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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 cm 2 (min 0.6 cm 2 ; max 6 cm 2 ). 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., Competing Interests: Declaration of competing interest M.P has received speaker and consultant honoraria from Geistlisch® Pharma. E.B, C.C, A.C and O.B declare they have no financial interests., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objective: The results of surgical versus conservative treatment of acute Achilles tendon ruptures are still controversial. The objective of this study was to compare surgical and conservative treatment at a minimum follow-up of 1 year in terms of the complications, functional outcomes and clinical results., Hypotheses: There is no difference in the complications, clinical results and functional outcomes between the two treatment groups. There is no difference in the occurrence of complications or the clinical results due to the immobilization or rehabilitation protocols., Methods: This was a retrospective comparative, multicenter, non-randomized study of acute Achilles tendon ruptures treated between 01/01/2018 and 31/12/2019 at 21 study sites in France. All patients who received surgical or conservative treatment were included. The demographics, sports participation, nature of treatment, immobilization parameters (type, duration, position) and rehabilitation protocol were collected. Rerupture, general and specific complications, clinical results (heel-rise test, single-leg hop, calf circumference, ankle dorsiflexion) and the functional outcomes (ATRS, VISA-A, EFAS, SF-12) were collected at the final review., Results: Four hundred five patients were reviewed at a mean follow-up of 24 (±7) months. Surgical treatment was done in 372 patients (92%) and conservative treatment in 33 patients (8%), with these two sets of patients having comparable preoperative characteristics. There was a similar number of reruptures in the conservative group (3 cases, 9%) as in the surgical group (15 cases, 4%) (p=0.176). There were more general complications in the conservative group (24%) than in the surgical group (11%) (p=0.04). There was a 9% rate of surgery-related complications (infection, nerve damage, anesthesia after-effects). The ATRS (p=0.017), EFAS Total (p=0.013), EFAS daily living (p=0.008), and SF-12 physical (p=0.01) were better in the surgical group. Strict then relative immobilization provided the best balance between functional recovery (EFAS total of 33, p<0.01) and tendon lengthening (0°, p=0.01) without increasing the occurrence of rerupture (2%, p=0.18). Early weightbearing accompanied by immobilization and rehabilitation within 30 days did not lead to more reruptures than if it was started beyond 30 days (p=0.082 and p=0.07)., Conclusions: This study found no differences in the number of reruptures between surgical treatment and conservative treatment of acute Achilles tendon ruptures. Surgical treatment led to better clinical results but had a variable effect on improving the functional scores. No matter which treatment is used, in the ideal case, 3 weeks of strict immobilization in equinus should be followed by progressive reduction over the next 3 weeks. Early weightbearing and mobilization within 30 days did not increase the risk of rerupture; it actually optimized the clinical and functional outcomes., Level of Evidence: III; retrospective comparative, non-randomized., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: Osteochondral defects of the knee due to trauma or osteochondritis are associated with osteoarthritis in the medium term. Defects 2 to 8cm 2 in size can be managed by autologous matrix-induced chondrogenesis (AMIC®), in which sub-chondral micro-fractures are created within the lesion and the defect is then covered by a matrix of type I and type III collagen to induce de novo cartilage formation. Although promising outcomes have been observed in small single-centre cohorts, the medium-term clinical and radiological effectiveness of AMIC® remains to be demonstrated in larger populations. The objective of this study was to evaluate outcomes of patients at least 2 years after AMIC® for knee osteochondral defects., Hypothesis: AMIC® is associated with clinical and radiological improvements after at least 2 years., Material and Method: This multicentre (16 centres), multisurgeon (18 senior orthopaedic surgeons), retrospective study included consecutive patients who underwent AMIC® with Chondro-Gide® membrane implantation between September 2011 and January 2020. The 36-item Short Form quality-of-life (SF-36) score, Knee Injury and Osteoarthritis Outcome Score (KOOS), and International Knee Documentation Committee (IKDC) score were determined before the procedure and during follow-up. The Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was assessed by magnetic resonance imaging 2 years after the procedure., Results: In total, 101 patients aged 12 to 60 years were included. Mean follow-up was 30 months. Mean defect size was 3.44cm 2 (range, 2-8cm 2 ). Significant improvements were documented in the SF-36 score, KOOS, and IKDC score. The mean MOCART score at 2 years was 75% (range, 20-100)., Discussion: The AMIC® procedure was associated with significant improvements at 2.5 years in patients treated for knee osteochondral defects measuring 2 to 8cm 2 . This method seems to provide similar outcomes to those of other available methods with the advantages of single-step surgery and elimination of osteochondral graft donor-site complications., Level of Evidence: IV, retrospective observational cohort study., (Copyright © 2023 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Introduction: A double level osteotomy (DLO) may be indicated in patients with genu varum when the deformity involves both the tibia and femur. These patients, who are often young and active, have a high functional demand and hope for a rapid return to sport. The purpose of our study was to assess return to sport and functional outcomes following DLO for symptomatic genu varum., Materials and Methods: A total of 40 patients (mean age 45.5±2 years) who underwent a DLO between 2018 and 2020, performed in 2 different hospitals, were reviewed after a minimum follow-up of 1-year. The mean initial varus was 11±2°. The type of sport and frequency of participation (UCLA activity score) as well as time to return to sport and level of activity recovered were defined as the primary endpoints. Functional scores were also assessed with the knee injury and osteoarthritis outcome score (KOOS)., Results: At the last follow-up, 87.5% (n=35) of patients reported that they had returned to sport. The mean time to return to sport was 6±1 months with a significant difference (p<0.001) between the pre- and postoperative UCLA activity scores. There was a strong correlation between the presence of a joint line obliquity >3° and decreased functional outcomes (p<0.0001). The overall KOOS score improved (p<0.001) by a mean of 38.6 points after the correction. The 8 lateral cortical fractures (Takeuchi type I and II) and the 2 medial cortical fractures (Nakayama type 1) that were found had no impact on functional outcomes (p>0.05)., Conclusion: Our findings demonstrated that DLO provided rapid return to sport, thus making it possible to meet the functional demands and expectations of patients., Level of Evidence: IV; Retrospective study., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

The past decade has seen the development of numerous arthroscopic techniques for ankle ligament repair or reconstruction in the treatment of chronic lateral ankle instability. Arthroscopy allows the assessment and treatment of intra-articular pathologies and is associated with faster functional recovery. The open surgery technique described by Blanchet, combining reinsertion of the lateral collateral ligament with reinforcement by an extensor retinaculum flap, has long proven its effectiveness. The aim of this article is to describe this technique under arthroscopy., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)