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Xue H, Xiao F, Li R, Wu G, Zhu Z, Zhang C, Li M. Transversal calcaneal anchored Achilles tendon reconstruction with free semitendinosus tendon autograft for acute rupture of Achilles tendon: clinical evaluation. Sci Rep 2024; 14:17815. [PMID: 39090165 PMCID: PMC11294335 DOI: 10.1038/s41598-024-68582-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024] Open
Abstract
Achilles tendon reconstruction is an effective method of repairing Achilles tendon rupture defects. We introduce a new approach for Achilles tendon reconstruction using transversal calcaneal anchored autogenous semitendinosus tendon graft. The study aimed to evaluate the clinical role of this new Achilles tendon reconstruction. We retrospectively enrolled patients who underwent Achilles tendon reconstruction using transversal calcaneal anchored autogenous semitendinosus tendon graft for acute Achilles tendon rupture defects from 2016 to 2021. The clinical and radiological results were assessed at the preoperative and the final postoperative follow-up with Visual Analog Score (VAS) scores, American Orthopaedic Foot & Ankle Society (AOFAS) scores and Achilles tendon Total Rupture Scores (ATRS). Besides, at the last postoperative follow-up, the difference in ankle range of motion between the two side of the patients and the incidence of postoperative complications were recorded. Results revealed patients had significantly lower VAS and higher AOFAS and ATRS (P < 0.01). Compared to the healthy ankle, the operative ankle showed significant deficits in ankle range of motion (P < 0.01). Additionally, radiological results showed no noticeable signs of tunnel enlargement in the calcaneus and no patient had re-rupture. Transversal calcaneal anchored Achilles tendon reconstruction with free semitendinosus tendon autograft is an effective treatment option for patients with acute Achilles tendon rupture with large defects and have high postoperative exercise demands.
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Affiliation(s)
- Han Xue
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Fengxu Xiao
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Ruochen Li
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Guangwei Wu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Zheyue Zhu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China
| | - Chen Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
| | - Miao Li
- Department of Ultrasound, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710004, China.
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Guo C, Zhang Y, Dong W, Huang B, Liu Y. Risk factors and clinical characteristics of surgical site infections in athletes undergoing Achilles tendon repair surgery. Int Wound J 2024; 21:e14666. [PMID: 38420668 PMCID: PMC10902687 DOI: 10.1111/iwj.14666] [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: 12/10/2023] [Revised: 12/25/2023] [Accepted: 12/29/2023] [Indexed: 03/02/2024] Open
Abstract
Achilles tendon ruptures are common in athletes, requiring surgical intervention. However, the risk of surgical site infections (SSIs) post-surgery poses significant challenges. This study aims to analyse the risk factors and microbial aetiology associated with SSIs in athletes undergoing Achilles tendon repair. A comprehensive retrospective analysis was conducted from May 2021 to July 2023. The study included 25 patients with SSIs (case group) and 50 patients without SSIs (control group) post Achilles tendon repair surgery. Inclusion criteria encompassed patients with medically confirmed Achilles tendon ruptures who underwent surgical repair. Exclusion criteria included prior tendon pathologies and significant chronic illnesses. Diagnostic criteria for SSIs involved symptoms like elevated body temperature and localized tenderness, along with laboratory confirmations such as positive microbiological cultures. The study utilized VITEK® 2 for bacterial identification and involved statistical analyses like univariate and multivariate logistic regression. The study identified Staphylococcus aureus as the primary pathogen in SSIs. Significant risk factors included lack of prophylactic antibiotic use, presence of diabetes, open wounds and prolonged surgery duration. Univariate analysis revealed stark contrasts in these factors between infected and non-infected groups, while multivariate analysis underscored their importance in SSI development. S. aureus emerged as the predominant pathogen in SSIs post Achilles tendon repair. Critical risk factors such as absence of prophylactic antibiotics, diabetes, open wounds and extended surgery duration play a vital role in SSIs. Addressing these factors is essential for better postoperative outcomes in Achilles tendon repair surgeries.
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Affiliation(s)
- Chenhao Guo
- College of Physical EducationShanxi UniversityTaiyuanChina
| | - Yuze Zhang
- College of Physical EducationShanxi UniversityTaiyuanChina
| | - Wenhan Dong
- College of Physical EducationTaiyuan University of TechnologyTaiyuanChina
| | - Bo Huang
- Department of Rehabilitation MedicineTaiyuan Seventh People's HospitalTaiyuanChina
| | - Yinghai Liu
- College of Physical EducationShanxi UniversityTaiyuanChina
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Samal S, Samal S, Thakre VM. The Significance of Proprioceptive Training in the Post-Operative Rehabilitation of Patients Undergoing Achilles Tendon Reconstruction. Cureus 2024; 16:e54431. [PMID: 38510861 PMCID: PMC10951674 DOI: 10.7759/cureus.54431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 02/18/2024] [Indexed: 03/22/2024] Open
Abstract
In the human anatomy, the Achilles tendon (AT) is the strongest and largest tendon. Also, it ruptures the most often. Because it impairs the patient's ability to function adequately, a ruptured AT injury is a serious clinical issue. Reconstruction of the tendon through surgical intervention is the preferred approach to treatment in the case of tendon rupture. Establishing an effective post-operative rehabilitation regimen that mostly consists of functional physiotherapy measures is crucial in the management of AT rupture. In this report, we have presented the case of an AT reconstruction patient who complained of pain in the ankle region, reduced strength and range of the ankle joint, and loss of proprioception. The tailor-made physiotherapy protocol was incorporated, which included strengthening exercises, proprioceptive retraining, cryotherapy, and ambulatory training, which were found to be effective in facilitating early functional recovery.
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Affiliation(s)
- Snehal Samal
- Neuro Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Subrat Samal
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Vaishnavi M Thakre
- Musculoskeletal Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Arya N, Sasun A, Burile G, Harjpal P, Kovela RK. From Trauma to Recovery: A Comprehensive Management of Achilles Tendon Injury in a Young Female. Cureus 2024; 16:e52286. [PMID: 38357068 PMCID: PMC10865149 DOI: 10.7759/cureus.52286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
The incidence of the Achilles tendon getting injured has recently increased by 18 in 100,000. Compared to non-surgical treatment, surgical results are superior. The Achilles tendon repaired with surgery has a re-rupture rate of only 5%, while if treated non-operatively, it has a rupture rate of 40%. This case report analyses the traumatic Achilles tendon rupture and subsequent surgical repair in a young woman. In this case study, a 19-year-old female patient's severe Achilles tendon injury was successfully managed by integrating prompt surgical intervention and structure. After rehabilitation, the patient's range of motion (ROM), muscle strength, and gait patterns all significantly improved. Scores on the Lower Extremity Functional Scale (LEFS) and the Dynamic Gait Index (DGI) both significantly improved. This case study reiterates the significance of an integrated healthcare strategy for Achilles tendon injuries. An immediate surgical procedure followed by a specific rehabilitation programme accelerates healing and the return to optimal function. The results emphasize the critical role of physical therapy in assisting surgical interventions and underline the necessity of comprehensive patient care in the treatment of complex orthopaedic problems.
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Affiliation(s)
- Neha Arya
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anam Sasun
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Ghanishtha Burile
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Pallavi Harjpal
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Rakesh K Kovela
- Neurophysiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Yu YH, Lee CH, Hsu YH, Chou YC, Hong BK, Huang CT, Liu SJ. Novel CO 2-encapsulated Pluronic F127 hydrogel for the treatment of Achilles tendon injury. Sci Rep 2023; 13:21895. [PMID: 38081952 PMCID: PMC10713641 DOI: 10.1038/s41598-023-49339-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 12/07/2023] [Indexed: 12/18/2023] Open
Abstract
Nonsurgical treatment and surgical repairment of injured Achilles tendons seldom restore the wounded tendon to its original elasticity and stiffness. Therefore, we hypothesized that the surgically repaired Achilles tendon can achieve satisfactory regeneration by applying multi-drug encapsulated hydrogels. In this study, a novel bupivacaine-eluting carbon dioxide-encapsulated Pluronic F127 hydrogel (BC-hydrogel) was developed for the treatment of Achilles tendon injuries. The rheological properties of BC-hydrogel were measured. A high-performance liquid chromatography assay was used to assess the release characteristics of bupivacaine in both in vitro and in vivo settings. Furthermore, the effectiveness of BC-hydrogel in treating torn tendons was examined in a rat model, and histological analyses were conducted. Evidently, the degradable hydrogels continuously eluted bupivacaine for more than 14 days. The animal study results revealed that the BC-hydrogel improved the post-surgery mobility of the animals compared with pristine hydrogels. Histological assay results demonstrated a significant reaction to high vascular endothelial growth factor in the surrounding tissues and expression of collagen I within the repaired tendon. This demonstrates the potential of this novel BC-hydrogel as an effective treatment method for Achilles tendon injuries.
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Affiliation(s)
- Yi-Hsun Yu
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, 33305, Taiwan
| | - Chen-Hung Lee
- Division of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital-Linkou, Chang Gung University College of Medicine, Tao-Yuan, 33305, Taiwan
| | - Yung-Heng Hsu
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, 33305, Taiwan
| | - Ying-Chao Chou
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, 33305, Taiwan
| | - Bo-Kui Hong
- Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, 33302, Taiwan
| | - Chao-Tsai Huang
- Department of Chemical and Materials Engineering, Tamkang University, New Taipei City, 251301, Taiwan
| | - Shih-Jung Liu
- Department of Orthopedic Surgery, Bone and Joint Research Center, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, 33305, Taiwan.
- Department of Mechanical Engineering, Chang Gung University, Tao-Yuan, 33302, Taiwan.
- Biomaterials Lab, Mechanical Engineering, Chang Gung University, 259, Wen-Hwa 1st Road, Kwei-Shan, Tao-Yuan, 33302, Taiwan.
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Patch DA, Andrews NA, Scheinberg M, Jacobs RA, Harrelson WM, Rallapalle V, Sinha T, Shah A. Achilles tendon disorders: An overview of diagnosis and conservative treatment. JAAPA 2023; 36:1-8. [PMID: 37751268 DOI: 10.1097/01.jaa.0000977720.10055.c4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
ABSTRACT Achilles tendon-related pain affects up to 6% of the US population during their lifetime and is commonly encountered by primary care providers. An accurate diagnosis and early conservative management can improve patient quality of life and reduce unnecessary surgical consultations, saving healthcare dollars. Achilles tendon pathologies can be categorized into acute (pain lasting less than 6 weeks), chronic (pain lasting more than 6 weeks), and acute on chronic (worsening of pain with preexisting chronic Achilles tendon pathology). This article describes the diagnosis, conservative management, indications for imaging, and indications for surgical referral for acute and chronic Achilles tendon rupture, Achilles tendinitis, gastrocnemius strain, plantaris rupture, insertional Achilles tendinopathy, Haglund deformity, and noninsertional Achilles tendinopathy.
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Affiliation(s)
- David A Patch
- In the Department of Orthopedic Surgery at the University of Alabama Birmingham, David A. Patch and Nicholas A. Andrews are resident physicians; Mila Scheinberg and Roshan A. Jacobs are orthopedic research assistants; Whitt M. Harrelson, Vyshnavi Rallapalle, and Tanvee Sinha are research assistants; and Ashish Shah is a professor and director of clinical research. The authors have disclosed no potential conflicts of interest, financial or otherwise
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Wang C, Jiang Z, Pang R, Zhang H, Li H, Li Z. Global trends in research of achilles tendon injury/rupture: A bibliometric analysis, 2000–2021. Front Surg 2023; 10:1051429. [PMID: 37051567 PMCID: PMC10083236 DOI: 10.3389/fsurg.2023.1051429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 03/10/2023] [Indexed: 03/28/2023] Open
Abstract
BackgroundThe Achilles tendon is the strongest and most susceptible tendon in humans. Achilles tendon injuries and ruptures have gradually attracted research attention. However, a bibliometric analysis of global research in this field is lacking. This study involved a bibliometric analysis of the developmental trends and research hotspots in Achilles tendon injuries/ruptures from 2000 to 2021.MethodsArticles published between 2001 and 2021 were retrieved from an extended database of the Science Citation Index using Web of Science. VOSviewer and CiteSpace were used to analyze the relationships between publications, countries, institutions, journals, authors, references, and keywords.ResultsThis study included 3,505 studies of 73 countries, 3,274 institutions, and 12,298 authors and explored the cooperation between them and the relationships between citations. Over the past 22 years, the number of publications has significantly increased. Foot Ankle International has published the most papers on Achilles tendon injuries/ruptures, and British Journal of Sports Medicine is the most famous journal. Re-rupture, exosomes, acute Achilles tendon rupture, and tendon adhesions gradually become the research focus over the past few years.ConclusionAchilles tendon injury and rupture are important research topics. A vast number of newly published papers on this topic have demonstrated that clinicians and researchers are interested in their study. Over time, these recent studies will be widely cited; therefore, this bibliometric analysis should be constantly updated.
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Affiliation(s)
- Chenguang Wang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhaohui Jiang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Ran Pang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Huafeng Zhang
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Hui Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Chinese & Western Medicine Hospital, Tianjin, China
- Correspondence: Zhijun Li Hui Li
| | - Zhijun Li
- Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, China
- Correspondence: Zhijun Li Hui Li
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Neill E, Shyy W. SONO case series: point-of-care ultrasound for Achilles tendon injury. Emerg Med J 2023; 40:385-387. [PMID: 36931712 DOI: 10.1136/emermed-2022-212665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
Affiliation(s)
- Emily Neill
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California, USA
| | - William Shyy
- Emergency Medicine, University of California Los Angeles, Los Angeles, CA, USA
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Campillo-Recio D, Comas-Aguilar M, Ibáñez M, Maldonado-Sotoca Y, Albertí-Fitó G. Percutaneous Achilles tendon repair with absorbable suture: Outcomes and complications. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:T56-T61. [PMID: 36265782 DOI: 10.1016/j.recot.2022.10.014] [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: 03/16/2022] [Accepted: 06/30/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous Achilles tendon repair with absorbable sutures. MATERIAL AND METHODS Prospective cohort study including 52 patients treated for Achilles tendon ruptures (January 2016 to March 2019). INCLUSION CRITERIA ≥18 years of age, non-insertional Achilles tendon ruptures. Diagnosis based on clinical criteria, confirmed by ultrasonography. Assessment using Visual Analogue Scale (VAS), Achilles Tendon Rupture Score (ATRS) and ultrasound. Re-rupture rate and postoperative complications were collected. RESULTS VAS scoring (SD) at 1, 3, 6 and 12 months follow-up (FU) were 2.63 (0.83), 1.79 (1.25), 0.69 (1.09) and 0.08 (0.39), respectively. Mean (SD) ATRS score was 92.45 points at 6 months (6.27) and 94.04 points at 12 months FU (4.59). Three re-ruptures (5.77%) occurred with a mean time between surgery and re-rupture of 108.75 days (SD 28.4), all of them within 4-month FU. No ruptures at the time to return to sports activity. Thirteen complications (25%) (3 re-ruptures, 1 superficial wound infection and 9 transitory sural nerve injuries). CONCLUSIONS Percutaneous Achilles tendon repair with absorbable sutures in patients with acute Achilles tendon ruptures has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, these would be avoided with conservative treatment. Conservative treatment associated with an early weight-bearing rehabilitation protocol should be considered a viable option for patients with Achilles tendon ruptures, specially in cooperative young patients.
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Affiliation(s)
| | | | - M Ibáñez
- Hospital Universitari Quiron Dexeus, Barcelona, España
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Campillo-Recio D, Comas-Aguilar M, Ibáñez M, Maldonado-Sotoca Y, Albertí-Fitó G. Percutaneous Achilles tendon repair with absorbable suture: Outcomes and complications. Rev Esp Cir Ortop Traumatol (Engl Ed) 2023; 67:56-61. [PMID: 35809780 DOI: 10.1016/j.recot.2022.06.008] [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: 03/16/2022] [Revised: 06/21/2022] [Accepted: 06/30/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVE The purpose of this study is to evaluate the clinical outcomes and complications of percutaneous Achilles tendon repair with absorbable sutures. MATERIAL AND METHODS Prospective cohort study including 52 patients treated for Achilles tendon ruptures (January 2016 to March 2019). INCLUSION CRITERIA ≥18 years of age, non-insertional Achilles tendon ruptures. Diagnosis based on clinical criteria, confirmed by ultrasonography. Assessment using Visual Analogue Scale (VAS), Achilles Tendon Rupture Score (ATRS) and ultrasound. Re-rupture rate and postoperative complications were collected. RESULTS VAS scoring (SD) at 1, 3, 6 and 12 months follow-up (FU) were 2.63 (0.83), 1.79 (1.25), 0.69 (1.09) and 0.08 (0.39), respectively. Mean (SD) ATRS score was 92.45 points at 6 months (6.27) and 94.04 points at 12 months FU (4.59). Three re-ruptures (5.77%) occurred with a mean time between surgery and re-rupture of 108.75 days (SD 28.4), all of them within 4-month FU. No ruptures at the time to return to sports activity. Thirteen complications (25%) (3 re-ruptures, 1 superficial wound infection and 9 transitory sural nerve injuries). CONCLUSIONS Percutaneous Achilles tendon repair with absorbable sutures in patients with acute Achilles tendon ruptures has shown good functional results but with a high incidence of complications. Although most complications were transitory sural nerve symptoms, these would be avoided with conservative treatment. Conservative treatment associated with an early weight-bearing rehabilitation protocol should be considered a viable option for patients with Achilles tendon ruptures, specially in cooperative young patients.
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Affiliation(s)
| | | | - M Ibáñez
- Hospital Universitari Quiron Dexeus, Barcelona, Spain
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Wetspun Polymeric Fibrous Systems as Potential Scaffolds for Tendon and Ligament Repair, Healing and Regeneration. Pharmaceutics 2022; 14:pharmaceutics14112526. [PMID: 36432717 PMCID: PMC9699541 DOI: 10.3390/pharmaceutics14112526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Tendon and ligament traumatic injuries are among the most common diagnosed musculoskeletal problems. Such injuries limit joint mobility, reduce musculoskeletal performance, and most importantly, lower people's comfort. Currently, there are various treatments that are used to treat this type of injury, from surgical to conservative treatments. However, they're not entirely effective, as reinjures are frequent and, in some cases, fail to re-establish the lost functionality. Tissue engineering (TE) approaches aim to overcome these disadvantages by stimulating the regeneration and formation of artificial structures that resemble the original tissue. Fabrication and design of artificial fibrous scaffolds with tailored mechanical properties are crucial for restoring the mechanical function of the tissues. Recently, polymeric nanofibers produced by wetspinning have been largely investigated to mimic, repair, and replace the damaged tissue. Wetspun fibrous structures are extensively used due to their exceptional properties, such as the ability to mimic the native tissue, their biodegradability and biocompatibility, and good mechanical properties. In this review, the tendon and ligament structure and biomechanics are presented. Then, promising wetspun multifunctional fibrous structures based on biopolymers, more specifically polyhydroxyalkanoates (PHA), polycaprolactone (PCL), and polyethylenes, will be discussed, as well as reinforcing agents such as cellulose nanocrystals (CNC), nanoparticles, and growth factors.
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Muacevic A, Adler JR, Coelho AP, Branco JP. Running on the Edge: Rupture of the Tibialis Anterior Muscle During an Ultramarathon. Cureus 2022; 14:e31930. [PMID: 36582552 PMCID: PMC9793751 DOI: 10.7759/cureus.31930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 11/28/2022] Open
Abstract
A 47-year-old male ultramarathon runner presented with persistent discomfort in the anterior region of the left leg. The patient reported a snapping sensation in his left leg four weeks earlier while running an ultramarathon, followed by ecchymosis and functional impairment the next day. Physical examination revealed a palpable area of fibrosis in his anterior left leg. Ultrasound of the left leg identified a partially organized rupture of the distal third of the tibialis anterior muscle. The rupture had an extension of 36 x 10 x 27mm with associated muscle edema. The patient was treated non-surgically with a customized rehabilitation program and later returned to ultramarathon running. This case illustrates the importance of proper differential diagnosis and individualized rehabilitation programs to achieve optimum clinical and functional results.
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Jun L, Hao Y, Junfeng Z, Jisen Z, Xinzhong X, Yunfeng Y, Dasheng T, Jia X. Comparison of Ma-Griffith combined with a minimally invasive small incision to a modified suture technique for the treatment of acute achilles tendon ruptures. BMC Musculoskelet Disord 2022; 23:822. [PMID: 36042433 PMCID: PMC9425948 DOI: 10.1186/s12891-022-05769-w] [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: 01/09/2022] [Accepted: 08/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background The Achilles tendon is the strongest tendon in the human body, although it is also prone to injury and rupture. Currently, the best treatment method for acute Achilles tendon rupture remains controversial. The aim of this study was to compare the efficacy of the Ma-Griffith method combined with a minimally invasive small incision (M-G/MISI) with the modified suture technique (MST). Methods We conducted a retrospective review of the medical records of all patients who underwent treatment for acute Achilles tendon rupture between January 2012 and January 2020 at our hospital. Demographic characteristics, operative details, and postoperative complications were recorded, and data were statistically analyzed to compare the treatment efficacy of the two operative methods. Results A total of 67 patients were enrolled in the study, 34 of whom underwent M-G/MISI treatment, and 33 of whom underwent MST treatment. The intraoperative blood loss in the M-G/MISI group (16.47 ± 13.23 ml) was significantly lower than that in the MST group (34.55 ± 13.01 ml), and the difference was statistically significant (P ˂0.001). The incision in the M-G/MISI group (3.79 ± 1.81 cm) was significantly shorter than that in the MST group (5.79 ± 1.00 cm), and the difference was statistically significant (P˂0.001). The Achilles tendon rupture score and the American Orthopedic Foot and Ankle Society (AOFAS) score were higher than those of the MST group at the sixth month after the operation (P˂0.001). Postoperatively, there was 1 case of traumatic Achilles tendon rupture in the M-G/MISI group and 1 case each of infection and deep vein thrombosis in the modified suture group. Conclusions Compared with the MST group, the M-G/MISI group had better Achilles tendon and ankle function scores at 6 months postoperatively, and less bleeding and shorter incisions. M-G/MISI is less invasive than MST.
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Affiliation(s)
- Li Jun
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China
| | - Yu Hao
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China
| | - Zhan Junfeng
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China
| | - Zhang Jisen
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China
| | - Xu Xinzhong
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China
| | - Yao Yunfeng
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China
| | - Tian Dasheng
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China
| | - Xie Jia
- Department of Orthopedics, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, 230601, Anhui, Hefei, People's Republic of China.
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Yu YH, Shen SJ, Hsu YH, Chou YC, Yu PC, Liu SJ. Tri-Layered Doxycycline-, Collagen- and Bupivacaine-Loaded Poly(lactic-co-glycolic acid) Nanofibrous Scaffolds for Tendon Rupture Repair. Polymers (Basel) 2022; 14:polym14132659. [PMID: 35808704 PMCID: PMC9269609 DOI: 10.3390/polym14132659] [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: 06/08/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 01/05/2023] Open
Abstract
Achilles tendon rupture is a severe injury, and its optimal therapy remains controversial. Tissue engineering scaffolds play a significant role in tendon healing and tissue regeneration. In this study, we developed tri-layered doxycycline/collagen/bupivacaine (DCB)-composite nanofibrous scaffolds to repair injured Achilles tendons. Doxycycline, collagen, and bupivacaine were integrated into poly(lactic-co-glycolic acid) (PLGA) nanofibrous membranes, layer by layer, using an electrospinning technique as healing promoters, a 3D scaffold, and painkillers, respectively. After spinning, the properties of the nanofibrous scaffolds were characterized. In vitro drug discharge behavior was also evaluated. Furthermore, the effectiveness of the DCB–PLGA-composite nanofibers in repairing ruptured Achilles tendons was investigated in an animal tendon model with histological analyses. The experimental results show that, compared to the pristine PLGA nanofibers, the biomolecule-loaded nanofibers exhibited smaller fiber size distribution and an enhanced hydrophilicity. The DCB-composite nanofibers provided a sustained release of doxycycline and bupivacaine for over 28 days in vivo. Additionally, Achilles tendons repaired using DCB-composite nanofibers exhibited a significantly higher maximum load-to-failure than normal tendons, suggesting that the biomolecule-incorporated nanofibers are promising scaffolds for repairing Achilles tendons.
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Affiliation(s)
- Yi-Hsun Yu
- Bone and Joint Research Center, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan; (Y.-H.Y.); (Y.-H.H.); (Y.-C.C.)
| | - Shih-Jyun Shen
- Department of Anesthesiology, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan;
| | - Yung-Heng Hsu
- Bone and Joint Research Center, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan; (Y.-H.Y.); (Y.-H.H.); (Y.-C.C.)
| | - Ying-Chao Chou
- Bone and Joint Research Center, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan; (Y.-H.Y.); (Y.-H.H.); (Y.-C.C.)
| | - Ping-Chun Yu
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Shih-Jung Liu
- Bone and Joint Research Center, Department of Orthopedic Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan; (Y.-H.Y.); (Y.-H.H.); (Y.-C.C.)
- Department of Mechanical Engineering, Chang Gung University, Taoyuan 33302, Taiwan;
- Correspondence: ; Tel.: +886-3-2118166; Fax: +886-3-2118558
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15
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Boden AL, Geller JS, Granger CJ, Summers SH, Kaplan J, Aiyer A. Achilles Injury and Access to Care in South Florida. Foot Ankle Spec 2022; 15:105-112. [PMID: 32703022 DOI: 10.1177/1938640020943711] [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] [Indexed: 11/16/2022]
Abstract
Introduction. Despite the amount of orthopaedic research evaluating access to care based on insurance status, no study quantifies the effects of insurance status on the care of acute Achilles tendon ruptures. Methods. Using Current Procedural Terminology codes, we identified all patients who underwent surgical management of Achilles tendon rupture between December 31, 2013, and December 31, 2018, and followed-up at either a county hospital-based orthopaedic surgery clinic and/or private university-based clinic. Inclusion criteria included patients who (1) underwent surgical management of an Achilles tendon rupture during this time period and (2) were at least 18 years of age at the time of surgery. A univariate 2-tailed t test was used to compare various groups. Statistical significance was set at P < 0.05. Results. When compared to adequately insured patients (private and Medicare), underinsured patients (uninsured and Medicaid) experienced a significantly greater time from the date of injury to first clinic visit (14.5 days vs 5.2 days, P < .001), first clinic visit to surgery (34.6 days vs 4.8 days, P < .002), injury to surgery date (48.9 days vs 9.8 days, P < .001), initial presentation to when magnetic resonance imaging was obtained (48.1 days vs 1.9 days, P < .002). Conclusions. Disparities in access to care for Achilles tendon ruptures are intimately related to insurance status. Uninsured and Medicaid patients are subject to institutional delays and decreased access to care when compared to patients with private insurance.Levels of Evidence: Level III: Prognostic, retrospective.
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Affiliation(s)
- Allison L Boden
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida (ALB, SHS, AA).,University of Miami Miller School of Medicine, Miami, Florida (JSG, CJG).,Hoag Orthopedic Institute, Irvine, California (JK)
| | - Joseph S Geller
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida (ALB, SHS, AA).,University of Miami Miller School of Medicine, Miami, Florida (JSG, CJG).,Hoag Orthopedic Institute, Irvine, California (JK)
| | - Caroline J Granger
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida (ALB, SHS, AA).,University of Miami Miller School of Medicine, Miami, Florida (JSG, CJG).,Hoag Orthopedic Institute, Irvine, California (JK)
| | - Spencer H Summers
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida (ALB, SHS, AA).,University of Miami Miller School of Medicine, Miami, Florida (JSG, CJG).,Hoag Orthopedic Institute, Irvine, California (JK)
| | - Jonathan Kaplan
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida (ALB, SHS, AA).,University of Miami Miller School of Medicine, Miami, Florida (JSG, CJG).,Hoag Orthopedic Institute, Irvine, California (JK)
| | - Amiethab Aiyer
- Department of Orthopaedic Surgery, University of Miami/Jackson Health Systems, Miami, Florida (ALB, SHS, AA).,University of Miami Miller School of Medicine, Miami, Florida (JSG, CJG).,Hoag Orthopedic Institute, Irvine, California (JK)
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16
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Singh A, Poteh N, Kim J, Starr R, Khalil P. Point-of-Care Ultrasound Diagnosis of Achilles Tendon Rupture in Pediatric Patients. Pediatr Emerg Care 2022; 38:e1164-e1165. [PMID: 34550919 DOI: 10.1097/pec.0000000000002531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Achilles tendon injuries are common in the adolescent population, particularly in individuals who participate in sports. The diagnosis of Achilles tendon rupture can be missed on clinical examination in 20% to 30% of patients. In the adult literature, there are several case reports describing the diagnosis of Achilles tendon rupture by point-of-care ultrasound POCUS. There is currently no literature examining POCUS for the diagnosis of Achilles tendon rupture in pediatric patients. This case series describes 2 pediatric patients who were diagnosed with Achilles tendon rupture by POCUS.
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Affiliation(s)
- Amar Singh
- From the University of Louisville School of Medicine, Louisville, KY
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17
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Patients with chronic Achilles tendon rupture have persistent limitations in patient-reported function and calf muscle function one year after surgical treatment - a case series. J Exp Orthop 2022; 9:15. [PMID: 35141849 PMCID: PMC8828811 DOI: 10.1186/s40634-022-00451-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/27/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose Evaluate the one-year postoperative outcomes in patients with Chronic Achilles tendon rupture. Methods Patients surgically treated for Chronic Achilles tendon rupture (n = 22, 14 males and 8 females, mean age 61 ± 15) were evaluated by Achilles tendon Total Rupture Score, The Physical Activity Scale, The Foot and Ankle Outcome Score, Calf muscle endurance test, counter movement jump, Hopping, ultrasound measurement of tendon length, Achilles Tendon Resting Angle, dorsi flexion range of motion and calf muscle circumference. Muscle function and tendon length outcomes on the injured side were compared with the healthy side. Results The patients scored a mean of 62 ± 26 on the Achilles tendon Total Rupture Score. Median scores on the injured compared with the healthy side were lower in heel-rise repetitions (20 vs 24 cm, p = 0.004), hel-rise height (8 vs 10 cm, p < 0.001), heel-rise total work (872 vs 1590 joule, p < 0.001) and hopping ratio (0.37 vs 0.48, p = 0.005). Median calf circumference was smaller (37 vs 38 cm, p = 0.001) and the mean tendon elongation greater on the injured side; Achilles tendon resting angle (55 vs 50°, p < 0.001) and ultrasound (22.4 vs 20.5 cm, p = 0.006). Conclusions At one year postoperatively, patients with chronic Achilles tendon rupture reported persistent limitations in subjective foot and ankle function. Heel-rise height and total work as well as hopping ratio were not recovered, and there was an elongation of the injured Achilles tendon compared with the healthy tendon. Level of evidence IV
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18
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Casciato D, Mendicino R, Steginsky B. A Novel Insertional Achilles Tendon Rupture Repair After Heel Spur Debridement: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00004. [PMID: 34986130 DOI: 10.2106/jbjs.cc.21.00442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We report a case of a 46-year-old woman who suffered an insertional Achilles tendon rupture secondary to a fall after undergoing retrocalcaneal and Achilles tendon debridements with flexor tendon transfer. Examination revealed posterior ankle pain with insertional Achilles tendon retraction. Treatment options included continued immobilization vs. surgical repair. She underwent Achilles tendon tenodesis to the calcaneus using a combined gastrocsoleus recession and Krackow suture technique. CONCLUSION At the 1-year follow-up, examination revealed pain-free return to normal function. In the presence of a ruptured Achilles tendon with retraction, this repair provided sufficient lengthening and fixation of the Achilles tendon complex.
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19
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Fricke B, Ng A, Bruera E. Multifocal Tendon Ruptures during Nivolumab and Ipilimumab Therapy for Metastatic Melanoma: A Case Report. PM R 2022; 14:151-153. [DOI: 10.1002/pmrj.12536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 11/18/2020] [Accepted: 12/04/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Brian Fricke
- Department of Palliative, Rehabilitation and Integrative Medicine The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Amy Ng
- Department of Palliative, Rehabilitation and Integrative Medicine The University of Texas MD Anderson Cancer Center Houston TX USA
| | - Eduardo Bruera
- Department of Palliative, Rehabilitation and Integrative Medicine The University of Texas MD Anderson Cancer Center Houston TX USA
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20
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Sommer B, Hollenstein A, Graf E. Stability boots for the treatment of Achilles tendon injuries: Gait analysis of healthy participants. Gait Posture 2022; 91:131-136. [PMID: 34689070 DOI: 10.1016/j.gaitpost.2021.10.009] [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: 11/26/2020] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Achilles tendon injuries are commonly treated with stability boots that secure the ankle at a specific position and aim to reduce loading of the tendon. These boots allow full weight bearing by limiting the range of movement. It is, however, unknown, to what extent these boots can reduce tendon loading and if the biomechanics are altered during walking. RESEARCH QUESTION How do orthopedic boots influence lower extremity biomechanics during walking? METHODS For this cross-sectional study, ten healthy participants walked with three orthopedic boots (Oped Vacoped, Kuenzli Ortho Rehab Absolut, Orthotech Variostabil) commonly used to treat Achilles tendon injuries. Kinematics and kinetics of the lower extremity of the booted leg and spatiotemporal parameters of both sides were collected using motion-capturing system and dynamometry. Each boot was tested in the maximally plantarflexed position. Group differences between boot conditions were analyzed by means of repeated-measures ANOVA and post-hoc paired t-test. RESULTS The boot dorsiflexion range of motion differed significantly between boots with Vacoped (1.8° (0.3)) showing the smallest range, followed by Kuenzli (5.0° (1.3)) and Orthotech (7.9° (1.7)). Orthotech displayed a higher peak plantarflexion moment (1.36 Nm/kg (0.09)) than both Kuenzli (1.06 Nm/kg (0.12)) and Vacoped (1.04 Nm/kg (0.14)). Concerning loading over time, significant differences in the plantarflexion impulse were found, with the highest impulse in Vacoped (0.42 Nms/kg (0.06)), followed by Orthotech (0.29 Nms/kg (0.03)) and Kuenzli (0.25 Nms/kg (0.05)). In addition, asymmetries were seen in stance and step length for the booted and contralateral sides. SIGNIFICANCE The lower extremity biomechanics were affected by the boots, with Kuenzli showing the lowest joint loading, Vacoped the smallest joint motion and Orthotech the most natural gait pattern. Future research is needed to determine the most relevant variable expressing the risk of re-rupture of the Achilles tendon in order to conclude which boot may be most favorable to use in clinical practice.
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Affiliation(s)
- Bettina Sommer
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Katharina-Sulzer-Platz 9, 8401 Winterthur, Switzerland
| | - Andreas Hollenstein
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Katharina-Sulzer-Platz 9, 8401 Winterthur, Switzerland
| | - Eveline Graf
- Zurich University of Applied Sciences, School of Health Professions, Institute of Physiotherapy, Katharina-Sulzer-Platz 9, 8401 Winterthur, Switzerland.
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21
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YURDAKUL E, KIZILCI H. Conservative treatment of acute Achilles tendon rupture. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.20.04490-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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22
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Slagers AJ, Dams OC, van Zalinge SD, Geertzen JHB, Zwerver J, Reininga IHF, van den Akker-Scheek I. Psychological Factors Change During the Rehabilitation of an Achilles Tendon Rupture: A Multicenter Prospective Cohort Study. Phys Ther 2021; 101:6380795. [PMID: 34636920 PMCID: PMC8697845 DOI: 10.1093/ptj/pzab226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 05/24/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The authors sought to gain insight into the changes in psychological factors during rehabilitation after Achilles tendon rupture (ATR) and to explore the association between psychological factors during rehabilitation and functional outcome 12 months after ATR. METHODS Fifty patients clinically diagnosed with ATR were invited to visit the hospital 3, 6, and 12 months after injury for data collection. They completed questionnaires assessing psychological factors: psychological readiness to return to sport (Injury Psychological Readiness to Return to Sport Questionnaire); kinesiophobia (Tampa Scale for Kinesiophobia); expectations, motivation, and outcome measures related to symptoms and physical activity (Achilles Tendon Total Rupture Score); and sports participation and performance (Oslo Sports Trauma Research Centre Overuse Injury Questionnaire). To determine whether psychological factors changed over time, generalized estimating equation analyses were performed. Multivariate regression analyses were used to study the association between psychological factors at 3, 6, and 12 months and outcome measures at 12 months after ATR. RESULTS Psychological readiness to return to sport improved, and kinesiophobia decreased significantly during rehabilitation. Psychological readiness at 6 and 12 months showed significant associations with sports participation and performance. Kinesiophobia at 6 months was significantly associated with symptoms and physical activity. Motivation remained high during rehabilitation and was highly associated with symptoms and physical activity, sports participation, and performance. CONCLUSION Psychological factors change during rehabilitation after ATR. Patients with lower motivation levels during rehabilitation, low psychological readiness to return to sports, and/or high levels of kinesiophobia at 6 months after ATR need to be identified. IMPACT According to these results, psychological factors can affect the rehabilitation of patients with ATR. Physical therapists can play an important role in recognizing patients with low motivation levels and low psychological readiness for return to sport and patients with high levels of kinesiophobia at 6 months post-ATR. Physical therapist interventions to enhance motivation and psychological readiness to return to sport and to reduce kinesiophobia need to be developed and studied in the post-ATR population. LAY SUMMARY With Achilles tendon rupture, level of motivation, psychological readiness for return to sport, and fear of movement can affect rehabilitation outcome. A physical therapist can help recognize these factors.
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Affiliation(s)
- Anton J Slagers
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, the Netherlands,Address all correspondence to Mr Slagers at:
| | - Olivier C Dams
- University of Groningen, University Medical Center Groningen, Department of Orthopaedics, Groningen, The Netherlands
| | - Sara D van Zalinge
- University of Groningen, University Medical Center Groningen, Department of Orthopaedics, Groningen, The Netherlands
| | - Jan HB Geertzen
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, the Netherlands
| | - Johannes Zwerver
- University of Groningen, University Medical Center Groningen, Center for Rehabilitation, Department of Rehabilitation Medicine, Groningen, the Netherlands,University of Groningen, University Medical Center Groningen, Center for Human Movement Sciences, Groningen, The Netherlands,Gelderse Vallei Hospital, Sports Valley, Department of Sports Medicine, Ede, The Netherlands
| | - Inge HF Reininga
- University of Groningen, University Medical Center Groningen, Department of Trauma Surgery, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- University of Groningen, University Medical Center Groningen, Department of Orthopaedics, Groningen, The Netherlands
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23
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Li Y, Jiang Y, Tao T, Pan Z, Zhang K, Gui J. Endoscopic reconstruction for chronic Achilles tendon ruptures using a hamstring tendon autograft. J Orthop Sci 2021; 26:854-859. [PMID: 33191066 DOI: 10.1016/j.jos.2020.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/06/2020] [Accepted: 09/03/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND To determine the safety and efficacy of endoscopic reconstruction of chronic Achilles tendon ruptures using a hamstring tendon autograft at mid-term follow-up. METHODS We reviewed the medical records of patients with chronic Achilles tendon rupture treated surgically by endoscopic reconstruction using a hamstring tendon autograft at our institution between March 2010 and October 2015. Radiologic outcomes were assessed using pre- and postoperative magnetic resonance imaging (MRI). Functional outcomes were evaluated with the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale, the Plantar Flexion Strength (PFS), the Victorian Institute of Sport Assessment-Achilles (VISA-A) scale, the Visual Analogue Scale (VAS) pain score, and the Arner-Lindholm standard. All patients achieved primary healing with no lengthening of the Achilles tendon, skin necrosis, infection, deep vein thrombosis or other complications. RESULTS Mean follow-up period was 15 ± 3 months (range, 12-18 months). There was no Achilles tendon re-rupture. MRI examination revealed that Achilles tendon continuity was restored. Patients' mean AOFAS, PFS, and VISA-A scores were significantly higher and mean VAS pain score was significantly lower after surgery compared to before (P < 0.05). According to Arner-Lindholm standards, there were twenty (76.9%) excellent, six (23.1%) good, and zero bad outcomes. CONCLUSION Endoscopic reconstruction utilizing a hamstring tendon autograft is a safe and efficacious option for repair of chronic Achilles tendon ruptures. Studies with larger sample sizes and a longer follow-up are required to confirm the advantage of this technique compared to open surgery.
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Affiliation(s)
- Yang Li
- Department of Sports Arthrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Yiqiu Jiang
- Department of Sports Arthrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Tianqi Tao
- Department of Sports Arthrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Zhu Pan
- Department of Sports Arthrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Kaibin Zhang
- Department of Sports Arthrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jianchao Gui
- Department of Sports Arthrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
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24
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Ruiz-Alonso S, Lafuente-Merchan M, Ciriza J, Saenz-Del-Burgo L, Pedraz JL. Tendon tissue engineering: Cells, growth factors, scaffolds and production techniques. J Control Release 2021; 333:448-486. [PMID: 33811983 DOI: 10.1016/j.jconrel.2021.03.040] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 02/07/2023]
Abstract
Tendon injuries are a global health problem that affects millions of people annually. The properties of tendons make their natural rehabilitation a very complex and long-lasting process. Thanks to the development of the fields of biomaterials, bioengineering and cell biology, a new discipline has emerged, tissue engineering. Within this discipline, diverse approaches have been proposed. The obtained results turn out to be promising, as increasingly more complex and natural tendon-like structures are obtained. In this review, the nature of the tendon and the conventional treatments that have been applied so far are underlined. Then, a comparison between the different tendon tissue engineering approaches that have been proposed to date is made, focusing on each of the elements necessary to obtain the structures that allow adequate regeneration of the tendon: growth factors, cells, scaffolds and techniques for scaffold development. The analysis of all these aspects allows understanding, in a global way, the effect that each element used in the regeneration of the tendon has and, thus, clarify the possible future approaches by making new combinations of materials, designs, cells and bioactive molecules to achieve a personalized regeneration of a functional tendon.
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Affiliation(s)
- Sandra Ruiz-Alonso
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | - Markel Lafuente-Merchan
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain
| | - Jesús Ciriza
- Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain
| | - Laura Saenz-Del-Burgo
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain.
| | - Jose Luis Pedraz
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country (UPV/EHU), Vitoria-Gasteiz, Spain; Biomedical Research Networking Center in Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Vitoria-Gasteiz, Spain; Bioaraba Health Research Institute, Vitoria-Gasteiz, Spain.
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25
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Bionic Silk Fibroin Film Induces Morphological Changes and Differentiation of Tendon Stem/Progenitor Cells. Appl Bionics Biomech 2020; 2020:8865841. [PMID: 33343699 PMCID: PMC7725557 DOI: 10.1155/2020/8865841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/17/2020] [Accepted: 11/20/2020] [Indexed: 12/25/2022] Open
Abstract
Purpose Tendon injuries are common musculoskeletal system disorders, but the ability for tendon regeneration is limited. Silk fibroin (SF) film may be suitable for tendon regeneration due to its excellent biocompatibility and physical properties. This study is aimed at evaluating the application value of bionic SF film in tendon regeneration. Methods Tendon stem/progenitor cells (TSPCs) were isolated from rat Achilles tendon and characterized based on their surface marker expression and multilineage differentiation potential. SF films with smooth or bionic microstructure surfaces (5, 10, 15, 20 μm) were prepared. The morphology and mechanical properties of natural tendons and SF films were characterized. TSPCs were used as the seed cells, and the cell viability and cell adhesion morphology were analyzed. The tendongenesis-related gene expression of TSPCs was also evaluated using quantitative polymerase chain reaction. Results Compared to the native tendon, only the 10, 15, and 20 μm SF film groups had comparable maximum loading and ultimate stress, with the exception of the breaking elongation rate. The 10 μm SF film group had the highest percentage of oriented cells and the most significant changes in cell morphology. The most significant upregulations in the expression of COL1A1, TNC, TNMD, and SCX were also observed in the 10 μm SF film group. Conclusion SF film with a bionic microstructure can serve as a tissue engineering scaffold and provide biophysical cues for the use of TSPCs to achieve proper cellular adherence arrangement and morphology as well as promote the tenogenic differentiation of TSPCs, making it a valuable customizable biomaterial for future applications in tendon repair.
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26
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Ali MA. A man with sudden onset calf pain. J Am Coll Emerg Physicians Open 2020; 1:1752. [PMID: 33392592 PMCID: PMC7771817 DOI: 10.1002/emp2.12271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 09/16/2020] [Indexed: 11/27/2022] Open
Affiliation(s)
- M Adam Ali
- Department of Trauma and OrthopaedicsRoyal Free HospitalRoyal Free London NHS Foundation TrustLondonUK
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27
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Okewunmi J, Guzman J, Vulcano E. Achilles Tendinosis Injuries-Tendinosis to Rupture (Getting the Athlete Back to Play). Clin Sports Med 2020; 39:877-891. [PMID: 32892973 DOI: 10.1016/j.csm.2020.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Recreational athletes are susceptible to experiencing pain in the Achilles tendon, affecting their ability to complete daily activities. Achilles tendinosis is a degenerative process of the tendon without histologic or clinical signs of intratendinous inflammation, which can be categorized by location into insertional and noninsertional tendinosis. This condition is one that can be treated conservatively with great success or surgically for refractory cases. Currently, there is a lack of consensus regarding the best treatment options. This review aims to explore both conservative and operative treatment options for Achilles tendinopathy and Achilles tendon rupture.
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Affiliation(s)
- Jeffrey Okewunmi
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Javier Guzman
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA
| | - Ettore Vulcano
- Department of Orthopaedic Surgery, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA.
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Chu J, Lu M, Pfeifer CG, Alt V, Docheva D. Rebuilding Tendons: A Concise Review on the Potential of Dermal Fibroblasts. Cells 2020; 9:E2047. [PMID: 32911760 PMCID: PMC7563185 DOI: 10.3390/cells9092047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 12/26/2022] Open
Abstract
Tendons are vital to joint movement by connecting muscles to bones. Along with an increasing incidence of tendon injuries, tendon disorders can burden the quality of life of patients or the career of athletes. Current treatments involve surgical reconstruction and conservative therapy. Especially in the elderly population, tendon recovery requires lengthy periods and it may result in unsatisfactory outcome. Cell-mediated tendon engineering is a rapidly progressing experimental and pre-clinical field, which holds great potential for an alternative approach to established medical treatments. The selection of an appropriate cell source is critical and remains under investigation. Dermal fibroblasts exhibit multiple similarities to tendon cells, suggesting they may be a promising cell source for tendon engineering. Hence, the purpose of this review article was in brief, to compare tendon to dermis tissues, and summarize in vitro studies on tenogenic differentiation of dermal fibroblasts. Furthermore, analysis of an open source Gene Expression Omnibus (GEO) data repository was carried out, revealing great overlap in the molecular profiles of both cell types. Lastly, a summary of in vivo studies employing dermal fibroblasts in tendon repair as well as pilot clinical studies in this area is included. Altogether, dermal fibroblasts hold therapeutic potential and are attractive cells for rebuilding injured tendons.
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Affiliation(s)
- Jin Chu
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany; (J.C.); (C.G.P.); (V.A.)
| | - Ming Lu
- Department of Orthopaedic Surgery, First Affiliated Hospital of Dalian Medical University, Dalian 116023, China;
| | - Christian G. Pfeifer
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany; (J.C.); (C.G.P.); (V.A.)
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
| | - Volker Alt
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany; (J.C.); (C.G.P.); (V.A.)
- Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany
| | - Denitsa Docheva
- Laboratory for Experimental Trauma Surgery, Department of Trauma Surgery, University Regensburg Medical Centre, 93053 Regensburg, Germany; (J.C.); (C.G.P.); (V.A.)
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Misir A, Kizkapan TB, Arikan Y, Akbulut D, Onder M, Yildiz KI, Ozkocer SE. Repair within the first 48 h in the treatment of acute Achilles tendon ruptures achieves the best biomechanical and histological outcomes. Knee Surg Sports Traumatol Arthrosc 2020; 28:2788-2797. [PMID: 31119340 DOI: 10.1007/s00167-019-05536-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/07/2019] [Indexed: 12/16/2022]
Abstract
PURPOSE To compare the biomechanical and histological properties of Achilles tendons repaired at different time points during the acute injury period. METHODS Thirty-six skeletally mature Sprague-Dawley rats underwent bilateral mid-substance Achilles tenotomy. The Achilles tendons were repaired either in the first 24 h (group 1), 24-48 h (group 2), 48-72 h (group 3), or > 72 h (mean: 120 ± 5.2 h) (group 4) after tenotomy. Six weeks after repair, nine tendons per group were assessed biomechanically and histologically. The Stoll histological scoring system was used for histological examination. The groups were compared with each other and native tendons (control group). The correlations between biomechanical and histological results were analysed. RESULTS There were no significant differences between groups 1, 2 and 3 regarding the mean load to failure; it was significantly lower in group 4. Healed tendons in groups 1, 2 and 3 had significantly greater stiffness than native tendons and group 4 tendons. All healed tendons had a larger cross-sectional area than native tendons. There was no significant difference in tendon length between the groups. There was no significant difference in Young's modulus between the groups; Young's modulus was lower in all the groups than in the control group. Group 1 had significantly higher extracellular matrix organization, cell alignment, cell distribution and nucleus morphology scores and total scores than group 4. Group 1 had significantly higher extracellular matrix organization, cell distribution, vascularization and inflammation scores and total scores than group 3. A significant positive correlation was detected between the maximum load to failure and total histological score. CONCLUSION Repair of acute Achilles tendon rupture within 48 h, and especially in the first 24 h, provides better biomechanical and histological outcomes. In the clinical practice, the data could be used to decrease re-rupture rates, to achieve more anatomical tendon healing and to implement more effective post-operative rehabilitation programme.
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Affiliation(s)
- Abdulhamit Misir
- Department of Orthopedics and Traumatology, Sanliurfa Training and Research Hospital, Akpıyar Mah. 4061. Sk. Yaşamkent Park evleri no:29 B blok d:21 Karaköprü, Şanlıurfa, Turkey.
| | - Turan Bilge Kizkapan
- Department of Orthopedics and Traumatology, Bursa Cekirge State Hospital, Bursa, Turkey
| | - Yavuz Arikan
- Department of Orthopedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Deniz Akbulut
- Department of Orthopedics and Traumatology, Bitlis Tatvan State Hospital, Bitlis, Turkey
| | - Murat Onder
- Department of Orthopedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Kadir Ilker Yildiz
- Department of Orthopedics and Traumatology, Baltalimani Bone and Joint Diseases Training and Research Hospital, Istanbul, Turkey
| | - Suheyla Esra Ozkocer
- Gazi University Faculty of Medicine Department of Histology and Embryology, Ankara, Turkey
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Zhang B, Tao T, Li Y, Jiang Y, Gui J. [Clinical analysis of autogenous tendon reconstruction under total arthroscopy in treatment of 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 2020; 34:726-729. [PMID: 32538563 DOI: 10.7507/1002-1892.201911055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of autogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture. Methods Between June 2015 and June 2018, 16 patients with chronic Achilles tendon ruptures were treated by autogenous tendon reconstruction under total arthroscopy. Of the 16 patients, 11 were males and 5 were females. Their mean age was 40.7 years (range, 21-55 years). The disease duration was 14-20 months (mean, 16.4 months). Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 41.2±2.2 and the pain visual analogue scale (VAS) score was 7.9±1.2. MRI and B-ultrasonography examinations showed that the Achilles tendon was not continuous. The length of Achilles tendon defect was 5.0-10.3 cm, with an average of 5.8 cm. The rupture of the Achilles tendon happened on top of the insertion of the tendon in 4 cases and at the tendon-muscle belly connection in 12 cases. The operation time, intraoperative blood loss, hospital stay, and related complications were recorded. The AOFAS score and VAS score were used to evaluate the improvement of ankle joint function and pain. Results The average operation time was 77.2 minutes (range, 60-90 minutes). The average intraoperative blood loss was 20.5 mL (range, 15-30 mL). The average hospital stay was 7.2 days (range, 5-10 days). All incisions healed by first intention. There was no skin necrosis, infection, or deep vein thrombosis. All the patients were followed up 8-18 months, with an average of 12 months; and 10 cases were followed up more than 12 months. During the follow-up, there was no Achilles tendon re-rupture, and the symptoms of pain and heel lifting failure significantly improved. MRI reexamination showed that the continuity of Achilles tendon recovered. At 1, 3, 6, and 12 months postoperatively, AOFAS scores significantly improved and VAS scores significantly reduced, except for 1 month postoperatively, the scores at other time points were superior to that before operation, the differences were significant ( P<0.05). Conclusion Autogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture has the advantages of small trauma, rapid functional recovery, and satisfactory surgical efficacy.
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Affiliation(s)
- Bin Zhang
- Department of Orthopaedics, the Fourth Affiliated Hospital of Nanjing Medical University (Nanjing Pukou Hospital), Nanjing Jiangsu, 210031, P.R.China
| | - Tianqi Tao
- Department of Sports and Joint, the First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China
| | - Yang Li
- Department of Sports and Joint, the First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China
| | - Yiqiu Jiang
- Department of Sports and Joint, the First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China
| | - Jianchao Gui
- Department of Sports and Joint, the First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China
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Yang YP, Tao LY, Gao JN, Wang P, Jiang YF, Zheng LM, Zhao YM, Ao YF. Elevated lipid levels in patients with achilles tendon ruptures: a retrospective matching study. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:217. [PMID: 32309364 PMCID: PMC7154433 DOI: 10.21037/atm.2020.01.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background Achilles tendon rupture (ATR) can lead to significant disability of patients. However, whether serum lipid levels are associated with ATR is still unclear. This study aimed to examine the difference in lipid levels between patients with and those without ATR. Methods Patients who received ATR surgery during January 2017 to December 2017 were categorized into the case group, and those who had physical examinations during the same period without ATR were in the control group. Different matching methods [case-control matching (CCM) and propensity score matching (PSM)] were used to match the cases and controls at a 1:1 ratio. Results Among a total of 216 pairs of subjects with CCM, cholesterol, triglyceride, and low-density lipoprotein (LDL) levels were significantly higher (all P<0.05) in the case group than in the control group. Among 241 pairs of subjects with PSM, the same results as those with CCM were obtained. Abnormal rates of cholesterol, triglyceride, and LDL levels in the case group were also significantly higher than those in the control group in CCM and PSM (all P<0.05). After adjusting for the factors of height and weight, there were still significant differences in cholesterol, triglyceride, and LDL levels, as well as high-density lipoprotein levels, between the case and control groups (all P<0.05). Conclusions Cholesterol, triglyceride, and LDL levels in patients with ATR are higher than those in healthy people. Further studies are required to verify the effect of some components of lipids on Achilles tendon structure.
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Affiliation(s)
- Yu-Ping Yang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - Li-Yuan Tao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
| | - Jia-Ning Gao
- The Institute of Cardiovascular Sciences and Institute of Systems Biomedicine, School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University Health Science Center, Beijing 100191, China
| | - Peng Wang
- Physical Examination Center, Peking University Third Hospital, Beijing 100191, China
| | - Yan-Fang Jiang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
| | - Le-Min Zheng
- The Institute of Cardiovascular Sciences and Institute of Systems Biomedicine, School of Basic Medical Sciences, Key Laboratory of Molecular Cardiovascular Sciences of Ministry of Education, Peking University Health Science Center, Beijing 100191, China
| | - Yi-Ming Zhao
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
| | - Ying-Fang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing 100191, China
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Park SH, Lee HS, Young KW, Seo SG. Treatment of Acute Achilles Tendon Rupture. Clin Orthop Surg 2020; 12:1-8. [PMID: 32117532 PMCID: PMC7031433 DOI: 10.4055/cios.2020.12.1.1] [Citation(s) in RCA: 62] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 10/31/2019] [Indexed: 12/15/2022] Open
Abstract
There is no clear consensus on the optimal treatment of acute Achilles tendon rupture. Recently, studies have demonstrated the critical role of functional rehabilitation in the treatment of ruptured Achilles tendons. Hence, conservative treatment is preferred by a growing number of surgeons seeking to treat the condition without the risk of complications from surgery. However, operative treatment is still considered as a more reliable treatment option for acute Achilles tendon rupture. In this review article, we provide an overview of recent treatment strategies for acute rupture of the Achilles tendon.
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Affiliation(s)
- Seung-Hwan Park
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ho Seong Lee
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Won Young
- Department of Orthopedic Surgery, Eulji Hospital, Seoul, Korea
| | - Sang Gyo Seo
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Zhao J, Guo W, Zeng X, Kan S. [Research progress of early postoperative rehabilitation for acute Achilles tendon rupture after surgical repair]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:382-386. [PMID: 30874399 PMCID: PMC8337926 DOI: 10.7507/1002-1892.201807146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 01/07/2019] [Indexed: 12/28/2022]
Abstract
Objective To summarize the latest research progress of early postoperative rehabilitation for acute Achilles tendon rupture after surgical repair. Methods The high-quality randomized controlled trials and systematic reviews/meta-analyses regarding early postoperative rehabilitation for acute Achilles tendon rupture in recent years were reviewed. Results There are three functional rehabilitations after acute Achilles tendon rupture surgery, including early postoperative mobilization, early weight-bearing with immobilization, and early weight-bearing combined with mobilization. The results of randomized controlled trials show that the effectiveness of early postoperative rehabilitation is similar or better than the early postoperative immobilization. The results of systematic reviews/meta-analyses show that the early postoperative rehabilitation is beneficial to the early function recovery of the Achilles tendon, can reduce the time for functional recovery, and do not adversely affect the outcomes. Conclusion Early postoperative rehabilitation is beneficial to the functional recovery, and do not increase postoperative complications. There is still no uniform protocol of early postoperative rehabilitation and the timing of weight-bearing, and further studies are needed in the future.
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Affiliation(s)
- Jiaguo Zhao
- Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211,
| | - Wenxuan Guo
- School of Graduates, Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China
| | - Xiantie Zeng
- Department of Foot and Ankle Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China
| | - Shilian Kan
- Department of Hand Surgery, Tianjin Hospital, Tianjin, 300211, P.R.China
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Singh K, Thukral CL, Gupta K, Singh A. Comparison of high resolution ultrasonography with clinical findings in patients with ankle pain. J Ultrason 2019; 18:316-324. [PMID: 30763016 PMCID: PMC6444321 DOI: 10.15557/jou.2018.0046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2018] [Indexed: 11/22/2022] Open
Abstract
Aim: The aim of this study was to investigate the diagnostic accuracy of high resolution ultrasonography for the assessment of painful ankle joint as compared with the clinical findings. Material and Methods: A prospective study was conducted on 136 patients having history of ankle pain and referred to the Department of Radiodiagnosis and Imaging for ultrasonography. Statistical analysis: Comparison of ultrasonography findings and clinical findings was done using McNemar Test. Results: 136 patients with 218 pathologies of the ankle joint were analyzed. Of these, 178 pathologies were clinically suspected, but 206 were diagnosed with ultrasonography. This difference was statistically significant (p value = 0.000). Conclusion: Ultrasonography is an excellent tool for evaluating patients with ankle pain, especially in cases of lateral ligament pathologies, tendinous pathologies, joint effusion, and miscellaneous pathologies. It can be used as the primary imaging investigation because it allows a rapid, dynamic, and cost-effective examination of the ankle joint. However, ultrasonography has limitations when using it to evaluate a suspected posterior talofibular ligament injury, marrow abnormalities, and deep seated pathologies, for which MRI should be incorporated for a diagnosis. Aim: The aim of this study was to investigate the diagnostic accuracy of high resolution ultrasonography for the assessment of painful ankle joint as compared with the clinical findings. Material and Methods: A prospective study was conducted on 136 patients having history of ankle pain and referred to the Department of Radiodiagnosis and Imaging for ultrasonography. Statistical analysis: Comparison of ultrasonography findings and clinical findings was done using McNemar Test. Results: 136 patients with 218 pathologies of the ankle joint were analyzed. Of these, 178 pathologies were clinically suspected, but 206 were diagnosed with ultrasonography. This difference was statistically significant (p value = 0.000). Conclusion: Ultrasonography is an excellent tool for evaluating patients with ankle pain, especially in cases of lateral ligament pathologies, tendinous pathologies, joint effusion, and miscellaneous pathologies. It can be used as the primary imaging investigation because it allows a rapid, dynamic, and cost-effective examination of the ankle joint. However, ultrasonography has limitations when using it to evaluate a suspected posterior talofibular ligament injury, marrow abnormalities, and deep seated pathologies, for which MRI should be incorporated for a diagnosis.
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Affiliation(s)
- Kunwarpal Singh
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Vallah, Sri Amritsar, Punjab , India
| | - Chuni Lal Thukral
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Vallah, Sri Amritsar, Punjab , India
| | - Kamlesh Gupta
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Vallah, Sri Amritsar, Punjab , India
| | - Avtar Singh
- Department of Radiodiagnosis and Imaging, Sri Guru Ram Das University of Health Sciences , Vallah, Sri Amritsar, Punjab , India
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