Chirurgie combinée : reconstruction du ligament croisé postérieur et ostéotomie d'ouverture antérieure

International audienc

Anterior Femoral Referencing in Total Knee Arthroplasty

International audienceA total knee arthroplasty (TKA) requires several bone cuts. The accuracy and quality of bone cuts determine proper positioning of TKA. Several ancillary instruments are used to perform these different steps and make these more accurate

Chirurgia di revisione nella rottura del legamento crociato anteriore

International audienceLa strategia della chirurgia di revisione nelle rotture del legamento crociato anteriore si basa sull'analisi dell'insuccesso, la valutazione del paziente (indicazioni) e lo studio delle caratteristiche anatomiche. Le cause d'insuccesso si devono ricercare mediante un esame clinico rigoroso, una misura della lassità e un esame radiografico e tomodensitometrico che permettano l'analisi dei tunnel. Le vie d'accesso utilizzate, così come il tipo di trapianto utilizzato (legamento patellare, zampa d'oca, tendine quadricipitale, tendine achilleo, fascia lata, materiale sintetico) guidano il chirurgo nella scelta del trapianto e della tecnica di perforazione dei tunnel dall'esterno all'interno, dall'interno all'esterno con tunnel dipendenti o indipendenti, potendo influenzare la strategia di realizzazione dei tunnel nella chirurgia di revisione. Si valuta l'impiego di una chirurgia in uno o due tempi. Infine, si tengono in considerazione le lesioni associate (punti d'angolo posterolaterale e/o posteromediale, lesioni al menisco o meniscectomie parziali, legamento anterolaterale) da trattare, sia tramite interventi ossei (correzione nel piano frontale e/o sagittale) che tramite interventi sulle parti molli

Variabilité spatio-temporelle des groupements végétaux d'un étang angevin (France)

National audienc

Robotic Assisted Unicompartmental Knee Arthroplasty

International audienc

Ligament croisé antérieur et gonarthrose

International audienc

Tibial tubercle osteotomy in primary total knee arthroplasty: A safe procedure or not?

The objective of this study was to investigate the influence of tibial tubercle osteotomy on postoperative outcome, intra- and postoperative complications, as well as postoperative clinical results and failures in primary total knee arthroplasty (TKA). In a continuous, consecutive series of 1474 primary TKA, we analysed 126 cases where a tibial tubercle osteotomy approach was performed and 1348 cases without tibia] tubercle osteotomy. Before surgery, all patients underwent a systematic assessment that included a clinical examination, radiographs (stress hip-knee-ankle film [pangonogram], weight bearing, anteroposterior knee view, schuss view, profile and patellar axial view at 30 degrees, stress valgus and varus view) and International Knee Society scores. When analysing intraoperative complications, tibial plateau fissures or fractures and tibia] tubercle fracture were considered as complications relating to the tibial tubercle osteotomy group (p<0.001, p=0.007). With a 2-year minimum follow-up, there was no statistical difference in the number of revisions carried out in the two study groups (p=0.084). However, postoperative tibial tubercle fracture and skin necrosis were significantly related to the osteotomy (p=0.001 and p <= 0.001, respectively). Tibial tubercle osteotomy cannot be considered an entirely safe procedure in primary TKA as it is associated with local complications, particularly skin necrosis and fracture of the tibial tubercle. Therefore, tibial tubercle osteotomy should be performed only when necessary, i.e. in cases where there are difficulties gaining adequate surgical exposure, ligament balance and correct implant positioning. The procedure also demands considerable surgical experience to achieve a good outcome. (C) 2008 Elsevier B.V. All rights reserved.15643944

Is previous knee arthroscopy related to worse results in primary total knee arthroplasty?

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)According to literature, knee arthroscopy is a minimal invasive surgery performed for minor surgical trauma, reduced morbidity and shortens the hospitalization period. Therefore, this type of surgery before total knee arthroplasty (TKA) could be considered a minor procedure with minimum postoperative complication. A retrospective and cohort series of 1,474 primary TKA was performed with re-assessment after a minimum follow-up period of 2 years: 1,119 primary TKA had no previous surgery (group A) and 60 primary TKA had arthroscopic debridement (group B). All the patients underwent a clinical and radiological evaluation as well as IKS scores. Statistical analysis of postoperative complications revealed that group B had a higher postoperative complication rate (P < 0.01). In this group, 30% of local complications were re-operated and 8.3% of these cases underwent revision TKA (P < 0.01). The mean interval between arthroscopy and primary TKA was 53 months. However, statistical analysis did not reveal a direct correlation between arthroscopy/primary TKA interval and postoperative complications/failures (P = 0.55). The Kaplan-Meier survival curves showed a survival rate of 98.1 and 86.8% at 10 years follow-up for groups A and B, respectively. Our data allow us to conclude that previous knee arthroscopy should be considered a factor related to postoperative primary TKA outcomes as demonstrated by the higher rate of postoperative complications and failures (P < 0.001) as well as a worse survival curve than group A.174328333Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)National Council for Scientific and Technological Development, BrazilConselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq