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Sonnery-Cottet B, Hopper GP, Gousopoulos L, Pioger C, Vieira TD, Thaunat M, Fayard JM, Freychet B, Cavaignac E, Saithna A. Incidence of and Risk Factors for Arthrogenic Muscle Inhibition in Acute Anterior Cruciate Ligament Injuries: A Cross-Sectional Study and Analysis of Associated Factors From the SANTI Study Group. Am J Sports Med 2024; 52:60-68. [PMID: 38164669 DOI: 10.1177/03635465231209987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 01/03/2024]
Abstract
BACKGROUND Arthrogenic muscle inhibition (AMI) is a process in which neural inhibition after injury or surgery to the knee results in quadriceps activation failure and knee extension deficit. PURPOSE To determine the incidence and spectrum of the severity of AMI after acute anterior cruciate ligament (ACL) injury using the Sonnery-Cottet classification, to determine the interobserver reliability of the classification system, and to investigate potential important factors associated with AMI after ACL injury. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Consecutive patients who had an acute ACL injury between October 2021 and February 2022 were considered for study inclusion. Eligible patients underwent a standardized physical examination at their first outpatient appointment. This included an assessment of quadriceps inhibition, identification of any extension deficits, and grading of AMI and its reversibility according to the Sonnery-Cottet classification. RESULTS A total of 300 consecutive patients with acute ACL ruptures were prospectively enrolled in the study. Of them, 170 patients (56.7%) had AMI. Patients evaluated with AMI showed a significantly inferior Lysholm score, International Knee Documentation Committee score, Simple Knee Value, and Knee injury and Osteoarthritis Outcome Score than patients without AMI (P < .0001). Multivariate analysis revealed that the presence of effusion, concomitant injuries, and high pain scores were associated with a significantly greater risk of AMI. Additional associations with the presence of AMI included a short duration between injury and evaluation, the use of crutches, and using a pillow as a support at night. In contrast, a previous ACL injury was associated with significantly lower odds of developing AMI (OR, 0.025; 95% CI, 0-0.2; P = .014). Among the 170 patients with AMI, 135 patients (79%) showed a resolution of their inhibition at the end of the consultation after application of simple exercises; the remaining 35 patients required specific rehabilitation. Interobserver reliability of the classification system was almost perfect (95% CI, 0.86-0.99). CONCLUSION AMI occurs in over half of patients with acute ACL injuries. When it occurs, it is easily reversible in the majority of patients with simple exercises targeted at abolishing AMI. The presence of "red flags" should increase the index of suspicion for the presence of AMI, and these include the presence of an effusion, high pain scores, a short time between injury and evaluation, multiligament injuries, the use of crutches, and using a pillow as a support at night. Patients with a history of ipsilateral or contralateral ACL injury are at a significantly lower risk of AMI than those with a first-time ACL injury.
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Affiliation(s)
- Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | | | | | - Charles Pioger
- Department of Orthopedic Surgery, Ambroise Paré Hospital, Paris Saclay University, Paris, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Benjamin Freychet
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Etienne Cavaignac
- Department of Orthopaedic Surgery, Hôpital Pierre Paul Riquet, CHU de Toulouse, Toulouse, France
| | - Adnan Saithna
- Arizona Brain, Spine & Sports Injuries Center, Scottsdale, Arizona
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Hopper GP, Gousopoulos L, Rowlands B, El Helou A, Philippe C, Vieira TD, Sonnery-Cottet B. Posterolateral Bundle Resection for an Anterior Cruciate Ligament Ganglion Cyst. Arthrosc Tech 2023; 12:e831-e835. [PMID: 37424658 PMCID: PMC10323632 DOI: 10.1016/j.eats.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 02/11/2023] [Indexed: 07/11/2023] Open
Abstract
The incidence of intra-articular ganglion cysts of the anterior cruciate ligament (ACL) is low and symptomatic presentation of this pathology is even lower. Nevertheless, symptomatic cases pose a real challenge for the orthopaedic community, as no general consensus exists regarding the most appropriate treatment. The purpose of this Technical Note is to describe the surgical treatment of an ACL ganglion cyst by arthroscopic resection of the entire posterolateral bundle of the ACL in a figure-of-four position after conservative treatment has failed.
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Affiliation(s)
- Graeme P. Hopper
- National Health Service, Lanarkshire University Hospitals, Glasgow, Scotland
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Lampros Gousopoulos
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | | | - Abdo El Helou
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Corentin Philippe
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
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Hopper GP, Gousopoulos L, Ouanezar H, Walch A, Dijoud F, Vieira TD, Helito CP, Sonnery-Cottet B. Technique for Surgical Dissection and Histological Investigation of the Anterolateral Ligament in the Fetal Knee. Arthrosc Tech 2023; 12:e837-e841. [PMID: 37424652 PMCID: PMC10323693 DOI: 10.1016/j.eats.2023.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 02/11/2023] [Indexed: 07/11/2023] Open
Abstract
There is growing evidence into the structure and function of the anterolateral ligament (ALL) of the knee. However, debate still exists about the anatomical characteristics, biomechanical role, and even the existence of the ALL, despite numerous cadaveric, biomechanical, and clinical studies. This article describes, with video illustration, the surgical dissection of the ALL in human fetal lower limbs, including determination of detailed anatomical and histological features of the ALL during fetal development. The ALL was clearly identified in dissected fetal knees, and histologic analysis shows well-organized, dense collagenous tissue fibers with elongated fibroblasts, consistent with the properties of a ligament.
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Affiliation(s)
- Graeme P. Hopper
- NHS Lanarkshire University Hospitals, Glasgow, Scotland
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Lampros Gousopoulos
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | | | - Arnaud Walch
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Frederique Dijoud
- Laboratoire d'Anatomopathologie, Centre de Biologie et Pathologie Est, Hospices Civils de Lyon, Bron, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Camilo P. Helito
- Knee Surgery Division, University of São Paulo, São Paulo, Brazil
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
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Bonnin MP, Gousopoulos L, Cech A, Bondoux L, Aït-Si-Selmi T. Arthroscopic popliteal tenotomy grants satisfactory outcomes in total knee arthroplasty with persistent localised posterolateral pain and popliteus tendon impingement. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07376-1. [PMID: 36920499 DOI: 10.1007/s00167-023-07376-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/02/2023] [Accepted: 02/27/2023] [Indexed: 03/16/2023]
Abstract
PURPOSE The purpose was to estimate the prevalence of popliteus tendon impingement following TKA, and to describe the characteristics and the differential diagnosis protocol for this rare condition. The hypothesis was that arthroscopic popliteal tenotomy in TKA patients with suspected popliteus tendon impingement would relieve pain and improve satisfaction. METHODS Of 741 TKAs performed over three years, eight (1.1%, all women) had suspected popliteus tendon impingement, of which seven had severe localised posterolateral knee pain and one global knee pain. Upon confirmation of popliteus tendon impingement, arthroscopic popliteal tenotomy was performed, and outcomes (Pain on visual analogue scale (pVAS; best, 0; worst, 10), Oxford Knee Score (OKS; best, 48; worst, 0) and satisfaction (best, 100%; worst, 0%) assessed at mean 18-month follow-up. RESULTS At four to 30 months after TKA, arthroscopic exploration revealed popliteus tendon impingement in all eight knees. Six reported complete pain relief (pVAS, 0) the day following arthroscopic popliteal tenotomy, whilst one reported some residual pain (pVAS, 2). The remaining patient with global pain reported no pain relief, and required revision TKA at 12 months. Excluding the revised TKA, OKS was between 19 and 43, and satisfaction was rated ≥ 80% in five of the remaining seven patients. CONCLUSIONS Arthroscopic popliteal tenotomy relieved symptoms in TKA patients with persistent localised posterolateral pain and a positive popliteus test. These findings suggest that the popliteus test is reliable to diagnose popliteus tendon impingement following TKA, which could be treated by arthroscopic popliteal tenotomy. LEVEL OF EVIDENCE Level IV, Small case series.
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Affiliation(s)
- Michel P Bonnin
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Lampros Gousopoulos
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Alexandre Cech
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Louka Bondoux
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
| | - Tarik Aït-Si-Selmi
- Centre Orthopédique Santy, Ramsay Santé, Hôpital Privé Jean Mermoz, Lyon, France
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El Helou A, Gousopoulos L, Shatrov J, Hopper GP, Philippe C, Ayata M, Thaunat M, Fayard JM, Freychet B, Vieira TD, Sonnery-Cottet B. Failure Rates of Repaired Bucket-Handle Tears of the Medial Meniscus Concomitant With Anterior Cruciate Ligament Reconstruction: A Cohort Study of 253 Patients From the SANTI Study Group With a Mean Follow-up of 94 Months. Am J Sports Med 2023; 51:585-595. [PMID: 36734511 DOI: 10.1177/03635465221148497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND Failure rates of repaired bucket-handle medial meniscal tears (BHMMTs) concomitant with anterior cruciate ligament reconstruction (ACLR) are as high as 20%. The outcomes of posteromedial portal suture hook repair have not been compared with all-inside repair techniques for this subtype of meniscal lesion. PURPOSE/HYPOTHESIS The aim of this study was to evaluate the outcomes and failure rates of patients who underwent BHMMT repair concomitant with ACLR using an all-inside technique, suture hook + all-inside technique, or suture hook + outside-in technique. It was hypothesized that no significant differences in failure rates would be found between the groups. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A retrospective analysis was performed on patients diagnosed with a BHMMT who underwent meniscal repair during primary ACLR and had a minimum follow-up of 2 years. Patients were grouped based on the meniscal repair technique used: all-inside repair, suture hook + all-inside repair, or suture hook + outside-in repair. At the end of the study period, secondary medial meniscectomy rates were determined. RESULTS The study population comprised 253 patients who underwent repair of a BHMMT with concomitant ACLR with a mean follow-up of 94.0 ± 47.6 months. A total of 114 patients (45.1%) underwent all-inside repair, 61 patients (24.1%) underwent suture hook + all-inside repair, and 78 patients (30.8%) underwent suture hook + outside-in repair. Overall, there were 36 failures. The failure rates were 20.2%, 14.8%, and 5.1%, respectively (P = .0135). All-inside repairs were >4 times more likely to fail than suture hook + outside-in repairs (hazard ratio [HR], 4.103; 95% CI, 1.369-12.296; P = .0117). Failure was also 3 times higher (HR, 2.943; 95% CI, 1.224-7.075; P = .0159) for patients <30 years of age compared with those aged ≥30 years. An additional anterolateral ligament reconstruction (ALLR) was also found to reduce the failure rate of repaired BHMMTs concomitant with ACLR. CONCLUSION Combined suture hook + outside-in repair of BHMMTs resulted in significantly fewer failures than all other techniques. Furthermore, age <30 years and no additional ALLR were associated with higher failure rates.
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Affiliation(s)
- Abdo El Helou
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Lampros Gousopoulos
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Jobe Shatrov
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Graeme P Hopper
- NHS Glasgow and Clyde South Glasgow University Hospitals NHS Trust Glasgow, Glasgow, UK
| | - Corentin Philippe
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Merwane Ayata
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Jean-Marie Fayard
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Benjamin Freychet
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopedique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
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Gousopoulos L, Dobbelaere A, Ratano S, Bondoux L, Tibesku CO, Aït-Si-Selmi T, Bonnin MP. Custom total knee arthroplasty combined with personalised alignment grants 94% patient satisfaction at minimum follow-up of 2 years. Knee Surg Sports Traumatol Arthrosc 2023; 31:1276-1283. [PMID: 36656348 DOI: 10.1007/s00167-023-07318-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 12/05/2022] [Accepted: 01/05/2023] [Indexed: 01/20/2023]
Abstract
PURPOSE The purpose was to report detailed patient-reported outcome measures (PROMs) and satisfaction rates for computed tomography (CT)-based custom TKA at minimum follow-up of 2 years. The hypothesis was that custom TKA combined with 'personalised alignment' would yield equivalent or better PROMs compared to values reported in systematic reviews and meta-analyses on off-the-shelf (OTS) TKA. METHODS Of an initial cohort of 150 custom TKAs, four died (unrelated to surgery), one required a revision, and five refused participation, leaving 140 patients for analysis. Patients completed pre- and post-operative PROMs (Oxford Knee Score (OKS), Forgotten Joint Score (FJS), Knee injury and Osteoarthritis Outcome Score (KOOS), Western Ontario and McMaster osteoarthritis index (WOMAC)) as well as overall level of satisfaction. Proportions that attained a patient acceptable symptom state (PASS) were calculated for OKS and FJS. Clinical findings were compared to the average scores reported for PROMs in recent systematic reviews and/or meta-analyses on OTS TKA. Descriptive statistics were used to summarise the clinical findings as means, standard deviations (SD) and ranges, or numbers and percentages. RESULTS At mean follow-up 33.5 ± 4.5 months, 94% (135/143) were either satisfied or very satisfied. Proportions that achieved PASS were 89% for OKS (120/135), and 85% for FJS (118/139). Median OKS, WOMAC and KOOS Symptoms and Pain scores were all within the 4th quartile of medians reported in systematic reviews and/or meta-analyses. CONCLUSIONS At a minimum follow-up of two years following custom TKA combined with 'personalised alignment', 94% of patients were either satisfied or very satisfied, and the PASS criteria were achieved in 89% for OKS and 85% for FJS, all of which compare favourably to published outcomes of OTS TKA. Direct comparisons to the literature may not be appropriate, however, considering the heterogeneity of patient demographics and alignment techniques. Randomised controlled trials with sufficient statistical power are needed to corroborate these findings and generalise them to unselected TKA patients. LEVEL OF EVIDENCE IV, retrospective cohort study.
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Affiliation(s)
- Lampros Gousopoulos
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Andreas Dobbelaere
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Salvatore Ratano
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Louka Bondoux
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | | | - Tarik Aït-Si-Selmi
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
| | - Michel P Bonnin
- Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, Lyon, France
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Pioger C, Gousopoulos L, Hopper GP, Vieira TD, Campos JP, El Helou A, Philippe C, Saithna A, Sonnery-Cottet B. Clinical Outcomes After Combined ACL and Anterolateral Ligament Reconstruction Versus Isolated ACL Reconstruction With Bone-Patellar Tendon-Bone Grafts: A Matched-Pair Analysis of 2018 Patients From the SANTI Study Group. Am J Sports Med 2022; 50:3493-3501. [PMID: 36255278 DOI: 10.1177/03635465221128261] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone-patellar tendon-bone (BPTB) autografts are widely considered the standard for anterior cruciate ligament reconstruction (ACLR). PURPOSE/HYPOTHESIS The aims of this study were to compare the clinical outcomes after ACLR with gold standard BPTB autografts versus combined ACLR + anterolateral ligament reconstruction (ALLR) with hamstring tendon (HT) autografts at medium-term follow-up in a large series of propensity-matched patients. The hypothesis was that combined ACLR + ALLR with HT autografts would result in lower graft rupture rates and non-graft rupture-related reoperation rates. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients undergoing combined ACLR + ALLR using HT autografts between January 2003 and December 2019 were propensity matched in a 1:1 ratio to patients undergoing isolated ACLR using BPTB autografts. At the end of the study period, graft ruptures, contralateral knee injuries, and any other reoperations or complications after the index procedure were identified by a search of a prospective database and a review of medical records. RESULTS A total of 1009 matched pairs were included. The mean duration of follow-up was 101.3 ± 59.9 months. Patients in the isolated group were >3-fold more likely to have graft failure than those in the combined group (hazard ratio, 3.554 [95% CI, 1.744-7.243]; P = .0005). Patients aged <20 years were at a particularly high risk of graft ruptures compared with patients aged >30 years (hazard ratio, 5.650 [95% CI, 1.834-17.241]; P = .0002). Additionally, there was a significantly higher reoperation rate after isolated ACLR than after combined ACLR + ALLR (20.5% vs 8.9%, respectively; P < .0001). The overall rate of subsequent contralateral ruptures was 9.1% after index surgery (isolated: 10.2%; combined: 8.0%; P = .0934), indicating that the risk profiles for both groups were similar. CONCLUSION Patients who underwent isolated ACLR with BPTB autografts experienced significantly worse graft survivorship and overall reoperation-free survivorship compared with those who underwent combined ACLR + ALLR with HT autografts. The risk of graft ruptures was >3-fold higher in patients who underwent isolated ACLR using BPTB autografts.
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Affiliation(s)
- Charles Pioger
- Centre Orthopedique Santy, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Lampros Gousopoulos
- Centre Orthopedique Santy, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Graeme P Hopper
- South Glasgow University Hospitals NHS Trust, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Thais Dutra Vieira
- Centre Orthopedique Santy, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Joao Pedro Campos
- Centre Orthopedique Santy, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Abdo El Helou
- Centre Orthopedique Santy, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Corentin Philippe
- Centre Orthopedique Santy, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Adnan Saithna
- Arizona Brain and Spine Center, Scottsdale, Arizona, USA
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Levy Y, Gousopoulos L, Hopper GP, Grob C, Vieira TD, Fayard JM, Thaunat M, Chambat P, Sonnery-Cottet B. Anterior Cruciate Ligament Reconstruction Using Bone-Patella Tendon-Bone Autograft With Press-Fit Femoral Fixation: The Original Chambat Technique. Arthrosc Tech 2022; 11:e1889-e1895. [PMID: 36457406 PMCID: PMC9705405 DOI: 10.1016/j.eats.2022.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/08/2022] [Accepted: 07/08/2022] [Indexed: 11/05/2022] Open
Abstract
Patellar tendon grafts have long been considered the gold standard for anterior cruciate ligament reconstruction (ACLR). This Technical Note describes ACLR using bone-patella tendon-bone (BPTB) autograft with press-fit femoral fixation using an outside-in drilling technique.
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Affiliation(s)
| | | | | | | | - Thais Dutra Vieira
- Address correspondence to Thais Dutra Vieira, M.D., Centre Orthopedique Santy, 24 Avenue Paul Santy, 69008, Lyon, France.
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Hopper GP, Pioger C, Philippe C, El Helou A, Campos JP, Gousopoulos L, Carrozzo A, Vieira TD, Sonnery-Cottet B. Risk Factors for Anterior Cruciate Ligament Graft Failure in Professional Athletes: An Analysis of 342 Patients With a Mean Follow-up of 100 Months From the SANTI Study Group. Am J Sports Med 2022; 50:3218-3227. [PMID: 36177758 DOI: 10.1177/03635465221119186] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injuries are among the most common knee injuries sustained in elite sport, and athletes generally undergo ACL reconstruction (ACLR) to facilitate their return to sport. ACL graft rupture is a career-threatening event for elite athletes. PURPOSE/HYPOTHESIS The purpose of this study was to determine the risk factors for graft failure in professional athletes undergoing ACLR. It was hypothesized that athletes who underwent combined ACLR with a lateral extra-articular procedure (LEAP) would experience significantly lower rates of graft rupture in comparison with those who underwent isolated ACLR. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Professional athletes who underwent primary ACLR with a minimum follow-up of 2 years were identified from the Santy database. Patients were excluded if they underwent major concomitant procedures, including multiligament reconstruction surgery or osteotomy. Further ipsilateral knee injury, contralateral knee injury, and any other reoperations or complications after the index procedure were identified by interrogation of the database and review of the medical notes. RESULTS A total of 342 athletes with a mean follow-up of 100.2 ± 51.9 months (range, 24-215 months) were analyzed. Graft failures totaling 31 (9.1%) were reported, requiring revision surgery because of symptomatic instability. The rate of graft failure was significantly higher when ACLR was not combined with a LEAP (15.5% vs 6.0%; P = .0105) and in athletes aged 21 years or younger (13.8% vs 6.6%; P = .0290). A multivariate analysis was performed using the Cox model and demonstrated that athletes undergoing an isolated ACLR were at >2-fold risk of ACL graft rupture (hazard ratio [HR], 2.678 [1.173; 4.837], P = .0164) when compared with those undergoing a combined ACLR with a LEAP. Additionally, athletes aged ≤21 years were also at >2-fold risk of graft failure (HR, 2.381 [1.313; 5.463]; P = .0068) than those aged >21 years. Sex, sport, and graft type were not found to be significant risk factors for graft failure. CONCLUSION Professional athletes undergoing isolated ACLR and aged ≤21 years are at >2-fold greater risk of graft failure. Orthopaedic surgeons treating elite athletes should combine an ACLR with a LEAP to improve ACL graft survivorship.
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Affiliation(s)
- Graeme P Hopper
- NHS Glasgow and Clyde South Glasgow University Hospitals NHS Trust Glasgow, Glasgow, UK.,Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Charles Pioger
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.,Hôpital Ambroise-Paré, Department of Orthopedic Surgery, Boulogne-Billancourt, Île-de-France, France
| | - Corentin Philippe
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Abdo El Helou
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Joao Pedro Campos
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Lampros Gousopoulos
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Alessandro Carrozzo
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France.,University of Rome La Sapienza, Orthopaedics and Traumatology Rome, Lazio, Italy
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Lyon, France; Hôpital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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10
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Dobbelaere A, Müller JH, Aït-Si-Selmi T, Gousopoulos L, Saffarini M, Bonnin MP. Sagittal femoral condylar shape varies along a continuum from spherical to ovoid: a systematic review and meta-analysis. Arch Orthop Trauma Surg 2022; 143:3347-3361. [PMID: 36121475 DOI: 10.1007/s00402-022-04613-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 05/26/2022] [Accepted: 09/03/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Considerable anatomic variations of sagittal femoral condylar shape have been reported, with a continuum between spherical (or single-radius) and ovoid (or multi-radius) condyles. The purpose of this systematic review and meta-analysis was to critically appraise and synthesise the available literature on the sagittal femoral profile. The hypothesis was that studies would reveal considerable variability among individuals, but also in their methodology to quantify sagittal profiles. METHODS This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. On 10 September 2021 two authors searched for Level I to IV studies that reported on the sagittal curvature of the medial and/or lateral femoral condyles using the MEDLINE®, EMBASE® and Cochrane Library. Results were summarised by tabulating means, standard deviations and/or ranges for the reported radii-of-curvature, or ellipsoidal semi-major and semi-minor lengths of the condyles. To quantify sagittal 'ovoidicity' and asymmetry, results were stratified according to coordinate reference frame (posterior condylar axis (PCA), clinical and surgical transepicondylar axis (cTEA and sTEA), unified sagittal plane (USP), or unclear) and summarised in forest plots as standardised mean differences (SMD). RESULTS Thirty-eight articles were eligible for full text extraction, quantifying sagittal radii-of-curvature by best-fit circles (BFC), ellipsoids, polynomials, spherical or cylindrical fitting. Studies with clear definition of the measurement plane revealed that both condyles were generally ovoid, with considerably greater 'ovoidicity' at the medial condyle (SMD, 4.09) versus the lateral condyle (SMD, 3.33). In addition, distal condylar radii were greater medially when measured normal to the TEA (cTEA: SMD, 0.81; sTEA: SMD, 0.79), but greater laterally when measured in a USP (SMD, - 0.83). Posterior condylar radii were greater laterally when measured in a USP (SMD, - 0.60). CONCLUSION Studies reported considerable variability of sagittal femoral condylar radii-of-curvature, which are not incremental, but rather a continuum that ranges from spherical to ovoid. Although this variation could be accommodated by single-, dual- and multi-radii femoral components, a surgeon typically uses only one or two TKA designs. Hence, there is a risk of mismatch between the native and prosthetic sagittal profile that could result in mid-flexion ligament imbalance unless other parameters are changed. These findings support the drive towards patient-specific implants to potentially achieve accurate sagittal bone-implant fit through implant customisation. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Andreas Dobbelaere
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | | | - Tarik Aït-Si-Selmi
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Lampros Gousopoulos
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
| | - Mo Saffarini
- ReSurg SA, Rue Saint-Jean 22, 1260, Nyon, Switzerland.
| | - Michel P Bonnin
- Centre Orthopédique Santy, Hôpital Privé Jean Mermoz, Ramsay Santé, Lyon, France
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11
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Gousopoulos L, Hopper GP, Saithna A, Grob C, Levy Y, Haidar I, Fayard JM, Thaunat M, Vieira TD, Sonnery-Cottet B. Suture Hook Versus All-Inside Repair for Longitudinal Tears of the Posterior Horn of the Medial Meniscus Concomitant to Anterior Cruciate Ligament Reconstruction: A Matched-Pair Analysis From the SANTI Study Group. Am J Sports Med 2022; 50:2357-2366. [PMID: 35666109 DOI: 10.1177/03635465221100973] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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] [Indexed: 01/31/2023]
Abstract
BACKGROUND Secondary meniscectomy rates after repair of longitudinal tears of the posterior horn of the medial meniscus (PHMM) performed concomitantly with anterior cruciate ligament reconstruction (ACLR) are reported to be as high as 25% with an all inside repair technique. Posteromedial portal suture hook repair is an emerging technique; however, it is unknown whether it confers a significantly reduced secondary meniscectomy rate compared with the current gold standard. PURPOSE/HYPOTHESIS The primary objective of this study was to compare the secondary meniscectomy rates of suture hook repair and all inside repair for longitudinal tears of the PHMM performed concomitant to ACLR. The secondary outcome was to determine the risk factors associated with the failure of the repair. It was hypothesized that repair with an all inside device would be associated with higher secondary meniscectomy rates when compared with suture hook repair and that concomitant anterolateral ligament reconstruction (ALLR) would confer improved meniscal repair survivorship. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Patients with longitudinal tears of the PHMM who underwent meniscal repair during primary ACLR between January 2011 and December 2015 at our institution were eligible for the study. Patients undergoing suture hook repair were propensity matched in a 1:1 ratio to patients who underwent all inside repair. At the end of the study period, secondary meniscectomy rates were determined. RESULTS The study population comprised 237 matched pairs. The mean follow up was 97.7 ± 17.3 months. Patients who underwent an all inside repair had a >2-fold higher failure rate compared with patients who underwent suture hook repair through a posteromedial portal (31.2% vs 15.6%; P = .0003). Patients in the suture hook repair group undergoing additional ALLR demonstrated a >3-fold higher meniscal repair survival rate compared with all other subgroups (P = .0014). This association was not seen in the all inside repair group. The only statistically significant risk factor for meniscal repair failure was the suture repair technique (hazard ratio, 2.133 [95% CI, 1.383-3.292]; P = .0008). CONCLUSION Suture hook repair through a posteromedial portal is associated with a significantly lower secondary meniscectomy rate when compared with the all inside meniscal repair of longitudinal tears of the PHMM performed at the time of ACLR. Furthermore, patients in the suture hook repair group who underwent an additional ALLR had a significantly better meniscal repair survivorship compared with all other subgroups.
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Affiliation(s)
- Lampros Gousopoulos
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Graeme P Hopper
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Adnan Saithna
- Arizona Brain, Spine & Sports Injuries Center, Scottsdale, Arizona, USA
| | - Charles Grob
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Yoann Levy
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Ibrahim Haidar
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Jean-Marie Fayard
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Mathieu Thaunat
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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12
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Hopper GP, Philippe C, El Helou A, Gousopoulos L, Fradin T, Vieira TD, Saithna A, Sonnery-Cottet B. Combined Revision Anterior Cruciate Ligament and Anterolateral Ligament Reconstruction. Arthrosc Tech 2022; 11:e1269-e1275. [PMID: 35936853 PMCID: PMC9353271 DOI: 10.1016/j.eats.2022.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 03/04/2022] [Indexed: 02/03/2023] Open
Abstract
There has been a substantial increase in the number of revision anterior cruciate ligament (ACL) reconstructions performed in the past decade. This Technical Note describes combined revision ACL and anterolateral ligament reconstruction using outside-in drilling, which avoids the need for 2-stage revision ACL reconstruction because it allows unconstrained anatomic placement.
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Affiliation(s)
- Graeme P. Hopper
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Corentin Philippe
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Abdo El Helou
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Lampros Gousopoulos
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Thomas Fradin
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France,Address correspondence to Thais Dutra Vieira, M.D., Centre Orthopedique Santy, 24 Avenue Paul Santy, F-69008, Lyon, France.
| | - Adnan Saithna
- Arizona Brain, Spine & Sports Injuries Center, Scottsdale, Arizona, U.S.A
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Centre of Excellence, Groupe Ramsay-Générale de Santé, Hopital Privé Jean Mermoz, Lyon, France
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13
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Abreu FG, Freychet B, Vieira TD, Gousopoulos L, Grob C, Levy Y, Hopper GP, Levy BA, Sonnery-Cottet B. All-Arthroscopic Treatment of Combined Posterior Cruciate Ligament and Posterolateral Corner Instability. Arthrosc Tech 2022; 11:e977-e982. [PMID: 35782836 PMCID: PMC9243670 DOI: 10.1016/j.eats.2022.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/31/2022] [Indexed: 02/03/2023] Open
Abstract
Injuries to the posterolateral corner (PLC) of the knee are uncommon, and usually associated with other ligamentous injuries. A combined posterior cruciate ligament (PCL) and PLC tear is the most frequent combination. Several studies describe anatomic reconstructive techniques using an open approach with large incisions and extensive exploration of the posterolateral structures. This Technical Note describes an all-arthroscopic technique as a safe and efficient treatment of combined PCL and PLC instability using the trans-septal approach.
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Affiliation(s)
- Felipe Galvão Abreu
- Centre Orthopédique Santy, Lyon, France; Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Benjamin Freychet
- Centre Orthopédique Santy, Lyon, France; Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, Lyon, France; Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France,Address correspondence to Thais Dutra Vieira, M.D., Centre Orthopédique Santy, Lyon, France 24 Avenue Paul Santy Lyon 69008, France.
| | - Lampros Gousopoulos
- Centre Orthopédique Santy, Lyon, France; Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Charles Grob
- Centre Orthopédique Santy, Lyon, France; Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Yoann Levy
- Centre Orthopédique Santy, Lyon, France; Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Graeme P. Hopper
- Centre Orthopédique Santy, Lyon, France; Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
| | - Bruce A. Levy
- Department of Orthopedic Surgery and Sports Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, Lyon, France; Hopital Privé Jean Mermoz, Ramsay-Générale de Santé, Lyon, France
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14
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From The Scientific Anterior Cruciate Ligament Network International Santi Study Group, Carrozzo A, Saithna A, Hopper G, Grob C, Levy Y, Gousopoulos L, Cavaignac E, Vieira TD, Sonnery-Cottet B. Regarding "Augmentation of Anterolateral Structures of the Knee Causes Undesirable Tibiofemoral Cartilage Contact in Double-Bundle Anterior Cruciate Ligament Reconstruction-A Randomized In-Vivo Biomechanics Study". Arthroscopy 2022; 38:1389-1392. [PMID: 35501005 DOI: 10.1016/j.arthro.2021.11.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/17/2021] [Indexed: 02/02/2023]
Affiliation(s)
| | | | | | - Graeme Hopper
- Santy Clinic, FIFA Medical Centre of Excellence, Lyon, France
| | - Charles Grob
- Santy Clinic, FIFA Medical Centre of Excellence, Lyon, France
| | - Yoann Levy
- Santy Clinic, FIFA Medical Centre of Excellence, Lyon, France
| | | | - Etienne Cavaignac
- Clinique Universitaire du Sport, CHU Pierre Paul Riquet, Toulouse, France
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15
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Gousopoulos L, Grob C, Ahrens P, Levy Y, Vieira TD, Sonnery-Cottet B. How to Avoid Iatrogenic Saphenous Nerve Injury During Outside-In or Inside-Out Medial Meniscus Sutures. Arthrosc Tech 2022; 11:e127-e132. [PMID: 35155103 PMCID: PMC8821034 DOI: 10.1016/j.eats.2021.09.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 09/29/2021] [Indexed: 02/03/2023] Open
Abstract
Medial meniscal sutures using outside-in or inside-out techniques are very popular. Nevertheless, a saphenous nerve entrapment may occur with these techniques. This Technical Note describes a modified outside-in medial meniscus suture without any additional skin incisions. By dissecting the space between the subcutaneous and the capsule, which is performed by grasping and knotting the sutures through the anteromedial portal, iatrogenic saphenous nerve injury is avoided.
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Affiliation(s)
- Lampros Gousopoulos
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Charles Grob
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | | | - Yoann Levy
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
| | - Thais Dutra Vieira
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France,Address correspondence to Thais Dutra Vieira, M.D., Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe Ramsay GDS, 69008 Lyon, France.
| | - Bertrand Sonnery-Cottet
- Centre Orthopédique Santy, FIFA Medical Center of Excellence, Hôpital Privé Jean Mermoz, Groupe GDS-Ramsay, Lyon, France
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16
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Despotidis V, Weihs J, Joseph Z, Gousopoulos L. Intra-articular horizontal dislocation of the patella: a rare injury and review of the literature. BMJ Case Rep 2020; 13:e232249. [PMID: 32646932 PMCID: PMC7351279 DOI: 10.1136/bcr-2019-232249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Accepted: 06/17/2020] [Indexed: 11/16/2022] Open
Abstract
Acute traumatic intra-articular dislocation of the patella is not a common presentation in orthopaedic practice; less frequently observed than extra-articular dislocation of the patella. In some of these cases, closed reduction is not possible and an open reduction in the operating theatre must be performed. In this case report, we present an elderly patient with an intra-articular horizontal dislocation of the patella without any other bony or ligamentous lesions seen in a postreduction MRI. We conducted a literature review looking at intra-articular patella dislocations, identifying 64 published studies (articles, case reports and papers). The following sources of data were searched until December 2017: PubMed, OVID, Google Scholar, Scopus, using the search strategy of (intra-articular dislocation of patella, horizontal patellar dislocation) with no limitation on the year or language of publication. The patient presented in this case report was managed with a closed reduction under general anaesthesia, without the need of any surgical intervention. As proposed in the literature, the hypothesis of an intra-articular entrapment of the patella due to the trapped osteophytes of the superior pole of the patella into the intercondylar notch was thought to be the cause of intra-articular dislocation in this elderly patient.
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Affiliation(s)
- Vasileios Despotidis
- Department of Orthopaedic Surgery and Traumatology, Inselspital University of Bern, Bern, Switzerland
| | - Johannes Weihs
- Department of Orthopaedic Surgery and Traumatology, Inselspital University of Bern, Bern, Switzerland
| | - Zacharia Joseph
- Department of Orthopaedic Surgery and Traumatology, Fiona Stanley Hospital, Murdoch, Perth, Western Australia, Australia
| | - Lampros Gousopoulos
- Department of Orthopaedic Surgery and Traumatology, Hôpital du Valais, Martigny, Switzerland
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17
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Krismer AM, Gousopoulos L, Kohl S, Ateschrang A, Kohlhof H, Ahmad SS. Factors influencing the success of anterior cruciate ligament repair with dynamic intraligamentary stabilisation. Knee Surg Sports Traumatol Arthrosc 2017; 25:3923-3928. [PMID: 28210790 DOI: 10.1007/s00167-017-4445-6] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [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: 07/25/2016] [Accepted: 01/20/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE Primary repair of the anterior cruciate ligament (ACL) has regained interest of clinicians with recent development of novel repair techniques. Dynamic intraligamentary stabilisation was introduced in an attempt to promote healing by shielding cyclic loads acting upon the ACL during the healing phase. The aim of this study was to identify negative factors likely to influence success of this procedure. METHODS Between 2009 and 2014, 264 patients with an acute ACL rupture undergoing dynamic intraligamentary stabilisation were included in this study. Patients were evaluated for anterior/posterior laxity; range of motion and patient reported outcome measures. Adverse events and re-operations were noted. Failure was defined as AP Translation >3 mm, re-rupture or conversion to ACL reconstruction. Minimum follow-up was 24 months. Univariate and multivariate regression models were utilized to determine predictors of failure. RESULTS An overall complication rate of 15.1% was noted comprising 9.5% (n = 25) re-ruptures, 4.1% (n = 11) persistent instability, and 1.5% (n = 4) > 10° fixed flexion deformity. Two factors were identified as negative predictors of failure: (1) pursuit of competitive sport activities with a Tegner pre-injury score >7 (Odds Ratio (OR) 4.4, CI 1.2-15.9, p = 0.02) and (2) mid-substance ACL rupture location (OR 2.5, 1.1-5.7, p = 0.02). When neither of those risk factors occurred the failure rate was limited to 3.9%. CONCLUSIONS Correct patient selection and narrowing of indications are necessary to maintain high success rates of the procedure. Mid-substance ACL ruptures and a high pre-injury sports activity level are two predictors of inferior outcome. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Anna M Krismer
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland
| | - Lampros Gousopoulos
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland
| | - Sandro Kohl
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland.
| | - Atesch Ateschrang
- Department of Traumatology and Reconstructive Surgery, BG Trauma Center Tübingen, Eberhard-Karls University of Tübingen, Schnarrenbergstr. 95, Tübingen, Germany
| | - Hendrik Kohlhof
- Department of Orthopaedic Surgery and Traumatology, University Hospital of Bonn, Bonn, Germany
| | - Sufian S Ahmad
- Department of Orthopaedic Surgery and Traumatology, Inselspital, University of Bern, Bern, Switzerland
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Scacchi P, Gousopoulos L, Juon B, Ahmed S, Krause FG. Tibial Nerve Palsy by a Crossing Posterior Tibial Artery Branch After Lateral Sliding Calcaneal Osteotomy. Foot Ankle Int 2017; 38:580-583. [PMID: 28457168 DOI: 10.1177/1071100717690785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Philipp Scacchi
- 1 Department of Orthopedic Surgery, Inselspital, University of Berne, Bern, Switzerland
| | - Lampros Gousopoulos
- 1 Department of Orthopedic Surgery, Inselspital, University of Berne, Bern, Switzerland
| | - Bettina Juon
- 1 Department of Orthopedic Surgery, Inselspital, University of Berne, Bern, Switzerland
| | - Sufian Ahmed
- 1 Department of Orthopedic Surgery, Inselspital, University of Berne, Bern, Switzerland
| | - Fabian G Krause
- 1 Department of Orthopedic Surgery, Inselspital, University of Berne, Bern, Switzerland
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