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Introduction: Insertional Achilles tendinopathy (IAT) is primarily caused by mechanical overload. Running and obesity are major risk factors. Medical treatment is limited, and surgery, particularly calcaneoplasty, is sometimes necessary. However, the choice between an endoscopic and open approach remains controversial., Hypothesis: This study is based on the hypothesis that endoscopic surgery would allow for better functional recovery with a faster return to sports activity compared to traditional open techniques., Materials and Methods: Our multicenter prospective study compared the outcomes of endoscopic (Endo) and open (Open) calcaneoplasty in patients with IAT resistant to medical treatment. Clinical outcomes were assessed using the EFAS (daily life and sports) and VISA-AF scores. The radiological criteria studied were the calcaneal slope and the X/Y ratio. An MRI was used to quantify tendon involvement., Results: Of the 85 patients included, 51 underwent endoscopic surgery, and 34 had open surgery. The two groups were comparable in terms of demographic, clinical, and radiographic characteristics. At 3 months postoperatively, significantly more patients had returned to sports in the Endo group (41.6% vs. 20.6% in the Open group; p = 0.004), and the EFAS sports score showed a significant difference in favor of the Endo group at 6 months postoperatively (9.3 vs. 5.7/16; p = 0.008)., Discussion: The results confirm faster recovery after endoscopic surgery, with comparable complication rates between the two approaches. However, long-term, the differences between the two techniques diminish, with similar functional outcomes at 12 months postoperatively., Conclusion: Endoscopic calcaneoplasty is a safe and effective option for the treatment of IAT. However, further studies with longer follow-up are needed to confirm these results and assess recurrence rates., Level of Evidence: III., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: Arthroscopic treatment of lateral ankle instability is a recent innovation. In 2014, a prospective study was initiated by the French Society of Arthroscopy demonstrating the feasibility, morbidity and short-term results of arthroscopic treatment of ankle instability., Hypothesis: The functional results of arthroscopic treatment of chronic ankle instability found after one year were maintained in the medium term., Material and Methods: The prospective follow-up of the patients included in the initial cohort was continued. The Karlsson and AOFAS scores, as well as patient satisfaction, were assessed. The causes of failure underwent univariate and multivariate analyzes. The results of 172 patients were included (40.2% ligament repairs; 59.7% ligament reconstructions). The average follow-up was 5years. The average satisfaction was 8.6/10, the average Karlsson score was 85 points and the average AOFAS score was 87.5 points. The reoperation rate was 6.4% of patients. The failures were related to an absence of sports practice, a high BMI and female gender. A high BMI and the intense sports practice were associated to ligament repair failure. The absence of sports practice and the intraoperative presence of the anterior talofibular ligament were associated to ligament reconstruction failure., Discussion: Arthroscopic treatment of ankle instability confers high satisfaction in the medium term, as well as long-lasting results with a low reoperation rate. A more detailed evaluation of the failure criteria could help guide the choice of treatment between ligament reconstruction or repair., Level of Evidence: II., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Introduction: One treatment option in insertional Achilles tendinopathy is open reconstruction of the insertion, resecting the enthesophyte and posterosuperior calcaneal prominence and reinserting the tendon using anchors. Although classically performed as an open procedure, the necessary subcutaneous release and dissection can entail problems of healing in at-risk patients., Hypothesis: It is possible to perform Achilles disinsertion-reinsertion with posterosuperior calcaneal prominence resection endoscopically, without iatrogenic risk, enabling complete resection of the enthesophyte and posterosuperior calcaneal prominence and satisfactory reinsertion., Material and Methods: An operative technique was developed, consisting in Achilles disinsertion-reinsertion with resection of the posterosuperior calcaneal prominence and enthesophyte endoscopically via 5 portals. A feasibility study was conducted in an anatomy laboratory on 10 foot specimens, assessing iatrogenic impact. Bone resection quality was assessed under endoscopic and fluoroscopic control. Reinsertion quality was assessed endoscopically and on dissection of the specimens., Results: In the 10 procedures, there were no failures. Resection of the calcifications and the calcaneal prominence was complete in all cases. Reinsertion was satisfactory in all cases. There were no iatrogenic neural lesions., Discussion/conclusion: It was possible to perform endoscopic Achilles disinsertion-reinsertion with resection of the posterosuperior calcaneal prominence and enthesophyte. The procedure did not seem to increase iatrogenic risk, and enabled complete bone resection and satisfactory reinsertion. This endoscopic technique now needs to be validated clinically, with comparison versus open surgery., Level of Evidence: IV; cadaver study., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Surgical treatment may be indicated after failure of medical management of insertional Achilles tendinopathy, and may consist in simple calcaneoplasty, increasingly performed endoscopically, or in open detachment-reattachment. Isolated calcaneoplasty sometimes shows poor results in case of multiple overlooked lesions (bone, tendon, pre- or retro-tendinous bursitis). Detachment-reattachment may be indicated in case of tendon lesion, but incurred scar and infection related risk in up to 30% of cases in certain reports. In this context, we describe a new original technique using an endoscopic Achilles speed bridge, which we call the "snake technique" for the S-shaped order of performance of the 6 necessary approaches., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Background: The surgical treatment of chronic ankle instability (CAI) relies chiefly on anterior talo-fibular ligament (ATFL) repair (with or without augmentation) or anatomical reconstruction with a tendon graft. Arthroscopy enables not only a complete assessment and the same-stage treatment of concomitant articular lesions, but also an accurate assessment of ligament lesions. Pre-operative imaging studies (MRI, CT, US) may fail to provide sufficient detail about chronic ATFL lesions to guide the decision between repair and reconstruction. The aim of this study was to develop an arthroscopic classification of chronic ATFL lesions designed to assist in selecting the optimal surgical technique., Material and Methods: Sixty-nine anterior ankle arthroscopy videos recorded before surgery for CAI were studied retrospectively. ATFL dissection was performed in all patients. Based on the video analysis, five ATFL grades were identified: 0, normal ATFL thickness and tension; 1, ATFL distension with normal thickness; 2, ATFL avulsion with normal thickness; 3, thin ATFL with no resistance during the hook test; and 4, no ATFL, with a bald malleolus. Intra- and interobserver reproducibility of the arthroscopic classification of chronic ATFL lesions was evaluated by computing the kappa coefficients (κ) after assessment by two independent observers., Results: All 69 ATFLs were classified as abnormal (none was grade 0). Each ATFL could be matched to a grade. Intra-observer agreement was good for both observers: κ was 0.67 with 75% of agreement for one observer and 0.68 with 76% of agreement for the other observer. Inter-observer agreement was fair to good, with κ values ranging from 0.59 to 0.88 and agreement from 70% to 91%., Discussion: Arthroscopic ATFL dissection is a simple procedure that provides a highly accurate assessment of ATFL lesions and mechanical resistance, focussing chiefly on the superior ATFL. Grade 1 and 2 lesions can be repaired using the Broström-Gould procedure, whereas grade 3 and 4 lesions require anatomic reconstruction with grafting., Conclusion: This arthroscopic classification of chronic ATFL lesions confirms the diagnostic role for arthroscopy in assessing the ligaments in patients with CAI. It is helpful for determining the best surgical technique for stabilising the ankle. These results must be confirmed in a larger study., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background: Imaging studies done to evaluate chronic ankle instability (CAI) often fail to accurately detail injuries to the anterior talo-fibular ligament (ATFL) and may, therefore, also fail to provide guidance for selecting the most appropriate surgical procedure. Arthroscopy is now an indispensable tool for accurately diagnosing ATFL injuries. This study looked at agreement between arthroscopy and imaging study assessments of ATFL injuries. The primary objective was to adapt an arthroscopic classification of chronic ATFL lesions to the pre-operative imaging study findings in order to estimate the performance of computed tomography (CT)-arthrography, ultrasonography, and magnetic resonance imaging (MRI) in diagnosing ATFL lesions, using arthroscopy as the reference standard., Hypothesis: Agreement between arthroscopic and imaging findings of chronic ATFL injuries can be assessed by using a shared classification developed from the arthroscopic evaluation, used as the reference standard., Material and Methods: A prospective multicentre study was conducted in 286 patients with arthroscopically-treated CAI. In each patient, the arthroscopic assessment of the ATFL was compared to the pre-operative findings by CT-arthrography, ultrasonography, and MRI. A classification of ATFL lesions based on the arthroscopic assessment was used to analyse the imaging studies. Using this classification, two independent observers compared the findings and evaluated the agreement between arthroscopy and imaging studies., Results: Of the 286 patients, 157 had complete information on the arthroscopic assessment and on pre-operative imaging studies and were included in the analysis. Imaging studies were CT-arthrography in 49 patients, ultrasonography in 63 patients, and MRI in 45 patients; both ultrasonography and MRI were performed in 3 patients. Agreement with arthroscopy was 82% and 88.5% for CT-arthrography, 66.7% and 76.2% for ultrasonography, 70.5% and 79.5% for MRI, and 73.4% and 81.2% for all imaging studies pooled., Discussion: Arthroscopy plays a crucial role in the definitive assessment of ligament lesions in patients with CAI, as it supplies far more accurate information than any of the current imaging studies and, in addition, provides a dynamic evaluation of the ligaments and assesses mechanical strength. In the study population, a simple arthroscopic evaluation consistently visualised ATFL lesions, thereby either correcting or confirming the pre-operative imaging study findings. Importantly, the arthroscopic assessment provided more accurate information on the lesions and quality of the ATFL compared to the imaging studies. Arthroscopy has improved our knowledge of chronic ATFL lesions and allowed the development of a simple but accurate four-grade classification of direct relevance to choosing the optimal therapeutic procedure. This classification must be disseminated among radiologists to improve the diagnostic performance of pre-operative imaging studies, assist surgeons in selecting the most appropriate ankle-stabilising procedure, and improve patient information. Further studies are needed to confirm the promising results reported here and the usefulness of this common arthroscopy and imaging-study classification for chronic ATFL lesions., Level of Evidence: II., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Background: Chronic ankle instability (CAI) is the main complication of ankle sprains and requires surgery if non-operative treatment fails. Surgical ankle stabilisation techniques can be roughly classified into two groups, namely, repair involving retensioning and suturing of the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) and reconstruction using a tendon graft. Arthroscopic repair and reconstruction techniques for CAI have been introduced recently. The objective of this prospective multicentre study was to assess the feasibility, morbidity, and short-term outcomes of these arthroscopic ankle-stabilisation techniques., Material and Methods: Consecutive patients scheduled for arthroscopic treatment of CAI were included prospectively. Of the 286 included patients, 115 underwent ligament repair and 171 ligament reconstruction. Mean follow-up was 9.6 months (range, 6-43 months). We recorded the AOFAS and Karlsson scores, patient satisfaction, complications, and time to return to sports., Results: The overall patient satisfaction score was 8.5/10. The AOFAS and Karlsson scores improved significantly between the pre- and postoperative assessments, from 62.1 to 89.2 and from 55 to 87.1, respectively. These scores were not significantly different between the groups treated by repair and by reconstruction. Neurological complications occurred in 10% of patients and consisted chiefly in transient dysesthesia (with neuroma in 3.5% of patients). Cutaneous or infectious complications requiring surgical revision developed in 4.2% of patients., Discussion: Arthroscopic treatment is becoming a method of choice for patients with CAI, as it allows a comprehensive assessment of the ligament lesions, the detection and treatment of associated lesions, and repair or reconstruction of the damaged ligaments. These simple, reliable, and reproducible arthroscopic techniques seem as effective as conventional surgical techniques. The rate of cutaneous complications is at least halved compared to open surgery., Conclusion: Arthroscopic ankle stabilisation repair and reconstruction techniques hold considerable promise but require further evaluation to better determine the indications of repair versus reconstruction and to obtain information on long-term outcomes., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Introduction: The present study reports the development of a CT assessment protocol for Teres Minor (TM) trophicity., Hypothesis: Quantitative reproductible Terres Minor assessment on CT estimates the influence of muscle trophicity on the clinical and radiological results of palliative treatment of irreparable rotator cuff tear., Materials and Method: An anatomic study of 30 cadaveric shoulders confirmed a constant anatomic relation between Terres Minor and the inferior pole of the glenoid cavity. This landmark was used to develop a novel CT assessment of TM trophicity., Results: The CT assessment showed excellent inter- and intra-observer reproductibility. The protocol defines a trophicity index, T2/G (T2 being TM thickness on axial CT slice, and G the maximum glenoid cavity thickness on axial slice), enabling reproductible TM analysis on preoperative arthro-CT., Conclusion: The study validated the CT protocol, allowing application in pre- and postoperative assessment of irreparable rotator cuff tear., Level of Evidence: Level IV. Retrospective study., (Copyright © 2013 Elsevier Masson SAS. All rights reserved.)

Anti-liver-kidney microsome type-1 antibodies (LKM1), present in sera from a group of patients with autoimmune hepatitis, are directed against P450IID6. Previous work, using cDNA constructions spanning most of the P450IID6 protein defined the main immunogenic site between the amino acids (aa), 254-271 and predicted the presence of other putative immunogenic sites in the molecule. Fusion proteins from new cDNA constructions, spanning so-far-untested regions between aa 1-125 and 431-522, were not recognized by LKM1-positive sera. Synthetic peptides, representing sequences from putative immunogenic regions or previously untested regions, allowed a precise definition of four antigenic sites located between peptides 257-269, 321-351, 373-389 and 410-429, which were recognized, respectively, by 14, 8, 1 and 2 out of 15 LKM1-positive sera tested. The minimal sequence of the main antigenic site (peptide 257-269) recognized by the autoantibody was established to be WDPAQPPRD (peptide 262-270). In addition, deletion and replacement experiments showed that aa 263 (Asp) was essential for the binding of the autoantibody to peptide 262-270. Analysis of the second most frequently recognized peptide between aa 321-351, was performed using peptides 321-339 and 340-351 in competitive inhibition studies. Complete elimination of antibody binding to peptide 321-351 obtained by absorption of both shorter peptides indicated that peptide 321-351 is a discontinuous antigenic site. LKM1-positive sera reacting against peptide 321-351 recognized either both the shorter peptides or just one of them preferentially. Results of the present study suggest that the production of LKM1 antibodies is an antigen-driven, poly- or oligoclonal B cell response. The identification of antigenic sites will allow: (i) the development of specific diagnostic tests and (ii) further studies on the pathogenic value of LKM1 antibodies in autoimmune hepatitis.

Antibodies present in the sera of a group of children with autoimmune hepatitis react with human cytochrome P450 IID6. cDNA constructions of various fragments of human P450 IID6 were made and expressed and the resulting peptides were tested in immunoblot with patients' sera. These allowed identification of at least two antigenic sites on the P450 molecule. The main one, recognized by all sera tested, is located between amino acids 239 and 271. Synthesis of three peptides covering this area of the molecule allowed identification of a sequence of three amino acids (tyrosine-tryptophane-asparagine) located at position 261-263 that constitutes the essential part of the epitope. A protein sequence data-base search revealed homologies between this region of human P450 and proteins from Salmonella typhimurium, from human T lymphotropic virus types 1 and 2 and Herpes simplex virus type 1.