[Mid-term results of Wallaby I posterior cruciate retaining total knee arthroplasty: a prospective study of the first 425 cases]. / Résultats à moyen terme de la prothèse totale du genou Wallaby I conservant le ligament croisé postérieur: à propos des 425 premiers cas suivis prospectivement.

PURPOSE OF THE STUDY: Posterior Wallaby I is a fixed polyethylene tibial plateau prosthesis enabling preservation of the posterior cruciate ligament (PCL). Its asymmetrical and divergent femoral condyles articulate with also asymmetrical tibial plateaus. The purpose of this prospective study was to analyze outcome of the first 425 Wallaby I prosthesis of the Guepar group implanted for first-intention treatment. MATERIALS AND METHODS: These 425 prostheses were implanted from December 1992 to February 1995 by senior and junior surgeons. Mean patient age at implantation was 70.5 years. 91% had primary or secondary osteoarthritis and only 8.9% had inflammatory rheumatoid disease. The mean preoperative IKS score was 25.34 points and the IKS function score was 29.04. 10.35% of knees were aligned normally (mechanical axis between 2 degrees varus and 3 degrees valgus) according to the IKS criteria (Ewald), 24% presented valgus > or = 4 degrees and 65.6% varus > or = 3 degrees. All tibial and patellar components (except one) were cemented, 5.8% of the femoral pieces were inserted without cement. All but 11 patellae were resurfaced. Clinical outcome was assessed with the IKS score and radiological outcome with the IKS criteria. The patella was considered to be tilted when the alpha angle was > 5 degrees and dislocated when the AA' distance was > 5 mm. The chi-square test was used for comparison of quantitative variables (significance set at 0.05). RESULTS: Early postoperative complications were rare: two infections cured with debridement-lavage and antibiotics without removal of the prosthesis, one peronal nerve palsy which regressed partially, ten late unions without clinical consequence (particularly in the inflammatory rheumatoid patients). Twenty-six prostheses were followed less than one year (eight patients died and eighteen were lost to follow-up) and 84 less than five years (27 patients died and 57 lost to follow-up before five years). 315 prostheses were followed for more than five years (5-9 years) with a mean follow-up of 6.3 years. Among the 399 prostheses followed for one year or more, we noted: four infections including three requiring change of the prosthesis (one cured by arthroscopic lavage), two aseptic loosenings which were revised (one global one tibial), one tibial loosening and three patellar loosenings which were not revised, and two femoral ossifications limiting joint motion but improved by arthrolysis and resection of the ossifications. Three patients experienced anterior pain requiring secondary patellar resurfacing in two and section of the lateral patellar wing in one. Ninteen patellar fractures (4.7%) were noted, including 17 with no significant functional impact which were not revised. The mean IKS knee score among prostheses followed for five years was 90.5 points, with mean motion 110.5 degrees. Mean IKS function score was 61.63 points. 72.9% of the knees were aligned, 22.2% in varus and 4.9% in valgus. The mechanical axis of 94.3% of the knees was between 5 degrees varus and 5 degrees valgus. Prosthesis survival at eight years (Kaplan-Meier method) was 97.7% considering all reasons for prosthesis removal and 98.5% for removal for aseptic loosening. CONCLUSION: This prospective multicentric study demonstrated that the results obtained with the Wallaby I prosthesis are as good as those obtained with other prostheses sparing the PCL and published in the literature. Preservation of the PCL enables better knee stability, correct motion (110.5 degrees in our series) with almost no radiological wear of the tibial polyethylene at eight years. The only worrisome complication is patellar fracture.

Avascular necrosis of the femoral head after allogenic bone-marrow transplantation. A retrospective study of 27 consecutive THAs with a minimal two-year follow-up.

After an allogenic bone-marrow transplant, avascular necrosis of the femoral head may affect young adults, producing destructive lesions which require hip replacement. We have reviewed 27 consecutive such total hip arthroplasties (THA) at a minimal follow-up of two years. Of these, 20 were primary operations for Ficat (1985) stage-III and stage-IV lesions, and seven were revisions after the failure of previous surgery. The median age at operation was 30 years (17.5 to 44). The prostheses had a cemented, collared titanium-alloy stem, an alumina-alumina joint, and a press-fit socket. Seven had a titanium-alloy metal back and 20 had all-alumina cups of which six had to be cemented. At an average follow-up of five years, no patient had been lost to follow-up. One had died from septicaemia after two years and another with chronic graft-versus-host disease developed a deep infection 2.5 years postoperatively and had a successful revision. There were no revisions for aseptic loosening. The clinical results on the Merle d'Aubigné++ and Postel (1954) scale were very good or excellent in 23 hips (88%), good in one and fair in two. Ten hips showed incomplete acetabular radiolucencies less than 1 mm thick, but there were no radiolucent lines around the stems. We conclude that for these difficult patients THA with ceramic joints and careful technique provides the best short- and medium-term option after the failure of medical treatment.

Hybrid alumina total hip arthroplasty using a press-fit metal-backed socket in patients younger than 55 years. A six- to 11-year evaluation.

Between 1990 and 1992, we implanted 71 hybrid alumina-on-alumina hip arthroplasties in 62 consecutive patients under the age of 55 years, with a mean age of 46 years at surgery. There were 56 primary and 15 secondary procedures. The prostheses involved a cemented titanium alloy stem, a 32 mm alumina head, and a press-fit metal-backed socket with an alumina insert. Three patients (four hips) died from unrelated causes. Four hips had revision surgery for either deep infection, unexplained persistent pain, fracture of the alumina head, or aseptic loosening of the socket. The nine-year survival rate was 93.7% with revision for any cause as the end-point and 98.4% with revision for aseptic loosening as the end-point. The outcome in the surviving patients (50 patients, 57 hips) with a minimum five-year follow-up (mean eight years) was excellent in 47 hips (82.5%), very good in eight (14%), good in one and fair in one. A thin, partial, lucent line, mainly in zone III was present in 38% of the sockets and one socket had a complete lucency less than 1 mm thick. One stem had isolated femoral osteolysis. There was no detectable component migration nor acetabular osteolysis. This hybrid arthroplasty gave satisfactory medium-term results in active patients. The press-fit metal-backed socket appeared to have reliable fixation in alumina-on-alumina hip arthroplasty. The excellent results using cemented fixation of the stem may be related to the low production of wear debris.

Alumina-on-alumina hip replacement. Results and survivorship in young patients.

Total hip replacement using an alumina head and socket and a titanium alloy stem is evaluated in a series of patients under 50 years of age. Between April 1977 and December 1986, 86 such replacements were performed in 75 patients, but mainly because patients had difficulty travelling from Africa, only 71 hips were followed up adequately; of these, 56 were primary procedures and 15 revisions. Survivorship analysis showed that 98% of the prostheses were retained for 10 years. On clinical and radiological examination 51 of the 71 hips were stable and acceptable, 15 had radiological changes on the acetabular side, and one on the femoral side; four other cases had clinical and radiological changes suggesting impending failure, possibly because fixation of the socket was inadequate. There were no differences between the results of the primary procedures and those of revisions. In these young patients, the results seem better with alumina-on-alumina hips than with other varieties, possibly because of their remarkably low wear.

Ceramic-ceramic and metal-polyethylene total hip replacements: comparison of pseudomembranes after loosening.

We made a semiquantitative study of the comparative histology of pseudomembranes from 12 loose cemented ceramic-ceramic and 18 metal-polyethylene total hip replacements. We found no significant difference in cellular reaction between the two groups, but there was a major difference in the origin of the particulate debris. In the metal-polyethylene group, polyethylene of articular origin was predominant, while in the ceramic-ceramic group the cellular reaction appeared to be a response to zirconia ceramic particles used to opacify cement used for fixation. Isolation and characterisation of the debris showed that the zirconia particles formed the greatest proportion (76%) in ceramic-ceramic hips, while alumina debris of articular origin formed only 12%. Our study has indicated that aseptic loosening of ceramic cups is not due to a response to debris generated at the articular interface, but to mechanical factors which lead to fragmentation of the cement.

Hydroxyapatite-coated versus grit-blasted femoral stems. a prospective, randomised study using EBRA-FCA.

We have carried out a prospective, randomised study designed to compare the long-term stability of the stem of cementless femoral implants with differing surface configurations. A total of 50 hips (46 patients) was randomised into two groups, according to whether the medullary stem had been grit blasted (GB) or coated with hydroxyapatite (HA). Both femoral prostheses were of the same geometrical design. We used Ein Bild Roentgen Analyse femoral component analysis (EBRA-FCA) to assess the stability of the stem. The mean follow-up was for 8.66 years. The mean migration of the stem was 1.26 mm in the HA group compared with 2.57 mm in the GB group (Mann-Whitney U test, p = 0.04). A mixed model ANOVA showed that the development of subsidence was statistically different in the two groups during the first 24 months. After this subsidence increased in both groups with no difference between them. Our results indicate that, with the same design of stem, HA coating enhanced the stability of the femoral stem when compared with GB stems.

[Treatment of anterior sternoclavicular dislocations. Apropos of 18 cases]. / Traitement des luxations sterno-claviculaires antérieures. A propos de 18 cas.

Eighteen cases of subluxation or dislocation of the sterno clavicular joint are reported. Six subluxations have been treated conservatively with prompt and good recovery. Out of twelve dislocations, three have not been operated on : two have recovered satisfactorily, after wiring and capsular suture (two recent cases) and after wiring and ligamentoplasty with palmaris longus (two old cases). But capsular suture and wiring gave only a fair result in one case of recurring dislocation, while tenodesis after Jackson Burrows gave excellent results in three cases. In recent cases, open reduction with wiring and capsular suture is advised, and tenodesis with subclavius, every time capsular suture is unsatisfactory and in all ancient and recurring cases, when troublesome.

[Measurement of carpal tunnel pressures in the idiopathic carpal tunnel syndrome without motor deficit]. / Mesures des pressions intra canalaires dans le syndrome du canal carpien idiopathique non déficitaire.

The pressure in the carpal tunnel was measured in ten patients suffering from purely painful carpal tunnel syndrome. Five normal individuals were also investigated as controls. It was shown that the pressure was always high in involved patients. A rise of pressure on flexion and extension of the wrist was much greater in patients than in controls. It is concluded that true compression plays the main role in carpal tunnel syndrome. A localised tenosynovitis was constantly found at operation. It was responsible for the rise of pressure inducing a functional ischaemia of the nerve.

[The role of peripheral capsulo-ligamentoplasties in the treatment of chronic anterior instability of the knee. Apropos of a series of 104 cases]. / La place des plasties capsulo-ligamentaires périphériques dans le traitement des instabilités antérieures chroniques du genou. A propos d'un série de 104 cas.

The authors have studied the results of 91 extra-articular ligamentoplasties amongst 104 knees treated surgically for chronic anterior laxity of the knee. The technique used in 40 cases was a Lemaire isolated lateral extra-articular ligamentoplasty using a strip of fascia lata and in 51 cases a double plasty, combining the same lateral plasty with a tightening of the posteromedial capsule and a forward transfer of the semimembranosus. The follow-up was from one to seven years, with a mean of four years. The results were assessed using the "ARPEGE" (Research Association for the Study of the Knee) scoring system, based on ability to undertake sports, functional stability, pain, resistance to fatigue, mobility and residual laxity. The overall results were excellent in 51 per cent, good in 10 per cent, fair in 10.5 per cent and bad in 28.5 per cent of cases. These results may seem to be unsatisfactory but a detailed study of the failures showed some errors in the indications for surgery which could have been avoided by a full appreciation of the type of laxity, the post-operative needs of the patient, his age and the level of sporting activity. Meniscectomy and lesions of the articular cartilage had a disturbing effect on the results. This study indicates a more precise place for extra-articular ligamentoplasties compared with in situ reconstructions of the anterior cruciate ligament.

[Arthroscopic release for knee joint stiffness after total knee arthroplasty]. / Arthrolyse arthroscopique du genou pour raideur après prothèse totale.

PURPOSE OF THE STUDY: Overall, the results of total knee replacement surgery are quite excellent, both with regard to pain and range of motion. Pain relief is obtained in more than 95% of the cases and more than 90% of the patients are able to bend their knee over 90 degrees. Nevertheless, in a small number of cases, stiffness can be an impairment. MATERIAL AND METHODS: Between 1992 and 1998, six arthroscopic releases were performed on six patients who had undergone total knee replacement. The six patients suffered from unacceptable stiffness. The average age of the patients was 68.5 years, and the time elapsed from implantation to arthroscopy averaged 24 months (6 months to 6 years). Average follow-up was 19 months (6 to 96 months). The six stiff knees were treated with arthroscopic debridement of fibrous tissue around the patella and quadriceps tendon (to improve extension) and by arthroscopic division of the medial and lateral retinacula (to address flexion). A gentle manipulation was carried out following lysis of adhesions, using a slight pressure on the tubercle to avoid fractures and disruptions of the extensor mechanisms. Postoperatively, immediate physical therapy was performed including continuous passive motion and active muscular contraction. Early weight bearing was allowed. RESULTS: The average flexion contracture decreased from 9 degrees prior to arthroscopy to 2.5 degrees at last follow-up. Average flexion increased from 70 to 100 degrees. Maximal improvement was obtained at three months. DISCUSSION: Results were found to be quite good, with a final knee score of 93 and a function score of 92 (following International Knee Society scoring). CONCLUSION: Arthroscopic release following total knee replacement complicated by joint stiffness provides a satisfactory increase in range of motion.

[Bilateral total hip prosthesis in osteopetrosis. Apropos of a case. Review of the literature]. / Prothèse totale de hanche bilatérale dans l'ostéopétrose. A propos d'un cas. Revue de la littérature.

PURPOSE OF THE STUDY: The authors report an original case of Albers-Schönberg's disease and describe its surgical treatment. MATERIAL: Comparison between roentgenogram of the pelvis at the age of 9 and 46 years showed the original evolution of coxa vara in a case of osteopetrosis. A 46 year old male had severe pain and instability in both hips related to numerous problems consisting of: 1) on the right side: subtrochanteric femoral non-union after repeated fractures, head and neck femoral disappearance associated to dislocation. 2) on the left side: acetabular dysplasia, osteoarthritis and subtrochanteric femoral fracture that had fusionned. Total hip arthroplasty was performed on both hips. RESULT: Clinical result was good in both hips (PMA score = 6-6-4) at the latest follow-up (four years on the left side and three years and four months on the right side). The surgical procedures were difficult because of the hardness and brittle character of the bony substance and because of non unions and deformities. Special care was required to avoid shattering femoral diaphysis and false routes during creation of a new medullary canal. CONCLUSION: Total hip prosthesis represents a functionnal salvage procedure in patients with Albers-Schönberg's disease.

[Total arthroplasty of the hip with a screwed titanium ring cup. Follow-up of 446 prostheses over four years]. / Arthoplastie totale de hanche avec anneau cotyloïdien en titane vissé. Devenir de 446 prothèses avec un recul moyen de 4 ans.

The current decrease of total hip arthroplasty using a cemented polyethylene cup point out that bone-cement interface and polyethylene wear are two weak points responsible for long term loosening. Alumina-alumina combination can avoid one of the weak points. But fixing an alumina cup with cement doesn't avoid the second one. So from 1983 we have been using a cup composed by a titanium alloy threaded ring with an alumina insert. From the 508 prosthesis we fixed in between 1983 and 1989, 446 have been followed up over one year with an average follow-up 4 +/- 1.6 years. The patients mean age was 61.7 +/- 12 years. 368 were primary THA performed mostly for osteoarthrosis, 78 were performed in revision cases of cemented cup. All the femoral stems were cemented, we noted only two loosenings. The clinical results were satisfactory in primary arthroplasties (90.7 per cent satisfactory results in the R. Merle d'Aubigné and M. Postel scoring system), whereas in revision cases of cemented cups the percentage of non satisfactory results (32.8 per cent) was very high. Nevertheless migration rate of the threaded rings was 13 per cent (n = 48/368) in primary operation. 8.11 per cent when no structural graft was needed, 22.8 per cent when grafted. Although only 17/48 have been revised up to now, the future of the last 31 remain uncertain. In our opinion, the threaded cup should not be used in revision cases of cemented cups. The long term fixation of a threaded cup remains a problem for the dysplasic acetabula. For the non dysplasic non operated acetabula the migration factors are statistically: female sex, osteoporosis whatever the aetiology, a wrong primary positioning (cup too vertical, protrusio). For all these reasons, from 1989 we have been using a press-fit titanium cup, with promising results.

[Single-compartment "Lotus" type knee prosthesis in the treatment of lateralized gonarthrosis: results in 135 cases with a mean follow-up of 4.6 years]. / Prothèses unicompartimentaires du genou type "Lotus" dans le traitement des gonarthroses latéralisées: résultats de 135 cas avec un recul moyen de 4.6 ans.

Controversy exists on the indications and results of unicompartmental arthroplasty in the treatment of unicompartmental knee arthritis. This led us to study 135 Lotus prostheses implanted from December 1974 to February 1990. The follow-up lower than 1 year for 14 knees (11 were lost to follow-up, 3 were reoperated). One hundred and twenty-one knees were clinically evaluated with an average follow-up of 4 years and 6 months using both the GUEPAR and the Knee society grading systems. 71.9 per cent of the knees were rated good, 28.1 per cent were rated poor (19 per cent were revised). This important rate of poor results was due to poor technique (11 knees) and to poor indications (7 knees). Polyethylene wear, and radiolucent line especially when it was evolutive were significantly correlated to failures and poor results. Failures were seldom unifactorial but often multifactorial. Over or undercorrection of coronal deformity, absence or lengthening of the anterior cruciate ligament were the failure factors most often found. Decrease of good results with time, and polyethylene wear of unicompartmental arthroplasties are factors which lead us to carefully consider osteotomy for patients under 65 years. The failure rate may decrease with good indications and a better technique allowing unicompartmental arthroplasty to be a good choice for unicompartmental arthritis.

[Results of Marshall-MacIntosh reconstruction according to 3 scoring systems (ARPEGE, Lysholm, IKDC). 90 cases reviewed with at least a one-year follow-up]. / Etude des résultats de l'intervention de Marshall-MacIntosh selon trois systèmes d'évaluation (ARPEGE, Lysholm, IKDC). 90 cas revus avec un recul d'au moins un an.

The "International Knee Documentation Committee" (IKDC) evaluation form was created in 1992 in order to make easier the comparison of the results obtained in the U.S. and Europe in the knee ligament surgery using various procedures. In order to evaluate the performances of the IKDC system, it has been applied to the analysis of the results of 90 Marshall-MacIntosh ACL augmented-reconstructions, all having at least one year follow-up, and compared to the ARPEGE and Lysholm-Tegner systems. All 3 systems have in common a functional activity scale, nevertheless only the IKDC system takes into consideration the ligament examination. In this system, the assessment of the overall result is based on the combination of 4 parameter groups (patient subjective assessment, symptoms, range of motion, ligament examination). The lowest grade within a group determines the group grade. The worst group grade determines the final evaluation. According to the ARPEGE system, 79 per cent of good and excellent results were observed. This percentage increased up to 92.5 per cent with the Lysholm-Tegner system, and up to 82 per cent with the IKDC system. There was a positive and significant correlation between the IKDC system and the two others. The final result, when evaluated with the IKDC system, first depends on the ligament examination, while with the two other systems, pain appears to be the predominant parameter.

[Radiologic and MRI evaluation of intra-articular ligamentoplasty using a patellar tendon. Correlations with anatomical results]. / Evaluation radiologique et IRM des ligamentoplasties intra-articulaires utilisant le tendon rotulien. Corrélations avec les résultats anatomiques.

INTRODUCTION: the purpose of this study was to evaluate the influence of the graft positioning on the clinical outcome and MRI signal of the graft as well, following ACL reconstruction using the central one-third of the patellar tendon. MATERIAL AND METHODS: twenty one patients having a chronic anterior instability sustained a modified Marshall-Mac Intosh procedure, while 15 having a subacute torn ACL had an ACL reconstruction using a free bone-patellar tendon-bone graft. The patients were retrospectively reviewed with a 1.8 year average follow-up (1-3 years). The clinical result was evaluated through the comparative range of motion, the residual laxity as measured with the KT 1000 arthrometer, and the pivot shift test. The roentgenographic analysis was performed from AP and ML views, made first on one-leg standing with the knee at 30 degrees of flexion, and then in "zero" extension with active quadriceps contraction. Lines were drawn to visualise the location of the tibial and femoral tunnels in relation to the tibial plateaus and the roof of the intercondylar notch represented by the Blumensaat line. The analysis of the AP IRM views of the graft allowed to discriminate between homogeneous and heterogeneous graft signals. RESULTS: on lateral roentgenograms of normal knees it was found that the Blumensaat line crossed the surface of the medial tibial plateau at its anterior third, at 30 +/- 9 per cent (20-40 per cent range), demonstrating the variability of the intercondylar roof inclination. The range of motion was normal in 22 patients (group 1), 8 patients had a flexion deficit (group II), and 6 exhibited an extension deficit (group III). The residual laxity was similar in each group (p > 0.05). When comparing group III to group I, patients from group III had a tibial tunnel significantly more anterior with regard to the Blumensaat line (p < 0.02). In group III, all patients exhibited an heterogeneous MRI graft signal (p < 0.05), and the angle between the intraarticular part of the graft and the tibial tunnel was higher (p < 0.001). These findings were not observed in group II where the location only of the femoral tunnel seemed to influence the flexion deficit (p > 0.05). DISCUSSION AND CONCLUSION: this study demonstrated that the location of the tibial tunnel with regard to the roof of the intercondylar notch, when the knee is in "zero" extension, was the most relevant parameter controlling the extension deficit resulting from a graft impingement. No relation was found between the tibial tunnel location with regard to the tibial plateaus and the mobility deficit. Graft impingement also was always associated with an heterogenous graft MRI signal. CLINICAL RELEVANCE: when reconstructing the ACL care must be taken when inserting the K-wire aimed to guide the tibial drill, to obtain a proper position with regard to the roof of the intercondylar notch. The K-wire location must be checked in "zero" extension. Intra-operative X-rays may help.

[Arthrodesis of the shoulder in paralysis of the brachial plexus. Apropos of 2 cases]. / Arthrodèses d'épaule dans les paralysies du plexus brachial. A propos de 23 cas.

Twenty-three shoulder arthrodeses after brachial plexus injuries have been performed. Average time between injury and arthrodesis was 3.4 years. 18 patients had palliative procedures or direct approach of the brachial plexus to improve shoulder and hand function. Average follow-up was 5 years and 11 months. An analysis based on pain, function, and fusion occurrence gave 15 good, 2 fair and 4 poor results. The authors conclude that the shoulder arthrodesis is indicated when elbow and hand functions are sufficient and deafferentation pain has not occurred.

[Experimental capsulo-ligamentar lesions of the knee during passive hyperextension. Biomechanical aspects. A lesional evaluation and consequences]. / Lésions expérimentales capsulo-ligamentaires du genou en hyperextension passive. Aspects biomécaniques. Bilan lésionnel et conséquences.

PURPOSE OF THE STUDY: Passive hyperextension is a rare mechanism of injury of knee ligaments in clinical practice. The lesions are often complex and no consensus exists about their sequence. Our purpose was to study the mechanical behavior and the anatomical lesions of the knee following passive hyperextension until rupture. MATERIAL AND METHODS: 12 pairs of fresh human cadaveric knees were tested after resection of soft tissue except for the ligaments and the Popliteus muscle. Some of them had specific ligaments sections (PCL or posterior capsule). We used a "four point bending" model at a constant rate (V = 3 10E-4 m/s) and measured failure torque and bending stiffness of the knee. Results were expressed as percent of the response of the normal contra lateral knee. RESULTS: A wide range of absolute data was noted and correlated to the age and bone quality. Bony avulsion was constant. The posterior capsule was the first structure injured at an average of 23 degrees of recurvatum, followed by the posterolateral ligament. The PCL was the ultimate structure to fail at its femoral attachment, preceding complete dislocation of the knee. No ruptures of the ACL and medial collateral ligament were noted. After section of the posterior capsule, the stiffness of the knee decreased 40 to 80 percent compared to the normal opposite knee, whereas the isolated section of the PCL had no significant effect. DISCUSSION: The method used in this study appears reliable. "The four point bending" is a reproducible model and the use of paired specimens allows a quantitative approach. The use of elderly specimens at a low strain rate in this experiment remains a questionable point. Passive hyperextension is characterized by automatic external rotation resulting in asymmetrical posterior lesions and tears of the PCL at its femoral attachment. On the contrary, active hyperextension of the knee can produce ACL injury by anterior translation of the tibia under the femur consecutive to Quadriceps femoris contraction. CONCLUSION: Our experimental model is an effective and reproducible method to create passive hyperextension of the knee. The first structure to fail is the posterior capsule followed by the posterolateral ligament. The PCL is the ultimate structure to fail and no ACL rupture has been noted before dislocation. CLINICAL RELEVANCE: if passive hyperextension mechanism is suspected, isolated posterior capsule lesion may occur and should be repaired. On the contrary, PCL tear should never be isolated and always associated with peripheral ligament injuries.

[Reduction of old unreduced anterior dislocations of the shoulder (author's transl)]. / Reposition avec plastie du long biceps dans les luxations antérieures invétérées de l'épaule.

The authors have reviewed 15 old unreduced anterior dislocations of the shoulder. Most of the results were poor after resection or surgical reduction with reefing of the capsule. In two cases the technique described by Boyd was employed. After open reduction, the joint was stabilised by a transplant of the long head of biceps which was attached to the clavicle after passing in front of the joint behind subscapularis. This technique allows an early mobilisation and gave good results in two cases.

[Percutaneous arthrolysis under arthroscopic control and manipulation under anesthesia in the treatment of postoperative stiffness of the knee]. / L'arthrolyse percutanée sous contrôle arthroscopique et la mobilisation sous anesthésie dans le traitement des raideurs post-opératoires du genou.

In the post-operative management of surgery of the knee complicated by stiffness, the results of manipulation under anaesthesia and percutaneous release of adhesions under arthroscopy have been compared in two groups of twenty and twenty-four patients. The two groups were identical in age, 32 years, in the cause, which was ligamentous surgery in 85 per cent and in their level of activity. Arthroscopic release was performed in 90 per cent of cases under continuous peridural anaesthesia whilst manipulations were performed under general anaesthesia in 75 per cent of cases. The mean duration of follow-up was 13 months in arthroscopic releases and 29 months in manipulations. Pre-operative limitation of flexion to 57 degrees in arthroscopic releases and 67 degrees in manipulations under anaesthesia improved to 124 degrees and 134 degrees respectively at the last follow-up. The speed of recovery proved to be twice as rapid in patients with arthroscopic release - 3.2 months compared with 6.1 months for straightforward manipulations. Manipulations under anaesthesia were followed by 6 patello-femoral syndromes (30 per cent) whilst arthroscopic release only had 4 syndromes (18 per cent). Arthroscopic releases and manipulations under anaesthesia made before the end of the third month after operation gave better results than those performed later. However, arthroscopic release can be done very late compared with manipulation under anaesthesia and avoids the need for surgical arthrolysis.

[Principles and value of isokinetic evaluation in ruptures of the anterior cruciate ligament]. / Principes et intérêt de l'évaluation isocinétique dans les ruptures du ligament croisé antérieur.

Isokinetic muscular evaluation allows to appreciate the knee joint functional patterns in conditions close to sports activities. Analyzing bilateral symmetry and agonist/antagonist ratios of the lower extremity, this method is a useful index for the objective evaluation of ligament-deficient knees. 106 patients with a chronic ACL deficient knee sustained a presurgery isokinetic evaluation. 94 patients had a post-operative evaluation and 13 a pre and post-surgery evaluation. All patients were simultaneously evaluated by clinical examination and measures of instrumental knee laxity (KT 1000). Results showed that isokinetic performance was not correlated to the objective laxity as measured with the KT 1000 but was correlated to 1) the type of laxity (i.e. associated postero-lateral laxity), 2) the functional level of activity, and 3) the time of disability. Best functional results were obtained in patients whose injured knee hamstring/quadriceps (H/Q) ratio was close to the uninjured knee H/Q ratio. The mean quadriceps deficit was over 15 per cent for 75 per cent of the patients one year after surgery, and for 50 per cent of the patients after two years. The quadriceps deficit was not parallel to the length of the autograft taken from the extensor mechanism. Isokinetic evaluation is a guideline for rehabilitation allowing specific strengthening of the weaker muscular groups.