INTRODUCTION: The authors present the results of a surgical technique for lateral ankle chronic instability, derived from Castaing and Duquennoy procedures. It uses a half peroneus brevis with a tightening of the antero- lateral capsule. A Plasty with the extensorum digitorum brevis was used in the event of associated subtalar instability.

MATERIAL AND METHODS: Between 2001 and 2005, 38 cases of ligamentoplasties have been performed for chronic instability of the ankle. 32 (25 men and 7 women) of them have been reviewed with a mean delay of 26 months (extremes of 10 months to 5 years). They were middle-aged of 28,5 years. All the patients have been reviewed with stress X-Ray in varus of the both ankles (measure of tibio talar angle, arthritis) and had a strength measure in eversion by the same examiner. The functional evaluation was performed with Molander and Olerud ankle score.

RESULTS: There were 20% of complications, especially cutaneous cicatrisation problems and algodystrophy. After surgery, no patient had instability; only one, had apprehension of the ankle. 90 % retrieved the same sport with the same level. No body changed of job. 3 patients were disappointed because of pain in sports and stiffness. At revision, the functional score was 90 against 59 at the pre operative time. The difference of strength in eversion between the two ankles was about 7%. Laxity had a good correction seeing the average tibio talar angle between the both ankle is 0,5°.

DISCUSSION: The results of this procedure show a distinct improvement of stability, radiological laxity and functional activity. The arthrotomy performed in Duquennoy procedure, is useful for diagnosis and treatment. It shows the cartilage and allows the removal of impingement and foreign bodies. A plasty that uses the single evertor deprives the ankle of a part of active and proprioceptive control. However, the patients didn’t feel a difference or a discomfort. The patients who had the surgery on the jump foot side had no significative difference of strength in eversion between the both ankles.

CONCLUSION: This anatomical procedure gives 91% of satisfaction, for these active young people. The postoperative physiotherapy allows the complete recovery of activities from the sixth month after surgery.

Purpose: We report the satisfactory results obtained in a retrospecive multicentric series of 80 shoulder prostheses implanted for aseptic osetonecrosis of the head of the humerus.

Material and methods: Seventy-four patients (43 men, 31 women, men age 59 years) with aseptic osteonecrosis of the head of the humerus treated with a shoulder prosthesis were reviewed at least two years after surgery. The mean weighted score before surgery was 37%. Twenty-six total prostheses and 54 humeral prostheses were implanted via the deltopectoral approach. There had been few complications at review: seven stiff shoulders, one torn suture of the subscapularis with instability, two inflammatory glenoids, one migration. Physical exam and x-ray (ossifications, lucent lines) findings were recorded.

Results: Mean follow-up was 47 months (24–104 months). The Constant score was improved significantly (p < 0.05). The total weighed score was 88% on the average and was not affected by gender, side, or dominant side. Ninety percent of the patients were satisfied or very satisfied. Gain in motion was significant in all movements with a mean 53° for active anterior elevation. For grade V shoulders, the improvement was significantly better with total shoulder arthroplasty while for grade II and III shoulders a humeral prosthesis was preferable. Full thickness tears of the rotator tendons did not influence overall outcome despite less recovery of motion (p < 0.05) and force (p = 0.09). Complications did not alter results.

Discussion: A humeral prosthesis should be preferred for grade II–III shoulders and a total shoulder arthroplasty for major degeneration of the glenoid (grade V). For grade IV, either prosthesis may be used depending on the patient’s age, activity level, and status of the rotator cuff. For very young or very old patients, high levels of physical activity may argue against prosthesis implantation due to the risk of loosening or rotator cuff tears which are unfavourable factors.

Conclusion: The results of this multicentric series corroborate data in the literature that shoulder arthroplasty provides good results for the treatment of aseptic necrosis of the head of the humerus. In generally, arthroplasty allows pain relief, good motion, particularly for external rotation, and good force recovery, explaining the better results obtained in active younger subjects.