Alban Fouasson-Chailloux

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.

Isolated Rupture of the Teres Major Muscle When Water Skiing: A Case Report and Literature Review

Isolated lesions to the teres major muscle are rare. They generally occur in patients participating in sports such as baseball, tennis, or boxing. We report the case of a sports patient who suffered an isolated injury to the teres major while water skiing. The clinical presentation was confirmed by MRI. Conservative treatment was chosen and consisted of brief analgesic immobilization, followed by rehabilitative treatment. The rapid recovery of this patient with normal isokinetic strength evaluation at 6 months was interesting for objectifying full muscle recovery. Our results and the data from the literature suggest that functional rather than surgical treatment is preferable in isolated lesions to the teres major muscle.

Letter to the editorProsthetic joint infection with pseudo-tumoral aspect due to Mycobacterium bovis infection after Bacillus-Calmette-Guerin therapy

Annals of Physical and Rehabilitation Medicine - In Press. Accepted Manuscript Available online since vendredi 8 septembre 2017

Surgical management of lower limb fractures in patients with spinal cord injury less associated with complications than non-operative management: a retrospective series of cases

Objectives: To evaluate the difference in terms of overall complications between surgical and non-surgical management of lower limb fractures in patients with chronic spinal cord injury (SCI). Design: A 13-year retrospective study including patients with chronic spinal cord lesion admitted for sublesional lower limb fractures. Setting: University hospital SCI reference departments (Rehabilitation department and orthopedic department). Participants: Forty patients with SCI were included, 24 men and 16 women. Fifty-six distinct fracture occurrences were responsible for a total of 59 lower limb fractures. We compared the number of overall complications between surgical and non-surgical management of fractures. Results: Non-surgical management was realized for 19 fractures and surgery for 40. Characteristics of operated and non-operated patients at the time of each fracture occurrence did not differ concerning age (P = 0.430), sex (P = 0.890), lesion levels (P = 0.410) and AIS classification (P = 0.790). Data analysis highlighted 20 complications directly due to the fracture site for 16 distinct fractures. Seven medical complications were found in 5 distinct fracture events. Only 10 (25.0%) of 40 surgical managements had at least one medical or post-surgical complication, whereas 12 (63.2%) of 19 non-operative managements had at least one complication. Therefore, the overall rate of complications was significantly higher after non-surgical treatment (P = 0.044). Conclusion: Lower extremity fractures due to osteoporosis in patients with SCI are responsible for local and general complications. When possible, surgery may be the best management to propose because of fewer overall complications.

Severe chronic compression of the spinal cord by a C2 laminar osteochondroma in a 71-year-old woman: A case report.

We present a rare case of a cervical osteochandroma compressing the spinal cord in the context of hereditary multiple exostoses (HME). This complication is one of the most severe in HME because of serious neurologic consequences. Spinal cord compression by an osteochandroma is not frequent, but clinicians must be aware of it because of the potential severe prognosis. A 71-year-old woman was hospitalized in an emergency department because of great difficulties walking and daily falls, so she could not stay home alone. This patient was known to have

Compression médullaire dans un contexte de maladie des exostoses multiples

Mots clés : Maladie des exostoses multiples ; Compression médullaire Introduction.– La maladie des exostoses multiples est une maladie héréditaire à transmission autosomique dominante se caractérisant par la présence d’exostoses. Des complications rares de compression médullaire au décours de l’évolution sont rapportées. Cette atteinte est liée à l’existence d’exostose vertébrale. L’évolution est souvent lente et les premiers symptômes restent peu spécifiques tels les troubles de la marche. Observation.– Une patiente de 71 ans aux antécédents de maladie des exostoses multiples est adressée dans le service via les urgences pour des difficultés croissantes à la marche responsables de chutes à répétition. L’examen clinique retrouve une tétraplégie spastique incomplète prédominant à gauche AIS D de niveau supérieur à C4. La marche s’effectue à l’aide d’un déambulateur depuis quatre ans sur un périmètre de 100 m. L’IRM montre une exostose naissant de la lame droite de C2 à développement endocanalaire, responsable d’une compression médullaire à ce niveau. Devant le risque d’aggravation, il est décidé de réaliser une décompression chirurgicale associée à la résection de l’exostose. Discussion.– L’ensemble des os peut être touché lors d’une maladie des exostoses multiples. Les localisations les plus fréquentes sont au niveau des os longs, notamment autour des genoux et avant-bras. Les complications neurologiques ne sont pas les plus fréquentes, mais sont loin d’être exceptionnelles. Elles sont retrouvées chez 1 à 9 % des patients lors de différentes études. L’atteinte du rachis cervical représente 80 % des atteintes vertébrales et la vertèbre C2 est la plus fréquente. Il est important au cours du suivi de ces patients de rechercher des signes de myélopathie. Devant des troubles de la marche associés à des signes d’atteinte médullaire, l’IRM permet de préciser l’étendue de la lésion et de discuter l’indication chirurgicale.

Spinal cord compression in hereditary multiple exostoses

Introduction.– Rotator cuff tears have a negative impact on the functional prognosis of persons with spinal cord injury subjecting them to further impairments. These tears are inevitably progressive by nature. Objective.– The proposed study was prospective and non-controlled. Its objective was to define the functional, lesional and clinical profiles as well as therapeutic pathways of patients with spinal cord injury seen in medicalsurgical consultation for shoulder pain and/or shoulder-related impairments. Materials and methods.– Twenty-eight patients with spinal cord injury including 23 with paraplegia, were seen in the framework of a specialized consultation due to the importance of their painful shoulder and/or functional impairment. Eighteen out of the 28 subjects had preventive or reconstructive surgery on one or both shoulders. The mean delay between initial injury and rotator cuff surgery was 28 years. Results and discussion.– Surgery became necessary for more than half of the population seen in this consultation. The time to surgery was quite lengthy. Results revealed the relevance of early screening based on a real strategy of multidisciplinary care management. When surgery becomes necessary, an early and as minimally invasive as possible approach would be the most adequate solution. Preventive acromioplasty should also be discussed. Further reading Dyson-Hudson TA, Kirshblum SA. Shoulder pain in chronic spinal cord injury. Part I: epidemiology, etiology, and pathomechanics. J Spinal Cord Med 2004;27(1):4–17. Akbar M, Balean G, et al. Prevalence of rotator cuff tear in paraplegic patients compared with controls. J Bone Joint Surg Am 2010;92(1):23–30.