Publications (13)34.3 Total impact
-
Dataset: art%3A10.1007%2Fs00264-012-1759-3
-
Article: The evolution of ACL reconstruction over the last fifty years.
[show abstract] [hide abstract]
ABSTRACT: Anterior cruciate ligament (ACL) reconstruction has evolved considerably over the past 30 years. This has largely been due to a better understanding of ACL anatomy and in particular a precise description of the femoral and tibial insertions of its two bundles. In the 1980s, the gold standard was anteromedial bundle reconstruction using the middle third of the patellar ligament. Insufficient control of rotational laxity led to the development of double bundle ACL reconstruction. This concept, combined with a growing interest in preservation of the ACL remnant, led in turn to selective reconstruction in partial tears, and more recently to biological reconstruction with ACL remnant conservation. Current ACL reconstruction techniques are not uniform, depending on precise analysis of the type of lesion and the aspect of the ACL remnant in the intercondylar notch.International Orthopaedics 01/2013; · 2.03 Impact Factor -
Article: Prevalence of septic arthritis after anterior cruciate ligament reconstruction among professional athletes.
[show abstract] [hide abstract]
ABSTRACT: Septic arthritis of the knee after anterior cruciate ligament (ACL) reconstruction is a rare complication. Its prevalence and characteristics have never been reported among professional athletes. To report the prevalence and the characteristics of septic arthritis after ACL reconstruction in professional athletes and a general population of patients. Case control study; Level of evidence, 3. A retrospective analysis of a consecutive series of 1957 patients who underwent an ACL reconstruction between 2003 and 2008 was performed; 88 patients were professional athletes. The patient demographics, the prevalence of infection, the involved organism, and the method of treatment were reviewed. Three potential risk factors for infection-level of sporting participation, indoor/outdoor sports, and the presence or not of a combined lateral tenodesis-were assessed using univariate and multivariate logistic regression analysis. The prevalence of septic arthritis was 0.37% in the nonprofessional group and 5.7% in the professional athlete population. Being a professional athlete (odds ratio [OR], 16.0; 95% confidence interval [CI], 3.9-59.8; P = .0001) or having a combined lateral tenodesis (OR, 4.8; 95% CI, 1.04-18.04; P = .02) was found to be significantly correlated with septic arthritis after ACL reconstruction. A significant correlation exists between being a professional athlete and having a combined lateral tenodesis (χ(2) = 16.7; P = 4 × 10(-5)), suggesting a potential confounding role is played by one of these variables. All the cases of infection in the professional athletes occurred in those who participated in outdoor sports, although this was not found to be statistically significant (P = .17). Participation in professional sports and having a combined lateral tenodesis are risk factors for the development of infection after ACL reconstruction. We hypothesize that professional athletes may be part of a specific group of patients at higher risk of infection after ACL reconstruction.The American journal of sports medicine 08/2011; 39(11):2371-6. · 3.61 Impact Factor -
Article: Activity level recovery after arthroscopic PCL reconstruction: a series of 21 patients with a mean follow-up of 29 months.
[show abstract] [hide abstract]
ABSTRACT: Surgical treatment of PCL tears is often indicated after conservative management failure and it is known to be challenging with unpredictable outcomes. This study aims to describe and to evaluate the outcome of an arthroscopic PCL anterolateral bundle reconstruction using a quadriceps tendon autograft. Our hypothesis is that knee stability and function can be restored using this technique allowing patients to resume their pre-injury level of activity. Between 2005 and 2008, 21 consecutive patients underwent an isolated PCL reconstruction and were evaluated after a mean follow-up of 29 months (range 12-48). The mean time from injury to surgery was 28 months. All patients were assessed pre- and post-operatively using IKDC evaluation, Tegner and Lysholm scores. The differential laxity was measured radiologically using the Telos® stress device. Pre-operatively, no patients were classified A or B on the IKDC objective score. At last follow-up, 81% of patients were classified A or B. The average differential anteroposterior laxity was 11.2 mm (range 8-15) in the preoperative evaluation and 3.6 mm (range 0-7) at the final follow-up (p=0.01). The mean subjective IKDC score was 39.5 before surgery and 74.5 at the last follow-up (p<0.01). The Tegner and Lysholm scores were significantly improved (p<0.001). 81% of patients were able to resume the same pre-injury level of activity. Patients with high level activity before injury were found to have the best subjective outcomes. Satisfactory laxity control and clinical outcomes were obtained in this series allowing patients to resume their pre-injury activities and sports.The Knee 12/2010; 18(6):392-5. · 1.74 Impact Factor -
Article: Preoperative factors correlating with prolonged range of motion deficit after anterior cruciate ligament reconstruction.
[show abstract] [hide abstract]
ABSTRACT: Impaired postoperative range of motion remains one of the most frequent complications after anterior cruciate ligament reconstruction. This study was undertaken to determine the preoperative factors associated with prolonged range of motion deficit after anterior cruciate ligament reconstruction. Cohort study; Level of evidence, 3. Between January 2007 and March 2008, a consecutive series of 217 patients underwent anterior cruciate ligament reconstruction and were reviewed at 6 weeks and 3 months after surgery. In this series, all data of patients who required a further surgery for arthrolysis until December 2009 were studied. Goniometric range of motion measurement was performed the day before surgery and at 6 weeks and 3 months postoperatively. Bone contusions were analyzed on preoperative magnetic resonance imaging (MRI). All MRI scans were performed in the 6 months before surgery. Seven potential risk factors-age, sex, limited preoperative range of motion, meniscal lesions, bone contusion(s), operative delay less than 45 days, and rehabilitation-were assessed using univariate analysis. The correlations between the significant factors previously identified were analyzed further using multivariate logistic regression analysis. Limited preoperative range of motion (P < .001), typical bone contusions of the lateral compartment (P < .001), operative delay less than 45 days (P = .003), and female sex (P = .049) were found to be significantly correlated with delayed recovery. The limited preoperative mobility and the presence of typical contusions were strongly correlated (P < .001). In the group of patients who underwent surgery within 45 days, delayed recovery was strongly correlated with limited preoperative mobility (P = .0008) and to the presence of typical contusions (P < .001). Arthrolysis was correlated with delayed range of motion (odds ratio [OR], 8.2; 95% confidence interval [CI], 1.9-50; P =.001) and bone bruise (OR, 7.6; 95% CI, 1.7-46.1; P = .002). Preoperative limited range of motion and typical bone bruises of the lateral femoral condyle and tibial plateau are major risk factors for a difficult rehabilitation after anterior cruciate ligament reconstruction.The American journal of sports medicine 10/2010; 38(10):2034-9. · 3.61 Impact Factor -
Article: Clinical and operative characteristics of cyclops syndrome after double-bundle anterior cruciate ligament reconstruction.
[show abstract] [hide abstract]
ABSTRACT: The purpose of this study was to investigate the clinical and operative characteristics of cyclops lesion in a consecutive series of patients with anterior cruciate ligament (ACL) double-bundle reconstruction. Included were 387 patients who underwent an ACL double-bundle reconstruction with quadriceps or hamstring tendons and were followed up at 6 weeks and 3, 6, and 12 months for clinical examination. When a persistent extension deficit was observed 3 months postoperatively, magnetic resonance imaging was performed to eventually diagnose a cyclops syndrome, and arthroscopic removal of the nodule was performed in these cases. The aspect of the nodule was explored before debridement. These patients were reviewed at a mean follow-up of 12 months (minimum, 6 months; maximum, 20 months) after nodule debridement for evaluation. There were 14 patients who had cyclops syndrome (3.61%); 10 cases (5.37%) occurred in the quadriceps tendon group and 4 cases (1.99%) in the hamstring tendon group. In the postoperative period these patients had a mean loss of extension of 6° (range, 5° to 15°), and 78.6% had pain and/or swelling. At the 6-week follow-up, 78.6% of the 14 patients had a significant quadriceps dysfunction associated with an active extension deficit. During arthroscopic debridement, the cyclops lesion was always located on the roof of the intercondylar notch. At the last follow-up, 12 patients had full range of motion, but an extension loss was still present in 2 patients. On the International Knee Documentation Committee objective evaluation, 78.5% of patients were graded A, 14.3% were graded B, and 7.2% were graded C. Cyclops syndrome after double-bundle ACL reconstruction was more frequently observed with quadriceps tendon graft than with hamstring graft. Its unique characteristic is that the nodule localization is from the roof of the intercondylar notch. The majority of the patients with cyclops syndrome presented with a significant quadriceps dysfunction and an active extension deficit in the immediate postoperative period. Level IV, therapeutic case series.Arthroscopy The Journal of Arthroscopic and Related Surgery 09/2010; 26(11):1483-8. · 3.02 Impact Factor -
Article: Author's Reply
Arthroscopy The Journal of Arthroscopic and Related Surgery 11/2009; 25(11):1204. · 3.02 Impact Factor -
Article: Arthroscopic identification of isolated tear of the posterolateral bundle of the anterior cruciate ligament.
[show abstract] [hide abstract]
ABSTRACT: The goal of this study was to arthroscopically identify and assess the progressive changes in isolated ruptures of the posterolateral bundle of the anterior cruciate ligament (ACL) over time. This prospective study investigated 174 patients for isolated posterolateral bundle tears during arthroscopic ACL reconstruction. The preoperative side-to-side anterior laxity was measured in all patients. The torn ACLs were inspected and analyzed arthroscopically to determine the tear pattern. Complete ACL tears were identified in 78.7% of patients and partial ACL tears in 21.3%. Isolated anteromedial bundle tears were identified in 22 patients and posterolateral bundle tears in 15 patients. Statistical analysis showed a significant difference in preoperative differential knee laxity between the group with complete ACL rupture and the group with partial ACL rupture. On arthroscopic evaluation, the posterolateral bundle had retracted distally toward the tibial surface over time. The amount of retraction was correlated to the time period from injury to reconstruction. In this study the exact diagnosis of an ACL partial tear was made at arthroscopy in all cases. Our observations confirm the evolution of the ruptured posterolateral bundle, which shows a retraction toward the tibia over time. Level II, development of diagnostic criteria based on consecutive patients with a universally applied gold standard.Arthroscopy The Journal of Arthroscopic and Related Surgery 08/2009; 25(7):728-32. · 3.02 Impact Factor -
Article: Arthroscopic identification of the anterior cruciate ligament posterolateral bundle: the figure-of-four position.
[show abstract] [hide abstract]
ABSTRACT: Anatomic double-bundle reconstruction in anterior cruciate ligament (ACL) tears has been developed during the last few years. Although anteromedial (AM) bundle reconstruction is routinely performed, finding the femoral attachment of the posterolateral (PL) bundle remains a problem. We describe how a classic arthroscopic position, the figure-of-4 position, allows the PL bundle to be easily recognized. During flexion, the femoral attachment of the PL bundle describes an arc around the AM femoral attachment. The femoral attachment of the AM bundle is the center of rotation of the ACL, which explains the isometric behavior of this bundle. After 45 degrees of flexion, the PL femoral attachment becomes anterior to the AM femoral attachment. The AM bundle is tight during flexion, whereas the PL bundle is under tension when the knee is extended and becomes lax with knee flexion. At 90 degrees of flexion, the PL bundle is difficult to identify because it is lax; only its femoral insertion lies anterior to the AM bundle close to the articular cartilage of the lateral condyle. The use of an additional tibial varus torque and internal rotation (i.e., the figure-of-4 position) tightens the PL bundle and enhances the visualization of its insertion, allowing for easy identification of this bundle.Arthroscopy The Journal of Arthroscopic and Related Surgery 11/2007; 23(10):1128.e1-3. · 3.02 Impact Factor -
Article: The incidence of anterior cruciate ligament injuries among competitive Alpine skiers: a 25-year investigation.
[show abstract] [hide abstract]
ABSTRACT: Little is known about the evolution of anterior cruciate ligament injury rates among elite alpine skiers. To evaluate epidemiologic aspects of anterior cruciate ligament injuries among competitive alpine skiers during the last 25 years. Descriptive epidemiology study. Data were collected from elite French national teams (379 athletes: 188 women and 191 men) from 1980 to 2005. Fifty-three of the female skiers (28.2%) and 52 of the male skiers (27.2%) sustained at least 1 anterior cruciate ligament injury. The overall anterior cruciate ligament injury incidence was 8.5 per 100 skier-seasons. The primary anterior cruciate ligament injury rate was 5.7 per 100 skier-seasons. The prevalence of reinjury (same knee) was 19%. The prevalence of a bilateral injury (injury of the other knee) was 30.5%. At least 1 additional anterior cruciate ligament surgery (mean, 2.4 procedures) was required for 39% of the injured athletes. Men and women were similar with regard to primary anterior cruciate ligament injury rate (P = .21), career remaining after the injury (P = .44), and skiing specialty (P = .5). There were more anterior cruciate ligament injuries (primary, bilateral, re-injuries) among athletes ranking in the world Top 30 (P < .001). Anterior cruciate ligament-injured athletes had a career length of 7.5 years, whereas athletes with no anterior cruciate ligament injury had a career of 4.5 years (P < .001). Finally, injury rates remained constant over time. Anterior cruciate ligament injury rates (primary injury, bilateral injury, reinjury) among national competitive alpine skiers are high and have not declined in the last 25 years. Finding a way to prevent anterior cruciate ligament injury in this population is a very important goal.The American Journal of Sports Medicine 08/2007; 35(7):1070-4. · 3.79 Impact Factor -
Article: Pretibial ganglion-like cyst formation after anterior cruciate ligament reconstruction: a consequence of the incomplete bony integration of the graft?
[show abstract] [hide abstract]
ABSTRACT: We report a case of subcutaneous pretibial ganglion, with direct communication to the tibial tunnel after an autologous reconstruction of the anterior cruciate ligament with hamstring tendons. The tibial graft fixation was with a 9 mm poly-L-lactide interference screw 5 years earlier. The screw had undergone complete resorption at the time the cyst occurred. No joint inflammatory reaction or graft insufficiency was detected. The patient underwent cyst excision and curettage of the tibial tunnel with full recovery. This complication seems to be the consequence of a direct communication between the joint and the pretibial subcutaneous tissue through a fibrous tibial tunnel and would have occurred, as there is no full osteointegration of the graft due to the resorption of the bioabsorbable interference screw.Knee Surgery Sports Traumatology Arthroscopy 06/2007; 15(5):522-4. · 2.21 Impact Factor -
Article: Anatomic double bundle: a new concept in anterior cruciate ligament reconstruction using the quadriceps tendon.
[show abstract] [hide abstract]
ABSTRACT: Surgical procedures for double-bundle anterior cruciate ligament reconstruction, which currently use hamstring graft, have been described, but some concerns remain regarding graft fixation and the ability to obtain adequate bundle size. We report an original double-bundle anterior cruciate ligament reconstruction technique using a quadriceps tendon graft and a simplified outside-in femoral tunnel-drilling process. The graft consists of a patellar bone block with its attached tendon split into superior and inferior portions, which yields 2 bundles. The anteromedial tunnel is drilled from the outside through a small lateral incision by use of a guide. The posterolateral tunnel is made through the same incision with a specific guide engaged in the anteromedial tunnel. A single tibial tunnel is created. The graft is routed from the tibia to the femur with the bone block in the tibial tunnel and the 2 bundles in their respective femoral tunnels. After fixation of the bone block in the tibia, the 2 bundles are tensioned and secured separately in their femoral tunnels.Arthroscopy The Journal of Arthroscopic and Related Surgery 12/2006; 22(11):1249.e1-4. · 3.02 Impact Factor -
Article: Anatomic anterior cruciate ligament reconstruction: the two-incision technique.
[show abstract] [hide abstract]
ABSTRACT: This article describes the anatomical two-incision reconstruction of anterior cruciate ligament (ACL) of knee. The major part of currently single incision tibial endoscopic techniques attempts to reproduce the most isometric anteromedial bundle of ACL. Often a relatively vertical femoral tunnel, respect to the notch, is drilled, which is not really efficacious in providing rotatory stability. The single incision technique was developed to obviate the necessity of the lateral femoral incision and dissection. This technical note describes a two-incision ACL reconstruction using an instrumentation, which avoids a large lateral femoral soft tissue dissection, and discusses the rational use of the two-incision ACL reconstruction technique.Knee Surgery Sports Traumatology Arthroscopy 07/2006; 14(6):510-6. · 2.21 Impact Factor
