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DEEPENING TROCHLEOPLASTY FOR TREATMENT OF RECURRENT DISLOCATION OF THE PATELLA : Indications, Surgical Technique, Results D. Dejour

MO n°176 August 2008

By nature, the patellofemoral joint has low congruity. Passive stability is provided both by the bony structures (congruity between the patella and the trochlear groove) and by the medial and lateral ligaments. Active stability depends on correct tension of the quadriceps muscles on the one hand, and on passive medial-lateral soft-tissue balance on the other hand. The patella needs both passive and active stability to transmit the quadriceps muscle force during flexion and extension movements, whether it be during normal gait cycle or high energy sports activities. In 1987, Henri Dejour's team developed a classification of patellofemoral disorders including three categories : 1) patellar pain syndrome, 2) potential instability (lateral tracking patella), 3) objective patellar instability.6 It did not take into account a possible history of ... D. Dejour

RECONSTRUCTIVE SURGERY IN DIFFICULT CIRCUMSTANCES – COVERAGE OF THE KNEE Patrick Knipper

MO n°161 February 2007

Soft tissue defect of the knee is something which is frequently observed in orthopaedic surgery and traumatology. The present article proposes a number of simple but reliable techniques for covering a loss of soft tissue in this region of the anatomy. In addition, these techniques are adapted to surgical management in hazardous conditions i.e. when the working environment is difficult or even precarious such as at some medical centres in developing countries or in some small French hospitals during on-call duty at the weekend and after 6 pm…Please refer to the article on reconstructive surgery under difficult conditions (Maîtrise d’Orthopédie, N° 118 and 122) for the general principles of reconstruction using simple techniques applied in difficult working circumstances. In this article we propose reconstructive surgery of the ... Patrick Knipper

The use of the Sheffiled hybrid fixator in trauma: Operative Technique M. Saleh, M.El-Shazly, A. Ali, J.McGregor-Riley

MO n°99 December 2000

The Sheffield Hybrid Fixator was designed to provide maximum support for the bone in a simple device, capable of dealing with simple and complex trauma cases. Tensioned Kirschner wires provide stable fixation in metaphyseal bone. It is this property that has been responsible for their successful use in metaphyseal and articulr fractures. The use of four fully tensioned wires off a single ring increases this stability to the extent that it will support an unstable tibial plateau fracture . In further studies three wires have proved sufficient to support metaphyseal fractures of the distal tibia . Beam loading is retained hy using a further ring for disphyseal fixation . Diaphyseal fixation is performed with 6mm screws which achieve good purchase in thick cortical bone. Application of these screws is simplified by the use of a standard clamp ... M. Saleh, M.El-Shazly, A. Ali, J.McGregor-Riley

SURGICAL APPROACHES: LATERAL APPROACH in TKA P.A. Keblish

MO n°96 August 2000

Fixed valgus deformity presents a major challenge in total knee arthroplasty (TKA), especially in moderate or severe cases . The literature suggests that correction of fixed valgus deformities via the standard medial parapatellar approach leads to higher failure rates, primarily at the patellofemoral joint. In a prospective case-controlled study, Karachalios and associates1 reported poorer clinical outcomes and significantly higher patellar subluxation/dislocation in patients with preoperative fixed valgus deforrnities. Merkow and colleagues2 reported that of 12 cases presenting to the Hospital for Special Surgery with patellar dislocation following TKA, nine had preexisting valgus deforrnities. Because valgus deformity represents under 15% of TKA cases, this failure rate is extremely high. Personal clinical experience 3, 4 (1974 to 1980) ... P.A. Keblish

TECHNIQUE OF ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION USING PES ANSERINUS TENDONS S. Plaweski

MO n°95 June 2000

A number of techniques have been found to work well in the reconstruction of a torn anterior cruciate ligament (ACL). We agree with JY Dupont that the chief outcome criterion in the long term is an anatomical one, with "complete restoration of the knee joint." However, in addition to the modified Marshall-MacIntosh and similar techniques for ACL reconstruction, which are known to provide long-term stability, several arthroscopic techniques have been developed, which have the benefit of being minimally invasive and of causing less iatrogenic damage. This, obviously, is a major consideration in ACL surgery. With the development of these techniques, the choice of graft harvesting site has also become an important factor. It should be borne in mind that, in many athletes, the patellofemoral pain following graft harvesting from the extensor mechanism ... S. Plaweski

Review: The anterolateral approach for total knee replacement B. Reignier

MO n°92 March 2000

The anterolateral approach to the knee has several advantages over the anteromedial or midline incisions customarily used in total knee replacement surgery.The rationale for this approach is the vascular pattern of the skin covering the anterior aspect of the knee. The blood vessels come from the medial side, as do the nerves. The arteries, as well as the nerves, spread transversely from medial to lateral, within the areolar subcutaneous tissue that overlies the superficial fascia. Anatomical injection specimens also show the presence of an anterolateral longitudinal skin strip that is virtually avascular2 .This anatomical pattern could be exploited for an approach through the avascular anterolateral skin strip. This route would leave the blood and nerve supply to the skin intact, which is an important consideration in total knee replacement.The ... B. Reignier

Is dislocation a specific risk inherent in mobile-bearing total knee replacements? J. Afriat*, F. Larrouy**

MO n°88 November 1999

The recent arrival on the market of several knee replacements with mobile bearings has drawn renewed attention to a complication that is well recognized, albeit rare, in fixed-bearing TKRs: dislocation.A comparative analysis of the new designs involves a number of factors, such as the implant’s degree of congruency, its degrees of freedom, and implant stress levels.One very important aspect is the dislocation potential of the mobile bearing. The risk of dislocation is difficult to assess. As the designers of the Tri CCC mobile-bearing prosthesis, we have been particularly interested in this problem. The literature on the subject is as yet scanty, and follow-up to date has been short. This is why we thought it useful to propose a classification of the different types of dislocation; to investigate the factors leading to the different ... J. Afriat, F. Larrouy

Osteochondral Grafting using the Mosaicplasty Technique P. Christel*, G. Versier**, Ph. Landreau***, P. Djian****

MO n°76 September 1998

Treatment of cartilage and osteochondral defects has always posed difficult problems for orthopaedic surgeons . Conventional methods, Pridie’s perforations, microfractures or subchondral abrasion (abrasion arthroplasty) lead to imperfect results in around 50% of cases . These techniques lead to the formation of fibrocartilaginous scar tissue whose biomechanical properties are significantly inferior to those of hyaline cartilage, and which does not prevent the onset or progression of a degenerative arthropathy. Figure 1: The problem: cartilage fracture with detached cartilage. Figure 2: Conventional treatment: excision of detached cartilage, subchondral abrasion, Pridie's perforations. In order to overcome the drawbacks inherent in traditional methods, alternative me... P. Christel, G. Versier, Ph. Landreau, P. Djian

Functionnal reconstruction of the knee after extra-articular resection of the proximal tibia R. Capanna Da Campanacci P. Caldora G. lauri G. BeltramiB. Gluckert P.B. Bassi

MO n°64 May 1997

A classical extra-articular resection of the knee involves sacrificing the whole extensor apparatus. It is possible to perform an extra-synovial resection in which all the extensor apparatus is divided coronally, but the procedure is technically difficult and carries the risk of spreading cancer cells, particularly if there is a synovial reaction with articular effusion. The most common reconstruction after extra-articular resection is arthrodesis of the knee. At the present time, the alternative to arthrodesis consists in the use of a total knee replacement in conjunction with a bulk tibial allograft that is harvested complete with the donor knee's extensor apparatus including the quadriceps tendon. The proximal part of the tibial component of the long-stem (semi-constrained) prosthesis reinforces the implant into which it is cemented, while ... R. Capanna Da Campanacci P. Caldora G. lauri G. BeltramiB. Gluckert P.B. Bassi

The Lemaire extra-articular Reconstruction T. Ait Si Selmi* **, L. Jacquot***, Ph. Neyret*

MO n°60 January 1997

The technique of extra-articular reconstruction using fascia lata, described by Marcel Lemaire in 1967 , has become one of the gold standard techniques used to treat anterior instability of the knee.The technique and its modifications were taught to us by Professor H. Dejour, with all the didactic rigour that has always been the hallmark of his teaching. Our Department has more than 15 years’ experience with the procedure. The technique was rapidly accepted as a supplementary procedure that can help to remedy knee instability: The procedure abolishes the pivot shift; however, there will still be an anterior drawer with a soft end-point in the Lachman test.The only way to control anterior tibial displacement and to restore nearly-normal joint kinematics is to reconstruct the cruciate ligaments. This gives lasting clinical results, which ... T. Ait Si Selmi , L. Jacquot, Ph. Neyret