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Background: Rotational malalignment deformities of the lower limb in adults mostly arise from excessive femoral anteversion and/or excessive external tibial torsion. The aim of this study was to assess the correction accuracy of a patient specific cutting guides (PSCG) used in tibial and femoral correction for lower-limb torsional deformities.Methods: Forty knees (32 patients) were included prospectively. All patients had patellofe-moral pain or instability with torsional malalignment for which a proximal tibial (HTO) or distal femoral (DFO) or a double-level osteotomy (DLO) had been performed. Accuracy of the correction between the planned and the postoperative angular values including femoral anteversion, tibial torsion, coronal and sagittal alignment were assessed after tibial and/or femoral osteotomy.Results: Forty knees were included in this study. In cases of HTO, the correction accuracy obtained with PSCG was 1.3 +/- 1.1 degrees for tibial torsion (axial plane), 0.8 +/- 0.7 degrees for MPTA (coro-nal plane) and 0.8 +/- 0.6 degrees for PPTA (sagittal plane). In cases of DFO, the correction accuracy obtained with PSCG was 1.5 +/- 1.4 degrees for femoral anteversion (axial plane), 0.9 +/- 0.9 degrees for LDFA (coronal plane) and 0.9 +/- 0.9 degrees for PDFA (sagittal plane). The IKSG was improved from 58.0 +/- 13.2 degrees to 71.4 +/- 10.9 (p = 0.04) and the IKSF from 50.2 +/- 14.3 to 87.0 +/- 6.9 (p < 0.001).Conclusions: Using the PSCG for derotational osteotomy allows excellent correction accu-racy in all the three planes for femoral and tibial torsional deformities associated with patellofemoral instability.Level of clinical evidence II, prospective cohort study.(c) 2022 Elsevier B.V. All rights reserved.

Purpose: Calcaneonavicular coalition accounts for more than half of all tarsal coalitions. Resection of calcaneonavicular coalition by an open approach is the standard treatment. Treatment of calcaneonavicular coalition by an arthroscopic approach appears promising. The objective of our study was to compare the clinical outcomes of calcaneonavicular coalition resection by open approach versus arthroscopic approach. Methods: A retrospective cohort study was conducted to evaluate 127 patients who underwent a resection of calcaneonavicular coalition from 2009 to 2017. Patients were divided into two groups according to whether an arthroscopic approach or an open approach was used. Demographics, operative parameters, and clinical outcomes (foot and ankle ability measure score, subjective score, and global ankle estimation) were assessed. Results: Arthroscopic approach was used for 81 patients and open approach for 46 patients. Treatment with arthroscopic approach resulted in a shorter hospital stay (2.6 ± 0.6 days vs 3.0 ± 0.7; p = 0.02) and a longer operative time (24.5 ± 8.1 min vs 20.5 ± 4.2; p Conclusions: Arthroscopic treatment of calcaneonavicular coalition is associated with a higher revision rate than the open approach. Level of evidence: Level III—retrospective comparative study.

International audience; Anterior cruciate ligament reconstruction after graft failure may need associated bone correction to ensure stability of the knee. This article presents a technique of posteromedial opening-wedge osteotomy using a custom cutting guide to correct increased tibial slope and metaphyseal varus deformity after recurrent graft failure. An autograft quadriceps tendon graft was selected for the revision anterior cruciate ligament graft. After exposure with an anteromedial incision a patient specific cutting guide was used to make the high tibial osteotomy. The final fixation of the posteromedial opening was achieved using a low-profile locking plate and a femoral head allograft bone wedge. The tibial tunnel was planned and included in the patient-specific cutting guide. The femoral tunnel was placed using an outside to in manner. Bioabsorbable screws were used as fixation devices.

Resume Introduction La pose d’une prothese totale de genou (PTG) en ambulatoire est sujette a controverse et beaucoup d’auteurs s’interrogent sur la securite d’une telle procedure. Cette pratique est encore tres marginale en France et ne represente que 1,1 % des poses des PTG (sources PMSI 2017). Cependant, grâce aux progres fait dans la prise en charge multimodale et multidisciplinaire du patient et l’optimisation des differentes procedures cette organisation est en train de se developper. Peu d’etudes traitent ce sujet. Hypothese Le taux de re-hospitalisation a J30 est comparable a celui des PTG hospitalisees. Objectif de travail Comparer le taux de re-hospitalisation d’un groupe de patient ayant eu une PTG en ambulatoire versus celui de ceux qui ont ete hospitalises. Materiel et methode Il s’agissait d’une etude mono-centrique, retrospective et continue evaluant les PTG posees entre avril 2014 et juillet 2017. Le taux de re-hospitalisation, les complications et le taux de satisfaction des patients etaient recueillis. Resultats Au total, 61 procedures ont ete realisees, dans une population selectionnee, en ambulatoire, contre 513 hospitalisees. Deux patients ont ete re-hospitalises au dernier recul (soit 3,3 %) dans le groupe ambulatoire contre 25 dans le groupe hospitalisation (soit 4,9 %). Le taux de complication globale etait de 8 % pour le groupe ambulatoire et 7,2 % pour le groupe hospitalise. Le taux de satisfaction etait qualifie de tres satisfaisant pour 80 % des patients et de satisfaisant pour 20 %. Conclusion La PTG en ambulatoire, pour une population ciblee, n’est pas associee a un taux de re-hospitalisation superieur aux PTG hospitalisees. Niveau de preuve IV, etude retrospective comparative.

Background Total knee arthroplasty (TKA) on an outpatient basis is controversial due to concerns about patient safety. In France, only 1.1% of TKAs performed in 2017 were outpatient procedures. Nevertheless, recent advances in the multi-modal and multidisciplinary management of TKA patients combined with optimisation of the various components of perioperative care are increasing the use of outpatient TKA. However, studies on outcomes remain scarce. The primary objective of this work was to compare readmission rates within 30 days after TKA between patients managed as outpatients and as inpatients. The secondary objectives were to compare complication rates and patient satisfaction between the two groups. Hypothesis After outpatient TKA, the day-30 rates of readmission and complications are similar to those seen after inpatient TKA. Material and methods A retrospective single-centre study of consecutive patients who underwent TKA between April 2014 and July 2017 was performed. Readmissions, complications, and patient satisfaction were collected. Results Of 574 patients, 61 were selected to undergo outpatient TKA and 513 had inpatient TKA. The day-30 readmission rate was 2/61 (3.3%) in the outpatient group and 25/513 (4.9%) in the inpatient group. The overall complication rate was 8% in the outpatients and 7.2% in the inpatients. The satisfaction rate was high in the outpatient group, with 80% very satisfied and 20% satisfied patients. Conclusion When performed in appropriately selected patients, outpatient TKA is not associated with a higher readmission rate compared to inpatient TKA. Level of evidence IV, retrospective comparative study.

Some researchers have suggested that bone bruises are evidence of rotational instability. The hypothesis was that the extent of lateral bone edema is correlated with the presence of an anterolateral ligament (ALL) injury. The main objective was to determine whether there was a correlation between the presence of an ALL injury the extent of bone bruises. A prospective diagnostic study enrolled all the patients who suffered an acute anterior cruciate ligament (ACL) who were operated on within 8 weeks. The extent of bone bruising according to the ICRS classification was measured on preoperative MRIs by two independent blinded raters twice with an interval of 4 weeks. Dynamic ultrasonography (US) to look for ALL injury and the pivot shift test were performed before the ACL surgery. The correlation between ALL injury and bone bruises, and the correlation between an ALL injury and a high-grade pivot shift test were determined. Sixty-one patients were included; 52% of patients had an ALL injury on US. The extent of lateral bone bruise was not related to the presence of an ALL injury, nor related to the presence of a high-grade pivot shift. A grade 2 or 3 pivot shift was significantly correlated with an ALL injury (p

Objectifs Les indications des renforts lateraux lors des reconstructions du ligament croise anterieur (LCA) sont encore tres discutees. Certains auteurs suggerent que les oedemes osseux femoral et tibial lateraux et le « lateral femoral notch sign » sont des criteres d’instabilite rotatoire devant inciter a effectuer un renfort lateral. Notre hypothese etait l’existence d’une correlation entre le volume des œdemes osseux lateraux et la presence d’une lesion du ligament anterolateral (LAL). L’objectif principal de notre etude etaient de demontrer une correlation entre les lesions du LAL reperees par echographie dynamique et le volume des œdemes osseux lateraux femoraux et tibiaux a l’IRM. Methode Nous avons effectue une etude observationnelle prospective. Tous les patients ayant presente une lesion aigue du LCA et operes a moins de 8 semaines du traumatisme, ont ete inclus entre avril 2018 et avril 2019. Une eventuelle rupture du ligament antero-lateral (LAL) a ete evaluee par echographie dynamique en pre-operatoire, sous anesthesie generale. Le grade du pivot shift test (Sous AG) a egalement etait rapporte. Le volume des oedemes osseux lateraux femoraux et tibiaux selon la classification ICRS a ete mesure sur les IRM pre-operatoires par deux lectures en aveugle espacee d’un mois, et par deux lecteurs differents. La correlation entre une lesion du LAL et l’importance des oedemes osseux a ete calculee. La correlation entre une lesion du LAL et un pivot shift test de haut grade a egalement ete determinee. Resultats Soixante et un patients ont ete inclus. Un total de 52,5 % presentaient une lesion du LAL a l’echographie dynamique preoperatoire. L’importance des œdemes osseux lateraux n’etait pas significativement correlee a la presence d’une lesion du LAL (femur : p = 0,6113, tibia : p = 0,7068), ni a la presence d’un pivot shift test (femur : p = 0,9522, tibia : p = 0,1387). Un pivot shift test de grade > 1 etait significativement correle a une lesion du LAL (p > 0,0001). Les reproductibilites inter et intra-observateurs etaient excellentes. Conclusion Le volume des oedemes osseux lateraux n’est pas correle a l’instabilite rotatoire du genou. La presence d’œdeme n’est associee ni a la presence d’une lesion du LAL, ni au pivot shift test. Nous n’avons pas trouve de lien entre les signes d’instabilite rotatoire et la presence d’œdemes osseux. L’excellente qualite diagnostique du pivot shift test dans le depistage d’une lesion du plan anterolateral est reaffirmee. La classification ICR est d’utilisation simple et reproductible.