Tunnel enlargement after anterior cruciate ligament reconstruction surgery.

INTRODUCTION: Tunnel enlargement following anterior cruciate ligament (ACL) reconstruction has been frequently reported since the nineties, yet its etiologies remain unclear. AIM: To elucidate the factors favoring this phenomenon and to investigate its clinical and anatomical consequences. METHODS: This was a descriptive retrospective study conducted on 37 patients who underwent ACL reconstruction surgery using single-bundle hamstring tendons with fixation using absorbable interference screws at the Traumatology Department of the Kassab National Institute of Orthopedics. The patients were collected between January 2014 and September 2016. Tunnel enlargement, footprint, and tunnel orientation were assessed using standard knee radiographs. At follow-up, patients were evaluated using functional scores (Lysholm, Tegner, and IKDC), clinical examination, and Telos radiographs. RESULTS: The average global Tunnel enlargement was 51.7% in the femur and 48.88% in the tibia. Femoral tunnel enlargement values were higher than tibial tunnel enlargement at all measurement levels, and it appeared to be a time-evolving phenomenon. Factors favoring tunnel enlargement seemed to include advanced age, male gender, delayed surgery, accelerated rehabilitation protocols, non-compliant placement of transplant footprints, and tunnel horizontalization. Tunnel enlargement did not influence functional scores (Lysholm, Tegner, and IKDC). However, based on the differential study of Telos radiographs, femoral and tibial tunnel enlargement in the lax knees group (38% of cases) was higher than in the stable knees group (62%). Nonetheless, our results were statistically non-significant with respective p-values of 0.584 and 0.53. CONCLUSION: Several modifiable factors such as delayed surgery, accelerated rehabilitation protocols, incorrect footprint placement, and tunnel orientation appeared to influence the tunnel enlargement phenomenon. However, prospective studies with a larger sample would be necessary to confirm these findings.

Effects of Different Plyometric Training Frequencies on Measures of Athletic Performance in Prepuberal Male Soccer Players.

Bouguezzi, R, Chaabene, H, Negra, Y, Ramirez-Campillo, R, Jlalia, Z, Mkaouer, B, and Hachana, Y. Effects of different plyometric training frequencies on measures of athletic performance in prepuberal male soccer players. J Strength Cond Res 34(6): 1609-1617, 2020-This study aimed to compare the effects of 1 vs. 2 sessions of equal-weekly volume plyometric training (PT) across 8 weeks on measures of athletic performance (i.e., sprint time, change of direction [CoD], jumping ability, and muscle strength) in prepuberal male soccer players. Thirty participants were randomly assigned either to 1 session PT group (1SPT [n = 15]) or 2 sessions PT group (2SPT [n = 15]). Plyometric training was integrated into their regular soccer training routine. Pretraining and posttraining tests for the assessment of sprint time (e.g., 5, 10, 20, and 30-m), CoD (e.g., T-test and modified Illinois change of direction test [MICODT]), jumping ability (e.g., standing long jump [SLJ], countermovement jump [CMJ], and squat jump [SJ]), muscle strength (reactive strength index [RSI]), and kicking distance were conducted. Results showed a main effect of time for 5-m sprint-time performance (F(1,56) = 4.00, effect size [ES] = 0.53 [medium], p = 0.05), T-test (F(1,56) = 23.19, ES = 1.28 [large], p < 0.001), MICODT (F(1,56) = 5.72, ES = 0.94 [large], p = 0.02), SLJ (F(1,56) = 16.63, ES = 1.09 [large], p < 0.001), CMJ (F(1,56) = 15.43, ES = 1.04 [large], p < 0.001), SJ (F(1,56) = 20.27, ES = 1.20 [large], p < 0.001), RSI (F(1,56) = 26.26, ES = 1.36 [large], p < 0.001), and kicking distance (F(1,56) = 47.19, ES = 1.83 [large], p < 0.001). There were no training group × time interactions in all the measured outcomes. In conclusion, when an equated moderate volume of jumps is performed, higher PT frequency across 8 weeks has no extra effects on prepuberal male soccer players' measures of athletic performance. The present findings may help optimizing PT interventions dedicated to prepuberal male soccer players.

About a rare cause of a coxitis.

OO of the acetabulum can clinically and radiologically mimic an ankylosing spondylitis (with coxitis and sacroiliitis). Management of OO include multidisciplinary approach including radiologist, rheumatologist, and orthopedist.

BROMETH: Methodology to design safe reconfigurable medical robotic systems.

BACKGROUND: This research paper deals with the development of a medical robotized control system for supracondylar humeral fracture treatment. Concurrent access to shared resources and applying reconfiguration scenarios can jeopardize the safety of the system. METHODS: A new methodology is proposed in this paper, termed BROMETH, to guarantee the safety of such critical systems from their specification to their deployment, and passing through certification and implementation. The solution is applied to a real case study named Browser-based Reconfigurable Orthopedic Surgery (abbrev. BROS), a robotized platform dedicated to the treatment of supracondylar fractures, to illustrate the paper's contribution. This work starts from a medical issue, namely supracondylar humeral fracture treatment, to establish a new informatics solution, namely a new methodology to design safe reconfigurable medical robotic systems. RESULTS: The results of the experiments performed on real SCH fracture radiographies were quite satisfactory. CONCLUSIONS: Clinical experiments can then be performed after deploying the system on real hardware.

[Battered child syndrome: clinical and radiological aspects]. / Le syndrome des enfants battus: aspects cliniques et radiologiques.

Physical child abuse or battered child syndrome is responsible for over 75.000 deaths per year in France. This public health problem is under-diagnosed in Tunisia and in the world. The path toward the recognition of battered child syndrom was arduous even in some western societies. This study aims to highlight this problem to healthcare practitioners in order that accurate diagnosis and appropriate management may be provided. Physical child abuse has wrongly been referred to as Silverman syndrome that includes only skeletal lesions in children such as fractures.

Acetabular roof stress fracture: a rare cause of hip pain in children.

Stress fracture of acetabular roof is an unusual cause of hip pain. It is considered as an underdiagnosed entity. People who are more susceptible to experience this fracture are athletes, soldiers and dancers. We present the case of an 11 year old girl with a roof acetabular stress fracture for which the diagnosis and follow-ups were possible by the means of MRI. The treatment was keeping the child at a complete rest. Failure to abide with this treatment can cause the stress fracture to evaluate into a complete fracture.

Multi slice computed tomography approach in the assessment of supracondylar humeral fractures in children.

The purpose of this study was to assess the impact of Multi Slice Computed Tomography (MSCT) on the understanding of the spatial displacement of supracondylar humeral (SCH) fractures, their classification and their management. A prospective study was conducted on 63 children with SCH fractures Gartland II or Lagrange 2 and 3, over a period of 30 months. The patients were 42 boys and 21 girls, aged between 3 and 14. All patients were imaged using conventional radiography. Thirty-two patients underwent MSCT and 3-dimensional reconstructions. According to the Lagrange classification system, 16 patients had type 2 fractures and 47 had type 3 fractures. In type 2, the posterior cortices of both medial and lateral columns were bent on CT (n = 6). In type 3, CT-scan made it possible to distinguish two subgroups. In the first subgroup (n = 12) there was fracture of both anterior and posterior cortices of the lateral column; however, the posterior cortical surface of the medial column was preserved. In the second subgroup (n = 14), there was no cortical surface contact in the medial column, but the continuity of the posterior cortical surface of the lateral column was preserved. Based on a new concept of column stability, the use of CT-scan has allowed for a better understanding of supracondylar fractures in children.