ACL reconstruction with unicondylar replacement in knee with functional instability and osteoarthritis

Severe symptomatic osteoarthritis in young and active patients with pre-existing deficiency of the anterior cruciate ligament and severe functionally instability is a difficult subgroup to manage. There is considerable debate regarding management of young patients with isolated unicompartment osteoarthritis and concomitant ACL deficiency. A retrospective analysis of was done in 9 patients with symptomatic osteoarthritis with ACL deficiencies and functional instability that were treated with unicompartment knee arthroplasty and ACL reconstruction between April 2002 and June 2005. The average arc of flexion was 119° (range 85° to 135°) preoperatively and 125° (range 105° to 140°). There were no signs of instability during the follow up of patients. No patients in this group were reoperated. In this small series we have shown that instability can be corrected and pain relieved by this combined procedure

Isolated patellofemoral osteoarthritis: A systematic review of treatment options using the GRADE approach

Background and purpose The optimal treatment for isolated patellofemoral osteoarthritis is unclear at present. We systematically reviewed the highest level of available evidence on the nonoperative and operative treatment of isolated patellofemoral osteoarthritis to develop an evidenced-based discussion of treatment options

What should an ideal spinal injury classification system consist of? A methodological review and conceptual proposal for future classifications

Since Böhler published the first categorization of spinal injuries based on plain radiographic examinations in 1929, numerous classifications have been proposed. Despite all these efforts, however, only a few have been tested for reliability and validity. This methodological, conceptual review summarizes that a spinal injury classification system should be clinically relevant, reliable and accurate. The clinical relevance of a classification is directly related to its content validity. The ideal content of a spinal injury classification should only include injury characteristics of the vertebral column, is primarily based on the increasingly routinely performed CT imaging, and is clearly distinctive from severity scales and treatment algorithms. Clearly defined observation and conversion criteria are crucial determinants of classification systems’ reliability and accuracy. Ideally, two principle spinal injury characteristics should be easy to discern on diagnostic images: the specific location and morphology of the injured spinal structure. Given the current evidence and diagnostic imaging technology, descriptions of the mechanisms of injury and ligamentous injury should not be included in a spinal injury classification. The presence of concomitant neurologic deficits can be integrated in a spinal injury severity scale, which in turn can be considered in a spinal injury treatment algorithm. Ideally, a validation pathway of a spinal injury classification system should be completed prior to its clinical and scientific implementation. This review provides a methodological concept which might be considered prior to the synthesis of new or modified spinal injury classifications

Bone remodeling around cementless tantalum cups

Purpose of the study.-Most studies have reported a significant decrease in periacetabular bone stock one year after implantation of a cementless cup. The purpose of this work was to study the bone-implant interface of the tantalum cup using plain X-rays and dual-energy X-ray absorptiometry (DEXA).Material and methods.-This retrospective analysis concerned 42 patients with a tantalum cup, Trabecular Metal (TM) (Zimmer, Warsaw, IN, USA). All hips had primary implantations, performed by one surgeon via the same approach and with the same postoperative rehabilitation protocol. Minimum follow-up was two years. The Harris clinical score, and radiographic (lucent lines and acetabular position) and densitometric (analysis of 3.3 mm of periacetabular bone in the three DeLee and Charnley zones) were recorded.Results.-At follow-up, the mean Harris score was 81. There were no implant malpositions (horizontal, vertical, inclination). Lucent lines were noted for 14% of the cups. Bone mineral density (BMD) was higher than generally observed with cementless cups (1.290 +/- 0.309g/cm(2)).Discussion.-The clinical and radiographic results are similar to data in the literature regarding correct implant position. The higher rate of lucent lines around the tantalum cup is also reported in the literature and is the result of the pressfit, resolving at one year. The greater BMD in zone 1 might reflect better force transfer to the weight-bearing zone.Conclusion.-As biomaterial recently introduced in orthopedic surgery, tantalum appears to provide a better force transfer to the central part of the iliac bone and thus possibly better preservation of pelvic bone stock. (C) 2008 Publie par Elsevier Masson SAS.</p

Etude de la force excentrique des fibulaires après entorse de la cheville rééduquée

La rééducation excentrique permet de récupérer une meilleure force excentrique et concentriqu