Influence des facteurs intrinsèques anatomiques dans la rupture du ligament croisé antérieur : étude anatomoradiologique comparative

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

Lésions musculo-aponévrotiques et tendineuses. Classification–explorations radiologiques

The aim of this paper is to remind the classifications of sport-related myofascial and myotendinous lesions and to discuss the place of medical imaging (MRI and sonography). Muscular lesions are divided in extrinsic and intrinsic ones, whether they result from a direct impact or a brutal contraction or extension. O'Donoghue classification evaluates injury severity. Myofascial lesions may be peri-muscular, inter-muscular or intra-muscular. In tendinous lesions, we distinguish tendinosis, longitudinal intra-tendinous tears, partial and full-thickness tears. They occur from several origins: overuse tendinopathy, brutal pulling, direct impact, paratendinopathy by repetitive frictions or snapping. Medical imaging provides differential and positive diagnosis as well as injury severity, allowing evaluation of sports intermission. It allows evaluation of healing (doppler sonography and post-Gadolinium MR imaging). Doppler sonography performed by musculoskeletal radiologists has become more and more efficient and sufficient in a lot of cases. MR imaging is used in first or second intent, especially in professional sports and in serious conditions. It remains more accurate in small acute lesions, and in complex lesions, which are not rare in sport-related injuries.     

Ostéome ostéoïde du grand trochanter révélé par une sciatalgie chez un sportif

Osteoid osteoma is a benign osseous tumour in the young adult most commonly found in the appendicular skeleton. This tumor makes preferentially on long bone diaphyse. The particular locations of the osteoid osteoma are at the origin of diagnostic wanderings. In same cases, nothing directs clinically to an osteoid osteoma. We report an unusual case of osteoid osteoma of the greater trochanter in a 21-year-old sportsman revealed by sciatica. We discuss the role of different imaging techniques in diagnosis and treatment of this benign tumor.     

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.     

Hernie musculaire postérieure de la cuisse réparée par plaque non résorbable. À propos d’un cas et revue de la littérature

Muscle hernias in the hamstring (semitendinosus, semimembranosus and biceps femoris) area of the thigh are rarely described in the literature. We report a case of an athletic patient, an avid cyclist, who presented a daily discomfort in the posterior region of the left thigh with irradiation to the knee and it became intensive in one year. A soft reducible non-painful superficial mass could be palpated. Ultrasonography reveals the herniation of fatty tissue through the superior superficial fascia of the thigh at the base of the posterior cutaneous nerve. Since primary repair of the fascial dehiscence was not possible, the surgery was performed by implanting a non-degradable surgical mesh, routinely used to treat inguinal hernias. The results after 24 months of follow-up are highly satisfactory: the patient has been able to return to all his daily and sports activities without discomfort or recurrence of the hernia.     

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.     

Fracture sur os pathologique révélatrice d’une myosite proliférante du muscle grand glutéal

Proliferative myositis is a benign pseudosarcomatous lesion that generally affects proximal limb muscles (often the shoulder). Its unspecific signs and symptoms, rapid growth and rarity arouse suspicion of malignancy. We report the case of a sporting woman of 28 years old who presented a fracture of the proximale left femur revealing at the histological examination a proliferative myositis of the muscle gluteus maximus. The patient refused any surgical act, the evolution was marked by the consolidation, the takeover of activity and the absence of local recurrence or metastasis.     

Ressaut distal du biceps fémoral : à propos de 2 cas et revue de la littérature

Snapping of the biceps femoris over the fibular head is an uncommon condition. Reported causes include an anomalous insertionof the tendon, trauma at the insertion site of the tendon, and an abnormality of the fibular head. This article reports two cases of a painful snapping biceps femoris tendon. Medical management resulted in a complete resolution of symtoms.     

Calcification post-traumatique du muscle ilio-psoas. À propos d’un cas et revue de la littérature

Post-traumatic iliopsoas calcifications are extremely rare affections. We report the case of a patient who presented a right hip discomfort after a wakeboard accident. A thick calcification of the right iliopsoas was visible on standard X-rays. Surgery was performed by the removal of the calcification associated to a non-steroidal anti-inflammatory treatment. The result after six months was excellent. The patient has resumed his sports activities at the same level without discomfort and no recurrence of the ossification.     

Les fractures du cartilage costal : un diagnostic souvent méconnu

Costal cartilage fracture is a rare misdiagnosed traumatic injury. Its clinical diagnosis is also underestimated. Clinically, it is difficult to differentiate costal cartilage fracture from osseous injuries or injuries of the soft tissues. Radiographs are insensitive for detecting cartilage injury. Sonography, CT, and MRI have been shown to be useful in distinguishing causes of chest wall pain. We report a case of costal cartilage fracture in a 25-year-old man practicing judoka.     

Septicémie à staphylocoque aureus (SAMS) révélant une pubo-discite septique chez un jeune footballeur professionnel de 17 ans

We report a case of septic osteomyelitis of the pubic symphisis revealing a MSAS septicemia in a young professionnal soccer player. Intravenous antibiotherapy was started during Hospitalization. He was back in competition after 3 months.     

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.     

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).     

La prise en charge rééducative globale de patients présentant un syndrome fémoro-patellaire : la lutte contre l’effondrement du membre inférieur par le renforcement du moyen fessier

The patellofemoral pain syndrome (PPS) is characterized by anterior knee pain and poor patellar kinetics. In this review, we focus on primary PPS. Several local factors are known to provoke knee pain (subchondral bony disorders, retraction of the lateral retinaculum, inflammation of the infrapatellar adipose pad). Furthermore, proximal factors involving the hip and pelvis as well as distal factors involving the ankle and foot explain the impact on lower limb mechanics, for instance on single-stance squat. In the 1980s, the gold standard management strategy for PPS was to strengthen the vastus medialis in order to counter lateral subluxation of the patella during knee flexion. More recently, with improved techniques for neuromuscular biomechanical investigations, several publications propose reinforcing the hip abductor muscles for PPS. This offers a more global approach by correcting the posture of the entire lower limb to provide relief from this difficult-to-treat complex syndrome. Strengthening the hip abductors (gluteus medius) appears to be the best way to eliminate the single-stance lower limb postural failure leading to several musculoskeletal disorders. This new approach to rehabilitation is a validated evidence-based therapeutic strategy.     

Rééducation accélérée après ligamentoplastie par la technique DIDT par un protocole simple et adapté à chacun

With most procedures of rehabilitation following reconstruction of the anterior cruciate ligament that was treated though the technique of ligamentoplasty using gracilis and semi-tendinous, the hamstring can’t resume activity until four to six weeks after the operation. Comparing the engraftment of post-traumatic muscle damage, the described rehabilitation procedure is an accelerated procedure that uses early eccentric strengthening of the hamstring starting on day 8. This is achieved first by manual resistance until day 21 then on a hamstring chair from day 21 to day 45. The aim of such a treatment is not to resume sporting activity more quickly, but to ensure that the conditions for recovery are optimized. The described treatment also presents some limitations and should therefore be applied with caution so as not to jeopardize the ultimate recovery of the ligament.     

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.     

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.