[The Need for Recovery Scale: French adaptation and validation.] / L'échelle de besoin de récupération : adaptation et validation françaises.

OBJECTIVES: The study presents the French validation of the scale of Need for Recovery after work (Need for Recovery) as well as the average scores according to sex, age, occupation and branch of industry. METHOD: A representative sample of the French employees completed a questionnaire made up of the Need for Recovery Scale, Perceived Stress Scale, Hospital Anxiety and Depression Scale and Maslach Burnout Inventory - General Survey. Analyses of internal consistency led us to withdraw an item from original scale; validity as well as discriminating quality were evaluated with the adequate analyses. RESULTS: The French version of the Need for Recovery Scale has very good psychometric qualities. Internal consistency (evaluated by Alpha of Cronbach) is 0.86. This scale is correlated mainly with the ?emotional exhaustion? dimension of the Maslach Burnout Inventory (r = 0.68). The analysis highlighted groups of French employees having levels of high need for recovery: men of less than 25 years, women of more than 55 years and people practicing the profession of Teachers and equivalents'. CONCLUSIONS: Given its predictive value on the physical and psychological health of employees, we recommend an individual or collective use of the Need for Recovery Scale in order to set up preventive actions in the workplaces.

Magnetically controlled growing rod in early onset scoliosis: a 30-case multicenter study.

PURPOSE: Preliminary results of magnetically controlled growing rods (MCGR) are encouraging. However, only short case series of MCGR for the treatment of early onset scoliosis (EOS) have been reported. Our aim was to evaluate its effectiveness and complications. METHODS: We report a 30-case retrospective, consecutive, multicenter series of MCGR. Effectiveness was judged upon: deformity correction and difficulties to achieve desired distraction. Secondary endpoints included complications and revision surgeries. RESULTS: Median age at surgery was 9.1 years (5-13). Mean follow-up was 18.4 months (12-33.9). Mean Cobb angle was 66° preoperatively and 44° at latest follow-up. MCGR has avoided an average of 2.03 scheduled surgical procedures per patient compared to traditional growing rod (GR). The intended total length gain was 40.1 mm per patient (5-140) and the total measured length gain was 21.9 mm (45.5% discrepancy). There were 24 complications: 7 proximal pull-outs of the hooks, 3 rod breakages, 6 failures of the lengthening of which 4 complete blockages and 2 complete blockages followed by backtracking, 1 proximal junctional kyphosis, 1 wound dehiscence, 1 superficial infection, 1 deep infection requiring implant removal, 1 pulmonary embolism, 1 pulmonary insufficiency, 1 secondary lumbar scoliosis, and 1 painful outpatient distraction. Eight patients had a gradual loss of effectiveness of distractions. There were 13 revision surgeries in 9 patients. CONCLUSIONS: MCGR provides satisfactory deformity correction and avoids repeated surgical procedures for lengthening. However, it has substantial complication rate. Although less frequent than in GR, the law of diminishing returns also applies to MCGR.

Clinical and anatomic results of surgical repair of chronic rotator cuff tears at ten-year minimum follow-up.

PURPOSE: The purpose of this study was to evaluate long-term clinical and anatomic results after open rotator cuff repair. MATERIALS AND METHOD: Fifty-three patients were included in this study. Rotator cuff tears were limited to one tendon in 34, and two tendons or more in 19. The supraspinatus tendon was involved alone in 30 cases, and the subscapularis in four. Clinical, radiographic and MRI evaluations were performed for all patients at ten-year minimum follow-up. RESULTS: At 11.4-years average follow-up, satisfactory results were obtained with improvement on pain level, in range of motion with a gain in active anterior elevation and in external rotation as well as in strength in abduction. Absolute Constant score reached 74.7 points and adjusted Constant score 99.6%. SSV was 82.5% with a SST score of 10 points. Osteoarthritis changes increased with follow-up with osteoarthritis lesion in 69% of the cases. MRI evaluation found a re-tear of the repair in 42% of the cases: 30% when only the supraspinatus tendon was initially involved, and 63% when two or more tendons were repaired. Tear size and quality of the repair were the most important prognosis factors for re-tear of the repair. No correlation was found between the occurrence of a new tear and the clinical outcome. CONLCUSION: Surgical repair of chronic rotator cuff tendon tear can produce consistent and lasting pain relief and improvement in range of motion. Re-tear of the repair was not correlated with degradation of clinical results. Best results were obtained for isolated supraspinatus tear with a complete surgical repair.

Evaluation of thirty eight cemented pegged glenoid components with variable backside curvature: two-year minimum follow-up.

BACKGROUND: The PERFORM™ pegged glenoid system has been used for shoulder arthroplasty since 2012. This system offers multiple backside curvatures per size to better match variable patient anatomy. As a result, less reaming is required and subchondral bone is preserved-a critical factor in preventing glenoid migration and loosening, thus enhancing implant longevity. PURPOSE: The purpose of this study was to analyze all radiographic modifications around this new glenoid implant. METHOD: Thirty-eight shoulders which received the PERFORM™ pegged glenoid component between June 2012 and January 2014 for primary or secondary osteoarthritis were reviewed at two-years minimum follow-up. There were 13 men and 22 women with an average age of 67 years. Humeral components were an uncemented short stem implant in nine (23%) and a resurfacing implant in 29 (77%). RESULTS: At 27-months average follow-up (24-41), Constant score improved from 30 to 65 points. Range of motion improved significantly at follow-up from 100° to 142° for the anterior elevation, and from 15 to 40° for the external rotation. Radiographic lucent lines (RLL) were observed post-operatively in eight cases (21%), and in 16 cases (42%) at the last follow-up with an increase of the RLL score from 0.36 ± 0.8 to 1.3 ± 2 (p < 0.001) without signs of loosening (RLL > 12). One revision has been performed after anterior shoulder dislocation, rotator cuff tear and glenoid component migration. RLL score was not correlated with dominant side, sex, age, or Constant score. DISCUSSION-CONCLUSION: The cemented pegged glenoid component with multiple backside curvatures gave satisfactory results at two-years minimum follow-up for up to three years with a low RLL score. Long-term studies are mandatory to confirm these results.

Is the Latarjet procedure risky? Analysis of complications and learning curve.

PURPOSE: The purpose of this study was to analyse the learning curve and complication rate of the open Latarjet procedure. METHODS: The first 68 Latarjet procedures performed by a single surgeon for chronic anterior shoulder instability were reviewed retrospectively. The standard open surgical technique was followed faithfully during each procedure. Post-operative complications were taken from patient medical records. Post-operative evaluation consisted of clinical and radiological assessments. RESULTS: The rate of early (<3 months) clinical complications was 7.4 % (5.9 % haematoma, 1.5 % neurological deficit), and the delayed complication rate was 7.3 %. Early complication rate, duration of surgery (mean 65 min; 35-135) and hospital stay (mean 3 days; 1-4) were significantly reduced as experience increased (respectively; P = 0.03, ρ = - 0.3; P = 0.009, ρ = - 0.3; P < 0.0001, ρ = - 0.6). On the radiographs, the bone block was healed and in perfect position in 87 % of cases, with no effect of surgical experience (P = 0.3, ρ = 0.1). The rate of complications on radiographs was 17 %: 11 % partial lysis, 2 % complete lysis and 4 % non-union. No recurrence of instability was found after an average follow-up of 21 months. CONCLUSION: Despite a high rate of post-operative complications, the morbidity of Latarjet procedure remains low. A surgeon's experience significantly affects the surgery duration and the occurrence of early complications. The main radiological complication is partial lysis of the bone block. After a short learning curve, the clinical outcomes of the Latarjet procedure appear to be satisfactory and reproducible. LEVEL OF EVIDENCE: IV.

Reverse shoulder arthroplasty for malignant tumors of proximal humerus.

BACKGROUND: Reverse shoulder arthroplasty (RSA) provides an alternative for shoulder girdle reconstruction after wide transarticular resection of the proximal humerus for malignant tumor. The aim of this study was to evaluate midterm outcomes of this therapeutic option. METHODS: Ten patients with RSA were included and reviewed with 24 months of minimum follow-up. Proximal resection of malignant tumor included the "V" deltoid insertion in 4 patients. The humeral stem was coated (with an allograft in 2 patients and a cement mantel in 3) or left uncoated (5 patients). RESULTS: At a mean follow-up of 42 months, among 8 prosthesis available for evaluation (2 patients died), the Constant and Murley score averaged 52 points, the 11-item version of the Disabilities of the Arm, Shoulder and Hand (QuickDASH) score averaged 29.5 points, the Subjective Shoulder Value averaged 58%, and the Musculoskeletal Tumor Society score averaged 20.25 points. Mean forward active elevation reached 122°, external rotation at side was -2°, and internal rotation was to L4. Three prostheses were unstable. The involvement of "V" deltoid insertion at surgery trended to worsen the clinical outcome. Atrophy of the anterior deltoid occurred in most of patients who had a previous transdeltoid biopsy. Radiographic evaluation found 1 stem loosening, 1 stem at risk, and 3 scapular notches without glenoid loosening. CONCLUSION: Use of RSA after resection of a malignant tumor of the proximal humerus seems to be an acceptable option to preserve function. However, radiographic evolution is worrisome, and long-term study remains necessary to validate this therapeutic option with follow-up.

Complications of radial head prostheses.

Radial head prostheses are indicated for treatment of complex radial head fractures not amenable for fixation. After the initial experience with silastic implants, metallic or pyrocarbon arthroplasty have been used for 20 years. Little is known about complications related to these implants. Main complications are related to loosening whether they are cemented or not cemented. Hypotheses have been proposed like inadequate stem design, insufficient cement technique, stress shielding, and foreign body reactions secondary to polyethylene wear. Pain and stiffness are other common complications often related to oversized radial head component or overstuffing of the joint with excessive lengthening of the radius. Instability can be another complication in the context of more complex trauma with lateral collateral ligament complex lesion and coronoid fracture. Fixation of the coronoid fracture, reinsertion of the lateral collateral ligament complex, and the use of monobloc radial head prosthesis are recommended to stabilize the joint. Finally, osteoarthritis is common with follow-up.

A New Step Toward Evidence of In Vivo Perineural Dexamethasone Safety: An Animal Study.

BACKGROUND AND OBJECTIVES: The aim of this study was to analyze histological nerve toxicity of perineural dexamethasone administration in combination with ropivacaine on mice. Efficacy of perineural dexamethasone in combination with regional anesthesia is clearly demonstrated. However, the safety of this procedure is still a matter of debate. METHODS: A sciatic nerve block was performed on 90 mice. Five groups, each containing 18 mice assigned randomly, were used in these experiments: the sham group (isotonic saline solution), R group (perineural ropivacaine), D group (perineural dexamethasone), RDPN group (perineural ropivacaine and perineural dexamethasone), and the RDS group (perineural ropivacaine and systemic dexamethasone). Sensory and motor blocks were evaluated every 30 minutes for 14 hours. Fourteen and 28 days after this procedure, 9 mice in each group were killed for sciatic nerve histological assessment. RESULTS: No statistical difference was observed between different groups for Wallerian degeneration (P = 0.28 at day 14 and P = 0.22 at day 28) and perineural inflammation (P = 0.9 at day 14). Motor and sensory block durations were tested for each group. A statistical difference was observed for motor block duration between the RDPN group (150 minutes [127-172 minutes]), the RDS group (120 minutes [90-120 minutes]), and the R group (60 minutes [60-90 minutes]). Sensory block duration was also statistically different: 660 minutes (660-720 minutes) in the RDPN group, 480 minutes (427-660 minutes) in RDS group, 330 minutes (240-410) in the R group. CONCLUSIONS: A combination of ropivacaine and perineural dexamethasone allows longer sensory block duration compared with ropivacaine alone or ropivacaine and systemic dexamethasone, without increased neural toxicity.