Persistence of neuromuscular activation deficit in the lower limb at 3-years of follow-up after ACL reconstruction surgery.

BACKGROUND: Almost all patients experience neuromuscular disorders of the quadriceps after knee trauma or surgery such as anterior cruciate ligament (ACL) reconstruction. This phenomenon is described in literature as arthrogenic muscle inhibition (AMI). It can be detrimental to patients and cause complications. However, few studies have evaluated the long-term persistence of deficits arising from this, following ACL reconstruction. PURPOSE: By comparing neuromuscular activation in the lower limb after ACL reconstruction with the unaffected lower limb, after more than 3-years of follow-up, this study aimed to evaluate the possible persistence of long-term deficits after surgery. METHODS: Fifty-one patients who underwent ACL reconstruction in 2018 were included in the study, with a minimum follow-up of 3 years. The neuromuscular activation deficit was assessed using the Biarritz Activation Score-Knee (BAS-K), whose intra- and inter-observer reproducibility was also evaluated. The ACL-RSI, KOOS, SANE Leg, Tegner and IKDC scores were also evaluated. RESULTS: The mean BAS-K score of the knee that underwent surgery was 21.8/50 versus 37.9/50 in the healthy knee (p < 0.05). The SANE leg score was 76.8/100 versus 97.6/100 (p < 0.05). The mean IKDC was 84.17 (±12.7). The mean KOOS was 86.2 (±9.2). The mean ACL-RSI was 70 (±7.9) and the Tegner score was 6.3 (±1.2). Intra- and inter-observer reproducibility was satisfactory for the BAS-K score. CONCLUSION: We found that the neuromuscular activation deficit was high (roughly 42%) at more than 3-years of follow-up after ACL reconstruction. The deficit is not limited to the quadriceps and affects the whole limb. Our findings highlight the need for appropriate rehabilitation after ACL surgery, targeting the corticospinal level in particular. LEVEL OF EVIDENCE III: prognostic retrospective case-control study.

[Results of total knee prostheses with or without preservation of the posterior cruciate ligament]. / Résultats des prothèses totales de genou en fonction de la conservation ou du sacrifice du ligament croisé postérieur.

PURPOSE OF THE STUDY: This study was undertaken to assess the functional repercussion of retention or sacrifice of the posterior cruciate ligament in total knee replacement. MATERIAL: Two homogeneous randomised series of 24 cases were matched. They concerned primary total knee arthroplasty for osteoarthritis using the same prosthetic design. In case of sacrifice of the posterior cruciate ligament, the prosthesis included a substitution system constituting the only difference between the two types of implants (the design of trochlea, femoral condyle and tibial plateau were identical). METHODS: Functional assessment was performed according to the Hospital for Special Surgery score, at a minimal follow up of 12 months. The Student "t" Test was used for statistical analysis. RESULTS: In cases with posterior cruciate retention, the mean HSS score was 86.6. In postero-stabilised cases. this score was 87.7: a non significant difference. The mean range of flexion was 108 degrees for the retaining cases versus 113 degrees for the postero-stabilised ones: a non significant difference. DISCUSSION: The functional outcome seems to be the same whether a postero-stabilised or a posterior cruciate retaining total knee prosthesis was used. The latter technique requires more care for ligament balancing, tibial cuts and exposure. CONCLUSION: The authors believe that there is no benefit to expect at mid-term follow up from retaining the posterior cruciate ligament in total knee replacement.

[Fracture of the ceramic head in total hip prosthesis. Apropos of 2 cases]. / Fracture des têtes en céramique dans les prothèses totales de hanche. A propos de deux cas.

Fracture of the ceramic head of a replacement arthroplasty of the hip has been encountered in 2 patients. After studying the literature the causation of such fractures has been assessed. Defects in manufacture of the prosthesis, damage during its handling and incorrect use may be responsible, with the tapered neck being the principal instrument of failure. The use of a new head with a used tapered neck is not recommended. Care must be taken in placing the head on the neck and a precise fit is required with no interposition of soft tissue.

[Digastric trochanterotomy in reoperated total hip prostheses. Apropos of 53 cases]. / La trochantérotomie digastrique dans les reprises de prothèse totale de hanche. A propos de 53 cas.

A new technic of trochanteric osteotomy preserving the attachment of the vastus-lateralis is described: this procedure leads to mobilize the greater trochanter which becomes interposed between the gluteus-medius upward and the vastus-lateralis downward. A true digastric muscle is therefore realized where functional integrity is preserved. The biomechanical and vascular advantages of this surgical approach are used in revisions of total hip arthroplasties in which a large exposure is often required. This procedure, used in 53 consecutive cases, has allowed to suppress the trochanteric non unions which jeopardized the functional results of revision surgery, especially in high grade femoral loosenings.