Masquelet's induced membrane technique associated with Reamer Irrigation Aspiration grafting and intramedullary Nailing (MaRIAN) for chronic diaphyseal osteomyelitis of the lower limb.

INTRODUCTION: Masquelet's induced membrane technique offers a definitive contribution to the treatment of diaphyseal osteomyelitis. To overcome its drawbacks while maintaining its principles, technical modifications have been proposed: antibiotic cement, femoral intramedullary autograft harvested by RIA (Reamer Irrigation Aspiration) and interlocking nails. MATERIAL AND METHOD: This retrospective study gathered patients with chronic osteomyelitis of the femur or tibia. The first surgical stage consisted of bone resection in the healthy zone and use of a gentamicin cement spacer to fill the bone defect. The second stage consisted of the placement of a statically locked intramedullary nail associated with a bone autograft using the RIA technique. RESULTS: Among this group of 12 men with diaphyseal osteomyelitis; 9 tibial and 2 femoral, and 1 knee nonunion, the mean bone defect was 7.3cm (±6.7). The mean time between the 2 stages was 2.7months (±3) with a mean antibiotic period of 3.25weeks (±3). There was a femoral diaphyseal fracture at the donor site, and a wrong trajectory intraoperatively during the RIA. Two patients with tibial nonunion presented with nail rupture without septic recurrence. A septic recurrence was healed by removal of the nail. At a minimum follow-up of 18months, with an average of 5years, consolidation was complete without infectious recurrence. Despite the statistical weakness related to the size of the cohort, the resumption of early weight bearing (OR=-7.68 95% CI [-13.33 to -2.08] (p=0.01)) and nail dynamization seemed to have an impact on the formation of complete consolidation (OR=-0.86 95% CI [-1.39 to -0.33] (p=0.007)). DISCUSSION AND CONCLUSION: This short series, compared to the literature, demonstrated that the proposed technical modifications improved the overall management of this rare and challenging condition while maintaining the reliability of the original technique. Dynamization was also seen to be of particular interest. LEVEL OF EVIDENCE: IV, retrospective study.

The effect of femoral tunnel widening on one-year clinical outcome after anterior cruciate ligament reconstruction using ZipLoop® technology for fixation in the cortical bone of the femur.

BACKGROUND: The effect of femoral tunnel widening on clinical outcomes of anterior cruciate ligament (ACL) reconstruction has been rarely investigated. In this study, ACL reconstructions were performed using semitendinosus and gracilis (STG) tendon grafts and single cortical fixation on the femoral side. The aim was to analyze femoral tunnel widening at one year and to evaluate its effect on clinical and laximetric outcomes. METHODS: A total of 46 patients were enrolled in this prospective continuous single-operator monocenter study. Clinical protocol included pre-operative and one-year evaluation with subjective and objective International Knee Documentation Committee (IKDC) clinical scores. Computed tomography (CT) scan was used for radiographic examination during the follow-up period. The femoral tunnel widening was measured as a three-dimensional (3D) image using OsiriX software. The cross-sectional area of each tunnel was measured at four different locations. RESULTS: The subjective preoperative IKDC score was 50 and one-year postoperative score was 81.8. The side-to-side difference in knee laxity decreased from 2.94 to 0.74 mm. The objective IKDC score during the final follow-up was rated A in 27 patients and B in 17. CT scan data revealed an average of 49.32% cone-shaped widening of the femoral tunnel. Femoral tunnel widening at the level of the joint (F4) was negatively correlated with the IKDC subjective score at one year. CONCLUSIONS: This study revealed a significant widening of the femoral tunnel by demonstrating its conical shape at one year post-surgery. A significant correlation could be established between femoral tunnel widening close to the joint and IKDC scores.

Modern dual-mobility cup implanted with an uncemented stem: about 100 cases with 12-year follow-up.

We report the results of a 12-year follow-up retrospective series of 100 total hip arthroplasties using cementless, press-fit, dual-mobility acetabular cups. The aim of our study was to evaluate the clinical and radiographic results of this acetabular cup at last follow-up. This continuous and homogeneous series included 100 primary total hip arthroplasties performed during the year 2000. The THA combined a Corail® stem (Corail®, Depuy, Warsaw, IN) with a stainless steel Novae Sunfit® (Serf, Decines, France) acetabular cup. Fifteen patients died and 2 were lost to follow-up. Two cases of early dislocation were observed, and 3 cases of aseptic loosening of the acetabular component were reported. The mean stem subsidence was 0.71 mm, the mean craniopodal acetabular migration was 1.37 mm, and the mean medio-lateral acetabular migration was 1.52 mm. The 12-year survivorship is comparable to the data from the literature. The low dislocation rate at 12 years confirms the long-term, high stability of dual mobility, which should be recommended in primary THA for patients at risk for postoperative instability. The absence of true intraprosthetic dislocation events at 12-year follow-up provides evidence of the good quality of the latest generation of polyethylene liners and the necessity of combining thin-mirror, polished femoral necks with dual-mobility cups.