Étude laxométrique après reconstruction du ligament croisé antérieur du genou

We made a follow-up at three, six and 12 months after 148 ACL reconstructions; 53% of the patients had an intensive rehabilitation of four weeks in the center during two months after surgery (including isokinetic and nonisokinetic reinforcement). On KT 2000 arthrometer, laxity and compliance are greater on the operated side. Laxity increases from three to six months but remains stable from six to 12 months after the plasty. After meniscal repair, laxity tends to be greater. Intensive rehabilitation in the center does not increase the laxity but when the resumption of the pivot athletic activities is too precocious, laxity is most frequently pathological. When isokinetic ratios are pathological, shears tend to be more frequently greater but multivariate analysis does not find correlation between functional (ARPEGE), isokinetic or laxometric data.     

La reconstruction du ligament croisé antérieur aux tendons ischiojambiers chez les sportifs de haut niveau. Étude prospective de 30 cas

Introduction

Anterior cruciate ligament (ACL) reconstruction using hamstring graft under arthroscopy makes it possible to restore the stability of the knee allowing an early resumption of the sport. Our study aims to determine in the high level sportsmen; clinical, organic and therapeutic characteristics through the revision of a clinical series, analyzed about literature.

Material and methods

It is about a prospective Moroccan study of 30 high-level sportsmen having profited from an ACL ligamentoplasty under arthroscopy. All the patients were re-examined with three years the average retreat. Our patients was level 7 of Tegner and 30% of them were professional footballers. The therapeutic time was three years on average. The intervention proceeded under arthroscopy using hamstring graft, the fixation was ensured by screw in femur and another screw associated with staples with barbs in tibia. The protocol of rehabilitation early and was adapted to the practiced sport.

Results

The average follow up was three years. According to the quotation of Lysholm, we noted 86% from goods and excellent results, 10% of average results and 4% of bad results. According to objective score of International Knee Documentation Committee (IKDC), we noted 43% of classified patients rank A, 51% of rank B, and 6% of rank C. To the KT-1000, average differential laxity was of 1.8 mm. The average time of resumption of the competition was six months.

Discussion

The use of hamstring graft for the petitioning high level sportsman salary of an early recovery, gave us satisfaction in spite of residual laxity. In our study, the average time of resumption of the competition was six months. These results are encouraging compared to the remainder of the studies published where the resumption of the competition is recommended between sixth and the tenth month, some is the transplant used.     

Stabilité posturale après reconstruction du ligament croisé antérieur

Injury of the anterior cruciate ligament (ACL) leads to static and dynamic instability, with a risk of joint degeneration. The purpose of surgical reconstruction is to re-establish joint stability and function. It does not restore the sensorial system. The purpose of this work was to compare, in terms of postural stability, healthy knees and operated knees five years after ligamentoplasty versus 31. A dynamic posturography device was used for assessment. It was concluded that there was no difference between the two groups concerning postural stability.     

Agénésie du ligament croisé antérieur et du ligament croisé postérieur du genou

This case report is an agenesia of the anterior and posterior cruciate ligament of the knee on a young man 35 year old. This malformation is rare and exceptional. The clinic is principally a knee laxity. On the plains radiographics, the diagnostic can be made because there is a hypoplasia or an agenesia of the tibial eminence and a malformation of the femoral intercondylar notch. MRI confirms the diagnostic.     

Épidémiologie des ruptures du ligament croisé antérieur du genou chez la joueuse de football de haut niveau : à propos de 66 cas

Our study focussed on the rupture of the anterior cruciate ligament in high level female soccer players in first and second national divisions. To this effect, we used a questionnaire to analyse 66 cases of anterior cruciate ligament injury according to the following criteria: age at the time of injury, the side injured, laterality, circumstances of the accident, the type of treatment (surgical or functional), the type of surgery, recovery time, the level of recovery, initial care in a rehabilitation centre. Rupture is generally due to a non-contact injury (65%), which is comparable with a male population of the same level. The risk of repeated rupture, in a player continuing her career, is significant (> 10%). The type of surgery does not affect return to sport. However, for high-level female soccer players, rehabilitation in a specialised centre improves the chances of returning at the same level (p < 0.025).     

Reconstruction du LCA chez le sportif de compétition. Évaluation, à court terme,après reprise du sport

Background

Most studies have observed satisfactory outcome after anterior cruciate ligament (ACL) reconstruction. The best series report 80 to 90% success, irrespective of the type of operation. The purpose of this work was to investigate resumption of sports activities after ACL reconstruction. We studied the impact of the conditions of sports activity after the operation, gender, type of sport, presence of an extra-articular reinforcement and time since surgery.

Material and method

In order to search for significant differences between the postoperative and follow-up scores, a questionnaire with a subjective IKDC grid was addressed 12 months after their hospitalization to all athletes who had undergone ACL reconstruction at the CERS from 1^st January, 2003 through 31^st October, 2004.

Results

For the period considered, 2248 athletes were hospitalized at the CERS for ACL reconstruction. The response rate was 43% (969 responses at 12 months). There was no significant difference between the hospitalized population and the responders in terms of type of sports activity or type of graft. There was however a significant female predominance among responders (p = 0.01). Mean follow-up was 13.9 ± 2.9 months. Reconstruction methods were: hamstring graft 54%, free patellar graft 43%, MacIntosh fascia lata 2%, MacIntosh quadriceps 1%. The main activity was a pivot sport for 74% of the athletes. Male gender predominated: 77%. There was no difference regarding postoperative training, but competition level was achieved more readily by males (65% versus 54%, p = 0.0038), since more females stated resumption of competition was not an objective. It was also noted that resumption of training occurred earlier for gliding sports than for pivot–contact sports (7.32 ± 2.09 months versus 8.23 ± 2.66 months, p = 0.021). The presence of a lateral reinforcement did not have a significant impact on resumption of sports activities which was more frequent in the hamstring group than the patellar group (16% versus 7%, p < 0.0001) and more frequent in the pivot–contact sports (p = 0.0039). Regarding the role of the surgical technique, resumption of training and competition was better after hamstring plasty compared with patellar tendon plasty for follow-up less than or equal to 12 months (p = 0.0009 and 0.0001 respectively). The subjective IKDC score was also significantly better in the hamstring group for the period considered (p = 0.0006). The differences observed early in the follow-up resolved over time and no significant difference was observed at 18 and 22 months. Regarding the MacIntosh fascia lata plasty, resumption of competition was significantly earlier (7.67 ± 1.87 months) compared with hamstring plasty (9.69 ± 2.58 months) and patellar tendon plasty (9.65 ± 3 months). Resumption of training (90%) and competition (76%) was also better with the MacIntosh fascia lata plasty compared with the two other techniques but the difference was not significant. These differences, in favor of the MacIntosh fascia lata plasty, might have been due to a recruitment bias since the level of the sports activities was significantly higher in the MacIntosh population than in the populations of the other two methods.

Conclusion

This study is of particular interest because of the size of the homogeneous study population resulting from the highly selective recruitment of athletes at the CERS. This study is generally in agreement with prior data in the literature, particularly concerning the rate of resumed training one year after surgery. This study shows that the patellar tendon plasty reaches maturity more slowly than the hamstring plasty although the two techniques yielded comparable results at 18 months for all criteria studied.     

Pente tibiale et rupture du ligament croisé antérieur : étude anatomoradiologique

Studies of knee-joint anatomy and biomechanics have demonstrated a main intrinsic factor having a negative impact on the anterior cruciate ligament (ACL): a weak tibial slope. The purpose of this work was to study tibial slope measured on plain X-rays in knees with and without ACL tears.     

Fonction et niveau d’activité physique deux à cinq ans après la reconstruction du ligament croisé antérieur (LCA)

Objectives

Evaluation of functionality and level of physical activity in patients 2 to 5 years after anterior cruciate ligament reconstruction.

Material and methods

A nonrandomized study, which included consecutive patients (n = 31) who underwent ACL reconstruction and were evaluated 2-5 years after ligament reconstruction. The surgical techniques used were the bone-patellar tendon-bone graft (BTB), quadriceps tendon (QT) and semitendinosus gracilis tendons (ST-G). The clinical evaluation included the Tegner activity Index (TI), Lysholm Index (LI), Index Knee Outcome Survey (KOS) in their sub-divisions “Total”, “Activities of Daily Living” and “Functionality” (KOS-T, KOS-ADL, KOS-IF) and Noyes Test (NT). The Package for Social Sciences (SPSS) version 17.0 for Windows was used for the statistical study.

Results

Before injury, the TI was 6.74 and after injury 4.35; the LI average was 89.55; the KOS-T was 70.48, KOS-ADL 30.48 and KOS-FI 39.95; and the NT gave a symmetry score of 96.6%. No significant correlations were found between the values of the TI before and after injury, or between the values of the LI and KOS-ADL, and the LI and NT.

Conclusion

ACL injury is associated with a high number of meniscal and chondral injuries, with direct impact on the prognosis of these patients’ sport activity and a reduction in activity levels. This reduction is not accompanied by a significant functional loss and normal daily activities are unaffected. The motivation of the patient and medical advice are considered key factors in promoting recovery to the pre-lesional level.     

Ostéotomies tibiales de valgisation associées à la ligamentoplastie du ligament croisé antérieur. À propos de 15 cas

The management of patients aged 30 to 50 years and with an anterior knee laxity in ACL tear associated with medial osteoarthritis femorotibial, is very difficult. Recent publications have shown that the combination of an valgus osteotomy and ligamentoplasty of the ACL is possible to halt the progression of osteoarthritis while correcting the laxity of the knee. We report our experience of 15 patients who received a valgus osteotomy associated with the ACL ligamentoplasty.     

Épidémiologie des pathologies du membre supérieur dominant chez les joueurs de tennis français

Objective

This retrospective study aimed at describing the epidemiology of dominant upper limb pathologies in French male and female tennis players aged between 11 and 30 years, and to study the relationships between injured/non-injured status and tennis practice.

Material and methods

One hundred and fifty six male and 67 female competitive French tennis players filled out a questionnaire to characterize their tennis practice and medical condition.

Results

Forty-one percent of players were injured at the dominant upper limb during the five years before the questionnaire. These injuries affected the musculotendinous structure (84%) at the elbow (42%), shoulder (23%) and wrist (21%) joints. Strong and significant relationships were found between injured/non-injured status and skill-level (ES = 0.33; P < 0.001), as well as between injured/non-injured status and rate of progression (ES = 0.50; P < 0.001). Tennis players practicing competition at high level and progressing rapidly could suffer from insufficient morphological adaptations of their dominant upper limb, hence suggesting that the strength and conditioning training program may focus on prophylactic objectives rather than on performance objectives at the upper limb sites.