Posterior cruciate ligament reconstruction for chronic lesions: clinical experience with hamstring versus ligament advanced reinforcement system as graft.

PURPOSE: The aim of this study was to compare clinical and laximetric results in chronic, isolated posterior cruciate ligament (PCL) rupture repairs, using either a hamstring graft or an artificial ligament (ligament advanced reinforcement system (LARS®)). METHODS: Sixteen patients presenting with an isolated unilateral PCL rupture were included in this retrospective study. Initially, eight underwent a PCL reconstruction using a hamstring tendon autograft (hamstring group), and over a later period, eight further patients underwent a reconstruction using an artificial ligament with a new procedure. RESULTS: Fifteen patients were male and one female, with an average age of 29.3 years. All patients were operated on within an average time of 18 months post-injury. Pre-operative posterior laxity was equivalent (p = 0.309), 18.25 mm on average for the hamstring group and 18.75 mm for the LARS group. With an average follow-up of 24 months, residual posterior laxity was significantly improved, decreasing from 18.25 to 7.37 mm for the hamstring group (p < 0.05) with a median at 7.5 mm and from 18.75 to 5.25 mm for the LARS group (p < 0.05) with a median at 5 mm. The improvement in laxity for the hamstring group was 60% and 71.5% for the LARS group. The LARS group compares favourably (p = 0.003 and 0.01). Tegner activity level improved significantly following ligamentoplasty, with no difference between the two groups (p = 0.4). Likewise, there was no significant difference in the Lysholm and IKDC scores between the two groups (p = 0.4). CONCLUSION: The initial hypothesis of this study was proven correct. Nevertheless, a longer term study is necessary to assess the consequences of residual laxity in hamstring grafts and the long-term behaviour and tolerance of the LARS artificial ligament.

Short- and long-term results of common peroneal nerve injuries treated by neurolysis, direct suture or nerve graft.

INTRODUCTION: Damage to the common peroneal nerve is the most frequent nerve injury in lower limb traumas. Our objective was to assess the motor and sensory recovery levels and the functional outcomes after remedial surgery for common peroneal nerve trauma, through either neurolysis, direct suture or nerve graft. METHODS: This is a transversal, observational study of a monocentric cohort of 20 patients who underwent surgery between January 2004 and June 2016, which included 16 men and 4 women whose median age was 35 ± 11 years. We assessed the level of sensory and motor nerve recovery and the Kitaoka score. Nine patients benefited from neurolysis, 5 had direct sutures, and 6 received a nerve graft. RESULTS: With 48 months' average follow-up, 7 out of 9 patients underwent neurolysis and 4 out of 5 with direct sutures had good motor recovery (≥ M4), but none for the grafts. Sensory recovery (≥ S3) was satisfactory in 7 out of 9 cases in the neurolysis group, 3 out of 5 in the direct suture group, and 3 out of 6 in the nerve graft group. The average Kitaoka score was 83.7 ± 11.5 for the neurolysis group, 86.8 ± 16 for the direct suture group, and 73 ± 14 for the graft group. CONCLUSION: Surgical treatment by neurolysis and direct suture yields good results with a motor recovery ratio nearing 80%. When a nerve graft becomes necessary, recovery is poor and resorting to palliative techniques in the shorter run is a strategy which should be evaluated.

Chronic anterior shoulder instability with significant Hill-Sachs lesion: Arthroscopic Bankart with remplissage versus open Latarjet procedure.

BACKGROUND: The objective of this study was to compare short-term shoulder stability after arthroscopic Bankart repair with remplissage versus the open Latarjet procedure in patients who had chronic anterior shoulder instability with a significant Hill-Sachs lesion. HYPOTHESIS: The dislocation recurrence rate is higher after Bankart repair with remplissage than after open Latarjet. PATIENTS AND METHODS: An observational non-randomised retrospective cohort study was conducted at two surgical centres in patients treated for chronic anterior shoulder instability with a significant Hill-Sachs defect between January 2009 and July 2014. The study compared 43 patients managed by arthroscopic Bankart repair and remplissage and 43 patients managed with open Latarjet. The two groups were matched on age at surgery and on follow-up duration. All patients were evaluated by independent observers based on a questionnaire including recurrences, range of motion, and functional outcomes (Shoulder Subjective Value [SSV], Walch-Duplay score, and Rowe score). RESULTS: Mean follow-up was 47.3 months (range, 24-67 months). The recurrence rate at last follow-up was not significantly different between the two groups (9.3% versus 11.2%; P=0.67). The Bankart group had significantly greater loss of external rotation and a significantly higher proportion of patients with residual pain (21% versus 9%, P=0.023). The SSV, Walch-Duplay score, and Rowe score values were similar between groups. DISCUSSION: In patients who had chronic anterior shoulder instability with a significant Hill-Sachs lesion, arthroscopic Bankart repair with remplissage and open Latarjet were reliable and safe procedures associated with low and similar recurrence rates. However, loss of external rotation and residual pain were significantly more common with the combined Bankart-remplissage procedure. LEVEL OF EVIDENCE: III; comparative retrospective study.

Efficacy of nighttime brace in preventing progression of idiopathic scoliosis of less than 25°.

INTRODUCTION: The objective of the present study was to assess, at skeletal maturity, the efficacy of non-operative treatment by isolated nighttime brace in the prevention of progression of progressive idiopathic scoliosis of less than 25°. HYPOTHESIS: Isolated nighttime brace treatment is effective in the prevention of progression of mild progressive idiopathic scoliosis (Cobb<25°). MATERIAL AND METHODS: A single-center retrospective study included 142 patients managed by nighttime brace for progressive idiopathic scoliosis with Cobb angle<25°, with assessment at skeletal maturity. Mean Cobb angle at start of treatment was 15.5° (range, 10-25°). Mean values for Cobb angle and sagittal parameters before treatment and at skeletal maturity were compared on Student t-test. Change in Cobb angle over time was also analyzed. RESULTS: Mean Cobb angle at skeletal maturity was 16.3°, showing significant increase over baseline (15.5°; P=0.04), although the difference was less than the uncertainty of measurement (±6°). In baseline Risser 0 or 1, mean change in Cobb angle at skeletal maturity (16.2°) was not significant (P=0.1). Cobb angle diminished in 26 cases (18%), increased in 24 (17%) and was unchanged in 92 (65%). CONCLUSION: The present study confirmed the efficacy of non-operative treatment by nighttime brace in mild progressive idiopathic scoliosis (<25°) in a large majority of cases. A nighttime brace thus seems to be an effective option for the treatment of adolescent scoliosis, ensuring a safe curve of around 20°. LEVEL OF EVIDENCE: Level IV, retrospective study.

Long-term outcomes of tension band wiring with a single K-wire in Rockwood type IV/V acute acromio-clavicular dislocations: 25 cases.

BACKGROUND: Our objective was to evaluate the long-term functional and radiological outcomes of tension band wiring with a single K-wire for acute Rockwood types IV and V acromio-clavicular dislocation (ACD). METHODS: Single-centre cross-sectional non-randomised observational cohort study of 25 shoulders treated surgically between January 2002 and December 2004, in 25 patients, 23 males and 2 females, with a mean age of 35±11years (24-46). The evaluation criteria were the absolute and weighted Constant scores, QuickDASH score, subjective shoulder value (SSV), visual analogue scale (VAS) pain score at rest and during activities, and radiographic features in clinically symptomatic patients. RESULTS: Mean values were as follows: follow-up, 150±17months (133-167); absolute Constant score, 88±17 (71-105); weighted Constant score, 92.5±12.5 (80-105); QuickDASH, 15.5±7 (8.5-22.5); SSV, 88±17% (71-105); VAS pain score at rest, 0.2±0.7 (0-0.9); and VAS pain score while active, 1.4±2.3 (0-3.7). The weighted Constant score was less than 70% in only 8% of patients. Of the 17 patients for whom radiographs were obtained, 8 had acromio-clavicular osteoarthritis. Mean coraco-clavicular distance was 12.3±4.3mm (8-16.6) and mean acromio-clavicular distance was 5±5mm (0-10). The recurrence rate was 8%. CONCLUSION: Tension band wiring with a single K-wire for acute acromio-clavicular dislocation reliably provides good long-term functional outcomes. Recurrences are uncommon and few patients experience symptoms (8%). LEVEL OF EVIDENCE: IV, retrospective study.