Hallux limitus fonctionnel (HLF) et rupture du LCA : liens de causalité, prévention et solutions thérapeutiques. Functional hallux limitus (FHL)

Autor: C. Tzioupis, J. Vallotton
Rok vydání: 2015
Předmět:
Zdroj: Revue de Chirurgie Orthopédique et Traumatologique. 101:e11
ISSN: 1877-0517
Popis: Introduction FHL is the clinical manifestation of a tenodesis effect of the flexor hallucis longus tendon (FHL) occurring at the level of its retrotalar tunnel, resulting in the limitation of the dorsiflexion of the first metatarsophalangeal ray (MP1). The timely passage from pronation to supination and vice versa during the gait cycle is deregulated. ACL injuries occur mainly during sudden direction changes and are linked to a rapid pivot movement concluding in valgus-internal rotation: the knee medial collapse. This abrupt transition from supination to an exaggerated pronation is related to FHL. Due to the FHL-caused time mismatch of muscle contraction, the knee is deprived of this injury preventive compensation mechanism and is trapped into a spiral movement, leading to the injury of the ACL. The aim of our study was to establish a causative relation between the FHL and the ACL rupture and to present a new treatment strategy. Methods Our population consisted of a prospective cohort of patients with ACL rupture and positive stretch test for the diagnosis of FHL. The patients underwent endoscopic retrotalar release of the flexor hallucis longus (FHL) tendon and arthroscopic single-bundle ACL reconstruction, by use of an autologous quadrupled hamstring graft (semitendinosus). Additional interventions for accompanying injuries were performed when needed. Gait analysis was implemented pre- and postoperatively by Wintrack analyzing static, postural and dynamic parameters. Clinical questionnaires were used prospectively. Statistical analysis was performed with SPPS for Mac with the statistical significance set at P Results One hundred and thirty-five patients were included in our study (m/f–47/53%) divided in 6 groups based on the time of the LCA rupture and the concomitant injuries. The mean age was 36.8 years old (range 14–72). The mean time of follow-up was 16 weeks. (15.2–16.4). The side of operation was bilateral in the 77.7% of the patients. There were no complications encountered. The average pressure under the Hallux was statistically significantly lower in all patients after the FHL tenolysis. The area of pressure under the Hallux and the first metatarsal heads were statistically significantly increased after the operation (P Conclusions In the presence of FHL, the mechanical support and stability mechanisms of the foot are disrupted with consequences in the knee, which is deprived of his protective mechanisms and adopts an increased flexion posture and valgus deformity. Arthroscopic release of the FHL can be considered a safe additional treatment in the presence of an ACL rupture. Additional research studies with longer follow-up period are warranted.
Databáze: OpenAIRE
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