To evaluate the efficacy of tibiotalocalcaneal arthrodesis using retrograde nailing (TTCAN) in post-traumatic conditions with high septic risk. We hypothesized that this minimally invasive technique would achieve bone union and satisfactory functional recovery without increasing septic risk. A prospective single-centre observational study included 20 patients who underwent TTCAN between January 2020 and December 2023. The primary outcome was the complete joint fusion rate at six months. Secondary outcomes included pain assessment, complications, functional evaluation using the modified AOFAS score, and quality of life assessment using the SF-12 questionnaire. Complete tibiotalocalcaneal fusion was achieved in 55

BACKGROUND:Rebound pain after regional anaesthesia remains a significant clinical problem. Intravenous dexamethasone is commonly used as an adjuvant to prevent rebound pain although its effectiveness varies among patients. We aimed to identify phenotypic and biological factors influencing glucocorticoid sensitivity contributing to dexamethasone resistance in the prevention of rebound pain. METHODS:Patients undergoing ambulatory upper limb surgery with an axillary brachial plexus block were enrolled prospectively to receive dexamethasone (0.1 mg kg-1 i.v.) before surgery. Preoperative factors analysed encompassed clinical aspects (central sensitivity, anxiety, and pain scores) and biological parameters (salivary cortisol, annexin-A1, and blood inflammatory markers). Postoperative outcomes comprised rebound pain incidence (numerical rating scale >7 within the first 24 h) and persistent pain at 3 months. RESULTS:Of the 104 patients included, 36 (34.6%) developed rebound pain. Preoperative nocturnal awakening pain (odds ratio [OR]=3.09, P=0.03), severe anxiety (OR=3.54, P=0.01), high catastrophising score (OR=4.14, P=0.01), and low salivary cortisol levels (<1147 pg ml-1) (OR=3.33, P=0.02) were associated with an increased risk of rebound pain. Persistent pain at 3 months (27%) was associated with the presence of postoperative rebound pain (P=0.04). CONCLUSIONS:Preoperative nocturnal pain, severe anxiety, high catastrophising, and low salivary cortisol levels are factors that might reduce the efficacy of dexamethasone in preventing rebound pain. These findings support the development of personalised preventive strategies. CLINICAL TRIAL REGISTRATION:NCT05763433.

Introduction La tendinopathie corporéale du tendon calcanéen est une pathologie fréquente dont le traitement endoscopique prend de plus en plus de place dans l’arsenal thérapeutique. L’objectif de notre étude était de comparer les résultats fonctionnels et anatomiques du traitement chirurgical à ciel ouvert et sous endoscopie des tendinopathies achilléennes corporéales. Hypothèse La chirurgie endoscopique donnerait des résultats fonctionnels supérieurs et une récupération plus rapide en comparaison à la chirurgie à ciel ouvert. Méthode Une étude prospective multicentrique, comparative non randomisée incluant tous les patients majeurs opérés d’une tendinopathie achilléenne corporéale résistante au traitement médical a été réalisée. L’évaluation clinique reposait sur les scores EFAS et VISA-A et la reprise du sport. Résultats Soixante patients ont été inclus dont 22 opérés sous endoscopie et 38 à ciel ouvert. Un retard de cicatrisation cutanée a été constaté à la suite d’une chirurgie endoscopique. Aucune lésion nerveuse n’a été rapportée. Aucune différence sur les scores fonctionnels n’était constatée entre ces deux approches. La reprise de la marche était précoce avant 6 semaines et la reprise du sport était progressive à partir du 3e mois postopératoire et possible dans 80 % des cas au 6e mois postopératoire, sans différence significative en fonction de la voie d’abord. Discussion Dans notre étude, la prise en charge chirurgicale des tendinopathies corporéales réfractaires au traitement médical, présentait une faible morbidité, permettait un retour précoce à la marche à 6 semaines et une reprise du sport dans 80 % des cas au 6e mois postopératoire, mais seulement dans un tiers des cas au même niveau. Ces résultats semblaient peu influencés par l’approche chirurgicale endoscopique ou à ciel ouvert. Niveau de preuve III.

BACKGROUND:Complex regional pain syndrome (CRPS) is a debilitating condition characterised by significant heterogeneity. Early diagnosis is critical, but limited data exists on the condition's early stages. This study aimed to characterise (very) early CRPS patients and explore potential subgroups to enhance understanding of its mechanisms. METHODS:A total of 113 early CRPS patients were recruited, with 89 undergoing physical assessments. Data included demographic information, work-related factors, CRPS history and clinical features, body perception disturbances, quantitative sensory testing (QST), and a visuospatial attention task. RESULTS:QST identified deficits in detecting thermal and mechanical stimuli, alongside increased sensitivity to thermal and blunt pressure painful stimuli. Participants reported body perception disturbances similar to those of persistent CRPS. Visuospatial biases were observed in two subgroups of patients. Latent class analysis (LCA) of 85 participants, based on five clinical parameters, identified four profiles: Mild, Moderate, Body Representation Disturbance (BRD), and Pressure Allodynia CRPS. The Mild and Moderate profiles were associated with higher-intensity trauma, with the latter showing worse outcomes. BRD and Pressure Allodynia CRPS followed mild trauma but exhibited the poorest outcomes. BRD CRPS displayed significant body perception disturbances, while Pressure Allodynia CRPS presented the highest sensitivity to pressure and psychosocial risk of chronification. Neither condition duration nor skin temperature effectively distinguished subgroups. CONCLUSIONS:These findings emphasise the heterogeneity within (very) early CRPS patients and support the absence of a minimum required duration prior to the CRPS diagnosis. Central/systemic mechanisms may play critical roles in severe cases. SIGNIFICANCE:This study identifies distinct (very) early CRPS profiles, suggesting different pathophysiological mechanisms and challenging traditional classifications. It paves the way for improved diagnosis and tailored treatments.

INTRODUCTION:Haemophilic elbow arthropathy (HEA) causes pain, limits mobility, and impairs upper limb function, often unrecognised until irreversible damage has occurred. AIMS:This narrative review sought to provide an updated overview of the current state of HEA knowledge, treatment approaches, and future perspectives. METHODS:We searched the PubMed/Medline, Embase and Scopus (through April 2025) databases for English articles using a combination of controlled vocabulary and free-text keywords related to haemophilia, elbow arthropathy, range of motion, physiotherapy, surgical interventions, and joint assessment. The review was organised around six key themes: normal function of the elbow, progressive loss of its mobility and functionality, monitoring, role of physiotherapy and exercise, invasive solutions, and future perspectives. A total of 60 articles were retrieved, 45 of which were examined in depth. RESULTS:HEA significantly affects the quality of life of people with haemophilia (PwH). Its insidious onset, coupled with the body's ability to compensate, frequently obscures the severity of mobility loss, leading to delayed interventions and irreversible joint damage. Early detection, precise monitoring, and targeted physiotherapy are crucial to slowing down disease progression and optimising functional outcomes. Surgical interventions are considered only in advanced-stage HEA, and are typically reserved for cases where conservative treatments have proven insufficient. Technological and telemedicine advances provide novel avenues to optimise care and promote patient self-management. CONCLUSIONS:HEA is a progressive, often overlooked condition that reduces quality of life in PwH, highlighting the need for early detection, monitoring, and targeted physiotherapy to prevent irreversible joint damage.

INTRODUCTION:A poorly treated acute ankle sprain can rapidly progress to chronic instability, with varying degrees of disability secondary to weakness of the ankle stabilizers. The aim of our study was to evaluate functional scores and physical tests in the assessment of eversion and proprioception deficits after non-surgical treatment of chronic ankle instability. Our hypothesis was that these functional scores and physical tests are suitable and sufficient for assessing the functional aspect of an unstable ankle. MATERIAL AND METHOD:This was a prospective, single-center study of patients managed for chronic ankle instability between November 2020 and November 2021. An ankle assessment was performed using two functional scores, the Foot Ankle Ability Measurement (FAAM) and the Ankle Ligament Reconstruction - Return to Sport after Injury (ALR-RSI), as well as two validated physical tests (Y-Balance Test and Side Hope Test). An objective (quantified) assessment of stabilizer muscle strength and proprioception was carried out using a connected device (Myolux™ Medik e-volution). RESULTS:At last recoil, twenty-eight unstable ankles were included. Only the ALR-RSI score correlated strongly with Myolux™ assessment of eversion strength (Rho ()ρ = 0.7; p < 0.001), and proprioception (Rho ()ρ = 0.8; p < 0.001). FAAM and physical tests were not or only very moderately correlated with Myolux™ assessments. DISCUSSION:In the absence of the Myolux™ test, the ALR-RSI score seemed the most suitable functional assessment of an unstable ankle in contrast to the FAAM score and the physical examinations Y-Balance Test and Side Hope Test. LEVEL OF EVIDENCE:IV; prospective study.

Complex regional pain syndrome (CRPS) is a challenging condition with unpredictable clinical evolution. Identifying early prognostic factors could transform patient management and improve outcomes. This prospective study followed 113 patients with early CRPS (<6 months) over 1 year to assess clinical evolution and investigate key predictors of chronification. Participants underwent repeated clinical assessments, quantitative sensory testing, and self-reported evaluations at 4 time points over 1 year. Multivariable mixed-effect models were used to identify independent early prognostic factors. Despite some improvement, 35% of the participants still met Budapest criteria at 1 year, with persistent pain, disability, and impaired quality of life. Sensory profiles appeared to stabilize after a few months, while body perception disturbance scores did not change during the follow-up period. Psychosocial factors, such as baseline disability, psychosocial severity, and social support, as well as body mass index and allodynia, were predictors of long-term outcomes. Biopsychosocial Early CRPS profiles defined through a latent class analysis carried out on the basis of data measured at inclusion revealed distinct clinical trajectories and showed stronger prognostic value than previously suggested CRPS classifications (eg, based on skin temperature). These findings highlight the importance of an early assessment incorporating biopsychosocial elements to stratify risk and tailor interventions. Our study paves the way for the development of a clinical tool to predict CRPS evolution, potentially enabling tailored treatments. Future research should validate these predictive models and explore their integration into routine practice, potentially improving the management of early CRPS.

Introduction Une entorse aiguë de cheville mal traitée peut rapidement évoluer vers une instabilité chronique dont le handicap secondaire à la faiblesse des stabilisateurs de la cheville peut être plus ou moins important. L’objectif de notre étude était d’évaluer les scores fonctionnels et les tests physiques dans l’évaluation du déficit des éverseurs et de la proprioception après traitement non chirurgical d’une instabilité chronique de cheville. Notre hypothèse était que ces scores fonctionnels et tests physiques sont adaptés et suffisent pour évaluer l’aspect fonctionnel d’une cheville instable. Matériel et méthode Il s’agissait d’une étude prospective, monocentrique, de patients pris en charge pour une instabilité chronique de cheville entre novembre 2020 et novembre 2021. Un bilan de la cheville était réalisé en utilisant deux scores fonctionnels, le Foot Ankle Ability Measurement (FAAM) et l’Ankle Ligament Reconstruction – Return to Sport Injury (ALR-RSI), ainsi que deux tests physiques (Y-Balance Test et Side Hope Test) validés. Une évaluation objective (chiffrée) de la force musculaire des stabilisateurs ainsi que de la proprioception était réalisée en utilisant un dispositif connecté (Myolux™ Medik E-volution). Résultats Au dernier recul, vingt-huit chevilles instables ont été incluses. Seul le score ALR-RSI était corrélé de manière forte à l’évaluation par Myolux™ de la force des éverseurs (Rho [ρ]=0,7 ; p<0,001), et de la proprioception (Rho [ρ]=0,8 ; p<0,001). Le FAAM et les tests physiques n’étaient pas ou très modérément corrélés aux évaluations Myolux™. Discussion En l’absence de test Myolux™, le score ALR-RSI semblait le plus adapté pour l’évaluation fonctionnelle d’une cheville instable à l’inverse du score FAAM et des examens physiques Y-Balance Test et Side Hope Test. Niveau de preuve IV ; étude prospective.

INTRODUCTION AND IMPORTANCE:This paper reports the technique we used to treat a recurrent fracture of the neck of the 5th metacarpal with bending of the pin that was still present in the patient bone. CASE PRESENTATION:A 26-year-old soldier presents to the emergency department following a direct trauma on the right hand. This patient had already presented a similar trauma one year ago with a fracture of the 5th metacarpal neck treated by intramedullary pins according to Foucher technique's. X-rays showed a recurrent fracture of the 5th metacarpal neck with pins bended. It was decided to remove the material with a change of osteosynthesis technique by intramedullary screwing with a headless screw. This allowed a return to work and activities without restriction 6 weeks after surgery. CLINICAL DISCUSSION: to our knowledge this is the first publication dealing with management of recurrent fracture of 5th metacarpal neck. This technique provides excellent outcome and a low risk of complication. CONCLUSION:This simple and original technique for revision osteosynthesis of a fracture the 5th metacarpal neck gives good short-term results and is interesting from a practical and functional point of view in the military patients.

INTRODUCTION:Non-insertional Achilles tendinopathy is a common condition, and endoscopic treatment is becoming an increasingly important therapeutic option. The aim of our study was to compare functional and anatomical results between open and endoscopic surgical treatment of non-insertional Achilles tendinopathy. HYPOTHESIS:Endoscopic surgery provides better functional results and faster recovery than open surgery. METHOD:A multicenter non-randomized prospective study included all adult patients operated on for non-insertional Achilles tendinopathy resistant to medical treatment. Clinical evaluation was based on EFAS and VISA-A scores and return to sport. RESULTS:Sixty patients were included, 22 of whom underwent endoscopic surgery and 38 open surgery. Skin healing was later following endoscopic surgery. No nerve damage was reported. There were no differences in functional scores between the two approaches. Walking was resumed before 6 weeks. Return to sport was progressive as of month 3 and achieved in 80% of cases by month 6, without significant difference according to approach. DISCUSSION:Surgical management of non-insertional tendinopathy refractory to medical treatment presented low morbidity, allowed early resumption of walking by 6 weeks and return to sport in 80% of cases by month 6, but only a third of cases at the previous level. Results were comparable between endoscopic and open approaches. LEVEL OF EVIDENCE:III.

IntroductionLes défects ostéochondraux du genou d’origine traumatiques ou secondaires à une ostéochondrite sont pourvoyeurs de gonarthrose à moyen terme. Lorsqu’ils sont de taille supérieure à 2cm2 et inférieure à 8cm2, la méthode AMIC (Autologous Matrix-Induced Chondrogenesis, ou chondrogenèse induite par membrane) peut être proposée. Cette technique consiste à réaliser des microfractures de l’os sous-chondral au sein de la perte de substance et de l’occlure par une matrice de collagène de type I et III afin d’induire un cartilage de novo. Des résultats encourageants ont été publiés dans des petites séries monocentriques mais son efficacité clinique et radiologique à moyen terme reste à prouver sur des séries plus importantes. Le but de cette étude était d’analyser les résultats de la technique AMIC avec deux ans de recul minimum pour une lésion ostéochondrale du genou.HypothèseLa technique AMIC est efficace sur le plan clinique et radiologique pour le traitement des lésions ostéochondrales du genou avec un recul minimum de deux ans.Matériels et méthodesIl s’agissait d’une étude rétrospective multicentrique (16 centres) et multi-opérateurs (18 chirurgiens orthopédistes seniors) incluant tous les patients opérés entre septembre 2011 et janvier 2020 selon la technique AMIC avec une membrane ChondroGide®. Une évaluation par un questionnaire des scores SF-36, KOOS et IKDC était réalisée en préopératoire et au cours du suivi. Une IRM à deux ans était également réalisée et analysée afin d’évaluer le comblement de la perte de substance via l’échelle MOCART.RésultatsCent un patients âgés de 12 à 60 ans ont été inclus. Le recul moyen était de 30 mois. La perte de substance moyenne était de 3,44cm2 (min 2 ; max 8) Les résultats montraient une amélioration significative sur les scores fonctionnels SF-36, KOOS et IKDC. Le score MOCART moyen était de 75 % (min 20 ; max 100) à deux ans postopératoire.DiscussionLa méthode AMIC améliorait significativement à deux ans et demi postopératoire les patients traités d’une lésion ostéochondrale du genou entre 2 et 8cm2. Elle semble donner des résultats comparables aux autres méthodes disponible et présente l’avantage d’être réalisée en un seul temps et sans la morbidité d’un prélèvement d’autogreffe ostéocartilagineuse.Niveau de preuveIV ; étude rétrospective observationnelle.

Las lesiones condrales u osteocondrales son relativamente frecuentes, a menudo se pasan por alto y afectan a muchas articulaciones, principalmente la rodilla y el tobillo. Su tratamiento es un auténtico desafío que debe permitir no sólo una reconstrucción duradera del cartílago hialino, sino sobre todo ser capaz de prevenir la artrosis. Las lesiones osteocondrales se producen en un marco traumático o en el marco de osteocondritis disecantes. En principio, el tratamiento de reconstrucción sólo se dirige a las lesiones profundas y sintomáticas correspondientes a los estadios III y IV de la clasificación de la International Cartilage Repair Society, lo que excluye el tratamiento de las lesiones superficiales, de las lesiones asintomáticas a menudo de descubrimiento fortuito, así como de las lesiones en espejo que entran en el marco de las lesiones de artrosis. El arsenal terapéutico está en constante evolución con técnicas nuevas procedentes de la investigación, cuya accesibilidad es muy variable según los países y la legislación vigente. Sin embargo, la evidencia clínica de su eficacia e incluso de su superioridad son muy difíciles de obtener. Se distinguen tres tipos de procedimientos: las técnicas paliativas (tratamiento médico, desbridamiento simple), las técnicas de reparación (microperforaciones, matrices acelulares, gel), que dan lugar a fibrocartílago, y las técnicas de regeneración (auto y aloinjertos en mosaico, injertos de condrocitos, injertos de cartílago particulado), dirigidas a obtener cartílago hialino. Su tratamiento requiere una evaluación de la lesión (localización, tamaño, profundidad), una evaluación local de la articulación (estabilidad, movilidad) y locorregional del miembro (eje), así como general del paciente (nivel de molestia funcional, nivel deportivo, índice de masa corporal, etc.). Las indicaciones para el tratamiento de la lesión cartilaginosa tienen en cuenta la localización, la superficie y la profundidad de la pérdida de sustancia, las molestias funcionales de los pacientes, el estado articular y el contexto del paciente. Para las osteocondritis disecantes, también se analizan la vitalidad y la estabilidad del fragmento. La inestabilidad o la desviación del eje se tratan previamente o de forma simultánea.

PurposeManaging the distal tibiofibular (DTF) joint remains a challenge despite recent developments. Ankle arthroscopy is emerging as a diagnostic and therapeutic means. Our study aimed to compare preoperative imaging data and arthroscopic data, with the hypothesis that imaging alone is insufficient to evaluate acute laxity, and with arthroscopy as the reference examination.MethodsAll patients treated in 2023 in our department for an acute isolated DTF lesion were included prospectively. Preoperative radiographic and MRI imaging were compared with arthroscopic data.ResultsTen patients were treated. For five patients, the instability was doubtful after carrying out an appropriate imaging assessment (X-rays of both ankles, MRI). For four of these five patients, instability was confirmed by arthroscopy. Arthroscopy was useful for suturing the anterior bundle of the DTF joint for two patients and allowed for verifying the reduction in the sagittal and coronal planes for two patients. No complications were detected.ConclusionsArthroscopy in isolated acute DTF lesions seems to provide a diagnostic and therapeutic advantage. Its use may allow for exhaustive assessment and complete repair of lesions. It must be offered as soon as possible; a delay in specialized imaging may delay therapeutic care.

BACKGROUND:Symptomatic osteochondral lesions of the talar dome (OLTD) represent a real therapeutic challenge. In the absence of appropriate treatment, these lesions can evolve into tibiotalar osteoarthritis. Stage 3 lesion of the SFA classification and resistant to medical non-operative treatment may require surgical treatment. The results of the membrane-induced chondrogenesis (AMIC®) technique in the knee have been previously reported. At the ankle, few publications exist. Our objective was to evaluate clinical results of the AMIC® technique. HYPOTHESIS:AMIC® technique is clinically effective for the treatment of LODT with a minimum follow-up of 12 months after surgery. MATERIAL AND METHOD:This was a multicenter (5 centers) retrospective study including patients operated on for an OLTD stage 3 of SFA between January 2019 and March 2021 using the AMIC® technique with a ChondroGide® membrane. A functional assessment by questionnaire (AOFAS, EFAS, FFI scores), clinical (VAS) and return to sport were carried out. RESULTS:21 patients (10 men and 11 women), aged 16-69 years (mean age 34 years) were included. The average follow-up was 34 months (min 12 months; max 72 months). The average loss of substance was 1.83 cm2 (min 0.6 cm2; max 6 cm2). The results showed a significant improvement in the AOFAS functional score which went on average from 71 [CI = 64; 77] to 90 [CI = 82; 97], EFAS which went from 15 [CI = 10; 20] to 32 [CI = 10; 20] = 26; 38], FFI which went from 28% [CI = 19%; 38%] to 10% [CI = 2%; 18%] and the EVA which decreased by 4 [CI = 3.9; 4.7] to 1 [CI = 0.5; 2.4]. 60% of patients returned to sport at the same level and 80% of patients were satisfied with the surgery. DISCUSSION:AMIC® method improved the functional results of patients with SFA stage 3 OLTD at an average follow-up of 34 months post-operatively. LEVEL OF EVIDENCE:IV; retrospective observational cohort study.