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Azam MT, Butler JJ, Weiss MB, Ubillus HA, Kirschner N, Mercer NP, Kennedy JG. Surgical Management of Chronic Achilles Tendon Ruptures: A Systematic Review and Proposed Treatment Algorithm. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231200491. [PMID: 37810568 PMCID: PMC10557420 DOI: 10.1177/24730114231200491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
Background As no evidence-based treatment guidelines exist for chronic Achilles tendon rupture (CATR), a systematic review of the literature was performed to compare the different treatment options and recommend a literature-based algorithm. Methods In June 2022, MEDLINE, Embase, and Cochrane Library databases were systematically reviewed based on the PRISMA guidelines. The level of evidence (LOE) and quality of evidence were evaluated, and statistics on clinical outcomes and complications were calculated. Results Twenty-seven studies with 614 patients were included. Three studies were LOE III and 25 studies were LOE IV. The mean Achilles tendon rupture score improved from a preoperative weighted mean of 38.8 ± 12.4 to a postoperative score 90.6 ± 4.7. The overall complication rate was 11.4%. Single techniques were used in 23 studies and dual techniques were used in 5 studies. The FHL tendon transfer was the most frequently used technique. We devised an algorithmic approach based on time from injury to surgical intervention and the length of the gap between the tendon stumps: >3 months: FHL transfer; <3 months (a) gap <2 cm, end-to-end repair; (b) gap 2 to 5 cm, gastrocnemius transfer, (c) gap >5 cm, semitendinosus autograft. Conclusion Surgical management of CATR produced improvements in patient-reported outcome scores at midterm follow up, but a high complication rate (11.4%) was noted. Our proposed treatment algorithm may assist in shared decision making for this complex problem.
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Affiliation(s)
- Mohammad T. Azam
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - James J. Butler
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
- Royal College Surgeons in Ireland, Dublin, Ireland
| | - Matthew. B. Weiss
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Hugo A. Ubillus
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | - Noah Kirschner
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
| | | | - John G. Kennedy
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, USA
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Filatova YS, Ilyin MV. [The use of sodium hyaluronate to treat upper limb disease: A review]. TERAPEVT ARKH 2023; 95:438-443. [PMID: 38158998 DOI: 10.26442/00403660.2023.05.202273] [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] [Received: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 01/03/2024]
Abstract
The most common diseases of the upper limb are osteoarthritis (OA) of the joints of the hands, lateral epiconlitis, tendinitis of the shoulder muscles, adhesive capsulitis. OA of the shoulder and acromioclavicular joints is less common. The development of acute and subacute pain in the elbow and shoulder joints in the vast majority of cases is determined by the pathology of soft tissues: muscles, ligamentous apparatus and related synovial bags, making it difficult to diagnose. A clinical and radiological heterogeneity of OA of the joints of the hands is a very complex pathology for the study, and also to create a unified algorithms for therapy. Therapy nonsteroidal anti-inflammatory drugs are effective in the short term, but it has several side effects. Despite a variety of attempts at therapy with successful and unsuccessful outcome, the attention of researchers for several decades converted to the injection therapy with hyaluronic acid. The article presents the data of studies demonstrating the anti-inflammatory effect of hyaluronic acid in the treatment of OA, as well as the results of clinical trials and data system of meta-analysis demonstrating the effectiveness of intra-articular and extra-articular therapy tendinopathy of the upper limb. Most of the cited studies demonstrated the efficacy and good tolerance of 1% sodium hyaluronate. In the domestic market it is presented in the drug Flexotron Forte. The authors provide the results of the study results, demonstrating the efficacy and safety of using Flexotron Forte to clinical practice.
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The Impact of Hyaluronic Acid on Tendon Physiology and Its Clinical Application in Tendinopathies. Cells 2021; 10:cells10113081. [PMID: 34831304 PMCID: PMC8625461 DOI: 10.3390/cells10113081] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 11/01/2021] [Accepted: 11/05/2021] [Indexed: 01/17/2023] Open
Abstract
The physical-chemical, structural, hydrodynamic, and biological properties of hyaluronic acid within tendons are still poorly investigated. Medical history and clinical applications of hyaluronic acid for tendinopathies are still debated. In general, the properties of hyaluronic acid depend on several factors including molecular weight. Several preclinical and clinical experiences show a good efficacy and safety profile of hyaluronic acid, despite the absence of consensus in the literature regarding the classification according to molecular weight. In in vitro and preclinical studies, hyaluronic acid has shown physical-chemical properties, such as biocompatibility, mucoadhesivity, hygroscopicity, and viscoelasticity, useful to contribute to tendon healing. Additionally, in clinical studies, hyaluronic acid has been used with promising results in different tendinopathies. In this narrative review, findings encourage the clinical application of HA in tendinopathies such as rotator cuff, epicondylitis, Achilles, and patellar tendinopathy.
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Arshad Z, Lau EJS, Leow SH, Bhatia M. Management of chronic Achilles ruptures: a scoping review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2543-2559. [PMID: 34089355 PMCID: PMC8514369 DOI: 10.1007/s00264-021-05102-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 05/25/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE This scoping review aims to systematically map and summarise the available evidence on the management of chronic Achilles ruptures, whilst identifying prognostic factors and areas of future research. METHODS A scoping review was performed according to the frameworks of Arksey and O'Malley, Levac and Peters. A computer-based search was performed in PubMed, Embase, EmCare, CINAHL, ISI Web of Science and Scopus, for articles reporting treatment of chronic Achilles ruptures. Two reviewers independently performed title/abstract and full text screening according to pre-defined selection criteria. RESULTS A total of 747 unique articles were identified, of which 73 (9.8%) met all inclusion criteria. A variety of methods are described, with flexor hallucis longus tendon transfer being the most common. The most commonly reported outcome is the American Orthopaedic Foot and Ankle Society (AOFAS) score, although 16 other measures were reported in the literatures. All studies comparing pre- and post-operative outcomes reported significant post-treatment improvement. Complications were reported in 50 studies, with an overall pooled complication rate of 168/1065 (15.8%). CONCLUSION Although beneficial results were reported following a variety of techniques, comparison between these is challenging due to the low-level study designs used and confounding factors such as treatment delay and tendon gap size. Further research comparing the efficacy of different techniques is required in order to facilitate the development of an evidence-based treatment protocol. Such work would allow clinicians to better understand the suitability of the large variety of reported techniques and select the optimal strategy for each individual patient.
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Affiliation(s)
- Zaki Arshad
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 111, Cambridge, CB2 0SP, UK.
| | - Edward Jun Shing Lau
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 111, Cambridge, CB2 0SP, UK
| | - Shu Hui Leow
- School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Box 111, Cambridge, CB2 0SP, UK
| | - Maneesh Bhatia
- Department of Trauma and Orthopaedic Surgery, University Hospitals Leicester NHS Trust, University Hospitals of Leicester Headquarters, Balmoral Building, Level 3, Leicester, UK
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Veronesi F, Borsari V, Contartese D, Xian J, Baldini N, Fini M. The clinical strategies for tendon repair with biomaterials: A review on rotator cuff and Achilles tendons. J Biomed Mater Res B Appl Biomater 2019; 108:1826-1843. [PMID: 31785081 DOI: 10.1002/jbm.b.34525] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 10/07/2019] [Accepted: 11/09/2019] [Indexed: 12/19/2022]
Abstract
Tendon repair is a complex process due to the low tenocyte density, metabolism, and vascularization. Tears of rotator cuff (RCT) and Achilles tendons ruptures have a major impact on healthcare costs and quality of life of patients. Scaffolds are used to improve the healing rate after surgery and long-term results. A systematic search was carried out to identify the different types of scaffolds used during RCT and Achilles tendon repair surgery in the last 10 years. A higher number of clinical studies were reported on RCT ruptures. Biological scaffolds were used more than synthetic ones, for both rotator cuff and Achilles tendons. Moreover, platelet-rich plasma (PRP)-based scaffolds were the most widely used in RCT. A different type of synthetic scaffold was used in each of the five studies found. Biological scaffolds either provide variable results, in particular PRP-based ones, or poor results, such as bovine equine pericardium. All the synthetic scaffolds demonstrated a significant increase in clinical and functional scores in biomechanics, and a significant decrease in pain and re-tear rate in comparison to conventional surgery. Despite the limited number of studies, further investigation in the clinical use of synthetic scaffolds should be carried out.
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Affiliation(s)
- Francesca Veronesi
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Veronica Borsari
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Deyanira Contartese
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Jie Xian
- Laboratory for Orthopedic Pathophysiology and Regenerative Medicine, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - Nicola Baldini
- Laboratory for Orthopedic Pathophysiology and Regenerative Medicine, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Department of Biomedical and Neuromotor Science, University of Bologna, Bologna, Italy
| | - Milena Fini
- Laboratory of Preclinical and Surgical Studies, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Vigani B, Rossi S, Sandri G, Bonferoni MC, Caramella CM, Ferrari F. Hyaluronic acid and chitosan-based nanosystems: a new dressing generation for wound care. Expert Opin Drug Deliv 2019; 16:715-740. [PMID: 31215823 DOI: 10.1080/17425247.2019.1634051] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The main goal in the management of chronic wounds is the development of multifunctional dressings able to promote a rapid recovery of skin structure and function, improving patient compliance. AREAS COVERED This review discusses the use of nanosystems, based on hyaluronic acid and chitosan or their derivatives for the local treatment of chronic wounds. The bioactive properties of both polysaccharides will be described, as well as the results obtained in the last decade by the in vitro and in vivo evaluation of the wound healing properties of nanosystems based on such polymers. EXPERT OPINION In the last decades, there has been a progressive change in the local treatments of chronic wounds: traditional inert dressings have been replaced by more effective bioactive ones, based on biopolymers taking part in wound healing and able to release the loaded active agents in a controlled way. With the advance of nanotechnologies, the scenario has further changed: nanosystems, characterized by a large area-to-volume ratio, show an improved interaction with the biological substrates, amplifying the activity of the constituent biopolymers. In the coming years, a deeper insight into wound healing mechanisms and the development of new techniques for nanosystem manufacturing will results in the design of new scaffolds with improved performance.
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Affiliation(s)
- Barbara Vigani
- a Department of Drug Science, University of Pavia , Pavia , Italy
| | - Silvia Rossi
- a Department of Drug Science, University of Pavia , Pavia , Italy
| | | | | | | | - Franca Ferrari
- a Department of Drug Science, University of Pavia , Pavia , Italy
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Liu W, Zhuang H, Shao D, Wang L, Shi M. High-Frequency Color Doppler Ultrasound in Diagnosis, Treatment, and Rehabilitation of Achilles Tendon Injury. Med Sci Monit 2017; 23:5752-5759. [PMID: 29199267 PMCID: PMC5728083 DOI: 10.12659/msm.904186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background This study evaluated the clinical application of high-frequency color Doppler ultrasonography (HFCDU) in the diagnosis, treatment, and rehabilitation of Achilles tendon injury. Material/Methods A total of 68 patients with suspected Achilles tendon injury were examined by HFCDU. There were 42 Achilles tendon injury patients who underwent surgery, and they were randomly divided into a routine treatment group (n=21) and a rehabilitation group (n=21). HFCDU was performed at weeks 1, 3, 6, and 9, and months 3, 6, 9, 12, and 24 after the operation. The thickness of the injured Achilles tendon, echo, blood flow, and tissue adhesion were compared to those of the uninjured side. Results Of the 68 patients, 14 had normal ultrasound presentation with strong echo; 7 had laceration, presenting as swelling and decreased echo; 26 had partial tear, presenting as discontinued rupture with no or low echo; 19 had complete rupture, presenting as discontinued fibers with hypoechoic hemorrhage and hyperechoic fat tissue between ends; 1 had plantar tendon rupture and periapical hemorrhage; and 1 had acute Achilles tendonitis. The postoperative tendon thickness decreased over time, echo turned homogeneous, blood flow and adhesions decreased, and these results were consistent with clinical symptoms. Patient condition and ultrasound recovery were better in the rehabilitation group, and the diameter of the injured tendon increased compared with the uninjured side. Conclusions HFCDU can determine the types and extent of tendon injuries, and can help in the diagnosis, treatment, and rehabilitation of Achilles tendon injury.
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Affiliation(s)
- Wen Liu
- Department of Ultrasound, Shandong Medical Imaging Research Institute, Jinan, Shandong, China (mainland)
| | - Haiying Zhuang
- Department of Rehabilitation, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - Dazhang Shao
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
| | - Liangliang Wang
- Department of Ultrasound, Liaocheng People's Hospital, , China (mainland)
| | - Miao Shi
- Department of Ultrasound, Liaocheng People's Hospital, Liaocheng, Shandong, China (mainland)
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Affiliation(s)
- Matthew J Kraeutler
- 1 Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Justin M Purcell
- 1 Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kenneth J Hunt
- 1 Department of Orthopedics, University of Colorado School of Medicine, Aurora, CO, USA
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