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See detailPhysiopathologie des tendinopathies
Kaux, Jean-François ULiege

Conference (2017, May 28)

Le tendon, tissu conjonctif fibreux, mécaniquement responsable de la transmission de la force des muscles vers les os, constitue une entitédynamique qui, en fonction des contraintes, se restructure en ... [more ▼]

Le tendon, tissu conjonctif fibreux, mécaniquement responsable de la transmission de la force des muscles vers les os, constitue une entitédynamique qui, en fonction des contraintes, se restructure en permanence et, ce, grâce à diverses modifications métaboliques et mécaniques. Cetterevue décrit l’histologie, la vascularisation et l’innervation du tendon sain. De plus, la biomécanique et les réponses physiologiques tendineuses,ainsi que la physiopathologie de la tendinopathie y sont abordées. [less ▲]

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See detailHow to manage a case of ischial tuberosity avulsion fracture?
Tyberghein, Maëlle; Kaux, Jean-François ULiege; GODON, Bernard ULiege et al

in The Future of Football Medicine (2017, May)

Introduction Apophyseal avulsion fractures of the pelvis are common among teenage football player. Usually, they are the result of a sudden forceful concentric or eccentric contraction of the muscle ... [more ▼]

Introduction Apophyseal avulsion fractures of the pelvis are common among teenage football player. Usually, they are the result of a sudden forceful concentric or eccentric contraction of the muscle attached to the apophysis. Indeed, before ossification, the apophyseal growth cartilage is the weakest point in the musculotendinous unit, making the apophysis vulnerable to injure. Athletes most commonly affected are soccer players when they tackle or shot powerful at goal and gymnasts during floor exercises which imposed sudden and excessive lengthening. Management of these fractures remains unclear. There are no guidelines between conservative and surgical approach even if most publications recommend a surgery if the diastasis exceeds 2cm and a conservative approach on the other hand. Case report A sixteen-year-old high-level player presented at the consultation with right ischial pain. Three months earlier, while he was sprinting, he had felt acute pain opposite the ischial tuberosity which compelled him to stop the training. He had already consulted another physician, who prescribed an X-ray which revealed an avulsion fracture of the ischial tuberosity with a maximal diastasis of 1.9 cm (Fig 1.a.). According to most publications (1,3), surgery is advisable from 2 cm of diastasis. 1.9 cm was within the range between a surgical and a conservative approach, and the conservative one was applied. An isokinetic assessment was planned. It highlighted hamstring strength imbalances with bilateral difference of 31% in concentric strength and 28% in eccentric strength in comparison with the healthy side. The mixed ratio of the hamstrings in eccentric mode at 30°/s to quadriceps in concentric mode at 240°/s was decreased to 0.8, while the lower limit in our clinical practice corresponded to 0.9. The patient was not allowed to resume competition and a rehabilitation by specific and progressive strengthening in both modes of contraction was initiated; in particular the eccentric training was initially submaximal and progressively intensified. Six weeks later, isokinetic assessment was repeated and showed significant improvement of right hamstring strength, particularly for eccentric contraction. The greatest improvement was the mixed Hecc/Qconc ratio wich had increased from 0.8 to 1.44. In regard to radiology, we observed no change since the previous X-Ray (Fig 1.b.). Intensified training on the field was allowed in order to resume competition. Less than one year after the injury, the patient restarted competition successfully with performance levels which were almost the same as before the injury. Discussion Many publications have discussed the surgical versus the conservative approach to treating ischiatic avulsion. Most of the published literature advocate the relevance of surgery when the diastasis exceeds 2 cm because widely displaced fractures may lead to chronic symptomatology if the treatment remains conservative. Different criteria, such as pain relief, ability to perform in sport, gross strength, activity score, X-Rays, are used by authors to demonstrate the recovery after treatment. No study accurately measured the hamstring strength before and after treatment. However, strength imbalance, especially as regards the H/Q mixed ratio, significantly increases the risk of sustaining hamstring injury in soccer player (2). For our patient, the rehabilitation enabled him to re-establish hamstring strength in six weeks with substantial improvement of eccentric assessment. The mixed Hecc/Qconc ratio increased from 0.8 to 1.44. This improvement significantly decreased the risk of recurrence of hamstring injury. Regarding X-Ray imagery, there was no evidence of healing. We advocate that radiological assessment should not be the main recovery criterion and that specific strengthening should be started even when avulsion persists on the X-Ray. Furthermore, hamstring strength should be measured accurately and objectively, e.g. by isokinetism, to be one of the main return to play criterion in association with clinical data. [less ▲]

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See detailImpact on athletic performance of an early return to play following an ACL rupture
Duval, Thomas; LEHANCE, Cédric ULiege; DANIEL, Christophe ULiege et al

in The Future of Football Medicine (2017, May)

Introduction and purpose: The rupture of the anterior cross ligament (ACL) is the most frequent knee injury incurred during participation in sports and especially in football. Typically, the injured ... [more ▼]

Introduction and purpose: The rupture of the anterior cross ligament (ACL) is the most frequent knee injury incurred during participation in sports and especially in football. Typically, the injured athlete must undergo a surgical reconstruction of the ligaments followed by a lengthy rehabilitation period. However, the timeline for return to competition after this operation remains a challenge. More than one third of the athletes are unable to go back to sport performing at the same level prior to the injury. Approximately 65% of patients who experience this injury are able to return to sport at the same level. The fear of undergoing a new accident remains a major hurdle with this sporting recovery and the persistence of functional deficits is the first cause of repetitive ligament injuries. A reathletization program guided by strength and conditioning coaches results in a greatly reduces the risk of recurring injury by approximately 66% Methods: Our study involved a randomized control test. Our sample included ten subjects, five in the experimental group and five in the control group. Beginning one month post-surgery, the first group participated in weekly reathletization session beginning one week post-operation, associated with rehabilitation in classical physiotherapy, over a period of six months. The second participated solely in standard physiotherapy. Both groups were subjected to an initial isokinetic test as a base measurement to track improvement. After six months, the subjects of the two groups were evaluated using the following tools: an isokinetic test, a questionnaire of KOOS and finally a Hop tests. Results: The analysis of the isokinetic test and the questionnaire of KOOS ( p= 0.30) enabled us to note differences between the two groups using quantified values; however, the results were significant. On the other hand, the analysis of the results obtained through the functional tests showed significant differences between the two groups, highlighting the increased performance and benefit for the group participating in weekly reathletization. The experimental group displayed results in the three jump tests which indicates a greater strength and recovery. For the single hop test and the triple hop, the result is p = 0.04, and for the cross over test, the result is p = 0.02. Conclusion: In our preliminary study, the quantified values for both groups indicated a greater improvement in the performances of the experimental group reathletization. Although during the statistical analysis and especially in the isokinetic test, few elements significantly evolved to see any for the questionnaire KOOS. The preliminary analysis warrants an experiment involving a larger subject pool be completed. A reathletisation program beginning one month after operation has been found to limit the nuisances and long period of inactivities (weight increase, losses of muscular force, decrease of aerobic performances) typically experienced by those who rupture the ACL. This program has been found to be especially effective when coupled with regular physiotherapy meetings. [less ▲]

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See detailIsokinetic profil of subjects with proximal patellar tendinopathy
Croisier, Jean-Louis ULiege; Roberjot, Mathieu; DELVAUX, François ULiege et al

in The Future of Football Medicine (2017, May)

Introduction: Proximal patellar tendinopathy is relatively common among sportsmen, even among football players who do repetitive shooting sessions. However, the strength profile of subjects with proximal ... [more ▼]

Introduction: Proximal patellar tendinopathy is relatively common among sportsmen, even among football players who do repetitive shooting sessions. However, the strength profile of subjects with proximal patellar tendinopathies is rarely described and the isokinetic profile remains unknown. Purpose: We aimed to determine the strength profile of subjects suffering from this frequently recurrent pathology. Methods: Forty-three players (29,1±8.5 y.o.; 78.1±11.9kg; 179.3±7.2cm) with chronic proximal patellar tendinopathy confirmed by ultrasounds were recruited. Quadriceps and hamstrings muscular performances of the healthy and pathological side were measured using an isokinetic dynamometer (Cybex Norm) at the concentric speed of 60°/s (C60) and 240°/s (C240) and at the eccentric speed of 30°/s (E30 - only for hamstrings). A visual analogic scale of pain (VAS) has also been used after each isokinetic test in order to associate the level of complaints and the intensity of contractions. Results: The results (Table 1) for the isokinetic tests comparing the healthy (HS) to the pathological side (PS) are significant for the different conditions of contraction and test speeds, as for the results of the VAS associated to those tests (p<0.01). Indeed, pathological limbs had a maximum peak torque for the quadriceps at C60 and at C240 lower than healthy limbs (2.17 ± 0.68 N.m/kg vs 2.47 ± 0.55 N.m/kg, p = 0.0003 and 1.46 ± 0.42 N.m/kg vs. 1.56 ± 0.31 N.m/kg, p = 0.02, respectively); this represents a bilateral difference of 14% for C60 and 7% in C240. In E30, pathological limbs were also weaker than the healthy limbs (2.46 ± 0.91 N.m/kg vs 2.79 ± 0.96 N.m/kg, p = 0.0008) which represents a difference of 13% between healthy and pathological limbs. For the hamstrings of the pathological limbs, we observed a maximum peak torque at C60 and C240 lower than for the hamstrings of the healthy limbs (1.26 ± 0.37 N.m/kg vs. 1.37 ± 0.36 N.m/kg, p = 0.006 and 0.80 ± 0.23 N.m/kg vs 0.85 ± 0.20 N.m/kg, p = 0.04). The bilateral differences of hamstring strength were 8.7% in C60 and 6% in C240. The PS were more painful than the HS (VAS C60: 3.47 ± 2.65 vs 0.20 ± 1.05; p>0.01; VAS C240: 2.83 ± 2.47 vs. 0.68 ± 0.10; p>0.01; VAS E30: 5,26 ± 2.78 vs 0.58 ± 1.93; p>0.01). The difference of pain can be seen especially in eccentric mode. This observation suggest that isokinetic tests, beyond the measure of strength, could represent a pain provocation test, even with a possible pronostic value for the efficacy of treatment. Conclusions: In our study, the isokinetic results of patients with proximal patellar tendinopathy showed a significant difference in strength profile between the HS and the PS as well as VAS associated with each tests. However, the diversity of outcomes recorded in our population suggests that an individualized rehabilitation treatment is probably more relevant than a common protocol for the healing of this tendon pathology. Isokinetic tests can also represent a tool for assessment of treatment planning. Finally, it would seem that isokinetic tests in the eccentric mode on the quadriceps can be a pain assessment tool for the pathological tendon. [less ▲]

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See detailPRTEE et épicondylite
Janssen, Arnaud; Kaux, Jean-François ULiege

in Kinésithérapie du Sport Information (2017), (2ème trimestre 2017), 4-7

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See detailEccentric training for tendon healing after lesion: a rat model
Kaux, Jean-François ULiege; Libertiaux, Vincent ULiege; Leprince, Pierre ULiege et al

in American Journal of Sports Medicine (2017), 45(6), 1440-1446

BACKGROUND:The tendon is a dynamic entity that remodels permanently. Platelet-rich plasma (PRP) injection has been shown to have a beneficial effect on tendon healing after lesion in rats. Furthermore ... [more ▼]

BACKGROUND:The tendon is a dynamic entity that remodels permanently. Platelet-rich plasma (PRP) injection has been shown to have a beneficial effect on tendon healing after lesion in rats. Furthermore, eccentric exercise seems to improve the mechanical quality of the tendon. HYPOTHESIS:A combination of PRP injection and eccentric training might be more effective than either treatment alone. STUDY DESIGN:Controlled laboratory study. METHODS:Adult male rats were anesthetized, an incision was performed in the middle of their left patellar tendon and an injection of physiological fluid (PF) or homologous PRP was randomly made at the lesion level. The rats were then divided into 2 groups: the eccentric group, undergoing eccentric training 3 times a week, and the untrained group, without any training. Thus, 4 groups were compared. After 5 weeks, the tendons were removed and their ultimate tensile strength and energy were measured. Tendons were frozen for proteomic analyses when all biomechanical tests were completed. Statistical analysis was performed with linear mixed effect models. RESULTS:No significant difference was found between the treatments using PF injection or PRP injection alone. However, the value of the ultimate tensile force at rupture was increased by 4.5 N (108% of control, P = .006) when eccentric training was performed. An intragroup analysis revealed that eccentric training significantly improved the ultimate force values for the PRP group. Proteomic analysis revealed that eccentric training led to an increase in abundance of several cytoskeletal proteins in the PF group, while a decrease in abundance of enzymes of the glycolytic pathway occurred in the PRP treated groups, indicating that this treatment might redirect the exercise-driven metabolic plasticity of the tendon. CONCLUSION: Eccentric training altered the metabolic plasticity of tendon and led to an improvement of injured tendon resistance regardless of the treatment injected (PF or PRP). CLINICAL RELEVANCE:This study demonstrates the necessity of eccentric rehabilitation and training in cases of tendon lesion regardless of the treatment carried out. [less ▲]

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See detailPlatelet-rich plasma versus hyaluronic acid to treat patellar tendinopathies
Kaux, Jean-François ULiege; Roberjot, Mathieu; SAMSON, Antoine ULiege

in The Future of Football Medicine (2017, May)

Introduction: The treatment of patellar tendinopathies could be difficult. This is the reason why new treatments have been developed, among which platelet rich plasma (PRP) injections. Some clinical ... [more ▼]

Introduction: The treatment of patellar tendinopathies could be difficult. This is the reason why new treatments have been developed, among which platelet rich plasma (PRP) injections. Some clinical series have previously evaluated the effect of PRP in the treatment of proximal patellar tendinopathies. Recent systematic review concluded that PRP could be recommend as a treatment in such indication (1). Recently, the viscoelastic properties of hyaluronic acid (HA) on liquid connective tissue have been proposed for the treatment of tendinopathies (2). Some fundamental studies show encouraging results on HA’s ability to promote tendon gliding and reduce adhesion as well as to improve tendon architectural organisation. Some observations also support its use in a clinical setting to improve pain and function. Purpose: We aimed to compare the effect of PRP injection versus two injections of HA after three months on patients who have a proximal patellar tendinopathy. Methods: Eleven leisure football players with proximal patellar tendinopathies being not relieved after minimum three months of physiotherapy treatments where included. Six of them (group 1: 29.5±9.9 y.o.; 78.9±12.8kg; 177.4±6;9cm) have received a leukocyte poor PRP injection (obtained using an aphaeresis machine) under US guidance. This technique of PRP collection enable to obtain reproducible pure PRP with the same chosen concentration of 850 000 platelets/microliter. The other five subjects (group 2: 29.3±8.1 y.o.; 77.1±10.6kg; 178.1±5.8cm) received two HA 2% (40mg/2mL) injections (2mL) at one week apart. All of them have benefited of standardized rehabilitation, 3 times a week. Concerning the evaluation of the pathology, algo-functional tests (visual analogic scale (VAS), pressure algometer, IKDC score, VISA-P score), isokinetics (Cybex Norm; concentric 60°/s (C60), concentric 240°/s (C240) and eccentric 30°/s(E30)) associated to VAS, along with the patellar tendon ultrasonography (US) have been realized over three times (pre-injection, after 6 weeks, after 3 months post-injections). Results: The results of VAS (p<0,01), algometric scores (p<0,01), IKDC scores (p<0,01) and VISA-P (p<0,01) show a considerable improvement in the two groups, but not for the US findings. For the group 1 (Table 1), isokinetic tests show significant results for the hamstrings in C60°/s with an improvement of maximum peak torque (p=0,01) for the pathological limb, a diminution (p>0,05) for the healthy limb and during the analysis of the bilateral difference (p=0,0002). For the group 2, the improvement of quadriceps maximum peak torque in C240°/s is significant (p>0,01) for the pathological knee after 6 weeks post-injections only. The VAS associated with isokinetic tests decreases significantly for all contraction modes after three months of study. Conclusions: Both PRP and HA can improve the symptoms of proximal patellar tendinopathy, even if the results are slightly better in the PRP group. [less ▲]

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See detailMotion analysis: a prevention tool
Schwartz, Cédric ULiege; CROISIER, Jean-Louis ULiege; Forthomme, Bénédicte ULiege et al

Conference (2017, April 28)

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See detailQuel « PRP » pour traiter les tendinopathies chroniques ?
Kaux, Jean-François ULiege; Emonds-Alt, Thibault ULiege

in Journal de Traumatologie du Sport (2017), 34(1), 76-90

Plasma rich platelets (PRP) consist of blood plasma with a high concentration of platelets autologous constituting a huge reservoir of growthfactors. The clinical use of the PRP is widespread in various ... [more ▼]

Plasma rich platelets (PRP) consist of blood plasma with a high concentration of platelets autologous constituting a huge reservoir of growthfactors. The clinical use of the PRP is widespread in various medical applications. Even it is very popular with athletes, the use of PRP intendinopathies is still scientifically discussed, particularly related to a disparity in the products called PRP. In order to optimize employment, itshould be interested in the different stages of obtaining of the PRP. In this literature review, we analyzed in particular 8 parameters that can influencethe quality of the PRP: (1) anticoagulants used to preserve the best feature of platelet; (2) centrifuge speeds used in order to extract platelets; (3)platelet concentrations and the presence of leukocytes and erythrocytes in the PRP; (4) the platelet activators for the mast of platelets and thus therelease of growth factors; (5) use of local anesthetics to achieve infiltration, in addition to these parameters, it might be interesting to analyze othervariables like: (6) employment or not of buffer to neutralize the acidity caused by anticoagulants; (7) injection under US guidance or not; and (8)volume of PRP injected to determine their influence on the healing potential. [less ▲]

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See detailImpact of an ultra-marathon of 330km on plasma levels of cardiac biomarkers
Le Goff, Caroline ULiege; Kaux, Jean-François ULiege; Gergelé, Laurent et al

in British Journal of Sports Medicine (2017, February), 51(4), 347

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See detailSelf-Administration of Medicines and Dietary Supplements Among Female Amateur Runners: A Cross-Sectional Analysis.
Locquet, Médéa ULiege; Beaudart, Charlotte ULiege; Larbuisson, Robert ULiege et al

in Advances in Therapy (2017), 33(12), 2257-2268

INTRODUCTION: Self-administration of medicines or dietary supplements without any physician's advice is a widespread behavior and appears to be more frequently practiced by women. Moreover, reasons to ... [more ▼]

INTRODUCTION: Self-administration of medicines or dietary supplements without any physician's advice is a widespread behavior and appears to be more frequently practiced by women. Moreover, reasons to self-administer products are often pains and injuries especially among athletes who might also use remedies to improve physical performance. The objective of this study was thus to assess the prevalence of self-administration of medicines and dietary supplements as well as its determinants among female amateur runners. METHODS: Our sample was comprised of women who took part in amateur running events. Data regarding self-administration of substances, exclusively aiming at being physically prepared for the running event (i.e., intake the week before), were collected through an anonymous self-administered questionnaire including four specific themes (i.e., general information, self-administered medicines and dietary supplements, context of self-administration of substances and knowledge of the anti-doping regulations). RESULTS: A total of 136 women, with a median age of 39 years (interquartile range: 27-47), volunteered. Among them, 34.6% reported self-administration of medicines during the period immediately preceding the running event, with the aim to be physically prepared. More than one third (33.8%) also declared self-administration of dietary supplements. Furthermore, we observed that about 8.1% of the sample had consumed a potentially doping substance. After adjustments for confounding variables, the probability of self-administration of products (medicines or supplements) increased significantly with the intensity of the activity and the membership in a sports club. CONCLUSIONS: Our study showed that self-administration of products among female runners seems to be a widespread behavior, where the intensity of the sports practice and the network of runners seem to influence the decision to resort to this behavior. [less ▲]

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See detailPathologies tendineuses
Kaux, Jean-François ULiege

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See detailPathologies musculaires traumatiques
Kaux, Jean-François ULiege

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See detailAnatomie, physiologie et sémiologie du membre supérieur
Kaux, Jean-François ULiege

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See detailEpaule abarticulaire
Kaux, Jean-François ULiege

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See detailTechniques de Médecine Physique
Kaux, Jean-François ULiege

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See detailCoude - Poignet - Main
Kaux, Jean-François ULiege

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See detailAvulsion fracture of the ischial tuberosity in a young sprinter: conservative or surgical treatment?
Tyberghein, Maëlle; Kaux, Jean-François ULiege; GODON, Bernard ULiege et al

in Abstract Book of Annual Congress of Physical & Rehabilitation Medicine 2016 (2016, December 09)

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See detailIntracanalar lumbar neurinoma
Manto, Florence; HOUET, Elise ULiege; LACREMANS, Pierre ULiege et al

in Abstract Book of Annual Congress of Physical & Rehabilitation Medicine 2016 (2016, December 09)

Neurinoma are slow growing encapsulated tumors, coming from Schwann cells. They are a rare cause of low back pain, possibly with a radiating pain in the inferior limb. This case report describes the ... [more ▼]

Neurinoma are slow growing encapsulated tumors, coming from Schwann cells. They are a rare cause of low back pain, possibly with a radiating pain in the inferior limb. This case report describes the managing of a patient with right cruralgia without strength lost. The CT- scan had failed to highlight a lesion corresponding to the symptoms of the patient. A MRI was therefore realized, and was able to show a lumbar intradural tumor. The MRI signal of neurinoma is usually typical. However, in this case, the histo-pathological analysis has been necessary to confirm the diagnosis. The patient underwent laminectomy and tumor resection with nearly complete resolution of symptoms, excepting a right perineal hemihypoesthesia, probably corresponding to the location of the concerned nervous root. The MRI is the best method to explore cruralgia or a sciatica not responding to treatment, and without precipitating factor such as disc herniation explaining the symptoms. [less ▲]

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