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Ibrahim MAA, Abdelkader MG, Nematallah SA, Elsawy GA, Alghandour SA, Shwitter LM. Modified gastro-soleus turn-down flap for chronic or neglected achilles tendon ruptures. J Orthop Surg Res 2024; 19:168. [PMID: 38449028 PMCID: PMC10918857 DOI: 10.1186/s13018-024-04625-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 02/12/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Achilles' tendon chronic rupture is a common entity that is usually misdiagnosed or mistreated. Hence, she was presented to us later or with complications affecting her gait. Surgical resection is needed to either bridge the gap or reinforce the strength of the tendon repair. OBJECTIVES Our study's goal was to assess the clinical results of repairing chronic Achilles' tendon lesions employing the middle segment of the proximal portion of the tendon (gastro-soleus), as a turn-down flap. METHODS Our prospective interventional single arm study included 18 patients with chronic Achilles' tendon rupture attending at Al-Azhar university hospitals in Cairo, Egypt from May 2020 to April 2023. Diagnosis of the patients was confirmed by radiographic and clinical investigations. They were all treated with the same open reconstruction procedure using a modified GSF. The average follow-up was 12 months. The results of this study were assessed by the Achilles tendon rupture score (ATRS), American Orthopedic Foot and Ankle Society (AOFAS) score, and capacity to perform repeated heel raises on the affected side. RESULTS The mean operative time was 72.77 min. The median (IQR) time of reconstruction was 10 (8-12) after the injury. The median (IQR) length of flab was 4.5 (4.3-5) 9 (Table 2). No intraoperative complications occurred. The typical follow-up period was 12 months (6-18 months). In terms of the ATRS, we found a significant reduction from 82.8 ± 3 preoperatively to 20.8 ± 6.7 at 12 months postoperatively (P value = 0.001). As regards the AOFAS score, it was increased from 49.5 ± 10 preoperatively to 83.8 ± 8.5 12 months postoperatively (P = 0.001). In terms of the post operative complications, there was no re-rupture. Two patients experienced superficial wound infection which improved with daily dressing and antibiotics. Additionally, two patients had slight ankle stiffness four months after the operation, which improved after programmed rehabilitation at the sixth month. CONCLUSION The modified GSTF is a simple, safe, well-tolerated and effective method of treatment with excellent functional results and greater patient content.
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Affiliation(s)
- Mohamed A A Ibrahim
- Al Azhar University-Faculty of Medicine-Orthopedic department., Cairo, Egypt.
| | | | - Samir A Nematallah
- Al Azhar University-Faculty of Medicine-Orthopedic department., Cairo, Egypt
| | - Gamal A Elsawy
- Al Azhar University-Faculty of Medicine-Orthopedic department., Cairo, Egypt
| | - Sameh A Alghandour
- Al Azhar University-Faculty of Medicine-Orthopedic department., Cairo, Egypt
| | - Lotfy M Shwitter
- Al Azhar University-Faculty of Medicine-Orthopedic department., Cairo, Egypt
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Feng SM, Maffulli N, Oliva F, Saxena A, Hao YF, Hua YH, Xu HL, Tao X, Xu W, Migliorini F, Ma C. Surgical management of chronic Achilles tendon rupture: evidence-based guidelines. J Orthop Surg Res 2024; 19:132. [PMID: 38341569 PMCID: PMC10858558 DOI: 10.1186/s13018-024-04559-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/11/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Chronic Achilles tendon ruptures (CATR) often require surgical intervention to restore function. Despite numerous treatment modalities available, the optimal management strategy remains controversial given the limited high-quality evidence available. This article aims to provide evidence-based guidelines for the surgical management of CATR through a comprehensive systematic review of the available data. The consensus reached by synthesizing the findings will assist clinicians in making informed decisions and improving patient outcomes. METHODS A group of 9 foot surgeons in three continents was consulted to gather their expertise on guidelines regarding the surgical management of CATR. Following the proposal of 9 clinical topics, a thorough and comprehensive search of relevant literature published since 1980 was conducted for each topic using electronic databases, including PubMed, MEDLINE, and Cochrane Library, to identify relevant studies published until 1 October 2023. All authors collaborated in drafting, discussing, and finalizing the recommendations and statements. The recommendations were then categorized into two grades: grade a (strong) and grade b (weak), following the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Additionally, feedback from 21 external specialists, who were independent from the authors, was taken into account to further refine and finalize the clinical guidelines. RESULTS Nine statements and guidelines were completed regarding surgical indications, surgical strategies, and postoperative rehabilitation protocol. CONCLUSION Based on the findings of the systematic review, this guideline provides recommendations for the surgical management of CATR. We are confident that this guideline will serve as a valuable resource for physicians when making decisions regarding the surgical treatment of patients with CATR.
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Affiliation(s)
- Shi-Ming Feng
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, China.
| | - Nicola Maffulli
- Department of Medicine and Psychology, University "La Sapienza", Rome, Italy
- Guy Hilton Research Centre, School of Pharmacy and Bioengineering, Keele University, Stoke-On-Trent, Staffordshire, ST4 7QB, England
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
| | - Francesco Oliva
- Department of Sports Traumatology, Universita' Telematica San Raffaele, Rome, Italy
| | - Amol Saxena
- Department of Sports Medicine, Sutter-PAMF, Palo Alto, CA, USA
| | - Yue-Feng Hao
- Orthopedics and Sports Medicine Center, Suzhou Municipal Hospital, Nanjing Medical University Affiliated Suzhou Hospital, Suzhou, Jiangsu, People's Republic of China
| | - Ying-Hui Hua
- Department of Sports Medicine, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Hai-Lin Xu
- Department of Trauma and Orthopedic, People's Hospital, Peking University, Beijing, People's Republic of China
| | - Xu Tao
- Department of Sports Medicine, Southwest Hospital, Army Medical University, Chongqing, People's Republic of China
| | - Wei Xu
- Department of Orthopaedics, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, People's Republic of China
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Medical Centre, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopedics and Trauma Surgery, Academic Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of the Paracelsus Medical University, 39100, Bolzano, Italy.
| | - Chao Ma
- Orthopaedic Department, Sports Medicine Department, Xuzhou Central Hospital, No. 199, the Jiefang South Road, Xuzhou, 221009, Jiangsu, China
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Jiménez-Carrasco C, Ammari-Sánchez-Villanueva F, Prada-Chamorro E, García-Guirao AJ, Tejero S. Allograft and Autologous Reconstruction Techniques for Neglected Achilles Tendon Rupture: A Mid-Long-Term Follow-Up Analysis. J Clin Med 2023; 12:jcm12031135. [PMID: 36769784 PMCID: PMC9917888 DOI: 10.3390/jcm12031135] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 01/22/2023] [Accepted: 01/25/2023] [Indexed: 02/04/2023] Open
Abstract
Achilles tendon ruptures that are not immediately recognized and treated are sometimes diagnosed as delayed injuries and may require different surgical repair options based on gap size. The potential complications associated with using an allograft for reconstruction may lead some surgeons to prefer the use of autologous techniques. However, allografts are often considered a salvagement option when large defects are present. In this study, we examined the long-term clinical outcomes and complications of 17 patients who underwent surgical repair for chronic ruptures with large gaps using both autologous and allograft techniques. During an 11-year period, nine patients were treated with autologous techniques (mean gap of 4.33 ± 1.32 cm) and Achilles allograft reconstruction was performed in eight patients (47.1%) (mean gap of 7.75 ± 0.89 cm). At a mean of 82 ± 36.61 months of follow-up, all 17 patients (100%) were able to perform a single heel rise and improved AOFAS (American Orthopaedic Foot and Ankle Society) and ATRS (Achilles Tendon Total Rupture Score) scores. No infections, complications, or re-ruptures were recorded at the end of the follow-up. No significant differences were found in the AOFAS and ATRS scales between both techniques. When an extensive defect is present, the reconstruction with an Achilles tendon allograft can be considered a proper treatment option, as it does not show a higher rate of complications than autologous techniques achieving similar functional outcomes.
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Affiliation(s)
- Cristina Jiménez-Carrasco
- Orthopedic Surgery and Traumatology Service, Hospital San Juan de Dios del Aljarafe, 41930 Bormujos, Spain
- Correspondence:
| | | | - Estefanía Prada-Chamorro
- Orthopedic Surgery and Traumatology Service, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
| | | | - Sergio Tejero
- Orthopedic Surgery and Traumatology Service, Hospital Universitario Virgen del Rocío, 41013 Seville, Spain
- School of Medicine, Universidad de Sevilla, 41009 Sevilla, Spain
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Ahn J, Jeong BO. Return to Sports Activities After Flexor Hallucis Longus Transfer for Neglected Achilles Tendon Rupture. J Foot Ankle Surg 2022; 61:1263-1266. [PMID: 35370054 DOI: 10.1053/j.jfas.2022.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 02/23/2022] [Accepted: 02/28/2022] [Indexed: 02/03/2023]
Abstract
Transfer of the flexor hallucis longus (FHL) is known to be effective in the treatment of neglected Achilles tendon rupture (ATR). However, evidence on the return to sports activity levels and clinical outcomes is not sufficient. The aim of this study was assessing clinical outcomes and level of sports activity after FHL tendon transfer for treatment of neglected ATR. Twenty-eight patients who underwent FHL transfer for neglected ATR were analyzed retrospectively. Sports activity status was assessed using the Tegner Activity Scale (TAS). Clinical outcomes were evaluated using the Achilles tendon total rupture score and the American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale. By the post hoc power analyses, the power level of more than 80% was identified. The preinjury median TAS score was 4 point and unchanged at the last follow-up. The mean Achilles tendon Total Rupture Scores and American Orthopedic Foot and Ankle Society Ankle-Hindfoot Scale scores at the last follow-up were 81 and 93, respectively. While the median TAS was unchanged, 9/28 patients suffered from lower activity level after the procedure. In conclusion, midterm results of FHL transfer for neglected ATR were shown to be favorable. The median TAS score was maintained. Nonetheless, 32% of patients returned to sports activities with a TAS score 1 point lower than that at preinjury and with less favorable clinical outcomes.
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Affiliation(s)
- Jungtae Ahn
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Bi O Jeong
- Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
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Usman MA, Murtaza B, Winangun PAN, Kennedy D. Chronic Rupture of Achilles Tendon Caused by Haglund's Deformity: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091216. [PMID: 36143893 PMCID: PMC9502300 DOI: 10.3390/medicina58091216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022]
Abstract
A chronic Achilles tendon rupture is a tendon rupture occurring more than 4-6 weeks after a traumatic injury. Haglund's deformity, caused by bony abnormalities in the ankle (mostly due to osteophyte or bone spur), can cause chronic inflammation and degeneration of the Achilles tendon, eventually leading to rupture. This presents a challenge for clinicians who provide tendon repair procedures. We present a 69-year-old woman who had difficulty moving her left leg and had a deformity on the left leg compared to her right leg after falling nine months before but with pain starting three months before the accident. There was a seven-centimeter gap in the calcaneus with a positive Thompson test. The Haglund's deformity on the left calcaneus was visible on the ankle X-ray. The patient had a chronic total rupture of the left Achilles tendon, which was treated with a flexor hallucis longus (FHL) tendon transfer and resection of the deformity. One week after surgery, the patient's ability to walk and the shape of the left leg improved. This case report describes a chronic left Achilles tendon condition that was successfully repaired through tendon repair surgery using FHL tendon transfer and removal of Haglund's deformity.
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蔡 飞, 刘 彦, 刘 凯, 艾 合, 加 莎. [V-Y plasty combined with gastrocnemius aponeurosis turndown repairing the Myerson type Ⅲ chronic Achilles tendon rupture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:410-414. [PMID: 35426278 PMCID: PMC9011082 DOI: 10.7507/1002-1892.202111023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 02/10/2022] [Indexed: 01/24/2023]
Abstract
Objective To investigate the clinical application and effectiveness of V-Y plasty combined with gastrocnemius aponeurosis turndown in the repair of Myerson type Ⅲ chronic Achilles tendon rupture combined with large tendon defect. Methods Between February 2008 and July 2019, 25 patients underwent the V-Y plasty combined with gastrocnemius aponeurosis turndown to treat the Myerson type Ⅲ chronic Achilles tendon rupture. There were 21 males and 4 females. The age ranged from 17 to 56 years, with an average of 34.3 years. Achilles tendon rupture was caused by sports injury in all patients, and the duration from Achilles tendon rupture to operation was 31-70 days, with an average of 53.9 days. After resection of fibrous scar tissue, the distance of Achilles tendon defect was 7-12 cm, with an average of 9.04 cm. The clinical results were evaluated by the Achilles tendon total rupture score (ATRS), American Orthopaedic Foot and Ankle Society (AOFAS) score, dorsiflexion and heel raise height before and after operation. Results The donor and recipient wounds of all 25 cases healed by first intention after operation. All patients were followed up 24 months. During the follow-up, 3 patients developed mild wound infection, which was cured after anti-infection treatment. One patient had Achilles tendon exposure, which was cured after local flap transfer and repair. Ultrasound and MRI reexamination at 3-12 months after operation showed no Achilles tendon elongation, adhesion, or re-rupture. At 24 months after operation, the ATRS score, AOFAS score, dorsiflexion and heel raise height of affected side significantly improved when compared with those before operation (P<0.05). However, the dorsiflexion and heel raise height of affected side were still significantly worse than those of the healthy side (P<0.05). Conclusion V-Y plasty combined with gastrocnemius aponeurosis turndown to repair the chronic Achilles tendon rupture can achieve good effectiveness, and the Achilles tendon function significantly improved after repair. However, the procedure is more invasive and has a long duration of intraoperative wound exposure, causing an increased risk of infection, and the aesthetic is not good.
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Affiliation(s)
- 飞宇 蔡
- 新疆医科大学第一附属医院骨科中心显微修复外科(乌鲁木齐 830054)Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 彦士 刘
- 新疆医科大学第一附属医院骨科中心显微修复外科(乌鲁木齐 830054)Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 凯 刘
- 新疆医科大学第一附属医院骨科中心显微修复外科(乌鲁木齐 830054)Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 合买提江·玉素甫 艾
- 新疆医科大学第一附属医院骨科中心显微修复外科(乌鲁木齐 830054)Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
| | - 莎热特·杰力勒 加
- 新疆医科大学第一附属医院骨科中心显微修复外科(乌鲁木齐 830054)Department of Microrepair and Reconstruction, the First Affiliated Hospital of Xinjiang Medical University, Urumqi Xinjiang, 830054, P. R. China
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Zhang CG, Zhao XY, Cao J, Lin YJ, Yang L, Duan XJ. Triple Hemisection Percutaneous Achilles Tendon Lengthening for Severe Ankle Joint Deformity. Orthop Surg 2021; 13:2373-2381. [PMID: 34806335 PMCID: PMC8654661 DOI: 10.1111/os.13096] [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: 09/02/2020] [Revised: 05/08/2021] [Accepted: 05/11/2021] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate the efficacy of modified percutaneous Achilles tendon lengthening for severe ankle joint deformity. Methods This retrospective case series study included 33 patients with an average age of 25.2 years who underwent surgery in our hospital from April 1, 2010 to March 1, 2018. Triple hemisection percutaneous Achilles tendon lengthening was performed. One stage surgery, other soft tissue surgery or bone correction surgery could be performed. After surgery, a plaster cast was used to fix the functional position, and rehabilitation training was carried out as planned. Complications during the perioperative period were recorded. Statistical analysis of the patients' visual analogue scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) score before and at the last follow‐up was performed. The recurrence rate of Achilles tendon contracture at the last follow‐up and the patients' satisfaction rate were investigated. Results All patients were followed up, with an average follow‐up period of 56.31 months (8–104 months). All achieved good ankle joint function and appearance improvement And there were no infection or skin necrosis complications. In two cases, the incision was poorly healed at non‐Achilles tendon site and was cured by change of dressing. The average VAS score at the last follow‐up was reduced from (2 ± 1.48) points before surgery to (0.26 ± 0.51) points (P = 0.001), and the average AOFAS score was increased from (64.97 ± 13.56) points before surgery to (90.06 ± 10.06) points (P = 0.001). During the follow‐up period, there was no chronic rupture of Achilles tendon. There were two cases of recurrence of foot drop (5.7%), and the patients' satisfaction rate was 93.9%. Conclusion In the surgical treatment of severe ankle joint deformity, the application of triple hemisection percutaneous Achilles tendon lengthening for Achilles tendon contracture has the advantages of less trauma, beautiful incision, and reliable efficacy. The satisfaction rate of patients with this treatment is high, and it is worth promoting in the clinic.
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Affiliation(s)
- Chang-Gui Zhang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xing-Yu Zhao
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jin Cao
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Yang-Jing Lin
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xiao-Jun Duan
- Center for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, China
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Anterolateral Thigh and Vascularized-tensor Fascia Lata Flaps for Long-gap Achilles Tendon Reconstruction. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3631. [PMID: 34123689 PMCID: PMC8191696 DOI: 10.1097/gox.0000000000003631] [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: 12/16/2020] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
We demonstrated our surgical technique of 8-cm segmental loss Achilles tendon reconstruction and repair of posterior heel skin and soft tissue defects with composite anterolateral thigh and 4-layer folding vascularized-tensor fasciae latae flaps of a 15-year-old adolescent boy's post-traumatic injury and infection after primary repair. This technique highlights the ease of harvesting the flap, short operative time, and facilitation of the strong and sustainable motion of the Achilles tendon after reconstruction.
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Arshad Z, Lau EJS, Leow SH, Bhatia M. Management of chronic Achilles ruptures: a scoping review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2543-2559. [PMID: 34089355 PMCID: PMC8514369 DOI: 10.1007/s00264-021-05102-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022]
Abstract
Purpose This scoping review aims to systematically map and summarise the available evidence on the management of chronic Achilles ruptures, whilst identifying prognostic factors and areas of future research. Methods A scoping review was performed according to the frameworks of Arksey and O’Malley, Levac and Peters. A computer-based search was performed in PubMed, Embase, EmCare, CINAHL, ISI Web of Science and Scopus, for articles reporting treatment of chronic Achilles ruptures. Two reviewers independently performed title/abstract and full text screening according to pre-defined selection criteria. Results A total of 747 unique articles were identified, of which 73 (9.8%) met all inclusion criteria. A variety of methods are described, with flexor hallucis longus tendon transfer being the most common. The most commonly reported outcome is the American Orthopaedic Foot and Ankle Society (AOFAS) score, although 16 other measures were reported in the literatures. All studies comparing pre- and post-operative outcomes reported significant post-treatment improvement. Complications were reported in 50 studies, with an overall pooled complication rate of 168/1065 (15.8%). Conclusion Although beneficial results were reported following a variety of techniques, comparison between these is challenging due to the low-level study designs used and confounding factors such as treatment delay and tendon gap size. Further research comparing the efficacy of different techniques is required in order to facilitate the development of an evidence-based treatment protocol. Such work would allow clinicians to better understand the suitability of the large variety of reported techniques and select the optimal strategy for each individual patient. Supplementary Information The online version contains supplementary material available at 10.1007/s00264-021-05102-5.
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Affiliation(s)
- Zaki Arshad
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 111, Cambridge, CB2 0SP, UK.
| | - Edward Jun Shing Lau
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 111, Cambridge, CB2 0SP, UK
| | - Shu Hui Leow
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 111, Cambridge, CB2 0SP, UK
| | - Maneesh Bhatia
- Department of Trauma and Orthopaedic Surgery, University Hospitals Leicester NHS Trust, University Hospitals of Leicester Headquarters, Balmoral Building, Level 3, Leicester, UK
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Mwafi N, Alasmar A, Al-Momani M, Alazaydeh S, Alajoulin O, Alsalem M, Kalbouneh H. Alkaptonuria with extensive ochronotic degeneration of the Achilles tendon and its surgical treatment: a case report and literature review. ASIAN BIOMED 2021; 15:129-136. [PMID: 37551372 PMCID: PMC10388780 DOI: 10.2478/abm-2021-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Alkaptonuria is a rare genetic metabolic disorder due to deficiency of homogentisate 1,2-dioxygenase (HGD), an enzyme catalyzing the conversion of homogentisate to 4-maleylacetoacetate in the pathway for the catabolism of phenylalanine and tyrosine. HGD deficiency results in accumulation of homogentisic acid and its pigmented polymer. Ochronosis is a bluish-black discoloration due to the deposition of the polymer in collagenous tissues. Extensive ochronotic involvement of the Achilles tendon in alkaptonuria and its surgical treatment is rarely reported. Case report A 43-year-old man presented to our clinic in March 2019 with sudden onset of left Achilles tendon pain with no history of prior trauma. Surgical exploration revealed a complete disruption of the tendon at its attachment to the calcaneus. Black pigmentation was extensive and reached the calcaneal tuberosity, extending about 7 cm from the insertion. Discussion Achilles reconstruction was performed using flexor hallucis longus tendon transfer. The patient experienced uncomplicated healing with satisfactory functional results. Conclusion Orthopedic surgeons should be aware of the progressive nature of alkaptonuria. Extensive degenerative changes of the ruptured tendon should be suspected so that physicians can plan tendon repair and facilitate prompt surgical intervention.
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Affiliation(s)
- Nesrin Mwafi
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, Mutah University, Alkarak61710, Jordan
| | - Ali Alasmar
- Department of Urology, Prince Hussein Urology Center, Jordanian Royal Medical Services, Amman11855, Jordan
| | - Monther Al-Momani
- Department of Radiology, Jordanian Royal Medical Services, Amman11855, Jordan
| | - Sattam Alazaydeh
- Department of Orthopedics and Trauma, Jordanian Royal Medical Services, Amman11855, Jordan
| | - Omar Alajoulin
- Department of Orthopedics and Trauma, Jordanian Royal Medical Services, Amman11855, Jordan
| | - Mohammad Alsalem
- Department of Anatomy and Histology, School of Medicine, The University of Jordan, Amman11942, Jordan
| | - Heba Kalbouneh
- Department of Anatomy and Histology, School of Medicine, The University of Jordan, Amman11942, Jordan
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Flexor hallucis longus hypertrophy secondary to Achilles tendon tendinopathy: an MRI-based case-control study. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1387-1393. [PMID: 33555443 PMCID: PMC8448710 DOI: 10.1007/s00590-021-02891-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/26/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE The purpose of this study was to outline an indirect sign of advanced Achilles tendinopathy on magnetic resonance imaging (MRI), based on the hypothesis that these patients would present with secondary hypertrophy of the flexor hallucis longus muscle (FHL). METHODS MRI scans of Achilles tendon were analyzed retrospectively in two cohorts. The study group consisted of consecutive patients presenting with clinical signs of Achilles tendinopathy and no previous surgeries, while the control group were patients that had an MRI due to other reasons and no signs of tendinopathy. Two parameters from two muscle bellies were measured and compared on axial MRI scans 4-5 cm above the ankle joint line at the level of greatest thickness: area and diameter of the triceps surae (TS) and of the FHL muscle. Ratios (FHL/TS) were calculated for area (Ar) and diameter (Dm) measurements. Interobserver agreement was analyzed. A receiver operating characteristic (ROC) curve was created for both ratios to assess potential cutoff points to differentiate between the groups. RESULTS A total of 60 patients for each study group were included. Both ratios Ar(FHL/TS) and Dm(FHL/TS) showed significant higher values in the tendinopathy group (p < 0.001). There were strong to very strong intraclass correlation coefficients (ICC = 0.75-0.93). A diameter ratio Dm (FHL/TS) of 2.0 or higher had a sensitivity of 49% and specificity of 90% for concomitant Achilles tendinopathy. CONCLUSION In our patient cohort, FHL hypertrophy was observed in patients with Achilles tendinopathy as a possible compensatory mechanism. Measuring a diameter ratio Dm(FHL/TS) of 2.0 or higher on an axial MRI, may be indicative as an indirect sign of functional deterioration of the Achilles tendon.
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Silvers CA, Lowe R, Cortez E. A Step in the Right Direction: Point-of-Care Ultrasound as an Evaluation Tool of Achilles Tendon Injuries in the Emergency Department. Cureus 2020; 12:e11823. [PMID: 33409065 PMCID: PMC7781505 DOI: 10.7759/cureus.11823] [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] [Indexed: 11/16/2022] Open
Abstract
This report describes the diagnosis of an Achilles tendon tear in a female patient with an inconclusive physical exam, which was limited by the patient’s body habitus. Expedient use of point-of-care ultrasound supported the diagnosis of an Achilles tear with findings of a tendinous defect, fibrous stranding, and surrounding anechoic fluid, suggestive of localized hemorrhage. The patient was splinted in plantar flexion and had prompt orthopedic referral with MRI that verified Achilles tear.
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Affiliation(s)
- Chase A Silvers
- Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA
| | - Robert Lowe
- Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA
| | - Eric Cortez
- Emergency Medicine, OhioHealth Doctors Hospital, Columbus, USA
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Karas M, Marinsek N, Goldhahn J, Foschini L, Ramirez E, Clay I. Predicting Subjective Recovery from Lower Limb Surgery Using Consumer Wearables. Digit Biomark 2020; 4:73-86. [PMID: 33442582 DOI: 10.1159/000511531] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 09/11/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction A major challenge in the monitoring of rehabilitation is the lack of long-term individual baseline data which would enable accurate and objective assessment of functional recovery. Consumer-grade wearable devices enable the tracking of individual everyday functioning prior to illness or other medical events which necessitate the monitoring of recovery trajectories. Methods For 1,324 individuals who underwent surgery on a lower limb, we collected their Fitbit device data of steps, heart rate, and sleep from 26 weeks before to 26 weeks after the self-reported surgery date. We identified subgroups of individuals who self-reported surgeries for bone fracture repair (n = 355), tendon or ligament repair/reconstruction (n = 773), and knee or hip joint replacement (n = 196). We used linear mixed models to estimate the average effect of time relative to surgery on daily activity measurements while adjusting for gender, age, and the participant-specific activity baseline. We used a sub-cohort of 127 individuals with dense wearable data who underwent tendon/ligament surgery and employed XGBoost to predict the self-reported recovery time. Results The 1,324 study individuals were all US residents, predominantly female (84%), white or Caucasian (85%), and young to middle-aged (mean age 36.2 years). We showed that 12 weeks pre- and 26 weeks post-surgery trajectories of daily behavioral measurements (steps sum, heart rate, sleep efficiency score) can capture activity changes relative to an individual's baseline. We demonstrated that the trajectories differ across surgery types, recapitulate the documented effect of age on functional recovery, and highlight differences in relative activity change across self-reported recovery time groups. Finally, using a sub-cohort of 127 individuals, we showed that long-term recovery can be accurately predicted, on an individual level, only 1 month after surgery (AUROC 0.734, AUPRC 0.8). Furthermore, we showed that predictions are most accurate when long-term, individual baseline data are available. Discussion Leveraging long-term, passively collected wearable data promises to enable relative assessment of individual recovery and is a first step towards data-driven intervention for individuals.
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Affiliation(s)
- Marta Karas
- Evidation Health Inc., San Mateo, California, USA.,Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Jörg Goldhahn
- Institute of Translational Medicine, Department of Health Sciences and Technology, Eidgenössische Technische Hochschule (ETH), Zurich, Switzerland
| | | | | | - Ieuan Clay
- Evidation Health Inc., San Mateo, California, USA
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“Don’t Make the Gap” Surgical Technique and Case Series for Chronic Achilles Rupture. TECHNIQUES IN FOOT AND ANKLE SURGERY 2020. [DOI: 10.1097/btf.0000000000000296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Apinun J, Jenvorapoj S, Arirachakaran A, Kongtharvonskul J. Clinical outcomes of chronic Achilles tendon rupture treated with flexor hallucis longus grafting and flexor hallucis longus grafting plus additional augmentation: A meta-analysis. Foot Ankle Surg 2020; 26:717-722. [PMID: 31635958 DOI: 10.1016/j.fas.2019.09.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 08/25/2019] [Accepted: 09/19/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND The treatment of chronic Achilles tendon rupture is still controversial. Many surgical procedures have been proposed and claim to have good post-operative clinical outcomes. These techniques include direct repair, V-Y flap, turndown flap, peroneus brevis tendon graft, flexor digitorum longus graft, FHL graft, semitendinosus graft, gracilis tendon graft or synthetic material. The two surgical techniques that are widely used include FHL grafting and the combination of FHL grafting plus additional augmentation. This meta-analysis was conducted with the purpose of comparing clinical outcomes of flexor hallucis longus (FHL) grafting and the combination of FHL grafting with additional augmentation techniques in the treatment of chronic Achilles tendon rupture. METHODS Systematic literature searches were conducted on Medline, Embase and Scopus from their inception to April 4, 2019, and proceedings of reference list and scientific meetings were also searched. Relevant clinical studies (e.g., observational, cross-sectional, cohort or randomized controlled trial (RCT)) that reported AOFAS (American Orthopedic Foot Ankle Score) and postoperative complications of either technique were identified. RESULTS Six studies (N = 68) were included for the analysis of FHL, and six studies (N = 124) were included for analysis of FHL with augmentation. A pooling of mean and standard deviation of preoperative and postoperative AOFAS were 57.09 (3.63), 92.97 (22.67) in FHL group and 66.92 (3.16), 95.25 (4.71) in FHL with additional augmentation group respectively. The pooled UMD of AOFAS in FHL with additional augmentation were 2.28 (-1.86, 6.42) scores higher when compared to the FHL group. The prevalence of complications in FHL and FHL with additional augmentation were 14 (N = 120) and 10 (N = 63) patients. The chance of having complications of FHL with additional augmentation group was 0.74 (95% CI: 0.35, 1.56) lower than FHL group. However, there is no statistically significant difference. CONCLUSIONS FHL with additional augmentation group has higher foot function scores (AOFAS) and lower complications when compared to the FHL group. However this did not reach to statistically significant. Further research that assesses a larger sample size of RCTs is necessary to further evaluate FHL with additional augmentation and FHL in the treatment of chronic Achilles tendon rupture.
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Affiliation(s)
- Jirun Apinun
- Orthopaedic Department, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
| | - Somjet Jenvorapoj
- Orthopaedic Department, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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Zhang B, Tao T, Li Y, Jiang Y, Gui J. [Clinical analysis of autogenous tendon reconstruction under total arthroscopy in treatment of chronic Achilles tendon rupture]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:726-729. [PMID: 32538563 DOI: 10.7507/1002-1892.201911055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To investigate the effectiveness of autogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture. Methods Between June 2015 and June 2018, 16 patients with chronic Achilles tendon ruptures were treated by autogenous tendon reconstruction under total arthroscopy. Of the 16 patients, 11 were males and 5 were females. Their mean age was 40.7 years (range, 21-55 years). The disease duration was 14-20 months (mean, 16.4 months). Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 41.2±2.2 and the pain visual analogue scale (VAS) score was 7.9±1.2. MRI and B-ultrasonography examinations showed that the Achilles tendon was not continuous. The length of Achilles tendon defect was 5.0-10.3 cm, with an average of 5.8 cm. The rupture of the Achilles tendon happened on top of the insertion of the tendon in 4 cases and at the tendon-muscle belly connection in 12 cases. The operation time, intraoperative blood loss, hospital stay, and related complications were recorded. The AOFAS score and VAS score were used to evaluate the improvement of ankle joint function and pain. Results The average operation time was 77.2 minutes (range, 60-90 minutes). The average intraoperative blood loss was 20.5 mL (range, 15-30 mL). The average hospital stay was 7.2 days (range, 5-10 days). All incisions healed by first intention. There was no skin necrosis, infection, or deep vein thrombosis. All the patients were followed up 8-18 months, with an average of 12 months; and 10 cases were followed up more than 12 months. During the follow-up, there was no Achilles tendon re-rupture, and the symptoms of pain and heel lifting failure significantly improved. MRI reexamination showed that the continuity of Achilles tendon recovered. At 1, 3, 6, and 12 months postoperatively, AOFAS scores significantly improved and VAS scores significantly reduced, except for 1 month postoperatively, the scores at other time points were superior to that before operation, the differences were significant ( P<0.05). Conclusion Autogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture has the advantages of small trauma, rapid functional recovery, and satisfactory surgical efficacy.
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Affiliation(s)
- Bin Zhang
- Department of Orthopaedics, the Fourth Affiliated Hospital of Nanjing Medical University (Nanjing Pukou Hospital), Nanjing Jiangsu, 210031, P.R.China
| | - Tianqi Tao
- Department of Sports and Joint, the First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China
| | - Yang Li
- Department of Sports and Joint, the First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China
| | - Yiqiu Jiang
- Department of Sports and Joint, the First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China
| | - Jianchao Gui
- Department of Sports and Joint, the First Affiliated Hospital of Nanjing Medical University, Nanjing Jiangsu, 210006, P.R.China
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Duffy DJ, Curcillo CP, Chang YJ, Gaffney L, Fisher MB, Moore GE. Biomechanical evaluation of an autologous flexor digitorum lateralis graft to augment the surgical repair of gastrocnemius tendon laceration in a canine ex vivo model. Vet Surg 2020; 49:1545-1554. [PMID: 32537801 DOI: 10.1111/vsu.13453] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 03/18/2020] [Accepted: 05/02/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the effect of an autologous flexor digitorum lateralis (FDL) graft to augment a three-loop pulley (3LP) core repair in a canine cadaveric gastrocnemius tendon (GT) laceration model. STUDY DESIGN Ex vivo, biomechanical study. SAMPLE POPULATION Twenty-six canine cadaveric hind limbs. METHODS Tendons were divided into two groups (n = 13). After sharp transection, paired GT were repaired with 3LP or 3LP + FDL tendon augmentation. Yield, peak and failure loads, tensile loads required to create 1 and 3-mm gapping, and failure modes were analyzed. Significance was set at P < .05. RESULTS Yield and failure force (mean ± SD) for 3LP + FDL were 134.9 ± 44.1 N and 205.4 ± 46.4 N, respectively, which were greater than for 3LP alone (67.9 ± 12.2 N and 91.8 ± 9.9 N, respectively, P < .0001). No constructs (0%) formed 1 or 3-mm gaps in the 3LP + FDL graft group compared with 84% and 39% for 3LP, respectively (P < .0001). Failure modes were different between groups (P < .001), with 85% of 3LP + FDL constructs failing by tissue rupture at the myotendinous junction, distant to the repair site. CONCLUSION Addition of an autologous FDL graft to a core 3LP tendon repair increased yield, peak, and failure forces by twofold, 2.3-fold, and 2.2-fold, respectively, compared with core 3LP alone while preventing the occurrence of gap formation. CLINICAL SIGNIFICANCE Use of FDL tendon augmentation for GT laceration may increase repair site strength and resist gap formation better than 3LP core suture use alone. Additional studies are required in vivo to determine the effect of FDL graft augmentation on clinical function.
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Affiliation(s)
- Daniel J Duffy
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Chiara P Curcillo
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Yi-Jen Chang
- Department of Clinical Sciences, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Lewis Gaffney
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina-Chapel Hill, Raleigh, North Carolina
| | - Matthew B Fisher
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina-Chapel Hill, Raleigh, North Carolina
| | - George E Moore
- Department of Veterinary Administration, College of Veterinary Medicine, Purdue University, West Lafayette, Indiana
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Karabeg R, Veljovic F, Voloder A, Becirbegovic S, Jahic D, Burak S, Begic E, Masic I. A Mathematical Model of Achilles Tendon Overload During Jump Shot. Med Arch 2019; 73:228-233. [PMID: 31762555 PMCID: PMC6853749 DOI: 10.5455/medarh.2019.73.228-233] [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] [Indexed: 11/03/2022] Open
Abstract
Introduction Achilles tendon injuries usually occur with abrupt movements at the level of the ankle and foot, and the consequence is the overload of the Achilles tendon. Aim Examine the Achilles tendon load as a function of the landing angle, and find the critical point at which the tendon overload begins and when a further increase in the landing angle can lead to rupture. Methods The study has a prospective character. The input data represent the anthropometric values of the respondents, who are professional basketball players in the senior national team of Bosnia and Herzegovina and were processed in the CATIA v5-6 software solution. Software data processing analyzed the landing angles and the transfer of force to the Achilles tendon. The end result is a regression curve, which projects the angle at which the Achilles tendon is overloaded, and indicates an increased risk of possible injury to the tendon itself. Results The onset of overloading starts at an angle of 32.28° and at an angle of 35.75° the overloaded load occurs, indicating the need for the subject to change the position of the foot to prevent damage to the tendon itself. Conclusion An angle of 35.75° is the critical point at which the Achilles tendons are overloaded at the very landing. Prevention of injury should go in the direction of practicing the feet for a particular position at the time of the landing, and in the direction to develop adequate footwear that would mitigate the angle at the landing.
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Affiliation(s)
- Reuf Karabeg
- Private Clinic «Karabeg», Sarajevo, Bosnia and Herzegovina
| | - Fikret Veljovic
- Faculty of Mechanical Engineering, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Avdo Voloder
- Faculty of Mechanical Engineering, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | | | - Dzenan Jahic
- Faculty of Sport and Physical Education, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Senad Burak
- Faculty of Mechanical Engineering, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Edin Begic
- Department of Cardiology, General Hospital "Prim.dr. Abdulah Nakas", Sarajevo, Bosnia and Herzegovina
| | - Izet Masic
- Academy of Medical Sciences of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina
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Modified Percutaneous Achilles Tendon Lengthening by Triple Hemisection for Achilles Tendon Contracture. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1491796. [PMID: 31781592 PMCID: PMC6874878 DOI: 10.1155/2019/1491796] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 08/10/2019] [Indexed: 01/04/2023]
Abstract
Background Both percutaneous Achilles tendon lengthening by triple hemisection and the traditional open Z-lengthening are effective methods for Achilles tendon contracture. This study aims to evaluate the efficacy and safety of this new therapeutic method, which is based on the percutaneous sliding technique with three hemi-cuts in the tendon, as compared with the traditional open Z-lengthening. Methods Retrospective analysis of the Achilles tendon contracture cases in our hospital between January 2010 and September 2016 was conducted. Twenty-five cases received percutaneous Achilles tendon lengthening (group A), and 30 patients who underwent open Z-lengthening during the same period were in the control group (group B). Operative time and hospital stay were statistically analyzed. Incision complication, equinus recurrence rate and Achilles tendon rupture morbidity were recorded. The function was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) score. All cases in group A received Magnetic Resonance Imaging (MRI) of ankle preoperatively and in the follow-ups. Results The mean follow-up period was 42.04 months in group A and 61.7 months in group B. The entire operative time and the mean hospitalization days were lower in group A than in group B. No incision and infection complication occurred in group A. The infection rate in group B was 3.3%. Equinus recurrence rate was 4% in group A and the equinus recurrence rate in group B was 21.4%. In group A, the mean AOFAS score increased from 64 ± 10.16 points preoperatively to 96.08 ± 3.17 at final follow-up, while the score in group B increased from 63.48 ± 6.2 points to 85.4 ± 10.3. MRI showed continuity of the Achilles tendon and homogeneous signal in group A. Conclusion Modified surgery can significantly reduce the risk of Achilles tendon rupture, provide better balance in soft tissue strength between ankle dorsiflexion and ankle plantarflexion, helping to avoid recurrence of the deformity.
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Duan X, Yang L. Arthroscopic management for early-stage tuberculosis of the ankle. J Orthop Surg Res 2019; 14:25. [PMID: 30670051 PMCID: PMC6343251 DOI: 10.1186/s13018-018-1048-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 12/26/2018] [Indexed: 01/10/2023] Open
Abstract
Background Due to atypical clinical presentation, wide use of antibiotics, and lack of specificity in diagnosis, diagnosis of tubercular (TB) infection in joints is increasingly difficult, and misdiagnosis is common. The use of arthroscopy for the diagnosis and treatment of early-stage ankle TB has rarely been reported. This case series intended to present the clinical outcomes of arthroscopic management for early-stage ankle TB. Methods Fifteen patients with chronic synovitis of the ankle and suspicious cause of early-stage ankle TB underwent arthroscopic treatment from April 1, 2010, to March 31, 2016. These cases all failed to confirm diagnosis of TB by ankle arthrocentesis. They included seven males and eight females with an average age of 37.5 (8 to 70) in the study. Among them, five cases had history of pulmonary tuberculosis, and six had history of trauma. The procedure included synovial membrane biopsy and debridement. The diagnosis was confirmed by pathologic examination and culture. The treatment was combined with systemic anti-tuberculous drugs. Follow-up measurements included VAS score, AOFAS score, ESR, CRP, and MRI. Results After arthroscopic management, 13 cases confirmed TB by pathologic examination and culture, and two cases still remained clinically suspected TB; the rate of confirmed case was 87%. The incision healed well in all cases, and no serious complications were observed. There were significant differences in VAS scores, AOFAS scores, ESR, and CRP between before and after treatment (P < 0.01). Joint swelling disappeared or was relieved after 2 months in most patients. Ankle swelling and pain in one patient was improved after changing anti-tuberculous drugs. MRI suggested that all patients had effusion in the articular cavity, accompanied by bone edema of the distal tibia and talus before the treatment. After the surgery, the effusion was significantly reduced, and the signal of bone edema almost disappeared. No recurrent TB was found during the follow-ups. Conclusion Arthroscopic management for early-stage ankle TB is minimally invasive, safe, and reliable. It can easily obtain samples from specific area of TB for further confirmation of the diagnosis, while the debridement can also assist in local disease control. For cases of highly suspicious joint TB, arthroscopic biopsy and debridement after transient anti-TB treatment is recommended. Level of evidence Level IV, therapeutic case series Electronic supplementary material The online version of this article (10.1186/s13018-018-1048-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiaojun Duan
- Centre for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400083, China.
| | - Liu Yang
- Centre for Joint Surgery, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400083, China
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Abubeih H, Khaled M, Saleh WR, Said GZ. Flexor hallucis longus transfer clinical outcome through a single incision for chronic Achilles tendon rupture. INTERNATIONAL ORTHOPAEDICS 2018; 42:2699-2704. [DOI: 10.1007/s00264-018-3976-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 05/04/2018] [Indexed: 12/26/2022]
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