Trohleoplastika: Kirurške indikacije i operacijska tehnika u liječenju rekurentne patelarne dislokacije pri uznapredovaloj patelofemoralnoj displaziji

Trochleoplasty is a surgical procedure which was initially reserved for the refractory cases where previous surgery has failed, but has become more popular in the past years because of a better knowledge of the knee anatomy and biomechanics and a greater availability of surgical instruments. The technical difficulty of the sulcus-deepening trochleoplasty lies in the fact that surgeons aim to reshape a usually extremely dysplastic articular surface of the trochlea without damaging it. If patients are carefully selected and the surgical rationale is carefully followed, recent bibliography presents very encouraging results of the application of trochleoplasty with other procedures in patients with severe trochlear dysplasia and recurrent patellar dislocation, in whom benign neglect of dysplasia would lead to unfavourable results. The surgical steps and technical pearls of the procedure are described in this review.Trohleoplastika je kirurški zahvat koji se koristi u liječenju rekurentnih dislokacija patele kod displazija patelofemoralnog zgloba. U početku se trohleoplastika primjenjivala samo kod pacijenata kod kojih ostale metode nisu polučile uspjeh. Kako saznanja o anatomiji i biomehanici napreduju, kao i tehnološka dostignuća u konstruiranju kirurških instrumenata, tako raste i popularnost takve vrste kirurškog zahvata raste. Radi se o zahtjevnom kirurškom zahvatu kod kojeg je potrebno preoblikovati displastično promijenjenu trohleu femura, a da se pritom značajno ne ošteti zglobna hrskavica. Noviji rezultati u pacijenata s visokim stupnjem displazije trohlee femura i rekurentnim dislokacijama patele, govore u prilog trohleoplastike u usporedbi s ostalim kirurškim postupcima. Ovaj rad u detalje opisuje kiruršku tehniku trohleoplastike

Modified Elmslie-Trillat procedure for distal realignment of patella tendon

Patellofemoral dysfunction, due to either a patellofemoral malalignment or patellar instability, is a complex and debilitating condition that significantly decreases the knee function. Conservative management may yield significant clinical outcomes; however, when morphologic anomalies are identified, the surgical approach should be employed. Hence, several surgical procedures have been described in the scientific literature aiming the correction of underlying extensor mechanism malalignments. Still, the rate of complications is higher than desirable. The described technique is based on the principles of transferring the tibial tubercle medially as described in the Elmslie-Trillat technique. However, a curvilinear horizontal cut is made prior to the vertical cut, which raises a thick osseous fragment and allows the formation of a gutter when the osseous fragment is moved medially. Whereas the horizontal gutter provides stability to the bone fragment, the thicker dimension of the osseous fragment and retention of the distal attachment significantly enhances the osteotomy union. Hence, adequate pain relief and stability with very low postoperative morbidity could be achieved. The purpose of this surgical note is to describe a modification to the Elmslie-Trillat technique to treat patellofemoral dysfunctions, achieving a higher osseous stability and decreased postoperative morbidity.info:eu-repo/semantics/publishedVersio

Deepening trochleoplasty with a thick osteochondral flap for patellar instability:Clinical and functional outcomes at mean 6 year follow-up

Background: In patients with patellar instability and severe trochlear dysplasia, trochleoplasty has become increasingly used as part of the surgical management. Hypothesis: Deepening trochleoplasty for severe dysplasia in patellofemoral instability improves function and increases sports participation. Study Design: Case series; Level of evidence, 4. Methods: Between 1995and 2010 the thick-flap deepening trochleoplasty was performed in 90 patients (107 knees) with severe trochlear dysplasia. Data was collected prospectively pre-operatively, at 6 weeks and 1-year follow-up. The patients were surveyed retrospectively to determine the clinical and functional outcomes including sports and exercise participation at a minimum of 2 years, with complete data available in 92%. Results: With a minimum follow-up of 2 years, average of 6 years (range 2 – 19 years). The Kujala score had a median and interquartile range (IQR) of 63 (47-75) pre-operatively rising to 79 (68-91) at 1 year follow-up and 84 (73-92) at final follow-up (p< 0.05). Seventy-two per cent were satisfied with their knee function at 1 year follow-up rising to 79% at final follow-up (p <0.0001). Sports and exercise participation increased from 36 patients (40%) pre-operatively to 60 (67%) at final follow-up. The numbers involved in competitions increased slightly from 10 (11%) to 11 (12%). Of those sports that involved twisting (e.g. soccer, cricket, badminton), the proportion of patients participation increased from 16 (18%) to 22 (24%), whereas in non-twisting sports (e.g. running, swimming, cycling) it increased from 24 (27%) to 47 (52%) of whom 14 (16%) used walking as exercise. Conclusion: The thick-flap deepening trochleoplasty improves the clinical and functional outcomes for patients with symptomatic patellar instability with severe trochlear dysplasia. These results improve over time and beyond the 1 year clinical follow-up. However trochleoplasty does not lead to a significant improvement in sports participation at a competitive level. It does improve the sports and exercise patient participation, principally in non-twisting sports activities

Évaluation de la performance d’un compresseur contra-rotatif à écoulement mixte

Résumé Le compresseur est une composante clé (et la plus longue) des moteurs d'avion. À ce titre, il est très souvent l'objet d'études visant à améliorer sa performance, en termes du rapport de pression et de rendement, et son opérabilité en termes de marge de décrochage. L'objectif de ce mémoire est de présenter la première évaluation d'un nouveau concept de compresseur non-axial contra-rotatif sous la forme d'un compresseur à écoulement mixte. Dans ce concept, le stator du compresseur mixte, ou le diffuseur d'un compresseur centrifuge, est remplacé par un rotor tournant dans le sens opposé du rotor amont. Le rotor contra-rotatif permet alors de ramener l'écoulement dans la direction axiale, et ce avec un virage de l'écoulement relatif beaucoup plus faible que celui d'un stator équivalent. Le rotor aval va de surcroît produire un travail supplémentaire équivalent à celui en amont, permettant d'obtenir une augmentation de pression bien supérieure à un compresseur standard. Ce meilleur rapport de compression peut alors permettre de remplacer un ou plusieurs étages du compresseur, réduisant ainsi la longueur, le poids, la complexité et les coûts de production et d'entretien du moteur. Ce mémoire présente une première preuve de concept de ce nouveau type de compresseur ainsi que des possibilités d'amélioration du design initial. Pour l'évaluer, un compresseur contra-rotatif à basse vitesse et écoulement mixte ainsi que son équivalent conventionnel (i.e. configuration rotor mixte/stator) avaient été conçus. Des simulations CFD ont été effectuées pour comparer la performance de ces deux compresseurs. Les résultats obtenus montrent que la configuration contra-rotative permet d'obtenir une augmentation de pression deux fois plus élevée que sa contrepartie conventionnelle mais aussi un meilleur rendement et une marge de décrochage plus importante. L'absence de décollement significatif de la couche limite sur le rotor contra-rotatif (pourtant présent dans le stator de la configuration conventionnelle) est à l'origine des améliorations du rendement et de la marge de décrochage. D'autres simulations réalisées sur des modélisations du compresseur au complet ont par la suite permis de valider le point et le mécanisme de décrochage de chacune de ces configurations. Le compresseur à l'étude représente par ailleurs un jalon vers un nouveau design de compresseur contra-rotatif centrifuge et non plus mixte. Dans cet esprit, différentes voies d'amélioration du présent compresseur ont été explorées, parmi lesquelles l'influence sur les performances du jeu d'aube ou encore de la méthode d'empilement des sections composant les pales (transformations dites ''sweep'' et ''dihedral''). Il en ressort que la taille du jeu d'aube a une forte influence sur la stabilité et le rendement du compresseur contra-rotatif, comme cela pouvait être attendu. Les modifications de la géométrie de l'aube ont quant à elles une influence modérée sur l'efficacité mais très forte sur la stabilité, pouvant permettre de plus que doubler la marge de décrochage.----------Abstract The compressor is a key (and the longest) component of modern aircraft engines and as such is often the subject of studies aiming to improve its performance, in terms of pressure and efficiency, and its operability, in terms of stall margin. The purpose of this thesis is to assess the performance of a new non-axial compressor concept in the form of a counter-rotating mixed-flow compressor. In this concept, the stator of a mixed-flow stage, or the diffuser of a centrifugal stage, is replaced with a rotor rotating in the opposite direction. This rotor will turn the flow back to the axial direction with lower relative flow turning than an equivalent stator or diffuser. Moreover, the counter-rotating rotor provides a work equivalent of the upstream rotor or impeller. This additional work can double the total pressure rise of the stage and thus allow the counter-rotating stage to replace several conventional stages, reducing the length, mechanical complexity, weight and manufacturing and maintenance costs of the aeroengine. This thesis presents a first proof of concept of such a compressor as well as possibilities for design improvements. In order to assess the performance of this concept, a low-speed mixed-flow counter-rotating compressor and its equivalent counterpart (i.e. mixed-flow rotor/stator) had been designed. CFD simulations have been carried out to compare the two configurations. Results show that the counter-rotating compressor presents twice the total pressure rise of the conventional configuration. Furthermore, its efficiency and stall margin are superior to the conventional design. The absence of significant boundary layer separation (present on the stator) on the counter-rotating rotor is the source of the efficiency and stall margin improvements. CFD calculations of the entire compressor have also been carried out to validate and to explore further the stall mechanism of both configurations. Given that the studied compressor represents a milestone toward a new kind of centrifugal counter-rotating compressor, possible design improvements are proposed and assessed. In particular, the influence on the performance of the tip clearance and several modifications of the stacking line of the blade sections (such as the ``sweep'' and ``dihedral'' transformations) have been studied. The results show that the tip clearance size has a great influence on both the efficiency and the stability while the modifications of the stacking line only involve an increase in the stall margin with only a moderate effect on efficiency

SOST/Sclerostin Improves Posttraumatic Osteoarthritis and Inhibits MMP2/3 Expression After Injury.

Patients with anterior cruciate ligament (ACL) rupture are two times as likely to develop posttraumatic osteoarthritis (PTOA). Annually, there are ∼900,000 knee injuries in the United States, which account for ∼12% of all osteoarthritis (OA) cases. PTOA leads to reduced physical activity, deconditioning of the musculoskeletal system, and in severe cases requires joint replacement to restore function. Therefore, treatments that would prevent cartilage degradation post-injury would provide attractive alternatives to surgery. Sclerostin (Sost), a Wnt antagonist and a potent negative regulator of bone formation, has recently been implicated in regulating chondrocyte function in OA. To determine whether elevated levels of Sost play a protective role in PTOA, we examined the progression of OA using a noninvasive tibial compression overload model in SOST transgenic (SOSTTG ) and knockout (Sost-/- ) mice. Here we report that SOSTTG mice develop moderate OA and display significantly less advanced PTOA phenotype at 16 weeks post-injury compared with wild-type (WT) controls and Sost-/- . In addition, SOSTTG built ∼50% and ∼65% less osteophyte volume than WT and Sost-/- , respectively. Quantification of metalloproteinase (MMP) activity showed that SOSTTG had ∼2-fold less MMP activation than WT or Sost-/- , and this was supported by a significant reduction in MMP2/3 protein levels, suggesting that elevated levels of SOST inhibit the activity of proteolytic enzymes known to degrade articular cartilage matrix. Furthermore, intra-articular administration of recombinant Sost protein, immediately post-injury, also significantly decreased MMP activity levels relative to PBS-treated controls, and Sost activation in response to injury was TNFα and NF-κB dependent. These results provide in vivo evidence that sclerostin functions as a protective molecule immediately after joint injury to prevent cartilage degradation. © 2018 The Authors. Journal of Bone and Mineral Research Published by Wiley Periodicals Inc

Sampling of free transplant bone-tendon-bone by mini-invasive way or by conventional way: prospective and comparative study of 36 cases

Service d’orthopédie, C.H. Draguignan, Service d’orthopédie, Clinique la Sauvegarde, Lyon, France, CHU Sf. Pantelimon, Bucarest, Romania, Al VIII-lea Congres Naţional de Ortopedie și Traumatologie cu participare internaţională 12-14 octombrie 2016The study has been carried out at the Emile de Vialar Clinic in Lyon (France) The aim of that study is to analyze the feasibility of the mini invasive technique through a comparative and prospective study uni-centric realized on two groups: “classical” and “mini-invasive” of 18 patients. The patients have been checked 6 to 8 months after the surgery. Check has been clinical, radiological and echographycal. Radiological laxity has been evaluated for each compartment. The echographycal study analyzed the the patellar tendon and peri tendon. All data were extracted on an Excel spreadsheet (Microsoft) and analyzed with spreadsheet tools and those of the toolbox Statistical Toolbox (Matlab). A radiological classification of the anterior tibial tuberosity (TTA) was established. The study highlights a correlation between the TTA and the patellar apex. The grafts taken by classical technique showed in every case good characteristic, against 45% of cases taken by «miniinvasive way". The earlier pain was 22 % in the "classic" group and 33% in «mini-invasive». Data analysis showed no correlation between the earlier pain and (a) the result of “knee walking” test or (b) the thickness of the peri- tendon. It was found a correlation between the results of «knee walking» test and the asymmetry of tabs width in the "mini-invasive" group. The IKDC scores: a) Subjective was virtually identical and b) Objective was 94% (or A) to the "classic" group and 81% (A or B) to the group "mini- invasive". This “mini- invasive" technique respects the infra- patellar branch of intern saphenous nerve in 95%. The indication of sampling patellar graft by “mini invasive” technique is the TTA type III

A 10 year follow-up study after Roux-Elmslie-Trillat treatment for cases of patellar instability

<p>Abstract</p> <p>Background</p> <p>A retrospective study concerning patients presenting with patella instability, treated using a Roux-Elmslie-Trillat reconstruction operation and followed up for 10 years following surgery, is presented.</p> <p>Methods</p> <p>Pre-operative and follow-up radiographic evaluation included the weight-bearing anteroposterior and merchant views. Evaluation was carried out using the Insall-Salvati index, sulcus and congruence angle. The Roux-Elmslie-Trillat reconstruction operation was performed on 18 patients. The clinical evaluation at follow-up was performed using the Knee-Society-Score (KSS) and Tegner-Score.</p> <p>Results</p> <p>Subjective results of the operation were classed as excellent or good in 16 of the 18 patients ten years after surgery; persistent instability of the patella was recorded in only one of the 18 patients. The majority of patients returned to the same level of sporting activity after surgery as they had participated in before injury.</p> <p>Conclusions</p> <p>The Roux-Elmslie-Trillat procedure could be recommended in cases presenting with an increased q-angle, trochlea dysplasia or failed soft tissue surgery. In the present study the majority of patients report a return to previous sporting activity ten years after surgery.</p

Surgical versus non-surgical interventions for treating patellar dislocation

Background: Patellar dislocation occurs when the patella disengages completely from the trochlear (femoral) groove. Following reduction of the dislocation, conservative (non-surgical) rehabilitation with physiotherapy may be used. Since recurrence of dislocation is common, some surgeons have advocated surgical intervention rather than non-surgical interventions. This is an update of a Cochrane review first published in 2011. Objectives: To assess the effects (benefits and harms) of surgical versus non-surgical interventions for treating people with primary or recurrent patellar dislocation. Search methods: We searched the Cochrane Bone, Joint and Muscle Trauma Group's Specialised Register, the Cochrane Central Register of Controlled Trials (The Cochrane Library), MEDLINE, EMBASE, AMED, CINAHL, ZETOC, Physiotherapy Evidence Database (PEDro) and a variety of other literature databases and trial registries. Corresponding authors were contacted to identify additional studies. The last search was carried out in October 2014. Selection criteria: We included randomised and quasi-randomised controlled clinical trials evaluating surgical versus non-surgical interventions for treating lateral patellar dislocation. Data collection and analysis: Two review authors independently examined titles and abstracts of each identified study to assess study eligibility, extract data and assess risk of bias. The primary outcomes we assessed were the frequency of recurrent dislocation, and validated patient-rated knee or physical function scores. We calculated risk ratios (RR) for dichotomous outcomes and mean differences MD) for continuous outcomes. When appropriate, we pooled data. Main results: We included five randomised studies and one quasi-randomised study. These recruited a total of 344 people with primary (first-time) patellar dislocation. The mean ages in the individual studies ranged from 19.3 to 25.7 years, with four studies including children, mainly adolescents, as well as adults. Follow-up for the full study populations ranged from two to nine years across the six studies. The quality of the evidence is very low as assessed by GRADE (Grading of Recommendations Assessment, Development and Evaluation Working Group) criteria, with all studies being at high risk of performance and detection biases, relating to the lack of blinding. There was very low quality but consistent evidence that participants managed surgically had a significantly lower risk of recurrent dislocation following primary patellar dislocation at two to five years follow-up (21/162 versus 32/136; RR 0.53 favouring surgery, 95% confidence interval (CI) 0.33 to 0.87; five studies, 294 participants). Based on an illustrative risk of recurrent dislocation in 222 people per 1000 in the non-surgical group, these data equate to 104 fewer (95% CI 149 fewer to 28 fewer) people per 1000 having recurrent dislocation after surgery. Similarly, there is evidence of a lower risk of recurrent dislocation after surgery at six to nine years (RR 0.67 favouring surgery, 95% CI 0.42 to 1.08; two studies, 165 participants), but a small increase cannot be ruled out. Based on an illustrative risk of recurrent dislocation in 336 people per 1000 in the non-surgical group, these data equate to 110 fewer (95% CI 195 fewer to 27 more) people per 1000 having recurrent dislocation after surgery. The very low quality evidence available from single trials only for four validated patient-rated knee and physical function scores (the Tegner activity scale, KOOS, Lysholm and Hughston VAS (visual analogue scale) score) did not show significant differences between the two treatment groups. The results for the Kujala patellofemoral disorders score (0 to 100: best outcome) differed in direction of effect at two to five years follow-up, which favoured the surgery group (MD 13.93 points higher, 95% CI 5.33 points higher to 22.53 points higher; four studies, 171 participants) and the six to nine years follow-up, which favoured the non-surgical treatment group (MD 3.25 points lower, 95% CI 10.61 points lower to 4.11 points higher; two studies, 167 participants). However, only the two to five years follow-up included the clear possibility of a clinically important effect (putative minimal clinically important difference for this outcome is 10 points). Adverse effects of treatment were reported in one trial only; all four major complications were attributed to the surgical treatment group. Slightly more people in the surgery group had subsequent surgery six to nine years after their primary dislocation (20/87 versus 16/78; RR 1.06, 95% CI 0.59 to 1.89, two studies, 165 participants). Based on an illustrative risk of subsequent surgery in 186 people per 1000 in the non-surgical group, these data equate to 11 more (95% CI 76 fewer to 171 more) people per 1000 having subsequent surgery after primary surgery. Authors' conclusions: Although there is some evidence to support surgical over non-surgical management of primary patellar dislocation in the short term, the quality of this evidence is very low because of the high risk of bias and the imprecision in the effect estimates. We are therefore very uncertain about the estimate of effect. No trials examined people with recurrent patellar dislocation. Adequately powered, multi-centre, randomised controlled trials, conducted and reported to contemporary standards, are needed. To inform the design and conduct of these trials, expert consensus should be achieved on the minimal description of both surgical and non-surgical interventions, and the anatomical or pathological variations that may be relevant to both choice of these interventions and the natural history of patellar instability. Furthermore, well-designed studies recording adverse events and long-term outcomes are needed

Devenir, former, recruter un géomaticien : Petit guide pratique de la géomatique à destination des employeurs, des candidats et des formateurs

Document pdf disponible sur le site de l'AFIGEOPublié à l'occasion du Colloque national " Métiers et compétences en géomatique : des formations aux emplois " le 14 novembre 2013 au CNAM, ce guide est le fruit d'une réflexion collective menée au sein du Pôle Formation-Recherche de l'AFIGEO. S'appuyant sur de nombreuses ressources (issues des résultats d'une enquête métier réalisée en 2013 avec GeoRezo et le GDR Magis, d'analyse de fiches de poste, de l'observatoire des GeoFormations, de la démarche de reconnaissance des métiers), il s'organise autour de 4 chapitres : - QU'EST-CE QUE LA GEOMATIQUE ? - A QUOI SERT UN GEOMATICIEN ? - SE FORMER A LA GEOMATIQUE ? - RECRUTER UN GEOMATICIEN ? En s'adressant aux étudiants, formateurs, recruteurs, géomaticiens débutants ou plus expérimentés, ce guide vise à apporter un éclairage pédagogique, concret sur le vaste monde de la géomatique, sur les spécificités des compétences, des métiers et des formations associés. Pour recevoir la version numérique du Guide, nous vous remercions de compléter le formulaire de demande suivant : https://docs.google.com/forms/d/1MYxjzslEeLd4VwsdOKwtxJyZwVLaLNv7d_lBj_mPGlM/viewfor