Biomedical subjects

J P Franceschi

Publications and source records attributed to J P Franceschi.

At least 19 recordsLinked to original sources

PubMed2004

[Focused lithotripsy in the treatment of tendinosis calcarea of the shoulder: results at 2 months and one year].

OBJECTIVE: The authors report their experience with extracorporeal lithotripsy in 30 patients with calcific tendinosis of the rotator cuff. MATERIALS AND METHOD: This technique is based upon the utilization of high-energy shockwaves (6000 shocks in 3 sessions Day 1, D8, D30) under continuous ultrasound localization of the lesion (EPOS Ultra1). Calcification were evaluated at plain film, US and CT to characterize their length and features. RESULTS: Complete or partial resorption of calcifying deposits within 2 months and one year was observed in 27.5% and 25% of cases respectively. Clinical improvement results are encouraging at two months (50%), but reduced at one year (28.5%), consistent with the rate of resorption of calcifications. CONCLUSION: This painful, long, and expensive technique seems to be disappointing in the treatment of the calcific tendinosis.

Adult↗

PubMed2002

Reorganization of equilibrium and movement control strategies after total knee arthroplasty.

This work was aimed at identifying changes in posturomotor control strategies in patients with unilateral total knee arthroplasty. Using kinetic and kinematic data, a previous study had revealed that, during a side step, patients with unilateral knee arthritis showed a shortened monopodal phase and a lengthened postural phase when the affected leg was the supporting one. It was expected that these strategies would be modified after undergoing total knee arthroplasty. Postoperatively the durations of the monopodal phase and of the postural phase became similar when the operated limb was supporting and when the sound limb was supporting. Concerning the upper body movements, the same asymmetrical results as before surgery were observed. Hence, patients with total knee arthroplasty exhibit posturomotor strategies which, although they become close to normal, remain asymmetrical. The durations of the monopodal and of the postural phases could be considered to assess the results of total knee arthroplasty.

Aged↗

PubMed2002

[Arthroscopic reconstruction of the anterior cruciate ligament using double anteromedial and posterolateral bundles].

We propose a method for repairing the anterior cruciate ligament which takes advantage of the multifascular nature of the ligament to achieve better physiological anteroposterior and rotational stability compared with conventional methods. Arthroscopic reconstruction of the anteromedial and posterolateral bundles of the ligament closely reproduces normal anatomy. We have used this technique in 92 patients with anterior cruciate ligament laxity and present here the mid-term results. The hamstring tendons (gracilis and semitendinosus) are harvested carefully to obtain good quality grafts. Arthroscopic preparation of the notch allows careful cleaning of the axial aspect of the lateral condyle; it is crucial to well visualize the region over the top and delimit the 9 h-12 h zone for the right knee or the 12-15 h zone for the left knee. The femoral end of the anteromedial tunnel lies close to the floor of the intercondylar notch, 5 to 10 mm in front of the posterior border of the lateral condyle, at 13 h for the left knee and 11 h for the right knee. The femoral end of the posterolateral tunnel lies more anteriorly, at 14 h for the left knee and 10 h for the right knee. The tibial end of the posterolateral tunnel faces the anterolateral spike of the tibia. The tibial end of the anteromedial tunnel lies in front of the apex of the two tibial spikes half way between the anteromedial spike and the anterolateral spike, 8 mm in front of the protrusion of the posteriolateral pin. The posterolateral graft is run through the femoral and tibial tunnels first. A cortical fixation is used for the femoral end. The femoral end of the anteromedial graft is then fixed in the same way. The tibial fixation begins with the posterolateral graft with the knee close to full extension. The anteromedial graft is fixed with the knee in 90 degrees flexion. Thirty patients were reviewed at least six months after the procedure. Mean age was 28.2 years. Mean overall IKDC score was 86% (36% A and 50% B). Gain in laxity was significant: 6.53 preoperatively and 2.1 postoperatively. Most of the patients (86.6%) were able to resume their former occupation 2 months after the procedure. The different components of the anterior cruciate ligament and their respective functions have been the object of several studies. The anteromedial bundle maintains joint stability during extension and anteroposterior stability during flexion. The posterolateral bundle contributes to the action of the anteromedial bundle with an additional effect due to its position: rotational stability during flexion. In light of the multifascicular nature of the anterior cruciate ligament and the residual rotational laxity observed after conventional repair, our proposed method provides a more anatomic reconstruction which achieves better correction of anteroposterior and rotational stability. This technique should be validated with comparative trials against currently employed methods.

Adult↗

PubMed2000

Asymmetry of gait initiation in patients with unilateral knee arthritis.

OBJECTIVE: To identify how patients with knee arthritis modify their equilibrium and movement control strategies during gait initiation. DESIGN: Observational study. SETTING: University hospital movement analysis laboratory. PARTICIPANTS: Twelve patients with unilateral knee arthritis and 12 healthy control subjects. MAIN OUTCOME MEASURES: Durations of the phases of gait initiation (ie, postural, monopodal, and double-support phases), center-of-pressure displacements, ground reaction forces, pelvic velocity, step length, and knee range of motion were measured using a movement analysis system and force plates. RESULTS: Gait initiation was slower in patients than in controls no matter which leg was the supporting one. In patients, the durations of the postural and the monopodal phases were modified in an asymmetrical way according to the leg used as the supporting one. The postural phase was lengthened and the monopodal phase was shortened when the affected leg was the supporting one. Opposite effects were observed when the sound leg was supporting. Step length, knee range of motion, and maximal pelvic velocity were reduced in patients whatever the side of the supporting leg. CONCLUSION: Gait initiation is an asymmetrical process in unilateral knee arthritis patients, who develop adaptive posturomotor strategies that shorten the monopodal phase on the affected leg.

Aged↗

PubMed1999

Surgical management of calcific tendinitis of the shoulder: an analysis of 26 cases.

Chronic calcific tendinitis of the shoulder has good results after medical treatment in most cases. Around 10% of the patients resistant to medical treatment require surgery. We report 22 patients operated on using an open procedure. The operation included removal of the calcific deposit and an acromioplasty. The patients were rated preoperatively and postoperatively for pain, limitations in activities of daily living, range of movement and power according to a questionnaire and the Constant assessment. Globally the average score increased from 52.2 points out of 100 at the preoperative examination to 89.3 postoperatively with a mean follow up of 23 months. The most favourable results are obtained in patients with the longest interval between onset of disease and intervention (over 1 year) and with a progressive course of disease. Different techniques are discussed. Arthroscopically assisted procedures and open techniques are compared.

Acromion↗

PubMed1999

Reorganization of equilibrium and movement control strategies in patients with knee arthritis.

The purpose of this study was to identify changes in equilibrium and movement control strategies in patients with arthritis of the knee. These strategies were expected to be different from those of healthy subjects because of the impairments caused by knee arthritis. The different phases of a side step were studied in patients with severe knee arthritis using a movement analysis system and force-plates. The duration of the postural phase and the intensity of the horizontal ground reaction forces during the postural phase were increased when the pathological limb was the supporting one. The monopodal phase was shortened on the pathological leg. These results show that knee arthritis patients develop new posturomotor strategies mainly aimed at shortening the monopodal phase when the affected leg is the supporting one. This movement analysis method enables quantification of differences that cannot be observed on clinical examination between knee arthritis patients and control subjects, and provides additional information to the usual clinical evaluation scales.

Aged↗

PubMed1999

[Influence of knee replacement arthroplasty on modalities of weight transfer during the lateral step].

INTRODUCTION: The aim of this work was to study the relations between equilibrium and movement in patients after total knee arthroplasty. A previous study, conducted in patients with unilateral knee osteoarthritis, had shown that the timing of the events occurring during a side-step was modified in an asymmetrical way according to the supporting leg with respect to the affected one. METHOD: A kinetic and kinematic analysis was performed in a population of 9 patients before and after total knee arthroplasty and in 11 control subjects, using an ELITE system and two AMTI force-plates. The different phases (i.e. postural, monopodal, landing and stabilization) of a side step were studied. RESULTS AND DISCUSSION: Before surgery, the postural phase was longer and the monopodal phase was shorter in knee arthritis patients when the affected leg was the supporting one than when the sound leg was supporting. Total step duration and landing-stabilization phase duration were longer in patients no matter which leg was supporting than in control subjects. After total knee arthroplasty, the postural phase remained longer when the operated leg was supporting than when the sound leg was supporting. Altered proprioception can provide an explanation for this result. However, the duration of the postural phase decreased significantly when the operated leg was supporting as compared to when the affected leg was supporting before surgery. The duration of the monopodal phase was the same when the operated leg was supporting than when the sound limb was supporting and increased significantly as compared to when the affected leg was supporting before surgery. This result can be related to the decrease of pain which was observed in all patients after surgery. The duration of the landing-stabilization phase and the total movement duration remained longer in patients after surgery no matter which leg was supporting than in control subjects. CONCLUSION: This study shows that relations between equilibrium and movement tend to become symmetrical with respect to the leg used as supporting one in patients after undergoing total knee arthroplasty but remain different from those of control subjects. This movement analysis method enables to determine and to quantify differences in patients before and after undergoing total knee arthroplasty and thus provides additional information for the functional evaluation of patients with total knee prosthesis.

Aged↗

PubMed1999

[Traumatic ruptures of the pectoralis major muscle. Apropos of 3 cases].

INTRODUCTION: Three ruptures of the pectoralis major are reported. The mechanism of injury was excessive external rotation with high muscular tension. Rupture of muscle often occurs at the humeral insertion or musculotendinous junction. MATERIAL AND METHODS: In the three cases, surgical repair was performed. Suture could be made without excessive tension. Patients were immobilized in a sling for three weeks. Passive exercises were begun at 3 weeks. RESULTS: All patients recovered and had postoperatively the same sport level as before. In late surgical repair the consistent fibrosis makes dissection of the ruptured tendon difficult and it's retraction hinders the suture. DISCUSSION: The symptoms are sometimes initially under evaluated. In limited number of cases the treatment may be delayed: functional disability and strength limitation justify surgical treatment. The results, however, are usually good according to the score of Mc Entire. Surgical repair is recommended in distal ruptures in active patients to restore previous muscle strength and contour.

Adult↗

PubMed1999

[Isokinetic comparative study at the third postoperative month after surgery of the anterior cruciate ligament with arthroscopy or after mini-arthrotomy].

PURPOSE: A double blind prospective study was performed in 64 patients with a clinical and isokinetic assessment three months after anterior cruciate ligament (A.C.L.) reconstruction. MATERIAL AND METHODS: This work included 64 patients (47 males and 17 females), divided in two groups: 41 patients had an arthroscopically assisted bone-tendon-bone A.C.L. reconstruction, 17 had an open procedure. The isokinetic records concerned peak torque and muscular work at two different speeds. RESULTS: Three months after surgery there was no significant difference between both groups particularly what concerns the isokinetic assessment in muscular performances. Peak torque in hamstring averaged 151.4 Nm in the open procedure group and 149.2 Nm in the arthroscopically assisted group (p = 0.7), in quadriceps 156.10 Nm vs 149.3 Nm (p = 0.47). DISCUSSION: The advantages of arthroscopy in early muscular recovery are rarely admitted in medical literature. CONCLUSIONS: The favorable opinion of the authors to the arthroscopically assisted A.C.L. reconstruction concerning its rapid muscular recovery abilities is only based on subjective criterions.

Anterior Cruciate Ligament↗

PubMed1998

[Methods of shifting body weight in patients with knee arthroses].

INTRODUCTION: The aim of this work was to study movement control strategies in patients with knee arthritis. These strategies were expected to be different from healthy subjects because of deficiencies due to knee arthritis (i.e. pain, altered proprioception). METHOD: A kinetic and kinematic analysis was performed in a population of 10 patients with unilateral knee arthritis and in 11 age-matched control subjects, using an ELITE system and two AMTI force-plates. The different phases of a side step were studied. RESULTS: The timing of the movement was different in the two populations. The postural phase was longer and the monopodal phase was shorter in knee arthritis patients when the affected leg was the supporting one than when the sound leg was supporting. Total step duration and landing-stabilization phase duration were longer in knee arthritis patients than in healthy subjects. CONCLUSION: This movement analysis method enables to determine and to quantify differences between knee arthritis patients and control subjects. Clinical examination cannot identify these differences. Movement analysis methods bring up additional information to usual clinical evaluation scales and could be used for evaluation of the results of total knee arthroplasty.

Aged↗

PubMed1998

[Pigmented villonodular synovitis of the knee. Treatment results in 22 cases].

PURPOSE OF THE STUDY: The authors report their experience about 22 cases of pigmented villonodular synovitis of the knee observed between 1970 and 1997. The authors studied the results of treatments according to localization, evolutionary stage and condition of an early diagnosis. MATERIAL AND METHODS: Among thirty three cases of pigmented villonodular synovitis treated during the same period the knee was involved in twenty two cases. Diagnosis was done or highly suspected in 13 cases because of significant symptoms (iterative hemarthrosis, bony gap in both articular components of the joint) or by MRI. The biopsy performed in each case allowed histological assessment in 22 patients. Surgical treatment was achieved in 19 patients. Three knees were not operated (two patients refused; one had a synoviorthesis) the treatment was a synovectomy alone for fifteen patients; four patients, needed a knee prosthesis, because of important degenerative joint disease. RESULTS: Fourteen patients, with a mean follow-up of five years were reviewed. Four had a recurrence which appeared between three and eight years after subtotal synovectomy for diffuse synovitis. There were no recurrence after arthroplastic treatment and in localized lesions. DISCUSSION: Pigmented villonodular synovitis should be treated as soon as possible but its different clinical features make diagnosis sometimes difficult. Because of an aggressive tendency of the disease which finds expression in extensive lesions in joint and bone, and early diagnosis allowed by MRI could make the prognosis more favourable. CONCLUSION: Surgical synovectomy is the usual treatment. In evolved stages arthroplasties are performed. Localized lesions and recurrences should need arthroscopic treatment.

Adolescent↗

PubMed1997

Anterior cruciate ligament reconstruction by mini-arthrotomy.

We present 50 consecutive patients with chronic anterior cruciate deficiency treated by reconstruction of the ligament through a limited arthrotomy using the middle third of the patellar tendon as a graft. The patients were all men with a mean age of 26 years (range 17 to 36 years) with an average follow up of 24 months. There were good or excellent results as measured by the Lysholm score in 41, and in 27 with the ARPEGE score. Movements were full in 46 and retropatellar pain was experienced by 4.

Adolescent↗

PubMed1996

[Synovial cyst of the supracapsular notch of the shoulder with supracapsular nerve compression in a sportsman. Apropos of a case. Review of the literature].

PURPOSE OF THE STUDY: Compression of the supra scapular nerve by a ganglion is rare. The authors report a case evoking rotator cuff tendinitis. MATERIALS AND METHODS: A 28 year old right handed handball player was seen for increasing pain and weakness in the right shoulder. He was treated in a first time for a rotator cuff tendinitis. In a second time a new clinical examination revealed an amyotrophy of the supraspinatus fossa. Electromyographic studies showed a denervation of the infra and supraspinatus muscle. An MRI was performed and showed a ganglion cyst at the suprascapular notch. RESULTS: An excision by posterior approach was performed and led to an uneventful recovery of the patient. DISCUSSION AND CONCLUSION: This case reveals that an entrapment neuropathy of the suprascapular nerve can take the appearance of an ordinary rotator cuff tendinitis.

Adult↗

PubMed1995

[Tuberculosis of the greater trochanter. Apropos of 2 cases].

INTRODUCTION: The authors report two cases of tuberculosis of the greater trochanter as an uncommon localization in osseous tuberculosis. MATERIAL AND METHODS: 1st case: A 77 year old male presented with hip pain and swelling. Laboratory studies revealed an increased erythrocyte sedimentation rate. The patient had a positive skin test reaction for tuberculosis. Radiographs showed greater trochanter remodeling. M.R.I. demonstrated a bilobed abscess. There were enough arguments to initiate medical treatment, before surgery: excision of the abscess and partial trochanteric resection. 2nd case: In a 51 year old male, a large lytic lesion of the whole greater trochanter suggesting benign bone tumors was found an radiographs after a traumatism. Curettage and grafting were undertaken. The final diagnosis was made with the results of the intra-operative samples culture of and led to appropriate medical treatment. RESULTS: The outcome was good in both cases with four years follow-up for the first case, and two years for the second one. DISCUSSION: Trochanteritis Tuberculosis occurs in 1.8 per cent of bony tuberculosis cases. Local symptoms are discrete and the diagnosis is belatedly made when the tuberculous abscess appears. Radiographs and CT scan show the bony lesions: unevenness of the contours of the trochanter and several gaps in it. MRI shows the abscess and its spread. The microbiological test (when antibiotic therapy has not been initiated) and anatomo-pathological tests confirm the diagnosis. General treatment is based on a six month long specific antibiotic therapy. Local treatment concerns the abscess and the bony lesions. As the case may be; careful curettage is undertaken, or wide excision is performed.

Aged↗

PubMed1994

[Coraco-trochineal conflict or anteromedial conflict of the shoulder. Contribution of arthroscanners].

Like the anterosuperior subracromial conflict, the coracotrochineal or anteromedial conflict of the shoulder is a groove pathology. In a series of 340 patients who had an arthroscan of the shoulder, including 245 with a conflict syndrome (70%), we observed an anteromedial conflict in 12 cases (8.5%) of the 140 patients with an intact cuff and 52 cases (50%) in 102 patients with an injured cuff. The frequency of the anteromedial conflict appears to be proportional to the degree of cuff injury. We described the signs of the trochin suggesting the anterior musculotendinous structures (subscapsular tendon and/or long biceps tendon) are involved and conclude that the anteromedial conflict is often misdiagnosed. It would appear to be a frequent complication of cuff injury (mechanical theory) which the surgeon should take into consideration when repairing cuff injury.

Arthrography↗

PubMed1992

[Post-operative iatrogenic hallux varus. Surgical treatment. Apropos of 19 cases].

The post operative iatrogenic hallux varus associates varus, big toe's dorsal flexion and supination. The pathogeny is dominated by musculo-tendinous lack of balance created by the initial operation and excessive exostosectomy. The authors have nineteen times surgically corrected this deformation. The procedure included in all cases, a medial arthrolysis; five times associated with a screwed capito-metatarsal osseous shelf (or graft) (when there was a metatarsal's head maiming); thirteen times associated with a metatarso-phalangeal arthrodesis (in cases of impaired joint surfaces). The authors analyse, besides, without excluding them the other surgical procedures for hallux varus, and particularly tendinous transfers. The results show the necessity of a perfect etiopathogenic analysis of the deformation.

Adult↗

PubMed1992

Serum and synovial fluid osteocalcin in rheumatic diseases.

The mechanisms involved in juxta-articular bone destruction are poorly understood. Osteocalcin or gamma-carboxyglutamic acid (GLA) protein is a small non-collagenous bone protein. It is a sensitive marker of osteoblastic bone formation. Its seric variations in the serum in such rheumatisms as rheumatoid arthritis remain unclear. Further information on local osteoblastic activity may be obtained by assaying the level of osteocalcin in the synovium. Its serum level can be evaluated by radioimmunoassay. The same method can be used in the synovial fluid. Paired serum and synovial fluid samples have been assayed from 63 patients, 33 patients with inflammatory arthritis (rheumatoid arthritis, psoriasis, chondrocalcinosis, pyogenic arthritis) and 30 patients with mechanical joint effusion (osteoarthritis, meniscal lesions). Serum levels of osteocalcin were the same in the inflammatory group (m: 8.69 +/- 0.68 ng/ml) and in the mechanical group (m: 10.2 +/- 0.67 ng/ml). In the synovial fluid, the levels of osteocalcin were significantly lower in the inflammatory group (m: 3.27 +/- 0.40 ng/ml) than in the mechanical group (m: 6.91 +/- 0.47 ng/ml). The same results were obtained with the ratio of synovial fluid osteocalcin on serum osteocalcin. There was a significant correlation between serum and synovial fluid osteocalcin and an inverse correlation between synovial fluid osteocalcin and the number of synovial fluid cells. The present study suggests that periarticular osteoblastic depression, among patients with inflammatory arthritis, is likely.

Adult↗

PubMed1991

[The rafter osteotomy of the first metatarsal with immediate weight bearing in the treatment of anterior and medial pes cavus in adults].

The difficulty of the exact adjustment of the first metatarsal's raising by dorsal cuneiform cutting and osteosynthesis, brought the authors to prefer proximal rafter osteotomy of the first metatarsal in the treatment of adult's anterior and medial pes cavus. Early weight bearing with a plaster cast or a wooden-shoe allowed the spontaneous raising of the metatarsal and an equal distribution of load between all the metatarsals. The excellent results reached by that single procedure in nine cases during ten years justify to suggest it for treatment of adult's anterior and medial pes cavus.

Adolescent↗