Coalitions du tarse ou « fausses entorses » de l’enfant et de l’adolescent. À propos d’un cas

Tarsal coalitions, also called synostoses, are a cause of pain and gait disturbance in children and adolescents. They are often diagnosed as tarsal sprains, leading to an inappropriate functional prognosis. This is the case of an 8-year-old child with talo-calcaneum synostosis, presenting pain, hind-foot stiffness and marked disability in daily life activities and sports.     

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.     

Traitement des luxations récentes du coude : à propos de 30 cas

Elbow dislocations are encountered in contact sports and other extreme sports. This retrospective study included 30 cases of elbow dislocations, treated between 2007 and 2012. The average age of our patients was 36 years, all male and victims of violent trauma in local equestrian competitions. The dislocation was posterolateral in 23 cases and direct posterior in the other seven. This involvement was associated to a fracture of the radial head in six cases and a medial epicondyle tear in a patient. All subjects had a reduction under sedation or general anesthesia. Fractures of the radial head were treated by screwing in four cases and resection in two cases. We also made screwing for the epicondyle fracture. The treatment was completed by analgesic immobilization for about 10 days followed by active mobilization in 22 patients, in whom the elbow was considered perfectly stable. In eight patients, mobilization in the area of stability, protected by an articulated orthosis, was established for a minimum of 45 days. After a mean follow-up of 22 months, a range of motion for flexion-extension greater than 100° was achieved in 80% of patients and only two cases have kept a severe stiffness. The overall results, as assessed using the Mayo Elbow Performance Score, were good to very good in 25 patients, fair in three patients and poor in only two cases. The sport recovery was gradual and the return to competition was not allowed before the sixth month.     

Test isocinétique précoce après ligamentoplastie antérieure de genou : résultats et conclusions

Objectives

To compare 4-months isokinetic results after anterior cruciate ligament reconstruction with patellar tendon or hamstring tendons.

Material and methods

A retrospective study during 5 years concerning isokinetic records from patients who went to our rehabilitation center after anterior cruciate ligament reconstruction, and who did an isokinetic test 4 months after surgery. There was 146 patients, 116 males and 30 females, 69 with hamstring reconstruction and 77 with patellar tendon reconstruction.

Results

In Kenneth-Jones surgery, there is more deficience on leg extensors, while hamstrings are more deficient after hamstrings reconstruction surgery. This deficience concerns peak torque and work, whatever speed.

Conclusion

Leg flexion deficience in hamstring reconstruction surgery is due to late work during reeducation, because of pain and injuries localized on sample area. There is also loose of biomechanical properties due to muscular fibrosis. For the two reconstruction surgeries, leg extension deficience is due to pain and edema.     

Association tendinopathie des fibulaires et fracture de fatigue de la malléole latérale : à propos de trois cas

Among the pathologies of the athlete's ankle, tendon distress and bone stress pathologies may often occur. Through three cases report, we describe the association of the fibular tendinopathies and the presence of stress fractures of the external malleolus. This association is important to detect since the treatment of the tendinopathy can be different if the condition is isolated or if it associated with a bone stress fracture, notably in the presence of correction for static difficulties. We highlight also the interest of the paraclinical exams, in particular MRI which gives evidence for the two pathologies.     

Rupture du muscle grand pectoral : à propos d’un cas

Pectoralis-major tendon rupture is a rare injury. It occurs in young, healthy athletes during violent, eccentric contraction of the muscle with the arm held in an abducted, extended position. Often undiagnosed at the beginning, the diagnosis is confirmed by magnetic resonance imaging. Early operative treatment is associated with better outcome than delayed treatment; however, both of them are better than conservative treatment.     

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.     

Malformation de Chiari type 1 et sports : à propos de trois cas découverts après apparition de symptômes neurologiques sur le terrain

The development of neurological symptoms in a context of sports activities, if reported, should be followed by complementary morphology tests, potentially leading to the identification of Chiari type 1 malformation. This congenital brain consists in the downward displacement of the cerebellar tonsils and the brain stem through the foramen magnum. We report three clinical cases to increase awareness of the diagnostic circumstances. The first case was a rugby player who lost consciousness during a game after contact without head trauma. The second case was a female handball player suffering from persistent headaches that worsened with the practice of sports; here posterior headache was triggered by certain head movements. The third case was a woman who experienced two episodes of transient tetraparesia related to bicycling. History taking is crucial during sports aptitude consultations. Symptoms of type 1 Chiari malformation include neurological deficits, predominantly posterior headache, and vertigo triggered by certain movements. Brain and spinal cord MRI is the gold standard imaging technique. Confirmation of Chiari type 1 malformation precludes contact sports and activities with a risk of fall. Specialized care is required.     

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 rupture du tendon calcanéen : à propos de 53 cas

The Achilles tendon is the most resistant of the tendons of the human body; its rupture is increasingly frequent in the world and our country because of the considerable development of the sporting activities. This retrospective study relates to 53 observations listed in the service of traumatology and orthopedics of the Hospital Avicenne of Rabat over a period of 5 years between 2005 and 2009. Each patient underwent monitoring protocolisé. Criteria for Comis were used for clinical evaluation. All patients received open surgery. The middle age was of 37 years. The clinical examination was sufficient to pose the diagnosis. All the patients profited from an open surgery. Three patients presented pain after surgery. Infection local skin was noted in two patients. One patient presented a rerupture and 88.6% of the patients have very good performances. The rupture of the Achilles tendon is much more frequent in men; this is explained by the frequency of sports activity in men. Three patients had a history of tendinitis. Clinical examination was easy enough for diagnosis. Open surgical treatment remains the method most widely and most used. In the classic controversy between the effectiveness of surgical and orthopedic treatment in the rupture of the Achilles tendon, the emergence and development of percutaneous techniques still currently did not make it possible to conclude to the superiority of treatment over another.     

Luxation carpo-métacarpienne divergente des doigts longs : à propos d’un cas

Divergent carpometacarpal joint dislocations of the fingers are exceptional. A 31-year-old judo player presented divergent carpometacarpal joint fracture-dislocations of the ulnar four fingers after a fall during competition. Radiographs showed dislocations and associated fractures. The patient underwent open reduction and fixation with percutaneous Kirschner-wires followed by 6 weeks immobilization. Physiotherapy was started and results were satisfactory after 3 years follow-up.     

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.     

Lombalgie chronique et réentraînement à l’effort : application de la notion de niveau de douleur cliniquement acceptable

Objectives

To search for predictors of reduced low back pain under the patient acceptable symptom state (PASS) at the end of a functional restoration program (FRP) in chronic low back pain, and then to compare the effectiveness of FRP depending on the rate of people returning to work, the acceptability threshold of pain has been reached or not at the end of the program.

Method

Open prospective study on 303 patients with chronic low back pain included in a FRP. An assessment of the deficiencies (finger-tip-to-floor (cm) and Schöber tests (cm), VO2 max (l/min), Shirado and Sorensen tests (seconds), lumbar and radicular VAS (0-100), the functional disability (Wadell and Quebec scales (0-9 and 0-100), and the psychological status (Beck and Hamilton scale (0-35 and 0-30), HAD scale (0-21), FABQ (0-42 and 0-24)) was conducted at the beginning and end of the program. Data on the work were also collected (arduous physical labor, work-related accident or not, sick leaves or not and length, return to work at the end of the program). The variables associated with a PASS at the end of the FRP and a correlation between the level of pain and the return to work were sought.

Results

The parameters were significantly improved : finger-tip-to-floor test (−17,5 ± 16,2), Schöber test (−0,5 ± 5,4), lumbar VAS(−6,3 ± 23,6), VO2 max (0,14 ± 0,4), Wadell (−1,3 ± 2,4), Quebec (−10,5 ± 17), Beck D (−3,1 ± 4,5), Beck A (−2,5 ± 4,3), HAD D (−2,4 ± 4,7), HAD A (−1,3 ± 3,8) et FABQ1 (−5,7 ± 11,6), FABQ2 (−3,9 ± 9,6) scores, endurance of the flexor (35 ± 63,83) and extensor (44,8 ± 112) spine. Patients reaching the PASS for pain level return significantly more to work (73% versus 52%). Five parameters indicative of a reduction of back pain under the PASS were identified : lumbar VAS and endurance of the flexor spine at the beginning, changes in finger-tip-to-floor test, radicular VAS and Beck score for anxiety.

Conclusion

The PASS appears to be a relevant concept associated with a successful return to work for patients with chronic low back pain and severe disability after a program of FRP.     

Traitement des ruptures négligées du tendon rotulien (à propos de deux cas)

The authors report two cases of neglected patellar ligament rupture treated surgically. The repair was made by suture of the tendon rotulien strengthened by a fragment of the vast medial associated with a hooping to the son of steel for the first case; and a reconstruction with transplant free bone-tendon-bone taken in depend on the knee controlateral, supported by a centring to the son of steel in 90°de flexion for the second case. No postoperative immobilization is made allowing beginning at once the re-education. The functional result was excellent on the active extension but with a sequellaire steepness concerning the flexion for the first patient. The surgical technique must be individually adapted; the centring of protection must be systematic but realized carefully to avoid the frequent abnormalities of location of the kneecap and the fémoro-patellaires conflicts and authorizing a fast reeducation. Through a review of the literature, we recall difficulties of care of this injury even on the diagnosis and therapeutic levels.     

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.     

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 bilatérale simultanée de rotule. À propos d’un cas

Bilateral simultaneous fractures of the patella occured with interruption of the apparatus bungee cord, in a young man is a exceptional occurrence. A mechanism in two times, without subjacent etiology, contributes to accentuate the originality of this observation. The authors propose to describe the assumptions of the organic mechanism and the physical therapeutic. The goal is the functional recovery most optimal and the restitution of a military efficiency.     

Apport de l’arthrodistension dans la prise en charge de la capsulite rétractile primitive de l’épaule : étude comparative versus rééducation

Objectives

To describe the epidemiological and clinical features of patients with primitive adhesive capsulitis of the shoulder treated by capsular distension and then rehabilitation; to evaluate the short-, mid- and long-term efficiency of this therapeutic protocol and compare it with rehabilitation alone.

Materials and methods

This was a two-year prospective study. Sixty patients were included and divided into populations P1 (capsular distension and rehabilitation) and P2 (rehabilitation only). Assessment of the treatments’ efficacy was based on the following parameters: pain on a visual analogue scale (VAS), joint motion in several axes, a simplified Constant score (functional ability) and the SF-36 quality of life score.

Results

Thirty patients (mean age: 56) underwent capsular distension. The Constant score was judged to be poor in over half of the patients. All the quality of life parameters were modified. When compared with P2, the P1 group showed a statistically significant improvement in terms of the pain score (p = 0.005), anterior elevation (p = 0.001), lateral elevation (p = 0.005), external rotation (p = 0.006) and the Constant score (p < 0.001) one week after capsular distension. One year after capsular distension, this gain persisted in a statistically significant manner for all functional parameters and all SF-36 dimensions (p < 0.001 for PF, RP, BP, SF and RE; p = 0.01 for GH and VT and p = 0.002 for MH).

Conclusion

Our results show that capsular distension and subsequent intensive rehabilitation have a beneficial effect. This combination enables rapid, significant improvement from the first week onwards. The improvement phase lasts for one month and may hold steady for up to 12 months.