Search PubMed⌕ Search

Biomedical subjects

P Neyret

Publications and source records attributed to P Neyret.

At least 19 recordsLinked to original sources
PubMed2001

The natural history of the knee following arthroscopic medial meniscectomy.

We examined the natural history of arthroscopic medial meniscectomy in knees with an isolated meniscal injury by reviewing 317 of 894 cases following medial meniscectomy. At the time of the initial surgery none of the knees had been operated on, and there was no evidence of ligament injury. The patients were reviewed clinically and radiologically after a mean of 11.5 years (range 10-15). The knee was considered "normal" or "nearly normal" by 91% of patients. In 218 patients the contralateral knee was asymptomatic without history of operation or significant injury and could be used as control for comparison. Radiology showed 22.4% greater excess prevalence of joint space narrowing in the operated compared to the control knee. The factors predisposing to a poor radiological result were age above 35 years, the presence of medial compartment cartilage degeneration at the time of the first arthroscopy, resection of the posterior one-third of the meniscus, and meniscal rim resection. Preoperative participation in sport was a predictor of a better outcome.

Adolescent↗
PubMed2000

[Revision in non-infected total knee arthroplasty: an analysis of 69 consecutive cases].

PURPOSE OF THE STUDY: We reviewed 69 consecutive cases of total knee arthroplasty revisions to analyze the causes of failure. MATERIAL AND METHODS: Sixty-nine total knee arthroplasty revisions were required between 1990 and 1997 for non-septic failure. Five categories of failures were identified: 30 loosenings including 11 with an initial malposition (varus position of the tibial component in 8 cases), 14 laxities (medial in 5, lateral in 5 and anteroposterior in 4), 11 stiff knees with no other clinical or radiological anomaly, 6 patellar failures (2 dislocations, 2 cases of excessive wear, 2 painful knees with a Freeman prosthesis), and 8 cases of painful knees with no other detectable anomaly. RESULTS: A three-phase reconstruction procedure was used after removing the failing TKA: 1) reconstruction of the tibia with replacement of lost bone, 2) reconstruction of the femur with balanced flexion determining the size of the implant, 3) balanced extension determining the distal/proximal position of the femoral component. A "simple" sliding prosthesis was used in 16 cases, a modular reconstruction prosthesis in 40 cases and a hinge prosthesis in 13 cases. Mean follow-up for functional and radiographic assessment after revision surgery was 37 months (59 cases) with a minimum follow-up of 1 year. The best outcome was observed in the "loosening", "laxity", and "stiffness" patients. Outcome was less favorable for the group "isolated pain" with IKS functional scores of 35.5 +/- 16 and 52.5 +/- 21. DISCUSSION: In 36 p. 100 of cases, TKA failure was related to a technical mistake (component malposition, poor ligament alignment). In 33 p. 100, failure was patient related (multiple procedures, congenital hip dysplasia, rheumatoid arthritis.). Outcome after revision TKA was less favorable than after primary TKA, particularly in case of painful knees with no other detectable anomaly. CONCLUSION: Surgical revision of TKA must follow a rigorous procedure with a detailed preoperative work-up. The decision for revision must not be made unless a precise anomaly has been identified.

Adult↗
PubMed1999

[Peroperative accidental contamination of bone-tendon-bone graft for the reconstruction of the anterior cruciate ligament. Report of 4 cases].

PURPOSE OF THE STUDY: The aim of this paper is to report the outcome in four patients in whom the graft (bone-patellar tendon-bone) was dropped onto the operating-room floor during anterior cruciate ligament reconstruction, and was then re-implanted after decontamination by topic antibiotic treatment. MATERIAL AND METHODS: Between 1992 and 1996, 1038 anterior cruciate ligament reconstructions were performed. In four cases, the bone-patellar-tendon-bone graft was dropped onto the operating theater floor. The graft was then soaked in rifamycin at a concentration of 0.8 mg/ml in normal saline for 10 mn, and soaked in gentamycin at 0.6 mg/ml for a further 10 mn. Finally, the graft was washed in physiological saline. All cases had been given a loading dose of second generation cephalosporin (cefamandole), after deflating the tourniquet. Post-operatively, the patients were given amoxicillin and clavulanic acid for 15 days. The patients were reviewed radiologically and clinically (IKDC form) with a mean follow-up of 24 months. RESULTS: Post operatively all patients had an uncomplicated recovery. No wound problems was observed in 3 of the four patients achieved an IKDC grade A knee. The final patient had a grade B, after 55 month follow-up. All patients recovered their initial sport level. The radiological Lachman test shows a mean differential value of 0.3 mm. DISCUSSION: Dropping the graft during ACL reconstruction is a very rare problem. In this event, the surgeon can choose several options: Harvesting an other site, sterilizing the graft by irradiation, autoclaving, ethylene oxyde..., or using a topical antibiotic treatment. Cooper showed, in an in vitro study that the contamination rate was halved by antibiotic soaking of the graft. CONCLUSION: We used a topic antibiotic treatment with success in all four cases. We feel warranted the implantation of a graft which has been dropped, and then antibiotic soaked. The patient should of course be informed and told to report any sign or symptom of infection. On the strength of this result, we would like to propose a decontamination protocol which can be used in this sort of incident, fortunately very rare.

Anterior Cruciate Ligament↗
PubMed1999

[Total knee prosthesis and simultaneous corrective tibial osteotomy, for osteoarthritis and severe congenital tibia varum deformity].

INTRODUCTION: Restoration of the normal mechanical axis of the knee and balancing of the surrounding soft tissues have been shown to have an important bearing on the final outcome of total knee arthroplasty. In knees with severe congenital varum deformity these goals may be difficult to achieve. MATERIAL AND METHODS: In four patients with osteoarthritis and severe congenital knee varum deformity of more than 15 degrees, we performed a high tibial valgus osteotomy with opening wedge, combined during the same procedure with total knee arthroplasty. RESULTS: As correction of the extra-articular deformity was obtained by the osteotomy, in none of the cases it was necessary to perform extensive soft tissue release or advancement to restore alignment. Postoperative X-rays demonstrated restoration of the normal mechanical axis in three cases, but in one case the angular correction of the osteotomy was insufficient and we observed a 9 degrees residual varus deformity. DISCUSSION: The osteoarthritic knee must be mechanically realigned for any total knee arthroplasty to be successful in the long term. Most commonly angular deformities are manifestations of the arthritis process, but sometimes, like in congenital varus deformity of the tibia, part of the deformation can be extra-articular in origin. In these cases, restoring alignment and stability may be difficult to achieve. The association of high tibial valgus osteotomy with total knee arthroplasty permits the correction of the extra-articular deformity, by the osteotomy, without performing extensive soft tissue release, as would be needed in total knee arthroplasty alone. CONCLUSION: Total knee arthroplasty associated with high tibial valgus osteotomy seems to be a technically satisfying alternative in patients with osteoarthritis and severe congenital varus deformity of the tibia.

Aged↗
PubMed1995

Arthroscopic stabilization for recurrent anterior shoulder dislocation: results of 59 cases.

Fifty-nine patients with recurrent anterior dislocation of the shoulder underwent the Morgan arthroscopic stabilization with transglenoidal suture of the inferior glenohumeral ligament. All patients were followed-up for an average of 49 months (range, 29 to 71 months). Using Rowe's scoring system, the overall objective results were disappointing. There were 33% excellent results, 9% good, 9% fair, and 49% poor. Twenty-six patients had a further dislocation, and 3 others had recurrent subluxation on average 13 months after the operation. The failures were associated with a preoperative clinical finding of inferior hyperlaxity as demonstrated by a positive sulcus sign, a preoperative radiological finding of a bony lesion on the anterior edge of the glenoid, or an arthroscopic finding of extended ligamentous lesions at the time of operation. The results of this study are clearly worse than those reported by other investigators. Direct comparison between the reported studies is problematic and is discussed. It was concluded that arthroscopic stabilization should only be performed by interested specialists as part of controlled clinical trials.

Adolescent↗
PubMed1994

Osteoarthritis of the knee following meniscectomy.

The relationship between age at meniscectomy and the time to developing OA requiring an operation was studied. A total of 63 patients (7.8% of those presenting for an operation for OA) had had a previous meniscectomy. It was found that there was a strong correlation between the age at meniscectomy and the time delay (r = -0.68, P < 0.0001). The equation for the regression line was y = -0.68x + 41.8, where y = the delay in years between meniscectomy and operation for OA, and x = the age at meniscectomy. It was noted that there were two distinct populations, those < or = 35 yr old with a mean delay of 26 yr (95% CI 20.8-31.4), and those > 35 yr old with a mean delay of 9.8 yr (95% CI 7.5-12.2). The development of OA requiring an operation following meniscectomy depends on the age at meniscectomy and the time delay. To show an increase rate of OA following meniscectomy in a young population would require follow-up of at least 26 yr.

Adult↗
PubMed1994

Extra-articular tenodesis for anterior cruciate ligament rupture in amateur skiers.

Thirty one amateur skiers with 33 knees which had had a symptomatic chronic rupture of the anterior cruciate ligament (ACL) treated with the Lemaire operation were reviewed retrospectively at an average of 4.5 years. Of the patients 23 were women. The operation failed to control symptoms in 17 out of the 33 knees. However the operation did control symptoms in 13 out of 19 knees in patients over 35 years old, compared with only three out of 14 knees in patients under 35 years old. Clinical and objective testing however showed that most knees were still unstable. Despite this 21 patients continued skiing. One patient with a successful result switched to playing tennis. Five patients gave up all sports. Four further patients, all under 35 years old, returned to skiing after an additional intra-articular reconstruction of the anterior cruciate ligament. An isolated extra-articular procedure in amateur skiers under 35 years old with symptomatic chronic ACL rupture is not recommended. They need at least an intra-articular reconstruction to control their symptoms and to stabilize the knee.

Adolescent↗
PubMed1994

Anterior cruciate reconstruction combined with valgus tibial osteotomy.

Forty-four of the first 50 knees to undergo anterior cruciate ligament (ACL) reconstruction combined with a valgus tibial osteotomy were reviewed retrospectively at an average of three and a half years later. The combined operation was performed on patients with symptomatic chronic ACL rupture who also had varus malalignment on unilateral weight bearing, usually secondary to a previous medial meniscectomy. All patients originally played regular sports, but before the combined operation, 31 did not play at all. The operation had a low morbidity, and significantly improved clinical symptoms, clinical stability, and functional stability. Postoperatively only one patient could play competitive sports, although a further 26 could play leisure sports. At review there was no radiological progression of osteoarthrosis, and 37 patients (91%) were satisfied or very satisfied with the operation. Performing a valgus tibial osteotomy improved the results of ACL reconstruction in patients with acquired varus malalignment and extended the indications of ACL reconstruction to include patients younger than 40 years of age with early medial compartment osteoarthrosis.

Adolescent↗
PubMed1993

Results of partial meniscectomy related to the state of the anterior cruciate ligament. Review at 20 to 35 years.

We reviewed 195 knees in 167 patients at least 20 years after a rim-preserving meniscectomy. They were considered in two groups: 102 knees had had an intact anterior cruciate ligament (ACL), and 93 had had an unrepaired rupture. More patients with a ruptured ACL had downgraded their sport activity by five years after meniscectomy. The incidence of radiographic osteoarthritis was about 65% at 27 years in patients with a ruptured ligament, and 86% in those followed up for over 30 years. In the ligament-deficient group 10% had had operations for osteoarthritis, and another 28% had had other operations, mainly further meniscectomies. Only 6% of those with an intact ligament had needed a second operation after meniscectomy and at long-term follow-up 92% of them were satisfied or very satisfied. Only 74% of the ligament-deficient patients were satisfied with their result. The long-term outcome after rim-preserving meniscectomy depends mainly upon the state of the anterior cruciate ligament.

Activities of Daily Living↗
PubMed1992

[Total knee replacement after valgus tibial osteotomy. Technical problems].

Forty total knee replacements following valgus tibial osteotomy were analysed. There were 38 patients (10 men and 28 women) with a mean age of 72 years at the time of the joint replacement, at a mean of 8.5 years after osteotomy. Mean follow-up was 3 years (1 to 5 years). Performing a total knee replacement after valgus tibial osteotomy posed some specific problems due to asymmetrical bone cuts, residual ligament laxity, loss of bone at the tibial plateau, and especially when there was a malunion of the previous osteotomy. The functional results were good. A group of 208 patients with total knee replacements for untreated osteoarthritis acted as a control for comparison. In the group with an osteotomy the results were worse in respect of the walking distance and flexion angle achieved after joint replacement compared with primary replacement (p < 0.001). However the GUEPAR and HSS score 77.2 +/- 2.3 were very similar. Using unilateral weight-bearing X-rays, 18.8p. 100 demonstrated opening from ligament laxity and 40.6p. 100 had radiolucent lines under the components, which was the same as in the control group. The tibio-femoral mechanical axis using long-leg films had a mean varus angle of 0.7 degrees.

Aged↗
PubMed1992

[Total prosthesis on a rheumatoid knee].

Results of 81 total knee replacements in 67 patients with rheumatoid arthritis were studied. Mean follow-up was three years. Pain was the main reason for knee replacement surgery; knee mobility was well preserved prior to surgery. Failure occurred in four patients, as the result of infection, due in three instances to skin necrosis. Arthrodesis of the knee proved necessary in these patients. The fourth patient developed delayed hematogenous infection which was treated by a change of prosthesis. At follow-up, 82% of patients reported no pain and 18% moderate pain. Mean passive flexion was 113 degrees +/- 17 degrees. HSS score was 83.6 +/- 1.3 and all the patients except for the four with prosthesis failure stated that they were satisfied on very satisfied. Mechanical results were satisfactory, with a mean mechanical femur-tibial angle of 180.4 degrees. A circling line was visible at follow-up in 40% of operated knees but was partial in every case. No reoperations for prosthesis loosening were required. These data show that total knee replacement is the only reliable and radical treatment of rheumatoid arthritis of the knee and should be performed as soon as fixed flessum or axial deviation develops.

Adult↗
PubMed1992

[Treatment of old or recurrent ruptures of the patellar ligament by contralateral autograft].

Patellar ligament ruptures are difficult to treat, and require transfer of good quality tissues for an effective reconstruction. In this study the contralateral patellar ligament was chosen in preference to other types of graft. A graft was taken from the opposite knee (length 16 cm, width 8 mm) composed of a block of tibial bone, middle third of patellar ligament, block of patella, and quadriceps tendon. The bone blocks were embedded in slots made on the anterior surface of the patella and the tibia. The method of fixation allowed exact positioning as regards the patella height, and was sufficiently strong to allow immediate mobilisation and full weight-bearing. A series of 13 knees was operated on between October 1988 and July 1990, with a mean post-operative follow-up of 8.6 months. The technique was used twice following total patellectomy and once following total knee arthroplasty. This operation, without any complications from the donor site, produced a stable knee, corrected the extensor lag, and resulted in a mean post-operative flexion of 91 degrees.

Adolescent↗
PubMed1991

[Different knee prostheses and their technical problems].

Depending on whether degenerative lesions are localized to one single compartment or extend to all three compartments of the knee, and depending on the state of the ligaments (notably the cruciate ligaments) and on the presence or absence of osseous and frontal deformations, various prostheses can be used in the treatment of gonarthrosis. These prostheses fall into three main categories: (i) hinge prostheses, which are very constrained; (ii) sliding prostheses with varying degrees of constraint depending on whether or not the cruciate ligament(s) are spared, and (iii) one-compartment prostheses which replace only one of the three compartments of the knee. Each type of prosthesis has its advantages and drawbacks. Total knee replacement has become a reliable procedure which regularly provides stable and painless knees with a mean flexion angle of 110 degrees and is mainly applied, for the time being, to subjects leading a sedentary life.

Biomechanical Phenomena↗
PubMed1990

[Dysplasia of the femoral trochlea].

Dysplasia of the trochlea was studied on a strict profile image of the knee. 1305 radiographs were analysed corresponding to several patello-femoral conditions (major and subjective patello-femoral osteoarthritis) and to control subjects. Two criteria are defined: the depth and the eminence of the trochlea. The depth was often minimal in instabilities that give a radiological characteristic image of intersection between the trochlear end line and the lateral condyle. This picture had a great diagnostic value for patellar instability. The eminence represented the owerhang of the trochlear end line in relation to the anterior cortex of the femur. By measuring it, it was possible to establish a statistically significant variability of the degree of instability on one hand, between instabilities, patellar syndromes and controles on the other hand. The intersection sign and the trochlear eminence in isolated patello-femoral osteoarthritis allows the direct filiation between dysplasia of the trochlea and osteoarthritis to be confirmed. Taking into account the size of the eminence, the hollowing out type trochleoplasties appears more fiable than raising of the lateral edge.

Bone Diseases, Developmental↗
PubMed1990

[Bilateral congenital absence of the anterior cruciate ligament and the internal menisci of the knee. A case report].

Bilateral congenital absence of the anterior cruciate ligament associated with the absence of the medial meniscus is reported in a 34-year-old-woman. The simultaneous absence may be explained by a common embryological mesenchymal origin of the anterior cruciate ligament and the menisci. This absence was at the origin of an abnormal development of the condyles and especially of the tibial epiphysis which was tipped over in flexum. Treatment consisted of a central ligamentous plasty associated with a lateral plasty, a medial plasty and a closing anterior tibial osteotomy. The result was good.

Adult↗
PubMed1989

[What is new about the knee?].

Surgery of the knee applies to the pathology of sports as well as to degenerative lesions. Surgery of the ligaments has benefited from the advances achieved in medical imaging, arthroscopy and rehabilitation. In case of gonarthrosis, prosthetic surgery has become reliable, but it is limited to sedentary subjects. Osteotomy remains very useful in ome indications.

Arthroscopy↗
PubMed1989

[What should be done in a meniscal lesion?].

The treatment of meniscal lesions closely depends on the context in which they occur. In isolated lesions of the medial meniscus, meniscectomy under arthroscopy remains the best method. When the meniscal lesion complicates a rupture of the anterior cruciate ligament, meniscal suture associated with reconstruction of the ligament may be contemplated. In case of degeneration of the medial meniscus or lesion of the lateral meniscus, various therapeutic approaches may be envisaged.

Arthroscopy↗