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See detailComparaison entre infiltrations de plasma riche en plaquettes et d’acide hyaluronique pour le traitement des tendinopathies patellaires
Kaux, Jean-François ULiege; Roberjot, Mathieu; Samson, Antoine

in 10ème Congrès Commun SFMES-SFTS (2017, September)

Introduction : Le traitement des tendinopathies patellaires reste difficile. C’est la raison pour laquelle de nouveaux traitements ont été développés, parmi lesquels les injections de plasma riche en ... [more ▼]

Introduction : Le traitement des tendinopathies patellaires reste difficile. C’est la raison pour laquelle de nouveaux traitements ont été développés, parmi lesquels les injections de plasma riche en plaquettes (PRP) ou d’acide hyaluronique (AH). Certaines séries cliniques ont précédemment évalué l’effet du PRP dans le traitement des tendinopathies patellaires proximales. Une revue systématique récente a conclu que les PRP pouvait être recommandé comme traitement dans cette indication. Récemment, l’AH en injection a été proposé comme traitement des tendinopathies. Certaines études fondamentales montrent des résultats encourageants sur la capacité de l’AH à promouvoir le glissement du tendon, de réduire les adhérences et améliorer son organisation architecturale. Quelques observations cliniques confirment également son impact sur la douleur et la fonction de patients avec tendinopathies. Méthodes : Trente-trois sportifs avec tendinopathies patellaires proximales non soulagés après plus de trois mois de traitements rééducatif classique ont été inclus dans l’étude. Dix-huit d'entre eux (groupe 1) ont reçu une injection de PRP pauvre en leucocytes (obtenu à l’aide d’un appareil d’aphérèse) et 15 autres sujets (groupe 2) ont bénéficié de 2 injections d’AH à 1 semaine d’intervalle; les 2 groupes ont bénéficié d’une rééducation standardisée post-infiltration. Concernant le suivi de la pathologie, une évaluation de la douleur par une échelle visuelle analogique (EVA), des scores algo-fonctionnels (IKDC, VISA-P), un algomètre de pression, un test isocinétique (associé à une EVA)) ainsi qu’une échographie du tendon patellaire (US) ont été réalisés à 3 reprises (avant injection, après 6 semaines, 3 mois après les injections). Résultats : Les résultats de l’EVA (p < 0,01), de l’algomètre de pression (p < 0,01), les scores IKDC (p < 0,01) et VISA-P (p < 0,01) montrent une amélioration significative dans les deux groupes, mais pas pour les résultats US. Pour le groupe 1, les tests isocinétiques montrent des résultats significatifs pour les ischio-jambiers à C60 °/ s, avec une amélioration de son couple de pointe maximale (p = 0, 01) pour le membre pathologique et une amélioration des différences bilatérales (p = 0,0002). Pour le groupe 2, l’amélioration du couple de pointe maximale du quadriceps à C240 ° /s est significative (p < 0,01) pour le genou pathologique après les injections après 6 semaines seulement. L’EVA associé aux tests isocinétiques diminue considérablement pour tous les modes de contraction au terme des trois mois d’études. Conclusions : Les infiltrations de PRP et d’HA peuvent toutes les 2 améliorer les symptômes de tendinopathie patellaire proximale, même si les résultats sont légèrement meilleurs au sein du groupe PRP. [less ▲]

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See detailTraumatologie des sports olympiques de ballon en salle. Partie 2 : le handball
Kaux, Jean-François ULiege; Roberjot, Mathieu; DELVAUX, François ULiege et al

in Journal de Traumatologie du Sport (2017)

Frequent often-rough contact between players explains why handball has one of the highest injury rates (mainly contusion) recorded at the LondonOlympic Games. Ankle injuries predominated. Head injuries ... [more ▼]

Frequent often-rough contact between players explains why handball has one of the highest injury rates (mainly contusion) recorded at the LondonOlympic Games. Ankle injuries predominated. Head injuries (commotion), shoulder injuries (dislocation and instability), and knee injuries (anteriorcruciate ligament tears) were also common. Wingmen are in constant activity both as attackers and defenders, making them the players with thehighest risk of injury. [less ▲]

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See detailResponders to platelet-rich plasma (PRP) in osteoarthritis: A technical analysis
MILANTS, Christophe ULiege; Bruyère, Olivier ULiege; Kaux, Jean-François ULiege

in BioMed Research International (2017)

Purpose. To evaluate the similarities and differences between the variety of platelet-rich plasma (PRP) formulations, preparation, and uses to try to determine the best responses for the treatment of knee ... [more ▼]

Purpose. To evaluate the similarities and differences between the variety of platelet-rich plasma (PRP) formulations, preparation, and uses to try to determine the best responses for the treatment of knee osteoarthritis. Materials and Methods. A comparison of the outcomes of randomized controlled trials (RCTs) included in the 3 most recent and high-quality meta-analyses to classify the different studies in 2 groups (bad responders group (BRG) and very good responders group (VGRG)). Results and Discussion. From the 19 RCTs analyzed, 7 trials were included in the VGRG and 4 in the BRG. In VGRG, 1 or 2 injections were performed in 4/7 trials, time between injections was 2 to 3 weeks in 4/5 studies with many injections, volume injected varied from 2.5 to 8 mL, and single spinning technique was used in 5/7 studies. PRP classification was Mishra 4B and PAWP2B𝛽 in 5/7 studies. The use of PRP with leukocytes is only found in the BRG. Conclusion. There is a lack of standardization in PRP preparation technique for knee osteoarthritis. However it appears that the use of a single spinning technique, a platelet concentration lower than 5 times the baseline, and avoidance of leukocytes should be preferred. [less ▲]

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See detailIntérêt de la cryothérapie chez le sportif
Kaux, Jean-François ULiege

Conference (2017, June 02)

La thérapie par le froid est couramment utilisée comme une procédure pour soulager les symptômes douloureux, particulièrement dans les maladies inflammatoires. La cryothérapie corps entier consiste en une ... [more ▼]

La thérapie par le froid est couramment utilisée comme une procédure pour soulager les symptômes douloureux, particulièrement dans les maladies inflammatoires. La cryothérapie corps entier consiste en une exposition à l’air très froid (maintenue entre -110 °C et -140 °C) en cryochambre spéciale, généralement pendant 2 minutes. En médecine sportive, la cryothérapie corps entier a gagné en popularité comme méthode améliorant la récupération ou accélérant la guérison des blessures. Malheureusement, il n’y a peu de documents relatifs à l’application de ce traitement chez les athlètes. [less ▲]

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See detailPRP & arthrose
Kaux, Jean-François ULiege

Conference (2017, June 02)

Les injections de Plasma Riche en Plaquettes (PRP) dans le traitement de diverses pathologies arthrosiques semblent se développer comme un nouveau traitement de pointe. Sur base de ce constat, nous avons ... [more ▼]

Les injections de Plasma Riche en Plaquettes (PRP) dans le traitement de diverses pathologies arthrosiques semblent se développer comme un nouveau traitement de pointe. Sur base de ce constat, nous avons relevé dans la littérature, les conditions de protocoles d’optimisation du traitement du PRP dans les lésions cartilagineuses. [less ▲]

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See detailMaladie coronaire et pratique sportive
ANCION, Arnaud ULiege; KAUX, Jean-François ULiege; PIERARD, Luc ULiege et al

in Revue Médicale de Liège (2017), 72(6), 281-287

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See detailTraumatologie des sports olympiques de ballon en salle. Partie 1: le basket-ball
Kaux, Jean-François ULiege; Roberjot, Mathieu; DELVAUX, François ULiege et al

in Journal de Traumatologie du Sport (2017), 34(2), 108-113

Basketball, handball and volleyball are three indoor ball sports played in the Olympic Games. An important solicitation of the upper limbs is acommon characteristic of these three sports. The main ... [more ▼]

Basketball, handball and volleyball are three indoor ball sports played in the Olympic Games. An important solicitation of the upper limbs is acommon characteristic of these three sports. The main objective of this review of the literature is to analyze the types of injury occurring in thesethree indoor ball games, looking for the specific localizations and their potential causes. Each sport will be discussed in a specific publication.Basketball is a very popular sport with a growing number of participants. The intensity of the game has increased as it has become more physical,leading to an increasing number of injuries. Ankle sprain is the most common injury in basketball. Back pain, finger fracture and tendon injury(jumper’s knee) or knee injury (anterior cruciate ligament tears) are also common. The main mechanism of traumatic injury is direct contact withthe opponent (during games) but there is also an increasing number of over-solicitation injuries. The length of time players must avoid sportsactivities after injury depends on the type of injury involved. [less ▲]

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See detailImpact of an ultra-trail of 330 km on plasma levels
LE GOFF, Caroline ULiege; Kaux, Jean-François ULiege; Gergelé, Laurent et al

in Clinical Chemistry and laboratory medicine (2017, June)

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See detailActualités dans le traitement des tendinopathies
Sauvant, Céline; Kaux, Jean-François ULiege

in Journal de Traumatologie du Sport (2017), 34(2), 99-107

Tendon injuries caused by overuse have been described as “tendinitis” for years before it was demonstrated that the histopathological process wasnot due to intratendinous inflammation. Cook and Purdam ... [more ▼]

Tendon injuries caused by overuse have been described as “tendinitis” for years before it was demonstrated that the histopathological process wasnot due to intratendinous inflammation. Cook and Purdam proposed a continuum model of tendon pathology, which provides a better understandingof the condition and the possibility to adapt the treatment. This allows a better recovery and a lower recurrence rate of the tendinopathy. This articleis a review of current treatments used in clinical practice. [less ▲]

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See detailActualités des traitements conservateurs des tendinopathies
Kaux, Jean-François ULiege

Conference (2017, May 28)

Les connaissances et la prise en charge des tendinopathies ont beaucoup évolué depuis ces dernières années. En effet, se substituant désormais à l’ancienne appellation « tendinite », les tendinopathies ... [more ▼]

Les connaissances et la prise en charge des tendinopathies ont beaucoup évolué depuis ces dernières années. En effet, se substituant désormais à l’ancienne appellation « tendinite », les tendinopathies sont majoritairement décrites selon le modèle de continuum établi par Cook et Purdam. La compréhension de la physiopathologie de ces lésions a permis l’émergence de nombreux traitements dans le but d’obtenir une récupération optimale et une limitation des récidives. L’objectif de cet article est de faire une revue de l’actualité thérapeutique des tendinopathies. [less ▲]

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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 detailIs oral feeding compatible with an unresponsive wakefulness syndrome?
MELOTTE, Evelyne ULiege; MAUDOUX, Audrey ULiege; DELHALLE, Sabrina ULiege et al

Conference (2017, May)

INTRODUCTION AND AIMS Vegetative state/Unresponsive wakefulness syndrome (VS/UWS) is defined by the presence of eye-opening and the absence of awareness and voluntary movement (Laureys et al., 2010). VS ... [more ▼]

INTRODUCTION AND AIMS Vegetative state/Unresponsive wakefulness syndrome (VS/UWS) is defined by the presence of eye-opening and the absence of awareness and voluntary movement (Laureys et al., 2010). VS/UWS patients classically receive hydration and nutrition through an enteral feeding tube. We present the cases of two patients that were diagnosed as VS/UWS but were able to resume oral feeding. It is however unclear if the presence of oral feeding is compatible with the diagnosis of VS/UWS or if this observation should lead to a modification of the diagnosis. METHODS AND RESULTS We retrospectively reviewed the clinical information of 65 VS/UWS patients (aged 45±12; range 16-85 years) evaluated at the CHU hospital of Liege searching for mention of oral feeding. VS/UWS diagnosis was made after repeated behavioral assessments using the standardized Coma Recovery Scale–Revised (CRS-R, (Teasdale & Jennet, 1974)) in association with complementary evaluations using neuroimaging techniques. Of the 65 VS/UWS patients, two could resume oral feeding (3%). One could achieve full oral feeding (mixed texture and liquid) and the other had oral feeding (liquid and semi-liquid) in addition to gastrostomy feeding. Neuroimaging evaluations showed in both patients a massive decrease in the spontaneous brain activity and its functional connectivity (using functional magnetic resonance imaging), bilateral cerebral cortex hypometabolism (fronto- parietal associative areas, posterior parietal areas, cingulate cortices, precuneus) and preserved metabolism in the brainstem and cerebellum (using positron emission tomography). CONCLUSIONS Oral feeding is rare in VS/UWS patients (3% in our cohort). Based on neuroimaging results, this behaviour does not seem to be incompatible with the diagnosis of VS/UWS but the neuromecanistic root, which allows this behavior, still needs to be elucidate. This study also emphasizes the importance of systematic swallowing evaluation in patients with altered state of consciousness regardless of their level of consciousness. Moreover, tactile oro-facial stimulation, manual therapy, taste stimulation and therapeutic feeding can be another “gateway” to interact with these patients and improve their quality of life. [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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