Les accidents musculo-squelettiques avec les consoles vidéos de nouvelle génération. À propos d’un cas et revue de la littérature

The rise of next generation consoles game, with their share of sport simulations, has caused appearance of new sport injuries. We present a case of a traumatic rupture of the calcaneal tendon, after a game of virtual sport. It concerned a non-athletic 40-year-old woman. The surgery was performed with a very good long-term result. Literature review demonstrated the extent of these pathologies, with a prevalence of musculoskeletal troubles.     

Achilles tendon problems: Not just an orthopaedic issue

Purpose. To review the current concepts on Achilles tendon involvement in various pathological conditions.

Method. A literature search was conducted to trace relevant literature on Achilles tendon problems in general pathologies.

Results. The Achilles tendon can be involved in inflammatory and autoimmune conditions, genetically determined collagen abnormalities, infectious diseases, tumours, and neurological conditions which are not of a primary surgical nature.

Conclusions. Although Achilles tendon problems are classically considered frequent in active individuals from overuse or a single acute episode, problems in the Achilles tendon can be a consequence of several conditions.     

Conservative,open or percutaneous repair for acute rupture of the Achilles tendon

Purpose. To review the complications and recovery of patients with Achilles tendon rupture managed by percutaneous repair, open repair, and non-operative means in a tertiary referral centre between 2001 and 2003.

Methods. The operating theatre register and logbooks of the Consultants were used to identify surgically managed patients, while plaster room records were used for conservatively managed patients. We collated demographic and management details.

Results. The number of plaster changes (p < 0.001), median length of time in cast (p < 0.001), and number of outpatient visits (p < 0.05) was greater in conservatively managed patients. We performed no formal statistical analysis given the small numbers. Conservative management was the least expensive and open surgery the most costly modality of management. Percutaneous surgery was approximately a third of the cost of open surgery when performed under local anaesthetic.

Conclusion. In our setting, percutaneous repair and conservative management are viable alternatives to open surgery, which carries higher complications rates and was the most costly of the three. Individual patients will have different needs due to their age, occupation, or level of sporting activity.     

Long-term outcome of superficialis-to-profundus tendon transfer in patients with clenched fist due to spastic hemiplegia

Background. Spastic hemiplegia is a common feature after stroke, which can result in a clenched fist deformity with secondary hygienic problems and pain. Operative treatment can improve these problems, although literature about its long-term effects is lacking.

Purpose. To determine whether Superficialis-to-Profundus tendon (StP-) transfer procedure leads to permanent improvement of hygiene and reduction of pain in patients with clenched fist due to spastic hemiplegia following stroke.

Method. Patients who underwent a StP-transfer in 2003 – 2005 were evaluated on skin condition, upper extremity joint mobility, resting position and muscle tone and with VAS scores on hygiene maintenance and pain in the hand.

Results. Six patients (mean age 54 years; duration after stroke 10 years) were included. Indications to operate were hygienic problems only (3) or combined with pain (3). The average follow-up period was 19 months. After 6 weeks of post-operative splinting, no standard follow-up was applied. Serious post-operative complications were not reported. At follow-up no hygienic problems were present and pain was decreased in all except one patient. All hands could passively be fully opened. In resting position, flexion was seen in the MCP-joints (60 – 90°). Muscle tone was raised in flexors of the wrist and fingers and m. adductor pollicis (Ashworth 1 – 2). Given the same pre- and post-operative circumstances, all patients would agree to have the surgery over again.

Conclusion. Even 19 months after the StP-transfer for clenched fist, all operated hands could still be fully opened and there was a permanent improvement of hygiene and pain reduction.     

Approach and treatment of the adult acquired flatfoot deformity

Adult acquired flatfoot deformity (AAFD), embraces a wide spectrum of deformities. AAFD is a complex pathology consisting both of posterior tibial tendon insufficiency and failure of the capsular and ligamentous structures of the foot. Each patient presents with characteristic deformities across the involved joints, requiring individualized treatment. Early stages may respond well to aggressive conservative management, yet more severe AAFD necessitates prompt surgical therapy to halt the progression of the disease to stages requiring more complex procedures. We present the most current diagnostic and therapeutic approaches to AAFD, based on the most pertinent literature and our own experience and investigations.     

超声弹性成像评价健康成人跟腱的初步探讨

目的初步探讨实时超声弹性成像在健康成人跟腱分级中的价值。方法对52例健康成人志愿者的跟腱(104条)进行二维超声和弹性成像检查,然后分级。每一跟腱分为近、中、远3段进行检查。每一段均行纵、横扫查,弹性成像至少取3个可以充分描述跟腱边界及跟腱周围规则结构的图像。然后对弹性成像和二维超声检查结果行相关性分析。结果二维超声显示跟腱厚度4.2～5.2mm,平均4.8mm。二维超声检出1级跟腱307段,3级跟腱5段,未检出2级跟腱。弹性成像检出1级跟腱264段,2级跟腱43段,3级跟腱5段。二维超声仅显示1级和3级跟腱,弹性成像的1级与二维超声的1级,弹性成像的2、3级与二维超声的3级比较,无明显相关性(r=0.27,P﹤0.01);弹性成像的1、2级与二维超声的1级,超声弹性成像的3级与二维超声的3级显著相关(r=0.87,P﹤0.01)。结论健康成人跟腱的超声弹性成像显示为硬结构组织,与二维超声有较好的相关性。超声弹性成像可以准确测量跟腱硬度的变化,有重要临床意义。     

可调节带袢锁扣钛板-自体半腱肌肌腱全内重建前交叉韧带断裂的效果

 目的 探讨可调节带袢锁扣钛板-自体半腱肌肌腱全内重建膝关节前交叉韧带(anterior cruciate ligament,ACL)断裂的可行性、优缺点及并发症。方法 选择2014-07至2015-07应用可调节带袢锁扣钛板-自体半腱肌肌腱全内重建膝关节ACL断裂47例。2～6周,关节镜下应用可调节带袢锁扣钛板-自体半腱肌肌腱全内重建膝关节ACL断裂,伴发内侧副韧带损伤,用股薄肌肌腱修复或直接缝合。取同侧半腱肌肌腱,修整后将肌腱移植物对折成4股,并与可调节带袢锁扣钛板相连,移植物长度为6～6.5 cm,直径为7～9 mm。在ACL胫骨侧、股骨侧印迹定位并用倒打钻钻孔,制作骨隧道,经前内侧入路将肌腱移植物牵入骨道,并两侧逐步锁紧线环,将胫骨向后复位,将钛板固定在骨皮质上。根据重建手术前、后膝关节前抽屉实验、Lachman 试验、侧方挤压实验、IKDC 膝关节功能评价表、 Lysholm 评分对患者进行主观和客观评分,以评定疗效。结果 本组47例随访2～3年,平均随访时间为2.1年。末次随访时,患者膝关节疼痛、肿胀、屈伸活动受限等症状明显改善,前抽屉实验(-),Lachman试验(-),IKDC膝关节功能评分、Lysholm评分较重建前明显提高。膝关节屈曲达115°～130°;膝关节IKDC评分结果:正常41例(87.2%),接近正常4例(8.5%),异常2例(4.3%);膝关节功能Lysholm评分:术前(51.4±5.4)分,术后(92.2±4.6)分,差异有统计学意义(P<0.05)。结论 应用可调节带袢锁扣钛板-自体半腱肌肌腱全内重建膝关节ACL,创伤小,能恢复膝关节的稳定性,功能恢复良好,疗效确切。     

Tubulin polymerization‐promoting protein family member 3, Tppp3, is a specific marker of the differentiating tendon sheath and synovial joints

Tppp3, a member of the Tubulin polymerization‐promoting protein family, is an intrinsically unstructured protein that induces tubulin polymerization. We show that Tppp3 is a distinct marker in the developing musculoskeletal system. In tendons, Tppp3 is expressed in cells at the circumference of the developing tendons, likely the progenitors of connective tissues that surround tendons: the tendon sheath, epitenon, and paratenon. These tissues form an elastic sleeve around tendons and provide lubrication to minimize friction between tendons and surrounding tissues. Tppp3 is the first molecular marker of the tendon sheath, opening the door for direct examination of these tissues. Tppp3 is also expressed in forming synovial joints. The onset of Tppp3 expression in joints coincides with cavitation, representing a molecular marker that can be used to indicate this stage in joint transition in joint differentiation. In late embryonic stages, Tppp3 expression highlights other demarcation lines that surround differentiating tissues in the forelimb. Developmental Dynamics 238:685–692, 2009. © 2009 Wiley‐Liss, Inc.