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The aim was to investigate the contribution of robotics assisted total hip arthroplasty (THA) through direct anterior approach (DAA) in improving radiographic precision, functional results and complications.This retrospective study compared 100 primary conventional THA (cTHA) to 50 primary robotic THA (rTHA) through DAA. All cups were placed with the objective of having no anterior overhang while respecting the safe zones (SZ). Radiographic analysis included cup inclination and anteversion, vertical and horizontal changes of the rotation centre (ΔVCOR, ΔHCOR), acetabular and femoral offset. SZ were 30-50° of inclination and 10-30° of anteversion. Outliers were defined as medial displacement of the COR 5 mm, vertical displacement of the COR 3 mm superiorly. Harris hip score (HHS) and complications were compared at one year of follow-up.The robotic cups were better oriented with 98% in the global SZ versus 68% in the cTHA group (p = 0.0002). The COR was on average better restored in the robotic group in both the horizontal and vertical planes (Δ HCOR = - 5.0 ± 5.0 vs - 3.4 ± 4.9, p = 0.03; Δ VCOR = 1.6 ± 3.3 vs 0.2 ± 2.7, p = 0.04). There were fewer outliers in the rTHA group concerning VCOR (28% versus 10%, p = 0.03). There was no significant difference in HHS and complication rate at one year.The use of robotics for THA by DAA provided an advantage in controlling the orientation of the cup and the restoration of its rotation centre. Thanks to the 3D planning on CT scan, it allowed to respect the thresholds while avoiding the anterior overhangs.

Nowadays, Kingella kingae (K. kingae) is considered as the main bacterial cause of osteoarticular infections (OAI) in children aged less than 48 months. Next to classical acute hematogenous osteomyelitis and septic arthritis, invasive K. kingae infections can also give rise to atypical osteoarticular infections, such as cellulitis, pyomyositis, bursitis, or tendon sheath infections. Clinically, K. kingae OAI are usually characterized by a mild clinical presentation and by a modest biologic inflammatory response to infection. Most of the time, children with skeletal system infections due to K. kingae would not require invasive surgical procedures, except maybe for excluding pyogenic germs’ implication. In addition, K. kingae’s OAI respond well even to short antibiotics treatments, and, therefore, the management of these infections requires only short hospitalization, and most of the patients can then be treated safely as outpatients.

Purpose The ability of kinematic alignment (KA) to consistently restore trochlea anatomy in total knee arthroplasty (TKA) is unknown despite recreation of constitutional anatomy being its rationale for use. The purpose of this study was to assess if alignment choice in TKA effects the ability to restore the native trochlea groove. Methods One hundred and twenty-two consecutive patients undergoing robotic-assisted TKA using the MAKO image-based robotic platform had simulated femoral components placed according to kinematic, mechanical and functional alignment principals. Implant position and trochlea restoration between groups were compared. Restoration was assessed by shift (medial–lateral) and depth relative to the native groove from three consistent points; full extension (0°), mid-flexion (30°–40°) and deep flexion (70°–80°). Results Three hundred and sixty-six alignment options were analysed. Femoral alignment was significantly different between groups. Of KA, 13.1% compared to 3.3% of FA plans were outside safe coronal boundaries. The trochlear groove was translated the most by MA compared to KA and FA (full extension, MA 7.84 ± 1.99 mm lateral to the native groove, KA 6.40 ± 2.43 mm and FA 6.88 ± 1.74 mm, p ≤ 0.001). In full extension, FA most closely restored the trochlear groove depth in all three positions of flexion. Conclusion Alignment philosophy led to significant differences in trochlea groove recreation. A kinematically placed femoral component led to positioning considered unsafe in over 13% of cases. A functionally placed femoral component most closely restored trochlea depth in all three positions of flexion.

Aim: This retrospective study’s objective was to evaluate osteoarticular infection in infants less than 12 months of age, with a particular focus on biological features and bacteriological etiology. Material & methods: We retrospectively reviewed the medical records of every infant younger than 12 months old admitted in our institution for a suspected osteoarticular infection between January 1980 and December 2016. Results: Sixty-nine patients records were reviewed, including eight neonates, 16 infants from 1 to 5 months old, and 45 from 6 to 12 months old. Conclusion: Neonates and infants aged from 6 to 12 months old were more exposed to infections. Staphylococcus aureus remained the main pathogen in children

AimsWe aimed to describe the epidemiological, biological, and bacteriological characteristics of osteoarticular infections (OAIs) caused by Kingella kingae.MethodsThe medical charts of all children presenting with OAIs to our institution over a 13-year period (January 2007 to December 2019) were reviewed. Among these patients, we extracted those which presented an OAI caused by K. kingae and their epidemiological data, biological results, and bacteriological aetiologies were assessed.ResultsK. kingae was the main reported microorganism in our paediatric population, being responsible for 48.7% of OAIs confirmed bacteriologically. K. kingae affects primarily children aged between six months and 48 months. The highest prevalence of OAI caused by K. kingae was between seven months and 24 months old. After the patients were 27 months old, its incidence decreased significantly. The incidence though of infection throughout the year showed no significant differences. Three-quarters of patients with an OAI caused by K. kingae were afebrile at hospital admission, 11% had elevated WBCs, and 61.2% had abnormal CRPs, whereas the ESR was increased in 75%, constituting the most significant predictor of an OAI. On MRI, we noted 53% of arthritis affecting mostly the knee and 31% of osteomyelitis located primarily in the foot.ConclusionK. kingae should be recognized currently as the primary pathogen causing OAI in children younger than 48 months old. Diagnosis of an OAI caused by K. kingae is not always obvious, since this infection may occur with a mild-to-moderate clinical and biological inflammatory response. Extensive use of nucleic acid amplification assays improved the detection of fastidious pathogens and has increased the observed incidence of OAI, especially in children aged between six months and 48 months. We propose the incorporation of polymerase chain reaction assays into modern diagnostic algorithms for OAIs to better identify the bacteriological aetiology of OAIs. Cite this article: Bone Joint J 2021;103-B(3):578–583.

Background: Combined anterior cruciate ligament (ACL) reconstruction (ACLR) and anterolateral ligament reconstruction (ALLR) have demonstrated reduced risk of graft rerupture as compared with isolated ACLR. However, concerns remain that the risk of osteoarthritis (OA) may be increased by the addition of ALLR. Purpose/Hypothesis: The aim of this study was to evaluate the incidence of OA with isolated ACLR in comparison with ACLR + ALLR at medium-term follow-up. We hypothesized that there would be no differences between the groups. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who underwent ACLR + ALLR with hamstring tendon autograft between January 2011 and March 2012 were propensity matched to patients who underwent isolated ACLR with bone–patellar tendon–bone (BPTB) or hamstring tendon autograft in the same period. Medium-term radiographic evaluation was performed using the International Knee Documentation Committee (IKDC) radiographic OA grading scale, modified Kellgren-Lawrence grade, and the surface fit method to assess percentage of joint space narrowing. Clinical outcomes were assessed with the following measures: IKDC, Knee injury and Osteoarthritis Outcome Score (KOOS), Lysholm, Tegner, and ACL Return to Sport after Injury. Results: A total of 80 patients (42 ACLR + ALLR and 38 isolated ACLR) were analyzed with a mean follow-up of 104 months. There was no significant difference between groups for joint space narrowing in the medial or lateral tibiofemoral or lateral patellofemoral (PF) compartment. However, 36.8% in the isolated ACLR group versus 11.9% in the ACLR + ALLR group had narrowing of the medial PF compartment ( P = .0118). A lateral meniscal tear increased the risk of lateral tibiofemoral narrowing by nearly 5 times (odds ratio, 4.9; 95% CI, 1.547-19.367; P = .0123). The risk of medial PF narrowing was >4-fold with an isolated ACLR (odds ratio, 4.8; 95% CI, 1.44-19.05; P = .0179). Between the isolated ACLR group and the ACLR + ALLR group, the secondary meniscectomy rate was 13.2% versus 11.9% (not significantly different). There was no difference between groups in KOOS, Tegner, or IKDC scores. There was also no difference between groups for grades of osteoarthritic change for any classification system. Patients who received a BPTB graft had medial PF joint narrowing in 66.7% of cases as compared with 11.9% in those who received ACLR + ALLR ( P = 0.118). Conclusion: ACLR + ALLR did not increase the risk of OA in the lateral tibiofemoral compartment when compared with an isolated ACLR at medium-term follow-up. Isolated ACLR using BPTB was associated with a significantly increased risk of medial PF joint space narrowing. Registration: NCT05123456 (ClinicalTrials.gov identifier).

We aimed to describe the epidemiological, biological, and bacteriological characteristics of osteoarticular infections (OAIs) caused byThe medical charts of all children presenting with OAIs to our institution over a 13-year period (January 2007 to December 2019) were reviewed. Among these patients, we extracted those which presented an OAI caused by

Distal patellar tendon avulsions are rare injuries in healthy individuals, and to date, no case affecting skeletally mature teenagers and adolescents has been reported. In the majority of cases, distal patellar tendon avulsions are associated with severe intra-articular knee lesions, signifying a high-energy trauma. We present the case of a 15.5-year-old female who was admitted to the emergency department after a knee injury. The mechanism of injury was a combination of landing after a jump off a scooter and sudden deceleration with a fixed foot. Lateral radiographs revealed a distal patellar tendon avulsion. An MRI was conducted to accurately diagnose concomitant lesions. The MRI revealed a complete tear of the ACL, and associated bone bruises on the lateral femoral condyle, and also on the posterolateral tibial plateau. A knee joint exam under general anesthesia demonstrated good stability during valgus stress testing and only a grade 1 positive Lachman test. Therefore, we decided to only reconstruct the extensor mechanism and to abstain from a primary ACL reconstruction. The presented case and review of the literature demonstrate the clinical relevance of this atypical lesion. In fact, a distal patellar tendon avulsion after physeal fusion of the proximal tibia should raise a strong suspicion of severe associated intra-articular knee lesions and requires prompt MRI investigation. However, controversy still exists regarding the management of these injuries, in particular concerning the question of whether to address both injuries in a single stage or in 2 stages.

Osteoarticular infections of the chest wall are relatively uncommon in pediatric patients and affect primarily infants and toddlers. Clinical presentation is often vague and nonspecific. Laboratory findings may be unremarkable in osteoarticular chest wall infections and not suggestive of an osteoarticular infection. Causative microbes are frequently identified if specific nucleic acid amplification assays are carried out. In the young pediatric population, there is evidence that Kingella kingae is 1 of the main the main causative pathogens of osteoarticular infections of the chest wall.

Background:The quadriceps tendon (QT) autograft is known as an effective graft for anterior cruciate ligament (ACL) reconstruction and shows a similar functional outcome to the bone-patellar tendon-bone (BPTB) in randomized controlled trials, with a lesser incidence of complications. Up until now, only 2 studies have compared QT to hamstring tendon (HT) autograft.Hypothesis:The functional outcomes of the QT technique are at least as good as those of the HT technique, with the same morbidity.Study Design:Cohort study; Level of evidence, 3.Methods:Ninety-five patients underwent isolated ACL reconstruction between January 1 and December 31, 2012. Fifty underwent ACL reconstruction with the QT and 45 with the HT. The same surgical technique, fixation method, and postoperative protocol were used in both groups. The following parameters were evaluated: surgical revisions, functional outcome (Lysholm, Knee injury and Osteoarthritis Outcome Score [KOOS], Tegner, subjective International Knee Documentation Committee), joint stability (KT-1000, Lachman, pivot shift), anterior knee pain (Shelbourne-Trumper score), and isokinetic strength. Descriptive statistics are presented for these variables using the Student t test.Results:Eighty-six patients (45 QT, 41 HT) were reviewed with a mean follow-up of 3.6 ± 0.4 years; minimum follow-up was 3 years. There were 4 reoperations in the QT group (including 1 ACL revision) and 3 in the HT group (including 2 ACL revisions) ( P > .05). The Lysholm (89 ± 6.9 vs 83.1 ± 5.3), KOOS Symptoms (90 ± 11.2 vs 81 ± 10.3), and KOOS Sport (82 ± 11.3 vs 67 ± 12.4) scores were significantly better in the QT group than in the HT group. In terms of stability, the mean side-to-side difference was 1.1 ± 0.9 mm for the QT group and 3.1 ± 1.3 mm for the HT group based on KT-1000 measurements ( P < .005). The negative Lachman component was higher in the QT group than in the HT group (90% vs 46%, P < .005). There was a trend for the negative pivot-shift component to be higher in the QT group than in the HT group (90% vs 64%, P = .052). The Shelbourne-Trumper score was the same in both groups. There was no difference between groups in terms of isokinetic strength.Conclusion:The use of a QT graft in ACL reconstruction leads to equal or better functional outcomes than does the use of an HT graft, without affecting morbidity.

In diabetic patients, foot ulcer is a common problem which prevalence during life is about 25%. Infection occurs as a complication in almost 50% of cases, is associated with significant morbidity and a reduced quality of life and is sometimes the trigger leading to amputation. Ulcers and infections occur among patients with predisposing factors such as peripheral neuropathy and arterial insufficiency, and require a multi-disciplinary care system. The knowledge of the microbiology of diabetic foot infection is necessary for a wise use of empirical and targeted antibiotic therapy. This article will focus on the definition and diagnosis of diabetic foot infection, on the main aspects of its microbiology and antibiotic treatment.

Introduction Notre hypothese est que l’utilisation d’un transplant de tendon quadricipital avec pastille osseuse (BQT) est une alternative fiable aux techniques dites classiques de ligamentoplastie du ligament croise anterieur (LCA). Notre objectif est de comparer l’efficacite et la morbidite d’un transplant BQT avec une technique aux ischiojambiers (DIDT). Materiel et methode Entre le 01/01/2012 et le 31/12/2012, 95 patients ont beneficie du ligamentoplastie isole du LCA soit avec BQT soit avec DIDT dans notre centre. La technique chirurgicale ainsi que le materiel de fixation utilise etaient les memes dans les deux groupes. Ont ete evalues : le nombre de reprises chirurgicales, le resultat fonctionnel (Lysholm, KOOS, Tegner, IKDC subjectif), la stabilite (KT 1000, Lachmann, pivot shift), la douleur anterieur (score de Shelbourne et Trumper) et les resultats isocinetiques. L’analyse statistique a ete descriptive puis comparative pour l’ensemble des criteres de jugement entre les deux groupes a l’aide de test t-Student. Nous avons obtenu un avis favorable du comite d’ethique de notre institution. Resultats Au total, 86 patients (45 BTQ/41 DIDT) ont ete inclus avec un recul moyen de 3,5 ans. Les caracteristiques demographiques (incluant le niveau et type de sport) des deux groupes etaient comparables. Il y eu 4 reoperations dans le groupe BQT dont une reprise de LCA et 3 dans le groupe DIDT dont 2 reprises de LCA (p > 0,005). Les scores de Lysholm (89 ± 6,9 vs. 81 ± 5,3) ainsi que KOOS symptomes (90 ± 11,2 vs. 81 ± 10,3) et KOOS sport (82 ± 11,3 vs. 67 ± 12,4) sont retrouves significativement plus important dans le groupe BQT. La difference moyenne de stabilite par rapport au cote oppose etait de 1,1 ± 0,9 mm dans le groupes BQT et de 3,1 ± 1,3 mm dans le groupe DIDT (p > 0,005). La proportion Lachmann negatif etait plus faible dans le groupe BQT (90 % vs. 46 %, p > 0,005). Le score de Shelbourne etait equivalent dans les deux groupes. En ce qui concerne l’analyse isocinetique, aucune difference n’etait statistiquement significative. Discussion Les resultats de BQT a un recul de 3,5 ans sont au moins equivalents aux IJ avec une morbidite qui n’est pas augmente. Les scores fonctionnelles sont retrouves plus important dans le groupe BQT. De meme la difference de laxite avec le cote controlaterale est en faveur du BQT. Le score de douleur anterieur est equivalent dans les deux groupes. Conclusion BQT represente une alternative fiable avec des resultats tres satisfaisants pour la reconstruction du LCA.

Introduction Notre hypothese est que l’utilisation d’un transplant de tendon quadricipital avec pastille osseuse (BQT) est une alternative fiable aux techniques dites classiques de ligamentoplastie du ligament croise anterieur (LCA). Notre objectif est de comparer l’efficacite et la morbidite d’un transplant BQT avec une technique aux ischiojambiers (DIDT). Materiel et methodes Entre le 01/01/2012 et le 31/12/2012, 95 patients ont beneficie du ligamentoplastie isole du LCA soit avec BQT soit avec DIDT dans notre centre. La technique chirurgicale ainsi que le materiel de fixation utilise etaient les memes dans les deux groupes. Ont ete evalues : le nombre de reprises chirurgicales, le resultat fonctionnel (Lysholm, KOOS, Tegner, IKDC subjectif), la stabilite (KT 1000, Lachmann, Pivot Shift), la douleur anterieur (score de Shelbourne et Trumper) et les resultats isocinetiques. L’analyse statistique a ete descriptive puis comparative pour l’ensemble des criteres de jugement entre les deux groupes a l’aide de test t-Student. Nous avons obtenu un avis favorable du comite d’ethique de notre institution. Resultats Quatre-vingt-six patients (45 BTQ, 41 DIDT) ont ete inclus avec un recul moyen de 3,5 ans. Les caracteristiques demographiques (incluant le niveau et type de sport) des deux groupes etaient comparables. Il y a eu 4 reoperations dans le groupe BQT dont une reprise de LCA et 3 dans le groupe DIDT dont 2 reprises de LCA (p > 0,005). Les scores de Lysholm (89 ± 6,9 vs 81 ± 5,3) ainsi que KOOS symptomes (90 ± 11,2 vs 81 ± 10,3) et KOOS sport (82 ± 11,3 vs 67 ± 12,4) sont retrouves significativement plus important dans le groupe BQT. La difference moyenne de stabilite par rapport au cote oppose etait de 1,1 ± 0,9 mm dans le groupes BQT et de 3,1 ± 1,3 mm dans le groupe DIDT (p Discussion Les resultats de BQT a un recul de 3,5 ans sont au moins equivalent aux IJ avec une morbidite qui n’est pas augmente. Les scores fonctionnels sont retrouves plus important dans le groupe BQT. De meme, la difference de laxite avec le cote controlaterale est en faveur du BQT. Le score de douleur anterieur est equivalent dans les deux groupes. Conclusion BQT represente une alternative fiable avec des resultats tres satisfaisants pour la reconstruction du LCA.

Introduction L’evolution de l’epidemiologie des fractures de l’acetabulum s’accompagne d’une progression des indications de protheses totales de hanche (PTH) de premiere intention. Quoique grevee d’un taux de complications important cette procedure est une alternative therapeutique pour les patients âges ou presentant des lesions non synthesables. Nous avons evalue les indications, les resultats fonctionnels et les complications de patients traites par PTH primaire pour des fractures de l’acetabulum. Materiel d’etude clinique Les patients traites pour une fracture de l’acetabulum par une PTH primaire associee ou non a une osteosynthese de 2000 a 2014, avec un recul minimum de 1 an furent inclus a cette etude retrospective monocentrique continue. Methodes Nous avons collectes les donnees demographiques, epidemiologiques (type de fracture et de traumatisme, lesions associees), operatoires et postoperatoires (scores cliniques, criteres radiologiques et complications). Resultats Vingt patients de 64,2 ans (45–81) furent inclus. Nous retrouvions 50 % de fractures interessant le mur posterieur + les autres etaient transverses (20 %), 2 colonnes (10 %), colonne anterieure + hemitransverse posterieure (10 %), T-Type (10 %). Cinquante-cinq pour cent resultaient d’un traumatisme a haute energie et 45 % a faible cinetique. Cinq patients presentaient une fracture du col ou de la tete femorale associes (25 %). Tous les patients etaient opere par voie posterieure, nous retrouvions 1 PTH seule (5 %), 4 PTH avec anneau (20 %) et 15 PTH + osteosynthese par plaque (75 %). Trente-cinq pour cent des cupules etaient a double mobilite, 75 % des implants femoraux etaient cimentes. Nous comptions 2 luxations et un hematome precoces et tardivement – 2 infections, 4 ossifications heterotopiques, 3 luxations recidivantes et 2 fractures peri-prothetiques. Quarante pour cent de patients presentait au moins une complication avec 25 % de revision. La mortalite etait de 30 % a 4,5 ans (2–7) postoperatoire. Le score de Harris etait de 82 (28–100) a 4,2 ans (1–13). Discussion Lorsque les fractures de l’acetabulum sont comminutives avec une faible qualite osseuse les echecs d’osteosynthese sont frequents et les conversions secondaires en PTH presentent des resultats contrastes. Les resultats cliniques des PTH primaires sont satisfaisants lorsque la technique chirurgicale est adaptee afin d’assurer stabilite et longevite, l’utilisation de double mobilite et d’implants cimentes semblent favorables. Conclusion Ainsi la PTH primaire associee a l’osteosynthese est donc un traitement en un temps fiable et necessaire dans la strategie therapeutique des fractures de l’acetabulum du patient âge et osteoporotique, en respectant ses specificites techniques et des indications strictes.