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Introduction: Femoral megaprostheses are used for bone reconstruction surgery in patients with local tumors or who require multiple revisions. Patient reported outcome measures (PROMs) provide a subjective result and, like patient satisfaction, have become an integral part of the outcomes in orthopedics. However, the threshold of satisfaction (PASS: Patient Acceptable Symptom State) has not yet been defined in a French population after this type of arthroplasty. This led us to carry out a retrospective study on a population of patients who received a femoral reconstruction megaprosthesis in order to 1) define the PASS for the Harris Hip Score (HHS), Knee Society Score (KSS) and the Musculoskeletal Tumor Society score (MSTS), 2) study the complications., Hypothesis: The PASS threshold for proximal femur and distal femur reconstruction prothesis for the HHS and the KSS, respectively, will be lower than the threshold for these same scores for primary arthroplasty., Materials and Methods: Forty-four patients who were operated on between 2009 and 2020 were included: 23 received a proximal femur prosthesis and 21 received a distal femur prosthesis. The PASS threshold was defined using an anchoring strategy by analyzing ROC curves for the HSS for the proximal femur, KSS for the distal femur and the MSTS for all the prostheses. Complications were classified according to Henderson., Results: The mean follow-up was 4.5 ± 3.6 (1-12.5) years. The PASS threshold was 47.5 (area under curve (AUC) 0.71 (0.45-0.97)) for the HHS, 69.5 (AUC 0.97 (0.92-1.0)) for the KSS knee and 62.5 (AUC 0.81 (0.61-0.99)) for the KSS function. Thirteen patients (29%) had complications, nine of whom required another surgery (20%). The most frequent were Henderson type 1 (soft tissue lesions, n = 5/44 [11%]) and type 2 (loosening, n = 5/44 [11%]) There was no relationship between satisfaction and postoperative complications (p = 0.071)., Discussion: Most of the patients who undergo femoral resection and reconstruction (59%) are satisfied with their function, albeit reduced, despite a high complication rate (29%). Our hypothesis is confirmed for the PASS threshold for the HHS (47.5 versus 93) and the KSS knee and function (69.5 and 62.5 versus 85.5 and 72.5)., Level of Evidence: IV; retrospective observational single-center study., (Copyright © 2024. Published by Elsevier Masson SAS.)

Background: The concept of dual mobility of total hip arthroplasties (THA) is a revolution in the prevention of dislocations and in the treatment of instability. Its use remains controversial in patients under 60 years old, providing poorer results with first generation cups coated with alumina. This study, carried out on modern dual mobility (DM) cups with a porous bilayer coating, in active patients under 60 years of age aimed to evaluate: (1) the mechanical survival of two latest generation DM THA, with failure defined as revision of acetabular or femoral implants for mechanical loosening, by comparing a tripod cup to a full pressfit cup, (2) to evaluate the complications, (3) to compare the rate of radiographic peri-prosthetic osteolysis between the 2 implants., Hypothesis: The hypothesis was that the medium-term survival of modern DM cups placed in young patients was the same regardless of the type of acetabular fixation used., Materials and Methods: This was a retrospective study of 119 latest generation DM THA with standard polyethylene, composed of 66 full pressfit cups and 53 tripod fixation cups, used in primary arthroplasty in 111 patients between 2005 and 2016. The survival study was carried out using medical records. The clinical evaluation was carried out using the modified Harris Hip Score (mHHS) as well as the self-administered Hip and Osteoarthritis Outcome Score (HOOS) and Oxford-12 questionnaires. Radiological analysis was carried out on radiographs looking for bone demineralization and acetabular and femoral lines., Results: At 8.6 years (5-16), no revision for mechanical loosening was observed regardless of the type of cup. The prosthesis dislocation rate (large joint) was 1.7%: 1 case in each group (p = 1), including one revision required in the full pressfit group. Three revisions for mechanical complications were recorded: a recurrent dislocating hip on a full pressfit cup that was not sufficiently anteverted, an acetabular peri-prosthetic fracture on a full pressfit cup and a case of iliopsoas impingement with a retroverted tripod cup. The survival rate for all-cause revision was 93.8% for pressfit (95% CI: 88.2%-99.9%) vs. 96.2% for tripod (95% CI: 91.1%-100%) (p = 0.63) and for revision due to any cause excluding infection, 96.9% for pressfit (95% CI: 92.8%-100%) vs. 98.1% for tripod (95% CI: 94.4%-100%) (p = 0.7). The rate of periacetabular osteolysis was 11%, significantly more present amongst tripod cups (24%, 9 cases) compared to full pressfit cups (2%, 1 case) (p < 0.01)., Conclusion: This series demonstrates good performance of 3rd generation DM cups with porous bilayer coating in patients under 60 years of age regardless of the type of acetabular fixation, at 8.6 years of follow-up. The rate of osteolysis around full pressfit cups remains very low, unlike that of tripod cups. The use of Double Mobility prostheses for primary hip osteoarthritis is possible in young patients, preferably with full pressfit cups (i.e., without any pegs or additional screws that may promote diffusion of polyethylene debris and osteolysis)., Level of Evidence: III; comparative retrospective study., (Copyright © 2024. Published by Elsevier Masson SAS.)

Introduction: Tibial correction is often performed during a valgus-producing osteotomy for genu varum. However, overcorrection and the creation of a joint line obliquity (JLO) have been associated with unfavorable functional outcomes after high tibial osteotomy (HTO). The aims of this study were to analyze: 1) the corrections obtained after HTO; 2) the rationale behind the indication per the European Society for Sports Traumatology Surgery and Arthroscopy (ESSKA) recommendations; and 3) the correlation between the postoperative corrections obtained and functional outcomes., Hypothesis: A significant number of patients who underwent an isolated HTO did not present an "ideal" theoretical indication based on the preoperative angles and correction targets to be performed., Materials and Methods: This multicenter study included 289 isolated HTOs. Demographic and morphometric data were anonymized and compiled in a database. Preoperative radiographic parameters were compared with the ESSKA consensus recommendations on osteotomies for genu varum. The consensus defined the "ideal" indication for performing an HTO as medial tibiofemoral compartment pain with significant tibial varus deformity (medial proximal tibial angle [MPTA]<85°), no significant femoral varus deformity (lateral distal femoral angle [LDFA]<90°), an expected postoperative obliquity of less than 5°, and a correction resulting in moderate tibial valgus (postoperative MPTA<94°). The incidence of patients with an "ideal" theoretical indication for isolated HTO and those with a theoretical indication not perfectly justified by the radiographic data and preoperative planning were recorded., Results: Under the ESSKA consensus criteria, 25.3% (n=73) of isolated HTOs, 15.6% (n=45) of isolated femoral osteotomies, 9.3% (n=27) of double-level osteotomies, and 49.9% (n=144) of cases where no osteotomy was performed due to the lack of significant extra-articular tibial and/or femoral deformity were deemed justified. The presence of a preoperative femoral deformity and the absence of an "ideal" indication for HTO did not affect the postoperative Tegner Activity Scale or the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores (p>0.05). A high preoperative hip-knee-ankle (HKA) angle and MPTA, which indicated less varus, were associated with a greater risk of there being no "ideal" theoretical indication for an HTO (coefficient of determination [R 2 ]=0.19 and R 2 =1, respectively; p<0.001)., Conclusion: This study showed that isolated HTOs in current practice were not justified in a significant number of patients, even though they could lead to tibial overcorrection and excessive JLO. This did not impact the functional results of this series, but it might complicate the performance of a secondary knee arthroplasty. Nevertheless, some young patients in this series underwent a salvage osteotomy outside the "ideal" indications of the European recommendations., Level of Evidence: IV; case series., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Introduction: Although an autogenous graft has the highest rate of bone union to fill the void created in medial opening wedge high tibial osteotomy (MOWHTO), it also has some disadvantages, such as prolonged surgical time, donor site pain and morbidity. Two possible candidates for ideal grafts to replace autogenous grafts are allogeneic and synthetic graft, which are free from donor site pain and morbidity. However, previous reports comparing the clinical results of allogeneic to synthetic graft have been limited and controversial. The purpose of this study is to compare radiological findings and clinical outcomes of using synthetic versus allogenic graft to fill the void created in MOWHTO., Hypothesis: The present clinical study hypothesized that allogenic graft to fill the void would allow the higher rate of bone union and better clinical outcomes., Material and Methods: This study compared the clinical and radiological outcomes of 95 patients who received MOWHTO to fill the void with either synthetic or allogenic graft (44 in Syn group, 51 in Allo group). Preoperatively and postoperatively, all patients were clinically evaluated; Return to work, Tegner activity score, and the Western Ontario and Macmaster University scores were reported. Radiographically, osteoarthritis grade and pre- and postoperative parameters were reported, including Hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle, joint line convergence angle, proximal posterior tibial angle, and limb length discrepancy. Perioperative details and complications were also reported., Results: Mean follow-up (months) were 24.0±1.3 in Syn group and 26.8±1.2 in Allo group (p=0.13). The postoperative improvement of pain and global WOMAC scores in Allo group were significantly better than in Syn group (ΔPain of WOMAC: Syn group 27.8±4.4, Allo group 49.3±3.8, p value <0.001*) (ΔGlobal score of WOMAC: Syn group 16.7±3.2, Allo group 37.4±4.9, p value=0.002*). The risk of hinge fracture in Syn group was significantly higher than in Allo group (Hinge fracture by Takeuchi grade (0/1/2/3): Syn group 37/3/3/1, Allo group 43/8/0/0, p value=0.04*). The timing of full weight bearing in Allo group was significantly earlier than in Syn group (Weight Bearing (1=FWB, 2=PWB 3wk, 3=PWB 6wk): Syn group 2.7±0.1, Allo group 2.3±0.1, p value=0.01*)., Discussion: The use of allogenic graft to fill the void in MOWHTO does not show superiority in bone union compared to synthetic graft, however it improves pain, function, decreases the risk of hinge fracture and allows faster weight bearing than synthetic graft., Level of Proof: III; Case-control study., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Introduction: Despite the growing concept of meniscal preservation, partial meniscectomy could be the definitive procedure in specific scenarios. And total meniscectomy was once before a frequent procedure, with current sequelae of degenerate knees. High tibial osteotomy (HTO) is an effective treatment for patients suffering from unicompartmental degenerative changes, and substantial deformities. However, it is yet to be answered, whether HTO is similarly effective in both post-meniscectomy knees and knees with not previously operated meniscus., Hypothesis: Outcomes of HTO is similar with or without previous history of total or subtotal meniscectomy., Methods: This study compared the clinical and radiological outcomes of 41 patients who received HTO and had no previous history of surgery in the ipsilateral knee (group I), and 41 age, and gender-matched patients who had meniscectomy surgery in the ipsilateral knee (group II). Preoperatively and postoperatively, all patients were clinically evaluated; the visual analogue scale scores, Tegner activity score, and the Western Ontario and Macmaster University scores were reported. Radiographically, osteoarthritis grade and pre- and postoperative parameters were reported, including hip-knee-ankle angle, femoral mechanical angle, medial proximal tibial angle, joint line convergence angle, proximal posterior tibial angle, and limb length discrepancy. Perioperative details and complications were reported., Results: A total of 82 patients were included; group I (n=41) and group II (n=41). The mean age was 51.18±8.64 (27-68) and 90.24% were male. The duration since the onset of symptoms was longer in group II vs. group I, 43.34±41.03 versus 38.07±36.11months respectively. No significant differences in the clinical evaluation between the two groups with a greater proportion of patients demonstrating moderate degenerative changes. Similar preoperative and postoperative radiographic parameters were reported, in group I, Δ HKA was 7.19±4.14 versus 7.65±3.16 in group II. Preoperative pain VAS scores were slightly higher in group II vs. group I, 79.23±26.35 vs. 76.31±24.45, respectively. However, postoperatively, the pain scores significantly improved in group I vs. group II, 22.84±3.65 vs. 41.69±17.33, respectively. Tegner activity scores and WOMAC scores were comparable between both groups preoperatively and postoperatively. Only the WOMAC function scores were better in group I when compared to group II, 26.13±25.84 versus 20.01±17.98. All patients returned to work at an average of 0.82±0.38months., Conclusion: Knee preservation with high tibial osteotomy is equally effective in managing unicompartmental degenerative changes in varus malaligned knees with either no previous history of meniscal surgeries or where a meniscal sacrifice was inevitable, either with subtotal or total meniscectomy., Level of Evidence: III, retrospective case-control study., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Introduction: The diagnosis of periprosthetic joint infection (PJI) can be challenging and rests on several principles. The use of diagnostic biomarkers, such as the synovial C-Reactive Protein (CRP), seems promising. The purpose of this study was to determine whether synovial CRP was a more discriminating test than serum CRP for the diagnosis of hip and knee PJI., Materials and Methods: In total, 194 patients were included in this single center prospective study: 42 primary arthroplasties (control group [CG]), 111 revisions for aseptic prosthesis (aseptic revision group [ARG]), and 41 revisions for septic prosthesis (septic revision group [SRG]) based on the Musculoskeletal Infection Society (MSIS) criteria., Results: The serum and synovial CRP levels were significantly higher in the SRG than the other two groups (SRG serum CRP=75.6mg/L vs. ARG serum CRP=6mg/L and CG serum CRP=2.7mg/L, p<0.001; SRG synovial CRP=31.5mg/L vs. CG synovial CRP=2.6mg/L and ARG synovial CRP=1.7mg/L, p<0.001). The positive likelihood ratios (LR+) were very similar for both the synovial CRP cut-off value of 4.4mg/L (LR+=7.04; sensitivity [Se] 82.5%, specificity [Sp] 88.3%) and the serum CRP cut-off value of 9mg/L (LR+=6.3; Se 87.5%, Sp 86.1%)., Conclusion: This study showed that synovial CRP testing was not more discriminating than serum CRP in the diagnosis of hip and knee PJI. A serum CRP level greater than 9mg/L was a sign of PJI., Level of Evidence: III; case-control study., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Introduction: In total knee replacement (TKR) surgeries, "fast-track" or enhanced recovery after surgery (ERAS) programs are being developed, but their impact on care pathway quality and safety has not been fully explored in the French literature. The present study aimed to compare results in TKR between fast-track and conventional pathways, addressing the following questions: (1) Are 90-day rates of complications, readmission and surgical revision higher with fast-track? (2) Is mean length of stay (LoS) shorter with fast-track? (3) Are postoperative pain and clinical results improved by fast-track? And, (4) are patients and care staff satisfied with these new programs?, Hypothesis: Implementing fast-track for TKR in a university hospital center is beneficial for the patient and does not impair the quality and safety of care., Patients and Method: A case-control study was performed using a retrospective analysis of prospectively collected data. A fast-track program was implemented for TKR by modifying the care pathway. This involved instituting a therapeutic education consultation, optimizing blood sparing, modifying surgical practices, and hastening early mobilization thus actively involving patients in their own management. Between January 2017 and January 2019, 216 patients with a mean age of 69.23±7.80years and mean BMI of 30.15±4.79kg/m 2 were included in the fast-track group, with 335 matched patients included in the conventional group., Results: At 90days, there were no significant inter-group differences in rates of infection (fast-track=1.39%, conventional=0.90%; p=0.34), readmission (fast-track=3.24%, conventional=3.58%; p=0.49), or surgical revision (fast-track=2.78%, conventional=2.69%; p=0.298). The visual analog scale (VAS) pain rating was 1.56±1.36 in the fast-track group versus 5±2.41 in the conventional group; p<0.001. LoS was 3.17±1.59days in fast-track versus 7.25±1.85days in the conventional group; p<0.001. Ninety-five percent of patients and 96% of care staff were satisfied with the fast-track program., Discussion: Fast-track implementation ensured quality and safety of care; it did not increase the rate of complications in primary TKR. Mean length of stay was drastically reduced. Both patients and care staff were very satisfied with these new procedures., Level of Evidence: III; case-control study., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)

Introduction: High tibial osteotomy (HTO) and unicompartmental knee arthroplasty (UKA) are two surgical solutions for isolated medial tibiofemoral osteoarthritis. Results depend on preoperative criteria and patient selection, but also on postoperative factors: implant positioning, limb alignment. Factors for HTO survival need identifying to reduce risk of failure requiring total knee arthroplasty (TKA)., Hypothesis: Age, gender, weight, osteoarthritis grade, degree of correction, type of osteotomy, technique and intraoperative complications impact HTO survival., Material and Method: As part of a symposium of the French Society of Arthroscopy (SFA), a multicenter retrospective study compared 2 series. The HTO series comprised 488 patients: 153 female (31.4%); mean age, 55.1 years; mean weight, 83.1kg; mean body-mass index (BMI), 28.6. The UKA series comprised 284 patients: 172 female (60.6%); mean age, 64.1 years; mean weight, 75.3kg; mean BMI, 27.6. The main endpoint was comparative survival at 5, 8 and 10 years; secondary endpoints comprised pre- and post-operative hip-knee-ankle (HKA) angle, mechanical femoral angle (mFA) and mechanical tibial angle (mTA), surgical technique, satisfaction, time to and level of return to work, WOMAC and Tegner scores and complications rates. The significance threshold was set at p<0.05; 95% confidence intervals were calculated., Results: Age>54 years, male gender, BMI>25, medial tibiofemoral wear severity Ahlback ≥3, ≥0.9° varus joint component, HKA correction<8°, postoperative HKA<180° and hinge fracture were significantly associated with poorer survival. There was no impact of type of osteotomy, navigation assistance or postoperative HKA 183-186°. Ten-year survival was 74.3% for HTO and 71% for UKA (non-significant); however, survival curves crossed at 6 years., Conclusion: HTO showed survival and functional results comparable to those of UKA in selected patients when target limb alignment correction was achieved. The present study determined selection criteria. A predictive score for results of either procedure would facilitate decision-making., Level of Evidence: IV, retrospective cohort study., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Introduction: Preoperative planning in high tibial osteotomy (HTO) is a critical step for achieving the desired correction and a clinically satisfactory outcome. Conventional radiography, navigation assistance and patient-specific instrumentation (PSI) are the 3 means of planning, but no prospective studies have compared precision between the 3. The aims of the present study were: (1) to analyze and compare correction precision between the 3 planning approaches at 1 year's follow-up; (2) to compare results to those reported in the literature; and (3) to analyze factors influencing the achievement of planned correction., Hypothesis: The study hypothesis was that PSI provides more precise and reproducible planned correction than conventional methods or navigation., Material and Method: Between June 2017 and June 2018, a multicenter non-randomized prospective observational study was conducted in 11 centers. One hundred and twenty-six patients with Ahlbäck grade I, II or III idiopathic medial tibiofemoral osteoarthritis with stable knee were included and allocated to 3 preoperative planning groups: conventional (group 1), navigation (group 2) and PSI (group 3). Mean age at surgery was 51.2 years (range, 19-69 years; median, 53.2 years); 100 male, 26 female. Complete weight-bearing radiographic work-up was performed preoperatively and at 1 year's follow-up. The PSI group also underwent CT as part of guide production. Target angular correction and mechanical Hip-Knee-Ankle (HKA) axis were set preoperatively. The main endpoint was the difference between planned HKA and HKA at a minimum 12 months., Results: Mean HKA difference was 1.1±3 in group 1, 2.1±2.6 in group 2 and 0.3±3.1 in group 3. Precision was better with PSI, but not significantly when comparing all 3 groups together. On pairwise intergroup comparison, there was a significant difference only between groups 2 and 3, in favor of PSI (P=0.011)., Discussion: None of the 3 techniques demonstrated superiority in achieving target correction at 1 year. The study hypothesis was thus not confirmed. All 3 techniques proved reliable and precise in HTO planning., Level of Evidence: III, prospective non-randomized comparative study., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Under the new categorization introduced by the Health Authorities, ambulatory surgery (AS) in France now accounts for 50% of procedures, taking all surgical specialties together. The replacement of full hospital admission by AS is now well established and recognized. Health-care centers have learned, in coordination with the medico-surgical and paramedical teams, how to set up AS units and the corresponding clinical pathways. There is no single model handed down from above. The authorities have encouraged these developments, partly by regulations but also by means of financial incentives. Patient eligibility and psychosocial criteria are crucial determining factors for the success of the AS strategy. The surgeons involved are strongly committed. Feedback from many orthopedic subspecialties (shoulder, foot, knee, spine, hand, large joints, emergency and pediatric surgery) testify to the rise of AS, which now accounts for 41% of all orthopedic procedures. Questions remain, however, concerning the role of the GP in the continuity of care, the role of innovation and teaching, the creation of new jobs, and the attractiveness of AS for surgeons. More than ever, it is the patient who is "ambulatory", within an organized structure in which surgical technique and pain management are well controlled. Not all patients can be eligible, but the AS concept is becoming standard, and overnight stay will become a matter for medical and surgical prescription., (Copyright © 2016 Elsevier Masson SAS. All rights reserved.)

Background: Meniscal suture provides well-documented benefits. Integrity of the cruciate ligaments of the knee is a prerequisite for meniscal healing. Nevertheless, reconstruction of the anterior cruciate ligament (ACL) does not consistently prevent recurrent tearing of a sutured meniscus. We evaluated meniscal survival rates, 5 and 10 years after meniscal suture concomitant with an ACL reconstruction. We compared the outcomes of these repaired menisci to those in which no menisci tears were detected during ACL reconstruction., Methods: In this multi-centric retrospective study, we included two groups. One group consists of patients who underwent a meniscal repair. This group was further divided into two subgroups based on whether follow-up was 5 years (n=76) or 10 years (n=39). The control group included 120 patients with normal menisci observed during surgery. We studied meniscal survival rates in each group, and we analyzed risk factors associated with the recurrence of meniscal lesions., Results: The 5-year meniscal survival rate was significantly higher in the control group than in the meniscal-repair group (95% vs. 80%, respectively; P=0.0029). The controls group also had a higher meniscal survival rate after 10 years, although the difference was not statistically significant (88% vs. 77%, P=0.07). A difference in knee laxity greater than 4mm was associated with a 5-fold increase in the risk of recurrent meniscal tears (P=0.0057). After 5 years, the risk of recurrence was higher for the medial than for the lateral meniscus, whereas after 10 years the difference was no longer statistically significant., Discussion: Although insufficient healing after meniscal suturing contributes to the risk of further meniscal tears, new lesions can develop in menisci that were undamaged at the time of ACL reconstruction. The risk of a new meniscal lesion is strongly associated with inadequate control of antero-posterior and rotational laxity. Some apparently "new menisci lesions" seems to have been missed during ACL reconstruction., Level of Evidence: IV, retrospective study., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: Early treatment of initial anterior glenohumeral dislocation in young patients is controversial and the interest of surgery, and notably arthroscopic stabilization, has not been demonstrated. A prospective study was therefore performed to assess (1) short-to-medium-term recurrence rate, (2) functional outcome, and (3) and medium-term osteoarthritis rate., Hypothesis: Early arthroscopic stabilization by anterior capsule-labrum reinsertion after initial anterior shoulder dislocation is associated with low recurrence rate., Materials and Methods: Twenty-one patients with initial anterior dislocation were included between June 2002 and February 2004. All patients underwent arthroscopic Bankart repair within 30 days of dislocation. Patients were followed up prospectively, with clinical (Duplay and Constant scores) and radiological assessment (osteoarthritis)., Results: There were 5 recurrent dislocations (25%); 2 patients reported sensations of subluxation: i.e., 7 failures (35%). Mean Walch-Duplay score at 10 years was 88±1 (range, 30-100) and mean Rowe score 86±22 (range, 35-100). There was significant internal rotation deficit of one vertebral level between operated and contralateral shoulder (P < 0.005). At 10 years, 3 shoulders (15%) showed Samilson grade 1 centered glenohumeral osteoarthritis., Conclusion: Early arthroscopic capsule-labrum reinsertion by the Bankart technique in the month following initial anterior dislocation of the shoulder in patients under 25 years of age provided a low recurrence rate (35%) compared to the literature, including dislocation (25%) and subluxation (10%). Functional outcome was satisfactory, and osteoarthritis rate was low (15% Samilson grade 1)., Level of Evidence: IV, prospective non-comparative study., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

Introduction: Symptomatic horizontal meniscal tears are rare but worrisome lesions in young adults. These are overuse injuries not amenable to the classic arthroscopic sutures. An open meniscal repair allows the meniscal lesion to be suture vertically, perpendicular to its in the vascularized zone. The purpose of this study was to evaluate the short and long-term clinical and radiological outcomes of the aforementioned surgical technique., Material and Method: The first cohort consisted of 24 patients operated between 2009 and 2011 (6 women, 18 men; mean age 26years) having 11 lateral and 13 medial meniscal tears. The second cohort was of 10 patients operated between 2001 and 2002 (3 women, 7 men; mean age 24years) having 8 lateral and 2 medial meniscal tears. Patients were reviewed at the last follow-up using the IKDC, Lysholm and KOOS scores. Patients in the first cohort had an MRI, while those in the second cohort had X-rays., Results: Eighteen patients in the first cohort were reviewed with a mean follow-up of 2 years (12-45 months) and 9 patients from the second cohort were reviewed after 10years (97-142 months). In the first cohort, one patient required secondary menisectomy. The mean Lysholm score was 90 and the subjective IKDC was 85. Every MRI examination found reduced extent and intensity of the hyperintense signal. In the second cohort, no patients required secondary meniscectomy. Two patients had joint space narrowing (less than 50%) on radiographs. The mean Lysholm score was 99 and the subjective IKDC was 91., Conclusion: Open repair of horizontal meniscal tears in young adults leads to good subjective and objective results in the short term, which are maintained in the long-term., Level of Evidence: Level IV - retrospective study., (Copyright © 2015. Published by Elsevier Masson SAS.)

Introduction: Surgical management of meniscal lesion consists of either a meniscectomy or meniscal repair. Although repair offers immediate recovery after surgery, it is also associated with higher rates of revision. A meniscectomy, on the other hand is known to be associated with an early onset of osteoarthritis. The present study compared clinical and radiological results at 10 years between meniscectomy and meniscal repair in isolated vertical lesion in an otherwise stable knee. The hypothesis was that repair shows functional and radiological benefit over meniscectomy., Patients and Method: A multi-centric retrospective comparative study of 32 patients (24 male, 8 female). Mean follow-up was 10.6 years (range, 10-13 years). There were 10 meniscal repairs (group R) and 22 meniscectomies (group M), in 17 right and 15 left knees. Mean age at surgery was 33.45±12.3 years (range, 9-47 years). There were 28 medial and 4 lateral meniscal lesions; 26 were in the red-red zone and 6 in red-white zone., Results: Functional score: KOOS score was significantly higher in group R than M on almost all parameters: 98±4.69 versus 77.38±21.97 for symptoms (P=0.0043), 96.89±7.20 versus 78.57±18.9 for pain (P=0.0052), 99.89±0.33 versus 80.88±19.6 for daily life activities (P=0.0002), 96.11±9.83 versus 54.05±32.85 for sport and leisure (P=0.0005), but 91±16.87 versus 68.15±37.7 for quality of life (P=0.1048). Radiology score: in group R, 7 patients had no features of osteoarthritis, and 2 had grade 1 osteoarthritis. In group M, 5 patients had grade 1 osteoarthritis, 10 grade 2, 3 grade 3 and 3 grade 4. Mean quantitative score was 0 (mean, 0.22±0.44) in-group R and 2 (mean, 2.19±0.98) in group M (P<0.0001)., Discussion: At more than 10year's follow-up, functional scores were significantly better with meniscal repair than meniscectomy on all parameters of the KOOS scale except quality of life. Functional and radiological scores correlated closely. These results show that meniscal repair for vertical lesions in stable knees protects against osteoarthritis and is therefore strongly recommended., Level of Evidence: IV; retrospective study., (Copyright © 2015 Elsevier Masson SAS. All rights reserved.)

The annual incidence of ACL tears is increasing steadily in pediatric patients. Chronic anterior instability causes meniscal lesions at a frequency that increases significantly with the injury-to-surgery interval. Conservative therapy, simple suturing, and isolated extra-articular tendon reconstruction are associated with high failure rates. Intra-articular arthroscopy-assisted tendon reconstruction is a good treatment method, although several different techniques have been described. We used a transphyseal technique with a hamstring tendon graft to treat 14 knees in 13 patients with a mean age of 13 years and 7 months. Mean injury-to-surgery interval was 6 months. Strict compliance with technical rules is required when using this technique. Bone tunnel diameter must not exceed 8 mm. Bone tunnels must be as vertical and central as possible. The fixation material must not bridge the physis (at the femur, cortical fixation; and at the tibia, fixation using a resorbable screw no longer than 25 mm combined with a staple). Meniscal lesions were present in half the knees and meniscal preservation considered mandatory. Conservative treatment of concomitant lesions was performed routinely. After a mean follow-up of 15 months, no recurrent tears or revision procedures for meniscectomy had been recorded. The IKDC grade was A or B in 93% of knees. The mean subjective IKDC score was 83.3 and the Lysholm score was in the excellent or good range in 93% of knees. Of the 14 knees, 2 exhibited signs suggesting femoral epiphysiodesis, with 4° of valgus deformity compared to the contra-lateral knee and no clinical consequences. Transphyseal reconstruction with open physes conducted in strict compliance with technical rules can be performed to control the instability and preserve the menisci. Nevertheless, this technique carries a risk of epiphysiodesis, chiefly at the femur., (Copyright © 2014 Elsevier Masson SAS. All rights reserved.)