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Mabrouk A, Fernandes LR, Jacquet C, Kley K, Claes S, Ollivier M. The tipping point in medial opening wedge high tibial osteotomy relates to the shape of the proximal tibia more than to lower limb alignment correction. Knee Surg Sports Traumatol Arthrosc 2024; 32:1008-1015. [PMID: 38469922 DOI: 10.1002/ksa.12121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/13/2024]
Abstract
PURPOSE The tipping point (TP) of the knee joint is the centre of rotation of the joint in the coronal plane. This study aimed to define the TP in medial opening wedge high tibial osteotomy (MOWHTO). METHODS Data from 154 consecutive patients with varus knee malalignment, who underwent MOWHTO between 2017 and 2021, was retrospectively reviewed. The degree of preoperative osteoarthritis (OA), using the Kellgren-Lawrence (KL) grading system, was recorded. Long-leg standing radiographs were used to record the alignment parameters, including the hip-knee-ankle angle (HKA), the mechanical lateral distal femoral angle (mLDFA), the medial proximal tibial angle (MPTA), the joint line convergence angle (JLCA) and the joint line obliquity (JLO) angle. Postoperative Tegner activity scores, Western Ontario and McMaster University Scores and patients' satisfaction were recorded. To define the TP, the relationship of all variables to Δ JLCA (absolute difference between preoperative to postoperative JLCA values) was analysed. Linear regression was employed for Δ JLCA to preoperative JLCA and postoperative and Δ MPTA (absolute difference between preoperative and postoperative values). K-means clustering was used to partition observations into clusters, in which each observation belongs to the cluster with the nearest mean serving as a prototype of the cluster, and analysed if there was any specific threshold influencing Δ JLCA. After defining the TP, further subanalysis of the TP based on the preoperative KL OA grade and analysis of variance of this TP to the KL OA grade was performed. RESULTS A total of 154 patients (77.9% males and 22.1% females) were included. The mean age was 48.2 ± 11 years, and the mean body mass index was 27.1 ± 4 kg/m2. Preoperatively, 26 (16.9%) patients had KL grade IV OA. The mean preoperative and postoperative JLCA and the significance of their relation to Δ JLCA were 2.6° ± 1.8° (p < 0.0001) and 1.9° ± 1.8° (p = 0.6), respectively. The mean Δ JLCA was 1.4° ± 1.5°. The mean pre- and postoperative MPTA and the significance of their relation to Δ JLCA were 84.6 ± 2.2 (p = 0.005) and 91.8 ± 2.5 (p < 0.0007), respectively. The mean Δ MPTA was 7.2 ± 2.3 (p = 0.3). The mean preoperative and postoperative HKA and the significance of their relation to Δ JLCA were 174.6 ± 2.5 (p = 0.2) and 181.9 ± 2.4 (p = 0.7), respectively. The overall linear regression for Δ JLCA was statistically significant for preoperative JLCA (R2 = 0.3, p < 0.0001) and postoperative MPTA (R2 = 0.09, p = 0.0001) and statistically insignificant for Δ MPTA (R2 = 0.01, p = 0.2) and postoperative HKA (R2 = 0.04, p = 0.7). MPTA > 91.5° was the optimal threshold dividing this series data set between substantial and nonsignificant Δ JLCA. CONCLUSION In this study, the main predictive factors for intra-articular correction (Δ JLCA) after MOWHTO were the preoperative value of JLCA and the postoperative value of MPTA. A value of 92° for postoperative MPTA is potentially the optimal threshold to predict intra-articular correction. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
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Affiliation(s)
- Ahmed Mabrouk
- Department of Trauma and Orthopaedics, Mid Yorkshire Teaching Hospitals, England
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
| | | | | | | | | | - Matthieu Ollivier
- Institut du mouvement et de l'appareil locomoteur, Marseille, France
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Ollivier M, An JS, Kley K, Khakha R, Fernandes LR, Micicoi G. A significant rate of tibial overcorrection with an increased JLO occurred after isolated high tibial osteotomy without considering international consensus. Knee Surg Sports Traumatol Arthrosc 2023; 31:4927-4934. [PMID: 37597039 DOI: 10.1007/s00167-023-07518-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/18/2023] [Indexed: 08/21/2023]
Abstract
PURPOSE The recent ESSKA consensus recommendations defined indications and outlined parameters for osteotomies around a degenerative varus knee. The consensus collated these guidelines based on the published literature available to answer commonly asked questions including the importance of identifying the site and degree of the lower limb deformity. In the consensus, the authors suggest that a knee joint line obliquity (JLO) greater than 5° or a planned medial proximal tibial angle (MPTA) > 94° preferentially indicates a double level osteotomy (DLO) compared to an isolated opening wedge high tibial osteotomy (OWHTO). This study aimed to analyze the corrections performed on a cohort of isolated opening wedge high tibial osteotomies (OWHTOs) prior to the recent ESSKA recommendations, with a focus on the impact of knee joint line obliquity (JLO) and medial proximal tibial angle (MPTA) on the choice of osteotomy procedure. METHODS This monocentric, retrospective study included 129 patients undergoing medial OWHTO for symptomatic isolated medial knee osteoarthritis (Ahlbäck grade I or II) and a global varus malalignment (hip-knee-ankle angle ≤ 177°). An automated software trained to automatically detect lower limb deformity was implemented using patients preoperative long leg alignment X-rays to identify suitability for an isolated HTO in knee varus deformity. Based on the ESSKA recommendations, the site of the osteotomy was identified as well as the degree of correction required. The ESSKA consensus considers avoiding an isolated high tibial osteotomy if the planned resultant knee joint line orientation exceeds 5 ̊ or MPTA exceeds 94°. A preoperative abnormal MPTA was defined by a value lower than 85° and a preoperative abnormal LDFA by a value greater than 90°. The cases of DLO or DFO suggested by the software and the number of extra-tibial anomalies were collected. Multiple linear regression models were developed to establish a relationship between preoperative values and the risk of being outside of ESSKA recommendations postoperatively. RESULTS Based on ESSKA recommendations and on threshold values considered abnormal, the software suggested a DLO in 17.8% (n = 23/129) of cases, a distal femoral osteotomy in 27.9% (n = 36/129) of cases and advised against an osteotomy procedure in 24% (n = 31/129) of cases. The software detected a femoral anomaly in 34.9% (n = 45/129) of cases and an JLCA > 6° in 9.3% (n = 12/129). Postoperatively, the MPTA exceeds 94° in 41.1% (n = 53/129) and the JLO exceeds 5° in 29.4% (n = 38/129). On multivariate analysis, a high preoperative MPTA was associated with higher risk of postoperative MPTA > 94° (R2 = 0.36; p < 0.001). Similarly, the probability of the software advising a DLO or DFO was associated with the presence of an "normal" preoperative MPTA (R2 = 0.42; p < 0.001) or an abnormal preoperative LDFA (R2 = 0.48; p < 0.001) or a planned JLO > 5° (R2 = 0.27; p < 0.001). CONCLUSIONS Analysis of patients who underwent an isolated OWHTO prior to the ESSKA guidelines, demonstrated a significant rate of post-operative tibial overcorrection and a resultant increased JLO. Pre-operative planning that considers the ESSKA guidelines, allows for better identification of those patients requiring a DFO or DLO and avoidance of resultant post-operative deformities. LEVEL OF EVIDENCE IV, case-series.
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Affiliation(s)
- Matthieu Ollivier
- APHM, CNRS, ISM, Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Sainte-Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France.
| | - Jae-Sung An
- APHM, CNRS, ISM, Institute of Movement and Locomotion, Department of Orthopedics and Traumatology, Aix Marseille University, Sainte-Marguerite Hospital, 270 Boulevard Sainte Marguerite, BP 29, 13274, Marseille, France
| | - Kristian Kley
- Orthoprofis Hannover Luisenstraße, 10/11, 30539, Hannover, Germany
| | - Raghbir Khakha
- Guys and St. Thomas' Hospitals, Great Maze Pond, London, SE1 9RT, England
| | - Levi Reina Fernandes
- Department of Orthopedics and Traumatology, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Grégoire Micicoi
- Institute for Locomotion and Sports, iULS-University, Pasteur 2 Hospital, University Côte d'Azur, UR2CA, Nice, France
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Fernandes LR, Arce C, Martinho G, Campos JP, Meneghini RM. Accuracy, Reliability, and Repeatability of a Novel Artificial Intelligence Algorithm Converting Two-Dimensional Radiographs to Three-Dimensional Bone Models for Total Knee Arthroplasty. J Arthroplasty 2023; 38:2032-2036. [PMID: 36503105 DOI: 10.1016/j.arth.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND With the emergence of advanced technology, such as robotics, three-dimensional (3D) imaging is necessary to execute preoperative surgical plans accurately. However, 3D imaging adds cost and potential risk to patients. This study determined the measurement accuracy, reliability, and repeatability of a novel artificial intelligence (AI) algorithm which converts two-dimensional (2D) radiographs to 3D bone models. METHODS An AI algorithm was developed to convert 2D radiographs to 3D bone model reconstructions. The accuracy of the AI algorithm was evaluated by comparing mean absolute error in measurements performed on 3D bone reconstructions, 3D computed tomography (CT) scans, and manual measurements on five cadaveric knees. Reliability and repeatability of the AI algorithm were evaluated by assessing the inter-observer and intra-observer agreement between measurements performed on 3D bone reconstructions, respectively. RESULTS Accuracy of the AI algorithm was considered excellent with mean absolute errors <2mm in 9 of 12 anatomical parameters compared with measurements performed on CTs and manual calipers. All inter-observer and intra-observer correlation coefficients were greater than 0.90 representing a high level of measurement reliability and repeatability by independent observers and the same observers. CONCLUSION This particular AI algorithm demonstrated a high degree of accuracy, reliability, and repeatability for converting 2D radiographs to 3D bone reconstructions similar to a CT-scan. Study results suggest this AI algorithm has the potential for use in preoperative surgical planning due to its efficiencies related to cost and time and reduced radiation exposure without the use of 3D imaging.
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Affiliation(s)
| | - Carlos Arce
- Department of Orthopaedic Surgery, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Gonçalo Martinho
- Department of Orthopaedic Surgery, Hospital CUF Santarém, Santarém, Portugal
| | - João Pedro Campos
- Department of Orthopaedic Surgery, Hospital Pedro Hispano, Matosinhos, Portugal
| | - R Michael Meneghini
- Indiana Joint Replacement Institute, Indianapolis, Indiana; Department of Orthopaedic Surgery, Indiana University School of Medicine, Indianapolis, Indiana
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Yang CZ, Abdelhameed MA, AlMaeen BN, Bernard de Villeneuve F, Fernandes LR, Jacquet C, Ollivier M. In slope-changing osteotomy one millimeter is not one degree: results of an artificial intelligence-automated software analysis. Int Orthop 2023; 47:915-920. [PMID: 36574022 DOI: 10.1007/s00264-022-05676-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Anterior closing wedge osteotomies (ACWO) are performed in revision anterior cruciate ligament (ACL) surgery to correct an excessive posterior tibial slope (PTS). PURPOSE With the help of automated planning software, this study investigates the assumption that 1mm of wedge height gives 1° of slope correction (1:1). METHODS Fifty patients underwent ACWO, with the wedge height calculated using the 1:1 formula. Pre- and postosteotomy PTS were measured manually, and the achieved post-operative PTS was compared with the target PTS of 5.3° ± 1.9. The X-ray analysis was repeated virtually with the automated software, which also recommended a resection height. These parameters were then compared with the manually obtained parameters. RESULTS Using a 1:1 formula, wedge heights of 8.5mm ± 2.3 was resected to achieve a PTS of 4.2° ± 0.32. This showed an overcorrection of 1.6° ± 0.8 from the target slope. This was consistent with the data from the automated software, which recommended a lower wedge height of 7.7mm ± 2.9. CONCLUSION In trans-tubercle ACW, using a wedge height (mm) to slope correction (°) ratio of 1:1 can lead to slight over-correction. Automated software planning is useful for planning correction osteotomies in the sagittal plane.
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Affiliation(s)
- Chia Zi Yang
- Department of Orthopaedic Surgery, Singapore General Hospital, 20 College Road, Academia Level 4, Singapore, 169856, Singapore
| | | | | | - Florent Bernard de Villeneuve
- Institute for Movement and Locomotion, Hôpital Sainte-Marguerite, Aix-Marseille Université, ISM, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | | | - Christophe Jacquet
- Institute for Movement and Locomotion, Hôpital Sainte-Marguerite, Aix-Marseille Université, ISM, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France
| | - Matthieu Ollivier
- Institute for Movement and Locomotion, Hôpital Sainte-Marguerite, Aix-Marseille Université, ISM, 270, Boulevard Sainte-Marguerite, 13009, Marseille, France.
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Fernandes LR, Nunes VRH, Peonorio PEM, Cortes LGF, Rosa SEA, Silveira CN, Lima LB, Velloso E, Campregher P. NEOPLASIAS MIELOIDES COM MUTAÇÃO SF3B1. Hematol Transfus Cell Ther 2022. [DOI: 10.1016/j.htct.2022.09.949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Sonnery-Cottet B, Abreu FG, Saithna A, Ouanezar H, Fernandes LR, Fayard JM, Bulle S, Pedron O, Chambat P, Boisgard S. Successful Return to Elite Sport After Bilateral Knee Dislocations: A Case Report. Orthop J Sports Med 2019; 7:2325967119845017. [PMID: 31157283 PMCID: PMC6512155 DOI: 10.1177/2325967119845017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Felipe Galvão Abreu
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Adnan Saithna
- Advanced Orthopedics & Sports Medicine, Kansas City, Missouri, USA.,School of Science and Technology, Nottingham Trent University, Nottingham, UK
| | - Hervé Ouanezar
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Levi Reina Fernandes
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Stephane Bulle
- Fédération Française de Ski, Annecy, France.,Centre de Consultation Spécialisé de Décines Pôle Médical du Grand Large-OL City, Decines, France
| | - Olivier Pedron
- Centre National d'Entrainement, Fédération Française de Ski, Albertville, France
| | - Pierre Chambat
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Hôpital Privé Jean Mermoz, Ramsay Générale de Santé, Lyon, France
| | - Stephane Boisgard
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
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Sappey-Marinier E, Sonnery-Cottet B, O'Loughlin P, Ouanezar H, Reina Fernandes L, Kouevidjin B, Thaunat M. Clinical Outcomes and Predictive Factors for Failure With Isolated MPFL Reconstruction for Recurrent Patellar Instability: A Series of 211 Reconstructions With a Minimum Follow-up of 3 Years. Am J Sports Med 2019; 47:1323-1330. [PMID: 31042437 DOI: 10.1177/0363546519838405] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Reconstruction of the medial patellofemoral ligament (MPFL) is widely acknowledged as an integral part of the current therapeutic armamentarium for recurrent patellar instability. The procedure is often performed with concomitant bony procedures, such as distalization of the tibial tuberosity or trochleoplasty in the case of patella alta or high-grade trochlear dysplasia, respectively. At the present time, few studies have evaluated the clinical effectiveness of MPFL reconstruction as an isolated intervention. PURPOSE To report the clinical outcomes of isolated MPFL reconstruction in cases of patellar instability and to identify predictive factors for failure. STUDY DESIGN Case series; Level of evidence, 4. METHODS A retrospective analysis of prospectively collected data was performed, including all patients who had undergone isolated MPFL reconstruction between January 2008 and January 2014. Preoperative assessment included the Kujala score, assessment of patellar tracking ("J-sign"), and radiographic features, such as trochlear dysplasia according to Dejour classification, patellar height with the Caton-Deschamps index (CDI), tibial tubercle-trochlear groove distance, and patellar tilt. The Kujala score was assessed postoperatively. Failure was defined by a postoperative patellar dislocation or surgical revision for recurrent patellar instability. RESULTS A total of 239 MPFL reconstructions were included; 28 patients (11.7%) were uncontactable and considered lost to follow-up. Thus, 211 reconstructions were analyzed with a mean follow-up of 5.8 years (range, 3-9.3 years). The mean age at surgery was 20.6 years (range, 12-48 years), and 55% of patients were male. Twenty-seven percent of patients had a preoperative positive J-sign, and 93% of patients had trochlear dysplasia (A, 47%; B, 25%; C, 15%; D, 6%). The mean CDI was 1.2 (range, 1.0-1.7); mean tibial tubercle-trochlear groove distance, 15 mm (range, 5-30 mm); and mean patellar tilt, 23° (range, 9°-47°). The mean Kujala score improved from 56.1 preoperatively to 88.8 ( P < .001). Ten failures were reported that required surgical revision for recurrent patellar instability (4.7%). Uni- and multivariate analyses highlighted 2 preoperative risk factors for failure: patella alta (CDI ≥1.3; odds ratio, 4.9; P = .02) and preoperative positive J-sign (odds ratio, 3.9; P = .04). CONCLUSION In cases of recurrent patellar instability, isolated MPFL reconstruction would appear to be a safe and efficient surgical procedure with a low failure rate. Preoperative failure risk factors identified in this study were patella alta with a CDI ≥1.3 and a preoperative positive J-sign.
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Affiliation(s)
- Elliot Sappey-Marinier
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Padhraig O'Loughlin
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Herve Ouanezar
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Levi Reina Fernandes
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Biova Kouevidjin
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Groupe Ramsay-Generale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Groupe Ramsay-Generale de Santé, Lyon, France
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Ouanezar H, Blakeney WG, Latrobe C, Saithna A, Fernandes LR, Delaloye JR, Thaunat M, Sonnery-Cottet B. The popliteus tendon provides a safe and reliable location for all-inside meniscal repair device placement. Knee Surg Sports Traumatol Arthrosc 2018; 26:3611-3619. [PMID: 29502169 DOI: 10.1007/s00167-018-4889-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/28/2018] [Indexed: 12/22/2022]
Abstract
PURPOSE Repairs of the posterior horn of the lateral meniscus can be technically challenging. In contrast to medial meniscus repairs, the capsule around the posterior segment attachment of the lateral meniscus is quite thin. This study evaluates the clinical results of an arthroscopic all-inside repair technique for unstable, vertical, lateral meniscus tears, using a suture repair placed directly into the popliteus tendon. METHODS A retrospective analysis of prospectively collected data from the SANTI database was performed. All patients who had undergone combined ACL reconstruction with lateral meniscus all-inside repair, using sutures placed in the popliteus tendon, between 2011 and 2015, were included. Patients were reviewed clinically at 1 and 2 years' follow-up. At final follow-up, all patients were contacted to identify if they underwent further surgery or had knee pain, locking or effusion. Symptomatic patients were recalled for clinical evaluation by a physician and Magnetic Resonance Imaging of the knee. Operative notes for those undergoing further surgery were reviewed and rates and type of re-operation, including for failed lateral meniscal repair were recorded. RESULTS Two hundred patients (mean age 28.6 ± 10.2 years) with a mean follow-up of 45.5 ± 12.8 months (range 24.7-75.2) were included. The mean Subjective International Knee Documentation Committee (IKDC) at final follow-up was 85.0 ± 11.3. The post-operative mean side-to-side laxity measured at 1 year was 0.6 ± 1.0 mm. Twenty-six patients underwent re-operation (13%) at a mean follow-up of 14.8 ± 7.8 months. The ACL graft rupture rate was 5.0%. Other causes for re-operation included medial meniscus tear (2.5%), cyclops lesion (1.5%) and septic arthritis (0.5%). The lateral meniscus repair failure rate was 3.5%. No specific complications relating to placement of sutures in the popliteus tendon were identified. CONCLUSION Arthroscopic all-inside repair of unstable, vertical, lateral meniscus tears using a suture placed in the popliteus tendon is a safe technique. It is associated with a very low failure rate with no specific complications. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Hervé Ouanezar
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - William G Blakeney
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Charles Latrobe
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Adnan Saithna
- Department of Orthopaedic Surgery, Southport and Ormskirk Hospital, Southport, UK
| | - Levi Reina Fernandes
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Jean Romain Delaloye
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Ramsay-Générale de Santé, Hôpital Privé Jean Mermoz, 24 Avenue Paul Santy, 69008, Lyon, France.
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Fernandes LR, Ouanezar H, Saithna A, Sonnery-Cottet B. Combined ACL reconstruction and Segond fracture fixation fails to abolish anterolateral rotatory instability. BMJ Case Rep 2018; 2018:bcr-2018-224457. [PMID: 29559494 DOI: 10.1136/bcr-2018-224457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
The Segond fracture (SF) is considered pathognomonic of an anterior cruciate ligament (ACL) tear. However, the anatomy of the soft-tissue attachments responsible for the avulsion of SFs has been a cause of controversy. A 31-year-old male patient presented with an injury to his right knee that resulted in ACL tear and a SF. Open SF fixation and arthroscopic ACL reconstruction were performed. The anatomical dissection demonstrated that the avulsion of SFs had occurred because of the tibial attachment of the anterolateral ligament (ALL) with an intact Iliotibial band. At 1-year postoperative follow-up, the ACL graft had restored anterior tibial translation to within normal limits. However, residual rotational knee laxity was observed. This finding highlights that patients with SF may be at increased risk of persistent instability after ACL reconstruction. Consideration should be given to recession of the fixation or augmentation of the ALL when dealing with this injury pattern.
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Affiliation(s)
| | - Herve Ouanezar
- Sports Medicine, Centre Orthopédique Santy, Lyon, France
| | - Adnan Saithna
- Medical Technologies and Advanced Materials, Nottingham Trent University, Clifton Campus, Nottingham, UK.,Orthopaedic Surgery, Renacres Hospital, Ormskirk, Lancashire, UK
| | - Bertrand Sonnery-Cottet
- Sports Medicine, Centre Orthopédique Santy, Lyon, France.,Chirurgie Orthopédique, Hôpital privé Jean Mermoz, Lyon, France
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10
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Ouanezar H, Blakeney WG, Fernandes LR, Borade A, Latrobe C, Temponi EF, Sonnery-Cottet B. Clinical Outcomes of Single Anteromedial Bundle Biologic Augmentation Technique for Anterior Cruciate Ligament Reconstruction With Consideration of Tibial Remnant Size. Arthroscopy 2018; 34:714-722. [PMID: 29198590 DOI: 10.1016/j.arthro.2017.08.309] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/30/2017] [Accepted: 08/30/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE The primary aim of this study was to evaluate the functional outcomes, knee stability, complications, and reoperations associated with anatomic anterior cruciate ligament (ACL) reconstruction using the single anteromedial bundle biological augmentation (SAMBBA) technique in a consecutive series of 128 patients with a minimum follow-up of 24 months. A secondary aim was to compare larger preserved ACL remnants with smaller preserved remnants. METHODS Patients who underwent primary anatomic ACL reconstruction using the SAMBBA technique from July 2013 to October 2014 were analyzed. Exclusion criteria were (1) age <16 years, (2) revision cases, (3) multiple ligament injuries, (4) chondral lesions greater than grade 2 according to the Outerbridge classification, (5) additional injuries to the collateral ligaments greater than grade 2, or (6) a history of a contralateral ACL injury. Clinical assessment including evaluation of side-to-side difference and functional outcome measures with the International Knee Documentation Committee (IKDC) subjective score and the Tegner Activity Scale were used to evaluate outcomes before surgery and at the last follow-up. Any subsequent surgical procedures were systematically recorded during the study period. The patients were also divided in 2 groups according to their ACL remnant size, ≥50% or <50%, and compared. RESULTS Of the 135 patients who underwent primary SAMBBA technique, 128 patients returned to final follow-up, with a mean follow-up of 31.7 months (range, 24-44.3). At last follow-up, the IKDC score significantly improved from 54.1 ± 15.1 to 92.5 ± 11.4 (P < .001); the Tegner activity score (6.4 ± 1.2) was similar (P = .3) to the preinjury score (6.5 ± 1.2). Side-to-side laxity significantly improved from 6.7 ± 1.2 mm to 0.7 ± 1 mm (P < .001). Twenty-four subsequent surgeries (18.7%) were performed including 10 meniscal procedures, 7 ACL revisions, 5 arthroscopies for cyclops lesions, one microfracture, and one manipulation under anaesthesia. The side-to-side laxity (P = .30) and rates of reoperation (P = .65), graft failure (P = .45), and cyclops lesions (P = .67) were not significantly different between ≥50% or <50% ACL remnant groups. CONCLUSIONS The results of this study demonstrate that primary anatomic ACL reconstruction using the SAMBBA technique significantly improved clinical and functional outcomes between baseline and follow-up at a minimum of 24 months. A low rate of complications was observed with this technique. No significant differences between large and moderate size ACL remnants were detected for all outcome measures. LEVEL OF EVIDENCE Level IV case series with subgroup analysis.
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Affiliation(s)
- Hervé Ouanezar
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France
| | - William G Blakeney
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France
| | - Levi Reina Fernandes
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France
| | - Amrut Borade
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France
| | - Charles Latrobe
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France
| | | | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France.
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Ouanezar H, Thaunat M, Saithna A, Fernandes LR, Sonnery-Cottet B. Suture Repair of Full Radial Posterior Lateral Meniscus Tears Using a Central Midline Portal. Arthrosc Tech 2017; 6:e1801-e1806. [PMID: 29416968 PMCID: PMC5796884 DOI: 10.1016/j.eats.2017.06.054] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Accepted: 06/28/2017] [Indexed: 02/03/2023] Open
Abstract
Full radial posterior lateral meniscus root tears are frequently associated with injuries to the anterior cruciate ligament. Left unrepaired, they result in loss of the meniscus hoop stress function and can lead to overload of the lateral compartment and early degenerative changes. Arthroscopic suture repairs show successful results with long-term follow-up. However, previously described suture repair techniques have often required special instrumentation and can be technically demanding. This Technical Note describes the use of an accessory portal through the patellar tendon as a safe and easy method for repairing full posterior radial tears of the lateral meniscus.
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Affiliation(s)
- Hervé Ouanezar
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France
| | - Adnan Saithna
- Southport and Ormskirk Hospitals NHS Trust, Lancashire, England
- University of Liverpool, Liverpool, England
| | - Levi Reina Fernandes
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Group Ramsay-Générale de Santé, Lyon, France
- Address correspondence to Bertrand Sonnery-Cottet, M.D., Centre Orthopédique Santy, 24 Avenue Paul Santy, Lyon F-69008, France.Centre Orthopédique Santy24 Avenue Paul SantyLyonF-69008France
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Fernandes LR, Gomes AC, Lopes A, Albuquerque A, Simões RM. Sugar and volatile fatty acids dynamic during anaerobic treatment of olive mill wastewater. Environ Technol 2015; 37:997-1007. [PMID: 26496487 DOI: 10.1080/09593330.2015.1096310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Biogas production has been the main route used to exploit olive mill wastewater (OMW), after pretreatment and/or in combination with other effluents, but more recently the production of chemicals and biopolymers by biotechnological routes has deserved increasing attention by the scientific community. The present paper aims to explore the potential of fresh OMW as a source of volatile fatty acids (VFAs) and biogas. The time profile of VFAs production and the corresponding sugar consumption was followed by high-performance liquid chromatography, in batch anaerobic assays. The experimental results have revealed the very high potential of the OMW for the production of VFAs, mainly due to the high sugar concentration in the effluent (37.8 g/L) and its complete conversion into VFAs, in a time period of 2-3 days. The most abundant VFAs were acetic (48-50%), n-butanoic (12-27%), iso-pentanoic (12-14%) and propanoic (5-13%). The ratio of VFA containing even and odd carbon chains increased with the reduction in the initial chemical oxygen demand concentration of the samples used in the experiments. The conversion of the VFAs to biogas was inhibited at concentrations of 3.5 g/L of VFAs.
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Affiliation(s)
- L R Fernandes
- a Department of Chemistry , University of Beira Interior , Covilhã , Portugal
| | - A C Gomes
- a Department of Chemistry , University of Beira Interior , Covilhã , Portugal
- b FibEnTech - Materiais Fibrosos e Tecnologias Ambientais , University of Beira Interior , Covilhã , Portugal
| | - A Lopes
- a Department of Chemistry , University of Beira Interior , Covilhã , Portugal
- b FibEnTech - Materiais Fibrosos e Tecnologias Ambientais , University of Beira Interior , Covilhã , Portugal
| | - A Albuquerque
- b FibEnTech - Materiais Fibrosos e Tecnologias Ambientais , University of Beira Interior , Covilhã , Portugal
- c Department of Civil Engineering and Architecture , University of Beira Interior , Covilhã , Portugal
| | - R M Simões
- a Department of Chemistry , University of Beira Interior , Covilhã , Portugal
- b FibEnTech - Materiais Fibrosos e Tecnologias Ambientais , University of Beira Interior , Covilhã , Portugal
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Portugal LR, Gonçalves JL, Fernandes LR, Silva HPS, Arantes RME, Nicoli JR, Vieira LQ, Alvarez-Leite JI. Effect of Lactobacillus delbrueckii on cholesterol metabolism in germ-free mice and on atherogenesis in apolipoprotein E knock-out mice. Braz J Med Biol Res 2006; 39:629-35. [PMID: 16648901 DOI: 10.1590/s0100-879x2006000500010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Elevated blood cholesterol is an important risk factor associated with atherosclerosis and coronary heart disease. Several studies have reported a decrease in serum cholesterol during the consumption of large doses of fermented dairy products or lactobacillus strains. The proposed mechanism for this effect is the removal or assimilation of intestinal cholesterol by the bacteria, reducing cholesterol absorption. Although this effect was demonstrated in vitro, its relevance in vivo is still controversial. Furthermore, few studies have investigated the role of lactobacilli in atherogenesis. The aim of the present study was to determine the effect of Lactobacillus delbrueckii on cholesterol metabolism in germ-free mice and the possible hypocholesterolemic and antiatherogenic action of these bacteria using atherosclerosis-prone apolipoprotein E (apo E) knock-out (KO) mice. For this purpose, Swiss/NIH germ-free mice were monoassociated with L. delbrueckii and fed a hypercholesterolemic diet for four weeks. In addition, apo E KO mice were fed a normal chow diet and treated with L. delbrueckii for 6 weeks. There was a reduction in cholesterol excretion in germ-free mice, which was not associated with changes in blood or liver cholesterol concentration. In apo E KO mice, no effect of L. delbrueckii was detected in blood, liver or fecal cholesterol. The atherosclerotic lesion in the aorta was also similar in mice receiving or not these bacteria. In conclusion, these results suggest that, although L. delbrueckii treatment was able to reduce cholesterol excretion in germ-free mice, no hypocholesterolemic or antiatherogenic effect was observed in apo E KO mice.
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Affiliation(s)
- L R Portugal
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
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Rosa R, Rosa CD, Ocampos D, Fernandes LR, Bacila M. Comparative levels between enzymes of the glycolytic pathway from erythrocytes and somatic tissues of the chicken Gallus gallus domesticus. Comp Biochem Physiol C Comp Pharmacol Toxicol 1983; 75:267-73. [PMID: 6138195 DOI: 10.1016/0742-8413(83)90191-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
A comparative study on the glycolytic enzymes from chicken erythrocytes and somatic tissues has been carried out, the results being shown as active units per mg protein in supernatants of 1085, 12,100 and 106,000 g fractionated centrifugation. The profiles of the glycolytic enzymes have been analyzed in terms of their activity relative to hexokinase and as the ratios between pairs of enzymes bearing a product-substrate relationship. Chicken erythrocyte displays a very peculiar profile of glycolytic enzymes. It possesses a FruP2-activated pyruvate kinase of the L isoenzyme type, which does not seem to be the predominant isoenzyme together with the M type, the content in glycolytic enzymes being much lower than in the somatic tissues.
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