Traitement par PRP 1 partie : les lésions cartilagineuses et musculaires

Background

The frequency and diversity of injuries affecting the musculoskeletal system have incited much research leading to the discovery of new treatment options including Platelet-Rich Plasma (PRP) therapy. To date, indications have been extended to injuries involving several types of tissues including cartilage and muscles.

Method

We searched the English and French literature for articles reporting a high level of proof on PRP therapy for cartilage or muscle injuries. We found six articles on cartilage lesions and three on muscle lesions.

Results

For cartilage lesions, PRP provides superior results compared with hyaluronic acid for early stage injuries, but the evidence is limited to a short follow-up (maximum 6 months). For muscle lesions, the PRP results are encouraging.

Conclusion

As long as a consensus has not been reached concerning the methods applied for preparing PRP, the concentrations used, the activation method, and the formulation, it will be difficult to compare studies, despite their high level of proof, and to affirm that PRP has a beneficial effect on repair of different body tissues. Use of PRP therapy for cartilage injury is now a validated option for pain relief, especially in young patients after failure of hyaluronic acid. The delay of action is long (at least 6 months). Injection formulations are easy to use, well tolerated and safe. Cost is relatively low.     

Aspect quantitatif et qualitatif de la traumatologie du sport dans les services d’accueil et d’urgence

The purpose of this article is to report a qualitative and quantitative analysis of sports trauma activity in emergency units in France. A prospective survey was conducted in four emergency units and included 598 cases of sports trauma, which accounted for 17% of the trauma activity. Emergency room physicians thus play an essential role in care for sports trauma victims in France. Diagnosis of the severity of the injury is essential in sports trauma, particularly when the knee is involved. A prospective analysis of two prospective series showed that triage in the emergency room could be perfected. This leads to discuss the importance of training emergency physicians in sports trauma.     

Incidence des équipements modernes sur les lésions traumatiques du membre inférieur chez le rugbyman

Our study concerned the rugby players from Var area in the south of France. These players were graduated in all the categories during the season 2008–2009. We tried to compare the impact: first of the rugby shoes with blade studs versus classic studs and second the training on synthetic rugby field versus natural rugby field, on the increase in lower limb injuries. Indeed, the incidence of these wounds does not stop increasing since the rugby professionalization in spite of the preventives measures. Our study demonstrates that the users of shoes with blades studs presented more knee injuries and precisely more anterior cruciate ligament (P = 0.04) and these hurts occurred without opponent contact (P = 0.02) while they occurred during a tackle in the group of shoes with classics studs. We noticed more tendinitis on synthetic rugby field than on natural rugby field (P = 0.04), even there the type of shoe contributed to these injuries, indeed no players used the turf shoes on synthetic rugby field. So we suggest to limit the use of shoes with blade studs and to decrease the trainings on synthetic rugby field and especially the alternation between synthetic and natural rugby field.     

Les ancres en traumatologie de la cheville et du pied du sportif

Anchors are commonly used in ligament and arthroscopic surgery. They may be useful too when treating little bone avulsions. It’s a very easy procedure, anchors are not prominent under the skin, and removing them is not necessary, which is very convenient when treating sportsmen. They are useful in various procedures of foot and ankle traumas: little bones fractures, Achille’s avulsions, ankle sprains.     

Nouvelle classification des lésions cervicales pour l’aptitude au rugby professionnel

Rugby union is a collision sport exposing to a medullar risk through trauma but also by early degenerative lesions. The prevalency of cervical pathologies has grown with the onset of professionalism. These lesions often happen on a developmental narrow cervical canal, which increases the risk of serious neurological complication. A first classification of criterias of aptitude for professional rugby practice had been adopted by the French Ligue Nationale de Rugby in the early years of professionalism. Since cervical imaging and screening became mandatory, numbers of narrow or very narrow cervical canals on asymptomatic players have been detected. Meanwhile, the initially used Torg index appeared to be imperfect. These elements led to a necessary evolution of this classification. The new decision-making tool enables a precise evaluation of neurologic risk with data given by clinical examination and cervical IRM, and if necessary, cervical X-rays. New classification has been introduced with four groups of risk and aptitude (group 0 [G0]: no cervical pathology; group 1 [G1]: pathology without contraindication for professional rugby practice; group 2 [G2]: relative contraindication [known higher risk, to be accepted by the player]; group 3 [G3]: absolute contraindication). This new classification is presented and discussed. Nevertheless, as the structural risk related to the rugby practice will persist, sharing responsibilities with the player by implicating him in decision-making process remains necessary.     

Apport de l’arthroscopie du poignet dans la prise en charge des lésions du ligament scapho-lunaire

The scapholunate ligament injury is most frequently encountered in the aftermath of trauma in supination and wrist extension. It generates instability with chronic arthritic evolution. It can be associated with a fracture of the radial epiphysis of the radius. Acute injuries (within two months) are difficult to diagnose. The use of wrist arthroscopy can see these same lesions at an early stage and treat, achieving stable fixation without the need to open the wrist. Chronic lesions of the scapholunate ligament before the onset of osteoarthritis remain a challenge for the surgeon who often comes to properly stabilize the instability at the cost of a stiff wrist. The advent of arthroscopy has completely changed the therapeutic approach to these lesions.     

Les troubles mictionnels chez les sujets porteurs de séquelles de lésions périnatales sans handicap intellectuel

Micturition disorders in cerebral palsy without intellectual deficit. Sixty-three patients with cerebral palsy and micturition disorders were investigated. The age ranged between 5.5 and 38 years (mean 13.5). Half had diplegia, one-third had quadriplegia and were dependant. Incontinence was the most common sympton (dysuria was noted in half cases), mainly in quadriplegic, dependant patients. The urodynamic assessment confirmed the dysfunction and showed hyperreflectivity with or without asynergy. However, no therapeutic approach has been validated.     

Rupture haute des tendons ischiojambiers chez le sportif. À propos d'une série de neuf cas opérés

Objectives

Muscular pathology of the hamstring is frequent among athletes. On the other hand, complete rupture with avulsion at the proximal bone-tendon junction is a rare injury. Functional treatment of this injury gives no successful results. This study aims at providing information on the results of operations on 9 athletes.

Methods

Between 2002 and 2006, 9 male patients with an average age of 36.4 years (from 20 to 59) were operated on for a complete rupture of the hamstring at the proximal bone tendon junction due to sporting accidents — 4 rugby accidents, two soccer, one fencing and one aikido accident — and one domestic accident. Emergency magnetic resonance imaging was systematically employed. All nine were operated on using the same technique: by reinserting the tendons into the bone with several Mitek GII^® anchors (3.6 on average). A specific rehabilitation programme was set up. An isokinetic Biodex™test was done after 6 months.

Results

All 9 patients were reviewed after a mean period of 33 months (from 9 to 64). At the last review, all patients were satisfied with their functional results. Eight patients out of 9 had gone back to their sporting activities at the same level, a mean 5 months after the operation (from 4 to 7 months). The isokinetic tests related to the unimpaired member show a muscular deficit of less than 8% after the 6th month.

Conclusion

Complete rupture of the hamstring at the proximal bone tendon junction is a rare but serious injury. With an early diagnosis and rapid surgical treatment, normal functions can be recuperated with a rapid return to high level sporting activity.     

Lésions méniscales isolées chez le sportif. À propos de 120 cas

Meniscal lesion is a frequent affection in sport practice and which can affect – in mid and long terms – the fonctionnal prognosis of the knee and thus the sport career of the patient. Hence the importance of precocious diagnosis and adequate take-in-charge. We report a series of 120 cases of isolate meniscal lesions (76% internal meniscal lesions and 24% external meniscal lesions) in a sports population treated under arthroscopy and rechecked after a mean relapse of four years. Our results were good to excellent in 82.5% of the cases with retake of sport activity in 90% of our patients of which 60% in the preoperative level. 54% of the cases underwent standard radio control in their last visit. This control was normal in 46% of them, showed a pinching in the internal compartment in 22% of the cases and external in 32% of the cases. As for its reliability, its simplicity and relative innocuteness, the treatment of meniscal lesions under arthroscopy fulfills the requirements imposed by sport population's tasks.     

Lésions isolées du ménisque latéral sur genou stable opérées : étude fonctionnelle à 10 ans de suivi

Meniscals lesions are frequent during sport practice. Although lateral meniscus is affected in only 25% of all meniscus lesions, lateral lesions are usually known to have a poor clinical outcome. Our monocentric study consisted in a systematic evaluation of all patients treated in our unit for a unique lesion of the lateral meniscus in an otherwise normal knee. Follow-up was at least of ten years. Functional results were rated with four cotations currently used in traumatologic practice. A statistic analysis was made to identify predictive factors of poor outcome. Thirty-nine patients have been included. Functional evaluation showed 12% of excellent, 41% of good, 35% of medium and 12% of bad results with Arpege score, 65% of good and very good and 35% of medium results with Lysholm score. The average subjective IKDC score was 58 ± 15, objective IKDC cotation found 0% of A, 88% of B and 12% of C. The average Koos score was 83.7 ± 17. Better evolution was found for patients with horizontal lesions (P = 0.04) or patients with central segment injury (P = 0.05). Similar data concerning the poor functional outcome of lateral meniscus tears has been published. Only two thirds of patients have good or excellent results after 10 years.     

Intérêt de l’arthroscopie du poignet dans les lésions du ligament triangulaire

TFCC lesions are common among athletes. They are often overlooked, and entail, if they are not diagnosed and treated, severe functional impairment which results in a lower level of sports or sports stop before seeing appear more serious degenerative lesions, thus, justifying a palliation signing the final judgment of a sport at a high level. The advent of wrist arthroscopy, resulting from the success of arthroscopy of other joints (knee, shoulder) has improved the diagnosis of these lesions, to facilitate the understanding of the pathogenic mechanisms and the development of new treatments and the results look promising.     

Apport de l’exercice physique et du régime dans la prise en charge de la gonarthrose chez l’obèse

Objective

Our objective was to determine whether exercise and weight loss are more effective either separately or in combination, in improving pain and physical function in obese adults with moderate knee osteoarthritis (OA).

Patients and methods

Forty-five obese adults, with a body mass index greater than 35 kg/m² or 30 ≤ BMI < 35 associated to at least one cardiovascular risk factor, suffering from knee pain with evident radiographic signs of knee OA, were involved in our study. All patients were evaluated at baseline and at the end of the study. The assessment parameters were weight loss, the bioelectric impedance analysis, pain, six-minute walk distance, cardiovascular parameters, and muscular strength. The physical function was measured with the Womac and the Lequesne indexes. Patients were randomized into four groups, a control group (G1), exercise only group (G2), diet plus exercise group (G3) and diet only group (G4).

Results

There was no difference between the four groups at baseline. Significant improvement of function (Womac) was noticed in groups performing exercise only (G2) (26 %), diet plus exercise (G3) (37,89 %) and diet only (G4) (18,34 %). We also noticed an improvement in pain in G2 (p = 0.04), G3 (p < 0.001) and G4 (p = 0.02). The improvement of quadriceps strength was noted only in G2 (p = 0.01) et G3 (p = 0.001) without any change in control group and diet only group (G4). The improvement of cardiovascular parameters was observed only in G2 and G3. Weight loss, decreased BMI and waist circumference was more important in diet plus exercise group (G3).

Conclusion

The combination of weight loss and exercise provide better improvements in physical function and pain in obese adults with knee OA compared with either intervention alone. Exercise used alone or associated to dietary provides better improvements in physical capacity and muscle strength.     

Ténorraphie percutanée pour rupture fraîche sous-cutanée du tendon calcanéen. À propos de 28 cas

The under cutaneous rupture of the tendon of Achilles is increasingly frequent because of the considerable development of the sports activities and the increase in their intensities. In the beginning, the treatment of the tendon of Achilles rupture was orthopedical, then it was supplanted by the advent of the surgery. The comparisons between the advantages and the disadvantages of the two methods made it possible to gradually develop a technique of percutaneous tenorraphy, which takes its place according to the risks or insufficiencies of the other therapeutic methods. Our study is related to 28 observations of recent under cutaneous ruptures, in full tendinous body, treated and followed in the service of traumatology-orthopedy II of Mohammed V military hospital of instruction between January 2002 and April 2009. Our series was composed of nine professional sportsmen and 19 soldiers subjected to a constant and regular drive. All our patients profited during this period from a percutaneous tenorraphy of the tendon of Achilles by using Ténolig^®. We obtained satisfactory functional results with resumption of the former sporting level for 25 patients. Concerning complications there was minor infections in four cases, namely the cutaneous excoriations under the discs, which responded to local care, no case of iterative rupture was brought back so far, neither thromboembolic accident nor major infections or nerve sural attacks.     

Tuméfaction de la face dorsale du poignet révélant un muscle manieux

The authors report a case of bilateral extensor digitorum brevis manus muscle, hypertrophied on the dominant side in a young and sportsman patient. The diagnosis was established by magnetic resonance imaging and ultrasonography. Treatment abstention was decided.     

Avulsion de la tubérosité ischiatique chez l’adolescent : à propos de deux cas cliniques

Ischial avulsion, often diagnosed as a musculotendinous injury, is a traumatic pathology related to physical activity. Treatment of ischial avulsion fractures is not consensual. The authors present two case reports of adolescent football players with an ischial tuberosity avulsion submitted to a conservative rehabilitation programme, with different outcomes. One of the patients returned to competition but the other gave up football due to pain. In these case reports diagnosis, treatment and follow-up results are discussed.