Orthopaedic surgery and sports injuries

Ankle and foot

Acute rupture of the Achilles tendon

The Achilles tendon, or calcaneal tendon, is the thickest and most voluminous tendon in the human body. It is also the strongest, able to withstand loads of up to four times its body weight. Its anatomy and vascularisation have a weak point around 10 cm from the heel.

Rupture of the Achilles tendon is a common pathology, occurring mainly in men and sportsmen between the ages of 30 and 40. In 90% of cases, the injury is caused by an impulse during sports (badminton, handball, basketball, tennis, football, etc.). Pre-existing tendinopathies can alter tendon resistance and lead to ruptures in cases of minimal trauma or low kinetics in an older population.

The description of the trauma is very evocative, with the patient very often feeling a blow to the back of the ankle, during an impulse movement, or an audible crack, associated with exquisite pain. Walking is possible after the trauma and can reassure the patient about the seriousness of the injury, sometimes leading him or her to seek medical attention too late. The diagnosis of an Achilles tendon rupture can be made clinically, without further investigation, by looking for specific clinical signs. Additional tests (x-rays, ultrasound) are only carried out to rule out a fracture, a bone tear or phlebitis.

The ultrasound report may falsely reassure the patient of a "partial rupture", encouraging him or her to consult an orthopaedic surgeon too late, or even not at all. A rupture of the Achilles tendon is a relative emergency, and once the diagnosis has been made, it must be treated rapidly. An undetected or chronic rupture will require invasive and palliative secondary surgery, with poor functional results.

There are several types of treatment for recent Achilles tendon ruptures. Orthopaedic treatment (prolonged immobilisation for 2 to 3 months) should only be reserved for elderly patients, or those with surgical contraindications, as there is a frequent risk of the tendon rupturing again.

Surgical treatment remains the gold standard.

Open repair gives very good long-term functional results (return to sport), but sometimes at the cost of complications such as scarring, adhesions or infection. There are also a number of percutaneous treatments that give good results with a low risk of complications.

Among these, Tenolig® allows percutaneous and "biological" repair, giving excellent results and early ambulation, provided that this technique is performed under ultrasound control during the operation.

Our specialists perform this technique at the Floréal Medical and Surgical Centre with a series of 200 patients, all of whom returned to work and sport early on, thanks to a strict functional rehabilitation protocol, with an extremely low rate of recurrence of rupture.

Regardless of the type of surgery performed, Achilles tendon ruptures are operated on on an outpatient basis. In most cases, the anaesthetic is local. For post-operative care, preventive anticoagulation is prescribed for 45 days. Functional recovery must be gradual and adapted to the type of treatment.

Shoulder surgery

The Clinique Floréal's shoulder surgery centre treats all shoulder pathologies related to extensive sporting or professional activity, or related to wear and tear. The most common pathologies are: tendinopathies or rotator cuff tears, shoulder instability (recurrent dislocations or subluxations), osteoarthritis and traumatology. These conditions are treated by a qualified team that is fully conversant with modern techniques such as arthroscopic surgery.

For surgery on cuff tendons or instabilitywe give priority to arthroscopic repair wherever possible. This modern, safe technique leaves very little scarring, and full functional recovery is possible after rehabilitation.

(Dr MAMANE William collection)

Osteoarthritis can have a degenerative, rheumatological or traumatic origin. The principle of treatment is to ensure that the joint is pain-free, while maintaining satisfactory functional mobility. To achieve this, a shoulder prosthesis, known as an "inverted" prosthesis, makes it possible to obtain a satisfactory result once rehabilitation has been carried out.

(Collection Dr MAMANE William)

Traumatology is an important activity at the Floréal Clinic. The trauma surgery team has acquired a wealth of experience through its training at some of France's leading hospitals, as well as through its extensive daily activity.

In addition, the most modern osteosynthesis methods are used to treat our patients as effectively as possible. There are many areas of experience: clavicle, acromioclavicular, humerus, brachial plexus, etc.

Some examples of surgery:

(Collection Dr MAMANE William)

(Dr MAMANE William Collection)

Knee

Surgery for osteoarthritis: total knee replacement

Osteoarthritis of the knee is a frequent pathology. It is caused by wear and tear on the cartilage of the femur and tibia (ageing of the cartilage, either primary or secondary to a previous deformation of the bone structures), which results in friction in the knee. In the early stages, this results in pain and effusions ("osteoarthritis flare-up") interspersed with periods of calm.

As the osteoarthritis progresses, the pain becomes increasingly incapacitating, and knee mobility decreases, leading to a reduction in walking perimeter. Episodes of knee buckling and effusion may also occur. When medical treatment (painkillers, infiltrations) is no longer effective, knee replacement is necessary.

The surgeon will examine your knee and, depending on your pain, will assess with you when knee replacement is necessary. The aim of the prosthesis is to give you a pain-free, stable knee with full mobility so that you can lead a "normal life".

There are different types of knee prosthesis depending on the stage of your osteoarthritis. Floréal's surgical team specialising in knee surgery will assess the prosthesis best suited to your knee.

This is a surgical procedure requiring hospitalisation for a few days. In most cases, you will be able to walk with full support the same day. A return home or convalescence after the operation will be discussed with you during the initial consultation. Your surgeon will then see you regularly to monitor progress.

Osteoarthritis of the knee treated with a total knee prosthesis (face and profile) (Collection Dr LIPPMANN)

Knee osteoarthritis with ligament instability and femorotibial subluxation requiring a more massive knee prosthesis ("constrained" prosthesis)
(Dr LIPPMANN Collection)

Dr Stenley LIPPMANN

Orthopaedic Surgeon - Hip, Knee and Foot Surgery, Artroscopy & Sports Surgery

stenley.lippmann@hotmail.com

Hip

Surgery for osteoarthritis: total hip replacement

Total hip replacement is one of the most frequent orthopaedic operations. The main indication is osteoarthritis of the hip. Osteoarthritis of the hip (coxarthrosis) is a frequent pathology, involving wear and tear of the cartilage (smooth sliding surface covering the ends of the bones), the rate of progression of which varies greatly. It is most often a phenomenon of joint ageing.

This wear may be encouraged by the existence of birth or growth anomalies in the architecture of the joint (= dysplasia or protrusion), or it may be the result of trauma (old fracture of the acetabulum or femoral neck). Other causes requiring the fitting of a prosthesis are rarer (inflammatory rheumatism, osteonecrosis, etc.). Family factors can also favour the onset of osteoarthritis, as can lifestyle (excess weight, intensive professional or sporting activities). When the cartilage is affected, the bony part of the femur gradually comes into contact with the bony part of the pelvis (the acetabulum), causing friction.

In the early stages, this results in pain ("osteoarthritis flare-up") interspersed with periods of calm. When this cartilage deterioration becomes significant, the pain can become permanent. This, combined with stiffening of the hip joints, leads to a reduction in walking perimeter and ultimately affects activities of daily living, with potentially significant disability. When medical treatment (painkillers, infiltration) is no longer effective in the long term, total hip replacement is necessary. The surgeon will work with you to assess when this operation becomes necessary, depending on your pain. The aim of hip replacement is to give you a pain-free, flexible hip. Walking is made possible without discomfort (the hip is often "forgotten"). The aim is to return to a normal life. Floréal's surgical team, which specialises in hip surgery, performs all approaches (i.e. access to the joint during the surgical procedure) and mainly the anterior approach, which allows access to the hip without cutting any muscle.

This anterior approach allows faster recovery. There are also different types of prosthesis depending on your bone quality (classic "long" femoral stem with or without cement, short femoral stem). Some short stems can be used if bone quality allows. These allow the bone capital to be preserved as much as possible. The new materials currently used (ceramic-ceramic friction torque) are so strong and durable that they can be used to resume sporting activity at a high level.

This is a surgical procedure requiring hospitalisation for a few days. In most cases, full weight-bearing and walking are permitted on the same day. This is started quickly in the department by our team of physiotherapists who are used to this type of surgery. A return home or convalescence will be decided with you during the initial consultation. Your surgeon will then see you regularly to monitor progress.

X-ray of a hip joint treated with a hip prosthesis (front and side): short stem
(Collection Dr LIPPMANN)