Arthropathies et analyse du mouvement : arthrose et arthropathie hémophilique

La marche est un critère d’évaluation particulièrement intéressant compte-tenu de son poids prépondérant dans le handicap fonctionnel rapporté par les patients ayant des troubles musculo-squelettiques. En effet, elle arrive volontiers aux premiers rangs des plaintes fonctionnelles. Son étude en recherche clinique semble être un bon critère dans l’évaluation d’une pathologie ou d’une prise en charge thérapeutique. Ainsi, de nombreuses études animales se sont intéressées aux conséquences fonctionnelles des arthropathies sur la marche. Cependant, les différences entre marche animale et humaine sont nombreuses, ce qui rend nécessaire les études cliniques chez l’homme. Nous avons donc évalué les conséquences fonctionnelles de deux pathologies responsables d’atteintes articulaires majeures, source de handicap important et d’un coût médico-économique très élevé : - L’arthrose, maladie ostéo-articulaire la plus fréquente dans le monde et responsable de douleur et handicap dans les populations vieillissantes. Dans ce cas, un modèle de souris a été utilisé afin d’évaluer l’impact de la gonarthrose post-traumatique sur la marche. - L’hémophilie, pathologie rare liée à un déficit congénital en facteurs de coagulation VIII ou IX dont la complication principale est la survenue d’arthropathies sévères, notamment aux membres inférieurs chez des individus le plus souvent jeunes. Nous avons choisi deux démarches différentes pour chacune des pathologies afin d’évaluer la complémentarité de ces approches scientifiques et leur aspect transversal.Walking is a particularly interesting criterion due to its rule in the disability reported by patients with musculoskeletal disorders. Indeed, it is one of the first functional complaints. Clinical research on walking seems to be a good criterion in the evaluation of pathologies or therapeutic management. Thus, many animal studies have focused on the functional consequences of arthropathies while walking. However, the differences between animal and human walking are numerous, which makes clinical studies in humans necessary. Therefore, we assessed the functional consequences of two pathologies responsible for major joint damage, sources of significant disability and very high medico-economic burden: - Osteoarthritis, the most common osteo-articular disease in the world and responsible for pain and disability in aging populations. In this case, a mouse model was used to assess the impact of post-traumatic knee osteoarthritis on walking. - Haemophilia, a rare pathology linked to a congenital deficiency in clotting factors VIII or IX. The main complication of haemophilia is the occurrence of severe arthropathies, especially in the lower limbs in young patients. We have chosen two different approaches for each pathology in order to assess the complementarity of these scientific approaches and their transverse aspect

Therapeutic Patient Education after Anterior Cruciate Ligament Reconstruction: Evaluation of the Knowledge and Certitudes with a Self-Report Questionnaire

Therapeutic education aims to help patients acquire skills and knowledge, and to improve psychosocial aspects to manage chronic disease. After anterior cruciate ligament reconstruction (ACLR), only 35 to 60% of the patients are able to go back to their previous sport. Return to sport depends on the motivation of the patient. No therapeutic education has already been proposed. We aimed to evaluate the effect of therapeutic education sessions on knowledge improvement during inpatient rehabilitation after ACLR, compared to patients operated with the same surgical technic, but who had no therapeutic education because of outpatient rehabilitation. Sessions were performed by a multidisciplinary team. The evaluation of the knowledge was performed with a true or false 12-items self-report questionnaire. Fifty-four patients were studied and compared to 54 patients with no therapeutic education. The educated and the non-educated groups were comparable. The number of correct answers increased from 73% before therapeutic education to 95% at the end of the hospitalization (p < 0.001). This improvement persisted over time with 91.5% of correct answers at four months (p = 0.94). The non-educated group had 70% of correct answers. This was significantly lower than the results obtained from the educated group at four months (p < 0.001). It was comparable to the result obtained before therapeutic education (p = 0.91). Therapeutic patient education performed during hospitalization for rehabilitation enables patients to have a better knowledge of the stages from rehabilitation to return to sport and the risks of complication after ACLR

Effects of the COVID-19 confinement period on physical conditions in young elite soccer players

International audienceBackground: The rapid spread of the SARS-CoV-2 infection required general confinement measures reducing or even preventing sport practice, which was a risk of detraining in athletes. In adolescents, detraining is poorly known as well as its prevention by homeexercises. This article aimed to assess the effects of Covid-19 confinement on detraining in young high-level soccer players despite a multimodal training program conducted at home.Methods: Twenty-five elite soccer players, aged 14, were included to perform physical exercises at home during the Covid-19 confinement. Two cardio-training sessions and two upper and lower limb muscle strengthening sessions were performed per week. The exercise program was monitored remotely via the web. Hooper, training and mental indexes allowed a psychological follow-up. The effect of Covid-19 confinement on aerobic capacity was measured using a pre- and post-confinement Yo-Yo test.Results: Out of the 25 adolescences who completed the exercises program, 19 performed the post-confinement Yo-Yo test. The running distance decreased by 614 +/- 630 m (-25%) (p = 0001) and the maximal running speed by 0.97 +/- 1 km/h (-5%) (p=0.001), confirming detraining. Hooper, training and mental indexes remained stable showing a well-supported home Covid-19 confinement.Conclusions: The 2-month period of strict home confinement due to the SARS-CoV-2 pandemic was responsible for a decrease of aerobic abilities in adolescent soccer players, despite a remotely monitored multimodal exercises program

Cutoffs of isokinetic strength ratio and hamstring strain prediction in professional soccer players

International audienceHamstring strain injuries frequently occur during professional soccer practice. Low hamstring strength represents an intrinsic modifiable risk factor but cutoffs of isoki-netic knee strength ratios are controversial to predict hamstring strain in professional soccer players. We aimed to predict hamstring strain in accordance with cutoffs of isokinetic knee strength ratios. Bilateral, conventional, and functional isokinetic strength ratios were calculated in 194 professional soccer players at the beginning of 15 consecutive seasons. 36 soccer players presented a moderate hamstring strain and 158 were not injured. The different calculated isokinetic ratios were compared with the right and left limb of the uninjured population. Different usual cutoffs were tested: at 0.85 and 0.90 for the bilateral concentric and eccentric hamstring-to-hamstring ratio, at 0.60 and 0.47 for the conventional hamstring-to-quadriceps ratio and at 0.80 and 1 for the mixed hamstring-to-quadriceps ratio. The specific ratios for the studied population were also determined by the 10th percentile and then tested. Hamstring strain prediction was established in terms of odds ratios. No cutoff with bilateral, conventional, or functional isokinetic strength ratio was predictive of hamstring strain after univariate analysis. Specific cutoffs determined from the studied population were not more predictive. Very few injured soccer players presented values under the cutoffs at 0.47 for the conventional ratio and at 0.80 for the mixed ratio. Regardless of their values, cutoffs of isokinetic strength ratios were not predictive of hamstring injuries. The use of isokinetic cutoffs is not recommended to predict hamstring muscle strain in professional soccer players

Lower-Limb Arthropathies and Walking: The Use of 3D Gait Analysis as a Relevant Tool in Clinical Practice

Arthropathy refers to the notion of joint diseases [...

Hamstring Muscle Injury Prediction by Isokinetic Ratios Depends on the Method Used

International audienceOBJECTIVES: Hamstring muscle injury prediction by isokinetic strength ratios is low but could result from the method-depending either on the use of the limbs or of the sportsmen as references. We aimed to establish a predictive model including unilateral and bilateral ratios calculated from the dominant, nondominant, right, and left limb in injured and uninjured professional soccer players.DESIGN: Cohort study.SETTING: Soccer team of the French Professional Premier League.PATIENTS: Ninety-one professional soccer players.INTERVENTIONS: Isokinetic muscle strength was prospectively measured at the beginning of 5 consecutive seasons (2009-2014).MAIN OUTCOME MEASURES: Several bilateral, conventional, and functional ratios were calculated from isokinetic measurements at different angular speeds (60 and 240 degrees/s in concentric mode and 30 degrees/s in eccentric mode). Thirty-one soccer players had a hamstring injury during the seasons and were compared with 60 uninjured players. Four models were tested to predict the occurrence of hamstring injury from isokinetic ratios calculated in accordance with the dominant, nondominant, right, and left limb.RESULTS: No predictive model was found when ratios were calculated from the dominant or the right limb. Two models of prediction were found when ratios were calculated from the nondominant or the left limb. In these 2 models, only the bilateral concentric hamstring-to-hamstring ratio at 60 degrees/s was predictive. The best prediction was found with the left limb.CONCLUSIONS: We identified 2 low predictive models for hamstring muscle injuries depending on the limbs studied. Because of a low prediction, the consensual method used to predict hamstring muscle injury must be defined in future studies

Strength assessment after proximal hamstring rupture: A critical review and analysis

International audienceBackground: Muscular strength should be one of the main parameters to assess the interest or not of surgery after proximal hamstring rupture. Yet, this parameter is difficult to compare between the different studies because of the heterogeneous assessment methods.Methods: We realized a critical review of strength assessment methods used to evaluate treatments performed after proximal hamstring rupture. The studies were selected from several medical databases with the keywords: "proximal hamstring rupture" OR "proximal hamstring avulsion" AND "strength" OR "isokinetic".Findings: 24 articles evaluated muscular strength after proximal hamstring rupture. 7 have been excluded because the method was not described. 6 types of dynamometric evaluation were used: 2 with an isometric method, 3 with a pneumatic isotonic method and 13 with an isokinetic method. Muscular strengths after non-surgical treatment could not be compared because of the low number of studies and different methods of assessment. After surgery, only isokinetic results measured at the angular speed of 60°/s could have been weighted. A 15% strength deficit was shown at >12 months after surgery.Interpretation: Muscular strength assessment methods currently used to evaluate the strength after proximal hamstring rupture are too disparate to clearly define the strength deficit after rupture and surgery. Strength evaluation should be more rigorous in order to prove the real interest of the surgical management

Determination of the predictive clinical parameters to diagnose chronic exertional compartment syndrome

International audienceChronic exertional compartment syndrome (CECS) is characterized by pain occurring during physical activity. As clinical examination is not sufficient to diagnose it, intracompartmental pressure (ICP) measure is used for CECS confirmation. Numerous clinical signs are reported but their diagnosis predictive ability has never been studied. We aimed to determine if the 12 classically reported clinical signs are predictive of CECS. We performed a single-centre retrospective cohort study on patients referred for CECS suspicion. Patients were asked to run on a treadmill. When pain occurred, post-exercise ICP was performed. We diagnosed CECS if the ICP was ≥30 mmHg and used a logistic regression to calculate the predictive value of clinical signs. One hundred twenty-five patients were evaluated. Ninety-six had CECS and 29 did not, according to the ICP 30 mmHg cut-off. Anterior and lateral compartments were the most frequently affected. After exercise, mean ICP was 58.6 mmHg ± 20.5 in the group with CECS versus 20.9 mmHg ± 4 in the group without (p < .001). Muscle hardness, muscle hernia after exercise, absence of pain at rest and pain recidivism for the same exercise were predictive of CECS. The predictive model associated muscle hardness (Odds Ratio (OR) = 2.18; p < .001) and muscle hernia after exercise (OR = 1.44; p < .001). This model identified 88.6% of CECS subjects. The ROC curve area was 0.808 [95% CI: 0.71-0.90]. This study confirmed the importance of clinical parameters to diagnose CECS. A better knowledge of the relevant parameters could help physicians to indicate invasive examinations

Arthrogenic muscle inhibition and return to sport after arthrofibrosis complicating anterior cruciate ligament surgery

International audienceAbstracts Arthrofibrosis is a devastating complication after Anterior Cruciate Ligament reconstruction (ACLr) characterized by a muscle weakness secondary to an arthrogenic muscle inhibition process. The loss of knee isokinetic strength due to arthrogenic muscle inhibition may be more important after arthrofibrosis, compared to an ACLr population with no complication. The isokinetic strength deficit [Limb Symmetry Index (LSI) at 60 and 180°/s of angular speed] was measured at 4, 7 and 12 post-operative months. Knee function, return to running and return to sport were evaluated. A comparison of the Quadriceps and the Hamstring LSI between patients with arthrofibrosis and those without post-operative complication was performed according to time and taking into consideration the type of surgical procedure. 539 primary ACLr patients were assessed. The arthrofibrosis group presented at 4, 7 et 12 post-operative months a Quadriceps LSI significantly lower compared to the control group, without influence of the graft procedure (LSI: 38, 53, 68% vs 63, 73, 85% at 60°/s respectively). The Hamstring LSI was significantly lower at 4 and 7 post-operative months, but comparable at 12 months with an influence of the Hamstring procedure. Knee function was significantly lower at 4 and 7 post-operative months. Few arthrofibrosis ACLr patients returned to running at 7 post-operative months (6.8% vs 69.9%; p<0.0001). An important and durable Quadriceps muscle weakness occurred after arthrofibrosis, whatever the type of graft procedure. This is explained by an Arthrogenic muscle inhibition which compromised the return to sport at the same level until 12 post-operative months