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Objective To translate into Arabic and validate the SF-36 quality of life index in a Tunisian Arabic population. Background No validated Arabic quality of life index is published. Design Arabic translation of the SF-36 scale was obtained by the “forward/backward translation” method. Adaptations were made after a pilot study involving 22 subjects from general population. Inter-rater reliability was assessed by use of intraclass correlation coefficient (ICC) and Bland and Altman method. Construct validity was assessed by Spearman rank correlation coefficient (convergent and divergent validity), and factor analysis with Varimax rotation. Internal consistency was assessed by Cronbach alpha coefficient. Results We note that 130 Tunisian subjects were included in the validation study. No items were excluded. Inter-rater reliability was excellent (ICC = 0.98). Cronbach alpha coefficient was 0.94 conferring to translated index a good internal consistency. Expected divergent and convergent validity results suggested good construct validity. Two main factors were extracted by factor analysis and explained 62.3% of the cumulative variance: the first factor represented mental component, the second physical component. The Cronbach alpha coefficient was 0.88 and 0.91 respectively for factor 1 and factor 2. Conclusion We translated into Arabic language and adapted the SF-36 scale for use in Tunisian population. The Arabic version is reliable and valid. Although the scale was validated in a Tunisian population, we expect that it is suitable for other Arab populations, especially North Africans. Further studies are needed to confirm such a hypothesis.

Mots cles : Purpura croissance amputation prothese Depuis les progres de la reanimation medicale, le nombre d’enfants ayant eu un purpura fulminans avec des amputations de membres s’est accru. Nous suivons actuellement 15 enfants avec une atteinte severe des membres. L’atteinte des membres est assez stereotypee. Pour les atteintes des membres inferieurs, le plus souvent les amputations du tiers moyen de jambe bilaterale posent de serieux problemes d’appareillage. Nous vous presentons le dossier d’Adrien, âge de 18 ans, suivi depuis quinze ans pour des sequelles d’un purpura fulminans survenu a l’âge de cinq mois. Il a presente une amputation d’avant bras gauche, du tiers moyen de jambe droite et une arthrite septique de cheville gauche. Le premier appareillage a ete realise a l’âge de 11 mois, consistant pour le membre inferieur droit a une prothese a appui ischiatique et pour le membre inferieur gauche une orthese articulee cruropedieuse. Au cours des premieres annees, on constate l’existence de lesions severes des cartilages de croissance laissant presager une taille finale tres reduite. Des lesions asymetriques du cartlilage de croissance tibial inferieur ont abouti a une deviation en varus corrige chirurgicalement a deux reprises. A l’âge de 13 ans, nos craintes quant a sa taille finale se sont averees exactes. Nous avons envisage de l’appareiller en femoral des deux cotes. Afin de faciliter cet appareillage, il a ete realise une amputation partielle du pied gauche. L’etat articulaire de ses genoux etait deteriore, l’appareillage en femoral permettait d’eviter leur sollicitation importante. Adrien porte maintenant ses protheses plus longtemps, il a renoue des liens sociaux. Le purpura fulminans donne non seulement des lesions d’ischemie necessitant des amputations a la phase aigue de la maladie, mais aussi une atteinte des zones de croissance plus pouvant aller jusqu’a une sterilisation complete de l’ensemble des CC. Ceci pose le probleme ulterieur apres, la phase aigue, de deviation d’axe et d’inegalite de longueur. Les problemes orthopediques risquent de se poser tout au long de la « croissance ». La frequence de ces atteintes ne doit pas etre meconnue. La prise en charge au long terme de ces enfants requiert des consultations multidisciplinaires avec ergotherapeutes, kinesitherapeutes, medecins MPR et chirurgiens.

Background Although peak torque has shown acceptable reproducibility, this may not be the case with two other often used parameters: time to peak torque (TPT) and the angle of peak torque (APT). Those two parameters should be used for the characterization of muscular adaptations in athletes. Methods The isokinetic performance of the knee extensors and flexors in both limbs was measured in 29 male athletes. The experimental protocol consisted of three consecutive identical paradigms separated by 45 min breaks. Each test consisted of four maximal concentric efforts performed at 60 and 180°/s. Reproducibility was quantified by the standard error measurement (SEM), the coefficient of variation (CV) and by means of intra-class correlation coefficients (ICCs) with the calculation of 6 forms of ICCs. Results Using ICC as the indicator of reproducibility, the correlations for TPT of both limbs showed a range of 0.51–0.65 in extension and 0.50–0.63 in flexion. For APT, the values were 0.46–0.60 and 0.51–0.81, respectively. In addition, the calculated standard error of measurement (SEM) and CV scores confirmed the low level of absolute reproducibility. Conclusions Due to their low reproducibility, neither TPT nor APT can serve as independent isokinetic parameters of knee flexor and extensor performance. So, given its reproducibility level, TPT and APT should not be used for the characterization of muscular adaptations in athletes.

Satisfaction des attentes ; Satisfaction Objectif .– La relation entre les attentes des patients avant arthroplastie totale de hanche (ATH) et la satisfaction postoperatoire est mal comprise. L’objectif de ce travail etait d’evaluer les facteurs associes a la satisfaction globale et a la satisfaction des attentes 1 an apres ATH. Methodes.– Dans une precedente etude [1], les attentes de 132 patients en attente d’ATH et de leurs chirurgiens respectifs etaient evaluees par le « Hospital for Special Surgery Total Hip Replacement Expectations Survey » (THR survey). Un an apres l’intervention, 123 patients repondaient a un questionnaire sur la satisfaction de leurs attentes (THR survey), leur satisfaction globale, leur fonction (Womac) et leur qualite de vie (SF-12). Des analyses uniet multivariees etaient realisees pour evaluer les determinants de la satisfaction globale et de la satisfaction des attentes. Resultats.– Les attentes des chirurgiens etaient plus realistes que celles des patients concernant la persistance de douleurs nocturnes et le besoin d’aide a la marche. Les patients et les chirurgiens avaient des attentes trop optimistes concernant la reprise des activites sportives et professionnelles, l’amelioration des activites sexuelles, la possibilite de se chausser ou de se couper les ongles de pied. Chez les patients satisfaits (n = 113), la composante psychologique du SF12 preoperatoire etait plus elevee, et les attentes des chirurgiens plus optimistes. La satisfaction des attentes etait le seul facteur associe de facon significative a la satisfaction globale (OR ajuste 1,08, IC a 95% [1,04 ; 1,12]). La satisfaction des attentes pouvait etre predite en preoperatoire par un âge peu eleve (coefficient de regression –0,55 [–0,88 ; –0,21]), un meilleur etat psychologique (0,56 [0,14 ; 0,99]) et unemeilleure fonction (–0,96 [–1,82 ; –0,1]). Apres la chirurgie, la recuperation fonctionnelle etait le seul determinant de la satisfaction des attentes (–2,10 [–2,79 ; –1,42]). Discussion.– Quelles ques soient les attentes des patients avant ATH, seule leur satisfaction determine la satisfaction globale 1 an apres l’intervention. Les chirurgiens, dont les attentes paraissent realistes, pourraient mieux communiquer avec les patients de facon a moderer leurs attentes concernant certaines activites. Reference [1] Jourdan C, et al. Comparison of patient and surgeon expectations of total hip arthroplasty. PLoS One 2012;7(1):e30195.

ObjectivesValidate the use of the PPLP scoring scale in the follow-up of athletes after anterior cruciate ligament (ACL) reconstruction.Patient and methodWe conducted a prospective follow-up study on athletes with ACL reconstruction during several time periods between 2003 and 2009, we analyzed the score validity, its reproducibility, its responsiveness to change and its relevance in the follow-up and monitoring of ACL reconstructive surgeries.ResultsThe PPLP scoring scale was defined for the monitoring of ACL reconstruction in athletes. The PPLP tool is made of two parts: the first one (PPLP1) with a total of 100 points for postoperative follow-up and the second one also with a total of 100 points (PPLP2) adding up to the first score for determining a final post-op monitoring score of 200 points. The PPLP2 scoring scale is administered at a distance from the initial ACL reconstruction. For construct validity, we showed the differences in items’ characteristics (coefficient r of 0.20 in 763 patients), and adequate correlation of the PPLP score to other scoring scales found in the literature (OAK, Lysholm, Tegner, Knee injury and Osteoarthritis Outcome Score [KOOS], Arpege, IKDC Subjective Knee Evaluation Form and Psychovitality Test). The intra/interexaminer reproducibility is excellent going from 0.92 to 1. The PPLP scoring scale shows a statistically significant responsiveness to change during the hospital stay, according to the postoperative delay but with great variations. Complicated clinical evolutions (among 3296 ACL reconstructions with postoperative follow-up) are well identified by a low PPLP score, mainly for complex regional pain syndrome Type 1 (CRPS1: 1.9%) with a mean PPLP1 score of 80.33 whereas uncomplicated clinical evolutions (80.8%) have a mean score of 94.28 with a significant difference (p

Objectives Isokinetic assessment is currently the reference method for measuring dynamic muscle strength. We have sought to evaluate the reproducibility over time of isokinetic testing of the hip flexor (FI) and extensor (Ext) muscles and to establish whether there is a significant difference in peak torque (PT) between the left and right hips. Patients and methods Ten adults were tested once a week for 3 weeks by the same investigator and according to the same protocol, with two velocities (60°/s and 180°/s) for the hip FI and Ext in concentric tests and one velocity (30°/s) for the Ext only in eccentric tests. The reproducibility of the measured PT was analyzed by using the intraclass correlation coefficient (ICC) and a Bland and Altman plot. The difference in PT between the right and left hips was tested using Student's T test. Results The ICC for the observed PT values revealed very good reproducibility (with a value of between 0.75 and 0.96) for the hip FI and Ext measurements (regardless of the body side, test velocity or contraction mode). We did not observe any significant PT differences between the right and left hips. Conclusion The isokinetic assessment of the concentric and eccentric PT values generated by the hip FI and Ext is highly reproducible. There is no difference between dominant and nondominant body sides, which enables the use of the contralateral limb as a reference.