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– If the lateral retinaculum is too tight, the patella exerts too much external pressure on the femoral cartilage, or trochlea.

The surgical procedure is performed arthroscopically, through two small incisions using a camera to view the joint, and consists in cutting the lateral retinaculum to relieve the excessive pressure and thus reduce the rubbing between the external part of the patella and the trochlea. The retinaculum will then heal, but more loosely.

– Retraction of the lateral retinaculum is often associated with a lateral position of the patella, which is due to the off-centre insertion of the patellar tendon owing to the position of the tibial tuberosity bump, which is also in an abnormally lateral position. In addition, this situation results in excess rubbing on the lateral side of the trochlea and causes pain in the kneecap and sometimes its dislocation.

In addition to retinaculum release, the therapeutic procedure consists in repositioning the tuberosity, released beforehand by an incision of a few centimeters, in the centre of the knee and then fixing it with two screws to realign the patellar tendon in the centre of the trochlear groove.
Correct patella tracking is restored and the excessive rubbing that caused the pain in the patella and the cartilage damage is eliminated.

Any cartilage damage can be treated at the same time. Once consolidated, it is often useful to remove the screws.

– Firstly, a small section of cartilage can come away from the joint with a piece of bone attached.
This type of lesion can heal. The fragment can be reattached using a screw to enable stabilization and consolidation of the cartilage.
The surface of the joint is thus restored.
Once consolidated, it is often useful to envisage removing the screw.

– The second possible scenario is damage to the cartilage alone, which breaks into several fragments that come away in the joint causing pain and blocking.
The fragments are removed arthroscopically.
The damaged area where the bone is exposed is thus abraded. A technique called Pridie drilling is used to create micro-holes to induce fibrocartilaginous healing with recovery of 80% of the mechanical function of normal cartilage.
A few weeks, or even a few months, are necessary for the surface of the cartilage to heal.

– Finally, a fragment can come away with a piece of subchondral bone. Both bone and cartilage are lost in this case and the fragment, altered and worn, cannot be reattached.
It is thus necessary to reconstruct the cartilage but also the subchondral bone.
To do this, bone and cartilage plugs are harvested from a location on the surface of the knee where the cartilage is of little use. The damaged site is prepared and these samples are grafted.
Several plugs are often required; we thus talk of “Mosaicplasty”.
In this case, it is also necessary to wait several weeks for complete osteochondral consolidation and restoration of the joint surface.

These procedures are all performed arthroscopically, through two small incisions using a camera to view the joint. After the operation, it is necessary to use crutches to move around for several weeks to keep the weight off the knee, as healing is significantly improved with decreased mechanical stress due to weight.

As two-thirds of the surface remain intact, we can envisage a unicompartmental knee replacement, in other words only replace the area of worn cartilage.
A minimally invasive approach is thus used.

The cartilage surfaces damaged by knee osteoarthritis are resected. Specific cutting guides are placed on the tibial and femoral surfaces to ensure the correct positioning of the tibial and femoral implants.

All the other structures, ligaments, tendons and remaining knee cartilage, are conserved.

To deal with isolated knee osteoarthritis, a unicompartmental replacement helps preserve the natural sensations in the knee joint. Moreover, recovery after the operation is faster than with total knee replacement, and in over 70 % of cases the lifespan of the implant exceeds 20 years.

– In the case of an unstable shoulder where the bone lesions and stress on the joint are relatively minor, the first technique consists in tightening the ligaments arthroscopically, that is through small incisions using a camera to view the joint.
The anterior zone of ligament detachment is abraded to optimize healing.
Anchors are implanted in the glenoid bone near the surface of the cartilage with threads that are then passed through the ligaments to reinsert and tighten them.
The shoulder is thus stabilized, which helps prevent recurrent luxations whilst conserving the natural environment of the shoulder.

– Sometimes, damage that is more significant can result in an unstable shoulder. Particularly in the case of bone damage, whether it entails the humeral head or the glenoid cavity, the Latarjet bone graft technique is preferred. This operation consists in removing the end of the coracoid where the biceps muscle is attached.
The bone fragment is then placed in the damaged part of the glenoid cavity and secured with screws. Displacing this bone fragment has no effect on function.
The lost bone is replaced and the modified insertion of the biceps dynamically stabilizes the humeral head with the biceps muscles thus preventing luxation.
Choosing this technique to stabilize the shoulder enables rapid resumption of very demanding activities and considerably limits the risk of relapse.
It can be performed using a non-invasive minimal anterior approach.

The hip joint comprises the femoral head that articulates with the acetabulum. Osteoarthritis is the wear of the cartilage on the femoral head and the acetabulum.
A hip prosthesis comprises 2 main components. The worn femoral head is cut for the placement of the first component. The acetabulum is prepared using a motorised cutter for the impaction and the integration of the cotyloidal impant in the pelvis. The femur is then prepared using rasps for the insertion of the femoral stem of the correct size. The femoral head is then attached to the stem forming the second component. The hip replacement is complete. The hip recovers full mobility and is no longer painful. Cementless alumina-based implants are generally used providing optimal duration of the prosthesis. This replacement is performed using a minimally invasive anterior approach; all the hip muscles are preserved thus enabling rapid recovery and good stability. An incision can also be made in the groin for esthetic purposes.