Traitement conservateur de la rupture du ligament croisé antérieur

The aims of non-operative treatment of anterior cruciate ligament injuries are to promote dynamic stability, improve function and decrease the risk of osteoarthritis. There is controversy in the studies with heterogeneous and non- randomized samples, currently recommending this treatment for isolated ruptures, elderly adults and patients without motivation for physical activity. Patient education, range of motion rehabilitation, hamstring and quadriceps muscle strengthening, proprioception training in closed kinetic-chain and fitness reconditioning are the most important approaches to a functional return.     

Laxité chronique antérieure du genou chez le sportif. À propos de 118 cas

The chronic anterior laxity of the knee is an evolutive disease owing to a rupture of the anterior crossed ligament which engages the functional prognosis of the lower member and compromise sportive activity. Many techniques of ligamentous plasty were described. Our study is about 118 sportsmen suffering from chronic anterior laxity treated by the modified Kenneth-Jones procedure between 1998 and 2002. After a main following-up of 25 months, we tried to value our results and determine the real place of ligamentous plasty using patellar tendon in the treatment of sportsmen chronic anterior laxity.     

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).     

Les kystes du ligament croisé antérieur : à propos de 24 cas

The purpose of this study is to present clinical and magnetic resonance imaging (MRI) features of ganglion cysts of the anterior cruciate ligament (ACL). Such cysts are rare and often unsuspected. We reviewed a series of 24 ganglion cysts of the ACL (7 females, 17 males) between 1998 and 2004. The mean age was 45 years old (25–74). All patients presented with knee pain. The mean follow-up was 25 months (6–48). All patients had a preoperative MRI, which confirmed the diagnosis. Seventeen patients had an arthroscopic treatment and 7 were treated with percutaneous aspiration and steroid injection under. Fourteen patients were evaluated with the International knee Documentation Committee (IKDC) subjective score. Computed tomography or ultrasound guidance. MRI demonstrated 16 mucoid degenerative cysts of the ACL and 8 well circumscribed ganglion cysts with a fluid collection. The surgical pathology confirmed 13 mucoid cysts and 4 ganglion cysts; 2 recurrences were observed after surgical treatment. After percutaneous aspiration, we observed 3 recurrences, 2 failures and one vascular complication. We observed two types of ACL cysts, which could be differentiated on the MRI. Percutaneous treatment was less reliable than surgical treatment. The percutaneous aspiration should be reserved to the ganglion cysts with fluid collection, while arthroscopy is indicated for the failure cases. We recommend resection for the mucoid cysts. An aggressive resection of the ACL may compromise the knee stability so that the patient must be informed preoperatively. In theses cases, aspiration was often inefficient.