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Si Heng Sharon T, Fadzil K, Andrew Kean Seng L, James Hoipo H. Surgical management of tibial eminence avulsion fractures: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05318-1. [PMID: 38896276 DOI: 10.1007/s00402-024-05318-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 04/04/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE The ideal surgical management for tibial eminence avulsion fractures remains controversial with varying approach, methods of fixation and post-operative regimes reported throughout literature. The current systematic review and meta-analysis aims to compare between the different approaches, methods of fixation and post-operative regimes for tibial eminence fractures. METHODS The systematic review was conducted according to PRISMA guidelines. A search was conducted using PubMed, MEDLINE and CINAHL databases. The keywords used were "anterior cruciate ligament", "tibial spine" or "tibial eminence" and "fracture" or "avulsion". All original human studies that reported the surgical outcomes of tibial eminence fractures were included. Individual patient data meta-analysis was performed. RESULTS 48 studies with 1367 patients were included. Arthroscopic fixation resulted in significantly greater stability in terms of anterior drawer test (p = 0.018) and Lachman's test (p = 0.042), as compared to open fixation, though there was no significant difference for pivot shift test. There was no significant difference identified in functional scores and activity, including Lysholm score, IKDC subjective score, Tegner score and return to sports. Suture fixation had significantly increased stability compared to screw fixation, in terms of anterior drawer test (p = 0.001) and Lachman's test (p = 0.001), though no significant difference was identified for pivot shift test. Significantly better subjective scores and return to activity were also noted for suture fixation, in terms of Lysholm score (p = 0.008), IKDC subjective score (p = 0.001) and Tegner score (p = 0.001), though no significant difference was identified for return to sports. CONCLUSION Arthroscopic and suture fixation had significantly superior outcomes when compared to open and screw fixation. Arthroscopic fixation resulted in significantly improved stability of the knee as compared to open fixation, though no significant difference was identified in terms of functional knee scores and return to activity. Suture fixation resulted in significantly improved stability of the knee and functional knee screws as compared to screw fixation.
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Affiliation(s)
- Tan Si Heng Sharon
- Department of Orthopaedic Surgery, National University Health System (NUHS), 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore.
| | - Kamarudin Fadzil
- Department of Orthopaedic Surgery, National University Health System (NUHS), 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Lim Andrew Kean Seng
- Department of Orthopaedic Surgery, National University Health System (NUHS), 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
| | - Hui James Hoipo
- Department of Orthopaedic Surgery, National University Health System (NUHS), 1E Kent Ridge Road, NUHS Tower Block, Level 11, Singapore, 119228, Singapore
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Yu D, Yu R, Zhang J, Chen T, Zhang B. Arthroscopic treatment of adult displaced tibial eminence fractures with anchor and pushlock fixation. Medicine (Baltimore) 2020; 99:e21237. [PMID: 32957304 PMCID: PMC7505351 DOI: 10.1097/md.0000000000021237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Arthroscopic techniques are considered the gold standard for treatment of displaced avulsion fractures of the anterior cruciate ligament. However, most arthroscopic surgical techniques and fixation methods are technically demanding and require removal of hard implant. This report describes a new, easy, safe, and all-arthroscopic method for reduction and fixation of displaced tibial intercondylar eminence fractures by using 1 anchor and 1 Pushlock.From January 2015 to June 2017, 8 adult patients with type II and III displaced tibial intercondylar eminence fractures were operated using this technique. Clinical assessment included patient demographics, cause of injury, delay before surgery, operation time, time to return to work and sport, International Knee Documentation Committee scores, and Lysholm knee scores.The average operation time was 48 minutes. The average follow-up period was 12.5 months. At the 6-month follow-up, all patients had acquired fracture union and complete functional recovery and were able to return to work. International Knee Documentation Committee objective scores and Lysholm knee scores were 92.4 (range 88-94) and 93.6 (range 90-96), respectively. At the last follow-up, anterior drawer, Lachman's test, and pivot shift tests were negative, and all patients had returned to their preinjury activity levels.Arthroscopic fixation by use of 1 anchor and 1 Pushlock is an easy, safe, and minimally invasive technique for treatment of displaced tibial intercondylar eminence fractures and does not require further surgery to remove fixation devices.Level of Evidence: Level IV, therapeutic case series.
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Pailhé R, Bauer T, Flecher X, Bonnevialle N, Roussignol X, Saragaglia D, Ehlinger M. Better functional outcomes for ORIF in tibial eminence fracture treatment: a national comparative multicentric study of ORIF vs ARIF. Knee Surg Sports Traumatol Arthrosc 2020; 28:653-657. [PMID: 31797020 DOI: 10.1007/s00167-019-05785-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE Tibial eminence fractures can occur in adults and are equivalent to an acute ACL rupture. The purpose of this retrospective study was to compare the therapeutic outcomes of ARIF versus ORIF in tibial eminence fractures. Our hypothesis was that ARIF does not offer better results. METHODS A retrospective national multicentric study was conducted in five university hospitals between 2010 and 2015. A total of 65 consecutive patients were included. 33 patients were treated with ARIF and 32 with ORIF. Clinical functional outcomes were assessed using the Lysholm score and IKDC score. Radiographic findings were recorded, and a statistical analysis carried out. RESULTS IKDC score at the mean last follow-up of 68.8 ± 11.8 months was significantly higher in the ORIF group with a mean difference of 20.2 points ± 8.9 (p = 0.028). There were early osteoarthritis findings in 12 patients (18.4%). At last follow-up, 7 patients (10.7%) presented complications. CONCLUSION In this retrospective multicentric study, better functional outcomes were observed in the ORIF group. This difference needs to be carefully interpreted as many confounding factors exist. In terms of complications, the results for both ORIF and ARIF are similar at midterm follow-up. ORIF should remain gold standard for tibial eminence fracture treatment. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Régis Pailhé
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, Avenue de Kimberley, BP 338, 38434, Échirolles Cedex, France. .,Service de Chirurgie Orthopédique, Hôpital Sud Grenoble, Grenoble Cedex, France.
| | - Thomas Bauer
- Hôpitaux Universitaires Paris Ile-de-France Ouest, Assistance Publique-Hôpitaux de Paris, 92100, Boulogne-Billancourt, France
| | - Xavier Flecher
- Institute for Locomotion, Aix-Marseille University, Marseille, France.,Department of Orthopedics and Traumatology, St Marguerite Hospital, Marseille, France
| | - Nicolas Bonnevialle
- Institut Locomoteur, Hôpital Pierre-Paul Riquet, Place du Docteur Baylac, 31059, Toulouse, France
| | - Xavier Roussignol
- Department of Orthopaedics Surgery and Traumatology, Rouen University Hospital, Rouen, France
| | - Dominique Saragaglia
- Department of Orthopaedic Surgery and Sport Traumatology, Grenoble South Teaching Hospital, Avenue de Kimberley, BP 338, 38434, Échirolles Cedex, France
| | - Matthieu Ehlinger
- Service de Chirurgie Orthopédique Et de Traumatologie, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, 67098, Strasbourg Cedex, France
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Li J, Liu C, Li Z, Fu Y, Yang Y, Zhang Q. Arthroscopic Fixation for Tibial Eminence Fractures: Comparison of Double-Row and Transosseous Anchor Knot Fixation Techniques with Suture Anchors. Med Sci Monit 2018; 24:7348-7356. [PMID: 30318505 PMCID: PMC6198712 DOI: 10.12659/msm.912961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Tibial eminence fractures often occur during sports participation, but the optimum choice of technique for treatment is still controversial. The aim of the current work was to compare the clinical outcomes of 2 new arthroscopic anchor fixation techniques for tibial eminence fracture. Material/Methods We included 72 isolated tibial eminence fracture patients treated at our hospital from October 2010 to August 2015; 37 patients received the classic double-row (DR) suture anchor fixation technique and 35 received the transosseous anchor knot (TAK) fixation under arthroscopy. The clinical efficacies of the 2 techniques were assessed by radiographs, Lysholm score, and International Knee Documentation Committee (IKDC) score in follow-ups. Results Patients were followed for 37.6 months (range, 18–54 months). There was no significant difference of the operative time between groups (P=0.169). Postoperative radiographs of all patients showed accurate reduction and fracture healing within 3 months. Lysholm and IKDC scores improved significantly compared with preoperative scores (P<0.001). However, no significant difference in the knee range of motion or improvement of Lysholm and IKDC scores was found between groups (P>0.05). Conclusions The DR and TAK techniques provide precise reduction and stable fixation methods for treating tibial eminence fractures, and the clinical outcomes of the 2 arthroscopic techniques with suture anchors are satisfactory.
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Affiliation(s)
- Ji Li
- Department of Orthopedics, General Hospital of PLA (People's Liberation Army), Beijing, China (mainland)
| | - Chuihui Liu
- Department of Orthopedics, General Hospital of PLA (People's Liberation Army), Beijing, China (mainland)
| | - Zhongli Li
- Department of Orthopedics, General Hospital of PLA (People's Liberation Army), Beijing, China (mainland)
| | - Yangmu Fu
- Department of Orthopedics, General Hospital of PLA (People's Liberation Army), Beijing, China (mainland)
| | - Yimeng Yang
- Department of Orthopedics, General Hospital of PLA (People's Liberation Army), Beijing, China (mainland)
| | - Qiang Zhang
- Department of Orthopedics, General Hospital of PLA (People's Liberation Army), Beijing, China (mainland)
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Li J, Yu Y, Liu C, Su X, Liao W, Li Z. Arthroscopic Fixation of Tibial Eminence Fractures: A Biomechanical Comparative Study of Screw, Suture, and Suture Anchor. Arthroscopy 2018; 34:1608-1616. [PMID: 29397286 DOI: 10.1016/j.arthro.2017.12.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 12/09/2017] [Accepted: 12/09/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare biomechanical outcomes of 4 different arthroscopic techniques for fixation of tibial eminence fractures. METHODS Twenty-four skeletally mature, fresh-frozen cadaveric knees were divided into 4 comparison groups based on the fixation method: screw fixation (group A), traditional sutures fixation with 2 FiberWire sutures (group B), a modified suture technique with 2 FiberWire sutures that created neckwear knots to firmly trap the fracture fragment (group C), or suture anchors which was based on the suture bridge technique primarily used in the shoulder for repair of rotator cuff tears and greater tuberosity fractures (group D). A tibial eminence fracture was created in each knee for subsequent fixation. After fixation, each knee underwent cyclic loading of 100 N to assess the displacement change after 500 cycles of the fixation construct. Afterward, a single tensile failure test load was performed to assess the ultimate failure load, stiffness, and failure mode for each specimen. RESULTS All specimens survived cyclic testing and were subsequently loaded to failure. Group C had the highest ultimate failure load (P < .05) and group D had the lowest displacement compared with the other 3 groups (P < .05). Different failure modes were found among the 4 groups. CONCLUSIONS Suture fixation using the neckwear knots technique provides superior fixation with regard to higher ultimate failure load, and absorbable suture anchor fixation with the suture bridge technique provides less displacement under cyclic loading conditions. Both techniques exhibited superior biomechanical properties compared with traditional screw and suture fixation. CLINICAL RELEVANCE The new techniques showed satisfactory biomechanical properties and provided more choice for surgeons in the treatment of tibial eminence fractures.
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Affiliation(s)
- Ji Li
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China
| | - Yang Yu
- Department of Orthopedics, Chinese PLA 252 Hospital, Baoding, Hebei, China
| | - Chunhui Liu
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China
| | - Xiangzheng Su
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China
| | - Weixiong Liao
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China
| | - Zhongli Li
- Department of Orthopedics, General Hospital of PLA, Haidian District, Beijing, China.
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Loriaut P, Moreau PE, Loriaut P, Boyer P. Arthroscopic treatment of displaced tibial eminence fractures using a suspensory fixation. Indian J Orthop 2017; 51:187-191. [PMID: 28400665 PMCID: PMC5361470 DOI: 10.4103/0019-5413.201706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Avulsion fractures of the tibial intercondylar eminence are fairly common injuries requiring surgery for the optimal functional outcome. The purpose of this study was to assess the clinical and radiological outcomes of an arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory device. MATERIAL AND METHODS Five patients with type 2 and 3 displaced tibial intercondylar eminence fractures who received an arthroscopically assisted fixation using a double button device were enrolled from 2011 to 2012. Clinical assessment included the patient demographics, cause of injury, the delay before surgery, time for surgery, time to return to work and sport, the International Knee Documentation Committee (IKDC) and Lysholm knee scores. Stability was measured with the KT-2000 arthrometer with a force of 134 N. A side to side difference on the KT-2000 examination superior to 3 mm was considered as a significant and abnormal increase in the anterior translation. Radiological examination consisted of anteroposterior and lateral radiographs, as well as computed tomography (CT) scan of the affected knee. Clinical and radiological followup was done at 1, 2, 3, 6, and 12 months postoperatively and at final followup. CT-scan was performed before surgery and at 3 months followup. RESULTS The median age of patients was 31 years. Mean followup was 27 ± 5.1 months. The average delay before surgery was 3 days. At final followup, the mean IKDC and Lysholm knee scores were, 93.9 and 94.5 respectively. All patients had a complete functional recovery and were able to return to work and to resume their sport activities. No secondary surgeries were required to remove hardware. No complication was noted. Bony union was achieved in all patients. CONCLUSION The arthroscopic treatment of displaced tibial intercondylar eminence fractures using a suspensory system provided a satisfactory clinical and radiological outcome at a followup of 2 years.
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Affiliation(s)
- Philippe Loriaut
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l’Hôpital, 75013 Paris, France,Address for correspondence: Dr. Philippe Loriaut, Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l’Hôpital, 75013 Paris, France. E-mail:
| | - Pierre-Emmanuel Moreau
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l’Hôpital, 75013 Paris, France
| | - Patrick Loriaut
- Department of Ophthalmology, Quinze-Vingts National Ophthalmology Hospital, 28 rue de Charenton 75012 Paris, France
| | - Patrick Boyer
- Department of Orthopaedic Surgery and Sports Traumatology, Pitié Salpêtrière Hospital, Pierre and Marie Curie University, 47 Boulevard de l’Hôpital, 75013 Paris, France
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Liao W, Li Z, Zhang H, Li J, Wang K, Yang Y. Arthroscopic Fixation of Tibial Eminence Fractures: A Clinical Comparative Study of Nonabsorbable Sutures Versus Absorbable Suture Anchors. Arthroscopy 2016; 32:1639-50. [PMID: 27039964 DOI: 10.1016/j.arthro.2016.01.032] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Revised: 12/14/2015] [Accepted: 01/21/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To compare clinical outcomes of arthroscopic therapy for tibial eminence fracture with nonabsorbable suture and absorbable suture anchor. METHODS Between February 2010 and September 2012, a total of 60 tibial eminence fracture patients were treated with nonabsorbable suture fixation or absorbable suture anchor fixation under arthroscopy. Patients with tibial plateau fractures and other significant injuries, including osteochondral lesions, meniscal tear, and anterior cruciate ligament (ACL) or mutiligament injuries, were excluded from the study. Radiographs, anterior drawer test (ADT), Lachman test, Lysholm score, and International Knee Documentation Committee (IKDC) 2000 subjective score were employed to evaluate clinical outcomes in follow-up. RESULTS A total of 41 patients were analyzed. Among these patients, 22 were treated with nonabsorbable suture fixation and 19 with absorbable suture anchor fixation. According to the modified Meyers-McKeever classification, 15 cases were categorized as type II, 21 as type III, and 5 as type IV fractures. The mean time from injury to surgery was 7.1 days (range, 3 to 12 days). All patients were followed up for a median period of 33.7 months (range, 24 to 45 months). Radiographic evaluation showed optimal reduction immediately after operation and bone union within 3 months in all patients. At the final follow-up, there was no limitation of knee motion range in any patient. Grade II laxity was found in 2 cases from suture group and 1 from suture anchor group, showing no significant difference based on ADT (χ(2) = 0.538, P = .764) and Lachman test (χ(2) = 0.550, P = .760). Lysholm and IKDC 2000 subjective scores were significantly improved (P < .001). However, there were no significant differences in the improvement of Lysholm (t = 0.522, P = .604) and IKDC 2000 subjective scores (t = 0.644, P = .523) between the 2 groups. CONCLUSIONS Nonabsorbable suture fixation and absorbable suture anchor fixation are equivalent techniques in terms of the clinical efficacy of arthroscopic tibial eminence fracture treatment. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Weixiong Liao
- Department of Orthopedics, General Hospital of PLA, Beijing, China
| | - Zhongli Li
- Department of Orthopedics, General Hospital of PLA, Beijing, China.
| | - Hao Zhang
- Department of Orthopedics, General Hospital of PLA, Beijing, China
| | - Ji Li
- Department of Orthopedics, General Hospital of PLA, Beijing, China
| | - Ketao Wang
- Department of Orthopedics, General Hospital of PLA, Beijing, China
| | - Yimeng Yang
- Department of Orthopedics, General Hospital of PLA, Beijing, China
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Faivre B, Benea H, Klouche S, Lespagnol F, Bauer T, Hardy P. An original arthroscopic fixation of adult's tibial eminence fractures using the Tightrope® device: a report of 8 cases and review of literature. Knee 2014; 21:833-9. [PMID: 24863950 DOI: 10.1016/j.knee.2014.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2012] [Revised: 01/03/2014] [Accepted: 02/07/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The objective of this study is to asset the efficiency of the use of the Tightrope® device to treat isolated tibial spine fractures in adults. METHODS All patients treated for isolated tibial spine fracture between November 2007 and February 2011 have been retrospectively included. The main judgment criteria was the post-operative knee laxity measured by Rolimeter® (Aircast) and the secondary criteria were the IKDC scores, the knee mobility, the Lachman test and the bone union. 8 patients have been included. The mean age was 34.2 years (± 12.5). The classification of Meyers and McKeever identified 5 types II, 2 types IIIa and 1 type IIIb. The mean follow-up period was 10 months. RESULTS The mean post-operative anterior knee laxity was 6 ± 2.14 mm for the operated side and 5.6 ± 1.85 mm for the opposite side. No significant difference was found (P=0.73). According to the IKDC classification 3 patients were normal (A), 2 were nearly normal (B), 1 was abnormal (C) and 1 was very abnormal (D). The mean IKDC subjective score was 70.71 ± 17.56. All 8 fractures achieved union without elevation. 3 patients developed motion complications and 2 required an arthroscopic arthrolysis. No other significant complication was noted. The outcome was compared to the different series published during the last 10 years. CONCLUSION The use of the Tightrope® device is a simple technique occurring a rigid fixation, allowing early rehabilitation with a high rate of arthrofibrosis. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Bruno Faivre
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France.
| | - Horea Benea
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; University Clinic of Orthopedics and Traumatology, R-400132 Cluj-Napoca, Romania
| | - Shahnaz Klouche
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France
| | - Florent Lespagnol
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France
| | - Thomas Bauer
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France
| | - Philippe Hardy
- Hôpitaux Universitaires Paris Ile-de-France Ouest, AP-HP, F-92100 Boulogne-Billancourt, France; Université de Versailles Saint-Quentin, F-78035 Versailles, France
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