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Wang R, Huang L, Jiang S, You G, Zhou X, Wang G, Zhang L. Immediate mobilization after repair of Achilles tendon rupture may increase the incidence of re-rupture: a systematic review and meta-analysis of randomized controlled trials. Int J Surg 2024; 110:01279778-990000000-01159. [PMID: 38477123 PMCID: PMC11175757 DOI: 10.1097/js9.0000000000001305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/23/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Achilles tendon rupture (ATR) is a significant injury that can require surgery and can have the risk of re-rupture even after successful treatment. Consequently, to minimize this risk, it is important to have a thorough understanding of the rehabilitation protocol and the impact of different rehabilitation approaches on preventing re-rupture. MATERIALS AND METHODS Two independent team members searched several databases (PubMed, EMBASE, Web of Science, Cochrane Library, and CINAHL) to identify randomized controlled trials (RCTs) on operative treatment of ATR. We included articles that covered open or minimally invasive surgery for ATR, with a detailed rehabilitation protocol and reports of re-rupture. The study protocol has been registered at PROSPERO and has been reported in the line with PRISMA Guidelines, Supplemental Digital Content 1, http://links.lww.com/JS9/C85, Supplemental Digital Content 2, http://links.lww.com/JS9/C86 and assessed using AMSTAR Tool, Supplemental Digital Content 3, http://links.lww.com/JS9/C87. RESULTS A total of 43 RCTs were eligible for the meta-analysis, encompassing a combined cohort of 2553 patients. Overall, the postoperative incidence of ATR patients developing re-rupture was 3.15% (95% CI: 2.26-4.17; I2=44.48%). Early immobilization group patients who had ATR had a 4.07% (95% CI: 1.76-7.27; I2=51.20%) postoperative incidence of re-rupture; Early immobilization + active range of motion (AROM) group had an incidence of 5.95% (95% CI: 2.91-9.99; I2=0.00%); Early immobilization + weight-bearing group had an incidence of 3.49% (95% CI: 1.96-5.43; I2=20.06%); Early weight-bearing + AROM group had an incidence of 3.61% (95% CI: 1.00-7.73; I2= 64.60%); Accelerated rehabilitation (immobilization) group had an incidence of 2.18% (95% CI: 1.11-3.59; I2=21.56%); Accelerated rehabilitation (non-immobilization) group had a rate of 1.36% (95% CI: 0.12-3.90; I2=0.00%). Additionally, patients in the immediate AROM group had a postoperative re-rupture incidence of 3.92% (95% CI: 1.76-6.89; I2=33.24%); Non-immediate AROM group had an incidence of 2.45% (95% CI: 1.25-4.03; I2=22.09%). CONCLUSIONS This meta-analysis suggests the use of accelerated rehabilitation intervention in early postoperative rehabilitation of the Achilles tendon. However, for early ankle joint mobilization, it is recommended to apply after one to two weeks of immobilization.
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Affiliation(s)
- Ruihan Wang
- School of Physical Education, Southwest Medical University
- Department of Rehabilitation, Yibin Integrated Traditional Chinese and Western Medicine Hospital, Yibin, China
| | - Lei Huang
- School of Physical Education, Southwest Medical University
| | - Songtao Jiang
- School of Clinical Medicine, Southwest Medical University
| | - Guixuan You
- School of Physical Education, Southwest Medical University
| | - Xin Zhou
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University
- Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University
- Luzhou Key Laboratory of Orthopedic Disorders, Luzhou
| | - Guoyou Wang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University
- Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University
- Luzhou Key Laboratory of Orthopedic Disorders, Luzhou
| | - Lei Zhang
- Department of Orthopedics, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University
- Center for Orthopedic Diseases Research, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University
- Luzhou Key Laboratory of Orthopedic Disorders, Luzhou
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Wang MW, Lee WN, Hung CC, Hsieh JH, Chen YH, Ting-Fang Shih T, Wang JH, Yin NH, Wang HK. Validation of the Efficacy of Ultrasound Speckle Tracking in Measuring Tendon Gliding After Finger Flexor Tendon Repair. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2548-2556. [PMID: 37741741 DOI: 10.1016/j.ultrasmedbio.2023.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 07/31/2023] [Accepted: 08/23/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE Restricted tendon gliding is commonly observed in patients after finger flexor tendon (FFT) repair. The study described here was aimed at quantifying the amount of FFT gliding to evaluate the recovery of post-operative tendons using a 2-D radiofrequency (RF)-based ultrasound speckle tracking algorithm (UST). METHODS Ex vivo uniaxial tensile testing of porcine flexor tendons and in vivo isometric testing of human FFT were implemented to verify the efficacy of UST beforehand. The verified UST was then applied to the patients after FFT repair to compare tendon gliding between affected and healthy sides and to investigate its correlation with the joint range of motion (ROM). RESULTS Excellent validity was confirmed with the average R2 value of 0.98, mean absolute error of 0.15 ± 0.08 mm and mean absolute percentage error of 5.19 ± 2.43% between results from UST and ex vivo testing. The test-retest reliability was verified with good agreement of ICC (0.90). The affected side exhibited less gliding (p = 0.001) and smaller active ROM (p = 0.002) than the healthy side. Meanwhile, a significant correlation between tendon gliding and passive ROM was found only on the healthy side (ρ = 0.711, p = 0.009). CONCLUSION The present study provides a promising protocol to evaluate post-operative tendon recovery by quantifying the amount of FFT gliding with a validated UST. FFT gliding in patients with different levels of ROM restriction should be further explored for categorizing the severity of tendon adhesion.
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Affiliation(s)
- Ming-Wei Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Ning Lee
- Department of Electrical and Electronic Engineering, University of Hong Kong, Hong Kong, China; Medical Engineering Programme, University of Hong Kong, Hong Kong, China
| | - Chih-Chien Hung
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Orthopedic Surgery, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan
| | - Jung-Hsien Hsieh
- Division of Plastic Surgery, Department of Surgery, Medical College and Hospital, National Taiwan University, Taipei, Taiwan
| | - Yueh-Hsia Chen
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan
| | - Tiffany Ting-Fang Shih
- Department of Medical Imaging and Radiology, Medical College and Hospital, National Taiwan University, Taipei, Taiwan
| | - Jyh-Horng Wang
- Department of Orthopedic Surgery, Medical College and Hospital, National Taiwan University, Taipei, Taiwan
| | - Nai-Hao Yin
- Centre for Human and Applied Physiological Sciences, School of Basic and Biomedical Sciences, King's College London, London, UK
| | - Hsing-Kuo Wang
- School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan; Center of Physical Therapy, National Taiwan University Hospital, Taipei, Taiwan.
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Wu CX, Xiong CY, Bai L, Chen SM, Yan YX, Wang L, Zhang XT. Achilles tendon thickening does not affect elasticity and functional outcome after surgical repair of Achilles rupture: A retrospective study. Chin J Traumatol 2023; 26:323-328. [PMID: 37940448 PMCID: PMC10755773 DOI: 10.1016/j.cjtee.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/21/2023] [Accepted: 10/01/2023] [Indexed: 11/10/2023] Open
Abstract
PURPOSE Previous studies have confirmed that Achilles tendon occurs Achilles thickening after repair surgery of the rupture. Although this mechanism has been elucidated in the laboratory, there are few reports on its impact on clinical function. We designed a retrospective study to investigate the Achilles thickening after Achilles tendon rupture repair and its correlation between the elasticity and postoperative function. METHODS In this retrospective analysis, patients who underwent surgical treatment for acute Achilles tendon rupture from April 2016 to April 2020 were included. All the patients were regularly followed up at 3 months, 1 year, and 2 years after surgery. American Orthopaedic Foot Ankle Surgeon (AOFAS) scale and Leppilahti score were used to evaluate functional outcomes. Achilles elasticity was measured by ultrasound shear wave of elasticity. Achilles thickening was calculated as maximal transverse and longitudinal diameter in cross-sectional plane of magnetic resonance scan. Sample t-tests was used for different follow-up periods. Correlation between Achilles thickening and other factors were analyzed using Pearson's method. p < 0.05 indicates a statistically significant difference. RESULTS AOFAS scale and Leppilahti score at 1 year were significantly higher than at 3 months postoperatively (both p < 0.001). These functional scales were also improved at 2-year follow-up significantly (both p < 0.001). The dorsiflexion difference showed gradually recovery in each follow-up period (t = -17.907, p < 0.001). The elasticity of the Achilles appeared to continuously decreases during the postoperative follow-up period in all position sets (p < 0.001). In thickening evaluation, the cross-sectional area of the thickest plane of Achilles was significantly higher at 1 year postoperatively (310.5 ± 25.2) mm2 than that at 3 months postoperatively ((278.0 ± 26.2) mm2, t = -8.219, p < 0.001) and became thinner in 2-year magnetic resonance scan ((256.1 ± 15.1) mm2, t = 16.769, p < 0.001). The correlations between Achilles thickening, elasticity, and functional outcome did not show statistical significance (p > 0.05) in every follow-up period. CONCLUSION Achilles tendon thickens after surgery in the 1st year, but begins to gradually return to thinning about 2 years after surgery. There was no significant correlation between the increase and decrease of thickening and the patients' clinical function scores, Achilles elasticity, and bilateral ankle dorsiflexion difference.
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Affiliation(s)
- Chen-Xi Wu
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
| | - Chang-Yue Xiong
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
| | - Lu Bai
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China.
| | - Su-Meng Chen
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
| | - Yu-Xin Yan
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
| | - Lu Wang
- Department of Statistics and Mathematical Sciences, Southern University of Science and Technology, Shenzhen, 518055, Guangdong province, China
| | - Xin-Tao Zhang
- Department of Sports Medicine Peking University Shenzhen Hospital, Shenzhen, 518036, Guangdong province, China
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Maffulli N, Nilsson Helander K, Migliorini F. Tendon appearance at imaging may be altered, but it may not indicate pathology. Knee Surg Sports Traumatol Arthrosc 2023; 31:1625-1628. [PMID: 36800008 DOI: 10.1007/s00167-023-07339-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 01/30/2023] [Indexed: 02/18/2023]
Abstract
Both in tendon repair following a tear and in tendinopathy, recovery from pain and restoration of (acceptable) function does not go hand in hand with the appearance of the affected tendon at imaging. The tendon may remain altered for a long while and possibly forever, indicating a possible dissociation between morphology and symptoms. The predictive value of asymptomatic abnormal findings remains limited, and interventions in such instances are inappropriate and not supported by current evidence. Once an initial imaging investigation has depicted the condition of the tendon, additional imaging investigations are unlikely to provide further information or change prognosis in patients in whom abnormalities compatible with a diagnosis of tendinopathy have been identified by either ultrasonography or MRI. Patient education and close clinical monitoring are recommended. This is applicable to the patellar tendon, Achilles tendon, rotator cuff, for both tendon repair and tendinopathy. Given the modest risk of sonographic abnormalities to develop in symptomatic tendinopathy, planning and trying to implement any form of intervention may not be warranted. The current evidence mostly arises from low-quality studies, with heterogeneous risk factors and populations, and caution must be maintained when interpreting the significance of such incidental findings in athletes.
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Affiliation(s)
- Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, SA, Italy.
- School of Pharmacy and Bioengineering, Faculty of Medicine, Keele University, Stoke-on-Trent, ST4 7QB, England.
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, 275 Bancroft Road, London, E1 4DG, England.
| | - Katarina Nilsson Helander
- Department of Orthopaedics, Sahlgrenska University Hospital, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, 52074, Aachen, Germany
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany
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Nakamura G, Yasuda T, Shima H, Togei K, Hirai Y, Neo M. Morphology of the asymptomatic Αchilles tendon: Measurement of tendon length and shape using magnetic resonance imaging, and investigation of related factors. J Orthop Sci 2023; 28:204-211. [PMID: 34756633 DOI: 10.1016/j.jos.2021.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/27/2021] [Accepted: 09/20/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND One of the severe complications of Achilles tendon (AT) rupture is muscle weakness due to tendon lengthening. It is very important to prevent tendon lengthening during treatment; however, data on the length, thickness, and width of normal ATs are scarce. Furthermore, no studies have investigated the factors related to the AT length and shape. We aimed to determine the normal AT length and shape and to investigate any correlating factors. METHODS We measured the AT length, thickness, and width of 100 asymptomatic patients using magnetic resonance imaging. We also investigated the correlation between the AT length, thickness, and width and factors including age, sex, height, body weight, body mass index, history of sports activities, and the area of Kager's fat pad. RESULTS The mean AT length was 42.1 ± 12.9 mm. The AT length in 73% of the patients was within the range of 30-55 mm. Individual differences in the tendon length were large, but there was no correlation between the tendon length and patient height (P = 0.505). There was a strong correlation between the AT length and area of Kager's fat pad on magnetic resonance imaging (r = 0.734, P < 0.001). Furthermore, the correlation coefficient between the area of Kager's fat pad on magnetic resonance imaging and the area of Kager's triangle on radiography was extremely high (r = 0.851, P < 0.001). CONCLUSIONS The AT length can be predicted based on the area of Kager's triangle of the unaffected ankle on radiography. If the AT length is > 55 mm or longer than the length measured directly or calculated from the estimated area of Kager's triangle, tendon lengthening should be suspected. Our findings could provide an important indicator for the evaluation of AT lengthening not only in daily clinical situations but also in clinical studies.
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Affiliation(s)
- Gen Nakamura
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki City, Osaka 569-8686 Japan
| | - Toshito Yasuda
- Faculty of Nursing, Osaka Medical and Pharmaceutical University, 7-6 Hatchonishi-machi, Takatsuki City, Osaka 569-0095, Japan.
| | - Hiroaki Shima
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki City, Osaka 569-8686 Japan
| | - Kosho Togei
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki City, Osaka 569-8686 Japan
| | - Yoshihiro Hirai
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki City, Osaka 569-8686 Japan
| | - Masashi Neo
- Department of Orthopedic Surgery, Osaka Medical and Pharmaceutical University, 2-7, Daigaku-machi, Takatsuki City, Osaka 569-8686 Japan
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Fackler NP, Karasavvidis T, Ehlers CB, Callan KT, Lai WC, Parisien RL, Wang D. The Statistical Fragility of Operative vs Nonoperative Management for Achilles Tendon Rupture: A Systematic Review of Comparative Studies. Foot Ankle Int 2022; 43:1331-1339. [PMID: 36004430 PMCID: PMC9527367 DOI: 10.1177/10711007221108078] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The statistical significance of randomized controlled trials (RCTs) and comparative studies is often conveyed utilizing the P value. However, P values are an imperfect measure and may be vulnerable to a small number of outcome reversals to alter statistical significance. The interpretation of the statistical strength of these studies may be aided by the inclusion of a Fragility Index (FI) and Fragility Quotient (FQ). This study examines the statistical stability of studies comparing operative vs nonoperative management for Achilles tendon rupture. METHODS A systematic search was performed of 10 orthopaedic journals between 2000 and 2021 for comparative studies focusing on management of Achilles tendon rupture reporting dichotomous outcome measures. FI for each outcome was determined by the number of event reversals necessary to alter significance (P < .05). FQ was calculated by dividing the FI by the respective sample size. Additional subgroup analyses were performed. RESULTS Of 8020 studies screened, 1062 met initial search criteria with 17 comparative studies ultimately included for analysis, 10 of which were RCTs. A total of 40 outcomes were examined. Overall, the median FI was 2.5 (interquartile range [IQR] 2-4), the mean FI was 2.90 (±1.58), the median FQ was 0.032 (IQR 0.012-0.069), and the mean FQ was 0.049 (±0.062). The FI was less than the number of patients lost to follow-up for 78% of outcomes. CONCLUSION Studies examining the efficacy of operative vs nonoperative management of Achilles tendon rupture may not be as statistically stable as previously thought. The average number of outcome reversals needed to alter the significance of a given study was 2.90. Future analyses may benefit from the inclusion of a fragility index and a fragility quotient in their statistical analyses.
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Affiliation(s)
- Nathan P. Fackler
- University of California, Irvine, CA,
USA,Georgetown University School of
Medicine, Washington, DC, USA
| | | | | | | | | | | | - Dean Wang
- University of California, Irvine, CA,
USA,Dean Wang, MD, University of California,
Irvine, 101 The City Drive South, Pavilion III, Building 29A, Orange, CA 92686,
USA.
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Doyle TR, Davey MS, Hurley ET. Statistical Findings Reported in Randomized Control Trials for the Management of Acute Achilles Tendon Ruptures are at High Risk of Fragility: A Systematic Review. J ISAKOS 2022; 7:72-81. [DOI: 10.1016/j.jisako.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/18/2022] [Accepted: 04/12/2022] [Indexed: 10/18/2022]
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Julies E, Williams T, Hall S. The Surgical Care Practitioner role in Achilles tendon re-rupture: A case study. J Perioper Pract 2021; 31:454-462. [PMID: 34478332 DOI: 10.1177/17504589211002377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The value of a Surgical Care Practitioner to an orthopaedic team is demonstrated in this case study of a patient who presented with a re-ruptured Achilles tendon. It highlights the role the practitioner plays in the patient journey and illustrates it's value throughout the clinical course from consultation through to discharge. The Surgical Care Practitioner, as a member of the extended surgical team can help to explain the diagnosis and associated treatment options, facilitate informed consent and provide expert procedural assistance to the surgeon. A Surgical Care Practitioner is ideally placed to answer patient queries and aid in rehabilitation.
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Affiliation(s)
- Elda Julies
- Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - Tim Williams
- Colchester Hospital University NHS Foundation Trust, Colchester, UK
| | - Susan Hall
- Anglia Ruskin University, Chelmsford, UK
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Repair of acute Achilles tears with plantaris augmentation. INTERNATIONAL ORTHOPAEDICS 2021; 45:2285-2290. [PMID: 34350472 DOI: 10.1007/s00264-021-05169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 07/21/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine the benefits associated with using the fanned out plantaris tendon as a membrane to cover and augment the acute Achilles tendon midportion end-to-end suture repair. METHODS Between 2014 and 2018, 31 (67.4%) patients had plantaris augmented reconstruction and 15 simple end-to-end suture. The clinician filled out the American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot scale and the patient the Achilles tendon total rupture score (ATRS). Examination included clinical examination, limb symmetry index (LSI) using the heel rise test, and ultrasound determination of cross-sectional area (CSA). RESULTS 80.4% were males, mean age 41 (SD 6.7, range 29-57), of which 82.6% were sports accidents. 39/46 were operated in less than two weeks from injury. 82.6% were available at the two year follow-up. Duration of surgery (62.3 min vs 58, p = 0.45), AOFAS (89.6 vs 88.4, p = 0.61 and 97.2 vs 96.8, p = 0.72), ATRS (86.3 vs 83.8, p = 0.33 and 95.6 vs 93.6, p = 0.12), LSI (60.8% vs 58.75, p = 0.24 and 80.5 vs 79, p = 0.29), CSA (3.39cm2 vs 3.36, p = 0.82 and 2.57 vs 2.59, p = 0.87), return to sport (80% vs 57, p = 0.15 and 84.6 vs 85.7, p = 1.00), and complications at six months and two years were comparable between the two techniques. CONCLUSION Fanned out plantaris augmentation of acute Achilles tendon tears yields excellent and comparable clinical and ultrasonographic results to end-to-end suture at mid-term follow-up.
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Pereira PM, Amaro J, Ribeiro BT, Gomes A, De Oliveira P, Duarte J, Ferraz J, Baptista JS, Costa JT. Musculoskeletal Disorders' Classification Proposal for Application in Occupational Medicine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8223. [PMID: 34360516 PMCID: PMC8345928 DOI: 10.3390/ijerph18158223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 07/14/2021] [Accepted: 07/29/2021] [Indexed: 11/22/2022]
Abstract
Occupational-specific classifications of musculoskeletal disorders (MSD) are scarce and do not answer specific clinical questions. Thus, a specific classification was developed and proposed, covering criteria applicable to daily clinical activity. It was considered that the disorder development process is the same across all work-related MSDs (WRMSDs). Concepts of clinical pathology were applied to the characteristics of WRMSDs pathophysiology, cellular and tissue alterations. Then, the correlation of the inflammatory mechanisms with the injury onset mode was graded into four levels (MSDs 0-3). Criteria of legal, occupational and internal medicine, semiology, physiology and orthopaedics, image medicine and diagnostics were applied. Next, the classification was analysed by experts, two occupational physicians, two physiatrists and occupational physicians and one orthopaedist. This approach will allow WRMSD prevention and improve therapeutic management, preventing injuries from becoming chronic and facilitating communication between occupational health physicians and the other specialities. The four levels tool relate aetiopathogenic, clinical, occupational and radiological concepts into a single classification. This allows for improving the ability to determine a WRMSD and understanding what preventive and therapeutic measures should be taken, avoiding chronicity. The developed tool is straightforward, easy to understand and suitable for WRMSDs, facilitating communication between occupational physicians and physicians from other specialities.
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Affiliation(s)
- Pablo Monteiro Pereira
- Associated Laboratory for Energy, Transports and Aeronautics, (LAETA/ROA), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (P.M.P.); (J.T.C.)
| | - João Amaro
- Institute of Public Health, University of Porto, 4200-319 Porto, Portugal; (J.A.); (P.D.O.)
| | | | - Ana Gomes
- Occupational Safe and Health Department, Ria Blades/Siemens Gamesa, 3840-346 Vagos, Portugal;
| | - Paulo De Oliveira
- Institute of Public Health, University of Porto, 4200-319 Porto, Portugal; (J.A.); (P.D.O.)
| | - Joana Duarte
- Associated Laboratory for Energy, Transports and Aeronautics, (LAETA/PROA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal; (J.D.); (J.F.)
| | - João Ferraz
- Associated Laboratory for Energy, Transports and Aeronautics, (LAETA/PROA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal; (J.D.); (J.F.)
| | - João Santos Baptista
- Associated Laboratory for Energy, Transports and Aeronautics, (LAETA/PROA), Faculty of Engineering, University of Porto, 4200-465 Porto, Portugal; (J.D.); (J.F.)
| | - José Torres Costa
- Associated Laboratory for Energy, Transports and Aeronautics, (LAETA/ROA), Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal; (P.M.P.); (J.T.C.)
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11
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Stäudle B, Seynnes O, Laps G, Göll F, Brüggemann GP, Albracht K. Recovery from Achilles Tendon Repair: A Combination of Postsurgery Outcomes and Insufficient Remodeling of Muscle and Tendon. Med Sci Sports Exerc 2021; 53:1356-1366. [PMID: 33433154 DOI: 10.1249/mss.0000000000002592] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Achilles tendon rupture (ATR) patients have persistent functional deficits in the triceps surae muscle-tendon unit (MTU). The complex remodeling of the MTU accompanying these deficits remains poorly understood. The purpose of the present study was to associate in vivo and in silico data to investigate the relations between changes in MTU properties and strength deficits in ATR patients. METHODS Eleven male subjects who had undergone surgical repair of complete unilateral ATR were examined 4.6 ± 2.0 (mean ± SD) yr after rupture. Gastrocnemius medialis (GM) tendon stiffness, morphology, and muscle architecture were determined using ultrasonography. The force-length relation of the plantar flexor muscles was assessed at five ankle joint angles. In addition, simulations (OpenSim) of the GM MTU force-length properties were performed with various iterations of MTU properties found between the unaffected and the affected side. RESULTS The affected side of the patients displayed a longer, larger, and stiffer GM tendon (13% ± 10%, 105% ± 28%, and 54% ± 24%, respectively) compared with the unaffected side. The GM muscle fascicles of the affected side were shorter (32% ± 12%) and with greater pennation angles (31% ± 26%). A mean deficit in plantarflexion moment of 31% ± 10% was measured. Simulations indicate that pairing an intact muscle with a longer tendon shifts the optimal angular range of peak force outside physiological angular ranges, whereas the shorter muscle fascicles and tendon stiffening seen in the affected side decrease this shift, albeit incompletely. CONCLUSIONS These results suggest that the substantial changes in MTU properties found in ATR patients may partly result from compensatory remodeling, although this process appears insufficient to fully restore muscle function.
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Affiliation(s)
| | - Olivier Seynnes
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, NORWAY
| | - Guido Laps
- Orthopaedie am Guerzenich, Cologne, GERMANY
| | - Fabian Göll
- Institute of Movement and Neurosciences, German Sport University Cologne, Cologne, GERMANY
| | - Gert-Peter Brüggemann
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, GERMANY
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12
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Johnson SA, Valdés-Martínez A, Turk PJ, Wayne McIlwraith C, Barrett MF, McGilvray KC, Frisbie DD. Longitudinal tendon healing assessed with multi-modality advanced imaging and tissue analysis. Equine Vet J 2021; 54:766-781. [PMID: 34101888 DOI: 10.1111/evj.13478] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 04/25/2021] [Accepted: 05/28/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The range of diagnostic modalities available to evaluate superficial digital flexor tendon (SDFT) injury includes magnetic resonance imaging (MRI), computed tomography (CT) and ultrasonography (US). Direct, comprehensive comparison of multi-modality imaging characteristics to end-point data has not previously been performed using a model of tendinopathy but is required to obtain a better understanding of each modality's diagnostic capabilities. OBJECTIVE To compare CT, MRI and US evaluation to outcome measures for histologic, biochemical and biomechanical parameters using an equine surgical model of tendinopathy. STUDY DESIGN Controlled experiment. METHODS Lesions were surgically created in both forelimb SDFTs of eight horses and imaged using MRI, CT and US at seven time points over 12 months. Imaging characteristics were then correlated to end point histologic, biochemical and biomechanical data using lasso regression. Longitudinal lesion size was compared between imaging modalities. RESULTS Lesion to tendon isoattenuation on CT evaluation correlated with the greatest levels of aggrecan deposition. A significant correlation between cellular density and percentage of tendon involvement on the T2-weighted sequence and signal intensity on the proton density fat saturated (PD FS) sequence was appreciated at the 12-month time point (P = .006, P = .02 respectively). There was no significant correlation between end-point data and US or contrast imaging characteristics. Cross sectional area lesion to tendon measurements were significantly largest on CT evaluation, followed by MRI and then US (P < .001). MAIN LIMITATIONS Experimentally induced tendon injury with singular end-point data correlation. CONCLUSIONS Lesion isoattenuation on CT evaluation suggested scar tissue deposition, while T2-weighted hyperintensity indicated hypercellular tendinopathy even in chronic stages of healing. Non contrast-enhanced MRI and CT evaluation correlated most closely to cellular characteristics of surgically damaged tendons assessed over a twelve month study period. Ultrasonographic evaluation underestimates true lesional size and should be interpreted with caution.
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Affiliation(s)
- Sherry A Johnson
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Orthopaedic Research Center at the C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, CO, USA
| | | | - Philip J Turk
- Atrium Health, Center for Outcomes Research and Evaluation, Charlotte, NC, USA
| | - Cyril Wayne McIlwraith
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Orthopaedic Research Center at the C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, CO, USA
| | - Myra F Barrett
- Department of Environmental and Radiological Health Sciences, College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, CO, USA
| | - Kirk C McGilvray
- Orthopaedic Bioengineering Research Laboratory, Department of Mechanical Engineering, School of Biomedical Engineering, Colorado State University, Fort Collins, CO, USA
| | - David D Frisbie
- Department of Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Orthopaedic Research Center at the C. Wayne McIlwraith Translational Medicine Institute, Colorado State University, Fort Collins, CO, USA
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13
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Evaluation of Current Symptoms in Postoperative Achilles Tendons: A Multimodal Ultrasound Study. Healthcare (Basel) 2021; 9:healthcare9030288. [PMID: 33807841 PMCID: PMC8000856 DOI: 10.3390/healthcare9030288] [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] [Received: 01/28/2021] [Revised: 02/24/2021] [Accepted: 03/01/2021] [Indexed: 11/17/2022] Open
Abstract
(1) Background: It is unknown which imaging parameters are associated with clinical persistent symptoms in postoperative Achilles tendons. This study used B-Mode, Power Doppler (PD-US), Ultrasound Tissue Characterization (UTC) and Shear Wave Elastography (SWE) to investigate which imaging parameters are associated with persistent symptoms in postoperative Achilles tendon tissue. (2) Methods: Retrospective, cross-sectional, multimodal imaging study. Based on the VISA-A score, postoperative tendons were assigned to two groups: 1. asymptomatic (VISA-A ≥ 90, n = 18); 2. symptomatic (VISA-A < 90, n = 10). The following imaging parameters were analyzed: UTC (echo type I, II, III, IV), B-Mode (diameter, cross sectional area, calcification, fiber irregularity), PD-US (Öhberg score) and SWE (SWE 3 mm, SWE area) using a t-test and a Mann–Whitney U test. (3) Results: SWE and PD-US showed significantly reduced elasticity and increased neovascularization in symptomatic tendons (SWE 3 mm p = 0.031, SWE area p = 0.046, Öhberg score p < 0.001). The only significant correlation between imaging parameters and the VISA-A score was assessed for SWE 3 mm (r = 0.378; p = 0.047) and the Öhberg score (r = −0.737; p < 0.001). Conclusions: Symptomatic postoperative Achilles tendons showed increased neovascularization and lower SWE values than asymptomatic ones. Future studies should examine the diagnostic accuracy of PD-US and SWE in detecting current symptoms in postoperative Achilles tendons.
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14
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M Khair R, Stenroth L, Péter A, Cronin NJ, Reito A, Paloneva J, Finni T. Non-uniform displacement within ruptured Achilles tendon during isometric contraction. Scand J Med Sci Sports 2021; 31:1069-1077. [PMID: 33464638 DOI: 10.1111/sms.13925] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 01/21/2023]
Abstract
The purpose of this study was investigate tendon displacement patterns in non-surgically treated patients 14 months after acute Achilles tendon rupture (ATR) and to classify patients into groups based on their Achilles tendon (AT) displacement patterns. Twenty patients were tested. Sagittal images of AT were acquired using B-mode ultrasonography during ramp contractions at a torque level corresponding to 30% of the maximal isometric plantarflexion torque of the uninjured limb. A speckle tracking algorithm was used to track proximal-distal movement of the tendon tissue at 6 antero-posterior locations. Two-way repeated measures ANOVA for peak tendon displacement was performed. K-means clustering was used to classify patients according to AT displacement patterns. The difference in peak relative displacement across locations was larger in the uninjured (1.29 ± 0.87 mm) than the injured limb (0.69 ± 0.68 mm), with a mean difference (95% CI) of 0.60 mm (0.14-1.05 mm, P < .001) between limbs. For the uninjured limb, cluster analysis formed 3 groups, while 2 groups were formed for the injured limb. The three distinct patterns of AT displacement during isometric plantarflexion in the uninjured limb may arise from subject-specific anatomical variations of AT sub-tendons, while the two patterns in the injured limb may reflect differential recovery after ATR with non-surgical treatment. Subject-specific tendon characteristics are a vital determinant of stress distribution across the tendon. Changes in stress distribution may lead to variation in the location and magnitude of peak displacement within the free AT. Quantifying internal tendon displacement patterns after ATR provides new insights into AT recovery.
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Affiliation(s)
- Ra'ad M Khair
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Lauri Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Annamária Péter
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
| | - Neil J Cronin
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland.,Department for Health, University of Bath, Bath, UK
| | - Aleksi Reito
- Central Finland Health Care District, Jyväskylä, Finland
| | - Juha Paloneva
- Central Finland Health Care District, Jyväskylä, Finland
| | - Taija Finni
- Faculty of Sport and Health Sciences, Neuromuscular Research Center, University of Jyväskylä, Jyväskylä, Finland
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15
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Post-operative MRI and US appearance of the Achilles tendons. J Ultrasound 2020; 23:387-395. [PMID: 32488649 DOI: 10.1007/s40477-020-00479-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 05/12/2020] [Indexed: 12/17/2022] Open
Abstract
The Achilles tendon is one of the most commonly ruptured tendons in the human body. Minimally invasive and open surgical repairs are commonly undertaken to manage acute Achilles ruptures. This article describes the postoperative imaging findings and their evolution after surgery. Ultrasound and magnetic resonance imaging provide crucial information regarding the morphology, structure, vascularization and mobility of the Achilles tendon on the surrounding planes. Morphologically, a repaired tendon is physiologically larger and wider than an intact one, with a loss of its fibrillary structure; the presence of surgical material in the context of the tendon is normal after the rupture has been repaired. After surgery, the tendon is more vascularized in power-Doppler imaging. Elastography and diffusion tensor Imaging are innovative tools which allow for the visualization of microstructural abnormalities not apprehensible using conventional imaging techniques. A treated Achilles tendon is unlikely to regain a normal imaging appearance, and the health care professional must distinguish between postoperative findings and actual pathological features. In this context, clinical examination still reigns supreme.
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16
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Zellers JA, Pohlig RT, Cortes DH, Grävare Silbernagel K. Achilles tendon cross-sectional area at 12 weeks post-rupture relates to 1-year heel-rise height. Knee Surg Sports Traumatol Arthrosc 2020; 28:245-252. [PMID: 31267192 PMCID: PMC6939153 DOI: 10.1007/s00167-019-05608-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 06/26/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Achilles tendon rupture leads to long-term plantar flexor deficits, but some patients recover functional performance better than others. Early indicators of tendon healing could be helpful in establishing patient prognosis and making individualized decisions regarding rehabilitation progression. The purpose of this study was to investigate relationships between early tendon morphology and mechanical properties to long-term heel-rise and jumping function in individuals after Achilles tendon rupture. METHODS Individuals after Achilles tendon rupture were assessed at 4, 8, 12, 24, and 52 weeks post-injury. Tendon cross-sectional area, length, and mechanical properties were measured using ultrasound. Heel-rise and jump tests were performed at 24 and 52 weeks. Correlation and regression analysis were used to identify relationships between tendon structural variables in the first 12 weeks to functional outcomes at 52 weeks, and determine whether the addition of tendon structural characteristics at 24 weeks strengthened relationships between functional performance at 24 and 52 weeks. Functional outcomes of individuals with < 3 cm of elongation were compared to those with > 3 cm of elongation using a Mann-Whitney U test. RESULTS Twenty-two participants [mean (SD) age = 40 (11) years, 17 male] were included. Tendon cross-sectional area at 12 weeks was the strongest predictor of heel-rise height (R2 = 0.280, p = 0.014) and work symmetry (R2 = 0.316, p = 0.008) at 52 weeks. Jumping performance at 52 weeks was not significantly related to any of the tendon structural measures in the first 12 weeks. Performance of all functional tasks at 24 weeks was positively related to performance on the same task at 52 weeks (r = 0.456-0.708, p < 0.05). The addition of tendon cross-sectional area improved the model for height LSI (R2 = 0.519, p = 0.001). Tendon elongation > 3 cm significantly reduced jumping symmetry (p < 0.05). CONCLUSION Tendon cross-sectional area and excessive elongation related to plantar flexor performance on functional testing after Achilles tendon rupture. Once an individual is able to perform function-based testing, tendon structural measures may inform long-term prognosis. Ultrasound-based measures of tendon structure early in recovery seem to relate to later performance on functional testing. Clinically, assessing tendon structure has the potential to be used as a biomarker of tendon healing early in recovery and better predict patients at risk of negative functional outcome. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Jennifer A Zellers
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Ryan T Pohlig
- College of Health Sciences biostatistics Core Facility, University of Delaware, Newark, DE, USA
| | - Daniel H Cortes
- Department of Mechanical and Nuclear Engineering, Penn State University, State College, PA, USA
| | - Karin Grävare Silbernagel
- Department of Physical Therapy, University of Delaware, 540 South College Ave, Newark, DE, 19713, USA.
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17
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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] [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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18
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Zellers JA, Cortes DH, Pohlig RT, Silbernagel KG. Tendon morphology and mechanical properties assessed by ultrasound show change early in recovery and potential prognostic ability for 6-month outcomes. Knee Surg Sports Traumatol Arthrosc 2019; 27:2831-2839. [PMID: 30415387 PMCID: PMC6510650 DOI: 10.1007/s00167-018-5277-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 10/29/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE Optimizing tendon structural recovery during the first 12 weeks after Achilles tendon rupture is a prime target to improve patient outcomes, but a comprehensive understanding of biomarkers is needed to track early healing. The purpose of this study was to observe healing of tendon structure over time using ultrasound-based, tendon-specific measures and to identify relationships between tendon structural characteristics and clinical measures of gait and strength. METHODS Twenty-seven participants (21 males, mean (SD) age 39 (11) years) were assessed at 4, 8, 12, and 24 weeks after injury or surgery using ultrasound imaging techniques. Gait analysis and strength testing were added at the later time points. RESULTS Ruptured tendons had significantly lower dynamic shear modulus (p < 0.001), greater tendon cross-sectional area (p < 0.001), and greater length (p < 0.001) than the uninjured side. Dynamic shear modulus, cross-sectional area, and length were found to increase over time (p < 0.01). Tendon structure at 4 weeks post-injury [cross-sectional area symmetry (r = 0.737, p = 0.002) and dynamic shear modulus (r = 0.518, p = 0.040)] related to stance phase walking symmetry at 24 weeks. CONCLUSIONS Tendon structure assessed by ultrasound imaging changes over the first 24 weeks of healing after Achilles tendon rupture, suggesting it could be used as a biomarker to track tendon healing early in recovery. Additionally, tendon structure within the first 12 weeks relates to later walking gait and heel-rise symmetry, which may indicate that tendon structure could have prognostic value in the care of these patients. This study's clinical relevance is in its support for using ultrasound imaging to assess early patient healing and prognosticate later patient outcomes after Achilles tendon rupture. LEVEL OF EVIDENCE Level 2, prospective cohort prognostic study.
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Affiliation(s)
- Jennifer A Zellers
- Department of Physical Therapy, University of Delaware, 540 South College Ave, Newark, DE, 19713, USA
| | - Daniel H Cortes
- Department of Mechanical and Nuclear Engineering, Penn State University, State College, PA, USA
| | - Ryan T Pohlig
- College of Health Sciences Biostatistics Core Facility, University of Delaware, Newark, DE, USA
| | - Karin Grävare Silbernagel
- Department of Physical Therapy, University of Delaware, 540 South College Ave, Newark, DE, 19713, USA.
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19
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Thoirs KA, Childs J. Are Ultrasound Measurements of Achilles Tendon Size Reliable? A Systematic Review of Rater Reliability. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:2476-2491. [PMID: 30154035 DOI: 10.1016/j.ultrasmedbio.2018.07.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 07/04/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
Ultrasound measurements of Achilles tendon size are used to assess the tendon's response to exercise, aging, rehabilitation, tendon loading and healing. It is important to understand and minimise the measurement error that occurs with these measurements. This review identified and synthesised studies reporting on intra- and inter-rater reliability of ultrasound measurements of Achilles tendon size. Analysis of 21 studies revealed that good to excellent intra- and inter-rater reliability can be achieved for ultrasound measurements of Achilles tendon size. Reliability can be optimised by using one experienced operator, standardising transducer pressure and orientation and averaging two or three measurements. There was a high risk of methodological bias across the included studies. Reporting of reliability studies needs to be improved by the use of existing reporting guidelines and expansion of these guidelines to include important elements of ultrasound imaging.
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Affiliation(s)
- Kerry A Thoirs
- International Centre of Allied Health Evidence, School of Health Sciences, University of South Australia, Adelaide, South Australia 5001, Australia.
| | - Jessie Childs
- School of Health Sciences, University of South Australia, Adelaide, South Australia 5001, Australia
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20
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Hiramatsu K, Tsujii A, Nakamura N, Mitsuoka T. Ultrasonographic Evaluation of the Early Healing Process After Achilles Tendon Repair. Orthop J Sports Med 2018; 6:2325967118789883. [PMID: 30135861 PMCID: PMC6090484 DOI: 10.1177/2325967118789883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Background: Little is known about early healing of repaired Achilles tendons on imaging, particularly up to 6 months postoperatively, when patients generally return to participation in sports. Purpose: To examine changes in repaired Achilles tendon healing with ultrasonography for up to 12 months after surgery. Study Design: Case series; Level of evidence, 4. Methods: Ultrasonographic images of 26 ruptured Achilles tendons were analyzed at 1, 2, 3, 4, 6, and 12 months after primary repair. The cross-sectional areas (CSAs) and intratendinous morphology of the repaired tendons were evaluated using the authors’ own grading system (tendon repair scores), which assessed the anechoic tendon defect area, intratendinous hyperechoic area, continuity of intratendinous fibrillar appearance, and paratendinous edema. Results: The mean ratios (%) of the CSA for the affected versus unaffected side of repaired Achilles tendons gradually increased postoperatively, reached a maximum (632%) at 6 months, and then decreased at 12 months. The mean tendon repair scores increased over time and reached a plateau at 6 months. Conclusion: Ultrasonography is useful to observe the intratendinous morphology of repaired Achilles tendons and to provide useful information for patients who wish to return to sports. Clinical parameters such as strength, functional performance, and quality of healed repaired tendons should also be assessed before allowing patients to return to sports.
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Affiliation(s)
- Kunihiko Hiramatsu
- Department of Orthopaedic Surgery, Yao Municipal Hospital, Yao, Japan.,Department of Orthopaedic Surgery, Tamai Orthopaedic Hospital, Hannan, Japan
| | - Akira Tsujii
- Department of Orthopaedic Surgery, Yao Municipal Hospital, Yao, Japan.,Department of Orthopaedic Surgery, Hoshigaoka Medical Center, Hirakata, Japan
| | - Norimasa Nakamura
- Institute for Medical Science in Sports, Osaka Health Science University, Osaka, Japan
| | - Tomoki Mitsuoka
- Department of Orthopaedic Surgery, Yao Municipal Hospital, Yao, Japan
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21
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Lower material stiffness in rupture-repaired Achilles tendon during walking: transmission-mode ultrasound for post-surgical tendon evaluation. Knee Surg Sports Traumatol Arthrosc 2018; 26:2030-2037. [PMID: 28660438 DOI: 10.1007/s00167-017-4624-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 06/19/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE This cross-sectional study used transmission-mode ultrasound to evaluate dynamic tendon properties during walking in surgically repaired and contralateral Achilles tendon (AT), with a median (range) post-operative period of 22 (4-58) months. It was hypothesised that the axial transmission speed of ultrasound (TSOU) during walking would be slower, indicating lower material stiffness in repaired compared with contralateral AT. METHODS Ten patients [median (range) age 47 (37-69) years; height 180 (170-189) cm; weight 93 (62-119) kg], who had undergone open surgical repair of the AT and were clinically recovered according to their treating clinicians, walked barefoot on a treadmill at self-selected speed (1.0 ± 0.2 m/s). Synchronous measures of TSOU, sagittal ankle motion, vertical ground reaction force (GRF), and spatiotemporal gait parameters were recorded during 20 s of steady-state walking. Paired t tests were used to evaluate potential between-limb differences in TSOU, GRF, ankle motion, and spatiotemporal gait parameters. RESULTS TSOU was significantly lower (≈175 m/s) in the repaired than in the contralateral AT over the entire gait cycle (P < 0.05). Sagittal ankle motion was significantly greater (≈3°) in the repaired than in the contralateral limb (P = 0.036). There were no significant differences in GRF or spatiotemporal parameters between limbs. CONCLUSIONS Repaired AT was characterised by a lower TSOU, reflecting a lower material stiffness in the repaired tendon than in the contralateral tendon. A lower material stiffness may underpin greater ankle joint motion of the repaired limb during walking and long-term deficits in the muscle-tendon unit reported with AT repair. Treatment and rehabilitation approaches that focus on increasing the material stiffness of the repaired AT may be clinically beneficial. Transmission-mode ultrasound would seem useful for quantifying tendon properties post AT rupture repair and may have the potential to individually guide rehabilitation programmes, thereby aiding safer return to physical activity. LEVEL OF EVIDENCE II.
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22
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Valle X, Alentorn-Geli E, Tol JL, Hamilton B, Garrett WE, Pruna R, Til L, Gutierrez JA, Alomar X, Balius R, Malliaropoulos N, Monllau JC, Whiteley R, Witvrouw E, Samuelsson K, Rodas G. Muscle Injuries in Sports: A New Evidence-Informed and Expert Consensus-Based Classification with Clinical Application. Sports Med 2018; 47:1241-1253. [PMID: 27878524 DOI: 10.1007/s40279-016-0647-1] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Muscle injuries are among the most common injuries in sport and continue to be a major concern because of training and competition time loss, challenging decision making regarding treatment and return to sport, and a relatively high recurrence rate. An adequate classification of muscle injury is essential for a full understanding of the injury and to optimize its management and return-to-play process. The ongoing failure to establish a classification system with broad acceptance has resulted from factors such as limited clinical applicability, and the inclusion of subjective findings and ambiguous terminology. The purpose of this article was to describe a classification system for muscle injuries with easy clinical application, adequate grouping of injuries with similar functional impairment, and potential prognostic value. This evidence-informed and expert consensus-based classification system for muscle injuries is based on a four-letter initialism system: MLG-R, respectively referring to the mechanism of injury (M), location of injury (L), grading of severity (G), and number of muscle re-injuries (R). The goal of the classification is to enhance communication between healthcare and sports-related professionals and facilitate rehabilitation and return-to-play decision making.
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Affiliation(s)
- Xavier Valle
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain. .,Sports Medicine School, Universitat de Barcelona, Barcelona, Spain. .,Mapfre Centre for Tennis Medicine, Barcelona, Spain. .,Department de Cirurgia de la Facultat de Medicina, 'Universitat Autònoma de Barcelona', Barcelona, Spain.
| | - Eduard Alentorn-Geli
- Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University, Durham, NC, USA
| | - Johannes L Tol
- Department of Sports Medicine, Aspetar, Doha, Qatar.,Department of Sports Medicine, The Sports Physician Group, OLVG-West, Amsterdam, The Netherlands.,Academic Center for Evidence Based Sports Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Bruce Hamilton
- Department of Sports Medicine, Aspetar, Doha, Qatar.,High Performance Sport NZ, Millenium Institute of Sport and Health, Auckland, New Zealand
| | - William E Garrett
- Department of Orthopaedic Surgery, Duke Sports Sciences Institute, Duke University, Durham, NC, USA
| | - Ricard Pruna
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain
| | - Lluís Til
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain.,High Performance Centre, Health Consortium of Terrassa, Barcelona, Spain
| | - Josep Antoni Gutierrez
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain.,Sport Catalan Council, Generalitat de Catalunya, Barcelona, Spain
| | | | - Ramón Balius
- Mapfre Centre for Tennis Medicine, Barcelona, Spain.,Sport Catalan Council, Generalitat de Catalunya, Barcelona, Spain
| | - Nikos Malliaropoulos
- Musculoskeletal Department, Thessaloniki Sports Medicine Clinic, Thessaloníki, Greece.,Department of Rheumatology, Sports Clinic, Mile End Hospital, Barts Health NHS Trust, London, UK
| | - Joan Carles Monllau
- Department of Orthopaedic Surgery, Parc de Salut Mar-Hospital del Mar and Hospital de l'Esperança, Universitat Autònoma de Barcelona, Barcelona, Spain.,Hospital Universitari Dexeus (ICATME), Barcelona, Spain
| | - Rodney Whiteley
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Erik Witvrouw
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.,Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Kristian Samuelsson
- Department of Orthopaedic Surgery, Sahlgrenska Academy, University of Gothenburg, Göteburg, Sweden
| | - Gil Rodas
- Medical Department, FC Barcelona, Ciutat Esportiva Joan Gamper, Av. Onze de Setembre, s/n, Sant Joan Despí, 08970, Barcelona, Spain
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Ellison P, Molloy A, Mason LW. Early Protected Weightbearing for Acute Ruptures of the Achilles Tendon: Do Commonly Used Orthoses Produce the Required Equinus? J Foot Ankle Surg 2018; 56:960-963. [PMID: 28842105 DOI: 10.1053/j.jfas.2017.06.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Indexed: 02/03/2023]
Abstract
Conservative "functional" management of acute Achilles tendon ruptures has become increasingly popular. Critical to this is the use of the walking orthosis, which positions the ankle in equinus to allow for early weightbearing. Our aim was to test whether 2 common orthoses achieved a satisfactory equinus position. A total of 11 sequentially treated Achilles tendon ruptures were assigned to either a fixed angle walking boot with wedges (FAWW) or an adjustable external equinus-corrected brace (EEB). The lateral radiographs of the cast immobilized tendons showed a mean tibiotalar angle (TTA) of 56° (range 54° to 57°) and a mean tibio-first metatarsal angle (1MTA) of 74° (range 62° to 85°). The FAWW resulted in a mean TTA of 28° (range 15° to 35°) and 1MTA of 37° (range 30° to 45°). The EEB resulted in a TTA of 48° (range 43° to 45°) and 1MTA of 54° (range 47° to 57°). Ankle equinus was significantly greater with the EEB than with the FAWW (p < .05) and similar to that with an equinus cast. The use of wedges produced an equinus appearance through the midfoot but not at the ankle. We express caution in the use of the FAWW because it is unlikely to achieve sufficient ankle equinus to shorten the Achilles tendon.
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Affiliation(s)
- Philip Ellison
- Lower Limb Extended Scope Practitioner, Trauma and Orthopaedic Department, University Hospital Aintree, Liverpool, UK.
| | - Andrew Molloy
- Consultant Foot and Ankle Surgeon, Trauma and Orthopaedic Department, University Hospital Aintree, Liverpool, UK
| | - Lyndon William Mason
- Consultant Foot and Ankle Surgeon, Trauma and Orthopaedic Department, University Hospital Aintree, Liverpool, UK
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Kanamoto T, Tanaka Y, Yonetani Y, Kita K, Amano H, Okamoto K, Shino K, Horibe S. Sex Differences in the Residual Patellar Tendon After Harvesting Its Central Third for Anterior Cruciate Ligament Reconstruction. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2018; 37:755-761. [PMID: 28945278 DOI: 10.1002/jum.14419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 06/21/2017] [Accepted: 06/24/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Some studies have found that sex can affect the clinical results after anterior cruciate ligament reconstruction. We hypothesized that sex would significantly affect the healing of the postoperative patellar tendon. This study evaluated the patellar tendon after bone-patellar tendon-bone autograft harvest, specifically with regard to sex-dependent differences. METHODS At 6 months postoperatively, an ultrasonographic evaluation was performed. We measured the residual donor site gap width between tendon tissues and the thickness of newly formed nontendinous tissue in the gap. In addition, the cross-sectional area of tendon tissue was measured. The ratios between the operated and contralateral sides were calculated, and the sexes were compared. A paired Student t test was performed, with P < .05 considered statistically significant. RESULTS The population of 52 patients (32 male and 20 female) had a mean age ± SD of 23 ± 8 years. We observed no significant sex-dependent differences in the residual donor site gap and the thickness of newly formed nontendinous tissue when calculating ratios to the contralateral tendon. The mean cross-sectional area of tendon tissue was 101 ± 26 mm2 (male, 114 ± 26 mm2 ; female, 80 ± 16 mm2 ). When the ratios to the contralateral tendon were calculated, male patients had significantly higher cross-sectional area ratios than female patients (male, 124% ± 20%; female, 100% ± 19%, P = .024). CONCLUSIONS We have reported a dramatic increase in the cross-sectional area of patellar tendon tissue during the first 6 months after anterior cruciate ligament reconstruction with a bone-patellar tendon-bone autograft, which was more prominent in male patients than in female patients. This difference might have contributed to the sex-dependent variation in clinical outcomes.
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Affiliation(s)
- Takashi Kanamoto
- Department of Orthopedic Surgery, Hannan Chuo Hospital, Matsubara, Japan
| | | | - Yasukazu Yonetani
- Department of Orthopedic Surgery, Hoshigaoka Medical Center, Hirakata, Japan
| | - Keisuke Kita
- Sports Orthopedic Center, Yukioka Hospital, Osaka, Japan
| | | | | | - Konsei Shino
- Department of Orthopedic Surgery, Hoshigaoka Medical Center, Hirakata, Japan
| | - Shuji Horibe
- Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Japan
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Dams OC, Reininga IHF, Gielen JL, van den Akker-Scheek I, Zwerver J. Imaging modalities in the diagnosis and monitoring of Achilles tendon ruptures: A systematic review. Injury 2017; 48:2383-2399. [PMID: 28943056 DOI: 10.1016/j.injury.2017.09.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 09/10/2017] [Accepted: 09/11/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the role of imaging in the diagnosis and monitoring of the Achilles tendon rupture (ATR). STUDY DESIGN Systematic review. DATA SOURCES PubMed and EMBASE in November 2016. ELIGIBILITY CRITERIA Clinical studies providing information on the methods and role of imaging in the diagnosis and monitoring of the ATR were included. RESULTS Fifty-six studies were included, most concerning the use of ultrasound (n=37) or MRI (n=18). Seven studies provided data on the diagnostic accuracy of imaging. Most ultrasound studies used a 7.5MHz probe (19/32 studies) and scanned the patient bilaterally in prone position, with recent studies tending to use higher frequency probes (r=0.42). Sensitivity [for detecting a rupture] ranged from 79.6 to 100%; the spread in specificity was large but two studies showed perfect (100%) data. Negative and positive likelihood ratios ranged from 0 to 0.23 and 1.0 to 10 respectively. MRI examination was generally performed with 1.5Tesla (T) MRI (6/12 studies) with a strong trend for higher T strength in more recent studies (r=0.71). One study reported a sensitivity of 90.9% and one a specificity of 100%. Although imaging can visualize structure and healing, these results were generally not related to the clinical picture. Overall, ultrasound was recommended over MRI for diagnosis and monitoring. Results of other imaging modalities remain inconclusive. CONCLUSION The adjunct role of imaging, especially of ultrasound and MRI, in the diagnosis and monitoring of ATRs was established. It is therefore recommended to rely primarily on the clinical examination and evaluation and to use imaging for ruling out other injuries and providing additional clinical information. More high-quality research is warranted into the diagnostic accuracy of imaging as well as less conventional imaging modalities' diagnostic and monitoring capabilities.
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Affiliation(s)
- Olivier C Dams
- University of Groningen, University Medical Center Groningen, Department of Sport and Exercise Medicine, Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
| | - Inge H F Reininga
- University of Groningen, University Medical Center Groningen, Department of Trauma Surgery, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Jan L Gielen
- Antwerp University Hospital, S.P.O.R.T.S., Wilrijkstraat 10, Edegem-Antwerp, 2650, Belgium
| | - Inge van den Akker-Scheek
- University of Groningen, University Medical Center Groningen, Department of Sport and Exercise Medicine, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Johannes Zwerver
- University of Groningen, University Medical Center Groningen, Department of Sport and Exercise Medicine, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
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26
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Abstract
MR imaging has an important role in the evaluation of the postoperative foot and ankle. In this article, a variety of operative techniques and postoperative findings in the foot and ankle are described, including tendon and ligament reconstruction, as well as the treatment of tarsal coalition and Morton neuroma. The role of MR imaging in the assessment of complications of foot and ankle surgery is also detailed.
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Affiliation(s)
- Samuel D Madoff
- Department of Radiology, New England Baptist Hospital, Tufts University School of Medicine, 125 Parker Hill Avenue, Boston, MA 02120, USA.
| | - Jeffrey Kaye
- Department of Radiology, New England Baptist Hospital, Tufts University School of Medicine, 125 Parker Hill Avenue, Boston, MA 02120, USA
| | - Joel S Newman
- Department of Radiology, New England Baptist Hospital, Tufts University School of Medicine, 125 Parker Hill Avenue, Boston, MA 02120, USA
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Ho G, Tantigate D, Kirschenbaum J, Greisberg JK, Vosseller JT. Increasing age in Achilles rupture patients over time. Injury 2017; 48:1701-1709. [PMID: 28457569 DOI: 10.1016/j.injury.2017.04.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/11/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The changing demographics of Achilles tendon rupture (ATR) patients have not fully been investigated. However, there has been a general suspicion that this injury is occurring in an increasingly older population, in terms of mean age. The aim of this study was to objectively show an increase in age in Achilles tendon rupture patients over time. METHODS Published literature on Achilles tendon ruptures was searched for descriptive statistics on the demographics of patients in the studies, specifically mean and median age of Achilles tendon rupture patients, gender ratio, percentage of athletics-related injuries, percentage of smokers, and BMI. Linear regression analyses were performed to determine the trend of patient demographics over time. A Welch one-way ANOVA was carried out to identify any possible differences in data obtained from different types of studies. RESULTS The patient demographics from 142 studies were recorded, with all ATR injuries occurring between the years 1953 and 2014. There was no significant difference in the mean age data reported by varying study types, i.e. randomized controlled trial, cohort study, case series, etc. (P=0.182). There was a statistically significant rise in mean age of ATR patients over time (P<0.0005). There was also a statistically significant drop in percentage of male ATR patients (P=0.02). There is no significant trend for percentage of athletics-related injuries, smoking or BMI. CONCLUSION Since 1953 to present day, the mean age at which ATR occurs has been increasing by at least 0.721 years every five years. In the same time period, the percentage of female study patients with ATR injuries has also been increasing by at least 0.6% every five years. LEVEL OF EVIDENCE Level III; Retrospective cohort study.
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Affiliation(s)
- Gavin Ho
- Columbia University Medical Center/New York Presbyterian Hospital, 622 West 168th Street, PH-11, New York, NY 10032, United States
| | - Direk Tantigate
- Columbia University Medical Center/New York Presbyterian Hospital, 622 West 168th Street, PH-11, New York, NY 10032, United States
| | - Josh Kirschenbaum
- Columbia University Medical Center/New York Presbyterian Hospital, 622 West 168th Street, PH-11, New York, NY 10032, United States
| | - Justin K Greisberg
- Columbia University Medical Center/New York Presbyterian Hospital, 622 West 168th Street, PH-11, New York, NY 10032, United States
| | - J Turner Vosseller
- Columbia University Medical Center/New York Presbyterian Hospital, 622 West 168th Street, PH-11, New York, NY 10032, United States.
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28
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Follow-up of surgical and minimally invasive treatment of Achilles tendon pathology: a brief diagnostic imaging review. Musculoskelet Surg 2017; 101:51-61. [PMID: 28197895 DOI: 10.1007/s12306-017-0456-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 01/15/2017] [Indexed: 10/20/2022]
Abstract
The follow-up of an operated tendon is primarily clinical, although clinical examination may not be sufficient in the presence of certain complications. The imaging techniques are of great value not only in the diagnosis of tendon pathologies, but also as an adjunct to clinical evaluation. This is particularly true in the follow-up of patients submitted to surgical tendon reconstruction, by monitoring morphological effects of different interventions and evaluating tendon healing processes. Interpretation of imaging findings requires knowledge of the imaging appearance of the operated tendon during the healing phase, to distinguish between normal postsurgical changes and real pathology, as well as knowledge of surgical technique, postoperative course (including type of prescribed therapy) and possible postoperative complications. The most important imaging modalities to examine the Achilles tendon are ultrasound and magnetic resonance imaging. This article gives a review of some of the most common treatment strategies for Achilles tendon pathology, expected postoperative imaging findings and postoperative complications.
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Fröberg Å, Cissé AS, Larsson M, Mårtensson M, Peolsson M, Movin T, Arndt A. Altered patterns of displacement within the Achilles tendon following surgical repair. Knee Surg Sports Traumatol Arthrosc 2017; 25:1857-1865. [PMID: 28004174 PMCID: PMC5487597 DOI: 10.1007/s00167-016-4394-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/01/2016] [Indexed: 01/22/2023]
Abstract
PURPOSE Ultrasound speckle tracking was used to compare tendon deformation patterns between uninjured and surgically repaired Achilles tendons at 14-27-month follow-up. The hypothesis was that the non-homogenous displacement pattern previously described in uninjured tendons, where displacement within deep layers of the tendons exceeds that of superficial layers, is altered following tendon rupture and subsequent surgical repair. METHODS In the first part of this study, an in-house-developed block-matching speckle tracking algorithm was evaluated for assessment of displacement on porcine flexor digitorum tendons. Displacement data from speckle tracking were compared to displacement data from manual tracking. In the second part of the study, eleven patients with previous unilateral surgically treated Achilles tendon rupture were investigated using ultrasound speckle tracking. The difference in superficial and deep tendon displacement was assessed. Displacement patterns in the surgically repaired and uninjured tendons were compared during passive motion (Thompson's squeeze test) and during active ankle dorsiflexion. RESULTS The difference in peak displacement between superficial and deep layers was significantly (p < 0.01) larger in the uninjured tendons as compared to the surgically repaired tendons both during Thompson's test (-0.7 ± 0.2 mm compared to -0.1 ± 0.1 mm) and active dorsiflexion (3.3 ± 1.1 mm compared to 0.3 ± 0.2 mm). The evaluation of the speckle tracking algorithm showed correlations of r ≥ 0.89 between displacement data acquired from speckle tracking and the reference displacement acquired from manual tracking. Speckle tracking systematically underestimated the magnitude of displacement with coefficients of variation of less than 11.7%. CONCLUSIONS Uninjured Achilles tendons display a non-uniform displacement pattern thought to reflect gliding between fascicles. This pattern was altered after a mean duration of 19 ± 4 months following surgical repair of the tendon indicating that fascicle sliding is impaired. This may affect modulation of the action between different components of the triceps surae, which in turn may affect force transmission and tendon elasticity resulting in impaired function and risk of re-rupture.
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Affiliation(s)
- Åsa Fröberg
- Division of Orthopaedics and Biotechnology Karolinska University Hospital, Department of Clinical Sciences Intervention and Technology (Clintec), Karolinska University Hospital, Karolinska Institute, Huddinge, 141 86, Stockholm, Sweden.
| | - Ann-Sophie Cissé
- Division of Orthopaedics and Biotechnology Karolinska University Hospital, Department of Clinical Sciences Intervention and Technology (Clintec), Karolinska University Hospital, Karolinska Institute, Huddinge, 141 86 Stockholm, Sweden
| | - Matilda Larsson
- School of Technology and Health, KTH Royal Institute of Technology, Huddinge, Sweden
| | - Mattias Mårtensson
- School of Technology and Health, KTH Royal Institute of Technology, Huddinge, Sweden
| | | | - Tomas Movin
- Division of Orthopaedics and Biotechnology Karolinska University Hospital, Department of Clinical Sciences Intervention and Technology (Clintec), Karolinska University Hospital, Karolinska Institute, Huddinge, 141 86 Stockholm, Sweden ,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
| | - Anton Arndt
- Division of Orthopaedics and Biotechnology Karolinska University Hospital, Department of Clinical Sciences Intervention and Technology (Clintec), Karolinska University Hospital, Karolinska Institute, Huddinge, 141 86 Stockholm, Sweden ,The Swedish School of Sports and Health Sciences, Stockholm, Sweden
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Gitto S, Draghi AG, Bortolotto C, Draghi F. Sonography of the Achilles Tendon After Complete Rupture Repair: What the Radiologist Should Know. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2529-2536. [PMID: 27738294 DOI: 10.7863/ultra.16.01092] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 02/22/2016] [Accepted: 03/16/2016] [Indexed: 06/06/2023]
Abstract
This review aims to provide the radiologist with simple and systematic guidelines for evaluation of the Achilles tendon after complete rupture repair. Currently, there is a plethora of nonsurgical and surgical treatments, but sonographic examination has shown no significant differences between them. A systematic analysis of several parameters (morphologic characteristics, structure, color Doppler vascularization, and mobility) should be undertaken. Morphologically, the repaired tendon is larger, wider, or both. The loss of the fibrillary structure, inhomogeneity, and the surgical material in the context of the tendon are "normal" aspects after a repaired rupture. The presence of fluid collections when affecting greater than 50% of the surface of the tendon and extensive calcifications should be considered pathologic aspects. In the immediate postoperative period, there is the absence of vascularization detectable by color Doppler imaging. During the first 3 months, there is an increase in intratendinous vascularization with hypervascularization. From 3 to 6 months, stabilization and regression of the vascularization occur. Beyond the first 6 months, the hypervascularization is pathologic. The pattern of motion is, generally, reduced considerably more often in surgically treated tendons than in non-surgically treated ones. Elastography generally shows a hard appearance, with only a relatively heterogeneous pattern. In conclusion, a treated tendon will never regain a normal sonographic appearance, and the operator must distinguish between normal posttreatment changes and real pathologic characteristics.
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Affiliation(s)
- Salvatore Gitto
- Postgraduation School in Radiodiagnostics, Università Degli Studi di Milano, Milan, Italy
| | - Anna Guja Draghi
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Chandra Bortolotto
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
| | - Ferdinando Draghi
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo Foundation, University of Pavia, Pavia, Italy
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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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Sarman H, Muezzinoglu US, Memisoglu K, Aydin A, Atmaca H, Baran T, Odabas Ozgur B, Ozgur T, Kantar C. Comparison of Semi-Invasive "Internal Splinting" and Open Suturing Techniques in Achilles Tendon Rupture Surgery. J Foot Ankle Surg 2016; 55:965-70. [PMID: 27338652 DOI: 10.1053/j.jfas.2016.04.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Indexed: 02/03/2023]
Abstract
The goal of the present study was to evaluate the semi-invasive "internal splinting" (SIIS) method for repair of Achilles tendon rupture relative to open repair with Krakow sutures. Efficacy was evaluated based on the clinical and functional outcomes, postoperative magnetic resonance imaging measurements, isokinetic results, and surgical complication rates. Functional measurements included the Thermann and American Orthopaedic Foot and Ankle Society (AOFAS) ankle scores, bilateral ankle dorsiflexion, and plantar flexion measurements. Magnetic resonance imaging was used to compare the bilateral length and thickness of each Achilles tendon. The isokinetic outcomes were evaluated using a Biodex System 3 dynamometer. Of the 45 patients meeting the inclusion criteria, 24 were treated by SIIS and 21 by the open Krackow suture technique. The mean follow-up time for all patients was 43.7 (range 6 to 116) months. In the SIIS group, patients returned to normal daily activities after 7.2 (range 6 to 8) weeks compared with 14.3 (range 12 to 15) weeks in the open surgery group. The AOFAS ankle scores were 93.5 (range 82 to 100) points in the open repair group and 96.2 (range 86 to 100) points in the SIIS group. The Thermann scores were 80.4 (range 53 to 91) points for the open repair group and 87.9 (range 81 to 100) points for the SIIS method. The mean Achilles length on the operated side measured using magnetic resonance imaging was 175.06 (range 110 to 224) mm and 177.76 (range 149 to 214) mm for the open surgery and SIIS groups, respectively. Sensory impairment in the territory of the sural nerve was identified in 1 patient immediately after SIIS surgery, although this defect had completely resolved within 12 months. SIIS yielded better outcomes relative to the open surgery group according to the isokinetic measurements. Taken together, these data indicate the SIIS method for Achilles tendon ruptures performed better in terms of both functional and objective outcomes compared with open surgery.
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Affiliation(s)
- Hakan Sarman
- Assistant Professor, Department of Orthopedics and Traumatology, Abant Izzet Baysal University School of Medicine, Bolu, Turkey.
| | - Umit Sefa Muezzinoglu
- Professor, Department of Orthopedics and Traumatology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Kaya Memisoglu
- Associate Professor, Department of Orthopedics and Traumatology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | | | - Halil Atmaca
- Associate Professor, Department of Orthopedics and Traumatology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Tuncay Baran
- Surgeon, Department of Orthopedics and Traumatology, Erzurum Regional Training and Research Hospital, Erzurum, Turkey
| | - Bahar Odabas Ozgur
- Assistant Professor, Department of Sports Management, Kocaeli University Physical Education and Sports High School, Kocaeli, Turkey
| | - Turgay Ozgur
- Associate Professor, Department of Sports Management, Kocaeli University Physical Education and Sports High School, Kocaeli, Turkey
| | - Cengizhan Kantar
- Resident Physician, Department of Orthopedics and Traumatology, Kocaeli University School of Medicine, Kocaeli, Turkey
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Ruptured human Achilles tendon has elevated metabolic activity up to 1 year after repair. Eur J Nucl Med Mol Imaging 2016; 43:1868-77. [DOI: 10.1007/s00259-016-3379-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 03/22/2016] [Indexed: 01/08/2023]
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34
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Geremia JM, Bobbert MF, Casa Nova M, Ott RD, Lemos FDA, Lupion RDO, Frasson VB, Vaz MA. The structural and mechanical properties of the Achilles tendon 2 years after surgical repair. Clin Biomech (Bristol, Avon) 2015; 30:485-92. [PMID: 25828432 DOI: 10.1016/j.clinbiomech.2015.03.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 03/03/2015] [Accepted: 03/04/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Acute ruptures of the Achilles tendon affect the tendon's structural and mechanical properties. The long-term effects of surgical repair on these properties remain unclear. PURPOSE To evaluate effects of early mobilization versus traditional immobilization rehabilitation programs 2 years after surgical Achilles tendon repair, by comparing force-elongation and stress-strain relationships of the injured tendon to those of the uninjured tendon. METHODS A group of males with previous Achilles tendon rupture (n=18) and a group of healthy male controls (n=9) participated. Achilles tendon rupture group consisted of patients that had received early mobilization (n=9) and patients that had received traditional immobilization with a plaster cast (n=9). Comparisons of tendon structural and mechanical properties were made between Achilles tendon rupture and healthy control groups, and between the uninjured and injured sides of the two rehabilitation groups in Achilles tendon rupture group. Ultrasound was used to determine bilaterally tendon cross-sectional area, tendon resting length, and tendon elongation as a function of torque during maximal voluntary plantar flexion. From these data, Achilles tendon force-elongation and stress-strain relationships were determined. FINDINGS The Achilles tendon rupture group uninjured side was not different from healthy control group. Structural and mechanical parameters of the injured side were not different between the Achilles tendon rupture early mobilization and the immobilization groups. Compared to the uninjured side, the injured side showed a reduction in stress at maximal voluntary force, in Young's modulus and in stiffness. INTERPRETATION Two years post-surgical repair, the Achilles tendon mechanical properties had not returned to the uninjured contralateral tendon values.
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Affiliation(s)
- Jeam Marcel Geremia
- Exercise Research Laboratory, School of Physical Education, Federal University of Rio Grande do Sul, Porto Alegre, Brazil; Faculty of Physical Education Sogipa, Porto Alegre, Brazil.
| | - Maarten Frank Bobbert
- Faculty of Human Movement Sciences, Move Research Institute Amsterdam, VU University Amsterdam, Amsterdam, The Netherlands
| | - Mayra Casa Nova
- Exercise Research Laboratory, School of Physical Education, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafael Duvelius Ott
- São Lucas Hospital, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Fernando de Aguiar Lemos
- Exercise Research Laboratory, School of Physical Education, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Raquel de Oliveira Lupion
- Exercise Research Laboratory, School of Physical Education, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Marco Aurélio Vaz
- Exercise Research Laboratory, School of Physical Education, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
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Healing of human Achilles tendon ruptures: radiodensity reflects mechanical properties. Knee Surg Sports Traumatol Arthrosc 2015; 23:884-9. [PMID: 24162760 DOI: 10.1007/s00167-013-2720-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2013] [Accepted: 10/08/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE This study tests the idea of using radiodensity from computed tomography to quantitatively evaluate the healing of ruptured Achilles tendons. METHODS The radiodensity of the healing tendons in sixty-five patients who were treated for Achilles tendon rupture was measured. The hypothesis was that density would correlate with an estimate for e-modulus, derived from strain, measured by radiostereometry with different mechanical loadings. RESULTS Radiodensity 7 weeks after injury was decreased to 67 % (SD 11) of the contralateral, uninjured tendon. There was no improvement in radiodensity from 7 to 19 weeks, whereas at 1 year, it had increased to 106 % (SD 7). Only 2 of 52 measured values at 1 year were lower than the highest value at 19 weeks, i.e. there was minimal overlap. The variation in radiodensity could explain 80 % of the variation in e-modulus, but radiodensity correlated only weakly with e-modulus at each time point separately. At 1 year, both radiodensity and e-modulus correlated with functional results, although weakly. CONCLUSIONS From 19 weeks onwards, radiodensity appears to reflect mechanical properties of the tendon and might to some extent predict the final outcome. Radiodensity at 7 weeks is difficult to interpret, probably because it reflects both callus and damaged tissues.
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Sarman H, Atmaca H, Cakir O, Muezzinoglu US, Anik Y, Memisoglu K, Baran T, Isik C. Assessment of Postoperative Tendon Quality in Patients With Achilles Tendon Rupture Using Diffusion Tensor Imaging and Tendon Fiber Tracking. J Foot Ankle Surg 2015; 54:782-6. [PMID: 25736446 DOI: 10.1053/j.jfas.2014.12.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Indexed: 02/03/2023]
Abstract
Although pre- and postoperative imaging of Achilles tendon rupture (ATR) has been well documented, radiographic evaluations of postoperative intratendinous healing and microstructure are still lacking. Diffusion tensor imaging (DTI) is an innovative technique that offers a noninvasive method for describing the microstructure characteristics and organization of tissues. DTI was used in the present study for quantitative assessment of fiber continuity postoperatively in patients with acute ATR. The data from 16 patients with ATR from 2005 to 2012 were retrospectively analyzed. The microstructure of ART was evaluated using tendon fiber tracking, tendon continuity, fractional anisotropy, and apparent diffusion coefficient values by way of DTI. The distal and proximal portions were measured separately in both the ruptured and the healthy extremities of each patient. The mean patient age was 41.56 ± 8.49 (range 26 to 56) years. The median duration of follow-up was 21 (range 6 to 80) months. The tendon fractional anisotropy values of the ruptured Achilles tendon were significantly lower statistically than those of the normal side (p = .001). However, none of the differences between the 2 groups with respect to the distal and proximal apparent diffusion coefficient were statistically significant (p = .358 and p = .899, respectively). In addition, the fractional anisotropy and apparent diffusion coefficient measurements were not significantly different in the proximal and distal regions of the ruptured tendons compared with the healthy tendons. The present study used DTI and fiber tracking to demonstrate the radiologic properties of postoperative Achilles tendons with respect to trajectory and tendinous fiber continuity. Quantifying DTI and fiber tractography offers an innovative and effective tool that might be able to detect microstructural abnormalities not appreciable using conventional radiologic techniques.
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Affiliation(s)
- Hakan Sarman
- Assistant Professor, Department of Orthopedics and Traumatology, Abant Izzet Baysal University School of Medicine, Bolu, Turkey.
| | - Halil Atmaca
- Assistant Professor, Department of Orthopedics and Traumatology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ozgur Cakir
- Radiology Specialist Physician, Department of Radiology, Ministry of Health Batman Regional Hospital, Batman, Turkey
| | - Umit Sefa Muezzinoglu
- Professor, Department of Orthopedics and Traumatology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Yonca Anik
- Professor, Department of Radiology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Kaya Memisoglu
- Associate Professor, Department of Orthopedics and Traumatology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Tuncay Baran
- Resident Physician, Department of Orthopedics and Traumatology, Kocaeli University School of Medicine, Kocaeli, Turkey
| | - Cengiz Isik
- Assistant Professor, Department of Orthopedics and Traumatology, Abant Izzet Baysal University School of Medicine, Bolu, Turkey
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Knobe M, Gradl G, Klos K, Corsten J, Dienstknecht T, Rath B, Sönmez TT, Hoeckle C, Pape HC. Is percutaneous suturing superior to open fibrin gluing in acute Achilles tendon rupture? INTERNATIONAL ORTHOPAEDICS 2014; 39:535-42. [PMID: 25500954 DOI: 10.1007/s00264-014-2615-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Accepted: 11/25/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Open fibrin gluing is reported to enable anatomical reconstruction with less soft tissue compromise than suture repair. Our main objective was to compare the complication rate, function, pain and disability of the two operative approaches of percutaneous suture using the Paessler technique and open fibrin gluing. METHODS Sixty-four patients (two centres, retrospective cohort study, 2000-2009) who had undergone acute Achilles tendon repair with either percutaneous suture (n = 27; 44 years) or open fibrin glue (n = 37; 45 years) took part in a follow-up examination after a median of 63 months (range, six to 180). Ankle range of motion, calf and ankle circumferences and return to work and sports activities were evaluated. Isokinetic und sonographic evaluation results were retrieved. RESULTS Complications were noted in 22 patients (34 %). Delayed wound healing without evidence of surgical site infection was found in three patients in the fibrin group and two patients in the suture group. Postoperative scar tenderness described as pain at the rim of the shoe was significantly more frequent in the suture group (p = 0.03). Re-rupture requiring re-operation occurred in one patient. Transient paresthesia of the heel occurred in 12 patients. No sural nerve lesions were reported. There was no significant difference between groups regarding lower leg circumference, disability, or function. Ultrasound and isokinetic measurements did not reveal a significant difference between the two methods. CONCLUSIONS The present study suggests that open fibrin gluing is a reasonable alternative to percutaneous repair of acute ruptures of the Achilles tendon and both techniques can yield reliably good results.
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Affiliation(s)
- Matthias Knobe
- Department of Orthopaedic Trauma, University of Aachen Medical Center, Aachen, Germany,
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Ooi CC, Malliaras P, Schneider ME, Connell DA. "Soft, hard, or just right?" Applications and limitations of axial-strain sonoelastography and shear-wave elastography in the assessment of tendon injuries. Skeletal Radiol 2014; 43:1-12. [PMID: 23925561 DOI: 10.1007/s00256-013-1695-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/01/2013] [Accepted: 07/15/2013] [Indexed: 02/02/2023]
Abstract
Injury to a tendon leads to alterations in the mechanical properties of the tendon. Axial-strain sonoelastography and shear-wave elastography are relatively new, real-time imaging techniques that evaluate the mechanical properties of tendons in addition to the existing morphological and vascular information that is obtained with traditional imaging tools. Axial-strain sonoelastography displays the subjective distribution of strain data on an elastogram caused by tissue compression, whereas shear-wave elastography provides a more objective, quantitative measure of the intrinsic tissue elasticity using the acoustic push-pulse. Recent studies suggest that axial-strain sonoelastography is able to distinguish between asymptomatic and diseased tendons, and is potentially more sensitive than conventional ultrasound in detecting early tendinopathy. Shear-wave elastography seems to be a feasible tool for depicting elasticity and functional recovery of tendons after surgical management. While initial results have been promising, axial-strain sonoelastography and shear-wave elastography have not yet found routine use in wider clinical practice. Possible barriers to the dissemination of axial-strain sonoelastography technique include operator dependency, technical limitations such as artefacts and lack of reproducibility and quantification of sonoelastography data. Shear-wave elastography may improve the reproducibility of elastography data, although there is only one published study on the topic to date. Large-scale longitudinal studies are needed to further elucidate the clinical relevance and potential applications of axial-strain sonoelastography and shear-wave elastography in diagnosing, predicting, and monitoring the progress of tendon healing before they can be widely adopted into routine clinical practice.
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Affiliation(s)
- C C Ooi
- Department of Medical Imaging & Radiation Sciences, Faculty of Medicine, Nursing & Health Sciences, Monash University, Clayton Campus, Building 13C, Melbourne, VIC, 3800, Australia
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Ozsoy MH, Cengiz B, Ozsoy A, Aksekili MAE, Yucel M, Fakioglu O, Dincel VE, Aydogan NH. Minimally invasive Achilles tendon repair: a modification of the Achillon technique. Foot Ankle Int 2013; 34:1683-8. [PMID: 24045854 DOI: 10.1177/1071100713505754] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The purpose of the study was to present the results of a new minimally invasive operative method for Achilles tendon (AT) ruptures that could reduce nerve injuries and add no extra cost. METHODS Thirteen patients with acute AT ruptures who were treated with minimally invasive surgery and followed for a minimum of 12 months were included. At the latest follow-up, American Orthopaedic Foot & Ankle Society (AOFAS) score, calf diameters, ability to walk on tiptoe, and ultrasound examination were evaluated. The average age was 42.8 years (range, 31-62 years). Average follow up was 24.5 months (range, 12-34 months). RESULTS AOFAS score was 92.5 (range, 85-100). Average calf diameters on the operated and nonoperated extremities were 38.9 cm (range, 36-44 cm) and 38.9 cm (range, 36-41 cm), respectively. On ultrasound examination, the site of the rupture was found to be 46.2 mm proximal from the calcaneal insertion, and the operated side was found to be significantly thicker than the nonoperated side (P = .008). There was 1 deep vein thrombosis, which recovered without sequelae. There were no wound problems, reruptures, or nerve injuries. CONCLUSIONS This new minimally invasive operative method was successful, showing good functional results and low complication rates. In our experience, the use of 3 continuous polyester sutures was less irritable with 3 knots. LEVEL OF EVIDENCE Level IV, retrospective case series.
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Affiliation(s)
- Mehmet Hakan Ozsoy
- Ankara Training and Research Hospital, Department of Orthopedics and Traumatology, Ankara, Turkey
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Chen XM, Cui LG, He P, Shen WW, Qian YJ, Wang JR. Shear wave elastographic characterization of normal and torn achilles tendons: a pilot study. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:449-455. [PMID: 23443185 DOI: 10.7863/jum.2013.32.3.449] [Citation(s) in RCA: 113] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the feasibility of using quantitative shear wave elastography for assessing the functional integrity of the Achilles tendon and to summarize the changes in elasticity of ruptured Achilles tendons in comparison with normal controls. METHODS Thirty-six normal and 14 ruptured Achilles tendons were examined with shear wave elastography coupled with a linear array transducer (4-15 MHz). The elasticity value of each Achilles tendon in a longitudinal view was measured. RESULTS The mean elasticity value ± SD for the normal Achilles tendons was 291.91 ± 4.38 kPa (note that there are saturated measurement phenomena for the normal Achilles tendon, so the actual value will be >300 kPa), whereas the ruptured Achilles tendons had an elasticity value of 56.48 ± 68.59 kPa. A statistically significant difference was found in relation to the findings in healthy volunteers (P = .006). CONCLUSIONS Our results suggest that shear wave elastography is a valuable tool that can provide complementary biomechanical information for evaluating the function of the Achilles tendon.
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Affiliation(s)
- Xiang-Mei Chen
- Department of Ultrasonography, Peking University Third Hospital, Beijing China
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Jielile J, Sabirhazi G, Chen J, Aldyarhan K, Zheyiken J, Zhao Q, Bai J, Bai J. Novel surgical technique and early kinesiotherapy for acute Achilles tendon rupture. Foot Ankle Int 2012. [PMID: 23199864 DOI: 10.3113/fai.2012.1119] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This prospective study was performed to investigate the contribution of early kinesiotherapy, the active exercise and movement of the ankle and knee joints, following a novel surgical technique for reconstruction of the acutely ruptured Achilles tendon and the underlying mechanisms involved. MATERIALS AND METHODS One hundred and seven patients with an acute Achilles tendon rupture received postoperative early kinesiotherapy treatment following the novel ``Pa-bone'' surgical technique. Clinical outcomes were evaluated using the Achilles tendon rupture score, a score for measuring outcomes related to symptoms and physical activity, and bilateral ultrasonographic examination of the Achilles tendon. RESULTS Range-of-motion recovery equal to the intact side averaged 7~weeks. Double-legged heel rises and sustained single-leg heel rise exercises were possible at an average of 1~week and 60± 2 days, respectively. All patients could perform single-leg heel rise of the injured foot for 60± 23 seconds at an average of 12 weeks. No rerupture was observed. In addition, ultrasonographic examination revealed that the cross-sectional areas of the ruptured tendon were significantly larger than those of the healthy side. Overall reconstruction of the Achilles tendon was obtained for most of the patients. CONCLUSION Postoperative early kinesiotherapy treatment following Pa-bone surgical technique resulted in excellent clinical outcomes and contributed to the overall reconstruction of the Achilles tendon.
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Affiliation(s)
| | | | | | | | | | | | | | - Jingping Bai
- The Third Teaching Hospital of Xinjiang Medical University, Urumqi, China
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de Oliveira RR, Bezerra MA, de Lira KDS, Novaes KA, Teixeira MFHBI, Chaves CDC, Moraes SRAD. Aerobic physical training restores biomechanical properties of Achilles tendon in rats chemically induced to diabetes mellitus. J Diabetes Complications 2012; 26:163-8. [PMID: 22520401 DOI: 10.1016/j.jdiacomp.2012.03.017] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2011] [Revised: 03/15/2012] [Accepted: 03/15/2012] [Indexed: 01/21/2023]
Abstract
UNLABELLED The aim of this study is to evaluate if the application of a moderate aerobic exercise protocol reverses the damage caused by diabetes on the mechanical properties of the Achilles tendon. METHODS Forty-four rats were divided randomly into four groups as follows: Sedentary Control Group-SCG, Sedentary Diabetic Group-SDG, Trained Control Group-TCG and Trained Diabetic Group-TDG, the trained groups were submitted to a protocol of moderate physical training on a continuous treadmill. For mechanical testing the tendons were fixed in a conventional mechanical testing machine and pulled to the point of failure of the specimen, the cell load of 500N. The parameters were: Elastic Modulus (MPa), Stress Maximum Strength (MPa), Strain Specific Maximum Force (mm), Energy / Tendon Area (N.mm/mm(2)) and Cross-sectional Area (mm(2)). RESULTS The evaluation of the biomechanical properties of the Achilles tendon of the SDG indicated that the elastic modulus (MPa) is decreased when compared to the TDG and the other groups (p<0.01). However, the specific deformation (%), the deformation at maximum force (mm), and energy / tendon area (N.mm/mm(2)) of the SDG were significantly higher than in the other groups (p<0.01). Moreover, moderate aerobic training on a treadmill caused the biomechanical property values to move closer to the values shown by the control groups (p>0.01). CONCLUSION In summary, our study indicates that moderate-intensity aerobic training restored the normal mechanical properties of tendons in diabetic animals, since the elastic modulus (MPa), the specific deformation (%), the deformation of the maximum force (mm) and energy / tendon area (N.mm/mm(2)) approached the values shown by the control groups.
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Amlang MH, Zwipp H, Friedrich A, Peaden A, Bunk A, Rammelt S. Ultrasonographic classification of achilles tendon ruptures as a rationale for individual treatment selection. ISRN ORTHOPEDICS 2011; 2011:869703. [PMID: 24977069 PMCID: PMC4063199 DOI: 10.5402/2011/869703] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 08/14/2011] [Indexed: 12/28/2022]
Abstract
Purpose. This work introduces a distinct sonographic classification of Achilles tendon ruptures which has proven itself to be a reliable instrument for an individualized and differentiated therapy selection for patients who have suffered an Achilles tendon rupture.
Materials and Methods. From January 1, 2000 to December 31, 2005, 273 patients who suffered from a complete subcutaneous rupture of the Achilles tendon (ASR) were clinically and sonographically evaluated. The sonographic classification was organized according to the location of the rupture, the contact of the tendon ends, and the structure of the interposition between the tendon ends.
Results. In 266 of 273 (97.4%) patients the sonographic classification of the rupture of the Achilles tendon was recorded. Type 1 was detected in 54 patients (19.8%), type 2a in 68 (24.9%), type 2b in 33 (12.1%), type 3a in 20 (7.3%), type 3b in 61 (22.3%), type 4 in 20 (7.3%), and type 5 in 10 (3.7%).
Of the patients with type 1 and fresh ASR, 96% (n = 47) were treated nonoperative-functionally, and 4% (n = 2) were treated by percutaneous suture with the Dresden instrument (pDI suture). Of the patients classified as type 2a with fresh ASR, 31 patients (48%) were treated nonoperatively-functionally and 33 patients (52%) with percutaneous suture with the Dresden instrument (pDI suture). Of the patients with type 3b and fresh ASR, 94% (n = 34) were treated by pDI suture and 6% (n = 2) by open suture according to Kirchmayr and Kessler.
Conclusion. Unlike the clinical classification of the Achilles tendon rupture, the sonographic classification is a guide for deriving a graded and differentiated therapy from a broad spectrum of treatments.
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Affiliation(s)
- Michael H Amlang
- Department of Trauma and Reconstructive Surgery, University Hospital Carl Gustav Carus, Fetscherstra β e 74, 01309 Dresden, Germany
| | - Hans Zwipp
- Department of Trauma and Reconstructive Surgery, University Hospital Carl Gustav Carus, Fetscherstra β e 74, 01309 Dresden, Germany
| | - Adina Friedrich
- Department of Trauma and Reconstructive Surgery, University Hospital Carl Gustav Carus, Fetscherstra β e 74, 01309 Dresden, Germany
| | - Adam Peaden
- Podiatric Medicine and Surgery Residency, Florida Hospital, East Orlando, Orlando, FL, USA
| | - Alfred Bunk
- Department of General Surgery, University Hospital Carl Gustav Carus, Fetscherstra β e 74, 01309 Dresden, Germany
| | - Stefan Rammelt
- Department of Trauma and Reconstructive Surgery, University Hospital Carl Gustav Carus, Fetscherstra β e 74, 01309 Dresden, Germany
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de Oliveira RR, Lemos A, de Castro Silveira PV, da Silva RJ, de Moraes SRA. Alterations of tendons in patients with diabetes mellitus: a systematic review. Diabet Med 2011; 28:886-95. [PMID: 21749441 DOI: 10.1111/j.1464-5491.2010.03197.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS To perform a systematic review of observational studies which analyse tendon alterations in patients with diabetes mellitus compared with healthy individuals. METHODS Data collection was performed, with no language restriction, using the databases of PubMed/Medline, BIREME, CINAHL, LILACS and Cochrane, as well as the references found in these studies. Three reviewers performed independent extractions of articles. Subsequently, these reviewers analysed the articles, focusing on their methodological quality, using the appropriate scale to evaluate observational studies from the Agency for Healthcare Research and Quality. RESULTS Six articles were included in the analysis. Of these, four had used ultrasonographic diagnostics, one computed tomography and one magnetic resonance imaging. The patient pool comprised 396 individuals. All the articles evaluated tendon thickness and presented heterogeneous results. Two articles stated thickening or increased volume of the tendons in diabetic people, one article did not report any alteration, the fourth failed to determine any alterations and the fifth showed thinning of the tendons. The arrangement of collagen fibrils and the presence of calcification were analysed in only one article (n = 80), showing that 88.10% (n = 68) of individuals with diabetes presented disorientation of collagen fibril arrangement, while only 10% (n = 1) of healthy individuals presented this condition. Regarding tendon calcification, the article showed diabetic individuals with higher values than healthy individuals. CONCLUSIONS All the articles indicated some relation between diabetes mellitus and tendon alterations in human beings, but due to methodological drawbacks, this association could not be sustained.
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Affiliation(s)
- R R de Oliveira
- Master Program in Physical Therapy, Universidade Federal de Pernambuco (UFPE), Brazil.
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Fullerton BD, Reeves KD. Ultrasonography in regenerative injection (prolotherapy) using dextrose, platelet-rich plasma, and other injectants. Phys Med Rehabil Clin N Am 2011; 21:585-605. [PMID: 20797551 DOI: 10.1016/j.pmr.2010.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Recent advances in ultrasound technology are leading physiatrists to new understandings of pain sources, new treatment options, and the ability to guide soft tissue interventions. This article examines the role of imaging ultrasound in diagnosing soft tissue injury and disease that may respond to regenerative medicine techniques (known as prolotherapy) using injectants such as dextrose, morrhuate sodium, or platelet-rich plasma. The current state of ultrasound evidence for these interventions is reviewed. Case examples assist in understanding clinical applications that currently outpace the evidence base. Development of quantitative ultrasound measures to objectively evaluate soft tissue organization is discussed.
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Affiliation(s)
- Bradley D Fullerton
- Dell Children's Medical Center of Central Texas, 4900 Mueller Boulevard, Austin, TX 78723, USA.
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Abstract
BACKGROUND There is a lack of consensus on the best management of the acute Achilles tendon rupture. Treatment can be broadly classified into surgical (open or percutaneous) and non-surgical (cast immobilisation or functional bracing). OBJECTIVES To evaluate the relative effects of surgical versus non-surgical treatment, or different surgical interventions, for acute Achilles tendon ruptures in adults. SEARCH STRATEGY We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (July 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 3), MEDLINE (1966 to 20th July 2009), EMBASE (1966 to 2009 week 29), CINAHL (1983 to July 2007) and reference lists of articles. SELECTION CRITERIA All randomised and quasi-randomised trials comparing surgical versus non-surgical treatment or different surgical methods for acute Achilles tendon ruptures in adults. DATA COLLECTION AND ANALYSIS Two review authors independently selected potentially eligible trials; trials were then assessed for quality using a 10-item scale. Where possible, data were pooled. MAIN RESULTS Twelve trials involving 844 participants were included. One trial tested two comparisons.Quality assessment revealed a poor level of methodological rigour in many studies, particularly with regard to concealment of allocation and the lack of assessor blinding.Open surgical treatment compared with non-surgical treatment (6 trials, 536 participants) was associated with a statistically significant lower risk of rerupture (risk ratio (RR) 0.41, 95% confidence interval (CI) 0.21 to 0.77), but a higher risk of other complications including infection (RR 4.89, 95% CI 1.09 to 21.91), adhesions and disturbed skin sensibility (numbness). Functional status including sporting activity was variably and often incompletely reported, including frequent use of non standardised outcome measures, and the results were inconclusive.Open surgical repair compared with percutaneous repair (4 trials, 174 participants) was associated with a higher risk of infection (RR 9.32, 95% CI 1.77 to 49.16). These figures should be interpreted with caution because of the small numbers involved. Similarly, no definitive conclusions could be made regarding different tendon repair techniques (3 trials, 147 participants). AUTHORS' CONCLUSIONS Open surgical treatment of acute Achilles tendon ruptures significantly reduces the risk of rerupture compared with non-surgical treatment, but produces significantly higher risks of other complications, including wound infection. The latter may be reduced by performing surgery percutaneously.
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Affiliation(s)
- Riaz Jk Khan
- Department of Surgery and Pathology, University of Western Australia, Gate 3 Verdun Street, Nedlands, Perth, Western Australia, Australia, 6009
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Dyson SJ, Murray R, Schramme MC. Lameness associated with foot pain: results of magnetic resonance imaging in 199 horses (January 2001-December 2003) and response to treatment. Equine Vet J 2010; 37:113-21. [PMID: 15779622 DOI: 10.2746/0425164054223804] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY The diagnosis of foot-related lameness often remains elusive and it can be difficult to offer rational treatment, or to predict outcome. OBJECTIVES To describe the spectrum of injuries of the foot identified using magnetic resonance imaging (MRI), to determine their relative prevalence among MRI diagnoses and to establish the long-term results of treatment. METHODS The MR images of horses examined from January 2001--December 2003 were reviewed. Horses were selected for MRI if the pain causing lameness was localised to the foot using perineural analgesia but any clinical, radiological or ultrasonographic abnormalities were insufficient to explain the degree of lameness. The clinical significance of lesions identified using MRI was determined with reference to the results of local analgesia, radiography, ultrasonography and nuclear scintigraphy. Follow-up information was obtained in January 2004 for horses which had been examined 6-36 months previously and the outcome classified as excellent (horse returned to full athletic function without recurrent lameness), moderate (sound, but only in light work), or poor (persistent or recurrent lameness). RESULTS One hundred and ninety-nine horses underwent MRI examinations. Deep digital flexor (DDF) tendonitis was the most common injury (59%) with primary injury in 65 horses (33%) and a further 27 horses (14%) having lesions of the DDF tendon and navicular bone. Seventeen percent of horses had injuries to multiple structures, including 24 with DDF tendonitis. Desmitis of a collateral ligament (CL) of the distal interphalangeal (DIP) joint was the second most common injury (62 horses, 31%), with primary injuries in 30 horses (15%) and a further 32 horses (16%) that had CL desmitis in conjunction with other injuries. Prognosis was best for horses with traumatic injuries of the middle or distal phalanges, with 5 of 7 horses (71%) having an excellent outcome. Horses with primary lesions of the DDF tendon or CL of the DIP joint had excellent results in only 13 of 47 (28%) and 5 of 17 horses (29%), respectively. Horses with combined injuries of the DDF tendon and navicular bone, or primary navicular bone abnormalities, had a poor outcome, with the majority of horses suffering persistent lameness. CONCLUSIONS A wide variety of lesions associated with foot pain were identified using MRI, a high proportion of which were primary soft tissue injuries with a guarded prognosis for return to full athletic function. POTENTIAL RELEVANCE It is now possible to propose more rational treatment strategies for the variety of foot injuries identified using MRI than had previously been possible; however, further information concerning aetiopathogenesis of these injuries is needed to improve their management.
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Affiliation(s)
- S J Dyson
- Centre for Equine Studies, Animal Health Trust, Kentford, Newmarket, Suffolk CB8 7UU, UK
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Doral MN, Bozkurt M, Turhan E, Ayvaz M, Atay OA, Uzümcügil A, Leblebicioğlu G, Kaya D, Aydoğ T. Percutaneous suturing of the ruptured Achilles tendon with endoscopic control. Arch Orthop Trauma Surg 2009; 129:1093-101. [PMID: 19404654 DOI: 10.1007/s00402-009-0880-2] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2008] [Indexed: 10/20/2022]
Abstract
INTRODUCTION A prospective study of modified percutaneous Achilles tendon repair performed between 1999 and 2005 under local infiltration anesthesia is presented; the study evaluated the results of percutaneous repair technique by visualization of the synovia under endoscopic control, followed by early functional postoperative treatment for surgical intervention of acute Achilles tendon ruptures. PATIENTS Sixty-two patients (58 males, 4 females, mean age 32) were treated by percutaneous suturing with modified Bunnel technique under endoscopic control within 10 days after acute total rupture. Physiotherapy was initiated immediately after the operation and patients were encouraged to weight-bearing ambulation with a walking brace-moon boot as tolerated. Full weight-bearing was allowed minimum after 3 weeks postoperatively without brace. RESULTS The procedure was tolerated in all patients. There were no significant ROM limitation was observed. Two patients experienced transient hypoesthesia in the region of sural nerve that spontaneously resolved in 6 months. Fifty-nine patients (95%) including professional athletes returned to their previous sportive activities, while 18 of them (29%) had some minor complaints. The interval from injury to return to regular work and rehabilitation training was 11.7 weeks (10-13 weeks). At the latest follow-up (mean: 46 months; range: 12-78 months), all the patients had satisfactory results with a mean American Orthopedic Foot and Ankle Society's ankle-hindfoot score of 94.6. No re-ruptures, deep venous thrombosis or wound problems occurred. CONCLUSION The proposed method offers a reasonable treatment option for acute total Achilles tendon rupture with a low number of complications. The rerupture rate and return to preinjury activities are comparable to open and percutaneous without endoscopic control procedures.
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Affiliation(s)
- Mahmut Nedim Doral
- Department of Orthopaedics and Sports Medicine, Faculty of Medicine, Hacettepe University, Sihhiye, 06100, Ankara, Turkey.
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Devitt D, Koike Y, Doherty GP, Ramachandran N, Dinh L, Uhthoff HK, Lecompte M, Trudel G. The Ability of Ultrasonography, Magnetic Resonance Imaging and Bone Mineral Densitometry to Predict the Strength of Human Achilles' Tendons. Arch Phys Med Rehabil 2009; 90:756-60. [DOI: 10.1016/j.apmr.2008.10.031] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Revised: 10/26/2008] [Accepted: 10/29/2008] [Indexed: 11/29/2022]
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