Publications by authors named "Franck Accadbled"

77 Publications

A leg nodule in a 4-month-old girl.

Pediatr Dermatol 2021 May;38(3):677-679

Department of Hematology and Oncologyt, Children's Hospital, Toulouse, France.

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http://dx.doi.org/10.1111/pde.14584DOI Listing
May 2021

[Pediatric traumatology in "green zone" during Covid-19 lockdown: A single-center study].

2021 Apr 27. Epub 2021 Apr 27.

Service d'Orthopédie, Hôpital des Enfants, 330, avenue de grande bretagne, 31300 Toulouse, France.

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http://dx.doi.org/10.1016/j.rcot.2021.04.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8229904PMC
April 2021

Does a combined screw and dowel construct improve tibial fixation during anterior cruciate ligament reconstruction?

Eur J Orthop Surg Traumatol 2021 Jun 14. Epub 2021 Jun 14.

Department of Orthopaedics, Children's Hospital, CHU de Toulouse, Toulouse, France.

Purpose: The aims of the present study were to compare the biomechanical properties of tibial fixation in hamstring-graft ACL reconstruction using interference screw and a novel combination interference screw and dowel construct.

Material And Methods: We compared the fixation of 30 (2- and 4-stranded gracilis and semitendinosis tendons) in 15 fresh-frozen porcine tibiae with a biocomposite resorbable interference screw (Group 1) and a screw and dowel construct (Group 2). Each graft was subjected to load-to-failure testing (50 mm/min) to determine maximum load, displacement at failure and pullout strength.

Results: There were no significant differences between the biomechanical properties of the constructs. Multivariate analysis demonstrated that combination constructs (β = 140.20, p = 0.043), screw diameter (β = 185, p = 0.006) and 4-strand grafts (β = 51, p = 0.050) were associated with a significant increase in load at failure. Larger screw diameter was associated with increased construct stiffness (β = 20.15, p = 0.020).

Conclusion: The screw and dowel construct led to significantly increased fixation properties compared to interference screws alone in a porcine model. Increased screw diameter and utilization of 4-strand ACL grafts also led to improvement in load-to-failure of the construct. However, this is an in vitro study and additional investigations are needed to determine whether the results are reproducible in vivo.

Level Of Evidence: Level V; Biomechanical study.
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http://dx.doi.org/10.1007/s00590-021-03049-2DOI Listing
June 2021

Bone Lengthening with a Motorized Intramedullary Nail in 34 Patients with Posttraumatic Limb Length Discrepancies.

J Clin Med 2021 May 28;10(11). Epub 2021 May 28.

Department of Pediatric Orthopaedics, CHU de Toulouse, 31300 Toulouse, France.

The Fitbone motorized nail system has been used to correct limb length discrepancies (LLD) for several years. This study focuses on its application in posttraumatic limb lengthening surgery, its outcome and challenges.

Materials And Methods: A prospective, single center study was conducted between 2010 and 2019 in patients treated with motorized lengthening nails. The inclusion criteria were symptomatic LLD of 20 mm or more. An imaging analysis was done using TraumaCad software (Brainlab AG, Munich, Germany) to compare frontal alignment angles and limb length discrepancy (LLD) on preoperative and latest follow-up radiographs of the lower limbs.

Results: Thirty-four patients were included with a mean age of 28.8 ± 9.7 years, a mean follow-up of 27.8 ± 13 months and a mean hospital stay of 4.4 ± 1.7 days. The mean LLD was 44 ± 18 mm in 29 femoral and 32 ± 8 mm in 4 tibial cases, which was reduced to less than 10 mm in 25/34 (74%) patients. The mean healing index was 84.6 ± 62.5 days/cm for femurs and 92 ± 38.6 days/cm for tibias. The mean time to resume full weight-bearing without walking aids was 226 days ± 133. There was no significant difference between preoperative and final follow-up alignment angles and range of motion. The mechanical lateral distal femoral angle (mLDFA) was corrected in the subgroup of 10 LLD patients with varus deformity of the femur (preoperative 95.7° (±5.0) vs. postoperative 91.5° (±3.4), = 0.008). According to Paley's classification, there were 14 problems, 10 obstacles and 2 complications.

Discussion: Six instances of locking screw pull out, often requiring reoperation, raise the question of whether a more systematic use of blocking screws that provide greater stability might be indicated. Lack of compliance can lead to poor outcomes, patient selection in posttraumatic LLD patients is therefore important.

Conclusion: Limb lengthening with a motorized lengthening nail for posttraumatic LLD is a relatively safe and reliable procedure. Full patient compliance is crucial. In-depth knowledge of lengthening and deformity correction techniques is essential to prevent and manage complications.
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http://dx.doi.org/10.3390/jcm10112393DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8198387PMC
May 2021

Discoid meniscus in human fetuses: A systematic review.

Knee 2021 Jun 1;30:205-213. Epub 2021 May 1.

Orthopedic Department, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy; Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France; School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.

Background: Discoid meniscus (DM) is a rare variant of regular knee anatomy. Compared to standard meniscus it is thicker and abnormal in shape; these characteristics make it more prone to tear. It is a congenital defect whose correct etiology is still debated and far from being clarified. The purpose of this systematic review is to evaluate evidences of DM in human fetuses in order to assess whether embryological development may have a role.

Methods: A systematic review was performed on PubMed, Scopus, and Embase with different combinations of the keywords "discoid meniscus", "embryology", "fetus", "neonatal". Search yielded 1013 studies, on which we performed a primary evaluation.

Results: Seven studies were considered including a total of 1378 fetal menisci specimens, from 396 different fetuses. Discoid shape was not found represented as a normal stage of prenatal development. From 782 lateral menisci analyzed, only 86 (10.86%) were discoid (13 complete, 73 incomplete type). None of medial menisci was found to be discoid. Lateral meniscus was observed to cover a larger surface of tibial plateau than medial one until 28th gestational week.

Conclusion: Lateral meniscus seems to be more prone to discoid shape for its natural tendency of covering a larger surface of the tibial plateau during fetal stages. However the fact that a discoid shape was not found in the majority of fetuses suggests that it is not a normal stage of fetal development. To support a single etiological factor it will be appropriate to have further morphological and morphometric studies.
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http://dx.doi.org/10.1016/j.knee.2021.04.006DOI Listing
June 2021

Prevalence and Detection of Meniscal Ramp Lesions in Pediatric Anterior Cruciate Ligament-Deficient Knees.

Am J Sports Med 2021 06 30;49(7):1822-1826. Epub 2021 Apr 30.

Department of Orthopaedics, Children's Hospital, CHU de Toulouse, Toulouse, France.

Background: Anterior cruciate ligament (ACL) tears represent 13% of knee injuries in children. Medial meniscal tears are commonly associated with ACL ruptures. Ramp lesions correspond to posterior meniscocapsular tears of the medial meniscus. Depending on the study, the prevalence of ramp lesions is inconsistent.

Purpose: To describe the prevalence of ramp lesions in children and adolescents and to investigate the sensitivity of magnetic resonance imaging (MRI) for diagnosing such lesions.

Study Design: Cohort study (Diagnosis); Level of evidence, 3.

Methods: We analyzed videos from arthroscopic ACL reconstruction (ACLR) in children. During these procedures, we systematically looked for potential ramp lesions. To do so, an arthroscope was passed through the intercondylar notch to visualize the posteromedial compartment. A needle was introduced at the site of a posteromedial portal to unfold the meniscocapsular junction to reveal any hidden meniscal tear. Surgical procedures were performed by 2 senior surgeons. Videos were blindly analyzed by a third surgeon. Preoperative MRIs were screened by 2 blinded, independent senior radiologists to look specifically for ramp lesions.

Results: Videos of 50 consecutive arthroscopic ACLRs concerning 32 boys and 18 girls were analyzed. Mean age at surgery was 14.2 years (range, 8.5-17.6 years). A total of 14 ramp lesions (28%) in 8 boys and 6 girls were identified. In addition, there were 22 tears of the meniscal body in 20 patients (40%). Arthroscopic and MRI findings did not correlate. Among 14 arthroscopically diagnosed ramp lesions, only 8 were detected on the MRI. Conversely, 12 patients had a ramp lesion detected on the MRI, which could not be confirmed intraoperatively. The sensitivity of MRI was 57% and the positive predictive value was 40%.

Conclusion: A meniscal ramp lesion was present in 14 of 50 children (28%) undergoing ACLR. MRI has a low sensitivity for diagnosis of ramp lesions in children. Careful exploration of the posteromedial compartment is strongly recommended. Overlooking such lesions during ACLR may contribute to ongoing instability and higher re-rupture rates in these young patients.
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http://dx.doi.org/10.1177/03635465211010123DOI Listing
June 2021

Pediatric traumatology in "green zone" during Covid-19 lockdown: A single-center study.

Orthop Traumatol Surg Res 2021 Apr 24:102946. Epub 2021 Apr 24.

Service d'Orthopédie, Hôpital des Enfants, 330, Avenue de Grande Bretagne, 31300 Toulouse, France.

Introduction: The 8-week lockdown for the Covid-19 epidemic in France restricted travel, and interrupted schooling and sports. The study hypothesis was that this exceptional situation temporarily altered childhood trauma epidemiology.

Material And Method: A prospective study was performed during the 8 weeks of lockdown. Pediatric traumatology emergency activity was compared to that during the same period in the previous 3 years.

Results: During lockdown, emergency consultations decreased by 50%. The number of patients operated on was 86% of that in the previous 3 years. Patients operated on during lockdown had a mean age of 7.6 years (median, 7.5 years) compared to 9.3 years (9.4 years). The rate of domestic accidents (59% versus 23%) and trampoline accidents (16% versus 5%) increased, while those of sport and locomotion-related accidents decreased. Wounds were more frequent, at 35% of procedures, versus 13% previously. The rate of surgery for upper-limb fracture deceased, while that of lower-limb fracture was unchanged. Distal forearm fracture was less frequent, as was distal tibial fracture.

Discussion: The present study found a 50% decrease in pediatric traumatology emergency activity during lockdown, without decrease in surgery. In case of renewed lockdown, we recommend reorganizing emergency admission to free teams for management of Covid-19 patients, while maintaining operative rooms for emergency surgery. A general public information campaign could help prevent domestic accidents and risk related to use of trampolines.

Level Of Evidence: III.
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http://dx.doi.org/10.1016/j.otsr.2021.102946DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064820PMC
April 2021

Monitoring adolescent idiopathic scoliosis by measuring ribs prominence using surface topography device.

Spine Deform 2021 Mar 29. Epub 2021 Mar 29.

Hopital Des Enfants, 330 avenue de grande Bretagne, TSA 70034, 31059, Toulouse Cedex 9, France.

Due to the danger of repeated exposure to X-rays for patients with Adolescent Idiopathic Scoliosis (AIS), reducing the number of radiographs is necessary. By using Surface Topography (ST), trunk asymmetry evaluation could be used. The number of radiographs required can be reduced by 30% when the radio is used only for patients with worsening ST.

Hypothesis: ST is a reliable technique for deformity monitoring in AIS.

Design: Observational prospective study.

Introduction: The risk of curve progression in AIS is high during a growth spurt and necessitates regular radiographic follow-up, despite the adverse effects of repeated exposure to X-rays.

Aim: The aim of this study was to determine a simple and reproducible parameter for deformity monitoring using ST in AIS patients.

Material And Methods: Consecutive AIS patients with a Cobb angle between 10° and 40° were included. Every 6 months, X-ray and ST acquisitions were performed. Radiographic parameters and the ribs prominence curve calculated from ST were collected. This curve was deduced from the axial rotation of the 100 axial sections of the trunk. We analyzed correlations between the evolution of Cobb angle and the curve.

Results: 123 patients were included, 111 girls, 12 boys, mean age 12 years. The measurement of the curve had a good reproducibility (ICC: 0.816). ST differentiated patients with or without increased Cobb. (p = 0.0294).

Conclusion: ST is useful for monitoring AIS. This device could reduce the number of radiographs by 30%.

Level Of Evidence: II.
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http://dx.doi.org/10.1007/s43390-021-00327-1DOI Listing
March 2021

Proximal Fixation in Adolescent Scoliosis Lenke 1 and 3 Treated by Posteromedial Translation Using Sublaminar Bands: Transverse-pedicular Hook Claw Versus Transverse Hook-pedicular Screw Claw.

Clin Spine Surg 2021 Mar 24. Epub 2021 Mar 24.

Department of Pediatric Orthopaedics, Children Hospital Purpan, Toulouse Department of Orthopaedic, Pitié Salpétrière Hospital, Paris Toulouse Institute of Fluid Mechanics, CNRS, Toulouse, France.

Study Design: This is retrospective comparative study.

Summary Or Background Data: Numerous studies have focused on the efficacy, safety, and restoration of thoracic kyphosis in adolescent idiopathic scoliosis surgery using posteromedial translation method with sublaminar bands and hook claws at the top. The relevance of exchanging the penultimate anchor, that is, the pedicle hook with a pedicle screw in a hybrid construction has not yet been assessed.

Objective: Our objective was to assess, in adolescent scoliosis Lenke 1 and 3 operated by posteromedial translation using sublaminar bands, the proximal fixation claw influence (transverse-pedicular hook vs. transverse hook-pedicular screw) for postoperative correction and the proximal junctional kyphosis (PJK) at 2 years follow-up.

Materials And Methods: A comparative monocentric retrospective study included adolescent idiopathic scoliosis thoracic requiring surgery, between 2015 and 2017, with 2 years follow-up. Clinical (complications, revision surgery, and scoliosis research society-30) and radiographic (coronal and sagittal parameters) assessment were reported. Radiologic PJK was defined by a proximal junctional angle increase of 10 degrees or more between postoperative period and the last follow-up.

Results: Sixty patients (age at surgery=16±2 y; mean Cobb angle=58.2±12 degrees) were divided into 2 similar groups according to upper fixation: transverse-pedicular hook (H-H) and transverse hook-pedicle screw (S-H). No statistical differences were found for correction parameters (P>0.05). We reported 2 cases of PJK in H-H group (N=2/30=6.6%) and none in S-H group (N=0/30) (P=0.1) none requiring revision. No infectious or neurological events were reported. Mean scoliosis research society-30 was 126±12.7 in H-H group whereas 129.3±10 in S-H group (P=0.4).

Conclusions: No differences in postoperative correction and clinical results at 2 years follow-up were found. A claw with transverse-pedicular hook increase proximal junctional angle without significant increase on radiographic PJK incidence compared with a claw with transverse hook and pedicle screws.
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http://dx.doi.org/10.1097/BSD.0000000000001169DOI Listing
March 2021

Pediatric Simple Knee Value: a simple patient-reported outcome measure for the knee.

J Child Orthop 2021 Feb;15(1):76-80

Pediatric Orthopaedics Unit, Children Hospital, CHU Toulouse, Toulouse, France.

Purpose: The pediatric Simple Knee Value (pedi-SKV) is an outcome score in which paediatric patients are asked 'How would you rate your knee today as a percentage of normal (0% to 100% scale with 100% being normal)?'. The primary aim of this study was to validate the pedi-SKV by measuring its correlation with validated knee function scores used most often in paediatric orthopaedics.

Methods: This prospective study was conducted at a teaching hospital to evaluate the pedi-SKV's validity. A total of 44 paediatric patients (ten to 15 years old), were enrolled prior to anterior cruciate ligament reconstruction as well as 17 healthy controls. A survey form consisting of the Lysholm, International Knee Documentation Committee Pediatric Form (Pedi-IKDC) and pedi-SKV was given to subjects twice (enrolment and six months postoperatively). The criterion validity of the pedi-SKV was determined by correlating it to existing knee functional scores. Responsiveness to change was evaluated by comparing the pedi-SKV scores before and after surgery (enrolment visit and six-month postoperative visit). Discriminative ability was evaluated by comparing the pedi-SKV distribution in patients controls.

Results: There was a strong and significant correlation between the pedi-SKV and the Lysholm and Pedi-IKDC (p < 0.0001). The pedi-SKV had a good responsiveness to change (p < 0.0001 for the pedi-SKV before six months postoperatively). Like the other knee-specific functional sores (p < 0.0001), the pedi-SKV was able to distinguish between patients and controls (p < 0.0001).

Conclusion: The pedi-SKV is a valid outcome measure that is strongly correlated with the Lysholm and Pedi-IKDC. This is a novel simple score that can be used by physicians in their daily practice.

Level Of Evidence: II.
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http://dx.doi.org/10.1302/1863-2548.15.200237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7907760PMC
February 2021

Diagnosis and treatment of flexible flatfoot: results of 2019 flexible flatfoot survey from the European Paediatric Orthopedic Society.

J Pediatr Orthop B 2020 Dec 30;Publish Ahead of Print. Epub 2020 Dec 30.

Department of General Surgery and Medical Surgical Specialties, Section of Orthopaedics and Traumatology, University Hospital Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy Orthopaedic Department, Olgahospital, Stuttgart, Germany Department of Pediatric Orthopedic Surgery, "V. Buzzi" Children Hospital, Milan, Italy Department of Orthopaedics, Children's Hospital, Toulouse University Hospital, Toulouse Department of Pediatric Surgery, University Hospital Estaing, Clermont Ferrand, France.

The aim of the study was to evaluate flexible flatfoot (FFF) diagnostic and current therapeutic modalities, as well as treatment expectations, among members of the European Paediatric Orthopaedic Society (EPOS). A 59-questions survey on FFF diagnosis and treatment preferences was distributed to EPOS members. The survey consisted of six sections (1) general clinical parameters; (2) foot aspects; (3) X-ray angles (or lines); (4) expectations; (5) standard clinical assessment; and (6) management options. Descriptive statistics were performed. A total of 93 responses were analysed. In general, clinical parameters, age (91.4% of cases), laxity (81.7%), diffuse pain (84.9%), and pain at the ankle joint (81.7%) were rated as 'average' and 'crucial importance' by the vast majority of respondents. Meary's angle (47.3% of cases), talonavicular coverage (35.5%), and lateral talocalcaneal angle (35.5%) were assessed as main radiological tools in the FFF evaluation. Among respondents, 61.3% rated 'improved ability to walk longer without symptoms' as of 'crucial importance'. Eighty-two percent of the respondents felt less than 10% of patients with FFF are candidates for corrective surgery. Arthroereisis (29.3%) was the most common surgical procedure (16.4% for subtalar and 12.9% for extra-articular arthroereisis, respectively), followed by lateral column lengthening (17.9%) and medializing calcaneal osteotomy (12.3%). There is great variation among respondents in diagnostic and treatment preferences in the management of children with FFF. The results of the EPOS 2019 FFF survey clearly show that large-scale, multicentric, international studies are necessary to elucidate which diagnostic and treatment practices lead to the best outcomes.
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http://dx.doi.org/10.1097/BPB.0000000000000849DOI Listing
December 2020

What's new about etiopathogenesis of musculoskeletal injuries in adolescent athletes?

Minerva Pediatr 2020 Oct 27. Epub 2020 Oct 27.

Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.

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http://dx.doi.org/10.23736/S0026-4946.20.05944-7DOI Listing
October 2020

An energy approach describes spine equilibrium in adolescent idiopathic scoliosis.

Biomech Model Mechanobiol 2021 Feb 2;20(1):359-370. Epub 2020 Oct 2.

Institut de Mécanique des Fluides de Toulouse, IMFT, CNRS, Université de Toulouse, Toulouse, France.

The adolescent idiopathic scoliosis (AIS) is a 3D deformity of the spine whose origin is unknown and clinical evolution unpredictable. In this work, a mixed theoretical and numerical approach based on energetic considerations is proposed to study the global spine deformations. The introduced mechanical model aims at overcoming the limitations of computational cost and high variability in physical parameters. The model is constituted of rigid vertebral bodies associated with 3D effective stiffness tensors. The spine equilibrium is found using minimization methods of the mechanical total energy which circumvents forces and loading calculation. The values of the model parameters exhibited in the stiffness tensor are retrieved using a combination of clinical images post-processing and inverse algorithms implementation. Energy distribution patterns can then be evaluated at the global spine scale to investigate given time patient-specific features. To verify the reliability of the numerical methods, a simplified model of spine was implemented. The methodology was then applied to a clinical case of AIS (13-year-old girl, Lenke 1A). Comparisons of the numerical spine geometry with clinical data equilibria showed numerical calculations were performed with great accuracy. The patient follow-up allowed us to highlight the energetic role of the apical and junctional zones of the deformed spine, the repercussion of sagittal bending in sacro-illiac junctions and the significant role of torsion with scoliosis aggravation. Tangible comparisons of output measures with clinical pathology knowledge provided a reliable basis for further use of those numerical developments in AIS classification, scoliosis evolution prediction and potentially surgical planning.
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http://dx.doi.org/10.1007/s10237-020-01390-9DOI Listing
February 2021

Simple Knee Value: a simple evaluation correlated to existing knee PROMs.

Knee Surg Sports Traumatol Arthrosc 2021 Jun 23;29(6):1952-1959. Epub 2020 Sep 23.

Musculoskeletal Institute, Hôpital Pierre Paul Riquet, CHU Toulouse Purpan, 1 place Baylac, 31000, Toulouse, France.

Purpose: The Simple Knee Value (SKV) is an outcome score in which patients are asked to grade their knee function as a percentage of that of a normal knee. The primary aim of this study was to validate the SKV by measuring its correlation with existing knee-related PROMs.

Methods: This was a prospective study conducted at a teaching hospital to assess the SKV's validity. The study enrolled 47 young patients (16-54 years old), 49 older patients (≥ 55 years) and 30 healthy controls. A paper questionnaire consisting of the Lysholm, IKDC, KOOS, WOMAC and SKV was given to subjects three times (enrolment, 1-month preoperative visit and 6 months postoperative visit). The criterion validity of the SKV was determined by correlating it to existing knee PROMs using the Spearman correlation coefficient (S). SKV test-retest reliability was assessed by the intraclass correlation coefficient (ICC) between two time points (initial consultation at enrolment and preoperative visit, reflecting the same clinical condition). Responsiveness to change was determined by comparing the SKV scores before and after surgery (enrolment consultation and 6 months postoperative). Discriminative ability was determined by comparing the SKV distribution in patients and controls.

Results: There was a strong and significant correlation between the SKV and the gold standard Lysholm, IKDC, KOOS and WOMAC in the younger patients and the older patients (p < 0.0001). The reliability between the SKV at the initial consultation and before surgery was excellent (ICC 0.862, 95% CI 0.765; 0.921) in the younger patients, and moderate (ICC 0.506, 95% CI 0.265; 0.688) in the older patients. The SKV was responsive to change in both patient groups (p < 0.0001 for the SKV before versus 6 months after surgery). Like the other knee-specific PROMs (p < 0.0001), the SKV was able to distinguish between patients and controls (p < 0.0001).

Conclusions: The SKV is valid as it is significantly correlated to existing knee PROMs. It is also reliable, responsive to change and discriminating. Its simplicity gives it many advantages and it can be used by physicians in their daily practice.

Level Of Evidence: Level II.
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http://dx.doi.org/10.1007/s00167-020-06281-1DOI Listing
June 2021

Implantation of an Actifit® Polyurethane Meniscal Scaffold 18 Months After Subtotal Lateral Meniscectomy in a 13-Year-Old Male Adolescent.

Am J Case Rep 2020 May 31;21:e920688. Epub 2020 May 31.

Department of Pediatrics - Orthopedic, Trauma and Plastic Surgery, Children's Hospital, Toulouse University Hospital Center, Toulouse, France.

BACKGROUND Implantation of the Actifit® polyurethane meniscal scaffold is indicated for knee pain after partial meniscectomy in adults who are skeletally mature. This report is of a case of implantation of an Actifit® polyurethane meniscal scaffold 18 months after subtotal lateral meniscectomy in a 13-year-old male adolescent. CASE REPORT A 13-year-old male presented with right knee pain, localized to the lateral joint, 18 months after undergoing subtotal lateral meniscectomy. Magnetic resonance imaging (MRI) of the knee showed a complete amputation of the lateral meniscal middle segment with subchondral bone damage. Arthroscopic exploration of the knee joint showed a subtotal posterior and middle lateral meniscectomy and a 4 cm² area of International Cartilage Repair Society (ICRS) grade 3 cartilage damage on the posterior aspect of the lateral tibial plateau. The anterolateral portal was enlarged to introduce the Actifit® scaffold. The implant was secured using three all-inside Fast-Fix® sutures and three outside-in vertical sutures, which rapidly reduced the pain symptoms. At five-year follow-up, the patient reported no pain, and he had resumed sporting activities and recovered a full knee range of motion at 0/0/145°. MRI showed a type 2 meniscal implant shape and size, according to the Genovese MRI score. The ICRS MRI score was stable at grade 3b. CONCLUSIONS This case showed that the use of the Actifit® polyurethane meniscal scaffold is an option for the treatment of knee pain after partial or subtotal meniscectomy in skeletally immature patients, resulting in a stable functional outcome at five-year follow-up.
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http://dx.doi.org/10.12659/AJCR.920688DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7286186PMC
May 2020

Emergency Ravitch Procedure for Inferior Vena Cava Compression After Surgical Scoliosis Correction.

Ann Thorac Surg 2020 10 12;110(4):e299-e301. Epub 2020 Mar 12.

Department of Thoracic Surgery, Toulouse University Hospital, Hospital Larrey, Toulouse, France.

Pectus excavatum is a common chest malformation, classically asymptomatic. The pectus excavatum surgical procedure allows aesthetic correction. Funnel chest is a malformation frequently associated with thoracic scoliosis, especially in Marfan syndrome. Scoliosis is treated with first-line nonsurgical treatment. Second-line treatment consists of a scoliosis operation. In this case report, we present an exceptional emergency indication of funnel chest correction with the Ravitch procedure for a 14-year-old girl who presented with postoperative acute compression of the inferior vena cava due to a surgical scoliosis correction.
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http://dx.doi.org/10.1016/j.athoracsur.2020.02.015DOI Listing
October 2020

Influence of the sublaminar band density in the treatment of Lenke 1 adolescent idiopathic scoliosis.

Orthop Traumatol Surg Res 2020 11 26;106(7):1269-1274. Epub 2019 Dec 26.

Department of Orthopaedics, Children's Hospital, Toulouse University Hospital, France.

Introduction: Optimal pedicle screw density for the treatment of adolescent idiopathic scoliosis (AIS) remains unknown. It is not clear whether higher implant density results in better clinical outcomes. Large variability in implant density exists among hybrid or all screw constructs. Significant heterogeneity exists with respect to the number of sublaminar bands (SB) used, and the influence of SB density on curve correction in the treatment of AIS.

Hypothesis: We hypothesize that increased SB density does not improve sagittal or coronal plane curve correction.

Methods: A single-center, retrospective study of 131 consecutive patients (118 females) with Lenke 1 adolescent idiopathic scoliosis, all operated between 2012 and 2015 by two surgeons using identical surgical technique and type of instrumentation (SB hybrid instrumentation treatment). SB density was measured using the number of SB reported as well as the number of vertebrae instrumented. Radiographic measurements included preoperative thoracic curve flexibility, Cincinnati reduction index (CRI), and postoperative thoracic Cobb (POCC) and kyphosis (POKC) angle correction measured on immediate postoperative radiographs and at 2 years postoperatively.

Results: Median patient age was 15.6 years (IQR, 12-18). The median SB density was 0.4 (IQR 0.4-0.5). No statistically significant correlation was identified between SB density and CRI (p=0.71), POCC (p=0.55), or POKC (p=0.61) at 2-years postoperatively. Preoperative curve flexibility was found to have significant effect both on immediate (r=-3.02, p<0.001) and 2-year (r=-2.69, p<0.001).

Discussion: SB utilized as a part of a hybrid construct for patients with flexible Lenke I AIS achieve satisfactory deformity correction regardless of SBd. The use of low SB density is appropriate for a subset of patients with flexible Lenke 1 adolescent idiopathic scoliosis.
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http://dx.doi.org/10.1016/j.otsr.2019.10.021DOI Listing
November 2020

Lessons taught by a knee arthroscopy simulator about participants in a European arthroscopy training programme.

Orthop Traumatol Surg Res 2019 12 20;105(8S):S287-S291. Epub 2019 Sep 20.

15, rue Ampère, 92500 Rueil-Malmaison, France.

Background: Arthroscopy simulators offer safe and reproducible training to orthopaedic residents, thereby obviating the need for cadaver specimens. In addition, they collect data that can serve to investigate learning curves and evaluate training programmes with the goal of improving the quality of arthroscopy teaching. In this study, a cohort of surgeons was evaluated before and after a European theoretical and practical training programme that used a knee arthroscopy simulator. The primary objective was to assess whether the overall performance score was improved by the training programme. The secondary objectives were to determine which tasks and skills were improved by the programme, to compare a novice group to an experienced group, and to identify targets for improvement.

Hypothesis: A theoretical and practical training course improves the scores achieved on an arthroscopy simulator task.

Methods: A prospective comparative study was performed in 34 surgeons during the advanced arthroscopy training course organised by the European Paediatric Orthopaedic Society (EPOS) in January 2018. All participants performed a diagnostic task on the VirtaMed ArthroS™ simulator before and after the programme. The participants were divided into two groups based on number of knee arthroscopies performed each year, i.e.,>20 (experienced group) vs.≤20 (inexperienced group). The following parameters were compared between the two groups: overall score, operative time, percentage of iatrogenic injuries, camera and hook path lengths, and success in identifying anatomical structures.

Results: The overall score on the diagnostic task was 199 before and 203 after the training programme (p=0.02). The operative time decreased significantly, from 185 to 115.9seconds (p<0.01). Camera path length decreased from 85.2 to 49.2cm and hook path length from 65.5 to 15.0cm (p<0.05). The mean proportion of arthroscopies with iatrogenic tibial cartilage injuries diminished from 2.7%±1.7% (range, 0-6.7) to 1.8%±1.8% (range, 0-7) (p=0.03); no change occurred in femoral injuries. When each group was assessed separately, the only significant change found in the experienced group was a decrease in operative time, whereas in the inexperienced group all parameters improved significantly. However, visualisation of anatomical structures was unchanged.

Conclusion: Participation in the training programme improved overall performance, and the gains were greatest in the inexperienced group. During the post-training evaluation, some of the major anatomical structures were classified by the simulator as incompletely visualised, raising concern about a risk of underdiagnosis during arthroscopic explorations.

Level Of Evidence: III, prospective comparative study.
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http://dx.doi.org/10.1016/j.otsr.2019.09.008DOI Listing
December 2019

Foot and ankle compensation for anterior cruciate ligament deficiency during gait in children.

Orthop Traumatol Surg Res 2020 Feb 13;106(1):179-183. Epub 2019 Sep 13.

Service d'orthopédie, hôpital des Enfants, CHU de Toulouse, 330, avenue de Grande Bretagne, 31059 Toulouse, France.

Background: Anterior cruciate ligament (ACL) injuries are common in adults and cause knee instability, pain, and an increased risk of osteoarthritis. Previous studies demonstrated changed gait patterns in adult patients with ACL deficiency. In paediatric patients, ACL injuries were once thought to be rare but are being increasingly diagnosed due to greater involvement of children in contact sports and to the introduction of more effective diagnostic tools such as magnetic resonance imaging (MRI). However, little is known about gait adaptation in children with ACL deficiency. The objective of this study was to look for compensatory foot and ankle behaviours during gait in paediatric patients with symptomatic ACL deficiency.

Hypothesis: Compensation for ACL deficiency during gait occurs at the foot and ankle in children, because compensation at the hip and pelvis would require greater energy expenditure.

Material And Methods: We included 47 patients, 33 males and 14 females, ranging in age from 9 to 17 years (mean, 14.1 years). The patients had a history of unilateral ACL injury documented by MRI and initially treated by immobilisation and physical therapy. They were allowed to walk with full weight-bearing on the affected limb and were not taking medications at the time of the study. All patients had pain, knee instability, or functional limitation. The physical examination showed joint laxity indicating surgical ACL reconstruction. None had neurological conditions, congenital musculoskeletal abnormalities, or a history of knee surgery. Gait analysis (GA) was performed using a Vicon 460 system. Kinematic data for the ankle and foot were compared to those in a control group of 37 healthy children. Ankle angular positions were calculated for each group at the following stance time points: initial contact (0% of gait cycle [GC]), mid-stance (25% GC), terminal stance (60% GC), and swing (83% GC). Foot progression data were recorded at mid-stance (25% GC) and swing (70% GC). Student's t test was applied to compare the results to reference values obtained at our laboratory and to data from the control group.

Results: Compared to the reference values, the ankle was in plantar flexion at initial contact in 41 patients, and ankle dorsiflexion during the stance phase was diminished in 39 patients. The external foot progression angle was increased in 23 patients during the stance phase and 38 patients during the swing phase. Compared to the control group (mean age, 9.1 years), the patients had plantar flexion of the ankle at initial contact (3.43°±3.5° vs. 0.74°±3.6°, p<0.05) and decreased dorsiflexion during the stance phase (3.43°±3.5° vs. 0.74°±3.6°, p<0.05). No significant differences were found for any of the other parameters.

Discussion: Children with ACL deficiency developed compensatory foot and ankle behaviours during gait that improved knee stability. Understanding these compensations may guide treatment optimisation.

Level Of Evidence: III, retrospective comparative study.
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http://dx.doi.org/10.1016/j.otsr.2019.07.009DOI Listing
February 2020

Evolution of Hip Dysplasia in Pediatric Patients With Prader-Willi Syndrome Treated With Growth Hormone Early in Development.

J Pediatr Orthop 2020 May/Jun;40(5):e357-e361

Pediatric Orthopaedics Unit, Children's Hospital.

Background: Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by obesity, hypotonia, feeding difficulties, obesity, musculoskeletal manifestations including scoliosis, and hip dysplasia (HD). The aim of this study was to characterize the clinical and radiographic evolution of HD in the pediatric PWS population.

Methods: The authors performed a retrospective cohort study of 72 patients (147 anteroposterior pelvic radiographs) between January 2004 and December 2016. Center-edge angle (CEA) of Wiberg, acetabular index (AI), and neck-shaft angle (NSA) were measures in all hips. The relationship between radiographic and demographic parameters of age, sex, and body mass index z-score (BMIzs) were assessed.

Results: A total of 274 radiographic measurements were performed and analyzed in 72 patients. The mean CEA, AI, and NSA were 21.8±7.1 degrees (range, 5 to 35 degrees), 16.7±7 degrees (range, 5 to 45 degrees), and 142±8.5 degrees (range, 128 to 165 degrees), respectively. HD was diagnosed in 79 (29%) hip radiographs and varied significantly between the age groups (P<0.01). A statistically significant association was identified between age and CEA [β coef, 0.80; 95% confidence interval (CI), 0.6-1; P<0.01], AI (β coef, -0.90; 95% CI, -1.1 to -0.7; P<0.01), and NSA (β coef, -1.11; 95% CI, -1.4 to -0.9; P<0.01) angles. Sex and BMIzs were not identified as independent predictors of radiographic hip angles (P>0.1).

Conclusions: The present study demonstrated favorable evolution of hip radiographic parameters in the PWS population treated with growth hormone early in development. This finding should prompt orthopedists to consider observation alone in the management algorithm for HD in patients with PWS.

Levels Of Evidence: Level III-a retrospective comparative study.
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http://dx.doi.org/10.1097/BPO.0000000000001443DOI Listing
September 2020

Anterior cruciate ligament tears in children: Management and growth disturbances. A survey of French Arthroscopy Society members.

Orthop Traumatol Surg Res 2019 06 11;105(4):747-750. Epub 2019 Apr 11.

S.F.A., 15, rue Ampère, 92500 Rueil-Malmaison, France.

Background: Anterior cruciate ligament (ACL) tears are becoming more common and occurring at earlier ages in the paediatric population. The surgical indications and the optimal time for surgery, technique, and graft type remain controversial in skeletally immature patients. Growth disturbances have been reported after ACL reconstruction, further complicating treatment decisions. The primary objective of this study was to describe current practices of French Arthroscopy Society (Société Francophone d'Arthroscopie, SFA) members regarding ACL tear management in skeletally immature patients. The secondary objectives were to determine the incidence, type, and severity of growth disturbances after ACL reconstruction.

Hypothesis: Recent publications support early surgical reconstruction and the further development of transphyseal techniques, even in pre-pubertal patients.

Material And Methods: An email invitation to complete a 52-item questionnaire was sent to all SFA members. Participation was voluntary and replies were kept confidential. The data were collected automatically via the SurveyMonkey tool. Descriptive statistics were computed.

Results: Of 1280 invited SFA members, 142 replied, yielding a participation rate of 11%. Among respondents, 14% recommended ACL reconstruction within 3 months for pre-pubertal patients, compared to 35% for pubertal paediatric patients. The preferred tibial tunnel was transphyseal for both pre-pubertal patients (44.4% of respondents) and pubertal patients (97.7% of respondents). The preferred femoral tunnel was epiphyseal for pre-pubertal patients (62.2% of respondents) and transphyseal for pubertal patients (55.5% of respondents). Growth disturbances after ACL reconstruction were reported by 7% of respondents.

Conclusion: No consensus exists to date about the surgical management of ACL tears in skeletally immature patients. Transphyseal tunnels are gaining in popularity, even for pre-pubertal children. Reports of significant growth disturbances, although relatively rare, warrant the implementation of technical precautions.

Level Of Evidence: IV, descriptive epidemiological survey.
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http://dx.doi.org/10.1016/j.otsr.2019.02.017DOI Listing
June 2019

Diffusion-weighted MRI for outcome prediction in early Legg-Calvé-Perthes disease: Medium-term radiographic correlations.

Orthop Traumatol Surg Res 2019 05 5;105(3):547-550. Epub 2019 Apr 5.

Orthopédie, hôpital des Enfants, CHU de Toulouse, 31059 Toulouse, France.

Background: Outcome prediction at the early sclerotic stage of Legg-Calvé-Perthes disease (LCPD) is valuable to select patients likely to benefit from early surgery. The metaphyseal apparent diffusion coefficient (ADC) ratio correlated significantly with Herring's classification of LCPD in a preliminary study of 49 MRIs, in which values greater than 1.63 were associated with poor outcomes. The objective of this study was to determine whether the femoral neck ADC ratio, with the 1.63 cut-off, determined at the initial stage of LCPD correlated with medium-term radiographic outcomes.

Hypothesis: The metaphyseal ADC ratio correlates significantly with medium-term radiographic outcomes of LCPD.

Materials And Methods: A prospective study was performed in 27 children (mean age, 13 years; range, 9.5-16 years) who underwent 49 MRIs at the sclerosis or fragmentation stage of unilateral LCPD. ADCs measured bilaterally at the femoral head and neck were used to compute the corresponding ADC ratios between the affected and unaffected sides. The patients received regular follow-up for at least 5 years. The correlation between the ADC ratios and Stulberg grade at last follow-up was assessed.

Results: After a mean follow-up of 6.8 years (range, 5.2-8.4 years) from the date of the first MRI, 13 hips were Stulberg 1 or 2, 13 were Stulberg 3 or 4, and 1 was Stulberg 5. The metaphyseal ADC ratio increased significantly with the Stulberg grade (p<0.01). When only MRIs obtained at the early stage of sclerosis were considered, the correlation remained significant (p=0.03). It was also significant in the subgroup of surgically treated patients (p<0.0001) but was not significant in the subgroup without surgery (p=0.51). A metaphyseal ADC ratio greater than 1.63 was associated with a worse Stulberg grade (p=0.02).

Discussion/conclusion: Diffusion-weighted MRI is a non-irradiating and non-invasive investigation that contributes to the management of LCPD when used in combination with morphological MRI sequences. Elevation of the femoral neck ADC is a finding of adverse prognostic significance that correlates with Herring's grade at the fragmentation stage and with Stulberg's grade at the healed stage. Early ADC elevation in the affected femoral neck can serve to select those patients most likely to benefit from early surgery before the fragmentation stage, i.e., before Herring's classification can be applied.

Level Of Evidence: III, prospective uncontrolled study 3.
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http://dx.doi.org/10.1016/j.otsr.2019.01.010DOI Listing
May 2019

Delayed reconstruction and high BMI z score increase the risk of meniscal tear in paediatric and adolescent anterior cruciate ligament injury.

Knee Surg Sports Traumatol Arthrosc 2019 Mar 23;27(3):905-911. Epub 2018 Oct 23.

CHU Toulouse, Hôpital des enfants, 330 Avenue de Grande Bretagne, TSA 70034, 31059, Toulouse cedex 9, France.

Purpose: The purpose of this study was to identify epidemiologic risk factors for secondary meniscal tears in paediatric and adolescent patients who sustain an anterior cruciate ligament (ACL) tear. The hypothesis was that delayed reconstruction and elevated BMI z score, increase the risk for secondary meniscal tears.

Methods: A prospective, descriptive and analytical study of consecutively accrued children and adolescents with an ACL tear was performed. One hundred and sixty subjects (114 males and 46 females) were identified between 2006 and 2015 at one institution. The age range was between 7 and 19 years. Fifteen parameters were recorded and analysed: age at initial trauma, initial trauma circumstance, sex, BMI z score, affected side, type of sport, Tegner score, athletic level, time to MRI, time to first referral, time to surgery, age at surgery, attempted non-operative treatment, operative report and associated meniscal tear. These meniscal lesions could be diagnosed by an MRI and / or during surgery.

Results: Out of the 160 cases, 143 were treated surgically and 17 cases non-operatively. Median corrected BMI z score was 0.5 (range - 1.8 to 4.7). 41.9% had one or more meniscal lesions. 55 patients were initially treated non-operatively, of which 39 patients were secondarily operated. There was a positive relationship between meniscal lesion and: BMI z score (p = 0.0364), attempted non-operative treatment (p = 0.001) and time to surgery (p = 0.002). The median time to ACL reconstruction was 229 days for patients with secondary meniscal lesions.

Conclusions: Patients with ACL tears treated non-operatively developed secondary meniscal lesions requiring delayed surgical management. There was a positive correlation between BMI z score and secondary meniscal lesions. Thus, early ACL reconstruction is advocated in young athletes.

Level Of Evidence: Retrospective comparative study, Level III.
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http://dx.doi.org/10.1007/s00167-018-5201-2DOI Listing
March 2019

Arthroscopic Treatment of Pediatric Fractures.

J Pediatr Orthop 2018 Jul;38 Suppl 1:S29-S32

Department of Orthopaedics, Children's Hospital, Toulouse University Hospital, France.

Management of pediatric articular fractures has evolved over the years with a growing interest in arthroscopic handling. Several factors account for this recent appeal among which are progress in technology with increased availability of diagnostic methods, rise in athletic activities responsible for these fractures, and pediatric orthopaedic surgeons getting familiar with arthroscopic techniques. In our institution, 9 of 100 arthroscopic procedures are performed as a consequence of an articular fracture. In total, 80% of the fractures concern the knee (56% of tibial eminence fracture, 24% osteochondral fracture). Most of the remaining 20% are located at the ankle joint. Given the thorough articular exploration that arthroscopy provides, any associated cartilaginous or meniscal lesions is identified and addressed in the same procedure as the fracture fixation. Being a less invasive surgery with low complication rate, arthroscopic management of pediatric articular fractures provides very satisfactory results with earlier recovery. Of note, it is technically demanding and requires constant training. The operative time should be monitored and alternative options considered for each surgery. In this regard, arthroscopy has to be viewed as a means not an end.
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http://dx.doi.org/10.1097/BPO.0000000000001163DOI Listing
July 2018

Arthroscopic Osteochondral Autograft Transfer for Juvenile Osteochondritis Dissecans of the Humeral Head: A Case Report.

JBJS Case Connect 2017 Jul-Sep;7(3):e63

1Service de Chirurgie Orthopédique Pédiatrique, Hôpital des Enfants, CHU de Toulouse, Toulouse, France2Service de Chirurgie Orthopédique, Clinique de l'Union, Saint-Jean, France3Service de Chirurgie Orthopédique Pédiatrique, Le Centre Hospitalier Régional Universitaire de Tours, Tours, France.

Case: Osteochondritis dissecans (OCD) rarely affects the humeral head. We describe a 14-year-old adolescent who, despite conservative treatment, had persistent pain in the left shoulder as well as limited function. Radiographs and a computed tomography (CT) arthrogram revealed an osteochondral defect of the humeral head. He was managed with an arthroscopic osteochondral autograft transfer from the knee, which provided a satisfactory outcome.

Conclusion: Arthroscopic osteochondral autograft transfer is an effective option for the treatment of OCD of the humeral head.
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http://dx.doi.org/10.2106/JBJS.CC.17.00003DOI Listing
August 2018

Paper #12: Effectiveness of Bracing Alone in Idiopathic EOS.

Spine Deform 2017 Nov;5(6):445

We hypothesized that bracing alone was an adequate treatment for idiopathic EOS and was as effective as serial casting in most cases. This retrospective, single Institution series demonstrates this is a valid alternative under close monitoring.
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http://dx.doi.org/10.1016/j.jspd.2017.09.015DOI Listing
November 2017

Hamstring Graft Incorporation According to the Length of the Graft Inside Tunnels.

Am J Sports Med 2018 02 24;46(2):348-356. Epub 2017 Oct 24.

Department of Orthopedic Surgery and Trauma, Hôpital Pierre-Paul Riquet, Toulouse, France.

Background: Anterior cruciate ligament (ACL) reconstruction with a quadrupled semitendinosus (ST4) graft is an evolution of the standard technique with 2 hamstring tendons (semitendinosus + gracilis [STG]). However, there is no published comparison of how well these 2 types of hamstring grafts are incorporated into the bone tunnels. Because the ST4 graft is shorter, there is less graft material inside the tunnels.

Purpose: To use magnetic resonance imaging (MRI) to compare graft incorporation in the tibial bone tunnels 1 year after ACL reconstruction with either an STG graft or ST4 graft.

Study Design: Cohort study; Level of evidence, 2.

Methods: Sixty-two patients who underwent ACL reconstruction were enrolled prospectively: 31 with an ST4 graft and 31 with an STG graft. The same surgical technique, fixation method, and postoperative protocol were used in both groups. Graft incorporation and ligamentization were evaluated with MRI after 1 year of follow-up. The following parameters were evaluated: signal-to-noise quotient (SNQ), tibial tunnel enlargement, signal intensity at the bone-graft interface, and graft signal according to the Howell scale. The number of participants needed to show that the mean SNQ did not differ between the 2 techniques was 31 in each group (with a 1-sided alpha of 2.5% and a 1-sided beta of 10.0%). The Student t test was used to compare the distribution of continuous secondary endpoints.

Results: The mean SNQ was 5.2 ± 4.5 for the STG group and 5.9 ± 3.7 for the ST4 group ( P = .5100). The mean tibial tunnel widening was 93.7% ± 51.7% for the STG group versus 80.0% ± 42.9% for the ST4 group ( P = .2605). The groups did not differ in signal intensity at the bone-graft interface ( P = .7502) or in graft signal according to the Howell scale ( P = .4544).

Conclusion: At the 1-year postoperative follow-up, incorporation and ligamentization of the STG and ST4 grafts were the same based on MRI analysis. The results were at least as good with the ST4 technique as with the standard STG technique in terms of incorporation and ligamentization.
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http://dx.doi.org/10.1177/0363546517733472DOI Listing
February 2018

Gartland types IIB and III supracondylar fractures of the humerus in children: is Blount's method effective and safe?

J Shoulder Elbow Surg 2017 Dec 20;26(12):2226-2231. Epub 2017 Jul 20.

Service de chirurgie orthopédique et traumatologique pédiatrique, Hôpital des Enfants, CHU Toulouse, Toulouse, France.

Background: Blount's method is controversial for the treatment of Gartland types IIB and III supracondylar fracture of the humerus (SCFH) in children. The purpose of this study was to evaluate the clinical and radiologic outcomes and the failure and complication rates.

Methods: All types IIB and III SCFH treated with Blount's method from 2003-2013 were included in this retrospective single-center study. Clinical assessment was performed according to Flynn criteria. Baumann angle, anteversion angle, anterior humeral line, and humeroulnar angle were measured for radiographic assessment.

Results: Among 447 children with types IIB and III SCHF, 339 were treated according to Blount's method. There were 173 boys (51%), and the mean age was 6.3 years (1-14 years); 71% were type III. Mean time to surgery was 5.7 hours. According to Flynn criteria, results were satisfactory in 91% of cases. No compartment syndrome was encountered. There were 16 (4.7%) secondary displacements requiring surgical revision. Five (1.9%) children developed a cubitus varus deformity. At latest follow-up, the mean Baumann angle was 74.7° (95% confidence interval, 74.1-75.3), the mean anteversion angle was 39.9° (95% confidence interval, 39.5-40.3), the anterior humeral line was normal in 87.6% of cases, and the mean humeroulnar angle was 8.7°.

Conclusion: Blount's method is appropriate to manage types IIB and III SCFH, provided anatomic and stable reduction is obtained.
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http://dx.doi.org/10.1016/j.jse.2017.05.018DOI Listing
December 2017

Correction of hypokyphosis in thoracic adolescent idiopathic scoliosis using sublaminar bands: a 3D multicenter study.

Eur Spine J 2018 02 13;27(2):350-357. Epub 2017 Jun 13.

Pediatric Orthopaedic Department, CHU Robert Debré, AP-HP, Paris Diderot University, Paris, France.

Introduction: The comparison of implants and correction methods remain controversial in AIS. Excellent frontal and axial correction rates have been reported with all-screw constructs, but at the expense of sagittal alignment, which has a tendency to flatten postoperatively. Posteromedial translation using hybrid constructs seems to preserve and improve thoracic kyphosis (TK), but no series exist to date with a significant number of hypokyphotic patients. In addition, the measures of TK in 2D are often wrong in severe AIS due to axial rotation. The goals of this study were therefore to analyze the 3D radiological outcomes of a group of hypokyphotic AIS patients operated with sublaminar bands.

Methods: 35 consecutive AIS hypokyphotic patients (T4T12 <15°) operated in three centers were included, with a minimum 2-year follow-up. The surgical technique was similar in all centers, associating lumbar pedicle screws and thoracic sublaminar bands. Posteromedial translation was the main correction technique, and no patient underwent prior anterior release. 3D spinal reconstructions were performed preoperatively, postoperatively and at the latest follow-up by an independent observer using SterEOS (EOS imaging, Paris, France), and 2D and 3D measurements were compared. In addition, a new 3D parameter [sagittal shift of the apical vertebra (SSAV)], reflecting the translation of the apical vertebra of the main curve in the patient sagittal plane, was described and reported.

Results: The age of the cohort was 16 years and the number of sublaminar bands used for correction averaged 6 (±1.5). T1T12 and T4T12 sagittal Cobb angles appeared to be overestimated on 2D postoperatively (3°, p = 0.002 and 4°, p < 0.001, respectively). Hence, only 3D measurements were kept for the quantitative analysis of the postoperative correction. T4T12 TK significantly increased after surgery (average 8° ± 7°, p < 0.001), but 11 patients (31.4%) remained hypokyphotic. Seven out of the eight patients (87.5%) who presented a thoracic lordosis (i.e., T4T12 <0°) preoperatively were corrected after surgery (mean gain 16° ± 4°). A posterior shift (positive SSAV) of the apical vertebra was reported in 24 patients (68.6%). In this subgroup, the mean SSAV was +2 cm (±1). Good correlation was found between the SSAV and the postoperative change in 3D T4T12 kyphosis (r = 0.62).

Conclusion: Measures in 2D tend to overestimate sagittal alignment and are not sufficient to evaluate postoperative correction. SSAV is a new 3D parameter reflecting the TK change that needs to be further investigated and used in the future. This series confirms that sublaminar bands should be considered in hypokyphotic patients, since thoracic sagittal alignment was restored in 68.6% of the cases.
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http://dx.doi.org/10.1007/s00586-017-5166-8DOI Listing
February 2018

Magnetically controlled growing rod in early onset scoliosis: a 30-case multicenter study.

Eur Spine J 2017 06 31;26(6):1567-1576. Epub 2016 Dec 31.

Centre Hospitalier Universitaire de Toulouse, Toulouse, France.

Purpose: Preliminary results of magnetically controlled growing rods (MCGR) are encouraging. However, only short case series of MCGR for the treatment of early onset scoliosis (EOS) have been reported. Our aim was to evaluate its effectiveness and complications.

Methods: We report a 30-case retrospective, consecutive, multicenter series of MCGR. Effectiveness was judged upon: deformity correction and difficulties to achieve desired distraction. Secondary endpoints included complications and revision surgeries.

Results: Median age at surgery was 9.1 years (5-13). Mean follow-up was 18.4 months (12-33.9). Mean Cobb angle was 66° preoperatively and 44° at latest follow-up. MCGR has avoided an average of 2.03 scheduled surgical procedures per patient compared to traditional growing rod (GR). The intended total length gain was 40.1 mm per patient (5-140) and the total measured length gain was 21.9 mm (45.5% discrepancy). There were 24 complications: 7 proximal pull-outs of the hooks, 3 rod breakages, 6 failures of the lengthening of which 4 complete blockages and 2 complete blockages followed by backtracking, 1 proximal junctional kyphosis, 1 wound dehiscence, 1 superficial infection, 1 deep infection requiring implant removal, 1 pulmonary embolism, 1 pulmonary insufficiency, 1 secondary lumbar scoliosis, and 1 painful outpatient distraction. Eight patients had a gradual loss of effectiveness of distractions. There were 13 revision surgeries in 9 patients.

Conclusions: MCGR provides satisfactory deformity correction and avoids repeated surgical procedures for lengthening. However, it has substantial complication rate. Although less frequent than in GR, the law of diminishing returns also applies to MCGR.
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http://dx.doi.org/10.1007/s00586-016-4929-yDOI Listing
June 2017
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