Purpose: Arthroscopic reconstruction of the anterior cruciate ligament (ACL) with a free patellar tendon graft is a classical method for the treatment of anterior knee laxity. The purpose of this study was to analyse clinical and radiological outcome in 218 cases at five years and to search for prognostic factors.

Material and methods: Between 1993 and 1994, arthroscopic repair of the ACL was performed in 218 knees with two independent tunnels using a free patellar graft. This prospective study included 177 knees reviewed at a mean 67±7 months follow-up using the IKDC criteria and instrumental manual KT-1000 laxity measurements. The series included 67.4% men and 32.6% women, mean age 26.7 years (14–59). Delay from the accident to surgery was a mean 22.3 months (1–228 months). Two medial, 15 lateral and five medial and lateral meniscectomies had been performed before the operation studied. The position of the tunnels was studied using the Aglietti method. Differences were considered significant at p < 0.05.

Results: Sports activities could be resumed in 87% of the cases at the same level for 62% with a mean delay of 12 months. Subjectively, the patients were satisfied or very satisfied in 86% of the cases. Symptom score was A in 50%, B in 38%, C in 8.3% and D in 3.7%. Maximal manual residual differential measured with KT-100 was 0.75 ± 2.3 mm with an abolished click in 82% of the cases and a glide in 12%. Sceondary medial meniscectomy was performed in 19 cases. At last follow-up the meniscal material was intact in 127 cases (60%). Overall IKDC score for the 177 cases reviewed was: A 57%, B 24%, C 9%, D 9%. Radiographically, the knee was normal in 66.6% of the cases, remodelled in 29.6%, and exhibited joint space narrowing less than 50% in 13.4% and overall osteoarthritis in 0.6%. The Aglietti lateral score as 25.5±7% for the tibia and 66.3±7.2% for the femur. During follow-up, there were 13 cases of recurrent tears related to repeated sports trauma or poor femoral position. During this same period, there were 20 tears of the contralateral ACL. Functional outcome was correlated with the presence of a medial meniscus, the length of delay from accident to surgery, and the presence of radiological evidence of residual laxity.

Conclusion: This study demonstrated that chronic anterior laxity of the knee, treated with a free patellar tendon graft implanted arthroscopically provides good restoration of the knee in 82% of the cases with little residual laxity. Joint space narrowing was found in 1% of the cases and was strongly correlated with the status of the medial meniscus that should be preserved. The number of recurrent tears was equivalent to the number of contralateral tears observed during the same period.

Purpose: Tibiotalar arthrodesis is a classical procedure for the treatment of painful deformation-destruction of the tibiotalar joint. The purpose of this retrospective study was to determine prognostic factors and tolerance to tibiotalar arthrodesis observed in 68 procedures performed with two different techniques (47 surgical fusions (Group 1), and 21 arthroscopic fusions (Group 2)).

Material and methods: Between 1985 and 1999, 68 patients, mean age 51 years (22–88) underwent 55 arthrodesis procedures (47 post-traumatic, 2 paralytic, 6 rheumatoid polyarthritis, 4 sequelae of septic arthritis). All patients had major functional impairment. The tibiotalar joint was stiff in all cases and mean motion was 20 ± 15°. The subtalar facet was nearly normal in 33 cases, altered in six and had already fused in nine. The mediotarsal facet was altered in 12 cases, six had already had a double arthrodesis, and was normal in 50. On the preoperative Méary view, there was a normal axis in 13 patients, valgus in 28 and varus in 24. According to the Duquennoy radiographic criteria, there was subtalar involvement in 32 cases and mediotarsal involvement in 19. Tibiotalar arthrodeses procedures were performed arthroscopically after 1993 for cases with little axial deformation. Open surgery was used for all other cases (43 Méary technique). A plaster cast was used in all cases. All patients were reviewed using the Duguennoy score and two radiographic views: lateral weight-bearing view for the sagittal plane position (tibiopedious angle) and the Méary view for the frontal plane.

Results: At a mean follow-up of four years, fusion rate was 82% (group 1 83%, group 2 81%). Mean delay to fusion was 3.2 ± 1 month irrespective of the causal disease or surgical technique. Functional outcome was very good in 28%, good in 34.5%, fair in 34.5% and poor in 3% and did not depend on the surgical technique. The subtalar was painful with zero motion in 18 cases (26.5%), generally associated with residual equine. The mediotarsal was stiff in 17 cases and very painful in four. In the frontal plane, 16 ankles were correctly axed, 27 were in valgus (mean 5.6°) and 20 in varus (mean 7.6°) with no difference between the two groups. In the sagittal plane, four ankles were in talus, nine in neutral position, and 49 had a residual equine, including 32 > 5°. In most cases, fair or poor outcome was related to subtalar pain. More than 50% of the patients with equine fusion greater than 5° had subtalar pain.

Conclusion: For the same deformity, arthroscopic arthrodesis can shorten hospital stay and improve the rate and degree of trophic disorders. Arthroscopic tibiotalar arthrodesis is an elegant technique that we use for centred ankles or for patients with risk factors, particularly skin conditions. The rate of fusion with the arthroscopic approach is not however better than with open surgery. Precise clinical and radiological assessment of the subtalar facet as well as the position of the fusion in the sagittal plane at 90° without equine deviation are important prognostic factors observed in this series.

Purpose: After cementing, various changes are observed in femoral bone resulting from various factors (ageing process, stress forces, granuloma…). The purpose of this work was to examine the radiological expression of these changes a mean 12 years after prosthesis implantation.

Material and methods: Charnley-Kerboull total hip arthroplasty was performed in 304 patients (338 hips) between January 1st, 1984 and December 31st, 1986. Mean age of the population was 65.5 years. Most of the patients had degenerative hip disease (81.4%). Among these 304 patients, 108 had died and 56 were lost to follow-up, giving 174 patients retained for analysis at a maximum follow-up of 16 years (mean 12 years). Noble and Nordin scores were recorded before surgery and during follow-up as were the cortical and cement thicknesses in the seven zones described by Gruen.

Results: The actuarial curve, calculated for the 338 hips showed 95.1% survival at 12 years (taking into account all revisions irrespective of the cause). Femoral stem survival was 97.1±2% taking certain or probable loosening as the endpoint. Several categories or radiological changes were observed: – femoral defects (18%) correlated with cup wear; – progressive widening of the medullary canal without loosening and a mean femoral score moving from 55.7 to 52.16 (p< 0.01) especially in thin women and for wide-mouthed femurs; – cortical thickening near the tip (57%) more frequently for greater distal filling; – stress shielding especially in women (p< 0.001) with a low initial score for the femur (p< 0.0006) and with greater distal filling.

Conclusion: Like Kerboull, we tried to achieve primary stem stability before cementing. Cementing results were good (97% at 12 years), but detailed radiographic analysis demonstrated that cortical thinning remained in zone 7, especially when the primary stability was achieved in the distal portion of the femur (high preoperative Noble index). Variations in the metaphyseal-diaphyseal ratio require adaptating the form of the stem to be cemented in order to achieve better filling and avoid primary stability mainly in the distal portion.

Purpose: The MacIntosch method for reconstruction of the anterior cruciate ligament using a free intra-articular plasty with an extra-articular reinforcement was the classical treatment during the eighties for chronic anterior laxity. In 1992, we reported our short-term resuls in 180 cases. The purpose of this report is to analyse the results in 112 of these 180 cases with a mean follow-up of 14 years.

Material and methods: One hundred twelve knees operated between 1982 and 1987 were included in this study. There were 82 men (73.2%) and 30 women (26.8%), mean age 24.9±5.8 years. Mean follow-up was 165.3 ± 25.9 months. Mean delay from accident to repair was 30.9 months (3–144) and meniscectomy was performed in 88% of the cases, mainly for contact pivot sports (85%). All patients had an overt laxity (advanced in 73.2% or isolated in 26.9%). The MacIntosh plasty performed by arthrotomy used a patellar tendon with a quadriceps tendon band prolongation. Arthros-copy was performed prior to surgery in all cases. If the transplant was implanted over the top, the radiographic analysis of the tunnel position was only made for the tibia. An independent examiner reviewed all the patients clinically and radiographically using the IKDC criteria with instrumental KT 1000 measurements.

Results: Sports activities were resumed in 78% of the cases with a trend towards pivot sports without contact practised in an amateur setting. Subjectively, 69.6% of the patients were very satisfied and 25% were satisfied. The click was abolished in 83% of the cases, was minimal in 15% and overt in 2%. The medial meniscus was intact in 40% of the cases with only 10 secondary meniscal tears 14 years later. The residual manual maximal traction differential at KT 1000 was 1 ± 1.225 mm and the mean compliance was 1.69 ± 1 mm. The overall IKDC score was: 31% A, 47/6% B, 19.1% C, 1.9% D. X-rays were normal in 17%, showed remodelling in 55.4%, and joint narrowing < 50% in 23.8% and > 50% in 3.8%. For patients with an intact medial meniscus, joint narrowing was observed in 5.5% compared with 24% after resection of the medial meniscus. There were two repeat tears in this series compared with 22 tears of the contra-lateral anterior cruciate ligament. The unsatisfactory results (22%) were related to anatomic failure (two cases) and functional problems (18 cases, defective mobility and pain). The prognostic factors were age at time of operation and preservation of the medial meniscus.

Conclusions: This study confirms the persistently good clinical and functional results 14 years after plasty using the patellar tendon associated with lateral reinforcement. Ligament stabilisation was satisfactory but it must be recalled that at 14 years, the functional needs were different for these knees. The radiological course was more worrisome with joint narrowing in 27.6% of the cases.