Papers by Olivier Courage
Orthopaedics & traumatology: surgery & research, Jun 1, 2009
Masson SAS. Tous droits réservés.-Document téléchargé le 28/11/2021 Il est interdit et illégal de... more Masson SAS. Tous droits réservés.-Document téléchargé le 28/11/2021 Il est interdit et illégal de diffuser ce document. S20 L. Favard et al. of patients, the AHI and the degree of fatty infiltration of the infraspinatus and subscapularis muscles.
Orthopaedic Proceedings, Jul 1, 2008
While using a single four-strand semitendinosus tendon posterior harvesting, we make sure we adop... more While using a single four-strand semitendinosus tendon posterior harvesting, we make sure we adopt a mini-invasive technique with minimal scars and less postoperative morbidity. It is a very demanding technique, but quite easily reproducible once we respect each step. In this chapter, we describe every step of this mini-invasive technique while describing how to avoid the pitfalls using simple tricks.
The PCL reconstruction is a rare procedure, often avoided by lots of surgeons. In this chapter, w... more The PCL reconstruction is a rare procedure, often avoided by lots of surgeons. In this chapter, we describe this technique while using the four-strand semitendinosus tendon with a Y-plasty. It is of utmost importance that we use the image intensifier with a spatula to ensure the safety of the posterior soft tissue components.
In this chapter, we describe the MPFL reconstruction using a noninvasive technique after harvesti... more In this chapter, we describe the MPFL reconstruction using a noninvasive technique after harvesting the gracilis tendon. This procedure is indicated for the patellar instability and can be added to the ATT osteotomy depending on the indication. The use of the image intensifier is essential to locate the isometric point of the femoral tunnel entry point. Also, the adjustment of the tension of the graft is essential to reduce postoperative pain while avoiding patellar instability.
ACL reconstruction with quadruple bundle gracilis and semitendinosus is the most common ACL proce... more ACL reconstruction with quadruple bundle gracilis and semitendinosus is the most common ACL procedure due to its simplicity and lesser morbidity related to graft harvesting. Like in all techniques, the time dedicated to the graft harvesting is paramount. The quality of the graft dictates the long-term results of the ACL reconstruction. In this chapter, we shall also place emphasis on the well positioning of the femoral tunnel because an anteriorly positioned femoral tunnel is the number one cause of ACL failure.
Elsevier eBooks, 2013
Resume L'intervention de Bankart arthroscopique fait partie de l'arsenal therapeutique de... more Resume L'intervention de Bankart arthroscopique fait partie de l'arsenal therapeutique de l'instabilite anterieure de l'epaule. Elle permet de traiter essentiellement les lesions capsulo-labrales antero-inferieures, survenant suite a des episodes de luxation antero-inferieures recidivantes de l'articulation scapulo-humerale. Cette technique permet d'obtenir des resultats satisfaisants, pourvu que ses indications soient ciblees et le geste, exigeant, soit maitrise. Les principes de base de l'intervention, les differentes options techniques ainsi que quelques astuces utilisees par les differentes equipes seront detailles.
Orthopaedic Proceedings, 2004
Purpose: The purpose of our retrospective analysis was to describe results of arthroscopic treatm... more Purpose: The purpose of our retrospective analysis was to describe results of arthroscopic treatment of painful ankle instability without clinical or radiological laxity. Material and methods: Eighteen patients, mean age 27 years (seven men and nine women) were operated on by the same surgeon between 1999 and 2000. Sixteen patients (90%) were reviewed by an independent investigator at 20±4 months. Fifteen patients were athletes, ten at the competition level, and five had amateur sports activities. The accident caused forced inversion in 15/16 cases, during sports activities in 85.5% of the cases. Mean age at injury was 17±6 years. Mean time between the accident and arthroscopy was eight years. All patients had pain in the anterolateral region associated with effusion in 50% and apprehension or instability for daily life activities. Standard x-rays were normal in fourteen patients (87.5%). Comparative stress images did not demonstrate pathological laxity. Complementary imaging (MRI, ...
Journal De Traumatologie Du Sport, Mar 1, 2018
Recueil des communications particulières / Revue de chirurgie orthopédique et traumatologique 103... more Recueil des communications particulières / Revue de chirurgie orthopédique et traumatologique 103S (2017) S239-S284 patients avaient repris une activité professionnelle à 4,5 mois. Au dernier recul, 18 patients présentaient une lacune visible radiographiquement, et tous les patients présentaient un kyste visible à l'imagerie par résonance magnétique. Pour les ancres de 1,5 mm, non résorbable, il y a une formation kystique de 6,5 fois la taille de l'ancre, en comparaison avec les ancres résorbables de 4,75 mm qui entraînent des lésions de 4,5 fois la taille de l'ancre. Discussion Nous avons montré que les ancres filaires entraînent des lésions osseuses de taille relativement importante en comparaison au diamètre initial de l'ancre, avec cependant, des résultats cliniques très bons en ce qui concerne les douleurs et les mobilités, avec l'absence de complication liée aux ancres telles que les fractures décrites par certains auteurs. Les ancres filaires donnent de bons résultats cliniques avec cependant, des géodes radiologiques persistantes à 2 ans de recul sans aucune conséquence. Une étude à plus long terme est nécessaire afin de connaître l'évolution de ces géodes osseuses. Déclaration de liens d'intérêts Les auteurs déclarent ne pas avoir de liens d'intérêts.
American Journal of Sports Medicine, Feb 1, 2021
Background:Rotator cuff tears are common shoulder injuries that often cause pain and loss of func... more Background:Rotator cuff tears are common shoulder injuries that often cause pain and loss of function. Nonanatomic side-to-side techniques facilitate repair by minimizing tensions within tendons to improve healing and optimize the thickness of sutured tissues.Purpose/Hypothesis:The purpose was to evaluate long-term clinical and radiographic outcomes of arthroscopic side-to-side repair of massive rotator cuff tears (mRCTs). The hypothesis was that, at a minimum follow-up of 12 years, arthroscopic side-to-side repair maintains clinically important improvements.Study Design:Case series; Level of evidence, 4.Methods:The authors reviewed records of all patients who underwent arthroscopic repair of mRCTs over 2 consecutive years. A total of 30 adult patients met the eligibility criteria and underwent side-to-side repair. Patients were evaluated clinically using the Constant score (CS) and ultrasound to assess retears at 3 timepoints after surgery: 2 to 4 years, 5 to 7 years, and 12 to 14 years.Results:At first follow-up (3.2 ± 0.5 years), all 30 patients had clinical and ultrasound assessment, which revealed 13 retears (43%). At second follow-up (6.2 ± 0.5 years), all 30 patients had clinical and ultrasound assessment, which revealed 2 new retears (total 50%). At final follow-up (13.0 ± 0.7 years), only 21 patients had clinical assessment (1 died and 8 could not be reached), and only 19 patients had ultrasound assessment, which revealed 6 new retears (total 79%). Both absolute CS and age-/sex-adjusted CS improved significantly from baseline values at first follow-up (73.5 and 96.6, respectively), and remained stable at second follow-up (69.0 and 91.9, respectively), and final follow-up (64.4 and 87.0, respectively). Compared to shoulders with intact repairs, those with retears tended to have lower absolute CS at all follow-up visits, although differences were not statistically significant.Conclusion:Patients with mRCTs maintain satisfactory clinical scores at 12 to 14 years after arthroscopic side-to-side repair despite a high incidence of retears. Repair is a safe and effective treatment for mRCTs, providing a less invasive and less complex alternative to reverse shoulder arthroplasty and tendon transfer procedures.
Elsevier Masson, May 25, 2009
Purpose of the study: Little is known about the clinical profile of patients aged less than 65 ye... more Purpose of the study: Little is known about the clinical profile of patients aged less than 65 years who present a large or massive rotator cuff tear. We hypothesized that this clinical profile depends on the type of tear. Material and method: This was a prospective descriptive multicentric study over a period of six months which included 112 patients aged less than 65 years, 66 men and 46 women, mean age 56.3 years (range 35–65) who had a large or massive rotator cuff tear. The Constant score and active and passive range of motion, subacromial height and fatty infiltration according to the Goutallier classification were noted. Patients were divided into four classes according to deficit in active elevation and external rotation: class A (n=55, no deficit), class B (n=19, deficient elevation alone), class C (n=28, deficient external rotation alone), class C (n=10, deficient elevation and external rotation). Results: These classes were not significantly different for age, sex-ratio, ...
Purpose of the study: For patients aged less than 65 years who have a large rotator cuff tear, po... more Purpose of the study: For patients aged less than 65 years who have a large rotator cuff tear, potential solutions include anatomic repair, palliative treatment, non-anatomic repair with flaps or cuff prosthesis, and reversed prosthesis. The later solution is not recommended at this age and anatomic repair is not always possible. In this situation, what is best, palliative treatment or flap or prosthesis repair? Material and method: This retrospective multicentric study included 142 patients, 74 men and 68 women with a large or massive cuff tear. Palliative treatment (group A) involved acromioplasty (n=48) associated as needed with a biceps procedure and partial repair (n=41). Non-anatomic repair (group B) included supra-spinatous translation (n=16), deltoid flaps (n=22), and cuff prostheses (n=15). Preoperatively, the two groups were not statistically different for acromiohumeral height (AH, 6 mm in group A versus 7.5 mm in group B) and percent of fatty infiltration of the infraspi...
Orthopaedics & Traumatology: Surgery & Research, 2010
The objectives of this study on arthroscopic treatment of chronic anterior shoulder instability w... more The objectives of this study on arthroscopic treatment of chronic anterior shoulder instability were the collection of the current practices for this indication, their development as reported in the literature, and the analysis of preliminary results on a multicenter prospective series of Bankart arthroscopic procedures undertaken using a common technique on patients selected based on the Instability Severity Index Score (ISIS). This procedure predominates in the English-speaking world, whereas the Latarjet protocol is preferred in France. The choice between the two seems to be cultural since neither technique could be demonstrated to be superior in an analysis of 171 responses to an Internet questionnaire in this study. The literature reports disappointing results in the Bankart arthroscopic procedure and recent articles have researched the predictive factors for its failure. Eleven centers prospectively included 125 patients from 1 December 2007 to 30 November 2008. The inclusion criteria were recurrence
Revue de Chirurgie Orthopédique et Traumatologique, 2010
ABSTRACT Les objectifs de cette étude consacrée au traitement arthroscopique de l’instabilité ant... more ABSTRACT Les objectifs de cette étude consacrée au traitement arthroscopique de l’instabilité antérieure chronique de l’épaule étaient le recueil des pratiques, leur évolution dans la littérature et l’analyse des résultats préliminaires d’une série prospective multicentrique d’interventions de Bankart arthroscopiques réalisées avec une technique commune sur des patients sélectionnés en utilisant le score Instability Severity Index Score (ISIS). Cette intervention prédomine dans le monde anglo-saxon alors que la butée de Latarjet est préférée en France. Le choix apparaît culturel car aucune hiérarchisation des critères d’indications entre les différentes techniques n’a pu être mise en évidence par l’analyse des 117 réponses au questionnaire internet de cette étude. La littérature rapporte les résultats décevants de l’intervention de Bankart arthroscopique et les articles récents ont recherché les facteurs prédictifs de son échec. Onze centres ont inclus prospectivement 125 patients du 1er décembre 2007 au 30 novembre 2008. Les critères d’inclusion étaient la répétition d’accidents d’instabilité antérieure et un score ISIS inférieur ou égal à 4 points sur 10. Tous les patients sélectionnés ont bénéficié d’une réinsertion capsuloligamentaire avec une technique minimale commune d’au moins trois ancres et quatre sutures avec un protocole postopératoire commun. Au recul moyen de 18 mois, quatre patients (3,2 %) ont récidivé. Pour les 84 patients réexaminés à un an, les scores de Walch-Duplay et de Rowe étaient respectivement de 88,4 et de 87,8 points sur 100. Subjectivement, 88,1 % des patients se déclaraient satisfaits et reféraient l’intervention. Cette étude a confirmé la simplicité d’utilisation du score ISIS comme outil de consultation. Seule sa poursuite de l’étude avec l’obtention d’un recul minimum de trois ans permettra de valider la limite inférieure du score ISIS en dessous de laquelle cette technique pourra être proposée à la condition qu’elle respecte le prérequis technique de quatre sutures capsuloligamentaires minimum. Niveau de preuve Niveau IV. Série prospective non randomisée.
The American Journal of Sports Medicine, 2014
Background:Acromioplasty is commonly performed during arthroscopic rotator cuff repair, but its e... more Background:Acromioplasty is commonly performed during arthroscopic rotator cuff repair, but its effect on short-term outcomes is debated.Purpose:To report the short-term clinical outcomes of patients undergoing arthroscopic repair of full-thickness rotator cuff tears with and without acromioplasty.Study Design:Randomized controlled trial; Level of evidence, 2.Methods:Patients undergoing arthroscopic repair of full-thickness rotator cuff tears were randomized into acromioplasty or nonacromioplasty groups. The Simple Shoulder Test (SST), American Shoulder and Elbow Surgeons (ASES) score, Constant score, University of California–Los Angeles (UCLA) score, and Short Form–12 (SF-12) health assessment were collected along with physical examination including range of motion and dynamometer strength testing. Intraoperative data including tear size, repair configuration, and concomitant procedures were recorded. Follow-up examination was performed at regular intervals up to 2 years. Preoperat...
Revue de Chirurgie Orthopédique et Traumatologique, 2013
Recueil des communications particulières e15 et TS arthroscopiques. La position à 120 • met en pé... more Recueil des communications particulières e15 et TS arthroscopiques. La position à 120 • met en péril le nerf fibulaire commun lors de la réalisation de la voie PL par sa proximité. En revanche, la réalisation des voies PM et TS à 120 • respecte les distances conventionnelles. La position à 30 • de flexion du genou est non recommandée pour établir les voies postérieures arthroscopiques compte tenu de la proximité des rapports vasculo-nerveux.
Knee Surgery, Sports Traumatology, Arthroscopy
EMC - Técnicas Quirúrgicas - Ortopedia y Traumatología, 2021
Resumen La boveda acromiocoracoidea presenta relaciones anatomicas estrechas con el manguito de l... more Resumen La boveda acromiocoracoidea presenta relaciones anatomicas estrechas con el manguito de los rotadores. Neer describio en 1972 el conflicto (impingement syndrome) entre la parte anterior del acromion y el manguito de los rotadores (supraespinoso). Asi, el acromion se considera como el factor extrinseco responsable de rupturas de los tendones del manguito. Entonces se describio la acromioplastia anteroinferior. Esto permite reducir el conflicto subacromial en caso de un pico acromial importante e igualmente puede permitir aumentar el espacio de trabajo durante una reparacion concomitante del manguito de los rotadores. En caso de artrosis acromioclavicular con un voluminoso osteofito inferior, se puede considerar una reseccion parcial de la articulacion acromioclavicular (coplaning). Si esta artrosis es sintomatica, podria estar indicada tambien una reseccion del cuarto externo de la clavicula. En un principio, la tecnica de acromioplastia se describio a cielo abierto pero en la actualidad se realiza casi exclusivamente bajo artroscopia, para respetar mejor la capa deltoidea. Por ultimo, el reciente concepto del critical shoulder angle puede motivar la realizacion de una acromioplastia lateral para disminuir este angulo y reducir asi las fuerzas de compresion de los tendones del manguito contra la boveda acromial.
Uploads
Papers by Olivier Courage