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Qianman B, Wupuer A, Jiasharete T, Luo B, Nihemaiti M, Jielile J. iTRAQ-based proteomics reveals potential markers and treatment pathways for acute Achilles tendon rupture. J Orthop Surg Res 2023; 18:852. [PMID: 37946221 PMCID: PMC10636927 DOI: 10.1186/s13018-023-04346-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Due to its limited blood supply and irregular mechanical loading, the Achilles tendon is the most frequently ruptured tendon. Despite the rising incidence of acute Achilles tendon rupture (AATR), the optimal treatment remains controversial. Missed diagnoses and delayed treatments lead to poor outcomes and limited treatment options. This study aimed to identify potential biomarkers for diagnosing and developing therapies for AATR. METHODS We employed the coupled isobaric tag for relative and absolute quantitation-liquid chromatography-electrospray ionization-tandem mass spectrometry approach to investigate protein expression in tissues from AATR patients. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were conducted to identify differentially expressed proteins (DEPs) between AATR patients and healthy individuals. A protein-protein interaction (PPI) network of DEPs was constructed using the Search Tool for the Retrieval of Interacting Genes. The screened hub genes were selectively verified by immunohistochemical staining. RESULTS We identified 410 DEPs between AATR patients and controls. The DEPs were significantly enriched in GO terms such as the extracellular region, extracellular region part, and defense response, as well as KEGG pathways, including complement and coagulation cascades, focal adhesion, and regulation of actin cytoskeleton. The main hub nodes in the PPI network comprised fibronectin 1 (FN1), major histocompatibility complex, class I, B (HLA-B), filamin A (FLNA), heat shock 27-kDa protein 1 (HSPB1), heat shock protein family A member 5 (HSPA5), apolipoprotein A4 (APOA4), and myosin IC (MYO1C). Although APOA4 and collagens I, II, and III were detectable in healthy tendons, immunohistochemical staining confirmed higher expression of these proteins in the acutely ruptured Achilles tendon. CONCLUSIONS Our findings lay a foundation for further molecular studies of AATR. Inflammation and age-related degeneration may contribute to the pathogenesis of AATR. Moreover, the identified DEPs could be potential biomarkers for AATR diagnosis and treatment.
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Affiliation(s)
- Bayixiati Qianman
- Department of Osteopathy and Orthopedics (Ankle) Surgery, The Sixth Teaching Hospital of Xinjiang Medical University, No. 39 Wuxing South Road, Ürümqi, 830001, Xinjiang Uygur Autonomous Region, China
| | - Aikeremu Wupuer
- Department of Osteopathy and Orthopedics (Ankle) Surgery, The Sixth Teaching Hospital of Xinjiang Medical University, No. 39 Wuxing South Road, Ürümqi, 830001, Xinjiang Uygur Autonomous Region, China
| | - Tuomilisi Jiasharete
- Urumqi No.1 Middle School, No. 195, West 2nd Lane, Kanas Hubei Road, Urumqi Economic and Technological Development Zone (Toutunhe District), Ürümqi, 830015, Xinjiang Uygur Autonomous Region, China
| | - Biao Luo
- Department of Orthopaedics, Pingmei Shenma Medical Group General Hospital, No.1 South of Kuanggoong Middle Road, Xinhua District, Pingdingshan, 467000, Henan, China
| | - Meihua Nihemaiti
- Altay Traditional Chinese Medicine Hospital (Regional Kazakh Medical Hospital) in Xinjiang Uygur Autonomous Region, No. 40 Yingbin Road, Altay City, 836500, Xinjiang Uygur Autonomous Region, China
| | - Jiasharete Jielile
- Department of Osteopathy and Orthopedics (Ankle) Surgery, The Sixth Teaching Hospital of Xinjiang Medical University, No. 39 Wuxing South Road, Ürümqi, 830001, Xinjiang Uygur Autonomous Region, China.
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De la Fuente C, Henriquez H, Carmont MR, Huincahue J, Paredes T, Tapia M, Araya JP, Díaz N, Carpes FP. Do the heel-rise test and isometric strength improve after Achilles tendon repair using Dresden technique? Foot Ankle Surg 2022; 28:37-43. [PMID: 33509663 DOI: 10.1016/j.fas.2021.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Achilles' tendon ruptures result in impaired plantar flexion strength and endurance. It is interesting to know the plantar flexion strength, the number of heel-rise repetitions, and the maximal calf circumference following Achilles' tendon ruptures repair. METHODS Both the injured and non-injured legs of thirty male patients with Achilles' tendon ruptures treated with the percutaneous Dresden technique were compared with the ankle function of 30 healthy participants. Rehabilitation involved partial weight-bearing for three weeks and then increased to full weight-bearing and ankle exercises. RESULTS The injured legs had weaker plantar flexion strength (1.64 ± 0.17 Nm/kg) compared with the non-injured legs (1.91 ± 0.24 Nm/kg; p = 0.002) and the healthy participants' legs (1.93 ± 0.32 Nm/kg; p < 0.001). The non-injured leg had greater ability in doing heel-rise repetitions (39.4 ± 6.1 rep.) compared with the injured legs (37.2 ± 5.7 rep.; p < 0.023) and the healthy participants' legs (31.0 ± 13.0 rep.; p < 0.001). CONCLUSIONS The injured leg had not recovered full isometric strength but had improved heel-rise repetition.
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Affiliation(s)
- Carlos De la Fuente
- Laboratory of Neuromechanics, Universidade Federal do Pampa #97500-970, Campus Uruguaiana, Uruguaiana, Brazil; Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile; Clinica MEDS, Santiago #7691236, Santiago, Chile; Centro de Salud Deportiva, Clinica Santa Maria, Santiago #7520380, Santiago, Chile
| | - Hugo Henriquez
- Centro de Salud Deportiva, Clinica Santa Maria, Santiago #7520380, Santiago, Chile; Traumatologia, Facultad de Medicina, Instituto Traumatológico-Universidad de Chile, Universidad de Chile, Santiago #8340220, Chile
| | - Michael R Carmont
- Department of Trauma and Orthopaedic Surgery, Princess Royal Hospital, Shrewsbury and Telford Hospital NHS Trust #TF16TF, Shropshire, UK
| | - Javiera Huincahue
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile
| | - Tamara Paredes
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile
| | - María Tapia
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile
| | - Juan Pablo Araya
- Carrera de Kinesiología, Departamento de Cs. de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile #7820244, Santiago, Chile
| | - Nicolás Díaz
- Interno de Medicina, Facultad de Medicina #8340220, Universidad de Chile, Santiago, Chile
| | - Felipe P Carpes
- Laboratory of Neuromechanics, Universidade Federal do Pampa #97500-970, Campus Uruguaiana, Uruguaiana, Brazil.
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Zellers JA, Christensen M, Kjær IL, Rathleff MS, Silbernagel KG. Defining Components of Early Functional Rehabilitation for Acute Achilles Tendon Rupture: A Systematic Review. Orthop J Sports Med 2019; 7:2325967119884071. [PMID: 31803789 PMCID: PMC6878623 DOI: 10.1177/2325967119884071] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Early functional rehabilitation is frequently discussed in treating Achilles tendon rupture. A consistent definition of what constitutes early functional rehabilitation has not been established across the literature, despite studies supporting its efficacy. A standardized definition would be helpful to pool data across studies, allow for between-study comparisons, and ultimately work toward developing clinical guidelines. PURPOSE To define early functional rehabilitation (including when it is initiated and what it entails) when used to treat Achilles tendon rupture and to identify outcome measures for evaluating the effect of treatment. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS Ovid MEDLINE, EMBASE, PEDro, CINAHL, and Cochrane databases were searched for relevant studies. Eligibility criteria for selecting studies consisted of randomized controlled trials, cohort studies, and case series (≥10 participants) including weightbearing or exercise-based interventions within 8 weeks after Achilles tendon rupture. RESULTS A total of 174 studies published between 1979 and 2018 were included. Studies were rated a median (interquartile range [IQR]) of 17 (15-20) on the Downs & Black checklist and included 9098 participants. Early functional rehabilitation incorporated weightbearing (95%), range of motion (73%), and isometric/strengthening exercises (50%). Weightbearing was initiated within the first week, whereas exercise (eg, ankle range of motion, strengthening, whole-body conditioning) was initiated in the second week. Initiation of exercises varied based on whether treatment was nonsurgical (mean, 3.0 weeks; IQR, 2.0-4.0 weeks) or simple (mean, 2.0 weeks; IQR, 0.0-2.3 weeks) or augmented surgical repair (mean, 0.5 weeks; IQR, 0.0-2.8 weeks) (P = .017). Functional outcomes including ankle range of motion (n = 84) and strength (n = 76) were reported in 130 studies. Other outcome domains included patient-reported outcomes (n = 89), survey-based functional outcomes (n = 50), and tendon properties (n = 53). CONCLUSION Early functional rehabilitation includes weightbearing and a variety of exercise-based interventions initiated within the first 2 weeks after acute Achilles tendon rupture/repair. Because early functional rehabilitation has lacked a standardized definition, interventions and outcome measures are highly variable, and pooling data across studies should be done with attention paid to what was included in the intervention and how treatment was assessed.
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Affiliation(s)
- Jennifer A. Zellers
- Program in Physical Therapy, Washington University School of Medicine in St Louis, St Louis, Missouri, USA
| | - Marianne Christensen
- Physiotherapy and Occupational Therapy, Aalborg University Hospital, Aalborg, Denmark
- Orthopaedic Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Inge Lunding Kjær
- Orthopaedic Research Unit, Aalborg University Hospital, Aalborg, Denmark
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Aisaiding A, Wang J, Maimaiti R, Jialihasi A, Aibek R, Qianman B, Shawutali N, Badelihan A, Bahetiya W, Kubai A, Kelamu M, Nuerdoula Y, Makemutibieke E, Bakyt Y, Wuerliebieke J, Jielile J. A novel minimally invasive surgery combined with early exercise therapy promoting tendon regeneration in the treatment of spontaneous Achilles tendon rupture. Injury 2018; 49:712-719. [PMID: 29153451 DOI: 10.1016/j.injury.2017.10.046] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 10/27/2017] [Accepted: 10/29/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Acute closed spontaneous Achilles tendon rupture often occurs in elderly individuals and is usually accompanied with many complications. Conventional surgical approaches to remove the tendon lesions and enthesophytes are highly traumatic and cause complications. In this study, a previously established minimally invasive surgical approach was modified and combined with a Kazakh exercise therapy to reduce trauma, improve wound healing, and promote tendon regeneration in the management of acute closed spontaneous Achilles tendon rupture. METHODS Fifty-two patients with acute closed spontaneous Achilles tendon rupture were randomly classified into 2 groups. Group A included 23 patients that were treated with the novel approach. Group B included 29 patients that were treated with a continuous medial oblique surgical approach. Follow-up examinations were performed at post-operative weeks 12 and 24, and year 2. Outcomes were assessed by Achilles tendon rupture score (ATRS), a heel-rise endurance test, and ultrasonographic and multislice spiral computerized tomography. RESULTS Mean ATRS in Group A was 68.6 and 86.0 at post-operative week 12 and 24, respectively, significantly higher than that in Group B (55.9 and 72.0, respectively). Recovery of patients in Group A was significantly better compared to Group B (p < 0.01), allowing them to participate in early rehabilitating kinesiotherapy. Patients in Group A rarely experienced complications after surgery, such as infection and Achilles tendon exposure, while in Group B, the wound healing was slower, the inside flaps were prone to necrosis and infection, and Achilles tendon exposure occurred in 10% of patients. CONCLUSIONS The novel minimally invasive surgery is more advantageous in the treatment of acute closed spontaneous Achilles tendon rupture over previous approaches by promoting wound healing and tendon regeneration.
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Affiliation(s)
- Amuding Aisaiding
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Jianping Wang
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Rouziwanguli Maimaiti
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Ayidaer Jialihasi
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Rakimbaiev Aibek
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Bayixiati Qianman
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Nuerai Shawutali
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Ayinazi Badelihan
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Wulan Bahetiya
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Aliya Kubai
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Mailamuguli Kelamu
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Yeermike Nuerdoula
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Elihaer Makemutibieke
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Yerzat Bakyt
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Jianati Wuerliebieke
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China
| | - Jiasharete Jielile
- Department of Microrepair and Reconstruction of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, The Sports Medicine Research Centre of Orthopedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, 830054, China.
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Development of an accelerated functional rehabilitation protocol following minimal invasive Achilles tendon repair. Knee Surg Sports Traumatol Arthrosc 2018; 26:846-853. [PMID: 26410099 DOI: 10.1007/s00167-015-3795-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 09/15/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Surgical repair after acute Achilles tendon rupture leads to lower re-rupture rates than non-surgical treatment. After open repair, early functional rehabilitation improves outcome, but there are risks of infection and poor wound healing. Minimal invasive surgery reduces these risks; however, there are concerns about its stability. Consequently, physicians may have reservations about adopting functional rehabilitation. There is still no consensus about the post-operative treatment after minimal invasive repair. The aim of this study was to define the most effective and safe post-operative rehabilitation protocol following minimal invasive repair. METHODS A systematic literature search in Embase, MEDLINE and Cochrane Library for prospective trials reporting on early functional rehabilitation after minimal invasive repair was performed. Seven studies were included. RESULTS One randomized controlled trail, one prospective comparative and five prospective non-comparative studies were identified. Four studies performed full weight bearing, all demonstrating good functional results, an early return to work/sports and high satisfaction. One study allowed early mobilization leading to excellent subjective and objective results. The only randomized controlled trial performed the most accelerated protocol demonstrating a superior functional outcome and fewer complications after immediate full weight bearing combined with free ankle mobilization. The non-comparative study reported high satisfaction, good functional results and an early return to work/sports following combined treatment. CONCLUSION Immediate weight bearing in a functional brace, together with early mobilization, is safe and has superior outcome following minimally invasive repair of Achilles tendon rupture. Our recommended treatment protocol provides quality assurance for the patient and reliability for the attending physician. LEVEL OF EVIDENCE II.
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Qianman B, Jialihasi A, Asilehan B, Kubai A, Aibek R, Wupuer A, Tangkejie W, Maimaitiaili A, Shawutali N, Badelhan A, Aizezi A, Aisaiding A, Wuerliebieke J, Bakyt Y, Makemutibieke E, Jielile J. Active exercise promotes Achilles tendon healing and is accompanied by the upregulation of collapsin response mediator protein‑2 in rats. Mol Med Rep 2017; 16:2355-2360. [PMID: 28677754 DOI: 10.3892/mmr.2017.6889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 01/20/2017] [Indexed: 11/05/2022] Open
Abstract
Collapsin response mediator protein-2 (CRMP-2) is involved in neurite elongation and regeneration; however, its role in wound healing remains to be elucidated. The present study aimed to investigate the effects of active mobilization treatment on Achilles tendon healing and to determine the role of CRMP‑2 in the healing process. Sprague Dawley rats were subjected to Achilles tendon injury, which was verified by hematoxylin and eosin staining and scanning electronic microscopy. Immobilization induced the disruption of collagen fibril arrangement and promoted collagen fibril damage. The average collagen fibril perimeter in the active mobilization group was significantly increased compared with in the immobilization group (125.6±0.8 nm vs. 119.9±1.7 nm; P<0.05). In addition, immunohistological analysis revealed that CRMP‑2 expression was significantly upregulated, particularly in the ruptured site of Achilles tendon tissues derived from animals in the mobilization group compared with the immobilization group (0.32±0.00 vs. 0.08±0.00; P<0.05). The increased CRMP‑2 levels were also confirmed by western blotting (active mobilization group, 0.71±0.03; immobilization group, 0.49±0.01 nm; P<0.05). These results indicated that active mobilization may promote Achilles tendon healing via upregulation of CRMP‑2 protein expression.
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Affiliation(s)
- Bayixiati Qianman
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Ayidaer Jialihasi
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Batiza Asilehan
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Aliya Kubai
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Rakimbaiev Aibek
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Aikeremu Wupuer
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Wulanbai Tangkejie
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Abudouheilil Maimaitiaili
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Nuerai Shawutali
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Aynaz Badelhan
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Adili Aizezi
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Amuding Aisaiding
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Jianati Wuerliebieke
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Yerzat Bakyt
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Elihaer Makemutibieke
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
| | - Jiasharete Jielile
- Department of Orthopedics Centre, The First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region and The Sports Medicine Research Centre of Orthopedics Research Institute, Urumqi, Xinjiang Uygur Autonomous Region 830054, P.R. China
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De la Fuente CI, Lillo RPY, Ramirez-Campillo R, Ortega-Auriol P, Delgado M, Alvarez-Ruf J, Carreño G. Medial Gastrocnemius Myotendinous Junction Displacement and Plantar-Flexion Strength in Patients Treated With Immediate Rehabilitation After Achilles Tendon Repair. J Athl Train 2016; 51:1013-1021. [PMID: 27922288 DOI: 10.4085/1062-6050-51.12.23] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
CONTEXT Pathologic plantar flexion frequently occurs after operative repair of the Achilles tendon (AT) because of immobilization and non-weight bearing in the first weeks of traditional rehabilitation. Novel rehabilitation strategies that apply mobilization and weight bearing have been proposed, but their effects on medial gastrocnemius myotendinous junction displacement (MJD) and isometric plantar-flexion strength (PFS) are unknown. OBJECTIVE To compare the effects of 12 weeks of immediate versus traditional rehabilitation on MJD and PFS in patients with percutaneous AT repair and to compare AT rupture scores (ATRSs) during follow-up. DESIGN Controlled laboratory study. SETTING Human performance laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 26 amateur soccer players (age = 42.3 ± 9.7 years, body mass index = 29.5 ± 3.9 kg/m2) with percutaneous AT repair. INTERVENTION(S) Athletes were randomly divided into 2 groups: an immediate group, given physical therapy from day 1 to day 84, and a traditional group, given physical therapy from day 29 to day 84. We used repeated-measures analysis of variance to compare the data. MAIN OUTCOME MEASURE(S) We measured MJD and PFS at days 28 (fourth week), 56 (eighth week), and 84 (12th week) after AT repair. RESULTS After 12 weeks of rehabilitation, we observed a large clinically meaningful effect and statistical difference between groups. At day 28, the immediate group showed higher values for PFS (P = .002), MJD (P = .02), and ATRS (P = .002) than the traditional group. At day 56, the immediate group presented higher values for MJD (P = .02) and ATRS (P = .009). At day 84, the immediate group registered more MJD (P = .001). CONCLUSIONS Compared with traditional rehabilitation, 12 weeks of immediate rehabilitation after percutaneous AT repair resulted in better MJD, PFS, and ATRS after 4 weeks; better MJD and ATRS after 8 weeks; and better MJD after 12 weeks.
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Affiliation(s)
- Carlos I De la Fuente
- Carrera de kinesiología, UDA Cs de la salud, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago.,Facultad Cs de la Rehabilitacion, Universidad Andres Bello, Santiago, Chile
| | | | | | | | - Mauricio Delgado
- Carrera de kinesiología, UDA Cs de la salud, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago
| | - Joel Alvarez-Ruf
- Universidad Metropolitana de ciencias de la Educación, Santiago, Chile
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Jielile J, Asilehan B, Wupuer A, Qianman B, Jialihasi A, Tangkejie W, Maimaitiaili A, Shawutali N, Badelhan A, Niyazebieke H, Aizezi A, Aisaiding A, Bakyt Y, Aibek R, Wuerliebieke J. Early Ankle Mobilization Promotes Healing in a Rabbit Model of Achilles Tendon Rupture. Orthopedics 2016; 39:e117-26. [PMID: 26821224 DOI: 10.3928/01477447-20160106-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 06/15/2015] [Indexed: 02/03/2023]
Abstract
The use of early mobilization of the ankle joint without orthosis in the treatment of Achilles tendon rupture has been advocated as the optimal management. The goal of this study was to compare outcomes in a postoperative rabbit model of Achilles tendon rupture between early mobilization and immobilized animals using a differential proteomics approach. In total, 135 rabbits were randomized into the control group (n=15), the postoperative cast immobilization (PCI) group (n=60), and the early mobilization (EM) group (n=60). A rupture of the Achilles tendon was created in each animal model and repaired microsurgically, and tendon samples were removed at 3, 7, 14, and 21 days postoperatively. Proteins were separated using 2-dimensional polyacrylamide gel electrophoresis and identified using peptide mass fingerprinting, tandem mass spectrometry, NCBI database searches, and bioinformatics analyses. A series of differentially expressed proteins were identified between groups, some of which may play an important role in Achilles tendon healing. Notable candidate proteins that were upregulated in the EM group were identified, such as CRMP-2, galactokinase 1, tropomyosin-4, and transthyretin. The healing of ruptured Achilles tendons appears to be affected at the level of protein expression with the use of early mobilization. The classic postoperative treatment of Achilles tendon rupture with an orthosis ignored the self-protecting instinct of humans. With a novel operative technique, the repaired tendon can persist the load that comes from traction in knee and ankle joint functional movement. In addition, kinesitherapy provided an excellent experimental outcome via a mechanobiological mechanism.
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9
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Jielile J, Badalihan A, Qianman B, Satewalede T, Wuerliebieke J, Kelamu M, Jialihasi A. Clinical outcome of exercise therapy and early post-operative rehabilitation for treatment of neglected Achilles tendon rupture: a randomized study. Knee Surg Sports Traumatol Arthrosc 2016; 24:2148-55. [PMID: 25894749 DOI: 10.1007/s00167-015-3598-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2013] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Treatment of neglected Achilles tendon rupture is very challenging. This randomized study aimed to compare the clinical outcome of early post-operative rehabilitation (EPR) with post-operative cast immobilization (PCI). METHODS Fifty-seven patients with neglected Achilles tendon rupture were randomized to receive EPR (n = 26) or PCI (n = 31) management following surgery. Clinical outcome was monitored by follow-up at weeks 8, 12, 18 and 26 and year 2. The significance of intergroup differences from the Leppilahti scoring system (LSS), ultrasonography, multislice spiral computerized tomography (MSCT) and electromyography was assessed. RESULTS Ultrasonography and MSCT revealed no occurrence of tendon elongation or adhesion. Four patients could perform sustained single-leg heel-raise exercise for 60 s at post-operative day 40. The PCI group also showed increased post-operative LSS score, but recovery was slower. Post-operative complications, such as ankle joint ankylosis and osteoporosis, only occurred in the PCI group. CONCLUSIONS Compared with cast immobilization, early post-operative rehabilitation results in better clinical outcome and faster overall tendon regeneration of neglected Achilles tendon rupture. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Jiasharete Jielile
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Ayinazi Badalihan
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Bayixiati Qianman
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Tuerde Satewalede
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Jianati Wuerliebieke
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Mailamuguli Kelamu
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China
| | - Ayidaer Jialihasi
- Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Sports Medicine Research Centre of Orthopaedics Research Institute, and Kazakh Traditional Medical Association of Xinjiang, No. 137 Liyushan South Road, Urumqi, 830054, Xinjiang Uygur Autonomous Region, China.
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10
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Badalihan A, Aihemaiti A, Shawutali N, Jielile J, Jialihasi A, Tangkejie W, Nuerdoula Y, Satewalede T, Hunapiya B, Niyazebieke H, Hezibieke H, Zhao Q, Bahetijiang A, Kelamu M, Qianman B. Outcome of a one-stage tensile stress surgical technique and early postoperative rehabilitation in the treatment of neglected achilles tendon rupture. J Foot Ankle Surg 2015; 54:153-9. [PMID: 25703445 DOI: 10.1053/j.jfas.2014.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Indexed: 02/03/2023]
Abstract
The present study evaluated the effect of single-stage internal traction combined with early postoperative active rehabilitation and the yurt bone suture method, a new surgical technique, on the clinical outcomes after surgical repair of Achilles tendon. A total of 51 patients with neglected Achilles tendon rupture who underwent the yurt bone suture treatment also participated in an accelerated postoperative rehabilitation program. The clinical outcome was evaluated for 18 weeks using the Leppilahti scoring system, bilateral ultrasound examination, and computed tomography examination. The ultrasound and computed tomography examinations revealed that Achilles tendon elongation and adhesion occurred in none of the patients. All the patients could perform the single leg heel raise exercise for a mean of 30 ± 7.6 seconds at 12 weeks postoperatively. In addition, the patients could participate in sport exercises and heavy physical activities by around 13 weeks postoperatively. The mean Leppilahti score was 85.8 ± 3.7 at 8 weeks postoperatively, and it had increased to 96.1 ± 3.2 and 100.0 ± 0.0 at 12 and 18 weeks, respectively, after the operation. The 1-stage internal traction technique, combined with early postoperative active rehabilitation and the yurt bone surgical technique, resulted in good clinical outcomes for the treatment of neglected Achilles tendon rupture.
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Affiliation(s)
- Ayinazi Badalihan
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | | | - Nuerai Shawutali
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Jiasharete Jielile
- Assistant Professor, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China.
| | - Ayidaer Jialihasi
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Wulanbai Tangkejie
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Yeermike Nuerdoula
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Turde Satewalede
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Beisen Hunapiya
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Hadelebieke Niyazebieke
- Surgeon, Department of Orthopaedics, Kazakh Traditional Medical Hospital of Toli County, Tacheng Prefecture, Toli County, Xinjiang, China
| | - Hayilat Hezibieke
- Orthopedist, Department of Orthopaedics, People's Hospital of Shawan County, Shawan, Xinjiang, China
| | - Qin Zhao
- Associate Professor, Department of Ultrasonographic Examination, Institute of Medical Image Canter, First Teaching Hospital of Xinjiang Medical University, Urumqi, China
| | - Ahezhuoli Bahetijiang
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Mailamuguli Kelamu
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
| | - Bayixiati Qianman
- Orthopedist, Department of Orthopaedics Centre, First Teaching Hospital of Xinjiang Medical University, Kazakh Medical Association of Xinjiang Uygur Autonomous Region, and Sports Medicine Research Centre of Orthopaedics Research Institute, Xinjiang Uygur Autonomous Region, Urumqi, China
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11
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Guelfi M, Pantalone A, Vanni D, Rosati D, Guelfi MGB, Salini V. Bilateral traumatic rupture of Achilles tendons in absence of risk factors treated with percutaneous technique and platelet-rich plasma: a case report. Foot Ankle Surg 2014; 20:e43-6. [PMID: 25103716 DOI: 10.1016/j.fas.2014.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 04/02/2014] [Accepted: 05/01/2014] [Indexed: 02/04/2023]
Abstract
We present a clinical case of a 52-year-old man with bilateral traumatic rupture of the Achilles tendon (AT) in absence of risk factors. In medical history, the patient does not report pre-existing tendon diseases. AT ruptures occurred following a skiing injury in which the forward fall caused a severe stress and elongation of the AT. Associated with tendon injury there was a fracture of the right humeral greater tuberosity. The patient was subjected to percutaneous tenorraphy according to Maffulli's technique and subsequently topical injection of autologous platelet-rich plasma (PRP) 7 days after the injury. After surgery, the patient followed an accelerated rehabilitation protocol, allowing the weight bearing with guards (Rom-Walker) and crutches to four weeks then freely to 8 weeks. We performed a clinical (AOFAS ankle-hindfoot score) and ultrasonography follow-up at month 1, 3, 6 and 12, with excellent results in the end. To the best of our knowledge bilateral cases like this have not been described in the literature.
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Affiliation(s)
- Matteo Guelfi
- Orthopaedic and Traumatology Division, "G. d'Annunzio" University, Via dei Vestini 35, 66013 Chieti, Italy.
| | - Andrea Pantalone
- Orthopaedic and Traumatology Division, "G. d'Annunzio" University, Via dei Vestini 35, 66013 Chieti, Italy
| | - Daniele Vanni
- Orthopaedic and Traumatology Division, "G. d'Annunzio" University, Via dei Vestini 35, 66013 Chieti, Italy
| | - Denise Rosati
- Orthopaedic and Traumatology Division, "G. d'Annunzio" University, Via dei Vestini 35, 66013 Chieti, Italy
| | - Marco G B Guelfi
- Orthopaedic Division, Clinica Montallegro, Via M.Te Zovetto 27, 16145 Genoa, Italy.
| | - Vincenzo Salini
- Orthopaedic and Traumatology Division, "G. d'Annunzio" University, Via dei Vestini 35, 66013 Chieti, Italy.
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