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Cavalier M, Jullion S, Kany J, Grimberg J, Lefebvre Y, Oudet D, Grosclaude S, Charousset C, Boileau P, Joudet T, Bonnevialle N. Management of Massive Rotator Cuff Tears: Prospective study in 218 patients. Orthop Traumatol Surg Res 2018; 104:S193-S197. [PMID: 30253987 DOI: 10.1016/j.otsr.2018.09.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Accepted: 08/23/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND No consensus exists about the management of massive and symptomatic rotator cuff tears (RCTs). The objective of this study was to compare the 12-month clinical outcomes of various treatment options for massive RCTs. HYPOTHESIS Arthroscopic surgery has a role to play in the treatment of massive and apparently irreparable RCTs. MATERIAL AND METHODS A prospective multicentre non-randomised study was performed in patients with massive RCTs managed non-operatively (NONOP) or by arthroscopic tenotomy/tenodesis of the long head of biceps (aTLB), arthroscopic partial tendon repair (aPTR), arthroscopic latissimus dorsi transfer (aLDT), or reverse shoulder arthroplasty (RSA). Clinical outcomes were evaluated based on the Constant score, Subjective Shoulder Value (SSV), and American Shoulder and Elbow Surgeons (ASES) score after 3, 6, and 12 months. RESULTS The 218 included patients (mean age, 69 years) were distributed as follows: NONOP, n=71; aTLB, n=26; aPTR, n=61; aLDT, n=25; and RSA, n=35. After 12 months, the mean Constant score, SSV, and ASES score values were 70, 68%, and 73, respectively, and had improved significantly versus the preoperative values in all treatment groups. RSA was the only treatment followed by improvements in all Constant score items. Active forwards elevation improved significantly in the NONOP (+25°), aPTR (+26°), and RSA (+66°) groups. An improvement in active external rotation was seen only in the RSA group, where it was small (+10°, p=0.046). Significant increases in internal rotation were seen in the NONOP (+1.6 points) and aPTR (+1.7 points) groups. CONCLUSION Arthroscopic techniques (aTLB, aPTR, and aLDT) for managing massive irreparable RCTs produce significant functional gains. Partial tendon repair (aPTR) and RSA may provide better outcomes than isolated aTLB or aLDT. LEVEL OF EVIDENCE III, non-randomised prospective study.
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Affiliation(s)
- Maxime Cavalier
- IULS, hôpital Pasteur 2, CHU de Nice, 30, voie romaine, 06001 Nice, France.
| | - Stéphane Jullion
- Centre chirurgical Emile Gallé, CHRU, 49, rue Hermite, 54000 Nancy, France
| | - Jean Kany
- Clinique de l'Union, 31240 Saint-Jean, France
| | | | - Yves Lefebvre
- Clinique Rhéna, 16, allée de la Robertsau, 67000 Strasbourg, France
| | - Didier Oudet
- Clinique de l'Alliance, 1, boulevard Alfred Nobel, 37540 Saint-Cyr-sur-Loire, France
| | | | | | - Pascal Boileau
- Clinique chirurgical du Libournais, 33500 Libourne, France
| | - Thierry Joudet
- Clinique chirurgical du Libournais, 33500 Libourne, France
| | - Nicolas Bonnevialle
- Service d'orthopédie, institut universitaire du sport, hôpital Riquet, CHU de Toulouse, 31059 Toulouse cedex 09, France
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- 15, rue Ampère, 92500 Rueil-Malmaison, France
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Ruyer J, Grosclaude S, Lacroix P, Jardel S, Gazarian A. Arthroscopic isolated capsular release for shoulder contracture after brachial plexus birth palsy: clinical outcomes in a prospective cohort of 28 children with 2 years' follow-up. J Shoulder Elbow Surg 2018; 27:e243-e251. [PMID: 29609998 DOI: 10.1016/j.jse.2018.01.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2017] [Revised: 01/14/2018] [Accepted: 01/22/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The primary objective of this study was to evaluate improvements in external rotation after isolated arthroscopic capsular release in children with shoulder contracture due to brachial plexus birth palsy. MATERIALS AND METHODS This study included all children older than 2 years with a range of active external rotation limited to 30° or less and/or active anterior elevation (AE) limited to 90° or less secondary to brachial plexus palsy treated between 2011 and 2015. Passive glenohumeral motion, passive global (glenohumeral plus scapulothoracic) motion, active global motion for external rotation with the elbow at the side (ER1), AE, and internal rotation with the elbow at the side were recorded before and 2 years after surgery. Improvement was evaluated by comparing the preoperative and follow-up values. The operation performed was subscapularis-sparing arthroscopic capsular release. RESULTS Thirty-five patients were included, and 28 completed 2 years of follow-up. The average changes in active global ER1, passive glenohumeral ER1, and passive global ER1 were +35° (range, -20° to +100°; P <.0001), +35° (range, +0° to +75°; P <.0001), and +26° (range, -15° to +60°; P <.0001), respectively. There were no significant changes in internal rotation with the elbow at the side or AE. The mean improvement in the aggregate Mallet score was 3.9 points (range, -3 to +9 points; P <.0001). CONCLUSIONS For children with shoulder contracture secondary to brachial plexus palsy, subscapularis-sparing isolated capsular release improves external rotation and functional scores and avoids any loss of active internal rotation but does not improve AE.
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Affiliation(s)
- Justin Ruyer
- Université Claude Bernard Lyon 1, Villeurbanne, France; Chirurgie Orthopédique et Traumatologie, Clinique du Parc Lyon, Lyon, France
| | - Sophie Grosclaude
- Chirurgie Orthopédique et Traumatologie, Clinique du Parc Lyon, Lyon, France
| | - Philippe Lacroix
- Médecine et Traumatologie du Sport, Clinique du Parc Lyon, Lyon, France
| | - Sabine Jardel
- Service de Médecine Interne et Pathologies Vasculaires, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Aram Gazarian
- Chirurgie Orthopédique et Traumatologie, Clinique du Parc Lyon, Lyon, France; Orthopédie et Traumatologie Pédiatrique, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Bron, France.
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Viste A, Piperno M, Desmarchelier R, Grosclaude S, Moyen B, Fessy MH. Autologous chondrocyte implantation for traumatic full-thickness cartilage defects of the knee in 14 patients: 6-year functional outcomes. Orthop Traumatol Surg Res 2012; 98:737-43. [PMID: 23026726 DOI: 10.1016/j.otsr.2012.04.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 03/22/2012] [Accepted: 04/05/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) was introduced in 1987 in Sweden by Brittberg and Peterson for the treatment of severe chondral defects of the knee. Here, our objective was to evaluate mid-term outcomes of ACI in young athletic patients with deep chondral defects of the knee after trauma. HYPOTHESIS ACI is effective in filling full-thickness chondral defects of the knee. PATIENTS AND METHODS We prospectively monitored 14 patients, with International Cartilage Repair Society grade III or IV lesions, who underwent ACI between 2001 and 2006. Standard evaluation measurements were used. Mean age at surgery was 37.7 years (range, 30-45). A history of surgery on the same knee was noted in ten (67%) patients. The defect was on the medial femoral condyle in 11 patients, lateral femoral condyle in two patients, and both femoral condyles in one patient. Mean defect surface area after debridement was 2.1cm(2) (1-6.3). RESULTS After a mean follow-up of six years, improvements were noted in 12 (86%) patients, with an International Knee Documentation Committee (IKDC) score increase from 40 (27.6-65.5) to 60.2 (35.6-89.6) (P=0.003) and a Brittberg-Perterson score decrease from 54.4 (11.8-98.2) to 32.9 (0-83.9) (P=0.02), between the preoperative assessment and last follow-up. The visual analogic scale pain score decreased from 66.3 (44-89) to 23.2 (0-77) (P=0.0006). In two (14%) patients, no improvements were detectable at last follow-up. The remaining 12 patients were satisfied and able to resume sporting activities, albeit at a less strenuous level. Two ACI-specific complications occurred, namely, periosteal hypertrophy treated with debridement in one patient and transplant delamination in another. DISCUSSION Our findings are consistent with previous reports but cover a longer follow-up period. Although the outcomes are promising, longer follow-ups are needed to confirm the long-term effectiveness of ACI. LEVEL OF EVIDENCE IV, prospective therapeutic study.
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Affiliation(s)
- A Viste
- Lyon Civilian Hospitals, Department of Orthopaedic Surgery and Sports Medicine, Southern Lyon Hospital Center, 69495 Pierre-Bénite, France.
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Lévigne C, Garret J, Grosclaude S, Borel F, Walch G. Surgical technique arthroscopic posterior glenoidplasty for posterosuperior glenoid impingement in throwing athletes. Clin Orthop Relat Res 2012; 470:1571-8. [PMID: 22389224 PMCID: PMC3348321 DOI: 10.1007/s11999-012-2294-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Posterosuperior glenoid impingement (PSGI) is the repetitive impaction of the supraspinatus tendon insertion on the posterosuperior glenoid rim in abduction and external rotation. While we presume the pain is mainly caused by mechanical impingement, this explanation is controversial. If nonoperative treatment fails, arthroscopic débridement of tendinous and labral lesions has been proposed but reportedly does not allow a high rate of return to sports. In 1996, we proposed adding abrasion of the bony posterior rim, or glenoidplasty. DESCRIPTION OF TECHNIQUE After arthroscopic assessment of internal impingement in abduction-extension-external rotation, extensive posterior labral and partial tendinous tear débridement is performed. Glenoidplasty involves recognition of a posterior glenoid spur and when present subsequent abrasion with a motorized burr. METHODS We retrospectively reviewed 27 throwing athletes treated between 1996 and 2008. Age averaged 27 years. CT arthrogram showed bony changes on the posterior glenoid rim in 21 shoulders. We evaluated 26 of the 27 patients at a minimum followup of 19 months (mean, 47 months; range, 19-123 months). RESULTS Eighteen of the 26 patients resumed their former sport level. Six improved but had to change to an inferior sport level or another sport. Two patients did not improve after the procedure, one of whom changed sport practice. There were no complications or posterior instability. In the 15 patients who had radiographs at followup times from 20 to 87 months, we observed no arthritis or osteophyte. CONCLUSIONS Comparison with an earlier series of soft tissue débridement shows glenoidplasty improves the likelihood of resuming a former sport level in patients with PSGI. LEVEL OF EVIDENCE Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Christophe Lévigne
- Department of Orthopaedic Surgery, Clinique du Parc Lyon, 155 Boulevard de Stalingrad, Lyon, Rhone 69006 France
| | - Jérome Garret
- Department of Orthopaedic Surgery, Clinique du Parc Lyon, 155 Boulevard de Stalingrad, Lyon, Rhone 69006 France
| | - Sophie Grosclaude
- Department of Orthopaedic Surgery, Clinique du Parc Lyon, 155 Boulevard de Stalingrad, Lyon, Rhone 69006 France
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Abstract
BACKGROUND While conservative treatment may be successful in most cases, partial rupture at the calcaneal insertion point is a significant concern with insertional Achilles tendinopathy. We report on the outcomes of a surgical technique for Achilles tendon augmentation using a bone-tendon graft harvested from the knee extensor system. MATERIALS AND METHODS Our retrospective case series includes 25 surgical procedures performed in 24 patients, 19 males and five females, with a mean age of 47 (range, 30 to 59) years, 18 of whom were athletes. The mean followup period was 52 (range, 12 to 156) months. All patients underwent MRI examination prior to surgery which showed partial Achilles tendon rupture. The Achilles tendon was debrided through a posterolateral approach. The bone-quadriceps tendon graft was harvested, then the bone plug of the graft was inserted into a blind tunnel drilled into the calcaneus and fixed with an interference screw. The fibers of the quadriceps tendon were sutured to the residual part of the Achilles tendon with the foot at an angle of 90 degrees. RESULTS Patients were able to resume their sporting activity after an average of 6.7 months. At last followup examination, physical activity was scored 5.2 on the 10-point Tegner Scale; the mean AOFAS score was 98.4. MRI examination showed good graft integration 1 year postoperatively. CONCLUSION The bone-quadriceps tendon grafting technique was a good alternative for the insertional Achilles lesions with partial detachment which we felt required augmentation.
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Affiliation(s)
- Rémi Philippot
- Orthopaedic Surgery Department, Hopital Nord, Saint Etienne 42055, Cedex 2, France.
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Abstract
The iliopsoas bursa is situated immediately anterior to the hip joint. Communication can develop between a hip prosthesis and the iliopsoas bursa leading to distension and formation of an inguinal mass revealing complication of total hip arthroplasty. We report five clinical cases. The five patients with a total hip arthroplasty developed a mass in the Scarpa triangle which correlated with defective prosthesis function. We chose not to dissect the cystic mass but to treat the intra-articular cause. Symptoms resolved after the intervention in all cases. This rare condition should be envisioned if an inguinal mass develops or has a functional impact, particularly on the lymphovenous circulation. Anatomic relations can be distinguished with computed tomography. Prosthetic complications include infection, loosening or wear. The work-up should include search for infection and standard x-rays of the hip joint. Before surgery, duplex Doppler should be performed systematically to search for a thromboembolic complication.
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Affiliation(s)
- S Grosclaude
- Centre d'Orthopédie-Traumatologie, Pavillon 1-3, Hôpital Bellevue, CHRU de Saint-Etienne, 42055 Saint-Etienne Cedex 02.
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Abstract
A patient who developed severe sleepiness and sleep apnoea in association with adult acquired retrognathia and subluxation of the cervical spine at the level of C3-C4, both resulting from rheumatoid arthritis, is described. The possible causative factors of the association between sleep apnoea and rheumatoid arthritis include reduction of the size of the upper airway by temporomandibular joint destruction, brainstem compression due to rheumatoid arthritis affecting the cervical spine, sleep fragmentation, and drug effects.
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Affiliation(s)
- J L Pépin
- Department of Respiratory Medicine, CHRU de Grenoble, France
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Phelip X, Grosclaude S, Rouge P, Mouries D, Blanc D. [Sideroblastic anemia in a multiple myeloma treated by melphalan (author's transl)]. Sem Hop 1979; 55:1633-5. [PMID: 231836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A case of sideroblastic anemia arised in multiple myeloma is related. Eighteen cases of literature are studied. This evolution usually appears in old and remitted myeloma. The pathogeny of the sideroblastic anemia is unknown, and possibly related to leukemia complicating multiple myeloma.
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