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Ramelli L, Docter S, Kim C, Sheth U, Park SSH. Single-Row Repair Versus Double-Row Repair in the Surgical Management of Achilles Insertional Tendinopathy: A Systematic Review. Orthop J Sports Med 2024; 12:23259671241262772. [PMID: 39143983 PMCID: PMC11322933 DOI: 10.1177/23259671241262772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/02/2024] [Indexed: 08/16/2024] Open
Abstract
Background Approximately 6% of people will report Achilles tendon pain during their lifetime, and one-third of these individuals will have Achilles insertional tendinopathy (AIT). For patients who have failed conservative treatment, surgical repair is performed. Achilles tendon repair can occur through various techniques, including a single-row or double-row repair. Purpose To determine if there are significant advantages to double-row repair over single-row repair with respect to biomechanical and clinical outcomes. Study design Systematic review; Level of evidence, 3. Methods A systematic review of the literature was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An electronic search of the EMBASE and PubMed databases was performed for all studies related to surgical treatment of AIT, which yielded 1431 unique results. These included both biomechanical and clinical studies. Clinical studies in which patients were not diagnosed with AIT, underwent surgery for repair of acute Achilles tendon rupture, or studies that included additional procedures such as a concomitant flexor hallucis longus transfer were excluded. Eligible studies were independently screened by 2 reviewers. A risk-of-bias assessment was conducted using the Cochrane Risk Of Bias In Non-randomized Studies-of Interventions and risk-of-bias tool for randomized trials tools. Results A total of 23 studies were included, 4 of which were biomechanical studies and 19 were clinical studies. Biomechanical comparison found that there was a significant advantage to using double-row versus single-row fixation with respect to load at yield (354.7 N vs 198.7 N; P = .01) and mean peak load (433.9 N vs 212 N; P = .042). There was no significant difference between double-row and single-row repair with respect to load to failure. Significant heterogeneity of the studies did not allow for a statistical comparison of the clinical outcomes between double-row and single-row repairs. Conclusion Although biomechanical studies favor double-row repair for AIT, the current data available on the clinical outcomes are not sufficient to determine if there is a clinical advantage of double-row repair. Larger, prospective randomized controlled trials utilizing validated outcome measures are needed to further elucidate whether the biomechanical advantages associated with double-row repair also translate into improved patient-reported outcomes.
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Affiliation(s)
- Luca Ramelli
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- Division of Orthopaedic Surgery, Women's College Hospital, Toronto, Ontario, Canada
- University of Toronto Orthopaedic Sports Medicine (UTOSM) Program, University of Toronto, Toronto, Ontario, Canada
| | - Shgufta Docter
- Division of Orthopaedic Surgery, Women's College Hospital, Toronto, Ontario, Canada
- University of Toronto Orthopaedic Sports Medicine (UTOSM) Program, University of Toronto, Toronto, Ontario, Canada
| | - Christopher Kim
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Ujash Sheth
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Health Sciences Centre, North York, Ontario, Canada
| | - Sam Si-Hyeong Park
- School of Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- Division of Orthopaedic Surgery, Women's College Hospital, Toronto, Ontario, Canada
- University of Toronto Orthopaedic Sports Medicine (UTOSM) Program, University of Toronto, Toronto, Ontario, Canada
- Orthopaedic Foot and Ankle Program, University of Toronto, Toronto, Ontario, Canada
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Ma L, Chang L, Gong Y, Wang Y, Bian X, Hu C, Guo L, Chen W, Tang K. Haglund resection versus Haglund non-resection for calcific insertional Achilles tendinopathy with Haglund deformity: A retrospective study. Foot Ankle Surg 2024; 30:432-439. [PMID: 38494414 DOI: 10.1016/j.fas.2024.03.002] [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: 01/03/2024] [Revised: 03/07/2024] [Accepted: 03/09/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Calcific insertional Achilles tendinopathy(CIAT) with Haglund deformity is a type of recalcitrant tendinopathy. The necessity of concomitant removal of Haglund deformity during CIAT treatment is controversial. The present study aimed to evaluate the functional outcomes between Haglund resection and Haglund non-resection in the treatment of CIAT with Haglund deformity. METHODS A retrospective study included 29 patients who were underwent Achilles tendon debridement, bursal excision, and subsequent tendon reattachment.for CIAT with Haglund deformity. All patients were divided into 2 groups according to Haglund resection (resection group, n = 16) and Haglund non-resection (non-resection group, n = 13) using the parallel line method on lateral calcaneal X ray after surgery. Patients were evaluated in terms of the American Orthopedic Foot and Ankle Society (AOFAS), Visual Analog Scale (VAS) and Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and the mean time of activities of daily living (ADL). Anatomy changes included the Fowler-Philip angle, calcaneal pitch angle and Achilles tendon force arm were measured with radiography preoperatively and postoperatively. RESULTS Both groups exhibited a significant increase in AOFAS, VAS and VISA-A scores after surgery. There were no significant differences between the resection group and the non-resection group for the AOFAS (92.38 ± 5.7 vs. 93.15 ± 12.17; P = 0.82), VAS (0.5 ± 0.52 vs. 0.61 ± 0.87; P = 0.66) and VISA-A questionnaire (82.56 ± 13.46 vs. 74.92 ± 16.4; P = 0.18) at the latest follow-up. The mean time of ADL in the non-resection group was significantly faster compared to that of the resection group (8.15 ± 2.51 weeks vs. 11.31 ± 4.06 weeks, P = 0.02). The Fowler-Philip angle of the resection group decreased from 55.55° ± 12.34° preoperatively to 44.52° ± 10.24° at the latest follow-up (P = 0.001). The Fowler-Philip angle of the non-resection group decreased from 54.38° ± 8.41° preoperatively to 46.52° ± 8.02° at the latest follow-up (P = 0.016). The calcaneal pitch angle of the resection group increased from 22.76° ± 5.37° preoperatively to 25.98° ± 6. 4° at the latest follow-up (P = 0.018). The Achilles tendon force arm of the resection group decreased from 178.50 mm ± 5.37 mm preoperatively to 173.90 mm ± 8.07 mm at the latest follow-up (P = 0.018). CONCLUSION Resection or non-resection of the posterosuperior calcaneal tuberosity for CIAT with Haglund deformity would both provide satisfactory functional outcomes. Haglund non-resection may expedite patients' return to their daily activities, suggesting a Haglund deformity resection may be unnecessary in the surgical treatment for CIAT with Haglund deformity.
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Affiliation(s)
- Lin Ma
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Le Chang
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Yan Gong
- Department of Hypertension and Endocrinology, Daping Hospital, Army Medical University, Chongqing 400038, China
| | - Yunjiao Wang
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Xuting Bian
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Chao Hu
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Lin Guo
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China
| | - Wan Chen
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China.
| | - Kanglai Tang
- Department of Sports Medicine Center, Southwest Hospital, Army Medical University, Chongqing 400038, China.
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Vora A, Ingwer SJ, Withrow M, Denove N, Hauck O, Khoury A. Double-Row Achilles Insertional Repair With Rip-Stop Increases Construct Strength Compared to Traditional Techniques: A Biomechanical Study. Foot Ankle Int 2024; 45:535-541. [PMID: 38348561 DOI: 10.1177/10711007241227948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
BACKGROUND Although double-row suture-anchored (DRSA) techniques for Achilles insertional tendinosis has proven successful, a reoccurring failure mode not yet addressed is suture tearing through the tendon. This study aims to address suture tearing by incorporating a rip-stop element. Authors hypothesized that the Rip-Stop group would demonstrate increased strength compared with more traditional techniques. METHODS 12 paired cadaveric feet were used in this study (n = 24). One sample from each pair was assigned to receive the standard double-row (SDR) Achilles repair with 4.75-mm knotless anchors (n = 12). The control's matched sides were divided between 2 DRSA bridge groups: modified double-row (MDR) bridge with 3.9-mm anchors or rip-stop double-row (RS-DR) bridge repair with soft proximal anchors and 3.9-mm anchored distal row. In neutral position, specimens underwent 1000 cycles (20-100 N) followed by load to failure. Displacements, stiffness, ultimate load, and failure mode were recorded. RESULTS RS-DR had the lowest initial displacement values followed by SDR and MDR (1.3 ± 0.4, 2.7 ± 1.4, and 3.2 ± 1.3 mm, respectively). Significance was detected when comparing initial displacement of RS-DR to MDR (P = .038). Cyclic displacement was lowest for RS-DR, followed by MDR and SDR (1.6 ± 0.9, 2.2 ± 1.1, and 4.5 ± 3.2 mm, respectively). Cyclic stiffness was similar for RS-DR and MDR (89.1 ± 24.6 and 81.9 ± 5.6 N/mm, respectively). RS-DR ultimate load (1116.8 ± 405.7 N) was statistically greater than SDR (465.6 ± 352.7, P = .003). CONCLUSION RS-DR-repaired specimens demonstrated a decrease in displacement values and increased ultimate load and stiffness when compared to other groups. Results of this cadaveric model suggest that the addition of a rip-stop to DRSA Achilles repair is more impactful than anchor size. Limitations include that this was a time-zero biomechanical study, which cannot simulate the performance of the repairs during postoperative healing and recovery. CLINICAL RELEVANCE A rip-stop technique for Achilles repair effectively improves dynamic mechanical characteristics and may mitigate suture tearing through tendon in a patient cohort.
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Affiliation(s)
- Anand Vora
- Illinois Bone & Joint Institute, Libertyville, IL, USA
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Leiß F, Spörrer JF, Grifka J, Schwarz T. [Achilles tendon pathologies]. ORTHOPADIE (HEIDELBERG, GERMANY) 2023; 52:857-866. [PMID: 37737321 DOI: 10.1007/s00132-023-04434-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/02/2023] [Indexed: 09/23/2023]
Abstract
Achilles tendon pathologies are a frequent problem in the clinical practice. A distinction must be made between insertional and noninsertional tendinopathies. In addition to intrinsic risk factors, such as diabetes mellitus, there are also extrinsic risk factors, such as overuse and running. Sonography, X‑ray imaging and magnetic resonance imaging (MRI) are established imaging methods, depending on the question. The primary treatment includes a conservative approach. First-line treatment includes administration of nonsteroidal anti-inflammatory drugs (NSAID), physical rest and the use of assistive devices. Established conservative treatment procedures include eccentric stretching, shockwave therapy and infiltration with, e.g., platelet-rich plasma. There are numerous other conservative treatment options. After exhausting the conservative treatment options, a surgical approach can be considered. The surgical procedure depends on the clinical symptoms and findings. Established procedures are minimally invasive or endoscopic procedures or even open debridement.
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Affiliation(s)
- F Leiß
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland.
| | - J-F Spörrer
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
| | - T Schwarz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Deutschland
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Guyonnet C, Dutra Vieira T, Lopes R. Arthroscopic Double-Row Repair for Acute Proximal Detachment of the Lateral Collateral Ligament in a Complex Ankle Sprain. Arthrosc Tech 2023; 12:e1409-e1416. [PMID: 37654887 PMCID: PMC10466297 DOI: 10.1016/j.eats.2023.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/30/2023] [Accepted: 04/12/2023] [Indexed: 09/02/2023] Open
Abstract
Management of ankle sprains is still being discussed. For athletes, recent studies recommend surgical treatment for acute grade III rupture, because of better long-term ankle stability. The purpose of this technical note is to describe the arthroscopic acute double-row repair for proximal disinsertion of collateral lateral ligament ankle. With the patient in dorsal decubitus under spinal anesthesia, the foot and ankle are extended beyond the edge of the surgical table. The anteromedial portal is created inside the anterior tibial tendon in which the arthroscope is introduced. The anterolateral approach is simulated with a needle under arthroscopic control, in front and under the tip of the lateral malleolus. The anterior talofibular ligament (ATFL) is released from the capsule with a beaver blade. The tip of the lateral malleolus is sharpened, and a soft anchor is impacted there. ATFL is caught with a Mini-Scorpio plier, a Lasso loop is performed to improve tissue grasping. The ligament is pressed against the anchor, with the foot in maximum dorsiflexion and eversion. A knotless anchor is impacted 5 mm above and with the threads of the soft anchor, creating a double-row fixation. The arthroscopic acute double-row repair for proximal desinsertion of collatéral lateral ligament ankle can be done especially for athletes.
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Affiliation(s)
- Clément Guyonnet
- Clinique Brétéché, Nantes, France
- Polyclinique de l’Atlantique, Saint-Herblain, France
| | | | - Ronny Lopes
- Clinique Brétéché, Nantes, France
- Polyclinique de l’Atlantique, Saint-Herblain, France
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Zhao X, Yang X, Hao Y, Yang F, Zhang Z, Qian Q, Fu P, Zhou Q. Treatment of Calcific Insertional Achilles Tendinopathy: Knotless Internal Brace versus Knot-Tying Suture Bridge. J Pers Med 2023; 13:jpm13030404. [PMID: 36983586 PMCID: PMC10059861 DOI: 10.3390/jpm13030404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 02/15/2023] [Accepted: 02/19/2023] [Indexed: 03/03/2023] Open
Abstract
Background: This study aimed to compare the knotless internal brace technique and the knot-tying suture bridge technique via the medial approach in the treatment of calcific Achilles tendinopathy. Methods: The clinical data of 25 cases of calcific Achilles tendinopathy in which nonoperative treatments had failed were retrospectively collected. All the patients received Achilles tendon debridement and Haglund deformity excision through a medial approach, followed by repair using the knotless internal brace technique or the knot-tying suture bridge technique. Pain was evaluated by using the visual analog scale (VAS). The American Orthopedic Foot and Ankle Score (AOFAS) questionnaire was administered preoperatively and postoperatively. Results: The mean follow-up time was 2.6 (range 2–3.5) years. There were no wound complications and no Achilles tendon ruptures. At 1 year postoperatively, the internal brace group was superior to the suture bridge group in terms of the VAS scores (p = 0.003). However, no differences were noticed between the two groups in either the VAS or the AOFAS scores at 2 years postoperatively. Conclusions: The medial approach in combination with the suture bridge technique was effective in treating calcific Achilles tendinopathy. The knotless internal brace technique involved less pain compared to the knot-tying suture bridge technique only at the early postoperative stage.
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Affiliation(s)
- Xiaodong Zhao
- Department of Sports Medicine, Weifang Hospital of Traditional Chinese Medicine, Weifang 261021, China
| | - Xiaolei Yang
- Department of Anesthesia, Naval Medical University Second Affiliated Hospital, Shanghai 200003, China
| | - Yifan Hao
- Department of Sports Medicine, Weifang Hospital of Traditional Chinese Medicine, Weifang 261021, China
| | - Fujun Yang
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai 200003, China
| | - Zhenping Zhang
- Department of Sports Medicine, Weifang Hospital of Traditional Chinese Medicine, Weifang 261021, China
| | - Qirong Qian
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai 200003, China
| | - Peiliang Fu
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai 200003, China
| | - Qi Zhou
- Department of Orthopedics, Naval Medical University Second Affiliated Hospital, Shanghai 200003, China
- Correspondence:
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Amlang MH, Luttenberger M, Rammelt S. [Surgical treatment of calcifying insertional Achilles tendinopathy via a lateral approach]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2022; 34:392-404. [PMID: 36342529 DOI: 10.1007/s00064-022-00787-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 02/20/2022] [Accepted: 05/05/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Reduction of pain and swelling over the Achilles tendon insertion while maintaining function. INDICATIONS Strong, intolerable pain over the Achilles tendon insertion with chronic, calcifying insertional tendinopathy that does not respond to non-operative treatment over a minimum of 6 months. CONTRAINDICATIONS Chronic wounds or severe circulatory deficits at the foot or ankle, irradiating or projected pain, complex regional pain syndrome (CRPS). SURGICAL TECHNIQUE The intratendinous heel spur is resected via a lateral approach. The superior surface of the calcaneal tuberosity is trimmed by resection of the dorsal heel spur with the oscillating saw. A second osteotomy at the medial edge of the tuberosity extends to the insertion of the plantaris tendon. With the third osteotomy, the Haglund deformity is resected. At the resulting area with cancellous bone, the Achilles tendon is reinserted with a suture anchor. POSTOPERATIVE MANAGEMENT A ventral plastic splint in 20° plantar flexion is worn for a week. Full weight-bearing is allowed in a walking boot with 4 cm heel lift for 6 weeks. The heel lift is then gradually reduced for another 2 weeks. After 8 weeks only an elastic wedge of 1 cm is worn. Physical therapy (isometric exercises) starts in the boot and is intensified after removal of the boot. RESULTS Seven of 12 patients treated with that technique for calcifying insertional Achilles tendinopathy (58%) stated being pain free according to the Likert scale, while the remaining 5 patients (42%) reported a "substantial improvement". The VISA‑A score averaged 84 of 100 points. Postoperative complications have not been observed.
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Affiliation(s)
- Michael H Amlang
- UniversitätsCentrum für Orthopädie, Plastische und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Martin Luttenberger
- UniversitätsCentrum für Orthopädie, Plastische und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Stefan Rammelt
- UniversitätsCentrum für Orthopädie, Plastische und Unfallchirurgie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
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Mateen S, Sansosti LE, Meyr AJ. A Critical Biomechanical Evaluation of Foot and Ankle Soft Tissue Repair. Clin Podiatr Med Surg 2022; 39:521-533. [PMID: 35717067 DOI: 10.1016/j.cpm.2022.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The objective of this article is to review the biomechanical stresses that occur during normal physiologic function of lower extremity soft tissue anatomic structures and to use this as a baseline for a critical analysis of the medical literature because it relates to surgical reconstruction following injury. The Achilles tendon, anterior talofibular ligament, plantar plate, and spring ligament are specifically evaluated.
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Affiliation(s)
- Sara Mateen
- Temple University Hospital Podiatric Surgical Residency Program, Philadelphia, PA, USA
| | - Laura E Sansosti
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA, USA
| | - Andrew J Meyr
- Department of Podiatric Surgery, Temple University School of Podiatric Medicine, Philadelphia, PA, USA.
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Phisitkul P, Mansur NSB, Netto CDC. Failed Surgery for Achilles Tendinopathy. Foot Ankle Clin 2022; 27:431-455. [PMID: 35680298 DOI: 10.1016/j.fcl.2021.11.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Treatments of Achilles tendinopathy continue to evolve. The body of literature is inadequate to provide a comprehensive guide to evaluation and treat failed surgeries. Issues related to failed surgical treatment may be divided into infection/wound issue, mechanical failure, and persistent pain. Awareness of the potential problems described in this article will allow surgeons to have a foundation in clinical assessment and making accurate diagnoses. Various surgical treatment options are available and should be executed carefully to treat individualized patient conditions.
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Affiliation(s)
- Phinit Phisitkul
- Tri-state Specialists, LLP, 2730 Pierce Street #300, Sioux City, IA 51104, USA.
| | - Nacime Salomao Barbachan Mansur
- Department of Orthopaedics and Rehabilitation, University of Iowa Carver College of Medicine, 200 Hawkins Drive, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA 52242, USA
| | - Cesar de Cesar Netto
- Department of Orthopaedics and Rehabilitation, University of Iowa Carver College of Medicine, 200 Hawkins Drive, John PappaJohn Pavillion (JPP), Room 01066, Lower Level, Iowa City, IA 52242, USA
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Management of Insertional Achilles Tendinopathy. J Am Acad Orthop Surg 2022; 30:e751-e759. [PMID: 35286285 DOI: 10.5435/jaaos-d-21-00679] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 01/29/2022] [Indexed: 02/01/2023] Open
Abstract
Insertional Achilles tendinopathy is a common condition that can lead to chronic, debilitating heel pain in athletes and nonathletes alike. Conservative treatment options include activity and shoe wear modification, physical therapy, injections, and extracorporeal shock wave therapy. When nonsurgical treatment fails, surgical treatment is recommended. Although there are options aimed at preserving the tendon and débriding the retrocalcaneal bursa and excess bone formation, others are aimed at detaching the Achilles tendon to perform a thorough débridement and subsequent reattachment. Additional or alternate procedures may include a calcaneal closing wedge osteotomy, gastrocnemius lengthening, and flexor hallucis longus tendon transfer. Recent advances in suture anchor techniques further add to the complexity of available options. This review discusses the relevant anatomy, biomechanics, and pathophysiology as well as the recent available evidence for nonsurgical and surgical management of this condition to guide surgeons in selecting the most appropriate treatment for their patients.
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Lewis TL, Srirangarajan T, Patel A, Yip GCK, Hussain L, Walker R, Singh S, Latif A, Abbasian A. Clinical outcomes following surgical management of insertional Achilles tendinopathy using a double-row suture bridge technique with mean two-year follow-up. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2022; 33:1179-1184. [PMID: 35507118 DOI: 10.1007/s00590-022-03270-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/15/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The clinical outcomes following surgical management of insertional Achilles tendinopathy (IAT) vary depending on the surgical technique used to reattach the Achilles tendon following debridement. The aim of this study was to investigate the clinical outcomes of patients with IAT who underwent surgical management with a double-row suture bridge technique used to reattach the Achilles tendon. METHODS A retrospective review of consecutive patients diagnosed with IAT, who underwent surgical management utilising a double-row suture bridge technique (Arthex Speedbridge), and a minimum of 3-month follow-up were included. The primary outcome was the Manchester-Oxford Foot Questionnaire (MOXFQ) Index score which is a patient reported outcome measure (PROM). Secondary outcomes included EuroQol EQ-5D-5L health-related quality of life PROM and complication rates. RESULTS Between July 2013 and June 2020, 50 consecutive patients (23 male; 27 female) were included. The mean age (± standard deviation) was 52.3 ± 11.3 (range 29.0-84.3). Pre- and post-operative PROM data were available for all cases. The mean follow-up was 2.4 ± 1.9 years. The MOXFQ Index score improved from 48.5 to 12.4 (p < 0.01), EQ-5D-5L improved from 2.7 ± 0.46 to 1.2 ± 0.37 (p < 0.01), and EQ-VAS improved from 48.0 ± 18.4 to 84.1 ± 12.6 (p < 0.01). Four patients had complications which were of minimal clinical relevance and caused no deviation from routine recovery. There were no cases of tendon rupture. CONCLUSION This study has demonstrated that surgical management of IAT is safe and effective with clinical improvement in both clinical and general health-related quality of life outcome PROMs. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- T L Lewis
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK.
| | - T Srirangarajan
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - A Patel
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - G C K Yip
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - L Hussain
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - R Walker
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - S Singh
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - A Latif
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
| | - A Abbasian
- Guy's and St Thomas' NHS Foundation Trust, Maze Pond, London, SE1 9RT, UK
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孙 睿, 段 茗, 刘 蕈, 陈 思, 王 君, 张 杭. [Comparative study of transosseous suture and suture anchor technique in medial patellofemoral ligament double bundle reconstruction]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2022; 36:45-51. [PMID: 35038798 PMCID: PMC8844617 DOI: 10.7507/1002-1892.202108010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/15/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the effectiveness of transosseous suture in medial patellofemoral ligament (MPFL) double bundle reconstruction. METHODS The clinical data of 75 patients with recurrent patella dislocation who met the selection criteria between January 2014 and December 2017 were retrospectively analyzed. All of them were treated with MPFL double bundle reconstruction, and divided into study group (39 cases, using new transosseous suture technique) and control group (36 cases, using traditional suture anchor fixation) depending on the intraoperative fixation technique. There was no significant difference in gender, age, body mass index, affected knee side, preoperative tibial tuberosity-trochlear groove distance, Insall-Salvati ratio, knee range of motion, Kujala score, International Knee Documentation Committee (IKDC) score, congruence angle, and tilt angle between the two groups ( P>0.05). The operation time, intraoperative blood loss, hospital stay, and postoperative complications were recorded and compared between the two groups. Kujala score, IKDC score, and knee range of motion were used to evaluate the functional improvement of patients before and after operation. The congruence angle and tilt angle were measured on X-ray films. RESULTS There was no significant difference in operation time, intraoperative blood loss, and hospital stay between the two groups ( P>0.05). Patients in both groups were followed up 24-36 months, with an average of 29.4 months. There was no complication such as incision infection, fat liquefaction, patellar redislocation, and prepatellar pain during follow-up. At last follow-up, the Kujala score, IKDC score, knee range of motion, congruence angle, and tilt angle of two groups significantly improved when compared with those before operation ( P<0.05), while there was no significant difference between the two groups ( P>0.05). CONCLUSION The application of suture anchor or transosseous suture to complete MPFL double bundle reconstruction can restore patellar stability, and there is no significant difference in the short-term effectiveness between them.
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Affiliation(s)
- 睿 孙
- 中国医科大学附属第一医院骨科-运动医学与关节外科(沈阳 110000)Department of Orthopedics-Sports Medicine/Joint Surgery, First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110000, P. R. China
| | - 茗一 段
- 中国医科大学附属第一医院骨科-运动医学与关节外科(沈阳 110000)Department of Orthopedics-Sports Medicine/Joint Surgery, First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110000, P. R. China
| | - 蕈萁 刘
- 中国医科大学附属第一医院骨科-运动医学与关节外科(沈阳 110000)Department of Orthopedics-Sports Medicine/Joint Surgery, First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110000, P. R. China
| | - 思奇 陈
- 中国医科大学附属第一医院骨科-运动医学与关节外科(沈阳 110000)Department of Orthopedics-Sports Medicine/Joint Surgery, First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110000, P. R. China
| | - 君媛 王
- 中国医科大学附属第一医院骨科-运动医学与关节外科(沈阳 110000)Department of Orthopedics-Sports Medicine/Joint Surgery, First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110000, P. R. China
| | - 杭州 张
- 中国医科大学附属第一医院骨科-运动医学与关节外科(沈阳 110000)Department of Orthopedics-Sports Medicine/Joint Surgery, First Affiliated Hospital of China Medical University, Shenyang Liaoning, 110000, P. R. China
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