scholarly journals Minimum 3.5-year outcomes of operative treatment for Achilles tendon partial tears in the midportion and retrocalcaneal area

Author(s):  
Heinz Lohrer

Abstract Background Achilles tendon partial tears are not easy to diagnose and to manage. Most frequently, they are located in the midportion and insertional area. These entities result from different pathologic pathways, and different treatment strategies are applied. The outcome is rarely investigated. Methods This study includes patients who underwent surgery for partial tears in the midportion or retrocalcaneal Achilles tendon area between the years 2009 and 2015 by a single surgeon. Patients were prospectively assessed preoperatively and 3, 6, and 12 months postoperatively, using the VISA-A-G questionnaire. The final retrospective follow-up was performed after a minimum of 3.5 years postoperatively. Forty-eight Achilles tendon partial tears at the level of the retrocalcaneal bursa (impingement lesions) and 27 midportion Achilles tendon partial tears were identified. After applying rigorous exclusion criteria, 21 and 16 cases, respectively, remained for the final follow-up. Results were analysed by inferential and descriptive statistics. Results The VISA-A-G outcome scores improved significantly from preoperative to 6 months, 12 months, and final postoperative assessment. Preoperatively, the average VISA-A-G score was 42.1 (range, 18–73) for patients operated for Achilles tendon partial tears at the level of the retrocalcaneal bursa and 44.6 (range, 10–73) for the midportion Achilles tendon partial tear group, respectively. At final follow-up 88.8 (range, 15 to 100) and 96.9 (range, 71 to 100) were scored in the respective treatment groups. A repeated measures ANOVA determined that mean performance levels showed a statistically significant difference between measurements (p < 0.001). There was no systematic effect found between groups (p = 0.836). Conclusions In Achilles tendon partial tears recalcitrant to conservative treatment, operative intervention is highly successful in most cases, irrespective of the level of the injury. Results were statistically equal when comparing the midportion and retrocalcaneal Achilles tendon partial tear groups. Trial registration DRKS, DRKS00014266. Registered 06 April 2018. ‘Retrospectively registered’, https://www.drks.de/drks_web/navigate.do?navigationId=results.

2020 ◽  
Author(s):  
Heinz Lohrer

Abstract Background: Achilles tendon partial tears are not easy to diagnose and to manage. Most frequently, they are located in the midportion and insertional area. These entities result from different pathologic pathways and different treatment strategies are applied. The outcome is rarely investigated. Methods: This study includes patients who underwent surgery for partial tears in the midportion or retrocalcaneal Achilles tendon area between the years 2009 and 2015 by a single surgeon. Patients were prospectively assessed preoperatively and 3, 6, and 12 months postoperatively, using the VISA-A-G questionnaire. The final retrospective follow-up was performed after a minimum of 3.5 years postoperatively. Forty-eight Achilles tendon partial tears at the level of the retrocalcaneal bursa (impingement lesions) and 27 midportion Achilles tendon partial tears were identified. After applying rigorous exclusion criteria, 21 and 16 cases, respectively, remained for the final follow-up. Results were analysed by inferential and descriptive statistics.Results: The VISA-A-G outcome scores improved significantly from preoperative to six months, 12 months, and final postoperative assessment. Preoperatively, the average VISA-A-G score was 42.1 (range, 18-73) for patients operated for Achilles tendon partial tears at the level of the retrocalcaneal bursa and 44.6 (range, 10-73) for the midportion Achilles tendon partial tear group, respectively. At final follow-up 88.8 (range, 15 to 100) and 96.9 (range, 71 to 100) were scored in the respective treatment groups. A repeated measures ANOVA determined that mean performance levels showed a statistically significant difference between measurements (p < 0.001). There was no systematic effect found between groups (p = 0.836).Conclusions: In Achilles tendon partial tears recalcitrant to conservative treatment, operative intervention is highly successful in most cases, irrespective of the level of the injury. Results were statistically equal when comparing the midportion and retrocalcaneal Achilles tendon partial tear groups. Trial registration: DRKS, DRKS00014266. Registered 06 April 2018. 'Retrospectively registered', https://www.drks.de/drks_web/navigate.do?navigationId=results .


2020 ◽  
Author(s):  
Heinz Lohrer

Abstract Background: Achilles tendon partial tears are not easy to diagnose and to manage. Most frequently, they are located in the midportion and insertional area. These entities result from different pathologic pathways and different treatment strategies are applied. The outcome is rarely investigated. Methods: This study includes patients who underwent surgery for partial tears in the midportion or retrocalcaneal Achilles tendon area between the years 2009 and 2015 by a single surgeon. Patients were prospectively assessed preoperatively and 3, 6, and 12 months postoperatively, using the VISA-A-G questionnaire. The final retrospective follow-up was performed after a minimum of 3.5 years postoperatively. Forty-eight Achilles tendon partial tears at the level of the retrocalcaneal bursa (impingement lesions) and 27 midportion Achilles tendon partial tears were identified. After applying rigorous exclusion criteria, 21 and 16 cases, respectively, remained for the final follow-up. Results were analysed by inferential and descriptive statistics. Results: The VISA-A-G outcome scores improved significantly from preoperative to six months, 12 months, and final postoperative assessment. Preoperatively, the average VISA-A-G score was 42.1 (range, 18-73) for patients operated for Achilles tendon partial tears at the level of the retrocalcaneal bursa and 44.6 (range, 10-73) for the midportion Achilles tendon partial tear group, respectively. At final follow-up 88.8 (range, 15 to 100) and 96.9 (range, 71 to 100) were scored in the respective treatment groups.A repeated measures ANOVA determined that mean performance levels showed a statistically significant difference between measurements (p < 0.001). There was no systematic effect found between groups (p = 0.836). Conclusions: In Achilles tendon partial tears recalcitrant to conservative treatment, operative intervention is highly successful in most cases, irrespective of the level of the injury. Results were statistically equal when comparing the midportion and retrocalcaneal Achilles tendon partial tear groups.


2020 ◽  
Author(s):  
Heinz Lohrer

Abstract BackgroundAchilles tendon partial tears are not easy to diagnose and to manage. Most frequently, they are located in the midportion and insertional area. These entities result from different pathologic pathways and different treatment strategies are applied. The outcome is rarely investigated.MethodsThis study includes patients who underwent surgery for partial tears in the midportion or retrocalcaneal Achilles tendon area between the years 2009 and 2015 by a single surgeon. Patients were prospectively assessed preoperatively and 3, 6, and 12 months postoperatively, using the VISA-A-G questionnaire. The final retrospective follow-up was performed after a minimum of 3.5 years postoperatively. Forty-eight Achilles tendon partial tears at the level of the retrocalcaneal bursa (impingement lesions) and 27 midportion Achilles tendon partial tears were identified. After applying rigorous exclusion criteria, 21 and 16 cases, respectively, remained for the final follow-up. Results were analysed by descriptive statistics.ResultsThe VISA-A-G outcome scores improved significantly from preoperative to six months, 12 months, and final postoperative assessment. Preoperatively, the average VISA-A-G score was 42.1 (range, 18–73) for patients operated for Achilles tendon partial tears at the level of the retrocalcaneal bursa and 44.6 (range, 10–73) for the midportion Achilles tendon partial tear group, respectively (p = 0.690). At final follow-up 88.8 (range, 15 to 100) and 96.9 (range, 71 to 100) were scored in the respective treatment groups (p = 0.002).ConclusionsIn Achilles tendon partial tears recalcitrant to conservative treatment, operative intervention is highly successful in most cases, irrespective of the level of the injury. Twelve months postoperatively and at final follow-up, however, results were significantly better in the midportion Achilles tendon partial tear group.Trial registrationDRKS, DRKS00014266. Registered 06 April 2018. 'Retrospectively registered', https://www.drks.de/drks_web/navigate.do?navigationId=results .


2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Riccardo D’Ambrosi ◽  
Camilla Maccario ◽  
Federico Giuseppe Usuelli

Category: Ankle, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: to assess the functional and radiological outcomes after AT-AMIC® (arthroscopic talus autologous matrix induced chondrogenesis) in 2 groups: patients with and without bone marrow edema (BME). Methods: Thirty-seven patients of which 24 without edema (GNE) and 13 with edema (GE) were evaluated. All patients were treated with AT-AMIC® repair for osteochondral talar lesion. MRI and CT-scan evaluations, as well as clinical evaluations measured by the VAS score for pain, AOFAS and SF-12 were performed preoperatively (T0) and at 6 (T1), 12 (T2), and 24 (T3) months postoperatively. Results: GNE consisted of 24 patients while GE consisted of 13 patients. In both groups we found a significant difference for clinical and radiological parameters with ANOVA for repeated measures through four time points(p<0.001). In GNE, AOFAS improved significantly at each follow-up(p<0.05); while CT and MRI showed a significant decrease between T1 and T2 and T2 and T3(p<0.05). In GE, AOFAS improved significantly between T0 and T1 and T2 and T3(p<0.05); CT decreased between T1 and T2(p<0.05), while MRI showed a reduction at each follow-up(p<0.05). Lesion size was significantly higher both in MRI and CT in GE in respect to GNE(p<0.05). In the GNE no patients presented edema at T3, while in GE only 23.08% of the patients presented edema at T3. Conclusion: The study revealed that osteochondral lesions of the talus were characterized by bigger size both in MRI and CT in patients with edema. We conclude that AT-AMIC® can be considered a safe and reliable procedure that allows effective healing, regardless of edema and more than half of patients did not present edema six months after surgery.


2020 ◽  
Vol 2 (Supplement_3) ◽  
pp. ii13-ii13
Author(s):  
Masami Shirota ◽  
Masayuki Nitta ◽  
Taiichi Saitou ◽  
Syunsuke Tuduki ◽  
Atsushi Fukui ◽  
...  

Abstract Introduction: APT image(APT),which images the concentration of amide groups that increases in tumors, is expected to be applied clinically in diagnostic imaging of glioma. Purpose: APT was compared with MET-PET based on the pathological diagnosis results, and it was retrospectively verified that APT was useful for diagnostic imaging of glioma. Methods: A total of 46cases with glioma (WHO 2016 Grade: GII/III/IV) and Pseudoprogression were included. APT measured the APT measurement value by placing the region of interest in the tumor part. MET-PET was administered with 370MBq and the accumulation ratio(TNR) between the tumor part and the normal part was measured. Results: The APT measurement value in all cases was 2.22±1.01 and the TNR was 2.58±1.50,and a correlation was observed between the APT measurement value and the TNR(r=0.6, p&lt;0.001).When the accuracy of discrimination between GII/III/IV (32cases) and Pseudoprogression(14cases) by APT measurement was verified, the sensitivity was 91% and the specificity was 100% at the threshold of 1.81. In the verification of malignancy diagnosis, the measured APT value of GII (6cases) was 2.18±0.43,the measured APT value of GIII (11cases) was 2.67±0.69,and the measured APT value of GIV (15cases) was 2.99±0.61.The measured value showed a significant difference. The measured APT value in the oligodendroglioma group (GII/III:10cases) was 2.37±0.66,the TNR was 3.52±1.41,and the measured APT value in the astrocytoma group (GII/III: 7cases)Was 2.67±0.45 and TNR was 2.41±0.87.In the oligodendroglioma group, the measured APT value was lower and the TNR was higher than in the astrocytoma group. Conclusion: It was suggested that APT may have the same diagnostic ability as MET-PET in diagnosing malignant tumors and distinguishing between recurrence and Pseudoprogression. Patients with an actual APT of 1.81 or higher should consider treatment strategies, and follow-up may be an option for patients with an APT of &lt;1.81.APT,which is not affected by the blood-brain barrier, has little variation in measured values and is considered to be useful for diagnostic imaging of glioma.


2017 ◽  
Vol 26 (1) ◽  
pp. 69-75
Author(s):  
Shaheen Islam ◽  
Roufun Naher

The present study examined the effectiveness of nonviolent communication (NVC) workshop on marital adjustment. The hypothesis was receiving nonviolent communication (NVC) workshop has positive impact on marital adjustment. The independent variable was NVC workshop and the dependent variable was marital adjustment score. For conducting this research, repeated measures design was followed and 20 Bangladeshi married people participated in it. The results have shown that there was a statistically significant difference (F = 16.790, p < 0.05) in marital adjustment score of experimental group over the three time periods and pairwise comparisons indicate that there was significant difference between pretest and post-test and also between pretest and follow- up test at the 0.05 level. Results also have shown that, there was statistically significant difference of marital adjustment score between experimental and control group in posttest (t = 4.276, p < 0.05) and follow-up test (t = 4.176, p < 0.05). Thus, after receiving NVC workshop the marital adjustment score of experimental group increased significantly (F = 16.79, p < 0.001) in post-test measure and also remain constant in follow-up, whereas the marital adjustment score of control group had no significant change. This implied a significant positive impact of participation in NVC workshop on marital adjustment. Dhaka Univ. J. Biol. Sci. 26(1): 69-75, 2017 (January)


Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Richard L Harvey ◽  
Charles Liu ◽  
Dylan Edwards ◽  
Kari Dunning ◽  
Felipe Fregni ◽  
...  

Introduction: Upper limb function following stroke is limited, with only 50% regaining some function and less than 20% regaining normal function. Repetitive TMS has promise as an adjunct to upper limb therapy after stroke. We aimed to determine if navigated brain stimulation (NBS) with a low-frequency (1 Hz) protocol to non-injured hemisphere combined with upper limb rehabilitation would improve arm motor function better than rehabilitation alone. Method: We enrolled 199 patients with hemiplegia from ischemic or hemorrhagic stroke within 3-12 m post ictus. Randomization was in a 2:1 ratio to NBS with 18 sessions of rehabilitation over 6 weeks, or to sham NBS with therapy. The primary end-point was rate of achieving a 5-point improvement on the upper limb Fugl-Myer (ULFM) score at 6 m post-treatment and safety. Secondary outcomes included post-treatment, 1 m, 3 m and 6 m change on ULFM, action research arm test (ARAT), and EQ-5D-3L health questionnaire. Results: Of 199 subjects enrolled, 167 completed treatment and follow-up due to early stoppage of data collection after interim futility analysis. All subjects improved significantly on each outcome measure at each point of follow up, including 6 m post-treatment ULFM: treatment (8.1±7.4, p<0.001) and sham (8.5±8.7, p<0.001). In the ITT analysis, there was no difference on achievement of 5 points on ULFM at 6 m post-treatment: 67% treatment vs. 65% sham (chi-sq 1.105, p=0.76). Repeated measures ANCOVA group*time interaction showed no significant difference between groups for ULFM (p=0.87), ARAT (p=0.80) and the EQ 5D (p=0.96). There were no study or device related serious adverse events and no difference in SAE’s between groups. Conclusion: NBS can be safely used in the clinical setting. Clinically important gains were observed in both study arms suggesting no additional effect of 1 Hz NBS in stroke subjects within 3-12 m post ictus. The lack of NBS effects may be explained by the large effect size (ceiling effect) or potentially that the sham coil unintentionally induced cortical currents. Further analysis of the sham method and also secondary subgroup analyses will provide further insights and generate novel hypothesis to be confirmed in future NBS trials.


2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0003
Author(s):  
Federico Giuseppe Usuelli ◽  
Camilla Maccario ◽  
Riccardo D’Ambrosi

Category: Ankle, Ankle Arthritis, Arthroscopy, Basic Sciences/Biologics Introduction/Purpose: The purpose is to evaluate the clinical and radiological outcomes of patients younger than 20 years, treated with the arthroscopic-talus autogolous matrix-induced chondrogenesis (AT-AMIC®) technique and autologous bone graft for osteochondral lesion of the talus (OLT) at a follow-up of 24 months. Methods: 13 patients under 20 years (range 13.2 – 19.85) underwent the AT-AMIC® procedure and autologous bone graft for OLTs. Patients were evaluated pre-operatively (T0) and at 6 (T1), 12 (T2) and 24 (T3) months postoperatively, using the AOFAS score, the VAS and the SF-12 respectively in its Mental (MCS) and Physical component (PCS). Radiological assessment included CT-scan, MRI and intraoperative measurement of the lesion. A multivariate statistical analysis was performed. Results: Mean size lesion measured during surgery was 1.1102 cm3 ± 0.518 cm3. We found a significant difference in clinical and radiological parameters with ANOVA for repeated measures (p<0.001). All clinical scores significantly improved (p<0.05) from T0 to T3. Lesion area significantly reduced from 120.12 ± 29.58 mm2 pre-operatively to 75.78 ± 15.00 mm2 (p<0.05) at final follow- up as assessed by CT, and from 133.32 ± 32.42 mm2 to 83.45 ± 15.54 mm2 (p<0.05) as assessed by MRI. Moreover we noted an important correlation between intra-operative size measurement of the lesion and BMI (p=0.0114). Conclusion: The technique can be considered safe and effective, reporting early good results in young patients. Moreover we demonstrated a significant correlation between BMI and lesion size and a significant impact of OLTs on quality of life.


2020 ◽  
Vol 8 (1) ◽  
pp. e001507
Author(s):  
Antonio Carlo Bossi ◽  
Valentina De Mori ◽  
Carlotta Galeone ◽  
Davide Pietro Bertola ◽  
Margherita Gaiti ◽  
...  

IntroductionSitagliptin is a dipeptidyl peptidase 4 inhibitor for the treatment of type 2 diabetes (T2D). Limited real-world data on its effectiveness and safety are available from an Italian population.Research design and methodsWe evaluated long-term clinical data from the single-arm PERsistent Sitagliptin Treatment & Outcomes (PERS&O) study, which collected information on 440 patients with TD2 (275 men, 165 women; mean age 64.1 years; disease median duration: 12 years) treated with sitagliptin ‘add-on’. For each patient, we estimated the 10-year cardiovascular (CV) risk using the UK Prospective Diabetes Study (UKPDS) Risk Engine (RE). Drug survival was evaluated using Kaplan-Meier survival curves; repeated measures mixed effects models were used to evaluate the evolution of glycated hemoglobin (HbA1c) and CV risk during sitagliptin treatment.ResultsAt baseline, most patients were overweight or obese (median body mass index (BMI) (kg/m2) 30.2); median HbA1c was 8.4%; median fasting plasma glucose: 172 mg/dL; median UKPDS RE score: 24.8%, being higher in men (median 30.2%) than in women (median 17.0%) as expected. Median follow-up from starting sitagliptin treatment was 5.6 years. From Kaplan-Meier curves, the estimated median drug survival was 32.8 months when considering discontinuation for any cause and 58.4 months when considering discontinuation for loss of efficacy. A significant improvement in HbA1c was evident during treatment with sitagliptin (p<0.01): the reduction was rapid (median HbA1c after 4–6 months: 7.5%) and continued at longer follow-up. When comparing patients treated with sitagliptin versus those stopping sitagliptin and switching to another antihyperglycemic drug, we detected a significant difference in the evolution of HbA1c in favor of patients who continued sitagliptin treatment. The UKPDS RE score at 10 years and the BMI significantly improved during treatment with sitagliptin (p<0.001). Adverse events were relatively uncommon.ConclusionPatients with T2D treated with sitagliptin achieved an improvement in metabolic control and a reduction in CV risk and did not experience relevant adverse events.


2016 ◽  
Vol 30 (1) ◽  
pp. 20-24 ◽  
Author(s):  
Dominic Giuliano ◽  
Marion McGregor DC

Objective: We evaluated learning retention in interns exposed to simulation. It was hypothesized that learning would degrade after 6 months and there would be a difference in retention between interns who played a critical role versus those who did not. Methods: A total of 23 groups of 5 to 9 interns underwent a cardiac scenario twice during 1 simulation experience and again 6 months later. We captured 69 recordings (23 before debrief at baseline [PrDV], 23 after debrief at baseline [PoDV], and 23 at 6-month follow-up [FUV]). Students were assigned different roles, including the critical role of “doctor” in a blinded, haphazard fashion. At 6-month follow-up, 12 interns who played the role of doctor initially were assigned that role again, while 11 interns who played noncritical roles initially were newly assigned to doctor. All videos of intern performance were scored independently and in a blinded fashion, by 3 judges using a 15-item check list. Results: Repeated-measures analysis of variance for interns completing all 3 time points indicated a significant difference between time points (F2,22 = 112, p = .00). Contrasts showed a statistically significant difference between PrDV and PoDV (p = .00), and PrDV and FUV (p = .00), but no difference between PoDV and FUV (p = .98). This was consistent with results including all data points. Checklist scores were more than double for PoDV recordings (16) and FUV (15), compared to PrDV recordings (6.6). Follow-up scores comparing old to new doctors showed no statistically significant difference (15.4 vs 15.2 respectively, t21 = 0.26, p = .80, d = .11). Conclusions: Learning retention was maintained regardless of role.


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