Proximal row carpectomy generates better mid- to long-term outcomes than four-corner arthrodesis for post-traumatic wrist arthritis: A meta-analysis.

INTRODUCTION: In posttraumatic wrist arthritis of intermediate severity, two main palliative procedures are used to preserve some mobility in the wrist: proximal row carpectomy (PRC) and scaphoid excision followed by four corner arthrodesis (4CA). Despite satisfactory overall results, the debate continues about which one provides the best results and long-term outcomes, particularly prevention of arthritis progression. Recent comparative studies now provide us with information about mid- and long-term results. The aim of this study was to compare the clinical results, complications, conversion rate to total wrist arthrodesis and progression to osteoarthritis of PRC versus 4CA in the medium and long term. HYPOTHESIS: The null hypothesis was that there is no significant difference between PRC and 4CA in the clinical results, complications, conversion to total wrist arthrodesis and arthritis progression. MATERIALS AND METHODS: A systematic literature review was carried out by following the PRISMA guidelines. Included were studies comparing 4CA and PRC for the treatment of post-traumatic wrist arthritis secondary to scapholunate dissociation (SLAC) and scaphoid nonunion (SNAC) with a mean follow-up of 5 years. A search was performed of the MEDLINE, EMBASE and Cochrane databases that identified 831 articles. After removing 230 duplicates and excluding 595 articles based on their title and/or abstract, and then adding 1 article manually, 7 articles were included in our analysis. Parameters analyzed were range of motion (ROM), pain, grip strength, functional scores, complications, conversion to total wrist arthrodesis, and arthritis progression. RESULTS: In the 7 articles, 1059 wrists - 582 PRC and 477 4CA - were analyzed with follow-up ranging from 5.2 to 18 years. PRC produced significantly better ROM in flexion (weighted mean difference [WMD]=10.0°; p<0.01) and in ulnar deviation (WMD=8.7°; p<0.01) along with significantly lower complication rates (OR=0.3; p<0.01) and reoperation rates (OR=0.1; p<0.01). There was no significant difference in the conversion rate, grip strength, extension, radial deviation, pain, DASH and PRWE scores. The progression of osteoarthritis could not be analyzed due to lack of data. DISCUSSION: This meta-analysis was the first to include recently published mid- and long-term studies comparing PRC and 4CA. The main finding is that PRC is superior overall with better ROM and a lower complication rate. Another important finding was the absence of differences in grip strength and the conversion rate to total wrist arthrodesis. Unfortunately, the lack of systematic studies on arthritis progression leaves this question unanswered. Our findings must be interpreted cautiously because it was impossible to stratify the cases by etiology and osteoarthritis stage. LEVEL OF EVIDENCE: III; systematic review and meta-analysis.

Pain catastrophizing and pre-operative psychological state are predictive of chronic pain after joint arthroplasty of the hip, knee or shoulder: results of a prospective, comparative study at one year follow-up.

PURPOSE: To assess the relationship between pre-operative psychological state, postoperative pain and function one year after total shoulder, hip or knee arthroplasty. METHODS: Patients undergoing shoulder, hip or knee arthroplasty between March 2014 and November 2015 were included. Pain catastrophizing score (PCS) was determined preoperatively, at six months and at one year follow-up. Joint pain at rest was quantified using a Visual Analogue Scale (0‒100). Depressive symptoms were measured using the Beck Depression Inventory or Geriatric Depression Score, situational anxiety and dispositional anxiety were measured using the State-Trait Inventory and joint function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index for the hip and knee and Oxford Shoulder Score for the shoulder. RESULTS: A total of 266 patients were included (65% female; mean (± SD) age: 71.8 ± 10.3 years; mean body mass index: 27.5 ± 5.0 kg/m2). Pre-operative PCS was significantly correlated with pain > 30/100 at one year and with functional scores, for all joints. Multivariate analysis identified the following variables as risk factors for pain intensity > 30/100 at one year: pre-operative PCS > 20/52 (OR = 3.5 ± 1.1 [95% CI: 1.9‒6.6]; p = 0.0001), trait-anxiety score ≥ 46 (OR = 2.4 ± 0.9 [95% CI: 1.1‒5.2]; p = 0.03), pre-operative pain ≥ 60/100 (OR = 3.2 ± 1 [95% CI: 1.8‒6.1]; p = 0.0001) and pain for at least 3 years (OR = 1.8 ± 0.6 [95% CI: 1‒3.4]; p = 0.04). CONCLUSION: Pre-operative pain catastrophizing and trait-anxiety are risk factors for post-operative pain after shoulder, hip and knee arthroplasty. TRIAL REGISTRATION NUMBER: www. CLINICALTRIALS: gov NCT02361359.

Psychological risk factors for the occurrence of frozen shoulder after rotator cuff repair.

INTRODUCTION: Frozen shoulder is a dreaded complication after rotator cuff repair. HYPOTHESIS: There are psychological determinants for this complication. MATERIALS AND METHODS: We prospectively included 77 consecutive patients who underwent arthroscopic rotator cuff repair between May 2018 and April 2019. Along with a functional evaluation, we determined the Constant score, anxiety and depression levels based on the HADS, and kinesiophobia based on the Tampa Scale preoperatively and 6months after the surgery. RESULTS: At the 6-month follow-up, 8 patients had been diagnosed with frozen shoulder (group A), 65 patients had satisfactory joint range of motion (group B) and 4 were lost to follow-up. In the frozen shoulder group, the preoperative anxiety rate was significantly higher than in group B (50% versus 17%, p=0.04). Furthermore, there were significantly more women (p=0.028) and more patients with an occupational disease in group A (75% versus 18%, p=0.027). At 6months postoperative, the Constant score was 55 in the group with a frozen shoulder versus 72 in group B (p=0.004). Neither depression nor kinesiophobia were risk factors for the development of frozen shoulder after rotator cuff repair. CONCLUSION: Preoperative anxiety, the female sex and occupational disease are all risk factors for the occurrence of frozen shoulder after rotator cuff repair. Knowing these predisposing factors will help us better manage at-risk patients. LEVEL OF EVIDENCE: III, prospective study.

Tarsal Tunnel Syndrome: Outcome According to Etiology.

Surgical results in tarsal tunnel syndrome are variable, and etiology seems to be a factor. Three possible etiologies can be distinguished. The aim of the present study was to compare surgical results according to etiology. Three continuous retrospective series (45 patients overall) of tarsal tunnel syndrome were compared. Group 1 presented a permanent intra- or extra-tunnel space-occupying compressive structure. Group 2 presented intermittent intra-tunnel venous dilatations. Group 3 comprised idiopathic tarsal tunnel syndrome. The mean follow-up was 3.6 +/- 1.8 years. The main endpoint was subjective postoperative improvement on Likert scale. Group 1 reported greater improvement than groups 2 and 3. Preoperative neuropathy on ultrasound was associated with poorer improvement, which was not the case for neuropathy on electromyography. Surgical treatment of tarsal tunnel syndrome provides better results in etiologies involving structural compression.

A higher reliability with a computed tomography scan-based three dimensional technique than with a two dimensional measurement for lower limb discrepancy in total hip arthroplasty planning.

PURPOSE: The goal was to compare the reliability of a novel 3D method with the standard 2D technique for lower limb discrepancy (LLD) measurement during pre-operative THA planning. METHODS: This prospective study included 100 consecutive patients who underwent THA using 3D planning based on a low-dose CT scan. The LLD was subdivided into three parameters: the intra-articular LLD (IA-LLD), the segmental extra-articular LLD (EA-LLD), and the total LLD (T-LLD). The LLD was assessed with a standard 2D technique on CT scanograms and also with a 3D method. A pelvic reference line (PBL) was determined as the 3D line joining the deepest part of the two great sciatic notches. The IA length was measured from the lesser trochanters (MLT) to the PBL. The EA length was measured from the MLT to the ankle center, and the total length was measured from the ankle center to the PBL. The intra- and inter-observer reliability of the measurements was assessed with the intra-class correlation coefficient (ICC). RESULTS: The intra-observer ICC was higher with the 3D technique for IA-LLD (0.96-0.97 vs. 0.79-0.84), EA-LLD (0.96 vs. 0.78-0.92), and T-LLD (0.99 vs. 0.90-0.97). Inter-observer ICC was also higher with the 3D technique for IA-LLD (0.90-0.94 vs. 0.70-0.84) and EA-LLD (0.93-0.96 vs. 0.80-0.82), but not for T-LLD (0.91-0.94 vs. 0.91-0.94). CONCLUSION: The presented 3D method has a higher reliability than 2D assessment of LLD during pre-operative THA planning. This article presents the first discussion of measuring LLD from 3D models. As 3D reconstruction becomes both more feasible and less-invasive, this study has interest to the orthopaedic surgeon.

The "sleeper's sign" is valid and suggestive of a medial sub-meniscal flap tear.

PURPOSE: To describe, evaluate and validate the diagnostic performance of a new clinical sign, the sleeper's sign, for the diagnosis of a medial submeniscal flap tear (MSMFT). METHODS: This retrospective single-center series included patients aged 18-55 years old who underwent arthroscopic treatment in 2013-2015 for a medial meniscal tear. This study was performed according to STARD (standards for reporting of diagnostic accuracy) guidelines, and the reference test was a peroperative diagnosis of a MSMFT. The preoperative consultation reports were all analyzed to search for the sleeper's sign, defined as night time medial tibiofemoral pain when the patient is in the fetal position with both knees in contact and no pain during daytime activities. RESULTS: Three-hundred and ten patients responded to the study criteria, mean age 41.7 ± 9.7 years old. The sleeper's sign was identified in 39 (12.6%) patients and a MSMFT was confirmed during arthroscopy in 47 (15.2%) cases, with significant agreement between this sign, arthroscopy (kappa = 0.78, p = 10-4) and MR-imaging (kappa = 0.72, p < 0.0001). The performance parameters of the sleeper's sign were: sensitivity 74.5 ± 12.5%, specificity 98.5 ± 1.6%, Youden index 0.73 and accuracy 96.9%. MR imaging was found to be more sensitive (91.5 ± 8%). Multivariate analysis identified the sleeper's sign as a risk factor of MSMFT during arthroscopy: OR 131.9 CI 95% [26.9-646.2], p < 0.0001 and a bone edema next to the flap tear on MR-imaging: OR 13, CI 95% [1.9-7.1], p = 0.008. CONCLUSION: The "sleeper's sign" is a new, valid, highly specific clinical sign for the diagnosis of a medial submeniscal flap tear. MRI was found to be more sensitive than the sleeper's sign. LEVEL OF EVIDENCE: II.

Preoperative Osteopathic Manipulative Therapy Improves Postoperative Pain and Reduces Opioid Consumption After Total Knee Arthroplasty: A Prospective Comparative Study.

CONTEXT: Pain is a therapeutic challenge after total knee arthroplasty (TKA), and it could lead to the overuse of opioids. Few methodologically robust clinical studies have been performed to assess the effectiveness of osteopathic manipulative therapy (OMTh; manipulative care performed by non-US-trained osteopaths) for postsurgical pain. OBJECTIVE: To evaluate the effectiveness of standardized preoperative OMTh on early postoperative pain and opioid consumption after TKA. METHODS: This comparative, nonrandomized study took place from 2013 to 2015 and included patients who had primary unilateral TKA for osteoarthritis in a knee that had not undergone any previous surgery. Patients were divided into 2 consecutive groups: 1 group received traditional preoperative management, and the other group received associated preoperative OMTh (general OMTh [rhythmic mobilization of all the body joints, from the ankles to the skull, using long-lever manipulation] and myofascial relaxation). The primary evaluation criterion was knee pain at rest 1 month after surgery: 0 (no pain) to 100 (the worst imaginable pain). The secondary evaluation criteria were: (1) knee pain while walking 1 month after surgery, (2) average weekly knee pain during the first month after surgery, (3) the presence of night pain and the consumption of sleeping pills and opioids or morphine at least once per week, (4) the International Knee Society scores and the Western Ontario and McMaster University Osteoarthritis index at postoperative 6 months and 1 year. The number of patients needed for a superiority trial was determined. RESULTS: No eligible patient refused OMTh when proposed. Seventy patients were evaluated (mean [SD] age, 75 [8] years; 47 women and 23 men). The 2 treatment groups contained 35 patients each. At postoperative month 1, the OMTh group had significantly less pain at rest (mean [SD], 6.8 [6] vs 20.9 [17.3]; P=.00001) and while walking (7.9 [9.4] vs 23.5 [20.6]; P=.0001) compared with the group that received traditional preoperative management. The consumption of opioids during the first postoperative week was significantly lower in the OMTh group (P=.0001). No statistically significant difference was found in the International Knee Society or Western Ontario and McMaster University Osteoarthritis scores between the 2 groups at 6 months and 1 year of follow-up. CONCLUSION: Standardized preoperative OMTh was found to be effective in reducing pain in the first month after TKA for osteoarthritis and significantly reduced opioid consumption during the first postoperative week.

Pre-operative bone mineral density is a predictive factor for excellent early patient-reported outcome measures in cementless total hip arthroplasty using a proximally fixed anatomic stem. A prospective study at two year minimum follow-up.

PURPOSE: The goal of the study was to analyze the impact of the pre-operative bone mineral density on the patients' reported outcomes at two year minimum follow-up of cementless THA using a proximally fixed anatomic stem. METHODS: A prospective study included all patients who underwent a cementless THA using a specific proximally fixed anatomic stem and a 3D preoperative CT scan-based planning. The bone mineral density (BMD) of the metaphyseal cancellous bone was computed in a volume (of 1 mm thick and of 1 cm2 surface) at the level of the calcar 10 mm above the top of the lesser trochanter. Patients were assessed at two year follow-up using self-administered auto-questionnaires corresponding to the modified Harris (mHHS), the Oxford (OHS), and the Forgotten Hip (FHS) scores. A multiple linear regression statistical analysis was performed to assess the link between the mHHS, the age, body mass index (BMI), BMD, gender, and ASA grade. RESULTS: Fifty patients were included (29 men, 21 women), with an average age of 62 ± 12 years and an average BMI of 27 ± 5 kg/m2. At two year follow-up, on multivariate analysis, excellent mHHS (≥ 90%) was significantly associated with only two parameters: a BMI ≤ 25 kg /m2 with an odd ratio OR = 10 (CI95% [2.1-48.3], p = 0.004) and a BMD ≥ 72 mg/cm3 with an odd ratio OR = 4.87 (CI95% [1.2-18.6], p = 0.02). CONCLUSION: The short-term PROMs after cementless THA are impacted by pre-operative cancellous bone density. However, the BMI remains the most influential parameter on the clinical outcomes.

Can primary total hip arthroplasty be performed in an outpatient setting? Prospective feasibility and safety study in 321 patients in a day-surgery unit.

INTRODUCTION: Total hip arthroplasty (THA) performed as day-surgery is an emerging and growing practice. The main aim of the present study was to assess the feasibility and safety of primary THA in an outpatient setting. The study hypothesis was that, within a specifically dedicated structure, such surgery is feasible and safe. MATERIAL AND METHODS: A prospective observational study was performed in two centers, one private hospital and one university hospital, including all patients operated on by two senior surgeons between 2014 and 2017 for primary THA and eligible for day-surgery. The clinical pathway was governed by a pre-established protocol. Preoperatively, all patients took part in an information workshop, with their spouses and the surgeon. Postoperative phone interviews were held on D1 and D3, then out-patient consultations were conducted at 1 and 6 weeks. The main study endpoint was successful outpatient management, failure being defined as crossover or readmission within 1 week of discharge. Secondary endpoints comprised complications rate and satisfaction as assessed by patient and spouse at 6 weeks. RESULTS: During the study period, 1,303 patients received primary THA. 338 (25.9%) were eligible for day-surgery, but 17 (5%) declined; the day-surgery series thus comprised 321 patients (24.6%): 166 men, 155 women; mean age, 61.2±9.7 years. Same-day discharge was not possible for 14 patients (4.5%): 9 due to persistent faintness, 2 to intraoperative femoral fracture, 1 to organizational issues, 1 to an uncomplicated fall, and 1 to hemoglobinemia<11g/100ml in a coronary patient. There were no readmissions during week 1. At 6 weeks' follow-up, there had been 3 adverse events: 2 dislocations, and 1 periprosthetic fracture. 312 patients (97.2%) were satisfied. CONCLUSION: The present prospective study found no major adverse events in patients undergoing day-surgery for primary THA. However, patients should be selected, consenting, prepared and managed on a standardized clinical pathway. LEVEL OF EVIDENCE: IV; non-comparative prospective study.

Correction to: Vancomycin-soaked autografts during ACL reconstruction reduce the risk of post-operative infection without affecting return to sport or knee function.

The article Vancomycin­soaked autografts during ACL reconstruction reduce the risk of post­operative infection without affecting return to sport or knee function, written by Yoann Bohu.

Vancomycin-soaked autografts during ACL reconstruction reduce the risk of post-operative infection without affecting return to sport or knee function.

PURPOSE: To compare return to sport and knee function 1 year after anterior cruciate ligament (ACL) reconstruction using autografts with and without vancomycin presoaking. METHODS: A case-control study based on a retrospective analysis of prospective data included athletes over the age of 16 operated from 2012 to 2018 for ACL reconstruction. There were two groups of patients due to a change in treatment protocols: Group 1 « without vancomycin ¼ before November 2016 and Group 2 « with vancomycin¼ after this date. In Group 2, the graft was soaked in a vancomycin solution for 10 min and then fixed into the bone tunnels. The primary evaluation criterion was the return to sport 1 year after surgery. The secondary criteria were various knee scores. The number of patients needed to perform a non-inferiority study was calculated. RESULTS: 1674 patients fulfilled the selection criteria, 1184 in Group 1 and 490 in Group 2. The series included 1112 men and 562 women, mean age 30 ± 9.7 years, 68 professional athletes, 674 competitive athletes and 932 recreational athletes. While seven patients presented with post-operative septic arthritis in Group 1, this complication was not found in Group 2. No significant difference was identified in the return to running between the two groups 1 year after surgery (75.9% vs. 76.1%, n.s.). Significantly more of the patients in Group 2 returned to their preinjury sport (p = 0.04). Knee function was comparable between the groups. CONCLUSION: Vancomycin-soaked grafts during ACL reconstruction reduce the risk of post-operative infection of the knee without affecting the return to sport or knee function. LEVEL OF EVIDENCE: III. TRIAL REGISTRATION: https://clinicaltrials.gov/ , ClinicalTrials.gov Identifier: NCT02511158.

Risk factors for passive anterior tibial subluxation on MRI in complete ACL tear.

INTRODUCTION: In anterior cruciate ligament (ACL) tear, passive spontaneous anterior tibial subluxation (ATS), with respect to the femur, is sometimes observed on MRI. In a case-control study, ATS>3.5mm showed 100% specificity (±3.6, 95% CI) for complete ACL tear. The aim of the present study was to assess the relation between ATS on MRI and associated lesions in complete ACL tear. The study hypothesis was that associated lesions are a risk factor for ATS. MATERIAL AND METHODS: A retrospective study included patients operated on for complete ACL tear between 2010 and 2015. Exclusion criteria comprised associated posterior cruciate ligament tear, partial ACL tear, and history of knee surgery. Preoperative MRI was performed with the patient in supine position and the knee in 20° flexion in neutral rotation. ATS was measured by axial superimposition of the bicondylar slice on the slice through the tibial plateau. Associated lesions were assessed: medial and lateral menisci, collateral ligaments, posteromedial and posterolateral corners, tibiofemoral compartment cartilage and cancellous bone. Factors associated with ATS>3.5mm were analyzed. Ninety-one patients were included: mean age, 31.1±10.1 years; 34 female, 57 male. Mean time from injury to MRI was 7.8±11.7 months (range, 0.7-60 months). RESULTS: Mean ATS was 4.7±2.3mm. Inter- and intra-observer reproducibility for ATS measurement were excellent. On preoperative MRI, 61.1% of patients showed bone edema, 48.4% medial meniscal tear, and 36.3% lateral meniscal tear. ATS was significantly greater in case of medial meniscal tear (5.4±2.3mm vs. 4±2.1mm; p=0.003). No significant differences were found according to other lesions. Fifty-four patients (59.3%) showed ATS>3.5mm; risk factors comprised medial meniscal tear (OR=2.6, 95%CI [1.1-6.2]; p=0.03) and injury-to-MRI time>9 months (OR=9.8, 95% CI [1.1-85.2]; p=0.04). CONCLUSION: Spontaneous anterior tibial subluxation on MRI in complete ACL tear was significantly associated with medial meniscal tear and accident-to-MRI time. LEVEL OF EVIDENCE: IV, retrospective cohort study.

Reliability of a new dynamic ultrasound test for quantifying first-ray mobility.

BACKGROUND: First-ray hypermobility (FRHM) is a documented abnormality whose pathogenic role is controversial. FRHM has been suggested to participate in many common disorders such as paediatric hallux valgus and recurrence after hallux valgus surgery. The controversy is due to lack of functional data on the first tarso-metatarsal joint (TMT1) in real-life situations, to its major anatomical variability, and to the absence of simple investigation methods. The objective of this study was to assess the feasibility and the inter- and intra-observer reproducibility of a new dynamic ultrasound test that quantifies TMT1 mobility and is simple to use provided a good-quality ultrasound machine is available. HYPOTHESIS: The new ultrasound TMT1 mobility test is reproducible. MATERIAL AND METHODS: The 32 feet of 16 consecutive patients whose first ray was considered normal were included. Ultrasonography was performed at rest and during a stress test consisting in causing TMT1 gaping by applying a distal dorsal drawer movement to the first metatarsal. The two plantar bony prominences on either side of the TMT1 were identified, and the distance between them was measured at rest and during the stress test. The stress/rest ratio was computed. Each foot was tested twice by two different examiners, for a total of 128 tests. RESULTS: Mean TMT1 gaping distance was 1.38mm (range, 1.01-2.02mm) at rest and 1.67mm (range, 1.12-2.95mm). The mean stress/rest ratio was 1.21 (range, 1.02-1.62). Both inter- and intra-observer reliability was strong for all measured parameters. DISCUSSION: A simple and reproducible ultrasound test for measuring TMT1 mobility is described for the first time. The good reproducibility confirms the working hypothesis. This preliminary study was designed to validate the new test. The measured values need to be assessed in various disorders including FRHM, for which the test was designed. Should the results prove conclusive, the TMT1 gaping test may become a pivotal diagnostic tool. LEVEL OF EVIDENCE: IV, diagnostic study.

Autologous Conditioned Plasma for tendon healing following arthroscopic rotator cuff repair. Prospective comparative assessment with magnetic resonance arthrography at 6 months' follow-up.

INTRODUCTION: Despite improvements in technique and materials for rotator cuff repair, mean re-tear rates remain close to 30%. The aim of the present study was to assess injection of Autologous Conditioned Plasma (ACP™, Arthrex) for tendon healing after arthroscopic repair. The study hypothesis was that ACP™ improves the tendon-healing rate. MATERIAL AND METHOD: A non-randomized comparative prospective study included all patients aged over 18 years operated on in 2010 for arthroscopic repair of full-thickness rotator cuff tear with≤2 fatty degeneration on the Goutallier classification, whatever the severity of retraction, on virgin non-osteoarthritic shoulder without contraindications for magnetic resonance (MR) arthrography. The surgical protocol was standardized. The first half of the patient sample received end-of-procedure ACP™ injection to the repaired tendon, tuberosity freshening surface and subacromial space, and the second (control) half received no supplementary treatment. The main endpoint was tendon healing on MR arthrography at 6 months according to Sugaya. Secondary endpoints comprised shoulder pain at rest on a numerical scale (0=no pain to 10=worst imaginable pain) and Constant functional score. RESULTS: Two of the 58 patients refused MR arthrography and 7 were lost to follow-up. Forty-nine patients (26 ACP™, 23 controls) were analyzed: 20 male, 29 female; mean age, 61±7.3 years. There were no significant intergroup differences in healing rate at 6 months (ACP™ 73.1% vs. 78.3% controls; p=0.75), shoulder pain (2±1.8 vs. 2.6±1.7, respectively; p=0.24), or Constant score (77±13.5/100 vs. 72.4±12.3, respectively; p=0.18). CONCLUSION: Associating ACP™ did not improve healing after arthroscopic rotator cuff repair. Sample size, however, had been calculated for a large expected difference, leading to lack of power. LEVEL OF EVIDENCE: III; case-control study.

Hermes patellofemoral arthroplasty: Annual revision rate and clinical results after two to 20 years of follow-up.

BACKGROUND: Patellofemoral arthroplasty (PFA) is an alternative to a total knee arthroplasty (TKA) in patients with severe isolated patellofemoral osteoarthritis. The main goal of this study was to determine the revision rate of the Hermes™ (Ceraver) anatomical unconstrained PFA. METHODS: A retrospective single surgeon study was performed including all patients operated for PFA between 1997 and 2015. A standardized procedure was used to perform PFA with one type of prosthesis. All patients in the study were contacted at the final follow-up. The main judgment criterion was the annual rate of revision. Secondary criteria were the severity of anterior knee pain on a numerical scale (0-10) and functional scores (IKS and AKP scores). RESULTS: During this period, PFA was performed in 64 patients (74 PFA), 52 women/12 men, mean age at surgery 59.6 ±â€¯11.8 (31.3-82.1) years old. Four patients (5.4% of PFA) were lost to follow-up. Mean follow-up for the remaining 70 PFA was 7.5 ±â€¯7.1 (2-20) years. TKA was required in 10 (14.3%) patients after a mean 5.4 ±â€¯3.4 (1-9.3) years. The annual rate of revision was two-percent CI95% [1.1-3.7%] if TKA was considered to be the defining event and 3.1% CI95% [1.9-5.1%] for all types of revision (partial/total PFA replacement or TKA). Patients who underwent revision were significantly younger. After a mean eight (2-20) years of follow-up, mean anterior pain, the IKS and AKP scores improved significantly. CONCLUSION: In this series, 78.6% of patients with a Hermes™ PFA did not require any revision after a follow-up of between two and 20 years. LEVEL OF EVIDENCE: Level IV - retrospective study.

Bioabsorbable screws, whatever the composition, can result in symptomatic intra-osseous tibial tunnel cysts after ACL reconstruction.

PURPOSE: To describe the clinical results of patients who underwent surgical treatment for a intra-osseous tibial tunnel cyst on a bioabsorbable interference screw following anterior cruciate ligament reconstruction (ACL). METHODS: This retrospective study included all patients who underwent surgery between 2004 and 2016 for an intra-osseous tibial tunnel cyst on bioabsorbable interference screw following ACL reconstruction. The diagnosis was suggested clinically by pretibial pain at the incision site, sometimes associated with a palpable subcutaneous nodule and then confirmed on MRI. The first stage of surgery included exploratory arthroscopy followed by open excision/curettage of the cyst and then the tunnel was filled. The main criterion for outcome was a clinically normal knee (no pain, 0-120 range of motion, stable, with no effusion) at 6 months of follow-up. RESULTS: This series included 53 patients, mean age 35.3 ± 9.9 years old w ith a mean 4.6 ± 3.1 years (between 3.1 months and 19 years) of follow-up after ligament reconstruction. The tibial screw was completely absorbed in 9/53 (17%) of patients, and fragmented in 22/53 (41.5%). At the 6-month follow-up, 42/53 (79.2%) patients had a normal knee, 11/53 (20.8%) persistent pain in the cyst area, 52/53 (98.1%) normal range of motion and 53 (100%) a stable knee. A recurrent cyst developed at 2 years of follow-up in one patient. CONCLUSION: Complete absorption of a bioabsorbable interference screw is long, increasing the risk of developing intra-osseous tibial cysts during this period. The development of new materials with improved absorption properties is needed. LEVEL OF EVIDENCE: IV-Retrospective study.

Professional Athletes Are Not at a Higher Risk of Infections After Anterior Cruciate Ligament Reconstruction: Incidence of Septic Arthritis, Additional Costs, and Clinical Outcomes From the French Prospective Anterior Cruciate Ligament Study (FAST) Cohort.

BACKGROUND: The rate of septic arthritis in the knee after anterior cruciate ligament (ACL) reconstruction varies in the literature but is generally less than 1%. It has been reported to be higher in professional athletes (5.7%). PURPOSE: The primary goal was to evaluate the rate of septic arthritis after ACL reconstruction in professional athletes compared with other patients. The secondary goals were to analyze the risk factors; increased cost of infections; return to sport, satisfaction, and functional results at 1-year follow-up; and resolution rate of infections at final follow-up. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: This retrospective analysis of prospective data included a continuous series of patients who underwent isolated ACL reconstruction between 2012 and 2016. The main outcome criterion was the development of intra-articular infections in the operated knee. An infection was suggested clinically (knee pain with fever and/or chills) and confirmed bacteriologically in deep tissue samples obtained during revision surgery. All infected patients underwent an emergency reoperation with lavage and debridement along with dual antibiotic therapy first by an intravenous route and then orally for 6 weeks. RESULTS: A total of 1809 of 1859 patients included in the cohort during this period fulfilled inclusion criteria; there were 1632 (90.2%) who underwent primary reconstruction and 177 (9.8%) who underwent revision. The series included 1249 (69%) men and 560 (31%) women, with a mean age of 29.1 ± 9.8 years. Ninety-eight percent of the patients participated in a sport, including 90 (5.0%) at a professional level and 712 (39.4%) competitively. Septic arthritis of the knee developed after a mean 15.7 ± 5.5 days in 7 (0.38%) patients: 5 of 1632 (0.31%) who underwent primary reconstruction and 2 of 177 (1.13%) who underwent revision. Septic arthritis did not develop in any professional or competitive athletes; all affected patients were recreational athletes ( P = .02). The risk factors identified for the development of septic arthritis on multivariate analysis were prior knee surgery (odds ratio [OR], 15; P = .002) and hemarthrosis during the immediate postoperative period (OR, 127.2; P = .002). There were no recurrent infections after a mean follow-up of 2.8 ± 1.2 years. CONCLUSION: None of the professional athletes in this cohort had septic arthritis after ACL reconstruction. There are no particular precautions to be taken in this population. The risk factors identified for the development of septic arthritis on multivariate analysis were prior knee surgery and hemarthrosis during the immediate postoperative period. Similar to all studies published on the subject, there were very few infected patients, which limits the identification of risk factors. REGISTRATION: NCT02511158 (ClinicalTrials.gov identifier).

Are athletes able to resume sport at six-month mean follow-up after anterior cruciate ligament reconstruction? Prospective functional and psychological assessment from the French Anterior Cruciate Ligament Study (FAST) cohort.

BACKGROUND: The decision to return to sport following anterior cruciate ligament (ACL) reconstruction should not only be based on time since surgery. This study aimed to assess, using isokinetic and neuromuscular (hops) testing in a large group, postoperative objective functional recovery of the knee. The secondary objective was to determine the relationship between psychological, functional scores, and these postoperative tests. METHODS: This prospective study included athletes who underwent surgery between 2013 and 2016 for an isolated full-thickness ACL tear. They received a complete evaluation of functional performance of the knee by isokinetic tests performed on a dynamometer to measure quadriceps and hamstring strength, and neuromuscular assessment based on single-leg hop tests. The main judgment criterion was satisfactory functional recovery (yes/no) defined as a difference of ≤10% both in the quadriceps 60°/s and the single hop at a minimum of four months of follow-up. RESULTS: A total of 234 athletes were analyzed. The mean age was 28.4 ±â€¯8.6 years. At 6.5 ±â€¯1.7 months mean follow-up, 44 (18.5%) patients had satisfactory functional recovery of the knee. The correlations between isokinetic/hop tests and the different scores were variable. During follow-up, two patients presented with a graft tear and two with a contralateral ACL tear, all in the group with unsatisfactory functional recovery. CONCLUSION: At a mean of six months after ACL reconstruction, objective functional recovery of the knee was generally unsatisfactory and this seemed to be a risk factor for recurrent tears. LEVEL OF EVIDENCE: IV; case series.