Entraînement en endurance à partir du membre inférieur sain chez des footballeurs amateurs opérés de ligamentoplastie de genou

Objective

To examine cardiorespiratory fitness changes in subjects having undergone knee surgery and to assess the benefits of one-leg cycling aerobic training program during the rehabilitation period.

Method

Two groups of 12 patients took part in this study. The control group profited from a five weeks conventional rehabilitation in day hospital without cardiorespiratory training. The second group profited in supplement from a one-leg cycling aerobic training program with the valid leg. The subjects were trained for 21 min, by alternating 3 min at 70% and 3 min at 85% of VO_2peak. They totaled 15 sessions spread over five weeks. The initial evaluation (T1) is carried out the first day of rehabilitation and the final evaluation (T2) at a distance within 35 days. The evaluation consisted in realizing a maximal graded tests starting from the valid leg.

Results

After five weeks of conventional rehabilitation, we record a reduction of peak power output (W_peak), peak oxygen uptake (VO_2peak) and peak minute ventilation (VE_peak), respectively of 11, 12 and 13% for the control group. On the other hand, in T2, the training group has on average identical maximum values and some of them increased (W_peak: +14%; VE_peak: +15%). The first and second ventilatory thresholds appear with higher intensities of exercises.

Conclusion

After knee surgery, conventional rehabilitation does not limit cardiorespiratory deconditioning. One leg cycling appears to be an adapted method to stop the effects of hypoactivity.     

Test isocinétique précoce après ligamentoplastie antérieure de genou : résultats et conclusions

Objectives

To compare 4-months isokinetic results after anterior cruciate ligament reconstruction with patellar tendon or hamstring tendons.

Material and methods

A retrospective study during 5 years concerning isokinetic records from patients who went to our rehabilitation center after anterior cruciate ligament reconstruction, and who did an isokinetic test 4 months after surgery. There was 146 patients, 116 males and 30 females, 69 with hamstring reconstruction and 77 with patellar tendon reconstruction.

Results

In Kenneth-Jones surgery, there is more deficience on leg extensors, while hamstrings are more deficient after hamstrings reconstruction surgery. This deficience concerns peak torque and work, whatever speed.

Conclusion

Leg flexion deficience in hamstring reconstruction surgery is due to late work during reeducation, because of pain and injuries localized on sample area. There is also loose of biomechanical properties due to muscular fibrosis. For the two reconstruction surgeries, leg extension deficience is due to pain and edema.     

La rééducation d'emblée des ischiojambiers après chirurgie du DIDT

Introduction

Following knee ligamentoplasty, the task of muscle restoration principally focuses on the hamstrings, which are the only active structure which can protect the graft and prevent detachment. However, specialists generally advise against work on these muscles for a period of 3–6 weeks following semi-tendinosus and gracilis surgery. The hamstrings are thus left resting during this period, which encourages their wasting and tightening.

Objective

Our team, guided by the principles of rehabilitation for muscular problems, has for more than 2 years been strengthening the hamstrings immediately following ligamentoplasty surgery, making use of the semi-tendinous and gracilis. The objective is not only muscle performance and the protection of the graft, but above all encouraging the healing of the semi-tendinous and gracilis in order to align the collagen fibres and improve their mechanical resistance.

Content

It is a single-focus study, continually rolled forward. This protocol was practised on 56 patients, two patients having to withdraw from the programme because of strain problems.

Methodology

During the hospitalisation of the patient, concentric contraction of the knee flexors was engendered using weak resistance operated manually. Later in our rehabilitation centre, our patients exercised in a hamstring « chair », in the eccentric mode below maximum charge, with an increasing load progression. This was done daily up to the sixth week.

Results

Our results, at the 3rd and 6th week post-surgery, showed a favourable change in articular amplitude and pain suffered, with a low rate of complications. Evidence of pain was found in 12.5% of cases (7/56). Of these 7 patients, 2 (3.5%) had incidents involving muscular strain, rendering the interruption of the physiotherapy necessary for more than 3 consecutive days. Isokinetic results carried out at 4.6 ± 0.7 months showed excellent muscular recuperation of the hamstrings with a deficit of 9.6 ± 14% at slow speed and of 6.8 ± 13.1% at fast speed compared with the heterolateral side.

Discussion

The number of painful occurrences in our study, at 12.5%, is lower than the 20% ad higher frequently found in other documented cases. However the definition of these painful occurrences is imprecise. The performance deficit of hamstrings measured by isokinetic tests after 6 months varied between 15 and 20% depending upon the published study. In our study the results at 4.6 months were better (< 10%).

Conclusion

There can no longer be any doubt about the benefits of strengthening the hamstrings in pathologies of an anterior cruciate ligament. Our work has shown that the early strengthening of these muscles is not disadvantageous. On the contrary we believe that our policy promotes the patient's muscular and functional recovery.     

Functional electrical stimulation elliptical stepping versus cycling in spinal cord-injured individuals

Background

The cardiorespiratory responses and mechanical efficiencies of two modalities of functional electrical stimulation augmented leg exercises – isokinetic cycling and isokinetic elliptical stepping – were compared amongst individuals with spinal cord injury.

Methods

Five subjects performed seated isokinetic evoked cycling and elliptical stepping leg exercise at 10, 20 and 30 rev·min^− 1 pedal cadences. 3-D motion analysis and force transducers attached onto the foot pedals quantified the external forces and power outputs developed by each lower extremity. Hip, knee and ankle joints power were derived via inverse dynamics analysis. The subjects' cardiorespiratory responses during exercise were measured by respiratory gas analysis.

Findings

Ensemble-averaged oxygen uptakes across pedal cadences were higher during stepping (448 (75) ml·min^− 1) compared to cycling (422 (54) ml·min^− 1). External power outputs and metabolic efficiencies during stepping (9.9 (8.3) W, 2.9 (3.2) %) were double those observed during cycling (5.3 (6.3) W, 1.6 (1.9) %). Cumulative internal and external leg joint powers during stepping were twice higher than cycling, but the stepping mechanical efficiencies derived from inverse dynamics analysis were comparable to cycling (76.3 (21.2) % and 63.6 (12.3) % respectively). Heart rate responses were similar between cycling and stepping, while carbon dioxide production and expired ventilation were slightly higher during elliptical stepping.

Interpretation

Both exercise modalities could deliver appropriate training stimuli for improving the aerobic fitness and leg pedalling strength of spinal cord-injured individuals. However electrical stimulation-enhanced elliptical stepping might provide greater exercise dose-potency for leg muscle strengthening than electrically-enhanced cycling due to the higher power outputs observed.     

Hernie discale,microchirurgie et sport. De la rééducation au retour sur le terrain

Background

Microdiscectomy of lumbar disc herniation changed rehabilitation after lumbar disc surgery of athletes.

Hypothesis

Returning to a high activity level after microdiscectomy for athletes versus possible with a well-conducted rehabilitation and athlete training.

Methods

Thirty-three athletes (29 males and four females with a mean age of 30.8 years, range: 20–49 years) were identified in Centre européen de rééducation du sportif (CERS) during 2007–2008 after lumbar disc microdiscectomy. By phone, 31 answered a Oswestry's low back pain disability questionnaire, a Prolo's questionnaire, gave the delays of training's resumption, of competition return and the importance of residual pain with numeric verbal scale (0 to 10).

Results

At the time of the inquiry, the average post-surgery delay was 768 days (from 405 at 1642 days). The mean Oswestry's disability questionnaire was 6.5 (range: 0–32) and the median sum of Prolo's scales was 8.9 (range: 3–10). Forty-three percent of athletes have pain estimated at 4. On a scale from 0 to 10, mean score of functional abilities was 8.6. Seventy-seven percent of athletes returned jogging 4.9 months (range: 1.5–10 months), 81% returned training 6.5 months and 52% athletes came back competition at 8.2 months with 33% returned to sport on previous level.

Discussion and conclusion

The authors discuss the literature's data and conclude that the rehabilitation must be early, heavy, long until return on the field.     

Comment prévenir l’altération rachidienne lombaire et les blessures chez le jeune sportif

Objectives

The discovery of lumbar damage early in the practice of high level sporting activity led us to propose a simple program for the protection of the lumbar spine, applicable to each training session, since the age of 10 years, to limit the deleterious effects of physical activity.

Patients and method

A previous study realized in 30 young patients with lumbar pain has evidenced the effectiveness of a simple functional restoration program. We used it to propose preventive lumbar injury exercises combined in a comprehensive program with exercises for the prevention of lower limbs injuries.

Discussion

No longitudinal study has been realised on the potentially deleterious effects of early high level sport activity and no program is currently offered in a systematic way to limit its possible harmful effects. The simplicity of the protocol that we propose, validated for the spine allows its integration into a prevention program during the training of youth, since the beginning of rachis growth phase.

Conclusion

The early disc degeneration is a reality in combat and contact sports. Careful clinical monitoring is necessary to detect and take care of these pathologies. But as a priority, it is necessary to integrate since the young age a program of protection of the spine and to adapt it to the growing constraints required in above age categories, depending on the level of practice and this until the age of 18 years. This program is effective in the school rugby of the Association Sportive Montferrandaise and in the training centre.     

Évaluation d’un protocole de kinésithérapie ambulatoire pour la prise en charge des coxarthroses et conflits antérieurs fémoro-acétabulaires des sportifs

Introduction

Hip osteoarthritis and femoroacetabular impingement frequently affect sportsmen and are origins of permanent incapacity. The therapic behaviour before surgery step is not yet established. Physiotherapy is often suggested but it is still difficult to prescribe it correctly. The main goal of our study is to show superiority, both in terms of decrease of pain and increase of sportive activity, of the process “PROTOCOX” including both physiotherapy and manual therapy in comparison with a physiotherapy process “CONTROLE”.

Method

Twenty-six sportive patients of the “Institut régional de médecine du sport de Haute Normandie (IRMSHN)” have been included in the study in an 18-month period. Our secondary aims are to show improvement of life quality and range of motion. Several data including HOOS and Lequesne index have been harvested before and after the six sessions and after 3 months.

Results

For patients (n = 11) of the “PROTOCOX” group (P = 0.034), a significant improvement of the HOOS index, mainly on pain (P = 0.04) and allowing an increase of sportive activity (P = 0.007). After 3 months, there was still a transitory improvement allowing an increase of sportive activity for 75% of the patients (n = 8) of the “PROTOCOX” group in comparison of 18.2% for the “CONTROLE” patients.

Conclusion

The “PROTOCOX” process is simple and practicable in liberal sector, and gives benefits in terms of decrease of pain and sportive activity increase with a reduce number of sessions and its transitory efficiency stays at mid term.     

Structural adaptations of rat lateral gastrocnemius muscle–tendon complex to a chronic stretching program and their quantification based on ultrasound biomicroscopy and optical microscopic images

Background

A chronic regimen of flexibility training can increase range of motion, with the increase mechanisms believed to be a change in the muscle material properties or in the neural components associated with this type of training.

Methods

This study followed chronic structural adaptations of lateral gastrocnemius muscle of rats submitted to stretching training (3 times a week during 8 weeks), based on muscle architecture measurements including pennation angle, muscle thickness and tendon length obtained from ultrasound biomicroscopic images, in vivo. Fiber length and sarcomere number per 100 μm were determined in 3 fibers of each muscle (ex vivo and in vitro, respectively), using conventional optical microscopy.

Findings

Stretching training resulted in a significant pennation angle reduction of the stretched leg after 12 sessions (25%, P = 0.002 to 0.024). Muscle thickness and tendon length presented no significant changes. Fiber length presented a significant increase for the stretched leg (8.5%, P = 0.00006), with the simultaneous increase in sarcomere length (5%, P = 0.041) since the stretched muscles presented less sarcomeres per 100 μm.

Interpretation

A stretching protocol with characteristics similar to those applied in humans was sufficient to modify muscle architecture of rats with absence of a sarcomerogenesis process. The results indicate that structural adaptations take place in skeletal muscle tissue submitted to moderate-intensity stretching training.     

Hospitalisation en court séjour pour reconstruction du ligament croisé antérieur : étude prospective comparative

Introduction

In France, the median duration of hospitalization for a reconstruction of the anterior cruciate ligament (ACL) is 3 days. The purpose of this study was to evaluate the feasibility and acceptability of hospitalization for one day for this surgery.

Patients and methods

A prospective study conducted in 2011 included patients who underwent surgery for an ACL rupture. Exclusion criteria were age > 60 years, scores ASA3-4 and patients unmanageable in short-stay. Two groups of patients were formed: “short-stay” with an output at D1 and “conventional hospitalization” with an output at D3. The postoperative analgesia protocol included analgesics I-II, morphine on demand during hospitalization. “Short-stay” group received a telephone follow-up (D1–D4). The primary outcome was patient satisfaction at D3. The secondary endpoints were postoperative pain assessed on a visual analogue scale at D3 and adverse events. Thirty patients were included in each group, 34 men and 26 women, mean age 29 ± 5 years.

Results

Patients in group “short-stay” were on average more satisfied than the “conventional hospitalization” group, P = 0.01. The pain was significantly less pronounced in the “short-stay” group, P = 0.00001. No complications occurred.

Conclusion

Inpatients short-stay were significantly more satisfied and less painful than those in conventional hospitalization group. Future studies should evaluate the feasibility of ambulatory surgery for ACL reconstruction.     

Activity levels after pulmonary rehabilitation – what really happens?

Objectives

To assess the changes in physical activity in subjects with chronic obstructive pulmonary disease over 6 months after pulmonary rehabilitation.

Design

Prospective, observational study. Activity was measured over 2-day periods at the end of rehabilitation, and repeated every 6 weeks for 6 months using the ActivPAL uni-axial accelerometer. These results were compared with the shuttle walking test (SWT) and the St. George's Respiratory Disease Questionnaire (SGRDQ).

Setting

UK community hospital.

Participants

Adults completing a community rehabilitation programme.

Main outcome measure

Time spent standing and mobilising (‘uptime’).

Results

Of 34 subjects recruited, 28 completed the 6-month study period (mean age 69 years, mean forced expiratory volume in 1 second 1.3 l). Participants wore the monitor for 13.8 to 14.2 hours/day. At baseline (post-rehabilitation), participants spent 1.7 [standard deviation (SD) 1.3] hours/day walking and 3.5 (SD 2.6) hours/day standing. Taking the group as a whole, mean uptime decreased marginally by 13.6 minutes after 24 weeks compared with baseline, with significant individual variability. In all but one subject who showed decreased activity, this was apparent after 6 weeks. There were no significant changes in the mean SWT or SGRDQ. Significant associations between total uptime and the SWT were found, but coefficients were weak. It was not possible to predict individual responses from baseline data.

Conclusion

The accelerometer provides useful supplementary data in patients completing rehabilitation programmes, and the results reveal wide variation. The weak associations between activity data and the SWT suggest that monitors provide additional information. More work is required to determine the factors associated with early deterioration in activity in order to design appropriate interventions.     

Predictors of shuttle walking test performance in patients with cardiovascular disease

Objective

The incremental shuttle walking test (ISWT) is used to estimate cardiorespiratory fitness, but data from healthy individuals suggest that demographic and anthropometric measures account for much of the variance in test performance. The aim of this study was to determine whether anthropometric, demographic and selected gait measures also predict ISWT performance (i.e. distance walked) in patients with cardiovascular disease.

Design

Observational study.

Setting

A community-based cardiac rehabilitation centre (Cohort 1) and a hospital outpatient cardiac rehabilitation programme (Cohort 2).

Participants

Sixteen patients with clinically stable cardiovascular disease (Cohort 1) and 113 patients undergoing cardiac rehabilitation (Cohort 2).

Interventions

Patients in Cohort 1 performed the ISWT on two occasions. Anthropometric data and walking and turning variables were collected. Linear regression analyses were used to identify the predictors of test performance. The authors subsequently attempted to validate the equation created by comparing predicted and actual ISWT values in a larger (n = 113) validation sample (Cohort 2).

Main outcome measures

Distance walked during ISWT, step length and height.

Results

No gait or turning measures were significantly associated with ISWT performance. Distance walked correlated most strongly with step length (r = 0.83, P < 0.05) and height (r = 0.74, P < 0.05). Given the similarity of these correlations and the rarity of step length assessment in clinical practice, ISWT performance was predicted using patient's height; this explained 55% of the variance in ISWT performance. Height was also the best predictor in Cohort 2, explaining 17% of test variance (P < 0.01). Body mass index explained an additional 3% of variance (P < 0.05) in ISWT performance.

Conclusions

Routine clinical measures, particularly patient's height, are predictive of ISWT performance. The findings of the present study are in partial agreement with similar studies performed in healthy individuals, and it remains unclear whether the ISWT performance of patients with cardiovascular disease is influenced by the same factors as the ISWT performance of healthy individuals.     

Facteurs de risque intrinsèques de tendinopathie patellaire chez le volleyeur. Étude prospective de 29 cas

Background

Patellar tendinopathy is a common and disabling injury among athletes, especially in sports with jumps such as volleyball.

Objective

The aim of this study was to determine intrinsic risk factors of patellar tendinopathy among young volleyball players.

Methods

This prospective study was conducted from August 2012 to April 2013. It included a clinical examination, ultrasound, muscle isokinetic assessment and tests of jumps at the beginning of the season, and then only a clinical examination at the end of the season. Athletes who developed patellar tendinopathy were compared to healthy subjects.

Results

Patellar tendinopathy (PT) group athletes (6) were older (17.2 ± 0.4 years vs 16.2 ± 0.9 years, P = 0.02) and had a stiffness of hamstrings higher (popliteal angle of 24 ± 12° vs 14 ± 9°, P = 0.04) than healthy athletes (16). They had an eccentric quadriceps peak torque at slow speed (30°/s) lower than healthy athletes (2.7 ± 0.2 Nm/kg vs 3.2 ± 0.5 Nm/kg, P = 0.05).

Conclusion

Age, stiffness of hamstrings and an eccentric strength deficit of quadriceps at slow speed (30°/s) would be intrinsic risk factors of PT among young volleyball players.     

Efficacité thérapeutique de l’autologous conditioned plasma (ACP™) : analyse de sa composition cellulaire et revue de la littérature

Purpose

To analyze the platelet counts of autologous conditioned plasma (ACP™) in a group of patients compared to that of whole blood and to determine the value of ACP™ based on a literature review.

Methods

In 2011, a prospective study was performed in a continuous series of patients presenting with chronic tendinopathies. Three 9 μL venous blood samples were obtained from each patient: the first to perform a full blood count and the second and third to prepare two doses of ACP™, one which was injected into the patient and the other which underwent biological testing. A bibliographic search was performed on PubMed with the key words “autologous conditioned plasma”. All studies both clinical and experimental, in English and in French, were included.

Results

The series included 14 male patients mean age 39 ± 14 years. The mean platelet count was 230,538.5 ± 23,663/μL in whole blood and 377,153.8 ± 69,169.9/μL in ACP™, P = 0.00015. The mean “ACP™ platelet count/whole blood platelet count” ratio was 1.64 ± 0.30. The number of red and white blood cells was below the detection thresholds. The systematic review identified eight studies: three in animals and five in human of which two clinical studies.

Conclusion

The preparation technique for ACP™ was rapid and easy to use. ACP™ had a platelet count that was significantly higher than that of whole blood and did not contain any red or white blood cells. The review of the literature did not clearly confirm the therapeutic efficacy of ACP™. Randomized clinical studies comparing ACP™ to placebo are needed.

Level of evidence

IV.     

Évaluation isocinétique des muscles fléchisseurs et extenseurs du genou chez de jeunes footballeurs

Objective

To assess the knee muscles power using isokinetic in a population of young soccer players. To investigate the relationships between isokinetic peak torque and each player's position in the playground.

Population and methods

Thirty-eight young soccer players (mean age 14.57 years old with extremes ranging from 13 to 17 years old) underwent an isokinetic assessment on both knees on an isokinetic dynamometer Cybex-NORM™ on three angular velocities: 60 °/s, 180 °/s and 240 °/s concentric mode. The peak torque, the peak torque on the weight and the ratio of hamstring/quadriceps were noted. These athletes were divided into three groups: strikers (16), defenders (16), and goalkeepers (6).

Results

Hamstring/quadriceps ratio was at low speed 60 °/s between 72 and 74%, at medium speed (180 °/s) between 78 and 80%, and high speed (240 °/s) between 85 and 90%, the peak torque by extensor muscles weight was around 2.6 N m/kg. Overall, there was no significant difference between the three groups of players; there were no significant difference between the dominant side and the non dominant side.

Conclusion

There was no significant difference of the isokinetic peak torque between the players, no difference between agonist and antagonist muscles activity in isometric knee strength and no difference between the dominant side and the non dominant side. The isokinetic is a method for the assessment of the force and preventing muscle injuries of the knee.     

Factors associated with ambulatory status 6 months after total hip arthroplasty

Objective

To identify an assessment tool and its cut-off point for indicating ambulatory status 6 months after total hip arthroplasty (THA).

Design

Cross-sectional study.

Setting

Kyoto University Hospital.

Participants

Eighty-eight patients who underwent unilateral THA.

Main outcome measure

Lower-extremity muscle strength, hip range of motion and hip pain were measured 6 months after THA. The patients were divided into two groups according to their ability to walk 6 months after THA: an independent ambulation group and a cane-assisted ambulation group.

Results

A stepwise multiple logistic regression analysis indicated that age and lower-extremity maximal load were significant variables affecting mid-term ambulatory status following THA. Receiver operating characteristic curve analyses revealed that ambulatory status following THA was indicated more accurately by leg extension strength (cut-off point = 8.24 N/kg, sensitivity = 92%, specificity = 82%, area under the curve = 0.93) than age.

Conclusion

Lower-limb load force with a cut-off point of 8.24 N/kg is a reliable assessment tool for indicating ambulatory status 6 months after primary THA.     

Leg preference associated with protective stepping responses in older adults

Background

Asymmetries in dynamic balance stability have been previously observed. The goal of this study was to determine whether leg preference influenced the stepping response to a waist-pull perturbation in older adult fallers and non-fallers.

Methods

39 healthy, community-dwelling, older adult (> 65 years) volunteers participated. Participants were grouped into non-faller and faller cohorts based on fall history in the 12 months prior to the study. Participants received 60 lateral waist-pull perturbations of varying magnitude towards their preferred and non-preferred sides during quiet standing. Outcome measures included balance tolerance limit, number of recovery steps taken and type of recovery step taken for perturbations to each side.

Findings

No significant differences in balance tolerance limit (P ≥ 0.102) or number of recovery steps taken (η²_partial ≤ 0.027; P ≥ 0.442) were observed between perturbations towards the preferred and non-preferred legs. However, non-faller participants more frequently responded with a medial step when pulled towards their non-preferred side and cross-over steps when pulled towards their preferred side (P = 0.015).

Interpretation

Leg preference may influence the protective stepping response to standing balance perturbations in older adults at risk for falls, particularly with the type of recovery responses used. Such asymmetries in balance stability recovery may represent a contributing factor for falls among older individuals and should be considered for rehabilitation interventions aimed at improving balance stability and reducing fall risk.     

Profile of Patients at Admission into an Inpatient Stroke Rehabilitation Programme: Cardiorespiratory Fitness and Functional Characteristics

Purpose:

The purposes of this study were to characterize the cardiorespiratory capacity of individuals on admission to inpatient rehabilitation following stroke and to examine the relationship between measures of cardiorespiratory capacity and standard indices of neurological deficit and functional status.

Methods:

We recruited 45 patients within the first 10 days of admission to rehabilitation. We performed measures of aerobic fitness (VO₂peak), functional status (Functional Independence Measure [FIM] and Clinical Outcomes Variable Score [COVS]), and neurological deficit (National Institutes of Health Stroke Scale [NIHSS] and Chedoke-McMaster Stroke Assessment scale [CMSA]).

Results:

Nineteen women and 26 men with a mean (SD) age of 65.2 (14.5) years were admitted to rehabilitation 16.2 (11.9) (minimum 3, maximum 62) days post-stroke. Average VO₂peak was less than half the value expected in age-matched healthy individuals at 11.1 (3.1) ml/kg/min. The associations between VO₂peak and FIM, NIHSS, and COVS were weak (r = 0.25, -0.12, and 0.26 respectively, p = 0.12, 0.46, and 0.10 respectively). There were no differences in VO₂peak in higher-functioning individuals with CMSA leg scores of 5 and 6 compared to lower-functioning individuals with scores of 3 and 4 (p = 0.30).

Conclusion:

Cardiorespiratory capacity is extremely low in individuals during the first 3 months after stroke. Alternative measures of functional or clinical status do not adequately reflect this cardiorespiratory state; thus, routine measurement of cardiorespiratory capacity should be considered, along with a risk-factor profile.     

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.     

Block-step asymmetry 5 years after large-head metal-on-metal total hip arthroplasty is related to lower muscle mass and leg power on the implant side

Background

Metal-on-metal articulations mimic the human hip anatomy, presumably lower dislocation rates and increase the range-of-motion. This study aims to measure the muscle mass and power of both legs in patients with unilateral metal-on-metal total hip arthroplasty, and to investigate their effect on block-step test, spatio-temporal gait parameters and self-reported function.

Methods

Twenty-eight patients (7 women), mean age 50 (28–68) years, participated in a 5–7 year follow-up. Patients had received one type unilateral large-head metal-on-metal total hip articulation, all of which were well-functioning at follow-up. Mean muscle mass was measured by the total-body Dual energy X-ray Absorption scans, and muscle power was measured in a leg extensor power rig. Block-step test and spatio-temporal gait parameters were measured with an inertial measurement unit. Self-reported function was assessed by the Hip Disability and Osteoarthritis Outcome Score.

Findings

We found a significant difference between the mean muscle mass of the implant-side leg and the non-implant-side leg in hip, thigh and calf areas (P < 0.008) and in mean muscle power (P = 0.025). Correlations between mean muscle mass and mean muscle power were significant for both the implant-side leg (r = 0.45, P = 0.018) and the non-implant-side leg (r = 0.51, P = 0.007). The difference in mean muscle power between legs correlated with block-step test asymmetry during ascending (r = 0.40, P = 0.047) and descending (r = 0.53, P = 0.006). Correlations between self-reported function and power of the implant-side leg were not significant.

Interpretations

Young patients have not fully regained muscle mass, muscle power and function 5–7 years after metal-on-metal total hip arthroplasty.     

Effect of lumbar lordotic angle on lumbosacral joint during isokinetic exercise: A simulation study

Background

It is important to consider lumbar lordotic angle for setup of training program in field of sports and rehabilitation to prevent unexpected posture deviation and back pain. The purpose of this study was to to analyze the biomechanical impact of the level of lumbar lordosis angle during isokinetic exercise through dynamic analysis using a 3-dimensional musculoskeletal model.

Methods

Gait analysis and isokinetic exercise for the healthy adults (n = 10) were performed to design a 3-dimensional musculoskeletal model and then we made each model for normal lordosis, excessive lordosis, lumbar kyphosis, and hypo-lordosis according to lordotic angle and inputted experimental data as initial values to perform inverse dynamic analysis to quantify muscle joint torque, joint forces of each joint, system energy, and estimated muscle forces at lumbosacral joint.

Findings

Comparing the joint torques, the largest torque of excessive lordosis was 16.6% larger than that of normal lordosis, and lumbar kyphosis was 11.7% less than normal lordosis. There existed no significant difference in the compressive intervertebral forces of each lumbar joint (P > 0.05), but statistically significant difference in the anterioposterior shear force (lumbar kyphosis > hypo-lordosis > excessive lordosis > normal lordosis, P < 0.05). Lastly, lumbar kyphosis required the least and most energy during flexion and extension respectively.

Interpretation

During the rehabilitation process, more efficient training will be possible by taking into consideration not simply weight and height but biomechanical effects on the skeletal muscle system according to lumbar lordortic angles.