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Biomedical subjects

Philippe Clavert

Publications and source records attributed to Philippe Clavert.

8 recordsLinked to original sources
PubMed2006

Trans-cuff portal for arthroscopic posterior capsulorrhaphy.

Arthroscopic repair of posterior shoulder instability is becoming an accepted method of treatment. Most surgeons perform this procedure with the patient in a lateral decubitus position to facilitate access to the posterior glenoid. We have developed an accessory portal placed through the midportion of the rotator cuff that allows easy and complete viewing of the posterior glenohumeral joint when the patient is in a beach chair position and does not require the use of traction. This portal provides a superior-to-inferior view of the posterior glenoid rim and capsule and allows use of anterior and posterior routine portals for posterior Bankart repair. In this study, the technique of posterior labral repair in the beach chair position with use of the trans-cuff portal is described, and preliminary results in 5 patients at an average follow-up of 24 months are presented. Through this approach, we were able to place 3 anchors, with the lowest at the 7 o'clock position (for a right shoulder), in all patients. Mean American Shoulder Elbow Surgeons (ASES) score improved from 53 +/- 15 preoperatively to 87 +/- 8 postoperatively (P < .01). All patients had an excellent result with complete resolution of pain and instability.

Adolescent↗
PubMed2006

Recurrent posterior shoulder instability.

Recurrent posterior shoulder instability is an uncommon condition. It is often unrecognized, leading to incorrect diagnoses, delays in diagnosis, and even missed diagnoses. Posterior instability encompasses a wide spectrum of pathology, ranging from unidirectional posterior subluxation to multidirectional instability to locked posterior dislocations. Nonsurgical treatment of posterior shoulder instability is successful in most cases; however, surgical intervention is indicated when conservative treatment fails. For optimal results, the surgeon must accurately define the pattern of instability and address all soft-tissue and bony injuries present at the time of surgery. Arthroscopic treatment of posterior shoulder instability has increased application, and a variety of techniques has been described to manage posterior glenohumeral instability related to posterior capsulolabral injury.

Biomechanical Phenomena↗
PubMed2005

Are there age induced morphologic variations of the superior glenoid labrum? About 100 shoulder arthroscopies.

Different anterosuperior aspects of the glenoid labrum have already been described and are thought to be normal anatomical variations. The goals of this study were first to characterize these anterosuperior labral morphologies and then to analyze their variations in function of the patients' age. One hundred shoulder arthroscopies were recorded to study the macroscopic characteristics of the anterosuperior labrum of the glenohumeral joint and its relationships with the proximal insertion of the tendon of the long head of the biceps. Then, patients were divided into two groups in function of their age (below and over 30 years old). Morphological modifications of the labrum were found in function of the age of the patient with an increase of the nonpathologic "mobile labrum" type after 30 years (P=0.0423). Therefore a mobile and loosely attached superior labrum should not always be considered as abnormal, especially in case of patient older than 30 years.

Adolescent↗
PubMed2005

Panacryl synovitis: fact or fiction?

PURPOSE: It has been suggested from anecdotal experience that Panacryl suture (Ethicon, Johnson & Johnson, Westwood, MA) may be responsible for an exaggerated inflammatory response. Our goal was to test the null hypothesis that Panacryl causes aseptic synovitis when used on anchors in the case of arthroscopic Bankart and rotator cuff repair. TYPE OF STUDY: Retrospective review of the postoperative outcome, specifically looking for clinical criteria that are associated with aseptic synovitis. METHODS: Eighty-three arthroscopic Bankart and 33 arthroscopic rotator cuff repairs were performed using anchors loaded with Panacryl. The clinical factors associated with synovitis that we assessed were motion, pain, hyperthermia, and swelling. RESULTS: There was no hyperthermia. Two patients had transient swelling and 10 patients had initial transient postoperative pain. One patient had chronic pain and a second arthroscopy was performed 5 months after the initial procedure, which revealed obvious synovitis. Biopsy examinations were performed and these showed typical foreign-body reaction. Two anterior redislocations occurred after new traumas, 2 failed rotator cuff repairs were observed, due to early active motion, and 2 underwent an open revision repair; synovitis was not observed in any of these cases. After 6 months, the loss of external rotation was a mean of 6.7 degrees (Bankart) and 3.3 degrees (rotator cuff repair). The loss of forward elevation was a mean of 5.8 degrees (Bankart) and of 3.3 degrees (rotator cuff repair). CONCLUSIONS: In only 1 of 116 cases of arthroscopic repair was there direct evidence of synovitis. Even in the cases undergoing revision surgery, there was no indication that Panacryl caused aseptic synovitis. Clinical course after these repairs appeared to be similar to historical experience using nonabsorbable braided suture material. Failure rates in each series appeared to be more related to new trauma and use of other implants than to Panacryl suture. LEVEL OF EVIDENCE: Level IV.

Arthroscopy↗
PubMed2005

Open operative treatment for anterior shoulder instability: when and why?

The treatment of anterior glenohumeral instability continues to evolve. Open capsulolabral repairs are time-tested and reliable. In an era in which arthroscopic techniques continue to improve, open surgery remains an acceptable option, and there are still certain injury patterns that cannot be adequately addressed arthroscopically. Decision-making regarding surgery for instability is influenced by the surgeon's experience and the relevant pathological findings. Open operative treatment is the preferred approach in many instances of recurrent anterior instability, particularly when there is bone and soft-tissue loss and in revision settings.

Humans↗
PubMedDate not supplied

Contribution to the study of the pathogenesis of type II superior labrum anterior-posterior lesions: a cadaveric model of a fall on the outstretched hand.

With a cadaveric model, we studied the effects on the superior labrum-biceps tendon complex of a fall on the outstretched hand to assess one of the supposed mechanisms of creation of superior labrum anterior-posterior (SLAP) lesions. Ten shoulders were used to simulate either a forward or a backward fall with a custom shoulder-testing apparatus capable of simulating muscle forces, attached to a servohydraulic testing machine (INSTRON 8500+). Impaction of the humeral head on the glenoid cavity was applied in 0.1 seconds. The presence or absence of a SLAP lesion was determined. For the 5 shoulders used to simulate a forward fall, 5 type II SLAP lesions were found; for the 5 shoulders used to simulate a backward fall, only 2 type II SLAP lesions were observed. The role of shearing forces seems to be a major factor in the pathogenesis of these lesions, in association with predisposing anatomic factors.

Accidental Falls↗