Periprosthetic fracture around total knee arthroplasty: What are the advantages of minimal-invasive surgery?

OBJECTIVES: Periprosthetic femur fractures after total knee arthroplasty in older adults are mostly treated by internal fixation. Members of the GETRAUM (French Orthopedic Trauma Society) sought to compare two surgical techniques - conventional open surgery and minimally invasive surgery - with the aim of analyzing the patients' functional recovery. We hypothesized that a minimally invasive technique would produce better early functional outcomes with recovery of independence. MATERIALS AND METHODS: This retrospective multicenter study of patients treated between 2009 and 2015 consisted of 90 fractures with a follow-up of 1 year. Demographic, preoperative data and the characteristics of fractures, type of fixation and the surgeon's experience level were collected. The endpoints were the Parker Mobility score, Katz ADL, place of residence at the time of fracture and at 6 months and one-year follow-up. All complications and one-year mortality during the follow up were searched. RESULTS: At 6 months follow-up, the minimally invasive technique contributed to significantly better functional recovery as measured by the Parker (p < 0.05) and Katz scores (p < 0.05). However, there were no differences in these scores at one-year follow-up. The complication rate was 31% at one year follow-up. Mortality rate was 12 % (11 patients). CONCLUSION: Our hypothesis was confirmed, as there was a difference between techniques that impacted functional recovery and independence, but only in the early postoperative phase. A minimally invasive technique appears to be beneficial in the short term for distal femur fractures after total knee arthroplasty but must be evaluated in a comparative and prospective study to fully confirm its reliability.

Three-corner arthrodesis for scapholunate and scaphoid nonunion advanced collapsed wrists: outcomes at long term follow-ups.

OBJECTIVES: This study aimed to assess clinical, functional and radiological outcomes after three-corner arthrodesis in patients suffering from symptomatic scapholunate or scaphoid non-union advanced collapsed wrists. We hypothesised that three-corner arthrodesis provided satisfactory clinical and radiological results in the long term. MATERIAL AND METHODS: This was a retrospective study of 13 patients (14 wrists) who underwent a three-corner arthrodesis between March 2004 and January 2019 with a mean follow-up of 6,7 years. Clinical assessment consisted of wrist motion, grip strength, pain and functional scores (Quick-DASH, PRWE, MWS). All complications and surgical revisions were investigated. Radiographic assessment searched for union, evaluated carpal height and ulnar translation, lunate tilt and occurrence of radio-lunate arthritis. RESULTS: At the last follow-up Quick-DASH and PRWE scores were 24,87(± 17.2) and 47.4 (± 26.9) respectively and were significantly improved. Wrist motion was 35°, 32°, 10° et 24° of flexion, extension, radial and ulnar deviation respectively. Union was obtained for 13 (92,9%) wrists. The mean radiolunate angle was 11° (-17°-34°). Three patients needed reintervention, which 2 consisted of total wrist arthrodesis due to persisting pain. Mild signs of radio-lunate arthritis were found in three patients. CONCLUSION: Three-corner arthrodesis seemed to provide satisfactory long-term functional outcomes. The union rate was high and even patients with signs of radio-lunate arthritis still had improved outcomes at the last follow-up. It could be a part of surgical options in wrists with radio- and midcarpal arthritis, among other procedures.

Serious injuries of Lisfranc joint: A retrospective multicenter study of 141 patients.

INTRODUCTION: Lisfranc joint injuries are common and often underdiagnosed. They occur during trauma of various mechanisms, high or low energy. Their management is difficult because of the wide spectrum of lesions and the management of associated lesions, particularly in the emergency stage. Their surgical treatment remains controversial. Therefore, the objective of this study was to evaluate and compare the management of Lisfranc injuries and to study their clinical, functional and radiologic evolution. We also wanted to assess the consequences of these lesions on the patient's quality of life. MATERIAL AND METHODS: This was a retrospective multicenter study of 141 patients over 16 years at the time of the trauma. The patients included had presented a Lisfranc injury from January 2010 to June 2018. The epidemiological characteristics, the type of osteosynthesis, and the immediate and radiographic results at the last follow-up were collected. Functional assessment was analyzed by telephone review using the SF12, FAAM and AOFAS scores. RESULTS: An associated M2 base fracture was found in almost 50 % of cases. A closed reduction and fixation was made in 25 % of cases. There was 69 % pins fixation. The reduction was not anatomical in 1/3 of the cases and was more difficult to achieve with an associated fracture. The FAAM score was statistically superior in the patients with internal fixation by screws compared to the treatment by pins. We found 18 % early complications. At least 1 year after the injury, C2M2 osteoarthritis was found in 45 % of patients. DISCUSSION: Contrary to what is recommended in the literature, this study reported a high rate of osteosynthesis by pins whereas screws and plates were more recommended. Open reduction was also recommended and was the strategy of choice in this study. An M2 fracture was often associated with Lisfranc dislocations. The quality of reduction was essential and was better with open reduction and screw fixation.

Comparison of classical and minimally invasive superolateral approach for reconstruction of proximal humerus fractures with locking plates.

CONTEXT: Minimally invasive (MI) approaches are purported to present advantages for osteosynthesis when compared with conventional approaches. This study aimed to compare the medium-term clinical and radiological outcomes of patients with proximal humerus fractures treated by plate osteosynthesis with conventional and MI superolateral approaches. METHOD: The study carried out was a retrospective monocentric comparative analysis. Forty-three cases were followed up - 18 were treated with an MI approach and 25 with a conventional approach. Constant-Murley, DASH and SSV scores were established and standard complications were investigated. RESULTS: No significant differences in functional scores or complications were found between the 2 groups. The only significant difference was for pain which was significantly lower for the MI group. The overall revision rate was 18.3 %. The mean adjusted Constant-Murley for the entire population was 80.1 ± 20.2; the mean DASH score was 17.8 ± 15.9 and the mean SSV was 73.2 ± 19.5. CONCLUSION: This study did not demonstrate any significant differences between the 2 approaches. Given the low patient population in our series, the superiority of the MI approach - as indicated in the literature - was not proven.

Clinical and functional outcomes of 405 Achilles tendon ruptures after a minimum follow-up of 1 year.

OBJECTIVE: The results of surgical versus conservative treatment of acute Achilles tendon ruptures are still controversial. The objective of this study was to compare surgical and conservative treatment at a minimum follow-up of 1 year in terms of the complications, functional outcomes and clinical results. HYPOTHESES: There is no difference in the complications, clinical results and functional outcomes between the two treatment groups. There is no difference in the occurrence of complications or the clinical results due to the immobilization or rehabilitation protocols. METHODS: This was a retrospective comparative, multicenter, non-randomized study of acute Achilles tendon ruptures treated between 01/01/2018 and 31/12/2019 at 21 study sites in France. All patients who received surgical or conservative treatment were included. The demographics, sports participation, nature of treatment, immobilization parameters (type, duration, position) and rehabilitation protocol were collected. Rerupture, general and specific complications, clinical results (heel-rise test, single-leg hop, calf circumference, ankle dorsiflexion) and the functional outcomes (ATRS, VISA-A, EFAS, SF-12) were collected at the final review. RESULTS: Four hundred five patients were reviewed at a mean follow-up of 24 (±7) months. Surgical treatment was done in 372 patients (92%) and conservative treatment in 33 patients (8%), with these two sets of patients having comparable preoperative characteristics. There was a similar number of reruptures in the conservative group (3 cases, 9%) as in the surgical group (15 cases, 4%) (p=0.176). There were more general complications in the conservative group (24%) than in the surgical group (11%) (p=0.04). There was a 9% rate of surgery-related complications (infection, nerve damage, anesthesia after-effects). The ATRS (p=0.017), EFAS Total (p=0.013), EFAS daily living (p=0.008), and SF-12 physical (p=0.01) were better in the surgical group. Strict then relative immobilization provided the best balance between functional recovery (EFAS total of 33, p<0.01) and tendon lengthening (0°, p=0.01) without increasing the occurrence of rerupture (2%, p=0.18). Early weightbearing accompanied by immobilization and rehabilitation within 30 days did not lead to more reruptures than if it was started beyond 30 days (p=0.082 and p=0.07). CONCLUSIONS: This study found no differences in the number of reruptures between surgical treatment and conservative treatment of acute Achilles tendon ruptures. Surgical treatment led to better clinical results but had a variable effect on improving the functional scores. No matter which treatment is used, in the ideal case, 3 weeks of strict immobilization in equinus should be followed by progressive reduction over the next 3 weeks. Early weightbearing and mobilization within 30 days did not increase the risk of rerupture; it actually optimized the clinical and functional outcomes. LEVEL OF EVIDENCE: III; retrospective comparative, non-randomized.

Revision total knee arthroplasty with periprosthetic distal femoral fracture.

Treatment strategies for periprosthetic distal femoral fracture depend on the type of fracture, level with respect to the prosthesis, and prosthesis fixation. The usual treatment is internal fixation by nail or locking plate. This can be more difficult when the fracture is close to the joint, is destabilizing the prosthesis or is associated with reduced bone stock, and implant exchange should be considered, depending on the patient's health status. The aim is to obtain the fastest possible recovery while limiting complications and minimizing surgery time for often frail and elderly patients. The present study details the implant revision technique in periprosthetic distal femoral fracture, which requires experience in traumatology and prosthetic revision and material adapted to the situation. LEVEL OF EVIDENCE: V, expert opinion.

Poor clinical outcomes and high rates of dislocation after modular reverse shoulder arthroplasty for proximal humeral oncologic resection.

PURPOSE: The shoulder is the most common site for upper extremity tumors. The aim of the study was to analyze the outcomes and the complications of modular reverse shoulder arthroplasty (RSA) after proximal humerus resection. METHODS: We retrospectively included 15 consecutive patients who underwent a modular MUTARS™ RSA reconstruction after proximal humerus tumour resection between 2017 and 2020. The mean age was 52 years. Their clinical outcomes were assessed using the Constant-Murley score and the MSTS shoulder. Radiological outcomes were assessed based on the presence of loosening, osteolysis, and scapular notching. Complications such as dislocation, oncological recurrence, and infection were assessed. Mean follow-up time was 32.9 months (24 to 45). RESULTS: The mean adjusted Constant score was 50.7% (min 22, max 81), and the mean MSTS score was 15.6 (min 4, max 26). We had no loosening, osteolysis, or scapular notching on the radiographs at last follow-up. We had a high complication rate of 53%: one infection, one oncological recurrence, and six dislocations (40%), of which five were re-operated. CONCLUSION: In our experience, the MUTARS™ Implantcast™ modular RSA has poor functional results and a high rate of dislocation in the case of large proximal humerus resections below the distal insertion of the deltoid.

Limb schwannoma: Factors for postoperative neurologic deficit and poor functional results.

INTRODUCTION: Neurologic complications after limb schwannoma resection are not unusual, but there is no consensus on risk factors for neurologic deficit or poor functional results. We therefore conducted a retrospective study, to screen for factors predicting, firstly, postoperative neurologic deficit and, secondly, poor functional results. HYPOTHESIS: Certain pre- and intraoperative features predict risk of failure, poor results or aggravation. PATIENTS AND METHODS: A single-center retrospective study was conducted in the University Hospital of Lille, France, for the period January 2004 to March 2020, including 71 patients. Preoperative variables (gender, age, symptoms, progression, tumor location and size) and operative data (type of surgery) were collected as possible risk factors for postoperative sensory deficit (Weber) and/or motor deficit [Medical Research Council (MRC)] and poor functional result [Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH); Lower Extremity Functional Scale (LEFS) and douleur neuropathique (neuropathic pain) 4 (DN4)]. RESULTS: Results were assessed a mean 69.4±38.5 months' follow-up (range, 6-180 months). In total, 21 patients (29.6%) had deficits (21 sensory, 1 motor) preoperatively and 25 patients (35.2%) postoperatively (20 sensory, 9 motor) (p=0.689). Fourteen patients (19.7%) showed functional aggravation. Fascicular resection was associated with risk of postoperative deficit [OR = 4.65 (95% CI: 1.485-15.543); p=0.004] and functional deterioration [OR = 3.9 (95% CI: 1.143-13.311); p=0.042]. Thirteen patients (18.3%) showed no improvement on DN4. Preoperative pain was a factor for improvement on DN4 [OR = 3.667 (95% CI: 1.055-12.738); p=0.0409]. DISCUSSION: The study identified fascicular resection as a risk factor for postoperative deficit and functional deterioration after limb schwannoma resection. Patients with preoperative neuropathic pain showed alleviation. Resection should be precise, under magnification, avoiding fascicular resection. Preoperative patient information is essential. LEVEL OF EVIDENCE: IV; retrospective series.

Systematic literature review of in vivo rat femoral defect models using biomaterials to improve the induced membrane technique: a comprehensive analysis.

Purpose: The aim of this study was to conduct a systematic literature review analyzing the results of in vivo rat femoral defect models using biomaterials for improving the induced membrane technique (IMT). Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the PubMed, Embase, and Web of Science databases were searched. Inclusion criteria were studies reporting results of the IMT in in vivo rat femoral critical-sized defect models using a biomaterial possibly combined with molecules. Methodologic quality was assessed with the Animal Research: Reporting In Vivo Experiments guidelines. Results: Twenty studies met the inclusion criteria. Femoral stabilization with plate and screws was the most frequent. Histologic, biomechanical, and/or radiologic analyses were performed. In two-stage strategies, the PMMA spacer could be associated with bioactive molecules to enhance IM growth factor expression and improve bone formation. Modulating the roughness of spacers could increase IM thickness and accelerate its formation. In one-stage strategies, human tissue-derived membranes combined with bone grafting achieved bone formation comparable to a standard IMT. All calcium phosphate grafts seemed to require a functionalization with growth factors or bone marrow mononuclear cells to improve outcomes compared with non-functionalized grafts. Conclusion: This systematic review described the main parameters of the in vivo rat femoral defect models using biomaterials to improve the induced membrane technique. Although the studies included had several methodological limitations that may limit the scope of these conclusions, one- and two-stage strategies reported promising results with biomaterials to improve the IMT.

Long-term clinical and radiological results after scaphoid non-union treatment: a retrospective study about 60 cases.

PURPOSE: Scaphoid non-union treatment remains nonconsensual and is based on vascularized or non-vascularized bone grafting. This study aimed to evaluate with a long follow-up the functional, clinical, and radiological outcomes, reported complications and reoperations and studied non-union treatment prognostic factors. METHODS: Patients who had undergone bone graft surgery for scaphoid non-union were retrospectively reviewed. The evaluated outcomes were pain, qDASH, PRWE and MWS scores, active range of motion, grip strength, union rate, scapholunate angle, carpal height, and presence of arthrosis. Complications and reinterventions were also reported. RESULTS: This study included 60 scaphoid non-union treatments with a mean follow-up of 7.7 (1.5-20.3) years. Twenty (33.3%) non-unions were located at the proximal pole, including 6 (10%) with preoperative avascular necrosis (AVN). Union occurred in 51 patients (85%). The functional, clinical, and radiological results were good. The complication rate was 21.3% and the reintervention rate was 16.7%. Subgroup union rate analysis found no difference if the non-union is localized in the proximal pole or if there is AVN. CONCLUSION: With a representative sample of the population and a long follow-up, we have found a good union rate, clinical and functional results regardless of the treatment method chosen. Scaphoid non-union treatment is still controversial and more studies are needed to accurate indications of each graft according to the patient and non-union characteristics. LEVEL OF EVIDENCE IV: Retrospective cohort study.

Hereditary neuropathy associated with liability to pressure palsies: a 24-year experience with carpal and cubital tunnel surgery.

The aim of this single-centre retrospective study was to evaluate the outcomes of carpal tunnel release surgery in patients with hereditary neuropathy with pressure palsies (HNPP). The secondary aims were to identify prognostic factors for the outcome of carpal tunnel release and to assess the outcome of cubital tunnel release. Our primary hypothesis was postoperative improvement. In total, 18 patients (26 carpal tunnel releases) with at least one symptomatic carpal tunnel syndrome were included. At a median follow-up of 8.5 years, more than 73% of the patients were satisfied with the results. The visual analogue scale (0 to 10) for discomfort decreased by 2.2 points (p < 0.001). The Boston Carpal Tunnel Questionnaire symptom severity scale decreased by 1.3 points (p < 0.001). The decrease in the Functional Status Scale was not significant. No significant prognostic factor for outcome was identified. A total of 12 patients also underwent cubital tunnel release, and three patients underwent just this procedure (23 procedures). Despite the lack of preoperative data, cubital tunnel release provided encouraging results. Level of evidence: III.

The Sauvé-Kapandji procedure for post-traumatic distal radio-ulnar arthrosis: Long-term results and analysis of risks factors for revision surgery.

INTRODUCTION: The Sauvé-Kapandji (SKp) procedure is a frequently used surgery for the management of post-traumatic sequelae of the distal radio-ulnar joint (DRU). Series evaluating long-term outcomes and the risk of complications are rare. The main objective was to describe the long-term clinical and radiographic results after SKp performed in a post-traumatic context. The secondary objectives were to identify postoperative complications, surgical revisions, and their risk factors for occurrence. Our hypothesis was that although SKp confers good clinical results, identifiable risk factors for complications exist. PATIENTS AND METHODS: This monocentric retrospective study included all patients for whom an SKp was performed in a post-traumatic context from 2008 to 2018. Pain, satisfaction, range of motion and pre- and postoperative radiographic measurements were recorded. All complications were sought and described, as well as surgical revisions. Several variables were analysed to identify risk factors for revision surgery after SKp: age, sex, initial traumatic mechanism, initial non-surgical or surgical treatment and type of surgery, time until revision surgery with SKp after the initial trauma. RESULTS: Thirty-seven patients were included. At a median follow-up of 9.5 years (min 7.3-max 11.5), 22 patients (60%) had a VAS of 0. Range of motion was significantly improved for all the patients (p<0.001). Seventeen (46%) patients had a complication, including 5 (13.4%) cases of ossification, 4 (10.8%) cases of discomfort related to the hardware and 4 (10.8%) painful instability at the proximal ulnar stump. Thirteen (35%) patients required revision surgery. Two risk factors for revision surgery after SKp were found: time period between initial treatment and SKp of less than 7.2 months and an age of less than 53.5 years; the combination of the two factors having a sensitivity of 97.5 and a specificity of 56.7. CONCLUSION: SKp in a post-traumatic context significantly improved range of motion and allowed pain control at long follow-up. Revision surgery seemed more frequent in patients under 53.5 years of age and when SKp was performed less than 7.2 months after the initial trauma. LEVEL OF EVIDENCE: IV, retrospective study.

Portable device for measuring isometric plantar-flexion force after open Achilles repair: Retrospective cohort of 30 recreational athletes with one-year minimum follow-up.

BACKGROUND: Plantar flexion force in recreational athletes after repair of Achilles tendon tears has rarely been reported, due to the lack of a widely available and fast measurement method. Knowledge of this parameter would allow optimisation of muscular and sports recovery. The main objective of this study was to measure the isometric force of the triceps surae at least 1 year after unilateral Achilles-tendon repair, comparatively to the unaffected side, using a portable device. The secondary objectives were to compare Achilles tendon and calf-muscle trophicity, dorsiflexion, and the single-leg heel-rise test versus the normal side and to assess functional scores at last follow-up. HYPOTHESES: (i) Plantar flexion force does not differ significantly between the operated and contralateral sides. (ii) Calf-muscle trophicity, dorsiflexion, and the single-leg heel-rise test do not differ significantly between the operated and contralateral sides. PATIENTS AND METHODS: This single-centre retrospective study included patients aged 18 to 65 years with a history of open repair of an acute unilateral Achilles tear at least 1 year earlier. Plantar flexion force, calf-muscle trophicity, dorsiflexion, and the heel-to-floor distance were measured on both sides and compared. The ATRS, VISA-A score, and EFAS score were determined. All complications were recorded. RESULTS: The study included 30 patients with a mean follow-up of 20.3 months (range, 12-28 months). The operated side had significantly lower values for isometric triceps surae force, calf circumference, and heel-to-floor distance compared to the contralateral side (p<0.0001). Tendon width was significantly greater on the operated side (p<0.0001). Dorsiflexion did not differ significantly between sides (p=0.106). Mean functional score values were 91.5±6 for the ATRS (maximum, 100), 85±12 for the VISA-A score (maximum, 100), and 19.5±4 for the EFAS score (maximum, 24). DISCUSSION: Isometric triceps-surae force measured using a portable device at least 1 year after open surgical Achilles-tendon repair was significantly decreased compared to the contralateral side. Calf circumference and heel-to-floor distance were also significantly lower. These data indicate a need for improved monitoring of triceps surae recovery to optimise rehabilitation and sports resumption. LEVEL OF EVIDENCE: IV, retrospective comparative cohort study.

The role of optical coherence tomography angiography in dome-shaped maculopathy.

PURPOSE: To demonstrate the role of optical coherence tomography angiography (OCT-A) in the management of dome-shaped maculopathy (DSM). METHODS: Retrospective case review. RESULTS: A 52-year-old woman was referred to our retina service for potential bilateral choroidal neovascular membrane (CNVM) and blurry vision bilaterally. Initial spectacle-corrected visual acuity (VA) was 20/30-2 in the right eye (RE) and 20/30+2 in the left eye (LE). DSM was diagnosed on OCT. In both eyes, OCT B-scan passing through the fovea showed shallow, irregular RPE elevation (SIRE) suspicious of occult (type 1) CNVM. The outer retina and choriocapillaris angiograms showed a zone of nonexudative CNVM in the RE and exudative CNVM in the LE. Given the persistent SRF with CNVM in the LE, we elected to perform intravitreal injections of ranibizumab 0.5 mg on a treat and extend regimen. Upon the most recent follow-up, the best corrected VA improved to 20/20 in the LE with no persisting SRF. CONCLUSION: We present a case where assessing disease progression, the development of CNVM and evaluating the efficiency of therapies were realized through the application of novel OCT-A technology. This diagnostic tool may be used to guide clinicians in their management of DSM, as demonstrated through our experience. OCT-A can also make it possible to visualize nonexudative CNVM lesions that may be missed on traditional imaging assessments.

Paracentral Acute Middle Maculopathy in Migraines with Aura.

Paracentral acute middle maculopathy (PAMM) has recently been described following episodes of migraine. In this report, we present a case of PAMM and describe the role of en face optical coherence tomography (OCT). A 75-year-old woman presented with subjective vision loss over a 2-week period in the right eye. She was known for migraines with aura that presented with progressive spreading of positive and negative visual phenomena which usually resolved in under an hour. Her recent migraine episode was "atypical," as it lasted 3 days. She also experienced a monocular central scotoma with "black spots and jagged, zig-zag edges." The positive auras resolved spontaneously, whereas the central scotoma persisted. Spectral domain OCT showed an area of perifoveal hyperreflectivity from the inner plexiform to the outer plexiform layers consistent with PAMM. The mid-retina en face OCT and OCT angiography demonstrated an ovoid focal patch of hyperreflectivity with flow interruption, characteristic of globular PAMM. We diagnosed her with migraines with aura and presumed retinal vasospasm, complicated by retinal ischemia in the form of globular PAMM. Acute retinal ischemia, which may require urgent neurovascular workup and giant cell arteritis evaluation, must be considered in patients with migraines alongside persistent visual changes. Diagnosing PAMM requires a high level of suspicion since it can present without significant changes in visual acuity, visual fields, and fundus photographs. With the inclusion of en face OCT in the clinicians' diagnostic armamentarium, the slightest signs of retinal ischemic changes, such as PAMM, become evident.

Functional and radiologic outcomes of non-displaced scaphoid waist fractures in adolescents approaching skeletal maturity: Comparison between conservative treatment and percutaneous screw fixation.

BACKGROUND: Treatment of scaphoid waist fractures is generally conservative in children but surgical in adults, given the relatively high risk of non-union in adults. In adolescents, the required therapeutic strategy is less well defined. The objective of this study was to compare the radiographic and clinical parameters, and the rate of complications, between non-surgical orthopedic treatment (OT) and surgical treatment (ST) by percutaneous screw fixation of these fractures in adolescents approaching skeletal maturity. HYPOTHESIS: ST of non-displaced scaphoid waist fractures in adolescents allows radiographic union, a functional result and a complication rate comparable to that of ST. METHODS: This single-center retrospective study included patients who presented with a non-displaced scaphoid waist fracture, with a chronological age (CA) and a bone age (BA) between 14 and 18 years. Clinical and radiographic parameters and complications were analyzed during the trauma and at one year, including functional scores, between two groups of patients; OT and ST. RESULTS: Thirty-seven patients had OT (63.8%) and 21 had ST (36.2%). The median CA was 16 years [14.25-16]. The median BA was 16 years [15;17] according to the Greulich and Pyle method and corresponded to R9 [R7-R10] and U7 [U7;U8] according to the Distal Radius and Ulnar (DRU) classification system. All non-unions were found in the OT group (23.4% vs. 0%, p=0.019). The duration of immobilization (8 weeks) and the number of consultations were higher after OT than ST. Functional scores were lower in patients with non-union after OT (p≤0.002) CONCLUSION: OT of scaphoid waist fractures in adolescents results in a higher rate of non-union than ST, similar to the rate found in adults. Findings from this study recommend a surgical approach by percutaneous screw fixation. LEVEL OF EVIDENCE: III; comparative retrospective study.

Recovery of leg strength based on isokinetic testing after tumor resection and reconstruction with a modular rotating hinge knee system: Prospective cross-sectional study with a minimum follow-up of 24 months.

BACKGROUND: While modular reconstruction implants can be used to replace the bone lost after bone tumor resection, tumor excision from the neighboring soft tissues can lead to loss of strength and joint range of motion (ROM), which results in worse knee function. Functional recovery after total knee arthroplasty for osteoarthritis has been extensively documented. But few studies have evaluated the recovery after total knee reconstruction following tumor excision despite the fact that most of these patients are young and have high functional demands. We did a prospective cross-sectional study to: 1) compare muscle strength recovery around the knee with an isokinetic dynamometer after tumor excision and reconstruction with a modular implant to the healthy contralateral knee; 2) determine if the differences in peak torque (PT) in the knee extensors and flexors had a clinical impact. HYPOTHESIS: Resection of soft tissues during tumor excision around the knee causes strength loss that cannot be fully recovered. METHODS: The 36 patients who underwent extra- or intra-articular resection of a primary or secondary bone tumor in the knee area followed by reconstruction with a rotating hinge knee system between 2009 and 2021 were eligible for this study. The primary outcome was the ability to actively lock the operated knee. The secondary outcomes were the concentric PT during isokinetic testing at slow (90°/sec) and fast (180°/sec) speeds, flexion-extension ROM, Musculoskeletal Tumor Society (MSTS) score, the IKS, Oxford Knee Score (OKS) and KOOS. RESULTS: Nine patients agreed to participate in the study, all of whom had regained the ability to lock their knee postoperatively. PT in flexion and extension on the operated knee was less than the healthy knee. The PT ratio for the operated/healthy knee at 60°/sec and 180°/sec in flexion was 56.3%±16.2 [23.2-80.1] and 57.8%±12.3 [37.7-77.4], respectively, which corresponded to a slow-speed strength deficit of 43.7% in the knee flexors. The PT ratio for the operated/healthy knee at 60°/sec and 180°/sec in extension was 34.3%±24.6 [8.6-76.5] and 43%±27.2 [13.1-93.4], respectively, which corresponded to a slow-speed strength deficit of 65.7% in the knee extensors. The mean MSTS was 70%±20 [63-86]. The OKS was 29.9/48±11 [15-45], the mean IKS knee was 149.6±36 [80-178] and the mean KOOS was 67.43±18.5 [35-88.7]. DISCUSSION: Despite all patients having the ability to lock out their knee, there was an imbalance in the strength between opposite muscle groups: 43.7% strength deficit at slow-speed and 42.2% at fast speed for the hamstring muscles, and 65.7% at slow-speed and 57% at fast speed for the quadriceps muscles. This difference is considered pathological with an increased risk of knee injury. Despite this strength deficit, this joint replacement technique, which is free of complications, can preserve good knee function with acceptable knee joint ROM and satisfactory quality of life. LEVEL OF EVIDENCE: III; prospective cross-sectional case-control study.

Osteoinductive Bone Morphogenic Protein, Collagen Scaffold, Calcium Phosphate Cement, and Magnesium-Based Fixation Enhance Anterior Cruciate Ligament Tendon Graft to Bone Healing In Animal Models: A Systematic Review.

PURPOSE: To perform a systematic literature review to analyze the results of the in vivo animal models and strategies that use osteoinductive materials to enhance the tendon graft-bone interface for anterior cruciate ligament reconstruction (ACLR). METHODS: Following the Preferred Reporting Items for Systemic Reviews and Meta-Analysis guidelines, the PubMed, Embase, and Web of Science databases were searched. The inclusion criteria were studies of in vivo animal models of ACLR using a material to enhance tendon graft-bone interface healing and reporting at least the histologic results at the interface, along with radiologic and biomechanical data. Studies without control group or with another tendon-bone healing model were excluded. Methodologic quality was assessed with the Animal Research: Reporting In Vivo Experiments 1guidelines. RESULTS: Twenty-seven studies met the inclusion criteria. Rabbit was the main animal model of ACLR, along with sheep and dog models. ACLR procedures varied widely between studies.. The main promising strategies and materials were wrapping the material around the graft, with a collagen scaffold loaded with an osteoinductive molecule (mostly bone morphogenetic proteins). The second strategy consisted of injecting the material at the tendon-bone interface; calcium phosphate cement or a derivative were the most used materials. Finally, using osteoinductive fixation devices was the third strategy; magnesium-based interference screws seemed to show most favorable results. CONCLUSIONS: The studies retained had major methodologic flaws that limit the scope of these conclusions. However, based on histologic, biomechanical, and radiologic analyses, the most promising materials were a collagen scaffold loaded with an osteoinductive molecule and wrapped around the graft, calcium phosphate cement injected in the bone tunnel, and a magnesium-based fixation device. CLINICAL RELEVANCE: In vivo animal models have identified several promising strategies and materials to optimize the tendon-bone interface after ACLR, but standardized and reproducible assessments are needed before these strategies can be adopted clinically.