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Purpose: This study aimed to evaluate which preoperative patient, injury or clinical factors were associated with the anterior cruciate ligament (ACL) remnant volume in patients undergoing ACL surgery. It was hypothesized that the main factors determining an insufficient ACL remnant volume at the time of surgery were younger age and longer time to surgery., Methods: A retrospective analysis from the Francophone Arthroscopic Society's registry was conducted, including 1565 patients with an ACL lesion underdoing a primary ACL surgery (reconstruction or repair) between June 2020 and June 2023. Patients were excluded in case of revision surgery and incomplete data. Preoperative factors-including patient demographics, delay to surgery, preoperative laxity and the presence of meniscal tears or cartilage lesions-were analysed to determine their influence on ACL remnant volume (estimated by the surgeon as the percentage of residual volume). Univariate, multivariate and receiver operating characteristic curve analyses were performed to explore these relationships., Results: Multivariate analyses demonstrated that younger age (<20 years and 20-30 years compared to ≥40, p = 0.02), higher time from injury to surgery (≥12 months compared to <3 months, p = 0.01) and the presence of a medial (p = 0.01) or a lateral meniscal tear (p = 0.02) were significant predictors of an ACL remnant volume ≤ 50%., Conclusions: Younger age (under 30 years of age), a time from injury to surgery above 12 months and the presence of medial and lateral meniscal tears are associated with higher odds of observing a smaller ACL remnant volume at the time of the ACL surgery. These factors should be considered when planning ACL remnant preservation techniques., Level of Evidence: Level III., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Fracture of the hallucial sesamoids is a pathology that causes difficulty for surgeons and patients. Because of the low incidence and the fact that up to 64-90 % heal with non-operative management, there is a lack of clear guidance in the literature for the surgical treatment of sesamoid fracture in cases of failure of non-operative management. Here long term follow up of an alternative method of surgical treatment of sesamoid fracture recalcitrant to nonoperative management is presented. 32 individuals were treated with temporary surgical immobilisation of the 1st metatarsophalangeal joint using either crossed wires or two orthogonally placed two hole plates. The patients then underwent removal of the construct at 8 weeks post op after confirmation of healing on a CT scan. There was a 94 % union rate. Return to work was 61 days (15-90) return to sport 80 days (64-112) with no immediate complications and no recurrence. At last follow up mean 10 years (4-16) only 2 patients had gone on to asymptomatic non-union and one patient developed arthritis between the sesamoid and the metatarsal head. No patient has required further surgical intervention. This retrospective cohort of patients demonstrate that this method of treatment is a valuable option in the management of sesamoid fracture which does not alter the biomechanics of the foot and has none of the long term complications of sesamoidectomy or partial sesamoidectomy., Competing Interests: Declaration of Competing Interest The authors of this manuscript declare that they have no conflicts of interest in the publication of this article., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Introduction: Tibial correction is often performed during a valgus-producing osteotomy for genu varum. However, overcorrection and the creation of a joint line obliquity (JLO) have been associated with unfavorable functional outcomes after high tibial osteotomy (HTO). The aims of this study were to analyze: 1) the corrections obtained after HTO; 2) the rationale behind the indication per the European Society for Sports Traumatology Surgery and Arthroscopy (ESSKA) recommendations; and 3) the correlation between the postoperative corrections obtained and functional outcomes., Hypothesis: A significant number of patients who underwent an isolated HTO did not present an "ideal" theoretical indication based on the preoperative angles and correction targets to be performed., Materials and Methods: This multicenter study included 289 isolated HTOs. Demographic and morphometric data were anonymized and compiled in a database. Preoperative radiographic parameters were compared with the ESSKA consensus recommendations on osteotomies for genu varum. The consensus defined the "ideal" indication for performing an HTO as medial tibiofemoral compartment pain with significant tibial varus deformity (medial proximal tibial angle [MPTA]<85°), no significant femoral varus deformity (lateral distal femoral angle [LDFA]<90°), an expected postoperative obliquity of less than 5°, and a correction resulting in moderate tibial valgus (postoperative MPTA<94°). The incidence of patients with an "ideal" theoretical indication for isolated HTO and those with a theoretical indication not perfectly justified by the radiographic data and preoperative planning were recorded., Results: Under the ESSKA consensus criteria, 25.3% (n=73) of isolated HTOs, 15.6% (n=45) of isolated femoral osteotomies, 9.3% (n=27) of double-level osteotomies, and 49.9% (n=144) of cases where no osteotomy was performed due to the lack of significant extra-articular tibial and/or femoral deformity were deemed justified. The presence of a preoperative femoral deformity and the absence of an "ideal" indication for HTO did not affect the postoperative Tegner Activity Scale or the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (p>0.05). A high preoperative hip-knee-ankle (HKA) angle and MPTA, which indicated less varus, were associated with a greater risk of there being no "ideal" theoretical indication for an HTO (coefficient of determination [R 2 ]=0.19 and R 2 =1, respectively; p<0.001)., Conclusion: This study showed that isolated HTOs in current practice were not justified in a significant number of patients, even though they could lead to tibial overcorrection and excessive JLO. This did not impact the functional results of this series, but it might complicate the performance of a secondary knee arthroplasty. Nevertheless, some young patients in this series underwent a salvage osteotomy outside the "ideal" indications of the European recommendations., Level of Evidence: IV; case series., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Purpose: The study aimed to estimate the prevalence of ramp lesions among patients undergoing anterior cruciate ligament (ACL) reconstruction and identify risk factors associated with these lesions., Methods: A retrospective, multicentre cohort study was conducted using data from the Francophone Arthroscopic Society's registry, including 5359 patients who underwent ACL reconstruction (ACLR) from June 2020 to June 2023. Potential risk factors for ramp lesion such as patient demographics, revision surgery, pivot shift, side-to-side anteroposterior laxity, medial collateral ligament (MCL) injury, lateral meniscal tear and the volume of ligament remnant were evaluated using multivariate regression analyses. BMI and delay to surgery were also assessed., Results: Ramp lesions were identified in 822 patients (15.3%). Univariate analysis identified male sex, younger age, revision surgery, lateral meniscal injury, percentage of ACL remnant (all p < 0.0001) and pivot shift (p = 0.0103) as significant risk factors. MCL injury was associated with a lower risk (p < 0.0001). In multivariate analysis, male sex, younger age, revision surgery, lateral meniscal injury and percentage of ACL remnants remained significant risk factors, while MCL injury remained a protective factor. The anteroposterior laxity wasn't a significant predictor in either analysis. In subgroup analysis, there were no differences concerning body mass index (n.s) and the delay to surgery (n.s)., Conclusion: The study identified male sex, younger age, revision surgery, lateral meniscal injury and pourcentage of ACL remnant as significant risk factors for ramp lesions, with MCL injury acting as a protective factor. This will help regarding the suspicion and identification of ramp lesions., Level of Evidence: Level III., (© 2024 European Society of Sports Traumatology, Knee Surgery and Arthroscopy.)

Purpose: To determine the incidence of lateral meniscus posterior root tears (LMPRTs) in patients undergoing anterior cruciate ligament (ACL) reconstruction and identify associated risk factors., Methods: We conducted a retrospective, multicenter study using data from the Francophone Arthroscopic Society's registry. The study included all the patients in the registry who underwent ACL reconstruction surgery between June 2020 and June 2023; we excluded incomplete data. We compared delay from injury to surgery between LMPRTs group and no-LMPRTs group. Variables investigated as potential risk factors for LMPRTs included age, sex, nature of surgery (primary or revision), pivot shift test result, side-to-side laxity under anesthesia, presence of ACL remnant, occurrence of medial meniscal tear, and presence of collateral ligament injury. Risk factors were analyzed using a logistic regression model., Results: Among the 5,359 patients analyzed, LMPRTs occurred in 7.0% (n = 375) of cases during ACL reconstruction. Mean age at surgery was 29.3 ± 10.3 years old [11-77]. Concerning delay to surgery, the mean time was 8.4 ± 23.1 weeks [0.0-347.2] in the no-LMPRTs group and 6.5 ± 10.2 weeks [0.2-61.6] in the LMPRTs group (P = .109). Univariate analysis revealed that male sex (P < .001), revision surgery (P < .001), medial meniscal injury (P = .007), ACL remnant (0% vs >70%, <10% vs >70%, 10%-30% vs >70%, >30%-50% vs >70%, >50%-70% vs >70%; P < .001), and greater pivot shift grade (P = .011) were significantly associated with a presence of LMPRTs. Age, side-to-side laxity, and collateral ligament injury were not found to be significant risk factors. In multivariate analysis, male sex, revision surgery, pivot shift test result, and a low volume of ACL remnant remained significant. Side-to-side laxity was also a significant factor in multivariate analysis., Conclusions: This study identified male sex, revision surgery, low volume of ACL remnant, side-to-side laxity, and greater grade of pivot shift as significant risk factors for LMPRTs during ACL reconstruction., Level of Evidence: Level III, retrospective comparative case series., (Copyright © 2024 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Introduction: With the recent interest in hip-spine relationship, the link between femoroacetabular impingement (FAI) and the lumbar-pelvic-femoral complex (LPFC) appears decisive. The objectives of this study were (1) to compare the pelvic version, as well as (2) all the parameters of the LPFC between two populations of healthy subjects, comparing those with radiological signs of FAI to those without and finally, (3) to evaluate the LPFC parameters according to the type of FAI., Hypothesis: Asymptomatic subjects with radiological signs of FAI had superior pelvic anteversion., Materials and Method: This retrospective study was based on a prospective cohort of 118 voluntary asymptomatic patients including 62 men (52.5%) with a mean age of 25.6 years±4.4 (19-39). The following parameters: pelvic version (PV), pelvic incidence (PI), lumbar lordosis (LL), sacral slope (SS), hip flexion, intrinsic (IER) and extrinsic (EER) extension reserve were measured using EOS imaging™ in the reference standing position and the lunge position. The radiological signs of FAI (cam, pincer, mixed) were identified on these acquisitions then separated into 2 groups. The first was the group presenting with one or more images of FAI (FAI+) and the second group with no images of FAI (FAI-)., Results: There were 143 hips in the FAI+ group compared to 93 hips in the FAI- group. There were 36.4% cams and 45% pincers. With an average of 9.08°±7.81 (-11.0; 27.0) versus 12.33°±8.94 (-5.0; 55.0), the PV was significantly lower (p=0.022) in the FAI+ group compared to the FAI- group. A post-hoc power analysis on the primary outcome (PV) confirmed sufficient power (1-β=0.809). Compared to the FAI- group, the cam group presented a significantly lower IER and EER (respectively p=0.014 and p=0.047). The comparative analysis between the FAI- and pincer groups found a significant difference in PI (p=0.001), PV (p<0.001), IER (p=0.017) and hip flexion (p<0.001), SS in lunge position (p=0.031) and EER (p=0.039)., Conclusion: Asymptomatic subjects with radiographic signs of FAI present with weak pelvic version when standing. This pelvic hyper-anteversion is mainly found in the event of a radiological pincer sign., Level of Evidence: III, retrospective comparative study., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Introduction: Although an autogenous graft has the highest rate of bone union to fill the void created in medial opening wedge high tibial osteotomy (MOWHTO), it also has some disadvantages, such as prolonged surgical time, donor site pain and morbidity. Two possible candidates for ideal grafts to replace autogenous grafts are allogeneic and synthetic graft, which are free from donor site pain and morbidity. However, previous reports comparing the clinical results of allogeneic to synthetic graft have been limited and controversial. The purpose of this study is to compare radiological findings and clinical outcomes of using synthetic versus allogenic graft to fill the void created in MOWHTO., Hypothesis: The present clinical study hypothesized that allogenic graft to fill the void would allow the higher rate of bone union and better clinical outcomes., Material and Methods: This study compared the clinical and radiological outcomes of 95 patients who received MOWHTO to fill the void with either synthetic or allogenic graft (44 in Syn group, 51 in Allo group). Preoperatively and postoperatively, all patients were clinically evaluated; Return to work, Tegner activity score, and the Western Ontario and Macmaster University scores were reported. Radiographically, osteoarthritis grade and pre- and postoperative parameters were reported, including Hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle, proximal posterior tibial angle, and limb length discrepancy. Perioperative details and complications were also reported., Results: Mean follow-up (months) were 24.0±1.3 in Syn group and 26.8±1.2 in Allo group (p=0.13). The postoperative improvement of pain and global WOMAC scores in Allo group were significantly better than in Syn group (ΔPain of WOMAC: Syn group 27.8±4.4, Allo group 49.3±3.8, p value <0.001*) (ΔGlobal score of WOMAC: Syn group 16.7±3.2, Allo group 37.4±4.9, p value=0.002*). The risk of hinge fracture in Syn group was significantly higher than in Allo group (Hinge fracture by Takeuchi grade (0/1/2/3): Syn group 37/3/3/1, Allo group 43/8/0/0, p value=0.04*). The timing of full weight bearing in Allo group was significantly earlier than in Syn group (Weight Bearing (1=FWB, 2=PWB 3wk, 3=PWB 6wk): Syn group 2.7±0.1, Allo group 2.3±0.1, p value=0.01*)., Discussion: The use of allogenic graft to fill the void in MOWHTO does not show superiority in bone union compared to synthetic graft, however it improves pain, function, decreases the risk of hinge fracture and allows faster weight bearing than synthetic graft., Level of Proof: III; Case-control study., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Introduction: Despite the growing concept of meniscal preservation, partial meniscectomy could be the definitive procedure in specific scenarios. And total meniscectomy was once before a frequent procedure, with current sequelae of degenerate knees. High tibial osteotomy (HTO) is an effective treatment for patients suffering from unicompartmental degenerative changes, and substantial deformities. However, it is yet to be answered, whether HTO is similarly effective in both post-meniscectomy knees and knees with not previously operated meniscus., Hypothesis: Outcomes of HTO is similar with or without previous history of total or subtotal meniscectomy., Methods: This study compared the clinical and radiological outcomes of 41 patients who received HTO and had no previous history of surgery in the ipsilateral knee (group I), and 41 age, and gender-matched patients who had meniscectomy surgery in the ipsilateral knee (group II). Preoperatively and postoperatively, all patients were clinically evaluated; the visual analogue scale scores, Tegner activity score, and the Western Ontario and Macmaster University scores were reported. Radiographically, osteoarthritis grade and pre- and postoperative parameters were reported, including hip-knee-ankle angle, femoral mechanical angle, medial proximal tibial angle, joint line convergence angle, proximal posterior tibial angle, and limb length discrepancy. Perioperative details and complications were reported., Results: A total of 82 patients were included; group I (n=41) and group II (n=41). The mean age was 51.18±8.64 (27-68) and 90.24% were male. The duration since the onset of symptoms was longer in group II vs. group I, 43.34±41.03 versus 38.07±36.11months respectively. No significant differences in the clinical evaluation between the two groups with a greater proportion of patients demonstrating moderate degenerative changes. Similar preoperative and postoperative radiographic parameters were reported, in group I, Δ HKA was 7.19±4.14 versus 7.65±3.16 in group II. Preoperative pain VAS scores were slightly higher in group II vs. group I, 79.23±26.35 vs. 76.31±24.45, respectively. However, postoperatively, the pain scores significantly improved in group I vs. group II, 22.84±3.65 vs. 41.69±17.33, respectively. Tegner activity scores and WOMAC scores were comparable between both groups preoperatively and postoperatively. Only the WOMAC function scores were better in group I when compared to group II, 26.13±25.84 versus 20.01±17.98. All patients returned to work at an average of 0.82±0.38months., Conclusion: Knee preservation with high tibial osteotomy is equally effective in managing unicompartmental degenerative changes in varus malaligned knees with either no previous history of meniscal surgeries or where a meniscal sacrifice was inevitable, either with subtotal or total meniscectomy., Level of Evidence: III, retrospective case-control study., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Introduction: The high tibial osteotomy (HTO) survival rate is strongly correlated with surgical indications and predictive factors. This study aims to assess HTO survival in the long term, to determine the main predictive factors of this survival, to propose a predictive score for HTO based on those factors., Methods: This multicentric study included 481 HTO between 2004 and 2015. The inclusion criteria were all primary HTO in patients 70 years old and younger, without previous anterior cruciate ligament injury, and without the limitation of body mass index (BMI). The assessed data were preoperative clinical and radiological parameters, the surgical technique, the complications, the HKA (hip knee ankle angle) correction postoperatively, and the surgical revision at the last follow-up., Results: The mean follow-up was 7.8 ± 2.9 years. The HTO survival was 93.1% at 5 years and 74.1% at 10 years. Age < 55, female sex, BMI < 25 kg/m 2 and incomplete narrowing were preoperative factors that positively impacted HTO survival. A postoperative HKA angle greater than 180° was a positive factor for HTO survival. The SKOOP (Sfa Knee OsteOtomy Predictive) score, including age (threshold value of 55 years), BMI (threshold values of 25 and 35 kg/m 2 ), and the presence or absence of complete joint line narrowing, have been described. If the scale was greater than 3, the survival probability was significantly lower (p < 0.001) than if the scale was less than 3., Conclusion: A predictive score including age, BMI, and the presence or absence of joint line narrowing can be a helpful in making decisions about HTO, particularly in borderline cases., Level of Evidence: Retrospective cohort study., (© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Introduction: The primary objective of this study was to compare the radiological and clinical results of anterograde and retrograde screwing in subtalar arthrodesis using a single compression screw. The secondary objective was to evaluate the subjective results and consolidation of this procedure. The hypotheses were that isolated screw fixation was sufficient to achieve good consolidation and that there was no difference between the two techniques with a similar rate of bone fusion., Methods: This is a monocentric, retrospective, radio-clinical study based on 99 patients (101 feet), 58 males and 41 females, with an average age of 64 years. The main aetiology was post-traumatic osteoarthritis, which represented 51% of cases. Two groups were formed: group A (52 feet) consisting of fixed arthrodesis with ascending (retrograde) screwing and group D (49 feet) consisting of fixed arthrodesis with descending (anterograde) screwing. The two groups were statistically comparable in terms of demographic data as well as aetiologies and comorbidities. Arthrodeses which were not fused at 6 months were reassessed at one year and in the event of any radio-clinical doubt regarding consolidation, an additional CT scan was prescribed. Average post-operative follow-up was 11 ± 5 years (2-27 years)., Results: Ninety-two arthrodeses (93%) were fused at one year and 9 were considered to be in non-union, 5 (9.8%) in group A, and 4 (8.3%) in group D. We recorded 30 complications, 22 of which were due to a conflict with the screw head, 18 (34.5%) in group A and 4 (8.3%) in group D (p = 0.03). Conflict between the screw head and the heel led to the removal of the screw after consolidation of the arthrodesis. The clinical results were evaluated using Odom's criteria. Nine per cent of patients described their results as excellent, 29% as good, 51% as satisfactory and 11% found the result to be poor., Conclusion: The fusion rate for isolated compression screw arthrodesis is good, and there is no difference between anterograde and retrograde screws. However, the discomfort caused by the screw head being insufficiently embedded in the retrograde group led to a non-negligible number of additional surgeries to remove the screw., (© 2021. The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature.)

The past decade has seen the development of numerous arthroscopic techniques for ankle ligament repair or reconstruction in the treatment of chronic lateral ankle instability. Arthroscopy allows the assessment and treatment of intra-articular pathologies and is associated with faster functional recovery. The open surgery technique described by Blanchet, combining reinsertion of the lateral collateral ligament with reinforcement by an extensor retinaculum flap, has long proven its effectiveness. The aim of this article is to describe this technique under arthroscopy., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Background: The Latarjet procedure is one of the most well-established treatment options for anterior shoulder instability. However, meaningful clinical outcomes after this surgery have not been defined., Purpose: This study aimed to establish the minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) for commonly used outcome measures in patients undergoing the Latarjet procedure and determine correlations between preoperative patient characteristics and achievement of MCID or PASS., Study Design: Case series; Level of evidence, 4., Methods: A multicenter retrospective review at 4 institutions was performed to identify patients undergoing primary open Latarjet procedure with minimum 2-year follow-up. Data collected included patient characteristics (age, sex, sports participation), radiological parameters (glenoid bone loss, off-track Hill-Sachs lesion), and 4 patient-reported outcome measures (collected preoperatively and 2 years postoperatively): the American Shoulder and Elbow Surgeons (ASES) score, the Single Assessment Numeric Evaluation (SANE), the visual analog scale (VAS) for pain, and the Western Ontario Shoulder Instability Index (WOSI). The MCID and PASS for each outcome measure were calculated, and Pearson and Spearman coefficient analyses were used to identify correlations between MCID or PASS and preoperative variables (age, sex, sports participation, glenoid bone loss, off-track Hill-Sachs lesion)., Results: A total of 156 patients were included in the study. The MCID values for ASES, SANE, VAS pain, and WOSI were calculated to be 9.6, 12.4, 1.7, and 254.9, respectively. The PASS values for ASES, SANE, VAS pain, and WOSI were 86.0, 82.5, 2.5, and 571.0, respectively. The rates of patients achieving MCID were 61.1% for VAS pain, 71.6% for ASES, 74.1% for SANE, and 84.2% for WOSI. The rates of achieving PASS ranged from 78.4% for WOSI to 84.0% for VAS pain. There was no correlation between any of the studied preoperative variables and the likelihood of achieving MCID or PASS., Conclusion: This study defined MCID and PASS values for 4 commonly used outcome measures in patients undergoing the Latarjet procedure. These findings are essential for incorporating patient perspectives into the clinical effectiveness of the Latarjet procedure and provide valuable parameters for the design and interpretation of future clinical trials.

The Zadek osteotomy is a therapeutic option in Haglund' syndrome for patients with a X/Y ratio measurement of the calcaneus under 2.5. We hypothesized that Zadek osteotomy would lead to improvement in ankle dorsiflexion and functional scores. Twenty-two patients (mean age: 48.5 years) with Haglund's syndrome underwent a Zadek osteotomy and were enrolled in a prospective study investigating the proposed hypothesis. Radiological measurements included the X/Y ratio and the pitch angle. Measurements of the dorsiflexion of the ankle, using a hand-made frame, were performed twice by 2 independent observers. Inter and intra classes correlations were calculated. Functional results were assessed using AOFAS, EFAS and EFAS sport. Correlation between ankle dorsiflexion and functional scores were determined using linear regression curves. Our hypothesis was validated with a mean improvement of dorsiflexion of 7.27° (54.98% improvement from pre-operative measurement) (p < 0.0001). Ankle dorsiflexion measurements were highly reproducible with an interclass correlation coefficient(ICC)> 0.95 (0.98-0.99). All mean values of functional scores were significantly improved(p < 0.05) [AOFAS (61.95-94), EFAS (14-21.82), EFAS sport (7.68-13.69)] and were strongly correlated to the dorsiflexion values with a coefficient of determination of 0.82 for AOFAS and EFAS and of 0.86 for EFAS sport, respectively. The mean values of X/Y ratio and pitch angle improved from pre to postoperative conditions, 2.18-2.75 and 28.95-19.77° (p < 0.05), respectively. The angle correction obtained from modifiying the shape of the calcaneus, due to the Zadek osteotomy, confirms it as a safe and reliable treatment, with improvements of both ankle dorsiflexion and functional scores., (Copyright © 2021 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

Local debridement or decompression of the posterior heel in Haglund's syndrome yields variable results. This condition is sometimes due to an excessively long calcaneus rather than simply a large posterosuperior bony prominence. Failure to address this abnormality may explain the poor results in some series. We recently published a new measurement (the X/Y ratio) which, combined with the calcaneal pitch angle, assesses the abnormality of the shape of the calcaneus. The Zadek osteotomy strongly modifies that shape. We retrospectively reviewed 50 patients treated by a Zadek osteotomy at a mean 7 years follow-up using the AOFAS ankle-hindfoot score, the VISA-A score and Tegner scale. We measured only the X/Y ratio and the calcaneal inclination angle, as the classically described radiographic measurements in Haglund's syndrome are unreliable. We then assessed the condition of the distal end of the Achilles tendon with an MRI. Our results demonstrate excellent outcomes(40/50, 80%) following Zadek osteotomy and correspond to the change in pre- and post-operative measurements, especially the X/Y ratio. An algorithm using those geometrical measurements of the calcaneus is proposed for decision making in Haglund's syndrome. Level of clinical evidence: Level 3., (Copyright © 2021 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.)

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., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: Metatarsal osteotomy is a major means of treating mechanical metatarsalgia. Open techniques are widely used, and notably that described by Weil. They have, however, certain drawbacks, and new types of osteotomy have been developed. Percutaneous techniques are presently very much in favor, and Distal Metatarsal Minimally Invasive Osteotomy (DMMO) has emerged as a treatment for metatarsalgia. Although very widely used, it is poorly codified in the literature., Method: The present study detailed DMMO techniques and their variants (oblique and reverse), with corresponding indications and treatment decision-tree., Results: Initial findings seem encouraging, with functional results comparable to those of open surgery. Postoperative edema and radiologic bone healing time seem to be longer in DMMO. There is, on the other hand, no difference regarding stiffness., Conclusion: DMMO is an effective option to treat metatarsalgia, with variants enabling adaptation to foot morphology, but needing confirmation by studies with higher levels of evidence., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Definitive diagnosis and optimal surgical treatment of chronic lateral ankle instability remains controversial. This review distills available biomechanical evidence as it pertains to the clinical assessment, imaging work up, and surgical treatment of lateral ankle instability. Current data suggest that accurate assessment of ligament integrity during physical examination requires the ankle to ideally be held in 16° of plantar flexion when performing the anterior drawer test and 18° of dorsiflexion when performing the talar tilt test, respectively. Stress radiographs are limited by their low sensitivity, and MRI is limited by its static nature. Surgically, both arthroscopic and open repair techniques appear biomechanically equivalent in their ability to restore ankle stability, although sufficient evidence is still lacking for any particular procedure to be considered a superior construct. When performing reconstruction, grafts should be tensioned at 10 N and use of nonabsorbable augmentations lacking viscoelastic creep must factor in the potential for overtensioning. Anatomic lateral ligament surgery provides sufficient biomechanical strength to safely enable immediate postoperative weight bearing if lateral ankle stress is neutralized with a boot. Further research and comparative clinical trials will be necessary to define which of these ever-increasing procedural options actually optimizes patient outcome for chronic lateral ankle instability., (Copyright © 2020 by the American Academy of Orthopaedic Surgeons.)

Introduction: Preoperative planning in high tibial osteotomy (HTO) is a critical step for achieving the desired correction and a clinically satisfactory outcome. Conventional radiography, navigation assistance and patient-specific instrumentation (PSI) are the 3 means of planning, but no prospective studies have compared precision between the 3. The aims of the present study were: (1) to analyze and compare correction precision between the 3 planning approaches at 1 year's follow-up; (2) to compare results to those reported in the literature; and (3) to analyze factors influencing the achievement of planned correction., Hypothesis: The study hypothesis was that PSI provides more precise and reproducible planned correction than conventional methods or navigation., Material and Method: Between June 2017 and June 2018, a multicenter non-randomized prospective observational study was conducted in 11 centers. One hundred and twenty-six patients with Ahlbäck grade I, II or III idiopathic medial tibiofemoral osteoarthritis with stable knee were included and allocated to 3 preoperative planning groups: conventional (group 1), navigation (group 2) and PSI (group 3). Mean age at surgery was 51.2 years (range, 19-69 years; median, 53.2 years); 100 male, 26 female. Complete weight-bearing radiographic work-up was performed preoperatively and at 1 year's follow-up. The PSI group also underwent CT as part of guide production. Target angular correction and mechanical Hip-Knee-Ankle (HKA) axis were set preoperatively. The main endpoint was the difference between planned HKA and HKA at a minimum 12 months., Results: Mean HKA difference was 1.1±3 in group 1, 2.1±2.6 in group 2 and 0.3±3.1 in group 3. Precision was better with PSI, but not significantly when comparing all 3 groups together. On pairwise intergroup comparison, there was a significant difference only between groups 2 and 3, in favor of PSI (P=0.011)., Discussion: None of the 3 techniques demonstrated superiority in achieving target correction at 1 year. The study hypothesis was thus not confirmed. All 3 techniques proved reliable and precise in HTO planning., Level of Evidence: III, prospective non-randomized comparative study., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Introduction: Acromioclavicular (AC) arthropathy can contribute to shoulder pain; it can be treated surgically by distal clavicle resection (DCR). The aim of this study was to determine whether increased T2 signal intensity in the clavicle on MRI is an argument in favour of AC resection arthroplasty by DCR during rotator cuff repair., Methods: The MRI images from 107 shoulders in 107 patients were analysed. We looked for statistical relationships and correlations between shoulders with T2 hyperintensity (HI+) and those without (HI-) before surgery and then in shoulders with T2 hyperintensity (HI+) that underwent AC resection arthroplasty (AC+) and those who did not (AC-)., Results: On MRI, T2 hyperintensity in the AC joint was correlated with sex (more often found in men) and radiological signs of AC arthropathy. There was no statistical correlation before surgery, particularly with AC pain, or after surgery, with outcomes in shoulders undergoing DCR., Conclusion: When repairing rotator cuff tears, the presence of T2 hyperintensity on MRI in the distal clavicle is not a predictor of better clinical outcomes after AC resection arthroplasty is done. The AC pain may be related to the rotator cuff tear instead., Level of Evidence: II, prospective randomised study., (Copyright © 2020. Published by Elsevier Masson SAS.)

Introduction: In case of failure of non-operative treatment of isolated supraspinatus tear, tendon surgery can improve shoulder function and alleviate pain. The present study hypothesis was that isolated supraspinatus repair shows good healing, with improved clinical results., Materials and Methods: A prospective multicentre study followed up 199 patients (mean age, 57 years) for one year. Inclusion criteria comprised: isolated full-thickness supraspinatus tear, retraction grade<3, with the same double-row arthroscopic technique. Clinical assessment used Constant score at 6 weeks and 3, 6 and 12 months. Ultrasound control checked tendon repair quality on the Sugaya criteria, types I-II-III being considered as healed., Results: At one year, mean Constant score had increased by 26 points (p<0.001). Healing rate was 94% (n=187): Sugaya type I, 46% (n=92); type II, 41% (n=81); type III, 7% (n=14). Mean Constant score was significantly higher in case of healing: 81 vs. 70 points (p=0.002). Constant score progression was identical in both healing groups throughout follow-up. Univariate analysis showed no correlation between epidemiological or tear-related factors and tendon healing., Conclusion: Arthroscopic repair of isolated small supraspinatus tear provided 94% healing. Clinical results were better when healing was achieved., Level of Evidence: I, prospective cohort study., (Copyright © 2020. Published by Elsevier Masson SAS.)

Introduction: Osteoarthritis is the second most frequent cause of elbow stiffness, after trauma sequelae. Surgical treatment mainly consists of debridement. The main aim of the present study was to assess the efficacy of arthroscopic treatment of osteoarthritis of the elbow on Andrews-Carson score. Secondary objectives comprised assessment of the impact of associated procedures and of epidemiological factors on functional results., Method: A prospective multicenter study involving 8 centers, in a symposium held by the French Society of Arthroscopy (SFA), included patients treated by arthroscopy for primary or secondary osteoarthritis of the elbow between January 2017 and March 2018, with a minimum 6 months' follow-up. Clinical assessment was based on change in Andrews-Carson functional score (AC), specific to osteoarthritis of the elbow, and on other functional scores: QuickDash (QD), Patient-Rated Elbow Evaluation (PREE), Mayo Elbow Performance Score (MEPS) and Self-Evaluation Elbow (SEE). Progression in pain on visual analog scale (VAS) and range of motion (RoM) was also assessed. Initial imaging work-up comprised standard X-ray and CT arthrography; paraclinical follow-up was based on X-ray. The impact of the following procedures associated to arthroscopic debridement was analyzed: radial head resection, ulnar nerve release, humeral fenestration, lateral ramp release, and medial collateral ligament posterior bundle release. The functional impact of epidemiological factors (age, handedness, manual occupation, smoking, body-mass index, and work accident/occupational disease status) and radiographic factors (foreign bodies, joint impingement, osteophytes, and fossa filling) was also assessed., Results: The series comprised 87 patients: 75 male (86.2%); mean age, 49 years (range, 18-73 years). Arthroscopic debridement significantly improved all functional scores at a minimum 6 months, and notably the specific AC score: 113.6±25.4 (40-180) versus 178.7±20.2 (110-200) (P<0.0001). Pain diminished significantly: 6.4±2.1 (0-10) versus 1.7±1.8 (0-8) (P<0.0001). RoM increased significantly: flexion/extension, 93.44±20.5° (5-130°) versus 124.2±13.8° (90-160°) (P<0.0001); pronation/supination, 147.6±25.6° (60-180°) versus 162.5±20.6° (100-180°) (P<0.0001). Strength (kg) increased in flexion (8.8±4.0 (4 to 20) versus 15.3±5.1 (3 to 32) (P<0.0008) and in grip [33.1±12.3 (10 to 58) versus 42.1±14.0 (2 to 68) (P<0.0001)]. Epidemiologically, males showed better recovery than females for both pain and strength. There was a significant positive impact of manual work on functional recovery, pain and also strength. There was a significant negative impact of work-accident/occupational disease on pain and strength. Regarding associated procedures, lateral ramp debridement improved AC score, with a gain of 75.4±25.3 points (-5 to 110) vs. 49.6±23.5 (10 to 100) (P<0.0001), and pain on VAS, with a fall of -5.6±2.1 points (-10 to -1) vs. -3.6±3.0 (-8.5 to 1) (P=0.0013). Ulnar nerve release, radial head resection and humeral fenestration had no positive impact. Preoperative foreign body was a factor for good prognosis. Cartilage wear, especially in the humeroulnar compartment, was associated with poorer functional results., Discussion/conclusion: Arthroscopic treatment of osteoarthritis of the elbow significantly improved clinical results at 6 months, with significant improvements in functional scores, pain, strength and range of motion. Gender, type of work and work-accident/occupational disease status influenced clinical results. Lateral ramp release is an often overlooked technical factor improving functional results. Radiologically, the best candidates are those presenting with a foreign body and no humeroulnar impingement., Level of Evidence: III, Prospective observational multicenter cohort study., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Objective: For chronic lateral ankle instability an anatomical repair procedure of the lateral collateral ligaments (LCL) of the ankle with augmentation by an inferior extensor retinaculum (IER) flap is proposed., Indications: To treat the mechanical parts of an instable ankle involving both LCL and subtalar joint ligament damage., Contraindications: This technique is not suitable when the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) are in a poor anatomical condition (exhaustive preoperative lesion mapping mandatory)., Surgical Technique: This technique combines the reinsertion of the remnants of the lateral ligaments of the ankle, the ATFL and the CFL using anchors, with augmentation using an inferior extensor retinaculum flap fixed in a tunnel by an interference screw. This flap works as an actual neoligament, providing not only reinforcement and collagen input but also peripheral stabilization of the subtalar joint by its calcaneal insertion and reinforcing the CFL stabilizing effect., Postoperative Management: Following immediate immobilization in an ankle-foot orthosis, proprioceptive physiotherapy exercises are initiated with a return to sports depending on the type of sport., Results: The postoperative outcomes and long-term follow-up results of this technique are discussed.

Introduction: In Haglund syndrome, standard radiologic measurements lack specificity and reliability in assessing etiologic morphologic calcaneal abnormalities. We report a simple X/Y ratio to measure posterior calcaneal length, where X is calcaneal length on lateral weight-bearing view and Y is greater tuberosity length., Objective: To compare this new parameter against the radiologic gold standard in a group of Haglund patients and a healthy control group., Hypothesis: Measuring this ratio significantly distinguishes between Haglund patients and healthy subjects., Material and Methods: A retrospective study included 50 Haglund syndrome patients and 30 healthy controls. Standard measurements (Fowler-Philipangle, Chauveaux-Liet angle, Ruch pitch, Heneghan-Pavlov test) and X/Y ratio were calculated twice by 2 independent observers. Intra- and inter-observer correlations were calculated, as were the specificity and sensitivity of the various parameters, with a ROC curve to establish the X/Y threshold., Results: All measurements were reproducible on intra- and inter-observer testing. There were no significant inter-group differences in standard measurement specificity or sensitivity. The Haglund group showed significantly lower X/Y ratio (2.07) than controls (2.70; p<0.0001), with a cut-off at 2.5. Threshold sensitivity in confirming Haglund syndrome was 100% (p<0.0001) and specificity 95% (p<0.0001)., Discussion: This new parameter measures the length of the calcaneus and its greater tuberosity. It is more reliable and reproducible in terms of sensitivity and specificity than standard measurements in Haglund syndrome. The 2.5 ratio threshold can guide surgical decision-making., Level of Evidence: III., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Purpose: To determine the location of the subscapularis split during arthroscopic Latarjet created by an inside-out technique passing a switching stick from the posterior portal across the glenohumeral joint., Methods: An inside-out technique was used to arthroscopically create a subscapularis split in 20 fresh-frozen human cadaveric shoulders. The distance between the exit point of the switching stick and the upper border of the subscapularis and the anterior circumflex vessels was measured arthroscopically and after open dissection., Results: Twelve splits were in the upper third of the subscapularis, 3 were at the junction of the upper third and the middle third, and 5 were in the middle third. None were at the junction between the middle and lower third as desired., Conclusions: Using the inside-out method during arthroscopic Latarjet may produce a high subscapularis split if it is performed from with a switching stick that is inserted through the posterior approach, and passed across the glenohumeral joint at the level of the inferior glenoid., Clinical Relevance: This study analyzed the relative risk of high subscapularis split during the arthroscopic Latarjet procedure., (Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.)

Purpose: Management of proximal humeral tumours remains a surgical challenge. No study to date has assessed the quality of life scores following the composite reverse shoulder arthroplasty for this indication. We, therefore, evaluated function and quality of life following reconstruction with allograft for malignant tumour of the humerus., Methods: A series of six cases of humeral tumour treated by a single surgeon in a single centre was reviewed after a mean follow-up of 5.9 years. The tumours included two chondrosarcomas, one plasmocytoma and three metastases. Resection involved bone epiphysis, metaphysis and diaphysis in five cases (S3S4S5A) and epiphysis and metaphysis in one case (S3S4A). For reconstruction, an allograft composite reverse shoulder arthroplasty was used in all the cases. Outcomes were assessed with range of motion, the QuickDash score and the Short Form 12 (SF-12) Health Survey. Radiographs assessed osseointegration and complications., Results: At the final follow-up, the mean shoulder range of motion were respectively 95°, 57° and 11° for forward flexion, abduction and external rotation. Mean QuickDASH score improved from 28 to 41 and VAS-pain scores improved from 5.1 to 2.3. The post-operative MSTS score was 73% and the Constant score was 46.1/100. The SF-12 PCS and MCS scores were also improved, respectively from 44.4 and 39.7 to 45.5 and 56.1. The mean satisfaction score was 8.1/10., Conclusions: Composite reverse shoulder arthroplasty is a viable alternative for reconstruction after resection of malignant humeral tumour. Although total tumour resection was the most important objective, the functional and quality of life scores were satisfactory.

Introduction: Coracoid bone graft transfer has become the gold standard in patients with recurrent anterior shoulder instability associated with bony defect. Several studies have shown that the main stabilizing component of this procedure is the sling effect by the conjoint tendon and the lower portion of subscapularis (SS). The purpose of this study was to determine whether a larger SS volume below the bone block was correlated to greater postoperative shoulder stability., Materials and Methods: This prospective study included a cohort of patients who underwent open coracoid bone graft transfer for post-traumatic recurrent anterior shoulder instability. Forty patients were reviewed at 2 years with a clinical and CT scan evaluation. A correlation analysis assessed the relation between the SS volume index (ratio of SS volume below the bone block to volume over the bone block) and Rowe and Walch-Duplay instability scores., Results: There exists a positive and significant correlation between SS volume index and postoperative Rowe score, r=0.37 (P=0.03). The same trend was observed for Walch-Duplay score without statistical significance. A larger inferior SS volume did not result in a limitation of external rotation, greater fatty infiltration, or malposition of the coracoid graft., Conclusion: A larger SS volume below the bone block is related to greater postoperative shoulder stability. We recommend performing the split in the middle of the SS or higher instead of the junction of the superior two-thirds and inferior one-third as usually reported., Level of Evidence: III, prospective study., (Copyright © 2017 Elsevier Masson SAS. All rights reserved.)

Background: The aim of the study was to develop a computed tomography (CT)-based measurement protocol for coracoid graft (CG) placement in both axial and sagittal planes after a Latarjet procedure and to test its intraobserver and interobserver reliability., Methods: Fifteen postoperative CT scans were included to assess the intraobserver and interobserver reproducibility of a standardized protocol among 3 senior and 3 junior shoulder surgeons. The evaluation sequence included CG positioning, its contact area with the glenoid, and the angle of its screws in the axial plane. The percentage of CG positioned under the glenoid equator was also analyzed in the sagittal plane. The intraobserver and interobserver agreement was measured by the intraclass correlation coefficient (ICC), and the values were interpreted according to the Landis and Koch classification., Results: The ICC was substantial to almost perfect for intraobserver agreement and fair to almost perfect for interobserver agreement in measuring the angle of screws in the axial plane. The intraobserver agreement was slight to almost perfect and the interobserver agreement slight to substantial regarding CG positioning in the same plane. The intraobserver agreement and interobserver agreement were both fair to almost perfect concerning the contact area. The ICC was moderate to almost perfect for intraobserver agreement and slight to almost perfect for interobserver agreement in analyzing the percentage of CG under the glenoid equator., Conclusion: The variability of ICC values observed implies that caution should be taken in interpreting results regarding the CG position on 2-dimensional CT scans. This discrepancy is mainly explained by the difficulty in orienting the glenoid in the sagittal plane before any other parameter is measured., (Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Background: Shoulder arthroscopic arthrodesis is an uncommon and non-standardized procedure. Results are poorly evaluated. We describe the findings in 8 patients who underwent shoulder arthroscopic arthrodesis for brachial plexus injury., Methods: The humeral head and glenoid were excised through standard arthroscopic portals. A Hoffmann external fixator and cannulated screws were used to stabilize the shoulder. Standard clinical assessment and radiographic evaluation were performed each month until bony fusion occurred. With a mean follow-up of 28 months, functional evaluation included pain level (on a 0- to 10-mm visual analog scale); American Shoulder and Elbow Surgeons index; Disabilities of the Arm, Shoulder and Hand score; and Simple Shoulder Test score. Mobility was systematically investigated. Blood loss was assessed by measuring hematocrit proportion., Results: Glenohumeral fusion was achieved in all 8 patients. The mean time to arthrodesis was 3 months (range, 2-8 months). At last follow-up, the mean pain level was 1 (range, 0-4); the mean American Shoulder and Elbow Surgeons score was 69; the mean Disabilities of the Arm, Shoulder and Hand score was 36; and the mean Simple Shoulder Test score was 4. Mean active flexion and abduction were 80° (range, 60°-90°) and 59° (range, 40°-80°), respectively. Mean blood loss during the perioperative period was 432 mL (range, 246-792 mL). We observed one superficial wound infection and one migration of an acromiohumeral screw. These complications did not compromise the final results., Conclusions: Arthroscopic arthrodesis of the shoulder can be a reliable procedure and associated with a low rate of complications., (Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Purpose: Osteolysis in total hip arthroplasty (THA) depends on polyethylene wear and dictates the survival of the prosthesis. Dual mobility in THAs, which is claimed to reduce dislocation risk, has very good long-term clinical results. However, little is known about how the liner wears in this design, compared to the standard single mobility model., Methods: A comparative study looking at wear of a conventional ultra-high-molecular-weight polyethylene liner, using gravimetric measurement, between dual mobility implants and standard implants, was performed on a simulator in accordance with a normed protocol based on the same dimensions, environmental conditions and stresses. A linear regression test was employed., Results: Under the same conditions (loading, cycles, sterilization, material and surface roughness), the gravimetric wear (for conventional polyethylene) is comparable between a standard and a dual mobility cup. This correlates to ten year follow-up results of dual mobility cup., Discussion - Conclusion: This in vitro equivalent wear serves to confirm the very good long-term clinical results observed with dual mobility bearing, whose use should not be restricted by concerns about increased polyethylene wear.

Background: Neurologic lesions are relatively common after total shoulder arthroplasty. These injuries are mostly due to traction. We aimed to identify the arm manipulations and steps during reverse total shoulder arthroplasty (RTSA) that affect nerve stress., Methods: Stress was measured in 10 shoulders of 5 cadavers by use of a tensiometer on each nerve from the brachial plexus, with shoulders in different arm positions and during different surgical steps of RTSA., Results: When we studied shoulder position without prostheses, relative to the neutral position, internal rotation increased stress on the radial and axillary nerves and external rotation increased stress on the musculocutaneous, median, and ulnar nerves. Extension was correlated with increase in stress on all nerves. Abduction was correlated with increase in stress for the radial nerve. We identified 2 high-risk steps during RTSA: humeral exposition, particularly when the shoulder was in a position of more extension, and glenoid exposition. The thickness of polyethylene humeral cups used was associated with increased nerve stress in all but the ulnar nerve., Conclusion: During humeral preparation, the surgeon must be careful to limit shoulder extension. Care must be taken during exposure of the glenoid. Extreme rotation and oversized implants should be avoided to minimize stretch-induced neuropathies., (Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.)

Capsule/ligament lesions of the lateral compartment of the ankle lead to lateral laxity, which is a prime contributor to chronic ankle instability. Lateral ligament reconstruction stabilizes the joint. Exhaustive preoperative clinical and paraclinical work-up is essential. The present article classifies, presents and criticizes the main techniques in terms of long-term stabilization and reduction of osteoarthritis risk. Anatomic ligament repair with reinforcement (mainly extensor retinaculum) or anatomic ligament reconstruction are the two recommended options. Non-anatomic reconstructions using the peroneus brevis should be abandoned. Arthroscopy is increasingly being developed, but results need assessment on longer follow-up than presently available. Postoperative neuromuscular reprogramming is fundamental to optimal recovery. Finally, the concept of complex ankle instability is discussed from the diagnostic and therapeutic points of view. The various forms of ligament reconstruction failure and corresponding treatments are reported., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: The Latarjet-Patte procedure consisting in transfer and screw fixation of the coracoid process to the anterior glenoid is a treatment of reference for anterior shoulder instability. Over time, surgical innovations translated into a number of improvements and, in late 2003, an arthroscopically assisted variant of the procedure was described., Objective: To evaluate and compare clinical outcomes of the modified Latarjet-Patte procedure performed by open surgery, arthroscopy with screw fixation, or arthroscopy with endobutton fixation., Material and Method: A total of 390 patients who underwent surgery to treat anterior shoulder instability between March 2013 and June 2014 were included and divided into three groups depending on whether they were managed using open surgery with screw fixation, arthroscopy with screw fixation, or arthroscopy with endobutton fixation. Clinical findings were recorded pre-operatively then 6 months post-operatively and at last follow-up (mean, 27.7 months). Range of motion and apprehension test (arm in external rotation at 0°, 90°, and 140° of abduction) were assessed and the Walch-Duplay and modified Rowe scores were determined., Results: Motion range restriction was minimal with all three techniques, and motion range continued to improve throughout follow-up. Apprehension in external rotation was noted at 90° of abduction in 11% of cases and at 140° of abduction in 4% of cases. The mean total Walch-Duplay score improved from 46 pre-operatively to 90.6 and the mean total modified Rowe score from 46 pre-operatively to 91.1. By statistical analysis, external rotation at 90° of abduction and internal rotation at 0° of abduction were better after open surgery, but the differences were of limited clinical significance. Recurrence was noted in 3.3% of cases, nerve injury in 0.8%, and infection in 1.5%., Conclusion: In this study, the three techniques produced similar clinical outcomes, with a stable shoulder and no joint stiffness., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: Standard radiography with an antero-posterior view and Bernageau's glenoid profile view is the method most widely reported in the literature to assess coracoid bone block position and fusion., Objective: The aim of this cadaver study was to determine whether the antero-posterior and Bernageau's radiographs provide a reliable and reproducible evaluation of the position of a coracoid bone block and its fixation screws., Method: An isolated scapula showing no evidence of osteoarthritis or other abnormalities was used. The coracoid process was transferred to the anterior glenoid rim. Fixation was with two slightly diverging malleolar screws, chosen of different sizes for ease of identification. Computed tomography (CT) was performed as the reference imaging technique. The standard radiographs were then obtained, using fluoroscopy to accurately position the scapula for the antero-posterior and Bernageau's views. This position was defined as 0°, and radiographs were taken at angles of 5°, 10°, and 15° in all three planes. All radiographs were taken during a single session to ensure that the distance separating the tube from the scapula remained unchanged. The images were exported to OsiriX for analysis. We measured the angles formed by the screws and the glenoid surface, as well as bone block position and overhang. Finally, we used 1-mm thick disks to evaluate bone-to-bone contact., Results: No correlations were found between values by CT and by standard radiography (both views) for the screw angles or overhang. A space≤1mm between the neck of the scapula and the bone block was not visible on the standard radiographs in any of the positions., Conclusion: Standard radiography does not provide an accurate analysis of bone block position or bone-to-bone contact. CT is needed to assess bone block and screw position and bone-to-bone contact., Level of Evidence: Level III., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Aims: To report and analyze both the surgical and radiographic complications associated with anatomic coracoclavicular (CC) ligament procedures and to evaluate the effect of these complications on patient outcomes., Patients and Methods: From July 2012 to July 2013, 116 primary anatomic CC ligament procedures (all arthroscopic endobutton fixations) were performed in 14 different centers. Demographic, surgical, subjective, and radiographic data were prospectively analyzed in 14 centers with a minimum follow-up of 12 months., Results: This series included 96 men and 20 women, mean age 37 years old, with a mean delay to surgery of 10 days. No intraoperative complications were reported. There were 11 complications due to hardware failure resulting in a loss of reduction, 1 coracoid fracture, 7 cases of adhesive capsulitis, 2 local infections, 5 cases of hardware pain. There were significant differences in outcomes between patients who did and did not develop complications: mean CS=71 vs. 93, (P<0.0001). All the parameters of the CS were statistically affected (P<0.0001). Forty-eight patients had persistent dislocation>150% on an AP X-ray which affected the pain and activity CS (P=0.023 and P=0.044). No preoperative predictive factors were identified. These patients could not return to the same level of sports activities due to persistent pain., Discussion: Anatomic procedures to treat AC joint dislocation using CC ligament reconstruction resulted in an overall complication rate of 22.4% and influenced the return to sports. Good to excellent outcomes were reported in patients without complications., Clinical Series: Level of evidence 4., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Background: The primary objective was to evaluate correlations linking anatomical to functional outcomes after endoscopically assisted repair of acute acromioclavicular joint dislocation (ACJD)., Hypothesis: Combined acromioclavicular and coracoclavicular stabilisation improves radiological outcomes compared to coracoclavicular stabilisation alone., Material and Methods: A prospective multicentre study was performed. Clinical outcome measures were pain intensity on a visual analogue scale (VAS), subjective functional impairment (QuickDASH score), and Constant's score. Anatomical outcomes were assessed on standard radiographs (anteroposterior view of the acromioclavicular girdle and bilateral axillary views) obtained preoperatively and postoperatively and on postoperative dynamic radiographs taken as described by Tauber et al., Results: Of 116 patients with acute ACJD included in the study, 48% had type III, 30% type IV, and 22% type V ACJD according to the Rockwood classification. Coracoclavicular stabilisation was achieved using a double endobutton in 93% of patients, and concomitant acromioclavicular stabilisation was performed in 50% of patients. The objective functional outcome was good, with an unweighted Constant's score ≥ 85/100 and a subjective QuickDASH functional disability score ≤ 10 in 75% of patients. The radiographic analysis showed significant improvements from the preoperative to the 1-year postoperative values in the vertical plane (decrease in the coracoclavicular ratio from 214 to 128%, p=10(-6)) and in the horizontal plane (decrease in posterior displacement from 4 to 0mm, p=5×10(-5)). The anatomical outcome correlated significantly with the functional outcome (absolute R value=0.19 and p=0.045). We found no statistically significant differences across the various types of constructs used. Intra-operative control of the acromioclavicular joint did not improve the result. Implantation of a biological graft significantly improved both the anatomical outcome in the vertical plane (p=0.04) and acromioclavicular stabilisation in the horizontal plane (p=0.02). The coracoclavicular ratio on the anteroposterior radiograph was adversely affected by a longer time from injury to surgery (p=0.02) and by a higher body mass index (BMI) (p=0.006). High BMI also had a negative effect on the difference in the distance separating the anterior edge of the acromion from the anterior edge of the clavicle between the injured and uninjured sides, as assessed on the axillary views (p=0.009)., Conclusion: This study demonstrates that acute ACJD requires stabilisation in both planes, i.e., at the coracoclavicular junction and at the acromioclavicular joint. Coracoclavicular stabilisation alone is not sufficient, regardless of the type of implant used. Implantation of a biological graft should be considered when the time from injury to surgery is longer than 10days. The weight of the upper limb should be taken into account, with 6weeks of immobilisation to unload the construct in patients who have high BMI values., Level of Evidence: II, prospective non-randomised comparative study., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: Treatment of chronic acromioclavicular joint dislocation (ACJD) remains a poorly known and controversial subject. Given the many surgical options, it is not always easy to determine which steps are indispensable., Methods: This article reports a multicenter prospective study. The clinical and radiological follow-up involved a comparative analysis of the preoperative and postoperative data at 1 year, including pain (visual analogue scale), subjective functional incapacity (QuickDASH), and the objective Constant score, as well as a comparative analysis of vertical and horizontal movements measured on simple x-rays., Results: Based on a series of 140 operated ACJDs, we included 24 chronic ACJDs. The mean time to surgery was 46 weeks (range, 1 month to 4 years). The patients' mean age was 41 years, with a majority of males (75%), 72% of whom participated in recreational sports. Professionally, 40% of the subjects had jobs involving manual labor. We noted 40% grade III, 24% grade IV, and 36% grade V injury according to the Rockwood classification. In 92% of cases, coracoclavicular stabilization was provided by a double button implant, reinforced with a biological graft in 88% of the cases. In 29%, millimeters to centimeters of the distal clavicle were resected and acromioclavicular stabilization was associated in 54%. We observed complications in 33% of the cases. At 1 year postoperative, 21 patients underwent clinical and radiological follow-up (87.5%). Only 35% of the patients were satisfied or very satisfied, whereas 100% of them would recommend the operation. Full-time work was resumed in 91% of the cases and all sports could be resumed in 86%. The pre- and postoperative values at 1 year changed as follows: the mean Constant score improved from 61 to 87 (p=0.00002); the subjective QuickDASH score decreased from 41 to 9 (p=0.00002); and radiologically significant reduction of the initial displacement was observed in the vertical plane (p<10(-3)) and the horizontal plane (p=0.022)., Conclusion: In this study, the favorable prognostic factors found were: time to surgery less than 3 months (p=0.02), associated acromioclavicular stabilization, and postoperative immobilization with a sling extended to 6 weeks. However, resection of the distal clavicle did not influence the final result., Level of Proof: Level II prospective non-randomized comparative study., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)