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1. ef C mmen By quand Physicians and surgeons are fond of the term paradigm shift This is a gentle phrasing of a disruptive concept It suggests that the familiar practices of today will gradually and peacefully transition to the kinder gentler more advanced practices of tomorrow It suggests that we will barely notice the shift as we transition easily to new tech nologies It may be reassuring to view paradigm shifts in terms of riding the gentle waves of change but nothing could be further from the truth Technological change is not Technological change is not gentle it is not easy and it is often not kind It does not ask permission nt TERI LI RIETI Evsow Surcery www clsevier comvlooate ymse Expanding the frontiers of shoulder arthroscopy Stephen S Burkhart MD Department of Orthopaedic Surgery University of Texas Health Science Center at San Antonio The San Antonio Orthopaedic Group San Antonio TX USA L innovation c est difficile c est laborieux ce n est pas une mise a jour automatique Knee Surg Sports Traumatol Arthrosc 2012 20 5 47 Fig 35 David Macintosh of Toronto on far left performing his extra articular fascia lata tenodesis The procedure was popular with surgeons during the 1980 and 1990s and was used in isolation or in combination with intra articular reconstructions photograph courtesy of David Dandy Illustration with kind permission of2. Christensen CM The innovator s dilemma New York Harper Business 2006 Faut il suivre Il faut relire le pass pour le regarder avec humilit e Les replis synoviaux la compresse OhAP pour combler les OTV les ligaments synth tiques la m niscectomie au Laser les PTG en Titane les rotules metal back les plateaux PTG PE charg s de Carbone les x nogreffes bovines la PTG mini invasive par le cot et autres e C est arriv pres de chez nous ca peut revenir soyons vigilants Second European Congress of Knee Surgery and Avosconi Fa U t suivre P Basel Switzerland Seplember 29 ES Savoir relire le pass Abstract Book 34 Basic elements biomechanics preliminary clinical results with proflex in the replacement EE ni i i j a 3 mo i of the anterior cruciate ligament At Z de Dessus r n le Ce Lazar a i sn arte i de Ehud Dd de peri gen POCA The technique of repair or replacement ofthe A C L often being unsatisfactory and sometimes even impossible to carry out the salvage operation must consist in the use of artificial ligaments Furthermore these allografts offer numerous advan tages a simplified procedure insertion by arthrotomy or arthroscopy preservation of the anatomic structure of the knee early postoperative reeducation and resumption of sports The further backward you look the further forward vou can see Winston Churchill Second European Cong
3. Elsevier Oxford 129 La courbe S Technology S curve Technology S curve Third technology Second technology Product Performance Product Performance First technology Time or Engineering Effort Time or Engineering Effort Figure 1 Technology S curve The rate of progress is initially Figure 2 Enhancement technologies produce improvements by slow it then accelerates and then reaches a physical limit the method of stair step intersection of S curves La courbe S et la concurrence Technology S curve Application Market A Application Market B Technology 2 Technology 2 Performance as Defined in Application A Performance as Defined in Application B Technology 1 Time or Engineering Effort Figure 3 A disruptive technology develops in one market until it reaches the performance demands of another market Then it invades the second market disrupting the established technology Faut il suivre Il faut rester vigilant et l coute e IBM leader incontest des gros ordinateurs n glige l mergence des petits ordinateurs Clayton Christensen 1s an associate professor at the Harvard Business School He coined the term disruptive technology and identified 1t as the way that rapid para diem shifts occur In his book The Innovator s Dilemma he described the computer industry as a prime example of the contrasting means by which change can occur
4. nt pour connaitre les mouvements et leurs valuations e Lire discuter partager e Savoir sortir de son cercle d amis fid les qui sont toujours d accord avec vous e Aller voir les autres op rer Et voyager ca fait du bien Innovation mode d emploi 1 se m fier e Se m fier de soi ma technique marche tres bien je ne vois pas pourquoi je changerais e Se m fier des autres moi j en ai fait 100 avec 100 de bons r sultats e Se m fier du commercial il vend du r ve c est son m tier With knowledge increasing at rocket like speed we can choose either to resist the change that is the byproduct of this knowledge or to ride the rocket I Innovation mode d emploi 2 avancer e Avoir en permanence un projet de remise en question e Avoir r gulierement une de nos op ration en learning curve Change 1s intimidating Adopting change can be chal lenging But truly assimilating change is exhilarating In today s Information Age the rapid doubling time of human knowledge makes change inevitable In 1950 the doubling time was 10 years By 2004 the doubling time was 18 months Faut il suivre les implants ne sont pas les proc d s Paradoxe tonnant e Il est simple de changer d implant et pourtant les cons quences sont durables si d faillance par exemple couple de frottement mat riaux e Il est compliqu de changer de technique et pourtant les cons quences sont
5. ress of Knee Surgery and Arthroscopy Anterior cruciate ligament reconstruction using ligament the Leeds Keio Terylene JE Hamilton G K Sefton AB Smet TU Cain Woodlands Orthopaedic Hospital Bouchsrs PVR 5 Villas Bradtord BD8 7JX l J Bradtord 7JX England Instability of the knee following rupture of the anterior cruciate ligament ACL has treated by several methods in the pest This paper describes experience in surgeon 2 Stress measurement using the Stryker KT 1000 3 Using the Cincinnati Sports Medicine Self Assessment Knee Chart Results CGinical examination including the use of lateral radi tension showed increased stability of the joint The Cincinnati Self Assessment Knee Chart typically showed an improvement of from 40t0 70 0n a scale of 100 The Stryker KT 1000 did show reproduceabie results and indicated a si vement in stability but we are less convinced about the reliability of thes method as an indication of t La de 1 i Discussion From our study of 50 cases we are convinced that reconstruction of the A C by the Leeds Keio Ligament is a reliable and effective means of stabilising a knee joint even in a young athiete where it can be demonstrated that the instability is due to rupture of the ACL The post operative behaviour of the ligament as assessed by arthroscopy and histo of the ACL torepair indicates that it is sur rounded by firm fibrous similar to that of the origina igament and remains stable over
6. temporaires si d faillance par exemple navigation mode de vis e Faut il suivre Le progres n apparait pas ou on l attend Thomas Edison p re de la Chirurgie Moderne Edison was not a surgeon He didn t know anatomy and he never conducted a single biological experiment But consider this Prior to the invention of the light bulb much of the surgery that was done in the United States was performed outdoors on a sunny day so that the surgeon could see to operate It was necessary to operate outdoors because ether was highly flammable and the use of indoor lanterns with an open flame for lighting was extremely dangerous Conclusion Faut il suivre e Qui il faut suivre et pour cela e 1 Etre au courant regarder lire voir couter e 2 Garder le sens critique e Etil faut r gler le curseur e 3 Too high foncer sur tout ce qui bouge e 4 Too low habiller notre paresse naturelle du costume de la prudence d sabus e Technological change ts not gentle it is not easy and it is often not kind It does not ask permission vi QA nk Ou for your a attentio
7. the period of review ce even in a young athiete It is sur liga sr e eni Faut il suivre Il faut garder le sens critique 30 Reconstruction of the anterior cruciate ligament using a ligament prosthesis Jan Gifquist MO Magnus Odenstein MD Department of Orthopaedic Surgery University Hospital 581 85 Link ping 76 patients 27 women and 49 mon age range 16 35 years were operated on because of antenor cruciate iInsufhciency La progres der dgr a population subjected to muscie rehabilitation due to significant instability of nea Orly esa wie ME Band vigenti pone papa Muscie replaced using a new technique tor accurate positioning of the drili holes Stability nation Tha posiionine of the prosthesis was controlled by X ray Immediate the operation f with full welightbearng was allowed afer the operation Results The preoperative mean Lysholm knee function score was 67 5 which increased to 90 8 in 39 patients followed for 1 year and to 93 7 in 37 patients followed for 2 years between legs with a laxity tester was valy 7 mm at 1 year 0 5 mm and at 2 years 08 mm Muscle strength was generally normal at 5 months postop and the results of a figure run as well as a one leg hop tost were normalized at one yoar ru AA opts pra la 2 qui Uti eh La PH pre 277 by S Ady hate Om erper que Lora de La maple 3 S tug Ar Auge Genre plus besoin da tm LCA dici ria sine Faut il suivre Il faut lire le prese
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