Évaluation de la gravité des lésions du ligament collatéral latéral de cheville : étude de corrélation clinique-échographie

The clinical examination is sometimes insufficient to assess the severity of lateral collateral ligament (LCL) sprain of the ankle, making it difficult to choose the most appropriate treatment. The purpose of this study was to compare retrospectively the observed or reported clinical signs assessed two days after the trauma and ultrasound findings in patients who experienced a recent ankle inversion trauma. Between 1st May and 1st November 2004, 34 patients referred in the sports medicine service were clinically examined in a standardized way two days after the injury, and underwent an ultrasound by the same operator. No isolated clinical sign was correlated with the severity of ligamentous lesions revealed by ultrasound. Taking in account the whole set of the clinical signs appear to better guide for diagnosing the presence or absence of a ligament rupture: positive predictive value if the presence of all the signs equal to 75% for the anterior talofibular ligament (LTFA) and 88% for fibular ligament (CFL), negative predictive value if all the signs of lack of gravity equal to 80% for LTFA and 62% for the CFL. These results confirm the lack of correlation between clinical signs and Imaging findings in ankle sprains. They raise questions about the adequacy of clinical classifications and suggest an expansion of indications for ultrasound in ambiguous situations, especially for athletes showing little signs of severity, to ensure optimal treatment and faster recovery.     

Contrôle de l’équilibre et port unilatéral d’une orthèse rigide de cheville. Partie II : effets sur des sujets sains évalués debout en bipédie

In order to compare the effects induced by the unilateral wearing of a rigid orthosis (Thuasne, Ligacast Immo^®) in comparison to a reference model consisting of an elastic stocking, balance control strategies of 14 healthy subjects have been evaluated in two-legged standing. To this aim, 10 trials lasting 32 s have been recorded through a device made of two separate force platform allowing the separate measurement of the reaction forces intervening under each foot. Balance strategies have been assessed from the centre of pressure trajectories issued from the left (CP_G) and right feet (CP_D) and, through a calculation, from the resultant CP (CP_Res). These various trajectories, projected along mediolateral (ML) and anteroposterior (AP) axes, have been then analysed in the frequency domain. If no difference has been observed for the CP_Res trajectories, the separate analysis of each support has furnished statistically significant results for the CP trajectories measured under the foot wearing the orthosis since the amplitudes decrease along both ML and AP axes. Contrary to what was observed in the previous study conducted in one-legged standing, with effects occurring only along the AP axis, these results appear thus in better accordance with the objectives of an orthosis since diminishing the involvement of the lateral ligaments. This kind of protocol appears thus more relevant for characterising in situ the effects of an orthosis made of two rigid shells.     

Veines gastrocnémiennes et douleurs du mollet chez le sportif

The venous pressure is often taken as the aetiology of pain in the calf after exercise in athletes and leads to therapeutic practices not yet codified. The purpose of this study is to measure the diameter of the veins of the medial gastrocnemius at rest and after exercise and highlight a possible cause and effect between venous distension and the onset of pain.     

Instabilité d’épaule et isocinétisme : apport de l’isocinétisme dans une situation clinique complexe

Introduction

The treatment of shoulder instability is codified. In case of a resistant instability to a well-conducted rehabilitation, the surgery can be proposed with good results. Sometimes, the situation can be more complex, and the case report presents the interest of isokinetics as an alternative therapeutic.

Case report

A man of 36 years, operated of Latarjet for recurrent anterior dislocation of the shoulder, presented in postoperation an infectious osteoarthritis. After recovery of the infectious episode, in a painful and stiffness shoulder, shoulder instability repeated with a clinical examination agreeing and an evocative context: failure of the surgical treatment, osseous postinfectious rehandlings. The surgery having been excluded and traditional rehabilitation having shown its limits. A rehabilitation oriented by the research of a muscular imbalance in isokinetic evaluation permitted a functional improvement with disappearance of the instability feeling.

Discussion

In complex clinical situations, isokinetic evaluation showed an interest to adapt and to optimize rehabilitation. A practical application of isokinetics is in the pathologies of articular instability and in particular the shoulder instability. The positions of evaluation will be adapted to the patients. That opens new prospects in rehabilitation.

Conclusion

This case report illustrates isokinetic interest for an objective and rigorous assessment of muscular strength and so an adaptation and optimization of the rehabilitation.     

Contrôle de l’équilibre et port unilatéral d’une orthèse rigide de cheville. Partie I : effets sur des sujets sains évalués debout en unipédie

In order to assess the effects induced by wearing a rigid ankle orthosis, 14 healthy adults, without traumatic previous injuries at this level, were tested in a one-legged postural task. The subjects stood upright on a force platform and were required to remain still, eyes open. Ten trials lasting 32 s were recorded in a random order in two conditions: with a rigid orthosis model worn at the ankle level of the supporting leg (Thuasne, Ligastrap Immo^®) and with an elastic stocking. Balance strategies have been quantified by studying the centre of pressure (CP) trajectories, that is, the successive positions of the resultant reaction forces, and processed through a frequency analysis. The results indicate that slight decreases occur for the CP displacements intervening along the medio-lateral axis whereas statistically significant trends were found for those intervening along the anteroposterior one. This finding a priori suggests that wearing a rigid orthosis affects one-legged standing in healthy individuals but mainly along an axis not usually weakened by sprained ankles.     

La fracture de Tillaux chez l’enfant et l’adolescent. À propos d’une série de 11 cas

Background

Tillaux fracture in child correspond to Salter and Harris type III fracture involving the anterolateral portion of the distal tibial epiphysis. These are intra-articular fracture. The aim of this study was to analyze the therapeutic modalities and long-term clinical and radiological outcome.

Patients and methods

We reviewed retrospectively 11 Tillaux fractures. All underwent surgical treatment.

Results

The average age was 13.5 years. Patients were treated by open reduction and screw fixation. At mean follow-up of 28 months, results were rated well in nine of 11 cases.

Conclusion

The prognosis of Tillaux fracture in child is good as was observed in our studies and in series reported in the literature.     

La fracture de fatigue du col fémoral chez le sportif d’endurance : l’importance d’un diagnostic précoce

Stress fractures of the femoral neck are rare traumatic events but they are far from being exceptional within the high level sportsmen community and even less rare within the military. The authors report the case of a 19 years old young man enlisted in the French Foreign Legion. He came up with a right femoral neck stress fracture as a result of intense physical exercices. Although painful prodromic signs had been evolving for 15 days, the right diagnosis wasn’t made until the fracture moved to Garden III. The surgical treatment consisted in a reduction with a triple screwing of the femoral neck. One year later, the fracture was set to anatomic position, the hip function was normal and the femoral head showed no signs of osteonecrosis. The patient was then lost for further follow-up. When there has been no slipping, these fractures develop favourably with an ad integrum hip restoration. On the other hand, a secondary slipping leads to a pathology that has to be taken care of in a quite different way, with an often catastrophic outcome at the functional level. Nearly constant prodromic signs come in usefully for an early diagnosis. Secondary slipping of the femoral neck stress fractures should happen less frequently by an appropriate awareness campaign aimed at all the health professionals including sports trainers.     

Luxation antérieure bilatérale des épaules chez le bodybuilder (à propos d’un cas)

Bilateral glenohumeral joint dislocations are rare. The most common occurrences are posterior during epileptic convulsions. Bilateral simple anterior glenohumeral dislocations are uncommon. We report a case of bilateral anterior shoulder dislocation in a young bodybuilder.     

Influence du type d’orthèse de genou sur l’évolution clinique postopératoire d’une chirurgie du ligament croisé antérieur chez le sportif

Objectives

To establish the influence of the type of brace on the postoperative clinical evolution after anterior cruciate ligament (ACL) surgery in competitive sportspeople.

Methods

The authors prospectively followed the evolution of three populations of ACL reconstruction: one who received a functional brace, the other a rigid brace and last no brace. The three groups followed the same rehabilitation program. The clinical parameters of evaluation were pain, perimeter patellar joint, range of motion, muscular atrophy, locking the quadriceps, and the quality of walking. We also used the IKDC subjective Knee Evaluation Form and PPLP scoring scale.

Results

There is no clinically significant difference at about a month of surgery between the three groups (407 patients). There is no difference with the PPLP scoring scale. No repeat rupture is occurred postoperatively. There is a significant difference in the IKDC subjective (P = 0.03) between the group with functional brace and rigid brace.

Conclusion

With the same active rehabilitation program, the clinical evolution is identical with or without brace. The only difference is subjective (IKDC subjective Knee Evaluation Form).     

Évaluation des orthèses de genou et de cheville en pathologie de l’appareil locomoteur. Avis d’experts

A french committee of experts worked to create an assessment methodology for knee and ankle orthoses in order to evaluate the beneficial effects of these devices in current pathologies. It lead to the establishment of a simple evaluation tool for knee and ankle orthoses.     

Évaluation,par l’imagerie ultrasonore,du recrutement musculaire,de la force motrice et de la détente verticale du quadriceps après électromyostimulation (cas de 15 étudiants de l’INJS)

The increase of strength seems to be an element of performance in some sports.     

L’apport du muscle pectoralis minor dans le traitement de l’instabilité antérieure de l’épaule

The surgical stabilization of the shoulder knew many technical improvements energy. We propose a preliminary study about an engineering change by the addition of a fourth muscular bolt for the treatment of former instabilities of the shoulder. Our study is prospective gathering 16 patients having a stabilization of the shoulder by a quadruple locking using an osseous thrust by the coaracoid process, a tendineux bolt by a hammock applied thanks to the coaraco-biceps tendon to the lower bank of the sub-scapularis, a capsular bolt by joining the acromio-coracoid ligament to the glenohumeral capsule and a fourth bolt by the joining of the pectoral small tendon to the coraco-biceps. Our results evaluated by the score of Dupaly after 18 months show that the average retreat are satisfactory with an early resumption of the activity (2 months on average). The techniques of former stabilization of the shoulder are currently allowing that triple locking is indicated among all patients whose score ISIS exceeds five points. The addition of small pectoral as fourth bolt seems to us as well interesting because of the good preliminary results.     

Luxation antérieure de l’épaule associée à une fracture de la diaphyse humérale homolatérale (à propos d’un cas)

The association of shoulder dislocation with ipsilateral humeral shaft fracture remains rare. Is presented along with a review of the literature regarding 18 reported cases. The prognosis depends on that of the shoulder. The authors report a case of shoulder dislocation with ipsilateral humeral shaft fracture at a patient of 34 years an accident of sport (cyclocross). After closed reduction of the anterior shoulder dislocation. The treatment was surgical, required open reduction of the humeral fracture with compression plating. At recession of one year, the clinical examination finds amplitudes comparable to the shoulder controlatéral without instability.     

Force isocinétique des muscles rotateurs de l’épaule dans l’instabilité chronique antérieure

Given the role of dynamic stabilization means in shoulder recurrent anterior instability, due to the failure of passive stabilization means, a better understanding of the role of internal (IR) and external (ER) rotators muscle strength, and their agonist/antagonist balance, could be of interest in the therapeutic arsenal around this disease. In the light of the literature, a deficit of IR and ER muscle strength seems associated with unoperated recurrent anterior instability. After surgical stabilization using the Bristow-Latarjet procedure, there appears a transitional post-surgical deficit of the IR and ER muscle strength compared to preoperative values during 3 to 6 months post-surgery, but the preoperative deficit compared to contralateral shoulder seems to persist despite the surgical procedure and the postoperative rehabilitation care. Evaluation of IR and ER isokinetic muscle strength is relevant in monitoring patients with shoulder recurrent anterior instability, unoperated and post-surgery, in order to determine the orientation of rehabilitation, to help the decision for continuing or not strength rehabilitation, and to help the decision when deciding upon an appropriate time for return to sports.     

Fracture-avulsion de l’épine iliaque antéro-inférieure et du petit trochanter chez un jeune adolescent

The avulsion fractures of the anterior-inferior iliac spine and lesser trochanter are rare. They occur most often in adolescents during sports activities. The forms in adults are rare. We report a case in a young 15-year-old teenager. He had consulted for pelvic trauma with groin pain and functional impotence of the right lower limb occurred during a recent game in triple jump. Physical examination revealed pain in the mobilization of the right hip in extension. Standard radiography of the pelvis has highlighted an avulsion fracture of the anterior-inferior iliac spine avulsion of the right with small trochanter, which has been confirmed by computed tomography. The patient has been treated orthopedically by rest and landfilling lower limb trauma, evolution was marked the disappearance of pain a few weeks later and resumption of the sporting activity in order to 6 months.     

Plaidoyer pour une réathlétisation des plasties du ligament croisé antérieur chez le sportif pour préparer le retour sur le terrain

The objective of this study was to evaluate the clinical results of a continuous prospective series from 2008 of 408 anterior cruciate ligament (ACL) reconstruction in stay of reathleticization in competitive athletes.