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Chalopin T, Lemaignen A, Guillon A, Geffray A, Derot G, Bahuaud O, Agout C, Rosset P, Castellier C, De Pinieux G, Valentin AS, Bernard L, Bastides F. Acute Tibial osteomyelitis caused by intraosseous access during initial resuscitation: a case report and literature review. BMC Infect Dis 2018; 18:665. [PMID: 30558553 PMCID: PMC6296120 DOI: 10.1186/s12879-018-3577-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 12/03/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intra-osseous (IO) access is recommended in cases of pre-hospital emergency or resuscitation when intravascular (IV) route is difficult or impossible. Despite recent improvement in IO devices and increasing indications, it remains rarely used in practice. Various complications have been reported but are uncommon. CASE PRESENTATION We report a case of massive acute tibial osteomyelitis in an adult male three months after an IO catheter insertion for emergency drug infusion. We review the literature on association between IO access and acute osteomyelitis in children and adults. CONCLUSIONS Emergency-care givers and radiologists should be informed about this infrequent complication in order to make early diagnosis and initiate adequate antibiotic therapy.
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Affiliation(s)
- Thomas Chalopin
- Department of Internal Medicine and Infectious Diseases, University Hospital of Tours, Hospital Bretonneau, Tours, France
- François Rabelais University, Tours, France
| | - Adrien Lemaignen
- Department of Internal Medicine and Infectious Diseases, University Hospital of Tours, Hospital Bretonneau, Tours, France
- François Rabelais University, Tours, France
| | - Antoine Guillon
- Department of Intensive Care Unit, University Hospital of Tours, Tours, France
| | - Arnaud Geffray
- Department of Medical Imaging, University Hospital of Tours, Tours, France
| | - Gaelle Derot
- Department of Medical Imaging, University Hospital of Tours, Tours, France
| | - Olivier Bahuaud
- Department of Internal Medicine and Infectious Diseases, University Hospital of Tours, Hospital Bretonneau, Tours, France
- François Rabelais University, Tours, France
| | - Charles Agout
- Department of Orthopedic Surgery, University Hospital of Tours, Tours, France
| | - Philippe Rosset
- Department of Orthopedic Surgery, University Hospital of Tours, Tours, France
| | - Claire Castellier
- Department of Anatomopathology, University Hospital of Tours, Tours, France
| | | | | | - Louis Bernard
- Department of Internal Medicine and Infectious Diseases, University Hospital of Tours, Hospital Bretonneau, Tours, France
- François Rabelais University, Tours, France
| | - Frederic Bastides
- Department of Internal Medicine and Infectious Diseases, University Hospital of Tours, Hospital Bretonneau, Tours, France
- François Rabelais University, Tours, France
- 2 boulevard Tonnellé, 37044 Tours, Cedex 9 France
| | - Centre De Référence Des Infections Ostéo-Articulaires Du Grand-Ouest (CRIOGO) Study Team
- Department of Internal Medicine and Infectious Diseases, University Hospital of Tours, Hospital Bretonneau, Tours, France
- François Rabelais University, Tours, France
- Department of Intensive Care Unit, University Hospital of Tours, Tours, France
- Department of Medical Imaging, University Hospital of Tours, Tours, France
- Department of Orthopedic Surgery, University Hospital of Tours, Tours, France
- Department of Anatomopathology, University Hospital of Tours, Tours, France
- Bacteriological Laboratory, University Hospital of Tours, Tours, France
- 2 boulevard Tonnellé, 37044 Tours, Cedex 9 France
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Agout C, Berhouet J, Spiry C, Bonnevialle N, Joudet T, Favard L. Functional outcomes after non-operative treatment of irreparable massive rotator cuff tears: Prospective multicenter study in 68 patients. Orthop Traumatol Surg Res 2018; 104:S189-S192. [PMID: 30077657 DOI: 10.1016/j.otsr.2018.08.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 06/15/2018] [Accepted: 07/24/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Massive rotator cuff tears (RCTs) account for 10% to 40% of all RCTs and over 80% of re-tears. The objectives of this prospective study were to assess functional outcomes 6 and 12 months after starting non-operative therapy for an irreparable massive RCT and to identify predictors of good outcomes of non-operative treatment. HYPOTHESIS Non-operative treatment deserves to be tried because it can produce improvements in patients with irreparable massive RCTs. MATERIAL AND METHODS A prospective multicenter (12 centres) study was conducted between March 2015 and March 2016. Consecutive patients managed non-operatively for RCTs involving two or more tendons including one with a fatty infiltration score greater than 2 were included. Non-operative treatment consisted in rehabilitation and sub-acromial corticosteroid injections. Functional outcomes were assessed based on the Constant score and Subjective Shoulder Value (SSV) after 3, 6, and 12 months. RESULTS Of 71 included patients, 3 underwent surgery during the study year, leaving 68 patients for the analysis of 12-month outcomes. Significant improvements were noted after 12 months in the Constant score (from 40.7 at baseline to 57.7 after 6 months and 57.1 after 12 months), in each of its items except force, and in the SSV. Constant score values after 6 and 12 months were not significantly different. No significant differences in functional outcomes were found across initial tear type. CONCLUSION Non-operative treatment produces significant functional gains in patients with irreparable massive RCTs. These gains are obtained after 6 months. Surgery can therefore be considered if the outcome is unsatisfactory after 6 months. LEVEL OF EVIDENCE III, prospective study.
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Affiliation(s)
- Charles Agout
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - Julien Berhouet
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - Clément Spiry
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - Nicolas Bonnevialle
- Département d'orthopédie traumatologie, hôpital Riquet, CHU de Toulouse, 31059 Toulouse, France
| | - Thierry Joudet
- Clinique chirurgicale du Libournais, 119, rue de la Marne, 33500 Libourne, France
| | - Luc Favard
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
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- 15, rue Ampère, 92500 Rueil-Malmaison, France
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Agout C, Berhouet J, Bouju Y, Godenèche A, Collin P, Kempf JF, Favard L. Clinical and anatomic results of rotator cuff repair at 10 years depend on tear type. Knee Surg Sports Traumatol Arthrosc 2018; 26:2490-2497. [PMID: 29411080 DOI: 10.1007/s00167-018-4854-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 09/25/2017] [Accepted: 02/01/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Although good short-term and mid-term outcomes are reported for rotator cuff repair, few studies have investigated long-term outcome with clinical and MRI evaluation. The hypothesis was that 10 years following repair of rotator cuff tear, the clinical and anatomic results depend on the extension of the tear. METHODS The records of all 965 patients who underwent repair of rotator cuff tears in 2003 were retrieved. The patients were reviewed in 2014 for evaluation at a minimum follow-up of 10 years. A total of 511 patients were evaluated clinically, of whom 397 were also evaluated using MRI. There were 289 isolated supraspinatus tears (SS), 94 tears with posterior extension (P), 92 with anterior extension (A) and 36 with anteroposterior (AP) extension. RESULTS The Constant score had significantly improved from 53.8 ± 14.7 preoperatively to 77.7 ± 12.1 (P < 0.0001) at 10 years, with no significant difference between the four groups. The rate of retear (Sugaya IV, V) was lower in the SS group (19%) and higher in the P (32%) and AP groups (31%). At review, infraspinatus fatty degeneration was significantly greater (Fuchs > 2) in the P (P < 0.001) and AP (P < 0.001) groups and subscapularis fatty degeneration was significantly greater (Fuchs > 2) in the A (P < 0.001) and AP (P < 0.001) groups. The rate of osteoarthritis (Samilson > 2) was significantly higher at 11% (P = 0.001) in the A group. The failure rate was significantly lower (P = 0.044) in the SS group (25%) than the massive rotator cuff tear groups (A, P and AP groups) (35%). Complications occurred in 51 shoulders (10%) and repeat surgery was required in 62 shoulders (12%), with no difference between the four groups. CONCLUSIONS The long follow-up period of this study, large series of patients and MRI evaluation of tendon repair allowed us to demonstrate that 10 years following rotator cuff tear repair, between 68 and 81% of tendons had healed. These findings are of value in predicting response to surgical treatment. Tears with posterior extension had a higher risk of retear. However, surgical repair appeared to give a good functional outcome whatever the type of tear, despite the overall rate of complications and repeat surgery. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Charles Agout
- Services de Chirurgie Orthopédique 1 et 2, Hôpital Trousseau, CHRU de Tours, Avenue de la République, 37170, Chambray-Lès-Tours, France.
| | - Julien Berhouet
- Services de Chirurgie Orthopédique 1 et 2, Hôpital Trousseau, CHRU de Tours, Avenue de la République, 37170, Chambray-Lès-Tours, France
| | - Yves Bouju
- Institut de la Main Nantes-Atlantique, Clinique Jeanne-d'Arc, 21 Rue Des Martyrs, 44100, Nantes, France
| | - Arnaud Godenèche
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz (Ramsay Général De Santé), Lyon, France
| | | | - Jean-François Kempf
- Centre de Traumatologie, Hôpitaux Universitaires de Strasbourg, Illkirch-Graffenstaden, France
| | - Luc Favard
- Services de Chirurgie Orthopédique 1 et 2, Hôpital Trousseau, CHRU de Tours, Avenue de la République, 37170, Chambray-Lès-Tours, France
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Bonnevialle N, Thélu CE, Bouju Y, Vogels J, Agout C, Duriez P, Azoulay V. Arthroscopic Latarjet procedure with double-button fixation: short-term complications and learning curve analysis. J Shoulder Elbow Surg 2018; 27:e189-e195. [PMID: 29337029 DOI: 10.1016/j.jse.2017.12.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 11/19/2017] [Accepted: 12/03/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND The arthroscopic Latarjet with double-button fixation is a guided procedure recently proposed to treat anterior shoulder instability with glenoid bone loss. The goal of this study was to report intraoperative and early postoperative complications and to analyze the learning curve. METHODS This was a prospective, nonrandomized study that included 88 patients. Intraoperative or postoperative complications as well as adverse events and operative time were recorded. Clinical outcomes were evaluated at 2 weeks, 1.5 months, and at the last follow-up. Radiologic analysis was based on an immediate postoperative computed tomography scan. RESULTS The intraoperative complications or adverse events rate was 3.3%: 1 conversion to open surgery, 1 bone block fracture, and 1 instrumentation problem. The postoperative complication rate was 6.8%: 4 coracoid migrations, and 2 subluxations. None of these complications occurred beyond the 10th case performed. The average operative time significantly decreased with surgical experience (r = -0.8426; 95% confidence interval, -0.9074 to -0.7384; P < .0001) to reach 76 ± 12 minutes (range, 62-95 minutes) at 30 cases. Radiologically, 90% of the bone blocks were flush and subequatorial beyond the 30th case. At a mean follow-up of 12.6 months (range, 6-24 months), Walch-Duplay and Rowe scores were 80 and 81 points, respectively. CONCLUSIONS At short-term follow-up, the arthroscopic Latarjet procedure with double-button fixation exhibited a low complication rate. Operative time significantly improved with surgical experience and was optimized after 30 cases. Early clinical results confirmed that this procedure can be safe and reliable.
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Affiliation(s)
- Nicolas Bonnevialle
- Département d'Orthopédie Traumatologie du Centre Hospitalier Universitaire de Toulouse, Hôpital Riquet, Toulouse, France; Laboratoire de Biomécanique, Institut de Mécanique des Fluides de Toulouse- Unité Mixte de Recherche-Le Centre national de la recherche scientifique 5502, Hôpital Riquet, Toulouse, France.
| | | | | | - Jérôme Vogels
- Centre Ostéo-articulaire Condorcet, Villeurbanne, France
| | - Charles Agout
- Service d'orthopédie traumatologie, Centre Hospitalier Régional Universitaire de Trousseau, Chambray-les-Tours, France
| | - Pauline Duriez
- Centre Ostéo-articulaire Condorcet, Villeurbanne, France
| | - Vadim Azoulay
- Département d'Orthopédie Traumatologie du Centre Hospitalier Universitaire de Toulouse, Hôpital Riquet, Toulouse, France
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Agout C, Rosset P, Druon J, Brilhault J, Favard L. Epidemiology of malpractice claims in the orthopedic and trauma surgery department of a French teaching hospital: A 10-year retrospective study. Orthop Traumatol Surg Res 2018; 104:11-15. [PMID: 29247818 DOI: 10.1016/j.otsr.2017.11.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 08/22/2017] [Revised: 10/24/2017] [Accepted: 11/13/2017] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Orthopedic and trauma surgery is the specialty for which claims for compensation are most often filed. Little data exists on the subject in France, especially in a teaching hospital. We conducted a retrospective study aimed at (1) identifying the epidemiological characteristics of patients filing claims against the orthopedic surgery and traumatology department of a teaching hospital in France, (2) analyzing the surgical procedures involved, the type of legal proceedings, and the financial consequences. HYPOTHESIS The epidemiological profile of proceedings seeking damages in France is consistent with the data from European and American studies. MATERIALS AND METHODS An observational, retrospective, single-center study of all claims for damages between 2007 and 2016 involving the orthopedic and trauma surgery department of a teaching hospital was carried out. Patients' epidemiological data, the surgical procedure, type of legal proceeding, and financial consequences were analyzed. RESULTS Of the 51,582 surgical procedures performed, 71 claims (0.0014%) were analyzed (i.e., 1/726 procedures). A significant increase in the number of cases (p=0.040) was found over a 10-year period. Of these, 36/71 (53.7%) were submitted to the French regional conciliation and compensation commission (CRCI), 23/71 (32.8%) were filed with the administrative court, and 12/71 (13.4%) were submitted for an amicable settlement. The most common reason for which patients filed claims was hospital-acquired infections, with 36/71 (50.7%) cases. Twenty-nine complaints (40.8%) resulted in monetary damages being awarded to the patient, with an average award of € 28,301 (€ 2,400-299,508). Damage awards were significantly higher (p<0.05) for cases involving surgery on a lower limb than those involving an upper limb. CONCLUSION Claims against orthopedic surgeons have been increasing significantly over the last 10 years. Although rare, they represent a significant cost to society. Hospital-acquired infections are the main reason for disputes in our specialization. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- C Agout
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France.
| | - P Rosset
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - J Druon
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - J Brilhault
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
| | - L Favard
- Service de chirurgie orthopédique et traumatologique, hôpital Trousseau, CHRU de Tours, avenue de la République, 37170 Chambray-lès-Tours, France
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Collin P, Kempf JF, Molé D, Meyer N, Agout C, Saffarini M, Godenèche A. Ten-Year Multicenter Clinical and MRI Evaluation of Isolated Supraspinatus Repairs. J Bone Joint Surg Am 2017; 99:1355-1364. [PMID: 28816895 DOI: 10.2106/jbjs.16.01267] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [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: 02/01/2023]
Abstract
BACKGROUND Early repair of isolated supraspinatus tears could prevent further deterioration of the rotator cuff; however, there is no consensus on the management of such tears because of a lack of long-term outcome studies. The purposes of this study were to report the 10-year outcomes of isolated supraspinatus repairs and to investigate the factors that favor healing and recovery. METHODS We retrieved the records of all 511 patients who, in 2003, underwent repair of full-thickness isolated supraspinatus tears, performed by 15 surgeons at 15 centers. In 2014, the patients were asked to return for evaluation at a minimum follow-up of 10 years. One hundred and eighty-eight patients could not be reached, and 35 were excluded because they had a reoperation (17 had a retear, 7 had conversion to an arthroplasty, and 11 had other causes). A total of 288 patients (50% were men) who had a mean age (and standard deviation) at index surgery of 56.5 ± 8.3 years (range, 32 to 77 years) were evaluated clinically, and 210 of them were also evaluated using magnetic resonance imaging (MRI). RESULTS Thirty shoulders (10.4%) had complications, including stiffness (20 shoulders), infection (1 shoulder), and other complications (9 shoulders). The total Constant score improved from a mean of 51.8 ± 13.6 points (range, 19 to 87 points) preoperatively to 77.7 ± 12.1 points (range, 37 to 100 points) at 10 years. At the 10-year follow-up evaluation, the mean Subjective Shoulder Value (SSV) was 84.9 ± 14.8 (range, 20 to 100), and the mean Simple Shoulder Test (SST) was 10.1 ± 2.2 (range, 3 to 12). Of the 210 shoulders evaluated using MRI, the repair integrity was Sugaya type I in 26 shoulders (12%), type II in 85 (41%), type III in 59 (28%), type IV in 27 (13%), and type V in 13 (6%). The total Constant score at the final follow-up was significantly associated with tendon healing (p < 0.005) and was inversely associated with preoperative fatty infiltration (p < 0.001). Neither the surgical approach nor the preoperative retraction influenced the outcomes. CONCLUSIONS Repairs of isolated supraspinatus tears maintained considerable improvement in clinical and radiographic outcomes at 10 years. Preoperative fatty infiltration and postoperative retear have a significantly detrimental effect on the long-term functional outcome of rotator cuff repair. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
| | | | - Daniel Molé
- Centre de Traumatologie, Hôpitaux Universitaires de Strasbourg, Illkirch-Graffenstaden, France
| | - Nicolas Meyer
- Laboratoire de Bio Statistiques, Faculté de Médecine de l’Université de Strasbourg, Strasbourg CEDEX, France
| | - Charles Agout
- Service de Chirurgie Orthopédique et Traumatologique Hôpital Trousseau CHRU, Tours, France
| | | | - Arnaud Godenèche
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz (Ramsay Genérale de Santé), Lyon, France
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Agout C, Ardouin L, Bellemère P. A ten-year prospective outcome study of Pi2 pyrocarbon spacer arthroplasty in carpometacarpal joint osteoarthritis. Hand Surgery and Rehabilitation 2016; 35:255-261. [DOI: 10.1016/j.hansur.2016.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 04/13/2016] [Accepted: 05/20/2016] [Indexed: 10/21/2022]
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Agout C, Lakhal W, Fournier J, de Bodman C, Bonnard C. Arthroscopic treatment of septic arthritis of the knee in children. Orthop Traumatol Surg Res 2015; 101:S333-6. [PMID: 26421608 DOI: 10.1016/j.otsr.2015.09.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 07/02/2015] [Accepted: 08/30/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Childhood septic arthritis of the knee is a serious disease that can impair growth and cause serious functional sequelae. There are few data on arthroscopic treatment in children, and series were always less than 20 cases. HYPOTHESIS The objective of this study was to assess clinical and radiographic results of arthroscopic drainage combined with antibiotic therapy for the treatment of childhood septic arthritis of the knee. The hypothesis was that arthroscopic treatment is also effective in children. MATERIALS AND METHODS A retrospective study, conducted between January 2003 and December 2012, included patients under 15 years of age with septic arthritis of the knee treated by arthroscopic drainage with a minimum of 2 years' follow-up. RESULTS Fifty-six patients, with a mean age at surgery of 3.4 years (range, 3 months to 12 years), were included. Staphylococcus aureus was the most common causative organism. Two patients (3.6%) had recurrence, successfully treated by repeat arthroscopic drainage. Mean Lysholm score was 96.9 (range, 70-100) and mean KOOS-Child pain, symptoms, daily life, sports and quality of life scores were respectively 97 (81-100), 95 (75-100), 98 (89-100), 93 (71-100) and 95 (70-100) at a mean 65 months' follow-up. Ranges of motion were normal. Radiology found no joint damage. DISCUSSION AND CONCLUSION Arthroscopic drainage combined with antibiotic treatment is a simple and effective treatment for childhood septic arthritis of the knee and is for our reference attitude. It can also be indicated in case of recurrence. LEVEL OF EVIDENCE IV, retrospective study.
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Affiliation(s)
- C Agout
- Service de chirurgie orthopédique pédiatrique, université F.-Rabelais, hôpital G.-de-Clocheville, CHU de Tours, boulevard Béranger, 37044 Tours, France.
| | - W Lakhal
- Service de chirurgie orthopédique pédiatrique, université F.-Rabelais, hôpital G.-de-Clocheville, CHU de Tours, boulevard Béranger, 37044 Tours, France
| | - J Fournier
- Service de chirurgie orthopédique pédiatrique, université F.-Rabelais, hôpital G.-de-Clocheville, CHU de Tours, boulevard Béranger, 37044 Tours, France
| | - C de Bodman
- Service de chirurgie orthopédique pédiatrique, université F.-Rabelais, hôpital G.-de-Clocheville, CHU de Tours, boulevard Béranger, 37044 Tours, France
| | - C Bonnard
- Service de chirurgie orthopédique pédiatrique, université F.-Rabelais, hôpital G.-de-Clocheville, CHU de Tours, boulevard Béranger, 37044 Tours, France
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