Praticien Universitaire-Praticien Hospitalier (PU-PH)
Chef de Service de Chirurgie Orthopédique et Traumatologique du Sport
Chef de Service de Traumatologie
Diplôme d’état de docteur en médecine. Université Claude Bernard Lyon I- Faculté de médecine Lyon Nord
Diplôme d’Études Spécialisées de chirurgie générale. Université de la Méditerranée (Aix-Marseille II) – Faculté de médecine de Marseille
Diplôme d’Études Spécialisées Complémentaires de chirurgie orthopédique et traumatologie. Université de la Méditerranée (Aix-Marseille II) – Faculté de médecine de Marseille
Capacité médicale
Capacité de médecine de catastrophe. Université Paris XII – Val-de-Marne – Faculté de médecine de Créteil.
Diplômes inter-universitaires
DIU des pathologies de l’appareil locomoteur lié à la pratique du sport. Facultés de médecine de Marseille – Paris VII – Grenoble – Lyon – Nice
DIU d’arthroscopie. 17 facultés de médecine sous l’égide de la Société Française d’Arthroscopie
DIU de pathologies chirurgicales du genou. Facultés de médecine de Marseille – Créteil – Grenoble – Lyon
DIU de pathologies chirurgicales de l’épaule et du coude. Facultés de médecine de Créteil – Rouen – Toulouse – Strasbourg
Diplômes universitaires
DU de médecine et hygiène tropicales. Faculté de médecine de Lyon
DU de recherches microchirurgicales. Faculté de médecine de Marseille
Diplômes universitaires de recherche
Certificat de maîtrise de sciences biologiques et médicales de pharmacologie générale. Université Claude Bernard Lyon I- Faculté de médecine Lyon
Certificat de maîtrise de sciences biologiques et médicales d’anatomie générale, imagerie, et morphogénèse. Université de la Méditerranée (Aix-Marseille II) – Faculté de médecine de Marseille
Master I Recherche du domaine Sciences de la Santé. Université de la Méditerranée (Aix-Marseille II) – Faculté de médecine de Marseille
Master II Recherche d’Anthropologie Biologique. Université de la Méditerranée (Aix-Marseille II) – Faculté de médecine de Marseille
Titre d’enseignement
Professeur associé des universités, faculté de médecine de Nice, 2016
Titre hospitalier
Reçu au concours national de praticien des établissements publics de santé, Session 2013
Titres militaires
Assistant des Hôpitaux des Armées, spécialités chirurgicales discipline chirurgie orthopédique et traumatologie, 2001
Chirurgien des Hôpitaux des Armées, spécialités chirurgicales, discipline de chirurgie orthopédique et traumatologie, 2007
Professeur Agrégé du Val-de-Grâce, spécialités chirurgicales, discipline de chirurgie orthopédique et traumatologie, 2012
Background: The pararectus approach has emerged as an alternative to the traditional ilioinguinal approach for complex both-column (BC) fractures of the acetabulum. Concurrently, suprapectineal plates have evolved to enhance anatomical fixation of the quadrilateral surface (QLS) and restore joint congruency. This study aimed to answer the following questions: Does the pararectus approach provide comparable articular reduction to the ilioinguinal approach in BC fractures? Does it reduce operative time and blood loss? Are mid-term functional outcomes similar? We hypothesized that the pararectus approach, combined with anatomical QLS plating, would yield similar reduction quality and functional outcomes while decreasing surgical time and blood loss compared to the ilioinguinal approach.
Patients and methods: This retrospective, single-center study included 43 patients with BC fractures treated between 2009 and 2022. Patients were divided into two groups: ilioinguinal approach with conventional suprapectineal plate (II, n = 15) and Pararectus approach with anatomical QLS plate (PR, n = 28). Pre- and postoperative CT scans assessed axial, coronal, and sagittal residual gap, step and femoral head displacement. Operative time, blood loss, transfusion needs, and complications were recorded. Functional outcomes were assessed at two years using the Harris Hip Score (HHS) and PMA score.
Results: Articular gap reduction was similar: axial (II: 5.0 ± 2.9 mm vs. PR: 4.6 ± 5.1 mm, p = 0.3), coronal (II: 5.7 ± 2.4 mm vs. PR: 5.6 ± 5.5 mm, p = 0.2), sagittal (II: 5.6 ± 2.8 mm vs. PR: 6.4 ± 6.5 mm, p = 0.6). Residual coronal step was lower in PR (1.9 ± 2.0 mm vs. 3.6 ± 1.9 mm, p = 0.01). Anterior femoral head displacement improved in PR (-1.7 mm vs. + 5.6 mm, p < 0.001). Medial (5.9 mm vs. 3.98 mm, p = 0.4) and proximal displacement (1.1 mm vs. 1.2 mm, p = 0.46) were comparable. Operative time (PR: 125.1 ± 37.9 min vs. II: 309 ± 85.5 min, p < 0.001) and postoperative transfusions (p = 0.01) were significantly reduced in PR. Functional outcomes were comparable (HHS and PMA good-to-excellent: II: 70% vs. PR: 70%, p = 0.9).
Conclusion: The shift from the ilioinguinal to the pararectus approach with QLS plate fixation appears to offer at least equivalent reduction quality while reducing surgical time, transfusion needs, and complications. These findings support evolving strategies in BC fracture management and highlight the key role of implant design. Further prospective studies are needed to confirm these results over the long term.
Level of evidence: Level III: comparative cohort study.
Introduction: Degenerative sacroiliac (SI) joint syndrome is known to be more common after lumbosacral fusion. While this diagnosis is suspected based on various clinical criteria and diagnostic tests, it is confirmed with a diagnostic nerve block. If conservative treatment fails, SI joint fusion through a minimally invasive approach is a useful palliative approach for patients at a treatment crossroads. The aim of this study was to evaluate the clinical and functional results at 2years postoperative after minimally invasive SI joint fusion in patients with SI joint syndrome following lumbosacral fusion.
Materials and methods: We carried out a single-center retrospective study of patients operated between June 2017 and October 2020. Included were patients who had a confirmed diagnosis of SI joint syndrome after lumbosacral fusion surgery, who underwent SI joint fusion and had at least 2years’ follow-up. The primary outcome was the improvement in lumbar and radicular pain on a numerical rating scale (NRS). The secondary outcomes were the functional scores (Oswestry and SF-12) along with the level of patient satisfaction. Our study population consisted of 54 patients (41 women, 13 men) with a mean age of 59years (27-88). Thirty-one of these patients were operated on both sides (85 fusions in all). The patients had undergone a mean of 3 lumbar surgeries (1-7) before the SI fusion.
Results: The lumbar and radicular NRS were 8.4 (7-10) and 5.1 (2-10) preoperatively and 5.2 (0-8) and 3.0 (0-8) at 2years postoperatively, which was a reduction of 37% and 42% (p<0.001), respectively. The Oswestry score went from 69.4 (52-86) preoperatively to 45.6 (29-70) at 2years, which was a 33% improvement (p<0.001). Eighty-six percent of patients were satisfied or very satisfied with the surgery.
Discussion: After minimally invasive SI joint fusion, the patients in this study had clear clinical and functional improvements. Previous publications analyzing the results of SI joint fusion found even more improvement, but those patients were relatively heterogenous; in our study, only patients who had a history of lumbosacral fusion were included.
Conclusion: Minimally invasive SI joint fusion helped patients who developed SI joint syndrome after lumbosacral fusion to improve clinically and functionally.
Hypothesis: Chronic epilepsy may cause important bipolar bony lesions. We aim to compare the specific pathoanatomic metrics of the bony lesions in chronic shoulder anterior instability that occur in patients with epilepsy vs. patients without epilepsy.
Methods: From 2006 to 2020, we included epileptic and nonepileptic patients with anterior recurrent shoulder instability. We randomly adjusted the patients of the 2 groups according to the sex, age, and type of management. We included 50 patients. For each included patient, we performed an in-depth analysis and comparison of the glenoid bone loss based on the computed tomography scan: PICO method (patient/population, intervention, comparison and outcomes) using the best-fit circle; and the Hill-Sachs lesion: the depth and width were given as a percentage of the humeral head diameter on an axial view. We also evaluated the engaging character of the involved lesion using the on-track vs. off-track analysis. Those characteristics were compared between the 2 groups.
Results: We found a glenoid bone loss in 32 patients. Glenoid bone loss was not significantly greater in patients with epilepsy (P = .052). A Hill-Sachs lesion was found in 42 patients (22 in the group with epilepsy and 20 in the group without epilepsy). Hill-Sachs lesions were significantly deeper and larger in the group with epilepsy (depth: 22% vs. 9%, P < .001; width: 43% vs. 28%, P = .003). In the group with epilepsy, 90% of the bone lesions were off-track vs. 30% in the group without epilepsy. Thus, the patients with epilepsy presented more engaging bony lesions than patients without epilepsy (P = .001) (OR = 23).
Conclusions: In a population of patients with epilepsy who had shoulder instability, Hill-Sachs lesions are larger and deeper than in normal patients with shoulder instability. By contrast, there is no significant difference regarding the characteristics of the glenoid bone loss if present. This implies that bone lesions in instable shoulders of patients with epilepsy need at least a bony stabilization procedure on the humeral side in the majority of cases.
Keywords: Hill-Sachs, shoulder stabilization; Shoulder; anterior instability; bone lesion; epilepsy.
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Morphological analysis of the retrotalar pulley and its role in flexor hallucis longus impingement: Insights from a CT-based study
Morphological analysis of the retrotalar pulley and its role in flexor hallucis longus impingement: Insights from a CT-based study
Morphological analysis of the retrotalar pulley and its role in flexor hallucis longus impingement: Insights from a CT-based study
Lolita Micicoi, Barbara Piclet-Legré, Tristan Fauchille, Alexandre Rudel, Nicolas Bronsard, Jean-François Gonzalez, Matthieu Ollivier
The Flexor Hallucis Longus (FHL) is a muscle that can be subject to multiple conflicts. The most common conflict is due to inflammation of the tendon at the retrotalar pulley. The constraints exerted on the FHL are responsible for a pathology called functional Hallux Limitus. The purpose of this anatomical study is to describe morphologic finding about retrotalar pulley, which may account the impingement between FHL and the hindfoot. Using a retrospective approach at a single center, a detailed analysis was conducted on a cohort of 350 patients. Precise measurements were taken to document the angles, areas, and distances that define the relationship between the Flexor Hallucis Longus (FHL) tendon and its surrounding anatomical structures. The angle between the retrotalar pulley and the sustentaculum tali exhibited a range of 124 to 170 degrees in profile and 113.3 to 178 degrees in frontal view. The dimensions of the retrotalar pulley varied from 1.1 to 54 mm², while the posterolateral and posteromedial tubercles displayed dimensions ranging from 3.4 to 77.9 mm² and 2.6 to 35.2 mm², respectively. Distances between posterior tubercles further underscored the anatomical diversity, ranging from 4.3 to 17 cm proximally and 10.5 to 18.4 cm distally. In unraveling the morphological complexities surrounding FHL impingement, this study provides valuable insights into the biomechanical intricacies of the foot. These findings not only deepen our understanding of musculoskeletal anatomy but also pave the way for future investigations into the dynamic interplay between structure and function in the lower extremities.
Introduction: Total knee arthroplasty (TKA) carries a significant hemorrhagic risk, with a non-negligible rate of postoperative transfusions. The blood-sparing strategy has evolved to reduce blood loss after TKA by identifying the patient’s risk factors preoperatively. In practice, a blood count is often performed postoperatively but rarely altering the patient’s subsequent management. This study aimed to identify the preoperative variables associated with hemorrhagic risk, enabling the creation of a machine-learning model predictive of transfusion risk after total knee arthroplasty and the need for a complete blood count.
Hypothesis: Based on preoperative data, a powerful machine learning predictive model can be constructed to estimate the risk of transfusion after total knee arthroplasty.
Material and methods: This retrospective single-centre study included 774 total knee arthroplasties (TKA) operated between January 2020 and March 2023. Twenty-five preoperative variables were integrated into the machine learning model and filtered by a recursive feature elimination algorithm. The most predictive variables were selected and used to construct a gradient-boosting machine algorithm to define the overall postoperative transfusion risk model. Two groups were formed of patients transfused and not transfused after TKA. Odds ratios were determined, and the area under the curve evaluated the model’s performance.
Results: Of the 774 TKA surgery patients, 100 were transfused postoperatively (12.9%). The machine learning predictive model included five variables: age, body mass index, tranexamic acid administration, preoperative hemoglobin level, and platelet count. The overall performance was good with an area under the curve of 0.97 [95% CI 0.921-1], sensitivity of 94.4% [95% CI 91.2-97.6], and specificity of 85.4% [95% CI 80.6-90.2]. The tool developed to assess the risk of blood transfusion after TKA is available at https://arthrorisk.com.
Conclusion: The risk of postoperative transfusion after total knee arthroplasty can be predicted by a model that identifies patients at low, moderate, or high risk based on five preoperative variables. This machine learning tool is available on a web platform that is accessible to all, easy to use, and has a high prediction performance. The model aims to limit the need for routine check-ups, depending on the risk presented by the patient.
Introduction: While outcomes after total hip arthroplasty (THA) are generally excellent, prosthetic dislocation remains a multifactorial complication. This study hypothesized that differences in combined anteversion (CA) exist between patients with and without dislocation. The objectives were to (1) compare postoperative alignment parameters between dislocated and stable hips, (2) assess differences of alignement according to surgical approach, and (3) evaluate patient-related risk factors for dislocation.
Materials and methods: In this retrospective case-control study, 37 dislocated hips were matched to 74 stable hips by sex, age, body mass index, and surgical approach. Postoperative CT scans measured acetabular anteversion, femoral anteversion, CA, and cup inclination. Alignment was assessed relative to Lewinnek’s safe zone (acetabular anteversion 15 ° ± 10 °, inclination 40 ° ± 10 °) and Jolles’ target zone for CA (50 ° ± 10 °).
Results: Mean CA did not differ between dislocated and stable hips (45.9 ° vs 48.5 °, Δ = 2.6 °, p = 0.35). Target CA was achieved in 51% of dislocated and 54% of stable hips (p = 0.80). Cup inclination, acetabular anteversion, and femoral anteversion also showed no significant differences. Achievement of Lewinnek’s safe zone was similar between groups, except for acetabular inclination (67.6% in dislocated vs 83.8% in stable hips, p = 0.04). Surgical approach (direct anterior vs posterior) was not associated with alignment differences. In multivariate analysis, ASA (American Society of Anesthesiologists) score ≥3 (OR = 2.5, p = 0.04) and degenerative lumbar spine symptoms (OR = 3.2, p < 0.01) were independently associated with dislocation risk.
Conclusion: CA did not differ between dislocated and stable hips, suggesting that implant orientation alone does not explain instability. Instead, acetabular inclination, high ASA score, and lumbar spine pathology emerged as significant risk factors, underscoring the multifactorial nature of dislocation after THA.
Introduction: Total knee arthroplasty (TKA) is a procedure associated with risks of electrolyte and kidney function disorders, which are rare but can lead to serious complications if not correctly identified. A routine check-up is very often carried out to assess the seric ionogram and kidney function after TKA, that rarely requires clinical intervention in the event of a disturbance. The aim of this study was to identify perioperative variables that would lead to the creation of a machine learning model predicting the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty.
Hypothesis: A predictive model could be constructed to estimate the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty.
Material and methods: This single-centre retrospective study included 774 total knee arthroplasties (TKA) operated on between January 2020 and March 2023. Twenty-five preoperative variables were incorporated into the machine learning model and filtered by a first algorithm. The most predictive variables selected were used to construct a second algorithm to define the overall risk model for postoperative kalaemia and/or acute kidney injury (K+ A). Two groups were formed of K+ A and non-K+ A patients after TKA. A univariate analysis was performed and the performance of the machine learning model was assessed by the area under the curve representing the sensitivity of the model as a function of 1 – specificity.
Results: Of the 774 patients included who had undergone TKA surgery, 46 patients (5.9%) had a postoperative kalaemia disorder requiring correction and 13 patients (1.7%) had acute kidney injury, of whom 5 patients (0.6%) received vascular filling. Eight variables were included in the machine learning predictive model, including body mass index, age, presence of diabetes, operative time, lowest mean arterial pressure, Charlson score, smoking and preoperative glomerular filtration rate. Overall performance was good with an area under the curve of 0.979 [CI95% 0.938-1.02], sensitivity was 90.3% [CI95% 86.2-94.4] and specificity 89.7% [CI95% 85.5-93.8]. The tool developed to assess the risk of impaired kalaemia and/or acute kidney injury after TKA is available on https://arthrorisk.com.
Conclusion: The risk of kalaemia disturbance and postoperative acute kidney injury after total knee arthroplasty could be predicted by a model that identifies low-risk and high-risk patients based on eight pre- and intraoperative variables. This machine learning tool is available on a web platform accessible for everyone, easy to use and has a high predictive performance. The aim of the model was to better identify and anticipate the complications of dyskalaemia and postoperative acute kidney injury in high-risk patients. Further prospective multicentre series are needed to assess the value of a systematic postoperative biochemical work-up in the absence of risk predicted by the model.
Level of evidence: IV; retrospective study of case series.
Background: We aim to analyze recurrence of dislocation after Latarjet bone block with or without Hill-Sachs Remplissage (HSR) to specify the indication of a combined procedure.
Methods: We analyzed 118 patients with a bipolar lesions and a minimum follow-up of 2 years. All procedures were performed arthroscopically by 3 surgeons in on center. Preoperative and postoperative computed tomography (CT) scans were collected. We also collected preoperative and postoperative clinical scores Two groups were identified: 30 patients with arthroscopic Latarjet bone block combined with a HSR (group I) and 88 patients with an isolated Latarjet (group II). Measurements were performed on a reformatted shoulder CT-scan. On preoperative CT-scans, we measured the glenoid bone loss, the width and the length of the humeral lesion then the glenoid track and Hill-Sachs interval.
Results: The mean follow-up is 6 years. Five dislocations occurred in group II, none in group I. The area of glenoid bone loss was higher in group I than in group II (33.4% ± 4.5% vs. 20.5% ± 8.9%, P = .001). Twenty shoulders presented an Off-Track lesion preoperatively that was always compensated postoperatively by the bone block in group I. No cutoff was found to be discriminating enough to help in the decision-making process. All recurrences had an Instability Severity Index score > 6.
Conclusion: No recurrence occurred in Group I. However, 5 patients (6%) in Group II experienced a recurrent dislocation with no significant difference. Glenoid track is not an isolated argument to indicate an isolated bone block procedure or a combined HSR. The risk of recurrence increases in patients with an Instability Severity Index score over 6 and in this case, a combine procedure should be recommended.
Anatomic total shoulder arthroplasty with keeled glenoids in patients younger than 60 years at 10 years minimum: which risk factors of failure are still valid at long-term follow-up?
Anatomic total shoulder arthroplasty with keeled glenoids in patients younger than 60 years at 10 years minimum: which risk factors of failure are still valid at long-term follow-up?
Anatomic total shoulder arthroplasty with keeled glenoids in patients younger than 60 years at 10 years minimum: which risk factors of failure are still valid at long-term follow-up?
Background: To assess the long-term (>10 years) outcomes in anatomic total shoulder arthroplasty (aTSA) and implant survival in patients younger than 60 years and identify risk factors for complications and revision.
Methods: This was a retrospective, multicenter study conducted from 1993 to 2008. From more than 104 aTSAs, 87 in 82 patients (mean age 55 years, range 36-60 years) were included at a mean follow-up of 14 ± 4 years (10-25 years). Outcome measures included pain, motion, Constant score, and subjective shoulder value at 10 years minimum. On AP radiograph, the radiolucent line (RLL) score of Molé was used to assess loosening around the glenoid. A glenoid was considered « loose » in 3 circumstances: (1) revision for glenoid loosening, (2) radiologic migration of the implant, or (3) RLL score ≥12. Preoperative glenoid morphology according to Walch, glenohumeral mismatch, and cementing technique were evaluated. Survivorship free of revision and free of glenoid loosening were calculated at 10 and 15 years. The mean follow-up was 14 ± 4 years (10-25 years) or until revision.
Results: Revision-free survivorship was 81% at 10 years and 65% at 15 years. Glenoid failure was the main cause of revision: among the 28 revised shoulders (32%), 19 (22%) were revised for glenoid loosening. Heavy labor was a risk factor for glenoid component loosening (P = .029). The curettage technique and flat-back glenoids were risk factors for glenoid revision (P = .035) but presented a longer follow-up than compaction technique and convex-back glenoids. The type of preoperative glenoid erosion (Walch type) and glenohumeral mismatch did not correlate with a higher glenoid loosening rate.
Conclusion: aTSA is a reliable procedure for primary OA at age <60 years, but survivorship declines after 10 years. Glenoid loosening, often combined with cuff deficiency or infection, is the main cause of failure and revision. Glenoid morphology as classified by the modified Walch classification does not influence the revision rate beyond 10 years.
Keywords: Anatomic total shoulder arthroplasty; Walch classification; glenoid implant survivorship; glenoid loosening; long term outcomes; revision; risk factors.
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Keblish's lateral subvastus approach for total knee arthroplasty: A technical note
Keblish's lateral subvastus approach for total knee arthroplasty: A technical note
Keblish’s lateral subvastus approach for total knee arthroplasty: A technical note
Grégoire Micicoi, Rayan Fairag, Styliani Stergiadou, Régis Bernard de Dompsure, Nicolas Bronsard, Axel Machado, Matthieu Perras, Jean-François Gonzalez
Keblish’s lateral surgical approach for total knee arthroplasty enables a direct release of the lateral structures in valgus deformities. In recent years, the development of quadriceps-sparing techniques has improved early functional recovery after arthroplasty, which has been well described using a medial approach. The authors present Keblish’s lateral subvastus approach for genu valgum deformities, with key surgical considerations and preliminary outcomes. The novelty of this technique lies in its combination of a lateral subvastus approach with Keblish’s Z-plasty, aiming to optimize quadriceps recovery while ensuring secure knee closure following valgus deformity correction. The Keblish’s lateral subvastus approach provided adequate surgical exposure without any observed complications in this small short follow-up series, allowing for early recovery of active knee extension and satisfactory clinical outcomes. LEVEL OF EVIDENCE: IV.
Purpose: To objectively identify the 100 most influential scientific publications in knee osteotomy and provide an analysis of their main characteristics.
Methods: The Clarivate Analytics Web of Knowledge database was used to obtain data and metrics on knee osteotomy research. The search list was sorted by the number of citations, and articles were included or excluded based on relevance to knee osteotomy. The information extracted for each article included the author’s name, publication year, country of origin, journal name, article type and the level of evidence.
Results: These 100 studies generated a total of 16,246 citations, with an average of 162.5 citations per article. The most-cited article was cited 752 times. The 100 studies included in this analysis were published between 1976 and 2015. Twenty-one different journals published these 100 publications. The majority of the publications were from the United States (n = 30), followed by Germany (n = 17) and Japan (n = 11). The most prevalent study designs were case series (n = 55) and cohort studies (n = 19).
Conclusion: The 100 most influential publications in knee osteotomy were cited a total of 16,246 times. The study designs most used were case series and cohort studies with low-level evidence. This publication serves as a reference to direct orthopaedic practitioners to the 100 most influential studies in knee osteotomy and target future research directions.
Clinical relevance: This analysis of the 100 most influential (or cited) scientific publications in osteotomy around the knee will provide a comprehensive inventory of the most impactful academic contributions to a field that has recently regained interest among medical students, residents, fellows and attending physicians.
Is preoperative 3D planning reliable for predicting postoperative clinical differences in range of motion between two stem designs in reverse shoulder arthroplasty
Is preoperative 3D planning reliable for predicting postoperative clinical differences in range of motion between two stem designs in reverse shoulder arthroplasty
Is preoperative 3D planning reliable for predicting postoperative clinical differences in range of motion between two stem designs in reverse shoulder arthroplasty
Background: We aim to predict a clinical difference in the postoperative range of motion (RoM) between 2 reverse shoulder arthroplasty (RSA) stem designs (Inlay-155° and Onlay-145°) using preoperative planning software. We hypothesized that preoperative 3D planning could anticipate the differences in postoperative clinical RoM between 2 humeral stem designs and by keeping the same glenoid implant.
Methods: Thirty-seven patients (14 men and 23 women, 76 ± 7 years) underwent a BIO-RSA (bony increased offset-RSA) with the use of preoperative planning and an intraoperative 3-dimensional-printed patient-specific guide for glenoid component implantation between January 2014 and September 2019 with a minimum follow-up of 2 years. Two types of humeral implants were used: Inlay with a 155° inclination (Inlay-155°) and Onlay with a 145°inclination (Onlay-145°). Glenoid implants remained unchanged. The postoperative RSA angle (inclination of the area in which the glenoid component of the RSA is implanted) and the lateralization shoulder angle were measured to confirm the good positioning of the glenoid implant and the global lateralization on postoperative X-rays. A correlation between simulated and clinical RoM was studied. Simulated and last follow-up active forward flexion (AFE), abduction, and external rotation (ER) were compared between the 2 types of implants.
Results: No significant difference in RSA and lateralization shoulder angle was found between planned and postoperative radiological implants’ position. Clinical RoM at the last follow-up was always significantly different from simulated preoperative RoM. A low-to-moderate but significant correlation existed for AFE, abduction, and ER (r = 0.45, r = 0.47, and r = 0.57, respectively; P < .01). AFE and abduction were systematically underestimated (126° ± 16° and 95° ± 13° simulated vs. 150° ± 24° and 114° ± 13° postoperatively; P < .001), whereas ER was systematically overestimated (50° ± 19° simulated vs. 36° ± 19° postoperatively; P < .001). Simulated abduction and ER highlighted a significant difference between Inlay-155° and Onlay-145° (12° ± 2°, P = .01, and 23° ± 3°, P < .001), and this was also retrieved clinically at the last follow-up (23° ± 2°, P = .02, and 22° ± 2°, P < .001).
Conclusions: This study is the first to evaluate the clinical relevance of predicted RoM for RSA preoperative planning. Motion that involves the scapulothoracic joint (AFE and abduction) is underestimated, while ER is overestimated. However, preoperative planning provides clinically relevant RoM prediction with a significant correlation between both and brings reliable data when comparing 2 different types of humeral implants (Inlay-155° and Onlay-145°) for abduction and ER. Thus, RoM simulation is a valuable tool to optimize implant selection and choose RSA implants to reach the optimal RoM.
Keywords: Reverse shoulder arthroplasty; clinical range of motion; inlay; modelization; onlay; prediction; preoperative planning.
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Total shoulder arthroplasty for primary glenohumeral osteoarthritis: does posterior humeral subluxation persist after correction of the glenoid version at 5 years minimum?
Total shoulder arthroplasty for primary glenohumeral osteoarthritis: does posterior humeral subluxation persist after correction of the glenoid version at 5 years minimum?
Total shoulder arthroplasty for primary glenohumeral osteoarthritis: does posterior humeral subluxation persist after correction of the glenoid version at 5 years minimum?
Marc-Olivier Gauci, Romain Ceccarelli,Vincent Lavoue, Mikael Chelli, Olivier A J van der Meijden, Jean-François Gonzalez, Pascal Boileau
Background: Primary glenohumeral osteoarthritis is associated with both excessive posterior humeral subluxation (PHS) and excessive glenoid retroversion in 40% of cases. These morphometric abnormalities are a particular issue because they may be responsible for a deterioration in long-term clinical and radiologic outcomes. The aim of this study was to perform a computed tomographic (CT) analysis of patients who underwent total shoulder arthroplasty (TSA) for primary osteoarthritis (OA) with B2-, B3-, or C-type glenoids in whom an attempt was made to correct for excessive glenoid retroversion and excessive posterior humeral subluxation intraoperatively.
Material: We performed a retrospective, single-center study including 62 TSA patients with a preoperative PHS of the glenohumeral joint (31 men, 31 women, 70 ± 9 years) between January 2000 and January 2014. Glenoids were classified as B2 (32 cases), B3 (13 cases), or C (17 cases). Glenoid retroversion was corrected by anterior asymmetric reaming. Patients were reviewed for clinical and CT scan assessment with a mean follow-up of 8.3 years (minimum 5 years). At final follow-up, the CT images were reconstructed in the scapular plane. A PHS index >65% defined persistence.
Results: The revision-free rate was estimated at 93%. Correlation between PHS and retroversion was moderate preoperatively (ρ = 0.58) and strong at final follow-up (ρ = 0.73). Postoperative CT scans on average showed a surgical correction of PHS compared to preoperatively (79% vs. 65% respectively, P < .05) and retroversion (20° vs. 10° respectively, P < .05). At final follow-up, 25 of 62 patients had a persistence in the 2-dimensional (2D) model and 41 of 62 in the corrected 2D model. Persistence of PHS had no influence on clinical outcomes but did demonstrate a significantly higher glenoid loosening rate (20% vs. 59%, P < .05).
Conclusion: Correlation between PHS and retroversion was moderate preoperatively and strengthened at long-term follow-up. Anterior asymmetric reaming allowed for a surgical improvement of both PHS and retroversion, but it was not sufficient to maintain a correction over time. Glenoid loosening was more frequent in case of PHS persistence but seemingly without clinical relevance.
Keywords: Anatomic total shoulder arthroplasty; B glenoid; biconcave glenoid; osteoarthritis; persistence; posterior humeral subluxation.
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Reliability of Angle Measurements Based on the Epiphyseal Scar for Knee Osteotomy: An International Multicenter Radiographic Study
Reliability of Angle Measurements Based on the Epiphyseal Scar for Knee Osteotomy: An International Multicenter Radiographic Study
Reliability of Angle Measurements Based on the Epiphyseal Scar for Knee Osteotomy: An International Multicenter Radiographic Study
Philipp Schippers, Matthieu Peras, Bernard de Geofroy, Philipp Drees, Erol Gercek, Marius Junker, Lolita Micicoi, Jean-François Gonzalez, Grégoire Micicoi
Background: The proximal tibial epiphyseal inclination can be used as a prognostic factor for good results after knee osteotomy and measured using the tibial bone varus angle (TBVA). This angle depends on the visibility of the epiphyseal plate, which has shown poor reproducibility when measured on standard radiographs by conventional methods.
Purpose: To evaluate the measurement reliability of the TBVA and other angles based on the epiphyseal scar using a digital image display.
Study design: Cohort study (diagnosis); Level of evidence, 3.
Methods: A total of 100 whole-leg radiographs were analyzed twice by 3 orthopaedic surgeons from 2 countries in a blinded and randomized manner. Observers measured the hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle, and TBVA. The growth plate-tibial plateau (GPTP) angle, defined as the angle between the epiphyseal scar and tibial plateau, was measured; this angle has not yet been described for osteotomy. In addition, a modified version of the TBVA (mTBVA), defined as that between the epiphyseal scar, its center, and the center of the talus, was measured. The Ahlbäck score for osteoarthritis and a 3-grade score for epiphyseal scar visibility were also determined. The reliability of the angle measurements and scoring was evaluated using the Fleiss kappa and intraclass correlation coefficient (ICC).
Results: The scores for epiphyseal scar visibility showed fair interobserver (Fleiss kappa correlation coefficient [κ] = 0.29-0.35) and strong intraobserver (Fleiss κ = 0.62-0.69) reliability. TBVA, GPTP angle, and mTBVA measurements showed good interobserver reliability (ICC, 0.76-0.77), while the GPTP angle achieved excellent intraobserver reliability (ICC, >0.9).
Conclusion: Using digital image display, angles that depend on the epiphyseal scar-such as TBVA, GPTP angle, and mTBVA-can achieve acceptable measurement reliability despite the low agreement on the visibility of the epiphyseal scar.
Keywords: angle; growth plate–tibial plateau; knee osteotomy; measurement reliability; modified tibial bone varus angle; planning; tibial bone varus angle.
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Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Descriptive Study With Minimum 10-Year Follow-up
Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Descriptive Study With Minimum 10-Year Follow-up
Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Descriptive Study With Minimum 10-Year Follow-up
Grégoire Micicoi, Rayan Fairag,Axel Machado, Adil Douiri, Nicolas Bronsard, Justin Ernat, Jean-François Gonzalez
Background: Anterior cruciate ligament (ACL) reconstruction is increasingly being performed in patients >50 years old; however, the long-term outcomes are unclear.
Purpose: To analyze the functional results, osteoarthritic progression, reoperation rate, and failure rate at minimum 10-year follow-up in patients >50 years old who have undergone primary ACL reconstruction.
Study design: Case series; Level of evidence, 4.
Methods: Included in this study were patients >50 years old who underwent primary ACL reconstruction and had at least 10 years of follow-up data. All patients had instability with limitation of their activities, indicating the necessity of surgical intervention. Patients with revision surgeries, ACL repairs, and nonoperative treatment were excluded. Failure was defined as the presence of revision, high-grade Lachman, positive pivot shift (2+), or subjective instability. The Knee injury and Osteoarthritis Outcome Score (KOOS), subjective and objective functional scores, and osteoarthritic progression were analyzed at final follow-up.
Results: A total of 38 patients were identified. The mean age at surgery was 56.8 ± 5.7 years (range, 50.6-70 years). The mean clinical follow-up was 16.2 ± 4.3 years (range, 10.9-23.3 years). The failure rate was 10.5% (4/38): 1 of the 4 patients had a recurrence of instability at 13 years postoperatively and underwent revision with a modified Lemaire extra-articular tenodesis, 1 patient had a positive pivot shift (2+) without subjective instability, and 2 patients underwent total knee arthroplasty. The overall KOOS was 74.2 ± 22.2, and 91.4% of patients were satisfied or very satisfied with the results of the procedure. Radiographic osteoarthritis was identified in 88.5% of patients at final follow-up; however, there was no statistical significance on clinical outcomes (P > .05). Concomitant partial medial meniscectomy (P < .01) and meniscal repair (P < .01) were associated with the presence of Ahlbäck grade 3 or 4 osteoarthritic manifestations.
Conclusion: In patients over the age of 50 years who underwent primary ACL reconstruction, there was a low long-term failure rate and a high level of patient satisfaction, despite osteoarthritic progression in 88.5% of cases. Concomitant meniscal procedures were associated with more severe osteoarthritic progression.
Keywords: 50 years old; ACL; failures; functional outcomes; long-term; osteoarthritis.
Avulsions of the retrospinal surface are rare injuries resulting from high-energy trauma. Displacement of this fracture frequently indicates a surgical treatment to restore posterior cruciate ligament function. Several approaches have been proposed in the literature, either open or arthroscopic, which can be tricky due to the fracture’s proximity to the popliteal vascular-nervous elements. Badet’s open approach is a medial trans-gastrocnemius approach, providing a direct access to the retro-spinal surface for osteosynthesis. In this technique, an L-shaped incision is made along precise skin lines, followed by discision of the muscle fibers. The capsule is then approached, allowing a view of the retro-spinal surface protected from the popliteal vasculo-nervous elements by the muscular lateral lip of the gastrocnemius. A reduction followed by screw osteosynthesis is usually performed, allowing early mobilization of the patient. In this technical note, we describe the Badet approach supporting by video and case series. LEVEL OF EVIDENCE: IV.
Background: Osteoporosis (OP) is a pathology characterized by bone fragility affecting 30% of postmenopausal women, mainly due to estrogen deprivation and increased oxidative stress. An autophagy involvement is suspected in OP pathogenesis but a definitive proof in humans remains to be obtained.
Methods: Postmenopausal women hospitalized for femoral neck fracture (OP group) or total hip replacement (Control group) were enrolled using very strict exclusion criteria. Western blot was used to analyze autophagy level.
Results: The protein expression level of the autophagosome marker LC3-II was significantly decreased in bone of OP patients relative to the control group. In addition, the protein expression of the hormonally upregulated neu-associated kinase (HUNK), which is upregulated by female hormones and promotes autophagy, was also significantly reduced in bone of the OP group.
Conclusions: These results demonstrate for the first time that postmenopausal OP patients have a deficit in bone autophagy level and suggest that HUNK could be the factor linking estrogen loss and autophagy decline.
Total blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approach
Total blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approach
Total blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approach
Grégoire Micicoi, Bernard de Geofroy, Julien Chamoux, Ammar Ghabi, Marc-Olivier Gauci, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez
Introduction: Femoral neck fractures constitute a public health problem due to significant associated morbidity and mortality amongst the ageing population. Perioperative blood loss can increase this morbidity. Blood loss, as well as the influence that the surgical approach exerts on it, remains poorly evaluated. We therefore conducted a retrospective comparative study in order to: (1) compare total blood loss depending on whether the patients were operated on using an anterior or posterior approach, (2) compare the transfusion rates, operating times and hospital stays between these two groups and, (3) analyze dislocation rates.
Hypothesis: Total blood loss is greater from an anterior approach following a hip hemiarthroplasty for femoral neck fracture, compared to the posterior approach.
Material and methods: This retrospective single-center comparative study included 137 patients operated on by hip hemiarthroplasty between December 2020 and June 2021, and seven patients were excluded. One hundred and thirty patients were analyzed: 69 (53.1%) had been operated on via the anterior Hueter approach (AA) and 61 (46.9%) via the posterior Moore approach (PA). The analysis of total blood loss was based on the OSTHEO formula to collect perioperative « hidden » blood loss. The risk of early dislocation (less than 6 months) was also analyzed.
Results: Total blood loss was similar between the two groups, AA: 1626±506mL versus PA: 1746±692mL (p=0.27). The transfusion rates were also similar between the two groups, AA: 23.2% versus PA: 31.1% (p=0.31) as well as the duration of hospitalization, AA: 8.5±3.2 versus PA: 8.2±3.3 days (p=0.54). The operating time was shorter in the PA group (Δ=10.3±14.1minutes [p<0.001]) with a greater risk of early dislocation when the patient was operated on by PA with AA: 9.8% versus PA: 1.4% (p=0.03).
Conclusion: This study does not demonstrate any influence of the approach (anterior or posterior) on total blood loss. Transfusion rates and length of hospitalization were similar between the groups with a slightly shorter operating time but a greater risk of early dislocations after posterior hemiarthroplasty in a population at high anesthesia-related risk.
Level of proof: III, comparative study of continuous series.
Ultrasound-Guided Iliopsoas Tenotomy for Iliopsoas Tendon Impingement: Surgical Technique in Cadaveric Models
Ultrasound-Guided Iliopsoas Tenotomy for Iliopsoas Tendon Impingement: Surgical Technique in Cadaveric Models
Ultrasound-Guided Iliopsoas Tenotomy for Iliopsoas Tendon Impingement: Surgical Technique in Cadaveric Models
Pablo Froidefond, Rayan Fairag, Alexandre Rudel, Peter N Chalmers, Nicolas Bronsard, Régis Bernard de Dompsure, Jean-François Gonzalez, Grégoire Micicoi
Iliopsoas tendon impingement after total hip replacement has been reported with an incidence of up to 8.3%. Iliopsoas tendon impingement has also been observed in young active patients engaged in extreme sports. In such cases, surgical iliopsoas tendon release or tenotomy may be considered to improve anterior hip pain and function. Currently, iliopsoas tenotomy is performed either in an open manner or arthroscopically. This article describes a surgical technique using percutaneous ultrasound-guided iliopsoas tenotomy in cadaveric models. We perform the release at the acetabulum because it is safe and provides good sonographic visualization. This study describes the effectiveness of percutaneous iliopsoas tendon tenotomy under ultrasound guidance. However, clinical studies are warranted to confirm these findings. This minimally invasive procedure opens opportunities for clinical applications, comparing outcomes with those of standard approaches and conducting cost analyses. It may offer a cost-effective outpatient clinic option with local anesthesia, avoiding operating room expenses.
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Ultrasound-Guided Percutaneous Fasciotomies for Patients With Chronic Exertional Compartment Syndrome
Ultrasound-Guided Percutaneous Fasciotomies for Patients With Chronic Exertional Compartment Syndrome
Ultrasound-Guided Percutaneous Fasciotomies for Patients With Chronic Exertional Compartment Syndrome
Axel Machado, Tristan Fauchille, Rayan Fairag, Jonathan Cornacchini, Nicolas Bronsard, Nicolas Ciais, Jean-François Gonzalez,Alexandre Rudel, Grégoire Micicoi
Chronic exertional compartment syndrome is a well-described potential cause of leg pain in high-level athletes and soldiers. Surgical treatment of chronic exertional compartment syndrome usually involves fasciotomy, with a reported rate of complications of up to 16%, including failure of complete compartmental release and delayed return to normal daily activity, which can take up to 6 to 12 weeks. The use of a minimally invasive approach under ultrasound guidance seems to improve clinical outcomes in young active patients. We recommend the following steps for effective execution of ultrasound-guided percutaneous fasciotomy: (1) location of the compartmental fascia and identification of the superficial peroneal nerve, (2) skin incision, (3) insertion of a hook under the compartmental fascia, and (4) sectioning of the fascia.
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Restoring the Preoperative Phenotype According to the Coronal Plane Alignment of the Knee Classification After Total Knee Arthroplasty Leads to Better Functional Results
Restoring the Preoperative Phenotype According to the Coronal Plane Alignment of the Knee Classification After Total Knee Arthroplasty Leads to Better Functional Results
Restoring the Preoperative Phenotype According to the Coronal Plane Alignment of the Knee Classification After Total Knee Arthroplasty Leads to Better Functional Results
Background: Mechanical alignment after total knee arthroplasty (TKA) is still widely used in the surgical community, but the alignment finally obtained by conventional techniques remains uncertain. The recent Coronal Plane Alignment of the Knee (CPAK) classification distinguishes 9 knee phenotypes according to constitutional alignment and joint line obliquity (JLO). The aim of this study was to assess the phenotypes of osteoarthritic patients before and after TKA using mechanical alignment and to analyze the influence of CPAK restoration on functional outcomes.
Methods: This retrospective multicenter study included 178 TKAs with a minimum follow-up of 2 years. Patients were operated on using a conventional technique with the goal of neutral mechanical alignment. The CPAK grade (1 to 9), considering the arithmetic Hip-Knee-Ankle angle (aHKA) and the JLO, was determined before and after TKA. Functional results were assessed using the following patient-reported outcome measures: Knee Injury and Osteoarthritis Outcome Score, the Simple Knee Value, and the Forgotten Joint Score.
Results: A true neutral mechanical alignment was obtained in only 37.1%. Isolated restoration of JLO was found in 31.4%, and isolated restoration of the aHKA in 44.9%. Exact restoration of the CPAK phenotype was found in 14.6%. Restoration of the CPAK grade was associated with an improvement in the « daily living »: 79.2 ± 5.3 versus 62.5 ± 2.3 (R2 = 0.05, P < .05) and « Quality of life » Knee Injury and Osteoarthritis Outcome Score subscales: 73.8 ± 5.0 versus 62.9 ± 2.2 (R2 = 0.02, P < .05).
Conclusions: This study shows that few neutral mechanical alignments are finally obtained after TKA by conventional technique. A major number of patients present a postoperative modification of their constitutional phenotype. Functional results at 2 years of follow-up appear to be improved by the restoration of the CPAK phenotype, JLO, and aHKA.
Level of clinical art evidence: III, Retrospective Cohort Study.
Background: Acute compartment syndrome (ACS) of the lower limbs is a function-threatening event usually managed by extended dermofasciotomy. Closure of the skin may be delayed, creating a risk of complications when there is an underlying fracture. Early treatment at the pre-ACS stage might allow isolated fasciotomy with no skin incision. The primary objective of this study was to compare intracompartmental pressure (ICP) changes after fasciotomy and after dermofasciotomy. The secondary objectives were to evaluate potential associations linking the starting ICP to achievement of an ICP below the physiological cut-off of 10mm Hg and to determine whether the ICP changes after fasciotomy and dermofasciotomy varied across muscle compartments.
Hypothesis: Fasciotomy with no skin incision may not provide a sufficient ICP decrease, depending on the initial ICP value.
Material and methods: A previously validated model of cadaver ACS of the lower limbs was used. Saline was injected gradually to raise the ICP to>15mmHg (ICP15), >30mmHg (ICP30), and >50mmHg (ICP50). We studied 70 leg compartments (anterior, lateral, and superficial posterior) in 13 cadavers (mean age, 89.1±4.6years). ICP was monitored continuously. Percutaneous, minimally invasive fasciotomy consisting in one to three 1-cm incisions was performed in each compartment. ICP was measured before and after fasciotomy then after subsequent skin incision. The objective was to decrease the ICP below 10mmHg after fasciotomy or dermofasciotomy.
Results: Overall, mean ICP was 37.8±19.1mmHg after the injection of 184.0±133.01mL of saline. In the ICP15 group, the mean ICP of 16.1mmHg fell to 1.4mmHg after fasciotomy (ΔF=14.7) and 0.3mmHg after dermofasciotomy (ΔDF=1.1). Corresponding values in the ICP30 group were 33.9mmHg, 4.7mmHg (ΔF=29.2), and 1.2mmHg (ΔDF=3.5); and in the ICP50 group, 63.7mmHg, 17.0mmHg (ΔF=46.7), and 1.2mmHg (ΔDF=15.8). Thus, in the group with initial pressures >50mmHg, the ICP decrease was greater after both procedures, but fasciotomy alone nonetheless failed to achieve physiological values (<10mmHg). The pressure changes were not significantly associated with the compartment involved (anterior, lateral, or superficial posterior) (p<0.05).
Conclusion: Under the conditions of this study, higher baseline ICPs were associated with larger ICP drops after fasciotomy and dermofasciotomy. Nevertheless, when the baseline ICP exceeded 50mmHg, fasciotomy alone failed to decrease the ICP below 10mmHg. Adding a skin incision achieved this goal.
Can hip function be assessed with self-report questionnaires? Feasibility study of a French self-report version of the Harris Hip and Merle d'Aubigné scores
Can hip function be assessed with self-report questionnaires? Feasibility study of a French self-report version of the Harris Hip and Merle d'Aubigné scores
Can hip function be assessed with self-report questionnaires? Feasibility study of a French self-report version of the Harris Hip and Merle d’Aubigné scores
Bernard de Geofroy, Ammar Ghabi, Joseph Attas, Lolita Micicoi, Michael Lopez, Régis Bernard de Dompsure, Jean-François Gonzalez, Grégoire Micicoi
Introduction: The Harris Hip Score (HHS) and the Merle D’Aubigné Postel (MDP) score both provide an objective and subjective evaluation of hip function. These scores are collected during the follow-up of patients who have a hip disease. The objectives of this prospective study were (1) to analyze the differences between the two new French self-report versions of the HHS and MDP, and the traditional surgeon-assessed HHS and MDP; (2) to analyze the correlation between the self-report HHS and MDP and the surgeon-assessed HHS and MDP; (3) to analyze the floor and ceiling effects of the two self-report scores and the reliability of these self-report scores in operated and non-operated patients.
Hypothesis: The French self-report HHS and MDP are sufficiently reliable to accurately estimate the patient’s objective and subjective outcomes compared to the clinical examination done by a surgeon.
Methods: A prospective multicenter study was done with patients who had a hip disease. Two self-report questionnaires were completed by the patient, independently of the clinical examination done by the surgeon. The questionnaires were in French and consisted solely of checkboxes, with sample photos that corresponded to the various range of motion items in the HHS and MDP. The agreement between the self-report scores and the surgeon-assessed scores were evaluated using the intraclass correlation coefficient (ICC). Differences in the mean values were evaluated with a paired t test.
Results: The analysis involved 89 patients. The self-report HHS was 2.7±3.7 points (/100) lower than the surgeon-assessed HHS, but this difference was not statistically significant (p=0.34). The self-report MDP was significantly less by 1.2±2.9 points (/18) than the surgeon-assessed MDP (p=0.01). The agreement between the self-report HSS and the surgeon-assessed HSS was excellent (ICC=0.86) as was the one between the self-report MDP and the surgeon-assessed MDP (ICC=0.75). There was a strong positive correlation between the surgeon-assessed and self-report HHS in operated patients (ICC= 0.84; R=0.75; p<0.001) and in non-operated patients (ICC=0.96; R=0.89; p<0.001). This positive correlation was also found between the surgeon-assessed and self-report MDP for operated patients (ICC=0.73; R=0.62; p<0.001) and non-operated patients (ICC=0.79; R=0.64; p<0.001). A ceiling effect (maximum of 100 points) was found in 22% of patients (20/89) for the self-report HHS and in 34% of patients (30/89) for the self-report MDP (maximum of 18 points). No floor effect was observed for either questionnaire.
Conclusion: The French version of the HHS self-report questionnaire is an excellent overall estimator of the HHS score for patients with hip osteoarthritis or fracture, whether operated or not. The addition of the MDP, whose self-report version is less accurate, is also a reliable tool. These self-report questionnaires, when validated on a larger scale, will be useful for the long-term follow-up of patients undergoing hip arthroplasty.
Level of evidence: III; prospective diagnostic study.
Validation of the shoulder range of motion software for measurement of shoulder ranges of motion in consultation: coupling a red/green/blue-depth video camera to artificial intelligence
Validation of the shoulder range of motion software for measurement of shoulder ranges of motion in consultation: coupling a red/green/blue-depth video camera to artificial intelligence
Validation of the shoulder range of motion software for measurement of shoulder ranges of motion in consultation: coupling a red/green/blue-depth video camera to artificial intelligence
Marc-Olivier Gauci, Manuel Olmos, Caroline Cointat, Pierre-Emmanuel Chammas, Manuel Urvoy, Albert Murienne, Nicolas Bronsard, Jean-François Gonzalez
Purpose: Clinical evaluation of the shoulder range of motion (RoM) may vary significantly depending on the surgeon. We aim to validate an automatic shoulder RoM measurement system associating image acquisition by an RGB-D (red/green/blue-depth) video camera to an artificial intelligence (AI) algorithm.
Methods: Thirty healthy volunteers were included. A 3D RGB-D sensor that simultaneously generated a colour image and a depth map was used. Then, an open-access convolutional neural network algorithm that was programmed for shoulder recognition provided a 3D motion measure. Each volunteer adopted a randomized position successively. For each position, two observers made a visual (EyeREF) and goniometric measurement (GonioREF), blind to the automated software which was implemented by an orthopaedic surgeon. We evaluated the inter-tester intra-class correlation (ICC) between observers and the concordance correlation coefficient (CCC) between the three methods.
Results: For manual evaluations EyeREF and GonioREF, ICC remained constantly excellent for the widest motions in the vertical plane (i.e., abduction and flexion). It was very good for ER1 and IR2 and fairly good for adduction, extension, and ER2. Differences between the measurements’ means of EyeREF and shoulder RoM was significant for all motions. Compared to GonioREF, shoulder RoM provided similar results for abduction, adduction, and flexion and EyeREF provided similar results for adduction, ER1, and ER2. The three methods showed an overall good to excellent CCC. The mean bias between the three methods remained under 10° and clinically acceptable.
Conclusion: RGB-D/AI combination is reliable in measuring shoulder RoM in consultation, compared to classic goniometry and visual observation.
Keywords: Artificial intelligence; Automatic clinical assessment; Goniometer comparison; Markerless sensor; Range of motion; Shoulder.
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Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty
Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty
Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty
Lolita Micicoi, Axel Machado, Justin Ernat, Philipp Schippers, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi
Purpose: The alignment obtained after unicompartmental knee arthroplasty (UKA) influences the risk of failure. Kinematic alignment after UKA based on Cartier angle restauration is likely to improve clinical outcomes compared with mechanical alignment. The purpose of this study is to analyze the influence of implant alignment and native knee restoration after UKA using the conventional techniques on clinical outcomes.
Methods: This retrospective study included 144 medial UKA patients from 2015 to 2020. Radiographic measurements were performed pre- and postoperatively. Outliers were defined as follows: Δ Cartier > 3° (difference between the preoperative and postoperative Cartier angle); Δ MPTA (Medial Proximal Tibial angle) and postoperative TCA (Tibial Coronal component Angle) > 3° (difference between the positioning of the tibial implant and the preoperative proximal tibial deformity). The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee score, the Forgotten Joint Score (FJS), and the Subjective Knee Value (SKV) were evaluated. A Student t test or a non-parametric Wilcoxon test was used for non-normal data to compare pre- and postoperative values for functional scores and angular measurements. The correlation of postoperative angles with functional outcomes was assessed by the Spearman’s rank correlation coefficient.
Results: During the inclusion period, 214 patients underwent medial UKA, 71 patients were excluded, and 19 were lost to follow-up leaving 124 patients with 144 knees (20 bilateral UKA) included for analysis with a mean follow-up of 54.7 months ± 22.1 (24-95). The Δ Cartier was significantly correlated with IKS function (R2 = 0.06, p < 0.001) and FJS (R2 = 0.05, p < 0.01) scores. The Δ preoperative MPTA-TCA was significantly correlated (p < 0.001) with KOOS (R2 = 0.38), IKS Knee (R2 = 0.17), IKS function (R2 = 0.34), SKV (R2 = 0.08), and FJS (R2 = 0.37) scores. In subgroup analysis, non-outliers (< 3°) for Δ preoperative MPTA-TCA had better KOOS score (Δ = 23.5, p < 0.001) and IKS Function (Δ = 17.7, p < 0.001) compared to outliers (> 3°) patients.
Conclusion: Functional results after medial UKA can be influenced by implant alignment in the coronal plane with slight clinical improvement when positioning the tibial implant close to the preoperative tibial deformity, rather than by restoring the Cartier angle. This series suggests the interest of a more personalized alignment strategy, but these results will have to be confirmed by other controlled studies.
Introduction: On the 16th of March 2020, in the face of a health emergency declared in France, the government imposed containment measures whose impact on orthopaedic and trauma surgery remains to be demonstrated. The hypothesis of this study was that confinement reduced orthopaedic and trauma surgical activity. The main objective was to assess orthopaedic and trauma surgical activity during confinement and to compare it to the activity outside confinement.
Materials and methods: This was a retrospective, monocentric, observational and comparative study of a continuous cohort of patients included during the confinement period of March 16th to May 11th, 2020. This cohort was retrospectively compared to a group of patients over the same non-confinement period in the previous year, from March 16th to May 11th, 2019. The primary outcome measured was the incidence rate of surgical activity in 2020 versus 2019 over an identical period. The secondary outcome was the analysis of the trauma identified.
Results: The number of patients operated on was significantly reduced during confinement: 194 patients were included in 2020, i.e. an incidence of 57 per 100,000 inhabitants against 772 patients included in 2019, i.e. an incidence of 227 per 100,000 inhabitants; p<0.001. Planned orthopaedic surgery decreased from an incidence rate of 147 in 2019 to 5 in 2020 per 100,000 inhabitants (p<0.001). Trauma surgery decreased from an incidence rate of 80 in 2019 to 50 in 2020 per 100,000 inhabitants (p: NS). We found a significant increase in patients over 65years of age during confinement, 70% compared to 61% in 2019; p=0.04. The rate of femoral neck fractures was significantly increased during confinement, 48.5% compared to 39.3% in 2019; p=0.03. Degenerative surgery was significantly reduced during confinement (p<0.001).
Discussion: This study shows that the surgical activity of orthopaedics and trauma was significantly reduced by confinement, with a difference in incidence of 170 per 100,000 inhabitants, thus confirming the hypothesis of the authors. This decrease is due to both the cessation of planned orthopaedics and the 40% decrease in the number of trauma patients. During confinement, the percentage of patients over the age of 65 with a fracture increased significantly.
Conclusion: Confinement had a significant impact on orthopaedic and trauma surgical activity.
Level of evidence: III; comparative and retrospective.
Purpose: To evaluate the efficacy and safety of embolization of hyperemic synovial tissue for the treatment of persistent pain after total knee arthroplasty (TKA).
Materials and methods: Twelve patients with persistent pain after TKA were enrolled in this prospective, single-center pilot study. Genicular artery embolization (GAE) was performed using 75-μm spherical particles. The patients were assessed using a 100-point Visual Analog Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and 3 and 6 months thereafter. Adverse events were recorded at all time points.
Results: A mean of 1.8 ± 0.8 abnormal hyperemic genicular arteries were identified and embolized, with a median volume of diluted embolic material of 4.3 mL in all 12 (100%) patients. The mean VAS score on walking improved from 73 ± 16 at baseline to 38 ± 35 at the 6-month follow-up (P < .05). The mean KOOS pain score improved from 43.6 ± 15.5 at baseline to 64.6 ± 27.1 at the 6-month follow-up (P < .05). At the 6-month follow-up, 55% and 73% of the patients attained a minimal clinically important change in pain and quality of life, respectively. Self-limited skin discoloration occurred in 5 (42%) patients. The VAS score increased by more than 20 immediately after embolization in 4 (30%) patients, who required analgesic treatment for 1 week.
Conclusions: GAE is a safe method of treating persistent pain after TKA that demonstrates potential efficacy at 12 months.
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.
Access provided by Nice University Hospital, Hospital of Cimiez, documentation service
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Glomus tumor of the scapular neck with axillary nerve compression at the shoulder. A case report
Glomus tumor of the scapular neck with axillary nerve compression at the shoulder. A case report
Background: Glomus tumors, also known as benign acral tumors are extremely rare. Previous glomus tumors from other regions of the body have been linked to neurological compression symptoms, however axillary compression at the scapular neck has never been described.
Case presentation: Here, we report a case of axillary nerve compression in a 47-year-old man, secondary to a glomus tumor of the neck of the right scapula, initially misdiagnosed with biceps tenodesis performed and no pain improvement. The magnetic resonance imaging demonstrated a well-contoured, 12 mm tumefaction at the inferior pole of the scapular neck T2-hyperintense and T1-isointense and interpreted as a neuroma. An axillary approach allowed the dissection of the axillary nerve, and the tumor was completely removed. The pathological anatomical analysis resulted in a nodular red lesion measuring 14 × 10 mm, delimited and encapsulated with a definitive diagnostic of glomus tumor. The neurologic symptoms and pain disappeared 3 weeks after surgery and the patient reported satisfaction with the surgical procedure. After 3 months, the results remain stable with a complete resolution of the symptoms.
Conclusions: In cases of unexplained and atypical pain in the axillary area, and to avoid potential misdiagnoses and inappropriate treatments, an in-depth exploration for a compressive tumor should be performed as a differential diagnosis.
Validation of the shoulder range of motion software for measurement of shoulder ranges of motion in consultation: coupling a red/green/blue-depth video camera to artificial intelligence
Validation of the shoulder range of motion software for measurement of shoulder ranges of motion in consultation: coupling a red/green/blue-depth video camera to artificial intelligence
Purpose: Clinical evaluation of the shoulder range of motion (RoM) may vary significantly depending on the surgeon. We aim to validate an automatic shoulder RoM measurement system associating image acquisition by an RGB-D (red/green/blue-depth) video camera to an artificial intelligence (AI) algorithm.
Methods: Thirty healthy volunteers were included. A 3D RGB-D sensor that simultaneously generated a colour image and a depth map was used. Then, an open-access convolutional neural network algorithm that was programmed for shoulder recognition provided a 3D motion measure. Each volunteer adopted a randomized position successively. For each position, two observers made a visual (EyeREF) and goniometric measurement (GonioREF), blind to the automated software which was implemented by an orthopaedic surgeon. We evaluated the inter-tester intra-class correlation (ICC) between observers and the concordance correlation coefficient (CCC) between the three methods.
Results: For manual evaluations EyeREF and GonioREF, ICC remained constantly excellent for the widest motions in the vertical plane (i.e., abduction and flexion). It was very good for ER1 and IR2 and fairly good for adduction, extension, and ER2. Differences between the measurements’ means of EyeREF and shoulder RoM was significant for all motions. Compared to GonioREF, shoulder RoM provided similar results for abduction, adduction, and flexion and EyeREF provided similar results for adduction, ER1, and ER2. The three methods showed an overall good to excellent CCC. The mean bias between the three methods remained under 10° and clinically acceptable.
Conclusion: RGB-D/AI combination is reliable in measuring shoulder RoM in consultation, compared to classic goniometry and visual observation.
Keywords: Artificial intelligence; Automatic clinical assessment; Goniometer comparison; Markerless sensor; Range of motion; Shoulder.
Background: Few studies have investigated postoperative tendon integrity after reoperation for failed rotator cuff repair. The purpose of this study was to evaluate the anatomic and clinical outcomes of arthroscopic revision rotator cuff repair (AR-RCR) and identify the risk factors related to re-retear.
Methods: Sixty-nine consecutive patients (mean age, 55 years) with primary failed open (38%) or arthroscopic (62%) cuff repairs underwent AR-RCR and were reviewed regarding clinical examination findings and imaging studies. Patients with massive cuff tears and upward humeral migration (acromiohumeral distance < 6 mm) or glenohumeral osteoarthritis were excluded. Revision repair was performed by a single, experienced shoulder surgeon. Complete footprint coverage was achieved in all cases using a single-row (70%), double-row (19%), or side-to-side (11%) technique. The primary outcome measure was tendon healing assessed with magnetic resonance imaging (57 cases) or computed tomography arthrogram (12 cases) performed at minimum 1-year follow-up. Secondary outcome measures included functional outcome scores, subjective results, and complications. The mean follow-up period was 43 months (range, 12-136 months).
Results: The cuff tendons did not heal to the tuberosity in 36% of the shoulders (25 of 69) following revision cuff surgery. Absence of tendon healing was associated with poorer shoulder function (average Constant score, 69 ± 20 vs. 54 ± 18; P = .003) and a decreased Subjective Shoulder Value (72% vs. 54%, P = .002). Factors that were negatively associated with tendon healing were age ≥ 55 years (odds ratio [OR], 4.5 [95% confidence interval, 1.6-12.5]; P = .02), tendon retraction of stage 2 or higher (OR, 4.4 [95% confidence interval, 1.4-14.3]; P = .01), and fatty infiltration index > 2 (OR, 10.2; P < .0001). No differences in retear rates were found between single-row and double-row cases. In 36 shoulders, tissue samples were harvested and submitted for bacteriologic culture analysis; 13 (36%) showed positive findings for infection (Cutibacterium acnes in 12 of 13) and associated antibiotic treatment was given. Overall, 25% of patients had unsatisfactory clinical results and 22% were disappointed or dissatisfied. At last follow-up, 4 patients (5.7%) underwent reoperations, with a second AR-RCR in 1 and conversion to reverse shoulder arthroplasty in 3.
Conclusion: Despite careful patient selection and intraoperative complete footprint coverage, in this study the tendons did not heal to bone in 36% of cases after revision cuff surgery. The absence of tendon healing is associated with poorer clinical and subjective results. Patients aged ≥ 55 years and patients with larger tears (stage 2 or higher) and/or muscle fatty infiltration (fatty infiltration index > 2) have significantly lower rates of healing. Surgeons should be aware that structurally failed cuff repair may also be associated with low-grade infection.
Background: Glomus tumors, also known as benign acral tumors are extremely rare. Previous glomus tumors from other regions of the body have been linked to neurological compression symptoms, however axillary compression at the scapular neck has never been described.
Case presentation: Here, we report a case of axillary nerve compression in a 47-year-old man, secondary to a glomus tumor of the neck of the right scapula, initially misdiagnosed with biceps tenodesis performed and no pain improvement. The magnetic resonance imaging demonstrated a well-contoured, 12 mm tumefaction at the inferior pole of the scapular neck T2-hyperintense and T1-isointense and interpreted as a neuroma. An axillary approach allowed the dissection of the axillary nerve, and the tumor was completely removed. The pathological anatomical analysis resulted in a nodular red lesion measuring 14 × 10 mm, delimited and encapsulated with a definitive diagnostic of glomus tumor. The neurologic symptoms and pain disappeared 3 weeks after surgery and the patient reported satisfaction with the surgical procedure. After 3 months, the results remain stable with a complete resolution of the symptoms.
Conclusions: In cases of unexplained and atypical pain in the axillary area, and to avoid potential misdiagnoses and inappropriate treatments, an in-depth exploration for a compressive tumor should be performed as a differential diagnosis.
Introduction: On the 16th of March 2020, in the face of a health emergency declared in France, the government imposed containment measures whose impact on orthopaedic and trauma surgery remains to be demonstrated. The hypothesis of this study was that confinement reduced orthopaedic and trauma surgical activity. The main objective was to assess orthopaedic and trauma surgical activity during confinement and to compare it to the activity outside confinement.
Materials and methods: This was a retrospective, monocentric, observational and comparative study of a continuous cohort of patients included during the confinement period of March 16th to May 11th, 2020. This cohort was retrospectively compared to a group of patients over the same non-confinement period in the previous year, from March 16th to May 11th, 2019. The primary outcome measured was the incidence rate of surgical activity in 2020 versus 2019 over an identical period. The secondary outcome was the analysis of the trauma identified.
Results: The number of patients operated on was significantly reduced during confinement: 194 patients were included in 2020, i.e. an incidence of 57 per 100,000 inhabitants against 772 patients included in 2019, i.e. an incidence of 227 per 100,000 inhabitants; p<0.001. Planned orthopaedic surgery decreased from an incidence rate of 147 in 2019 to 5 in 2020 per 100,000 inhabitants (p<0.001). Trauma surgery decreased from an incidence rate of 80 in 2019 to 50 in 2020 per 100,000 inhabitants (p: NS). We found a significant increase in patients over 65years of age during confinement, 70% compared to 61% in 2019; p=0.04. The rate of femoral neck fractures was significantly increased during confinement, 48.5% compared to 39.3% in 2019; p=0.03. Degenerative surgery was significantly reduced during confinement (p<0.001).
Discussion: This study shows that the surgical activity of orthopaedics and trauma was significantly reduced by confinement, with a difference in incidence of 170 per 100,000 inhabitants, thus confirming the hypothesis of the authors. This decrease is due to both the cessation of planned orthopaedics and the 40% decrease in the number of trauma patients. During confinement, the percentage of patients over the age of 65 with a fracture increased significantly.
Conclusion: Confinement had a significant impact on orthopaedic and trauma surgical activity.
Level of evidence: III; comparative and retrospective.
Introduction: In patients aged over-50 years, although data are sparse, results of anterior cruciate ligament (ACL) surgery are good if selection is correctly performed. However, non-operative treatment is usually proposed for this age group, as patients generally prefer just to scale down their sports activities. Non-operative results are acceptable, but with a high risk of residual instability, secondary lesions and lifestyle alteration. The main aim of the present study was to compare results between surgical versus non-surgical treatment of ACL tear in over-50 year-olds. Secondary objectives comprised assessing prognostic factors for poor functional outcome, and comparing the 2 groups epidemiologically to identify clinical decision-making factors. The study hypothesis was that results are comparable between operative and non-operative treatment of ACL tear.
Material and method: Three hundred twenty patients were followed up prospectively: 92 non-surgical (NS group) and 288 surgical (S group). Classical epidemiological data were collected. Clinical laxity, differential laximetry, KOOS, IKDC, Tegner and ACL-RSI scores and radiologic assessment were collected pre- and postoperatively, as were intraoperative data. Early and late complications were collected.
Results: All patients were followed up. Patients were principally female, and were older, less athletic, with more stable knee and less severe functional impact in the NS group. Functional scores improved in both groups, and especially in group S, where sports scores were also better. In the NS group, laximetry at follow-up correlated with preoperative marked pivot-shift (p=0.024). Severe differential laxity was predictive of poor IKDC score (p=0.06). In the S group, laximetry at follow-up correlated with preoperative explosive pivot-shift (p<0.001), lateral meniscal lesion (p=0.007), use of hamstring tendon (p=0.007), and non-operated early complications (p=0.004). Factors for poor global KOOS score in group S comprised female gender (p<0.001), high BMI (p<0.001) and skiing (p=0.038). Factors for poor Tegner scores comprised skiing or team sport (p<0.05), isolated moderate medial osteoarthritis (p=0.01), and non-operated early complications (p=0.022). Factors for poor IKDC score comprised female gender (p=0.064), and non-operated early complications (p=0.019). Complications did not differ between groups.
Discussion/conclusion: Results were satisfactory in both groups, with significant improvement in functional scores, but were better in group S. For NS patients, pivot sport was barely feasible and sports activity scores decreased. In case of severe laxity at diagnosis, surgical treatment should be proposed.
Level of evidence: III; non-randomized prospective comparative series.
Background: Prosthetic joint infections (PJI) are one of the most serious complication of arthroplasty. The management of PJI needs a multidisciplinary collaboration between orthopaedic surgeon, infectious disease specialist and microbiologist. In France, the management of PJI is organized around reference centres (CRIOACs). Our main objective was to perform an audit through a questionnaire survey based on clinical cases, to evaluate how French physicians manage PJI. Eligible participants were all physicians involved in care of patients presenting a PJI. Physicians could answer individually, or collectively during a multidisciplinary team meeting dedicated to PJI. The survey consisted as three questionnaires organized in a total of six clinical cases.
Results: Answers from the CRIOACs to the three questionnaires were 92, 77, and 53%. Between 32 and 39% of respondents did not administer antibiotic prophylaxis despite positive S. aureus pre-operative documentation. One-stage exchange strategy was widely preferred in all clinical cases, with no difference between CRIOACs and other centres. Rifampicin was prescribed for S. aureus PJI, in a situation with (90-92%) or without any prosthesis (70%). There was no consensus for the total antibiotic regimen duration, with prescriptions from six to 12 weeks for a majority of respondents.
Conclusions: Surgical strategy for the management of PJI was homogenous with a preference for a one-stage exchange strategy. Medical management was more heterogenous, which reflects the heterogeneity of those infections and difficulties to perform studies with strong conclusions.
Female gender and medial meniscal lesions are associated with increased pain and symptoms following anterior cruciate ligament reconstruction in patients aged over 50 years
Female gender and medial meniscal lesions are associated with increased pain and symptoms following anterior cruciate ligament reconstruction in patients aged over 50 years
Purpose: Several studies report satisfactory clinical outcomes following ACLR in older patients, but none evaluated the effects of meniscal and cartilage lesions. The aim was to evaluate the influence of meniscal and cartilage lesions on outcomes of ACLR in patients aged over 50 years.
Methods: The authors prospectively collected records of 228 patients that underwent primary ACLR, including demographics, time from injury to surgery, whether injuries were work related, and sports level (competitive, recreational, or none). At a minimum follow-up of 6 months, knee injury and osteoarthritis outcome scores (KOOS), International Knee Documentation Committee (IKDC) score and Tegner activity level were recorded, and differential laxity was measured as the side-to-side difference in anterior tibial translation (ATT) using instrumented laximetry devices. Regression analyses were performed to determine associations between outcomes and meniscal and cartilage lesions as well as nine independent variables.
Results: A total of 228 patients aged 54.8 ± 4.3 years at index ACLR were assessed at a follow-up of 14.3 ± 3.8 months. KOOS subcomponents were 85 ± 13 for symptoms, 91 ± 10 for pain, 75 ± 18 for daily activities, 76 ± 18 for sport, and 88 ± 12 for quality of life (QoL). The IKDC score was A for 84 (37%) knees, B for 96 (42%) knees, C for 29 (13%) knees, and D for 8 (4%) knees. Tegner scores showed a decrease (median 0, range -4 to 4) and differential laxity also decreased (median – 4, range – 23.5 to 6.0). KOOS symptoms worsened with higher BMI (p = 0.038), for women (p = 0.007) and for knees that had medial meniscectomy (p = 0.029). KOOS pain worsened with higher BMI (p ≤ 0.001), for women (p = 0.002) and for knees with untreated (p = 0.047) or sutured (p = 0.041) medial meniscal lesions. Differential laxity increased with follow-up (p = 0.024) and in knees with lateral cartilage lesions (p = 0.031).
Conclusion: In primary ACLR for patients aged over 50 years, female gender and medial meniscal lesions significantly compromised KOOS symptoms and pain, while lateral cartilage lesions significantly increased differential laxity. Compared to knees with an intact medial meniscus, those with sutured or untreated medial meniscal lesions had worse pain, while those in which the medial meniscus was resected had worse symptoms. These findings are clinically relevant as they could help surgeons with patient selection and adjusting expectations according to their functional demands.
We report a case of a pyrocarbon humeral head resurfacing implant fracture, occurring 6 years after its implantation, without any obvious trauma or dislocation. Initial radiographs showed a proud and oversized pyrocarbon resurfacing implant. On clinical examination, the patient had a painful and pseudoparalyzed shoulder with subscapularis insufficiency. Imaging studies confirmed implant fracture and severe fatty infiltration (Goutallier, grade 4) of the subscapularis muscle. Intraoperatively, the implant was found to be fractured with multiple pyrocarbon debris in the glenohumeral joint. The implant was loose, and gross inspection showed no visible bony adhesion or ongrowth. Histologic analysis showed multiple seats of metallosis in the synovial tissue and cancellous bone of the humeral head. Successful management of this complication was managed with a thorough débridement and irrigation and revision to reverse shoulder arthroplasty. Our observation put into question the use of pyrocarbon as a humeral head resurfacing implant. The material seems to be too fragile to be used as a resurfacing implant and cannot achieve fixation of the implant to bone.
Background: The treatment of severe proximal humeral bone loss (PHBL) secondary to tumor resection or failed arthroplasty is challenging. We evaluated the outcomes and complications of reconstruction with reverse shoulder-allograft prosthesis composite (RS-APC), performed with or without tendon transfer.
Methods: An RS-APC procedure was performed in 25 consecutive patients with severe PHBL (>4 cm): 12 after failed reverse shoulder arthroplasty, 5 after failed hemiarthroplasty for fracture, 6 after failed mega-tumor prosthesis placement, and 2 after tumor resection. The median length of humeral bone loss or resection was 8 cm (range, 5-23 cm). Humeral bone graft fixation was obtained with a long monobloc reverse stem and a « mirror step-cut osteotomy, » without plate fixation. Nine infected shoulders underwent a 2-stage operation with a temporary cement spacer. In addition, 9 patients (36%) underwent an associated L’Episcopo procedure. The median follow-up duration was 4 years (range, 2-11 years).
Results: Overall, 76% of patients (19 of 25) were satisfied. In 8 patients (32%), a reoperation was needed. At last follow-up, we observed incorporation at the allograft-host junction in 96% of the cases (24/25); partial graft resorption occurred in 3 cases and severe in 1. The median adjusted Constant score was 53% (range 18-105); Subjective Shoulder Value, 50% (range 10%-95%). Additional tendon transfers significantly improved active external rotation (20° vs. 0°, P < .001) and forward elevation (140° vs. 90°, P = .045).
Conclusions: (1) Shoulder reconstruction with RS-APC provides acceptable shoulder function and high rates of graft survival and healing. (2) Additional L’Episcopo tendon transfer (when technically possible) improves active shoulder motion. (3) The use of a long monobloc (cemented or uncemented) humeral reverse stem with mirror step-cut osteotomy provides a high rate of graft-host healing, as well as a limited rate of graft resorption, and precludes the need for additional plate fixation. (4) Although rewarding, this reconstructive surgery is complex with a high risk of complications and reoperations. The main advantages of using an allograft with a reverse shoulder arthroplasty (compared with other reconstruction options) are that this type of reconstruction (1) allows restoration of the bone stock, thus improving prosthesis fixation and stability, and (2) gives the possibility to perform a tendon transfer by fixing the tendons on the bone graft to improve shoulder motion.
Approximately 20% of patients have persistent unexplained pain after total knee arthroplasty (TKA). Currently available treatments are unsatisfactory. The present report describes four patients in whom transcatheter arterial embolization had a remarkable effect on pain after TKA. Abnormal neovessels were identified in all patients. For 48 h, one patient experienced remarkable postprocedural pain at the inner side of the knee that was subsided by level 1 analgesics and another patient development of a spontaneous skin ulceration resolving within 8 days. The mean Knee injury and Osteoarthritis Outcome Score pain subtotal had increased from 39 to 82 one month after treatment. Endovascular occlusion of neovascularization, decreasing chronic inflammation and the growth of unmyelinated sensory nerves may be treatment options for persistent unexplained pain following TKA.Level of Evidence IV, Case report.
Keywords: Embolization; Neovascularization; Persistent pain; Total knee arthroplasty.
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The distal-medial pilot hole: A simple way to ease volar plate positioning in extra-articular distal radius fractures
The distal-medial pilot hole: A simple way to ease volar plate positioning in extra-articular distal radius fractures
Volar plating is one of the most used surgical treatments for dorsally displaced extra-articular distal radius fractures. However, the reduction of the dorsal tilt can be difficult. It usually requires a flexion maneuver of the wrist while maintaining and screwing the plate, which is cumbersome. Plate positioning also is a crucial step and is sometimes difficult because of the large size of the plate relative to the width of the distal radius. We use an epiphysis-first technique. We place all the epiphyseal screws before reduction, and then we take advantage of the anatomical shape of a locking plate to automatically reduce the dorsal tilt by fixing the proximal radius to the plate with cortical compression screws. To ensure easy and accurate positioning of the plate, we drill a distal medial pilot hole in a free-hand fashion 10 mm proximal to the watershed line and 10 mm lateral to the medial rim of the radius, without positioning the plate. This allows a clear view of the location of this first hole. The locking plate is then applied to the distal radius with help of a monocortical non-locking screw, and it is controlled under fluoroscopy. When this medial pilot hole is properly positioned and the plate correctly tilted on the anteroposterior view, the remaining epiphyseal holes are filled with locking screws. Then the plate is fixed on the proximal radius with bicortical compression screws, allowing an automatic reduction of the epiphyseal dorsal tilt. We believe this technique is a safe and reproducible way to position volar plates and to reduce anatomically the dorsal tilt in extra-articular posteriorly displaced distal radius fractures (AO A2 and A3). Furthermore, the automatic fracture reduction provided by this technique decreases operation time and radiation.
Background: A consequence of the steady growth in the worldwide population of elderly individuals who remain in good health and continue to engage in sports is an increase in the incidence of anterior cruciate ligament (ACL) rupture occurring after 50 years of age. ACL reconstruction was formerly reserved for young athletes but now seems to produce good outcomes in over 50s. The type of graft and graft fixation method were selected empirically until now, given the absence of investigations into potential relationships of these two parameters with the outcomes. The objective of this study was to assess associations linking the type of graft and the method of femoral graft fixation to outcomes in patients older than 50 years at ACL reconstruction.
Hypothesis: The operative technique is not associated with the clinical outcomes or differential laxity.
Material and methods: A multicentre retrospective cohort of 398 patients operated between 1 January 2011 and 31 December 2015 and a multicentre prospective cohort of 228 patients operated between 1 January 2016 and 30 June 2017 were conducted. Mean follow-up was 42.7 months in the retrospective cohort and 14.2 months in the prospective cohort. The primary evaluation criterion was the clinical outcome as assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Score (TAS). Differential laxity was the secondary evaluation criterion. The Wilcoxon rank sum test and Kruskal-Wallis test were used to compare groups, and p-values<0.05 were considered significant.
Results: In the retrospective and prospective cohorts, hamstring tendons were used in 269 (67.6%) and 197 (86.4%) patients and extensor apparatus tendons in 124 (31.2%) and 31 (13.6%) patients. Femoral fixation in the retrospective cohort was cortical in 81 (20.4%) cases, by press-fit in 112 (28.1%) cases, and by interference screw in 205 (51.5%) cases; corresponding figures in the prospective cohort were 135 (59.2%), 17 (7.5%), and 76 (33.3%). The multivariate analysis of the retrospective data identified no significant associations of graft type or femoral fixation type with the KOOS, TAS, or differential laxity values. In the prospective cohort, hamstring grafts were associated with 0.6mm of additional laxity (p=0.007); compared to cortical fixation, press-fit fixation of patellar tendon grafts was associated with 0.3mm of additional laxity (p=0.029) and a 0.5-point lower TAS value (p=0.033), with no difference in KOOS values. None of these differences were clinically significant.
Discussion: The various ACL reconstruction techniques used in patients older than 50 years produce similar outcomes. The technique can be chosen based on surgeon preference without regard for patient age.
Level of evidence: IV.
Keywords: 50 years of age; Anterior cruciate ligament; Differential laxity; KOOS; Operative technique; Tegner Activity Score.
Jean-Claude Panisset, Jean-François Gonzalez, Christophe de Lavigne, Quentin Ode, David Dejour, Matthieu Ehlinger, Jean-Marie Fayard, Sébastien Lustig; French Arthroscopic Society
Introduction: ACL reconstruction is increasingly proposed for over-50 year-olds, although surgery had a poor reputation in this age-group, mainly due to postoperative stiffness. ACL reconstruction results were compared between two prospective series of, respectively, over-50 year-old (group 1) and under-40 year-old patients (group 2). The main study hypothesis was that ACL surgery provides the same functional results after 50 as before 40 years of age, and the secondary hypothesis was that the rate of complications does not differ.
Methods: A multicenter prospective non-randomized follow-up study included 228 over-50 year-old and 130 under-40 year-old patients in 10 public and private sector centers. Epidemiological data were collected. Clinical laxity, differential laxity, KOOS, IKDC, Tegner and ACL-RSI scores and radiologic aspect were assessed pre- and post-operatively. Early (<3 months) and late (>3 months) complications were collected. Functional scores were compared between groups at last follow-up: 14.2 months (range, 3.5-30.5 months in group 1, and 20.5 months (range, 11.4-29.4 months) in group 2.
Results: Analysis of epidemiological data showed some inter-group differences: female predominance in group 1 (59% versus 35%), longer trauma-to-surgery time in group 2 (23.6 versus 8.7 weeks), predominance of pivot-contact (team) sports in group 2 (49% versus 6%), and predominance of pivot sports (skiing) in group 1. Tegner scores were lower in group 1 (5.2 versus 7.6). Meniscal lesions were more frequent in group 1 (68% versus 36%), as were cartilage lesions (76% versus 10%). Initial laxity levels were identical (6.5mm in group 1 and 6.7mm in group 2). Type of surgery was identical: 86% hamstring graft in group 1 and 89% in group 2. There were more early complications (hematoma) in group 1; rates of late complications were comparable. Laxity at last follow-up was 2.2mm in both groups, and thus Lachman and pivot-shift test results were identical in terms of firm end-feel and absence of pivot shift. Quality-of-life assessment found higher KOOS scores in group 2, although ACL-RSI scores were identical. Global IKDC scores were slightly better in group 2, due to osteoarthritis in the older patients.
Conclusion: ACL reconstruction after 50 years of age gave good results, correcting laxity as effectively as in under-40 year-olds, with identical technique and identical rates of complications. Time to return to sports and resumed level were comparable.
Level and type of study: III, prospective comparative non-randomized.
Keywords: 50 year-old; ACL; Prospective; Quality of life; Return to sport.
Background: Reverse shoulder arthroplasty (RSA) is offered to young patients with a failed previous arthroplasty or a cuff-deficient shoulder, but the overall results are still uncertain. We conducted a systematic review of the literature to report the midterm outcomes and complications of RSA in patients younger than 65 years.
Methods: A search of the MEDLINE and Cochrane electronic databases identified clinical studies reporting the results, at a minimum 2-year follow-up, of patients younger than 65 years treated with an RSA. The methodologic quality was assessed with the Methodological Index for Non-Randomized Studies score by 2 independent reviewers. Complications, reoperations, range of motion, functional scores, and radiologic outcomes were analyzed.
Results: Eight articles were included, with a total of 417 patients. The mean age at surgery was 56 years (range, 21-65 years). RSA was used as a primary arthroplasty in 79% of cases and revision of a failed arthroplasty in 21%. In primary cases, the indications were cuff tear arthropathy and/or massive irreparable cuff tear in 72% of cases. The overall complication rate was 17% (range, 7%-38%), with the most common complications being instability (5%) and infection (4%). The reintervention rate was 10% at 4 years, with implant revision in 7% of cases. The mean weighted American Shoulder and Elbow Surgeons score, active forward elevation, and external rotation were 64 points, 121°, and 29°, respectively.
Conclusions: RSA provides reliable clinical improvements in patients younger than 65 years with a cuff-deficient shoulder or failed arthroplasty. The complication and revision rates are comparable to those in older patients.
Background: Our aim was to analyze the epidemiology, etiologies, and revision options for failed shoulder arthroplasty from 2 tertiary centers.
Methods: From 1993 to 2013, 542 failed arthroplasties were revised in 540 patients (65% women): 224 hemiarthroplasties (HAs, 41%), 237 anatomic total shoulder arthroplasties (TSAs, 44%) and 81 reverse total arthroplasties (RSAs, 15%). Data about patients, pathology, and reintervention procedures, as well as intraoperative data, were analyzed from our 2 local registries that prospectively captured all the revision procedures. Patients had an average follow-up period of 8.7 years.
Results: The revision rate was 12.7% for HAs, 6.7% for TSAs, and 3.9% for RSAs. HAs were revised earlier (33 ± 40 months) than RSAs (47 ± 150 months) and TSAs (69 ± 61 months). Glenoid failure was a major cause of reintervention: erosion in HAs (29%) or loosening in TSAs (37%) and RSAs (24%). Instability was another major cause of reintervention: 32% in RSAs, 20% in TSAs, and 13% in HAs. Humeral implant loosening led to revision in 10% of RSAs, 6% of HAs, and 6% of TSAs. Multiple reinterventions were required in 21% of patients, mainly for instability (26%) and/or infection (25%). The final implant was an RSA in 48%, especially when associated with cuff insufficiency, instability, and/or bone loss. Final reimplantation was possible in 90% of cases, with the remaining 10% treated with a resection or spacer.
Conclusion: Glenoid failure and instability are the most common causes of revision. Soft-tissue insufficiency and/or infection results in multiple revisions. Surgeons must recognize all complications so that they can be addressed at the first revision operation and avoid further reinterventions. RSA was the most common final revision implant.
Background: On 14 July 2016, a terrorist drove a truck through the crowd on the Promenade des Anglais in Nice, France, killing 87 people and injuring 458. The objective of this study was to evaluate the management strategy used to handle the osteo-articular injuries caused by this attack.
Hypothesis: The management strategy used ensured that open fractures were treated within 6hours.
Material and method: This single-centre retrospective study included all victims of the attack admitted to the Pasteur 2 Hospital in Nice, France, for osteo-articular injuries, and treated between 14 and 31 July 2016. The following data were collected for each patient: age, sex, type of injury, Injury Severity Score (ISS), whether the damage control orthopaedics (DCO) or early total care (ETC) approach was followed, time from injurytotreatment, operative time, and surgical revisions. The primary outcome measure was the injury to treatment time for each lesion.
Results: Of the 182 patients admitted to the emergency department, 32 required admission for osteo-articular injuries, including 18 with severe injuries (ISS>15) and 11 with multiple fractures. Their injuries were of the type seen in traffic accidents. Of the 87 fractures, 45% involved the lower limbs and 25% were open fractures. Surgery was performed in 14 patients on the first night (14 to 15 July) and in 19 patients overall. The approach was DCO in 12 and ETC in 7 of these 19 patients. All lesions were managed within recommended time intervals, including the 21 open fractures and 2 closed femoral shaft fractures.
Discussion: Injury-to-surgery time complied with recommendations in all cases. In 25% of cases, ETC would have been feasible during the mass influx of patients without hospital capacity saturation.
Level of evidence: IV, retrospective observational study.
Keywords: Damage control orthopaedics; Mass casualty events; Osteo-articular injuries; Terrorist attack.
Introduction: The Constant score, allows an objective and subjective assessment of the shoulder function. It has been proven to have a poor interobserver reliability for some of its aspects and is not usable as a remote assessment tool.
Hypothesis: The Constant-Murley functional shoulder score can be assessed with a self-administered questionnaire.
Methods: We conducted a prospective continuous study in a shoulder-specialized service. For each patient seen in consultation or hospitalized for a shoulder pathology, a self-administered questionnaire was delivered, and a clinical examination was performed by a surgeon. The questionnaire, in French language, was composed of checkboxes only, with pictures preferred over text for most items. Correlations with surgeon examination were assessed with the intraclass correlation coefficients, differences with the paired t-test.
Results: One hundred consecutive patients were analyzed. Correlation between the two scores was excellent (0.87), as were the range of motion and the pain subscores (0.85 and 0.78), good for the activity (0.69) and fair for the strength (0.57). The mean total score was 3 points lower for the self-administered questionnaire (CI95 [-5; -1]; p<0.01). Activity and pain were not significantly different (-0.4/20 and -0.3/40; p>0.05) but pain and force were slightly different (+0.8/15; -3.0/25; p<0.01).
Conclusion: The Auto-Constant questionnaire in French is an excellent estimator of the Constant score, and of its pain and mobility sub-scores. It is less accurate for the evaluation of the strength, but differences between sub-scores compensate and allow its use in daily practice.
Level of proof: II, Prospective continuous clinical series.
Keywords: Patient Reported Outcome Measures; Shoulder; Surveys and Questionnaires.
Purpose: To evaluate mid-term clinical outcomes, complications, bone-block healing, and positioning using suture-button fixation for an arthroscopic Latarjet procedure.
Methods: Patients with traumatic recurrent anterior instability and glenoid bone loss underwent guided arthroscopic Latarjet with suture-button fixation. We included patients with anterior shoulder instability, glenoid bone loss >20%, and radiographic and clinical follow-up minimum of 24 months. Patients with glenoid bone loss <20% or those that refused computed tomography imaging were excluded. Bone-block fixation was accomplished with 2 cortical buttons connected with a looped suture (4 strands). The looped suture was tied posteriorly with a sliding-locking knot. After transfer of the bone block on the anterior neck of the scapula, compression (100 N) was obtained with the help of a tensioning device. Clinical assessment was performed at 2 weeks, 3 months, 6 months, and then yearly with computed tomography completed at 2 weeks and 6 months to confirm bony union.
Results: A consecutive series of 136 patients underwent arthroscopic Latarjet with 121 patients (89%; mean age 27 years) available at final follow-up (mean follow-up, 26 months; range, 24-47 months). No neurologic complications or hardware failures were observed; no patients had secondary surgery for implant removal. The transferred coracoid process healed to the scapular neck in 95% of the cases (115/121). The bone block did not heal in 4 patients; it was fractured in 1 and lysed in another. Smoking was a risk factor associated with nonunion (P < .001). The coracoid graft was positioned flush to the glenoid face in 95% (115/121) and below the equator in 92.5% (112/121). At final follow-up, 93% had returned to sports, whereas 4 patients (3%) had a recurrence of shoulder instability. The subjective shoulder value for sports was 94 ± 3.7%. Mean Rowe and Walch-Duplay scores were 90 (range, 40-100) and 91 (range, 55-100), respectively.
Conclusions: Suture-button fixation is an alternative to screw fixation for the Latarjet procedure, obtaining predictable healing with excellent graft positioning, and avoiding hardware-related complications. There was no need for hardware removal after suture-button fixation. The systematic identification of the axillary and musculocutaneous nerves reduced risk of neurologic injury. A low instability recurrence rate and excellent return to pre-injury activity level was found. Suture-button fixation is simple, safe, and may be used for both open and arthroscopic Latarjet procedure.
Level of evidence: Level IV, therapeutic case series.
Patients presenting with recurrent shoulder instability and bipolar glenohumeral bone loss are at risk of failed standard soft-tissue repair techniques. Even isolated bony-stabilization procedures such as the Latarjet or remplissage technique may not provide sufficient stability in the face of combined bone loss. We use a combined all-arthroscopic remplissage, Latarjet, and Bankart repair for patients with significant combined glenohumeral bone loss and/or in the revision setting. This allows reconstruction of both the Hill-Sachs and glenoid bone defects and repair of the capsulolabral complex in a minimally invasive manner. Furthermore, the use of cortical-button fixation of the coracoid bone graft may reduce the risk of hardware-related complications while still achieving excellent bone union.
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Publications 2016 du Pr GONZALEZ Jean-François
Mass casualty events and health organisation: terrorist attack in Nice
Mass casualty events and health organisation: terrorist attack in Nice
Background: The purpose of this study was to evaluate suture button fixation in a bone block (Bristow and Latarjet) procedure. We hypothesize that (1) cortical button fixation will allow predictable and reproducible bone union and (2) minimize the complications reported with screw fixation.
Materials and methods: Seventy patients (mean age, 27 years) underwent an arthroscopic bone block procedure with a guided surgical approach and suture button fixation for recurrent anterior shoulder instability. There were two groups of patients: 35 Bristow procedures (group A) and 35 Latarjet procedures (group B). Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging at 2 weeks and 6 months, respectively.
Results: The coracoid graft was positioned below the equator in 93% and strictly tangential to the glenoid surface in 94% of the cases. Bone healing was observed in 83% of the cases (58/70) with 74% bone union in group A and 91% in group B. Neurologic and hardware complications, classically reported with screw fixation, were not observed with this novel fixation method.
Conclusions: (1) Suture button fixation can be an alternative to screw fixation, obtaining bone block union, (2) in the lying position (Latarjet) bone healing was better than in the standing position (Bristow), and (3) complications classically reported with screw fixation were not observed.
Background: Most of the complications of the Latarjet procedure are related to the bone block positioning and use of screws. The purpose of this study was to evaluate if an arthroscopic Latarjet guiding system improves accuracy of bone block positioning and if suture button fixation could be an alternative to screw fixation in allowing bone block healing and avoiding complications.
Materials and methods: Seventy-six patients (mean age, 27 years) underwent an arthroscopic Latarjet procedure with a guided surgical approach and suture button fixation. Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging. Clinical examinations were performed at each visit.
Results: At a mean of 14 months (range, 6-24 months) postoperatively, 75 of 76 patients had a stable shoulder. No neurologic complications were observed; no patients have required further surgery. The coracoid graft was positioned strictly tangential to the glenoid surface in 96% of the cases and below the equator in 93%. The coracoid graft healed in 69 patients (91%).
Conclusions: A guided surgical approach optimizes graft positioning accuracy. Suture button fixation can be an alternative to screw fixation, obtaining an excellent rate of bone union. Neurologic and hardware complications, classically reported with screw fixation, have not been observed with this guided technique and novel fixation method.
The complications of total hip arthroplasty (THA) during the immediate postoperative period consist mainly in dislocation of the prosthesis, haematomas under antocoagulants, early infections, dismantling of osteotomy, neurological injury, heterotopic ossification and delayed restoration of the range of motion of the hip joint. We present here an infrequently described case of haematoma of the pectineus muscle following THA. Haematomas are not described in literature except in rare cases of compressive haematoma associated with neurological injury. In our case, the intraoperative blood losses were not particularly massive, there were no anticoagulation accident or postoperative trauma and no secondary deglobulinization. The question to be considered is that of a possible stretching of the pectineus during hip dislocation, and possibly during the surgical procedures for the implementation of the prosthesis with increased length, as it is the case here. Haematomas of the pectineus are probably underdiagnosed as they imitate other, more known, symptomatologies.
Background: The purpose is to report the results of reverse shoulder arthroplasty (RSA) after previous failed rotator cuff surgery.
Materials and methods: A retrospective multicenter study of 42 RSA in 40 patients (mean age, 71 years) with a mean follow-up of 50 months. Thirty shoulders presented with a pseudoparalytic shoulder and 12 with a painful shoulder with maintained active anterior elevation (AAE >or= 90 degrees).
Results: Five complications (12%) occurred and 2 patients (5%) underwent re-operation. In pseudoparalytic shoulders, AAE increased from 56 degrees to 123 degrees and 7% were disappointed or dissatisfied. In painful shoulders, AAE decreased from 146 degrees to 122 degrees and 27% were disappointed or dissatisfied.
Discussion: RSA can improve function in patients with cuff deficient shoulders after failure of previous cuff surgery. However, results are inferior to primary RSA. RSA when the patient maintains greater than 90 degrees of preoperative AAE risks loss of AAE and lower patient satisfaction.
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Publications 2007 du Pr GONZALEZ Jean-François
Arthroscopic revision of failed open anterior stabilization of the shoulder
Arthroscopic revision of failed open anterior stabilization of the shoulder
Arthroscopic revision of failed open anterior stabilization of the shoulder
Pascal Boileau, Julian Richou, Jean Francois Gonzalez, Lionel Neyton, Nicolas Jacquot, Christopher Chuinard
Background: The results of surgical treatment of anterior instability of the shoulder are well reported. The recurrence of instability represents the most common complication of this surgery and its evaluation poses both a diagnostic and therapeutic problem. A failed open stabilization has often been thought to necessitate an open revision. The purpose of this study is to report the results of arthroscopic Bankart repair following failed open treatment of anterior instability. Materials and Methods: We performed a retrospective review of 22 patients with recurrent anterior shoulder instability (ie, subluxations or dislocations, with or without pain) after open surgical stabilization. There were 17 men and five women with an average age of 31 years (range, 15-65). The most recent interventions consisted of 16 osseous transfers (12 Latarjet and four Eden-Hybinette), three open Bankart repairs and three capsular shifts. The causes of failure were additional trauma in 12 patients and complications related to the bone-block in 13 (poor position, fracture, pseudarthrosis or lysis). All patients were noted to have distension of the anterior-inferior capsular structures. Labral re-attachment and capsulo-ligamentous re-tensioning with suture anchors was performed in all cases with an additional rotator interval closure in four patients and an inferior capsular plication in 12 patients; the bone block screws were removed in eight patients. Results: At an average of 43 months (range, 24-72 months), 19 patients were evaluated by two independent observers. One patient had recurrent subluxation, and two patients had persistent apprehension. Anterior elevation was unchanged, and loss of external rotation (RE1) was 6°. Nine patients returned to sport at the same level; all patients returned to their previous occupations, including the six cases of work-related injury. Eighty-nine percent were satisfied or very satisfied; the subjective shoulder value (SSV) was 83% ± 23%; the Walch-Duplay, Rowe and UCLA scores were 85 ± 21, 81 ± 23 and 30 ± 7 points respectively. The number of previous interventions did not influence the results. Eight patients (42%) were still painful (six with light pain and two with moderate pain). Conclusions: Arthroscopic revision of open anterior shoulder stabilization gives satisfactory results. The shoulders are both stable and functional. While the stability obtained with this approach is encouraging, our enthusiasm is tempered by some cases of persistent pain.
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Publications 2006 du Pr GONZALEZ Jean-François
Polyarthritis and familial pulmonary fibrosis in a child
Polyarthritis and familial pulmonary fibrosis in a child
A 7-year-old girl presented with seropositive polyarthritis, autoimmune thyroiditis, and pulmonary fibrosis. Several family members had complex autoimmune disorders and pulmonary fibrosis, and the pedigree was consistent with autosomal dominant inheritance. The possible links between polyarthritis and familial pulmonary fibrosis are discussed, as well as the therapeutic challenges raised by this extraordinarily rare combination.
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Réflexion sur la chirurgie orthopédique en milieu tropical.
M Di Schino, H de Belenet, C Drouin, P Candoni, J-F Gonzalez, J Limouzin, F-M Grimaldi.
Revue du Rhumatisme. 2003, 70 : 185-194.
Evaluation fonctionnelle de l’arthrodèse d’épaule après résection tumorale de l’extrémité supérieure de l’humérus.
J-F Gonzalez, F Launay, E Viehweger, A Hamel, L Lino, J-L Jouve, G Bollini.
Revue de Chirurgie Orthopédique, 2004, 90 (Suppl. au N°6) :46-2S52.
Le pied lepreux : aspects cliniques.
E Demortière, H de Belenet, Ph Candoni, C Drouin, JF Gonzalez, M Di Schino
Bull de l’Association de Léprologie de Langue Française. 2005 ; 16 :26-29.
Les muscles fibulaires dans le pied neurologique.
E Demortière, J-F Gonzalez, A Rochewerger, G Curvale.
Médecine et chirurgie du pied, 2005, 21 :102-106.
Arthrodèse d’épaule avec fibula vascularisée après résection tumorale de l’extrémité supérieure de l’humérus.
E Viehweger, J-F Gonzalez, F Launay, R Legre, J-L Jouve, G Bollini
Revue de Chirurgie Orthopédique, 2005, 91, 523-529.
Actinomycetome abdominal avec atteinte viscérale.
T Peycru, JF Gonzalez, P Kraemer, P Calvet, B Tramond, F Martin.
La presse médicale. 2005, 27, 34 (14) : 1039.
La prise en charge chirurgicale de l’Hallux rigidus (à propos de 113 cas).
I Farhat, E Demortière, JF Gonzalez, A Rochewerger, G Curvale.
Revue de Chirurgie Orthopédique, 2005, 91(Suppl. au N°6), 56-3S62.
Syndrome de loge chronique bilatéral de pied, intérêt de la scintigraphie dynamique au Thallium 201. A propos d’un cas.
JF Gonzalez, E Demortière, J Limouzin, P Candoni, E Bussy, M Di Schino.
Revue de Chirurgie Orthopédique, 2005, 91 (Suppl. au N°6), 51-3S60.
Association chez un enfant de polyarthrite à fibrose pulmonaire familiale.
F Launay, J-M Guillaume, J-M Gennari, J-F Gonzales, G Bollini, I Koné Paut.
Revue du Rhumatisme, 2006, 73 :302-305.
Notre scarf autostable est-il aussi efficace que le classique ?
G Curvale, J-F Gonzalez, E Demortière, D Louzan, V Rosca, D Ould-Ali, A Rochwerger.
Médecine et chirurgie du pied, 2006,22 : 105-106.
La reconstruction osseuse de l’exostose en traitement de l’hallux varus iatrogène.
G. Curvale, J.F.Gonzalez, A. Rochwerger
Médecine et chirurgie du pied, 2006, 22 : 111-112.
Le SCARF nous a-t-il apporté de meilleurs résultats que la technique de Mac Bride en traitement de l’hallux valgus ?
G. Curvale , JF Gonzalez, A. Rochwerger
Médecine et chirurgie du pied, 2006, 22 : 198-199.
Infection à pneumocoque sur prothèse : A propos d’un cas clinique et revue de la littérature.
A Bertani, C Drouin, E Demortière, JF Gonzalez, Ph Candoni, M Di Schino.
Revue de Chirurgie Orthopédique : 2006, 92 : 610-614.
Résultats des prothèses totales d’épaule inversées après échec de chirurgie de la coiffe des rotateurs.
JF Gonzalez, L. Favard, F. Sirveaux, G. Walch, D. Molé, P. Boileau
Revue de Chirurgie Orthopédique, 2006,92 (Suppl. au N°6): 254-3S144.
Echec de stabilisation antérieure de l’épaule à ciel ouvert repris par Bankart arthroscopique.
P. Boileau, J. Richou, A. Lisai, J.C. Balestro, J.F. Gonzalez.
Revue de Chirurgie Orthopédique, 2006, 92 (Suppl. au N°6): 10-3S35.
Transfert du Grand Dorsal et du Grand Rond, isolé ou associé à une Prothèse d’Epaule Inversée, pour Perte de la Rotation Externe Active.
P Boileau, C Chuinard, N Jacquot , L Neyton, C Trojani, J-F Gonzalez.
Revue de Chirurgie Orthopédique, 2006, 92 (Suppl. au N°6): 16-3S38.
Echec de stabilisation antérieure de l’épaule à ciel ouvert repris par Bankart arthroscopique.
P. Boileau, J. Richou, A. Lisai, J.C. Balestro, J.F. Gonzalez.
Revue de Chirurgie Orthopédique, 2006; 92 (Suppl. au N°8): 49-4S76.
Ostéotomie de type scarf pour hallux valgus : l’ostéosynthèse est-elle indispensable ?
JF Gonzalez, A Rochwerger, E Demortière, G Curvale
Revue de Chirurgie Orthopédique, 2007, 92 (Suppl. au N°6): 16-3S38.
La fracture de fatigue du col fémoral chez le sportif d’endurance : l’importance d’un diagnostic précoce.
A Bertani, E Soucanye de Landevoisin, JF Gonzalez, P.H. Savoie, E. Demortière.
Journal de Traumatologie du Sport, 2008, 25 (2), 99-101.
Intérêt de la mesure de l’incidence pelvienne simienne dans la compréhension du développement de la statique rachidienne humaine.
JF Gonzalez, B Blondel, F Marchal, G Berillon, M Panuel, JL Jouve.
Revue de Chirurgie Orthopédique, 2010, 94 (Suppl. au N°7):220-S302.
Stratégie d’exofixation et damage control orthopédique en contexte de chirurgie de guerre.
L Mathieu, J-F Gonzales, B Bauer, B Deloynes, R Breda, S Rigal
Revue de Chirurgie Orthopédique, 2010, 96 (Suppl. au N°7):171-S179.
Hématome du muscle pectiné après prothèse totale de hanche.
Bernard P, Gonzalez JF, Facione J, Chapus JJ, Lagauche D.
Annales de Réadaptation et de Médecine Physique, 2011, Jul;54(5):293-7.
Évaluation du profil thromboélastométrique du sang épanche après arthroplastie primaire du genou
Esnault P, Prunet B, Cungi PJ, Caubere A, Lacroix G, Bordes J, David JS, Gonzalez JF, Kaiser E
Transfus Clin Biol. 2015, mars ; 22 (1) : 30-36.
Une approche chirurgicale guidée et un nouveau mode de fixation pour la butée de Latarjet sous arthroscopie
Gendre P, Gonzalez JF, D’Ollonne T, Boileau P
Revue de Chirurgie Orthopédique, 2015, 101 (Suppl. au N°7):69-S138.
Les entorses du pied chez le sportif militaire
E. Soucanye de Landevoisin, L. Thefenne, J-F. Gonzalez
Médecine et Armées, 2015, 43, 5, 452-459.
Le double-bouton, une alternative aux vis pour la fixation et la consoidation des butées de Latarjet
Gendre P, D’Ollonne T, Gastaud O, Clowez G, Gonzalez JF, Trojani C, Boileau P
Revue de Chirurgie Orthopédique, 2016, 102 (Suppl. au N°7):257-S167.
Résultats et limites de l’opération de L’Episcopo modifiée pour le traitement des pertes isolées de la rotation externe active du bras.
Boileau P, Baba M, Gauci MO, MacClelland W, Gendre P, D’Ollonne T, Gonzalez JF.
Revue de Chirurgie Orthopédique, 2016, 102 (Suppl. au N°7):317-S189.
Révision après échec de réparation de coiffe : le tendon a-t-il une deuxième chance de cicatriser ?
Azar M , Gonzalez JF, Boileau P.
Revue de Chirurgie Orthopédique, 2018, 104 (Suppl. au N°8):61-S95.
L’« Auto-Constant » : peut-on estimer le score de Constant-Murley à l’aide d’un auto-questionnaire ? Étude pilote
M Chelli, Y Levy, V Lavoué, G Clowez, J-F Gonzalez, P Boileau.
Revue de chirurgie orthopédique et traumatologique 105 (2019) 149–154
Arthrodèse arthroscopique tibiotalienne. F. Kelberine, J. Cazal, J.-F. Gonzales, D. Molé, P. Christel
Arthroscopie. Société Française d’Arthroscopie. Editions Elsevier, pages 283-286, 2006.
Arthroscopie de la hanche : anatomie, exploration normale. F. Kelberine, J.-F. Gonzales, J. Cazal
Arthroscopie. Société Française d’Arthroscopie. Editions Elsevier, pages 300-302, 2006.
Traitement arthroscopique des raideurs et de la pathologie synoviale du coude. F. Kelberine, J.-F. Gonzales, B. Clouet d’Orval
Arthroscopie. Société Française d’Arthroscopie. Editions Elsevier, pages 461-464, 2006.
Bilan articulaire de la cheville et du pied chez l’adulte. A Delarque, E Demortière, H Collado, S Mesure, T Rubino, J-F Gonzalez, G Curvale.
Encyclopédie Médico-Chirurgicale (Elsevier SAS, Paris), Podologie, 27-010-A-25, 2006.
Reversed total shoulder arthroplasty after failed rotator cuff surgery.
J-F Gonzalez,C Chuinard, P Boileau.
Reverse Shoulder Arthroplasty: Clinical results – Complications – Revision. Sauramps Medical, pages 133-147, 2006.
Complications des prothèses anatomiques de l’épaule.
J-F Gonzalez, F Baqué, P Boileau.
Prothèses d’épaule – Etat actuel. Cahiers d’enseignement de la SOFCOT n°98. Elsevier Masson, page 253–270, 2008.
Evaluation à 10 ans de recul d’un traitement de l’hallux valgus par ostéotomie SCARF. C Charpail, J-F Gonzalez, A Rochwerger, G Curvale.
Monographie AFCP (Association Française de Chirurgie du Pied) n°4. Sauramps Medical, page 71-80, 2008.
Chirurgie orthopédique. C Saby, JF Gonzales, P Candoni
Procédure anesthésiques liées aux techniques chirurgicales. ARNETTE, page 127- 169, 2011.
Traitement chirurgical initial des traumatismes des membres de guerre L Mathieu, A Bertani, JF Gonzalez, F Rongiéras et F Chauvin Le blessé de guerre, ARNETTE, 2014.
Prise en charge chirurgicale secondaire des traumatismes des membres de guerre A Bertani,L Mathieu, JF Gonzalez, F Rongiéras et F Chauvin Le blessé de guerre, ARNETTE, 2014.
Revision of Shoulder Arthroplasty: 20 Years’ French Experience.
JF Gonzalez, N Holzer, T Baring, MO Gauci, M Cavalier, G Walch, P Boileau. Shoulder concepts: Revision surgery of shoulder arthroplasty, SAURAMPS, 2014.
Multiple revision shoulder arthroplasty: reasons and result. Holzer N, Baring T, Bessiere C, Gendre P, D’Ollone T, Gonzalez JF, Boileau P Shoulder concepts: Revision surgery of shoulder arthroplasty, SAURAMPS, 2014.
Patholgies du pied liées à la pratique du sport. E Soucanye de Landevoisin, JF Gonzalez, L Thefenne, E Demortièrer
SPORT et APPAREIL LOCOMOTEUR, p 255-296, Sauramps Médical, 2015.
A guided surgical approach and novel fixation method for arthroscopic Latarjet P Boileau, P Gendre, M Baba, CE Thélu, T Baring, JF Gonzalez, C Trojani. Shoulder concepts: Arthroscopy, Arthroplasty & Fractures, SAURAMPS, 2016, 149-167.
Reverse Shoulder Arthroplasty for non-operated, irreparable massive cuff tear (Hamada I – II – III) Minimum 5-year follow-up.
JF Gonzalez, K Fountzoulas, M Chelli, B Seeto, P Boileau Shoulder concepts: Reverse Shoulder Arthroplasty, SAURAMPS, 2016, 71-80.
Reverse Shoulder Arthroplasty for failure after cuff strgery – Minimum 5 year follow-up. O Gastaud, J Thomas, K Fountzoulas, JF Gonzalez, P Boileau Shoulder concepts: Reverse Shoulder Arthroplasty, SAURAMPS, 2016, 81-82.
Long term results of reverse shoulder arthroplasty for revision after failed reverse P Gendre, T D’Ollonne, M Cavalier, O Gastaud, JF Gonzalez, G Walch, L Favard, P Boileau. Shoulder concepts: Reverse Shoulder Arthroplasty, SAURAMPS, 2016, 153-158.
Results of proximal humeral reconstruction with massive allograft combined with reverse shoulder arthroplasty JL Raynier, P Gendre, Y Bouju, C Spiry, JF Gonzalez, L Favard, P Boileau. Shoulder concepts: Reverse Shoulder Arthroplasty, SAURAMPS, 2016, 337-343.
Shoulder Concepts: Arthroplasty for the Young Arthitic Shoulder.
P. Boileau, G. Walch, D. Molé, L. Lafosse, L. FAvard, C. Lévigne, F. Sirveaux, J-F. Kempf, P. Clavert, P. Collin, L. Neyton, N. Bonnevialle, J-F. Gonzalez
Sauramps Medical, 2018.
Arthroscopic Latarjet : Suture-button Fixation is a Safe and Reliable Alternative to Screw Fixation.
P Boileau, D Saliken, P Gendre, B-L Seeto, T d’Ollonne, J-F Gonzalez, N Bronsard
Shoulder concepts: Arthroscopy, Arthroplasty & Fractures, SAURAMPS, 2018, 53-70.
Revision after Failed Rotator Cuff: Does the Tendon Have a Second Chance to Heal ?
M Azar, J-F Gonzalez, O Van Der Meijden, P Boileau
Shoulder concepts: Arthroscopy, Arthroplasty & Fractures, SAURAMPS, 2018, 53-70.
2025 Influence de l’interligne oblique sur les résultats cliniques après ostéotomie tibiale de valgisation à moyen-long terme Dr GHARBI Lilia
2025 Influence des paramètres morphologiques sur la difficulté peropératoire après PTH par Voie Ant Dr LOPEZ Michaël
2025 Etude clinico-radiologique des PTEA avec VS sans PSI à 10 ans de recul Dr MILLET Nahel
2025 Positionnement des implants dans l’arthroplastie totale de hanche, comparaison voie ant et voie post. Dr ATTAS Joseph
2024 Influence de l’alignement sur les résultats cliniques après ostéotomie tibiale de varisation par fermeture médiale Dr MERIC Vincent
2023 Influence de l’alignement sur les résultats cliniques après ostéotomie tibiale de varisation par fermeture médiale Dr MACHADO Axel
2023 Associer un Hill-Sachs Remplissage à une butée de Latarjet : Le GlenoidTrack une aide à la prise de décision thérapeutique ? Dr RECANATESI Nicolas
2023 Arthrodèse sacro-iliaque chez les patients atteints de SDSI avec antécédent d’arthrodèse lombo-sacrée : résultats cliniques et fonctionnels à deux ans. Dr BRICARD Renaud
2022 Ostéosynthèse des fractures bi-colonnes : Comparaison de la réduction articulaire par voie pararectale versus ilio-inguinale. Dr FROIDEFOND Pablo
2022 Epaule douloureuse et instable postérieure : Un stade précoce de subluxation postérieure statique? Description clinique et morphométrique avec résultats arthroscopiques à deux ans minimum. Dr CHAMOUX Julien
2022 Ostéosynthèse des fractures de la colonne antérieure du cotyle : Observe-t-on un déplacement secondaire plus important chez le sujet âgé ? Dr HERCE Corentin
2021 Intérêt de la voie d’abord de Neviaser pour les fractures de l’extrémité proximale de l’humérus. Dr MONIN Brieuc
2020 Infections du site opératoire sur prothèse totale du genou dans un hôpital neuf. Dr D’ASCOLI Alessander
2020 Infections du site opératoire sur prothèse totale de hanche dans un hopitâl neuf. Dr OUATTARA Karim
2020 Vissage dynamique du col (DHS) dans les fractures cervicales vraies du fémur: quels facteurs prédictifs de complications? Dr KARAM Sami
2019 Analyse morphologique tridimensionnelle informatisée des fractures de l’humérus proximal – Étude de faisabilité. Dr RIPOLL Thomas
2019 Diagnostic du Syndrome Douloureux Sacro-Iliaque après arthrodèse lombo-sacrée. Dr PELLETIER Yann
2019 Prothèse Totale d’Épaule Inversée pour Fractures de l’Humérus Proximal du Sujet Âgé: Place du trochiter ? Dr SABAH Yann
2018 Résection complète du ligament croisé antérieur pour dégénérescence mucoïde : étude rétrospective de 24 cas. Dr CASTOLDI Marie
2016 PTG bilaterales en une session operatoire versus PTG unilaterales : Analyse comparative. Dr RAFFAELLI Antoine
2014 L’erosion glenoïdienne est-elle une contre-indication au « hill-sachs remplissage » associe a la reparation de bankart ? Dr CAVALIER Maxime
2014 Analyse échographique de la cicatrisation tendineuse après réparation arthroscopique de la coiffe des rotateurs. Dr SCHRAMM Martin
Background: The pararectus approach has emerged as an alternative to the traditional ilioinguinal approach for complex both-column (BC) fractures of the acetabulum. Concurrently, suprapectineal plates have evolved to enhance anatomical fixation of the quadrilateral surface (QLS) and restore joint congruency. This study aimed to answer the following questions: Does the pararectus approach provide comparable articular reduction to the ilioinguinal approach in BC fractures? Does it reduce operative time and blood loss? Are mid-term functional outcomes similar? We hypothesized that the pararectus approach, combined with anatomical QLS plating, would yield similar reduction quality and functional outcomes while decreasing surgical time and blood loss compared to the ilioinguinal approach.
Patients and methods: This retrospective, single-center study included 43 patients with BC fractures treated between 2009 and 2022. Patients were divided into two groups: ilioinguinal approach with conventional suprapectineal plate (II, n = 15) and Pararectus approach with anatomical QLS plate (PR, n = 28). Pre- and postoperative CT scans assessed axial, coronal, and sagittal residual gap, step and femoral head displacement. Operative time, blood loss, transfusion needs, and complications were recorded. Functional outcomes were assessed at two years using the Harris Hip Score (HHS) and PMA score.
Results: Articular gap reduction was similar: axial (II: 5.0 ± 2.9 mm vs. PR: 4.6 ± 5.1 mm, p = 0.3), coronal (II: 5.7 ± 2.4 mm vs. PR: 5.6 ± 5.5 mm, p = 0.2), sagittal (II: 5.6 ± 2.8 mm vs. PR: 6.4 ± 6.5 mm, p = 0.6). Residual coronal step was lower in PR (1.9 ± 2.0 mm vs. 3.6 ± 1.9 mm, p = 0.01). Anterior femoral head displacement improved in PR (-1.7 mm vs. + 5.6 mm, p < 0.001). Medial (5.9 mm vs. 3.98 mm, p = 0.4) and proximal displacement (1.1 mm vs. 1.2 mm, p = 0.46) were comparable. Operative time (PR: 125.1 ± 37.9 min vs. II: 309 ± 85.5 min, p < 0.001) and postoperative transfusions (p = 0.01) were significantly reduced in PR. Functional outcomes were comparable (HHS and PMA good-to-excellent: II: 70% vs. PR: 70%, p = 0.9).
Conclusion: The shift from the ilioinguinal to the pararectus approach with QLS plate fixation appears to offer at least equivalent reduction quality while reducing surgical time, transfusion needs, and complications. These findings support evolving strategies in BC fracture management and highlight the key role of implant design. Further prospective studies are needed to confirm these results over the long term.
Level of evidence: Level III: comparative cohort study.
Introduction: Degenerative sacroiliac (SI) joint syndrome is known to be more common after lumbosacral fusion. While this diagnosis is suspected based on various clinical criteria and diagnostic tests, it is confirmed with a diagnostic nerve block. If conservative treatment fails, SI joint fusion through a minimally invasive approach is a useful palliative approach for patients at a treatment crossroads. The aim of this study was to evaluate the clinical and functional results at 2years postoperative after minimally invasive SI joint fusion in patients with SI joint syndrome following lumbosacral fusion.
Materials and methods: We carried out a single-center retrospective study of patients operated between June 2017 and October 2020. Included were patients who had a confirmed diagnosis of SI joint syndrome after lumbosacral fusion surgery, who underwent SI joint fusion and had at least 2years’ follow-up. The primary outcome was the improvement in lumbar and radicular pain on a numerical rating scale (NRS). The secondary outcomes were the functional scores (Oswestry and SF-12) along with the level of patient satisfaction. Our study population consisted of 54 patients (41 women, 13 men) with a mean age of 59years (27-88). Thirty-one of these patients were operated on both sides (85 fusions in all). The patients had undergone a mean of 3 lumbar surgeries (1-7) before the SI fusion.
Results: The lumbar and radicular NRS were 8.4 (7-10) and 5.1 (2-10) preoperatively and 5.2 (0-8) and 3.0 (0-8) at 2years postoperatively, which was a reduction of 37% and 42% (p<0.001), respectively. The Oswestry score went from 69.4 (52-86) preoperatively to 45.6 (29-70) at 2years, which was a 33% improvement (p<0.001). Eighty-six percent of patients were satisfied or very satisfied with the surgery.
Discussion: After minimally invasive SI joint fusion, the patients in this study had clear clinical and functional improvements. Previous publications analyzing the results of SI joint fusion found even more improvement, but those patients were relatively heterogenous; in our study, only patients who had a history of lumbosacral fusion were included.
Conclusion: Minimally invasive SI joint fusion helped patients who developed SI joint syndrome after lumbosacral fusion to improve clinically and functionally.
Hypothesis: Chronic epilepsy may cause important bipolar bony lesions. We aim to compare the specific pathoanatomic metrics of the bony lesions in chronic shoulder anterior instability that occur in patients with epilepsy vs. patients without epilepsy.
Methods: From 2006 to 2020, we included epileptic and nonepileptic patients with anterior recurrent shoulder instability. We randomly adjusted the patients of the 2 groups according to the sex, age, and type of management. We included 50 patients. For each included patient, we performed an in-depth analysis and comparison of the glenoid bone loss based on the computed tomography scan: PICO method (patient/population, intervention, comparison and outcomes) using the best-fit circle; and the Hill-Sachs lesion: the depth and width were given as a percentage of the humeral head diameter on an axial view. We also evaluated the engaging character of the involved lesion using the on-track vs. off-track analysis. Those characteristics were compared between the 2 groups.
Results: We found a glenoid bone loss in 32 patients. Glenoid bone loss was not significantly greater in patients with epilepsy (P = .052). A Hill-Sachs lesion was found in 42 patients (22 in the group with epilepsy and 20 in the group without epilepsy). Hill-Sachs lesions were significantly deeper and larger in the group with epilepsy (depth: 22% vs. 9%, P < .001; width: 43% vs. 28%, P = .003). In the group with epilepsy, 90% of the bone lesions were off-track vs. 30% in the group without epilepsy. Thus, the patients with epilepsy presented more engaging bony lesions than patients without epilepsy (P = .001) (OR = 23).
Conclusions: In a population of patients with epilepsy who had shoulder instability, Hill-Sachs lesions are larger and deeper than in normal patients with shoulder instability. By contrast, there is no significant difference regarding the characteristics of the glenoid bone loss if present. This implies that bone lesions in instable shoulders of patients with epilepsy need at least a bony stabilization procedure on the humeral side in the majority of cases.
Keywords: Hill-Sachs, shoulder stabilization; Shoulder; anterior instability; bone lesion; epilepsy.
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Morphological analysis of the retrotalar pulley and its role in flexor hallucis longus impingement: Insights from a CT-based study
Morphological analysis of the retrotalar pulley and its role in flexor hallucis longus impingement: Insights from a CT-based study
Morphological analysis of the retrotalar pulley and its role in flexor hallucis longus impingement: Insights from a CT-based study
Lolita Micicoi, Barbara Piclet-Legré, Tristan Fauchille, Alexandre Rudel, Nicolas Bronsard, Jean-François Gonzalez, Matthieu Ollivier
The Flexor Hallucis Longus (FHL) is a muscle that can be subject to multiple conflicts. The most common conflict is due to inflammation of the tendon at the retrotalar pulley. The constraints exerted on the FHL are responsible for a pathology called functional Hallux Limitus. The purpose of this anatomical study is to describe morphologic finding about retrotalar pulley, which may account the impingement between FHL and the hindfoot. Using a retrospective approach at a single center, a detailed analysis was conducted on a cohort of 350 patients. Precise measurements were taken to document the angles, areas, and distances that define the relationship between the Flexor Hallucis Longus (FHL) tendon and its surrounding anatomical structures. The angle between the retrotalar pulley and the sustentaculum tali exhibited a range of 124 to 170 degrees in profile and 113.3 to 178 degrees in frontal view. The dimensions of the retrotalar pulley varied from 1.1 to 54 mm², while the posterolateral and posteromedial tubercles displayed dimensions ranging from 3.4 to 77.9 mm² and 2.6 to 35.2 mm², respectively. Distances between posterior tubercles further underscored the anatomical diversity, ranging from 4.3 to 17 cm proximally and 10.5 to 18.4 cm distally. In unraveling the morphological complexities surrounding FHL impingement, this study provides valuable insights into the biomechanical intricacies of the foot. These findings not only deepen our understanding of musculoskeletal anatomy but also pave the way for future investigations into the dynamic interplay between structure and function in the lower extremities.
Introduction: Total knee arthroplasty (TKA) carries a significant hemorrhagic risk, with a non-negligible rate of postoperative transfusions. The blood-sparing strategy has evolved to reduce blood loss after TKA by identifying the patient’s risk factors preoperatively. In practice, a blood count is often performed postoperatively but rarely altering the patient’s subsequent management. This study aimed to identify the preoperative variables associated with hemorrhagic risk, enabling the creation of a machine-learning model predictive of transfusion risk after total knee arthroplasty and the need for a complete blood count.
Hypothesis: Based on preoperative data, a powerful machine learning predictive model can be constructed to estimate the risk of transfusion after total knee arthroplasty.
Material and methods: This retrospective single-centre study included 774 total knee arthroplasties (TKA) operated between January 2020 and March 2023. Twenty-five preoperative variables were integrated into the machine learning model and filtered by a recursive feature elimination algorithm. The most predictive variables were selected and used to construct a gradient-boosting machine algorithm to define the overall postoperative transfusion risk model. Two groups were formed of patients transfused and not transfused after TKA. Odds ratios were determined, and the area under the curve evaluated the model’s performance.
Results: Of the 774 TKA surgery patients, 100 were transfused postoperatively (12.9%). The machine learning predictive model included five variables: age, body mass index, tranexamic acid administration, preoperative hemoglobin level, and platelet count. The overall performance was good with an area under the curve of 0.97 [95% CI 0.921-1], sensitivity of 94.4% [95% CI 91.2-97.6], and specificity of 85.4% [95% CI 80.6-90.2]. The tool developed to assess the risk of blood transfusion after TKA is available at https://arthrorisk.com.
Conclusion: The risk of postoperative transfusion after total knee arthroplasty can be predicted by a model that identifies patients at low, moderate, or high risk based on five preoperative variables. This machine learning tool is available on a web platform that is accessible to all, easy to use, and has a high prediction performance. The model aims to limit the need for routine check-ups, depending on the risk presented by the patient.
Introduction: While outcomes after total hip arthroplasty (THA) are generally excellent, prosthetic dislocation remains a multifactorial complication. This study hypothesized that differences in combined anteversion (CA) exist between patients with and without dislocation. The objectives were to (1) compare postoperative alignment parameters between dislocated and stable hips, (2) assess differences of alignement according to surgical approach, and (3) evaluate patient-related risk factors for dislocation.
Materials and methods: In this retrospective case-control study, 37 dislocated hips were matched to 74 stable hips by sex, age, body mass index, and surgical approach. Postoperative CT scans measured acetabular anteversion, femoral anteversion, CA, and cup inclination. Alignment was assessed relative to Lewinnek’s safe zone (acetabular anteversion 15 ° ± 10 °, inclination 40 ° ± 10 °) and Jolles’ target zone for CA (50 ° ± 10 °).
Results: Mean CA did not differ between dislocated and stable hips (45.9 ° vs 48.5 °, Δ = 2.6 °, p = 0.35). Target CA was achieved in 51% of dislocated and 54% of stable hips (p = 0.80). Cup inclination, acetabular anteversion, and femoral anteversion also showed no significant differences. Achievement of Lewinnek’s safe zone was similar between groups, except for acetabular inclination (67.6% in dislocated vs 83.8% in stable hips, p = 0.04). Surgical approach (direct anterior vs posterior) was not associated with alignment differences. In multivariate analysis, ASA (American Society of Anesthesiologists) score ≥3 (OR = 2.5, p = 0.04) and degenerative lumbar spine symptoms (OR = 3.2, p < 0.01) were independently associated with dislocation risk.
Conclusion: CA did not differ between dislocated and stable hips, suggesting that implant orientation alone does not explain instability. Instead, acetabular inclination, high ASA score, and lumbar spine pathology emerged as significant risk factors, underscoring the multifactorial nature of dislocation after THA.
Introduction: Total knee arthroplasty (TKA) is a procedure associated with risks of electrolyte and kidney function disorders, which are rare but can lead to serious complications if not correctly identified. A routine check-up is very often carried out to assess the seric ionogram and kidney function after TKA, that rarely requires clinical intervention in the event of a disturbance. The aim of this study was to identify perioperative variables that would lead to the creation of a machine learning model predicting the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty.
Hypothesis: A predictive model could be constructed to estimate the risk of kalaemia disorders and/or acute kidney injury after total knee arthroplasty.
Material and methods: This single-centre retrospective study included 774 total knee arthroplasties (TKA) operated on between January 2020 and March 2023. Twenty-five preoperative variables were incorporated into the machine learning model and filtered by a first algorithm. The most predictive variables selected were used to construct a second algorithm to define the overall risk model for postoperative kalaemia and/or acute kidney injury (K+ A). Two groups were formed of K+ A and non-K+ A patients after TKA. A univariate analysis was performed and the performance of the machine learning model was assessed by the area under the curve representing the sensitivity of the model as a function of 1 – specificity.
Results: Of the 774 patients included who had undergone TKA surgery, 46 patients (5.9%) had a postoperative kalaemia disorder requiring correction and 13 patients (1.7%) had acute kidney injury, of whom 5 patients (0.6%) received vascular filling. Eight variables were included in the machine learning predictive model, including body mass index, age, presence of diabetes, operative time, lowest mean arterial pressure, Charlson score, smoking and preoperative glomerular filtration rate. Overall performance was good with an area under the curve of 0.979 [CI95% 0.938-1.02], sensitivity was 90.3% [CI95% 86.2-94.4] and specificity 89.7% [CI95% 85.5-93.8]. The tool developed to assess the risk of impaired kalaemia and/or acute kidney injury after TKA is available on https://arthrorisk.com.
Conclusion: The risk of kalaemia disturbance and postoperative acute kidney injury after total knee arthroplasty could be predicted by a model that identifies low-risk and high-risk patients based on eight pre- and intraoperative variables. This machine learning tool is available on a web platform accessible for everyone, easy to use and has a high predictive performance. The aim of the model was to better identify and anticipate the complications of dyskalaemia and postoperative acute kidney injury in high-risk patients. Further prospective multicentre series are needed to assess the value of a systematic postoperative biochemical work-up in the absence of risk predicted by the model.
Level of evidence: IV; retrospective study of case series.
Background: We aim to analyze recurrence of dislocation after Latarjet bone block with or without Hill-Sachs Remplissage (HSR) to specify the indication of a combined procedure.
Methods: We analyzed 118 patients with a bipolar lesions and a minimum follow-up of 2 years. All procedures were performed arthroscopically by 3 surgeons in on center. Preoperative and postoperative computed tomography (CT) scans were collected. We also collected preoperative and postoperative clinical scores Two groups were identified: 30 patients with arthroscopic Latarjet bone block combined with a HSR (group I) and 88 patients with an isolated Latarjet (group II). Measurements were performed on a reformatted shoulder CT-scan. On preoperative CT-scans, we measured the glenoid bone loss, the width and the length of the humeral lesion then the glenoid track and Hill-Sachs interval.
Results: The mean follow-up is 6 years. Five dislocations occurred in group II, none in group I. The area of glenoid bone loss was higher in group I than in group II (33.4% ± 4.5% vs. 20.5% ± 8.9%, P = .001). Twenty shoulders presented an Off-Track lesion preoperatively that was always compensated postoperatively by the bone block in group I. No cutoff was found to be discriminating enough to help in the decision-making process. All recurrences had an Instability Severity Index score > 6.
Conclusion: No recurrence occurred in Group I. However, 5 patients (6%) in Group II experienced a recurrent dislocation with no significant difference. Glenoid track is not an isolated argument to indicate an isolated bone block procedure or a combined HSR. The risk of recurrence increases in patients with an Instability Severity Index score over 6 and in this case, a combine procedure should be recommended.
Anatomic total shoulder arthroplasty with keeled glenoids in patients younger than 60 years at 10 years minimum: which risk factors of failure are still valid at long-term follow-up?
Anatomic total shoulder arthroplasty with keeled glenoids in patients younger than 60 years at 10 years minimum: which risk factors of failure are still valid at long-term follow-up?
Anatomic total shoulder arthroplasty with keeled glenoids in patients younger than 60 years at 10 years minimum: which risk factors of failure are still valid at long-term follow-up?
Background: To assess the long-term (>10 years) outcomes in anatomic total shoulder arthroplasty (aTSA) and implant survival in patients younger than 60 years and identify risk factors for complications and revision.
Methods: This was a retrospective, multicenter study conducted from 1993 to 2008. From more than 104 aTSAs, 87 in 82 patients (mean age 55 years, range 36-60 years) were included at a mean follow-up of 14 ± 4 years (10-25 years). Outcome measures included pain, motion, Constant score, and subjective shoulder value at 10 years minimum. On AP radiograph, the radiolucent line (RLL) score of Molé was used to assess loosening around the glenoid. A glenoid was considered « loose » in 3 circumstances: (1) revision for glenoid loosening, (2) radiologic migration of the implant, or (3) RLL score ≥12. Preoperative glenoid morphology according to Walch, glenohumeral mismatch, and cementing technique were evaluated. Survivorship free of revision and free of glenoid loosening were calculated at 10 and 15 years. The mean follow-up was 14 ± 4 years (10-25 years) or until revision.
Results: Revision-free survivorship was 81% at 10 years and 65% at 15 years. Glenoid failure was the main cause of revision: among the 28 revised shoulders (32%), 19 (22%) were revised for glenoid loosening. Heavy labor was a risk factor for glenoid component loosening (P = .029). The curettage technique and flat-back glenoids were risk factors for glenoid revision (P = .035) but presented a longer follow-up than compaction technique and convex-back glenoids. The type of preoperative glenoid erosion (Walch type) and glenohumeral mismatch did not correlate with a higher glenoid loosening rate.
Conclusion: aTSA is a reliable procedure for primary OA at age <60 years, but survivorship declines after 10 years. Glenoid loosening, often combined with cuff deficiency or infection, is the main cause of failure and revision. Glenoid morphology as classified by the modified Walch classification does not influence the revision rate beyond 10 years.
Keywords: Anatomic total shoulder arthroplasty; Walch classification; glenoid implant survivorship; glenoid loosening; long term outcomes; revision; risk factors.
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Keblish's lateral subvastus approach for total knee arthroplasty: A technical note
Keblish's lateral subvastus approach for total knee arthroplasty: A technical note
Keblish’s lateral subvastus approach for total knee arthroplasty: A technical note
Grégoire Micicoi, Rayan Fairag, Styliani Stergiadou, Régis Bernard de Dompsure, Nicolas Bronsard, Axel Machado, Matthieu Perras, Jean-François Gonzalez
Keblish’s lateral surgical approach for total knee arthroplasty enables a direct release of the lateral structures in valgus deformities. In recent years, the development of quadriceps-sparing techniques has improved early functional recovery after arthroplasty, which has been well described using a medial approach. The authors present Keblish’s lateral subvastus approach for genu valgum deformities, with key surgical considerations and preliminary outcomes. The novelty of this technique lies in its combination of a lateral subvastus approach with Keblish’s Z-plasty, aiming to optimize quadriceps recovery while ensuring secure knee closure following valgus deformity correction. The Keblish’s lateral subvastus approach provided adequate surgical exposure without any observed complications in this small short follow-up series, allowing for early recovery of active knee extension and satisfactory clinical outcomes. LEVEL OF EVIDENCE: IV.
Purpose: To objectively identify the 100 most influential scientific publications in knee osteotomy and provide an analysis of their main characteristics.
Methods: The Clarivate Analytics Web of Knowledge database was used to obtain data and metrics on knee osteotomy research. The search list was sorted by the number of citations, and articles were included or excluded based on relevance to knee osteotomy. The information extracted for each article included the author’s name, publication year, country of origin, journal name, article type and the level of evidence.
Results: These 100 studies generated a total of 16,246 citations, with an average of 162.5 citations per article. The most-cited article was cited 752 times. The 100 studies included in this analysis were published between 1976 and 2015. Twenty-one different journals published these 100 publications. The majority of the publications were from the United States (n = 30), followed by Germany (n = 17) and Japan (n = 11). The most prevalent study designs were case series (n = 55) and cohort studies (n = 19).
Conclusion: The 100 most influential publications in knee osteotomy were cited a total of 16,246 times. The study designs most used were case series and cohort studies with low-level evidence. This publication serves as a reference to direct orthopaedic practitioners to the 100 most influential studies in knee osteotomy and target future research directions.
Clinical relevance: This analysis of the 100 most influential (or cited) scientific publications in osteotomy around the knee will provide a comprehensive inventory of the most impactful academic contributions to a field that has recently regained interest among medical students, residents, fellows and attending physicians.
Is preoperative 3D planning reliable for predicting postoperative clinical differences in range of motion between two stem designs in reverse shoulder arthroplasty
Is preoperative 3D planning reliable for predicting postoperative clinical differences in range of motion between two stem designs in reverse shoulder arthroplasty
Is preoperative 3D planning reliable for predicting postoperative clinical differences in range of motion between two stem designs in reverse shoulder arthroplasty
Background: We aim to predict a clinical difference in the postoperative range of motion (RoM) between 2 reverse shoulder arthroplasty (RSA) stem designs (Inlay-155° and Onlay-145°) using preoperative planning software. We hypothesized that preoperative 3D planning could anticipate the differences in postoperative clinical RoM between 2 humeral stem designs and by keeping the same glenoid implant.
Methods: Thirty-seven patients (14 men and 23 women, 76 ± 7 years) underwent a BIO-RSA (bony increased offset-RSA) with the use of preoperative planning and an intraoperative 3-dimensional-printed patient-specific guide for glenoid component implantation between January 2014 and September 2019 with a minimum follow-up of 2 years. Two types of humeral implants were used: Inlay with a 155° inclination (Inlay-155°) and Onlay with a 145°inclination (Onlay-145°). Glenoid implants remained unchanged. The postoperative RSA angle (inclination of the area in which the glenoid component of the RSA is implanted) and the lateralization shoulder angle were measured to confirm the good positioning of the glenoid implant and the global lateralization on postoperative X-rays. A correlation between simulated and clinical RoM was studied. Simulated and last follow-up active forward flexion (AFE), abduction, and external rotation (ER) were compared between the 2 types of implants.
Results: No significant difference in RSA and lateralization shoulder angle was found between planned and postoperative radiological implants’ position. Clinical RoM at the last follow-up was always significantly different from simulated preoperative RoM. A low-to-moderate but significant correlation existed for AFE, abduction, and ER (r = 0.45, r = 0.47, and r = 0.57, respectively; P < .01). AFE and abduction were systematically underestimated (126° ± 16° and 95° ± 13° simulated vs. 150° ± 24° and 114° ± 13° postoperatively; P < .001), whereas ER was systematically overestimated (50° ± 19° simulated vs. 36° ± 19° postoperatively; P < .001). Simulated abduction and ER highlighted a significant difference between Inlay-155° and Onlay-145° (12° ± 2°, P = .01, and 23° ± 3°, P < .001), and this was also retrieved clinically at the last follow-up (23° ± 2°, P = .02, and 22° ± 2°, P < .001).
Conclusions: This study is the first to evaluate the clinical relevance of predicted RoM for RSA preoperative planning. Motion that involves the scapulothoracic joint (AFE and abduction) is underestimated, while ER is overestimated. However, preoperative planning provides clinically relevant RoM prediction with a significant correlation between both and brings reliable data when comparing 2 different types of humeral implants (Inlay-155° and Onlay-145°) for abduction and ER. Thus, RoM simulation is a valuable tool to optimize implant selection and choose RSA implants to reach the optimal RoM.
Keywords: Reverse shoulder arthroplasty; clinical range of motion; inlay; modelization; onlay; prediction; preoperative planning.
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Total shoulder arthroplasty for primary glenohumeral osteoarthritis: does posterior humeral subluxation persist after correction of the glenoid version at 5 years minimum?
Total shoulder arthroplasty for primary glenohumeral osteoarthritis: does posterior humeral subluxation persist after correction of the glenoid version at 5 years minimum?
Total shoulder arthroplasty for primary glenohumeral osteoarthritis: does posterior humeral subluxation persist after correction of the glenoid version at 5 years minimum?
Marc-Olivier Gauci, Romain Ceccarelli,Vincent Lavoue, Mikael Chelli, Olivier A J van der Meijden, Jean-François Gonzalez, Pascal Boileau
Background: Primary glenohumeral osteoarthritis is associated with both excessive posterior humeral subluxation (PHS) and excessive glenoid retroversion in 40% of cases. These morphometric abnormalities are a particular issue because they may be responsible for a deterioration in long-term clinical and radiologic outcomes. The aim of this study was to perform a computed tomographic (CT) analysis of patients who underwent total shoulder arthroplasty (TSA) for primary osteoarthritis (OA) with B2-, B3-, or C-type glenoids in whom an attempt was made to correct for excessive glenoid retroversion and excessive posterior humeral subluxation intraoperatively.
Material: We performed a retrospective, single-center study including 62 TSA patients with a preoperative PHS of the glenohumeral joint (31 men, 31 women, 70 ± 9 years) between January 2000 and January 2014. Glenoids were classified as B2 (32 cases), B3 (13 cases), or C (17 cases). Glenoid retroversion was corrected by anterior asymmetric reaming. Patients were reviewed for clinical and CT scan assessment with a mean follow-up of 8.3 years (minimum 5 years). At final follow-up, the CT images were reconstructed in the scapular plane. A PHS index >65% defined persistence.
Results: The revision-free rate was estimated at 93%. Correlation between PHS and retroversion was moderate preoperatively (ρ = 0.58) and strong at final follow-up (ρ = 0.73). Postoperative CT scans on average showed a surgical correction of PHS compared to preoperatively (79% vs. 65% respectively, P < .05) and retroversion (20° vs. 10° respectively, P < .05). At final follow-up, 25 of 62 patients had a persistence in the 2-dimensional (2D) model and 41 of 62 in the corrected 2D model. Persistence of PHS had no influence on clinical outcomes but did demonstrate a significantly higher glenoid loosening rate (20% vs. 59%, P < .05).
Conclusion: Correlation between PHS and retroversion was moderate preoperatively and strengthened at long-term follow-up. Anterior asymmetric reaming allowed for a surgical improvement of both PHS and retroversion, but it was not sufficient to maintain a correction over time. Glenoid loosening was more frequent in case of PHS persistence but seemingly without clinical relevance.
Keywords: Anatomic total shoulder arthroplasty; B glenoid; biconcave glenoid; osteoarthritis; persistence; posterior humeral subluxation.
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Reliability of Angle Measurements Based on the Epiphyseal Scar for Knee Osteotomy: An International Multicenter Radiographic Study
Reliability of Angle Measurements Based on the Epiphyseal Scar for Knee Osteotomy: An International Multicenter Radiographic Study
Reliability of Angle Measurements Based on the Epiphyseal Scar for Knee Osteotomy: An International Multicenter Radiographic Study
Philipp Schippers, Matthieu Peras, Bernard de Geofroy, Philipp Drees, Erol Gercek, Marius Junker, Lolita Micicoi, Jean-François Gonzalez, Grégoire Micicoi
Background: The proximal tibial epiphyseal inclination can be used as a prognostic factor for good results after knee osteotomy and measured using the tibial bone varus angle (TBVA). This angle depends on the visibility of the epiphyseal plate, which has shown poor reproducibility when measured on standard radiographs by conventional methods.
Purpose: To evaluate the measurement reliability of the TBVA and other angles based on the epiphyseal scar using a digital image display.
Study design: Cohort study (diagnosis); Level of evidence, 3.
Methods: A total of 100 whole-leg radiographs were analyzed twice by 3 orthopaedic surgeons from 2 countries in a blinded and randomized manner. Observers measured the hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle, and TBVA. The growth plate-tibial plateau (GPTP) angle, defined as the angle between the epiphyseal scar and tibial plateau, was measured; this angle has not yet been described for osteotomy. In addition, a modified version of the TBVA (mTBVA), defined as that between the epiphyseal scar, its center, and the center of the talus, was measured. The Ahlbäck score for osteoarthritis and a 3-grade score for epiphyseal scar visibility were also determined. The reliability of the angle measurements and scoring was evaluated using the Fleiss kappa and intraclass correlation coefficient (ICC).
Results: The scores for epiphyseal scar visibility showed fair interobserver (Fleiss kappa correlation coefficient [κ] = 0.29-0.35) and strong intraobserver (Fleiss κ = 0.62-0.69) reliability. TBVA, GPTP angle, and mTBVA measurements showed good interobserver reliability (ICC, 0.76-0.77), while the GPTP angle achieved excellent intraobserver reliability (ICC, >0.9).
Conclusion: Using digital image display, angles that depend on the epiphyseal scar-such as TBVA, GPTP angle, and mTBVA-can achieve acceptable measurement reliability despite the low agreement on the visibility of the epiphyseal scar.
Keywords: angle; growth plate–tibial plateau; knee osteotomy; measurement reliability; modified tibial bone varus angle; planning; tibial bone varus angle.
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Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Descriptive Study With Minimum 10-Year Follow-up
Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Descriptive Study With Minimum 10-Year Follow-up
Anterior Cruciate Ligament Reconstruction in Patients Older Than 50 Years: A Descriptive Study With Minimum 10-Year Follow-up
Grégoire Micicoi, Rayan Fairag,Axel Machado, Adil Douiri, Nicolas Bronsard, Justin Ernat, Jean-François Gonzalez
Background: Anterior cruciate ligament (ACL) reconstruction is increasingly being performed in patients >50 years old; however, the long-term outcomes are unclear.
Purpose: To analyze the functional results, osteoarthritic progression, reoperation rate, and failure rate at minimum 10-year follow-up in patients >50 years old who have undergone primary ACL reconstruction.
Study design: Case series; Level of evidence, 4.
Methods: Included in this study were patients >50 years old who underwent primary ACL reconstruction and had at least 10 years of follow-up data. All patients had instability with limitation of their activities, indicating the necessity of surgical intervention. Patients with revision surgeries, ACL repairs, and nonoperative treatment were excluded. Failure was defined as the presence of revision, high-grade Lachman, positive pivot shift (2+), or subjective instability. The Knee injury and Osteoarthritis Outcome Score (KOOS), subjective and objective functional scores, and osteoarthritic progression were analyzed at final follow-up.
Results: A total of 38 patients were identified. The mean age at surgery was 56.8 ± 5.7 years (range, 50.6-70 years). The mean clinical follow-up was 16.2 ± 4.3 years (range, 10.9-23.3 years). The failure rate was 10.5% (4/38): 1 of the 4 patients had a recurrence of instability at 13 years postoperatively and underwent revision with a modified Lemaire extra-articular tenodesis, 1 patient had a positive pivot shift (2+) without subjective instability, and 2 patients underwent total knee arthroplasty. The overall KOOS was 74.2 ± 22.2, and 91.4% of patients were satisfied or very satisfied with the results of the procedure. Radiographic osteoarthritis was identified in 88.5% of patients at final follow-up; however, there was no statistical significance on clinical outcomes (P > .05). Concomitant partial medial meniscectomy (P < .01) and meniscal repair (P < .01) were associated with the presence of Ahlbäck grade 3 or 4 osteoarthritic manifestations.
Conclusion: In patients over the age of 50 years who underwent primary ACL reconstruction, there was a low long-term failure rate and a high level of patient satisfaction, despite osteoarthritic progression in 88.5% of cases. Concomitant meniscal procedures were associated with more severe osteoarthritic progression.
Keywords: 50 years old; ACL; failures; functional outcomes; long-term; osteoarthritis.
Avulsions of the retrospinal surface are rare injuries resulting from high-energy trauma. Displacement of this fracture frequently indicates a surgical treatment to restore posterior cruciate ligament function. Several approaches have been proposed in the literature, either open or arthroscopic, which can be tricky due to the fracture’s proximity to the popliteal vascular-nervous elements. Badet’s open approach is a medial trans-gastrocnemius approach, providing a direct access to the retro-spinal surface for osteosynthesis. In this technique, an L-shaped incision is made along precise skin lines, followed by discision of the muscle fibers. The capsule is then approached, allowing a view of the retro-spinal surface protected from the popliteal vasculo-nervous elements by the muscular lateral lip of the gastrocnemius. A reduction followed by screw osteosynthesis is usually performed, allowing early mobilization of the patient. In this technical note, we describe the Badet approach supporting by video and case series. LEVEL OF EVIDENCE: IV.
Background: Osteoporosis (OP) is a pathology characterized by bone fragility affecting 30% of postmenopausal women, mainly due to estrogen deprivation and increased oxidative stress. An autophagy involvement is suspected in OP pathogenesis but a definitive proof in humans remains to be obtained.
Methods: Postmenopausal women hospitalized for femoral neck fracture (OP group) or total hip replacement (Control group) were enrolled using very strict exclusion criteria. Western blot was used to analyze autophagy level.
Results: The protein expression level of the autophagosome marker LC3-II was significantly decreased in bone of OP patients relative to the control group. In addition, the protein expression of the hormonally upregulated neu-associated kinase (HUNK), which is upregulated by female hormones and promotes autophagy, was also significantly reduced in bone of the OP group.
Conclusions: These results demonstrate for the first time that postmenopausal OP patients have a deficit in bone autophagy level and suggest that HUNK could be the factor linking estrogen loss and autophagy decline.
Total blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approach
Total blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approach
Total blood loss after hip hemiarthroplasty for femoral neck fracture: Anterior versus posterior approach
Grégoire Micicoi, Bernard de Geofroy, Julien Chamoux, Ammar Ghabi, Marc-Olivier Gauci, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez
Introduction: Femoral neck fractures constitute a public health problem due to significant associated morbidity and mortality amongst the ageing population. Perioperative blood loss can increase this morbidity. Blood loss, as well as the influence that the surgical approach exerts on it, remains poorly evaluated. We therefore conducted a retrospective comparative study in order to: (1) compare total blood loss depending on whether the patients were operated on using an anterior or posterior approach, (2) compare the transfusion rates, operating times and hospital stays between these two groups and, (3) analyze dislocation rates.
Hypothesis: Total blood loss is greater from an anterior approach following a hip hemiarthroplasty for femoral neck fracture, compared to the posterior approach.
Material and methods: This retrospective single-center comparative study included 137 patients operated on by hip hemiarthroplasty between December 2020 and June 2021, and seven patients were excluded. One hundred and thirty patients were analyzed: 69 (53.1%) had been operated on via the anterior Hueter approach (AA) and 61 (46.9%) via the posterior Moore approach (PA). The analysis of total blood loss was based on the OSTHEO formula to collect perioperative « hidden » blood loss. The risk of early dislocation (less than 6 months) was also analyzed.
Results: Total blood loss was similar between the two groups, AA: 1626±506mL versus PA: 1746±692mL (p=0.27). The transfusion rates were also similar between the two groups, AA: 23.2% versus PA: 31.1% (p=0.31) as well as the duration of hospitalization, AA: 8.5±3.2 versus PA: 8.2±3.3 days (p=0.54). The operating time was shorter in the PA group (Δ=10.3±14.1minutes [p<0.001]) with a greater risk of early dislocation when the patient was operated on by PA with AA: 9.8% versus PA: 1.4% (p=0.03).
Conclusion: This study does not demonstrate any influence of the approach (anterior or posterior) on total blood loss. Transfusion rates and length of hospitalization were similar between the groups with a slightly shorter operating time but a greater risk of early dislocations after posterior hemiarthroplasty in a population at high anesthesia-related risk.
Level of proof: III, comparative study of continuous series.
Ultrasound-Guided Iliopsoas Tenotomy for Iliopsoas Tendon Impingement: Surgical Technique in Cadaveric Models
Ultrasound-Guided Iliopsoas Tenotomy for Iliopsoas Tendon Impingement: Surgical Technique in Cadaveric Models
Ultrasound-Guided Iliopsoas Tenotomy for Iliopsoas Tendon Impingement: Surgical Technique in Cadaveric Models
Pablo Froidefond, Rayan Fairag, Alexandre Rudel, Peter N Chalmers, Nicolas Bronsard, Régis Bernard de Dompsure, Jean-François Gonzalez, Grégoire Micicoi
Iliopsoas tendon impingement after total hip replacement has been reported with an incidence of up to 8.3%. Iliopsoas tendon impingement has also been observed in young active patients engaged in extreme sports. In such cases, surgical iliopsoas tendon release or tenotomy may be considered to improve anterior hip pain and function. Currently, iliopsoas tenotomy is performed either in an open manner or arthroscopically. This article describes a surgical technique using percutaneous ultrasound-guided iliopsoas tenotomy in cadaveric models. We perform the release at the acetabulum because it is safe and provides good sonographic visualization. This study describes the effectiveness of percutaneous iliopsoas tendon tenotomy under ultrasound guidance. However, clinical studies are warranted to confirm these findings. This minimally invasive procedure opens opportunities for clinical applications, comparing outcomes with those of standard approaches and conducting cost analyses. It may offer a cost-effective outpatient clinic option with local anesthesia, avoiding operating room expenses.
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Ultrasound-Guided Percutaneous Fasciotomies for Patients With Chronic Exertional Compartment Syndrome
Ultrasound-Guided Percutaneous Fasciotomies for Patients With Chronic Exertional Compartment Syndrome
Ultrasound-Guided Percutaneous Fasciotomies for Patients With Chronic Exertional Compartment Syndrome
Axel Machado, Tristan Fauchille, Rayan Fairag, Jonathan Cornacchini, Nicolas Bronsard, Nicolas Ciais, Jean-François Gonzalez,Alexandre Rudel, Grégoire Micicoi
Chronic exertional compartment syndrome is a well-described potential cause of leg pain in high-level athletes and soldiers. Surgical treatment of chronic exertional compartment syndrome usually involves fasciotomy, with a reported rate of complications of up to 16%, including failure of complete compartmental release and delayed return to normal daily activity, which can take up to 6 to 12 weeks. The use of a minimally invasive approach under ultrasound guidance seems to improve clinical outcomes in young active patients. We recommend the following steps for effective execution of ultrasound-guided percutaneous fasciotomy: (1) location of the compartmental fascia and identification of the superficial peroneal nerve, (2) skin incision, (3) insertion of a hook under the compartmental fascia, and (4) sectioning of the fascia.
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Restoring the Preoperative Phenotype According to the Coronal Plane Alignment of the Knee Classification After Total Knee Arthroplasty Leads to Better Functional Results
Restoring the Preoperative Phenotype According to the Coronal Plane Alignment of the Knee Classification After Total Knee Arthroplasty Leads to Better Functional Results
Restoring the Preoperative Phenotype According to the Coronal Plane Alignment of the Knee Classification After Total Knee Arthroplasty Leads to Better Functional Results
Background: Mechanical alignment after total knee arthroplasty (TKA) is still widely used in the surgical community, but the alignment finally obtained by conventional techniques remains uncertain. The recent Coronal Plane Alignment of the Knee (CPAK) classification distinguishes 9 knee phenotypes according to constitutional alignment and joint line obliquity (JLO). The aim of this study was to assess the phenotypes of osteoarthritic patients before and after TKA using mechanical alignment and to analyze the influence of CPAK restoration on functional outcomes.
Methods: This retrospective multicenter study included 178 TKAs with a minimum follow-up of 2 years. Patients were operated on using a conventional technique with the goal of neutral mechanical alignment. The CPAK grade (1 to 9), considering the arithmetic Hip-Knee-Ankle angle (aHKA) and the JLO, was determined before and after TKA. Functional results were assessed using the following patient-reported outcome measures: Knee Injury and Osteoarthritis Outcome Score, the Simple Knee Value, and the Forgotten Joint Score.
Results: A true neutral mechanical alignment was obtained in only 37.1%. Isolated restoration of JLO was found in 31.4%, and isolated restoration of the aHKA in 44.9%. Exact restoration of the CPAK phenotype was found in 14.6%. Restoration of the CPAK grade was associated with an improvement in the « daily living »: 79.2 ± 5.3 versus 62.5 ± 2.3 (R2 = 0.05, P < .05) and « Quality of life » Knee Injury and Osteoarthritis Outcome Score subscales: 73.8 ± 5.0 versus 62.9 ± 2.2 (R2 = 0.02, P < .05).
Conclusions: This study shows that few neutral mechanical alignments are finally obtained after TKA by conventional technique. A major number of patients present a postoperative modification of their constitutional phenotype. Functional results at 2 years of follow-up appear to be improved by the restoration of the CPAK phenotype, JLO, and aHKA.
Level of clinical art evidence: III, Retrospective Cohort Study.
Background: Acute compartment syndrome (ACS) of the lower limbs is a function-threatening event usually managed by extended dermofasciotomy. Closure of the skin may be delayed, creating a risk of complications when there is an underlying fracture. Early treatment at the pre-ACS stage might allow isolated fasciotomy with no skin incision. The primary objective of this study was to compare intracompartmental pressure (ICP) changes after fasciotomy and after dermofasciotomy. The secondary objectives were to evaluate potential associations linking the starting ICP to achievement of an ICP below the physiological cut-off of 10mm Hg and to determine whether the ICP changes after fasciotomy and dermofasciotomy varied across muscle compartments.
Hypothesis: Fasciotomy with no skin incision may not provide a sufficient ICP decrease, depending on the initial ICP value.
Material and methods: A previously validated model of cadaver ACS of the lower limbs was used. Saline was injected gradually to raise the ICP to>15mmHg (ICP15), >30mmHg (ICP30), and >50mmHg (ICP50). We studied 70 leg compartments (anterior, lateral, and superficial posterior) in 13 cadavers (mean age, 89.1±4.6years). ICP was monitored continuously. Percutaneous, minimally invasive fasciotomy consisting in one to three 1-cm incisions was performed in each compartment. ICP was measured before and after fasciotomy then after subsequent skin incision. The objective was to decrease the ICP below 10mmHg after fasciotomy or dermofasciotomy.
Results: Overall, mean ICP was 37.8±19.1mmHg after the injection of 184.0±133.01mL of saline. In the ICP15 group, the mean ICP of 16.1mmHg fell to 1.4mmHg after fasciotomy (ΔF=14.7) and 0.3mmHg after dermofasciotomy (ΔDF=1.1). Corresponding values in the ICP30 group were 33.9mmHg, 4.7mmHg (ΔF=29.2), and 1.2mmHg (ΔDF=3.5); and in the ICP50 group, 63.7mmHg, 17.0mmHg (ΔF=46.7), and 1.2mmHg (ΔDF=15.8). Thus, in the group with initial pressures >50mmHg, the ICP decrease was greater after both procedures, but fasciotomy alone nonetheless failed to achieve physiological values (<10mmHg). The pressure changes were not significantly associated with the compartment involved (anterior, lateral, or superficial posterior) (p<0.05).
Conclusion: Under the conditions of this study, higher baseline ICPs were associated with larger ICP drops after fasciotomy and dermofasciotomy. Nevertheless, when the baseline ICP exceeded 50mmHg, fasciotomy alone failed to decrease the ICP below 10mmHg. Adding a skin incision achieved this goal.
Can hip function be assessed with self-report questionnaires? Feasibility study of a French self-report version of the Harris Hip and Merle d'Aubigné scores
Can hip function be assessed with self-report questionnaires? Feasibility study of a French self-report version of the Harris Hip and Merle d'Aubigné scores
Can hip function be assessed with self-report questionnaires? Feasibility study of a French self-report version of the Harris Hip and Merle d’Aubigné scores
Bernard de Geofroy, Ammar Ghabi, Joseph Attas, Lolita Micicoi, Michael Lopez, Régis Bernard de Dompsure, Jean-François Gonzalez, Grégoire Micicoi
Introduction: The Harris Hip Score (HHS) and the Merle D’Aubigné Postel (MDP) score both provide an objective and subjective evaluation of hip function. These scores are collected during the follow-up of patients who have a hip disease. The objectives of this prospective study were (1) to analyze the differences between the two new French self-report versions of the HHS and MDP, and the traditional surgeon-assessed HHS and MDP; (2) to analyze the correlation between the self-report HHS and MDP and the surgeon-assessed HHS and MDP; (3) to analyze the floor and ceiling effects of the two self-report scores and the reliability of these self-report scores in operated and non-operated patients.
Hypothesis: The French self-report HHS and MDP are sufficiently reliable to accurately estimate the patient’s objective and subjective outcomes compared to the clinical examination done by a surgeon.
Methods: A prospective multicenter study was done with patients who had a hip disease. Two self-report questionnaires were completed by the patient, independently of the clinical examination done by the surgeon. The questionnaires were in French and consisted solely of checkboxes, with sample photos that corresponded to the various range of motion items in the HHS and MDP. The agreement between the self-report scores and the surgeon-assessed scores were evaluated using the intraclass correlation coefficient (ICC). Differences in the mean values were evaluated with a paired t test.
Results: The analysis involved 89 patients. The self-report HHS was 2.7±3.7 points (/100) lower than the surgeon-assessed HHS, but this difference was not statistically significant (p=0.34). The self-report MDP was significantly less by 1.2±2.9 points (/18) than the surgeon-assessed MDP (p=0.01). The agreement between the self-report HSS and the surgeon-assessed HSS was excellent (ICC=0.86) as was the one between the self-report MDP and the surgeon-assessed MDP (ICC=0.75). There was a strong positive correlation between the surgeon-assessed and self-report HHS in operated patients (ICC= 0.84; R=0.75; p<0.001) and in non-operated patients (ICC=0.96; R=0.89; p<0.001). This positive correlation was also found between the surgeon-assessed and self-report MDP for operated patients (ICC=0.73; R=0.62; p<0.001) and non-operated patients (ICC=0.79; R=0.64; p<0.001). A ceiling effect (maximum of 100 points) was found in 22% of patients (20/89) for the self-report HHS and in 34% of patients (30/89) for the self-report MDP (maximum of 18 points). No floor effect was observed for either questionnaire.
Conclusion: The French version of the HHS self-report questionnaire is an excellent overall estimator of the HHS score for patients with hip osteoarthritis or fracture, whether operated or not. The addition of the MDP, whose self-report version is less accurate, is also a reliable tool. These self-report questionnaires, when validated on a larger scale, will be useful for the long-term follow-up of patients undergoing hip arthroplasty.
Level of evidence: III; prospective diagnostic study.
Validation of the shoulder range of motion software for measurement of shoulder ranges of motion in consultation: coupling a red/green/blue-depth video camera to artificial intelligence
Validation of the shoulder range of motion software for measurement of shoulder ranges of motion in consultation: coupling a red/green/blue-depth video camera to artificial intelligence
Validation of the shoulder range of motion software for measurement of shoulder ranges of motion in consultation: coupling a red/green/blue-depth video camera to artificial intelligence
Marc-Olivier Gauci, Manuel Olmos, Caroline Cointat, Pierre-Emmanuel Chammas, Manuel Urvoy, Albert Murienne, Nicolas Bronsard, Jean-François Gonzalez
Purpose: Clinical evaluation of the shoulder range of motion (RoM) may vary significantly depending on the surgeon. We aim to validate an automatic shoulder RoM measurement system associating image acquisition by an RGB-D (red/green/blue-depth) video camera to an artificial intelligence (AI) algorithm.
Methods: Thirty healthy volunteers were included. A 3D RGB-D sensor that simultaneously generated a colour image and a depth map was used. Then, an open-access convolutional neural network algorithm that was programmed for shoulder recognition provided a 3D motion measure. Each volunteer adopted a randomized position successively. For each position, two observers made a visual (EyeREF) and goniometric measurement (GonioREF), blind to the automated software which was implemented by an orthopaedic surgeon. We evaluated the inter-tester intra-class correlation (ICC) between observers and the concordance correlation coefficient (CCC) between the three methods.
Results: For manual evaluations EyeREF and GonioREF, ICC remained constantly excellent for the widest motions in the vertical plane (i.e., abduction and flexion). It was very good for ER1 and IR2 and fairly good for adduction, extension, and ER2. Differences between the measurements’ means of EyeREF and shoulder RoM was significant for all motions. Compared to GonioREF, shoulder RoM provided similar results for abduction, adduction, and flexion and EyeREF provided similar results for adduction, ER1, and ER2. The three methods showed an overall good to excellent CCC. The mean bias between the three methods remained under 10° and clinically acceptable.
Conclusion: RGB-D/AI combination is reliable in measuring shoulder RoM in consultation, compared to classic goniometry and visual observation.
Keywords: Artificial intelligence; Automatic clinical assessment; Goniometer comparison; Markerless sensor; Range of motion; Shoulder.
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Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty
Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty
Restoration of preoperative tibial alignment improves functional results after medial unicompartmental knee arthroplasty
Lolita Micicoi, Axel Machado, Justin Ernat, Philipp Schippers, Régis Bernard de Dompsure, Nicolas Bronsard, Jean-François Gonzalez, Grégoire Micicoi
Purpose: The alignment obtained after unicompartmental knee arthroplasty (UKA) influences the risk of failure. Kinematic alignment after UKA based on Cartier angle restauration is likely to improve clinical outcomes compared with mechanical alignment. The purpose of this study is to analyze the influence of implant alignment and native knee restoration after UKA using the conventional techniques on clinical outcomes.
Methods: This retrospective study included 144 medial UKA patients from 2015 to 2020. Radiographic measurements were performed pre- and postoperatively. Outliers were defined as follows: Δ Cartier > 3° (difference between the preoperative and postoperative Cartier angle); Δ MPTA (Medial Proximal Tibial angle) and postoperative TCA (Tibial Coronal component Angle) > 3° (difference between the positioning of the tibial implant and the preoperative proximal tibial deformity). The Knee injury and Osteoarthritis Outcome Score (KOOS), the International Knee Society (IKS) Function and Knee score, the Forgotten Joint Score (FJS), and the Subjective Knee Value (SKV) were evaluated. A Student t test or a non-parametric Wilcoxon test was used for non-normal data to compare pre- and postoperative values for functional scores and angular measurements. The correlation of postoperative angles with functional outcomes was assessed by the Spearman’s rank correlation coefficient.
Results: During the inclusion period, 214 patients underwent medial UKA, 71 patients were excluded, and 19 were lost to follow-up leaving 124 patients with 144 knees (20 bilateral UKA) included for analysis with a mean follow-up of 54.7 months ± 22.1 (24-95). The Δ Cartier was significantly correlated with IKS function (R2 = 0.06, p < 0.001) and FJS (R2 = 0.05, p < 0.01) scores. The Δ preoperative MPTA-TCA was significantly correlated (p < 0.001) with KOOS (R2 = 0.38), IKS Knee (R2 = 0.17), IKS function (R2 = 0.34), SKV (R2 = 0.08), and FJS (R2 = 0.37) scores. In subgroup analysis, non-outliers (< 3°) for Δ preoperative MPTA-TCA had better KOOS score (Δ = 23.5, p < 0.001) and IKS Function (Δ = 17.7, p < 0.001) compared to outliers (> 3°) patients.
Conclusion: Functional results after medial UKA can be influenced by implant alignment in the coronal plane with slight clinical improvement when positioning the tibial implant close to the preoperative tibial deformity, rather than by restoring the Cartier angle. This series suggests the interest of a more personalized alignment strategy, but these results will have to be confirmed by other controlled studies.
Introduction: On the 16th of March 2020, in the face of a health emergency declared in France, the government imposed containment measures whose impact on orthopaedic and trauma surgery remains to be demonstrated. The hypothesis of this study was that confinement reduced orthopaedic and trauma surgical activity. The main objective was to assess orthopaedic and trauma surgical activity during confinement and to compare it to the activity outside confinement.
Materials and methods: This was a retrospective, monocentric, observational and comparative study of a continuous cohort of patients included during the confinement period of March 16th to May 11th, 2020. This cohort was retrospectively compared to a group of patients over the same non-confinement period in the previous year, from March 16th to May 11th, 2019. The primary outcome measured was the incidence rate of surgical activity in 2020 versus 2019 over an identical period. The secondary outcome was the analysis of the trauma identified.
Results: The number of patients operated on was significantly reduced during confinement: 194 patients were included in 2020, i.e. an incidence of 57 per 100,000 inhabitants against 772 patients included in 2019, i.e. an incidence of 227 per 100,000 inhabitants; p<0.001. Planned orthopaedic surgery decreased from an incidence rate of 147 in 2019 to 5 in 2020 per 100,000 inhabitants (p<0.001). Trauma surgery decreased from an incidence rate of 80 in 2019 to 50 in 2020 per 100,000 inhabitants (p: NS). We found a significant increase in patients over 65years of age during confinement, 70% compared to 61% in 2019; p=0.04. The rate of femoral neck fractures was significantly increased during confinement, 48.5% compared to 39.3% in 2019; p=0.03. Degenerative surgery was significantly reduced during confinement (p<0.001).
Discussion: This study shows that the surgical activity of orthopaedics and trauma was significantly reduced by confinement, with a difference in incidence of 170 per 100,000 inhabitants, thus confirming the hypothesis of the authors. This decrease is due to both the cessation of planned orthopaedics and the 40% decrease in the number of trauma patients. During confinement, the percentage of patients over the age of 65 with a fracture increased significantly.
Conclusion: Confinement had a significant impact on orthopaedic and trauma surgical activity.
Level of evidence: III; comparative and retrospective.
Purpose: To evaluate the efficacy and safety of embolization of hyperemic synovial tissue for the treatment of persistent pain after total knee arthroplasty (TKA).
Materials and methods: Twelve patients with persistent pain after TKA were enrolled in this prospective, single-center pilot study. Genicular artery embolization (GAE) was performed using 75-μm spherical particles. The patients were assessed using a 100-point Visual Analog Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline and 3 and 6 months thereafter. Adverse events were recorded at all time points.
Results: A mean of 1.8 ± 0.8 abnormal hyperemic genicular arteries were identified and embolized, with a median volume of diluted embolic material of 4.3 mL in all 12 (100%) patients. The mean VAS score on walking improved from 73 ± 16 at baseline to 38 ± 35 at the 6-month follow-up (P < .05). The mean KOOS pain score improved from 43.6 ± 15.5 at baseline to 64.6 ± 27.1 at the 6-month follow-up (P < .05). At the 6-month follow-up, 55% and 73% of the patients attained a minimal clinically important change in pain and quality of life, respectively. Self-limited skin discoloration occurred in 5 (42%) patients. The VAS score increased by more than 20 immediately after embolization in 4 (30%) patients, who required analgesic treatment for 1 week.
Conclusions: GAE is a safe method of treating persistent pain after TKA that demonstrates potential efficacy at 12 months.
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.
Access provided by Nice University Hospital, Hospital of Cimiez, documentation service
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Glomus tumor of the scapular neck with axillary nerve compression at the shoulder. A case report
Glomus tumor of the scapular neck with axillary nerve compression at the shoulder. A case report
Background: Glomus tumors, also known as benign acral tumors are extremely rare. Previous glomus tumors from other regions of the body have been linked to neurological compression symptoms, however axillary compression at the scapular neck has never been described.
Case presentation: Here, we report a case of axillary nerve compression in a 47-year-old man, secondary to a glomus tumor of the neck of the right scapula, initially misdiagnosed with biceps tenodesis performed and no pain improvement. The magnetic resonance imaging demonstrated a well-contoured, 12 mm tumefaction at the inferior pole of the scapular neck T2-hyperintense and T1-isointense and interpreted as a neuroma. An axillary approach allowed the dissection of the axillary nerve, and the tumor was completely removed. The pathological anatomical analysis resulted in a nodular red lesion measuring 14 × 10 mm, delimited and encapsulated with a definitive diagnostic of glomus tumor. The neurologic symptoms and pain disappeared 3 weeks after surgery and the patient reported satisfaction with the surgical procedure. After 3 months, the results remain stable with a complete resolution of the symptoms.
Conclusions: In cases of unexplained and atypical pain in the axillary area, and to avoid potential misdiagnoses and inappropriate treatments, an in-depth exploration for a compressive tumor should be performed as a differential diagnosis.
Validation of the shoulder range of motion software for measurement of shoulder ranges of motion in consultation: coupling a red/green/blue-depth video camera to artificial intelligence
Validation of the shoulder range of motion software for measurement of shoulder ranges of motion in consultation: coupling a red/green/blue-depth video camera to artificial intelligence
Purpose: Clinical evaluation of the shoulder range of motion (RoM) may vary significantly depending on the surgeon. We aim to validate an automatic shoulder RoM measurement system associating image acquisition by an RGB-D (red/green/blue-depth) video camera to an artificial intelligence (AI) algorithm.
Methods: Thirty healthy volunteers were included. A 3D RGB-D sensor that simultaneously generated a colour image and a depth map was used. Then, an open-access convolutional neural network algorithm that was programmed for shoulder recognition provided a 3D motion measure. Each volunteer adopted a randomized position successively. For each position, two observers made a visual (EyeREF) and goniometric measurement (GonioREF), blind to the automated software which was implemented by an orthopaedic surgeon. We evaluated the inter-tester intra-class correlation (ICC) between observers and the concordance correlation coefficient (CCC) between the three methods.
Results: For manual evaluations EyeREF and GonioREF, ICC remained constantly excellent for the widest motions in the vertical plane (i.e., abduction and flexion). It was very good for ER1 and IR2 and fairly good for adduction, extension, and ER2. Differences between the measurements’ means of EyeREF and shoulder RoM was significant for all motions. Compared to GonioREF, shoulder RoM provided similar results for abduction, adduction, and flexion and EyeREF provided similar results for adduction, ER1, and ER2. The three methods showed an overall good to excellent CCC. The mean bias between the three methods remained under 10° and clinically acceptable.
Conclusion: RGB-D/AI combination is reliable in measuring shoulder RoM in consultation, compared to classic goniometry and visual observation.
Keywords: Artificial intelligence; Automatic clinical assessment; Goniometer comparison; Markerless sensor; Range of motion; Shoulder.
Background: Few studies have investigated postoperative tendon integrity after reoperation for failed rotator cuff repair. The purpose of this study was to evaluate the anatomic and clinical outcomes of arthroscopic revision rotator cuff repair (AR-RCR) and identify the risk factors related to re-retear.
Methods: Sixty-nine consecutive patients (mean age, 55 years) with primary failed open (38%) or arthroscopic (62%) cuff repairs underwent AR-RCR and were reviewed regarding clinical examination findings and imaging studies. Patients with massive cuff tears and upward humeral migration (acromiohumeral distance < 6 mm) or glenohumeral osteoarthritis were excluded. Revision repair was performed by a single, experienced shoulder surgeon. Complete footprint coverage was achieved in all cases using a single-row (70%), double-row (19%), or side-to-side (11%) technique. The primary outcome measure was tendon healing assessed with magnetic resonance imaging (57 cases) or computed tomography arthrogram (12 cases) performed at minimum 1-year follow-up. Secondary outcome measures included functional outcome scores, subjective results, and complications. The mean follow-up period was 43 months (range, 12-136 months).
Results: The cuff tendons did not heal to the tuberosity in 36% of the shoulders (25 of 69) following revision cuff surgery. Absence of tendon healing was associated with poorer shoulder function (average Constant score, 69 ± 20 vs. 54 ± 18; P = .003) and a decreased Subjective Shoulder Value (72% vs. 54%, P = .002). Factors that were negatively associated with tendon healing were age ≥ 55 years (odds ratio [OR], 4.5 [95% confidence interval, 1.6-12.5]; P = .02), tendon retraction of stage 2 or higher (OR, 4.4 [95% confidence interval, 1.4-14.3]; P = .01), and fatty infiltration index > 2 (OR, 10.2; P < .0001). No differences in retear rates were found between single-row and double-row cases. In 36 shoulders, tissue samples were harvested and submitted for bacteriologic culture analysis; 13 (36%) showed positive findings for infection (Cutibacterium acnes in 12 of 13) and associated antibiotic treatment was given. Overall, 25% of patients had unsatisfactory clinical results and 22% were disappointed or dissatisfied. At last follow-up, 4 patients (5.7%) underwent reoperations, with a second AR-RCR in 1 and conversion to reverse shoulder arthroplasty in 3.
Conclusion: Despite careful patient selection and intraoperative complete footprint coverage, in this study the tendons did not heal to bone in 36% of cases after revision cuff surgery. The absence of tendon healing is associated with poorer clinical and subjective results. Patients aged ≥ 55 years and patients with larger tears (stage 2 or higher) and/or muscle fatty infiltration (fatty infiltration index > 2) have significantly lower rates of healing. Surgeons should be aware that structurally failed cuff repair may also be associated with low-grade infection.
Background: Glomus tumors, also known as benign acral tumors are extremely rare. Previous glomus tumors from other regions of the body have been linked to neurological compression symptoms, however axillary compression at the scapular neck has never been described.
Case presentation: Here, we report a case of axillary nerve compression in a 47-year-old man, secondary to a glomus tumor of the neck of the right scapula, initially misdiagnosed with biceps tenodesis performed and no pain improvement. The magnetic resonance imaging demonstrated a well-contoured, 12 mm tumefaction at the inferior pole of the scapular neck T2-hyperintense and T1-isointense and interpreted as a neuroma. An axillary approach allowed the dissection of the axillary nerve, and the tumor was completely removed. The pathological anatomical analysis resulted in a nodular red lesion measuring 14 × 10 mm, delimited and encapsulated with a definitive diagnostic of glomus tumor. The neurologic symptoms and pain disappeared 3 weeks after surgery and the patient reported satisfaction with the surgical procedure. After 3 months, the results remain stable with a complete resolution of the symptoms.
Conclusions: In cases of unexplained and atypical pain in the axillary area, and to avoid potential misdiagnoses and inappropriate treatments, an in-depth exploration for a compressive tumor should be performed as a differential diagnosis.
Introduction: On the 16th of March 2020, in the face of a health emergency declared in France, the government imposed containment measures whose impact on orthopaedic and trauma surgery remains to be demonstrated. The hypothesis of this study was that confinement reduced orthopaedic and trauma surgical activity. The main objective was to assess orthopaedic and trauma surgical activity during confinement and to compare it to the activity outside confinement.
Materials and methods: This was a retrospective, monocentric, observational and comparative study of a continuous cohort of patients included during the confinement period of March 16th to May 11th, 2020. This cohort was retrospectively compared to a group of patients over the same non-confinement period in the previous year, from March 16th to May 11th, 2019. The primary outcome measured was the incidence rate of surgical activity in 2020 versus 2019 over an identical period. The secondary outcome was the analysis of the trauma identified.
Results: The number of patients operated on was significantly reduced during confinement: 194 patients were included in 2020, i.e. an incidence of 57 per 100,000 inhabitants against 772 patients included in 2019, i.e. an incidence of 227 per 100,000 inhabitants; p<0.001. Planned orthopaedic surgery decreased from an incidence rate of 147 in 2019 to 5 in 2020 per 100,000 inhabitants (p<0.001). Trauma surgery decreased from an incidence rate of 80 in 2019 to 50 in 2020 per 100,000 inhabitants (p: NS). We found a significant increase in patients over 65years of age during confinement, 70% compared to 61% in 2019; p=0.04. The rate of femoral neck fractures was significantly increased during confinement, 48.5% compared to 39.3% in 2019; p=0.03. Degenerative surgery was significantly reduced during confinement (p<0.001).
Discussion: This study shows that the surgical activity of orthopaedics and trauma was significantly reduced by confinement, with a difference in incidence of 170 per 100,000 inhabitants, thus confirming the hypothesis of the authors. This decrease is due to both the cessation of planned orthopaedics and the 40% decrease in the number of trauma patients. During confinement, the percentage of patients over the age of 65 with a fracture increased significantly.
Conclusion: Confinement had a significant impact on orthopaedic and trauma surgical activity.
Level of evidence: III; comparative and retrospective.
Introduction: In patients aged over-50 years, although data are sparse, results of anterior cruciate ligament (ACL) surgery are good if selection is correctly performed. However, non-operative treatment is usually proposed for this age group, as patients generally prefer just to scale down their sports activities. Non-operative results are acceptable, but with a high risk of residual instability, secondary lesions and lifestyle alteration. The main aim of the present study was to compare results between surgical versus non-surgical treatment of ACL tear in over-50 year-olds. Secondary objectives comprised assessing prognostic factors for poor functional outcome, and comparing the 2 groups epidemiologically to identify clinical decision-making factors. The study hypothesis was that results are comparable between operative and non-operative treatment of ACL tear.
Material and method: Three hundred twenty patients were followed up prospectively: 92 non-surgical (NS group) and 288 surgical (S group). Classical epidemiological data were collected. Clinical laxity, differential laximetry, KOOS, IKDC, Tegner and ACL-RSI scores and radiologic assessment were collected pre- and postoperatively, as were intraoperative data. Early and late complications were collected.
Results: All patients were followed up. Patients were principally female, and were older, less athletic, with more stable knee and less severe functional impact in the NS group. Functional scores improved in both groups, and especially in group S, where sports scores were also better. In the NS group, laximetry at follow-up correlated with preoperative marked pivot-shift (p=0.024). Severe differential laxity was predictive of poor IKDC score (p=0.06). In the S group, laximetry at follow-up correlated with preoperative explosive pivot-shift (p<0.001), lateral meniscal lesion (p=0.007), use of hamstring tendon (p=0.007), and non-operated early complications (p=0.004). Factors for poor global KOOS score in group S comprised female gender (p<0.001), high BMI (p<0.001) and skiing (p=0.038). Factors for poor Tegner scores comprised skiing or team sport (p<0.05), isolated moderate medial osteoarthritis (p=0.01), and non-operated early complications (p=0.022). Factors for poor IKDC score comprised female gender (p=0.064), and non-operated early complications (p=0.019). Complications did not differ between groups.
Discussion/conclusion: Results were satisfactory in both groups, with significant improvement in functional scores, but were better in group S. For NS patients, pivot sport was barely feasible and sports activity scores decreased. In case of severe laxity at diagnosis, surgical treatment should be proposed.
Level of evidence: III; non-randomized prospective comparative series.
Background: Prosthetic joint infections (PJI) are one of the most serious complication of arthroplasty. The management of PJI needs a multidisciplinary collaboration between orthopaedic surgeon, infectious disease specialist and microbiologist. In France, the management of PJI is organized around reference centres (CRIOACs). Our main objective was to perform an audit through a questionnaire survey based on clinical cases, to evaluate how French physicians manage PJI. Eligible participants were all physicians involved in care of patients presenting a PJI. Physicians could answer individually, or collectively during a multidisciplinary team meeting dedicated to PJI. The survey consisted as three questionnaires organized in a total of six clinical cases.
Results: Answers from the CRIOACs to the three questionnaires were 92, 77, and 53%. Between 32 and 39% of respondents did not administer antibiotic prophylaxis despite positive S. aureus pre-operative documentation. One-stage exchange strategy was widely preferred in all clinical cases, with no difference between CRIOACs and other centres. Rifampicin was prescribed for S. aureus PJI, in a situation with (90-92%) or without any prosthesis (70%). There was no consensus for the total antibiotic regimen duration, with prescriptions from six to 12 weeks for a majority of respondents.
Conclusions: Surgical strategy for the management of PJI was homogenous with a preference for a one-stage exchange strategy. Medical management was more heterogenous, which reflects the heterogeneity of those infections and difficulties to perform studies with strong conclusions.
Female gender and medial meniscal lesions are associated with increased pain and symptoms following anterior cruciate ligament reconstruction in patients aged over 50 years
Female gender and medial meniscal lesions are associated with increased pain and symptoms following anterior cruciate ligament reconstruction in patients aged over 50 years
Purpose: Several studies report satisfactory clinical outcomes following ACLR in older patients, but none evaluated the effects of meniscal and cartilage lesions. The aim was to evaluate the influence of meniscal and cartilage lesions on outcomes of ACLR in patients aged over 50 years.
Methods: The authors prospectively collected records of 228 patients that underwent primary ACLR, including demographics, time from injury to surgery, whether injuries were work related, and sports level (competitive, recreational, or none). At a minimum follow-up of 6 months, knee injury and osteoarthritis outcome scores (KOOS), International Knee Documentation Committee (IKDC) score and Tegner activity level were recorded, and differential laxity was measured as the side-to-side difference in anterior tibial translation (ATT) using instrumented laximetry devices. Regression analyses were performed to determine associations between outcomes and meniscal and cartilage lesions as well as nine independent variables.
Results: A total of 228 patients aged 54.8 ± 4.3 years at index ACLR were assessed at a follow-up of 14.3 ± 3.8 months. KOOS subcomponents were 85 ± 13 for symptoms, 91 ± 10 for pain, 75 ± 18 for daily activities, 76 ± 18 for sport, and 88 ± 12 for quality of life (QoL). The IKDC score was A for 84 (37%) knees, B for 96 (42%) knees, C for 29 (13%) knees, and D for 8 (4%) knees. Tegner scores showed a decrease (median 0, range -4 to 4) and differential laxity also decreased (median – 4, range – 23.5 to 6.0). KOOS symptoms worsened with higher BMI (p = 0.038), for women (p = 0.007) and for knees that had medial meniscectomy (p = 0.029). KOOS pain worsened with higher BMI (p ≤ 0.001), for women (p = 0.002) and for knees with untreated (p = 0.047) or sutured (p = 0.041) medial meniscal lesions. Differential laxity increased with follow-up (p = 0.024) and in knees with lateral cartilage lesions (p = 0.031).
Conclusion: In primary ACLR for patients aged over 50 years, female gender and medial meniscal lesions significantly compromised KOOS symptoms and pain, while lateral cartilage lesions significantly increased differential laxity. Compared to knees with an intact medial meniscus, those with sutured or untreated medial meniscal lesions had worse pain, while those in which the medial meniscus was resected had worse symptoms. These findings are clinically relevant as they could help surgeons with patient selection and adjusting expectations according to their functional demands.
We report a case of a pyrocarbon humeral head resurfacing implant fracture, occurring 6 years after its implantation, without any obvious trauma or dislocation. Initial radiographs showed a proud and oversized pyrocarbon resurfacing implant. On clinical examination, the patient had a painful and pseudoparalyzed shoulder with subscapularis insufficiency. Imaging studies confirmed implant fracture and severe fatty infiltration (Goutallier, grade 4) of the subscapularis muscle. Intraoperatively, the implant was found to be fractured with multiple pyrocarbon debris in the glenohumeral joint. The implant was loose, and gross inspection showed no visible bony adhesion or ongrowth. Histologic analysis showed multiple seats of metallosis in the synovial tissue and cancellous bone of the humeral head. Successful management of this complication was managed with a thorough débridement and irrigation and revision to reverse shoulder arthroplasty. Our observation put into question the use of pyrocarbon as a humeral head resurfacing implant. The material seems to be too fragile to be used as a resurfacing implant and cannot achieve fixation of the implant to bone.
Background: The treatment of severe proximal humeral bone loss (PHBL) secondary to tumor resection or failed arthroplasty is challenging. We evaluated the outcomes and complications of reconstruction with reverse shoulder-allograft prosthesis composite (RS-APC), performed with or without tendon transfer.
Methods: An RS-APC procedure was performed in 25 consecutive patients with severe PHBL (>4 cm): 12 after failed reverse shoulder arthroplasty, 5 after failed hemiarthroplasty for fracture, 6 after failed mega-tumor prosthesis placement, and 2 after tumor resection. The median length of humeral bone loss or resection was 8 cm (range, 5-23 cm). Humeral bone graft fixation was obtained with a long monobloc reverse stem and a « mirror step-cut osteotomy, » without plate fixation. Nine infected shoulders underwent a 2-stage operation with a temporary cement spacer. In addition, 9 patients (36%) underwent an associated L’Episcopo procedure. The median follow-up duration was 4 years (range, 2-11 years).
Results: Overall, 76% of patients (19 of 25) were satisfied. In 8 patients (32%), a reoperation was needed. At last follow-up, we observed incorporation at the allograft-host junction in 96% of the cases (24/25); partial graft resorption occurred in 3 cases and severe in 1. The median adjusted Constant score was 53% (range 18-105); Subjective Shoulder Value, 50% (range 10%-95%). Additional tendon transfers significantly improved active external rotation (20° vs. 0°, P < .001) and forward elevation (140° vs. 90°, P = .045).
Conclusions: (1) Shoulder reconstruction with RS-APC provides acceptable shoulder function and high rates of graft survival and healing. (2) Additional L’Episcopo tendon transfer (when technically possible) improves active shoulder motion. (3) The use of a long monobloc (cemented or uncemented) humeral reverse stem with mirror step-cut osteotomy provides a high rate of graft-host healing, as well as a limited rate of graft resorption, and precludes the need for additional plate fixation. (4) Although rewarding, this reconstructive surgery is complex with a high risk of complications and reoperations. The main advantages of using an allograft with a reverse shoulder arthroplasty (compared with other reconstruction options) are that this type of reconstruction (1) allows restoration of the bone stock, thus improving prosthesis fixation and stability, and (2) gives the possibility to perform a tendon transfer by fixing the tendons on the bone graft to improve shoulder motion.
Approximately 20% of patients have persistent unexplained pain after total knee arthroplasty (TKA). Currently available treatments are unsatisfactory. The present report describes four patients in whom transcatheter arterial embolization had a remarkable effect on pain after TKA. Abnormal neovessels were identified in all patients. For 48 h, one patient experienced remarkable postprocedural pain at the inner side of the knee that was subsided by level 1 analgesics and another patient development of a spontaneous skin ulceration resolving within 8 days. The mean Knee injury and Osteoarthritis Outcome Score pain subtotal had increased from 39 to 82 one month after treatment. Endovascular occlusion of neovascularization, decreasing chronic inflammation and the growth of unmyelinated sensory nerves may be treatment options for persistent unexplained pain following TKA.Level of Evidence IV, Case report.
Keywords: Embolization; Neovascularization; Persistent pain; Total knee arthroplasty.
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The distal-medial pilot hole: A simple way to ease volar plate positioning in extra-articular distal radius fractures
The distal-medial pilot hole: A simple way to ease volar plate positioning in extra-articular distal radius fractures
Volar plating is one of the most used surgical treatments for dorsally displaced extra-articular distal radius fractures. However, the reduction of the dorsal tilt can be difficult. It usually requires a flexion maneuver of the wrist while maintaining and screwing the plate, which is cumbersome. Plate positioning also is a crucial step and is sometimes difficult because of the large size of the plate relative to the width of the distal radius. We use an epiphysis-first technique. We place all the epiphyseal screws before reduction, and then we take advantage of the anatomical shape of a locking plate to automatically reduce the dorsal tilt by fixing the proximal radius to the plate with cortical compression screws. To ensure easy and accurate positioning of the plate, we drill a distal medial pilot hole in a free-hand fashion 10 mm proximal to the watershed line and 10 mm lateral to the medial rim of the radius, without positioning the plate. This allows a clear view of the location of this first hole. The locking plate is then applied to the distal radius with help of a monocortical non-locking screw, and it is controlled under fluoroscopy. When this medial pilot hole is properly positioned and the plate correctly tilted on the anteroposterior view, the remaining epiphyseal holes are filled with locking screws. Then the plate is fixed on the proximal radius with bicortical compression screws, allowing an automatic reduction of the epiphyseal dorsal tilt. We believe this technique is a safe and reproducible way to position volar plates and to reduce anatomically the dorsal tilt in extra-articular posteriorly displaced distal radius fractures (AO A2 and A3). Furthermore, the automatic fracture reduction provided by this technique decreases operation time and radiation.
Background: A consequence of the steady growth in the worldwide population of elderly individuals who remain in good health and continue to engage in sports is an increase in the incidence of anterior cruciate ligament (ACL) rupture occurring after 50 years of age. ACL reconstruction was formerly reserved for young athletes but now seems to produce good outcomes in over 50s. The type of graft and graft fixation method were selected empirically until now, given the absence of investigations into potential relationships of these two parameters with the outcomes. The objective of this study was to assess associations linking the type of graft and the method of femoral graft fixation to outcomes in patients older than 50 years at ACL reconstruction.
Hypothesis: The operative technique is not associated with the clinical outcomes or differential laxity.
Material and methods: A multicentre retrospective cohort of 398 patients operated between 1 January 2011 and 31 December 2015 and a multicentre prospective cohort of 228 patients operated between 1 January 2016 and 30 June 2017 were conducted. Mean follow-up was 42.7 months in the retrospective cohort and 14.2 months in the prospective cohort. The primary evaluation criterion was the clinical outcome as assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Score (TAS). Differential laxity was the secondary evaluation criterion. The Wilcoxon rank sum test and Kruskal-Wallis test were used to compare groups, and p-values<0.05 were considered significant.
Results: In the retrospective and prospective cohorts, hamstring tendons were used in 269 (67.6%) and 197 (86.4%) patients and extensor apparatus tendons in 124 (31.2%) and 31 (13.6%) patients. Femoral fixation in the retrospective cohort was cortical in 81 (20.4%) cases, by press-fit in 112 (28.1%) cases, and by interference screw in 205 (51.5%) cases; corresponding figures in the prospective cohort were 135 (59.2%), 17 (7.5%), and 76 (33.3%). The multivariate analysis of the retrospective data identified no significant associations of graft type or femoral fixation type with the KOOS, TAS, or differential laxity values. In the prospective cohort, hamstring grafts were associated with 0.6mm of additional laxity (p=0.007); compared to cortical fixation, press-fit fixation of patellar tendon grafts was associated with 0.3mm of additional laxity (p=0.029) and a 0.5-point lower TAS value (p=0.033), with no difference in KOOS values. None of these differences were clinically significant.
Discussion: The various ACL reconstruction techniques used in patients older than 50 years produce similar outcomes. The technique can be chosen based on surgeon preference without regard for patient age.
Level of evidence: IV.
Keywords: 50 years of age; Anterior cruciate ligament; Differential laxity; KOOS; Operative technique; Tegner Activity Score.
Jean-Claude Panisset, Jean-François Gonzalez, Christophe de Lavigne, Quentin Ode, David Dejour, Matthieu Ehlinger, Jean-Marie Fayard, Sébastien Lustig; French Arthroscopic Society
Introduction: ACL reconstruction is increasingly proposed for over-50 year-olds, although surgery had a poor reputation in this age-group, mainly due to postoperative stiffness. ACL reconstruction results were compared between two prospective series of, respectively, over-50 year-old (group 1) and under-40 year-old patients (group 2). The main study hypothesis was that ACL surgery provides the same functional results after 50 as before 40 years of age, and the secondary hypothesis was that the rate of complications does not differ.
Methods: A multicenter prospective non-randomized follow-up study included 228 over-50 year-old and 130 under-40 year-old patients in 10 public and private sector centers. Epidemiological data were collected. Clinical laxity, differential laxity, KOOS, IKDC, Tegner and ACL-RSI scores and radiologic aspect were assessed pre- and post-operatively. Early (<3 months) and late (>3 months) complications were collected. Functional scores were compared between groups at last follow-up: 14.2 months (range, 3.5-30.5 months in group 1, and 20.5 months (range, 11.4-29.4 months) in group 2.
Results: Analysis of epidemiological data showed some inter-group differences: female predominance in group 1 (59% versus 35%), longer trauma-to-surgery time in group 2 (23.6 versus 8.7 weeks), predominance of pivot-contact (team) sports in group 2 (49% versus 6%), and predominance of pivot sports (skiing) in group 1. Tegner scores were lower in group 1 (5.2 versus 7.6). Meniscal lesions were more frequent in group 1 (68% versus 36%), as were cartilage lesions (76% versus 10%). Initial laxity levels were identical (6.5mm in group 1 and 6.7mm in group 2). Type of surgery was identical: 86% hamstring graft in group 1 and 89% in group 2. There were more early complications (hematoma) in group 1; rates of late complications were comparable. Laxity at last follow-up was 2.2mm in both groups, and thus Lachman and pivot-shift test results were identical in terms of firm end-feel and absence of pivot shift. Quality-of-life assessment found higher KOOS scores in group 2, although ACL-RSI scores were identical. Global IKDC scores were slightly better in group 2, due to osteoarthritis in the older patients.
Conclusion: ACL reconstruction after 50 years of age gave good results, correcting laxity as effectively as in under-40 year-olds, with identical technique and identical rates of complications. Time to return to sports and resumed level were comparable.
Level and type of study: III, prospective comparative non-randomized.
Keywords: 50 year-old; ACL; Prospective; Quality of life; Return to sport.
Background: Reverse shoulder arthroplasty (RSA) is offered to young patients with a failed previous arthroplasty or a cuff-deficient shoulder, but the overall results are still uncertain. We conducted a systematic review of the literature to report the midterm outcomes and complications of RSA in patients younger than 65 years.
Methods: A search of the MEDLINE and Cochrane electronic databases identified clinical studies reporting the results, at a minimum 2-year follow-up, of patients younger than 65 years treated with an RSA. The methodologic quality was assessed with the Methodological Index for Non-Randomized Studies score by 2 independent reviewers. Complications, reoperations, range of motion, functional scores, and radiologic outcomes were analyzed.
Results: Eight articles were included, with a total of 417 patients. The mean age at surgery was 56 years (range, 21-65 years). RSA was used as a primary arthroplasty in 79% of cases and revision of a failed arthroplasty in 21%. In primary cases, the indications were cuff tear arthropathy and/or massive irreparable cuff tear in 72% of cases. The overall complication rate was 17% (range, 7%-38%), with the most common complications being instability (5%) and infection (4%). The reintervention rate was 10% at 4 years, with implant revision in 7% of cases. The mean weighted American Shoulder and Elbow Surgeons score, active forward elevation, and external rotation were 64 points, 121°, and 29°, respectively.
Conclusions: RSA provides reliable clinical improvements in patients younger than 65 years with a cuff-deficient shoulder or failed arthroplasty. The complication and revision rates are comparable to those in older patients.
Background: Our aim was to analyze the epidemiology, etiologies, and revision options for failed shoulder arthroplasty from 2 tertiary centers.
Methods: From 1993 to 2013, 542 failed arthroplasties were revised in 540 patients (65% women): 224 hemiarthroplasties (HAs, 41%), 237 anatomic total shoulder arthroplasties (TSAs, 44%) and 81 reverse total arthroplasties (RSAs, 15%). Data about patients, pathology, and reintervention procedures, as well as intraoperative data, were analyzed from our 2 local registries that prospectively captured all the revision procedures. Patients had an average follow-up period of 8.7 years.
Results: The revision rate was 12.7% for HAs, 6.7% for TSAs, and 3.9% for RSAs. HAs were revised earlier (33 ± 40 months) than RSAs (47 ± 150 months) and TSAs (69 ± 61 months). Glenoid failure was a major cause of reintervention: erosion in HAs (29%) or loosening in TSAs (37%) and RSAs (24%). Instability was another major cause of reintervention: 32% in RSAs, 20% in TSAs, and 13% in HAs. Humeral implant loosening led to revision in 10% of RSAs, 6% of HAs, and 6% of TSAs. Multiple reinterventions were required in 21% of patients, mainly for instability (26%) and/or infection (25%). The final implant was an RSA in 48%, especially when associated with cuff insufficiency, instability, and/or bone loss. Final reimplantation was possible in 90% of cases, with the remaining 10% treated with a resection or spacer.
Conclusion: Glenoid failure and instability are the most common causes of revision. Soft-tissue insufficiency and/or infection results in multiple revisions. Surgeons must recognize all complications so that they can be addressed at the first revision operation and avoid further reinterventions. RSA was the most common final revision implant.
Background: On 14 July 2016, a terrorist drove a truck through the crowd on the Promenade des Anglais in Nice, France, killing 87 people and injuring 458. The objective of this study was to evaluate the management strategy used to handle the osteo-articular injuries caused by this attack.
Hypothesis: The management strategy used ensured that open fractures were treated within 6hours.
Material and method: This single-centre retrospective study included all victims of the attack admitted to the Pasteur 2 Hospital in Nice, France, for osteo-articular injuries, and treated between 14 and 31 July 2016. The following data were collected for each patient: age, sex, type of injury, Injury Severity Score (ISS), whether the damage control orthopaedics (DCO) or early total care (ETC) approach was followed, time from injurytotreatment, operative time, and surgical revisions. The primary outcome measure was the injury to treatment time for each lesion.
Results: Of the 182 patients admitted to the emergency department, 32 required admission for osteo-articular injuries, including 18 with severe injuries (ISS>15) and 11 with multiple fractures. Their injuries were of the type seen in traffic accidents. Of the 87 fractures, 45% involved the lower limbs and 25% were open fractures. Surgery was performed in 14 patients on the first night (14 to 15 July) and in 19 patients overall. The approach was DCO in 12 and ETC in 7 of these 19 patients. All lesions were managed within recommended time intervals, including the 21 open fractures and 2 closed femoral shaft fractures.
Discussion: Injury-to-surgery time complied with recommendations in all cases. In 25% of cases, ETC would have been feasible during the mass influx of patients without hospital capacity saturation.
Level of evidence: IV, retrospective observational study.
Keywords: Damage control orthopaedics; Mass casualty events; Osteo-articular injuries; Terrorist attack.
Introduction: The Constant score, allows an objective and subjective assessment of the shoulder function. It has been proven to have a poor interobserver reliability for some of its aspects and is not usable as a remote assessment tool.
Hypothesis: The Constant-Murley functional shoulder score can be assessed with a self-administered questionnaire.
Methods: We conducted a prospective continuous study in a shoulder-specialized service. For each patient seen in consultation or hospitalized for a shoulder pathology, a self-administered questionnaire was delivered, and a clinical examination was performed by a surgeon. The questionnaire, in French language, was composed of checkboxes only, with pictures preferred over text for most items. Correlations with surgeon examination were assessed with the intraclass correlation coefficients, differences with the paired t-test.
Results: One hundred consecutive patients were analyzed. Correlation between the two scores was excellent (0.87), as were the range of motion and the pain subscores (0.85 and 0.78), good for the activity (0.69) and fair for the strength (0.57). The mean total score was 3 points lower for the self-administered questionnaire (CI95 [-5; -1]; p<0.01). Activity and pain were not significantly different (-0.4/20 and -0.3/40; p>0.05) but pain and force were slightly different (+0.8/15; -3.0/25; p<0.01).
Conclusion: The Auto-Constant questionnaire in French is an excellent estimator of the Constant score, and of its pain and mobility sub-scores. It is less accurate for the evaluation of the strength, but differences between sub-scores compensate and allow its use in daily practice.
Level of proof: II, Prospective continuous clinical series.
Keywords: Patient Reported Outcome Measures; Shoulder; Surveys and Questionnaires.
Purpose: To evaluate mid-term clinical outcomes, complications, bone-block healing, and positioning using suture-button fixation for an arthroscopic Latarjet procedure.
Methods: Patients with traumatic recurrent anterior instability and glenoid bone loss underwent guided arthroscopic Latarjet with suture-button fixation. We included patients with anterior shoulder instability, glenoid bone loss >20%, and radiographic and clinical follow-up minimum of 24 months. Patients with glenoid bone loss <20% or those that refused computed tomography imaging were excluded. Bone-block fixation was accomplished with 2 cortical buttons connected with a looped suture (4 strands). The looped suture was tied posteriorly with a sliding-locking knot. After transfer of the bone block on the anterior neck of the scapula, compression (100 N) was obtained with the help of a tensioning device. Clinical assessment was performed at 2 weeks, 3 months, 6 months, and then yearly with computed tomography completed at 2 weeks and 6 months to confirm bony union.
Results: A consecutive series of 136 patients underwent arthroscopic Latarjet with 121 patients (89%; mean age 27 years) available at final follow-up (mean follow-up, 26 months; range, 24-47 months). No neurologic complications or hardware failures were observed; no patients had secondary surgery for implant removal. The transferred coracoid process healed to the scapular neck in 95% of the cases (115/121). The bone block did not heal in 4 patients; it was fractured in 1 and lysed in another. Smoking was a risk factor associated with nonunion (P < .001). The coracoid graft was positioned flush to the glenoid face in 95% (115/121) and below the equator in 92.5% (112/121). At final follow-up, 93% had returned to sports, whereas 4 patients (3%) had a recurrence of shoulder instability. The subjective shoulder value for sports was 94 ± 3.7%. Mean Rowe and Walch-Duplay scores were 90 (range, 40-100) and 91 (range, 55-100), respectively.
Conclusions: Suture-button fixation is an alternative to screw fixation for the Latarjet procedure, obtaining predictable healing with excellent graft positioning, and avoiding hardware-related complications. There was no need for hardware removal after suture-button fixation. The systematic identification of the axillary and musculocutaneous nerves reduced risk of neurologic injury. A low instability recurrence rate and excellent return to pre-injury activity level was found. Suture-button fixation is simple, safe, and may be used for both open and arthroscopic Latarjet procedure.
Level of evidence: Level IV, therapeutic case series.
Patients presenting with recurrent shoulder instability and bipolar glenohumeral bone loss are at risk of failed standard soft-tissue repair techniques. Even isolated bony-stabilization procedures such as the Latarjet or remplissage technique may not provide sufficient stability in the face of combined bone loss. We use a combined all-arthroscopic remplissage, Latarjet, and Bankart repair for patients with significant combined glenohumeral bone loss and/or in the revision setting. This allows reconstruction of both the Hill-Sachs and glenoid bone defects and repair of the capsulolabral complex in a minimally invasive manner. Furthermore, the use of cortical-button fixation of the coracoid bone graft may reduce the risk of hardware-related complications while still achieving excellent bone union.
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Publications 2016 du Pr GONZALEZ Jean-François
Mass casualty events and health organisation: terrorist attack in Nice
Mass casualty events and health organisation: terrorist attack in Nice
Background: The purpose of this study was to evaluate suture button fixation in a bone block (Bristow and Latarjet) procedure. We hypothesize that (1) cortical button fixation will allow predictable and reproducible bone union and (2) minimize the complications reported with screw fixation.
Materials and methods: Seventy patients (mean age, 27 years) underwent an arthroscopic bone block procedure with a guided surgical approach and suture button fixation for recurrent anterior shoulder instability. There were two groups of patients: 35 Bristow procedures (group A) and 35 Latarjet procedures (group B). Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging at 2 weeks and 6 months, respectively.
Results: The coracoid graft was positioned below the equator in 93% and strictly tangential to the glenoid surface in 94% of the cases. Bone healing was observed in 83% of the cases (58/70) with 74% bone union in group A and 91% in group B. Neurologic and hardware complications, classically reported with screw fixation, were not observed with this novel fixation method.
Conclusions: (1) Suture button fixation can be an alternative to screw fixation, obtaining bone block union, (2) in the lying position (Latarjet) bone healing was better than in the standing position (Bristow), and (3) complications classically reported with screw fixation were not observed.
Background: Most of the complications of the Latarjet procedure are related to the bone block positioning and use of screws. The purpose of this study was to evaluate if an arthroscopic Latarjet guiding system improves accuracy of bone block positioning and if suture button fixation could be an alternative to screw fixation in allowing bone block healing and avoiding complications.
Materials and methods: Seventy-six patients (mean age, 27 years) underwent an arthroscopic Latarjet procedure with a guided surgical approach and suture button fixation. Bone graft union and positioning accuracy were assessed by postoperative computed tomography imaging. Clinical examinations were performed at each visit.
Results: At a mean of 14 months (range, 6-24 months) postoperatively, 75 of 76 patients had a stable shoulder. No neurologic complications were observed; no patients have required further surgery. The coracoid graft was positioned strictly tangential to the glenoid surface in 96% of the cases and below the equator in 93%. The coracoid graft healed in 69 patients (91%).
Conclusions: A guided surgical approach optimizes graft positioning accuracy. Suture button fixation can be an alternative to screw fixation, obtaining an excellent rate of bone union. Neurologic and hardware complications, classically reported with screw fixation, have not been observed with this guided technique and novel fixation method.
The complications of total hip arthroplasty (THA) during the immediate postoperative period consist mainly in dislocation of the prosthesis, haematomas under antocoagulants, early infections, dismantling of osteotomy, neurological injury, heterotopic ossification and delayed restoration of the range of motion of the hip joint. We present here an infrequently described case of haematoma of the pectineus muscle following THA. Haematomas are not described in literature except in rare cases of compressive haematoma associated with neurological injury. In our case, the intraoperative blood losses were not particularly massive, there were no anticoagulation accident or postoperative trauma and no secondary deglobulinization. The question to be considered is that of a possible stretching of the pectineus during hip dislocation, and possibly during the surgical procedures for the implementation of the prosthesis with increased length, as it is the case here. Haematomas of the pectineus are probably underdiagnosed as they imitate other, more known, symptomatologies.
Background: The purpose is to report the results of reverse shoulder arthroplasty (RSA) after previous failed rotator cuff surgery.
Materials and methods: A retrospective multicenter study of 42 RSA in 40 patients (mean age, 71 years) with a mean follow-up of 50 months. Thirty shoulders presented with a pseudoparalytic shoulder and 12 with a painful shoulder with maintained active anterior elevation (AAE >or= 90 degrees).
Results: Five complications (12%) occurred and 2 patients (5%) underwent re-operation. In pseudoparalytic shoulders, AAE increased from 56 degrees to 123 degrees and 7% were disappointed or dissatisfied. In painful shoulders, AAE decreased from 146 degrees to 122 degrees and 27% were disappointed or dissatisfied.
Discussion: RSA can improve function in patients with cuff deficient shoulders after failure of previous cuff surgery. However, results are inferior to primary RSA. RSA when the patient maintains greater than 90 degrees of preoperative AAE risks loss of AAE and lower patient satisfaction.
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Publications 2007 du Pr GONZALEZ Jean-François
Arthroscopic revision of failed open anterior stabilization of the shoulder
Arthroscopic revision of failed open anterior stabilization of the shoulder
Arthroscopic revision of failed open anterior stabilization of the shoulder
Pascal Boileau, Julian Richou, Jean Francois Gonzalez, Lionel Neyton, Nicolas Jacquot, Christopher Chuinard
Background: The results of surgical treatment of anterior instability of the shoulder are well reported. The recurrence of instability represents the most common complication of this surgery and its evaluation poses both a diagnostic and therapeutic problem. A failed open stabilization has often been thought to necessitate an open revision. The purpose of this study is to report the results of arthroscopic Bankart repair following failed open treatment of anterior instability. Materials and Methods: We performed a retrospective review of 22 patients with recurrent anterior shoulder instability (ie, subluxations or dislocations, with or without pain) after open surgical stabilization. There were 17 men and five women with an average age of 31 years (range, 15-65). The most recent interventions consisted of 16 osseous transfers (12 Latarjet and four Eden-Hybinette), three open Bankart repairs and three capsular shifts. The causes of failure were additional trauma in 12 patients and complications related to the bone-block in 13 (poor position, fracture, pseudarthrosis or lysis). All patients were noted to have distension of the anterior-inferior capsular structures. Labral re-attachment and capsulo-ligamentous re-tensioning with suture anchors was performed in all cases with an additional rotator interval closure in four patients and an inferior capsular plication in 12 patients; the bone block screws were removed in eight patients. Results: At an average of 43 months (range, 24-72 months), 19 patients were evaluated by two independent observers. One patient had recurrent subluxation, and two patients had persistent apprehension. Anterior elevation was unchanged, and loss of external rotation (RE1) was 6°. Nine patients returned to sport at the same level; all patients returned to their previous occupations, including the six cases of work-related injury. Eighty-nine percent were satisfied or very satisfied; the subjective shoulder value (SSV) was 83% ± 23%; the Walch-Duplay, Rowe and UCLA scores were 85 ± 21, 81 ± 23 and 30 ± 7 points respectively. The number of previous interventions did not influence the results. Eight patients (42%) were still painful (six with light pain and two with moderate pain). Conclusions: Arthroscopic revision of open anterior shoulder stabilization gives satisfactory results. The shoulders are both stable and functional. While the stability obtained with this approach is encouraging, our enthusiasm is tempered by some cases of persistent pain.
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Publications 2006 du Pr GONZALEZ Jean-François
Polyarthritis and familial pulmonary fibrosis in a child
Polyarthritis and familial pulmonary fibrosis in a child
A 7-year-old girl presented with seropositive polyarthritis, autoimmune thyroiditis, and pulmonary fibrosis. Several family members had complex autoimmune disorders and pulmonary fibrosis, and the pedigree was consistent with autosomal dominant inheritance. The possible links between polyarthritis and familial pulmonary fibrosis are discussed, as well as the therapeutic challenges raised by this extraordinarily rare combination.
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Réflexion sur la chirurgie orthopédique en milieu tropical.
M Di Schino, H de Belenet, C Drouin, P Candoni, J-F Gonzalez, J Limouzin, F-M Grimaldi.
Revue du Rhumatisme. 2003, 70 : 185-194.
Evaluation fonctionnelle de l’arthrodèse d’épaule après résection tumorale de l’extrémité supérieure de l’humérus.
J-F Gonzalez, F Launay, E Viehweger, A Hamel, L Lino, J-L Jouve, G Bollini.
Revue de Chirurgie Orthopédique, 2004, 90 (Suppl. au N°6) :46-2S52.
Le pied lepreux : aspects cliniques.
E Demortière, H de Belenet, Ph Candoni, C Drouin, JF Gonzalez, M Di Schino
Bull de l’Association de Léprologie de Langue Française. 2005 ; 16 :26-29.
Les muscles fibulaires dans le pied neurologique.
E Demortière, J-F Gonzalez, A Rochewerger, G Curvale.
Médecine et chirurgie du pied, 2005, 21 :102-106.
Arthrodèse d’épaule avec fibula vascularisée après résection tumorale de l’extrémité supérieure de l’humérus.
E Viehweger, J-F Gonzalez, F Launay, R Legre, J-L Jouve, G Bollini
Revue de Chirurgie Orthopédique, 2005, 91, 523-529.
Actinomycetome abdominal avec atteinte viscérale.
T Peycru, JF Gonzalez, P Kraemer, P Calvet, B Tramond, F Martin.
La presse médicale. 2005, 27, 34 (14) : 1039.
La prise en charge chirurgicale de l’Hallux rigidus (à propos de 113 cas).
I Farhat, E Demortière, JF Gonzalez, A Rochewerger, G Curvale.
Revue de Chirurgie Orthopédique, 2005, 91(Suppl. au N°6), 56-3S62.
Syndrome de loge chronique bilatéral de pied, intérêt de la scintigraphie dynamique au Thallium 201. A propos d’un cas.
JF Gonzalez, E Demortière, J Limouzin, P Candoni, E Bussy, M Di Schino.
Revue de Chirurgie Orthopédique, 2005, 91 (Suppl. au N°6), 51-3S60.
Association chez un enfant de polyarthrite à fibrose pulmonaire familiale.
F Launay, J-M Guillaume, J-M Gennari, J-F Gonzales, G Bollini, I Koné Paut.
Revue du Rhumatisme, 2006, 73 :302-305.
Notre scarf autostable est-il aussi efficace que le classique ?
G Curvale, J-F Gonzalez, E Demortière, D Louzan, V Rosca, D Ould-Ali, A Rochwerger.
Médecine et chirurgie du pied, 2006,22 : 105-106.
La reconstruction osseuse de l’exostose en traitement de l’hallux varus iatrogène.
G. Curvale, J.F.Gonzalez, A. Rochwerger
Médecine et chirurgie du pied, 2006, 22 : 111-112.
Le SCARF nous a-t-il apporté de meilleurs résultats que la technique de Mac Bride en traitement de l’hallux valgus ?
G. Curvale , JF Gonzalez, A. Rochwerger
Médecine et chirurgie du pied, 2006, 22 : 198-199.
Infection à pneumocoque sur prothèse : A propos d’un cas clinique et revue de la littérature.
A Bertani, C Drouin, E Demortière, JF Gonzalez, Ph Candoni, M Di Schino.
Revue de Chirurgie Orthopédique : 2006, 92 : 610-614.
Résultats des prothèses totales d’épaule inversées après échec de chirurgie de la coiffe des rotateurs.
JF Gonzalez, L. Favard, F. Sirveaux, G. Walch, D. Molé, P. Boileau
Revue de Chirurgie Orthopédique, 2006,92 (Suppl. au N°6): 254-3S144.
Echec de stabilisation antérieure de l’épaule à ciel ouvert repris par Bankart arthroscopique.
P. Boileau, J. Richou, A. Lisai, J.C. Balestro, J.F. Gonzalez.
Revue de Chirurgie Orthopédique, 2006, 92 (Suppl. au N°6): 10-3S35.
Transfert du Grand Dorsal et du Grand Rond, isolé ou associé à une Prothèse d’Epaule Inversée, pour Perte de la Rotation Externe Active.
P Boileau, C Chuinard, N Jacquot , L Neyton, C Trojani, J-F Gonzalez.
Revue de Chirurgie Orthopédique, 2006, 92 (Suppl. au N°6): 16-3S38.
Echec de stabilisation antérieure de l’épaule à ciel ouvert repris par Bankart arthroscopique.
P. Boileau, J. Richou, A. Lisai, J.C. Balestro, J.F. Gonzalez.
Revue de Chirurgie Orthopédique, 2006; 92 (Suppl. au N°8): 49-4S76.
Ostéotomie de type scarf pour hallux valgus : l’ostéosynthèse est-elle indispensable ?
JF Gonzalez, A Rochwerger, E Demortière, G Curvale
Revue de Chirurgie Orthopédique, 2007, 92 (Suppl. au N°6): 16-3S38.
La fracture de fatigue du col fémoral chez le sportif d’endurance : l’importance d’un diagnostic précoce.
A Bertani, E Soucanye de Landevoisin, JF Gonzalez, P.H. Savoie, E. Demortière.
Journal de Traumatologie du Sport, 2008, 25 (2), 99-101.
Intérêt de la mesure de l’incidence pelvienne simienne dans la compréhension du développement de la statique rachidienne humaine.
JF Gonzalez, B Blondel, F Marchal, G Berillon, M Panuel, JL Jouve.
Revue de Chirurgie Orthopédique, 2010, 94 (Suppl. au N°7):220-S302.
Stratégie d’exofixation et damage control orthopédique en contexte de chirurgie de guerre.
L Mathieu, J-F Gonzales, B Bauer, B Deloynes, R Breda, S Rigal
Revue de Chirurgie Orthopédique, 2010, 96 (Suppl. au N°7):171-S179.
Hématome du muscle pectiné après prothèse totale de hanche.
Bernard P, Gonzalez JF, Facione J, Chapus JJ, Lagauche D.
Annales de Réadaptation et de Médecine Physique, 2011, Jul;54(5):293-7.
Évaluation du profil thromboélastométrique du sang épanche après arthroplastie primaire du genou
Esnault P, Prunet B, Cungi PJ, Caubere A, Lacroix G, Bordes J, David JS, Gonzalez JF, Kaiser E
Transfus Clin Biol. 2015, mars ; 22 (1) : 30-36.
Une approche chirurgicale guidée et un nouveau mode de fixation pour la butée de Latarjet sous arthroscopie
Gendre P, Gonzalez JF, D’Ollonne T, Boileau P
Revue de Chirurgie Orthopédique, 2015, 101 (Suppl. au N°7):69-S138.
Les entorses du pied chez le sportif militaire
E. Soucanye de Landevoisin, L. Thefenne, J-F. Gonzalez
Médecine et Armées, 2015, 43, 5, 452-459.
Le double-bouton, une alternative aux vis pour la fixation et la consoidation des butées de Latarjet
Gendre P, D’Ollonne T, Gastaud O, Clowez G, Gonzalez JF, Trojani C, Boileau P
Revue de Chirurgie Orthopédique, 2016, 102 (Suppl. au N°7):257-S167.
Résultats et limites de l’opération de L’Episcopo modifiée pour le traitement des pertes isolées de la rotation externe active du bras.
Boileau P, Baba M, Gauci MO, MacClelland W, Gendre P, D’Ollonne T, Gonzalez JF.
Revue de Chirurgie Orthopédique, 2016, 102 (Suppl. au N°7):317-S189.
Révision après échec de réparation de coiffe : le tendon a-t-il une deuxième chance de cicatriser ?
Azar M , Gonzalez JF, Boileau P.
Revue de Chirurgie Orthopédique, 2018, 104 (Suppl. au N°8):61-S95.
L’« Auto-Constant » : peut-on estimer le score de Constant-Murley à l’aide d’un auto-questionnaire ? Étude pilote
M Chelli, Y Levy, V Lavoué, G Clowez, J-F Gonzalez, P Boileau.
Revue de chirurgie orthopédique et traumatologique 105 (2019) 149–154
Arthrodèse arthroscopique tibiotalienne. F. Kelberine, J. Cazal, J.-F. Gonzales, D. Molé, P. Christel
Arthroscopie. Société Française d’Arthroscopie. Editions Elsevier, pages 283-286, 2006.
Arthroscopie de la hanche : anatomie, exploration normale. F. Kelberine, J.-F. Gonzales, J. Cazal
Arthroscopie. Société Française d’Arthroscopie. Editions Elsevier, pages 300-302, 2006.
Traitement arthroscopique des raideurs et de la pathologie synoviale du coude. F. Kelberine, J.-F. Gonzales, B. Clouet d’Orval
Arthroscopie. Société Française d’Arthroscopie. Editions Elsevier, pages 461-464, 2006.
Bilan articulaire de la cheville et du pied chez l’adulte. A Delarque, E Demortière, H Collado, S Mesure, T Rubino, J-F Gonzalez, G Curvale.
Encyclopédie Médico-Chirurgicale (Elsevier SAS, Paris), Podologie, 27-010-A-25, 2006.
Reversed total shoulder arthroplasty after failed rotator cuff surgery.
J-F Gonzalez,C Chuinard, P Boileau.
Reverse Shoulder Arthroplasty: Clinical results – Complications – Revision. Sauramps Medical, pages 133-147, 2006.
Complications des prothèses anatomiques de l’épaule.
J-F Gonzalez, F Baqué, P Boileau.
Prothèses d’épaule – Etat actuel. Cahiers d’enseignement de la SOFCOT n°98. Elsevier Masson, page 253–270, 2008.
Evaluation à 10 ans de recul d’un traitement de l’hallux valgus par ostéotomie SCARF. C Charpail, J-F Gonzalez, A Rochwerger, G Curvale.
Monographie AFCP (Association Française de Chirurgie du Pied) n°4. Sauramps Medical, page 71-80, 2008.
Chirurgie orthopédique. C Saby, JF Gonzales, P Candoni
Procédure anesthésiques liées aux techniques chirurgicales. ARNETTE, page 127- 169, 2011.
Traitement chirurgical initial des traumatismes des membres de guerre L Mathieu, A Bertani, JF Gonzalez, F Rongiéras et F Chauvin Le blessé de guerre, ARNETTE, 2014.
Prise en charge chirurgicale secondaire des traumatismes des membres de guerre A Bertani,L Mathieu, JF Gonzalez, F Rongiéras et F Chauvin Le blessé de guerre, ARNETTE, 2014.
Revision of Shoulder Arthroplasty: 20 Years’ French Experience.
JF Gonzalez, N Holzer, T Baring, MO Gauci, M Cavalier, G Walch, P Boileau. Shoulder concepts: Revision surgery of shoulder arthroplasty, SAURAMPS, 2014.
Multiple revision shoulder arthroplasty: reasons and result. Holzer N, Baring T, Bessiere C, Gendre P, D’Ollone T, Gonzalez JF, Boileau P Shoulder concepts: Revision surgery of shoulder arthroplasty, SAURAMPS, 2014.
Patholgies du pied liées à la pratique du sport. E Soucanye de Landevoisin, JF Gonzalez, L Thefenne, E Demortièrer
SPORT et APPAREIL LOCOMOTEUR, p 255-296, Sauramps Médical, 2015.
A guided surgical approach and novel fixation method for arthroscopic Latarjet P Boileau, P Gendre, M Baba, CE Thélu, T Baring, JF Gonzalez, C Trojani. Shoulder concepts: Arthroscopy, Arthroplasty & Fractures, SAURAMPS, 2016, 149-167.
Reverse Shoulder Arthroplasty for non-operated, irreparable massive cuff tear (Hamada I – II – III) Minimum 5-year follow-up.
JF Gonzalez, K Fountzoulas, M Chelli, B Seeto, P Boileau Shoulder concepts: Reverse Shoulder Arthroplasty, SAURAMPS, 2016, 71-80.
Reverse Shoulder Arthroplasty for failure after cuff strgery – Minimum 5 year follow-up. O Gastaud, J Thomas, K Fountzoulas, JF Gonzalez, P Boileau Shoulder concepts: Reverse Shoulder Arthroplasty, SAURAMPS, 2016, 81-82.
Long term results of reverse shoulder arthroplasty for revision after failed reverse P Gendre, T D’Ollonne, M Cavalier, O Gastaud, JF Gonzalez, G Walch, L Favard, P Boileau. Shoulder concepts: Reverse Shoulder Arthroplasty, SAURAMPS, 2016, 153-158.
Results of proximal humeral reconstruction with massive allograft combined with reverse shoulder arthroplasty JL Raynier, P Gendre, Y Bouju, C Spiry, JF Gonzalez, L Favard, P Boileau. Shoulder concepts: Reverse Shoulder Arthroplasty, SAURAMPS, 2016, 337-343.
Shoulder Concepts: Arthroplasty for the Young Arthitic Shoulder.
P. Boileau, G. Walch, D. Molé, L. Lafosse, L. FAvard, C. Lévigne, F. Sirveaux, J-F. Kempf, P. Clavert, P. Collin, L. Neyton, N. Bonnevialle, J-F. Gonzalez
Sauramps Medical, 2018.
Arthroscopic Latarjet : Suture-button Fixation is a Safe and Reliable Alternative to Screw Fixation.
P Boileau, D Saliken, P Gendre, B-L Seeto, T d’Ollonne, J-F Gonzalez, N Bronsard
Shoulder concepts: Arthroscopy, Arthroplasty & Fractures, SAURAMPS, 2018, 53-70.
Revision after Failed Rotator Cuff: Does the Tendon Have a Second Chance to Heal ?
M Azar, J-F Gonzalez, O Van Der Meijden, P Boileau
Shoulder concepts: Arthroscopy, Arthroplasty & Fractures, SAURAMPS, 2018, 53-70.
2025 Influence de l’interligne oblique sur les résultats cliniques après ostéotomie tibiale de valgisation à moyen-long terme Dr GHARBI Lilia
2025 Influence des paramètres morphologiques sur la difficulté peropératoire après PTH par Voie Ant Dr LOPEZ Michaël
2025 Etude clinico-radiologique des PTEA avec VS sans PSI à 10 ans de recul Dr MILLET Nahel
2025 Positionnement des implants dans l’arthroplastie totale de hanche, comparaison voie ant et voie post. Dr ATTAS Joseph
2024 Influence de l’alignement sur les résultats cliniques après ostéotomie tibiale de varisation par fermeture médiale Dr MERIC Vincent
2023 Influence de l’alignement sur les résultats cliniques après ostéotomie tibiale de varisation par fermeture médiale Dr MACHADO Axel
2023 Associer un Hill-Sachs Remplissage à une butée de Latarjet : Le GlenoidTrack une aide à la prise de décision thérapeutique ? Dr RECANATESI Nicolas
2023 Arthrodèse sacro-iliaque chez les patients atteints de SDSI avec antécédent d’arthrodèse lombo-sacrée : résultats cliniques et fonctionnels à deux ans. Dr BRICARD Renaud
2022 Ostéosynthèse des fractures bi-colonnes : Comparaison de la réduction articulaire par voie pararectale versus ilio-inguinale. Dr FROIDEFOND Pablo
2022 Epaule douloureuse et instable postérieure : Un stade précoce de subluxation postérieure statique? Description clinique et morphométrique avec résultats arthroscopiques à deux ans minimum. Dr CHAMOUX Julien
2022 Ostéosynthèse des fractures de la colonne antérieure du cotyle : Observe-t-on un déplacement secondaire plus important chez le sujet âgé ? Dr HERCE Corentin
2021 Intérêt de la voie d’abord de Neviaser pour les fractures de l’extrémité proximale de l’humérus. Dr MONIN Brieuc
2020 Infections du site opératoire sur prothèse totale du genou dans un hôpital neuf. Dr D’ASCOLI Alessander
2020 Infections du site opératoire sur prothèse totale de hanche dans un hopitâl neuf. Dr OUATTARA Karim
2020 Vissage dynamique du col (DHS) dans les fractures cervicales vraies du fémur: quels facteurs prédictifs de complications? Dr KARAM Sami
2019 Analyse morphologique tridimensionnelle informatisée des fractures de l’humérus proximal – Étude de faisabilité. Dr RIPOLL Thomas
2019 Diagnostic du Syndrome Douloureux Sacro-Iliaque après arthrodèse lombo-sacrée. Dr PELLETIER Yann
2019 Prothèse Totale d’Épaule Inversée pour Fractures de l’Humérus Proximal du Sujet Âgé: Place du trochiter ? Dr SABAH Yann
2018 Résection complète du ligament croisé antérieur pour dégénérescence mucoïde : étude rétrospective de 24 cas. Dr CASTOLDI Marie
2016 PTG bilaterales en une session operatoire versus PTG unilaterales : Analyse comparative. Dr RAFFAELLI Antoine
2014 L’erosion glenoïdienne est-elle une contre-indication au « hill-sachs remplissage » associe a la reparation de bankart ? Dr CAVALIER Maxime
2014 Analyse échographique de la cicatrisation tendineuse après réparation arthroscopique de la coiffe des rotateurs. Dr SCHRAMM Martin
