Does combined anterior cruciate ligament and anterolateral ligament reconstruction improve return to sport?

PURPOSE: Only 50-65% of patients return to their previous sporting level after ACL rupture. The literature reports a reduced rate of graft rupture when an anterolateral ligament reconstruction (ALLR) is associated with ACL reconstruction. ACL reconstruction combined with ALL allows a higher return to sport at pre-injury level than isolated reconstruction in patients playing pivot-contact sports. METHODS: A retrospective, single-centre study between 2012 and 2020 comparing reconstruction by hamstring tendon technique, isolated ACLR vs ACL with ALLR. An isokinetic test was performed at 6 months post-operatively and patients were re-contacted at a minimum 2-year follow-up to assess their level and delay to return to sport, graft rupture rate and functional evaluation. RESULTS: 83 patients were included, 42 in ACLR group and 41 in ACL + ALLR group. Four patients were lost to follow-up and 79 patients were analysed. No significant difference was found on the level of return to sport (28.2% vs. 42.5%; p = 0.18), return to competition (43% vs. 60%; p = 0.18), delay to sports return, isokinetic assessment, functional scores, but a significant difference was found on graft rupture rate in favour of ALLR (12.8% vs. 0%; p = 0.02). CONCLUSION: In our study, the addition of an ALL to ACL reconstruction did not improve pre-injury sports recovery or return to competition. STUDY DESIGN: Cohort study, level of evidence 4.

Arthroscopic Trillat technique for chronic post-traumatic anterior shoulder instability: outcomes at 2 years of follow-up.

BACKGROUND: The purpose of this study was to assess the outcomes of a new arthroscopic Trillat technique at a 2-year follow-up. Our current hypothesis was that this technique could be used for the effective treatment of chronic post-traumatic unidirectional anterior shoulder instability, and that the recurrence and complication rates, external rotation, and functional outcomes would be as good as those of the reference technique. METHODS: Between April 2012 and August 2016, all patients older than 16 years who underwent the arthroscopic Trillat technique for unidirectional chronic post-traumatic anterior shoulder instability at the Dijon University Hospital (France), after the failure of well-conducted medical and rehabilitation treatment with at least 24 months of follow-up, were included. Criteria for noninclusion were association with posterior and/or inferior instabilities, voluntary instabilities, and glenoid bone loss greater than 20%. Patients attended follow-up with their surgeon before the intervention, in the immediate postoperative period, at 6 weeks, 3 and 6 months, and then by an independent observer for the last evaluation. Patients were then examined clinically with scores such as Constant, Rowe and Walch-Duplay scores, and subjective shoulder value, for shoulder range of motion, and radiographically (anteroposterior and Lamy's lateral x-rays of the operated shoulder). RESULTS: Forty-nine patients and 52 shoulders were included, with a mean follow-up of 40 months (range, 24-71 months). The recurrence rate of instability was 3.8% (2 of 52). No conversion to arthrotomy was necessary. No intraoperative complications, postoperative neurological lesions, or sepsis were observed. The mean Constant score was 92.1 (77.5-100) points, Walch-Duplay 82.9 (40-100), Rowe 81.73 (5-100), and subjective shoulder value 86.1 (50-100) at the last follow-up. The arm at side external rotation limitation averaged 8.4° (-25° to 40°) and the external rotation with 90° arm abduction limitation 0.34° (-5° to 15°). Forty-one patients (79%) resumed their sports activity at the same level. Fifty patients (96%) were satisfied to very satisfied. One patient developed nonunion of the coracoid process and subsequently underwent a Latarjet procedure with a good outcome. CONCLUSIONS: The arthroscopic Trillat procedure offers good outcomes as a first-line treatment for chronic anterior post-traumatic glenohumeral instability. It should be excluded in cases of glenoid loss greater than 20%.

Double level knee osteotomy using patient-specific cutting guides is accurate and provides satisfactory clinical results: a prospective analysis of a cohort of twenty-two continuous patients.

PURPOSE: Double level osteotomy (DLO) (femoral and tibial) is a technically demanding procedure for which pre-operative planning accuracy and intraoperative correction are key factors. The aim of this study was to assess the accuracy of the achieved correction using patient-specific cutting guides (PSCGs) compared to the planned correction, its ability to maintain joint line obliquity (JLO), and to evaluate clinical outcomes and level of patient satisfaction at a follow-up of two years. METHODS: A single-centre, prospective observational study including 22 patients who underwent DLO by PSCGs between 2014 and 2018 was performed. Post-operative alignment was evaluated and compared with the target angular values to define the accuracy of the correction for the hip-knee-ankle angle (ΔHKA), medial proximal tibial angle (ΔMPTA), lateral distal femoral angle (ΔLDFA), and posterior proximal tibial angle (ΔPPTA). Pre- and post-operative JLO was also evaluated. At two year follow-up, changes in the KOOS sub-scores and patient satisfaction were recorded. The Mann-Whitney U test with 95% confidence interval (95% CI) was used to evaluate the differences between two variables; the paired Student's t test was used to estimate evolution of functional outcomes. RESULTS: The mean ΔHKA was 1.3 ± 0.5°; the mean ΔMPTA was 0.98 ± 0.3°; the mean ΔLDFA was 0.94 ± 0.2°; ΔPPTA was 0.45 ± 0.4°. The orientation of the joint line was preserved with a mean difference in the JLO of 0.4 ± 0.2. At last follow-up, it was recorded a significant improvement in all KOOS scores, and 19 patients were enthusiastic, two satisfied, and one moderately satisfied. CONCLUSION: Performing a DLO using PSCGs produces an accurate correction, without modification of the joint line orientation and with good functional outcomes at two year follow-up.

Contemporary rotating hinge arthroplasty can safely be recommended in complex primary surgery.

PURPOSE: The objective was to evaluate clinical and radiological outcomes, survival rate and complications of primary contemporary rotating hinged total knee arthroplasty (CRH-TKA). METHODS: Through a national multicenter retrospective study (14 centers), 112 primary CRH-TKA performed between 2006 and 2011 were included. Indications were: severe frontal plane deformity (55%), inflammatory, constitutional, congenital or post-trauma arthritis (26%), ligament laxity (10%), primary osteoarthritis (9%). Population was elderly (68 ± 13), sedentary (37.5% with a Devane score ≥ 3) and with important comorbidities (87% with ASA score ≥ 2). A clinical (KSS, Oxford scores) and radiological evaluation (implant loosening), as well as survival and reoperation rates assessment, were performed. RESULTS: At last follow-up (7 ± 3 years), KSS and Oxford scores were 64 ± 43 and 33 ± 10 each with a significant improvement of both scores overtime (respectively, p = 0.047 and p < 0.001). Twenty-eight complications (25%) were reported: 12 infections, 6 stiffness, 5 aseptic loosening and 5 patellofemoral instabilities. All in all, 91% (n = 102) of implants were still sealed and in place, 6% (n = 7) required revision and 3% (n = 3) were loose but could not undergo revision due to weak general health status. Mortality rate (18%, n = 20), linked to comorbidities, was high. CONCLUSION: Clinical outcomes and survival of primary CRH-TKA are acceptable given the difficult and complex clinical situations it faced, but with high infection rate. In primary surgery, for patients with severe deformity, bone loss or ligament laxity, the use of CRH-TKA can be recommended. The choice of these implants must remain cautious and limited to situations not allowing the use of less constrained implants. LEVEL OF EVIDENCE: Retrospective therapeutic and cohort study, Level III; retrospective case series, Level IV.

Outcomes of Augmented Dual Mobility Acetabular Cups.

INTRODUCTION: Total hip arthroplasty (THA) in patients with acetabular bone defects is associated with a high risk of dislocation and aseptic loosening. No studies to date have examined the use of uncemented and augmented dual mobility cups (DMC) in patients with acetabular defects. We hypothesized that the use of augmented DMC under these conditions would reduce the dislocation rate and lead to satisfactory bone integration in the medium term despite acetabular bone defects. MATERIALS AND METHODS: This continuous multicenter study included all cases of augmented DMC performed between 2010 and 2017 in patients with acetabular bone loss (Paprosky 2A: 46%, 2B: 32%, 2C: 15% and 3A: 6%). The indications for implantation were revisions for cup aseptic loosening (AL) (n=45), femoral stem AL (n=3), bipolar AL (n=11), septic loosening (n=10), periprosthetic fracture (n=5), chronic dislocation (n=4), intraprosthetic dislocation (n=2), cup impingement (n=1), primary posttraumatic arthroplasty (n=8), and acetabular dysplasia (n=4). The clinical assessment consisted of the Harris hip score (HHS) and Merle d'Aubigné Postel score (MDP), along with preoperative and final follow-up radiographs. The primary endpoint was surgical revision for aseptic acetabular loosening or the occurrence of dislocation. RESULTS: Overall, 93 patients were reviewed at a mean follow-up of 5.3 ± 2.3 years [0, 10]. As of the last follow-up, the acetabular cup had been changed in five cases: 3 AL (3.2%) and 2 infections (2.1%). Thus the overall survivorship of the cup was 94.6% and the survivorship for AL was 96.8%. Three patients (3%) suffered a dislocation. At the last follow-up visit, the mean MDP and HHS scores were 14.75 and 72.15, respectively, which reflected significant improvements relative to the preoperative scores (p < 0.05). CONCLUSION: Use of an uncemented and augmented DMC in cases of acetabular bone defect leads to satisfactory medium-term results with low dislocation and loosening rates. We recommend its use in these cases.

Influence of body mass index on sagittal hip range of motion and gait speed recovery six months after total hip arthroplasty.

PURPOSE: In practice, obesity leads to poor functional outcomes after total hip arthroplasty (THA). However, in clinical research, the influence of body mass index (BMI) on the gait recovery and kinematics for THA is not well documented. The purpose of this study was to assess the influence of BMI on gait parameters pre-operatively and six months after THA for hip osteoarthritis (OA) patients. METHODS: We included 76 THA for hip OA: non-obese group (G1): 49 (BMI < 30 kg/2) and obese group (G2): 37 (BMI ≥ 30 kg/m2) with a control group of 61 healthy people. Clinical evaluation (HOOS) and a 3D gait analysis (gait speed and flexion range of the hip (ROM)) were performed before and six months after THA: The gains between the two visits were calculated and we looked for correlations between outcomes and BMI. RESULTS: Preoperative gait speed and hip ROM were significantly lower in obese patients (speed G1: 0.81 ± 0.22 m/s vs. G2: 0.64 ± 0.23 m/s, p = 0.004 and hip ROM G1: 26.1° ± 7.3 vs. G2: 21.4° ± 6.6, p = 0.005), and obese patients were more symptomatic. At six months, gait speed and hip ROM were significantly lower for all patients compared with the control group. No correlation between gait velocity, hip ROM, and BMI was found. Biomechanical and clinical gains were comparable in the two groups. CONCLUSIONS: All patients, including obese patients, have significant functional improvement after THA, objectively assessed by gait speed. Even if patients did not fully recover to the level of a healthy control person after THA, functional gain is comparable irrespective of BMI.

Is distal locking screw necessary for intramedullary nailing in the treatment of humeral shaft fractures? A comparative cohort study.

PURPOSE: The gold standard for intramedullary nailing (IMN) in humeral shaft fracture treatment is bipolar interlocking. The aim of this study was to compare clinical and radiographic outcomes in two cohorts of patients treated with IMN with or without distal interlocking. We hypothesized that there was no significant difference between isolated proximal interlocking and bipolar interlocking in terms of consolidation and clinical results. METHODS: One hundred twenty-one acute humeral shaft fractures were retrospectively included in group WDI (without distal interlocking screw, n = 74) or in group DI (with distal interlocking screw, n = 47). One hundred six patients (87.60%) could be verified by an X-ray, and 63 (52.07%) could be examined clinically. Fracture union at 6 months was the primary outcome, and the second was the final clinical outcome for shoulder and elbow after at least 6 months of follow-up. Pain, operating time, and radiation time were also analyzed. RESULTS: The two groups were not significantly different for population, fractures, or immobilization duration. No significant difference was found for bone union (WDI 89.06% vs DI 83.33%, p = 0.51), shoulder or elbow functional outcomes, or pain. However, there were significant differences in advantage to the WDI group for operating time (WDI 63.09 ± 21.30 min vs DI 87.96 ± 30.11 min, p < 0.01) and fluoroscopy time (WDI 59.06 ± 30.30 s vs DI 100.36 ± 48.98 s, p < 0.01). CONCLUSIONS: Thus, it seems that there were no significant differences between proximal unipolar and bipolar interlocking for humeral shaft fractures in terms of consolidation and clinical outcomes. WDI avoided the additional operating time and fluoroscopy time and risks linked to DI.

Influence of Body Mass Index on Sagittal Knee Range of Motion and Gait Speed Recovery 1-Year After Total Knee Arthroplasty.

BACKGROUND: The purpose of this prospective study was to investigate the influence of body mass index (BMI) on gait parameters preoperatively and 1 year after total knee arthroplasty (TKA). METHODS: Seventy-nine patients were evaluated before and 1 year after TKA using clinical gait analysis. The gait velocity, the knee range of motion (ROM) during gait, their gains (difference between baseline and 1 year after TKA), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), quality of life, and patient satisfaction were assessed. Nonobese (BMI <30 kg/m2) and obese patients (BMI ≥30 kg/m2) were compared. Healthy controls were also assessed. Univariate and multivariate linear regression analyses were used to assess the association between gait speed and ROM gains. Adjustment was performed for gender, age, and WOMAC pain improvement. RESULTS: At baseline, gait velocity and knee ROM were significantly lower in obese compared with those in the nonobese patients (0.99 ± 0.27 m/s vs 1.11 ± 0.18 m/s; effect size, 0.53; P = .021; and ROM, 41.33° ± 9.6° vs 46.05° ± 8.39°; effect size, 0.52; P = .022). Univariate and multivariate linear regressions did not show any significant relation between gait speed gain or knee ROM gain and BMI. At baseline, obese patients were more symptomatic than nonobese (WOMAC pain: 36.1 ± 14.0 vs 50.4 ± 16.9; effect size, 0.9; P < .001), and their improvement was significantly higher (WOMAC pain gain, 44.5 vs 32.3; effect size, 0.59; P = .011). CONCLUSION: These findings show that all patients improved biomechanically and clinically, regardless of their BMI.

Linear relationship between lateralization of the bicipital groove and humeral retroversion and its link with the biepicondylar humeral line. Anatomical study of seventy cadaveric humerus scans.

INTRODUCTION: Morphological studies of the humerus have shown that the position of the bicipital groove varies with the individual and the retroversion of the humeral head. Depending on the authors, these two parameters are independent or associated. This study evaluated the relationship between the humeral head axis and its retroversion and the bicipital groove relative to the humeral biepicondylar line. MATERIALS AND METHODS: Seventy cadaveric humeri were scanned to obtain 3D reconstructions. Views of the 3D reconstruction from above showed the bicondylar line, the bicipital groove and the humeral head on a single image. After measuring the humeral retroversion angle and the bicipital groove angle relative to the bicondylar line, we assessed the relationship between these two angles with Pearson's correlation coefficient. RESULTS: Pearson's correlation coefficient indicated a significant linear correlation between the angle of the groove and the angle of humeral retroversion based on the 70 cadaveric humeral bones (the p-value was 7.510-7, the correlation coefficient was -0.5515, and the 95% confidence interval was (-0.6962; -0.3636)). Our study thus demonstrates that the less lateralized the bicipital groove is, the greater the humeral retroversion will be. CONCLUSION: We demonstrated a linear relationship between humeral head retroversion and bicipital groove lateralization. Within our reliability interval, this relationship can be used in clinical practice to evaluate retroversion without resorting to CT of the entire humerus.

Total hip arthroplasty with dual mobility cup in osteonecrosis of the femoral head in young patients: over ten years of follow-up.

Osteonecrosis of the femoral head affects mainly young patients with high functional needs this increases the risk of dislocation. Dual mobility cups known for low rate of dislocation and high mobility range seems indicated. We evaluate functional efficiency, survival and dislocation rate of dual mobility cup for total hip arthroplasty for osteonecrosis in young patients. Monocentric retrospective clinical study, from 2000 to 2008. With a clinical analysis in pre-operative and over ten years of follow-up of one cohort of patients under 55 years old with an indication of THA for ONFH. The judgement criteria was: clinical scores at the maximal follow-up, the dislocation rate, and the cumulate survival rate over ten years follow-up. Forty THA in 31 patients, nine bilateral cases, 23 males and eight females with average age of 44 (±4) years old. In pre-operative: PMA 11 (±3.3), HHS 50,8 (±15.5). At the final follow-up of 129.8 (±33.8) months: PMA (17.4 ± 1.12), HHS (95.7 ± 6.9), no dislocation. We had 11 deaths on average at 95.2 ± 47.3 months. The cumulate survival rate over ten years follow-up is 100% without revisions or long-term dislocation. Analysis concludes to very significant functional improvement without any dislocation despite the young population with high level of activity. Thus, dual mobility cups is a reliable choice preventing dislocation with a very good survival rate without premature wear, preserving mobility and activity.

Röttinger approach with dual-mobility cup to improve functional recovery in hip osteoarthritis patients: biomechanical and clinical follow-up.

PURPOSE: We assumed that the combination of dual-mobility total hip arthroplasty (THA) using the minimally-invasive Röttinger anterolateral approach could guarantee hip stability with faster functional recovery. We objectively analyzed functional improvement after dual-mobility THA by quantitative gait analysis. METHODS: We compared the results achieved following two different surgical approaches: Röttinger's versus Moore's approach (posterolateral approach). We included 70 patients in an open prospective single-centre study: 38 by Rottinger's approach (age = 67yo) and 32 by Moores's approach (age = 68yo). Clinical and biomechanical analysis (kinematic and kinetic parameters of the hip) were conducted at the pre-operative period and at six months post-op RESULTS: We found a significant improvement in all clinical scores and all biomechanical parameters but no difference was found between the two approaches. However, the study showed marked clinical, biomechanical and functional improvements for patients treated with dual-mobility THA for osteoarthritis without complete hip recovery compared with a control group. CONCLUSIONS: The combination of the Röttinger approach with a dual-mobility cup remains a valid choice for primary THA without functional advantage at midterm.

Determination of a new computed tomography method for measuring the glenoid version and comparing with a reference method. Radio-anatomical and retrospective study.

PURPOSE: In the literature, there are several techniques for measuring the glenoidal version of the scapula. The superiority of the scannographic measurement over the standard radiologic measures seems evident. The main problems are the evaluation and the reproducibility of these methods, which are dependent on the quality of the CT scan and the orientation of its sections. We pinpoint a simple method of the "scapular triangle", the reliability of which deserves special consideration. The aim of this study is to report a simple and reproducible computed tomography method to measure the glenoidal version. METHODS: Thrity-one shoulder CT scans, performed on patients attending the emergency department of the University Hospital of Dijon between January 2012 and April 2013 for shoulder trauma, were evaluated retrospectively. The CT scan must include the entire body of scapula to allow measurements to be made with both methods: the conventional method of Friedman and our new method of the "scapular triangle". Two independent operators performed inter-observer and intra-observer reproducibility. We compared both techniques with Pearson's test. RESULT: Pearson's test showed a trend line according to a linear correlation between the two methods with a p value of 7.791(-10) and a correlation coefficient of 0.85 with the 95% confidence interval (0.7213; 0.929). CONCLUSION: The method of the "scapular triangle" is easily applicable on most sections of the CT scan of scapula whether or not it takes the whole body. It is more reliable and reproducible and could be used by any radiologist.

Shoulder Stabilization Technique Using the Medial Glenohumeral Ligament in Patients With the Buford Complex.

The Buford complex is an anatomic variation defined as the association of a cordlike middle glenohumeral ligament (MGHL) and an absent anterosuperior labrum. It can be challenging to properly identify on preoperative imaging and remains mostly an arthroscopic finding. It may, however, lead to problematic situations when encountered during an arthroscopic soft-tissue stabilization procedure, as the treatment of choice in such cases is a bone block. Moreover, reattaching the MGHL to the anterior border of the glenoid rim has traditionally not been recommended because it theoretically leads to severe restriction in external rotation. This technical note describes arthroscopic stabilization for anterior traumatic glenohumeral instability associated with the Buford complex. The cordlike MGHL is used to reconstruct a neo-labrum, associated with an anteroinferior glenohumeral ligament plication. Glenohumeral stabilization using the cordlike MGHL of the Buford complex may be an efficient alternative to a bone block procedure.

Subscapularis atrophy and function after arthroscopic Trillat procedure.

INTRODUCTION: Several studies have reported a strength deficit in internal rotation (IR) following a Latarjet procedure, which can persist for months or even years. The arthroscopic Trillat procedure does not require splitting the subscapularis muscle, potentially making it less damaging. HYPOTHESIS: The arthroscopic Trillat procedure does not cause any atrophy or strength deficit in the subscapularis muscle. METHODS: This was a single center, retrospective study of patients treated between 2013 and 2021. Included were patients who had chronic anterior shoulder instability with an indication for surgical stabilization using an arthroscopic Trillat procedure and who underwent a CT scan before surgery and a second one at 6 months postoperative. The following morphological parameters were measured on all the rotator cuff muscles: cross-sectional area (CSA), thickness and fatty infiltration using the mean muscle attenuation (MMA) measurement. Isokinetic tests were done 1 year post-surgery. RESULTS: One hundred seventeen patients underwent arthroscopic Trillat surgery between 2013 and 2021; 58 were included, 30 were analyzed and 17 patients underwent isokinetic testing. The CSA of the subscapularis was significantly smaller by 5.3% (17.0 vs. 16.1; p = 0.03). None of the other rotator cuff muscles had a smaller CSA. The MMA of the subscapularis increased significantly while the MMA of the external rotators decreased postoperatively. No strength deficit was found at 1 year postoperative in the internal and external rotators. DISCUSSION: The arthroscopic Trillat procedure produces minor atrophy of the subscapularis muscle at 6 months, with no strength deficit at 1 year postoperative. Several studies have reported a deficit in internal rotation strength after a Latarjet procedure, ranging from 6% to 19% depending on the study. LEVEL OF EVIDENCE: IV.

Functional outcomes and center of rotation restoration in total hip arthroplasty after acetabular fracture: A review of 367 hips.

BACKGROUND: Total hip arthroplasty (THA) after acetabular fracture is typically performed months or years later for posttraumatic arthritis after initial conservative treatment. But THA can be performed earlier after open reduction and internal fixation (ORIF) of the fracture. The aim of this study was to determine which strategy is best. The primary outcome measure was the radiological restoration of the hip's center of rotation (COR). The secondary outcome measures were the incidence of complications and the hip's functional scores. MATERIALS AND METHODS: A multicenter cohort was analyzed by splitting patients into three groups: group A (THA within 3weeks of fracture); group B (THA deferred after early ORIF); group C (THA more than 3weeks after fracture, without ORIF). Group B was separated into two subgroups: B- (THA less than 1year after ORIF) and B+ (THA more than 1year after ORIF). The demographics, surgical techniques, COR superior and lateral migration coefficient and functional scores (HHS, HOOS-PS and FJS) were recorded. The functional scores were gathered using PROMs. RESULTS: In all, 367 patients were included: 108 in group A, 69 in group B-, 113 in group B+ and 77 in group C. The mean follow-up was 5.8years [3.4 months-35years]. The mean age of the patients was 69.2years [SD 15; 26-101], 52years [SD 16; 19-83], 49years [SD 16; 16-85] and 58.1years [SD 17; 13-94], respectively (p<0.01). The mean ASA score was 2.13 [SD 0.70], 1.84 [SD 0.65], 1.67 [SD 0.63] and 1.79 [SD 0.60], respectively (p<0.01). A complex Letournel fracture was present in 63 patients (61%), 46 patients (71%), 48 patients (49%) and 38 patients (62%), respectively (p<0.01). A reinforcement cage was implanted in 38 patients (69%), 16 patients (62%), 5 patients (12%) and 19 patients (66%), respectively (p<0.01). Cement was used in 45 patients (45%), 23 patients (35%), 19 patients (18%) and 21 patients (32%), respectively (p<0.01). A graft was needed in 46 patients (46%), 35 patients (53%), 17 patients (16%) and 21 patients (48%), respectively (p<0.01). Posterior ORIF was done in 40 patients (46%), 32 patients (55%), 64 patients (61%) and 9 patients (82%), respectively (p<0.01). The COR lateral migration coefficient was significantly higher in group C with a mean of +0.17 (SD 0.85) [-0.27 to +6] compared to the other groups (p=0.02). The COR superior migration coefficient was comparable between groups, with a mean of +0.77 (SD 2.26) [-0.99 to 27], p>0.05. There were complications in 10 patients (9.2%), 6 patients (8.7%), 6 patients (5.3%) and 3 patients (3.9%), respectively, with no significant difference between groups. The PROMs were completed by 51% of patients. At the final review, the mean HHS was 79.2 (SD 21.8) and the mean HOOS-PS was 77.7 (SD 20.1) in the entire cohort, p>0.05. The mean FJS by group was 55.9 (30.2), 47.7 (SD 36.4), 66.1 (SD 30.4) and 65.8 (SD 30.3), respectively (p=0.02). DISCUSSION AND CONCLUSION: The B strategy (B+) yielded good outcomes in terms of function and COR restoration. When using this strategy, anterior ORIF preserves the native hip for a subsequent THA through a posterior approach. Strategy C also produces good functional outcomes but shifts the COR laterally. This study confirms the poor results of strategy A in previous publications. When the prognosis is poor, immediate mobilization after anterior ORIF followed by THA within 1year appears to be a good strategy (group B-). LEVEL OF EVIDENCE: IV, observational study.

Experimental study of risk of medial hinge fracture during distal femoral varus osteotomy.

INTRODUCTION: Lateral opening wedge distal femoral osteotomy (LOWDFO) is indicated for isolated lateral osteoarthritis in the valgus morphotype. Medial hinge fracture is a factor for poor prognosis. The present study had two aims: (1) to assess the impact of a temporary K-wire on hinge fracture risk; and (2) to assess the impact of LOWDFO opening speed. HYPOTHESIS: The main study hypothesis was that a temporary hinge K-wire reduces hinge fracture risk. The second hypothesis was that faster opening speed increases fracture risk. MATERIAL AND METHOD: Twenty femurs were produced by 3D printing from a CT database, reproducing LOWDFO anatomy. The ABS® polymer showed the same breaking-point behavior as human bone. Ten specimens were included in the "K-wire" group (KW+) and 10 in the "No K-wire" group (KW-). To determine high and low speed, a motion-capture glove was used by 2 operators, providing 3D modeling of the surgeon's hand. High speed was defined as 152mm/min and low speed as 38mm/min. The KW+ and KW- groups were subdivided into high- and low-speed subgroups (HS, LS) of 5 each. Compression tests were conducted using an Instron® mechanical test machine up to hinge fracture. The main endpoint was maximum breaking-point force (N); the secondary endpoints were maximum displacement (mm) and maximum speed (min) at breaking point. RESULTS: The K-wire significantly increased maximum breaking-point force (LS, 143.08N vs. 93.71N, p<0.01; and HS, 186.98N vs. 95.22N, p<0.01), but not maximum displacement (LS, 26.17mm vs. 24.11mm, p=0.31; and HS 26.18mm vs. 23.66mm, p=0.14) or maximum time (LS, 27.07s vs. 24.94s, p=0.31; and HS, 5.24s vs. 4.73s, p=0.14). Speed did not affect maximum force (KW+, 143.08N vs. 186.98N, p=0.06; and KW-, 93.71N vs. 95.22N, p=0.42) or maximum displacement (KW+, 26.17mm vs. 26.18mm, p=1; and KW-, 24.11mm vs. 23.66mm, p=0.69). Only maximum time was greater at low speed (KW+, 27.07s vs. 5.24s, p>0.01; and KW-, 24.94s vs. 4.73s, p<0.01), which is obvious for constant distance. DISCUSSION: The first study hypothesis was confirmed, with significantly lower hinge fracture risk with the K-wire, independently of opening speed. The second hypothesis was not confirmed. The study was performed under strict experimental conditions, unprecedented to our knowledge in the literature. However, complementary clinical studies are needed to confirm the present findings. LEVEL OF EVIDENCE: IV, experimental study.

Functional recovery after total hip/knee replacement in obese people: A systematic review.

OBJECTIVE: Several studies have investigated the influence of body mass index (BMI) on functional gain after total hip replacement (THR) or total knee replacement (TKR) in osteoarthritis, with contradictory results. This systematic literature review was conducted to ascertain whether obesity affects functional recovery after THR or TKR in the short (<1 year), medium (<3 years) and long term (>3 years). METHODS: The study was registered with PROSPERO and conducted according to the PRISMA guidelines. A systematic literature search was conducted across Medline and EMBASE databases for articles published between 1980 and 2020 that investigated patient-reported measures of functional recovery after THR and TKR in participants with osteoarthritis and obesity (defined as BMI ≥30 kg/m2). RESULTS: Twenty-six articles reporting on 68,840 persons (34,955 for THR and 33,885 for TKR) were included in the final analysis: 5 case-control studies, 21 cohort studies (9 for THR only, 10 for TKR only and 2 for both). The average minimum follow-up was 36.4 months, ranging from 6 weeks to 10 years. Most studies found significantly lower pre-operative patient-reported functional scores for participants with obesity. After THR, there was a small difference in functional recovery in favor of those without obesity in the short term (<6 months), but the difference remained below the minimal clinically important difference (MCID) threshold and disappeared in the medium and long term. After TKR, functional recovery was better for those with obesity than those without in the first year, similar until the third year, and then decreased thereafter. CONCLUSIONS: Although there is a paucity of high-quality evidence, our findings show substantial functional gains in people with obesity after total joint replacement. Functional recovery after THR or TKR does not significantly differ, or only slightly differs, between those with and without obesity, and the difference in functional gain is not clinically important. PROSPERO NUMBER: CRD42018112919.

Labral tears in hip dysplasia and femoroacetabular impingement: A systematic review.

INTRODUCTION: Hip dysplasia and femoroacetabular impingement are pathologies whose impact on the function and survival of the hip joint is no longer debated. Labral tears may be present and impact the prognosis of the causal pathology. Labral tear management lacks consensus and still raises several questions, thus we conducted a systematic analysis to clarify: 1) What is its prevalence in hip dysplasia and femoroacetabular impingement? 2) Does it modify the symptomatology of the causal pathology? 3) Is its repair better than resection or abstention? MATERIAL AND METHOD: A systematic literature review was carried out following the PRISMA guidelines, using the Medline and Embase databases and including all articles in French or English, written until June 2022 referring to labral tears in hip dysplasia and femoroacetabular impingement. The articles were analyzed by 2 surgeons in order to select them according to a predefined algorithm. 1) Articles were selected by title from the search results. 2) A selection based on the abstract was then made. 3) A final selection was made upon complete reading. 4) In the event of a discrepancy during the selection, a third co-author was contacted for a final decision. 5) Data extraction was then carried out by the two readers using a preformatted sheet. RESULTS: Of the 1177 articles identified, 43 articles were kept for the final analysis. The prevalence of labral tears was on average 78.80±4.7% [17 to 100%] in dysplasia and 93.8±16.8% [33% to 100%] in impingement. The review did not reveal any symptomatology specific to the labral tear. In dysplasia, 5 comparative studies were analyzed. A single study on shelf arthroplasties demonstrated the negative impact of a labral tear in the event of resection on survival compared to no tear (83% versus 15.2% (p=0.048)). Regarding impingements, 8 comparative studies were analyzed. At 7 years of follow-up, only one study found a significant and clinically relevant functional gain in terms of MCID (minimal clinically important difference) for labral repair compared to debridement on the mHHS score (p=0.008), SF-12 score (p=0.012), and pain scale (p=0.002). One study showed superiority of repair over labral debridement in terms of 10-year survival (78% 95% CI [64-92%] vs 46% 95% CI [26-66%] (p=0.009)). DISCUSSION: The literature analysis was heterogeneous with a few comparative studies and predominantly short periods of follow-up. Understanding labral pathology and its impact requires differentiating between the different tear categories and proposing treatment to restore or preserve the biomechanical properties of the joint. LEVEL OF EVIDENCE: IV, Systematic Review of Level 1-4 Evidence.

Slope-decreasing anterior closing wedge proximal tibial osteotomies using the freehand technique are accurate to within 2̊.

INTRODUCTION: Anterior cruciate ligament (ACL) reconstruction requires a detailed analysis of the posterior tibial slope (PTS) as excessive values may cause the reconstruction to fail and require a slope-decreasing anterior closing wedge tibial osteotomy combined with revision of the failed ACL reconstruction. The main purpose of this study was to assess the accuracy of correction after slope-decreasing anterior closing wedge tibial osteotomy in cases of chronic anterior instability caused by ACL rerupture. MATERIALS AND METHODS: This single-center retrospective study included 19 patients (20 knees) operated on by slope-decreasing anterior closing wedge tibial osteotomy combined with a second revision ACL reconstruction. The mean age was 22.4±3.3 years and the mean follow-up was 12.7±4.4 months. The preoperative planning was based on lateral calibrated X-rays of the entire tibia. The height of the closing wedge, which corresponded to the base of the osteotomy, was measured in millimeters. The procedure was performed using the freehand technique. The accuracy of the correction was defined as the difference between the desired preoperative PTS and the postoperative PTS achieved. An inter- and intraobserver analysis was performed. RESULTS: The mean preoperative PTS was 13.9±2̊ and the mean postoperative PTS was 4.0±1.7̊. The mean PTS correction was 10.1±2.1̊ with a planned target of 5.4±1.8̊. The accuracy obtained between the planned target and the postoperative corrections was 1.7±1.1̊. The regression analysis showed that the accuracy of the PTS correction was not influenced by the patient's age, BMI, excessive preoperative PTS, or degree of correction achieved (p>0.05). CONCLUSION: Slope-decreasing anterior closing wedge tibial osteotomies performed using the freehand technique for ACL graft rerupture can correct an excessive PTS within 2̊ of the planned slope correction. This accuracy is not determined by demographic factors, excessive preoperative PTS or degree of correction achieved. LEVEL OF EVIDENCE: IV; retrospective cohort study.

The influence of the sacral slope on pelvic kinematics and clinical manifestations in femoroacetabular impingement.

INTRODUCTION: The radiological study of the sagittal alignment of the spine in static and dynamic positions has allowed a better understanding of the clinical results of total hip prostheses. According to the Roussouly classification, the sacral slope in a standing position characterizes the patient with a stiff spine (less than 35̊) or a flexible spine (greater than 35̊). The objectives of this study were to compare, in a population of patients operated on for femoroacetabular impingement (FAI), firstly, the kinematics of the lumbar-pelvic-femoral complex and secondly, the clinical presentation depending on whether the spine is stiff or flexible. HYPOTHESIS: Patients with stiff spines (SS<35̊) were "hip users" and had less ability to compensate for their hip pathology. MATERIAL AND METHOD: This prospective and comparative multicenter study was conducted with patients operated on arthroscopically for FAI between 2020 and 2021. All patients included received preoperative EOS imaging of the lower limbs and spine, in standing and seated positions. The following parameters were measured: pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), and sacral slope (SS), as well as dynamic parameters (intrinsic mobility of the hip: delta standing/sitting femoral sacral angle, and of the pelvis: delta standing/sitting sacral slope). The functional result was evaluated at 1 year. RESULTS: In the stiff spine group, 62 patients were included versus 138 in the flexible spine group. The mean follow-up was 15.1±3.3 months (9.2-24.3). Nineteen patients were lost to follow-up and there were 2 revisions for iterative arthroscopy. Intrinsic pelvic mobility and intrinsic hip mobility were 16̊±13.5 (-12; 44) and 44.5̊±28.5 (-9; 99) respectively in the stiff spine group. In the flexible spine group, these same measurements were 22̊±11.5 (-30; 45) and 29.7̊±22.7 (-33; 82) respectively. In the stiff spine group, the symptoms occurred at a significantly younger age: 28.3 years±9.5 (18-51) versus 31 years±8 (18-54) (p=0.017). DISCUSSION: The sacral slope is a determining factor in the kinematics of impingement and the appearance of symptoms. The sacral slope helps define the concept of a "hip user" in symptomatic FAI. LEVEL OF EVIDENCE: IV.