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We aimed to evaluate the clinical outcomes after surgical repair of patellar tendon rupture (PTR) and compare the evolution of 2 types of rupture (acute and chronic) after the same rehabilitation protocol.This was a prospective cohort study of patients with PTR treated between January 2006 and January 2014 in the department of trauma surgery, Ibn Rochd university hospital, Casablanca.We evaluated 25 patients (21 men) after a median follow-up of 75 months (range 29-120). The mean age was 34.7±8.59 years. Overall, 17 patients had acute rupture and 8 chronic rupture. Fifteen healthy volunteers (13 men) were recruited as a control group. Mean Knee Society Score (KSS) knee score was significantly higher after than before surgery (82.28±12.297 vs 20.64±7.6; P0.0001) as was KSS function score (88.40±17.483 vs 23.40±8.98; P0.0001). Pain measured on a visual analog scale was significantly lower after than before surgery (1.96±1.24 vs 6.60±1.26; P0.0001). ROM and KSS knee and function scores were significantly lower on the operated than non-operated side after surgery. For both types of PTR, only knee extensor muscle strength was significantly lower on the operated than non-operated side and as compared with healthy volunteer knees.Surgical repair of PTR with reinforcement and an early rehabilitation program demonstrate good results after a long follow-up. However, chronic PTR may need longer or a different rehabilitation protocol of the knee-extensor apparatus.

Resume Le conflit anterolateral dans les suites d’une entorse externe de la cheville est mieux connu depuis l’apport de l’arthroscopie. Une synovite chronique hypertrophique de la region anterolaterale de la cheville semble etre responsable de douleurs chroniques avec œdeme, sans instabilite ni laxite, entrainant un « conflit anterolateral » de la cheville. Les auteurs proposent l’etude des resultats du traitement arthroscopique dans une serie retrospective continue de 22 sportifs presentant un conflit tissulaire anterolateral de la cheville. Les patients ayant des atteintes osseuses ou articulaires ont ete exclus. L’âge moyen etait de 26 ans. Les patients presentaient des douleurs mecaniques anterolaterales associees a un œdeme dans les suites d’une entorse externe de la cheville. Un traitement medical et reeducatif a toujours ete entrepris pendant plus de 6 mois avant l’arthroscopie. Aucun patient ne presentait d’instabilite de cheville, ni de laxite a l’examen clinique. L’arthroscanner a ete realise dans 18 cas et l’IRM dans 4 cas. Le delai moyen entre le traumatisme et la prise en charge arthroscopique etait de 21 mois. Un debridement avec un lavage articulaire a ete realise sous arthroscopie. La reeducation a ete demarree a j2 postoperatoire. Le recul moyen etait de 23 mois. Au score de Kitaoka, 17 patients avaient un excellent resultat et trois un bon resultat. Le traitement arthroscopique a donne des benefices significatifs sur la douleur, l’œdeme, ainsi que sur la reprise des activites sportives.

L’histiocytofibrome est une tumeur mesenchymateuse localisee principalement a la peau des extremites, rarement au niveau de l’os (surtout dans les os longs y compris le femur, le tibia et l’os iliaque). Elle siege habituellement en situation epiphysaire ou metaphysaire. La localisation humerale diaphysaire est tres exceptionnelle. Peu de travaux ont decrit les caracteristiques cliniques, pathologiques et pronostiques des histiocytofibromes osseux, il est donc difficile de les differencier des autres lesions rares telles que la tumeur a cellules geantes (TCG) et le fibrome non ossifiant. Le but de cet article est de decrire cette lesion osseuse tres rare et d’en resumer les caracteristiques cliniques, therapeutiques et pronostiques a partir d’un cas et d’une revue de la litterature.

Resume Introduction La prothese totale de hanche est une intervention orthopedique privilegiee, actuellement frequente, qui a bouleverse le traitement des pathologies articulaires degeneratives et inflammatoires. Objectif L’objectif de ce travail est de determiner le devenir fonctionnel et la qualite de vie apres reeducation d’une serie de protheses totales de hanche (PTH), dans notre contexte marocain, et de les comparer a la litterature. Patients et methodes Il s’agit d’une etude prospective portant sur 93 PTH (dont 15 bilaterales) colligees au service de medecine physique et de readaptation au CHU Ibn Rochd de Casablanca, durant la periode allant de janvier 2009 a janvier 2013, indiquees dans le cadre de coxopathies inflammatoires ou degeneratives severes. L’evaluation a ete realisee en preoperatoire, a la 6e semaine et au 3e mois postoperatoires ; elle a consiste en une evaluation de la douleur, de la mobilite articulaire active et passive, de la fonction par l’indice de Postel-Merle d’Aubigne (PMA) et de la qualite de vie par l’echelle Western Ontario and McMaster Universities Arthritis Index (WOMAC). Resultats Il s’agit de 49 femmes et 29 hommes, d’âge moyen 47,23 ans (20–75 ans). L’EVA douleur moyenne est passee de 67/100 a 12/100, six mois apres la chirurgie (p = 4 × 10−4). Le score de PMA est passe de 7,2 a 14,8 (p = 5 × 10−3). Le score de qualite de vie WOMAC a ete nettement ameliore qui est passe de 89 a 36 en fin de reeducation. L’amelioration de cette derniere parait bien correlee a la diminution de la douleur et a l’amelioration du score de PMA. Discussion–conclusion Nos resultats confirment la diminution du handicap des coxopathies apres PTH, ce qui retentit positivement sur la qualite de vie des patients.

Objectives The aim of this retrospective study was to evaluate the long-term clinical and radiological results in a continuous series of total hip arthroplasties performed for aseptic necrosis of the femoral head and discuss the therapeutic indications. Patients and methods The series included 88 arthroplasties performed between January 1992 and December 2008 in 79 patients with a mean age of 43, 5 years. Functional evaluation was made according to the Postel-Merle d’Aubigne (PMA) score. The preoperative PMA score averaged 8. According to the classification of Ficat and Arlet, 60 hips were classified as stage IV and 28 hips as stage III. The implants used were a total hip prosthesis in 90.9% of cases; cemented in 55 cases, uncemented in 22 cases and hybrid in 3 cases. Bipolar hemiarthoplasty was made in 8 patients. Postoperative analysis and at follow-up was looking for local or systemic complications. Radiographic analysis radiolucent lines around the implants. Finally, the causes of re interventions were studied. Results Functional and radiological results were established 5.1 years mean follow. The mean PMA score was of 15, 8. Radiographic inspection showed that the loosening rate was 3.4% of acetabular implants and 2.27% of the stems. The rate of periarticular ossification was 9%, of which 1.5% were in stage 3 or 4 of Brooker's score. Discussion-conclusion Some pathologies (haematological disorders, renal failure) have received considerable therapeutic progress resulting from both an increase in the life of patients and an increase in the prevalence of osteonecrosis of the femoral head. Necrosis may also be the result of the treatments themselves (corticosteroids, immunosuppressants, allografts). The results of arthroplasty in this indication are demonstrative in terms of level of activity and PMA score. The results of this series conclude that arthroplasty remains the treatment of choice for advanced stages of necrosis.

Objectives The subject of this work is to clarify the epidemiological, clinical, therapeutic and prognostic of neglected rupture of the patellar tendon. Patients and methods A retrospective study of 24 cases of neglected rupture of patellar tendon, treated between June 2000 and June 2012. Results Our patients were 13 men and 10 women. The average age was 33 years, ranging from 21 to 52 years. Eight patients were followed for systemic diseases. The mean time to consultation was 52 days (28 days to three months). The diagnosis was done through imaging. Surgical exploration specified that the rupture was total in 19 cases, partial in five cases and located at the infra-patella in fourteen cases. All patients were operated. The repair of the lesions were made by using a fascial flap from quadriceps in 19 cases and a plasty with the semitendinosus tendon in five cases. In all cases, the tendon was put to rest and protected by a metal framing for a period. Distant results were evaluated after a mean of 27 months by Kelly and Dubourg clinical and radiological criteria. The result was fair in 18 cases and poor in 5 cases. Discussion-conclusion The results of our work allowed us to conclude that the neglected rupture of the patellar tendon was the prerogative of the young and active adult. The only treatment is surgical. The major prognosis factor is the length of duration of the lesion. Early postoperative rehabilitation is of a great interest and determines the functional prognosis.