T. Cucurulo

Université de Versailles Saint-Quentin, Versailles, Île-de-France, France

Are you T. Cucurulo?

Claim your profile

Publications (23)11.44 Total impact

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose The aim of this study was to investigate the histological features of the remaining fibers bridging femur and tibia in partial ACL tears. Methods 26 ACL remnants were harvested from patients who had arthroscopic criteria concordant with a partial tear. Histological analysis includes cellularity, blood vessel density evaluation and characterization of the femoral bony insertion morphology. Immunohistochemical studies were carried out to determine cell positive for α-smooth actin and for mechanoreceptors detection. Results In this samples, a normal femoral insertion of the remnant was present in 22.7% of the cases. In 54 % of the samples, substantial areas of hypercellularity were observed. Myofibroblasts were the predominant cell type and numerous cells positive for α-smooth actin were detected at immunostaining. Blood vessel density was increased in hypercellularity areas and in the synovial sheet. Free nerve endings and few Golgi or Ruffini corpuscles were detected in 41 % of the specimens. The cellularity was correlated to the time between injury to surgery (p = .001). Conclusion Competent histological structures including a well vascularized synovial sheet, numerous fibroblasts and myofibroblasts and mechanoreceptors were found in ACL remnants. These histological findings bring additional knowledge towards the preservation of the ACL remnant in partial tears when ACL reconstruction or augmentation is considered.
    The Knee 01/2014; · 2.01 Impact Factor
  • Source
    Journal de Traumatologie du Sport 12/2013;
  • [Show abstract] [Hide abstract]
    ABSTRACT: Les déchirures musculaires des ischio-jambiers sont fréquentes chez les sportifs et peuvent être traitées sans intervention chirurgicale. Une avulsion complète proximale des ischio-jambiers est une lésion rare qui peut mettre un terme à la carrière d’un sportif de haut niveau. Pour ces athlètes, la réparation chirurgicale doit être immédiatement entreprise pour raccourcir le délai de retour au sport et améliorer le résultat fonctionnel. Dans cet article, nous rapportons le cas d’une rupture complète proximale des tendons ischio-jambiers chez un footballeur professionnel. Nous décrivons le tableau clinique, les examens paracliniques, la technique chirurgicale de réinsertion ainsi que le programme de rééducation post opératoire. La qualité de la réinsertion a été confirmée par une IRM effectuée cinq mois après l’intervention. Le retour à la compétition a été possible six mois après la chirurgie. Au test isocinétique, le couple de force maximal des ischio-jambiers était, par rapport au côté sain, de 80 % à six mois et de 106 % 11 mois après l’intervention.
    Revue de Chirurgie Orthopédique et Traumatologique 12/2012; 98(8):834–835.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION: Partial anterior cruciate ligament (ACL) tear is frequent, and indications for surgery may be raised by a diagnostic aspect associating slight laxity with no clear pivot-shift. Unlike that of complete ACL tear, the natural history of partial tear remains controversial. MATERIAL AND METHOD: A systematic literature review searched for referenced publications on the natural history of partial ACL tear. Twelve specific articles were retrieved. Initial diagnosis was systematically confirmed on arthroscopy, without ACL surgery. The following criteria were analyzed: firstly, preoperative: confirmation of inclusion criteria, preoperative clinical data, follow-up, arthroscopic lesion assessment, Lachman test, Pivot shift test, hemarthrosis, associated lesions and secondly, follow-up: Lachman test, Pivot shift test, revision surgery, functional clinical scores, pain, sport and return to sport, meniscal events. RESULTS: Preoperatively, Lachman tests were positive (soft or delayed) in a mean 49.7% of cases (range, 0-100%); pivot shift test was systematically negative. At a mean 5.2years' follow-up, Lachman test was "positive" in 47.6% of cases (range, 38-59%), with positive pivot shift test in 26.3% (range, 5-51%). 54.3% patients reported pain (range, 36-64%), and mean Lysholm score was 88.4 (17-100%). Fifty-two percent (21-60%) of patients resumed sport at their previous level. DISCUSSION/CONCLUSION: The natural history of non-operated partial ACL tear is good over the medium term, especially if patients limit their sports activities. The greater the functional instability, the more frequent is residual pain. Laxity, although not quantified, seems to progress with time, with a positive pivot shift test emerging in a quarter of cases. Functional management may be recommended in non-athletic patients without meniscal lesion, but surgical treatment may be recommended in other patients. Indications for ACL reconstruction are thus the same in partial as in complete tear. LEVEL OF EVIDENCE: IV, Meta-analysis of cohort and retrospective studies.
    Orthopaedics & Traumatology Surgery & Research 11/2012; · 1.06 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION: Partial tears of the anterior cruciate ligament (ACL) are frequent. Conserving ACL remnants is central to the concept of anatomic, biomechanical and biological reconstruction. The interest of such conservation remains theoretical. The present hypothesis was that selective anteromedial (AM) bundle reconstruction is preferable to the standard single-bundle reconstruction in partial ACL tear. MATERIALS AND METHODS: A multicenter prospective randomized study recruited 54 partial ACL tears operated on either by selective AM bundle reconstruction (Group 1, n=29) or by standard anatomic single-bundle reconstruction (Group 2, n=25). All patients were clinically assessed on subjective and objective IKDC, Lysholm and KOOS scores, with a minimum 12months' follow-up. Comparative pre- to postoperative anterior laxity was measured on the Rolimeter(®) device, with statistical analysis of results. RESULTS: There were no significant preoperative differences between the two groups. All patients were followed-up at 6months and 1year. Mean subjective IKDC scores for groups 1 and 2 respectively were 55.8 and 56.8 preoperatively versus 86.2 and 85.7 at 1year; Lysholm scores were 69.9 and 71.1 versus 90.9 and 91.8. These inter-group differences were non-significant. Differential laxity for groups 1 and 2 respectively was 5.0mm (range, 2-10) and 5.1mm (2-12) preoperatively (P=0.73), versus 1.2mm and 1.9mm postoperatively (P=0.03). DISCUSSION AND CONCLUSION: In partial ACL tear, selective AM bundle reconstruction conserving the posterolateral bundle remnant provides clinical results comparable to the standard single-bundle technique, with better control of anterior laxity. Longer follow-up, however, will be needed to compare evolution in anterior and rotational laxity and in subjective results over time. TYPE OF STUDY: Prospective randomized, level I.
    Orthopaedics & Traumatology Surgery & Research 11/2012; · 1.06 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: INTRODUCTION: Over the past decade, our understanding of the anterior cruciate ligament (ACL) has evolved considerably. Based on this knowledge, ACL reconstruction techniques have changed and selective reconstruction procedures have been developed for partial tears. Our hypothesis was that stability and function can be restored to the knee with selective bundle reconstruction of partial ACL tears and preservation of the residual fibers. MATERIALS AND METHODS: This was a multicenter retrospective study of 168 partial reconstructions of the anteromedial (AM) bundle of the ACL with preservation of the posterolateral (PL) bundle. All patients underwent a clinical evaluation based on the objective and subjective IKDC scores and the Lysholm score after a mean follow-up of 26months (12-59months). Preoperative and postoperative instrumental measurement of knee laxity was performed by arthrometer and/or by (Telos(®)) stress radiography. Statistical analysis and comparison was performed between pre- and postoperative results. RESULTS: The preoperative and postoperative subjective IKDC scores were 63.7 and 90.5 at the final follow-up respectively (P<0.001). The preoperative and postoperative Lysholm scores were 80 and 95.5 respectively (P<0.001). Preoperatively, most patients were classified C on the objective IKDC score. At the final follow-up 92% of the patients were classified A or B (P<0.001). Differential preoperative laxity was 5.5mm (range: 0-14mm) and 1.1mm (range: 0-4mm) at the final follow-up (P<0.00001). DISCUSSION AND CONCLUSION: Our study confirms that selective reconstruction of the AM bundle of the ACL with preservation of the PL bundle restores stability and function to the knee. Special attention should be paid to the size of the graft used to avoid excess tissue in the intercondylar notch. TYPE OF STUDY: Retrospective study, level of evidence IV.
    Orthopaedics & Traumatology Surgery & Research 11/2012; · 1.06 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Acute hamstring strains are a common athletic injury, which may be treated non-operatively with a satisfactory outcome. A complete proximal hamstring avulsion is a rare and potentially career ending injury to an elite athlete. For these high demand patients, surgical reattachment should be immediately undertaken to shorten return to sport and to improve functional outcome. This report describes the occurrence of a complete avulsion of the proximal hamstrings in a professional footballer during an international match. We highlight the clinical presentation, the appropriate diagnostic investigations, the surgical technique and the rehabilitation protocol for this injury. The successful surgical reattachment of the common hamstring tendon was confirmed by magnetic resonance imaging done 5 months after repair and allowed the player a full return to competition at 6 months after surgery. Hamstrings isokinetic peak torque was 80% at 6 months and 106% at 11 months after repair comparing with the uninjured side.
    Orthopaedics & Traumatology Surgery & Research 08/2012; · 1.06 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: It has been suggested that an increased posterior tibial slope (PTS) and a narrow notch width index (NWI) increase the risk of anterior cruciate ligament (ACL) injury. The aim of this study was to establish why there are conflicting reports on their significance. A total of fifty patients with a ruptured ACL and 50 patients with an intact ACL were included in the study. The group with ACL rupture had a statistically significantly increased PTS (p < 0.001) and a smaller NWI (p < 0.001) than the control group. When a high PTS and/or a narrow NWI were defined as risk factors for an ACL rupture, 80% of patients had at least one risk factor present; only 24% had both factors present. In both groups the PTS was negatively correlated to the NWI (correlation coefficient = -0.28, p = 0.0052). Using a univariate model, PTS and NWI appear to be correlated to rupture of the ACL. Using a logistic regression model, the PTS (p = 0.006) and the NWI (p < 0.0001) remain significant risk factors. From these results, either a steep PTS or a narrow NWI predisposes an individual to ACL injury. Future studies should consider these factors in combination rather than in isolation.
    Journal of Bone and Joint Surgery - British Volume 11/2011; 93(11):1475-8. · 2.69 Impact Factor
  • Source
    Orthopaedics & Traumatology Surgery & Research 11/2009; 95(8 Suppl 1):S72-7. · 1.06 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to evaluate the results of surgery, in particular arthroscopic procedures in the treatment of patellar tendinopathies that are refractory to conservative treatment in athletes.MethodA retrospective multicenter study was performed in four centers. Patients were athletes who did not respond to carefully followed conservative treatment and who underwent surgery. Sixty-four patients were included, 10 who underwent arthroscopy. Patients were questioned and followed-up for an average of 22 months (6–116 months).ResultsAt the final follow-up, 87% of the patients had an improved Blazina score and 63% were again practicing their sport at the same level. None of the preoperative factors influenced the final result and one surgical technique was not more effective than another (patellar tip resection versus arthroscopic approach).DiscussionThe results of this study are comparable to those in the literature which show a success rate of more than 80% whatever the surgical technique. This study limits a certain number of biases because the patient group is homogenous (athletes, unsuccessful conservative treatment) with similar functional scores, and well-defined protocols for postoperative rehabilitation. However, the study of this entity is difficult because of the limited number of subjects and its different anatomopathological forms.ConclusionSurgical treatment is indicated in motivated athletes if carefully followed conservative treatment is unsuccessful after more than six months, making it impossible to practice a sport (Blazina grade 3). Arthroscopic techniques seem to be as effective as open surgery with an equivalent delay for beginning sports activities.Level of evidence: IV.
    Orthopaedics & Traumatology Surgery & Research 01/2009; · 1.06 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The presence of an extra-articular deformation along with osteoarthritis of the knee might question the indication for total knee prosthesis and an osteotomy during the same surgery. The causes of extra-articular deformations are varied: 1) They can be inherent: for example major varus seen in the sequela of childhood Blount disease, poly epiphyseal dysplasia, sequela of rickets or of Paget disease; 2) They are often post-traumatic: sequela of malunion having led to osteoarthritis of the knee; 3) They are sometimes iatrogenic, subsequent to a surgical treatment: this is particularly the case of hypercorrections after tibial or femoral osteotomy.
    Interactive Surgery 02/2008; 3(1):55-62.
  • [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE OF THE STUDY: We present a retrospective multicentric series of carefully selected patients presenting "isolated" laxity of the posterior cruciate ligament.MATERIAL AND METHODS: The series included 103 patients who were reviewed clinically (with a dedicated review chart) and radiographically with measurement of posterior laxity (Telos 15 kg).RESULTS: In these patients with an isolated injury of the PCL (without associated injury of the peripheral ligament) DISCUSSION: The short follow-up of this series (four years) does not enable an assessment of the risk or benefit of PCL ligamentoplasty for arthrosic knees.
    Revue de Chirurgie Orthopédique et Réparatrice de l Appareil Moteur 01/2006; 91(S8):43-54. · 0.37 Impact Factor
  • T. Cucurulo, J.-M. Fayard, P. Chambat
    Revue De Chirurgie Orthopedique Et Reparatrice De L Appareil Moteur - REV CHIR ORTHOP REPARAT APP. 01/2005; 91(8):66-66.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose of the studyWe present a retrospective multicentric series of carefully selected patients presenting « isolated » laxity of the posterior cruciate ligament.
    Revue De Chirurgie Orthopedique Et Reparatrice De L Appareil Moteur - REV CHIR ORTHOP REPARAT APP. 01/2005; 91(8):44-54.
  • Source
    T. Cucurulo, P. Gaudin, T. Bauer, P. Hardy
    Revue De Chirurgie Orthopedique Et Reparatrice De L Appareil Moteur - REV CHIR ORTHOP REPARAT APP. 01/2004; 90(2):185-185.
  • Revue de Chirurgie Orthopédique et Traumatologique. 95(8).
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction Les lésions partielles du ligament croisé antérieur (LCA) sont fréquentes. La préservation de ce tissu ligamentaire encore inséré en bonne position entre dans le cadre d’un concept de reconstruction anatomique, biomécanique et biologique du LCA. L’intérêt de cette conservation reste théorique. Notre hypothèse était qu’une reconstruction sélective du faisceau antéromédial (AM) est supérieure dans les lésions partielles du LCA à une reconstruction monofaisceau classique. Patients et méthodes Il s’agit d’une étude prospective randomisée multicentrique où 54 lésions partielles opérées du LCA ont eu soit une reconstruction sélective du faisceau AM (groupe 1, n = 29), soit une reconstruction monofaisceau anatomique standard (groupe 2, n = 25). Tous les patients ont été évalués cliniquement par les scores IKDC subjectifs et objectifs, Lysholm et KOOS avec un recul minimal de 12 mois. Une mesure instrumentée comparative de la laxité antérieure du genou a été réalisée en préopératoire et postopératoire par Rolimeter®. Une analyse statistique a été effectuée pour comparer les résultats pré- et postopératoire. Résultats Il n’y avait pas de différence entre les deux groupes pour les données préopératoires. Tous les patients ont été revus à six mois et un an. Le score IKDC subjectif était respectivement de 55,8 et 56,8 en préopératoire et de 86,2 et 85,7 à un an pour les groupes 1 et 2. Le score de Lysholm était respectivement de 69,9 et 71,1 en préopératoire et de 90,9 et 91,8 à un an pour les groupes 1 et 2. Il n’y avait pas de différence entre les deux groupes. La laxité différentielle préopératoire était respectivement de 5,0 mm (2–10) et 5,1 mm (2–12) au pour les groupes 1 et 2 (p = 0,73). En postopératoire à 12 mois, elle était de 1,2 mm (groupe 1) pour 1,9 mm (groupe 2) (p = 0,03). Discussion et conclusion Dans les lésions partielles du LCA, la reconstruction sélective du faisceau AM en conservant les résidus de faisceau postérolatéral (PL) donne à court terme, des résultats cliniques comparables à celle d’une reconstruction monofaisceau standard, avec un meilleur contrôle de la laxité antérieure. Une analyse à plus long terme est cependant nécessaire afin de comparer la progression de la laxité antérieure et rotatoire, et les modifications des résultats subjectifs dans le temps. Type d’étude Étude prospective-randomisée, niveau I.
    Revue de Chirurgie Orthopédique et Traumatologique 98(8):S402–S409.
  • [Show abstract] [Hide abstract]
    ABSTRACT: La strategia operatoria nelle deformità importanti del ginocchio dipende in primo luogo dalla loro analisi e dalla determinazione di queste tre componenti: l’usura, la lassità legamentosa e la deformità ossea. Un riequilibrio legamentoso mediante liberazione della concavità è necessario qualora esista uno squilibrio legamentoso o quando, dopo le sezioni ossee, si crei uno spazio trapezoidale, in particolare in caso di deformità extrarticolare. Se quest’ultima è importante, è necessario realizzare un’osteotomia o prima della protesi o nello stesso tempo operatorio. Questa osteotomia può essere femorale o tibiale in funzione della sede della deformità. In funzione del tipo di deformità, si può realizzare una varizzazione, una valgizzazione, una derotazione, una flessione o una deflessione. L’esistenza di una rigidità del ginocchio causa dei problemi tecnici per l’esposizione dell’articolazione. Per ottenerla possono essere necessari una plastica del quadricipite o un sollevamento della tuberosità tibiale. Possono essere praticate una semplice artrolisi o una liberazione del quadricipite per migliorare la flessione.
    EMC - Techniche Chirurgiche - Chirurgica Ortopedica. 7(1):1–11.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Introduction Au cours des dix dernières années, nos connaissances sur le ligament croisé antérieur (LCA) ont considérablement évolué. Ces connaissances ont entraîné une modification de nos techniques de reconstruction du LCA avec l’apparition de reconstruction sélective lorsque la rupture n’est pas complète. Notre hypothèse était qu’une reconstruction partielle du LCA avec préservations de fibres résiduelles permet de restaurer une bonne stabilité et une bonne fonction du genou, quelle que soit la greffe où la technique utilisée. Patients et méthodes Il s’agit d’une étude rétrospective multicentrique des résultats de 168 reconstructions partielles du faisceau AM du LCA avec préservation du faisceau PL. Tous les patients ont été évalués cliniquement par les scores International Knee Documentation Committee (IKDC) subjectifs et objectifs et par le score de Lysholm avec un recul moyen de 26 mois (12–59 mois). Une mesure instrumenté de la laxité du genou a été réalisée en préopératoire et postopératoire par arthromètre et/ou par mesure radiologique (Telos®). Une analyse statistique a été effectuée pour comparer les résultats pré- et postopératoire. Résultats Le score IKDC subjectif était de 63,7 en préopératoire et de 90,5 au dernier contrôle (p < 0,001). Le score de Lysholm était de 80 en préopératoire et de 95,5 en postopératoire (p < 0,001). En préopératoire, la majorité des patients étaient classés C au score IKDC objectif. Au dernier recul, 92 % des patients étaient classés A or B (p < 0,001). La laxité différentielle préopératoire était de 5,5 mm (extrêmes : 0–14 mm) pour 1,1 mm (extrêmes : 0–4 mm) au dernier recul (p < 0,00001). Discussion et conclusion Notre étude permet de confirmer qu’une reconstruction sélective du faisceau antéro-médial du LCA avec préservation de fibres postéro-latérales permet de restaurer une bonne stabilité et fonction du genou. Une attention toute particulière doit être portée sur la taille de la greffe utilisée pour éviter un excès de tissu dans l’échancrure. Niveau de preuve Étude rétrospective, niveau IV.
    Revue de Chirurgie Orthopédique et Traumatologique 98(8):S396–S401.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Le but de l’étude est d’évaluer les résultats la chirurgie et notamment l’apport des techniques arthroscopiques dans le traitement des tendinopathies rotuliennes, résistantes au traitement médical chez le sujet sportif. Une étude rétrospective multicentrique a été menée sur quatre centres. Il s’agissait de patients sportifs, résistant au traitement médical bien conduit, ayant bénéficié d’un traitement chirurgical. Soixante-quatre patients ont été inclus, dont dix avaient été opérés par une technique arthroscopique. Les patients ont été interrogés et examinés à un recul moyen de 22 mois (six à 116 mois). Au dernier recul, 87 % des patients avaient une amélioration du score de Blazina et 63 % avaient repris le sport au niveau initial. Il n’a pas été possible de mettre en évidence de facteurs de l’examen préopératoire ayant une influence sur le résultat final, ni de mettre en évidence la supériorité d’une technique chirurgicale par rapport à une autre (résection de la pointe de rotule, abord arthroscopique). Les résultats de cette série sont comparables à ceux de la littérature qui indiquent un taux de succès de plus de 80 % quelle que soit la technique employée. Cette étude a permis de limiter un certain nombre de biais en utilisant un groupe homogène de patients (sportifs, échec du traitement médical), des scores fonctionnels uniformes et des protocoles de rééducation définis. Cependant, l’étude de cette pathologie reste difficile, compte tenu du nombre de sujet limité et des différentes formes anatomopathologique existantes. Le traitement chirurgical est indiqué en cas d’échec du traitement médical bien conduit pendant plus de six mois, empêchant la pratique du sport (stade 3 de Blazina) chez un sportif motivé. Les techniques arthroscopiques semblent donner des résultats équivalents aux techniques à ciel ouvert en terme d’efficacité et de délai de reprise sportive. Niveau de preuve IV.
    Revue de Chirurgie Orthopédique et Traumatologique. 95(8).

Publication Stats

30 Citations
11.44 Total Impact Points

Top co-authors View all

Institutions

  • 2012
    • Université de Versailles Saint-Quentin
      Versailles, Île-de-France, France
  • 2011–2012
    • Centre Orthopedique Santy
      Lyons, Rhône-Alpes, France
  • 2009
    • L'Institut de Chirurgie Orthopedique et Sportive
      Lutetia Parisorum, Île-de-France, France