Search PubMed⌕ Search

Biomedical subjects

J-L Lerat

Publications and source records attributed to J-L Lerat.

6 recordsLinked to original sources
PubMed2006

[Analysis of meniscal lesions accompanying anterior cruciate ligament tears: A retrospective analysis of 156 patients].

PURPOSE OF THE STUDY: The purpose of this retrospective study of a continuous series was to document preferential types and localizations of meniscal lesions accompanying anterior cruciate ligament tears and to demonstrate the relationships between meniscal lesions, patient age and time from trauma to surgery. MATERIAL AND METHODS: One hundred fifty-six patients with no history of meniscal lesions underwent ligamentoplasty in 2003. All procedures were performed by the same operator. The time from trauma to surgery was 31.6 months on average. This was a retrospective continuous series using data from detailed operative reports. RESULTS: An isolated lesion of the medial meniscus was observed in 25.6% of cases. There was an isolated lesion of the lateral meniscus in 21.8% and lesions of both menisci in 9%. The most frequent injury was a longitudinal fissuration, for both menisci. Patient age and time from trauma to surgery were statistically correlated with presence of a medial lesion. There was no statistical relationship for the lateral meniscus nor for type of meniscal injury. DISCUSSION: The proportion of lesions to the lateral meniscus appeared to be unaffected by age or time to surgery after trauma, suggesting that lateral meniscal lesions occurred at the time of the initial curciate injury. On the contrary, the incidence of medial lesions increased with time and patient age, confirming the important role of the medial meniscus to block anterior displacement of the knee. We thus recommend early repair of anterior cruciate ligament tears in order to avoid medial meniscectomy which would increase with increasing time from injury to surgery and thus affect the postoperative outcome.

Adolescent↗
PubMed2006

[Axial lower limb alignment and knee geometry in patients with osteoarthritis of the knee].

PURPOSE OF THE STUDY: We conducted a retrospective radiographic study to identify and quantify medial and lateral misalignments in candidates for total knee arthroplasty. MATERIAL AND METHODS: We studied a discontinuous series of 101 patients (164 knees) among candidates for total knee arthroplasty seen between 1990 and 2002. We selected a random sample for study. Exclusion criteria were any history of fracture, surgical treatment, rheumatoid disease, or congenital disorder. A first group of 136 genu varum knees was identified in 82 patients (mean age 72 years, mean weight 79 kg). A second group of 28 genu valgum knees was identified in 19 patients (mean age 67 years, mean weight 71 kg). The standard radiograms were digitalized for semi-automatic measurements using the Metros software. We recorded overall deformation, femoral valgus, tibial varus, HKA angle, HKS angle (mechanical/anatomic axis of the femur) and angle C (horizontal inclination of the ankle to the ground). All measures were compared between each other for each patient to search for relations. RESULTS: In the genu varum group (136 knees), mean overall deformation was 9 degrees , mainly due to tibial misalignment (5.5 degrees ) with a 1 degrees femoral valgus component. The HKS angle was 6.3 degrees , and lateral joint gap 4.3 degrees ; the C angle was 4 degrees . Overall varus followed tibial varus (p<0.01). Ankle inclination followed tibial varus (p<0.01). In the genu valgum group (28 knees), overall deformation was 4.2 degrees , mainly due to femoral misalignment (5.6 degrees) with 1 degrees tibial varus and a medial joint gap of 2 degrees . The HKS angle was 4.7 degrees and the mean C angle -4 degrees . Overall valgus was related to femoral valgus (p<0.001). Tibial varus was greater with greater femoral valgus (p<0.01). In both groups, the HKS angle was smaller with greater femoral valgus. DISCUSSION: Semi-automatic measurements on digitalized films enabled excellent reproducibility. Causes of error were related to limb rotation at acquisition. This study showed that genu varum worsens because of tibial wear followed by ligament distension, while for genu valgum, worsening predominantly results from femoral wear. The ankle joint line was nearly horizontal in one-third of the limbs, even when there was a major misalignment of the lower limb. The HKS angle was quite variable in both morphotypes, but was smaller with greater femoral valgus in both groups. CONCLUSION: Measuring all components involved in medial and lateral knee misalignment is very useful for understanding the morphotype of each individual knee before performing osteotomy or implanting a knee prosthesis.

Aged↗
PubMed2006

[One-stage reconstruction of the two cruciate ligaments with a single autogenous graft from the extensor system: techniques and results of 25 chronic cases].

PURPOSE OF THE STUDY: Chronic tears of both cruciate ligaments are rarely encountered. Management practices have varied. One-stage reconstruction of both ligaments using arthroscopically implanted allografts was proposed starting in 1996 for such chronic laxity but only 44 cases have been reported in six papers mixed in with recent cases raising very different problems. Treatments using allografts or autogenous grafts or both implanted arthroscopically have often been combined with open surgery. We report a retrospective analysis of 25 knees treated with the same technique from 1983 to 2004: reconstruction with a single transplant taken from the extensor system. MATERIAL AND METHODS: A 30-cm lenght patella tendon-patella-quadriceps tendon graft was harvested. The patellar block was fixed in a hole drilled under the tibial spine, the patellar tendon replacing the posterior cruciate ligament and the quadriceps tendon passing through the lateral condyle and replacing the anterior cruciate ligament before implantation on Gerdy's tubercle, this also creating an extra-articular plasty with the same implant. Medial, lateral and posterior plasties were performed, depending on the radiographic assessment of laxity. Twenty-five knees with major laxity and instability were operated on, including 14 in two-stage operations. The differential anterior drawer was 10+/-3 mm medially and 9+/-5 mm laterally. The posterior drawer at 70 degrees was 15+/-4 mm medially and 10+/-6 degrees laterally. The total anteroposterior laxity of the medial compartment was 29 mm, it was 30 mm for the lateral compartment. Lateral laxity was considered major (>10 degrees ) in 17 knees and medial laxity in 7. Lateral and medial laxities were associated in eleven knees. Hyper-extension was very severe in five knees. RESULTS: Functional outcome at mean 6.5 years follow-up (range 1-21) was satisfactory (except in three knees) allowing renewed occupational activity. Resumption of sports activity was less marked and none of the knees was in IKDC class A, corroborating results in the literature. Anatomic outcome was assessed on the radiological drawer decrease which was modest, mean gain in the anterior drawer measuring 4 and 5 mm in the medial and lateral compartments and mean gain in the posterior drawer measuring 5 mm medially and 3 mm laterally. Peripheral laxity was corrected for best. DISCUSSION: Classically, one or other of the cruciate ligaments is repaired, sometimes both, but in a two-stage procedure associating two different methods and autogenous tendon grafts. One-stage reconstruction of both cruciate ligaments with a single autogenous graft and a wide approach has not led to any complications. One-stage reconstruction using this technique has several advantages: one anterior incision, single transplant which also enables lateral plasty, short immobilization time with rapid rehabilitation.

Adolescent↗
PubMed2005

[Not Available].

Explore the source record for details and available documents.

Journal Article↗
PubMed2005

[Not Available].

Explore the source record for details and available documents.

Journal Article↗