Introduction

Proper rotational alignment of the tibial component in total knee arthroplasty (TKA) could be achieved using several techniques. The self adjustment methodology allows the alignment of the tibial component under the femoral component after several flexion-extension movements. Our hypothesis was that this technique allowed a posterior tibial component alignment parallel to the femoral component posterior bicondylar axis. The aim of this study was to access this hypothesis using a post-operative CT-scan study.

The bare area of the humeral head is limited in front by the cartilage and backwards by the insertion of the Infra Spinatus tendon. There are few references in the current literature. The aim of this work was to precise the anatomic description of the bare area and to compare the size of this area in patients with anterior shoulder instability and patients without anterior shoulder instability.

Purpose of the study: Tibial osteotomy to correct for varus deformity is a well defined procedure. Survival has reached 80% at ten years. Nevertheless, a number of early failures are related to inadequate initial correction. Computer assisted surgery has demonstrated its efficacy for knee arthroplasty. We hypothesised that it could also improve the reliability of correction for tibial osteotomy.

Material and method: From 2007, in a prospective case-control study, 34 tibial wedge osteotomies were performed, 17 were computer assisted (Navitrack, Orthosoft) with plate fixation (Tomofix, Synthès) without wedge insertion; the objective was valgus measuring 2 to 5°.

Results: The two series were comparable for age (54.2±6 and 55.7±4.5), body mass index (28.9±6.2 and 28.7±5.7), and varus deformity (7.2±3 and 6.2±6) respectively in the standard and navigated groups. Osteoarthritis was more severe in the navigated group, with five patients stage 2 and 12 stage 2 versus one stage 1, 12 stage 2 and 4 stage 3 in the standard group (p=0.0152). The duration of the operation was not longer in the navigation group (p)0.2779). Comparisons were made for alignment at three months, between the groups and in relation to the preoperative data. There was no significant difference between the intraoperative navigation alignment and the alignment measured at 3 months: 3.6±6 and 2.5±3 at 3 months (p=0.2187). At 3 months, there was no significant difference in alignment between the two groups with 3.22 and 2.5±1.6 valgus in the standard and navigation groups respectively (p=0.2136). The objective was achieved in 25 patients: 12 in the standard group and 13 in the navigated group. In the navigation group, there were four failures, no cases of over correction, two cases of insufficient valgus at 1.5, one neutral alignment, and one recurrent varus. In the standard group, there were five failures with two over corrections at 7 and 8, two under corrections at 0 and 1, and 1 recurrent varus at 4.

Discussion: We were unable to prove that navigation improves the reliability of the correction but it did appear to avoid important errors, particularly over correction. Few series have compared standard varus navigated osteotomies, and all published series have been small. Our study has the advantage of being monocentric with two comparable series of patients. The sample size nevertheless remains small and the follow-up short.

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.

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.

Introduction: Lateral meniscectomies lead to degenerative arthritis and therefore meniscus transplantation has been considered. In literature, this procedure appears to have good clinical results. The aim of this study was to evaluate our clinical results at mid-term follow-up and to correlate these results to the morphology and position of the transplanted meniscus.

Material and methods: Twenty-eight patients operated in 4 surgical centers, were retrospectively reviewed following lateral meniscal allograft transplantation. The mean age of the patients was 34 years (range, 18 to 50 years). Before surgery, all these patients suffered of permanent lateral femorotibial pain without radiological knee arthritis. The knees were all stable or stabilized, without axial malalignment of the lower limbs or corrected by a concomitant high tibial osteotomy. Arthroscopic procedure was performed for 9 patients and arthrotomy for 19 patients. Different techniques of fixation of the transplant were used, with or without bone plugs. The associated procedures were 2 ACL reconstruction, 3 high tibial varus osteotomies, and 1 mosaicplasty. The IKDC score were used for the analysis of the functional results. An arthroTDM or an arthro MRI was used to analyse the morphology and position of the transplanted meniscus.

Results: The mean follow-up was 35 months (range, 12 months to 6 years). The mean post-operative subjective IKDC score was 65.5 points (range, 19.5 to 89 points). There were 2 failures associated with a fast arthritic evolution and 2 functional bad results. The others 24 patients (85%) were satisfied or very satisfied, with a real improvement of the pain and the function. Seventeen patients (60%) have started again a sportive activity superior than the one pre-operating. At the last follow-up, all transplanted meniscus have healed, but the morphology and position of the transplanted meniscus was not always normal with absence of the middle segment in 3 cases; its extrusion in 9 cases, a posterior segment shortened or partially hurt in 5 cases and its absence in 3 cases. Better results were associated with good meniscus positioning and morphology.

Discussion: Our works confirm that lateral meniscal allograft is a therapeutic option with favourable results in terms of pain reduction and functional improvement in the medium term for symptomatic patients after lateral meniscectomy. Our results are comparable with those of the literature. The allograft is technically reliable, reproducible notably for the methods of fixation. A long term follow-up is necessary to evaluate the benefit of these grafts on the protection of the cartilage.

Purpose of the study: The aim of this prospective study was to assess functional outcome one year after meniscal repair and to correlate them with healing as assessed by arthroscan performed systematically at six months. Follow-up was 12 to 28 months.

Material and methods: Forty one meniscal repairs were included (28 medial and 13 lateral menisci). There were 33 longitudinal vertical tears, five horizontal cleavages in young athletes, one hypermobile meniscus and two complex lesions. The meniscal repair was associated with ACL reconstruction in 26 cases. In six cases, meniscal repair was an open procedure, in 34 a medial arthroscopic procedure and in one a combined arthroscopic open technique. 71% of the tears were recent, 29% were chronic. Mean length of the lesion was 21 mm. Physical examinations were performed in all patients at six weeks, and 3, 6, and 12 months. The

IKDC score was established preoperatively and at 6 and 12 months. An arthroscan was obtained at six months.

Results: There were no neurological complications related to the open approach. In three cases, the suture was loose but without subsequent intra-articular loss. There were no infections. Three patients presented recurrent meniscal tears 12 to 26 months postoperatively: secondary meniscectomy in one and a new repair in another. Therapeutic abstention was proposed for the third (a hypermobile meniscus). Mean subjective IKDC score was 67.0 points preoperatively, 73.2 at six months and 83.6 at one year. Moderate pain persisted at one year in four patients. The six-month arthroscan showed complete or incomplete (but greater than 50%) healing of the meniscal surface in 33 cases and less than 50% healing in 8. Radiologically, healing was similar for medial and lateral repairs. The joint surface was normal in all cases on the plain x-ray.

Discussion: AT 12–28 months follow-up, the rate of recurrence was low (3/41), less than in a retrospective review reported by the French Society of Arthroscopy with the same follow-up. The technique has improved.

Conclusion: The one-year functional outcome is good. Complete healing as assessed on the arthroscan does not indicate the functional outcome at this follow-up.