Philippe Massin

Long-Term Follow-Up of 24.5 Years After Intra-Articular Anterior Cruciate Ligament Reconstruction With Lateral Extra-Articular Augmentation

Background: Many studies have reported successful outcomes 10 to 15 years after ACL reconstruction. However, few authors report results at ultra long-term follow-up (more than 20 years of follow-up). Purpose: The aim of this study was to determine how the status of the medial meniscus and the medial compartment articular cartilage observed at the time of ACL reconstruction affects results more than 24 years after surgery. This article examines long-term outcome of ACL reconstruction with extra-articular augmentation (procedure performed through a medial arthrotomy). Study Design: Case series; Level of evidence, 4. Methods: One hundred of 148 patients reviewed at 11.5 years of follow-up could be reviewed at 24.5 years. Complete clinical and radiographic evaluation (International Knee Documentation Committee scale and Knee Injury and Osteoarthritis Outcome Score) was performed. Results: The radiographic International Knee Documentation Committee rating was as follows: grade A, 39%; grade B, 7%; grade C, 27%; and grade D, 27%. Onset of osteoarthritis was correlated with medial meniscal status and femoral chondral defects at time of surgery. Conclusion: Total medial meniscectomy and articular cartilage damage were risk factors for osteoarthritis.

Water absorption of poly(methyl methacrylate) measured by vertical interference microscopy.

PMMA (poly(methyl methacrylate)) is widely used to prepare orthopedic cements. They are in direct contact with cells and body fluids. PMMA, despite its hydrophobic nature, can absorb ~2% w/w water. We have evaluated by vertical interference microscopy if water absorption can produce a significant swelling in different types of PMMA blocks: pure, with a plasticizer, with a cross-linker, and in two types of commercial bone cements. Graphite rods which do not swell in water were used as internal standard. Hardness, indentation modulus, plastic, and elastic works were determined by nanoindentation under a 25mN fixed force. Vertical interference microscopy was used to image the polymer in the dry state and hydrated states (after 24 h in distilled water). On the surface of the polished polymers (before and after hydration), we measured roughness by the fractal dimension, the swelling in the vertical and the lateral directions. For each polymer block, four images were obtained and values were averaged. Comparison and standardization of the images in the dry and hydrated states were done with Matlab software. The average value measured on the graphite rod between the two images (dried and hydrated) was used for standardization of the images which were visualized in 3D. After grinding, a small retraction was noticeable between the surface of the rod and the polymers. A retraction ring was also visible around the graphite rod. After hydration, only the pure PMMA and bone cements had a significant swelling in the vertical direction. The presence of polymer beads in the cements limited the swelling in the lateral direction. Swelling parameters correlated with the nanoindentation data. PMMA can swell by absorbing a small amount of water and this induces a swelling that varies with the polymer composition and particle inclusions.

Migration of wear debris of polyethylene depends on bone microarchitecture

The mechanism of hip arthroplasties loosening is related to the migration of wear debris throughout the implant environment. In vivo, polyethylene particles (PE) were shown to infiltrate the bone implant interface and the medullary spaces of the cancellous bone. Our test hypothesis was that polyethylene particle migration is correlated to bone porosity. Bone samples with a high or low trabecular volume and microarchitecture were harvested in 20 calves and 20 human cadavers. They were extensively washed to remove marrow cells. Bone cylinders were filled with a light-curing monomer having the same viscosity as bone marrow. PE particles (7 and 33 microm) were deposited at the surface of the polymer. The bone cylinders were agitated during 7 days on an orbital shaker and the gel was left to polymerize at day light. X-ray microtomography was performed to characterize bone volume and microarchitecture. Cylinders were sectioned and observed under polarized light. The migration distance and rate were determined. Migration of PE particles strongly depended on trabecular bone volume and microarchitecture. We found a linear relationship (r = 0.61) between speed migration and bone volume and an exponential relationship between speed migration and bone architecture. The present in vitro model confirmed our hypothesis about the key role of bone microarchitecture in the migration of large PE wear particles. This is an explanation for the development of inflammatory reaction at distance from a prosthesis although our study did not include submicron particles.

Navigated revision knee arthroplasty using a system designed for primary surgery.

While navigation is now recognized as an efficient tool for improving femoro-tibial alignment of primary knee prostheses, its use in revision surgery has not yet been fully evaluated. We describe a procedure based on a bone morphing acquisition performed on the surface of the original implants, followed by a dependant bone cut sequence (tibia first). Using the current system, a preoperative CT-scan measurement of the original femoral component was required. Knee balancing was achieved using spacer blocks, with the trial tibial component and the original femoral component still in place. Preliminary experience from 19 cases, some with severe bone loss requiring reconstruction, is reported. A retrospective comparison to 10 non-navigated revision cases performed concomitantly by the same operating surgeon was carried out. Although there was no significant difference in the number of outliers for the two series, navigation appeared to be a valuable aid in reconstructing both bone extremities, while controlling the level of the joint line. However, definitive validation requires further prospective and comparative investigations in larger series.

Visual Impairment and Hip Fractures: A Case-Control Study in Elderly Patients

Aims: To investigate the relationship between visual impairment and fall-related hip fracture and to determine the etiology of visual impairment in a population of elderly patients with hip fracture. Methods: A case-control study compared 96 patients diagnosed with hip fracture to a randomly selected control group of 103 patients without hip fracture. Inclusion criteria for the case group were as follows: patients aged 60 years and over with a hip fracture. Clinical assessment included visual acuity and ophthalmic examination. Results: Forty-three patients with hip fracture had a visual impairment compared to only 12 patients in the control group. Visual impairment was a significant risk factor for hip fracture (OR = 6.15; 95% CI 2.98-12.69). Twenty-seven hip fracture patients had an uncorrected refractive error compared to only 15 controls (OR = 2.78; 95% CI 0.92-8.35). There was no significant difference of dense cataract between both groups (OR = 2.28; 95% CI 0.75-6.93). Fourteen hip fracture patients had a macular degeneration compared to only 8 controls (OR = 5.63; 95% CI 1.57-20.18), and 10 patients had suspicion of glaucoma compared to only 5 controls (OR = 10.65; 95% CI 2.21-51.3). Conclusion: Visual impairment was significantly associated with an increased risk of hip fracture in elderly people. There are many etiologies that may contribute to hip fractures, most notably refractive error, cataract, macular degeneration and glaucoma.

Extraspinal sciatica revealing late metastatic disease from parotid carcinoma.

Sciatica is a clinical symptom usually caused by a disk herniation and less often by other conditions such as tumors, infections, or inflammatory diseases. We report the case of a woman in whom sciatica led to the identification of a large pelvic metastasis from a carcinoma of the parotid gland.

Contents Vol. 52, 2014

175 SIRCOVA-OFTARED-RIG Joined Congress Abstracts Valencia (Spain), November 7–8, 2014 (online only) 239 Acknowledgement to Referees

130 Traitement des lésions ostéochondrales latérales du talus par abord transmalléolaire

Introduction Les lesions osteochondrales du talus sont rares ? mais peuvent entrainer des sequelles, car elles touchent des sujets jeunes et passent frequemment inapercues. Ce travail s’interesse aux fractures fraiches, siegeant au niveau de la joue laterale du talus, dont l’abord chirurgical est limite par la malleole laterale, d’ou l’interet d’un abord transmalleolaire lateral pour traiter ces lesions. Materiel et Methode Il s’agit d’une etude retrospective de six fractures osteochondrales du talus survenues entre 1994 et 2006 chez cinq patients. Dans trois cas, il existait une fracture de la malleole laterale associee, qui a permis d’acceder aux lesions osteochondrales, et dans trois cas une osteotomie originale de la malleole laterale a ete realisee. Cette osteotomie metaphysaire comportait un trait oblique vers le bas et l’avant et un deuxieme trait oblique vers le bas et l’arriere emportant l’insertion du ligament tibiofibulaire anterieur. La synthese des lesions osteochondrales etaient obtenue par des broches resorbables ou de la colle biologique. Resultats Un patient presentait un tres bon resultat subjectif, trois patients un bon resultat et un patient un resultat moyen, le recul moyen etant de 20 mois. Les mobilites articulaires etaient bonnes chez tous les patients, il existait une arhrose radiologique chez un patient sur les six. Discussion Les lesions osteochondrales laterales du talus sont peu decrites dans la litterature alors que pour les lesions mediales ou centrales le traitement est plus codifie avec realisation d’osteotomies mediale ou anterieure du tibia. Quelques auteurs ont decrits des osteotomies de la malleole laterale, mais qui necessitaient toutes une section du ligament tibiofibulaire anterieur et de la membrane interosseuse, c’est pourquoi nous proposons cette osteotomie, car elle respecte les parties molles. L’osteotomie est realisee en zone metaphysaire, ce qui favorise la consolidation par rapport a une osteotomie diaphysaire. L’interet d’une telle technique peut se discuter avec le developpement de l’arthroscopie de cheville, mais celle-ci permet generalement uniquement l’excision des fragments osteochondraux, un abord a ciel ouvert etant necessaire pour realiser une synthese. L’osteotomie de malleole laterale pourra aussi etre utilisee a l’avenir pour le traitement des lesions chroniques laterales du talus permettant la realisation de mosaicplasty a ce niveau. Conclusion L’abord transmalleolaire lateral permet de syntheser de maniere anatomique des lesions osteochondrales du talus, qui ne sont pas accessibles par d’autre voie d’abord ou par arthroscopie, mais cet abord doit etre realise de maniere rigoureuse et atraumatique pour ne pas s’exposer a la survenue de complication.