scholarly journals Clinical and Radiological Outcomes of Operative Therapy in Insertional Achilles Tendinopathy With Debridement and Double-Row Refixation

2021 ◽  
pp. 107110072110028
Author(s):  
Fabian Greiner ◽  
Hans-Jörg Trnka ◽  
Michel Chraim ◽  
Elena Neunteufel ◽  
Peter Bock
Keyword(s):  
Case Series ◽  
Operative Therapy ◽  
Achilles Tendinopathy ◽  
Retrospective Case ◽  
Double Row ◽  
Postoperative Result ◽  
Foot Function ◽  
American Orthopaedic ◽  
Insertional Achilles Tendinopathy

Background: Insertional Achilles tendinopathy (IAT) is a painful pathology in which the strongest and thickest tendon of the human body is affected. Different conservative and operative treatments have been described to address this pathology. This study aimed to evaluate the medium-term clinical and radiological outcomes of patients who underwent a surgical therapy via a longitudinal tendon-splitting approach with debridement and double-row refixation. Methods: All patients were assessed pre- and postoperatively using a visual analog scale (VAS), the American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score, the Foot and Ankle Outcome Score (FAOS), and the Foot Function Index (FFI). Additionally, a lateral radiograph of the foot was performed to assess the postoperative result. Forty-two patients with confirmed IAT who underwent surgery between 2013 and 2017 with a longitudinal tendon-splitting approach and tendon refixation using a double-row refixation system were evaluated. The average follow-up was 32.8 (range, 18-52) months. We included 26 female and 16 male patients with an average age of 56.8 (range, 27-73) years. Results: The mean VAS improved from 8.91 ± 1.0 preoperatively to 1.47 ± 2.5 postoperatively ( P < .01). AOFAS scores improved significantly from 51.0 ± 12.5 preoperatively to 91.3 ± 14.3 postoperatively ( P < .01). All total and subscores of the FFI and FAOS saw a significant improvement at follow-up ( P < .01). Lateral radiographs showed recurrent calcification in 30 patients (71.4%). Conclusion: We found that, at an average of 33 months posttreatment, insertional Achilles tendinopathy via a longitudinal tendon-splitting approach resulted in good outcomes for patients after failure of initial conservative therapy. Recurrent calcification seems to be very common but shows no association with inferior outcomes or the return of symptoms. Level of Clinical Evidence: Level IV, retrospective case series.

Role of Arthroscopic Debridement of Hemophilic Ankles

2018 ◽  
Vol 39 (10) ◽  
pp. 1199-1204 ◽  
Author(s):  
Elcil Kaya Bicer ◽  
Kemal Kayaokay ◽  
Andac Alsina ◽  
Huseyin Gunay ◽  
Kaan Kavakli ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Case Series ◽  
Patient Reported Outcome ◽  
Arthroscopic Debridement ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Foot Function ◽  
Bleeding Episodes ◽  
American Orthopaedic

Background: Arthroscopic debridement has been used in the treatment of early stages of hemophilic ankle arthropathy. The aim of this procedure is to alleviate pain, improve function, and diminish bleeding episodes. Evaluation of patient-reported outcomes of arthroscopic debridement for hemophilic ankle arthropathies was evaluated in this study. Methods: Fifteen patients with hemophilia who had undergone arthroscopic debridement between 2008 and 2017 were included in this study. Preoperative American Orthopaedic Foot & Ankle Society Score (AOFAS) and Foot Function Index (FFI) with its subscales were obtained. Patient-reported outcome was measured using FFI at the latest follow-up. Radiologic severity of hemophilic arthropathy was assessed with the Pettersson score. Preoperative and postoperative intraarticular bleeding frequencies of the hemophilic patients were compared. Results: Patients experienced statistically significant improvements of FFI and its subscales. Median preoperative FFI scores dropped from 42.2% to 22.2% postoperatively. Median value for the Pettersson score was 3. Annual median bleeding frequency of the study group was 18 preoperatively and 1.5 postoperatively ( P = .002). Conclusion: By assessing patient-reported outcomes, pain and functional restrictions associated with hemophilic ankle arthropathy were improved following arthroscopic debridement. By means of subjective measures, this procedure was effective. Level of Evidence: Level IV, retrospective case series.

scholarly journals Outcomes of Nitinol Compression Staples in Tarsometatarsal Fusion

2020 ◽  
Vol 5 (3) ◽  
pp. 247301142094490
Author(s):  
Carissa C. Dock ◽  
Katie L. Freeman ◽  
J. Chris Coetzee ◽  
Rebecca Stone McGaver ◽  
M. Russell Giveans
Keyword(s):  
Patient Satisfaction ◽  
Case Series ◽  
Fusion Rate ◽  
Perioperative Outcomes ◽  
Wound Complications ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Patient Satisfaction Score ◽  
Foot Function

Background: Tarsometatarsal (TMT) arthrodesis is commonly performed in the management of midfoot arthritis, trauma, or deformity. The purpose of this study was to collect aggregate data (demographic, surgical, and perioperative outcomes) on patients who previously had a TMT fusion with BME compression staples. Methods: Sixty-six patients underwent TMT fusion with BME compression staples. Outcomes included demographics, surgical information, the Veterans Rand VR-12 Health Survey, Foot and Ankle Ability Measure (FAAM), visual analog scale (VAS), Revised-Foot Function Index (FFI-R), Ankle Osteoarthritis Scale (AOS), patient satisfaction survey scores, radiographic fusion rate, level of pain reduction, and complications. Sixty-six patients (68 feet) were analyzed (59 females) with an average age of 64 years (range, 18-83). The mean latest follow-up was 35.9 (range, 6-56.6 months). Results: The average surgical time was 38.1±14.3 minutes (range, 11-75). All outcomes improved significantly ( P < .001) from preoperative to latest follow-up except for the VR-12 Mental and Physical score. The average time to fusion determined by radiographs was 8.4 weeks (range, 6.1-46.1 weeks). Wound complications were not seen. Indications for subsequent surgeries (26.5%, 18/68 feet) in this current study included pain (n = 14), broken staples, and nonunion (n = 3). Conclusions: The fusion rate in this study, 89.7%, was similar to values reported in the literature. The patient satisfaction score of 81.9 at latest follow-up is consistent with patient satisfaction for other methods of fusion. Level of Evidence: Level IV, retrospective case series.

Recurrence Rate After Wide Resection of Plantar Fibromatosis: A Case Series and Systematic Literature Review

2021 ◽  
pp. 193864002110320
Author(s):  
Helen Anwander ◽  
Florian Weichsel ◽  
Jennifer Cullmann ◽  
Angela Seidel ◽  
Annabel Hayoz ◽  
...  
Keyword(s):  
Systematic Review ◽  
Recurrence Rate ◽  
Case Series ◽  
Local Resection ◽  
Wide Resection ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
American Orthopaedic ◽  
Plantar Fibromatosis

Background The aim was to assess the recurrence rate and clinical outcome after wide resection for plantar fibromatosis. Methods A total of 12 patients, 2 to 13 years after wide resection, were assessed for local and magnetic resonance imaging tomographic signs of recurrence at the clinical follow-up. In addition, a systematic review of the literature was conducted. Results After 7.8 years (2-13), 2 patients (17%) suffered a recurrence. At the last follow-up, median Foot Functional Index was 1 (0-66) and American Orthopaedic Foot and Ankle Society score was 95 (44-100). Six studies with 109 feet (92 patients) were included in the systematic review. The recurrence rate depends on the width of the resection: 67% after local resection, 42% after wide resection, and 27% after fasciectomy. Conclusion In patients with symptomatic plantar fibromatosis, we recommend a wide resection or fasciectomy over a local resection because of the inferior recurrence rate. Levels of Evidence Level IV: Retrospective case series

Efficacy of Calcaneus Osteotomy for Treatment of Symptomatic Müller-Weiss Disease

2016 ◽  
Vol 38 (3) ◽  
pp. 261-269 ◽  
Author(s):  
Shu-Yuan Li ◽  
Mark S. Myerson ◽  
Manuel Monteagudo ◽  
Ernesto Maceira
Keyword(s):  
Case Series ◽  
Stage Iv ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Vas Score ◽  
Calcaneal Osteotomy ◽  
Alternative Treatment Option ◽  
American Orthopaedic ◽  
Hindfoot Arthrodesis

Background: Various methods of midfoot and hindfoot arthrodesis for treating symptomatic Müller-Weiss disease (MWD) have been reported in the literature. In this study, we present the results of a previously unreported method of treatment using a calcaneal osteotomy incorporating a wedge and lateral translation. Methods: Thirteen patients (14 feet) with MWD were treated with a calcaneal osteotomy and retrospectively reviewed. These included 7 females and 6 males, with an average age of 56 years (33-79 years), and an average symptoms duration of 10.6 years (1-16 years). The disease was staged according to Maceira, which included 5 feet in stage II, 4 feet in stage III, 4 feet in stage IV, and 1 foot in stage V. Pre- and postoperative visual analog scale (VAS) score, American Orthopaedic Foot & Ankle Society (AOFAS), radiologic examination, and patients’ satisfaction rate of the surgery were evaluated at an average of 3.7 years (range, 1-8.5 years) following surgery. Results: The final follow-up visit showed satisfactory outcomes, with VAS score reducing from the preoperative 8 (7-9) to postoperative 2 (0-4), whereas the AOFAS score improved from the preoperative 29 (20-44) to the postoperative 79 (70-88). The patient’s subjective ratings showed excellent results in 4 feet, good results in 8 feet, and fair outcomes in 2 feet. The hindfoot range of motion remained unchanged, as did the extent of the navicular complex arthritis, and no patient required an arthrodesis since surgery. Conclusion: A calcaneal osteotomy can be used as an alternative treatment option for selected MWD patients regardless of the radiologic stage of the disease. Level of Evidence: Level IV, retrospective case series.

A Single Platelet-Rich Plasma Injection for Chronic Midsubstance Achilles Tendinopathy

2014 ◽  
Vol 7 (5) ◽  
pp. 372-376 ◽  
Author(s):  
Christopher D. Murawski ◽  
Niall A. Smyth ◽  
Hunter Newman ◽  
John G. Kennedy
Keyword(s):  
Platelet Rich Plasma ◽  
Short Form ◽  
General Health Questionnaire ◽  
Case Series ◽  
Achilles Tendinopathy ◽  
Therapeutic Level ◽  
Retrospective Case ◽  
Plasma Injection ◽  
Open Debridement

The purpose of this study was to evaluate a series of patients undergoing a single platelet-rich plasma (PRP) injection for the treatment of chronic midsubstance Achilles tendinopathy, in whom conservative treatment had failed. Thirty-two patients underwent a single PRP injection for the treatment of chronic midsubstance Achilles tendinopathy and were evaluated at a 6-month final follow-up using the Foot and Ankle Outcome Score and Short Form 12 general health questionnaire. Magnetic resonance imaging was performed on all patients prior to and 6 months after injection. Twenty-five of 32 patients (78%) reported that they were asymptomatic at the 6-month follow-up visit and were able to participate in their respective sports and daily activities. The remaining 7 patients (22%) who reported symptoms that did not improve after 6 months ultimately required surgery. Four patients went on to have an Achilles tendoscopy, while the other 3 had an open debridement via a tendon splitting approach. A retrospective evaluation of patients receiving a single PRP injection for chronic midsubstance Achilles tendinopathy revealed that 78% had experienced clinical improvement and had avoided surgical intervention at 6-month follow-up. Levels of Evidence: Therapeutic, Level IV: Retrospective case series

scholarly journals Micronized Dehydrated Amnion Chorion Membrane (mdHACM) Injection in the Treatment of Chronic Achilles Tendinitis: A Large Retrospective Case Series

2021 ◽  
Author(s):  
Jay Spector ◽  
Brandon Hubbs ◽  
Kimberly Kot ◽  
Niki Istwan ◽  
David Mason
Keyword(s):  
Medical Record ◽  
Electronic Medical Record ◽  
Complete Resolution ◽  
Case Series ◽  
Achilles Tendinopathy ◽  
Retrospective Case ◽  
Short Term Treatment ◽  
Achilles Tendinitis ◽  
Retrospective Case Series

Background: Human amniotic membrane contains growth factors and cytokines, which promote epithelial cell migration and proliferation, stimulate metabolic processes leading to collagen synthesis, and attract fibroblasts, while also reducing pain and inflammation. Randomized studies have shown that micronized dehydrated human amnion chorion membrane (mdHACM) allograft injection is an effective treatment for plantar fasciitis. Our objective is to present our experience with using mdHACM injection as a treatment for Achilles tendinopathy and report short term treatment outcomes. Methods: Included in this retrospective case series were patients diagnosed with Achilles tendinopathy treated with mdHACM by a single physician were identified from an electronic medical record system. Included for analysis were those with at least 2 follow up visits within 45 days of mdHACM injection. Outcomes examined included change in reported level of pain during the 45-day observation period and adverse events associated with treatment. Results: Follow-up data were available for 32 mdHACM-treated patients and abstracted from the electronic medical record. At treatment initiation 97% of patients reported severe (66%) or moderate (31%) pain. At first follow-up visit (mean 8.1 {plus minus} 2.7 days after injection), 84% (27/32) had reported improvement in pain levels, although 37% of patients continued to report severe (6%) or moderate (31%) pain. At the second follow-up visit (mean 23.1 {plus minus} 6.2 days after injection), no patients reported severe pain and one reported moderate pain. Within 45 days of mdHACM injection complete resolution of symptoms was reported by 66% of treated patients (n=21) with the remaining 34% reporting improvement but not complete resolution (n=11) of their symptoms. Two patients reported calf or quadricep pain or tightness post-injection. Conclusions: In a single practice mdHACM injection reduced or eliminated pain in all patients where follow-up data was available.

Percutaneous Bunionette Correction: Retrospective Case Series

2020 ◽  
pp. 193864002093750
Author(s):  
Gustavo Nunes ◽  
Tiago Baumfeld ◽  
Caio Nery ◽  
Daniel Baumfeld ◽  
Paulo Carvalho ◽  
...  
Keyword(s):  
Case Series ◽  
Distal Region ◽  
Pain Scale ◽  
Invasive Technique ◽  
Visual Analogue Pain Scale ◽  
Retrospective Case ◽  
Visual Analogue Pain ◽  
Significant Difference ◽  
American Orthopaedic

Introduction. Bunionette is a deformity of the fifth metatarsal in which there is a painful lateral bony prominence of the distal region of this bone caused by various anatomical and biomechanical changes. The aim of this study is to report on a minimally invasive technique without the use of hardware to treat these deformities. Methods. This is a case series of 18 patients, 25 feet, who underwent bunionette percutaneous surgical treatment. All patients answered the American Orthopaedic Foot and Ankle Society (AOFAS) scale and the visual analogue pain scale (VAS) preoperatively and at the last follow-up. Standard radiological evaluation included measurement of intermetatarsal (4-5 IMA) and fifth toe metatarsophalangeal (5-MTTP) angles. Time to radiographic consolidation, complications, and satisfaction rate were also documented. Results. The average follow-up was 15.9 months, the AOFAS increased from 49.6 to 92.4 and the VAS decreased from 7.7 to 1.2. It was observed that average 5-MTTP decreased from 15° to 2.7° and that 4-5-IMA decreased from 9.1° to 3.3°. These outcomes showed a statistically significant difference ( P < .001). The most common observed complication was the formation of a hypertrophic bone callus in the third postoperative month in three operated feet (12%). One patient had algodystrophy, which improved after conservative treatment. There were no cases of infection, neuropraxis, or recurrences. Fifteen patients rated the result as excellent, 2 as good, and 2 as regular. Conclusion. Percutaneous osteotomy of the fifth metatarsal without the use of hardware is a safe, reproducible technique and presents good clinical and radiographic results for the treatment of bunionette. Levels of Evidence: Therapeutic studies, Level IV: Case series

scholarly journals Central Tendon-Splitting Approach and Double Row Suturing for the Treatment of Insertional Achilles Tendinopathy

2019 ◽  
Vol 2019 ◽  
pp. 1-10
Author(s):  
Ze Zhuang ◽  
Yang Yang ◽  
Kishor Chhantyal ◽  
Jianning Chen ◽  
Guohui Yuan ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Daily Activities ◽  
Symptom Improvement ◽  
Aofas Score ◽  
Double Row ◽  
Bone Contact ◽  
Patient Reported ◽  
Insertional Achilles Tendinopathy

Background. To assess the clinical outcomes of central tendon-splitting approach and double row anchor suturing for the treatment of insertional Achilles tendinopathy. Methods. 28 patients (28 feet) diagnosed with insertional Achilles tendinopathy were included in this study. The inclusions were symptom of hindfoot pain around the insertion of the Achilles tendon, radiographic demonstration of calcification, or degeneration of the Achilles tendon, showing no symptom improvement even after standard nonsurgical treatment for more than six months. The X-ray revealed that patients had obvious posterior superior calcaneal exostosis with the possibility of friction with the Achilles tendon or intratendinous calcification. Surgical correction by the central tendon-splitting approach and double row Achilles tendon suturing was performed. The ankles were immobilized with plaster for four weeks postoperatively. The American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analogue score (VAS) were assessed preoperatively and at 2 years postoperatively. At final follow-up, the Manchester-Oxford Foot Questionnaire (MOXFQ) as patient-reported outcome measures (PROMs) was also evaluated. Results. No complication, including postoperative wound infection and tendon rupture, was not found. All the patients resumed their daily activities with no high level of daily activities, such as jumping and jogging after 6 weeks postoperatively. 27 patients were available for follow-up for at least 2 years, while only one patient was lost to follow-up. At postoperative 2 years, the postoperative AOFAS score increased significantly, while the VAS score decreased statistically when compared with preoperative values. At final follow-up, 24 patients had complete alleviation of pain, whereas the remaining 3 patients complained of mild heel pain after walking for a long time. The MOXFQ score showed obvious relief of previous symptoms for all included cases. Conclusions. Central tendon-splitting approach and double row Achilles tendon suture provide excellent intraoperative visual field, larger tendon-bone contact area, and stronger pullout strength and, thus, facilitate early rehabilitation. It can be a safe and effective method for the treatment of insertional Achilles tendinopathy.

scholarly journals The effect of high-volume image-guided injection in the chronic non-insertional Achilles tendinopathy: a retrospective case series

2020 ◽  
Vol 7 (1) ◽  
Author(s):  
Torsten Grønbech Nielsen ◽  
Lene Lindberg Miller ◽  
Bjarne Mygind-Klavsen ◽  
Martin Lind
Keyword(s):  
Case Series ◽  
High Volume ◽  
Achilles Tendinopathy ◽  
Retrospective Case ◽  
Image Guided ◽  
Retrospective Case Series ◽  
Insertional Achilles Tendinopathy
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