Chronic Achilles tendon rupture reconstruction using a modified flexor hallucis longus transfer.

The purpose of this study was to report the management and outcome of 11 patients presenting with chronic Achilles tendon (AT) rupture treated by a modified flexor hallucis longus (FHL) transfer. Seven patients presented with a neglected AT rupture, one with a chronic AT rupture associated with Achilles tendinosis and three with an AT re-rupture. AT defect after fibrosis debridement averaged 7.4 cm. In addition to FHL transfer, we performed an augmentation using the two remaining fibrous scar stumps of the ruptured AT. Functional assessment was performed using the AOFAS score and isokinetic evaluation was performed to assess ankle plantarflexion torque deficit. Follow-up averaged 79 months. Functional outcome was excellent with a significant improvement of the AOFAS score at latest follow-up. No re-rupture nor major complication, particularly of wound healing, was observed. All patients presented with a loss of active range of motion of the hallux interphalangeal joint without functional weakness during athletic or daily life activities. Isokinetic testing at 30 degrees/second and 120 degrees/second revealed a significant average decrease of 28 ± 11% and 36 ± 4.1%, respectively, in plantarflexion peak torque. Although strength deficit persisted at latest follow-up, functional improvement was significant without morbidity due to FHL harvesting. For patients with chronic AT rupture with a rupture gap of at least 5 cm, surgical repair using FHL transfer with fibrous AT stump reinforcement achieved excellent outcomes.

Study of a new indirect method based on absolute norms of variation to detect autologous blood transfusion.

The aim of this study was to investigate an indirect method based on a determination of absolute norms of variation in biological markers that could be used to identify autologous blood transfusion within the framework of the fight against doping. The selection of markers was made from experimental variations obtained during different phases including an increase in training volume at sea level, high altitude training, blood withdrawal and autologous blood reinfusion. The global statistical method was then developed in order to fix absolute norms of variation for each selected marker. The markers selected were haematocrit (Hct), haemoglobin concentration ([Hb]), stimulation index (Off-hr) and the absolute norms of variation (normDelta) established for a maximal 15 days period were normDeltaHct(0-15) >6%, normDelta[Hb](0-15) >4% and normDeltaOff-hr(0-15) >20%. From analyses between two blood samples spaced at an interval of maximum 15 days, this method allows to show "abnormal" variation when a variation for one of the selected markers is strictly superior to the absolute norms of variation established. The legal framework for an immediate application of this method could be that of the internal regulations implemented by each international federation in accordance with the health policy in vigour.