Purpose of the study: Scarf osteotomy is currently the gold standard treatment for hallux valgus. The purpose of our work was to search for anatomic and clinical factors affecting the outcome.

Material and methods: This retrospective review concerned 125 osteotomies performed in 105 patients (101 women and 4 men, mean age 48 years, age range 16–75 years). For 55 cases, Scarf osteotomy was associated with osteotomy of the proximal phalanx. Osteotomies to reduce the lateral metatarsals were performed in 32 cases. Clinical outcome was assessed in terms of pain, hallux function and motion using the AOFAS and Groulier systems. AP and lateral weight-bearing views were used to assess the metatarsophalangeal, intermetatarsal, interphalangeal, PPAA, DMAA, and Djian angles and metatarsal slope.

Results: Mean follow-up was 45 months (range 24–95). The Kiaoka and Groulier score improved respectively from 50 to 84/100 points and 38 to 68/100 points (p< 0.0001). Pain relief was total or nearly total in 95% of patients. MPJ stiffness was related to gastrocnemius retraction, osteoarthritic degeneration, and residual deformation (p< 0.05). Subjectively, 72% of patients were satisfied or very satisfied, corresponding to 73% good or very good results. At last follow-up M1P1, M1M2 and DMAA had decreased significantly (p< 0.001) respectively improving from 33° to 18°, 14° to 9.5° and 13.2° to 9.4°. Conversely, mean P1P2 and PAA increased significantly (p< 0.05) because certain inter- and intraphalangeal deformations, radiographically masked by the preoperative hallux pronation, were not corrected. There were 29 recurrences (MP angle > 25°) statistically related to under correction of the intermetatarsal angles (p< 0.0001), M1M5, DMAA (p< 0.05), persistent hallomegaly (p=0.015), and presence of an oblique cuenometatarsal space (p=0.02). Recurrence was more frequent in patients with flat foot (p=0.04); greater calcanceal valgus was associated with wider MP angle (p=0.02).

Discussion and conclusion: Scarf osteotomy enabled complee correction of 80% of the deformations. To improve the final outcome, displacement of the first metatarsal should correct the metatarsus varus and the DMAA. Careful radioclinical analysis pre- and intra-operatively should held detect posterior (flat foot) and anterior (hallomegaly, inter- and intraphalangeal crossover) of the MPJ because they significantly influence persistence or recurrence of the deformation.

We compared the long-term function of subscapularis after the Latarjet procedure using two surgical approaches. We treated 102 patients (106 shoulders) with a mean age of 26.8 years (15 to 51) with involuntary unidirectional recurrent instability. The operation was carried out through an L-shaped incision with trans-section of the upper two-thirds of the muscle in 69 cases and with a subscapularis split in 37. All clinical results were assessed by the Rowe and the Duplay scores and the function of subscapularis by evaluating the distance and strength at the lift-off position. Bilateral CT was performed in 77 patients for assessment of fatty degeneration. The mean follow-up was 7.5 years (2 to 15) and 18% of cases were lost to follow-up. The mean Duplay score was 82 of 100 for the L-shaped incision group and 90 of 100 for those with a subscapularis split (p = 0.02). The mean fatty degeneration score was 1.18 after an L-shaped incision compared with 0.12 after subscapularis split (p = 0.001). The subscapularis split approach is therefore recommended.

Purpose: Failure is still observed after 20% of acromioplasties which can be explained by acromioclavicular osteoarthritis. The purpose of this study was to demonstrate the deleterious effect of this degeneration on outcome.

Material and methods: We reviewed 103 arthroscopic acromioplasties performed in 100 patients who presented non-torn non-calcified tenopathies. Seven patients were excluded so 96 patients, 63 women and 33 men were retained for analysis. Mean age at operation was 48.2 years and mean follow-up was 3.8 years. Patients were divided into two groups on the basis of the sonographic findings: group 1 had no computed tomography (CT) signs of acromioclavicular osteoarthritis (66 patients), such signs were found in group 2 (30 patients). Each patient was reviewed clinically and CT-scan was used to diagnosis osteoarthritis classed as stage 0 to 3. Subjective outcome was assessed in terms of patient satisfaction and objectively with the Constant score.

Results: Subjectively, three-quarters of the patients in group 1 were satisfied versus one-third in group 2. The Constant score confirmed this finding with a mean 76 points in group 1 versus 68 in group 2 (the weighted score was 93.5% and 83% respectively). The weighted score showed that good or excellent results were achieved in 84.84% of the patients in group 1 and in 43% in group 2.

Discussion: Our results are in agreement with data in the literature and provide scientific evidence of the influence of acromioclavicular osteoarthritis on the failure of acromioplasty. The results in group 1 were clearly better than in group 2, proving statistically a widely accepted notion: acromioclavicular osteoarthritis compromises significantly outcome of acromioplasty. Furthermore, it is interesting to note that among the seven cases excluded (for resection of the articulation), six had satisfactory outcomes.

Conclusion: These results confirm the unfavourable influence of acromioclavicular osteoarthritis on the outcome of acromioplasty. A prospective study designed to determine the effect of simultaneous acromioclavicular resection would be useful to propose a coherent therapeutic approach.

Purpose: Mediotarsal arthrodesis can correct the deformation and relieve pain in adults with reducible talipes planovalgus. We assess clinical and radiological outcome.

Material and methods: This retrospective analysis involved 22 cases of reducible talipes planovalgus (Johson stage 2) in 19 patients (eleven men and eight women), mean age 43 years (15–75). Clinical assessment was based on pain, function and motion (AOFAS and Mann). AP and lateral weight-bearing radiographs with Meary cerclage were used to determine the Djian angle, talometatarsal alignment, talar tilt, calcaneal valgus, and stage of osteoarthritis in adjacent joints.

Results: Mean follow-up was 88 months (6–243). Two non-unions evolved favourably after cancellous graft. The Kitaoka score was 73.5 points/94 (53–94). Pain and function improved respectively from 2.8 to 1.1/4 points and 3.5 to 1.6/4 points on the de Mann scale. Flexion-extension remained unchanged. The foot was well aligned in 68% of the cases (7.5 points). Mean talar tilt and talocalcaneal divergence were normalised but defective Djian angle persisted with a broken de Meary line in 98% and 41% of cases respectively. Calcaneal valgus was reduced 6.6° (16.6 to 10°) and podoscopy showed that flat foot persisted in 86% of the cases. In 50%, neighbouring joints presented progressive osteoarthritic degeneration with clinical impact in only one patient (4.5%). Subjectively, 73% of the patients were satisfied or very satisfied and none of the patients were disappointed. The objective outcome was excellent or good in 68% of cases.

Discussion: Pain, function, motion, complications and rate of satisfaction were comparable with data in the literature (Mann, Baxter, Steinhäuser). Mediotarsal arthrodesis is effective against pain and allows satisfactory recovery of function without morbidity greater than talonavicular arthrodesis (Harper). However, while the foot is well aligned in the majority of the cases, the plantar vault is poorly restored clinically and radiologically. Compensatory over-motion of the adjacent joints probably leads to bone remodelling and moderate asymptomatic osteoarthritis seven years after the procedure.

Purpose: Arthroscopic tenotomy of the long head of the biceps brachial is indicated for pain relief in the treatment of unrepairable tears of the rotator cuff. The purpose of our study was to evaluate clinical and radiological outcome.

Material and methods: This retrospective study included 38 patients (21 women and 17 men) mean age 65 years (44–78) who presented rotator cuff tears that could not be repaired by suture. These patients underwent arthroscopic tenotomy associated with acromioplasty in eight cases. Preoperative imaging included arthroscan and standard radiograms to assess retraction of the supraspinatus stump and fatty degeneration. The clinical outcome was assessed with the Constant score and search for loss of biceps force (estimated in comparision of an age- and gender-matched cohort). Modifications of the subarcomial height and the stage of joint degeneration were assessed on AP radiograms (standing and reclining position).

Results: Mean follow-up was 31 months. There were no complications related to the operation. The overall constant score improved 19 points from 39 to 58 (pain +7 and motion +6.1 increased most). The activity score improved 6 points. Active joint motion in antepulsion, abduction, and lateral rotation (elbow to body) increased 36.5°, 13.1° and 20.8° respectively. The sub acromial height decreased very little (from 7.4 mm preoperatively to 7.4 mm postoperatively). We observed a 37% decrease in arm force in flexion/supination on the operated side (6.05 kg vs 9.65 kg). Subjectively, 85% of the patients were very satisfied or satisfied, 10% were disappointed and 2.5% were discontent. For 88% of the patients the decision for surgical intervention was wise.

Discussion: Tenotomy of the long head of the brachial biceps is effective for pain relief and consequently joint motion. It is a technically simple procedure which does not accelerate degeneration of the excentered joint, at the follow-up considered. It does however reduce flexion force of the arm.

Purpose: The distal tibiofibular joint is implicated in ankle movement but has been the topic of less work than the talotibial joint. Its mobility within the talo-crural complex has not been described in detail as precisely as its static role. The purpose of this work was to develop a simple noninvasive method for characterising in vivo the mobility of the fibula at the ankle level between is positions in dorsal and plantar flexion.

Material and methods: We used 32 computed tomo-graphic studies of the ankle in 16 healthy volunteers (men and women), one study in each position of ankle flexion. We identified one cross-sectional slice through the syndesmosis in each of the two positions. A medio-lateral reference line was drawn tangent to the posterior cortical of the tibial metaphysis. The displacement of the fibula in relation to the tibia when moving between the two positions of ankle flexion was calculated using a remarkable landmark on the tibia, the anterior rim of the posterior tibial incisure, and the polar co-ordinates of the ends of the anteroposterior axis of the fibula.The repeatability and reproducibility of this method were tested.

Results: Repeatability was satisfactory for translation movements. Reproducibility was fair except for the reference line where it was good. When the ankle moved from dorsal flexion to plantar flexion, the fibula moved medially 1.25 mm (0.03–2.58 mm) (p< 0.0001) without correlation with the amplitude of the ankle flexion. Mean anterioposterior displacement was 0.46 mm (NS) with a wide range from −1.58 to +7.2 mm. It was correlated with lesser amplitude of ankle flexion.

Discussion: This dynamic method confirms published data concerning active mediolateral tibiofibular approach during plantar flexion. The results point out the variability of the anteroposterior movement of the fibula, the influence of the amplitude and the flexion position of the ankle, and the possible antepulsion effect of fibular tendons. The three-dimensional movement of the ankle joint merits further study including its tibio-fibular and talofibular components in view of potential prosthetic repair of the ankle.

Conclusion: Distal tibiofibular mobility is undeniable. We call for more work to achieve a better understanding of the lateral component of the talocrural complex.

Purpose: We examined the long-term effect of the Latarjet-Patte procedure on subscapularis function and trophicity.

Material and methods: The series included 102 patients (106 shoulders) reviewed at a mean follow-up of 7.5 years. The subscapularis was opened by dissection along the direction of the fibres in 27 shoulders (group I) and via inverted-L tenotomy in 69 (group II). Duplay and Rowe scores were used to assess clinical outcome. Subscapularis function was measured with the hand-back distance and the Gerber lift-off test in comparison with a control group composed of healthy subjects in order to account for limb dominance. Computed tomography was used to measure fatty degeneration and muscle atrophy.

Results: The Duplay and Rowe scores gave 76.4% and 87.7% satisfactory results. The Duplay score was 89.9/100 in group I and 82.1 in group II (p = 0.02). The hand-back distance and muscle force as judged by the lift-off test were statistically different between the dominant and non-dominant sides (p = 0.001). Loss of muscle force was greater for dominant sides in the operated shoulders. The mobility score, the lift-off test, and the hand-back distance were significantly altered in group II patients. Fatty degeneration of the sub-scapularis was greater on the operated side (0.76 vs 0.054) (p = 0.001). It increased with age at surgery and at review (p = 0.0001), for dominant shoulders in group II (1.18 vs 0.12). It affected the Duplay score (p = 0.006), the hand-back distance, and the lift-off test (p = 0.01). Fatty degeneration was greater than 2 in 66% of the shoulders with a poor outcome and persistent apprehension in 35.3%. Subscapular atrophy was greater on the operated side (0.91 vs 1.17) (p = 0.0001) and was statistically correlated with fatty degeneration, the Duplay score, the lift-off test, and the hand-back distance. It was greater in group II (0.71) than in group I (0.2).

Discussion: Recovery of muscle force is better for dominant shoulders. Muscle trophicity and function are influenced by subscapular tenotomy that leads to significant loss of internal rotation force, atrophy, and fatty degeneration affecting final long-term outcome.

Conclusion: We recommend discission of the subscapularis for coracoid bone block procedures.

Purpose: We analysed outcome of 106 Latarjet-Patte procedures at 7.5 years mean follow-up. Computed tomography of 80 bone blocks provided further details.

Material and methods: One hundred two patients (106 bone blocks), mean age 34 years, were reviewed at a mean 7.5 years follow-up. The sex ratio was 5/1 M/F. The accident had occurred at a mean age of 22 years, by trauma in 87% of the cases, generally involving the dominant limb. Eighty-seven patients practised sports, a high-risk sport in 48% of the cases. Clinical outcome was assessed with the Duplay and Row score, radiographs and a bilateral computed tomography scan in 80 cases.

Results: Postoperative morbidity was 12% and only required revision surgery in 2.8% of the cases. Posterior pain required screw ablation in 6% of the cases. Global outcome was excellent or good in 66% of the patients and 60% of the patients who practised sports were able to resume their activities at the same level. Painless shoulders were achieved for 70% of the patients. There was one post-traumatic recurrence and residual apprehension in 13% of the cases. Grade 3 or 3 osteoarthritis was present in 15% of the cases with a clear narrowing of the joint space in 3.5%. The CT scans were less favourable, showing global or posterior joint space narrowing in 17.5% of the cases. Monocortical screwing led to nonunion in 7%. Advanced osteolysis led to pain with alteration of the functional score.

Discussion: Postoperative complications deteriorated the global result. Overly long malleolar screws led to posterior pain with fatty degeneration of the infraspinatus. Osteoarthritis and “inverted L” subscapularis were the main factors related to loss of rotation. Persistent apprehension was not related to technical error, but to exaggerated anteversion of the humeral cap, basically due to the presence of a notch. Revision scans clearly contributed to the evaluation of the bone block and its position. It allowed a more objective assessment of the osteoarthritis, showing that plain radiographs underestimated both incidence and gravity related to delay after surgery, patient age and the overhanging property of the joint stop.

Conclusion: The Latarjet-Patte procedure has given satisfactory results that can be improved with rigorous technique. Computed tomography provides a more objective analysis of the results.