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1.
Knee Surg Sports Traumatol Arthrosc ; 32(1): 124-134, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38226676

RESUMO

PURPOSE: Environmental sustainability in medicine is a growing concern. Determining the carbon footprint of medical procedures may aid in selecting a less impactful technique moving forward. The purpose of this study was to understand the environmental impact of different anterior cruciate ligament reconstruction techniques, for which there is no consensus in terms of optimal graft. METHODS: A life cycle analysis of different anterior cruciate ligament reconstruction techniques was performed. These included quadrupled semitendinosus graft, bone-patellar tendon-bone graft, iliotibial band augmented with gracilis graft, doubled semitendinosus and doubled gracilis graft, and quadriceps tendon graft. All procedures were systematically paired with a lateral extra-articular procedure. The study was conducted in a specialised centre using surgeon preference cards, with the help of a dedicated organisation for calculation according to the ISO 14044 standard. The primary outcome measure was the carbon footprint of each of the five techniques. Secondary outcomes included other environmental impact indicators, including human carcinogenic toxicity and mineral resource scarcity, among others, based on the ReCiPe 2016 midpoint guideline. The analysis had three scopes, each encompassing varying numbers of processes: graft implantation, full procedure, and entire environmental impact, from medical prescription to patient discharge. Results were reported as percentage increases compared to the graft technique with the lowest environmental impact. RESULTS: It was demonstrated that the surgical procedure itself accounted for <40% of the life cycle, with arthroscopy being 88% of surgery's GHG emissions, and scrubbing and draping contributing 39% to the carbon footprint. The iliotibial band augmented with gracilis tendon technique had the lowest carbon footprint (0.199 Kg Co2 eq), and the least impact in most categories at all scopes of the life cycle analysis. Using this technique as a reference, in terms of graft implantation, it was determined that extensor mechanism grafts had the highest carbon footprint (300% higher than the reference). Greater scopes showed a similar trend, with percentage differences decreasing significantly, reaching 1-3% when considering the entire environmental impact for most categories. Nevertheless, among the aforementioned factors of the ReCiPe 2016 guidelines, the semitendinosus graft paried with a lateral extra-articular procedure displayed greater difference in human carcinogenic toxicity and mineral resource scarcity (6% and 10% respectively) compared to the reference. The individual processes with the highest impact were also highlighted. CONCLUSIONS: In the institution where the study was conducted, the studied iliotibial band graft option was found to have the lowest environmental impact. Such analyses of standardised procedures can be replicated in individual institutions in order to determine their environmental impact. Identification of procedures with comparable results and differing environmental consequences may influence the future decision-making process. LEVEL OF EVIDENCE: Level II, prospective cohort study.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Humanos , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Pegada de Carbono , Estudos Prospectivos , Artroscopia/métodos , Minerais
2.
Artigo em Inglês | MEDLINE | ID: mdl-39171445

RESUMO

PURPOSE: To introduce a new magnetic resonance imaging (MRI) sign, termed the Cobra sign, and identify its diagnostic metrics. The secondary aim was to demonstrate that this sign can be a source of false evaluation of tendon retraction in patients with proximal hamstring avulsion injury. METHOD: This retrospective cohort study targeted patients surgically treated for proximal hamstring avulsion injury from January 2019 to June 2023. The MRI Cobra sign was defined as a wavy curved T2-hypointense band with the free end folding distally over itself, resembling a cobra head. The primary outcome measure was the characterization of the Cobra sign in patients with proximal hamstring avulsion injury. The secondary outcome was the association of this sign with tendon retraction. The study included 81 proximal hamstring avulsion injury patients (mean age of 45.7, SD = 13.9), with 41 (50.6%) complete avulsions, 33 semimembranosus, and 7 conjoint tendons. RESULTS: The MRI Cobra sign was found in 25 patients (17 semimembranosus and 8 complete). It was confirmed surgically only in semimembranosus cases. It demonstrated 51.5% sensitivity and 83.3% specificity for isolated semimembranosus avulsions, with a significant positive likelihood ratio of 3.0. MRI retraction was 10.05 cm (±3.0), reducing to 7.9 cm (±2.5) on surgical measurement (mean difference = 2.0 cm, p < 0.001). The regression analysis confirmed MRI retraction's influence on the Cobra sign, with a 1.4 odds increase per unit (p < 0.001). In linear regression analysis, each unit increase in MRI retraction corresponded to a 79% increase in surgical retraction (coefficient 0.7, t = 11.1, p < 0.001). CONCLUSION: The Cobra sign demonstrated acceptable diagnostic accuracy for isolated semimembranosus avulsion, with a high specificity of 83.3%, a low sensitivity of 51.5%, and a positive likelihood ratio of 3.0. The presence of the Cobra sign indicates an overestimated MRI retraction by approximately 21%. LEVEL OF EVIDENCE: Level III.

3.
Eur J Orthop Surg Traumatol ; 34(1): 181-190, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37392257

RESUMO

PURPOSE: Multiple different materials are used for filling bone defects following bone-patellar tendon-bone (BPTB) graft ACL reconstruction surgery. The theoretical objective being to minimize kneeling pain, improve clinical outcomes and reduce anterior knee pain following surgery. The impact of these materials is assessed in this study. METHODS: A prospective monocentric cohort study was conducted from January 2018 to March 2020. There were 128 skeletally mature athletic patients who underwent ACL reconstruction using the same arthroscopic-assisted BPTB technique, with a minimum follow-up of two years identified in our database. After obtaining approval from the local ethics committee, 102 patients were included in the study. Patients were divided into three groups based on type of bone substitute. The Bioactive glass 45S5 ceramic Glassbone™ (GB), collagen and hydroxyapatite bone void filler in sponge form Collapat® II (CP), and treated human bone graft Osteopure®(OP) bone substitutes were used according to availability. Clinical evaluation of patients at follow-up was performed using the WebSurvey software. A questionnaire completed in the 2nd post-operative year included three items: The ability to kneel, the presence of donor site pain, and the palpation of a defect. Another assessment tool included the IKDC subjective score and Lysholm score. These two tools were completed by patients preoperatively, and postoperatively on three occasions (6 months, 1 year, and 2 years). RESULTS: A total of 102 patients were included in this study. In terms of Kneeling pain, the percentage of GB and CP patients' who kneel with ease were much higher than that of OP patients (77.78%, 76.5% vs 65.6%, respectively). All three groups experienced an important increase in IKDC and Lysholm scores. There was no difference in anterior knee pain between the groups. CONCLUSION: The use of Glassbone® and Collapat II® bone substitutes reduced the incidence of kneeling pain compared to Osteopure®. There was no influence of the bone substitute type on the functional outcome of the knee or on the anterior knee pain at two years of follow.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Substitutos Ósseos , Ligamento Patelar , Humanos , Ligamento Patelar/cirurgia , Autoenxertos , Estudos de Coortes , Estudos Prospectivos , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Enxerto Osso-Tendão Patelar-Osso/métodos , Articulação do Joelho , Transplante Autólogo , Dor , Lesões do Ligamento Cruzado Anterior/cirurgia
4.
Knee Surg Sports Traumatol Arthrosc ; 31(7): 2593-2601, 2023 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-36586000

RESUMO

PURPOSE: Patient-reported outcome measures (PROMS) are increasingly used for patient evaluation, as well as for scientific research. Few are used for practical purposes in the clinical setting, and few are reliable enough to allow proper feedback to physicians. Two of the most commonly used assessment tools in shoulder instability are the Walch-Duplay and the Rowe scores. The aim of this study was to evaluate the validity of self-administered versions of the Walch-Duplay and Rowe scores following shoulder stabilization procedure. METHODS: Between the months of May and December 2021, all patients who were followed in one of six institutions for shoulder instability were included. Patients were required to anonymously fill a self-administered version of Walch-Duplay and Rowe score. The classic scores were measured by the surgeon. Correlations between self-assessment and physician-assessment were then recorded. RESULTS: A total of 106 patients were evaluated during the study period. Using the Spearman coefficient for correlation, a strong correlation (r > 0.5) was found between the results of the self-administered questionnaire and the surgeon-measured score. The difference between surgeon- and patient-administered questionnaires was non-significant. CONCLUSION: The self-administered version of the Walch-Duplay and Rowe questionnaires can reliably be used in the clinical setting for post-operative follow-up of patients undergoing shoulder stabilization procedures. LEVEL OF EVIDENCE: Level II.


Assuntos
Instabilidade Articular , Articulação do Ombro , Humanos , Articulação do Ombro/cirurgia , Ombro/cirurgia , Instabilidade Articular/diagnóstico , Instabilidade Articular/cirurgia , Autoavaliação (Psicologia) , Artroscopia/métodos , Inquéritos e Questionários
5.
Int Orthop ; 47(12): 2961-2965, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37526678

RESUMO

PURPOSE: Mucoid degeneration of the anterior cruciate ligament is rare condition; mucoid degeneration affects the range of motion of the knee with pain on terminal extension and terminal flexion. Arthroscopic treatment of the mucoid anterior cruciate ligament (ACL) is the treatment of choice. The purpose of this study was to provide demographic and clinical characteristic of mucoid degeneration of ACL and assess the outcomes of partial arthroscopic ACL resection. METHODS: Patients who underwent partial ACL resection for mucoid degeneration between February 2007 and February 2019 were considered for study eligibility. Patients were evaluated for International Knee Documentation Committee (IKDC), The Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI), The Knee injury and Osteoarthritis Outcome Score (KOOS) and Tegner activity scale. RESULTS: Sixty patients underwent partial ACL resection for mucoid degeneration of the ACL. Nine patients were lost to follow-up, 43 were males, the average age was 52.12±12.09 and a mean follow-up of 83.55±44.79 months. At final follow-up six patients underwent ACL reconstruction for ACL rupture (11.7%) at an average of 15.66±12 months. Patient satisfaction was at 71%. CONCLUSION: Arthroscopic partial resection of the ACL led to good clinical outcome for treating mucoid degeneration of the ACL.


Assuntos
Lesões do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior , Masculino , Humanos , Adulto , Pessoa de Meia-Idade , Feminino , Ligamento Cruzado Anterior/cirurgia , Resultado do Tratamento , Articulação do Joelho/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Escore de Lysholm para Joelho
6.
Knee Surg Sports Traumatol Arthrosc ; 29(8): 2606-2615, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33743029

RESUMO

PURPOSE: Systematic reviews report return to play (RTP) within 5.8 months (range, 3-8) following the Latarjet procedure, but the factors that influence RTP remain unknown. The present study aimed to report the rate and time of return to play (RTP) during the first 8 months following the Latarjet procedure, and to determine the influence of sport type or patient characteristics. METHODS: The authors retrospectively collected the records of patients that underwent Latarjet procedures for anterior shoulder instability between 2015 and 2017. Patients were excluded if they had any concomitant rotator cuff tendon lesions, or previous ipsilateral shoulder surgery. The authors retrieved patient demographics, time from injury to surgery, type of sport practiced (overhead/non-overhead, contact/non-contact), as well as pre- and postoperative Western Ontario Shoulder Instability index (WOSI), Shoulder Instability-Return to Sport After Injury index (SIRSI), and Rowe score. RESULTS: A total of 217 patients (217 shoulders) were eligible for inclusion, comprising 184 males and 33 females, aged 26.8 ± 7.3 years at index surgery. The main sport practiced prior to surgery involved overhead (n = 173, 80%) and/or contact (n = 152, 70%) activities. By 8 month follow-up, 158 patients (73%) resumed their main sport, at a mean of 5.1 ± 1.5 months. Multivariable analysis revealed that RTP was more likely in patients with higher preoperative Rowe score (OR, 1.02; p = 0.024) and SIRSI score (OR, 1.02; p = 0.008). CONCLUSIONS: By 8 months following the Latarjet procedure, 73% of patients had resumed their main sport. The likelihood of RTP was significantly associated with preoperative Rowe and SIRSI scores, but not with sport type. LEVEL OF EVIDENCE: IV.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Artroscopia , Feminino , Humanos , Masculino , Recidiva , Estudos Retrospectivos , Volta ao Esporte , Articulação do Ombro/cirurgia
7.
Knee Surg Sports Traumatol Arthrosc ; 29(1): 51-58, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31377828

RESUMO

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.


Assuntos
Traumatismos do Joelho/diagnóstico , Postura , Sono , Lesões do Menisco Tibial/diagnóstico , Adolescente , Adulto , Artroscopia/métodos , Osso e Ossos , Feminino , Humanos , Traumatismos do Joelho/cirurgia , Imageamento por Ressonância Magnética , Masculino , Meniscos Tibiais/patologia , Meniscos Tibiais/cirurgia , Pessoa de Meia-Idade , Análise Multivariada , Dor/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Lesões do Menisco Tibial/cirurgia , Adulto Jovem
8.
Artigo em Inglês | MEDLINE | ID: mdl-32140740

RESUMO

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.

9.
Knee Surg Sports Traumatol Arthrosc ; 28(8): 2578-2585, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32025764

RESUMO

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.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Antibacterianos/administração & dosagem , Traumatismos em Atletas/cirurgia , Autoenxertos , Volta ao Esporte , Infecção da Ferida Cirúrgica/prevenção & controle , Vancomicina/administração & dosagem , Adulto , Lesões do Ligamento Cruzado Anterior/fisiopatologia , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Traumatismos em Atletas/fisiopatologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Risco , Transplante Autólogo , Adulto Jovem
10.
Knee Surg Sports Traumatol Arthrosc ; 27(1): 76-85, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29961095

RESUMO

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.


Assuntos
Implantes Absorvíveis/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/instrumentação , Parafusos Ósseos/efeitos adversos , Cistos/etiologia , Complicações Pós-Operatórias/etiologia , Adulto , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Artroscopia , Cistos/diagnóstico , Cistos/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Estudos Retrospectivos , Tíbia/cirurgia , Resultado do Tratamento
11.
Knee Surg Sports Traumatol Arthrosc ; 26(1): 203-211, 2018 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28707114

RESUMO

PURPOSE: The main goal of this study was to propose and validate a tool to quantify the psychological readiness of athletes to return to sport following traumatic shoulder instability and conservative or surgical management. METHODS: «Knee¼ was replaced by the term «shoulder¼ in the Anterior Cruciate Ligament-Return to Sport after Injury scale. This pilot test of the Shoulder Instability-Return to Sport after Injury scale (SIRSI) was performed in a group of athletes who underwent surgery for post-traumatic chronic anterior shoulder instability. The final version was then validated according to the international COSMIN methodology. A retrospective study was performed including all rugby players who had reported an episode of instability between 2012 and 2013. The WOSI and the Walch-Duplay scales were used as reference questionnaires. RESULTS: Sixty-two patients were included, mean age 26 ± 5.2 years old, 5 women/57 men. Patients were professional or competitive athletes (70.9%) and followed-up for 4.6 ± 1.6 years after the first episode of shoulder instability. Shoulder surgery was performed in 30/62 (48.4%) patients, a mean 1.6 ± 1.2 years after the first episode of instability. The SIRSI was strongly correlated with the reference questionnaires (r = 0.80, p < 10-5). The mean SIRSI score was significantly higher in patients who returned to play rugby (60.9 ± 26.6% vs 38.1 ± 25.6%, p = 0.001). The internal consistency of the scale was high (α = 0.96). Reproducibility of the test-retest was excellent (ρ = 0.93, 95% CI [0.89-0.96], p < 10-5). No ceiling/floor effects were found. CONCLUSION: The SIRSI is a valid, reproducible scale that identifies patients who are ready to return to the same sport after an episode of shoulder instability, whether they undergo surgery or not. LEVEL OF EVIDENCE: III.


Assuntos
Futebol Americano/lesões , Instabilidade Articular/terapia , Avaliação de Resultados da Assistência ao Paciente , Volta ao Esporte/psicologia , Articulação do Ombro , Adulto , Feminino , Seguimentos , Humanos , Instabilidade Articular/etiologia , Instabilidade Articular/psicologia , Masculino , Reprodutibilidade dos Testes , Estudos Retrospectivos , Adulto Jovem
12.
Knee Surg Sports Traumatol Arthrosc ; 24(2): 496-501, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24013460

RESUMO

PURPOSE: The success of shoulder stabilization with the Latarjet procedure depends on the correct positioning of the coracoid graft at the glenoid. The aim of this study was to assess intra-observer reproducibility and inter-observer reproducibility of a new standardized CT scan analysis for coracoid graft positioning in the axial plane after the Latarjet procedure and to assess the positioning in the study group. METHODS: A consecutive series of 27 patients (22 men, 5 woman, 26.1 ± 6.4 years-13 right, 14 left shoulders) were followed up with CT scans between 2010 and 2012. The analysis of the CT scans (2.4 ± 0.7 months postoperatively) was performed with Osirix™ software. The assessment included two criteria in the axial plane: relation of the graft to the articular surface of the glenoid and impingement of the graft with the maximal humeral head circumference. Grafts were judged to be lateral, congruent, flush or medial. The strength of intra-observer agreement and inter-observer agreement was measured by the Kappa coefficient. RESULTS: The Kappa coefficient for intra-observer agreement was "substantial" (K = 0.64 ± 0.14, z = 4.6) to "almost perfect" (K = 0.81 ± 0.14, z = 5.7). The Kappa coefficient for inter-observer variability was "substantial" (K = 0.59 ± 0.14, z = 4.3) to "almost perfect" (K = 0.89 ± 0.14, z = 6.0). In our study, in the axial plane, 3 (11 %) transplants were lateral; 6 (22 %) transplants were congruent; 16 (60 %) flush and 2 (7 %) medial. CONCLUSION: This standardized CT scan analysis after Latarjet procedure has shown to accurately describe graft positioning in the axial plane with both good intra-observer reproducibility and inter-observer reproducibility. LEVEL OF EVIDENCE: Case series, treatment study, Level IV.


Assuntos
Transplante Ósseo/métodos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Escápula/cirurgia , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/cirurgia , Adulto , Feminino , Humanos , Cabeça do Úmero/diagnóstico por imagem , Masculino , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Escápula/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
13.
Br J Sports Med ; 49(23): 1535-40, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25097059

RESUMO

BACKGROUND: An understanding of the epidemiology of shoulder dislocation/subluxation in rugby union players could help develop targeted prevention programmes and treatment. We performed a multiyear epidemiological survey of shoulder dislocation/subluxation in a large cohort of rugby players. METHODS: A descriptive epidemiological study was performed prospectively for five playing seasons (2008-2013) in all players licensed in the French Rugby Union. Rugby players were categorised into five groups by age. The player and the team physician reported the injury to the club insurance company if it occurred during training or a match. The goals of the study were to define the rate, type and causes of shoulder dislocation/subluxation. RESULTS: 88,044 injuries were reported, including 1345 (1.5%) episodes of dislocation/subluxation in 1317 men and 28 women, mean age 22.5±5.9 years. About 10/10,000 men and 5/10,000 women reported an episode of shoulder dislocation/subluxation per season, including 83/10,000 senior professionals, 17/10,000 senior amateurs, 21/10,000 juniors, 12/10,000 cadets and <1/10,000 rugby school players. Shoulder dislocation/subluxation was significantly more frequent in senior and junior players (p<0.001). Injuries mainly occurred during a match (66%) in the middle of the season (44%). The most frequent playing position was forwards (56%) and the main mechanism was tackling (69%). When reported, the history of recurrence was found in 66% of injured players, fractures in 22% and acromioclavicular injury in 6.7%. Nerve injury was associated with shoulder dislocation in 6% of cases. CONCLUSIONS: Senior professionals and junior male forward rugby players with a history of shoulder dislocation/subluxation should receive special attention from sports medicine professionals and orthopaedic surgeons.


Assuntos
Futebol Americano/lesões , Luxação do Ombro/epidemiologia , Traumatismos em Atletas/epidemiologia , Feminino , França/epidemiologia , Humanos , Masculino , Estudos Prospectivos , Fatores Socioeconômicos , Adulto Jovem
14.
Arthroscopy ; 30(10): 1327-41, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24999007

RESUMO

PURPOSE: We aimed to determine the rate of local recurrence, the rate of postoperative complications, and the functional outcome at final follow-up of surgical and nonsurgical treatment approaches for pigmented villonodular synovitis (PVNS) of the knee. METHODS: Medline, Embase, and the Cochrane Library were systematically searched for studies that reported the results of treatment for any type of PVNS between January 1, 1950, and August 1, 2013. Two authors extracted the data independently using predefined data fields including study quality indicators. RESULTS: Sixty studies (1,019 patients) met the inclusion criteria. Thirty-five presented data on the treatment of localized pigmented villonodular synovitis (LPVNS), 40 on diffuse pigmented villonodular synovitis (DPVNS), 1 on extra-articular LPVNS, and 7 on DPVNS with extra-articular involvement. Many therapeutic options were reported. Depending on these options, DPVNS recurred in 8% to 70% of the series and LPVNS recurred in 0% to 8% of the series. For LPVNS, the 2 most-reported options were open localized synovectomy and arthroscopic local synovectomy. Between these 2 courses of treatment, no difference was found in terms of local recurrence (8.7% for open synovectomy and 6.9% for arthroscopic synovectomy) and postoperative complications (<1% for open synovectomy and 0% for arthroscopic synovectomy). For DPVNS, the 2 most-reported options were open total synovectomy and arthroscopic total synovectomy. Between these 2 courses of treatment, no difference was found in terms of local recurrence (22.6% for open synovectomy and 16.1% for arthroscopic synovectomy). However, we found a lower rate of reported complications between open synovectomy (19.3%) and arthroscopic synovectomy (0%). Internal irradiation or external beam radiation as an adjuvant treatment to surgical synovectomy seemed to decrease the rate of local recurrence in DPVNS cases with a high risk of recurrence. Finally, we found a great heterogeneity in the way the functional results were reported, and no valid conclusion could be made based on the data we extracted. CONCLUSIONS: We found no difference in local recurrence rates after open or arthroscopic surgery for either LPVNS or DPVNS. However, a lower rate of postoperative complications was reported after arthroscopic surgery for DPVNS. LEVEL OF EVIDENCE: Level IV, systematic review of Level IV therapeutic studies.


Assuntos
Articulação do Joelho/cirurgia , Sinovite Pigmentada Vilonodular/cirurgia , Artroscopia/efeitos adversos , Humanos , Recuperação de Função Fisiológica , Recidiva , Sinovectomia , Sinovite Pigmentada Vilonodular/terapia
15.
Orthop J Sports Med ; 12(8): 23259671241258505, 2024 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-39157024

RESUMO

Background: Screws for graft fixation are available in 3 different materials for anterior cruciate ligament reconstruction (ACLR) with the Tape Locking Screw (TLS) technique: titanium, poly-l-lactic acid bioabsorbable, and polyetheretherketone (PEEK). Purpose: To compare the effect of the 3 different fixation materials on graft and implant survival after ACLR with the TLS technique. Study Design: Cohort study; Level of evidence, 3. Methods: Included were 521 patients from the French Prospective ACL Study (FAST) cohort who underwent primary surgical ACLR with the TLS technique. Patients were divided into 3 groups depending on the type of screw material used: titanium (TLS-T group), poly-l-lactic acid bioabsorbable (TLS-B group), or PEEK (TLS-P group). The primary endpoint was a retear within 2 years after ACLR. The secondary endpoints were complication rate, return to sports rate, and functional scores. Objective and subjective functional scores-including the International Knee Documentation Committee, the Knee injury and Osteoarthritis Outcome Score (KOOS), and the Lysholm score-were evaluated preoperatively and at the 2-year follow-up. Pain was assessed with the KOOS-Pain subscore recorded pre- and postoperatively every 6 months up to 2 years. Patient satisfaction was recorded at the 2-year follow-up. Results: No significant differences between the study groups were found in retear rates (4.4%, 4.5%, and 4.3% in the TLS-T, TLS-P, and TLS-B groups 2 years after surgery) or subjective and objective outcomes. The TLS-T group had the lowest rate of intraoperative implant-related complications (0.9%) compared with the TLS-P (4.3%) and TLS-B (7.7%) groups. Young age was a significant risk factor for retear in the TLS-T (P = .03) and TLS-B (P = .0001) groups, while a high level of sports was found to be a significant risk factor in the TLS-P (P = .04) group. All functional scores improved significantly at the 2-year follow-up (P < .0001), with no significant group difference. The KOOS-Pain subscore improved continuously with no significant group difference. The rate of return to preinjury sports was between 43.4% and 58.6%. The rate of highly satisfied patients at the final follow-up was between 86.2% and 91.8%. Conclusion: There was no difference in retear rate or objective and subjective functional scores between implant materials for TLS ACLR in this study.

16.
Am J Sports Med ; 52(5): 1173-1182, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38482843

RESUMO

BACKGROUND: Despite the prevalence of proximal hamstring avulsion injuries (PHAIs), the understanding of rerupture risk factors and the influence of injury chronicity on these rates remain limited. PURPOSE: To investigate the rerupture rate after PHAI repair and identify its associated risk factors and the optimal time to primary surgery. STUDY DESIGN: Case-control study; Level of evidence, 3. METHOD: This is a retrospective analysis of prospectively collected data from the French Proximal Hamstring Avulsion Surgery Cohort Study targeting patients surgically treated for PHAI between 2002 and 2022. The primary outcome measure of this study was the rerupture rate of PHAI repair. The secondary outcome measures included the assessment of the potential risk factors for rerupture as well as the investigation of the incidence rate of rerupture for 100 person-years depending on various injury-surgery delay definitions. RESULTS: This study analyzed 740 patients with a mean age of 45.9 years (SD, 13.6 years) and followed up for a mean of 4.9 years (SD, 3.9 years). The rerupture rate was 4.59% (34/740). Most reruptures (75%) occurred within the first 6 months after surgery (median, 88.5 days; interquartile range, 39.5-182 days), and 74% were atraumatic. Univariate analysis identified potential risk factors: longer initial surgery delay (hazard ratio [HR], 1.03; 95% CI, 1.01-1.04; P = .04) and initial complete ruptures (HR, 4.47; 95% CI, 1.07-18.7; P = .04). Receiver operating characteristic curve analysis found the optimal injury-surgery delay cutoff predicting rerupture to be 32 days (area under the curve, 0.62; 95% CI, 0.53-0.71). The relative Youden index was calculated at 0.24, corresponding to a sensitivity of 65% and a specificity of 59%. Surpassing this cutoff showed the highest HR (2.56), narrowest 95% CI (1.27-5.17), and highest incidence of rerupture (1.42 per 100 person-years) (P = .01). In the multivariate analysis, an injury-surgery delay of >32 days (HR, 2.5; 95% CI, 1.24-5.06; P = .01) and initial complete ruptures (HR, 4.33; 95% CI, 1.04-18.08; P = .04) emerged as significant risk factors for rerupture. CONCLUSION: This study found a 4.59% rerupture risk after PHAI repair. Most reruptures (75%) occurred within the first 6 months after surgery. Risk factors for rerupture included chronicity and initial complete injury. The optimal threshold for chronicity of PHAI lesions, based on rerupture rate, was marked by an injury-surgery delay of >32 days.


Assuntos
Músculos Isquiossurais , Traumatismos da Perna , Lesões dos Tecidos Moles , Humanos , Pessoa de Meia-Idade , Estudos de Coortes , Estudos Retrospectivos , Estudos de Casos e Controles , Músculos Isquiossurais/cirurgia , Músculos Isquiossurais/lesões , Fatores de Risco , Ruptura/cirurgia
17.
Am J Sports Med ; 52(4): 1014-1021, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38353118

RESUMO

BACKGROUND: No validated score is available for the prediction of return to sport (RTS) after proximal hamstring avulsion (PHA) surgery. PURPOSE: To validate a new assessment tool for patients after PHA surgery: the Parisian Hamstring Avulsion Score (PHAS). STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 3. METHODS: All patients at our clinic who had surgery for PHA between January 2015 and March 2018 were included in this study. A suspected clinical diagnosis of PHA was confirmed by magnetic resonance imaging. PHA was repaired by surgical reinsertion with suture anchors. Minimum postoperative follow-up was 2 years, and the PHAS, University of California, Los Angeles (UCLA), score, and Tegner score were used. The PHAS is a patient-reported outcome measure, evaluating the effect of PHA injury with 9 items. It was validated by calculating its psychometric properties, and then correlation analysis was performed to determine the relationship between the PHAS, UCLA score, and Tegner score. Cutoff values for the prediction of RTS were determined. RESULTS: A prospective case series study was performed. A total of 156 patients were included. Median age (first quartile; third quartile) was 54.2 years (44.7 years; 61.3 years), and the mean ± SD time of the final follow-up was 69 ± 11.6 months. Two years after surgery, 66.7% (n = 104) of patients were able to RTS. A strong correlation was noted between all 3 scores at 1 year postoperatively. Overall internal consistency was high, with a Cronbach alpha coefficient of 0.86. The intraclass correlation coefficient was 0.96, showing excellent reliability. The minimal detectable change was 12.9. No patients reached the maximum score at 2 years. Analysis of the receiver operating characteristic curves of the 3 scores at postoperative 9 months in relation to the RTS at 1 and 2 years showed area under the curve values of >0.7, indicating significant discriminant capacity for the RTS. A PHAS cutoff value of 86 at 9 months for the prediction of RTS at postoperative 1 year had a sensitivity of 65.6% (95% CI, 53.7%-77.5%) and a specificity of 81.4% (95% CI, 69.8%-93%). CONCLUSION: PHAS is a valid and reliable tool for follow-up after PHA surgery. It also offers a simple way to predict RTS.


Assuntos
Músculos Isquiossurais , Tendões dos Músculos Isquiotibiais , Humanos , Estudos de Coortes , Seguimentos , Reprodutibilidade dos Testes , Músculos Isquiossurais/cirurgia , Volta ao Esporte , Tendões dos Músculos Isquiotibiais/cirurgia
18.
Orthop Traumatol Surg Res ; 110(4): 103848, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38408559

RESUMO

PURPOSE: Theoretically, short semitendinosus grafts result in less pain and morbidity while providing greater knee flexion strength and sparing the gracilis tendon. They often require the use of blind bone tunnels as well as fixation at both ends of the graft with suspensory cortical buttons. The "Tape Locking Screw" (TLS) system is another option. There are few studies comparing ACL reconstruction with a short graft using the 4-strand semitendinosus graft (ST4-TLS) technique with that of the semitendinosus-gracilis (STG) procedure. This study was designed: (1) to compare the retear rate following these two technics after 2years of follow-up, (2) to compare the clinical scores, complications and return to sport times between the two procedures Q1, Q2. HYPOTHESIS: Our hypothesis was that there would be no differences in retear rates between the two techniques. METHODS: This single center case control study included 290 patients who underwent STG reconstruction that were paired by propensity score matching to 299 patients who underwent ST4-TLS reconstruction. The main evaluation criterion was the retear rate 2years after surgery. Secondary criteria were the two-year postoperative complication rate, the time to return to sport, to pivot sports and to running, as well as the complication rates and clinical scores 6months, 1year and 2years after surgery. RESULTS: At the final follow-up, the overall retear rate in our series of ACL ligament reconstruction was 6.0% (36/596). There was no difference in retear rates between the groups 2years after ligament reconstruction [ST4-TLS: 6.7% (20/299) vs. STG: 5.4% (16/297); p=0.47]. The postoperative KOOS symptom score and the Tegner score were found to be better in the STG group at 1year (81 vs. 78, p=0.008) and 2years (5.64 vs. 5.10, p=0.016), respectively, representing the minimally clinically important difference (MCID) for the latter. No difference was found in the other clinical scores 6months, 1year or 2years after surgery. There was no significant difference in the return to sport [TLS: 93.0% (164/299) vs. STG: 93.0% (158/297) p=0.99] or the complication rate [TLS: 8.7% (26/299) vs. STG: 7.4% (22/297) p=0.89] between the groups. DISCUSSION: The ST4-TLS ACL ligament reconstruction technique was found to be as reliable as the standard STG procedure 2years after surgery for the retear rate and the return to sport, although the results of certain postoperative clinical scores seem to be lower. LEVEL OF EVIDENCE: III; case control study.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Parafusos Ósseos , Pontuação de Propensão , Humanos , Reconstrução do Ligamento Cruzado Anterior/métodos , Masculino , Feminino , Adulto , Estudos de Casos e Controles , Lesões do Ligamento Cruzado Anterior/cirurgia , Tendões dos Músculos Isquiotibiais/transplante , Adulto Jovem , Estudos Retrospectivos , Músculo Grácil/transplante , Volta ao Esporte , Seguimentos , Recidiva
19.
Orthop J Sports Med ; 12(2): 23259671231220959, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38322979

RESUMO

Background: The 12-item Anterior Cruciate Ligament-Return to Sport after Injury (ACL-RSI) scale was developed to assess the psychological readiness of patients to return to sports after ACL reconstruction (ACLR). A short (6-item) English version was also developed, which has shown to have good reliability and validity. Purpose/Hypothesis: We aimed to develop and validate a French version of the short ACL-RSI scale. We hypothesized that the same questions would remain in the selection as the English version and that the French version of the scale would have the same psychometric properties. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: The full 12-item French ACL-RSI scale was administered to 1000 patients who had undergone ACLR surgery. Reliability (Cronbach alpha) and factor analysis of the full scale were determined. Item selection and elimination process was conducted to develop a short (6-item) version. The same methodology was used to develop the English short ACL-RSI scale. A minimal (3-item) version was also developed and assessed. Results: Internal consistency of the full version of the French ACL-RSI was found to be high (Cronbach alpha = .95), suggesting item redundancy. The short (6-item) version was also found to have high internal consistency (Cronbach alpha = .92) and was strongly correlated with the full version (r = 0.98). The minimal (3-item) version was also found to have high internal consistency, as well as a strong correlation with the full version (r = 0.94). Conclusion: The French version of the short (6-item) ACL-RSI scale was valid, discriminant, consistent, and reproducible. The minimal (3-item) version was also found to be useful and more efficient to collect the information provided by the full ACL-RSI in a French-speaking population.

20.
Am J Sports Med ; 52(11): 2850-2859, 2024 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-39214077

RESUMO

BACKGROUND: Isokinetic torque in shoulder internal rotation (IR) and external rotation (ER) can be considered as potential indicators for dynamic stability of the glenohumeral joint. PURPOSE: To assess the efficacy of 4-month isokinetic testing in predicting the 6-month return-to-sports (RTS) status after Latarjet surgery, explore its correlations with testing parameters, and identify optimal thresholds to ensure a safe RTS. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: The study assessed athletes who underwent the Latarjet stabilization procedure between January 2022 and June 2023. The primary outcome was RTS at 6 months after surgery. The primary examined predictors were isokinetic testing metrics at 4 months postoperatively. Secondary outcomes comprised the modified Closed Kinetic Chain Upper Extremity Stability Test (mCKCUEST) and several patient-reported outcome measures, including the Walch-Duplay score, the Western Ontario Shoulder Instability Index (WOSI), and the Shoulder Instability-Return to Sports after Injury scale. To assess the predictors, patients were divided into those who returned to any level of sports compared with those who did not return to sports. The correlation between isokinetic testing results and other outcome scores was also analyzed. RESULTS: A total of 71 patients (mean age, 27.43 ± 9.09 years) were included in the study. Of these, 23.61% did not return to sports, 38.89% returned at a lower level, and 37.50% returned to the same level. Significant rotational strength disparities were noted. Patients who did not return to sports at 6 months demonstrated inferior strength in concentric ER at 60 deg/s, concentric ER at 240 deg/s, concentric IR at 240 deg/s, and eccentric IR at 30 deg/s (P < .05). Similar trends appeared for all studied patient-reported outcome measures and the mCKCUEST (P < .05). Receiver operating characteristic analysis emphasized the significance of isokinetic testing in concentric ER at 240 deg/s (area under the curve = 0.759; P = .001; cutoff = 0.32 N·m/kg; sensitivity = 100.0%; specificity = 49.1%) and eccentric ER at 30 deg/s (area under the curve = 0.760; P = .001; cutoff = 0.51 N·m/kg; sensitivity = 94.1%; specificity = 49.1%) for RTS prediction. Additionally, ER strength moderately correlated with the Walch-Duplay score across all examined velocities (r = 0.26-0.34; P < .05). The modified WOSI score was weakly linked to ER strength at 240 deg/s and 30 deg/s (r = 0.24-0.25; P < .05) as well as moderately linked to the limb symmetry index in ER at 60 deg/s and 30 deg/s (r = 0.30-0.38; P < .05). CONCLUSION: Isokinetic testing can act as an independent predictor of successful RTS after Latarjet surgery, with concentric ER at 240 deg/s, concentric IR at 240 deg/s, eccentric ER at 30 deg/s, and eccentric IR at 30 deg/s showing the most accuracy. Strength recovery in ER was associated with better Walch-Duplay and modified WOSI scores.


Assuntos
Força Muscular , Volta ao Esporte , Humanos , Estudos Prospectivos , Masculino , Feminino , Força Muscular/fisiologia , Estudos Transversais , Adulto Jovem , Adolescente , Articulação do Ombro/cirurgia , Articulação do Ombro/fisiologia , Articulação do Ombro/fisiopatologia , Instabilidade Articular/cirurgia , Instabilidade Articular/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Adulto , Torque , Equilíbrio Postural/fisiologia
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