Biomedical subjects

Y Acquitter

Publications and source records attributed to Y Acquitter.

4 recordsLinked to original sources

PubMed2004

[Arthroscopic knee arthrodesis: 4 cases].

PURPOSE OF THE STUDY: Arthroscopic arthrodesis of the knee joint is an alternative to classical surgery, which retains a few exceptional indications. We report the first four cases of our experience, describing the technical modalities and indications. MATERIAL AND METHODS: The four patients had undergone multiple operations for severe trauma. All four had persistent severe pain with a very limited walking distance. Before the procedure, the IKS score ranged from 11 to 44 and the mean function score was 20 to 45 points. Arthroscopic arthrodesis was proposed after several consultations and took into account the young age of the patient and a positive brace test. The successive arthroscopic times were: exploration and adherence release, complete extramural meniscectomy, joint surface avivement. Traction was not necessary. Careful avivement spared the anatomic curvatures of the condyles and slightly scraped out the plateaus. Finally, the arthrodesis was fixed in correct position under fluoroscopy using a single tube external fixator. The fixation was maintained until fusion (satisfactory x-ray and no pain). RESULTS: A drain was inserted only for the first patient. There were no cutaneous complications. Patients were discharged after 3 days on the average with immediate simulated weight bearing using two crutches. The external fixator was dynamized at two months (mean) and removed at five months. The functional gain was considerable in four patients, assessed at two years, with a mean IKS score of 75 and a mean function score of 80. The four patients walked without crutches and without pain. Single leg stance was stable. Final leg shortening was 1 to 2 cm. CONCLUSION: The arthroscopic approach provides several benefits: uneventful postoperative period, little bleeding, no cutaneous complications, shorter hospital stay. The time to fusion appears to be shorter than with classical techniques, but cannot be demonstrated clearly because of the diversity of the series reported in the literature. Arthroscopic arthrodesis does not require any special instruments, but does require surgical skill and a lengthy procedure. When arthrodesis is required the arthroscopic procedure is indicated for minimally deformed knees without major loss of bone stock.

Adult↗

PubMed2003

[Patellar tendon-bone autograft reconstruction of the anterior cruciate ligament for advanced-stage chronic anterior laxity: is an extra-articular plasty necessary? A prospective randomized study of 100 patients with five year follow-up].

PURPOSE OF THE STUDY: This prospective randomized study was conducted to analyze the anatomic and functional impact of an extra-articular lateral plasty associated with patellar tendon-bone autograft in anterior cruciate ligament reconstruction. MATERIAL AND METHODS: A consecutive series of 100 patients with grade II (Noyes classification) chronic anterior laxity confirmed on stress x-rays were included in the study. All patients had a positive Trillat-Lachman test, a direct anterior drawer at 90 degrees flexion confirmed on the lateral x-ray, and an instrumental differential laxity greater than 5 mm (manual arthrometry, Medmetric KT1000). Mean patient age was 27 years (range 16-29 years) and time from the accident to ligamentoplasty was 29 months (range 3-156 months). In the operating theater, the patients were assigned at random to two groups. Group 1 (50 patients) underwent arthroscopic free patellar tendon-bone autograft reconstruction of the anterior cruciate ligament. In the second group (50 patients) the same reconstruction was further supported by a lateral extra-articular plasty using the quadriceps tendon. All patients were followed prospectively. At 58 months follow-up (none of the patients were lost to follow-up) residual laxity (Medmetric KT1000) was noted and functional outcome was assessed using the IKDC criteria. The Aglietti method was used to assess the position of the drill holes. RESULTS: The two groups were strictly identical at inclusion. At last follow-up, the statistical analysis did not reveal any significant difference between the groups for subjective outcome, joint motion, instrumental residual laxity, meniscal stock, or radiological changes. The overall IKDC score was A or B in 80% of the patients in group 1 and 88% of the patients in group 2. Delay to resumed sports activities (about 12 months) was also equivalent in the two groups with a trend towards lower intensity and sports producing less stress on the knee. A minimally positive pivot test with no effect on stability was observed in 4 patients in group 1 (intra-articular plasty alone) and in 2 patients in group 2 (intra- and extra-articular plasty). 16% of the insufficient results (IKDC C and D) were related to repeated tears (n=8, 6 patients in group 1 and 2 patients in group 2, p=0.268), and failure (n=8, 4 in each group) due to defective motion and pain. Repeated tears were strongly correlated with incorrect drill hole position in the tibia (p=0.01) or femur (p=0.024). Despite the stabilization, radiological remodeling was observed in 31% of the patients in both groups. DISCUSSION: The results in this consecutive series of patients demonstrated the good results obtained with intra-articular ligamentoplasy using the mid third of the patellar tendon. The rate of repeated tears or minimally positive pivot tests was higher in group 1 with intra-articular plasty alone but did not reach statistical significance and was generally related to a technical error in positioning the autograft, making it difficult to draw any conclusion concerning the anatomic superiority of mixed plasty. CONCLUSION: At the current follow-up of 5 years, this study was unable to demonstrate any advantage of systematic conjunction of an extra-articular lateral support for advanced chronic anterior laxity of the knee treated by a free patellar tendon graft.

Adolescent↗

PubMed2002

[Ligamentoplasty of the anterior cruciate ligament after 40 years: a series of 41 patients].

PURPOSE OF THE STUDY: Ligamentoplasty for tears of the anterior cruciate ligament (ACL) is generally thought to be unreliable after the age of 40 years. The purpose of this retrospective analysis was to assess the five-year outcome after ACL plasty in patients aged over 40 at the time of surgery. MATERIAL AND METHODS: Between 1990 and 1997, 41 patients aged 44.5 +/- 4.5 years (28 men, 25 right side) underwent intra-articular reconstruction of the ACL. Clinical and radiological assessment using the IKDC criteria was obtained at a mean 62 months postoperatively using manual instrumental measurements with KT-1000. The indication for reconstruction was instability in daily life activities for 40 patients and difficulties encountered in sports activities in one; there were three cases of remodeling. Arthroscopy was used in all cases to perform a patellar tendon graft (bone-tendon-bone in 30 cases associated with extra-articular lateral reinforcement in eleven). RESULTS: There were no significant complications. Among 12 patients who initially participated in competition sports, seven were able to resume their activity at their former level. At last follow-up, global IKDC score was A for 12, B for 25, and C for three and D for one. All patients scored C or D had a poor IKDC symptom score, basically because of pain. Motion was not modified. The IKDC radiology score was A for 25, B for 15 and C for one, but the three cases of remodeling did not progress. Prognostic factors for overall IKDC result were: age of the patient at the time of reconstruction (under 45 years), and the delay to surgery for accident victims (less than one year). The following criteria had no effect at last follow-up: gender, sport practiced, type of initial laxity (anterior alone or global anterior), presence of meniscal damage, preservation of the medial and/or lateral meniscus, chondral injury observed peroperatively, and use of a lateral reinforcement. Radiographic remodeling observed in this group of 41 patients was related to delay from accident to surgery (p=0.0007) and preservation of the medial meniscus (p=0.03). Age, gender, type of activity before surgery, degree of initial and residual laxity had no statistically significant effect on remodeling. CONCLUSION: Age over 40 years is not a contraindication for arthroscopic free patellar tendon graft for the treatment of chronic anterior laxity. Using rigorous preoperative assessment criteria (delay from accident to surgery, absence of joint space narrowing on the AP and lateral view before intervention, symptomatic instability in daily life activities and motivated patient) this type of procedure can be performed safely and provides good functional outcome at five years. The current follow-up is insufficient to judge potential joint degradation. Age is not a contraindication if certain precautions are taken.

Adult↗

PubMed2001

[Arthroscopy-assisted revision in failed reconstruction of anterior cruciate ligament: 32 cases].

PURPOSE OF THE STUDY: The aim of this retrospective study was to analyze mid-term outcome after anterior cruciate ligament (ACL) revision performed arthroscopically with a patellar tendon graft. MATERIAL AND METHOD: The series included 32 revision arthroscopies for ligamentoplasties of the ACL performed after primary intraarticular plasty. Outcome was assessed using the IKDC score at least 2 years after revision surgery. A free patellar autograft was used in all cases in association with an anterolateral plasty in 9 cases using the Marshal-MacIntosh technique. There were 25 men, mean age 28.5 years. Mean follow-up was 4 years. The initial plasty was done with a synthetic ligament in 15 cases and an autograft in 17, including 12 patellar tendons. In 3 cases, the revision was needed for synovitis involving the synthetic ligament. In all the other cases, revision was indicated for instability, most of the failures resulting from a defective femoral position (particularly for autografts) or renewed trauma. RESULTS: Among the 23 patients who were initially competition-level athletes, 18 recovered their sports activity, 8 at an equivalent level. At last follow-up, the IKDC global scores were: A 5 patients (15.6%), B 16 patients (50%), C 8 patients (25%), D 3 patients (9.4%). Certain residual laxity was present in 3 cases (C and D laxity score for 2 of them). A tibiofemoral narrowing was present in the medial compartment in one patient alone. Factors of poor prognosis for the IKDC score were: long delay from accident to initial treatment (p=0.04), associated medial meniscectomy (p=0.02). Presence of an initial femoral tunnel had no effect on revision due to its very anterior situation. DISCUSSION: The technical difficulty of revision of an intra-articular ligamentoplasty of the ACL is to position the new transplant so it will satisfy the same requirements as the initial plasty. This position depends particularly on the femoral component due to the importance of the position of the initial femoral tunnel and the degree of bone loss (osetolysis, ablation of an interfering screw.). The homolateral patellar tendon was used for the graft in all cases except one and iterative use of the patellar tendon for grafting did not cause supplementary morbidity. The patellar tendon remains the transplant of choice for ligament reconstruction. Meniscectomy had a deleterious effect on the final outcome. As for first intention plasty, the therapeutic strategy should preserve as much meniscal stock as possible, depending on the type and degree of damage. CONCLUSION: Revision ACL plasty can provide good anatomic results although functional outcome is less satisfactory than after primary intention ligamentoplasty. A precise clinical and radiographic analysis of the cause of failure of the primary plasty must be obtained in order to establish a surgical strategy allowing the most clinically effective plasty with well positioned bone tunnels.

Adult↗