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Ibrahim MAA, Abdelkader MG, Nematallah SA, Elsawy GA, Alghandour SA, Shwitter LM. Modified gastro-soleus turn-down flap for chronic or neglected achilles tendon ruptures. J Orthop Surg Res 2024; 19:168. [PMID: 38449028 PMCID: PMC10918857 DOI: 10.1186/s13018-024-04625-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Achilles' tendon chronic rupture is a common entity that is usually misdiagnosed or mistreated. Hence, she was presented to us later or with complications affecting her gait. Surgical resection is needed to either bridge the gap or reinforce the strength of the tendon repair. OBJECTIVES Our study's goal was to assess the clinical results of repairing chronic Achilles' tendon lesions employing the middle segment of the proximal portion of the tendon (gastro-soleus), as a turn-down flap. METHODS Our prospective interventional single arm study included 18 patients with chronic Achilles' tendon rupture attending at Al-Azhar university hospitals in Cairo, Egypt from May 2020 to April 2023. Diagnosis of the patients was confirmed by radiographic and clinical investigations. They were all treated with the same open reconstruction procedure using a modified GSF. The average follow-up was 12 months. The results of this study were assessed by the Achilles tendon rupture score (ATRS), American Orthopedic Foot and Ankle Society (AOFAS) score, and capacity to perform repeated heel raises on the affected side. RESULTS The mean operative time was 72.77 min. The median (IQR) time of reconstruction was 10 (8-12) after the injury. The median (IQR) length of flab was 4.5 (4.3-5) 9 (Table 2). No intraoperative complications occurred. The typical follow-up period was 12 months (6-18 months). In terms of the ATRS, we found a significant reduction from 82.8 ± 3 preoperatively to 20.8 ± 6.7 at 12 months postoperatively (P value = 0.001). As regards the AOFAS score, it was increased from 49.5 ± 10 preoperatively to 83.8 ± 8.5 12 months postoperatively (P = 0.001). In terms of the post operative complications, there was no re-rupture. Two patients experienced superficial wound infection which improved with daily dressing and antibiotics. Additionally, two patients had slight ankle stiffness four months after the operation, which improved after programmed rehabilitation at the sixth month. CONCLUSION The modified GSTF is a simple, safe, well-tolerated and effective method of treatment with excellent functional results and greater patient content.
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Affiliation(s)
- Mohamed A A Ibrahim
- Al Azhar University-Faculty of Medicine-Orthopedic department., Cairo, Egypt.
| | | | - Samir A Nematallah
- Al Azhar University-Faculty of Medicine-Orthopedic department., Cairo, Egypt
| | - Gamal A Elsawy
- Al Azhar University-Faculty of Medicine-Orthopedic department., Cairo, Egypt
| | - Sameh A Alghandour
- Al Azhar University-Faculty of Medicine-Orthopedic department., Cairo, Egypt
| | - Lotfy M Shwitter
- Al Azhar University-Faculty of Medicine-Orthopedic department., Cairo, Egypt
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2
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Feng SM, Maffulli N, Oliva F, Saxena A, Hao YF, Hua YH, Xu HL, Tao X, Xu W, Migliorini F, Ma C. Surgical management of chronic Achilles tendon rupture: evidence-based guidelines. J Orthop Surg Res 2024; 19:132. [PMID: 38341569 PMCID: PMC10858558 DOI: 10.1186/s13018-024-04559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Chronic Achilles tendon ruptures (CATR) often require surgical intervention to restore function. Despite numerous treatment modalities available, the optimal management strategy remains controversial given the limited high-quality evidence available. This article aims to provide evidence-based guidelines for the surgical management of CATR through a comprehensive systematic review of the available data. The consensus reached by synthesizing the findings will assist clinicians in making informed decisions and improving patient outcomes. METHODS A group of 9 foot surgeons in three continents was consulted to gather their expertise on guidelines regarding the surgical management of CATR. Following the proposal of 9 clinical topics, a thorough and comprehensive search of relevant literature published since 1980 was conducted for each topic using electronic databases, including PubMed, MEDLINE, and Cochrane Library, to identify relevant studies published until 1 October 2023. All authors collaborated in drafting, discussing, and finalizing the recommendations and statements. The recommendations were then categorized into two grades: grade a (strong) and grade b (weak), following the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Additionally, feedback from 21 external specialists, who were independent from the authors, was taken into account to further refine and finalize the clinical guidelines. RESULTS Nine statements and guidelines were completed regarding surgical indications, surgical strategies, and postoperative rehabilitation protocol. CONCLUSION Based on the findings of the systematic review, this guideline provides recommendations for the surgical management of CATR. We are confident that this guideline will serve as a valuable resource for physicians when making decisions regarding the surgical treatment of patients with CATR.
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Affiliation(s)
- Shi-Ming Feng
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, China.
| | - Nicola Maffulli
- Department of Medicine and Psychology, University "La Sapienza", Rome, Italy
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-On-Trent, Staffordshire, ST4 7QB, England
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
| | - Francesco Oliva
- Department of Sports Traumatology, Universita' Telematica San Raffaele, Rome, Italy
| | - Amol Saxena
- Department of Sports Medicine, Sutter-PAMF, Palo Alto, CA, USA
| | - Yue-Feng Hao
- Orthopedics and Sports Medicine Center, Suzhou Municipal Hospital, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Ying-Hui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Hai-Lin Xu
- Department of Trauma and Orthopedic, People's Hospital, Peking University, Beijing, People's Republic of China
| | - Xu Tao
- Department of Sports Medicine, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Wei Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Chao Ma
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, China
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3
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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: 0] [Impact Index Per Article: 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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Xu Y, Li C, Liu T, Xiang F, Deng Y, Li Z, Wei D. Long-term outcome of flexor hallucis longus tendon transfer for chronic Achilles tendon rupture with large defect: A retrospective series. Medicine (Baltimore) 2023; 102:e35302. [PMID: 37773872 PMCID: PMC10545221 DOI: 10.1097/md.0000000000035302] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/30/2023] [Indexed: 10/01/2023] Open
Abstract
There are multiple surgical options for treatment of chronic Achilles tendon (AT) rupture according to the classifications and length of defect. However, no gold standard method has been confirmed, and there is no clear evidence to support the superiority of 1 procedure over others. This study aimed to evaluate the long-term clinical outcome of flexor hallucis longus tendon (FHL) transfer for chronic AT rupture with large defect. Clinical data of patients treated with FHL transfer due to chronic AT rupture between January 2009 and October 2019 were reviewed retrospectively. All cases were presented with AT rupture for more than 4 weeks after injury. The gap between ruptured ends was > 5 cm after debridement in all patients. The harvest of FHL was performed through a single incision in accordance with AT rupture debridement in all cases. Clinical outcomes were assessed with AOFAS ankle-hindfoot scale, Achilles tendon total rupture score and AOFAS hallux metatarsophalangeal-interphalangeal scale. Twenty-eight patients were followed successfully for 62.6 ± 22.2 months. According to the complete datasets obtained from 28 patients, none of the tendons re-ruptured. The AOFAS ankle-hindfoot scale and Achilles tendon total rupture score at last follow-up visit was 90.4 ± 5.7 and 89.8 ± 5.3 respectively, which revealed statistically significant improvement from the preoperative score of 61.1 ± 6.7 and 53.8 ± 8.3. The AOFAS hallux metatarsophalangeal-interphalangeal scale at last follow-up visit was 87.5 ± 6.1. The FHL transfer through a single incision for chronic AT rupture with large defect is a safe and simple method with low risk of morbidity and complications.
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Affiliation(s)
- Yangbo Xu
- Department of Orthopaedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, China
| | - Cui Li
- Department of Nosocomial Infection Control, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
| | - Tianyu Liu
- Department of Clinical Medicine, Southwest Medical University, Luzhou, Sichuan, China
| | - Feifan Xiang
- Department of Orthopaedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, China
| | - Yong Deng
- Department of Orthopaedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, China
| | - Zhong Li
- Department of Orthopaedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, China
| | - Daiqing Wei
- Department of Orthopaedics, Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, China
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Ikuta Y, Nakasa T, Kawabata S, Adachi N. Achilles Tendon Reconstruction Using a Hamstring Tendon Autograft for Chronic Rupture of the Achilles Tendon in Patients Over 70 Years of Age: A Retrospective Case Series. Cureus 2023; 15:e42788. [PMID: 37664307 PMCID: PMC10469802 DOI: 10.7759/cureus.42788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/05/2023] Open
Abstract
Reconstruction techniques using autologous hamstring tendons were generally applied for chronic Achilles tendon rupture with a large defect size. Previous studies have reported good clinical results of this technique for young or middle-aged patients, however, the clinical outcomes in older patients have been unclear. This retrospective case series reviewed four male patients aged >70 years (mean age, 78.5 years) who underwent Achilles tendon reconstruction using the hamstring tendon autograft for chronic rupture of the Achilles tendon with a large tendon defect. The proximal-distal length between the healthy tendon stumps was measured using sagittal T2-weighted magnetic resonance imaging (MRI). The American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and postoperative complications were evaluated. The duration from the traumatic event or appearance of symptoms to surgery was 3.8 (range, 2-6) months. The mean measured gap between the healthy tendon stumps was 67.5 mm on MRI. The AOFAS ankle-hindfoot score improved from 67.3 to 99.5 at the mean follow-up period of 40.3 (range, 23-75) months. No donor site morbidity was observed in all patients. Re-rupture was detected at the five-month follow-up in one patient who had removed a hinged ankle-foot orthosis with adjustable heel wedges without permission. Achilles tendon reconstruction using a hamstring tendon is a viable option for treating selected patients with chronic rupture of the Achilles tendon with a large tendon defect even in older patients. To improve clinical outcomes, a better understanding should be provided to family members as well as older patients regarding the postoperative rehabilitation program.
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Affiliation(s)
- Yasunari Ikuta
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Tomoyuki Nakasa
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Shingo Kawabata
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
| | - Nobuo Adachi
- Department of Orthopedic Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, JPN
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Kawai A, Morimoto S, Morio F, Tachibana T, Iseki T. Chronic Achilles tendon rupture in elderly treated with a combination of the side-locking loop suture technique and early rehabilitation protocol: two cases report. J Surg Case Rep 2023; 2023:rjad339. [PMID: 37309549 PMCID: PMC10257792 DOI: 10.1093/jscr/rjad339] [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: 04/06/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023] Open
Abstract
A chronic Achilles tendon rupture (ATR) is generally defined as a rupture that occurs more than 4-6 weeks after the initial injury. A variety of corrective techniques have been reported, such as direct repair, V-Y plasty, turndown flap, tendon transfer and free tendon grafting. These procedures generally produce good results, but have the disadvantage of requiring prolonged immobilization and weight-bearing restrictions. This may be a risk factor for falls and decreased function in the lower limbs, especially in older patients. Side-locking loop sutures (SLLS) were first introduced in 2010 as a direct repair technique for acute ATR. This technique provides higher tensile strength, which may allow for early rehabilitation protocols such as early range of motion and early weight-bearing of the ankle without postoperative immobilization. In this report, we describe two cases of chronic ATR in elderly patients treated with SLLS and an early rehabilitation protocol.
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Affiliation(s)
- Akira Kawai
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Shota Morimoto
- Correspondence address. Department of Orthopaedic Surgery, Hyogo Medical University, 1-1, Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan. Tel: +81-798-45-6452; Fax: +81-798-45-6453; E-mail:
| | - Futoshi Morio
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Toshiya Tachibana
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
| | - Tomoya Iseki
- Department of Orthopaedic Surgery, Hyogo Medical University, Nishinomiya, Hyogo, Japan
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Ahn J, Jeong BO. Return to Sports Activities After Flexor Hallucis Longus Transfer for Neglected Achilles Tendon Rupture. J Foot Ankle Surg 2022; 61:1263-1266. [PMID: 35370054 DOI: 10.1053/j.jfas.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 02/03/2023]
Abstract
Transfer of the flexor hallucis longus (FHL) is known to be effective in the treatment of neglected Achilles tendon rupture (ATR). However, evidence on the return to sports activity levels and clinical outcomes is not sufficient. The aim of this study was assessing clinical outcomes and level of sports activity after FHL tendon transfer for treatment of neglected ATR. Twenty-eight patients who underwent FHL transfer for neglected ATR were analyzed retrospectively. Sports activity status was assessed using the Tegner Activity Scale (TAS). Clinical outcomes were evaluated using the Achilles tendon total rupture score and the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale. By the post hoc power analyses, the power level of more than 80% was identified. The preinjury median TAS score was 4 point and unchanged at the last follow-up. The mean Achilles tendon Total Rupture Scores and American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale scores at the last follow-up were 81 and 93, respectively. While the median TAS was unchanged, 9/28 patients suffered from lower activity level after the procedure. In conclusion, midterm results of FHL transfer for neglected ATR were shown to be favorable. The median TAS score was maintained. Nonetheless, 32% of patients returned to sports activities with a TAS score 1 point lower than that at preinjury and with less favorable clinical outcomes.
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Affiliation(s)
- Jungtae Ahn
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Bi O Jeong
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
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8
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Yassin M, Gupta V, Martins A, Mahadevan D, Bhatia M. Patient reported outcomes and satisfaction following single incision Flexor Hallucis Longus (FHL) augmentation for chronic Achilles tendon pathologies. J Clin Orthop Trauma 2021; 23:101650. [PMID: 34824973 PMCID: PMC8600537 DOI: 10.1016/j.jcot.2021.101650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 08/02/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Various procedures exist to augment or reconstruct the Achilles tendon (AT) in patients suffering from chronic pathologies. The aim of this study is to assess patient reported outcomes and satisfaction following single incision FHL augmentation using a short tendon harvest with interference screw fixation. METHODS This is a multicentre case series where postoperative patient reported outcome and satisfaction scores were collected on 30 patients. Outcome measures included EQ-5D, EQ-VAS, Achilles Tendon Rupture Scores (ATRS), and satisfaction scores. Scores were also collected on the unaffected limbs for comparison. RESULTS Mean patient age was 61 years (range 40-79, SD 11). Mean EQ-5D index value was 0.750 (0.100-1.00, SD 0.238), and mean EQ-VAS score was 74 (36-99, SD 15), at a mean follow-up of 57 months (4-118, SD 32). For patients with ≥24 months' follow-up, a mean deficit of 16 ATRS points was found between the operated and unaffected limb. Overall satisfaction was over 86%. In cases of chronic AT rupture, younger age and increasing time from initial injury to surgery were predictors of greater residual deficit. No serious complications or failures occurred. CONCLUSIONS FHL augmentation using short tendon harvest and interference screw fixation is a safe treatment option. It appears to take at least 24 months to functionally recover following this procedure, and despite a residual function deficit, there is a high level of patient satisfaction. Further studies are required to determine optimal patient selection and timing of surgery.
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Affiliation(s)
- Mohamed Yassin
- Department of Trauma & Orthopaedics, Royal Berkshire Hospital, Reading, United Kingdom
| | - Vatsal Gupta
- Department of Trauma & Orthopaedics, Royal Berkshire Hospital, Reading, United Kingdom
| | - Andre Martins
- Department of Trauma & Orthopaedics, University Hospitals of Leicester, Leicester, United Kingdom
| | - Devendra Mahadevan
- Department of Trauma & Orthopaedics, Royal Berkshire Hospital, Reading, United Kingdom
| | - Maneesh Bhatia
- Department of Trauma & Orthopaedics, University Hospitals of Leicester, Leicester, United Kingdom
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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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Gunaratne R, Chong YC, Heng Y, Hahn J, Lek J, Randazzo A, Brankov B. Chronic Achilles tendon rupture: a novel modification of surgical technique described by El Shewy. ANZ J Surg 2021; 91:1447-1450. [PMID: 33956383 DOI: 10.1111/ans.16921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic Achilles tendon rupture is commonly defined as a rupture presenting 6 weeks after the time of injury and operative management is recommended. This research aims to describe a novel modified surgical technique in the repair of chronic Achilles tendon rupture and to report the result of this technique. METHODS This is a retrospective study performed between January 2007 and January 2017, and a novel modification of El Shewy et al.'s surgical technique is described. Fifteen patients with chronic rupture of Achilles tendon repaired with the technique by a single experienced surgeon were identified. Patients were contacted via phone call and questionnaires completed. Achilles Tendon Rupture Score and pain score were assessed via questionnaires. RESULTS Thirteen patients were contacted and two patients were uncontactable. Ten patients were able to return to their premorbid level of function. Twelve patients were satisfied or very satisfied with the outcome. Only one patient was very dissatisfied with the outcome. The average Achilles Tendon Rupture score was 72 (n = 7, 54%). The average pain score was 1.23 (n = 13, 100%). CONCLUSIONS This novel modified surgical technique demonstrated good functional outcomes and high levels of patient satisfaction in patient with chronic Achilles tendon rupture. It can be considered in the repair of chronic Achilles tendon rupture.
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Affiliation(s)
- Rajitha Gunaratne
- Orthopaedic department, Fremantle Hospital, Fremantle, Western Australia, Australia.,Curtin University, Perth, Western Australia, Australia.,Orthopaedic Department, Joondalup Health Campus, Perth, Western Australia, Australia
| | - Yu Chuan Chong
- Orthopaedic department, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Yi Heng
- Orthopaedic department, Fremantle Hospital, Fremantle, Western Australia, Australia.,Orthopaedic Department, Joondalup Health Campus, Perth, Western Australia, Australia
| | - Jayhee Hahn
- Orthopaedic Department, Joondalup Health Campus, Perth, Western Australia, Australia
| | - Jeremy Lek
- Orthopaedic Department, Joondalup Health Campus, Perth, Western Australia, Australia
| | - Amy Randazzo
- Orthopaedic department, Fremantle Hospital, Fremantle, Western Australia, Australia
| | - Boris Brankov
- Orthopaedic department, Fremantle Hospital, Fremantle, Western Australia, Australia
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Mansur NSB, Fonseca LF, Matsunaga FT, Baumfeld DS, Nery CADS, Tamaoki MJS. Achilles Tendon Lesions - Part 2: Ruptures. Rev Bras Ortop 2020; 55:665-672. [PMID: 33364642 PMCID: PMC7748929 DOI: 10.1055/s-0040-1702948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/05/2019] [Indexed: 11/07/2022] Open
Abstract
The increasing incidence of calcaneal tendon ruptures has substantially impacted orthopedic care and costs related to its treatment and prevention. Primarily motivated by the increasing of life expectancy, the growing use of tenotoxic drugs and erratic access to physical activity, this injury accounts for considerable morbidity regardless of its outcome. In recent years, the evolution of surgical and rehabilitation techniques gave orthopedists better conditions to decide the most appropriate conduct in acute tendon rupture. Although still frequent due to their high neglect rate, Achilles chronic ruptures currently find simpler and more biological surgical options, being supported by a new specialty-focused paradigm.
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Affiliation(s)
- Nacime Salomão Barbachan Mansur
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
| | - Lucas Furtado Fonseca
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
| | - Fábio Teruo Matsunaga
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
| | - Daniel Soares Baumfeld
- Departamento de Ortopedia e Traumatologia, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
| | - Caio Augusto de Souza Nery
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
| | - Marcel Jun Sugawara Tamaoki
- Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Saõ Paulo, SP, Brasil
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“Don’t Make the Gap” Surgical Technique and Case Series for Chronic Achilles Rupture. TECHNIQUES IN FOOT AND ANKLE SURGERY 2020. [DOI: 10.1097/btf.0000000000000296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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González-Quevedo D, Díaz-Ramos M, Chato-Astrain J, Sánchez-Porras D, Tamimi I, Campos A, Campos F, Carriel V. Improving the regenerative microenvironment during tendon healing by using nanostructured fibrin/agarose-based hydrogels in a rat Achilles tendon injury model. Bone Joint J 2020; 102-B:1095-1106. [PMID: 32731821 DOI: 10.1302/0301-620x.102b8.bjj-2019-1143.r2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
AIMS Achilles tendon injuries are a frequent problem in orthopaedic surgery due to their limited healing capacity and the controversy surrounding surgical treatment. In recent years, tissue engineering research has focused on the development of biomaterials to improve this healing process. The aim of this study was to analyze the effect of tendon augmentation with a nanostructured fibrin-agarose hydrogel (NFAH) or genipin cross-linked nanostructured fibrin-agarose hydrogel (GP-NFAH), on the healing process of the Achilles tendon in rats. METHODS NFAH, GP-NFAH, and MatriDerm (control) scaffolds were generated (five in each group). A biomechanical and cell-biomaterial-interaction characterization of these biomaterials was then performed: Live/Dead Cell Viability Assay, water-soluble tetrazolium salt-1 (WST-1) assay, and DNA-released after 48 hours. Additionally, a complete section of the left Achilles tendon was made in 24 Wistar rats. Animals were separated into four treatment groups (six in each group): direct repair (Control), tendon repair with MatriDerm, or NFAH, or GP-NFAH. Animals were euthanized for further histological analyses after four or eight weeks post-surgery. The Achilles tendons were harvested and a histopathological analysis was performed. RESULTS Tensile test revealed that NFAH and GP-NFAH had significantly higher overall biomechanical properties compared with MatriDerm. Moreover, biological studies confirmed a high cell viability in all biomaterials, especially in NFAH. In addition, in vivo evaluation of repaired tendons using biomaterials (NFAH, GP-NFAH, and MatriDerm) resulted in better organization of the collagen fibres and cell alignment without clinical complications than direct repair, with a better histological score in GP-NFAH. CONCLUSION In this animal model we demonstrated that NFAH and GP-NFAH had the potential to improve tendon healing following a surgical repair. However, future studies are needed to determine the clinical usefulness of these engineered strategies. Cite this article: Bone Joint J 2020;102-B(8):1095-1106.
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Affiliation(s)
- David González-Quevedo
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Málaga, Spain.,University of Granada, Granada, Spain
| | - Miriam Díaz-Ramos
- Department of Histology (Tissue Engineering Group), University of Granada, Granada, Spain
| | - Jesús Chato-Astrain
- University of Granada, Granada, Spain.,Department of Histology (Tissue Engineering Group), University of Granada, Granada, Spain
| | - David Sánchez-Porras
- Department of Histology (Tissue Engineering Group), University of Granada, Granada, Spain
| | - Iskandar Tamimi
- Department of Orthopedic Surgery and Traumatology, Regional University Hospital of Málaga, Málaga, Spain
| | - Antonio Campos
- Department of Histology (Tissue Engineering Group), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - Fernando Campos
- Department of Histology (Tissue Engineering Group), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria Ibs, Granada, Spain
| | - Víctor Carriel
- Department of Histology (Tissue Engineering Group), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria Ibs, Granada, Spain
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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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Zhao XY, Zhao HW, Yu M, Zheng ZH, Tang Y, Cui MM, Sun XY, Qin XZ, Liu YQ. Anatomical Study of the Compositions and Internal Connections of the Chiasma Plantare (Master Knot of Henry): Exploring Its Possible Clinical Impact. J Foot Ankle Surg 2019; 58:1235-1244. [PMID: 31494029 DOI: 10.1053/j.jfas.2018.09.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 09/08/2018] [Accepted: 09/09/2018] [Indexed: 02/03/2023]
Abstract
The purposes of this study were to integrate the types of interconnecting fibers among components of the chiasma plantare and to deduce their flexion actions. The chiasma plantare and the long flexor tendons in 52 cadaveric feet (26 left feet and 25 right feet) were dissected and removed via gross anatomic dissection. The connections among the flexor digitorum longus (FDL), flexor hallucis longus (FHL), and quadratus plantae (QP) were then classified and analyzed. The connection between the FHL and FDL was type I in 43 (86%) cases, type III in 2 (4%) cases, and type V in 5 (10%) cases, with the FHL manipulating the first through third toes and the FDL manipulating the first through the fifth toes. The shape of the QP in 28 (56%) cases exhibited a 2-headed QP, and in 22 (44%) cases, a medial-headed QP. The composition of the chiasma plantare was 2 layers in 28 (56%) cases and 3 layers in 22 (44%) cases: 9 (18%) cases were type a, 2 (4%) cases were type b1, and 1 (2%) case each was classified as type b2 and b3. The FHL controlled the second toe in 10 (20%) cases; both the second and third toes in 27 (54%) cases; and the second, third, and fourth toes in 13 (26%) cases. The QP manipulated the third and fourth toes in all cases, the second toe in 38 (76%) cases, and the fifth toe in 11 (22%) cases. These data suggest that such variations might result from tendon transfer. In conclusion, we considered the FDL to be more advanced for the recovery of both the ankle and the forefoot based on this study.
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Affiliation(s)
- Xin-Yue Zhao
- Undergraduate, Clinical Medicine, Medical College of Yanbian University, Yanji, Jilin Province, China
| | - Hong-Wei Zhao
- Associate Professor, Department of Anatomy, Medical College of Yanbian University, Yanji, Jilin Province, China
| | - Miao Yu
- Undergraduate, Clinical Medicine, Medical College of Yanbian University, Yanji, Jilin Province, China
| | - Ze-Hua Zheng
- Undergraduate, Clinical Medicine, Medical College of Yanbian University, Yanji, Jilin Province, China
| | - Yun Tang
- Undergraduate, Clinical Medicine, Medical College of Yanbian University, Yanji, Jilin Province, China
| | - Miao-Miao Cui
- Undergraduate, Clinical Medicine, Medical College of Yanbian University, Yanji, Jilin Province, China
| | - Xue-Yu Sun
- Undergraduate, Clinical Medicine, Medical College of Yanbian University, Yanji, Jilin Province, China
| | - Xiang-Zheng Qin
- Lecturer, Department of Anatomy, Medical College of Yanbian University, Yanji, Jilin Province, China.
| | - Yan-Qun Liu
- Associate Director Physician, Orthopaedic Department, Yanbian University Hospital, Yanji, Jilin Province, China.
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Vega J, Vilá J, Batista J, Malagelada F, Dalmau-Pastor M. Endoscopic Flexor Hallucis Longus Transfer for Chronic Noninsertional Achilles Tendon Rupture. Foot Ankle Int 2018; 39:1464-1472. [PMID: 30124070 DOI: 10.1177/1071100718793172] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND: Operative management of chronic Achilles tendon ruptures is challenging, and numerous techniques have been described. Risk of infection and wound breakdown have been described after open techniques, and minimally invasive methods have been proposed to avoid them. The aim of this study was to describe the clinical and radiological results obtained after endoscopic flexor hallucis longus (FHL) tendon transfer in patients with chronic Achilles tendon rupture. METHODS: Between 2012 and 2015, a total of 22 patients were endoscopically treated for chronic Achilles tendon rupture. Mean age was 69 years (range, 59-84 years). Mean follow-up was 30.5 months (range, 18-46 months). Preoperative magnetic resonance imaging (MRI) was obtained and tendon gap measured. An MRI was obtained at 9 to 12 months following surgery to evaluate Achilles tendon changes. RESULTS: Preoperative MRI examination showed a mean tendon gap of 6.3 cm (range, 3-10.7 cm). The MRI control was obtained only in 12 patients, and a normal or close to normal Achilles tendon was observed in all but 1 patient. The mean American Orthopaedic Foot & Ankle Society score increased from 55 preoperatively (range, 26-75) to 91 (range, 74-100) at final follow-up. All patients returned to their daily activities without difficulties. No patients reported complaints or symptomatic deficits of great toe flexion strength. No major complications were encountered. CONCLUSION: Chronic Achilles tendon ruptures were successfully treated by an all-endoscopic procedure. The endoscopically assisted FHL transfer provided excellent results while benefiting from the minimally invasive procedure advantages. However, it entailed some technical challenges and may not be suitable for less experienced surgeons. LEVEL OF EVIDENCE: Level IV, retrospective case series.
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Affiliation(s)
- Jordi Vega
- 1 Human Anatomy and Embriology Unit, University of Barcelona, Barcelona, Spain
- 2 Foot and Ankle Unit, Hospital Quirón Barcelona and, iMove Traumatology Tres Torres, Barcelona, Spain
- 3 Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied et de la Cheville (GRECMIP), Merignac, France
| | - Jesus Vilá
- 4 Orthopaedic and Trauma Surgery, Hospital Universitario 12 de Octubre, and Hospital Quirón Ruber, Madrid, Spain
- 5 Surgical Department, University Complutense of Madrid, Madrid, Spain
| | - Jorge Batista
- 6 Club Atletico Boca Juniors, Buenos Aires, Argentina
| | - Francesc Malagelada
- 7 Foot and Ankle Unit, Department of Trauma and Orthopaedic Surgery, Royal London Hospital, Barts Health NHS Trust, London, United Kingdom
| | - Miki Dalmau-Pastor
- 1 Human Anatomy and Embriology Unit, University of Barcelona, Barcelona, Spain
- 3 Groupe de Recherche et d'Etude en Chirurgie Mini-Invasive du Pied et de la Cheville (GRECMIP), Merignac, France
- 8 Faculty of Health Sciences at Manresa, University of Vic-Central University of Catalonia, Manresa, Barcelona, Spain
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Ushio K, Imade S, Takuwa H, Kadowaki M, Uchio Y. Atraumatic Spontaneous Achilles Tendon Rupture in Patients Receiving Oral Corticosteroids Treated With the Modified Side-Locking Loop Suture Technique. J Foot Ankle Surg 2018; 57:600-604. [PMID: 29398512 DOI: 10.1053/j.jfas.2017.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Indexed: 02/03/2023]
Abstract
Atraumatic spontaneous Achilles tendon ruptures sometimes occur in patients receiving oral corticosteroids. In general, these cases are treated surgically; however, delayed postoperative management can lead to impaired activities of daily living. The modified side-locking loop suture (SLLS) technique is a useful suture method for safe and early active mobilization. Three cases of spontaneous Achilles tendon ruptures were treated with the modified SLLS technique with good clinical results. The modified SLLS technique is a useful method with a short rehabilitation period for treating atraumatic spontaneous Achilles tendon rupture in patients undergoing corticosteroid therapy.
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Affiliation(s)
- Kiminori Ushio
- Orthopedist, Department of Orthopaedic Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Shinji Imade
- Assistant Professor, Department of Orthopaedic Surgery, Shimane University Faculty of Medicine, Shimane, Japan.
| | - Hiroshi Takuwa
- Orthopedist, Department of Orthopaedic Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Masaru Kadowaki
- Assistant Professor, Department of Orthopaedic Surgery, Shimane University Faculty of Medicine, Shimane, Japan
| | - Yuji Uchio
- Professor, Department of Orthopaedic Surgery, Shimane University Faculty of Medicine, Shimane, Japan
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Bąkowski P, Rubczak S, Wolff-Stefaniak M, Grygorowicz M, Piontek T. Reliability and validity of the Polish version of the Achilles tendon Total Rupture Score. Knee Surg Sports Traumatol Arthrosc 2018; 26:2074-2079. [PMID: 29094171 PMCID: PMC6061432 DOI: 10.1007/s00167-017-4764-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2017] [Accepted: 10/23/2017] [Indexed: 11/12/2022]
Abstract
PURPOSE The aim of this study was to perform the translation and cross-cultural adaptation of the Achilles tendon Total Rupture Score (ATRS) into Polish version, and to evaluate its reliability and validity. METHODS The ATRS was translated into Polish language according to the Beaton recommendations. A total number of 71 patients previously treated surgically (from 2011 to 2015), due to the Achilles tendon rupture, were enrolled in this study. ATRS-Polish was performed twice within a period of 5-10 days. To evaluate test-retest reliability, intra-rater coefficient (ICC) was calculated. Construct validity was determined by the Spearman's rank coefficient correlation between the ATRS-Polish and a Polish version of EQ-5D-5L questionnaire. RESULTS Test-retest reliability was found to be excellent (ICC 0.9). The mean and standard deviation of the first and second assessment amounted 87.4 ± 14.0 and 88.4 ± 13.2, respectively. Construct validity analysis showed a strong correlation between the ATRS and the EQ-5D-5L score (r = - 0.69.) and moderate correlation between ATRS and actual comfort (r = 0.47). CONCLUSIONS AND PERSPECTIVES Polish version of the Achilles tendon Total Rupture Score was found to be reliable and valid. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Paweł Bąkowski
- Orthopedic Department, Rehasport Clinic, Górecka 30, 60-201, Poznan, Poland.
| | - Szymon Rubczak
- Orthopedic Department, Rehasport Clinic, Górecka 30, 60-201, Poznan, Poland
| | | | | | - Tomasz Piontek
- Orthopedic Department, Rehasport Clinic, Górecka 30, 60-201, Poznan, Poland.,Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences Poznań, Poznan, Poland
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19
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Abstract
Healing in continuity with lengthening of the Achilles tendon is a disabling complication after Achilles tendon rupture. This results in weakness of ankle plantarflexion and a non-propulsive gait on the affected side. The elongated tendon may have to be shortened or reconstructed to re-establish the length and the physiologic tension in triceps surae muscle and allow restoration of push off. This technical note describes the details of endoscopic shortening of the Achilles tendon.
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Affiliation(s)
- T H Lui
- Department of Orthopaedics and Traumatology, North District Hospital, 9 Po Kin Road, Sheung Shui, NT, Hong Kong, China.
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Affiliation(s)
- Matthew J Kraeutler
- 1 Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Justin M Purcell
- 1 Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kenneth J Hunt
- 1 Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
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