The position of the upper limb during shoulder arthroscopy does not affect the distance between axillary nerve and glenoid.

PURPOSE: The segment of the axillary nerve (AxN) near the glenoid rim is at risk of iatrogenic lesion during arthroscopic procedures. We hypothesize that the distance between the AxN and the glenoid rim is not modified by the patient's positioning. The primary objective was to compare the position of the AxN with the inferior glenoid rim in lateral decubitus or in beach chair and positions of the upper limb. METHODS: Sixteen shoulders were dissected in beach chair position with the shoulder in neutral rotation. Needle one was placed in the axillary nerve where it was the closest with the inferior glenoid rim. In lateral decubitus with traction and 70° of abduction needle two was placed in the AxN at the closest with the inferior glenoid rim. The glenoid rim was marked with a needle at 6 o'clock. In beach chair position, the distance between needle one and the glenoid needle was measured for six positions. In lateral decubitus, measures were done for two positions of abduction. In lateral decubitus with 70° of abduction, the distance between needle two and the glenoid needle was also measured. RESULTS: The mean distance between AxN and the inferior glenoid rim was 14.4 mm in reference position in beach chair. The results showed the absence of difference between the positions during surgery except for lateral decubitus with 70° of abduction. CONCLUSION: Our study showed that the position of the shoulder during arthroscopic procedures cannot take away the AxN from the inferior glenoid rim. LEVEL OF EVIDENCE: Level IV-basic science study.

Anatomy of the biceps brachii osseous footprint: study of 100 radii and literature review.

Biceps brachii (BB) tendon rupture is frequent in young males and may require surgical repair. Non-anatomic reinsertion leads to loss of strength in supination. The main aim of the present study was to describe the anatomy of the osseous footprint of the distal BB tendon. The dimensions of the footprint of the distal BB insertion were analyzed in 100 dry cadaver radii, using MicroScribe 3D software. Insertion area, assimilated to an ellipse, was calculated from 4 points (medial, lateral, cranial and caudal) determining the two axes of the ellipse. Mean footprint length, width and area were 18 mm (range, 7-24 mm), 9 mm (range, 4-15 mm), and 129 mm2 (range, 46-266 mm²), respectively. Intra- and inter-observer correlation coefficients were satisfactory: κ = 0.75 and κ = 0.7, respectively. The present study reported BB footprint dimensions in 100 radii, providing a basis to guide surgical treatment of distal BB tendon rupture. Non-anatomical restoration of the BB tendon footprint leads to poorer clinical and biomechanical results; precise knowledge of the footprint is necessary for anatomical repair.

Shoulder arthrodesis in brachial plexus palsy.

Long considered as the ultimate surgery for limb salvage in case of brachial plexus palsy, shoulder fusion has seen its indications reduced with the development of more numerous and multiple tendon transfers. This option remains valid and should always be suggested first because of its reliable effects on pain and function. However, it is a demanding surgery, the position of the fusion remains difficult to determine and the complication rate is not negligible.

Scaphotrapezial ligament: normal arthro-CT and arthro-MRI appearance with anatomical and clinical correlation.

The purpose of our study was to demonstrate and describe the MR and arthro-CT anatomic appearance of the scaphotrapezial ligament and illustrate some of the pathologies involving this structure. This ligament consists of two slips that originate from the radiopalmar aspect of the scaphoid tuberosity and extend distally, forming a V shape. The ulnar fibers, which are just radial to the flexor carpi radialis sheath, inserted along the trapezial ridge. The radial fibers were found to be thinner and inserted at the radial aspect of the trapezium. Twelve fresh cadaver wrists were dissected, with close attention paid to the scaphotrapezio-trapezoidal (STT) joint. An osseoligamentous specimen was dissected with removal of all musculotendinous structures around the STT joint and was performed with high-resolution acquisition in a 128-MDCT scanner. Samples of the wrist area were collected from two fetal specimens. A retrospective study of 55 patients with wrist pain that were submitted to arthrography, arthro-CT, and arthro-MRI imaging was performed (10 patients on a 3-T superconducting magnet and 45 patients on a 1.5-T system). Another ten patients had high-resolution images on a 3-T superconducting magnet without arthrographic injection. MR arthrography and arthro-CT improved visualization and provided detailed information about the anatomy of the scaphotrapezial ligament. Knowledge of the appearance of this normal ligament on MRI allows accurate diagnosis of lesions and will aid when surgery is indicated or may have a role in avoiding unnecessary immobilization.

Is the high submandibular transmasseteric approach to the mandibular condyle safe for the inferior buccal branch?

PURPOSE: There are basically 3 main approaches for extra-articular mandibular condyle fractures: low cervical, retromandibular and preauricular. These include a risk of facial palsy affecting the marginal mandibular branch. We use a high submandibular transmasseteric approach featuring masseter section 10-20 mm above the mandibular basilar edge. Our null hypothesis was that both the marginal mandibular and the inferior buccal branches are not more at risk than in other surgical approaches. METHODS: This study was based on 20 parotidomasseteric dissections from 10 embalmed cadaveric heads. We used as reference the vertical line, passing through the mandibular angle, parallel to the preauricular line. We performed measurements of the marginal mandibular and inferior buccal branches' heights. RESULTS: The inferior buccal branch had an average height of 16.8 mm and the highest standard deviation (7.2). Extremes were, respectively, 32 and 7 mm. The marginal mandibular branch had an average height of 3.2 mm with standard deviation equal to 3.0. Extremes were, respectively, 9 and -3 mm. CONCLUSION: The high submandibular transmasseteric approach provides great exposure of facial nerve branches lying on the masseter muscle, if even encountered. Through masseteric incision performed between 10 and 20 mm above the basilar edge of the mandible, the marginal mandibular branch is safe from wound with an added safety margin of 4 mm. The surgeon using this approach is most likely to encounter the inferior buccal branch. It can then be avoided under visual control. This makes it a swift and safe approach to the mandibular condyle.

The laryngeal fat body.

AIM: To describe the anatomy and topography of the laryngeal fat body and of the space it lies within. MATERIALS AND METHODS: The study is carried out on series of histological sections of head and neck blocks from six foetuses and three newborns. Three adult necks were dissected, a fourth one analysed through sagittal median section. CT-Scan and MRI imaging complete the description. RESULTS: The laryngeal fat body (LFB) lies within the pre-epiglottic (PE) space that stands in the median anterior part of the upper infrahyoid region, located just below the level of the hyoid bone. The walls of the PE space are: superior (base), anterior lateral right and left, posterior, inferior (apex). This space is divided into two compartments by a median septum. The LFB consists in a rather pure fat, structured in large polyhedral lobules. It shows no limiting capsule. DISCUSSION: Dissection-based description of the PE space made in literature matches ours conducted on series of histological sections. All authors agree on the fat content of the space but some of them find a capsule around the LFB that we did not observe on our histological sections. CT-Scan and MRI imaging are accurate for analysis of these structures and of similar efficiency. The study of the LFB should be considered regarding the one of other fat bodies in the human body. CONCLUSION: Anatomical knowledge of the PE space and its content, the LFB, is important, as alteration of their morphology is the early witness of neighbouring carcinological extension.

Innervation of flexor hallucis longus muscle: an anatomical study for selective neurotomy.

BACKGROUND: The aim of the study was to describe the innervation of flexor hallucis longus (FHL) and obtain its surgical coordinates to facilitate selective neurotomy. MATERIALS AND METHODS: Fifteen embalmed lower limbs of adults were studied. Anatomical dissections to isolate the innervating branches of FHL were performed. Distance between the supplying nerve of FHL, including both its origin and termination, and the medial malleolus were obtained, providing anatomical coordinates beneficial for surgery. RESULTS: In all cases, FHL was innervated by only one branch, which originated from the tibial nerve. Mean distance between the medial malleolus and the nervous branch origin was 21.39 ± 3.05 cm. Mean distance between the medial malleolus and the nervous branch termination was 12.7 ± 1.59 cm. Length of the nervous branch innervating FHL was proportional to the length of the leg, measuring 8.69 ± 2.45 cm. All nerves were located 15-17.4 cm above the medial malleolus. CONCLUSIONS: This anatomical study traced valuable surgical coordinates useful for performing selective peripheral neurotomy on the nerve branch innervating the FHL.

Glenoid exposure in total shoulder arthroplasty.

Glenoid exposure is agreed to be a difficult step, but is also a key step in total shoulder arthroplasty, both anatomic and reverse. It conditions unhindered use of the ancillary instrumentation and thus correct glenoid component positioning. The main stages comprise arthrotomy, by opening the rotator cuff, humeral head cut, and inferior glenohumeral release, enabling shifting of the humerus and good exposure of the glenoid cavity. The two main approaches are deltopectoral and anterosuperior transdeltoid. Using the deltopectoral approach, arthrotomy is performed through the subscapularis muscle, by various techniques. This approach enables extensive inferior glenohumeral release and thus an approach to the inferior apex of the glenoid cavity, which is a key area for glenoid implant positioning. The main drawbacks are postoperative shoulder instability and limited access to the posterior part of the glenoid in case of significant retroversion. Moreover, subscapularis healing is uncertain, which can impair the clinical outcomes, with risk of glenoid component loosening. Advantages, on the other hand, include the fact that it can be implemented in all cases, even the most difficult ones, and that the deltoid muscle is respected. The transdeltoid approach has the advantage of being simple, providing direct exposure of the glenoid cavity through a rotator cuff tear after passing through the deltoid. It is therefore especially indicated for reverse prosthesis in case of rotator cuff tear, and in traumatology. However, the approach to the inferior part of the glenoid cavity can be restricted, with insufficient exposure and a risk of glenoid component malpositioning (superior tilt). The preoperative assessment is essential, to detect at-risk situations such as severe stiffness and anticipate difficulties in glenoid exposure.

Popeye sign: Tenodesis vs. self-locking "T" tenotomy of the long head of the biceps.

INTRODUCTION: Treatment of long head of the biceps lesions is controversial. A new technique of self-locking "T" tenotomy was developed in our department in 2013. HYPOTHESIS: The main objective of the present study was to assess onset of Popeye sign after "T" tenotomy, with comparison to long head of the biceps tenodesis. MATERIAL AND METHODS: A continuous retrospective study included 180 patients with long head of the biceps lesion, either isolated or associated with rotator cuff tear. RESULTS: 130 underwent "T" tenotomy (group A), and 50 tenodesis (group B). Mean age was 57.9 years (range, 23-88 years) in group A and 50.8 years (range, 20-66 years) in group B. At last follow-up, 27.7% of patients in group A and 24% in group B showed Popeye sign (P=0.616), after equivalence test and adjustment on age and occupational activity. Bicipital groove pain was more frequent in the tenodesis group (44% versus 25.4%; P=0.025). DISCUSSION: Self-locking "T" tenotomy did not significantly differ from tenodesis in onset of Popeye sign or clinical results, and showed better postoperative course. LEVEL OF EVIDENCE: IV, retrospective study.

[Proposal for new anterior portals for wrist arthroscopic as a complementary approach to open anterior wrist surgery]. / Arthroscopie complémentaire de l'ostéosynthèse du radius distal par abord antérieur: bases anatomiques de nouvelles voies arthroscopiques antérieures.

PURPOSE OF THE STUDY: Morphological and morphometric studies of the wrist ligaments are scarce. The radiocapitatum and scapholunate ligaments play a pivotal role in wrist stability. Classically, a posterior approach is used for arthroscopic procedures, but an anterior approach should be possible. We conducted a cadaver study to search for new anterior portals for wrist arthroscopy. MATERIAL AND METHODS: Twenty-five formol-treated upper limbs were dissected. The classical anterior approach for open wrist surgery was executed. The different elements of the capsule-ligament system of the anterior aspect of the wrist were identified and labeled. The dissection was then extended to the ulna in search of soft points which were identified and evaluated. The different structures generally identified during wrist arthroscopy were noted. RESULTS: Two potential portals were identified in all wrists: one between the radiolunate ligament and the radio-scapho-capitatum ligament on the radial aspect and one between the radio-lunate ligament and the ulno-lunate ligament. Arthroscopic exploration enabled observation of the scapho-lunate ligament, the luno-triquetral ligament, the triangular complex of the carpus, and the entire inferior aspect of the radial joint surface, with no risk of vessel or nerve injury because of the exposure allowed by the osteosynthesis approach. DISCUSSION: Wrist arthroscopy is now accepted as a reliable technique not only for diagnostic purposes but also for therapeutic interventions for the treatment of fractures of the lower radius. Most of the arthroscopic portals described in the literature are posterior. The anterior portals described here do not involve any vascular or neurological risk since the radial approach is made under visual control by extension of the open anterior approach and on the ulnar side the noble structures are positioned medially to the ulnar flexor tendon of the carpus. This enables good triangulation necessary for the usual arthroscopic procedures. Finally, these portals have no supplementary morbidity which would be the case with percutaneous portals (injury to the medial nerve, the radial vasculonervous bundle, the radial flexor tendon). CONCLUSION: These new arthroscopic portals are complementary to the anterior approach for open wrist surgery and enable a natural extension of joint exploration via both the radial and ulnar approaches described in this study.

Cadaver study of anatomic landmark identification for placing ankle arthroscopy portals.

BACKGROUND: Arthroscopy-assisted surgery is now widely used at the ankle for osteochondral lesions of the talus, anterior and posterior impingement syndromes, talocrural or subtalar fusion, foreign body removal, and ankle instability. Injuries to the vessels and nerves may occur during these procedures. OBJECTIVE: To determine whether ultrasound topographic identification of vulnerable structures decreased the risk of iatrogenic injuries to vessels, nerves, and tendons and influenced the distance separating vulnerable structures from the arthroscope introduced through four different portals. HYPOTHESIS: Ultrasonography to identify vulnerable structures before or during arthroscopic surgery on the ankle may be useful. MATERIAL AND METHOD: Twenty fresh cadaver ankles from body donations to the anatomy institute in Strasbourg, France, were divided into two equal groups. Preoperative ultrasonography to mark the trajectories of vessels, nerves, and tendons was performed in one group but not in the other. The portals were created using a 4-mm trocar. Each portal was then dissected. The primary evaluation criterion was the presence or absence of injuries to vessels, nerves, and tendons. The secondary evaluation criterion was the distance between these structures and the arthroscope. RESULTS: No tendon injuries occurred with ultrasonography. Without ultrasonography, there were two full-thickness tendon lesions, one to the extensor hallucis longus and the other to the Achilles tendon. Furthermore, with the anterolateral, anteromedial, and posteromedial portals, the distance separating the vessels and nerves from the arthroscope was greater with than without ultrasonography (P=0.041, P=0.005, and P=0.002), respectively; no significant difference was found with the anterior portal. DISCUSSION: Preoperative ultrasound topographic identification decreases the risk of iatrogenic injury to the vessels, nerves, and tendons during ankle arthroscopy and places these structures at a safer distance from the arthroscope. Our hypothesis was confirmed. LEVEL OF EVIDENCE: IV, cadaver study.

Experimental validation of the GNRB® for measuring anterior tibial translation.

INTRODUCTION: The objective of this study was to validate the technique used to measure anterior tibial translation in cadaver knees using the GNRB® device by comparing it with the gold standard, the OrthoPilot® navigation system. HYPOTHESIS: Simultaneous measurement of anterior tibial translation by the GNRB® and the OrthoPilot® in the chosen experimental conditions will result in significant differences between devices. MATERIAL AND METHODS: Five fresh frozen cadavers were used. The knee was placed in 20° flexion. Four calibrated posterior-anterior forces (134N to 250N) were applied. For each applied force, the anterior tibial translation was measured simultaneously by both devices. Two conditions were analyzed: anterior cruciate ligament (ACL) intact and ACL transected. The primary criterion was anterior tibial translation at 250N. The measurements were compared using a paired Student's t-test and the correlation coefficient was calculated. Agreement between the two methods was determined using Bland-Altman plots. Consistency of the measurements was determined by calculating the intraclass correlation coefficient. RESULTS: For all applied forces and ligament conditions, the mean difference between the GNRB® and the navigation system was 0.1±1.7mm (n.s). Out of the 80 measurements taken, the difference between devices was less than ±2mm in 66 cases (82%). There was a strong correlation, good agreement and high consistency between the two measurement methods. DISCUSSION: The differences between the measurements taken by the GNRB® and the navigation system were small and likely have no clinical impact. We recommend using the GNRB® to evaluate anterior knee laxity. LEVEL OF EVIDENCE: II controlled laboratory study.

Outcomes of capsulolabral reconstruction for posterior shoulder instability.

BACKGROUND: Surgical treatment of isolated posterior shoulder instability-a rare and often misdiagnosed condition-is controversial because of poor outcomes. Failure of physical therapy in symptomatic young athletes requires capsulolabral reconstruction or bone block procedures. The goal of this study was to report the outcomes of patients who have undergone surgical capsulolabral reconstruction and to look for risk factors that contribute to failure of this procedure. MATERIAL AND METHOD: We analyzed the outcomes of 101 patients who underwent capsulolabral reconstruction: 83 included retrospectively, 18 included prospectively. The procedures were performed alone or in combination with capsular shift, labral repair, closure of the rotator interval and notch remplissage. The primary endpoint was failure of the procedure, defined as recurrence of the instability and/or pain. We also determined the outcomes based on specific (Walch-Duplay, modified Rowe) and non-specific (Constant, resumption of activities) scores of shoulder instability. RESULTS: The results were satisfactory despite a high failure rate: 35% in the retrospective cohort with 4.8±2.6 years' follow-up and 22% in the prospective cohort with 1.1±0.3 years' follow-up. The various outcome scores improved significantly. Ninety-two percent of patients returned to work and 80% of athletes returned to their pre-injury level of sports. Eighty-five percent of patients were satisfied or very satisfied after the surgery. No risk factors for failure were identified; however, failures were more common in older patients, those who underwent an isolated procedure and those who had unclassified clinical forms. CONCLUSION: Treatment of posterior shoulder instability by capsulolabral reconstruction leads to good clinical outcomes; however, the recurrence rate is high. LEVEL OF EVIDENCE: 4 - retrospective study.

Posterior interosseous nerve to the superficial branch of the ulnar nerve transfer at the distal third of the forearm through a single anterior approach: Anatomical feasibility study.

The purpose of this study was to determine in a cadaver model, whether transfer of the posterior interosseous nerve (PIN) to the superficial branch of the ulnar nerve (SBUN) by a single approach was feasible. The experiment was carried out on five fresh cadavers. The ulnar nerve was split into its motor branches and the SBUN. The PIN was collected behind the interosseous membrane and sutured to the SBUN on its anterior surface. All sutures were tensionless and technically possible with the PIN's diameter being at least 50% of the SBUN's diameter in all cases. Our results demonstrate that PIN to SBUN transfer through a single anterior approach is feasible in a cadaver model.

Painful posterior shoulder instability: Anticipating and preventing failure. A study in 25 patients.

BACKGROUND: Painful posterior shoulder instability (PPSI) is the least common of the three clinical patterns of posterior shoulder instability. PPSI is defined as pain combined with anatomical evidence of posterior instability but no instability events. MATERIAL AND METHOD: We studied a multicentre cohort of 25 patients with PPSI; 23 were identified retrospectively and had a follow-up of at least 2 years and 2 patients were included prospectively. Most patients engaged in sports. RESULTS: All 25 patients underwent surgery, which usually consisted in arthroscopic capsulo-labral reconstruction. The outcome was excellent in 43% of patients; another 43% had improvements but reported persistent pain. The pain remained unchanged or worsened in the remaining 14% of patients. Causes of failure consisted of a missed diagnosis of shoulder osteoarthritis with posterior subluxation, technical errors, and postoperative complications. The main cause of incomplete improvement with persistent pain was presence of cartilage damage. CONCLUSION: Outcomes were excellent in patients who were free of cartilage damage, bony abnormalities associated with posterior instability (reverse Hill-Sachs lesion, erosion or fracture of the posterior glenoid), technical errors, and postoperative complications.

Posterior shoulder instability: Prospective non-randomised comparison of operative and non-operative treatment in 51 patients.

BACKGROUND: The management of posterior shoulder instability remains controversial. Consequently, for a symposium on this topic, the French Arthroscopy Society (SFA) conducted a prospective multicentre study comparing outcomes of operative and non-operative treatment. OBJECTIVE: To compare outcomes after operative versus non-operative treatment of posterior shoulder instability. HYPOTHESIS: The surgical treatment of posterior shoulder instability may achieve better clinical outcomes than non-operative treatment in selected patients. MATERIAL AND METHODS: Fifty-one patients were included prospectively then followed-up for 12months. Three groups were defined based on the clinical presentation: recurrent dislocation or subluxation, involuntary instability or voluntary instability that had become involuntary, and shoulder pain with instability. Of the 51 patients, 19 received non-operative therapy involving a three-step rehabilitation programme and 32 underwent surgery with a posterior bone block, labral repair and/orcapsule tightening, or bone defect filling. At inclusion and at last follow-up, the Subjective Shoulder Value (SSV), Rowe score, Walch-Duplay score, and Constant score were determined. RESULTS: The preliminary results after the first 12 months are reported here. In the non-operative and operative groups, the Constant score was 78 versus 87, the Rowe score 64 versus 88, and the Walch-Duplay score 69 versus 82, respectively. These differences were statistically significant (P<0.05). DISCUSSION: To our knowledge, this study is the first comparison of non-operative versus operative treatment in a cohort of patients with documented posterior shoulder instability. Outcomes were better with operative treatment. However, this finding remains preliminary given the short follow-up of only 1 year. LEVEL OF EVIDENCE: III, case-control study.

Posterior shoulder instability managed by arthroscopic acromial pediculated bone-block. Technique.

In posterior shoulder instability (recurrent dislocation, involuntary posterior subluxation or voluntary subluxation that has become involuntary), surgery may be considered in case of failure of functional treatment if there are no psychological contraindications. Acromial bone-block with pediculated deltoid flap, as described by Kouvalchouk, is an alternative to iliac bone-block, enabling triple shoulder locking by the blocking effect, the retention hammock provided by the deltoid flap and posterior capsule repair. Arthroscopy allows shoulder joint exploration and diagnosis of associated lesions, with opening and conservation of the posterior capsule; it greatly facilitates bone-block positioning and capsule reinsertion. The present report describes the procedure in detail. LEVEL OF EVIDENCE: Technical note.

Clinical outcomes of posterior bone block procedures for posterior shoulder instability: Multicenter retrospective study of 66 cases.

BACKGROUND: The posterior bone block procedure is a well-known treatment option for posterior shoulder instability. The goal of this retrospective multicenter study was to evaluate the clinical and radiological outcomes of this procedure. MATERIAL AND METHODS: The study cohort consisted of 66 patients (55 men, 11 women) with an average age of 27.8 years who were evaluated clinically and radiologically using a standardized questionnaire after posterior bone block surgery. RESULTS: The Constant score significantly improved postoperatively (P<0.0001). The postoperative Walch-Duplay score was 81.5. The Rowe score was 86.5 points. The pain level (VAS) was significantly reduced after this procedure (P<0.0001). Eighty-five percent of patients were satisfied or very satisfied with the outcome. CONCLUSION: This multicenter study of 66 patients shows that the posterior bone block procedure is an effective technique with good subjective and objective outcomes; however, the possibility of complications cannot be ignored. CLINICAL STUDY: Level of evidence IV.

[Adult lateral meniscus]. / Le ménisque latéral de l'adulte.

Meniscal lesion does not mean meniscectomy and this is particularly true for the lateral meniscus. The reputation of mildness of the meniscectomy is usurped. The rate of joint space narrowing after lateral meniscectomy is of 40% at a follow-up of 13 years compared to 28% for the medial meniscus (symposium SFA 1996). Several arguments explain those results: biomechanical: the lateral meniscus contributes to the congruence; particularly the lateral meniscus is the zone where antero-posterior translational during knee flexion is 12 mm. The pejorative effects of lateral meniscectomy have conducted, more though to the medial meniscus, to the concept of meniscal economy. Lateral meniscectomy must be as partial as possible. Particularly, a discoid meniscus presenting a complete tear should be treated by a meniscoplasty in order to shape the meniscus in a more anatomic form than a total meniscectomy. Lateral meniscectomy is indicated in complex or horizontal cleavage, symptomatic, on stable knees. A particular case is the cyst of the lateral meniscus. It is a cystic subcutaneous formation, usual consequence of a horizontal cleaved meniscus of which the particularity is that it opens besides the articulation. The strategy must not consist in the isolated treatment of the cyst. This pathology should be addressed by an arthroscopic meniscectomy reaching the meniscosynovial junction at the level of the cyst. Meniscal repair must be proposed every time if possible. Criteria of reparability are better studied on MRI. Preoperatively MRI is the first choice radiological exam. Two essential indications can be held back: the vertical peripheral longitudinal lesion is on the non-vascularized area, and the horizontal cleaving of the junior athlete (if the cleaving remains purely intra meniscal). Meniscal repair is highly performed when the meniscal tear is associated to a rupture of the ACL (simultaneous reconstruction of the LCA). Postoperative outcome is different of that of a "simple" arthroscopic meniscectomy. The healing process being slow, it suits to protect the suture by a splint in the first month, and with an exclusion of sports with knee torsion during 6 months. Functional results (absence of secondary meniscectomy) and anatomical results (reality of the cicatrisation) are good in 77% of cases (symposium of the French Society of Arthroscopy 2003) at a follow-up of 55 months. Survivorship analysis indicates that majority of the failures occur within two years: this testifies a default of primary cicatrisation. At the studied follow-up, meniscal repair was efficient to protect the cartilage. Lateral meniscus results are better that medial meniscus one. Those data support indications: All suspicion of meniscal lesion must have an MRI preoperatively to confirm the lesion, to localize her and to search criteria of reparability; All vertical longitudinal peripheral lesions can and must be repaired especially in young patients and children; All horizontal cleaving of the junior athletes should be treated by open repair; surgical abstention must be proposed when the lesion is non symptomatic, or when lesion is limited and associated to an ACL tear (in that case isolated ACL reconstruction is proposed), or when clinical symptoms are minimal; Meniscectomy, always arthroscopic, is proposed for a symptomatic lesion in the avascular zone or for a deep horizontal cleavage or a complex tear; Tear of the discoid meniscus should be treated by meniscoplasty. A painful knee after lateral meniscectomy might be due to a too limited initial meniscectomy: an iterative meniscectomy may be indicated or lateral femorotibial arthritis, especially after subtotal or total meniscectomy. In this last case and after failure of usual medical treatment such as viscosupplementation surgery may be indicated. Osteotomy in order to unload the lateral femorotibial compartment gives a partial response as the shearing forces remain. This osteotomy is indicated only if the lower limb axis is normal or in valgus. Meniscal allograft is an option in young patients in grade I or II arthritis. Results are promising. Rene Verdonk's series show a survivorship analysis of 75% at 7 years. Early diagnosis of a postmeniscectomy syndrome before cartilaginous lesions occur is essential for an adapted treatment. In conclusion, lateral meniscectomy are less frequent than those of the medial meniscus but their prognosis is less favorable. They should be early diagnosed (MRI). Treatment options are various: abstention, meniscectomy, and repair. Painful post lateral meniscectomy syndrome may be treated by a new surgical option: meniscal allograft.

[Elbow arthroscopy]. / L'arthroscopie du coude.

This symposium of the French Arthroscopic Society is the 2005 state of the art of elbow arthrosocpy in France. A survey reports 499 cases during 2 years with a rate of complication higher than the arthroscopies of other joints (6% of minor and 1% of major complications). The main indication is the removal of loose bodies. They can come from arthritis, chondromatosis, osteochondritis or fracture. The most accurate radiologic examination is an arthroCTscan. The main pronostic factor is the cartilage status. Arthrolysis is the second indication. We performed a retrospective and a prospective studies to compare open and arthroscopic surgery. Results are almost similar with a significant higher improvement in flexion (7 degrees ) in the open group. Open surgery seems more efficient but with a franck loss of motion in the postoperative course. However, in this group elbows were preoperatively stiffer in relation with a trauma event instead of sport related microtrauma in the arthroscopically treated group. Removal of necrotic fragment combined with abrasion in osteochondritis of the capitulum yields to good results with 82% of patients resuming to sports. Long term prognosis is unknown as the joint line is narrowed at a 3 years follow up. Arthroscopy is usefull in synovial diseases as resection of synovial folds or removal of tumors like villonodular synovitis. In the treatment of epicondylitis, the results of our retrospective study are not so good as those reported in the literature. But in our comparative study the results are similar to the open surgery group. The numerous procedures and the different follow up in these two groups did not allow to give statistical analysis. Elbow arthroscopy is a hyper specialty with more and more advanced procedures.