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.

Gouty Achilles Tendinopathy: A Case Report

2019 ◽  
Vol 109 (4) ◽  
pp. 327-333 ◽  
Author(s):  
Chandana Halaharvi ◽  
Eric So ◽  
Cherreen Tawancy ◽  
Kurt A. Kibler ◽  
Daniel Logan
Keyword(s):  
Achilles Tendon ◽  
Operating Room ◽  
Fluid Collection ◽  
Achilles Tendinopathy ◽  
Flexor Hallucis Longus ◽  
Incision And Drainage ◽  
Computed Tomographic ◽  
Computed Tomographic Scan ◽  
The Right ◽  
The Relationship

Tendinopathy in the presence of gouty arthropathy is relatively common, yet the clinical suspicion for gout involvement in acute tendon pain remains low. A 49-year-old man presented with an acute, tender, erythematous mass to the right posterior heel. A computed tomographic scan was obtained, which revealed a septated fluid collection superficial to the Achilles tendon. The patient was taken to the operating room for an incision and drainage with debridement, and the abscess was found to be filled with caseous material. The diagnosis of gout was confirmed with pathology. The calcaneus was submitted to biopsy, and the results were negative for osteomyelitis. The patient was returned to the operating room for repair of the Achilles tendon with flexor hallucis longus tendon transfer. Postoperatively, the patient was nonweightbearing for 6 weeks. Oral colchicine was used perioperatively, and a steroid taper was administered. The patient was started on allopurinol and colchicine for chronic treatment. At 14 months, the patient was walking without pain or recurrence of the mass. Although the relationship between hyperuricemia and tendinopathy is not completely understood, it is apparent that tendon involvement may be a sequela in patients with gout. When a patient presents with acute tendon pain, gout should be considered in the differential diagnosis.

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 < .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 The anatomical variant of high soleus muscle may predispose to tendinopathy: a preliminary MR study

2021 ◽  
Author(s):  
Eleni E. Drakonaki ◽  
Khaldun Ghali Gataa ◽  
Pawel Szaro
Keyword(s):  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Control Group ◽  
Myotendinous Junction ◽  
Musculotendinous Junction ◽  
Anatomical Variant ◽  
Maximum Thickness ◽  
Mri Studies ◽  
Significant Difference ◽  
Tendon Insertion

Abstract Purpose This study aimed to examine the anatomic variations at the level of the distal soleus musculotendinous junction and the possible association between the length of the free tendon and the development of symptomatic Achilles tendinopathy. Methods We retrospectively assessed 72 ankle MRI studies with findings of Achilles tendinopathy (study group, 26 females/46 males, mean age 52.6 ± 10.5 years, 30 right/42 left) and 72 ankle MRI studies with normal Achilles tendon (control group, 32 females/40 males, mean age 35.7 ± 13.7 years, 42 right/30 left side). We measured the distance from the lowest outline of the soleus myotendinous junction to the proximal outline of the Achilles tendon insertion (length of the free tendon, diameter a) and to the distal outline of the insertion (distance B). We also measured the maximum thickness of the free tendon (diameter c) and the distance between the levels of maximum thickness to the proximal outline of the Achilles tendon insertion (distance D). All measurements were assessed twice. Statistical analysis was performed using independent t test. Results Distances A and B were significantly larger in tendinopathic tendons (59.7 and 83.4 mm, respectively) than normal Achilles tendons (38.5 and 60.8 mm, respectively) (p = 0.001). Mean distance C was larger in tendinopathic than normal tendons (11.2 versus 4.9 mm). Distances C and D were significantly larger in males than females. There was no significant difference in the measurements between sides. Conclusion There is wide anatomical variation in the length of the free Achilles tendon. Tendinopathy may be associated with the thicker free part of the Achilles tendon. The anatomical variant of the high soleus musculotendinous junction resulting in a longer free Achilles tendon may be a predisposing factor to the development of tendinopathy.

Open Versus Minimal Invasive Repair With Achillon Device

2009 ◽  
Vol 30 (5) ◽  
pp. 391-397 ◽  
Author(s):  
Seref Aktas ◽  
Baris Kocaoglu
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Achilles Tendon Rupture ◽  
Minimal Invasive ◽  
Flexor Hallucis Longus ◽  
Significant Difference ◽  
Outcome Scores ◽  
End To End ◽  
Group 2 ◽  
Group 1

Background: We prospectively analyzed and compared the functional and clinical results of patients with standard open and minimally invasive repair with the Achillon suture system at mid-term followup. Materials and Methods: From February 2004 to May 2007, 40 consecutive patients were operated for the treatment of acute Achilles tendon rupture with two different methods. None of the cases required adjunctive procedures like plantaris, flexor hallucis longus or gastrocnemius augmentation (Lindholm, Bosworth) to allow for acceptable end to end apposition. The patients were divided equally into two groups. In Group 1, only Krakow end-to-end suturing technique and in Group 2, Minimal invasive repair with Achillon suture system (Integra Life Sciences Corporation, Plainsboro, NJ) was used respectively. The average age of the patients was 40 years. Patients in study groups were followed up at mean of 22.4 (range, 10 to 48) months after surgery. At the end of the followup time, functional outcome scores and complications were evaluated. Results: The AOFAS hindfoot clinical outcome scores were 98.7 in Group 1, 96.8 in Group 2. Although there was a numerical increase in AOFAS Scores in Group 1, there was no significant difference. The surgical outcome concerning local tenderness, skin adhesions, scar and tendon thickness was better in Group 2 than in Group 1 with statistical significance. Conclusion: Although functional outcomes of both treatment groups were the same, minimally invasive repair with the Achillon suture system provided safe, reliable and practical treatment with low risk of complications in the treatment of acute Achilles tendon ruptures.

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.

Relationship between Thyroglobulin and Tumor Detectabilily with Thallium-201 in Differentiated Thyroid Cancer

2000 ◽  
Vol 39 (01) ◽  
pp. 10-15 ◽  
Author(s):  
S. P. Müller ◽  
Ch. Reiners ◽  
A. Bockisch ◽  
Katja Brandt-Mainz
Keyword(s):  
Thyroid Cancer ◽  
Differentiated Thyroid Cancer ◽  
Roc Analysis ◽  
Tsh Suppression ◽  
Significant Difference ◽  
Test Specificity ◽  
The Relationship ◽  
Tumor Scintigraphy ◽  
Tsh Stimulation

Summary Aim: Tumor scintigraphy with 201-TICI is an established diagnostic method in the follow-up of differentiated thyroid cancer. We investigated the relationship between thyroglobulin (Tg) level and tumor detectability. Subject and methods: We analyzed the scans of 122 patients (66 patients with proven tumor). The patient population was divided into groups with Tg above (N = 33) and below (N = 33) 5 ng/ml under TSH suppression or above (N = 33) and below (N = 33) 50 ng/ml under TSH stimulation. Tumor detectability was compared by ROC-analysis (True-Positive-Fraction test, specificity 90%). Results: There was no significant difference (sensitivity 75% versus 64%; p = 0.55) for patients above and below 5 ng/ml under TSH suppression and a just significant difference (sensitivity 80% versus 58%; p = 0.04) for patients above and below 50 ng/ml under TSH stimulation. In 18 patients from our sample with tumor, Tg under TSH suppression was negative, but 201-TICI-scan was able to detect tumor in 12 patients. Conclusion: Our results demonstrate only a moderate dependence of tumor detectability on Tg level, probably without significant clinical relevance. Even in patients with slight Tg elevation 201-TICI scintigraphy is justified.

Fecundity and Gonado-somatic Index of Trichiurus lepturus (Linnaeus, 1758) Along the Zamboanga del Norte Coast

2018 ◽  
Vol 6 (7) ◽  
pp. 120
Author(s):  
Ma. Dulce C. Guillena
Keyword(s):  
Sex Ratio ◽  
Stock Assessment ◽  
Chi Square ◽  
Moon Phases ◽  
Ovary Weight ◽  
Moment Coefficient ◽  
Trichiurus Lepturus ◽  
Significant Difference ◽  
The Relationship ◽  
Somatic Index

Gonado-somatic index and fecundity are tools for measuring the sexual maturity and ability of animals to reproduce.  This study investigates the reproduction of Trichiurus lepturus. Specifically, this aimed to determine the sex ratio, the GSI, the relationship between fecundity and total length, fecundity and total weight, fecundity and ovary weight. The Descriptive Method of research was used.  Percentage and chi-square was utilized in determining the percentage of occurrence and sex ratio respectively.   Pearson r Product Moment Coefficient of Correlation was used to determine the relationships of the parameters. The study revealed that females outnumbered males and the sex ratio for different month showed significant difference.  Spawning season was observed to occur in November and December as revealed in its GSI values and it synchronized with the full and new moon phases.  Fecundity is positively correlated with body weight, body size, and ovary weight where ovary weight is observed to be the best index for fecundity.  The results of this study could be used further for formal stock assessment of cutlassfish fishery.

Rendimento de grãos de soja e de milho, no Rio Grande do Sul, não difere entre eventos El Niño Oscilação Sul

Agrometeoros ◽  
2018 ◽  
Vol 26 (1) ◽  
Author(s):  
Ronaldo Matzenauer ◽  
Bernadete Radin ◽  
Alberto Cargnelutti Filho
Keyword(s):  
El Niño ◽  
El Nino ◽  
Southern Oscillation ◽  
Rio Grande ◽  
La Niña ◽  
Rio Grande Do Sul ◽  
La Nina ◽  
Significant Difference ◽  
Income Data ◽  
The Relationship

O objetivo deste trabalho foi avaliar a relação entre o fenômeno El Niño Oscilação Sul - ENOS e o rendimento de grãos de soja e de milho no Rio Grande do Sul e verificar a hipótese de que os eventos El Niño são favoráveis e os eventos La Niña são prejudiciais ao rendimento de grãos das culturas. Foram utilizados dados de rendimento de grãos dos anos agrícolas de 1974/75 a 2016/17, e relacionados com as ocorrências de eventos ENOS. Foram analisados os dados de rendimento observados na colheita e os dados estimados com a remoção da tendência tecnológica. Os resultados mostraram que não houve diferença significativa do rendimento médio de grãos de soja e de milho na comparação entre os eventos ENOS. Palavras-chave: El Niño, La Niña, safras agrícolas. Abstract – The objective of this work was to evaluate the relationship between the El Niño Southern Oscillation (ENSO) phenomenon with the grain yield of soybean and maize in Rio Grande do Sul state, Brazil and to verify the hypothesis that the El Niño events are favorable and the La Niña events are harmful to the culture’s grain yields. Were used data from the agricultural years of 1974/75 to 2016/17, and related to the occurrence of ENOS events. We analyzed income data observed at harvest and estimated data with technological tendency was removed. The results showed that there was no significant difference in the average yield of soybeans and corn in the comparison between events.

Income or Culture? Examining the Determinants of Subjective Wellbeing in an International Sample

2019 ◽  
Author(s):  
Siddharth Garg
Keyword(s):  
Online Survey ◽  
Subjective Wellbeing ◽  
Regression Coefficient ◽  
Marginal Utility ◽  
Economic Class ◽  
Income Groups ◽  
Significant Difference ◽  
The World ◽  
Diminishing Marginal Utility ◽  
The Relationship

Objective: The aim of this paper was to examine the relationship between income, subjective wellbeing, and culture among people from a higher socio-economic class across the world. Rationale: Ed Diener proposed the law of diminishing marginal utility as an explanation for differences in subjective wellbeing among different income groups across different countries (Diener, Ng, &amp; Tov, Balance in life and declining marginal utility of diverse resources, 2009). Thus, people with higher incomes would experience less subjective wellbeing due to income, and culture should emerge as a significant predictor. Method: Data from this study came from another study (https://siddharthgargblog.wordpress.com/2019/07/14/love-for-money/). I used an online survey to collect data on annual income in US dollars, subjective wellbeing (WHO-5), and country of residence (Indicator of Culture). 96 responses (Indians = 24, Foreigners = 72) were entered in IBM SPSS and a regression analysis was conducted. The raw dataset used in this study can be found at https://doi.org/10.6084/m9.figshare.8869040.v1Results: ANOVA showed a significant difference (p &lt; 0.05) between Indians and foreigners on levels of subjective wellbeing. Linear regression shows the regression coefficient of culture to be significant (Beta = -.254, p = .014) but the regression coefficient of income was not found to be significant. The overall model was found to explain 8.2% of the variance in wellbeing.Conclusion: The sample of this study is too small to make any kind of generalization; it does lend a little bit of support to the idea of diminishing marginal utility of income on subjective wellbeing and provides a rationale for further research.

T1 Relaxation Time of Achilles Tendon at 3 Tesla with Special Reference to Relevant Clinical Score: A Preliminary Study

2020 ◽  
Vol 16 (2) ◽  
pp. 164-173
Author(s):  
Zeineb Tbini ◽  
Mokhtar Mars ◽  
Mouna Bouaziz
Keyword(s):  
Relaxation Time ◽  
Achilles Tendon ◽  
Clinical Score ◽  
3 Tesla ◽  
Acquisition Time ◽  
Short Term ◽  
T1 Relaxation Time ◽  
T1 Relaxation ◽  
Spin Echo Sequence ◽  
Significant Difference

Purpose: The purpose of this study was to investigate T1 relaxation time of the human Achilles tendon, to test its short-term repeatability as well as the minimal detectable change, and to assess the extent that correlate with clinical symptoms. Methods: Twenty asymptomatic volunteers and eighteen patients with clinically and sonographically confirmed tendinopathy were scanned for ankle using a 3 Tesla (T) MR scanner. T1 maps were calculated from a variable flip angle gradient echo Ultra-short echo time sequence (VFA-GE UTE) and inversion recovery spin echo sequence (IR-SE) using a self-developed matlab algorithm in three regions of interest of Achilles Tendon (AT). Signal to Noise Ratio (SNR) between the two sequences was evaluated. INTRA-class Correlation Coefficient (ICC), Coefficient of Variation (CV) and the Least Significant Change (LSC) were calculated, to test short-term repeatability of T1. Subjects were assessed by the VISA-A clinical score. P values less than 0.005 were considered statistically significant. Results: Mean T1 values were 427.09 ± 53.37 ms and 528.70 ± 103.50 ms using IR-SE sequence and 575.43 ± 110.60 ms and 875.81 ± 425.77 ms with VFA-GE UTE sequence in the whole AT for volunteers and patients, respectively. : T1 values showed a significant difference between volunteers and patients (P=0.001). Regional variation of T1 in healthy and tendinopathic AT were greater for VFA-GE UTE sequence than for IR-SE sequence. VFA-GE UTE sequence showed clearly higher SNR compared to IR-SE sequence. Short-term repeatability of T1 values for volunteers showed an LSC of 22% and 14% for IR-SE sequence and VFA-GE UTE sequence, respectively. For patients, LSC was 14% and 5% for IR-SE sequence and VFA-GE UTE sequence, respectively. There was no correlation between T1 and VISA-A clinical score (p>0.005). Conclusion: VFA-GE UTE sequence used for T1 mapping calculation demonstrated short acquisition time and clearly high SNR. Results revealed that T1 relaxation time can be used as a biomarker to differentiate between healthy and pathologic Achilles tendon. However, T1 showed no correlation with the VISA-A clinical score.

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