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Hong CC, Seow D, Koh JH, Rammelt S, Pearce CJ. Paratenon preserving repair of the midsubstance acute Achilles tendon rupture: a systematic review and meta-analysis with best- and worst-case analyses for rerupture rates. Arch Orthop Trauma Surg 2024:10.1007/s00402-024-05486-0. [PMID: 39153101 DOI: 10.1007/s00402-024-05486-0] [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: 02/13/2024] [Accepted: 06/12/2024] [Indexed: 08/19/2024]
Abstract
INTRODUCTION Paratenon preserving techniques to facilitate acute Achilles tendon rupture repair (AATR) functions by maintaining vascularity and biology for optimal healing response. Therefore, the purpose is to evaluate the outcomes following paratenon preserving repair of the midsubstance AATR. The hypothesis was that paratenon-preserving techniques demonstrate high return to play rates and low complication rates for the repair of the midsubstance AATR. MATERIALS AND METHODS A systematic review of the PubMed, Embase, and the Cochrane Library databases was performed by two authors using specific search terms and eligibility criteria. The assessment of the evidence was two-fold: level and quality of evidence. A meta-analysis of proportions for the various complication rates was performed using the restricted maximum likelihood method following the Freeman-Tukey double-arcsine transformation. Fixed effects models were employed if I2 < 25% (low heterogeneity), and random effects models were employed if I2 ≥ 25% (moderate to high heterogeneity). RESULTS The pooled return to play rate was 90.3%. The pooled rerupture rate as reported was 0.9% (best-case scenario 0.8% and worst-case scenario 6.8%). No meaningful subgroup analysis for rerupture rates could be performed based on the meta-regression. The pooled complication rate other than reruptures was 4.8%. The pooled infection rates were 0.3%, DVT rates were 1.6%, and sural nerve injury rates were 0.3%. CONCLUSIONS Paratenon preserving techniques that are minimally invasive in nature demonstrated safe and favorable outcomes with high return to play rates and low complication rates for the repair of the midsubstance AATR.
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Affiliation(s)
- Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, 1E Kent Ridge Road, 119228, Singapore, Singapore.
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
| | - Dexter Seow
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, 1E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Jin Hean Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Stefan Rammelt
- University Center for Orthopaedics & Traumatology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Christopher J Pearce
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, 1E Kent Ridge Road, 119228, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Bullock M, Pierson Z. Achilles Tendon Rupture. Clin Podiatr Med Surg 2024; 41:535-549. [PMID: 38789169 DOI: 10.1016/j.cpm.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
There are many high-level studies comparing nonoperative treatment, open repair, and minimally invasive repair for Achilles tendon ruptures. This article summarizes the most up-to-date literature comparing these treatment options. The authors' preferred protocol for nonoperative treatment is discussed. Preferred techniques for open repair and chronic Achilles repair are discussed with reference to the literature.
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Affiliation(s)
- Mark Bullock
- Department of Orthopedics, Covenant Healthcare, Saginaw, MI, USA; Department of Podiatric Medicine and Surgery, Central Michigan University, Saginaw, MI, USA.
| | - Zachary Pierson
- Carolina Foot and Ankle Specialists, 1505 SW Cary Parkway, Suite 200, Cary, NC 27511, USA
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Čukelj F, Blažević D, Čukelj F, Sabalić S, Benčić I, Ćuti T, Pivalica D, Bakota B, Vidović D. Comparison of percutaneous and open repair of Achilles tendon rupture: results and complications from a single institution. BMC Surg 2024; 24:47. [PMID: 38321415 PMCID: PMC10845635 DOI: 10.1186/s12893-024-02333-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/25/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The Achilles tendon is the strongest tendon in the human body, but it is prone to injury, especially in modern times when recreational sports are growing in popularity. As a result, Achilles tendon rupture is becoming an increasingly common medical problem in modern society. The main objective of this study was to compare the outcomes of percutaneous repair and open repair for the treatment of Achilles tendon rupture. METHODS A retrospective study was conducted involving a total of 316 patients who had undergone surgical treatment for Achilles tendon rupture between 2013 and 2021. The data collected from the medical history of these patients included the type of surgical procedure, the mechanism of injury, the age and sex of the patients, the time spent in the hospital, and any possible complications of the surgical treatment (such as infections, reruptures, or sural nerve injuries). RESULTS The study revealed that there was no significant difference between percutaneous and open surgical approaches in terms of sural nerve injury. However, there was a statistically significant advantage of the percutaneous method in terms of the number of infections, which was significantly lower than that of the open method. Additionally, the median length of hospital stay was found to be four days longer with the open approach. However, the study noted that a statistically significant advantage of the percutaneous method for rerupture could not be established due to the small number of patients with rerupture and the insufficient ratio of patients with rerupture in relation to the size of the observed population. CONCLUSIONS Percutaneous repair is an effective treatment option for Achilles tendon rupture and has outcomes equal to or better than those of open repair. Therefore, this approach is recommended as the preferred method of treatment due to the presence of fewer complications, provided that the indications for this technique are appropriate.
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Affiliation(s)
- Fabijan Čukelj
- Department of Traumatology, Sestre milosrdnice University Hospital Center, Draškovićeva 19, Zagreb, 10000, Croatia
| | - Dejan Blažević
- Department of Traumatology, Sestre milosrdnice University Hospital Center, Draškovićeva 19, Zagreb, 10000, Croatia.
- University of Applied Health Sciences, Mlinarska cesta 38, Zagreb, 10000, Croatia.
- School of Medicine, Catholic University of Croatia, Ilica 242, Zagreb, 10000, Croatia.
| | - Fabijan Čukelj
- Department of Traumatology, Sestre milosrdnice University Hospital Center, Draškovićeva 19, Zagreb, 10000, Croatia
- School of Medicine, University of Split, Šoltanska 2, Split, 21000, Croatia
| | - Srećko Sabalić
- Department of Traumatology, Sestre milosrdnice University Hospital Center, Draškovićeva 19, Zagreb, 10000, Croatia
- School of Medicine, University of Split, Šoltanska 2, Split, 21000, Croatia
| | - Ivan Benčić
- Department of Traumatology, Sestre milosrdnice University Hospital Center, Draškovićeva 19, Zagreb, 10000, Croatia
| | - Tomislav Ćuti
- Department of Traumatology, Sestre milosrdnice University Hospital Center, Draškovićeva 19, Zagreb, 10000, Croatia
| | - Dinko Pivalica
- Department of Physical Medicine and Rehabilitation with Rheumatology, University Hospital of Split, Spinčićeva 1, Split, 21000, Croatia
| | - Bore Bakota
- Tauern Klinikum, Paracelsusstrasse 8, Zell am See, 5700, Austria
- MedUni Klinikum LKH, Auenbruggerplatz 15, Graz, 8036, Austria
| | - Dinko Vidović
- School of Medicine, University of Zagreb, Šalata 3, Zagreb, 10000, Croatia
- Department of Traumatology, Sestre milosrdnice University Hospital Center, Draškovićeva 19, Zagreb, 10000, Croatia
- School of Dental Medicine, University of Zagreb, Gundulićeva 5, Zagreb, 10000, Croatia
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Mashimo S, Nozaki T, Amaha K, Tanaka K, Kubota J, Sato H, Kitamura N. Quantitative Assessment of Calf Muscle Volume, Strength, and Quality After Achilles Tendon Rupture Repair: A 1-Year Prospective Follow-up Study. Am J Sports Med 2023; 51:3781-3789. [PMID: 37960840 DOI: 10.1177/03635465231206391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
BACKGROUND A number of studies have reported that calf muscle atrophy is a common long-term problem after Achilles tendon repair; however, there is still a lack of data concerning early postoperative morphological changes in the calf muscle after surgery. PURPOSE To investigate changes over time in calf muscle volume and fatty degeneration during 1 year after Achilles tendon repair. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A prospective 1-year serial magnetic resonance imaging study was carried out with 20 patients who underwent tendon repair for unilateral acute Achilles tendon rupture. The magnetic resonance imaging assessment in addition to clinical and functional evaluations was performed at 1, 3, 6, and 12 months after surgery. The muscle volume of the medial and lateral gastrocnemius, soleus, and flexor hallucis longus (FHL) and fatty degeneration of the medial and lateral gastrocnemius and soleus were measured for the calf muscles, and the relative volume and fatty degeneration changes in the affected leg compared with the healthy contralateral leg were calculated as a percentage ([injured/healthy control] × 100) to assess structural changes over time. RESULTS Muscle volumes of the medial gastrocnemius, lateral gastrocnemius, soleus, and FHL were 92.3%, 92.8%, 84.6%, and 95.9% at 12 months after surgery, respectively. Medial and lateral gastrocnemius and FHL muscle volumes improved over time and recovered to almost equal to that of the healthy side at 12 months after surgery. The soleus muscle volume did not recover significantly over time and was statistically significantly smaller than that of the healthy side at 12 months (P = .029). Fatty degeneration rates of the medial gastrocnemius, lateral gastrocnemius, and soleus were 118.2%, 113.9% and 121.1% at 12 months after surgery, respectively. Fatty degeneration of the medial and lateral gastrocnemius did not change significantly, but there was a statistically significant increase in fatty degeneration of the soleus over time (P < .001). CONCLUSION Within the triceps surae muscle, the soleus was the most negatively affected by injury and repair for both muscle volume and fatty degeneration. Postoperative management to recover the soleus muscle function before a return to sporting activities should be considered in the future.
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Affiliation(s)
- Shota Mashimo
- Department of Rehabilitation, St Luke's International Hospital, Tokyo, Japan
| | - Taiki Nozaki
- Department of Radiology, St Luke's International Hospital, Tokyo, Japan
| | - Kentaro Amaha
- Department of Orthopaedic Surgery, St Luke's International Hospital, Tokyo, Japan
| | - Keita Tanaka
- Department of Rehabilitation, St Luke's International Hospital, Tokyo, Japan
| | - Junya Kubota
- Department of Rehabilitation, St Luke's International Hospital, Tokyo, Japan
| | - Hiroyuki Sato
- Department of Rehabilitation, St Luke's International Hospital, Tokyo, Japan
| | - Nobuto Kitamura
- Department of Rehabilitation, St Luke's International Hospital, Tokyo, Japan
- Department of Orthopaedic Surgery, St Luke's International Hospital, Tokyo, Japan
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Maffulli N, Sammaria G, Ziello S, Migliorini F, Oliva F. Percutaneous cruciate repair of ruptured Achilles tendon. J Orthop Surg Res 2023; 18:677. [PMID: 37700324 PMCID: PMC10496360 DOI: 10.1186/s13018-023-04167-9] [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: 08/12/2023] [Accepted: 09/05/2023] [Indexed: 09/14/2023] Open
Abstract
Percutaneous repair is a safe and reliable method to restore continuity after acute Achilles tendon ruptures, with a lower incidence of wound complications compared to open techniques. We describe a novel percutaneous cruciate suture performed through 5 stab skin incisions, four of which are longitudinal and parallel to the course of the sural nerve to minimize the risk of injury and one transverse incision at the site of rupture, with a total of 16 suture threads and the knot outside the tendon body, increasing the tensile strength of the suture and minimizing the risk of re-rupture. Clinical studies are necessary to ascertain whether the theoretical advantages of the cruciate suture technique translate into better clinical outcomes compared to established percutaneous techniques.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, UK
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Thornburrow Drive, Stoke on Trent, ST4 7QB, UK
| | - Giuliano Sammaria
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
| | - Salvatore Ziello
- Department of Musculoskeletal Disorders, Faculty of Medicine and Surgery, University of Salerno, 84084, Baronissi, Italy
- Clinica Ortopedica, Ospedale San Giovanni di Dio e Ruggi d'Aragona, 84131, Salerno, Italy
| | - 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), 39100, Bolzano, Italy.
| | - Francesco Oliva
- Department of Human Sciences and Promotion of the Quality of Life, San Raffaele Open University, Rome, Italy
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Hammad ME, Fayed AM, Ayoub MA, Emran AM. Early satisfactory results of percutaneous repair in neglected achilles tendon rupture. BMC Musculoskelet Disord 2023; 24:446. [PMID: 37268932 DOI: 10.1186/s12891-023-06561-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 05/20/2023] [Indexed: 06/04/2023] Open
Abstract
PURPOSE This investigation aimed to study the outcome of percutaneous repair of Achilles tendon ruptures regarding patient-reported and objective outcomes. METHODS This is a retrospective review of a cohort of patients (n = 24) who underwent percutaneous repair of neglected Achilles rupture in the period between 2013 and 2019. Included patients were adults with closed injuries, presented 4-10 weeks after rupture, with intact deep sensation. All underwent clinical examination, X-rays to exclude bony injury and MRI for diagnosis confirmation. All underwent percutaneous repair by the same surgeon, using the same technique and rehabilitation protocol. The postoperative assessment was done subjectively using ATRS and AOFAS score and objectively using a percentage of heel rise comparison to the normal side and calf circumference difference. RESULTS The mean follow-up period was 14.85 months ± 3 months. Average AOFAS scores at 6,12 months were 91 and 96, respectively, showing statistically significant improvement from pre-op level (P < 0.001). Percentage of heel rise on the affected side and calf circumference showed statistically significant improvement over the 12 month follow up period (P < 0.001). Superficial infection was reported in two patients (8.3%), and two cases reported transient sural nerve neuritis. CONCLUSION Percutaneous repair of neglected Achilles rupture using the index technique proved a satisfactory patient-reported and objective measurement at a one-year follow-up. With only minor transient complications.
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Affiliation(s)
- Mostafa Elsebai Hammad
- Department of Orthopaedic surgery, Faculty of medicine, Tanta University, Hassan Radwan st. Tanta city, Gharbia governorate, Tanta city, Al-gharbia governorate, ZIP:31511, Egypt.
| | - Aly Maher Fayed
- Department of Orthopaedic surgery, Faculty of medicine, Tanta University, Hassan Radwan st. Tanta city, Gharbia governorate, Tanta city, Al-gharbia governorate, ZIP:31511, Egypt
| | - Mostafa Ahmed Ayoub
- Department of Orthopaedic surgery, Faculty of medicine, Tanta University, Hassan Radwan st. Tanta city, Gharbia governorate, Tanta city, Al-gharbia governorate, ZIP:31511, Egypt
| | - Ali Mahmoud Emran
- Department of Orthopaedic surgery, Faculty of medicine, Tanta University, Hassan Radwan st. Tanta city, Gharbia governorate, Tanta city, Al-gharbia governorate, ZIP:31511, Egypt
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Bashir A, Parry MA, Bhat AA. Functional Outcome in Percutaneous Achilles Tendon Repair. Indian J Orthop 2023; 57:917-922. [PMID: 37214370 PMCID: PMC10192476 DOI: 10.1007/s43465-023-00852-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/14/2023] [Indexed: 05/24/2023]
Abstract
Background Rupture of the Achilles tendon is a considerable cause of morbidity with reduced function following injury. Randomized studies have so far failed to show a difference in outcome between operative and nonoperative management of Achilles tendon rupture, provided that no re-rupture occurs. Percutaneous Achilles repair has been suggested to result in superior patient satisfaction compared with open repair in patients with an acute Achilles tendon rupture. Aim and Objectives To assess and evaluate the functional outcome after percutaneous repair in patients of the acute and closed Achilles tendon ruptures. Materials and Methods It was a prospective study conducted on patients diagnosed as having rupture of the Achilles tendon. A total of 25 patients with mean age of 44.4 (range 19-65) years were taken, who underwent percutaneous Achilles tendon repair. Results The number of patients who reported excellent or good scores (ATRS > 80) at 3, 6 and 12 months were 0%, 16% and 100%, respectively. The mean AOFAS hind foot score at 3-, 6- and 12-month follow-ups was 77.9 ± 4.3, 92.04 ± 2.4 and 96.16.32 ± 1.1, respectively. The number of patients who reported excellent or good scores (AOFAS > 74) at 3, 6 and 12 months were 76%, 100% and 100%, respectively. Most of the patients in our study showed no complications, and only 2 (8%) of patients had the features of sural nerve injury which was resolved in the subsequent follow-ups. Conclusion Percutaneous repair of the Achilles tendon is an effective procedure which gives excellent functional outcome with very few complications. The percutaneous technique gives an additional advantage of less operative time, no wound complications, less damage to the soft tissues, and improved cosmesis as compared to the open repair.
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Affiliation(s)
- Arshad Bashir
- Department of Orthopaedics, GMC Srinagar, Kandizal Pampore, Pulwama, 192121 India
| | - Mudasir Ahmad Parry
- Department of Orthopaedics, GMC Srinagar, Kandizal Pampore, Pulwama, 192121 India
| | - Ajaz Ahmad Bhat
- Department of Orthopaedics, GMC Srinagar, Kandizal Pampore, Pulwama, 192121 India
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Primary augmentation of percutaneous repair with flexor hallucis longus tendon for Achilles tendon ruptures reduces tendon elongation and may improve functional outcome. Knee Surg Sports Traumatol Arthrosc 2023; 31:94-101. [PMID: 36251046 DOI: 10.1007/s00167-022-07183-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 09/27/2022] [Indexed: 01/21/2023]
Abstract
PURPOSE Achilles tendon ruptures (ATR) result in loss of strength and function of the gastrosoleus-Achilles tendon complex, probably because of gradual tendon elongation and calf muscle atrophy, even after surgical repair. Flexor hallucis longus (FHL) augmentation not only reinforces the repair and provides new blood supply to the tendon, but also protects the repair, internally splinting the repaired Achilles tendon, maintaining optimal tension. We prospectively compared the clinical outcomes of patients with acute ATR, managed with either percutaneous repair only or percutaneous repair and FHL augmentation. METHODS Patients with acute ATR undergoing operative management were divided into two groups. Thirty patients underwent percutaneous repair under local anesthesia, and 32 patients underwent percutaneous repair augmented by FHL tendon, harvested through a 3 cm longitudinal posteromedial incision, and transferred to the calcaneus, under epidural anesthesia. All patients were treated by a single surgeon between 2015 and 2019 and were followed prospectively for 24 months. RESULTS The percutaneous only group was younger than the augmented one (35.4 ± 8.0 vs 40.4 ± 6.6 years, p = 0.01). In the augmented group, 25 patients stayed overnight and only 5 were day cases, whereas in the percutaneous only group 4 patients stayed overnight and 28 of them were day cases (p < 0.001). The duration of the procedure was significantly longer in the augmented group (38.9 ± 5.2 vs 13.2 ± 2.2 min, p < 0.001). At 24 months after repair, the Achilles tendon resting angle (ATRA) was better in the augmented group (-0.5 ± 1.7 vs -4.0 ± 2.7, p < 0.001), as was Achilles tendon rupture score (ATRS) (91.7 ± 2.2 vs 89.9 ± 2.4, p = 0.004). Calf circumference of the injured and the non-injured leg did not differ between the groups, as did the time interval to single toe raise and the time interval to walking in tiptoes. Although plantarflexion strength of the operated leg was significantly weaker than the non-operated leg in both groups, the difference in isometric strength of the operated leg between the groups was not significant at 24 months (435 ± 37.9 vs 436 ± 39.7 N, n.s.). CONCLUSION Percutaneous repair and FHL tendon augmentation may have a place in the management of acute Achilles tendon ruptures, reducing tendon elongation and improving functional outcome. LEVEL OF EVIDENCE Level II.
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Bach S, Biedlingmaier R. Achilles tendon rupture: A case report. Nurse Pract 2022; 47:13-17. [PMID: 36006813 DOI: 10.1097/01.npr.0000855296.82906.ab] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Aufwerber S, Naili JE, Grävare Silbernagel K, Ackermann PW. No effects of early functional mobilization on gait patterns after acute Achilles tendon rupture repair. J Orthop Res 2022; 40:1932-1942. [PMID: 34674300 DOI: 10.1002/jor.25199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 10/06/2021] [Accepted: 10/18/2021] [Indexed: 02/04/2023]
Abstract
This study aimed to compare recovery of gait patterns in patients treated with early functional mobilization (EFM) or standard treatment (ST) after Achilles tendon rupture repair. Second, this study aimed to explore associations between gait patterns and tendon elongation and calf muscle atrophy, respectively. Forty-seven patients (12 females), mean age 38.7 (7.3) years, were included. Patients were postoperatively randomized to EFM (n = 29), including immediate weightbearing and ankle motion for 6 weeks, or ST (n = 18), with 2 weeks of unloading in a plaster cast followed by 4 weeks of weightbearing in an orthosis. Three-dimensional gait analyses were performed at 8 weeks and 6 months postoperatively to evaluate ankle and knee kinematics and kinetics. Ultrasound imaging was performed to assess tendon length and calf muscle atrophy. At 8 weeks, there were no significant group differences in ankle and knee kinematics and kinetics, while side-to-side differences between injured and uninjured side were present within both groups. At 6 months, the ST group exhibited higher generating ankle power and greater peak moments in ankle and knee compared to the EFM group. In both groups, peak ankle dorsiflexion angle was greater on the injured side compared to the uninjured side. No correlations were found between ankle joint gait deviations and degree of tendon elongation or muscle atrophy. Clinical significance: The accelerated rehabilitation regimen with EFM did not result in a more symmetrical gait pattern. The gait pattern deviations in the ankle joint were not related to the degree of muscle atrophy or tendon elongation.
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Affiliation(s)
- Susanna Aufwerber
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy and Physiotherapy, Stockholm, Sweden
| | - Josefine E Naili
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | | | - Paul W Ackermann
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.,Department of Trauma, Acute Surgery and Orthopaedics, Karolinska University Hospital, Stockholm, Sweden
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Oliva F, Marsilio E, Asparago G, Giai Via A, Biz C, Padulo J, Spoliti M, Foti C, Oliva G, Mannarini S, Rossi AA, Ruggieri P, Maffulli N. Achilles Tendon Rupture and Dysmetabolic Diseases: A Multicentric, Epidemiologic Study. J Clin Med 2022; 11:jcm11133698. [PMID: 35806982 PMCID: PMC9267833 DOI: 10.3390/jcm11133698] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction: Achilles tendon ruptures are common. Metabolic disorders, such as diabetes mellitus, hypercholesterolemia, thyroid disorders, and obesity, impair tendons health, leading to Achilles tendinopathy and likely predisposing patients to Achilles tendon ruptures. Materials and methods: Patients who visited the Orthopedic Outpatient Clinics and the Accident and Emergency Departments of five different hospitals in Italy were recruited. Through telephone interviews, we administered a questionnaire to all the patients who had undergone surgical ATR repair, evaluating their past medical history, sport- and work-related activities, drug use, and post-operative rehabilitation outcomes. Results: “Return to work activities/sport” was negatively predicted by the presence of a metabolic disorder (β = −0.451; OR = 0.637) and ‘open’ surgery technique (β = −0.389; OR = 0.678). “Medical complications” were significantly predicted by metabolic disorders (β = 0.600 (0.198); OR = 1.822) and was negatively related to ‘mini-invasive’ surgery (i.e., not ‘open’ nor ‘percutaneous’) (β = −0.621; OR = 0.537). “Immediate weightbearing” and “immediate walking without assistance” were negatively predicted by ‘open’ technique (β = −0.691; OR = 0.501 and β = −0.359 (0.174; OR = 0.698)). Conclusions: Metabolic conditions can strongly affect post-operative outcomes following surgical repair of acute Achilles tendon tears.
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Affiliation(s)
- Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (F.O.); (G.A.); (N.M.)
| | - Emanuela Marsilio
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (F.O.); (G.A.); (N.M.)
- Correspondence: ; Tel.: +39-3465115396
| | - Giovanni Asparago
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (F.O.); (G.A.); (N.M.)
| | - Alessio Giai Via
- Department of Orthopaedic Surgery and Traumatology, San Camillo-Forlanini Hospital, 00152 Rome, Italy;
| | - Carlo Biz
- Orthopaedics and Orthopaedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35128 Padova, Italy; (C.B.); (P.R.)
| | - Johnny Padulo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20133 Milan, Italy;
| | - Marco Spoliti
- Orthopaedics and Traumatology Unit, Department of Emergency and Acceptance, Azienda Ospedaliera San Camillo-Forlanini, 00152 Rome, Italy;
| | - Calogero Foti
- Physical and Rehabilitation Medicine, Clinical Sciences and Translational Medicine Department, Tor Vergata University, 00133 Rome, Italy;
| | - Gabriella Oliva
- Department of Internal Medicine, Ospedale del Mare, ASL1, 80147 Napoli, Italy;
| | - Stefania Mannarini
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35128 Padova, Italy; (S.M.); (A.A.R.)
- Interdepartmental Center for Family Research, University of Padova, 35128 Padova, Italy
| | - Alessandro Alberto Rossi
- Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, 35128 Padova, Italy; (S.M.); (A.A.R.)
- Interdepartmental Center for Family Research, University of Padova, 35128 Padova, Italy
| | - Pietro Ruggieri
- Orthopaedics and Orthopaedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padua, 35128 Padova, Italy; (C.B.); (P.R.)
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi, Italy; (F.O.); (G.A.); (N.M.)
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, Thornburrow Drive, Stoke on Trent ST4 7QB, UK
- Centre for Sports and Exercise Medicine, Barts and the London School of Medicine and Dentistry, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London E1 4DG, UK
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12
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Supervised Physiotherapy Improves Three-Dimensional (3D) Gait Parameters in Patients after Surgical Suturing of the Achilles Tendon Using an Open Method (SSATOM). J Clin Med 2022; 11:jcm11123335. [PMID: 35743407 PMCID: PMC9225029 DOI: 10.3390/jcm11123335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to assess the effectiveness of 38 supervised postoperative physiotherapy (SVPh) visits conducted between 1 and 20 weeks after SSATOM on the values of 3D gait parameters measured at 10 and 20 weeks after surgery. MATERIAL Group I comprised male patients (n = 22) after SSATOM (SVPh x = 38 visits) and Group II comprised male patients (n = 22) from the control group. METHODS A non-randomized, open-label, controlled clinical trial was performed in the two groups to obtain the following values: Step length (cm), stride length (cm), step width (cm), next stance phase (%), swing phase (%), double support (%), gait velocity (m/s), and walking frequency (step/min). The measurements were carried out using the BTS SMART system (Italy). RESULTS Orthopedic examination showed no pain, a negative result of Thompson and Matles tests, and proper healing of Achilles tendon (ultrasound image). In Group I, between 10 and 20 weeks after SSATOM, there was a statistically significant improvement in all tested gait parameter values (p ≤ 0.001 to 0.009). CONCLUSIONS Conducting 38 SVPh visits significantly improved the values of the analyzed kinematic and spatiotemporal gait parameters in patients in the twentieth week after SSATOM, which were mostly close to the non-operated side and the results of the control group. However, the gait speed and stride length were not close to the results of the control group.
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13
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Maffulli N, Gougoulias N, Maffulli GD, Oliva F, Migliorini F. Slowed-Down Rehabilitation Following Percutaneous Repair of Achilles Tendon Rupture. Foot Ankle Int 2022; 43:244-252. [PMID: 34581220 PMCID: PMC8841642 DOI: 10.1177/10711007211038594] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Following percutaneous repair of acute Achilles tendon (AT) ruptures, early postoperative weightbearing is advocated; however, it is debatable how aggressive rehabilitation should be. We compared the clinical and functional outcomes in 2 groups of patients who followed either our "traditional" or a "slowed down" rehabilitation after percutaneous surgical repair. METHODS Sixty patients were prospectively recruited to a slowed down (29 patients) or a traditional (31 patients) rehabilitation program. Both groups were allowed immediate weightbearing postoperatively; a removable brace with 5 heel wedges was applied at 2 weeks. In the slowed-down group, 1 wedge was removed after 4 weeks. Gradual removal of the boot took place after 4 wedges were kept for 4 weeks. In the traditional group, 1 wedge was removed every 2 weeks, with removal of the boot after 2 wedges had been kept for 2 weeks. The AT Resting Angle (ATRA) evaluated tendon elongation. Patient reported functional outcomes were assessed using the AT Rupture Score (ATRS). Calf circumference difference and the isometric plantarflexion strength of the gastro-soleus complex were evaluated. RESULTS At the 12-month follow-up, both ATRA and ATRS were more favorable in the slowed-down group. The isometric strength and the calf circumference were more similar to the contralateral leg in the slowed-down group than in the traditional one. CONCLUSION Following percutaneous repair of acute Achilles tendon patients undergoing slowed down rehabilitation performed better than the traditional one. These conclusions must be considered within the limitations of the present study. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (SA), Italy,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England, United Kingdom,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, England, United Kingdom,Nicola Maffulli MD, MS, PhD, Queen Mary University of London, Mile End Hospital, 275 Bancroft Rd, London, E1 4DG, England, United Kingdom.
| | - Nikolaos Gougoulias
- General Hospital of Katerini, Greece,Frimley Park Hospital, Frimley, Surrey, England, United Kingdom
| | | | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi (SA), Italy
| | - Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
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14
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Maffulli N, Oliva F, Migliorini F. Check-rein technique for Achilles tendon elongation following conservative management for acute Achilles tendon ruptures: a two-year prospective clinical study. J Orthop Surg Res 2021; 16:690. [PMID: 34819119 PMCID: PMC8611836 DOI: 10.1186/s13018-021-02830-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/03/2021] [Indexed: 12/28/2022] Open
Abstract
Background Following conservative management for acute Achilles tendon (AT) ruptures, the tendon may heal in continuity, and some patients may present with an elongated Achilles tendon–gastrosoleus complex. This study investigated the efficacy and feasibility of a novel minimally invasive technique, which we named “check-rein procedure”, in patients with intact and elongated AT following conservative management for AT ruptures. Methods All patients who underwent the check-rein procedure for elongation of the gastrosoleus–AT complex by one experienced surgeon were prospectively enrolled. The AT resting angle (ATRA) and AT rupture score (ATRS) were assessed at baseline and repeated at 2-year follow-up, as were calf circumference and isometric plantarflexion strength of both ankles. Results Forty-three patients (43 procedures) were analysed. The mean time elapsed from injury to surgery was 28.7 ± 7.9 weeks. The mean age at surgery was 38.5 ± 5.7 years. At the last follow-up, ATRS, ATRA, isometric strength difference, and calf circumference of the affected side were increased (P < 0.0001). The rate of the return to sport was 98% (42 of 43). No wound complications or rupture were experienced by any patient. Conclusion The check-rein technique for AT elongation after conservative management of AT tears is effective and feasible to restore tendon length and calf function. The surgical outcome was influenced by the preoperative performance status, and longer time elapsed from injury to surgery worsens the outcomes.
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Affiliation(s)
- Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy.,School of Pharmacy and Bioengineering, Keele University School of Medicine, Thornburrow Drive, Stoke on Trent, England.,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, 275 Bancroft Road, London, E1 4DG, England
| | - Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081, Baronissi, SA, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH Aachen University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
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15
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Sikorski Ł, Czamara A. Ground Reaction Forces during Vertical Hops Are Correlated with the Number of Supervised Physiotherapy Visits after Achilles Tendon Surgery. J Clin Med 2021; 10:jcm10225299. [PMID: 34830581 PMCID: PMC8620226 DOI: 10.3390/jcm10225299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 11/05/2021] [Accepted: 11/11/2021] [Indexed: 12/26/2022] Open
Abstract
The objective of this study was to assess the effectiveness of, and the correlation between, an average of 42 supervised physiotherapy (SVPh) visits for the vertical ground reaction forces component (vGRF) using ankle hops during two- and one-legged vertical hops (TLH and OLH, respectively), six months after the surgical suturing of the Achilles tendon using the open method (SSATOM) via Keesler’s technique. Hypothesis: Six months of supervised physiotherapy with a higher number of visits (SPHNVs) was positively correlated with higher vGRF values during TLH and OLH. Group I comprised male patients (n = 23) after SSATOM (SVPh x = 42 visits), and Group II comprised males (n = 23) without Achilles tendon injuries. In the study groups, vGRF was measured during TLH and OLH in the landing phase using two force plates. The vGRF was normalized to the body mass. The limb symmetry index (LSI) of vGRF values was calculated. The ranges of motion of the foot and circumferences of the ankle joint and shin were measured. Then, 10 m unassisted walking, the Thompson test, and pain were assessed. A parametric test for dependent and independent samples, ANOVA and Tukey’s test for between-group comparisons, and linear Pearson’s correlation coefficient calculations were performed. Group I revealed significantly lower vGRF values during TLH and OLH for the operated limb and LSI values compared with the right and left legs in Group II (p ≤ 0.001). A larger number of visits correlates with higher vGRF values for the operated limb during TLH (r = 0.503; p = 0.014) and OLH (r = 0.505; p = 0.014). An average of 42 SVPh visits in 6 months was insufficient to obtain similar values of relative vGRF and their LSI during TLH and OLH, but the hypothesis was confirmed that SPHNVs correlate with higher relative vGRF values during TLH and OLH in the landing phase.
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Affiliation(s)
- Łukasz Sikorski
- Department of Physiotherapy, College of Physiotherapy in Wrocław, 50-038 Wrocław, Poland;
- Correspondence: ; Tel.: +48-601-911-013
| | - Andrzej Czamara
- Department of Physiotherapy, College of Physiotherapy in Wrocław, 50-038 Wrocław, Poland;
- Center of Rehabilitation and Medical Education, 50-038 Wrocław, Poland
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16
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Biz C, Cerchiaro M, Belluzzi E, Bragazzi NL, De Guttry G, Ruggieri P. Long Term Clinical-Functional and Ultrasound Outcomes in Recreational Athletes after Achilles Tendon Rupture: Ma and Griffith versus Tenolig. ACTA ACUST UNITED AC 2021; 57:medicina57101073. [PMID: 34684110 PMCID: PMC8537444 DOI: 10.3390/medicina57101073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 12/14/2022]
Abstract
Background and Objectives: The purpose of this retrospective study was to compare the long-term clinical-functional and ultrasound outcomes of recreational athletes treated with two percutaneous techniques: Ma and Griffith (M&G) and the Tenolig technique (TT). Materials and Methods: recreational athletes, between 18 and 50 years of age, affected by acute Achilles tendon rupture (AATR), treated by M&G or Tenolig techniques were recruited. Clinical-functional outcomes were evaluated using Achilles Tendon Rupture Score (ATRS), AOFAS Ankle-Hindfoot score, VAS (for pain and satisfaction) questionnaires, and ultrasound analysis (focal thickening, hypoechoic areas, presence of calcifications, tendinitis and alteration of normal fibrillar architecture). Results: 90 patients were included: 50 treated by M&G, 40 by TT. In all, 90% of patients resumed sports activities, with pre-injury levels in 56% of cases after M&G and in 60% after TT. In the M&G group, the averages of the questionnaires were ATRS 90.70 points, AOFAS 91.03, VAS satisfaction 7.08, and VAS pain 1.58. In the TT group: ATRS 90.38 points, AOFAS 90.28, VAS satisfaction 7.76, and VAS pain 1.34. The TT group showed a significantly higher satisfaction and return to sport activities within a shorter time. In the M&G group, ultrasound check showed a significantly greater incidence of thickening and an alteration of fibrillar architecture in the treated tendon. Three infections were reported, including one deep after M&G, two superficial in the TT group, and two re-ruptures in the Tenolig group following a further trauma. Conclusions: At long-term follow-up, M&G and TT are both valid techniques for the treatment of AATRs in recreational athletes, achieving comparable clinical-functional results. However, TT seems to have a higher patient satisfaction rate, a faster return to sports and physical activities, and fewer ultrasound signs of tendinitis. Finally, the cost of the device makes this technique more expensive.
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Affiliation(s)
- Carlo Biz
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
- Correspondence: (C.B.); (E.B.); Tel.: +39-0498213239 (C.B.); +39-0498213348 (E.B.)
| | - Mariachiara Cerchiaro
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
| | - Elisa Belluzzi
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
- Musculoskeletal Pathology and Oncology Laboratory, Department of Surgery, Oncology and Gastroenterology, University of Padova, 35128 Padova, Italy
- Correspondence: (C.B.); (E.B.); Tel.: +39-0498213239 (C.B.); +39-0498213348 (E.B.)
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada;
| | - Giacomo De Guttry
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
| | - Pietro Ruggieri
- Orthopedics and Orthopedic Oncology, Department of Surgery, Oncology and Gastroenterology DiSCOG, University of Padova, 35128 Padova, Italy; (M.C.); (G.D.G.); (P.R.)
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17
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Carmont MR, Brorsson A, Barfod KW, Ginder L, Littlehales J, Karlsson J, Nilsson-Helander K. The reliability, reproducibility and utilization of the radiographic Achilles Tendon Loading Angle in the management of Achilles Tendon rupture. Foot Ankle Surg 2021; 27:760-766. [PMID: 33059973 DOI: 10.1016/j.fas.2020.09.013] [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: 07/20/2020] [Revised: 09/16/2020] [Accepted: 09/29/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND During management of Achilles tendon rupture, determination of tendon-end approximation, either clinically or by ultrasound is difficult, following brace application of during loading. The Radiographic Achilles Tendon Loading Angle (RadATLA) is proposed as a method of measuring ankle position whilst loading in a brace during the management of Achilles tendon rupture. This study aims to determine the reliability and reproducibility of the RadATLA. METHODS A loaded true lateral ankle radiograph including the fifth metatarsal head was taken when wearing a brace at the 6-week time point in 18 patients (19 ankles). following Achilles tendon repair or reconstruction. The RadATLA was compared with the Tibio-talar angle, other radiographic and clinical measures used to quantify foot and ankle position during the first 6 weeks of early rehabilitation in a resting position and during loading. RESULTS The intra-rater reliability of both angles was found to be good (>0.8). The RadATLA was found to have an excellent intra-rater reliability with Intra-class correlation of (ICC) 0.992-0.996 (95%CI 0.889-0.999), standard error of the measurement (SEM) 1.03-3.65 and Minimal Detectable Change (MDC) 2.86-10.12. The inter-rater reliability was good with ICC of 0.798-0.969 (95%CI-0.03 to 0.964), SEM 2.9-7.6, and MDC 8.1-20.9. The RadATLA loaded at 6 weeks in all patients was at mean (SD) (range) 41.9˚ (16.5), (18.5-75.9). There was a significant difference between the patients in the Repair group compared with patients in the Reconstruction group both in RadATLA loaded at 6 weeks: 35.6˚ (11.2), (18.5-56.5) versus 55.5˚ (19), (20-75.9), (p = 0.01). The amount loaded in all patients was at mean (SD) (range) 29.2Kg (17.7), (2-56) and the percentage Body Weight was 30.7% (19), (2.1-63.2). There were no differences between the groups neither in amount loaded nor in percentage Body weight (p = 0.614-0.651). CONCLUSIONS The RadATLA is a reliable and reproducible angle and can be used to determine the position of the ankle, when loaded in a brace during rehabilitation following Achilles tendon rupture.
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Affiliation(s)
- Michael R Carmont
- The Department of Trauma & Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury & Telford Hospital NHS Trust, Shropshire, United Kingdom; The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden.
| | - Annelie Brorsson
- The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden
| | - Kristoffer Weisskirchner Barfod
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopaedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Laurence Ginder
- The Department of Radiology & Imaging, Princess Royal Hospital, Shrewsbury & Telford Hospital NHS Trust, Shropshire, United Kingdom
| | - Julie Littlehales
- The Department of Trauma & Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury & Telford Hospital NHS Trust, Shropshire, United Kingdom
| | - Jón Karlsson
- The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden
| | - Katarina Nilsson-Helander
- The Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, Sweden
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Haghverdian JC, Gross CE, Hsu AR. Knotless Reconstruction of Chronic Achilles Tendon Ruptures With <3-cm Defects: Technique Tip. FOOT & ANKLE ORTHOPAEDICS 2021; 6:24730114211050565. [PMID: 35097478 PMCID: PMC8544775 DOI: 10.1177/24730114211050565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Chronic Achilles tendon ruptures can result in tendon lengthening and significant functional deficits including gait abnormalities and diminished push-off strength. Surgical intervention is typically required to restore Achilles tension and improve ankle plantarflexion strength. A variety of surgical reconstruction techniques exist depending on the size of the defect and amount of associated tendinosis. For smaller tendon defects 2 to 3 cm in size, primary end-to-end repair using an open incision and multiple locking sutures is an established technique. However, a longer skin incision and increased soft tissue dissection is required, and failure at the suture-tendon interface has been reported that can result in postoperative tendon elongation and persistent weakness. In this report, we describe a novel technique to reconstruct chronic midsubstance Achilles tendon ruptures using a small incision with knotless repair of the tendon secured directly to the calcaneus. This technique minimizes wound healing complications, increases construct fixation strength, and allows for early range of motion and rehabilitation. Level of Evidence: Level V, Expert Opinion.
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Affiliation(s)
| | - Christopher E. Gross
- Department of Orthopaedics, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew R. Hsu
- Department of Orthopaedic Surgery, University of California-Irvine, Orange, CA, USA
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19
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Nadig N, Dowd T, Huh J. Management of acute Achilles tendon ruptures: a survey of Army orthopaedic surgeons. BMC Musculoskelet Disord 2021; 22:267. [PMID: 33706741 PMCID: PMC7953566 DOI: 10.1186/s12891-021-04121-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/25/2021] [Indexed: 12/28/2022] Open
Abstract
Background Despite the literature on acute Achilles tendon ruptures, there remains a lack of consensus regarding the optimal treatment. The purpose of this survey study was to investigate treatment preferences among Army orthopaedic surgeons when presented with a standardized case of an acute Achilles rupture and determine if surgeon factors correlated with treatment preference. Methods A hypothetical case of a 37-year-old male with history, physical exam, and imaging consistent with an Achilles rupture was sent to board-certified Army orthopaedic surgeons to determine their preferred management. Demographic data was collected to include: practice setting, years from residency graduation, and completion of fellowship. Correlations analyzed between demographics and treatment preferences. Results Sixty-two surgeons responded. 62% of respondents selected surgical intervention. Of these, 59% chose a traditional open technique. 50% of respondents were general orthopaedic. There was a correlation between fellowship training and operative management (P = 0.042). Within the operative management group there was no statistical difference (P > 0.05) in need for further imaging, technique used, post-operative immobilization, length of immobilization, weight-bearing protocol, and time to release to running. The majority of non-operative responders would splint/cast in plantarflexion or CAM boot with heel lift for < 3 weeks (50%) and keep non-weight bearing for < 4 weeks (63%). Only 38% of respondents would use DVT chemoprophylaxis. Conclusion When provided with a hypothetic case of an acute Achilles tendon rupture, queried Army orthopaedic surgeons would more often treat with a surgical procedure. This difference in treatment is secondary to training, fellowship or other. This propensity of surgical management, likely stems from the highly active population and the desire to return to duty. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04121-y.
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Affiliation(s)
- Nischal Nadig
- Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, 300 E Hospital Rd, Fort Gordon, GA, 30905, USA.
| | - Thomas Dowd
- Department of Orthopaedics & Rehab., San Antonio Military Medical Center, 3551 Roger Brooke Dr, San Antonio, TX, 78219, USA
| | - Jeannie Huh
- Department of Orthopaedics & Rehab., Womack Army Medical Center, 2817 Reilly Rd, Fort Bragg, NC, 28310, USA
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20
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He SK, Liao JP, Huang FG. Higher Rate of Postoperative Complications in Delayed Achilles Tendon Repair Compared to Early Achilles Tendon Repair: A Meta-Analysis. J INVEST SURG 2020; 35:157-163. [PMID: 32990099 DOI: 10.1080/08941939.2020.1824247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Some authors found that delayed repair of Achilles tendon ruptures achieved similar functional outcomes when compared with acute repair of Achilles tendon ruptures. The purpose of our study was to compare functional outcomes and complication rates of acute repair to delayed repair after Achilles tendon ruptures. METHODS PubMed, Embase (Ovid) and the Cochrane Library were searched. RESULTS For Achilles tendon rupture score (ATRS), the overall result revealed that there was no significant difference in ATRS between acute repair groups and delayed repair groups (P = 0.59). For Tegner scores, Halasi scores and Achilles tendon resting angle (ATRA), there was no significant difference between the two groups (P = 0.28, P = 0.47 and P = 0.68). There was no significant difference in the subjective assessment between acute repair groups and delayed repair groups (P = 0.84). However, delayed repair groups showed a higher incidence of complications than acute repair groups (P = 0.01). Subgroup analyses showed that the mean time from injury to surgery of delayed repair groups affect the pooled result substantially. For mean time less than 28d, there was no difference in the incidence of complications between acute repair groups and delayed repair groups (P = 0.09). However, for mean time more than 28d, delayed repair groups showed a higher incidence of complications than acute repair groups (P = 0.05). CONCLUSION Our study showed delayed repair could obtain similar functional outcomes and subjective assessment when compared with acute repair. However, the rate of complications after delayed repair was higher than that of early repair. Further high-quality randomized controlled trials (RCT) are needed to evaluate the difference.
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Affiliation(s)
- Shu-Kun He
- Department of Orthopedics, West China Hospital, Sichuan University Chengdu, Sichuan, PR China
| | | | - Fu-Guo Huang
- Department of Orthopedics, West China Hospital, Sichuan University Chengdu, Sichuan, PR China
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