Arthroscopic treatment of basal joint arthritis by partial trapeziectomy with ligament reconstruction: Short-term results from a prospective study of 20 patients.

Partial trapeziectomy for basal joint arthritis is an alternative to total trapeziectomy that preserves the height of the thumb column. Using arthroscopy reduces the incidence of periarticular lesions and the risks of complications. The purpose of this prospective single-center study was to evaluate the results of arthroscopic partial trapeziectomy combined with suspension and interposition ligament reconstruction using half of the abductor pollicis longus tendon. Twenty patients (18 women, 2 men) with a mean age of 55 years (43-65 years) were operated using this technique between November 2013 to February 2015. Patients were evaluated clinically and radiologically at 1 month, 3 months, 6 months and 12 months after surgery. The 20 patients were reviewed after 12 months. The subjective QuickDASH score improved from the 3rd post-operative month (P = 0.0029) from 50.6 preoperatively to 30.3 after 3 months, 17.6 after 6 months and 9.6 after 12 months. Pain was reduced in the 1st month post-operative (P < 0.0001). The Kapandji Score and pinch strength improved from the 3rd month (P = 0.034). Return to work was possible for 19% of employed patients after 1 month, 44% after 3 months and 87.5% after 6 and 12 months. Eighty-eight percent of the patients were satisfied or very satisfied after 3 months and 95% after 6 and 12 months. Pain levels, range of motion and QuickDASH Score are similar to those of open partial trapeziectomy described in the literature. However, recovery seems to be faster with this arthroscopic technique. Arthroscopic treatment of basal joint arthritis, which limits capsule and ligament lesions, leads to good short- and medium-term results in terms of pain relief and thumb motion while preserving strength. LEVEL OF EVIDENCE: 4 (Prospective, non-randomized).

Analysis of risk factors of the postoperative complications of surgical treatment of ankle fractures in the elderly: A series of 477 patients.

INTRODUCTION: The surgical strategy of ankle fractures in elderly subjects is controversial because of the high rate of local and general complications. The goal of this study was to identify the risk factors of complications of ankle fractures in elderly subjects. MATERIALS AND METHODS: Four hundred and seventy-seven patients operated between 2008 and 2014 were included in this retrospective study. The minimum age was 60 years old for women and 70 for men. Patients presenting with a pilon fracture or with less than 3 months of follow up were excluded. A clinical evaluation of autonomy based on the Parker score and a radiographic assessment were performed preoperatively and during follow up The characteristics of the fracture, comorbidities and the type of internal fixation used were reported. RESULTS: This series included 384 women (81%), mean age 74 years old (60-99). Most fractures were Weber type B (n=336). Four hundred and thirty-one patients (90.4%) received so-called standard internal fixation and 46 patients (9.6%) received so-called atypical fixation. The rate of general complications was 4.6%, and local complications was 23.9%. Univariate analysis of the risk factors of general complications identified 2 significant criteria: age older than 80 (OR=3.46, P=0.012) and more than 2 comorbidities 2 (OR=10.6, P<0.0001). Univariate analysis of risk factors of local complications identified 2 criteria: an open fracture (OR=4.90, P=0.0016) and age over 80 (OR=1.85, P=0.024). Multivariate analysis of risk factors of local complications confirmed the relationship with open fractures (OR=4.67, P<0.001). DISCUSSION: The results of the management of ankle fractures in elderly subjects is satisfactory. The use of standard internal fixation techniques is recommended. The risk of complications increases with age, the severity of the fracture and the number of associated diseases. LEVEL OF EVIDENCE: Level 4.

Ten-year follow-up of acute arthroscopic Bankart repair for initial anterior shoulder dislocation in young patients.

INTRODUCTION: Early treatment of initial anterior glenohumeral dislocation in young patients is controversial and the interest of surgery, and notably arthroscopic stabilization, has not been demonstrated. A prospective study was therefore performed to assess (1) short-to-medium-term recurrence rate, (2) functional outcome, and (3) and medium-term osteoarthritis rate. HYPOTHESIS: Early arthroscopic stabilization by anterior capsule-labrum reinsertion after initial anterior shoulder dislocation is associated with low recurrence rate. MATERIALS AND METHODS: Twenty-one patients with initial anterior dislocation were included between June 2002 and February 2004. All patients underwent arthroscopic Bankart repair within 30 days of dislocation. Patients were followed up prospectively, with clinical (Duplay and Constant scores) and radiological assessment (osteoarthritis). RESULTS: There were 5 recurrent dislocations (25%); 2 patients reported sensations of subluxation: i.e., 7 failures (35%). Mean Walch-Duplay score at 10 years was 88±1 (range, 30-100) and mean Rowe score 86±22 (range, 35-100). There was significant internal rotation deficit of one vertebral level between operated and contralateral shoulder (P < 0.005). At 10 years, 3 shoulders (15%) showed Samilson grade 1 centered glenohumeral osteoarthritis. CONCLUSION: Early arthroscopic capsule-labrum reinsertion by the Bankart technique in the month following initial anterior dislocation of the shoulder in patients under 25 years of age provided a low recurrence rate (35%) compared to the literature, including dislocation (25%) and subluxation (10%). Functional outcome was satisfactory, and osteoarthritis rate was low (15% Samilson grade 1). LEVEL OF EVIDENCE: IV, prospective non-comparative study.

Analysis of short and long-term results of horizontal meniscal tears in young adults.

INTRODUCTION: Symptomatic horizontal meniscal tears are rare but worrisome lesions in young adults. These are overuse injuries not amenable to the classic arthroscopic sutures. An open meniscal repair allows the meniscal lesion to be suture vertically, perpendicular to its in the vascularized zone. The purpose of this study was to evaluate the short and long-term clinical and radiological outcomes of the aforementioned surgical technique. MATERIAL AND METHOD: The first cohort consisted of 24 patients operated between 2009 and 2011 (6 women, 18 men; mean age 26years) having 11 lateral and 13 medial meniscal tears. The second cohort was of 10 patients operated between 2001 and 2002 (3 women, 7 men; mean age 24years) having 8 lateral and 2 medial meniscal tears. Patients were reviewed at the last follow-up using the IKDC, Lysholm and KOOS scores. Patients in the first cohort had an MRI, while those in the second cohort had X-rays. RESULTS: Eighteen patients in the first cohort were reviewed with a mean follow-up of 2 years (12-45 months) and 9 patients from the second cohort were reviewed after 10years (97-142 months). In the first cohort, one patient required secondary menisectomy. The mean Lysholm score was 90 and the subjective IKDC was 85. Every MRI examination found reduced extent and intensity of the hyperintense signal. In the second cohort, no patients required secondary meniscectomy. Two patients had joint space narrowing (less than 50%) on radiographs. The mean Lysholm score was 99 and the subjective IKDC was 91. CONCLUSION: Open repair of horizontal meniscal tears in young adults leads to good subjective and objective results in the short term, which are maintained in the long-term. LEVEL OF EVIDENCE: Level IV - retrospective study.

Meniscal survival rate after anterior cruciate ligament reconstruction.

BACKGROUND: Meniscal suture provides well-documented benefits. Integrity of the cruciate ligaments of the knee is a prerequisite for meniscal healing. Nevertheless, reconstruction of the anterior cruciate ligament (ACL) does not consistently prevent recurrent tearing of a sutured meniscus. We evaluated meniscal survival rates, 5 and 10 years after meniscal suture concomitant with an ACL reconstruction. We compared the outcomes of these repaired menisci to those in which no menisci tears were detected during ACL reconstruction. METHODS: In this multi-centric retrospective study, we included two groups. One group consists of patients who underwent a meniscal repair. This group was further divided into two subgroups based on whether follow-up was 5 years (n=76) or 10 years (n=39). The control group included 120 patients with normal menisci observed during surgery. We studied meniscal survival rates in each group, and we analyzed risk factors associated with the recurrence of meniscal lesions. RESULTS: The 5-year meniscal survival rate was significantly higher in the control group than in the meniscal-repair group (95% vs. 80%, respectively; P=0.0029). The controls group also had a higher meniscal survival rate after 10 years, although the difference was not statistically significant (88% vs. 77%, P=0.07). A difference in knee laxity greater than 4mm was associated with a 5-fold increase in the risk of recurrent meniscal tears (P=0.0057). After 5 years, the risk of recurrence was higher for the medial than for the lateral meniscus, whereas after 10 years the difference was no longer statistically significant. DISCUSSION: Although insufficient healing after meniscal suturing contributes to the risk of further meniscal tears, new lesions can develop in menisci that were undamaged at the time of ACL reconstruction. The risk of a new meniscal lesion is strongly associated with inadequate control of antero-posterior and rotational laxity. Some apparently "new menisci lesions" seems to have been missed during ACL reconstruction. LEVEL OF EVIDENCE: IV, retrospective study.

ACL reconstruction in children: a transphyseal technique.

The annual incidence of ACL tears is increasing steadily in pediatric patients. Chronic anterior instability causes meniscal lesions at a frequency that increases significantly with the injury-to-surgery interval. Conservative therapy, simple suturing, and isolated extra-articular tendon reconstruction are associated with high failure rates. Intra-articular arthroscopy-assisted tendon reconstruction is a good treatment method, although several different techniques have been described. We used a transphyseal technique with a hamstring tendon graft to treat 14 knees in 13 patients with a mean age of 13 years and 7 months. Mean injury-to-surgery interval was 6 months. Strict compliance with technical rules is required when using this technique. Bone tunnel diameter must not exceed 8 mm. Bone tunnels must be as vertical and central as possible. The fixation material must not bridge the physis (at the femur, cortical fixation; and at the tibia, fixation using a resorbable screw no longer than 25 mm combined with a staple). Meniscal lesions were present in half the knees and meniscal preservation considered mandatory. Conservative treatment of concomitant lesions was performed routinely. After a mean follow-up of 15 months, no recurrent tears or revision procedures for meniscectomy had been recorded. The IKDC grade was A or B in 93% of knees. The mean subjective IKDC score was 83.3 and the Lysholm score was in the excellent or good range in 93% of knees. Of the 14 knees, 2 exhibited signs suggesting femoral epiphysiodesis, with 4° of valgus deformity compared to the contra-lateral knee and no clinical consequences. Transphyseal reconstruction with open physes conducted in strict compliance with technical rules can be performed to control the instability and preserve the menisci. Nevertheless, this technique carries a risk of epiphysiodesis, chiefly at the femur.

Total talar fracture - long-term results of internal fixation of talar fractures. A multicentric study of 114 cases.

INTRODUCTION: Displaced talar neck and body fractures are rare and challenging for the surgeon. Results are often disappointing due to inadequate reduction or internal fixation and high rates of osteoarthritis and osteonecrosis. Very few published series describe the long-term results after internal fixation of talar factures. One of the goals of the 2011 SOO meeting symposium was to specifically evaluate the long-term results after internal fixation of talar fractures. This study included only central fractures. MATERIAL AND METHODS: We reviewed the results of 114 central talar fractures that had been treated by internal fixation between 1982 and 2006 in nine hospitals in the Western part of France. The clinical and radiological follow-up was 111 months on average. All the patients with a radiological assessment had at least 5 years of follow-up. RESULTS: Poor reduction was apparent in 33% of cases. The average Kitaoka score was 70/100, which corresponds to an average functional level. At the last follow-up evaluation, 34% of cases had osteonecrosis and 74% had peritalar osteoarthritis. Secondary fusion was required in 25% of cases with an average follow-up of 24 months. DISCUSSION: The complication rate for talar fractures was high, mostly due to osteonecrosis and osteoarthritis; these conditions had an impact on the final outcome. The outcome could be improved by better evaluating these fractures with a CT scan, developing dual surgical approaches to best preserve the bone vascular supply and achieve better reduction, and improving the internal fixation hardware, especially the use of plates for comminuted fractures.