[Surgery of the lower limbs in Duchenne's muscular dystrophy]. / La chirurgie des membres inférieurs dans la dystrophie musculaire de Duchenne.

Seventy-one children had surgical procedures on hips and/or knees and/or feet contractures before or after the age of loosing gait. Gait has been continued on 1 year and 7 months to 3 years and 8 months according to the evolving type of Duchenne Muscular Dystrophy (DMD). After analysis of results of the surgery upon contractures, surgical procedures have been determined for each joint. Before loosing gait, but when contractures were all present, surgery prolonged on gait without orthosis and relieved of physiotherapy. During the 6 months after loosing gait, surgery allowed to recover same walking ability more often with orthesis. After loosing gait, surgery gave a better comfort of life to the child and his family.

[Chronic anterior laxity of the knee treated by extra-articular ligamentoplasty. 226 cases reviewed after more than 2 years]. / Laxités chroniques antérieures du genou traitées par ligamentoplastie extra-articulaire. 226 cas revus à plus de 2 ans.

Two-hundred and twenty-six patients with chronic anterior laxity of the knee treated by Lemaire extra-articular ligamentoplasty were assessed after a follow-up of 2 to 9 years, with a mean of 4.5 years. Fifty-five knees had only an anterior laxity and 166 anterior laxity combined with medial laxity, in 100 of which tensioning or reinforcement of the medial ligament was needed. Forty-two per cent of sporting patients were able to return to sport at the same level, though half of them had some discomfort. Fifty-one per cent of patients did not experience any instability in daily and working life but half of them had occasional pain. Sixty-one per cent of knees did not, at review, show a positive MacIntosh pivot shift test and the absence of pivot shift correlated statistically with the quality of the functional result. In seventy-three per cent of knees there was a positive Lachmantest indicating definite laxity at the review. Thirty per cent of knees developed a lateral laxity, which questions the innocuousness of removal of the iliotibial tract. Twenty-seven per cent showed radiological deterioration of the medial joint space. A comparison of these results with the published results of intra-articular ligamentoplasty suggests that extra-articular ligamentoplasty with fascia lata should be limited to the treatment of isolated chronic anterior ligament laxity in middle-aged patients who do not participate in strenuous sporting activities.

[Anterior sacral meningocele. Report on 2 cases treated by the abdominal approach]. / Méningocèle sacrée antérieure. Présentation de 2 cas traités par voie abdominale.

Anterior sacral meningocele is a rare affection (150 cases published) that is frequently misdiagnosed with resulting inappropriate, always dangerous treatment. Diagnosis should however be simple to establish on the finding of a fluid hypogastric mass attached to the sacrum with associated radiologic anomalies of the sacrum. Two cases are reviewed and diagnostic and surgical therapy features discussed.