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Bak BM, Seow D, Teo YZE, Hasan MY, Pearce CJ. Return to Play and Functional Outcomes Following Treatment of Acute Achilles Tendon Ruptures: A Systematic Review and Meta-Analysis. J Foot Ankle Surg 2024; 63:420-429. [PMID: 38296023 DOI: 10.1053/j.jfas.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/19/2023] [Accepted: 12/18/2023] [Indexed: 02/12/2024]
Abstract
Return to play (RTP) and functional outcomes are critical to treatment success for acute Achilles tendon rupture (AATR). This systematic review and meta-analysis explored treatment superiority essential in optimal treatment selection concerning individual patients and their expectations regarding RTP and functional outcomes. This study was in accordance with the preferred reporting items for systematic reviews and meta-analyses guidelines. The included studies were assessed regarding the level and quality of evidence. Fixed-effects models were employed for I2 < 25% and random-effects models for I2 ≥ 25%. The RTP rate meta-analysis of surgical vs conservative treatment revealed no significant difference. This was similar to the subgroup analysis of open repair and conservative treatment. The RTP rate and Achilles Tendon Total Rupture Score (ATRS) meta-analysis of open repair + earlier rehabilitation (ER) vs + later rehabilitation (LR) also revealed no significant differences. The mean time to RTP meta-analysis of open repair + ER vs + LR showed that open repair + ER was significantly favored (-4.19 weeks; p = .002). The ATRS meta-analysis of conservative treatment with ER vs with LR revealed no significant difference. This meta-analysis has revealed that the RTP rates following treatment of AATR are high. Therefore, the decision for surgical vs conservative treatment or open repair + ER vs + LR for AATR should not be selected based on the expectation of RTP. However, open repair + ER can be advocated over + LR for reduced mean time to RTP.
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Affiliation(s)
| | - Dexter Seow
- National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | | | | | - Christopher J Pearce
- National University Health System, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Geng X, Yang X, Teng Z, Hu X, Wang C, Zhang C, Chen L, Huang J, Wang X, Ma X. Is a Preoperative MRI Scan Necessary for Acute Achilles Tendon Rupture? Orthop Surg 2023; 15:2777-2785. [PMID: 37749776 PMCID: PMC10622284 DOI: 10.1111/os.13845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 07/09/2023] [Accepted: 07/11/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND Different treatment methods have been developed for acute Achilles tendon rupture (ATR), including conservative treatment, minimally invasive or transdermal surgery, and open surgery, and there is no consensus about which method is superior. It is important to clarify the presence of Achilles tendon (AT) degeneration, the rupture site, and the rupture shape before surgery to determine whether minimally invasive or open surgery should be selected, thereby reducing the re-rupture rate following acute ATR. The aim of this study was to investigate the diagnostic value of MRI in identifying the presence of AT degeneration, the rupture site, and the rupture shape for acute closed ATR. METHODS From January 2016 to December 2019, patients with acute closed ATR who had undergone repair surgery were retrospectively enrolled. All patients received MRI examination, and the distance between the insertion site and broken end and the rupture shape (types I, II, and III) were independently determined by two observers. Then, the stump of the AT was exposed during the operation. The rupture site and rupture shape were recorded and compared and analyzed with the MRI results. Consistency analyses (using Cohen's kappa coefficient or intraclass correlation coefficient-ICC) and calculation of diagnostic performance indexes were, respectively, conducted to evaluate the diagnostic value of the MRI. RESULTS This study included 47 consecutive patients with acute ATR, with an average age of 38.4 years. Among them, 40 were male, and seven were female. The intraoperative exploration demonstrated a total of 34 (72.3%), 10 (21.3%), and three (6.4%) patients with type I, II, and III ruptures, respectively. The average distance between the insertion site and the proximal broken end measured intraoperatively was 4.07 ± 1.57 cm. High or excellent consistencies were found for ATR classifications (kappa: 0.739-0.770, p < 0.001) and rupture sites (ICC: 0.962-0.979, p < 0.001) between two observers and between observers 1 and 2 and intraoperative findings. Tendinopathy was identified in 22 patients by MRI and confirmed during surgery. CONCLUSIONS MRI scanning of acute closed ATR can help determine whether there is degeneration of the AT, as well as the location and shape of the rupture, which can guide the selection of the optimal operation method for orthopedic surgeons. Therefore, it is necessary to take preoperative MRI scans for patients with acute Achilles tendon ruptures.
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Affiliation(s)
- Xiang Geng
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Xiong‐gang Yang
- Department of OrthopaedicsThe First People's Hospital of Yunnan Province, Affiliated Hospital of Kunming University of Science and TechnologyKunmingChina
- The Key Laboratory of Digital Orthopaedics of Yunnan ProvincialKunmingChina
| | - Zhao‐lin Teng
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Xing‐xi Hu
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Chen Wang
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Chao Zhang
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Li Chen
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Jia‐zhang Huang
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Xu Wang
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
| | - Xin Ma
- Department of Orthopaedic SurgeryHuashan Hospital, Fudan University, ShanghaiKunmingChina
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Rong X, Tang Y, Cao S, Xiao S, Wang H, Zhu B, Huang S, Adeli M, Rodriguez RD, Cheng C, Ma L, Qiu L. An Extracellular Vesicle-Cloaked Multifaceted Biocatalyst for Ultrasound-Augmented Tendon Matrix Reconstruction and Immune Microenvironment Regulation. ACS NANO 2023; 17:16501-16516. [PMID: 37616178 DOI: 10.1021/acsnano.3c00911] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
The healing of tendon injury is often hindered by peritendinous adhesion and poor regeneration caused by the accumulation of reactive oxygen species (ROS), development of inflammatory responses, and the deposition of type-III collagen. Herein, an extracellular vesicles (EVs)-cloaked enzymatic nanohybrid (ENEV) was constructed to serve as a multifaceted biocatalyst for ultrasound (US)-augmented tendon matrix reconstruction and immune microenvironment regulation. The ENEV-based biocatalyst exhibits integrated merits for treating tendon injury, including the efficient catalase-mimetic scavenging of ROS in the injured tissue, sustainable release of Zn2+ ions, cellular uptake augmented by US, and immunoregulation induced by EVs. Our study suggests that ENEVs can promote tenocyte proliferation and type-I collagen synthesis at an early stage by protecting tenocytes from ROS attack. The ENEVs also prompted efficient immune regulation, as the polarization of macrophages (Mφ) was reversed from M1φ to M2φ. In a rat Achilles tendon defect model, the ENEVs combined with US treatment significantly promoted functional recovery and matrix reconstruction, restored tendon morphology, suppressed intratendinous scarring, and inhibited peritendinous adhesion. Overall, this study offers an efficient nanomedicine for US-augmented tendon regeneration with improved healing outcomes and provides an alternative strategy to design multifaceted artificial biocatalysts for synergetic tissue regenerative therapies.
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Affiliation(s)
- Xiao Rong
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Yuanjiao Tang
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Sujiao Cao
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China
| | - Sutong Xiao
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China
| | - Haonan Wang
- Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Bihui Zhu
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Songya Huang
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Mohsen Adeli
- Department of Organic Chemistry, Lorestan University, Khorramabad 6815144316, Iran
| | - Raul D Rodriguez
- Tomsk Polytechnic University, Lenina Avenue 30, 634034, Tomsk, Russia
| | - Chong Cheng
- College of Polymer Science and Engineering, State Key Laboratory of Polymer Materials Engineering, Sichuan University, Chengdu, 610065, China
| | - Lang Ma
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Li Qiu
- Department of Ultrasound, National Clinical Research Center for Geriatrics, Med-X Center for Materials, West China Hospital, Sichuan University, Chengdu, 610041, China
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Kokulu K, Altunok İ, Sert ET, Özdemir S, Mutlu H, Akça HŞ. Diagnostic Value of Lateral Ankle Radiography in Achilles Tendon Rupture. Foot Ankle Spec 2023; 16:384-391. [PMID: 36036526 DOI: 10.1177/19386400221118496] [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: 11/15/2022]
Abstract
INTRODUCTION Achilles tendon rupture (ATR) is a common sports injury, but approximately 20% of acute ATR cases are misdiagnosed as ankle sprains at first presentation. This study aimed to investigate the diagnostic value of lateral ankle radiography in the diagnosis of acute ATR. METHODS This was a retrospective case-control study in which the lateral ankle radiographs of patients who presented to the emergency department between January 1, 2015 and December 31, 2019 were examined. The study included a total of 154 patients with acute ATR, who underwent lateral ankle radiography at the presentation and were surgically or magnetic resonance imaging (MRI) confirmed to have ATR in our hospital. The lateral ankle radiographs of the patients were examined by 2 clinicians blinded to clinical data for the following 3 findings: Kager's fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle. The same procedure was repeated for 308 controls who underwent lateral ankle radiography and were diagnosed with ankle sprain. RESULTS Kager's fat pad sign was detected in 133 (86.4%) of the 154 patients with ATR and 26 (8.4%) of the 308 patients in the control group. The Kager's fat pad sign, tibio-first metatarsal angle, and tibiocalcaneal angle sensitivity values for the diagnosis of ATR were 86.4%, 61.7%, and 65.6%, respectively, and their specificity values were 91.6%, 78.9%, and 56.2%, respectively. Interobserver reliability was determined to be good for all 3 radiographic findings. CONCLUSION Clinicians should be particularly aware of Kager's fat pad sign when examining lateral ankle radiographs for ankle injury. LEVELS OF EVIDENCE Level IV: Case control study.
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Affiliation(s)
- Kamil Kokulu
- Department of Emergency Medicine, Aksaray University School of Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - İbrahim Altunok
- Department of Emergency Medicine, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Ekrem Taha Sert
- Department of Emergency Medicine, Aksaray University School of Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Serdar Özdemir
- Department of Emergency Medicine, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey
| | - Hüseyin Mutlu
- Department of Emergency Medicine, Aksaray University School of Medicine, Aksaray University Training and Research Hospital, Aksaray, Turkey
| | - Hatice Şeyma Akça
- Department of Emergency Medicine, University of Health Sciences, Ümraniye Training and Research Hospital, İstanbul, Turkey
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Sgadari A, Izzo A, Smeraglia F, Coviello A, Patel S, Mariconda M, Bernasconi A. Analysis of the 50 Most Cited Articles on Achilles Tendon Injury. Orthop J Sports Med 2023; 11:23259671231170846. [PMID: 37223076 PMCID: PMC10201165 DOI: 10.1177/23259671231170846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 02/22/2023] [Indexed: 05/25/2023] Open
Abstract
Background Achilles tendon injuries represent one of the most common reasons for referral to orthopaedic surgeons. Purpose To outline the characteristics, examine trends in publication, and evaluate the correlation between citations and study quality of the 50 most cited articles on Achilles tendon injury. Study Design Cross-sectional study. Methods After searching the Web of Science for articles published in orthopaedic journals, we identified the 50 most cited articles on Achilles tendon injury and abstracted their characteristics. Risk of bias was assessed using the modified Coleman Methodology Score (mCMS). Multiple bivariate analyses (Pearson or Spearman correlation coefficient) were used to evaluate the association among number of citations, citation rate (citations/year), 2020 journal impact factor (JIF), year of publication, level of evidence (LoE), study type (tendon rupture or chronic tendinopathy), sample size, and mCMS. Results The top 50 articles were cited 12,194 times. Each article had a mean ± SD 244 ± 88.8 citations (range, 157-657) and a citation rate of 12.6 ± 5.4 per year (range, 3-28). A total of 35 studies (70%) were published between 2000 and 2010. The citation rate of the 16 most recent studies was almost double that of the 16 oldest studies (17.5 vs 9.9; P < .001). Nineteen studies (49%) were classified as having poor quality (mCMS <50 points). The mean JIF of the 9 journals that published the studies was 5.1. The citation rate correlated with the number of citations (r = 0.56; P < .001), publication year (r = 0.60; P < .001), and LoE (r = -0.44; P = .005). The publication year correlated with the LoE (r = -0.40; P = .01). Study quality in terms of mCMS correlated with the JIF (r = 0.35; P = .03) and LoE (r = -0.48; P = .003) but not the citation rate (P = .15). Conclusion The mean LoE and the citation rate of the most cited articles on Achilles tendon injury both significantly increased over time. Although the JIF was positively correlated with study quality, almost half of the studies had poor-quality methodology.
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Affiliation(s)
- Arianna Sgadari
- Department of Public Health, Trauma and
Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Antonio Izzo
- Department of Public Health, Trauma and
Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Francesco Smeraglia
- Department of Public Health, Trauma and
Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Antonio Coviello
- Department of Public Health, Trauma and
Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Shelain Patel
- Foot and Ankle Unit, Royal National
Orthopaedic Hospital, Stanmore, UK
| | - Massimo Mariconda
- Department of Public Health, Trauma and
Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Alessio Bernasconi
- Department of Public Health, Trauma and
Orthopaedics, University of Naples Federico II, Naples, Italy
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Seow D, Islam W, Randall GW, Azam MT, Duenes ML, Hui J, Pearce CJ, Kennedy JG. Lower re-rupture rates but higher complication rates following surgical versus conservative treatment of acute achilles tendon ruptures: a systematic review of overlapping meta-analyses. Knee Surg Sports Traumatol Arthrosc 2023:10.1007/s00167-023-07411-1. [PMID: 37115231 DOI: 10.1007/s00167-023-07411-1] [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: 01/06/2023] [Accepted: 03/30/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE To systematically review and evaluate the current meta-analyses for the treatment of acute Achilles tendon rupture (AATR). This study can provide clinicians with a clear overview of the current literature to aid clinical decision-making and the optimal formulation of treatment plans for AATR. METHODS Two independent reviewers searched PubMed and Embase on June 2, 2022 based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Assessment of evidence was twofold: level of evidence (LoE) and quality of evidence (QoE). LoE was evaluated using published criteria by The Journal of Bone and Joint Surgery and the QoE by the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) scale. Pooled complication rates were highlighted for significance in favour of one treatment arm or no significance. RESULTS There were 34 meta-analyses that met the eligibility criteria, with 28 studies of LoE 1, and the mean QoE was 9.8 ± 1.2. Significantly lower re-rupture rates were reported with surgical (2.3-5%) versus conservative treatment (3.9-13%), but conservative treatment was favoured in terms of lower complication rates. The re-rupture rates were not significantly different between percutaneous repair or minimally invasive surgery (MIS) compared to open repair, but MIS was favoured in terms of lower complication rates (7.5-10.4%). When comparing rehabilitation protocols following open repair (four studies), conservative treatment (nine studies), or combined (three studies), there was no significant difference in terms of re-rupture or obvious advantage in terms of lower complication rates between early versus later rehabilitation. CONCLUSION This systematic review found that surgical treatment was significantly favoured over conservative treatment for re-rupture, but conservative treatment had lower complication rates other than re-rupture, notably for infections and sural nerve injury. Open repair had similar re-rupture rates to MIS, but lower complication rates; however, the rate of sural nerve injuries was lower in open repair. When comparing earlier versus later rehabilitation, there was no difference in re-rupture rates or obvious advantage in complications between open repair, conservative treatment, or when combined. The findings of this study will allow clinicians to effectively counsel their patients on the postoperative outcomes and complications associated with different treatment approaches for AATR. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Dexter Seow
- NYU Langone Health, NYU Langone Orthopedic Hospital, 171 Delancey Street, New York, NY, 10002, USA
- National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Wasif Islam
- NYU Langone Health, NYU Langone Orthopedic Hospital, 171 Delancey Street, New York, NY, 10002, USA
| | - Grace W Randall
- NYU Langone Health, NYU Langone Orthopedic Hospital, 171 Delancey Street, New York, NY, 10002, USA
| | - Mohammad T Azam
- NYU Langone Health, NYU Langone Orthopedic Hospital, 171 Delancey Street, New York, NY, 10002, USA
| | - Matthew L Duenes
- NYU Langone Health, NYU Langone Orthopedic Hospital, 171 Delancey Street, New York, NY, 10002, USA
| | - James Hui
- National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Christopher J Pearce
- National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - John G Kennedy
- NYU Langone Health, NYU Langone Orthopedic Hospital, 171 Delancey Street, New York, NY, 10002, USA.
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Hembree WC, Tarka MC, Pasternack JB, Mathew SE, Guyton GP. What's New in Foot and Ankle Surgery. J Bone Joint Surg Am 2023; 105:737-743. [PMID: 36888693 DOI: 10.2106/jbjs.22.01382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Affiliation(s)
- Walter C Hembree
- Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
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Yang S, Shi W, Yan W, Ao Y, Guo Q, Yang Y. Comparison between primary repair and augmented repair with gastrocnemius turn-down flap for acute Achilles tendon rupture: a retrospective study with minimum 2-year follow-up. BMC Musculoskelet Disord 2023; 24:163. [PMID: 36871017 PMCID: PMC9985193 DOI: 10.1186/s12891-023-06260-w] [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: 09/27/2022] [Accepted: 02/21/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND To explore and compare the clinical outcomes in patients undergoing primary repair versus augmented repair with a gastrocnemius turn-down flap for acute Achilles tendon rupture. METHODS From 2012 to 2018, the clinical data of 113 patients with acute Achilles tendon rupture who were treated with primary repair or augmented repair with a gastrocnemius turn-down flap by the same surgeon were retrospectively reviewed. The patients' preoperative and postoperative scores on the visual analog scale (VAS), American Orthopaedic Foot and Ankle Society Ankle⁃Hindfoot (AOFAS) score, the Victorian Institute of Sport Assessment⁃Achilles (VISA-A), the Achilles tendon total rupture score (ATRS), and the Tegner Activity Scale were examined and compared. The postoperative calf circumference was measured. A Biodex isokinetic dynamometer was used to evaluate the plantarflexion strength on both sides. The time to return to life and exercise as well as the strength deficits in both groups were recorded. Finally, the correlation analyses between patient characteristics and treatment details with clinical outcomes were conducted. RESULTS In total, 68 patients were included and completed the follow-up. The 42 and 26 patients who were treated with primary repair and augmented repair were assigned to group A and B, respectively. No serious postoperative complications were reported. No significant between-group differences in any outcomes were observed. It was found that female sex was correlated with poorer VISA-A score (P = 0.009), complete seal of paratenon was correlated with higher AOFAS score (P = 0.031), and short leg cast was correlated with higher ATRS score (P = 0.006). CONCLUSIONS Augmented repair with a gastrocnemius turn-down flap provided no advantage over primary repair for the treatment of acute Achilles tendon rupture. After surgical treatment, females tended to had poorer outcomes, while complete seal of paratenon and short leg cast contributed to better results. LEVEL OF EVIDENCE Cohort study; Level of evidence, 3.
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Affiliation(s)
- Shuai Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Beijing, Haidian District, 100191, China
| | - Weili Shi
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Beijing, Haidian District, 100191, China
| | - Wenqiang Yan
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Beijing, Haidian District, 100191, China
| | - Yingfang Ao
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Beijing, Haidian District, 100191, China
| | - Qinwei Guo
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Beijing, Haidian District, 100191, China.
| | - Yuping Yang
- Department of Sports Medicine, Peking University Third Hospital, Institute of Sports Medicine of Peking University, Beijing Key Laboratory of Sports Injuries, Engineering Research Center of Sports Trauma Treatment Technology and Devices, Ministry of Education, 49 North Garden Road, Beijing, Haidian District, 100191, China.
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9
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Jónsdóttir US, Brorsson A, Nilsson Helander K, Tranberg R, Larson ME. Factors That Affect Return to Sports After an Achilles Tendon Rupture: A Qualitative Content Analysis. Orthop J Sports Med 2023; 11:23259671221145199. [PMID: 36798800 PMCID: PMC9926006 DOI: 10.1177/23259671221145199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/26/2022] [Indexed: 02/12/2023] Open
Abstract
Background Achilles tendon rupture is common among physically active individuals, yet a high percentage fail to return to their former activity after the injury. Quantifiable factors such as type of treatment, hours of rehabilitation, and age have not been associated with return-to-play rates. A factor that influences recovery is the participant's experience before and throughout the rehabilitation process, which can be explored using a qualitative content analysis. Purpose To explore and describe what influences the participant to return to physical activity after an Achilles tendon rupture. Study Design Cross-sectional study; Level of evidence, 3. Methods Twenty participants (14 men; mean age, 46 years) were interviewed as part of this study. All participants had ruptured their Achilles tendon 4 to 6 years before the interviews. From the interviews, codes were extracted that evolved into 19 subcategories, 6 categories, and 1 theme. Results The overarching theme that emerged was "Help me and then I can fix this." The 6 categories were (1) one's own drive to succeed, (2) having a supportive social network, (3) trusting the support from the health and social systems, (4) receiving and adapting information from others drives persistence in returning to activity, (5) impact of the injury on psychological factors; and (6) influence of physiological aspects. Conclusion To be able to recover properly from an Achilles tendon rupture and return to activity, the study participants described the importance of obtaining the support needed to be able to gain optimal rehabilitation. In the participants' opinion, for a greater chance of successful treatment and rehabilitation, it was vital to be provided with good support.
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Affiliation(s)
- Unnur Sædís Jónsdóttir
- Department of Orthopaedics, Institute of Clinical Sciences at
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Unnur Sædís Jónsdóttir, PT, MSc, Department of Orthopaedics,
Institute of Clinical Sciences at Sahlgrenska Academy, Göteborgsvägen 31, 431 80
Mölndal, Sweden () (Twitter:
@unnursaedis)
| | - Annelie Brorsson
- Department of Orthopaedics, Institute of Clinical Sciences at
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katarina Nilsson Helander
- Department of Orthopaedics, Institute of Clinical Sciences at
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Roy Tranberg
- Department of Orthopaedics, Institute of Clinical Sciences at
Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria E.H. Larson
- Department of Clinical Neuroscience and
Rehabilitation/Physiotherapy, Institute of Neuroscience and Physiology, Sahlgrenska
Academy, University of Gothenburg, Gothenburg, Sweden.,Primary Health Care, Region Västra, Götaland, Sweden
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10
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The Effect of Real-Time Tibial Acceleration Feedback on Running Biomechanics During Gait Retraining: A Systematic Review and Meta-Analysis. J Sport Rehabil 2023; 32:449-461. [PMID: 36791728 DOI: 10.1123/jsr.2022-0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 12/08/2022] [Accepted: 12/13/2022] [Indexed: 02/16/2023]
Abstract
OBJECTIVES To explore the immediate and retention effect of real-time tibial acceleration feedback on running biomechanics during gait retraining. METHODS Five electronic databases were searched to identify relevant studies published before May 2022. The included studies were evaluated for methodological quality and bias risk, and data were extracted. A meta-analysis was conducted on the primary outcomes, including peak tibial acceleration (PTA) and vertical ground reaction force. Subgroup analysis was performed by gender, feedback criterion, mode, dosage, fading, retention period, and running environment to evaluate the source of heterogeneity. Qualitative analysis was performed to describe other variables. RESULTS Fourteen studies (174 participants) were eligible. Meta-analysis showed that real-time tibial acceleration feedback reduced PTA (P < .01, P < .01), vertical impact peak (P = .004, P < .01), vertical average loading rate (P < .01, P < .01), and vertical instantaneous loading rate (P < .01, P < .01) after feedback and during retention period (5 min-12 mo). Subgroup analysis showed that the immediate effect of vertical impact peak was more noticeable with mixed gender (P = .005) and fading feedback (P = .005) conditions, and the retention effect of PTA was more noticeable with high feedback dosage (P < .01) and fading feedback (P < .01) conditions. CONCLUSIONS Real-time tibial acceleration feedback can reduce PTA and vertical ground reaction force during gait retraining, and for periods of 5 minutes to 12 months when the feedback is removed.
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Leino O, Keskinen H, Laaksonen I, Mäkelä K, Löyttyniemi E, Ekman E. Incidence and Treatment Trends of Achilles Tendon Ruptures in Finland: A Nationwide Study. Orthop J Sports Med 2022; 10:23259671221131536. [PMID: 36389616 DOI: 10.1177/23259671221131536] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/04/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Global reports indicate rising Achilles tendon rupture (ATR) incidence. In recent decades, the optimal treatment for this injury has been widely studied. Alongside the cumulating comparative evidence regarding the optimal method of treatment, nonoperative treatment has increased in popularity compared with operative treatment. Purpose: To determine the current incidence of ATRs and their treatment in Finland and how these have changed from 1997 to 2019. Study Design: Descriptive epidemiology study. Methods: Two national registers (the National Hospital Discharge Register and the Finnish Register of Primary Health Care Visits) were used to identify all ATR cases and operations to treat them; the incidence was calculated based on the annual adult population size. Results: During the study period, ATR incidence increased from 17.3 to 32.3 per 100,000 person-years. The increase in incidence seemed to plateau starting in the second half of the study period. The rise in ATR incidence occurred in both sexes and all age groups but most markedly among the elderly. The incidence of operative treatment decreased from 13.6 to 4.9 per 100,000 person-years. This decline was observed from 2008 onward and in all age groups. Conclusion: The incidence of ATRs increased and the use of operative treatment decreased. The decreasing trend of operative treatment is in line with other international reports and resonates with the current literature about the optimal treatment of ATRs.
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Affiliation(s)
- Oskari Leino
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Heli Keskinen
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Inari Laaksonen
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Keijo Mäkelä
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Eliisa Löyttyniemi
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
| | - Elina Ekman
- Department of Orthopaedics and Traumatology, Turku University Hospital, Turku, Finland
- Faculty of Medicine, University of Turku, Turku, Finland
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Amendola F, Barbasse L, Carbonaro R, Alessandri-Bonetti M, Cottone G, Riccio M, De Francesco F, Vaienti L, Serror K. The Acute Achilles Tendon Rupture: An Evidence-Based Approach from the Diagnosis to the Treatment. Medicina (B Aires) 2022; 58:medicina58091195. [PMID: 36143872 PMCID: PMC9500605 DOI: 10.3390/medicina58091195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objective: Acute Achilles tendon rupture (AATR) is a common injury with a significant impact on daily living. Although various systematic reviews and meta-analyses have been written on the topic, no actual consensus exists on the best treatment. We aimed to collect the highest quality of evidence on the subject and to produce a document to which to refer, from the diagnosis to the final treatment. Material and Methods: Inclusion criteria were systematic reviews discussing Achilles tendon rupture, concerning either diagnostic criteria, classification, or treatment; English language; clearly stated inclusion and exclusion criteria for patients’ selection. Results: Thirteen systematic reviews were included in the study. A strong consensus exists about the higher risk of re-rupture associated with non-operative treatment and a higher risk of complications associated with surgical repair. Conclusions: The combination of minimally invasive repair and accelerated functional rehabilitation seems to offer the best results in the treatment of Achilles tendon rupture.
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Affiliation(s)
- Francesco Amendola
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi, 20122 Milan, Italy
| | - Léa Barbasse
- Plastic and Reconstructive Department, AP-HP, Hôpital Saint-Louis, 75010 Paris, France
| | - Riccardo Carbonaro
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi, 20122 Milan, Italy
| | - Mario Alessandri-Bonetti
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi, 20122 Milan, Italy
| | - Giuseppe Cottone
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi, 20122 Milan, Italy
| | - Michele Riccio
- Hand Surgery Unit, Department of Plastic and Reconstructive Surgery, Azienda “Ospedali Riuniti”, Via Conca 21, 60126 Ancona, Italy
| | - Francesco De Francesco
- Hand Surgery Unit, Department of Plastic and Reconstructive Surgery, Azienda “Ospedali Riuniti”, Via Conca 21, 60126 Ancona, Italy
- Correspondence: ; Tel.: +39-0715963945
| | - Luca Vaienti
- Plastic and Reconstructive Surgery Department, I.R.C.C.S. Istituto Ortopedico Galeazzi, 20122 Milan, Italy
| | - Kevin Serror
- Plastic and Reconstructive Department, AP-HP, Hôpital Saint-Louis, 75010 Paris, France
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Locating the danger zone to avoid injury to the sural nerve during Achilles calcaneal tendon repair. A systematic review of cadaveric studies with clinical implications. SURGICAL AND RADIOLOGIC ANATOMY : SRA 2022; 44:1131-1138. [PMID: 35918444 DOI: 10.1007/s00276-022-02997-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/26/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Although iatrogenic injuries to the sural nerve (SN) are commonly encountered in calcaneal (Achilles) tendon (CaT) repair surgeries, the relationship between both structures have anatomical variations. A quantitative evidence synthesis has not been yet conducted. Our systematic review aims to better define the safe zone where the SN crosses the lateral border of CaT. METHODS Electronic databases were searched to locate relevant anatomical studies recording details regarding the distance at which SN crosses the CaT. The Checklist for Anatomical Reviews and Meta-Analyses (CARMA) was followed. The primary outcome was the mean distance from CaT insertion to SN crossing site, to locate a safe zone. The secondary outcome was the mean horizontal distance from the SN to the CaT lateral border. RESULTS Seven studies met the inclusion criteria with a total of 204 cadaveric limbs. The danger zone was located 2 cm distal and proximal to the mean distance of the crossing point. The mean distance from CaT insertion to the SN crossing site was 9.91 ± 0.67 cm. The mean horizontal distance between SN and the CaT lateral border decreased from a mean of 19.8 ± 2.06 mm at the calcaneal tuberosity level to 3.6 ± 0.4 mm at 10 cm proximal to the tuberosity. DISCUSSION This review demonstrated that 10 cm is the average distance from the CaT insertion onto the calcaneal tuberosity to the point of crossing of the SN. A safe zone would be 2 cm away proximally and distally from the crossing point. We recommend placing the proximal lateral sutures away from this region. This finding should help surgeons avoid SN injuries during open or percutaneous approaches for calcaneal tendon rupture.
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Tang K, Deng Z, Wang T, Sun X, Yin L, Nie M. Panda rope bridge technique versus open repair of acute Achilles tendon rupture: A comparative clinical study. Injury 2022; 53:2666-2670. [PMID: 35636979 DOI: 10.1016/j.injury.2022.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 04/27/2022] [Accepted: 05/22/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The treatment options of acute Achilles tendon rupture (AATR) remain controversial. This article aims to compare the efficacy of a new surgical procedure, the panda rope bridge technique (PRBT) with open surgery of AATR. METHODS Ninety-eight patients with AATR were recruited, 53 underwent the PBRT, and 45 underwent open surgery. The operation time, postoperative American Orthopaedic Foot and Ankle Score, Achilles Tendon Rupture Score, complications and time to return to work and restore exercise were documented. RESULTS The average operation time, intraoperative blood loss and complication rate were 35.1 min, 18.2 ml and 3.8%, respectively, in the PRBT group, which were significantly lower than those of the open surgery group (P<0.001). The post-operative American Orthopaedic Foot and Ankle Score of 99.6 and the Achilles Tendon Rupture Score of 97.5 in the PRBT group were significantly higher than that of the open surgery group (P<0.001). The time to return to work and return to exercise were shorter in the PRBT group (P<0.001). CONCLUSION Compared to open surgery, PRBT is a better approach to the management of AATR. PRBT offers accelerated recovery, lower occurrence of post-operative complications and improved recovery of ankle joint function.
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Affiliation(s)
- Kaiying Tang
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Zhibo Deng
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Ting Wang
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Xianding Sun
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Liangjun Yin
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China
| | - Mao Nie
- Second affiliated hospital of Chongqing medical university, orthopaedics; Chongqing CN 400010, China.
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Kosiol J, Keiler A, Loizides A, Gruber H, Henninger B, Bölderl A, Gruber L. Operative versus conservative treatment of acute Achilles tendon ruptures: preliminary results of clinical outcome, kinematic MRI and contrast-enhanced ultrasound. Arch Orthop Trauma Surg 2022; 143:2455-2465. [PMID: 35567608 PMCID: PMC10110640 DOI: 10.1007/s00402-022-04457-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/15/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION There is no uniform consensus on the gold standard therapy for acute Achilles tendon rupture. The aim of this pilot study was to compare operative and conservative treatment regarding imaging findings and clinical outcome. MATERIALS AND METHODS Surgically or conservatively treated patients with acute Achilles tendon rupture were retrospectively evaluated. Differences in tendon length and diameter with and without load were analysed using kinematic MRI, tendon perfusion, structural alterations, movement and scar tissue by means of grey-scale and contrast-enhanced ultrasound (CEUS). Intra- and interobserver agreement were recorded. RESULTS No significant difference was detected regarding clinical outcome, B mode ultrasonography, contrast-enhanced sonography or MRI findings, although alterations in MRI-based measurements of tendon elasticity were found for both groups. Considerable elongation and thickening of the injured tendon were detected in both groups. CONCLUSION Both, conservative and surgical treatment showed comparable outcomes in our preliminary results and may suggest non-inferiority of a conservative approach.
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Affiliation(s)
- Juana Kosiol
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Alexander Keiler
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria.
| | - Alexander Loizides
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Hannes Gruber
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Andreas Bölderl
- Department of Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - Leonhard Gruber
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
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Doyle TR, Davey MS, Hurley ET. Statistical Findings Reported in Randomized Control Trials for the Management of Acute Achilles Tendon Ruptures are at High Risk of Fragility: A Systematic Review. J ISAKOS 2022; 7:72-81. [DOI: 10.1016/j.jisako.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/18/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
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