Anthony Hervé

Diagnosis and treatment of anteroinferior capsular redundancy associated with anterior shoulder instability using an open Latarjet procedure and capsulorrhaphy

PurposeThere is a paucity of data detailing management of anterior capsular redundancy (ACR) when using the Latarjet procedure for unidirectional instability. This study aimed to describe the surgical management and to assess the clinical profile of patients presenting with anterior capsular redundancy [ACR(+)] with anterior shoulder instability.MethodsSeventy-seven patients who had a Latarjet procedure were followed for a 55-month period. Per-operative ACR was assessed during surgery. ACR was considered present if the inferior capsular flap of a Neer T-shaft capsulorrhaphy was able to cover the superior capsular flap with the arm in the neutral position. Patients with ACR(+) received an additional Neer capsulorrhaphy, while patients with ACR(−) did not. This per-operative finding was correlated with demographics, clinical, radiological pre-operative data and surgical outcome.ResultsPatients presenting with a per-operative ACR(+) were significantly associated with a sulcus sign (Pxa0<xa00.001), a Beighton scorexa0>4 (Pxa0<xa00.01), a low-energy instability history (Pxa0<xa00.05), a predominant history of subluxations (Pxa0<xa00.05), fewer Hill–Sachs lesion (Pxa0<xa00.05) and a female gender (Pxa0<xa00.05), but not significantly with external rotationxa0>85°. Open standard Latarjet procedures with Neer capsulorrhaphy in ACR(+) patients showed excellent or good results and stability rate of 95xa0%. All patients except four who presented with a new dislocation after surgery were satisfied with their outcome. Thirteen patients (16xa0%) had a persistent apprehension sign at the last follow-up. ACR(+) and ACR(−) groups did not show significant difference in the mean values of Rowe, Walch–Duplay and Constant–Murley scores.ConclusionACR correlated with a sulcus sign, Beighton score and instability history. In anterior shoulder instability associated with ACR, the Latarjet procedure with a Neer capsulorrhaphy appears a satisfactory treatment alternative to arthroscopic or open capsular shift. It decreased apprehension in comparison with Latarjet procedures without capsular repair.Level of evidenceCases series, treatment study, Level IV.

Are spinoglenoid ganglion cysts early markers of glenohumeral arthritis

HYPOTHESISnThe objective of this study was to improve our understanding of the pathogenesis and symptoms of ganglion cysts (GCs) in the spinoglenoid notch. Two hypotheses were tested: (1) the labral tears responsible for these cysts are mainly degenerative and nontraumatic, (2) spinoglenoid cysts are early magnetic resonance image (MRI) markers of eccentric posterior glenoid wear.nnnMATERIALS AND METHODSnThis was a descriptive diagnostic study. Patients were included when a spinoglenoid cyst was discovered after complaints of pain in the posterosuperior aspect of the shoulder. MRI and arthroscopy were used to classify the glenoid GC and characterize the glenohumeral joint. The GCs were classified into 1 of 3 types: GC0 (isolated cyst), GC1 (cyst and associated labral lesion), and GC2 (cyst and associated labral and cartilage lesion).nnnRESULTSnTwenty patients (average age, 43 years) were included between 2000 and 2014. There were 7 GC0, 8 GC1, and 5 GC2 type cysts. Isolated labral tears (GC1) were always located posteriorly, without anterior extension or glenoid detachment. The humeral subluxation index was above 55% in 75% of shoulders, including all of the type GC2 shoulders. The 5 GC2 shoulders had type B1, B2, or C glenoids.nnnCONCLUSIONSnThe management of paraglenoid labral cysts must go beyond addressing the suprascapular nerve compression related to traumatic labral detachment, and surgeons should look automatically for associated degenerative joint damage. The diagnosis of GCs should be supplemented by humeral subluxation index measurement on computed tomography scan or MRI, and the patient should be informed that joint-related posterior shoulder pain might persist in cases of GC1 and GC2.nnnLEVEL OF EVIDENCEnBasic Science Study; Anatomy; Imaging and In Vivo.

Clinical and structural outcome twenty years after repair of isolated supraspinatus tendon tears

BACKGROUNDnThis study evaluated the clinical and structural outcome 20 years after repair of isolated supraspinatus tendon tears. We hypothesized that the results would deteriorate over time.nnnMATERIALS AND METHODSnFor this retrospective multicenter study, 137 patients were recalled for a clinical and imaging assessment. Six patients (4.3%) had died from unrelated causes, 52 (38.0%) were lost to follow-up, and 13 (9.5%) had undergone reoperations. This left 66 patients for clinical evaluation. Radiographs and magnetic resonance imaging were additionally performed for 45 patients, allowing assessment of osteoarthritis, tendon healing, fatty infiltration (FI), and muscle atrophy.nnnRESULTSnThe Constant Score (CS) improved from 51.5u2009±u200914.1 points preoperatively to 71 points (Pu2009<u2009.05) with a mean Subjective Shoulder Value (SSV) of 77.2%u2009±u200922%. Tendon discontinuity (Sugaya IV-V) was present in 19 of 45 patients (42 %), and there was advanced FI (Goutallier III-IV) of the supraspinatus in 12 (27%) and of the infraspinatus muscle in 16 (35%). Supraspinatus atrophy was present in 12 patients (28%), advanced arthritis in 6, and cuff tear arthropathy in 12 (30%). The CS and SSV were significantly inferior for shoulders with FI of stages III to IV (Pu2009<u2009.05). The CS was lower in cuff tear arthropathy and correlated with infraspinatus FI.nnnCONCLUSIONSnAt 20 years after surgical repair of isolated supraspinatus tears, the clinical outcome remains significantly above the preoperative state. FI of the infraspinatus is the most influential factor on long-term clinical outcome.

Les capsulites sont-elles plus fréquentes en cas d’évacuation de calcifications ?

Introduction L’evacuation arthroscopique d’une calcification (CA) tendineuse peut etre proposee apres echec du traitement medical. Le symposium de la SFA 2007xa0retrouvait un taux de capsulite retractile (CR) postoperatoire de 12xa0%. L’objectif etait de determiner si l’exerese arthroscopique d’une calcification a elle seule etait un facteur de risque de CR. Notre hypothese etait que l’exerese de la calcification entrainait un taux eleve de CR. Materiels et methodes Etude retrospective, monocentrique menee sur des patients operes entre juin 2013xa0et janvier 2017 (mono-operateur) presentant des douleurs d’epaules resistantes au traitement medical avec infiltration acromio-claviculaire, plus ou moins associe a la presence d’une CA de type A ou B (les type C ont ete exclus). Les patients ont ete repartis en deux groupes, le seul critere therapeutique differenciant les groupes etai la realisation d’une exerese de calcification intra-tendineuse ou non. Deux cent soixante-huit patients ont ete inclus. Aucun patient n’a ete perdu de vu. L’âge moyen a l’intervention etait de 52 ans. Tous les patients ont ete revus a 6xa0semaines, 3xa0mois et a 6xa0mois. Il etait note si le patient presentait lors du suivi une CR. Resultat Les deux groupes sont comparables sur l’âge et le sexe. La prevalence de CR etait de 16,9xa0%. On retrouvait significativement (pxa0=xa00,0001) plus de patients 28,4xa0% (nxa0=xa029) souffrant d’une CR dans le groupe CA++ contre 9,7xa0% (nxa0=xa016) dans le groupe CA++. Le risque de faire une CR lors d’une acromioplastie associee a une resection de externe de clavicule etait 3,7xa0fois plus important s’il est accompagne d’une exerese de calcification intra-tendineuse. Au terme du suivi, tous les patients ont recupere une epaule indolente et mobile apres 1xa0a 2xa0injections intra-articulaire et sous-acromiale. Discussion et conclusion A geste egal, l’exerese d’une CA multiplie par 3,7xa0le risque de presenter une CR dans les suites operatoires. La CR postoperatoire pourrait etre favorisee par des debris calciques macro ou microscopique et entrainer une reaction biochimique agressive. Notre hypothese est confirmee et modifie nos pratiques en termes d’information aux patients. En cas d’exerese, arthroscopique de calcification associee a une acromioplastie et resection laterale de clavicule, nous prevenons le patient d’un risque eleve de CR. La prevalence de CR dans notre population etait de 16,9xa0% et significativement (pxa0=xa00,0001) plus importante dans le groupe CA++ (28,4xa0%).

Prévalence de l’omarthrose dans une population de rupture de la coiffe des rotateurs opérée avec 20 ans de recul

Introduction La prevalence de l’omarthrose, apres rupture de la coiffe des rotateurs (CDR) operee a long terme, n’est pas connue. Le but de notre etude etait d’etudier la prevalence de l’omarthrose a 20xa0ans de recul apres rupture de la CDR operee a ciel ouvert, d’evaluer son retentissement clinique et d’identifier les liens avec la cicatrisation tendineuse et la degenerescence graisseuse (DG). Materiel et methodes Etude multicentrique retrospective incluant tous les patients operes a 20xa0ans de recul d’une CDR. Le groupe 1 (nxa0=xa057) regroupaient les patients sans arthroses (Hamada 1, 2xa0et 3, les tetes humerales centrees et Samilson 1xa0et 2). Le groupe 2 (nxa0=xa023) regroupaient les patients omarthrosiques (Samilson 3xa0ou Hamada 4A, 4B et 5). Les resultats clinique et radiologique ont ete analyses entre les deux groupes. Resultats Quatre-vingt patients ont ete revus avec un recul moyen de 250xa0mois (232–270xa0mois). La prevalence de l’omarthrose etait de 28,75xa0%. Le score de Constant brut moyen etait significativement inferieur dans le groupe omarthrose (60,9xa0points) que dans le groupe sans arthrose (70,6xa0points). Seule la force etait significativement moins elevee dans le groupe omarthrose. Le SSV moyen etait de 73,5xa0% sans difference significative entre les deux groupes. Il y avait significativement plus de lesion isolee du tendon du supra-epineux (SSN) dans le groupe sans arthrose (56,1xa0%). Il y avait significativement plus de rupture de coiffe massive a 3xa0tendons dans le groupe avec omarthrose (26,1xa0%). Les patients dont le tendon SSN etait cicatrise avaient significativement moins d’omarthrose (92,5xa0%) que si le tendon n’etait pas cicatrise. La non-cicatrisation tendineuse du SSN etait significativement associee a une forte DG du muscle infra-epineux (ISN). Conclusion A 20xa0ans de recul, plus d’un patient sur quatre operes de la CDR presentait une omarthrose. Les patients arthrosiques avaient significativement un score de Constant inferieur aux patients non arthrosiques. La cicatrisation du SSN etait significativement associee a une absence d’arthrose et a une faible DG de l’ISN.

A new approach for endoscopic neurolysis of the suprascapular nerve at the spinoglenoid notch: A preliminary cadaver study

The suprascapular nerve (SSN) can become compressed at its 2 scapular attachments: the suprascapular and the spinoglenoid notch. The objective of this study was to describe a new arthroscopic approach for SSN neurolysis at the spinoglenoid notch. Ten cadaver shoulders were used. Two were dissected to simulate the classical arthroscopic approach and to help in the creation of a new direct medial retrospinal approach. Eight other shoulders were used to validate this new approach, with control of the whole juxta-glenoid course of the SSN as criterion of success. The retrospinal posterior approach allowed the entire juxta-glenoid segment of the SSN to be explored in 6 cases out of 8. One exploration was incomplete, another not feasible. SSN neurolysis at the spinoglenoid notch was feasible in cadavers on a retrospinal approach.

Are ligament-tensioning devices interchangeable? A study of femoral rotation

BACKGROUNDnDuring total knee arthroplasty (TKA), femoral rotation can be adjusted either in relation to bony landmarks or by tensioning the ligaments with the knee in 90° of flexion. The primary objective of this study was to compare femoral rotations achieved using various ligament-tensioning devices. The secondary objective was to compare these femoral rotations to that indicated by the transepicondylar axis (TEA).nnnMATERIAL AND METHODSnWe performed 13 posterior-stabilised TKA procedures using HiFit (Ceraver(®)) on cadaver knees. Before performing the posterior condyle cut, we used an original method to measure the femoral rotation induced by five different ligament-tensioning devices (2 with a ratchet mechanism, 1 with screws, 1 force-sensing device, and 1 with spacer blocks) and the central tibio-femoral distance (CTFD).nnnRESULTSnBoth ratchet tensioners provided significantly greater mean external rotation values (P=0.002), of 4.94° and 4.46°, respectively, compared to the force-sensing and spacer tensioners. Significant differences were found across devices for CTFD, with a mean difference of about 2mm between the ratchet and screw tensioners versus the force-sensing and spacer tensioners. The mean differences in rotations obtained using the tensioners versus the TEA were close to 0° but with standard deviations greater than 4°.nnnCONCLUSIONnFemoral rotation was dependent on the distraction force applied to the joint. Tensioners that did not measure the distraction force were associated with greater distraction force and external rotation values. The TEA criterion did not reliably indicate good ligament balance.nnnLEVEL OF EVIDENCEnExperimental study.

Coracoid-like osteochondroma and painful giant thoracic bursitis.

Joint Bone Spine - In Press.Proof corrected by the author Available online since mercredi 9 decembre 2015

Giant synovial chondromatosis of the metacarpophalangeal joint

Joint Bone Spine - In Press.Proof corrected by the author Available online since lundi 14 decembre 2015