Abstract Tibiotalar arthrodesis (TTA) is the gold-standard treatment for advanced ankle osteoarthritis. We describe an original fibular shortening osteotomy (FSO) performed during TTA, to allow ...complete talar ascension and reduce the nonunion rate. Forty-two FSOs were associated to TTA (19 fixed by cross-screwing and 23 by anatomic plates) and assessed clinically and radiographically. At 24.7 months’ follow-up, fusion rates were 97.6% for TTA and 100% for FSO, with mean fusion time of 5.2 months. One infection and 1 nonunion (4.7%) required further surgery, with complete resolution. Radiological and clinical outcome in TTA, lack of specific complications of FSO and ease of implementation encourage us to publish the technique.
Purpose
A medializing calcaneal osteotomy (MCO) is a surgical procedure frequently performed to correct an adult acquired flatfoot (AAFD) deformity. However, most studies are limited to a 2D analysis ...of 3D deformity. Therefore, the aim is to perform a 3D assessment of the hind- and midfoot alignment using a weightbearing CT (WBCT) preoperatively as well as postoperatively.
Methods
Eighteen patients with a mean age of 49.4 years (range 18–67) were prospectively included in a pre–post-study design. A MCO was performed and a WBCT was obtained pre- and postoperative. Images were converted into 3D models to compute linear and angular measurements, respectively, in millimeters (mm) and degrees (°), based on previously reported landmarks of the hind- and midfoot alignment. A regression analysis was performed between the displacement of a MCO and the obtained postoperative correction.
Results
The mean 3D hindfoot angle improved significantly preoperative compared to postoperative (
p
< 0.001). This appeared according to a linear relation with the amount of medial translation in a MCO (
R
2
= 0.84,
p
< 0.001). The axes of the tibia showed significant coronal as well as axial changes (
p
< 0.05). Analysis of the midfoot showed significant changes in the navicular height and rotation as well as the Méary angle (
p
< 0.05). Additionally, a linear trend between the midfoot measurements and amount of medial translation in a MCO was observed, but not significant (
p
> 0.05).
Conclusion
This study demonstrates an effective 3D correction of an AAFD by a MCO according to a linear relationship. The concomitant formula can be used to perform a preoperative planning. The novelty is the comparative 3D weightbearing CT assessment of both the computed hind- and midfoot alignment after a medializing calcaneus osteotomy. This could improve accuracy of the currently performed preoperative planning in clinical practice.
Summary Introduction The best treatment for anterior cruciate ligament (ACL) mucoid degeneration remains open to debate. Current options are total or partial ACL resection, or a more conservative ...strategy, reduction plasty. The goal of this study was to retrospectively evaluate the effects of reduction plasty for ACL hypertrophy due to mucoid degeneration from clinical outcome and knee laxity points of view. Materials and methods Arthroscopy was carried out on 23 knees (21 patients) to perform a circular volume reduction plasty of the ACL, while preserving the greatest number of ligament fibers. Notchplasty was not performed. All the patients were seen again with an average follow-up of 32 months (range 8–70). Results All the knees except three had symmetric postoperative flexion. Three patients still had pain. No patient reported having subjective feelings of instability. Among the 20 knees tested with the GNRBTM knee laxity measurement device, one knee had a 2.4 mm difference in laxity and three had between 3 and 4 mm of difference; 16 knees had no residual laxity. Discussion Treatment of ACL mucoid degeneration by reduction plasty leads to complete pain relief in 80% of cases while maintaining good postoperative knee stability. Level of evidence Level IV. Retrospective study.
EPIDemio study is a multicenter, prospective and observational study. The objective is to estimate the prevalence and incidence of fibrosing interstitial lung diseases (ILDs) in the department of ...Haute Garonne (31) in France. Fifty-five pulmonologists from the Toulouse university hospital and 8 private establishments participated in this study. Two hundred and fifty-six cases of fibrosing ILDs were reported (gross overall prevalence: 22.8/100,000 and estimated 30.1/100,000. Idiopathic ILDs represent 55.8% of fibrosing ILDs ahead of systemic disease-related ILDs (24.6%) and ILDs associated with environmental exposure (13.3%). Idiopathic pulmonary fibrosis (IPF) represents 35.9% of fibrosing ILDs, which corresponds to a minimal prevalence of 8.2/100,000 and an estimated prevalence of 11.2/100,000. This study confirms epidemiological data collected in France and Europe.
Summary Introduction Mucoid degeneration of the anterior cruciate ligament (ACL) is a little-known entity. The clinical presentation is one of posterior pain with limited flexion. Its interstitial ...nature within the ACL structure contrasts with synovial cyst of the ACL. Arthroscopic treatment may include ACL resection, which raises the questions about the harmlessness of this procedure and the risk of anterior instability. Hypothesis Arthroscopic resection of ACL mucoid degeneration is effective for treating pain and flexion limitation, but at the expense of anterior laxity. Patients and methods This bicentric, retrospective cohort study with an average follow-up of 6 years involved 27 patients (29 knees) presenting with symptomatic ACL mucoid degeneration validated by magnetic resonance imaging (MRI). Noninfiltrating synovial cysts of the ACL were excluded. Average patient age was 49 (22 to 68) years. Preoperative assessment included a questionnaire, clinical examination (Lachman and pivot shift tests), MRI and standard radiography. Arthroscopic examination analyzed the ACL aspect and its associated lesions (meniscus, cartilage). Anatomopathology samples were collected in 18 cases. Postoperative follow-up included standard radiography and dynamic examination, measuring laxity with a Telos™ device. Results Pain was posterior in 23 knees (80%). Fourteen knees (48%) had limited flexion, on average 97°. Twelve partial and 17 total resections were performed. Twenty knees (69%) had associated cartilaginous lesions and 19 (66%) had meniscal lesions. Meniscectomy was undertaken in 11 cases (41%). Posterior pain disappeared in 27 cases (93%), on average 3.7 weeks after the procedure. Average improvement in flexion was 21.5° (0 to 60°). Twenty-eight knees (97%) showed soft and/or delayed stops on postoperative Lachman testing. Average postoperative differential laxity on the Telos™ device was 8.3 mm (5 to 13 mm). Average postoperative International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were 71.2 (42.5 to 92.0) and 78.2 (26.4 to 99). Two patients uderwent secondary ligamentoplasty. Discussion Treatment of ACL mucoid degeneration by arthroscopic resection is effective for posterior pain and flexion limitation. It results in postoperative laxity, but rarely in frank instability. Therefore, indications for ACL resection must be carefully selected. Young and active patients should be warned about the risk of requiring secondary ligamentoplasty. Level of evidence IV (retrospective cohort study).
Summary Introduction Resection margins constitute a recognized risk factor for local recurrence, but their impact on survival is less clear. Hypothesis Infiltrative proliferation and satellite ...nodules are prognostic factors for local and systemic aggressiveness. Type of study Retrospective cohort study. Patients and methods In 105 patients under curative treatment, resection quality was assessed on UICC criteria (R0/R1) and on a modified version (R0 M/R1 M) taking account of proliferation contours and satellite nodules for narrow margins (< 1 mm). Uni- and multi-variate analysis was performed, and Kaplan-Meier survival curves were compared on log-rank. Results Mean 5-year local recurrence-free survival (LRFS) was 0.64 0.52–0.76 after R1 surgery, 0.9 0.85–0.95 after R0, 0.64 0.519–0.751 after R1 M and 0.92 0.87–0.96 after R0 M. Resection type according to R classification correlated with disease-free survival (DFS) ( P = 0.028), but not with metastasis-free survival (MFS) ( P = 0.156). Resection type according to RM classification correlated with DFS and MFS. Multivariate analysis disclosed correlations between LRFS rate and RM resection type (HR 6.77 1.78–25.7, P = 0.005), DFS rate and RM resection type (HR 2.83 1.47–5.43, P = 0.001) and grade (HR = 3.17 1.38–7.27, P = 0.003), and MFS and grade (HR = 3.96 1.50–10.5, P = 0.006). Discussion The microscopic aspect of the proliferation contours and presence of satellite nodules were confirmed as prognostic factors for local and systemic aggressiveness. They impact both disease-free survival and metastasis-free survival in case of margins less than 1 mm. Their systematic consideration may help identify patients with elevated systemic risk. Level of evidence IV.
Abstract Background The Plantaris Longus Tendon (PLT) may be implicated in Achilles (AT) tendinopathy. Different mechanical characteristics may be the cause. This study is designed to measure these. ...Methods Six PLT and six AT were harvested from frozen cadavers (aged 65–88). Samples were stretched to failure using a Minimat 2000™ (Rheometric Scientific Inc.). Force and elongation were recorded. Calculated tangent stiffness, failure stress and strain were obtained. Averaged mechanical properties were compared using paired, one-tailed t -tests. Results Mean stiffness was higher ( p < 0.001) in the PLT, measuring 5.71 N/mm (4.68–6.64), compared with 1.73 N/mm (1.40–2.22) in AT. Failure stress was also higher ( p < 0.01) in PLT: 1.42 N/mm2 (0.86–2.23) AT: 0.20 N/mm2 (0.16–0.25). Failure strain was less ( p < 0.05) in PLT: 14.1% (11.5–16.8) than AT: 21.8% (14.9–37.9). Conclusions The PLT is stiffer, stronger than AT, demonstrating potential for relative movement under load. The stiffer PLT could tether AT and initiate an inflammatory response.
Summary In Tape Locking Screw (TLS® ) ligamentoplasty, transplant bone fixation uses polyethylene terephthalate (PET). We report two cases of aseptic arthritis following anterior cruciate ligament ...(ACL) reconstruction using this material. Diagnosis was founded on negative sampling and complete cure following arthroscopic lavage and synovectomy without curative antibiotherapy. This complication was also described with other synthetic materials used in this indication (Dacron, PFTE, carbon), and with PET as transplant material but never as bone fixation material. The physiopathological hypothesis is in terms of PET particle release in the suprapatellar bursa; sinking the strips into the bone as fully as possible on implantation could avoid impingement. Longer TLS® ligamentoplasty series with adequate follow-up will be needed in order to estimate the true incidence of this complication.
PDF
