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.     

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.     

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.     

L'ostéotomie tibiale chez le rugbyman professionnel. À propos de six cas

We report our experience of tibial osteotomy on 6 professional Rugby players. At revision, one was lost because he lived too far from our center, but still plays rugby. Five experienced a functional IKDC score (International Knee Documentation Committee) between 86/100 and 99/100 (versus 55/100 to 71/100 pre operative) and all returned to their sport at the same level. Modification of HKA angle (Hip-Knee-Ankle) didn't modify the impulsions during playing. Chondromalacia seems to go on despite the procedure. In all cases, pre-op washing arthroscopies (± viscosupplementation) failed. In conclusion, tibial osteotomy appears to be a quite simple procedure in the management of symptomatic chondromalacia for high level sportmen. Because of a quite short term follow up, it's impossible to preview long-term results of these osteotomies on arthro evolution.     

Évaluation à moyen terme d'une intervention type hémi-Castaing dans le traitement de l'instabilité chronique de cheville

Introduction

The purpose of this study is to evaluate the functional and subjective results of hemi-Castaing replacement ankleplasty associated with articular cleaning in the treatment of chronic instability of the ankle.

Material and method

The study is retrospective, monocentric and continuous. Fifty patients (50 ankles) underwent surgery by hemi-Castaing ligamentar ankleplasty associated with articular cleaning. An independent investigator on the basis of a radioclinical examination and an ankle scoring system made the assessment.

Results

After a period of 37 months, 44 patients were seen again. Ninety-one percent of them were satisfied; the average ankle score was 87.5%. Four patients had relapsed, 26 still had pain. Seventy percent had returned to sport activities, 97% had gone back to work. The main complications were: 6 cases of tendinitis (Achilles tendon), 6 algodystrophies, 3 nevromes of the external saphene nerve and 3 dysesthesis of the external side of the foot. No sign of arthrosis was found on the radiological records.

Discussion

The treatment of chronic instability of the ankle by hemi-Castaing ankleplasty associated with articular cleaning is a satisfactory intervention for the surgeon as well as for the patient. It makes possible the recovery of a stable and functional ankle. The pain, however, will not totally disappear, which the patient should be told before the operation. Mastering the tension of the plasty is the main difficulty of this intervention, which may fail, but not necessarily as a result of the plasty's being too loose. The cause for the failure should also be sought in other factors related to the region of this pathology (deltoidian ligament, neurologic trouble, proprioceptive).     

Traitement chirurgical des luxations et fractures-luxations périlunaires du carpe. Étude rétrospective d’une série de 12 cas

We report a retrospective series of 12 dislocations or perilunate fracture-dislocations having occurred in sportsmen. The results of our series are compared with the data of the literature and we discuss epidemiology, types of lesions, surgical treatment, complications and prognosis of this pathology. The displacement of all these lesions was posterior. The mean age was 24 years. All 12 patients had undergone surgical treatment through a dorsal approach. They were reviewed clinically and radiologically with a mean follow-up of 27 months. The average Cooney functional score was 70 over 100 with two excellent, four good, four fair and two poor results. Average flexion–extension motion arc was 72%, the grip strength was 77% compared to the other wrist. Persistent wrist pain was almost constant.     

Ruptures traumatiques de la coiffe des rotateurs chez le rugbyman

Rotator cuff tears are one of the shoulder lesions that can occur during modern Rugby. They are present in 3–10% of the traumatic lesions of the shoulder in this population and is this figure is expected to continue increasing because of the growth in popularity of the sport and the intensity of the game. The physician should be aware of the clinical signs in order to guide the correct imagery for this type of lesion to be correctly identified. The study of 29 rotator cuff tears in professional Rugby players from the French Rugby championships from 1996 to 2006 allowed us to clarify the epidemiology of these lesions and to specify the therapeutic indications. The surgical treatment, especially arthroscopic repair, proved to be efficient for the partial and full-thickness tears. Eighty-three percent of the patients were able to play Rugby at their presymptomatic competitive level with a delay of 5.5 months with a strictly normal clinical exam in more of 75% of the cases.     

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.     

Intérêt du Télos dans l'évaluation de la laxité chronique antérieure du genou en pré- et en postopératoire

The objective of our work is to clarify the contribution of knee arthrometer in the diagnosis of the anterior laxity of the knee, to look for the factors of escalation of this pathology, to estimate the objective results and outcomes following of the anterior cruciate ligament surgery. It is about a retrospective study which concerned 78 patients presenting the anterior chronic laxity of the knee, investigated, treated and followed in the M.-T.-Kassab Institute of Orthopaedics over a period of 10 years. The average age of our patients was of 27.6 years with a male ascendancy. The anterior cruciate ligament surgery was realized according to the technique of Kenneth-Jones under arthroscopy. The arthrometer has been used to determine the outcome 6 months after the surgery. Before the surgery, the average anterior translation of the tibia was 15.3 mm, 95% of the patients had 8 mm previous absolute laxity, while the differential was about 4 mm in 87% of the cases in which comparative study could be made. There was a statistically significant correlation between the Lachman's test, the internal meniscus injuries and the delay accident — surgery with the anterior knee laxity in the arthrometer. The postoperative average laxity was bout 8.2 mm and earning was proportional to the importance of the initial tibial translation. The present study demonstrates that arthrometer tests may be an objective complement for the clinical exam, with a diagnostic, previous and therapeutic purpose.     

Traumatismes de l'articulation sternoclaviculaire chez le joueur de rugby

Traumatisms of the sternoclavicular area are rare but not exceptional in rugby players. Sprains or fracture of the medial fourth of the clavicule are easy to treat and do not alter the ability to play. Posterior sternoclavicular dislocations are rare; usually stable after orthopedic reduction but the close proximity of vascular structures or the respiratory tract may be responsible for severe lesions, sometimes letal. Anterior dislocations are usually unstable and should not be operated on, if possible, in the rugby player. In patients under 23 years of age, it is usually a fracture through the epiphyseal plate and prognosis is good with conservative treatment.     

Le traitement des fractures comminutives de l’extrémité distale du radius par fixateur externe : à propos de 18 cas

Comminuted fractures of the distal radius are common. A retrospective study was conducted in the department of orthopaedic trauma-A of university hospital Hassan II of Fez on a six-year period between January 2005 and December 2010 involving 18 cases of comminuted fractures of the distal radius treated with distraction external fixator. The average age of our patients was 28 years old, all male, all of our patients had a wrist injury during a sports accident. The right side was affected in 88 % of cases. X-rays have objectified an articular fractures and/or comminuted without opening the skin, we adopted the Castaing classification stadifier for fractures of the distal radius. The treatment consisted of a bipolar distraction external fixator combined with a plug-in three patients, ablation of osteosynthesis material was carried out in 6 weeks, then physical therapy was started. After falling 21 months, our results were very satisfactory with good recovery of mobility of wrist and back of any sport.     

Incidence et sévérité des blessures au sein d’une équipe professionnelle de rugby du championnat français. Étude rétrospective sur quatre ans

Our objective was to study the incidence and the severity of match injuries in the professional team of rugby players of Pau, which participate to the French first division championship. It was a four-year retrospective study, from 2002/2003 to 2005/2006 season. Data were gathered about incidence, type, location and severity of injuries. Injury was defined as a traumatism occurring in match and resulting in the player being stopped for 8 days or more and thus to miss one match or more. Severity was defined in terms of number of days the player was stopped, corresponding to a number of missed matches. The average of annual incidence of match injuries was 40.7 per 1000 hours of playing position game. The rate of injuries was superior to forwards (57% of all injuries) in comparison with backs (43% of all injuries). It was mostly osteoarticular lesions (45%) and inferior members were the most frequent location (62%). Concerning severity, injuries which resulting in the player being stopped for 28 to 89 days (corresponding to four to 13 missed matches) was the most frequent. Whereas, those which rendered the player ineffective for 90 days or more was less frequent. Despite the facts that our results were directly linked with the protocols used, they have proved to be concordant with a number of the publications. In order to better understand the particulars of French professional rugby, we deemed necessary to undertake a prospective study whose aim will be to further investigate the circumstances and characteristics of these match and training injuries.     

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 instabilités antérieures de l’épaule. Á propos de 50 cas

We performed 54 consecutive Latarjet procedures for the treatment of recurrent anterior instability of the shoulder between 1996 and 2005. We retrospectively reviewed the clinical and radiographic results of the procedure. The procedure was performed for the treatment of recurrent anterior dislocation in 51 shoulders, painful recurrent anterior subluxation in two cases and painful shoulder in one case. All patients had a radiographic evaluation before the operation and at the latest follow-up examination. At the time of the latest follow-up, none of the patients had recurrent dislocation. According to the system of Rowe, 51 (94 %) of the 54 shoulders had an excellent or good result. Fifty-one shoulders had no glenohumeral osteoarthrosis.     

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.     

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.     

Étude épidémiologique prospective des pathologies dans le XV de France féminin de rugby de juillet 2006 à septembre 2010

The objective of this prospective study is to determine the rate of injury on the population of the French women's rugby team. It was conducted over 50 months from July 2006 to September 2010. The medical staff of the French team collected data during training and match exposure. One of the main results of the study is the significant difference in the incidence of injury leading to a sports interruption greater than 8 days between female and male (5.99/1000 hours vs. 42,1/1000 hours). Lower limb injuries represent half of the injuries observed in our study but the articular lesions represent 80.43% of the injuries leading to an interruption superior to 8 days with an incidence of 4.62/1000 hours of exposure per position. This confirms the data found in the medical literature. The ruptures of the anterior cruciate ligament, following a tackle, are the most severe lesions of our study. The forwards had a higher rate of injury than backs. The three positions most exposed to injuries are the nos. 8, 9 and 14. The players are most vulnerable when they are being tackled, during the runs and during the rucks. The study described significant differences concerning a much higher number of severe articular lesions, a more significant vulnerability of women in sustained tackles in a match situation and a different exposure of certain position, particularly the scrum-half and the right-wing.     

Épidémiologie des traumatismes orthopédiques liés à la pratique du rugby à XV. Revue de la littérature

Objective

To undertake a review of international epidemiological studies on match orthopedic injuries among rugby union players in order to define their frequency and some of their associated factors.

Method

Studies for this review were selected as identified by the PubMed medical database and/or published in reviewed journals. Only studies for which the methodology was described were selected at the final step.

Results

Most of the studies reviewed concerned anglo-saxon and male players. Despite the fact that the definition of injury was not the same between all studies, our review indicates that the traumatology in rugby union players is increasing since the coming of professionalism after the third IRB World Cup in 1995. Tackle was the most frequent game event cited when an injury occured but the risk for an injury was increased for scrum and collision. Muscular strains were identified as frequent injuries and prevention programs can help to reduce their incidence. Knee was the most injured localization cited for injuries with a subsequent indisponibility. As for muscle strains, prevention programs led to a decline of the frequency and the seriousness of head and spine injuries. Even though forbidden, foul play events were identified for 10 to 15% of the injuries.

Conclusion

Our review indicates that the traumatology in rugby union players is increasing since the coming of professionalism. A standardized (internal validity and reliability) and mastered methodology must be defined and applied in order to develop and to assess primary, secondary and tertiary prevention strategies.     

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.