Osteoid osteoma of the acetabular fossa: Five cases treated with percutaneous resection

SummaryBackgroundOsteoid osteoma is a painful benign osteogenic tumour for which the treatment objective is surgical resection of the nidus. The acetabular fossa is an uncommon site of involvement where surgical access can prove challenging.Materials and methodsWe report a case-series composed of five patients with osteoid osteoma of the acetabular fossa treated with percutaneous bone resection and drilling under computed tomography guidance.ResultsAll five patients had an uneventful postoperative course with immediate pain relief that was sustained over time.DiscussionThe outcomes achieved using our percutaneous technique compare favourably with those of other percutaneous methods, most notably regarding pain relief and patient tolerance of the procedure.ConclusionPercutaneous bone resection and drilling under computed tomography guidance proved effective for the treatment of osteoid osteoma involving the acetabular fossa.Level of evidenceLevel IV

Cartilaginous tibial eminence fractures in children: which recommendations for management of this new entity ?

PURPOSE: Cartilaginous tibial eminence fracture (CTEF) is a new pattern of ACL rupture in children under the age of nine. MRI signs have been recently reported, but no series gave information about outcomes. It was hypothesized that primary treatment gave better results than delayed management due to frequent misdiagnosis. METHOD: This retrospective study focused on 15 patients, managed acutely (n = 7) or delayed (n = 8). The patients' median age at the time of initial injury was 6.5 years (range 5-9). Lysholm, IKDC 2000 subjective scores, and the measurement of the residual laxity by a side-to-side difference with a KT-1000 junior arthrometer were used at the time of revision. RESULTS: After a mean follow-up of 9.8 years (range 1-18.5), the mean Lysholm and IKDC subjective scores were, respectively, 97.7 ± 2.6 and 97 ± 3.4. The median residual laxity was 2 mm (range 0-4). Non-operative treatment lead to 2 failures: intermeniscal ligament entrapment and combined avulsion fracture at the femoral site. Suture fixation of the avulsed fragment allows regularly good results when performed acutely or even 4 years after the injury. The hypothesis that primary treatment gives better result than delayed treatment tends to be wrong as 2 failures were reported in each group. An ACL reconstruction was performed in 3 out of the 4 treatment failures. Progressive resorption of the avulsed fragment was noticed in 3 of the 4 failures suggesting an associated ACL resorption. CONCLUSION: CTEF has a good prognosis even after misdiagnosis and treatment at the time of non-union; this could be due to low-energy mechanism of injury and low rate of associated lesion. Orthopaedic treatment for acute minimally displaced fractures is only indicated under strict MRI control, and suture fixation is the recommended strategy in other situations. Conservative management of non-union could expose to ACL involution and cannot be recommended. LEVEL OF EVIDENCE: Retrospective case series, Level IV

Return to sport and re-tears after anterior cruciate ligament reconstruction in children and adolescents

BACKGROUND: The primary objective of this study was to determine the time to and level of return to sports after anterior cruciate ligament (ACL) reconstruction in children and adolescents. The secondary objectives were to evaluate the risk of early ACL re-tear after return to sports and the risk of ACL tear in the contralateral knee. HYPOTHESIS: The time to return to sports in young patients is considerably longer than in adults. METHODS: A prospective multicentre study was conducted at 12 centres specialised in knee ligament surgery, in children and adolescents younger than 18 years, between 1 January 2015 and 31 October 2015. The patients were divided into a paediatric group with open physes and a skeletally mature group with closed physes. We recorded the time to return to sport, the type of sport resumed, and the occurrence of early re-tears on the same side. A poor outcome was defined as a re-tear or an objective IKDC score of C or D. A contralateral ACL tear was not considered a poor outcome. RESULTS: Of 278 included patients, 100 had open physes and 178 closed physes. In the open physes group, return to running occurred after 10.4±4.7 months, return to pivoting/contact sport training after 13.1±3.9 months, and return to pivoting/contact sport competitions after 13.8±3.8 months. Of the 100 patients, 80% returned to the same sport and 63.5% to pivoting/contact sport competitions. Re-tears occurred in 9% of patients, after 11.8±4.1 months, and contralateral tears in 6% of patients, after 17.2±4.4 months. In all, 19.4% of patients had a poor outcome, including 10.4% with an IKDC score of C or D and 9% with re-tears. In the group with closed physes, return to running occurred after 8.8±5.1 months, return to pivoting/contact sport training after 11.7±4.7 months, and return to pivoting/contact sport competitions after 12.3±4.2 months. Of the 178 patients, 76.9% returned to the same sport and 55.6% to pivoting/contact sport competitions. The re-tear rate was only 2.8% and the contralateral tear rate 5%. In all, 14.7% of patients had poor outcome, including 11.9% with an IKDC score of C or D and 2.8% with re-tears. No risk factors for re-tears were identified; the quadruple-bundle semitendinosus technique showed a non-significant association with re-tears. CONCLUSION: In young children, the return to sport time after ACL reconstruction is considerably longer than 1 year and the return to competitions occurs later and is more difficult. The results of this study indicate that reservations are in order when informing the family about return to sports prospects after ACL reconstruction. The return to pivoting/contact sport competitions should not be allowed until 14 months after surgery in young skeletally immature patients, and the risk of re-injury is high within the first 2 years. LEVEL OF EVIDENCE: IV, retrospective study

Return to sport activity after anterior cruciate ligament reconstruction in skeletally immature athletes with manual drilling original all inside reconstruction at 8 years follow-up

Objective: Anterior cruciate ligament (ACL) tears are common injuries in adolescent athletes, especially in those who bear high stress on their knees due to shearing forces. The goal of the surgical procedures in skeletally immature patients is to restore joint stability avoiding the adverse effects on the growth process. The aim of this study was to verify the return of the skeletally immature professional athletes to sports in the long-term, following ACL reconstruction with the original all-inside technique and with manual drilling. Methods: This study included 24 athletes (14 boys, 10 girls; mean age: 13.15 years, range: 9e14 years) who had radiographic evidence of open physes, were less than 14 years of age at the time of surgery and those with a minimum follow-up of eight years. All patients completed a questionnaire, the IKDC subjective knee evaluation form, and Tegner Activity Scale. Biomechanical outcomes of the KT-1000 arthrometer, gait analysis, and stabilometric and isokinetic results were also evaluated. A plain radiograph of both lower limbs was taken to obtain a precise measurement of the limb length and mechanical axis angles. Results: The patients returned to sport activities in a mean time of 6.43 months. No rerupture or resurgery due to growth abnormalities was observed. The mean difference in length between the operated and contralateral legs was 0.4 (range: 0.2 to 0.7) cm. The mean side-to-side difference measured with the KT-1000 arthrometer was 5.2 (range: 3.5 to 7) mm in the preoperative and 0.8 (range: 0 to 2.5) mm in the postoperative measurements. Conclusion: In conclusion, the original all-inside technique with manual drilling with a half tunnel and short graft seems to be a very effective technique for the surgical management of ACL injuries in pediatric/ adolescent athletes. A good rate of return to sports at pre-injury levels or higher, high patient satisfaction and a decent motor and proprioceptive function is possible as shown by our analysis. Level of evidence: Level IV, Therapeutic study

Arthroscopic Treatment of Pediatric Fractures

Management of pediatric articular fractures has evolved over the years with a growing interest in arthroscopic handling. Several factors account for this recent appeal among which are progress in technology with increased availability of diagnostic methods, rise in athletic activities responsible for these fractures, and pediatric orthopaedic surgeons getting familiar with arthroscopic techniques. In our institution, 9 of 100 arthroscopic procedures are performed as a consequence of an articular fracture. In total, 80% of the fractures concern the knee (56% of tibial eminence fracture, 24% osteochondral fracture). Most of the remaining 20% are located at the ankle joint. Given the thorough articular exploration that arthroscopy provides, any associated cartilaginous or meniscal lesions is identified and addressed in the same procedure as the fracture fixation. Being a less invasive surgery with low complication rate, arthroscopic management of pediatric articular fractures provides very satisfactory results with earlier recovery. Of note, it is technically demanding and requires constant training. The operative time should be monitored and alternative options considered for each surgery. In this regard, arthroscopy has to be viewed as a means not an end

The sarcoma diagnostic interval: a systematic review on length, contributing factors and patient outcomes

Sarcomas are rare and heterogeneous mesenchymal tumours of soft tissue or bone, making them prone to late diagnosis. In other malignancies, early diagnosis has an impact on stage of disease, complexity of therapeutic procedures, survival and health-related quality of life (HRQoL). Little is known about what length of diagnostic interval should be considered as delay in patients with bone (BS) or soft tissue sarcomas (STS). To quantify total interval (defined as time from first symptom to histological diagnosis) and its components, identify contributing factors to its length and determine the impact on patients’ outcome in terms of mortality and HRQoL. A systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Seventy-six articles out of 2310 met the predefined inclusion criteria. Total intervals, varied broadly; 9–120.4 weeks for BS and 4.3–614.9 weeks for STS. Older age and no initial radiological examinations were contributing factors for a long interval in BS, while in STS results were conflicting. The impact of length of total interval on clinical outcomes in terms of survival and morbidity remains ambiguous; no clear relation could be identified for both BS and STS. No study examined the impact on HRQoL. The length of total interval is variable in BS as well as STS. Its effect on outcomes is contradictory. There is no definition of a clinically relevant cut-off point that discriminates between a short or long total interval. Prospero: CRD42017062492

Analyser la conception pédagogique d'un MOOC de langue sous l'angle de la "massivité"

International audienceManaging the massive participation of learners in Language MOOCs is a real challenge for instructional design (interactivity, correction and feed-back, assessment, etc.). This paper provides the analysis from a Case Study on an English Language Learning MOOC which shows that while tasks, resources and tools were well designed to manage massive participation, the design features for correction, learner support, assessment and communication scenario were not adequately designed for efficient language learning and constitute real limitations for the LMOOC.La dimension massive des MOOC de langues pose de véritables défis en termes de conception pédagogique (interactions, correction, évaluation, etc.). A partir d'une étude de cas sur un MOOC d'anglais, cet article montre que les points forts en termes de gestion de la massivité sont les tâches, les ressources et les artefacts techniques. Toutefois, si ces éléments peuvent faciliter les apprentissages langagiers, les faiblesses liées à la correction des tâches, aux aides, à l'évaluation et au scénario de communication constituent des limites pour le MOOC analysé

Pratique d'une langue étrangère en autoformation sur un site d'apprentissage et de réseautage en langues : analyse des interactions médiatisées par chat

National audienceDans la mouvance du "web social", les réseaux socionumériques pour l'apprentissage des langues se développent et font l'objet de recherches en apprentissage des langues assisté par ordinateur. La présente étude, issue d'un travail plus vaste (Chotel, 2012), porte sur l'analyse des interactions médiatisées par chat de trois apprenants chinois sur le site d'apprentissage et de réseautage social Busuu, ceci dans un contexte non formel. Pour ce faire, nous nous référons à l'approche instrumentale, à la communication médiatisée par ordinateur et à la perspective interactionniste. A partir d'enregistrements de captures d'écran dynamiques, de questionnaires, de journaux d'apprentissage et d'entretiens d'explicitation, nous décrivons ces interactions, montrons comment la communication s'établit entre les interlocuteurs et considérons le potentiel acquisitionnel de ces échanges. Nous suggérons que des liens soient tissés entre apprentissage formel et non formel afin de soutenir les apprenants dans leur autonomisation

Comprendre l'activité d'apprenants dans un MOOC de français langue étrangère : quelle méthodologie et quels outils pour le recueil et l'analyse de traces en ligne ?

International audienceCette communication aborde des questions de méthodologie afin de pouvoir circonscrire, recueillir, transformer et analyser des données hérétogènes et massives issues d'un MOOC (Massive Open Online Course) en Français Langue Etrangèr

Table ronde : "Peut-on apprendre le FLE avec un MOOC ?"

International audiencePrésentation et analyse du MOOC "Exploring English and Culture". Cette table ronde donnera la parole à différents concepteurs, animateurs ou chercheurs ayant l'expérience des MOOC de langues. Il s'agira de mettre en lumière les différents contextes dans lesquels ces MOOC ont été créés et les atouts et limites de ce type de cours en ligne tels qu'ils ont pu être évalués par les différents acteurs. On cherchera également à savoir si certaines dimensions pédagogiques ou techniques développées dans les MOOC ne peuvent pas en retour être intégrées à des formations hybrides par exempl