Measure of horizontal and vertical displacement of the acromioclavicular joint after cutting ligament using X-ray and opto-electronic system.

INTRODUCTION: Surgical versus orthopedic treatments of acromioclavicular disjunction are still debated. The aim of this study was to measure horizontal and vertical acromion's displacement after cutting the ligament using standard X-ray and an opto-electronic system on cadaver. MATERIALS AND METHODS: Ten cadaveric shoulders were studied. A sequential ligament's section was operated by arthroscopy. The sequence of cutting was chosen to fit with Rockwood's grade. The displacement of the acromion was measured on standard X-ray and with an opto-electronic system allowing measuring of the horizontal displacement. Statistical comparisons were performed using a paired Student's t test with significance set at p < 0.05. RESULTS: Cutting the coracoclavicular ligament and delto-trapezius muscles cause a statistical downer displacement of the acromion, but not after sectioning the acromioclavicular ligament. The contact surface between the acromion and the clavicle decreases statistically after sectioning the acromioclavicular ligament and the coracoclavicular ligament with no effect of sectioning the delto-trapezius muscles. Those results are superposing with those dealing with the anterior translation. DISCUSSION: The measure concerning the acromioclavicular distance and the coracoclavicular distance are superposing with those of Rockwood. However, there is a significant horizontal translation after cutting the acromioclavicular ligament. Taking into account this displacement, it may be interesting to choose either surgical or orthopedic treatment. CONCLUSION: There is a correlation between anatomical damage and importance of instability. Horizontal instability is misevaluated in clinical practice.

The dual mobility socket concept: experience with 668 cases.

Long-term results of a retrospective series of primary arthroplasty with the original cementless dual mobility socket (A) and the midterm results with the second generation (B) are reported. In series A (follow-up 16.5 years) 437 total hip arthroplasties (THA) were included and in series B (follow-up five years) 231 hips. The 15-year survival rate was 84.4 ± 4.5% (revision for any reason as endpoint); 30 hips (6.8%) were revised for aseptic loosening. Five THA were revised for dislocation: two early and three after ten years or more. With the second generation socket neither dislocation nor revision for mechanical reasons were observed. The survival rate was 99.6 ± 0.4% (revision for any reason). The prevalence of revision for dislocation was very low in our series. This concept does not avoid wear and aseptic loosening, especially in young active patients, but the long-term stability has been confirmed. Dual mobility can be recommended for patients over 70 years of age and for younger patients with high risk of dislocation.

Short versus extended thromboprophylaxis after total knee arthroplasty: a randomized comparison.

INTRODUCTION: The optimal duration of thromboprophylaxis after total knee arthroplasty remains uncertain. MATERIAL AND METHODS: We performed a randomized, open trial to determine whether to stop thromboprophylactic therapy at Day 10±2 ('short thromboprophylaxis') was non-inferior to continue thromboprophylactic therapy up to Day 35±5 ('extended thromboprophylaxis') after total knee arthroplasty. At Day 7±2, subjects were screened by ultrasonography for asymptomatic deep-vein thrombosis and randomized. The primary outcome was a composite of proximal deep-vein thrombosis, any symptomatic deep-vein thrombosis, non-fatal symptomatic pulmonary embolism, major bleeding, heparin-induced thrombocytopenia, or all-cause death up to Day 35±5. The secondary outcome was ultrasonographic (extension or new onset) distal deep-vein thrombosis at Day 35±5. RESULTS: Twenty-one patients (2.4%) were not randomized, because of asymptomatic proximal deep-vein thrombosis on systematic ultrasonography at Day 7±2. Among the 857 randomized patients, mean (SD) duration of anticoagulant treatment was 11.2 (6.7) and 33.9 (3.7) days in the short and extended thromboprophylaxis groups, respectively. The respective rates of the primary outcome were 4.0% (17/420) and 2.4% (10/422), with an absolute difference of 1.7% (90% confidence interval, -0.3 to 3.7). In 285 patients with asymptomatic distal deep-vein thrombosis at Day 7±2, the respective rates of the primary outcome were 7.8% and 2.8% (p=0.067). The rates of the secondary outcome were 14.8% (62/420) and 4.5% (19/422), respectively (p<0.001). CONCLUSIONS: Short thromboprophylaxis was not non-inferior to extended thromboprophylaxis after total knee arthroplasty. In this setting, the thromboembolic risk persisted longer than seven days, notably in patients with asymptomatic distal deep-vein thrombosis at discharge. ClinicalTrials.gov number: NCT00362492.

Arthroscopic reconstruction of the anterior cruciate ligament using bone-patellar tendon-bone autograft: a minimum 10-year follow-up.

BACKGROUND: Anterior cruciate ligament reconstruction surgery and technique have changed over the past decade. HYPOTHESIS: Modern arthroscopic management of an anterior cruciate ligament tear using patellar tendon autograft offers a high patient satisfaction rate and good clinical results over the long term. However, it may be associated with osteoarthritis changes over time. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: In 1992, a prospective computerized database of anterior cruciate ligament reconstruction was established. Since that time, 101 anterior cruciate ligament arthroscopic reconstructions performed at our institution have been observed. Inclusion criteria were as follows: reconstruction with bone-patellar tendon-bone graft, a minimum 10-year follow-up, a standardized operative procedure, and no previous anterior cruciate ligament repair or associated ligament lesions. Before surgery, the mean age of the patients was 28.8 years +/- 8.3 (mean +/- SD). The follow-up assessment was established using the International Knee Documentation Committee (IKDC) 2000 form and quantitative laxity testing with a KT-1000 arthrometer. The joint space narrowing assessment used the IKDC score with a 30 degrees posteroanterior weightbearing view. RESULTS: Mean follow-up was 11.6 +/- 0.8 years. Nine graft ruptures occurred. The satisfaction rate was excellent (90%). Seventy patients (74%) were still actively participating in sports. The mean subjective IKDC 2000 score was 90.5 +/- 8.8 points. The IKDC score was statistically correlated to laxity, time from injury, and osteoarthritis development at final follow-up. Ninety-one percent of patients were graded A or B according to the overall IKDC score. The radiological assessment reported osteoarthritis development in 17.8% of patients, and 39% showed radiological changes. Osteoarthritis was correlated with body mass index (P = .01) and age at follow-up (P = .006). In a selected population without meniscus and articular cartilage injury, an osteoarthritis rate of only 8% was found. Conclusion Arthroscopic anterior cruciate ligament reconstruction using bone-patellar tendon-bone autograft resulted in high patient satisfaction levels and good clinical results after 10 years. Moreover, a high percentage of patients remained involved in sports activities, and anterior cruciate ligament reconstruction protected their meniscus from a secondary tear. However, knee osteoarthritis developed in 17.8% of patients so treated.