SICOT-J - Société Internationale de Chirurgie Orthopédique et de Traumatologie
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Does meniscal repair impact muscle strength following ACL reconstruction?
No full textPurpose: Meniscal lesions are commonly associated with anterior cruciate ligament (ACL) rupture. Meniscal repair, when possible, is widely accepted as the standard of care. Despite advancements in surgical and rehabilitation techniques, meniscal repair may impact muscle recovery when performed in conjunction with ACL reconstruction. The objective of this study was to explore if meniscal repairs in the context of ACL reconstruction affected muscle recovery compared to isolated ACL reconstruction. Methods: Fifty-nine patients with isolated ACL reconstruction were compared to 35 patients with ACL reconstruction with an associated meniscal repair. All ACL reconstructions were performed using hamstring grafts with screw-interference graft fixation. Isokinetic muscle testing was performed between six and eight months of follow-up. Muscle recovery between both groups was compared. A further subgroup analysis was performed to compare muscle recovery function of gender and meniscal tear location. Tegner scores were assessed at six months’ follow-up. Results: No significant differences were found between the two groups regarding muscle recovery. No difference in muscle recovery was found concerning gender. Lesion of both menisci significantly increased the deficit of hamstrings muscular strength at 60°/s compared to a lesion of one meniscus (26.7% ± 15.2 vs. 18.1% ± 13.5, p = 0.018) and in eccentric test (32.4% ± 26.2 vs. 18.1% ± 13.5, p = 0.040). No significant differences were found concerning the Tegner score. Conclusion: Meniscal repairs performed during an ACL reconstruction do not impact muscle recovery at 6–8 months post-operatively compared to an isolated ACL reconstruction. However, reparations of both menisci appear to impact hamstring muscle recovery negatively.
Level of evidence: III, Retrospective cohort stud
Surgical treatment of developmental dysplasia of the hip in children – A monocentric study about 414 hips
No full textIntroduction: No consensus exists about the open reduction of developmental dysplasia of the hip (DDH; age of surgery and the need for additional bone surgery). We report clinical and radiological outcomes of a large monocentric study. The objectives are to analyze outcomes and to give recommendations. Materials and methods: This was a retrospective review of 414 hips (301 patients) operated on for DDH between 2010 and 2018. The mean age at the time of surgery was 34.6 months (14–96 months). In all, 72 hips had open reduction (OR) alone, 130 had OR with femoral osteotomy, 37 had OR with pelvic osteotomy, and 175 hips OR was associated with femoral and pelvic osteotomy. The mean follow-up was 6.5 years (3–10 years). Clinical outcomes were evaluated according to Mckay’s classification. The acetabular index was measured, and Severin classification was used for radiological outcomes. Reduction failure and residual dysplasia were noted, and avascular necrosis of femoral head (AVN) was assessed according to Kalamchi and MacEwen classification. Results: At the last follow-up, 331 hips (80.2%) had good clinical results, and 319 (77%) had satisfactory radiological results. The AI measured on the last follow-up radiograph was ≤25° in 350 hips. AVN was noted in 83 hips (20%). Redislocation was founded in 53 hips (12%). Overall: 293 hips (72%) had stable reduction without AVN with good clinical and radiological outcomes. Discussion: Clinical outcomes are better and the risk of AVN decreases significantly when a femoral osteotomy is performed. There were better radiological results when pelvic osteotomy was performed. The rate of residual dysplasia was higher when pelvic osteotomy was not performed. We recommend a femoral shortening osteotomy for high dislocations (Tönnis 3 or 4) for children over 18 months and a pelvic osteotomy for children over 36 months or over 18 months with an acetabular index > 25°
Ligament reconstruction using a semitendinosus tendon graft for proximal tibiofibular joint disorder: Case report
No full textWe report our case of ligament reconstruction for treatment of proximal tibiofibular joint disorder using a semitendinosus tendon graft. A 21-year-old male college soccer player with no remarkable history of injury had been suffering from pain at the lateral aspect of the left knee when playing soccer. At another hospital, the patient was diagnosed with a lateral meniscus injury and cartilage injury of the external condyle of the tibia and underwent partial resection of the meniscus and bone drilling. However, his symptoms continued, and he was referred to our institution. Instability of the left proximal tibiofibular joint and pain were noted during weight-bearing dorsiflexion of the ankle. We diagnosed the case as a proximal tibiofibular joint disorder and surgically treated it by dissecting the proximal portion of the semitendinosus tendon, creating one transfibular and two transtibial tunnels, and then reconstructing the proximal tibiofibular ligament using the harvested semitendinosus tendon graft. The patient was allowed to run at postoperative 2 months, with no pain occurring while squatting at postoperative 3 months, subsequently resuming soccer at postoperative 8 months. The proximal tibiofibular joint disorder is a relatively rare pathology, and diagnosis and conservative treatment are often difficult. Although various surgical treatments are known, the clinical outcome of our case has been successful after reconstructing the anterior and posterior proximal tibiofibular ligaments using a semitendinosus tendon graft
Autologous osteophyte grafting for ankle arthrodesis
No full textPurpose: Various graft sources had been identified to facilitate gap-filling in ankle arthrodesis procedures with related articular defects. This was a preliminary study with the aim of analyzing the efficacy and feasibility of using autologous osteophyte as a grafting source. Methods: Retrospective evaluation of ten patients having ankle arthrodesis procedure using identical anterior approach and plate fixation technique was conducted. Basic anthropometric measurements and underlying disease were recorded. Functional outcome and fusion rate were assessed at a 12-month post-surgery follow-up visit. Results: The underlying diseases include primary osteoarthritis (OA), post-traumatic OA, rheumatoid arthritis, and Charcot arthropathy. The patient’s age mean was 56.6 years (range 36–71 years), and BMI varied from 17.9 kg/m2 to 29.3 kg/m2. Nearly all patients had improved functional outcomes as described by foot and ankle ability measure (FAAM) score and fusion rate as described by modified radiographic union score for tibia (RUST). One patient had failed surgery due to implant failure with diminished protective foot sensory. Conclusion: Osteophytes from the distal tibia and talar neck were a viable source of bone graft, especially for ankle arthrodesis using anterior approach among various ages and BMI, in which the surgeons would not need additional incision for graft harvesting
Operative stabilisation versus non-operative management of mid-shaft clavicle fractures
No full textIntroduction: Fractures of the mid-shaft clavicle are commonly encountered in clinical practice. These can be managed either by conservative method or operative by internal fixation. This study aims to compare the outcomes of conservative and operative management. Methods: Forty patients with displaced and comminuted mid-shaft clavicle fractures were included in the study, among which twenty-five patients were treated conservatively and 15 patients underwent surgery and were followed up for a period of 1 year. Time taken for union, functional outcome, complications, and patient satisfaction were compared. Results: In the non-operative group, 28% of the fractures took less than twelve weeks to unite, whereas in the operative group 60% of them took less than 12 weeks to unite. At the end of 1 year, there was no statistical difference in mean UCLA (University of California and Los Angeles) score and the mean DASH score of the non-operative group and operative group. There were more complications in the operative group. Re-operative rate in the operative group was 40%. Patient satisfaction was 80% in the non-operative group, whereas 48% of patients were satisfied in the operative group. Conclusion: Displaced and comminuted mid-shaft clavicle fractures treated conservatively have more advantages when compared to surgically treated fractures
Evaluation of patella height in native knees and arthroplasty: an instructional review
No full textTotal knee arthroplasty (TKA) is the gold standard for treating advanced knee osteoarthritis. Among the postoperative complications of TKA are true patella infera (TPI) and pseudo patella infera (PPI), which should be differentiated since TPI exhibits significantly worse clinical outcomes. Multiple radiological patella height indices (PHI) exist; some were modified or originally designed for knees with implanted endoprostheses. However, there is no consensus on measuring and comparing patella height. Due to the lack of established, simple, reliable, and reproducible concepts for assessing patella height for arthroplasty, measuring patella height and the change of patella height by or after TKA have been challenging tasks for clinicians and researchers. This is a review of the current literature on methods for measuring patella height, with special attention to the ability to differentiate between the TPI and PPI after TKA. All literature on the topic was retrieved, and references from relevant articles were investigated until the end of April 2022
Experience of Kapandji technique in treating Colles’ fracture in central region of Vietnam
No full textIntroduction: Extra-articular fractures of the distal radius, known as Colles’ fractures, are very common. The optimal management of Colles’ fracture is still controversial. The Kapandji technique is one option for orthopedic surgeons to maintain reduced fractures, however, the effectiveness of this method is no clear consensus. This study aims to access Colles’ fracture treatment by the Kapandji technique with our experiences. Methods: This prospective study of 33 patients treated with three K-wires intra-focal fractures by the Kapandji procedure for Colles’ fractures at Hue University of Medicine and Pharmacy Hospital in Vietnam between February 2017 and May 2019. The functional outcome of the patients was assessed by the demerit score system of Gartland and Werley, and the quality of reduction was elevated on radiographic as well at 3, 6, 12, and 24 weeks postoperative. Results: 33 patients’ mean age is 54.64 ± 18.00; After 24 weeks of postoperative follow-up, 78.79% presented excellent, 21.21% good, and there are not any fair or poor cases on the functional outcome. All patients achieved complete fracture union at 12 weeks postoperative. The average immediate postoperative radial length was 9.85 mm, the radial inclination was 20.64°, and the volar tilt was 9.2°. Conclusion: The study emphasizes that the Kapandji technique in Colles’ fracture treatment is simple and possible to bring a satisfactory outcome and fast recovery
Clinical results at 10 years of minimum follow-up with the ABG 2 hip arthroplasty, matched with ceramic-on-ceramic bearings
No full textIntroduction: The current study aimed as a primary goal is to assess the results of a ceramic-on-ceramic (CoC) bearing hip system matched with ABG (Anatomic Benoist Girard) 2 components in terms of survivorship. Secondary objectives addressed specifically ceramic-related complications as well as specific patterns at the bone-implant interface. Material and methods: This is a retrospective bicentric continuous series involving 147 patients (95 males vs. 52 females) who underwent ABG 2 arthroplasties with CoC bearings. One hundred and twenty-five hips were closely followed-up at a mean period of 11.3 years. Results and discussion: With a mean follow-up of 11.3 years, nine cases (5.7%) underwent revision surgery, four caused by acetabular aseptic loosening, three by deep infections, one ceramic head fracture, and one femoro-acetabular impingement. The global survivorship was 92.2% at 12.7 years. The Harris Hip Score (HHS) mean scores increased post-operatively from 50.1 up to 96.1 points (p < 0.001). All stems featured patterns of radiological osseous integration onto the hydroxyapatite (HA)-coated zones. No radiological wear or osteolysis of ceramic bearings was demonstrated however, five patients reported hip squeaking using this bearing. This study demonstrated excellent results at mid-term follow-up in patients younger than 70 years of age using cementless ABG 2 components coupled with CoC bearings with no increase in complication rate
Managing periprosthetic fractures – a review of the hub and spoke model
No full textIntroduction: Periprosthetic fractures are associated with significant morbidity and mortality. The “hub and spoke model” consists of a central organisation (the hub) and a series of secondary units (the spokes). This study reviews the presentation, management, and outcomes of periprosthetic fractures at a large general district hospital, the Royal Blackburn Hospital. Methods: A retrospective data analysis for patients presenting with periprosthetic fractures from a single general district hospital between January 2011 and December 2020. Details recorded were patient demographics, primary arthroplasty procedure, fracture management, ASA grade, morbidity and mortality, and Unified Classification System for Periprosthetic Fractures (UCSPF). Results: With 229 periprosthetic fractures, the number tripled in 2020 that admitted in 2011. The mean age was 78.6 years (range 33–100), 151 were females. Seventy-five percent of the fractures were managed locally, while 25% a referral to the higher specialist centre was sort. Of the 57 referrals, 50 were transferred to the hub, 5 were operated on locally, and 2 were managed non-operatively. Higher-level care transfer resulted in a delayed definitive treatment (4.8 versus 12 days, p = 0.001). About 94.4% of patients treated locally had a favourable outcome versus 92% of patients treated at the hub hospital. Cumulative mortality rates for the two sites were comparable. Discussion: Most of the patients presenting to the local spoke hospital with periprosthetic fractures were managed in house. For this practice to be preserved, there is a need for future planning, such as maintaining an appropriate skill mix at spoke units. Discussion between specialists at the hub and spoke hospitals reduced patient transfer by 14%
The role of suprascapular nerve block in hydrodilatation for frozen shoulder
No full textIntroduction: Frozen shoulder is a debilitating problem that requires comprehensive diagnosis and management. Patients usually recover, but the possibility of not reobtaining a full range of motion exists. Thus, early shoulder exercises are necessary to achieve their full range of motion. This study aims to understand the effects of suprascapular nerve block (SSNB) augmentation at the spinoglenoid notch in hydrodilatation to treat frozen shoulder to facilitate early shoulder exercises. Methods: The current study retrospectively observed 31 patients, including 40–60-year-old patients diagnosed and treated with primary frozen shoulder. The participants were divided into groups A (hydrodilatation) and B (hydrodilatation and the augmentation of an SSNB). Shoulder function and pain scores were assessed before, during, and after the intervention (at months 1 and 6). Results: The result of this study shows that suprascapular nerve block plays a role in decreasing pain in intraintervention (0.69 vs. 5.73; p 0.05). Better delta functional scores were noted in the therapy group during month 1 of the follow-up (delta American shoulder and elbow surgeons [ASES]: 19.29 vs. 34.40, p 0.05; delta DASH: 36.63 vs. 38.92, p > 0.05). Discussion: One rationale for using an SSNB augmentation at spinoglenoid notch in hydrodilatation for treating frozen shoulder was to obtain pain relief immediately to facilitate early manual exercise. SSNB has positive effects on short-term evaluation of shoulder pain and function after glenohumeral hydrodilatation, but not in the long term