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Cornebarrieu, France

Sonnery-Cottet B.,Center orthopedique Paul Santy | Panisset J.-C.,Clinique des Cedres | Colombet P.,Clinique du sport | Cucurulo T.,Clinique Juge | And 7 more authors.
Orthopaedics and Traumatology: Surgery and Research

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 26months (12-59months). 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 5.5. mm (range: 0-14. mm) and 1.1. mm (range: 0-4. mm) 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. Type of study: Retrospective study, level of evidence IV. © 2012. Source

Sonnery-Cottet B.,Center Orthopedique Santy | Bazille C.,Caen University Hospital Center | Hulet C.,Caen University Hospital Center | Colombet P.,Clinique du sport | And 8 more authors.

Background: The aim of this study was to investigate the histological features of the remaining fibers bridging the femur and tibia in partial ACL tears. Methods: Twenty-six ACL remnants were harvested from patients who had arthroscopic criteria concordant with a partial tear. Histological analysis includes cellularity, blood vessel density evaluation and characterization of the femoral bony insertion morphology. Immunohistochemical studies were carried out to determine cells positive for α-smooth actin and for mechanoreceptor detection. Results: In these samples, a normal femoral insertion of the remnant was present in 22.7% of the cases. In 54% of the samples, substantial areas of hypercellularity were observed. Myofibroblasts were the predominant cell type and numerous cells positive for α-smooth actin were detected at immunostaining. Blood vessel density was increased in hypercellularity areas and in the synovial sheet. Free nerve endings and few Golgi or Ruffini corpuscles were detected in 41% of the specimens. The cellularity was correlated to the time between injury to surgery (p= 0.001). Conclusion: Competent histological structures including a well-vascularized synovial sheet, numerous fibroblasts and myofibroblasts and mechanoreceptors were found in ACL remnants. These histological findings bring additional knowledge towards the preservation of the ACL remnant in partial tears when ACL reconstruction or augmentation is considered. © 2014 Elsevier B.V. Source

Caton J.H.,Clinique Emilie de Vialar | Prudhon J.L.,Clinique des Cedres | Ferreira A.,Clinique Du Parc | Aslanian T.,Groupe Lepine | Verdier R.,Groupe Lepine
International Orthopaedics

Purpose: Mid- and long-term follow-up of Charnley total hip arthroplasty (THA) demonstrated good functional results with 85% survivorship at 25-year follow-up. However, dislocation still remains an unsolved problem. Dislocation may occur throughout the patient's and implant's life. The aim of this study is to answer the question: does a dual mobility cup (DMC) decrease the dislocation risk? Methods: We report comparative results at ten years of follow-up of two groups of primary cemented Charnley-type THA, one with a standard polyethylene cup (group 1, n =215) and the other one with a DMC (group 2, n =105). Results: In group 1, 26 dislocations (12.9%) occurred. In group 2 only one dislocation (0.9%) occurred. This dislocation was successfully reduced by closed reduction, without any recurrence. This difference was statistically significant (p =0.0018). In group 1, the reason for revision was recurrent dislocation in 21 cases. Five patients were revised for other reasons. The global revision rate was 12.9%. In group 2, two patients needed revision surgery for aseptic loosening. The global revision rate was 2.1%. This difference was statistically significant (p =0.054). The goal was reached for the patients of group 2 who had more risks factors for dislocation (age, aetiology, American Society of Anesthesiologists and Devane scores) than those of group 1. Conclusions: When using a DMC, we observed a low rate of dislocation in primary THA (0.9%). This surgical choice seems to be a safe and effective technique in Charnley-type THA, especially in a high-risk population. © Springer-Verlag 2014. Source

Prudhon J.-L.,Clinique des Cedres | Ferreira A.,Clinique Du Parc | Verdier R.,Groupe Lepine
International Orthopaedics

Purpose: The dual mobility cup introduced in France by Gilles Bousquet has been used in total hip replacement in high-risk patients. This device acts as a large ball implant and significantly reduces the risk of dislocation following hip arthroplasty. Published French literature has focused on low rates of dislocation and long-term follow-up similar to the low-friction arthroplasty. Methods: We retrospectively reviewed a continuous series of 105 cases of dual mobility cup Quattro (Groupe Lépine, Genay, France) implanted from 2000 to 2002. Selection of the patients requiring a primary hip replacement depended on risk criteria such as age, hip disease and activity score. The dual mobility cup was associated with a modular cemented femoral component and a 22.2-mm stainless steel head. Results: One dislocation occurred one month after the index surgery requiring no revision surgery. According to the Kaplan-Meier method, survival probability was 95.0 % (95 % confidence interval 81.5-98.8) at ten years of follow-up. Conclusions: Based on clinical outcome and patient assessment we conclude that the dual mobility cup is a reliable option to decrease dislocation risk without increasing polyethylene wear. © 2013 Springer-Verlag Berlin Heidelberg. Source

Collette M.,rue Jean Benaets | Cassard X.,Clinique des Cedres
Orthopaedics and Traumatology: Surgery and Research

The Tape Locking Screw (TLS ®) system, developed in 2003, is a new anterior cruciate ligament (ACL) reconstruction method that is based on three principles: one hamstring tendon is harvested, prepared into a short (50 to 60mm), four to five strand closed loop, with a diameter of 8 to 10mm and a 500N pre-load; the tunnels are shorter than usual (10 or 15mm) and created in a retrograde manner to match the diameter of each end of the graft. Maximum press-fit into the bone recesses is obtained by a specific graft introduction method; femoral and tibial fixation is provided by polyethylene terephthalate tape strips, or TLS ® strips, that pass through each end of the closed tendon loop and attach to bone with a dedicated interference screw, the TLS ® screw.Our preliminary clinical evaluation consisted of a follow-up of 134 patients. © 2011 Elsevier Masson SAS. Source

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