François Genêt

• MD, PhD
• Medical Doctor at Assistance Publique – Hôpitaux de Paris

Purpose Total knee arthroplasty (TKA) in patients with sequelae of poliomyelitis is a surgical challenge due to muscle weakness, bone deformities or post-polio syndrome (PPS). Few data exist to determine the factors contributing to poor functional results. This study aimed: (1) to describe a cohort of patients with poliomyelitis sequelae who underw...

Article A glucocorticoid spike derails muscle repair to heterotopic ossification after spinal cord injury Graphical abstract Highlights d Severe SCI causes a spike in blood corticosterone in mice d Treatment with GC triggers heterotopic ossifications in injured muscles in mice d Post-natal deletion of the GR gene in mice prevents NHO development af...

Neurogenic heterotopic ossifications (NHOs) are ectopic bones developing in periarticular muscles after severe central nervous system injuries such as spinal cord injuries (SCI) and traumatic brain injuries (TBI). The pathogenesis of NHO is still poorly understood, and the only effective therapy remains surgical resection. Using our unique mouse mo...

Purpose: The 6-item Foot Posture Index (FPI-6) is a reliable tool for the evaluation of foot deformities. Our aim was to translate and cross-culturally validate the FPI-6 for use in French-speaking countries and to determine the intra-rater and inter-rater reliability of the French version. Methods: Cross-cultural adaptation was performed accord...

Purpose: Orthotic devices may be prescribed for the management of foot and ankle deformities caused by Charcot-Marie-Tooth disease (CMT). However, the actual use of these devices is variable. No studies have evaluated the impact of prescription, delivery and follow-up of orthotic devices on their use.We aimed to describe the relationship between t...

The cells of origin of neurogenic heterotopic ossifications (NHOs), which develop frequently in the periarticular muscles following spinal cord injuries (SCIs) and traumatic brain injuries, remain unclear because skeletal muscle harbors two progenitor cell populations: satellite cells (SCs), which are myogenic, and fibroadipogenic progenitors (FAPs...

Background Satisfaction with hallux valgus repair is often poor, despite good surgical outcomes. Many tools have been developed to assess the outcome of the procedure; however none evaluate the association between the initial motive for repair and the reasons for post-surgical dissatisfaction. The aim of this study was to develop a new tool to anal...

Objective : To evaluate the accuracy of 4 equations validated for the general population to determine resting energy expenditure (RRE) in polio survivors. Design A descriptive, ambispective, single centre, observational cohort study of minimal risk care. Setting Tertiary university care hospital Participants DATAPOL database of Polio survivors f...

Objective : This study intended to establish international recommendations for the management of spastic equinovarus foot deformity. Design Delphi method Setting International study Participants 24 international experts in neuro-orthopedic deformities, from different specialties (Physical and Rehabilitation Medicine physicians, neurologists, ger...

Foot drop is a common disability in post-stroke patients and represents a challenge for the clinician. To date, Ankle Foot Orthosis (AFO) combined with conventional rehabilitation is the gold standard of rehabilitation management. AFO has a palliative mechanical action without actively restoring the associated neural function. Functional Electrical...

Neurogenic heterotopic ossifications (NHOs) are incapacitating complications of traumatic brain and spinal cord injuries (SCI) that manifest as abnormal bone formation in periarticular muscles. Using a unique model of NHO after SCI in genetically unmodified mice, we have previously established that the innate immune system plays a key driving role...

Neurogenic heterotopic ossifications (NHOs) form in periarticular muscles following severe spinal cord (SCI) and traumatic brain injuries. The pathogenesis of NHO is poorly understood with no effective preventive treatment. The only curative treatment remains surgical resection of pathological NHOs. In a mouse model of SCI‐induced NHO that involves...

The cells-of-origin of neurogenic heterotopic ossifications (NHO), which develop frequently in the periarticular muscles following spinal cord injuries (SCI) and traumatic brain injuries, remain unclear because the skeletal muscle harbors two progenitor cell populations: satellite cells (SCs) which are myogenic, and fibro-adipogenic progenitors (FA...

Neurogenic heterotopic ossifications (NHOs) form in periarticular muscles following severe spinal cord (SCI) and traumatic brain injuries. The pathogenesis of NHO is poorly understood with no effective preventive treatment. The only curative treatment remains surgical resection of pathological NHOs. In a mouse model of SCI-induced NHO that involves...

The clinical assessment of a hypertonic upper limb in central neurological diseases should be analytical, systematic (shoulder, elbow, extrinsic and intrinsic hand) and focused on the patient or caregiver’s wishes and on the expected objectives (esthetic, hygienic, functional). Nerve blocks can help to separate mixed contractures, show the existenc...

Neuro-immune dysfunction is thought to promote the development of several acute and chronic complications in spinal cord injury (SCI) patients. Putative roles for adrenal stress hormones and catecholamines are increasingly being recognized, yet how these adversely affect peripheral tissue homeostasis and repair under SCI conditions remains elusive....

Hematopoiesis and bone interact in various developmental and pathological processes. Neurogenic heterotopic ossifications (NHO) are the formation of ectopic hematopoietic bones in peri-articular muscles that develop following severe lesions of the central nervous system such as traumatic cerebral or spinal injuries or strokes. This review will focu...

Like Stoira et al., we have experienced a high prevalence of troublesome HO in severe COVID patients. We would like to respond to the letter « High prevalence of heterotopic ossification in critically ill patients with severe COVID-19 » to give the point of view of an experienced medicosurgical team in charge of neurogenic Heterotopic Ossification...

Background: Heterotopic ossification (HO) is defined as the formation of endochondral bone within soft tissue. Non-genetic forms, mainly corresponding to a consequence of bone, brain or spinal cord injury, are the most common. HO leads to important functional limitations and alteration of quality of life. To our knowledge, the time between brain,...

Neurogenic heterotopic ossifications (NHO) are incapacitating heterotopic bones in periarticular muscles that frequently develop following traumatic brain or spinal cord injuries (SCI). Using our unique model of SCI-induced NHO, we have previously established that mononucleated phagocytes infiltrating injured muscles are required to trigger NHO via...

Objective: To evaluate recurrence and early postoperative complications (sepsis) following surgical excision combined with radiotherapy for troublesome hip heterotopic ossification in patients with spinal cord injury and traumatic brain injury. Design: Retrospective case-control study. Setting: Data relating to patients with spinal cord injury...

Late effects of poliomyelitis (LEoP) are characterized by new gait abnormalities that occur many years after the initial poliomyelitis illness. Currently, there is no consensus on the most appropriate evaluation to detect gait disorders following LEoP. This study aimed to assess and compare the effectivenes of the gait profile score with that of th...

Background: Sleep disturbances, especially sleep disordered breathing and sleep movement disorders, seem to be highly prevalent among aging polio survivors. They could contribute to late functional deterioration, fatigue, poor quality of life and negative health outcomes, thereby increasing cardiovascular risk. Objectives: This review focused on...

Neurological heterotopic ossifications (NHO) are frequent complications of traumatic brain and spinal cord injuries (SCI). NHO are abnormal ossifications within periarticular muscles resulting in joint ankylosis, vessel and nerve compression. To elucidate NHO pathogenesis, we have developed the first murine model of SCI-NHO, in which NHO is induced...

Traumatic neurological lesions may lead to development of heterotopic ossification. These cases are classified as ‘neurogenic heterotopic ossifications’ (NHOs). The associated neurological lesions can be caused by cranial trauma or spinal cord injury and may sometimes include a local trauma. NHOs that form around the hip joints are of particular in...

Introduction: Motor nerve blocks with anesthetic drug for local anesthesia are commonly used in physical and rehabilitation medicine (PRM), especially in the field of spasticity. Guidelines in this context are currently lacking. Method: Eighteen experts selected on the basis of their recognized experience by the scientific committees of the Fren...

Background: Stroke is a common and debilitating neurological disorder having a negative impact on quality of life. Objectives: We aimed to compare differences in participation in work and leisure activities between patients with and without a self-reported stroke at the national level in France. Methods: This study used cross-sectional data fr...

Neurogenic heterotopic ossifications (NHO) are very incapacitating complications of traumatic brain and spinal cord injuries (SCI) which manifest as abnormal formation of bone tissue in periarticular muscles. NHO are debilitating as they cause pain, partial or total joint ankylosis and vascular and nerve compression. NHO pathogenesis is unknown and...

Objectif Les troubles respiratoires du sommeil (TRS) sont fréquents chez les patients avec séquelles de poliomyélite. Cependant, aucun facteur prédictif spécifique n’a pu être identifié. Ce travail a deux objectifs : – résumer les connaissances sur le lien entre poliomyélite et TRS ; – identifier des facteurs prédictifs spécifiques de survenue d’ap...

Since ancient times, the aim of orthopedic surgery has been to correct limb and joint deformities, including those resulting from central nervous system lesions. Recent developments in the treatment of spasticity have led to changes in concepts and management strategies. The increase in life expectancy has increased the functional needs of patients...

Introduction/Background To ascertain a role for muscle spasticity in the development of NHO, by blocking neuromuscular signalling using botulinum toxin during spinal cord injury-induced NHO formation in a murine model. Material and method Spinal Cord Injury (SCI) was performed on 5–6-week-old C57BL/6 mice. To promote NHO development, cardiotoxin (...

Introduction/Background Raymond-Poincaré hospital is a national rehabilitation center for disabled patients with orthopedic issues. Physical medicine and rehabilitator physicians and orthopedic surgeons have developed interdisciplinary neuro-orthopedic approach for treatment of patients, with over 30 years of experience. The framework of diagnosis...

Introduction/Background Neurogenic heterotopic ossification (NHO) of the hip is secondary to neurologic lesions such as cranial trauma, stroke, medullary injury or cerebral anoxia. Our practice of heterotopic ossification surgery has progressed during our experience, becoming better adapted to the pathology and to the patients, who are often fragil...

Introduction/Background Heterotopic ossification (HO) is a frequent complication after damage to the central nervous system (CNS), with an estimated prevalence of up to 76%. The primary site of HO is the hip joint (60,9%). The only effective treatment of troublesome HO is surgery. The main purpose of this study was to identify the relationship betw...

Introduction/Background We previously reported the development of a new acquired neurogenic HO (NHO) mouse model, combining spinal cord transection (SCI) and chemical muscle injury. Pathological mechanisms responsible for ectopic osteogenesis after central neurological damage are still to be elucidated. In this study, we first hypothesized that per...

Introduction/Background Poliomyelitis is still a problem because the eradication is not obtained and the population is more important than spinal cord injury population. The reduction of activity, the lean mass transformed into fat mass and the decreased in BMR are the significant risk factors that predisposes them to become overweight. Can we use...

Introduction/Background Estimates of sleep disorder breathing (SDB) prevalence are higher in patients with polio sequelae than in general population, ranging from 50% to 65%. No specific predictive factors have been described in our knowledge. The aim of this study was to identify SDB predictive factors among polio survivors. Material and method A...

Heterotopic ossification.: Heterotopic ossification (HO) is the ectopic formation of bone tissue in the soft tissues surrounding the joints. They are congenital or acquired after a trauma, severe central nervous system injuries, etc. HO is extremely debilitating in everyday life and also delays rehabilitation. The pathological mechanisms leading to...

We read with great interest the recent article in the Journal of Bone and Mineral Research by Convente and colleagues "Depletion of mast cells and macrophage impairs heterotopic ossification in an Acvr1R206H mouse model of fibrodysplasia ossificans progressiva".⁽¹⁾ This paper reports that muscle injury caused by intramuscular injection of cardiotox...

Background Knee flexion contractures occur frequently in non-ambulatory, aged persons and persons with central nervous system lesions, rendering positioning and nursing care difficult. There are often risks associated with surgical interventions. Objective To evaluate the effectiveness of percutaneous needle tenotomy to lengthen the knee flexor mu...

All the data for the article can be found in: Data file.docx. (DOCX)

Neurogenic heterotopic ossification (NHO) is the formation of ectopic bone generally in muscles surrounding joints following spinal cord or brain injury. We investigated the mechanisms of NHO formation in 64 patients and a mouse model of spinal cord injury-induced NHO. We show that marrow from human NHOs contains hematopoietic stem cell (HSC) niche...

Introduction L’objectif de cette étude cas témoins était d’évaluer l’effet de la radiothérapie en périopératoire d’une exérèse chirurgicale de para-ostéoarthropathie neurogène (POAN) gênante de hanche sur les complications postopératoires (récidive et sepsis) chez le patient neurologique central. Matériel et méthodes Les patients blessés médullair...

Neurogenic heterotopic ossification of the hip is secondary to neurologic lesions such as cranial trauma, stroke, medullary injury or cerebral anoxia. We shall not deal here with the other etiologies of heterotopic ossification. There are numerous locations within the hip, depending on etiology, and relations with adjacent neurovascular structures...

Objective: To measure the prevalence of traumatic brain injury-related disability and health status in the general population. Design: The French National Survey, conducted in households and institutions, assessed 33,896 adults. Data included sequelae from traumatic brain injury, impairments, current health conditions and uses of health services...

Objective In intensive care unit (ICU), the frequent association of organ failure, neurological, orthopedic lesions and undernutrition promotes the development of neuro-orthopedic disorders (NOD). They can affect the acute phase management and the functional prognosis of patients. Caregivers (nurses and nursing auxiliaries) have a sentinel role in...

Objective Soft tissue surgery for upper extremity contractures is uncommon or under evaluated, however can improve hygiene, pain and appearance in adults with central nervous system lesions. The goal of such interventions is highly individual, thus goal attainment scaling (GAS) is pertinent to evaluate outcome. The objective of this study was to as...

We previously reported the development of a new acquired neurogenic HO (NHO) mouse model, combining spinal cord transection (SCI) and chemical muscle injury. Pathological mechanisms responsible for ectopic osteogenesis after central neurological damage are still to be elucidated. In this study, we first hypothesized that peripheral nervous system (...

Gene expression ratio in real time QPCR and statistical analysis. (PDF)

Micro-CT measurements of bone volumes and statistical analysis. (PDF)

Objectives Life after severe burns is conditioned by the remaining sequelae. The pathophysiology and risk factors of Heterotopic Ossification (HO) after burns are still poorly understood. The aim of this study was to determine: 1) the incidence of HO after burns and 2) the risk factors associated with HO development, in a large retrospective study....

Database of the heterotopic ossification features. (PDF)

Database of the series of patients. (PDF)

Les paraostéoarthropathies neurogènes (POAN) sont habituellement traitées par exérèse chirurgicale, mais cette intervention peut se compliquer d’infection postopératoire (IPO). Cependant, l’épidémiologie, l’écologie bactérienne et les facteurs de risque de ces infections sont mal connus. Aussi, nous avons mené une étude rétrospective afin de : (1)...

Background: Neurogenic heterotopic ossification (NHO) is usually treated by surgical excision. Postoperative infection (POI) is a possible complication, whose epidemiology, causative organisms, and risk factors are poorly known. We therefore conducted a case-control study to (1) identify the risk factors for POI after surgical excision of NHO at t...

Heterotopic ossification (HO) is a pathology characterized by the formation of ectopic bone in soft tissues generally in muscles surrounding joints such hip, knee, elbow or shoulder. The etiology of this pathology is not known but it is well established that the risk of HO is increased after traumatic brain or spinal cord injuries and also after fr...

Botulinum Toxin A has been the main treatment for spasticity since the beginning of the 1990s. Surprisingly, there is still no consensus regarding injection parameters or, importantly, how to determine which muscles to target to improve specific functions. The aim of this study was to develop a systematic approach to determine this, using the examp...

Background: Almost 10% of older adults in nursing homes have a fixed flexion deformity of the fingers (claw hand). Such contractures have important functional consequences, often leading to hygiene difficulties. Medical treatment (such as botulinum toxin injections, physiotherapy or positioning) is not always effective and surgery is often not pos...

Digital percutaneous needle tenotomy. (AVI)

Introduction Une compression du nerf sciatique est une situation relativement fréquente chez les patients présentant une ossification hétérogène neurogène (OHN) postérieure de la hanche, qui peut être responsable de douleurs prolongées et d’une dégradation fonctionnelle. Or, cette lésion est sous-diagnostiquée, la symptomatologie étant souvent intr...

Introduction Neurogenic heterotopic ossification (NHO) are a common complication after lesions of the central nervous system (10–23% after head injury). The late removal of hip NHOs sometimes causes the risk of femoral head and femoral neck fracture per or postoperatively. Indeed ankylosis of a joint eventually induces bone loss and joint destructi...

Introduction after central nervous system injuries or dementia, loss of muscle elasticity is common. This can major the difficulties for installation (to bed or chair) or for the nursing of severely disabled patients. To take no anesthetic and surgical risk in frail patients we have developed a technique of percutaneous muscle lengthening with a la...

Objectives Life after a burn is conditioned by the sequelae that can persist. Heterotopic ossifications may result in limitations of range of motion and functional impairment. Physiopathology and risk factors are still poorly understood. The purpose was to study the epidemiology of patients managed in burn care center, and to study the potential ro...

Objectives Traumatic Brain Injury (TBI) epidemiological literature lacks information on prevalence of TBI-related disability, and on its long-term consequences on a population-based scale. Methods A National Disability and Health Survey was conducted in French households and institutions in 2008–2009. Participants were 33,896 adults representative...

Objectives In France, the epidemiology of multiple sclerosis and its functional consequences are little known. This study aims to describe prevalence and consequences of MS in the French Population. Methods Two large population-based surveys “Disability health household” and “Disability health institutions” interviewed individuals living in France...

Introduction Neurological heterotopic ossifications (NHOs) are bone formations developed around joints following central nervous system lesion. The pathological mechanism remains unknown and there is no therapeutic option to prevent this complication. Several studies have examined the risk factors occurred in the NHO including spasticity. Some see...

Introduction Optimising the first model developing heterotopic ossification (HO) on paraplegic mouse requires the study of cardiotoxin intramuscular injection substitution by a mechanical injury. Two lines of research were developed: pressure by extended crush and brief high-energy physical impact, with and without IM injection of LPS (purified bac...

Background: Twenty-two percent of institutionalised elderly persons have muscle contractures. Contractures have important functional consequences, rendering hygiene and positioning in bed or in a chair difficult. Medical treatment (such as botulinum toxin injections, physiotherapy or positioning) is not very effective and surgery may be required....

Aim To identify patient and carer expectations regarding information necessary for the first therapeutic leave. This is part of a Patient Education Program on therapeutic leave for patients with brain injury. Patients and methods Questionnaires designed by the multidisciplinary team were given to 30 hospitalised patients and their families before...

Intramuscular injection of botulinum toxin (BoNTA) is one of the primary treatments for focal spasticity. This treatment is considered costly and the level of reimbursement by health insurance has been decreasing in many countries for several years. The aim of this study was to determine the real cost of treating spasticity with BoNTA and to compar...

L es innovations chirurgicales en neuro-orthopédie concernent certes les aspects techniques, mais posent aussi la question de la meil-leure utilisation possible des différentes solutions thérapeutiques, basée sur une évaluation plus fine des lésions, et une meilleure connais-sance des risques chirurgicaux. Il persiste par contre encore un certain n...

To determine the features of stroke-related HO in a large sample of patients and to assess if HO risk is increased by haemorrhagic stroke. A case control study (risk factor of a rare event using retrospective analysis). Sixty-one patients with stroke-81 troublesome HOs-were included, each was matched with four controls, i.e. 244 patients with no HO...

Neurological heterotopic ossification (NHO) is the abnormal formation of bone in soft tissues as a consequence of spinal cord or traumatic brain injury. NHO causes pain, ankyloses, vascular and nerve compression and delays rehabilitation in this high morbidity patient group. The pathological mechanisms leading to NHO remain unknown and consequently...

Study design: Review of the literature. Objectives: It is widely believed that the timing of surgery and the size of the initial Neurological Heterotopic Ossification (NHO) affect the recurrence risk of NHO after SCI. A large number of studies were published in the 80s and the 90s, mostly of poor quality despite the fact that they were carried o...

To characterize electromyographic abnormalities according to symptoms (asymptomatic, fatigue, pseudo-botulism) reported one month after botulinum toxin injection. Retrospective, single center study comparing SFEMG (single-fiber electromyography) in the extensor digitorum communis (EDC) or orbicularis oculi (OO) muscles SETTING: Non-profit rehabilit...

Objective: To describe the characteristics of neurogenic heterotopic ossification (NHO) based on clinical tests, electroneuromyography (ENMG) and CT in a database of patients with lesions of the central nervous system who required sciatic nerve neurolysis along with posterior hip NHO resection, and to determine the respective roles of ENMG and CT...

Deformities of the hand may occur following central nervous system disorders cerebral palsy, despite medical treatment, regular follow-up visits, and rehabilitation. Spasticity, along with impairments of motor and sensory function and coordination, can lead to contractures of the extrinsic and/or intrinsic muscles of the wrist and hand, resulting i...

Neurological heterotopic ossification (NHO) is the abnormal formation of bone in soft tissues as a consequence of spinal cord or traumatic brain injury. NHO causes pain, ankyloses, vascular and nerve compression and delays rehabilitation in this high-morbidity patient group. The pathological mechanisms leading to NHO remain unknown and consequently...

Contexte Les récents conflits armés (Afghanistan) ont vu réapparaître mines antipersonnel et agents explosifs improvisés, responsables de lésions traumatiques complexes à haute énergie associant polyfracas de membres et blast. État de l’art Le pied de mine associe amputations partielles, fracas osseux, lésions des parties molles. Il est « direct »...