Calcaneal Tuberosity Fracture With Complete Achilles Tendon Rupture: A Unique Surgical Challenge

A calcaneal tuberosity avulsion fracture occurring simultaneously with a rupture of the Achilles tendon, although occurring through similar mechanisms, is a rare injury pattern to see in combination and presents a unique challenge to the surgeon. The patient we present was initially found to have a type II fracture of the calcaneal tuberosity. However, during surgical fixation of the fracture, a complete rupture of the Achilles tendon was noticed. The technique used in this case was the fixation of the fracture fragment with two 5 mm fully threaded screws. The tendon was then reattached to the calcaneus using two Mitek anchors (DePuy Mitek Inc., MA, USA) with a modified Bunnell technique. There are a number of techniques suggested in the literature, including, among others, K-wires (DePuy Mitek Inc., MA, USA) and screw fixation. Our patient recovered well and has now been discharged from further orthopaedic follow-up.

Achilles Tendon Tear Following an Unusual Pattern of Open Pure Ankle Dislocation: A Case Report

We present a rare case of concurrent open Achilles tendon tear and pure subtalar dislocation in a 20-year-old male following a motorcycle accident, highlighting the complexity of managing such unique musculoskeletal injuries. The patient was initially admitted with an open and deformed left ankle, underwent prompt primary debridement, and received immediate medical intervention. Despite unsuccessful attempts to reduce the dislocation through external maneuvers, subsequent radiographic evaluation revealed a subtalar dislocation associated with a 90° rotation of the talus. A direct reduction was achieved in the operating room, uncovering a complete tear of the Achilles tendon and a section of the posterior tibial artery during more intensive debridement. The vascular surgery team repaired the posterior tibial artery, followed by Achilles tendon repair using a Kessler suture technique. Postoperative care involved immobilization and adapted rehabilitation, resulting in the patient regaining full range of motion without complications. To the best of our knowledge, this case represents the first reported open lateral subtalar dislocation associated with an open Achilles tendon tear. The detailed treatment strategies and outcomes offer valuable insights for clinicians facing similar challenges and inspire further research on rare musculoskeletal injuries.

The Significance of Proprioceptive Training in the Post-Operative Rehabilitation of Patients Undergoing Achilles Tendon Reconstruction

In the human anatomy, the Achilles tendon (AT) is the strongest and largest tendon. Also, it ruptures the most often. Because it impairs the patient's ability to function adequately, a ruptured AT injury is a serious clinical issue. Reconstruction of the tendon through surgical intervention is the preferred approach to treatment in the case of tendon rupture. Establishing an effective post-operative rehabilitation regimen that mostly consists of functional physiotherapy measures is crucial in the management of AT rupture. In this report, we have presented the case of an AT reconstruction patient who complained of pain in the ankle region, reduced strength and range of the ankle joint, and loss of proprioception. The tailor-made physiotherapy protocol was incorporated, which included strengthening exercises, proprioceptive retraining, cryotherapy, and ambulatory training, which were found to be effective in facilitating early functional recovery.

Foreign Body Reaction Following Achilles Tendon Reconstruction With the Ligament Advanced Reconstructive System: Patient Outcomes and Clinical Course

The Ligament Advanced Reinforcement System (LARS) is a common choice for ligament reconstruction in the lower limb due to its good functional and quality of life (QoL)-related outcomes. It is commonly used for Achilles tendon repair following a rupture. While it facilitates tissue ingrowth and boasts good biocompatibility, we report on multiple cases whereby foreign body reactions have led to the growth of granulomas requiring surgical excision and Flexor Hallucis Longus (FHL) transfer. Following these cases, patients have been shown to have excellent functional and QoL-related outcomes using the Manchester Oxford Foot Questionnaire (MOX-FQ) and Foot and Ankle Ability Measure (FAAM). Surgeons should consider FHL transfer as an alternative in patients undergoing Achilles tendon repair and be aware of the risk of foreign body reactions and the impact on ankle function and QoL post-operatively.

Identification of Three Loci Associated with Achilles Tendon Injury Risk from a Genome-wide Association Study

PURPOSE

This study aimed to screen the entire genome for genetic markers associated with risk for Achilles tendon injury.

METHODS

A genome-wide association analysis was performed using data from the Kaiser Permanente Research Board and the UK Biobank. Achilles tendon injury cases were identified based on electronic health records from the Kaiser Permanente Research Board databank and the UK Biobank from individuals of European ancestry. Genome-wide association analyses from both cohorts were tested for Achilles tendon injury using a logistic regression model adjusting for sex, height, weight, and race/ethnicity using allele counts for single nucleotide polymorphisms (SNP). Previously identified genes within the literature were also tested for association with Achilles tendon injury.

RESULTS

There were a total of 12,354 cases of Achilles tendon injury and 483,080 controls within the two combined cohorts, with 67 SNP in three chromosomal loci demonstrating a genome-wide significant association with Achilles tendon injury. The first locus contains a single SNP (rs183364169) near the CDCP1 and TMEM158 genes on chromosome 3. The second locus contains 65 SNP in three independently segregating sets near the MPP7 gene on chromosome 10. The last locus contains a single SNP (rs4454832) near the SOX21 and GPR180 genes on chromosome 13. The current data were used to test 14 candidate genes previously reported to show an association with Achilles tendon injury, but none showed a significant association (all P > 0.05).

CONCLUSION

Three loci were identified as potential risk factors for Achilles tendon injury and deserve further validation and investigation of molecular mechanisms.

The Role of Point of Care Ultrasound (PoCUS) in Orthopaedic Emergency Diagnostics

Ultrasound has been described as the "stethoscope" of the radiologist; its ability to aid in clinical diagnosis with both static and dynamic imaging has allowed fast and accurate diagnosis. However, traditionally unlike a stethoscope, a large and bulky ultrasound machine made it difficult to use portably in a hospital environment where patients can be scattered across a hospital. With the development of innovative ultrasound technology, Point of Care Ultrasound (PoCUS) can readily be carried by a clinician to make a quick and timely diagnosis. In this review article we look at the uses of PoCUS within orthopaedic emergencies. Diagnosis in orthopaedics often requires further imaging beyond history taking, clinical examination and plain radiographs. In these cases PoCUS can be useful for ruling out occult fractures, diagnosing joint effusions and tendon ruptures. By aiding a speedy diagnosis, we can reduce unnecessary immobilisation, reduce inpatient stays, introduce early mobilisation and reduce harm to patients. With PoCUS becoming increasingly cheaper and more portable we feel this really can become the stethoscope of an orthopaedic surgeon.

Polydeoxyribonucleotide improves tendon healing following achilles tendon injury in rats

Tendon injuries are major musculoskeletal disorders. Polydeoxyribonucleotide activates the adenosine receptor subtype A2A, resulting in tissue growth and neogenesis. This experimental study confirms that polydeoxyribonucleotide can improve secretion of various growth factors, promote collagen synthesis, and restore tensile strength of the Achilles tendon in a rat model with Achilles tendon injury. Thirty-six male Sprague-Dawley rats, aged 7 weeks, were divided into two groups, and the Achilles tendon was transected and repaired using the modified Kessler's method. In the experimental group (n = 18), the rats received daily intraperitoneal administration of polydeoxyribonucleotide (8 mg/kg/day for 1, 2, or 4 weeks). The control groups received the same amount of normal saline. The rats were euthanized at 1, 2, and 4 weeks, and tissues from the repair site were harvested. The cross-sectional area of the tendon was significantly increased at 2 and 4 weeks in polydeoxyribonucleotide group (p = 0.008 and p = 0.017, respectively). Moreover, tendons in the polydeoxyribonucleotide group were more resistant to mechanical stress at 2 and 4 weeks (p = 0.041 and p = 0.041, respectively). The staining levels of collagen type I in the experimental group were significantly stronger at 2 and 4 weeks (p = 0.026 and p = 0.009, respectively). Furthermore, higher expression levels of fibroblast growth factor, vascular endothelial growth factor, and transforming growth factor β1 were detected in the experimental group at 4 weeks (p = 0.041, p = 0.026, and p = 0.041, respectively). This study confirms that polydeoxyribonucleotide can improve the tensile strength of the rats' Achilles tendon following injury and repair. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1767-1776, 2018.