scholarly journals Instrumented immobilizing boot quantifies reduced Achilles tendon loading during gait

2020 ◽  
Author(s):  
Todd J Hullfish ◽  
Kathryn M. O’Connor ◽  
Josh R. Baxter
Keyword(s):  
Achilles Tendon ◽  
Plantar Flexion ◽  
Calibration Procedure ◽  
Functional Deficits ◽  
Handheld Device ◽  
Biomechanical Loading ◽  
Rehabilitation Protocols ◽  
Healing Tendon ◽  
Tendon Ruptures ◽  
Patients Experience

ABSTRACTAchilles tendon ruptures are common injuries that lead to functional deficits in two-thirds of patients. Progressively loading the healing tendon has been associated with superior outcomes, but the loading profiles that patients experience throughout rehabilitation have not yet been established. In this study, we developed and calibrated an instrumented immobilizing boot paradigm that is aimed at longitudinally quantifying patient loading biomechanics to develop personalized rehabilitation protocols. We used a 3-part instrumented insole to quantify the ankle loads generated by the Achilles tendon and secured a load cell in-line with the posterior strut of the immobilizing boot to quantify boot loading. We then collected gait data from five healthy young adults to demonstrate the validity of this instrumented immobilizing boot paradigm to assess Achilles tendon loading during ambulation. We developed a simple calibration procedure to improve the measurement fidelity of the instrumented insole needed to quantify Achilles tendon loading while ambulating with an immobilizing boot. By assessing Achilles tendon loading with the ankle constrained to 0 degrees and 30 degrees plantar flexion, we confirmed that walking with the foot supported in plantar flexion decreased Achilles tendon loading by 60% (P < 0.001). This instrumented immobilizing boot paradigm leverages commercially available sensors and logs data using a small microcontroller secured to the boot and a handheld device, making our paradigm capable of continuously monitoring biomechanical loading outside of the lab or clinic.

scholarly journals Knotless Reconstruction of Chronic Achilles Tendon Ruptures With <3-cm Defects: Technique Tip

2021 ◽  
Vol 6 (4) ◽  
pp. 247301142110505
Author(s):  
Justin C. Haghverdian ◽  
Christopher E. Gross ◽  
Andrew R. Hsu
Keyword(s):  
Achilles Tendon ◽  
Skin Incision ◽  
Surgical Reconstruction ◽  
Fixation Strength ◽  
Level Of Evidence ◽  
Functional Deficits ◽  
Tendon Lengthening ◽  
Soft Tissue Dissection ◽  
Tendon Ruptures ◽  
Gait Abnormalities

Chronic Achilles tendon ruptures can result in tendon lengthening and significant functional deficits including gait abnormalities and diminished push-off strength. Surgical intervention is typically required to restore Achilles tension and improve ankle plantarflexion strength. A variety of surgical reconstruction techniques exist depending on the size of the defect and amount of associated tendinosis. For smaller tendon defects 2 to 3 cm in size, primary end-to-end repair using an open incision and multiple locking sutures is an established technique. However, a longer skin incision and increased soft tissue dissection is required, and failure at the suture-tendon interface has been reported that can result in postoperative tendon elongation and persistent weakness. In this report, we describe a novel technique to reconstruct chronic midsubstance Achilles tendon ruptures using a small incision with knotless repair of the tendon secured directly to the calcaneus. This technique minimizes wound healing complications, increases construct fixation strength, and allows for early range of motion and rehabilitation. Level of Evidence: Level V, Expert Opinion.

scholarly journals Flexor hallucis longus vs. peroneus brevis: the better tendon for augmentation surgery in chronic achilles tendon ruptures

2019 ◽  
Vol 5 (2) ◽  
pp. 264 ◽  
Author(s):  
K. V. Nagakiran ◽  
Sudeep Madhukar Nambiar ◽  
Prasad Soraganvi ◽  
Sameer Wooly ◽  
H. Balakrishna Gadiyar
Keyword(s):  
Achilles Tendon ◽  
Functional Outcome ◽  
Tendon Rupture ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Flexor Hallucis Longus ◽  
Proximal Migration ◽  
Calcific Tendonitis ◽  
Tendon Ruptures ◽  
Peroneus Brevis

<p class="abstract"><strong>Background:</strong> Chronic degenerative Achilles tendon ruptures are increasing in incidence. Calcific tendonitis, poor vascularity, prior steroid injections, and proximal migration of tendon render conservative management ineffective. Flexor hallucis longus (FHL) and peroneus brevis (PB) have shown promising results with tendon augmentation procedures. The study was done to find out which was a better tendon for augmentation among the two.</p><p class="abstract"><strong>Methods:</strong> A total of 27 patients underwent tendon augmentation surgeries using FHL (n=14) and PB (n=13) after randomization at PES Institute of medical sciences and research, Kuppam from March 2014 to December 2018. Both the groups had a standard postoperative regimen and rehabilitative protocol. Functional outcome was assessed using AOFAS, Leppilahti score and ATRS scores.<strong></strong></p><p class="abstract"><strong>Results:</strong> The functional outcome was comparable in both FHL and PB and there was no clear winner in the study.</p><p class="abstract"><strong>Conclusions:</strong> Predictably<strong> </strong>good results are seen with tendon augmentation procedures for Achilles tendon rupture. Both FHL and PB are equally good in providing good plantar flexion power needed in achilles tendon rupture.</p>

scholarly journals Suture-Only Repair Versus Suture Anchor–Augmented Repair for Achilles Tendon Ruptures With a Short Distal Stump

2017 ◽  
Vol 5 (1) ◽  
pp. 232596711667872 ◽  
Author(s):  
Michael A. Boin ◽  
Matthew A. Dorweiler ◽  
Christopher J. McMellen ◽  
Gregory C. Gould ◽  
Richard T. Laughlin
Keyword(s):  
Achilles Tendon ◽  
Suture Anchor ◽  
Achilles Tendon Rupture ◽  
Peak Load ◽  
Tendon Repair ◽  
Distal Stump ◽  
Rehabilitation Protocols ◽  
Load To Failure ◽  
Tendon Ruptures ◽  
Active Rehabilitation

Background: Chronic noninsertional Achilles tendinosis can result in an acute Achilles tendon rupture with a short distal stump. In such tendon ruptures, there is a limited amount of adequate tissue that can hold suture, thus presenting a challenge for surgeons who elect to treat the rupture operatively. Hypothesis: Adding suture anchors to the repair construct may result in biomechanically stronger repairs compared with a suture-only technique. Study Design: Controlled laboratory study. Methods: Nine paired Achilles-calcaneus complexes were harvested from cadavers. An artificial Achilles rupture was created 2 cm proximal to the insertion on the calcaneus. One specimen from each cadaver was assigned to a suture-only or a suture anchor–augmented repair. The contralateral specimen of the same cadaver received the opposing repair. Cyclic testing was then performed at 10 to 100 N for 2000 cycles, and load-to-failure testing was performed at 0.2 mm/s. This was followed by analysis of repair displacement, gapping at repair site, peak load to failure, and failure mode. Results: The suture anchor–augmented repair exhibited a 116% lower displacement compared with the suture-only repair (mean ± SD, 1.54 ± 1.13 vs 3.33 ± 1.47 mm, respectively; P < .03). The suture anchor–augmented repair also exhibited a 45% greater load to failure compared with the suture-only repair (303.50 ± 102.81 vs 209.09 ± 48.12 N, respectively; P < .04). Conclusion: Suture anchor–augmented repairs performed on acute Achilles tendon ruptures with a short distal stump are biomechanically stronger than suture-only repairs. Clinical Relevance: Our results support the use of suture anchor–augmented repairs for a biomechanically stronger construct in Achilles tendon ruptures with a short distal stump. Biomechanically stronger repairs may lead to less tendon repair gapping and failure, increasing the ability to start early active rehabilitation protocols and thus improving patient outcomes.

scholarly journals The Achilles Heel of Rehabilitation: Communication: A First Look at a National Research Survey

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0023
Author(s):  
David Jenkins ◽  
Daniel Urness ◽  
Austin Thompson ◽  
James Meeker
Keyword(s):  
Physical Therapy ◽  
Achilles Tendon ◽  
Weight Bearing ◽  
Years Of Experience ◽  
Good Communication ◽  
Research Survey ◽  
Successful Recovery ◽  
Rehabilitation Protocols ◽  
Tendon Ruptures ◽  
Communication Modalities

Category: Hindfoot, Rehabilitation Introduction/Purpose: For decades, there has been much debate over the proper treatment and rehabilitation protocols regarding the management of Achilles tendon ruptures (ATRs). With so much controversy, communication between physical therapists (PTs) and orthopaedic surgeons could prove to be paramount in ensuring successful recovery and return to post- morbid activities. Little research has been done in identifying effective communication modalities between surgeons and PTs and it remains unclear how this dynamic impacts the rehabilitation course. We examined the frequency of how common it is for PTs to receive rehabilitation protocols from referring orthopedic surgeons in patients who suffered Achilles tendon ruptures. Methods: A blinded national research survey was conducted of PTs who had treated ATR from 2012-2017. Researchers sought to create a generalizable sample of US PTs by selecting physical therapy clinics located in rural and urban areas of randomly selected states. Those who were actively practicing as a PTs and held a corresponding degree (DPT, MPT, and MSPT) were included. Non-practicing PTs, and those without a degree in physical therapy were excluded. A total of 56 respondents took part in the survey. Results: PTs practicing for 10 or more years were more likely to promote slower rehabilitation for non-surgical patients, while PTs with less than 10 years of experience preferred slower progress for operative patients (p=0.04). PTs with 10 or more years of experience were significantly more likely to have patients full weight bearing (FWB) after 6 weeks (p=0.01). PTs were also asked what factor was most important for good ATR outcomes. Three themes emerged, one was good communication between PTs and doctors. One respondent wrote “better communication between MD and PT for best outcomes.” The second theme was timing and implementation of proper clinical techniques such as ”early ROM and weight bearing.” A final theme centered on patient education, especially physicians educating patients on mobility restrictions. Conclusion: Despite belief that protocol driven approach improves outcomes, it remains unclear how well applied this is in practice. One of the most common responses given by PTs when asked what the most important factor is to ensure good outcomes in ATRs was good communication between PTs and doctors. This insight juxtaposed with 49% of PTs stating most of their recent patients arrived with no protocol, suggests one way to help improve patient outcomes might be to focus on improving communication between doctors and PTs.

Postoperative Rehabilitation Protocols for Achilles Tendon Ruptures

2006 ◽  
Vol 445 ◽  
pp. 216-221 ◽  
Author(s):  
Amar A Suchak ◽  
Carol Spooner ◽  
David C Reid ◽  
Nadr M Jomha
Keyword(s):  
Achilles Tendon ◽  
Postoperative Rehabilitation ◽  
Rehabilitation Protocols ◽  
Tendon Ruptures

Complete Achilles Tendon Ruptures

1992 ◽  
Vol 11 (4) ◽  
pp. 741-758 ◽  
Author(s):  
Stephanie J. Landvater ◽  
Per A.F.H. Renström
Keyword(s):  
Achilles Tendon ◽  
Tendon Ruptures

scholarly journals Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110035
Author(s):  
Keisuke Tsukada ◽  
Youichi Yasui ◽  
Maya Kubo ◽  
Shinya Miki ◽  
Kentaro Matsui ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Scale Score ◽  
Tendon Rupture ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Semitendinosus Tendon ◽  
Level Of Evidence ◽  
Operative Outcomes

Background: The purpose of this retrospective study was to clarify the operative outcomes of the side-locking loop suture (SLLS) technique accompanied by autologous semitendinosus tendon grafting for chronic Achilles tendon rupture. Methods: A chart review was conducted of consecutive patients treated with the SLLS technique at our department from 2012 to 2017. Postoperatively, a below-knee splint was applied for 2 weeks in 20 degrees of plantar flexion and then active range of motion exercise was started. Partial weightbearing exercise was allowed at 4 weeks according to patient tolerance, and full weightbearing without crutches was allowed at 8 weeks. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score and the Achilles tendon rupture score (ATRS) were used to evaluate clinical outcomes preoperatively and at the final follow-up. Results: Ten patients (6 men, 4 women) were included in the analysis. Mean AOFAS ankle-hindfoot scale score increased significantly from 64.2 ± 5.6 points preoperatively to 95.0 ± 5.3 points at the final follow-up ( P < .001). The mean ATRS also increased significantly from 29.8 ± 4.4 points to 86.2 ± 7.7 points, respectively ( P < .001). Mean time between surgery and ability to perform 20 continuous double-leg heel raises of the operated foot was 13.5 ± 3.4 (range 10-18) weeks. One patient complained of postoperative hypoesthesia in the foot, which had spontaneously resolved by 3 months after surgery. Conclusion: The SLLS technique accompanied by autologous semitendinosus tendon grafting provided successful operative outcomes for patients with chronic Achilles tendon rupture regardless of the size of the defect, and thus long-term orthotic use was not needed after surgery. Level of Evidence: Level IV, retrospective case series.

Neglected Achilles Tendon Ruptures

2021 ◽  
Vol 38 (2) ◽  
pp. 261-277
Author(s):  
James M. Cottom ◽  
Charles A. Sisovsky
Keyword(s):  
Achilles Tendon ◽  
Tendon Ruptures
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