Philippe Neyret

University of Lyon, Lyons, Rhône-Alpes, France

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Publications (215)268.29 Total impact

  • International Orthopaedics 12/2014; · 2.32 Impact Factor
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    ABSTRACT: Closing-wedge high tibial osteotomy is a surgical option for patients with isolated medial compartment osteoarthritis and varus knee alignment. Vascular complications are rare, but incriminate the use of oscillating saw or osteotome. It is important to know the steps of this surgery that involve risk of vascular injury and what to do to decrease that risk. Performing the distal osteotomy cut using an oscillating saw is a step with high risk of vascular injury. A protective device behind the tibia may decrease this risk. In this descriptive angiographic cadaver study, closing-wedge high tibial osteotomy was performed on 6 cadaveric knees in 90° knee flexion, and the distance between the surgical instrument and the popliteal artery was measured on fluoroscopy with artery opacification at the various steps of surgery. Tibial osteotomy with oscillating saw involves high vascular risk: the mean distance between the saw-blade and the popliteal artery is 10.6mm in 90° knee flexion. Using a specific device placed behind the tibia protects the vascular structures. High tibial osteotomy is indicated in medial compartment osteoarthritis of the knee and can be performed by closing or opening-wedge. Vascular injuries in closing-wedge osteotomy exist and it is recommended to perform this surgery at 90° knee flexion, although some studies report that this does not move the artery out of the way. A risk of vascular lesion should be kept in mind. The oscillation of the saw and the direction of the osteotomy should also be taken into consideration when performing a closing-wedge high tibial osteotomy in order to protect the popliteal artery. Descriptive cadaver study. Level IV. Copyright © 2014 Elsevier Masson SAS. All rights reserved.
    Orthopaedics & traumatology, surgery & research : OTSR. 11/2014;
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    ABSTRACT: Varisation distal femoral osteotomy is a well-described treatment for lateral compartment arthrosis in the young, active patient. This treatment may potentially alter the length of the lower limb . The objective of this study was to quantify the change in leg length following lateral opening wedge distal femoral osteotomy using a blade plate.
    Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 10/2014;
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    ABSTRACT: Introduction En novembre 2011, la Knee Society publiait le nouveau score IKS, évaluant avant et après la prothèse totale de genou (PTG), les données cliniques objectives, mais aussi les attentes des patients, leur satisfaction, et la fonction du genou à travers des activités physiques variées. Nous avons entrepris son adaptation transculturelle en langue française selon les recommandations actuelles. Hypothèse Le nouveau score IKS adapté en français est un score cohérent, faisable, fiable et discriminant. Matériel et méthodes Une étude bicentrique a permis de recruter 80 patients présentant une arthrose de genou, répartis en un groupe de 40 patients avec indication de PTG et un groupe de 40 patients avec indication de traitement médical. Le nouveau score IKS, après une étape de traduction/contre-traduction, était comparé à trois autres scores validés : le KOOS, l’AMIQUAL et le SF-12 afin d’évaluer la validité de construit, la capacité discriminante, la faisabilité à travers le taux de réponse et l’existence d’un effet plancher ou plafond, la cohérence interne à l’aide du coefficient alpha de Cronbach, et la fiabilité à travers la reproductibilité et la sensibilité au changement. Résultats Deux cas ont été éliminés pour cause de données manquantes. On observait un score discriminant, un taux de réponse proche de 100 %, l’existence d’un effet plafond pour le domaine « attentes », un coefficient alpha de Cronbach satisfaisant, une reproductibilité excellente, et une bonne sensibilité au changement. Discussion Ces résultats confirment que le nouveau score IKS est fiable, faisable, discriminant, cohérent et sensible au changement. Son originalité tient aux domaines « attentes » et « satisfaction », à sa présentation sous forme de questionnaire auto-administré et à l’évaluation de la fonction dans le cadre d’activités diverses. Niveau de preuve Type d’étude : niveau III.
    Revue de Chirurgie Orthopédique et Traumatologique 09/2014; 100(5):387–391.
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    ABSTRACT: The literature results of unicompartmental knee arthroplasty (UKA) for isolated lateral osteoarthritis (OA) are not as good as for isolated medial OA. In 1988 our department started using a UKA with a fixed, all polyethylene tibial component and a resurfacing femoral component. The aim of this retrospective study is to report on the progression of medial OA and the long term results of this prosthesis implanted for isolated lateral OA, at a minimum follow up of ten years.
    The Knee 09/2014; 21 Suppl 1:S26-32. · 2.01 Impact Factor
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    ABSTRACT: Introduction In November 2011, the Knee Society published its new KSS score to evaluate objective clinical data and also patient expectations, satisfaction and knee function during various physical activities before and after total knee arthroplasty (TKA). We undertook the French cross-cultural adaptation of this scoring system according to current recommendations. Hypothesis The French version of the new KSS score is a consistent, feasible, reliable and discriminating score. Patients and methods Eighty patients with knee osteoarthritis were recruited from two centers: one group of 40 patients had a TKA indication, while the other group of 40 patients had an indication for conservative treatment. After the new KSS score was translated and back-translated, it was compared to three other validated instruments (KOOS, AMIQUAL and SF-12) to determine construct validity, discriminating power, feasibility in terms of response rate and existence of floor or ceiling effect, internal consistency with Chronbach's alpha and reliability based on reproducibility and sensitivity to change (responsiveness). Results Due to missing data, two cases were eliminated. We found that the score could discriminate between groups; it had a nearly 100% response rate, a ceiling effect in the “expectations” domain, satisfactory Chronbach's alpha, excellent reproducibility and good responsiveness. Discussion These results confirm that the French version of the new KSS score is reliable, feasible, discriminating, consistent and responsive. The novelty of this scoring system resides in the “expectations” and “satisfaction” domains, its availability as a self-assessment questionnaire and the evaluation of function during various activities. Level of proof, type of study Level III.
    Orthopaedics & Traumatology Surgery & Research 09/2014; · 1.06 Impact Factor
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    ABSTRACT: Medial structures repair is a well-established approach in the treatment for patellar instability. However, the literature is confusing concerning the indications for surgery, the different surgical techniques and outcomes. The goal of this systematic review was to clarify the indications for medial structures repair and to analyse the results of both arthroscopic and open techniques.
    Knee Surgery Sports Traumatology Arthroscopy 07/2014; · 2.68 Impact Factor
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    ABSTRACT: Static, one-dimensional testing cannot predict the behaviour of the anterior cruciate ligament (ACL)-deficient knee under realistic loading conditions. Currently, the most widely accepted method for assessing joint movement patterns is gait analysis. The purpose of the study was in vivo evaluation of the behaviour of the anterior cruciate ligament-deficient (ACLD) knees during walking, using 3D, real-time assessment tool.
    Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 07/2014;
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    ABSTRACT: Long-term survival in total knee arthroplasty (TKA) depends on multiple factors, including restoration of mechanical alignment and obtaining optimal ligament balance. The aim of this study was to document the results of single-stage TKA combined with high tibial osteotomy for managing femorotibial arthrosis with significant frontal-plane deformity.
    International Orthopaedics 06/2014; · 2.32 Impact Factor
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    ABSTRACT: Opening wedge high tibial osteotomy (HTO) is an accepted treatment option for medial compartment knee osteoarthritis with associated varus lower limb axis in younger, more active patients. A concern with the use of this technique is that posterior tibial slope (PTS) and tibial rotation can be altered. We hypothesized that there is a tendency to increase the PTS and internal rotation of the distal tibia during the procedure and that certain intra-operative parameters may influence the amount of change that can be expected.
    Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA. 06/2014;
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    ABSTRACT: Although kinematic changes in the sagittal plane of the osteoarthritic knee (OA) have been elucidated, very few studies have analysed changes in the frontal and horizontal planes. Therefore, the aim of this study was to investigate in vivo 3D knee kinematics during walking in patients wth knee OA. Thirty patients with medial knee OA and a control group of similarly aged individuals were prospectively collected for this study. All participants were assessed with KneeKG(TM) system while walking on a treadmill at a self-selected speed. In each trial, we calculated the angular displacment of flexion/extension, abduction/adduction and external/internal tibial rotation. Statistical analysis was performed to determine differences between the knee OA group and the control group. Patients with knee OA had reduced extension during the stance phase (p < 0.05; 8.5° and 4.4°, OA and control group, respectively) and reduced flexion during pushoff and initial swing phase (p < 0.05; 41.9° and 49.4°, respectively). Adduction angle was consistently greater for OA patients (p < 0.05; 3.4° and -0.9°, respectively). Frontal laxity for OA patients was positively correlated with varus deformity (r = 0.42, p < 0.05). There was a significant difference (p) < 0.05 in tibial rotation during the midstance phase; OA patients retained a neutral position (-0.4°), while the control group presented internal tibial rotation (-2.2°). Weight-bearing kinematics in medial OA knees differs from that of normal knees. The knee OA group showed an altered "screw-home" mechanism by decreased excursion in sagittal and axial tibial rotation and posterior tibial translation.
    International Orthopaedics 03/2014; · 2.32 Impact Factor
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    ABSTRACT: EDUCATIONAL OBJECTIVES As a result of reading this article, physicians should be able to: 1. Delineate the indications for high tibial osteotomy (HTO) and report on its functional results in relation to the conversion to total knee arthroplasty (TKA). 2. Outline the principles and anatomic implications of opening- and closing-wedge HTO. 3. Describe how to undertake soft tissue balance in the knees of patients who previously underwent HTO. 4. Analyze tibial malunions after HTO and their implications for further HTO and TKA. High tibial osteotomy may be indicated in the treatment of varus knee in young, active patients. The preservation of proprioception and native joint and biomechanics is crucial for functional recovery in these patients. However, deterioration of initial good results can occur with time. In such cases, revision with total knee arthroplasty is indicated. However, this is a more surgically demanding option compared with a primary prosthesis. Accurate preoperative planning is mandatory to decrease the risk of intraoperative complications. A precise surgical technique, which is crucial to improving functional outcomes, includes hardware removal, joint exposition, tibial deformities due to previous osteotomy, and managing soft tissue mismatches. Possible technical challenges and surgical solutions exist for each of these aspects. However, several studies report lower functional results compared with primary implants. Thus, patients should be informed before high tibial osteotomy about its failure rate, the difficult surgical aspects of an additional prosthesis, and less satisfactory clinical results. [Orthopedics. 2014; 37(3):191-198.].
    Orthopedics 03/2014; 37(3):191-8. · 1.05 Impact Factor
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    ABSTRACT: El genu recurvatum se define como la hiperextensión de la rodilla más allá de 180° o posición cero de referencia. En la mayoría de los casos es bilateral, simétrico, de origen constitucional y asintomático. Puede ser congénito o adquirido (óseo, ligamentoso o mixto) y, en este caso, asimétrico y posiblemente sintomático. Se presenta con diversas manifestaciones clínicas: dolor, inestabilidad femorotibial, inestabilidad femoropatelar, desigualdad de longitud de los miembros inferiores e incluso un perjuicio estético. La exploración física debe ser completa y, sobre todo, bilateral comparativa. La exploración radiológica permite medir el grado del recurvatum, tanto en el aspecto óseo intraarticular o extraarticular como en el aspecto ligamentoso. El recurvatum óseo es distinto al ligamentoso, pero pueden estar asociados. La búsqueda etiológica permite escoger el tratamiento adecuado. En el tratamiento quirúrgico predominan las técnicas de osteotomía de abertura tibial anterior, pero no son las únicas. De forma asociada o aislada también pueden efectuarse procedimientos ligamentosos o conservadores.
    EMC - Aparato Locomotor. 02/2014; 47(1):1–9.
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    ABSTRACT: Lateral extra-articular procedures were popular in the treatment of anterior cruciate ligament injury in the nineteen seventies and eighties, but fell from favor due to poor results, concerns regarding biomechanics, and concurrent advances in intra-articular reconstruction. Persistent problems with rotational control in modern reconstructive techniques have lead to a resurgence of interest in the concept of lateral reinforcement. In this article, we examine the history of lateral extra-articular procedures, the reasons for renewed interest in the technique, recent research that lends support to lateral procedures and possible indications for selective use.
    Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology. 01/2014; 1(1):3–10.
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    ABSTRACT: The purpose of this study was to analyse the results of total knee arthroplasty (TKA) in stiff knees (flexion ≤90° and/or flexion contracture ≥20°). Our hypothesis was that despite having poorer results than those obtained in a "standard" population and a high rate of complications, TKA was a satisfactory treatment in patients with osteoarthritis of the knee associated with significant stiffness. Three hundred and four consecutive primary HLS TKAs (Tornier), whose data were prospectively collected between October 1987 and October 2012, were retrospectively analysed at a mean of 60 months (range, 12-239) postoperatively. Two groups, those with a "flexion contracture" and those with a "flexion deficit", were assessed for postoperative range of motion (as integrated to the Knee Society score [KSS]), physical activity level and patient satisfaction. At the latest follow-up, range of motion was significantly improved, as was the KSS. Ninety-four percent of patients were satisfied or very satisfied, and activity levels were increased after surgery. The complication rate, however, was high in patients with a preoperative flexion deficit (17 %). Pain and residual stiffness were the most common complications. TKA provides satisfactory results in patients with knee osteoarthritis associated with significant pre-operative stiffness. The surgical plan should be adapted to anticipate complications, which are particularly frequent in the presence of a flexion deficit.
    International Orthopaedics 12/2013; · 2.32 Impact Factor
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    ABSTRACT: BACKGROUND:In recent years, significantly more attention has been focused on the role of the medial patellofemoral ligament (MPFL) in patellar stability, and MPFL reconstruction has become a mainstay of surgical treatment of episodic patellar dislocations. Although previously described in detail after reconstruction of the anterior cruciate ligament, tunnel enlargement has not been investigated after MPFL reconstruction. HYPOTHESES:(1) Femoral tunnel enlargement occurs after MPFL reconstruction. (2) Patella alta, trochlear dysplasia, and tunnel malposition are risk factors for tunnel enlargement. (3) The presence of tunnel enlargement is not associated with recurrent dislocations or poorer patient-reported outcome scores after MPFL reconstruction. STUDY DESIGN:Case-control study; Level of evidence, 3. METHODS:Fifty-five of 59 knees treated for episodic patellar dislocations with MPFL reconstruction between 2005 and 2010 were evaluated at 1 year postoperatively for the presence of tunnel enlargement on lateral radiographs. Tunnel enlargement was defined as a tunnel area greater than 2 times that of the original tunnel. Knees with tunnel enlargement at 1 year were compared with those without tunnel enlargement. Patients were assessed for recurrent subluxations or dislocations at a mean of 3 years postoperatively, and patient-reported outcome scores were assessed in a subset of patients at a mean of 3.7 years postoperatively. RESULTS:Tunnel enlargement was noted in 23 knees (41.8%). No differences in patient age or body mass index were noted between the 2 groups. The mean patellar height was significantly higher in the enlarged tunnel group (P = .03). A higher prevalence of trochlear dysplasia or tunnel malposition was not demonstrated in the enlarged tunnel group. Patient-reported outcome scores and the risk of recurrent patellar instability were equal in the 2 groups. CONCLUSION:Femoral tunnel enlargement after MPFL reconstruction is common, with patients with patella alta at an increased risk. The influence of tunnel malposition and trochlear dysplasia on this condition requires further research. Recurrent instability and patient-reported outcome scores are not affected by tunnel enlargement.
    The American journal of sports medicine 12/2013; · 3.61 Impact Factor
  • C. Trojani, P. Neyret
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    ABSTRACT: El objetivo de este artículo es resumir la anatomía, la biomecánica y la anatomía patológica traumática del aparato extensor de la rodilla. La técnica del tratamiento quirúrgico se describe en un artículo complementario. El aparato extensor de la rodilla consta de cinco elementos: el músculo cuádriceps (cuya inserción proximal se realiza en el fémur y la pelvis) el tendón cuadricipital, la rótula, el tendón o ligamento rotuliano y la tuberosidad tibial anterior. El aparato extensor de la rodilla participa en el mantenimiento del cuerpo en posición erecta y tiene una acción antigravitatoria. Los elementos musculares intervienen en la estabilización activa del aparato extensor de la rodilla. El cuádriceps mantienen la rótula en tensión, pero su acción tiende a causar la subluxación lateral de la rótula. Durante la flexión, la rótula se recentra automáticamente, a expensas de tensiones elevadas en compresión, que pueden ser de hasta siete veces el peso del cuerpo en flexión completa. La patología traumática consta de las lesiones traumáticas, del cuádriceps en sus porciones proximal, muscular y distal, las fracturas rotulianas las ruptura del tendón rotuliano y las fracturas de la tuberosidad tibial anterior.
    EMC - Aparato Locomotor. 12/2013; 46(4):1–12.
  • Revue de Chirurgie Orthopédique et Traumatologique 12/2013; 99(8):e8–e9.
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    ABSTRACT: Uni-compartmental knee replacement (UKR) is an attractive surgical option for the treatment of single compartment femoro-tibial osteoarthritis. While UKR for medial compartment arthritis is a well-established procedure with an excellent track record, UKR for lateral compartment arthritis has seen more limited success and remains a challenging operation, even in the hands of experienced arthroplasty surgeons. Despite this, several studies have now reported satisfactory mid- and long-term results with lateral UKR in appropriately selected patients. A better understanding of the aetiology and biomechanics of lateral compartment arthritis, as well as an appreciation for the technical challenges unique to lateral UKR, are likely to lead to improved outcomes with this procedure. The purpose of this level 4 study is to highlight the current concepts surrounding lateral UKR, to review the current body of literature, and to explore future directions for improving the results of lateral UKR.
    Knee Surgery Sports Traumatology Arthroscopy 07/2013; · 2.68 Impact Factor
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    ABSTRACT: Objective: The goals of this study are to address several questions, the answers to which are key to the understanding and eventually to the prevention of this frequent source of morbidity. These questions include the following: (1) What is the natural history of anterior cruciate ligament (ACL) deficiency? (2) How important is the status of the meniscus at the time of reconstruction? (3) Does ACL reconstruction prevent the development of osteoarthritis in the long term? (4) Can we predict which patients will develop osteoarthritis? (5) What can be done? Design: This study addresses the key questions above through the long-term follow-up of a cohort of patients treated with ACL reconstruction by Professor Henri Dejour in Lyon, France, supplemented with a review of the relevant literature. Results: The prevalence of osteoarthritis in ACL-deficient knees is about 40% after 15 years and close to 90% after 25 to 35 years. It remains unclear whether reconstruction of the ACL significantly reduces this risk. The status of the meniscus at the time of ACL reconstruction is a strong predictor of the risk of osteoarthritis: Patients who undergo total meniscectomy are at 2- to 10-fold increased risk of developing osteoarthritis relative to those with intact menisci. Patients showing early evidence of arthritis at short- to medium-term follow-up are at high risk for progression over subsequent years. Numerous emerging techniques may provide tools to more effectively prevent and treat osteoarthritis following ACL injury in the future. Conclusion: Osteoarthritis following ACL injury continues to be a major problem requiring further research.
    Cartilage 07/2013; 4(3 suppl):22S-26S.

Publication Stats

1k Citations
268.29 Total Impact Points


  • 2011–2014
    • University of Lyon
      Lyons, Rhône-Alpes, France
    • The Ohio State University
      • Sports Health and Performance Institute
      Columbus, Ohio, United States
    • Centre Hospitalier Universitaire de Nice
      Nice, Provence-Alpes-Côte d'Azur, France
  • 1999–2014
    • CHU de Lyon - Hôpital de la Croix-Rousse
      Lyons, Rhône-Alpes, France
  • 2013
    • University of Geneva
      • Division of Orthopaedic and Trauma Surgery
      Genève, Geneva, Switzerland
  • 2004–2013
    • Centre Hospitalier Universitaire de Lyon
      Lyons, Rhône-Alpes, France
    • Clinique des Cèdres
      Cornebarrien, Midi-Pyrénées, France
  • 2012
    • HCL
      Noida, Uttar Pradesh, India
  • 2011–2012
    • CHU de Lyon - Groupement Hospitalier Edouard Herriot
      Lyons, Rhône-Alpes, France
  • 2008–2012
    • University of Campinas
      Conceição de Campinas, São Paulo, Brazil
    • Centre Hospitalier Universitaire de Brest
      • Services de chirurgie orthopédique et de traumatologie
      Brest, Brittany, France
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
  • 2007–2011
    • Hospices Civils de Lyon
      Lyons, Rhône-Alpes, France
  • 2010
    • Centre Hospitalier Universitaire de Toulouse
      Tolosa de Llenguadoc, Midi-Pyrénées, France
    • Università degli Studi del Molise
      • Department of Health Sciences (S.Pe.S.)
      Campobasso, Molise, Italy
    • CHU de Lyon - Hôpital Gériatrique Antoine Charial 
      Lyons, Rhône-Alpes, France
    • CHU de Lyon - Centre Hospitalier Lyon Sud
      Lyons, Rhône-Alpes, France
    • University of Angers
      Angers, Pays de la Loire, France
  • 2009
    • Centre Hospitalier de Versailles
      Versailles, Île-de-France, France
  • 2005
    • Celal Bayar Üniversitesi
      • Department of Orthopaedics and Traumatology
      Saruhan, Manisa, Turkey
    • Centre Hospitalier Régional et Universitaire de Besançon
      Becoinson, Franche-Comté, France
  • 1988–1994
    • Centre Hospitalier Lyon Sud
      Lyons, Rhône-Alpes, France