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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).Age, gender, weight, osteoarthritis grade, degree of correction, type of osteotomy, technique and intraoperative complications impact HTO survival.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 p0.05; 95% confidence intervals were calculated.Age54 years, male gender, BMI25, medial tibiofemoral wear severity Ahlback ≥3, ≥0.9° varus joint component, HKA correction8°, postoperative HKA180° 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.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.IV, retrospective cohort study.

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.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.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, p0.001; SRG synovial CRP=31.5mg/L vs. CG synovial CRP=2.6mg/L and ARG synovial CRP=1.7mg/L, p0.001). 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%).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.III; case-control study.

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 26 years) 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 24 years) 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 10 years (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.

All meniscal repairs have become increasingly popular and have tended to convert meniscal suturing into a standard procedure. The most classical complications are neurovascular damage in relation to the minimal invasive approach for arthroscopic posteromedial and posterolateral portals as well as insertions of implants without direct visualization of the neurovascular structures. With the evolution of meniscal devices and implants, new complications in meniscal repair surgery have emerged, especially with first-generation implants (arrow, dart, staples, and screws). Repair techniques have also been developed. Over the years, many reports on specific complications relating to all-interior devices have been published. Chondral injuries, implant loosening, device migration, capsular or neural irritations, foreign body reactions, and cystic granulomas have all been described in the literature following the use of meniscal fixation devices. Since hybrid meniscal devices allow for easier meniscal sutures with lower risk of neurovascular injury, more appropriate suture placement, and the easy handling of the instruments, information delivered to patients regarding potential complications should take into account the rarefaction of complications reported in the literature.

The menisci perform crucial tasks for the normal functioning and homeostasis of the knee. Meniscus removal, which is still necessary in many instances, reduces the contact areas and increases the peak stresses in the femorotibial joint which in turn may cause cartilage wear, pain and loss of knee function. The greater the tissue mass excised, the more important the degenerative changes. This process, so-called postmeniscectomy syndrome, is worse in the lateral compartment, due to its particular features. Arthroscopic partial lateral meniscectomies gives excellent short-term outcomes. However, their results deteriorate overtime and are associated with a high incidence of arthritic changes and low functional outcomes. A cautious meniscal removal policy is warranted to avoid these deleterious effects.

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 4 mm 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.

IntroductionEarly 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.HypothesisEarly arthroscopic stabilization by anterior capsule-labrum reinsertion after initial anterior shoulder dislocation is associated with low recurrence rate.Materials and methodsTwenty-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).ResultsThere 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

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 Discussion At more than 10 year'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.