Nicolas Lefevre

Purpose: The main goal of this study was to compare the results of the GNRB^® arthrometer to those of Telos™ in the diagnosis of partial thickness tears of the anterior cruciate ligament (ACL).Methods: A prospective study performed January–December 2011 included all patients presenting with a partial or full‐thickness ACL tears without ACL reconstruction and with a healthy contralateral knee. Anterior laxity was measured in all patients by the Telos™ and GNRB^® devices. This series included 139 patients, mean age 30.7 ± 9.3 years. Arthroscopic reconstruction was performed in 109 patients, 97 for complete tears and 12 single bundle reconstructions for partial thickness tears. Conservative treatment was proposed in 30 patients with a partial thickness tear. The correlation between the two devices was evaluated by the Spearman coefficient. The optimal laxity thresholds were determined with ROC curves, and the diagnostic value of the tests was assessed by the area under the curve (AUC).Results: The differential laxities of full and partial thickness tears were significantly different with the two tests. The correlation between the results of laxity measurement with the two devices was fair, with the strongest correlation between Telos™ 250 N and GNRB^® 250 N (r = 0.46, p = 0.00001). Evaluation of the AUC showed that the informative value of all tests was fair with the best results with the GNRB^® 250 N: AUC = 0.89 [95 % CI 0.83–0.94]. The optimal differential laxity threshold with the GNRB^® 250 N was 2.5 mm (Se = 84 %, Sp = 81 %).Conclusion: The diagnostic value of GNRB^® was better than Telos™ for ACL partial thickness tears.Level of evidence: Diagnostic study, Level II.

Purpose: Although the treatment of choice for acute proximal hamstring ruptures is now surgical repair, this technique is relatively new and requires further evaluation. Our hypothesis was that patients return to sports at the same level after surgical repair as before injury.Methods: From 2002 to 2011, a prospective observational study including 34 patients, mean age 39.3 ± 11.4 years old underwent surgical repair of an acute proximal hamstring rupture. Surgical, rehabilitation and follow‐up protocols were standardized. Mean follow‐up was 27.2 ± 22.9 months and there were no lost to follow‐up. The primary outcome was the level of activity on the UCLA and Tegner scores.Results: The mean UCLA score was 9.1 ± 1.3 before injury and 8.7 ± 1.7 at the final follow‐up (p = 0.03). The median Tegner activity level was 6 (range, 4–10) before injury and 6 (range, 3–10) at the final follow‐up (p = 0.05). The two scores were correlated (r = 0.76, p = 0.00001). Patients returned to sports within a mean 5.7 ± 1.6 months, at the same level in 27 patients (79.4 %) and at a lower level in 7 patients (20.6 %). The average hamstring/quadriceps ratio at 240°/second was 54.7 ± 8.6 % which was positively correlated to the level of activity on the UCLA score (r = 0.49, n.s.). The level of satisfaction was related to their level of activity at the final follow‐up (p = 0.03).Conclusion: Although surgical repair of acute proximal hamstring ruptures has significantly improved the functional prognosis of patients it remains a serious condition that can compromise future sports activities.Level of evidence: Case–control study, Level III.

Purpose: The main purpose of this study was to investigate whether judo could be practised after joint replacement.Methods: Two hundred and twelve questionnaires were sent to Judokas licensed at the French Judo Federation, over the age of 60, with at least a black belt 6th Dan. Out of 83 responses, 38 individuals, mean age 72.8 ± 7.9 years old, had at least one implant. The survey identified 36 total hip arthroplasties (THA) in 27 patients, 10 total knee arthroplasties (TKA) in 8 patients and 3 total shoulder arthroplasties (TSA) in 3 patients. The main evaluation criterion was the return to judo after joint replacement. Secondary criteria were the level of judo after surgery, rate of surgical revision at the final follow‐up and the level of patient satisfaction.Results: Twenty‐nine out of 38 patients who underwent joint replacement returned to judo practice (76.3 %) a mean 4.1 ± 2.9 months after surgery. On the other hand, all patients stopped competitive judo. The surgeon recommended 65.8 % of these patients to stop practising judo. There were 2 surgical revisions in the THA group (5.5 %) for loosening at 6 and 9 years of follow‐up. No dislocations or fractures were reported at the final follow‐up. Thirty‐two patients (84.2 %) were satisfied with their implant.Conclusion: The practice of judo does not seem to be limited by joint replacement. A clinical and radiological study should be performed to confirm these results.Level of evidence: Case series with no comparison group, Level IV.