Hypothesis: We hypothesized that cyclops syndrome represents a mechanical issue, suggesting that the problem (extension deficit) is definitively resolved and solved once the cyclops is removed. Materials and Methods: During a two-year period (from January 1992 to December 1994), in which 835 bone-patella-bone autograft ACL reconstructions were performed, 36 patients (4.3%) required arthroscopic revision for Cyclops lesions. The mean age of patients was 26.2 years old (range, 16-43 years). Average time of treatment of the Cyclops lesion after primary surgery was 10 months (range, 2.5-26 months). Activity level was intensive for most of the patients. All patients were evaluated with the IKDC scoring system (subjective evaluation and clinical exam) and KT 1000 testing. Residual Cyclops symptoms were also analyzed. The mean follow-up was 9 years (range, 8-10 years). Results: Seven patients were lost to follow-up and were excluded from the study. Twenty-nine patients were followed up: 6 by phone (16.7%) and 23 clinically (63.9%). Two recurrent ACL lesions were noticed (6.9%). The mean final IKDC subjective score was 81.6 points (range, 50-100). Half of the patients had good results (greater than 82 points), while the other half had reduced scores (between 50 to 80 points). The distribution of the final IKDC objective score was: A = 17.4%; B = 65.2%; C = 8.7%; D = 8.7%. Thirteen patients had persistent Cyclops symptoms (44.8%), 14 patients still had loss of motion (48.3%), and 15 patients had diminished levels of activity (51.7%). Conclusions: Cyclops syndrome, while not affecting knee laxity, is associated with significant long-term symptoms. This suggests a complex etiology beyond mechanical factors. Early surgical intervention may mitigate chronic complications.

PURPOSE:This study aimed to evaluate the long-term functional outcomes and survivorship of medial closing wedge high tibial osteotomy (MCWHTO) in treating lateral femorotibial osteoarthritis (OA) and factors associated. METHODS:Between 1997 and 2018, 65 patients (67 knees) who underwent an MCWHTO were longitudinally assessed. Inclusion criteria were symptomatic lateral femorotibial OA in valgus knees with no signs of medial compartment OA. The primary outcome was osteotomy survivorship with a failure endpoint defined by the necessity for total knee arthroplasty (TKA). Clinical and functional outcomes, including Knee injury and Osteoarthritis Outcome Score (KOOS), University of California, Los Angeles (UCLA) activity scale and patient satisfaction, as well as radiological evaluation, including hip-knee-ankle angle (HKA), mechanical proximal tibial angle (mPTA) and mechanical lateral distal femoral angle (mLDFA), were assessed both preoperatively and at final follow-up. RESULTS:The mean follow-up was 11.5 ± 6.3 years [3.3-24.5]. Three patients were lost at final follow-up. Overall, 25 (39.1%) patients progressed to TKA. Median time to TKA was 12.7 years [95% CI: 10.6-17.1]. Risk of TKA conversion before 10 years was 7.4 times higher in patients with body mass index (BMI) > 30 (p = 0.004). Among the 39 remaining patients, significant postoperative improvements were observed in the KOOS from 40.8 ± 14.7 to 68.2 ± 19.2 (p < 0.0001) and the UCLA activity scale from 4.6 ± 2.1 to 7.0 ± 1.8 (p < 0.0001). Radiological evaluations showed a shift toward varus alignment (HKA: 184.5 ± 2.5 vs. 178.8 ± 2.8; p < 0.0001). There was a significant evolution of the mPTA from 89.5 ± 2.6 preoperatively to 84.0 ± 2.3 postoperatively (p < 0.0001). There was no significant difference in the measurement of mLDFA. More than 80% of patients were very satisfied or would recommend the surgery. CONCLUSION:MCWHTO offers reliable long-term outcomes in valgus knees with lateral OA. Patient selection, particularly regarding BMI, is essential to achieve optimal survivorship. LEVEL OF EVIDENCE:Level IV, case series.

Background: There is a lack of consensus about whether stable ramp lesions associated with anterior cruciate ligament (ACL) injuries need to be repaired. Purpose/Hypothesis: The purpose of this study was to evaluate how many stable ramp lesions left in situ during ACL reconstruction (ACLR) have subsequently failed after >20 years of follow-up. We hypothesized that ACL-reconstructed knees with ramp lesions left in situ without repair have a high risk of meniscal failure over the long term. Study Design: Case series; Level of evidence, 4. Methods: All patients who underwent arthroscopic ACLR by a single experienced surgeon between January 1998 and December 2000 were evaluated retrospectively. Included were all cases of longitudinal tears in the meniscocapsular junction or the red zone of the posterior horn of the medial meniscus that were left in situ and identified through the anterior portals. Successful anterior probing confirmed a meniscal tear of the posterior segment. A lesion was considered stable if it was ≤2 cm and did not extend beyond the lower pole of the femoral condyle. The following data were collected preoperatively and at the last follow-up: demographics, time to surgery, side-to-side laxity, pivot shift, Lysholm score, subjective International Knee Documentation Committee score, Knee injury and Osteoarthritis Outcome Score, Tegner activity scale, and meniscal failure rate. We defined 2 groups based on our findings: medial meniscal failure versus no medial meniscal failure. Results: A total of 716 knees underwent primary ACLR during this period. The 39 (5.4%) stable unrepaired ramp lesions identified were included in the case series. Mean ± standard deviation follow-up was 262.1 ± 10.5 months. Eleven patients (28%) were lost to follow-up. Of the remaining patients, 8 (28.6%) had a medial meniscal failure, of which 6 (21.4%) were bucket-handle tears. The average time elapsed before complications was 87.8 ± 52 months (range, 6-156 months). The medial meniscal survival rate was 93% at 5 years, 75% at 10 years, and 71% at 15 and 20 years. The failure event mainly happened between 96 and 120 months (8 and 10 years) after ACLR. No risk factors for failure were found, but some trends appeared, such as older age, higher body mass index, and preoperative rotational instability. All postoperative scores were significantly improved at the last follow-up ( P < .0001); 16 patients (57%) returned to their sport of choice. Conclusion: With nearly one-third of patients developing meniscal complications, including a large share of bucket-handle tears and mostly occurring 8 years after the ACLR, it may not be wise to leave stable ramp lesions unrepaired.

Une pente tibiale excessive est un facteur de risque d’échec de reconstruction du LCA. Certains auteurs ont proposé d’associer une ostéotomie de correction de la pente tibiale à la reconstruction du LCA en cas de pente tibiale excessive. Cependant, l’efficacité de cette intervention à long terme n’a pas été démontrée. Entre 2000 et 2021, 22 patients ont été opérés dans notre centre d’une reconstruction du LCA avec ostéotomie de fermeture antérieure du tibia proximal. Ils avaient tous présenté au moins une rupture du LCA avec une laxité antérieure clinique, et présentaient tous une pente tibiale excessive (>12°). Ils ont été évalués rétrospectivement à un recul moyen de 10 ans (min 1, max 21). L’évaluation préopératoire et postopératoire comprenait un score IKDC, un score de Lysholm et une échelle d’activité de Tegner. Un score SKV était réalisé au dernier recul. Aucune rupture itérative n’a été rapportée dans la série. La pente tibiale moyenne est passée de 16,4° en préopératoire, à 7,6° en postopératoire. Le score IKDC moyen en préopératoire était de 49 %, et de 68 % en postopératoire. Le score de Lysholm était de 53 % en préopératoire, et de 71 % en postopératoire. L’échelle d’activité de Tegner était de 1,9 en préopératoire, et de 5,2 en postopératoire. Le score SKV au dernier recul était de 77 %. L’évolution de notre pratique s’est faite notamment vers une utilisation accrue des allogreffes et le non-relèvement de la tubérosité tibiale antérieure, initialement réalisé de manière systématique. Ces allègements dans la technique opératoire nous ont permis de proposer cette chirurgie de plus en plus précocement, à des patients ayant présenté moins de ruptures itératives et présentant moins de lésions méniscales ou cartilagineuses que dans les premiers cas. L’ostéotomie de fermeture antérieure du tibia proximal associée à une reconstruction du LCA est efficace pour la prévention des ruptures itératives du LCA et la restauration de la fonction du genou. Cette intervention devrait être proposée dès la première rupture itérative du LCA en cas de pente tibiale excessive.

Patellar tendon grafts have long been considered the gold standard for anterior cruciate ligament reconstruction (ACLR). This Technical Note describes ACLR using bone-patella tendon-bone (BPTB) autograft with press-fit femoral fixation using an outside-in drilling technique.

Objectives: Ramp lesion is a specific type of injury, located in the posterior horn of the medial meniscus. The purpose of the study was to evaluate the complications for meniscal ramp lesions left in situ during ACL reconstruction, after more than 20 months of follow up. Methods: All patients who underwent arthroscopic ACLR between January 1998 and December 2000 were evaluated retrospectively. Surgery was performed by the same surgeon. In case of a stable vertical tear, i.e. without instability, the lesion was left in situ, without suture or debridement. The following parameters were examined: demographics; history and clinical findings including time between injury and surgery, side-to-side laxity, pivot shift; knee function and activity by Lysholm score, subjective IKDC, KOOS and Tegner activity scale; and progression to bucket handle. We established two groups: the bucket handle group versus the no bucket handle group. Results: A total of 716 patients underwent a primary ACLR during this period. The overall incidence of ramp lesions in the study population was 5.4% (39 ramp lesions in 716 patients). Mean follow-up time was 262.1 (± 10.5) months. Bucket handle tear of the medial meniscus occurs in 21.4% of our population, with an average lead time of 99 (± 50) months, and a concentration of injuries between 96 and 156 months. The postoperative scores significantly improved for the entire population at more than 20 years of follow-up (p <0.0001), except for the Tegner score (p = 0.3424). Functional scores and side-to-side laxity were the same for the two groups. No risk factors were identified. Conclusion: There is a high incidence of bucket-handle injury after ACL surgery with a residual ramp lesion (21.4%). This high rate is only found in series with a long follow-up, since these lesions appear between 8 and 12 years after the first surgery.

Ramp lesion is a specific type of injury, located in the posterior horn of the medial meniscus. The purpose of the study was to evaluate the complications for meniscal ramp lesions left in situ during ACL reconstruction, after more than 20 of follow-up. All patients who underwent arthroscopic ACLRs between January 1998 and December 2000 were evaluated retrospectively. Surgery was performed by the same surgeon. In case of a stable vertical tear, i.e. without instability, lesion was left in situ, without suture or debridement. The following parameters were studied: demographics; history and clinical findings including time from injury to surgery, side-to-side laxity, pivot shift; knee and activity function by Lysholm score, subjective IKDC, KOOS and Tegner activity scale; and evolution to bucket handle. We defined two groups: bucket handle group versus no bucket handle group. A total of 716 patients underwent a primary ACLR during this period. The overall incidence of ramp lesions in the study population was 5.4% (39 ramp lesions in 716 patients). Mean follow-up time was 262.1 (± 10.5) months. The occurrence of medial meniscus bucket handle represented 21.4% of our population, with an average delay of 99 (± 50) months, and a concentration of this injury between 96 and 156 months. The postoperative scores were significantly improved for the whole population at more than 20 years of follow-up (P < 0.0001), except for the Tegner score (P = 0.3424). Functional scores and side-to-side laxity was the same for the two groups. No risk factors were identified. There is a high incidence of bucket-handle injury after ACL surgery with a ramp lesion left in place (21.4%). This high rate is only found in series with a long follow-up, since these lesions appear between 8 and 12 years after the first surgery.

To summarise the literature on 3rd-condyle total knee arthroplasty (TKA) designs and compare their survival rates to those of post-cam TKA designs. The null hypothesis was that 3rd-condyle TKAs would have equivalent survival rates compared to contemporary post-cam TKAs. An electronic literature search for Level I–V studies was independently conducted by two researchers using Medline® and Web of Science for studies published between January 1984 and October 2020 that specifically reported on rates of implant survival and complications, joint kinematics, clinical outcomes, and radiographic outcomes of 3rd-condyle TKA. The methodological quality of clinical studies was assessed according to the Downs and Black Quality Checklist for Health Care Intervention Studies, and for in vitro and in silico studies according to the Joanna Briggs Institute (JBI) tool for assessing analytical cross-sectional studies. Findings extracted for each TKA design were presented as reported and synthesised narratively. Survival rates at 5, 10 and > 10 years of 3rd-condyle TKA designs were graphically compared to rates of post-cam TKA designs published in joint registries. A total of 38 studies were identified that reported on kinematics, clinical outcomes, radiographic alignment, and rates of complications and survival. Mean survival rates ranged from 96 to 98% at 5 years, 78–100% at 5–10 years, and 86–99% at > 10 years for 3rd-condyle PS TKAs. Mean survival rates ranged from 93 to 98% at 5 years, 89–99% at 5–10 years, and 88–95% at > 10 years for post-cam PS TKAs. Implant survival rates of 3rd-condyle TKAs are comparable to those of post-cam TKAs at follow-up > 10 years. When compared to post-cam PS TKA, 3rd-condyle designs offer an alternative for younger and more active patients when considering the added benefits of a lowered point-of-contact and larger congruent contact area at the intercondylar tibial sulcus, that reduce risks of loosening and component wear. V.

Knee dislocations are uncommon and occur with a reported incidence of less than 0.02% of all orthopaedic injuries. These injuries are defined by complete disruption of the integrity of the tibiofemoral articulation. They are challenging injuries to manage and are associated with the risk of potentially devastating immediate and short-term complications, including popliteal artery injuries, common peroneal nerve injuries, acute compartment syndrome, and deep venous thrombosis, and controversy still exists regarding their optimal treatment. Despite the severity of these injuries, a recent systematic review has demonstrated that some level of sport participation is possible after multiligament knee injuries (MLKIs) for more than half of patients, but returning to preinjury levels of sport after surgical treatment is low, at just 22% to 33%. Bilateral knee dislocations occur even less frequently than unilateral injuries, and the literature contains sporadic case reports only. In view of the guarded prognosis of unilateral knee dislocations with respect to returning to preinjury levels of sport, it could be assumed that the results after bilateral knee dislocations would be considerably less favorable. To our knowledge, successful return to preinjury levels of sport in an elite athlete after bilateral knee dislocations has not previously been reported.

Purpose: Associating autologous chondrocytes with a biomaterial has the advantage of facilitating fixation of graft cells and simplifies reimplantation. To evaluate the feasibility, tolerance, and efficacy of the Cartipatch(r) product, we are conducting a phase IIb study.Material and methods: Cartilage (200–500 mg) was harvested arthroscopically from the lateral borders of the trochlea in the intercondylar space of damaged knees. After enzymatic digestion, the freed chondrocytes were cultured in monolayer in presence of autologous serum. The number of cells needed to achieve a concentration of 107/ml were suspended in an aragose and alginate solution. Before gelification, the suspension was poured into pits to obtain grafts measuring 10, 14 or 18 mm depending on the configuration of the lesion identified by MRI and arthroscopy. A specific instrument set was used to prepare one or two cavities for press fit insertion of the grafts. The grafts were justapositioned in order to best cover the damaged area.Nin...

En raison du risque élevé de rupture itérative, le choix du délai optimal pour la reprise du sport après plastie du ligament croisé antérieur (LCA) s'avère souvent épineux en pratique quotidienne. Par ailleurs, la littérature fait état d'un manque de critères objectifs pour autoriser ce retour au sport. Les auteurs rapportent un test composite d'évaluation des capacités de retour au sport après plastie du LCA : le test K-STARTS. Le K-STARTS est un test sur 21 points comprenant 7 items côtés sur 3 points chacun. L'objectif de l'étude était de valider ce test comme score d'évaluation des capacités de retour au sport après plastie du LCA. Il s'agissait d'une étude prospective comparative incluant 410 participants répartis en 2 groupes : un groupe de 371 patients opérés d'une plastie du LCA et un groupe témoin de 39 sujets sains. La validation du test était basée sur la validité de construction, la consistance interne, la validité discriminante et la sensibilité au changement. L'évaluation du K-STARTS a montré un excellent taux de remplissage (100 %), une forte reproductibilité (coefficient de corrélation intra-classe : 0,87 ; coefficient de variation : 7,8 %) et une forte sensibilité au changement. Il existait une corrélation modérée ou faible entre chacun des items du test et le score final. Il n'existait pas d'effet plafond ou plancher. Il existait une différence significative entre les scores au test K-STARTS à 6 et 8 mois postopératoires dans le groupe des patients opérés (11,2 ± 2,7 vs 16,8 ± 3,2, p > 0,001). Le score au test K-STARTS était significativement meilleur dans le groupe témoin que dans le groupe des patients opérés (17,3 ± 2,1 vs 13,7 ± 3,8, p > 0,001). En conclusion, le test K-STARTS est un outil d'évaluation des capacités fonctionnelles après plastie du LCA objectif et reproductible.

BACKGROUND:Extension loss is a potentially devastating consequence of anterior cruciate ligament reconstruction (ACLR). It can often be treated by anterior arthroscopic release. In rare cases, a chronic flexion contracture requires an additional posterior open release. To our knowledge, no study analysing the results of both posteromedial and posterolateral approaches has been performed so far. The purposes of this study were (1) to analyse the midterm outcome and complications of a combined procedure, anterior arthroscopic debridement and posterior open capsulotomy - for the treatment of chronic extension deficits after ACLR and (2) to describe the surgical technique of posterior open release with both posteromedial and posterolateral approaches.MATERIAL AND METHODS:This is a retrospective clinical cohort study. Twelve patients presenting a chronic flexion contracture of 10° or more after ACLR treated by open posterior arthrolysis with an average follow-up time of 38months (range six to 90) were included. At last follow-up, they underwent both a clinical examination with range of motion analysis, International Knee Documentation Committee (IKDC) and KOOS scores.RESULTS:At follow-up, all patients except one (93%) achieved complete extension. Only one patient (7%) had a residual post-operative flexion deformity of five degrees. The range of motion (ROM) improved significantly after arthrolysis from 96°±14.3° (SD) to 14.3°±7°(SD)(p<0.001). No post-operative complications were recorded. No patients required further open debridement. The post-operative objective IKDC score was grade A for five patients, B for seven versus C for five patients and D for seven preoperatively. The mean post-operative subjective IKDC score was 86.4±9.7. The post-operative Knee injury and Osteoarthritis Outcome Score (KOOS) distribution was as follows: pain 93.8±5 (SD); symptoms 88±8.6 (SD); ADL 96.8±3.7 (SD); sports activities 83.6±12.3 (SD); and quality of life 82.9±8.8 (SD). Mean patients' satisfaction was 9.25±0.6 (SD) out of 10 after arthrolysis.CONCLUSIONS:Open posterior release with both posteromedial and posterolateral approaches is a safe and efficient additional procedure in case of persistent flexion contracture after ACLR with good ROM gain, functional scores and patients' satisfaction.LEVEL OF EVIDENCE:Therapeutic study - Level IV.

Le traitement chirurgical de l'arthrose fémoro-tibiale latérale reste controversé pour les patients les plus jeunes ou actifs. Le but de cette étude est de rapporter les résultats cliniques et radiologiques à long terme des ostéotomies tibiales de varisation par fermeture (OTVr), leurs complications et leurs taux de reprise par prothèse de genou. Trente et un cas consécutifs d'OTVr réalisées entre 1997 et 2011 ont été revus rétrospectivement au recul minimum de 36 mois. La reprise par prothèse totale de genou était le critère de jugement pour l'analyse de survie. L'évaluation préopératoire et au recul comportait pour le résultat clinique, le score de la Knee Society, et le score UCLA. L'évaluation radiographique comprenait la classification d'Ahlbäck pour l'arthrose, et la méthode de Paley pour l'alignement. Les complications et les ré-opérations étaient prises en compte depuis la chirurgie. Trente et un OTVr chez 30 patients ont été réalisés pour gonarthrose latérale primaire et ont été revues au recul moyen de 12 (3,1–16,6) ans. Une méniscectomie latérale avait été réalisées pour 23 patients (24 cas) avant l'ostéotomie. L'âge moyen au moment de la chirurgie était de 56 (38,8–67,1) ans. Le taux de survie de l'OTVr était de 96 % (IC95 % [0,92–1,00]) à 5 ans, 87 % (IC95 % [0,80–0,94]) à 10 ans, et 60 % (IC95 % [0,47–0,74]) à 15 ans. Au recul, 13 patients ne pouvaient pas être évalués cliniquement - un refus, 9 patients repris par prothèse totale de genou, 2 patients étaient perdus de vue et une patiente était grabataire. Le score objectif moyen augmentait de 53,4 (14–80) à 72,1 (43–95) (p = 0,001). Le score fonction moyen augmentait de 78,8 (30–100) à 91,7 (70–100) (p = 0,02). Le score UCLA moyen augmentait de 6 (4–9) à 8 (4–9) (p < 0,001). L'angle mécanique tibiofémoral moyen passait de 184° (178°–188°) à 178° (170–186) (p < 0,001). Il n'y avait pas de différence statistiquement significative pour l'évaluation radiographique de l'arthrose. On dénombrait 6 ablations de matériel. Aucune complication majeur (infection, fracture, déficit neurologique, raideur ou pseudarthrose) n'a été rapporté. L'ostéotomie peut être pratiquée sur le fémur et ou sur le tibia selon le siège de la déformation. L'OTVr est efficace en extension et en flexion. L'ostéotomie tibiale de varisation par fermeture pour l'arthrose fémoro-tibiale latérale du patient jeune et ou actif offre un résultat fonctionnel satisfaisant à long terme associé à un faible taux de complication et de reprise.

Background: There is little known about return to sport and performance after anterior cruciate ligament (ACL) tear in high-level alpine skiers. Purpose: To analyze the parameters that influence the return to sport and performance after an ACL tear in French alpine skiers from 1980 to 2013. Study Design: Descriptive epidemiology study. Methods: The study population included 239 male and 238 female skiers who competed on the national French alpine ski team for at least 1 season between 1980 and 2013 in the speed (downhill and super-G) and technical disciplines (giant slalom and slalom). Two groups were formed: group 1 (G1) included athletes who had sustained an ACL rupture, and group 2 (G2) included athletes who had never sustained an ACL rupture. Three performance indicators were selected: International Ski Federation (FIS) points calculation, FIS ranking, and podium finishes in the World Cup, World Championships, and Olympic Games. Results: The first-decile FIS points and international FIS ranking showed that G1 skiers obtained better performance than did G2 skiers. The mean ± SD career length of G1 skiers (men, 7.9 ± 4.7 years; women, 7.1 ± 4.1 years) was longer than that of G2 skiers (men, 4.5 ± 3.3 years; women, 4.2 ± 3.5 years). In addition, 12.8% (61 of 477) of the skiers achieved at least a podium finish during their careers: 23.0% (34 of 148) in G1 and 8.3% (27 of 329) in G2. The mean age at ACL rupture was 22.6 ± 4.1 years for men and 19.9 ± 3.5 years for women. In G1, 55 podiums were achieved before ACL rupture and 176 after in all competitions. Skiers who improved their performances after ACL rupture were significantly younger (men, 22.2 ± 3.0 years; women, 18.7 ± 2.2 years; P < .0001) at the time of injury than those showing a performance deterioration after ACL rupture (men, 25.3 ± 4.2 years; women, 22.4 ± 4.0 years). All skiers who had ACL tears continued their competitive careers after the injury. Conclusion: The overall results showed that it is possible to return to preinjury or even higher levels of performance after an ACL rupture and that age is the main element that guides postsurgical recovery.

Les séries de la littérature de suture du ménisque médial sur genou stable ou dans le cadre d’une reconstruction du LCA montrent un taux d’échec significatif. Le but de cette étude prospective est d’évaluer les résultats des sutures tout en dedans par abord postéromédial des lésions du segment postérieur du ménisque médial lors de la reconstruction du LCA. Nous faisons l’hypothèse que cette technique améliore le taux de survie des sutures du ménisque médial. Entre octobre 2012 et mars 2013, 132 patients consécutifs d’un âge médian de 26,4 ans (12–57) ont bénéficié d’une suture du ménisque médial au crochet (QuickPass suture lasso et No 2 Fiberstick ; Arthrex, Naples, Florida, États-Unis) par un à quatre points verticaux par abord postéromedial pour une lésion du segment postérieur conjointement à une reconstruction du LCA. Les lésions étendues au segment moyen et anses de seau (n = 51) faisaient l’objet d’une procédure dite « mixte » associant suture au crochet et ou suture hybride à implant méniscal et/ou suture à l’aiguille de dehors en dedans. On dénombrait 9 % de lésions en anse de seau du ménisque médial et 34 % de lésion du ménisque latéral. Le délai médian avant chirurgie était de 4 mois (1 semaine–30 ans). L’évaluation clinique au dernier recul comportait le score IKDC subjectif et la reprise des activités sportives (Échelle de Tegner). Le succès clinique était défini par l’absence de ré-opération pour échec de la réparation méniscale. Ce dernier résultat a fait l’objet d’une analyse de survie Selon Kaplan–Meier. Au recul moyen de 24 mois (21–26 mois), aucun patient n’était perdu de vue. Le taux de succès clinique était de 93,2 % (95 % IC 0,887–0,974). On dénombre 9 ré-opérations pour récidive symptomatique d’une lésion méniscale médiale. Dans 5 cas, les lésions récurrentes survenaient dans une portion plus centrale du ménisque en avant des fils décrivant un « timbre-poste ». Les lésions étendues au segment moyen semblent plus à risque de récidive (6 versus 3) (p = 0,069). Le score IKDC subjectif moyen était de 87 (43–100). La reprise des activités sportives au même niveau a été possible pour 87,1 % des patients. L’échelle de Tegner moyen passait de 7,2 (3–10) avant l’accident à 6,9 (3–10) au recul (p = 0,002). Aucune complication neurologique ou vasculaire n’a été rapportée. Nos résultats montrent que la suture au crochet sous arthroscopie des lésions postérieures du ménisque médial permet un taux de cicatrisation élevé au niveau de la lésion sans augmenter la morbidité liée à l’abord supplémentaire. En effet, cette technique permet une visualisation optimale, un débridement efficace des lésions du segment postérieur du ménisque médial et la réalisation de points verticaux. La récidive de certaines lésions peut s’expliquer par la survenue de nouvelles lésions induites par les outils de suture et/ou l’utilisation de fil non résorbable. Des études prospectives comparatives menées à plus long terme semblent nécessaires pour confirmer cette impression.

PURPOSE:The purpose of this retrospective multicentric study was to evaluate the long-term effects of lateral meniscectomy and to identify those patients who are at the most risk of developing osteoarthritis (OA).METHODS:Eighty-nine arthroscopic partial lateral meniscectomies in stable knees with a mean follow-up of 22 ± 3 years were included. The following influencing factors were analyzed: age, sex, body mass index (BMI), physical activity, alignment, the types of meniscal lesions, the extent of meniscal resections and the initially associated cartilage lesions. An independent examiner reviewed all patients, using subjective (KOOS and IKDC scores) and objective clinical and radiological evaluations (IKDC score). The contralateral knee was used as a reference to calculate the prevalence and the incidence of OA.RESULTS:The mean age at the time of surgery was 35 ± 13 years. The main location of the lesions was the mid-section of the lateral meniscus (79% of the cases). At the latest follow-up, 48% of the patients had an active lifestyle with as many as 48% of the patients enjoying moderate to intense physical activity 22 years after the procedure (vs. 71% before surgery). The KOOS score evolved from 82 to 69% during the same period. The prevalence of OA was 56% in the affected knee and the difference of prevalence between the operated and healthy knees was 44%. In those patients presenting with an OA of the operated knee and a normal contralateral knee, the incidence of OA was 53%. Predictors of OA were an age superior to 38 years at the time of surgery, obesity (BMI >30), and valgus malalignment as well as the presence of cartilage and degenerative meniscal lesions at the time of surgery.CONCLUSION:In the long term, arthroscopic partial lateral meniscectomy in stable knees without initial cartilage lesions might yield good to excellent results in young patients. Patients are at higher risk to develop symptomatic OA if they are over 40, having a high BMI, valgus malalignment and cartilage lesions at the time of surgery. This study provides precise guidelines for the surgical treatment of lateral meniscus tears.LEVEL OF EVIDENCE:IV.

Lesões parciais do ligamento cruzado anterior (LCA) são comuns e representam 10%‐27% das totais. As principais razões para atenção ao feixe não rompido são biomecânicas, vasculares e proprioceptivas. A permanência do feixe serve ainda de proteção durante o processo cicatricial. A definição dessa lesão é controversa, baseada na anatomia, no exame clínico, na medida da translação, nos exames de imagem e na artroscopia. Seu tratamento vai depender da frouxidão e da instabilidade existentes. O tratamento conservador é opcional para casos sem instabilidade, com enfoque na reabilitação motora. O tratamento cirúrgico é desafiador, pois exige correto posicionamento dos túneis ósseos e conservação dos remanescentes do feixe rompido. O teste do pivot‐shift sob anestesia, os achados à ressonância magnética, o nível e o tipo de atividade esportiva prévia e o aspecto artroscópico dos remanescentes e suas propriedades mecânicas auxiliarão o ortopedista no processo decisório entre o tratamento conservador, o tratamento cirúrgico com reforço do LCA nativo (reconstrução seletiva) ou a reconstrução clássica (anatômica).

Partial tears of the anterior cruciate ligament (ACL) are common and represent 10-27% of the total. The main reasons for attending to cases of non-torn bundles are biomechanical, vascular and proprioceptive. Continued presence of the bundle also serves as protection during the healing process. There is controversy regarding the definition of these injuries, which is based on anatomy, clinical examination, translation measurements, imaging examinations and arthroscopy. The way in which it is treated will depend on the existing laxity and instability. Conservative treatment is optional for cases without instability, with a focus on motor rehabilitation. Surgical treatment is a challenge, since it requires correct positioning of the bone tunnels and conservation of the remnants of the torn bundle. The pivot shift test under anesthesia, the magnetic resonance findings, the previous level and type of sports activity and the arthroscopic appearance and mechanical properties of the remnants will aid the orthopedist in the decision-making process between conservative treatment, surgical treatment with strengthening of the native ACL (selective reconstruction) and classical (anatomical) reconstruction.

L’arthrose après rupture du ligament croisé antérieur est analysée à partir de deux statistiques : la première est tirée de la révision de 150 plasties du ligament croisé antérieur (LCA) revues à plus de 3ans et où 13,3 p. 100 d’évolutions arthrosiques ont été observées. La deuxième concerne 64 arthroses unilatérales opérées par ostéotomie tibiale de valgisation et ayant eu dans leurs antécédents une rupture du LCA. Le délai de tolérance fonctionnelle de ces arthroses est très variable, allant pour l’histoire naturelle de 10 à 50ans avec un délai moyen de 35ans. Les signes radiologiques de début de cette arthrose sont importants à connaître : ostéophytose de l’échancrure, ostéophyte postérieur du plateau tibial interne et surtout pincement postérieur de l’interligne interne avec subluxation postérieure du condyle interne, bien visible sur la radiographie de profil en appui monopodal. Les arthroses précoces (10ans) peuvent s’observer dans l’histoire naturelle, mais elles sont surtout fréquentes après chirurgie, quand celle-ci ne corrige pas la laxité antérieure et surtout quand elle est réalisée sur des genoux déjà préarthrosiques. Le principal facteur de l’arthrose est la laxité antérieure, mesurée radiologiquement par un cliché dit de « Lachman actif ». L’ablation du ménisque interne, en elle-même arthrogène, est d’autant plus nocive qu’elle double l’importance de la subluxation antérieure du tibia qui apparaît en appui monopodal. La bascule du genou en varus qui caractérise les arthroses évolutives trouve d’abord son origine dans l’usure de la partie postérieure du plateau libial interne, induite par la laxité antérieure. D’autres facteurs jouent également un rôle important : laxité externe associée, genu varum constitutionnel, faiblesse des muscles ischio-jambiers qui s’opposent normalement à l’action subluxante du quadriceps.

Background: Postoperative knee joint chondrolysis is a rare but serious complication. The aim of our study is to report the clinical presentation, the early, mid and long-term outcomes of rapid chondrolysis after a partial lateral meniscectomy in elite athletes.Methods: Clinical records of 10 consecutive cases of rapid chondrolysis after partial lateral meniscectomy in eight professional athletes were retrospectively reviewed. There were seven males and one female with a mean age of 25.2 years (range 20-32 years) at index procedure. An initial conservative approach to its treatment was attempted in all cases. Arthroscopic lavage was advocated in two cases. Patients were clinically reviewed at last follow-up with comparative X-rays, a subjective IKDC, a Lysholm and Tegner scale.Results: All patients resumed their pre-injury level of activity at a mean 8(+/- 2.45) months after the index procedure. At a mean of 82 (36) months of follow-up, the mean subjective IKDC, Lyshom and Tegner scale were respectively 82.64 (+/- 8.61), 86.6 (+/- 6.44), 9 (+/- 1.41). All knees demonstrated joint space narrowing scored Kellgren and Lawrence II! (n = 1) III (n = 4) or IV (n = 5) on conventional radiographs.Conclusion: By reviewing the common factors in each of these cases we believe that rapid chondrolysis occurs primarily due to the excessive loading of the articular cartilage in the lateral compartment of the knee. In this series, although the results in the medium term were good, the long-term outcome must be guarded due to the high rate of radiographic osteoarthritis of the lateral compartment seen in this population.Study design: Retrospective case series, Level IV. (C) 2014 Elsevier B.V. All rights reserved.