are satisfactory when the deformity is located in the proximal tibia. The joint line obliquity is not significantly altered with small tibial correction and, obtaining an overall neutral or slightly varus alignment under the conditions of this study allowed an improvement in the postoperative clinical scores. The literature is still inconclusive on the ideal alignment for valgus deformities and larger series are needed to draw definitive conclusions.
Level of evidence: IV, case series.
Keywords: High tibia osteotomy; Joint line obliquity; Knee osteoarthritis; Medial closure; Valgus deformity.
© 2023. The Author(s) under exclusive licence to European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
ClosePublications 2022 du Dr MICICOI Grégoire
Comparative study of bilateral total hip arthroplasty in one or two stagesComparative study of bilateral total hip arthroplasty in one or two stages
Comparative study of bilateral total hip arthroplasty in one or two stages
Grégoire Micicoi, Régis Bernard de Dompsure, Pascal Boileau, Christophe Trojani
https://pubmed.ncbi.nlm.nih.gov/35781050/
Abstract
Introduction: Bilateral total hip arthroplasty (Bi THA) for disabling bilateral hip osteoarthritis can be performed in one or two operative sessions. The objective of this study was to compare the complication rates of a group of patients who had bilateral THA in one operating session (Bi-1S THA) to a matched group of patients who had bilateral THA in two separate operating sessions (Bi-2S THA).
Materials and methods: This retrospective case-control study compared 84 Bi-1S THA matched to 84 Bi-2S THA by age, gender, diagnosis, ASA score (1-2) and surgical approach. The minimum follow-up was 12 months. Complication rates, total blood loss, number of blood transfusion units, and functional outcomes were assessed.
Results: Twelve patients (14.3%) in the Bi-1S THA group had minor or major complications, compared to twenty-one (25%) in the Bi-2S THA group (p=0.08): there were fewer minor complications in the Bi-1S THA group and a similar rate of major complications amongst the two groups. Total blood loss estimated using the OSTHEO formula was significantly lower in patients operated on by Bi-1S THA (1853±753mL versus 2804±1012mL, p <0.0001). The number of blood transfusion units was similar between the groups (0.5±0.8 versus 0.3±1.4 respectively, p=0.55). No significant difference was found regarding the functional results.
Conclusion: Under the conditions of this study, bilateral total hip arthroplasty in one operative session leads to fewer minor complications, and a similar rate of major complications, when compared to bilateral total hip arthroplasty in two separate sessions. This strategy can therefore be recommended for ASA 1 and 2 patients, under the age of 80 with disabling bilateral osteoarthritis.
Level of evidence: III, retrospective comparative study.
Keywords: Bilateral; Complications; One session; Total hip arthroplasty.
Copyright © 2022. Published by Elsevier Masson SAS.
ClosePatient specific instrumentation allow precise derotational correction of femoral and tibial torsional deformitiesPatient specific instrumentation allow precise derotational correction of femoral and tibial torsional deformities
Grégoire Micicoi, Boris Corin, Jean-Noël Argenson, Christophe Jacquet, Raghbir Khakha, Pierre Martz, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/36058123/
Abstract
Background: Rotational malalignment deformities of the lower limb in adults mostly arise from excessive femoral anteversion and/or excessive external tibial torsion. The aim of this study was to assess the correction accuracy of a patient specific cutting guides (PSCG) used in tibial and femoral correction for lower-limb torsional deformities.
Methods: Forty knees (32 patients) were included prospectively. All patients had patellofemoral pain or instability with torsional malalignment for which a proximal tibial (HTO) or distal femoral (DFO) or a double-level osteotomy (DLO) had been performed. Accuracy of the correction between the planned and the postoperative angular values including femoral anteversion, tibial torsion, coronal and sagittal alignment were assessed after tibial and/or femoral osteotomy.
Results: Forty knees were included in this study. In cases of HTO, the correction accuracy obtained with PSCG was 1.3 ± 1.1° for tibial torsion (axial plane), 0.8 ± 0.7° for MPTA (coronal plane) and 0.8 ± 0.6° for PPTA (sagittal plane). In cases of DFO, the correction accuracy obtained with PSCG was 1.5 ± 1.4° for femoral anteversion (axial plane), 0.9 ± 0.9° for LDFA (coronal plane) and 0.9 ± 0.9° for PDFA (sagittal plane). The IKSG was improved from 58.0 ± 13.2° to 71.4 ± 10.9 (p = 0.04) and the IKSF from 50.2 ± 14.3 to 87.0 ± 6.9 (p < 0.001).
Conclusions: Using the PSCG for derotational osteotomy allows excellent correction accuracy in all the three planes for femoral and tibial torsional deformities associated with patellofemoral instability. Level of clinical evidence II, prospective cohort study.
Keywords: Accuracy; Clinical outcomes; Derotational osteotomy; Patellofemoral instability; Patient-specific cutting guide; Torsional malalignment syndrome.
Copyright © 2022 Elsevier B.V. All rights reserved.
CloseSlope-decreasing anterior closing wedge proximal tibial osteotomies using the freehand technique are accurate to within 2̊Slope-decreasing anterior closing wedge proximal tibial osteotomies using the freehand technique are accurate to within 2̊
Robin Rassat, Grégoire Micicoi, Christophe Jacquet, Sylvain Guy, Jean-Marie Fayard, Pierre Martz, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/36377059/
Abstract
Introduction: Anterior cruciate ligament (ACL) reconstruction requires a detailed analysis of the posterior tibial slope (PTS) as excessive values may cause the reconstruction to fail and require a slope-decreasing anterior closing wedge tibial osteotomy combined with revision of the failed ACL reconstruction. The main purpose of this study was to assess the accuracy of correction after slope-decreasing anterior closing wedge tibial osteotomy in cases of chronic anterior instability caused by ACL rerupture.
Materials and methods: This single-center retrospective study included 19 patients (20 knees) operated on by slope-decreasing anterior closing wedge tibial osteotomy combined with a second revision ACL reconstruction. The mean age was 22.4±3.3 years and the mean follow-up was 12.7±4.4 months. The preoperative planning was based on lateral calibrated X-rays of the entire tibia. The height of the closing wedge, which corresponded to the base of the osteotomy, was measured in millimeters. The procedure was performed using the freehand technique. The accuracy of the correction was defined as the difference between the desired preoperative PTS and the postoperative PTS achieved. An inter- and intraobserver analysis was performed.
Results: The mean preoperative PTS was 13.9±2̊ and the mean postoperative PTS was 4.0±1.7̊. The mean PTS correction was 10.1±2.1̊ with a planned target of 5.4±1.8̊. The accuracy obtained between the planned target and the postoperative corrections was 1.7±1.1̊. The regression analysis showed that the accuracy of the PTS correction was not influenced by the patient’s age, BMI, excessive preoperative PTS, or degree of correction achieved (p>0.05).
Conclusion: Slope-decreasing anterior closing wedge tibial osteotomies performed using the freehand technique for ACL graft rerupture can correct an excessive PTS within 2̊ of the planned slope correction. This accuracy is not determined by demographic factors, excessive preoperative PTS or degree of correction achieved.
Level of evidence: IV; retrospective cohort study.
Keywords: Closing wedge tibial osteotomy; Posterior tibial slope; Revision ACL reconstruction; Slope-decreasing tibial osteotomy.
Copyright © 2022 Elsevier Masson SAS. All rights reserved.
ClosePublications 2021 du Dr MICICOI Grégoire
High tibial flexion osteotomy for symptomatic ligamentous genu recurvatumHigh tibial flexion osteotomy for symptomatic ligamentous genu recurvatum
High tibial flexion osteotomy for symptomatic ligamentous genu recurvatum
Christophe Trojani, Grégoire Micicoi, Pascal Boileau
https://pubmed.ncbi.nlm.nih.gov/34329759/
Abstract
Introduction: Symptomatic Ligamentous Genu Recurvatum (SLGR) is characterized by an asymmetrical hyperextension of the knee associated with pain and a feeling of instability occurring even during walking. The ligamentous origin of the recurvatum is linked to a sprain in hyperextension responsible for a rupture of the posterior structures that may be associated or not with a rupture of the cruciate ligaments.
Hypothesis: Tibial Flexion Osteotomy (TFO) allows control of a SLGR without rupture of the cruciate ligaments secondary to a sprain in hyperextension.
Material and methods: Ten patients (12 knees) including 8 women, aged 30.8 years on average (16-52) with asymmetrical SLGR secondary to a hyperextension sprain without rupture of the cruciate ligaments underwent TFO. An anterior tibial tuberosity (ATT) osteotomy was performed with an associated trans-tuberosity anterior opening wedge osteotomy of the tibia in the sagittal plane. The ATT was secured by two compression screws with lowering of the patella culminating from the opening wedge procedure. The genu recurvatum angle (GRA), tibial slope (TSangle) and patellar height according to the Caton-Deschamps index (CDI) were established. All patients were assessed using the IKDC and Lecuire scores (anatomical and functional scores).
Results: The average follow-up was 4.2 years (12-106 months). The GR angle was 7.3±3.2° preoperatively versus 22.7±4.1° postoperatively (p<0.01). The TS angle averaged 95.5±2.3° preoperatively versus 104.0±3.7° postoperatively (p<0.01). The CDI decreased from 1.17±0.21 preoperatively to 0.83±0.11 postoperatively (p<0.01). The IKDC and Lecuire scores improved.
Conclusion: Trans-tuberosity high tibial flexion osteotomy is an effective strategy in cases of Symptomatic Ligamentous Genu Recurvatum without rupture of the cruciate ligaments secondary to a hyperextension sprain, and with constitutional hyperlaxity. This procedure allows significant clinical improvement and correction of the recurvatum deformity in the medium term.
Level of evidence: IV, retrospective descriptive study.
Keywords: Genu recurvatum; High tibial flexion osteotomy; Opening wedge; Tibia; Tibial tuberosity.
Copyright © 2021. Published by Elsevier Masson SAS.
CloseLateral femoral closing wedge osteotomy in genu varumLateral femoral closing wedge osteotomy in genu varum
Lateral femoral closing wedge osteotomy in genu varum
Matthieu Ollivier, Maxime Fabre-Aubrespy, Grégoire Micicoi, Matthieu Ehlinger, Lukas Hanak, Kristian Kley
https://pubmed.ncbi.nlm.nih.gov/34144255/
Abstract
The distal femoral valgisation osteotomy has a variety of indications due to enhanced understanding of segmental deformities of the lower limb. Historically, an overall varus deformity was corrected at the tibia, and a valgus deformity at the femur. This approach of performing an « all in the tibia » correction for an overall varus can nevertheless lead to abnormal postoperative morphology because it is non-anatomical; creating joint line obliquity, and potentially shear stress on the cartilage. An original lateral femoral closing wedge osteotomy technique is described, allowing the correction of a genu varum of femoral or mixed origin, in the event of an associated tibial valgisation osteotomy. The detailed technique minimizes the risk of a hinge fracture while improving post-operative outcomes.
Keywords: Biplanar; Distal femur osteotomy; Hinge; Knee; Osteoarthritis; Surgical technique.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
CloseGlobal varus malalignment increase from double-leg to single-leg stance due to intra-articular changesGlobal varus malalignment increase from double-leg to single-leg stance due to intra-articular changes
Léo-Pôhl Bardot, Grégoire Micicoi, Henri Favreau, Petr Zeman, Raghbir Khakha, Matthieu Ehlinger, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/33486561/
Abstract
Purpose: Preoperatively planned correction for tibial osteotomy surgery is usually based on weightbearing long-leg Xrays, while the surgery is performed in a supine non-weightbearing position. The purpose of this study was to assess the differences in lower limb alignment in three different weightbearing conditions: supine position, double-leg (DL) stance and single-sleg (SL) stance prior to performing a medial opening wedge high tibial osteotomy (MOWHTO) for varus malalignment. The hypothesis of this study was that progressive limb-loading would lead to an increased preoperative varus deformity.
Material and methods: This retrospective study included 89 patients (96 knees) with isolated medial knee osteoarthritis (Ahlbäck grade I or II) and significant metaphyseal tibial vara (> 6°). The differences between supine position, DL stance and SL stance were analysed for the hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), weight-bearing line ratio (WBL) and joint line convergence angle (JLCA).
Results: From a supine position to DL stance, the HKA angle slightly increased from 175.5° ± 1.1° to 176.3° ± 1.1° and JLCA changed from 2.0° ± 0.3° to 1.8° ± 0.3° without a statistically significant difference. From DL to SL stances, the HKA angle decreased from 176.3° ± 1.1° to 174.4° ± 1.1° (p < 0.05) and the JLCA increased from 1.8° ± 0.3° to 2.6° ± 0.3° (p < 0.05). A significant correlation was found between ΔHKA and ΔJLCA between the DL and the SL stances (R2 = 0.46; p = 0.01).
Conclusion: Varus malalignment increases with weight-bearing loading from double-leg to single-leg stances with an associated JLCA increase. Thus, single-leg stance radiographs may be useful to correct preoperative planning considering patient-specific changes in JLCA.
Level of clinical evidence: III, retrospective comparative study.
Keywords: Genu varum; Joint line convergence; Knee; Osteotomy; Weight-bearing; Weight-bearing radiographs.
© 2021. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
CloseOsteotomy around the knee is planned toward an anatomical bone correction in less than half of patientsOsteotomy around the knee is planned toward an anatomical bone correction in less than half of patients
Grégoire Micicoi, Francesco Grasso, Kristian Kley, Henri Favreau, Raghbir Khakha, Matthieu Ehlinger, Christophe Jacquet, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/33753267/
Abstract
Introduction: In cases where the femur or tibial deformity is not correctly analysed, the corrective osteotomies may result in an oblique joint line. The aim of this study was to assess the preoperative deformity of patients due to undergo corrective osteotomy and the resulting abnormal tibial and femoral morphologies after the planned correction using 3D software.
Methods: CT scans of 327 patients undergoing corrective osteotomy were retrospectively included. Each patient was planned using a software application and the simulated correction was validated by the surgeon. Following the virtual osteotomy, tibial and femoral coronal angular values were considered abnormal if the values were outside 97.5% confidence intervals for non-osteoarthritis knees. After virtual osteotomy, morphological abnormalities were split into two types. Type 1 was an under/overcorrection at the site of the osteotomy resulting in abnormal bone morphology. A type 2 was defined as an error in the site of the correction, resulting in an uncorrected abnormal bone morphology.
Results: The global rate of planned abnormalities after tibial virtual osteotomy was 50.7% (166/327) with abnormalities type 1 in 44% and type 2 in 6.7%. After femoral virtual osteotomy the global rate was 6.7% (22/327) with only abnormalities type 1. A lower preoperative HKA was significantly associated with a non-anatomical correction (R2=0.12, p<0.001) for both femoral (R2=0.06, p<0.001) and tibial (R2=0.07, p<0.001) abnormalities.
Conclusion: Non-anatomical correction was found in more than half the cases analysed more frequently for preoperative global varus alignment. These results suggest that surgeons should considered anatomical angular values to avoid joint line obliquity.
Level of evidence: III; retrospective cohort study.
Keywords: Deformity; Knee; Osteoarthritis; Osteotomy.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
ClosePatellar height is not modified after isolated open-wedge high tibial osteotomy without change in posterior tibial slopePatellar height is not modified after isolated open-wedge high tibial osteotomy without change in posterior tibial slope
Mathieu Carissimi, Pierre Sautet, Dimitri Charre, Lukas Hanak, Matthieu Ollivier, Grégoire Micicoi
https://pubmed.ncbi.nlm.nih.gov/34358712/
Abstract
Introduction: Open-wedge high tibial osteotomy (OWHTO) corrects coronal deformity and can impact sagittal parameters such as posterior tibial slope and patellar height. The aim of the present study was to analyze change in patellar height after medial OWHTO with respect to tibial and femoral-referenced indices.
Material and method: This single-center retrospective study included 129 patients undergoing isolated posteromedial OWHTO, without change in tibial slope, using patient-specific cutting-guides. Patellar height was assessed on Caton-Deschamps (CD), Insall-Salvati (IS) and Schröter indices. Posterior tibial slope and coronal femoral and tibial angles were also measured. X-rays were taken preoperatively and at 12 months, and analyzed by 2 independent observers.
Results: OWHTO modified the global lower-limb alignment (Δ=6.3±0.95̊, p<0.0001) and the proximal tibial deformity (Δ=7±0.88̊, p<0.0001). Posterior tibial slope and tibial (CD and IS) and femoral (Schröter) patellar height indices were unchanged. Intra- and inter-observer reproducibility was excellent (ICC 0.79-0.91). There were no correlations between HKA or MPTA angles and change in patellar height.
Conclusion: The present clinical series showed that patellar height was unchanged by isolated posteromedial OWHTO without change in tibial slope, using patient-specific cutting-guides, with whichever femoral or tibial reference index. The Schröter patellar femoral height index was highly reliable and is independent of proximal tibial changes in assessing patellar height, and can thus be recommended in the follow-up of OWHTO.
Level of evidence: III; retrospective cohort study.
Keywords: Deformity; Knee; Open-wedge high tibial osteotomy; Patellar height; Posterior tibial slope.
Copyright © 2021 Elsevier Masson SAS. All rights reserved.
ClosePatients with varus knee osteoarthritis undergoing high tibial osteotomy exhibit more femoral varus but similar tibial morphology compared to non-arthritic varus kneesPatients with varus knee osteoarthritis undergoing high tibial osteotomy exhibit more femoral varus but similar tibial morphology compared to non-arthritic varus knees
Hamid Rahmatullah Bin Abd Razak, Grégoire Micicoi, Raghbir S Khakha, Matthieu Ehlinger, Ahmad Faizan, Sally LiArno, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/33423093/
Abstract
Purpose: The aim of this study was to compare alignment parameters between patients undergoing high tibial osteotomy (HTO) for knee osteoarthritis (OA) and non-arthritic controls.
Methods: Pre-operative computed tomography images from 194 patients undergoing HTO for medial knee OA and 118 non-arthritic controls were utilized. All patients had varus knee alignment (mean age: 57 ± 11 years; 45% female). The hip-knee-ankle (HKA) angle, mechanical lateral distal femoral angle (mLDFA), medial proximal tibial angle (MPTA) and non-weight-bearing joint line convergence angle (nwJLCA) were compared between « control group » and « HTO group ». Femoral and tibial phenotypes were also assessed and compared between groups. Variables found on univariate analysis to be different between the groups were entered into a binary logistic regression model.
Results: The mean age was lower (Δ = 4 ± 6 years, p = 0.024), body mass index (BMI) was higher (Δ = 1.1 ± 2.8 kg/m2, p = 0.032) and there were more females (Δ = 14%, p = 0.020) in the HTO group. The HTO group had more overall varus (7° ± 4.7° vs 4.8° ± 1.3°, p < 0.001). There was a significant difference in the mean mLDFA between the two groups with the HTO group having more femoral varus (88.7 ± 3.2° vs 87.3 ± 1.8°, p < 0.001). MPTA was similar between the groups (p = 0.881). Age was found to be a strong determinant for femoral varus (p = 0.03).
Conclusion: Patients undergoing HTO for medial knee OA have more femoral varus compared to non-arthritic controls while tibial morphology was similar. This will be an important consideration in pre-operating planning for realignment osteotomy in patients presenting with medial knee OA and warrants further investigation.
Level of evidence: III, retrospective comparative study.
Keywords: Femur; Joints; Knee; Morphology; Osteoarthritis; Osteotomy; Phenotype; Tibia.
© 2021. European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA).
CloseDouble level knee osteotomy using patient-specific cutting guides is accurate and provides satisfactory clinical results: a prospective analysis of a cohort of twenty-two continuous patientsDouble level knee osteotomy using patient-specific cutting guides is accurate and provides satisfactory clinical results: a prospective analysis of a cohort of twenty-two continuous patients
Francesco Grasso, Pierre Martz, Grégoire Micicoi, Raghbir Khakha, Kristian Kley, Lukas Hanak, Matthieu Ollivier, Christophe Jacquet
https://pubmed.ncbi.nlm.nih.gov/34536082/
Abstract
Purpose: Double level osteotomy (DLO) (femoral and tibial) is a technically demanding procedure for which pre-operative planning accuracy and intraoperative correction are key factors. The aim of this study was to assess the accuracy of the achieved correction using patient-specific cutting guides (PSCGs) compared to the planned correction, its ability to maintain joint line obliquity (JLO), and to evaluate clinical outcomes and level of patient satisfaction at a follow-up of two years.
Methods: A single-centre, prospective observational study including 22 patients who underwent DLO by PSCGs between 2014 and 2018 was performed. Post-operative alignment was evaluated and compared with the target angular values to define the accuracy of the correction for the hip-knee-ankle angle (ΔHKA), medial proximal tibial angle (ΔMPTA), lateral distal femoral angle (ΔLDFA), and posterior proximal tibial angle (ΔPPTA). Pre- and post-operative JLO was also evaluated. At two year follow-up, changes in the KOOS sub-scores and patient satisfaction were recorded. The Mann-Whitney U test with 95% confidence interval (95% CI) was used to evaluate the differences between two variables; the paired Student’s t test was used to estimate evolution of functional outcomes.
Results: The mean ΔHKA was 1.3 ± 0.5°; the mean ΔMPTA was 0.98 ± 0.3°; the mean ΔLDFA was 0.94 ± 0.2°; ΔPPTA was 0.45 ± 0.4°. The orientation of the joint line was preserved with a mean difference in the JLO of 0.4 ± 0.2. At last follow-up, it was recorded a significant improvement in all KOOS scores, and 19 patients were enthusiastic, two satisfied, and one moderately satisfied.
Conclusion: Performing a DLO using PSCGs produces an accurate correction, without modification of the joint line orientation and with good functional outcomes at two year follow-up.
Keywords: Accuracy; Clinical outcomes; Double level osteotomy; Joint line obliquity; Patient-specific cutting guide.
© 2021. The Author(s) under exclusive licence to SICOT aisbl.
CloseFemoral and Tibial Bony Risk Factors for Anterior Cruciate Ligament Injuries Are Present in More Than 50% of Healthy IndividualsFemoral and Tibial Bony Risk Factors for Anterior Cruciate Ligament Injuries Are Present in More Than 50% of Healthy Individuals
Grégoire Micicoi, Christophe Jacquet, Raghbir Khakha, Sally LiArno, Ahmad Faizan, Romain Seil, Baris Kocaoglu, Simone Cerciello, Pierre Martz, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/34710345/
Abstract
Background: Anterior cruciate ligament (ACL) injuries are multifactorial events that may be influenced by morphometric parameters. Associations between primary ACL injuries or graft ruptures and both femoral and tibial bony risk factors have been well described in the literature.
Purpose: To determine values of femoral and tibial bony morphology that have been associated with ACL injuries in a reference population. Further, to define interindividual variations according to participant demographics and to identify the proportion of participants presenting at least 1 morphological ACL injury risk factor.
Study design: Cross-sectional study; Level of evidence, 3.
Methods: Computed tomography scans of 382 healthy participants were examined. The following bony ACL risk factors were analyzed: notch width index (NWI), lateral femoral condylar index (LFCI), medial posterior plateau tibial angle (MPPTA), and lateral posterior plateau tibial angle (LPPTA). The proportion of this healthy population presenting with at least 1 pathological ACL injury risk factor was determined. A multivariable logistic regression model was constructed to determine the influence of demographic characteristics.
Results: According to published thresholds for ACL bony risk factors, 12% of the examined knees exhibited an intercondylar notch width <18.9 mm, 25% had NWI <0.292, 62% exhibited LFCI <0.67, 54% had MPPTA <83.6°, and 15% had LPPTA <81.6°. Only 14.4% of participants exhibited no ACL bony risk factors, whereas 84.5% had between 2 and 4 bony risk factors and 1.1% had all bony risk factors. The multivariate analysis demonstrated that only the intercondylar notch width (P < .0001) was an independent predictor according to both sex and ethnicity; the LFCI (P = .012) and MMPTA (P = .02) were independent predictors according to ethnicity.
Conclusion: The precise definition of bony anatomic risk factors for ACL injury remains unclear. Based on published thresholds, 15% to 62% of this reference population would have been considered as being at risk. Large cohort analyses are required to confirm the validity of previously described morphological risk factors and to define which participants may be at risk of primary ACL injury and reinjury after surgical reconstruction.
Keywords: ACL rupture; intercondylar notch width (NWI); lateral femoral condylar index (LFCI); morphological risk factors; posterior tibial slope.
CloseNeutral alignment resulting from tibial vara and opposite femoral valgus is the main morphologic pattern in healthy middle-aged patients: an exploration of a 3D-CT databaseNeutral alignment resulting from tibial vara and opposite femoral valgus is the main morphologic pattern in healthy middle-aged patients: an exploration of a 3D-CT database
Grégoire Micicoi, Christophe Jacquet, Akash Sharma, Sally LiArno, Ahmad Faizan, Kristian Kley, Sébastien Parratte, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/32372282/
Abstract
Purpose: Given the goal of achieving optimal correction and alignment after knee arthroplasty or high tibial osteotomy, literature focusing on the inter-individual variability of the native knee, tibia and femur with regards to the coronal or sagittal alignment is lacking. The aim of this study was to analyse normal angular values in the healthy middle-aged population and determine differences of angular values according to inter-individual features. The first hypothesis was that common morphological patterns may be identified in the healthy middle-aged non-osteoarthritic population. The second hypothesis was that high inter-individual variability exists with regards to gender, ethnicity and alignment phenotype.
Methods: A CT scan-based modelling and analysis system was used to examine the lower limb of 758 normal healthy patients (390 men, 368 women; mean age 58.5 ± 16.4 years) with available data concerning angular values and retrieved from the SOMA database. The hip-knee-ankle angle (HKA), lateral distal femoral angle (LDFA), medial proximal tibial angle (MPTA), posterior distal femoral angle (PDFA), posterior proximal tibial angle (PPTA) and non weight-bearing joint line convergence angle (nwJLCA) were then measured for each patient. Results were analysed for the entire cohort and based on gender, ethnicity and phenotype.
Results: The mean HKA was 179.4° ± 2.6°, LDFA: 85.8° ± 2.0°, MPTA: 85.6° ± 2.4°, PDFA: 85.2° ± 1.5°, PPTA: 83.8° ± 2.9° and nwJLCA: 1.09° ± 0.9°. Gender was associated with higher LDFA and lower HKA for men. Ethnicity was associated with greater proximal tibial vara and distal femoral valgus for Asian patients. Patients with an overall global varus alignment had more tibia vara and less femoral valgus than patients with an overall valgus alignment.
Conclusion: Even if significant differences were found based on subgroup analysis (gender, ethnicity or phenotype), this study demonstrated that neutral alignment is the main morphological pattern in the healthy middle-aged population. This neutrality is the result from tibia vara compensated by an ipsilateral femoral valgus.
Level of clinical evidence: III, retrospective cohort study.
Keywords: Alignment; CT; HKA; HTO concepts; JLCA; Knee; LDFA; MPTA; Native; PPTA; Phenotypes.
CloseHealthy middle-aged Asian and Caucasian populations present with large intra- and inter-individual variations of lower limb torsionHealthy middle-aged Asian and Caucasian populations present with large intra- and inter-individual variations of lower limb torsion
P Mathon, G Micicoi, R Seil, B Kacaoglu, S Cerciello, F Ahmad, S LiArno, R Teitge, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/32548676/
Abstract
Purpose: There is a lack of standardization in the measurement of lower limb torsional alignment. Normal values published in the literature are inconsistent. A 3D-CT-scan-based method was used in a healthy population to define the femoral neck version (FNV) and the tibial torsion (TT) and their relationship with demographic parameters. The study objectives were (1) to define normal values of lower limb torsional alignment, (2) to estimate inter- and intra-individual variations of torsional deformity of healthy individuals’ lower limbs. The hypothesis was that FNV and TT values would be influenced by patient characteristics such as gender, age, and ethnicity, and would have low side-to-side asymmetry.
Methods: Torsional landmarks of the lower limbs from 191 healthy subjects were automatically calculated with a 3D CT-scan-based program. The FNV was defined by the angle between the femoral neck axis and the femoral posterior condylar line. The TT angle was considered between the tibial plateau axis and the axis of the ankle. For the former, two alternatives were considered: the line connecting the more medial and lateral point of the medial and lateral plateau, respectively (method 1; TT1), or the line connecting the two more posterior points of the medial et lateral plateau (method 2; TT2). The ankle axis was defined as the line connecting the medial and lateral malleoli. These reference lines were automatically calculated. Age, gender, ethnic group, and BMI were recorded for every subject. A p value < 0.05 was considered as statistically significant.
Results: Overall, the mean FNV was 15.3 ± 9.5° and the mean TT was 31.6 ± 6.3°. Female hips were more anteverted than male hips. Caucasians had less anteverted hips than Asians, but more externally rotated tibias. Age and BMI were not correlated with any anatomical parameter. A substantial side-to-side asymmetry was found for FNV [absolute difference (AD) = 6.3°; percentage of asymmetry (%As) = 47%], TT1 (AD = 3°; %As = 12%), and TT2 (AD = 4.9°; %As = 9%) (p = 0.008).
Conclusion: The findings showed that lower limb torsional parameters were highly variable from patient to patient and from one leg to the other for the same patient. The understanding of normal values concerning femoral version and external tibial torsion in the present healthy population will help surgeons to define pathological values of FNV and TT, as well as corrections to perform in case of torsional deformities.
Level of evidence: Level III.
Keywords: Anteversion; Femoral neck version; Lower limb torsion; Tibial torsion; Torsional alignment.
ClosePublications 2020 du Dr MICICOI Grégoire
Managing intra-articular deformity in high Tibial osteotomy: a narrative reviewManaging intra-articular deformity in high Tibial osteotomy: a narrative review
Managing intra-articular deformity in high Tibial osteotomy: a narrative review
Grégoire Micicoi, Raghbir Khakha, Kristian Kley, Adrian Wilson, Simone Cerciello, Matthieu Ollivier
https://pubmed.ncbi.nlm.nih.gov/32902758/
Abstract
The joint line convergence angle (JLCA) has a normal range between 0° to 2°, which increases in magnitude depending on the severity and stage of osteoarthritis in the knee.The JLCA represents the interaction of the intra-articular deformity arising from the osteoarthritis and the surrounding soft tissue laxity. Therefore, the JLCA has become a vital parameter in analysing the long leg alignment views for corrective planning before osteotomy surgery. Recent studies have considered the influence on how the preoperative JLCA is measured and its influence on achieving accurate postoperative desired correction in high tibial osteotomy surgery.The JLCA also reflects the influence of soft tissue laxity in a lower limb malalignment and many surgeons encourage it to be taken into account to avoid non physiological correction and/or overcorrection with negatively impacted postoperative patient outcome.This present review addressed how to obtain an accurate preoperative measurement of the JLCA, its influence on postoperative deformity analysis and how to reduce errors arising from an elevated preoperative JLCA.We have proposed a formula to help determine the value to subtract from the planned correction in order to avoid an overcorrection when performing a corrective osteotomy.Level of clinical evidence IV, narrative review.
Keywords: Joint line convergence angle; Osteotomy; Overcorrection; Soft tissue correction.
CloseDorsal intercarpal ligament capsulodesis: a retrospective study of 120 patients according to types of chronic scapholunate instabilityDorsal intercarpal ligament capsulodesis: a retrospective study of 120 patients according to types of chronic scapholunate instability
Grégoire Micicoi, Lolita Micicoi, Nicolas Dreant
https://pubmed.ncbi.nlm.nih.gov/32216521/
Abstract
The purpose of this study was to assess the results of dorsal intercarpal ligament capsulodesis (Mayo technique) for cases of chronic scapholunate instability and to specify the indications according to the severity of instability. A retrospective analysis was conducted and examined dorsal intercarpal ligament capsulodesis procedures performed for chronic scapholunate instability without intercarpal or radiocarpal arthritis. One-hundred and twenty patients were examined by an independent observer (48 predynamic, 48 dynamic and 24 static scapholunate instabilities). The follow-up period averaged 54 months (range 24-127). Mean final Mayo wrist score was 70, mean final Patient-Rated Wrist Evaluation was 27 and mean final QuickDASH score was 26. Functional, clinical and radiological data were improved for the operated patients. We concluded that dorsal intercarpal ligament capsulodesis is a good option for treating early stages of scapholunate instability.Level of evidence: IV.
Keywords: Scapholunate dissociation; capsulodesis; carpal instability; ligamentous repair; wrist; wrist instability.
CloseComments on: ``Is patient-specific instrumentation more precise than conventional techniques and navigation in achieving planned correction in high tibial osteotomy?`` by N. Tardy, C. Steltzlen, N. Bouguennec, J.-L. Cartier, P. Mertl, C. Bataillé, et al. published in Orthop Traumatol Surg Res 2020;8S:S231-S236Comments on: ``Is patient-specific instrumentation more precise than conventional techniques and navigation in achieving planned correction in high tibial osteotomy?`` by N. Tardy, C. Steltzlen, N. Bouguennec, J.-L. Cartier, P. Mertl, C. Bataillé, et al. published in Orthop Traumatol Surg Res 2020;8S:S231-S236
Grégoire Micicoi, Henri Favreau, Christophe Jacquet, Matthieu Ehlinger, Matthieu Ollivier
CloseOne-stage bilateral total hip arthroplasty versus unilateral total hip arthroplasty: A retrospective case-matched studyOne-stage bilateral total hip arthroplasty versus unilateral total hip arthroplasty: A retrospective case-matched study
Grégoire Micicoi, Régis Bernard de Dompsure, Lolita Micicoi, Laurie Tran, Michel Carles, Pascal Boileau, Christophe Trojani
https://pubmed.ncbi.nlm.nih.gov/32265170/
Abstract
Background: One-stage bilateral hip replacement has the advantage of involving a single anesthesia, single hospital admission and single rehabilitation program. The theoretic drawback is increased surgical risk. Few French series have been reported, and none with comparison versus unilateral arthroplasty. We therefore conducted a comparative case-control study between 1-stage bilateral (1B-THA) and unilateral total hip arthroplasty (U-THA), assessing (1) morbidity/mortality, (2) survival, and (3) functional scores and forgotten hip rates.
Hypothesis: In a selected ASA 1 or 2 population, 1B-THA shows complications rates and implant survival comparable to U-THA.
Material and method: Between 2004 and 2018, 327 patients were included: 109 with 1B-THA, 218 with U-THA. One 1B-THA patient was matched to 2 U-THA patients on age, gender, diagnosis, ASA score 1 or 2, and anterior or posterior approach. Minimum follow-up was 12 months. Complications were collected for all patients in both groups. Early (≤90 days) or late (>90 days) morbidity/mortality and implant survival were recorded for both groups. Secondary endpoints concerned blood-sparing strategy and blood loss, functional scores, and patient satisfaction.
Results: Mortality was zero in both groups. There was no significant difference in complications rates (1B-THA 38.5%, U-THA 40.8%) (p=0.69), whether early (8.3% [9/109] and 7.8% [17/218] respectively [p=0.89]) or late (30.3% [33/109] and 33.0% [72/218] respectively [p=0.61]). Limb-length discrepancy was significantly less frequent in 1B-THA (5.5% [6/109] versus 13.3% [29/218] [p=0.03]). Forgotten hip rate was significantly more frequent in 1B-THA (86% [94/109] versus 70% [152/218] [p=0.01]). Five-year Kaplan-Meier implant survival was 97.2% (95% CI [91.9-99.1]) in 1B-THA and 96.6% (95% CI [93.0-98.4]) in U-THA (p=0.08).
Discussion: One-stage bilateral total hip arthroplasty gave acceptable results in disabling bilateral osteoarthritis of the hip with low surgical risk in selected patients (ASA 1 or 2). Mortality, complications and implant survival were unaffected, but the 1-stage bilateral procedure allowed better control of limb-length and provided a higher rate of forgotten hip.
Level of evidence: III, matched case-control study.
Keywords: 1-stage procedure; Bilateral total hip arthroplasty; Complications; Hip osteoarthritis; Outcome; Postoperative morbidity; Unilateral.
Copyright © 2020. Published by Elsevier Masson SAS.
CloseAccuracy of the correction obtained after tibial valgus osteotomy. Comparison of the use of the Hernigou table and the so-called classical methodAccuracy of the correction obtained after tibial valgus osteotomy. Comparison of the use of the Hernigou table and the so-called classical method
Xavier Nicolau, François Bonnomet, Grégoire Micicoi, David Eichler, Matthieu Ollivier, Henri Favreau, Matthieu Ehlinger
https://pubmed.ncbi.nlm.nih.gov/32820360/
Abstract
Introduction: Medial valgus-producing tibial osteotomy (MVTO) is classically used to treat early medial femorotibial osteoarthritis. Long-term results depend on the mechanical femorotibial angle (HKA) obtained at the end of the procedure. A correction goal between 3 and 6° valgus is commonly accepted. Several planning methods are described to achieve this goal, but none is superior to the other.
Objective: The main objective was to compare the accuracy of the correction obtained using either the Hernigou table (HT) or a so-called conventional method (CM) for which 1° of correction corresponds to 1° of osteotomy opening. The secondary objective was to analyze the variations observed in the sagittal plane on the tibial slope and on the patellar height. The working hypothesis was that the HT allowed a more accurate correction and that the tibial slope and patellar height were modified in both groups.
Material and method: In this monocentric and retrospective study, two senior surgeons operated on 39 knees (18 in the CM group, 21 in the HT group) between January 1, 2009 and December 31, 2014. The operator was unique for each group and expert in the technique used. The correction objective chosen for each patient, and written in the operative report, was considered as the one to be achieved. The surgical correction was the difference between the pre-operative and immediate post-operative data (< 5 J) for the mechanical tibial angle (MTA) and the hip-knee-ankle (HKA) angle. Surgical accuracy, where a value close to 0 is optimal, was the absolute value of the difference between the surgical correction performed and the goal set by the surgeon.
Results: The median surgical accuracy on the MTA was 3.5° [0.2-7.4] versus 1.4° [0-4.1] in the CM and HT groups, respectively (p = 0.006). In multivariate analysis, with the same objective, the CM had a significantly lower accuracy of 1.9° ± 0.8 (p = 0.02). For HKA, the median accuracy was 3.1° [0.3-7.3] versus 0.8° [0-5] in the CM and HT groups, respectively (p = 0.006). Five (5/18, 28%) and 16 (16/21, 76%) knees were within 3° of the target in the CM and HT groups, respectively (p = 0.004). The median tibial slope increased in both groups. This increase was significantly greater in the CM group compared with the HT group, with 5.5° [- 0.3-13] versus 0.5 [- 5.2-5.6], respectively (p < 0.001). The median Caton-Deschamps index decreased (patella lowered) in both groups after surgery, by – 0.21 [- 1.03; – 0.05] and – 0.14 [- 0.4-0.16], but without significant difference (p = 0.19). In univariate analysis, changes in tibial slope and patellar height were not significantly related to frontal surgical correction performed according to ΔMTA (R2 = 0.07; p = 0.055) and (R2 = – 0.02; p = 0.54) respectively.
Discussion: The correction set by the surgeons was achieved with greater accuracy and more frequently in the HT group, confirming the working hypothesis. The HT is therefore recommended as a simple way of achieving the set objective; the tibial slope and patellar height were modified unaffected by the frontal correction performed.
Keywords: Accuracy; Knee surgery; Navigation; Open wedge osteotomy; Tibial osteotomy.
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Early morbidity and mortality after one-stage bilateral THA: Anterior versus posterior approachEarly morbidity and mortality after one-stage bilateral THA: Anterior versus posterior approach
Early morbidity and mortality after one-stage bilateral THA: Anterior versus posterior approach
Grégoire Micicoi, Régis Bernard de Dompsure, Laurie Tran, Michel Carles, Pascal Boileau, Nicolas Bronsard, Christophe Trojani
https://pubmed.ncbi.nlm.nih.gov/31591065/
Abstract
Background: Advantages of performing bilateral total hip arthroplasty (THA) in one stage include a single hospital stay, a single exposure to anaesthesia risks, and expedited rehabilitation. Controversy persists however, regarding safety, notably morbidity and mortality rates. Importantly, few studies have compared the anterior to the posterior approach for single-stage bilateral THA (1B-THA). The objective of this retrospective study in a uniform patient population was to compare the anterior and posterior approaches for 1B-THA in terms of: 1) early mortality rates, 2) early complications, 3) and 90-day re-admission rates, hospital stay lengths, and blood loss.
Hypothesis: 1B-THA in patients younger than 80 years who have an ASA score of 1 or 2 is associated with no early mortality and with low early morbidity rates regardless of whether the anterior or posterior approach is used.
Material and methods: A single-centre retrospective comparative design was used to assess 90-day mortality and morbidity rates in consecutive patients who underwent 1B-THA between 2004 and 2018. The groups managed with the anterior approach (AA) without traction table and posterior approach (PA) were compared. The ASA score was ≤2 and age ≤80 years in all patients. The groups were comparable for age, sex distribution, ASA score, pre-operative haemoglobin level, and reason for THA.
Results: We included 55 patients managed via the AA and 82 managed via the PA. No patients died in either group. Early complications occurred in 3 patients in the AA group and 6 in the AP group (p=0.74). No differences were noted between the two groups for each type of complication. In the AA group, 3 patients experienced major complications (p=0.06) (2 cerebrovascular events and 1 peri-prosthetic fracture). In the PA group, 6 patients experienced minor complications (1 case each of dislocation, piriformis syndrome, sacral pressure sore, and deep vein thrombosis and 2 cases of ilio-psoas irritation; p=0.08). Operative time was 144minutes (range, 110-195minutes) in the AA group and 171minutes (range, 108-255minutes) in the PA group (p<0.001). Mean hospital stay length was 7.6 days (range, 3-13 days) overall, 6.7 days (range, 5-11 days) in the AA group, and 8.2 days (range, 3-13 days) in the PA group (p<0.001). The early re-admission rate was 2.9% overall, with no difference between the AA group (3.6% [2/55]) and the PA group (2.4% [2/82]) A post-operative blood transfusion was required by 34/137 (24.8%) patients overall, 15/55(27.3%) patients in the AA group and 19/82 (23.2%) patients in the PA group (p=0.58).
Discussion: In selected patients (ASA score 1 or 2 and age ≤80 years), 1B-THA was not followed by any early deaths in the patients managed using the anterior or posterior approach. Total early morbidity rates were low. Neither the types of complications nor the early re-admission rates differed between the AA and PA groups. The shorter operative time in the AA group is ascribable to change in patient installation between the two arthroplasties when the PA is used.
Level of evidence: III, comparative study of consecutive patients.
Keywords: Bilateral total hip replacement; Early complications; Hip osteoarthritis; Mortality; One-stage surgery.
Copyright © 2019. Published by Elsevier Masson SAS.
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