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C Hulet

Publications and source records attributed to C Hulet.

At least 19 recordsLinked to original sources
PubMed2006

[Hip dysplasia and misalignment in patients aged 20-50 years].

Anterior hip pain in young adult (20 to 50) has two main causes: secondary osteo-arthritis on development dysplasia of the hip, and femoro-acetabular impigement (FAI). This symposium had two parts: the first one analyses long-term results of non-prosthetic surgery (283 osteotomies and shelfs at 15 years FU). The second part concerned the different syndromes with acute anterior hip pain, especially due to FAI and to labral tears.In hip dysplasia, 56 shelf operations, 100 proximal femoral varus osteotomies associated or not with a shelf arthroplasty,and 127 Chiari osteotomies were examined with 10 years minimum follow-up. Only 15% of patients were lost at follow-up before 10 years and average follow-up was 15 years. Results were considered as satisfactory when the Merle d'Aubigne rating was 15/18 or more. The 3 main factors of good prognosis were: a complete correction of both femoral and acetabular dysplasia; age at operation under 40; a moderate arthritis (grade I or II according to De Mourgues and Patte). In single acetabular dysplasia with 3 favorable prognosis factors(no coxa valga, age under 40, arthritis 1 or 2), 85% good results were achieved at 15 years. When patients were over 40 at operation, or in arthritis grade over 2, only 55% of good results were observed. Varus osteotomies, associated or not with shelf arthroplasties, achieved also 85% goods results at 15 years when the 3 favorable prognosis factors were present. Similar good results were also obtained by Chiari osteotomy, but this operation was associated with 12% complications, and more that 25% of lasting limping. Therefore, with 85% good results at 15 years (and often over 20 years), non prosthetic surgery performed at 30-35 years, achieved better functional results than total hip arthroplasty, longer lasting, and not jeopardizing any further possibility of prosthetic surgery.As concerns acute anterior pain of the hip, the clinical and imaging patterns of the different syndromes have been precised: femoro-acetabular impigement by cam (or by pincer), labral tears in hip dysplasia. There were distinguished from the other secondary impigements, for example by acetabular malposition due to pelvis anteflexion or by other hip diseases: overuse arthritis, coxa retrorsa, etc. Several examples of typical syndromes were presented to support the recommended imaging techniques. The results of the speakers with different surgical treatments were reported as well as concerns open surgery than arthroscopic treatment (60 cases).

Acetabulum↗
PubMed2006

[Adult lateral meniscus].

Meniscal lesion does not mean meniscectomy and this is particularly true for the lateral meniscus. The reputation of mildness of the meniscectomy is usurped. The rate of joint space narrowing after lateral meniscectomy is of 40% at a follow-up of 13 years compared to 28% for the medial meniscus (symposium SFA 1996). Several arguments explain those results: biomechanical: the lateral meniscus contributes to the congruence; particularly the lateral meniscus is the zone where antero-posterior translational during knee flexion is 12 mm. The pejorative effects of lateral meniscectomy have conducted, more though to the medial meniscus, to the concept of meniscal economy. Lateral meniscectomy must be as partial as possible. Particularly, a discoid meniscus presenting a complete tear should be treated by a meniscoplasty in order to shape the meniscus in a more anatomic form than a total meniscectomy. Lateral meniscectomy is indicated in complex or horizontal cleavage, symptomatic, on stable knees. A particular case is the cyst of the lateral meniscus. It is a cystic subcutaneous formation, usual consequence of a horizontal cleaved meniscus of which the particularity is that it opens besides the articulation. The strategy must not consist in the isolated treatment of the cyst. This pathology should be addressed by an arthroscopic meniscectomy reaching the meniscosynovial junction at the level of the cyst. Meniscal repair must be proposed every time if possible. Criteria of reparability are better studied on MRI. Preoperatively MRI is the first choice radiological exam. Two essential indications can be held back: the vertical peripheral longitudinal lesion is on the non-vascularized area, and the horizontal cleaving of the junior athlete (if the cleaving remains purely intra meniscal). Meniscal repair is highly performed when the meniscal tear is associated to a rupture of the ACL (simultaneous reconstruction of the LCA). Postoperative outcome is different of that of a "simple" arthroscopic meniscectomy. The healing process being slow, it suits to protect the suture by a splint in the first month, and with an exclusion of sports with knee torsion during 6 months. Functional results (absence of secondary meniscectomy) and anatomical results (reality of the cicatrisation) are good in 77% of cases (symposium of the French Society of Arthroscopy 2003) at a follow-up of 55 months. Survivorship analysis indicates that majority of the failures occur within two years: this testifies a default of primary cicatrisation. At the studied follow-up, meniscal repair was efficient to protect the cartilage. Lateral meniscus results are better that medial meniscus one. Those data support indications: All suspicion of meniscal lesion must have an MRI preoperatively to confirm the lesion, to localize her and to search criteria of reparability; All vertical longitudinal peripheral lesions can and must be repaired especially in young patients and children; All horizontal cleaving of the junior athletes should be treated by open repair; surgical abstention must be proposed when the lesion is non symptomatic, or when lesion is limited and associated to an ACL tear (in that case isolated ACL reconstruction is proposed), or when clinical symptoms are minimal; Meniscectomy, always arthroscopic, is proposed for a symptomatic lesion in the avascular zone or for a deep horizontal cleavage or a complex tear; Tear of the discoid meniscus should be treated by meniscoplasty. A painful knee after lateral meniscectomy might be due to a too limited initial meniscectomy: an iterative meniscectomy may be indicated or lateral femorotibial arthritis, especially after subtotal or total meniscectomy. In this last case and after failure of usual medical treatment such as viscosupplementation surgery may be indicated. Osteotomy in order to unload the lateral femorotibial compartment gives a partial response as the shearing forces remain. This osteotomy is indicated only if the lower limb axis is normal or in valgus. Meniscal allograft is an option in young patients in grade I or II arthritis. Results are promising. Rene Verdonk's series show a survivorship analysis of 75% at 7 years. Early diagnosis of a postmeniscectomy syndrome before cartilaginous lesions occur is essential for an adapted treatment. In conclusion, lateral meniscectomy are less frequent than those of the medial meniscus but their prognosis is less favorable. They should be early diagnosed (MRI). Treatment options are various: abstention, meniscectomy, and repair. Painful post lateral meniscectomy syndrome may be treated by a new surgical option: meniscal allograft.

Cysts↗
PubMed2005

[Not Available].

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Journal Article↗
PubMed2005

[Not Available].

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Journal Article↗
PubMed2004

[Arthroscopic knee arthrodesis: 4 cases].

PURPOSE OF THE STUDY: Arthroscopic arthrodesis of the knee joint is an alternative to classical surgery, which retains a few exceptional indications. We report the first four cases of our experience, describing the technical modalities and indications. MATERIAL AND METHODS: The four patients had undergone multiple operations for severe trauma. All four had persistent severe pain with a very limited walking distance. Before the procedure, the IKS score ranged from 11 to 44 and the mean function score was 20 to 45 points. Arthroscopic arthrodesis was proposed after several consultations and took into account the young age of the patient and a positive brace test. The successive arthroscopic times were: exploration and adherence release, complete extramural meniscectomy, joint surface avivement. Traction was not necessary. Careful avivement spared the anatomic curvatures of the condyles and slightly scraped out the plateaus. Finally, the arthrodesis was fixed in correct position under fluoroscopy using a single tube external fixator. The fixation was maintained until fusion (satisfactory x-ray and no pain). RESULTS: A drain was inserted only for the first patient. There were no cutaneous complications. Patients were discharged after 3 days on the average with immediate simulated weight bearing using two crutches. The external fixator was dynamized at two months (mean) and removed at five months. The functional gain was considerable in four patients, assessed at two years, with a mean IKS score of 75 and a mean function score of 80. The four patients walked without crutches and without pain. Single leg stance was stable. Final leg shortening was 1 to 2 cm. CONCLUSION: The arthroscopic approach provides several benefits: uneventful postoperative period, little bleeding, no cutaneous complications, shorter hospital stay. The time to fusion appears to be shorter than with classical techniques, but cannot be demonstrated clearly because of the diversity of the series reported in the literature. Arthroscopic arthrodesis does not require any special instruments, but does require surgical skill and a lengthy procedure. When arthrodesis is required the arthroscopic procedure is indicated for minimally deformed knees without major loss of bone stock.

Adult↗
PubMed2003

[Arthroscopic tibio-talar arthrodesis: limitations and indications in 20 patients].

PURPOSE OF THE STUDY: The purpose of this study was to present the clinical and radiological outcome in 20 patients who underwent arthroscopic tibiotalar arthrodesis. MATERIAL AND METHODS: Between 1993 and 1999, twenty patients (twelve men and eight women) underwent arthroscopic tibiotalar arthrodesis and have been followed for a minimum of one year. Mean age at the time of the procedure was 55 years. The left side was treated in eleven patients and the right in nine. There were a variety of underlying conditions, but post-traumatic osetoarthritis predominated (ten patients); five patients had primary degenerative disease, three had "neurological" ankles, one had polyarthrtis and one necrosis of the talus. Three patients had previously undergone a double fusion and one other had had a subtalar arthrodesis. The preoperative Broquin score, which accounts for pain and walking distance, was 3.3 points on a scale of 8. The walking distance was less than 1000 meters for most of the patients. Radiographically, ten feet presented a frontal valgus deformity (mean 5.3 degrees); three had a varus deformity (mean 8 degrees) and seven were well-aligned. In the sagittal plane, there were ten cases of pes equin, including five greater than 10 degrees. The mean tibiopedal angle was 94+/-8 degrees. RESULTS: Mean hospital stay was four days. There were four complications: two superficial infections that resolved and two cases of reflex dystrophy. First-intention fusion was achieved in 17 patients (85%) after a mean 3.7 months (range 3-10 months). Three patients presented a non-union, two undergoing successful open surgery and one preferring to decline surgery on a well tolerated non-fused ankle. At last follow-up, fifteen patients were satisfied or very satisfied and five were dissatisfied. Pain was minimal or absent in 67% of the cases. The Duquennoy score was good or very good in eleven patients, fair in eight, and poor in one. Radiographical data were available for nineteen patients: four had a correct alignment in the frontal plane, eight exhibited valgus (mean 4 degrees), and seven varus (mean 8 degrees). In the sagittal plane, fifteen feet exhibited pes equin (mean 7 degrees), three a neutral position and one pes talus (4 degrees). The mean tibiopedal angle at last follow-up was 95.4 degrees. CONCLUSION: Although arthroscopic tibiotalar arthrodesis cannot improve the rate and delay to fusion in comparison with open surgery, it does reduce morbidity and the length of the hospital stay. We reserve the arthroscopic approach for ankles which are correctly or nearly correctly aligned without loss of bone stock, especially if there are local or general risk factors for open surgery.

Arthrodesis↗
PubMed2003

[Patellar tendon-bone autograft reconstruction of the anterior cruciate ligament for advanced-stage chronic anterior laxity: is an extra-articular plasty necessary? A prospective randomized study of 100 patients with five year follow-up].

PURPOSE OF THE STUDY: This prospective randomized study was conducted to analyze the anatomic and functional impact of an extra-articular lateral plasty associated with patellar tendon-bone autograft in anterior cruciate ligament reconstruction. MATERIAL AND METHODS: A consecutive series of 100 patients with grade II (Noyes classification) chronic anterior laxity confirmed on stress x-rays were included in the study. All patients had a positive Trillat-Lachman test, a direct anterior drawer at 90 degrees flexion confirmed on the lateral x-ray, and an instrumental differential laxity greater than 5 mm (manual arthrometry, Medmetric KT1000). Mean patient age was 27 years (range 16-29 years) and time from the accident to ligamentoplasty was 29 months (range 3-156 months). In the operating theater, the patients were assigned at random to two groups. Group 1 (50 patients) underwent arthroscopic free patellar tendon-bone autograft reconstruction of the anterior cruciate ligament. In the second group (50 patients) the same reconstruction was further supported by a lateral extra-articular plasty using the quadriceps tendon. All patients were followed prospectively. At 58 months follow-up (none of the patients were lost to follow-up) residual laxity (Medmetric KT1000) was noted and functional outcome was assessed using the IKDC criteria. The Aglietti method was used to assess the position of the drill holes. RESULTS: The two groups were strictly identical at inclusion. At last follow-up, the statistical analysis did not reveal any significant difference between the groups for subjective outcome, joint motion, instrumental residual laxity, meniscal stock, or radiological changes. The overall IKDC score was A or B in 80% of the patients in group 1 and 88% of the patients in group 2. Delay to resumed sports activities (about 12 months) was also equivalent in the two groups with a trend towards lower intensity and sports producing less stress on the knee. A minimally positive pivot test with no effect on stability was observed in 4 patients in group 1 (intra-articular plasty alone) and in 2 patients in group 2 (intra- and extra-articular plasty). 16% of the insufficient results (IKDC C and D) were related to repeated tears (n=8, 6 patients in group 1 and 2 patients in group 2, p=0.268), and failure (n=8, 4 in each group) due to defective motion and pain. Repeated tears were strongly correlated with incorrect drill hole position in the tibia (p=0.01) or femur (p=0.024). Despite the stabilization, radiological remodeling was observed in 31% of the patients in both groups. DISCUSSION: The results in this consecutive series of patients demonstrated the good results obtained with intra-articular ligamentoplasy using the mid third of the patellar tendon. The rate of repeated tears or minimally positive pivot tests was higher in group 1 with intra-articular plasty alone but did not reach statistical significance and was generally related to a technical error in positioning the autograft, making it difficult to draw any conclusion concerning the anatomic superiority of mixed plasty. CONCLUSION: At the current follow-up of 5 years, this study was unable to demonstrate any advantage of systematic conjunction of an extra-articular lateral support for advanced chronic anterior laxity of the knee treated by a free patellar tendon graft.

Adolescent↗
PubMed2002

Distribution of bone mineral density at the proximal tibia in knee osteoarthritis.

One hundred and thirteen knees with osteoarthritis (OA) were studied to assess the distribution of bone mineral density (BMD) in the proximal tibia and the potential relation between osteoarthritis and osteoporosis in evaluating hip BMD. All patients had severe knee pain and were diagnosed with Kellgren and Lawrence grade IV osteoarthritis. According to the magnitude of the axial deformity, four categories were created: varus>10 degrees ( 28.3%), varus 4-10 degrees (38.9%), aligned 180 +/- 3 degrees (13.3%), and valgus>4 degrees (19.5%). For each category, the medial and lateral proximal tibial density were assessed. BMD was measured at the femoral neck and at 14 regions of interest (ROI) in the proximal part of the tibia using dual X-ray absorptiometry. Based on the femoral neck BMD, patients were classified according to the World Health Organization (WHO) definition of osteoporosis. The mean knee BMD was positively correlated with the hip BMD value (knee BMD m = 0.38 + 0.73 x hip BMD, r = 0.60, P<0.001). The knee BMD distribution of the 113 patients was negatively correlated with the axial deformity (BMD MT-LT = 5.15 - 0.027 x HKA, r = 0.77, P<0.0001). In the varus deformity, BMD of the medial side was higher than that of the lateral side with an important asymmetry (0.587 g/cm2). This asymmetry was also found in the valgus deformity for the lateral side but was less important (-0.112 g/cm2). With equal deformity, the asymmetry of BMD was higher in varus deformity (0.587 g/cm2) than in valgus deformity (-0.112 g/cm2). Asymmetry of the knee BMD distribution revealed that progression of the deformity (either varus or valgus) with joint space narrowing led to an increase in the medio-lateral difference of the proximal tibia density. Lesser severity of Kellgren and Lawrence grades may reveal different results. Twenty patients with osteoporosis developed knee osteoarthritis (OA) and the relation between osteoporosis and knee OA remains unclear.

Absorptiometry, Photon↗
PubMed2002

[Ligamentoplasty of the anterior cruciate ligament after 40 years: a series of 41 patients].

PURPOSE OF THE STUDY: Ligamentoplasty for tears of the anterior cruciate ligament (ACL) is generally thought to be unreliable after the age of 40 years. The purpose of this retrospective analysis was to assess the five-year outcome after ACL plasty in patients aged over 40 at the time of surgery. MATERIAL AND METHODS: Between 1990 and 1997, 41 patients aged 44.5 +/- 4.5 years (28 men, 25 right side) underwent intra-articular reconstruction of the ACL. Clinical and radiological assessment using the IKDC criteria was obtained at a mean 62 months postoperatively using manual instrumental measurements with KT-1000. The indication for reconstruction was instability in daily life activities for 40 patients and difficulties encountered in sports activities in one; there were three cases of remodeling. Arthroscopy was used in all cases to perform a patellar tendon graft (bone-tendon-bone in 30 cases associated with extra-articular lateral reinforcement in eleven). RESULTS: There were no significant complications. Among 12 patients who initially participated in competition sports, seven were able to resume their activity at their former level. At last follow-up, global IKDC score was A for 12, B for 25, and C for three and D for one. All patients scored C or D had a poor IKDC symptom score, basically because of pain. Motion was not modified. The IKDC radiology score was A for 25, B for 15 and C for one, but the three cases of remodeling did not progress. Prognostic factors for overall IKDC result were: age of the patient at the time of reconstruction (under 45 years), and the delay to surgery for accident victims (less than one year). The following criteria had no effect at last follow-up: gender, sport practiced, type of initial laxity (anterior alone or global anterior), presence of meniscal damage, preservation of the medial and/or lateral meniscus, chondral injury observed peroperatively, and use of a lateral reinforcement. Radiographic remodeling observed in this group of 41 patients was related to delay from accident to surgery (p=0.0007) and preservation of the medial meniscus (p=0.03). Age, gender, type of activity before surgery, degree of initial and residual laxity had no statistically significant effect on remodeling. CONCLUSION: Age over 40 years is not a contraindication for arthroscopic free patellar tendon graft for the treatment of chronic anterior laxity. Using rigorous preoperative assessment criteria (delay from accident to surgery, absence of joint space narrowing on the AP and lateral view before intervention, symptomatic instability in daily life activities and motivated patient) this type of procedure can be performed safely and provides good functional outcome at five years. The current follow-up is insufficient to judge potential joint degradation. Age is not a contraindication if certain precautions are taken.

Adult↗
PubMed2002

[Total hip arthroplasty after proximal femoral osteotomy: 75 cases with 9-year follow-up].

PURPOSE OF THE STUDY: Clinical outcome and technical difficulties observed after total hip arthroplasty subsequent to osteotomy of the proximal femur were studied in 75 total hip arthroplasties. MATERIAL AND METHOD: Sixty-four patients underwent 75 total hip arthroplasty procedures at the Caen University Hospital between 1978 and 1995. These patients were reviewed at least two years after implantation. The Postel Merle d'Aubigné (PMA) score was used to assess clinical outcome and the Lequesne criteria to determine acetabular and femoral parameters on the weight-bearing AP radiograph. Off-set of the femoral epiphysis was determined by measuring the relation between the femoral shaft axis and the digital fossa. The population was composed of young active subjects who had had several operations. The main underlying diseases were: congenital dislocation of the hip (32%), dysplasia (23%), and primary degenerative hip disease (34%). Two-thirds of the hips were stiff and more than three-quarters were unstable. There were 28 osteotomies for varisation, 19 medial translations, 20 osteotomies for valgisation, and 7 subtrochanteric osteotomies. All femoral pieces except one were cemented. Implantation required 39 trochanterotomies, 39 Hardinge approaches, and 5 deosteotomies. RESULTS: The medial offset of the digital fossa compared with the diaphysis led to operative difficulties and femoral complications: Their were eight femoral fractures: 7 of these occurred with a digital fossa situated medially to the diaphysis. The Postel-Merle-d'Aubigné score at last follow-up was satisfactory in 57 cases (76%). Among the 18 non-satisfactory results, there was 7 failures requiring surgical revision, 5 potential loosenings, and 6 stiff hips in patients with congenital dislocation. For the 7 revisions (9.3%), 3 were for infection (2 late hematogenous), 1 for early dislocation, 2 for aseptic acetabular loosening, and 1 for aseptic femoral loosening. Medial translation of the digital fossa led to a larger number of varus positions (44%). For femoral cementing, 10 hips showed a non-progressive secondary lucent line; these prostheses were considered as potentially loose. Among them, varisation osteotomies has been performed in 5 cases, and in 8 the digital fossa was medial to the diaphyseal axis. There was only one aseptic femoral loosening requiring surgical revision. Implant survival, established according to the actuarial method, was 94.9% at 10 years. DISCUSSION: The almost 95% implant survival at 10 years observed in our patients is comparable with most reports in the literature and slightly better than those reported at the 1997 SOFCOT symposium on total hip arthroplasty after 50 years (84%). The most important factor determining surgical difficulty and operative complications at the femoral level was the position of the digital fossa, more than the type of initial osteotomy. CONCLUSION: Indications for osteotomy must account for subsequent total hip arthoplasty. Implantation is difficult after subtrochanteric osteotomy which can cause important technical problems. The rate of failure is very high. The risk of femoral complications and misalignment of the femoral stem, irrespective of the type of initial osteotomy, is greater when the digital fossa lies medially to the diaphyseal axis. We prefer trochanterotomy or desosteotomy for such cases. Osteotomy did not rule out arthroplasty for any of the femurs. There were however important operative difficulties and the frequency of complications suggest we should be most prudent about careful preoperative planning in the frontal plane.

Adult↗
PubMed2001

[Dual x-ray absorptiometry assessment of bone density of the proximal tibia in advanced-stage degenerative disease of the knee].

PURPOSE OF THE STUDY: Axial deformity secondary to degenerative joint disease of the knee can modify stress forces. Certain studies have reported an inversely proportional relationship between degenerative disease and osteoporosis. The aim of this prospective study was to quantify the horizontal linear distribution of bone density using dual x-ray absorptiometry (DXA) of the proximal tibia as a function of the femoral neck bone density in patients with knee osteoarthritis. MATERIAL AND METHODS: Between September 1996 and March 1998, 90 cases of primary degenerative joint disease of the knee were programmed for total knee arthroplasty. Prior to the procedure, the patients were assessed clinically and radiologically according to the International Knee Society (IKS) criteria. The mechanical femorotibial angle was measured in all patients and the varus angles were recorded. Most of the patients were women (65 p. 100) with a mean age of 70 +/- 5 years. Valgus knees were excluded from this series. The mean mechanical femorotibial angle was 172 +/- 5 degrees. Fifteen patients had a normal axis (16 p. 100), 32 had a varus measuring 4 degrees to 10 degrees (35 p. 100) and 43 had a varus measuring 10 degrees or more (48 p. 100). The overall varus distance was 6.4 +/- 2 cm. All patients had two DXA explorations: femoral neck to determine the bone status according to the WHO criteria (normal, osteopenia, osteoporosis), knee to determine the linear distribution of bone density of the proximal tibia. A 7 mm high band including 7 regions of interest covering the width of the tibia were explored in the area where the tibial cut was to be made. These 7 regions of interest were: R1, R2 under the lateral compartment, R6, R7 under the medial compartment, and R3, R4, R5 on either side of the tibial spines. The level of significance was set at 5 p. 100. RESULTS: The mean Z score (0.54 +/- 1) in the 90 patients showed a symmetrical distribution. These patients were representative of their age range. Their T score was - 1.40 +/- 1 (m +/- SD) and most had osteopenia (54 p. 100) according to the WHO criteria, although 16 p. 100 had osteoporosis. Mean bone density of the knee was 0.898 +/- 0.163 g/cm(3) and was correlated with that of the femoral neck (r=0.61, p=0.001). There were significant correlations between the differences in the bone densities of the knee compartments (R6-R2, R7-R1) and the mechanical femorotibial angle [(r=0.39, p=0.0001); (r=0.52, p=0.001)]. Irrespective of the overall bone density, there was a strong medial compartment overloading, which correlated with the degree of varus deformation. CONCLUSION: DXA assessment of bone mineral density of the proximal tibia is a simple, reliable, precise and reproducible method. The distribution of bone density in the degenerative knee depends on the degree of deformation. The average level depends on the subject's general state of mineralization. Osteoporosis does not protect against degeneration of the knee joint since 16 p. 100 of our patients had osteoporosis according to the WHO criteria.

Absorptiometry, Photon↗
PubMed2001

Inhibition of Na(+)/K(+)-atpase by endothelin-1 in human nonpigmented ciliary epithelial cells.

Endothelin-1 (ET-1), a potent vasoconstrictor, lowers intraocular pressure in mammals, either by enhancing the outflow of aqueous humor (AH) via the trabecular meshwork and Schlemm's canal or by reducing AH formation at the ciliary epithelium. Aqueous humor production occurs by passive diffusion of water coupled with active transport of ions, mainly involving Na(+):K(+):2Cl(-) cotransporter and Na(+)/K(+)-ATPase pump from serosal to aqueous side. Presently, we have evaluated the effects of ET-1 on Na(+):K(+):2Cl(-) cotransport and Na(+)/K(+)-ATPase activity in HNPE cells using (86)Rb(+) uptake. ET-1 (100 pM-100 nM) decreased mean (86)Rb(+) uptake by 15% during a 15-min uptake period. ET-1's effect was not prevented by BQ610, an ET(A) receptor antagonist, but was blocked by BQ788, an ET(B) receptor antagonist. ET-1's effect was mimicked by sarafotoxin, an ET(B) agonist. ET-1-induced reduction in (86)Rb(+) uptake was additive with bumetanide, a selective inhibitor of Na(+):K(+):2Cl(-) cotransporter but not with ouabain, a selective inhibitor of the Na(+)/K(+)-ATPase. ET-1 did not affect iberiotoxin-sensitive maxi K(+) channels. This suggests that ET-1-induced reduction in (86)Rb(+) uptake is mediated through the inhibition of the Na(+)/K(+)-ATPase via an ET(B)-like receptor. These findings are consistent with an ET-1 effect on active ion transport activity in HNPE cells that could explain the reduction in aqueous humor production and the lowering of intraocular pressure.

Antihypertensive Agents↗
PubMed2001

[Arthroscopy-assisted revision in failed reconstruction of anterior cruciate ligament: 32 cases].

PURPOSE OF THE STUDY: The aim of this retrospective study was to analyze mid-term outcome after anterior cruciate ligament (ACL) revision performed arthroscopically with a patellar tendon graft. MATERIAL AND METHOD: The series included 32 revision arthroscopies for ligamentoplasties of the ACL performed after primary intraarticular plasty. Outcome was assessed using the IKDC score at least 2 years after revision surgery. A free patellar autograft was used in all cases in association with an anterolateral plasty in 9 cases using the Marshal-MacIntosh technique. There were 25 men, mean age 28.5 years. Mean follow-up was 4 years. The initial plasty was done with a synthetic ligament in 15 cases and an autograft in 17, including 12 patellar tendons. In 3 cases, the revision was needed for synovitis involving the synthetic ligament. In all the other cases, revision was indicated for instability, most of the failures resulting from a defective femoral position (particularly for autografts) or renewed trauma. RESULTS: Among the 23 patients who were initially competition-level athletes, 18 recovered their sports activity, 8 at an equivalent level. At last follow-up, the IKDC global scores were: A 5 patients (15.6%), B 16 patients (50%), C 8 patients (25%), D 3 patients (9.4%). Certain residual laxity was present in 3 cases (C and D laxity score for 2 of them). A tibiofemoral narrowing was present in the medial compartment in one patient alone. Factors of poor prognosis for the IKDC score were: long delay from accident to initial treatment (p=0.04), associated medial meniscectomy (p=0.02). Presence of an initial femoral tunnel had no effect on revision due to its very anterior situation. DISCUSSION: The technical difficulty of revision of an intra-articular ligamentoplasty of the ACL is to position the new transplant so it will satisfy the same requirements as the initial plasty. This position depends particularly on the femoral component due to the importance of the position of the initial femoral tunnel and the degree of bone loss (osetolysis, ablation of an interfering screw.). The homolateral patellar tendon was used for the graft in all cases except one and iterative use of the patellar tendon for grafting did not cause supplementary morbidity. The patellar tendon remains the transplant of choice for ligament reconstruction. Meniscectomy had a deleterious effect on the final outcome. As for first intention plasty, the therapeutic strategy should preserve as much meniscal stock as possible, depending on the type and degree of damage. CONCLUSION: Revision ACL plasty can provide good anatomic results although functional outcome is less satisfactory than after primary intention ligamentoplasty. A precise clinical and radiographic analysis of the cause of failure of the primary plasty must be obtained in order to establish a surgical strategy allowing the most clinically effective plasty with well positioned bone tunnels.

Adult↗
PubMed2001

[Outcome of 95 stable meniscal tears left in place after reconstruction of the anterior cruciate ligament].

PURPOSE OF THE STUDY: The purpose of this retrospective analysis was to study clinical and radiological outcome of 95 stable meniscal tears left in place after arthroscopic reconstruction of the anterior cruciate ligament with a free patellar autograft (with or without a lateral component). MATERIAL AND METHODS: We reviewed 86 patients who had undergone arthroscopic treatment for chronic anterior laxity (56% solely anterior laxity) with at least one meniscal lesion left in place after ligamentoplasty. IKDC criteria and ARPEGE scores were recorded. A total of 95 stable meniscal lesions had been left in place: 35 lateral lesions (80% longitudinal tears and 77% posterior lesions) and 60 medial lesions (55% peripheral disinsertions and 90% posterior lesions). The lesions measured a mean 10 mm (range 5-20 mm) for the lateral and medial menisci. Mean follow-up was 4 years (range 3-9 years). These patients were young (mean age 26 years), and predominantly men (75%). The right knee was involved in 53% of the cases. RESULTS: At last follow-up, 26% of the patients were grade A, 65% B, 7% C and 2% D according to the IKDC criteria. No revision procedure was required for lateral menisci despite the large size of the lesions left in place in certain cases. Among the 60 medial lesions left in place, 10 (17%) had become symptomatic (8 bucket-handle, 1 longitudinal tear, 1 posterior fragment) and required surgery a mean 3 years (range 1-6 years) after ligamentoplasty. There was no statistical difference between functional score, residual laxity, or type of stabilization in patients who had revision surgery for symptomatic meniscal lesions and the others. Inversely, these lesions were statistically larger (p=0.038) than the others (mean 13 mm versus 9.8 mm). CONCLUSION: Outcome of stable meniscal lesions left in place after treatment for anterior laxity depends on the meniscus involved. For the lateral meniscus, irrespective of the size of the lesion, therapeutic abstention has no clinical impact at 4 years. Inversely, for the medial meniscus, 37.5% of the lesions measuring more than 10 mm that were left in place required revision while only 9% of those measuring less than 10 mm necessitated subsequent surgery. Beyond 10 mm, therapeutic abstention led to a revision procedure in 17% of the cases, suggesting the usefulness of a discussion on other indications. Stable lesions of the medial meniscus should not be left in place if they measure more than 10 mm.

Adult↗
PubMed2000

[Functional gait adaptations in patients with painful hip].

PURPOSE OF THE STUDY: This prospective study was conducted to analyze the mechanisms of gait compensation in patients with painful hip and to search for correlations with preoperative clinical and radiographic findings. MATERIAL AND METHODS: Optoelectronic and multicomponent force-plate datas were used to calculate joint motion, moments and intersegmental forces for 26 patients with unilateral hip pain and 20 normal age and sex-matched patients. Height was similar in the two groups but mean weight in the study group (83 kg) was greater than in the controls (68 kg). The preoperative Harris score was 53 in the study group and 16 patients had a permanent flexion contracture of the knee (mean 15 degrees, range 5-30 degrees). Radiographically, there were 22 cases of osteo-arthritis hip disease and 4 cases of necrosis. RESULTS: Gait analysis showed a significant 0.66 +/- 0.06 m (12 p. 100) reduction in step length. Patients who had severe hip pain walked with a decreased dynamic range of motion (18 +/- 5 degrees, p<0.0001) with a curve reversal as they extended the hip. They also reduced dynamic range of motion of the knee and ankle. Patients who presented a reversal in their dynamic hip range of motion had a greater passive flexion contracture and a greater loss in range of motion during gait than those with a smooth regular pattern (p<0.0001). Patients with hip pain walked with significantly decreased external extension, adduction, and internal and external rotation moments (p<0.0001). They also unloaded the ipsilateral knee and ankle. The decreased hip extension moment was significantly correlated with an increased level of pain (p<0.0001). There was no correlation with radiological findings. DISCUSSION: Reversal of dynamic hip range of motion was interpreted as a mechanism to increase effective hip extension during stance phase through increased anterior pelvic tilt and lumbar lordosis. CONCLUSION: Patients with painful hip walked with a manner that was asymmetric. These gait modifications were related to hip limitation in passive motion and pain. Patients with flexion contracture adopted a compensatory gait mechanism. This study confirms relation between hip pain and forces across the hip joint.

Adaptation, Physiological↗