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.     

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.     

Arrachements des épines iliaques antérosupérieures et antéro-inférieures chez l’enfant et l’adolescent sportifs. À propos de dix cas

The avulsions of anterior-iliac spines in child and adolescent athletes are rare injuries. All children have been treated as orthopaedic with strict rest, nonsteroidal anti-inflammatory substances and dispensation of sport for three months. No subsequent sequelae has been reported, all patients who got back to a sporting activity identical to that practiced before accident. It seems that the orthopaedic treatment among adolescents and children victims of avulsions of anterior-iliac apophysis, superior or inferior, is sufficient and does not involve any subsequent sequelae.     

L’ostéome ostéoïde du col fémoral du sportif : intérêt de la résection percutanée scanno-guidée (À propos de 11 cas avec revue de la littérature)

Introduction

Treatment of the osteoid osteoma was based a long time on the surgical resection, but with a considerable frequency of complications. The percutaneous resection tomography-guided belongs to therapeutic progress of these last years, it became the method of choice for the treatment of osteoid osteoma in our institution. The purpose of our study is to evaluate effectiveness of this technic by analyzing the clinical evolution, the duration of convalescence and resumption of sports activities.

Patients and methods

It is a retrospective study concerning 11 observations of osteoid osteoma of the femoral neck, treated and followed to the service of Traumatology-Orthopedy II of the military hospital of the CHU Rabat between January 2004 and October 2009. Our series was composed of three professional athletes, two footballers exercising in national shampionship and six soldiers subjected to a constant and regular drive.

Results

This intervention was done in the day's hospital, all the patients left the hospital the same day with resumption of the total support in the 24 hours following operation. Nine patients (80%) observed a total disappearance of the pain a few hours after the intervention. With a minimal retreat one year, no case of complication was raised. And finally on the subjective level all the patients were satisfied and took again their sports activities on the same former level.

Discussion

The treatment for osteoid osteoma must be simple, precise, effective and the least expensive possible. In the light of our results and those brought back in the literature, the percutaneous resection tomography-guided is proven effective, sure, not very invasive and is associated with a reduction in the health expenditure. It can be recommended like the treatment of choice of osteoid osteoma as well for the femoral neck as for the other localisations. More aggressive and more expensive treatments are difficult to justify, in particular in sportsmen, thus allowing them a fast convalescence and an early recovery their sports activities.     

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.     

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.     

L’avulsion de la tubérosité tibiale antérieure chez l’adulte

The authors report two cases of patients operated for avulsion fracture of the tibial tubercle. The traumatisms occurred during sports activities (karate, basketball). The treatment consisted in open reduction of the tibial tubercle then fixing it by screwing. At the end, after rehabilitation, the functional results were good.     

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.     

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).     

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.     

Suivi des patients après injection de toxine botulique intradétrusorienne: Recommandations de bonne pratique clinique chez le patient neurologique

Injections of botulinum toxin into the detrusor is a major evolution for treatment of neurogenic bladder. They are now considered as a treatment of choice, safe and efficient, in refractory neurogenic overactivity in catheterized patient. To date, there are no consensual practical guidelines for the follow-up of patients having been treated by intradetrusor botulinum toxin, whatever the indication of the treatment, functional, that is, for improving continence and overactive bladder syndrome or organic, that is, for treatment of high-detrusor pressure and their deleterious impact of urinary tract. This lack of guidelines leads to heterogeneity of treatment management and limit the definition of optimal modalities of intradetrusor botulinum toxin treatment in neurogenic patients. The aim of your work, prepared jointly with the International Francophone Neuro-Urological expert study group (GENULF), aimed at putting forward well-informed specific recommendations for the follow-up of patients having been treated by intradetrusor botulinum toxin for functional or organic indication of neurogenic detrusor overactivity.     

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.     

Fracture-avulsion négligée de la tubérosité tibiale antérieure

Avulsion-fracture of the tibial tubercle has been well described and its management is now well codified in standard orthopaedic textbooks. Diagnosis is based on clinical features and standard radiology. The authors present a case of a neglected type IIA avulsion-fracture of the tibial tubercle. Surgical treatment gives an excellent outcome despite intra operative difficulties.     

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.     

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.     

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.     

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.     

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.     

Stabilité physicochimique de trois produits régulièrement utilisés seuls ou en association en mésothérapie traumatologique

Mesotherapy is a technical used for the treatment of the tendinous muscular pain. We analyzed the physical-chemistry stability of three products usually used: procaine, thiocolchicoside and piroxicam.

Method

The studied products were analyzed alone or in combination with HPLC-MS. The stability kinetic with ambient temperature was realized at T0, T1 (five minutes), T2 (ten minutes) and T3 (three hours) for each compound, and at T0, T1 and T2 for the blend of the three ones. Each kinetic was realized three times with an averaged result.

Results

We notice a degradation by 8.93% of procaine from T2. At T1, no degradation was observed. Piroxicam was found on its initial form concerning T inferior to five minutes. As regards thiocolchicoside at T2, the compound was recovered on an unchanged form. The blend of the three compounds accelerates their own degradation and at T equal to five minutes no compound was found on a spoiled form.

Discussion

With air contact, at ambient temperature and with a natural light, each product turns sour according to its kinetic. The blend of the three products accelerates this degradation. Just a five-minute interval between the preparation and an injection allows stability into the blend.

Conclusion

The physical-chemistry stability of procaine, piroxicam and thiocolchicoside begins as soon as the ampules are open, results increased after the blend of the three ones. During a consultation, the blend preparatory time should be between the two times of disinfection. The reuse of the same ampule during the next consultation is to ban.