[PRP and knee osteoarthritis]. / Plasma riche en plaquettes et gonarthrose.

Knee osteoarthritis is a common degenerative disease. The functional impact on patients can be major. Platelet-rich plasma (PRP) is a platelet concentrate obtained by centrifugation of a blood sample rich in growth factors. Once injected into the joint, they induce a natural cascade that can lead to a stimulation of the potential regenerative capacity of cartilage. The effectiveness of PRP in knee osteoarthritis is debated, but recent studies exist. The aim of this article is to provide a relatively exhaustive summary. The results of our review tend to demonstrate that intra-articular injections of PRP have an important, allowing a significant analgesic effect and functional improvement.

La gonarthrose est une maladie dégénérative fréquente. Les répercussions fonctionnelles pour les patients peuvent être majeures. Le plasma riche en plaquettes (PRP) est un concentré plaquettaire obtenu par centrifugation d'un échantillon de sang riche en facteurs de croissance. Une fois injectés dans l'articulation, ils induisent une cascade naturelle conduisant à une stimulation des potentielles capacités de régénération du cartilage. L'efficacité du PRP dans la gonarthrose reste débattue mais des études récentes existent. Le but de cet article est de les résumer de manière relativement exhaustive. Les résultats de notre synthèse tendent à démontrer que les injections intra-articulaires de PRP ont une place importante, permettant un effet antalgique et une amélioration fonctionnelle significatifs.

Predictive Factors of Recovery after an Acute Lateral Ankle Sprain: A Longitudinal Study.

A prominent feature of ankle sprains is their variable clinical course. The difficulty of providing a reliable early prognosis may be responsible for the substantial rate of poor outcomes after an ankle sprain. The aim of the present study was to evaluate the prognostic value of objective clinical measures, pain, and functional scores for ankle sprain recovery. Fifty-two participants suffering from lateral ankle sprain were included. Sprain status was assessed four weeks following injury and included evaluations of ankle range of motion, strength, function, and pain. Seven months following injury, a second assessment classified the patients into recovered and non-recovered groups using ankle ability measures. Following a predictor pre-selection procedure, logistic regressions evaluated the association between the four-week predictors and the seven-month recovery status. Twenty-seven participants (52%) fully recovered and 25 did not (48%). The results of the logistic regressions showed that walking pain was negatively associated with the probability of recovering at seven months (odds ratio: 0.71, 95% CI: 0.53-0.95). Pain four weeks after ankle sprain had relevant predictive value for long-term recovery. Special attention should be paid to patients reporting persistent pain while walking four weeks following sprain to reduce the risk of chronicity.

Epidemiology of injuries in professional ice hockey: a prospective study over seven years.

BACKGROUND: Ice hockey injuries epidemiology is still poorly understood and very few studies are focused on it, especially about professional players. METHODS: Our prospective study collected all injuries occurring on ice during practice and games over 7 years (2006-2013) in a professional hockey team playing in the 1st division championship in Switzerland. RESULTS: During the 7 seasons, we recorded a total of 525 injuries and 190 injuries with time loss (TL). Mean injuries incidence was 5.93 (95% CI 5.28 to 6.27) injuries/1000 h/player and with time loss 2.14 (95% CI 1.79 to 2.39) injuries/1000 h/player. The lower limb was the most affected part of the body, with a total of 40.4% of all injuries, mostly knee Medial Collateral Ligament tear and muscle adductors/abdominal sprain. For the upper limb, shoulder was the most affected joint with mostly acromioclavicular sprain and shoulder dislocation. Forwards had a significant (p < 0.05) higher risk than defensemen for knee Medial Collateral Ligament (MCL) tear. There was no significant difference in the concussion risk between forwards and defensemen, but defensemen had a significant higher risk (p < 0.05) to have a more severe concussion. CONCLUSION: This study provides a better understanding about professional ice hockey epidemiology, which is still insufficiently researched and understood. We also found some significant risk factors, being a forward for knee MCL tear, being a defensemen for concussion severity. Concussion program prevention seems to be effective but it is crucial to continue the follow up of concussion on long term and expand the surveillance system to all the League.

[Lower limb muscle injury prevention]. / Prévention des lésions musculaires des membres inférieurs.

Muscle injuries are one of the most common injuries in professional and recreational sports. Their impact on absence during the games is therefore major. There are many risk factors, the main ones being a previous muscle injury, a lack of strength in the muscle in question, and the age of the athlete. Preventive medicine in this field, although essential, remains perfectible and the various preventive measures are sometimes not fully studied, or present variable evidence. Stretching, neuro-muscular exercises, muscle strengthening, nutrition or genetics can all be part of the most comprehensive preventive possible approach.

Les lésions musculaires sont l'une des blessures les plus fréquentes dans la pratique sportive professionnelle et de loisir. Leur impact sur les absences de terrain est donc majeur. Les facteurs de risque sont nombreux, avec comme facteurs principaux un antécédent de lésion musculaire, un déficit de force du muscle considéré, ainsi que l'âge du sportif. La médecine préventive dans ce domaine, pourtant essentielle, reste encore perfectible et les différentes mesures de prévention sont parfois très peu étudiées, ou présentent des évidences variables. Le stretching, les exercices neuromusculaires, le renforcement musculaire, la nutrition ou la génétique peuvent tous participer à une approche préventive la plus globale possible.

Electrocardiographic findings in elite professional cyclists: The 2017 international recommendations in practice.

OBJECTIVES: To categorize ECG findings into normal, borderline or abnormal in a team of professional elite cyclists according to the 2017 international recommendations. DESIGN: A cross-sectional study was performed. METHODS: Twelve-lead ECGs collected between 2012 and 2015 as part of an annual routine examination for a team of professional elite cyclists were analysed, and findings classified as normal, borderline or abnormal according to the 2017 recommendations. Information on exercise capacity testing was also collected. RESULTS: A total of 43 professional cyclists, all Caucasian males ranging between 21 and 38years of age, were included. Given most were followed up for multiple years, a total of 103 ECGs were collected. Normal variations were found in 43 (100%) athletes; borderline findings in 4 (9.3%), and 2 (4.7%) athletes had abnormal findings. No pathology was identified on further investigation of the four cyclists with two concurrent borderline or any abnormal ECG findings, reflecting a false positive rate of 9.3%. CONCLUSIONS: In this team of professional cyclists, the prevalence of abnormal ECG findings requiring further investigation, and the false positive rate were low, despite a very high prevalence of normal variations expected in athletes. This may be as a result of heightened specificity of the new international recommendations for ECG interpretation in athletes.

[Return to sport and to competition after anterior crusiate ligament reconstruction.] / Retour au sport et à la compétition après reconstruction du ligament croisé antérieur.

The return to sport (RTS) and return to competition (RTC) after anterior cruciate ligament reconstruction (ACLR) in the recreational and professionnel sports population remains a challenge. Previous level of activity, associated injuries, the type of reconstruction, and rehabilitation associated factors such as strength, neuromuscular control, and mobility all influence the RTS and RTC. Psychologic aspects, overall fitness, and patient's expectations equally play an important role. ACLR rehabilitation needs ideally a multi-disciplinary setting and follows functional steps rather than chronological time-lines, with passing criteria until RTS and RTC. Standardized and sport-specific tests are mandatory to evaluated optimal readiness for RTS and RTC.

Le retour au sport (RTS) et à la compétition (RTC) du patient sportif amateur ou d'élite après une reconstruction du ligament croisé antérieur (RLCA) est une décision importante qui nécessite un avis éclairé et partagé entre les différents intervenants dans le traitement. Le niveau et le type d'activité prélésionel, les facteurs liés à la blessure comme les lésions associées, le type de réparation, et ceux liés à la rééducation comme la force, les compétences neuromusculaires et la mobilité influencent tous le RTS et le RTC, sans compter les aspects psychologiques, le niveau de fitness, les attentes et la situation personnelle du patient. La rééducation se fait par étapes fonctionnelles avec des critères de passage jusqu'au RTS et RTC, en collaboration multidisciplinaire. Des tests standardisés et spécifiques au sport pratiqué sont finalement nécessaires pour valider l'aptitude au retour au sport et à la compétition.

Effect of Wii Fit™ exercise therapy on gait parameters in ankle sprain patients: A randomized controlled trial.

Ankle sprains are the most common sport related injuries. An alternative to physical therapy in the treatment of ankle sprains is home based exercise therapy. This study aims to compare the effectiveness of Wii Fit™ exercise therapy in ankle sprain patients on temporal-spatial and kinematic gait parameters with a) conventional therapy and b) a control group not receiving exercise therapy. Ninety patients were randomly assigned to a Wii Fit™, physical therapy or control group. Temporal-spatial and kinematic gait parameters were assessed at baseline, 6 weeks and 6 months follow-up. All groups improved gait speed, cadence and step length between baseline and 6-week follow-up (P<0.036). Single support time improved only in the Wii Fit™ group (P<0.001). Symmetry index of the single support time improved in the Wii Fit™ group and physical therapy group (P<0.048). No between-group differences were found for temporal-spatial gait parameters (P>0.050). Maximum plantar flexion improved in the physical therapy and control group between baseline and 6-week follow-up (P<0.035). However, none of the groups improved dorsiflexion (P>0.050). In conclusion, an unsupervised home-based 6-week Wii Fit™ exercise therapy can be applied in ankle sprain patients. However, it was not more effective compared to physical therapy or no exercise therapy at all.

[Sport-related concussion]. / La commotion cérébrale dans le sport.

Sport-related concussion is a frequent and complex pathology whose physiopathological mechanisms are not completely understood yet. A recent consensus statement has been published with the objective to provide practicioners with an overview of literature and give some guidelines based on the current state of knowledge. An 11R approach (Recognise, Remove, Re-evaluate, Rest, Rehabilitation, Refer, Recover, Return to sport, Reconsider, Residual effects and sequelae, Risk reduction) is proposed to evaluate and manage sport-related concussion. There is currently no available test predicting recovery, but the risk factors for a slow recovery are now known. Return to daily activities (as school) and to full sport participation should follow the graduated return-to-school or - sport strategy, and the ultimate decision is clinically based, and made by the physician.

La commotion dans le sport est une pathologie fréquente, complexe et dont les mécanismes physiopathologiques ne sont pas encore entièrement élucidés. Un consensus international vient récemment d'être publié avec une mise à jour des connaissances scientifiques, fournissant des conseils pour le médecin de terrain. L'évaluation et la prise en charge de la commotion se résument par les 11 R : Reconnaître, Retirer, Réévaluer, Repos, Réhabilitation, Référer, Récupérer, Retour au sport, Reconsidérer, séquelles et symptômes Résiduels, prévention du Risque. Il n'existe à ce jour aucun test pouvant prédire l'évolution de la commotion, mais certains facteurs sont reconnus comme responsables d'une récupération lente. Le retour à l'école et au sport est une décision médicale, après avoir suivi un protocole de réhabilitation progressive.

[Female athlete triad : what's new ?] / Triade de l'athlète féminine : quoi de neuf ?

The Relative Energy Deficiency in Sport has been suggested as the new and wider denomination of the Female athlete triad. This new terminology enables a wider approach to the different consequences of an insufficient energy intake amongst regular athletes. In fact, this energy dysbalance leads to a wider pathological phenomenon touching many systems (e.g. cardiovascular, psychological, hematological…). This designation is no longer restricted to the female gender, and now also includes men, whom are nowadays less affected or maybe only less assessed. This syndrome is still unknown to most primary care physicians and specialists, thereby its incidence and prevalence is probably greatly underestimated.

Le Relative Energy Deficiency in Sport (RED-S) a été proposé comme nouvelle dénomination plus large de la triade de l'athlète féminine. Ce nouveau terme introduit une vision plus globale des atteintes liées à une insuffisance d'apport calorique lors de la pratique régulière d'un sport. En effet, le RED-S amène d'autres implications physiologiques en lien avec un déséquilibre énergétique (atteintes cardiovasculaire, psychologique, hématologique…). De plus, cette appellation ne se restreint plus au sexe féminin, mais intègre également le genre masculin, toutefois encore relativement peu touché ou alors sous-évalué. Cette problématique reste encore méconnue de la plupart des médecins de premier recours et de certains spécialistes, ainsi son incidence et sa prévalence sont très probablement encore largement sous-estimées.

Gait and physical impairments in patients with acute ankle sprains who did not receive physical therapy.

OBJECTIVE: To assess ankle function 4 weeks after conservative management and to examine the correlation of function with gait. DESIGN: A prospective comparison study. PATIENTS: Thirty patients with grade I or II acute ankle sprains were followed up after 4 weeks of conservative management not involving physical therapy. METHODS: Participants underwent a clinical assessment and had to walk at a normal self-selected walking speed. Their results were compared with the data of 15 healthy subjects. MAIN OUTCOME MEASURES: Participants' joint swelling, muscle strength, passive mobility, and pain were assessed. In addition, patients' temporal-spatial, kinematic, and kinetic gait data were measured while walking. RESULTS: Muscle strength and passive mobility were significantly reduced on the injured side compared with the noninjured side (P < .001). During gait analysis, patients with ankle sprains showed slower walking speed, shorter step length, shorter single support time, reduced and delayed maximum plantar flexion, decreased maximum power, and decreased maximum moment (P < .050) compared with healthy persons. Decreased walking speed was mainly correlated with pain (R = -0.566, P = .001) and deficits in muscle strength of dorsiflexors (R = 0.506, P = .004). CONCLUSION: Four weeks after an ankle sprain, patients who did not receive physical therapy showed physical impairments of the ankle that were correlated with gait parameters. These findings might help fine-tune rehabilitation protocols.

[The sports preparticipation medical screening]. / L'examen médical de préparticipation d l'activité sportive.

Globally, populations are more and more physically active in western countries, also participating in competitions, even if not professionally. The main goals of the sports preparticipation screening is to detect conditions that may predispose to injuries, may cause sudden death, or trigger worsening in preexisting conditions. In Switzerland, primary care physicians are regularly confronted to it. The requests mainly come from people practicing sports in bordering countries, where the examination is mandatory, or from people concerned with their health. This article reviews the essential points of this examination, mainly consisting in history taking and physical examination. On a cardiovascular point of view, it details the main differences between the European and the American recommendations regarding athletes between 12 to 35 years old and those older.

[Medical certification for high altitude travel and scuba diving]. / Certificats médicaux pour les séjours en haute montagne et la plongée sous-marine.

People are more and more looking for adventures and discovery of unusual locations. Journeys to high altitude and scuba diving are part of these activities and their access has become easier for a lot of people not necessarily experienced with their dangers. The general practitioner will have to be able to deliver some advices and recommendations to his patients about the risks related to these activities and their ability to practice them. He will also have to deliver some certificates of medical fitness to dive. This paper proposes a brief review of the most important medical aspects to know about high altitude and scuba diving.

[Rehabilitation after rotator cuff repair: developments and recommendations]. / Rééducation après chirurgie de la coiffe des rotateurs: développements et recommandations.

Rehabilitation post surgical repair of the rotator cuff is an important determinant of the quality of the healing process, and of the clinical and functional results. Techniques used have been reported to favor certain of those parameters at the expense of others. Several approaches have been proposed; none has reached a consensus yet. The level of evidence in the literature does not allow for definitive recommendations and elaborating a protocol relies on clinical experience as well as expert opinion, incorporating scientific data. An initial period of rest with limited passive motion emerges though as an approach suited to the treatment of most clinical situations.

[Scapular dyskinesis]. / Dyskinésie de l'omoplate.

The scapula plays a crucial role for proper shoulder function, serving as a stable base for rotator cuff activation and as a link in the kinetic chain. Joint, ligament or muscular problems near the scapula can lead to malpositions or to an altered movement pattern. This abnormal situation is called "scapular dyskinesis", which appears to be a non-specific response to a painful condition of the shoulder. The clinical examination of the scapula is crucial for every patient presenting a painful shoulder. Systematic observation and testing enable the practitioner to detect subtle static and dynamic abnormalities. Visual evaluation, objective measurements and corrective manoeuvres can evaluate the role of the "scapular dyskinesis" in the shoulder painful condition. The scapular rehabilitation will address muscular retractions and imbalances and restore a good dynamic stability, starting with analytical work, and evolving into more functional and specific exercises.

[Achilles tendon disorders: etiology and management]. / Lésions du tendon d'Achille chez le "sportif": etiologie et prise en charge.

The disorders of the Achilles tendon, acute or chronic, are common among the physically active subject. We will treat successively chronic tendinopathies due to overuse, and then acute ruptures. Predisposing intrinsic or extrinsic factors have to be systematically identified if present, because taking them into account for the treatment will be important. The diagnosis of Achilles lesions remains clinical in a first step, either in acute cases or in chronic ones. The therapeutic options will be systematically discussed for the 2 entities, guided on validated evidence-based studies.

[Benefits of physical activity]. / Les bienfaits de l'activité physique (et/ou les méfaits de la sédentarité).

With the evolution of the development of knowledge and progress in automatic technologies, the human society gradually turned into a sedentary population. It is moreover clearly established that the physical activity is insufficient in Europe and in the developed countries. The physical activity is certainly beneficial for many reasons, but it is especially the inactivity which is dangerous. To date, many scientific publications showed the benefits of the physical activity as well in the treatment of chronic diseases as in the prevention of those diseases. The objective of this article is, on the one hand, to show the concrete influence of the physical activity as a treatment, and on the other hand to briefly review its impact on different systems of the human organism.

[Sports injuries and NSAID]. / Anti-inflammatoires non stéroïdiens: utilisation en médecine du sport.

Sports medicine physicians often treat painful athletes with non steroidal anti-inflammatory drugs (NSAID). However, there is a lack of high-quality evidence to guide them and the adverse effects of those medications have clinical relevance. Moreover, their potential negative consequences on long-term healing process are slowly growing. This article reviews some practical management guidelines with NSAID drawn to assist sports physicians in frequent sports-related injuries. We do not recommend their use in muscle injuries, bone fracture or stress fracture, neither in tendinopathies. In all the cases, if used, length of NSAID treatment should always be kept as short as possible, with considerations of the specific type of injury, level of dysfunction and pain.

Mitofusins 1/2 and ERRalpha expression are increased in human skeletal muscle after physical exercise.

Mitochondrial impairment is hypothesized to contribute to the pathogenesis of insulin resistance. Mitofusin (Mfn) proteins regulate the biogenesis and maintenance of the mitochondrial network, and when inactivated, cause a failure in the mitochondrial architecture and decreases in oxidative capacity and glucose oxidation. Exercise increases muscle mitochondrial content, size, oxidative capacity and aerobic glucose oxidation. To address if Mfn proteins are implicated in these exercise-induced responses, we measured Mfn1 and Mfn2 mRNA levels, pre-, post-, 2 and 24 h post-exercise. Additionally, we measured the expression levels of transcriptional regulators that control mitochondrial biogenesis and functions, including PGC-1alpha, NRF-1, NRF-2 and the recently implicated ERRalpha. We show that Mfn1, Mfn2, NRF-2 and COX IV mRNA were increased 24 h post-exercise, while PGC-1alpha and ERRalpha mRNA increased 2 h post-exercise. Finally, using in vitro cellular assays, we demonstrate that Mfn2 gene expression is driven by a PGC-1alpha programme dependent on ERRalpha. The PGC-1alpha/ERRalpha-mediated induction of Mfn2 suggests a role of these two factors in mitochondrial fusion. Our results provide evidence that PGC-1alpha not only mediates the increased expression of oxidative phosphorylation genes but also mediates alterations in mitochondrial architecture in response to aerobic exercise in humans.

[Chronic exertional compartment syndrome (CECS)]. / Le syndrome chronique de loge à l'effort (SCLE).

The chronic exertional compartment syndrome (CECS) consists of a disturbance of the muscular function of a compartment related to a rise in the intramuscular pressure of the aforementioned compartment, during an exercise. The most frequent location of this pathology is the leg. The 2 parts of this article are treating the subject. The clinical presentation is often not very specific and the realization of complementary investigations is essential to confirm the diagnosis. Among those, the measurement of the intramuscular pressures of all the compartments potentially accused, at rest, during an effort and especially in phase of recovery, represents the determining criteria. The physiopathological mechanisms implied in the syndrome and currently recognized, are also the object of this 1st part.