Benoit Rousselin

Does arthroscopic rotator cuff repair actually heal? Anatomic evaluation with magnetic resonance arthrography at minimum 2 years follow-up

PURPOSE The goal of this series was to evaluate the clinical and anatomical outcomes of all-arthroscopic rotator cuff tears repair at a mid-term follow-up, using MR arthrography in order to assess tendon-to-bone healing. MATERIALS AND METHODS This retrospective study included 29 patients (31 shoulders) presenting, according to Cofield classification, a small or moderate-sized supraspinatus full thickness tear with (7/31) or without (24/31) infraspinatus extension. The mean size of the tear was 2.64 ± 1.61 cm. The Constant score was used for pre- and postoperative clinical evaluation. All tendons were repaired under arthroscopic control. A single row technique was used. Biceps tenotomy and subacromial decompression were systematically performed. All patients operated arm were immobilized in a sling for 4 weeks and full activity was allowed at 6 months. At last follow-up, a rotator cuff MR arthrography was performed by an independent radiologist to evaluate the anatomical status of repair. RESULTS The mean follow-up was 49.4 ± 17.3 months. Sixteen patients (17 shoulders) had a rotator cuff MR arthrography. Mean Constant score at last follow-up was 82.3 ± 12.4, with a mean improvement of 24%. Eighty-eight percent of repairs (15/17) showed a small or a large leakage at the MR arthrography. There was no significant correlation between the clinical and anatomical outcomes. CONCLUSION The interest of this series is to show, at a mid-term follow-up and using an invasive imaging technique, the low rate of tendon-to-bone healing in arthroscopic rotator cuff repair but with a minimal influence on clinical outcome.

Residual inferior glenohumeral instability after arthroscopic Bankart repair: Radiological evaluation and functional results

INTRODUCTION Treatment of anteroinferior shoulder instability by arthroscopy must restore stability while preserving joint motion. Inferior glenohumeral ligament (IGHL) laxity is an important parameter in the pathomechanism of this condition. The goals of this study is to use the Shoulder HyperAbduction Test (SHART) radiological test to quantify the tension in the IGHL following surgery and look for an eventual correlation between ligament tightening and joint motion. METHODS This was a single-center, retrospective study that included patients with unilateral anteroinferior instability who were treated with an arthroscopic Bankart repair between September 2004 and December 2005. These patients did not experience any recurrence within a follow-up period of at least 2 years. Twenty-three patients were followed-up. This series included 16 men and seven women with an average age of 29.7±12 years. The average Instability Severity Index Score (ISIS) was 1.7±1.3 (from 0 to 3). The main outcome measures were the bilateral SHART test at the last follow-up visit and bilateral joint range of motion, before surgery and at the last follow-up. RESULTS The follow-up was 3.3 years on average. The average SHART on the operated side (116.9±11.7°) was lower than the healthy side (121.9±9.6°), P=0.01. A difference of less than 4° was statistically related to loss of external rotation, with an odds ratio of 16, P=0.03. At the last follow-up, the average Walch-Duplay functional score was 72.4±13.8/100 and the Rowe score 90.2±11.6/100. DISCUSSION It is difficult to achieve a perfect compromise between shoulder stability and joint motion. Progress in arthroscopy technique has led to a greater demand for the tightening of capsulo-labral and ligament structures. An arthroscopic Bankart repair provides IGHL tightening that is quantifiable with the SHART. External rotation is reduced when excessive tightening is made.

Double localisation à la cheville d’un ostéome ostéoïde : traitement par forage percutané: À propos d’un cas

A 26-year-old woman presented a rare double localization of an osteoid osteoma of the ankle. The first focus was situated in the tibial metaphysic, bordering the distal tibiofibular joint. The second focus was also superficial, located in the neck of the homolateral talus. Percutaneous drilling was performed for both localizations under computed tomographic (CT) guidance. The postoperative period was uneventful and the patient has remained symptom-free at four years follow-up. Compared with disphyseal localizations, it is often more difficult to recognize an osteoid osteoma located in the foot or ankle. Scintigraphy and CT are necessary and sufficient for diagnosis. Progress in imaging techniques has greatly facilitated the treatment of osteoid osteomas, allowing excellent outcome with limited morbidity.

3 Que deviennent à long terme les coiffes réparées par arthroscopie ? Étude avec contrôle arthro-IRM avec un recul moyen de 4 ans

Introduction Aucune etude ne rapporte par des methodes d’imagerie invasive les resultats a long terme des reparations arthroscopiques de la coiffe des rotateurs. Le but de cette etude etait d’evaluer les resultats cliniques et anatomiques par arthro-IRM des reparations arthroscopiques du sus-epineux avec un recul minimal de deux ans. Materiel Etude clinique mono-operateur portant sur des patients operes par arthroscopie d’une reparation du tendon du sus-epineux avec un recul minimum de deux ans. Methode Cette serie etait retrospective concernant les donnees cliniques et radiologiques preoperatoires et prospective concernant les donnees au dernier recul. Le score de Constant a ete utilise pour evaluer le statut clinique preoperatoire. La reparation consistait en une reinsertion par des points simples sur une simple rangee d’ancres. Une tenotomie du long-biceps et une acromioplastie etaient systematiquement associees. Le resultat clinique final etait etabli en utilisant les scores de Constant. Une arthrographie et une arthro-IRM ont ete realisees pour evaluer le resultat anatomique de la reparation. Le resultat anatomique etait classe en 4 stades : 1) coiffe normale ; 2) image d’addition intra-tendineuse ; 3) fuite etroite ; 4) fuite importante de gadolinium. Resultats Le recul moyen etait de 48 mois. 31 epaules ont ete evaluees cliniquement et 17 ont ete etudiees par arthro-IRM. Le score moyen de Constant au dernier recul etait de 82,3 avec un gain significatif sur la douleur, l’activite et la mobilite sans toutefois rejoindre les scores de l’epaule controlaterale saine. 88 % des arthro-IRM ont mis en evidence une fuite etroite (35 %) ou large (53 %) de gadolinium. Il n’y avait pas de correlation entre les resultats cliniques et anatomiques. Discussion Bien que portant sur un faible effectif, cette etude montre de bons resultats cliniques en depit d’un taux significatif de ruptures transfixiantes iteratives dans la cohorte operee. Les reruptures pourraient etre expliquees par l’importance du recul au moment de la realisation de l’arthro-IRM, par la sensibilite de cette technique d’imagerie, mais egalement par des points faibles sur le plan biomecanique de la technique de reinsertion employee. Conclusion L’evaluation par arthro-IRM a long terme des coiffes reparees par arthroscopie est un fait nouveau qui semble montrer que la methode chirurgicale pratiquee dans cette etude ne procure pas des resultats anatomiques durables sans que cela ne semble etre pejoratif sur le resultat clinique.