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Biomedical subjects

B Moyen

Publications and source records attributed to B Moyen.

At least 37 records · Page 2Linked to original sources
PubMed1995

[Sequelae in the knee extensor system following graft removal for the "Mac in Jones" type procedure].

PURPOSE OF STUDY: The aim of this study was to evaluate clinical and radiological sequelae following removal of part of the patellar tendon for A.C.L. reconstruction. MATERIALS AND METHODS: A consecutive and homogenous series of 100 patients operated for chronic anterior instability (66 men, 34 women; age 16 to 55 years, average: 28.5 years) was studied. The procedure involved a free patellar tendon graft harvested from the mid third of the tendon and including its bony attachments, and in particular a long strip from the patella and a strip 10 centimeters long from the rectus femoris tendon for extra-articular reconstruction. Tendon graft sites were closed. Patellae and tibial tunnels were filled with bone debris from the drilling, and the pre-patellar fascia was closed. The mean follow-up period was 35 months. pain and radiological alterations (with pre-operative X-rays as reference) were studied, particularly for: calcifications, patellar height changes using the Insall, Blackburne and Caton methods, increase in patella tip length, femoro-patellar joint alteration. RESULTS: Calcification were found in: quadriceps tendon: 24 per cent of cases (always painless), Pre-patellar: 16 per cent of cases (usually less than 5 mm), Superior patellar tendon: 47 per cent of cases (only 2 cases being painful, no unaffected tendons were painful), Inferior patellar tendon: 7 per cent of cases (1 in the mid), Tibia tunnel: 26 per cent of cases. No cases required surgical removal. Patellar tip length did not increased significantly. Patellar tendon length decreased by 1.37 mm. Patellar height measured by the Insall, Blackburne and Caton methods was not significantly affected. The femoro-patellar joint was normal in 95 per cent of cases. There were five cases of remodelling, one being painful. CONCLUSION: Graft harvested from the extension system for A.C.L. reconstruction frequently resulted in radiological sequelae but were usually asymptomatic. In most cases these calcifications concerned the superior patellar tendon, quadricipital tendon and pre-patellar zone. Patella height was not affected.

Adolescent↗
PubMed1995

[Distal reconstruction of the Achilles tendon with a bone-tendon graft from extensor system of the knee].

PURPOSE OF THE STUDY: The authors describe a new surgical technique of tendo achilles reconstruction using bone tendon plasty from the patellar tendon, for rare chronic ruptures of the Achilles tendon flush within its calcaneal insertion, with distal loss of substance, requiring bone fixation. METHODS: The two step operation was carried out either in lateral or ventral decubitus (the latter two involving repositioning the patient): 1) Plasty harvesting. By a short anterior approach, we harvested either a strip of patellar tendon (10 mm wide) with a piece of tibia tuberosity or a strip of rectus femoris tendon (10 mm wide, up to 10-15 cm long) with a piece of patellar bone, in cases with a greater loss of substance. Tendo achilles reconstruction: following resection of fibrous tissue, and drilling of a blind calcaneous tunnel, the bone plasty is fitted into the calcaneous with interference screw for safety, the two tendon ends are superposed and sutured. The patient is placed in a cast for two months. RESULTS: Two patients (1 thirty-eight year old sportsman, 1 thirty-seven year old woman) were treated with a good morphological and functional outcome at two years. DISCUSSION: This new technique is compared with other available solutions: triceps plasty, other local tendon plasties, artificial plasties, It met the two criteria for these unusual ruptures: solid calcaneous fixation, no skin damage.

Achilles Tendon↗
PubMed1995

[Results of sutures of the internal meniscus associated with reconstruction of the anterior cruciate ligament in chronic knee joint instability. Apropos of 42 cases, 30 of them controlled by arthrography].

PURPOSE OF THE STUDY: Most authors agree on the importance of medial meniscus preservation in the case of A.C.L. reconstructive surgery. The purpose of this study was to analyze the anatomical results of sutures of medial meniscus tears by the means of arthrography. MATERIAL: Medial meniscus 42 sutures for peripheral tears at the posterior horn (length between 10 and 50 mm, 70 per cent greater than 20 mm) had been performed through an open procedure using a posterior approach. The average age of the patients was 24 years (17-54) with a clear male predominance (64 per cent). The average age at the time of injury was 22 years, 6 months. METHODS: The patients were operated on by the same surgeon, with the same technique. Resorbable sutures were used spaced every-3 mm, and tightened outside the joint. The A.C.L. was reconstructed by a bone-patellar tendon-bone technique (modified K.G. Jones). A first series of 13-patients were no weight bearing allowed for 6 weeks post-operatively. A second series of 29 patients were allowed immediate partial weight bearing. All the patients were permitted active flexion. All the patients had been examined with a minimum of 6 months follow-up. They were all controlled clinically (results evaluated with the I.K.D.C. score) and with passive dynamic X rays to measure residual laxity. 32 patients had an arthrogram before the operation in the aim to compare with the postoperative arthrogram. 30 patients had an arthrogram after an average of 21 months. 12 patients refused follow-up arthrograms. 9 patients had arthroscopy for pain or effusion. RESULTS: All the patients obtained a range of flexion-between 90 degrees and 110 degrees at 4 weeks. A flexed contracture of 10 degrees was noted in only 1 case. Meniscal functional results were good for 32 cases after a mean follow-up of 4 years and 4 months. Arthrograms in 30 cases showed no residual tear in 19 cases (63 per cent), 3 cases had incomplete healing and 8 cases had failed. The healing was influenced by the size of the tear, its situation near the posterior wall. In the first series (no weight bearing), there were 2 failures for 9 cases and 6 out of 21 in the second series and 3 incomplete healing. There was no correlation between meniscal functional results and functional ligamentous results evaluated with the I.K.D.C. score. 9 patients had an arthroscopy and 7 out of them a meniscectomy (after 17 months 3). CONCLUSIONS: This study confirms the possibility of healing following suture of peripheral medial meniscal tears in the case of ACL reconstructive surgery (even if the tear is long). The use of arthrogram, before the operation and for anatomical control after the operation, ensures complete healing (better than M.R.I. for the suture control). Arthrography is certainly a less invasive technique than arthroscopy.

Adolescent↗
PubMed1994

[Arthroscopy of the ankle: a new of postero-internal point of entry].

INTRODUCTION: The development of the indications in the arthroscopic surgery of the ankle and the narrowness of this joint impose perfectly adapted portals. Several posterior portals which allow to access to the postero medial corner of the joint have been already described, but are not satisfying. We describe, here, a new postero-medial portal which allows a safe and easy access to the posterior part of the joint. METHODS: The arthroscopy is performed with a standard arthroscope (30 degrees, 4.5 mm in diameter) and a lateral ankle distractor. The landmark for this portal is the posterior crest of the medial malleolus. Above the posterior tip of the medial malleolus, this crest is directed up and back, then its direction becomes strictly vertical. The new portal is situated there, 5 millimeters behind the crest (generally 2 centimeters above the posterior tip of the medial malleolus). A needle visualized by the anterior portal is helpful to show the right direction for the portal. After skin incision, a forceps is used to widen the portal. Then the instruments or the arthroscope can be introduced. Posterior tibial artery and nerve are protected by the tendons of tibialis posterior and flexor digitorum longus. MATERIAL: We have used this portal (instrumentation and arthroscope) in four patients (3 osteochondritis dissecans of the medial part of the talus, 1 loose body) without problem. RESULTS: This portal is safe; it does not intersect the direction of posterior tibial artery and nerve as in the postero-medial portal described by Parisien and avoids in most cases the approach described by Guhl. DISCUSSION: Because the medial malleolus is more anterior than the lateral malleolus, it allows a larger approach to the posterior part of the joint than the postero-lateral portal. We recommend it for the arthroscopic treatment of all the lesions of the postero-medial part of the joint.

Ankle Joint↗
PubMed1994

[Dynamic anterior jerk of the shoulder. A new clinical test for shoulder instability. Preliminary study].

PURPOSE OF STUDY: A new clinical test named "The shoulder anterior jerk test" is proposed to confirm the diagnosis of chronic shoulder anterior instability. MATERIAL: The test combines of a compression force and a translation force, applied along the arm between the humeral head and the glenoid cavity. In so doing, a subluxation of the humeral head is provoked and it is accompanied with a jerk recognised by the patient as his instability. METHODS: Three different populations of patients had been studied: Population A: 28 patients operated on for chronic anterior dislocation, uni or bilateral (32 shoulders), had been tested before the operation, without and under anesthesia. Population B: 100 patients without any problem at the shoulder, had been tested before and under anesthesia done for knee or hip surgery. Population C: 100 young sportive athletes with normal shoulder tested without anesthesia. RESULTS: Population A: The 28 patients suffering from shoulder instability had all a positive shoulder jerk test under anesthesia. Without anesthesia the test had been positive only in 10 cases (30 per cent). The jerk is potentially present for all the patients, but it is disturbed by apprehension. Population B: Among the 200 shoulders tested, 26 shoulders (17 patients) had a positive test under anesthesia (13 per cent). 5 had positive jerk test without anesthesia. Population C: 5 among the 200 shoulders tested had a positive jerk test (2.5 per cent) Under anesthesia the test has a sensitivity of 100 per cent, a specificity of 87 per cent, a positive predictive value of 55 per cent and a negative value of 100 per cent. Without anesthesia, the test has a sensitivity of 31 per cent, a specificity of 97.5 per cent, a positive predictive value of 66 per cent and a negative predictive value of 90 per cent. DISCUSSION: The instability which is shown by the jerk test is in relation with the anterior subluxation of the humeral head in front of the anterior edge of the glenoïd cavity. It reproducts, with a minimal amplitude, the clinical instability which is recognized by the patient. The test is always positive under anesthesia in case of chronic anterior instability, it may confirm pre-operative diagnosis just before the begining of the procedure and may orientate the choice of it. Apprehension is a major obstacle to the research of the jerk, but it is the same with the other classical clinical tests of the shoulder anterior instability. CONCLUSION: The anterior jerk test of the shoulder is thus a test which is able to prove the diagnosis of an anterior instability. The future will permit to confirm its efficiency and will confirm if the test may differenciate anterior and inferior instability with variation of the abduction, as it has been shown in this preliminary study.

Adolescent↗
PubMed1993

A comparison of pre-operative evaluation of anterior knee laxity by dynamic X-rays and by the arthrometer KT 1000.

The comparison of bilateral dynamic X-rays in passive anterior and posterior drawer with a load of 9 kg, and the arthrometer KT 1000 measurements obtained from 100 patients before anterior cruciate ligament reconstruction, confirms the good diagnostic efficiency of the following methods: (1) radiological measurement of the anterior translation of the medial compartment, as an absolute value and especially as a differential value in relation to the opposite, uninjured knee, the normal value limits being respectively 5 and 2 mm; and (2) arthrometric measurement of the maximal manual translation, also as absolute and differential values, the normal value limits being 10 and 2 mm respectively. These two measurements have a predictive value of 90%. No numerical equivalency exists between the radiological and arthrometric values, but their variations in relation to each other are statistically correlated. The arthrometer, simple to use and totally innocuous, is an excellent test device for consultation, while dynamic X-rays allow separate studies of each compartment to look for lesions of the posteromedial or posterolateral corners.

Equipment Design↗
PubMed1993

[Anterior laxity and internal arthritis of the knee. Results of the reconstruction of the anterior cruciate ligament associated with tibial osteotomy].

Fifty-one knees were reviewed out of 53 which had been operated on (between 1981 and 1991) for instability due to a long-standing rupture of the anterior cruciate ligament (A.C.L.), associated with medial arthritis related to a varus deformity. They had undergone a reconstruction of the cruciate ligament using the patellar tendon (5 cases had received an artificial ligament) and a high tibial osteotomy. In 80 per cent of cases this was an opening osteotomy with interposition of a heterologous bone graft, and in 39 cases it was a closing osteotomy. The average age was 37 +/- 6 years. The oldest patient was 58 years old. 80 per cent of cases were men and 88 per cent of the patients practised sport on a regular basis at the time of the accident. The average delay before surgery was 9.5 years. Almost all the patients has already undergone a medial meniscectomy and there were deep cartilaginous lesions and the bone was exposed in 50 per cent of cases. 28 knees were reexamined after a follow-up of over 4 years. Based on the ARPEGE score the results on pain and stability were good. Return to sport has been possible for 43 per cent of patients. Pivot shift, which was constant before surgery (grade 2 or 3), disappeared in 20 cases and was estimated at grade 1 in 8 cases (of which 6 had suffered a rupture of the graft). For the 20 cases in which the reconstruction of the A.C.L. had held, the average anterior radiological subluxation was 4.3 +/- 3.2 mm (from 2 to 14 mm) and the average gain after surgery was 6.7 +/- 3.7 mm (from 2.5 to 18 mm). The femoro-tibial angle went from an average of 6 degrees of varus to 3 degrees of valgus. The opening osteotomy was more precise for correction in the frontal plane. A large valgus (over 3 degrees) was not desirable and a hypercorrection was occasionally difficult to accept by relatively young patients who are likely to take up sport again. The osteotomy often involuntarily modified the normal posterior tibial plateau slope (especially closing osteotomy). A backwards increase of the tibial plateau slope is a factor which increases the anterior subluxation of the femur on the tibia. This is confirmed before and after surgery. It seems preferable to decrease the tibial slope during the osteotomy in order to protect the A.C.L. reconstruction.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1993

Surgical treatment of pubic pain refractory to conservative treatment.

After some considerations on the biomechanical nature of pubic pain, the authors present a series of 17 leading athletes (14 professional football players, 1 marathon runner, 1 weight-lifter and 1 French boxer), complaining of this disorder for at least one year and refractory to conservative treatment, surgically treated with the Nesovic technique and evaluated after an average follow-up period of two years (18-30 months).

Adult↗
PubMed1990

Aluminas with dispersoids. Tribologic properties and in vivo aging.

Three base alumina ceramics with dispersoids: monoclinic zirconia alumina (A5Z), tetragonal zirconia alumina (A20Z) and aluminalon (Aa20) have been investigated because of their improved mechanical properties with reference to pure alumina (AI203). Bending strength and fracture toughness are twice higher than alumina for the most toughened. These two parameters were measured by four-points bending tests after 1 week, 1, 2, 3, 6, 12 months of non loaded in vivo aging in wistar rats. They showed a little decrease for AI203 and Aa20 and a total stability for A5Z and A20Z even after one year. For tribologic study of the ceramic/polyethylene combination, cylinder against plane and pin on flat tests were conducted on an alternative movement with hip parameters of speed and load in presence of ringer solution. For the most representative test (pin on disk), the friction coefficients were nearly the same for all materials but UHMWPE wear volume was twice lower against A20Z than against AI203. A20Z/UHMWPE combination would be very interesting as new friction couple for total hip arthroplasty. Further studies are currently conducted.

Aluminum↗
PubMed1989

Randomized trial of a low-molecular-weight heparin (Kabi 2165) versus adjusted-dose subcutaneous standard heparin in the prophylaxis of deep-vein thrombosis after elective hip surgery.

124 patients undergoing total hip replacement were randomly allocated to receive Kabi 2165, 2,500 anti-Xa units twice a day (group A); Kabi 2165, 2,500 anti-Xa units twice a day during the first 48 h postoperatively and then 5,000 anti-Xa units once a day (group B), or adjusted-dose standard heparin, monitored by activated partial thromboplastin time (group C). The first dose was given 2 h before surgery in the three groups. Deep-vein thrombosis (DVT) was detected by radiolabelled fibrinogen uptake and bilateral venography was performed in patients who had a positive scan. In patients who had a negative scan, bilateral venography was performed routinely the day before discharge from hospital. The frequency of DVT demonstrated by venography was 4.9% in group A, 7.3% in group B and 10% in group C. The difference between the three groups was not statistically significant. The incidence of proximal DVT was 2.4, 2.4 and 7.5%, respectively, for the three groups. There was no significant difference between the three groups with respect to mean estimated blood loss, the number of blood units transfused, wound hematoma formation, or hemoglobin and hematocrit levels.

Drug Evaluation↗