References of "KAUX, Jean-François"
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See detailMultidisciplinary rehabilitation program after breast cancer: benefits on physical function, anthropometry and quality of life.
Leclerc, Anne-France ULg; Foidart-Dessalle, Marguerite ULg; Tomasella, Marco ULg et al

in European Journal of Physical and Rehabilitation Medicine (in press)

BACKGROUND: Different clinical trials show beneficial effects of physical training offered during and / or after breast cancer treatment. However, given the variety of side effects that may be encountered ... [more ▼]

BACKGROUND: Different clinical trials show beneficial effects of physical training offered during and / or after breast cancer treatment. However, given the variety of side effects that may be encountered, physical training could be combined with psychological, relational and social guidance. This kind of multidisciplinary program has been little studied so far. AIM: To determine the benefits of a three-month multidisciplinary rehabilitation program among women after breast cancer treatment. DESIGN: Controlled no-randomized trial. SETTING: University for outcomes, University Hospital Center for interventions. POPULATION: Two hundred and nine outpatients who have been treated for a primary breast carcinoma. METHODS: Patients were divided into a control group (n=106) and an experimental group (n=103) which has benefited from a rehabilitation program of three months including physical training and psycho-educational sessions. The assessments, performed before and after the program, included functional assessments ("Sit and Reach Test", maximal incremental exercise test and "Six-Minute Walk Test"), body composition measurements (body mass index (BMI) and body fat percentage) and a questionnaire (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30). RESULTS: After three months, flexibility, walking distance and all parameters measured during the maximal incremental exercise, except maximal heart rate, were significantly improved in the experimental group. The body fat percentage was significantly decreased and a significant improvement was observed for perceived health status (quality of life), functional role, emotional state, physical, cognitive and social functions and for most symptoms. In the control group, most of these improvements didn't appear and a significant increase in BMI and body fat percentage was observed. CONCLUSIONS: This trial identifies the benefits of a well detailed multidisciplinary rehabilitation program, including physical re-conditioning and psycho-educational sessions, with important improvements in functional capacity, body composition and the majority of functions and symptoms among women after breast cancer treatment. CLINICAL REHABILITATION IMPACT: Through its results, this study could contribute to the development of hospital quality standards for oncologic rehabilitation. Physiotherapists can efficiently propose this kind of multidisciplinary rehabilitation program. [less ▲]

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See detailThe use of platelet-rich plasma (PRP) to treat chronic tendinopathies: a technical analysis
Kaux, Jean-François ULg; Emonds-Alt, Thibault ULg

in Platelets (in press)

Platelet-rich plasma (PRP) is blood plasma with a high concentration of autologous platelets which constitute an immense reservoir of growth factors. The clinical use of PRP is widespread in various ... [more ▼]

Platelet-rich plasma (PRP) is blood plasma with a high concentration of autologous platelets which constitute an immense reservoir of growth factors. The clinical use of PRP is widespread in various medical applications. Although highly popular with athletes, the use of PRP for the treatment of tendinopathies remains scientifically controversial, particularly due to the diversity of products that go by the name of “PRP.” To optimize its use, it is important to look at the various stages of obtaining PRP. In this literature review, we take a closer look at eight parameters which may influence the quality of PRP: 1) anticoagulants used to preserve the best platelet function, 2) the speed of centrifugation used to extract the platelets, 3) the platelet concentrations obtained, 4) the impact of the concentration of red and while blood cells on PRP actions, 5) platelet activators encouraging platelet degranulation and, hence, the release of growth factors, and 6) the use or nonuse of local anesthetics when carrying out infiltration. In addition to these parameters, it may be interesting to analyze other variables such as 7) the use of ultrasound guidance during the injection with a view to determining the influence they have on potential recovery. [less ▲]

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See detailReliability of unipodal and bipodal counter movement jump landings in a recreational male population
Schwartz, Cédric ULg; Forthomme, Bénédicte ULg; Paulus, Julien ULg et al

in European Journal of Sport Science (in press)

Movement patterns during landing have been suggested to be related to injury risk. The purpose of this study was to determine the inter-session reliability of kinematic variables and ground reaction ... [more ▼]

Movement patterns during landing have been suggested to be related to injury risk. The purpose of this study was to determine the inter-session reliability of kinematic variables and ground reaction forces during landing in a population of male recreational athletes after a counter movement jump. Both unipodal and bipodal landings were evaluated. Furthermore, the possibility to improve landing reliability with a verbal instruction was also studied. Twenty- four male volunteers with no history of lower-extremity trauma were randomly assigned to two groups (with and without verbal landing instruction). An optoelectronic 3D system and force plates were used to measure the lower-limb joint angles and the ground reaction forces during landing. Intraclass correlation values show moderate to excellent inter-session reliability for the bipodal task (ICC average: 0.80, range: 0.46 to 0.97) and poor to excellent reliability for the unipodal task (ICC average: >0.75, range: 0.20 to 0.95). However, large standard errors of measurement values at the ankle joint at impact (27.6 ± 11.5°) and for the vertical ground reaction forces (394 ± 1091 N) show that some variables may not be usable in practice. The verbal instruction had a negative effect on the reliability of unipodal landing but improved the reliability of bipodal landing. These findings show that the reliability of a landing task is influenced by its motor complexity as well as the instruction given to the subject. [less ▲]

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See detailClinical classification criteria for radicular pain caused by lumbar disc herniation: the RAPIDH criteria (RAdicular PaIn caused by Disc Herniation)
Genevay, Stéphane; Courvoisier, Delphine; Konstantinou, Kika et al

in Spine Journal (in press)

BACKGROUND CONTEXT: Classification criteria are recommended for diseases that lack specific biomarkers to improve homogeneity in clinical research studies. Because imaging evidence of lumbar disc ... [more ▼]

BACKGROUND CONTEXT: Classification criteria are recommended for diseases that lack specific biomarkers to improve homogeneity in clinical research studies. Because imaging evidence of lumbar disc herniations (LDHs) may not be associated with symptoms, clinical classification criteria based on patient symptoms and physical examination findings are required. PURPOSE: This study aimed to produce clinical classification criteria to identify patients with radicular pain caused by LDH. STUDY DESIGN: The study design was a two-stage process. Phase 1 included a Delphi process and Phase 2 included a cohort study. PATIENT SAMPLE: The patient sample included outpatients recruited from spine clinics in five countries. OUTCOME MEASURES: The outcome measures were items from history and physical examination. MATERIALS AND METHODS: In Phase 1, 17 spine experts participated in a Delphi process to select symptoms and signs suggesting radicular pain caused by LDH. In Phase 2, 19 different clinical experts identified patients they confidently classified as presenting with (1) radicular pain caused by LDH, (2) neurogenic claudication (NC) caused by lumbar spinal stenosis, or (3) non-specific low back pain (NSLBP) with referred leg pain. Patients completed survey items and specialists documented examination signs. A score to predict radicular pain caused by LDH was developed based on the coefficients of the multivariate model. An unrestricted grant of less than US$15,000 was received from MSD: It was used to support the conception of the Delphi, data management, and statistical analysis. No fees were allocated to participating spine specialists. RESULTS: Phase 1 generated a final list of 74 potential symptoms and signs. In Phase 2, 209 patients with pain caused by LDH (89), NC (63), or NSLBP (57) were included. Items predicting radicular pain caused by LDH (p<.05) were monoradicular leg pain distribution, patient-reported unilateral leg pain, positive straight leg raise test <60° (or femoral stretch test), unilateral motor weakness, and asymmetric ankle reflex. The score had an AUC of 0.91. An easy-to-use weighted set of criteria with similar psychometric characteristics is proposed (specificity 90.4%, sensitivity 70.6%). CONCLUSIONS: Classification criteria for identifying patients with radicular pain caused by LDH are proposed. Their use could improve the homogeneity of patients enrolled in clinical research studies. [less ▲]

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See detailTraduction et validation du "Exercise-Induced Leg Pain Questionnaire" pour les patients francophones
Kaux, Jean-François ULg; Hagelstein, Thibaut; Van Beveren, Julien et al

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

Contexte : L’EILP-G a été développé afin d’évaluer la sévérité des symptômes affectant la fonction physique et les capacités sportives chez des patients présentant des douleurs de jambe à l’effort. Le ... [more ▼]

Contexte : L’EILP-G a été développé afin d’évaluer la sévérité des symptômes affectant la fonction physique et les capacités sportives chez des patients présentant des douleurs de jambe à l’effort. Le questionnaire a déjà été traduit en anglais et en grec. Objectifs : Le but de cette étude est de traduire et de réaliser une adaptation interculturelle du questionnaire EILP-G en français ainsi que d’en évaluer ses propriétés psychométriques. Matériel et Méthode : Le processus de traduction et d’adaptation interculturelle de l’exercise-induced leg pain questionnaire for German-speaking patients (EILP-G) a été guidé par les recommandations internationales d’adaptation interculturelle de questionnaires mesurant l’état de santé. Six étapes ont été respectées : (1) traduction française initiale, (2) synthèse de traduction française, (3) traduction inverse allemande, (4) comité d’expert, (5) test de la version pré-finale, (6) approbation du comité d’expert. 84 sujets furent recrutés et répartis en 3 groupes afin de tester l’EILP-FR : un groupe de sujets pathologiques (n=28), des sportifs à risque de développer ce type de pathologie (n=28) et des étudiants en sciences de la motricité asymptomatiques (n=28). Tous les sujets (n=84) ont rempli le questionnaire français à deux reprises avec un intervalle de 7 à 10 jours, parallèlement au Short Form Health Survey (SF-36) afin de pouvoir évaluer la fiabilité et la validité de l’EILP-FR. Résultats : L’EILP-FR indique une fidélité test-retest très bonne concernant le score total (ICC 0,96). Il en va de même pour le score total de chaque sous-groupe (ICC 0,88-0,94) ainsi que pour chaque item (0,75-0,92). Le questionnaire français présente une cohérence interne élevée (0,93). La corrélation entre l’EILP-FR et le SF-36 est modérée pour le score total (0,51;p<0.001). Une corrélation forte se présente entre le questionnaire et une partie des sous-échelles convergentes du SF-36 (PF, RP et BP ; chaque p<0.001). Les sous-échelles divergentes évaluant les propriétés psychologiques du SF-36 présentent toutes une corrélation faible et statistiquement non-significatives (RE, SF, VT), excepté MH (p<0.05). Aucun effet plancher ou plafond n’a été détecté. Conclusion : La version française, adaptée de la version originale EILP-G, a été traduite et adaptée interculturellement avec succès. L’EILP-FR est un questionnaire fiable et valide pour évaluer les patients francophones souffrant de douleurs chroniques de jambe à l’effort. [less ▲]

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See detailAdaptation interculturelle du questionnaire"Kujala Anterior Knee Pain Scale » pour les patients francophones
Buckinx, Fanny ULg; Remy, Gaël; Bornheim, Stephen ULg et al

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

Introduction : Le syndrome fémoro-patellaire est l'un des problèmes du genou les plus fréquemment rencontrés. Il se caractérise par une douleur antérieure du genou dans les activités mettant en charge l ... [more ▼]

Introduction : Le syndrome fémoro-patellaire est l'un des problèmes du genou les plus fréquemment rencontrés. Il se caractérise par une douleur antérieure du genou dans les activités mettant en charge l'articulation fémoro-patellaire. Le Kujala Anterior Knee Pain Scale (Kujala AKPS) est un questionnaire utilisé pour évaluer les symptômes subjectifs, telles que les limitations fonctionnelles et la douleur antérieure du genou. Le questionnaire a déjà été traduit et validé en turc, en portugais brésilien, en persan, en chinois, et en néerlandais. Le but de cette étude est de traduire ce questionnaire en français afin d'en évaluer sa fiabilité et sa validité. Matériel et méthode : La traduction et l’adaptation interculturelle du questionnaire ont été réalisées selon les recommandations internationales comprenant 6 étapes : traduction initiale, synthèse des traductions, traduction de retour vers la langue d’origine, comité d'experts, test de la version pré-finale et approbation du comité d'experts. Une fois la version française obtenue, les participants (n=101) ont rempli 2 fois le Kujula AKPS à un intervalle de 7 jours, et le Short Form Health Survey (SF-36) afin d'en évaluer les propriétés psychométriques (la cohérence interne, la fidélité test-retest et la validité de construit). Résultats : Le Kujula AKPS montre une fidélité test-retest élevée pour le score total (ICC 0,97). La traduction française possède une cohérence interne élevée (0,87). Le Kujula AKPS possède une corrélation forte avec une partie des sous-échelles convergentes du SF-36 (PF, RP et BP). Il y a une corrélation faible ou modérée avec les sous-échelles divergentes du SF-36 (MH, SF et VT). Il n’y a pas d’effet plancher et plafond. Conclusion : La version française du questionnaire Kujula AKPS étant facilement compréhensible, elle semble avoir une bonne adaptation interculturelle. Cette étude a démontré que le Kujula AKPSF est fiable et valide pour les patients francophones souffrant d'un syndrome rotulien. [less ▲]

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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 ULg; 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 ULg; Roberjot, Mathieu; DELVAUX, François ULg 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 ULg; Bruyère, Olivier ULg; Kaux, Jean-François ULg

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 ULg

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 ULg

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

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 ULg

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 ULg

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 ULg; GODON, Bernard ULg 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 ULg; DANIEL, Christophe ULg 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 ULg; Roberjot, Mathieu; DELVAUX, François ULg 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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