Pour une amélioration de la prise en charge du diabète des résidents en EHPAD

Abstract

Postoperative stiffness is a feared complication after anterior cruciate ligament (ACL) reconstruction. In case of associated dislocated bucket-handle meniscal tear (BHMT), reduction is urgent, with ligament reconstruction in the same surgical step.Treatment of associated dislocated BHMT in ACL reconstruction incurs increased risk of arthrolysis for stiffness in flexion and/or extension.A retrospective exposure/non-exposure study included 208 patients undergoing ACL reconstruction between January 2009 and December 2018. Those showing dislocated medial or lateral BHMT at surgery (group A) were compared versus those free of meniscal lesions (group B). The main objective was to assess the risk of surgical revision for arthrolysis within 12 months. Group A included 69 patients: 40 male (58%), 29 female (42%); mean age, 29.0 ± 11.2 years. Group B included 139 patients: 68 male (49%), 71 female (51%); mean age, 30.0 ± 10.4 years. Patients were classified according to age of ACL tear, as acute (< 6 weeks), subacute (6 weeks to 6 months), or chronic (> 6 months).Risk of revision surgery for arthrolysis was greater in Group A than in Group B, with 7 (10.1%) and 4 (2.9%) cases respectively (p = 0.044), with 12-month arthrolysis-free survival of 89.7% (95% CI, 82.7–97.2) and 97.1% (95% CI, 94.3–99.9) respectively (p = 0.023). Stiffness in flexion and extension was more frequent in Group A at 6 weeks and at 6 months (p > 0.05). Risk of arthrolysis did not significantly differ according to accident-to-surgery time in the overall series (p = 0.421) or specifically in Group A (p = 0.887). The BHMT was sutured in 39 cases (56.5%), including 3 failures (7.7%) at 12 months’ follow-up. Arthrolysis was required in 6 patients treated by meniscal suture (15.4%) and just 1 patient treated by meniscectomy (3.3%) (p = 0.128).The present study confirmed increased risk of surgical revision for arthrolysis after ACL reconstruction in case of dislocated BHMT treated in the same surgical step. Age of ACL tear and type of BHMT treatment (suture or meniscectomy) showed no impact on postoperative stiffness.IV, retrospective exposure/non-exposure cohort study.