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Lee M, Lee Y, Choi JH, Kim H, Jeong D, Park K, Kim J, Park J, Jang WY, Seo J, Lee J. Postoperative Long-Term Monitoring of Mechanical Characteristics in Reconstructed Soft Tissues Using Biocompatible, Immune-Tolerant, and Wireless Electronic Sutures. ACS NANO 2024; 18:12210-12224. [PMID: 38695533 DOI: 10.1021/acsnano.4c00396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Accurate postoperative assessment of varying mechanical properties is crucial for customizing patient-specific treatments and optimizing rehabilitation strategies following Achilles tendon (AT) rupture and reconstruction surgery. This study introduces a wireless, chip-less, and immune-tolerant in vivo strain-sensing suture designed to continuously monitor mechanical stiffness variations in the reconstructed AT throughout the healing process. This innovative sensing suture integrates a standard medical suturing thread with a wireless fiber strain-sensing system, which incorporates a fiber strain sensor and a double-layered inductive coil for wireless readout. The winding design of Au nanoparticle-based fiber electrodes and a hollow core contribute to the fiber strain sensor's high sensitivity (factor of 6.2 and 15.1 pF for revised sensitivity), negligible hysteresis, and durability over 10,000 stretching cycles. To ensure biocompatibility and immune tolerance during extended in vivo periods, an antibiofouling lubricant layer was applied to the sensing suture. Using this sensing system, we successfully monitored the strain responses of the reconstructed AT in an in vivo porcine model. This facilitated the postoperative assessment of mechanical stiffness variations through a well-established analytical model during the healing period.
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Affiliation(s)
- Mugeun Lee
- Department of Robotics and Mechatronics Engineering, DGIST Daegu 42988, Republic of Korea
| | - Yeontaek Lee
- School of Electrical and Electronic Engineering, Yonsei University Seoul 03722, Republic of Korea
| | - Ji Hye Choi
- Department of Orthopedic Surgery, Korea University College of Medicine Seoul 02841, Republic of Korea
- Institute of Nanobiomarker-Based Medicine, Korea University, Seoul 02841, Republic of Korea
| | - Hwajoong Kim
- Department of Robotics and Mechatronics Engineering, DGIST Daegu 42988, Republic of Korea
| | - Daun Jeong
- Department of Orthopedic Surgery, Korea University College of Medicine Seoul 02841, Republic of Korea
- Institute of Nanobiomarker-Based Medicine, Korea University, Seoul 02841, Republic of Korea
| | - Kijun Park
- School of Electrical and Electronic Engineering, Yonsei University Seoul 03722, Republic of Korea
| | - Jinho Kim
- Department of Robotics and Mechatronics Engineering, DGIST Daegu 42988, Republic of Korea
| | - Jae Park
- School of Electrical and Electronic Engineering, Yonsei University Seoul 03722, Republic of Korea
| | - Woo Young Jang
- Department of Orthopedic Surgery, Korea University College of Medicine Seoul 02841, Republic of Korea
- Institute of Nanobiomarker-Based Medicine, Korea University, Seoul 02841, Republic of Korea
| | - Jungmok Seo
- School of Electrical and Electronic Engineering, Yonsei University Seoul 03722, Republic of Korea
| | - Jaehong Lee
- Department of Robotics and Mechatronics Engineering, DGIST Daegu 42988, Republic of Korea
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Christensen M, Silbernagel KG, Zellers JA, Kjær IL, Rathleff MS. Feasibility of an early progressive resistance exercise program for acute Achilles tendon rupture. Pilot Feasibility Stud 2024; 10:66. [PMID: 38650039 PMCID: PMC11034137 DOI: 10.1186/s40814-024-01494-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 04/14/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Long-term strength deficits are common after Achilles tendon ruptures. Early use of progressive resistance exercises may help reduce strength deficits, but the feasibility of this approach is unknown. The aim was to investigate the feasibility of early progressive resistance exercises regarding patient acceptability and compliance with the intervention. METHODS We recruited patients with an acute Achilles tendon rupture treated non-surgically. During 9 weeks of immobilisation with a walking boot, participants attended weekly supervised physiotherapy sessions of progressive resistance exercises and performed home exercises, consisting of isometric ankle plantarflexion, seated heel-rise, and elastic band exercises. Acceptability was evaluated using a 7-point Likert scale (1 = very unacceptable and 7 = very acceptable) with feasibility threshold at 80% of the participants rating ≥ 4. Adherence to the exercises was defined as 80% of the participants performing at least 50% of the home exercises. During the intervention, tendon healing and adverse events were monitored. RESULTS Sixteen participants (mean age 46 (range 28-61), male/female = 13/3) completed the intervention. Pre-injury Achilles tendon total rupture score was 98 (SD 8). All participants rated the acceptability of the exercises ≥ 5 (moderate acceptable to very acceptable) at 9- and 13-week follow-up and 9/16 rated 7 points (very acceptable). Participants performed 74% (range 4-117) of the total prescribed home exercises and 15/16 performed > 50%. One participant was not compliant with the home exercises due to feeling uncomfortable performing these independently. There were no re-ruptures, but one case of deep venous thrombosis. CONCLUSIONS The early progressive resistance exercise program for treatment of non-surgically treated Achilles tendon rupture was feasible. Future studies should investigate the efficacy of the progressive intervention. TRIAL REGISTRATION The study was registered at Clinical Trials (NCT04121377) on 29 September 2019. CLINICALTRIALS NCT04121377 .
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Affiliation(s)
- Marianne Christensen
- Physiotherapy and Occupational Therapy, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark.
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark.
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
| | | | - Jennifer A Zellers
- Program in Physical Therapy and Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Inge Lunding Kjær
- Department of Orthopaedic Surgery, Aalborg University Hospital, Aalborg, Denmark
| | - Michael Skovdal Rathleff
- Physiotherapy and Occupational Therapy, Aalborg University Hospital, Hobrovej 18-22, Aalborg, 9000, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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McCarthy PA, Shah S, Thakker D, David L. Calcaneal Tuberosity Fracture With Complete Achilles Tendon Rupture: A Unique Surgical Challenge. Cureus 2024; 16:e57914. [PMID: 38725765 PMCID: PMC11081407 DOI: 10.7759/cureus.57914] [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: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
A calcaneal tuberosity avulsion fracture occurring simultaneously with a rupture of the Achilles tendon, although occurring through similar mechanisms, is a rare injury pattern to see in combination and presents a unique challenge to the surgeon. The patient we present was initially found to have a type II fracture of the calcaneal tuberosity. However, during surgical fixation of the fracture, a complete rupture of the Achilles tendon was noticed. The technique used in this case was the fixation of the fracture fragment with two 5 mm fully threaded screws. The tendon was then reattached to the calcaneus using two Mitek anchors (DePuy Mitek Inc., MA, USA) with a modified Bunnell technique. There are a number of techniques suggested in the literature, including, among others, K-wires (DePuy Mitek Inc., MA, USA) and screw fixation. Our patient recovered well and has now been discharged from further orthopaedic follow-up.
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Affiliation(s)
- Phillip A McCarthy
- Trauma and Orthopaedics, Maidstone and Tunbridge Wells National Health Service (NHS) Trust, Royal Tunbridge Wells, GBR
| | - Sohaib Shah
- Trauma and Orthopaedics, Maidstone and Tunbridge Wells National Health Service (NHS) Trust, Royal Tunbridge Wells, GBR
| | - Dev Thakker
- Trauma and Orthopaedics, Maidstone and Tunbridge Wells National Health Service (NHS) Trust, Royal Tunbridge Wells, GBR
| | - Lee David
- Trauma and Orthopaedics, Maidstone and Tunbridge Wells National Health Service (NHS) Trust, Royal Tunbridge Wells, GBR
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Schoenrock B, Muckelt PE, Hastermann M, Albracht K, MacGregor R, Martin D, Gunga HC, Salanova M, Stokes MJ, Warner MB, Blottner D. Muscle stiffness indicating mission crew health in space. Sci Rep 2024; 14:4196. [PMID: 38378866 PMCID: PMC10879143 DOI: 10.1038/s41598-024-54759-6] [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: 11/07/2023] [Accepted: 02/16/2024] [Indexed: 02/22/2024] Open
Abstract
Muscle function is compromised by gravitational unloading in space affecting overall musculoskeletal health. Astronauts perform daily exercise programmes to mitigate these effects but knowing which muscles to target would optimise effectiveness. Accurate inflight assessment to inform exercise programmes is critical due to lack of technologies suitable for spaceflight. Changes in mechanical properties indicate muscle health status and can be measured rapidly and non-invasively using novel technology. A hand-held MyotonPRO device enabled monitoring of muscle health for the first time in spaceflight (> 180 days). Greater/maintained stiffness indicated countermeasures were effective. Tissue stiffness was preserved in the majority of muscles (neck, shoulder, back, thigh) but Tibialis Anterior (foot lever muscle) stiffness decreased inflight vs. preflight (p < 0.0001; mean difference 149 N/m) in all 12 crewmembers. The calf muscles showed opposing effects, Gastrocnemius increasing in stiffness Soleus decreasing. Selective stiffness decrements indicate lack of preservation despite daily inflight countermeasures. This calls for more targeted exercises for lower leg muscles with vital roles as ankle joint stabilizers and in gait. Muscle stiffness is a digital biomarker for risk monitoring during future planetary explorations (Moon, Mars), for healthcare management in challenging environments or clinical disorders in people on Earth, to enable effective tailored exercise programmes.
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Affiliation(s)
- Britt Schoenrock
- NeuroMuscular System & Signaling Group, Berlin Center of Space Medicine and Extreme Environments, 10115 Berlin, Germany, Institute of Integrative Neuroanatomy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany, 10115, Berlin, Germany
| | - Paul E Muckelt
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Maria Hastermann
- Experimental and Clinical Research Center (ECRC) and NeuroCure Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | | | | | - Hans-Christian Gunga
- Institute of Physiology, Berlin Center of Space Medicine and Extreme Environments, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany, Berlin, Germany
| | - Michele Salanova
- NeuroMuscular System & Signaling Group, Berlin Center of Space Medicine and Extreme Environments, 10115 Berlin, Germany, Institute of Integrative Neuroanatomy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany, 10115, Berlin, Germany
| | - Maria J Stokes
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Martin B Warner
- School of Health Sciences, University of Southampton, Southampton, UK
| | - Dieter Blottner
- NeuroMuscular System & Signaling Group, Berlin Center of Space Medicine and Extreme Environments, 10115 Berlin, Germany, Institute of Integrative Neuroanatomy, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 10115 Berlin, Germany, 10115, Berlin, Germany.
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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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Barfod KW, Overgård AB, Hansen MS, Haddouchi IE, Toft M, Hölmich P. Effect of the Copenhagen Achilles Rupture Treatment Algorithm (CARTA) on Calf Muscle Volume and Tendon Elongation After Acute Achilles Tendon Rupture: A Predefined Secondary Analysis of the First 60 Patients in a Randomized Controlled Trial. Orthop J Sports Med 2023; 11:23259671231211282. [PMID: 38021304 PMCID: PMC10664448 DOI: 10.1177/23259671231211282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 06/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Surgical treatment of acute Achilles tendon rupture (ATR) lowers the risk of rerupture and may reduce calf atrophy and elongation of the Achilles tendon. The Copenhagen Achilles Rupture Treatment Algorithm (CARTA) was developed to provide individualized treatment selection based on ultrasonographic evaluation of the rupture. Purpose In a randomized setup, the present study aimed to investigate whether treatment selection using the CARTA could reduce atrophy and tendon elongation compared with (1) patients treated surgically and (2) patients treated nonsurgically. Study Design Randomized controlled trial; Level of evidence, 2. Methods A total of 60 patients with an acute ATR were randomly assigned to receive treatment based on the CARTA (intervention), surgical treatment (control), or nonsurgical treatment (control) in a 1 to 1 to 1 ratio. After 1 year, magnetic resonance imaging of both calves was performed, and muscle volume and Achilles tendon length were measured. Results were presented as the ratio between the affected and the unaffected limbs (ie, limb symmetry index; %). Results A total of 156 patients were assessed for eligibility, 60 patients were randomized, and 54 patients provided data for the study-19 patients received treatment based on the CARTA (intervention group), 17 patients received nonsurgical treatment (control), and 18 patients received surgical treatment (control). No statistically significant differences were found between the intervention group and the 2 control groups regarding muscle volume and tendon length. No statistically significant differences were found between patients treated surgically and patients treated nonsurgically. Comparison between the affected and the unaffected limb showed statistically significant muscle atrophy (24%-30%) and tendon elongation (soleus, 59%-76%; gastrocnemius, 8%-14%) in the affected limb in all 3 groups. Conclusion Individualized treatment of acute ATR using an ultrasonographic selection algorithm did not reduce calf muscle atrophy or tendon elongation when compared with surgical and nonsurgical treatment. Surgical treatment did not reduce calf muscle atrophy or tendon elongation compared with nonsurgical treatment.
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Affiliation(s)
- Kristoffer Weisskirchner Barfod
- Department of Orthopedic Surgery, Sports Orthopedic Research Center–Copenhagen (SORC-C), Copenhagen University Hospital Amager-Hvidovre, Denmark
| | - Anders Brøgger Overgård
- Department of Orthopedic Surgery, Sports Orthopedic Research Center–Copenhagen (SORC-C), Copenhagen University Hospital Amager-Hvidovre, Denmark
| | - Maria Swennergren Hansen
- Department of Physical and Occupational Therapy, Physical Medicine & Rehabilitation Research–Copenhagen (PMR-C), Copenhagen University Hospital Amager-Hvidovre, Denmark
| | - Ibrahim El Haddouchi
- Department of Orthopedic Surgery, Sports Orthopedic Research Center–Copenhagen (SORC-C), Copenhagen University Hospital Amager-Hvidovre, Denmark
| | - Marianne Toft
- Department of Orthopedic Surgery, Viborg Regional Hospital, Viborg, Denmark
| | - Per Hölmich
- Department of Orthopedic Surgery, Sports Orthopedic Research Center–Copenhagen (SORC-C), Copenhagen University Hospital Amager-Hvidovre, Denmark
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Geng X, Yang X, Teng Z, Hu X, Wang C, Zhang C, Chen L, Huang J, Wang X, Ma X. Is a Preoperative MRI Scan Necessary for Acute Achilles Tendon Rupture? Orthop Surg 2023; 15:2777-2785. [PMID: 37749776 PMCID: PMC10622284 DOI: 10.1111/os.13845] [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: 09/11/2022] [Revised: 07/09/2023] [Accepted: 07/11/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Different treatment methods have been developed for acute Achilles tendon rupture (ATR), including conservative treatment, minimally invasive or transdermal surgery, and open surgery, and there is no consensus about which method is superior. It is important to clarify the presence of Achilles tendon (AT) degeneration, the rupture site, and the rupture shape before surgery to determine whether minimally invasive or open surgery should be selected, thereby reducing the re-rupture rate following acute ATR. The aim of this study was to investigate the diagnostic value of MRI in identifying the presence of AT degeneration, the rupture site, and the rupture shape for acute closed ATR. METHODS From January 2016 to December 2019, patients with acute closed ATR who had undergone repair surgery were retrospectively enrolled. All patients received MRI examination, and the distance between the insertion site and broken end and the rupture shape (types I, II, and III) were independently determined by two observers. Then, the stump of the AT was exposed during the operation. The rupture site and rupture shape were recorded and compared and analyzed with the MRI results. Consistency analyses (using Cohen's kappa coefficient or intraclass correlation coefficient-ICC) and calculation of diagnostic performance indexes were, respectively, conducted to evaluate the diagnostic value of the MRI. RESULTS This study included 47 consecutive patients with acute ATR, with an average age of 38.4 years. Among them, 40 were male, and seven were female. The intraoperative exploration demonstrated a total of 34 (72.3%), 10 (21.3%), and three (6.4%) patients with type I, II, and III ruptures, respectively. The average distance between the insertion site and the proximal broken end measured intraoperatively was 4.07 ± 1.57 cm. High or excellent consistencies were found for ATR classifications (kappa: 0.739-0.770, p < 0.001) and rupture sites (ICC: 0.962-0.979, p < 0.001) between two observers and between observers 1 and 2 and intraoperative findings. Tendinopathy was identified in 22 patients by MRI and confirmed during surgery. CONCLUSIONS MRI scanning of acute closed ATR can help determine whether there is degeneration of the AT, as well as the location and shape of the rupture, which can guide the selection of the optimal operation method for orthopedic surgeons. Therefore, it is necessary to take preoperative MRI scans for patients with acute Achilles tendon ruptures.
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Affiliation(s)
- Xiang Geng
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Xiong‐gang Yang
- Department of OrthopaedicsThe First People's Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and TechnologyKunmingChina
- The Key Laboratory of Digital Orthopaedics of Yunnan ProvincialKunmingChina
| | - Zhao‐lin Teng
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Xing‐xi Hu
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Chen Wang
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Chao Zhang
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Li Chen
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Jia‐zhang Huang
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Xu Wang
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Xin Ma
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
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Shitrit E, Valentin E, Baudrier N, Bohu Y, Rauline G, Lopes R, Bauer T, Hardy A. The ALR-RSI score can be used to evaluate psychological readiness to return to sport after acute Achilles tendon tear. Knee Surg Sports Traumatol Arthrosc 2023; 31:4961-4968. [PMID: 37612477 PMCID: PMC10598148 DOI: 10.1007/s00167-023-07548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 08/10/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE The return to sport is one of the main goals following Achilles tendon tear repair. Several psychological factors influence the return to sport after a sports injury. The traditional tools to assess the return to sport do not take into account psychological factors. The ankle ligament reconstruction-return to sport injury (ALR-RSI), validated for ankle instability, is a score to evaluate psychological readiness to return to sport. The goal of this study was to validate the ALR-RSI score for the assessment of the readiness to return to sport after Achilles tendon repair. METHODS The ALR-RSI score, adapted from the anterior cruciate ligament-return to sport injury (ACL-RSI) score used following knee ligament reconstruction, was validated according to the international COSMIN methodology. Patients operated for Achilles tendon repair responded to the questionnaire during the rehabilitation period. The EFAS, FAAM and VISA-A scores were used as reference questionnaires. RESULTS A total of 50 patients were included. The ALR-RSI score was strongly (r > 0.5) correlated to the EFAS score: r = 0.68 [0.50-0.80] the FAMM sport score: r = 0.7 [0.52-0.84] the FAAM AVQ score (r = 0.6 [0.35-0.78]), and the VISA-A score (r = 0.54 [0.26-0.76]). The discriminant validity was good with the ALR-RSI, which was significantly lower in the patients that did not return to sport: 60.7 (40-81.4) compared to those that did: 83.2 (64.3-100) p = 0.001. Reproducibility was excellent with an intra-class correlation coefficient ρ of 0.99 [097-1.00]. The internal consistency was excellent (alpha coefficient = 0.95). CONCLUSION The ALR-RSI score provides a valid, reproducible assessment of the psychological readiness to return to sport in patients who undergo surgical Achilles tendon suture repair. LEVEL OF EVIDENCE III.
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Affiliation(s)
- E Shitrit
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France
| | - E Valentin
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France
| | - N Baudrier
- Clinique Jouvenet, 6 Sq. Jouvenet, 75016, Paris, France
| | - Y Bohu
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France
| | - G Rauline
- , 34 Rue Michal, 75013, Paris, France
| | - R Lopes
- chirurgie orthopedique, Pied cheville Nantes Atlantique, sante Atlantique, avenue Claude-Bernard, 44800, Saint-Herblain, France
- Clinique Brétéché, 3, rue de la Béraudière, BP 54613, 44046, Nantes Cedex 1, France
| | - T Bauer
- Service de chirurgie orthopedique et traumatologique, hopital Ambroise Paré, universite Paris-Saclay, Assistance publique-Hôpitaux de Paris, 9, avenue Charles-de-Gaulle, 92100, Boulogne-Billancourt, France
| | - A Hardy
- Clinique Du Sport, 28 Boulevard Saint-Marcel, 75005, Paris, France.
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van Dijk K, Khair RM, Sukanen M, Cronin NJ, Finni T. Medial gastrocnemius muscle fascicle function during heel-rise after non-operative repair of Achilles tendon rupture. Clin Biomech (Bristol, Avon) 2023; 105:105977. [PMID: 37156191 DOI: 10.1016/j.clinbiomech.2023.105977] [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: 08/21/2022] [Revised: 03/23/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND To better understand muscle remodelling in dynamic conditions after an Achilles tendon rupture, this study examined the length of medial gastrocnemius muscle fascicles during a heel-rise at 6- and 12-months after non-operative ATR treatment. METHODS Participants (15 M, 3F) were diagnosed with acute Achilles tendon rupture. Medial gastrocnemius subtendon length, fascicle length and pennation angle were assessed in resting conditions, and fascicle shortening during bi- and unilateral heel-rises. FINDINGS Fascicle shortening was smaller on the injured side (mean difference [95% CI]: -9.7 mm [-14.7 to -4.7 mm]; -11.1 mm [-16.5 to -5.8 mm]) and increased from 6- to 12 months (4.5 mm [2.8-6.3 mm]; 3.2 mm [1.4-4.9 mm]) in bi- and unilateral heel-rise, respectively. The injured tendon was longer compared to contralateral limb (2.16 cm [0.54-3.79 cm]) and the length decreased over time (-0.78 cm [-1.28 to -0.29 cm]). Tendon length correlated with fascicle shortening in bilateral (r = -0.671, p = 0.002; r = -0.666, p = 0.003) and unilateral (r = -0.773, p ≤ 0.001; r = -0.616, p = 0.006) heel-rise, at 6- and 12-months, respectively. In the injured limb, the change over time in fascicle shortening correlated with change in subtendon length in unilateral heel-rise (r = 0.544, p = 0.02). INTERPRETATION This study showed that the lengths of the injured tendon and associated muscle can adapt throughout the first year after rupture when patients continue physiotherapy and physical exercises. For muscle, measures of resting length may not be very informative about adaptations, which manifest themselves during functional tasks such as unilateral heel-rise.
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Affiliation(s)
- Koen van Dijk
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Rautpohjankatu 8, 40700 Jyväskylä, Jyväskylä, Finland
| | - Raad M Khair
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Rautpohjankatu 8, 40700 Jyväskylä, Jyväskylä, Finland
| | - Maria Sukanen
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Rautpohjankatu 8, 40700 Jyväskylä, Jyväskylä, Finland
| | - Neil J Cronin
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Rautpohjankatu 8, 40700 Jyväskylä, Jyväskylä, Finland; School of Sport & Exercise, University of Gloucestershire, Gloucestershire, UK
| | - Taija Finni
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Rautpohjankatu 8, 40700 Jyväskylä, Jyväskylä, Finland.
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Qureshi A, Gulati A, Adukia V, Shah A, Mangwani J. The influence of the site of rupture and gap distance in acute Achilles tendon rupture treated with functional rehabilitation. Injury 2023; 54:1216-1221. [PMID: 36828734 DOI: 10.1016/j.injury.2023.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 02/02/2023] [Accepted: 02/08/2023] [Indexed: 02/26/2023]
Abstract
AIM To determine the influence of gap distance and its location on clinical and radiological outcomes in patients with acute rupture of Tendo-Achilles (TA) treated non-operatively with functional rehabilitation. METHODS Twenty-six patients with acute complete TA rupture underwent ultrasound (US) scanning within a week of their injury. The measurements taken included the distance of the rupture from the enthesis and the gap distance between the tendon edges in varying degrees of ankle and knee positions. All patients were managed non-operatively in functional weight-bearing orthoses. Nineteen patients were then followed up at a mean of 6.1 years (range 5.8-6.5) to assess their clinical and radiological outcomes. The outcomes included ultrasound assessment of tendon healing, Achilles Tendon Rupture Score (ATRS) and modified Leppilahti Score (mLS). RESULTS In the initial ultrasound, the mean distance of the rupture from the enthesis was 52 mm (range: 40-76). The mean gap distance with the foot plantigrade was 11.4 mm, which reduced to 4.8 mm with the foot in equinus. At final follow up, no re-ruptures had occurred. The mean ATRS and mLS were 86 and 71 respectively. There was a significant correlation between the distance of the rupture from the enthesis with the MLS total score (p = 0.02), mLS Fatigue domain score (p = 0.03), and the ATRS domains of strength (p = 0.04) and fatigue (p = 0.02). There was no significant correlation between the measured gap distance with respect to the mLS, ATRS or individual ATRS domain scores. Also, there was no significant difference in ATRS and mLS outcomes when comparing tendons with respect to healed tissue appearance and fibre orientation on ultrasound. CONCLUSION The initial gap distance had no relationship with any of the measured clinical outcomes at the final follow up. The distance of the gap from the enthesis, however, may carry a greater prognostic value following non-operative treatment of Achilles tendon injuries.
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Affiliation(s)
| | | | - Vidhi Adukia
- University Hospitals of Leicester NHS Trust, UK.
| | - Amit Shah
- University Hospitals of Leicester NHS Trust, UK
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Tarczyńska M, Szubstarski M, Gawęda K, Przybylski P, Czekajska-Chehab E. Outcomes of Open Repair Treatment for Acute Versus Chronic Achilles Tendon Ruptures: Long-Term Retrospective Follow-Up of a Minimum 10 Years-A Pilot Study. Med Sci (Basel) 2023; 11:medsci11020025. [PMID: 37092494 PMCID: PMC10123621 DOI: 10.3390/medsci11020025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 04/25/2023] Open
Abstract
The aim of the present study was to compare repaired Achilles tendon (AT) remodelling, whether its function was restored and what effects the surgery had on our patients' gait cycle in a long-term follow-up study. The study population comprised 30 human subjects treated acutely and chronically for AT ruptures, using the same surgical technique in all cases. The study group was divided into two subgroups regarding the age of their AT injury, i.e., how much time elapsed between the injury and when a correct diagnosis was made and when adequate treatment was applied. Following these criteria, persons presenting at less than 4 weeks postinjury were classified as acute rupture (AR) patients and those presenting at more than 4 weeks after injury were grouped as chronic rupture (CR) patients. Both patient groups were operated on using a surgical method favoured at least a decade ago, i.e., open repair through a posteromedial approach. The AT was augmented with a plantaris longus tendon autograft, followed by suturing using the pull-out suture technique. The results were measured using clinical, ultrasonographic (US) and pedobarographic methods. Our ultrasonographic and pedobarographic findings revealed differences between both patient groups, thus indicating that delayed surgery had negative impacts on treatment success, however, with good long-term functional score outcomes in both patient groups. Nevertheless, delayed treatment of AT ruptures did not leave individual gait phases unaffected, as it also affected the plantar surface and balance performance of the affected limb. As per the results, the Achilles tendon manifested decreased capacity following delayed treatment; however, its long-term functional outcomes were favourable, irrespective of whether it was for acute or chronic patients.
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Affiliation(s)
- Marta Tarczyńska
- Orthopaedic Surgery and Traumatology Department, Medical University of Lublin, 20-950 Lublin, Poland
| | - Mateusz Szubstarski
- Orthopaedic and Traumatology Department, District Hospital of Krasnik, 20-950 Lublin, Poland
| | - Krzysztof Gawęda
- Orthopaedic Surgery and Traumatology Department, Medical University of Lublin, 20-950 Lublin, Poland
| | - Piotr Przybylski
- 1st Department of Medical Radiology, Medical University of Lublin, 20-950 Lublin, Poland
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Notermans T, Isaksson H. Predicting the formation of different tissue types during Achilles tendon healing using mechanoregulated and oxygen-regulated frameworks. Biomech Model Mechanobiol 2022; 22:655-667. [PMID: 36542228 PMCID: PMC10097799 DOI: 10.1007/s10237-022-01672-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 12/08/2022] [Indexed: 12/24/2022]
Abstract
AbstractDuring Achilles tendon healing in rodents, besides the expected tendon tissue, also cartilage-, bone- and fat-like tissue features have been observed during the first twenty weeks of healing. Several studies have hypothesized that mechanical loading may play a key role in the formation of different tissue types during healing. We recently developed a computational mechanobiological framework to predict tendon tissue production, organization and mechanical properties during tendon healing. In the current study, we aimed to explore possible mechanobiological related mechanisms underlying formation of other tissue types than tendon tissue during tendon healing. To achieve this, we further developed our recent framework to predict formation of different tissue types, based on mechanobiological models established in other fields, which have earlier not been applied to study tendon healing. We explored a wide range of biophysical stimuli, i.e., principal strain, hydrostatic stress, pore pressure, octahedral shear strain, fluid flow, angiogenesis and oxygen concentration, that may promote the formation of different tissue types. The numerical framework predicted spatiotemporal formation of tendon-, cartilage-, bone- and to a lesser degree fat-like tissue throughout the first twenty weeks of healing, similar to recent experimental reports. Specific features of experimental data were captured by different biophysical stimuli. Our modeling approach showed that mechanobiology may play a role in governing the formation of different tissue types that have been experimentally observed during tendon healing. This study provides a numerical tool that can contribute to a better understanding of tendon mechanobiology during healing. Developing these tools can ultimately lead to development of better rehabilitation regimens that stimulate tendon healing and prevent unwanted formation of cartilage-, fat- and bone-like tissues.
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Affiliation(s)
- Thomas Notermans
- Department of Biomedical Engineering, Lund University, Lund, Sweden.
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Lund, Sweden
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13
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Boksh K, Elbashir M, Thomas O, Divall P, Mangwani J. Platelet-Rich Plasma in acute Achilles tendon ruptures: A systematic review and meta-analysis. Foot (Edinb) 2022; 53:101923. [PMID: 36037774 DOI: 10.1016/j.foot.2022.101923] [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: 12/02/2021] [Accepted: 03/13/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Platelet Rich Plasma (PRP) is known to exert multi-directional biological effects favouring tendon healing. However, conclusions drawn by numerous studies on its clinical efficacy for acute Achilles tendon rupture are limited. We performed a systematic review and meta-analysis to investigate this and to compare to those without PRP treatment. METHODS The Cochrane Controlled Register of Trials, Pubmed, Medline and Embase were used and assessed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria with the following search terms: ('plasma' OR 'platelet-rich' OR 'platelet-rich plasma' or 'PRP') AND ('Achilles tendon rupture/tear' OR 'calcaneal tendon rupture/tear' OR 'tendo calcaneus rupture/tear'). Data pertaining to biomechanical outcomes (heel endurance test, isokinetic strength, calf-circumference and range of motion), patient-reported outcome measures (PROMs) and incidence of re-ruptures were extracted. Meta-analysis was performed for same outcomes measured in at least three studies. Pooled outcome data were analysed by random- and fixed-effects models. RESULTS After abstract and full-text screening, 6 studies were included. In total there were 510 patients of which 256 had local PRP injection and 254 without. The average age was 41.6 years, mean time from injury to treatment 5.9 days and mean follow-up at 61 weeks. Biomechanically, there was similar heel endurance, isokinetic strength, calf circumference and range of motion between both groups. In general, there were no differences in patient reported outcomes from all scoring systems used in the studies. Both groups returned to their pre-injured level at a similar time and there were no differences on the incidence of re-rupture (OR 1.13, 95% CI, 0.46-2.80, p = 0.79). CONCLUSION PRP injections for acute Achilles tendon ruptures do not improve medium to long-term biomechanical and clinical outcomes. However, future studies incorporating the ideal application and biological composition of PRP are required to investigate its true clinical efficacy.
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Affiliation(s)
- Khalis Boksh
- Academic Team of Musculoskeletal Surgery, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK.
| | - Mohamed Elbashir
- Academic Team of Musculoskeletal Surgery, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Owain Thomas
- Academic Team of Musculoskeletal Surgery, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Pip Divall
- Academic Team of Musculoskeletal Surgery, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Jitendra Mangwani
- Academic Team of Musculoskeletal Surgery, Department of Trauma and Orthopaedics, University Hospitals of Leicester NHS Trust, Leicester, UK
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Fast Functional Rehabilitation Protocol versus Plaster Cast Immobilization Protocol after Achilles Tendon Tenorrhaphy: Is It Different? Clinical, Ultrasonographic, and Elastographic Comparison. Diagnostics (Basel) 2022; 12:diagnostics12081824. [PMID: 36010175 PMCID: PMC9406849 DOI: 10.3390/diagnostics12081824] [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: 07/04/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 11/17/2022] Open
Abstract
Background: the incidence of Achilles tendon (AT) rupture is rising; however, there is no clear consensus regarding the optimal treatment. The aim of this retrospective study was to compare instrumental and patient-reported outcome scores after fast functional rehabilitation (group A) versus plaster cast immobilization (group B) programs in patients who underwent AT tenorrhaphy. Methods: 33 patients, with similar clinical and demographic features, underwent open AT tenorrhaphy between January and July 2018. Of these, 15 patients were treated with fast functional rehabilitation program (group A), and 18 patients were treated with plaster cast immobilization protocol (group B). Sural triceps hypotrophy and functional scores (American Orthopaedic Foot and Ankle Society (AOFAS) Ankle–Hindfoot Score, and Achilles tendon Total Rupture Score (ATRS)) were recorded at a 12-month follow-up. Ultrasonography (US) and elastosonography (ES) were used to compare the characteristics of the tendons after surgery. Results: At 12 months, no significant differences in any of the patient-reported outcomes or the instrumental measurement tests were seen between the two groups. Conclusions: fast functional rehabilitation after AT surgical repair is safe, effective, and may be the first choice of treatment, especially in young, collaborative, and active patients.
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de Oliveira PR, Arrebola LS, Stéfani KC, Pinfildi CE. Photobiomodulation Associated With Conservative Treatment for Achilles Tendon Rupture: A Double-Blind, Superiority, Randomized Controlled Trial. Arch Rehabil Res Clin Transl 2022; 4:100219. [PMID: 36545533 PMCID: PMC9761261 DOI: 10.1016/j.arrct.2022.100219] [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] [Indexed: 12/24/2022] Open
Abstract
Objective To investigate the effects of photobiomodulation on Achilles tendon rupture (ATR) treated conservatively. Design Prospective, patient- and assessor-blinded, parallel, randomized controlled trial. Setting Patients with acute ATR treated conservatively. Participants Thirty-four male individuals with acute unilateral ATR treated conservatively (N=34), equally divided in 2 groups: photobiomodulation group (PBMG) and sham group, with mean age of 45.5±9.47 and 48.7±8.38 years, respectively. Intervention All participants underwent through an immobilization period, followed by rehabilitation sessions (2 d/wk for 12 weeks) comprising strengthening, range of motion, and balance/weightbearing exercises. In PBMG, the tendon was irradiated with a photobiomodulation cluster (1 904 nm/50 mW infrared laser, 4 858 nm/50 mW infrared diodes, and 4 658 nm/40 mW red diodes; power density of 105 mW/cm2 per cluster area) during the immobilization period (2 d/wk for 8 weeks) and the sham group received a simulation of the procedure with no irradiation. Outcomes were assessed at the removal of the immobilization 12 and 16 weeks after tendon rupture. Main Outcome Measures Primary outcome was the Achilles Tendon Rupture Score. Secondary outcomes included Numerical Pain Rating Scale at rest and during effort, plantar flexor strength, and ankle range of motion. Results Both groups demonstrated an increase in the Achilles Tendon Rupture Score and improvements in range of motion, plantar flexor strength, and pain. There were no significant differences in outcomes between the 2 groups (P>.05) except in pain during walking, which was significantly lower in the PBMG in week 12 (P<.01, effect size=0.56) and week 16 (P<.01, effect size=0.55). Conclusion Photobiomodulation associated with conservative treatment is not superior to conservative treatment alone for improving function in patients with acute ATR.
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Key Words
- ATR, Achilles tendon rupture
- ATRS, Achilles Tendon Rupture Score
- Achilles tendon
- CI, confidence interval
- ES, effect size
- IAMSPE, Institute of Medical Assistance to the State Public Servant
- Low-level light therapy
- NPRS, Numerical Pain Rating Scale
- PBM, photobiomodulation
- PBMG, photobiomodulation group
- ROM, range of motion
- Rehabilitation
- SG, sham group
- WALT, World Association for Photobiomodulation Therapy
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Affiliation(s)
- Pedro Rizzi de Oliveira
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Baixada Santista Campus, São Paulo,Physical Therapy Department, Institute of Medical Assistance to the State Public Servant (IAMSPE), São Paulo,Corresponding author Pedro Rizzi de Oliveira, PT, MSc, Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Rua Silva Jardim, 136 Vila Matias, Santos, São Paulo 11015-020.
| | - Lucas Simões Arrebola
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Baixada Santista Campus, São Paulo,Physical Therapy Department, Institute of Medical Assistance to the State Public Servant (IAMSPE), São Paulo
| | - Kelly Cristina Stéfani
- Center of Technological Innovation, University of Sao Paulo Hospital of Clinics (HC-FMUSP), São Paulo, Brazil
| | - Carlos Eduardo Pinfildi
- Department of Human Movement Sciences, Federal University of São Paulo (UNIFESP), Baixada Santista Campus, São Paulo
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Mansfield K, Dopke K, Koroneos Z, Bonaddio V, Adeyemo A, Aynardi M. Achilles Tendon Ruptures and Repair in Athletes-a Review of Sports-Related Achilles Injuries and Return to Play. Curr Rev Musculoskelet Med 2022; 15:353-361. [PMID: 35804260 DOI: 10.1007/s12178-022-09774-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Achilles tendon ruptures (ATR) are detrimental to sports performance, and optimal treatment strategy and guidelines on return to play (RTP) remain controversial. This current review investigates the recent literature surrounding nonoperative versus operative management of ATR, clinical outcomes, and operative techniques to allow the athlete a successful return to their respective sport. RECENT FINDINGS The Achilles tendon (AT) is crucial to the athlete, as it is essential for explosive activities such as running and jumping. Athletes that sustain an ATR play in fewer games and perform at a lower level of play compared to age-matched controls. Recent studies also theorize that ATRs occur due to elongation of the tendon with fatigue failure. Biomechanical studies have focused on comparing modes of fixation under dynamic loading to recreate this mechanism. ATRs can be career-ending injuries. Fortunately, the recent incorporation of early weight-bearing and functional rehabilitation programming for non-operative and operative patients alike proves to be beneficial. Especially for those treated nonoperatively, with the incorporation of functional rehabilitation, the risk of re-rupture among non-operative patients is beginning to approach the historical lower risk of re-rupture observed among patients treated operatively. Despite this progress in decreasing risk of re-rupture particularly among non-operative patients, operative managements are associated with unique benefits that may be of particular interest for athletes and active individuals. Recent studies demonstrate that operative intervention improves strength and functional outcomes with more efficacy compared to nonoperative management with rehabilitation. The current literature supports operative intervention in elite athletes to improve performance and shorten the duration to RTP. However, we acknowledge that surgical intervention does have inherent risks. Ultimately, most if not all young and/or high-level athletes with an ATR benefit from surgical repair, but it is crucial to take a stepwise algorithmic approach and consider other factors, which may lead towards nonoperative intervention. These factors include age, chronicity of injury, gap of ATR, social factors, and medical history amongst others in this review.
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Affiliation(s)
- Kirsten Mansfield
- Center for Orthopaedic Research and Translational Science, The Pennsylvania State University, 500 University Drive, H089, Hershey, PA, 17033, USA
| | - Kelly Dopke
- Center for Orthopaedic Research and Translational Science, The Pennsylvania State University, 500 University Drive, H089, Hershey, PA, 17033, USA
| | - Zachary Koroneos
- Center for Orthopaedic Research and Translational Science, The Pennsylvania State University, 500 University Drive, H089, Hershey, PA, 17033, USA
| | - Vincenzo Bonaddio
- Penn State Milton Hershey Medical Center Department of Bone and Joint, 30 Hope Drive, Building A; PO Box 859, Hershey, PA, 17033, USA
| | - Adeshina Adeyemo
- Penn State Milton Hershey Medical Center Department of Bone and Joint, 30 Hope Drive, Building A; PO Box 859, Hershey, PA, 17033, USA
| | - Michael Aynardi
- Penn State Milton Hershey Medical Center Department of Bone and Joint, 30 Hope Drive, Building A; PO Box 859, Hershey, PA, 17033, USA.
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Tang K, Deng Z, Wang T, Sun X, Yin L, Nie M. Panda rope bridge technique versus open repair of acute Achilles tendon rupture: A comparative clinical study. Injury 2022; 53:2666-2670. [PMID: 35636979 DOI: 10.1016/j.injury.2022.05.038] [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: 10/19/2021] [Revised: 04/27/2022] [Accepted: 05/22/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The treatment options of acute Achilles tendon rupture (AATR) remain controversial. This article aims to compare the efficacy of a new surgical procedure, the panda rope bridge technique (PRBT) with open surgery of AATR. METHODS Ninety-eight patients with AATR were recruited, 53 underwent the PBRT, and 45 underwent open surgery. The operation time, postoperative American Orthopaedic Foot and Ankle Score, Achilles Tendon Rupture Score, complications and time to return to work and restore exercise were documented. RESULTS The average operation time, intraoperative blood loss and complication rate were 35.1 min, 18.2 ml and 3.8%, respectively, in the PRBT group, which were significantly lower than those of the open surgery group (P<0.001). The post-operative American Orthopaedic Foot and Ankle Score of 99.6 and the Achilles Tendon Rupture Score of 97.5 in the PRBT group were significantly higher than that of the open surgery group (P<0.001). The time to return to work and return to exercise were shorter in the PRBT group (P<0.001). CONCLUSION Compared to open surgery, PRBT is a better approach to the management of AATR. PRBT offers accelerated recovery, lower occurrence of post-operative complications and improved recovery of ankle joint function.
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Affiliation(s)
- Kaiying Tang
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Zhibo Deng
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Ting Wang
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Xianding Sun
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Liangjun Yin
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Mao Nie
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China.
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18
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Functional outcome of early weight bearing for acute Achilles tendon rupture treated conservatively in a weight-bearing orthosis. Foot Ankle Surg 2022; 28:595-602. [PMID: 34301483 DOI: 10.1016/j.fas.2021.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 06/07/2021] [Accepted: 06/28/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The optimal management for Achilles tendon (AT) ruptures is controversial and still continues to encourage debate. Conventionally, operative repair was favoured secondary to its lower rates of re-rupture, however in more recent years, we have seen promising results and a reduction in complications with conservative management. One reason for this improvement may be due to the introduction of a functional weight-bearing orthosis, however, results for complete AT ruptures is still unclear. This study aims to evaluate the functional outcomes of early weight bearing in a functional orthosis for conservatively managed, complete AT ruptures. METHODOLOGY This study was done at East Kent Hospital University Foundation Trust in between 2019-2020. In this prospective study, we have analysed data from 41 patients with US diagnosed compete AT ruptures, with a gap less than 5 cm. Every patient was treated in a functional weight-bearing orthosis (VACOped®) for 8 weeks with early weight-bearing following a specific treatment protocol, followed by rehabilitation with a trained physiotherapist. All patients received a final follow-up at 1 year post injury, where we recorded the following functional outcome measurements on each leg: calf girth, single leg heel raise height, single leg heel raise repetitions and the ATRS score. RESULT Our study population was predominantly male with an average age of 50 (range 22-79). The majority of the cohort were physically active, with more than 75% involved in a form of sporting activity pre-injury and 15% involved in higher level activity and competitive sport. The mean ATRS score was 82.1, with a re-rupture rate of only 2%. The average calf bulk difference was 1.6 cm, average heel raise height difference was 1.8 cm and a heel raise repetition difference of 6. There was a statistically significant correlation between ATRS score and calf muscle girth (p = 0.02). However, there was no significant correlation between ATRS score and heel raise height or single heel raise repetitions. CONCLUSION Early weight-bearing in a functional orthosis provides excellent functional outcomes for conservatively managed, complete AT ruptures, and is associated with very low re-rupture rates. However, a multidisciplinary approach with a guided rehabilitation programme is essential for optimising functional outcome.
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19
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Burton I, McCormack A. Blood Flow Restriction Resistance Training in Tendon Rehabilitation: A Scoping Review on Intervention Parameters, Physiological Effects, and Outcomes. Front Sports Act Living 2022; 4:879860. [PMID: 35548459 PMCID: PMC9083008 DOI: 10.3389/fspor.2022.879860] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 03/31/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To identify current evidence on blood flow restriction training (BFRT) in tendon injuries and healthy tendons, evaluating physiological tendon effects, intervention parameters, and outcomes. Methods This scoping review was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Databases searched included MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, Cochrane library (Controlled trials, Systematic reviews), and five trial registries. Two independent reviewers screened studies at title/abstract and full text. Following screening, data was extracted and charted, and presented as figures and tables alongside a narrative synthesis. Any study design conducted on adults, investigating the effects of BFRT on healthy tendons or tendon pathology were included. Data were extracted on physiological tendon effects, intervention parameters and outcomes with BFRT. Results Thirteen studies were included, three on tendinopathy, two on tendon ruptures, and eight on healthy Achilles, patellar, and supraspinatus tendons. A variety of outcomes were assessed, including pain, function, strength, and tendon morphological and mechanical properties, particularly changes in tendon thickness. BFRT intervention parameters were heterogeneously prescribed. Conclusion Despite a dearth of studies to date on the effects of BFRT on healthy tendons and in tendon pathologies, preliminary evidence for beneficial effects of BFRT on tendons and clinical outcomes is encouraging. As BFRT is a relatively novel method, definitive conclusions, and recommendations on BFRT in tendon rehabilitation cannot be made at present, which should be addressed in future research, due to the potential therapeutic benefits highlighted in this review.
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Affiliation(s)
- Ian Burton
- Musculoskeletal (MSK) Service, Fraserburgh Physiotherapy Department, Fraserburgh Hospital, National Health Service (NHS) Grampian, Aberdeen, United Kingdom
- *Correspondence: Ian Burton
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20
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Khair RM, Stenroth L, Cronin NJ, Reito A, Paloneva J, Finni T. Muscle-tendon morphomechanical properties of non-surgically treated Achilles tendon 1-year post-rupture. Clin Biomech (Bristol, Avon) 2022; 92:105568. [PMID: 35066440 DOI: 10.1016/j.clinbiomech.2021.105568] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 10/12/2021] [Accepted: 12/30/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Achilles tendon rupture appears to alter stiffness and length of the tendon. These alterations may affect the function of tendon in force transmission and in energy storage and recovery. We studied the mechanical properties of the Achilles' tendon post-rupture and their association with function. METHODS Twenty-four (20 males, 4 females) participants (mean age: 43 y, 176 cm, 81 kg) were recruited. Ultrasonography and dynamometry were used to assess the muscle-tendon unit morphological and mechanical properties of non-surgically treated patients 1-year post rupture. FINDINGS Injured tendons were longer with difference of 1.8 cm (95%CI: 0.5-1.9 cm; P < 0.001), and thicker by 0.2 mm (0.2-0.3 mm; P < 0.01). Medial gastrocnemius cross-sectional area was 1.0 cm2 smaller (0.8-1.1 cm2; P < 0.001), fascicles were 0.6 cm shorter (0.5-0.7 cm; P < 0.001) and pennation angle was 2.5° higher (1.3-3.6°; P < 0.001) when compared to the uninjured limb. We found no differences between injured and uninjured tendon stiffness 1-year post-rupture (mean difference: 29.8 N/mm, -7.7-67.3 N/mm; P = 0.170). The injured tendon showed 1.8 mm (1.2-2.4 mm; P < 0.01) lower elongation during maximal voluntary isometric contractions. Patient-reported functional outcome was related to the tendon resting length (β = 0.68, r(10) = 4.079, P = 0.002). Inter-limb differences in the medial gastrocnemius fascicle length were related to inter-limb differences in maximum contractions (β = 1.17, r(14) = 2.808, P = 0.014). INTERPRETATION Longer Achilles tendon resting length was associated with poorer self-evaluated functional outcome. Although the stiffness of non-surgically treated and uninjured tendons was similar 1-year post rupture, plantar flexion strength deficit was still present, possibly due to shorter medial gastrocnemius fascicle length.
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Affiliation(s)
- Ra'ad M Khair
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland.
| | - Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Neil J Cronin
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland; School of Sport & Exercise, University of Gloucestershire, UK
| | | | - Juha Paloneva
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland; Central Finland Health Care District, Finland
| | - Taija Finni
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
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Kvist J, Silbernagel KG. Fear of Movement and Reinjury in Sports Medicine: Relevance for Rehabilitation and Return to Sport. Phys Ther 2022; 102:6480895. [PMID: 34971375 DOI: 10.1093/ptj/pzab272] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/21/2021] [Accepted: 11/15/2021] [Indexed: 11/14/2022]
Abstract
Athletes are defined by their ability to move and are often accustomed to pain as it relates to their sports and exercise regime. The forced movement restriction and pain associated with an acute or overuse injury has a profound effect not only on their physical abilities but also on their psychological well-being and social context. With the goal of returning to sport, the rehabilitation focus historically has been on recovery of physical attributes, but more recent research is addressing the psychological factors. This Perspective proposes that-according to the current evidence in sports medicine-the fear that affects choice of treatment, rehabilitation, and return to sports is intertwined with physical capacity and recovery of function. Past injury is also 1 of the main risk factors for a sports injury; therefore, fear of reinjury is not irrational. For an athlete, the fear related to a sports injury encompasses the fear of reinjury along with fear of not being able to return to the sport at their highest performance level-and the fear of having lifelong debilitating pain and symptoms. This Perspective reviews the evidence for the influence of fear of movement and reinjury on choice of treatment, rehabilitation, and return to sport and provides suggestions on how to address this fear during the continuum of treatment and return to sports.
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Affiliation(s)
- Joanna Kvist
- Unit of Physiotherapy, Department of Health, Medicine, and Caring Science, Linköping University, Linköping, Sweden.,Stockholm Sports Trauma Research Center, Dept of Molecular Medicine & Surgery, Karolinska Institute, Stockholm, Sweden
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22
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Coopmans L, Amaya Aliaga J, Metsemakers WJ, Sermon A, Misselyn D, Nijs S, Hoekstra H. Accelerated Rehabilitation in Non-operative Management of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-analysis. J Foot Ankle Surg 2022; 61:157-162. [PMID: 34400090 DOI: 10.1053/j.jfas.2021.07.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/10/2021] [Indexed: 02/03/2023]
Abstract
The optimal treatment and rehabilitation strategy for Achilles tendon ruptures is still under debate. There is a paradigm shift toward early mobilization and weightbearing. We examined the treatment effect of accelerated functional rehabilitation in nonoperative management of acute Achilles tendon ruptures. A systematic search of PubMed, EMBASE, and Web of Science databases for articles comparing accelerated versus delayed rehabilitation in the nonoperative management of acute Achilles tendon rupture was performed. Outcomes of interest were Achilles tendon rupture score (ATRS) (standardized patient-reported instrument related to symptoms and physical activity after treatment of an acute Achilles tendon rupture), rerupture rate, strength, range of motion, return to work, and sports. A total of 2001 articles were identified using our search strategy. We included 6 randomized controlled trials of interest. Although the concept of accelerated rehabilitation has gained popularity in recent years, no statistically significant differences could be revealed in any of the outcomes of interest. We performed a meta-analysis on the following outcomes: ATRS (mean difference -0.93 95% confidence interval [CI] -6.01 to 4.14), Rerupture rate (odds ratio [OR] 0.97, 95% CI: 0.46-2.03), Return to sports (OR 1.31, 95% CI 0.76-2.25), Return to work (mean difference 5.24, 95% CI to -12.04 to 22.51). The treatment effect of accelerated rehabilitation in nonoperatively treated patients seems to be small. However, we recommend accelerated rehabilitation for all conservatively treated patients, because it is a safe option and no detrimental effects have been described in the literature. Furthermore, many patients prefer this type of rehabilitation to avoid the practical disadvantages of prolonged immobilization.
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Affiliation(s)
- Laurens Coopmans
- Faculty of Medicine, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jorge Amaya Aliaga
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Orthopaedics and Traumatology, VU Brussel - Free University of Brussels, Brussels, Belgium
| | - Willem-Jan Metsemakers
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - An Sermon
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Dominique Misselyn
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Stefaan Nijs
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Harm Hoekstra
- Department of Trauma Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium.
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23
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Abbas DB, Lintel H, Griffin M, Guardino NJ, Guo JL, Spielman AF, Cotterell AC, Parker JBL, Januszyk M, Wan DC. OUP accepted manuscript. J Surg Case Rep 2022; 2022:rjac066. [PMID: 35280050 PMCID: PMC8907408 DOI: 10.1093/jscr/rjac066] [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: 01/26/2022] [Accepted: 02/12/2022] [Indexed: 11/12/2022] Open
Abstract
Hypertrophic scar formation and non-healing wounds following Achilles tendon repair arise from poor vascularity to the incisional site or from excess mechanical stress/strain to the incision during the healing process. The embrace® scar therapy dressing is a tension offloading device for incisional scars. This study explored the effects of tension offloading during Achilles scar formation. A healthy 30-year-old male without any medical co-morbidities developed an acute rupture of his left Achilles tendon. The patient underwent open repair 1 week after injury. At post-operative day (POD) 14, the patient started daily tension offloading treatment on the inferior portion of the incision through POD 120. By POD 120, the untreated portion of the Achilles incision appeared hypertrophic and hyperpigmented, while the treated portion of the scar appeared flat with minimal pigmentation changes. The 12-week treatment of tension offloading on an Achilles tendon repair incision significantly improved cosmesis compared to untreated incision.
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Affiliation(s)
- Darren B Abbas
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Hendrik Lintel
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Michelle Griffin
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Nicholas J Guardino
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jason L Guo
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Amanda F Spielman
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Asha C Cotterell
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer B L Parker
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Januszyk
- Hagey Laboratory for Pediatric Regenerative Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Derrick C Wan
- Correspondence address. Department of Surgery, Hagey Family Faculty Scholar in Stem Cell and Regenerative Medicine, Stanford University School of Medicine, 257 Campus Drive West, Stanford, CA 94305, USA. Tel: +1-650-736-1704; Fax: +1-650-736-1705; E-mail:
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24
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Wenning M, Mauch M, Heitner A, Streicher P, Ritzmann R, Paul J. Midterm functional performance following open surgical repair of acute Achilles tendon rupture. Arch Orthop Trauma Surg 2022; 142:1337-1349. [PMID: 33484315 PMCID: PMC9217896 DOI: 10.1007/s00402-020-03746-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 12/19/2020] [Indexed: 12/02/2022]
Abstract
INTRODUCTION Various impairments such as soleus atrophy and consecutive functional deficits in end-range plantarflexion have been described in surgical repair of acute Achilles tendon rupture. The aim of this study was to assess the functional performance at midterm following open surgical repair. MATERIALS AND METHODS This cross-sectional study includes n = 52 patients which were tested on average 3.5 ± 1.4 years postoperatively using three different functional performance tests and patient-reported outcome measures. Two different surgical techniques (anatomical repair = AR vs. conventional repair = CR) were compared in a subanalysis. The testing included isokinetic strength testing, a novel setup of heel-rise testing using a marker-based 3D motion analysis system and a gait analysis. RESULTS At an average 3.5 years post-surgery, there is a persisting deficit in plantarflexion strength of 10.2%. Moreover, analysis of maximum peak torque angle and strength deficits according to the plantarflexion angle revealed that these deficits are not equally distributed across the range of motion. AR results in a significantly smaller deficit at 10° of plantarflexion compared to CR (13.9 vs. 29.9%, p < 0.05). This reflects into the functional performance during different modalities (static vs. dynamic) in this novel method of heel-rise testing. CONCLUSION In summary, there are persisting functional deficits at > 3 years following Achilles tendon repair which range from strength deficits to specific impairments of functional performance e.g. during heel rise. Anatomical reconstruction is associated with an improved functional performance potentially due to a more symmetric strength during end-range plantarflexion which transfers into a higher satisfaction during athletic activities. LEVEL OF EVIDENCE III, retrospective cohort study.
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Affiliation(s)
- Markus Wenning
- Rennbahnklinik, Kriegackerstr. 100, CH-4132, Muttenz, Baselland, Switzerland
- Department of Orthopedic and Trauma Surgery, University Medical Center Freiburg, Faculty of Medicine, Albert-Ludwigs University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany
| | - Marlene Mauch
- Rennbahnklinik, Kriegackerstr. 100, CH-4132, Muttenz, Baselland, Switzerland
| | - Albrecht Heitner
- Rennbahnklinik, Kriegackerstr. 100, CH-4132, Muttenz, Baselland, Switzerland
| | - Paul Streicher
- Department of Sport and Sport Science, University of Freiburg, Freiburg, Germany
| | - Ramona Ritzmann
- Rennbahnklinik, Kriegackerstr. 100, CH-4132, Muttenz, Baselland, Switzerland
| | - Jochen Paul
- Rennbahnklinik, Kriegackerstr. 100, CH-4132, Muttenz, Baselland, Switzerland.
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Muscular and Tendon Degeneration after Achilles Rupture: New Insights into Future Repair Strategies. Biomedicines 2021; 10:biomedicines10010019. [PMID: 35052699 PMCID: PMC8773411 DOI: 10.3390/biomedicines10010019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/10/2021] [Accepted: 12/19/2021] [Indexed: 11/17/2022] Open
Abstract
Achilles tendon rupture is a frequent injury with an increasing incidence. After clinical surgical repair, aimed at suturing the tendon stumps back into their original position, the repaired Achilles tendon is often plastically deformed and mechanically less strong than the pre-injured tissue, with muscle fatty degeneration contributing to function loss. Despite clinical outcomes, pre-clinical research has mainly focused on tendon structural repair, with a lack of knowledge regarding injury progression from tendon to muscle and its consequences on muscle degenerative/regenerative processes and function. Here, we characterize the morphological changes in the tendon, the myotendinous junction and muscle belly in a mouse model of Achilles tendon complete rupture, finding cellular and fatty infiltration, fibrotic tissue accumulation, muscle stem cell decline and collagen fiber disorganization. We use novel imaging technologies to accurately relate structural alterations in tendon fibers to pathological changes, which further explain the loss of muscle mechanical function after tendon rupture. The treatment of tendon injuries remains a challenge for orthopedics. Thus, the main goal of this study is to bridge the gap between clinicians’ knowledge and research to address the underlying pathophysiology of ruptured Achilles tendon and its consequences in the gastrocnemius. Such studies are necessary if current practices in regenerative medicine for Achilles tendon ruptures are to be improved.
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26
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Roopnarinesingh R, Kenyon R, Turley L, Feeley A, Bayer T, Merghani K. Achilles' tendon rupture dancing the 'Jerusalema' - A case series. Int J Surg Case Rep 2021; 87:106368. [PMID: 34537526 PMCID: PMC8455660 DOI: 10.1016/j.ijscr.2021.106368] [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: 07/31/2021] [Revised: 08/24/2021] [Accepted: 09/02/2021] [Indexed: 11/06/2022] Open
Abstract
Introduction and importance The weekend warrior has long been prey to musculoskeletal injuries as a result of intermittent, high intensity activity. The Achilles tendon is known to be particularly vulnerable in this population cohort but during the COVID-19 lockdowns in Ireland and all over the world there has been a certain level of detraining and deconditioning among all age groups and populations. Throughout the worldwide restrictions, viral internet challenges and dances have encapsulated the spirit of a global community with the ‘Jerusalema’ dance being no exception. The rise of this particular viral sensation was at the detriment of the Achilles tendons of three middle aged gentlemen on who we base our case series. Presentation of cases Over the space of ten days three cases of Achilles tendon rupture repair presented to the emergency department in Midlands Regional Hospital Tullamore (MRHT) with the mechanism of tendon rupture being through the ‘Jerusalema’ dance. These patients were surgically managed in line with local institution practice and postoperative outcomes were good with no complications noted. Follow up is ongoing. Clinical discussion This retrospective case series is based on the impact of the ‘Jerusalema Dance’ on presentations of Achilles tendon rupture to the Emergency Department in a single regional hospital from January to March 2021. We used these cases in conjunction with a review of current literature to highlight the benefit of an integrated Achilles Tendon rehabilitation programme in this at-risk patient cohort. Conclusion This paper highlights the dangers inherent when well intentioned, but physically deconditioned individuals endeavour to perform a physical exercise which is deceptively demanding. Going forward, viral challenges such as the ‘Jerusalema’ may contribute to new and interesting mechanisms of injuries in our ‘weekend warrior’ cohort. In addition to this, given the global deconditioning seen due to the COVID 19 pandemic and subsequent lockdowns we may see a higher rate of Achilles tendon injuries in the near future across a multitude of patient cohorts. Level one evidence suggests that conservative treatment is just as effective as surgical treatments in the majority of patients with an Achilles tendon rupture, as long as a protocol of rehabilitation with early weightbearing is performed. Our accelerated rehabilitation programme in MRHT is in line with others however internal audit and new literature in the future may enable us to refine it further. Achilles Tendon Rupture is common amongst the conditioned and deconditioned population. Surgical and conservative management options are widely explored in the literature. Viral dance challenges such as the Jerusalema offer new and interesting patterns of injury. An early weightbearing rehabilitation programme after TA rupture shows lower re-rupture rates.
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Affiliation(s)
- Ryan Roopnarinesingh
- Midland Regional Hospital Tullamore, Orthopaedic Department, Tullamore, Co. Offaly R35 NY51, Ireland.
| | - Robert Kenyon
- Midland Regional Hospital Tullamore, Orthopaedic Department, Tullamore, Co. Offaly R35 NY51, Ireland
| | - Luke Turley
- Midland Regional Hospital Tullamore, Orthopaedic Department, Tullamore, Co. Offaly R35 NY51, Ireland
| | - Aoife Feeley
- Midland Regional Hospital Tullamore, Orthopaedic Department, Tullamore, Co. Offaly R35 NY51, Ireland
| | - Thomas Bayer
- Midland Regional Hospital Tullamore, Orthopaedic Department, Tullamore, Co. Offaly R35 NY51, Ireland
| | - Khalid Merghani
- Midland Regional Hospital Tullamore, Orthopaedic Department, Tullamore, Co. Offaly R35 NY51, Ireland
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Röell AE, Timmers TK, van der Ven DJC, van Olden GDJ. Rehabilitation After Surgical Repair of Acute Achilles Tendon Rupture: Functional Outcome With a Minimum Follow-Up of 6 Months. J Foot Ankle Surg 2021; 60:482-488. [PMID: 33546991 DOI: 10.1053/j.jfas.2020.09.003] [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: 06/24/2018] [Revised: 05/02/2020] [Accepted: 09/03/2020] [Indexed: 02/03/2023]
Abstract
The best treatment and rehabilitation of Achilles tendon ruptures remains controversial. Current literature focuses mainly on objective outcomes despite possible incongruity with patient-reported functional outcomes. Therefore, we aimed to identify the course of patient-reported symptoms, function and quality of life during the early rehabilitation period. In this prospective cohort study, 33 patients with an acute Achilles tendon rupture treated with minimally invasive tendon repair were included in this study. They were followed up at 6, 12, 18 and 24 weeks after surgery with the Foot and Ankle Outcome Score questionnaire. At 6 weeks, patient-reported outcomes were poor regarding quality of life and sports. They however were quite high in the domains activities of daily living, symptoms and pain. All scores improved over the course of 6 months (symptoms (p = .03), activities of daily living (p = .001), sports (p = .002) and quality of life (p = .001). Pain did not improve significantly (p = .12), but patients had good pain scores from the start. There were no significant differences between patients with or without physical therapy. There were 3 minor complications and no re-ruptures in this cohort. In conclusion, patient-reported outcomes improve significantly during the first 6 months after surgery, except for pain. Scores for sports and quality of life remain suboptimal.
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Affiliation(s)
- Anna E Röell
- Junior Doctor, Department of Surgery, Meander Medical Center Amersfoort, Amersfoort, the Netherlands; Junior Doctor, Department of Intensive Care, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Tim K Timmers
- Trauma Surgeon, Department of Surgery, Meander Medical Center Amersfoort, Amersfoort, the Netherlands
| | - Denise J C van der Ven
- Surgical Resident, Department of Surgery, Meander Medical Center Amersfoort, Amersfoort, the Netherlands
| | - Ger D J van Olden
- Trauma Surgeon, Department of Surgery, Meander Medical Center Amersfoort, Amersfoort, the Netherlands
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28
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Hidd SMCM, Tim CR, Dutra EDF, Maia ALM, Assis L, Ferreira RS, Barraviera B, Silva JF, Amaral MM. Fibrin biopolymer sealant and aquatic exercise association for calcaneal tendon repair. Acta Cir Bras 2021; 36:e360407. [PMID: 34037082 PMCID: PMC8148814 DOI: 10.1590/acb360407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/21/2021] [Accepted: 03/19/2021] [Indexed: 01/19/2023] Open
Abstract
PURPOSE The aim of this work was to analyze the effect of fibrin biopolymer sealant (FS) associated or not to aquatic exercise (AE) on the calcaneal tendon repair. METHODS Forty-four female Wistar rats were randomly divided into four experimental groups: Lesion control (L), Lesion and FS (LS), Lesion and AE (LE) and Lesion and FS associated to AE (LSE). The edema volume (EV), collagen ratio, and histopathological analysis were evaluated after 7, 14, and 21 days of partial tendon transection. RESULTS The EV was statistically reduced for all treatment groups after 7 and 21 days when compared to L group. The LS and LSE had the highest EV reduction after 21 days of treatment. The FS group didn't induce tissue necrosis or infections on the histopathological analysis. It was observed tenocytes proliferation, granulation tissue and collagen formation in the tendon partial transection area in the FS group. The LSE demonstrated higher amount of granulation tissue and increased the collagen deposition at the injury site. CONCLUSIONS Our data suggests that the therapeutic potential of the association of heterologous fibrin biopolymer sealant with aquatic exercise program should be further explored as it may stimulate the regeneration phase and optimize calcaneal tendon recovery.
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Affiliation(s)
| | - Carla Roberta Tim
- PhD. Universidade Brasil – Scientific and Technological Institute –
Sao Paulo (SP), Brazil
| | - Eneas de Freitas Dutra
- PhD. Universidade Estadual do Piauí – Center for Research in
Biotechnology and Biodiversity – Teresina (PI), Brazil
| | - Antônio Luiz Martins Maia
- PhD. Universidade Estadual do Piauí – Center for Research in
Biotechnology and Biodiversity – Teresina (PI), Brazil
| | - Lívia Assis
- PhD. Universidade Brasil – Scientific and Technological Institute –
Sao Paulo (SP), Brazil
| | - Rui Seabra Ferreira
- PhD. Universidade Estadual Paulista – Center for the Study of Venoms
and Venomous Animals – Botucatu (SP), Brazil
| | - Benedito Barraviera
- PhD. Universidade Estadual Paulista – Botucatu Medical School –
Botucatu (SP), Brazil
| | - José Figueiredo Silva
- PhD. Universidade Estadual do Piauí – Center for Research in
Biotechnology and Biodiversity – Teresina (PI), Brazil
| | - Marcello Magri Amaral
- PhD. Universidade Brasil – Scientific and Technological Institute –
Sao Paulo (SP), Brazil
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Serial Ultrasonographic and Real-Time Elastosonographic Assessment of the Ovine Common Calcaneal Tendon, after an Experimentally Induced Tendinopathy. Vet Sci 2021; 8:vetsci8040054. [PMID: 33806121 PMCID: PMC8064454 DOI: 10.3390/vetsci8040054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 12/31/2022] Open
Abstract
Real-time elastosonography (RTE) is a recently described, non-invasive, ultrasonographic technique developed to assess tissue elasticity. The main aim of this study was to investigate the ultrasonographic and elastosonographic appearance of the common calcaneal tendon (CCT) in an ovine model, and to monitor the progression of tendon healing after an experimentally-induced tendinopathy. Sound tendons were initially evaluated (T0) with a caliper and by a single operator with ultrasound. Ultrasonographic and elastosonographic images were then acquired. Subsequently, ultrasound-guided tendon lesions were induced by injecting 500 IU of Type IA collagenases proximally to the calcaneal tuberosity. Caliper measurement, ultrasonography and elastosonography were then repeated at 15 (T1), 30 (T2) and 60 (T3) days. Clinically measured width of the tendon, ultrasonographic thickness and width and percentage of hard (Elx-t%hrd) and soft (Elx-t%sft) tissue were recorded. Statistical analysis was performed on the data collected; statistical significance was set at p < 0.05. Intra-class correlation coefficient (ICC) revealed good (0.68) repeatability of elastosonographic evaluation of the CCT. The tendon width was significantly increased when comparing T0 with T1–2 and decreased when comparing T1–2 with T3. Ultrasound-assessed thickness was significantly increased between T0–T1 and decreased between T1-T2–3. Elx-t%hrd was significantly decreased at T1–2–3 and Elx-t%sft was significantly increased at T1–2–3. In conclusion, the ovine CCT is a highly stiff structure that undergoes a severe loss of stiffness during the healing process. Thickness and width of the tendon increased during the first 30 days and then reduced progressively along the subsequent 30 days. Ultrasonographic appearance of the tendon remained severely abnormal and the tendon showed severely reduced elastic proprieties 60 days after lesion induction.
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30
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Xu XY, Gao S, Lv Y, Zhou F, Jiao C, Fan JX, Zhu TJ. Duration of immobilisation after Achilles tendon rupture repair by open surgery: a retrospective cohort study. J Orthop Surg Res 2021; 16:196. [PMID: 33731160 PMCID: PMC7968267 DOI: 10.1186/s13018-021-02342-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/09/2021] [Indexed: 12/28/2022] Open
Abstract
Background The best treatment for acute Achilles tendon ruptures remains controversial. No cohort studies have compared different immobilisation durations after open surgery. This retrospective cohort study aimed to determine the optimal duration of immobilisation after this surgery. Methods A total of 266 patients with acute Achilles tendon rupture were divided into 4 groups (A, B, C, and D) according to immobilisation duration of 0, 2, 4, and 6 weeks, respectively. All patients underwent the same suture technique with a similar rehabilitation protocol and were examined clinically at 2, 4, 6, 8, 10, 12, 14, 16, 24, and 48 weeks, with a final follow-up at a mean of 22.3 months postoperatively. The primary outcome was the time of return to light sports activity (LSA). Secondary outcomes included range of motion (ROM) and single-legged heel rise height (SHRH). Data on operation time, complications, visual analogue pain scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score, and Achilles tendon Total Rupture score (ATRS) were also collected. Demographic baseline data were analysed using one-way analysis of variance; outcome parameters were analysed using Kruskal-Wallis H test, and complications were analysed using Fisher’s exact test. Statistical significance was considered at P ≤ 0.05. Results VAS scores decreased significantly, reaching 0 in all groups after 12 weeks. The AOFAS and ATRS scores were significantly different between the groups from weeks 2 to 12 (P<0.001) and weeks 2 to 16 (P<0.001), respectively. All the mean scores showed better results in group B than in the other groups. In terms of recovery time of ROM, SHRH, and LSA, groups A and B were significantly faster than groups C and D (P<0.001). There were 13 (13/266, 4.9%) complications: 5 superficial infections, 3 deep venous thrombosis, and 5 trauma-related re-ruptures. On the last follow-up, all complications had recovered. There were no significant differences in complications between the groups. Conclusions Immobilisation for 2 weeks after this open surgery is the best choice for early rehabilitation and weight-bearing while minimising pain and other complications.
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Affiliation(s)
- Xiang Yu Xu
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, 100191, China
| | - Shan Gao
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, 100191, China
| | - Yang Lv
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, 100191, China.
| | - Fang Zhou
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, 100191, China.
| | - Chen Jiao
- Department of Sports Medicine, Peking University Third Hospital, Haidian District, Beijing, 100191, China
| | - Ji Xing Fan
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, 100191, China
| | - Teng Jiao Zhu
- Orthopaedic Department, Peking University Third Hospital, Haidian District, Beijing, 100191, China
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She G, Teng Q, Li J, Zheng X, Chen L, Hou H. Comparing Surgical and Conservative Treatment on Achilles Tendon Rupture: A Comprehensive Meta-Analysis of RCTs. Front Surg 2021; 8:607743. [PMID: 33681281 PMCID: PMC7931800 DOI: 10.3389/fsurg.2021.607743] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 01/11/2021] [Indexed: 12/28/2022] Open
Abstract
Background: The Achilles tendon is the strongest tendon in human and is frequently injured, mainly in the young to middle age active population. Increasing incidence of Achilles tendon rupture (ATR) is still reported in several studies. Surgical repair and conservative treatment are two major management strategies widely adopted in ATR patients, but the consensus of the optimal treatment strategy is still debated. We aimed at thoroughly reviewing the ATR topic with additional assessments and performed a most comprehensive meta-analysis of randomized controlled trials (RCTs). Method: We comprehensively searched PubMed, Embase, Cochrane, and ClinicalTrial.gov and retrieved all RCTs comparing surgical and conservative treatment on ATR for further analysis. Two independent reviewers performed data extraction and random effect model was adopted when I 2 > 50%, with data presentation of risk ratio, risk difference, or mean difference and 95% confidence interval. Results: A total of 13 RCTs were included in this meta-analysis. A significant difference was observed in re-rupture, complication rate, adhesion to the underlying tendon, sural nerve injury, and superficial infection. A substantial reduction in re-rupture rate could be observed for surgical treatment while the complication rate was higher compared with conservative treatment. Conclusion: Surgical treatment revealed significance in reducing the re-rupture rate but was associated with a higher complication rate, while conservative treatment showed similar outcomes with a lower complication rate. Collectively, we recommend conservative treatment if patients' status and expectations are suitable, but surgeon and physician discretion is also crucial in decision making.
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Affiliation(s)
- Guorong She
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Qiang Teng
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jieruo Li
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Xiaofei Zheng
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Lin Chen
- Drug Clinical Trial Institution, First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Huige Hou
- Department of Sport Medicine, First Affiliated Hospital of Jinan University, Guangzhou, China
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Bolus NB, Jeong HK, Blaho BM, Safaei M, Young AJ, Inan OT. Fit to Burst: Toward Noninvasive Estimation of Achilles Tendon Load Using Burst Vibrations. IEEE Trans Biomed Eng 2021; 68:470-481. [PMID: 32746041 DOI: 10.1109/tbme.2020.3005353] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Tendons are essential components of the musculoskeletal system and, as with any mechanical structure, can fail under load. Tendon injuries are common and can be debilitating, and research suggests that a better understanding of their loading conditions could help mitigate injury risk and improve rehabilitation. To that end, we present a novel method of noninvasively assessing parameters related to mechanical load in the Achilles tendon using burst vibrations. METHODS These vibrations, produced by a small vibration motor on the skin superficial to the tendon, are sensed by a skin-mounted accelerometer, which measures the tendon's response to burst excitation under varying tensile load. In this study, twelve healthy subjects performed a variety of everyday tasks designed to expose the Achilles tendon to a range of loading conditions. To approximate the vibration motor-tendon system and provide an explanation for observed changes in tendon response, a 2-degree-of-freedom mechanical systems model was developed. RESULTS Reliable, characteristic changes in the burst response profile as a function of Achilles tendon tension were observed during all loading tasks. Using a machine learning-based approach, we developed a regression model capable of accurately estimating net ankle moment-which captures general trends in tendon tension-across a range of walking speeds and across subjects (R2 = 0.85). Simulated results of the mechanical model accurately recreated behaviors observed in vivo. Finally, preliminary, proof-of-concept results from a fully wearable system demonstrated trends similar to those observed in experiments conducted using benchtop equipment. CONCLUSION These findings suggest that an untethered, unobtrusive system can effectively assess tendon loading during activities of daily life. SIGNIFICANCE Access to such a system would have broad implications for injury recovery and prevention, athletic training, and the study of human movement.
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Peterson JG, Tjong VK, Mehta MP, Goyette BN, Patel M, Kadakia AR. A qualitative assessment of return to sport following Achilles tendon repair. J Orthop 2020; 23:46-51. [PMID: 33456215 DOI: 10.1016/j.jor.2020.12.010] [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: 10/23/2020] [Accepted: 12/20/2020] [Indexed: 02/06/2023] Open
Abstract
Studies have demonstrated successful return to sport rates following Achilles tendon rupture and repair. The purpose of this study is to understand the subjective intrinsic and extrinsic motivational factors influencing an athlete's return to pre-injury level of sport following Achilles tendon repair. Qualitative, semi-structured interviews of 23 athletes who had undergone Achilles tendon repair were conducted and analyzed to derive codes, categories, and themes. Three major themes affecting return to sport were elucidated from the interviews: personal motivation, shift in focus, and confidence in healthcare team. These findings can direct healthcare teams on how to better guide patients post-operatively.
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Affiliation(s)
- Joshua G Peterson
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Vehniah K Tjong
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Mitesh P Mehta
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Bailey N Goyette
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Milap Patel
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
| | - Anish R Kadakia
- Department of Orthopaedic Surgery, Feinberg School of Medicine, Northwestern University, 676 North St. Clair Street, Suite 1350, Chicago, IL, 60611, USA
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Tarantino D, Palermi S, Sirico F, Corrado B. Achilles Tendon Rupture: Mechanisms of Injury, Principles of Rehabilitation and Return to Play. J Funct Morphol Kinesiol 2020; 5:jfmk5040095. [PMID: 33467310 PMCID: PMC7804867 DOI: 10.3390/jfmk5040095] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 12/16/2022] Open
Abstract
The Achilles tendon is the thickest, strongest and largest tendon in the human body, but despite its size and tensile strength, it frequently gets injured. Achilles tendon ruptures (ATRs) mainly occur during sports activities, and their incidence has increased over the last few decades. Achilles tendon tears necessitate a prolonged recovery time, sometimes leaving long-term functional limitations. Treatment options include conservative treatment and surgical repair. There is no consensus on which is the best treatment for ATRs, and their management is still controversial. Limited scientific evidence is available for optimized rehabilitation regimen and on the course of recovery after ATRs. Furthermore, there are no universally accepted outcomes regarding the return to play (RTP) process. Therefore, the aim of this narrative review is to give an insight into the mechanism of injuries of an ATR, related principles of rehabilitation, and RTP.
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Resistance Exercises in Early Functional Rehabilitation for Achilles Tendon Ruptures Are Poorly Described: A Scoping Review. J Orthop Sports Phys Ther 2020; 50:681-690. [PMID: 33094667 PMCID: PMC8168134 DOI: 10.2519/jospt.2020.9463] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To (1) describe which resistance exercises are used in the first 8 weeks of treatment for acute Achilles tendon rupture and (2) assess the completeness of reporting of the exercise descriptions. DESIGN Scoping review. LITERATURE SEARCH We searched the MEDLINE, Embase, CINAHL, Cochrane Library, and Physiotherapy Evidence Database (PEDro) databases. STUDY SELECTION CRITERIA Randomized controlled trials, cohort studies, and case series (10 or more participants) that reported using resistance exercise in the immobilization period in the first 8 weeks of treatment for acute Achilles tendon rupture were included. DATA SYNTHESIS Completeness of exercise description was assessed with the Consensus on Exercise Reporting Template (CERT) and the Toigo and Boutellier exercise descriptor framework. RESULTS Thirty-eight studies were included. Fifty-one resistance exercises were extracted and categorized as isometric exercises (n = 20), heel raises (n = 6), strengthening with external resistance (n = 13), or unspecified (n = 12). A median of 8 (interquartile range, 6-10) of a possible 19 CERT items was reported. The amount of items described of the 13 Toigo and and Boutellier exercise descriptors ranged from 0 to 11. CONCLUSION A variety of resistance exercises targeted at the ankle plantar flexors were used as part of early functional rehabilitation after Achilles tendon rupture. However, most studies provided inadequate description of resistance exercise interventions. J Orthop Sports Phys Ther 2020;50(12):681-691. Epub 23 Oct 2020. doi:10.2519/jospt.2020.9463.
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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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Agres AN, Arampatzis A, Gehlen T, Manegold S, Duda GN. Muscle Fascicles Exhibit Limited Passive Elongation Throughout the Rehabilitation of Achilles Tendon Rupture After Percutaneous Repair. Front Physiol 2020; 11:746. [PMID: 32792966 PMCID: PMC7385380 DOI: 10.3389/fphys.2020.00746] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 06/08/2020] [Indexed: 12/28/2022] Open
Abstract
Achilles tendon rupture (ATR) results in long-term functional and structural deficits, characterized by reduced ankle mobility and plantarflexor muscle atrophy. However, it remains unclear how such functional impairments develop after surgical repair. While it is known that this injury negatively affects the tendon’s function, to date, limited work has focused on the short-term effect of ATR on the structure of the muscles in series. The aim of this study was to characterize changes in medial gastrocnemius architecture and its response to passive lengthening during the post-surgical rehabilitative period following ATR. Both injured and contralateral limbs from 10 subjects (1 female, BMI: 27.2 ± 3.9 kg/m2; age: 46 ± 10 years) with acute, unilateral ATR were assessed at 8, 12, and 16 weeks after percutaneous surgical repair. To characterize the component tissues of the muscle-tendon unit, resting medial gastrocnemius muscle thickness, fascicle length, and pennation angle were determined from ultrasound images with the ankle in both maximal plantarflexion and dorsiflexion. The ankle range of motion (ROM) was determined using motion capture; combined ultrasound and motion capture determined the relative displacement of the musculotendinous junction (MTJ) of the AT with the medial gastrocnemius. The ATR-injured gastrocnemius muscle consistently exhibited lower thickness, regardless of time point and ankle angle. Maximal ankle plantarflexion angles and corresponding fascicle lengths were lower on the injured ankle compared to the contralateral throughout rehabilitation. When normalized to the overall ankle ROM, both injured fascicles and MTJ displacement exhibited a comparably lower change in length when the ankle was passively rotated. These results indicate that when both ankles are passively exposed to the same ROM following ATR surgery, both ipsilateral Achilles tendon and gastrocnemius muscle fascicles exhibit limited lengthening compared to the contralateral MTU tissues. This appears to be consistent throughout the rehabilitation of gait, suggesting that current post-operative rehabilitative exercises do not appear to induce muscle adaptations in the affected MTU.
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Affiliation(s)
- Alison N Agres
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Adamantios Arampatzis
- Department of Training and Movement Sciences, Humboldt University of Berlin, Berlin, Germany
| | - Tobias Gehlen
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sebastian Manegold
- Department for Foot and Ankle Surgery, BG Unfallklinik Frankfurt am Main, Frankfurt am Main, Germany
| | - Georg N Duda
- Julius Wolff Institute, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Functional and early weight-bearing protocol for achilles tendon ruptures: a retrospective study. Eur J Trauma Emerg Surg 2020; 47:2049-2054. [DOI: 10.1007/s00068-020-01376-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 04/15/2020] [Indexed: 11/27/2022]
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No YJ, Tarafder S, Reischl B, Ramaswamy Y, Dunstan C, Friedrich O, Lee CH, Zreiqat H. High-Strength Fiber-Reinforced Composite Hydrogel Scaffolds as Biosynthetic Tendon Graft Material. ACS Biomater Sci Eng 2020; 6:1887-1898. [PMID: 33455306 DOI: 10.1021/acsbiomaterials.9b01716] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The development of suitable synthetic scaffolds for use as human tendon grafts to repair tendon ruptures remains a significant engineering challenge. Previous synthetic tendon grafts have demonstrated suboptimal tissue ingrowth and synovitis due to wear particles from fiber-to-fiber abrasion. In this study, we present a novel fiber-reinforced hydrogel (FRH) that mimics the hierarchical structure of the native human tendon for synthetic tendon graft material. Ultrahigh molecular weight polyethylene (UHMWPE) fibers were impregnated with either biosynthetic polyvinyl alcohol/gelatin hydrogel (FRH-PG) or with polyvinyl alcohol/gelatin + strontium-hardystonite (Sr-Ca2ZnSi2O7, Sr-HT) composite hydrogel (FRH-PGS). The scaffolds were fabricated and assessed to evaluate their suitability for tendon graft applications. The microstructure of both FRH-PG and FRH-PGS showed successful impregnation of the hydrogel component, and the tendon scaffolds exhibited equilibrium water content of ∼70 wt %, similar to the values reported for native human tendon, compared to ∼50 wt % water content retained in unmodified UHMWPE fibers. The tensile strength of FRH-PG and FRH-PGS (77.0-81.8 MPa) matched the range of human Achilles' tendon tensile strengths reported in the literature. In vitro culture of rat tendon stem cells showed cell and tissue infiltration into both FRH-PG and FRH-PGS after 2 weeks, and the presence of Sr-HT ceramic particles influenced the expression of tenogenic markers. On the other hand, FRH-PG supported the proliferation of murine C2C12 myoblasts, whereas FRH-PGS seemingly did not support it under static culture conditions. In vivo implantation of FRH-PG and FRH-PGS scaffolds into full-thickness rat patellar tendon defects showed good collagenous tissue ingrowth into these scaffolds after 6 weeks. This study demonstrates the potential viability for our FRH-PG and FRH-PGS scaffolds to be used for off-the-shelf biosynthetic tendon graft material.
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Affiliation(s)
- Young Jung No
- Biomaterials and Tissue Engineering Research Unit, School of Biomedical Engineering, University of Sydney, Sydney 2006, Australia.,Australian Research Council Training Centre for Innovative BioEngineering, Sydney 2006, Australia
| | - Solaiman Tarafder
- Regenerative Engineering Laboratory, Columbia University, New York 10032, New York, United States
| | - Barbara Reischl
- Institute of Medical Biotechnology, Department of Chemical and Biological Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91052, Germany
| | - Yogambha Ramaswamy
- Biomaterials and Tissue Engineering Research Unit, School of Biomedical Engineering, University of Sydney, Sydney 2006, Australia.,Australian Research Council Training Centre for Innovative BioEngineering, Sydney 2006, Australia
| | - Colin Dunstan
- Biomaterials and Tissue Engineering Research Unit, School of Biomedical Engineering, University of Sydney, Sydney 2006, Australia.,Australian Research Council Training Centre for Innovative BioEngineering, Sydney 2006, Australia
| | - Oliver Friedrich
- Institute of Medical Biotechnology, Department of Chemical and Biological Engineering, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen 91052, Germany
| | - Chang Hun Lee
- Regenerative Engineering Laboratory, Columbia University, New York 10032, New York, United States
| | - Hala Zreiqat
- Biomaterials and Tissue Engineering Research Unit, School of Biomedical Engineering, University of Sydney, Sydney 2006, Australia.,Australian Research Council Training Centre for Innovative BioEngineering, Sydney 2006, Australia
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Fell D, Enocson A, Lapidus LJ. Surgical repair of acute Achilles tendon ruptures: a follow-up of 639 consecutive cases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:895-899. [DOI: 10.1007/s00590-020-02650-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/03/2020] [Indexed: 11/30/2022]
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Hamrin Senorski E, Svedman S, Svantesson E, Danielsson A, Krupic F, Ackermann P, Westin O. Understanding limitations in sport 1 year after an Achilles tendon rupture: a multicentre analysis of 285 patients. Knee Surg Sports Traumatol Arthrosc 2020; 28:233-244. [PMID: 31250056 DOI: 10.1007/s00167-019-05586-0] [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: 04/05/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The purpose of this study was to determine patient-related and treatment-related predictors of superior and inferior function in sport and recreational activities 1 year after an Achilles tendon rupture. METHODS This study is based on a multicentre cohort from 4 previous randomised controlled trials. All the patients who had responded to the Foot and Ankle Outcome Score (FAOS) at the 1-year follow-up were included. All the patients had a clinically verified Achilles tendon rupture and patients who underwent surgery were treated within 96 h of the time of rupture. Patients were excluded in the event of a previous Achilles tendon rupture or the presence of other lifestyle diseases. The primary outcomes of the study were reported in the 20th and 80th percentiles of the FAOS subscale, function in sports and recreational activities. RESULTS A total of 285 (84% men) patients with an average age of 40.0 (SD 8.4) years were included. Smoking increased the odds of superior self-reported FAOS sport and recreation [OR 4.59 (95% CI 1.58-13.32), p = 0.005] compared with non-smoking, while being female [OR 0.38 (95% CI 0.16-0.93), p = 0.035] and every increment of one unit in BMI [OR 0.89 (95% CI 0.81-0.99), p = 0.029] reduced the odds. No variable was statistically significant when attempting to predict which patients report inferior FAOS sport and recreation. The recovery of symmetry in heel-rise tests had no effect on 1-year FAOS sport and recreation. Patient-reported outcomes had a good-to-excellent explanatory capacity of superior and inferior 1-year function in sport and recreational activities (AUC = 0.87-0.93). CONCLUSION BMI is a modifiable risk factor, which, when lowered, may be associated with less impairment in sports 1 year after an Achilles tendon rupture. Females appear to perceive more limitations than males. Unexpectedly, smokers experience less limitations in foot and ankle function. Patients who report no functional limitation in sport are characterised by an overall perception of adequate foot, ankle and Achilles function, despite not having recovered symmetry in the heel-rise test. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.
| | - Simon Svedman
- Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Adam Danielsson
- Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Ferid Krupic
- Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Paul Ackermann
- Integrative Orthopedic Laboratory, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Westin
- Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
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Aufwerber S, Heijne A, Edman G, Grävare Silbernagel K, Ackermann PW. Early mobilization does not reduce the risk of deep venous thrombosis after Achilles tendon rupture: a randomized controlled trial. Knee Surg Sports Traumatol Arthrosc 2020; 28:312-319. [PMID: 31679069 PMCID: PMC6971132 DOI: 10.1007/s00167-019-05767-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 10/21/2019] [Indexed: 11/06/2022]
Abstract
PURPOSE The hypothesis was that early functional mobilization would reduce the incidence of deep venous thrombosis (DVT) during leg immobilization after Achilles tendon rupture surgery. A secondary aim was to evaluate if the amount of weightbearing and daily steps influenced the risk of sustaining a DVT. METHODS One-hundred and fifty patients with Achilles tendon rupture repair were randomized to treatment with early functional mobilization, encouraging full weightbearing and ankle motion in orthosis, or treatment-as-usual, i.e., 2 weeks of unloading in plaster cast followed by 4 weeks weightbearing in orthosis. At 2 and 6 weeks postoperatively, all patients were screened for DVT using compression duplex ultrasound. During the first 2 weeks postoperatively, patient-reported loading, pain and step counts were assessed. RESULTS At 2 weeks, 28/96 (29%) of the patients in early functional mobilization group and 15/49 (31%) in the control group (n.s) had sustained a DVT. At 6 weeks, the DVT rate was 35/94 (37%) in the early functional mobilization and 14/49 (29%) in the control group (n.s). During the first postoperative week, the early functional mobilization group reported low loading and higher experience of pain vs. the control group (p = 0.001). Low patient-reported loading ≤ 50% (OR = 4.3; 95% CI 1.28-14.3) was found to be an independent risk factor for DVT, in addition to high BMI and higher age. CONCLUSIONS Early functional mobilization does not prevent the high incidence of DVT during leg immobilization in patients with Achilles tendon rupture as compared to treatment-as-usual. The low efficacy of early functional mobilization is mainly explained by postoperative pain and subsequent low weightbearing. To minimize the risk of DVT, patients should be encouraged to load at least 50% of body weight on the injured leg 1 week after surgery. LEVEL OF EVIDENCE Therapeutic, level 1.
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Affiliation(s)
- Susanna Aufwerber
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. .,Functional Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, A6:U1, Karolinska University Hospital, 171 76, Stockholm, Sweden.
| | - Annette Heijne
- grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
| | - Gunnar Edman
- R&D, Norrtälje Hospital, Tiohundra AB, Norrtälje, Sweden ,grid.4714.60000 0004 1937 0626Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Karin Grävare Silbernagel
- grid.33489.350000 0001 0454 4791Department of Physical Therapy, University of Delaware, Newark, DE USA
| | - Paul W. Ackermann
- grid.4714.60000 0004 1937 0626Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Department of Orthopedic Surgery, Karolinska University Hospital, Stockholm, Sweden
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Zellers JA, Christensen M, Kjær IL, Rathleff MS, Silbernagel KG. Defining Components of Early Functional Rehabilitation for Acute Achilles Tendon Rupture: A Systematic Review. Orthop J Sports Med 2019; 7:2325967119884071. [PMID: 31803789 PMCID: PMC6878623 DOI: 10.1177/2325967119884071] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background: Early functional rehabilitation is frequently discussed in treating Achilles tendon rupture. A consistent definition of what constitutes early functional rehabilitation has not been established across the literature, despite studies supporting its efficacy. A standardized definition would be helpful to pool data across studies, allow for between-study comparisons, and ultimately work toward developing clinical guidelines. Purpose: To define early functional rehabilitation (including when it is initiated and what it entails) when used to treat Achilles tendon rupture and to identify outcome measures for evaluating the effect of treatment. Study Design: Systematic review; Level of evidence, 4. Methods: Ovid MEDLINE, EMBASE, PEDro, CINAHL, and Cochrane databases were searched for relevant studies. Eligibility criteria for selecting studies consisted of randomized controlled trials, cohort studies, and case series (≥10 participants) including weightbearing or exercise-based interventions within 8 weeks after Achilles tendon rupture. Results: A total of 174 studies published between 1979 and 2018 were included. Studies were rated a median (interquartile range [IQR]) of 17 (15-20) on the Downs & Black checklist and included 9098 participants. Early functional rehabilitation incorporated weightbearing (95%), range of motion (73%), and isometric/strengthening exercises (50%). Weightbearing was initiated within the first week, whereas exercise (eg, ankle range of motion, strengthening, whole-body conditioning) was initiated in the second week. Initiation of exercises varied based on whether treatment was nonsurgical (mean, 3.0 weeks; IQR, 2.0-4.0 weeks) or simple (mean, 2.0 weeks; IQR, 0.0-2.3 weeks) or augmented surgical repair (mean, 0.5 weeks; IQR, 0.0-2.8 weeks) (P = .017). Functional outcomes including ankle range of motion (n = 84) and strength (n = 76) were reported in 130 studies. Other outcome domains included patient-reported outcomes (n = 89), survey-based functional outcomes (n = 50), and tendon properties (n = 53). Conclusion: Early functional rehabilitation includes weightbearing and a variety of exercise-based interventions initiated within the first 2 weeks after acute Achilles tendon rupture/repair. Because early functional rehabilitation has lacked a standardized definition, interventions and outcome measures are highly variable, and pooling data across studies should be done with attention paid to what was included in the intervention and how treatment was assessed.
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Affiliation(s)
- Jennifer A Zellers
- Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Marianne Christensen
- Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark.,Orthopaedic Research Unit, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Inge Lunding Kjær
- Orthopaedic Research Unit, Aalborg University Hospital, Aalborg, Denmark
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Cole W, Samsell B, Moore MA. Achilles Tendon Augmented Repair Using Human Acellular Dermal Matrix: A Case Series. J Foot Ankle Surg 2019; 57:1225-1229. [PMID: 29779989 DOI: 10.1053/j.jfas.2018.03.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Indexed: 02/03/2023]
Abstract
Achilles tendon ruptures are common in the general population, especially among members of the older demographic occasionally active in sports. Operative treatments provide a lower incidence of rerupture than do nonoperative treatments, although surgical complications remain a concern. The use of a human acellular dermal matrix to augment Achilles tendon repair might reduce the incidence of complications. In the present case series, we describe the outcomes of 9 patients who underwent Achilles tendon repair with acellular dermal matrix augmentation. Functional outcomes were evaluated using the Foot Function Index-Revised long form, and the clinical results were recorded. After a mean average follow-up period of 14.4 (range 12.0 to 20.0) months, the mean Foot Function Index-Revised long form score was 33.0% ± 4.2%. No cases of rerupture or complications that required additional treatment occurred during the observation period. The outcomes we have presented support further evaluation beyond this case series for using a human acellular dermal matrix to augment Achilles tendon repairs.
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Affiliation(s)
- Windy Cole
- Adjunct Faculty and Director, Wound Care Research, Kent State University College of Podiatric Medicine, Independence, OH; Medical Director, Wound Care Center, University Hospitals Ahuja Medical Center, Beachwood, OH.
| | - Brian Samsell
- Scientific Writer, Scientific Affairs, LifeNet Health, Virginia Beach, VA
| | - Mark A Moore
- Global Senior Director, Scientific Affairs, LifeNet Health, Virginia Beach, VA
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Dams OC, van den Akker-Scheek I, Diercks RL, Wendt KW, Bosma E, van Raaij TM, Munzebrock AV, Zijlstra WP, Zwerver J, Reininga IHF. The recovery after Achilles tendon rupture: a protocol for a multicenter prospective cohort study. BMC Musculoskelet Disord 2019; 20:69. [PMID: 30744626 PMCID: PMC6371453 DOI: 10.1186/s12891-019-2437-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 01/28/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Achilles tendon rupture (ATR) is a common sports injury, with a rising incidence and significant impairments. Due to the lack of treatment guidelines, there is no consensus about diagnostic methods, primary treatment (non-surgical or surgical) and rehabilitation. It is hypothesized that this lack of consensus and guidelines leads to sub-optimal recovery and higher societal costs. The primary aim of this study is to give a broad insight into the recovery after ATR. Secondarily this study aims to explore factors contributing to recovery and gain insight into the cost-effectiveness of ATR management. METHODS This multicenter prospective cohort study will include all adult (≥ 18 years) patients with an ATR treated at the three main hospitals in the Northern Netherlands: University Medical Center Groningen, Martini Hospital Groningen and Medical Center Leeuwarden. All subjects will be invited for three visits at 3, 6 and 12 months post-injury. The following data will be collected: patient-reported outcome measures (PROMs), physical tests, imaging and economic questionnaires. At 3 months post-injury personal, injury, and treatment data will be collected through a baseline questionnaire and assessment of the medical file. The PROMs concern the Dutch version of the Achilles Tendon Total Rupture Score, EQ-5D-5 L, Oslo Sport Trauma Research Center Overuse Injury Questionnaire, Injury Psychological Readiness Return to Sport Scale, Tampa Scale of Kinesiophobia, Expectations, Motivation and Satisfaction questionnaire and a ranking of reasons for not returning to sport. The administered physical tests are the heel-rise test, standing dorsiflexion range of motion, resting tendon length and single leg hop for distance. Ultrasound Tissue Characterization will be used for imaging. Finally, economic data will be collected using the Productivity Cost Questionnaire and Medical Consumption Questionnaire. DISCUSSION This prospective cohort study will contribute to optimal decision making in the primary treatment and rehabilitation of ATRs by providing insight into (1) ATR recovery (2) novel imaging for monitoring recovery (3) (barriers to) return to sport and (4) cost-effectiveness of management. The analysis of these data strives to give a broad insight into the recovery after ATR as well as provide data on novel imaging and costs, contributing to individualized ATR management. TRIAL REGISTRATION Trialregister.nl. NTR6484 . 20/06/2017. 20/07/2017.
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Affiliation(s)
- Olivier C. Dams
- Department of Sport and Exercise Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Ron L. Diercks
- Department of Orthopedics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Klaus W. Wendt
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eelke Bosma
- Department of Surgery, Martini Hospital, Groningen, The Netherlands
| | - Tom M. van Raaij
- Department of Orthopaedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Arvid V. Munzebrock
- Department of Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Wierd P. Zijlstra
- Department of Orthopaedic Surgery, Medical Center Leeuwarden, Leeuwarden, The Netherlands
| | - Johannes Zwerver
- Department of Sport and Exercise Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Zadro JR, Harris IA, Abdelshaheed C, Broderick C, Barton CJ, Linklater J, Maher CG. Choosing Wisely after a sport and exercise-related injury. Best Pract Res Clin Rheumatol 2019; 33:16-32. [DOI: 10.1016/j.berh.2019.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Dams OC, van den Akker-Scheek I, Diercks RL, Wendt KW, Zwerver J, Reininga IHF. Surveying the management of Achilles tendon ruptures in the Netherlands: lack of consensus and need for treatment guidelines. Knee Surg Sports Traumatol Arthrosc 2019; 27:2754-2764. [PMID: 29971520 PMCID: PMC6706364 DOI: 10.1007/s00167-018-5049-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 06/29/2018] [Indexed: 12/11/2022]
Abstract
PURPOSE This study aimed to describe and analyse usual care of Achilles tendon ruptures (ATRs) by orthopaedic surgeons and trauma surgeons in the Netherlands. METHODS A nationwide online survey of ATR management was sent to all consultant orthopaedic and trauma surgeons in the Netherlands, requesting participation of those involved in ATR management. Data on individual characteristics and the entire ATR management (from diagnosis to rehabilitation) were gathered. Consensus was defined as ≥ 70% agreement on an answer. RESULTS A total of 91 responses (70 orthopaedic surgeons and 21 trauma surgeons) were analysed. There was consensus on the importance of the physical examination in terms of diagnosis (> 90%) and a lack of consensus on diagnostic imaging (ultrasound/MRI). There was consensus that non-surgical treatment is preferred for sedentary and systemically diseased patients and surgery for patients who are younger and athletic and present with larger tendon gap sizes. There was consensus on most of the non-surgical methods used: initial immobilisation in plaster cast with the foot in equinus position (90%) and its gradual regression (82%) every 2 weeks (85%). Only length of immobilisation lacked consensus. Surgery was generally preferred, but there was a lack of consensus on the entire followed protocol. Orthopaedic and trauma surgeons differed significantly on their surgical (p = 0.001) and suturing techniques (p = 0.002) and methods of postoperative immobilisation (p < 0.001). Orthopaedic surgeons employed open repair and Bunnell sutures more often, whereas trauma surgeons used minimally invasive approaches and bone anchors. Rehabilitation methods and advised time until weight-bearing and return to sport varied. Orthopaedic surgeons advised a significantly longer time until return to sport after both non-surgical treatment (p = 0.001) and surgery (p = 0.002) than trauma surgeons. CONCLUSION This is the first study to describe the entire ATR management. The results show a lack of consensus and wide variation in management of ATRs in the Netherlands. This study shows that especially the methods of the perioperative and rehabilitation phases were inconclusive and differed between orthopaedic and trauma surgeons. Further research into optimal ATR management regimens is recommended. In addition, to achieve uniformity in management more multidisciplinary collaboration between Dutch and international surgeons treating ATRs is needed. LEVEL OF EVIDENCE Cross-sectional survey, Level V.
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Affiliation(s)
- Olivier C. Dams
- 0000 0000 9558 4598grid.4494.dDepartment of Sport and Exercise Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Inge van den Akker-Scheek
- 0000 0000 9558 4598grid.4494.dDepartment of Sport and Exercise Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands ,0000 0000 9558 4598grid.4494.dDepartment of Orthopaedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Ron L. Diercks
- 0000 0000 9558 4598grid.4494.dDepartment of Orthopaedics, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Klaus W. Wendt
- 0000 0000 9558 4598grid.4494.dDepartment of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Johannes Zwerver
- 0000 0000 9558 4598grid.4494.dDepartment of Sport and Exercise Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Inge H. F. Reininga
- 0000 0000 9558 4598grid.4494.dDepartment of Trauma Surgery, University of Groningen, University Medical Center Groningen, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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El-Habta R, Chen J, Pingel J, Backman LJ. Tendinosis-like changes in denervated rat Achilles tendon. BMC Musculoskelet Disord 2018; 19:426. [PMID: 30497469 PMCID: PMC6267070 DOI: 10.1186/s12891-018-2353-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 11/20/2018] [Indexed: 01/02/2023] Open
Abstract
Background Tendon disorders are common and lead to significant disability and pain. Our knowledge of the ‘tennis elbow’, the ‘jumpers knee’, and Achilles tendinosis has increased over the years, but changes in denervated tendons is yet to be described in detail. The aim of the present study was to investigate the morphological and biochemical changes in tendon tissue following two weeks of denervation using a unilateral sciatic nerve transection model in rat Achilles tendons. Methods Tendons were compared with respect to cell number, nuclear roundness, and fiber structure. The non-denervated contralateral tendon served as a control. Also, the expression of neuromodulators such as substance P and its preferred receptor neurokinin-1 receptor, NK-1R, was evaluated using real-time qRT-PCR. Results Our results showed that denervated tendons expressed morphological changes such as hypercellularity; disfigured cells; disorganization of the collagen network; increased production of type III collagen; and increased expression of NK-1R. Conclusion Taken together these data provide new insights into the histopathology of denervated tendons showing that denervation causes somewhat similar changes in the Achilles tendon as does tendinosis in rats.
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Affiliation(s)
- Roine El-Habta
- Department of Integrative Medical Biology, Section for Anatomy, Umeå University, Johan Bures väg 12, 901 87, Umeå, Sweden.
| | - Jialin Chen
- Department of Integrative Medical Biology, Section for Anatomy, Umeå University, Johan Bures väg 12, 901 87, Umeå, Sweden
| | - Jessica Pingel
- Department of Neuroscience, University of Copenhagen, København, Denmark
| | - Ludvig J Backman
- Department of Integrative Medical Biology, Section for Anatomy, Umeå University, Johan Bures väg 12, 901 87, Umeå, Sweden.,Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden
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Abstract
Objectives The incidence of acute Achilles tendon rupture appears to be increasing. The aim of this study was to summarize various therapies for acute Achilles tendon rupture and discuss their relative merits. Methods A PubMed search about the management of acute Achilles tendon rupture was performed. The search was open for original manuscripts and review papers limited to publication from January 2006 to July 2017. A total of 489 papers were identified initially and finally 323 articles were suitable for this review. Results The treatments of acute Achilles tendon rupture include operative and nonoperative treatments. Operative treatments mainly consist of open repair, percutaneous repair, mini-open repair, and augmentative repair. Traditional open repair has lower re-rupture rates with higher risks of complications. Percutaneous repair and mini-open repair show similar re-rupture rates but lower overall complication rates when compared with open repair. Percutaneous repair requires vigilance against nerve damage. Functional rehabilitation combining protected weight-bearing and early controlled motion can effectively reduce re-rupture rates with satisfactory outcomes. Biological adjuncts help accelerating tendon healing by adhering rupture ends or releasing highly complex pools of signalling factors. Conclusion The optimum treatment for complete rupture remains controversial. Both mini-open repair and functional protocols are attractive alternatives, while biotherapy is a potential future development. Cite this article: X. Yang, H. Meng, Q. Quan, J. Peng, S. Lu, A. Wang. Management of acute Achilles tendon ruptures: A review. Bone Joint Res 2018;7:561–569. DOI: 10.1302/2046-3758.710.BJR-2018-0004.R2.
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Affiliation(s)
- X Yang
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - H Meng
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - Q Quan
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - J Peng
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - S Lu
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
| | - A Wang
- Department of Orthopedic Surgery, Key Laboratory of Musculoskeletal Trauma & War Injuries PLA, Beijing Key Lab of Regenerative Medicine in Orthopedics, Chinese PLA General Hospital, Beijing, China
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van Maele M, Misselyn D, Metsemakers WJ, Sermon A, Nijs S, Hoekstra H. Is open acute Achilles tendon rupture repair still justified? A single center experience and critical appraisal of the literature. Injury 2018; 49:1947-1952. [PMID: 30144965 DOI: 10.1016/j.injury.2018.08.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 07/31/2018] [Accepted: 08/14/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Acute Achilles tendon ruptures are injuries with multiple treatment strategies with possibly far reaching consequences. Open repair is associated with a high complication rate, whereas percutaneous techniques are associated with higher re-rupture rates. The goal of this study was to evaluate the clinical outcome and economic burden of open surgical repair and define a medically and economically sound treatment protocol for acute Achilles tendon ruptures. METHODS Between June 2012 and December 2016 one hundred and five patients with an acute Achilles tendon rupture, treated in an open surgical manner, were studied retrospectively. All demographic, clinical and hospital-related costs were retrieved from the electronic patient database. ATRS questionnaires were sent to assess the functional outcome. A response rate of 70.5% was achieved. RESULTS We recorded a complication rate of 40%, respectively sural nerve hypoesthesia (14.3%), delayed wound healing (28.6%), infection (20.9%) and re-rupture (4.8%). Surgical resident, as primary operating surgeon was associated with a higher complication rate (p = 0.042). Overall, a median functional ATRS score of 17 (IQR 6.5-39.5) was recorded. Infection was associated with significantly higher total healthcare costs per patient as compared to re-rupture (€17,435 vs. €4,537, p = 0.013). The total cost for surgical debridement (n = 6) was approximately 5-times higher than for re-rupture (n = 5), €108,382 vs. €22,272. The median ATRS score for surgical debridement after infection and re-rupture did not differ significantly from the overall ATRS score, respectively 32 (IQR 21-63) and 28 (IQR 15-28). Nevertheless, a difference of 10 points is considered clinically relevant. CONCLUSION The overall functional outcome of open repair of Achilles tendon ruptures is rather good, however associated with a high complication rate, mainly due to wound problems and infection. Although several risk factors were identified, only the operating surgeon is modifiable. Considering the high total costs for surgical debridement in the context of infection compared to re-rupture surgery, despite equal functional outcome,we decided to change clinical practice to reduce the complication rate and healthcare costs. The outcome and precise costs for percutaneous repair will be addressed.
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Affiliation(s)
- Margaux van Maele
- KU Leuven - University of Leuven, Faculty of Medicine, B-3000 Leuven, Belgium
| | - Dominique Misselyn
- University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium
| | - Willem-Jan Metsemakers
- University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, Department of Development and Regeneration, B-3000 Leuven, Belgium
| | - An Sermon
- University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, Department of Development and Regeneration, B-3000 Leuven, Belgium
| | - Stefaan Nijs
- University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, Department of Development and Regeneration, B-3000 Leuven, Belgium
| | - Harm Hoekstra
- University Hospitals Leuven, Department of Trauma Surgery, B-3000 Leuven, Belgium; KU Leuven - University of Leuven, Department of Development and Regeneration, B-3000 Leuven, Belgium.
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