Christophe Daniel

Return-To-Play criteria after hamstring injury: actual medicine practice in professional soccer

Background Return-to-play (RTP) criteria after a sport injury represent a key point in order to decrease the risk of subsequent re-injury. Objective To analyze how clinicians decide, in their daily practice, when a hamstring injured professional soccer player is fully able to get back to competitive activities. Methods Thirty-seven doctors for French and Belgian professional soccer clubs filled in a questionnaire formulated with multiple choice questions. Results Nearly 80% of the questioned doctors declared to use at least 7 criteria in order to assess players ability to return to competitive soccer after a hamstring injury. The most important ones are: complete pain relief, normalized muscle strength assessment, subjective feeling reported by the player, normalized flexibility and achievement of a specific soccer test. For some of these criteria, most notably muscle strength assessment, there is a lack of consensus about the choice of assessment parameters and the limit value allowing doctors to authorize or forbid RTP. Our study also highlighted the interest for clinicians to consider the opinion of physical therapists and physical trainers. Conclusion After a hamstring injury, clinicians for professional soccer clubs assess players ability to return to full sport according to a “criteria-approach” instead of a “timed-based” approach. However, even if the scientific evidence about this topic is not sufficient at the moment, the implementation, in daily practice, of scientifically demonstrated assessment parameters and limit values should help the RTP decision and decrease the risk of re-injury.

PLATELET-RICH PLASMA (PRP) TO TREAT CHRONIC UPPER PATELLAR TENDINOPATHIES

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 process,1 clinical series are subject to controversy.2 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).

Early Clinically Relevant Improvement in Quality of Life and Clinical Outcomes 1 Year Postsurgery in Patients with Knee and Hip Joint Arthroplasties.

Objective To measure and identify the determinants of the outcomes after hip/knee arthroplasty (HA/KA) in patients with osteoarthritis during the first postsurgical year. Design In this prospective observational study, we evaluated the preoperative and postoperative (3, 6, and 12 months) outcomes of 626 patients who underwent HA (346 with median age 65 years, 59% female) or KA (280 with median age 66.5 years, 54% female) between 2008 and 2013. Generic and specific tools were used to measure health-related quality of life (HRQoL) and utility. Good outcome was defined as an improvement in WOMAC (Western Ontario and McMaster Universities Osteoarthritis Index) greater than or equal to the minimal important difference (MID). Regressions were performed to evaluate the relationship between preoperative and postoperative measures and evolution of WOMAC/good outcome. Results We observed an almost systematic improvement of all parameters for up to 12 months, but especially at the 3-month follow-up. The low number of comorbidities and the absence of postoperative complications were the common determinants of improvement of WOMAC total score after 12 months. Other parameters (background of the joint, preoperative function and length of hospital stay in KA group; place of discharge in HA group) affected the evolution of WOMAC scores. 87.09% of HA and 73.06% of KA patients experienced a good outcome. A small number of comorbidities, a worse preoperative function, a shortened hospital stay (KA only), and an absence of early postoperative complications (HA only) significantly predicted a good outcome. Conclusions Intermediate HRQoL following HA or KA improved quickly from preoperative levels for all instruments. More than 70% of patients achieved a good outcome defined as improved pain, stiffness and disability and the predictors are slightly close.