Minimally invasive harvesting of the quadriceps tendon: Technical note.

Place: FranceInternational audienceThe quadriceps tendon is gaining preference as an autograft over conventional grafts for the primary reconstruction of the anterior and posterior cruciate ligaments and of the medial patello-femoral ligament. In the past, the use of the quadriceps tendon was associated with considerable morbidity and less favourable outcomes compared to other grafts, specifically due to post-operative weakness of the quadriceps and other complications such as patellar fracture and rupture of the extensor apparatus. These problems are partially ascribable to the graft harvesting method used (large incision, bone block\textgreater2cm, and full-thickness tendon harvesting). Recent technical advancements have made reproducible harvesting of quadriceps grafts possible, thereby largely preventing the complications. In this study we describe an original quadriceps tendon harvesting technique in which a minimally invasive approach allows the collection of a sufficiently long graft, while sparing the deep layer of the quadriceps tendon. This technique decreases intra-operative morbidity and improves the post-operative outcomes

Higher re-rupture rate in quadriceps tendon ACL reconstruction surgeries performed in Denmark: let’s return to the mean

International audienceWe read with deep interest the registry study from Lind et al., published recently in the Knee Surgery, Sports Traumatology and Arthroscopy journal [7]. In their analysis, the authors described a higher re-rupture rate after quadriceps tendon (QT) anterior cruciate ligament (ACL) reconstruction as compared to hamstring and patellar tendon grafts. As we are using the QT as primary reconstruction graft in high risk patients, we were surprised by the reported threefold revision-rate difference between the three groups of patients

Moore I postero-medial articular tibial fracture in alpine skiers: Surgical management and return to sports activity

International audiencePURPOSE:Over the past 10 years, like many authors, we observed an increasing number of Moore I tibial plateau fractures related to alpine skiing for which the surgeon may face difficult choices regarding surgical approach and fixation means. Some authors have recently been suggesting a posterior approach associated to open reduction and osteosynthesis by a buttress plate. But in our knowledge there is no specific study on sports activity recovery after Moore I tibial fractures. The aim of this work was to assess sports activities and clinical outcomes after surgically treated Moore I tibial plateau fractures in an athletic population of skiers.METHODS:We conducted a prospective case series between 2012 and 2014. This included fifteen patients aged 39.6±7 years whom presented with a Moore I tibial plateau fracture during a skiing accident. 12 cases (80%) presented with an associated tibial spine fracture. Treatment consisted of a standard antero-medial approach, with a medial para patellar arthrotomy to allow direct visualisation of articular reduction and spinal fixation. Two or three 6.5mm long cancellous bone screws were placed antero-posteriorly so as to ensure perfect compression of the fracture site. Radiological and functional results were assessed by an independent observer (Lysholm-Tegner, UCLA, KOOS scores) at the longest follow-up.RESULTS:Mean follow-up was 18.2±6 months (12-28). An immediate postoperative anatomical reduction was achieved in all cases and remained stable in time. At last follow-up Lysholm mean score was 85±14 points (59-100), UCLA score was 7.3±1.6 (4-10) and Tegner score was 4.6±1.3 (3-6). Mean KOOS score was 77±15 (54-97). 87% of patients had resumed their skiing activity and 93% were satisfied or very satisfied from their post-operative surgical outcome. We observed no pseudarthrosis or secondary varus displacement.CONCLUSION:In our series 87% of patients had resumed back to their sporting activities. Surgical management of Moore I tibial plateau fractures by isolated antero-posterior screwing provides excellent clinical and radiological results. The anteromedial incision has a dual advantage of anatomical reduction, tibial spine fixation (in 80% of our cases) and posteromedial fragment reduction

Computerised navigation of unicondylar knee prostheses: from primary implantation to revision to total knee arthroplasty

International audienceAIM:Computerized navigation of unicondylar knee arthroplasties (UKA) is not a widespread technique. The lifespan of a UKA depends on the quality of its implantation. We know that overcorrection leads to a rapid extension of the osteoarthritis to the opposite side of the knee and undercorrection to a rapid loosening or wear of the prosthesis. Because of these difficulties and following a long experience with navigation of total knee arthroplasties (TKA) and osteotomies around the knee, we began using navigation for revisions to TKA in 2003 and for UKAs in 2008. The aim of this work is to present, firstly, the axial alignment of 79 medial and 19 lateral computer-assisted UKAs and, secondly, the axial alignment of 23 computer-assisted UKA revisions to TKA.METHODS:In all the cases we used the Orthopilot® device (BBraun-Aesculap, Tuttlingen, Germany), which is a non image-based navigation system.RESULTS:For medial prostheses, the main objective was to obtain a post-operative HKA angle of 177° ± 2°, i.e. an under correction of 1-5°. This objective was met in 88.5 % of the cases. For lateral prostheses, the main objective was to achieve a post-operative HKA angle of 183° ± 2°, i.e. also an under correction of 1-5°. This objective was met in 84 % of the cases (3 cases at 186° and no cases of over correction). Regarding UKA revisions, the main objective was to ensure an HKA angle of 180° ± 3°. This was met in 92.4 % of the cases.CONCLUSION:As for TKA and osteotomies, computerized navigation of UKAs and UKA revisions allows the pre-operative goal to be met easily

Every layer of quadriceps tendon’s central and medial portion offers similar tensile properties than Hamstrings or Ilio-Tibial Band Grafts

International audiencePurpose: The aim of our cadaveric study was to compare the mechanical properties of different parts of the quadriceps' tendon in a load to failure analysis as compared to three other, and most common types of grafts that are used to perform ligament's reconstruction. Methods: Ten fresh-frozen cadavers (5 women, 5 men) were selected from our anatomical department. Mean age at death was 64 years (48-87 years). Tendons were harvested to prepare (1) different quadriceps tendon's specimens: lateral portion (QTlat), medial portion superficial layer (QTMsup) and deep layer (QTMdeep) and central portion superficial (QTCsup) and deep layers (QTCdeep) (2) Patellar Tendon (PT), (3) Gracilis+Semi-Tendinosus specimens (GST). Specimens were stored at − 40°C in a freezing solution. Specimens were securely attached to a dedicated loading platform, measurements were done using a validated software. Load to failure testing was then carried out. Young's Elastic moduli, ultimate Stress (MPa) and Deformation (%) were analysed. Results: The elastic moduli of the PT was significantly higher than all other grafts, all medial and central QT layers (superficial and deep) were significantly higher than its lateral part (QTlat). In terms of Ultimate Stress, all grafts were significantly greater than QTlat, PT and GST were significantly superior to QT central portions and to ITB but there did not differ with the medial portion of QT. ITB ultimate stress values were significantly higher than QTlat. The ultimate deformations of all grafts were similar. Conclusions: This study provides reference values in in order to characterize different parts of the QT that presents anatomically and Mechanically with complex characteristics. Every Layer of Quadriceps Tendon's Central and Medial Portion Offered Similar Mechanical Properties than Two Strand Hamstrings or Ilio-Tibial Band

Gait analysis following medial opening-wedge high tibial osteotomy

International audiencePURPOSE: High tibial osteotomy (HTO) is used to treat young and active patients with knee osteoarthritis (OA) and varus deformity. The medial compartment OA alters the patients' gait.METHODS: A prospective study was carried out in 21 consecutive patients operated for HTO due to knee OA with varus deformity. There were 14 men and 7 women, with a median age of 51.9 years (38-64). Their gait was analyzed preoperatively and at 1 year postoperatively, and compared to a healthy control group. Clinical assessment (KOOS, WOMAC, Lysholm, and SF-36 scores) was also performed preoperatively and postoperatively.RESULTS: Patients with medial compartment OA had altered gait relative to the control population. Their walking speed was slower, step length was shorter, and single-leg stance time was shorter, while the double-leg stance time was longer (P < 0.001). Step width was not different between the two groups preoperatively (n.s.), but it was wider in the patient group postoperatively (P = 0.003). There were no differences in the patients' gait parameters before and after the osteotomy (n.s.). However, there was an improved perception of walking so that it is no longer different from controls (n.s.). The KOOS, WOMAC, Lysholm and SF-36 scores improved after HTO. The preoperative median of 7° varus (1-11) was corrected to 3° valgus (0-6).CONCLUSION: Medial compartment OA with varus deformity leads to gait modifications. HTO does not alter the time-distance parameters of gait; however, patients have improved perception of their walking ability. HTO leads to excellent results for knee function, and improves quality of life without modifying the gait pattern