O. Gosselin

Influence de l'exploration gléno-humérale associée sur les suites du traitement endoscopique des calcifications de la coiffe des rotateurs

PURPOSE OF THE STUDY Arthroscopic treatment of calcifying tendonitis usually includes a glenohumeral exploration first, followed by deposit removal via a bursal approach. The aim of this study was to analyze the relevance of a systematic glenohumeral exploration during arthroscopic treatment of calcified tendonitis of the rotator cuff. MATERIAL AND METHODS Sixty-four consecutive patients treated by arthroscopic removal of calcific deposits in the rotator cuff were studied retrospectively. All patients had had at least six months of medical treatment. The treatment involved a glenohumeral approach in 32 patients (group GH) and an isolated bursal approach in 32 (group B). Both groups were similar with regard to epidemiological data and deposit aspect. In all cases, the deposit was removed from the bursal side and the cuff was not sutured. Assessment included duration of pain after surgery, Constant score, and x-ray aspect at six months follow-up and the delay for return to work. RESULTS In the GH group, degenerative changes were noted on the labrum in three cases and a partial tear of the supraspinatus in two. No lesions noted in the glenohumeral joint required specific treatment. Postoperatively, the average duration of pain was significantly higher in group GH than in group B (11 weeks versus 6 weeks, p < 0.05) with a significant latency in return-to-work (12 weeks versus 5 weeks, p < 0.05). At six months follow-up, there was no difference between the groups for Constant score and deposit disappearance. DISCUSSION Systematic exploration of the glenohumeral joint is not relevant in the arthroscopic treatment of calcified tendonitis and has a negative effect. Considering these results and those previously published in the literature, we recommend using an isolated bursal approach for arthroscopic calcifying tendonitis removal.

Traitement de l’instabilité postérieure de l’épaule par butée iliaque ou acromiale: À propos d’une série de 18 cas

Resume Dix-huit patients (8 femmes et 10 hommes), d’un âge moyen de 27 ans, presentant une instabilite posterieure de l’epaule operee par butee osseuse ont ete revus. Il s’agissait d’une luxation recidivante posterieure dans 1 cas, d’une subluxation posterieure involontaire recidivante dans 12 cas et d’une epaule douloureuse pure dans 5 cas. Neuf patients ont ete operes par butee iliaque (groupe BI) et 9 par butee acromiale pediculee selon la technique de Kouvalchouk (BA). Au recul moyen de 13 ans (groupe BI) et de 3,5 ans (groupe BA), aucun patient n’a presente de recidive d’instabilite posterieure. Le score de Duplay moyen etait de 70 points dans le groupe BI et de 86 points dans le groupe BA. Sur treize patients sportifs, neuf ont pu reprendre une activite sportive, dans un delai de 13 mois dans le groupe BI et de 7 mois dans le groupe BA. A la revision, il existait une limitation de la rotation interne de l’epaule dans 6 cas et 6 patients gardaient une apprehension en flexion rotation interne. Un patient presentait une arthrose de stade 4 liee a une vis intra-articulaire. Un patient presentait une arthrose de stade 3 preexistante a l’intervention, et deux patients presentaient une arthrose de stade 1. La butee posterieure par greffon iliaque est une intervention efficace et peu generatrice d’arthrose a long terme. L’utilisation d’une butee acromiale permet une recuperation plus rapide et les resultats a court terme sont encourageants. Une capsuloplastie complementaire est recommandee dans les formes d’instabilite posterieure avec hyperlaxite inferieure associee.PURPOSE OF THE STUDY The posterior bone block procedure is a popular option for the treatment of involuntary posterior instability of the shoulder. The purpose of this study was to analyze the long-term results of this procedure using an iliac bone graft and to point out the advantages of Kouvalchouk technique using an acromial pediculated block. MATERIAL AND METHODS Eighteen patients, ten men and eight women, mean age 27 years, were reviewed: thirteen were active in sports activities including four at the competition level. The duration of symptoms before surgery was four years on the average. One patient experienced recurrent dislocation, twelve suffered regular involuntary subluxation, and five had painful shoulders possibly related to posterior instability considering the arthroscopic findings. For nine patients (group 1), an iliac block was combined with the soft-tissue procedure. In nine others (group 2), the procedure described by Kouvalchouk was used to create a posterolateral acromial bone block with pediculated deltoid fibers. Functional outcome was assessed with the 100-point Duplay score. The position of the bone block and osteoarthritis were assessed on plain x-rays. RESULTS Mean follow-up was 13.5 years in group 1 and 3.5 years in group 2. Four patients needed a revision procedure to remove a screw. At last follow-up, the average Duplay score was 78 points. Nine patients returned to their former sports activities. Seven patients were pain free and ten had moderate discomfort at effort. We did not observe any recurrent dislocation no subluxation but did have six patients who described apprehension. The mean Duplay score was 70 points in group 1 and 86 points in group 2. In two patients in group 1, the x-rays showed signs of grade 3 or 4 osteoarthritis, which was related to an intra-articular screw in one; the other patient had had the same degenerative signs before surgery. Two patients developed grade 1 osteoarthritis. DISCUSSION AND CONCLUSION The bone block procedure is effective for posterior instability of the shoulder. Occurrence of osteoarthritis, compared with the anterior bone block, is lower after long-term follow-up. The results of the Kouvalchouk procedure with an acromial pediculated bone block look promising. We recommend an additional capsuloplasty when inferior hyperlaxity is associated with posterior instability.

Traitement de l’instabilité postérieure de l’épaule par butée iliaque ou acromiale

Resume Dix-huit patients (8 femmes et 10 hommes), d’un âge moyen de 27 ans, presentant une instabilite posterieure de l’epaule operee par butee osseuse ont ete revus. Il s’agissait d’une luxation recidivante posterieure dans 1 cas, d’une subluxation posterieure involontaire recidivante dans 12 cas et d’une epaule douloureuse pure dans 5 cas. Neuf patients ont ete operes par butee iliaque (groupe BI) et 9 par butee acromiale pediculee selon la technique de Kouvalchouk (BA). Au recul moyen de 13 ans (groupe BI) et de 3,5 ans (groupe BA), aucun patient n’a presente de recidive d’instabilite posterieure. Le score de Duplay moyen etait de 70 points dans le groupe BI et de 86 points dans le groupe BA. Sur treize patients sportifs, neuf ont pu reprendre une activite sportive, dans un delai de 13 mois dans le groupe BI et de 7 mois dans le groupe BA. A la revision, il existait une limitation de la rotation interne de l’epaule dans 6 cas et 6 patients gardaient une apprehension en flexion rotation interne. Un patient presentait une arthrose de stade 4 liee a une vis intra-articulaire. Un patient presentait une arthrose de stade 3 preexistante a l’intervention, et deux patients presentaient une arthrose de stade 1. La butee posterieure par greffon iliaque est une intervention efficace et peu generatrice d’arthrose a long terme. L’utilisation d’une butee acromiale permet une recuperation plus rapide et les resultats a court terme sont encourageants. Une capsuloplastie complementaire est recommandee dans les formes d’instabilite posterieure avec hyperlaxite inferieure associee.PURPOSE OF THE STUDY The posterior bone block procedure is a popular option for the treatment of involuntary posterior instability of the shoulder. The purpose of this study was to analyze the long-term results of this procedure using an iliac bone graft and to point out the advantages of Kouvalchouk technique using an acromial pediculated block. MATERIAL AND METHODS Eighteen patients, ten men and eight women, mean age 27 years, were reviewed: thirteen were active in sports activities including four at the competition level. The duration of symptoms before surgery was four years on the average. One patient experienced recurrent dislocation, twelve suffered regular involuntary subluxation, and five had painful shoulders possibly related to posterior instability considering the arthroscopic findings. For nine patients (group 1), an iliac block was combined with the soft-tissue procedure. In nine others (group 2), the procedure described by Kouvalchouk was used to create a posterolateral acromial bone block with pediculated deltoid fibers. Functional outcome was assessed with the 100-point Duplay score. The position of the bone block and osteoarthritis were assessed on plain x-rays. RESULTS Mean follow-up was 13.5 years in group 1 and 3.5 years in group 2. Four patients needed a revision procedure to remove a screw. At last follow-up, the average Duplay score was 78 points. Nine patients returned to their former sports activities. Seven patients were pain free and ten had moderate discomfort at effort. We did not observe any recurrent dislocation no subluxation but did have six patients who described apprehension. The mean Duplay score was 70 points in group 1 and 86 points in group 2. In two patients in group 1, the x-rays showed signs of grade 3 or 4 osteoarthritis, which was related to an intra-articular screw in one; the other patient had had the same degenerative signs before surgery. Two patients developed grade 1 osteoarthritis. DISCUSSION AND CONCLUSION The bone block procedure is effective for posterior instability of the shoulder. Occurrence of osteoarthritis, compared with the anterior bone block, is lower after long-term follow-up. The results of the Kouvalchouk procedure with an acromial pediculated bone block look promising. We recommend an additional capsuloplasty when inferior hyperlaxity is associated with posterior instability.

Fémoroplastie adaptive pour prothèse totale de hanche dans les déviations proximales majeures du fémur

Resume Les auteurs decrivent, en s’appuyant sur un cas clinique documente, une nouvelle approche chirurgicale simplifiant la mise en place d’une prothese totale de hanche dans les grandes deviations femorales proximales. Cette technique repose sur un abord par femorotomie et osteotomie court-circuitant les deviations, sur l’utilisation d’une tige femorale modulaire non cimentee a ancrage diaphysaire, et sur la reconstruction femorale proximale autour de la prothese.Using a illustrative case, we describe a new surgical approach simplifying implantation of a total hip prosthesis for major proximal femur deformity. The technique uses femorotomy and osteotomy to short circuit the deformation with a non-cemented modular femoral stem with shaft anchorage allowing reconstruction of the proximal femur around the prosthesis, i.e. adaptative femoroplasty.

MémoireTraitement de l’instabilité postérieure de l’épaule par butée iliaque ou acromiale: À propos d’une série de 18 casSurgical treatment of posterior instability of the shoulder joint using an iliac bone block or an acromial pediculated bone block: outcome in eighteen patients

Resume Dix-huit patients (8 femmes et 10 hommes), d’un âge moyen de 27 ans, presentant une instabilite posterieure de l’epaule operee par butee osseuse ont ete revus. Il s’agissait d’une luxation recidivante posterieure dans 1 cas, d’une subluxation posterieure involontaire recidivante dans 12 cas et d’une epaule douloureuse pure dans 5 cas. Neuf patients ont ete operes par butee iliaque (groupe BI) et 9 par butee acromiale pediculee selon la technique de Kouvalchouk (BA). Au recul moyen de 13 ans (groupe BI) et de 3,5 ans (groupe BA), aucun patient n’a presente de recidive d’instabilite posterieure. Le score de Duplay moyen etait de 70 points dans le groupe BI et de 86 points dans le groupe BA. Sur treize patients sportifs, neuf ont pu reprendre une activite sportive, dans un delai de 13 mois dans le groupe BI et de 7 mois dans le groupe BA. A la revision, il existait une limitation de la rotation interne de l’epaule dans 6 cas et 6 patients gardaient une apprehension en flexion rotation interne. Un patient presentait une arthrose de stade 4 liee a une vis intra-articulaire. Un patient presentait une arthrose de stade 3 preexistante a l’intervention, et deux patients presentaient une arthrose de stade 1. La butee posterieure par greffon iliaque est une intervention efficace et peu generatrice d’arthrose a long terme. L’utilisation d’une butee acromiale permet une recuperation plus rapide et les resultats a court terme sont encourageants. Une capsuloplastie complementaire est recommandee dans les formes d’instabilite posterieure avec hyperlaxite inferieure associee.PURPOSE OF THE STUDY The posterior bone block procedure is a popular option for the treatment of involuntary posterior instability of the shoulder. The purpose of this study was to analyze the long-term results of this procedure using an iliac bone graft and to point out the advantages of Kouvalchouk technique using an acromial pediculated block. MATERIAL AND METHODS Eighteen patients, ten men and eight women, mean age 27 years, were reviewed: thirteen were active in sports activities including four at the competition level. The duration of symptoms before surgery was four years on the average. One patient experienced recurrent dislocation, twelve suffered regular involuntary subluxation, and five had painful shoulders possibly related to posterior instability considering the arthroscopic findings. For nine patients (group 1), an iliac block was combined with the soft-tissue procedure. In nine others (group 2), the procedure described by Kouvalchouk was used to create a posterolateral acromial bone block with pediculated deltoid fibers. Functional outcome was assessed with the 100-point Duplay score. The position of the bone block and osteoarthritis were assessed on plain x-rays. RESULTS Mean follow-up was 13.5 years in group 1 and 3.5 years in group 2. Four patients needed a revision procedure to remove a screw. At last follow-up, the average Duplay score was 78 points. Nine patients returned to their former sports activities. Seven patients were pain free and ten had moderate discomfort at effort. We did not observe any recurrent dislocation no subluxation but did have six patients who described apprehension. The mean Duplay score was 70 points in group 1 and 86 points in group 2. In two patients in group 1, the x-rays showed signs of grade 3 or 4 osteoarthritis, which was related to an intra-articular screw in one; the other patient had had the same degenerative signs before surgery. Two patients developed grade 1 osteoarthritis. DISCUSSION AND CONCLUSION The bone block procedure is effective for posterior instability of the shoulder. Occurrence of osteoarthritis, compared with the anterior bone block, is lower after long-term follow-up. The results of the Kouvalchouk procedure with an acromial pediculated bone block look promising. We recommend an additional capsuloplasty when inferior hyperlaxity is associated with posterior instability.