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Wang R, Huang L, Jiang S, You G, Zhou X, Wang G, Zhang L. Immediate mobilization after repair of Achilles tendon rupture may increase the incidence of re-rupture: a systematic review and meta-analysis of randomized controlled trials. Int J Surg 2024; 110:01279778-990000000-01159. [PMID: 38477123 PMCID: PMC11175757 DOI: 10.1097/js9.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/23/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Achilles tendon rupture (ATR) is a significant injury that can require surgery and can have the risk of re-rupture even after successful treatment. Consequently, to minimize this risk, it is important to have a thorough understanding of the rehabilitation protocol and the impact of different rehabilitation approaches on preventing re-rupture. MATERIALS AND METHODS Two independent team members searched several databases (PubMed, EMBASE, Web of Science, Cochrane Library, and CINAHL) to identify randomized controlled trials (RCTs) on operative treatment of ATR. We included articles that covered open or minimally invasive surgery for ATR, with a detailed rehabilitation protocol and reports of re-rupture. The study protocol has been registered at PROSPERO and has been reported in the line with PRISMA Guidelines, Supplemental Digital Content 1, http://links.lww.com/JS9/C85, Supplemental Digital Content 2, http://links.lww.com/JS9/C86 and assessed using AMSTAR Tool, Supplemental Digital Content 3, http://links.lww.com/JS9/C87. RESULTS A total of 43 RCTs were eligible for the meta-analysis, encompassing a combined cohort of 2553 patients. Overall, the postoperative incidence of ATR patients developing re-rupture was 3.15% (95% CI: 2.26-4.17; I2=44.48%). Early immobilization group patients who had ATR had a 4.07% (95% CI: 1.76-7.27; I2=51.20%) postoperative incidence of re-rupture; Early immobilization + active range of motion (AROM) group had an incidence of 5.95% (95% CI: 2.91-9.99; I2=0.00%); Early immobilization + weight-bearing group had an incidence of 3.49% (95% CI: 1.96-5.43; I2=20.06%); Early weight-bearing + AROM group had an incidence of 3.61% (95% CI: 1.00-7.73; I2= 64.60%); Accelerated rehabilitation (immobilization) group had an incidence of 2.18% (95% CI: 1.11-3.59; I2=21.56%); Accelerated rehabilitation (non-immobilization) group had a rate of 1.36% (95% CI: 0.12-3.90; I2=0.00%). Additionally, patients in the immediate AROM group had a postoperative re-rupture incidence of 3.92% (95% CI: 1.76-6.89; I2=33.24%); Non-immediate AROM group had an incidence of 2.45% (95% CI: 1.25-4.03; I2=22.09%). CONCLUSIONS This meta-analysis suggests the use of accelerated rehabilitation intervention in early postoperative rehabilitation of the Achilles tendon. However, for early ankle joint mobilization, it is recommended to apply after one to two weeks of immobilization.
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Affiliation(s)
- Ruihan Wang
- School of Physical Education, Southwest Medical University
- Department of Rehabilitation, Yibin Integrated Traditional Chinese and Western Medicine Hospital, Yibin, China
| | - Lei Huang
- School of Physical Education, Southwest Medical University
| | - Songtao Jiang
- School of Clinical Medicine, Southwest Medical University
| | - Guixuan You
- School of Physical Education, Southwest Medical University
| | - Xin Zhou
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University
- Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University
- Luzhou Key Laboratory of Orthopedic Disorders, Luzhou
| | - Guoyou Wang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University
- Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University
- Luzhou Key Laboratory of Orthopedic Disorders, Luzhou
| | - Lei Zhang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University
- Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University
- Luzhou Key Laboratory of Orthopedic Disorders, Luzhou
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Qianman B, Wupuer A, Jiasharete T, Luo B, Nihemaiti M, Jielile J. iTRAQ-based proteomics reveals potential markers and treatment pathways for acute Achilles tendon rupture. J Orthop Surg Res 2023; 18:852. [PMID: 37946221 PMCID: PMC10636927 DOI: 10.1186/s13018-023-04346-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Due to its limited blood supply and irregular mechanical loading, the Achilles tendon is the most frequently ruptured tendon. Despite the rising incidence of acute Achilles tendon rupture (AATR), the optimal treatment remains controversial. Missed diagnoses and delayed treatments lead to poor outcomes and limited treatment options. This study aimed to identify potential biomarkers for diagnosing and developing therapies for AATR. METHODS We employed the coupled isobaric tag for relative and absolute quantitation-liquid chromatography-electrospray ionization-tandem mass spectrometry approach to investigate protein expression in tissues from AATR patients. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted to identify differentially expressed proteins (DEPs) between AATR patients and healthy individuals. A protein-protein interaction (PPI) network of DEPs was constructed using the Search Tool for the Retrieval of Interacting Genes. The screened hub genes were selectively verified by immunohistochemical staining. RESULTS We identified 410 DEPs between AATR patients and controls. The DEPs were significantly enriched in GO terms such as the extracellular region, extracellular region part, and defense response, as well as KEGG pathways, including complement and coagulation cascades, focal adhesion, and regulation of actin cytoskeleton. The main hub nodes in the PPI network comprised fibronectin 1 (FN1), major histocompatibility complex, class I, B (HLA-B), filamin A (FLNA), heat shock 27-kDa protein 1 (HSPB1), heat shock protein family A member 5 (HSPA5), apolipoprotein A4 (APOA4), and myosin IC (MYO1C). Although APOA4 and collagens I, II, and III were detectable in healthy tendons, immunohistochemical staining confirmed higher expression of these proteins in the acutely ruptured Achilles tendon. CONCLUSIONS Our findings lay a foundation for further molecular studies of AATR. Inflammation and age-related degeneration may contribute to the pathogenesis of AATR. Moreover, the identified DEPs could be potential biomarkers for AATR diagnosis and treatment.
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Affiliation(s)
- Bayixiati Qianman
- Department of Osteopathy and Orthopedics (Ankle) Surgery, The Sixth Teaching Hospital of Xinjiang Medical University, No. 39 Wuxing South Road, Ürümqi, 830001, Xinjiang Uygur Autonomous Region, China
| | - Aikeremu Wupuer
- Department of Osteopathy and Orthopedics (Ankle) Surgery, The Sixth Teaching Hospital of Xinjiang Medical University, No. 39 Wuxing South Road, Ürümqi, 830001, Xinjiang Uygur Autonomous Region, China
| | - Tuomilisi Jiasharete
- Urumqi No.1 Middle School, No. 195, West 2nd Lane, Kanas Hubei Road, Urumqi Economic and Technological Development Zone (Toutunhe District), Ürümqi, 830015, Xinjiang Uygur Autonomous Region, China
| | - Biao Luo
- Department of Orthopaedics, Pingmei Shenma Medical Group General Hospital, No.1 South of Kuanggoong Middle Road, Xinhua District, Pingdingshan, 467000, Henan, China
| | - Meihua Nihemaiti
- Altay Traditional Chinese Medicine Hospital (Regional Kazakh Medical Hospital) in Xinjiang Uygur Autonomous Region, No. 40 Yingbin Road, Altay City, 836500, Xinjiang Uygur Autonomous Region, China
| | - Jiasharete Jielile
- Department of Osteopathy and Orthopedics (Ankle) Surgery, The Sixth Teaching Hospital of Xinjiang Medical University, No. 39 Wuxing South Road, Ürümqi, 830001, Xinjiang Uygur Autonomous Region, China.
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Li J, Zhou X, Chen J, Eliasson P, Kingham PJ, Backman LJ. Secretome from myoblasts statically loaded at low intensity promotes tenocyte proliferation via the IGF-1 receptor pathway. FASEB J 2023; 37:e23203. [PMID: 37732638 DOI: 10.1096/fj.202301097r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/16/2023] [Accepted: 09/05/2023] [Indexed: 09/22/2023]
Abstract
Exercise is widely recognized as beneficial for tendon healing. Recently, it has been described that muscle-derived molecules secreted in response to static exercise influence tendon healing. In this study, the optimal static loading intensity for tendon healing and the composition of secretome released by myoblasts in response to different intensities of static strain were investigated. In an in vitro coculture model, myoblasts were mechanically loaded using a Flexcell Tension System. Tenocytes were seeded on transwell inserts that allowed communication between the tenocytes and myoblasts without direct contact. Proliferation and migration assays, together with RNA sequencing, were used to determine potential cellular signaling pathways. The secretome from myoblasts exposed to 2% static loading increased the proliferation and migration of the cocultured tenocytes. RNA-seq analysis revealed that this loading condition upregulated the expression of numerous genes encoding secretory proteins, including insulin-like growth factor-1 (IGF-1). Confirmation of IGF-1 expression and secretion was carried out using qPCR and enzyme-linked immunosorbt assay (ELISA), revealing a statistically significant upregulation in response to 2% static loading in comparison to both control conditions and higher loading intensities of 5% and 10%. Addition of an inhibitor of the IGF-1 receptor (PQ401) to the tenocytes significantly reduced myoblast secretome-induced tenocyte proliferation. In conclusion, IGF-1 may be an important molecule in the statically loaded myoblast secretome, which is responsible for influencing tenocytes during exercise-induced healing.
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Affiliation(s)
- Junhong Li
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Xin Zhou
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
| | - Jialin Chen
- School of Medicine, Southeast University, Nanjing, China
| | - Pernilla Eliasson
- Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Paul J Kingham
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
| | - Ludvig J Backman
- Department of Integrative Medical Biology, Umeå University, Umeå, Sweden
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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蔡 飞, 刘 彦, 刘 凯, 艾 合, 加 莎. [V-Y plasty combined with gastrocnemius aponeurosis turndown repairing the Myerson type Ⅲ chronic Achilles tendon rupture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:410-414. [PMID: 35426278 PMCID: PMC9011082 DOI: 10.7507/1002-1892.202111023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/10/2022] [Indexed: 01/24/2023]
Abstract
Objective To investigate the clinical application and effectiveness of V-Y plasty combined with gastrocnemius aponeurosis turndown in the repair of Myerson type Ⅲ chronic Achilles tendon rupture combined with large tendon defect. Methods Between February 2008 and July 2019, 25 patients underwent the V-Y plasty combined with gastrocnemius aponeurosis turndown to treat the Myerson type Ⅲ chronic Achilles tendon rupture. There were 21 males and 4 females. The age ranged from 17 to 56 years, with an average of 34.3 years. Achilles tendon rupture was caused by sports injury in all patients, and the duration from Achilles tendon rupture to operation was 31-70 days, with an average of 53.9 days. After resection of fibrous scar tissue, the distance of Achilles tendon defect was 7-12 cm, with an average of 9.04 cm. The clinical results were evaluated by the Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) score, dorsiflexion and heel raise height before and after operation. Results The donor and recipient wounds of all 25 cases healed by first intention after operation. All patients were followed up 24 months. During the follow-up, 3 patients developed mild wound infection, which was cured after anti-infection treatment. One patient had Achilles tendon exposure, which was cured after local flap transfer and repair. Ultrasound and MRI reexamination at 3-12 months after operation showed no Achilles tendon elongation, adhesion, or re-rupture. At 24 months after operation, the ATRS score, AOFAS score, dorsiflexion and heel raise height of affected side significantly improved when compared with those before operation (P<0.05). However, the dorsiflexion and heel raise height of affected side were still significantly worse than those of the healthy side (P<0.05). Conclusion V-Y plasty combined with gastrocnemius aponeurosis turndown to repair the chronic Achilles tendon rupture can achieve good effectiveness, and the Achilles tendon function significantly improved after repair. However, the procedure is more invasive and has a long duration of intraoperative wound exposure, causing an increased risk of infection, and the aesthetic is not good.
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Affiliation(s)
- 飞宇 蔡
- 新疆医科大学第一附属医院骨科中心显微修复外科(乌鲁木齐 830054)Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 彦士 刘
- 新疆医科大学第一附属医院骨科中心显微修复外科(乌鲁木齐 830054)Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 凯 刘
- 新疆医科大学第一附属医院骨科中心显微修复外科(乌鲁木齐 830054)Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 合买提江·玉素甫 艾
- 新疆医科大学第一附属医院骨科中心显微修复外科(乌鲁木齐 830054)Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 莎热特·杰力勒 加
- 新疆医科大学第一附属医院骨科中心显微修复外科(乌鲁木齐 830054)Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
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Arshad Z, Lau EJS, Leow SH, Bhatia M. Management of chronic Achilles ruptures: a scoping review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2543-2559. [PMID: 34089355 PMCID: PMC8514369 DOI: 10.1007/s00264-021-05102-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022]
Abstract
Purpose This scoping review aims to systematically map and summarise the available evidence on the management of chronic Achilles ruptures, whilst identifying prognostic factors and areas of future research. Methods A scoping review was performed according to the frameworks of Arksey and O’Malley, Levac and Peters. A computer-based search was performed in PubMed, Embase, EmCare, CINAHL, ISI Web of Science and Scopus, for articles reporting treatment of chronic Achilles ruptures. Two reviewers independently performed title/abstract and full text screening according to pre-defined selection criteria. Results A total of 747 unique articles were identified, of which 73 (9.8%) met all inclusion criteria. A variety of methods are described, with flexor hallucis longus tendon transfer being the most common. The most commonly reported outcome is the American Orthopaedic Foot and Ankle Society (AOFAS) score, although 16 other measures were reported in the literatures. All studies comparing pre- and post-operative outcomes reported significant post-treatment improvement. Complications were reported in 50 studies, with an overall pooled complication rate of 168/1065 (15.8%). Conclusion Although beneficial results were reported following a variety of techniques, comparison between these is challenging due to the low-level study designs used and confounding factors such as treatment delay and tendon gap size. Further research comparing the efficacy of different techniques is required in order to facilitate the development of an evidence-based treatment protocol. Such work would allow clinicians to better understand the suitability of the large variety of reported techniques and select the optimal strategy for each individual patient. Supplementary Information The online version contains supplementary material available at 10.1007/s00264-021-05102-5.
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Affiliation(s)
- Zaki Arshad
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 111, Cambridge, CB2 0SP, UK.
| | - Edward Jun Shing Lau
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 111, Cambridge, CB2 0SP, UK
| | - Shu Hui Leow
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 111, Cambridge, CB2 0SP, UK
| | - Maneesh Bhatia
- Department of Trauma and Orthopaedic Surgery, University Hospitals Leicester NHS Trust, University Hospitals of Leicester Headquarters, Balmoral Building, Level 3, Leicester, UK
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Flexor digitorum longus tendon transfer to the navicular: tendon-to-tendon repair is stronger compared with interference screw fixation. Knee Surg Sports Traumatol Arthrosc 2020; 28:320-325. [PMID: 29627930 PMCID: PMC6971128 DOI: 10.1007/s00167-018-4936-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/26/2018] [Indexed: 11/01/2022]
Abstract
PURPOSE To assess whether early rehabilitation could be safe after flexor digitorum longus (FDL) tendon transfer, the current biomechanical study aimed to measure tendon displacement under cyclic loading and load to failure, comparing a traditional tendon-to-tendon (TT) repair with interference screw fixation (ISF). METHODS 24 fresh-frozen cadaveric below knee specimens underwent FDL tendon transfer. In 12 specimens a TT repair was performed via a navicular bone tunnel. In a further 12 specimens ISF was performed. Using a materials testing machine, the FDL tendon was cycled 1000 times to 150 N and tendon displacement at the insertion site measured. A final load to failure test was then performed. Statistical analysis was performed using two-way ANOVA and an independent t test, with a significance level of p < 0.05. RESULT No significant difference in tendon displacement occurred after cyclic loading, with mean tendon displacements of 1.9 ± 1.2 mm (mean ± SD) in the TT group and 1.8 ± 1.5 mm in the ISF group (n.s.). Two early failures occurred in the ISF group, none in the TT group. Mean load to failure was significantly greater following TT repair (459 ± 96 N), compared with ISF (327 ± 76 N), p = 0.002. CONCLUSION Minimal tendon displacement of less than 2 mm occurred during cyclic testing in both groups. The two premature failures and significantly reduced load to failure observed in the ISF group, however, indicate that the traditional TT technique is more robust. Regarding clinical relevance, this study suggests that early active range of motion and protected weight bearing may be safe following FDL tendon transfer for stage 2 tibialis posterior tendon dysfunction.
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Jielile J, Li P, Bahetiya W, Badelhan A, Qianman B, Jialihasi A, Shawutali N, Wuerliebieke J, Aizezi A, Yeerboo N, Makemutibieke E, Aisaiding A, Hazehan T, Shatewalede T, Awuyyesihan Z. The Treatment of Complex Motorcycle Spoke Injuries in Children. J Am Podiatr Med Assoc 2018; 108:409-418. [PMID: 34670345 DOI: 10.7547/16-066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Motorcycle spoke injuries involving the soft tissue, Achilles tendon, and calcaneal defects are rare in children. Currently, calcaneal defects are very challenging to treat. Multiple methods have been used in clinical practice; however, an effective treatment has yet to be established, especially when Achilles tendon and soft-tissue defects are also present. It is important to address this condition, because the calcaneus plays a key role in standing and gait. Unsatisfactory treatment of calcaneal defects may significantly decrease patients' quality of life (eg, by limiting mobility). In this article, we report the effective treatment of calcaneal defects in four children using distraction osteogenesis with an external fixator framework designed by the authors. From May 2014 to May 2015, four children (age range, 6-11 years) with defects of the Achilles tendon, soft tissue, and calcaneus resulting from a motorcycle accident were treated at our hospital. The Achilles tendon and soft-tissue defects were treated with second-stage reconstruction. In the third-stage surgery, osteotomy of the residual calcaneus was performed. A customized external fixator was used to lengthen the calcaneus at a rate of 1.5 mm/day in the posterior direction and reposition it by 40° in the inferior direction. In all four children, the calcaneus was lengthened by 5 cm. Distraction osteogenesis through external fixation is effective for restoring the length, width, and height of the calcaneus in children.
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Affiliation(s)
- Jiasharete Jielile
- Department of Microsurgical and Reconstruction of Orthopedics Centre, First Teaching Hospital of Xinjiang Medical University and Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang, China
| | - Pengfei Li
- Department of Microsurgical and Reconstruction of Orthopedics Centre, First Teaching Hospital of Xinjiang Medical University and Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang, China
| | - Wulan Bahetiya
- Department of Microsurgical and Reconstruction of Orthopedics Centre, First Teaching Hospital of Xinjiang Medical University and Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang, China
| | - Aynaz Badelhan
- Department of Microsurgical and Reconstruction of Orthopedics Centre, First Teaching Hospital of Xinjiang Medical University and Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang, China
| | - Bayixiati Qianman
- Department of Microsurgical and Reconstruction of Orthopedics Centre, First Teaching Hospital of Xinjiang Medical University and Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang, China
| | - Ayidaer Jialihasi
- Department of Microsurgical and Reconstruction of Orthopedics Centre, First Teaching Hospital of Xinjiang Medical University and Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang, China
| | - Nuerai Shawutali
- Department of Pediatric Surgery, Peoples' Hospital of Xinjiang Uygur Autonomous Region, Urumqi, Xinjiang, China
| | - Jianati Wuerliebieke
- Department of Microsurgical and Reconstruction of Orthopedics Centre, First Teaching Hospital of Xinjiang Medical University and Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang, China
| | - Adili Aizezi
- Department of Microsurgical and Reconstruction of Orthopedics Centre, First Teaching Hospital of Xinjiang Medical University and Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang, China
| | - Naertai Yeerboo
- Department of Microsurgical and Reconstruction of Orthopedics Centre, First Teaching Hospital of Xinjiang Medical University and Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang, China
| | - Elihaer Makemutibieke
- Department of Microsurgical and Reconstruction of Orthopedics Centre, First Teaching Hospital of Xinjiang Medical University and Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang, China
| | - Amuding Aisaiding
- Department of Microsurgical and Reconstruction of Orthopedics Centre, First Teaching Hospital of Xinjiang Medical University and Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang, China
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Marsland D, Stephen JM, Calder T, Amis AA, Calder JDF. Strength of Interference Screw Fixation to Cuboid vs Pulvertaft Weave to Peroneus Brevis for Tibialis Posterior Tendon Transfer for Foot Drop. Foot Ankle Int 2018; 39:858-864. [PMID: 29582684 DOI: 10.1177/1071100718762442] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Tibialis posterior (TP) tendon transfer is an effective treatment for foot drop. Currently, standard practice is to immobilize the ankle in a cast for 6 weeks nonweightbearing, risking postoperative stiffness. To assess whether early active dorsiflexion and protected weightbearing could be safe, the current study assessed tendon displacement under cyclic loading and load to failure, comparing the Pulvertaft weave (PW) to interference screw fixation (ISF) in a cadaveric foot model. METHODS Twenty-four cadaveric ankles had TP tendon transfer performed, 12 with the PW technique and 12 with ISF to the cuboid. The TP tendon was cycled 1000 times at 50 to 150 N and then loaded to failure in a materials testing machine. Tendon displacement at the insertion site was recorded every 100 cycles. An independent t test and 2-way analysis of variance were performed to compare techniques, with a significance level of P < .05. RESULTS Mean tendon displacement was similar in the PW group (2.9 ± 2.5 mm [mean ± SD]) compared with the ISF group (2.4 ± 1.1 mm), P = .35. One specimen in the ISF group failed early by tendon pullout. None of the PW group failed early, although displacement of 8.9 mm was observed in 1 specimen. Mean load to failure was 419.1 ± 82.6 N in the PW group in comparison to 499.4 ± 109.6 N in the ISF group, P = .06. CONCLUSION For TP tendon transfer, ISF and PW techniques were comparable, with no differences in tendon displacement after cyclical loading or load to failure. Greater variability was observed in the PW group, suggesting it may be a less reliable technique. CLINICAL RELEVANCE The results indicate that early active dorsiflexion and protected weightbearing may be safe for clinical evaluation, with potential benefits for the patient compared with cast immobilization.
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Affiliation(s)
| | - Joanna M Stephen
- 1 Fortius Clinic, London, UK.,2 The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, UK
| | | | - Andrew A Amis
- 2 The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, UK.,4 Musculoskeletal Surgery Group, Department of Surgery & Cancer, Imperial College London School of Medicine, London, UK
| | - James D F Calder
- 1 Fortius Clinic, London, UK.,2 The Biomechanics Group, Department of Mechanical Engineering, Imperial College London, UK
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Aisaiding A, Wang J, Maimaiti R, Jialihasi A, Aibek R, Qianman B, Shawutali N, Badelihan A, Bahetiya W, Kubai A, Kelamu M, Nuerdoula Y, Makemutibieke E, Bakyt Y, Wuerliebieke J, Jielile J. A novel minimally invasive surgery combined with early exercise therapy promoting tendon regeneration in the treatment of spontaneous Achilles tendon rupture. Injury 2018; 49:712-719. [PMID: 29153451 DOI: 10.1016/j.injury.2017.10.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/27/2017] [Accepted: 10/29/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Acute closed spontaneous Achilles tendon rupture often occurs in elderly individuals and is usually accompanied with many complications. Conventional surgical approaches to remove the tendon lesions and enthesophytes are highly traumatic and cause complications. In this study, a previously established minimally invasive surgical approach was modified and combined with a Kazakh exercise therapy to reduce trauma, improve wound healing, and promote tendon regeneration in the management of acute closed spontaneous Achilles tendon rupture. METHODS Fifty-two patients with acute closed spontaneous Achilles tendon rupture were randomly classified into 2 groups. Group A included 23 patients that were treated with the novel approach. Group B included 29 patients that were treated with a continuous medial oblique surgical approach. Follow-up examinations were performed at post-operative weeks 12 and 24, and year 2. Outcomes were assessed by Achilles tendon rupture score (ATRS), a heel-rise endurance test, and ultrasonographic and multislice spiral computerized tomography. RESULTS Mean ATRS in Group A was 68.6 and 86.0 at post-operative week 12 and 24, respectively, significantly higher than that in Group B (55.9 and 72.0, respectively). Recovery of patients in Group A was significantly better compared to Group B (p < 0.01), allowing them to participate in early rehabilitating kinesiotherapy. Patients in Group A rarely experienced complications after surgery, such as infection and Achilles tendon exposure, while in Group B, the wound healing was slower, the inside flaps were prone to necrosis and infection, and Achilles tendon exposure occurred in 10% of patients. CONCLUSIONS The novel minimally invasive surgery is more advantageous in the treatment of acute closed spontaneous Achilles tendon rupture over previous approaches by promoting wound healing and tendon regeneration.
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Affiliation(s)
- Amuding Aisaiding
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Jianping Wang
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Rouziwanguli Maimaiti
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Ayidaer Jialihasi
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Rakimbaiev Aibek
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Bayixiati Qianman
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Nuerai Shawutali
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Ayinazi Badelihan
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Wulan Bahetiya
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Aliya Kubai
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Mailamuguli Kelamu
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Yeermike Nuerdoula
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Elihaer Makemutibieke
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Yerzat Bakyt
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Jianati Wuerliebieke
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Jiasharete Jielile
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China.
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10
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Dams OC, Reininga IHF, Gielen JL, van den Akker-Scheek I, Zwerver J. Imaging modalities in the diagnosis and monitoring of Achilles tendon ruptures: A systematic review. Injury 2017; 48:2383-2399. [PMID: 28943056 DOI: 10.1016/j.injury.2017.09.013] [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: 07/06/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the role of imaging in the diagnosis and monitoring of the Achilles tendon rupture (ATR). STUDY DESIGN Systematic review. DATA SOURCES PubMed and EMBASE in November 2016. ELIGIBILITY CRITERIA Clinical studies providing information on the methods and role of imaging in the diagnosis and monitoring of the ATR were included. RESULTS Fifty-six studies were included, most concerning the use of ultrasound (n=37) or MRI (n=18). Seven studies provided data on the diagnostic accuracy of imaging. Most ultrasound studies used a 7.5MHz probe (19/32 studies) and scanned the patient bilaterally in prone position, with recent studies tending to use higher frequency probes (r=0.42). Sensitivity [for detecting a rupture] ranged from 79.6 to 100%; the spread in specificity was large but two studies showed perfect (100%) data. Negative and positive likelihood ratios ranged from 0 to 0.23 and 1.0 to 10 respectively. MRI examination was generally performed with 1.5Tesla (T) MRI (6/12 studies) with a strong trend for higher T strength in more recent studies (r=0.71). One study reported a sensitivity of 90.9% and one a specificity of 100%. Although imaging can visualize structure and healing, these results were generally not related to the clinical picture. Overall, ultrasound was recommended over MRI for diagnosis and monitoring. Results of other imaging modalities remain inconclusive. CONCLUSION The adjunct role of imaging, especially of ultrasound and MRI, in the diagnosis and monitoring of ATRs was established. It is therefore recommended to rely primarily on the clinical examination and evaluation and to use imaging for ruling out other injuries and providing additional clinical information. More high-quality research is warranted into the diagnostic accuracy of imaging as well as less conventional imaging modalities' diagnostic and monitoring capabilities.
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Affiliation(s)
- Olivier C Dams
- University of Groningen, University Medical Center Groningen, Department of Sport and Exercise Medicine, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Inge H F Reininga
- University of Groningen, University Medical Center Groningen, Department of Trauma Surgery, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Jan L Gielen
- Antwerp University Hospital, S.P.O.R.T.S., Wilrijkstraat 10, Edegem-Antwerp, 2650, Belgium
| | - Inge van den Akker-Scheek
- University of Groningen, University Medical Center Groningen, Department of Sport and Exercise Medicine, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Johannes Zwerver
- University of Groningen, University Medical Center Groningen, Department of Sport and Exercise Medicine, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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11
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Qianman B, Jialihasi A, Asilehan B, Kubai A, Aibek R, Wupuer A, Tangkejie W, Maimaitiaili A, Shawutali N, Badelhan A, Aizezi A, Aisaiding A, Wuerliebieke J, Bakyt Y, Makemutibieke E, Jielile J. Active exercise promotes Achilles tendon healing and is accompanied by the upregulation of collapsin response mediator protein‑2 in rats. Mol Med Rep 2017; 16:2355-2360. [PMID: 28677754 DOI: 10.3892/mmr.2017.6889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/20/2017] [Indexed: 11/05/2022] Open
Abstract
Collapsin response mediator protein-2 (CRMP-2) is involved in neurite elongation and regeneration; however, its role in wound healing remains to be elucidated. The present study aimed to investigate the effects of active mobilization treatment on Achilles tendon healing and to determine the role of CRMP‑2 in the healing process. Sprague Dawley rats were subjected to Achilles tendon injury, which was verified by hematoxylin and eosin staining and scanning electronic microscopy. Immobilization induced the disruption of collagen fibril arrangement and promoted collagen fibril damage. The average collagen fibril perimeter in the active mobilization group was significantly increased compared with in the immobilization group (125.6±0.8 nm vs. 119.9±1.7 nm; P<0.05). In addition, immunohistological analysis revealed that CRMP‑2 expression was significantly upregulated, particularly in the ruptured site of Achilles tendon tissues derived from animals in the mobilization group compared with the immobilization group (0.32±0.00 vs. 0.08±0.00; P<0.05). The increased CRMP‑2 levels were also confirmed by western blotting (active mobilization group, 0.71±0.03; immobilization group, 0.49±0.01 nm; P<0.05). These results indicated that active mobilization may promote Achilles tendon healing via upregulation of CRMP‑2 protein expression.
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Affiliation(s)
- Bayixiati Qianman
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Ayidaer Jialihasi
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Batiza Asilehan
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Aliya Kubai
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Rakimbaiev Aibek
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Aikeremu Wupuer
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Wulanbai Tangkejie
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Abudouheilil Maimaitiaili
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Nuerai Shawutali
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Aynaz Badelhan
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Adili Aizezi
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Amuding Aisaiding
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Jianati Wuerliebieke
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Yerzat Bakyt
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Elihaer Makemutibieke
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Jiasharete Jielile
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
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12
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Choi GW, Kim HJ, Lee TH, Park SH, Lee HS. Clinical comparison of the two-stranded single and four-stranded double Krackow techniques for acute Achilles tendon ruptures. Knee Surg Sports Traumatol Arthrosc 2017; 25:1878-1883. [PMID: 27502942 DOI: 10.1007/s00167-016-4265-0] [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: 03/18/2016] [Accepted: 08/02/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE Several different Krackow stitch configurations have been used for acute Achilles tendon rupture repair. Although several biomechanical studies compared different Krackow stitch configurations, to our knowledge, no previous studies compared the clinical outcome of these different suture methods. Therefore, in this study, we aimed to compare the clinical outcomes and complications of the two-stranded single and four-stranded double Krackow techniques. METHODS Sixty-eight consecutive patients who underwent open repair by using the four-stranded double Krackow (33 patients, group A) or the two-stranded single Krackow (35 patients, group B) techniques between September 2011 and August 2014 were reviewed retrospectively. The isokinetic strength of plantar flexion and dorsiflexion of both ankles was assessed on a Cybex dynamometer 3 and 6 months after surgery. Clinical outcomes were evaluated 3, 6, and 12 months post-operatively. RESULTS No significant differences were found between the groups regarding patient demographics or activity levels prior to treatment. Significant differences in the Achilles tendon Total Rupture Score, the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot score, or the four-point Boyden scale were not found at any time during follow-up. Rerupture occurred only in one patient from group A. No significant differences were observed between the groups regarding the isokinetic plantar flexion and dorsiflexion strength at any time or any test speed. CONCLUSION Equally favourable clinical outcomes and isokinetic muscle strength and a low complication rate were achieved with the two-stranded single Krackow technique as compared with the four-stranded double Krackow technique for acute Achilles tendon rupture repair. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Gi Won Choi
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, South Korea
| | - Hak Jun Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea.
| | - Tae Hoon Lee
- Department of Orthopaedic Surgery, Korea University Guro Hospital, 148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea
| | - Se Hyun Park
- Sports Medical Center, Korea University Guro Hospital, Seoul, South Korea
| | - Hee Seop Lee
- Department of Orthopaedic Surgery, Korea University Ansan Hospital, Ansan-si, South Korea
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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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Rehabilitation of Achilles tendon ruptures: is early functional rehabilitation daily routine? Arch Orthop Trauma Surg 2017; 137:333-340. [PMID: 28097423 DOI: 10.1007/s00402-017-2627-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Ruptures of the Achilles tendon are the most common tendon injuries of the lower extremities. Besides the initial operative or non-operative treatment, rehabilitation of patients plays a crucial role for tendon healing and long-term outcome. As only limited evidence is available for optimized rehabilitation regimen and guidelines for the initial (e.g., first 6 weeks) rehabilitation are limited, this study investigated the current rehabilitation concepts after Achilles tendon rupture. MATERIALS AND METHODS We analyzed 213 written rehabilitation protocols that are provided by orthopedic and trauma surgery institutions throughout Germany in terms of recommendations for weight-bearing, range of motion (ROM), physiotherapy, and choice of orthosis. All protocols for operatively and non-operatively treated Achilles tendon ruptures were included. Descriptive analysis was carried out and statistical analysis applied where appropriate. RESULTS Of 213 institutions, 204 offered rehabilitation protocols for Achilles tendon rupture and, therefore, 243 protocols for operative and non-operative treatment could be analyzed. While the majority of protocols allowed increased weight-bearing over time, significant differences were found for durations of fixed plantar flexion between operative (o) and non-operative (n) treatments [fixed 30° (or 20)° to 15° (or 10)°: 3.6 weeks (±0.1; o) vs 4.7 weeks (±0.3; n) (p ≤ 0.0001) and fixed 15° (or 10)° to 0°: 5.8 weeks (±0.1; o) vs 6.6 weeks (±0.2; n) (p ≤ 0.001)]. The mean time of the recommended start of physiotherapy is at 2.9 weeks (±0.2; o) vs 3.3 weeks (±0.4; n), respectively. CONCLUSION Our study shows that a huge variability in rehabilitation after Achilles tendon rupture exists. This study shows different strategies in rehabilitation of Achilles tendon ruptures using a convertible vacuum brace system. To improve patient care, further clinical as well as biomechanical studies need to be conducted. This study might serve as basis for prospective randomized controlled trials to optimize rehabilitation for Achilles tendon ruptures.
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15
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Jielile J, Asilehan B, Wupuer A, Qianman B, Jialihasi A, Tangkejie W, Maimaitiaili A, Shawutali N, Badelhan A, Niyazebieke H, Aizezi A, Aisaiding A, Bakyt Y, Aibek R, Wuerliebieke J. Early Ankle Mobilization Promotes Healing in a Rabbit Model of Achilles Tendon Rupture. Orthopedics 2016; 39:e117-26. [PMID: 26821224 DOI: 10.3928/01477447-20160106-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 06/15/2015] [Indexed: 02/03/2023]
Abstract
The use of early mobilization of the ankle joint without orthosis in the treatment of Achilles tendon rupture has been advocated as the optimal management. The goal of this study was to compare outcomes in a postoperative rabbit model of Achilles tendon rupture between early mobilization and immobilized animals using a differential proteomics approach. In total, 135 rabbits were randomized into the control group (n=15), the postoperative cast immobilization (PCI) group (n=60), and the early mobilization (EM) group (n=60). A rupture of the Achilles tendon was created in each animal model and repaired microsurgically, and tendon samples were removed at 3, 7, 14, and 21 days postoperatively. Proteins were separated using 2-dimensional polyacrylamide gel electrophoresis and identified using peptide mass fingerprinting, tandem mass spectrometry, NCBI database searches, and bioinformatics analyses. A series of differentially expressed proteins were identified between groups, some of which may play an important role in Achilles tendon healing. Notable candidate proteins that were upregulated in the EM group were identified, such as CRMP-2, galactokinase 1, tropomyosin-4, and transthyretin. The healing of ruptured Achilles tendons appears to be affected at the level of protein expression with the use of early mobilization. The classic postoperative treatment of Achilles tendon rupture with an orthosis ignored the self-protecting instinct of humans. With a novel operative technique, the repaired tendon can persist the load that comes from traction in knee and ankle joint functional movement. In addition, kinesitherapy provided an excellent experimental outcome via a mechanobiological mechanism.
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van Dijk PAD, Lubberts B, Verheul C, DiGiovanni CW, Kerkhoffs GMMJ. Rehabilitation after surgical treatment of peroneal tendon tears and ruptures. Knee Surg Sports Traumatol Arthrosc 2016; 24:1165-74. [PMID: 26803783 PMCID: PMC4823352 DOI: 10.1007/s00167-015-3944-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/09/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE The purpose of this study was to provide an overview of the available evidence on rehabilitation programmes after operatively treated patients with peroneal tendon tearsand ruptures. METHODS A systematic review was performed, and PubMed and EMBASE were searched for relevant studies. Information regarding the rehabilitation programme after surgical management of peroneal tendon tears and ruptures was extracted from all included studies. RESULTS In total, 49 studies were included. No studies were found with the primary purpose to report on rehabilitation of surgically treated peroneal tendon tears or ruptures. The median duration of the total immobilization period after primary repair was 6.0 weeks (range 0-12), 7.0 weeks (range 3.0-13) after tenodesis, 6.3 weeks (range 3.0-13) after grafting, and 8.0 weeks (range 6.0-11) after end-to-end suturing. Forty one percent of the studies that reported on the start of range of motion exercises initiated range of motion within 4 weeks after surgery. No difference was found in duration of immobilization or start of range of motion between different types of surgical treatment options. CONCLUSION Appropriate directed rehabilitation appears to be an important factor in the clinical success of surgically treated peroneal tendon tears and ruptures. There seems to be a trend towards shorter immobilization time and early range of motion, although there is no consensus in the literature on best practice recommendations for optimizing rehabilitation after surgical repair of peroneal tendon tears or ruptures. It is important to adjust the rehabilitation protocol to every specific patient for an optimal rehabilitation. LEVEL OF EVIDENCE Systematic Review, Level IV.
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Affiliation(s)
- Pim A. D. van Dijk
- />Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands , />Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands , />Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands , />Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Bart Lubberts
- />Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Claire Verheul
- />Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands , />Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands , />Orthopaedic Manual Therapy and (Sport)Physiotherapy, ManualFysion, Amsterdam, The Netherlands
| | - Christopher W. DiGiovanni
- />Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Gino M. M. J. Kerkhoffs
- />Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands , />Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands , />Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
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