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Baverel L, Cucurulo T, Lutz C, Colombet, Cournapeau J, Dalmay F, Lefevre N, Letartre R, Potel JF, Roussignol X, Surdeau L, Servien E. Anesthesia and analgesia methods for outpatient anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res 2016; 102:S251-S255. [PMID: 27687059 DOI: 10.1016/j.otsr.2016.08.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [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: 07/10/2016] [Accepted: 08/20/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION More and more anterior cruciate ligament (ACL) reconstructions are being performed as outpatient surgery in France, because of economic considerations. Postoperative pain is the most common reason for delayed discharge that could require hospitalization, and the main reason for unanticipated hospital admission. The purpose of this study was to define the best anesthesia and analgesia methods for ACL reconstruction. MATERIALS AND METHODS This was a prospective, multicenter, comparative study performed between January 2014 and April 2015. Inclusion criteria were ACL reconstruction in patients above 15 years of age performed as an outpatient surgical procedure. The anesthesia techniques analyzed were general anesthesia, spinal anesthesia and quadruple nerve blockade. The analgesic methods studied were single-shot nerve blocks, continuous nerve blocks, peri-articular and intra-articular local infiltration analgesia (LIA), non-steroidal anti-inflammatory agents (NSAIDs) and intravenous corticosteroids. The main outcome criterion was pain on a visual analog scale (VAS). The secondary outcome criteria were delayed discharge of a patient who had undergone outpatient surgery, consumption of opioids and complications for the various anesthesia techniques and analgesia methods. RESULTS In all, 680 patients were included in this study, which was 63% of the ACL reconstruction procedures performed during this period. The study population was 69% male and 31% female, with an average age of 30 years. Twenty-three patients (3.4%) could not be discharged on the day of surgery. No correlation was found with the anesthesia technique used. NSAID treatment was protective relative to delayed discharge (P=0.009), while opioid consumption was a risk factor (P<0.01). There were no differences in the pain levels related to the type of anesthesia. Peri-articular LIA of the hamstring tendon harvest site was effective. Intra-articular LIA did not provide better analgesia. Continuous nerve block had complication rates above 13%. DISCUSSION All types of anesthesia were compatible with outpatient ACL reconstruction. No gold standard analgesia method can be defined based on this study's findings. However, we recommend multimodal analgesia associating peri-articular LIA or one-shot sensory saphenous nerve block, NSAIDs and corticosteroid treatment, and cryotherapy. LEVEL OF EVIDENCE II, prospective comparative non-randomized study.
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Affiliation(s)
- L Baverel
- Centre hospitalier universitaire, Hôtel-Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France.
| | - T Cucurulo
- Institut de Chirurgie Orthopédique et Sportive (ICOS 13), 463, rue Paradis, 13008 Marseille, France
| | - C Lutz
- ICOSS, 50, avenue des Vosges, 67000 Strasbourg, France
| | - Colombet
- Centre de Chirurgie Orthopédique et Sportive, 2, rue Negrevergne, 33700 Mérignac, France
| | - J Cournapeau
- Centre hospitalier universitaire, Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - F Dalmay
- Inserm 1094, UMR, NET, 2, rue du Docteur-Marcland, 87025 Limoges, France
| | - N Lefevre
- Institut de l'Appareil Locomoteur Nollet, 75017 Paris, France; Clinique du Sport Paris V, 75005 Paris, France
| | - R Letartre
- Hôpital privé la Louvière, 122, rue de la Louvière, 59000 Lille, France
| | - J-F Potel
- Medipôle, 45, rue de Gironis, 31036 Toulouse, France
| | - X Roussignol
- Centre hospitalier universitaire, Ch.-Nicolle, 76031 Rouen, France
| | - L Surdeau
- Centre de Chirurgie Orthopédique et Sportive, 2, rue Negrevergne, 33700 Mérignac, France
| | - E Servien
- Hopital universitaire de la croix-rousse, Centre Albert-Trillat, 103, grande rue de la Croix-Rousse, 69004 Lyon, France
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Lutz C, Dalmay F, Ehkirch FP, Cucurulo T, Laporte C, Le Henaff G, Potel JF, Pujol N, Rochcongar G, Salledechou E, Seil R, Gunepin FX, Sonnery-Cottet B. Meniscectomy versus meniscal repair: 10 years radiological and clinical results in vertical lesions in stable knee. Orthop Traumatol Surg Res 2015; 101:S327-31. [PMID: 26439421 DOI: 10.1016/j.otsr.2015.09.008] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [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: 07/02/2015] [Accepted: 09/03/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Surgical management of meniscal lesion consists of either a meniscectomy or meniscal repair. Although repair offers immediate recovery after surgery, it is also associated with higher rates of revision. A meniscectomy, on the other hand is known to be associated with an early onset of osteoarthritis. The present study compared clinical and radiological results at 10 years between meniscectomy and meniscal repair in isolated vertical lesion in an otherwise stable knee. The hypothesis was that repair shows functional and radiological benefit over meniscectomy. PATIENTS AND METHOD A multi-centric retrospective comparative study of 32 patients (24 male, 8 female). Mean follow-up was 10.6 years (range, 10-13 years). There were 10 meniscal repairs (group R) and 22 meniscectomies (group M), in 17 right and 15 left knees. Mean age at surgery was 33.45±12.3 years (range, 9-47 years). There were 28 medial and 4 lateral meniscal lesions; 26 were in the red-red zone and 6 in red-white zone. RESULTS Functional score: KOOS score was significantly higher in group R than M on almost all parameters: 98±4.69 versus 77.38±21.97 for symptoms (P=0.0043), 96.89±7.20 versus 78.57±18.9 for pain (P=0.0052), 99.89±0.33 versus 80.88±19.6 for daily life activities (P=0.0002), 96.11±9.83 versus 54.05±32.85 for sport and leisure (P=0.0005), but 91±16.87 versus 68.15±37.7 for quality of life (P=0.1048). Radiology score: in group R, 7 patients had no features of osteoarthritis, and 2 had grade 1 osteoarthritis. In group M, 5 patients had grade 1 osteoarthritis, 10 grade 2, 3 grade 3 and 3 grade 4. Mean quantitative score was 0 (mean, 0.22±0.44) in-group R and 2 (mean, 2.19±0.98) in group M (P<0.0001). DISCUSSION At more than 10year's follow-up, functional scores were significantly better with meniscal repair than meniscectomy on all parameters of the KOOS scale except quality of life. Functional and radiological scores correlated closely. These results show that meniscal repair for vertical lesions in stable knees protects against osteoarthritis and is therefore strongly recommended. LEVEL OF EVIDENCE IV; retrospective study.
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Affiliation(s)
- C Lutz
- Clinique du Diaconat, 50, avenue des Vosges, 67000 Strabourg, France.
| | - F Dalmay
- 2, rue du Docteur-Marcland, 87025 Limoges cedex, France
| | - F P Ehkirch
- Clinique Maussins-Nollet, 67, rue de Romainville, 75019 Paris, France
| | - T Cucurulo
- 118, rue Jean-Mermoz, 13008 Marseille, France
| | - C Laporte
- CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | | | - J F Potel
- Medipôle, 45, rue de Gironis, 31036 Toulouse cedex 1, France
| | - N Pujol
- Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - G Rochcongar
- Département d'orthopédie traumatologie, CHRU de Caen-Côte-de-Nacre, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - E Salledechou
- Département d'orthopédie traumatologie, CHRU de Caen-Côte-de-Nacre, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - R Seil
- Centre hospitalier de Luxembourg, 78, rue d'Eich, 1460 Luxembourg, Luxembourg
| | - F-X Gunepin
- Clinique Mutualiste, 3, rue Robert-de-la-Croix, 56324 Lorient cedex, France
| | - B Sonnery-Cottet
- Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
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Rochcongar G, Cucurulo T, Ameline T, Potel JF, Dalmay F, Pujol N, Sallé de Chou É, Lutz C, Ehkirch FP, Le Henaff G, Laporte C, Seil R, Gunepin FX, Sonnery-Cottet B. Meniscal survival rate after anterior cruciate ligament reconstruction. Orthop Traumatol Surg Res 2015; 101:S323-6. [PMID: 26602252 DOI: 10.1016/j.otsr.2015.09.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [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: 07/02/2015] [Accepted: 08/31/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Meniscal suture provides well-documented benefits. Integrity of the cruciate ligaments of the knee is a prerequisite for meniscal healing. Nevertheless, reconstruction of the anterior cruciate ligament (ACL) does not consistently prevent recurrent tearing of a sutured meniscus. We evaluated meniscal survival rates, 5 and 10 years after meniscal suture concomitant with an ACL reconstruction. We compared the outcomes of these repaired menisci to those in which no menisci tears were detected during ACL reconstruction. METHODS In this multi-centric retrospective study, we included two groups. One group consists of patients who underwent a meniscal repair. This group was further divided into two subgroups based on whether follow-up was 5 years (n=76) or 10 years (n=39). The control group included 120 patients with normal menisci observed during surgery. We studied meniscal survival rates in each group, and we analyzed risk factors associated with the recurrence of meniscal lesions. RESULTS The 5-year meniscal survival rate was significantly higher in the control group than in the meniscal-repair group (95% vs. 80%, respectively; P=0.0029). The controls group also had a higher meniscal survival rate after 10 years, although the difference was not statistically significant (88% vs. 77%, P=0.07). A difference in knee laxity greater than 4mm was associated with a 5-fold increase in the risk of recurrent meniscal tears (P=0.0057). After 5 years, the risk of recurrence was higher for the medial than for the lateral meniscus, whereas after 10 years the difference was no longer statistically significant. DISCUSSION Although insufficient healing after meniscal suturing contributes to the risk of further meniscal tears, new lesions can develop in menisci that were undamaged at the time of ACL reconstruction. The risk of a new meniscal lesion is strongly associated with inadequate control of antero-posterior and rotational laxity. Some apparently "new menisci lesions" seems to have been missed during ACL reconstruction. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- G Rochcongar
- Département d'orthopédie traumatologie, CHRU Caen - Côte-de-Nacre, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France.
| | - T Cucurulo
- 118, rue Jean-Mermoz, 13008 Marseille, France
| | - T Ameline
- Département d'orthopédie traumatologie, CHRU Caen - Côte-de-Nacre, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - J F Potel
- Medipôle, 45, rue de Gironis, 31036 Toulouse cedex 1, France
| | - F Dalmay
- 2, rue du Docteur-Marcland, 87025 Limoges cedex, France
| | - N Pujol
- Centre hospitalier de Versailles, 177, rue de Versailles, 78150 Le Chesnay, France
| | - É Sallé de Chou
- Département d'orthopédie traumatologie, CHRU Caen - Côte-de-Nacre, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - C Lutz
- Clinique du Diaconat, 50, avenue des Vosges, 67000 Strasbourg, France
| | - F P Ehkirch
- Clinique Maussins-Nollet, 67, rue de Romainville, 75019 Paris, France
| | | | - C Laporte
- CHU de Rennes, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
| | - R Seil
- Centre hospitalier de Luxembourg, 78, rue d'Eich, 1460 Luxembourg-Ville, Luxembourg, France
| | - F X Gunepin
- Clinique mutualiste, 3, rue Robert-de-la-Croix, 56324 Lorient cedex, France
| | - B Sonnery-Cottet
- Centre orthopédique Santy, 24, avenue Paul-Santy, 69008 Lyon, France
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Guenoun D, Champsaur P, Coudreuse JM, Cucurulo T, Lagier A, Le Corroller T. A symptomatic anomalous biceps femoris tendon insertion. Diagn Interv Imaging 2015; 97:113-5. [PMID: 26319957 DOI: 10.1016/j.diii.2014.11.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Revised: 10/28/2014] [Accepted: 11/12/2014] [Indexed: 10/23/2022]
Affiliation(s)
- D Guenoun
- Radiology Department, hôpital Sainte-Marguerite, AP-HM, 13009 Marseille, France.
| | - P Champsaur
- Radiology Department, hôpital Sainte-Marguerite, AP-HM, 13009 Marseille, France.
| | - J-M Coudreuse
- Sports Medicine Department, hôpital Salvator, AP-HM, 13009 Marseille, France.
| | - T Cucurulo
- Orthopedic Surgery Department, Clinique Juge, 13008 Marseille, France.
| | - A Lagier
- Anatomy Department, AMU, 13005 Marseille, France.
| | - T Le Corroller
- Radiology Department, hôpital Sainte-Marguerite, AP-HM, 13009 Marseille, France.
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Pujol N, Colombet P, Potel JF, Cucurulo T, Graveleau N, Hulet C, Panisset JC, Servien E, Sonnery-Cottet B, Trojani C, Djian P. Anterior cruciate ligament reconstruction in partial tear: selective anteromedial bundle reconstruction conserving the posterolateral remnant versus single-bundle anatomic ACL reconstruction: preliminary 1-year results of a prospective randomized study. Orthop Traumatol Surg Res 2012; 98:S171-7. [PMID: 23142049 DOI: 10.1016/j.otsr.2012.09.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [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: 09/01/2012] [Accepted: 09/25/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Partial tears of the anterior cruciate ligament (ACL) are frequent. Conserving ACL remnants is central to the concept of anatomic, biomechanical and biological reconstruction. The interest of such conservation remains theoretical. The present hypothesis was that selective anteromedial (AM) bundle reconstruction is preferable to the standard single-bundle reconstruction in partial ACL tear. MATERIALS AND METHODS A multicenter prospective randomized study recruited 54 partial ACL tears operated on either by selective AM bundle reconstruction (Group 1, n=29) or by standard anatomic single-bundle reconstruction (Group 2, n=25). All patients were clinically assessed on subjective and objective IKDC, Lysholm and KOOS scores, with a minimum 12 months' follow-up. Comparative pre- to postoperative anterior laxity was measured on the Rolimeter(®) device, with statistical analysis of results. RESULTS There were no significant preoperative differences between the two groups. All patients were followed-up at 6 months and 1 year. Mean subjective IKDC scores for groups 1 and 2 respectively were 55.8 and 56.8 preoperatively versus 86.2 and 85.7 at 1 year; Lysholm scores were 69.9 and 71.1 versus 90.9 and 91.8. These inter-group differences were non-significant. Differential laxity for groups 1 and 2 respectively was 5.0mm (range, 2-10) and 5.1mm (2-12) preoperatively (P=0.73), versus 1.2mm and 1.9 mm postoperatively (P=0.03). DISCUSSION AND CONCLUSION In partial ACL tear, selective AM bundle reconstruction conserving the posterolateral bundle remnant provides clinical results comparable to the standard single-bundle technique, with better control of anterior laxity. Longer follow-up, however, will be needed to compare evolution in anterior and rotational laxity and in subjective results over time.
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Affiliation(s)
- N Pujol
- Versailles Hospital Center, Versailles-Saint-Quentin University, 177, rue de Versailles, 78157 Le Chesnay, France.
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Sonnery-Cottet B, Panisset JC, Colombet P, Cucurulo T, Graveleau N, Hulet C, Potel JF, Servien E, Trojani C, Djian P, Pujol N. Partial ACL reconstruction with preservation of the posterolateral bundle. Orthop Traumatol Surg Res 2012; 98:S165-70. [PMID: 23142050 DOI: 10.1016/j.otsr.2012.10.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 09/09/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Over the past decade, our understanding of the anterior cruciate ligament (ACL) has evolved considerably. Based on this knowledge, ACL reconstruction techniques have changed and selective reconstruction procedures have been developed for partial tears. Our hypothesis was that stability and function can be restored to the knee with selective bundle reconstruction of partial ACL tears and preservation of the residual fibers. MATERIALS AND METHODS This was a multicenter retrospective study of 168 partial reconstructions of the anteromedial (AM) bundle of the ACL with preservation of the posterolateral (PL) bundle. All patients underwent a clinical evaluation based on the objective and subjective IKDC scores and the Lysholm score after a mean follow-up of 26 months (12-59 months). Preoperative and postoperative instrumental measurement of knee laxity was performed by arthrometer and/or by (Telos(®)) stress radiography. Statistical analysis and comparison was performed between pre- and postoperative results. RESULTS The preoperative and postoperative subjective IKDC scores were 63.7 and 90.5 at the final follow-up respectively (P<0.001). The preoperative and postoperative Lysholm scores were 80 and 95.5 respectively (P<0.001). Preoperatively, most patients were classified C on the objective IKDC score. At the final follow-up 92% of the patients were classified A or B (P<0.001). Differential preoperative laxity was 5.5mm (range: 0-14 mm) and 1.1mm (range: 0-4mm) at the final follow-up (P<0.00001). DISCUSSION AND CONCLUSION Our study confirms that selective reconstruction of the AM bundle of the ACL with preservation of the PL bundle restores stability and function to the knee. Special attention should be paid to the size of the graft used to avoid excess tissue in the intercondylar notch.
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Affiliation(s)
- B Sonnery-Cottet
- Centre orthopédique Paul-Santy, 24, avenue Paul-Santy, 69008 Lyon, France.
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Pujol N, Colombet P, Cucurulo T, Graveleau N, Hulet C, Panisset JC, Potel JF, Servien E, Sonnery-Cottet B, Trojani C, Djian P. Natural history of partial anterior cruciate ligament tears: a systematic literature review. Orthop Traumatol Surg Res 2012; 98:S160-4. [PMID: 23153663 DOI: 10.1016/j.otsr.2012.09.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2012] [Accepted: 09/25/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Partial anterior cruciate ligament (ACL) tear is frequent, and indications for surgery may be raised by a diagnostic aspect associating slight laxity with no clear pivot-shift. Unlike that of complete ACL tear, the natural history of partial tear remains controversial. MATERIAL AND METHOD A systematic literature review searched for referenced publications on the natural history of partial ACL tear. Twelve specific articles were retrieved. Initial diagnosis was systematically confirmed on arthroscopy, without ACL surgery. The following criteria were analyzed: firstly, preoperative: confirmation of inclusion criteria, preoperative clinical data, follow-up, arthroscopic lesion assessment, Lachman test, Pivot shift test, hemarthrosis, associated lesions and secondly, follow-up: Lachman test, Pivot shift test, revision surgery, functional clinical scores, pain, sport and return to sport, meniscal events. RESULTS Preoperatively, Lachman tests were positive (soft or delayed) in a mean 49.7% of cases (range, 0-100%); pivot shift test was systematically negative. At a mean 5.2 years' follow-up, Lachman test was "positive" in 47.6% of cases (range, 38-59%), with positive pivot shift test in 26.3% (range, 5-51%). 54.3% patients reported pain (range, 36-64%), and mean Lysholm score was 88.4 (17-100%). Fifty-two percent (21-60%) of patients resumed sport at their previous level. DISCUSSION/CONCLUSION The natural history of non-operated partial ACL tear is good over the medium term, especially if patients limit their sports activities. The greater the functional instability, the more frequent is residual pain. Laxity, although not quantified, seems to progress with time, with a positive pivot shift test emerging in a quarter of cases. Functional management may be recommended in non-athletic patients without meniscal lesion, but surgical treatment may be recommended in other patients. Indications for ACL reconstruction are thus the same in partial as in complete tear.
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Affiliation(s)
- N Pujol
- Versailles Hospital Center, Orthopedics Department, Versailles-Saint-Quentin University, 177, Rue de Versailles, 78157 Le Chesnay, France.
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Sonnery-Cottet B, Archbold P, Thaunat M, Fayard JM, Canuto SMG, Cucurulo T. Proximal hamstring avulsion in a professional soccer player. Orthop Traumatol Surg Res 2012; 98:928-31. [PMID: 22926296 DOI: 10.1016/j.otsr.2012.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 04/09/2012] [Accepted: 05/03/2012] [Indexed: 02/02/2023]
Abstract
Acute hamstring strains are a common athletic injury, which may be treated non-operatively with a satisfactory outcome. A complete proximal hamstring avulsion is a rare and potentially career ending injury to an elite athlete. For these high demand patients, surgical reattachment should be immediately undertaken to shorten return to sport and to improve functional outcome. This report describes the occurrence of a complete avulsion of the proximal hamstrings in a professional footballer during an international match. We highlight the clinical presentation, the appropriate diagnostic investigations, the surgical technique and the rehabilitation protocol for this injury. The successful surgical reattachment of the common hamstring tendon was confirmed by magnetic resonance imaging done 5 months after repair and allowed the player a full return to competition at 6 months after surgery. Hamstrings isokinetic peak torque was 80% at 6 months and 106% at 11 months after repair comparing with the uninjured side.
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Affiliation(s)
- B Sonnery-Cottet
- Santy Orthopaedic Surgical Center, 24 avenue Paul-Santy, Lyon, France.
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9
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Sonnery-Cottet B, Archbold P, Cucurulo T, Fayard JM, Bortolletto J, Thaunat M, Prost T, Chambat P. The influence of the tibial slope and the size of the intercondylar notch on rupture of the anterior cruciate ligament. ACTA ACUST UNITED AC 2012; 93:1475-8. [PMID: 22058297 DOI: 10.1302/0301-620x.93b11.26905] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
It has been suggested that an increased posterior tibial slope (PTS) and a narrow notch width index (NWI) increase the risk of anterior cruciate ligament (ACL) injury. The aim of this study was to establish why there are conflicting reports on their significance. A total of fifty patients with a ruptured ACL and 50 patients with an intact ACL were included in the study. The group with ACL rupture had a statistically significantly increased PTS (p < 0.001) and a smaller NWI (p < 0.001) than the control group. When a high PTS and/or a narrow NWI were defined as risk factors for an ACL rupture, 80% of patients had at least one risk factor present; only 24% had both factors present. In both groups the PTS was negatively correlated to the NWI (correlation coefficient = -0.28, p = 0.0052). Using a univariate model, PTS and NWI appear to be correlated to rupture of the ACL. Using a logistic regression model, the PTS (p = 0.006) and the NWI (p < 0.0001) remain significant risk factors. From these results, either a steep PTS or a narrow NWI predisposes an individual to ACL injury. Future studies should consider these factors in combination rather than in isolation.
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Affiliation(s)
- B Sonnery-Cottet
- Centre Orthopédique Santy, 24 Avenue Paul Santy, Lyon 69008, France.
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Abstract
UNLABELLED The purpose of this study was to evaluate the results of surgery, in particular arthroscopic procedures in the treatment of patellar tendinopathies that are refractory to conservative treatment in athletes. METHOD A retrospective multicenter study was performed in four centers. Patients were athletes who did not respond to carefully followed conservative treatment and who underwent surgery. Sixty-four patients were included, 10 who underwent arthroscopy. Patients were questioned and followed-up for an average of 22 months (6-116 months). RESULTS At the final follow-up, 87% of the patients had an improved Blazina score and 63% were again practicing their sport at the same level. None of the preoperative factors influenced the final result and one surgical technique was not more effective than another (patellar tip resection versus arthroscopic approach). DISCUSSION The results of this study are comparable to those in the literature which show a success rate of more than 80% whatever the surgical technique. This study limits a certain number of biases because the patient group is homogenous (athletes, unsuccessful conservative treatment) with similar functional scores, and well-defined protocols for postoperative rehabilitation. However, the study of this entity is difficult because of the limited number of subjects and its different anatomopathological forms. CONCLUSION Surgical treatment is indicated in motivated athletes if carefully followed conservative treatment is unsuccessful after more than six months, making it impossible to practice a sport (Blazina grade 3). Arthroscopic techniques seem to be as effective as open surgery with an equivalent delay for beginning sports activities.
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Affiliation(s)
- T Cucurulo
- Hôpital de la Conception, 13005 Marseille, France
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Bohu Y, Lefèvre N, Bauer T, Laffenetre O, Herman S, Thaunat M, Cucurulo T, Franceschi JP, Cermolacce C, Rolland E. Surgical treatment of Achilles tendinopathies in athletes. Multicenter retrospective series of open surgery and endoscopic techniques. Orthop Traumatol Surg Res 2009; 95:S72-7. [PMID: 19892618 DOI: 10.1016/j.otsr.2009.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Y Bohu
- Service de chirurgie orthopédique et traumatologique du sport, groupe hospitalier Pitié-Salpêtrière, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
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Badet R, Chambat P, Boussaton M, Bousquet V, Chassaing V, Cucurulo T, Djian P, Franceschi JP, Potel JF, Siegrist O, Sbihi A, Cerciello S. ["Isolated" injury of the posterior cruciate ligament. Surgical treatment of isolated posterior cruciate ligament tears: a multicentric retrospective study of 103 patients]. Rev Chir Orthop Reparatrice Appar Mot 2005; 91:43-54. [PMID: 16609553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
PURPOSE OF THE STUDY We present a retrospective multicentric series of carefully selected patients presenting "isolated" laxity of the posterior cruciate ligament. MATERIAL AND METHODS The series included 103 patients who were reviewed clinically (with a dedicated review chart) and radiographically with measurement of posterior laxity (Telos 15 kg). RESULTS In these patients with an isolated injury of the PCL (without associated injury of the peripheral ligament) DISCUSSION The short follow-up of this series (four years) does not enable an assessment of the risk or benefit of PCL ligamentoplasty for arthrosic knees.
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Affiliation(s)
- R Badet
- Clinique Saint-Vincent-de-Paul, 98, rue de la Libération, 38300 Bourgoin-Jallieu; Centre Livet, 8, rue de Margnolles, 69300 Caluire
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Cucurulo T, Fayard JM, Chambat P. [Not Available]. Rev Chir Orthop Reparatrice Appar Mot 2005; 91:66. [PMID: 16609579 DOI: 10.1016/s0035-1040(05)84534-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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