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de la Fuente C, Carreño-Zillmann G, Marambio H, Henríquez H. Is the Dresden technique a mechanical design of choice suitable for the repair of middle third Achilles tendon ruptures? A biomechanical study. Rev Esp Cir Ortop Traumatol (Engl Ed) 2016; 60:279-85. [PMID: 27435986 DOI: 10.1016/j.recot.2016.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/30/2016] [Accepted: 06/13/2016] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To compare the mechanical failure of the Dresden technique for Achilles tendon repair with the double modified Kessler technique controlled repair technique. The maximum resistance of the two repair techniques are also compared. MATERIAL AND METHODS A total of 30 Achilles tendon ruptures in bovine specimens were repaired with an Ethibond(®) suture to 4.5cm from the calcaneal insertion. Each rupture was randomly distributed into one of two surgical groups. After repair, each specimen was subjected to a maximum traction test. The mechanical failure (tendon, suture, or knot) rates (proportions) were compared using the exact Fisher test (α=.05), and the maximum resistances using the Student t test (α=.05). RESULTS There was a difference in the proportions of mechanical failures, with the most frequent being a tendon tear in the Dresden technique, and a rupture of the suture in the Kessler technique. DISCUSSION The repair using the Dresden technique performed in the open mode, compared to the Kessler technique, has a more suitable mechanical design for the repair of middle third Achilles tendon ruptures on developing a higher tensile resistance in 58.7%. However, its most common mechanical failure was a tendon tear, which due to inappropriate loads could lead to lengthening of the Achilles tendon.
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Affiliation(s)
- C de la Fuente
- Carrera de Kinesiología, UDA cs. de Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Programa de Magíster en Ciencias de la Ingeniería, mención Ingeniería Biomédica, Universidad de Valparaíso, Santiago, Chile.
| | - G Carreño-Zillmann
- Programa de Quiropraxia, Facultad de Ciencias de la Salud, Universidad Central, Santiago, Chile; Facultad de Ciencias de la Salud, Universidad Iberoamericana de Ciencias y Tecnología, Santiago, Chile
| | - H Marambio
- Servicio de Traumatología, Clínica Santa Maria, Santiago, Chile; Escuela de Medicina, Universidad de Chile, Santiago, Chile
| | - H Henríquez
- Servicio de Traumatología, Clínica Santa Maria, Santiago, Chile; Servicio de Tobillo y Pie, Instituto Traumatológico «Teodoro Gebauer Weisser», Santiago, Chile; Escuela de Medicina, Universidad de Chile, Santiago, Chile
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De Carli A, Lanzetti RM, Ciompi A, Lupariello D, Vadalà A, Argento G, Ferretti A, Vulpiani MC, Vetrano M. Can platelet-rich plasma have a role in Achilles tendon surgical repair? Knee Surg Sports Traumatol Arthrosc 2016; 24:2231-7. [PMID: 25796585 DOI: 10.1007/s00167-015-3580-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 02/25/2015] [Indexed: 01/14/2023]
Abstract
PURPOSE Our hypothesis was that the Achilles tendon healing process after surgical treatment would be promoted by PRP with a faster return to sports activities. METHODS Thirty patients with Achilles tendon rupture and surgically treated with a combined mini-open and percutaneous technique were prospectively enroled in the study. Patients were alternately case-by-case assigned to Group A (control group; 15 patients) or Group B (study group; 15 patients). In Group B, PRP was locally infiltrated both during surgery and 14 days after surgery. Patients in both groups were followed up at 1, 3, 6 and 24 months post-operatively via physical examination, VAS, FAOS and VISA-A scales; ultrasonography (US) and MRI were also conducted at one and 6 months; at the 6-month follow-up, isokinetic and jumping capacity tests were also performed. RESULTS The VAS, FAOS and VISA-A scale showed no difference between the two groups at 1, 3, 6 and 24 months post-operatively. Isokinetic evaluation showed no differences at both angular speeds. Jumping evaluation showed no difference at 6 months. Also US evaluation showed no differences. MRI data analysis before administration of gadolinium did not reveal significant differences between the two groups. Moreover, after intravenous injection of gadolinium, patients in Group B showed signal enhancement in 30 % of patients compared to 80 % in Group A at 6 months, as indirect evidence of better tendon remodelling (P < 0.05). CONCLUSIONS A substantial equivalence in structural and functional results in Achilles tendon ruptures surgically treated with and without addition of PRP is shown by present study. Clinical results, morphological features and jumping capability were similar in both groups. The addition of PRP to the surgical treatment of Achilles tendon rupture does not appear to offer superior clinical and functional results. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Angelo De Carli
- Orthopaedic Unit, "Kirk Kilgour" Sports Injury Center, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, Italy
| | - Riccardo Maria Lanzetti
- Orthopaedic Unit, "Kirk Kilgour" Sports Injury Center, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, Italy
| | - Alessandro Ciompi
- Orthopaedic Unit, "Kirk Kilgour" Sports Injury Center, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, Italy.
| | - Domenico Lupariello
- Orthopaedic Unit, "Kirk Kilgour" Sports Injury Center, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, Italy
| | - Antonio Vadalà
- Orthopaedic Unit, "Kirk Kilgour" Sports Injury Center, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, Italy
| | - Giuseppe Argento
- Diagnostic Imaging Unit, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, Italy
| | - Andrea Ferretti
- Orthopaedic Unit, "Kirk Kilgour" Sports Injury Center, S. Andrea Hospital, University of Rome "La Sapienza", Via di Grottarossa 1035, 00189, Rome, Italy
| | - M C Vulpiani
- Physical Medicine and Rehabilitation Unit, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
| | - M Vetrano
- Physical Medicine and Rehabilitation Unit, S. Andrea Hospital, University of Rome "La Sapienza", Rome, Italy
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Spoendlin J, Meier C, Jick SS, Meier CR. Bisphosphonate therapy start may transiently increase the risk of tendon rupture in patients with glucocorticoid co-medication: a population-based observational study. Pharmacoepidemiol Drug Saf 2016; 25:1116-1123. [PMID: 27297005 DOI: 10.1002/pds.4042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/30/2016] [Accepted: 05/01/2016] [Indexed: 11/10/2022]
Abstract
PURPOSE The effect of bisphosphonates on extra-osseous tissue is rarely investigated. We performed an exploratory analysis on the association of new bisphosphonate use and incident tendon rupture in patients with or without oral glucocorticoid co-medication. METHODS We conducted a matched case-control study using data from the UK-based Clinical Practice Research Datalink. Cases were patients aged 30-89 years with an incident diagnosis of Achilles or biceps tendon rupture between 1995 and 2013. We compared new oral bisphosphonate use between cases and controls with or without oral glucocorticoid co-medication, by timing (last prescription </≥180 days) and duration (number of prescriptions) of bisphosphonate use. In a case-crossover analysis, we compared new bisphosphonate exposure in the event period and the control period controlling for glucocorticoid use. RESULTS Among 7859 cases, 246 (3.1%) were new users of bisphosphonates. Patients with glucocorticoid co-medication had an odds ratio (OR) for tendon rupture of 6.42 (95%CI 4.03-10.22) for short-term bisphosphonate use (≤4 prescriptions), which declined with increasing number of prescriptions. Among people with continuous prednisone use of 5-10 mg/day, bisphosphonate users with <9 prescriptions had an OR of 2.46 (95%CI 1.00-6.03), compared with bisphosphonate non-users. The case-crossover analysis yielded an OR of 4.46 (95%CI 2.76-7.20) for new bisphosphonate treatment in patients with glucocorticoid co-medication, and a null result in glucocorticoid non-users. CONCLUSIONS New bisphosphonate treatment may transiently increase the risk of tendon rupture in oral glucocorticoid users. Further research is needed to establish causality of this yet unreported adverse drug reaction or drug-drug interaction. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Julia Spoendlin
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Christian Meier
- Division of Endocrinology, Diabetes and Metabolism, University Hospital Basel, Basel, Switzerland
| | - Susan S Jick
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA, USA
| | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland. .,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland. .,Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA, USA.
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Li Q, Wang C, Huo Y, Jia Z, Wang X. Minimally invasive versus open surgery for acute Achilles tendon rupture: a systematic review of overlapping meta-analyses. J Orthop Surg Res 2016; 11:65. [PMID: 27266275 PMCID: PMC4893828 DOI: 10.1186/s13018-016-0401-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/01/2016] [Indexed: 01/05/2023] Open
Abstract
Background A number of meta-analyses have been carried out to evaluate the effects of minimally invasive surgery (MIS) versus open surgery (OS) for acute Achilles tendon rupture. However, discordant findings were seen in these meta-analyses. The present study, performing a systematic review of overlapping meta-analyses regarding MIS versus OS of acute Achilles tendon rupture, aimed to assist decision-makers interpret and choose among conflicting meta-analyses, as well as to offer treatment recommendations based on current best evidence. Methods The literature search was performed to identify systematic reviews comparing MIS with OS for Achilles tendon rupture. Meta-analyses only comprising randomized controlled trials (RCTs) were included. Two authors individually evaluated the quality of meta-analysis and extracted data. The Jadad decision algorithm was conducted to ascertain which meta-analysis offered the best evidence. Results A total of four meta-analyses was included. All these meta-analyses comprised RCTs or quasi-RCTs and were determined as Level-II evidence. The scores of the Assessment of Multiple Systematic Reviews (AMSTAR) ranged from 7 to 10 (median 9.5). The Jadad algorithm indicated that the best meta-analysis should be chosen according to the search strategies and application of selection. A high-quality meta-analysis with more RCTs was chosen, which suggested that there was no statistically significant difference between MIS and OS regarding rerupture rate, tissue adhesion, sural nerve injury, deep infection, and deep vein thrombosis. However, MIS could decrease superficial infection rate, and had a better patient satisfaction for good to excellent outcomes in comparison to OS. Conclusions Based on the best available evidence, MIS may be superior to OS for treating acute Achilles tendon rupture. However, due to some limitations, this should be cautiously interpreted, and further high-quality studies are needed.
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Affiliation(s)
- Qingbo Li
- Department of Orthopaedic Trauma, The Second Hospital of Shandong University, Jinan, People's Republic of China
| | - Chuanying Wang
- Department of Rehabilitation, The Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, No.1 Jingba Road, Jinan, 250001, People's Republic of China.
| | - Yanqing Huo
- Department of Orthopaedic Trauma, The Second Hospital of Shandong University, Jinan, People's Republic of China
| | - Zhiwei Jia
- Department of Orthopaedics, The 306th Hospital of People's Liberation Army, Beijing, People's Republic of China.
| | - Xiqian Wang
- Department of Orthopaedic Trauma, The Second Hospital of Shandong University, Jinan, People's Republic of China
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Silbernagel KG, Shelley K, Powell S, Varrecchia S. Extended field of view ultrasound imaging to evaluate Achilles tendon length and thickness: a reliability and validity study. Muscles Ligaments Tendons J 2016; 6:104-10. [PMID: 27331037 DOI: 10.11138/mltj/2016.6.1.104] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Achilles tendon structural changes are common after injury and correlate with recovery of function. Having simple, inexpensive, yet valid and reliable measures of Achilles tendon structure are useful both in research and clinical. The purpose of this study was to perform reliability and validity measures of extended field of view (EFOV) ultrasound (US) imaging of the Achilles tendon. METHODS eight cadavers (16 tendons) were used for the validation study to compare Achilles tendon length measurements from US images with actual measured length from dissected tendons. Nine healthy subjects (18 tendons) were included in the test-retest evaluation. RESULTS the correlation between the US images and cadaveric measurements was excellent (ICC=0.895) for the length between calcaneus and the gastrocnemius and good (ICC=0.744) for the length between the calcaneus and the soleus. The between-limb reliability was excellent (ICC 0.886-0.940) for the tendon length measurements with standard error of measurements (SEM) of 0.64 cm for calcaneus to soleus and 0.67 cm for calcaneus to gastrocnemius. Between-day test-retest reliability was also excellent (ICC=0.898-0.944). CONCLUSION this study supports the use of EFOV US imaging as a reliable and valid method to determine Achilles tendon length and thickness, and using the uninjured limb for comparison.
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Affiliation(s)
| | - Kristen Shelley
- Department of Physical Therapy for University of the Sciences, Philadelphia, USA
| | - Stephen Powell
- Department of Physical Therapy for University of the Sciences, Philadelphia, USA
| | - Shaun Varrecchia
- Department of Physical Therapy for University of the Sciences, Philadelphia, USA
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Macera A, Carulli C, Matassi F, Veneziani C, Innocenti M. Traumatic bilateral Achilles tendon rupture in a young athlete treated with percutaneous tenorrhaphy. JOINTS 2016; 3:218-20. [PMID: 26904529 DOI: 10.11138/jts/2015.3.4.218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
While rupture of the Achilles tendon is one of the most frequent injuries sustained in sports and physical activity, bilateral Achilles tendon rupture is uncommon. We present the case of a 33-year-old man who sustained a bilateral Achilles tendon rupture in the absence of predisposing factors. The lesions were managed by percutaneous tenorrhaphy and casting. Six months after surgery he was able to return to his daily-life activities and to perform light sports activity. The Authors review the current literature on the management of this rare condition in young people, with or without risk factors.
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Belmoubarik A, Abouchane M, Mahraoui MA. [Rare case of bilateral rupture of the Achilles tendon with no notion of tendinopathy or ankle surgery in a young athlete: report of a case and review of literature]. Pan Afr Med J 2015; 20:223. [PMID: 26140066 PMCID: PMC4482520 DOI: 10.11604/pamj.2015.20.223.5985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2014] [Accepted: 03/05/2015] [Indexed: 11/11/2022] Open
Abstract
Les lésions du tendon d'Achille sont plus fréquentes que celles du tendon quadricipital ou patellaire. Les lésions bilatérales sont par contre plus rares et sont souvent associées à une notion de tendinopathie, d'injection de corticoïdes ou de maladies systémiques tels que le lupus érythémateux, l'ostéomalacie ou l'insuffisance rénale chronique. Nous rapportons le cas d'un patient de 34 ans victime d'une rupture bilatérale des tendons d'Achille suite à une réception de saut lors de la pratique de gymnastique. Le patient n’était pas suivi pour maladie de système ou mis sous corticothérapie ou fluoroquinolones. Le diagnostic a été suspecté devant une dépression anormalement creusant le relief sous cutané des deux tendons d'Achille avec une impossibilité de flexion dorsale des deux chevilles en association à un signe de Thompson bilatéralement positif. L’échographie a confirmé le diagnostic. Le patient a été traité par laçage et suture tendineuse à ciel ouvert. La rupture bilatérale du tendon d'Achille est rare. La plupart des patients rapportent une notion de maladie systémique ou un antécédent de chirurgie du genou. Nous rapportons le cas d'une lésion rare dans la littérature, une rupture bilatérale des tendons achiléens sans notions de maladies auto-immunes ni de traitement aux corticoïdes. Les lésions bilatérales présentent certaines particularités thérapeutiques et évolutives. En effet, deux difficultés sont à noter la première réside dans l'absence de référence comparative pour régler et apprécier l’équin physiologique lors de la réparation tendineuse. La deuxième difficulté est l'obligation de différer l'appui à 45 jours. Ce qui est contraignant pour le patient. La technique de réparation à ciel ouvert couplée à une immobilisation en équin protégeant la suture nous a donné des résultats satisfaisants.
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Silbernagel KG, Brorsson A, Olsson N, Eriksson BI, Karlsson J, Nilsson-Helander K. Sex Differences in Outcome After an Acute Achilles Tendon Rupture. Orthop J Sports Med 2015; 3:2325967115586768. [PMID: 26665094 PMCID: PMC4622365 DOI: 10.1177/2325967115586768] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background: Tendon healing differs between the sexes. Comparisons in outcome between the sexes after an Achilles tendon rupture are often not possible because of the small cohort (<20%) of women. Purpose: To evaluate whether there are any differences in outcome between the sexes by combining the data from 2 large randomized controlled trials that used identical outcome measures. Study Design: Cohort study; Level of evidence, 3. Methods: Included in the evaluation were patients from 2 consecutive randomized controlled trials comparing surgical and nonsurgical treatment performed at our research laboratory. Patients who had a rerupture were excluded from analysis. A total of 182 patients (152 males, 30 females), with mean ± SD age of 40 ± 11 years, were included; 94 (76 males, 18 females) were treated with surgery and 88 (76 males, 12 females) nonsurgically. Patient-reported outcome was evaluated using the Achilles tendon Total Rupture Score (ATRS), and the functional outcome was measured with a heel-rise test (measurement of muscular endurance and heel-rise height) at 6 and 12 months after injury. Results: Male patients had a greater improvement in heel-rise height at 12 months (P = .004). When each treatment group was analyzed separately, it was found that female patients had significantly (P < .03) more symptoms after surgical treatment (mean ± SD ATRS, 59 ± 24) compared with males at 6 (73 ± 19) and 12 months (74 ± 27 vs 86.5 ± 17). This sex difference was not found in the nonsurgical treatment group. For the entire group, there were no significant differences between treatments on ATRS at 6 and 12 months. The surgical group had significantly better results compared with the nonsurgical group in heel-rise endurance at 6 and 12 months and in heel-rise height recovery at 6 months (P < .03 for both). Conclusion: Sex differences were demonstrated, and female patients had a greater degree of deficit in heel-rise height as compared with males, irrespective of treatment. Females had more symptoms after surgery both at 6 and 12 months, but this difference was not found when treated nonsurgically. Clinical Relevance: Further research is needed to determine whether women will benefit more from nonsurgical compared with surgical treatment after an Achilles tendon rupture.
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Affiliation(s)
- Karin Grävare Silbernagel
- Department of Physical Therapy, University of Delaware, Newark, Delaware, USA. ; Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annelie Brorsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ; IFK Kliniken Rehab, Gothenburg, Sweden
| | - Nicklas Olsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ; Sahlgrenska University Hospital, Mölndal, Sweden
| | - Bengt I Eriksson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ; Sahlgrenska University Hospital, Mölndal, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ; Sahlgrenska University Hospital, Mölndal, Sweden
| | - Katarina Nilsson-Helander
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. ; ¶Hallands Sjukhus, Kungsbacka, Sweden
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Gulati V, Jaggard M, Al-Nammari SS, Uzoigwe C, Gulati P, Ismail N, Gibbons C, Gupte C. Management of achilles tendon injury: A current concepts systematic review. World J Orthop 2015; 6:380-386. [PMID: 25992315 PMCID: PMC4436906 DOI: 10.5312/wjo.v6.i4.380] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 03/28/2015] [Accepted: 04/20/2015] [Indexed: 02/06/2023] Open
Abstract
Achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmBase databases were searched for Achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined.
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Korkmaz M, Erkoc MF, Yolcu S, Balbaloglu O, Öztemur Z, Karaaslan F. Weight bearing the same day versus non-weight bearing for 4 weeks in Achilles tendon rupture. J Orthop Sci 2015; 20:513-6. [PMID: 25773309 DOI: 10.1007/s00776-015-0710-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 02/20/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Achilles tendon rupture (ATR) often occurs in 40- to 50-year-old men. Multiple studies discuss the correct treatment strategy based on surgical or nonsurgical intervention, including early mobilization. We aimed to compare the outcomes of bearing weight on the same day with non-weight bearing over a 4-week period of ATR patients. MATERIALS AND METHOD Forty-seven ATR patients were conservatively treated and entered into our study. Group 1 consisted of 23 patients treated with partial weight bearing beginning the same day of conservative treatment; Group 2 consisted of 24 patients treated with non-weight bearing after a 4-week period. Patients were at least 18 years old and were followed for 12 months. Evaluation criteria were mechanism of injury, admission time to our clinic, complication rate, and time to return to work. Symptoms and physical activity levels of all patients were assessed on 6 and 12 months after treatment began, according to the Achilles Tendon Total Rupture Score (ATRS), Physical Activity Scale (PAS), and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score. RESULTS Rerupture rates were rate 17.4% (4 patients) in Group 1 and 12.5% (3 patients) in Group 2 (p = 0.81). Time to return to work was shorter in Group 1 compared with Group 2, but it was not statistically significant (p = 0.86). AOFAS, ATRS, and PAS scores at 6 and 12 months showed no significant differences between groups (p = 0.69, p = 0.59, p = 0.89, p = 0.77, p = 0.94, p = 0.66, respectively). CONCLUSION This study showed that a well-conducted early-weight-bearing treatment has good clinical outcomes, with a complication rate no higher than non-weight-bearing treatment.
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Affiliation(s)
- Murat Korkmaz
- Department of Orthopaedics and Traumatology, Bozok University, Yozgat, Turkey,
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Erickson BJ, Mascarenhas R, Saltzman BM, Walton D, Lee S, Cole BJ, Bach BR. Is Operative Treatment of Achilles Tendon Ruptures Superior to Nonoperative Treatment?: A Systematic Review of Overlapping Meta-analyses. Orthop J Sports Med 2015; 3:2325967115579188. [PMID: 26665055 PMCID: PMC4622342 DOI: 10.1177/2325967115579188] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Multiple meta-analyses have been published in efforts to determine whether operative or nonoperative treatment of Achilles tendon ruptures affords superior outcomes. PURPOSE To perform a systematic review of overlapping meta-analyses comparing operative and nonoperative treatment of Achilles tendon ruptures to determine which meta-analyses provide the highest level of evidence for treatment recommendations. STUDY DESIGN Systematic review; Level of evidence, 3. METHODS A systematic review of the literature was performed to identify meta-analyses that fit the study inclusion criteria. Data were extracted from these meta-analyses regarding patient outcomes and reruptures. Meta-analysis quality was assessed using the Oxman-Guyatt and QUOROM (Quality of Reporting of Meta-analyses) systems. The Jadad algorithm was applied to determine the meta-analyses with the highest level of evidence. RESULTS Nine meta-analyses met the eligibility criteria, with all but 1 study including level 1 evidence. A total of 5842 patients were included. Seven studies found a higher rate of rerupture in the nonoperative group but a higher rate of complications in the operative group. One study found no differences in rerupture or complication rates, and 1 study found surgery decreased rerupture rates only when compared with nonoperative treatment without a functional brace. Three studies also identified an earlier return to work in the operative group. Almost all (8 of 9) of the meta-analyses had Oxman-Guyatt scores >3, indicating no major flaws. CONCLUSION Operative treatment of Achilles tendon ruptures decreases rerupture rates but increases the risk for minor complications when compared with nonoperative treatment. Additionally, surgical treatment may allow earlier return to work.
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Affiliation(s)
- Brandon J Erickson
- Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Randy Mascarenhas
- Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Bryan M Saltzman
- Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - David Walton
- Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Simon Lee
- Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Brian J Cole
- Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
| | - Bernard R Bach
- Rush University Medical Center, Midwest Orthopaedics at Rush, Chicago, Illinois, USA
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Rosso C, Buckland DM, Polzer C, Sadoghi P, Schuh R, Weisskopf L, Vavken P, Valderrabano V. Long-term biomechanical outcomes after Achilles tendon ruptures. Knee Surg Sports Traumatol Arthrosc 2015; 23:890-8. [PMID: 24162761 DOI: 10.1007/s00167-013-2726-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2013] [Accepted: 10/14/2013] [Indexed: 11/29/2022]
Abstract
PURPOSE The ideal treatment for Achilles tendon ruptures is still unknown. Biomechanical were correlated to radiological and clinical parameters to study outcomes. METHODS In this retrospective, assessor-blinded multi-centre cohort study, 52 patients with unilateral Achilles tendon rupture were assessed, each at least 3 years after injury. Patients underwent open surgery, percutaneous surgery or non-surgical treatment of Achilles tendon rupture. Both legs underwent plantar pressure distribution and isokinetic measures. Demographic parameters, maximum calf circumference (MCC) and clinical scores (American Orthopaedic Foot and Ankle Society, Achilles tendon rupture score, Hannover) were also evaluated. Complications were not assessed. RESULTS Peak plantar flexion torque (PPFT) was significantly weaker on the treated side compared to the untreated leg [80.4 ± 29.7 Nm (mean ± SD) vs. 92.1 ± 27.4 Nm, p < 0.0001]. PPFT and push-off force (POFF) were not different between treatment groups nor was there a leg difference in POFF alone. There was only a weak correlation of clinical scores and PPFT or POFF, respectively. MCC correlated significantly with both PPFT (R (2) = 0.21, p = 0.01) and POFF (R (2) = 0.29, p < 0.0001). POFF appeared to be a predictor of PPFT (R (2) = 0.31, p < 0.0001). Open surgery outperformed non-surgical treatment in terms of centre-of-pressure line (p = 0.007), torque per muscle volume (p = 0.04) and relative POFF per body weight (p = 0.02) and relative in side comparison (p = 0.03). CONCLUSIONS Clinical scores do not predict biomechanical outcomes. Clinically measured MCC is a good predictor of PPFT and POFF and can easily be used in clinical practice. Relative POFF in side comparison as well as per body weight favours surgical treatment.
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Affiliation(s)
- Claudio Rosso
- Orthopaedic Department, University Hospital Basel, University of Basel, Spitalstrasse 21, 4031, Basel, Switzerland,
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Maffulli N, Oliva F, Del Buono A, Florio A, Maffulli G. Surgical management of Achilles tendon re-ruptures: a prospective cohort study. INTERNATIONAL ORTHOPAEDICS 2015; 39:707-14. [DOI: 10.1007/s00264-015-2686-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 01/12/2015] [Indexed: 01/09/2023]
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64
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Leggit J, Carey PM, Alisangco JB. Disorders of the Lower Extremity. Fam Med 2015. [DOI: 10.1007/978-1-4939-0779-3_118-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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65
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Knobe M, Gradl G, Klos K, Corsten J, Dienstknecht T, Rath B, Sönmez TT, Hoeckle C, Pape HC. Is percutaneous suturing superior to open fibrin gluing in acute Achilles tendon rupture? INTERNATIONAL ORTHOPAEDICS 2014; 39:535-42. [PMID: 25500954 DOI: 10.1007/s00264-014-2615-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 11/25/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Open fibrin gluing is reported to enable anatomical reconstruction with less soft tissue compromise than suture repair. Our main objective was to compare the complication rate, function, pain and disability of the two operative approaches of percutaneous suture using the Paessler technique and open fibrin gluing. METHODS Sixty-four patients (two centres, retrospective cohort study, 2000-2009) who had undergone acute Achilles tendon repair with either percutaneous suture (n = 27; 44 years) or open fibrin glue (n = 37; 45 years) took part in a follow-up examination after a median of 63 months (range, six to 180). Ankle range of motion, calf and ankle circumferences and return to work and sports activities were evaluated. Isokinetic und sonographic evaluation results were retrieved. RESULTS Complications were noted in 22 patients (34 %). Delayed wound healing without evidence of surgical site infection was found in three patients in the fibrin group and two patients in the suture group. Postoperative scar tenderness described as pain at the rim of the shoe was significantly more frequent in the suture group (p = 0.03). Re-rupture requiring re-operation occurred in one patient. Transient paresthesia of the heel occurred in 12 patients. No sural nerve lesions were reported. There was no significant difference between groups regarding lower leg circumference, disability, or function. Ultrasound and isokinetic measurements did not reveal a significant difference between the two methods. CONCLUSIONS The present study suggests that open fibrin gluing is a reasonable alternative to percutaneous repair of acute ruptures of the Achilles tendon and both techniques can yield reliably good results.
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Affiliation(s)
- Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Aachen, Germany,
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66
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Mahdane H, Khaissidi A, Hammou N, Elidrissi M, Mohamed S, Elibrahim A, Elmrini A. [Open surgical treatment of recent ruptures of the Achilles tendon]. Pan Afr Med J 2014; 18:144. [PMID: 25419282 PMCID: PMC4236771 DOI: 10.11604/pamj.2014.18.144.4335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 04/21/2014] [Indexed: 11/22/2022] Open
Abstract
Les ruptures du tendon calcanéen quelles soient sous cutanées ou par section direct sont de plus en plus fréquentes. Plusieurs techniques chirurgicales, qu'elles soient à ciel ouvert ou percutanées ont été mises au point pour traitée ce type de lésion. À travers une étude rétrospective descriptive sur la prise en charge chirurgicale des ruptures de tendon calcanéen fraiches. Nous avons analysé les résultats fonctionnels de 38 patients, tous opéré par une chirurgie à ciel ouvert. Les points forts de notre étude étaient l'absence de rupture itérative, principale complication du traitement chirurgicale des ruptures du tendon calcanéen, un faible taux de complications liées à la chirurgie à ciel ouvert, ainsi que les résultats fonctionnels satisfaisants.
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Affiliation(s)
- Hicham Mahdane
- Service de Chirurgie Ostéoarticulaire B4, CHU Hassan II, Fes, Maroc
| | | | | | | | - Shimi Mohamed
- Service de Chirurgie Ostéoarticulaire B4, CHU Hassan II, Fes, Maroc
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Ollivere BJ, Bosman HA, Bearcroft PWP, Robinson AHN. Foreign body granulomatous reaction associated with polyethelene 'Fiberwire(®)' suture material used in Achilles tendon repair. Foot Ankle Surg 2014; 20:e27-9. [PMID: 24796842 DOI: 10.1016/j.fas.2014.01.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/27/2013] [Accepted: 01/24/2014] [Indexed: 02/04/2023]
Abstract
Repair of acute Achilles tendon rupture is a common procedure. There are many accepted surgical techniques; suture selection is largely due to surgeon preference. We present a case report of a granulomatous reaction to suture material following Achilles tendon repair. 'Fiberwire(®)' is an increasingly popular suture material for the repair of tendons and ligamentous structures; the polyethelene braided structure with silicone and polyester coating provides high tensile strengths and good handling characteristics. Eight months following uneventful Achilles tendon repair surgery in an otherwise fit and well patient, pain, swelling and loss of function was noted. She required revision surgery with debridement and reconstruction of the tendo Achillis with flexor hallucis longus tendon transfer. Histology revealed a granulomatous reaction with giant cell response surrounding sections of the suture. Both the silicone coating of Fiberwire(®) and polyethylene core have the potential to cause a severe granulomatous reaction. We would advise caution in the use of this suture for tendo Achillis repair, and use the readily available alternatives.
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Sun C, Zhuo Q, Chai W, Chen J, Yang W, Tang P, Wang Y. Conservative interventions for treating Achilles tendon ruptures. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Tengman T, Riad J. Three-Dimensional Gait Analysis Following Achilles Tendon Rupture With Nonsurgical Treatment Reveals Long-Term Deficiencies in Muscle Strength and Function. Orthop J Sports Med 2013; 1:2325967113504734. [PMID: 26535245 PMCID: PMC4555491 DOI: 10.1177/2325967113504734] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Precise long-term assessment of movement and physical function following Achilles tendon rupture is required for the development and evaluation of treatment, including different regimens of physical therapy. Purpose: To assess intermediate-term (<10 years by conventional thinking) objective measures of physical function following Achilles tendon rupture treated nonsurgically and to compare these with self-reported measures of physical function. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Two to 5 years after Achilles tendon rupture, 9 women and 43 men (mean age, 49.2 years; range, 26-68 years) were assessed by physical examination, performance of 1-legged jumps, and 3-dimensional gait analysis (including calculation of muscle work). Self-reported scores for foot function (Achilles tendon rupture score) and level of physical activity were collected. Twenty age- and sex-matched controls were assessed in the same manner. Results: Physical examination of patients with the knee extended revealed 11.1° of dorsiflexion on the injured side and 9.2° on the uninjured side (P = .020), indicating gastrocnemius muscle lengthening. The 1-legged jump distance was shorter on the injured side (89.5 vs 96.2 cm; P < .001). Gait analysis showed higher peak dorsiflexion (14.3° vs 13.3°; P = .016) and lower concentric (positive) plantar flexor work (16.6 vs 19.9 J/kg; P = .001) in the ankle on the uninjured side. At the same time, eccentric (negative) dorsiflexor work was higher on the injured side (13.2 vs 11.9 J/kg; P = .010). Self-perceived foot function and physical activity were lower in patients than in healthy controls (mean Achilles tendon rupture score, 78.6 and 99.8, respectively). Conclusion: Nonsurgically treated patients with Achilles tendon rupture showed signs of both anatomic and functional lengthening of the tendon. Attenuated muscle strength and function were present during walking as long as 2 to 5 years after rupture, as determined by 3-dimensional gait analysis. More extensive future studies involving patients having both surgical and nonsurgical treatment could provide additional valuable information.
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Affiliation(s)
- Tine Tengman
- Department of Orthopaedics, Skaraborg Hospital, Skövde, Sweden
| | - Jacques Riad
- Department of Orthopaedics, Skaraborg Hospital, Skövde, Sweden
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Carmont MR, Silbernagel KG, Edge A, Mei-Dan O, Karlsson J, Maffulli N. Functional Outcome of Percutaneous Achilles Repair: Improvements in Achilles Tendon Total Rupture Score During the First Year. Orthop J Sports Med 2013; 1:2325967113494584. [PMID: 26535234 PMCID: PMC4555500 DOI: 10.1177/2325967113494584] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Randomized studies have so far failed to show a difference in outcome between operative and nonoperative management of Achilles tendon rupture, provided that no rerupture occurs. Percutaneous Achilles repair has been suggested to result in superior patient satisfaction compared with open repair in patients with an acute Achilles tendon rupture, but there are no outcome data available with validated methods describing the progression of recovery during the first year. Purpose: To evaluate the outcome of patients with a ruptured Achilles tendon, managed by percutaneous repair, during the first year following repair with a valid, reliable, and responsive outcome measure. Furthermore, the effects of time between injury and surgery, age, and complications on outcome were also evaluated. Study design: Case series. Methods: A total of 73 patients (60 males and 13 females) with a mean age of 45.5 years were included. Patient age, length of time between injury and surgery, and complications were documented. Patients were evaluated using the Achilles tendon Total Rupture Score (ATRS) at 3, 6, 9, and 12 months following repair. Results: The median ATRS results at 3, 6, 9, and 12 months were 42.5, 73, 83, and 89, respectively. The number of patients who reported excellent or good scores (ATRS >84) at 3, 6, 9, and 12 months were 3%, 36%, 57%, and 69%, respectively. There were no significant differences in outcome at each time point for those patients undergoing early (≤48 hours) compared with late surgery or between those <65 and those >65 years of age. The complication rate was 13.5%. Patients who had a complication had a lower ATRS result at 3 months following surgery, but there were no differences after that time point. Conclusion: The patients in the present study reported marked improvement in function between 3 and 6 months following surgery, with continuing but less steep improvement up to 1 year following surgery. The presence of a complication other than rerupture did not affect the end-stage outcome but did affect that at 3 months following surgery. Clinical Relevance: This study demonstrates improving scores with time over the first year following surgery, against which other treatment methods can be compared.
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Affiliation(s)
- Michael R Carmont
- Department of Orthopaedic Surgery, Princess Royal Hospital, Telford, Shropshire, UK
| | | | - Antonia Edge
- Department of Orthopaedic Surgery, Princess Royal Hospital, Telford, Shropshire, UK
| | - Omer Mei-Dan
- Department of Sports Medicine, University of Colorado Hospitals, Boulder, Colorado, USA
| | - Jón Karlsson
- Department of Orthopaedic Surgery, Sahlgrenska University Hospital, MöIndal, Sweden
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, London, UK
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71
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Carmont MR, Heaver C, Pradhan A, Mei-Dan O, Gravare Silbernagel K. Surgical repair of the ruptured Achilles tendon: the cost-effectiveness of open versus percutaneous repair. Knee Surg Sports Traumatol Arthrosc 2013; 21:1361-8. [PMID: 23377798 DOI: 10.1007/s00167-013-2423-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 01/21/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE Recent meta-analyses have shown reduced re-rupture rates for the surgical management of Achilles ruptures. However, percutaneous repair has been demonstrated to lead to improved function and patient satisfaction but greater complications than open repair. In the current economic climate, it is reasonable to consider the financial cost of rupture management for both the patient and the provider. The cost-effectiveness of operative treatment of ruptures of the Achilles tendon was determined based upon theatre occupancy, clinic attendance and cast changes, operative complications and functional assessment score. METHODS The cost-effectiveness of the surgical management of Achilles tendon ruptures between 2005 and 2011 in our unit was audited by comparing 49 patients receiving percutaneous repair to 35 patients whom had open repairs. RESULTS There was no significant difference in complications between the two surgical techniques: (Open vs. Percutaneous) overall rates 14.3 versus 10.4 %: infection; 2.7 versus 2.0 %, transient sural nerve damage: 5.6 versus 8.1 %, wound breakdown: 2.8 versus 0.0 %, re-rupture: 2.8 versus 2.0 %. Achilles Total Rupture Scores (ATRS) were comparable [Open 89 (65-100) at 49 months vs. Percutaneous 88.8 (33-100) at 12 months (n.s.)]. Theatre occupancy (P < 0.00) and hospital stay (P < 0.00) were significantly longer with open repair [43 min (26-70) and 2.9 days (0-4)] compared to percutaneous repair [15 min (12-43) and 1.2 days (0-2)]. Excluding the costs of running the operating theatre, we have estimated the costs of surgery for open repair to be £ 935 and percutaneous repair to be £ 574. CONCLUSIONS This study suggests that percutaneous repair of the Achilles tendon resulted in reduced costs and yet had comparable outcome and complications rates to open repair in surgical management of the Achilles tendon. Percutaneous repair should be considered as the primary method of cost-effective surgical management of Achilles tendon rupture.
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Affiliation(s)
- M R Carmont
- The Department of Orthopaedic Surgery, Princess Royal Hospital, Telford, Shropshire, TF1 6TF, UK.
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Kołodziej L, Bohatyrewicz A, Kromuszczyńska J, Jezierski J, Biedroń M. Efficacy and complications of open and minimally invasive surgery in acute Achilles tendon rupture: a prospective randomised clinical study--preliminary report. INTERNATIONAL ORTHOPAEDICS 2012; 37:625-9. [PMID: 23250350 PMCID: PMC3609980 DOI: 10.1007/s00264-012-1737-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 11/20/2012] [Indexed: 11/29/2022]
Abstract
PURPOSE Surgical treatment of an acute Achilles tendon rupture can effectively reduce the risk of re-rupture, but it increases the probability of surgical complications. We postulated that a minimally invasive surgical treatment might reduce the number of complications related to open surgery and improve the functional results. METHOD We enrolled 47 patients with acute Achilles tendon ruptures in a prospective, randomised trial to compare clinical results and complications between a minimally invasive procedure with the Achillon(®) device and traditional open surgery with Krackow-type sutures. The average patient age was 46 years. The follow up time was 24 months. RESULTS No Achilles tendon re-rupture or nerve injury occurred in treated patients. There were two cases of wound infections in the open surgery group, and one superficial wound infection occurred in the minimally invasive group. The groups were not significantly different in the amount of pain, range of ankle movements, the single heel-rise test, calf circumference, or time to return to work and sports. CONCLUSION After a two year follow-up period, we found no significant differences in clinical outcomes between groups treated with traditional open surgery or minimally invasive surgery.
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Affiliation(s)
- Lukas Kołodziej
- Department of Orthopaedics, Traumatology and Musculoskeletal Oncology, Pomeranian Medical University, Szczecin, Poland.
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Abstract
The value of endoscopic surgery as a minimally invasive treatment is well recognized and includes less perioperative pain, less scarring, minimal blood loss, and faster recovery. While open surgery on the Achilles tendon is notorious for wound complications, the tendon is situated in a well-formed tunnel allowing surgical procedures to be performed endoscopically. Various endoscopic techniques have been successfully applied to the treatment of non-insertional Achilles tendinopathy, Haglund's syndrome, Achilles tendon rupture, and equinus contracture. Although the evidence is currently limited, results from authors acquainted with the techniques have been encouraging. Both an understanding of surgical anatomy of the hindfoot and familiarity in soft tissue endoscopy are required to achieve successful outcomes while minimizing complications.
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Affiliation(s)
- Phinit Phisitkul
- Orthopaedic Department, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA, 52242, USA,
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Longo UG, Forriol F, Campi S, Maffulli N, Denaro V. A biomechanical comparison of the primary stability of two minimally invasive techniques for repair of ruptured Achilles tendon. Knee Surg Sports Traumatol Arthrosc 2012; 20:1392-7. [PMID: 22228376 DOI: 10.1007/s00167-011-1868-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 12/29/2011] [Indexed: 12/28/2022]
Abstract
PURPOSE To compare the primary stability of two minimally invasive procedures of Achilles tendon (AT) repair, namely a modified percutaneous repair of ruptured AT and the Achillon suture configuration. METHODS Eighteen (nine matched pairs) frozen ovine ATs were tenotomized 5 cm from the calcaneal insertion. In each pair, one tendon was randomly allocated to one of the two techniques: a modified percutaneous repair group and the Achillon device suture configuration. Specimens were tested performing an unidirectional tensile load to failure using a servo-hydraulic testing device (MTS Systems, Eden Prairie, MN, USA), controlled by an electropulse e3000 INSTRON machine (Instron Ltd, Buckinghamshire, UK). The tendons were then loaded to failure at a rate of 10 mm/s. RESULTS Two of the nine pairs of specimens were discarded because one specimen for each of the pair pulled out of the pneumatic clamp during mechanical testing. The remaining seven matched pairs were successfully tested. There were no differences in mean strength, mean maximum load, mean failure elongation, tension, stiffness and mode of failure between the two groups. CONCLUSION The Achillon-like configuration and the modified percutaneous repair of ruptured AT provided similar biomechanical performance.
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Affiliation(s)
- Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Via Alvaro del Portillo, 200, 00128, Rome, Italy
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Jiang N, Wang B, Chen A, Dong F, Yu B. Operative versus nonoperative treatment for acute Achilles tendon rupture: a meta-analysis based on current evidence. INTERNATIONAL ORTHOPAEDICS 2011; 36:765-73. [PMID: 22159659 DOI: 10.1007/s00264-011-1431-3] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2011] [Accepted: 11/13/2011] [Indexed: 12/28/2022]
Abstract
PURPOSE The aim of this study was to evaluate, in a meta-analysis, the clinical effectiveness of operative treatment for acute Achilles tendon rupture (AATR) compared with nonoperative treatment. METHODS We systematically searched six electronic databases (Medline, Embase, Clinical Ovid, BIOSIS and Cochrane registry of controlled clinical trials) to identify randomised controlled trials (RCTs) in which operative treatment was compared with nonoperative treatment for AATR from 1980 to 2011. Trial quality was assessed using the modified Jadad scale. The data was using fixed-effects and random-effects models with mean differences and risk ratios for continuous and dichotomous variables, respectively. RESULTS Ten RCTs with a total of 894 patients were screened. The results showed that operative was superior to nonoperative treatment regarding lower risk of re-rupture (P = 0.002) and shorter time for sick leave (P = 0.009) but inferior to nonoperative treatment regarding complication risks (P = 0.004). No significant difference was identified between the two methods regarding the number of patients who successfully returned to pre-injury sports (P = 0.30). Subgroup analyses revealed significant differences in relation to scar adhesion (P < 0.00001), superficial infection (P = 0.05), and sensibility disturbance (P = 0.0003). However, no significant differences were found between the two interventions in relation to deep infection (P = 0.22), deep vein thrombosis (DVT) (P = 0.14), and extreme Achilles tendon lengthening (P = 0.31). Little consensus was obtained in the functional recovery from current trials as a result of an inconsistent assessment system. CONCLUSIONS Compared with conservative treatment, operative treatment can effectively reduce the risk of re-rupture but increase the probability of complications. The increased complication risk may be associated with open repair surgery. However, no sufficient evidence is available from current studies to support the belief that operation may lead to better functional recovery.
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Affiliation(s)
- Nan Jiang
- Department of Orthopaedics and Traumatology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, People's Republic of China
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Abstract
Achilles tendon rupture is a common sports-related injury, with the incidence of acute ruptures continuing to increase. Achilles ruptures can be missed, or presentation may be delayed. Clinical tests assist diagnosis, with the Thompson and Matles tests being the most sensitive and specific. Ultrasound provides a valuable adjunct for diagnosing acute Achilles tendon ruptures. Traditionally, operative management has led to lower re-rupture rates than conservative treatment, but surgery increases the risk of complications such as adhesions and wound infection. More recently, however, non-operative treatment consisting of early mobilisation and rehabilitation, produces comparable re-rupture rates and functional outcomes to surgery. Percutaneous surgery may reduce the risk of operative complications, but needs to be more widely practised. In the present review we discuss the anatomy, aetiology, mechanism of injury, clinical assessment and investigations for diagnosing acute Achilles tendon ruptures. The debate regarding operative versus non-operative management is also considered.
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Affiliation(s)
- Rajpal S Nandra
- Department of Trauma and Orthopaedics, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Gulraj S Matharu
- Department of Trauma and Orthopaedics, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Keith M Porter
- Department of Trauma and Orthopaedics, University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
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Stoll C, John T, Conrad C, Lohan A, Hondke S, Ertel W, Kaps C, Endres M, Sittinger M, Ringe J, Schulze-Tanzil G. Healing parameters in a rabbit partial tendon defect following tenocyte/biomaterial implantation. Biomaterials 2011; 32:4806-15. [DOI: 10.1016/j.biomaterials.2011.03.026] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2011] [Accepted: 03/10/2011] [Indexed: 10/18/2022]
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