Commonly reported isokinetic parameters do not reveal long-term strength deficits of the Triceps surae complex following operative treatment of Achilles tendon rupture

BACKGROUND: Missed traumatic Achilles tendon ruptures in children are rarely reported in the literature. Various techniques have been described to reconstruct delayed Achilles tendon ruptures for adults, but the long-term consequences in the growing child are unknown. CLINICAL CASE: The article presents a clinical observation of a 8-year-old girl with missed rupture of the Achilles tendon operated 7 weeks after the trauma by end-to-end Kessler-type sutures augmented with the plantaris tendon. At 2-year follow-up, the patient was completely asymptomatic. DISCUSSION: A review of the literature shows that this is the third neglected pediatric case of post-traumatic Achilles tendon rupture. The first case concerns a 10-year-old boy treated successfully six weeks after the traumat by open surgical repair using the Bunnell sutures technique. The second patient was a 7-year-old girl, she was operated 8 weeks after the trauma with a termino-terminal tenorrhaphy using the Bunnell technique augmented with the plantaris tendon. CONCLUSIONS: Using the plantaris tendon to reinforce the Achilles tendon repair offers satisfactory results with minimal morbidity. Prognosis depends on the extent of tendon defect which determines the long-term functional outcome. Any skin wound that sits on the back of the leg requires a systematic and careful physical examination to check the integrity of the Achilles tendon.

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V-Y Tendon Plasty for Reconstruction of Chronic Achilles Tendon Rupture: A Medium-term and Long-term Follow-up

Orthopaedic Surgery ◽

10.1111/os.12429 ◽

2019 ◽

Vol 11 (1) ◽

pp. 109-116 ◽

Cited By ~ 2

Author(s):

Yang-jing Lin ◽

Xiao-jun Duan ◽

Liu Yang

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Medium Term ◽

Long Term Follow Up

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12 Efficacy of early controlled motion of the ankle in non-operative treatment of acute achilles tendon rupture. An assessor-blinded RCT

10.1136/bjsports-2019-scandinavianabs.12 ◽

2019 ◽

Cited By ~ 1

Author(s):

Kristoffer Weisskirchner Barfod ◽

Maria Swennergren Hansen ◽

Per Hölmich ◽

Morten Tange Kristensen ◽

Anders Troelsen

Keyword(s):

Achilles Tendon ◽

Operative Treatment ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Controlled Motion

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Operative Treatment of Acute Achilles Tendon Rupture: Open End-to-End-Reconstruction Versus Reconstruction with Mitek-Anchors

Acta Chirurgica Belgica ◽

10.1080/00015458.2008.11680210 ◽

2008 ◽

Vol 108 (2) ◽

pp. 236-239 ◽

Cited By ~ 1

Author(s):

T.J.A. Schönberger ◽

H.M.J. Janzing ◽

J.W. Morrenhof ◽

A.C. de Visser ◽

P. Muitjens

Keyword(s):

Achilles Tendon ◽

Operative Treatment ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

End To End

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Outcome after operative treatment for chronic versus acute Achilles tendon rupture — A comparative analysis

Foot and Ankle Surgery ◽

10.1016/j.fas.2016.12.003 ◽

2018 ◽

Vol 24 (2) ◽

pp. 110-114 ◽

Cited By ~ 7

Author(s):

C. Becher ◽

S. Donner ◽

J. Brucker ◽

K. Daniilidis ◽

H. Thermann

Keyword(s):

Comparative Analysis ◽

Achilles Tendon ◽

Operative Treatment ◽

Tendon Rupture ◽

Achilles Tendon Rupture

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Operative versus Nonoperative Management of Acute Achilles Tendon Rupture

The American Journal of Sports Medicine ◽

10.1177/03635465020300060501 ◽

2002 ◽

Vol 30 (6) ◽

pp. 783-790 ◽

Cited By ~ 83

Author(s):

Mininder S. Kocher ◽

Julius Bishop ◽

Ryan Marshall ◽

Karen K. Briggs ◽

Richard J. Hawkins

Keyword(s):

Decision Making ◽

Achilles Tendon ◽

Operative Treatment ◽

Management Strategy ◽

Tendon Rupture ◽

Nonoperative Management ◽

Achilles Tendon Rupture ◽

Back Analysis ◽

Major Complication ◽

Optimal Management

Background The optimal management strategy for acute Achilles tendon rupture is controversial. Purpose To determine the optimal management by using expected-value decision analysis. Study Design Cross-sectional study. Methods Outcome probabilities were determined from a systematic literature review, and patient-derived utility values were obtained from a visual analog scale questionnaire. A decision tree was constructed, and fold-back analysis was used to determine optimal treatment. Sensitivity analyses were used to determine the effect of varying outcome probabilities and utilities on decision-making. Results Outcome probabilities (expressed as operative; nonoperative) were as follows: well (0.762; 0.846), rerupture (0.022; 0.121), major complication (0.030; 0.025), moderate complication (0.075; 0.003), and mild complication (0.111; 0.005). Outcome utility values were well operative (7.9), well nonoperative (7.0), rerupture (2.6), major complication (1.0), moderate complication (3.5), and mild complication (4.7). Fold-back analysis revealed operative treatment as the optimal management strategy (6.89 versus 6.30). Threshold values were determined for the probability of a moderate complication from operative treatment (0.21) and the utility of rerupture (6.8). Conclusions Operative management was the optimal strategy, given the outcome probabilities and patient utilities we studied. Nonoperative management was favored by increasing rates of operative complications; operative, by decreasing utility of rerupture. We advocate a model of doctor-patient shared decision-making in which both outcome probabilities and patient preferences are considered.

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Long Term Clinical–Functional and Ultrasound Outcomes in Recreational Athletes after Achilles Tendon Rupture: Ma and Griffith Versus Tenolig

Medicina ◽

10.3390/medicina57101073 ◽

2021 ◽

Vol 57 (10) ◽

pp. 1073

Author(s):

Carlo Biz ◽

Mariachiara Cerchiaro ◽

Elisa Belluzzi ◽

Nicola Luigi Bragazzi ◽

Giacomo De Guttry ◽

...

Keyword(s):

Achilles Tendon ◽

Tendon Rupture ◽

Achilles Tendon Rupture ◽

Return To Sport ◽

Functional Results ◽

Return To Sports ◽

Recreational Athletes ◽

Sport Activities ◽

Long Term Follow Up

Background and Objectives: The purpose of this retrospective study was to compare the long-term clinical–functional and ultrasound outcomes of recreational athletes treated with two percutaneous techniques: Ma and Griffith (M&G) and the Tenolig technique (TT). Materials and Methods: recreational athletes, between 18 and 50 years of age, affected by acute Achilles tendon rupture (AATR), treated by M&G or Tenolig techniques were recruited. Clinical–functional outcomes were evaluated using Achilles Tendon Rupture Score (ATRS), AOFAS Ankle–Hindfoot score, VAS (for pain and satisfaction) questionnaires, and ultrasound analysis (focal thickening, hypoechoic areas, presence of calcifications, tendinitis and alteration of normal fibrillar architecture). Results: 90 patients were included: 50 treated by M&G, 40 by TT. In all, 90% of patients resumed sports activities, with pre-injury levels in 56% of cases after M&G and in 60% after TT. In the M&G group, the averages of the questionnaires were ATRS 90.70 points, AOFAS 91.03, VAS satisfaction 7.08, and VAS pain 1.58. In the TT group: ATRS 90.38 points, AOFAS 90.28, VAS satisfaction 7.76, and VAS pain 1.34. The TT group showed a significantly higher satisfaction and return to sport activities within a shorter time. In the M&G group, ultrasound check showed a significantly greater incidence of thickening and an alteration of fibrillar architecture in the treated tendon. Three infections were reported, including one deep after M&G, two superficial in the TT group, and two re-ruptures in the Tenolig group following a further trauma. Conclusions: At long-term follow-up, M&G and TT are both valid techniques for the treatment of AATRs in recreational athletes, achieving comparable clinical–functional results. However, TT seems to have a higher patient satisfaction rate, a faster return to sports and physical activities, and fewer ultrasound signs of tendinitis. Finally, the cost of the device makes this technique more expensive.

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Morphological and Functional Outcomes >13 Years After Achilles Tendon Rupture Treated Operatively and Non-operatively

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00511 ◽

2020 ◽

Vol 8 (7_suppl6) ◽

pp. 2325967120S0051

Author(s):

Kevin Willits ◽

Trevor Birmingham ◽

Alison Spouge ◽

Dianne Bryant ◽

Michaela Khan

Keyword(s):

Achilles Tendon ◽

Operative Treatment ◽

Tendon Rupture ◽

Morphological Changes ◽

Vertical Jump ◽

Achilles Tendon Rupture ◽

Jump Height ◽

Vertical Jump Height ◽

Functional Measures ◽

Superior Margin

Objectives: In patients >13yrs after treatment for acute Achilles tendon rupture (AATR), 1) investigate side-to-side differences in MRI-defined morphological changes in the Achilles tendon and surrounding calf musculature, 2) investigate side-to-side differences in single-limb functional tasks, and 3) compare patients who received operative vs non-operative treatment. Methods: 28 patients (11 operative, 17 non-operative) from a previous randomized trial returned 15±1 years post-AATR for testing (age: 57±7 years; BMI: 30±5 kg/m2). Patients underwent bilateral 3T MRI (MAGNETOM Prisma, Siemens) including sagittal and axial T1 and T2-weighted turbo spin echo (TSE), axial T1-weighted inversion recovery, and sagittal T2-weighted 3D isotropic TSE sequences. The maximum anteroposterior Achilles tendon diameter (MAD) and cross-sectional area (CSA), distance from the MAD to the superior margin of the calcaneus, tendon length, gastrocnemius and soleus CSA, and calf circumference were measured using distance and area software tools (Figure 1; AGFA Healthcare). Functional measures included single-legged heel-rise repetitions and maximum vertical jump height. All outcomes were compared between limbs and between groups. Results: Overall, there were significant side-to-side differences in most MRI and functional measures, with the injured limb Achilles tendon typically wider and thicker (MAD often twice as large), calf musculature CSA smaller, number of heel raises lower, and vertical jump height lower (Table 1). The only differences between treatment groups was in MAD and the distance from the MAD to the superior margin of the calcaneus, with a greater side-to-side difference for patients treated operatively (Table 1). Conclusion: Substantial side-to-side differences in tendon diameter, thickness, muscle bulk and functional performance persist beyond a decade after treatment for AATR. There were no differences favoring operative treatment over non-operative treatment.

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