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Abstract
The Achilles tendon has a high incidence of ruptures often occurring in weekend warriors and the aging population. Based on anatomic studies of the Achilles tendon, ruptures are commonly found in the watershed area proximal to the insertion site. Traditionally, treatment options included conservative therapy with immobilization and a prolonged non-weight-bearing phase versus surgical treatment. Surgical treatment can vary between open, minimally invasive, or percutaneous approaches. In more recent years, early functional rehabilitation with or without surgery has shown to have successful results.
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Affiliation(s)
- Varsha Salunkhe Ivanova
- Kaiser Permanente Foot and Ankle Surgery, 700 Lawrence Expressway, Santa Clara, CA 95051, USA.
| | - Khanh Phuong Sieu Tong
- Kaiser Permanente Foot and Ankle Surgery, 700 Lawrence Expressway, Santa Clara, CA 95051, USA
| | - Cristian Neagu
- Kaiser Permanente Santa Clara Foot and Ankle Surgery, 700 Lawrence Expressway, Santa Clara, CA 95051, USA
| | - Christy M King
- Kaiser Permanente, Department of Foot & Ankle Surgery, 3600 Broadway, Clinic 17, Oakland, CA 94611, USA; Kaiser San Francisco Bay Area Foot & Ankle Residency Program, Oakland, CA, USA
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Learning curve of the Krackow suture technique for the repair of Achilles tendon rupture. Arch Orthop Trauma Surg 2022; 142:3747-3754. [PMID: 34661712 DOI: 10.1007/s00402-021-04213-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/03/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Knowledge on the learning curve for the repair of Achilles tendon rupture is limited. The aim of this study was to quantify the learning curve for the Krackow suture technique for the repair of Achilles tendon rupture and to identify the correlation between the cumulative volume of cases and clinical outcome measures. MATERIALS AND METHODS A total of 226 cases of Achilles tendon repair using the Krackow suture technique were reviewed. Each surgery was independently performed by four surgeons who started a foot and ankle specialty career after fellowship training. After logarithmic transformation of the operative time and cumulative volume of cases, a linear regression analysis was performed to determine the best-fit linear equations to predict the required time for the Krackow suture technique according to the cumulative volume of cases. The correlation between the cumulative volume of cases and clinical outcome measures was analyzed using Pearson correlation coefficients. Receiver operating characteristic curves were constructed to determine the minimum number of cases with an operative time shorter than the average in the first 30 cases. RESULTS In all four surgeons, significant log-linear correlations were observed between the operative time and cumulative volume of cases. The best-fit linear equations showed estimated learning rates of 90%, 87%, 92%, and 86% for each of the four surgeons, indicating that the necessary operative time decreased by 10%, 13%, 8%, and 14%, respectively, when the cumulative volume of cases had doubled. The minimum number of cases with an operative time shorter than the average was 9 (91% sensitivity and 59% specificity). The clinical outcome measures at 6 and 12 months postoperatively were available for one surgeon; however, no correlation was found with the cumulative volume of cases. CONCLUSION The learning rate for the Krackow suture technique for the repair of Achilles tendon rupture was approximately 89%, indicating that the required operative time can decrease by up to 11% when the cumulative volume of cases doubles. Therefore, it is important to rapidly accumulate surgical experience during the early phase of training.
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Gong F, Li X, Zhang H, Wu J, Ma G, Zhang B, Gao J, Ding Y, Huang Y, Cheng S, Zhou X, Zhao F. Comparison of the Effects of Open Surgery and Minimally Invasive Surgery on the Achilles Tendon Rupture Healing Based on Angiogenesis. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:1447129. [PMID: 36093506 PMCID: PMC9458374 DOI: 10.1155/2022/1447129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/05/2022] [Accepted: 07/08/2022] [Indexed: 11/17/2022]
Abstract
Objective To compare the effect of three different surgical methods on rabbit Achilles tendon rupture. Methods The Achilles tendon transection model was constructed by cutting off the inner half of the Achilles tendon. Rabbits were divided into 4 groups: model group, open surgery (OS) group, minimally invasive surgery (MS) group, and conservative treatment (CT) group. Biomechanical evaluation, H&E, and Picrosirius Red staining were applied to evaluate the histological changes and healing. RT-qPCR, Western blot, ELISA, and IHC staining were used to detect the expression of COLIII, IL-1β, TNF-α, IL-6, CD31, VEGF, bFGF, and TGF-β1. Results Different surgery treatments significantly alleviated the histological changes in rabbits. The tension and elasticity of the Achilles tendon were significantly increased after surgery. In addition, surgery treatments notably alleviated the inflammatory responses in vivo via downregulation of IL-1β, TNF-α, and IL-6 and promoted the tube formation in tissues through upregulating VEGF, bFGF, TGF-β1, and CD31. Furthermore, MS exhibited best therapeutic efficiency on Achilles tendon rupture healing, compared with OS or CT. Conclusions Our research revealed the superiority of MS in Achilles tendon rupture treatment at the molecular level compared with OS or CT.
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Affiliation(s)
- Fan Gong
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Xiaoliang Li
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Hanling Zhang
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Jianke Wu
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Guoxu Ma
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Bowen Zhang
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Jian Gao
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Yi Ding
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Yonglu Huang
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Suoli Cheng
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Xuebing Zhou
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
| | - Fei Zhao
- Hand & Foot & Reconstruction Microsurgery, People's Hospital of Ningxia Hui Autonomous Region (The First Affiliated Hospital of Northwest University for Nationalities), Yinchuan 750002, Ningxia, China
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Hoeffner R, Svensson RB, Bjerregaard N, Kjær M, Magnusson SP. Persistent Deficits after an Achilles Tendon Rupture: A Narrative Review. TRANSLATIONAL SPORTS MEDICINE 2022; 2022:7445398. [PMID: 38655161 PMCID: PMC11022787 DOI: 10.1155/2022/7445398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/03/2022] [Accepted: 06/15/2022] [Indexed: 04/26/2024]
Abstract
Persistent muscle weakness, tendon elongation, and incomplete return to preinjury level are frequent sequelae after acute Achilles tendon rupture, and evidence-based knowledge of how to best rehabilitate the injury is largely absent in the literature. The objective of this review is to illuminate and discuss to what extent an Achilles tendon rupture affects muscle, tendon, and function when assessed with the Achilles tendon total rupture score (ATRS), muscle strength, muscle cross-sectional area, tendon length, and the heel-rise test. The patient-reported outcome measures (PROM) data in the literature suggest that the recovery takes longer than 6 months (ATRS, 70 out of 100), that one-year postinjury, the ATRS only reaches 82, and that this does not appear to noticeably improve thereafter. Loss of muscle mass, strength, and function can in some cases be permanent. Over the first 6 months postinjury, the tendon undergoes elongation, which appears to be negatively correlated to heel-rise function. More recently, there has been some interest in how muscle length and excursion is related to the reduced function. The available literature indicates that further research is highly warranted and that efforts to restore normal tendon length may improve the likelihood of returning to preinjury level after an Achilles tendon rupture.
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Affiliation(s)
- Rikke Hoeffner
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Rene B. Svensson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nicolai Bjerregaard
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Kjær
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Stig Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Physical and Occupational Therapy, Copenhagen University Hospital—Bispebjerg and Frederiksberg, Copenhagen, Denmark
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KEHRİBAR L, COŞKUN S, SURUCU S. Comparison of open repair and modified percutaneous repair techniques for the treatment of acute achilles tendon ruptures. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1020281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Wenning M, Mauch M, Heitner A, Lienhard J, Ritzmann R, Paul J. Neuromechanical activation of triceps surae muscle remains altered at 3.5 years following open surgical repair of acute Achilles tendon rupture. Knee Surg Sports Traumatol Arthrosc 2021; 29:2517-2527. [PMID: 33660053 PMCID: PMC8298360 DOI: 10.1007/s00167-021-06512-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/17/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To assess whether the neuromuscular activation pattern following Achilles tendon rupture and repair may contributes to the observable functional deficits in this severe and increasingly frequent injury. METHODS In this study, the neuromuscular activation using surface EMG of n = 52 patients was assessed during a battery of functional performance tasks to assess potential alterations of muscular activation and recruitment. We analyzed the injured leg vs. the contralateral healthy leg at a mean of 3.5 years following open surgical repair. The testing battery included isokinetic strength testing, bipedal and single-legged heel-rise testing as well as gait analysis. RESULTS During isokinetic testing, we observed a higher activation integral for all triceps surae muscles of the injured side during active dorsiflexion, e.g., eccentric loading on the injured leg, while concentric plantarflexion showed no significant difference. Dynamic heel-rise testing showed a higher activation in concentric and eccentric loading for all posterior muscles on the injured side (not significant); while static heel-rise for 10 sec. revealed a significantly higher activation. Further analysis of frequency of fast Fourier-transformed EMG revealed a significantly higher median frequency in the injured leg. Gait analysis revealed a higher pre-activation of the tibialis anterior before ground contact, while medial and lateral gastrocnemius muscles of the injured leg showed a significantly higher activation during push-off phase. CONCLUSIONS The results of this study provide evidence on the neuromuscular changes 3.5 years following open surgical Achilles tendon repair. These complex neuromuscular changes are manifested to produce the maximum force output whilst protecting the previously injured tendon. The observed alterations may be related to an increased recruitment of type II muscle fibers which could make the muscles prone to fatigue. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Markus Wenning
- Rennbahnklinik, Muttenz, Basel, Switzerland.
- Department of Orthopedic and Trauma Surgery, Faculty of Medicine, University Medical Center Freiburg, Albert-Ludwigs University of Freiburg, Freiburg, Germany.
| | | | | | - Johannes Lienhard
- Department of Sport and Sport Science, Biomechanics and Motor Control, Albert-Ludwigs University of Freiburg, Freiburg, Germany
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