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Oliva F, Marsilio E, Mastrodonato F, Migliorini F, Maffulli N. Minimally invasive excision and reconstruction of Achilles tendon xanthoma using free autologous semitendinosus tendon transfer: a surgical technique. J Orthop Surg Res 2023; 18:274. [PMID: 37013640 PMCID: PMC10071761 DOI: 10.1186/s13018-023-03757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/26/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Tendon xanthomatosis is often associated with familial hypercholesterolemia, but it can also occur in other medical conditions. The Achilles tendon is the most common site of tendon xanthomas. Reconstruction of large defects after the xanthoma excision, can be challenging. METHODS We propose a novel technique for Achilles tendon reconstruction with the use of an ipsilateral autologous semitendinosus tendon graft. The technique consists of six steps. RESULTS This procedure has a low rate of complications and provides results that are at least comparable with those reported with other surgical approaches.
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Affiliation(s)
- Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
| | - Emanuela Marsilio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
| | - Federica Mastrodonato
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, ST4 7QB, Stoke on Trent, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, E1 4DG, London, England
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Nakazawa K, Yano K, Kaneshiro Y, Sakanaka H. Endoscopic resection of tendon xanthoma in the elbow of a patient with cerebrotendinous xanthomatosis. BMJ Case Rep 2021; 14:e244931. [PMID: 34772677 PMCID: PMC8593707 DOI: 10.1136/bcr-2021-244931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2021] [Indexed: 11/04/2022] Open
Abstract
We describe the case of a 44-year-old woman with cerebrotendinous xanthomatosis (CTX) who had a tendon xanthoma on the right olecranon. The patient successfully underwent endoscopic resection. There were no signs of recurrence on MRI 2 years postoperatively. There were no complications related to the surgery, and the patient is completely satisfied with the treatment outcomes. CTX, a genetic metabolic disorder, is associated with the development of tendon xanthomas. Endoscopic resection of tendon xanthoma in the elbow of patients with CTX is a less invasive method than open resection.
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Affiliation(s)
- Katsumasa Nakazawa
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai, Osaka, Japan
| | - Koichi Yano
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai, Osaka, Japan
| | - Yasunori Kaneshiro
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai, Osaka, Japan
| | - Hideki Sakanaka
- Department of Orthopaedic Surgery, Seikeikai Hospital, Sakai, Osaka, Japan
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Karakaplan M, Ergen E, Görmeli G, Korkmaz MF, Elmalı N. Bilateral Achilles Tendon Xanthomas in a Patient with Cerebrotendinous Xanthomatosis A Case Report. J Am Podiatr Med Assoc 2017; 107:85-89. [PMID: 28271939 DOI: 10.7547/15-085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Cerebrotendinous xanthomatosis is a rare, autosomal recessive, lipid storage disease with accumulation of cholestanol in most tissues, particularly in the Achilles tendons. We described a 23-year-old female patient who had progressive painfull swelling of both Achilles tendons due to cerebrotendinous xanthomatosis. We performed surgery on both-side Achilles tendon tumors. Wide degenerative areas of the tendons were resected, and the flexor hallucis longus tendon was harvested and transferred to reconstruct motion function.
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Affiliation(s)
- Mustafa Karakaplan
- Department of Orthopaedics and Traumatology, Turgut Ozal Medical Center, Inönü University Medical School, Malatya, Turkey
| | - Emre Ergen
- Elazig Kovancilar State Hospital, Elazig, Turkey
| | - Gökay Görmeli
- Department of Orthopaedics and Traumatology, Turgut Ozal Medical Center, Inönü University Medical School, Malatya, Turkey
| | - Mehmet Fatih Korkmaz
- Department of Orthopaedics and Traumatology, Turgut Ozal Medical Center, Inönü University Medical School, Malatya, Turkey
| | - Nurzat Elmalı
- Department of Orthopaedics and Traumatology, Bezmialem Vakıf University, Faculty of Medicine, Istanbul, Turkey
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Abstract
A 19 year old male presented with progressive enlargement of both tendoachilles for 2 years and difficulty in walking for 3 months. The neurological history and examination revealed progressive mental deterioration and ataxia. The blood investigation revealed hypercholesterolemia. We report this rare case of cerebrotendinous xanthomatosis with bilateral tendoachilles enlargement, which was treated by excision of bilateral tendoachilles and reconstruction with fascia lata. The American Orthopedic Foot and Ankle Society hindfoot score was 93/100 bilaterally and the subjective evaluation of the patient showed very good results.
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Affiliation(s)
- Vikas Saxena
- Department of Orthopedics, BRD Medical College, Gorakhpur, Uttar Pradesh, India
| | - Pavan Pradhan
- Department of Orthopedics, BRD Medical College, Gorakhpur, Uttar Pradesh, India
| | - Ashok Yadav
- Department of Orthopedics, BRD Medical College, Gorakhpur, Uttar Pradesh, India
| | - Neeraj Nathani
- Department of Plastic Surgery, BRD Medical College, Gorakhpur, Uttar Pradesh, India
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Moroney PJ, Besse JL. Resection of bilateral massive Achilles tendon xanthomata with reconstruction using a flexor hallucis longus tendon transfer and Bosworth turndown flap: A case report and literature review. Foot Ankle Surg 2012; 18:e25-8. [PMID: 22857971 DOI: 10.1016/j.fas.2012.03.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Revised: 02/07/2012] [Accepted: 03/22/2012] [Indexed: 02/04/2023]
Abstract
Tumours of the Achilles tendon are rare. Reconstruction of the large defect following excision, however, is often a challenge and is sometimes a factor in deciding against operative treatment of a benign lesion. We report a case of excision of bilateral Achilles tendon xanthomata, with reconstruction using a flexor hallucis longus tendon transfer and Bosworth turndown flap.
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Affiliation(s)
- P J Moroney
- Department of Orthopaedic Surgery, Centre Hospitalier Lyon-Sud, 69495 Pierre-Benite Cedex, Lyon, France.
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Abstract
Cerebrotendinous xanthomatosis is a rare, autosomal-recessive, lipid-storage disease with accumulation of cholestanol in most tissues, particularly within the Achilles tendons. It has been characterized both clinically and biochemically, and recently from the molecular biological aspect as well. Juvenile cataract, childhood diarrhea, mental retardation, cerebellar ataxia, and tendon xanthomas are the most prominent features of this disease. Bilateral symmetrical firm masses of Achilles tendons may be the first symptom the patient recognizes because it can jeopardize his or her ability to walk. However, the treatment strategies for tendon tumors vary. In a recent case, we diagnosed the disease properly, according to the clinical manifestations and the radiological and laboratory examinations. The genetic mutation was characterized by analyzing sterol 27-hydroxylase from the patient's family (located on nucleotide 599) and led to a nonsense mutation. It is a unique type of mutation that has never been reported to our knowledge. Tendon lesions are characterized by the loss of muscle fibers and accumulation of lipid products. To help the patient regain the strength of the Achilles tendon and walking abilities, a large area of tendon tumor was excised, followed by reconstruction with a tibialis posterior allograft, which is the second strongest tendon in the foot and ankle. Although the use of this type of graft is uncommon, the final result was satisfactory. At the 10-month follow-up examination, the patient could walk easily without pain. This case report suggests that the surgical procedure will provide an alternative for the repair of large-area degenerative Achilles tendons.
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Affiliation(s)
- Lu Huang
- Department of Orthopedics, 2nd Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Ahn JH, Chun TJ, Lee S. Nodular excision for painful localized Achilles tendon xanthomas in type II hyperlipoproteinemia: a case report. J Foot Ankle Surg 2011; 50:603-6. [PMID: 21621429 DOI: 10.1053/j.jfas.2011.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Indexed: 02/03/2023]
Abstract
Achilles tendon xanthomas are often associated with type II hyperlipoproteinemia, in which low-density lipoprotein derived from the circulation accumulates in the tendons. Sometimes coronary artery disease can jeopardize the life of the patient if the condition is neglected. We describe the case of bilateral painful Achilles tendon xanthomas in a heterozygous type II hyperlipoproteinemia family. Her symptoms were not alleviated despite anti-inflammatory medication and eccentric exercise for 6 months. She was treated with nodular excision of the xanthomas bilaterally and then with postoperative statins to avoid recurrence.
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Affiliation(s)
- Jae Hoon Ahn
- Department of Orthopaedic Surgery, The Catholic University of Korea, Seoul, Korea
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Parkar AAH, Taylor M, Patel N, Ramakrishnan V. Regeneration of tendo Achillis. THE JOURNAL OF BONE AND JOINT SURGERY. BRITISH VOLUME 2010; 92:885-887. [PMID: 20513890 DOI: 10.1302/0301-620x.92b6.23323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
A child with traumatic laceration of the tendo Achillis developed secondary infection after primary repair. This resulted in the loss of 5 cm of the distal part of the tendon and overlying soft tissue. The patient was treated with a free skin flap to cover the wound and to control the infection leaving reconstruction for a second-stage procedure. However, when he was assessed two years after the skin-flap, delayed reconstruction proved to be unnecessary since he had regained normal ankle function spontaneously and could demonstrate equal function in both tendons.
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