Long-Term Results for Treatment of Chronic Ankle Instability With Fibular Periosteum Ligamentoplasty and Extensor Retinaculum Flap.

Long-term results of anatomic reconstruction for chronic ankle instability are good, but no study has shown the results of fibular periosteum ligamentoplasty associated with extensor retinaculum flap at long-term follow-up. To demonstrate the efficacy of fibular periosteum ligamentoplasty and extensor retinaculum flap in chronic lateral instability, 40 patients underwent surgery for ankle instability. Thirty-three (82.5%) patients were reviewed, with a median follow-up duration of 8.2 (range 4 to 13) years. Functional results were assessed using the Karlsson score. Static and dynamic x-ray images were realized to measure varus tilt and anterior drawer, and osteoarthritis was evaluated with the van Dijk classification. The median Karlsson score was 95 (range 80 to 100). The mean decrease in varus laxity was 11° (range 0 to 18) and in anterior drawer was 1 (range -8 to 4) mm. At the last follow-up visit, 3 (7.5%) patients showed an evidence of osteoarthritis according to the preoperative criteria of the van Dijk classification (grade 2) and 6 (15%) patients had radiologic changes, without narrowing of the joint space (grade 1). Studies that have a follow-up time >5 years are rare. This study shows that despite the excellent control of ankle laxity, severe radiographic changes (grade 2) continue to evolve in the long term. This study indicates a good long-term outcome but suggests the need to monitor the occurrence of osteoarthritis over the long term.

Recurrent posterior knee laxity: diagnosis, technical aspects and treatment algorithm.

PURPOSE: Aim of this study was to determine the characteristics, clinical and radiological diagnostic methods of PCL isolated and combined knee injuries. METHODS: One hundred and twelve patients with a recurrent posterior knee laxity were surgically treated. Clinical examination, MRI, Telos™ stress dynamic X-rays, KT-1000 measurements and the IKDC questionnaire were used to diagnose and evaluate these injuries. RESULTS: Median follow-up was 4.5 years (2-11 years). Thirty-two patients (28.6 %) had an isolated posterior laxity, 53 (47.3 %) a posterior posterolateral laxity, 21 (18.7 %) a posterior posteromedial laxity and six (5.4 %) patients had a complex posterior and mediolateral laxity. Road traffic accidents and sports injuries were the main causes of trauma. The mean preoperative value of posterior tibial translation was 13.5 mm (SD 1.4) and the mean postoperative value was 4.4 mm (SD 1.7) as measured with the Telos device. In the cases with a concomitant ACL rupture, the mean preoperative value of anterior tibial translation was 6.5 mm (SD 1.3) and the mean postoperative value was 1.7 mm (SD 0.8). The mean pre- and postoperative IKDC scores were 74.5 (SD 4.2) and 87.9 (SD 3.1), respectively. Meniscal and/or cartilage injuries were found in 80 patients (71.4 %). CONCLUSIONS: Recurrent posterior knee laxity can be restored with the one-stage PCL reconstruction using a quadriceps graft and reconstruction of the posteromedial-posterolateral lesions using the LaPrade techniques. The benefits of this study include enabling surgeons to accurately manage these injuries from a clinical perspective, and treating them with a specific surgical algorithm. LEVEL OF EVIDENCE: III.

Graft position and fusion rate following arthroscopic Latarjet.

PURPOSE: The arthroscopic Latarjet procedure is recently becoming an increasingly popular technique. Nevertheless, position and fusion of the autograft had not been well studied yet. The purpose of this study was to assess the positioning of the coracoid graft and the fusion rate on CT scan in the arthroscopic Latarjet procedure. METHODS: The study design was a prospective series of 19 consecutive patients who received arthroscopic Latarjet procedure. Radiological assessment on CT scan performed 3 months post-operatively included an analysis of the fusion and the position of the coracoid bone graft using a validated method. 02:30-04:20 was considered an ideal positioning in the sagittal view. In the axial view, the positioning was considered as flush, congruent, medial, too medial, or lateral. RESULTS: The median age of patients was 27.6 (±6.9). Mean operative time was of 161 min ±34.8. The fusion rate was of 78 %. Coracoid grafts were positioned 01:52 h (56° ± 14°) to 4:04 h (122° ± 12.5°). In the axial view, 32 % of the grafts positioning were considered as flush, 38 % as congruent, 30 % as medial, and 6 % too medial. No lateral position was noted. Two complications occurred, one graft fracture during screwing requiring opening conversion and an early case of osteolysis in a medial-positioned graft. CONCLUSION: The arthroscopic Latarjet procedure is a technically challenging technique that provides satisfactory fusion rate and graft positioning with a low complication rate. The clinical importance of this study lies in the observation that it is the first study to evaluate the position of the coracoid bone graft in arthroscopic Latarjet according to a detailed and validated method. LEVEL OF EVIDENCE: IV.

Injuries in judo: a systematic literature review including suggestions for prevention.

BACKGROUND: There is limited knowledge on epidemiological injury data in judo. OBJECTIVE: To systematically review scientific literature on the frequency and characteristics of injuries in judo. METHODS: The available literature up to June 2013 was searched for prospective as well as retrospective studies on injuries in judo. Data extraction and presentation focused on the incidence rate, injury risk, types, location and causes of injuries. RESULTS: During the Olympic Games in 2008 and 2012, an average injury risk of about 11-12% has been observed. Sprains, strains and contusions, usually of the knee, shoulder and fingers, were the most frequently reported injuries, whereas being thrown was the most common injury mechanism. Severe injuries were quite rare and usually affected the brain and spine, whereas chronic injuries typically affected the finger joints, lower back and ears. The most common types of injuries in young judo athletes were contusions/abrasions, fractures and sprains/strains. Sex-differences data on judo injuries were mostly inconsistent. Some studies suggested a relationship between nutrition, hydration and/or weight cycling and judo injuries. Also, psychological factors may increase the risk of judo injuries. CONCLUSIONS: The present review provides the latest knowledge on the frequency and characteristics of injuries in judo. Comprehensive knowledge about the risk of injury during sport activity and related risk factors represents an essential basis to develop effective strategies for injury prevention. Thus, the introduction of an ongoing injury surveillance system in judo is of utmost importance.

High-level judo practice after hip resurfacing.

BACKGROUND AND HYPOTHESIS: The ability to participate in sports after hip arthroplasty is increasingly being requested by patients. The possibilities of participating in sports such as judo after hip arthroplasty have not been explored sufficiently even though these sports are associated with a high risk of loosening, dislocation or revision. The aim of this study was to evaluate the return to judo after hip resurfacing arthroplasty (HRA) in terms of time and level of practice in an expert population and to determine the surgical complication rate. MATERIALS AND METHODS: This was a retrospective observational study of all licensed judo practitioners at an expert level (≥black belt 3rd Dan) who underwent HRA. Patients filled out a sport-specific questionnaire that captured their level of judo practice (international, national, regional, recreational), type of practice (teaching, technical recreational, competitive recreational), dan grade, weekly volume of practice and time elapsed after surgery before resuming judo. The features of the return to judo were analyzed (technical, ground, combat). RESULTS: Sixty-seven HRA were implanted in 60 patients: 11 were international judokas, 3 were national, 8 were regional and 38 were recreational. The case series consisted of 18 patients who were 3rd Dan, 18 were 4th Dan, 7 were 5th Dan, 5 were 6th Dan and 12 were 7th Dan. The average follow-up was 65.3 months (range 9.9-11.9). All the clinical scores pointed to clinically and statistically significant improvement. Of the 60 patients, 53 had resumed judo at the final assessment (90%) after a mean of 4 months (2-7) for technical judo, 6 months (3-10) for ground judo and 7 months (3-12) for combat judo. Of those who did not resume their judo practice, 3 patients voluntarily changed sports, 2 had psychological apprehension and 2 had residual groin pain. The weekly volume of practice preoperatively was 0.9hours (0-5) and postoperatively it reached 5hours (2-18) (P<0.001). CONCLUSION: HRA in a population of high-level judokas allows for return to sport practice without short-term complications such as fracture, dislocation or loosening. LEVEL OF EVIDENCE: III.

Very long-term osteoarthritis rate after anterior cruciate ligament reconstruction: 182 cases with 22-year' follow-up.

BACKGROUND: Few data are available on the 20-year outcomes of anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to assess the prevalence and risk factors of knee osteoarthritis at least 20 years after ACL reconstruction. HYPOTHESIS: Factors associated with progression to knee osteoarthritis include meniscal lesions, level of physical activity, injury-to-surgery time, body mass index, residual laxity, tunnel position and cartilage injury. MATERIAL AND METHODS: One hundred and eighty two patients were included in a multicentre retrospective study conducted in the setting of a SoFCOT symposium. Females contributed two-thirds of the study population. ACL reconstruction was performed arthroscopically in 82% of cases, and a bone-patellar tendon-bone transplant was used in 92.8% of cases. Mean age at surgery was 26±7years. Clinical outcomes were assessed based on the objective and subjective IKDC scores and on the KOOS. Radiographic evidence of osteoarthritis was classified according to the IKDC. Factors evaluated for their ability to predict progression to osteoarthritis included age, sex, body mass index, level of physical activity, injury-to-surgery time, meniscectomy, cartilage injury, tunnel position and residual laxity. RESULTS: At last follow-up, the objective IKDC score was A (normal) for 48%, B for 35%, and C or D for 17% of the knees. The mean subjective IKDC score was 82.7±13.1. Moderate-to-severe osteoarthritis was present in 29% of cases. The following risk factors for osteoarthritis were identified: medial or lateral meniscectomy, residual laxity, age >30years at surgery, and engaging in a pivoting sport. Meniscectomy was a major contributor to the development of osteoarthritis (17% of knees without vs. 46% with meniscectomy). Finally, the ACL re-tear rate was 13%. CONCLUSION: ACL reconstruction provides satisfactory knee stability. The risk of subsequent osteoarthritis depends chiefly on the status of the menisci. Residual laxity is also associated with the development of osteoarthritis. LEVEL OF EVIDENCE: IV, retrospective cohort study.

Complications After Anterior Cruciate Ligament Reconstruction and Their Relation to the Type of Graft: A Prospective Study of 958 Cases.

BACKGROUND: Complications and adverse events after anterior cruciate ligament (ACL) reconstruction are well known, but they have been underestimated in previous studies. PURPOSE: To describe the complications and adverse events after ACL reconstruction within a 2-year follow-up and analyze them in relation to the type of graft. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: From 2000 to 2012, 958 patients with an isolated ACL injury underwent surgery by a single knee surgeon. ACL reconstruction was performed with the medial portal technique for the femoral tunnel and the use of bone-patellar tendon-bone (BPTB) or hamstring tendon graft. Patients were reviewed at 6 weeks and 3, 6, 12, and 24 months after surgery with the International Knee Documentation Committee score, plain radiographs, and the KT-1000 arthrometer. RESULTS: Of 958 patients enrolled, 147 (15%) were lost at last follow-up. The 2 groups (bone-patellar tendon-bone [n = 257] and hamstring [n = 554]) were similar regarding the mean age at the time of surgery and preoperative anterior laxity. The main complications were as follows: anterior knee pain (n = 130 of 811, 16%), stiffness (n = 72, 8.8%), secondary meniscal lesions (n = 59, 7.2%), pain attributed to fixation (n = 79, 9.7%), ACL rerupture (n = 47, 5.7%), contralateral ACL ruptures (n = 24, 3%), patellar fractures (n = 3, 0.3%), infections (n = 9, 1%), and thromboembolic complications (n = 5, 0.6%). There was no significant difference between the grafts with respect to the frequency of joint stiffness, secondary meniscal lesions, or anterior knee pain. During the first 2 postoperative years, the percentage of patients with anterior knee pain was higher in the patellar tendon group (23.3% vs 12.6%, P < .001); however, this difference was not significant after the 2-year interval (3.1% vs 2.5%, P = .63). The percentage of patients with a rerupture of the graft was significantly lower in the patellar tendon group than in the hamstring group (25 of 811 [3.1%] vs 57 of 811 [7%], P = .023). Similar results were recorded regarding the pain related to the hardware material (7 of 811 [0.8%] in the BPTB group vs 113 of 811 [13.9%] in the hamstring group, P = .001). The percentage of ACL ruptures contralateral to the repair was higher in the patellar tendon group (41 of 811 [5%] vs 17 of 811 [2%], P = .016). CONCLUSION: The total rate of complications after an ACL reconstruction was 39%, and the surgical revision rate for any reason was 28%. Problems with the hardware material were more frequent in the hamstring group, leading to an increased rate of surgical revision. Anterior knee pain was initially higher in the patellar tendon group, but there was no significant difference in a 2-year interval. The rerupture rate was statistically higher in the hamstring group.

Epidemiology of Judo-Related Injuries in 21 Seasons of Competitions in France: A Prospective Study of Relevant Traumatic Injuries.

BACKGROUND: Judo is a full-contact fighting sport that may lead to severe injuries. There are limited data available on the incidence of judo-related injuries. The French Judo Federation has established a surveillance system to document the frequency and type of injuries during judo competitions. PURPOSE: To describe the incidence rates and types of judo-related traumatic injuries during 21 seasons of competitions in France with respect to athlete (judoka) age, sex, and level of performance. STUDY DESIGN: Descriptive epidemiology study. METHODS: Between 1993 and 2014, each physician in charge of each judo competition filled out a form in which he/she documented the number of competing judokas, the number of fights, the number of medical interventions, the specific type of traumatic injuries for each intervention, the number of fight interruptions, and the number of athletes removed from the competition venue because of an injury. The age, sex, and level of performance of each judoka were also documented. Variance analysis was applied to assess whether differences in incidence rates of injuries between groups were significant (Student t test and chi-square test). RESULTS: Surveillance of 421,670 fights demonstrated 3511 injuries in 316,203 judokas (incidence proportion, 1.1%). Among the injuries recorded, the most common were sprains (54.3%), fractures (15.6%), and dislocations (12.5%). Female athletes exhibited significantly higher incidence rates for knee sprains and elbow dislocations, whereas male athletes exhibited a higher incidence rate for shoulder dislocations (P < .001 for all). Regarding age, higher incidence rates were observed in young adults (aged 18-20 years) for acromioclavicular sprains and in children (aged 10-14 years) for clavicle fractures compared with adults (aged 21-35 years) (P < .001 for both). Both young adult and adult athletes had a higher incidence rate of shoulder dislocations (P < .001). Regarding the level of performance, athletes competing at higher levels had a higher incidence rate of sprains to the knee (P < .001). CONCLUSION: During 21 years of surveillance of injuries in judo competitions in France, the incidence proportion of injuries was 1.1%. Significant differences in incidence rates demonstrated when considering age, sex, and level of performance may help in developing strategies to prevent traumatic injuries in the future.

Functional outcomes and return to sports after surgical treatment of insertional Achilles tendinopathy: Surgical approach tailored to the degree of tendon involvement.

INTRODUCTION: Insertional Achilles tendinopathy is a generic term that encompasses several types of ailments. While conservative treatment is less effective than for conditions isolated to the tendon body, there is no consensus as to the best type of surgical care. HYPOTHESIS: Surgical treatment for insertional Achilles tendinopathy that is tailored to the severity of the tendon involvement will lead to satisfactory functional outcomes. MATERIAL AND METHODS: Forty-six patients were included with an average age of 44.1±11.4 years and a mean preoperative AOFAS score of 62.2±11.7. The mean duration of symptoms before the surgery was 33.1±24 months. The inclusion criteria were pain at the tendon insertion and failure of at least 6 months of conservative treatment. Tendon involvement was evaluated preoperatively using MRI and confirmed intraoperatively after debridement. The primary treatment in all patients was resection of the calcaneal abnormality. Depending on the degree of tendon involvement, debridement or detachment/reattachment were also performed. The minimum follow-up was 12 months. RESULTS: The mean follow-up was 33±13.5 months. None of the patients were lost to follow-up. The mean AOFAS score was 93.7±7.3 at the last follow-up. The ATRS and VISA-A scores were 89.2±4.1 and 89±3.2, respectively. The sports participation level was the same or higher in 71.7% of cases. Increased preoperative passive dorsiflexion was statistically correlated with the degree of tendon involvement. CONCLUSION: Surgery for insertional Achilles tendinopathy led to good functional outcomes and satisfactory return to sports when the surgical care was tailored to the sdegree of tendon involvement. LEVEL OF EVIDENCE: IV.

[Management of shoulder instability]. / Prise en charge de l'instabilité de l'épaule.

Management of shoulder instability. Shoulder instability is a commonly encountered problem in young active athletes. Instability is most often due to a traumatic gleno-humeral dislocation. The diagnosis is based on clinical apprehension tests and on diagnostic imaging. Most frequent lesions are Bankart lesion and Hill-Sachs injury. Shoulder instability could be managed conservatively with rehabilitation or surgically. The therapeutic indication should be discussed taking into account several criteria such as: traumatic versus atraumatic mechanisms, hyperlaxity, age, number of dislocations, type of work and sports activities and the presence of associated lesions.

Prise en charge de l'instabilité de l'épaule. L'instabilité de l'épaule est une pathologie fréquente qui touche le plus souvent des hommes jeunes et sportifs. Il s'agit le plus souvent d'une instabilité post-traumatique au décours d'une luxation gléno-humérale complète. Le diagnostic positif repose sur les tests cliniques d'appréhension ainsi que sur la réalisation d'examens d'imagerie. Les lésions les plus fréquentes sont la lésion de Bankart et l'encoche de Malgaigne. Cette instabilité peut faire l'objet d'un traitement conservateur avec rééducation ou d'un traitement chirurgical. La stratégie thérapeutique est définie en fonction du caractère traumatique ou atraumatique de l'instabilité, de la présence d'une hyperlaxité ligamentaire généralisée, de l'âge, du nombre d'épisodes de luxation, de l'activité professionnelle et sportive du patient et de la présence de lésions associées.

Spontaneous Knee Ankylosis through Heterotopic Ossification after Total Knee Arthroplasty.

This paper reports on a case of total ankylosis of the knee after a cruciate-sacrificing cemented total knee arthroplasty (TKA). An 82-year-old female patient previously underwent primary TKA for osteoarthritis twenty years ago in our institution. She had recovered uneventfully and returned to her regular activities. There was no history of postsurgical trauma; however, she progressively lost knee range of motion. Radiographs revealed severe bridging heterotopic ossification.