Minimally Invasive Mid-Substance Achilles Tendon Repair Using the Percutaneous Achilles Repair System (PARS)

Foot and Ankle Curricular Guidelines in Entry-Level Physical Therapist Education: How Are We Doing?

INTRODUCTION

The Foot and Ankle Curricular Guidelines for Physical Therapist Professional Degree Programs (FACG) provided recommendations regarding essential entry-level content and skills. Eight years later, the extent of its implementation is unknown. This study characterizes entry-level Doctor of Physical Therapy (DPT) programs' foot and ankle curriculum with reference to the FACG.

REVIEW OF LITERATURE

Curricular guidelines offer recommendations to professional degree programs striving for excellence. Review and revisions of guidelines are important to keep pace with and reflect evolving evidence and practice.

SUBJECTS

One faculty member from 116 of 250 DPT programs participated (46.6% response rate). Participants were an average of 50.8 years old and taught a mean of 14.5 years.

METHODS

A cross-sectional 25-item online survey assessed foot and ankle contact hours, coverage of FACG recommended content, coverage of surgical procedures, and the use of FACG for curricular assessment, modification, and development.

RESULTS

Foot and ankle content was covered in physical therapy curriculum for a mean of 48.2 hours (range 12-120 hours). Eleven of the 25 recommended diagnoses, 29 of the 49 examination skills, 6 of the 7 intervention skills, and 3 of the 14 surgical procedures were covered by most (≥90%) of the programs. Reported use of FACG for curricular processes averaged 50.1-51.5 (0-100 numerical scale).

DISCUSSION AND CONCLUSIONS

Across a wide range of contact hours, coverage of FACG recommended content was approximately 57% (46/81 recommended elements in ≥90% of programs). Although not specifically recommended by FACG, surgical procedures were less commonly covered by programs. Study findings question FACG implementation and may reflect differences across programs in depth and breadth of content. Identified curricular gaps may warrant addressing in future guidelines.

Two mini transverse-incision repair yields better results than percutaneous repair for acute closed midsubstance Achilles tendon rupture: a retrospective case-control study

BACKGROUND

Acute closed midsubstance Achilles tendon rupture(ACMATR) is common, with various treatment methods developed over time. We retrospectively compared the two mini transverse-incision repair (2MTIR) with percutaneous repair (PR) to determine which method yields better results.

METHODS

All cases meeting criteria from 2018 to 2021 in our hospital were included and followed up for 1 to 5 years. A final questionnaire with multiple indexes was conducted via phone call. Comparative analysis of these indexes between the two groups was performed using IBM SPSS Statistics (V.26). Continuous variables that passed tests for normality and equal variance were compared using the Student's t-test. Ranked data were compared using the Mann-Whitney U test. Categorical variables were tested with the chi-square test or Fisher's exact test. A p-value of less than 0.05 was considered statistically significant.

RESULTS

There was one rerupture in the PR group. The final indexes for "Tightness Feeling", "Heel Rising Strength", and "Foot Numbness" were statistically different (P < 0.05) between the two groups. The "Re-rupture" and "Return to Sports" indexes showed no statistical difference (P > 0.05).

CONCLUSIONS

The 2MTIR technique provided a technically straightforward, minimally invasive procedure with well-preserved paratenon and direct end-to-end firm fixation in cases of ACMATR. It resulted in very low complications, easy rehabilitation, and full weight-bearing as early as 5-6 weeks postoperatively, yielding better functional outcomes compared to the PR technique in the 1-5 year follow-up.

TRIAL REGISTRATION

The study was preliminarily registered and approved by the University of Hong Kong-Shenzhen Hospital Ethical Board with Project number: hkuszh2023074 on May 4, 2023.

Surgical management of chronic Achilles tendon rupture: evidence-based guidelines

BACKGROUND

Chronic Achilles tendon ruptures (CATR) often require surgical intervention to restore function. Despite numerous treatment modalities available, the optimal management strategy remains controversial given the limited high-quality evidence available. This article aims to provide evidence-based guidelines for the surgical management of CATR through a comprehensive systematic review of the available data. The consensus reached by synthesizing the findings will assist clinicians in making informed decisions and improving patient outcomes.

METHODS

A group of 9 foot surgeons in three continents was consulted to gather their expertise on guidelines regarding the surgical management of CATR. Following the proposal of 9 clinical topics, a thorough and comprehensive search of relevant literature published since 1980 was conducted for each topic using electronic databases, including PubMed, MEDLINE, and Cochrane Library, to identify relevant studies published until 1 October 2023. All authors collaborated in drafting, discussing, and finalizing the recommendations and statements. The recommendations were then categorized into two grades: grade a (strong) and grade b (weak), following the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) concept. Additionally, feedback from 21 external specialists, who were independent from the authors, was taken into account to further refine and finalize the clinical guidelines.

RESULTS

Nine statements and guidelines were completed regarding surgical indications, surgical strategies, and postoperative rehabilitation protocol.

CONCLUSION

Based on the findings of the systematic review, this guideline provides recommendations for the surgical management of CATR. We are confident that this guideline will serve as a valuable resource for physicians when making decisions regarding the surgical treatment of patients with CATR.