Background

Traditional measurements of hindfoot alignment are based on the tibio-calcaneal angle and do not take the forefoot into account. We have developed an algorithm based on standard radiographs to calculate calcaneal offset using Ground Reaction Force (GRF).

Purpose

To investigate the prognostic effect of surgical margins in soft tissue sarcoma on Local Recurrence (LRFS), Metastasis (MFS) and Disease Free Survival (DFS).

Background

The Plantaris Longus Tendon (PLT) may be implicated in Achilles (AT) tendinopathy. Different mechanical characteristics may be the cause. This study is designed to measure these.

Purpose of the study: Conservative surgical treatment of osteochondritis dissecans (OCD) in adults raises the problem of integration of the sequestered bone. Mechanical techniques using screw fixation are often insufficient to achieve healing. Adjunction of a biological fixation with osteochondral graft tissue for a mosaicplasty might favour integration of the fragment. The purpose of this study was to assess the short-term outcomes in an initial series using a technique called fixation plus where screw fixation is associated with mosaiplasty.

Material and methods: This was a retrospective analysis of eight adults who underwent surgery from 2003 to 2008 for stage IIB or III (Bedouelle) OCD of the medial condyle. Loss of subchondral tissue could be filled with a cancellous graft. Clinical and radiographic (Hugston) parameters were noted. At three months, the screws were removed arthroscopically. The ICRS-OCD score was noted. At six months, five patients had an arthroMRI to evaluate fragment integration, determine its signal and vitality.

Results: Mean follow-up was 17.4 months (range 3–36). The Hugston score improved from 1.6 (0–3) preoperatively to 3.4 (2–4) postoperatively and the radiological score from 2.5 (2–4) to 3.2 (3–4). The arthroscopy performed to remove the screws revealed integration of the OCD fragment. The ICRS-OCD score was I in two cases, II in five and III in one. The postoperative arthroMRI confirmed continuity with the cartilage at the periphery of the fragment, with no passage of contrast agent into the defect.

Discussion: Screw fixation of OCD fragments is often followed by nonunion and thus failure. Moasaicplasty is an alternative but does not preserve quality cartilage cover (curvature, thickness, cover). The technique proposed here ensures osseous integration of he fragment, complete cartilage cover, and a smaller number of osteochondral pits. Fixation Plus associates mechanical and biological fixation with good preliminary clinical results. Comparative longer term assessment is needed to confirm its pertinence.

Purpose of the study: Acute compartment syndrome of the leg can lead to serious sequelae affecting patient autonomy. Retractile postischemic fibrosis leads to various deformities of the ankle and foot from simple claw toe to complex multidirectional dislocations. Aggressive surgery, or even amputation, may be needed to save soft tissue. Data are scarce on management practices for these deformities. We present a long-term follow-up.

Material and method: From 1981 to 2006, 150 patients with a compartment syndrome of the leg were managed in our unit. Ten of these patients later required repeated surgery directly related to the sequelae of the compartment syndrome affecting the foot and ankle. These patients were followed in our unit. Personal data, as well as potential risk factors and sequelae were noted. Data were analysed and compared with reports in the literature.

Results: For nine of the ten patients, the initial diagnosis was established late, for seven, more than 24 hours after onset. The anterior and lateral compartments were involved (10/10 and 9/10) and less often the deep posterior compartment (3/10), motor deficit (3/10) and sensorial deficit (5/10) of the tibial nerve. The deep posterior loge was the cause of late equine deformity in eight patients. Functional outcome was good in eight patients after secondary surgery. For the other two cases, leg amputation was the only solution.

Discussion: Complicated acute compartment syndrome of the leg most commonly involves the anterior and anterolateral compartments. Conversely, the posterior compartment is implicated in the development of invalidating sequelae. We analysed the different procedures used in the literature for managing these sequelae and established a classification. Effective treatment of the foot and ankle affected by a late postischemic syndrome depends on a rigorous surgical strategy taking into account the multidirectional and multifactorial aspects of the resulting deformity. Prevention nevertheless remains the most effective treatment, both by early initial aponeurotomy and by prevention of the secondary deformity.

Introduction: Clinical presentation of mucoid degeneration of the anterior cruciate ligament (MDACL) associated knee flexion limitation and posterior knee pain. Treatment needs an anterior cruciate ligament resection, with some questions about harmlessness of this procedure. Our hypothesis was that arthroscopic MDACL treatment is an effective procedure for pain and mobility but creates some anterior knee laxity.

Materials and Methods: This is a retrospective cohort study including 29 cases of MDACL (19 men, 8 women). Mean age was 49 years (range 28 to 68). Mean follow-up was 6 years. Diagnosis was done associated clinical and MRI criteria and was confirmed using Mc Intyre’s arthroscopic criteria. A histological analysis was done in 18 cases. Postoperative functional evaluation was done using IKDC and KOOS score. Knee laxity was appreciated using clinical evaluation and radiological evaluation by TELOS measurement. Statistical analysis was done using Student t-test (level of significance: p< 0.005).

Results: Preoperatively, posterior knee pain was present in 23 knees, and knee flexion limitation in 14 cases. In 10 cases, MDACL was initially misdiagnosed with an inappropriate primary operative treatment. None of theses patients have an anterior knee laxity. Partial anterior cruciate ligament resection was done in 12 cases and complete resection in 17 cases. Meniscectomy was associated in 11 cases. In cases with histological study, diagnosis was always confirmed. After resection knee was painless in 27 cases, and knee flexion increase was 21.52°. A positive Lachman’s test was noted after surgery in all cases, (with a positive Jerk test in 8 cases). Postoperative radiological laxity was greater on the operated side (operated knee vs normal knee: 12.64 /4.33 mm, p< 0.001) Two young patients have need secondary an ACL reconstruction. Two old patients have needed secondary knee prosthesis after 2 and 3 years. Mean postoperative IKDC score was 71.19 (range 42.53 to 91.95) and mean postoperative KOOS score was 78.16 (range 26.40 to 99). Statistical analysis have showed better results for patient older than 50 years, after partial resection and for patient without meniscal associated lesions.

Discussion: Mucoid degeneration of the anterior cruciate ligament should not be confused with anterior cruciate ligament ganglia. Accurate diagnosis could be done using clinical, MRI and arthroscopic diagnosis criteria’s. Arthroscopic treatment of MDACL is an efficient procedure for knee pain and to restore a better knee flexion. However, this procedure created a signifiant anterior knee laxity and could lead in some cases to knee instability especially in young patients.

Planning resection margins for soft tissue sarcomas is a compromise between functional sacrifice and therapeutic safety. In practice, the histological analysis of the resection margins often shows that the preoperative objective has not been achieved. We studied the prevalence and factors of risk of this surgical outcome.

This was a prospective monocentric study of 133 patients. The resection objectives, pathological results and operative reports were examined. Margins were classified according to the UICC (R0, R1, R2). Data were included in a grid which also included patient related and tumour related preoperative information. Inadequate resection was noted as planned R0 with R1 or R2 outcome. Statistical analysis was performed with Statview 5.0.

The prevalence of inadequate resection was 25.2%. Among the factors analysed, the aspect of tumor limits (badely or well defined) was significantly related to poor surgical results (odds ration 2.85 [1.47–5.52], p < 0.005). No other significant risk factor could be identified. Margins greater than two mm were associated with adequate surgery in every case.

No preoperative risk factor predictive of inadequate resection margins was clearly identified in this study. Postoperatively, the microscopic aspect of the proliferation limits at the final pathology examination is for us significantly associated with inadequate resection. However the current classification for resection margins lacks precision, especially regarding R0 and R1 when margins are small, in defining the risk of inadequate resection. This appears to be the source of the difficulties encountered in interpreting pathology samples and therefore in choosing the right treatment. Further follow-up is needed to clarify such questions.

We conclude that where resection margins are thin (less than two mm), the definition of R0 or R1 resections should be clarified to optimize patient care. To achieve this, potential risk factors for inadequate resection such as tumor limits should be taken into account and further studied.

Purpose of the study: Planning resection margins for soft tissue sarcomas is a compromise between functional sacrifice and therapeutic safety. In practice, the histological analysis of the resection margins often shows that the preoperative objective has not been achieved. We defined this as anatomo-surgical discordance and studied its prevalence and factors of risk.

Materials and Methods: This was a prospective mono-centric study of 133 patients. The resection objectives, pathological results and operative reports were examined. Margins were classified according to the UICC (R0, R1, R2). Data were included in a grid which also included patient related and tumour related preoperative information. Discordance was noted as planned R0 with R1 or R2 outcome. Statistical analysis was performed with Statview 5.0.

Results: The prevalence of anatomo-surgical discordance was 25.2%. Among the factors analysed, the aspect of the margins was significantly related to poor surgical results (odds ration 2.85 [1.47–5.52], p=0.0031). No other significant risk factor could be identified. Margins greater than 2mm were associated with adequate surgery in every case.

Discussion: No preoperative risk factor predictive of inadequate resection margins was clearly identified in this study. Postoperatively, the microscopic aspect of the proliferation margins at the final pathology examination is for us significantly associated with inadequate resection. But the current classification of resection margins (R0 and R1), especially for poorly delimited tumours lacks precision. This appears to be the source of the difficulties encountered in interpreting pathology samples and therefore in choosing the right treatment. Further follow-up is needed to clarify such questions.

Conclusion: We were unable to identify any preoperative factor predictive of inadequate resection. A poorly-defined microscopic aspect of the tumour is significantly associated with inadequate resection but the current classification system raises certain interpretation problems for resections with margins less than 2 mm. Concerning these cases, the definition of margins must be clarified to optimize patient care.