The rehabilitation program that results in better tendon healing by preventing postoperative stiffness has not yet been identified. Our results suggest that early passive motion should be authorized: the functional results were better with no significant difference in healing.

The analysis showed the importance of the axial reconstruction plan chosen to allow interpretable and reproducible measures. A decreasing version of the glenoid superior-to-inferior was observed, presenting a spiraling twist as described in previous studies. The profile of variation does not change in the four groups of patients included. The reconstruction of an articular surface as close to the anatomy as possible would also participate in establishing the muscular balance and the constraints on implants. Up to now, implants do not take into account this cranio-caudal twisting.

Purpose Idiopathic scoliosis can lead to sagittal imbalance. The relationship between thoracic hyper-and hypokyphotic segments, vertebral rotation and coronal curve was determined. The effect of segmental sagittal correction by in situ contouring was analyzed. Methods Pre-and post-operative radiographs of 54 scoliosis patients (Lenke 1 and 3) were analyzed at 8 years follow-up. Cobb angles and vertebral rotation were determined. Sagittal measurements were: kyphosis T4-T12, T4-T8 and T9-T12, lordosis L1-S1, T12-L2 and L3-S1, pelvic incidence, pelvic tilt, sacral slope, T1 and T9 tilt. Results Thoracic and lumbar curves were significantly reduced (p = 0.0001). Spino-pelvic parameters, T1 and T9 tilt were not modified. The global T4-T12 kyphosis decreased by 2.1°on average (p = 0.066). Segmental analysis evidenced a significant decrease of T4-T8 hyperkyphosis by 6.6°(p = 0.0001) and an increase of segmental hypokyphosis T9-T12 by 5.0°(p = 0.0001). Maximal vertebral rotation was located at T7, T8 or T9 and correlated (r = 0.422) with the cranial level of the hypokyphotic zone (p = 0.003). This vertebra or its adjacent levels corresponded to the coronal apex in 79.6 % of thoracic curves.Conclusions Lenke 1 and 3 curves can show normal global kyphosis, divided in cranial hyperkyphosis and caudal hypokyphosis. The cranial end of hypokyphosis corresponds to maximal rotation. These vertebrae have most migrated anteriorly and laterally. The sagittal apex between segmental hypo-and hyper-kyphosis corresponds to the coronal thoracic apex. A segmental sagittal imbalance correction is achieved by in situ contouring. The concept of segmental imbalance is useful when determining the levels on which surgical detorsion may be focused.

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