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"
PRP - platelet concentrates
Information and course of the meeting
P ar Dr. Yves Guglielmetti
Clinical Sports Paris V
36, Bd Saint Marcel
75005 paris 5
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.
For my part, informed by my experience and scientific studies, I retained the preparation and protocol I describe below with a routine ultrasound guidance and a pain management by the inhalation of an equimolar mixture of oxygen and nitrous oxide (nitrous oxide., Kalinox system).
Before the session, it is important to point out to me any fever, infection, any skin lesion (wound), any medication taken in particular aspirin, anti-inflammatory, anticoagulant, antiplatelet agent of any allergy to iodine, a vitamin B12 deficiency or folic acid deficiency, pregnancy. The analgesia MEOPA is formally against indicated if you have recently received an ophthalmic gas, used in eye surgery.
Three injections are required at weekly intervals. In some directions a single injection is sufficient. The injection can be painful and it seems that local anesthesia impair the effectiveness of the treatment, which is why I use depending on the injection site and your tolerance to pain the MEOPA, injection PRP is then quite bearable.
Injection of platelet concentrates course of the meeting:
┬Ě 8 ml sample of blood from a vein, under stringent aseptic conditions, with a single-use equipment, closed circuit (A-PRP system RegenLab, impregnated tube sodium citrate, anticoagulant, and containing separating gel ).
┬Ě Separation of blood components, red cells, leukocytes and platelets by centrifugation for 5 minutes at 3100 rpm. Red blood cells are at the bottom (3 ml), separated by the plasma of the gel containing the wafers (5ml). The plasma is platelet rich and poor in the bottom surface plates.
┬Ě Clinical and ultrasound localization of the lesion to be treated.
┬Ě Inhalation of nitrous oxide, sedation and analgesia appears in 3 minutes
┬Ě Plasma concentration by removing 2 ml of the supernatant platelet-poor plasma.
┬Ě Series 3 ml remaining platelet rich plasma (approximately 3 times the plasma concentration) and injected into the treatment area.
┬Ě Compression of the injected area and setting up a dry dressingmaintained for 24 hours.
┬Ě Strict rest an hour waiting room
A painful reaction is usually for 2 to 3 days, imposing relative rest during which you will need if a simple analgesic (paracetamol). This preventstaking any anti-inflammatory including aspirin and applying ice for at least 15 days after injection.
Physical activity will be moderate between each session and for 3 weeks. The effect will not be felt after a few weeks. We define together a rehabilitation program and return to depending on your condition and your activities deadlines.
No infectious complications has been described in the literature. However, even if all precautions are taken, the risk inherent in any injection, can not be ruled out entirely. According to recent studies, in the conditions of realization in practice, their impact is of the order of 1 to 70,000 infection infiltration. They occur within 48 to 72 hours. In case of fever or severe pain in the days following the infiltration (possible signs of infection), it is importantContact me immediately or if your doctor.
The Health Insurance Fund does not reimburse treatment. Only one can be chosen trading infiltration as set out in the nomenclature. A prior estimate and a detailed invoice will be given. If injections of PRP related injury which was the subject of a declaration of accident insurance (leisure activity sporting license), you can claim this insurance eventual reimbursement.
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 a tendon levy 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
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 ....)
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...)
The injection of platelet concentrates, platelet rich plasma, or PRP, in the injured tissue has become widespread in recent years, especially in sports traumatic pathology. There is no consensus on the optimal concentration but a value between 200,000 and 1,000,000 ? L appears have a therapeutic effect. The autologous conditioned plasma (ACP TM) is a fast PRP to prepare but its average concentration of platelets is significantly lower compared to other PRP. The main purpose of the study was to analyze the platelet concentration of the ACPTM in a group of patients and compare it to that of whole blood in the same subjects. The secondary objective was to take stock of the interests of the ACP TM through a literature review.
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..)