Orthopaedics & Traumatology-Surgery & Research最新文献

{"title":"Influence of age and severity of Lenke 5 or 6 idiopathic scoliosis on postoperative quality of life in adult patients","authors":"","doi":"10.1016/j.otsr.2023.103742","DOIUrl":"10.1016/j.otsr.2023.103742","url":null,"abstract":"<div><h3>Introduction</h3><div>Thoracolumbar adolescent idiopathic scoliosis<span><span> can continue to progress beyond skeletal maturity. Ideal timing of surgery remains undefined. Earlier intervention, with shorter instrumentation, incurs early partial loss of lumbar motion. Waiting for progression incurs a greater risk of extensive arthrodesis. The aim of the present study was to assess the quality-of-life impact of age and </span>scoliosis severity at surgery.</span></div></div><div><h3>Material and methods</h3><div><span>Patients with Lenke 5 or 6 adolescent idiopathic scoliosis, aged 16–45</span> <span>years, were analyzed based on a prospective clinical registry. Oswestry Disability Index (ODI) and Scoliosis Research Society (SRS)-22 scores were collected preoperatively and at 6</span> <!-->months, 1<!--> <!-->year and 2<!--> <span>years. Coronal and sagittal alignments were measured on full-spine radiographs, and curve flexibility was assessed on bending radiographs. A mixed linear model was used to assess the impact of age, Cobb angle and flexibility on quality of life.</span></div></div><div><h3>Results</h3><div>Thirty-six patients were included. Mean ODI was 20.5% preoperatively and 13.8% at 2<!--> <!-->years (<em>p</em> <em>=</em> <em>0.017</em>). Mean SRS-22 was 3.2 preoperatively and 3.9 at 2<!--> <!-->years (<em>p</em> <em>&lt;</em> <em>0.001</em>). Mean Cobb angle was 56.6° preoperatively and 23.2° at 2<!--> <!-->years (<em>p</em> <em>&lt;</em> <em>0.001</em>), with mean preoperative reducibility of 68.1%. Age and ODI correlated preoperatively (r<!--> <!-->=<!--> <!-->0.6; <em>p</em> <em>&lt;</em> <em>0.001</em>) and at 6<!--> <!-->months (r<!--> <!-->=<!--> <!-->0.5; <em>p</em> <em>=</em> <em>0.002</em>), as did age and SRS-22 (r<!--> <!-->=<!--> <!-->–0.6; <em>p</em> <em>&lt;</em> <em>0.001</em> and r<!--> <!-->=<!--> <!-->–0.6; <em>p</em> <em>&lt;</em> <em>0.001</em><span>, respectively). Linear regression found a significant negative correlation between thoracolumbar Cobb angle and change in SRS-22 at 6</span> <!-->months.</div></div><div><h3>Discussion</h3><div>In 16–45 year-olds with Lenke 5 or 6 idiopathic scoliosis, age influenced SRS-22 score. Younger patients had better quality of life both pre- and post-operatively. Curve magnitude influenced postoperative score. The present study suggests that early surgical correction in younger patients, where instrumentation can be shorter, does not impair quality of life.</div></div><div><h3>Level of evidence</h3><div>IV; prospective registry study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103742"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71429253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative duloxetine improves postoperative outcomes after anterior talofibular ligament repair for chronic lateral ankle instability for patients with depression: A prospective randomized clinical trial","authors":"","doi":"10.1016/j.otsr.2024.103837","DOIUrl":"10.1016/j.otsr.2024.103837","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Recent studies have indicated that depression is associated with persistent postoperative pain and decreased satisfaction following &lt;/span&gt;foot and ankle surgery&lt;span&gt;. This study aimed to evaluate the effect of perioperative duloxetine on postoperative outcomes of anterior talofibular ligament (ATFL) surgical repair for chronic ankle instability (CAI) in patients with depression. We further sought to evaluate patients’ satisfaction and side effects related to duloxetine.&lt;/span&gt;&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Material and methods&lt;/h3&gt;&lt;div&gt;&lt;span&gt;Patients undergoing ATFL repair were screened for depression preoperatively with the Patient Health Questionnaire (PHQ-9). Among 249 patients who underwent arthroscopic or open surgical Brostrom repair of the ATFL, 120 patients were identified as being “possibly depressed” and were included in the study. Sixty patients were randomly assigned to the duloxetine group (one day preoperatively and for 6 weeks postoperatively), and the other sixty were randomized to the placebo group. Painkillers and opioid consumption, pain scores, and patient satisfaction were recorded at 12, 24, 48, and 72&lt;/span&gt; &lt;!--&gt;hours postoperatively and at follow-up visits 1, 3, and 6 months after surgery. Patient-reported outcome measures (PROMs) were assessed preoperatively and at 3, 6, 12 and 24 months postoperatively. Duloxetine-related side effects such as nausea/vomiting and fatigue were also recorded.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;&lt;span&gt;&lt;span&gt;&lt;span&gt;&lt;span&gt;The patients in the duloxetine group reported a significantly longer time to rescue &lt;/span&gt;analgesic and reduced opioid requirements (including &lt;/span&gt;celecoxib, &lt;/span&gt;pregabalin&lt;span&gt;, acetaminophen, and tramadol). The patients experienced decreased pain intensity and greater satisfaction with their pain management at 24, 48, 72&lt;/span&gt;&lt;/span&gt; &lt;!--&gt;h and 1 and 3 months after surgery (&lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.05). The duloxetine group also had significantly better clinical and functional outcomes at 3 and 6 months of follow-up compared to the placebo group (&lt;em&gt;p&lt;/em&gt; &lt;!--&gt;&lt;&lt;!--&gt; &lt;!--&gt;0.05). The occurrence and rate of symptoms of duloxetine side effects were not significant.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Discussion&lt;/h3&gt;&lt;div&gt;Depression is an important factor to consider and address because its presence before surgery can predict poor postoperative outcomes, including more severe postoperative pain, persistent postoperative pain, and increased consumption of painkillers and opioids.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Perioperative administration of duloxetine following ATFL repair for CAI in patients with depression increased the time to first postoperative rescue analgesic request and reduced both opioid consumption and postoperative pain. This approach also led to a high level of patient satisfaction. In addition, duloxetine improved the quality of recovery without leading to significant side effects.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Level of evidence&lt;/h3","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103837"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736715","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Patient Acceptable Symptom State (PASS) after proximal and distal femoral replacement","authors":"","doi":"10.1016/j.otsr.2024.103931","DOIUrl":"10.1016/j.otsr.2024.103931","url":null,"abstract":"<div><h3>Introduction</h3><div><span>Femoral megaprostheses are used for bone reconstruction surgery in patients with local tumors or who require multiple revisions. Patient reported outcome measures (PROMs) provide a subjective result and, like patient satisfaction, have become an integral part of the outcomes in </span>orthopedics<span><span>. However, the threshold of satisfaction (PASS: Patient Acceptable Symptom State) has not yet been defined in a French population after this type of arthroplasty<span>. This led us to carry out a retrospective study on a population of patients who received a femoral reconstruction megaprosthesis in order to 1) define the PASS for the Harris Hip Score (HHS), </span></span>Knee Society Score<span> (KSS) and the Musculoskeletal Tumor Society score (MSTS), 2) study the complications.</span></span></div></div><div><h3>Hypothesis</h3><div>The PASS threshold for proximal femur<span> and distal femur reconstruction prothesis for the HHS and the KSS, respectively, will be lower than the threshold for these same scores for primary arthroplasty.</span></div></div><div><h3>Materials and methods</h3><div>Forty-four patients who were operated on between 2009 and 2020 were included: 23 received a proximal femur prosthesis and 21 received a distal femur prosthesis. The PASS threshold was defined using an anchoring strategy by analyzing ROC curves for the HSS for the proximal femur, KSS for the distal femur and the MSTS for all the prostheses. Complications were classified according to Henderson.</div></div><div><h3>Results</h3><div>The mean follow-up was 4.5 ± 3.6 (1–12.5) years. The PASS threshold was 47.5 (area under curve (AUC) 0.71 (0.45–0.97)) for the HHS, 69.5 (AUC 0.97 (0.92–1.0)) for the KSS knee and 62.5 (AUC 0.81 (0.61–0.99)) for the KSS function. Thirteen patients (29%) had complications, nine of whom required another surgery (20%). The most frequent were Henderson type 1 (soft tissue lesions, n = 5/44 [11%]) and type 2 (loosening, n = 5/44 [11%]) There was no relationship between satisfaction and postoperative complications (p = 0.071).</div></div><div><h3>Discussion</h3><div>Most of the patients who undergo femoral resection and reconstruction (59%) are satisfied with their function, albeit reduced, despite a high complication rate (29%). Our hypothesis is confirmed for the PASS threshold for the HHS (47.5 versus 93) and the KSS knee and function (69.5 and 62.5 versus 85.5 and 72.5).</div></div><div><h3>Level of evidence</h3><div>IV; retrospective observational single-center study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103931"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141581469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term safety of total knee arthroplasty in patients with chronic kidney disease in Taiwan: A retrospective cohort study","authors":"","doi":"10.1016/j.otsr.2024.103847","DOIUrl":"10.1016/j.otsr.2024.103847","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease<span> (CKD) is a prevalent condition in Taiwan, and the incidence of total knee arthroplasty (TKA) is on the rise. This study aimed to evaluate the postoperative results of patients with different degrees of CKD after TKA, using data from the Taiwan National Health Insurance Research Database.</span></div></div><div><h3>Methods</h3><div>The study analyzed 3078 patients who received TKA from 2012 to 2017, equally divided into three groups: none-CKD, mild CKD (without dialysis), and severe CKD (with dialysis). Propensity score matching was used to minimize selection bias.</div></div><div><h3>Results</h3><div><span>After TKA, there was no significant difference in the risk of debridement surgery for infection between the three groups (adjusted HR of mild CKD: 0.71 95% CI</span> <!-->=<!--> <!-->0.36–1.38, <em>p</em> <!-->=<!--> <!-->0.3073; adjusted HR of severe CKD: 1.14, 95% CI<!--> <!-->=<!--> <!-->0.63–2.06, <em>p</em> <!-->=<!--> <!-->0.6616). However, CKD patients requiring dialysis had a significantly higher risk of mortality (adjusted HR: 1.98, 95% CI<!--> <!-->=<!--> <!-->1.57–2.50, <em>p</em> <!-->&lt;<!--> <!-->0.001) and readmission within 90<!--> <!-->days of any causes (adjusted HR: 1.83, 95% CI<!--> <!-->=<!--> <!-->1.48–2.26, <em>p</em> <!-->&lt;<!--> <!-->0.001) than non-CKD and mild CKD patients.</div></div><div><h3>Conclusion</h3><div>Severe CKD patients needing dialysis after TKA have a higher risk of mortality and readmission rates than that of the non-CKD or mild CKD patients. If the patient is in the early stage of CKD, their prognosis after receiving TKA is expected to be as good as non-CKD patients.</div></div><div><h3>Level of evidence</h3><div>IV; well-designed cohort study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103847"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139991866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does inverse kinematic alignment coupled with robot-assisted TKA optimize patellofemoral clinical and radiological results?","authors":"","doi":"10.1016/j.otsr.2024.103880","DOIUrl":"10.1016/j.otsr.2024.103880","url":null,"abstract":"<div><h3>Introduction</h3><div><span>With a satisfaction rate of 80%, total knee arthroplasty (TKA) surgery has seen significant improvements in recent decades. The 20% of poor results may be explained by the alignment technique used for </span>implant placement, which can influence patellofemoral kinematics. The objective of this study was to demonstrate that the use of inverse kinematic alignment makes it possible to obtain satisfactory clinical and radiological patellar scores in robotic TKA.</div></div><div><h3>Hypothesis</h3><div>The inverse kinematic alignment technique coupled with robotic surgery<span> makes it possible to restore the native kinematics of the patella.</span></div></div><div><h3>Materials and methods</h3><div>This prospective study including 100 TKAs with a primary TKA performed using the Stryker Mako™ robotic surgery system, and the inverse kinematic alignment technique. Patients who underwent patella resurfacing were excluded. Clinical and radiological scores were recorded preoperatively and 1 year postoperatively.</div></div><div><h3>Results</h3><div>At one year, the specific patellar clinical scores were excellent with an average Kujala score of 85.69 and an average HSS Patellar score 88.15. The average patellar lateralization index was 0.15 and the average patellar tilt was 5.1°, showing no significant difference compared to preoperation (<em>p</em> <!-->=<!--> <!-->0.45 and <em>p</em> <!-->=<!--> <!-->0.18). The average external rotation of the femoral implant was 0.47<!--> <!-->±<!--> <!-->0.6° [–1.9; 2.1].</div></div><div><h3>Discussion</h3><div>The patellofemoral clinical results were excellent. The use of the robotic arm coupled with this alignment technique makes it possible to obtain a controlled external rotation of the femoral implant as well as an optimized orientation of the tibial component, favoring good restitution of the alignment of the extensor apparatus. This study did not demonstrate any radiological correction of patellar tilt and lateralization.</div></div><div><h3>Conclusion</h3><div>The combined use of robotic surgery with the inverse kinematic alignment technique seems effective on specific clinical results of the patellofemoral joint.</div></div><div><h3>Level of evidence</h3><div>II; prospective cohort.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103880"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140867832","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lumbar scoliosis and stenosis: What outcomes for which treatment? Analysis of three surgical techniques in 154 patients with minimum two-year follow-up","authors":"","doi":"10.1016/j.otsr.2023.103632","DOIUrl":"10.1016/j.otsr.2023.103632","url":null,"abstract":"<div><h3>Study design</h3><div>Prospective multicentric study.</div></div><div><h3>Objective</h3><div>This study goal was to analyze the clinical and radiographic outcomes of lumbar stenosis and scoliosis (LSS) patients, treated with lumbar decompression (LD), short fusion and decompression (SF) or long fusion with deformity correction (LF).</div></div><div><h3>Hypothesis</h3><div>Procedures without correction lead to poorer long-term outcomes.</div></div><div><h3>Methods</h3><div>Consecutive patients with two-year minimum follow-up, older than 50, with lumbar scoliosis (Cobb angle<!--> <!-->&gt;<!--> <span><span><span>15°), and symptomatic lumbar stenosis were included. Age, gender, Lumbar and Radicular Visual Analog Scale, </span>ODI, </span>SF12 and SRS30 were collected. Main and adjacent curves Cobb angles, C7 coronal tilt (C7CT), spinopelvic parameters, and spino-sacral angle (SSA) were measured preoperatively, at one and two years. Patients were sorted into surgery type groups.</span></div></div><div><h3>Results</h3><div>In total, 154 patients were included, with respectively 18, 58 and 78 patients in LD, SF and LF groups. Mean age was 69, 85% were women. Clinical scores improved in each group at one year, but only LF group exhibited persistent improvement at 2<!--> <!-->years. A significant fractional Cobb angle increase was noted in the SF group at 2<!--> <!-->years (from 12<!--> <!-->±<!--> <!-->11° to 18<!--> <!-->±<!--> <!-->14°). C7CT significantly increased in the LD group at 2<!--> <!-->years (from 2.5<!--> <!-->±<!--> <!-->1.3° to 5.1<!--> <!-->±<!--> <!-->3.5°). LF group presented the highest complication rate (45%, 19% for SF and 0% for LD). The overall revision rate was 14% in SF group and 30% in LF group.</div></div><div><h3>Conclusion</h3><div>LSS is a complex pathology requiring custom-made surgical treatment. LD, SF and LF allow satisfactory clinical outcome, with a better and more sustained clinical improvement for LF despite higher complication and revision rates.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103632"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9604670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patellar resurfacing might not be mandatory in contralateral second total knee replacement even if performed during replacement of the first knee","authors":"","doi":"10.1016/j.otsr.2024.103857","DOIUrl":"10.1016/j.otsr.2024.103857","url":null,"abstract":"<div><h3>Introduction</h3><div>The appropriateness or necessity of patellar resurfacing in total knee arthroplasty (TKA) is not clearly established. The objective of the present study was to compare the clinical and functional results of patients with bilateral involvement, operated on in one knee by TKA with patellar resurfacing and in the other knee by TKA without resurfacing. The hypothesis was that there was no difference in results between the two sides.</div></div><div><h3>Method</h3><div><span>This was a retrospective cohort of patients operated on by TKA without patellar resurfacing in a second osteoarthritic knee after contralateral TKA with patellar resurfacing. Twenty consecutive patients who underwent second primary TKA constituted their own control group (40 knees). Iwano scores were comparable. Mean age was 75.9</span> <!-->±<!--> <!-->6.2<!--> <!-->years. Mean time between the two procedures was 20.6<!--> <!-->±<!--> <!-->11.9<!--> <!-->months.</div></div><div><h3>Results</h3><div>There were no differences in SF-36, KOOS<span> or Lille patellofemoral scores between the right and left knees. Sixty-five percent of patients were unable to differentiate the performance of their knees in activities of daily living.</span></div></div><div><h3>Conclusion</h3><div>The present study did not differentiate results according to patellar resurfacing, showing the limitations of resurfacing for early functional gain after primary TKA. Resurfacing might thus not be essential, even if it was performed in replacement of the first knee.</div></div><div><h3>Level of evidence</h3><div>IV; retrospective cohort study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103857"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140051006","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy and childbirth after adolescent idiopathic scoliosis surgery: A study of 80 pregnancies","authors":"","doi":"10.1016/j.otsr.2023.103711","DOIUrl":"10.1016/j.otsr.2023.103711","url":null,"abstract":"<div><h3>Background</h3><div>Adolescent idiopathic scoliosis<span> (AIS) is a common spinal disease affecting 2% of adolescents, and women in 90% of the cases. When a surgical treatment is opted for, many questions are frequently asked by families and patients about the course of pregnancy and childbirth<span> after the spinal fusion. This subject remains little studied in the literature, especially with modern instrumentation techniques.</span></span></div></div><div><h3>Hypothesis</h3><div><span>The goal was to describe pregnancy and childbirth after AIS surgery in terms of access to epidural analgesia, need for </span>cesarean section (c-section), and low back pain during and after pregnancy. We thus hypothesized that women undergoing spinal surgery for AIS have subsequently uncomplicated pregnancies and childbirths, and have access to epidural analgesia as women without AIS do.</div></div><div><h3>Patients and methods</h3><div><span>In this retrospective multicenter study, 198 women who underwent surgery between 1984 and 2014 were reviewed from two university hospitals. Among them, 50 women became pregnant, for a total of 80 pregnancies. Surgical data were collected [approach, uppermost and lowermost instrumented vertebra (UIV, LIV)]. Pregnancy characteristics were evaluated: time between surgery and pregnancy, number of births, mode of analgesia, type of delivery, weight gain. Occurrence of low back pain during pregnancy and at follow-up was recorded using </span>ODI.</div></div><div><h3>Results</h3><div>Of the 50 women, 34 had posterior surgery and 16 had anterior surgery. Deliveries took place from 1988 to 2018. Of the 80 pregnancies, 81% were delivered by vaginal route (<em>n</em> <!-->=<!--> <span>65/80), and an effective epidural anesthesia was performed for 49% of them (</span><em>n</em> <!-->=<!--> <!-->39/80). Epidural analgesia failed in 9% of pregnancies (<em>n</em> <!-->=<!--> <!-->7/80), and was denied in 35% of cases (<em>n</em> <!-->=<!--> <!-->28/80), half of the time by anesthesiologists (<em>n</em> <!-->=<!--> <!-->15/80). Patients refused epidural in 13 pregnancies (16%, <em>n</em> <!-->=<!--> <span>13/80). A general anesthesia was used in six pregnancies (8%, </span><em>n</em> <!-->=<!--> <span>6/80), for c-sections only. Back pain was reported in 48% of the pregnancies (</span><em>n</em> <!-->=<!--> <!-->38/80). The level of fusion was correlated with c-section, and conversely with epidural anesthesia.</div></div><div><h3>Discussion</h3><div>A normal pregnancy with vaginal delivery seems to be the rule for women undergoing spinal fusion for AIS. The c-section rate in AIS women was similar to the general population (19%). Yet, access to epidural anesthesia still seems problematic with only 49% of births in this series, compared with 81% in the French population.</div></div><div><h3>Level of evidence</h3><div>IV, retrospective cohort.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103711"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49685051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retroarticular drilling for osteochondritis dissecans of the talus: A systematic review","authors":"","doi":"10.1016/j.otsr.2024.103834","DOIUrl":"10.1016/j.otsr.2024.103834","url":null,"abstract":"<div><h3>Background</h3><div><span>Opinions differ on the optimal treatment for stable talar osteochondritis dissecans (OCD) with intact cartilage. Some recommend conservative management, while others prefer surgical care, which includes </span>debridement<span><span> and micro-fractures, transarticular drilling through a direct or medial malleolus approach and retroarticular drilling. The rationale behind retroarticular drilling is to induce bone marrow healing without touching the intact cartilage. The goal of this </span>systematic review is to summarize the clinical outcomes of retroarticular drilling as a standalone procedure for stable talar OCD with intact cartilage.</span></div></div><div><h3>Patients and methods</h3><div>A systematic review of the literature prospectively registered in the PROSPERO register was performed along the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Medline, EMBASE and Evidence-Based Medicine databases were searched from inception to December 2021 for retroarticular drilling for stable talar OCD with an intact cartilage. Two independent evaluators screened the search results, selected the articles to be included in the analysis and assessed the methodological quality of all included articles with the Newcastle-Ottawa Scale (NOS).</div></div><div><h3>Results</h3><div>Twelve studies, on 99 patients were included in the final analysis. Methodological quality was poor for all the included studies. High heterogeneity prevented any pooling or meta-analysis, but favorable clinical results were reported according to excellent post-intervention scores on the American Orthopedic<span> Foot and Anke Score (AOFAS), ranging from 88.9 to 100. There was also significant improvement in pain as measured by the Visual Analog Scale (VAS), ranging between 2.3 and 5.9.</span></div></div><div><h3>Discussion</h3><div>Favorable results seem to be achieved with retroarticular drilling without grafting for stable talar OCD with intact cartilage, but more powered comparative studies between surgical options and conservative management are needed to establish the gold standard treatment.</div></div><div><h3>Level of evidence</h3><div>IV.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103834"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139716681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MPFL reconstruction with proximal rather than distal femoral tunnel position leads to less favorable short-term results","authors":"","doi":"10.1016/j.otsr.2024.103816","DOIUrl":"10.1016/j.otsr.2024.103816","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to compare the clinical and radiological outcomes of medial patellofemoral ligament (MPFL) reconstruction (MPFLR) between anatomic femoral tunnel positions: proximal (near adductor tubercle [AT]) and distal (near medial epicondyle [ME]).</div></div><div><h3>Hypothesis</h3><div>MPFLR with the proximal femoral tunnel position has worse clinical and radiological outcomes than those with the distal femoral tunnel position.</div></div><div><h3>Patients and methods</h3><div>Fifty-five patients who underwent isolated MPFLR with proximal or distal femoral tunnels with at least 2 years of follow-up were retrospectively analyzed. Based on postoperative CT images, 28 patients were classified as group AT and the remaining 27 patients were classified as group ME. The International Knee Documentation Committee, Lysholm, Tegner, Kujala scores, and complications were evaluated. Radiologically, the Caton-Deschamps Index (CDI), patellar tilt angle, patellofemoral osteoarthritis (PFOA), patellofemoral cartilage status by the International Cartilage Repair Society (ICRS) grade, bone contusion, and MPFL graft signal intensity were evaluated.</div></div><div><h3>Results</h3><div>All clinical scores significantly improved in both groups (<em>p</em> <!-->&lt;<!--> <span>0.01). No statistically significant difference was noted between the two groups in regards to their preoperative demographic data, postoperative clinical scores, complications, or radiological findings<span> (CDI, patellar tilt angle, PFOA, bone contusion, and graft signal intensity). The group AT had worse cartilage status on the medial facet of the patella (</span></span><em>p</em> <!-->=<!--> <!-->0.02). The ICRS grade for the medial facet of the patella statistically progressed in group AT compared to group ME (<em>p</em> <!-->=<!--> <!-->0.04) as well.</div></div><div><h3>Discussion</h3><div>Both groups showed significantly improved clinical outcomes. However, for the medial facet of the patella, MPFLR with the proximal femoral tunnel position had worse cartilage status and ICRS grade progression than those with the distal femoral tunnel position.</div></div><div><h3>Level of evidence</h3><div>III; retrospective comparative study.</div></div>","PeriodicalId":54664,"journal":{"name":"Orthopaedics & Traumatology-Surgery & Research","volume":"110 7","pages":"Article 103816"},"PeriodicalIF":2.3,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139508046","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}