scholarly journals Flexor hallucis longus vs. peroneus brevis: the better tendon for augmentation surgery in chronic achilles tendon ruptures

2019 ◽  
Vol 5 (2) ◽  
pp. 264 ◽  
Author(s):  
K. V. Nagakiran ◽  
Sudeep Madhukar Nambiar ◽  
Prasad Soraganvi ◽  
Sameer Wooly ◽  
H. Balakrishna Gadiyar
Keyword(s):  
Achilles Tendon ◽  
Functional Outcome ◽  
Tendon Rupture ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Flexor Hallucis Longus ◽  
Proximal Migration ◽  
Calcific Tendonitis ◽  
Tendon Ruptures ◽  
Peroneus Brevis

<p class="abstract"><strong>Background:</strong> Chronic degenerative Achilles tendon ruptures are increasing in incidence. Calcific tendonitis, poor vascularity, prior steroid injections, and proximal migration of tendon render conservative management ineffective. Flexor hallucis longus (FHL) and peroneus brevis (PB) have shown promising results with tendon augmentation procedures. The study was done to find out which was a better tendon for augmentation among the two.</p><p class="abstract"><strong>Methods:</strong> A total of 27 patients underwent tendon augmentation surgeries using FHL (n=14) and PB (n=13) after randomization at PES Institute of medical sciences and research, Kuppam from March 2014 to December 2018. Both the groups had a standard postoperative regimen and rehabilitative protocol. Functional outcome was assessed using AOFAS, Leppilahti score and ATRS scores.<strong></strong></p><p class="abstract"><strong>Results:</strong> The functional outcome was comparable in both FHL and PB and there was no clear winner in the study.</p><p class="abstract"><strong>Conclusions:</strong> Predictably<strong> </strong>good results are seen with tendon augmentation procedures for Achilles tendon rupture. Both FHL and PB are equally good in providing good plantar flexion power needed in achilles tendon rupture.</p>

Endoscopic Flexor Hallucis Longus Transfer for Chronic Noninsertional Achilles Tendon Rupture

2018 ◽  
Vol 39 (12) ◽  
pp. 1464-1472 ◽  
Author(s):  
Jordi Vega ◽  
Jesus Vilá ◽  
Jorge Batista ◽  
Francesc Malagelada ◽  
Miki Dalmau-Pastor
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Flexor Hallucis Longus ◽  
Level Of Evidence ◽  
Wound Breakdown ◽  
Tendon Ruptures

Background: Operative management of chronic Achilles tendon ruptures is challenging, and numerous techniques have been described. Risk of infection and wound breakdown have been described after open techniques, and minimally invasive methods have been proposed to avoid them. The aim of this study was to describe the clinical and radiological results obtained after endoscopic flexor hallucis longus (FHL) tendon transfer in patients with chronic Achilles tendon rupture. Methods: Between 2012 and 2015, a total of 22 patients were endoscopically treated for chronic Achilles tendon rupture. Mean age was 69 years (range, 59-84 years). Mean follow-up was 30.5 months (range, 18-46 months). Preoperative magnetic resonance imaging (MRI) was obtained and tendon gap measured. An MRI was obtained at 9 to 12 months following surgery to evaluate Achilles tendon changes. Results: Preoperative MRI examination showed a mean tendon gap of 6.3 cm (range, 3-10.7 cm). The MRI control was obtained only in 12 patients, and a normal or close to normal Achilles tendon was observed in all but 1 patient. The mean American Orthopaedic Foot & Ankle Society score increased from 55 preoperatively (range, 26-75) to 91 (range, 74-100) at final follow-up. All patients returned to their daily activities without difficulties. No patients reported complaints or symptomatic deficits of great toe flexion strength. No major complications were encountered. Conclusion: Chronic Achilles tendon ruptures were successfully treated by an all-endoscopic procedure. The endoscopically assisted FHL transfer provided excellent results while benefiting from the minimally invasive procedure advantages. However, it entailed some technical challenges and may not be suitable for less experienced surgeons. Level of Evidence: Level IV, retrospective case series.

Limited Scar Resection for Chronic Achilles Tendon Repair: Use of a Rat Model

2021 ◽  
pp. 036354652110230
Author(s):  
Matthew Counihan ◽  
Thomas Leahy ◽  
Courtney Nuss ◽  
Joseph Newton ◽  
Sarthak Mohanty ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Functional Outcome ◽  
Outcome Measures ◽  
Tendon Rupture ◽  
Surgical Intervention ◽  
Achilles Tendon Rupture ◽  
Intervention Strategy ◽  
Vascular Perfusion ◽  
Tendon Ruptures ◽  
Functional Outcome Measures

Background: Achilles tendon rupture diagnosis is frequently missed, leading to the development of a chronic rupture that requires surgical intervention to remove scar tissue and return the elongated Achilles tendon to appropriate functional length. The limited scar resection (LSR) intervention strategy may provide an advantage over other techniques, as it is less invasive and nondestructive to other tissues, although there is little evidence comparing outcomes between intervention strategies. Hypothesis: The LSR technique would be a viable treatment option for chronic Achilles tendon ruptures and would perform comparably with a more clinically accepted procedure, the gastrocnemius fascial turndown (GFT), in postintervention functional outcome measures and tendon mechanical and histological properties. Study Design: Controlled laboratory study. Methods: Chronic Achilles tendon ruptures were induced in the right hindlimb of Sprague-Dawley rats by Achilles tendon transection without repair, immobilization in dorsiflexion, and 5 weeks of cage activity. Animals were randomly divided between the intervention strategy groups (LSR and GFT), received 1 week of immobilization in plantarflexion, and were sacrificed at 3 or 6 weeks postintervention. In vivo functional outcome measures (gait kinetics, passive joint function, tendon vascular perfusion) were quantified during healing, and tendon mechanical and histological properties were assessed postsacrifice. Results: When compared with the GFT, the LSR technique elicited a faster return to baseline in gait kinetics, although there were few differences between groups or with healing time in other functional outcome measures (passive joint function and vascular perfusion). Quasi-static mechanical properties were improved with healing in both surgical intervention groups, although only the LSR group showed an improvement in fatigue properties between 3 and 6 weeks postintervention. Histological properties were similar between intervention strategies, except for decreased cellularity in the LSR group at 6 weeks postintervention. Conclusion: The LSR technique is a viable surgical intervention strategy for a chronic Achilles tendon rupture in a rodent model, and it performs similarly, if not better, when directly compared with a more clinically accepted surgery, the GFT. Clinical Relevance: This study supports the increased clinical use of the LSR technique for treating chronic Achilles tendon rupture cases.

scholarly journals Operative Outcome of Side-Locking Loop Suture Technique Accompanied by Autologous Semitendinosus Tendon Grafting for Chronic Rupture of Achilles Tendon

2021 ◽  
Vol 6 (2) ◽  
pp. 247301142110035
Author(s):  
Keisuke Tsukada ◽  
Youichi Yasui ◽  
Maya Kubo ◽  
Shinya Miki ◽  
Kentaro Matsui ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Scale Score ◽  
Tendon Rupture ◽  
Plantar Flexion ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Semitendinosus Tendon ◽  
Level Of Evidence ◽  
Operative Outcomes

Background: The purpose of this retrospective study was to clarify the operative outcomes of the side-locking loop suture (SLLS) technique accompanied by autologous semitendinosus tendon grafting for chronic Achilles tendon rupture. Methods: A chart review was conducted of consecutive patients treated with the SLLS technique at our department from 2012 to 2017. Postoperatively, a below-knee splint was applied for 2 weeks in 20 degrees of plantar flexion and then active range of motion exercise was started. Partial weightbearing exercise was allowed at 4 weeks according to patient tolerance, and full weightbearing without crutches was allowed at 8 weeks. The American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot scale score and the Achilles tendon rupture score (ATRS) were used to evaluate clinical outcomes preoperatively and at the final follow-up. Results: Ten patients (6 men, 4 women) were included in the analysis. Mean AOFAS ankle-hindfoot scale score increased significantly from 64.2 ± 5.6 points preoperatively to 95.0 ± 5.3 points at the final follow-up ( P < .001). The mean ATRS also increased significantly from 29.8 ± 4.4 points to 86.2 ± 7.7 points, respectively ( P < .001). Mean time between surgery and ability to perform 20 continuous double-leg heel raises of the operated foot was 13.5 ± 3.4 (range 10-18) weeks. One patient complained of postoperative hypoesthesia in the foot, which had spontaneously resolved by 3 months after surgery. Conclusion: The SLLS technique accompanied by autologous semitendinosus tendon grafting provided successful operative outcomes for patients with chronic Achilles tendon rupture regardless of the size of the defect, and thus long-term orthotic use was not needed after surgery. Level of Evidence: Level IV, retrospective case series.

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 Flexor hallucis longus tendon transfer for chronic Achilles tendon rupture. A retrospective study

2019 ◽  
Vol 25 (5) ◽  
pp. 630-635 ◽  
Author(s):  
Ole Kristian Alhaug ◽  
Gøran Berdal ◽  
Elisabeth Ellingsen Husebye ◽  
Kjetil Hvaal
Keyword(s):  
Retrospective Study ◽  
Achilles Tendon ◽  
Tendon Transfer ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Flexor Hallucis Longus ◽  
Longus Tendon

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.

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