Sports clinic Paris
Metro: Saint Marcel
Parking 6 rue test
The information provided on this website is provided by medical professionals: sports doctors, rheumatologists, functional rehabilitation doctors, orthopedic, clinical surgeons sport, podiatrist sports meeting within the group "chirurgiedusport.com"
The main objective of this study was to present a synthesis of the current literature in order to provide a useful tool for clinicians in radiological analysis of the meniscus. The magnetic resonance imaging (MRI) is the most accurate and least invasive for the diagnosis of meniscal tears. This technique has revolutionized the imaging of the knee and has become the "gold standard" for imaging the meniscus. It confirms and characterize the meniscal lesion, type, extension, its possible association with a cyst meniscal extrusion, assessment of cartilage and subchondral bone. All anatomical descriptions were clearly illustrated in this articleby MRI, arthroscopic and / or drawings. We also described standard radiography for differential diagnosis as osteoarthritis. Ultrasound is often used as a diagnostic tool for meniscal pathology. CT arthrography with multiplanar reconstructions can detect some cracks not visible meniscus on MRI. CT arthrography is also useful in case of against-MRI in the postoperative evaluation of meniscal sutures or for analysis cartilage covering the articular surfaces.
MRI is the most accurate and least invasive method for the diagnosis of meniscal tears.New 3D MRI in three dimensions with isotropic resolution allow creating multiplanar reformatted images to obtain from an acquisition in one sectional plane, reconstructions in other spatial planes. 3D MRI should further improve the diagnosis of meniscal tears
This article describes MRI imaging of all meniscal lesions.
This technique of reconstruction of the anterior cruciate ligament plasty involving extra and intra-articular fascia lata was described by Hey-Groves in 1917, modified in 1972 and MacIntosh Jaeger recently. This reconstruction is a technique increasingly practiced for controlling the tibial rotation and rotational jump experienced by the patient and the surgeon objectified by clinical examination.
This lateral grafting used in this technique is called the fascia lata is a transplant with high resistance comparable to other biomechanical transplants used. The fascia lata retains its tibial insertion, which is a natural attachment system and therefore superior to any other system used. This technique has the advantages of not having to levy tendon and therefore the hope of postoperative muscle recovery and normalization of the fastest isokinetic tests.
The coracoid bone block screwed in front of the glenoid realized today either open or arthroscopically.
The advantages of arthroscopic abutment technique are:
- Take stock of the damage to the joint, bead, cartilage, loss of bone substance, tendon injuries
- The precise positioning of the stop because under direct control by the camera,
- Of smaller sizes scars,
- The treatment of lesions as lesions of the biceps (SLAP lesion) or lesions of the rotator cuff (tendon rupture) that can be treated in the same operation
- Early functional recovery
Partial ACL tear
Isolated ruptures of the anterior cruciate ligament (ACL) injuries are the most frequent ligament of the knee. These breaks may be complete or partial. In partial tears, clinical diagnosis is more difficult because the clinical presentation is variable. The diagnosis, evolution in time and treatment its partial tears are still subject to much controversy. The purpose of this article is to clarify the definitions, clinical diagnosis and therapeutic strategies to these partial ACL tears. (read more ...)
The aim of this operation is to achieve anatomic ACL reconstruction using autologous (patient's tendon) under arthroscopic control. The principle of TLS is to use a single hamstring tendon in short graft (transplant economy). The half tendon tendon is one of two hamstring tendons (hamstring). It is thin (3-4 mm) and long (about 25 cm). It is the termination of the semitendinosus that ends on the bridle. The harvesting the graft is carried out by a short nearly horizontal incision of 2 cm to the surface of the tibia, is removed only the semitendinosus tendon over its entire length with a stripper. He bent over backwards to get a transplant ACL bundles 4 or 4 strands with diameters ranging from 7 to 9 mm. It's ashort 50 mm average length graft (Fig.8). At both ends of the graft are passed two textile strips for fixing the graft in tunnels. A traction table is used to make a claim to the graft to 500 Newtons
Latarjet arthroscopic intervention
The procedure is most often performed under general anesthesia with an inter-scalene block made ??preoperatively by the anesthetist. It involves taking a bone block of about 2 cm at the expense of the coracoid and place it in the anterior and inferior part of the glenoid cavity, passing through the subscapularis muscle. The coracoid can be positioned upright and secured by a screw according to Bristow or lying and fixed by two screws according Latarjet. (read more..)
PTG MY KNEE INTERVENTION
A preoperative CT scan is performed 3 weeks before the operative date to carry out the cutting guide on measurement of the prosthesis by printing 3D printer. The various bone cuts are made ??using 3D custom cutting guides, then the instrumentation adapted to the selected prosthesis (ancillary equipment), we must ensure the ligament balance and if necessary make releases (release) rarely ligament retentions. (read more ....)
Since its first description by Neer in 1963, the ideal management of the fracture of distal third of the clavicle remains a matter of debate. Traditionally, conservative treatment is the rule. Functional results of the surgically treated group were comparable to those treated functionally, which has led many authors to advocate a non-surgical approach to this initial fracture. But this type of treatment does not bring good results. Recent data suggest that some patients may be at high risk of consolidation, have a dysfunction of the shoulder girdle on malunion, or have chronic pain. However, despite sometimes higher nonunion rates of 22-44%, less than 15% of the patients required surgical treatment for the treatment of a nonunion. In theory, surgery might minimize long-term complications. (read more ...)
The shoulder dislocations and recurrent anterior instability is a common problem among young athletes making up 90% of shoulder dislocations. Surgical indication can be provided in these cases of glenohumeral dislocations previous recurrent, but also in cases of painful and unstable shoulders. A question now arises, should we offer it immediately after the first dislocation or should we expect one or more recurrences? (Read more ...)
Around a recent need, the treatment of pathologies related to the sport, the former Clinique Saint-François, now Sport Clinic, was taken over by General of Health in 2002. The renewal of the medical staff with surgical team renowned helped to design and implement a medical and scientific project based on the quality of practice. Générale de Santé has worked to support this project, including through an intense program of renovation and careful management of human resources.
Today, the sport of Clinic is a hyper-specialized private institution under agreement in orthopedics, traumatology and sports medicine.
Medical and surgical consultations highly specialized, a reference imaging and functional rehabilitation recognized competence guarantee our patients the best care for diseases of the musculoskeletal system, either degenerative or related to physical activity.
Patient, 58, sporting good level with chronic tendinitis of the Achilles tendon of the left.
chronic Achilles tendon pain lasting for more than a year after a triathlon.
The patient has received medical treatment (necessary before any surgical decision): rehabilitation, Stanish stretching, shock wave, orthopedic soles. (read more...)
While muscle injuries of the posterior region of the thigh are common in athletes, the proximal hamstring rupture is a rare disease. A study published in 2003  analyzed in a consecutive series of 170 patients, 179 trauma hamstrings occurred over a period of 3 years. MRI and / or ultrasound showed that only 12% of the injuries were fractures of the proximal and 9% complete ruptures. It is also little known, the first cases described in the literature from 1988 . Clinically the patients describe a violent pain in the buttock (stab printing) followed by leg weakness. ( To be continued..)
The main objective of the study was to compare the performance of GNRB® and that of Telos ™ in the diagnosis of a partial tear of the anterior cruciate ligament (ACL) methods. A prospective study from January to December 2011 included all patients with partial or complete tear of the ACL reconstruction without prior with a healthy contralateral knee. The anterior laxity was measured in all patients by the ™ Télos and GNRB®. read lsuite ...
The pure ligamentous injuries of the child are certainly underestimated, with the commonly accepted concept of more fragile bones and ligaments of the concept lesions preferentially affecting domestic growth plate in epiphyseal and metaphyseal rather than ligaments.
Yet before a LCAE lesion in children, unless you have a child captivated by video games, most of these children practice sports daily basis pivot physical activities, see pin contact, hardly observing soon as the acute episode happened precautionary instructions that may be required to do.
Anatomic laxity are often important even less well tolerated functionally they can occur on land of physiological general joint hypermobility.
What sport are we talking about?. In effect resumption of sport is a generic term that encompasses businesses that lives and cardiovascular, an activity of a well pivots sports activities in competition. We talk of return to sport or to pre-injury or to pre-surgery or even be the maximum possible level of the knee recovery. For example, the recovery of a knee that has been unstable for several years with meniscal and cartilage damage could not be the same without a knee cartilage injuries of the meniscus operated in a quick time after the breakup.
The rotator cuff tear is typically a degenerative disease. Many studies have reported satisfactory results in elderly patients. However few studies have evaluated the results of repair of partial or complete ruptures of the rotator cuff (arthroscopic or open) in a younger population. The purpose of this study was to analyze literature repairs of the rotator cuff in patients aged under 50 years.
The use of PRP has become widespread in sports trauma for the last decade, as an alternative to surgery or as a surgical adjuvant. High-profile successes in high-level athletes, and the abolition of the list of substances and methods prohibited by WADA at the end of 2010, have literally sparked the appeal for this technique.
The absence of side effects and excellent tolerance, make the injection of PRP, carried out under rigorous conditions, a technique of great safety .
In our current state of knowledge, the effectiveness of PRP treatment is no longer demonstrated in the treatment of cartilage lesions(7 studies with high level of evidence), superior to hyaluronic acid.
Ultrasound guidance and good pain management (analgesia of pallium 1 or 2, MEOPA) are essential in the injection of tendon and muscular lesions but rarely necessary in the painful joint injection.
Treatments vary greatly from one practitioner to another, in terms of platelet concentration, cell richness (erythrocytes, leukocytes), ultrasound tracking, pain management, number of sessions and accompaniment. It is essential to better define the protocols through comparative studies.
The phase ofRehabilitation and reconditioning to stress is an essential step, often overlooked when PRP is presented as a miracle cure!
Before considering a platelet concentrates processing a visit is required to confirm the indication to define the therapeutic protocol, eliminating against indications and remind the precautions that surround it.
Numerous preparations on the market, variable in terms of platelet concentration, red blood cells and leukocytes, in terms of adjuvants (activator, anticoagulant), in terms of volume. Many protocols exist no scientific consensus on the ideal platelet concentrate, the number and frequency of injections, local anesthesia, the use of anti inflammatories and ice, rehabilitation and return to physical activity.
The rupture of the anterior cruciate ligament (ACL) is one of the most common injuries in athletes. Many studies have shown that equivalent practical level the risk of ACL injury in women was four to seven times higher than in men [1-4]. In the US, approximately 38,000 ACL injuries in female athletes occur per year .
The aim of this study Was to translate, validate and adapted in the Anterior Cruciate Ligament French-Return to Sport after-Injury (ACL-RSI), a 12-item scale English lan- guage Assessing the psychological impact of returning to sports after-ACL reconstruction .Methods The ACL-RSI Was scale forward and back trans- lated, cross-adapté Culturally and validated using international guidelines.
The main goal of this study Was to compare the results of the GNRB arthrometer To Those of Telos TM in the diagnosis of partial thickness tears of the anterior cru- ciate ligament (ACL). A prospective study Performed January- December 2011 included all patients presenting with a partial or full-thickness tears ACL without ACL recon- struction and with a healthy contralateral knee. Anterior laxity Was Measured in all patients by the Telos TM and GNRBÒ devices.
Women have four to eight times more likely than men to have a ruptured anterior cruciate ligament (ACL). This risk seems more important during the pre-ovulatory phase of the menstrual cycle than during the post-ovulatory phase. The main objective of the study was to describe the distribution of ACL injuries during the menstrual cycle in a large recreational skiers population.
The meniscus is a small wedge between the two knee bones. At the top is the femur, the thigh bone. Downstairs there is the tibia, the leg bones. The bottom of the femur is rather round and the top of the tibia appears much flatter. These two bones do not fit together well. The menisci that allow a better insertion of the tibia on the femur. There are two menisci in each knee.
Surgery: The principle of operation is to repair the anterior cruciate ligament (ACL) with a broken bone autograft bone tendon taken from the patellar tendon. Intervention performed under local or general anesthesia with a tourniquet.
Meniscal injuries athlete are frequent (fissure, fracture tear of the meniscus). These lesions should be properly diagnosed and treated. The treatment is no longer based on the simple meniscectomy may be the cause of cartilage changes over time. The term goal is to preserve the cartilage in this young athletic population and submitting his knees major constraints, priority should be given the meniscal economy (suture or abstention). (Continued ...)
Meniscus - Arthroscopic knee surgery is the gold standard of meniscal lesions of the knee. The goal is to treat meniscal tear (tear, crack, tongue, bucket handle ...) being the least traumatic possible for the knee and the most conservative to the meniscus.
The development of ambulatory surgery in France has fallen behind compared to other countries of the world and Europe. Comparing the practice of ambulatory surgery in the United States, Canada and the UK has shown some differences. These are financial constraints that motivated primarily the development of ambulatory surgery in the United States and Canada. In the US, financial incentives have been implemented by public and private payers. read more ......
Arthroscopic knee surgery is the gold standard of meniscal lesions of the knee. The goal is to treat meniscal tear (tear, crack, tongue, bucket handle ...) being the least traumatic possible for the knee and the most conservative to the meniscus
Indeed three options are available depending on the type of meniscal tear:
Conservative treatment with no treatment.
Conservative treatment and suture meniscal repair.
Remove the lesion by partial meniscectomy
An update on this surgery is necessary because the quality of the results is based on a rigorous in the indication, the choice of the prosthesis, and chirurgicale.L'amélioration technical design of the prosthesis, its integration into the ligament balance and the quality of materials has helped to make this reliable surgery.
Surgical treatment of partial or total rupture (new or old) Anterior Cruciate Ligament is based on the realization of a single or dual beam ligament arthroscopically using the technique using the (s) tendon (s) of domestic law and / or semitendinosus (hamstring or DT4)
Compliance with this protocol (rehabilitation and recovery instructions to schedule physical activities and sports) is fundamental in order not to defeat the operation performed.
The meniscus is semilunar fibrocartilage (orange area) triangular cut.
Each knee has two menisci, a medial meniscus and a lateral meniscus.
They are "shock absorbers" of the knee: they have a role in the transmission and distribution constraints. They increase joint congruency and stabilization of the knee. They allow shock absorption and protection of cartilage.
The meniscus is semilunar fibrocartilage (orange area) triangular cut. Each knee has two menisci, a medial meniscus and a lateral meniscus. They are "shock absorbers" of the knee: they have a role in the transmission and distribution constraints. They increase joint congruency and stabilization of the knee.
There are two menisci in the knee. They look like two crescents placed between the tibia and the femur. They crash and sometimes break when the knee twist, flip or flexes strongly! Through their shapes banked corner, they contribute to the stability of the knee. Above all, they cushion the stresses and distribute the pressure on the cartilage.
We sent a questionnaire to licensees judokas of the French Judo Federation to identify carriers sports a total hip replacement. We sent 212 questionnaires to older judokas over 60 years and at least 6th Dan black belt. Of 83 responses, 36 men, mean age 72 years (60-86 years) are holders of at least a prosthesis.
Introduction: The intensive sport promotes osteoarthritis. The chondral lesions are more common in subjects with sudden changes of direction. Cartilage degradation is significantly aggravated by trauma moderate physical articulaires.L'activité, varied, can participate in the prevention and treatment of osteoarthritis.
After medical advice, as soon as the march is painless, as soon as the ascent and descent of stairs are painless, as soon as jitter on the tip of one foot is painless, it is possible to resume sports activities as follows :
1 / Slow Race, on flat ground, 20 minutes, every other day, increasing by 5 to 10% per week to 45 or 60 minutes.
2 / Race with a faster pace 30 minutes, instead of a slow session.
3 / Running with changes of pace or ribs.
4 / Reprise drives.
5 / Freestyle.
Do not take the next step if the previous wake up pain.
The rupture of the Achilles tendon in athletes, is a rare event that usually occurs during the 3rd decade in athletes and 4th among the sedentary. The break often occurs when an eccentric effort (Work together a muscle elongation instead of the normal shortening) as a startup, acceleration or landing from a jump. Read more ......
Attention! This is no shock absorbing soles, type "ready to wear" sold in stores. No, they are "haute couture", tailored to your injury and imperfections of your stride. They are made "to measure" by a podiatrist sports. He knows the injuries encountered in sports. It does not use cork or leather. It uses synthetic materials flexibility cleverly distributed, which tolerate sweat and mechanical stress.
Lateral collateral ligament (LCL)
Ligament of the outer side of the knee
Short ligament, and tubular end
It is stretched between the femur top
and the fibular head down
It allows external stabilization of the knee
At the top is the femur, the thigh bone. Downstairs there is the tibia, the leg bones. The bottom of the femur is rather round and the top of the tibia appears much flatter. The menisci are small blocks located between the two knee bones.
Some physical characteristics or child's health concerns are too often subject to abuses against-indications sports. Scoliosis, the ball joint pain, asthma, "heart murmur" or obesity are characteristic examples. Often, these problems do not affect the performance. More rarely, the sporting performance is not as good as the physical effort draws on a somewhat faulty function of the body.
The hamstring muscle group consists of three muscles of the posterior region of the thigh:
the biceps femoris muscle (long head)
the semitendinosus muscle
the semimembranosus muscle.
They are mainly flexors and secondarily leg extensors of the thigh. When walking or running, they are also antagonists quadriceps, slowing the advance of the leg at the end of the step and preventing the brutal and full knee extension.
The trauma of the face and neck, in sport and especially for team sports, is more frequently observed. This increase is explained by the intensification of the physical preparation of athletes, amateur and professional, of course, the physical mass and velocity involve contacts increasingly violent and repeated.
The high and complete rupture of the hamstring tendons, tendon avulsion, at the ischial is rare. The severity of the injury is often underestimated. There is no consensus on treatment. Functional treatment of these lesions simply by immobilization in a splint flexion knee gives bad results, unlike the early surgical treatment and / or late.
It is necessary to distinguish:
- The fracture lesions which are always found with certainty notion traumatic (new or old)
- Chronic lesions with onset of osteonecrosis subchondral more or less extensive, described in the literature under different terminologies (osteochondrosis, osteochondritis, osteonecrosis).
This distinction seems to us essential because etiology, radiographic appearance, treatment and prognosis of such lesions are sometimes totally different.
Attention! This is no shock absorbing soles, type "ready to wear" sold in stores. No, they are "haute couture", tailored to your injury and imperfections of your stride. They are made ??"to measure" by a podiatrist sports. He knows the injuries encountered in sports. It does not use cork or leather. It uses synthetic materials flexibility cleverly distributed, which tolerate sweat and mechanical stress.
The aim of this operation is to achieve anatomic ACL reconstruction using autologous (patient's tendon) under arthroscopic control. The principle of TLS is to use a single hamstring tendon graft in short. Parameters of ACL reconstruction with hamstring TLS.
There during physical exercise, especially long-term, especially if carried out under the summer sun, a significant loss of water and minerals through sweating. Losses that can result in serious health consequences if they are important and are not compensated. The sensation of thirst during exercise and late and did not compensate for the losses! Sweating can lead to a loss of water 0.5 to 2.5 l / hour.
Each sports movement constitutes a solicitation for the bone structure. At each reception process, the tibia runner undergoes vibratory impacts. Unrolling not, the hiker twists slightly small bone in his foot. Even the body-builders, powerfully contracting its muscles, pulls on his bone.
Each strain injures a little bone of sports. Fortunately, during the rest period, the bone trying to rebuild. If time allows, if they bring him the necessary food, it is repaired! It reconstructs even louder than before as if to prepare for new mechanical attacks. This phenomenon is called by coaches cycle decompensation / overcompensation. This process has been described in many body organs and functions: muscle, stock energy, hormones, etc. It is a key driver of growth.
Thus, it was shown that the well-trained marathoner had stronger bones than sedentary. Indeed, its more dense bone structure, higher in fiber and calcium. In addition, the microscopic architecture of the bone is perfectly oriented along the axis of mechanical stresses.
Indeed, the chemical structure of the bone is comparable to reinforced concrete. The protein network is the steel rods. Calcium is comparable to concrete mired these metal axes. At the hip and pelvis direction of the bone structure is very characteristic. On a radiograph, it is found that the fibers leave the femur, the thigh bone, tilt in, come from hip to withstand the weight of the body resting on the hips. The lines of force from the right leg and left leg meet in the middle of the basin and support each other in the manner of the nave of a church.
Physical activity associated with a sufficiently high protein diet, vitamin D and calcium is a great engine of bone construction. This cocktail is particularly useful to hinge periods of life. During growth, it is necessary to eat 4-5 dairy products every day to build strong bones. It should also move: it is essential to practice a sport requiring the running and jumping at least 3 times a week for 30 minutes. In the absence of impact, bones harden less. It has been shown that a young competitive swimmer had lower bone density than sedentary because he was deprived of gravity during those long hours of pool training. In addition, bone densification stops 25 years. At this age you have made up your bone capital for life!
In adulthood, sport reinforces very hard bone and the amount of calcium necessary for the maintenance of bone is still debated. In case of fracture, the rest of the broken area needed a few weeks to allow to "ensnare" the broken area. In addition, gradually increasing mechanical stress are indispensable to "mechanize" the callus. Again, they help to guide the fabric of the bone in the center of the constraints to prepare him for his mission. An increase in calcium intake in consolidation period is proposed by some doctors without that interest has been really shown.
After menopause, the bone structure is gradually degraded to make the brittle bones is osteoporosis. Ladies, remember, your resistance to hip fracture depends on your diet and your sport for 25 years! If physical activity after menopause can no longer denser bones, reduces the loss of bone tissue. So it is advisable to go see jumping around or jog. It is also good to make the soft gym to maintain bone strength to strength. To make the most of this stimulation, it is again necessary to take 4-5 dairy products daily. It should also go out every day to enjoy the sun and make the vitamin D essential for the absorption and calcium binding. Fresh coordinating sports such as Thai Chi or "balance workshops" have proven effective in reducing the risk of falls and fractures.
If the sporting activity is excessive, the micro-cracks caused by impacts on the bones fail to consolidate over the rest. Rather, these lesions worsen in the next workout. Finally the splits right through bone, it breaks without any violent trauma. It is the stress fracture. In a postmenopausal woman, it was demonstrated that 6 hours of sport load per week may be sufficient to break insidiously bones. Among younger adults, this type of injury is favored by dietary deficiencies and hormonal disorders. Lack of calcium, vitamin D and protein alters the rebuild bone victim of microcracks in the exercise. Insufficiency sex hormones reduces the stimulation microscopic chemical plants be responsible for the synthesis of bone tissue. Functional changes occur when the deep depletion of the body. That kind of burnout is most often diagnosed in women because it causes menstrual irregularities and a cessation of menses. The victim is found in a state of "early menopause". In humans this hormone suffering is more insidious but it exists and its effects on bone density are comparable. The sports overwork cocktail, dietary deficiencies and disappearance of rules typically found in young women anorexic. Faced with a stress fracture, the sports physician must remain vigilant. It should not simply treat a "bone". It has an obligation to support a whole person, he is responsible for seeking overtraining or behavioral disorders.
Iron is essential to your health and performance. It is a central component of hemoglobin. The latter is contained in red blood cells and gives it color. It is the iron that captures oxygen when blood passes through the lungs. It carries the precious gas to muscles. When they arrived, it drops its cargo which then allows the burning of energy substances and muscle contraction.
When you run or when you jump, your heels hit the ground and the fat pad of the foot of the plant is crushed. It is through many blood vessels. These red blood cells burst and release their hemoglobin. Iron is released into the blood and pass into urine.
Muscle contains a twin sister of hemoglobin, myoglobin. The latter also contains a lot of iron which sets some oxygen. This small local reserve allows starting the contraction before the blood vessels do not provide the necessary complement. When you experience aches, your muscle membranes are victims of micro-fissures. Myoglobin and iron leaves the muscle and gaining the blood. The precious metal is eliminated in the urine.
When you make an effort, the majority of blood flow is directed towards your muscles. There remains very little to the digestive tract and the bladder wall. These organs suffer from lack of oxygen and are shaken with every stride. Small areas are damaged and start to bleed. Red blood cells and iron are lost in the feces and in urine.
You enter the assiduous why athletes often lack iron, especially if they do not take care to concoct "menus and recipes" adapted. Sports are even more concerned since all these iron losses are added the massive elimination of blood during menstruation!
That is why it is good to occasionally perform a blood test to assess the stock in body iron. This levy is necessary when it comes to review a state of fatigue. It unnecessary to dose iron in the blood because the body is able to keep within the limits of normal while the reserves are at their lowest! It is necessary to measure levels of "serum ferritin" because this structure is the storage form of iron.