Results and longevity of total knee arthroplasty depend on the correction of axis of the lower limb and the stability of the prosthesis. Faithful to the principle of dependent cuts, our goal was to obtain two equal correlated, rectangular extension and flexion gaps using a ligament balancing tensor called CORES^® (Stryker^®).

Material and Methods: We retrospectively studied the results of a continuous series of 122 total knee arthroplasties (Jade^®, Stryker^®) implanted by only one operator, between December 1994 and 1997. The mean follow-up is 9,5 years. Tibial plateaus were slip and fixed, with or without conservation of the posterior cruciate ligament. Mean patient age at implantation was 71,2 years. 94% had osteoarthritis and 6% rheumatoid disease. The mean preoperative IKS score was 23,4 and the IKS function score was 42,6. 16% of knees were aligned normally, according to the IKS criteria, 24% presented valgus > 4°, and 60% presented varus > 3°. Patella was centred (AA’ distance < 3mm) in 65% of cases and not tilted (alpha angle< 5°) in 41% of cases. There were 22% antero-medial and 78% antero-lateral with ATT eversion approaches. All tibial and femoral components were cemented. Resurfacing patella was not the rule (5%). Clinical outcome was assessed with the IKS score and radiological outcome with the IKS criteria.

Results: There were no early complications. At follow up, the mean IKS knee score was 90 points with mean motion 109°. Mean IKS function was 85 points. 82% of the knees were aligned (HKA angle between 177° and 183°), 7% in varus, and 11% in valgus. Patella position was centered in 80% of cases, and tilted in 8%. No patellar dislocation was observed. Radiolucent lines were observed in 20% of the tibial components, without aseptic loosening. 3% of the femoral component presented radiolucent line, and one was symptomatic. Four TKA were removed at ten and eleven years, corresponding to three deep haematogenous infections and one aseptic loosening (a young man with haemophilic arthritis). Arthroplasty survival rate was 95% at 9,5 years (Kaplan-Meier method), considering all reasons for removal, and 99,4% for removal for aseptic loosening with 95% confidence interval.

Discussion: Since a well-balanced distribution of medial and lateral contact forces avoids overload of one compartment and thus premature wear, knee imbalance assessment is a key point in TKA. This method allows ongoing intraoperative assessment of the angular and rotational correction, bone defect, as well as bone resection levels.

Conclusion: To our knowledge, our study report the first results at 9,5 years of a TKA based on dependent femoral cuts using a ligament tensor. This confirms the durability and longevity of this model of prosthesis, and the accuracy of the method.

Purpose of the study: Spontaneous repair of lost deep chondral tissue is minimal in the knee joint. A clinical trial of chondrocyte autografts as described by Brittberg and Peterson was undertaken by the Nantes University Hospital and the French Society of Arthroscopy in 1999.

Material and methods: Twenty-eight patients, mean age 28 years, underwent surgery in eight centers. Etiologies were: osteochondritis (n=14), isolated posttraumatic chondorpathy (n=7), chondropathy and full-thickness ACL tear (n=7). All lesions involved the condyles and were deep (ICRS grades 3 and 4). Mean surface area involved after debridement was 490 mm2 (range 150–1000 mm2). Patients were followed three years after the autologous grafting to assess functional outcome. An MRI was obtained at 2–3 years. Thirteen control arthroscopy procedures were performed including eight with biopsy specimens for histology and immunohisto-chemistry studies.

Results: Twenty-six patients were reviewed at more than two years. There were no general complications, three patients presented a partial avulsion of the graft treated by arthroscopy and one underwent arthrolysis at six months. Function improved in all patients except three and pain improved in all. The ICRS score improved from 43 points (range 19–70) to 77 points (range 39–84). Sixteen control MRIs were available and showed that the graft was hypertrophic in eleven cases, on level in four, and insufficient in one. Marginal integration was good in 11 cases and partial in five. Subchondral integration was complete in ten cases and mediocre in six. The arthroscopic score was nearly normal (score 8–11) in eight cases and abnormal in five (score 4–7). The histological class according to Knutsen (hyaline richness) was: one in group 1 (> 60%), three in group 2 (> 40%), four in group 3 (< 40%) and one in group 4 (bony or fibrous tissue). Function score (r=0.78 and MRI score (r=0.76) were correlated with arthroscopic sores. There was no correlation with the histological results.

Discussion: Clinical outcome was improved in more than 80% of cases, similar to results reported for histological series. The arthroscopic and histological results were equivalent to those reported by Knutsen but inferior to those reported by Bentley or Peterson.

Purpose of the study: The objective of this retrospective analysis was to examine the functional and radiographic results of 33 resvisions for femoral implants using a long locked stem inserted without cement and coated with hydroxyapatite.

Material and methods: Mean follow-up was two years for 33 patient who underwent revison total hip arthroplasty (rTHA) with implantation of a press-fit long locked hydroxyapatite coated femoral stem (Aura or Linea) between 2000 and 2004. The explanted prosthesis was cemented in 23 cases. The reason for revision was femoral loosentng for 60%, femoral fracture for five pateints, and infection for two. According to the SOFCOT 1999 criteria, ten patients had bone defects score grade III or IV. Femorotomy was performed in 21 cases. Patients were reviewed clinically and radiologically. Function was assessed with the Postel-Merle-d’Aubligné (PMA) score and radiographic analysis determined the quality of osteointegration of the implants and the restitution of bone stock.

Results: There were six early complications (one death, one disloction with sciatic paralysis), and six late complications, mainly related to defective locking. The PMA score was less than 3 for only three patients. Twenty-six patients were satisfied or very satisfied and seven patients reported thigh pain which was generally moderate. The locking was released for five prostheses because of failure or pain (relief observed in three cases). Migration was noted in three cases, illustrating their non-integration. For 15 patients, corticalisation around the lower part of the prosthesis suggested implant mobility. This image was observed in all patients who complained of thigh pain (p=0.057). There was a significant increase in the cortical index, reflecting progression of the bone stock favoring the internal cortex.

Conclusion: This type of implant has provided a solution for the difficult problems of explantation and reimplantation of THA. These prostheses provide satisfactory short-term results and a significant improvement in bone stock. There remains the problem of osteointegration of certain implants. Technical factors can contribute to improved clinical results.

Purpose of the study: Free patellar tendon plasty is the most common technique for repairing anterior knee laxity. Functional outcome can be compromised by invalidating knee pain. The purpose of this prospective randomized study was to compare the outcome of plasty procedures using hamstring tendon versus patellar tendon autografts.

Material and methods: From May 1998 through May 2001, 100 patients presenting an isolated grade I anterior cruciate ligament (ACL) tear were included. Exclusion criteria were: history of fracture, advanced-stage laxity (grade II or greater), and contralateral ACL tear. Randomization was performed in the operative theater using the closed envelop method. Two groups of 50 patients were designated: group A: arthroscopic free bone-tendon-bone patellar autograft; group B: arthroscopic free four-strand hamstring autograft. Two metallic interference screws were used for fixation in both groups. The two groups were comparable for demographic features and clinical, radiological, and instrumental laxity variables recorded before surgery. The position of the tunnels was noted according to Aglietti and was the same in the two groups. The same rehabilitation protocol in a dedicated center was used for both groups. All patients (none lost to follow-up) were assess using the IKDC 1993 criteria with objective instrumental measurement of residual laxity. The level of significance was set at 5%.

Results: There was no significant difference between the groups regarding: resumption of sports activity (level and delay), joint motion, ligament examination, the overall IKDC score, and radiological findings ate mean 40±13 months (range 13–69 months) follow-up. Pain at the harvesting site was observed in 34.78% of patients in group A at six months and in 39.5% of those in group B. Conversely, anterior pain was found in 8.5% of patients in group B at six months and 6.6% at one year (p< 0.05). This statistically significant difference disappeared at two years. Instrumental differential laxity was 0.57±1.3 mm in group A and 1.22±1.9 mm in group B (p=0.56, but with power < 80%). There were two cases of repeated traumatic tears in each group. Repeated meniscectomy was performed in one patient in group A and in three in group B (p=0.3074).

Conclusion: The results at 40 months follow-up of this prospective randomized study with no patients lost to follow-up confirmed the minimal morbidity observed at the harvesting site for hamstring plasty. There was no significant difference between the transplants (patellar tendon, hamstring). Anterior pain with the patellar tendon plasty attenuated after two years. Residual laxity was greater when using the hamstring method.

Purpose of the study: The purpose of this retrospective study was to analyze outome at more than one year of 33 anterior cruciate ligament (ACL) ligmanetoplasties performed in subjects aged over 50 years.

Material and methods: Between 1997 and 2002, arthroscopic ACL ligmantoplasty with a free graft was performed for 33 patients aged 50–67 years (mean 55.2 years). All patients were reviewed clinically and radiologically at least one year after surgery (mean follow-up 31 months, range 12–60 months). IKDC criteria and manual KT-1000 measurements were recorded. All subjects were classified C or D before the operation (IKCD 93 criteria). Plain x-rays were considered normal for 21 patients (63.5%) and eight (24%) presented remodeling of the medial femorotibial compartment or the intercondylar eminences. Four knees (12.5%) presented an asymptomatic narrowing of the medial femorotibial space (< 50%). In all patients, the indication for surgery was instability for daily life and/or sports activities, even for patients presenting an asymptomatic narrowing. An inter-articular patellar tendon graft, using two independent tunnels was performed for 29 patients. A hamstring plasty was performed for the others. Mean time from injury to surgery was 18 months. There were 15 lesions of the medial meniscus (45.5%). Six lesions were not repaired because they were considered stable. The lateral meniscus was involved less often (n=11 lesions). The lateral meniscal stock was preserved in nine knees. The rehabilitation protocol was the same as used for ligamentoplasty in young sportive patients.

Results: There were no intraoperative complications. Supplementary fixation of the tibia was required for three knees. All patients resumed their sports activities at the same level. The overall IKDS score was A for eight patients, B for 19 and C for six. For the patients in class C, the poor IKDC score resulted from persistent pain, generally present before the operation. Joint motion was preserved in 30 patients. IKDC laxity was A or B in all patients. At last follow-up, there was no radiological worsening and no meniscal injury left unrepaired required secondary treatment.

Conclusion: The operative technique was joint instability for daily life activities. Stability was improved in all patients, but the surgery did not improve pain relief. Age greater than 50 years is not a contraindication for arthroscopic reconstruction of the central pivot for chronic anterior instability. Fixation of the implant must be precise. The indication for surgery depends on the severity of the instability for daily life activities in a motivated patient.

Purpose of the study: The issue of which graft to choose for anterior cruciate ligament (ACL) reconstruction is still a matter of debate. An analysis of the literature reveals the difficulty encountered when performing comparative trials. It is also difficult to demonstrate significant differences with results obtained with an insufficient number of patients. We propose here a meta-analysis in order to combine the results obtained with different comparative studies.

Material and methods: The literature search (Medline 1990–2005) was based on the following selection criteria: ACL reconstruction, patellar tendon (PT), gracilis and semitendinous (four-strand hamstring) reconstruction and comparative prospective study. Studies were retained with: > 30 patients per group, minimum follow-up 24 months, IKDC score. Evaluation criteria retained were: anterior pain, resumed activity, IKDC score, differential laxity. The relative risk (RR) statistical method with 95% confidence interval (CI) was applied. Means were calculated and the chi-square and z-tests were applied.

Results: Thirteen studies satisfied our inclusion criteria. These studies had included more than 1300 transplants. Mean rate of anterior pain was 23.2% with PR and 17.3% with hamstring reconstructions. The RR was 0.73 with a CI different from 1. The difference was significant. Resumption of sports activities at the same level, subjective assessment, number of failures, and overall IKDC score were not statistically different between the two types of transplants. The IKDC laxity score was not different but the residual maximal manual differential laxity was greater in the hamstring patients than in the patellar patients in 80% of the cases.

Conclusion: At the observed follow-up, free grafting with a four-strand hamstring tendon or a patellar tendon is an effective method for reconstruction of the ACL. Anterior pain is more frequent with the patellar tendon method and residual laxity is greater with the hamstring method. The long-term outcome will determine whether the residual laxity observed with the hamstring graft has a deleterious effect on the meniscocartilaginous structures. This criteria would minimize the advantage of this technique over the patellar tendon technique concerning the initial anterior pain.

Purpose: The risk of recurrence and progression to chronic instability after a first episode of anteromedial shoulder dislocation is high in young patients. Risk assessment has varied in published reports but is constantly high in subjects aged less than 25 years. The injuries occurring during the first episode are poorly identified and rarely treated. We thus propose an arthroscopic assessment for young subjects with sports activities to identify lesions and achieve stabilisation after the first dislocation. The purpose of this work was to report the lesions observed and present our surgical protocol.

Material and methods: Between February 2002 and March 2003, we included fifteen patients in a prospective study. All patients were aged 17–25 years at the first episode of traumatic anteromedial dislocation of the shoulder. The patients were informed of the “usual” orthpaedic treatment and of the risk of recurrence. We proposed an arthroscopic assessment of their lesions and concomitant treatment. All patients accepted this therapeutic alternative. All procedures were performed by the same operator within ten days of dislocation. Patients were immobilised for 21 days with an elbow to body brace followed by rehabilitation in an outpatient setting, avoiding external rotation for 21 days. The Duplay score was determined.

Results: In this prospective series of patients, we identified a haematoma, a Malgaigne notch, and disinsertion of the anteroinferior capsulolabral complex in all patients. We were unable to find any glenoid or ligament injury on the humerus. The cuff was intact in all patients except one who had a deep wound of the supraspinatus. Lesion suture with resorbable anchors was satisfactory in 14 patients. We have not observed any recurrences. Physical examination did not disclose any apprehension and there has been no case of altered external rotation (< 5).

Conclusion: Considering the major risk of recurrent dislocation after a first episode in these young patients, we have studied an alternative to orthopaedic treatment. All patients accepted the proposed arthroscopic treatment. All patients presented capsulolabral detachment which was easily treated. At last follow-up, all patients have recovered a pain-free stable shoulder. This was a small series with a short follow-up so these results must be considered with caution. They are nevertheless very encouraging.

Purpose: The purpose of our retrospective analysis was to describe results of arthroscopic treatment of painful ankle instability without clinical or radiological laxity.

Material and methods: Eighteen patients, mean age 27 years (seven men and nine women) were operated on by the same surgeon between 1999 and 2000. Sixteen patients (90%) were reviewed by an independent investigator at 20±4 months. Fifteen patients were athletes, ten at the competition level, and five had amateur sports activities. The accident caused forced inversion in 15/16 cases, during sports activities in 85.5% of the cases. Mean age at injury was 17±6 years. Mean time between the accident and arthroscopy was eight years. All patients had pain in the anterolateral region associated with effusion in 50% and apprehension or instability for daily life activities. Standard x-rays were normal in fourteen patients (87.5%). Comparative stress images did not demonstrate pathological laxity. Complementary imaging (MRI, CT scan, arthroscan, ultrasonography) was obtained in six patients with 50% negative results. Arthroscopy revealed anterior tissue interposition (antero lateral in thirteen patients (81%) and anteromedial and anterolateral in three) which was removed with the shaver. Joint cartilage was intact in fifteen patients (81.25%).

Results: At last follow-up, functional outcome was good in all patients who had all resumed their sports activities. Subjectively, six patients felt they had normal function, seven nearly normal function and three abnormal function (81% satisfied or very satisfied). Six patients were symptom free even during intense physical activity. Eight patients reported some difficulties for strenuous exercise and two for moderate exercise. Joint motion was normal in ten patients and 5° dorsal flexion deficit was observed in six. There were no recurrent sprains. The x-ray was normal and identical to the initial image in 87.5% of the patients. Globally, 87.5% of the patients had good or excellent outcome. Two patients had fair or poor outcome.

Discussion: Diagnosis of anterolateral ankle conflict can be established in patients with a compatible history and a typical clinical presentation with normal x-rays. Arthroscopic treatment can remove tissue interposition allowing good functional results and total recovery of sports activities. Complementary MRI or arthroscan have little specificity and poor sensitivity.

Purpose: The position of the femoral implant in external rotation remains a controversial issue. It can be determined using bone landmarks (Whiteside line, parallel to the biepicondylar axis, 3° external rotation from the posterior condylar plane). For the last seven years, we have related femoral rotation to the orientation of the tibial cut in order to ensure good femorotibial stability in flexion using specific instruments (Cores®). This prospective study was conducted to examine the position of the femoral implant determined with this method and to measure the position from bone landmarks.

Material and methods: Twenty consecutive patients were included in this study. Bilateral computed tomographic measurements were made before and after surgery. Joining 8mm/8 slices were obtained for the femoral necks and 5mm/3 slices for the knees. The angle of femoral torsion was defined in two ways: the first by the angle formed between the axis of the femoral neck (on two superimposed slices) and the tangent to the most posterior part of the femoral condyles; the second by the angle formed between the epidondylar line and the posterior condylar line.

Results: The preoperative scans demonstrated that the angle between the biepicondylar line and the posterior condylar line was 5.8±1.5°. Using Cores®, led to an external rotation of the femoral implant to 2.7±0.6°. The postoperative scans demonstrated that the angle between the biepicondylar line and the posterior condylar prosthetic play was a mean 3.3°. The measurements using the femoral neck were less precise, with, in one case, an external rotation of 5°. The patella was well balanced postoperatively (irrespective of the external rotation position of the femoral implant).

Discussion: The angle of about 6° between the biepicondylar line and the posterior plane of the condyles has also been reported by others (Beaufils, Matsuda). To obtain a rectangular space in flexion, the posterior condyle cuts are more important medially than laterally. We found a correlation between the correction provided by the specific instrument set and the difference in the posterior condyle cuts, demonstrating the intraoperative precision of Cores®. It is difficult to orient the femoral piece parallel to the biepicondylar axis. This study demonstrates that there always remains 2 to 3° of inclination of the biepi-condylar axis from the posterior condylar plane.

Conclusion: The positioning the femoral implant parallel to the biepicondylar line leads to inducing an important external rotation. While using 3° rotation systematically would reduce the risk of internal malrotation, we feel it better to adapt the rotation to each individual knee depending on the anatomic presentation. Cores® enables positioning the femoral implant in external rotation as a function of the ligament balance obtained in flexion after peripheral tension is applied. This enables avoiding medial femorotibial laxity in flexion.

Purpose: Free patellar tendon plasty is classically used for the treatment of chronic anterior instability of the knee. Good functional results may however be compromised by invalidating anterior pain. The purpose of this randomised trial was to obtain a prospective comparison of outcome after hamstring plasty or patellar tendon plasty.

Material and methods: One hundred patients with an isolated tear of the anterior cruciate ligament were included in the study between May 1998 and 2001. Exclusion criteria were history of fracture, grade II laxity, and tear of the contralateral ACL. Patients were assigned to one of the treatment arms in random order in the operating room: Group A: arthroscopic free patellar tendon-bone graft; Group B: arthroscopic free four-strand hamstring graft. Two metal interference screws were used for fixation in all cases. The Aglietti method was used to calculate the position of the bore holes in all cases. The same rehabilitation protocol, in the same centre, was applied in all cases. The two groups were comparable for epidemiological, clinical, radiological, and instrumental laxity (KT1000®) data. IKDC criteria, activity level (sports), and instrumental measurement of laxity (KT1000® Medtronic) were used to assess outcome. Differences were considered significant for p < 0.05.

Results: At mean follow-up (24 months, range 6 – 38) groups A and B were not significantly different for delay to resumed sports activity at the initial level, motion, clinical examination of ligaments, IKDC global score, and radiological evolution. At six months, 30% of the patients in group A complained of anterior pain; 20% of the patients still complained of pain at one year. In group B, femoropatellar pain or pain at the harvesting site was reported by 8% of the patients at six months and 4% at one year (p = 0.0005). These differences were no longer present at two years. The instrumental differential laxity was 0.66±1.1 mm in group A and 1±1.5 mm in group B (p =0.20). Two repeated trauma-induced tears were observed in group B.

Conclusion: The preliminary results of this prospective randomised trial confirm the low morbidity of the harvesting site for hamstring grafts and the reliable stability of hamstring repair of isolated ACL laxity. A longer follow-up is however needed for long-term validation, particular concerning secondary distension of hamstring grafts as is frequently reported in the literature and which we have also observed in certain patients treated before this series.

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.