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Choi JY, Choo SK, Kim BH, Suh JS. Conservative treatment outcome for Achilles tendon re-rupture occurring in the subacute phase after primary repair. Arch Orthop Trauma Surg 2024; 144:1055-1063. [PMID: 38114740 DOI: 10.1007/s00402-023-05161-w] [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: 07/21/2023] [Accepted: 11/26/2023] [Indexed: 12/21/2023]
Abstract
INTRODUCTION Until now, a treatment protocol for Achilles tendon re-rupture (ATRR) occurring in the postoperative period 5-12 weeks following primary Achilles tendon repair has not been established. We refer to this time frame as the subacute postoperative phase, and the objective of this study was to assess the efficacy of conservative treatment for subacute ATRR in this phase. MATERIALS AND METHODS We conducted a retrospective review of 390 cases (385 patients) who had undergone primary Achilles tendon repair using the 4-strand Krachow method between January 2010 and August 2021. All patients were subjected to more than 12 months of follow-up and were categorized into two groups based on the presence of subacute ATRR: Group 1 comprised 370 cases without ATRR, while Group 2 comprised 20 cases with ATRR. Following confirmation of ATRR, we immediately applied a below-knee cast in an ankle plantar flexed position (25°-30°), followed by bracing according to the same rehabilitation plan used for the primary repair. After administering conservative treatment to the patients with ATRR, we compared several outcome parameters between the two groups, including isokinetic plantar flexion power measured using a dynamometer, time required for a single heel raise (t-SHR), time needed for ten repetitive SHRs (t-SHR10), Achilles Tendon Total Rupture Score (ATRS), and Foot and Ankle Ability Measure (FAAM) scores. The baseline timepoints for Groups 1 and 2 were the dates of the primary repair and the re-injury event. RESULTS After primary Achilles tendon repair, subacute ATRR occurred in 5.1% of patients. There were no significant differences between the groups in terms of t-SHR and t-SHR10 (P = 0.281, 0.486). Similarly, the isokinetic dynamometer measurements revealed no significant differences in peak torque for plantar flexion at angular velocities of 30°/s and 120°/s, both in absolute values and as a percentage of the contralateral side, between the groups (P > 0.05 for each). However, ATRSs were significantly lower in Group 2 compared to Group 1 before 6 months (P < 0.05), as were FAAM-Activities of Daily Living scores at 6 months (P < 0.05). After 12 months, there were no significant differences in these scores between the two groups (both P > 0.05). CONCLUSION Conservative treatment for subacute ATRR following primary Achilles tendon repair yields clinical outcomes comparable to those without ATRR. Therefore, we recommend that surgeons consider relying on the patient's natural healing capabilities rather than opting for aggressive surgical interventions, as expediting such operations may be unnecessary for subacute injuries.
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Affiliation(s)
- Jun Young Choi
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea
| | - Suk Kyu Choo
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea
| | - Byung Ho Kim
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea
| | - Jin Soo Suh
- Department of Orthopedic Surgery, Inje University, Ilsan Paik Hospital, 170 Juhwa-Ro, Ilsanseo-Gu, Goyang-Si, Gyeonggi-Do, South Korea.
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Chuckpaiwong B, Glisson RR, Usuelli FG, Madi NS, Easley ME. Biomechanical Comparison of Nonlocked Minimally Invasive and Locked Open Achilles Tendon Simulated Rupture Repairs. Foot Ankle Int 2023; 44:913-921. [PMID: 37329183 DOI: 10.1177/10711007231178819] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
BACKGROUND Open repair of Achilles tendon ruptures is associated with a risk of infection and other wound complications. Although percutaneous repairs reduce these complications, they may increase the risk of nerve injury. This study was designed to determine whether a percutaneous nonlocking repair can approach the gapping resistance offered by a standard open repair under conditions approximating typical postoperative physiotherapy. METHODS Ten pairs of cadavers Achilles tendons were transected in situ 5 cm above the insertion. One tendon from each pair was repaired using an open 4-strand Krackow locking loop, and the contralateral tendon was repaired with the Achillon system using the same suture material. Displacement transducers were attached to the medial, lateral, anterior, and posterior aspects of the tendon, spanning the repair. Each tendon underwent 1000 tensile loading cycles to 86.5 N, simulating passive ankle range-of-motion physiotherapy. Gapping was documented on the 1st, 50th, 100th, 500th, and 1000th cycles. The ultimate tensile strength of each repaired tendon was then measured by distracting until gross failure occurred. RESULTS Gapping of the percutaneous repairs exceeded that of conventional open repairs on the first, 500th, and 1000th load cycles. All 10 conventionally repaired tendons withstood 1000 load cycles without gross failure, but 4 of 10 percutaneous minimally invasive repairs failed, one on the 9th load cycle and the others between the 100th and 500th cycles. On average, tendons repaired with the open technique withstood 66% greater tensile load in failure testing than those repaired with the percutaneous technique. CONCLUSION Open Krackow Achilles tendon repairs may better withstand more aggressive postoperative physiotherapy than nonlocked percutaneous repairs. CLINICAL RELEVANCE The study suggests that surgeons should consider locking suture approaches to avoid loss of repair integrity with early motion.
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Affiliation(s)
- Bavornrit Chuckpaiwong
- Department of Orthopaedic Surgery, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Richard R Glisson
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
| | | | - Naji S Madi
- Department of Orthopaedic Surgery, West Virginia University, Morgantown, WV, USA
| | - Mark E Easley
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
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Kim J, Kang HJ, Kim BS, Kim YM, Kim HN, Park JY, Choi YR, Bat-Ulzii A, Cho J. Clinical Features and Treatment of Intra-Tendinous Suture Reaction Following Achilles Tendon Repair Using Nonabsorbable Suture Material: A Retrospective Case Series Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12897. [PMID: 36232194 PMCID: PMC9564661 DOI: 10.3390/ijerph191912897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 08/26/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
We aimed to investigate the clinical manifestations, radiological findings, and therapeutic outcome of treatment for patients with surgically confirmed foreign body reaction following an Achilles tendon repair using non-absorbable suture material. Eight consecutive patients who were confirmed as having an intra-tendinous suture foreign body reaction in the histopathological report were enrolled in this study. Medical records of all patients in terms of clinical and radiological features were retrieved. Also, the outcome of treatment was evaluated at a follow-up of at least 12 months. All the patients complained of pain and a palpable mass around a previous surgical site at mean 25.1 months (range, 4-72 months) after the initial surgery. Magnetic resonance imaging (MRI) or ultrasound were used to detect the lesion. All the patients underwent surgical excision of foreign body reaction tissue and primary repair using absorbable suture material. After the treatment, the wounds were healed completely in all, and the average FAOS (foot and ankle outcome score) was 91.32 at mean follow-up for 22.4 months. In conclusion, intra-tendinous suture reaction is a rare complication following an Achilles tendon repair using nonabsorbable suture material, but it can be treated adequately with only surgical excision of foreign body reaction tissue and primary repair using absorbable suture material.
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Affiliation(s)
- Jahyung Kim
- Department of Orthopaedic Surgery, Armed Force Yangju Hospital, Yangju 11429, Korea
| | - Hwa-Jun Kang
- Department of Orthopedic Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Korea
| | - Bom-Soo Kim
- Department of Orthopedic Surgery, Inha University Hospital, Incheon 22332, Korea
| | - Yu-Mi Kim
- Department of Orthopedic Surgery, Sanbon Hospital, Wonkwang University College of Medicine, Gunpo-si 15865, Korea
| | - Hyong-Nyun Kim
- Department of Orthopedic Surgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Korea
| | - Jae-Yong Park
- Department of Orthopedic Surgery, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang-si 14068, Korea
| | - Young-Rak Choi
- Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul 03924, Korea
| | - Altanzul Bat-Ulzii
- Institute for Skeletal Aging and Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon 24253, Korea
| | - Jaeho Cho
- Department of Orthopedic Surgery, Chuncheon Sacred Heart Hospital, Hallym University, Chuncheon 24253, Korea
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Naldo J, Agnew P, Brucato M, Dayton P, Shane A. ACFAS Clinical Consensus Statement: Acute Achilles Tendon Pathology. J Foot Ankle Surg 2021; 60:93-101. [PMID: 33199168 DOI: 10.1053/j.jfas.2020.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/29/2020] [Indexed: 02/03/2023]
Abstract
Injuries to the Achilles tendon are a challenge to the foot and ankle surgeon. In recent years, research has led to a relative change in the way that many surgeons view acute Achilles tendon rupture. In an effort to fully evaluate these trends, as well as to evaluate all aspects of care for acute Achilles tendon rupture, the American College of Foot and Ankle Surgeons convened a panel of experts to create a clinical consensus statement to address selected aspects of care of the acute Achilles tendon injury.
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Affiliation(s)
- Jason Naldo
- Chairperson, ACFAS Acute Achilles Tendon Pathology Clinical Consensus Statement, Chicago, IL; Assistant Professor, Department of Orthopaedics, Virginia Tech Carilion School of Medicine, Roanoke, VA; Foot and Ankle Surgeon, Institute for Orthopaedics and Neurosciences, Carilion Clinic, Roanoke, VA.
| | - Patrick Agnew
- Director of Podiatric Medical and Surgical Education, Associate Professor, Eastern Virginia Medical School, Norfolk, VA
| | | | - Paul Dayton
- Private Practice, Foot & Ankle Center of Iowa, Ankeny, IA
| | - Amber Shane
- Chair, Department of Podiatric Surgery, Advent Health System, Orlando, FL; Faculty, Advent Health East Orlando Podiatric Surgical Residency, Orlando, FL
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Prospective randomized clinical trial of open operative, minimally invasive and conservative treatments of acute Achilles tendon tear. Arch Orthop Trauma Surg 2021; 141:751-760. [PMID: 32367375 DOI: 10.1007/s00402-020-03461-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The acute Achilles tendon rupture (AATR) is a common injury of great importance in an increasingly active society. When early functional treatment is established, recent literature shows comparable rates of re-rupture in conservative and surgical treatments of AATR. However, there is no study comparing the outcome using a dynamometer. The aim of this study is to evaluate the results of patients with AATR treated conservatively and surgically using a dynamometer. In addition, the data are compared to evaluation of the Achilles tendon with ultrasound. MATERIALS AND METHODS Between 2012 and 2015, 90 patients (mean age 41 years, male-to-female ratio 81:9) with AATR were enrolled in a prospective, randomized, and monocentric study. Thirty patients were assigned to each of the three different treatment groups. Group OPEN received a conventional open suture of the Achilles tendon, group MIN received a minimally invasive suture and patients in group CONS were treated conservatively. Follow-up treatment was the same for all patients regardless of the group they were assigned to. Plantar flexion force was assessed using a dynamometer (Biodex® System 3 Pro, Biodex Medical Systems). Further evaluation included a physical test and ultrasound of the Achilles tendon. RESULTS Sixty-nine patients were available for a 24-month follow-up. In each of the OPEN and MIN groups, there was one re-rupture. In the CONS group, there were two re-ruptures. A positive correlation between the Biodex® dynamometer measurement and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Score (AOFAS-AH) could be found in all groups. Nevertheless, there were no significant differences between the treatment groups after 2 years. On sonography, all patients showed isolated structure loosening and a significantly thickened cross-sectional area compared with the non-injured opposite side, without differences between the groups. There was no correlation between the Biodex® measurement and sonographic outcome. CONCLUSION At 24-month follow-up, no significant difference can be found in patients with AATR treated operatively or conservatively. It is, therefore, important to inform patients with AATR regarding the respective advantages and disadvantages of the individual treatment strategies. LEVEL OF EVIDENCE Randomized controlled trial; level 1.
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Open Achilles Tendon Rerupture: A Case Report and Review of the Literature. Case Rep Orthop 2020; 2020:6694968. [PMID: 33343955 PMCID: PMC7728476 DOI: 10.1155/2020/6694968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/23/2020] [Accepted: 11/27/2020] [Indexed: 12/05/2022] Open
Abstract
In this report, we describe a rare case of open rerupture of an Achilles tendon following primary surgical repair. The rerupture occurred 12 weeks postoperatively and was associated with a transverse open wound perpendicular to the original surgical incision. This complication was successfully managed utilizing the preexisting transverse wound and a minimally invasive repair technique, minimizing further risk to the soft tissues overlying the tendon. This rare complication has only been described a few times in the literature and is likely associated with adhesions between the tendon repair and the subcutaneous tissues.
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Holzgrefe RE, McCarthy TP, Wilson JM, Bariteau JT, Labib S. Association of Strength Following Achilles Tendon Repair With Return to Same Level of Play in High-Level Athletes. Foot Ankle Int 2020; 41:1041-1048. [PMID: 32660267 DOI: 10.1177/1071100720936276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Rupture of the Achilles tendon is a common injury and the ability to return to the same level of sporting activity after treatment is an important outcome for patients. The objective of the current study was to examine the relationship between ankle strength and the ability to return to previous level of play following operative repair of an Achilles tendon rupture. METHODS Patients aged 18 to 50 years at a minimum 1 year postoperation from surgical repair of an Achilles tendon returned for a study visit. Patients reported both preinjury and current activity level using the 10-point Tegner Activity Level Scale. Isokinetic strength testing was performed and the Isokinetic Strength Score (ISS) was calculated. Logistic regression analysis was used to determine the relationship between ISS and return to play by Tegner level. A total of 36 patients (mean 35 years old, 72% male) completed the study protocol at a mean 1.8 years postoperatively. RESULTS Logistic regression revealed no association between ISS and return to play in the complete cohort. Subgroup analysis revealed that for 20 high-level athletes (preinjury Tegner ≥ 7), for every 16-point increase in ISS, the odds ratio (OR) for return to same level of play was 8.3 (P = .055) and the OR for return to within 1 Tegner level of play was 6.3 (P = .043). There was no association between ISS and return to previous activity in the 16 patients with lower preinjury levels of activity. CONCLUSION Improved ankle strength was associated with return to previous level of activity in patients participating in high-level athletic activity, suggesting that these patients were more dependent on recovery of ankle strength in the postoperative time period in order to return to their previous high level of play. In contrast, regaining strength may be less important for returning to normal activities for less active patients. LEVEL OF EVIDENCE Level III, comparative series.
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Affiliation(s)
| | - Timothy P McCarthy
- USAF, Landstuhl Regional Medical Center, Landstuhl, Rhineland-Palatinate, Germany
| | - Jacob M Wilson
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Jason T Bariteau
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
| | - Sameh Labib
- Department of Orthopaedic Surgery, Emory University, Atlanta, GA, USA
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Sun D, Fekete G, Baker JS, Mei Q, István B, Zhang Y, Gu Y. A Pilot Study of Musculoskeletal Abnormalities in Patients in Recovery from a Unilateral Rupture-Repaired Achilles Tendon. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134642. [PMID: 32605170 PMCID: PMC7369810 DOI: 10.3390/ijerph17134642] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to compare the inter-limb joint kinematics, joint moments, muscle forces, and joint reaction forces in patients after an Achilles tendon rupture (ATR) via subject-specific musculoskeletal modeling. Six patients recovering from a surgically repaired unilateral ATR were included in this study. The bilateral Achilles tendon (AT) lengths were evaluated using ultrasound imaging. The three-dimensional marker trajectories, ground reaction forces, and surface electromyography (sEMG) were collected on both sides during self-selected speed during walking, jogging and running. Subject-specific musculoskeletal models were developed to compute joint kinematics, joint moments, muscle forces and joint reaction forces. AT lengths were significantly longer in the involved side. The side-to-side triceps surae muscle strength deficits were combined with decreased plantarflexion angles and moments in the injured leg during walking, jogging and running. However, the increased knee extensor femur muscle forces were associated with greater knee extension degrees and moments in the involved limb during all tasks. Greater knee joint moments and joint reaction forces versus decreased ankle joint moments and joint reaction forces in the involved side indicate elevated knee joint loads compared with reduced ankle joint loads that are present during normal activities after an ATR. In the frontal plane, increased subtalar eversion angles and eversion moments in the involved side were demonstrated only during jogging and running, which were regarded as an indicator for greater medial knee joint loading. It seems after an ATR, the elongated AT accompanied by decreased plantarflexion degrees and calf muscle strength deficits indicates ankle joint function impairment in the injured leg. In addition, increased knee extensor muscle strength and knee joint loads may be a possible compensatory mechanism for decreased ankle function. These data suggest patients after an ATR may suffer from increased knee overuse injury risk.
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Affiliation(s)
- Dong Sun
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (D.S.); (Q.M.); (Y.Z.)
| | - Gusztáv Fekete
- Savaria Institute of Technology, Eötvös Loránd University, 9700 Szombathely, Hungary;
| | - Julien S. Baker
- Department of Sport and Physical Education, Hong Kong Baptist University, Hong Kong 999077, China;
| | - Qichang Mei
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (D.S.); (Q.M.); (Y.Z.)
| | - Bíró István
- Department of Technology, Faculty of Engineering, University of Szeged, 6727 Szeged, Hungary;
| | - Yan Zhang
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (D.S.); (Q.M.); (Y.Z.)
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo 315211, China; (D.S.); (Q.M.); (Y.Z.)
- Correspondence: ; Tel.: +86-574-87600208
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Bąkowski P, Ciemniewska-Gorzela K, Talaśka K, Górecki J, Wojtkowiak D, Kerkhoffs GMMJ, Piontek T. Minimally invasive reconstruction technique for chronic Achilles tendon tears allows rapid return to walking and leads to good functional recovery. Knee Surg Sports Traumatol Arthrosc 2020; 28:305-311. [PMID: 31606762 PMCID: PMC6970963 DOI: 10.1007/s00167-019-05723-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 08/22/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE Chronic Achilles tendon tears, including chronic ruptures with end gap over 6 cm making end-to-end suturing impossible, can be treated with autologous hamstring graft reconstruction. The primary goal of this study was to present the biomechanical and long-term clinical results of recently developed minimally invasive Achilles tendon reconstruction technique. METHODS Minimally invasive Achilles tendon reconstruction was applied to 8 foot and ankle cadaveric specimens as well as 18 patients with chronic Achilles tendon tears. Repaired cadavers were subjected to the biomechanical testing using a cyclic loading protocol. Patients with reconstructed Achilles tendon were subjected to the clinical, functional and isokinetic tests at 12 months after the treatment. RESULTS All of tested Achilles cadaveric specimens survived 2 loading blocks (250 cycles of 10-100 N load followed by additional 250 cycles of 10-200 N load). With three specimens, it was possible to perform the third cyclic loading block with 20-300 N load and two specimens survived the fourth block with 20-400 N load. Therefore, a mean number of 838 cycles (±178) within the range of 509-1000 was recorded. Two specimens which survived all 1000 cycles were pulled to failure at 25 mm/s rate. The results obtained in the load to failure testing were as follows: 398 N and 608 N of maximum load. The results of functional heel rise endurance test and single leg hop for distance test indicated a decrease in the endurance and strength of the injured limb. However, the results of the weight-bearing lunge tests indicated no tendency for elongation of the Achilles tendon. A comparative analysis of the isokinetic test results for the non-injured and injured limb was revealed no statistically significant differences for every isokinetic test (n. s.), with significant difference for isometric strength parameters (p = 0.0006). CONCLUSIONS The results of the biomechanical tests as well as 1-year extensive functional, clinical and isokinetic results of the minimally invasive technique for chronic Achilles tendon tears are encouraging. Patients returned to their normal physical activity, including sport pre-injury level in most cases. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Paweł Bąkowski
- Department of Orthopedic Surgery, Rehasport Clinic, Poznan, Poland
| | | | - Krzysztof Talaśka
- Department of Basics Machine Design, Poznan University of Technology, Poznan, Poland
| | - Jan Górecki
- Department of Basics Machine Design, Poznan University of Technology, Poznan, Poland
| | - Dominik Wojtkowiak
- Department of Basics Machine Design, Poznan University of Technology, Poznan, Poland
| | | | - Tomasz Piontek
- Department of Orthopedic Surgery, Rehasport Clinic, Poznan, Poland
- Department of Spine Disorders and Pediatric Orthopedics, University of Medical Sciences Poznan, Poznan, Poland
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Abstract
The goal of treatment after Achilles tendon rupture (ATR) is to restore appropriate tension to the tendon, so that normal baseline strength and functional soft-tissue length can be achieved. The assessment of plantarflexion strength has shown widespread variability. The purpose of this study is to document variations in strength assessment after the treatment of ATR in the literature. A comprehensive literature review was performed. In total, 2758 articles were found on Achilles tendon rupture and Achilles tendon strength measurement. The full text of articles including strength as a functional outcome measurement in the abstract were assessed. All objective strength measurements performed were reviewed and recorded for comparison. One-hundred articles were included in our study. In 78 articles, a dynamometer was used to measure strength, whereas in 22 articles, an endurance test (n=14) or formal gait assessment (n=8) was applied. When a dynamometer was used, there was wide variability in the various methods used including the incorporation of both isokinetic (n = 65) and isometric (n = 29) exercises utilizing varying degrees of knee flexion and patient testing position. Furthermore, the number of measurements at certain angular velocities varied. This study illustrates that no general consensus exists regarding an optimal method for measuring strength after ATR. The variability creates difficulty and challenges medical professionals' ability to formulate consistent conclusions when determining functional performance outcomes. A more uniform way of measuring strength after ATR may allow for better comparisons between studies in the literature, potentially leading to a better understanding of strength. Levels of Evidence: Therapeutic, Level II.
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Affiliation(s)
- Henrik C Bäcker
- Department of Orthopedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY
| | - Adrian J Yenchak
- Department of Orthopedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY
| | - David P Trofa
- Department of Orthopedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY
| | - J Turner Vosseller
- Department of Orthopedic Surgery, New York Presbyterian/Columbia University Medical Center, New York, NY
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Ryu CH, Lee HS, Seo SG, Kim HY. Results of tenorrhaphy with early rehabilitation for acute tear of Achilles tendon. J Orthop Surg (Hong Kong) 2019; 26:2309499018802483. [PMID: 30295123 DOI: 10.1177/2309499018802483] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND For the treatment of acute Achilles tendon rupture, early rehabilitation after surgical repair is believed to be a useful method. The purpose of this study was to evaluate the outcome of open tenorrhaphy followed by early rehabilitation. METHODS A total of 112 patients who underwent open repair and early rehabilitation for acute Achilles tendon rupture from January 2003 to March 2015 were retrospectively reviewed. These 112 patients (80 men, 32 women) had an average age of 43.1 years (22-62 years), and the mean follow-up period was 91.8 months (12-171 months). A short leg cast was applied postoperatively for an average of 16.5 days (12-20 days). The mean duration of bracing was 6.9 weeks (6-8 weeks). Each patient was assessed based on range of motion, single heel raising test, calf circumference compared to the contralateral limb, ability to return to previous activity, the Arner-Lindholm scale, and the American orthopaedic foot and ankle society (AOFAS) hind foot scale. Isokinetic plantar flexion power was also checked. RESULTS All patients were fully satisfied (AOFAS ≥ 90) with the treatment results, and 96 patients were able to return to their previous athletic activities. As assessed by the Arner-Lindholm scale, 103 cases were rated as excellent and the other 9 cases were rated as good. At the 1-year follow-up period, single heel raise and hopping was possible in every patient. Compared to the contralateral side, 10 subjects (8.9%) had minor limitation of dorsiflexion motion, and an average of 1.6 cm calf circumference difference without functional disabilities. There were no major complications such as re-rupture, nerve injury, or infection. CONCLUSION For acute Achilles tendon ruptures, open surgical repair with optimal length restoration, followed by earlier rehabilitation results in good functional outcomes and a successful return to pre-injury levels of physical activity without major complications. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Chang Hyun Ryu
- 1 Department of Orthopedic Surgery, Seoul CHUK hospital, Seoul, South Korea
| | - Ho Seong Lee
- 2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sang Gyo Seo
- 2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Ho Yeon Kim
- 2 Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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Čretnik A, Kosanović M, Košir R. Long-Term Results With the Use of Modified Percutaneous Repair of the Ruptured Achilles Tendon Under Local Anaesthesia (15-Year Analysis With 270 Cases). J Foot Ankle Surg 2019; 58:828-836. [PMID: 31474397 DOI: 10.1053/j.jfas.2018.11.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Indexed: 02/03/2023]
Abstract
Controversy regarding the optimal treatment of fresh total Achilles tendon rupture remains. This article presents results with the use of modified percutaneous Achilles tendon repair under local anesthesia performed from January 1991 to December 2005 with a 2- to 10-year follow-up. There were 270 procedures in 247 male patients (92.51%) and 20 female patients (7.49%), mean ± SD age 38.7 ± 11.56 (range 20 to 83) years, in all consecutively treated patients within 7 days after acute total rupture; 3 patients sustained ruptures on both sides in different periods. Postoperative care consisted of wearing a cast or soft cast or functional immobilization for 6 weeks. The procedure was well tolerated in all patients. There were 3 (1.11%) complete and 5 (1.85%) partial repeat ruptures (8 [2.96%] altogether). Fourteen patients (5.18%) developed transient sural neuritis that spontaneously resolved in 2 to 10 months. One case (0.3%) of deep venous thrombosis was successfully treated. There were 25 (9.36%) major and minor complications altogether, with no cases of increased postoperative dorsiflexion, deep infection, or necrosis. Forty-four patients (16.48%) had a slightly decreased range of ankle motion, and 216 (80.89%) patients, including all high-caliber athletes, resumed all their previous activities. The mean American Orthopedic Foot and Ankle Society hindfoot-ankle score was 96.10 points. Long-term results of the analyzed modified method suggest a reasonable treatment option for acute total Achilles tendon ruptures, with a low number of complications and repeat rupture rate and return to preinjury activities comparable to those of open procedures.
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Affiliation(s)
- Andrej Čretnik
- Professor of Surgery, General and Trauma Surgeon, Department of Traumatology, University Clinical Centre Maribor, Maribor, Slovenia.
| | - Miloš Kosanović
- Orthopaedic and Trauma Surgeon, Department of Traumatology, General and Teaching Hospital Celje, Celje, Slovenia
| | - Roman Košir
- Assistant, General Surgeon, Department of Traumatology, University Clinical Centre Maribor, Maribor, Slovenia
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13
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Abstract
Achilles tendon rupture is a common injury to the lower extremity that requires appropriate treatment to minimize functional deficit. Available treatments of Achilles tendon ruptures include nonoperative, open surgical repair, percutaneous repair, and minimally invasive repair. Open surgical repair obtains favorable functional outcomes with significant potential for deep soft tissue complications, calling into question the value of open repair. Percutaneous repair is an alternative option with comparable functional results and minimal soft tissue complications; however, sural nerve injury is a complication. Minimally invasive Achilles repair offers optimal results with superior functional outcomes with minimal soft tissue complications and sural nerve injury.
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Affiliation(s)
- Milap S Patel
- Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 259 East Erie, 13th Floor, Chicago, IL 60611, USA
| | - Anish R Kadakia
- Department of Orthopaedic Surgery, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, 259 East Erie, 13th Floor, Chicago, IL 60611, USA.
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14
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de Cesar Netto C, Bernasconi A, Roberts L, Saito GH, Hamilton WG, O'Malley MJ. Open Re-rupture of the Achilles Tendon Following Minimally Invasive Repair: A Case Report. J Foot Ankle Surg 2019; 57:1272-1277. [PMID: 30115453 DOI: 10.1053/j.jfas.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Indexed: 02/03/2023]
Abstract
In this report, we describe a rare complication of an open re-rupture of the Achilles tendon following a minimally invasive Achilles tendon repair on a healthy 29-year-old active male. The reinjury happened 19 weeks following the primary surgical repair of a spontaneous rupture, performed by minimally invasive technique with the help of a jig using partially absorbable sutures and four locking stitches. The wound of the open re-rupture was transverse, in a perpendicular orientation relative to the longitudinal approach used in the index procedure. Increased scar tissue formation, the absence of an adequate layer of paratenon overlying the primary tendon repair, and foreign-body reaction to the suture may have been involved in the occurrence of this unusual complication in the surgical treatment of Achilles tendon rupture.
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Affiliation(s)
| | | | - Lauren Roberts
- Clinical Fellow, Hospital for Special Surgery, New York, NY
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15
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Grassi A, Amendola A, Samuelsson K, Svantesson E, Romagnoli M, Bondi A, Mosca M, Zaffagnini S. Minimally Invasive Versus Open Repair for Acute Achilles Tendon Rupture: Meta-Analysis Showing Reduced Complications, with Similar Outcomes, After Minimally Invasive Surgery. J Bone Joint Surg Am 2018; 100:1969-1981. [PMID: 30480601 DOI: 10.2106/jbjs.17.01364] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no consensus on the optimal technique for repairing an acute Achilles tendon rupture. The purpose of this meta-analysis was to compare the complications, subjective outcomes, and functional results between minimally invasive surgery and open repair of an Achilles tendon rupture. METHODS A systematic literature search of MEDLINE/PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), EBSCOhost, and ClinicalTrials.gov was performed. Eligible studies were randomized controlled trials (RCTs) comparing minimally invasive surgery and open repair of acute Achilles tendon ruptures. A meta-analysis was performed, while bias and the quality of the evidence were rated according to the Cochrane Database questionnaire and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines. The meta-analysis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. RESULTS Eight studies, with 182 patients treated with minimally invasive surgery and 176 treated with open repair, were included. The meta-analysis showed a significantly decreased risk ratio (RR) of 0.21 (95% confidence interval [CI] = 0.10 to 0.40, p = 0.00001) for overall complications and 0.15 (95% CI = 0.05 to 0.46, p = 0.0009) for wound infection after minimally invasive surgery. Patients treated with minimally invasive surgery were more likely to report good or excellent subjective results (RR = 1.18, 95% CI = 1.04 to 1.33, p = 0.009). No differences between groups were found with respect to reruptures, sural nerve injury, return to preinjury activity level, time to return to work, or ankle range of motion. The overall quality of evidence was generally low because of a substantial risk of bias, heterogeneity, indirectness of outcome reporting, and evaluation of a limited number of patients. CONCLUSIONS There was a significantly decreased risk of postoperative complications, especially wound infection, when acute Achilles tendon rupture was treated with minimally invasive surgery compared with open surgery. Patients treated with minimally invasive surgery were significantly more likely to report a good or excellent subjective outcome. Current evidence is associated with high heterogeneity and a considerable risk of bias. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Alberto Grassi
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, Bologna, Italy.,II Clinica Ortopedica e Traumatologica (A.G., M.R., M.M., and S.Z.) and Dipartimento Rizzoli Sicilia (A.B.), IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Annunziato Amendola
- Michael W. Krzyzewski Human Performance Laboratory, Department of Orthopaedic Surgery, Duke University, Durham, North Carolina
| | - Kristian Samuelsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eleonor Svantesson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Matteo Romagnoli
- II Clinica Ortopedica e Traumatologica (A.G., M.R., M.M., and S.Z.) and Dipartimento Rizzoli Sicilia (A.B.), IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Alice Bondi
- II Clinica Ortopedica e Traumatologica (A.G., M.R., M.M., and S.Z.) and Dipartimento Rizzoli Sicilia (A.B.), IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Massimiliano Mosca
- II Clinica Ortopedica e Traumatologica (A.G., M.R., M.M., and S.Z.) and Dipartimento Rizzoli Sicilia (A.B.), IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Stefano Zaffagnini
- Dipartimento di Scienze Biomediche e Neuromotorie (DIBINEM), University of Bologna, Bologna, Italy.,II Clinica Ortopedica e Traumatologica (A.G., M.R., M.M., and S.Z.) and Dipartimento Rizzoli Sicilia (A.B.), IRCCS Rizzoli Orthopaedic Institute, Bologna, Italy
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16
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Zayni R, Coursier R, Zakaria M, Desrousseaux JF, Cordonnier D, Polveche G. Activity level recovery after acute Achilles tendon rupture surgically repaired: a series of 29 patients with a mean follow-up of 46 months. Muscles Ligaments Tendons J 2017; 7:69-77. [PMID: 28717614 DOI: 10.11138/mltj/2017.7.1.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Achilles tendon rupture is a common injury but its optimal management is still controversial. When decided, surgical repair can be performed by open or percutaneous techniques. Till now, there is no agreement on the ideal type of surgical management. PURPOSE To compare the outcomes of the percutaneous and open surgical treatment for acute Achilles tendon rupture and to assess the postoperative activity level recovery. METHODS Between 2008 and 2013, 29 patients were surgically treated for acute Achilles tendon rupture in our institution. 16 patients were operated by percutaneous technique and 13 by open repair. All patients received the same postoperative rehabilitation protocol. Patients were evaluated objectively and subjectively after an average of 46 months (23-91). RESULTS 96.6% of patients had excellent and good results according to subjective assessment. No significant difference was observed with respect to the examined clinical variables between the open and percutaneous repair groups. 20.68% of patients had minor complications related to the operation with lesser complications in the percutaneous group. 89.6% of patients resumed sport activity with an average delay of 7,7 months (4-24) and 57,7% of them resumed at a level equal or superior to their level before injury, with higher rate in the percutaneous group. CONCLUSION Percutaneous technique has similar satisfactory outcomes to open surgery in repairing acute ruptured Achilles tendon with lesser complications and higher activity level recovery rate. LEVEL OF EVIDENCE Retrospective comparative study. Level III.
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Affiliation(s)
- Richard Zayni
- Department of Orthopedic Surgery. Groupe Hospitalier de l'Est de la Meurthe-et-Moselle (GHEMM), France
| | - Raphaël Coursier
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
| | - Moudasser Zakaria
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
| | - Jean-François Desrousseaux
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
| | - Denis Cordonnier
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
| | - Gilles Polveche
- Department of Orthopedic Surgery. Groupement Hospitalier de l'Institut Catholique de Lille (GHICL), France
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17
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Maffulli G, Buono AD, Richards P, Oliva F, Maffulli N. Conservative, minimally invasive and open surgical repair for management of acute ruptures of the Achilles tendon: a clinical and functional retrospective study. Muscles Ligaments Tendons J 2017; 7:46-52. [PMID: 28717611 DOI: 10.11138/mltj/2017.7.1.046] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND At present, it is unclear which is the best management for Achilles tendon rupture. PURPOSE We assess the clinical, functional and imaging outcomes of active patients undergoing 3 different types of management for acute subcutaneous rupture of the Achilles tendon, including conservative cast immobilization, traditional open surgery and percutaneous repair. METHODS 26 active patients were managed for a rupture of the Achilles Tendon from January 2007 to March 2008. Anthropometric measurements, Functional assessment, Isometric strength, Ultrasonographic assessment, Patient satisfaction, Working life, Physical activity, Functional score and Complications were recorded retrospectively. RESULTS All 23 (21 men, 2 women) patients were reviewed at a minimum follow-up of 24 months (average 25.7, range 24 to 32 months, SD: 6.3) from the index injury. Thermann scores and patient satisfaction were significantly higher following surgery than conservative management with no significance between open and minimally invasive operated patients. Sensitive disturbances occur in up to 12% of open repairs and 1.8% of patients managed nonsurgically. CONCLUSIONS Clinical and functional outcomes following surgical repair, percutaneous and open, of the Achilles tendon are significantly improved than following conservative management. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Gayle Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK
| | - Angelo Del Buono
- Department of Orthopaedic and Trauma Surgery, Campus Biomedico University of Rome, Rome, Italy
| | - Paula Richards
- Department of Radiology, University Hospitals of North Midlands NHS Trust, Stoke on Trent, UK
| | - Francesco Oliva
- Department of Trauma and Orthopaedics, "Tor Vergata" University, Rome, Italy
| | - Nicola Maffulli
- Centre for Sports and Exercise Medicine, Barts and The London School of Medicine and Dentistry, Mile End Hospital, London, UK.,Department of Musculoskeletal Disorders, University of Salerno, School of Medicine, Salerno, Italy
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18
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Lawrence JE, Nasr P, Fountain DM, Berman L, Robinson AHN. Functional outcomes of conservatively managed acute ruptures of the Achilles tendon. Bone Joint J 2017; 99-B:87-93. [PMID: 28053262 DOI: 10.1302/0301-620x.99b1.bjj-2016-0452.r1] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/27/2016] [Indexed: 11/05/2022]
Abstract
AIMS This prospective cohort study aims to determine if the size of the tendon gap following acute rupture of the Achilles tendon shows an association with the functional outcome following non-operative treatment. PATIENTS AND METHODS All patients presenting within two weeks of an acute unilateral rupture of the Achilles tendon between July 2012 and July 2015 were considered for the study. In total, 38 patients (nine female, 29 male, mean age 52 years; 29 to 78) completed the study. Dynamic ultrasound examination was performed to confirm the diagnosis and measure the gap between ruptured tendon ends. Outcome was assessed using dynamometric testing of plantarflexion and the Achilles tendon Total Rupture score (ATRS) six months after the completion of a rehabilitation programme. RESULTS Patients with a gap ≥ 10 mm with the ankle in the neutral position had significantly greater peak torque deficit than those with gaps < 10 mm (mean 23.3%; 7% to 52% vs 14.3%; 0% to 47%, p = 0.023). However, there was no difference in ATRS between the two groups (mean score 87.2; 74 to 100 vs 87.4; 68 to 97, p = 0.467). There was no significant correlation between gap size and torque deficit (τ = 0.103), suggesting a non-linear relationship. There was also no significant correlation between ATRS and peak torque deficit (τ = -0.305). CONCLUSION This is the first study to identify an association between tendon gap and functional outcome in acute rupture of the Achilles tendon. We have identified 10 mm as a gap size at which deficits in plantarflexion strength become significantly greater, however, the precise relationship between gap size and plantarflexion strength remains unclear. Large, multicentre studies will be needed to clarify this relationship and identify population subgroups in whom deficits in peak torque are reflected in patient-reported outcome measures. Cite this article: Bone Joint J 2017;99-B:87-93.
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Affiliation(s)
- J E Lawrence
- Addenbrooke's Hospital, Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, UK
| | - P Nasr
- Addenbrooke's Hospital, Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, UK
| | - D M Fountain
- Addenbrooke's Hospital, Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, UK
| | - L Berman
- Addenbrooke's Hospital, Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, UK
| | - A H N Robinson
- Addenbrooke's Hospital, Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge University NHS Foundation Trust, Hills Road, Cambridge, UK
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19
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Kaymaz B, Gölge UH, Ozyalvaclı G, Kömürcü E, Goksel F, Mermerkaya MU, Doral MN. Effects of boric acid on the healing of Achilles tendons of rats. Knee Surg Sports Traumatol Arthrosc 2016; 24:3738-3744. [PMID: 25931129 DOI: 10.1007/s00167-015-3617-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 04/22/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Tendinous lesions are among the most frequent pathologies encountered in sportsmen. The objectives of new treatments are to improve the healing process and reduce the recovery time. Boron plays an important role in the wound repair process by increasing components of extracellular matrix and angiogenesis. This animal study aimed to investigate the effect of boric acid on healing of the Achilles tendon. METHODS The right Achilles tendons of 40 rats were completely sectioned, and the rats were randomly divided into five groups. Each group consisted of eight rats. Groups 1 and 2 were oral boric acid groups with the doses of 4 and 8 mg/kg/day boric acid, respectively. Group 3 was the local boric acid group (8 mg/kg boric acid intratendinous injection). Group 4 was administered both oral and local boric acid (8 mg/kg/day orally and 8 mg/kg boric acid intratendinous injection), and group 5 was the control group with no boric acid application. At the end of the fourth week, all the rats were killed and histopathological examination of the Achilles tendon repair site was made. RESULTS Histopathological examination of the tissue sections revealed more properly oriented collagen fibres, more normal cellular distribution of tenocytes and more properly organized vascular bundles in group 1 and group 2, which were the groups administered oral boric acid. Pathological sum scores of groups 1 and 2 were less than those of the other groups, and the differences between the oral boric acid groups (group 1 and group 2) and the other three groups (groups 3, 4 and 5) were statistically significant (p = 0.001). CONCLUSION As boric acid is safe and toxicity even after very high doses is unusual, oral boric acid may be used as an agent to improve the healing process of tendon injuries. However, biomechanical tests should also be performed to show the effect of boric acid on strength and endurance of the tendon before it can be used in clinical practice.
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Affiliation(s)
- Burak Kaymaz
- Department of Orthopaedics and Traumatology, Medical School, Çanakkale Onsekiz Mart University, Kepez, Çanakkale, Turkey.
| | - Umut Hatay Gölge
- Department of Orthopaedics and Traumatology, Medical School, Çanakkale Onsekiz Mart University, Kepez, Çanakkale, Turkey
| | - Gulzade Ozyalvaclı
- Department of Pathology, Medical School, Bolu Abant Izzet Baysal University, Bolu, Turkey
| | - Erkam Kömürcü
- Department of Orthopaedics and Traumatology, Medical School, Çanakkale Onsekiz Mart University, Kepez, Çanakkale, Turkey
| | - Ferdi Goksel
- Department of Orthopaedics and Traumatology, Medical School, Çanakkale Onsekiz Mart University, Kepez, Çanakkale, Turkey
| | - Musa Ugur Mermerkaya
- Department of Orthopaedics and Traumatology, Medical School, Bozok University, Yozgat, Turkey
| | - Mahmut Nedim Doral
- Department of Orthopaedics and Traumatology, Medical School, Hacettepe University, Ankara, Turkey
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20
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Zellers JA, Carmont MR, Grävare Silbernagel K. Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play. Br J Sports Med 2016; 50:1325-1332. [PMID: 27259751 DOI: 10.1136/bjsports-2016-096106] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/26/2022]
Abstract
AIM This systematic review and meta-analysis sought to identify return to play (RTP) rates following Achilles tendon rupture and evaluate what measures are used to determine RTP. DESIGN A systematic review and meta-analysis were performed. Studies were assessed for risk of bias and grouped based on repeatability of their measure of RTP determination. DATA SOURCES PubMed, CINAHL, Web of Science and Scopus databases were searched to identify potentially relevant articles. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies reporting RTP/sport/sport activity in acute, closed Achilles tendon rupture were included. RESULTS 108 studies encompassing 6506 patients were included for review. 85 studies included a measure for determining RTP. The rate of RTP in all studies was 80% (95% CI 75% to 85%). Studies with measures describing determination of RTP reported lower rates than studies without metrics described, with rates being significantly different between groups (p<0.001). CONCLUSIONS 80 per cent of patients returned to play following Achilles tendon rupture; however, the RTP rates are dependent on the quality of the method used to measure RTP. To further understand RTP after Achilles tendon rupture, a standardised, reliable and valid method is required.
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Affiliation(s)
- Jennifer A Zellers
- Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - Michael R Carmont
- Department of Orthopaedic Surgery, The Princess Royal Hospital, Telford, Shropshire, UK.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Grävare Silbernagel
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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21
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Kocaoglu B, Ulku TK, Gereli A, Karahan M, Turkmen M. Evaluation of absorbable and nonabsorbable sutures for repair of achilles tendon rupture with a suture-guiding device. Foot Ankle Int 2015; 36:691-5. [PMID: 25941197 DOI: 10.1177/1071100714568868] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of this study was to compare the functional and clinical results of Achilles tendon repairs with an Achilles tendon suture-guiding device using nonabsorbable versus absorbable sutures. We hypothesized that the absorbable suture would have clinical results comparable to those of the nonabsorbable suture for Achilles tendon repair with an Achilles tendon suture-guiding system. METHODS From January 2010 to September 2013, 48 consecutive patients who had sustained a spontaneous rupture of the Achilles tendon underwent operative repair with an Achilles tendon suture-guiding device using 2 different suture types. All ruptures were acute. The patients were divided equally into 2 groups according to suture type. In the nonabsorbable suture group, No. 2 braided nonabsorbable polyethylene terephthalate sutures were used, and in the absorbable suture group, braided absorbable polyglactin sutures were used. The average age of the patients was 38 years (range, 28-50 years). Functional outcome scores and complications were evaluated. RESULTS All patients had an intact Achilles repair after surgery. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot clinical outcome scores were 98 (range, 90-100) in the nonabsorbable suture group and 96.8 (range, 87-100) in the absorbable suture group. All patients returned to their previous work. The absorbable suture group had fewer postoperative complications (0%) than the nonabsorbable suture group (12.5%) (P < .05). CONCLUSION Use of an absorbable suture in the treatment of Achilles tendon repair by an Achilles tendon suture-guiding system was associated with a lower incidence of suture reaction; however, functionally the results were not notably different from those using a traditional nonabsorbable suture. We conclude that repair with absorbable sutures is appropriate for Achilles tendon ruptures. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Baris Kocaoglu
- Acibadem University Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Tekin Kerem Ulku
- Acibadem University Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Arel Gereli
- Acibadem University Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Mustafa Karahan
- Acibadem University Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
| | - Metin Turkmen
- Acibadem University Faculty of Medicine, Department of Orthopedics and Traumatology, Istanbul, Turkey
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22
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Guelfi M, Pantalone A, Vanni D, Rosati D, Guelfi MGB, Salini V. Bilateral traumatic rupture of Achilles tendons in absence of risk factors treated with percutaneous technique and platelet-rich plasma: a case report. Foot Ankle Surg 2014; 20:e43-6. [PMID: 25103716 DOI: 10.1016/j.fas.2014.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 04/02/2014] [Accepted: 05/01/2014] [Indexed: 02/04/2023]
Abstract
We present a clinical case of a 52-year-old man with bilateral traumatic rupture of the Achilles tendon (AT) in absence of risk factors. In medical history, the patient does not report pre-existing tendon diseases. AT ruptures occurred following a skiing injury in which the forward fall caused a severe stress and elongation of the AT. Associated with tendon injury there was a fracture of the right humeral greater tuberosity. The patient was subjected to percutaneous tenorraphy according to Maffulli's technique and subsequently topical injection of autologous platelet-rich plasma (PRP) 7 days after the injury. After surgery, the patient followed an accelerated rehabilitation protocol, allowing the weight bearing with guards (Rom-Walker) and crutches to four weeks then freely to 8 weeks. We performed a clinical (AOFAS ankle-hindfoot score) and ultrasonography follow-up at month 1, 3, 6 and 12, with excellent results in the end. To the best of our knowledge bilateral cases like this have not been described in the literature.
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Affiliation(s)
- Matteo Guelfi
- Orthopaedic and Traumatology Division, "G. d'Annunzio" University, Via dei Vestini 35, 66013 Chieti, Italy.
| | - Andrea Pantalone
- Orthopaedic and Traumatology Division, "G. d'Annunzio" University, Via dei Vestini 35, 66013 Chieti, Italy
| | - Daniele Vanni
- Orthopaedic and Traumatology Division, "G. d'Annunzio" University, Via dei Vestini 35, 66013 Chieti, Italy
| | - Denise Rosati
- Orthopaedic and Traumatology Division, "G. d'Annunzio" University, Via dei Vestini 35, 66013 Chieti, Italy
| | - Marco G B Guelfi
- Orthopaedic Division, Clinica Montallegro, Via M.Te Zovetto 27, 16145 Genoa, Italy.
| | - Vincenzo Salini
- Orthopaedic and Traumatology Division, "G. d'Annunzio" University, Via dei Vestini 35, 66013 Chieti, Italy.
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23
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Carmont MR, Silbernagel KG, Mathy A, Mulji Y, Karlsson J, Maffulli N. Reliability of Achilles tendon resting angle and calf circumference measurement techniques. Foot Ankle Surg 2013; 19:245-9. [PMID: 24095232 DOI: 10.1016/j.fas.2013.06.007] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 06/12/2013] [Accepted: 06/17/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND The resting angle of the ankle joint may be altered following apparently successful management of Achilles tendon rupture. The reliability of the Achilles Tendon Resting Angle and Calf Circumference measurements was determined. METHODS Three test-retest measurements for reliability assessment were performed on 16 healthy subjects: 10 males and 6 females. RESULTS The mean left Achilles Tendon Resting Angle was mean 50.1° (range [26-61]), ICC 0.92 (CI [0.83-0.97]), SEM 2.4°. The mean right Achilles tendon resting angle was mean 49.9° (range [26-60]), ICC 0.91 (CI [0.80-0.96]), SEM 2.6°. The mean left calf circumference was mean 38.5cm (range [33.3-44.2]), ICC 0.97 (CI [0.94-0.98]), SEM 0.6cm, and the mean right calf circumference was mean 38.4cm (range [33.3-43.6]), ICC 0.97 (CI [0.94-0.99]), SEM 0.5cm. CONCLUSIONS The Achilles Tendon Resting Angle and Calf Circumference at 15cm from the antero-medial joint line had excellent test-retest reliability. These are simple, quick and inexpensive measurements, which have the potential to correlate with tendon elongation and functional outcome. The Achilles tendon resting angle may be used as a guide to tendon length during intra-operative repair and rehabilitation.
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Affiliation(s)
- M R Carmont
- Department of Orthopaedic Surgery, Princess Royal Hospital, Telford, Shropshire, UK.
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Karabinas PK, Benetos IS, Lampropoulou-Adamidou K, Romoudis P, Mavrogenis AF, Vlamis J. Percutaneous versus open repair of acute Achilles tendon ruptures. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2013; 24:607-13. [PMID: 24190345 DOI: 10.1007/s00590-013-1350-7] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 10/18/2013] [Indexed: 12/28/2022]
Abstract
BACKGROUND Controversy exists regarding the optimal treatment for acute Achilles tendon ruptures. Conservative and surgical treatments have been reported with variable results and complications rates. The purpose of this study is to compare the postoperative clinical and functional results of percutaneous versus open repair of acute Achilles tendon ruptures. MATERIALS AND METHODS We present 34 patients with acute Achilles tendon ruptures treated with open and percutaneous surgical repair. There were 15 patients who had open surgical repair and 19 patients who had percutaneous repair. The mean follow-up was 22 months (range 10-24 months) for the open repair group and 20 months (range 9-24 months) for the percutaneous repair group; no patient was lost to follow-up. Postoperative rehabilitation was the same for both groups. Wound healing, complications, ankle range of motion, and patients' return to work, activity level, weight-bearing, and subjective assessment of their treatment were recorded. RESULTS No significant difference was observed with respect to any of the examined variables between the open and percutaneous repair groups. Tendon healing was observed in all patients of both groups by 7-9 weeks. The mean time of patients' return to work was 7 weeks for the open repair group and 9 weeks for the percutaneous repair group. All patients were capable of full weight bearing by the 8th postoperative week time; the time to return to previous activities including non-contact sports was 5 months for both groups. All patients expressed satisfaction and graded their treatment as good. As expected, cosmetic appearance was significantly better in the percutaneous repair group. One patient who had open repair experienced skin incision pain and dysesthesia and graded his operation as fair. No patient experienced other complications such as re-rupture, infection, sural neuroma, or Achilles tendinitis within the period of this study. CONCLUSIONS The present study showed similarly successful clinical and functional results after both open and percutaneous repair of acute Achilles tendon ruptures are similar. Cosmetic appearance is superior in the group of patients who had a percutaneous treatment.
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Jallageas R, Bordes J, Daviet JC, Mabit C, Coste C. Evaluation of surgical treatment for ruptured Achilles tendon in 31 athletes. Orthop Traumatol Surg Res 2013; 99:577-84. [PMID: 23886633 DOI: 10.1016/j.otsr.2013.03.024] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 02/10/2013] [Accepted: 03/14/2013] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In the past few decades, the incidence of Achilles tendon rupture has increased in parallel with increased sports participation. Although the optimal treatment remains controversial, there is a trend towards surgical treatment in athletes. HYPOTHESIS Surgical repair of ruptured Achilles tendon in athlete results in good functional and objective recovery, irrespective of the type of surgery performed. Subsidiarily, are the results different between percutaneous surgery (PS) and standard open surgery (OS)? MATERIALS AND METHODS This was a cross-sectional study of 31 patients who presented with a ruptured Achilles tendon that occurred during sports participation. Percutaneous surgery was performed in 16 patients and open surgery in 15 patients between 2005 and 2009. The objective recovery status was evaluated by open chain goniometry, measurement of leg muscle atrophy and assessment of isokinetic strength. The functional analysis was based on the delay, level of sports upon return, AOFAS and VAS for pain. RESULTS Our series of Achilles tendon rupture patients consisted of 88% men and 12% women, with an average age of 38 years. In 71% of cases, the rupture occurred during eccentric loading. After a follow-up of 15 months, the muscle atrophy was 13 mm after PS and 24 mm after OS (P=0.01). A strength deficit of 19% in the plantar flexors was found in the two groups. No patient experienced a rerupture. The return to sports occurred at 130 days after PS and 178 days after OS (P=0.005). The average AOFAS score was 94 and the VAS was 0.5. There were no differences in ankle range of motion between the two groups. The majority (77%) of patients had returned to their preinjury level of sports activity. DISCUSSION The return to activities of daily living was slower in our study than in studies based in Anglo-Saxon countries; this can be explained by the different sick leave coverage systems. Percutaneous surgery resulted in a faster return to sports (about 130 days) and less muscle atrophy than open surgery. Our results for return to sports and return to preinjury levels were similar to published results for athletes and were independent of the type of surgery performed. The AOFAS score was comparable to published studies. We found no difference in muscle strength between the two surgery groups 15 months after the procedure. Apart from venous thrombosis typically described after lower-limb immobilization, secondary postoperative complications mostly consisted of sural paresthesia, which had resolved at the 15-month postoperative follow-up evaluation. CONCLUSION The results of surgical treatment for ruptured Achilles tendon are good overall. By combining the simplicity of conservative treatment and the reliability of standard surgical treatment, percutaneous surgery is the treatment of choice to achieve excellent results. The return to sports occurred earlier, the muscle atrophy was less and the functional score was better in our patients treated by percutaneous surgery. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- R Jallageas
- CRHUMS, centre régional hospitalo-universitaire de médecine du Sport, CHU Dupuytren, avenue du Buisson, 87042 Limoges, France.
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What is the effect of the early weight-bearing mobilisation without using any support after endoscopy-assisted Achilles tendon repair? Knee Surg Sports Traumatol Arthrosc 2013; 21:1378-84. [PMID: 23011584 DOI: 10.1007/s00167-012-2222-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 09/17/2012] [Indexed: 01/26/2023]
Abstract
PURPOSE The aim of this study was to assess the effect of immediate weight-bearing mobilisation with intensive rehabilitation on muscle strength and lower extremity functional level after endoscopy-assisted Achilles tendon repairs. METHODS After warming up for 5 min at a self-selected intensity on a stationary bike 32 male patients were tested for bilateral peak concentric isokinetic ankle dorsi- and plantar-flexor torque, passive range of motion for ankle joint, one-leg hop for distance, single-leg vertical jump height, Achilles Tendon Total Rupture Score, and perceived function using the Foot and Ankle Outcome Score (FAOS). A series of paired sample t tests were used to compare side-to-side differences (p < 0.05). RESULTS There were no significant differences in hop and jump tests, dorsi- and plantar-flexor isokinetic muscle strength, and dorsi- and plantar-flexion range of motion between the affected and unaffected side of the patients. Pain score of FAOS was 95 ± 8, other symptoms score was 92 ± 11, function in daily living score was 95 ± 6, function in sport and recreation was 85 ± 16, and Quality of Life score was 85 ± 12. The mean of the Achilles Tendon Rupture Score was 86. CONCLUSIONS There was no significant difference in both ankle muscle strength and lower extremity functional level between the endoscopy-assisted repairs and the unaffected sides. The early tolerated weight-bearing mobilisation without cast-brace and/or special shoe at the first day after the surgery may easily provide to return the daily living activities. It improves muscle strength, functional level, and range of motion. Further comprehensive and prospective studies on large patients should be warranted to analyse and compare the clinical and functional results in patients with endoscopy-assisted Achilles tendon repair.
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Kaya D, Doral MN, Nyland J, Toprak U, Turhan E, Donmez G, Citaker S, Atay OA, Callaghan MJ. Proprioception level after endoscopically guided percutaneous Achilles tendon. Knee Surg Sports Traumatol Arthrosc 2013; 21:1238-44. [PMID: 22527417 DOI: 10.1007/s00167-012-2007-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 04/12/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE To evaluate ankle function following endoscopically guided percutaneous Achilles tendon repair. The hypothesis of this study was that patients with percutaneous repair of the Achilles tendon would still display impaired involved side ankle proprioception. METHODS Nineteen male patients with percutaneous Achilles tendon surgery were tested for bilateral ankle active angle reproduction at 10° dorsiflexion and 15° plantar flexion, peak concentric isokinetic ankle dorsiflexor and plantar flexor torque, one-leg hop for distance, and single-leg vertical jump height. Dominant sides of age- and sex-matched 19 healthy controls were evaluated for ankle active angle reproduction at 10° dorsiflexion and 15° plantar flexion, peak concentric isokinetic ankle dorsiflexor and plantar flexor torque. RESULTS Peak isokinetic torque, one-leg hop for distance, single-leg vertical jump for height and ankle joint position sense at 10° dorsiflexion did not differ between the affected and unaffected side. Ankle joint position sense for active angle replication at 15° plantar flexion revealed a significant side-to-side difference. Joint position sense at 10° dorsiflexion and at 15° plantar flexion at affected side was poor in patients compared with the controls, while joint position sense at 10° dorsiflexion and at 15° plantar flexion at unaffected side was same in patients compared with the controls. CONCLUSIONS It has revealed a significant difference in joint position sense at plantar flexion of the patients at least 1 year after percutaneous Achilles tendon surgery compared to their unaffected limb. Large prospective longitudinal studies are needed to evaluate therapeutic interventions designed to improve proprioception.
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Affiliation(s)
- Defne Kaya
- Department of Sports Medicine, Faculty of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey.
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Carmont MR, Heaver C, Pradhan A, Mei-Dan O, Gravare Silbernagel K. Surgical repair of the ruptured Achilles tendon: the cost-effectiveness of open versus percutaneous repair. Knee Surg Sports Traumatol Arthrosc 2013; 21:1361-8. [PMID: 23377798 DOI: 10.1007/s00167-013-2423-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 01/21/2013] [Indexed: 12/28/2022]
Abstract
PURPOSE Recent meta-analyses have shown reduced re-rupture rates for the surgical management of Achilles ruptures. However, percutaneous repair has been demonstrated to lead to improved function and patient satisfaction but greater complications than open repair. In the current economic climate, it is reasonable to consider the financial cost of rupture management for both the patient and the provider. The cost-effectiveness of operative treatment of ruptures of the Achilles tendon was determined based upon theatre occupancy, clinic attendance and cast changes, operative complications and functional assessment score. METHODS The cost-effectiveness of the surgical management of Achilles tendon ruptures between 2005 and 2011 in our unit was audited by comparing 49 patients receiving percutaneous repair to 35 patients whom had open repairs. RESULTS There was no significant difference in complications between the two surgical techniques: (Open vs. Percutaneous) overall rates 14.3 versus 10.4 %: infection; 2.7 versus 2.0 %, transient sural nerve damage: 5.6 versus 8.1 %, wound breakdown: 2.8 versus 0.0 %, re-rupture: 2.8 versus 2.0 %. Achilles Total Rupture Scores (ATRS) were comparable [Open 89 (65-100) at 49 months vs. Percutaneous 88.8 (33-100) at 12 months (n.s.)]. Theatre occupancy (P < 0.00) and hospital stay (P < 0.00) were significantly longer with open repair [43 min (26-70) and 2.9 days (0-4)] compared to percutaneous repair [15 min (12-43) and 1.2 days (0-2)]. Excluding the costs of running the operating theatre, we have estimated the costs of surgery for open repair to be £ 935 and percutaneous repair to be £ 574. CONCLUSIONS This study suggests that percutaneous repair of the Achilles tendon resulted in reduced costs and yet had comparable outcome and complications rates to open repair in surgical management of the Achilles tendon. Percutaneous repair should be considered as the primary method of cost-effective surgical management of Achilles tendon rupture.
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Affiliation(s)
- M R Carmont
- The Department of Orthopaedic Surgery, Princess Royal Hospital, Telford, Shropshire, TF1 6TF, UK.
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Thevendran G, Sarraf KM, Patel NK, Sadri A, Rosenfeld P. The ruptured Achilles tendon: a current overview from biology of rupture to treatment. Musculoskelet Surg 2013; 97:9-20. [PMID: 23546858 DOI: 10.1007/s12306-013-0251-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Accepted: 03/21/2013] [Indexed: 06/02/2023]
Abstract
The Achilles tendon (AT) is the most frequently ruptured tendon in the human body yet the aetiology remains poorly understood. Despite the extensively published literature, controversy still surrounds the optimum treatment of complete rupture. Both non-operative management and percutaneous repair are attractive alternatives to open surgery, which carries the highest complication and cost profile. However, the lack of a universally accepted scoring system has limited any evaluation of treatment options. A typical UK district general hospital treats approximately 3 cases of AT rupture a month. It is therefore important for orthopaedic surgeons to correctly diagnose and treat these injuries with respect to the best current evidence-based practice. In this review article, we discuss the relevant pathophysiology and diagnosis of the ruptured AT and summarize the current evidence for treatment.
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Affiliation(s)
- G Thevendran
- Department of Trauma and Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore
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30
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Wang CC, Chen PY, Wang TM, Wang CL. Ultrasound-guided minimally invasive surgery for achilles tendon rupture: preliminary results. Foot Ankle Int 2012; 33:582-90. [PMID: 22835396 DOI: 10.3113/fai.2012.0582] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Many surgeons prefer surgical repair for Achilles tendon ruptures in an attempt to reduce the risk of rerupture. To minimize wound complications, the use of minimally invasive surgery has become more popular recently. In line with this, the use of ultrasound to guide Achilles tendon repair is reported in this study. METHODS From March 2005 to January 2008, 23 patients with Achilles tendon rupture were repaired by the same surgeon. The ages of the patients ranged from 19 to 67 years old, with an average of 43 years old. The repair of the Achilles tendon was achieved through a stab wound under the guidance of ultrasonography. A control group consisted of 25 patients who received traditional open Achilles tendon repair. RESULTS The average operation time was 52 minutes, and the average wound size was 1.1 cm. The short leg cast was removed 4 weeks after the surgery, and serial casting was used for another 3 to 4 weeks. The postoperative AOFAS ankle-hindfoot scores were 98.7 in the experimental group, 96.5 in the control group with no significant difference. The rates of local infection, stiffness of the ankle, pain of the scar and sural nerve injury were better in the experimental group than in the control group with significant difference. CONCLUSIONS Ultrasound-guided surgery was a good choice due to its availability and real-time soft tissue visualization. It can further minimize the size of the surgical wound. Our method has the potential to achieve reliable results.
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Henríquez H, Muñoz R, Carcuro G, Bastías C. Is percutaneous repair better than open repair in acute Achilles tendon rupture? Clin Orthop Relat Res 2012; 470:998-1003. [PMID: 21365335 PMCID: PMC3293952 DOI: 10.1007/s11999-011-1830-1] [Citation(s) in RCA: 88] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Open repair of Achilles tendon rupture has been associated with higher levels of wound complications than those associated with percutaneous repair. However, some studies suggest there are higher rerupture rates and sural nerve injuries with percutaneous repair. QUESTIONS/PURPOSES We compared the two types of repairs in terms of (1) function (muscle strength, ankle ROM, calf and ankle perimeter, single heel rise tests, and work return), (2) cosmesis (length scar, cosmetic appearance), and (3) complications. PATIENTS AND METHODS We retrospectively reviewed 32 surgically treated patients with Achilles rupture: 17 with percutaneous repair and 15 with open repair. All patients followed a standardized rehabilitation protocol. The minimum followup was 6 months (mean, 18 months; range, 6-48 months). RESULTS We observed similar values of plantar flexor strength, ROM, calf and ankle perimeter, and single heel raising test between the groups. Mean time to return to work was longer for patients who had open versus percutaneous repair (5.6 months versus 2.8 months). Mean scar length was greater in the open repair group (9.5 cm versus 2.9 cm). Cosmetic appearance was better in the percutaneous group. Two wound complications and one rerupture were found in the open repair group. One case of deep venous thrombosis occurred in the percutaneous repair group. All complications occurred before 6 months after surgery. We identified no patients with nerve injury. CONCLUSIONS Percutaneous repair provides function similar to that achieved with open repair, with a better cosmetic appearance, a lower rate of wound complications, and no apparent increase in the risk of rerupture. LEVEL OF EVIDENCE Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hugo Henríquez
- Foot and Ankle Service, Instituto Traumatológico–University of Chile, Avenida San Martín 771, Santiago, Chile
| | - Roberto Muñoz
- Foot and Ankle Service, Instituto Traumatológico–University of Chile, Avenida San Martín 771, Santiago, Chile
| | - Giovanni Carcuro
- Foot and Ankle Service, Instituto Traumatológico–University of Chile, Avenida San Martín 771, Santiago, Chile
| | - Christian Bastías
- Foot and Ankle Service, Instituto Traumatológico–University of Chile, Avenida San Martín 771, Santiago, Chile
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Guillo S, Del Buono A, Dias M, Denaro V, Maffulli N. Percutaneous repair of acute ruptures of the tendo Achillis. Surgeon 2012; 11:14-9. [PMID: 22341001 DOI: 10.1016/j.surge.2011.12.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Revised: 12/18/2011] [Accepted: 12/19/2011] [Indexed: 11/30/2022]
Abstract
Minimally invasive repair of acute traumatic ruptures of the tendo Achillis may produce lower complications compared to open repair. Twenty-three active patients underwent percutaneous repair of an acute rupture of the tendo Achillis. Post-operatively, the ATRS score was administered to assess the functional status. The maximum calf circumference, isometric plantar flexion strength of the gastrocsoleus muscle complex, ankle dorsiflexion, and return to sport activity were assessed in all patients at an average post-operative follow-up of 25.7 months. At the last follow-up, the mean Achilles tendon total rupture score (ATRS) score was 84 (range: 53-99). Ankle dorsiflexion and maximum calf circumference on the operated limb were not significantly different compared to the uninjured side. The isometric strength on the operated limb was significantly lower (P=0.04) compared to the contralateral side. Of the 21 (90%) patients participating in sports activities, 16 (80%) had returned to their pre-operative sport, 2 changed to lower activity, and 1 increased his performance. This percutaneous technique provides satisfactory outcome in terms of strength and return to pre-operative level of sport activity.
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Affiliation(s)
- Stephane Guillo
- Sports Clinic, Department of Orthopaedic Surgery, Bordeaux-Mérignac, France.
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McMahon SE, Smith TO, Hing CB. A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture. Foot Ankle Surg 2011; 17:211-7. [PMID: 22017889 DOI: 10.1016/j.fas.2010.11.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 10/27/2010] [Accepted: 11/18/2010] [Indexed: 02/04/2023]
Abstract
Achilles tendon ruptures are a common injury afflicting predominantly the young male occasional sportsman. Previous studies have shown that outcome is better with surgical repair for the young active patient. There is no consensus as to whether there is a difference in outcome between open and percutaneous minimally invasive surgery (MIS). A meta-analysis was undertaken to compare the clinical outcomes of MIS with conventional open surgical repair. Six randomised controlled trials of 277 Achilles tendon repairs were eligible for review. This included 136 minimally invasive repairs and 141 conventional open repairs. On analysis, there was no significant difference between the two surgical approaches in respect to the incidence of re-rupture, tissue adhesion, sural nerve injury, deep infection and deep vein thrombosis (p>0.05). However, MIS had a significantly reduced risk of superficial wound infection, with three times greater patient satisfaction for good to excellent results compared with conventional open surgical approaches.
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Affiliation(s)
- Samuel E McMahon
- Watford General Hospital, 60 Vicarage Rd, Watford WD18 OHB, United Kingdom
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Highlander P, Greenhagen RM. Wound complications with posterior midline and posterior medial leg incisions: a systematic review. Foot Ankle Spec 2011; 4:361-9. [PMID: 21926359 DOI: 10.1177/1938640011418488] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED There is no consensus on the optimal incisional approach at the posterior leg to avoid wound healing complications. The purpose of this systematic review is to report and compare complication rates associated with two common incisions used to approach the Achilles tendon in order to provide additional recommendations for optimal incision placement. MATERIALS AND METHODS Four electronic databases were searched using keywords for procedures using posterior leg incisions. A total of 8724 studies were analyzed and subjected to inclusion and exclusion criteria. Once inclusion criteria were met, each article was placed in 1 of 2 groups based on incision placement: midline (group 1) or posterior medial (group 2). Study format, patient demographics, surgical indication and other details, and wound complications were recorded. The data obtained was reviewed for trends between the two groups. RESULTS 38 articles met the inclusion criteria. Seven articles used the midline approach (group 1) whereas 31 articles used the posterior medial incision (group 2). The 38 articles included 1287 patients, of whom 25.6% were female with an average age of 43.9 years. Group 1 included 142 patients and group 2 had 1145 patients. The total wound complication rate among all reports was determined to be 8.2%, with 7.0% and 8.3% between groups 1 and 2, respectively. DISCUSSION Although incision placement may influence wound healing complications, it appears that additional factors such as advanced age, delay in surgical intervention, gender, comorbid conditions, prior surgery, and postoperative protocols also play a role. This report suggests that a midline approach is no less precarious in avoidance of wound complications regardless of patient demographics or other surgical details in comparison with a posterior medial incision. LEVEL OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Peter Highlander
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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35
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Tenenbaum S, Dreiangel N, Segal A, Herman A, Israeli A, Chechik A. The percutaneous surgical approach for repairing acute Achilles tendon rupture: a comprehensive outcome assessment. J Am Podiatr Med Assoc 2010; 100:270-5. [PMID: 20660878 DOI: 10.7547/1000270] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Treatment modalities for acute Achilles tendon rupture can be divided into operative and nonoperative. The main concern with nonoperative treatment is the high incidence of repeated ruptures; operative treatment is associated with risk of infection, sural nerve injury, and wound-healing sequelae. We assessed our experience with a percutaneous operative approach for treating acute Achilles tendon rupture. METHODS The outcomes of percutaneous surgery in 29 patients (25 men; age range, 24-58 years) who underwent percutaneous surgery for Achilles tendon rupture between 1997 and 2004 were retrospectively evaluated. Their demographic data, subjective and objective evaluation findings, and isokinetic evaluation results were retrieved, and they were assessed with the modified Boyden score and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. RESULTS All 29 patients demonstrated good functional outcome, with no- to mild-limitations in recreational activities and high patient satisfaction. Mean follow-up was 31.8 months. Changes in ankle range of motion in the operated leg were minimal. Strength and power testing revealed a significant difference at 90 degrees /sec for plantarflexion power between the injured and healthy legs but no difference at 30 degrees and 240 degrees /sec or in dorsiflexion. The mean modified Boyden score was 74.3, and the mean Ankle-Hindfoot Scale score was 94.5. CONCLUSIONS Percutaneous surgery for Achilles tendon rupture is easily executed and has excellent functional results and low complication rates. It is an appealing alternative to either nonoperative or open surgery treatments.
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Affiliation(s)
- Shay Tenenbaum
- Department of Orthopedic Surgery, Sheba Medical Center, Tel-Hashomer, Israel.
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Dogan A, Uzumcugil O, Sarisozen B, Ozdemir B, Akman YE, Bozdag E, Sunbuloglu E, Bozkurt E. A comparison of percutaneous and mini-open techniques of Achilles tenotomy: an experimental study in rats. J Child Orthop 2009; 3:485-91. [PMID: 19795145 PMCID: PMC2782064 DOI: 10.1007/s11832-009-0207-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 09/17/2009] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To investigate the effect of Achilles tenotomy performed percutaneously and by mini-open methods on tendon healing and final strength. MATERIALS AND METHODS In two groups, each consisting of 14 rats, percutaneous and mini-open techniques in Achilles tenotomy were compared in terms of biomechanical, histological and gross properties. RESULTS In the gross evaluation, it was observed that an obvious thickening and adhesion to the subcutaneous tissue of the healing tendon were observed in nearly all rats in which the mini-open technique was performed. In the biomechanical analysis, there was no significant difference between percutaneous and mini-open groups and between operated and intact Achilles tendons in both groups, in terms of tendon strength (P > 0.05). In the histological evaluation, irregularity in the parallel pattern of the collagen fibres, emergence of a non-specific collagenous tissue formation and infiltration of mild mononuclear inflammatory cells were reported. These changes were more marked in the rats in which the percutaneous technique was performed. CONCLUSION Mini-open technique for Achilles tenotomy may be considered as an alternative method of treatment to apply the tenotomy technique in a secure way. CLINICAL RELEVANCE There are two basic advantages of Achilles tenotomy performed by the mini-incision open technique: (1) a complete tenotomy is guaranteed, as it has to be in the original Ponseti technique, (2) iatrogenic neuro-vascular injury risk is nearly completely avoided due to the subparatenon exploration of the tendon and direct visual observation during the transection. The mini-open technique may only be used in cases in which a vascular compromise is clinically suspected or confirmed by Doppler ultrasonography and/or arteriography. On the other hand, the technique may be performed in all cases routinely by the choice of the surgeon.
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Affiliation(s)
- Ahmet Dogan
- Orthopaedy and Traumatology Department, S.B. Istanbul Education and Research Hospital, Incirli cad. No: 108, 34144 Bakirkoy, Istanbul, Turkey
| | - Onat Uzumcugil
- Orthopaedy and Traumatology Department, S.B. Istanbul Education and Research Hospital, Incirli cad. No: 108, 34144 Bakirkoy, Istanbul, Turkey
| | - Bartu Sarisozen
- Orthopaedy and Traumatology Department, Uludag Medical Faculty, University of Uludag, Bursa, Turkey
| | - Bulent Ozdemir
- Orthopaedy and Traumatology Department, Uludag Medical Faculty, University of Uludag, Bursa, Turkey
| | - Y. Emre Akman
- Orthopaedy and Traumatology Department, S.B. Istanbul Education and Research Hospital, Incirli cad. No: 108, 34144 Bakirkoy, Istanbul, Turkey
| | - Ergun Bozdag
- Faculty of Mechanical Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Emin Sunbuloglu
- Faculty of Mechanical Engineering, Istanbul Technical University, Istanbul, Turkey
| | - Erol Bozkurt
- Pathology Department, S.B. Istanbul Education and Research Hospital, Istanbul, Turkey
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Abstract
Since the first reports in the medical literature of treatment of the Achilles tendon, complications have been recognized from both non-operative and operative techniques. These include tendon rerupture, sural nerve morbidity, wound healing problems, changes in tendon morphology, venous thromboembolism, elongation of the tendon, complex regional pain syndrome, and compartment syndrome. This article delineates the incidence for each of these complications, with differing techniques, methods of avoiding these complications and treatment methods if they occur.
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Affiliation(s)
- Andy Molloy
- University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK.
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Metz R, van der Heijden GJMG, Verleisdonk EJMM, Tamminga R, van der Werken C. Recovery of calf muscle strength following acute achilles tendon rupture treatment: a comparison between minimally invasive surgery and conservative treatment. Foot Ankle Spec 2009; 2:219-26. [PMID: 19825777 DOI: 10.1177/1938640009348338] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study was to measure the effect of treatment of acute Achilles tendon ruptures on calf muscle strength recovery. Eighty-three patients with acute Achilles tendon rupture were randomly allocated to either minimally invasive surgery with functional after-treatment or conservative treatment by functional bracing. Calf muscle strength using isokinetic testing was evaluated at 3 months and after 6 or more months posttreatment. To exclusively investigate the effect of treatment on outcome, the authors excluded patients with major complications from the analysis. In 31 of 39 patients in the surgical treatment group and 25 of 34 patients in the conservative treatment group, isokinetic strength tests were performed. In the analysis of differences in mean peak torque, no statistically significant differences were found between surgery and conservative treatment, except for plantar flexion strength at 90 degrees per second at the second measurement, favoring conservative treatment. After 8 to 10 months follow- up, loss of plantar flexion strength was still present in the injured leg in both treatment groups. In conclusion, isokinetic muscle strength testing did not detect a statistically significant difference between minimally invasive surgical treatment with functional after-treatment and conservative treatment by functional bracing of acute Achilles tendon ruptures.
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Affiliation(s)
- Roderik Metz
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, the Netherlands.
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Doral MN, Bozkurt M, Turhan E, Ayvaz M, Atay OA, Uzümcügil A, Leblebicioğlu G, Kaya D, Aydoğ T. Percutaneous suturing of the ruptured Achilles tendon with endoscopic control. Arch Orthop Trauma Surg 2009; 129:1093-101. [PMID: 19404654 DOI: 10.1007/s00402-009-0880-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2008] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A prospective study of modified percutaneous Achilles tendon repair performed between 1999 and 2005 under local infiltration anesthesia is presented; the study evaluated the results of percutaneous repair technique by visualization of the synovia under endoscopic control, followed by early functional postoperative treatment for surgical intervention of acute Achilles tendon ruptures. PATIENTS Sixty-two patients (58 males, 4 females, mean age 32) were treated by percutaneous suturing with modified Bunnel technique under endoscopic control within 10 days after acute total rupture. Physiotherapy was initiated immediately after the operation and patients were encouraged to weight-bearing ambulation with a walking brace-moon boot as tolerated. Full weight-bearing was allowed minimum after 3 weeks postoperatively without brace. RESULTS The procedure was tolerated in all patients. There were no significant ROM limitation was observed. Two patients experienced transient hypoesthesia in the region of sural nerve that spontaneously resolved in 6 months. Fifty-nine patients (95%) including professional athletes returned to their previous sportive activities, while 18 of them (29%) had some minor complaints. The interval from injury to return to regular work and rehabilitation training was 11.7 weeks (10-13 weeks). At the latest follow-up (mean: 46 months; range: 12-78 months), all the patients had satisfactory results with a mean American Orthopedic Foot and Ankle Society's ankle-hindfoot score of 94.6. No re-ruptures, deep venous thrombosis or wound problems occurred. CONCLUSION The proposed method offers a reasonable treatment option for acute total Achilles tendon rupture with a low number of complications. The rerupture rate and return to preinjury activities are comparable to open and percutaneous without endoscopic control procedures.
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Affiliation(s)
- Mahmut Nedim Doral
- Department of Orthopaedics and Sports Medicine, Faculty of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey.
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40
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Ozkaya U, Parmaksizoglu AS, Kabukcuoglu Y, Sokucu S, Basilgan S. Open minimally invasive Achilles tendon repair with early rehabilitation: functional results of 25 consecutive patients. Injury 2009; 40:669-72. [PMID: 19232585 DOI: 10.1016/j.injury.2008.10.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Revised: 10/11/2008] [Accepted: 10/20/2008] [Indexed: 02/02/2023]
Abstract
BACKGROUND Various treatment techniques have been described for the treatment of acute Achilles tendon rupture. However, there is no consensus among orthopaedic surgeons regarding the surgical technique and the postoperative rehabilitation program. Mid-term functional outcome results of the patients who had undergone open minimally invasive repair of fresh Achilles tendon ruptures followed by an early rehabilitation programme were evaluated. METHODS Twenty-five consecutive patients who underwent open minimally invasive repair of Achiles tendon ruptures during January 2004-October 2005 were independently reviewed at an average follow-up of 34 months (range 24-45 months). The mean age of the patients was 41 (35-47). A functional rehabilitation protocol based on early range of motion exercises was used after surgery. The American Orthopaedic Foot and Ankle Society score was used to evaluate the outcomes of the patients. Ankle range of motion; thigh, calf and ankle circumferences of the injured leg and the contralateral side, return to work and sports activities time were evaluated. RESULTS One patient had a partial rerupture and one had superficial wound infection. The mean American Orthopaedic Foot and Ankle Society score was 93 (80-100). Patients returned to work at 3 weeks (range 1-5 weeks) and to preinjury sportive activities at 3 months (range 2-4 months). Ankle ROM and circumference measurements did not reveal a significant difference between the two sides. CONCLUSION These results suggest that open minimally invasive Achilles tendon repair and an early rehabilitation programme provides satisfactory results with early return to previous functional status with low complication rates.
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Affiliation(s)
- Ufuk Ozkaya
- Taksim Training and Research Hospital, Orthopedics and Traumatology Department, Siraselviler Street, No: 112, Taksim, Istanbul, Turkey.
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41
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Repair of achilles tendon rupture under endoscopic control. Arthroscopy 2008; 24:683-8. [PMID: 18514112 DOI: 10.1016/j.arthro.2008.02.018] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2007] [Revised: 02/13/2008] [Accepted: 02/13/2008] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the functional outcomes and complications after endoscopically assisted percutaneous repair of Achilles tendon rupture. METHODS An arthroscopically assisted percutaneous repair was performed in 20 patients between the ages of 28 and 47 years. Two patients were suffering from a long-standing rupture. Follow-up was 2.5 years. Evaluation entailed Merkel's scale for pain, functional load (weight) bearing capacity, and the heel raise test. For statistical analysis, a random effects Poisson regression model was used. RESULTS All patients achieved good to excellent outcomes. The median score on Merkel's scale was 600. All patients were able to stand on the tiptoe of the operated leg and none had limitations placed on their daily activities. A 12% decrease in maximum torque and 16.5% decrease in work performance of the injured side were noted. There was no statistical significant difference in the heel raise test between the operated and non-operated leg. No wound problems, re-ruptures, or infections were reported. Two patients (10%) had sural neuralgia; in 1 case, it subsided without further treatment. CONCLUSIONS Endoscopy in percutaneous Achilles tendon repair is useful in determining the initial gap and providing adequate apposition of the tendon ends. It is a safe technique with good outcomes and minimal complications. Despite its promising results, potential problems include sural neuralgia and some decrease in strength.
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Aktas S, Kocaoglu B, Nalbantoglu U, Seyhan M, Guven O. End-to-end versus augmented repair in the treatment of acute Achilles tendon ruptures. J Foot Ankle Surg 2007; 46:336-40. [PMID: 17761317 DOI: 10.1053/j.jfas.2007.06.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Indexed: 02/03/2023]
Abstract
We prospectively analyzed the functional and clinical results of patients who underwent a single end-to-end suture and an augmented tendon repair with plantaris tendon at middle-term follow-up. From January 2003 to May 2005, 30 consecutive patients were operated on for the treatment of acute Achilles' tendon rupture by means of 2 different methods. No cases required adjunctive procedures to allow for acceptable end-to-end apposition. All ruptures were acute and repairable. The patients were divided into 2 groups. In group 1, augmentation with plantaris tendon was performed in addition to the Krakow end-to-end suturing technique in 16 patients, and in group 2, only the Krakow end-to-end suturing technique was used in 14 patients. The average age of the patients was 40.6 years. Patients in the study groups were followed up at a mean of 17.8 months after surgery. At the end of the follow-up, functional and subjective outcome scores were evaluated. The American Orthopaedic Foot and Ankle Society hindfoot clinical outcome scores were 96.7 in group 1 and 98.8 in group 2. Although there was a numerical increase in group 2, no significant difference was determined between the 2 study groups statistically. The surgical outcome concerning local tenderness, skin adhesion scar, and tendon thickness was better in group 2 than in group 1 without a statistical significance. Although functional outcomes of both treatment groups were the same, the end-to-end suturing technique provided a safer and more reliable treatment with a low risk of complications in the treatment of acute Achilles' tendon ruptures compared with the plantaris tendon augmentation technique.
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Affiliation(s)
- Seref Aktas
- Department of Orthopaedic Surgery and Traumatology, Acibadem Hospital, Istanbul, Turkey
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Ceccarelli F, Berti L, Giuriati L, Romagnoli M, Giannini S. Percutaneous and minimally invasive techniques of Achilles tendon repair. Clin Orthop Relat Res 2007; 458:188-93. [PMID: 17290155 DOI: 10.1097/blo.0b013e3180396f07] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Despite the controversy regarding the best treatment for an acute Achilles tendon rupture, percutaneous and minimally invasive techniques seem to offer good results in terms of low risks of rerupture and complications with satisfactory clinical and functional outcomes. A comparison between a percutaneous surgical technique and a minimally invasive one has not been reported in the literature. We consecutively evaluated 12 patients who had a modified Ma and Griffith percutaneous Achilles tendon repair and 12 patients who had a minimally invasive technique. The same semifunctional rehabilitation protocol was used after surgery in both groups. At a minimum followup of 24 months (mean, 33 months; range, 24-42 months), we observed no reruptures or major complications in either group. Both groups had similarly high values for the American Orthopaedic Foot and Ankle Society score. The two techniques allowed equivalent time for return to work and sports. In the group of patients treated with the modified Ma and Griffith suture only, the mean loss of calf circumference in the injured leg was greater, compared with the contralateral leg. The two groups were isokinetically similar. In this study, the percutaneous and minimally invasive techniques of repair of the Achilles tendon yielded essentially identical clinical and functional outcomes.
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Minimally Invasive Achilles Tendon Repair Using the Achillon Repair System. TECHNIQUES IN FOOT AND ANKLE SURGERY 2006. [DOI: 10.1097/01.btf.0000235234.20325.f7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Christopher P Chiodo
- Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA 02115, USA.
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