C. Radier

Long-term functional and structural outcome in patients with intact repairs 1 year after open transosseous rotator cuff repair

HYPOTHESIS Tendon-to-bone suture and a fatty degeneration index (FDI) <or= 2 are required to achieve an intact cuff in the mid-term. Our primary objective was to determine the structural and functional long-term outcomes of repaired cuffs that were intact after one year. MATERIALS AND METHODS We studied 30 cuffs with FDI <or= 2 at surgery and no tear one year after tension-free tendon-to-bone suture. Mean follow-up was 9 +/- 0.8 years. Gross tendon-stump lesions were excised prior to repair. RESULTS Re-tear after one year was rare: only one cuff showed a recurrent tear. In the 29 intact cuffs, mean un-weighted Constant score and sub-scores improved significantly (P values, < .0001- .0002; final Constant score = 77) for two years then remained stable. FDI values increased during the first year and then remained stable. Mild osteoarthritis was noted in one shoulder at last follow-up. CONCLUSION Final functional outcomes correlated significantly to FDI at baseline and last follow-up. Tension free tendon-to-bone suture is effective functionally and structurally at nine years follow-up provided the FDI at surgery is <or= 2 and the repair is intact after one year. LEVEL OF EVIDENCE Level 3; Retrospective cohort therapeutic study.

Influence of Lower-Limb Torsion on Long-Term Outcomes of Tibial Valgus Osteotomy for Medial Compartment Knee Osteoarthritis

BACKGROUND The results of tibial osteotomy used to treat osteoarthritis of the medial compartment of the knee deteriorate over time even when the initial correction is optimal. Studies have shown that tibial and femoral torsion and the femorotibial index (tibial torsion minus femoral torsion) contribute, together with coronal malalignment, to the development of single-compartment knee osteoarthritis. The objective of our study was to evaluate the impact of femoral and tibial torsion and of coronal realignment on the long-term clinical and radiographic outcomes of valgus tibial osteotomy. METHODS A function score was calculated for sixty-eight patients at a mean of thirteen years after the osteotomy. Anteroposterior single-leg-stance radiographs were used to evaluate loss of the femorotibial joint space. Goniometry was used to measure coronal malalignment preoperatively, at one year, and at the time of the last follow-up, and postoperative computed tomography was performed to measure femoral anteversion and tibial torsion and to calculate the femorotibial index. We looked for associations linking body mass index, initial loss of joint space, coronal malalignment, femoral and tibial torsion, the femorotibial index, and functional outcomes. RESULTS Worse outcomes were associated with changes in coronal alignment (>/=2 degrees ) over time, which were associated with deterioration of the femorotibial space. Femoral anteversion was significantly greater in patients in whom valgus increased over time than in those in whom valgus decreased over time. Stability of coronal alignment seemed to be dependent on a linear relationship between the femorotibial index and the degree of postoperative realignment. A body mass index of >25 kg/m(2) was associated with a long-term loss of coronal realignment. Preoperative loss of the medial femorotibial joint space, coronal alignment at one year, and age were not associated with secondary malalignment or functional outcomes. CONCLUSIONS Long-term success of a valgus tibial osteotomy is related to the stability over time of the postoperative coronal realignment. Therefore, the results of our study suggest that modifying the realignment according to the extent of femoral anteversion may improve long-term outcomes.

Acromio humeral distance less than six millimeter: Its meaning in full-thickness rotator cuff tear

UNLABELLED The present study sought to identify full-thickness rotator cuff tears liable to induce an acromiohumeral distance (AHD) of less than 6 mm. The hypothesis was that, less than 6mm AHD is found exclusively in association with total full-thickness infraspinatus tear. MATERIALS A continuous single-center series recruited 109 shoulders, free of glenohumeral osteoarthritis, presenting with full-thickness tear requiring surgery. Preoperative acromiohumeral distance, rupture location and extension on the various tendons and muscular fatty degeneration (FD) were known. METHODS Full-thickness tears were categorized by location and extension on the various tendons. For each group, the number of shoulders showing AHD<6 mm was determined. RESULTS Total full-thickness infraspinatus tears were almost the only tendon lesions able to induce AHD<6 mm, but this only when the infraspinatus muscle showed FD equal to or greater than 2.25: i.e., when the tear was longstanding. DISCUSSION Unlike previous reports, the present study took account of the total or partial nature of infraspinatus and subscapularis tendon tear. The findings may suggest that AHD<6 mm is induced by posterior migration of the humeral head secondary to longstanding total infraspinatus tear, reducing AHD projection height on X-ray. CONCLUSION AHD<6 mm is a sign of rotator-cuff rupture almost systematically involving longstanding total infraspinatus tear, not always amenable to suture repair due to advanced fatty degeneration. AHD equal to or greater than 6mm is of no diagnostic relevance and in no way indicates whether there is subscapularis tear and, if so, whether suture repair is feasible.

Total shoulder arthroplasty using the superior approach: influence on glenoid loosening and superior migration in the long-term follow-up after Neer II prosthesis installation.

Glenoid component loosening and superior humeral translation are common after Neer II total shoulder arthroplasty using the anterior approach. To determine whether the superior approach reduced these complications, we retrospectively reviewed 20 shoulders in 16 patients. Both components were cemented. Patient satisfaction, unweighted Constant score, and imaging studies were evaluated at a mean of 3.5 years and at a mean of 11.1 years. Fourteen patients were satisfied or very satisfied. The mean unweighted Constant score improved from 25/100 preoperatively to 57/100 after 3.5 years and to 51/100 after 11.1 years. Pain relief contrasted with low strength. Radiolucent lines appeared around 95% of glenoid components and 20% of humeral stems. Computed tomography showed severe glenoid osteolysis in 3 of 13 shoulders. Humeral superior translation did not occur. This study confirms the glenoid component fixation issue. The superior approach may reduce the risk of humeral superior translation and radiologic glenoid component loosening.

Reproductibilité des gonométries en position couchée après implantation d’une prothèse totale de genou. Comparaison avec la reproductibilité des gonométries des genoux non prothésés

PURPOSE OF THE STUDY Outcomes after total knee replacement are correlated with the postoperative HKA angle. Therefore, it seems crucial to determine the precision of the whole lower limb X-rays which are currently used to determine the frontal knee alignment. The aim of the study was to analyze the precision of the whole lower limb X-Rays made in supine position, after total knee replacement. MATERIAL AND METHOD A prospective study included 100 knees which were analyzed with two whole lower limb X-rays made at eight days interval. Seventy knees were non-replaced and 30 had total replacement with a posterior stabilized knee prosthesis. The X-rays were made in supine position and neutral rotation using the patella as a reference mark. One independent observer compared the HKA angle on the two consecutive X-Rays in order to evaluate the reproducibility of the X-Rays. RESULTS In the group of patients with total knee replacement, the reproducibility was poor with a low correlation coefficient (0.5) and a poor precision of 5 degrees . On the contrary, in the non-replaced knee group, the reproducibility was very good with a high correlation factor between the two X-rays (0.99, p<0.0001) and a very good precision of 1.7 degrees (p<0.05). The group of patients with an HKA angle of less than 8 degrees had a significantly better precision (1.5 degrees ) than the group of patients with an angle HKA above 8 degrees (3 degrees , p<0.04). CONCLUSION Reproducibility and precision of whole lower limb X-rays made in supine position is poor in patients with total knee replacement. Thus, we should be very careful for the analysis of the influence of the mechanical axis on the outcomes after total knee replacement.