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6 Réparation arthroscopique des ruptures isolées transfixiantes du sous-scapulaire
3S78
6
RÉSUMÉS DES COMMUNICATIONS — SFA 2004
Réparation arthroscopique des ruptures isolées transfixiantes du sousscapulaire B. JOST, S. AUDEBERT, G. BAIER, L. LAFOSSE
INTRODUCTION. Whereas open subscapularis repair is reported to be successful, the outcome of all arthroscopic subscapularis repair is not yet known. The purpose of this study was to evaluate the results of arthroscopic subscapularis repair. PATIENTS AND METHODS. Arthroscopic repairs of isolated transmural subscapularis tears were performed in 17 consecutive patients. The13 males and 4 females had an average age of 47 years. The dominant side was involved in 94%. Tears of the subscapularis were diagnosed clinically (lift off and belly press-test) and with Arthro-CT scan. Subscapularis repair was performed all arthroscopic with suture anchors and nonabsorbable sutures. Patients were pre- and postoperative assessed clinically (Constant Score, UCLA score) and with Arthro-CT scan. RESULTS. After a mean follow-up of 24 months the average relative Constant score significantly increased from 58% preoperatively to 96% postoperatively (p < 0.05) as well as the UCLA score from 16 to 32 points (p < 0.05). Pain improved from 5.9 points to 13.5 points (p<0.05), forward flexion from 146q to 175q (p < 0.05), external rotation from 50q to 61q (p < 0.05), internal rotation from sacrum to L12 (p < 0.05) and abduction strength from 7.4 to 15.6 points (p < 0.05). Two patients had a partial rerupture of the subscapularis tendon. Radiographically there was not progression of fatty muscle infiltration. CONCLUSION. All arthroscopic repairs of isolated transmural subscapularis tears yield good results with restoration of shoulder function similar to open repair.
7
Libération arthroscopique du nerf supra-scapulaire S. CORBETT, A. TOMASI, G. BAIER, L. LAFOSSE
PURPOSE. Suprasprascapular nerve (SSN) entrapment by compression in it’s course through the transverse scapular notch has been well documented. When refractory to conservative management surgical decompression is indicated. This usually requires a large open incision which must either split the trapezius muscle or remove it’s insertion. This may cause surgical morbidity of pain and also require protection of the muscular repair after surgery. We have developed an arthroscopic technique of SSN decompression using three portals that avoid muscle detachment and allow for outpatient surgery. The purpose of this paper is to describe our technique and preliminary results of this procedure in our first four cases. METHODS. Four patients with electromyographic (EMG) documentation of chronic suprascapular nerve compression at the transverse scapular notch underwent arthroscopic decompression using three portals. In all cases the landmarks of the coracoclavicular ligaments were identified and the transverse scapular ligament, the artery, and the nerve were clearly visualized prior to section of the transverse scapular ligament.
RESULTS. All patients were discharged from the hospital on the day of surgery and there were no complications from the procedure. At an average follow-up of 11.8 months (range: 2.4-17.9) 3 patients described their shoulders as completely relieved of pain and graded their result as excellent. One patient had relief of most of his pain and graded his outcome as good. In all cases, postoperative EMG documented recovery of suprascapular nerve compression (complete in 3 and partial in 1). CONCLUSION. Arthroscopic release of refractory and painful SSN compression is an effective alternative to open release and it seems that perioperative morbidity is reduced with this treatment method. Early experience demonstrates that this effectiveness is rapidly experienced by the patient after surgery.
8
Analyse des facteurs d’échec anatomique de 50 plasties du ligament croisé antérieur H. ROBERT, P. CALAS, D. BERTIN, P. FURNO, M. COLLETTE, V. BOUSQUET, J. HUMMER, P. GUINGAND
INTRODUCTION. Quinze à vingt-cinq pour cent des plasties du LCA sont considérées comme des échecs si l’on inclut les douleurs, les limitations de mobilité, l’instabilité et la récidive de laxité. Nous nous sommes intéressés aux seuls échecs anatomiques par récidive de la laxité (laxité différentielle au Télos ou au KT-1000 supérieure à 5 mm, récidive du Jerk-test) pour évaluer la fréquence de chacune des 3 principales causes (techniques, traumatique et biologiques) [Harner C, Giffin JR, Dunteman RC, Annunziata C, Friedman M. Evaluation and treatment of recurrent instability after ACL reconstruction. J Bone Joint Surg (Am), 2000, 82, 1652-1664]. MATÉRIEL ET MÉTHODE. Nous avons étudié 50 dossiers de rupture de plasties par autogreffe, issus de 7 centres. Les greffes utilisées se répartissaient en 26 tendons ischio-jambiers, 21 tendons rotuliens, 2 tenseurs du facia lata et 1 tendon quadricipital ; 15 ténodèses extra-articulaires avaient été associées. Il y avait 30 hommes et 20 femmes dont le niveau sportif se répartissait selon la classification CLAS en 32 C, 14 L et 4 A ; 2 sports dominaient : foot dans 23 cas et hand dans 5 cas. Les dossiers ont été étudiés en recherchant les défauts techniques (lâchages de fixation, malpositions des tunnels et conflit avec la ligne de Blumensaât), les anomalies biologiques (défaut de ligamentisation, anomalie du collagène, hyperlaxité) et les re-ruptures vraies sur un nouveau traumatisme au moins un an après la plastie. Les malpositions fémorales ont été étudiées selon les critères d’Aglietti (AB/AC : 60 à 70 %) et les défauts tibiaux selon les critères de Howell et Gillquist (CTT/STD : 35 à 45 %). RÉSULTATS. Les erreurs techniques ont été retrouvées dans 44 cas dont 4 lâchages précoces et 40 malpositions fémorales ou tibiales ou mixtes ; les re-ruptures traumatiques ne représentent que 3 cas et les anomalies biologiques également 3 cas. Les malpositions fémorales surtout par antéposition sont le défaut le plus fréquent (75 %) suivies des malpositions tibiales (58 %). Sur 40 malpositions, un traumatisme mineur « providentiel » est invoqué par le patient dans 24 cas mais on notait une distension préalable de la plastie.
6
RÉSUMÉS DES COMMUNICATIONS — SFA 2004
Réparation arthroscopique des ruptures isolées transfixiantes du sousscapulaire B. JOST, S. AUDEBERT, G. BAIER, L. LAFOSSE
INTRODUCTION. Whereas open subscapularis repair is reported to be successful, the outcome of all arthroscopic subscapularis repair is not yet known. The purpose of this study was to evaluate the results of arthroscopic subscapularis repair. PATIENTS AND METHODS. Arthroscopic repairs of isolated transmural subscapularis tears were performed in 17 consecutive patients. The13 males and 4 females had an average age of 47 years. The dominant side was involved in 94%. Tears of the subscapularis were diagnosed clinically (lift off and belly press-test) and with Arthro-CT scan. Subscapularis repair was performed all arthroscopic with suture anchors and nonabsorbable sutures. Patients were pre- and postoperative assessed clinically (Constant Score, UCLA score) and with Arthro-CT scan. RESULTS. After a mean follow-up of 24 months the average relative Constant score significantly increased from 58% preoperatively to 96% postoperatively (p < 0.05) as well as the UCLA score from 16 to 32 points (p < 0.05). Pain improved from 5.9 points to 13.5 points (p<0.05), forward flexion from 146q to 175q (p < 0.05), external rotation from 50q to 61q (p < 0.05), internal rotation from sacrum to L12 (p < 0.05) and abduction strength from 7.4 to 15.6 points (p < 0.05). Two patients had a partial rerupture of the subscapularis tendon. Radiographically there was not progression of fatty muscle infiltration. CONCLUSION. All arthroscopic repairs of isolated transmural subscapularis tears yield good results with restoration of shoulder function similar to open repair.
7
Libération arthroscopique du nerf supra-scapulaire S. CORBETT, A. TOMASI, G. BAIER, L. LAFOSSE
PURPOSE. Suprasprascapular nerve (SSN) entrapment by compression in it’s course through the transverse scapular notch has been well documented. When refractory to conservative management surgical decompression is indicated. This usually requires a large open incision which must either split the trapezius muscle or remove it’s insertion. This may cause surgical morbidity of pain and also require protection of the muscular repair after surgery. We have developed an arthroscopic technique of SSN decompression using three portals that avoid muscle detachment and allow for outpatient surgery. The purpose of this paper is to describe our technique and preliminary results of this procedure in our first four cases. METHODS. Four patients with electromyographic (EMG) documentation of chronic suprascapular nerve compression at the transverse scapular notch underwent arthroscopic decompression using three portals. In all cases the landmarks of the coracoclavicular ligaments were identified and the transverse scapular ligament, the artery, and the nerve were clearly visualized prior to section of the transverse scapular ligament.
RESULTS. All patients were discharged from the hospital on the day of surgery and there were no complications from the procedure. At an average follow-up of 11.8 months (range: 2.4-17.9) 3 patients described their shoulders as completely relieved of pain and graded their result as excellent. One patient had relief of most of his pain and graded his outcome as good. In all cases, postoperative EMG documented recovery of suprascapular nerve compression (complete in 3 and partial in 1). CONCLUSION. Arthroscopic release of refractory and painful SSN compression is an effective alternative to open release and it seems that perioperative morbidity is reduced with this treatment method. Early experience demonstrates that this effectiveness is rapidly experienced by the patient after surgery.
8
Analyse des facteurs d’échec anatomique de 50 plasties du ligament croisé antérieur H. ROBERT, P. CALAS, D. BERTIN, P. FURNO, M. COLLETTE, V. BOUSQUET, J. HUMMER, P. GUINGAND
INTRODUCTION. Quinze à vingt-cinq pour cent des plasties du LCA sont considérées comme des échecs si l’on inclut les douleurs, les limitations de mobilité, l’instabilité et la récidive de laxité. Nous nous sommes intéressés aux seuls échecs anatomiques par récidive de la laxité (laxité différentielle au Télos ou au KT-1000 supérieure à 5 mm, récidive du Jerk-test) pour évaluer la fréquence de chacune des 3 principales causes (techniques, traumatique et biologiques) [Harner C, Giffin JR, Dunteman RC, Annunziata C, Friedman M. Evaluation and treatment of recurrent instability after ACL reconstruction. J Bone Joint Surg (Am), 2000, 82, 1652-1664]. MATÉRIEL ET MÉTHODE. Nous avons étudié 50 dossiers de rupture de plasties par autogreffe, issus de 7 centres. Les greffes utilisées se répartissaient en 26 tendons ischio-jambiers, 21 tendons rotuliens, 2 tenseurs du facia lata et 1 tendon quadricipital ; 15 ténodèses extra-articulaires avaient été associées. Il y avait 30 hommes et 20 femmes dont le niveau sportif se répartissait selon la classification CLAS en 32 C, 14 L et 4 A ; 2 sports dominaient : foot dans 23 cas et hand dans 5 cas. Les dossiers ont été étudiés en recherchant les défauts techniques (lâchages de fixation, malpositions des tunnels et conflit avec la ligne de Blumensaât), les anomalies biologiques (défaut de ligamentisation, anomalie du collagène, hyperlaxité) et les re-ruptures vraies sur un nouveau traumatisme au moins un an après la plastie. Les malpositions fémorales ont été étudiées selon les critères d’Aglietti (AB/AC : 60 à 70 %) et les défauts tibiaux selon les critères de Howell et Gillquist (CTT/STD : 35 à 45 %). RÉSULTATS. Les erreurs techniques ont été retrouvées dans 44 cas dont 4 lâchages précoces et 40 malpositions fémorales ou tibiales ou mixtes ; les re-ruptures traumatiques ne représentent que 3 cas et les anomalies biologiques également 3 cas. Les malpositions fémorales surtout par antéposition sont le défaut le plus fréquent (75 %) suivies des malpositions tibiales (58 %). Sur 40 malpositions, un traumatisme mineur « providentiel » est invoqué par le patient dans 24 cas mais on notait une distension préalable de la plastie.