Hôpital Paule de Viguier

To compare MRI-based graft maturation and tibial tunnel behavior in all-inside anterior cruciate ligament (ACL) reconstruction using either a quadrupled semitendinosus (ST4) graft or a standard doubled semitendinosus-gracilis (DSTG) technique and to assess mid-term clinical outcomes. This is a single-center prospective comparative cohort with sequential, non-randomized allocation. Primary imaging endpoints were graft signal-to-noise quotient (SNQ, PD-FS) and tibial tunnel cross-sectional area (CSA) change; clinical endpoints included PROMs and laxity at ≥ 24 months. Reliability was assessed with two independent evaluators and reported using ICC (two-way random, absolute agreement) with 95% CIs. Forty patients (n = 20 per group) completed MRI at 12 months and clinical follow-up at 24 months. SNQ was similar between groups (ST4 1.94 [95% CI 1.28-2.60] vs DSTG 2.84 [1.93-3.75]; difference - 0.90 [- 1.99 to 0.19], P = 0.39). Tibial tunnel widening was lower with ST4 (45.5% [23.7-67.3]) versus DSTG (106.7% [78.3-135.1]); difference - 61.2% [- 95.8 to - 26.6]; P = .02. PROMs and laxity were comparable. AI-ST4 and DSTG ACL reconstruction demonstrated similar graft maturation at 12months, with less tibial tunnel widening after AI-ST4. At 24months, clinical outcomes were equivalent between groups; although SNQ and tibial tunnel CSA demonstrated good reproducibility, these imaging differences were not demonstrably associated with functional superiority.

Introduction: Femoral neck fractures in older adults are associated with appreciable short-term mortality, yet long-term survival after hip arthroplasty is incompletely characterized. We analyzed early mortality risk factors and 5- and 10-year mortality after hemi-arthroplasty or total hip arthroplasty (THA) for femoral neck fractures. Materials and Methods: In this single-center retrospective cohort, 397 consecutive patients underwent arthroplasty for femoral neck fracture in 2014 and 2015. Mean age was 83.3 years and 70.3% were women. Demographic data, Charlson Comorbidity Index, Parker Mobility Score, medication history, operative and anesthetic details, transfusion, and peri-operative complications were extracted. Survival status up to 10 years was obtained from hospital and civil registries. p-value < 0.05 was considered statistically significant. Results: A total of 397 patients were included. When categorized by age and ASA scores into low-, medium-, and high-risk groups, mortality rates increased with higher risk (p < 0.001). The mortality rate at 30 days, 90 days, 1 year, 5 years, and 10 years postoperatively was 3.5%, 7.1%, 14.1%, 48.36% and 71.03%, respectively; mean time-to-death was 3.3 years. At 30 days, mortality was higher in males, those on clopidogrel, in patients with lower mobility (lower Parker Score), higher morbidity (higher Charlson Score), NNIS score of 1, higher ASA, patient who underwent hemiarthroplasty, and patients with medical complications post-op. Additional 90-day risks were antivitamin K therapy, immunosuppressants, and continuous spinal anesthesia; 1-year risks also encompassed advanced age, prolonged hospital stay, and peri-operative transfusion. Conclusions: Arthroplasty after femoral neck fracture is associated with high mortality rate; only half of patients survive 5 years and fewer than one-third reach 10 years. Mortality rate is affected by many risk factors, both non-modifiable factors and modifiable peri-operative variables. Targeted optimization of modifiable peri-operative factors and multidisciplinary geriatric-orthopedic care may improve outcomes in this frail population.

Numerous publications have questioned the lack of analytical reliability and clinical relevance of sperm morphology assessment for infertility workup and before use of assisted reproductive techniques (ART). There is a huge variability in the performance and interpretation of this test. It has become necessary to evaluate its true medical service rendered to the patient. To develop clinical guidelines for use of spermatozoa morphology assessment during male fertility check-up and before ART. These guidelines were produced following a pre-defined standard methodology for narrative and Patient Intervention Comparison Outcomes (PICO) questions. The French Working Group (WG) on Sperm Morphology Assessment consisted of 15 members including an expert in statistics. R1: WG does not recommend systematic detailed analysis of abnormalities (or groups of abnormalities) during sperm morphology assessment. R2: WG recommends that the laboratory should use a qualitative or quantitative method for detection of a monomorphic abnormality (globozoospermia, macrocephalic spermatozoa syndrome, pinhead spermatozoa syndrome, multiple flagellar abnormalities). The result may be given as an interpretative commentary or as a numerical report of the percentage of detailed abnormalities. R3: There is insufficient evidence to demonstrate the clinical value of indexes of multiple sperm defects (TZI, SDI, MAI) in investigation of infertility and before ART. Accordingly, the working group does not recommend the use of sperm abnormality indexes (TZI, SDI, MAI) in sperm morphology assessment. R4: WG gives a positive opinion on the use of automated systems based on cytological analysis after staining after qualification of the operators, and validation of the analytical performance within their own laboratory. R5: WG does not recommend using the percentage of spermatozoa with normal morphology as a prognostic criterion before IUI, IVF, or ICSI, or as a tool for selecting the ART procedure. This article examines the clinical interest of sperm morphology assessment during fertility check-up and before ART. The overall level of evidence from studies is low, challenging current practices regarding sperm morphology assessment. These guidelines suggest a significant simplification of sperm morphology assessment in the light of the examined publications while maintaining the detection of monomorphic sperm abnormalities.

Microvascular ischemic neuropathy is a common cause of third nerve palsy (TNP) in adults. Gadolinium enhancement of the intracavernous segment of the third cranial nerve (CNIII) has been previously reported in this context. Given the high spatial resolution of the 3D CISS sequence for analyzing the cavernous sinus, our objective was to evaluate the diagnostic accuracy of intracavernous third nerve changes on 3D contrast-enhanced CISS in differentiating microvascular ischemic TNP from other etiologies. We conducted a single-center retrospective case-control study involving patients presenting with isolated TNP at the emergency department between 2018 and 2022, where all of whom underwent 3T MRI, including a 3D contrast-enhanced CISS sequence. Based on clinical examination and paraclinical investigations, a neurologist and an ophthalmologist jointly established the etiology of TNP during the initial patient care. Patients diagnosed with microvascular ischemic TNP were matched with a control group of TNP from other etiologies. Two radiologists independently assessed contrast enhancement and thickening of the intracavernous third nerve on the 3D contrast-enhanced CISS without knowledge of the etiological diagnosis. Sensitivity and specificity for diagnosing microvascular ischemic TNP were calculated. Fifty-four patients were included: 27 with microvascular ischemic TNP and 27 controls (59% men, mean age 72 years). The control group comprised TNP of inflammatory (18%), infectious (18%), aneurysmal (16%), tumoral (11%), stroke-related (22%), and undetermined (15%) origins. Contrast enhancement and thickening of the intracavernous third nerve were more frequent in microischemic TNP compared with the control group (78% versus 52%, P = .046, and 67% versus 27%, P = .003, respectively). The combination of contrast enhancement and nerve thickening demonstrated a sensitivity of 67% and a specificity of 74% for diagnosing microvascular ischemic TNP. Detection of contrast enhancement and thickening of the intracavernous third nerve by using the 3D contrast-enhanced CISS sequence on 3T MRI is significantly more frequent in microvascular ischemic TNP than in TNP from other etiologies. Though not specific, these findings may support this diagnosis when accompanied by supportive clinical features.

To compare graft synovialization and tear rates between autograft and allograft anterior cruciate ligament (ACL) reconstruction based upon second-look arthroscopy (SLA), along with joint stability, subjective and objective clinical outcomes. A systematic search of PubMed, Embase and the Cochrane Library was conducted on 7 March 2025, to identify studies reporting graft synovial coverage and tear rates on SLA following primary ACL reconstruction. Meta-analyses were conducted using a random-effects model with logit transformation. Study weights were calculated via the inverse variance method. Heterogeneity was assessed using Cochran's Q and the I² statistic. Forest plots were created to display individual and pooled estimates with 95% confidence intervals. A total of 26 clinical studies comprising 2891 patients were included in this systematic review. Of these, 2164 patients underwent ACL reconstruction with autografts and 727 with allografts. SLA was performed in 2009 patients, including 1570 in the autograft group (78.1%) and 481 in the allograft group (23.9%). Good synovial coverage (>50% of the graft) was observed in 1303 autograft cases (83%) and 341 allograft cases (70.9%) (p < 0.001). Poor synovial coverage (<50%) was seen in 146 autografts (9.3%) and 93 allografts (19.3%) (p < 0.001). Torn grafts were found in 125 autografts (8%) and 25 allografts (10%) (n.s.). No significant differences in synovial coverage or graft tear rates were observed when comparing single bundle versus double bundle ACL reconstructions. Mean anterior tibial translation was significantly lower in the autograft group compared to the allograft group (1.23 ± 0.68 vs. 2.00 ± 0.38 mm; p < 0.001). No significant differences were noted in postoperative Lachman (n.s.) and pivot shift tests (n.s.), or in subjective outcomes based on Lysholm (p = 0.05) and Tegner scores (n.s.). However, significantly more patients in the autograft group achieved normal (A) or nearly normal (B) International Knee Documentation Committee (IKDC) objective scores (p = 0.02), whereas higher rates of abnormal or severely abnormal (grades C and D) IKDC scores were observed in the allograft group (p < 0.001). Remnant-preserving ACL reconstruction resulted in significantly better synovial coverage, fewer graft tears and improved knee stability compared to conventional ACL reconstruction (all p < 0.001), with no difference in cyclops lesion incidence (n.s.). Autograft ACL reconstruction showed superior synovial coverage, lower retear and failure rates, reduced anterior tibial translation and better IKDC objective scores compared to allografts. Remnant-preserving techniques further enhanced synovial coverage, lowered graft tear rates and improved joint stability. No significant differences in synovial coverage, graft tears or failure rates were observed between single bundle and double bundle ACL reconstruction. Level IV, systematic review and meta-analysis.