scholarly journals The Influence of Diabetes on Acute Achilles Tendon Rupture Repair

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0028
Author(s):  
Jonathan Kaplan ◽  
Jeffery Hillam ◽  
Amiethab Aiyer ◽  
Niall Smyth
Keyword(s):  
Diabetes Mellitus ◽  
Postoperative Complications ◽  
Achilles Tendon ◽  
Power Analysis ◽  
Tendon Rupture ◽  
Surgical Repair ◽  
Achilles Tendon Rupture ◽  
The United States ◽  
Foot And Ankle ◽  
Tendon Ruptures

Category: Sports Introduction/Purpose: Diabetes Mellitus (DM) is an epidemic affecting millions of individuals in the United States. Multiple studies have demonstrated an increase in complications in foot and ankle surgery in patients with DM, including wound healing complications, surgical site infections (SSI), or surgical failure. The goal of this study was to retrospectively review outcomes data from the National Surgical Quality Improvement Program (NSQIP) to determine the impact of DM on operative treatment of achilles tendon ruptures. Methods: Using the NSQIP from 2006-2015, patients were identified using common procedure terminology (CPT) for Achilles tendon ruptures. Diabetic and non-diabetic cohorts were evaluated to compare demographics, comorbidities, perioperative details and 30-day outcomes. Statistical evaluation included a power analysis for the primary outcome measure of wound disruption as well as univariate analysis was performed using chi-squared or Fisher’s exact and Wilcoxon signed-rank tests. Results: A total of 2,014 patients were identified having sustained an Achilles tendon rupture. There were 1,981 patients without DM and 33 patients with DM. There were no significant differences in postoperative complications, including SSI, medical complications, and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures. The power analysis for wound disruption showed a P=0.9 with an alpha of 0.05, sample size of n=2014, and Pearson correlation coefficient of r=0.0721 Conclusion: While DM has been shown to have an increase in complications in various foot and ankle procedures, this study demonstrates that there is no significant difference in postoperative complications and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures using the NSQIP database from 2006-2015. Based on this data, patients with diabetes mellitus can be considered adequate surgical candidates for acute Achilles tendon rupture repair.

scholarly journals Epidemiology of Achilles Tendon Injuries in Collegiate Level Athletes in the United States

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0013
Author(s):  
Jimmy J. Chan ◽  
Kevin K. Chen ◽  
Javier Z. Guzman ◽  
Ettore Vulcano
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Injury Rate ◽  
Collegiate Athletes ◽  
The United States ◽  
Tendon Injuries ◽  
Time Loss ◽  
Contact Sports ◽  
Tendon Ruptures

Category: Hindfoot, Sports, Trauma Introduction/Purpose: Achilles tendon rupture is a potentially devastating injury particularly for National Collegiate Athletic Association (NCAA) athletes. Little has been studied regarding the incidence and implications of Achilles tendon ruptures in this patient population. Better characterization of the factors commonly found in athletes who rupture their Achilles may provide clues to aid in their prevention. Methods: Achilles injuries across 16 sports among NCAA men and women during the 2004-05 to 2013-14 academic years were analyzed using the NCAA Injury Surveillance Program (NCAA-ISP). Achilles tendon rupture rates per 100,000 athlete-exposures (IR), operative rate, annual injury rate trends, re-injury rates, mechanism of injury, in-season status (pre/in/post-season) and time loss distributions were compiled and calculated. A sub-analysis of contact sports and sports played by both genders (C-BG) was performed to determine if there were significant differences in risks in patients who played in contact sports. Results: N=255 Achilles tendon injuries were identified over 10 academic years (IR: 2.17). The injury rate was higher in males compared to females (IR=2.33 vs. 1.89 respectively). Achilles injuries were most common in Men’s Basketball (IR=4.26), Soccer (IR=3.06), and Football (IR=2.69). The top three women’s sports with Achilles injury were Gymnastics (IR=16.73), Basketball (IR=3.32), and Soccer (IR=1.81). Thirty-three injuries were operative (13.1%) and 14.9% (N=38) were season-ending injuries. The average time loss was 10.65 days when excluding patients who had season/career ending injuries. Reinjury rate was 11.0% (N=28). 61.2% of all injuries occurred during the regular season (N=156) with 36.0% (N=92) and 2.7% (N=7) occurring in pre- and post- season, respectively. There was a significantly greater number of injuries in contact (N=198) versus non-contact sports (N=50) (p<0.001). Conclusion: Achilles tendon ruptures can be devastating injuries in professional and collegiate athletes. In our study, nearly 15% of all NCAA Achilles tendon ruptures resulted in season ending injuries or significant time loss and over 13% of injuries required operative management with a majority of injuries occurring during practice. In addition, a significantly higher proportion of athletes who played a contact sport had Achilles injuries. Better understanding of what circumstances more often tend to result in Achilles injuries can help establish prevention strategies.

scholarly journals Professional Athletes’ Return to Play and Performance after Achilles Tendon Ruptures

2017 ◽  
Vol 2 (2) ◽  
pp. 2473011416S0000
Author(s):  
Johnathan Miller ◽  
Denzel Woode ◽  
Eugene Jang ◽  
David Trofa ◽  
Justin Greisberg ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Surgical Repair ◽  
Achilles Tendon Rupture ◽  
Return To Play ◽  
Inclusion Criteria ◽  
Post Injury ◽  
Tendon Ruptures ◽  
Performance Statistics ◽  
And Performance

Category: Sports Introduction/Purpose: The majority of Achilles tendon ruptures are sports-related. A significant decrease in return to play, playing time, and performance has been shown in National Basketball Association (NBA) players who sustained a complete Achilles tendon rupture requiring surgical repair. However, no study to date has examined and compared the impact on performance and return to play across multiple professional sports. Methods: Publicly available records yielded a list of NBA, National Football League (NFL), Major League Baseball (MLB), and National Hockey League (NHL) athletes who suffered Achilles tendon ruptures requiring surgical repair from 1989-2013. Demographic information and performance-related statistics were recorded from public sports statistics websites. The primary outcome of this study was the proportion of games played post- vs. pre-injury. Secondary markers of longevity were minutes played for NBA, games started for NFL, and innings played in field for MLB. Inclusion criteria included individuals in the NBA, NFL, MLB, and NHL with professional experience for at least 2 years before and after sustaining a primary Achilles tendon rupture requiring surgical repair. A matched control was selected for all returning players by identifying athletes with similar playing position, number of seasons played, and career performance statistics. The study was powered to detect a 15% difference in games played between ruptures and controls. Results: Of 100 athletes initially screened for the study, 43 met the inclusion criteria. Others were excluded for not completing at least 2 seasons pre- (n=16) or post-injury (n=32), or having a confounding injury (n=9). Athletes on average played 75.4% (p < 0.001) and 81.9% (p=0.002) of the games played the season prior to injury at 1 and 2 years post-injury, respectively. Other markers of longevity were also significantly decreased in athletes at 1 and 2 years post-injury (p < 0.001). Athletes also performed worse, with post-injury performances equivalent to 74.8% of pre-injury performance at 1 year (p=0.001) and 77.7% at 2 years (p < 0.001). Compared to controls, athletes with Achilles injuries played fewer games (p < 0.001) and had decreased longevity (p=0.025), and performance statistics (p < 0.001) at 1 year, but not 2 years after injury. Conclusion: An Achilles rupture is a devastating injury with many athletes unable to return to play. Further, athletes who managed to play for 2 years after injury play significantly fewer games, and experience significant decreases in secondary measures of longevity and performance metrics. Compared to controls, however, only the 1-year post-injury longevity and performance statistics were significantly worse. This implies a bimodal distribution of successful return to play: a significant portion of athletes undergoing repair never return to their prior level of competition, but those that do can often perform at a level commensurate with non-injured controls after 2 years.

Surgical Repair of Achilles Tendon Ruptures Using Polypropylene Braid Augmentation

1994 ◽  
Vol 15 (7) ◽  
pp. 372-375 ◽  
Author(s):  
Giannini Sandro ◽  
Girolami Mauro ◽  
Ceccarelli Francesco ◽  
Catani Fabio ◽  
Susanna Stea
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Surgical Repair ◽  
Achilles Tendon Rupture ◽  
Plaster Cast ◽  
Test Evaluation ◽  
Level Of Activity ◽  
Significant Difference ◽  
Tendon Ruptures ◽  
Active Patients

Surgical repair in fresh rupture of the Achilles tendon should be considered in active patients and athletes to restore their preinjury level of activity. Fifteen cases of Achilles tendon rupture underwent surgical repair using interpositional augmentation. This technique provides an immediate mechanical strength of the repair, avoiding the need for a postoperative plaster cast and allowing immediate motion of the ankle. No wound infection, scar adherence of the skin to the tendon, or rerupture of the tendon is present in this series. All patients were subjectively satisfied with the results and returned to their preinjury level of activity. Objectively, isokinetic assessment revealed no significant difference, as per t-test evaluation ( P < .05), between the operated leg and the contralateral one.

scholarly journals Management of Missed Traumatic Achilles Tendon Rupture in a Pediatric Patient: A Case Report

2021 ◽  
Vol 9 (4) ◽  
pp. 465-470
Author(s):  
Saad Andaloussi
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Skin Wound ◽  
Plantaris Tendon ◽  
First Case ◽  
Tendon Ruptures ◽  
Post Traumatic

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.

scholarly journals Ultrasonographic Classification of Achilles Tendon Ruptures as a Rationale for Individual Treatment Selection

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Michael H. Amlang ◽  
Hans Zwipp ◽  
Adina Friedrich ◽  
Adam Peaden ◽  
Alfred Bunk ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Individual Treatment ◽  
Reliable Instrument ◽  
Tendon Ruptures ◽  
Selection For ◽  
Sonographic Classification

Purpose. This work introduces a distinct sonographic classification of Achilles tendon ruptures which has proven itself to be a reliable instrument for an individualized and differentiated therapy selection for patients who have suffered an Achilles tendon rupture. Materials and Methods. From January 1, 2000 to December 31, 2005, 273 patients who suffered from a complete subcutaneous rupture of the Achilles tendon (ASR) were clinically and sonographically evaluated. The sonographic classification was organized according to the location of the rupture, the contact of the tendon ends, and the structure of the interposition between the tendon ends. Results. In 266 of 273 (97.4%) patients the sonographic classification of the rupture of the Achilles tendon was recorded. Type 1 was detected in 54 patients (19.8%), type 2a in 68 (24.9%), type 2b in 33 (12.1%), type 3a in 20 (7.3%), type 3b in 61 (22.3%), type 4 in 20 (7.3%), and type 5 in 10 (3.7%). Of the patients with type 1 and fresh ASR, 96% () were treated nonoperative-functionally, and 4% () were treated by percutaneous suture with the Dresden instrument (pDI suture). Of the patients classified as type 2a with fresh ASR, 31 patients (48%) were treated nonoperatively-functionally and 33 patients (52%) with percutaneous suture with the Dresden instrument (pDI suture). Of the patients with type 3b and fresh ASR, 94% () were treated by pDI suture and 6% () by open suture according to Kirchmayr and Kessler. Conclusion. Unlike the clinical classification of the Achilles tendon rupture, the sonographic classification is a guide for deriving a graded and differentiated therapy from a broad spectrum of treatments.

scholarly journals Seasonal Variation of Achilles Tendon Injury

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0017
Author(s):  
Jon-Michael Caldwell ◽  
Harry Lightsey ◽  
Hasani Swindell ◽  
Justin Greisberg ◽  
J. Turner Vosseller
Keyword(s):  
Seasonal Variation ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Seasonal Pattern ◽  
Achilles Tendon Rupture ◽  
Tendon Injury ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Significant Difference ◽  
Tendon Ruptures

Category: Sports Introduction/Purpose: Achilles tendon ruptures are increasingly common injuries. There are several known risk factors for Achilles tendon rupture, although little is reported on the seasonal variation of the incidence of these injuries. Of the few studies in the literature touching on this question, the results have been varied. We sought to determine if there is any seasonal pattern of Achilles tendon ruptures. Knowledge of such a seasonal pattern could be advantageous for patient education, risk assessment, and ultimately prevention of these injuries. Methods: We queried billing records for CPT codes 27650, 27652, and 27654 as well as ICD diagnosis codes 727.67, 845.09, and S86.01x pertaining to Achilles tendon injury, repair, and reconstruction. Charts were screened and included if the patient suffered an acute Achilles tendon rupture on a known date. Charts were excluded if the patient had a chronic Achilles tear or underwent reconstruction or debridement for tendonitis, Haglunds deformity, tendon laceration, or any other indication aside from acute rupture. Data was analyzed using a chi-squared test for categorical variables, binomial tests for dichotomous variables and Mann-Whitney-U or Welch t-test for continuous variables. Significance was set at p < 0.05. Results: Our search yielded 499 cases with 245 meeting inclusion criteria. Sixty-six percent (66%) of injuries were identified as sports-related while 34% were non-sports related. When stratified by month, significant peaks occurred in April and July (p = .036, .011 respectively) with significantly fewer injuries occurring in October through December (p = 0.049). The highest rate of injury was seen in Spring (p = .015) and the lowest was seen in Fall (p < .001). There was no significant difference between seasons when only the non-sports related injuries were considered. Basketball was the most common sport involved (n=78) accounting for 51% of injuries (p < .001), followed by soccer and tennis. There was no significant variation between seasons in any particular sport. Conclusion: There was significant seasonal variation in the incidence of Achilles tendon ruptures. Both sports and non-sports-related injuries followed a similar pattern, with most injuries occurring during the Spring and Summer and fewer during Fall and Winter. This increase corresponds to the increase in activity in the recreational athlete population in the region which is often preceded by a time of relative inactivity. Our study confirms that the deconditioned athlete is at particularly elevated risk for Achilles tendon rupture during the Spring season when abrupt increases in sporting activity are common. Targeted education and prevention efforts could help mitigate this risk.

Postoperative Complications Following Repair of Acute Achilles Tendon Rupture

2019 ◽  
Vol 40 (6) ◽  
pp. 679-686 ◽  
Author(s):  
X. J. Ruben Stavenuiter ◽  
Bart Lubberts ◽  
Robert M. Prince ◽  
A. Holly Johnson ◽  
Christopher W. DiGiovanni ◽  
...  
Keyword(s):  
Risk Factors ◽  
Postoperative Complications ◽  
Achilles Tendon ◽  
Postoperative Complication ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Subspecialty Training ◽  
Complication Rates ◽  
Operative Repair ◽  
Trauma Surgeons

Background: Controversy remains regarding which patients with acute Achilles tendon rupture would best be treated nonoperatively and which might benefit from operative repair. The primary aim of this study was to characterize the overall incidence of—and specific risk factors associated with—postoperative complications that follow operative repair. We also evaluated the specific differences between complications after the use of an open or minimally invasive surgical (MIS) approach. Methods: Retrospective chart review identified 615 adult patients who underwent operative repair for an acute Achilles tendon rupture between January 1, 2001, and May 1, 2016, at 3 level I trauma centers. Minimum follow-up was 3 months. Patient demographics, comorbidities, injury mechanism, procedural details, and surgeon subspecialty were collected. Assessed complications included wound healing issues, rerupture, hematoma, nerve injury, deep vein thrombosis, and pulmonary embolism. Results: Seventy-two patients (11.7%) developed a postoperative complication. Risk factors included advancing patient age (odds ratio [OR], 1.04, P = .007), active tobacco use (OR, 3.20, P = .007), and specific subspecialty training (OR, 2.04, P = .046). No difference in overall complication rate was found between the open and MIS approaches (11.6% vs 13.2%, P = .658). A subgroup analysis among orthopedic subspecialties demonstrated that patients treated by trauma surgeons had increased rates of wound complication ( P = .043) and rerupture ( P = .025) compared with those treated by other subspecialties. Patients treated by trauma surgeons were also more likely to be younger or have a body mass index (BMI) > 30, although neither factor was found to be independently predictive for postoperative complications. Conclusion: Approximately 1 in 9 patients undergoing operative repair of an acute Achilles tendon rupture developed a postoperative complication. Advancing age and active tobacco use were independent risk factors for developing such complications. Differences in subspecialty training also appear to impact complication rates, but the potential reason for this discrepancy remains unclear. As controversy remains regarding which patients who sustain acute Achilles tendon rupture should be treated nonoperatively and which would benefit most from surgical repair, a better understanding of postoperative complication rates and associated risk factors may enhance the decision-making processes in treating these injuries. It is not clear whether MIS techniques are superior to traditional open repair in terms of postoperative complications. Level of Evidence: Level III, retrospective comparative series.

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