[Percutaneous tenorrhaphy for Achilles tendon rupture. Study of 29 cases]. / Ténorraphie percutanée pour rupture du tendon d'Achille. Etude de 29 cas.

PURPOSE OF THE STUDY: Closed percutaneous repair, described first by Ma and Griffith in 1977, have bridged the gap between surgical and conservative treatment of Achilles tendon rupture. The purpose of this study was to evaluate the results of percutaneous repair. MATERIAL AND METHODS: Between 1994 and 1996, 28 patients (18 male, 10 female) with 29 spontaneous ruptures of the Achilles tendon (one bilateral case) underwent percutaneous repair based on approximation and bringing closer both ends of the ruptured tendon using a subcutaneous suture. Material used was 2 Dacron yarn suture 30 cm length fitted with a 5 mm wide harpon and with its other end crimped into a malleable needle 12 cm length. Early mobilization was encouraged, partial weight bearing allowed at 3 weeks and full weight bearing at 6 weeks. Sutures were removed at 8 weeks without anesthesia. Two patients were lost for follow up after complication, one foreign patient returned to his country with good results, 26 tendons underwent physical examination at an average follow up of 15 months; 20 underwent ultrasound examination and Cybex testing. RESULTS: Two patients experienced reruptures after suture removal; 2 patients fell a few days after repair and had rupture of the suture; both were treated with a cast. There were no infection, skin necrosis, hematoma, neurological injuries, or deep vein thrombosis. Eighteen patients were free of pain, 7 had intermittent pain and one permanent pain. Active and passive ankle motion were similar to the contralateral side. Calf circumference measurements on the repaired and normal extremities showed a difference of less than 3 cm in 4 cases, less than 2 cm in 13 cases and 9 patients had symmetrical calves. The average difference between the width of the repaired and normal tendon was 0.5 cm. Clinical documentation of muscle strength was normal in 9 cases, decreased in 14 cases. Three tendons could not be tested. Using the Trillat and Mounier-Kuhn score, 12 patients were rated excellent; 7 good, 7 fair and 4 poor (4 complications). Ultrasound examination demonstrated homogeneous and fibrilate structure in 10 cases. The width of the tendon was found increased in all cases. The strength, power and endurance testing performed on Cybex at 90 degrees and 180 degrees/second and compared to the normal ankle, averaged 65 p. 100 for plantar flexion. DISCUSSION: Complication rate of operative and conservative treatment were compared to percutaneous repair. The results of Cybex testing points out the advantages of early mobilization after Achilles tendon rupture treatment. Ultrasound examination is useful to guide post operative rehabilitation and sports activities. All patients return to work more quickly after percutaneous repair. CONCLUSION: Percutaneous repair of the Achilles tendon is a simple, easy and reliable technique. It seems to fulfil the required conditions: bringing closer tendon ends, maintenance of strong contact, preservation of all anatomical and histological factors inducing healing and a rapid return to social and working activities.

[Femoropatellar osteoarthritis treated by prosthesis. Retrospective study of 50 implants]. / Traitement de l'arthrose fémoro-patellaire par prothèse sphéro-centrique. Etude rétrospective de 50 implants.

MATERIAL AND METHODS: 51 prosthesis were performed in 47 patients and were studied in order to assess long term results. One patient was lost for follow up. The diagnosis was: primitive arthritis in 48 knees and post traumatic arthritis in 3 knees. 25 knees had patellofemoral subluxation, 16 patients had been previously operated on patellofemoral joint. The average age at the time of surgery was 60.5 years and follow up time averaged 3 years. 22 prosthesis had more than 4 years follow-up. The operations were performed using a lateral approach with tibial tubercle osteotomy and lateral patellar retinaculum release. The trochlear component was asymetric and made of chrome cobalt alloy; the patellar component was shaped in polyethylene. Both components were cemented. RESULTS: Using the Guepar scoring system, 41 (82 per cent) PFA were rated excellent or good and 9 poor. Post operative roentgenograms demonstrated patellofemoral alignment in all knees, even in cases of preoperative patellar subluxation, without tilting of the patella. Follow up roentgenograms demonstrated progressive but moderate deterioration of the tibio femoral joint in 9 cases. In 3 cases, more severe tibio femoral arthritis were treated by T.K.R one to three years after P.F.A. In one of these knees, we discovered an asymptomatic loosening of trochlear component. The last 6 poor results were always due to persistent pain. DISCUSSION: The purpose of this study was to assess the results of P.F.A. and to clarify the indications. It appears that the 82 per cent success rate of this study may be compared with the results of literature. All the authors have found P.F.A. to be a viable solution, preferable to patellectomy (even in older patients) or isolated patellofemoral realignment. The clinical and radiological results did not deteriorate with time. Persistent patellofemoral malalignment was not observed in this study thanks to the use of a lateral approach. The presence of tibio femoral arthritis adversely affected the outcome, but accelerated changes on the tibio femoral joint after P.F.A. were not observed.

[Labeled leukocyte scintigraphy and total hip prosthesis]. / Scintigraphie aux leucocytes marqués et prothèse totale de hanche.

During the last few years, labelled leukocyte scintigraphy has become a decisive tool in the diagnosis of bone infections. However, this test may sometimes be deceptive as far as hip prostheses are concerned. The authors have carried out a retrospective study of 62 labelled leucocyte scintigraphies performed for suspected infection of a hip prosthesis. The comparison of the results with the different clinical, biological and radiological factors and the follow up of the patients allows determination of the sensitivity and specificity of this test which are 41% and 100% respectively. The results reported in the literature and the indications for this examination are discussed.