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Oliva F, Marsilio E, Mastrodonato F, Migliorini F, Maffulli N. Minimally invasive excision and reconstruction of Achilles tendon xanthoma using free autologous semitendinosus tendon transfer: a surgical technique. J Orthop Surg Res 2023; 18:274. [PMID: 37013640 PMCID: PMC10071761 DOI: 10.1186/s13018-023-03757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/26/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Tendon xanthomatosis is often associated with familial hypercholesterolemia, but it can also occur in other medical conditions. The Achilles tendon is the most common site of tendon xanthomas. Reconstruction of large defects after the xanthoma excision, can be challenging. METHODS We propose a novel technique for Achilles tendon reconstruction with the use of an ipsilateral autologous semitendinosus tendon graft. The technique consists of six steps. RESULTS This procedure has a low rate of complications and provides results that are at least comparable with those reported with other surgical approaches.
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Affiliation(s)
- Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
| | - Emanuela Marsilio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
| | - Federica Mastrodonato
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, ST4 7QB, Stoke on Trent, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, E1 4DG, London, England
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Nakazawa K, Yano K, Kaneshiro Y, Sakanaka H. Endoscopic resection of tendon xanthoma in the elbow of a patient with cerebrotendinous xanthomatosis. BMJ Case Rep 2021; 14:e244931. [PMID: 34772677 PMCID: PMC8593707 DOI: 10.1136/bcr-2021-244931] [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] [Accepted: 10/19/2021] [Indexed: 11/04/2022] Open
Abstract
We describe the case of a 44-year-old woman with cerebrotendinous xanthomatosis (CTX) who had a tendon xanthoma on the right olecranon. The patient successfully underwent endoscopic resection. There were no signs of recurrence on MRI 2 years postoperatively. There were no complications related to the surgery, and the patient is completely satisfied with the treatment outcomes. CTX, a genetic metabolic disorder, is associated with the development of tendon xanthomas. Endoscopic resection of tendon xanthoma in the elbow of patients with CTX is a less invasive method than open resection.
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Affiliation(s)
- Katsumasa Nakazawa
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai, Osaka, Japan
| | - Koichi Yano
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai, Osaka, Japan
| | - Yasunori Kaneshiro
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai, Osaka, Japan
| | - Hideki Sakanaka
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai, Osaka, Japan
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A Rare Case of Bilateral Achilles Tendon Xanthomas in a Teenager, Successfully Treated with Tendon Sparing Technique. Case Rep Orthop 2021; 2021:1932763. [PMID: 34395005 PMCID: PMC8360742 DOI: 10.1155/2021/1932763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/09/2021] [Accepted: 07/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background Xanthoma of the Achilles tendon, even though being benign, is a surgically challenging orthopaedic condition. Causality is believed to be due to a pathological error in the metabolism of low-density lipoprotein and their resultant accumulation, as foam cells within the tendon. Tendon xanthomas are often found to accompany heterozygous familial hypercholesterolemia. Case Presentation. A 19-year-old girl presented to our institution (a District General Hospital), with soft tissue lumps over posterior aspect of the ankle on both sides for several years. She had noticed a rapid increase in size in recent 3 months and sought medical advice. During investigation, she was diagnosed having bilateral Achilles tendon xanthomas clinically, confirmed by ultrasound scan and magnetic resonance imaging, and familial hypercholesterolemia concomitantly. The former was managed with intralesion subtotal resection where the histology further confirmed the diagnosis. The patient was commenced on statins and followed up while assessing the functional outcome and recurrences up to 2 years, with favourable results. Conclusion Subtotal resection of Achilles tendon xanthoma (tendon sparingly) offers cosmetically and functionally acceptable outcomes, with faster recovery and no recurrences over 2 years.
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Yang Y, Lu H, Qu J. Tendon pathology in hypercholesterolaemia patients: Epidemiology, pathogenesis and management. J Orthop Translat 2018; 16:14-22. [PMID: 30723677 PMCID: PMC6350019 DOI: 10.1016/j.jot.2018.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/04/2018] [Accepted: 07/12/2018] [Indexed: 01/18/2023] Open
Abstract
Tendon pathology is a general term used to describe a group of musculoskeletal conditions related to tendons and surrounding structures. There is only limited evidence available regarding the exact aetiology and natural history of tendon pathology. In hypercholesterolaemia environments, lipids could accumulate within the extracellular matrix of the tendon and thus affect the mechanical properties of the tendon. Current evidence suggested that hypercholesterolaemia was an important risk factor in the development and progression of tendon pathology. The severity of hypercholesterolaemia was correlated with the severity of tendon pathology. The translational potential of this article: Hypercholesterolaemia lead to the structural, inflammatory and mechanical changes in tendons, which predispose hypercholesterolaemia patients to a greater risk of tendon pathology. Measurements of serum cholesterol are suggested to be performed in patients presenting with tendon pathology. The strict control of hypercholesterolaemia would mitigate the development and progression of tendon pathology.
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Affiliation(s)
- Yang Yang
- Department of Cardiovascular Disease, The Second Xiangya Hospital, Central South University, Changsha 410011, PR China
| | - Hongbin Lu
- Department of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Jin Qu
- Department of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha 410008, PR China
- Corresponding author. Department of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha 410008, PR China.
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Karakaplan M, Ergen E, Görmeli G, Korkmaz MF, Elmalı N. Bilateral Achilles Tendon Xanthomas in a Patient with Cerebrotendinous Xanthomatosis A Case Report. J Am Podiatr Med Assoc 2017; 107:85-89. [PMID: 28271939 DOI: 10.7547/15-085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cerebrotendinous xanthomatosis is a rare, autosomal recessive, lipid storage disease with accumulation of cholestanol in most tissues, particularly in the Achilles tendons. We described a 23-year-old female patient who had progressive painfull swelling of both Achilles tendons due to cerebrotendinous xanthomatosis. We performed surgery on both-side Achilles tendon tumors. Wide degenerative areas of the tendons were resected, and the flexor hallucis longus tendon was harvested and transferred to reconstruct motion function.
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Affiliation(s)
- Mustafa Karakaplan
- Department of Orthopaedics and Traumatology, Turgut Ozal Medical Center, Inönü University Medical School, Malatya, Turkey
| | - Emre Ergen
- Elazig Kovancilar State Hospital, Elazig, Turkey
| | - Gökay Görmeli
- Department of Orthopaedics and Traumatology, Turgut Ozal Medical Center, Inönü University Medical School, Malatya, Turkey
| | - Mehmet Fatih Korkmaz
- Department of Orthopaedics and Traumatology, Turgut Ozal Medical Center, Inönü University Medical School, Malatya, Turkey
| | - Nurzat Elmalı
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
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Zhao C, Kong M, Cao L, Zhang Q, Fang Y, Ruan W, Dou X, Gu X, Bi Q. Multiple large xanthomas: A case report. Oncol Lett 2016; 12:4327-4332. [PMID: 28101197 PMCID: PMC5228295 DOI: 10.3892/ol.2016.5282] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 03/22/2016] [Indexed: 02/06/2023] Open
Abstract
A 23-year-old male patient presented with multiple large masses in his elbows, buttocks, knees, Achilles tendons, feet, shoulders and hands. The large masses in the elbows and buttocks measured ~6×5×5 cm and ~7×5×4 cm, respectively. The patient presented with an elevated level of low-density lipoprotein cholesterol, and had been previously diagnosed with homozygous familial hypercholesterolemia (FH) and multiple xanthomas. Local surgical excisions were performed to remove the massive xanthomas from the elbows and buttocks, and histological analysis of the surgical specimens confirmed the previous diagnosis of homozygous FH (HoFH). The aim of the present study was to report a rare case of HoFH coinciding with multiple, large and widely-distributed xanthomas and to discuss the clinical characteristics, in order to provide a better understanding of xanthomas and FH.
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Affiliation(s)
- Chen Zhao
- Department of Orthopedics and Joint Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Mingxiang Kong
- Department of Orthopedics, The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Li Cao
- Department of Orthopedics and Joint Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Qiong Zhang
- Operating Room, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Yong Fang
- Department of Orthopedics, The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Weiwei Ruan
- Department of Orthopedics, The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
| | - Xiaofan Dou
- Department of Orthopedics and Joint Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Xiaohui Gu
- Department of Orthopedics and Joint Surgery, Zhejiang Provincial People's Hospital, Hangzhou, Zhejiang 310014, P.R. China
| | - Qing Bi
- Department of Orthopedics, The Second Clinical Medical College, Wenzhou Medical University, Wenzhou, Zhejiang 325000, P.R. China
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Simonson DC, Elliott AD, Roukis TS. Catastrophic Failure of an Infected Achilles Tendon Rupture Repair Managed with Combined Flexor Hallucis Longus and Peroneus Brevis Tendon Transfer. Clin Podiatr Med Surg 2016; 33:153-62. [PMID: 26590732 DOI: 10.1016/j.cpm.2015.06.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Deep infection is one of the most devastating complications following repair of an Achilles tendon rupture. Treatment requires not only culture-driven antibiotic therapy, but more importantly, appropriate débridement of some or even all of the Achilles tendon. This may necessitate delayed reconstruction of the Achilles tendon. The authors present a successful case of reconstruction of a chronically infected Achilles tendon in an otherwise healthy 43-year-old man via a multistaged approach using the flexor hallucis longus and peroneus brevis tendons. We also provide a brief review of the literature regarding local tendon transfer used in the reconstruction of Achilles tendon rupture.
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Affiliation(s)
- Devin C Simonson
- Departments of Orthopaedics, Podiatry, and Sports Medicine, Gundersen Health System, 1900 South Avenue, La Crosse, WI 54601, USA
| | - Andrew D Elliott
- Podiatric Medicine and Surgery Resident (PGY-III), Gundersen Medical Foundation, 1900 South Avenue, La Crosse, WI 54601, USA
| | - Thomas S Roukis
- Departments of Orthopaedics, Podiatry, and Sports Medicine, Gundersen Health System, 1900 South Avenue, La Crosse, WI 54601, USA.
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Xanthomas: clinical and pathophysiological relations. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 158:181-8. [PMID: 24781043 DOI: 10.5507/bp.2014.016] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 03/28/2014] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Xanthomas are well circumscribed lesions in the connective tissue of the skin, tendons or fasciae that predominantly consist of foam cells; these specific cells are formed from macrophages as a result of an excessive uptake of low density lipoprotein (LDL) particles and their oxidative modification. RESULTS Until recently, xanthelasma was considered to be only a cosmetic lesion; however, according to the results of recent prospective studies it is connected with an increased cardiovascular risk and reduced average lifespan. Pathogenetic mechanisms involved in the development of xanthomas resemble early stages of atherogenesis. In clinical practice, xanthomas can signalise various congenital or acquired dyslipidemias. The most prevalent form of xanthomas is xanthelasma palpebrarum. Tendinous and tuberous xanthomas are typical for autosomal dominant hypercholesterolemia, as well as for some rare conditions, such as cerebrotendinous xanthomatosis and familial β-sitosterolemia. In patients with familial hypercholesterolemia, the presence of tendinous xanthomas has been shown to be associated with a two to four times higher risk for cardiovascular disease. Eruptive xanthomas are skin manifestations of a severe hypertriglyceridemia and implicate an elevated risk for acute pancreatitis or type 2 diabetes mellitus. Xanthoma striatum palmare is pathognomic for primary dysbetalipoproteinemia, whereas diffuse plane xanthomas are frequently associated with paraproteinemia and lymphoproliferative disorders. CONCLUSION Thorough familiarity with the clinical presentation of xanthomas helps in the diagnosis and follow-up of different forms of dyslipidemia. Moreover, xanthelasma palpebrarum, the most prevalent form of xanthomas, is connected with increased risk of atherothrombotic disease independently of conventional cardiovascular risk factors. To fully understand the pathogenesis, further experimental and clinical research is required.
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