A New Modification of Bosworth’s Technique to Repair Infectious Achilles Tendon Rupture

2019 ◽  
Author(s):  
Qipeng Wu ◽  
Yuan Xiong ◽  
Zhenhua Fang ◽  
Junwen Wang ◽  
Guohui Liu ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Achilles Tendon ◽  
Nerve Injury ◽  
Sural Nerve ◽  
Skin Necrosis ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Vein Thrombosis ◽  
Deep Vein

Abstract Background The aim of this study was to assess radiographic and clinical outcomes of a new modified approach on the basis of Bosworth’s technique in the treatment of infectious Achilles tendon rupture (IATR). Materials and methods 15 patients (9 males and 6 females; 15 feet; average age of 38.3 years) were included in the study. After infection, the wounds were transferred to our department for treatment (Figure 1).Radiographic and clinical outcome in terms of the American Orthopaedic Foot&Ankle Society score (AOFAS), the Victorian institute of sports assessment Achilles (VISA-A), and the Achilles tendon total rupture score (ATRS) were investigated at 6 months, 12 months, and 24 months postoperatively. Results Preoperative AOFAS, VISA-A, and ATRS showed statistically significant improvement (p≤0.05) from35.03±6.81 (25-45), 21.04±8.17 (5-45), and 20.08±8.93 (6-55) to 90.04±5.32 (82-97), 95.11±3.09 (79-99), and 96.34±3.61 (89-97) at the last follow-up, respectively. All patients could lift heel on one foot and return to work at 12 to 16 weeks after operation (average 14.2 weeks). Overall, No complications such as infection, skin necrosis, sural nerve injury, deep vein thrombosis, and re-rupture of Achilles tendon occurred at last follow-up. Conclusion The new modified approach of Bosworth’s technique provided powerful curative efficacy of infectious Achilles tendon rupture, without severe complications in terms of infection, skin necrosis, sural nerve injury, deep vein thrombosis, and re-rupture of Achilles tendon. Level of Evidence: Level IV, case series.

scholarly journals 13 Deep vein thrombosis after acute achilles tendon rupture. An RCT comparing early controlled motion of the ankle with no motion

2019 ◽  
Author(s):  
Kristoffer Weisskirchner Barfod ◽  
Emil Nielsen ◽  
Beth Hærsted Olsen ◽  
Pablo Gustavo Vinicoff ◽  
Anders Troelsen ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Vein Thrombosis ◽  
Controlled Motion ◽  
Deep Vein

scholarly journals Risk of Deep Vein Thrombosis After Acute Achilles Tendon Rupture: A Secondary Analysis of a Randomized Controlled Trial Comparing Early Controlled Motion of the Ankle Versus Immobilization

2020 ◽  
Vol 8 (4) ◽  
pp. 232596712091590 ◽  
Author(s):  
Kristoffer Weisskirchner Barfod ◽  
Emil Graakjær Nielsen ◽  
Beth Hærsted Olsen ◽  
Pablo Gustavo Vinicoff ◽  
Anders Troelsen ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Controlled Trial ◽  
Achilles Tendon Rupture ◽  
Vein Thrombosis ◽  
Randomized Controlled ◽  
Deep Vein ◽  
D Dimer

Background: Immobilization of the ankle joint has been suggested as a key element in the pathogenesis leading to deep vein thrombosis (DVT). Purpose: To investigate whether early controlled ankle motion (ECM) could reduce the incidence of DVT compared with immobilization (IM) in the treatment of acute Achilles tendon rupture. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Patients aged 18 to 70 years were eligible for inclusion, and treatment was nonoperative. The ECM group performed movements of the ankle 5 times a day from weeks 3 to 8 after rupture. The control group was immobilized for 8 weeks. The outcome measure was DVT diagnosed with color Doppler ultrasound for above- and below-knee DVT at 2 and 8 weeks. The Achilles tendon Total Rupture Score, the heel-rise work test, and the Copenhagen Achilles ultrasonographic Length Measurement were performed at 4-, 6-, and 12-month follow-up. Results: A total of 189 patients were assessed for eligibility from February 2014 to December 2016. Of these, 130 were randomized: 68 patients were allocated to the ECM group and 62 to the IM group. All patients participated in follow-up at 8 weeks assessing for DVT. In total, 62 (47.7%) patients were diagnosed with DVT: 33 of 68 (48.5%) in the ECM group and 28 of 61 (46.8%) in the IM group ( P = .84). DVT did not affect treatment outcomes at 4, 6, and 12 months. D-dimer had low sensitivity (71%) for detecting DVT. Conclusion: We found that 1 in 2 patients presented with DVT in nonoperative treatment of acute Achilles tendon rupture. The ECM protocol revealed no benefit versus IM in reducing the incidence of DVT. DVT did not influence functional and patient-reported outcomes the first year after rupture. D-dimer seems an inappropriate test for detection of DVT in patients with acute Achilles tendon rupture. Registration: NCT02015364 ( ClinicalTrials.gov identifier).

Achilles tendon rupture: what you need to know

2021 ◽  
pp. 1-7
Author(s):  
A Biggs ◽  
G Scott ◽  
MC Solan ◽  
M Williamson
Keyword(s):  
Deep Vein Thrombosis ◽  
Achilles Tendon ◽  
Best Practice ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Operative Management ◽  
Vein Thrombosis ◽  
History Of ◽  
Non Operative Management ◽  
Deep Vein

Heel pain and a history of a ‘pop’ or feeling ‘something go’ are the buzz phrases classically associated with Achilles tendon rupture. However, the diagnosis is often missed in clinical practice because of the assumption that this is a sporting injury suffered only by the young or middle-aged. In a sedentary older patient, the injury may be dismissed as an ankle sprain. If swelling is present but no injury is recalled then deep vein thrombosis is suspected, but Achilles rupture is not. The diagnosis of Achilles tendon rupture is clinical, based on history and examination. Radiological imaging (ultrasound scan) is useful to plan orthopaedic management and exclude concomitant deep vein thrombosis. In most cases, non-operative management with the ankle held plantar flexed in a boot is the current best practice.

scholarly journals Ageing, deep vein thrombosis and male gender predict poor outcome after acute Achilles tendon rupture

2016 ◽  
Vol 98-B (12) ◽  
pp. 1635-1641 ◽  
Author(s):  
E. Domeij- Arverud ◽  
P. Anundsson ◽  
E. Hardell ◽  
G. Barreng ◽  
G. Edman ◽  
...  
Keyword(s):  
Deep Vein Thrombosis ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Male Gender ◽  
Vein Thrombosis ◽  
Poor Outcome ◽  
Deep Vein

scholarly journals Intraoperative Ultrasonography assistance for minimally invasive repair of the acute Achilles Tendon Rupture

2020 ◽  
Author(s):  
Yongliang Yang ◽  
Honglei Jia ◽  
Wupeng Zhang ◽  
Shihong Xu ◽  
Fu Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Nerve Injury ◽  
Saphenous Vein ◽  
Sural Nerve ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Intraoperative Ultrasonography ◽  
Medial Side ◽  
Significant Difference

Abstract Background: Minimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The major problem is sural nerve injury. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture.Methods: A retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography from January 2015 to December 2017. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. The course of the small saphenous vein and sural nerve were identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the SSV.Results: All patients were followed up for at least 12 months. No sural nerve injury or other complications was found intraoperatively and postoperatively. All the patients returned to work and light sporting activities at a mean of 12.78±1.40 weeks and 17.28±2.34 weeks, respectively. The Mean AOFAS scores improved from 59.17±5.31 preoperatively to 98.92±1.63 at the time of 12 months follow-up. There was statistically significant difference (P<0.001). No patient complained a negative effect on their life.Conclusions: The minimally invasive repair assisted with intraoperative ultrasonography can yield good clinical outcomes, less surgical time and less complications, especially sural nerve injury. It is an efficient, reliable and safe method for acute AT rupture.

scholarly journals Intraoperative Ultrasonography assistance for minimally invasive repair of the acute Achilles Tendon Rupture

2020 ◽  
Author(s):  
Yongliang Yang ◽  
Honglei Jia ◽  
Wupeng Zhang ◽  
Shihong Xu ◽  
Fu Wang ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Achilles Tendon ◽  
Nerve Injury ◽  
Saphenous Vein ◽  
Sural Nerve ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Intraoperative Ultrasonography ◽  
Medial Side ◽  
Significant Difference

Abstract Background: Minimally invasive repair is a better option for Achilles tendon rupture with low re-rupture and wound-related complications than conservative treatment or traditional open repair. The major problem is sural nerve injury. The purpose of this study was to evaluate the effect and advantage of the intraoperative ultrasonography assistance for minimally invasive repair of the acute Achilles tendon rupture. Methods: A retrospective study was performed on 36 cases of acute Achilles tendon rupture treated with minimally invasive repair assisted with intraoperative ultrasonography from January 2015 to December 2017. The relationship of the sural nerve and small saphenous vein was confirmed on the preoperative MRI. The course of the small saphenous vein and sural nerve were identified and marked by intraoperative ultrasonography. The ruptured Achilles tendon was repaired with minimally invasive Bunnell suture on the medial side of the small saphenous vein (SSV).Results: All patients were followed up for at least 12 months. No sural nerve injury or other complications was found intraoperatively and postoperatively. All the patients returned to work and light sporting activities at a mean of 12.78±1.40 weeks and 17.28±2.34 weeks, respectively. The Mean American Orthopaedic Foot & Ankle Society (AOFAS) scores improved from 59.17±5.31 preoperatively to 98.92±1.63 at the time of 12 months follow-up. There was statistically significant difference (P<0.001). No patient complained a negative effect on their life.Conclusions: The minimally invasive repair assisted with intraoperative ultrasonography can yield good clinical outcomes, less surgical time and less complications, especially sural nerve injury. It is an efficient, reliable and safe method for acute Achilles Tendon (AT) rupture.

scholarly journals A comparative study of innovative percutaneous repair and open repair for acute Achilles tendon rupture: Innovative usage of intraoperative ultrasonography

2020 ◽  
Vol 28 (1) ◽  
pp. 230949902091027
Author(s):  
Jeong-Kil Lee ◽  
Chan Kang ◽  
Deuk-Soo Hwang ◽  
Dong-Hun Kang ◽  
Gi-Soo Lee ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Clinical Outcomes ◽  
Nerve Injury ◽  
Sural Nerve ◽  
Tendon Rupture ◽  
Open Repair ◽  
Achilles Tendon Rupture ◽  
Operative Outcomes ◽  
Athletic Ability ◽  
Percutaneous Repair

Purpose: There is no definitive consensus on the optimal treatment of Achilles tendon rupture. We comparatively analyzed the clinical outcomes of two types of repair surgeries in treating Achilles tendon rupture. Methods: This retrospective study included 12 patients of Achilles tendon rupture (group A) treated with ultrasound-guided percutaneous repair and 18 patients (group B) treated with open repair. Clinical evaluation was performed using the Arner–Lindholm scale, American Orthopedic Foot and Ankle Society (AOFAS) ankle–hindfoot score, Achilles Tendon Total Rupture score (ATRS), visual analog scale, time to single heel raise, bilateral calf circumferences, recovery of athletic ability, and other complications. Results: While the Arner–Lindholm scale, AOFAS ankle–hindfoot score, ATRS, time point when single heel raise was possible, differences in bilateral calf circumference, and recovery of athletic ability compared to pre-rupture level were not significantly different between the two groups (p = 0.999, 0.235, 0.357, 0.645, 0.497, and 0.881, respectively), overall and aesthetic satisfaction levels were higher in the group treated with percutaneous repair under ultrasonography guidance (p = 0.035 and 0.001, respectively). Overall, there were no cases involving sural nerve injury in either group. Conclusion: Innovative percutaneous repair provides not only similar clinical outcomes but also greater overall and aesthetic satisfaction levels of operative outcomes and minimal complications (i.e. sural nerve injury) compared to open repair surgeries. Therefore, percutaneous repair may be a useful technique in the treatment of Achilles tendon rupture.

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