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See detailIsokinetic profile of subjects with proximal patellar tendinopathy
Kaux, Jean-François ULiege; Croisier, Jean-Louis ULiege; Libertiaux, Vincent ULiege

in British Journal of Sports Medicine (in press)

Introduction Patellar tendinopathy (PT) is commonly observed in jumping sports. Even if its biomechanic is somewhat explored, no information is known about the muscle strength profile of these patients ... [more ▼]

Introduction Patellar tendinopathy (PT) is commonly observed in jumping sports. Even if its biomechanic is somewhat explored, no information is known about the muscle strength profile of these patients. We aimed to determine if there exists a specific profile of patients suffering from a PT Methods 43 patients (42 males; 29 y.o +/- 9.8 y.o) suffering from PT were recruited. To be eligible, the patients must not have suffered from any other traumatic or micro-traumatic injury than the PT on the pathologic limb. After a physical examination, the tendon damage was assessed by ultrasounds examination. The patients were then tested on an isokinetic dynamometer and the peak torque per unit of mass (PTm) developed by the quadriceps and the hamstrings were recorded for various testing modalities. After each test, a visual analog scale (VAS) was used to estimate the pain felt by the patients. Results No significant correlation was found between the MTm and the demographic variables. The difference in MTm between the healthy and the pathological limbs was significant only in concentric 60°/s, for both the quadriceps and the hamstrings. Lastly, the VAS score showed that the most intense pain was experienced after the eccentric test. Conclusions There is no specific patient strength profile emerging from the isokinetic test. This stresses the importance for the clinicians to make testing and to apply a personalized treatment to each patient. On the other hand, the isokinetic eccentric testing of the quadriceps could be used to induce a mechanical stress on the tendon for a reliable pain assessment. [less ▲]

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See detailFrench translation and validation of the AKPS questionnaire
Buckinx, Fanny ULiege; Remy, Gaël; Bornheim, Stephen ULiege et al

in British Journal of Sports Medicine (in press)

Introduction: The Anterior Knee Pain Scale (AKPS) is a questionnaire used to examine the subjective symptoms, such as the functional limitations and the anterior knee pain. First developed in English ... [more ▼]

Introduction: The Anterior Knee Pain Scale (AKPS) is a questionnaire used to examine the subjective symptoms, such as the functional limitations and the anterior knee pain. First developed in English, this questionnaire has since been translated and validated into several languages. The aims of the study were to translate and cross-culturally adapt the AKPS into French and to evaluate the reliability and validity of this translated version of the questionnaire. Methods: The translation part was articulated in six stages, according to international guidelines: (i) two initial translations from english to french; (ii) synthesis of the two translations; (iii) backward translations into the original language; (iv) expert committee to compare the backward translations with the original questionnaire (v) pre-final version testing and (VI) expert committee appraisal. To validate the French AKPS questionnaire, we assessed its validity, reliability and floor/ceiling effects. To do this, volunteer patients from Belgium and France, with patellofemoral pain syndrome were asked to answer the french version of the AKPS questionnaire at baseline and after 7 days, as well as the generic SF-36 questionnaire. Results: The AKPS questionnaire was translated without any major difficulties. A total of 101 subjects aged 34.49 ± 11.38 years on average were included in this study. Among them, 58.4% were women. Results indicated an excellent test-retest reliability (intraclass coefficient correlation of 0.97, 95% CI 0.96 - 0.98), a high internal consistency (Cronbach’s alpha of 0.87), a consistent construct validity (high correlations with the SF-36 questionnaire were found with domains related to physical function (r = 0.80), physical role (r = 0.70), pain (r = 0.64)) and low or moderate correlations with domains related to mental health (r = 0.26), vitality (r = 0.32), social function (r = 0.41)). Moreover, no floor/ceiling has been found. Conclusion: A valid AKPS french questionnaire is now available and can be used with confidence to better assess the disease burden associated with femoropatellar syndrom. It was successfully cross-culturally adapted into French. [less ▲]

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See detailFrench Translation and validation of the Exercise-Induced Leg Pain
Kaux, Jean-François ULiege; Hagelstein, Thibaut; Van Beveren, Julien et al

in British Journal of Sports Medicine (in press)

Objective: The « Exercise-Induced Leg Pain » (EILP) questionnaire has been developed (in German) to evaluate the severity of symptoms and sports ability in individuals with exercise-induced leg pain. The ... [more ▼]

Objective: The « Exercise-Induced Leg Pain » (EILP) questionnaire has been developed (in German) to evaluate the severity of symptoms and sports ability in individuals with exercise-induced leg pain. The purpose of the present study was to translate and cross-culturally adapt this questionnaire into French and to study the reliability and validity of the French-translated version (EILP-F). Methods: Translation and cross-culturally adaptation of the original EILP (EILP-G) was performed according to established guidelines. The translation part was articulated in six stages: (i) two initial translations from German to French; (ii) synthesis of the two translations; (iii) backward translations; (iv) expert committee to compare the backward translations with the original questionnaire; (v) pre-test; and (vi) approval of the final version of the EILP-F. To validate the EILP-F questionnaire, 84 subjects were recruited (28 pathological patients with a confirmed diagnosis of chronic leg pain, 28 asymptomatic sport students, 28 athletes healthy control). Discriminative power of the questionnaire was tested as well as reliability (internal consistency, test–retest reliability after a 7-10-day interval), construct validity and floor/ceiling effects. Results: the EILP-F version of the questionnaire has been generated without any major difficulties. The ability of the questionnaire to discriminate the three groups of subjects has been showed with a total score of 61.0 ± 18.5 for the pathologic group; 93.9 ± 7.57 for the asymptomatic group and 94.1 ± 9.79 for the control group (p-value adjusted on age = 0.008). A high internal consistency (Cronbach's alpha of 0.93) and an excellent test-retest radiality (ICC of 0.98 (95% CI 0.97-0.99, p<0.001)) indicated that the EILP-F is reliable. The EILP-F also demonstrated a good construct validity against different subscales of the Short Form-36 questionnaire, a generic quality of life questionnaire, with more than 87 % of prespecified hypotheses confirmed. Finally, no floor or ceiling effects were observed. Conclusion: The EILP-F questionnaire, a French version adapted from the original EILP-G, was successfully translated and cross-culturally adapted. The EILP-F questionnaire is consistent, valid and reliable for evaluating the French-speaking patients with chronic exercise-induced leg pain. [less ▲]

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See detailComparison of Platelet Rich Plasma (PRP) versus Hyaluronic Acid (HA) injections to treat patellar tendinopathies
Kaux, Jean-François ULiege; Roberjot, Mathieu; SAMSON, Antoine ULiege

in British Journal of Sports Medicine (in press)

Introduction: The treatment of patellar tendinopathies could be difficult. Recent systematic review concluded that PRP could be recommend as a treatment in such indication. Recently, the viscoelastic ... [more ▼]

Introduction: The treatment of patellar tendinopathies could be difficult. Recent systematic review concluded that PRP could be recommend as a treatment in such indication. Recently, the viscoelastic properties of hyaluronic acid (HA) on liquid connective tissue have been proposed for the treatment of tendinopathies. Some observations also support its use in a clinical setting to improve pain and function. 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: Thirty-three sportsmen with proximal patellar tendinopathies being not relieved after minimum three months of normal physiotherapy treatments where included. Eighteen of them (group 1) have received a leukocyte poor PRP injection (obtained using an aphaeresis machine (3)) and the other fifteen (group 2) two HA injections, all of them have benefited of standardized rehabilitation. Concerning the evaluation of the pathology, algo-functional tests (visual analogic scale (VAS), pressure algometer, IKDC score, VISA-P score), isokinetic (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, isokinetic tests show significative results for the hamstrings in C60°/s with an improvement of maximum peak torque (p=0,01) for the pathological member, 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. Conclusion: 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 detailCross-cultural adaptation in French and validation of Functional Assessment Scale for acute Hamstring injuries
Kaux, Jean-François ULiege; Willems, Tom; Locquet, Médéa ULiege

in British Journal of Sports Medicine (in press)

Introduction : Acute hamstring injury is a very common muscle injury particularly in sports that require high explosive strength, sports with impulsions and sports with running phases. Among those sports ... [more ▼]

Introduction : Acute hamstring injury is a very common muscle injury particularly in sports that require high explosive strength, sports with impulsions and sports with running phases. Among those sports, the most widespread are soccer, rugby and sprinting. The Functional Assessment Scale for acute Hamstring injuries (FASH) assesses pain, physical activity and how patients realize some exercises while suffering hamstring injury. Current available versons are in English, in German and in Greek. Objectives : The aims of thus study were to reach a reliable and valid translation and a cross-cultural adaptation of this questionnaire in French. Methods: FASH translation and adaptation were realized in respect of international guidelines. The population composed of 116 subjects filled the questionnaire twice separated by 48-60th. FASH reliability and validity were assessed thanks to SF-36 allowing us to assess the test re-test reliability (with intra-class correlation ICC), internal consistency (with Cronbach’s alpha coefficient and construct validity, with Spearman’s correlation coefficients). Results : ICC showed a strong correlation between test and re-test (ICC total=0.9985). Internal consistency was also found to be strong with Cronbach’s alpha coefficient = 0.98. Correlation between FASH and SF-36 overall score was considered as strong (Rs=0.69, p<0.0001). Correlation with SF-36 sub scales (PF, RP, BP) were also considered as strong, showing their convergent validity. Other SF-36 subclass (GH, MH, REm, SF, VT) displayed a moderate correlation with FASH questionnaire, showing their divergent validity. No floor or ceiling effect was observed. Conclusions: FASH translation and cross-cultural adaptation into French can be considered as successful. FASF-F is now a reliable and valid tool for patients suffering acute hamstring injury. [less ▲]

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See detailExploring the effect of a second closely-timed PRP infiltration for tendinopathy
Kaux, Jean-François ULiege; Croisier, Jean-Louis ULiege; Forthomme, Bénédicte ULiege et al

in British Journal of Sports Medicine (in press)

Introduction: Some clinical series have previously evaluated the effect of PRP in the treatment of proximal patellar tendinopathies. Although it is possible that a single infiltrative administration may ... [more ▼]

Introduction: Some clinical series have previously evaluated the effect of PRP in the treatment of proximal patellar tendinopathies. Although it is possible that a single infiltrative administration may prove to be an effective treatment for this indication, most of the existing studies evaluated the effects of successive infiltrations which is arguably likely to increase the risks of complications. Methods: Our study is a single blinded, randomized controlled clinical trial on 20 leisure sportsmen (2 groups, respectively 1 or 2 infiltrations of pure PRP) with chronic proximal patellar tendinopathies, rebel to classical management. PRP was obtained using an aphaeresis machine. The one-year follow-up evaluation consisted of VAS, IKDC and VISA-P scores, while algometer, isokinetic and ultrasounds evaluations were carried out up to 3 months. Results: The concentration of the PRP used was similar in both groups. The VAS significantly decreased with time over the 3-month follow-up period (p=0.002), with no difference observed between the two groups (p=0.2). Values obtained with the pressure algometer increased with time across both groups over the 3-month follow-up period (p<0.0001), and values were significantly higher for Group 1 (p=0.001). The IKDC score increased with time in both groups over the follow-up period (p=0.034), with values again significantly higher for Group 1 (p=0.0026). The VISA-P score increased with time in both groups over the follow-up period (p=0.0023), with no difference observed between the groups (p=0.41). No improvements in isokinetic physical performance were observed in either group. However, pain during E30 significantly decreased over the 3-month follow-up period (p=0.027) for patients in both groups. No improvement in either jumping performances or in pain was observed in either group during opto-jump evaluation. No improvements in US findings were observed. After one year, 90% patients of group 1 did not report anymore pain during daily activities, in comparison with only 20% in group 2. Conclusions: A second closely-timed infiltration of PRP to treat proximal patellar tendinopathies is not necessary to improve the efficacy of this treatment. [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 detailEccentric training improves tendon biomechanical properties: a rat model
Kaux, Jean-François ULiege; Drion, Pierre ULiege; Libertiaux, Vincent et al

in British Journal of Sports Medicine (2014, April), 48(7), 155

Background: Even if eccentric exercises appear favourable in primary prevention of tendons lesions and, especially, in secondary prevention after tendinopathy, the biomechanical changes to the tissue are ... [more ▼]

Background: Even if eccentric exercises appear favourable in primary prevention of tendons lesions and, especially, in secondary prevention after tendinopathy, the biomechanical changes to the tissue are not yet clear. Objective: We aimed to better define the biomechanical changes that affect healthy tendon after eccentric and concentric training. Design: Randomised controlled trial. Participants: Eighteen Sprague-Dawley rats of 2 months. Interventions: The six rats in the control group (U) were not subjected to physical exercise. The 12 remaining rats (6 in each group) ran on a treadmill set at a +15° incline for concentric training (C) or a -15° incline for eccentric training (E), at a speed of 17 m/min for 1 h, three times per week for 5 weeks. Main Outcome Measurements: The tricipital, patellar and Achilles tendons were subsequently removed to perform a traction test until rupture, and a histological analysis was performed. Results: There was a significant improvement in the rupture force of the patellar and tricipital tendons between the U and E groups. The tricipital tendons in the control group presented a significantly smaller cross-section than the E- and C-trained groups, but none between E and C groups. No significant difference was observed for the mechanical stress at rupture per surface unit between the three groups for all three tendons. However, a tendency towards improvement these values was observed between the trained and the U groups for the patellar tendon. Histological studies demonstrated the tendency of the development of a greater number of blood vessels and a larger quantity of collagen in the eccentric group. Conclusions: The mechanical properties of tendons in rats improve after specific training, especially following eccentric training. Our results partly explained how mechanical loading, especially in eccentric mode, could improve the tendon structure. [less ▲]

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See detailCardiac troponins and natriuretic peptides in runners: useful for cardiac risk screening ?
LE GOFF, Caroline ULiege; Kaux, Jean-François ULiege; Fillet, Marianne ULiege et al

in British Journal of Sports Medicine (2014, April), 48(7), 173

Background Cardiac troponins (cTn) are considered as the best biomarkers for detection of myocardial cell injury and NT-proBNP as the best for the cardiac insufficiency. Objective Our aim was to compare ... [more ▼]

Background Cardiac troponins (cTn) are considered as the best biomarkers for detection of myocardial cell injury and NT-proBNP as the best for the cardiac insufficiency. Objective Our aim was to compare cTnT and NT-proBNP levels before and after the stress tests, in sportive subjects. Design Prospective, cohort study. Setting Amateur marathon runners and ultrarunners. Patients 28 subjects (26 men, 42.5±11 yrs) were enrolled. Interventions Subjects ran the Maasmarathon (42.195 kilometers) and 33 subjects (33 men, 45.7±9.3 yrs) ran the Ultratour of Liège (Belgium; 67 km). All subjects gave their informed consent. We took blood sample before (T0), just after (T1) and 3 hours after the race (T3). Main outcome measurements cTnT concentrations were measured by high sensitive methods (hsTnT, Roche Diagnostics) on heparin plasma. The NT-proBNP was also determined with the kit Roche on heparin plasma. All statistical analyses were performed using Medcalc version 8.1 for Windows. P-value <.01 was regarded as statistically significant. Results A significant difference between hsTnT concentrations at T0 and T1 (P<.001), and between T0 and T3 (P<.001) for NT-proBNP have been observed, but not between T1 and T3. This observation appeared only after a strenuous exercise. However, up to now this type of exercise is not reproducible easily in a laboratory. Moreover, nobody knows if these observations would have cardiac consequences at long terms. Conclusion Measurement of cardiac troponins by high sensitive methods allows detecting significant release of biomarkers from the heart during exercise. The value of NT-proBNP are also significant but less than TnThs. We think that the TnThs could be an interesting tool in the future to help sport medicine to detect risk of developing a cardiac problem in the future or a sudden death. [less ▲]

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See detailTwo biomarkers for the screening of cardiac risk among runners ?
LE GOFF, Caroline ULiege; Kaux, Jean-François ULiege; Fillet, Marianne ULiege et al

in British Journal of Sports Medicine (2014, April), 48(7), 174

Background Heart-type fatty acid-binding protein (H-FABP) is a low molecular weight protein involved in the intracellular uptake and buffering of long chain fatty in the myocardium. Troponin T is a ... [more ▼]

Background Heart-type fatty acid-binding protein (H-FABP) is a low molecular weight protein involved in the intracellular uptake and buffering of long chain fatty in the myocardium. Troponin T is a component of the contractile apparatus of the striated musculature. Both are early markers for acute coronary syndrome. Objective The aim of our study was to compare the results obtained with the H-FABP and the highly sensitive cardiac troponins (hsTnT) and to test their cardiospecificity in healthy runners. Design Prospective, cohort study. Setting Amateur marathon runners. Patients 23 runners (marathon) were enrolled. Interventions We drowned blood samples at three times: just before (T0), just after (T1), and three hours after the end of the race (T3). Main outcome measurements H-FABP and hs-TnT were performed according to the manufacturer's instructions. A linear regression was calculated to observe if there is any correlation between the two biomarkers. Values above the 95th percentile for H-FABP (2.5 ng/mL) and the 99th percentile for hsTnT (14 ng/L) were considered as positive. Results At T0, none of the subjects were positive for hsTnT but 35% were positive for H-FABP; at T1, 83% for hsTnT and 100% for H-FABP; at T3, 83% for hsTnT and 96% for H-FABP. At T0, the regression equation was H-FABP T0=3.9454–0.1001×hsTnT T0; at T1: H-FABP T1=51.838–1.7026×hsTnT T1; at T3: H-FABP T3=47.977–1.6193×hsTnT T3. No correlation was observed between the 2 biomarkers. Conclusion We observed a significant increase of H-FABP and hsTnT in runners. These markers are independent to each other. These values could biologically correspond to a heart ischemia. These biomarkers could be helpful for the screening of cardiac risk among runners. [less ▲]

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See detailEccentric training for elbow hypermobility
Kaux, Jean-François ULiege; Delvaux, François ULiege; Forthomme, Bénédicte ULiege et al

in British Journal of Sports Medicine (2014, April), 48(7), 154

Background: Patients with hypermobility suffer from joints problems and chronic pain is the most frequently reported symptom. Objective: Eccentric muscle strengthening could be very important to protect ... [more ▼]

Background: Patients with hypermobility suffer from joints problems and chronic pain is the most frequently reported symptom. Objective: Eccentric muscle strengthening could be very important to protect hypermobile joints. Design: Case report. Patient: A girl (16 y.o.) affected by an Ehler-Danlos syndrome presented pain in the right elbow and the right wrist after a season of tennis. Interventions: Her training consisted of wrist prono-supination and flexion-extension muscle group reinforcement and proprioceptive training. To protect the wrist against excessive load, the eccentric strengthening exercises of prono-supinator and flexor-extensor muscles of elbow and wrist were undertaken gradually, at increasing speeds within a limited range of motion in flexion and extension, on an isokinetic device after an evaluation. She was also given an orthesis restricting the joint range of motion of the wrist. Main outcome measurements: The evaluation was made by isokinetic evaluation, visual analog scale and MOS-SF36 questionnaire before and after training. Results: The patient rapidly noted a decrease in pain and an increase in the stability of her right arm even when playing tennis. Isokinetic evaluation objectified a significant improvement in maximal torque in flexion-extension muscles of the right elbow. She was also given individualized home exercises. Conclusions: The goal of this eccentric training is to avoid hypermobility by using the muscles as a protective brake in the control of joint positioning. Muscles can be reinforced in eccentric mode with starting position at the maximum length of these muscles when unstreched. The exercises can be carried out safely on an isokinetic device, at slow speed and limited range of joint motion to avoid risk of luxation. Thus, in this case report, the eccentric exercises using an isokinetic device were effective to safely reinforce the muscles as a protective brake for joint hypermobility and prevent pain during practicing tennis. [less ▲]

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

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

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

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

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See detailExuberant inflammatory reaction after an infiltration of platelet-rich plasma (PRP)
Kaux, Jean-François ULiege; Croisier, Jean-Louis ULiege; LEONARD, Philippe ULiege et al

in British Journal of Sports Medicine (2013, June), 47(10 (e3)), 92

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

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

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See detailPlatelet-rich plasma (PRP) and tendon healing: animal model
Kaux, Jean-François ULiege; Drion, Pierre ULiege; Renouf, Julien et al

in British Journal of Sports Medicine (2011, February), 45(2), 1

Introduction: The tendon is a tissue which does not heal easily. Recently, several studies have demonstrated the positive effects of platelets on the healing process of tendons. A local injection of ... [more ▼]

Introduction: The tendon is a tissue which does not heal easily. Recently, several studies have demonstrated the positive effects of platelets on the healing process of tendons. A local injection of platelet–rich plasma (PRP), which releases in situ many growth factors, has the potentiality to enhance the tendon healing process. The aim of our experiment was to ascertain by an original mechanical measure whether the use of PRP was of interest for accelerating the healing process of rats’ Achilles tendons after surgical induced lesion. Methods: A 5mm defect was surgically induced in 90 rats’ Achilles tendon. Rats were divided into 2 groups of 45: (A) control (no treatment) and (B) PRP treatment. Rats of group B received a PRP injection in situ after the surgery. Afterwards, rats of both groups were placed in their cages without immobilization. After 5, 15 and 30 days, 10 traumatized Achilles tendons of each group were dissected and removed. Immediately after sampling, tendons were submitted to a biomechanical tensile test up to rupture, using a “Cryo-jaw”. After that, transcriptomic analyses were made on the tendon samples, to study the expression of type III collagen, matrix metalloproteases and tenomodulin. A hydroxyproline dosage was done to quantify the collagen in the tendon during its healing process. Tendons of the 15 remaining rats of each group were subjected to a histological study, respectively at day 5, 15 and 30 (5 rats for each time). Results: We demonstrated that the force necessary to induce tendon rupture during biomechanical tensile test study was greater for tendons which had been submitted to an injection of PRP compared to the control group: +19% (day 5), +30% (day 15) and +43% (day 30). Histological study showed that PRP could enhance cells proliferation, angiogenesis and collagen organisation. Our biochemical analyses did not explain beneficial effects of PRP. Indeed, there was no significant difference neither between the expression of different studied genes, nor in the quantity of hydroxyproline between both groups. Conclusion: This experimentation has shown that a PRP injection could accelerate the tendons healing process and improve its quality. [less ▲]

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See detailInfluence of practice characteristics on injury risk in young athletes
Frisch, Anne ULiege; Urhausen, Axel; Seil, Romain et al

in British Journal of Sports Medicine (2011), 45

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See detailEFFECT OF DIFFERENT WARMING-UP PROTOCOLS ON TIME TO EXHAUSTION AT MAXIMAL AEROBIC SPEED
Rodriguez de la Cruz, Carlos ULiege; Brennenraedts, C.; Bury, Thierry ULiege

in British Journal of Sports Medicine (2011), 45

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See detailOral salt supplementation and long-distance exercise
Lehance, Cédric ULiege; Rodriguez de la Cruz, Carlos ULiege; Counet, Laurence ULiege et al

in British Journal of Sports Medicine (2011), 45

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See detailAn isokinetic eccentric programme for the management of chronic lateral epicondylar tendinopathy
Croisier, Jean-Louis ULiege; Foidart-Dessalle, Marguerite ULiege; Tinant, France ULiege et al

in British Journal of Sports Medicine (2007), 41(4), 269-275

Background: Lateral epicondylitis represents a frequent overuse injury. In spite of many conservative treatment procedures, prolonged symptoms and relapse are frequently observed. Objective: To compare ... [more ▼]

Background: Lateral epicondylitis represents a frequent overuse injury. In spite of many conservative treatment procedures, prolonged symptoms and relapse are frequently observed. Objective: To compare the outcome of patients performing an isokinetic eccentric training with that of age-, gender-, activity-matched patients receiving a non-strengthening classical rehabilitation. Methods: Ninety-two patients with unilateral chronic lateral epicondylar tendinopathy (mean duration of symptoms 8 +/- 3 months) were assigned either to a control group (n = 46) or to an eccentrically trained group (n = 46). The control group underwent a passive standardised rehabilitation programme that excluded strengthening exercises. In addition to this programme, the trained group also performed eccentric exercises based on the repetitive lengthening of the active musculo-tendinous unit. The latter exercises started with submaximal contraction intensity and slow speed movement. Modalities were progressively intensified (increase in intensity contraction and speed movement) over a long priod of treatment. Programme effectiveness was assessed through pain score evaluation, a disability questionnaire, muscle strength measurement and ultrasonographic examination. Results: Compared to the non-strengthening control group, the following observations were made in the eccentrically trained group: (1) a significantly more marked reduction of pain intensity, mainly after one month of treatment; (2) an absence of strength deficit on the involved side through bilateral comparison for the forearm supinator and wrist extensor muscles; (3) an improvement of the tendon image as demonstrated by decreasing thickness and a recovered homogenous tendon structure; and (4) a more marked improvement in disability status during occupational, spare time and sports activities. Conclusion: These results highlight the relevance of implementing isokinetic adapted eccentric training in the management of chronic lateral epicondylar tendinopathy. [less ▲]

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Croisier, Jean-Louis ULiege; Ganteaume, S.; Ferret, J. M.

in British Journal of Sports Medicine (2005, June), 39(6), 379

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