Does Spinal Surgery in Elderly Patients (Over 80 Years-Old) Lead to More Early Post-Operative Complications Than Lower Limb Prosthetic Surgery?

Purpose: Patients and surgeons may be reluctant on spinal surgery over 80 years old, fearing medical complications despite the possible improvement on quality of life. However, fewer reservations for lower limb prosthetic surgery (LLPS) seem to be arisen in this population. Is spinal surgery after 80 years-old responsible of more complications than lower limb surgery? Methods: The consecutive files of 164 patients over 80 years that had spinal surgery or LLPS were analyzed. The data collected pre-operatively were demographic, clinical and post-operatively the number and types of medical complications and length of stay. Results: The mean number of medical complications was 1.11 ± 0.6 [0-6] for spinal surgery and 1.09 ± 1.0 [0-3] for LLPS, (p = 0,87). The length of stay in orthopedic unit was comparable between the two groups: 10.7 ± 4.9 days [2-36] for SS and 10.7 ± 3.0 days [5-11] for LLPS (p = 0,96). Conclusion: The global rate of peri-operative complications and the length of hospital stay were similar between spinal surgery and lower limb prosthetic surgery. These results may be explained by the rising cooperation between geriatric specialist and surgeons and the development of mini-invasive surgical technics, diminishing the early post-operative complication rates.

Adaptation of the Signal Noise Quotient MRI classification for graft ligamentization analysis following ATFL and CFL anatomical reconstruction: Validation of the SNQA.

BACKGROUND: Chronic ankle instability is the most frequent clinical sign of an antero tibiofibular (ATFL) and/or calcaneo fibular ligament (CFL) tear. One common surgical technique is to use the distal tendon of the gracilis muscle to reconstruct both the ATFL and CFL. In the knee, the hamstring tendons used in anterior cruciate ligament (ACL) reconstruction may go through structural modifications called "ligamentization ". A noninvasive MRI technique has been developed using the Signal/Noise Quotient to compare the signal of the graft following reconstruction to that of the posterior cruciate ligament. To our knowledge no studies have ever evaluated radiographic changes in the graft over time. The main goal of this study was to develop a specific MRI protocol to evaluate graft remodeling following ATFL and CFL reconstruction over time. METHODS: A prospective study of the changes in the MRI signal of the ATFL-CFL graft 3-months postoperatively was performed in 20 patients. The main outcome was a comparison of the graft signal to that of the peroneal fibular tendon and the surrounding noise to determine the Ankle SNQ (SNQA). MRI images were evaluated by two senior radiologists to assess inter-rater reliability and then 2 weeks later for the intra-rater reproducibility. RESULTS: The intraclass correlation (ICC) showed excellent inter- and intra rater reliability for the ATFL SNQA (0.96 and 0.91, respectively); and for the CFL SNQA, the ICC was 0.97 and 0.99, respectively. Bland-Altman analysis showed very limited bias in the interpretation of SNQA. CONCLUSION: This preliminary study confirmed the inter- and intra- rater reliability of a new tool using the SNQA.

Femoral intercondylar notch: Accuracy of a novel MRI measurement protocol.

OBJECTIVE: The most common mechanical complication following an anterior cruciate ligament (ACL) reconstruction is joint stiffness, due in part to cyclops syndrome. A narrow intercondylar notch is an anatomical risk factor. A reliable preoperative notch measurement would help anticipate proper graft size, or plan a notchplasty during the ligament reconstruction, if necessary. No study has yet assessed the accuracy of the methods used to measure notch size. HYPOTHESIS: The novel measurement protocol proposed in this study would be more reproducible than the reference technique. METHODS: A total of 20 preoperative knee MRIs performed during the assessment of an ACL rupture were randomly selected. The notch size was measured using 2 methods: traditional (ratio of the notch and metaphyseal widths measured on a line drawn through the popliteal groove) and novel. The latter was measured using the same ratio but took into account the notch width in its proximal third, according to a coronal slice that passes through the ACL tibial attachment. Three orthopedic surgeons with different levels of experience (senior surgeon, junior surgeon and surgical resident) performed these measurement protocols twice on anonymized MRI scans, 10days apart. Spearman's rank correlation coefficient was used to assess the intraobserver correlations and a concordance index was used to assess the interobserver correlations. The influence of the second MRI reading was analyzed with a bootstrap test. RESULTS: The mean intraobserver reliability was 0.73 for the reference method and 0.83 for the proposed method. The values of the bootstrap tests were higher for the proposed method (0.45 vs. 0.45 and 0.70; p<05 for interobserver; 0.49 vs. 0.69 and 0.62; p<05 for intraobserver). CONCLUSION: The proposed measurement protocol showed a higher reproducibility in assessing notch size than the traditional method. This technique therefore provides a reliable assessment of the intercondylar notch width. LEVEL OF EVIDENCE: IV; retrospective study.

Acute Achilles Tendon Rupture: Ultrasonography and Endoscopy-Assisted Percutaneous Repair.

To date, there is no consensus concerning the treatment of acute Achilles tendon ruptures. Although surgical treatment decreases the risk of a recurrent rupture, it is not without complications. In particular, percutaneous sutures may cause a lesion of the sural nerve. The purpose of this Technical Note is to describe a reliable and reproducible surgical procedure for treating these lesions. The first operative phase consists of an ultrasound detection that makes it possible to identify the tendon extremities and the sural nerve, which is necessary to secure the posterolateral arthroscopic tract as well as to perform the percutaneous suture. The entry point is thus centered on the lesion and placed at a distance from any surrounding nerve risk. The second arthroscopic phase makes it possible to release the tendon lesion, control the transtendon passage of the surgical threads, and evaluate the dynamic contact of the tendon edges. At the end of the intervention, the complete disappearance from the transillumination via the rupture also makes it possible to ensure the disappearance of the tendon gap. Achilles tendon percutaneous sutures after the ultrasound detection and under arthroscopic control thus makes it possible to control the contact of the tendon edges, while at the same time decreasing the risk of a lesion of the sural nerve, with minimal scarring.