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See detailActualités thérapeutiques dans la prise en charge des tendinopathies
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; Forthomme, Bénédicte ULg et al

in Annals of Physical and Rehabilitation Medicine (2013, October), 56(Sup 1), 050-003

“Conventional” treatments of tendinopathies are generally employed empirically to fight pain and inflammation but they do not modify the histological structure of the tendon. However, these treatments are ... [more ▼]

“Conventional” treatments of tendinopathies are generally employed empirically to fight pain and inflammation but they do not modify the histological structure of the tendon. However, these treatments are not completely satisfactory and the recurrence of symptoms is common. In contrast to the passive pattern of many therapies dedicated to tendon disorders, some authors have promoted an eccentric training mode. Such active eccentric training programs are aimed at thwarting an aetiopathogenic theory proposing insufficient tensile strength of the tendon exposed to external loads which could progressively damage it. Though the literature remains incomplete on tendon architecture remodelling and real histological adaptations following an adapted eccentric training, clinical results following such therapy appear promising. Due to its noninvasiveness, low complication rate and high applicability combined with good results, extracorporeal shock wave therapy has become a well known option within the therapeutic spectrum for many tendinopathies. More specifically, it has been successfully applied in chronic tendinopathy resistant to a conservative training program including eccentric exercises. Platelets release different cytokines and growth factors that could promote angiogenesis, tissue remodelling (bone, skin etc.), and wound healing. Platelet-rich plasma (PRP) is obtained by centrifuging autologous blood to have a high concentration of platelets depending on the isolation method. For this reason, different PRP preparation techniques cannot provide a consistently identical final product, but there is currently no international consensus on this issue. Despite the proven efficacy of PRP tissue regeneration in labs, there is currently little tangible clinical evidence for chronic tendon disorders. The few studies that have been performed appear unlikely to be comparable. Up to now, randomised controlled studies with appropriate placebo groups are needed to determine the real effectiveness of PRP for treating chronic tendon conditions. However, this therapeutic option remains very popular in sports, and many top athletes are using it in case of musculoskeletal conditions. What is more, it has been removed from the doping lost of the World AntiDoping Agency. Other new therapeutic options (infiltrations of polidocanol, hyaluronic acid, botulinum toxin, patches of derivatives Nitro...) for treating tendinopathies are also discussed in this review. [less ▲]

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See detailRéaction inflammatoire exubérante comme effet secondaire d’une infiltration de PRP
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; LEONARD, Philippe ULg et al

in Annals of Physical and Rehabilitation Medicine (2013, October), 56(Sup 1), 068

Introduction : Infiltrations of plasma rich platelets (PRP) represent a new treatment of tendinopathies. Currently, no side effects were reported in this indication. Case report: We report the case of a ... [more ▼]

Introduction : Infiltrations of plasma rich platelets (PRP) represent a new treatment of tendinopathies. Currently, no side effects were reported in this indication. Case report: We report the case of a 35-year-old type 1 diabetic patient with right upper patellar tendinopathy that had persisted for more than 6 months. The patient benefited from an intratendinous infiltration of 6 mL of PRP (8.105 platelets/mm3, almost no red or white blood cells) after a carefully disinfection but without local anesthesia. Typically, a standardized program of sub-maximal eccentric rehabilitation should be started 1 week after infiltration. However, the patient experienced local swelling with erythema, increased heating and pain, which appeared just underneath the patella, without biological inflammatory syndrome. In absence of septic general symptoms, no blood or wound culture were made. At 2 weeks post-infiltration, a greatly increased Doppler signal in a thicker tendon was observed by ultrasounds compared to that before infiltration, but there was no sign of infection demonstrated by either MRI or CT. However, the local inflammation did not decrease after a 3-week treatment of local cryotherapy, local and oral NSAID, and adjunct use of colchicine 1 mg. Thus, an insidious infection was suspected, even though there was no evidence of biological inflammatory syndrome or sign of infectious lesion on imagery examination. Antibiotic therapy (rifampicine 600 mg + minocycline 100 mg), was initiated for three months. Due to a lack of improvement via imaging and clinical examination, a 3-phase bone scintigraphy was performed. The results suggested the presence of a complex regional pain syndrome type 1. The patient benefited from classical physical therapy and concomitant pain killers. The evolution was favorable after 6 months of treatment. Discussion : Even though PRP infiltration represents a new and promising treatment for tendinopathy, more studies are needed both to verify its clinical efficacy. Moreover, implementing this innovative treatment requires caution because of potential adverse events. Thus, the balance between benefits and risks must be carefully evaluated before using this treatment, especially in patients with type 1 diabetes. [less ▲]

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See detailUne infiltration de plasma riche en plaquettes (PRP) pour traiter les tendinopathies rotuliennes supérieures chroniques
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; Bruyère, Olivier ULg et al

in Annals of Physical and Rehabilitation Medicine (2013, October), 56(Sup 1),

Objective: Jumper’s knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons ... [more ▼]

Objective: Jumper’s knee is a frequent chronic overuse syndrome of the upper part of the patellar tendon. Platelets contain lots of growth factors which could enhance the healing process of tendons. Infiltration of platelet-rich plasma (PRP) could be a new therapy for such chronic tendinopathies. Materiel and methods: Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments were made before infiltration of PRP, and 6 weeks and 3 months after the infiltration, using a 10-point Visual Analogic Scale, clinical examinations with a pressure algometer, algofunctional scores (IKDC and VISA-P), functional assessments (isokinetic and optojump evaluations) and imagery (ultrasounds and MRI). The PRP was obtained with an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a standardised sub-maximal eccentric reeducation. Results: Pain during daily activities significantly decreased with time (especially after 6 weeks and continued to a lesser extend up to 3 months). During functional evaluation, it decreased as well, but without significant functional improvement. No improvements in the imagery measurements were observed. Younger patients seemed to be more susceptible to have an improvement of pain by the PRP infiltration. Discussion: This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol is efficient to improve symptoms of chronic jumper’s knee in patients non-responsive to classical conservative treatments. [less ▲]

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See detailProteomic study of lumbar spinal cord after quadricipital eccentric exercise
Lacrosse, Zoé ULg; Hody, Stéphanie ULg; Leprince, Pierre ULg et al

Poster (2013, September 12)

Eccentric muscle contractions are characterized by an increase of muscle tension as it lengthens (slowering movements). Unaccustomed or intense eccentric exercise causes “Delayed-Onset Muscle Soreness” ... [more ▼]

Eccentric muscle contractions are characterized by an increase of muscle tension as it lengthens (slowering movements). Unaccustomed or intense eccentric exercise causes “Delayed-Onset Muscle Soreness” (DOMS). DOMS include muscle pain that appears 24 to 72 hours after exercise, but also stiffness, edema and muscle proteins release in plasma as a hallmark of muscle fibers injuries. The only systematic intervention that brings a muscle protection against DOMS is to realize submaximal eccentric contractions with a progressively increased intensity. The mechanism of this protection, called the “Repeated Bout Effect” (RBE), is not understood. However, it is likely explained by cellular, mechanical and neural theories [Scand.J.Med.&Sci.Sports, 13, 88, 2003]. The objective of this study is to better understand which neural signal is released in the muscle synapse and which brings protection by RBE. Male adult mice (C57BL6) were randomly divided into downhill running (DHR), uphill running (UHR) and untrained control (CONT) groups (n=4/group). DHR group is characterized by eccentric contractions of the quadriceps while UHR is concerned by concentric contractions. Running groups performed a warm-up of ten minutes followed by an interval exercise on an inclined treadmill at a velocity of 20cm/s. The latter consisted of running 18 bouts of 5 minutes interspersed with a 2 minutes rest. Lumbar spinal cord was dissected 24h after the race. Nuclear and cytoplasmic proteins were separately extracted and subjected to a 2D-DIGE analysis coupled with mass spectrometry. We do not observe any cytoplasmic protein modification while in the nuclear extract, seven spots were more abundant in eccentric group and four in concentric group in comparison with control group. The mass spectrometry of these proteins reveals that they are implicated in axoplasmic transport. At 24 hours, too few proteins modifications were detected in lumbar spinal cord, maybe as a consequence of a too short period between race and euthanasia. Implication of axoplasmic transport comforts our starting hypothesis that nervous system is able to protect muscle during the RBE by a synthesis and then a synaptic release of molecules modifying the muscle physiology. [less ▲]

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See detailShoulder and handball
Gleizes Cervera, S.; Croisier, Jean-Louis ULg; Kaux, Jean-François ULg et al

in European Journal of Sports Medicine (2013, September), 1(1),

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See detailProteomic study of lumbar spinal cord after quadricipital eccentric exercise
Lacrosse, Zoé ULg; Lacrosse, Zoé ULg; Hody, Stéphanie ULg et al

in 17th EURON PhD meeting (2013, September)

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See detailThe susceptibility of the knee extensors to eccentric exercise-induced muscle damage is not affected by leg dominance but by exercise order .
Hody, Stéphanie ULg; Rogister, Bernard ULg; Leprince, Pierre ULg et al

in Clinical Physiology & Functional Imaging (2013), 33(5), 373-380

The aims of this study were first to compare the response of dominant and non-dominant legs to eccentric exercise and second, to examine whether there is an effect of exercise order on the magnitude of ... [more ▼]

The aims of this study were first to compare the response of dominant and non-dominant legs to eccentric exercise and second, to examine whether there is an effect of exercise order on the magnitude of symptoms associated with intense eccentric protocols. Eighteen young men performed 3 sets of 30 maximal eccentric isokinetic (60°.sec-1) contractions of the knee extensors (range of motion, ROM: 0°-100°, 0=full extension) using either dominant or nondominant leg. They repeated a similar eccentric bout using the contralateral leg six weeks later. The sequence of leg’s use was allocated to create equally balanced groups. Four indirect markers of muscle damage including subjective pain intensity, maximal isometric strength, muscle stiffness and plasma CK activity were measured before and 24 hours after exercise. All markers changed significantly following the eccentric bout performed either by dominant or non-dominant legs but no significant difference was observed between legs. Interestingly, the comparison between the first and second eccentric bouts revealed that muscle soreness (-42%, p<0.001), CK activity (-62%, p<0.05) and strength loss (-54%, p<0.01) were significantly lower after the second bout. This study suggests that leg dominance does not influence the magnitude of exercise-induced muscle damage and supports for the first time the existence of a contralateral protection against exercise-induced muscle damage in the lower limbs. [less ▲]

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See detailPhysiological interpretation of the slope during an isokinetic fatigue test of the knee
Bosquet, L.; Gouadec, K.; Berryman, N. et al

in European Journal of Sports Medicine (2013, September), 1(1), 151

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See detailEffect of the lengthening of the protocol on the reliability of knee muscle fatigue indicators
Bosquet, L.; Maquet, Didier ULg; Forthomme, Bénédicte ULg et al

in European Journal of Sports Medicine (2013, September), 1(1), 150

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See detailCritères de retour sur le terrain après plastie LCA chez le footballeur professionnel
Croisier, Jean-Louis ULg; Rochcongar, Pierre; Bruyère, Olivier ULg et al

in European Journal of Sports Medicine (2013, September), 1(1),

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See detailRéaction inflammatoire exubérante suite à une infiltration de PRP
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; LEONARD, Philippe ULg et al

in European Journal of Sports Medicine (2013, September), 1(Supplement 1), 278-279

Background: PRP, obtained from centrifuged autologous blood, contains a large quantity of growth factors, which may enhance the tissue healing processes. Local infiltration of PRP represents a relatively ... [more ▼]

Background: PRP, obtained from centrifuged autologous blood, contains a large quantity of growth factors, which may enhance the tissue healing processes. Local infiltration of PRP represents a relatively new treatment for tendinopathies. To date, no side effects have been reported after infiltration of PRP to treat tendinopathy. Case report: A 35-year-old patient had a right upper patellar tendinopathy which was resistant to all conservative treatments for more than 6 months. The patient was a type 1 diabetic (well controlled). He had an intratendinous infiltration of 6 mL of PRP (8.105 platelets/mm3, almost no red or white blood cells) after disinfection but without local anaesthetic. Immediately following the infiltration, local cryotherapy was performed for 15 minutes. NSAIDs were avoided, but class-1 or -2 pain-killers were authorised if necessary. A standardised sub-maximal eccentric rehabilitation should have been started 1 week after. However, the patient experienced local swelling with erythema, increased heating and pain which appeared just underneath the patella, but without biological inflammatory syndrome. A great Doppler signal in a thicker patellar tendon was observed by US, but there was no sign of local infectious disease demonstrated by either CT or MRI. However, the local inflammation did not decrease after a progressive 3-week treatment of local cryotherapy, local and oral NSAIDs and colchicine 1 mg. Thus, an insidious infection was suspected, even though there was neither evidence of biological inflammatory syndrome nor sign of infectious lesion on imagery examination. An antibiotic therapy (rifampicine 600 mg + minocycline 100 mg) was initiated for 3 months. Finally, a 3-phase bone scintigraphy suggested the presence of a complex regional pain syndrome type 1 treated by a classical physical therapy and concomitant class-2 pain killers. The evolution was favourable after 6 months of symptomatic treatment, and the pain decreased to a level similar to that before the infiltration of PRP. Discussion/Conclusions: This case report draws attention to potential side effects that are linked to this new therapy by infiltration of platelet rich plasma in case of tendinopathy, in particular when used in patients with type 1 diabetes. Thus, the balance between benefits and risks must be carefully evaluated before using this treatment in patients with type 1 diabetes. [less ▲]

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See detailHazard factors of ACL rupture: Neuromuscular factors
Kaux, Jean-François ULg; Delvaux, François ULg; MASSART, Nicolas ULg et al

in European Journal of Sports Medicine (2013, September), 1(supplement 1), 50-51

Injuries to the anterior cruciate ligament (ACL) of the knee are disabling, often associated with other intra-articular damages and increase the risk of early onset of osteoarthritis. It is very probable ... [more ▼]

Injuries to the anterior cruciate ligament (ACL) of the knee are disabling, often associated with other intra-articular damages and increase the risk of early onset of osteoarthritis. It is very probable that multiple risk factors act in combination to influence injury risk. It is important to have a comprehensive understanding of these ACL risk factors, whose neuromuscular factors, even if investigations on neuromuscular factors reported to date do not provide a complete understanding of ACL injury risk. According to several recent studies, the neuromuscular control of joint biomechanics during a specific activity seems to represent a predicting factor of an ACL injury, by quantifying the intersegmental forces and moments generated about the tibio-femoral joint. Laboratory studies have shown that landing from a jump performs cutting and pivoting maneuvers with less knee and hip flexion, increases knee valgus and internal rotation of the hip coupled, with increased external rotation of the tibia and quadriceps muscle activation (especially in women). It has been hypothesized that these movement patterns increase the strain in the ACL during activity and that the large difference in knee injury incidence rates between males and females (1/4.5) may be attributed to neuromuscular differences and resultant mechanics. Although studies have shown that the position of the knee and the magnitude and sequence of muscle contraction can increase ACL strain values, it is hard to exactly correlate these movements to what occurs during activity and sport and at the time of ACL injury. Recently, a simpler assessment tool has been validated and is able to be administered in a clinic-based testing environment Consequently, the screening for ACL injury risk could be performed on a more widespread population. Athletes who went on to a primary ACL injury also demonstrated significant side to side differences in lower extremity biomechanics as well as reduced relative lower extremity flexor activation relative to an uninjured control population during the vertical drop jump. Similar mechanisms of injury risk have been identified in athletes medically cleared to return to sport after ACL reconstruction. These seminal findings indicate that these abnormal and asymmetrical biomechanical and neuromuscular control profiles are likely both residual to, and exacerbated by, the initial injury. A study revealed that a fatigue-induced protocol altered the latency as well as the magnitude of reflex responses of the hamstring muscles and the tibial translation only in women. The authors of various studies have suggested that the hamstring muscles play an important role in maintaining knee stability and that they protect the ACL during movements of the tibia relative to the femur. Therefore, decreased reflex responses of the hamstring muscles and in turn an increased the tibial translation might contribute to the pathomechanics of the ACL injuries. It is therefore conceivable that the fatigue-induced decrease of the hamstring neuromuscular function may increase the tibial translation and probably contributes to the higher incidence of ACL injuries, especially in women. A preventive approach to decrease ACL injuries could integrate muscle imbalances as a risk factor. If it has been scientifically validated than the muscle strength profile determined by an isokinetic testing offers a predictive value on the hamstring lesion occurrence, similar studies have not permitted such a conclusion about ACL injury. The isokinetic assessments after ACL reconstruction have allowed us to observe, on the healthy contralateral knee, a higher frequency of reduced hamstring/quadriceps ratios. A possible pre-existing weakness in the hamstring and the occurrence of an ACL injury is therefore possible but only a difficult prospective approach due to the multifactorial nature of ligament injuries could clarify that point. In conclusion, a functional analysis of the landing of a jump and an isokinetic muscle strength assessment have been suggested to represent predictive elements of an ACL rupture, but further studies are needed to have a stronger evidence of their predictive qualities of injury. [less ▲]

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See detailReference populations for shoulder studies should be selected carefully
Schwartz, Cédric ULg; Denoël, Vincent ULg; Bruls, Olivier ULg et al

Conference (2013, August 06)

To assess various shoulder pathologies / treatments, non pathological populations are often used as references. However, some factors may influence significantly the scapular kinematics within a healthy ... [more ▼]

To assess various shoulder pathologies / treatments, non pathological populations are often used as references. However, some factors may influence significantly the scapular kinematics within a healthy population and consequently alter the final kinematic evaluation. Results of 3D shoulder assessment found in this study show that small (≈5°) but significant differences exist between gender and between the dominant and non-dominant arms. Therefore the populations used for referential data should be selected carefully. [less ▲]

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See detailEccentric rehabilitation for elbow hypermobility
Kaux, Jean-François ULg; Forthomme, Bénédicte ULg; FOIDART, Marguerite ULg et al

in Journal of Novel Physiotherapies (2013), 3(6), 1805

Introduction: Joint hypermobility involves an increased range of motion compared to normal amplitudes for the same age, sex and ethnic group. Patients with hypermobility suffer from joints problems and ... [more ▼]

Introduction: Joint hypermobility involves an increased range of motion compared to normal amplitudes for the same age, sex and ethnic group. Patients with hypermobility suffer from joints problems and chronic pain is the most frequently reported symptom. Eccentric muscle strengthening could be very important to protect hypermobile joints. Case report: An Ehler-Danlos syndrome patient presented pain in the right elbow and the right wrist after a season of tennis. Her physiotherapy (18 sessions, 3 times a week) consisted of wrist prono-supination and flexion-extension muscle group reinforcement and proprioceptive training. To protect the wrist against excessive load, the eccentric strengthening exercises of prono-supinator and flexor-extensor muscles of elbow and wrist were undertaken gradually, at increasing speeds [30°/s, 60°/s, and 90°/s] within a limited range of motion in flexion and extension, on an isokinetic device after an evaluation. She was also given an ortheosis restricting the joint range of motion of the wrist. The patient rapidly noted a decrease in pain and an increase in the stability of her right arm even when playing tennis. Isokinetic evaluation objectified an improvement in maximal torque of 20 to 25% in flexion-extension muscles of the right elbow. She was also given individualized home exercises. Conclusion: The goal of rehabilitation is to avoid hypermobility by using the muscles as a protective brake in the control of joint positioning. Muscles can be reinforced in eccentric mode with starting position at the maximum length of these muscles when unstreched. The exercises can be carried out safely on an isokinetic device, at slow speed and limited range of joint motion to avoid risk of luxation. Thus, in this case report, the eccentric exercises using an isokinetic device were effective to safely reinforce the muscles as a protective brake for joint hypermobility. [less ▲]

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See detailEffects of eccentrically and concentrically biased training on mouse muscle phenotype
Hody, Stéphanie ULg; Lacrosse, Zoé ULg; Leprince, Pierre ULg et al

in Medicine & Science in Sports & Exercise (2013), 45(8), 1460-1468

Introduction: The molecular adaptations specifically induced by different muscle contraction types have only been partially elucidated. We previously demonstrated that eccentric contractions in human ... [more ▼]

Introduction: The molecular adaptations specifically induced by different muscle contraction types have only been partially elucidated. We previously demonstrated that eccentric contractions in human quadriceps elicited proteome modifications that suggest a muscle fiber typology adaptation. We address this question in a more systematic way by examining here the effects of different running modes on the mouse muscle proteome and the muscle fiber typology. Methods: Male adult mice (C57BL6) were randomly divided into downhill running (DHR, quadricipital eccentrically biased contractions), uphill running (UHR, quadricipital concentrically biased contractions) and untrained control (CONT) groups. Running groups performed five training sessions on an inclined treadmill for 75 to 135 min/day and the quadriceps muscles were dissected 96hours after the last session. Muscle protein extracts of DHR and UHR groups (n=4/group) were subjected to a 2D-DIGE analysis coupled with mass spectrometry. The assessment of fiber type, size and number was performed on the rectus femoris of the three groups (n=6/group) using myosin heavy chain (MHC) immunohistochemistry. Results: In the proteomic analysis, eight spots identified as the fast MHC isoforms exhibited a lower abundance in DHR compared to UHR (p<0.05, t-test). In contrast, ATP synthase subunit α and tubulin β were more expressed in DHR (p<0.05). A significant higher proportion of type I and IIa fibers was found for DHR compared to UHR or CONT groups (p<0.05, one-way ANOVA). Conclusions: Our data suggest that the eccentrically biased contractions in mice induced specific adaptations in protein expression and muscle fiber composition which may reflect a more oxidative muscle phenotype. The differences in stress placed on the muscle between both trainings may be responsible for some unique adaptations resulting from the eccentrically biased training. [less ▲]

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See detailMuscle fatigue experienced during maximal eccentric exercise is predictive of the plasma creatine kinase (CK) response
Hody, Stéphanie ULg; Rogister, Bernard ULg; Leprince, Pierre ULg et al

in Scandinavian Journal of Medicine & Science in Sports (2013), 23(4), 501-7

Unaccustomed eccentric exercise may cause skeletal muscle damage with an increase in plasma creatine kinase (CK) activity. Although the wide variability among individuals in CK response to standardized ... [more ▼]

Unaccustomed eccentric exercise may cause skeletal muscle damage with an increase in plasma creatine kinase (CK) activity. Although the wide variability among individuals in CK response to standardized lengthening contractions has been well described, the reasons underlying this phenomenon have not yet been understood. Therefore, this study investigated a possible correlation of the changes in muscle damage indirect markers after an eccentric exercise with the decline in muscle performance during the exercise. Twenty-seven healthy untrained male subjects performed three sets of 30 maximal isokinetic eccentric contractions of the knee extensors. The muscular work was recorded using an isokinetic dynamometer to assess muscle fatigue by means of various fatigue indices. Plasma CK activity, muscle soreness, and stiffness were measured before (pre) and one day after (post) exercise. The eccentric exercise bout induced significant changes of the three muscle damage indirect markers. Large intersubject variability was observed for all criteria measured. More interestingly, the log (CKpost/CKpre) and muscle stiffness appeared to be closely correlated with the relative work decrease (r = 0.84, r2 = 0.70 and r = 0.75, r2 = 0.56, respectively). This is the first study to propose that the muscle fatigue profile during maximal eccentric protocol could predict the magnitude of the symptoms associated with muscle damage in humans. [less ▲]

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See detailPlatelet-rich plasma (PRP) to treat chronic upper patellar tendinopathies
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; Bruyère, Olivier ULg et al

in British Journal of Sports Medicine (2013, July), 47(10 (e3)), 15

Background: Upper patellar tendinopathies remain often chronic and rebel to a thorough conservative treatment. Moreover, the option of a surgical treatment could be disappointing. New treatments are being ... [more ▼]

Background: Upper patellar tendinopathies remain often chronic and rebel to a thorough conservative treatment. Moreover, the option of a surgical treatment could be disappointing. New treatments are being developed. Injection of PRP is one of these. Platelets contain lot of growth factors which would have the potentiality to enhance the healing process of tendons. Even if in vitro and animal experiments have demonstrated this stimulation of tendon healing process1, clinical series are subject to controversy2. Methods: Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments [VAS, clinical examination with an algometer, algofunctional scores (IKDC and VISA-P), functional assessments (isokinetic and Optojump) and imagery (ultrasounds and MRI)]were made before infiltration of PRP, and 6 weeks and 3 months after. The PRP was obtained by an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a 6-week standardised sub-maximal eccentric reeducation. Results: We observed a very significant improvement of the algofunctional status as soon as 6 weeks after the infiltration of PRP, and continued to a lesser extent up to 3 months. During functional evaluation, pain decreased as well, but without significant improvement of performances. No significant improvements in the imagery were observed. Interestingly, patients who had a VAS equal or below 1 after 3 months post-infiltration were younger (24.7 vs 32.2 y.o.). Moreover, these younger patients had a significant increase of the IKDC score (p=0.003), a significant improvement of pain during isokinetic evaluations (p<0.05), and during Optojump assessments (p=0.01). Seventy-five percent of subjects were able to return to sport, even if only half of these patients recovered the same level than before the tendinopathy. Discussion / Conclusions: This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol is efficient to improve symptoms of chronic upper patellar tendinopathies, non-responsive to classical conservative treatments. However, up to now, there is no consensus on the method to prepare the PRP. Indeed, each technique could provide a very different PRP (variations in the platelet concentrations and of the amount of red and white cells). [less ▲]

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See detailIsocinétisme : aspects spécifiques chez le sportif
Croisier, Jean-Louis ULg; Delvaux, François ULg; Kaux, Jean-François ULg et al

in Abstract Book de la 1ère Journée de Rééducation de l'INSEP (2013, June)

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See detailThe risk factors for the rupture of the anterior cruciate ligament of the knee: the neuromuscular state
Kaux, Jean-François ULg; Delvaux, François ULg; Forthomme, Bénédicte ULg et al

in OA Sports Medicine (2013), 1(1), 95

Multiple factors act conjointly to influence the risk of injury of the anterior cruciate ligament of the knee. An understanding of neuromuscular factors remains necessary, although this does not guarantee ... [more ▼]

Multiple factors act conjointly to influence the risk of injury of the anterior cruciate ligament of the knee. An understanding of neuromuscular factors remains necessary, although this does not guarantee a complete analysis of the risks of injury to the anterior cruciate ligament. Women have a greater risk of injury to the anterior cruciate ligament in comparison to men. This can be explained by an increase in the internal rotation of the hip, coupled with an increase in the external rotation of the tibia and increased muscular activation of the quadriceps (with a concomitant decrease in hamstring activity) during landing or pivotal movements. In addition, muscular fatigue of the hamstrings and a weak hamstring/quadriceps ratio could contribute to the risk of injury to the anterior cruciate ligament. Finally, a lack of relative joint laxity can also constitute a risk factor of injury to the anterior cruciate ligament in women. Other potential neuromuscular risk factors could also be highlighted. Screening for these risk factors, for example, by means of a functional jump-landing test, together with an isokinetic test, could help to recommend new prevention protocols. The aim of this review was to discuss the risk factors for the rupture of the anterior cruciate ligament of the knee. In conclusion, thanks to an overall knowledge of all the possible risk factors (intrinsic and extrinsic, modifiable or not), sports people who are predisposed to a recurrence of rupture of the anterior cruciate ligament could be identified. However, the hypothetical neuromuscular factors reported till date (Table 1) do not offer a complete understanding of this risk. [less ▲]

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See detailExuberant inflammatory reaction after an infiltration of platelet-rich plasma to treat tendinopathy
Kaux, Jean-François ULg; Croisier, Jean-Louis ULg; LEONARD, Philippe ULg et al

in Book of abstracts of 18th Annual Congress of the ECSS (2013, June)

Background: PRP, obtained from centrifuged autologous blood, contains a large quantity of growth factors, which may enhance the tissue healing processes. Local infiltration of PRP represents a relatively ... [more ▼]

Background: PRP, obtained from centrifuged autologous blood, contains a large quantity of growth factors, which may enhance the tissue healing processes. Local infiltration of PRP represents a relatively new treatment for tendinopathies. To date, no side effects have been reported after infiltration of PRP to treat tendinopathy. Case report: A 35-year-old patient had a right upper patellar tendinopathy which was resistant to all conservative treatments for more than 6 months. The patient was a type 1 diabetic (well controlled). He had an intratendinous infiltration of 6 mL of PRP (8.105 platelets/mm3, almost no red or white blood cells) after disinfection but without local anaesthetic. Immediately following the infiltration, local cryotherapy was performed for 15 minutes. NSAIDs were avoided, but class-1 or -2 pain-killers were authorised if necessary. A standardised sub-maximal eccentric rehabilitation should have been started 1 week after. However, the patient experienced local swelling with erythema, increased heating and pain which appeared just underneath the patella, but without biological inflammatory syndrome. A great Doppler signal in a thicker patellar tendon was observed by US, but there was no sign of local infectious disease demonstrated by either CT or MRI. However, the local inflammation did not decrease after a progressive 3-week treatment of local cryotherapy, local and oral NSAIDs and colchicine 1 mg. Thus, an insidious infection was suspected, even though there was neither evidence of biological inflammatory syndrome nor sign of infectious lesion on imagery examination. An antibiotic therapy (rifampicine 600 mg + minocycline 100 mg) was initiated for 3 months. Finally, a 3-phase bone scintigraphy suggested the presence of a complex regional pain syndrome type 1 treated by a classical physical therapy and concomitant class-2 pain killers. The evolution was favourable after 6 months of symptomatic treatment, and the pain decreased to a level similar to that before the infiltration of PRP. Discussion/Conclusions: This case report draws attention to potential side effects that are linked to this new therapy by infiltration of platelet rich plasma in case of tendinopathy, in particular when used in patients with type 1 diabetes. Thus, the balance between benefits and risks must be carefully evaluated before using this treatment in patients with type 1 diabetes. Reference: Platelet-rich plasma application in the management of chronic tendinopathies. Acta Orthop Belg 2013; 79: 10-15. [less ▲]

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