Intérêt du Télos dans l'évaluation de la laxité chronique antérieure du genou en pré- et en postopératoire

The objective of our work is to clarify the contribution of knee arthrometer in the diagnosis of the anterior laxity of the knee, to look for the factors of escalation of this pathology, to estimate the objective results and outcomes following of the anterior cruciate ligament surgery. It is about a retrospective study which concerned 78 patients presenting the anterior chronic laxity of the knee, investigated, treated and followed in the M.-T.-Kassab Institute of Orthopaedics over a period of 10 years. The average age of our patients was of 27.6 years with a male ascendancy. The anterior cruciate ligament surgery was realized according to the technique of Kenneth-Jones under arthroscopy. The arthrometer has been used to determine the outcome 6 months after the surgery. Before the surgery, the average anterior translation of the tibia was 15.3 mm, 95% of the patients had 8 mm previous absolute laxity, while the differential was about 4 mm in 87% of the cases in which comparative study could be made. There was a statistically significant correlation between the Lachman's test, the internal meniscus injuries and the delay accident — surgery with the anterior knee laxity in the arthrometer. The postoperative average laxity was bout 8.2 mm and earning was proportional to the importance of the initial tibial translation. The present study demonstrates that arthrometer tests may be an objective complement for the clinical exam, with a diagnostic, previous and therapeutic purpose.     

宫颈高度鳞状上皮内瘤变的“即诊即治”策略

目的探讨宫颈高度鳞状上皮内瘤变应用＂即诊即治＂策略的价值。方法选取宫颈细胞学检查为高度鳞状上皮内瘤变（HSIL）,并经阴道镜检查、镜下活检及宫颈电圈切除术（LEEP）治疗的患者76例,按阴道镜RCI评分分成高评分组、低评分组,对组织病理结果及过度治疗率进行回顾性分析。结果 RCI高评分组CINⅡ、Ⅲ及以上病变比例为97.4%,低评分组59.5%,高评分组过度治疗率2.6%,低评分组40.5%（P〈0.001）,不同RCI评分组的过度治疗率差异有统计学意义,高评分组过度治疗率显著低于低评分组。结论对于细胞学为HSIL,经阴道镜检查RCI高评分,提示高度病变的患者,采取＂即诊即治＂策略快速而有效地进行诊治,是较为适宜的;而细胞学检查HISL、RCI低评分者,仍以传统三阶梯方案进行筛查诊治为宜。     

Analysis of older adults visiting the emergency department with fever as a suspected Covid-19 vaccine-related adverse reaction: A retrospective multicenter study

IntroductionAfter COVID-19 vaccination was initiated, the number of patients visiting the emergency department (ED) with vaccine-related adverse reactions increased. We investigated the clinical features of older adults (aged 65 years and older) visiting the ED with self-reported COVID-19 postvaccination fever.MethodsWe conducted a retrospective observational study at three EDs between March 2021 and September 2021. Patients who reported adverse reactions, fever (≥37.5 °C) and/or febrile sensation or rigors following COVID-19 vaccination were included. The demographic and clinical data of these patients were collected by reviewing their medical records.ResultsA total of 562 patients were selected, and 396 (70.5%) were female. The older adult group included 155 (27.6%) patients, and the median age was 75 (69–79 years). The older adults less frequently had a fever (≥37.5 °C) upon ED presentation (75.5% vs. 85.7%, respectively), used more emergency medical services (43.9% vs. 18.7%, respectively), and visited an ED more frequently during early hours (00:00–06:00) (31% vs. 20.1%, respectively) compared to the younger adults (p = 0.004, p < 0.001 and p = 0.036). Fewer older adults visited an ED within 2 days of fever onset (73.5% vs. 84%) (p = 0.012), and more older adults were admitted for medical conditions other than vaccine-related adverse reactions (32.9% vs. 4.2%) (p < 0.001). Older adults received more thorough testing (laboratory and imaging tests). Among the older adults, the admission rate was associated with age (p = 0.003).ConclusionOlder adults presenting with fever as an adverse reaction following COVID-19 vaccination less frequently had a fever upon visiting the ED, required more ED testing, and had higher admission rates for non-vaccination-related medical conditions.     

Place du traitement médicamenteux et des infiltrations dans la prise en charge médicale des lésions de la coiffe des rotateurs

One of the main objectives of medical treatment of rotator cuff lesions is to attenuate or totally relieve pain and allow the patient to access the next phase of functional rehabilitation. Relative rest is desirable. Harmful sports movement should be avoided. Strict immobilization is never indicated. The question is raised as to whether wider use of analgesics would be warranted. The inflammatory nature of rotator cuff tendiopathies remains to be clearly demonstrated and the efficacy of analgesics in this indication would be related more to their intrinsic pain killer action. Analgesics should thus be prescribed prudently and limited to a few days, particularly because of the potential adverse effects. Theoretically, steroidal anti-inflammatory drugs should not be used for tendonitis. Myorelaxing agents could be used in the event of associated muscle contracture. If the patient requires further relief, corticosteroid injections could be considered, taking care to avoid contraindications for intra-articular injections and avoiding any risk of contamination while keeping in mind the possible adverse effects.     

Instabilité antérieure récidivante de l'épaule chez le rugbyman. Résultats d'une série de 85 épaules opérées par la technique de Latarjet avec un recul moyen de sept ans

The stabilization of an unstable chronic shoulder is a difficult challenge in the contact sportsman especially the rugby player. We report our experience of the modified Latarjet procedure with a retrospective series of 85 shoulders (79 rugbymen at 75 months follow-up). It acted all young men with a prevalence of dominant shoulder, occupying all the stations (over-representation of the third lines). Eighty percent presented osseous lesions; the first luxation was traumatic during a tackle. We describe our technique and our postoperative protocol. Seven percent experienced recurrence of their instability after a new traumatism and 67% returned to rugby within 8 months by keeping for some of them a sport practice functional embarrassment (16 patients). Only two mechanical complications were observed, 93% of the patients were satisfied with their intervention.     

Spécificités de la pratique du rugby chez l'enfant

The knowledge of the specificity of the child compared to the adult and his reactions regarding the exercise will make it possible to answer parents questions as well as possible and to accompany the child and the teenager in their sporting practice. Five essential concepts govern the practice of Rugby in the child: 1) the child is not an adult in miniature. It is an organization in constant evolution towards its physical and psychic statute of adult. He has a free will depending on the others; 2) Rugby must remain for him a ludic space, where the motivation must be the first condition; 3) the child is a mosaic of growth cartilages. Traumatic pathology is preferentially a pathology of this structure in the acute traumatisms (epiphysium separation rather than distorsion, muscular apophyse avulsion rather than tear) and under the effect of chronic microtraumatisms (osteochondrosis rather than tendinitis); 4) overtraining will result in a disturbance of one of the factors of the general balance of the organization which it acts of a pain, of against performance, an abnormal tiredness, of a demotivation, a relational disorder (mood, affectivity), of lower school output of which it will be necessary to establish a relationship to the sporting practice; 5) the execution of a sporting gesture must always be modulated as of the appearance of a pain, true alarm.     

Épicondylites : « les nouveautés en 2007 »

What news for 2007 concerning sportsmen lateral epicondylitis? Concerning biomechanics, we will evaluate the role of the supinatus at the same time we will talk about the complex characteristics of the functionnel unit. An anatomic work has showed in some cases, the involvment of ligment structure that could explain the atypical side of the pain and sometime the failure of the treatment. As for rehabilitation, we will insist on the importance of excentric work. The braces conserve a certain importance. We insist on new therapeutics and mostly on the interest of trinitrine patches. Botulinium toxic is still discussed and the recent study of Hayton does not show any significant difference with placebo injection. An original autologue blood injection in the epicondylitis tendon demonstrates good results and specially in the cases that resist to the corticoid therapeutics. We will talk about our experience. Considering corticoide injections a Crowther publication reveals a significant result compared to choc waves therapy. At last, we will criticize the Smidt study because we believe that the use of fluorite corticoid induce iatrogenic effects. We will conclude this article by our 2007 propositions about the local corticoid indication.     

Laxité chronique antérieure du genou chez le sportif. À propos de 118 cas

The chronic anterior laxity of the knee is an evolutive disease owing to a rupture of the anterior crossed ligament which engages the functional prognosis of the lower member and compromise sportive activity. Many techniques of ligamentous plasty were described. Our study is about 118 sportsmen suffering from chronic anterior laxity treated by the modified Kenneth-Jones procedure between 1998 and 2002. After a main following-up of 25 months, we tried to value our results and determine the real place of ligamentous plasty using patellar tendon in the treatment of sportsmen chronic anterior laxity.     

Rôle de l’équipe paramédicale dans la réalisation du contrôle ciblé de la température après un arrêt cardiaque récupéré

Therapeutic hypothermia, also called targeted temperature management, is increasingly used in the intensive care unit (ICU), based on its assessed neuroprotective effects against ischemia-reperfusion-induced brain damage. Targeted temperature management is indicated in comatose adult patients after cardiac arrest if successfully resuscitated from a witnessed out-of-hospital cardiac arrest of presumed cardiac cause with an initial rhythm of ventricular fibrillation or non-perfusing ventricular tachycardia and in a stable hemodynamic condition. Patients after in-hospital cardiac arrest or with other initial rhythms may also benefit. When indicated, therapeutic hypothermia should be quickly performed and tightly controlled. Both surface and core cooling methods target a body temperature of 32 to 34 °C. Thus, it is mandatory to know how to simply manage the routinely available techniques in order to perform hypopthermia as soon as possible, being aware of all side-effects that may alter the expected benefits. Therefore, implementing hypothermia in the ICU involve the whole medical and paramedical staff.     

Les kystes du ligament croisé antérieur : à propos de 24 cas

The purpose of this study is to present clinical and magnetic resonance imaging (MRI) features of ganglion cysts of the anterior cruciate ligament (ACL). Such cysts are rare and often unsuspected. We reviewed a series of 24 ganglion cysts of the ACL (7 females, 17 males) between 1998 and 2004. The mean age was 45 years old (25–74). All patients presented with knee pain. The mean follow-up was 25 months (6–48). All patients had a preoperative MRI, which confirmed the diagnosis. Seventeen patients had an arthroscopic treatment and 7 were treated with percutaneous aspiration and steroid injection under. Fourteen patients were evaluated with the International knee Documentation Committee (IKDC) subjective score. Computed tomography or ultrasound guidance. MRI demonstrated 16 mucoid degenerative cysts of the ACL and 8 well circumscribed ganglion cysts with a fluid collection. The surgical pathology confirmed 13 mucoid cysts and 4 ganglion cysts; 2 recurrences were observed after surgical treatment. After percutaneous aspiration, we observed 3 recurrences, 2 failures and one vascular complication. We observed two types of ACL cysts, which could be differentiated on the MRI. Percutaneous treatment was less reliable than surgical treatment. The percutaneous aspiration should be reserved to the ganglion cysts with fluid collection, while arthroscopy is indicated for the failure cases. We recommend resection for the mucoid cysts. An aggressive resection of the ACL may compromise the knee stability so that the patient must be informed preoperatively. In theses cases, aspiration was often inefficient.     

Infiltrations articulaires et para-articulaires chez le sportif : intérêts et limites

Few studies have validated the use of corticosteroid joint injections in sports medicine, and many recent studies have questioned their usefulness. The beneficial effect is essentially short lived, enabling the athlete to complete a specific performance. Local complications have been well described but the systemic effects are underestimated, especially during the first week. Corticosteroid joint injections are not on the regulatory list of products requiring an Authorization for Use for Therapeutic Applications (AUTa) for sportive events. Several studies have demonstrated that the corticotrop axis can be inhibited after a single injection, reflected by decreased production of endogenous cortisol for as long as two weeks. This biological adrenal insufficiency can lead to acute renal insufficiency if the athlete resumes competition too early under stressful conditions. Since there is no known way to identify predisposed individuals, the risk appears to be disproportionate compared with the expected benefit. Rest from sports must therefore be prescribed for any individual given a joint injection.     

Évaluation à moyen terme d'une intervention type hémi-Castaing dans le traitement de l'instabilité chronique de cheville

Introduction

The purpose of this study is to evaluate the functional and subjective results of hemi-Castaing replacement ankleplasty associated with articular cleaning in the treatment of chronic instability of the ankle.

Material and method

The study is retrospective, monocentric and continuous. Fifty patients (50 ankles) underwent surgery by hemi-Castaing ligamentar ankleplasty associated with articular cleaning. An independent investigator on the basis of a radioclinical examination and an ankle scoring system made the assessment.

Results

After a period of 37 months, 44 patients were seen again. Ninety-one percent of them were satisfied; the average ankle score was 87.5%. Four patients had relapsed, 26 still had pain. Seventy percent had returned to sport activities, 97% had gone back to work. The main complications were: 6 cases of tendinitis (Achilles tendon), 6 algodystrophies, 3 nevromes of the external saphene nerve and 3 dysesthesis of the external side of the foot. No sign of arthrosis was found on the radiological records.

Discussion

The treatment of chronic instability of the ankle by hemi-Castaing ankleplasty associated with articular cleaning is a satisfactory intervention for the surgeon as well as for the patient. It makes possible the recovery of a stable and functional ankle. The pain, however, will not totally disappear, which the patient should be told before the operation. Mastering the tension of the plasty is the main difficulty of this intervention, which may fail, but not necessarily as a result of the plasty's being too loose. The cause for the failure should also be sought in other factors related to the region of this pathology (deltoidian ligament, neurologic trouble, proprioceptive).     

Traumatologie maxillofaciale chez le joueur de rugby : attitude pratique pour le médecin de terrain

The maxillofacial traumatisms are frequent during the practice of rugby and of a variable level of gravity. Their knowledge as well as an early-adapted management is the only guarantors of later minimal after-effects. The medical staff must familiarize himself with these lesions, which justify sometimes specific gesture in emergency and always an assessment in a specialized unit within the shortest possible time.