scholarly journals Endoscopic treatment of Achilles tendon enthesopathies: An anatomical and clinical feasibility study

2020 ◽  
Vol 8 (2_suppl) ◽  
pp. 2325967120S0000
Author(s):  
Olivier Boniface ◽  
Thomas Vervoort
Keyword(s):  
Achilles Tendon ◽  
Feasibility Study ◽  
Open Surgery ◽  
Wound Complications ◽  
Operating Technique ◽  
Clinical Series ◽  
Open Reconstruction ◽  
Tendon Insertion ◽  
Calcaneal Tuberosity

Background: One possible treatment for Achilles tendon enthesopathy is open reconstruction of the Achilles tendon insertion by resection of calcified enthesis and the calcaneal tuberosity followed by reinsertion of the tendon with anchors. Subcutaneous dissection of the tendon in open procedure is at risk of wound complications. We hypothesized that this procedure could be performed under endoscopy. Methods: An innovative operating technique was described. It consisted in removal and reinsertion of the Achilles tendon under endoscopy using five portals with resection of the calcaneal tuberosity and calcified enthesis. A feasibility study was first conducted on five cadaveric feet followed by an in vivo study on five patients. Results: In all cases, the Achilles tendon could be reinserted with the same technique than in open surgery. None of the ten surgical procedures technically failed. It was possible to correctly resect calcifications and the calcaneal tuberosity. Resection was performed under endoscopic and fluoroscopic control for the ten cases. Proper reinsertion was verified under endoscopy, by placement of the ankle in physiological equinus for clinical series and by dissection for cadaveric cases. There were no complications in the clinical series 3 months postoperatively. Conclusion: Achilles enthesopathies can be treated by detachment/reinsertion of the Achilles tendon under endoscopy with resection of calcified enthesis and the calcaneal tuberosity. This endoscopic technique should now be validated by analyzing longer-term clinical and anatomical results and comparing them with the results of open surgery.

scholarly journals Cadaveric Anatomical Study of Sural Nerve: Where is The Safe Area for Endoscopic Gastrocnemius Recession?

2017 ◽  
Vol 11 (1) ◽  
pp. 1094-1098 ◽  
Author(s):  
Alvin Chin Kwong Tan ◽  
Zhi Hao Tang ◽  
Muhammad Farhan Bin Mohd Fadil
Keyword(s):  
Achilles Tendon ◽  
Sural Nerve ◽  
Anatomical Study ◽  
Lower Limbs ◽  
Lateral Border ◽  
Safe Area ◽  
Gastrocnemius Recession ◽  
The Mean ◽  
Tendon Insertion ◽  
Calcaneal Tuberosity

Purpose: To ascertain in cadavers where the sural nerve crosses the gastro-soleus complex and where the gastrocnemius tendon merges with the Achilles tendon in relation to the calcaneal tuberosities. Methods: Twelve cadaveric lower limbs (6 right and 6 left) were dissected. The distances between the calcaneal tuberosities and the lateral border of the Achilles tendon where the sural nerve crosses from medial to lateral, as well as to the gastrocnemius tendon insertion into the Achilles tendon, were measured. Results: The mean and median longitudinal distances from the calcaneal tuberosity to where the sural nerve crosses the lateral border of the Achilles tendon are 9.9cm and 10cm respectively (range 7cm to 14cm). The mean and median longitudinal distances from the calcaneal tuberosity to where the gastrocnemius tendon inserts into the Achilles tendon are 19.9cm and 18.5cm (range 17cm to 25cm) respectively. Conclusion: It is generally safe to place the posterolateral incision more than 14cm above the calcaneal tuberosity to avoid the sural nerve if surgeons plan to use a posterolateral incision for endoscopic recession. The distance between the calcaneal tuberosity to the gastrocnemius tendon insertion into the Achilles tendon is too highly variable to be used as a landmark for locating the gastrocnemius insertion.

Visualization of brain microvasculature and blood flow in vivo: Feasibility study using confocal laser endomicroscopy

2021 ◽  
Author(s):  
Evgenii Belykh ◽  
Xiaochun Zhao ◽  
Brandon Ngo ◽  
Dara S. Farhadi ◽  
Adam Kindelin ◽  
...  
Keyword(s):  
Blood Flow ◽  
Feasibility Study ◽  
Confocal Laser Endomicroscopy ◽  
Confocal Laser ◽  
Brain Microvasculature

scholarly journals Ultrasound and surgical inspection of plantaris tendon involvement in chronic painful insertional Achilles tendinopathy: a case series

2021 ◽  
Vol 7 (1) ◽  
pp. e000979
Author(s):  
Håkan Alfredson ◽  
Lorenzo Masci ◽  
Christoph Spang
Keyword(s):  
Achilles Tendon ◽  
Clinical Symptoms ◽  
Fatty Infiltration ◽  
Case Series ◽  
Achilles Tendinopathy ◽  
Level Of Evidence ◽  
Plantaris Tendon ◽  
Medial Pain ◽  
Tendon Insertion ◽  
Insertional Achilles Tendinopathy

ObjectivesChronic painful insertional Achilles tendinopathy is known to be difficult to manage. The diagnosis is not always easy because multiple different tissues can be involved. The plantaris tendon has recently been described to frequently be involved in chronic painful mid-portion Achilles tendinopathy. This study aimed to evaluate possible plantaris tendon involvement in patients with chronic painful insertional Achilles tendinopathy.MethodsNinety-nine consecutive patients (74 males, 25 females) with a mean age of 40 years (range 24–64) who were surgically treated for insertional Achilles tendinopathy, were included. Clinical examination, ultrasound (US)+Doppler examination, and surgical findings were used to evaluate plantaris tendon involvement.ResultsIn 48/99 patients, there were clinical symptoms of plantaris tendon involvement with pain and tenderness located medially at the Achilles tendon insertion. In all these cases, surgical findings showed a thick and wide plantaris tendon together with a richly vascularised fatty infiltration between the plantaris and Achilles tendon. US examination suspected plantaris involvement in 32/48 patients.ConclusionPlantaris tendon involvement can potentially be part of the pathology in chronic painful insertional Achilles tendinopathy and should be considered for diagnosis and treatment when there is distinct and focal medial pain and tenderness.Level of evidenceIV case series.

Characterization of in vivo Achilles tendon forces in rabbits during treadmill locomotion at varying speeds and inclinations

2004 ◽  
Vol 37 (11) ◽  
pp. 1647-1653 ◽  
Author(s):  
John R. West ◽  
Natalia Juncosa ◽  
Marc T. Galloway ◽  
Gregory P. Boivin ◽  
David L. Butler
Keyword(s):  
Achilles Tendon ◽  
Treadmill Locomotion

scholarly journals Gender Difference in Architectural and Mechanical Properties of Medial Gastrocnemius–Achilles Tendon Unit In Vivo

Life ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 569
Author(s):  
Liqin Deng ◽  
Xini Zhang ◽  
Songlin Xiao ◽  
Baofeng Wang ◽  
Weijie Fu
Keyword(s):  
Mechanical Properties ◽  
Gender Differences ◽  
Gender Difference ◽  
Achilles Tendon ◽  
Medial Gastrocnemius ◽  
Regular Exercise ◽  
Training Experience ◽  
Exercise Habits ◽  
Vertical Stiffness

This study aims to explore whether gender differences exist in the architectural and mechanical properties of the medial gastrocnemius–Achilles tendon unit (gMTU) in vivo. Thirty-six healthy male and female adults without training experience and regular exercise habits were recruited. The architectural and mechanical properties of the gMTU were measured via an ultrasonography system and MyotonPRO, respectively. Independent t-tests were utilized to quantify the gender difference in the architectural and mechanical properties of the gMTU. In terms of architectural properties, the medial gastrocnemius (MG)’s pennation angle and thickness were greater in males than in females, whereas no substantial gender difference was observed in the MG’s fascicle length; the males possessed Achilles tendons (ATs) with a longer length and a greater cross-sectional area than females. In terms of mechanical properties, the MG’s vertical stiffness was lower and the MG’s logarithmic decrement was greater in females than in males. Both genders had no remarkable difference in the AT’s vertical stiffness and logarithmic decrement. Gender differences of individuals without training experience and regular exercise habits exist in the architectural and mechanical properties of the gMTU in vivo. The MG’s force-producing capacities, ankle torque, mechanical efficiency and peak power were higher in males than in females. The load-resisting capacities of AT were greater and the MG strain was lesser in males than in females. These findings suggest that males have better physical fitness, speed and performance in power-based sports events than females from the perspective of morphology and biomechanics.

Geometric and Elastic Properties of in vivo Human Achilles Tendon in Young Adults

2004 ◽  
Vol 178 (4) ◽  
pp. 197-203 ◽  
Author(s):  
Tetsuro Muraoka ◽  
Tadashi Muramatsu ◽  
Tetsuo Fukunaga ◽  
Hiroaki Kanehisa
Keyword(s):  
Young Adults ◽  
Achilles Tendon ◽  
Elastic Properties
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