Évaluation de la gravité des lésions du ligament collatéral latéral de cheville : étude de corrélation clinique-échographie

The clinical examination is sometimes insufficient to assess the severity of lateral collateral ligament (LCL) sprain of the ankle, making it difficult to choose the most appropriate treatment. The purpose of this study was to compare retrospectively the observed or reported clinical signs assessed two days after the trauma and ultrasound findings in patients who experienced a recent ankle inversion trauma. Between 1st May and 1st November 2004, 34 patients referred in the sports medicine service were clinically examined in a standardized way two days after the injury, and underwent an ultrasound by the same operator. No isolated clinical sign was correlated with the severity of ligamentous lesions revealed by ultrasound. Taking in account the whole set of the clinical signs appear to better guide for diagnosing the presence or absence of a ligament rupture: positive predictive value if the presence of all the signs equal to 75% for the anterior talofibular ligament (LTFA) and 88% for fibular ligament (CFL), negative predictive value if all the signs of lack of gravity equal to 80% for LTFA and 62% for the CFL. These results confirm the lack of correlation between clinical signs and Imaging findings in ankle sprains. They raise questions about the adequacy of clinical classifications and suggest an expansion of indications for ultrasound in ambiguous situations, especially for athletes showing little signs of severity, to ensure optimal treatment and faster recovery.     

Évaluations prédictives de l’entorse de cheville. À propos de 58 cas

When an injury comes out, it is seen like a fatality for a sportsman and the medical staff. The ankle sprain is from far the most common pathology. Preventions programs proved their efficiency in many fields. However, it is very hard to put them into practice because there is few or no tools to these persons. The goal of this work is to provide assessments reliable, reproducible and non-dependent operator that will identify potential topics victim of a sprain ankle in the medium term. We tested 58 youngs healthy athletes whose sport practice was up to 2 hours a week. We have made assessments on a motor coordination machine, on a posturography platform and we analysed the muscular benefits of each lower limbs thanks to a accelerometer. These analyses have been done in November 2007, January 2008 and March 2008. We sorted out five articulars instability. Topics victims of the ankle sprain during the study got a 13% coordination deficiency. The difference is statisticly significant. All the tests which have been done on the postuography plateform were not accepted because the evaluation results were not comparables with the 1985 norms of the French Association of Posturology. We were able to see a curve problem with wounded patients during the ground absorbtion phase and had a stabilisation time shorter than the one for the healthy subjects. This significative difference was up to 110 ms. Pope et al. find out on patients hit by a talocrural sprain, a significative diminution of the dorsiflexion during the previous traumatism report. Willems et al. find these facts and describe others intrinsic factors of predisposition which match our results. Our work proved that it is possible to warn, in a mid term, the sprain of the ankle. These warnings reports must be done in the beginning of the sporting season and will allow to determine the athletes weakness thanks to reliable and reproducible evaluations.     

L’acide hyaluronique avant l’arthrose : à propos de 339 sportifs

Introduction

Physical activities, through traumas and intensity of practice expose the athletes to cartilage pain caused earlier compared to a population of sedentary people. Lesions at the origin of the pain may be traumatic or microtrauma however without meeting the radio-clinical osteoarthritis criteria defined by the American College of Rheumatology. Hyaluronic acid (HA) is commonly used in the treatment of knee osteoarthritis. It became legitimate to think that the mechanism of action of the product can lead to a pain relief of patients when used in other joints and pre-arthritic stage. As such, we use it in these indications for over 10 years. The objective of this study is to evaluate its effectiveness in the knee, hip and ankle and to identify prognostic factors.

Method

Retrospective study analysing the effectiveness of the viscosupplementation through a questionnaire assessing pain, athletic/professional level, pain relief on a daily basis and satisfaction. All of the lesions have been classified Kellgren 0 and staging of the ICRS for the knee. Definition of the criteria for response on the sedation of pain, and the maintenance of the sport/professional level. We also searched factors prognostications for the knee, only joint with sufficient sample size expected (biometric data: sex, age, body mass index, sports and professional profile, used presentation and prior injected corticosteroid solution).

Results

Three hundred and thirty-nine protocols have been realized to 332 cartilaginous traumatic or microtraumatic degenerative lesions (279 knees with single cartilaginous injury, 61 patients with associated treated meniscal tear, 29 hips, 31 ankles) and seven painful after-effects of osteochondritis. The average age of patients was 39.30 (± 14.38), 76% male; 83.2% had a sports profile with strong joint solicitation. Overall effectiveness was 49.85% (single chondral injury: 46.26%, chondral injury plus meniscal tear both treated: 60.66%, 44.82% for hip and 57.14% for the ankle). Four patients on seven treated for painful sequela of osteochondritis have been relieved. The rate of adverse events was 4.13%, represented by puncture pain or swelling reaction. In the knee, the stage lesion did not impact on efficiency (P = 0.17), neither the presence of an associated meniscal tear non-treated (P = 0.15); the pursuit of a support activity is correlated with a loss of efficiency (P = 0.039).

Discussion

This study is interesting as far as no study in vivo exists regarding the use of HA in support of isolated microtraumatic or traumatic chondral lesions except in the course of surgery of the meniscus with visualization of an arthroscopic cartilage injury. Efficiency appears interesting, almost equal to that found in the available studies on arthritis in these joints, although, because of the heterogeneity of the protocols and the results obtained, the estimation of a reliable response rate seems delicate.

Conclusion

The use of HA for the treatment of the pain of single traumatic or microtraumatic cartilage injury appears safe, with an interesting efficiency to be confirmed by studies of high level of evidence.     

Contention adhésive de cheville et contrôle postural en condition quasi statique : impact de la pose d’une sous-bande en mousse

Aim

This study's purpose is to estimate the effect of an elastic rubber band ankle strapping on the postural control with or without underwrap.

Method

Fifteen healthy volunteers have been tested on a two feet standing position while performing a task under three conditions: without being strapped, with the strapping over the skin and with the strapping over and underwrap. The variable on trial, recorded using a force platform, was the pression center movement (CP) defined by its frontal (AP) and medial (ML) axes. We extracted CP trajectories decomposed into two elementary motions: the horizontal displacements of the centre of gravity (CG) and the vertical projection of the difference between centre of pressure and the centre of gravity (CP–CG).

Results

The only statistically significative decrease of variance from the no strapping condition was with over skin strapping condition for the CP and CG on ML axe. No CP–CG variance was significally modified.

Conclusion

The over skin strapping provide a lateral stabilization. The hypothesis of additional sensory information and mechanical restriction of the ankle could provide explanation.     

Traitement de la laxité latérale de cheville par ligamentoplastie à l’hémitendon du court fibulaire avec remise en tension capsuloligamentaire

The authors developed an original method, using tenodesis and anatomical repair, for the treatment of lateral chronic instability of the ankle in young military people. In this medium-term retrospective study, 32 patients were rewieved for functional and radiological evaluation. With a mean follow-up period of 20 months (range from six to 64 months), 90.6% (n = 29) of the patients were “satisfied” or “very satisfied”, 78.1% (n = 25) were painfree, but 15,6% (n = 5) complained about stiffness. Ninety-seven percent of them (n = 31) returned to athletic activity and no instability occured. The mean score for the Olerud and Molander Ankle Score was 91.5 (range from 70 to 100). On postoperative stress radiographs the mean side-to-side talar tilt difference was 0.6 ± 2.9°. The mean loosening of eversion isometric strength on the ankle operated was 5.4%. The present study demonstrates that this mixed procedure give excellent results in terms of stability, despite of a well-tolerated stiffness.     

The inner flap of the thigh: an alternative about the cover of the ankle and the foot

The authors relate a case of cutaneous cover of the ankle and the right foot on a leg with precarious vascularization by the inner flap of the thigh with a serious burnt person the left leg amputated. The flap, which has been autonomized first before being set apart, got a well development and allowed to cover the ankle and the foot. It is a flap which deserve to be used and can count among the cover means of the ankle and the foot and even to constitute an alternative to the use of classical flaps (sural and supramalleolar flaps) in case of vascular risk.