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Application of internal fixation of steel-wire limited loop in early achilles tendon rupture

Asian Pacific Journal of Tropical Medicine 2013年第11期6卷 902-907页

作者： Zhe Chen Jia-Sen Wei Zhao-Yang Hou Jiong Hu Yan-Guang Cao Qi-Xin Chen Department of Orthopaedics The Second Affiliated Hospital of Zhejiang Chinese Medical University Department of Orthopaedics The Second Affiliated Hospital of Zhejiang University School of Medicine

Objective:To explore the clinical effect and safety of internal fixation of steel-wire limited loop in early achilles tendon rupture.Methods:Seventy-six patients respectively with early transected and avulsed types of achilles tendon rupture were selected and treated with internal fixation of steel-wire limited loop.The patients began to take exercise for their lower limbs through continous passive motion as early as possible after surgical repair,and the loops were removed after 3-5 months.Six months later,the condition of complications including achilles tendon re-rupture,wound fistula,wound infection and skin necrosis,cutaneous sensation in sural nerve dominance region,time back to preinjury work or learning as well as time to physical activities were observed.One year later,the therapeutic effect was evaluated,and the maximum circumferences of bilateral legs and raptured plane circumferences of achilles tendon were measured.Results:The wound of all patients healed well,no complications like achilles tendon re-rupture,wound fistula,wound infection and skin necrosis occured,and the cutaneous sensation in sural nerve dominance region was normal.The mean time back to preinjury work or learning as well as to pysical activities of all patients were respectively 10 and 22 weeks.Seventy out of 76 patients(92.1%) achieved an excellent effect,and 6(7.9%) good effect.The excellent and good rate came up to 100%.The maximum circumference in the affected leg decreased to 2 mm averagely compared with the offside,while the ruptured plane circumferences of achilles tendon in the affected side increased to 2.2 mm compared with the offside.Conclusions:Kor early achilles tendon rupture,internal fixation of steel-wire limited loop can recover the ankle function better,return to the preinjury state in the shortest lime,and has few complications.

关键词： achilles tendon rupture Steel-wire limited loop Internal fixation Ankle function

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Dutch version of the Victorian Institute of Sports Assessment-achilles questionnaire for achilles tendinopathy: Reliability, validity and applicability to non-athletes

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World Journal of Orthopedics 2018年第1期9卷 1-6页

作者： Inger Sierevelt Maayke van Sterkenburg Hans Tol Bella van Dalen Niek van Dijk Daniel Haverkamp Department of Orthopaedic Surgery Slotervaart Hospital Department of Orthopedic Surgery Academic Medical Center Academic Center for Evidence Based Sports Medicine Academic Medical Center Amsterdam Bergmanclinics te Naarden

AIM To translate the Victorian Institute of Sports Assessmentachilles(VISA-A) questionnaire into the Dutch language(VISA-A-NL), and to assess its reliability, validity, and applicability to non-athletes.METHODS After translation according to a forward-backward protocol, 101 patients with complaints of achilles tendinopathy were asked to fill out the VISA-A-NL at two time points together with visual analogue scale, the Foot and Ankle Outcome Score, and the Short Form-36 questionnaires. Reliability, internal consistency, construct validity, and content validity were tested.RESULTS The VISA-A-NL showed high reliability(0.97, 95%CI: 0.95-0.98). Cronbach's alpha(internal consistency) was 0.80. It increased to 0.88 without activity domain. Correlation with other questionnaires was moderate or poorer.CONCLUSION The VISA-A-NL proved to be an excellent evaluation instrument for the Dutch physician. If applied to nonathletes, using a modified score(questions 1-6) should be considered.

关键词： achilles tendon Victorian Institute of Sports Assessment-achilles Validity Patient reported outcome measurement

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achilles Tendoscopy for Non-Insertional Tendinopathy

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International Journal of Clinical Medicine 2013年第6期4卷 1-4页

作者： Giovanni Carcuro Leonardo Lagos Hugo Henríquez Natalio Cuchacovich Manuel Pellegrini Christian Bastías Foot and Ankle Unit Instituto Traumatológico Teodoro Gebauer Santiago Chile Foot and Ankle Unit Instituto Traumatológico Teodoro Gebauer Santiago Chile.

achilles tendinopathy is a very common pathology, especially in the athletic population. Its etiology is multifactorial and the underlying pathophysiology is still not fully understood. For non-insertional tendinopathy is increasingly recognized the influence of paratendinopathy in the genesis of patients symptoms, so various surgical treatments have been accordingly developed;they are indicated when conservative treatment fails. The achilles tendoscopy is one of these techniques, it has the advantages of minimally invasive surgery, resulting in a low complication rate and good functional results. In relation to this procedure we review the surgical technique, which is exemplified by the case of a high performance athlete treated satisfactorily.

关键词： achilles Tendinitis Non-Insertional Tendoscopy Surgical Treatment Tendinopathy

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Analysing the outcome of surgery for chronic achilles tendinopathy over the last 50 years

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World Journal of Orthopedics 2015年第6期6卷 491-497页

作者： Wasim S Khan Seema Malvankar Jagmeet S Bhamra Ioannis Pengas University College London Institute of Orthopaedics and Musculoskeletal Science Royal National Orthopaedic Hospital

AIM: To determine an association between when the study was performed, the robustness of the study and the outcomes for insertional and non-insertional achilles tendinopathy surgery. METHODS: We performed a systematic review in accordance with the PRISMA guidelines to assess the methodology of studies investigating the outcome of surgery in chronic achilles tendinopathy over the last 50 years to identify any trends that would account for the variable results. The Coleman Methodology Scores were correlated with the reported percentage success rates and with the publication year to determine any trends using Pearson's correlation. RESULTS: We identified 62 studies published between 1964 and 2014 reporting on a total of 2923 surgically treated achilles tendinopathies. The average followup time was 40 mo(range 5-204 mo), and the mean reported success rate was 83.5%(range 36%-100%). The Coleman Methodology Scores were highly reproducible(r = 0.99, P < 0.01), with a mean of 40.1(SD 18.9, range 2-79). We found a negative correlation between reported success rate and overall methodology scores(r =-0.40, P < 0.001), and a positive correlation between year of publication and overall methodology scores(r = 0.46, P < 0.001). CONCLUSION: We conclude that although the success rate of surgery for chronic Acilles tendinopathy described in the literature has fallen over the last 50 years, this is probably due to a more rigorous methodology of the studies.

关键词： achilles tendon Surgery Methodology Outcome Tendinopathy

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Management of achilles tendon injury: A current concepts systematic review

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World Journal of Orthopedics 2015年第4期6卷 380-386页

作者： Vivek Gulati Matthew Jaggard Shafic Said Al-Nammari Chika Uzoigwe Pooja Gulati Nizar Ismail Charles Gibbons Chinmay Gupte Department of Orthopaedic Surgery Chelsea and Westminster Hospital Department of Orthopaedic Surgery Imperial College

achilles tendon rupture has been on the rise over recent years due to a variety of reasons. It is a debilitating injury with a protracted and sometimes incomplete recovery. Management strategy is a controversial topic and evidence supporting a definite approach is limited. Opinion is divided between surgical repair and conservative immobilisation in conjunction with functional orthoses. A systematic search of the literature was performed. Pubmed, Medline and EmB ase databases were searched for achilles tendon and a variety of synonymous terms. A recent wealth of reporting suggests that conservative regimens with early weight bearing or mobilisation have equivalent or improved rates of re-rupture to operative regimes. The application of dynamic ultrasound assessment of tendon gap may prove crucial in minimising re-rupture and improving outcomes. Studies employing functional assessments have found equivalent function between operative and conservative treatments. However, no specific tests in peak power, push off strength or athletic performance have been reported and whether an advantage in operative treatment exists remains undetermined.

关键词： Orthopaedic surgery achilles tendon injury Sports injury Tendon rupture Conservative management

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Bilateral achilles Tendon Xanthoma in an 18-Year-Old Patient

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Open Journal of Orthopedics 2017年第4期7卷 110-116页

作者： S. K. Venkatesh Gupta B. Sahithya S. P. Prashanth Department of Orthopaedics Mamata Medical College Khammam Telangana India

Background: Xanthomas are rare, non-neoplastic lesions which occur due to defect in the LDL receptors leading to their accumulation in tendons and synovium. The prevalence of heterozygous familial hypercholesterolaemia (HFH) is approximately 1 in 500. Aim: To study a rare case of bilateral achilles tendon xanthoma and its functional outcome. Case Presentation: We presented a case of xanthoma over posterior aspect of both lower third legs just above the heel in an 18-year-old female, and diagnosis was confirmed by clinical examination ultrasound and MRI, for which subtotal resection was planned and further followed up. Postoperative treatment consisted of six weeks long leg cast immobilization. After 10 weeks the patient started walking without any difficulties. Conclusion: Subtotal resection of achilles tendon xanthoma has given a good functional outcome. There is no need for reconstruction of tendon in every case.

关键词： achilles Tendon Xanthoma Low Density Lipoprotein Magnetic Resonance Imaging Ultrasound

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Major physical but also psychological effects after pain relief from surgical scraping in patients with achilles tendinopathy—A 1-year follow-up study

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Pain Studies and Treatment 2014年第1期2卷 21-25页

作者： Anna Ruergard Hakan Alfredson Department of Surgical and Perioperative Science Sports Medicine University of UmeaUmeaSweden

Treatment with Ultrasound (US) and Color Doppler (CD)-guided surgical scraping has shown good short-term clinical results in patients with chronic painful midportion achilles tendinopathy. The objective was to prospectively follow the patients 1-year after surgery. Material: Sixty- four tendons in 47 patients (28 men and 19 women, mean age 52 (+/-12 years) on different activity levels) were in local anaestesia operated with US+CD-guided surgical scraping. In 43/64 tendons, there was also removal of the plantaris tendon. Methods: Questionnaires evaluating activity level, VAS for pain during activity, satisfaction with treatment result, and the SF-36 score (quality of life), were used before and 1-year after surgery. Results: At follow-up, the mean VAS for pain during activity had decreased from 62 (+/-20) before surgery to 15 (+/-15) after surgery (p achilles tendinopathy, US+CD-guided surgical scraping, often combined with plantaris tendon removal, seems to be an efficient treatment method to recover physically and psychologically.

关键词： achilles Tendinopathy Midportion Surgical Scraping

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Incidence and Predictors of Complications of Acute achilles Tendon Rupture Repair at Hamad General Hospital, Doha, Qatar

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Surgical Science 2014年第2期5卷 46-52页

作者： Sameh M. Abolfotouh Mohamed A. Al Dosari Nader Sayed Hussam Banna Mostafa A. Abolfotouh Hamad General Hospital Doha Qatar King Abdullah International Medical Research Center Riyadh KSA

Aim: The aims of this study were: 1) to estimate the prevalence and pattern of complications after achilles tendon (AT) repair, and 2) to determine the significant predictors of post-operative infection. Methods: A retrospective cohort study of all patients who were operated at Hamad General Hospital (HGH) between June 2010 and June 2012 for AT rupture (n = 102), was conducted. Data was collected on 1) patient’ characteristics such as age, sex;2) disease characteristics such as mechanism of rupture, type of rupture (partial or complete), whether an anterior or posterior slab was applied, number of suture materials, number of antibiotics, surgical time, time to surgery and length of hospital stay (LOS), number of follow up visits, and 3) complications. Descriptive and analytical statistical analyses were applied. Receiver operating characteristic curve was applied to identify the validity of different LOS values, with a significance level at p ≤ 0.05. Results: Of the 102 patients with achilles rupture, almost males (96.1%), with a mean age 31.07 ± 9.71 years, 52% with complete rupture, the majority were open ruptures (81.4%) and bathroom-related (70.6%). Anterior slab was applied to 58.2% and 2 types of suture materials to 71.6% of cases. Fifteen cases (14.7%, 95% CI: 7.8% - 21.6%) presented with one or more complications (9.8% post-operative infections, 5.9% stiffness and 2% re-rupture). Post-operative infections were significantly associated with: old age (z = 2.11, p = 0.035), longer LOS (z = 2.01, p = 0.04), and presence of diabetes (Fisher exact test: p = 0.003). After adjustment for age, LOS (p = 0.04) and diabetes (p = 0.017) remained as significant predictors of post-operative infections. LOS of 2.5 days was the optimum cut-off point above which post-operative infection is more likely to occur, with sensitivity of 80% and specificity of 54%. Conclusion: achilles repair post operative infection ranks first as a complication of AT surgical repair, and its incidence is relatively higher in HGH than the counte

关键词： achilles Tendon Repair Surgical Outcome HGH Qatar

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Analyzing the Use of Ultrasound: achilles Tendon Rupture

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Open Journal of Emergency Medicine 2019年第3期7卷 41-47页

作者： Massud Atta Shadi Jafari Kareen Moore Coliseum Medical Center Macon Georgia USA American University of Antigua COM Coolidge Antigua

Growing evidence has made it obvious that early intervention in patients with achilles tendon rupture extensively affects the prognosis. This requires the use of easily accessible imaging modalities such as ultrasound in establishing accurate diagnosis of tendinopathies so that early therapeutic decisions can be made. Ultrasound allows for assessment of tendons in a dynamic real time setting. Physicians can interact with patients and receive feedback regarding the symptomatic area, and assessing the tendon from different angles while under stress. It also offers a faster method to diagnose achilles tendon rupture and therefore provide early intervention. Furthermore, ultrasound is a safe, non-invasive, and a patient friendly method that has become less expensive, portable, and a faster imaging modality to diagnose tendinopathies. In this paper, we review the application of ultrasound in diagnosing achilles tendon rupture and comparing it with other imaging modalities, after thoroughly studying the current literature.

关键词： achilles Tendon Rupture ATR Ultrasound achilles Tendon Tendon Rupture Anisotropy Compression Elastography Gastrocnemius

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Ultrasound and Color Doppler-Guided Surgery for Insertional achilles Tendinopathy-Results of a Pilot Study

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Open Journal of Orthopedics 2014年第1期4卷 7-14页

作者： Hakan Alfredson Martin Isaksson Department of Surgical and Perioperative Science Sports Medicine UnitUmea UniversityUmeaSweden Faculty of Medicine Umea UniversityUmeaSweden

Background: Treatment of insertional achilles tendinopathy is known to be difficult. Eccentric calf muscle exercises and extracorporeal shockwave therapy have been proposed as the primary treatments for this condition, but surgery is indicated after failed conservative management. There is no consensus about the most efficient surgical treatment. Objectives: To evaluate a new ultrasound and color Doppler-guided surgical treatment for insertional achilles tendinopathy. Patients and methods: 24 consecutive patients (13 men and 11 women, mean age 47 years) with a long duration of insertional achilles tendon pain (median 18 months) were included in the study. The surgical procedure consisted of extirpation of the subcutaneous and retrocalcaneal bursa, scraping of the ventral distal achilles tendon and removal of prominent bone at the upper calcaneal tuberosity (Haglund’s deformity). In 13 patients, the plantaris tendon was also cut and excised. VAS for pain during activity, satisfaction with the treatment result and the SF-36 score to measure quality of life were used for evaluation. Results: The mean VAS had decreased from 72 before surgery to 19 after surgery (p 0.001), and 20/24 (83%) patients were satisfied with the result and had returned to full tendon loading activity at the one-year follow-up. The SF-36 score had improved significantly. Conclusion: Ultrasound and color Doppler-guided surgical treatment seems to be a good method for treatment of chronic painful insertional achilles tendinopathy. Longer follow-up studies on larger materials are needed.

关键词： Insertional achilles Tendinopathy Bursitis Haglund’s Deformity Ultrasound+Doppler

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