An Outcome Study of Chronic Achilles Tendinosis After Excision of the Achilles Tendon and Flexor Hallucis Longus Tendon Transfer

2005 ◽  
Vol 26 (9) ◽  
pp. 691-697 ◽  
Author(s):  
RobRoy L. Martin ◽  
Christopher M. Manning ◽  
Christopher R. Carcia ◽  
Stephen F. Conti
Keyword(s):  
United States ◽  
Achilles Tendon ◽  
Range Of Motion ◽  
Functional Status ◽  
Flexor Hallucis Longus ◽  
Modified Technique ◽  
Achilles Tendinosis ◽  
United States Population ◽  
Sf 36 ◽  
Significant Difference

Background: A number of operative techniques, including decompression with debridement and flexor hallucis longus (FHL) tendon augmentation, have been described for chronic degenerative Achilles tendinosis. Decompression with debridement has been shown to be effective; however, pain and functional limitation can persist in individuals with more severe tendon involvement. Augmentation with the FHL tendon can add mechanical support; however, difficulty in achieving proper tendon tensioning and the potential to leave behind painful diseased tendon are disadvantages of the technique. The purpose of this study was to present the results of a modified technique in which the Achilles tendon is completely excised and the FHL tendon is transferred. Methods: Fifty-six surgeries using this modified technique were done between October, 1994, and March, 2002, for patients with chronic degenerative Achilles tendinosis. Forty-four patients with and average age of 58.2 (SD 10.1) years and an average time of followup of 3.4 (SD 1.9) years were available for testing. All subjects were mailed a packet of standardized questionnaire information that included the Self-Reported Health Related Quality of Life measures Short Form (SF-36) and the subjective component of the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle and Hindfoot Score. Nineteen patients returned to the clinic for objective assessment. Statistical analysis tested for a difference in the SF-36 scores between our subjects and the general United States population and for a difference in strength and range of motion between the involved and uninvolved lower extremities. Results: Pain decreased in 95.5% ( n = 42) patients, and 86.4% ( n = 38) patients were satisfied with the result. There was no significant difference ( p >.05) between the SF-36 scores obtained by our sample compared to the general United States population. The average AOFAS score for the 19 patients was 91.6 (SD 7.7). Dorsiflexion range of motion was not significantly different ( p = 0.17); however, significant deficits were found in plantarflexion range of motion ( p = 0.001) and plantarflexion strength ( p < 0.025). Strength deficits were 30% on average; however, all but one patient could do a heel raise. Conclusion: Complete Achilles tendon excision reduces pain while preserving functional status. Although strength deficits persisted, these deficits did not seem to affect the functional status in this sample of patients.

scholarly journals Anatomical Feasibility Study of Flexor Hallucis Longus Transfer in Treatment of Achilles Tendon and Posterior Ankle Arthroscopy

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0033
Author(s):  
Haijiao Mao
Keyword(s):  
Achilles Tendon ◽  
Magnetic Resonance Images ◽  
Neurovascular Bundle ◽  
Flexor Hallucis Longus ◽  
Muscle Morphology ◽  
Musculotendinous Junction ◽  
Muscle Belly ◽  
Lateral Muscle ◽  
Significant Difference ◽  
The Relationship

Category: Hindfoot Introduction/Purpose: The aim of this study was to evaluate the occurrence of anatomical variations of the musculotendinous junction of the flexor hallucis longus (FHL) muscle, the relationship between FHL tendon or muscle and the tibial neurovascular bundle at the level of the posterior ankle joint in human cadavers. Methods: Seventy embalmed feet from 20 male and 15female cadavers, the cadavers’ mean age was 65.4 (range from 14 to 82) years, were dissected and anatomically classified to observe FHL muscle morphology define the relationship between FHL tendon or muscle and the tibial neurovascular bundle . The distance between the musculotendinous junction and thehe relationship between FHL tendon or muscle and the tibial neurovascular bundle was determined. Results: The three morphology types of FHL muscle were identified: a long lateral and shorter medial muscle belly, which was observed in 63 specimens (90%).; equal length medial and lateral muscle bellies, this variant was only observed in 5 specimens (7.1%); a lateral and no medial muscle belly, which was observed in 2 specimens (2.9%). No statistically significant difference was observed according to gender or side (p > 0.05). Two patterns were identified and described between FHL tendon or muscle and the tibial neurovascular bundle. Pattern 1, the distance between the neurovascular bundle and FHL tendon was 3.46 mm (range, 2.34 to 8.84, SD = 2.12) which was observed in 66 specimens (94.3%); Pattern 2, there was no distance which was observed in 4 specimens (5.7%). Conclusion: Knowing FHL muscle morphology variations provide new important insights into secure planning and execution of a FHL transfer for Achilles tendon defect as well as for the interpretation of ultrasound and magnetic resonance images. During posterior arthroscopic, posteriormedial portal may be introduced into the posterior aspect of the ankle without gross injury to the tibial neurovascular structures.

Achilles Tendon Injuries in a United States Population

2013 ◽  
Vol 34 (4) ◽  
pp. 475-480 ◽  
Author(s):  
Steven M. Raikin ◽  
David N. Garras ◽  
Philip V. Krapchev
Keyword(s):  
United States ◽  
Achilles Tendon ◽  
Tendon Injuries ◽  
United States Population

The Clinical Impact of Mild Hemophilia A, Report of a Cohort Study.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 3210-3210 ◽  
Author(s):  
Mary-Frances Scully ◽  
David MacGregor ◽  
Meghan Walsh ◽  
Brendan Barrett ◽  
Marc Kawaja ◽  
...  
Keyword(s):  
Factor Viii ◽  
Range Of Motion ◽  
General Health ◽  
Hemophilia A ◽  
P Value ◽  
Base Line ◽  
Role Emotional ◽  
Left Ankle ◽  
Sf 36 ◽  
Significant Difference

Abstract Due to a founder affect certain regions of the Canadian province of Newfoundland and Labrador have a very high prevalence of mild Hemophilia A. To accurately plan for future health related needs of these patients, a base-line cross-sectional study of a large cohort segregating a known founder mutation (Val2016Ala) was undertaken. Characteristics of Study Participants Characteristic Affected Males Control Males P-Values (Affected vs Control) Carrier Females Control Females P-Value (Carrier vs Control) Values are expressed as number, mean*, median(interquartile range)†, or percentage Overall N 61(5–76yrs) 44(4–81yrs) 0.883 88(8–88yrs) 65(16–78yrs) 0.935 Factor VIII* 0.15(0.05) 1.29(0.37) <0.001 0.78(0.31) 1.34(0.41) <0.001 Hepatitis Bc Antibodies 15.8%(9/57) 0%(0/28) 0.012 0%(0/75) 0%(0/58) - Hepatitis C Positive 19.7%(12/61) 0%(0/33) 0.001 0%(0/88) 0%(0/65) - HIV Positive 1.6%(1/61) 0%(0/33) 0.420 0%(0/88) 0%(0/65) - Diabetes 24.4%(11/45) 6.1%(2/33) 0.031 - - - BMI†(Adults Only) 30.0(27.0–33.0) 27.0(26.0–30.0) 0.028 29.0(20–57) 28.0(19–46) .446 Statistically Significant Difference SF-36 & Colorado PE-05 Mean Scores for Affected and Unaffected Males Affected Males Affected Males Affected Males Unaffected Siblings Unaffected Siblings Unaffected Siblings t-test Difference vs References Dimension n Mean SD n Mean SD P-Value P<0.05)* Affected Males(age 23–76 years) Unaffected Siblings(age 20–81 years) SF-36 Scores General Health Scale 44 58.1 28.7 32 71.4 21.4 0.024* Role Emotional 44 89.2 19.9 33 98.0 5.5 0.007* Colorado PE-05 Musculoskeletal Scores Axial Deformity 47 0.9 1.4 33 0.2 0.8 0.008* Range of Motion 47 4.2 2.0 33 2.9 1.8 0.005* Gait 47 2.4 3.5 33 0.4 1.4 0.002* Left Ankle 47 3.3 5.0 33 1.0 2.9 0.015* Right Ankle 47 3.2 4.6 33 0.7 1.3 0.002* There was a positive association between the SF-36 General Health Scale scores and the following values of the Colorado PE-05 Scores. Gait (R -.45, p<.001), Range of Motion (R-.08, P=.508), Axial Deformity (R -.35, P<.001), Right Ankle (R -.42, p<.001), and Left Ankle (R-.49, p<.001). The association between the SF-36 Role Emotional Scales for affected males and the values of the Colorado PE-05 was also positive. Gait (R -.52, P<.001), Range of Motion (R - .30, P = .01), Axial Deformity (R -.54, P<.001), Right Ankle (R -.06, P<.001) and Left Ankle (R-.52, p<.001). No patients studied have acquired an inhibitor to Factor VIII. Obese males (BMI >30) had significantly greater impairment in their Range of Motion than non-obese males (4.59 vs (3.34), p<0.05) independent of whether or not they had hemophilia. These results are consistent with our clinical experience that mild Hemophilia A causes episodic bleeding, lack of recognition and delayed treatment leads to significant morbidity. The association with diabetes was unexpected. Future interventions will now focus on prevention and early treatment of ankle bleeds and will include strategies to reduce the risk of obesity.

Plantarflexion Torque Following Reconstruction of Achilles Tendinosis or Rupture with Flexor Hallucis Longus Augmentation

2000 ◽  
Vol 21 (4) ◽  
pp. 324-329 ◽  
Author(s):  
Michael T. Monroe ◽  
David J. Dixon ◽  
Timothy C. Beals ◽  
Gregory Pomeroy ◽  
David L. Crowley ◽  
...  
Keyword(s):  
Primary Repair ◽  
Subjective Evaluation ◽  
Achilles Tendon Rupture ◽  
Peak Torque ◽  
Flexor Hallucis Longus ◽  
Ankle Motion ◽  
Achilles Tendinosis ◽  
Level Of Satisfaction ◽  
Significant Difference ◽  
High Level

Nine patients treated surgically for Achilles tendon rupture (7 patients) or tendinosis (2 patients) with primary repair or debridement and augmentation with the flexor hallucis longus muscle-tendon unit were evaluated at a mean of 19 months postoperative. Subjective evaluation revealed a high level of satisfaction. All patients returned to work and only two patients reported limitation in their recreational activities. The mean post-operative AOFAS Ankle-Hindfoot Score was 90 points. Four patients reported mild occasional pain and one patient complained of moderate daily pain. Motion assessment showed a 20% increase in the hallux MTP dorsiflexion compared to the non-operative side (p = 0.045). No difference in ankle motion was noted. Cybex II+ dynamic evaluation of plantarflexion peak torque was complete on both extremities. The torque deficit on the reconstructed extremity was 20% (p = 0.01) at 120 degrees per second and 26% (p = 0.003) at 30 degrees per second. There is no significant difference between the torque deficit recorded for patients with Achilles rupture and those with Achilles tendinosis. A trend toward improved torque production with longer follow up was observed.

scholarly journals The Effect of Acupuncture and Physiotherapy on Patients with Knee Osteoarthritis: A Randomized Controlled Study

2021 ◽  
pp. E269-E278
Author(s):  
Sevgi Gumus Atalay
Keyword(s):  
Clinical Trial ◽  
Knee Osteoarthritis ◽  
Functional Status ◽  
Acupuncture Group ◽  
Controlled Study ◽  
Randomized Controlled ◽  
Sf 36 ◽  
Tertiary Center ◽  
Significant Difference

Background: Osteoarthritis is the most prevalent form of joint disease, and the most common location is the knee. Objectives: The aim of this study was to determine the effect of acupuncture treatment and physiotherapy on pain, physical function, and quality of life (QOL) in patients with knee osteoarthritis (KOA). Study Design: This study was a prospective, randomized, controlled clinical trial. Settings: The research took place in the interventional pain unit of a tertiary center in a university hospital. Methods: One hundred patients with KOA were randomly divided into the acupuncture group and the physiotherapy group. Both treatments were given in 12 sessions over 6 weeks. Thirteen acupuncture points were selected for the knee. Local points were GB34, SP10, SP9, ST36, ST35, ST34, EX-LE2, EXLE5, EXLE4, and distal (distant) points were defined as KI3, SP6, LI4, and ST41. The Visual Analog Scale (VAS) was used to measure pain intensity. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the 36-Item Short Form Health Survey (SF-36) were used to determine functional status and health-related QOL, respectively. All patients were evaluated at baseline, after the last treatment, and at the 12-week follow-up period. Results: There was no statistically significant difference between the acupuncture group and physiotherapy group in terms of pain, total WOMAC, and SF-36 levels at baseline, after treatment, and at the 12th week after treatment (P > 0.05). Both treatments significantly improved functional status (acupuncture, from 63.8 ± 20.81 to 53.72 ± 19.43; and physiotherapy, from 59.04 ± 21.49 to 52.28 ± 19.54; P < 0.05) and decreased the level of pain assessed by VAS (acupuncture, from 8.32 ± 1.61 to 5.54 ± 2.34; and physiotherapy, from 7.86 ± 1.9 to 5.68 ± 2.42; P < 0.05) at the 12-week follow-up of the study. There was no adverse advent related to therapeutic methods. Limitations: Sham or placebo control groups are lacking in this study. Conclusions: The acupuncture and physiotherapy performed twice weekly for 6 weeks have similar effects with regard to pain, functional status, and QOL. There were no significant differences between the acupuncture and physiotherapy groups in relief of pain, improved functional status, and QOL in the treatment of KOA. Both acupuncture and physiotherapy treatments were found to yield significantly superior results when compared with baseline values. Key words: Knee osteoarthritis, acupuncture, physiotherapy, randomized clinical trial

scholarly journals PO 18221 - Minimally invasive treatment of acute Achilles tendon injuries with flexor hallucis longus tendon augmentation assisted by posterior ankle arthroscopy

2019 ◽  
Vol 13 (Supl 1) ◽  
pp. 51S
Author(s):  
Thiago Coelho Paim Lima ◽  
Rodrigo Gonçalves Pagnano ◽  
Gustavo Eiji Nodu Sato ◽  
Mauro Cesar Mattos e Dinato
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Range Of Motion ◽  
Functional Outcomes ◽  
Achilles Tendon Rupture ◽  
Contralateral Side ◽  
Flexor Hallucis Longus ◽  
Posterior Ankle Arthroscopy ◽  
The Mean ◽  
Flexion Strength

Introduction: Achilles tendon ruptures cause significant functional limitations. The treatment for acute injury is controversial; conservative or surgical treatment and open or minimally invasive surgery are available options. The objective of this study is to evaluate the clinical and functional outcomes of patients with acute Achilles tendon rupture treated with minimally invasive tendon repair and augmentation with flexor hallucis longus tendon transfer assisted by posterior ankle arthroscopy. Methods: A retrospective, cross-sectional and observational study in which 5 patients with more than 24 months of postoperative follow-up were evaluated using the American Orthopedic Foot and Ankle Society (AOFAS) score, the Victorian Institute of Sport Assessment-Achilles (VISA-A), the Achilles Tendon Total Rupture Score (ATRS), the pain visual analog scale (VAS), and assessments of range of motion and strength. Results: The mean scores on the following instruments were obtained: pain VAS: 0.6; AOFAS: 98; VISA-A: 98.2 and ATRS: 100. The mean dorsiflexion range of motion was smaller (4.8º) than the contralateral range of motion (7.6º). The mean plantar flexion strength was 24.02 kgf on the operated side and 24.64 kgf on the contralateral side. The flexion strength of the hallux interphalangeal joint was weaker on the operated side (13.94 kgf) than on the contralateral side (17.6 kgf), albeit with no complaints from the patients. Conclusion: The proposed surgical treatment method had good clinical and functional outcomes among the patients evaluated in this study. The surgical technique presented herein may be a good alternative for the treatment of uncooperative patients diagnosed with acute Achilles tendon rupture due to tendinosis with important tendon degeneration.

Arthroscopic, Single-Incision, and Double-Incision Approaches to Flexor Hallucis Longus Tendon Transfer Following Achilles Tendon Rupture: A Literature Review

2021 ◽  
Vol 111 (3) ◽  
Author(s):  
Ashley V. Mosseri ◽  
Phillip Calaj ◽  
Dominick J. Casciato ◽  
Bibi N. Singh
Keyword(s):  
Postoperative Complications ◽  
Achilles Tendon ◽  
Tendon Transfer ◽  
Tendon Rupture ◽  
Single Incision ◽  
Achilles Tendon Rupture ◽  
Athletic Injury ◽  
Flexor Hallucis Longus ◽  
Longus Tendon ◽  
Significant Difference

Achilles tendon rupture is a common athletic injury that results in a painful and antalgic gait. Flexor hallucis longus tendon transfer through arthroscopic, single-incision, or double-incision techniques is used as a treatment approach to address this rupture; however, no studies have compared postoperative complications between these three techniques. A systematic search of published articles was conducted using keywords “Achilles rupture,” “flexor hallucis tendon,” “transfer,” and “recovery.” Articles were then selected based on their title, abstract, and content following full-text review. From each article's reported surgical outcomes, a comparison was made between arthroscopic and single- and double-incision postoperative complications using a χ2 test with significance set at a value of P &lt; .05 followed by post hoc analysis. The arthroscopic approach maintained the lowest rate of postoperative complications, followed by the single- and double-incision techniques. A significant difference in the number of postoperative complications was found between all incisional approaches. The pairwise comparisons, however, could not identify which incisional approaches significantly differed between each other. A reduction in postoperative complications places arthroscopy and the single-incision techniques as the preferred approaches for flexor hallucis longus tendon transfer following an Achilles tendon rupture. Although current literature shows arthroscopy to be superior to single- and double-incision methods, this review demonstrates the need for a greater number of published cases using arthroscopy to establish significance regarding postoperative complications.

scholarly journals Single-Surgeon Experience with Supramalleolar Osteotomy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Alexej Barg ◽  
Charles Saltzman
Keyword(s):  
Prospective Study ◽  
Range Of Motion ◽  
Wedge Osteotomy ◽  
Short Term ◽  
Ankle Osteoarthritis ◽  
Radiographic Outcomes ◽  
Supramalleolar Osteotomy ◽  
Sf 36 ◽  
Significant Difference ◽  
Surgeon Experience

Category: Ankle, Ankle Arthritis Introduction/Purpose: Supramalleolar osteotomy is a joint-preserving option for patients with asymmetric ankle osteoarthritis. However, it remains unclear whether tibiotalar tilt can be effectively corrected by this procedure. The objective of this prospective study was to evaluate the short-term clinical and radiographic outcomes in patients who underwent a supramalleolar osteotomy procedure performed by one surgeon. Methods: A total of 16 patients with asymmetric ankle osteoarthritis and a concomitant supramalleolar deformity were included in this prospective study: 7 patients with valgus (medial closing wedge osteotomy) and 9 patients with varus deformity (medial opening wedge osteotomy). There were 11 male and 5 female patients with a mean age of 41.6 ± 10.9 years. Intraoperative and postoperative complications were recorded and analyzed. Clinical and radiographic outcomes were assessed after a mean follow- up of 3.6 ± 1.1 years. The clinical assessment included pain assessment (VAS), functional assessment (range of motion and AOFAS hindfoot score), and quality of life (SF-36). The radiographic assessment included alignment measurements (medial distal tibial angle, tibiotalar tilt, calcaneal moment arm) and osteoarthritis degree assessment in the tibiotalar joint. Outcomes were compared between both patient groups: valgus vs. varus ankle osteoarthritis. Results: In 10 of 16 patients, removal of hardware was performed. There was significant pain relief from 5.8 ± 0.8 to 2.4 ± 0.8. The AOFAS score increased significantly from 36 ± 12 to 84 ± 10. The average range of motion increased from 31 ± 5 to 33 ± 4. All categories of the SF-36 score showed significant improvement. Preoperatively, tibiotalar tilt was 4.8 ± 2.4 in the varus group and 1.8 ± 2.4 in the valgus group. Postoperatively, tibiotalar tilt improved significantly in both groups, however, there was significant difference between both groups with 2.3 ± 1.6 (varus) vs. 0.2 ± 0.5 (valgus) (p=0.005). Postoperative clinical outcomes were comparable in both groups. One patient showed progressive ankle osteoarthritis requiring ankle arthrodesis. Conclusion: Our prospective study demonstrated encouraging short-term results in patients with asymmetric ankle osteoarthritis who underwent supramalleolar osteotomy. A significant clinical and radiographic improvement can be expected. However, especially in patients with varus osteoarthritis, tibiotalar tilt cannot be fully corrected.

scholarly journals Functional and quality of life assessment of patients with ankle ulcers subjected to complete Achilles tendon resection

2019 ◽  
Vol 13 (2) ◽  
pp. 172-178
Author(s):  
Wrgelles Godinho Bordone Pires ◽  
Philipe Eduardo Carvalho Maia ◽  
Felipe Daniel Vasconcelos de Carvalho ◽  
Rodrigo Simões Castilho ◽  
Fernando Araújo Silva Lopes ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Achilles Tendon ◽  
Functional Status ◽  
Short Form ◽  
Case Series ◽  
Life Assessment ◽  
Diabetic Patients ◽  
Sf 36 ◽  
The Mean

Objective: To assess the quality of life and functional status of patients subjected to debridement of ulcers in the posterior ankle who required complete Achilles tendon resection without any type of reconstruction or tendon transfer. Method: This is a case series of 5 (mostly diabetic) patients who underwent complete Achilles tendon resection due to an ulcer in the posterior ankle region. Preservation of the Achilles tendon was prevented due to tendon exposure, extensive degeneration and the need for infection control. Patients answered the Brazilian Portuguese version of the Achilles Tendon Total Rupture Score (ATRS-BR) questionnaire and the 36-item Short-Form Health Survey (SF-36) during the postoperative period, and follow-up varied between 6 and 24 months. The ATRS-BR ranges from 0 to 100, and higher scores indicate fewer symptoms and limitations. The SF-36 consists of 36 questions comprising 8 domains, which are independently assessed and given a score of up to 100 points, with higher scores indicating better health status. Results: The mean age of patients was 70 years. The mean score on the SF-36 physical functioning domain was 70 (50-95) points. The mean value of the ATRS-BR was 54.6 (31-88) points; however, the patients had few complaints about their functional status. Conclusion: Non-reconstruction of the Achilles tendon in predominantly diabetic elderly patients with posterior ankle ulcers presents encouraging functional outcomes. This study suggests that complete Achilles tendon resection is a viable option for ulcer treatment in this population. Level of Evidence IV; Therapeutic Studies; Cases Series.

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