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Kruse RC, Rudolph L, Negaard M. Asymptomatic sonographic abnormalities of the hindfoot region in Division I collegiate gymnasts. PM R 2024; 16:563-569. [PMID: 37799012 DOI: 10.1002/pmrj.13077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/09/2023] [Accepted: 09/30/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The hindfoot region is commonly injured in gymnasts, and musculoskeletal ultrasound can be used to identify structural abnormalities in this region. Although prior studies have shown that sonographic abnormalities may not correlate with symptomatic pathology, the presence of asymptomatic sonographic abnormalities of the hindfoot in Division I collegiate gymnasts has not been evaluated. OBJECTIVE To identify and describe commonly seen asymptomatic sonographic abnormalities of the hindfoot region in Division I collegiate gymnasts. DESIGN Cross-sectional study. SETTING Tertiary care academic medical center. PARTICIPANTS 39 Division I NCAA men's and women's collegiate gymnasts without current hindfoot pain or history of hindfoot injury. INTERVENTIONS Diagnostic musculoskeletal ultrasound of the hindfoot region. MAIN OUTCOME MEASURES Sonographic appearance of the hindfoot region, specifically the plantar fascia, plantar fad pad, and Achilles tendon. RESULTS A total of 37 of 39 gymnasts included in the study were found to have at least one asymptomatic sonographic abnormality of the hindfoot region. A total of 28.2% of athletes were found to have sonographic abnormalities within the Achilles tendon, with Doppler flow being the most common finding, and 35.8% of athletes were found to have a Haglund's deformity. However, only 7% of athletes with a Haglund's deformity demonstrated abnormal sonographic findings within the tendon. Sonographic abnormalities of the plantar fascia and plantar fat pad were seen in 30.7% and 69.2% of athletes, respectively. CONCLUSIONS Asymptomatic sonographic abnormalities of the hindfoot region are common in collegiate gymnasts. Clinicians should use clinical judgment when interpreting these findings as they may not represent symptomatic pathology.
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Affiliation(s)
- Ryan C Kruse
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, USA
| | | | - Matthew Negaard
- Department of Emergency Medicine, University of Iowa, Iowa City, Iowa, USA
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Almousa S, Mullen R, Williams K, Bourne M, Williams M. Identification of potential risk factors for lower limb injuries in female team-sport athletes: a prospective cohort study. SCI MED FOOTBALL 2024; 8:126-137. [PMID: 36803421 DOI: 10.1080/24733938.2023.2181386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 02/22/2023]
Abstract
OBJECTIVES The purpose of this prospective cohort study was to assess the associations between lower limb injuries in female team-sport athletes and a number of factors. The potential risk factors explored included (1) lower limb strength, (2) history of life-event stress, (3) family history of ACL injuries, (4) menstrual history, and (5) history of oral contraception use. METHODS One hundred and thirty-five female athletes aged between 14 and 31 years (mean: 18.8 ± 3.6 years) from rugby union (n = 47), soccer (n = 72), and netball (n = 16) volunteered to participate in this study. Demographics, history of life-event stress, injury history and baseline data were obtained prior to the competitive season. The following strength measures were collected: isometric hip adductor and abductor strength, eccentric knee flexor strength and single leg jumping kinetics. Athletes were then followed for 12 months, and all lower limb injuries sustained were recorded. RESULTS One hundred and nine athletes provided one-year follow-up injury data, of whom, 44 suffered at least one lower limb injury. All athletes who reported high scores for negative life-event stress sustained lower limb injuries. Non-contact lower limb injury was positively associated with weak hip adductor strength (OR: 0.88; 95%CI: 0.78-0.98; p = 0.017), and between-limb adductor (OR: 5.65; 95%CI: 1.61-19.7.; p = 0.007) and abductor (OR: 1.95; 95%CI: 1.03-3.71; p = 0.039) strength asymmetries. CONCLUSION History of life event stress, hip adductor strength, and between-limb adductor and abductor strength asymmetries offer potential novel avenues for investigating injury risk factors in female athletes.
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Affiliation(s)
- Sania Almousa
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Richard Mullen
- Division of Sport, Health and Exercise Sciences, Department of Life Sciences, Brunel University London, London, UK
| | - Kate Williams
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
| | - Matthew Bourne
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Australia
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Morgan Williams
- Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UK
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Cushman DM, Carefoot A, Corcoran B, Vu L, Fredericson M, Fausett C, Teramoto M, Eby SF. Prevalence of Sonographic Achilles Tendon, Patellar Tendon, and Plantar Fascia Abnormalities in Division I Collegiate Athletes From a Variety of Sports. Clin J Sport Med 2024; 34:297-303. [PMID: 37540559 PMCID: PMC10838354 DOI: 10.1097/jsm.0000000000001183] [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: 12/29/2022] [Accepted: 06/28/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE This study aimed to determine the prevalence of ultrasound abnormalities in the Achilles tendon, patellar tendon, and plantar fascia among a large cohort of collegiate student-athletes. DESIGN Observational cross-sectional study. SETTING Three Division I institutions. PARTICIPANTS 243 student-athletes participated in this study. Exclusion criteria included those younger than 18 years or who underwent prior surgery/amputation of structures, including anterior cruciate ligament (ACL) surgeries with patellar tendon grafts. INTERVENTIONS Ultrasound examination of the Achilles tendon, patellar tendon, and plantar fascia of each leg was performed. An experienced sonographer reviewed each tendon video in a blinded manner, with a separate experienced sonographer separately reviewing to establish inter-rater reliability. MAIN OUTCOME MEASURES The primary outcome measured was the presence of any sonographic abnormality including hypoechogenicity, thickening, or neovascularity. RESULTS Ultrasound abnormalities were identified in 10.1%, 37.2%, and 3.9% of all Achilles tendons, patellar tendons, and plantar fasciae, respectively. Abnormalities were significantly associated with the presence of concurrent pain for all structures ( P < 0.01). Specifically, athletes with sonographic abnormalities were approximately 4 times [relative risk (RR) = 4.25; 95% confidence interval (CI), 2.05-8.84], 6 times (RR = 5.69; 95% CI, 2.31-14.00), and 5 times (RR = 5.17; 95% CI, 1.76-15.25) more likely to self-report pain in the Achilles tendon, patellar tendon, and plantar fascia, respectively. CONCLUSIONS This multi-institutional study completed at 3 Division I institutions is the largest study of its kind to identify the prevalence of sonographic abnormalities in the Achilles tendon, patellar tendon, and plantar fascia among collegiate student-athletes of various sports.
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Affiliation(s)
- Daniel M Cushman
- Departments of Physical Medicine & Rehabilitation; and
- Orthopaedics, University of Utah, Salt Lake City, Utah
| | | | - Blake Corcoran
- Washington State University, Cougar Health Services, Pullman, Washington
| | - Leyen Vu
- Washington State University, Cougar Health Services, Pullman, Washington
| | - Michael Fredericson
- Division of Physical Medicine & Rehabilitation, Department of Orthopedic Surgery, Stanford University, Palo Alto, California; and
| | - Cameron Fausett
- Division of Physical Medicine & Rehabilitation, Department of Orthopedic Surgery, Stanford University, Palo Alto, California; and
| | | | - Sarah F Eby
- Department of Physical Medicine & Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
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4
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Muhlenhaupt E, Stauss HM. Higher risk of Achilles tendon ruptures at competition than training sites in female collegiate gymnasts. J Sports Med Phys Fitness 2024; 64:392-401. [PMID: 38193754 DOI: 10.23736/s0022-4707.23.15558-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
BACKGROUND Reportedly, 17.2% of collegiate female gymnasts experience Achilles tendon ruptures (ATRs). Cumulative microtraumas resulting in chronic tendinopathy/tendinitis may contribute to this high injury risk. We hypothesized that the risk of ATRs in female collegiate gymnasts increases with years of competitive gymnastics, that non-steroidal anti-inflammatory drug (NSAID) use is associated with less ATRs, and that the risk is larger during competition than training. METHODS Female gymnasts from 78 USA collegiate teams completed a survey assessing the prevalence of ATRs, NSAID use, age at which competitive gymnastics started and age at which ATR occurred, and whether ATRs occurred during training or competition. RESULTS Twenty-one of 103 gymnasts (20.4%, 95% CI: 13.6% to 29.4%) experienced ATRs. Eighteen of 21 ruptures (85.7%, 95% CI: 61.3% to 95.8%) occurred after more than ten years of competitive gymnastics (mean: 14.0±2.6 years, 95% CI: 12.8 to 15.2 years). ATRs occurred 0.08±0.01 (95% CI: 0.06 to 0.11) times per 1000 hours at training versus 1.85±0.11 (95% CI: 1.60 to 2.10) times per 1000 hours at competition (P<0.05). Prevalence of NSAID use was 27.6% (95% CI: 18.6% to 39.0%) in gymnasts without ATR but only 5.5% (95% CI: 0.6% to 35.5%, P=0.09) in gymnasts with ATR. Multiple regression analysis demonstrated a negative association between NSAID use and incidence of ATRs (P<0.05). CONCLUSIONS Female collegiate gymnasts are at high risk for ATRs, especially after more than ten years of competitive gymnastics and during competition.
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Affiliation(s)
- Emily Muhlenhaupt
- Department of Biomedical Sciences, Burrell College of Osteopathic Medicine, Las Cruces, NM, USA
| | - Harald M Stauss
- Department of Biomedical Sciences, Burrell College of Osteopathic Medicine, Las Cruces, NM, USA -
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5
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Boldt KS, Olson BL, Thiele RM. Effects of Collagen and Exercise on Tendon Properties and Pain: A Critically Appraised Topic. J Sport Rehabil 2023; 32:938-941. [PMID: 37758259 DOI: 10.1123/jsr.2023-0115] [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: 04/11/2023] [Revised: 06/15/2023] [Accepted: 07/18/2023] [Indexed: 10/03/2023]
Abstract
CLINICAL SCENARIO Achilles tendon ruptures are prevalent and devastating injuries that require the need for extensive rehabilitation. The methods for preventing these injuries vary between different exercise methods and nutritional supplementation. Although proven effective for decreasing pain and increasing tendon properties, the influence of these 2 methods in combination has not yet been evaluated. CLINICAL QUESTION Does exercise combined with collagen supplementation improve Achilles tendon structural and mechanical properties and diminish subsequent patient-reported pain compared with exercise alone in adults? SUMMARY OF KEY FINDINGS Exercise training, including eccentric training protocols and concentric resistance training protocols, combined with collagen supplementation influence Achilles tendon properties and subsequent patient-reported pain compared with exercise alone. CLINICAL BOTTOM LINE Evidence supports that collagen along with exercise training has a significant influence on pain mitigation, augmented cross-sectional area, and tendon thickness, but may have little to no influence on tendon stiffness and microvascularity compared with exercise alone. Further research is needed to determine the effects of combined methods on various populations. STRENGTH OF RECOMMENDATION Collectively, the body of evidence included to answer the clinical question aligns with the strength of recommendation of A.
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Affiliation(s)
- Kylie S Boldt
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS, USA
| | - Bernadette L Olson
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS, USA
| | - Ryan M Thiele
- Department of Food, Nutrition, Dietetics, and Health, Kansas State University, Manhattan, KS, USA
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6
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Čretnik A, Košir R. Incidence of Achilles tendon rupture: 25-year regional analysis with a focus on bilateral ruptures. J Int Med Res 2023; 51:3000605231205179. [PMID: 37976267 PMCID: PMC10657533 DOI: 10.1177/03000605231205179] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/15/2023] [Indexed: 11/19/2023] Open
Abstract
OBJECTIVE We aimed to fill the research gap regarding the incidence of Achilles tendon rupture (ATR), which is reportedly increasing, as there is a lack of data on the incidence of ATR and no data on bilateral ruptures in our region. METHODS We determined the incidence of complete ATR among 273,485 people during 1991 to 2015. RESULTS In the study period, 524 patients (486 [92.75%] men and 38 [7.25%] women, average age 39.03±10.86 [range 20-83] years, = sex ratio 12.8:1) were treated for ATR in our study area. The average incidence was 7.77 per 100,000 person-years, with an increasing trend until 2008 and peak incidence of 11.33 per 100,000 person-years. Most injuries (67.04%) occurred while performing sports activities. In total, 7 (1.34%) patients (six men [1.23%] and one woman [2.63%]) experienced ruptures on both sides, an average of 5.1 years apart; the average age at the second rupture was 57.71±16.69 (range 39-83) years, with a calculated incidence for bilateral ATR of 0.1 per 100,000 person-years. CONCLUSIONS The incidence of complete ATR in our study region increased gradually between 1991 and 2008, after which it declined. Bilateral ATR during that period was a very rare injury.
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Affiliation(s)
- Andrej Čretnik
- Department of Traumatology, University Clinical Center Maribor, Maribor, Slovenia
| | - Roman Košir
- Department of Traumatology, University Clinical Center Maribor, Maribor, Slovenia
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Mao Y, John N, Protzman NM, Long D, Sivalenka R, Azimi S, Mirabile B, Pouliot R, Gosiewska A, Hariri RJ, Brigido SA. A tri-layer decellularized, dehydrated human amniotic membrane scaffold supports the cellular functions of human tenocytes in vitro. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2023; 34:37. [PMID: 37486403 PMCID: PMC10366303 DOI: 10.1007/s10856-023-06740-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 07/05/2023] [Indexed: 07/25/2023]
Abstract
Differences in scaffold design have the potential to influence cell-scaffold interactions. This study sought to determine whether a tri-layer design influences the cellular function of human tenocytes in vitro. The single-layer decellularized, dehydrated human amniotic membrane (DDHAM) and the tri-layer DDHAM (DDHAM-3L) similarly supported tenocyte function as evidenced by improved cell growth and migration, reduced dedifferentiation, and an attenuated inflammatory response. The tri-layer design provides a mechanically more robust scaffold without altering biological activity.
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Affiliation(s)
- Yong Mao
- Laboratory for Biomaterials Research, Department of Chemistry and Chemical Biology, Rutgers University, 145 Bevier Rd., Piscataway, NJ, 08854, USA
| | - Nikita John
- Laboratory for Biomaterials Research, Department of Chemistry and Chemical Biology, Rutgers University, 145 Bevier Rd., Piscataway, NJ, 08854, USA
| | - Nicole M Protzman
- Healthcare Analytics, LLC, 78 Morningside Dr, Easton, PA, 18045, USA
| | - Desiree Long
- Celularity Inc., 170 Park Ave., Florham Park, NJ, 07932, USA
| | - Raja Sivalenka
- Celularity Inc., 170 Park Ave., Florham Park, NJ, 07932, USA
| | - Shamshad Azimi
- Celularity Inc., 170 Park Ave., Florham Park, NJ, 07932, USA
| | | | - Robert Pouliot
- Celularity Inc., 170 Park Ave., Florham Park, NJ, 07932, USA
| | - Anna Gosiewska
- Celularity Inc., 170 Park Ave., Florham Park, NJ, 07932, USA.
| | - Robert J Hariri
- Celularity Inc., 170 Park Ave., Florham Park, NJ, 07932, USA
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Kobayashi JK, Kobayashi EF, Tomasevich KM, Lorens KL, Aoki SK. Characterization of Achilles Tendon Ruptures in Collegiate Women's Gymnastics. Orthopedics 2023; 46:205-210. [PMID: 36853933 DOI: 10.3928/01477447-20230224-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
Collegiate female gymnasts are at high risk of Achilles tendon injuries. Achilles tendon ruptures can negatively impact an athlete's ability to return to competitive sport. Understanding the natural history of Achilles tendon tears in collegiate female gymnasts is important in the development of preventive treatment. To expand our knowledge of the natural history of Achilles tendon ruptures among collegiate female gymnasts, a REDCap retrospective survey was emailed to athletic trainers on all 80 National Collegiate Athletic Association (NCAA) women's gymnastics teams. The survey gathered information regarding number of Achilles tendon injuries, pain prior to injuries, events and skills on which injuries occurred, and functional outcome after injuries among athletes competing in the 2013 to 2018 NCAA seasons. Forty-two of 80 (52.5%) programs responded to the survey. Seventy-one Achilles tendon ruptures were reported between 2013 and 2018. Among these, 46% had antecedent pain. Gymnasts sustained 95% of Achilles tendon ruptures while performing on floor exercise, with 98% of ruptures occurring during the take-off portion of a tumbling skill. Of the 61% of gymnasts who were able to return to competition, 59% were able to achieve the same level of function after injury. Achilles tendon ruptures in collegiate female gymnasts primarily occur during the take-off motion while tumbling on the floor exercise. Future studies should evaluate degenerative Achilles tendon changes in collegiate female gymnasts. A collaborative effort among gymnasts, coaches, judges, and medical experts is required to identify at-risk athletes and develop and implement injury prevention programs. [Orthopedics. 2023;46(4):205-210.].
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Fryar C, Tilley D, Casey E, Vincent H. A Research and Clinical Framework for Understanding Achilles Injury in Female Collegiate Gymnasts. Curr Sports Med Rep 2023; 22:260-267. [PMID: 37417663 DOI: 10.1249/jsr.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
ABSTRACT Gymnastics is a popular sport with a high injury rate, particularly at the collegiate level. Achilles tendon rupture is a catastrophic injury with career-changing impact. Over the last decade, there has been a growing incidence of Achilles tendon ruptures, especially in female gymnasts. Currently, neither the effects of contributing risk factors on Achilles tendon rupture nor the research frameworks to guide future intervention strategies have been well described. This article reviews the functional anatomy and mechanical properties of the Achilles tendon, provides precollegiate and collegiate intrinsic and extrinsic risk factors for Achilles tendon rupture, and proposes a research framework to address this injury from a systemic perspective. Potential clinical interventions to mitigate Achilles tendon injury are proposed based on currently available peer-reviewed evidence.
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Affiliation(s)
- Caroline Fryar
- Department of Physical Medicine and Rehabilitation, University of Florida College of Medicine, Gainesville, FL
| | - Dave Tilley
- Champion Physical Therapy & Performance, Watham, MA
| | - Ellen Casey
- Department of Physiatry, Hospital for Special Surgery, New York, NY
| | - Heather Vincent
- University of Florida College of Medicine, UF Physical Medicine & Rehabilitation
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Laboute E, Thoreux P, Beldame J, Caubere A, Giunta JC, Coursier R, Saab M. Re-ruptures and early outcomes after surgical repair of acute Achilles tendon ruptures: prospective, comparative multicenter study. INTERNATIONAL ORTHOPAEDICS 2023:10.1007/s00264-023-05827-5. [PMID: 37178229 DOI: 10.1007/s00264-023-05827-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023]
Abstract
PURPOSE The primary objective of this study was to compare the re-rupture rate, clinical results, and functional outcomes six months after the surgical repair of an acute Achilles tendon rupture between three different techniques (open repair, percutaneous repair with the Tenolig®, and minimally invasive repair). METHODS A prospective, comparative, multicenter, non-randomized study was performed and included 111 patients who had an acute ruptured Achilles tendon: 74 underwent an open repair, 22 underwent a percutaneous repair using the Tenolig® and 15 had a minimally invasive repair. At six months follow-up we analyzed the number of re-ruptures, phlebitis, infections, complex regional pain syndrome, clinical outcomes (muscle atrophy, ankle dorsal flexion), functional scores (ATRS, VISA-A, EFAS, SF-12), and return to running. RESULTS There were more re-ruptures (p=0.0001) after repair with the Tenolig® (27%) than with open repairs (1.3%) and minimally invasive repairs (0%). The rate of other complications was not different. No clinical differences were found between the three groups. Only some functional scores EFAS Total (p=0.006), and VISA-A (p=0.015) were worse in the Tenolig® group. All the other results were similar between the three groups. CONCLUSION Despite heterogeneous studies in literature, the results of this comparative and prospective study between three surgical techniques of Achilles tendon repair confirmed that Tenolig® repair increased the rate of early re-rupture compared to open or minimally invasive techniques.
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Affiliation(s)
- E Laboute
- Directeur scientifique Société Française de Traumatologie du Sport (SFTS), C.E.R.S. Groupe Ramsay Santé, 83 av Maréchal de Lattre de Tassigny, 40130, Capbreton, France.
| | - P Thoreux
- Hôpital Hôtel Dieu-APHP, Université Sorbonne Paris Nord, 1 place du Parvis Notre -Dame, 75004, Paris, France
| | - J Beldame
- Institut de la Cheville et du Pied, Clinique Blomet, 136 rue Blomet, 75015, Paris, France
| | - A Caubere
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital d'Instruction des Armées Sainte-Anne, 2, Bd Sainte Anne, 83800, Toulon, France
| | - J C Giunta
- Clinique du Parc Lyon, 155 Boulevard de Stalingrad, 69006, Lyon, France
| | - R Coursier
- GHICL Hôpital Saint Vincent, 51 Boulevard de Belfort, 59462, Lille, France
| | - M Saab
- CHU Lille, Service d'Orthopedie-Traumatologie, F-59000, Lille, France
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Moore ML, Hawkins RJ, Pollock JR, Makovicka JL, Haglin JM, Brinkman JC, Patel KA. Bibliometric Analysis of the Top 50 Most Cited Studies on Achilles Tendon Pathology. Orthop J Sports Med 2023; 11:23259671221134117. [PMID: 37223074 PMCID: PMC10201170 DOI: 10.1177/23259671221134117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 08/10/2022] [Indexed: 05/25/2023] Open
Abstract
Background The development of Achilles tendon treatment modalities has been rapid, and it is increasingly difficult for clinicians to stay up to date with the most influential studies in this field. In order to fully understand the current state of the literature regarding Achilles tendon injury, it is invaluable to be familiar with the foundational articles and studies upon which the field is built. Purpose To objectively determine the 50 most frequently cited studies in Achilles tendon pathology and to conduct a bibliometric analysis. Study Design Cross-sectional study. Methods The Clarivate Analytics Web of Knowledge database was used to gather data and metrics of Achilles tendon research. The 50 most cited articles were selected for analysis from an initial 17,244 identified articles. The information extracted for each article included author name, publication year, country of origin, journal name, study type, and level of evidence. Results For these 50 studies, the total number of citations was calculated to be 13,159, with a mean of 263.2 citations per paper. The most cited article collected 657 citations. The publication dates of the 50 studies included in this analysis spanned 41 years (1972-2013). The largest number of articles were published by Swedish authors (n = 14); however, many other countries were represented, including Canada and Finland (n = 6 articles each). The most prevalent study designs were cohort studies (n = 13) with level 4 evidence studies being the most common (n = 14). Conclusion Among the 50 most influential articles in Achilles tendon pathology, the study designs most commonly used were cohort studies and review articles. Sweden was the country of origin for the most studies included on this list, which reflects this country's interest and commitment to researching Achilles tendon injuries and treatments.
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Affiliation(s)
- M. Lane Moore
- Mayo Clinic Alix School of Medicine,
Scottsdale, Arizona, USA
| | | | | | - Justin L. Makovicka
- Department of Orthopedic Surgery, Mayo
Clinic Arizona, Phoenix, Arizona, USA
| | - Jack M. Haglin
- Department of Orthopedic Surgery, Mayo
Clinic Arizona, Phoenix, Arizona, USA
| | - Joseph C. Brinkman
- Department of Orthopedic Surgery, Mayo
Clinic Arizona, Phoenix, Arizona, USA
| | - Karan A. Patel
- Department of Orthopedic Surgery, Mayo
Clinic Arizona, Phoenix, Arizona, USA
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12
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Chan JJ, Xiao RC, Hasija R, Huang HH, Kim JM. Epidemiology of Hand and Wrist Injuries in Collegiate-Level Athletes in the United States. J Hand Surg Am 2023; 48:307.e1-307.e7. [PMID: 34895779 DOI: 10.1016/j.jhsa.2021.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 08/26/2021] [Accepted: 10/27/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Hand and wrist injuries are common among competitive athletes and can have a substantial impact on playing time and future participation. The purpose of this study was to provide epidemiological data from the National Collegiate Athletic Association Injury Surveillance Program to correlate injury diagnosis with the need for surgery and time loss. METHODS Using the National Collegiate Athletic Association Injury Surveillance Program, this retrospective study extracted data of hand and wrist injuries for all 25 National Collegiate Athletic Association sports from the academic years 2004-2005 to 2013-2014. The "severe" category was defined as injuries resulting in the following: (1) surgery, (2) season-ending status, or (3) more than 30 days of playing time loss. The epidemiologic data included injury rate per 100,000 athlete exposures (defined as 1 athlete participating in 1 practice or competition) based on diagnoses and demographic information such as sports and sex. We used a Poisson regression model to estimate the incidence rate and 95% confidence interval. RESULTS Overall, 4,851 hand injuries were identified, with an injury rate of 41.2 per 100,000 athlete exposures. The most common diagnoses were metacarpal or phalangeal fractures (19.9%), lacerations or contusions (15.4%), and wrist sprains (14.7%). The surgical rate was 9.6%, and the season-ending rate was 5.8%. Severe injuries occurred in 17.5% of the hand and wrist injuries; within this subset, the most common diagnoses included metacarpal or phalangeal fractures (43.8%), scaphoid fractures (12.8%), and thumb ulnar collateral ligament tears (8.7%). Scaphoid fractures and metacarpal or phalangeal fractures had the highest surgical rate and season-ending rate among all the injuries. CONCLUSIONS The injury rate of hand and wrist injuries is comparable with those of other common sports injuries. Approximately one fifth of the injuries were considered severe, which led to a high surgical rate, and these had a considerable impact on the athletes' ability to finish the season. TYPE OF STUDY/LEVEL OF EVIDENCE Outcome research level II.
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Affiliation(s)
- Jimmy J Chan
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ryan C Xiao
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rohit Hasija
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Hsin-Hui Huang
- Institute for Healthcare Delivery Science, Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jaehon M Kim
- Leni and Peter W. May Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY.
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Crook BS, Varshneya K, Meyer LE, Anastasio A, Cullen MM, Lau BC. Operative Versus Nonoperative Treatment of Acute Achilles Tendon Rupture: A Propensity Score-Matched Analysis of a Large National Dataset. Orthop J Sports Med 2023; 11:23259671231152904. [PMID: 36874053 PMCID: PMC9974620 DOI: 10.1177/23259671231152904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 11/09/2022] [Indexed: 03/02/2023] Open
Abstract
Background No consensus exists regarding the superiority of operative versus nonoperative management for Achilles tendon ruptures, as multiple randomized controlled trials conducted since the advent of early mobilization protocols have found outcomes for these 2 interventions to be more similar than were previously held. Purpose To use a large national database to (1) compare reoperation and complication rates between operative and nonoperative treatment of acute Achilles tendon ruptures and (2) evaluate trends in treatment and cost over time. Study Design Cohort study; Level of evidence, 3. Methods The MarketScan Commercial Claims and Encounters database was used to identify an unmatched cohort of 31,515 patients who sustained primary Achilles tendon ruptures between 2007 and 2015. Patients were stratified into operative and nonoperative treatment groups, and a propensity score-a matching algorithm-was used to establish a matched cohort of 17,996 patients (n = 8993 per treatment group). Reoperation rates, complications, and aggregate treatment costs were compared between groups with an alpha level of .05. A number needed to harm (NNH) was calculated from the absolute risk difference in complications between cohorts. Results The operative cohort experienced a significantly larger total number of complications within 30 days of injury (1026 vs 917; P = .0088). The absolute increase in cumulative risk was 1.2% with operative treatment, which resulted in an NNH of 83. Neither 1-year (1.1% [operative] vs 1.3% [nonoperative]; P = .1201) nor 2-year reoperation rates (1.9% [operative] vs 2% [nonoperative]; P = .2810) were significantly different. Operative care was more expensive than nonoperative care at 9 months and 2 years after injury; however, there was no difference in cost between treatments at 5 years. Before matching, the rate of surgical repair for Achilles tendon rupture remained stable, from 69.7% to 71.7% between 2007 and 2015, indicating little change in practice in the United States. Conclusion Results indicated no differences in reoperation rates between operative and nonoperative management of Achilles tendon ruptures. Operative management was associated with an increased risk of complications and higher initial costs, which dissipated over time. Between 2007 and 2015 the proportion of Achilles tendon ruptures managed operatively remained similar despite increasing evidence that nonoperative management of Achilles tendon rupture may provide equivalent outcomes.
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Affiliation(s)
- Bryan S Crook
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Kunal Varshneya
- Stanford University School of Medicine, Stanford, California, USA
| | - Lucy E Meyer
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Albert Anastasio
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Mark M Cullen
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Brian C Lau
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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Xu L, Jin J, Liu Z, Wu M, Peng B, Jiang J, Liu G, He J, White S, Xia Y. A New Technique of Achilles Tendon Rupture Repaired by Double Transverse Mini-incision to Avoid Sural Nerve Injury: A Consecutive Retrospective Study. Orthop Surg 2022; 15:517-524. [PMID: 36573277 PMCID: PMC9891928 DOI: 10.1111/os.13615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Percutaneous suture is a classic technique used in Achilles tendon repair. However, the complication rates surrounding the sural nerve remain relatively high. Modified percutaneous repair technology can effectively avoid these complications; however, the surgical procedure is complicated. Hence, the present study was conducted to describe a redesigned repair technique for the Achilles tendon able to avoid sural nerve injury and reduce the complexity of the procedure. METHODS Data of patients with acute primary Achilles tendon rupture at our hospital from January 2019 to May 2020 were included. Subjects with expectations for surgical scarring underwent a minimally invasive-combined percutaneous puncture technique. The surgical time, requirement for conversion to other technologies, and length of postoperative hospitalization were investigated to assess efficacy. The American Orthopedic Foot & Ankle Society (AOFAS) score and the Arner-Lindholm scale (A-L scale) were used to assess postoperative clinical outcomes (> 24 months). During the 2-year follow-up, MRI was performed to observe the healing of the Achilles tendon. In addition, subjective satisfaction with surgical scar healing was recorded. RESULTS Twenty consecutive subjects with an average follow-up of 28.3 ± 4.5 months (range, 24-41) met the inclusion criteria. None of the 20 enrolled patients required a converted surgical approach. The mean surgical time was 26.9 ± 6.47 min (range, 20-44). None of the patients experienced dysesthesia or anesthesia around the sural nerve. No signs of postoperative infections were observed. MRI data showed that the wounds of the Achilles tendon healed completely in all the subjects. The AOFAS score increased from 55.6 ± 11.07 (range, 28-71) preoperatively to 97.8 ± 3.34 (range, 87-100) at the last follow-up. The A-L scale showed that 90% of the subjects (n = 18) presented as excellent and 10% of the subjects (n = 2) presented as good, with an excellent/good rate of 100%. Moreover, subjects' satisfaction for surgical scars was 9.1 ± 0.78 (upper limit, 10). CONCLUSIONS The results indicate that this technique can achieve good postoperative function, a small surgical incision, and high scar satisfaction. In addition, this technique should be widely used in suturing Achilles tendon ruptures.
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Affiliation(s)
- Lihu Xu
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Jiaxin Jin
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Zhongcheng Liu
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Meng Wu
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Bo Peng
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Jin Jiang
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Guangyao Liu
- Key Laboratory of Medical Imaging of Gansu ProvinceLanzhou University Second Hospital, Gansu International Scientific and Technological Cooperation Base of Medical Imaging Artificial IntelligenceLanzhouChina
| | - Jinwen He
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
| | - Sylvia White
- Department of PathologyYale University School of MedicineNew HavenCTUSA
| | - Yayi Xia
- Department of OrthopaedicsLanzhou University Second Hospital, Orthopaedics Key Laboratory of Gansu Province, Orthopaedics Clinical Research Center of Gansu ProvinceLanzhouChina
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Effects of Body Posture and Different Exercise Intensity on Athletes’ Limb Injury. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:5103017. [PMID: 35799669 PMCID: PMC9256291 DOI: 10.1155/2022/5103017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/25/2022] [Accepted: 06/02/2022] [Indexed: 11/26/2022]
Abstract
The purpose of this study was to solve the problem of the influence of body posture and different exercise intensity on athletes' limb injuries, to meet the needs of understanding athletes' injuries, and to make up for the lack of investigations on athletes' limb injuries; this also increases the chances of an athlete avoiding injury. Severe acute sports injuries of high-level gymnasts endanger the personal safety of athletes. Many movements in gymnastics are done in the air much higher than the ground, and there is no fulcrum when the athlete does the movements; this just can only maintain balance and change your body posture through your own feelings, a slight error can easily cause your head or upper body to fall down, and the fragile spine cannot withstand the strong impact of the ground, resulting in high vertebral fractures, high paraplegia, and even death. Therefore, through a survey of 126 rhythmic gymnasts who participated in the 2011 “China Art Sports Cup” China Rhythmic Gymnastics Championship, a total of 172 injuries were found in 136 gymnasts, and the injury risk analysis was carried out from the main characteristics of the injuries.
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16
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Wang YH, Zhou HH, Nie Z, Cui S. Prevalence of Achilles tendinopathy in physical exercise: A systematic review and meta-analysis. SPORTS MEDICINE AND HEALTH SCIENCE 2022; 4:152-159. [PMID: 36090915 PMCID: PMC9453689 DOI: 10.1016/j.smhs.2022.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 03/21/2022] [Accepted: 03/21/2022] [Indexed: 11/11/2022] Open
Abstract
This comprehensive systematic review and meta-analysis assessed the prevalence of Achilles tendinopathy (AT) in physical exercise (PE). Specifically, we estimate the overall risk of AT in physical exercise and compare sport-specific estimates of AT risk. PubMed, Web of Science, Cochrane Library, and SPORTDiscus were searched before the 1st of October 2021. Random-effects, subgroup analysis, sensitivity analysis and meta-regressions were conducted, involving 16 publications. This meta-analysis found that the overall prevalence of AT was 0.06 (95%CI, 0.04–0.07). The prevalence of Achilles tendon rupture was 0.03 (95%CI, 0.02–0.05). Subgroup analysis showed that the prevalence of AT increased with age, the highest among the group aged over 45 (0.08; 95%CI, 0.04–0.11), and the lowest among the group under 18 years old (0.02; 95%CI, 0.01–0.03). The gymnastics and ball games had the highest prevalence of AT, at (0.17; 95%CI, 0.14–0.20) and (0.06; 95%CI, 0.02–0.11), respectively. The prevalence of AT in athletes (0.06; 95%CI, 0.04–0.08) was higher than that of amateur exercisers (0.04; 95%CI, 0.02–0.06) and there was no difference in the prevalence of AT between males and females. There are differences in the prevalence of AT in different ages, sport events and characteristics of participants. This systematic review and meta-analysis suggested that it was necessary to pay more attention to AT in people who were older or engaged in gymnastics.
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Application of Image Mosaic Technology in Tai Chi Animation Creation. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:4775189. [PMID: 35069718 PMCID: PMC8776481 DOI: 10.1155/2022/4775189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 11/17/2022]
Abstract
Panorama can reflect the image seen at any angle of view at a certain point of view. How to improve the quality of panorama stitching and use it as a data foundation in the “smart tourism” system has become a research hotspot in recent years. Image stitching means to use the overlapping area between the images to be stitched for registration and fusion to generate a new image with a wider viewing angle. This article takes the production of “Tai Chi” animation as an example to apply image stitching technology to the production of realistic 3D model textures to simplify the production of animation textures. A handheld camera is used to collect images in a certain overlapping area. After cylindrical projection, the Harris algorithm based on scale space is adopted to detect image feature points, the two-way normalized cross-correlation algorithm matches the feature points, and the algorithm to extract the threshold T iteratively removes mismatches. The transformation parameter model is quickly estimated through the improved RANSAC algorithm, and the spliced image is projected and transformed. The Szeliski grayscale fusion method directly calculates the grayscale average of the matching points to fuse the image, and finally, the best stitching method is used to eliminate the ghosting at the image mosaic. Data experiments based on Matlab show that the proposed image splicing technology has the advantages of high efficiency and clear spliced images and a more satisfactory panoramic image visual effect can be achieved.
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18
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Construction and Simulation of Injury Early Warning Model for Retired Athletes Based on Improved Self-organizing Neural Network. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2021; 2021:6728678. [PMID: 34707651 PMCID: PMC8545582 DOI: 10.1155/2021/6728678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022]
Abstract
With the progress of sci-tech, the interdisciplinary and comprehensive development, and various advanced sci-tech gradually integrated into the field of sports, it has become possible to study how to reasonably prevent sports injuries, minimize the risk of sports injuries, and maintain the best physical condition of retired athletes. Due to the long-term high-load exercise of retired athletes during their sports career, athletes' physical functions have been damaged to varying degrees, resulting in more injuries. According to the characteristics that many factors need to be considered in the prediction of retired athletes' injuries, this paper puts forward an improved self-organizing neural network (SOM) method to predict retired athletes' injuries. In this paper, an early warning analysis model of retired athletes' susceptibility to injury based on SOM is proposed, which screens the state of retired athletes' physical function variables in each stage, considers athletes' physical function data whose standard deviation is higher than the limit specification of susceptibility to injury as susceptible injury data, quickly judges all vulnerable injury data, and completes the high-speed early warning analysis of retired athletes' susceptibility to injury.
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Hodgens BH, Geller JS, Rizzo MG, Munoz J, Kaplan J, Aiyer A. Performance Outcomes After Surgical Repair of Achilles Tendon Rupture in the Women's National Basketball Association. Orthop J Sports Med 2021; 9:23259671211030473. [PMID: 34527757 PMCID: PMC8436311 DOI: 10.1177/23259671211030473] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 03/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Achilles tendon ruptures are devastating in elite athletes. There are currently no studies examining the effects of Achilles tendon rupture on performance outcomes in the Women’s National Basketball Association (WNBA). Hypothesis: Athletes in the WNBA who sustained an Achilles tendon rupture and underwent subsequent surgical repair will sustain declines in performance metrics when compared with their preinjury statistics and matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: Seventeen WNBA players who sustained an Achilles tendon rupture from 2000 to 2019 were identified through publicly available injury reports and player profiles. Athlete information collected included age, body mass index, position, and service in the WNBA when the tear occurred. Statistics were collected for 1 season before and 2 seasons after the injury, and the player efficiency rating (PER) was calculated. Players were matched to uninjured controls by service in the WNBA, position, and performance statistics. Results: On average, players were 28 years of age at the time of Achilles tendon rupture, with a service time in the WNBA of 6.5 years. Four players never returned to play in the WNBA, while 7 players failed to play more than 1 season. Players who did return played significantly fewer minutes per game compared with preinjury in both postinjury seasons 1 and 2 (mean difference, –6.11 and –6.54 min/game, respectively; P < .01 for both) and had a significantly decreased PER in postinjury season 2 (mean difference, –2.53; P = .024). After returning to play, the injured players experienced significant decreases when compared with controls in field goals (–0.85 vs +0.20; P = .047), free throws (–1.04 vs +0.12; P < .01), steals (–0.48 vs +0.24; P = .018), and points scored (–2.89 vs +0.58; P = .014). Conclusion: WNBA players experienced significant decreases in performance metrics after Achilles tendon rupture compared with their preinjury levels and compared with uninjured controls. Overall, 23.5% of players failed to return to the WNBA, while 41.2% failed to play for more than 1 season.
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Affiliation(s)
- Blake H Hodgens
- University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joseph S Geller
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
| | - Michael G Rizzo
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
| | - Julianne Munoz
- University of Miami Sports Medicine Institute, Miami, Florida, USA
| | | | - Amiethab Aiyer
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
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20
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Jiang X, Qian S, Chen C, Wu H, Zhi X, Xu D, Lian J, Liu X, Wei S, Xu F. Modified mini-incision "internal splinting" versus percutaneous repair technique of acute Achilles tendon rupture: five year retrospective case-controlled study. INTERNATIONAL ORTHOPAEDICS 2021; 45:3243-3251. [PMID: 34386884 DOI: 10.1007/s00264-021-05185-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Several kinds of minimally invasive surgical techniques are applied to acute Achilles tendon rupture. The risks of sural never injury and re-ruptures are still major issues. The purpose of this study was to compare the middle-term results of two different minimally invasive repair techniques for acute Achille tendon rupture. METHODS Twenty-four cases underwent the modified mini-incision "internal splinting" repair technique in group A, and 29 cases underwent a percutaneous repair technique in group B and were evaluated. The intra-operative data, complications, the time of recovery, and the post-operative magnetic resonance imaging were analyzed. At the final follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Thermann score were evaluated. RESULTS The mean follow-up time was 59.96 ± 4.16 months (range 48-67). At the final follow-up, the AOFAS score and Thermann score in both groups had similar feedback. No nerve injury, infection, or re-rupture was encountered in group A, except two cases with anchor irritation. One case with sural nerve injury and one with a re-rupture were recorded in group B, respectively. The final MRI showed thicker regeneration of the tendon in both groups. CONCLUSIONS The middle-term results indicated the modified mini-incision "internal splinting" technique for acute Achilles tendon rupture is similar to the percutaneous repair technique. A lower risk of sural nerve injury and re-rupture may be advantages.
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Affiliation(s)
- Xiang Jiang
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China
| | - Shenglong Qian
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China
| | - Cheng Chen
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China
| | - Helin Wu
- The First Clinical Medical School Of, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Xiaosong Zhi
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China
| | - Dan Xu
- Department of Rehabilitation, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China
| | - Junhong Lian
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China.
| | - Ximing Liu
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China
- The First Clinical Medical School Of, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
| | - Shijun Wei
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China.
- The First Clinical Medical School Of, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China.
| | - Feng Xu
- Department of Orthopaedics, General Hospital of Central Theater Command (Wuhan General Hospital of Guangzhou Command, Previously), Wuhan, Hubei Province, People's Republic of China
- The First Clinical Medical School Of, Southern Medical University, Guangzhou, Guangdong Province, People's Republic of China
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Bonanno J, Cheng J, Tilley D, Abutalib Z, Casey E. Factors Associated With Achilles Tendon Rupture in Women's Collegiate Gymnastics. Sports Health 2021; 14:358-368. [PMID: 34338076 DOI: 10.1177/19417381211034510] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Achilles injury risk in women's collegiate gymnastics is 10-fold higher than in all other collegiate sports. This study aims to identify risk factors for Achilles tendon ruptures in collegiate female gymnasts. HYPOTHESIS Gymnasts with Achilles tendon ruptures will be more likely to report early gymnastics specialization, elite-level training before college, and performance of high-difficulty skills on floor and vault. STUDY DESIGN Cross-sectional study. LEVEL OF EVIDENCE Level 4. METHODS Anonymous surveys were distributed to current and former collegiate female gymnasts, aged 18 to 30 years, via coaches, athletic trainers, Twitter, and ResearchMatch. Information about Achilles tendon ruptures, gymnastics-related injuries, sport specialization, event/skills participation, and medication use were collected. RESULTS A total of 581 gymnasts were included. One hundred gymnasts (17.2%; 95% CI: 14.1%-20.3%) reported Achilles tendon ruptures during collegiate training or competition. Most ruptures (91%) occurred on floor exercise; 85.7% of these occurred during back tumbling-take-off. Compared with gymnasts without ruptures during college, a greater percentage of gymnasts with ruptures competed at a Division I program, trained elite, competed difficult vaults and floor passes before and during college, competed in all 4 events during college, identified as Black/African American, and used retinoid medications. CONCLUSION Achilles tendon ruptures are more common in women's collegiate gymnastics than other sports. Competing at the elite level, performing difficult floor and vault skills, and competing in all 4 events may increase the risk for an Achilles tendon rupture. Potential nontraining risk factors include retinoid exposure and Black/African American race. Future studies regarding the mechanisms of Achilles tendon ruptures in female collegiate gymnasts are warranted. CLINICAL RELEVANCE Collegiate gymnasts who compete at the elite level, perform high levels of difficulty on floor and vault, and compete in all 4 events may be at increased risk for Achilles tendon ruptures.
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Affiliation(s)
- Joseph Bonanno
- Department of Physiatry, Hospital for Special Surgery, New York, New York
| | - Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, New York, New York
| | - Dave Tilley
- Champion PT and Performance, Waltham, Massachusetts
| | - Zafir Abutalib
- Healthcare Research Institute, Hospital for Special Surgery, New York, New York
| | - Ellen Casey
- Department of Physiatry, Hospital for Special Surgery, New York, New York
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22
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Li H. COMPUTED TOMOGRAPHY (CT) IMAGE IN REPAIRING TENDON INJURY IN ATHLETES. REV BRAS MED ESPORTE 2021. [DOI: 10.1590/1517-8692202127072021_0348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Introduction: endon injury can usually be divided into the following types: fracture, dislocation, compression, bone insert, tendon injury, among which dislocation and compression are more common. Objective: To evaluate the application value of Computed Tomography (CT) image in tendon display. Methods: CT scan of the hands and feet was performed in our hospital for suspected tendon lesions. The CT and MRI data of 61 patients with tendon injury were retrospectively analyzed, and the diagnostic efficiency of CT and MRI were compared and analyzed. Results: The diagnostic accuracy of 61 patients was 89.71% (61/68). Except for chronic tendon injury (12/19), the diagnostic accuracy of other lesions was 100%. The sensitivity of CT and MRI in the diagnosis of hand tendon injury was 94.7% and 90.7%, the specificity was 99.3% and 98.6%, and the coincidence rate was 97.7% and 96.3%. Conclusions: CT images are accurate in localization and characterization of tendon injury, with high sensitivity and specificity, and can provide accurate anatomical basis for surgery. Level of evidence II; Therapeutic studies - investigation of treatment results.
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23
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Sanchez R, Hodgens BH, Geller JS, Huntley S, Kaplan J, Aiyer A. Effect of Achilles Tendon Repair on Performance Outcomes After Return to Play in National Collegiate Athletic Association Division I Basketball Athletes. Orthop J Sports Med 2021; 9:23259671211015239. [PMID: 34262980 PMCID: PMC8246508 DOI: 10.1177/23259671211015239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/23/2021] [Indexed: 12/04/2022] Open
Abstract
Background: Achilles tendon (AT) ruptures are devastating injuries that are highly prevalent among athletes. Despite our understanding of the effect of AT rupture and in particular its relationship to basketball, no study has examined the effects of AT rupture and repair on performance metrics in collegiate basketball players. Purpose: To evaluate the effect of AT rupture and subsequent surgical repair on performance metrics in National Collegiate Athletic Association (NCAA) Division I basketball players who return to play after injury. Study Design: Descriptive epidemiology study. Methods: NCAA Division I basketball players who sustained an AT rupture and underwent subsequent surgical repair between 2000 and 2019 were identified by systematically evaluating individual injury reports from databases comprising NCAA career statistics and individual school statistics; 65 male and 41 female players were identified. Athletes were included if they participated in at least one-half of the games of 1 collegiate season before tearing the AT and at least 1 season after operative repair. A total of 50 male and 30 female athletes were included. Each injured athlete was matched to a healthy control by conference, position, starter status at time of injury, class year, and number of games played. Matched controls were healthy players and experienced no significant injuries during their NCAA careers. Results: After AT repair, male athletes had significantly more minutes per game, points per game, and compared with before injury. Total blocks significantly decreased after injury. Female athletes scored significantly more points per game but demonstrated a significantly lower 3-point shooting percentage after return to play. Despite undergoing AT rupture and repair, 14% of male players played in the National Basketball Association, and 20% of injured female athletes played in the Women’s National Basketball Association. Conclusion: After returning to play, men demonstrated a significant drop-off in performance only in regard to total blocks. Female athletes after AT repair demonstrated a significant improvement in points per game but had a significant drop-off in 3-point shooting percentage.
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Affiliation(s)
- Rafael Sanchez
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
| | - Blake H Hodgens
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Joseph S Geller
- Miller School of Medicine, University of Miami, Miami, Florida, USA
| | - Samuel Huntley
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
| | | | - Amiethab Aiyer
- Department of Orthopedic Surgery, University of Miami-Jackson Memorial Hospital, Miami, Florida, USA
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Flexor hallucis longus hypertrophy secondary to Achilles tendon tendinopathy: an MRI-based case-control study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1387-1393. [PMID: 33555443 PMCID: PMC8448710 DOI: 10.1007/s00590-021-02891-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/26/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of this study was to outline an indirect sign of advanced Achilles tendinopathy on magnetic resonance imaging (MRI), based on the hypothesis that these patients would present with secondary hypertrophy of the flexor hallucis longus muscle (FHL). METHODS MRI scans of Achilles tendon were analyzed retrospectively in two cohorts. The study group consisted of consecutive patients presenting with clinical signs of Achilles tendinopathy and no previous surgeries, while the control group were patients that had an MRI due to other reasons and no signs of tendinopathy. Two parameters from two muscle bellies were measured and compared on axial MRI scans 4-5 cm above the ankle joint line at the level of greatest thickness: area and diameter of the triceps surae (TS) and of the FHL muscle. Ratios (FHL/TS) were calculated for area (Ar) and diameter (Dm) measurements. Interobserver agreement was analyzed. A receiver operating characteristic (ROC) curve was created for both ratios to assess potential cutoff points to differentiate between the groups. RESULTS A total of 60 patients for each study group were included. Both ratios Ar(FHL/TS) and Dm(FHL/TS) showed significant higher values in the tendinopathy group (p < 0.001). There were strong to very strong intraclass correlation coefficients (ICC = 0.75-0.93). A diameter ratio Dm (FHL/TS) of 2.0 or higher had a sensitivity of 49% and specificity of 90% for concomitant Achilles tendinopathy. CONCLUSION In our patient cohort, FHL hypertrophy was observed in patients with Achilles tendinopathy as a possible compensatory mechanism. Measuring a diameter ratio Dm(FHL/TS) of 2.0 or higher on an axial MRI, may be indicative as an indirect sign of functional deterioration of the Achilles tendon.
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Briški N, Vrgoč G, Knjaz D, Janković S, Ivković A, Pećina M, Lauc G. Association of the matrix metalloproteinase 3 (MMP3) single nucleotide polymorphisms with tendinopathies: case-control study in high-level athletes. INTERNATIONAL ORTHOPAEDICS 2020; 45:1163-1168. [PMID: 32607795 DOI: 10.1007/s00264-020-04684-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/22/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND Matrix metalloproteinases (MMPs) play an important role in matrix remodelling, as well as in tendon integrity. Due to overuse, athletes often develop chronic tendinopathies. If not treated, they lead to severe impairment, even complete tendon ruptures. AIM The main purpose of this study was to investigate whether three functional polymorphisms within the MMP3 gene are associated with increased risk of developing tendinopathies in high-level Croatian athletes. METHODS We have recruited one hundred fifty-five (63 high-level athletes with diagnosed tendinopathies and 92 asymptomatic controls) unrelated Caucasians for this case-control genetic study. All participants were genotyped for three single nucleotide polymorphisms (SNP) within the MMP3 gene: rs591058 C/T, rs650108 A/G and rs679620 G/A using the pyrosequencing method. RESULTS The MMP3 rs650108 GG (P = 0.0074) and rs679620 AA (P = 0.0119) genotypes were significantly over-represented in cases compared with controls, while rs591058 TT (P = 0.0759), as well as haplotype variant T - G - A (P = 0.06), implicated that there is an indication of predisposition for tendinopathies. CONCLUSION These results support association between functional variants within the MMP3 gene and the risk of tendinopathies in high-level athletes. Further research is needed to replicate these results in a larger population.
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Affiliation(s)
- Nina Briški
- Genos Ltd, Borongajska cesta 83h, 10000, Zagreb, Croatia. .,Faculty of Kinesiology, University of Zagreb, Horvaćanski zavoj 15, 10000, Zagreb, Croatia.
| | - Goran Vrgoč
- Faculty of Kinesiology, University of Zagreb, Horvaćanski zavoj 15, 10000, Zagreb, Croatia.,Department of Orthopaedic Surgery, University Hospital, "Sveti Duh", Ulica Sveti Duh 64, 10000, Zagreb, Croatia
| | - Damir Knjaz
- Faculty of Kinesiology, University of Zagreb, Horvaćanski zavoj 15, 10000, Zagreb, Croatia
| | - Saša Janković
- Faculty of Kinesiology, University of Zagreb, Horvaćanski zavoj 15, 10000, Zagreb, Croatia.,Department of Orthopaedic Surgery, University Hospital, "Sveti Duh", Ulica Sveti Duh 64, 10000, Zagreb, Croatia
| | - Alan Ivković
- Department of Orthopaedic Surgery, University Hospital, "Sveti Duh", Ulica Sveti Duh 64, 10000, Zagreb, Croatia.,School of Medicine, University of Zagreb, Šalata 2, 10000, Zagreb, Croatia.,Department of Biotechnology, University of Rijeka, Ulica Radmile Matejčić 2, 51000, Rijeka, Croatia
| | - Marko Pećina
- School of Medicine, University of Zagreb, Šalata 2, 10000, Zagreb, Croatia
| | - Gordan Lauc
- Genos Ltd, Borongajska cesta 83h, 10000, Zagreb, Croatia.,Faculty of Pharmacy and Biochemistry, University of Zagreb, Ulica Ante Kovačića 1, 10000, Zagreb, Croatia
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Wang Z, Liu H, Luo W, Cai T, Li Z, Liu Y, Gao W, Wan Q, Wang X, Wang J, Wang Y, Yang X. Regeneration of skeletal system with genipin crosslinked biomaterials. J Tissue Eng 2020; 11:2041731420974861. [PMID: 33294154 PMCID: PMC7705197 DOI: 10.1177/2041731420974861] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 10/30/2020] [Indexed: 12/11/2022] Open
Abstract
Natural biomaterials, such as collagen, gelatin, and chitosan, are considered as promising candidates for use in tissue regeneration treatment, given their similarity to natural tissues regarding components and structure. Nevertheless, only receiving a crosslinking process can these biomaterials exhibit sufficient strength to bear high tensile loads for use in skeletal system regeneration. Recently, genipin, a natural chemical compound extracted from gardenia fruits, has shown great potential as a reliable crosslinking reagent, which can reconcile the crosslinking effect and biosafety profile simultaneously. In this review, we briefly summarize the genipin extraction process, biosafety, and crosslinking mechanism. Subsequently, the applications of genipin regarding aiding skeletal system regeneration are discussed in detail, including the advances and technological strategies for reconstructing cartilage, bone, intervertebral disc, tendon, and skeletal muscle tissues. Finally, based on the specific pharmacological functions of genipin, its potential applications, such as its use in bioprinting and serving as an antioxidant and anti-tumor agent, and the challenges of genipin in the clinical applications in skeletal system regeneration are also presented.
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Affiliation(s)
- Zhonghan Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - He Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Wenbin Luo
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Tianyang Cai
- College of Rehabilitation, Changchun University of Chinese Medicine, Changchun, Jilin, P.R. China
| | - Zuhao Li
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Yuzhe Liu
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Weinan Gao
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Qian Wan
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Xianggang Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Jincheng Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Yanbing Wang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
| | - Xiaoyu Yang
- Department of Orthopedics, The Second Hospital of Jilin University, Changchun, P.R. China
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