Revue de Chirurgie Orthopédique et Traumatologique, 2017
Resume Introduction Les plasties anterolaterales (PAL) sont utilisees pour diminuer le risque de ... more Resume Introduction Les plasties anterolaterales (PAL) sont utilisees pour diminuer le risque de rupture iterative apres reconstruction du ligament croise anterieur (LCA) chez les patients a risque. Ces plasties ajoutent un geste a la greffe isolee du LCA qui peut augmenter le temps operatoire et perturber les suites operatoires. L’objectif de cette etude etait d’evaluer le taux de complications precoces. L’hypothese etait que les plasties anterolaterales associees a une plastie du LCA n’augmentent pas le taux de complications par rapport aux plasties isolees. Materiel et methodes Il s’agit d’une etude multicentrique, prospective portant sur 392 patients dont 70 % d’hommes, âges en moyenne de 29,9 ans, operes d’une plastie du LCA avec PAL associee. L’ensemble des evenements indesirables ont ete releves. Resultats La duree moyenne d’hospitalisation a ete de 2 jours avec 46 % de chirurgie ambulatoire. La marche etait acquise en 27 jours en moyenne avec un avantage pour les patients op...
Purpose Several studies report satisfactory clinical outcomes following ACLR in older patients, b... more Purpose Several studies report satisfactory clinical outcomes following ACLR in older patients, but none evaluated the effects of meniscal and cartilage lesions. The aim was to evaluate the influence of meniscal and cartilage lesions on outcomes of ACLR in patients aged over 50 years. Methods The authors prospectively collected records of 228 patients that underwent primary ACLR, including demographics, time from injury to surgery, whether injuries were work related, and sports level (competitive, recreational, or none). At a minimum follow-up of 6 months, knee injury and osteoarthritis outcome scores (KOOS), International Knee Documentation Committee (IKDC) score and Tegner activity level were recorded, and differential laxity was measured as the side-to-side difference in anterior tibial translation (ATT) using instrumented laximetry devices. Regression analyses were performed to determine associations between outcomes and meniscal and cartilage lesions as well as nine independent variables. Results A total of 228 patients aged 54.8 ± 4.3 years at index ACLR were assessed at a follow-up of 14.3 ± 3.8 months. KOOS subcomponents were 85 ± 13 for symptoms, 91 ± 10 for pain, 75 ± 18 for daily activities, 76 ± 18 for sport, and 88 ± 12 for quality of life (QoL). The IKDC score was A for 84 (37%) knees, B for 96 (42%) knees, C for 29 (13%) knees, and D for 8 (4%) knees. Tegner scores showed a decrease (median 0, range −4 to 4) and differential laxity also decreased (median − 4, range − 23.5 to 6.0). KOOS symptoms worsened with higher BMI (p = 0.038), for women (p = 0.007) and for knees that had medial meniscectomy (p = 0.029). KOOS pain worsened with higher BMI (p ≤ 0.001), for women (p = 0.002) and for knees with untreated (p = 0.047) or sutured (p = 0.041) medial meniscal lesions. Differential laxity increased with follow-up (p = 0.024) and in knees with lateral cartilage lesions (p = 0.031). Conclusion In primary ACLR for patients aged over 50 years, female gender and medial meniscal lesions significantly compromised KOOS symptoms and pain, while lateral cartilage lesions significantly increased differential laxity. Compared to knees with an intact medial meniscus, those with sutured or untreated medial meniscal lesions had worse pain, while those in which the medial meniscus was resected had worse symptoms. These findings are clinically relevant as they could help surgeons with patient selection and adjusting expectations according to their functional demands. Level of evidence III.
La Lettre de médecine physique et de réadaptation, 2010
... W. Vasconcelos · J.-C. Panisset Médicèdres, 48, avenue de Grugliasco, F-38130 Echirolles, Fra... more ... W. Vasconcelos · J.-C. Panisset Médicèdres, 48, avenue de Grugliasco, F-38130 Echirolles, France Lett. ... d'une série continue de 418 patients [5] venant de cinq centres différents (Bordeaux, Grenoble, Lyon, Pau et Toulouse) qui ont tous utilisé la même méthodologie d'ana-lyse ...
Revue de Chirurgie Orthopédique et Traumatologique, 2012
Resume Introduction Les lesions partielles du ligament croise anterieur (LCA) sont frequentes. La... more Resume Introduction Les lesions partielles du ligament croise anterieur (LCA) sont frequentes. La preservation de ce tissu ligamentaire encore insere en bonne position entre dans le cadre d’un concept de reconstruction anatomique, biomecanique et biologique du LCA. L’interet de cette conservation reste theorique. Notre hypothese etait qu’une reconstruction selective du faisceau anteromedial (AM) est superieure dans les lesions partielles du LCA a une reconstruction monofaisceau classique. Patients et methodes Il s’agit d’une etude prospective randomisee multicentrique ou 54 lesions partielles operees du LCA ont eu soit une reconstruction selective du faisceau AM (groupe 1, n = 29), soit une reconstruction monofaisceau anatomique standard (groupe 2, n = 25). Tous les patients ont ete evalues cliniquement par les scores IKDC subjectifs et objectifs, Lysholm et KOOS avec un recul minimal de 12 mois. Une mesure instrumentee comparative de la laxite anterieure du genou a ete realisee en preoperatoire et postoperatoire par Rolimeter ® . Une analyse statistique a ete effectuee pour comparer les resultats pre- et postoperatoire. Resultats Il n’y avait pas de difference entre les deux groupes pour les donnees preoperatoires. Tous les patients ont ete revus a six mois et un an. Le score IKDC subjectif etait respectivement de 55,8 et 56,8 en preoperatoire et de 86,2 et 85,7 a un an pour les groupes 1 et 2. Le score de Lysholm etait respectivement de 69,9 et 71,1 en preoperatoire et de 90,9 et 91,8 a un an pour les groupes 1 et 2. Il n’y avait pas de difference entre les deux groupes. La laxite differentielle preoperatoire etait respectivement de 5,0 mm (2–10) et 5,1 mm (2–12) au pour les groupes 1 et 2 ( p = 0,73). En postoperatoire a 12 mois, elle etait de 1,2 mm (groupe 1) pour 1,9 mm (groupe 2) ( p = 0,03). Discussion et conclusion Dans les lesions partielles du LCA, la reconstruction selective du faisceau AM en conservant les residus de faisceau posterolateral (PL) donne a court terme, des resultats cliniques comparables a celle d’une reconstruction monofaisceau standard, avec un meilleur controle de la laxite anterieure. Une analyse a plus long terme est cependant necessaire afin de comparer la progression de la laxite anterieure et rotatoire, et les modifications des resultats subjectifs dans le temps. Type d’etude Etude prospective-randomisee, niveau I.
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2001
Progressive limb lengthening with an external fixator often leads to pin-related complications. A... more Progressive limb lengthening with an external fixator often leads to pin-related complications. A new technique allowing progressive lengthening with a centromedullary nail without external fixation has been developed. This original double-locked device consists of matching male and female components fitted with a continuous thread. Lengthening is achieved via a one-way ratchet system. Twelve back-and-forth movements produce 1.25 mm lengthening. We tested this new device on 20 sheep and compared results with external fixation lengthening in 20 other sheep. The animals were divided into groups for sacrifice on days 5, 10, 20, 45 and 90. Serial x-ray were obtained for all animals. In the 45-day and 90-day groups, histomorphometric (trichrome goldner coloration and polarized light microscopy) and densitometric studies were also performed. Bone mineral density (BMD) was determined and bone trabecular density (BTD) and trabecular bone volume (TBV) were expressed in percent of bone trabec...
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2008
The use of new technology in 3D laxity analysis in torn anterior cruciate ligament (ACL) knee has... more The use of new technology in 3D laxity analysis in torn anterior cruciate ligament (ACL) knee has recently improve the ability to assess the effect of reconstruction on laxity control. The aim of this study was to compare, in anatomic ACL reconstruction, the effect of each bundle, posterolateral (PL) and anteromedial (AM) on the residual laxity intraoperatively. We used an optoelectronic navigation system to measure the translation and the rotation during anterior drawer test, Lachman test and pivot shift test. Twenty-two patients were assessed with two protocols, group I with PL bundle reconstruction following the AM bundle reconstruction and group II with a reverse program. Addition of PL bundle has significantly improved the translation and rotation laxity control during the Lachman and pivot shift test, when the AM bundle was more important in the translation control during the anterior drawer test. Anatomic double bundle reconstruction improves the control of laxity intraoperat...
L’analyse des causes d’echec d’une ligamentoplastie du LCA doit permettre de choisir la technique... more L’analyse des causes d’echec d’une ligamentoplastie du LCA doit permettre de choisir la technique la plus adaptee lors de la reprise chirurgicale afin d’assurer au patient un bon controle de la stabilite rotatoire et de diminuer les risques de ruptures iteratives.
Orthopaedics & Traumatology: Surgery & Research, 2017
Introduction: During anterior cruciate ligament (ACL) reconstruction procedures, anterolateral re... more Introduction: During anterior cruciate ligament (ACL) reconstruction procedures, anterolateral reconstruction (ALR) can also be performed to improve the knee's rotational stability. However, the effectiveness of this supplemental technique and its impact on the risk of retears and on the onset of secondary degenerative changesare controversial. Hypothesis: ALR improves control over the pivot shift, reduces the retear risk and delays the appearance of secondary degenerative lesions. Material and methods: Clinical examination, knee laxity measurements and X-ray evaluations were done in 478 patients with more than 3 years' follow-up after combined ACL and ALR from 11 participating hospitals. The mean patient age at the time of surgery was 28 years. Eighty-eight percent of the patients participated in pivot sports and 45% were competitive athletes. The findings of this study were compared to historical isolated ACL reconstruction data. Results: The average follow-up was 6.8 years. No detectable pivot shift was found in 83% of patients, while 12.8% of patient had a smooth glide. The side-to-side difference in anteroposterior knee laxity with maximum manual force was less than 3 mm in 66% of patients and less than 5 mm in 95%. The retear rate was 5.4%, with half of these patients undergoing revision ACL surgery. Secondary meniscus damage requiring surgery occurred in 6.3% of patients; the radiological osteoarthritis rate was 17.5%. Discussion: When compared to historical ACL reconstruction data, combined intra-and extra-articular reconstruction does not increase the complication rate. At a mean follow-up of 6.8 years, it provides better control over the pivot shift along with a low retear rate and low occurrence of secondary meniscus injuries.
Revue de Chirurgie Orthopédique et Traumatologique, 2012
ABSTRACT Introduction Avec la meilleure connaissance anatomique du ligament croisé antérieur (LCA... more ABSTRACT Introduction Avec la meilleure connaissance anatomique du ligament croisé antérieur (LCA), le diagnostic de lésion du LCA, partielle ou totale doit être précis pour adapter la planification préopératoire à l’état anatomique. Les mesures instrumentées de la translation tibiale antérieure sont fondamentales pour quantifier l’importance de la laxité du genou. Plusieurs tests laximétriques sont disponibles, mais leur exactitude respective reste à établir. Hypothèse La combinaison de l’examen clinique et d’une mesure instrumentée par le Telos™ à 15 kg et/ou le Rolimeter™ améliore la sensibilité et la spécificité du diagnostic du type de rupture du LCA. Patients et méthode Cent soixante-dix-sept patients ont été inclus de façon prospective. La validation du type lésionnel étant faite par arthroscopie. Le taux de 69,5 % avait une rupture complète et 30,5 % une rupture partielle. Résultat Les laxités antérieures importantes avec des tests cliniques positifs étaient associées aux ruptures complètes du LCA. Le différentiel des translations tibiales antérieures était augmenté de façon significative dans les deux méthodes d’évaluation laximétrique. Une différence significative existait entre les ruptures partielles et les ruptures complètes. On ne pouvait établir de différence entre les types de lésions partielles. Le résultat du Telos™ était fiable dans les laxités importantes avec un ressaut positif alors que ce n’était pas toujours le cas avec le Rolimeter™. Les laxités importantes avec des tests cliniques positifs et une translation tibiale antérieure différentielle de plus de 5 mm au Telos™ montraient une association significative avec des ruptures complètes du LCA. Discussion La combinaison de l’examen clinique au Telos™ est plus précise qu’avec le Rolimeter™ dans l’identification préopératoire du type de rupture du LCA. L’utilisation de ces instruments diagnostiques peut aider le chirurgien dans le diagnostic différentiel entre ruptures partielles et complètes et dans le choix d’une chirurgie adaptée à l’état anatomique du patient. Niveau de preuve Niveau III étude cas contrôle.
Revue de Chirurgie Orthopédique et Traumatologique, 2012
Resume Introduction Au cours des dix dernieres annees, nos connaissances sur le ligament croise a... more Resume Introduction Au cours des dix dernieres annees, nos connaissances sur le ligament croise anterieur (LCA) ont considerablement evolue. Ces connaissances ont entraine une modification de nos techniques de reconstruction du LCA avec l’apparition de reconstruction selective lorsque la rupture n’est pas complete. Notre hypothese etait qu’une reconstruction partielle du LCA avec preservations de fibres residuelles permet de restaurer une bonne stabilite et une bonne fonction du genou, quelle que soit la greffe ou la technique utilisee. Patients et methodes Il s’agit d’une etude retrospective multicentrique des resultats de 168 reconstructions partielles du faisceau AM du LCA avec preservation du faisceau PL. Tous les patients ont ete evalues cliniquement par les scores International Knee Documentation Committee (IKDC) subjectifs et objectifs et par le score de Lysholm avec un recul moyen de 26 mois (12–59 mois). Une mesure instrumente de la laxite du genou a ete realisee en preoperatoire et postoperatoire par arthrometre et/ou par mesure radiologique (Telos®). Une analyse statistique a ete effectuee pour comparer les resultats pre- et postoperatoire. Resultats Le score IKDC subjectif etait de 63,7 en preoperatoire et de 90,5 au dernier controle (p Discussion et conclusion Notre etude permet de confirmer qu’une reconstruction selective du faisceau antero-medial du LCA avec preservation de fibres postero-laterales permet de restaurer une bonne stabilite et fonction du genou. Une attention toute particuliere doit etre portee sur la taille de la greffe utilisee pour eviter un exces de tissu dans l’echancrure. Niveau de preuve Etude retrospective, niveau IV.
Résumé Cette étude multicentrique prospective sur 418 ruptures du ligament croisé antérieur avai... more Résumé Cette étude multicentrique prospective sur 418 ruptures du ligament croisé antérieur avait pour but de rechercher les corrélations existantes entre les différents aspects du Ligament croisé antérieur, constatés au moment de l’intervention chirurgicale, et les données de l’examen clinique, de l’examen radiographique standard et en tiroir antérieur et de l’IRM. Quatre types de lésions du LCA ont été identifiés: disparu
Orthopaedics & traumatology, surgery & research : OTSR, 2012
Partial anterior cruciate ligament (ACL) tear is frequent, and indications for surgery may be rai... more Partial anterior cruciate ligament (ACL) tear is frequent, and indications for surgery may be raised by a diagnostic aspect associating slight laxity with no clear pivot-shift. Unlike that of complete ACL tear, the natural history of partial tear remains controversial. A systematic literature review searched for referenced publications on the natural history of partial ACL tear. Twelve specific articles were retrieved. Initial diagnosis was systematically confirmed on arthroscopy, without ACL surgery. The following criteria were analyzed: firstly, preoperative: confirmation of inclusion criteria, preoperative clinical data, follow-up, arthroscopic lesion assessment, Lachman test, Pivot shift test, hemarthrosis, associated lesions and secondly, follow-up: Lachman test, Pivot shift test, revision surgery, functional clinical scores, pain, sport and return to sport, meniscal events. Preoperatively, Lachman tests were positive (soft or delayed) in a mean 49.7% of cases (range, 0-100%); ...
Orthopaedics & traumatology, surgery & research : OTSR, 2012
Over the past decade, our understanding of the anterior cruciate ligament (ACL) has evolved consi... more Over the past decade, our understanding of the anterior cruciate ligament (ACL) has evolved considerably. Based on this knowledge, ACL reconstruction techniques have changed and selective reconstruction procedures have been developed for partial tears. Our hypothesis was that stability and function can be restored to the knee with selective bundle reconstruction of partial ACL tears and preservation of the residual fibers. This was a multicenter retrospective study of 168 partial reconstructions of the anteromedial (AM) bundle of the ACL with preservation of the posterolateral (PL) bundle. All patients underwent a clinical evaluation based on the objective and subjective IKDC scores and the Lysholm score after a mean follow-up of 26 months (12-59 months). Preoperative and postoperative instrumental measurement of knee laxity was performed by arthrometer and/or by (Telos(®)) stress radiography. Statistical analysis and comparison was performed between pre- and postoperative results. ...
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2008
This prospective multicentric study concerns 418 anterior cruciate ligament tears. It correlates ... more This prospective multicentric study concerns 418 anterior cruciate ligament tears. It correlates the arthroscopic data's and the clinical and radiological data's. Four types of anterior cruciate ligament tears were identified. Complete tears, postero lateral bundle preserved, healing on the posterior cruciate ligament and healing in the notch. The statistical correlations had shown a highest laxity in the complete tear group with a highest rate of soft Lachman and gross pivot shift, a highest incidence of medial meniscus tears was also noted and a longer delay between injury and surgery, 24 months for the complete tear group and seven months for the postero lateral bundle group. The mean medial compartment laxity, side to side, in the postero lateral bundle group was 4.93 mm and 7.93 mm in the complete tear group. These data could help the surgeon in his surgical planning especially in case of partial tears.
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2008
This study is a synthesis of three series. The first study was prospective on 418 patients with a... more This study is a synthesis of three series. The first study was prospective on 418 patients with an anterior cruciate ligament (ACL) tear (group I). Two population of ACL ruptures were identified. One population with a postero-lateral bundle preserved in 16%, the mean medial anterior tibial translation side to side was 4.97 mm, the Lachman test was delayed in 40% with no or glide pivot shift in 73%. The second population with a complete ACL tear had a mean medial anterior tibial translation side to side of 7.93 mm, the Lachman test was soft in 98% with gross pivot shift in 80%. The second study was a retrospective study on 258 patients (group II) at 26 months follow-up, it correlated the impact of the type of graft on the clinical objective and subjective results. Twenty-eight percent had anterior knee pain, 33% for the patellar tendon and 25% for the hamstrings, the subjective IKDC was significantly lower for the painful knees, and 68% of the patellar tendon had a hypoesthesia and o...
Orthopaedics & Traumatology: Surgery & Research, 2010
A partial tear of the anterior cruciate ligament is a frequent pattern of ACL injury, observed in... more A partial tear of the anterior cruciate ligament is a frequent pattern of ACL injury, observed in 10 to 27% of isolated ACL lesions. There are three reasons to preserve these remnants: biomechanical, vascular and proprioceptive advantages for the patient. Good quality fibers work as graft protection during the healing process. Periligamentous and endoligamentous vessels present into the native ACL tissue may enhance the vascularization of the ACL augmentation. Mechanoreceptors still remaining in the residual ACL fibers may have proprioceptive function. Definition is controversial, based on anatomy, on clinical examination, on instrumental laxity assessment or on MRI findings. Continuous remnant ACL fibers bridging the femur and tibia, from native femoral ACL footprint to native tibial ACL footprint seem to be a good definition. Diagnostic is suspected by accumulation of arguments brought by a thorough clinical examination, precise MRI analysis and examination under anesthesia. But the final diagnostic needs an arthroscopic evaluation to confirm the presence of fibers in good position and to validate its good mechanical properties. The treatment of ACL partial tear is a demanding surgery; difficulties to visualize the graft insertion site, especially on the femoral side, require a perfect knowledge of the normal anatomy of the native ACL footprint. Adapted portals, perfect controls of the tunnel drilling process, intercondylar notch space management are the keys of success. The pivot shift test under anesthesia, a hard stop Lachman test, MRI findings, level and type of sport, arthroscopic aspects of the remnants and its mechanical properties, allow the surgeon decide between non operative treatment, ACL augmentation or standard ACL reconstruction.
Background: The aim of this study was to investigate the histological features of the remaining f... more Background: The aim of this study was to investigate the histological features of the remaining fibers bridging the femur and tibia in partial ACL tears. Methods: Twenty-six ACL remnants were harvested from patients who had arthroscopic criteria concordant with a partial tear. Histological analysis includes cellularity, blood vessel density evaluation and characterization of the femoral bony insertion morphology. Immunohistochemical studies were carried out to determine cells positive for α-smooth actin and for mechanoreceptor detection. Results: In these samples, a normal femoral insertion of the remnant was present in 22.7% of the cases. In 54% of the samples, substantial areas of hypercellularity were observed. Myofibroblasts were the predominant cell type and numerous cells positive for α-smooth actin were detected at immunostaining. Blood vessel density was increased in hypercellularity areas and in the synovial sheet. Free nerve endings and few Golgi or Ruffini corpuscles were detected in 41% of the specimens. The cellularity was correlated to the time between injury to surgery (p = 0.001). Conclusion: Competent histological structures including a well-vascularized synovial sheet, numerous fibroblasts and myofibroblasts and mechanoreceptors were found in ACL remnants. These histological findings bring additional knowledge towards the preservation of the ACL remnant in partial tears when ACL reconstruction or augmentation is considered. Clinical relevance: Descriptive laboratory study.
Revue de Chirurgie Orthopédique et Traumatologique, 2017
Resume Introduction Les plasties anterolaterales (PAL) sont utilisees pour diminuer le risque de ... more Resume Introduction Les plasties anterolaterales (PAL) sont utilisees pour diminuer le risque de rupture iterative apres reconstruction du ligament croise anterieur (LCA) chez les patients a risque. Ces plasties ajoutent un geste a la greffe isolee du LCA qui peut augmenter le temps operatoire et perturber les suites operatoires. L’objectif de cette etude etait d’evaluer le taux de complications precoces. L’hypothese etait que les plasties anterolaterales associees a une plastie du LCA n’augmentent pas le taux de complications par rapport aux plasties isolees. Materiel et methodes Il s’agit d’une etude multicentrique, prospective portant sur 392 patients dont 70 % d’hommes, âges en moyenne de 29,9 ans, operes d’une plastie du LCA avec PAL associee. L’ensemble des evenements indesirables ont ete releves. Resultats La duree moyenne d’hospitalisation a ete de 2 jours avec 46 % de chirurgie ambulatoire. La marche etait acquise en 27 jours en moyenne avec un avantage pour les patients op...
Purpose Several studies report satisfactory clinical outcomes following ACLR in older patients, b... more Purpose Several studies report satisfactory clinical outcomes following ACLR in older patients, but none evaluated the effects of meniscal and cartilage lesions. The aim was to evaluate the influence of meniscal and cartilage lesions on outcomes of ACLR in patients aged over 50 years. Methods The authors prospectively collected records of 228 patients that underwent primary ACLR, including demographics, time from injury to surgery, whether injuries were work related, and sports level (competitive, recreational, or none). At a minimum follow-up of 6 months, knee injury and osteoarthritis outcome scores (KOOS), International Knee Documentation Committee (IKDC) score and Tegner activity level were recorded, and differential laxity was measured as the side-to-side difference in anterior tibial translation (ATT) using instrumented laximetry devices. Regression analyses were performed to determine associations between outcomes and meniscal and cartilage lesions as well as nine independent variables. Results A total of 228 patients aged 54.8 ± 4.3 years at index ACLR were assessed at a follow-up of 14.3 ± 3.8 months. KOOS subcomponents were 85 ± 13 for symptoms, 91 ± 10 for pain, 75 ± 18 for daily activities, 76 ± 18 for sport, and 88 ± 12 for quality of life (QoL). The IKDC score was A for 84 (37%) knees, B for 96 (42%) knees, C for 29 (13%) knees, and D for 8 (4%) knees. Tegner scores showed a decrease (median 0, range −4 to 4) and differential laxity also decreased (median − 4, range − 23.5 to 6.0). KOOS symptoms worsened with higher BMI (p = 0.038), for women (p = 0.007) and for knees that had medial meniscectomy (p = 0.029). KOOS pain worsened with higher BMI (p ≤ 0.001), for women (p = 0.002) and for knees with untreated (p = 0.047) or sutured (p = 0.041) medial meniscal lesions. Differential laxity increased with follow-up (p = 0.024) and in knees with lateral cartilage lesions (p = 0.031). Conclusion In primary ACLR for patients aged over 50 years, female gender and medial meniscal lesions significantly compromised KOOS symptoms and pain, while lateral cartilage lesions significantly increased differential laxity. Compared to knees with an intact medial meniscus, those with sutured or untreated medial meniscal lesions had worse pain, while those in which the medial meniscus was resected had worse symptoms. These findings are clinically relevant as they could help surgeons with patient selection and adjusting expectations according to their functional demands. Level of evidence III.
La Lettre de médecine physique et de réadaptation, 2010
... W. Vasconcelos · J.-C. Panisset Médicèdres, 48, avenue de Grugliasco, F-38130 Echirolles, Fra... more ... W. Vasconcelos · J.-C. Panisset Médicèdres, 48, avenue de Grugliasco, F-38130 Echirolles, France Lett. ... d'une série continue de 418 patients [5] venant de cinq centres différents (Bordeaux, Grenoble, Lyon, Pau et Toulouse) qui ont tous utilisé la même méthodologie d'ana-lyse ...
Revue de Chirurgie Orthopédique et Traumatologique, 2012
Resume Introduction Les lesions partielles du ligament croise anterieur (LCA) sont frequentes. La... more Resume Introduction Les lesions partielles du ligament croise anterieur (LCA) sont frequentes. La preservation de ce tissu ligamentaire encore insere en bonne position entre dans le cadre d’un concept de reconstruction anatomique, biomecanique et biologique du LCA. L’interet de cette conservation reste theorique. Notre hypothese etait qu’une reconstruction selective du faisceau anteromedial (AM) est superieure dans les lesions partielles du LCA a une reconstruction monofaisceau classique. Patients et methodes Il s’agit d’une etude prospective randomisee multicentrique ou 54 lesions partielles operees du LCA ont eu soit une reconstruction selective du faisceau AM (groupe 1, n = 29), soit une reconstruction monofaisceau anatomique standard (groupe 2, n = 25). Tous les patients ont ete evalues cliniquement par les scores IKDC subjectifs et objectifs, Lysholm et KOOS avec un recul minimal de 12 mois. Une mesure instrumentee comparative de la laxite anterieure du genou a ete realisee en preoperatoire et postoperatoire par Rolimeter ® . Une analyse statistique a ete effectuee pour comparer les resultats pre- et postoperatoire. Resultats Il n’y avait pas de difference entre les deux groupes pour les donnees preoperatoires. Tous les patients ont ete revus a six mois et un an. Le score IKDC subjectif etait respectivement de 55,8 et 56,8 en preoperatoire et de 86,2 et 85,7 a un an pour les groupes 1 et 2. Le score de Lysholm etait respectivement de 69,9 et 71,1 en preoperatoire et de 90,9 et 91,8 a un an pour les groupes 1 et 2. Il n’y avait pas de difference entre les deux groupes. La laxite differentielle preoperatoire etait respectivement de 5,0 mm (2–10) et 5,1 mm (2–12) au pour les groupes 1 et 2 ( p = 0,73). En postoperatoire a 12 mois, elle etait de 1,2 mm (groupe 1) pour 1,9 mm (groupe 2) ( p = 0,03). Discussion et conclusion Dans les lesions partielles du LCA, la reconstruction selective du faisceau AM en conservant les residus de faisceau posterolateral (PL) donne a court terme, des resultats cliniques comparables a celle d’une reconstruction monofaisceau standard, avec un meilleur controle de la laxite anterieure. Une analyse a plus long terme est cependant necessaire afin de comparer la progression de la laxite anterieure et rotatoire, et les modifications des resultats subjectifs dans le temps. Type d’etude Etude prospective-randomisee, niveau I.
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2001
Progressive limb lengthening with an external fixator often leads to pin-related complications. A... more Progressive limb lengthening with an external fixator often leads to pin-related complications. A new technique allowing progressive lengthening with a centromedullary nail without external fixation has been developed. This original double-locked device consists of matching male and female components fitted with a continuous thread. Lengthening is achieved via a one-way ratchet system. Twelve back-and-forth movements produce 1.25 mm lengthening. We tested this new device on 20 sheep and compared results with external fixation lengthening in 20 other sheep. The animals were divided into groups for sacrifice on days 5, 10, 20, 45 and 90. Serial x-ray were obtained for all animals. In the 45-day and 90-day groups, histomorphometric (trichrome goldner coloration and polarized light microscopy) and densitometric studies were also performed. Bone mineral density (BMD) was determined and bone trabecular density (BTD) and trabecular bone volume (TBV) were expressed in percent of bone trabec...
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2008
The use of new technology in 3D laxity analysis in torn anterior cruciate ligament (ACL) knee has... more The use of new technology in 3D laxity analysis in torn anterior cruciate ligament (ACL) knee has recently improve the ability to assess the effect of reconstruction on laxity control. The aim of this study was to compare, in anatomic ACL reconstruction, the effect of each bundle, posterolateral (PL) and anteromedial (AM) on the residual laxity intraoperatively. We used an optoelectronic navigation system to measure the translation and the rotation during anterior drawer test, Lachman test and pivot shift test. Twenty-two patients were assessed with two protocols, group I with PL bundle reconstruction following the AM bundle reconstruction and group II with a reverse program. Addition of PL bundle has significantly improved the translation and rotation laxity control during the Lachman and pivot shift test, when the AM bundle was more important in the translation control during the anterior drawer test. Anatomic double bundle reconstruction improves the control of laxity intraoperat...
L’analyse des causes d’echec d’une ligamentoplastie du LCA doit permettre de choisir la technique... more L’analyse des causes d’echec d’une ligamentoplastie du LCA doit permettre de choisir la technique la plus adaptee lors de la reprise chirurgicale afin d’assurer au patient un bon controle de la stabilite rotatoire et de diminuer les risques de ruptures iteratives.
Orthopaedics & Traumatology: Surgery & Research, 2017
Introduction: During anterior cruciate ligament (ACL) reconstruction procedures, anterolateral re... more Introduction: During anterior cruciate ligament (ACL) reconstruction procedures, anterolateral reconstruction (ALR) can also be performed to improve the knee's rotational stability. However, the effectiveness of this supplemental technique and its impact on the risk of retears and on the onset of secondary degenerative changesare controversial. Hypothesis: ALR improves control over the pivot shift, reduces the retear risk and delays the appearance of secondary degenerative lesions. Material and methods: Clinical examination, knee laxity measurements and X-ray evaluations were done in 478 patients with more than 3 years' follow-up after combined ACL and ALR from 11 participating hospitals. The mean patient age at the time of surgery was 28 years. Eighty-eight percent of the patients participated in pivot sports and 45% were competitive athletes. The findings of this study were compared to historical isolated ACL reconstruction data. Results: The average follow-up was 6.8 years. No detectable pivot shift was found in 83% of patients, while 12.8% of patient had a smooth glide. The side-to-side difference in anteroposterior knee laxity with maximum manual force was less than 3 mm in 66% of patients and less than 5 mm in 95%. The retear rate was 5.4%, with half of these patients undergoing revision ACL surgery. Secondary meniscus damage requiring surgery occurred in 6.3% of patients; the radiological osteoarthritis rate was 17.5%. Discussion: When compared to historical ACL reconstruction data, combined intra-and extra-articular reconstruction does not increase the complication rate. At a mean follow-up of 6.8 years, it provides better control over the pivot shift along with a low retear rate and low occurrence of secondary meniscus injuries.
Revue de Chirurgie Orthopédique et Traumatologique, 2012
ABSTRACT Introduction Avec la meilleure connaissance anatomique du ligament croisé antérieur (LCA... more ABSTRACT Introduction Avec la meilleure connaissance anatomique du ligament croisé antérieur (LCA), le diagnostic de lésion du LCA, partielle ou totale doit être précis pour adapter la planification préopératoire à l’état anatomique. Les mesures instrumentées de la translation tibiale antérieure sont fondamentales pour quantifier l’importance de la laxité du genou. Plusieurs tests laximétriques sont disponibles, mais leur exactitude respective reste à établir. Hypothèse La combinaison de l’examen clinique et d’une mesure instrumentée par le Telos™ à 15 kg et/ou le Rolimeter™ améliore la sensibilité et la spécificité du diagnostic du type de rupture du LCA. Patients et méthode Cent soixante-dix-sept patients ont été inclus de façon prospective. La validation du type lésionnel étant faite par arthroscopie. Le taux de 69,5 % avait une rupture complète et 30,5 % une rupture partielle. Résultat Les laxités antérieures importantes avec des tests cliniques positifs étaient associées aux ruptures complètes du LCA. Le différentiel des translations tibiales antérieures était augmenté de façon significative dans les deux méthodes d’évaluation laximétrique. Une différence significative existait entre les ruptures partielles et les ruptures complètes. On ne pouvait établir de différence entre les types de lésions partielles. Le résultat du Telos™ était fiable dans les laxités importantes avec un ressaut positif alors que ce n’était pas toujours le cas avec le Rolimeter™. Les laxités importantes avec des tests cliniques positifs et une translation tibiale antérieure différentielle de plus de 5 mm au Telos™ montraient une association significative avec des ruptures complètes du LCA. Discussion La combinaison de l’examen clinique au Telos™ est plus précise qu’avec le Rolimeter™ dans l’identification préopératoire du type de rupture du LCA. L’utilisation de ces instruments diagnostiques peut aider le chirurgien dans le diagnostic différentiel entre ruptures partielles et complètes et dans le choix d’une chirurgie adaptée à l’état anatomique du patient. Niveau de preuve Niveau III étude cas contrôle.
Revue de Chirurgie Orthopédique et Traumatologique, 2012
Resume Introduction Au cours des dix dernieres annees, nos connaissances sur le ligament croise a... more Resume Introduction Au cours des dix dernieres annees, nos connaissances sur le ligament croise anterieur (LCA) ont considerablement evolue. Ces connaissances ont entraine une modification de nos techniques de reconstruction du LCA avec l’apparition de reconstruction selective lorsque la rupture n’est pas complete. Notre hypothese etait qu’une reconstruction partielle du LCA avec preservations de fibres residuelles permet de restaurer une bonne stabilite et une bonne fonction du genou, quelle que soit la greffe ou la technique utilisee. Patients et methodes Il s’agit d’une etude retrospective multicentrique des resultats de 168 reconstructions partielles du faisceau AM du LCA avec preservation du faisceau PL. Tous les patients ont ete evalues cliniquement par les scores International Knee Documentation Committee (IKDC) subjectifs et objectifs et par le score de Lysholm avec un recul moyen de 26 mois (12–59 mois). Une mesure instrumente de la laxite du genou a ete realisee en preoperatoire et postoperatoire par arthrometre et/ou par mesure radiologique (Telos®). Une analyse statistique a ete effectuee pour comparer les resultats pre- et postoperatoire. Resultats Le score IKDC subjectif etait de 63,7 en preoperatoire et de 90,5 au dernier controle (p Discussion et conclusion Notre etude permet de confirmer qu’une reconstruction selective du faisceau antero-medial du LCA avec preservation de fibres postero-laterales permet de restaurer une bonne stabilite et fonction du genou. Une attention toute particuliere doit etre portee sur la taille de la greffe utilisee pour eviter un exces de tissu dans l’echancrure. Niveau de preuve Etude retrospective, niveau IV.
Résumé Cette étude multicentrique prospective sur 418 ruptures du ligament croisé antérieur avai... more Résumé Cette étude multicentrique prospective sur 418 ruptures du ligament croisé antérieur avait pour but de rechercher les corrélations existantes entre les différents aspects du Ligament croisé antérieur, constatés au moment de l’intervention chirurgicale, et les données de l’examen clinique, de l’examen radiographique standard et en tiroir antérieur et de l’IRM. Quatre types de lésions du LCA ont été identifiés: disparu
Orthopaedics & traumatology, surgery & research : OTSR, 2012
Partial anterior cruciate ligament (ACL) tear is frequent, and indications for surgery may be rai... more Partial anterior cruciate ligament (ACL) tear is frequent, and indications for surgery may be raised by a diagnostic aspect associating slight laxity with no clear pivot-shift. Unlike that of complete ACL tear, the natural history of partial tear remains controversial. A systematic literature review searched for referenced publications on the natural history of partial ACL tear. Twelve specific articles were retrieved. Initial diagnosis was systematically confirmed on arthroscopy, without ACL surgery. The following criteria were analyzed: firstly, preoperative: confirmation of inclusion criteria, preoperative clinical data, follow-up, arthroscopic lesion assessment, Lachman test, Pivot shift test, hemarthrosis, associated lesions and secondly, follow-up: Lachman test, Pivot shift test, revision surgery, functional clinical scores, pain, sport and return to sport, meniscal events. Preoperatively, Lachman tests were positive (soft or delayed) in a mean 49.7% of cases (range, 0-100%); ...
Orthopaedics & traumatology, surgery & research : OTSR, 2012
Over the past decade, our understanding of the anterior cruciate ligament (ACL) has evolved consi... more Over the past decade, our understanding of the anterior cruciate ligament (ACL) has evolved considerably. Based on this knowledge, ACL reconstruction techniques have changed and selective reconstruction procedures have been developed for partial tears. Our hypothesis was that stability and function can be restored to the knee with selective bundle reconstruction of partial ACL tears and preservation of the residual fibers. This was a multicenter retrospective study of 168 partial reconstructions of the anteromedial (AM) bundle of the ACL with preservation of the posterolateral (PL) bundle. All patients underwent a clinical evaluation based on the objective and subjective IKDC scores and the Lysholm score after a mean follow-up of 26 months (12-59 months). Preoperative and postoperative instrumental measurement of knee laxity was performed by arthrometer and/or by (Telos(®)) stress radiography. Statistical analysis and comparison was performed between pre- and postoperative results. ...
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2008
This prospective multicentric study concerns 418 anterior cruciate ligament tears. It correlates ... more This prospective multicentric study concerns 418 anterior cruciate ligament tears. It correlates the arthroscopic data's and the clinical and radiological data's. Four types of anterior cruciate ligament tears were identified. Complete tears, postero lateral bundle preserved, healing on the posterior cruciate ligament and healing in the notch. The statistical correlations had shown a highest laxity in the complete tear group with a highest rate of soft Lachman and gross pivot shift, a highest incidence of medial meniscus tears was also noted and a longer delay between injury and surgery, 24 months for the complete tear group and seven months for the postero lateral bundle group. The mean medial compartment laxity, side to side, in the postero lateral bundle group was 4.93 mm and 7.93 mm in the complete tear group. These data could help the surgeon in his surgical planning especially in case of partial tears.
Revue de chirurgie orthopédique et réparatrice de l'appareil moteur, 2008
This study is a synthesis of three series. The first study was prospective on 418 patients with a... more This study is a synthesis of three series. The first study was prospective on 418 patients with an anterior cruciate ligament (ACL) tear (group I). Two population of ACL ruptures were identified. One population with a postero-lateral bundle preserved in 16%, the mean medial anterior tibial translation side to side was 4.97 mm, the Lachman test was delayed in 40% with no or glide pivot shift in 73%. The second population with a complete ACL tear had a mean medial anterior tibial translation side to side of 7.93 mm, the Lachman test was soft in 98% with gross pivot shift in 80%. The second study was a retrospective study on 258 patients (group II) at 26 months follow-up, it correlated the impact of the type of graft on the clinical objective and subjective results. Twenty-eight percent had anterior knee pain, 33% for the patellar tendon and 25% for the hamstrings, the subjective IKDC was significantly lower for the painful knees, and 68% of the patellar tendon had a hypoesthesia and o...
Orthopaedics & Traumatology: Surgery & Research, 2010
A partial tear of the anterior cruciate ligament is a frequent pattern of ACL injury, observed in... more A partial tear of the anterior cruciate ligament is a frequent pattern of ACL injury, observed in 10 to 27% of isolated ACL lesions. There are three reasons to preserve these remnants: biomechanical, vascular and proprioceptive advantages for the patient. Good quality fibers work as graft protection during the healing process. Periligamentous and endoligamentous vessels present into the native ACL tissue may enhance the vascularization of the ACL augmentation. Mechanoreceptors still remaining in the residual ACL fibers may have proprioceptive function. Definition is controversial, based on anatomy, on clinical examination, on instrumental laxity assessment or on MRI findings. Continuous remnant ACL fibers bridging the femur and tibia, from native femoral ACL footprint to native tibial ACL footprint seem to be a good definition. Diagnostic is suspected by accumulation of arguments brought by a thorough clinical examination, precise MRI analysis and examination under anesthesia. But the final diagnostic needs an arthroscopic evaluation to confirm the presence of fibers in good position and to validate its good mechanical properties. The treatment of ACL partial tear is a demanding surgery; difficulties to visualize the graft insertion site, especially on the femoral side, require a perfect knowledge of the normal anatomy of the native ACL footprint. Adapted portals, perfect controls of the tunnel drilling process, intercondylar notch space management are the keys of success. The pivot shift test under anesthesia, a hard stop Lachman test, MRI findings, level and type of sport, arthroscopic aspects of the remnants and its mechanical properties, allow the surgeon decide between non operative treatment, ACL augmentation or standard ACL reconstruction.
Background: The aim of this study was to investigate the histological features of the remaining f... more Background: The aim of this study was to investigate the histological features of the remaining fibers bridging the femur and tibia in partial ACL tears. Methods: Twenty-six ACL remnants were harvested from patients who had arthroscopic criteria concordant with a partial tear. Histological analysis includes cellularity, blood vessel density evaluation and characterization of the femoral bony insertion morphology. Immunohistochemical studies were carried out to determine cells positive for α-smooth actin and for mechanoreceptor detection. Results: In these samples, a normal femoral insertion of the remnant was present in 22.7% of the cases. In 54% of the samples, substantial areas of hypercellularity were observed. Myofibroblasts were the predominant cell type and numerous cells positive for α-smooth actin were detected at immunostaining. Blood vessel density was increased in hypercellularity areas and in the synovial sheet. Free nerve endings and few Golgi or Ruffini corpuscles were detected in 41% of the specimens. The cellularity was correlated to the time between injury to surgery (p = 0.001). Conclusion: Competent histological structures including a well-vascularized synovial sheet, numerous fibroblasts and myofibroblasts and mechanoreceptors were found in ACL remnants. These histological findings bring additional knowledge towards the preservation of the ACL remnant in partial tears when ACL reconstruction or augmentation is considered. Clinical relevance: Descriptive laboratory study.
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Papers by J. Panisset