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
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.
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
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.
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.
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
