J. Bordes

Evaluation of surgical treatment for ruptured Achilles tendon in 31 athletes

INTRODUCTION In the past few decades, the incidence of Achilles tendon rupture has increased in parallel with increased sports participation. Although the optimal treatment remains controversial, there is a trend towards surgical treatment in athletes. HYPOTHESIS Surgical repair of ruptured Achilles tendon in athlete results in good functional and objective recovery, irrespective of the type of surgery performed. Subsidiarily, are the results different between percutaneous surgery (PS) and standard open surgery (OS)? MATERIALS AND METHODS This was a cross-sectional study of 31 patients who presented with a ruptured Achilles tendon that occurred during sports participation. Percutaneous surgery was performed in 16 patients and open surgery in 15 patients between 2005 and 2009. The objective recovery status was evaluated by open chain goniometry, measurement of leg muscle atrophy and assessment of isokinetic strength. The functional analysis was based on the delay, level of sports upon return, AOFAS and VAS for pain. RESULTS Our series of Achilles tendon rupture patients consisted of 88% men and 12% women, with an average age of 38 years. In 71% of cases, the rupture occurred during eccentric loading. After a follow-up of 15 months, the muscle atrophy was 13 mm after PS and 24 mm after OS (P=0.01). A strength deficit of 19% in the plantar flexors was found in the two groups. No patient experienced a rerupture. The return to sports occurred at 130 days after PS and 178 days after OS (P=0.005). The average AOFAS score was 94 and the VAS was 0.5. There were no differences in ankle range of motion between the two groups. The majority (77%) of patients had returned to their preinjury level of sports activity. DISCUSSION The return to activities of daily living was slower in our study than in studies based in Anglo-Saxon countries; this can be explained by the different sick leave coverage systems. Percutaneous surgery resulted in a faster return to sports (about 130 days) and less muscle atrophy than open surgery. Our results for return to sports and return to preinjury levels were similar to published results for athletes and were independent of the type of surgery performed. The AOFAS score was comparable to published studies. We found no difference in muscle strength between the two surgery groups 15 months after the procedure. Apart from venous thrombosis typically described after lower-limb immobilization, secondary postoperative complications mostly consisted of sural paresthesia, which had resolved at the 15-month postoperative follow-up evaluation. CONCLUSION The results of surgical treatment for ruptured Achilles tendon are good overall. By combining the simplicity of conservative treatment and the reliability of standard surgical treatment, percutaneous surgery is the treatment of choice to achieve excellent results. The return to sports occurred earlier, the muscle atrophy was less and the functional score was better in our patients treated by percutaneous surgery. LEVEL OF EVIDENCE Level IV.

Long-term transanal irrigation's continuation at home. Preliminary study

OBJECTIVE To determine the long-term outcome of Peristeens home use. METHOD Retrospective study on the 16 first patients treated by Peristeen in the department of physical and readaptation medicine of Limoges universitary hospital, by the mean of phone interviews. RESULTS Successful outcome was achieved in 62.5% patients after a mean follow-up of 2.6 years. All patients had neurogenic bowel disorders, including 75% of constipation. Most of cases of Peristeen discontinuation occurred at the treatment beginning, one month after introduction in two thirds of cases. In patients who were still using transanal irrigation (TAI), mean grade of satisfaction with the Peristeen system was 9.12/10, despite the high rate of technical problems (77.8% of cases). CONCLUSION This study highlights the limits of Peristeens long-term using and suggests the interest of a specific therapeutic education to Peristeen and of a systematic control consultation within the 3 first months of treatment.

Experience with a process for acquiring assistive technology devices with testing in a semi-ecological situation

Assistive technology (AT) refers to ‘‘any product (including any item, piece of equipment, instruments, technology and software) specially manufactured or existing on the market intended to prevent, to compensate, to control, to alleviate or neutralize deficiencies, activity limitations and participation restrictions’’ (International Organization for Standardization [ISO]: https:// www.iso.org/fr/standard/60547.html). The French National Authority for Health recommends a process for AT acquisition based on a multidisciplinary assessment of the disability and requirements of the disabled person [1]. Nevertheless, we lack a consensus method or any universal method for such acquisition. The acquisition of AT by a person in a disability situation involves complex mechanisms respecting the requirements and the acceptance of the AT [2,3]. Moreover, numerous obstacles include lack of finances and no way to test the AT in an ecological situation. Not many studies have assessed the effectiveness of the process of AT acquisition [4]. The AT tools have been well described [5,6]. Knowledge of the reasons for the non-acquisition and abandonment of AT is essential to improve the acquisition process. The description of what some teams have done could improve the practices [4]. In the department of physical medicine and rehabilitation (PM&R) of Centre Hospitalier et Universitaire Limoges (CHU Limoges), our AT acquisition process includes a multidisciplinary recommendation and testing in an semi-ecological situation. However, the efficiency of this process is unclear. In this context, we sought to share our experience and reflections on this subject. Our recommendation procedure involves 3 phases:

Outcome 4 years after non-operative and operative treatment of posterior cruciate ligament (PCL) injuries

taux optimum de vitamine et seulement 14 % une hypovitaminose. L’année suivante en février 2012 et juin 2012, nous avons retrouvé des chiffres similaires. Après supplémentation en novembre 2012, 94 % des sujets présentaient un taux supérieur à 30 ng/mL en février 2013. Discussion.– Comme Galan [1] l’avait déjà démontré en 2012, un taux sériqu de 25(OH)D3 d’environ 48,5 ng/mL est nécessaire à la mi-octobre pour assurer suffisance en vitamine D 30 ng/mL au début de février. La pratique intensive d’un sport d’extérieur n’exclut pas le risque d’hypovitaminose D, d’autant plus que les patients sont d’origine africaine. Il serait intéressant de corréler ces résultats aux apports quotidiens en vitamine D et calcium du sportif. Conclusion.– Les footballeurs professionnels ont un risque élevé d’hypovatimanose D, majoré chez les footballeurs de d’origine africaine, bien qu’ils pratiquent un sport intensif en extérieur. Cette réflexion attire des questions sur le statut vitaminique du sportif. Cela mériterait de poursuivre notre étude sur une éventuelle relation avec les blessures et la contre-performance. Référence [1] Galan F. Serum25-hydroxyvitamin D in early autumn to ensure vitamin D sufficiency in mid-winter in professional football players. Clin Nutr 2012;132–6.

Devenir à quatre ans après rupture du ligament croisé postérieur (LCP) opéré et non opéré

CO21-001-f Devenir à quatre ans après rupture du ligament croisé postérieur (LCP) opéré et non opéré J. Bordes *, C. Coste , R. Jallageas , J.Y. Salle , C. Mabit , J.C. Daviet d a CHU de Bordeaux, service de médecine physique et réadaptation, hôpital Tastet-Girard, CHU Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux, France b Clinique Chénieux, 18, rue du Général-Catroux 87000 Limoges, France c CHU de Rennes, Pontchaillou, service de médecine physique et réadaptation, 2, rue Henri Le-Guilloux, 35000 Rennes, France d CHU Dupuytren, service de médecine physique et réadaptation, hôpital Jean-Rebeyrol, avenue du Buisson, 87000 Limoges, France e CHU Dupuytren, service de chirurgie orthopédique et traumatologique, 2, rue du Docteur-Marcland, 87000 Limoges, France *Auteur correspondant. Adresse e-mail : Jeremie.bordes@chu-bordeaux.fr

Efficiency of cough: Maximum phonation time: Bedside assessment

patient, a student performed the test of swallowing one another and the same test associated with cervical auscultation. The alternation between students for the test is performed with or without auscultation eliminates the ‘‘test effect’’. No information was communicated between students among themselves and with the doctor. The results are presented in the form of ROC curves established according to the use or not of auscultation during the test food. Cervical auscultation does not change the area under the curve. The trend is even reversed with a decrease in performance with the severity of silent aspiration. Thus, auscultation did not improve the performance of the test food in terms of predicting aspiration in the learning phase of swallowing tests by two students in speech therapy. The same study is now complete with experienced pathologists.