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 aim of this operation is to achieve anatomic ACL reconstruction using autologous (patient's tendon) under arthroscopic control.
The anterior cruciate ligament is a short ligament, very durable. It is stretched between the femur and tibia. He participates in the central pivot with the posterior cruciate ligament is behind him. It works in synergy with the external and internal lateral ligament
medial collateral ligament (MCL) is the ligament of the inside of the knee. It is long, wide and spread out. It is stretched between the femur and tibia at the top to bottom. It allows the internal stabilization of the knee.
The lateral collateral ligament (LCL) is the ligament to the outside of the knee. He is short, thin and tubular. It is stretched between the femur above and the fibular head down. It allows external stabilization of the knee
Tendons domestic law and half tendon are thin (3 to 4 mm in diameter) and long (about 25 cm)
They are the termination of two hamstring muscles few powerful ending on the crow's feet, they are palpable to the inside of the leg.
Fig 3: hamstring tendon
Incision about 2 cm to the surface of the tibia and levy a "stripper" of domestic law and half tendon tendon. These two tendons are thin (3-4 mm diameter) but very resistant.
They are folded in half to obtain a graft ACL 4 bundles or strands 4 whose average diameter is from 7 to 9 mm.
Two small incisions of 5 mm on either side of the ball will allow to move the camera and instruments to perform the ligament
The first operative step is the exploration of the knee:
essential step of the surgery, it allows for a comprehensive lesion assessment of the noble elements of the knee (meniscus, cartilage, ligaments other ...)
Treated if necessary these peripheral lesions then realizes ligamentoplasty
Preparation of the notch, using mini motorized instruments (shaver) the fiber remains of the ruptured ACL and makes the cleaning of the graft area is removed.
Bone tunnels are drilled in the tibia and femur in order to place the graft (hamstring) within the knee, at the former ligament
It uses specific sights arthroscopically, with implementation guide pin to guide the drill bit to perform drilling
The graft is passed from bottom to top in the two tunnels by a traction thread.
She will take the exact place of the old ligament
The fixation of the graft is the last step of the operation and probably the most important because it allows to wedge grafting (primary fixation) to the healing and organic integration of the latter in the bone (secondary biological fixation ).
There are different method
interference screw, EndoButton, clip or pin
The goal is to have an excellent primary fixation, the surgeon will use the best hardware fit your situation.
The hospital is a few days. (3 to 6 days)
The next day, the resumption of walking in complete support possible
A splint simple protection and use two canes is desirable, not systematic.
Rehabilitation is started on the first day.
Finally a stay in a specialized rehabilitation center is not mandatory but may be desirable.
Flexible work interruption of 2 to 3 average is usual.
The recovery of a pivot sport is not possible before 6 months
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
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..)
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 ...)
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..)