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Local Tendon Transfers for Chronic Ruptures of the Achilles Tendon: A Systematic Review. J Clin Med 2023; 12:jcm12020707. [PMID: 36675635 PMCID: PMC9866603 DOI: 10.3390/jcm12020707] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction: A rupture of the Achilles tendon with a delay in diagnosis or treatment for more than 6 weeks is considered a chronic tear. Local tendon transfer procedures can be used in chronic Achilles tendon ruptures. This study evaluated the outcome, return to sport, and complications of local tendon transfer in patients with chronic Achilles tendon rupture. Material and methods: The present study was conducted according to the PRISMA 2020 guidelines. PubMed, Google Scholar, Embase, and Web of Science databases were accessed in November 2022. Results: Data were retrieved from 23 articles (463 patients, mean age 50.9 ± 13.5 years). The mean duration of the follow-up was 58.3 ± 76.8 months. The VAS improved by 1.8/10 (p = 0.4), the AOFAS by 33.4/100 (p < 0.0001), and the ATRS by 32.5/100 (p = 0.0001) points. Patients were able to return to sport after a mean of 19.6 ± 16.4 weeks. A total of 79% of patients were able to return to their previous activities. The rate of complications was 13.3%. Conclusions: The use of local tendon transfer for chronic Achilles tendon ruptures using the FHL or PB tendon resulted in good clinical outcomes and a reliable return to daily activities and sports. The rate of complications reflects the chronicity of the condition and the technical complexity of the procedure. Level of evidence: IV.
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Gamal O, Shams A, Mesregah MK. Augmented Repair of Acute Total Achilles Tendon Rupture With Peroneus Brevis Tendon Transfer Using Oblique Transosseous Calcaneal Tunnel: A Prospective Case Series. J Foot Ankle Surg 2021; 60:923-928. [PMID: 33875333 DOI: 10.1053/j.jfas.2021.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 02/07/2021] [Accepted: 03/21/2021] [Indexed: 02/03/2023]
Abstract
Acute Achilles tendon rupture is one of the most common tendon injuries. This prospective study aimed to evaluate the functional outcomes of augmented repair of acute Achilles tendon rupture with peroneus brevis tendon transfer and fixation to an oblique calcaneal transosseous tunnel. Functional evaluation was performed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and Achilles Tendon Total Rupture Score (ATRS). Postoperative complications were recorded. This study included 33 males and 9 females, with a mean age of 26.1 ± 4.2 years. The Achilles tendon ruptures were right in 24 patients and left in 18 patients. The cause of rupture was sports injuries in all patients. The mean distance from the calcaneal insertion to the tear site was 4.4 ± 1.3 cm. The mean time from injury to surgery was 2.4 ± 1.6 days. The mean follow-up time was 40.3 ± 4.9 months. The mean AOFAS and ATRS scores were 99.3 ± 1.2 and 95.9 ± 1.9, respectively, at 12 months of follow-up. The mean time to return to work was 12.1 ± 1.2 weeks. The mean time to return to light sports activities was 16.1 ± 1.8 weeks postoperatively. None of the patients developed re-rupture. Augmented repair of acute Achilles tendon ruptures with peroneus brevis tendon transfer is a robust repair with excellent functional outcomes and early weight-bearing and return to sports activities.
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Affiliation(s)
- Osama Gamal
- Assistant Professor, Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Ahmed Shams
- Professor, Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt
| | - Mohamed Kamal Mesregah
- Assistant Lecturer, Department of Orthopaedic Surgery, Faculty of Medicine, Menoufia University, Shebin El-Kom, Menoufia, Egypt.
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Parisien RL, Trofa DP, Gualtieri AP, Dodson CC, Li X, Levine WN, Vosseller JT. How Do Sports Medicine and Foot and Ankle Specialists Treat Acute Achilles Tendon Ruptures? Foot Ankle Spec 2021; 14:114-119. [PMID: 31971006 DOI: 10.1177/1938640019901055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background. The purpose of this study is to evaluate the treatment considerations and surgical techniques utilized by fellowship-trained orthopaedic sports medicine and foot and ankle specialists in the management of Achilles tendon ruptures. Methods. A blinded electronic survey was distributed to 2062 fellowship-trained sports medicine and 1319 fellowship-trained foot and ankle orthopaedic surgeons. The total number of acute Achilles tendon ruptures managed per year, patient-specific factors associated with surgical decision making and surgical techniques were evaluated. Results. Of the 3381 surveys distributed, 524 responses were included for analysis. Only 9% of respondents manage more than 20 acute Achilles tendon ruptures per year with the majority (75%) managing less than 10 per year. Operative management is the treatment of choice for 76% of total respondents with only 8% managing acute ruptures nonoperatively. Activity level and patient age were the single most important factors for 60.8% and 29.3% of surgeons, respectively, with regard to operative versus nonoperative decision making. Socioeconomic status and workers compensation were the least important patient factors. Conclusion. Surgical repair in the young and active patient is the preferred treatment for the majority of fellowship-trained subspecialists who most commonly encounter this pathology.Levels of Evidence: Therapeutic, Level V: Consensus of Expert Analysis.
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Affiliation(s)
- Robert L Parisien
- Department of Orthopaedic Surgery, Boston University Medical School and Medical Center, Boston, Massachusetts (RLP, XL).,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York (DPT, WNL, JTV).,Columbia University, College of Physicians and Surgeons, New York, New York (APG).,Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania (CCD)
| | - David P Trofa
- Department of Orthopaedic Surgery, Boston University Medical School and Medical Center, Boston, Massachusetts (RLP, XL).,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York (DPT, WNL, JTV).,Columbia University, College of Physicians and Surgeons, New York, New York (APG).,Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania (CCD)
| | - Anthony P Gualtieri
- Department of Orthopaedic Surgery, Boston University Medical School and Medical Center, Boston, Massachusetts (RLP, XL).,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York (DPT, WNL, JTV).,Columbia University, College of Physicians and Surgeons, New York, New York (APG).,Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania (CCD)
| | - Christopher C Dodson
- Department of Orthopaedic Surgery, Boston University Medical School and Medical Center, Boston, Massachusetts (RLP, XL).,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York (DPT, WNL, JTV).,Columbia University, College of Physicians and Surgeons, New York, New York (APG).,Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania (CCD)
| | - Xinning Li
- Department of Orthopaedic Surgery, Boston University Medical School and Medical Center, Boston, Massachusetts (RLP, XL).,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York (DPT, WNL, JTV).,Columbia University, College of Physicians and Surgeons, New York, New York (APG).,Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania (CCD)
| | - William N Levine
- Department of Orthopaedic Surgery, Boston University Medical School and Medical Center, Boston, Massachusetts (RLP, XL).,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York (DPT, WNL, JTV).,Columbia University, College of Physicians and Surgeons, New York, New York (APG).,Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania (CCD)
| | - J Turner Vosseller
- Department of Orthopaedic Surgery, Boston University Medical School and Medical Center, Boston, Massachusetts (RLP, XL).,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York (DPT, WNL, JTV).,Columbia University, College of Physicians and Surgeons, New York, New York (APG).,Department of Orthopaedic Surgery, Rothman Institute, Philadelphia, Pennsylvania (CCD)
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Zhang YJ, Zhang C, Wang Q, Lin XJ. Augmented Versus Nonaugmented Repair of Acute Achilles Tendon Rupture: A Systematic Review and Meta-analysis. Am J Sports Med 2018; 46:1767-1772. [PMID: 28467100 DOI: 10.1177/0363546517702872] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although simple end-to-end repair of the Achilles tendon is common, many augmented repair protocols have been implemented for acute Achilles tendon rupture. However, whether augmented repair is better than nonaugmented repair of an acute Achilles tendon rupture is still unknown. PURPOSE To conduct a meta-analysis to determine whether augmented surgical repair of an acute Achilles tendon rupture improved subjective patient satisfaction without an increase in rerupture rates. Secondary outcomes assessed included infections, ankle range of motion, calf muscle strength, and minor complications. STUDY DESIGN Meta-analysis. METHODS A systematic literature search of peer-reviewed articles was conducted to identify all randomized controlled trials (RCTs) comparing augmented repair and nonaugmented repair for acute Achilles tendon rupture from January 1980 to August 2016 in the electronic databases of PubMed, Web of Science (SCI-E/SSCI/A&HCI), and EMBASE. The keywords (Achilles tendon rupture) AND (surg* OR operat* OR repair* OR augment* OR non-augment* OR end-to-end OR sutur*) were combined, and results were limited to human RCTs and controlled clinical trials published in the English language. Four RCTs involving 169 participants were eligible for inclusion; 83 participants were treated with augmented repair and 86 were treated with nonaugmented repair. RESULTS Augmented repair led to similar responses when compared with nonaugmented repair for acute Achilles tendon rupture (93% vs 90%, respectively; P = .53). The rerupture rates showed no significant difference for augmented versus nonaugmented repair (7.2% vs 9.3%, respectively; P = .69). No differences in superficial and deep infections occurred in augmented (7 infections) and nonaugmented (8 infections) repair groups during postoperative follow-up ( P = .89). The average incisional infection rate was 8.4% with augmented repair and 9.3% with nonaugmented repair. No significant differences in other complications were found between augmented (7.2%) and nonaugmented (8.1%) repair ( P = .80). CONCLUSION Augmented repair, when compared with nonaugmented repair, was not found to improve patient satisfaction or reduce rerupture rate or infection rate. These conclusions are based on 4 trials with small sample sizes, and larger randomized trials are required to confirm these results.
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Affiliation(s)
- Yi-Jun Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Chi Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Quan Wang
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Xiang-Jin Lin
- Department of Orthopedic Surgery, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Piontek T, Bąkowski P, Ciemniewska-Gorzela K, Grygorowicz M. Minimally invasive, endoscopic Achilles tendon reconstruction using semitendinosus and gracilis tendons with Endobutton stabilization. BMC Musculoskelet Disord 2016; 17:247. [PMID: 27256340 PMCID: PMC4891922 DOI: 10.1186/s12891-016-1099-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Accepted: 05/25/2016] [Indexed: 12/28/2022] Open
Abstract
Background Plantaris tendon, peronus brevis tendon and flexor hallucis longus tendon augmentation, commonly used in Achilles tendon rupture, often lead to weakening of injured foot and they require the immobilization after the surgery. It is essential to develop the technique, which gives no such limitation and allows for immediate functional improvement. Methods We present our method of minimally invasive, endoscopic Achilles tendon reconstruction using semitendinosus and gracilis tendons with Endobutton stabilization. Results Posterolateral and posteromedial portals were made approximately 3 cm above the posterosuperior part of the calcaneus to clean the area of the Achilles tendon endoscopically. Then the hamstrings are harvested and prepared for the “Endobutton” system. A midline incision of the skin is performed approximately 1 cm above the posterosuperior part of the calcaneus to approach to the posterosuperior part of the calcaneus. Then under fluoroscopy the calcaneus was drilled through using K-wire. The distal end of the graft equipped with an Endobutton loop was entered into the drilled tunnel in the calcaneus. Later, 8 consecutive skin incisions are performed. Proximal ends of the graft were brought out through the native Achilles tendon reaching medial and lateral skin incisions. The final step was to transfer and tie the graft ends through the most proximal skin incision. Conclusions This minimally invasive, endoscopic technique allows reconstruction of the Achilles tendon using semitendinosus and gracilis tendons with Endobutton stabilization and can be used in so-called “difficult”, resistant cases as a “salvage procedure”.
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Affiliation(s)
- Tomasz Piontek
- Orthopedic Department, Rehasport Clinic, Górecka 30, Poznan, 60-201, Poland
| | - Paweł Bąkowski
- Orthopedic Department, Rehasport Clinic, Górecka 30, Poznan, 60-201, Poland.
| | | | - Monika Grygorowicz
- Research and Development Department, Rehasport Clinic, Górecka 30, Poznan, 60-201, Poland
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Heikkinen J, Lantto I, Flinkkilä T, Ohtonen P, Pajala A, Siira P, Leppilahti J. Augmented Compared with Nonaugmented Surgical Repair After Total Achilles Rupture: Results of a Prospective Randomized Trial with Thirteen or More Years of Follow-up. J Bone Joint Surg Am 2016; 98:85-92. [PMID: 26791028 DOI: 10.2106/jbjs.o.00496] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This prospective randomized trial with a mean fourteen-year follow-up compared simple end-to-end repair with fascial flap-augmented repair for acute Achilles tendon ruptures. METHODS From 1998 to 2001, sixty patients with acute Achilles tendon rupture were randomized to receive simple end-to-end repair or augmented repair; both groups were treated with postoperative bracing allowing free active plantar flexion. After a follow-up of thirteen years or more, fifty-five patients (twenty-eight in the nonaugmented-repair group and twenty-seven in the augmented-repair group) were reexamined. Outcome measures included the Leppilahti Achilles tendon score, isokinetic plantar flexion strength (peak torque and the work-displacement deficit at 10° intervals over the ankle range of motion), tendon elongation, and the RAND 36-item health survey. RESULTS After a mean of fourteen years of follow-up, the mean Leppilahti score was 87.1 points for the nonaugmented repairs and 91.5 points for the augmented repairs, with a mean difference of 4.3 points (95% confidence interval [CI], -0.1 to 8.8 points). The surgical technique did not have an impact on strength parameters, with a mean peak torque of 112.6 Nm after the nonaugmented repairs and 107.3 Nm after the augmented repairs (mean difference, 5.3 Nm [95% CI, -22.2 to 11.6 Nm]) and a median work-displacement deficit of 6.7% to 20.3% after the nonaugmented repairs and 12.8% to 18.0% after the augmented repairs (p = 0.9). Strength did not significantly change between the twelve-month and fourteen-year follow-up examinations. At a mean of fourteen years, the injured side showed a 12.2% to 18.0% median work-displacement deficit compared with the unaffected side (p < 0.001). RAND-36 scores indicated no between-group difference in health domains. CONCLUSIONS Augmented repair of total Achilles tendon ruptures provided no advantage over simple end-to-end repair. Achilles tendon ruptures result in a permanent calf muscle strength deficit, but its clinical relevance remains unclear. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Juuso Heikkinen
- Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., T.F., P.O., A.P., and J.L.), and Department of Physical Medicine and Rehabilitation (P.S.), Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
| | - Iikka Lantto
- Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., T.F., P.O., A.P., and J.L.), and Department of Physical Medicine and Rehabilitation (P.S.), Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
| | - Tapio Flinkkilä
- Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., T.F., P.O., A.P., and J.L.), and Department of Physical Medicine and Rehabilitation (P.S.), Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
| | - Pasi Ohtonen
- Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., T.F., P.O., A.P., and J.L.), and Department of Physical Medicine and Rehabilitation (P.S.), Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
| | - Ari Pajala
- Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., T.F., P.O., A.P., and J.L.), and Department of Physical Medicine and Rehabilitation (P.S.), Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
| | - Pertti Siira
- Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., T.F., P.O., A.P., and J.L.), and Department of Physical Medicine and Rehabilitation (P.S.), Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
| | - Juhana Leppilahti
- Division of Orthopaedic and Trauma Surgery, Department of Surgery (J.H., I.L., T.F., P.O., A.P., and J.L.), and Department of Physical Medicine and Rehabilitation (P.S.), Medical Research Center Oulu, Oulu University Hospital, University of Oulu, Finland
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Upadhyay S, Raza HKT. Letter to the editor: repair of achilles tendon ruptures with peroneus brevis tendon augmentation. J Orthop Surg (Hong Kong) 2014; 22:271-2. [PMID: 25163972 DOI: 10.1177/230949901402200235] [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: 11/17/2022] Open
Affiliation(s)
- Sachin Upadhyay
- Department of Orthopaedics, Netaji Subhash Chandra Bose Medical College Jabalpur, India
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