[Multicenter study of 210 rotator cuff ruptures treated with arthroscopic acromioplasty].
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Acromion↗
Biomedical subjects
J F Kempf
Publications and source records attributed to J F Kempf.
[Results of endoscopic treatment of tendinopathies of the rotator cuff (excluding total ruptures). 1: Non-calcifying tendinopathies].
The authors have studied the result of endoscopic treatment in 129 non ruptured and non calcified tendinitis of the rotator cuff as well as 33 partial thickness tears included in a multicentric study made by the french arthroscopic society. The files included a revision form using Constant's functional evaluation and filled by a physician different from the operator, and a radiological standardized evaluation allowing to appreciate, from A.P. and lateral views, the acromion shape and the importance of the resection. From the analysis of our results it appears that acromioplasty associated with a section of the coraco-acromial ligament (C.A.L.) under arthroscopic control is very efficient in tears of the superficial, bursal face of the rotator cuff. The same did not apply to the tears of the deep, articular face, as their origin is probably different. In non ruptured and non calcified tendinitis, 90 per cent of our patients were subjectively better. According to Constant's index, we noticed 75 per cent of satisfactory results. The importance of acromioplasty was not related to good results. We therefore think that one should relativise the notion of impingement between the coraco-acromial arch and the tendons of the rotator cuff. Acromioplasty is only effective on one of the factors of tendinous pain. The improvement of our indication by a better knowledge of this pathology should allow us to improve the results of an endoscopic procedure which is now well known and whose advantages do not need to be demonstrated any more.
Activities of Daily Living↗
[Results of endoscopic treatment of non-broken tendinopathies of the rotator cuff. 2. Calcifications of the rotator cuff].
The authors studied the results of the arthroscopic treatment of the chronic calcifying tendinitis within a multi-center study of the French Society of Arthroscopy. 112 patients were available for the study. All shoulders had a preoperative radiographic clinical and radiographic evaluation. At follow up, functional results were assessed, using the Constant score, and X rays allowed to appreciate the acromial shape and the calcific deposit aspect. Several arthroscopic procedures were used on the calcification (respect or removal), and the coracoacromial arch (respect, ACL release or acromioplasty). This study found an objective success rate of 89 per cent and a patient subjective satisfaction rate of 82 per cent. Based on follow up radiographs, 88 per cent of the patients had a complete disappearance of the calcific deposit. There were no recurrence, no secondary rotator cuff tear. The results were not correlated with the age of the patients, or with the radiographic aspect (type, size, localization) of the calcification. The results were correlated with the arthroscopic procedure: they were better when the calcification had been removed (superior to deposit respect). Associated acromioplasty gave no better results: it was only considered as necessary when the calcification was not found (12 per cent). The greatest care must be taken in the surgical indication for this pathology because of a high rate of spontaneous resorption. The authors conclude that the arthroscopic surgery is a very effective method for chronic calcific tendinitis, compared to open procedure.
Adult↗
[Exploration of menisci of the knee by MRI. Value of the acquisition 3D].
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Humans↗
[Experimental study of surgical cement reinforced with wire mesh].
We have used wire mesh in association with PMMA cement in six patients to reinforce a deficient medial acetabular wall. None of these cups show signs of loosening. We therefore investigated experimentally the mechanical characteristics of HDP cups embedded in cement reinforced with wire mesh. The mesh appears to increase the resistance of the cement to tensile stress and associated loading forces at the bone/cement interface by the "stiffening" affect of the metal framework.
Acetabulum↗
[Comparison of mechanical qualities of cortical bone preserved by various freezing methods].
The purpose of this study was to compare the mechanical properties of the human cortical bone following three deep-freezing techniques: addition of D.M.S.O. (di-methyl-sulfoxide) and staged decrease of temperature with immersion into liquid nitrogen, immersion into nitrogen without cryoprotection, deep freezing in an electric device, down to -80 degrees C. Axial loading tests performed on two femurs (88 samples) allowed to determine the strain of failure fmax and the Young's modulus E. Torsion tests were undertaken on four femur (66 samples) to obtain the strain failure tmax and the Young's modulus G. We have taken several samples from the cortex, that we randomly divided into four groups, three of them being deep-frozen with one of the methods studied, the fourth being tested "fresh", after standard sample manufacturing. The results obtained at the fresh state were comparable with those published in the literature (fmax = 158 MPa, E = 9000 MPa, tmax = 60 MPa, G = 4000 MPa). The results obtained after deep freezing both in axial loading and in torsion, demonstrated significant differences, ever though of low value. The surgeon may use one of either freezing method, without fearing any deterioration of the mechanical properties that could threaten the primary stability of the graft. However, only liquid nitrogen permits a long lasting storage, and only the use of cryoprotection can give the hope of preservation of the chondrocytes in case of diaphyseal-epiphyseal grafts.
Bone Transplantation↗
Single oral dose pharmacokinetics of the two main components of pristinamycin in humans.
A preliminary study of the pharmacokinetics of the two main components of pristinamycin, PIA and PIIA is reported. A single oral dose of 2 g of pristinamycin was administered to six patients with normal renal and hepatic function. The samples were withdrawn during 9.5 h and assayed by HPLC. PIA and PIIA plasma levels evolved in parallel in each subject and their kinetic parameters were comparable: Tmax of 3.25 +/- 1.80 h and 3.08 +/- 1.98 h, Cmax of 0.760 +/- 0.427 mg/l and 0.581 +/- 0.285 mg/l, elimination half-life of 4.03 +/- 2.77 h-1 and 2.83 +/- 0.75 h-1, respectively. The relative proportions of PIA and PIIA, which govern the antibacterial activity of the mixture, were maintained during the study in the range of values leading to 90-100% of optimal activity against Staphylococcus aureus. The sum of the plasma concentrations of PIA and PIIA, which can be considered to be equivalent to the concentration of total pristinamycin, was superior to the MICs for the most susceptible staphylococcal strains during the entire period of study. On the other hand, the sum of PIA and PIIA concentrations exceeded the MICs for the less susceptible strains for only 4 h. These results differ from the scanty pharmacokinetic data presently available, which were obtained by microbiological methods.
Administration, Oral↗
[The value of perforating cryopreserved massive bone allograft. Histologic data of an allograft removed after 27 months].
The authors reported one documented observation of a deep-frozen, non irradiated, intercalary allograft; it was perforated by drilling and then fixed by a blade plate. This allograft was removed 27 months after its implantation. Histological examination of the removed bone graft showed newly formed mature bone which developed near preexisting devitalized bone. The external cortex was also revitalized and reossified close to the periosteum, as it was previously reported. But osteogenesis filled all the paths of the perforations and extended to the haversian canals located in the vicinity of the perforations. The authors conclude that cortical perforations induce both cortical and medullary osteogenesis of the graft. If osteogenesis is observed in the whole medullary canal, it is more focal and located in the vicinity of the holes in the cortex.
Bone Neoplasms↗
[Uncommon surgical treatment of a tibial fibrous bone dysplasia].
The authors present an original method of treatment in prevention of fracture of the tibial shaft applied in one case of polyostosic fibrous dysplasia of bone. They treated this localization by closed intramedullary reaming and stuffage with cancellous bone grafts.
Adolescent↗
[Efficacy and tolerance of low molecular weight heparin in the prevention of deep venous thrombosis during non-emergent total hip arthroplasty. A prospective, multicenter trial].
A multicenter prospective trial was conducted on 149 patients to test the efficacy and tolerance of low molecular weight heparin (LMWH) in the preventive treatment of deep venous thrombosis consecutive to total hip arthroplastic surgery. An original dose-adjusted protocol was tested, whereby the patients were injected a single dose of LMWH daily, determined on a weight and operation date basis; the prophylactic efficacy of this protocol was assessed by bilateral phlebography performed systematically on the 10th postoperative day. Only 12.9% of patients developed deep venous thrombosis of the lower extremities, and the thrombus formation site was proximal in 3.6% of cases. These rates are low compared with published data and considering the diagnostic criterion used. The low incidence of premature treatment withdrawal and hemorrhagic complication (2%) cases is indicative of the good tolerance of this preventive treatment.
Adult↗
[Intrameniscal ossicle of the knee (lunula). Apropos of a case. Review of the literature].
An intrameniscal ossicle was discovered and resected by arthroscopy in the anterior horn of a medial meniscus. Intrameniscal ossicles are exceptional; 33 cases are described in the literature. In the great majority of cases, they are discovered in the posterior horn of the medial meniscus in young males. These ossicles most often cause diffuse pain in the knee, but may be asymptomatic. Conservative treatment seems to be recommended in the majority of the cases.
Adolescent↗
[Resection-reconstruction of the femur shaft by a massive allograft fixed by an interlocking nail].
Case report of a central midshaft osteosarcoma of the femur, treated conservatively under Rosen procedure. Bone resection was followed by reconstruction with a deep frozen (-196 degrees) conserved massive homograft, fixed by an interlocked Kuntscher's nail. The purpose of this paper is to expose the advantages of this type of fixation, V.S. conventional nails, or plates. X-Ray showed a bridging bone spindle between host and graft cortical bone, induced by initial stability of the nail, and a rapid fusion after secondary dynamisation of the nail, by removing one screw. We obtained an early functional recovery and a complete and rapid autonomy necessary to allow social and school reinsertion, whatever should the medium or long term presumed survival be.
Adolescent↗
[10-year follow-up of a homogeneous series of 467 total hip prostheses of the Charnley-Müller type. Study of 167 cases].
Four hundred and sixty-seven hips were operated upon by the authors between 1969 and 1974 using the Charnley-Müller prosthesis. 167 were reviewed with more than a ten-year follow-up. Eighty-one per cent were satisfactory after the initial procedure. In 56 cases an aseptic loosening had to be revised. At the femoral level, a varus position of the stem and the presence of cement between the calcar and the prosthesis appeared to be the responsible factors. At the acetabular level the causes of the loosening were an excess of cement, more than 10p. 100 uncovering of the cup by the acetabulum and, particularly, asymmetrical wear of the cup of more than one mm. A pathological study of 20 cases showed that particles of cement cause granulomata to develop all round the prosthesis. Polyethylene wear increases the frictional torque and produces micro-fractures of the cement at the bone-cement interface. It is concluded that the femoral stem should be as thick as possible and that the collar of the prosthesis is useless. Frictional torque should be as low as possible. The use of a metal mesh appears to be beneficial for the cementing of the acetabular cup.
Adult↗
[Statistical study of a series of 355 subtalar fractures of the calcaneus. Therapeutic conclusions].
A retrospective study has been made of 355 fractures of the os calcis involving the subtalar joint in order to determine the best method of treatment. A rating system was used to assess the different types of injury. The results were correlated with the pattern of depression of the posterior articular surface, the quality of restoration of this surface and the type of trauma. We conclude that Duparc Stage V fractures require reconstruction/arthrodesis (the Stulz proceedure). Duparc Stage I fractures, and Stage III or IV with grade I depression, should be treated conservatively with early mobilisation. Stage III or IV fractures with grade II or III depression require operation in order to restore and maintain a congruent posterior joint surface to allow early mobilisation.
Accidents, Occupational↗
[Posterior rotation osteotomy of the femoral head in femur head necrosis].
Since 1969 the authors have been developing a technique of posterior rotation osteotomy based on the concept of L. Molé as a conservative treatment for avascular necrosis of the femoral head in the adult. The technique consists of rotating the head round the axis of the neck so as to displace the necrotic bone from the weight bearing area to the posterior part of the joint. It is a safe procedure which leaves the joint undisturbed, the muscles intact and the vessels of the femoral head undamaged. It must be done very precisely to avoid undesirable displacement of the head. Since 1979 the technique has been modified in the light of Sugioka's concepts. It is indicated for grades II and III necroses. Twenty-six cases have been operated on and followed up for a maximum of 15 years. Seventy-five percent of the results were satisfactory as far as pain and function were concerned. The radiographic evaluation has shown no progress of the necrotic zones, but arthrosis, often severe, almost always appeared even though it was clinically silent. Although the procedure does not allow healing of the lesion, it permits conservation of the femoral head for some years and thus delays the need for arthroplasty.
Adult↗
[Cylindrical cancer of the lung. Analysis of a series of 191 cases].
The authors analyse 191 cases of cylindrical carcinoma of the lung. Study of the clinical and radiological characteristics, as well as the course, revealed the following: the reduced male predominance of this type of lesion, the often distal site and the primary pulmonary nature. The prognosis is identical to that for squamous forms: 31% survivors at 5 years.
Adenocarcinoma↗
[Post-traumatic hemarthrosis of the knee. Diagnostic steps and value of arthroscopy].
The authors report their experience of the arthroscopic diagnosis of acute traumatic hemarthrosis of the knee. They point out the value of testing stability under anaesthesia. A very important laxity, according to severe damage of peripheric structures and cruciate ligaments, need surgical repair. Otherwise, in all cases with minor instability, arthroscopy is very useful: some arthrotomies are so avoided, some associated lesions were diagnosed. Any way arthroscopy is reported to allow adequate treatment of traumatic hemarthrosis of the knee.
Arthroscopy↗
[Rotational 90 degrees Posterior osteotomy in the treatment of necrosis of the femur head].
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Femur Head Necrosis↗