Biomedical subjects

P Neyret

Publications and source records attributed to P Neyret.

10 recordsLinked to original sources

PubMed1992

[Total knee replacement after valgus tibial osteotomy. Technical problems].

Forty total knee replacements following valgus tibial osteotomy were analysed. There were 38 patients (10 men and 28 women) with a mean age of 72 years at the time of the joint replacement, at a mean of 8.5 years after osteotomy. Mean follow-up was 3 years (1 to 5 years). Performing a total knee replacement after valgus tibial osteotomy posed some specific problems due to asymmetrical bone cuts, residual ligament laxity, loss of bone at the tibial plateau, and especially when there was a malunion of the previous osteotomy. The functional results were good. A group of 208 patients with total knee replacements for untreated osteoarthritis acted as a control for comparison. In the group with an osteotomy the results were worse in respect of the walking distance and flexion angle achieved after joint replacement compared with primary replacement (p < 0.001). However the GUEPAR and HSS score 77.2 +/- 2.3 were very similar. Using unilateral weight-bearing X-rays, 18.8p. 100 demonstrated opening from ligament laxity and 40.6p. 100 had radiolucent lines under the components, which was the same as in the control group. The tibio-femoral mechanical axis using long-leg films had a mean varus angle of 0.7 degrees.

Aged↗

PubMed1992

[Total prosthesis on a rheumatoid knee].

Results of 81 total knee replacements in 67 patients with rheumatoid arthritis were studied. Mean follow-up was three years. Pain was the main reason for knee replacement surgery; knee mobility was well preserved prior to surgery. Failure occurred in four patients, as the result of infection, due in three instances to skin necrosis. Arthrodesis of the knee proved necessary in these patients. The fourth patient developed delayed hematogenous infection which was treated by a change of prosthesis. At follow-up, 82% of patients reported no pain and 18% moderate pain. Mean passive flexion was 113 degrees +/- 17 degrees. HSS score was 83.6 +/- 1.3 and all the patients except for the four with prosthesis failure stated that they were satisfied on very satisfied. Mechanical results were satisfactory, with a mean mechanical femur-tibial angle of 180.4 degrees. A circling line was visible at follow-up in 40% of operated knees but was partial in every case. No reoperations for prosthesis loosening were required. These data show that total knee replacement is the only reliable and radical treatment of rheumatoid arthritis of the knee and should be performed as soon as fixed flessum or axial deviation develops.

Adult↗

PubMed1992

[Treatment of old or recurrent ruptures of the patellar ligament by contralateral autograft].

Patellar ligament ruptures are difficult to treat, and require transfer of good quality tissues for an effective reconstruction. In this study the contralateral patellar ligament was chosen in preference to other types of graft. A graft was taken from the opposite knee (length 16 cm, width 8 mm) composed of a block of tibial bone, middle third of patellar ligament, block of patella, and quadriceps tendon. The bone blocks were embedded in slots made on the anterior surface of the patella and the tibia. The method of fixation allowed exact positioning as regards the patella height, and was sufficiently strong to allow immediate mobilisation and full weight-bearing. A series of 13 knees was operated on between October 1988 and July 1990, with a mean post-operative follow-up of 8.6 months. The technique was used twice following total patellectomy and once following total knee arthroplasty. This operation, without any complications from the donor site, produced a stable knee, corrected the extensor lag, and resulted in a mean post-operative flexion of 91 degrees.

Adolescent↗

PubMed1991

[Different knee prostheses and their technical problems].

Depending on whether degenerative lesions are localized to one single compartment or extend to all three compartments of the knee, and depending on the state of the ligaments (notably the cruciate ligaments) and on the presence or absence of osseous and frontal deformations, various prostheses can be used in the treatment of gonarthrosis. These prostheses fall into three main categories: (i) hinge prostheses, which are very constrained; (ii) sliding prostheses with varying degrees of constraint depending on whether or not the cruciate ligament(s) are spared, and (iii) one-compartment prostheses which replace only one of the three compartments of the knee. Each type of prosthesis has its advantages and drawbacks. Total knee replacement has become a reliable procedure which regularly provides stable and painless knees with a mean flexion angle of 110 degrees and is mainly applied, for the time being, to subjects leading a sedentary life.

Biomechanical Phenomena↗

PubMed1990

[Dysplasia of the femoral trochlea].

Dysplasia of the trochlea was studied on a strict profile image of the knee. 1305 radiographs were analysed corresponding to several patello-femoral conditions (major and subjective patello-femoral osteoarthritis) and to control subjects. Two criteria are defined: the depth and the eminence of the trochlea. The depth was often minimal in instabilities that give a radiological characteristic image of intersection between the trochlear end line and the lateral condyle. This picture had a great diagnostic value for patellar instability. The eminence represented the owerhang of the trochlear end line in relation to the anterior cortex of the femur. By measuring it, it was possible to establish a statistically significant variability of the degree of instability on one hand, between instabilities, patellar syndromes and controles on the other hand. The intersection sign and the trochlear eminence in isolated patello-femoral osteoarthritis allows the direct filiation between dysplasia of the trochlea and osteoarthritis to be confirmed. Taking into account the size of the eminence, the hollowing out type trochleoplasties appears more fiable than raising of the lateral edge.

Bone Diseases, Developmental↗

PubMed1990

[Bilateral congenital absence of the anterior cruciate ligament and the internal menisci of the knee. A case report].

Bilateral congenital absence of the anterior cruciate ligament associated with the absence of the medial meniscus is reported in a 34-year-old-woman. The simultaneous absence may be explained by a common embryological mesenchymal origin of the anterior cruciate ligament and the menisci. This absence was at the origin of an abnormal development of the condyles and especially of the tibial epiphysis which was tipped over in flexum. Treatment consisted of a central ligamentous plasty associated with a lateral plasty, a medial plasty and a closing anterior tibial osteotomy. The result was good.

Adult↗

PubMed1989

[What is new about the knee?].

Surgery of the knee applies to the pathology of sports as well as to degenerative lesions. Surgery of the ligaments has benefited from the advances achieved in medical imaging, arthroscopy and rehabilitation. In case of gonarthrosis, prosthetic surgery has become reliable, but it is limited to sedentary subjects. Osteotomy remains very useful in ome indications.

Arthroscopy↗

PubMed1989

[What should be done in a meniscal lesion?].

The treatment of meniscal lesions closely depends on the context in which they occur. In isolated lesions of the medial meniscus, meniscectomy under arthroscopy remains the best method. When the meniscal lesion complicates a rupture of the anterior cruciate ligament, meniscal suture associated with reconstruction of the ligament may be contemplated. In case of degeneration of the medial meniscus or lesion of the lateral meniscus, various therapeutic approaches may be envisaged.

Arthroscopy↗

PubMed1988

[Results of surgically treated chronic anterior laxities. Apropos of 251 cases reviewed with a minimum follow-up of 3 years].

Two hundred and fifty one chronic anterior laxities operated by intra-articular plasty using a free knee-cap tendon and by the Lemaire extra-articular procedure were reviewed with a minimum 3 year follow-up. Eighty-three per cent of the patients obtained a global functional result excellent or good, eight per cent fair and nine per cent poor. Clinical examination disclosed 24% equivocal pivot shifts and 4% true jerks in internal rotation. Most of the patients, at the check-up clinic, underwent a radiographic and dynamic examination, thereby allowing evaluation of postoperative arthrosis and residual anterior laxity in extension. Frontal radiographs of the knee on unilateral weight-bearing showed 29% joint remodelling, 16% "prearthrosis" and 8% arthrosis. These radiological modifications were most often medial femoro-tibial, they were highly correlated with the patient's age at the time of operation, with the state of the medial meniscus and with the residual laxity in extension. The residual anterior laxity in extension measured on the dynamic radiographs was, on average, 9 mm, i.e. an average difference of 5 mm in relation to the healthy knee; it was highly influenced by the pre- or peroperative treatment of the medial meniscus. Indications of precautions to be taken are defined and suggestions are drawn up whereby residual laxity in extension may be limited.

Adolescent↗

PubMed1988

[Intramural internal meniscectomy using the Trillat technic. Long-term results of 258 operations].

A study of 258 meniscectomy (245 patients), with a minimum follow-up of twenty years, confirms the excellent functional result obtained by intramural medial meniscectomy performed for isolated meniscus lesions. The joint remodelling, with absence of joint-space narrowing, represents the radiological cicatrix resulting from this surgery. It is a non-evolutive condition. The incidence of meniscectomy in the occurrence of an arthrosis is low (20%). On the other hand, when the meniscus lesion in associated with rupture of the anterior cruciate ligament, medial meniscectomy often proves to be inadequate. Clinical and radiological evolution is governed by tearing of the ligament. The radiological signs are, in this case, characteristic on unilateral weightbearing in profile at 20 degrees flexion. At the end of this study, the signs described by Fairbank (9) are discussed and the factors liable to determine the onset of a late arthrosis after medial meniscectomy are analysed.

Follow-Up Studies↗