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1. Influence of the post-operative axis on the clinical results of total knee replacement for severe varus deformities: does a slight residual varus improve the results?

Author

Brice Rubens-Duval, Ramsay Refaie, Dominique Saragaglia, Loïc Sigwalt, Régis Pailhé, Gabriel Lateur, CHU de Grenoble urgences Sud, Ministère de la santé, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France, parent, Wansbeck General Hospital, and Centre Hospitalier Universitaire [Grenoble] (CHU)

Subjects
Adult, Male, medicine.medical_specialty, Knee Joint, [SDV]Life Sciences [q-bio], Radiography, medicine.medical_treatment, Genu varum, Knee replacement, Osteoarthritis, 03 medical and health sciences, 0302 clinical medicine, Genu Varum, medicine, Humans, Orthopedics and Sports Medicine, Longitudinal Studies, Postoperative Period, Arthroplasty, Replacement, Knee, Alignment, Aged, Aged, 80 and over, 030203 arthritis & rheumatology, Orthodontics, Varus deformity, 030222 orthopedics, Arthrometry, Articular, biology, business.industry, Bone Malalignment, Middle Aged, Osteoarthritis, Knee, medicine.disease, biology.organism_classification, Valgus, Orthopedic surgery, Female, Surgery, Axis, medicine.symptom, Total knee arthroplasty (replacement), business, Oxford knee score
Abstract

International audience; PURPOSE:Some recent articles have suggested that in the case of large varus deformity, it may be advantageous to leave some residual post-operative varus as a means of improving functional outcome. The objective of this study is to compare the results of total knee replacement (TKR) performed for significant varus deformity (HKA 180°).METHODS:This series was made up of 208 knees. The mean pre-operative HKA angle was 166 ± 3° (154-169°), of which 150 were followed up for a mean 8.5 years (58 lost to follow-up). Based on post-operative radiographs, two groups were formed: group 1 (88 knees) in which post-operative alignment was 177.8 ± 1° (175-179°) and group 2 (62 knees) in which post-operative alignment was 181 ± 1° (180-184°).RESULTS:The mean international knee society (IKS) score for group 1 was 178.8 ± 22 points (113-200) and 181.7 ± 22 points (95-200) for group 2. Oxford knee score was 20.4 ± 9 points (12-45) in group 1 and 19.2 ± 9 (12-50) in group 2. The results were slightly better in group 2 (in slight valgus) but this difference was not statistically significant (p = 0.44 and 0.4).CONCLUSION:The results of knee replacement performed for severe varus deformity are not adversely affected by post-operative valgus alignment. There is in fact a trend towards superior results for neutral or valgus alignment than slight residual varus, but this difference was not statistically significant.

Published
2018
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2. Midterm results of combined intra- and extra-articular ACL reconstruction compared to historical ACL reconstruction data. Multicenter study of the French Arthroscopy Society

Author

P. Imbert, F P Ehkirch, Dominique Saragaglia, S Bertiaux, J.C. Panisset, Cécile Batailler, P. D’ingrado, Régis Pailhé, Philippe Colombet, Loïc Sigwalt, François Dalmay, M.-L. Louis, Camille Steltzlen, Bertrand Sonnery-Cottet, Sébastien Lustig, C. Lutz, B Schlaterrer, ICAPS, 87, avenue Archimède, 83700 Saint-Raphael, France, parent, Centre Albert Trillat [Hôpital de la Croix-Rousse - HCL], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre Hospitalier de Versailles André Mignot (CHV), Centre de chirurgie orthopédique et sportive, 2, rue Negrevergne, 33700 Mérignac, France, Plate forme de bioinformatique et biostatistique (CEBIMER), Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), Hôpital privé de l'Estuaire, 505, rue Irène-Joliot-Curie, 76620 Le Havre, France, Clinique du Parc Lyon (FRANCE), Clinique Maussins-Nollet, 67, rue de Romainville, 75019 Paris, France, Centre ICOS, 463, rue Paradis, 13008 Marseille, France, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre Hospitalier Universitaire [Grenoble] (CHU), Centre Ostéo-articulaire des Cèdres, IM2S, 11, avenue d'Ostende, 98000 Monaco, France, Centre Orthopédique Santy - Lyon, and ICOSS, 50, avenue des Vosges, 67000 Strasbourg, France

Subjects
Adult, Joint Instability, Male, Reoperation, Anterolateral ligament, Intra-articular and extra-articular reconstruction, medicine.medical_specialty, Adolescent, Anterior cruciate ligament reconstruction, [SDV]Life Sciences [q-bio], medicine.medical_treatment, Anterior cruciate ligament, Physical examination, Osteoarthritis, Meniscus (anatomy), Arthroscopy, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Recurrence, Humans, Results, Medicine, Orthopedics and Sports Medicine, Aged, 030222 orthopedics, Anterior Cruciate Ligament Reconstruction, medicine.diagnostic_test, business.industry, Anterior Cruciate Ligament Injuries, ACL, 030229 sport sciences, Middle Aged, Osteoarthritis, Knee, musculoskeletal system, medicine.disease, Tibial Meniscus Injuries, Surgery, medicine.anatomical_structure, Female, France, business, Follow-Up Studies
Abstract

Introduction During anterior cruciate ligament (ACL) reconstruction procedures, anterolateral reconstruction (ALR) can also be performed to improve the knee's rotational stability. However, the effectiveness of this supplemental technique and its impact on the risk of retears and on the onset of secondary degenerative changesare controversial. Hypothesis ALR improves control over the pivot shift, reduces the retear risk and delays the appearance of secondary degenerative lesions. Material and methods Clinical examination, knee laxity measurements and X-ray evaluations were done in 478 patients with more than 3 years’ follow-up after combined ACL and ALR from 11 participating hospitals. The mean patient age at the time of surgery was 28 years. Eighty-eight percent of the patients participated in pivot sports and 45% were competitive athletes. The findings of this study were compared to historical isolated ACL reconstruction data. Results The average follow-up was 6.8 years. No detectable pivot shift was found in 83% of patients, while 12.8% of patient had a smooth glide. The side-to-side difference in anteroposterior knee laxity with maximum manual force was less than 3 mm in 66% of patients and less than 5 mm in 95%. The retear rate was 5.4%, with half of these patients undergoing revision ACL surgery. Secondary meniscus damage requiring surgery occurred in 6.3% of patients; the radiological osteoarthritis rate was 17.5%. Discussion When compared to historical ACL reconstruction data, combined intra- and extra-articular reconstruction does not increase the complication rate. At a mean follow-up of 6.8 years, it provides better control over the pivot shift along with a low retear rate and low occurrence of secondary meniscus injuries. Level of evidence IV, multicenter study.

Published
2017
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3. Results with eight and a half years average follow-up on two hundred and eight e-Motion FP® knee prostheses, fitted using computer navigation for knee osteoarthritis in patients with over ten degrees genu varum

Author

Régis Pailhé, Vincent Morin, Brice Rubens-Duval, Dominique Saragaglia, Loïc Sigwalt, Julia Gaillot, CHU de Grenoble urgences Sud, Ministère de la santé, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France, parent, and Centre Hospitalier Universitaire [Grenoble] (CHU)

Subjects
Adult, Male, medicine.medical_specialty, Knee Joint, [SDV]Life Sciences [q-bio], Radiography, medicine.medical_treatment, Genu varum, Osteoarthritis, Prosthesis, 03 medical and health sciences, 0302 clinical medicine, Genu Varum, Deformity, medicine, Humans, Knee, Computer-assisted, Orthopedics and Sports Medicine, In patient, Computer navigation, Range of Motion, Articular, Arthroplasty, Replacement, Knee, Aged, Aged, 80 and over, Orthodontics, Severe genu varum, 030222 orthopedics, business.industry, 030229 sport sciences, Middle Aged, Osteoarthritis, Knee, medicine.disease, Navigation, Prosthesis Failure, Treatment Outcome, Surgery, Computer-Assisted, Total knee arthroplasty, Orthopedic surgery, Female, Surgery, medicine.symptom, Knee Prosthesis, business, Follow-Up Studies
Abstract

International audience; PURPOSE:The aim of this study was to analyse the clinical and radiographic results of 208 e-Motion® posterior cruciate-retaining, mobile bearing prostheses (BBraun-Aesculap, Tuttlingen, Germany) fitted using computer navigation, for knee osteoarthritis with a genu varum greater than 10°.METHODS:One hundred ninety-two patients were operated on with 208 e-Motion® prostheses fitted, between January 2006 and December 2011, using the OrthoPilot® computer navigation system. Average pre-operative IKS score was 70 ± 27 points (6-143) with a function score of 38 ± 20.5 (0-90) and a knee score of 32.5 ± 13 (0-63). Average flexion was 116.5° ± 13° (65-140°). Average pre-operative HKA angle was 166° ± 3° (154-169°).RESULTS:2Results are available for 134 patients, with a total of 150 knees operated on (38 lost to follow-up and 20 deceased). Average follow-up was 104.5 months (60-116 months). On last follow-up, the average IKS was 180 ± 22 points (95-200) with 86.5 ± 16 points (25-100) for the function score and 93.5 ± 8 points (55-100) for the knee score. Knee flexion was 116° ± 10.5° (80-135°) and average HKA angle was 179° ± 2° (175-184°). The pre-operative objective was achieved in 90.5% of knees.CONCLUSION:The e-Motion® mobile bearing posterior cruciate-retaining prosthesis, fitted using computer navigation, offers excellent results after an average of 8.5 years follow-up. These results are at least equivalent, even superior, to those of the posterior-stabilised prostheses usually used for this type of deformity.

Published
2017
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4. Anterior cruciate ligament reconstruction with the Tape Locking Screw (TLS) and a short hamstring graft: Clinical evaluation of 61 cases with a minimum 12 months' follow-up

Author

Brice Rubens Duval, Loïc Sigwalt, Stéphane Plaweski, Benoît Orfeuvre, Dominique Saragaglia, Gabriel Lateur, Régis Pailhé, Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre Hospitalier Universitaire [Grenoble] (CHU), Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France, parent, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), CHU de Grenoble urgences Sud, and Ministère de la santé

Subjects
Adult, Joint Instability, Male, Reoperation, medicine.medical_specialty, Anterior cruciate ligament reconstruction, Adolescent, Knee Joint, medicine.medical_treatment, Anterior cruciate ligament, Short graft, [SDV]Life Sciences [q-bio], Bone Screws, Good reduction, 03 medical and health sciences, Fixation (surgical), Young Adult, 0302 clinical medicine, Postoperative Complications, medicine, Humans, Orthopedics and Sports Medicine, Prospective Studies, Prospective cohort study, 030222 orthopedics, Knee laxity, Anterior Cruciate Ligament Reconstruction, business.industry, Anterior Cruciate Ligament Injuries, Hamstring Tendons, Ligament reconstruction, 030229 sport sciences, Lysholm Knee Score, Middle Aged, musculoskeletal system, ST4, Surgery, Return to Sport, medicine.anatomical_structure, Treatment Outcome, Tape Locking Screw (TLS(®)), Female, business, Clinical evaluation, Hamstring, Follow-Up Studies
Abstract

International audience; INTRODUCTION:The Tape Locking Screw (TLS®) technique for anterior cruciate ligament (ACL) reconstruction has the advantages of using only one hamstring tendon (semitendinosus) by preparing a short graft secured with screws and braided strips. The theoretical pitfall of this technique is that the graft length is determined arbitrarily. Thus, if the blind tunnels are not long enough, it will be impossible to tension the graft properly upon fixation. The primary objective of this study was to determine the postoperative side-to-side difference in knee laxity. We hypothesized that ACL reconstruction with the TLS(R) system would result in 3mm or less side-to-side difference in knee laxity.MATERIAL AND METHODS:This was a prospective single-center, single-surgeon study performed on patients operated between December 2014 and June 2016 who had a minimum 12 months' follow-up. The pre- and post-operative side-to-side difference in knee laxity was measured with a KT-1000 arthrometer. Secondary outcomes were the pre- and post-operative IKDC, Lysholm and Tegner functional scores.RESULTS:Sixty-one patients were included: 49 men (80%) and 12 women (20%). The average age was 31.6±13.7 years. The average follow-up was 19.3±6.3 months. The average side-to-side difference in laxity went from 6.5mm (min 3; max 12) preoperatively to -0.1mm postoperatively (min -5, max 4) (p

Published
2017
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5. Complications à court terme des plasties combinées intra- et extra-articulaires du ligament croisé antérieur : comparaison avec les plasties intra-articulaires isolées de la littérature. Étude multicentrique de la Société francophone d'arthroscopie (SFA)

Author

P. Colombet, Sébastien Lustig, Camille Steltzlen, M.-L. Louis, Simon Bertiaux, J C Panisset, B. Schlatterer, P. Imbert, Régis Pailhé, F P Ehkirch, François Dalmay, Cécile Batailler, Loïc Sigwalt, Dominique Saragaglia, P. D’ingrado, Bertrand Sonnery-Cottet, C. Lutz, Centre ostéo-articulaire des Cèdres, parent, Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, Hôpital Sud, CHU de Grenoble, IM2S, Centre orthopédique Santy, ICOSS, Laboratoire de Biomécanique et Mécanique des Chocs ( LBMC UMR T9406 ), Université Claude Bernard Lyon 1 ( UCBL ), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux ( IFSTTAR ), Centre Albert Trillat [Hôpital de la Croix-Rousse - HCL], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon ( HCL ) -Hospices Civils de Lyon ( HCL ), Hôpital privé de l'Estuaire, Clinique Maussins-Nollet, Centre de chirurgie orthopédique et sportive, Centre hospitalier de Versailles-André-Mignot, Centre ICOS, Clinique du Parc, Neuroépidémiologie Tropicale ( NET ), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Institut Génomique, Environnement, Immunité, Santé, Thérapeutique ( GEIST ), Université de Limoges ( UNILIM ) -Université de Limoges ( UNILIM ), ICAPS, Centre Ostéo-articulaire des Cèdres, Laboratoire de Biomécanique et Mécanique des Chocs (LBMC UMR T9406), Université Claude Bernard Lyon 1 (UCBL), Université de Lyon-Université de Lyon-Institut Français des Sciences et Technologies des Transports, de l'Aménagement et des Réseaux (IFSTTAR), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Centre Hospitalier de Versailles André Mignot (CHV), UMR Inserm 1094 NET, and INSERM

Subjects
030222 orthopedics, 03 medical and health sciences, BIOMECANIQUE, 0302 clinical medicine, [SPI.MECA.BIOM]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Biomechanics [physics.med-ph], Orthopedics and Sports Medicine, Surgery, 030229 sport sciences, [ SPI.MECA.BIOM ] Engineering Sciences [physics]/Mechanics [physics.med-ph]/Biomechanics [physics.med-ph], ANTERIOR CRUCIATE LIGAMENT
Abstract

Resume Introduction Les plasties anterolaterales (PAL) sont utilisees pour diminuer le risque de rupture iterative apres reconstruction du ligament croise anterieur (LCA) chez les patients a risque. Ces plasties ajoutent un geste a la greffe isolee du LCA qui peut augmenter le temps operatoire et perturber les suites operatoires. L’objectif de cette etude etait d’evaluer le taux de complications precoces. L’hypothese etait que les plasties anterolaterales associees a une plastie du LCA n’augmentent pas le taux de complications par rapport aux plasties isolees. Materiel et methodes Il s’agit d’une etude multicentrique, prospective portant sur 392 patients dont 70 % d’hommes, âges en moyenne de 29,9 ans, operes d’une plastie du LCA avec PAL associee. L’ensemble des evenements indesirables ont ete releves. Resultats La duree moyenne d’hospitalisation a ete de 2 jours avec 46 % de chirurgie ambulatoire. La marche etait acquise en 27 jours en moyenne avec un avantage pour les patients operes avec une technique aux ischio-jambiers. Le taux de complication postoperatoire precoce etait de 12 % dont 1,7 % specifiques a la PAL : douleur, hematome, raideur en flexion et extension, infection. Cinq pour cent de re-interventions ont ete observees la premiere annee avec une majorite d’arthrolyse pour flexum. Le taux de rupture iterative etait de 2,8 % a l’issue de la premiere annee. Discussion Les complications des PAL associees aux plasties intra-articulaires ne sont pas plus importantes que pour les plasties intra-articulaires isolees, sans augmentation du taux d’infection ni de raideur. Les complications liees a la PAL sont faibles, 1,7 %, et sont a mettre en rapport avec des erreurs techniques de fixation ayant engendre des conflits avec les parties molles laterales. Niveau de preuve Niveau IV, etude multicentrique prospective.

Published
2017
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6. Short-term complications in intra- and extra-articular anterior cruciate ligament reconstruction. Comparison with the literature on isolated intra-articular reconstruction. A multicenter study by the French Arthroscopy Society

Author

Bertrand Sonnery-Cottet, Camille Steltzlen, C. Lutz, P. Imbert, Dominique Saragaglia, J C Panisset, M.-L. Louis, Cécile Batailler, Régis Pailhé, François Dalmay, Loïc Sigwalt, S Bertiaux, Sébastien Lustig, B. Schlatterer, F P Ehkirch, Philippe Colombet, P. D’ingrado, Centre Ostéo-articulaire des Cèdres, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre Hospitalier Universitaire [Grenoble] (CHU), IM2S, Principauté de Monaco, Centre Orthopédique Santy, ICOSS, 50, avenue des Vosges, 67000 Strasbourg, France, parent, Centre Albert Trillat [Hôpital de la Croix-Rousse - HCL], Hôpital de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Hôpital privé de l'Estuaire, Clinique Maussins-Nollet, 67, rue de Romainville, 75019 Paris, France, Centre de chirurgie orthopédique et sportive, 2, rue Negrevergne, 33700 Mérignac, France, Centre Hospitalier de Versailles André Mignot (CHV), Centre ICOS, 463, rue Paradis, 13008 Marseille, France, Clinique du Parc, 155, boulevard de Stalingrad, 69006 Lyon, France, Neuroépidémiologie Tropicale (NET), CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM), ICAPS, 87, avenue Archimède, 83700 Saint-Raphael, France, and ZOPPIS, Catherine

Subjects
Male, Time Factors, Complications, Knee Joint, Anterior cruciate ligament reconstruction, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Tenodesis, Walking, Stiffness, Arthroscopy, Postoperative Complications, 0302 clinical medicine, Recurrence, Orthopedics and Sports Medicine, Prospective Studies, Range of Motion, Articular, Young adult, Prospective cohort study, Iterative tear, Fixation (histology), Hematoma, Pain, Postoperative, 030222 orthopedics, medicine.diagnostic_test, Middle Aged, musculoskeletal system, [SDV] Life Sciences [q-bio], medicine.anatomical_structure, Female, France, Anterior cruciate ligament, Infection, Adult, Reoperation, medicine.medical_specialty, Adolescent, Infections, Young Adult, 03 medical and health sciences, medicine, Humans, Aged, Anterior Cruciate Ligament Reconstruction, business.industry, Anterior Cruciate Ligament Injuries, 030229 sport sciences, Length of Stay, medicine.disease, Surgery, Anterolateral ligament of the knee, business, Hamstring
Abstract

Introduction Lateral tenodesis (LT) is performed to limit the risk of iterative tear following anterior cruciate ligament (ACL) reconstruction in at-risk patients. By adding an extra procedure to isolated ACL graft, LT reconstruction increases operating time and may complicate postoperative course. The objective of the present study was to evaluate the rate of early complications. The study hypothesis was that associating ALL reconstruction to ACL reconstruction does not increase the complications rate found with isolated ACL reconstruction. Material and methods A prospective multicenter study included 392 patients: 70% male; mean age, 29.9 years; treated by associated ACL and LT reconstruction. All adverse events were inventoried. Results Mean hospital stay was 2 days, with 46% day-surgery. Walking was resumed at a mean 27 days, with an advantage for patients treated by the hamstring technique. The early postoperative complications rate was 12%, with 1.7% specifically implicating LT reconstruction: pain, hematoma, stiffness in flexion and extension, and infection. There was a 5% rate of surgical revision during the first year, predominantly comprising arthrolysis for extension deficit. The 1-year recurrence rate was 2.8%. Discussion The complications rate for combined intra- and extra-articular reconstruction was no higher than for isolated intra-articular ACL reconstruction, with no increase in infection or stiffness rates. The rate of complications specific to ALL reconstruction was low, at 1.7%, and mainly involved fixation error causing lateral soft-tissue impingement. Level of evidence IV, prospective multicenter study.

Published
2017
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7. Concept of Combined Femoral and Tibial Osteotomies

Author

Dominique Saragaglia, Billy Chedal-Bornu, Régis Pailhé, Loïc Sigwalt, Brice Rubens-Duval, CHU de Grenoble urgences Sud, Ministère de la santé, Gestes Medico-chirurgicaux Assistés par Ordinateur (TIMC-IMAG-GMCAO), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Institut polytechnique de Grenoble - Grenoble Institute of Technology (Grenoble INP )-VetAgro Sup - Institut national d'enseignement supérieur et de recherche en alimentation, santé animale, sciences agronomiques et de l'environnement (VAS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France, parent, Centre orthopédique Flemming, and Centre Hospitalier Universitaire [Grenoble] (CHU)

Subjects
musculoskeletal diseases, medicine.medical_specialty, medicine.medical_treatment, Radiography, [SDV]Life Sciences [q-bio], Osteoarthritis, Osteotomy, 03 medical and health sciences, 0302 clinical medicine, High tibial osteotomy, Deformity, medicine, Orthopedics and Sports Medicine, Femur, Tibia, ComputingMilieux_MISCELLANEOUS, 030222 orthopedics, biology, business.industry, 030229 sport sciences, musculoskeletal system, biology.organism_classification, medicine.disease, Surgery, Valgus, medicine.symptom, business
Abstract

Medial knee osteoarthritis is not uncommon, and high tibial osteotomy (HTO) for some surgeons is a unique treatment option for young and active patients. However, the deformity is not always located at the level of proximal part of the tibia and the overcorrection needed to achieve a lasting functional result can lead to an oblique joint line. To avoid this undesirable effect to the joint line, a double-level osteotomy (DLO), one at the distal part of the femur and another one at the proximal part of the tibia, is a viable option. The aim of this article is to present the preoperative radiological assessment, the operative procedure, the indications of HTO, distal femoral osteotomy (DFO), and DLO presenting the rationale behind the treatment options. Long-leg radiographs are mandatory to measure the hip–knee–ankle angle, and the femoral and tibial mechanical axes to plan the location of the osteotomy. The best indication for DLO is a severe varus knee deformity with femoral and tibial mechanical axes in varus. This argument can be applied to a genu valgum deformity, especially when the femur is in valgus as well as the tibia, which is not rare. Although the operative technique is demanding, the biggest challenge is not the procedure itself but rather how to reach the exact degree of overcorrection. Computer-assisted surgery is a good alternative and can improve the accuracy of the surgery.

Published
2017
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