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AimsThis study aimed to evaluate rasterstereography of the spine as a diagnostic test for adolescent idiopathic soliosis (AIS), and to compare its results with those obtained using a scoliometer.MethodsAdolescents suspected of AIS and scheduled for radiographs were included. Rasterstereographic scoliosis angle (SA), maximal vertebral surface rotation (ROT), and angle of trunk rotation (ATR) with a scoliometer were evaluated. The area under the curve (AUC) from receiver operating characteristic (ROC) plots were used to describe the discriminative ability of the SA, ROT, and ATR for scoliosis, defined as a Cobb angle > 10°. Test characteristics (sensitivity and specificity) were reported for the best threshold identified using the Youden method. AUC of SA, ATR, and ROT were compared using the bootstrap test for two correlated ROC curves method.ResultsOf 212 patients studied, 146 (69%) had an AIS. The AUC was 0.74 for scoliosis angle (threshold 12.5°, sensitivity 75%, specificity 65%), 0.65 for maximal vertebral surface rotation (threshold 7.5°, sensitivity 63%, specificity 64%), and 0.82 for angle of trunk rotation (threshold 5.5°, sensitivity 65%, specificity 80%). The AUC of ROT was significantly lower than that of ATR (p < 0.001) and SA (p < 0.001). The AUCs of ATR and SA were not significantly different (p = 0.115).ConclusionThe rasterstereographic scoliosis angle has better diagnostic characteristics than the angle of trunk rotation evaluated with a scoliometer, with similar AUCs and a higher sensitivity.Cite this article: Bone Joint J 2023;105-B(4):431–438.

Flexor tendon rupture after volar plate fixation of distal radius fracture (DRF) is rare. There is no consensus as to how to prevent them. The aim of our study was to identify the pathological mechanisms, and to establish the clinical and epidemiological profile of patients suffering from this complication. We carried out a systematic review using the PubMed, Scopus and Cochrane databases. Studies were included if they described complete or partial flexor tendon rupture following volar plate fixation of DRF. Forty-six 46 were included, for a total of 145 patients were reported: 138 from the literature, and 7 from our personal experience. Etiology was usually mechanical, by impingement with either the plate or protruding screws. Plate impingement was due to positioning beyond the watershed line, consolidation with posterior tilt, plate thickness, or low palmar cortical angle. Mean patient age was 62.4 years (range, 23-89 years). Median postoperative interval was 8 months (range, 3-120 months). Flexor pollicis longus was the most frequently injured tendon. The plate should be positioned proximally to the watershed line if possible, to ensure good initial reduction. Hardware should be removed 4 months after surgery if the plate is causing impingement according to the Soong criteria or if signs of tenosynovitis appear.

In this paper, a novel surgical robotic platform intended to assist surgeons in cervical spine surgery is presented. The purpose of this surgery is to treat the cervical spine instabilities. The surgical procedure requires drilling into specific region of the vertebrae in order to attach spinal implants and thus ensure a normal spacing between each vertebra concerned. In this context, the proposed robotic platform allows to control and restrict the surgeon's movements to a specific drilling direction set by the surgeon. The current platform is composed of a collaborative robot with seven degrees-of-freedom (DoF) equipped with a drilling tool and directly comanipulated by the surgeon. A motion capture system, as an exteroceptive sensor device, provides the robot controller with the movement data of the vertebra to be drilled. Robot Operating System (ROS) framework is used to enable real-time communication between the collaborative robot and the visual exteroceptive device. In addition, an implemented compliance control program allows to enhance the safety aspect of the robotic platform. Indeed, the collaborative robot follows the patient's movements while constraining the tool movements to an optimal trajectory as well as a limited drilling depth selected by the surgeon. The collaborative robot's elbow movements are also restricted by exploiting the null-space in order to avoid collisions with other equipment or the medical team members. Experimental drilling trials have been performed by an orthopedic surgeon to validate the usefulness and different functionalities of the developed robotic platform, and provide that a collaborative robot can comply with a spine surgery procedure. These preliminary tests were performed in a lumbar spine model for which the use of a robotic device is most frequent due to a lower complexity compared to the cervical spine.

Aim: This retrospective study’s objective was to evaluate osteoarticular infection in infants less than 12 months of age, with a particular focus on biological features and bacteriological etiology. Material & methods: We retrospectively reviewed the medical records of every infant younger than 12 months old admitted in our institution for a suspected osteoarticular infection between January 1980 and December 2016. Results: Sixty-nine patients records were reviewed, including eight neonates, 16 infants from 1 to 5 months old, and 45 from 6 to 12 months old. Conclusion: Neonates and infants aged from 6 to 12 months old were more exposed to infections. Staphylococcus aureus remained the main pathogen in children

AimsWe aimed to describe the epidemiological, biological, and bacteriological characteristics of osteoarticular infections (OAIs) caused by Kingella kingae.MethodsThe medical charts of all children presenting with OAIs to our institution over a 13-year period (January 2007 to December 2019) were reviewed. Among these patients, we extracted those which presented an OAI caused by K. kingae and their epidemiological data, biological results, and bacteriological aetiologies were assessed.ResultsK. kingae was the main reported microorganism in our paediatric population, being responsible for 48.7% of OAIs confirmed bacteriologically. K. kingae affects primarily children aged between six months and 48 months. The highest prevalence of OAI caused by K. kingae was between seven months and 24 months old. After the patients were 27 months old, its incidence decreased significantly. The incidence though of infection throughout the year showed no significant differences. Three-quarters of patients with an OAI caused by K. kingae were afebrile at hospital admission, 11% had elevated WBCs, and 61.2% had abnormal CRPs, whereas the ESR was increased in 75%, constituting the most significant predictor of an OAI. On MRI, we noted 53% of arthritis affecting mostly the knee and 31% of osteomyelitis located primarily in the foot.ConclusionK. kingae should be recognized currently as the primary pathogen causing OAI in children younger than 48 months old. Diagnosis of an OAI caused by K. kingae is not always obvious, since this infection may occur with a mild-to-moderate clinical and biological inflammatory response. Extensive use of nucleic acid amplification assays improved the detection of fastidious pathogens and has increased the observed incidence of OAI, especially in children aged between six months and 48 months. We propose the incorporation of polymerase chain reaction assays into modern diagnostic algorithms for OAIs to better identify the bacteriological aetiology of OAIs. Cite this article: Bone Joint J 2021;103-B(3):578–583.

A new factor for patellofemoral instability-external torsion of the tibial tubercle-has recently been described. The primary aim of this biomechanics study was to analyze the consequences of internal torsion tibial tubercle osteotomy (TTO) on an experimentally unstable patella. We hypothesized that internal TTO can stabilize an experimental patellar instability.This in vitro study was conducted on six fresh anatomical specimens. The knees were flexed to 25°. The patella was destabilized by transecting the patellar retinaculae and the vastus medialis tendon and by applying continuous oblique traction on the quadriceps tendon. A 3D stereovision system was used to record patellar displacement and tilt and to determine whether patellar dislocation occurred. The measurements were done before the osteotomy then repeated on the same knee after a triangular internal torsion 30° TTO was completed, without medialization.There was a significant difference in the patellar displacement and tilt before and after the osteotomy (p0.05). Patellar dislocation, which was induced by traction on all the knees before osteotomy, did not occur after the osteotomy was performed.Internal torsion of the tibial tubercle improves patellar stability, confirming our hypothesis. These findings confirm the stabilizing effect of placing the tibial tuberosity in internal torsion. Although a knee without instability factors is not the perfect model for patellar instability, our findings suggest that tibial tubercle torsion influences patellar stability. Internal TTO may be justified as a surgical treatment of patellofemoral instability.

Resume Introduction Un nouveau facteur de l’instabilite patellaire, la torsion externe de la tuberosite tibiale anterieure (TTA) a ete recemment decrit. L’objectif principal de cette etude biomecanique etait d’analyser les consequences d’une osteotomie de torsion interne de la TTA sur une patella rendue instable. L’hypothese etait que l'osteotomie interne de la TTA peut stabiliser une patella rendue instable. Materiel et methodes L’etude in vitro a ete effectuee sur 6 pieces anatomiques fraiches. Les genoux etaient flechis a 25°. La patella etait rendue instable par section des retinaculums patellaires, du tendon du vaste medial et par traction oblique continue sur le tendon quadricipital. Un systeme de stereovision 3D enregistrait le deplacement et la bascule patellaire, ainsi que la survenue d’une luxation. Les mesures etaient effectuees avant osteotomie, puis repetees sur le meme genou, apres une osteotomie triangulaire de torsion interne de la TTA de 30°, sans medialisation. Resultats Les mesures avant et apres osteotomie retrouvaient une difference significative (p Discussion Ces resultats confirment le pouvoir stabilisant de la seule torsion interne de la TTA. Meme si un genou sans facteur d’instabilite n’est pas un modele d’instabilite patellaire parfait, ils montrent que la torsion de la TTA stabilise la patella rendue instable. Dans le traitement chirurgical de l’instabilite patellaire, la correction de cette malposition de la TTA pourrait etre justifiee.

To date, no study has described the microbiological profile of surgical site infections (SSIs) after spine surgery in a tropical environment. The main objective of this study is to describe the microbiology and the risk factors of SSI after spinal surgery in a tropical climate. Our hypothesis is that the microbiology of SSIs in tropical areas is different to what is mainly described in temperate countries. As a consequence, the recommendation for antibiotic prophylaxis administered in the operative room, which mainly relays on the literature, might not be adequate in such countries. We included 323 consecutive patients who underwent a spinal intervention between 2017 and 2019, with a 2-year minimum follow-up. Objective ISO criteria were established in accordance with the criteria accepted by the Center of Disease Control in Atlanta. The identification of risk factors for SSI was carried out by uni- and multivariate analysis with a significance threshold of P < 0.05. The incidence of SSI was 7.7%. A total of 54.8% were in favor of a predominantly digestive origin of germs with an average of 1.68 bacteria found by ISO. Inadequate antibiotic prophylaxis was found in 54.8%. Age and body mass index were found to be independent risk factors for SSI. We report here an unusual microbiological profile of SSI with a predominance of gram-negative bacteria and a low proportion of Staphylococcus aureus and Staphylococcus epidermidis.

Tibial plateau fracture is a frequent entity for which surgical management is difficult both surgically and postoperatively, with multiple complications and often delayed recovery. The challenge lies in the anatomical reduction of the joint, the limitation of complications and the rapid functional recovery. Tuberoplasty appears to be an innovative technique that meets current expectations. The objective is to evaluate the reliability of tuberoplasty in reducing surgical risks and improving postoperative clinical results. This single-centre retrospective study included 30 patients with depressed tibial plateau fractures who underwent tuberoplasty from September 2011 to March 2014. Reduction analysis was performed by comparing pre-operative and post-operative depression from computed tomography (CT) data. Clinical outcomes were assessed by measuring flexion joint ranges, time to weight-bearing, KOOS questionnaire and a pangonogram. The mean depression was 7.4mm pre-operatively and 2.6mm [0;9] post-operatively, with 47% (14/30) having a residual depression of 2mm or less. Mean flexion at 6 weeks was 103° [30; 130]. Partial and total weight-bearing were allowed on day 47 [3; 150] and day 58 [20; 150], respectively. The mean KOOS score was 25.43 [1.15; 62.30] at a minimum of 5 years after surgery and the mean axis was 176.54° [172; 180]. There was one case of thrombophlebitis and one sensory-motor deficit in the common fibular nerve territory. The reduction of the tibial plateau observed in our study from tuberoplasty is in line with the literature results obtained from a conventional approach. Our results indicate that tuberoplasty is stable in the long term, has good functional results and early recovery with few complications. This preliminary study presents results that need to be investigated in a prospective randomised double-blind study.

Coracoid process fractures are uncommon lesions but are frequently associated with an acromioclavicular dislocation. The aim of this article is to report our experience of an innovative fixation technique by osteosuture in a young athletic female patient presenting a displaced fracture of the coracoid process on the insertion footprint of coracoclavicular ligaments, with no breach of continuity of the lower coracoid cortex. She also had a roockwood type 3 acromioclavicular dislocation. After a deltopectoral approach, the fracture was reduced to the anatomical position and stabilized by a first lacing, using a non-absorbable large caliber thread passing under the mid part of the coracoid process between the 2 coracoclavicular ligaments. A second lacing passing under the coracoid process and through the trapezoid ligament, and a third one through the conoïd ligament. At 6 months, the fracture was consolidated and the constant score was 100/100. This innovative fixation provides good clinical and radiological results in the short and medium term.

Persistent Spinal Pain Syndrome Type 2 (PSPS-T2) represents a main cause of work disruption. Beyond its societal consequences, occupational inactivity is responsible for a major decrease in physical/mental health in individuals but remains poorly analyzed. We designed a study to prospectively examine Professional Status (PS) evolution and its association with key bio-psychological markers. Data from 151 consecutively included working-age PSPS-T2 patients were analyzed to determine the proportion of professional inactivity and the relationships between PS and Social Gradient of Health (SGH), Numeric Pain Rating Scale (NPRS), EuroQol 5-Dimensional 5-Level (EQ-5D-5L), Oswestry Disability Index (ODI), Hospital Anxiety and Depression Scale (HADS), and Fear-Avoidance Belief Questionnaire work subscale (FABQ-W). Despite optimized medical management, 73.5% of PSPS-T2 patients remained inactive after 1 year of follow-up/p = 0.18. Inactive patients presented a low SGH/p = 0.002, higher NPRS/p = 0.048, lower EQ-5D-5L/p &lt, 0.001, higher ODI/p = 0.018, higher HADS-D/p = 0.019 and higher FABQ-W/p &lt, 0.001. No significant mediation effect of FABQ-W on SGH consequences regarding PS was observed in our structural model/p = 0.057. The link between unemployment and bio-psycho-social pain dimensions appears bidirectional and justifies intense collaboration with social workers. Optimizing therapeutical sequencing towards personalized professional plans implies restoring “Adapted Physical Function” as an initial goal, and tailoring an “Adapted Professional Activity”, matching with patient expectations and capabilities, as a final objective.

The objective of this study was to correlate the data of the 6-month postoperative isokinetic muscle evaluation before resuming sports activities with the occurrence of ACL reconstruction rerupture after semitendinosus short graft.From 2015 to 2018, all patients who were operated for an ACL reconstruction with a short semitendinosus autograft (TLS System) and who performed isokinetic tests on dynamometer at their 6th postoperative month were included in this study. The follow-up was prospective with the measurement of epidemiological, radiographic, and isokinetic parameters at 6 months of the ACL reconstruction. The cohort was divided into 2 groups: one group without an ACL reconstruction rerupture (Group 1) and the second group with a rerupture (Group 2).One hundred and four patients were analyzed with an average follow-up of 42.3 months (Minimum: 24; Maximum: 63.5), of which 11 patients (10.6%) had an ACL reconstruction rerupture. Group 1 consisted of 93 patients with an average age of 26.5 ± 9.0 years old who did not have an ACL reconstruction rerupture with an average follow-up of 41.6 ± 12.1 months. Group 2 consisted of 11 patients with an average age of 22.7 ± 6.1 years old, who had an ACL reconstruction rerupture with an average follow-up of 44.8 ± 11.3 months. Concerning extension force recovery, the ratio between operated and healthy knee was 81.8% ± 32.0 for Group 1, and 53.4% ± 20.6 for Group 2 (This study revealed a significant link between muscle weakness in flexion and extension during 60°/s isokinetic test at 6 months of ACL reconstruction and semitendinosus autograft rerupture. Patients with an ACL reconstruction retear had inferior muscle dynamometric recovery results at 6 months before resuming sports activities.Level III, prognostic, retrospective cohort study.

International audience; Metabolic glycoengineering with unnatural sugars became a valuable tool for introducing recognition markers on the cell membranes via bioorthogonal chemistry. By using this strategy, we functionalized the surface of tumor and T cells using complementary artificial markers based on both β-cyclodextrins (β-CDs) and adamantyl trimers, respectively. Once tied on cell surfaces, the artificial markers induced cell–cell adhesion through non-covalent click chemistry. These unnatural interactions between A459 lung tumor cells and Jurkat T cells triggered the activation of natural killer (NK) cells thanks to the increased production of interleukin-2 (IL-2) in the vicinity of cancer cells, leading ultimately to their cytolysis. The ready-to-use surface markers designed in this study can be easily inserted on the membrane of a wide range of cells previously submitted to metabolic glycoengineering, thereby offering a simple way to investigate and manipulate intercellular interactions.

The Social Gradient of Health (SGH), or position in the social hierarchy, is one of the major determinants of health. It influences the development and evolution of many chronic diseases. Chronic pain dramatically affects individual and social condition. Its medico-economic impact is significant and worldwide. Failed Back Surgery Syndrome or Persistent Spinal Pain Syndrome type 2 (PSPS-T2) represents one of its most fascinating and disabling conditions. However, the influence of SGH on PSPS-T2 has been poorly explored. We designed a prospective multicentric study (PREDIBACK study) to assess the SGH prevalence, and to examine its association with medical and psychological variables, in PSPS-T2 patients. This study included 200 patients to determine the SGH association with pain (NPRS), Quality of life (EQ-5D-5L), kinesiophobia (FABQ-Work), catastrophism (CSQ), and functional capacity (ODI). Around 85.3% of PSPS-T2 patients in our study had low SGH. Low SGH patients had a higher FABQ-Work and CSQ-Catastrophizing score than high SGH patients (p &lt, 0.05). High SGH patients have a higher ODI score than low SGH patients (p &lt, 0.10). Our results suggest that SGH is a relevant factor to guide prevention, research, and ultimately intervention in PSPS-T2 patients and could be more widely transposed to chronic pain.

The identifications of fractures in cancellous bone using FE models became popular in the recent years. The most common FE methods are continuum level FE (Verhulp et al. 2006) models and high-resol...

Tibial plateau fractures correspond to articular injuries. It represents 1.03% of all bone fractures in general population and 8% in the elderly population. The most frequent tibial plateau fractur...

Physiotherapy is a health care discipline based on movement assessment and treatment. Mechanical Diagnosis and Therapy (MDT) is a reliable and efficient approach using repeated end-range movements ...

Resume Introduction Le cintrage de la tige est un temps essentiel lors d’une fusion posterieure lombaire. Le role precis de l’instrumentation posterieure lombaire reste a definir. Malgre un cintrage approprie de la tige, il peut exister une inadequation entre la lordose de la tige et la lordose du segment arthrodese. Il n’y a pas d’etude publiee sur le lien entre le cintrage de la tige et la lordose lombaire. L’objectif de cette etude etait d’evaluer les parametres influencant l’inadequation entre la lordose de la tige et la lordose du segment arthrodese lors d’une arthrodese lombaire courte posterieure avec vis poly axiales. Hypothese Des parametres radiologiques refletant la technique d’instrumentation expliquent l’inadequation entre le cintrage de la tige et la lordose postoperatoire. Methodes Cette etude etait monocentrique, retrospective, analytique, descriptive. Tous les patients ayant eu une arthrodese posterieure de L3 a L5 dans un centre hospitalier universitaire en 2017 ont ete inclus. Ont ete mesures sur une radiographie lombaire postoperatoire de profil : l’incidence pelvienne, la lordose lombaire, la lordose du segment arthrodese, la distance entre le mur posterieur et la tige a chaque etage (EcarT), l’angle entre la vis et la tige a chaque etage (thetaMA), l’angle entre la vis et le plateau superieur a chaque etage (LambdaMA) et la lordose de tige. Des analyses univariees et multivariees ont ete realisees a la recherche d’un lien entre ces parametres et l’inadequation lordose vertebrale/cintrage de la tige. Resultats Au total, 74 patients ont ete inclus, l’âge moyen etait de 67 ans. Dix-huit patients ont beneficie d’une fusion circonferentielle, 56 d’une fusion posterolaterale. Il n’y avait pas d’association statistique entre les parametres demographiques, les parametres pelviens, l’utilisation d’une cage intersomatique, et l’inadequation entre lordose de tige et lordose du segment fusionne. Il y avait une association statistique entre ThetaMA, LambdaMA, EcarT et cette inadequation (p Conclusion Notre etude est la premiere a etudier le lien entre cintrage de tige et lordose lombaire. Trois facteurs radiologiques sont impliques en cas d’inadequation entre la lordose de la tige et la lordose du segment fixe. Deux dependent du positionnement des vis par l’operateur : paralleles au plateau superieur (LambdaMA) et vissees de maniere homogene (EcarT) alors que ThetaMA depend de la technique chirurgicale : compression sur les vis, osteotomies, vis mono axiales, cages intersomatiques). Niveau de preuve IV.

The question of rod bending is essential during posterior lumbar fusion. The role of posterior instrumentation during spinal surgery remains to be defined. Despite an appropriate bending, a mismatch between rod lordosis and lumbar lordosis can occur. There is no study on the link between rod bending and lordosis. The purpose of this study was to evaluate parameters that explain the mismatch between lumbar lordosis and rod bending in lumbar surgery using polyaxial screws.Radiological parameters explain the mismatch between the rod and the lordosis.This study was monocentric, retrospective, descriptive and analytic. All patients with posterior L3L5 fusion in an university-affiliated hospital in 2017 were included. Patients with past surgical history of anterior fusion on the levels L3L5, Coronal malalignment with a Cobb angle superior to 5°, the use of dynamic fixation systems were excluded. We measured on immediate post-operative standing profile x-ray: pelvic incidency, lumbar lordosis, lordosis of the instrumented segment, the distance between posterior wall and rod (EcarT) which reflect how homogeneously the screws are put in depth, the angle between screw and rod (thetaMA), the angle between screw and superior endplate (lambdaMA), the rod lordosis. Univariate and multivariate analysis were conducted to see if there was a link between all those parameters and the mismatch: vertebral lordosis-rod lordosis.A total of 74 patients were included, mean age was 67. Eighteen were 360° fusion and 56 were postero-lateral fusions. There was no statistical association between demographic data, pelvic parameters, use of interbody devices and the mismatch. There was a statistical association between thetaMA, lambdaMA, EcarT and the mismatch (P0,0001). A multivariate linear regression model was developed to create a new index: Mismatch analysis index.Our study is the first on the link between rod bending and lumbar lordosis. Three radiologic factors are involved in not obtaining the planned lordosis in short lumbar fusion with polyaxial screws. Two factors depend on the way the surgeon positions screw parallel to the superior vertebral endplate(lambdaMA), and with a homogeneous depth (EcarT). And the last factor: ThetaMA is depending on the surgical technique (compression on screws, osteotomies, monoaxial screws, use of interbody devices).IV.

Metabolic glycoengineering with unnatural sugars became a valuable tool for introducing recognition markers on the cell membranes via bioorthogonal chemistry. By using this strategy, we functionalized the surface of tumor and T cells using complementary artificial markers based on both β-cyclodextrins (β-CDs) and adamantyl trimers, respectively. Once tied on cell surfaces, the artificial markers induced cell–cell adhesion through non-covalent click chemistry. These unnatural interactions between A459 lung tumor cells and Jurkat T cells triggered the activation of natural killer (NK) cells thanks to the increased production of interleukin-2 (IL-2) in the vicinity of cancer cells, leading ultimately to their cytolysis. The ready-to-use surface markers designed in this study can be easily inserted on the membrane of a wide range of cells previously submitted to metabolic glycoengineering, thereby offering a simple way to investigate and manipulate intercellular interactions., We designed complementary artificial markers that were introduced on the surface of cells previously modified by metabolic glycoengineering. These recognition markers enable unnatural cell–cell adhesion through non-covalent click chemistry.

We aimed to describe the epidemiological, biological, and bacteriological characteristics of osteoarticular infections (OAIs) caused byThe medical charts of all children presenting with OAIs to our institution over a 13-year period (January 2007 to December 2019) were reviewed. Among these patients, we extracted those which presented an OAI caused by

Background Pain is a major public health concern in the aging population. However, medication brings about negative effects that compel healthcare professionals to seek alternative management techniques to alleviate pain. Hypnosis has been recognized as an effective technique to manage pain, but its long-term efficacy has yet to be examined in older adults. Aims The aim was to assess the effectiveness, over a 12-month period, of home-care hypnosis in elderly participants suffering from chronic pain. Design Real-life retrospective one-arm study with a 12-month follow-up. Settings Elderly Persons Suffering From Chronic Pain enrolled in a clinical health care program that offered home medical follow-up. Participants/Subjects Fourteen elderly women (mean age 81 years) with chronic pain participated in the home-care hypnosis program. All participants presented chronic pain (≥6 months) with average pain score >4/10. Methods Participants took part in seven 15-minute hypnosis sessions within 12 months. The Brief Pain Inventory questionnaire was used to evaluate pain perception and pain interference at baseline and at 3-, 6-, and 12-month follow-up period. Results Hypnosis home-care program significantly decreased pain perception and pain interference compared to baseline after 3 months (–29% and –40%, p Conclusions Seven sessions of 15 minutes allocated throughout a 12-month period produced clinically significant decreases in pain perception and pain interference. Hypnosis could be considered as an optimal additional way for health practitioners to manage chronic pain in an elderly population with long-term efficacy. This study offers a new long-term option to improve chronic pain management at home in elderly populations through a low-cost nonpharmacological intervention.

Distal patellar tendon avulsions are rare injuries in healthy individuals, and to date, no case affecting skeletally mature teenagers and adolescents has been reported. In the majority of cases, distal patellar tendon avulsions are associated with severe intra-articular knee lesions, signifying a high-energy trauma. We present the case of a 15.5-year-old female who was admitted to the emergency department after a knee injury. The mechanism of injury was a combination of landing after a jump off a scooter and sudden deceleration with a fixed foot. Lateral radiographs revealed a distal patellar tendon avulsion. An MRI was conducted to accurately diagnose concomitant lesions. The MRI revealed a complete tear of the ACL, and associated bone bruises on the lateral femoral condyle, and also on the posterolateral tibial plateau. A knee joint exam under general anesthesia demonstrated good stability during valgus stress testing and only a grade 1 positive Lachman test. Therefore, we decided to only reconstruct the extensor mechanism and to abstain from a primary ACL reconstruction. The presented case and review of the literature demonstrate the clinical relevance of this atypical lesion. In fact, a distal patellar tendon avulsion after physeal fusion of the proximal tibia should raise a strong suspicion of severe associated intra-articular knee lesions and requires prompt MRI investigation. However, controversy still exists regarding the management of these injuries, in particular concerning the question of whether to address both injuries in a single stage or in 2 stages.

BackgroundWhile the evolution of technology provides new opportunities to manage chronic refractory pain using different waveform modalities of spinal cord stimulation in failed back surgery syndrome (FBSS), there is no randomized controlled trial available to compare the efficacy of these different stimulations waveforms to date. MULTIWAVE is a prospective, randomized, double-blinded, crossover trial study designed to compare the clinical efficacy of tonic conventional stimulation (TCS), burst stimulation (BURST) and high-frequency stimulation (HF) in FBSS patients over a 15-month period in SCS implanted patients.Methods/designTwenty-eight patients will be recruited in the Poitiers University Hospital, in Niort and La Rochelle Hospitals in France. Eligible patients with post-operative low back and leg pain with an average visual analog scale (VAS) score ≥ 5 for low back pain are implanted and randomly assigned to one of the six arms (in a 1:1:1:1:1:1 ratio), where they receive a 3-month combination of TCS, BURST and HF including one treatment modality per month and varying the order of the modality received within the six possible combinations. Patients receiving intrathecal drug delivery, peripheral nerve stimulation and back resurgery related to the original back pain complaint and experimental therapies are excluded from this study. Patients included in the spinal cord stimulation group undergo trial stimulation, and they all receive a TCS treatment for 2 months, as the gold standard modality. Thereafter, patients are randomly assigned to one of the six arms for the total duration of 3-month crossover period. Then, patients choose their preferred stimulation modality (TCS, BURST, or HF) for the follow-up period of 12 months. Outcome assessments are performed at baseline (first implant), before randomization (2 months after baseline) and at 1, 2, 3, 6, 9 and 15 months post-randomization. Our primary outcome is the average global VAS of pain over 5-day pain diary period between baseline and after each period of stimulation. Additional outcomes include changes in leg and back pain intensity, functional disability, quality of life, psychological state, paraesthesia intensity perception, patient satisfaction and the number of adverse events.DiscussionRecruitment began in February 2017 and will continue through 2019.Trial registrationClinicaltrials.govNCT03014583. Registered on 9 January 2017.