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Resume Introduction En cas de laxite anterieure chronique, la reconstruction du ligament croise anterieur (LCA) pourrait ralentir le developpement de l’arthrose. Cette etude a ete menee afin de determiner la prevalence globale de l’arthrose et d’identifier les facteurs de risque apres reconstruction du LCA. Hypothese Les lesions meniscales, le delai traumatisme–chirurgie, l’index de masse corporelle (IMC), la laxite residuelle et les lesions cartilagineuses influencent l’evolution vers l’arthrose. Materiels et methodes Cette etude multicentrique retrospective sur le devenir des ligaments croises a 12 ans de recul a ete realisee dans le cadre du symposium de la Sofcot 2014. La cohorte comprenait 675 reconstructions sous arthroscopie du LCA de janvier 2002 a decembre 2003. L’evaluation clinique comprenait le score IKDC objectif et subjectif. L’analyse de l’arthrose a ete realisee sur 589 radiographies du genou selon la classification IKDC. Les facteurs predictifs de developpement d’arthrose etudies etaient l’âge, le sexe, l’IMC, le delai traumatisme–chirurgie, le niveau d’activite, les meniscectomies mediales ou laterales, le type de greffe, les chondropathies mediales ou laterales, le positionnement des tunnels, la laxite residuelle. Une analyse univariee et multivariee avec regression logistique a ete realisee. Resultats Le recul moyen etait de 11,9 ± 0,8 ans. Le score IKDC subjectif etait de 83,7 ± 13. A 12 ans, le taux d’arthrose moderee a severe (C ou D IKDC) etait de 19 % (16 % d’arthrose femoro-tibiale mediale, 4 % d’arthrose femoro-tibiale laterale et 2 % d’arthrose femoro-patellaire). Les facteurs pronostiques etaient l’âge a la chirurgie superieur a 34 ans (p Conclusions Cette etude a grande echelle a identifie des facteurs de risque arthrosique qui devraient permettre d’ameliorer l’information des patients sur l’evolution a long terme apres reconstruction du LCA. Niveau de preuve Etude retrospective de cohorte de niveau IV.

PURPOSE: The purpose of this study is to review the indications for and outcomes of high tibial osteotomy in the treatment of patients with chronic knee laxity. METHODS: A comprehensive literature review was performed to identify surgical indications and results of high tibial osteotomy for the treatment of chronic knee laxity. RESULTS: Four distinct situations were identified in which a high tibial osteotomy may be advantageous: (1) anterior laxity with varus osteoarthritis, (2) chronic anterior laxity in the setting of varus with lateral ligamentous laxity, (3) chronic anterior laxity in the setting of a high tibial slope, and (4) chronic posterior laxity or posterolateral corner injury. A total of 24 studies were included in this report, including reports of the treatment of 410 knees as well as several review articles. The most frequently reported indication for that addition of HTO was anterior laxity in the setting of varus OA, which was noted to have good results, minimizing anterior knee laxity and allowing return to sports, while reducing the progression of osteoarthritis. More advanced cases in which lateral structures have also become stretched and incompetent are an excellent indication for HTO, with the need for subsequent lateral procedures dependent on the degree of varus laxity and especially hyperextension that is present. Excessive tibial slope has been identified as a cause of ACL reconstruction failure, and some authors have recommended addressing very high slope in revision cases. In knees with chronic posterior or posterolateral instability, correction of alignment first is generally recommended, with subsequent ligamentous procedures performed when instability persists. CONCLUSIONS: Knees with chronic instability pose a difficult treatment challenge. In all cases, the contribution of coronal plane alignment to varus-valgus knee stability must be carefully considered and addressed prior to ligament surgery. Sagittal plane alignment is also key and must not be overlooked. Such considerations drive the indication for osteotomy as well as the type of osteotomy that is chosen. Level of evidence IV.

Introduction Increasing the femoral offset when performing total hip arthroplasty (THA) theoretically increases the stresses and risks of the stem not integrating itself into bone. But this concept has not been validated for cementless stems; this led us to conduct a retrospective study to determine: (1) the risk factors for the occurrence of symptomatic femoral radiological abnormalities, (2) the incidence of these abnormal radiological findings, (3) the revision rate for aseptic non-integration of a cementless lateralized stem. Hypothesis Young patients with significant femoral canal flare and a small cementless lateralized stem have a higher risk of abnormal osseointegration. Material and methods We analyzed retrospectively 172 consecutive lateralized stems (KHO, Corail™ product line) implanted during primary THA between 2006 and 2012 in 157 patients (mean age 68 years ± 12.6 (20–95), 89% men). Radiographs were used to evaluate osseointegration scores, offset restoration and the Noble index. Kaplan-Meier survival analysis was performed using “symptomatic femoral radiological abnormalities” and “revision for aseptic stem non-integration” as endpoints. Results The mean follow-up was 5.9 years ± 2.7 (range, 2–12.4 years). Being more than 70 years of age (HR = 0.7, 95% CI: [0.3–0.9], P = 0.004) and having a larger stem (HR = 0.6, 95% CI: [0.4–0.9], P = 0.03) were protective against symptomatic femoral radiological abnormalities, while increasing the postoperative femoral offset (HR = 1.1, 95% CI: [1.01–1.2], P = 0.02) was deleterious. The survival free of “symptomatic femoral radiological abnormalities” was 93% (95% CI: 89–97) at 5 years and 84% (95% CI: 75–95) at 8 years. The survival free of “revision for aseptic stem non-integration” was 98% (95% CI: 96.8–100) at 5 years and 97% (95% CI: 95.2–100) at 8 years. Discussion In this study, the risk factors for symptomatic radiological abnormalities were being less than 70 years of age, having a small lateralized stem and restoring a large femoral offset. Lateralized stems used in this study had a 10% rate of symptomatic radiological abnormalities and a 4% rate of revision for aseptic non-integration. Level of evidence IV, retrospective study.

Introduction In cases of chronic anterior laxity, reconstruction of the anterior cruciate ligament (ACL) can slow the development of osteoarthritis. This study was conducted to determine the overall prevalence of osteoarthritis and to identify the risk factors after ACL reconstruction. Hypothesis Meniscus tears, time from injury to surgery, body mass index (BMI), residual laxity, and cartilage lesions influence the progression towards osteoarthritis. Materials and methods This multicenter, retrospective study on the outcome of cruciate ligaments at 12years of follow-up was conducted within the 2014 SOFCOT Symposium. The cohort included 675arthroscopic reconstructions of the ACL from January 2002 to December 2003. The clinical evaluation included the objective and subjective IKDC score. Osteoarthritis was analyzed on 589 knee X-rays according to the IKDC classification. The predictive factors of osteoarthritis development studied were age, gender, BMI, time from injury to surgery, activity level, medial or lateral meniscectomy, type of graft, medial or lateral chondropathy, tunnel positioning, and residual laxity. Univariate and multivariate analyses with logistic regression were performed. Results The mean follow-up was 11.9 ± 0.8years. The subjective IKDC score was 83.7 ± 13. At 12years, the rate of moderate to severe osteoarthritis l (IKDC C or D) was 19% (16% medial tibiofemoral osteoarthritis, 4% lateral tibiofemoral osteoarthritis, and 2% patellofemoral osteoarthritis). The prognostic factors were age at surgery greater than 34years (P < 0.05), cartilage lesions at surgery (P < 0.05), medial or lateral meniscectomy (P < 0.05), and residual laxity (P < 0.05). Conclusions This large-scale study identified risk factors for osteoarthritis that should improve the information provided to patients on long-term progression after ACL reconstruction. Level of evidence Retrospective cohort study, level IV.