ABSTRACT
PURPOSE: The aims of this article were to report the objective results of revision ACL reconstruction and to assess the influence of an associated lateral extra-articular tenodesis on knee stability and IKDC score. METHODS: This study focused on revision ACL reconstruction and was conducted over a 10-year period, from 1994 to 2003 with ten French orthopedic centers participating. The minimum follow-up required was 2 years. To be included, patients had to be evaluated at follow-up with the objective International Knee Documenting Committee (IKDC) scoring system. In 2006, 163 patients met the inclusion criteria. RESULTS: The objective IKDC knee score improved significantly after revision ACL reconstruction, with 72% IKDC A + B (26% A). When a lateral tenodesis was performed, 80% had a negative pivot shift, versus 63% without (P = 0.03), but there was no significant difference in the IKDC score. CONCLUSION: This study shows a significant improvement in the IKDC score after revision ACL reconstruction. The association of a lateral extra-articular tenodesis with the intra-articular graft increases knee stability after revision ACL reconstruction; however, this additional procedure does not significantly alter the IKDC score at follow-up. LEVEL OF EVIDENCE: Retrospective case series, Level IV.
Subject(s)
Anterior Cruciate Ligament Reconstruction/methods , Anterior Cruciate Ligament/surgery , Knee Joint/surgery , Tendons/surgery , Tenodesis/methods , Adolescent , Adult , Female , Follow-Up Studies , Humans , Male , Middle Aged , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
PURPOSE: To evaluate and quantify laxity of the inferior glenohumeral ligament (IGHL) in post-traumatic anterior instability of the shoulder with the shoulder hyperabduction radiological test (SHART) and correlate it with arthroscopic findings. METHODS: This prospective study included 21 patients undergoing arthroscopic stabilization for anteroinferior shoulder instability. The SHART test was performed as follows: a bilateral AP radiograph was performed in the supine position, and radiographs were compared. The shoulder was positioned in passive maximum abduction in neutral rotation, and neither general nor regional anesthesia was used. The angle between the axis of the humeral shaft and the line drawn between the lateral border of the scapular tubercle and the inferior edge of the glenoid fossa was measured. During arthroscopy, IGHL distension was classified into 4 stages according to the Detrisac classification. Extensive distension was considered to be the stages 3 and 4. RESULTS: The correlation between the SHART test and Detrisac staging was found to be statistically significant (P = 0.02). In the presence of a difference of more than 15° between the pathological and the contralateral shoulder on radiographs, the SHART test shows 87% of IGHL distension, Detrisac stages 3 and 4. CONCLUSION: We suggest that the SHART test should be added to conventional preoperative imaging tests for anterior instability.
Subject(s)
Arthroscopy/methods , Joint Instability/diagnostic imaging , Joint Instability/physiopathology , Ligaments, Articular/diagnostic imaging , Ligaments, Articular/physiopathology , Range of Motion, Articular/physiology , Shoulder Joint/diagnostic imaging , Shoulder Joint/physiopathology , Adolescent , Adult , Athletic Injuries/diagnostic imaging , Athletic Injuries/physiopathology , Athletic Injuries/surgery , Female , Humans , Joint Instability/surgery , Male , Predictive Value of Tests , Prospective Studies , Radiography , Sensitivity and Specificity , Shoulder Injuries , Shoulder Joint/surgery , Statistics, Nonparametric , Supine PositionABSTRACT
OBJECTIVES: Tibial plateau fractures are efficiently treated using arthroscopy when limited to one condyle. Operative technique and early results are now well documented. However, long term results have not been widely reported. The goal of this study was to evaluate clinical and radiological outcomes of arthroscopically treated tibial plateau fractures in the long term. METHODS: Fourteen out of thirty consecutive cases have been reviewed after more than 4 years post-op (4 to 8 years). The SF8 quality of life score and both IKS and Rasmussen knee function scores have been quoted. Radiological analysis looked at Resnick and Niwoyama osteoarthritis score. RESULTS: Functional knee scores at follow-up were 28.0 (Rasmussen) and 187.4 (IKS) in average. The average SF8 score was 4.64. The SF8 score did not correlated with Rasmussen and IKS scores, but with age. Radiological signs of osteoarthritis were noted in 50.0% of cases, with no relationships with the clinical status. CONCLUSIONS: Comparisons with historical long-term studies regarding open reduction and internal fixation show similar outcomes. No specific secondary degenerative problem would alleviate the advantages of the arthroscopic management of tibial plateau fractures in the early post-operative period.
