Aseptic arthritis after ACL reconstruction by Tape Locking Screw (TLS®): report of two cases.

In Tape Locking Screw (TLS(®)) ligamentoplasty, transplant bone fixation uses polyethylene terephthalate (PET). We report two cases of aseptic arthritis following anterior cruciate ligament (ACL) reconstruction using this material. Diagnosis was founded on negative sampling and complete cure following arthroscopic lavage and synovectomy without curative antibiotherapy. This complication was also described with other synthetic materials used in this indication (Dacron, PFTE, carbon), and with PET as transplant material but never as bone fixation material. The physiopathological hypothesis is in terms of PET particle release in the suprapatellar bursa; sinking the strips into the bone as fully as possible on implantation could avoid impingement. Longer TLS(®) ligamentoplasty series with adequate follow-up will be needed in order to estimate the true incidence of this complication.

[Rating of tumoral growth in non-operated primary or recurrent extra-abdominal aggressive fibromatosis]. / Etude de la croissance tumorale des tumeurs desmoïdes extra-abdominales (FDEA) primitives ou récidivées non opérées.

PURPOSE OF THE STUDY: Extra-abdominal aggressive fibromatosis (EAAF) is a benign desmoid tumor with a potentially aggressive behavior. Surgical treatment is compromised by a very high rate of recurrence, sometimes with significant morbidity. We conducted a prospective surveillance of our patients (clinical and MRI) with EAAF to search for prognostic factors. MATERIAL AND METHODS: This cohort included 17 patients with EAAF. For nine patients, biopsy alone was performed. For eight, the tumor was a recurrence after surgical removal. Patients were seen for a clinical assessment and MRI every six months. RESULTS: Median follow-up was 42 months (range 6-114). Three patients worsened clinically with pain or functional impairment. One patient required neurosurgery to control pain (good stable outcome). MRI showed progression for two tumors (12%) but with a short follow-up since diagnosis (9 and 14 months), in one case despite medical treatment. Three tumors regressed and twelve remained stable on successive MRI. On average the tumor growth lasted ten months. DISCUSSION: Tumor growth was never noted beyond 36 months. This notion of an interruption in tumor growth is mentioned sporadically in reports on EAAF, which have generally included recurrent tumors. To our knowledge this is the first series reporting tumors left in place a followed with modern imaging techniques. The high rate of spontaneous interruption of tumor growth must be counterbalanced with the difficult task of local treatment: the risk of recurrence is particularly high after surgery and functional sequelae can be significant when wide resection is proposed in an anatomically difficult localization. The precise role for surgery, and combined radiotherapy, remain to be determined. There are only scarce reports on general treatments. Considering these facts, we propose that surgical resection should not be considered the only solution for the treatment of EAAF. Further work is needed to define the useful contribution of simple surveillance of these benign tumors.