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Clinical failure after Dresden repair of mid-substance Achilles tendon rupture: human cadaveric testing. Knee Surg Sports Traumatol Arthrosc 2017; 25:1849-1856. [PMID: 27256278 DOI: 10.1007/s00167-016-4182-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/19/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this study was to describe the angle of clinical failure during cyclical mobilization exercises in the Achilles tendon of human cadaveric specimens that were repaired using the Dresden technique and FiberWire® No. 2. The secondary aim was to identify the secure limit of mobilization, the type of failure, and the type of apposition. METHODS The lower limbs of eight males (mean age: 60.3 ± 6.3 years) were repaired with the Dresden technique following complete, percutaneous mid-substance Achilles tendon rupture. A basal tension of 10 N at 30° of plantarflexion was placed on each specimen. The angle of the ankle during clinical failure (tendon ends separation >5 mm) was then tested via cyclical exercises (i.e. 100 cycles between 30° and 15° of plantarflexion; 100 cycles between 15° of plantarflexion and 0°; 100 cycles between 0° and 15° of dorsiflexion; and 100 cycles between 15° of dorsiflexion and full dorsiflexion). Clinical failure was determined using the Laplacian edge detection filter, and the angle of clinical failure was obtained using a rotatory potentiometer aligned in relation to the intermalleolar axis of each foot specimen. The type of failure (knot, tendon, or suture) and apposition (termino-terminal or non-termino-terminal) were determined. Descriptive statistics were used to obtain the mean; standard deviation; 95 % confidence interval; 1st, 25th, 50th, 75th, and 100th percentiles; and the standard error of the mean for angle data. Proportions were used to describe the type of failure and apposition. RESULTS The main results were a mean angle of clinical failure equal to 12.5° of plantarflexion, a limit of mobilization equal to 14.0° of plantarflexion, tendon failure type, and non-termino-terminal apposition in all specimens. CONCLUSIONS While the mean angle of clinical failure in human cadaveric models was 12.5° of plantarflexion, after 14.0° of plantarflexion, the percutaneous Dresden technique was found insecure for cyclical mobilization exercises, with a 5 % range of error. These findings are clinically relevant as they provide mechanical limits for diminishing the risk of Achilles lengthening during immediate rehabilitation.
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Heikkinen J, Lantto I, Flinkkila T, Ohtonen P, Niinimaki J, Siira P, Laine V, Leppilahti J. Soleus Atrophy Is Common After the Nonsurgical Treatment of Acute Achilles Tendon Ruptures: A Randomized Clinical Trial Comparing Surgical and Nonsurgical Functional Treatments. Am J Sports Med 2017; 45:1395-1404. [PMID: 28282504 DOI: 10.1177/0363546517694610] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND It remains controversial whether nonsurgical or surgical treatment provides better calf muscle strength recovery after an acute Achilles tendon rupture (ATR). Recent evidence has suggested that surgery might surpass nonsurgical treatment in restoring strength after an ATR. PURPOSE To assess whether magnetic resonance imaging (MRI) findings could explain calf muscle strength deficits and the difference between nonsurgical and surgical treatments in restoring calf muscle strength. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS From 2009 to 2013, 60 patients with acute ATRs were randomized to surgery or nonsurgical treatment with an identical rehabilitation protocol. The primary outcome measure was the volume of calf muscles assessed using MRI at 3 and 18 months. The secondary outcome measures included fatty degeneration of the calf muscles and length of the affected Achilles tendon. Additionally, isokinetic plantarflexion strength was measured in both legs. RESULTS At 3 months, the study groups showed no differences in muscle volumes or fatty degeneration. However, at 18 months, the mean differences between affected and healthy soleus muscle volumes were 83.2 cm3 (17.7%) after surgery and 115.5 cm3 (24.8%) after nonsurgical treatment (difference between means, 33.1 cm3; 95% CI, 1.3-65.0; P = .042). The study groups were not substantially different in the volumes or fatty degeneration of other muscles. From 3 to 18 months, compensatory hypertrophy was detected in the flexor hallucis longus (FHL) and deep flexors in both groups. In the nonsurgical treatment group, the mean difference between affected and healthy FHL muscle volumes was -9.3 cm3 (12%) and in the surgical treatment group was -8.4 cm3 (10%) ( P ≤ .001). At 18 months, Achilles tendons were, on average, 19 mm longer in patients treated nonsurgically compared with patients treated surgically ( P < .001). At 18 months, surgically treated patients demonstrated 10% to 18% greater strength results ( P = .037). Calf muscle isokinetic strength deficits for the entire range of ankle motion correlated with soleus atrophy (ρ = 0.449-0.611; P < .001). CONCLUSION Treating ATRs nonsurgically with a functional rehabilitation protocol resulted in greater soleus muscle atrophy compared with surgical treatment. The mean Achilles tendon length was 19 mm longer after nonsurgical treatment than after the surgical treatment of ATRs. These structural changes partly explained the 10% to 18% greater calf muscle strength observed in patients treated with surgery compared with those treated nonsurgically. Registration: NCT02012803 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Juuso Heikkinen
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Iikka Lantto
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Tapio Flinkkila
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Pasi Ohtonen
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Jaakko Niinimaki
- Research Unit of Medical Imaging, Physics and Technology, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Pertti Siira
- Department of Physical Medicine and Rehabilitation, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Vesa Laine
- Department of Physical Medicine and Rehabilitation, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
| | - Juhana Leppilahti
- Division of Orthopaedic and Trauma Surgery, Department of Surgery, Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Oulu, Finland
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Kauwe M. Acute Achilles Tendon Rupture: Clinical Evaluation, Conservative Management, and Early Active Rehabilitation. Clin Podiatr Med Surg 2017; 34:229-243. [PMID: 28257676 DOI: 10.1016/j.cpm.2016.10.009] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The Achilles tendon (AT) is the strongest, largest, and most commonly ruptured tendon in the human body. Physical examination provides high sensitivity and specificity. Imaging studies are not recommended unless there are equivocal findings in the physical examination. Recent studies have shown that the risk of re-rupture is negated with implementation of functional rehabilitation protocols. Heterogeneity in study design makes conclusions on the specifics of functional rehabilitation protocols difficult; however, it is clear that early weight bearing and early controlled mobilization lead to better patient outcome and satisfaction in both surgically and conservatively treated populations.
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Affiliation(s)
- Merrell Kauwe
- Foot and Ankle Department, UnityPoint Trinity Regional Medical Center, 804 Kenyon Road, Suite 310, Fort Dodge, IA 50501, USA.
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Davies H, Agrawal Y, Blundell C, Davies MB. Outcome following use of the Achillon jig for the repair of acutely ruptured Achilles tendons. Injury 2017; 48:781-783. [PMID: 28088379 DOI: 10.1016/j.injury.2017.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/05/2017] [Accepted: 01/07/2017] [Indexed: 02/02/2023]
Abstract
We report a series of 143 patients who underwent limited open Achilles tendon repair using the Achillon device at a mean follow-up of 25 months. All patients attending our institution with a diagnosis of acute Achilles tendon rupture were considered for operative repair using the Achillon jig unless they declined surgery or met the exclusion criteria. Following surgery patients were contacted and asked to complete an Achilles Tendon Rupture Score (ATRS). The clinical records were reviewed for evidence of complications, demographic information and evidence of re-rupture. Statistical analysis of subgroups including age at presentation, delay to surgery and patients with complications was carried out using the Kruskal Wallis non-parametric test. We report no re-ruptures at a mean of 25 months (minimum 12 months) following surgery. The mean ATRS score was 84/100 (range 15-100). There was no statistical significance between any of the subgroups analyzed. In conclusion, acute Achilles repair using the Achillon jig is safe, with a low re-rupture rate, excellent ATRS scores at a minimum of 12 months post-operatively and low complications. The incidence of sural nerve injury is much lower than published series of percutaneous Achilles tendon repair without the use of a jig.
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Affiliation(s)
- Howard Davies
- Sheffield Foot and Ankle Unit, Dept of Trauma and Orthopaedic Surgery, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK.
| | - Yuvraj Agrawal
- Sheffield Foot and Ankle Unit, Dept of Trauma and Orthopaedic Surgery, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
| | - Chris Blundell
- Sheffield Foot and Ankle Unit, Dept of Trauma and Orthopaedic Surgery, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
| | - Mark B Davies
- Sheffield Foot and Ankle Unit, Dept of Trauma and Orthopaedic Surgery, Northern General Hospital, Herries Road, Sheffield, S5 7AU, UK
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Sheth U, Wasserstein D, Jenkinson R, Moineddin R, Kreder H, Jaglal SB. The epidemiology and trends in management of acute Achilles tendon ruptures in Ontario, Canada: a population-based study of 27 607 patients. Bone Joint J 2017; 99-B:78-86. [PMID: 28053261 DOI: 10.1302/0301-620x.99b1.bjj-2016-0434.r1] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 09/19/2016] [Indexed: 11/05/2022]
Abstract
AIMS The aims of this study were to establish the incidence of acute Achilles tendon rupture (AATR) in a North American population, to select demographic subgroups and to examine trends in the management of this injury in the province of Ontario, Canada. PATIENTS AND METHODS Patients ≥ 18 years of age who presented with an AATR to an emergency department in Ontario, Canada between 1 January 2003 and 31 December 2013 were identified using administrative databases. The overall and annual incidence density rate (IDR) of AATR were calculated for all demographic subgroups. The annual rate of surgical repair was also calculated and compared between demographic subgroups. RESULTS A total of 27 607 patients (median age, 44 years; interquartile range 26 to 62; 66.5% male) sustained an AATR. The annual IDR increased from 18.0 to 29.3 per 100 000 person-years between 2003 and 2013. The mean IDR was highest among men between the ages of 40 and 49 years (46.0/100 000 person-years). The annual rate of surgical repair dropped from 20.1 in 2003 to 9.2 per 100 AATRs in 2013. There was a noticeable decline after 2009. CONCLUSION The incidence of AATR is increasing in Ontario, while the annual rate of surgical repair is decreasing. A sharp decline in the rate of surgical repair was noted after 2009. This coincided with the publication of several high-quality RCTs which showed similar outcomes for the 'functional' non-operative management and surgical repair. Cite this article: Bone Joint J 2017;99-B:78-86.
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Affiliation(s)
- U Sheth
- University of Toronto, Division of Orthopaedic Surgery, 160-500 University Avenue, Toronto, Ontario, Canada
| | - D Wasserstein
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - R Jenkinson
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - R Moineddin
- University of Toronto, 500 University Avenue, Ontario, Canada
| | - H Kreder
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, Ontario, Canada
| | - S B Jaglal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Lawrence JE, Nasr P, Fountain DM, Berman L, Robinson AHN. Functional outcomes of conservatively managed acute ruptures of the Achilles tendon. Bone Joint J 2017; 99-B:87-93. [PMID: 28053262 DOI: 10.1302/0301-620x.99b1.bjj-2016-0452.r1] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/27/2016] [Indexed: 11/05/2022]
Abstract
AIMS This prospective cohort study aims to determine if the size of the tendon gap following acute rupture of the Achilles tendon shows an association with the functional outcome following non-operative treatment. PATIENTS AND METHODS All patients presenting within two weeks of an acute unilateral rupture of the Achilles tendon between July 2012 and July 2015 were considered for the study. In total, 38 patients (nine female, 29 male, mean age 52 years; 29 to 78) completed the study. Dynamic ultrasound examination was performed to confirm the diagnosis and measure the gap between ruptured tendon ends. Outcome was assessed using dynamometric testing of plantarflexion and the Achilles tendon Total Rupture score (ATRS) six months after the completion of a rehabilitation programme. RESULTS Patients with a gap ≥ 10 mm with the ankle in the neutral position had significantly greater peak torque deficit than those with gaps < 10 mm (mean 23.3%; 7% to 52% vs 14.3%; 0% to 47%, p = 0.023). However, there was no difference in ATRS between the two groups (mean score 87.2; 74 to 100 vs 87.4; 68 to 97, p = 0.467). There was no significant correlation between gap size and torque deficit (τ = 0.103), suggesting a non-linear relationship. There was also no significant correlation between ATRS and peak torque deficit (τ = -0.305). CONCLUSION This is the first study to identify an association between tendon gap and functional outcome in acute rupture of the Achilles tendon. We have identified 10 mm as a gap size at which deficits in plantarflexion strength become significantly greater, however, the precise relationship between gap size and plantarflexion strength remains unclear. Large, multicentre studies will be needed to clarify this relationship and identify population subgroups in whom deficits in peak torque are reflected in patient-reported outcome measures. Cite this article: Bone Joint J 2017;99-B:87-93.
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Affiliation(s)
- J E Lawrence
- Addenbrooke's Hospital, Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, UK
| | - P Nasr
- Addenbrooke's Hospital, Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, UK
| | - D M Fountain
- Addenbrooke's Hospital, Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, UK
| | - L Berman
- Addenbrooke's Hospital, Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, UK
| | - A H N Robinson
- Addenbrooke's Hospital, Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, UK
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Spang C, Alfredson H, Docking SI, Masci L, Andersson G. The plantaris tendon: a narrative review focusing on anatomical features and clinical importance. Bone Joint J 2017; 98-B:1312-1319. [PMID: 27694583 DOI: 10.1302/0301-620x.98b10.37939] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 05/24/2016] [Indexed: 11/05/2022]
Abstract
In recent years, the plantaris tendon has been implicated in the development of chronic painful mid-portion Achilles tendinopathy. In some cases, a thickened plantaris tendon is closely associated with the Achilles tendon, and surgical excision of the plantaris tendon has been reported to be curative in patients who have not derived benefit following conservative treatment and surgical interventions. The aim of this review is to outline the basic aspects of, and the recent research findings, related to the plantaris tendon, covering anatomical and clinical studies including those dealing with histology, imaging and treatment. Cite this article: Bone Joint J 2016;98-B:1312-19.
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Affiliation(s)
- C Spang
- Umeå University, 901 87 Umeå, Sweden
| | - H Alfredson
- University College London Hospitals, 170 Tottenham Court Road, London W1T 7HA, UK
| | - S I Docking
- Federation University, Lydiard Street South, Ballarat VIC 3350, Australia
| | - L Masci
- Pure Sports Medicine Clinic, Cabot Place West, London E14 4QS, UK
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Guclu B, Basat HC, Yildirim T, Bozduman O, Us AK. Long-term Results of Chronic Achilles Tendon Ruptures Repaired With V-Y Tendon Plasty and Fascia Turndown. Foot Ankle Int 2016; 37:737-42. [PMID: 27036138 DOI: 10.1177/1071100716642753] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to evaluate the long-term follow-up results of V-Y tendon plasty with fascia turndown, for repairing chronic Achilles tendon ruptures. METHODS Seventeen patients (12 males, 5 females), who were diagnosed with chronic Achilles tendon rupture and met the inclusion criteria, were included in the study. These patients received treatment by means of V-Y tendon plasty with fascia turndown from January 1995 to December 2001. Clinical outcomes of the patients were assessed by using isokinetic strength testing, questioning the patient regarding residual discomfort, pain, or swelling and having the ability to perform heel rises and using American Orthopaedic Foot & Ankle Society's (AOFAS's) Ankle-Hind Foot Scale score. Mean follow-up duration was 16 years (13-18 years). RESULTS Mean time from the injury to operative treatment was 7 months. Mean operative defect of Achilles tendon in neutral position after debridement was 6 cm. During the follow-up, the mean calf atrophy was 3.4 cm. The mean 30 degrees/s plantarflex and 120 degrees/s plantarflex peak torques were 89 and 45 Nm, respectively. The mean 30 degrees/s plantarflex peak torque deficiency was 16%. The mean 120 degrees/s plantarflex peak torque deficiency was 17%. The average peak torque deficiency was 17%. The pre- and postoperative mean AOFAS Ankle-Hindfoot Scale scores were 64 and 95, respectively. No patient had a rerupture. Superficial wound infection was treated with oral antibiotic therapy in 2 patients (11%). CONCLUSIONS The V-Y tendon plasty with fascia turndown for repairing chronic Achilles tendon ruptures yielded results comparable with the literature regarding clinical outcomes. This method did not require synthetic materials for augmentation and was an economic alternative compared to other repair methods. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- Berk Guclu
- Department of Orthopedic Surgery, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - H Cagdas Basat
- Department of Orthopedic Surgery, Koru Hospital, Çukurambar, Ankara, Turkey
| | - Tugrul Yildirim
- Department of Orthopedic Surgery, Kazan Hamdi Eris State Hospital, Ankara, Turkey
| | - Omer Bozduman
- Department of Orthopedic Surgery, Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Ali Kemal Us
- Department of Orthopedic Surgery, Ankara University Faculty of Medicine, Ankara, Turkey
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Ruptured human Achilles tendon has elevated metabolic activity up to 1 year after repair. Eur J Nucl Med Mol Imaging 2016; 43:1868-77. [DOI: 10.1007/s00259-016-3379-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/22/2016] [Indexed: 01/08/2023]
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Hansen MS, Christensen M, Budolfsen T, Østergaard TF, Kallemose T, Troelsen A, Barfod KW. Achilles tendon Total Rupture Score at 3 months can predict patients' ability to return to sport 1 year after injury. Knee Surg Sports Traumatol Arthrosc 2016; 24:1365-71. [PMID: 26733273 DOI: 10.1007/s00167-015-3974-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To investigate how the Achilles tendon Total Rupture Score (ATRS) at 3 months and 1 year after injury is associated with a patient's ability to return to work and sports as well as to investigate whether sex and age influence ATRS after 3 months and 1 year. METHOD This is a retrospective study analysing the data from the Danish Achilles tendon Database. A total of 366 patients were included. Logistic regression was conducted to describe the effect of ATRS on return to work and sports. The effect of age and sex on ATRS was analysed by linear regression. RESULTS Three months after injury patients had a significantly increased chance of return to sport after 1 year with an increased ATRS (OR 1.06, p = 0.001) but a non-significant effect on return to work. After 1 year, patients had a significantly increased probability of having returned to sport (OR 1.11, p < 0.001) and also having returned to work (OR 1.05, p = 0.007) with an increased ATRS. Men had an average 7 (p = 0.006) points higher ATRS at 3 months and an average 22 (p = 0.006) points higher at 1 year. CONCLUSION ATRS is associated with patients' ability to return to sports and work. ATRS at 3 months can be used as a predictor of the patient's ability to return to sports after 1 year. Hereby, ATRS might help to individualise rehabilitation by identifying patients who do not respond adequately to the chosen treatment. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Maria Swennergren Hansen
- Department of Physiotherapy and Occupational Therapy, Danish Achilles Tendon Database, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark.
| | - Marianne Christensen
- Department of Physiotherapy and Occupational Therapy and Department of Orthopaedic Surgery, Danish Achilles Tendon Database, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Thomas Budolfsen
- Department of Physiotherapy and Occupational Therapy, Danish Achilles Tendon Database, Copenhagen University Hospital Hvidovre, Kettegård Allé 30, 2650, Hvidovre, Denmark
| | - Thomas Friis Østergaard
- Department of Orthopaedic Surgery, Danish Achilles Tendon Database, Lillebaelt Hospital, Skovvangen 2-8, 6000, Kolding, Denmark
| | - Thomas Kallemose
- Department of Orthopaedics, Clinical Orthopaedic Research Hvidovre, Clinical Research Centre, Danish Achilles Tendon Database, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anders Troelsen
- Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre, Danish Achilles Tendon Database, Copenhagen University Hospital, Hvidovre, Denmark
| | - Kristoffer Weisskirchner Barfod
- Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre, Danish Achilles Tendon Database, Copenhagen University Hospital, Hvidovre, Denmark
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Ebeling PB. More Isn't Always Better, But Is Less? Commentary on an article by Juuso Heikkinen, MD, et al.: "Augmented Compared with Nonaugmented Surgical Repair After Total Achilles Rupture. Results of a Prospective Randomized Trial with Thirteen or More Years of Follow-up". J Bone Joint Surg Am 2016; 98:e8. [PMID: 26791041 DOI: 10.2106/jbjs.15.01165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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