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1. Comparison of knee extensor strength after anterior cruciate ligament reconstruction using either quadriceps tendon or hamstring tendon autografts

Author: A Merlin, Régis Pailhé, Jérémy Cognault, B. Rubens Duval, C Horteur, Matthieu Ollivier, 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, Institut des Sciences du Mouvement Etienne Jules Marey (ISM), Aix Marseille Université (AMU)-Centre National de la Recherche Scientifique (CNRS), 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), and 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])
Subjects: 030222 orthopedics, Anterior cruciate ligament reconstruction, business.industry, medicine.medical_treatment, Anterior cruciate ligament, Quadriceps muscle weakness, [SDV.NEU.SC]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC]/Cognitive Sciences, Retrospective cohort study, 030229 sport sciences, Concentric, musculoskeletal system, 03 medical and health sciences, 0302 clinical medicine, medicine.anatomical_structure, Anesthesia, Medicine, Eccentric, Orthopedics and Sports Medicine, Surgery, [SDV.IB]Life Sciences [q-bio]/Bioengineering, Quadriceps tendon, business, Hamstring
Abstract: Purpose The aim was to assess the consequences of quadriceps tendon (QT) harvest on knee extensor strength after anterior cruciate ligament reconstruction (ACL-R) compared to hamstring tendon (HT) autograft. Secondary objectives were to evaluate flexor strength recovery and search for correlation between strength status and functional outcome. Methods This a retrospective cohort of 44 patients who underwent ACL-R using either QT (25) or HT (19). Median age was 31.1 years. We assessed thigh muscle strength thanks to concentric iso kinetic evaluation (peak torque) at 60 degrees.s(-1), 180 degrees.s(-1), 240 degrees.s(-1) and eccentric at 30 degrees.s(-1), 7 months on average after surgery. Muscle strength values were compared to the uninjured leg in order to calculate a percentage of deficit as well as unilateral hamstring/quadriceps (H/Q) ratios. KOOS score was obtained at a mean follow-up of 18 months. Results Extensor strength deficit (concentric 60 degrees.s(-1)) was one average 33.1% in the QT group and 28.2% in the HT group (p = 0.42). Difference of flexor strength deficit (concentric 60 degrees.s(-1)) was close to be significant with 5% and 12% of deficit in the QT and HT group, respectively (p = 0.1), and statistically significant for high angular velocity (14% versus 3% at 240 degrees.s(-1), p = 0.04). H/Q ratios were comparable in both groups ranging from 0.62 to 0.78. Quadriceps muscle strength deficit was negatively correlated with the KOOS score (Pearson coefficient = -0.4; p = 0.005). Conclusion QT autograft harvest does not yield significant quadriceps muscle weakness after ACL-R, which appear to be a pejorative factor for functional outcome.
Published: 2022

2. Application of the OMERACT synovitis ultrasound scoring system in juvenile idiopathic arthritis: a multicenter reliability exercise

Author: Laurence Goumy, S. Jean, Anne Mathiot, Sylvain Breton, Linda Rossi-Semerano, Emmanuel Chatelus, Luca Semerano, Frédérique Nugues, Valérie Devauchelle-Pensec, Marouane Boubaya, Bénédicte Rey, Marie Bossert, Annette von Scheven, L. Sparsa, Géraldine Durand, Haykanush Ohanyan, Gaël Mouterde, Sorina Boiu, Sandrine Jousse-Joulin, Ahmed Ould Hennia, Centre de Référence des Maladies Auto-Inflammatoires et des Amyloses [Le Kremlin-Bicêtre] (CeRéMAIA), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Bicêtre, CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Conservatoire National des Arts et Métiers [CNAM] (CNAM)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Paris (UP)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital Avicenne [AP-HP], Department of Rheumatology, Hôpital Avicenne, APHP, INSERM UMR 1125, Paris 13 University, Bobigny, Hôpital Nord Franche-Comté [Hôpital de Trévenans] (HNFC), Third Department of Pediatric [Athens, Greece], University of Athens Medical School [Athens]-University General Hospital ' Attikon ' [Athens, Greece], Service de rhumatologie [Strasbourg], CHU Strasbourg-Hôpital de Hautepierre [Strasbourg], Service de rhumatologie [Poitiers], Centre hospitalier universitaire de Poitiers (CHU Poitiers), Département de Pédiatrie [Rennes] = Paediatrics [Rennes], CHU Pontchaillou [Rennes], Service de Pédiatrie Générale [CHU Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Unité de rééducation neurologique pédiatrique [Bicêtre], Hôpital Bicêtre, Département de Rhumatologie[Montpellier], Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, Clinique Universitaire de Pédiatrie [CHU Grenoble Alpes], Hôpital Sud, CHU de Grenoble-Hôpital Couple Enfant de Grenoble, Centre hospitalier de Chartres (Chartres), Service de Neurologie Pédiatrique, HFME, Bron, France, Centre Hospitalier Universitaire Vaudois [Lausanne] (CHUV), Centre Hospitalier de Mulhouse (Service de Rhumatologie), Centre Hospitalier Emile Muller [Mulhouse] (CH E.Muller Mulhouse), Groupe Hospitalier de Territoire Haute Alsace (GHTHA)-Groupe Hospitalier de Territoire Haute Alsace (GHTHA), CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), APH - Methodology, and APH - Health Behaviors & Chronic Diseases
Subjects: musculoskeletal diseases, medicine.medical_specialty, genetic structures, Elbow, education, Wrist, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Synovitis, medicine, Humans, Pharmacology (medical), 030212 general & internal medicine, skin and connective tissue diseases, Ultrasonography, 030203 arthritis & rheumatology, reliability, business.industry, Ultrasound, scoring system, Reproducibility of Results, Metacarpophalangeal joint, medicine.disease, humanities, Arthritis, Juvenile, 3. Good health, medicine.anatomical_structure, Effusion, juvenile idiopathic arthritis, [SDV.IMM]Life Sciences [q-bio]/Immunology, Joints, Radiology, Ankle, business, Kappa
Abstract: Objectives To evaluate the reliability of the OMERACT paediatric ultrasound (US) synovitis definitions and scoring system in JIA. Methods Thirteen sonographers analysed 75 images for the presence/absence of elementary lesions (binary scoring) and for grading synovitis, synovial hypertrophy, effusion and Doppler signals. Static US images of the second metacarpophalangeal joint (MCP-II), wrist, elbow, knee and ankle in JIA patients at different ages and different disease stages were collected with standardized scanning by two experienced sonographers. Intra- and inter-reader reliability were analysed with kappa coefficients. Results Intra-reader reliability was good for binary scoring (Cohen’s kappa 0.62, range 0.47–0.75), synovitis and synovial hypertrophy; excellent for Doppler signals (quadratic weighted kappa 0.77, 0.66–0.86; 0.76, 0.61–0.84; and 0.87, 0.77–0.94, respectively); and moderate for effusion (0.55, 0.24–0.76). Inter-reader reliability was good for synovitis and synovial hypertrophy (Light’s kappa 0.68, 95% CI: 0.61, 0.75 and 0.63, 0.54–0.71, respectively), excellent for Doppler signals (0.85, 95% CI: 0.77, 0.90), and moderate for binary scoring and effusion (0.48, 95% CI: 0.36, 0.64 and 0.49, 0.40–0.60, respectively). We obtained the best scores for the knee (0.71, 0.54–0.85) except for Doppler signals, with reliability higher for MCP-II. We found a trend toward better results in older children. Conclusions This is the first study establishing the reliability of the OMERACT paediatric US synovitis definitions and scoring system in the five most commonly affected joints in JIA. The reliability was good among a large group of sonographers. These results support the applicability of these definitions and scoring system in clinical practice and multicentre studies.
Published: 2020

3. 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

4. Mixed qualitative and quantitative approach for validating an information booklet before total hip arthroplasty

Author: Sylvie Aubreton, Anne Plan-Paquet, Stéphane Descamps, Aurore Chabaud, Bénédicte Eschalier, Emmanuel Coudeyre, Myriam Zullian, Dominique Saragaglia, Service de Médecine Physique et de Réadaptation [CHU Clermont-Ferrand], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand-CHU Estaing [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Louise Michel [Clermont-Ferrand], CHU Clermont-Ferrand, Département de Médecine Générale, Faculté de Médecine, Université Clermont Auvergne, Service de médecine physique et de réadaptation, hôpital rhumatologique, Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, Hôpital Sud, CHU de Grenoble, 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]), Service de Chirurgie Orthopédique et Traumatologique [CHU Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Institut de Chimie de Clermont-Ferrand (ICCF), SIGMA Clermont (SIGMA Clermont)-Institut de Chimie du CNRS (INC)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), and Universite Clermont Auvergne
Subjects: Male, Health Knowledge, Attitudes, Practice, medicine.medical_specialty, Arthroplasty, Replacement, Hip, Health Personnel, [SDV]Life Sciences [q-bio], education, Sample (statistics), Osteoarthritis, Hip, 03 medical and health sciences, 0302 clinical medicine, Patient Education as Topic, Surveys and Questionnaires, Hip osteoarthritis, Humans, Medicine, Orthopedics and Sports Medicine, Postoperative Period, Aged, Aged, 80 and over, 030222 orthopedics, Health professionals, business.industry, Rehabilitation, Focus Groups, Middle Aged, Standard methods, Booklet, Focus group, 3. Good health, Hip arthroplasty, Physical therapy, Female, Pamphlets, Total hip arthroplasty, Self-care, business, 030217 neurology & neurosurgery
Abstract: International audience; ObjectiveProviding patients with validated information before total hip arthroplasty may help lessen discrepancies between patients’ expectations and the surgical result. This study sought to validate an information booklet for candidates for hip arthroplasty by using a mixed qualitative and quantitative approach based on a panel of patients and a sample of healthcare professionals.MethodsWe developed a booklet in accordance with the standard methods and then conducted focus groups to collect the opinions of a sample of multidisciplinary experts involved in the care of patients with hip osteoarthritis. The number of focus groups and experts was determined according to the data saturation principle. A panel of patients awaiting hip arthroplasty or those in the immediate post-operative period assessed the booklet with self-reporting questionnaires (knowledge, beliefs, and expectations) and semi-structured interviews.ResultsAll experts and both patient groups validated the booklet in terms of content and presentation. Semi-structured interviews were uninformative, especially for post-operative patients. Reading the booklet significantly (P < 0.001) improved the knowledge scores in both groups, with no intergroup differences, but did not affect beliefs in either patient group. Only pre-operative patients significantly changed their expectations.ConclusionOur mixed qualitative and quantitative approach allowed us to validate a booklet for patients awaiting hip arthroplasty, taking into account the opinions of both patients and healthcare professionals.
Published: 2018

5. Résultats des plasties combinées intra- et extra-articulaires dans les reprises de ligamentoplastie du LCA : étude multicentrique de la Société francophone d’arthroscopie (SFA)

Author: M.-L. Louis, Société francophone d’arthroscopie, C. Lutz, Simon Bertiaux, P. D’ingrado, B. Schlatterer, J C Panisset, Bertrand Sonnery-Cottet, Régis Pailhé, F P Ehkirch, François Dalmay, Dominique Saragaglia, Camille Steltzlen, Sébastien Lustig, Philippe Colombet, P. Imbert, Institut de chirurgie orthopédique et sportive, clinique Juge, 463, rue Paradis, 13008 Marseille, France, parent, Clinique du Parc, 155, boulevard de Stalingrad, 69006 Lyon, France, Clinique Maussins-Nollet, 67, rue de Romainville, 75019 Paris, France, Hôpital privé de l'Estuaire, 505, rue Irène-Joliot-Curie, 76620 Le Havre, France, Centre de chirurgie orthopédique et sportive, 2, rue Negrevergne, 33700 Mérignac, France, Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France, Institut monégasque de médecine du sport, 11, avenue d'Ostende, 98000, Monaco, Clinique universitaire, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France, Clinique des cèdres, 21, rue Albert-Londres, 38432 Échirolles, France, Centre Hospitalier de Versailles André Mignot (CHV), 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), ICOSS, 50, avenue des Vosges, 67000 Strasbourg, France, Neuroépidémiologie Tropicale (NET), Institut Génomique, Environnement, Immunité, Santé, Thérapeutique (GEIST), Université de Limoges (UNILIM)-Université de Limoges (UNILIM)-CHU Limoges-Institut d'Epidémiologie Neurologique et de Neurologie Tropicale-Institut National de la Santé et de la Recherche Médicale (INSERM), and Institut de chirurgie articulaire et des pathologies du sport, 87, avenue Archimède, 83700 St-Raphael, France
Subjects: BIOMECANIQUE, 030222 orthopedics, 03 medical and health sciences, LIGAMENT ANTEROLATERAL, 0302 clinical medicine, LIGAMENT CROISE ANTERIEUR, REVISION DE LIGAMENTOPLASTIE DU LCA, [SPI.MECA.BIOM]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Biomechanics [physics.med-ph], Orthopedics and Sports Medicine, Surgery, 030229 sport sciences, TENODESE LATERALE
Abstract: Resume Introduction L’analyse des causes d’echec d’une ligamentoplastie du LCA doit permettre de choisir la technique la plus adaptee lors de la reprise chirurgicale afin d’assurer au patient un bon controle de la stabilite rotatoire et de diminuer les risques de ruptures iteratives. Objectif L’objectif de ce travail est d’evaluer les plasties anterolaterales (PAL) dans les reprises de ligamentoplasties du LCA. Hypothese L’hypothese de ce travail etait que les PAL realisees lors des chirurgies de revision du LCA, permettaient d’assurer un bon controle du ressaut sans augmenter les risques de complication. Materiel et methodes Il s’agit d’une etude multicentrique, prospective (sur 24 mois) et retrospective (minimum 3 ans de recul) fondee sur 349 patients, 283 hommes et 66 femmes. Les criteres d’inclusion sont des patients pour lesquels une indication chirurgicale de revision du LCA avec plastie intra-articulaire et PAL a ete retenu suite a un echec de plastie du LCA par autogreffe avec un LCP intact. Les criteres d’exclusion sont les reconstruction du LCA de 1 re intention et les lesions peripheriques mediales et/ou laterale associees. Les patients ont eu une evaluation clinique et radiographique pre- et postoperatoire. Le score IKDC preoperatoire etait en moyenne de 56,5 ± 15,5 avec 96 % de score IKDC C ou D. Resultats Le taux de complications postoperatoires precoces etait de 5 % et postoperatoires tardives de 10,5 %. Au dernier recul, dans 97 % des cas le test de Lachman avait un arret dur. Le ressaut rotatoire etait positif dans 1 % des cas. Le score IKDC subjectif moyen etait de 84,5 ± 13 dont 86,5 % de classe A ou B. Les signes d’arthrose radiographique etaient stables au dernier recul sur les compartiments femorotibial lateral et femoropatellaire, mais en augmentation de 9,7 a 21,2 % sur le compartiment femorotibial medial. Le taux de reruptures etait de 1,2 % et le taux de re-intervention secondaire de 5,4 %. Conclusion La laxite anterieure au dernier recul est similaire aux autres series de revision de la litterature mais le controle du ressaut et le taux de rupture iterative sont inferieurs. Les PAL font partie des techniques a envisager dans l’arsenal therapeutique des chirurgies de reprise du LCA. Type d’etude Etude retrospective et prospective de cohorte niveau IV.
Published: 2017

6. 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

7. Use of morselized allografts for acetabular reconstruction during THA revision: French multicenter study of 508 cases with 8 years’ average follow-up

Author: Roger Erivan, Nicolas Reina, Nassima Ramdane, Pierre-Alain Matthieu, René-Christopher Rouchy, Stéphane Boisgard, Gilles Missenard, Aurélien Mulliez, Jean-Louis Rouvillain, Bertrand Boyer, Olivier Roche, Thomas Sanchez, Michel Rhame, Stéphane Descamps, Jacques H Caton, Traumatological Surgery, Sébastien Moreau, Institut de Chimie de Clermont-Ferrand (ICCF), SIGMA Clermont (SIGMA Clermont)-Institut de Chimie du CNRS (INC)-Université Clermont Auvergne [2017-2020] (UCA [2017-2020])-Centre National de la Recherche Scientifique (CNRS), CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand, Centre d'Orthopédie et Traumatologie (COT), CHU Saint-Etienne, CHU Casselardit - Junod, Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, Hôpital Sud, CHU de Grenoble, Laboratoire des champs magnétiques intenses (LCMI-GHMFL), Centre National de la Recherche Scientifique (CNRS), 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), Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), and Centre Hospitalier Universitaire de Saint-Etienne [CHU Saint-Etienne] (CHU ST-E)
Subjects: Male, THA revision, Time Factors, Arthroplasty, Replacement, Hip, [SDV]Life Sciences [q-bio], Overweight, law.invention, Postoperative Complications, 0302 clinical medicine, Randomized controlled trial, Allograft, law, Bone reconstruction, Orthopedics and Sports Medicine, Aged, 80 and over, 2. Zero hunger, 030222 orthopedics, Bone Transplantation, Incidence, Bone defect, Middle Aged, Allografts, Female, France, medicine.symptom, Adult, Reoperation, medicine.medical_specialty, Bone loss, Context (language use), Subgroup analysis, 03 medical and health sciences, medicine, Humans, Aged, Retrospective Studies, Acetabular revision, business.industry, Acetabulum, Retrospective cohort study, 030229 sport sciences, Plastic Surgery Procedures, Surgery, Relative risk, Hip Prosthesis, Complication, business, Body mass index, Follow-Up Studies
Abstract: International audience; BackgroundIn the context of acetabular reconstruction, bone defects can be filled with processed or unprocessed bone allografts. Published data are often contradictory on this topic and few studies have been done comparing processed allografts to fresh-frozen ones. This led us to conduct a large study to measure the factors impacting the survival of THA revision: (1) type of allograft and cup, (2) technical factors or patient-related factors.HypothesisAcetabular reconstruction can be performed equally well with frozen or processed morselized allografts.Materials and methodsThis retrospective, multicenter study of acetabular reconstruction included 508 cases with a minimum follow-up of 5 years. The follow-up for the frozen grafts was shorter (7.86 years ± 1.89 [5–12.32]) than that of the processed grafts (8.22 years ± 1.77 [5.05–15.48]) (p = 0.029). However, the patients were younger at the time of the primary THA procedure in the frozen allograft group (51.5 years ± 14.2 [17–80]) than in the processed group (57.5 years ± 13.0 [12–94]) (p < 0.001) and were also younger at the time of THA revision (67.8 years ± 12.2 [36.9–89.3] versus 70 years ± 11.7 [25–94.5]) (p = 0.041).ResultsThere were more complications overall in the frozen allograft group (46/242 = 19.0%) than the processed allograft group (35/256 = 13.2%) (p = 0.044) with more instances of loosening in the frozen group (20/242 [8.2%]) than in the processed group (6/266 [3.3%])(p = 0.001). Conversely, the dislocation rate (16/242 = 6.6% vs. 17/266 = 6.4%) (p = 0.844) and infection rate (18/242 = 7.4% vs. 15/266 = 5.7%) (p = 0.264) did not differ between groups. The subgroup analysis reveal a correlation between the occurrence of a complication and higher body mass index (BMI) (p = 0.037) with a higher overall risk of complications in patients with a BMI above 30 or under 20 (p = 0.006) and a relative risk of 1.95 (95% CI: 1.26–2.93). Being overweight was associated with a higher risk of dislocation (relative risk of 2.46; 95% CI: 1.23–4.70) (p = 0.007). Loosening was more likely to occur in younger patients at the time of the procedure (relative risk of 2.77; 95% CI: 1.52–6.51) (p = 0.040) before 60 years during the revision. Lastly, patients who were less active preoperatively based on the Devane scale had an increased risk of dislocation (relative risk of 2.51; 95% CI: 1.26–8.26) (p = 0.022).DiscussionOur hypothesis was not confirmed. The groups were not comparable initially, which may explain the differences found since the larger number of loosening cases in the frozen allograft group can be attributed to group heterogeneity. Nevertheless, morselized allografts appear to be suitable for acetabular bone defect reconstruction. A randomized study would be needed to determine whether frozen or processed allografts are superior.Level of evidenceIII, comparative retrospective study.
Published: 2019

8. Independent clinical appraisal of the Tape Locking Screw (TLS®) anterior cruciate ligament reconstruction technique compared with the hamstring graft technique with a minimum of 12-month follow-up

Author: B. Rubens Duval, Benoît Orfeuvre, Akash Sharma, Julia Gaillot, Dominique Saragaglia, R. Pailhé, Centre Hospitalier Universitaire [Grenoble] (CHU), 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 Queens Elizabeth Hospital [Birmingham]
Subjects: medicine.medical_specialty, Laxity, Anterior cruciate ligament reconstruction, Anterior cruciate ligament, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 03 medical and health sciences, 0302 clinical medicine, Tape Locking Screw (TLS®), medicine, Orthopedics and Sports Medicine, Prospective cohort study, 030222 orthopedics, business.industry, Significant difference, 030229 sport sciences, Hamstring graft, ST4, Tendon, Surgery, medicine.anatomical_structure, business, Hamstring, Month follow up
Abstract: International audience; INTRODUCTION:The aim of this study was to assess the differential laxity after reconstruction of the anterior cruciate ligament (ACL) by the TLS® technique using a single tendon, the semitendinosus in four-strand graft, compared with the hamstring technique which uses both the gracilis and semitendinosus. We hypothesised that this surgical technique would provide post-surgical differential laxity measurements at least as good as those of the hamstring technique.MATERIALS AND METHODS:We carried out a prospective monocentric study on patients undergoing unilateral anterior cruciate ligament repair between December 2014 and June 2016. All patients were followed up for at least 12 months. The series compares 61 patients operated on using the TLS® technique by the same surgeon, with 33 patients operated on using the hamstring technique by a second surgeon. The main objective of the study was to compare the post-operative differential laxity, measured using the KT1000, between the two techniques.RESULTS:There was no significant difference in the patients' epidemiological characteristics and pre-operative scores between the two groups. Average pre-operative differential laxity was 6.5 mm ± 2.1 (min 3; max 12) in the TLS group and 6.4 mm ± 2.0 (min 0; max 11) in the hamstring group, with no statistically significant difference. The average post-operative difference in laxity was - 0.1 mm ± 1.9 (min - 5; max 4) in the TLS group and 0.3 mm ± 2.0 (min - 7; max 5) in the hamstring group. Again, no significant difference was observed between groups.DISCUSSION:This study demonstrates a level of post-operative differential laxity control using TLS comparable with that of the ACL reconstruction technique using a hamstring graft with preserved tibial insertion
Published: 2019

9. A thoracic spinal bone giant cell tumor in a skeletally immature girl. A case report and literature review

Author: Jacques Griffet, Loic Sigwalt, C. Durand, Aurélien Courvoisier, E. Bourgeois, Ahmad Eid, Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France, parent, Service de chirurgie pédiatrique [CHU Grenoble], Centre Hospitalier Universitaire [Grenoble] (CHU), Santé, Plasticité, Motricité (TIMC-IMAG-SPM), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications, Grenoble - UMR 5525 (TIMC-IMAG), and 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])
Subjects: medicine.medical_specialty, Pathology, Adolescent, MESH: Giant Cell Tumor of Bone, [SDV]Life Sciences [q-bio], Scoliosis, Thoracic Vertebrae, MESH: Magnetic Resonance Imaging, Malignant transformation, Lesion, 03 medical and health sciences, 0302 clinical medicine, MESH: Thoracic Vertebrae, medicine, Humans, Giant Cell Tumors, Children, MESH: Treatment Outcome, Giant Cell Tumor of Bone, MESH: Adolescent, 030222 orthopedics, Spinal Neoplasms, MESH: Humans, medicine.diagnostic_test, business.industry, [SCCO.NEUR]Cognitive science/Neuroscience, MESH: Spinal Neoplasms, General Medicine, medicine.disease, Magnetic Resonance Imaging, Spine, 3. Good health, Treatment Outcome, Primary bone, Bone scintigraphy, Giant cell, 030220 oncology & carcinogenesis, Pediatrics, Perinatology and Child Health, Female, Giant cell tumor, Neurology (clinical), Neurosurgery, Radiology, medicine.symptom, Tomography, X-Ray Computed, MESH: Tomography, X-Ray Computed, business, MESH: Female
Abstract: Giant cell tumors (GCT) are benign primary bone tumors, locally aggressive, affecting in long bones in young adults during the third decade. It is rare to experience this lesion in skeletally immature patients. GCT are related to a risk of local recurrence and malignant transformation. We report a rare case of a giant cell tumor of the thoracic spine in a skeletally immature girl presenting with a painful right scoliosis. MRI, CT scan, and bone scintigraphy were discordant and the percutaneous biopsy non-contributive. A marginal “en bloc” resection was performed and revealed the GCT. Based on a literature review, the diagnosis and the surgical management of this case are discussed.
Published: 2016

10. Results of the Latarjet coracoid bone block procedure performed by mini invasive approach

Author: Gabriel Lateur, Mehdi Boudissa, Ramsay Refaie, Dominique Saragaglia, Billy Jeremy Chedal Bornu, Régis Pailhé, 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, Centre Hospitalier Universitaire [Grenoble] (CHU), CHU de Grenoble urgences Sud, and Ministère de la santé
Subjects: Adult, Male, medicine.medical_specialty, Shoulders, [SDV]Life Sciences [q-bio], Bone Screws, Coracoid, Cohort Studies, Rotator Cuff, Young Adult, 03 medical and health sciences, Mini invasive surgery, 0302 clinical medicine, Scapula, Anterior shoulder dislocations, Humans, Minimally Invasive Surgical Procedures, Medicine, Orthopedic Procedures, Orthopedics and Sports Medicine, Rotator cuff, Range of Motion, Articular, 030222 orthopedics, Shoulder Joint, business.industry, Shoulder Dislocation, 030229 sport sciences, Anterior shoulder, Middle Aged, Surgery, Treatment Outcome, medicine.anatomical_structure, Orthopedic surgery, Latarjet, Female, Shoulder joint, Bone block, Mini invasive approach, business
Abstract: International audience; INTRODUCTION:The coracoid block technique described by Latarjet was modified by Patte and Walch in order to increase the glenoid surface. Saragaglia further modified this technique and described a minimally invasive approach which allows faster post-operative recovery. The aim of this study was to evaluate the medium-term functional and radiological results of this technique.METHODS:This is a single surgeon cohort of 40 shoulders in 38 patients (32 men, 6 women) with an average age of 34.5 years operated on between January and December 2014. The skin incision was 3 to 6 cm long allowing the bony block to be passed under the subscapularis tendon without sectioning it and to be placed in lying position. The bone block was fixed with a 6.5 cancellous screw or a 7.0 cannulated screw.RESULTS:At an average follow-up of 48 months, there were no recurrent dislocations. The average WOSI score was 42, the average Constant score was 95 corrected to 97% and the average SSV was 97. Visual analogue scores were 0 at rest and 0.6 with activity. The bone block healed in 92.5% of cases. It was flush with the edge of the glenoid in 84% of cases, lateralised in 10% and medialised in 6% of cases. Mean internal rotation power was 12 kg in the operated shoulder compared with 9 kg in the non-operated shoulder.CONCLUSION:The treatment of recurrent anterior shoulder instability by mini invasive Latarjet gives excellent medium-term functional results. The rate of recurrent dislocation in this series was zero and internal rotation power was well preserved. This is an excellent alternative to arthroscopic procedures which are yet to demonstrate their superiority over open surgery.
Published: 2018

11. Results with nine years mean follow up on one hundred and three KAPS® uni knee arthroplasties: eighty six medial and seventeen lateral

Author: Ramsay Refaie, Dominique Saragaglia, Régis Pailhé, Adrien Bevand, 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]), Centre Hospitalier Universitaire [Grenoble] (CHU), Wansbeck General Hospital, Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France, and parent
Subjects: Osteoid osteoma, Adult, Male, medicine.medical_specialty, Knee Joint, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Genu varum, Population, Unicompartimental knee arthroplasty, Genu valgum, Prosthesis Design, Genu Valgum, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Mobile bearing, medicine, Gonarthrosis, Humans, Orthopedics and Sports Medicine, Longitudinal Studies, Unicompartmental knee arthroplasty, education, Arthroplasty, Replacement, Knee, Aged, Retrospective Studies, Aged, 80 and over, 030222 orthopedics, education.field_of_study, business.industry, 030229 sport sciences, Middle Aged, Osteoarthritis, Knee, medicine.disease, Arthroplasty, Surgery, Survival Rate, Treatment Outcome, Orthopedic surgery, Female, medicine.symptom, business, Knee Prosthesis, Oxford knee score, Follow-Up Studies
Abstract: International audience; PURPOSE:The purpose of this study was to present the results of the KAPS® uni knee arthroplasty system, both mobile and fixed bearing with reference to function, alignment and complications in 103 implants with a mean follow-up of nine years.METHODS:This was a retrospective study of 103 unicompartimental knee arthroplasties in 89 patients operated on between March 2005 and March 2010. The population was composed of 50 males and 39 females, with a mean age of 70.5 ± 7.5 years (41 - 90). Eighty-seven patients had a genu varum deformity (84.5%), one of whom had an osteoid osteoma of the lateral tibial plateau and 16 patients had a genu valgum (15.5%). Eighty-six medial prostheses were implanted (82 mobile bearings and 4 fixed bearings) and 17 lateral prostheses (all fixed bearings) including the osteoid osteoma.RESULTS:At a mean follow-up of 107.5 months (73-138), 72 knees (58 patients) were reviewed (70%). The mean IKS score was of 173 ± 31 points (58 - 200). The mean Oxford knee score was 21 ± 8 points (12 - 50). The cumulated survival rate at a follow up of 132 months was 98.2%.CONCLUSION:The KAPS® unicompartmental knee arthroplasty gives efficacious and safe outcomes in the majority of cases at a mean follow-up of nine years. The availability of both fixed and mobile bearings with the same instrumentation, allowing to choose the right implant intra-operatively, is a great advantage in order to avoid the occurrence of some complications, specific to mobile bearing prostheses (dislocation and over-correction).
Published: 2018

12. Multimorbidity medications and poor asthma prognosis

Author: Margaux Sanchez, Marie-Christine Boutron-Ruault, Sébastien Chanoine, Sofia Temam, Pierrick Bedouch, Jean Bousquet, Valérie Siroux, Raphaëlle Varraso, Christophe Pison, Isabelle Pin, Agnès Fournier, Nicole Le Moual, Pôle Pharmacie [CHU Grenoble Alpes], Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Centre Hospitalier Universitaire Grenoble Alpes (CHU Grenoble Alpes), Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health (IAB - INSERM U1209 - CNRS UMR5309), Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) (IAB), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Vieillissement et Maladies chroniques : approches épidémiologique et de santé publique (VIMA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Clinique Universitaire de Pédiatrie [CHU Grenoble Alpes], Hôpital Sud, CHU de Grenoble-Hôpital Couple Enfant de Grenoble, Université Paris-Sud [Le Kremlin-Bicêtre] (Faculté de Médecine), Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Institut Gustave Roussy (IGR), Service Hospitalier Universitaire Pneumologie-Physiologie [CHU Grenoble Alpes] (Pôle Thorax et Vaisseaux), Centre Hospitalier Universitaire Grenoble Alpes (CHU Grenoble Alpes), Laboratory of Fundamental and Applied Bioenergetics = Laboratoire de bioénergétique fondamentale et appliquée (LBFA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Clinique de pneumologie, CHU Grenoble, Contre les MAladies Chroniques pour un VIeillissement Actif en Languedoc-Roussillon (MACVIA-LR), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO)-Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), CHU Montpellier, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), 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]), This work was supported by a grant of the Institut pour la Recherche en Santé Publique (IReSP), and of the joint support of Direction Générale de la Santé (DGS), Mission recherche de la Direction de la recherche, des études, de l’évaluation et des statistiques (Mire-DREES), Caisse nationale d’assurance maladie des travailleurs salariés (CNAMTS), Régime Social des Indépendants (RSI), and Caisse nationale de solidarité pour l’autonomie (CNSA). In addition, the work was supported by a state grant ANR-10-COHO-0006 from the Agence Nationale de la Recherche within the Investissement d’Avenir program. The research was performed using data from the Inserm E3N cohort and support from the Mutuelle Générale de l’Education Nationale (MGEN), the Gustave Roussy Institute (IGR), the French League against Cancer (LNCC), and the National Institute for Health and Medical Research (Inserm) for setting up and maintaining the cohort., Centre Hospitalier Universitaire Grenoble Alpes ( CHU Grenoble Alpes ) -Université Grenoble Alpes ( UGA ), Team of Environmental Epidemiology Applied to Reproduction and Respiratory Health ( IAB - INSERM U1209 - CNRS UMR5309 ), Institute for Advanced Biosciences / Institut pour l'Avancée des Biosciences (Grenoble) ( IAB ), Centre Hospitalier Universitaire [Grenoble] ( CHU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Etablissement français du sang - Auvergne-Rhône-Alpes ( EFS ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ) -Centre Hospitalier Universitaire [Grenoble] ( CHU ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Etablissement français du sang - Auvergne-Rhône-Alpes ( EFS ) -Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ), Vieillissement et Maladies chroniques : approches épidémiologique et de santé publique ( VIMA ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Université Paris-Sud [Le Kremlin-Bicêtre] ( Faculté de Médecine ), Centre de recherche en épidémiologie et santé des populations ( CESP ), Université de Versailles Saint-Quentin-en-Yvelines ( UVSQ ) -Université Paris-Sud - Paris 11 ( UP11 ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale ( INSERM ), Institut Gustave Roussy [Villejuif], Service Hospitalier Universitaire Pneumologie-Physiologie [CHU Grenoble Alpes] ( Pôle Thorax et Vaisseaux ), Centre Hospitalier Universitaire Grenoble Alpes ( CHU Grenoble Alpes ), Laboratoire de bioénergétique fondamentale et appliquée ( LBFA ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Grenoble Alpes ( UGA ), Contre les Maladies Chroniques pour un VIeillissement Actif en France ( MACVIA-France ), Centre Hospitalier Universitaire de Montpellier ( CHU Montpellier ), Techniques de l'Ingénierie Médicale et de la Complexité - Informatique, Mathématiques et Applications [Grenoble] ( TIMC-IMAG ), Université Joseph Fourier - Grenoble 1 ( UJF ) -Institut polytechnique de Grenoble - Grenoble Institute of Technology ( Grenoble INP ) -IMAG-Centre National de la Recherche Scientifique ( CNRS ) -Université Grenoble Alpes ( UGA ), Centre Hospitalier Universitaire [Grenoble] (CHU)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019])-Centre Hospitalier Universitaire [Grenoble] (CHU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Etablissement français du sang - Auvergne-Rhône-Alpes (EFS)-Centre National de la Recherche Scientifique (CNRS)-Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Institut National de la Santé et de la Recherche Médicale (INSERM), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Universitaire [Grenoble] (CHU), Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Universitaire de Nîmes (CHU Nîmes)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS)-European Innovation Partnership on Active and Healthy Ageing Reference Site (EIP on AHA), Commission Européenne-Commission Européenne-Organisation Mondiale de la Santé / World Health Organization Office (OMS / WHO), and Faraldo, Beatrice
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Databases, Factual, multimorbidity, [SDV]Life Sciences [q-bio], MEDLINE, 03 medical and health sciences, 0302 clinical medicine, medications, Quality of life, immune system diseases, Internal medicine, Surveys and Questionnaires, Medicine, Multimorbidity, Cluster Analysis, Humans, 030212 general & internal medicine, Prospective Studies, Prospective cohort study, Adverse effect, Asthma, Aged, Polypharmacy, Aged, 80 and over, [ SDV ] Life Sciences [q-bio], business.industry, Case-control study, [ SDV.SPEE ] Life Sciences [q-bio]/Santé publique et épidémiologie, Original Articles, Middle Aged, asthma, medicine.disease, Prognosis, adverse events, 3. Good health, respiratory tract diseases, [SDV] Life Sciences [q-bio], 030228 respiratory system, [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie, Case-Control Studies, Quality of Life, Female, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, France, business
Abstract: Multimedication related to multimorbidity is common in the elderly with asthma. We aimed at comprehensively characterising medications used by elderly women and assessing how multimedication impacts on asthma prognosis. We performed network-based analyses on drug administrative databases to visualise the prevalence of drug classes and their interconnections among 17 458 elderly women from the Asthma-E3N study, including 4328 women with asthma. Asthma groups sharing similar medication profiles were identified by a clustering method relying on all medications and were studied in association with adverse asthma events (uncontrolled asthma, attacks/exacerbations and poor asthma-related quality of life). The network-based analysis showed more multimedication in women with asthma than in those without asthma. The clustering method identified three multimedication profiles in asthma: “Few multimorbidity-related medications” (43.5%), “Predominantly allergic multimorbidity-related medications” (32.8%) and “Predominantly metabolic multimorbidity-related medications” (23.7%). Compared with women belonging to the “Few multimorbidity-related medications” profile, women belonging to the two other profiles had an increased risk of uncontrolled asthma and asthma attacks/exacerbations, and had lower asthma-related quality of life. The integrative data-driven approach on drug administrative databases identified specific multimorbidity-related medication profiles that were associated with poor asthma prognosis. These findings support the importance of multimorbidity in the unmet needs in asthma management., Asthma phenotypes identified by multimorbidity medications are associated with asthma prognosis http://ow.ly/Phfq30iR1Qh
Published: 2018

13. Feasibility of FFOCT endomicroscope for cartilage evaluation (Conference Presentation)

Author: Alexandre Moreau-Gaudry, Emilie Benoit a la Guillaume, Albert Claude Boccara, Aurelien Jaffard, Régis Pailhé, Daria Andreoli, Cecilia Hughes, Sandrine Voros, Institut Langevin - Ondes et Images (UMR7587) (IL), Sorbonne Université (SU)-Ecole Superieure de Physique et de Chimie Industrielles de la Ville de Paris (ESPCI Paris), Université Paris sciences et lettres (PSL)-Université Paris sciences et lettres (PSL)-Université de Paris (UP)-Centre National de la Recherche Scientifique (CNRS), Centre d'Investigation Clinique - Innovation Technologique - INSERM - CHU de Grenoble (CIC-IT Grenoble (CIT803)), CHU Grenoble-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Grenoble Alpes (UGA), Ecole Superieure de Physique et de Chimie Industrielles de la Ville de Paris (ESPCI Paris), Université Paris sciences et lettres (PSL), 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), and 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])
Subjects: medicine.medical_specialty, [SDV.BIO]Life Sciences [q-bio]/Biotechnology, business.industry, Cartilage, media_common.quotation_subject, [SDV.CAN]Life Sciences [q-bio]/Cancer, [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, Presentation, medicine.anatomical_structure, [INFO.INFO-IM]Computer Science [cs]/Medical Imaging, medicine, Radiology, business, [SPI.SIGNAL]Engineering Sciences [physics]/Signal and Image processing, ComputingMilieux_MISCELLANEOUS, media_common
Abstract: International audience
Published: 2018

14. 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

15. Résultats à moyen 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. Imbert, S. Lustig, C. Steltzlen, C. Batailler, P. Colombet, F. Dalmay, S. Bertiaux, P. D’ingrado, F.P. Ehkirch, M.L. Louis, R. Pailhé, J.C. Panisset, B. Schlaterrer, B. Sonnery-Cottet, L. Sigwalt, D. Saragaglia, C. Lutz, ICAPS, 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 Hospitalier de Versailles André Mignot (CHV), 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 de chirurgie orthopédique et sportive, UMR Inserm 1094 NET, INSERM, Hôpital privé de l'Estuaire, Clinique du Parc, Clinique Maussins-Nollet, Centre ICOS, Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, Hôpital Sud, CHU de Grenoble, Centre ostéo-articulaire des Cèdres, Centre Ostéo-articulaire des Cèdres, IM2S, Centre orthopédique Santy, and ICOSS
Subjects: 030222 orthopedics, 03 medical and health sciences, BIOMECANIQUE, 0302 clinical medicine, LIGAMENT CROISE ANTERIEUR, [SPI.MECA.BIOM]Engineering Sciences [physics]/Mechanics [physics.med-ph]/Biomechanics [physics.med-ph], Orthopedics and Sports Medicine, Surgery, 030229 sport sciences
Abstract: SFA 2017 - Congrès annuel de la Société Francophone d'Arthroscopie, MARSEILLE, FRANCE, 06-/12/2017 - 09/12/2017; Lors de la ligamentoplastie du LCA, l'adjonction d'une plastie antérolatérale (PAL) a pour but d'améliorer le contrôle de la stabilité en rotation du genou. L'efficacité de cette technique et ses conséquences sur les risques de re-rupture et d'atteinte dégénérative secondaire sont discutées.
Published: 2017

16. 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

17. 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

18. Factors related to pregnancy and birth and the risk of childhood brain tumours: The ESTELLE and ESCALE studies (SFCE, France)

Author: Jean Michon, Jacqueline Clavel, Cécile Faure-Conter, Isabelle Pellier, Paula Rios, Claire Freycon, Léa Guerrini-Rousseau, Pierre Leblond, Anne-Isabelle Bertozzi, Stéphanie Puget, Helen D. Bailey, Stéphane Ducassou, Brigitte Lacour, Laurent Orsi, Equipe 7 : EPICEA - Epidémiologie des cancers de l'enfant et de l'adolescent (CRESS - U1153), Université Paris Descartes - Paris 5 (UPD5)-Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Registre National des Cancers de l'Enfant - National Registry of Childhood Cancers [Villejuif & CHU Nancy] (RNCE), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de cancérologie de l'enfant et de l'adolescent [Gustave Roussy], Institut Gustave Roussy (IGR), Unité d’Hémato-Immuno-Oncologie pédiatrique [CHU Toulouse] (Pôle Pédiatrique), CHU Toulouse [Toulouse], Unité d'oncologie pédiatrique [Centre Oscar Lambret, Lille], Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université Lille Nord de France (COMUE)-UNICANCER-Université Lille Nord de France (COMUE)-UNICANCER, Institut d'hématologie et d'oncologie pédiatrique [CHU - HCL] (IHOPe), Hospices Civils de Lyon (HCL), Innate Immunity and Immunotherapy (CRCINA-ÉQUIPE 7), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA), Service d'Immunologie Hématologie et Oncologie pédiatriques [CHU Angers], Centre Hospitalier Universitaire d'Angers (CHU Angers), PRES Université Nantes Angers Le Mans (UNAM)-PRES Université Nantes Angers Le Mans (UNAM), Clinique Universitaire de Pédiatrie [CHU Grenoble-Alpes], Hôpital Sud, CHU de Grenoble-Hôpital Couple Enfant de Grenoble, Département de Pédiatrie Adolescents et Jeunes Adultes [Institut Curie], Institut Curie [Paris], Service de neurochirurgie pédiatrique [CHU Necker], CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5), Université Sorbonne Paris Cité (USPC), Service d’Onco-Hématologie Pédiatrique [Hôpital Pellegrin, Bordeaux], Hôpital Pellegrin - Bordeaux, The authors would also like to thank all of the Société Française de lutte contre les Cancers de l’Enfant et de l’Adolescent (SFCE) principal investigators., Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Université Paris Diderot - Paris 7 (UPD7)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Sorbonne Paris Cité (USPC), Centre Oscar Lambret [Lille], Innate immunity and Immunotherapy (CRCINA - Département INCIT - Equipe 7), Centre de recherche de Cancérologie et d'Immunologie / Nantes - Angers (CRCINA), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Necker - Enfants Malades [AP-HP], Sercice Hématologie, immunologie et oncologie pédiatrique [CHU Toulouse], Pôle Enfants [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Université de Lille-UNICANCER-Université de Lille-UNICANCER, Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), and Bernardo, Elizabeth
Subjects: Adult, Male, Cancer Research, medicine.medical_specialty, Pediatrics, Adolescent, Birth weight, case-control study, Population, Breastfeeding, Mothers, [SDV.CAN]Life Sciences [q-bio]/Cancer, Body Mass Index, 03 medical and health sciences, 0302 clinical medicine, [SDV.CAN] Life Sciences [q-bio]/Cancer, Pregnancy, Risk Factors, medicine, Birth Weight, Humans, 030212 general & internal medicine, education, 2. Zero hunger, fertility, education.field_of_study, child, Brain Neoplasms, Obstetrics, business.industry, Case-control study, Odds ratio, medicine.disease, 3. Good health, Breast Feeding, Logistic Models, Oncology, Case-Control Studies, 030220 oncology & carcinogenesis, brain tumors, Female, France, business, Body mass index, Breast feeding, folic acid supplementation, fetal growth
Abstract: International audience; Little is known of the causes of childhood brain tumors (CBT). The aims of this study were to investigate whether extremes of birth weight were associated with increased risk of CBT and whether maternal preconceptional folic acid supplementation or breastfeeding reduced the risk. In addition, other maternal characteristics and birth related factors were also investigated. We pooled data from two French national population-based case-control studies with similar designs conducted in 2003–2004 and 2010–2011. The mothers of 510 CBT cases (directly recruited from the national childhood cancer register) and 3,102 controls aged under 15 years, frequency matched by age and gender did a telephone interview, which focussed on demographic and perinatal characteristics, and maternal life style habits and reproductive history. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional logistic regression, adjusted for age, sex, study of origin and relevant confounders. No association was found between CBT and birth weight or fetal growth. The use of preconceptional folic acid supplementation was rare (5.3% in cases and 7.8% in controls) and the OR was 0.8 (95% CI 0.5, 1.4). There was no association with breastfeeding, even prolonged (six months or more; OR 1.0, 95% CI 0.8, 1.4). Neither was there any association between CBT and other investigated factors (maternal body mass index, gestational weight gain, congenital abnormality, maternal reproductive history or use of fertility treatments. Although large, this study was underpowered for subtype analyses. Pooling data with other population-based studies may provide further insight into findings by CBT subtypes.
Published: 2017

19. Parental smoking, maternal alcohol, coffee and tea consumption and the risk of childhood brain tumours: the ESTELLE and ESCALE studies (SFCE, France)

Author: Claire Freycon, Isabelle Pellier, Stéphanie Puget, Brigitte Lacour, Pierre Leblond, Jacqueline Clavel, Léa Guerrini-Rousseau, Cécile Faure-Conter, Anne-Isabelle Bertozzi, Stéphane Ducassou, Laurent Orsi, François Doz, Helen D. Bailey, Equipe 7 : EPICEA - Epidémiologie des cancers de l'enfant et de l'adolescent (CRESS - U1153), Université Paris Descartes - Paris 5 (UPD5)-Centre de Recherche Épidémiologie et Statistique Sorbonne Paris Cité (CRESS (U1153 / UMR_A_1125 / UMR_S_1153)), Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Paris Descartes - Paris 5 (UPD5)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de la Recherche Agronomique (INRA)-Université Paris Diderot - Paris 7 (UPD7)-Université Sorbonne Paris Cité (USPC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Registre National des Cancers de l'Enfant - National Registry of Childhood Cancers [Villejuif & CHU Nancy] (RNCE), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy)-Institut National de la Santé et de la Recherche Médicale (INSERM), Département de cancérologie de l'enfant et de l'adolescent [Gustave Roussy], Institut Gustave Roussy (IGR), Sercice Hématologie, immunologie et oncologie pédiatrique [CHU Toulouse], Pôle Enfants [CHU Toulouse], Centre Hospitalier Universitaire de Toulouse (CHU Toulouse)-Centre Hospitalier Universitaire de Toulouse (CHU Toulouse), Unité d'oncologie pédiatrique [Centre Oscar Lambret, Lille], Centre Régional de Lutte contre le Cancer Oscar Lambret [Lille] (UNICANCER/Lille), Université de Lille-UNICANCER-Université de Lille-UNICANCER, Institut d'hématologie et d'oncologie pédiatrique [CHU - HCL] (IHOPe), Hospices Civils de Lyon (HCL), Innate Immunity and Immunotherapy (CRCINA-ÉQUIPE 7), Centre de Recherche en Cancérologie et Immunologie Nantes-Angers (CRCINA), Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université d'Angers (UA)-Université de Nantes (UN)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes), Clinique Universitaire de Pédiatrie [CHU Grenoble Alpes], Hôpital Sud, CHU de Grenoble-Hôpital Couple Enfant de Grenoble, Département de Pédiatrie Adolescents et Jeunes Adultes [Institut Curie], Université Paris Descartes - Paris 5 (UPD5)-Institut Curie [Paris], Service de neurochirurgie pédiatrique [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Université Paris Descartes - Paris 5 (UPD5), Université Sorbonne Paris Cité (USPC), Service d’Onco-Hématologie Pédiatrique [Hôpital Pellegrin, Bordeaux], Hôpital Pellegrin - Bordeaux, The ESCALE and ESTELLE studies were supported by Grants from INSERM, the Ligue Nationale Contre le Cancer, the Fondation de France, the Fondation ARC pour la Recherche sur le Cancer, the Agence Française de Sécurité Sanitaire des Produits de Santé (ANSM), the Agence Française de Sécurité Sanitaire de l’Environnement et du Travail (ANSES), the association Cent pour sang la vie, the association Enfants cancer et santé, the Institut National du Cancer (INCa), the Agence Nationale de la Recherche (ANR), the Cancéropôle Ile de France., Bernardo, Elizabeth, Unité d’Hémato-Immuno-Oncologie pédiatrique [CHU Toulouse] (Pôle Pédiatrique), CHU Toulouse [Toulouse], Université Lille Nord de France (COMUE)-UNICANCER-Université Lille Nord de France (COMUE)-UNICANCER, Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Centre National de la Recherche Scientifique (CNRS)-Université d'Angers (UA), CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Centre Oscar Lambret [Lille], Innate immunity and Immunotherapy (CRCINA - Département INCIT - Equipe 7), Centre de recherche de Cancérologie et d'Immunologie / Nantes - Angers (CRCINA), Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN)-Université d'Angers (UA)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Centre hospitalier universitaire de Nantes (CHU Nantes)-Université de Nantes - UFR de Médecine et des Techniques Médicales (UFR MEDECINE), Université de Nantes (UN)-Université de Nantes (UN), and Assistance publique - Hôpitaux de Paris (AP-HP) (APHP)-CHU Necker - Enfants Malades [AP-HP]
Subjects: Male, Cancer Research, Pediatrics, Logistic regression, Coffee, Fathers, 0302 clinical medicine, Pregnancy, Risk Factors, Epidemiology, Odds Ratio, 030212 general & internal medicine, Child, education.field_of_study, Brain Neoplasms, Smoking, 3. Good health, Oncology, 030220 oncology & carcinogenesis, Child, Preschool, Female, France, Alcohol, Adult, medicine.medical_specialty, Adolescent, Alcohol Drinking, Case–control study, Population, Parental smoking, Mothers, [SDV.CAN]Life Sciences [q-bio]/Cancer, Astrocytoma, 03 medical and health sciences, [SDV.CAN] Life Sciences [q-bio]/Cancer, medicine, Humans, education, Tea, business.industry, Brain tumours, Public health, Case-control study, Infant, Newborn, Infant, Odds ratio, medicine.disease, Confidence interval, Logistic Models, Case-Control Studies, business, Demography
Abstract: International audience; PURPOSE: To investigate whether parental smoking around the time of pregnancy or maternal consumption of beverages (alcohol, coffee, or tea) during pregnancy were associated with the risk of CBT.METHODS: We pooled data from two French national population-based case-control studies with similar designs conducted in 2003-2004 and 2010-2011. The mothers of 510 CBT cases (directly recruited from the national childhood cancer register) and 3,102 controls aged under 15 years, frequency matched by age and gender, were interviewed through telephone, which included questions about prenatal parental smoking and maternal consumption of alcohol, coffee and tea. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using unconditional logistic regression, adjusted for age, sex and study of origin.RESULTS: No association was seen between CBT and the mother smoking or drinking alcohol, coffee, or tea during the index pregnancy. The OR between CBT and paternal smoking in the year before birth (as reported by the mother) was 1.25 (95% CI 1.03, 1.52) with an OR of 1.09 (0.99, 1.19) for every 10 cigarettes per day (CPD) smoked. The association between paternal smoking and CBT appeared to be stronger in children diagnosed before the age of five years (OR 1.52, 95% CI 1.14, 2.02) and for astrocytoma (OR 1.86, 95% CI 1.26, 2.74).CONCLUSION: We found some evidence of a weak association between paternal smoking in the year before the child's birth and CBT, especially astrocytomas. These findings need to be replicated in other samples, using similar classifications of tumour subtypes.
Published: 2017

20. Long-term outcomes of tension band wiring with a single K-wire in Rockwood type IV/V acute acromio-clavicular dislocations: 25 cases

Author: Brice Rubens-Duval, Dominique Saragaglia, Gabriel Lateur, Mehdi Boudissa, R. Mader, R.C. Rouchy, Régis Pailhé, 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, and Hôpital Sud, CHU de Grenoble
Subjects: Adult, Male, medicine.medical_specialty, Visual analogue scale, Radiography, [SDV]Life Sciences [q-bio], Joint Dislocations, Osteoarthritis, 03 medical and health sciences, 0302 clinical medicine, medicine, Long term outcomes, Humans, Orthopedic Procedures, Orthopedics and Sports Medicine, Absolute constant, Retrospective Studies, 030222 orthopedics, business.industry, Tension band wiring, Retrospective cohort study, Recovery of Function, 030229 sport sciences, Middle Aged, medicine.disease, Acromio-clavicular joint, 3. Good health, Surgery, Cross-Sectional Studies, Treatment Outcome, Acromioclavicular Joint, Acute dislocation, Female, business, Bone Wires, Cohort study, Surgical repair
Abstract: Background Our objective was to evaluate the long-term functional and radiological outcomes of tension band wiring with a single K-wire for acute Rockwood types IV and V acromio-clavicular dislocation (ACD). Methods Single-centre cross-sectional non-randomised observational cohort study of 25 shoulders treated surgically between January 2002 and December 2004, in 25 patients, 23 males and 2 females, with a mean age of 35 ± 11 years (24–46). The evaluation criteria were the absolute and weighted Constant scores, QuickDASH score, subjective shoulder value (SSV), visual analogue scale (VAS) pain score at rest and during activities, and radiographic features in clinically symptomatic patients. Results Mean values were as follows: follow-up, 150 ± 17 months (133–167); absolute Constant score, 88 ± 17 (71–105); weighted Constant score, 92.5 ± 12.5 (80–105); QuickDASH, 15.5 ± 7 (8.5–22.5); SSV, 88 ± 17% (71–105); VAS pain score at rest, 0.2 ± 0.7 (0–0.9); and VAS pain score while active, 1.4 ± 2.3 (0–3.7). The weighted Constant score was less than 70% in only 8% of patients. Of the 17 patients for whom radiographs were obtained, 8 had acromio-clavicular osteoarthritis. Mean coraco-clavicular distance was 12.3 ± 4.3 mm (8–16.6) and mean acromio-clavicular distance was 5 ± 5 mm (0–10). The recurrence rate was 8%. Conclusion Tension band wiring with a single K-wire for acute acromio-clavicular dislocation reliably provides good long-term functional outcomes. Recurrences are uncommon and few patients experience symptoms (8%). Level of evidence IV, retrospective study.
Published: 2016

21. Prevention of iatrogenic infections in interventional rheumatology: Optimal measures but adapted to each risk

Author: Hervé Bard, Maria Antonietta D'Agostino, Jean-Gérard Bloch, Frédérique Gandjbakhch, Jean-David Albert, Véronique Dixneuf, Pierre Monod, Denis Rolland, Bertrand Lecoq, Grégoire Cormier, Yves Maugars, Philippe Gaudin, Dominique Baron, Fabien Etchepare, Jean-Philippe Sanchez, Benoit Le Goff, Henri Lellouche, Pierre Bourgeois, Vincent Diebolt, Service de Rhumatologie, Hôtel-Dieu, Service de rhumatologie [Rennes] = Rheumatology [Rennes], CHU Pontchaillou [Rennes], Foie, métabolismes et cancer, Université de Rennes (UR)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Hôpital Américain de Paris, Centre de rééducation et de réadaptation fonctionnelles [Trestel], CHU Strasbourg, CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Centre hospitalier La Roche-Sur-Yon, Hôpital Ambroise Paré [AP-HP], Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Service de rhumatologie [Nantes], Université de Nantes (UN)-Hôtel-Dieu-Centre hospitalier universitaire de Nantes (CHU Nantes), Clinique Universitaire de Rhumatologie, hôpital Sud, CHU de Grenoble, Service de Rhumatologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), Hôpital Lariboisière, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Lariboisière-Fernand-Widal [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Cabinet de Rhumatologie [ Castelnaudary ], Département de rhumatologie, Hôpital privé Guillaume de Varye, Centre de rhumatologie de Pau [Billère], Jonchère, Laurent, Service de Rhumatologie [CHU Pitié Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Service de rhumatologie [CHU Pitié Salpêtrière] (GRC-08 EEMOIS), Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière-Fernand-Widal [APHP], and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)
Subjects: Pathology, medicine.medical_specialty, Settore MED/16 - REUMATOLOGIA, Intra-Articular, [SDV]Life Sciences [q-bio], Elbow, Iatrogenic Disease, Asepsis, Injections, Intra-Articular, Injections, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, prevention, Internal medicine, medicine, Humans, Surgical Wound Infection, Orthopedic Procedures, Intensive care medicine, Knee operations, 030203 arthritis & rheumatology, 030222 orthopedics, Arthritis, Infectious, Cross Infection, Infection Control, [SDV.MHEP] Life Sciences [q-bio]/Human health and pathology, medicine.diagnostic_test, business.industry, Arthritis, Arthroscopy, Infectious, Sterilization, Recommendation, Bone Diseases, Infectious, Interventional rheumatology, 3. Good health, [SDV] Life Sciences [q-bio], medicine.anatomical_structure, Bone Diseases, business, [SDV.MHEP]Life Sciences [q-bio]/Human health and pathology, Iatrogenic infection
Abstract: International audience; Osteoarticular iatrogenic infections may be serious and justify suitable and optimised preventive measures depending on each risk, as much in terms of mortality as of morbidity. Its appreciation has been the subject of more and more studies, which allow the importance of the problem to be better evaluated. The level of iatrogenic infections after arthroscopy is evaluated at 1 to 5‰ on a recent series of knee operations, but they may be much higher for the elbow [1] and [2]. In practice, this examination is no longer used for diagnosis as it was 10 years ago, the progress in imagery means this invasive act is no longer necessary...
Published: 2016

22. Bone lengthening using the Fitbone ® motorized intramedullary nail: The first experience in France

Author: J. Sales de Gauzy, F. Accadbled, Régis Pailhé, Etienne Cavaignac, 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, Centre Hospitalier Universitaire Grenoble Alpes - CHU Grenoble Alpes (FRANCE), and Centre Hospitalier Universitaire de Toulouse - CHU Toulouse (FRANCE)
Subjects: Adult, medicine.medical_specialty, Time Factors, Adolescent, [SDV]Life Sciences [q-bio], Dwarfism, Bone lengthening, Bone Nails, Length discrepancy, Short stature, Bone Lengthening, law.invention, Intramedullary rod, Young Adult, 03 medical and health sciences, 0302 clinical medicine, Autre, law, medicine, Humans, Orthopedics and Sports Medicine, Femur, Prospective Studies, 030212 general & internal medicine, Tibia, Prospective cohort study, 030222 orthopedics, business.industry, Fitbone(®), Middle Aged, Leg Length Inequality, Surgery, Treatment Outcome, medicine.anatomical_structure, Nail (anatomy), Growth plates, France, medicine.symptom, business, Motorized nail
Abstract: Introduction Intramedullary limb lengthening systems include mechanical systems (the Albizzia nail and the ISKD nail) as well as motorized systems with the Fitbone® (Wittenstein, Igersheim, Germany) and the Precice® (Ellipse Technologies, Irvine, CA, USA) nails. We hypothesized that limb lengthening using the Fitbone® nail was reliable, reproducible, and comfortable for the patient. Patients and methods Between 2010 and 2013, a prospective single-center, single-operator (FA) study was conducted on patients who had undergone limb lengthening using the Fitbone® nail. The inclusion criteria were length discrepancy of the limbs equal to or greater than 25 mm or a short stature. The exclusion criteria were indications for cosmetic reasons and/or growth plates that were still open. The lengthening parameters were assessed postoperatively and at the last follow-up. Lengthening was considered achieved when the lengthening objective did not differ by more than 5 mm. All complications were noted. A statistical analysis was performed. Results Twenty-six Fitbone® nails were implanted in 23 patients, in the femur in 15 cases and the tibia in 11 cases. The patients’ mean age was 22.5 years (range: 15–53 years) and the mean follow-up was 3.4 years (range: 2–5.3 years). The limb lengthening targeted was obtained in 23 cases (88%) and the mean lengthening was 45.3 ± 18 mm (range: 20–80 mm). The mean time to healing was 277 ± 167 days (range: 86–638 days). The mean healing index was 73 ± 57 days/cm for the femurs and 83.5 ± 65 days/cm for the tibias. The mean complication rate was 15.4%. Discussion This study emphasizes the good short-term results of this motorized intramedullary lengthening system. An evaluation over the longer term and with a higher number of patients remains necessary. Level of evidence IV: uncontrolled, prospective, continuous study.
Published: 2016

23. Comparative study of computer-assisted total knee arthroplasty after opening wedge osteotomy versus after unicompartmental arthroplasty

Author: Régis Pailhé, Dominique Saragaglia, Akash Sharma, Rouchy Rc, Brice Rubens-Duval, Massfelder J, Cognault J, 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 Queens Elizabeth Hospital [Birmingham]
Subjects: musculoskeletal diseases, Male, Reoperation, medicine.medical_specialty, Computer-assisted surgery, Knee Joint, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Osteoarthritis, Osteotomy, Severity of Illness Index, 03 medical and health sciences, 0302 clinical medicine, High tibial osteotomy, Unicompartmental knee arthroplasty, medicine, Humans, Orthopedics and Sports Medicine, Tibia, Arthroplasty, Replacement, Knee, Aged, Retrospective Studies, 2. Zero hunger, 030203 arthritis & rheumatology, 030222 orthopedics, business.industry, Retrospective cohort study, Recovery of Function, Middle Aged, Osteoarthritis, Knee, medicine.disease, Arthroplasty, Surgery, Radiography, Treatment Outcome, Surgery, Computer-Assisted, Female, business, Follow-Up Studies
Abstract: AimsThe role of high tibial osteotomy (HTO) is being questioned by the use of unicompartmental knee arthroplasty (UKA) in the treatment of medial compartment femorotibial osteoarthritis. Our aim was to compare the outcomes of revision HTO or UKA to a total knee arthroplasty (TKA) using computer-assisted surgery in matched groups of patients.Patients and MethodsWe conducted a retrospective study to compare the clinical and radiological outcome of patients who underwent revision of a HTO to a TKA (group 1) with those who underwent revision of a medial UKA to a TKA (group 2). All revision procedures were performed using computer-assisted surgery. We extracted these groups of patients from our database. They were matched by age, gender, body mass index, follow-up and pre-operative functional score. The outcomes included the Knee Society Scores (KSS), radiological outcomes and the rate of further revision.ResultsThere were 20 knees in 20 patients in each group. The mean follow-up was 4.1 years (2 to 18.7). The mean total KSS at last follow-up was 185.7 (standard deviation (sd) 5) in group 1 compared with 176.5 (sd 11) for group 2 (p = 0.003). The mean hip-knee-ankle angle was 180.2° (sd 3.2°) in group 1 and 179.0° (sd 2.2°) in group 2. No revision was required.ConclusionWe found that good functional and radiological outcomes followed revision of both HTO and UKA to TKA. Revision of HTO showed significantly better functional outcomes. These results need to be further investigated by a prospective randomised controlled trial involving a larger group of patients. Cite this article: Bone Joint J 2016;98-B:1620–4.
Published: 2016

24. Unfolded protein response gene GADD34 is overexpressed in rheumatoid arthritis and related to the presence of circulating anti-citrullinated protein antibodies

Author: Laurent Grange, Maxime Chevreau, Philippe Pierre, Candice Trocme, Marine Clay, Souad Adriouach, Evelina Gatti, Jean-Louis Quesada, Jean-Yves Cesbron, Chantal Dumestre-Pérard, Philippe Gaudin, Giovanna Clavarino, Barrière Naturelle et Infectiosité (TIMC-IMAG-BNI), 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]), 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]), Laboratoire d'immunologie, CHU Grenoble, Direction de la Recherche Clinique et de l'Innovation, Pole Recherche, Clinique Universitaire de Rhumatologie, hôpital Sud, CHU de Grenoble, Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Laboratoire de Biochemie des enzymes et des protéines, Centre Hospitalier Universitaire [Grenoble] (CHU), Centre d'Immunologie de Marseille - Luminy (CIML), Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)-Aix Marseille Université (AMU), and Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS)
Subjects: 0301 basic medicine, Male, Immunology, Gene Expression, Peripheral blood mononuclear cell, Proinflammatory cytokine, Arthritis, Rheumatoid, 03 medical and health sciences, Protein Phosphatase 1, Gene expression, Odds Ratio, Immunology and Allergy, Medicine, Humans, ComputingMilieux_MISCELLANEOUS, Autoantibodies, biology, business.industry, Anti–citrullinated protein antibody, 3. Good health, 030104 developmental biology, Real-time polymerase chain reaction, [SDV.MP]Life Sciences [q-bio]/Microbiology and Parasitology, Case-Control Studies, Unfolded protein response, biology.protein, Leukocytes, Mononuclear, Biomarker (medicine), Female, Antibody, business, Biomarkers
Abstract: Growth arrest and DNA damage-inducible gene 34 (GADD34) is an inducible cofactor of protein phosphatase 1, which has an important role in the unfolded protein response. GADD34 has been shown to be necessary for type I interferon and proinflammatory cytokine production in response to viral infection in murine models. We investigate the expression of GADD34 in rheumatoid arthritis (RA), in which proinflammatory cytokines have an important pathogenic role. The objective of this study was to evaluate the potential of GADD34 expression as a biomarker in RA patients. We report a case-control study on GADD34 gene expression in peripheral blood mononuclear cells of patients (n = 75) with RA and age- and sex-matched healthy controls (n = 25). The study was approved by the relevant local ethics committees. GADD34 gene expression level in peripheral blood mononuclear cells was measured by quantitative PCR and analyzed with Mann-Whitney test. The relation between GADD34 gene overexpression and clinical or biological characteristics was analyzed with univariate and multivariate analysis. GADD34 gene expression was significantly higher in RA patients compared with healthy controls (p ≤ 0.001). Interestingly, GADD34 overexpression in PBMC of patients was related to the presence of circulating anti-citrullinated protein antibodies (p = 0.030). Data of this study strengthen the evidence of an unfolded protein response during the course of RA and provide an insight of the potential interest in GADD34 as a relevant marker for RA.
Published: 2016

25. Outcome of cartilage at 12 years of follow-up after anterior cruciate ligament reconstruction

Author: F. Rongieras, O. Cantin, Nicolas Lefevre, Société française de chirurgie orthopédique et traumatologique, Christophe Hulet, Nicolas Graveleau, Sébastien Lustig, D. Saragaglia, Service de Chirurgie Orthopédique [Centre Albert Trillat], 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 de la Croix-Rousse [CHU - HCL], Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), 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), Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, Hôpital Sud, CHU de Grenoble, 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]), Institut de l'appareil locomoteur Nollet, Centre de consultation orthopédique et sportive, Clinique du sport de Bordeaux-Mérignac, Mobilités : Attention, Orientation et Chronobiologie (COMETE), Université de Caen Normandie (UNICAEN), and Normandie Université (NU)-Normandie Université (NU)-Institut National de la Santé et de la Recherche Médicale (INSERM)
Subjects: Adult, Cartilage, Articular, Male, Chondropathy, medicine.medical_specialty, Anterior cruciate ligament reconstruction, Anterior cruciate ligament, medicine.medical_treatment, Osteoarthritis, Meniscus (anatomy), Young Adult, 03 medical and health sciences, BIOMECANIQUE, 0302 clinical medicine, LONG-TERM OUTCOMES, Risk Factors, Humans, Medicine, Orthopedics and Sports Medicine, RECONSTRUCTION, [PHYS.MECA.BIOM]Physics [physics]/Mechanics [physics]/Biomechanics [physics.med-ph], Retrospective Studies, 2. Zero hunger, 030222 orthopedics, Anterior Cruciate Ligament Reconstruction, business.industry, Anterior Cruciate Ligament Injuries, Retrospective cohort study, 030229 sport sciences, Osteoarthritis, Knee, medicine.disease, Surgery, LIGAMENT, Treatment Outcome, medicine.anatomical_structure, OSTEOARTHRITIS, MENISCUS, Cohort, Disease Progression, Ligament, Female, business, ANTERIOR CRUCIATE LIGAMENT, Follow-Up Studies
Abstract: Introduction In cases of chronic anterior laxity, reconstruction of the anterior cruciate ligament (ACL) can slow the development of osteoarthritis. This study was conducted to determine the overall prevalence of osteoarthritis and to identify the risk factors after ACL reconstruction. Hypothesis Meniscus tears, time from injury to surgery, body mass index (BMI), residual laxity, and cartilage lesions influence the progression towards osteoarthritis. Materials and methods This multicenter, retrospective study on the outcome of cruciate ligaments at 12years of follow-up was conducted within the 2014 SOFCOT Symposium. The cohort included 675arthroscopic reconstructions of the ACL from January 2002 to December 2003. The clinical evaluation included the objective and subjective IKDC score. Osteoarthritis was analyzed on 589 knee X-rays according to the IKDC classification. The predictive factors of osteoarthritis development studied were age, gender, BMI, time from injury to surgery, activity level, medial or lateral meniscectomy, type of graft, medial or lateral chondropathy, tunnel positioning, and residual laxity. Univariate and multivariate analyses with logistic regression were performed. Results The mean follow-up was 11.9 ± 0.8years. The subjective IKDC score was 83.7 ± 13. At 12years, the rate of moderate to severe osteoarthritis l (IKDC C or D) was 19% (16% medial tibiofemoral osteoarthritis, 4% lateral tibiofemoral osteoarthritis, and 2% patellofemoral osteoarthritis). The prognostic factors were age at surgery greater than 34years (P < 0.05), cartilage lesions at surgery (P < 0.05), medial or lateral meniscectomy (P < 0.05), and residual laxity (P < 0.05). Conclusions This large-scale study identified risk factors for osteoarthritis that should improve the information provided to patients on long-term progression after ACL reconstruction. Level of evidence Retrospective cohort study, level IV.
Published: 2016

26. Triple osteotomy of the pelvis for Legg-Calve-Perthes disease: a mean fifteen year follow-up

Author: Jérôme Sales de Gauzy, Franck Accadbled, Etienne Cavaignac, Jérôme Murgier, Régis Pailhé, Jean Philippe Cahuzac, Centre Hospitalier Universitaire Grenoble Alpes - CHU Grenoble Alpes (FRANCE), Centre Hospitalier Universitaire de Toulouse - CHU Toulouse (FRANCE), 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]), and CHU Toulouse [Toulouse]
Subjects: Male, medicine.medical_specialty, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Age at diagnosis, Osteoarthritis, Osteotomy, Pediatrics, Pelvis, 03 medical and health sciences, 0302 clinical medicine, Autre, medicine, Humans, Legg-Calve-Perthes disease, Orthopedics and Sports Medicine, Prospective Studies, 030212 general & internal medicine, Child, 030222 orthopedics, Hip, Legg Calve Perthes, business.industry, medicine.disease, Survival Analysis, 3. Good health, Surgery, Treatment Outcome, medicine.anatomical_structure, Child, Preschool, Cohort, Orthopedic surgery, Legg-Calve-Perthes Disease, Female, business, Follow-Up Studies
Abstract: International audience; PURPOSE:This study presents the results of a prospective consecutive cohort of patients with Legg-Calvé-Perthes disease (LCPD) operated with triple osteotomy of the pelvis (TOP) between 1989 and 2005. We attempted to determine whether the results of TOP remain stable with time and consequently lower the risk of subsequent osteoarthritis. The primary study aims were to determine the maintenance of head coverage and joint congruity, and functional outcomes of this surgery.METHODS:Forty-five patients with a mean follow-up of 15.2 years (range eight to 24) were included.RESULTS:At latest follow-up, two patients were lost to follow-up, and two required a surgical reoperation. Cumulative maintenance of head coverage and joint congruity rate for all TOP was 84.6 % (95 % CI: 82.3-90.6 %) at 15 years. Factors significantly associated with poor long-term results were the age at diagnosis and Greene index.CONCLUSION:TOP in LCPD provides satisfactory and reproducible long-term clinical results.
Published: 2016

27. Ultrasonographic Identification of the Anterolateral Ligament of the Knee

Author: Marie Faruch, Nicolas Reina, Karine Wytrykowski, Philippe Chiron, Etienne Cavaignac, Jérôme Murgier, Régis Pailhé, Anthropologie Moléculaire et Imagerie de Synthèse (AMIS), Université Toulouse III - Paul Sabatier (UT3), Université Fédérale Toulouse Midi-Pyrénées-Université Fédérale Toulouse Midi-Pyrénées-Centre National de la Recherche Scientifique (CNRS), Hôpital Pierre-Paul Riquet [Toulouse], CHU Toulouse [Toulouse], 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), and 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])
Subjects: Male, Anterolateral ligament, musculoskeletal diseases, Knee Joint, [SDV]Life Sciences [q-bio], Tendons, 03 medical and health sciences, 0302 clinical medicine, Cadaver, Humans, Medicine, Orthopedics and Sports Medicine, Femur, Tibia, Fibula, Muscle, Skeletal, Aged, Ultrasonography, Aged, 80 and over, 030222 orthopedics, business.industry, 030229 sport sciences, Anatomy, musculoskeletal system, medicine.anatomical_structure, Ligaments, Articular, Female, Anatomic Landmarks, Epicondyle, Cadaveric spasm, business
Abstract: International audience; PURPOSE:To determine ultrasonography's sensitivity for identifying the anterolateral ligament (ALL).METHODS:A descriptive study of 18 cadaveric knees was performed. Ultrasonography was used to locate any anterolateral structures at the knee that could correspond to the ALL. The structure's length and relation with other notable anatomic landmarks (fibular head, Gerdy tubercle, joint line, lateral femoral epicondyle, popliteus tendon insertion) were quantified. The ultrasonography measurements were validated by dissecting each knee. The sensitivity of ultrasonography for detecting the ALL and the agreement between the ultrasonographic and cadaveric measurements (Cohen κ) were determined by statistical analysis.RESULTS:The ALL was found in all 18 cadaveric knees and corresponded anatomically to the ultrasonographic descriptions. Ultrasonography had 100% sensitivity for detecting the presence of the ALL. The ALL's insertion on the lateral femoral condyle was, on average, 12.08 mm (SD, 4 mm; range, 7 to 15 mm) proximal and posterior to the lateral femoral epicondyle and 20.5 mm (SD, 3 mm; range, 16 to 24 mm) proximal to the middle of the popliteus tendon insertion. The ALL inserted onto the tibia, midway between the Gerdy tubercle and the fibular head; the distance between the midpoint of the tibial insertion and middle of the Gerdy tubercle was 19.05 mm (SD, 2.1 mm; range, 15 to 25 mm), and the distance was 19.13 mm (SD, 2.3 mm; range, 14 to 23 mm) to the tip of the fibular head. The agreement between the ultrasonographic and cadaveric findings was excellent (Cohen κ coefficient between 0.88 and 0.94).CONCLUSIONS:Ultrasound imaging is a suitable tool for identifying the ALL of the knee, and it allowed for a detailed analysis of the entire ALL in all 18 knees. However, its ability to evaluate any injuries to the ALL must still be shown.CLINICAL RELEVANCE:Ultrasonography can be used to confirm the integrity of the ALL.
Published: 2016

28. Non-operative treatment of four-part fractures of the proximal end of the humerus: results of a prospective and retrospective multicentric study

Author: Romain Bouchet, Damien Block, Thomas D’ollonne, Dominique Saragaglia, François Sirveaux, F. Gadea, Julia Gaillot, Clinique universitaire de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, avenue de Kimberley, 38130 Échirolles, France, parent, Centre Chirurgical Emile Gallé [Nancy], Hôpital Pasteur [Nice] (CHU), Département d'Orthopédie [Hôpital Trousseau, CHRU Tours], Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Hôpital Trousseau, Centre Hospitalier Régional Universitaire de Tours (CHRU Tours), 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]), Hôpital Trousseau, and Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Centre Hospitalier Régional Universitaire de Tours (CHRU Tours)-Centre Hospitalier Régional Universitaire de Tours (CHRU TOURS)
Subjects: medicine.medical_specialty, [SDV]Life Sciences [q-bio], 03 medical and health sciences, 0302 clinical medicine, Patient age, medicine, Humans, Orthopedics and Sports Medicine, Humerus, Quick dash, Prospective Studies, Prospective cohort study, Retrospective Studies, 030222 orthopedics, business.industry, Non operative treatment, Proximal, Retrospective cohort study, 030229 sport sciences, Four-part fracture, Surgery, Fracture, medicine.anatomical_structure, Orthopedic surgery, Shoulder Fractures, Constant score, business, Non-operative treatment
Abstract: International audience; PURPOSE:The aim of this study was to evaluate the short- and medium-term results of non-operative treatment of four-part fractures of the proximal end of the humerus. The initial hypothesis was that non-operative treatment of fractures with little or no displacement is equivalent or superior to surgical treatment, and that non-operative treatment is probably insufficient for displaced fractures.METHODS:This was a multicentric, prospective and retrospective study, based on 384 four-part proximal humerus fractures, 58 of which involved non-operative treatments - 37 in the prospective study (Pro-CT4) and 21 in the retrospective study (Retro-CT4). The average patient age was 64 +/- 14 years (39-90); 66 % were female and 34 % male. In 88 % of these cases, non-operative treatment was chosen for the fracture, as there was little or no displacement. In 10 % of cases, non-operative treatment was chosen "by default", due to the patient's medical conditions, as surgery was contraindicated, and in 2 % of cases due to the patient refusing surgery. All patients were reviewed clinically and radiologically, with SSV evaluation, absolute and weighted Constant scores and the Quick DASH score all assessed. The main evaluation criterion was the weighted Constant score which was considered a failure when below 70 %.RESULTS:In the Pro-CT4 study, the average follow-up period was 11 +/- four months (5-18) with functional scores as follows: average SSV: 72 +/- 26 % (8-100); average Constant score: 65 +/- 21 points (21-95); average weighted Constant score: 86 +/- 26 % (32-130); average Quick DASH: 23 +/- 21 (0-64). 27 % of patients had a weighted Constant score below 70 %. In the Retro-CT4 study, the average follow-up period was 38 +/- 13 months (18-62) with functional scores as follows: average SSV: 73 +/- 17 % (30-100); average Constant score: 68 +/- 18 points (33-95); average weighted Constant score: 88 +/- 27 % (47-133); average Quick DASH: 18 +/- 16 (0-48); 24 % of patients had a weighted Constant score below 70 %.CONCLUSION:This study confirms our initial hypothesis. When non-operative treatment of four-part proximal humerus fractures is carried out by choice, the results are excellent. However, when this treatment is carried out "by default" - especially because surgery is contraindicated - the results are disappointing.LEVEL OF EVIDENCE IV:prospective and retrospective studies
Published: 2015

29. Computer-assisted total knee replacement after medial opening wedge high tibial osteotomy: medium-term results in a series of ninety cases

Author: René Christopher Rouchy, Brice Rubens-Duval, Dominique Saragaglia, Ramsay Refaie, Julie Massfelder, Régis Pailhé, Roch Mader, 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]), and Wansbeck General Hospital
Subjects: musculoskeletal diseases, Male, medicine.medical_specialty, Knee Joint, Revision, medicine.medical_treatment, [SDV]Life Sciences [q-bio], Total knee replacement, Osteotomy, 03 medical and health sciences, 0302 clinical medicine, Postoperative Complications, High tibial osteotomy, Medicine, Humans, Orthopedics and Sports Medicine, Tibia, Arthroplasty, Replacement, Knee, Aged, Orthodontics, Aged, 80 and over, 030222 orthopedics, Series (stratigraphy), biology, business.industry, 030229 sport sciences, Middle Aged, Osteoarthritis, Knee, musculoskeletal system, biology.organism_classification, Navigation, Valgus, Opening wedge high tibial osteotomy, Treatment Outcome, Surgery, Computer-Assisted, Orthopedic surgery, Surgery, Female, business, Follow-Up Studies
Abstract: International audience; PURPOSE:The aim of this study was to evaluate the medium-term results of total knee replacements (TKRs) after medial opening wedge valgising tibial osteotomy to those of primary TKR (TKR1). The hypothesis being that there would be no difference in results between these groups.METHODS:Series 1 was made up of 45 TKRs after medial opening wedge high tibial osteotomy (MHTO)-30 men and ten women at an average age of 69 ± seven years (54-82). This was compared to a second series of TKR1s-30 men and ten women at an average age of 69 ± seven years (55-78). The average IKS scores were 91 ± 22.5 points (42-129) and 86 ± 18 points (38-116) in the two groups respectively. The average pre-operative HKA angle was 179 ± 5° (169-193°) in group 1, and 173 ± 7.5° (161-193°) in group 2. Tibial mechanical axes were 90.5 ± 4° (of which 24 knees had a valgus angle) and 85.05 ± 3.5° (79-93°) in the two groups respectively.RESULTS:All patients were reviewed at an average follow-up of 47 ± 24.5 months for series 1 and 185 ± 8.5 months for series 2. The average IKS score was 184 ± 6 for series 1 (172-200) and 185 ± 8.5 (163-200) for series 2 (p = 0.872). Thirty-seven patients in series 1 and 38 patients in series 2 were either extremely satisfied or satisfied with the intervention. The average post-operative HKA angle was 180.5 ± 2.5° and 181 ± 2° (p = 0.122) and the average tibial mechanical axis was 89 ± 1.5° against 90 ± 1° (p = 0.001). The results of the 24 knees with a valgus tibial mechanical axis were statistically no different.CONCLUSIONS:TKRs post medial opening wedge high tibial osteotomy have identical results to primary TKRs even in knees with a valgus tibial mechanical axis.
Published: 2015

30. Tocilizumab induces corticosteroid sparing in rheumatoid arthritis patients in clinical practice

Author: Jean Francis Maillefert, Marie Godfrin-Valnet, Elodie Constant, Christian Jorgensen, Clémentine Fortunet, Yves-Marie Pers, Hervé Devilliers, Philippe Gaudin, Joseph Lambert, Daniel Wendling, Béatrice Pallot Prades, Service de Rhumatologie (CHU de Dijon), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand ( CHU Dijon ), Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093] ( CAPS ), Université de Bourgogne ( UB ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Unité clinique d'Immuno-Rhumatologie & Thérapeutique des maladies ostéo-articulaires, Centre Hospitalier Régional Universitaire [Montpellier] ( CHRU Montpellier ) -Hôpital Lapeyronie, Clinique Universitaire de Rhumatologie, hôpital Sud, CHU de Grenoble, Service de Rhumatologie, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Hôpital Jean Minjoz, Service de Rhumatologie [Saint-Etienne], CHU Saint-Etienne-Hôpital de Bellevue, Service de Médecine Interne (SOC 1 et SOC 2) [CHU de Dijon], Abbott BMS Chugai Pfizer Roche Roche Chugai GSK AbbVie MSD UCB Amgen Nordic Pharma Swedish Orphan Biovitrum (SOBI), Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), Cognition, Action, et Plasticité Sensorimotrice [Dijon - U1093] (CAPS), Université de Bourgogne (UB)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Lapeyronie, and Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)
Subjects: Male, rheumatoid arthritis, Gastroenterology, corticosteroids, Arthritis, Rheumatoid, chemistry.chemical_compound, Prednisone, Adrenal Cortex Hormones, Pharmacology (medical), risk, systemic glucocorticoid therapy, treatment, factor-alpha inhibitors, Middle Aged, 3. Good health, Clinical Practice, Treatment Outcome, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Rheumatoid arthritis, Antirheumatic Agents, Corticosteroid, Drug Therapy, Combination, Female, Analysis of variance, management, medicine.drug, Adult, medicine.medical_specialty, medicine.drug_class, Antibodies, Monoclonal, Humanized, diseases, [ SDV.MHEP.RSOA ] Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, tocilizumab, Tocilizumab, Rheumatology, [SDV.SP.MED]Life Sciences [q-bio]/Pharmaceutical sciences/Medication, Internal medicine, medicine, Humans, In patient, biologics, Glucocorticoids, Aged, Retrospective Studies, business.industry, [ SDV.SP.MED ] Life Sciences [q-bio]/Pharmaceutical sciences/Medication, Repeated measures design, eular recommendations, medicine.disease, Endocrinology, chemistry, business
Abstract: International audience; Objective. The aim of this study was to evaluate the impact of introducing tocilizumab (TCZ) as co-therapy with CS in patients with RA.Methods. This study was an open, observational, retrospective multicentre study. RA patients treated with oral CS for >3 months who started treatment with TCZ between December 2009 and June 2011 in five centres were included. Variables included demographic data, disease history, co-treatments, disease activity and dose of CS at inclusion and at weeks 4, 8, 12 and 24. The evolution of disease activity and of the dose of CS (analysis of variance with repeated measures) were analysed, searching for factors correlated with changes in the dose of CS.Results. Inclusion of 130 patients [women 80.8%, mean age 56.7 years (S.D. 14.0), RA duration 16.3 years (S.D. 10.4), mean baseline 28-joint DAS (DAS28) 5.1 (S.D. 1.4), mean baseline dose of CS 10.0 mg/day (S.D. 8.2) prednisone equivalent. Decreases in the mean daily dose of CS and in the DAS28 were observed during follow-up [respectively 6.5mg (S.D. 4.8) at week 24 (P < 0.0001) and 3.0mg (S.D. 1.4) at week 24 (P < 0.0001)]. The only variable that correlated with the decrease in the dose of CS was the initial dose of the drug (r = 0.82, P < 0.001).Conclusion. The introduction of TCZ led to rapid and long-lasting CS sparing that did not correlate with the reduction in disease activity. It is possible that in patients treated with high-dose CS, the main objective of the clinician is to reduce dosage of CS rather than RA activity.
Published: 2015

31. Online training on skin cancer diagnosis in rheumatologists: results from a nationwide randomized web-based survey

Author: Viguier, Manuelle, Rist, Stéphanie, Aubin, François, Leccia, Marie-Thérèse, Richard, Marie-Aleth, Esposito-Farèse, Marina, Gaudin, Philippe, Pham, Thao, Richette, Pascal, Wendling, Daniel, Sibilia, Jean, Tubach, Florence, Dufrene, Charles, Darras, Yannick, Sauvage, Eric, Carret, Sophie, Amoura, Zahir, Benveniste, Olivier, Boyer, Olivier, Durez, Patrick, Fautrel, Bruno, Guerne, Pierre-André, Hachulla, Eric, Jullien, Denis, Mouthon, Luc, Puechal, Xavier, Sellam, Jérémie, Hôpital Saint-Louis, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris Diderot - Paris 7 (UPD7), Service de Rhumatologie, Centre Hospitalier Régional d'Orléans (CHRO), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (EA 3181) (CEF2P / CARCINO), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon)-Université de Franche-Comté (UFC), Université Bourgogne Franche-Comté [COMUE] (UBFC)-Université Bourgogne Franche-Comté [COMUE] (UBFC), Clinique de Dermatologie Allergologie et Photobiologie, Centre Hospitalier Universitaire [Grenoble] (CHU), Centre de Recherches en Oncologie biologique et Oncopharmacologie (CRO2), Aix Marseille Université (AMU)- Hôpital de la Timone [CHU - APHM] (TIMONE)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de Dermatologie, Assistance Publique - Hôpitaux de Marseille (APHM)- Hôpital de la Timone [CHU - APHM] (TIMONE), Centre de Pharmacoépidémiologie de l'AP-HP (Cephepi), CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Clinique Universitaire de Rhumatologie, hôpital Sud, CHU de Grenoble, Assistance Publique - Hôpitaux de Marseille (APHM)-CHU Marseille, Université Paris Diderot - Paris 7 (UPD7)-Hôpital Lariboisière-APHP, Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Immuno-Rhumatologie Moléculaire, Université de Strasbourg (UNISTRA)-Institut National de la Santé et de la Recherche Médicale (INSERM), Club Rhumatismes et Inflammation, HAL AMU, Administrateur, Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC (UR 3181) (CEF2P / CARCINO), Assistance publique - Hôpitaux de Paris (AP-HP)-Université Paris Diderot - Paris 7 ( UPD7 ), Centre Hospitalier Régional d'Orléans ( CHR ), Carcinogénèse épithéliale : facteurs prédictifs et pronostiques - UFC ( CEF2P / CARCINO ), Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ) -Université Bourgogne Franche-Comté ( UBFC ) -Université de Franche-Comté ( UFC ), Centre Hospitalier Universitaire [Grenoble] ( CHU ), Centre de Recherches en Oncologie biologique et Oncopharmacologie ( CRO2 ), Aix Marseille Université ( AMU ) - Hôpital de la Timone [CHU - APHM] ( TIMONE ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ), Assistance Publique - Hôpitaux de Marseille ( APHM ) - Hôpital de la Timone [CHU - APHM] ( TIMONE ), Centre de Pharmaco-épidémiologie (Céphépi), Université Paris Diderot - Paris 7 ( UPD7 ) -AP-HP - Hôpital Bichat - Claude Bernard [Paris], Assistance Publique - Hôpitaux de Marseille ( APHM ) -CHU Marseille, Université Paris Diderot - Paris 7 ( UPD7 ) -Hôpital Lariboisière-APHP, Centre Hospitalier Régional Universitaire [Besançon] ( CHRU Besançon ), Immunorhumathologie moléculaire, Institut National de la Santé et de la Recherche Médicale ( INSERM ), and Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)
Subjects: Adult, Male, medicine.medical_specialty, Randomization, Skin Neoplasms, Population, lcsh:Medicine, [SDV.CAN]Life Sciences [q-bio]/Cancer, THERAPY, [ SDV.CAN ] Life Sciences [q-bio]/Cancer, [SDV.CAN] Life Sciences [q-bio]/Cancer, Rheumatology, Internal medicine, Physicians, Surveys and Questionnaires, medicine, NECROSIS-FACTOR INHIBITORS, Humans, Medical diagnosis, education, lcsh:Science, METAANALYSIS, RISK, education.field_of_study, Internet, Multidisciplinary, integumentary system, business.industry, Incidence (epidemiology), lcsh:R, Middle Aged, medicine.disease, Confidence interval, 3. Good health, Surgery, RHEUMATOID-ARTHRITIS, Rheumatoid arthritis, lcsh:Q, Education, Medical, Continuing, Female, Skin cancer, business, Research Article
Abstract: International audience; Patients with inflammatory rheumatisms, such as rheumatoid arthritis, are more prone to develop skin cancers than the general population, with an additional increased incidence when receiving TNF blockers. There is therefore a need that physicians treating patients affected with inflammatory rheumatisms with TNF blockers recognize malignant skin lesions, requiring an urgent referral to the dermatologist and a potential withdrawal or modification of the immunomodulatory treatment. We aimed to demonstrate that an online training dedicated to skin tumors increase the abilities of rheumatologists to discriminate skin cancers from benign skin tumors. A nationwide randomized web-based survey involving 141 French rheumatologists was conducted. The baseline evaluation included short cases with skin lesion pictures and multiple choice questions assessing basic knowledge on skin cancers. For each case, rheumatologists had to indicate the nature of skin lesion (benign; premalignant/ malignant), their level of confidence in this diagnosis (10-points Likert scale), and the precise dermatological diagnosis among 5 propositions. Different scores were established. After randomization, only one group had access to the online formation consisting in 4 elearning modules on skin tumors, of 15 minutes each (online training group). After reevaluation, the trained and the non-trained group (control group) were compared. The primary end-point was the number of adequate diagnoses of the nature of the skin lesions. The mean number of adequate diagnosis for the benign versus premalignant/malignant nature of the lesions was higher in the online training group (13.4 vs. 11.2 points; p value
Published: 2015

32. Gardnerella vaginalis as a Rare Cause of Prosthetic Joint Infection

Author: Max Maurin, Jacques Croize, Patricia Pavese, Sylvain Bernard, Dominique Saragaglia, Gautier Hoarau, Université Grenoble Alpes - UFR Médecine (UGA UFRM), Université Grenoble Alpes [2016-2019] (UGA [2016-2019]), Institut de minéralogie, de physique des matériaux et de cosmochimie (IMPMC), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de recherche pour le développement [IRD] : UR206-Muséum national d'Histoire naturelle (MNHN)-Centre National de la Recherche Scientifique (CNRS), Service des Maladies Infectieuses, CHU Grenoble, Service de chirurgie orthopédique et de traumatologie du sport, hôpital Sud, CHU de Grenoble, Laboratoire Adaptation et pathogénie des micro-organismes [Grenoble] (LAPM), Centre National de la Recherche Scientifique (CNRS)-Université Joseph Fourier - Grenoble 1 (UJF), Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Muséum national d'Histoire naturelle (MNHN)-Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut de recherche pour le développement [IRD] : UR206-Centre National de la Recherche Scientifique (CNRS), and Université Joseph Fourier - Grenoble 1 (UJF)-Centre National de la Recherche Scientifique (CNRS)
Subjects: MESH: Sequence Analysis, DNA, Arthroplasty, Replacement, Hip, medicine.medical_treatment, Arthritis, Case Reports, medicine.disease_cause, Prosthesis, MESH: Trimethoprim-Sulfamethoxazole Combination, 0302 clinical medicine, MESH: Gardnerella vaginalis, MESH: Arthroplasty, Replacement, Hip, Gardnerella vaginalis, 030212 general & internal medicine, Prosthesis-Related Infection, MESH: Aged, 0303 health sciences, [SDV.BID.EVO]Life Sciences [q-bio]/Biodiversity/Populations and Evolution [q-bio.PE], Bacterial Infections, Anti-Bacterial Agents, 3. Good health, Female, Rifampin, medicine.drug, Microbiology (medical), medicine.medical_specialty, Prosthesis-Related Infections, MESH: Bacterial Infections, Molecular Sequence Data, MESH: Arthritis, Biology, 03 medical and health sciences, MESH: Anti-Bacterial Agents, Trimethoprim, Sulfamethoxazole Drug Combination, medicine, Humans, Aged, MESH: Humans, MESH: Molecular Sequence Data, 030306 microbiology, MESH: Prosthesis-Related Infections, Prosthetic joint infection, Sequence Analysis, DNA, bacterial infections and mycoses, medicine.disease, MESH: Rifampin, Trimethoprim, Arthroplasty, Surgery, Arthritis therapy, MESH: Female
Abstract: We describe a septic loosening of a hip prosthesis in a 71-year-old woman caused by Gardnerella vaginalis . Infection was confirmed by culture and molecular identification of this bacterium. The patient was treated by a one-step exchange of prosthesis and antibiotic therapy combining trimethoprim-sulfamethoxazole and rifampin, with favorable evolution.
Published: 2012

33. A Thermolabile Aldolase A Mutant Causes Fever-Induced Recurrent Rhabdomyolysis without Hemolytic Anemia

Author: Valérie Serre, Monique Piraud, Norma B. Romero, Florence Habarou, Asmaa Mamoune, Jean-Laurent Casanova, Michele Pelosi, Pascale de Lonlay, Mai Thao Viou, Patrick Nusbaum, Luc Nonnenmacher, Marie-Ange Nguyen Morel, Yamina Hamel, Chris Ottolenghi, Bertrand Boisson, Michel Bahuau, Sabrina Vergnaud, Joseph Vamecq, Imagine - Institut des maladies génétiques (IMAGINE - U1163), Université Paris Descartes - Paris 5 (UPD5)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de génétique [CHU Mondor], CHU Henri Mondor [Créteil], Institut Jacques Monod (IJM (UMR_7592)), Université Paris Diderot - Paris 7 (UPD7)-Centre National de la Recherche Scientifique (CNRS), Service de biochimie métabolique [CHU Necker], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Hôpital Couple-Enfant, Rockefeller University [New York], Dpt biochimie, toxicologie, pharmacologie [CHU Grenoble], CHU Grenoble, Institut de Myologie, Université Pierre et Marie Curie - Paris 6 (UPMC)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Association française contre les myopathies (AFM-Téléthon)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Laboratoire des Maladies Héréditaires du Métabolisme, Groupement Hospitalier Lyon-Est (GHE), Hospices Civils de Lyon (HCL)-Hospices Civils de Lyon (HCL), Hôpital Cochin [AP-HP], Laboratoire d'Hormonologie, Métabolisme-Nutrition & Oncologie (HMNO), Département de Biochimie et Biologie Moléculaire-Centre de Biologie et Pathologie (CBP) Pierre-Marie Degand-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Howard Hughes Medical Institute (HHMI), CHU Henri Mondor, Centre National de la Recherche Scientifique (CNRS)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Association française contre les myopathies (AFM-Téléthon)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Commissariat à l'énergie atomique et aux énergies alternatives (CEA)-Université Pierre et Marie Curie - Paris 6 (UPMC), Hospices Civils de Lyon (HCL)-CHU de Lyon-GH Est, Imagine - Institut des maladies génétiques (IHU), Université Paris Descartes - Paris 5 (UPD5) - Institut National de la Santé et de la Recherche Médicale (INSERM) - AP-HP Hôpital Necker - Enfants Malades [Paris], U781, Université Paris Descartes - Hôpital Necker-Enfants Malades, Institut National de la Santé et de la Recherche Médicale - Centre de Référence des Maladies Héréditaires du Métabolisme, Hôpital Henri Mondor, Assistance publique - Hôpitaux de Paris (AP-HP) - Hôpital Henri Mondor - Université Paris-Est Créteil Val-de-Marne - Paris 12 (UPEC UP12), Département de Génétique, Hôpital Henri-Mondor, Institut Jacques Monod (IJM), Centre National de la Recherche Scientifique (CNRS) - Université Paris Diderot - Paris 7 (UP7), Clinique Universitaire de Pédiatrie, hôpital Sud, CHU de Grenoble - Hôpital Couple Enfant de Grenoble, St. Giles Laboratory of Human Genetics of Infectious Diseases, The Rockefeller University, Département de Biochimie, Toxicologie et Pharmacologie, Centre de Référence Rhône-Alpes des Maladies NeuroMusculaires - CHU de Grenoble, AFM - Commissariat à l'énergie atomique et aux énergies alternatives (CEA) - Centre National de la Recherche Scientifique (CNRS) - Université Pierre et Marie Curie - Paris 6 (UPMC) - Assistance publique - Hôpitaux de Paris (AP-HP) - Institut National de la Santé et de la Recherche Médicale (INSERM), Hospices Civils de Lyon - CHU de Lyon-GH Est - Centre de Biologie et de Pathologie Est - CBPE, Banque de Cellules, AP-HP, Hôpital Cochin, Laboratoire de Biochimie et Biologie Moléculaire (LILLE - Biochimie et Biol Moléculaire), Institut National de la Santé et de la Recherche Médicale (INSERM) - Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Sciences pour l'environnement (SPE), Université Pascal Paoli - Centre National de la Recherche Scientifique (CNRS), Howard Hughes Medical Institute, University of Oxford [Oxford], Association Française contre les Myopathies (grant no. 15947), Agence Nationale de la Recherche (ANR-13-BSV1-0020-01), Fondation Lejeune, Fondation Bettencourt, Association Connaître les Syndromes Cérébelleux, Association Noa-Luu, Association Nos Anges, Association Hyperinsulinisme, HAL UPMC, Gestionnaire, Imagine - Institut des maladies génétiques ( IMAGINE - U1163 ), Centre National de la Recherche Scientifique ( CNRS ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Université Paris Descartes - Paris 5 ( UPD5 ), Institut Jacques Monod ( IJM ), Université Paris Diderot - Paris 7 ( UPD7 ) -Centre National de la Recherche Scientifique ( CNRS ), Assistance publique - Hôpitaux de Paris (AP-HP)-CHU Necker - Enfants Malades [AP-HP], Rockefeller University, Rockefeller University, New York, Université Pierre et Marie Curie - Paris 6 ( UPMC ) -Commissariat à l'énergie atomique et aux énergies alternatives ( CEA ) -Assistance publique - Hôpitaux de Paris (AP-HP)-Association française contre les myopathies ( AFM-Téléthon ) -Institut National de la Santé et de la Recherche Médicale ( INSERM ) -Centre National de la Recherche Scientifique ( CNRS ), Hospices Civils de Lyon ( HCL ) -CHU de Lyon-GH Est, CHU Cochin [AP-HP], Laboratoire d'Hormonologie, Métabolisme-Nutrition & Oncologie ( HMNO ), Département de Biochimie et Biologie Moléculaire-Centre de Biologie et Pathologie (CBP) Pierre-Marie Degand-Centre Hospitalier Régional Universitaire [Lille] ( CHRU Lille ), and Howard Hugues Medical Institute
Subjects: Hemolytic anemia, Male, Cancer Research, Erythrocytes, Protein Conformation, Fructose-bisphosphate aldolase, [SDV.GEN] Life Sciences [q-bio]/Genetics, Dexamethasone, Rhabdomyolysis, Myoblasts, 0302 clinical medicine, Fructose-Bisphosphate Aldolase, Genetics (clinical), 0303 health sciences, Glycogen Storage Disease, 3. Good health, Pedigree, Aldolase A deficiency, Female, medicine.symptom, Glycolysis, Research Article, medicine.medical_specialty, Anemia, Hemolytic, Fever, lcsh:QH426-470, Anemia, Biology, Arginine, 03 medical and health sciences, Internal medicine, medicine, Genetics, Humans, Myopathy, Muscle, Skeletal, Molecular Biology, Ecology, Evolution, Behavior and Systematics, 030304 developmental biology, [SDV.GEN]Life Sciences [q-bio]/Genetics, Aldolase A, Myoglobinuria, Biology and Life Sciences, Cell Biology, medicine.disease, lcsh:Genetics, Endocrinology, biology.protein, [ SDV.GEN ] Life Sciences [q-bio]/Genetics, 030217 neurology & neurosurgery
Abstract: International audience; Aldolase A deficiency has been reported as a rare cause of hemolytic anemia occasionally associated with myopathy. We identified a deleterious homozygous mutation in the ALDOA gene in 3 siblings with episodic rhabdomyolysis without hemolytic anemia. Myoglobinuria was always triggered by febrile illnesses. We show that the underlying mechanism involves an exacerbation of aldolase A deficiency at high temperatures that affected myoblasts but not erythrocytes. The aldolase A deficiency was rescued by arginine supplementation in vitro but not by glycerol, betaine or benzylhydantoin, three other known chaperones, suggesting that arginine-mediated rescue operated by a mechanism other than protein chaperoning. Lipid droplets accumulated in patient myoblasts relative to control and this was increased by cytokines, and reduced by dexamethasone. Our results expand the clinical spectrum of aldolase A deficiency to isolated temperature-dependent rhabdomyolysis, and suggest that thermolability may be tissue specific. We also propose a treatment for this severe disease.
Published: 2014

34. Predictors of response and remission in a large cohort of rheumatoid arthritis patients treated with tocilizumab in clinical practice

Author: Marie Godfrin-Valnet, Daniel Wendling, Hubert Marotte, Elodie Constant, Christian Jorgensen, Yves-Marie Pers, Gregoire Mercier, Clémentine Fortunet, Joseph Lambert, Jean-Francis Maillefert, Audrey De Jong, Béatrice Pallot Prades, Philippe Gaudin, Cellules souches mésenchymateuses, environnement articulaire et immunothérapies de la polyarthrite rhumatoide, Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR3, Université Montpellier 1 (UM1)-Université Montpellier 1 (UM1), Hôpital Lapeyronie [Montpellier] (CHU), CHU Dijon, Centre Hospitalier Universitaire de Dijon - Hôpital François Mitterrand (CHU Dijon), CHU Saint-Etienne, Centre Hospitalier Universitaire [Grenoble] (CHU), Centre Hospitalier Régional Universitaire de Besançon (CHRU Besançon), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Centre Hospitalier Universitaire de Saint-Etienne (CHU de Saint-Etienne), Service de Rhumatologie, Clinique Universitaire de Rhumatologie, hôpital Sud, CHU de Grenoble, Cellules Souches, Plasticité Cellulaire, Médecine Régénératrice et Immunothérapies (IRMB), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Université Montpellier 1 (UM1)-IFR3, Université Montpellier 1 (UM1)-Institut National de la Santé et de la Recherche Médicale (INSERM), Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), and Hennaut, Odile
Subjects: Male, rheumatoid arthritis, [SDV]Life Sciences [q-bio], Disease, Severity of Illness Index, Arthritis, Rheumatoid, chemistry.chemical_compound, 0302 clinical medicine, cardiovascular disease, Pharmacology (medical), skin and connective tissue diseases, 0303 health sciences, biology, Remission Induction, Middle Aged, Prognosis, 3. Good health, Clinical Practice, [SDV] Life Sciences [q-bio], Treatment Outcome, Rheumatoid arthritis, Female, musculoskeletal diseases, medicine.medical_specialty, Combination therapy, young age, Antibodies, Monoclonal, Humanized, C-reactive protein, 03 medical and health sciences, tocilizumab, Tocilizumab, Rheumatology, Internal medicine, medicine, Humans, 030304 developmental biology, Retrospective Studies, 030203 arthritis & rheumatology, business.industry, Tumor Necrosis Factor-alpha, Odds ratio, medicine.disease, predictors of response, chemistry, ROC Curve, biology.protein, Physical therapy, MESH: Antibodies, Monoclonal, Humanized / therapeutic use* Arthritis, Rheumatoid / diagnosis , Arthritis, Rheumatoid / drug therapy* , Arthritis, Rheumatoid / metabolism , Female , Follow-Up Studies , Humans , Male , Middle Aged , Prognosis , ROC Curve , Remission Induction , Retrospective Studies , Severity of Illness Index , Treatment Outcome , Tumor Necrosis Factor-alpha / antagonists & inhibitors ,Tumor Necrosis Factor-alpha / metabolism, business, Rheumatism, Follow-Up Studies
Abstract: Supplementary data are available at Rheumatology Online.; International audience; Objective: The objective of this study was to identify predictors of response and remission to tocilizumab (TCZ) in RA patients seen in daily routine clinical practice.Methods: The efficacy of TCZ was evaluated after 12 and 24 weeks of treatment by the European League Against Rheumatism (EULAR) response criteria. Regression analysis was performed to study the association between remission or EULAR response and the following characteristics: gender, age, current smokers, prior cardiovascular disease (CVD), 28-joint disease activity score (DAS28), CRP, RF or ACPA positivity, combination therapy with DMARDs and TCZ as the first biological therapy or after failure of at least one biological therapy.Results: In total, 204 patients were included with a mean DAS28 score of 5.14. EULAR response and remission were obtained in 86.1% and 40% of patients, respectively, at week 24. In multiple regression analysis, a high baseline CRP level [odds ratio (OR) 4.454 (95% CI 1.446, 13.726)] was significantly associated with EULAR response at week 24 and, inversely, age >55 years [OR 0.285 (95% CI 0.086, 0.950)] and prior CVD [OR 0.305 (95% CI 0.113, 0.825)] were significantly associated with lower EULAR response at week 24. Older age was also associated with less remission at week 24 [OR 0.948 (95% CI 0.920, 0.978)]. No additional effectiveness was found when TCZ was used in combination with a DMARD or when patients were naive to biological agents.Conclusion: In daily practice we identified three predictors of a better response for TCZ therapy in RA: a younger age, a high baseline CRP level and no history of CVD.
Published: 2014

35. Factors Influencing Concordance Between Clinical and Ultrasound Findings in Rheumatoid Arthritis

Author: Maria Antonietta D'Agostino, Sandrine Jousse-Joulin, Alain Saraux, Thierry Marhadour, Gérard Chalès, Jean-François Ferlet, Jérémie Sellam, Maxime Dougados, Philippe Gaudin, Isabelle Chary-Valckenaere, Fabien Etchepare, Cécile Hacquard-Bouder, Jacques Bentin, Damien Loeuille, Jean-David Albert, Christophe Hudry, Laurent Grange, Marion Le Boedec, CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Statistique, RCTS, Lyon, RCTS Lyon, CHU Pontchaillou [Rennes], Clinique Universitaire de Rhumatologie, hôpital Sud, CHU de Grenoble, Assistance publique-Hôpitaux de Paris - Espace éthique (AP-HP Espace éthique), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Centre de Recherche Saint-Antoine (UMRS893), Université Pierre et Marie Curie - Paris 6 (UPMC)-Institut National de la Santé et de la Recherche Médicale (INSERM), Service de rhumatologie [Rennes] = Rheumatology [Rennes], Service de Rhumatologie, CHU Brugmann, CHU Brugmann, Belgium, Service de Rhumatologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Service de rhumatologie [CHU Pitié Salpêtrière] (GRC-08 EEMOIS), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), AP-HP - Hôpital Cochin Broca Hôtel Dieu [Paris], and CHU Pitié-Salpêtrière [AP-HP]
Subjects: Adult, Male, musculoskeletal diseases, medicine.medical_specialty, Pathology, Settore MED/16 - REUMATOLOGIA, Shoulders, Concordance, Immunology, Metatarsophalangeal joints, Arthritis, Rheumatoid, 03 medical and health sciences, 0302 clinical medicine, Cohen's kappa, Rheumatology, Rheumatoid, Synovitis, Internal medicine, medicine, Immunology and Allergy, Humans, 030212 general & internal medicine, Prospective Studies, Rheumatoid arthritis, [SDV.BBM.BC]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Biochemistry [q-bio.BM], Physical Examination, Aged, Ultrasonography, 030203 arthritis & rheumatology, business.industry, Tumor Necrosis Factor-alpha, Arthritis, [SDV.BBM.BM]Life Sciences [q-bio]/Biochemistry, Molecular Biology/Molecular biology, Middle Aged, medicine.disease, medicine.anatomical_structure, Antirheumatic Agents, Cohort, Female, Joints, business, Kappa
Abstract: Objective.Clinical joint examination (CJE) is less time-consuming than ultrasound (US) in rheumatoid arthritis (RA). Low concordance between CJE and US would indicate that the 2 tests provide different types of information. Knowledge of factors associated with CJE/US concordance would help to select patients and joints for US. Our objective was to identify factors associated with CJE/US concordance.Methods.Seventy-six patients with RA requiring tumor necrosis factor-α (TNF-α) antagonist therapy were included in a prospective, multicenter cohort. In each patient, 38 joints were evaluated. Synovitis was scored using CJE, B-mode US (B-US), and power Doppler US (PDUS). Joints whose kappa coefficient (κ) for agreement CJE/US was < 0.1 were considered discordant. Multivariate analysis was performed to identify factors independently associated with CJE/US concordance, defined as factors yielding p < 0.05 and OR > 2.Results.Concordance before TNF-α antagonist therapy varied across joints for CJE/US (κ = −0.08 to 0.51) and B-US/PDUS (κ = 0.30 to 0.67). CJE/US concordance was low at the metatarsophalangeal joints and shoulders (κ < 0.1). Before TNF-α antagonist therapy, a low 28-joint Disease Activity Score (DAS28) was associated with good CJE/B-US concordance, and no factors were associated with CJE/PDUS concordance. After TNF-α antagonist therapy, only the joint site was associated with CJE/B-US concordance; joint site and short disease duration were associated with CJE/PDUS concordance.Conclusion.Concordance between CJE and US is poor overall. US adds information to CJE, most notably at the metatarsophalangeal joints and shoulders. Usefulness is decreased for B-US when DAS28 is low and for PDUS when disease duration is short.
Published: 2013

36. Predictive value of tender joints compared to synovitis for structural damage in rheumatoid arthritis

Author: M.A. D'Agostino, Xavier Mariette, Valérie Devauchelle-Pensec, Alain Saraux, Maxime Dougados, Peter P. Cheung, Philippe Gaudin, Gérard Chalès, K. Mari, Sandrine Jousse-Joulin, Division fo Rheumatology, National University Hospital Singapore, CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Immunologie et Pathologie (EA2216), Université de Brest (UBO)-IFR148, Service de Rhumatologie, Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Ambroise Paré [AP-HP], Service de rhumatologie [Rennes] = Rheumatology [Rennes], CHU Pontchaillou [Rennes], Clinique Universitaire de Rhumatologie, hôpital Sud, CHU de Grenoble, Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), CHRU Brest - Service de Rhumatologie ( CHU - BREST - Rhumato ), Centre Hospitalier Régional Universitaire de Brest ( CHRU Brest ), Immunologie et Pathologie ( EA2216 ), Université de Brest ( UBO ) -IFR148, Assistance publique - Hôpitaux de Paris (AP-HP)-Hôpital Ambroise Paré, Service de rhumatologie, Hôpital Sud, and CHU Cochin [AP-HP]
Subjects: musculoskeletal diseases, medicine.medical_specialty, Settore MED/16 - REUMATOLOGIA, Radiography, Immunology, Rheumatoid Arthritis, 03 medical and health sciences, 0302 clinical medicine, Rheumatology, Synovitis, Post-hoc analysis, medicine, [ SDV.IMM ] Life Sciences [q-bio]/Immunology, Immunology and Allergy, 030212 general & internal medicine, Disease Activity, Trial registration, ComputingMilieux_MISCELLANEOUS, Ultrasonography, 030203 arthritis & rheumatology, business.industry, Ultrasound, medicine.disease, Predictive value, 3. Good health, Surgery, Tenderness, Outcomes research, Rheumatoid arthritis, [SDV.IMM]Life Sciences [q-bio]/Immunology, Radiology, medicine.symptom, business
Abstract: Objective To evaluate the predictive value of tender joints compared to synovitis for structural damage in rheumatoid arthritis (RA). Methods A post hoc analysis was performed on a prospective 2-year study of 59 patients with active RA starting on antitumour necrosis factor (TNF). Tenderness and synovitis was assessed clinically at baseline, followed by blinded ultrasound assessment (B-mode and power Doppler ultrasound (PDUS)) on the hands and feet (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal and 10 metatarsophalangeal (MTP) joints). Radiographs of these joints were performed at baseline and at 2 years. The risk of radiographic progression with respect to the presence of baseline tenderness or synovitis, as well as its persistence (after 4 months of anti-TNF), was estimated by OR (95% CI). Results Baseline tender joints were the least predictive for radiographic progression (OR=1.53 (95% CI 1.02 to 2.29) p
Published: 2016

37. Lésions traumatiques du nerf fibulaire commun dans les lésions bicroisées ou luxations du genou

Author: Philippe Neyret, Paul Bonnevialle, Bertrand Galaud, Olivier Barbier, Sébastien Lustig, Frédéric Dubrana, Dominique Saragaglia, Philippe Rosset, Unité de traumatologie-orthopédie de Purpan, institut de l’appareil locomoteur, Service de chirurgie orthopédique, traumatologique et réparatrice [Brest], Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Service d’orthopédie-traumatologie [CHU Caen], Université de Caen Normandie (UNICAEN), Normandie Université (NU)-Normandie Université (NU)-CHU Caen, Normandie Université (NU)-Tumorothèque de Caen Basse-Normandie (TCBN)-Tumorothèque de Caen Basse-Normandie (TCBN), 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), CHU Trousseau [APHP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Service de chirurgie orthopédique et de traumatologie du sport, and hôpital Sud, CHU de Grenoble
Subjects: 030222 orthopedics, medicine.medical_specialty, business.industry, Common peroneal nerve palsy, Follow up studies, 030208 emergency & critical care medicine, Surgery, 03 medical and health sciences, BIOMECANIQUE, 0302 clinical medicine, Multicenter study, medicine, Orthopedics and Sports Medicine, [SDV.IB]Life Sciences [q-bio]/Bioengineering, business, Anterior Cruciate Ligament Injuries, Ligament rupture
Abstract: Resume Introduction La frequence des paralysies du nerf fibulaire commun (NFC) contemporaines d’une luxation ou d’une rupture bicroisee varie entre 10 et 40 %. Le but principal de cette etude etait de preciser les lesions anatomiques rencontrees, leur pronostic et de proposer une attitude therapeutique a partir d’une serie prospective observationnelle multicentrique de traumatismes ligamentaires du genou. Materiel et methode Parmi les 67 genoux pris en charge pour une luxation ou une lesion bicroisee, 12 etaient associees a une paralysie du NFC survenant chez deux femmes et dix hommes de 32 ans de moyenne d’âge. Quatre traumatismes sportifs, trois accidents de la voie publique et cinq mecanismes divers etaient responsables de sept luxations completes et cinq entorses bicroisees. Quatre etaient associees a une ischemie par rupture arterielle poplitee et une luxation etait ouverte. La paralysie etait complete huit fois et partielle quatre fois ; deux ruptures completes, trois contusions avec elongation tronculaire et trois troncs nerveux d’aspect macroscopique normal ont ete decouverts. Resultats Au recul minimum d’un an, quel que soit le geste realise sur le nerf, la recuperation a ete complete dans six cas, partielle au plan moteur une fois et nulle dans cinq cas. En l’absence de geste specifique sur le nerf, la paralysie a evolue vers une recuperation partielle dans un cas, totale dans deux cas et nulle dans un cas. Apres cinq simples explorations en urgence ou secondaires, quatre nerfs ont totalement recupere et un nerf est reste paralyse. Les trois greffes n’ont abouti a aucune recuperation. Discussion Cette serie est en conformite avec les donnees de la litterature. La frequence des paralysies varie en fonction des circonstances lesionnelles et du recrutement de l’equipe chirurgicale. Il existe un parallelisme entre l’atteinte neurologique et les lesions ligamentaires. L’etat anatomique du NFC soumis a une violente traction lors de la luxation est le facteur pronostique le plus important de recuperation neurologique. Une rupture tronculaire ou une elongation avec contusion sur plusieurs centimetres d’un aussi mauvais pronostic sont constatees dans environ un quart des cas. La liberation du NFC est recommandee si la recuperation clinique et electromyographique precoce ne progresse pas et/ou lors de toute reparation ligamentaire du plan lateral. L’integration d’une eventuelle participation neurologique dans le resultat fonctionnel global du traitement des entorses graves et des luxations du genou est necessaire. Type d’etude Prospective. Niveau IV.
Published: 2010

38. The relevance of knee arthroscopy photographs in medicolegal proceedings.

Author: Horteur C, Della Rosa T, Gaulin B, Morin V, Duval BR, Barth J, and Pailhe R
Subjects: Humans, Arthroscopy adverse effects, Reproducibility of Results, Knee Joint surgery, Menisci, Tibial surgery, Retrospective Studies, Anterior Cruciate Ligament Injuries diagnosis, Anterior Cruciate Ligament Injuries surgery, Anterior Cruciate Ligament Injuries complications, Tibial Meniscus Injuries diagnostic imaging, Tibial Meniscus Injuries surgery
Abstract: Purpose: Whether photographs included in the operative report of knee arthroscopies can make the surgeon liable in the event of a legal investigation remains unknown. The main objective of this study was to establish inter-observer reliability in determining the presence or absence of lesions of the cartilage, meniscus and anterior cruciate ligament (ACL). Secondary objective was to assess the inter-observer reliability in classifying lesions., Method: A retrospective observational study was conducted in a continuous serie of 60 patients who underwent knee arthroscopy from the same operator. The photographs of each patient's operative report were presented separately to three experts, blinded to each other. Each expert had to decide on the presence or absence of injuries to the following structures: meniscal, cartilage and ACL and then, classify it. Primary and secondary endpoints were evaluated using the Fleiss' kappa index., Results: Inter-observer reliability for lesion detection was between 0.4 and 0.61 for all structures with three exceptions: for cartilage, it was low (0.15) at the lateral tibial plateau and poor (-0.01) at the external condyle. On the contrary, the concordance was almost perfect (0.8) for the ACL. For classifying cartilaginous and meniscal lesions, inter-observer reliability was poor (from 0.03 to 0.14), except for at the lateral meniscus (0.65)., Conclusion: Inter-observer reliability of arthroscopic knee diagnoses is poor when photographs alone are used. In the event of a legal investigation following knee arthroscopy, the photographs included in the operative report should not be used alone to hold the surgeon liable., (© 2024. The Author(s) under exclusive licence to SICOT aisbl.)
Published: 2024
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39. Should trochanteric fractures in elderly patients be treated by arthroplasty or internal fixation?

Author: Steffann F, Rubens-Duval B, and Huten D
Subjects: Aged, Aged, 80 and over, Humans, Arthroplasty, Bone Nails adverse effects, Fracture Fixation, Internal adverse effects, Prospective Studies, Fracture Fixation, Intramedullary methods, Hip Fractures surgery, Osteoporosis
Abstract: Most trochanteric fractures are treated by fixation, most often intramedullary. Nevertheless, the desire to have patients walk as soon as possible and the fear of fixation failure has driven some surgeons to carry out an arthroplasty instead, especially for unstable fractures and/or in patients with severe osteoporosis, in order to avoid the difficult conversion to arthroplasty later on if the fixation fails. The aim of this review was to specify the role, technique and results of performing arthroplasty in this context. In which fractures? Unstable fractures (A2.2, A2.3 and A3), especially in osteoporotic bone, which are the most difficult to reduce and fix, and in cases with associated osteoarthritis. For which patients? Arthroplasty should not be done in patients who have ASA≤3 due to greater blood loss and longer operative time. Since the postoperative Parker score often drops, arthroplasty should not be done in patients having a Parker score<6. What are the technical problems? Arthroplasty must be done by an experienced surgeon because of the lack of anatomical landmarks, although fracture fixation has its own demands (satisfactory reduction, appropriate length and position of cervicocephalic screw). What are the results and complications? Despite several comparative studies (randomized trials, meta-analysis and prospective studies), it is difficult to draw any conclusions. These studies show worse performance of dynamic hip screws relative to intramedullary nails. The complication and revision rates were higher for nails than arthroplasty, but not in every study, while the functional outcomes with nails (with or without immediate weightbearing) were better than those of arthroplasty beyond 6 months. What is the mortality rate? It was lower after nailing in a few studies but was mainly determined by the patient's comorbidities and preoperative Parker score. The best indication for arthroplasty may be self-sufficient patients over 70 years of age who have an unstable fracture with severe osteoporosis. Nevertheless, new studies should be done to compare arthroplasty to nailing with immediate return to weightbearing in patients having the same type of fracture, defined using 3D CT scan. Level of evidence: Expert advice., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)
Published: 2024
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40. A predictive score of high tibial osteotomy survivorship to help in surgical decision-making: the SKOOP score.

Author: Batailler C, Gicquel T, Bouguennec N, Steltzlen C, Tardy N, Cartier JL, Mertl P, Pailhé R, Rochcongar G, and Fayard JM
Subjects: Humans, Female, Middle Aged, Aged, Retrospective Studies, Survivorship, Knee Joint surgery, Osteotomy methods, Treatment Outcome, Tibia surgery, Osteoarthritis, Knee surgery
Abstract: 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.)
Published: 2023
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41. Latent disconnectome prediction of long-term cognitive-behavioural symptoms in stroke.

Author: Talozzi L, Forkel SJ, Pacella V, Nozais V, Allart E, Piscicelli C, Pérennou D, Tranel D, Boes A, Corbetta M, Nachev P, and Thiebaut de Schotten M
Subjects: Humans, Cognition, Neuroimaging methods, Behavioral Symptoms, Brain pathology, Quality of Life, Stroke
Abstract: Stroke significantly impacts the quality of life. However, the long-term cognitive evolution in stroke is poorly predictable at the individual level. There is an urgent need to better predict long-term symptoms based on acute clinical neuroimaging data. Previous works have demonstrated a strong relationship between the location of white matter disconnections and clinical symptoms. However, rendering the entire space of possible disconnection-deficit associations optimally surveyable will allow for a systematic association between brain disconnections and cognitive-behavioural measures at the individual level. Here we present the most comprehensive framework, a composite morphospace of white matter disconnections (disconnectome) to predict neuropsychological scores 1 year after stroke. Linking the latent disconnectome morphospace to neuropsychological outcomes yields biological insights that are available as the first comprehensive atlas of disconnectome-deficit relations across 86 scores-a Neuropsychological White Matter Atlas. Our novel predictive framework, the Disconnectome Symptoms Discoverer, achieved better predictivity performances than six other models, including functional disconnection, lesion topology and volume modelling. Out-of-sample prediction derived from this atlas presented a mean absolute error below 20% and allowed personalize neuropsychological predictions. Prediction on an external cohort achieved an R2 = 0.201 for semantic fluency. In addition, training and testing were replicated on two external cohorts achieving an R2 = 0.18 for visuospatial performance. This framework is available as an interactive web application (http://disconnectomestudio.bcblab.com) to provide the foundations for a new and practical approach to modelling cognition in stroke. We hope our atlas and web application will help to reduce the burden of cognitive deficits on patients, their families and wider society while also helping to tailor future personalized treatment programmes and discover new targets for treatments. We expect our framework's range of assessments and predictive power to increase even further through future crowdsourcing., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Guarantors of Brain.)
Published: 2023
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42. Anterior cruciate ligament reconstruction in the over-50s. A prospective comparative study between surgical and functional treatment.

Author: Ehlinger M, Panisset JC, Dejour D, Gonzalez JF, Paihle R, Favreau H, Ollivier M, and Lustig S
Subjects: Aged, Female, Follow-Up Studies, Humans, Knee Joint surgery, Prospective Studies, Treatment Outcome, Anterior Cruciate Ligament Injuries complications, Anterior Cruciate Ligament Reconstruction methods, Hamstring Tendons
Abstract: 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.)
Published: 2021
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43. Functional connectivity within the network of verticality.

Author: Lemaire C, Jaillard A, Gornushkina I, Piscicelli C, Dai S, Pichat C, Detante O, Hommel M, Baciu M, and Pérennou D
Subjects: Brain, Brain Mapping, Humans, Magnetic Resonance Imaging, Space Perception, Visual Perception
Published: 2021
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44. Rotating-hinge prosthesis for aseptic revision knee arthroplasty: A multicentre retrospective study of 127 cases with a mean follow-up of five years.

Author: Houfani F, Mainard D, Rubens-Duval B, Papin PE, Pasquier G, and Ehlinger M
Subjects: Follow-Up Studies, France, Humans, Knee Joint surgery, Prosthesis Design, Prosthesis Failure, Reoperation, Retrospective Studies, Treatment Outcome, Arthroplasty, Replacement, Knee adverse effects, Knee Prosthesis
Abstract: Background: The use of third-generation rotating-hinge knee prostheses has increased considerably in recent years. The more anatomical design of these prostheses, together with their controlled rotation system that reduces constraints generated by the single degree of liberty, have produced better outcomes. The objective of this study was to evaluate the clinical and radiological outcomes of revision knee arthroplasty for aseptic failure using rotating-hinge prostheses., Hypothesis: The rotating-hinge knee prostheses currently used in France provide significant improvements in function and self-sufficiency of patients undergoing revision knee arthroplasty, with outcomes comparable to those reported with constrained condylar knees., Material and Methods: A multicentre retrospective study was conducted in 17 centres, under the auspices of the SoFCOT. The cohort consisted of 127 patients (127 knees) operated on before 2013. The main reasons for knee revision were aseptic loosening, major instability, mechanical failure, and extensor apparatus failure. Function and self-sufficiency were assessed using the International Knee Society (IKS) score and the Devane score, respectively. Survival was defined with all-cause surgical revision as the end point., Results: Mean follow-up was 67.3±11.8 months (range, 13-180 months). Significant improvements (p<0.001) were seen in the total IKS score (+42 points), the IKS function score (+12 points), and the knee IKS score (+30 points). Paradoxically, the Devane score decreased by 0.44 point. The 5-year survival rate was 77% (95% confidence interval, 0.70-0.85). Postoperative complications developed in 29% of patients (infection, n=12; aseptic loosening, n=11; and fracture, n=7)., Discussion: Rotating-hinge prostheses provide satisfactory outcomes of knee arthroplasty revision and remain an effective option for complex cases, confirming our working hypothesis. Self-sufficiency diminishes slightly. The long-term outcomes obtained using rotating-hinge prostheses are, however, less satisfactory than those observed with constrained condylar knees for aseptic TKA revision, and the complication rate is higher, although the population and local circumstances are different. Discernment is therefore in order when determining the indications of rotating-hinge prostheses., Level of Evidence: IV; retrospective cohort study., (Copyright © 2021. Published by Elsevier Masson SAS.)
Published: 2021
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45. Total knee arthroplasty: Latest robotics implantation techniques.

Author: Pailhé R
Subjects: Humans, Knee Joint surgery, Operative Time, Arthroplasty, Replacement, Knee, Knee Prosthesis, Robotic Surgical Procedures, Robotics
Abstract: The recent introduction of new robotic systems for total knee arthroplasty (TKA) has created somewhat of a craze. Nevertheless, we can ask ourselves whether it is justified to use these new but very costly technologies. The results and limitations of these robotic tools must be analyzed systematically before confirming their benefits. Most of the newest robotic systems are interactive ones. These systems can accurately restore the mechanical axis and can improve the ligament balance and implant positioning. Theoretically, this can lead to better survival, function and outcomes. Recent studies have shown that use of robotics for TKA implantation does not increase the surgery time and does not cause more complications. Nevertheless, the long-term advantages of robotics use in this context remains to be proven. This task will be more difficult since there is currently no consensus as to the ideal positioning of TKA implants for a given patient. The aim of this study is to summarize this topic by answering the following questions: What are the different types of robots that can be used for TKA implantation? Which steps of the TKA surgical procedure are done with robotic arm assistance? What are the outcomes of these new implantation techniques? What are the limitations of these new implantation techniques? LEVEL OF EVIDENCE: V; expert opinion., (Copyright © 2020. Published by Elsevier Masson SAS.)
Published: 2021
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46. Assessment of Evertor Strength Following Inferior Extensor Retinaculum Flap Ligamentoplasty in Patients With Chronic Lateral Ankle Instability.

Author: Giunta JC, Toschi B, Moroney P, and Tourné Y
Subjects: Ankle Joint surgery, Humans, Ligaments, Prospective Studies, Ankle, Joint Instability surgery
Abstract: The primary aim of our study was to evaluate the strength of ankle evertor muscles in patients who have undergone a lateral ankle ligamentoplasty (which combined tensioning of the primary ligament group and reinforcing it with a pediculated extensor retinaculum flap), using 2 measurement systems (isokinetic and the functional weightbearing test [MyoLux). Our hypothesis was the strength of evertor muscles on the treated side was comparable to that of the contralateral healthy side. This prospective study included 23 patients who had chronic ankle instability and underwent an inferior extensor retinaculum flap ligamentoplasty. Clinical and functional results were assessed using the American Orthopaedic Foot & Ankle Society and Karlsson scores. The evertor muscle strength was analyzed, in both treated and healthy contralateral ankles, using isokinetic testing (gold standard) - an open kinetic chain test and a functional closed kinetic chain test (MyoLux). Data were interpreted using the Stata 14.0 software. The American Orthopaedic Foot & Ankle Society score was 88.1 ± 4.5, and the Karlsson score was 89.6 ± 4.0. Isokinetic tests did not show any significant difference between the treated ankles and the healthy one. Functional tests measuring inversion control at the ankle did not demonstrate any functional differences between the 2 ankles. As confirmed by good functional scores and the lack of difference in evertor muscle strength, this study reports that the inferior extensor retinaculum flap ligamentoplasty is a satisfactory treatment of chronic ankle instability. In addition, the MyoLux is a reliable and effective test to properly assess proprioception at the ankle., (Copyright © 2020 the American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.)
Published: 2021
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47. Medium-term survival and clinical and radiological results in high tibial osteotomy: Factors for failure and comparison with unicompartmental arthroplasty.

Author: Bouguennec N, Mergenthaler G, Gicquel T, Briand C, Nadau E, Pailhé R, Hanouz JL, Fayard JM, and Rochcongar G
Subjects: Female, Humans, Knee Joint surgery, Male, Middle Aged, Osteotomy, Retrospective Studies, Tibia diagnostic imaging, Tibia surgery, Treatment Outcome, Arthroplasty, Replacement, Knee, Osteoarthritis, Knee diagnostic imaging, Osteoarthritis, Knee surgery
Abstract: Introduction: High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are two surgical solutions for isolated medial tibiofemoral osteoarthritis. Results depend on preoperative criteria and patient selection, but also on postoperative factors: implant positioning, limb alignment. Factors for HTO survival need identifying to reduce risk of failure requiring total knee arthroplasty (TKA)., Hypothesis: Age, gender, weight, osteoarthritis grade, degree of correction, type of osteotomy, technique and intraoperative complications impact HTO survival., Material and Method: As part of a symposium of the French Society of Arthroscopy (SFA), a multicenter retrospective study compared 2 series. The HTO series comprised 488 patients: 153 female (31.4%); mean age, 55.1 years; mean weight, 83.1kg; mean body-mass index (BMI), 28.6. The UKA series comprised 284 patients: 172 female (60.6%); mean age, 64.1 years; mean weight, 75.3kg; mean BMI, 27.6. The main endpoint was comparative survival at 5, 8 and 10 years; secondary endpoints comprised pre- and post-operative hip-knee-ankle (HKA) angle, mechanical femoral angle (mFA) and mechanical tibial angle (mTA), surgical technique, satisfaction, time to and level of return to work, WOMAC and Tegner scores and complications rates. The significance threshold was set at p<0.05; 95% confidence intervals were calculated., Results: Age>54 years, male gender, BMI>25, medial tibiofemoral wear severity Ahlback ≥3, ≥0.9° varus joint component, HKA correction<8°, postoperative HKA<180° and hinge fracture were significantly associated with poorer survival. There was no impact of type of osteotomy, navigation assistance or postoperative HKA 183-186°. Ten-year survival was 74.3% for HTO and 71% for UKA (non-significant); however, survival curves crossed at 6 years., Conclusion: HTO showed survival and functional results comparable to those of UKA in selected patients when target limb alignment correction was achieved. The present study determined selection criteria. A predictive score for results of either procedure would facilitate decision-making., Level of Evidence: IV, retrospective cohort study., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)
Published: 2020
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48. Higher re-rupture rate in quadriceps tendon ACL reconstruction surgeries performed in Denmark: let's return to the mean.

Author: Ollivier M, Jacquet C, Pailhe R, Cognault J, Cavaignac E, and Seil R
Subjects: Autografts, Denmark, Humans, Ligaments, Registries, Tendons surgery, Anterior Cruciate Ligament Reconstruction
Published: 2020
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49. Factors affecting outcome of ACL reconstruction in over-50-year-olds.

Author: Fayard JM, Wein F, Ollivier M, Paihle R, Ehlinger M, Lustig S, and Panisset JC
Subjects: Anterior Cruciate Ligament Injuries complications, Anterior Cruciate Ligament Injuries diagnostic imaging, Anterior Cruciate Ligament Injuries physiopathology, Female, Follow-Up Studies, Humans, Joint Instability etiology, Knee Joint diagnostic imaging, Male, Middle Aged, Osteoarthritis, Knee complications, Patient Selection, Radiography, Retrospective Studies, Tibial Meniscus Injuries complications, Treatment Outcome, Anterior Cruciate Ligament Injuries surgery, Anterior Cruciate Ligament Reconstruction, Knee Joint physiopathology, Knee Joint surgery
Abstract: Introduction: With increasing life expectancy and ever-improving quality of life in industrialized countries, functional demand and sports levels are increasing in older subjects, who are thus exposed to central pivot lesions almost as much as younger ones. While non-operative treatment provides acceptable results, it entails significant reduction in sports level. The aim of the present study was to analyze medium-term clinical, functional and radiological results of anterior cruciate ligament (ACL) reconstruction in over-50-year-olds, in order to identify factors for failure., Hypothesis: The study hypothesis was that surgical management provides good results if patient selection is rigorous., Patients and Methods: A multicenter retrospective study included 398 patients undergoing ACL reconstruction between April 1, 2009 and December 6, 2016. Inclusion criteria comprised: age≥50 years, with proven ACL tear. Preoperatively, clinical work-up was supplemented by measurement of differential anterior laxity and radiologic assessment of cartilage status. Functional level was assessed on the objective IKDC score. Intraoperative data comprised type of graft and meniscal and cartilage status. The same parameters were assessed postoperatively. Functional results were assessed on objective IKDS, KOOS and ACL-RSI scores., Results: The mean follow-up was 42.2 months. The mean improvement in differential anterior laxity was 4.2mm. Pivot-shift showed improvement, with 97% absent or glide (p<0.001). Objective IKDC score showed significant improvement (p<0.0001). 23% of patients had poor clinical results: IKDC C or D. Preoperative explosive pivot-shift (p<0.0001), medial tibiofemoral osteoarthritis (p<0.0001) and medial meniscus lesion (p<0.002) emerged as risk factors for poor functional outcome., Conclusion: ACL reconstruction in over-50-year-olds provided satisfactory clinical and functional results. Rigorous patient selection is mandatory, as radiologic signs of medial tibiofemoral osteoarthritis indicate a risk of poor outcome. Surgery may be proposed in patients with high functional and athletic demand, before medial meniscal lesions can set in. In case of explosive pivot shift, associated anterolateral reconstruction should be considered., (Copyright © 2019. Published by Elsevier Masson SAS.)
Published: 2019
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50. Influence of operative technique on anterior cruciate ligament reconstruction in patients older than 50 years.

Author: Ode Q, Gonzalez JF, Paihle R, Dejour D, Ollivier M, Panisset JC, and Lustig S
Subjects: Aged, Anterior Cruciate Ligament Injuries complications, Female, Femur surgery, Follow-Up Studies, Humans, Joint Instability etiology, Knee Joint physiopathology, Knee Joint surgery, Lysholm Knee Score, Male, Middle Aged, Prospective Studies, Retrospective Studies, Anterior Cruciate Ligament Injuries physiopathology, Anterior Cruciate Ligament Injuries surgery, Anterior Cruciate Ligament Reconstruction methods, Hamstring Tendons transplantation, Patellar Ligament transplantation
Abstract: Background: A consequence of the steady growth in the worldwide population of elderly individuals who remain in good health and continue to engage in sports is an increase in the incidence of anterior cruciate ligament (ACL) rupture occurring after 50 years of age. ACL reconstruction was formerly reserved for young athletes but now seems to produce good outcomes in over 50s. The type of graft and graft fixation method were selected empirically until now, given the absence of investigations into potential relationships of these two parameters with the outcomes. The objective of this study was to assess associations linking the type of graft and the method of femoral graft fixation to outcomes in patients older than 50 years at ACL reconstruction., Hypothesis: The operative technique is not associated with the clinical outcomes or differential laxity., Material and Methods: A multicentre retrospective cohort of 398 patients operated between 1 January 2011 and 31 December 2015 and a multicentre prospective cohort of 228 patients operated between 1 January 2016 and 30 June 2017 were conducted. Mean follow-up was 42.7 months in the retrospective cohort and 14.2 months in the prospective cohort. The primary evaluation criterion was the clinical outcome as assessed using the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the Tegner Activity Score (TAS). Differential laxity was the secondary evaluation criterion. The Wilcoxon rank sum test and Kruskal-Wallis test were used to compare groups, and p-values<0.05 were considered significant., Results: In the retrospective and prospective cohorts, hamstring tendons were used in 269 (67.6%) and 197 (86.4%) patients and extensor apparatus tendons in 124 (31.2%) and 31 (13.6%) patients. Femoral fixation in the retrospective cohort was cortical in 81 (20.4%) cases, by press-fit in 112 (28.1%) cases, and by interference screw in 205 (51.5%) cases; corresponding figures in the prospective cohort were 135 (59.2%), 17 (7.5%), and 76 (33.3%). The multivariate analysis of the retrospective data identified no significant associations of graft type or femoral fixation type with the KOOS, TAS, or differential laxity values. In the prospective cohort, hamstring grafts were associated with 0.6mm of additional laxity (p=0.007); compared to cortical fixation, press-fit fixation of patellar tendon grafts was associated with 0.3mm of additional laxity (p=0.029) and a 0.5-point lower TAS value (p=0.033), with no difference in KOOS values. None of these differences were clinically significant., Discussion: The various ACL reconstruction techniques used in patients older than 50 years produce similar outcomes. The technique can be chosen based on surgeon preference without regard for patient age., Level of Evidence: IV., (Copyright © 2019. Published by Elsevier Masson SAS.)
Published: 2019
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