Emergency reconstruction of extensor terminal slip defect by tendon plasty.

INTRODUCTION: We report our experience with a tendon plasty technique to reconstruct extensor terminal slip defect, with results in 11 patients. MATERIAL AND METHODS: The technique was proposed to 11 patients with mean tendon defects of 6 mm. Mean follow-up was 10.6 months. Clinical assessment comprised active distal interphalangeal (DIP) range of motion, active DIP extension and spontaneous DIP extension deficit. RESULTS: Mean range of motion was 50°. Active extension was restored in all cases. There was a mean 11° spontaneous DIP extension deficit. DISCUSSION: The present results confirmed those in the literature for this type of tendon plasty. As well as these encouraging outcomes, the technique has the advantage of being simple, with low morbidity thanks to remote harvesting.

Clinical relevance of 3D gait analysis in patients with haemophilia.

Haemophilia is characterized by a congenital deficiency of clotting factor VIII or IX. One of the consequences of haemophilia is joint bleedings. Repetitive haemathroses induce cartilage damage and chronic synovitis leading to joint deterioration, and to definitive haemophilic arthropathy which is source of walking disability. Three-dimension gait analysis (3DGA) appears particularly relevant in the case of haemophilia because it allows an evaluation of several joints in weight-bearing situations. The purpose of this study was to review the interest and the contribution of 3DGA in the management of patients with haemophilia. The greatest interest of gait analysis would be to detect early walking changes with a non-invasive and well-tolerated examination, especially in paediatric population. In adulthood, this technic may be also useful to help detect walking worsening in patients known to have already arthropathy. However, it takes time to realize and needs expensive equipment, which limits its possibility of routine use. Although generalizations of these results remain difficult, especially to compare patients with haemophilia to normal population. Indeed, in the studies, patient groups are small and usually heterogeneous in terms of age and target joints. It certainly results of the rarity of the disease. So, it could be interesting to perform a study with a larger cohort in order to allow subgroup analysis, helping to define clearly the place of 3DGA in the strategy of haemophilia evaluation.

Cutoffs of isokinetic strength ratio and hamstring strain prediction in professional soccer players.

Hamstring strain injuries frequently occur during professional soccer practice. Low hamstring strength represents an intrinsic modifiable risk factor but cutoffs of isokinetic knee strength ratios are controversial to predict hamstring strain in professional soccer players. We aimed to predict hamstring strain in accordance with cutoffs of isokinetic knee strength ratios. Bilateral, conventional, and functional isokinetic strength ratios were calculated in 194 professional soccer players at the beginning of 15 consecutive seasons. 36 soccer players presented a moderate hamstring strain and 158 were not injured. The different calculated isokinetic ratios were compared with the right and left limb of the uninjured population. Different usual cutoffs were tested: at 0.85 and 0.90 for the bilateral concentric and eccentric hamstring-to-hamstring ratio, at 0.60 and 0.47 for the conventional hamstring-to-quadriceps ratio and at 0.80 and 1 for the mixed hamstring-to-quadriceps ratio. The specific ratios for the studied population were also determined by the 10th percentile and then tested. Hamstring strain prediction was established in terms of odds ratios. No cutoff with bilateral, conventional, or functional isokinetic strength ratio was predictive of hamstring strain after univariate analysis. Specific cutoffs determined from the studied population were not more predictive. Very few injured soccer players presented values under the cutoffs at 0.47 for the conventional ratio and at 0.80 for the mixed ratio. Regardless of their values, cutoffs of isokinetic strength ratios were not predictive of hamstring injuries. The use of isokinetic cutoffs is not recommended to predict hamstring muscle strain in professional soccer players.

Test-retest Reliability of GPS derived Measurements in Patients with Claudication.

OBJECTIVE: In patients with peripheral artery disease (PAD), the different distances between stops and the stop durations recorded with Global Positioning System (GPS) during a 1 hour stroll in the community are highly variable. Nevertheless, the reliability of the greatest community walk distance (greatest distance), the average of walking speeds (average speed) and the durations of stops (average stop durations) have not been studied. DESIGN: Seventeen PAD patients performed two series of evaluations (T1 and T2) within a 1 month period. METHODS: Each series included: a 1 hour stroll in the community with the calculation of the walking impairment questionnaire (WIQ) scores, the measurement of maximal walking distance on a treadmill (MWD on treadmill) and a 1 hour stroll in the community with GPS. The Garmin GPS-60 (Garmin Ltd, Olathe, Kan) receiver was used for all patients. Test-retest reliability of MWD on treadmill, WIQ, and GPS parameters were assessed with intraclass coefficient of correlation (ICC). RESULTS: ICCs are almost perfect between T1 and T2 for greatest distance (ICC = 0.911), average speed (ICC = 0.905), and MWD on treadmill (ICC = 0.992), and substantial for the average WIQ (ICC = 0.794). Correlation of average stop durations was considered substantial (ICC = 0.691). CONCLUSIONS: Despite the previously reported "within stroll" variability of walking bouts for distances, speeds, and stop durations, GPS derived greatest distance and average speed are reliable in PAD patients in test-retest experiments. The GPS appears to be a new tool to assess walking limitation and allows objective clinical investigation.

Muscular isokinetic strength recovery after knee anterior cruciate ligament reconstruction revision: preliminary study.

METHOD: Thirty-nine revision of ACL reconstructions were evaluated: 23 primary ACL reconstructions with bone-patellar tendon-bone graft (BPTB) revised with hamstring tendon (HT) grafts, 10 primary ACL reconstructions with HT grafts revised with ipsilateral BPTB graft (iBPTB) and finally 6 primary ACL reconstructions with BPTB grafts revised with contralateral BPTB (cBPTB) grafts were compared with 78 primary ACL reconstructions (46 HT grafts and 32 BPTB grafts). Recovery of isokinetic muscle strength was evaluated at 4, 6 and 12 months post-revision surgery. RESULTS: Deficits in muscle strength at 12 months post-revision ACL surgery were comparable to the one observed for primary ACL reconstruction with the same technique. At 4 and 6 months post-surgery, strength deficits for the knee extensors were less pronounced after revision ACL reconstruction with HT grafts (25%±16 vs. 37%±16; P<0.001) and iBPTB grafts (41%±11 vs. 17%±17; P<0.001). DISCUSSION: Lower strength deficits for the knee extensors after revision ACL reconstruction with HT grafts can be explained by a less intensive rehabilitation program due to lower stakes in resuming sport activities. With cBPTB, donor-site morbidity could explain the decreased strength deficits for knee extensors. CONCLUSION: Deficits in isokinetic muscle strength after ACL revision seem similar to the ones observed after primary ACL reconstruction with the same surgical technique.