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Return to sport after ACL reconstruction of the anterior knee ligament

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These three criteria will overlap in time.
 
 
1 criterion ANATOMY:
 
GRAFT LIGAMENT REPLACE BROKEN AND CONTROL THE knee laxity.
 
It takes at least 6 months for the graft to be considered effective and robust. And for at least 36 months after surgery, the graft is still evolving, gaining strength. Plasty when integrated in the knee became capable of undergoing new phenomena traction, stretching, and bring knees feeling of comfort, safety, strength in sports exercises. This step can be evaluated with clinical examination of the surgeon, the extent of laxity (TELOS, GNRB) and MRI.
 
2nd criterion FUNCTIONAL:
 
KNEE RECOVERED ITS MOBILITY AND STABILITY. THIGH A RECOVERED ITS STRENGTH, ENDURANCE AND ITS MUSCLE PUISSANE.
 
Another major factor is the recovery of proprioception, ie the knee's ability to properly respond to external constraints by adapting the neuro muscular response. It shows the example of the pulse quality on jumps or lateral movements on flat unstable form.
THE PROPRIOCEPTION is tested by a jump performed on each leg, called "SHT = Single Hop Test." A jump must have recovered 90% of the length compared to the healthy side.
We can evaluate the recovery of muscle strength with an analysis of a ISOKINETIC TEST. We must have recovered 90% of the strength of the quadriceps and hamstrings hamstrings from the side. Is measured at 60 ° / s, 240 ° quadriceps and 30 ° / s hamstrings hamstrings. These values ??are used to assess and correct the joint protection of the knee muscles and the risk of secondary muscle damage.
We must also take into account the range of motion of the hip joint that will protect the operated knee.
 
We also perform a psychological evaluation of the patient's recovery, the disappearance of apprehensions of return of confidence in him and in his knee. These psychological elements are predominant over all other muscular elements, ligament, rehabilitative, anatomic for the period and the level of return to sport.
 
Our team uses an Australian score, ACL-RSI score, developed by PR K Webster at La Trobe University in Melbourne. We have validated its use in French before offering it to our patients. This score indicates the psychological recovery level. Below 56%, patients have not resumed their sport. Beyond 80% they resumed their sport. That is not a recovery criterion is an independent objective evidence of other factors tracking for tracking athletic recovery.
Indeed, the physical resilience is not correlated with psychological capacities. With identical anatomical lesions, patients will be occasions sports activities in time and to totally different levels. The most striking example is that of professional athletes patients we operate and who take their sport more quickly than other patients.
 
 
3rd criterion: CRITERIA SPORTS:
 
IS THE TECHNICAL MANAGEMENT (physical trainer, coach) WHO MAKES THE DECISION.
 
Neither the doctor nor the therapist will determine the ability to practice a sport. The medical staff ensures no against indication. The knee and the patient are not prepared according to the aforementioned criteria the risk of breaking the graft. However, the ability to be involved in a sport is the responsibility of the technical sports frames. The recovery in competition is determined by the coaches and conditioning coach, is the technical supervision which determines whether or not the player's ability is applied once the first two steps perfectly validated.

 

Doctor Yoann BOHU, Doctor Nicolas LEFEVRE, Doctor Serge HERMAN. - 3 janvier 2015.

Conflicts of interest: the author or authors have no conflicts of interest concerning the data published in this article.

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The Iroman lack of iron, the other sports too!

Doctor Stéphane CASCUA.

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.

The bone is strengthened or crack in contact sports

Doctor Stéphane CASCUA.

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.



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