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Kim YD, Bardovskaya YI, Romanova SN, Pankratov AS, Shitikov DS. Novel classification of Achilles tendon ruptures. BULLETIN OF THE MEDICAL INSTITUTE "REAVIZ" (REHABILITATION, DOCTOR AND HEALTH) 2022. [DOI: 10.20340/vmi-rvz.2022.6.clin.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In the literature, the treatment of patients with Achilles tendon ruptures begins with diagnosis and diagnosis. Depending on the classification of Achilles tendon rupture, treatment tactics are determined. From our point of view, the existing classification of Achilles tendon ruptures does not sufficiently reflect and systematize the approach to surgical treatment, which served as a more detailed study and addition to the existing classification of Achilles tendon ruptures.
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Assi C, Bonnel F, Mansour J, Daher J, Gerges B, Khoury A, Yammine K. The gracilis and semitendinosus muscles: a morphometric study on 18 specimens with clinical implications. Surg Radiol Anat 2022; 44:813-820. [PMID: 35314874 DOI: 10.1007/s00276-022-02925-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The pes anserinus consists of the sartorius, semitendinosus, and gracilis muscles. They coalesce together with the leg fascia to form the anserine plate. The semitendinosus and gracilis both form the deep layer of this plate and are clinically relevant for ligament reconstruction. The aim of the study is to report a detailed morphometric evaluation of the semitendinosus and gracilis muscles and assess their clinical implications. METHODS Using a rigorous dissection process on 18 cadaveric hips, measurements of both the semitendinosus and gracilis muscles with bone parameters were conducted. We measured the following: (a) total femur, femoral shaft, and neck lengths, (b) total muscle lengths, and (c) intra-muscular and extra-muscular (free) tendon lengths. Correlation values between bone variables, muscle variables, and in-between muscle variables were computed. RESULTS The total muscle and the distal intra-muscular tendon length of the St and Gr are correlated with the total femur length. When compared to gracilis, the total muscle and distal intra-muscular tendon lengths of the ST are much better correlated with the total femur length. The free distal tendon length for both muscles did not show a significant correlation with any of the femoral bone lengths. CONCLUSION The variability of tendon length of the ST/Gr poses a significant challenge to surgeons. This study reports a detailed morphometric evaluation of the ST/Gr hamstring muscle and tendons. It revealed a positive correlation between the femoral length and the ST/Gr graft lengths. This could help orthopedic surgeons in predicting the graft lengths pre-operatively and develop better planning for reconstructive surgeries.
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Affiliation(s)
- Chahine Assi
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon.,Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon
| | - Francois Bonnel
- Anatomy Laboratory, School of Medicine, BD. Henri IV, 34000, Montpellier, France.,Department of Orthopedic Surgery, Clinique Beau Soleil, 119 Avenue de Lodeve, 34070, Montpellier, France
| | - Jad Mansour
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon.,Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon
| | - Jimmy Daher
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon.,Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon
| | - Bassam Gerges
- Department of Anesthesia, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon
| | - Alfred Khoury
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center-Rizk Hospital, Lebanese American University School of Medicine, Achrafieh, Lebanon. .,Center for Evidence-Based Anatomy, Sport and Orthopedics Research, Beirut, Lebanon.
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Kotelnikov GP, Kim YD, Shitikov DS, Pankratov AS, Knyazev NA. [Method of surgical treatment of patients with a chronic rupture of the Achilles tendon]. Khirurgiia (Mosk) 2022:38-44. [PMID: 35146998 DOI: 10.17116/hirurgia202202138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To improve treatment outcomes in patients with long-standing Achilles tendon ruptures with severe diastasis and dysfunction of the calf muscle via the use of a new method of surgical treatment. MATERIAL AND METHODS The authors proposed a new method of Achilles tendon repair for diastasis from 5 to 10 cm. This technique consists in elimination of diastasis with a tendon of the long peroneal muscle on the distal base. Surgical stages are described. The authors also report a patient with long-standing Achilles tendon rupture. Surgical treatment and postoperative outcomes are described. RESULTS Postoperative outcomes were assessed in 23 patients. The control group consisted of 21 patients who underwent reconstruction according to Chernavsky's and Krasnov's methods. Assessment was carried out using clinical and biomechanical methods. The authors analyzed gait asymmetry and functional myography data. Their data indicate the advantage of treatment in the main group.
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Affiliation(s)
- G P Kotelnikov
- Samara State Medical University, Samara, Russian Federation
| | - Yu D Kim
- Samara State Medical University of the Ministry of Health of Russia Samara State Medical University Clinics, Samara, Russia
| | - D S Shitikov
- Samara State Medical University, Samara, Russian Federation
| | - A S Pankratov
- Samara State Medical University of the Ministry of Health of Russia Samara State Medical University Clinics, Samara, Russia
| | - N A Knyazev
- Samara State Medical University, Samara, Russian Federation
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Neglected Painful Chronic Achilles Tendon Rupture With No Palpable Gap. Tech Orthop 2021. [DOI: 10.1097/bto.0000000000000539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kotelnikov GP, Ardatov SV, Kim YD, Shitikov DS. [A new method of surgical treatment of patients with chronic distal Achilles tendon rupture]. Khirurgiia (Mosk) 2021:62-68. [PMID: 33395514 DOI: 10.17116/hirurgia202101162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To improve postoperative outcomes in patients with distal Achilles tendon rupture by using of a new method of surgical treatment. MATERIAL AND METHODS The authors proposed a new method to restore the Achilles tendon for its distal rupture (within 2 cm from attachment to the calcaneus). This approach implies forming a canal in the calcaneus and minimally invasive harvesting of the plantar tendon. At the next stage, the plantar tendon is passed through the canal of the calcaneus in U-shaped fashion and proximal part of Achilles tendon with maximum approximation of its fragments and imposing of interrupted sutures on the plantar and Achilles tendons to hold the position. The end of plantar tendon is used to reinforce damaged area. The schemes and surgical stages are shown in the figures. We reported a patient with distal Achilles tendon rupture and postoperative outcome. RESULTS An above-mentioned approach was applied in 26 patients. The control group consisted of 21 patients who underwent recovery with anchor fixers. Early and long-term postoperative results, as well as adverse events were analyzed in both groups. Biomechanical parameters of gait were evaluated from the standpoint of evidence-based medicine using podography and functional myography. We confirmed an advantage of treatment in the main group.
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Affiliation(s)
| | - S V Ardatov
- Samara State Medical University, Samara, Russia
| | - Yu D Kim
- Samara State Medical University, Samara, Russia
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Shane AM, Reeves CL, Nguyen GB, Sebag JA. Revision Surgery for the Achilles Tendon. Clin Podiatr Med Surg 2020; 37:553-568. [PMID: 32471618 DOI: 10.1016/j.cpm.2020.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Treatment of Achilles tendon ruptures may be surgical or nonsurgical depending on health, history, age, acuity, and severity of the injury. With chronic or revisional injuries, the best method often requires an open repair with reconstructive soft tissue procedures. Revision surgery can be challenging because of the complexity involving tendinous deficits with nonviable and friable tissue. Surgical treatment is based on tendon approximation, size of the defect, tendon integrity, and functional demands. The goal is to restore anatomic and physiologic tension, provide adequate strength for proper ambulation, optimize functional return to activity, decrease pain, and decrease complications.
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Affiliation(s)
- Amber M Shane
- Advent Health East Orlando Podiatric Surgery Residency, Orlando Foot and Ankle Clinic- Upperline Health, 250 North Alafaya Trail Suite 115, Orlando, FL 32828, USA.
| | - Christopher L Reeves
- Advent Health East Orlando Podiatric Surgery Residency, Orlando Foot and Ankle Clinic- Upperline Health, 250 North Alafaya Trail Suite 115, Orlando, FL 32828, USA
| | - Garrett B Nguyen
- Department of Podiatric Surgery, Advent Health East Orlando Podiatric Surgery Residency, 250 North Alafaya Trail Suite 1115, Orlando, FL 32828, USA
| | - Joshua A Sebag
- Department of Podiatric Surgery, Advent Health East Orlando Podiatric Surgery Residency, 250 North Alafaya Trail Suite 1115, Orlando, FL 32828, USA
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Kotelnikov GP, Chernov AP, Ardatov SV, Kim YD, Shitikov DS. [New surgical method for chronic rupture of the Achilles tendon]. Khirurgiia (Mosk) 2018:91-95. [PMID: 30560852 DOI: 10.17116/hirurgia201812191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To improve the outcomes in patients with chronic ruptures of the Achilles tendon followed by advanced diastase and reduced function of the gastrocnemius muscle by using of new surgical method. MATERIAL AND METHODS The authors proposed a new method of Achilles tendon repair for diastase over 10 cm. It imposes transposition of the tendons of short fibular muscle and posterior tibial muscle. Schemes and stages of surgery are presented in figures. The authors described clinical example of patient with chronic rupture of the Achilles tendon, illustrations of surgical stages and the outcome. RESULTS New surgical approach was applied in 16 patients. The control group consisted of 21 patients who underwent repair by Chernavsky, Krasnov. Clinical and biomechanical methods were used for evaluation. Functional myography and podography to assess the asymmetry of gait were performed. Our data confirmed the advantage of new approach.
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Affiliation(s)
- G P Kotelnikov
- Samara State Medical University of Healthcare Ministry of the Russia, Samara, Russia
| | - A P Chernov
- Samara State Medical University of Healthcare Ministry of the Russia, Samara, Russia
| | - S V Ardatov
- Samara State Medical University of Healthcare Ministry of the Russia, Samara, Russia
| | - Yu D Kim
- Samara State Medical University of Healthcare Ministry of the Russia, Samara, Russia
| | - D S Shitikov
- Samara State Medical University of Healthcare Ministry of the Russia, Samara, Russia
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Abstract
Participation in sports activity has increased significantly during the last several decades. This phenomenon has exposed orthopedic sports medicine surgeons to new challenges regarding the diagnosis and management of common sport-related injuries. Arthroscopy is becoming more commonly used in many of the surgical procedures for these injuries and carries the risk of complications. Wound and nerve complications make up the bulk of complications in most procedures. This article describes these complications associated with the common surgical procedures related to foot and ankle sport-related injuries and how to address and prevent them.
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Karnovsky SC, Drakos MC. Revision Achilles Reconstruction with Hamstring Autograft and FHL Tendon Transfer in an Athlete. HSS J 2017; 13:302-306. [PMID: 28983225 PMCID: PMC5617827 DOI: 10.1007/s11420-017-9572-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 07/31/2017] [Indexed: 02/07/2023]
Affiliation(s)
- Sydney C. Karnovsky
- 0000 0001 2285 8823grid.239915.5Department of Orthopedic Surgery, Foot and Ankle, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
| | - Mark C. Drakos
- 0000 0001 2285 8823grid.239915.5Department of Orthopedic Surgery, Foot and Ankle, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021 USA
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Abstract
The Achilles tendon is the strongest tendon in the human body and, as such, has its share of problems. Although many conditions affecting this tendon can be treated nonoperatively, surgical intervention is often necessary. Local, regional, distant, and allograft tendon can be used to supplement or enhance reconstruction or repair of the Achilles tendon. Specific techniques are explored and described and the published results from the literature summarized. This article explores the use of tendon transfers and supplementation in the treatment of insertional and noninsertional Achilles tendinosis as well as in cases of neglected or chronic ruptures of the tendoachilles.
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Affiliation(s)
- Steven K Neufeld
- Orthopaedic Foot & Ankle Center of Washington, 2922 Telestar Court, Falls Church, VA 22042, USA; Department of Orthopaedic Surgery, Virginia Commonwealth University, 1101 East Marshall Street, PO Box 980565 Richmond, VA 23298-0565, USA
| | - Daniel C Farber
- Foot and Ankle Service, Department of Orthopaedics, University of Maryland Orthopaedics and Rehabilitation Institute, University of Maryland Medical Center, University of Maryland School of Medicine, 2200 Kernan Drive, Room 1132, Baltimore, MD 21207, USA.
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