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Vaidya SR, Sharma SC, Al-Jabri T, Kayani B. Return to sport after surgical repair of the Achilles tendon. Br J Hosp Med (Lond) 2023; 84:1-14. [PMID: 37235667 DOI: 10.12968/hmed.2022.0239] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Achilles tendon rupture is among the most common sports injuries. In patients with high functional demands, surgical repair is preferred to facilitate early return to sporting function. This article reviews the literature and provides evidence-based guidance for return to sport after operative management of Achilles tendon rupture. A search was performed using PubMed, Embase and Cochrane Library for all studies reporting on return to sport after operative management of Achilles tendon rupture. The review included 24 studies reporting on 947 patients, and found that 65-100% of patients were able to return to sport between 3 and 13.4 months post-injury, with incidence of rupture recurrence 0-5.74%. These findings will help patients and healthcare professionals plan a recovery timeline, discuss athletic functionality post-recovery, and understand complications of repair and risk of tendon re-rupture.
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Affiliation(s)
| | | | - Talal Al-Jabri
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Babar Kayani
- Department of Trauma and Orthopaedic Surgery, University College Hospital, London, UK
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Effect of Platelet-Rich Plasma Augmentation on Endoscopy-Assisted Percutaneous Achilles Tendon Repair. J Clin Med 2022; 11:jcm11185389. [PMID: 36143034 PMCID: PMC9501121 DOI: 10.3390/jcm11185389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/10/2022] [Accepted: 09/11/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Achilles tendon ruptures are one of the most common sports injuries. Recently, platelet-rich plasma (PRP) has been widely used in tendon-related disorders to enhance tendon healing. However, studies regarding PRP treatment in Achilles tendon rupture show inconsistent results. The purpose of this study was to evaluate the effectiveness of PRP in patients with acute Achilles tendon rupture treated with endoscopy-assisted percutaneous repair. Methods: A total of 62 patients with acute Achilles tendon rupture treated with surgical repair from January 2014 to December 2018 were enrolled in this study. Surgical repair in conjunction with PRP augmentation after surgery was classified as the PRP group. Surgical repair without PRP augmentation was classified as the non-PRP group. All patients were followed up at least 2 years post-operation. The outcomes were evaluated on the basis of rate of return to sports, time to return to play, Achilles Tendon Total Rupture Score (ATRS), calf circumference ratio, ankle range of motion (ROM) and complications following surgery. Results: At 2-year follow-up, the ATRS score was not significantly different between groups (p = 0.8), but the ATRS score in both groups improved with time. Rate of return to sports and time to return to play were not different between the two groups (p = 1.00). Moreover, calf circumference ratio and ankle ROM were evaluated at 6-month, 12-month, 18-month and 24-month follow-ups. At 6 months, the PRP group had better ankle ROM (p = 0.003) and a higher calf circumference ratio (p = 0.011); however, at the 24-month evaluation, there were no between-group differences regarding calf circumference ratio, ankle dorsiflexion and plantarflexion (p > 0.05). Conclusion: We show that PRP augmentation in Achilles tendon surgery did not yield superior functional and clinical outcomes. Therefore, clinicians should inform patients of the above information when undergoing Achilles tendon surgery and offer correct expectations to family and patients regrading PRP treatment.
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Sanada T, Iwaso H, Fukai A, Honda E, Yoshitomi H. Comparison Study of Mini-Incision Versus Original Open Technique of the Half-Mini-Bunnell Achilles Tendon Repair. J Foot Ankle Surg 2022; 61:355-362. [PMID: 34656416 DOI: 10.1053/j.jfas.2021.02.017] [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: 02/03/2020] [Revised: 01/30/2021] [Accepted: 02/07/2021] [Indexed: 02/03/2023]
Abstract
Mini-incision surgical procedures in our institution have been developed by decreasing the total skin incision length from the original mini half-Bunnell tendon repair technique. We hypothesized that the mini-incision, or minimum invasive Achilles tendon repair technique, would promote the tendon healing process leading to better outcomes and a reduced complication rate compared to the conventional open repair. The study sought to determine the more optimal method by comparing 44 mini-incision sutures to the 99 sutures in the original open Achilles tendon repairs. The mean skin incision length of the mini-incision surgery was 2.9 (range 2.5-3.0) cm and the original repair was 4.2 (range 3.5-7.0) cm. The mean surgery time was 60.0 minutes in the mini-incision repair and 68.1 minutes in the original one (p = .0003). The mean achievement time of bilateral heel-rise, starting jogging, single-legged heel-rise movement and the time to return-to-play was not significantly different between the 2 groups. Achilles Tendon Rupture Score was not significantly different from 3 to 9 months after surgery. Re-injury rate was 1/44 (2.3%) in mini-incision and 4/99 (4.0%) in conventional open repair (p = .36). No patients in either group developed any postoperative infections nor deep vein thrombosis complications. Although the mini-incision half-mini-Bunnell suture was showed equivalent clinical results to the original open repair, the technique is recommended in terms of curtailment of the surgery time without increase of complication ratio.
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Affiliation(s)
- Takaki Sanada
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshi cho, Nakahara ku, Kawasaki city, Kanagawa prefecture, Japan.
| | - Hiroshi Iwaso
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshi cho, Nakahara ku, Kawasaki city, Kanagawa prefecture, Japan
| | - Atsushi Fukai
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshi cho, Nakahara ku, Kawasaki city, Kanagawa prefecture, Japan
| | - Eisaburo Honda
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshi cho, Nakahara ku, Kawasaki city, Kanagawa prefecture, Japan
| | - Hiroki Yoshitomi
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, 1-1 Kizuki Sumiyoshi cho, Nakahara ku, Kawasaki city, Kanagawa prefecture, Japan
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Kage T, Sanada T, Iwaso H, Goto H, Fukai A, Yamagami R, Honda E, Uchiyama E. Morphology of Acute Achilles Tendon Rupture by Intraoperative Evaluation. J Foot Ankle Surg 2021; 60:1198-1203. [PMID: 34134918 DOI: 10.1053/j.jfas.2021.05.005] [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: 02/07/2021] [Revised: 04/29/2021] [Accepted: 05/10/2021] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to clarify the morphology of acute Achilles tendon rupture (ATR) according to intraoperative evaluation. The morphology of 220 cases was evaluated retrospectively from intraoperative findings from June 2014 to December 2015. We noted 3 characteristics of rupture. First, we divided the ruptures into complete or partial type. Second, according to the level of rupture, we classified them into muscle-tendon junctional type, mid-substantial type, or calcaneal insertional avulsion type. Lastly, on the basis of the pattern of rupture, we divided them into transverse pattern, double-layer pattern, or Z-shaped pattern. All ruptured tendons were repaired with surgical procedures on the basis of the classification of rupture type or pattern. Of the total of 220 cases, 217 were complete ruptures (98.7%) and 3 partial ruptures (1.3%). Regarding the level of rupture, 5 cases were of the muscle-tendon junctional type (2.3%), 209 cases of the mid-substantial type (95%), and 6 cases of the calcaneal insertional avulsion type (2.7%). In terms of the pattern of rupture, there were 198 cases of the transverse pattern (90%), 10 cases of the double-layer pattern (4.5%), and 12 cases of the Z-shaped pattern (5.5%). There was significant gender difference only in the mid-substantial type. Although the morphology of a typical acute ATR was complete, of mid-substance type, and with transverse pattern, other types of ATR were recognized from the intraoperative investigation.
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Affiliation(s)
- Tomofumi Kage
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa Prefecture, Japan
| | - Takaki Sanada
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa Prefecture, Japan.
| | - Hiroshi Iwaso
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa Prefecture, Japan
| | - Hidetaka Goto
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa Prefecture, Japan
| | - Atsushi Fukai
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa Prefecture, Japan
| | - Ryota Yamagami
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa Prefecture, Japan
| | - Eisaburo Honda
- Department of Sports Orthopaedic Surgery, Kanto Rosai Hospital, Kawasaki, Kanagawa Prefecture, Japan
| | - Eiji Uchiyama
- Inanami Spine and Joint Hospital, Shinagawa-ku, Tokyo, Japan
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Early Short-Term Recovery of Single-Leg Heel Rise and ATRS After Achilles Tenorrhaphy: Cluster Analysis. Asian J Sports Med 2018. [DOI: 10.5812/asjsm.67661] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Toyooka S, Takeda H, Nakajima K, Masujima A, Miyamoto W, Pagliazzi G, Nakagawa T, Kawano H. Correlation Between Recovery of Triceps Surae Muscle Strength and Level of Activity After Open Repair of Acute Achilles Tendon Rupture. Foot Ankle Int 2017; 38:1324-1330. [PMID: 28891314 DOI: 10.1177/1071100717728686] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to determine whether physical findings reflecting triceps surae strength recovery could predict return to activities such as jogging and sports and whether patients' age and sex would influence recovery of triceps surae strength postoperatively. METHODS Between 2009 and 2013, 96 consecutive cases of postoperative acute Achilles tendon rupture were reviewed. The postoperative triceps surae strength recovery rate was investigated in all patients by using half body weight 1-time heel rise, full body weight (FBW) 1-time heel rise, FBW 20-time heel rise, jogging, and full return to sports activities. Influence of age and sex on triceps surae strength recovery was also investigated. RESULTS FBW 1-time heel rise and jogging were achieved at an average of 14 weeks (range, 6-24 weeks) and 15 weeks (range, 8-25 weeks) postoperatively, respectively. FBW 20-time heel rise and full return to sports activities were achieved at a mean of 21 weeks (range, 12-29 weeks) and 22 weeks (range, 13-29 weeks) postoperatively, respectively. Ability to perform FBW 1-time heel rise was directly related to resilience of jogging capability ( R2 = 0.317, P < 0.001), and ability to perform FBW 20-time heel rise was related to full return to sports activities ( R2 = 0.508, P < 0.001). Time to heel rise was not correlated with patient age or sex. CONCLUSION Postoperative ability to perform FBW 1-time heel rise in patients postoperatively was directly related to resilience of jogging, and ability to perform FBW 20-time heel rise was directly related to full return to sports activities. LEVEL OF EVIDENCE Level IV, case series.
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Affiliation(s)
- Seikai Toyooka
- 1 Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hideki Takeda
- 2 Department of Orthopaedic Surgery, Toshiba General Hospital, Tokyo, Japan
| | - Kohei Nakajima
- 2 Department of Orthopaedic Surgery, Toshiba General Hospital, Tokyo, Japan
| | - Atsushi Masujima
- 2 Department of Orthopaedic Surgery, Toshiba General Hospital, Tokyo, Japan
| | - Wataru Miyamoto
- 1 Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Gherardo Pagliazzi
- 3 Department of Orthopaedic Surgery, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Takumi Nakagawa
- 1 Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- 1 Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Yammine K, Assi C. Efficacy of repair techniques of the Achilles tendon: A meta-analysis of human cadaveric biomechanical studies. Foot (Edinb) 2017; 30:13-20. [PMID: 28171797 DOI: 10.1016/j.foot.2016.09.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/18/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Achilles injuries are very common, mainly among young athletes. When indicated, the surgical treatment aims for strong repairs that can resist distraction and consequently ruptures. The majority of the published clinical meta-analyses reported comparisons between broad treatment modalities such as conservative treatment, open, and minimally invasive surgery. METHODS A meta-analysis has been conducted to assess further clinical and biomechanical variables on human cadavers related to the efficacy of Achilles repair. A total of 26 studies with 596 legs met the inclusion criteria. The maximal load to failure was set as the primary outcome. Eleven studies were amenable to meta-analysis. RESULTS In the reinsertion group, the analysis of the single row vs. double row subgroup showed a significantly higher strength for the latter (1.27, 95% CI=0.748-1.806, I2=81%, P<0.0001). In the mid-tendon repair group, the Achillon vs. Krackow sutures and the Bunnell vs. Krackow sutures subgroups showed no difference while the Bunnell and Krakow sutures were significantly stronger than the Kessler sutures (0.96, 95% CI=0.510-1.405, I2=63.3%, P<0.0001 and 1.37, 95% CI=2.286-0.468, I2=83.4%, P=0.003; respectively). CONCLUSIONS The assessment of heterogeneity located variables such as age, suture/material type, number of strands, type of testing machine and software, preloading, ankle position and loading type as potential confounders. The results of this meta-analysis are likely to have a significant impact in clinical practice.
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Affiliation(s)
- Kaissar Yammine
- The Foot and Hand Clinic and The Center for Evidence-Based Anatomy, Sport & Orthopedic Research, Jdeideh Highway, Fouad Yammine Bld., 1st Floor, Beirut, Lebanon.
| | - Chahine Assi
- The Orthopedic Department, Lebanese American University, Lebanon.
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Miyamoto W, Imade S, Innami K, Kawano H, Takao M. Acute Achilles Tendon Rupture Treated by Double Side-Locking Loop Suture Technique With Early Rehabilitation. Foot Ankle Int 2017; 38:167-173. [PMID: 27765870 DOI: 10.1177/1071100716673589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although early accelerated rehabilitation is recommended for the treatment of acute Achilles tendon rupture, most traditional rehabilitation techniques require some type of brace. METHODS We retrospectively analyzed 44 feet of 44 patients (25 male and 19 female) with a mean age of 31.8 years who had an acute Achilles tendon rupture related to athletic activity. Patients had been treated by a double side-locking loop suture (SLLS) technique using double antislip knots between stumps and had undergone early accelerated rehabilitation, including active and passive range of motion exercises on the day following the operation and full weight-bearing at 4 weeks. No brace was applied postoperatively. The evaluation criteria included the American Orthopaedic Foot & Ankle Society Ankle-Hindfoot Scale (AOFAS) score; active plantar flexion and dorsiflexion angles; and the intervals between surgery and the time when patients could walk normally without any support, perform double-leg heel raises, and perform 20 continuous single-leg heel raises of the operated foot. RESULTS Despite postoperative early accelerated rehabilitation, the AOFAS score and active dorsiflexion angles improved over time (6, 12, and 24 weeks and 2 years). A mean of 4.3 ± 0.6 weeks was required for patients to be able to walk normally without any support. The mean period to perform double-leg heel raises and 20 continuous single-leg heel raises of the injured foot was 8.0 ± 1.3 weeks and 10.9 ± 2.1 weeks, respectively. All patients, except one who was engaged in classical ballet, could return to their preinjury level of athletic activities, and the interval between operation and return to athletic activities was 17.1 ± 3.7 weeks. CONCLUSION The double SLLS technique with double antislip knots between stumps adjusted the tension of the sutured Achilles tendon at the ideal ankle position and provided good clinical outcomes following accelerated rehabilitation after surgery without the use of a brace. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Wataru Miyamoto
- 1 Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Shinji Imade
- 2 Department of Orthopaedic Surgery, Shimane University School of Medicine, Izumo, Japan
| | - Ken Innami
- 1 Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Hirotaka Kawano
- 1 Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Masato Takao
- 1 Department of Orthopaedic Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Sanada T, Uchiyama E. Gravity Equinus Position to Control the Tendon Length of Reversed Free Tendon Flap Reconstruction for Chronic Achilles Tendon Rupture. J Foot Ankle Surg 2017; 56:37-41. [PMID: 27989345 DOI: 10.1053/j.jfas.2016.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Indexed: 02/03/2023]
Abstract
Repair of chronic Achilles tendon rupture is a surgical challenge. We describe the use of a free turndown tendon flap augmentation raised from the proximal gastrocnemius aponeurosis. To control optimal tension or the reconstructed Achilles tendon length, we used an original method by referring to the gravity planter flexion ankle angle of the contralateral limb. Key aspects of the technique are described. A retrospective analysis of the short-term outcomes achieved in a case series (n = 56) is presented. The postoperative anthropometric findings are also presented to indicate the successful outcomes achieved with this technique.
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Affiliation(s)
- Takaki Sanada
- Surgeon, Sports Orthopedics Surgery, Kanto Rosai Hospital, Kawasaki City, Japan.
| | - Eiji Uchiyama
- Surgeon, Sports Orthopedics Surgery, Kanto Rosai Hospital, Kawasaki City, Japan
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Jielile J, Badalihan A, Qianman B, Satewalede T, Wuerliebieke J, Kelamu M, Jialihasi A. Clinical outcome of exercise therapy and early post-operative rehabilitation for treatment of neglected Achilles tendon rupture: a randomized study. Knee Surg Sports Traumatol Arthrosc 2016; 24:2148-55. [PMID: 25894749 DOI: 10.1007/s00167-015-3598-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Treatment of neglected Achilles tendon rupture is very challenging. This randomized study aimed to compare the clinical outcome of early post-operative rehabilitation (EPR) with post-operative cast immobilization (PCI). METHODS Fifty-seven patients with neglected Achilles tendon rupture were randomized to receive EPR (n = 26) or PCI (n = 31) management following surgery. Clinical outcome was monitored by follow-up at weeks 8, 12, 18 and 26 and year 2. The significance of intergroup differences from the Leppilahti scoring system (LSS), ultrasonography, multislice spiral computerized tomography (MSCT) and electromyography was assessed. RESULTS Ultrasonography and MSCT revealed no occurrence of tendon elongation or adhesion. Four patients could perform sustained single-leg heel-raise exercise for 60 s at post-operative day 40. The PCI group also showed increased post-operative LSS score, but recovery was slower. Post-operative complications, such as ankle joint ankylosis and osteoporosis, only occurred in the PCI group. CONCLUSIONS Compared with cast immobilization, early post-operative rehabilitation results in better clinical outcome and faster overall tendon regeneration of neglected Achilles tendon rupture. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Jiasharete Jielile
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Ayinazi Badalihan
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Bayixiati Qianman
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Tuerde Satewalede
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Jianati Wuerliebieke
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Mailamuguli Kelamu
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Ayidaer Jialihasi
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China.
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Zellers JA, Carmont MR, Grävare Silbernagel K. Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play. Br J Sports Med 2016; 50:1325-1332. [PMID: 27259751 DOI: 10.1136/bjsports-2016-096106] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/26/2022]
Abstract
AIM This systematic review and meta-analysis sought to identify return to play (RTP) rates following Achilles tendon rupture and evaluate what measures are used to determine RTP. DESIGN A systematic review and meta-analysis were performed. Studies were assessed for risk of bias and grouped based on repeatability of their measure of RTP determination. DATA SOURCES PubMed, CINAHL, Web of Science and Scopus databases were searched to identify potentially relevant articles. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies reporting RTP/sport/sport activity in acute, closed Achilles tendon rupture were included. RESULTS 108 studies encompassing 6506 patients were included for review. 85 studies included a measure for determining RTP. The rate of RTP in all studies was 80% (95% CI 75% to 85%). Studies with measures describing determination of RTP reported lower rates than studies without metrics described, with rates being significantly different between groups (p<0.001). CONCLUSIONS 80 per cent of patients returned to play following Achilles tendon rupture; however, the RTP rates are dependent on the quality of the method used to measure RTP. To further understand RTP after Achilles tendon rupture, a standardised, reliable and valid method is required.
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Affiliation(s)
- Jennifer A Zellers
- Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - Michael R Carmont
- Department of Orthopaedic Surgery, The Princess Royal Hospital, Telford, Shropshire, UK.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Grävare Silbernagel
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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van Dijk PAD, Lubberts B, Verheul C, DiGiovanni CW, Kerkhoffs GMMJ. Rehabilitation after surgical treatment of peroneal tendon tears and ruptures. Knee Surg Sports Traumatol Arthrosc 2016; 24:1165-74. [PMID: 26803783 PMCID: PMC4823352 DOI: 10.1007/s00167-015-3944-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/09/2015] [Indexed: 12/26/2022]
Abstract
PURPOSE The purpose of this study was to provide an overview of the available evidence on rehabilitation programmes after operatively treated patients with peroneal tendon tearsand ruptures. METHODS A systematic review was performed, and PubMed and EMBASE were searched for relevant studies. Information regarding the rehabilitation programme after surgical management of peroneal tendon tears and ruptures was extracted from all included studies. RESULTS In total, 49 studies were included. No studies were found with the primary purpose to report on rehabilitation of surgically treated peroneal tendon tears or ruptures. The median duration of the total immobilization period after primary repair was 6.0 weeks (range 0-12), 7.0 weeks (range 3.0-13) after tenodesis, 6.3 weeks (range 3.0-13) after grafting, and 8.0 weeks (range 6.0-11) after end-to-end suturing. Forty one percent of the studies that reported on the start of range of motion exercises initiated range of motion within 4 weeks after surgery. No difference was found in duration of immobilization or start of range of motion between different types of surgical treatment options. CONCLUSION Appropriate directed rehabilitation appears to be an important factor in the clinical success of surgically treated peroneal tendon tears and ruptures. There seems to be a trend towards shorter immobilization time and early range of motion, although there is no consensus in the literature on best practice recommendations for optimizing rehabilitation after surgical repair of peroneal tendon tears or ruptures. It is important to adjust the rehabilitation protocol to every specific patient for an optimal rehabilitation. LEVEL OF EVIDENCE Systematic Review, Level IV.
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Affiliation(s)
- Pim A. D. van Dijk
- />Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands , />Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands , />Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands , />Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Bart Lubberts
- />Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Claire Verheul
- />Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands , />Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands , />Orthopaedic Manual Therapy and (Sport)Physiotherapy, ManualFysion, Amsterdam, The Netherlands
| | - Christopher W. DiGiovanni
- />Foot and Ankle Service, Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Gino M. M. J. Kerkhoffs
- />Department of Orthopaedic Surgery, Orthopaedic Research Center Amsterdam, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands , />Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands , />Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam, The Netherlands
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Ishikura H, Fukui N, Takamure H, Ohashi S, Iwasawa M, Takagi K, Horita A, Saito I, Mori T. Successful treatment of a fracture of a huge Achilles tendon ossification with autologous hamstring tendon graft and gastrocnemius fascia flap: a case report. BMC Musculoskelet Disord 2015; 16:365. [PMID: 26603375 PMCID: PMC4659239 DOI: 10.1186/s12891-015-0821-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/18/2015] [Indexed: 12/17/2022] Open
Abstract
Background Fracture of an ossified Achilles tendon is a rare entity, and no standard treatment has been established. This is the first report to describe the use of a hamstring tendon graft and gastrocnemius fascia flap for Achilles tendon reconstruction. Case presentation We present the case of a 50-year-old woman with fracture of an ossified Achilles tendon. She presented to our clinic with acute right hindfoot pain, which started suddenly while going up the stairs. Plain radiography and magnetic resonance imaging revealed a massive ossification on the right Achilles tendon extending over 14 cm in length; the ossification was fractured at 5 cm proximal to the calcaneus insertion. Surgical treatment included removal of the ossified tendon and reconstruction with an autologous hamstring tendon graft and gastrocnemius fascia flap. One year after surgery, she was able to walk with little pain or discomfort and to stand on her right tiptoe. Conclusion Our novel surgical procedure may be useful in the treatment of fractured ossified Achilles tendons and large Achilles tendon defects.
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Affiliation(s)
- Hisatoshi Ishikura
- Department of Orthopaedic Surgery, National Hospital Organization, Sagamihara Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa Prefecture, 252-0314, Japan.
| | - Naoshi Fukui
- Department of Orthopaedic Surgery, National Hospital Organization, Sagamihara Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa Prefecture, 252-0314, Japan.
| | - Hiroshi Takamure
- Department of Orthopaedic Surgery, National Hospital Organization, Sagamihara Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa Prefecture, 252-0314, Japan.
| | - Satoru Ohashi
- Department of Orthopaedic Surgery, National Hospital Organization, Sagamihara Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa Prefecture, 252-0314, Japan.
| | - Mitsuyasu Iwasawa
- Department of Orthopaedic Surgery, National Hospital Organization, Sagamihara Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa Prefecture, 252-0314, Japan.
| | - Kentaro Takagi
- Department of Orthopaedic Surgery, National Hospital Organization, Sagamihara Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa Prefecture, 252-0314, Japan.
| | - Ayako Horita
- Department of Pathology, National Hospital Organization, Sagamihara Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa Prefecture, 252-0314, Japan.
| | - Ikuo Saito
- Department of Pathology, National Hospital Organization, Sagamihara Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa Prefecture, 252-0314, Japan.
| | - Toshihito Mori
- Department of Orthopaedic Surgery, National Hospital Organization, Sagamihara Hospital, 18-1 Sakuradai, Minami-ku, Sagamihara City, Kanagawa Prefecture, 252-0314, Japan.
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Brorsson A, Olsson N, Nilsson-Helander K, Karlsson J, Eriksson BI, Silbernagel KG. Recovery of calf muscle endurance 3 months after an Achilles tendon rupture. Scand J Med Sci Sports 2015; 26:844-53. [DOI: 10.1111/sms.12533] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2015] [Indexed: 01/26/2023]
Affiliation(s)
- A. Brorsson
- Department of Orthopaedics; Institute of Clinical Sciences at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- IFK Kliniken Rehab; Gothenburg Sweden
| | - N. Olsson
- Department of Orthopaedics; Institute of Clinical Sciences at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Orthocenter IFK-Kliniken; Gothenburg Sweden
- Sahlgrenska University Hospital; Mölndal Sweden
| | - K. Nilsson-Helander
- Department of Orthopaedics; Institute of Clinical Sciences at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Hallands sjukhus; Kungsbacka Sweden
| | - J. Karlsson
- Department of Orthopaedics; Institute of Clinical Sciences at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Sahlgrenska University Hospital; Mölndal Sweden
| | - B. I. Eriksson
- Department of Orthopaedics; Institute of Clinical Sciences at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Sahlgrenska University Hospital; Mölndal Sweden
| | - K. G. Silbernagel
- Department of Orthopaedics; Institute of Clinical Sciences at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Department of Physical Therapy; University of Delaware; Newark Delaware USA
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15
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Clanton TO, Haytmanek CT, Williams BT, Civitarese DM, Turnbull TL, Massey MB, Wijdicks CA, LaPrade RF. A Biomechanical Comparison of an Open Repair and 3 Minimally Invasive Percutaneous Achilles Tendon Repair Techniques During a Simulated, Progressive Rehabilitation Protocol. Am J Sports Med 2015; 43:1957-64. [PMID: 26063402 DOI: 10.1177/0363546515587082] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While the nonoperative management of Achilles tendon ruptures is a viable option, surgical repair is preferred in healthy and active populations. Recently, minimally invasive percutaneous repair methods with assistive devices have been developed. HYPOTHESIS/PURPOSE The purpose of this study was to biomechanically analyze 3 commercially available, minimally invasive percutaneous techniques compared with an open Achilles repair during a simulated, progressive rehabilitation program. It was hypothesized that no significant biomechanical differences would exist between repair techniques. STUDY DESIGN Controlled laboratory study. METHODS A simulated, midsubstance Achilles rupture was created 6 cm proximal to the calcaneal insertion in 33 fresh-frozen cadaveric ankles. Specimens were then randomly allocated to 1 of 4 different Achilles repair techniques: (1) open repair, (2) the Achillon Achilles Tendon Suture System, (3) the PARS Achilles Jig System, or (4) an Achilles Midsubstance SpeedBridge Repair variation. Repairs were subjected to a cyclic loading protocol representative of progressive postoperative rehabilitation: 250 cycles at 1 Hz for each loading range: 20-100 N, 20-200 N, 20-300 N, and 20-400 N. RESULTS The open repair technique demonstrated significantly less elongation (5.2 ± 1.1 mm) when compared with all minimally invasive percutaneous repair methods after 250 cycles (P < .05). No significant differences were observed after 250 cycles between the Achillon, PARS, or SpeedBridge repairs, with mean displacements of 9.9 ± 2.2 mm, 12.2 ± 4.4 mm, and 10.0 ± 3.9 mm, respectively. When examined over smaller cyclic intervals, the majority of elongation, regardless of repair, occurred within the first 10 cycles. Within the first 10 cycles, open repairs achieved 71.2% of the total elongation observed after 250 cycles. Corresponding values for the Achillon, PARS, and SpeedBridge repairs were 81.8%, 77.9%, and 69.0%, respectively. No significant differences were observed in the total number of cycles to failure between minimally invasive percutaneous repairs and open repairs. Minor differences in the mechanism of failure were noted; however, the majority of all repairs failed at the suture-tendon interface. CONCLUSION Minimally invasive percutaneous repair techniques demonstrated a susceptibility to significant early repair elongation when compared with open repairs. However, the ultimate strengths of repairs (cycles to failure) were comparable across all techniques. CLINICAL RELEVANCE The reduced early elongation of open repairs suggests that patients treated with this technique may be able to progress through an earlier and/or more aggressive postoperative rehabilitation protocol with a lower risk of early irrevocable repair elongation or gapping about the repair site. However, in cases where cosmesis or wound-healing complications are of significant concern, minimally invasive percutaneous techniques provide a biomechanically reasonable alternative based on their repair strengths (cycles to failure). These repairs may need to be protected longer postoperatively to allow for biological healing and avoid early repair elongation and potential gapping between the healing tendon ends.
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Affiliation(s)
- Thomas O Clanton
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
| | | | | | | | | | | | | | - Robert F LaPrade
- Steadman Philippon Research Institute, Vail, Colorado, USA The Steadman Clinic, Vail, Colorado, USA
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16
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Fu C, Qu W. Acute Achilles tendon rupture: Mini-incision repair with double-Tsuge loop suture vs. open repair with modified Kessler suture. Surgeon 2015; 13:207-12. [DOI: 10.1016/j.surge.2014.03.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 03/15/2014] [Accepted: 03/21/2014] [Indexed: 12/28/2022]
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17
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Badalihan A, Aihemaiti A, Shawutali N, Jielile J, Jialihasi A, Tangkejie W, Nuerdoula Y, Satewalede T, Hunapiya B, Niyazebieke H, Hezibieke H, Zhao Q, Bahetijiang A, Kelamu M, Qianman B. Outcome of a one-stage tensile stress surgical technique and early postoperative rehabilitation in the treatment of neglected achilles tendon rupture. J Foot Ankle Surg 2015; 54:153-9. [PMID: 25703445 DOI: 10.1053/j.jfas.2014.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Indexed: 02/03/2023]
Abstract
The present study evaluated the effect of single-stage internal traction combined with early postoperative active rehabilitation and the yurt bone suture method, a new surgical technique, on the clinical outcomes after surgical repair of Achilles tendon. A total of 51 patients with neglected Achilles tendon rupture who underwent the yurt bone suture treatment also participated in an accelerated postoperative rehabilitation program. The clinical outcome was evaluated for 18 weeks using the Leppilahti scoring system, bilateral ultrasound examination, and computed tomography examination. The ultrasound and computed tomography examinations revealed that Achilles tendon elongation and adhesion occurred in none of the patients. All the patients could perform the single leg heel raise exercise for a mean of 30 ± 7.6 seconds at 12 weeks postoperatively. In addition, the patients could participate in sport exercises and heavy physical activities by around 13 weeks postoperatively. The mean Leppilahti score was 85.8 ± 3.7 at 8 weeks postoperatively, and it had increased to 96.1 ± 3.2 and 100.0 ± 0.0 at 12 and 18 weeks, respectively, after the operation. The 1-stage internal traction technique, combined with early postoperative active rehabilitation and the yurt bone surgical technique, resulted in good clinical outcomes for the treatment of neglected Achilles tendon rupture.
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Affiliation(s)
- Ayinazi Badalihan
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | | | - Nuerai Shawutali
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jiasharete Jielile
- Assistant Professor, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Ayidaer Jialihasi
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Wulanbai Tangkejie
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yeermike Nuerdoula
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Turde Satewalede
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Beisen Hunapiya
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Hadelebieke Niyazebieke
- Surgeon, Department of Orthopaedics, Kazakh Traditional Medical Hospital of Toli County, Tacheng Prefecture, Toli County, Xinjiang, China
| | - Hayilat Hezibieke
- Orthopedist, Department of Orthopaedics, People's Hospital of Shawan County, Shawan, Xinjiang, China
| | - Qin Zhao
- Associate Professor, Department of Ultrasonographic Examination, Institute of Medical Image Canter, First Teaching Hospital of Xinjiang Medical University, Urumqi, China
| | - Ahezhuoli Bahetijiang
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Mailamuguli Kelamu
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Bayixiati Qianman
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
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Nakajima K, Taketomi S, Inui H, Nakamura K, Sanada T, Tanaka S. Missed Medial Malleolar Fracture Associated With Achilles Tendon Rupture: A Case Report and Literature Review. J Foot Ankle Surg 2014; 55:169-72. [PMID: 25441273 DOI: 10.1053/j.jfas.2014.09.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Indexed: 02/03/2023]
Abstract
A 45-year-old man sustained an Achilles tendon rupture while playing futsal. A concomitant medial malleolar fracture was not diagnosed until the patient underwent an operation for Achilles tendon repair. A routine postoperative radiograph showed a minimally displaced medial malleolar fracture. Conservative treatment was chosen for the fracture. The function of the Achilles tendon recovered well, and the fracture was united. A medial malleolar fracture can be missed when an Achilles tendon rupture occurs simultaneously. Thus, surgeons should consider the possibility of medial malleolar fracture associated with an Achilles tendon rupture.
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Affiliation(s)
- Koji Nakajima
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Shuji Taketomi
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan.
| | - Hiroshi Inui
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kensuke Nakamura
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Takaki Sanada
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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19
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Vasileff WK, Moutzouros V. Unrecognized pediatric partial Achilles tendon injury followed by traumatic completion: a case report and literature review. J Foot Ankle Surg 2014; 53:485-8. [PMID: 24713492 DOI: 10.1053/j.jfas.2014.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Indexed: 02/03/2023]
Abstract
Achilles tendon ruptures are a relatively common athletic injury but are exceedingly rare in the pediatric population. We describe the case of a 10-year-old ice hockey player who experienced an Achilles tendon injury from a laceration to the posterior leg from a skate blade that led to a partial tendon laceration. This tendon injury was initially unrecognized despite an emergency department evaluation. The patient continued to complain of weakness and paresthesia after the skin laceration had healed. A traumatic dorsiflexion injury while running several weeks later led to a traumatic complete tendon rupture. The clinical, operative, and physical therapy records were reviewed to complete the history, treatment, and rehabilitation progress. The initial laceration injury had occurred 6 weeks before presentation, and the traumatic dorsiflexion injury had occurred 2 days before referral to an acute orthopedics clinic. Open repair was performed several days after the traumatic completion of the laceration, and the patient was immobilized in a cast for 5 weeks. The patient had weaned off crutches by 10 weeks postoperatively and had returned to some activities and light skating at 5.5 months. A full return to running and ice hockey had been achieved by 8 months postoperatively. The optimal repair for this injury has not been well established in published studies. We have concluded that laceration injuries have the potential to mask tendon injuries and that prolonged symptoms after a laceration should suggest occult pathologic features. Open tendon repair is a viable treatment option in the pediatric patient with Achilles tendon ruptures. A return to activities within a reasonable period can be expected with robust physical therapy.
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Affiliation(s)
- William Kelton Vasileff
- Department of Orthopaedic Surgery, Center For Athletic Medicine, Henry Ford Hospital, Detroit, MI.
| | - Vasilios Moutzouros
- Department of Orthopaedic Surgery, Center For Athletic Medicine, Henry Ford Hospital, Detroit, MI
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20
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Carmont MR, Silbernagel KG, Mathy A, Mulji Y, Karlsson J, Maffulli N. Reliability of Achilles tendon resting angle and calf circumference measurement techniques. Foot Ankle Surg 2013; 19:245-9. [PMID: 24095232 DOI: 10.1016/j.fas.2013.06.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/12/2013] [Accepted: 06/17/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND The resting angle of the ankle joint may be altered following apparently successful management of Achilles tendon rupture. The reliability of the Achilles Tendon Resting Angle and Calf Circumference measurements was determined. METHODS Three test-retest measurements for reliability assessment were performed on 16 healthy subjects: 10 males and 6 females. RESULTS The mean left Achilles Tendon Resting Angle was mean 50.1° (range [26-61]), ICC 0.92 (CI [0.83-0.97]), SEM 2.4°. The mean right Achilles tendon resting angle was mean 49.9° (range [26-60]), ICC 0.91 (CI [0.80-0.96]), SEM 2.6°. The mean left calf circumference was mean 38.5cm (range [33.3-44.2]), ICC 0.97 (CI [0.94-0.98]), SEM 0.6cm, and the mean right calf circumference was mean 38.4cm (range [33.3-43.6]), ICC 0.97 (CI [0.94-0.99]), SEM 0.5cm. CONCLUSIONS The Achilles Tendon Resting Angle and Calf Circumference at 15cm from the antero-medial joint line had excellent test-retest reliability. These are simple, quick and inexpensive measurements, which have the potential to correlate with tendon elongation and functional outcome. The Achilles tendon resting angle may be used as a guide to tendon length during intra-operative repair and rehabilitation.
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Affiliation(s)
- M R Carmont
- Department of Orthopaedic Surgery, Princess Royal Hospital, Telford, Shropshire, UK.
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21
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Jielile J, Sabirhazi G, Chen J, Aldyarhan K, Zheyiken J, Zhao Q, Bai J, Bai J. Novel surgical technique and early kinesiotherapy for acute Achilles tendon rupture. Foot Ankle Int 2012. [PMID: 23199864 DOI: 10.3113/fai.2012.1119] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This prospective study was performed to investigate the contribution of early kinesiotherapy, the active exercise and movement of the ankle and knee joints, following a novel surgical technique for reconstruction of the acutely ruptured Achilles tendon and the underlying mechanisms involved. MATERIALS AND METHODS One hundred and seven patients with an acute Achilles tendon rupture received postoperative early kinesiotherapy treatment following the novel ``Pa-bone'' surgical technique. Clinical outcomes were evaluated using the Achilles tendon rupture score, a score for measuring outcomes related to symptoms and physical activity, and bilateral ultrasonographic examination of the Achilles tendon. RESULTS Range-of-motion recovery equal to the intact side averaged 7~weeks. Double-legged heel rises and sustained single-leg heel rise exercises were possible at an average of 1~week and 60± 2 days, respectively. All patients could perform single-leg heel rise of the injured foot for 60± 23 seconds at an average of 12 weeks. No rerupture was observed. In addition, ultrasonographic examination revealed that the cross-sectional areas of the ruptured tendon were significantly larger than those of the healthy side. Overall reconstruction of the Achilles tendon was obtained for most of the patients. CONCLUSION Postoperative early kinesiotherapy treatment following Pa-bone surgical technique resulted in excellent clinical outcomes and contributed to the overall reconstruction of the Achilles tendon.
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Affiliation(s)
| | | | | | | | | | | | | | - Jingping Bai
- The Third Teaching Hospital of Xinjiang Medical University, Urumqi, China
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22
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Olsson N, Karlsson J, Eriksson BI, Brorsson A, Lundberg M, Silbernagel KG. Ability to perform a single heel-rise is significantly related to patient-reported outcome after Achilles tendon rupture. Scand J Med Sci Sports 2012; 24:152-8. [PMID: 22716232 DOI: 10.1111/j.1600-0838.2012.01497.x] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2012] [Indexed: 11/29/2022]
Abstract
This study evaluated the short-term recovery of function after an acute Achilles tendon rupture, measured by a single-legged heel-rise test, with main emphasis on the relation to the patient-reported outcomes and fear of physical activity and movement (kinesiophobia). Eighty-one patients treated surgically or non-surgically with early active rehabilitation after Achilles tendon rupture were included in the study. Patient's ability to perform a single-legged heel-rise, physical activity level, patient-reported symptoms, general health, and kinesiophobia was evaluated 12 weeks after the injury. The heel-rise test showed that 40 out of 81 (49%) patients were unable to perform a single heel-rise 12 weeks after the injury. We found that patients who were able to perform a heel-rise were significantly younger, more often of male gender, reported a lesser degree of symptoms, and also had a higher degree of physical activity at 12 weeks. There was also a significant negative correlation between kinesiophobia and all the patient-reported outcomes and the physical activity level. The heel-rise ability appears to be an important early achievement and reflects the general level of healing, which influences patient-reported outcome and physical activity. Future treatment protocols focusing on regaining strength early after the injury therefore seem to be of great importance. Kinesiophobia needs to be addressed early during the rehabilitation process.
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Affiliation(s)
- N Olsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Mölndal, Sweden
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23
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Ortiz C, Wagner E, Mocoçain P, Labarca G, Keller A, Del Buono A, Maffulli N. Biomechanical comparison of four methods of repair of the Achilles tendon. ACTA ACUST UNITED AC 2012; 94:663-7. [DOI: 10.1302/0301-620x.94b5.27642] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We tested four types of surgical repair for load to failure and distraction in a bovine model of Achilles tendon repair. A total of 20 fresh bovine Achilles tendons were divided transversely 4 cm proximal to the calcaneal insertion and randomly repaired using the Dresden technique, a Krackow suture, a triple-strand Dresden technique or a modified oblique Dresden technique, all using a Fiberwire suture. Each tendon was loaded to failure. The force applied when a 5 mm gap was formed, peak load to failure, and mechanism of failure were recorded. The resistance to distraction was significantly greater for the triple technique (mean 246.1 N (205 to 309) to initial gapping) than for the Dresden (mean 180 N (152 to 208); p = 0.012) and the Krackow repairs (mean 101 N (78 to 112; p < 0.001). Peak load to failure was significantly greater for the triple-strand repair (mean 675 N (453 to 749)) than for the Dresden (mean 327.8 N (238 to 406); p < 0.001), Krackow (mean 223.6 N (210 to 252); p < 0.001) and oblique repairs (mean 437.2 N (372 to 526); p < 0.001). Failure of the tendon was the mechanism of failure for all specimens except for the tendons sutured using the Krackow technique, where the failure occurred at the knot. The triple-strand technique significantly increased the tensile strength (p = 0.0001) and gap resistance (p = 0.01) of bovine tendon repairs, and might have advantages in human application for accelerated post-operative rehabilitation.
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Affiliation(s)
- C. Ortiz
- Clinica Alemana de Santiago, Orthopedics
and Traumatology Department, 6th floor, Vitacura
5951, Santiago, Chile
| | - E. Wagner
- Clinica Alemana de Santiago, Orthopedics
and Traumatology Department, 6th floor, Vitacura
5951, Santiago, Chile
| | - P. Mocoçain
- Clinica Alemana de Santiago, Orthopedics
and Traumatology Department, 6th floor, Vitacura
5951, Santiago, Chile
| | - G. Labarca
- Clinica Alemana de Santiago, Orthopedics
and Traumatology Department, 6th floor, Vitacura
5951, Santiago, Chile
| | - A. Keller
- Clinica Alemana de Santiago, Orthopedics
and Traumatology Department, 6th floor, Vitacura
5951, Santiago, Chile
| | - A. Del Buono
- Campus Biomedico, University of Rome, Department
of Orthopaedic and Trauma Surgery, Via Álvaro
del Portillo 21, 00128 Rome, Italy
| | - N. Maffulli
- Centre for Sports and Exercise Medicine,
Barts and The London School of Medicine and Dentistry, Mile
End Hospital, 275 Bancroft Road, London
E1 4DG, UK
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24
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Nuerai S, Ainuer J, Jiasharete J, Darebai R, Kayrat A, Tang B, Jiangannur Z, Bai J, Makabel B. Kazakh therapy on differential protein expression of Achilles tendon healing in a 7-day postoperative rabbit model. J TRADIT CHIN MED 2012; 31:367-75. [PMID: 22462247 DOI: 10.1016/s0254-6272(12)60020-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To compare the effect of cast immobilization with that of early Kiymil arkili emdew (Kazakh exercise therapy) on the post-operative healing of Achilles tendon rupture in rabbits, and to observe the influence of early Kiymil arkili emdew on the differentially expressed proteins in the healing tendon. METHODS Forty-five New Zealand white rabbits were randomly divided into three groups (Arm A: control group; Arm B: postoperative immobilization group; and Arm C: postoperative early Kiymil arkili emdew group). After tenotomy, the rabbits of the two experimental groups received microsurgery to repair the ruptured tendons, and then received either cast immobilization or early Kiymil arkili emdew treatment. Achilles tendon tissue samples were collected 7 days after the surgery, and two-dimensional gel electrophoresis and MALDI-TOF-MS technique were used to analyze differentially expressed proteins in the tendon tissue of the three Arms. RESULTS A total of 462.67 +/- 11.59, 532.33 +/- 27.79, and 515.33 +/- 6.56 protein spots were detected by the two-dimensional polyacrylamide gels in the Achilles tendon samples of the rabbits in Arms A, B, and C, respectively. Nineteen differentially expressed protein spots were randomly selected from Arm C. Among them, 7 were unique, and 15 had five times higher abundance than those in Arm B. These included annexin A2, gelsolin isoforms and alpha-1 Type III collagen. It was confirmed by western blot that gelsolin isoform b, annexin A2, etc. had specific and incremental expression in Arm C. CONCLUSIONS The self-protective instincts of humans were overlooked in the classical postoperative treatment for Achilles tendon rupture with cast immobilization. Kiymil arkili emdew induced the specific and incremental expression of proteins in the repaired Achilles tendon in the early healing stage in a rabbit model, compared with those treated with postoperative cast immobilization. These differentially expressed proteins may contribute to the healing of the Achilles tendon via a mechanobiological mechanism caused by the application of Kiymil arkili emdew.
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Affiliation(s)
- Shawutali Nuerai
- Department of Microsurgical Repair and Reconstruction, the First Teaching Hospital of Xinjiang Medical University & Sports Medicine Research Center, Research Institute of Orthopedics of Xinjiang Uyghur Autonomous Region, Urumqi 830054, China
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Proteomic Analysis of Differential Protein Expression of Achilles Tendon in a Rabbit Model by Two-Dimensional Polyacrylamide Gel Electrophoresis at 21 Days Postoperation. Appl Biochem Biotechnol 2011; 165:1092-106. [DOI: 10.1007/s12010-011-9327-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 07/08/2011] [Indexed: 10/17/2022]
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Abstract
BACKGROUND The management of Achilles tendon (AT) ruptures in elite athletes can be challenging. We performed a retrospective review of prospectively collected data study to evaluate the results of percutaneous repair of an acute AT rupture in elite athletes. MATERIALS AND METHODS Seventeen elite athletes with prodromal tendinous problems sustained an acute tear of the AT and underwent percutaneous surgical repair. We performed preoperative evaluations the day of surgery, and report the results of postoperative evaluation at a final followup at an average of 72 months from the procedure. Each patient was evaluated for limb dominance, trauma history, duration and type of preoperative symptoms, and postoperative AT Total Rupture Score (ATRS). RESULTS All patients were able to fully weightbear on the operated limb by the end of the 8th postoperative week. The average time to return to full sport participation was 4.8±0.9 months. Two of the 15 elite athletes on whom we have full data suffered from a superficial infection of the surgical wound. CONCLUSION Our study suggests that percutaneous repair of the AT is a good option for elite athletes, allowing a safe and prompt return to sport activities.
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Affiliation(s)
- Nicola Maffulli
- Queen Mary University of London, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, United Kingdom.
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Factors influencing the tensile strength of repaired Achilles tendon: a biomechanical experiment study. Clin Biomech (Bristol, Avon) 2010; 25:789-95. [PMID: 20696369 DOI: 10.1016/j.clinbiomech.2010.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 12/17/2009] [Accepted: 05/13/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND Operative treatment has been advocated as the method of choice to repair Achilles tendon rupture as surgery results in reduced re-rupture rate and faster rehabilitation. Many surgical techniques have been introduced allowing for postoperative early motion of the ankle joint. However, it is currently very difficult for surgeons to determine the optimal treatment conditions for ruptured Achilles tendon with an increasing number of end-to-end suture methods, suture materials, and epitenon suture techniques. METHODS In the present biomechanical experiment study based on an orthogonal design, thirty-two New Zealand white rabbits received Achilles tendon tenotomy and subsequent operative treatment to repair the tendon employing four end-to-end suture methods, four suture materials, and four epitenon suture techniques. The tensile strength of the repaired Achilles tendon was investigated at four rehabilitation periods, and in comparison with the results of another sixteen rabbits with normal Achilles tendons. FINDINGS The end-to-end suture method contributed most to the final Achilles tendon tensile strength in addition to rehabilitation period, with the highest values occurring with the use of the parachute-like ("Pa" bone) suture method. The other two factors, namely, suture material and epitenon suture technique, had relatively little influence on the results. INTERPRETATION The parachute-like ("Pa" bone) surgical technique is superior to the other three end-to-end suture methods, with enhanced tensile strength of the repaired tendon. This method allows for postoperative early kinesitherapy of the ankle and knee joints. Therefore, this technique is highly recommended in clinical situations for treatment of ruptured Achilles tendon.
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Abstract
This clinical practice guideline is based on a series of systematic reviews of published studies in the available literature on the diagnosis and treatment of acute Achilles tendon rupture. None of the 16 recommendations made by the work group was graded as strong; most are graded inconclusive; four are graded weak; two are graded as moderate strength; and two are consensus statements. The two moderate-strength recommendations include the suggestions for early postoperative protective weight bearing and for the use of protective devices that allow for postoperative mobilization.
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Yotsumoto T, Miyamoto W, Uchio Y. Novel approach to repair of acute achilles tendon rupture: early recovery without postoperative fixation or orthosis. Am J Sports Med 2010; 38:287-92. [PMID: 20044498 DOI: 10.1177/0363546509351557] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Immobilization or orthosis is required after conventional Achilles tendon surgery. Hypothesis This new Achilles tendon repair approach enables early rehabilitation without any postoperative immobilization or orthosis. STUDY DESIGN Case series; Level of evidence, 4. METHODS Twenty consecutive patients (14 men and 6 women; mean age, 43.4 years; range, 16-70 years) who had acute subcutaneous Achilles tendon rupture were treated by the new method, with an average follow-up of 2.9 years (range, 2-4.8 years). Among them, 15 injuries were sports-related and 5 were work-related. The authors applied a side-locking loop technique of their own design for the core suture, using braided polyblend suture thread, with peripheral cross-stitches added. The patients started active and passive ankle mobilization from the next day, partial weightbearing walking from 1 week, full-load walking from 4 weeks, and double-legged heel raises from 6 weeks after surgery. RESULTS The range of motion recovery equal to the intact side averaged 3.2 weeks. Double-legged heel raises and 20 continuous single-legged heel raise exercises were possible at an average of 6.3 weeks and 9.9 weeks, respectively. T2-weighted magnetic resonance signal intensity recovered to equal that of the intact portion of the same tendon at 12 weeks. The patients resumed sports activities or heavy labor at an average of 14.4 weeks. The Achilles tendon rupture score averaged 98.3 at 24 weeks. There were no complications. CONCLUSION This new Achilles tendon repair approach enables early mobilization exercise without costly specialized orthosis or immobilization and allows an early return to normal life and sports activities, reducing the physical and economic burden on patients.
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Affiliation(s)
- Tadahiko Yotsumoto
- Department of Orthopaedic Surgery, Shimane University School of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane-Pref. 693-8501, Japan.
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