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Prasetia R, Purwana SZB, Hidajat NN, Rasyid HN. Total elbow arthroplasty with tricep turn-down flap in an old unreduced elbow dislocation: A case report. Int J Surg Case Rep 2023; 108:108432. [PMID: 37356201 PMCID: PMC10382776 DOI: 10.1016/j.ijscr.2023.108432] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 06/27/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE The treatment preference for neglected elbow dislocation is by open reduction and lengthening the tricep muscle. If the dislocation is not reduced for more than 6 months, degenerative resorption would have occurred. We did total elbow arthroplasty (TEA) with a tricep turn-down flap for the management in this case. The use of a tricep flap for tricep shortening after unreduced elbow dislocation has been reported in previous publications but none used a turn-down flap. CASE PRESENTATION An 82-year-old woman came to the orthopedic outpatient clinic with pain and discomfort on her right elbow. The arm affected by the injury was her dominant hand, restricting her from farming and leisure activities. Exploration findings confirmed the presence of a dislocated elbow with associated soft tissue complications. The cartilage was degeneratively destructed, and the tricep muscle was retracted. CLINICAL DISCUSSION In our case, tricep shortening was managed with elongation using a turn-down flap. The lack of soft tissue layers and thin fibrous fascias results in tension-vulnerable TEA surgical wounds. This is caused by the insufficient coverage of the joint, which leads to wound complications. Previous studies of turn-down flap procedures showed good flap survival and functional outcomes. CONCLUSION Tricep turn-down flap could be an option for tricep lengthening procedures in unreduced neglected elbow joint dislocation.
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Affiliation(s)
- Renaldi Prasetia
- Department of Orthopaedics - Traumatology, Universitas Padjadjaran, Hasan-Sadikin General Hospital, Bandung, Indonesia.
| | - Siti Zainab Bani Purwana
- Faculty of Medicine, Universitas Padjadjaran, Hasan-Sadikin General Hospital, Bandung, Indonesia
| | - Nucki Nursjamsi Hidajat
- Department of Orthopaedics - Traumatology, Universitas Padjadjaran, Hasan-Sadikin General Hospital, Bandung, Indonesia
| | - Hermawan Nagar Rasyid
- Department of Orthopaedics - Traumatology, Universitas Padjadjaran, Hasan-Sadikin General Hospital, Bandung, Indonesia
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Nair V, Solunke S, Patil VS, Jawa S, Abhyankar R. A Case of Chronic Rupture of Achilles Tendon Managed Using a Combination of Multiple Surgical Techniques. Cureus 2023; 15:e37171. [PMID: 37153276 PMCID: PMC10162694 DOI: 10.7759/cureus.37171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 04/08/2023] Open
Abstract
Achilles tendon rupture is a common injury that occurs due to sudden dorsiflexion of the plantar-flexed foot. Both acute and chronic ruptures are frequently misdiagnosed and mistreated. Acute Achilles tendon rupture commonly occurs in middle-aged individuals (30-40 years). Although several operative procedures are available for Achilles tendon repair, the management of choice remains controversial and debatable. A 27-year-old male came to our clinic complaining of pain over the left ankle for the last five months. History revealed trauma caused by a heavy metal object five months ago. Physical examination revealed tenderness and swelling over the left heel. Ankle plantar flexion was restricted, and painful and squeeze test was positive. Magnetic resonance imaging was suggestive of a tear of the Achilles tendon in the left ankle. Surgical management was done with multiple techniques which included flexor hallucis longus tendon graft augmentation, end-to-end suturing (Krackow technique), V-Y plasty, and bioabsorbable suture anchor. Although complications such as scar stiffness and wound gaping are common in such cases, the postoperative outcome was excellent in our case according to the American Orthopedic Foot and Ankle Score.
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[Less invasive turn-down flap tendinoplasty in chronic Achilles tendon rupture]. OPERATIVE ORTHOPADIE UND TRAUMATOLOGIE 2022; 34:381-391. [PMID: 36036248 DOI: 10.1007/s00064-022-00782-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 04/06/2022] [Accepted: 05/15/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Bridging the defect in chronic ruptures of the Achilles tendon via a turn-down flap of the aponeurosis sparing the skin of the rupture zone. INDICATIONS Chronic Achilles tendon rupture with a defect distance ≤ 6 cm. CONTRAINDICATIONS Extended Achilles tendon defect interval ≥ 7 cm, chronic wounds or infections near the surgical approach, higher degrees of arterial or venous malperfusion, complex regional pain syndrome. SURGICAL TECHNIQUE Dorsomedial surgical approach proximal to the rupture zone, splitting of the crural fascia, loading of the distal Achilles tendon stump with a nonresorbable augmentation suture using the Dresden instrument, preparation of the turn-down flap of the aponeurosis securing the turning point with a catching suture. Transfer of the turn-down tendon flap under the skin bridge and suture to the distal tendon stump tying the augmentation suture under adequate pretension simultaneously closing the gap in the aponeurosis. Alternative technique: free advancement of the autologous tendon graft. POSTOPERATIVE MANAGEMENT Anterior splint in 20° of plantar flexion, consecutive mobilization and rehabilitation similar to the percutaneous technique in acute Achilles tendon rupture with the Dresden instrument. Lower leg orthosis with 20° of plantarflexion for 8 weeks, then stepwise reduction of the heel height. Physiotherapy beginning from the 2nd postoperative week, active full-range of ankle motion from 6 weeks after surgery. RESULTS In general, worse results than in percutaneous reconstruction of acute Achilles tendon injuries. Despite this, high degrees of patient satisfaction with a low rate of postsurgical complications and good functional outcome with admittedly poor data availability. Relevant increase of plantar flexion strength depending on the amount of degeneration of the triceps surae muscle.
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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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Bilge A, Kuru T. Results of Surgical Management of Achilles Tendon Rupture Using the Modified Lindholm Procedure. Cureus 2020; 12:e9159. [PMID: 32789095 PMCID: PMC7417327 DOI: 10.7759/cureus.9159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objectives Achilles tendon rupture (ATR) in adults often results from sporting activities, especially in young adults. There is no consensus in the literature on the best treatment approach in the treatment of these ruptures. The objective of this study was to evaluate the clinical long-term results of the augmented ATR repair using the modified Lindholm procedure (MLP). Methods Patients who underwent MLP due to ATR in the orthopedics and traumatology clinic of our hospital between 2007 and 2014 were retrospectively evaluated. Medical history of the patients was noted, and preoperative physical examination was routinely performed using the Thompson compression test. Patients’ demographic data such as age and gender, tendon rupture side, postoperative follow-up duration, and gap range values were recorded and evaluated. Results The mean age of the patients was 29.43 ± 7.10 years. The mean postoperative follow-up duration was 50.1 ± 8.20 months. Of the patients, 16 were injured during football, 10 during basketball, 2 during volleyball, and the remaining 8 during other sporting activities. When Arner-Lindholm scores were evaluated during follow-up, excellent outcome was achieved in 30 patients and good outcome was achieved in 6 patients, whereas there was no patient with poor outcome. None of the patients developed tendon re-rupture. At the end of the fourth postoperative month, the range of ankle motion was 100% in all patients. Conclusions In patients with spontaneous AT tendon rupture, MLP seems to prevent the re-rupture in the long-term period and should be considered as a safe procedure to repair ATR.
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Affiliation(s)
- Ali Bilge
- Orthopaedics and Traumatology, Canakkale Onsekiz Mart University, Canakkale, TUR
| | - Tolgahan Kuru
- Orthopaedics and Traumatology, Canakkale Onsekiz Mart University, Canakkale, TUR
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Cui J, Chen Z, Wu W. Expression of TGF-β1 and VEGF in patients with Achilles tendon rupture and the clinical efficacy. Exp Ther Med 2019; 18:3502-3508. [PMID: 31602226 PMCID: PMC6777322 DOI: 10.3892/etm.2019.7968] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/10/2019] [Indexed: 12/20/2022] Open
Abstract
Expression of transforming growth factor-β1 (TGF-β1) and vascular endothelial growth factor (VEGF) in patients with Achilles tendon rupture, and the predictive values and significance in clinical efficacy were explored. Forty-two patients with Achilles tendon rupture, surgically treated in the First Affiliated Hospital of University of South China, were selected and the clinical efficacy was evaluated based on the American Orthopaedic Foot and Ankle Society (AOFAS) scoring system. RT-qPCR was adopted to detect the expression of serum TGF-β1 and VEGF in the patients before and after treatment, and Spearman's correlation was used to analyze the correlation of TGF-β1 and VEGF with the clinical efficacy after treatment. Patients were divided into an excellent efficacy group and a good/general efficacy group according to the predictive efficacy. In the two groups, the expression levels of TGF-β1 and VEGF before treatment were observed, and the predictive values of TGF-β1 and VEGF in clinical efficacy using the receiver operating characteristic (ROC) curves were obtained. The 42 patients showed significantly higher expression of TGF-β1 and VEGF at 3 months after treatment, and significantly decreased expression at 6 months after treatment, compared to the results before treatment (both P<0.001). After treatment, the efficacy was excellent in 11 patients, good in 25 and general in 6. Spearman's correlation analysis revealed that the expression of TGF-β1 and VEGF decreased with the improvement of efficacy after treatment (P<0.001), and the excellent efficacy group showed significantly lower expression of TGF-β1 and VEGF than that in the good/general efficacy group (P<0.01). Moreover, according to ROC curves, the areas under the curves (AUCs) of TGF-β1 and VEGF were 0.651 and 0.645, respectively. In conclusion, TGF-β1 and VEGF can be considered as observational indexes and predictors for clinical efficacy in patients with Achilles tendon rupture, before and after treatment.
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Affiliation(s)
- Juncheng Cui
- Department of Orthopaedics, First Affiliated Hospital of University of South China, Henyang, Hunan 421001, P.R. China
| | - Zhiwei Chen
- Department of Orthopaedics, First Affiliated Hospital of University of South China, Henyang, Hunan 421001, P.R. China
| | - Wente Wu
- Department of Orthopaedics, First Affiliated Hospital of University of South China, Henyang, Hunan 421001, P.R. China
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Kelahmetoglu O, Gules ME, Elmadag NM, Guneren E, Sonmez Ergun S. Double-Layer Reconstruction of the Achilles' Tendon Using a Modified Lindholm's Technique and Vascularized Fascia Lata. J Hand Microsurg 2017; 10:49-51. [PMID: 29706738 DOI: 10.1055/s-0037-1608745] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022] Open
Abstract
Loss of the Achilles' tendon with overlying soft tissue and skin defects remains a complex reconstructive challenge. Herein we present our experience using a free composite anterolateral thigh (ALT) flap with vascularized fascia lata and a modified Lindholm's technique to repair the Achilles' tendon. A 37-year-old man suffered from tertiary Achilles' tendon rupture. For reconstruction, the free composite ALT flap with vascularized fascia lata was used to wrap Achilles' tendon. A modified Lindholm's technique was used to cover overlying soft tissue defects. The patient was followed up for 12 months. No wound healing problems were reported, and the patient was able to walk and return to his daily ambulating activities without any support after 5 months postoperatively. This technique may be useful to achieve satisfactory outcomes in patients with ruptured Achilles' tendons following tertiary repair.
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Affiliation(s)
- Osman Kelahmetoglu
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Mustafa Ekrem Gules
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Nuh Mehmet Elmadag
- Department of Orthopaedics and Traumatology, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Ethem Guneren
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
| | - Selma Sonmez Ergun
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Medical Faculty, Bezmialem Vakif University, Istanbul, Turkey
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Zellers JA, Carmont MR, Grävare Silbernagel K. Return to play post-Achilles tendon rupture: a systematic review and meta-analysis of rate and measures of return to play. Br J Sports Med 2016; 50:1325-1332. [PMID: 27259751 DOI: 10.1136/bjsports-2016-096106] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 12/26/2022]
Abstract
AIM This systematic review and meta-analysis sought to identify return to play (RTP) rates following Achilles tendon rupture and evaluate what measures are used to determine RTP. DESIGN A systematic review and meta-analysis were performed. Studies were assessed for risk of bias and grouped based on repeatability of their measure of RTP determination. DATA SOURCES PubMed, CINAHL, Web of Science and Scopus databases were searched to identify potentially relevant articles. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies reporting RTP/sport/sport activity in acute, closed Achilles tendon rupture were included. RESULTS 108 studies encompassing 6506 patients were included for review. 85 studies included a measure for determining RTP. The rate of RTP in all studies was 80% (95% CI 75% to 85%). Studies with measures describing determination of RTP reported lower rates than studies without metrics described, with rates being significantly different between groups (p<0.001). CONCLUSIONS 80 per cent of patients returned to play following Achilles tendon rupture; however, the RTP rates are dependent on the quality of the method used to measure RTP. To further understand RTP after Achilles tendon rupture, a standardised, reliable and valid method is required.
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Affiliation(s)
- Jennifer A Zellers
- Program in Biomechanics and Movement Science, University of Delaware, Newark, Delaware, USA
| | - Michael R Carmont
- Department of Orthopaedic Surgery, The Princess Royal Hospital, Telford, Shropshire, UK.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Grävare Silbernagel
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Physical Therapy, University of Delaware, Newark, Delaware, USA
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Wang B, Feng X, Yan M, Wang H, Li Y. Application of lariat lock catch knot suture in the achilles tendon rupture. Int J Clin Exp Med 2015; 8:19571-19575. [PMID: 26770612 PMCID: PMC4694512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 10/06/2015] [Indexed: 06/05/2023]
Abstract
The aim of this study was to summarize the clinical experience of repairing the Achilles tendon rupture by lariat lock catch knot suture. Between January 2011 and February, 2014, 32 cases of the Achilles tendon rupture were treated by lariat lock catch knot suture. There were 26 males and 6 females, with the average age of 39 years (range 17-53 years), including 13 left knees and 19 right knees. 29 wounds healed by first intention, and 3 cases who were performed local flap transfer due to necrosis of skin were healed by second intention. Thirty-two cases were followed up 10-25 months (13 months on average). No re-rupture of Achilles tendon or deep infection occurred during follow-up period. According to Arner-Lindholm assessment standard, the results were excellent in 19 cases and good in 13 cases, the excellent and good rate was 100%. Lariat lock catch knot suture is a safe and effective method for repairing Achilles tendon.
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Affiliation(s)
- Baocang Wang
- Department of Orthopedics, The Second Hospital of TangshanTangshan 063000, China
| | - Xiaona Feng
- Department of Pediatric Orthopedics, The Second Hospital of TangshanTangshan 063000, China
| | - Ming Yan
- Department of Orthopedics, The Second Hospital of TangshanTangshan 063000, China
| | - Hui Wang
- Department of Orthopedics, The Second Hospital of TangshanTangshan 063000, China
| | - Yong Li
- Department of Orthopedics, The Second Hospital of TangshanTangshan 063000, China
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Tawari AA, Dhamangaonkar AA, Goregaonkar AB, Chhapan JB. Augmented repair of degenerative tears of tendo achilles using peroneus brevis tendon: early results. Malays Orthop J 2015; 7:19-24. [PMID: 25722802 PMCID: PMC4341044 DOI: 10.5704/moj.1303.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Reconstruction of degenerated ruptures of the tendoachilles
is a challenge. Ruptured tendons and the remaining tendon
ends are abnormal. A number of methods have been
described in literature reconstruct the tendoachilles, but with
variable results1. We used peroneus brevis tendon in 20
patients to augment the repair of degenerated tendoachilles
tears by creating a dynamic loop as described by Teuffer et
al2. All patients were followed up for atleast 18 months. At
the last postoperative visit, 18 out of 20 patients were able to
do a toe raise. Eighty-five per cent of patients had excellent
or good results and 15% had fair or poor results using
modified Rupp scoring. Advantages offered by this
procedure are the use of a single incision and mini incision
and use of a dispensable tendon such as the peroneus brevis
without entirely depending on the damaged tendon for
healing.
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Affiliation(s)
- Akhil A Tawari
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Anoop A Dhamangaonkar
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Arvind B Goregaonkar
- Department of Orthopaedics, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India
| | - Jigar B Chhapan
- Department of Orthopaedics, SMT. NHL Municipal Medical College, Gujarat, India
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Flint JH, Wade AM, Giuliani J, Rue JP. Defining the terms acute and chronic in orthopaedic sports injuries: a systematic review. Am J Sports Med 2014; 42:235-41. [PMID: 23749341 DOI: 10.1177/0363546513490656] [Citation(s) in RCA: 131] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although many authors report on acute injuries and chronic injuries in the orthopaedic literature, the actual terms are seldom explicitly defined. HYPOTHESIS Much of the literature pertaining to sports injuries that are acute or chronic does not define these terms. It is believed that definitions will provide clarity and specificity in future literature. STUDY DESIGN Systematic review. METHODS A systematic review of 116 articles was conducted to determine whether and how the terms acute and chronic were defined as they pertain to several commonly treated conditions: Achilles tendon rupture, distal biceps tendon rupture, pectoralis major tendon rupture, anterior cruciate ligament (ACL) tear, anterior shoulder instability, and acromioclavicular (AC) joint dislocation. Articles were isolated from various databases and search engines by use of keywords to identify relevant literature. RESULTS This study determined that the terms acute and chronic for each injury are defined, respectively, as follows: Achilles tendon rupture: <1 week, >4 weeks; distal biceps tendon rupture: <6 weeks, >12 weeks; pectoralis major tendon rupture: <6 weeks, >6 weeks; ACL tear: <6 weeks, >6 months; anterior shoulder instability: <2 weeks, >6 months; AC joint dislocation, <3 weeks, >6 weeks. CONCLUSION The current literature varies greatly in defining the terms acute and chronic in common sports injuries. The vast majority of authors imply these terms, based on the method of their studies, rather than define them explicitly. Injuries involving tendons showed greater consistency among authors, thus making a definition based on consensus easier to derive. The literature on ACL and shoulder instability in particular showed great variability in defining these terms, likely representing the more complex nature of these injuries and the fact that timing of surgery in the majority of patients does not particularly affect the complexity of the surgical approach and treatment. CLINICAL RELEVANCE Defining injuries as acute or chronic is clinically relevant in many cases, particularly concerning tendon injuries, where these terms have implications regarding the anatomic pathologic changes and tissue quality, which may necessitate augmentation and alter the initial surgical plan. In cases where these terms are less pertinent to operative treatment considerations, they bring clarity to the discussion of the acuity of the injury (as it pertains to time from insult).
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Affiliation(s)
- James H Flint
- James H. Flint, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889-5600.
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Ramalingam M, Young MF, Thomas V, Sun L, Chow LC, Tison CK, Chatterjee K, Miles WC, Simon CG. Nanofiber scaffold gradients for interfacial tissue engineering. J Biomater Appl 2013; 27:695-705. [PMID: 22286209 PMCID: PMC3508378 DOI: 10.1177/0885328211423783] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We have designed a 2-spinnerette device that can directly electrospin nanofiber scaffolds containing a gradient in composition that can be used to engineer interfacial tissues such as ligament and tendon. Two types of nanofibers are simultaneously electrospun in an overlapping pattern to create a nonwoven mat of nanofibers containing a composition gradient. The approach is an advance over previous methods due to its versatility - gradients can be formed from any materials that can be electrospun. A dye was used to characterize the 2-spinnerette approach and applicability to tissue engineering was demonstrated by fabricating nanofibers with gradients in amorphous calcium phosphate nanoparticles (nACP). Adhesion and proliferation of osteogenic cells (MC3T3-E1 murine pre-osteoblasts) on gradients was enhanced on the regions of the gradients that contained higher nACP content yielding a graded osteoblast response. Since increases in soluble calcium and phosphate ions stimulate osteoblast function, we measured their release and observed significant release from nanofibers containing nACP. The nanofiber-nACP gradients fabricated herein can be applied to generate tissues with osteoblast gradients such as ligaments or tendons. In conclusion, these results introduce a versatile approach for fabricating nanofiber gradients that can have application for engineering graded tissues.
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Affiliation(s)
- Murugan Ramalingam
- Polymers Division, National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD 20899 (U.S.A.)
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892 (USA)
- National Institute of Health and Medical Research, Faculty of Medicine, University of Strasbourg, 67085 Strasbourg Cedex (France)
| | - Marian F. Young
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892 (USA)
| | - Vinoy Thomas
- Ceramics Division, National Institute of Standards and Technology, Gaithersburg, MD 20899 (U.S.A.)
- Center for Nanoscale Materials & Biointegration, University of Alabama at Birmingham, Birmingham, AL 35294 (U.S.A.)
| | - Limin Sun
- American Dental Association, Paffenbarger Research Center, National Institute of Standards and Technology, Gaithersburg, MD 20899 (U.S.A.)
| | - Laurence C. Chow
- American Dental Association, Paffenbarger Research Center, National Institute of Standards and Technology, Gaithersburg, MD 20899 (U.S.A.)
| | - Christopher K. Tison
- Polymers Division, National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD 20899 (U.S.A.)
| | - Kaushik Chatterjee
- Polymers Division, National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD 20899 (U.S.A.)
- National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, MD 20892 (USA)
| | - William C. Miles
- Polymers Division, National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD 20899 (U.S.A.)
| | - Carl G. Simon
- Polymers Division, National Institute of Standards and Technology, 100 Bureau Drive, Gaithersburg, MD 20899 (U.S.A.)
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Joseph RM, Barhorst J. Surgical reconstruction and mobilization therapy for a retracted extensor hallucis longus laceration and tendon defect repaired by split extensor hallucis longus tendon lengthening and dermal scaffold augmentation. J Foot Ankle Surg 2012; 51:509-16. [PMID: 22658790 DOI: 10.1053/j.jfas.2012.04.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Indexed: 02/03/2023]
Abstract
A reconstructive technique and physical therapy protocol is presented for the treatment of extensor hallucis longus (EHL) lacerations with critical size defects caused by tendon retraction. The primary goal of treatment was to restore EHL structure and function without the use of a bridging allograft or tendon transfer. The technique is performed by split lengthening the distal segment of the lacerated EHL and rotating the lengthened segment proximally 180° to bridge the tendon defect. The lengthened tendon is then sutured to the proximal segment of the EHL. The EHL is then tubularized with an acellular dermal scaffold at the region of tendon rotation to improve tendon strength, minimize the probability of tendon overlengthening or re-rupture, and improve the tendon gliding motion, which can be compromised by the tendon irregularity caused by rotation of the tendon. Postoperative range of motion therapy should be initiated at 3 weeks postoperatively. A case report of this technique and postoperative mobilization protocol is presented. The American Orthopaedic Foot and Ankle Society midfoot score at 3 and 6 months postoperatively was 90 of 100. The patient regained active dorsiflexion motion of the hallux without functional limitations, deformity, or contracture of the hallux. The advantages of this technique include that a large cadaveric allograft is not needed to bridge a critical size tendon defect and tendon lengthening provides a biologically active tendon graft without the secondary comorbidities and dysfunction commonly associated with tendon transfer procedures.
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Affiliation(s)
- Robert M Joseph
- Perspective Advantage Solutions, LLC, Dayton, OH 45409, USA.
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