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

2020 ◽  
Author(s):  
Heinz Lohrer
Keyword(s):  
Achilles Tendon ◽  
Treatment Strategies ◽  
Exclusion Criteria ◽  
Treatment Groups ◽  
Partial Tear ◽  
Partial Tears ◽  
Outcome Scores ◽  
Respective Treatment ◽  
Retrocalcaneal Bursa

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 .

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

2020 ◽  
Author(s):  
Heinz Lohrer
Keyword(s):  
Achilles Tendon ◽  
Repeated Measures ◽  
Treatment Strategies ◽  
Systematic Effect ◽  
Partial Tear ◽  
Partial Tears ◽  
Significant Difference ◽  
Respective Treatment ◽  
Retrocalcaneal Bursa

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 .

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

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Heinz Lohrer
Keyword(s):  
Achilles Tendon ◽  
Repeated Measures ◽  
Treatment Strategies ◽  
Systematic Effect ◽  
Partial Tear ◽  
Partial Tears ◽  
Significant Difference ◽  
Respective Treatment ◽  
Retrocalcaneal Bursa

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.

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

2020 ◽  
Author(s):  
Heinz Lohrer
Keyword(s):  
Achilles Tendon ◽  
Repeated Measures ◽  
Treatment Strategies ◽  
Systematic Effect ◽  
Partial Tear ◽  
Partial Tears ◽  
Significant Difference ◽  
Respective Treatment ◽  
Retrocalcaneal Bursa

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.

Hip Dislocation and Subluxation in Athletes: A Systematic Review

2021 ◽  
pp. 036354652110361
Author(s):  
Deepak V. Chona ◽  
Paul D. Minetos ◽  
Christopher M. LaPrade ◽  
Mark E. Cinque ◽  
Geoffrey D. Abrams ◽  
...  
Keyword(s):  
Systematic Review ◽  
Arthroscopic Surgery ◽  
Treatment Strategies ◽  
Hip Dislocation ◽  
Return To Play ◽  
Exclusion Criteria ◽  
Level Of Evidence ◽  
Radiographic Outcomes ◽  
Center Edge

Background: Hip dislocation is a rare occurrence during sports but carries serious implications for athletes. Purpose: To systematically review treatment strategies and outcomes for hip dislocation in athletes, with the ultimate goal of providing sports medicine physicians with the information necessary to appropriately treat and counsel patients sustaining this injury. Study Design: Systematic review; Level of evidence, 4. Methods: PubMed, MEDLINE, and Embase were searched for studies relating to hip instability and athletics from January 1, 1989 to October 1, 2019. Abstracts and articles were evaluated on the basis of predefined inclusion and exclusion criteria. Inclusion criteria were the following: (1) data from ≥1 patients, (2) native hip dislocation or subluxation occurring during sports, (3) patients aged at least 10 years, and (4) written in English. Exclusion criteria were (1) patients younger than 10 years; (2) nonnative or postoperative hip dislocation or subluxation; (3) a native hip injury without dislocation or subluxation; (4) patients with dislocation or subluxation secondary to neuromuscular, developmental, or syndromic causes; (5) dislocation or subluxation not occurring during sports; (6) patients with physeal fractures; or (7) review articles or meta-analyses. Data were recorded on patient demographics, injury mechanism, treatment strategies, and clinical and radiographic outcomes. Where possible, pooled analysis was performed. Studies were grouped based on reported outcomes. Meta-analysis was then performed on these pooled subsets. Results: A total of 602 articles were initially identified, and after screening by 2 reviewers, 27 articles reporting on 145 patients were included in the final review. There were 2 studies that identified morphological differences between patients with posterior dislocation and controls, including decreased acetabular anteversion ( P = .015 and .068, respectively), increased prevalence of a cam deformity ( P < .0035), higher alpha angles ( P≤ .0213), and decreased posterior acetabular coverage ( P < .001). No differences were identified for the lateral center edge angle or Tonnis angle. Protected postreduction weightbearing was most commonly prescribed for 2 to 6 weeks, with 65% of reporting authors recommending touchdown, toe-touch, or crutch-assisted weightbearing. Recurrence was reported in 3% of cases. Overall, 4 studies reported on findings at hip arthroscopic surgery, including a 100% incidence of labral tears (n = 27; 4 studies), 92% incidence of chondral injuries, 20% incidence of capsular tears, and 84% incidence of ligamentum teres tears (n = 25; 2 studies). At final follow-up, 86% of patients reported no pain (n = 14; 12 studies), 87% reported a successful return to play (n = 39; 10 studies), and 11% had radiographic evidence of osteonecrosis (n = 38; 10 studies). Conclusion: Various treatment strategies have been described in the literature, and multiple methods have yielded promising clinical and radiographic outcomes in patients with native hip dislocation sustained during sporting activity. Data support nonoperative treatment with protected weightbearing for hips with concentric reduction and without significant fractures and an operative intervention to obtain concentric reduction if unachievable by closed means alone. Imaging for osteonecrosis is recommended, with evidence suggesting 4- to 6-week magnetic resonance imaging and follow-up at 3 months for those with suspicious findings in the femoral head.

scholarly journals Bone anabolic changes progress in psoriatic arthritis patients despite treatment with methotrexate or tumour necrosis factor inhibitors

2012 ◽  
Vol 72 (7) ◽  
pp. 1176-1181 ◽  
Author(s):  
Stephanie Finzel ◽  
Sebastian Kraus ◽  
Sarah Schmidt ◽  
Axel Hueber ◽  
Juergen Rech ◽  
...  
Keyword(s):  
Psoriatic Arthritis ◽  
Tumour Necrosis Factor ◽  
Tumour Necrosis ◽  
Treatment Strategies ◽  
Appendicular Skeleton ◽  
Micro Ct ◽  
Treatment Groups ◽  
Tumour Necrosis Factor Inhibitors ◽  
Necrosis Factor

ObjectivesTo investigate whether methotrexate or tumour necrosis factor inhibitors (TNFi) affect osteophyte formation in patients with psoriatic arthritis (PsA).Methods41 patients with PsA were examined for the presence of osteophytes and erosions at the metacarpophalangeal joints by high-resolution micro-CT imaging. The size of each individual lesion was quantified at baseline and 1-year follow-up in PsA patients treated with TNFi (N=28) or methotrexate (N=13). Groups were comparable for age, sex, disease duration and activity and baseline burden of osteophytes.ResultsIn total, 415 osteophytes (TNFi N=284, methotrexate N=131) were detected. Osteophyte size increased significantly from baseline to follow-up in the TNFi group (mean±SEM change +0.23±0.02 mm; p<0.0001) and the methotrexate group (+0.27±0.03 mm, p<0.0001). In both treatment groups, the majority of osteophytes showed progression (TNFi 54.3%, methotrexate 61.1%), whereas regression of lesions was rare (less than 10%). In contrast to osteophytes, clinical disease activity decreased in both groups of PsA patients and erosions showed an arrest of progression in both groups.ConclusionsOsteophytes progress in PsA patients treated with either methotrexate or TNFi. These data provide the first evidence that pathological bone formation in the appendicular skeleton of patients with PsA is not affected by current antirheumatic treatment strategies.

The Minimum Distance May Affect Perioperative Complications and Completed Occlusions of Endovascular Treatment for Tandem Intracranial Aneurysms: A Multi-Institutional Retrospective Study

2020 ◽  
Vol 49 (6) ◽  
pp. 609-618
Author(s):  
Xin Feng ◽  
Xin Tong ◽  
Fei Peng ◽  
Kun Wang ◽  
Hao Niu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Endovascular Treatment ◽  
Clinical Outcomes ◽  
Intracranial Aneurysms ◽  
Minimum Distance ◽  
Perioperative Complications ◽  
Univariate Analysis ◽  
Treatment Strategies ◽  
Treatment Groups

<b><i>Background:</i></b> Tandem aneurysms (TAs) are a distinct type of multiple intracranial aneurysms (IAs), the treatment strategies for which remain controversial. We aimed to reveal the clinical and angiographic outcomes of endovascular treatment as well as their risk factors in these complex multiple IAs. <b><i>Methods:</i></b> This multicenter, retrospective follow-up study was carried out in 3 hospitals in China. In total, clinical and angiographical data of 137 patients with 145 lesions (7 patients had bilateral lesions) and 315 TAs were collected. The treatment strategies were divided into full or partial treatment, single- or multiple-session treatment, and coiling (including single coiling and stent-assisted coiling)- or flow-diverting stent (FDS) treatment. Perioperative complications, as well as angiographic and clinical outcomes and their risk factors, were analyzed using univariate analysis and a multiple regression model. <b><i>Results:</i></b> Of treated TA lesions, 17 (16.0%) perioperative complications were found. Significant differences were found between the single- and multiple-session treatment groups (<i>p</i> = 0.012). At the latest follow-up, there were no significant differences in the modified Raymond Scale scores between different treatment groups. Significant differences were found in the embolization degree between the coiling and FDS groups (<i>p</i> = 0.038) and between the single common stent (without coiling) and the other treatment groups (<i>p</i> &#x3c; 0.001). In IAs managed by a single LVIS stent (without coiling), 60% achieved improved or completed occlusion. Multivariate regression analysis found that a shorter minimum distance (odds ratio [OR] 5.967, 95% confidence interval [CI] 1.366–26.074; <i>p</i> = 0.018), multiple-session treatment (OR 9.961, 95% CI 1.707–58.127; <i>p</i> = 0.011), and diabetes (OR 8.106, 95% CI 1.928–34.084; <i>p</i> = 0.004) were predictors of perioperative complications, while shorter minimum distance (OR 5.619, 95% CI 1.493–21.152; <i>p</i> = 0.011), greater diameter ratio (OR 3.621, 95% CI 1.014–12.937; <i>p</i> = 0.048), and greater size ratio (OR 2.424, 95% CI 1.007–5.834; <i>p</i> = 0.048) were predictors of low completed occlusion rate. <b><i>Conclusions:</i></b> Both coiling and FDS can be utilized safely and can achieve similar clinical outcomes. FDS and LVIS are recommended for IAs that do not require embolization but cannot be prevented from being covered by stents. A multiple-session treatment may increase the treatment risk, and the minimum distance may affect the incidence of perioperative complications and completed occlusions. Further hemodynamic and prospective studies on such TAs in close proximity to one another are needed.

Outcomes of Surgical Repair Versus Primary Tenodesis for Proximal Rectus Femoris Avulsion Injuries in Professional Athletes

2020 ◽  
Vol 49 (1) ◽  
pp. 121-129
Author(s):  
Babar Kayani ◽  
Sandeep Singh ◽  
Justin S. Chang ◽  
Ahmed A. Magan ◽  
Ricci Plastow ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Surgical Repair ◽  
Rectus Femoris ◽  
Quadriceps Muscle ◽  
Treatment Groups ◽  
Risk Of Injury ◽  
Outcome Scores ◽  
Reduced Risk ◽  
Injury Recurrence

Background: Surgical repair of proximal rectus femoris avulsion injuries is associated with prolonged periods of rehabilitation and highly variable risk of injury recurrence. Surgical tenodesis of these injuries is often reserved for recurrent injuries or revision surgery. To our knowledge, the outcomes of proximal rectus femoris avulsion injuries treated with surgical repair versus primary tenodesis have not been previously reported. Hypothesis: Primary tenodesis of proximal rectus femoris avulsion injuries is associated with reduced risk of injury recurrence as compared with surgical repair. Study Design: Cohort study; Level of evidence, 3. Methods: This study included 25 patients (22 male and 3 female) who underwent surgical repair versus 30 patients (26 male and 4 female) who received primary tenodesis for proximal rectus femoris avulsion injuries. Predefined outcomes were recorded at regular intervals after surgery. Mean follow-up time was 27.9 months (range, 24.0-31.7 months) from date of surgery. Results: All patients returned to their preinjury levels of sporting activity. Primary tenodesis was associated with earlier return to preinjury level of sporting function as compared with surgical repair (mean ± SD, 12.4 ± 1.6 vs 15.8 ± 2.2 weeks; P < .001) and reduced risk of recurrence (0% vs 16%; P < .001). At 1-year follow-up, there was no difference in surgical repair versus primary tenodesis relating to patient satisfaction scores (12 very satisfied and 13 satisfied vs 16 very satisfied and 14 satisfied; P = .70), isometric quadriceps strength (95.6% ± 2.8% vs 95.2% ± 6.3%; P = .31), Tegner scores (median [interquartile range], 9 [8-9] vs 9 [8-9]; P = .54), and lower extremity functional scores (73 [72-76] vs 74 [72-75]; P = .41). High patient satisfaction, quadriceps muscle strength, and functional outcome scores were maintained and remained comparable between treatment groups at 2-year follow-up. Conclusion: Primary tenodesis was associated with reduced time for return to preinjury level of sporting function and decreased risk of injury recurrence when compared with surgical repair for proximal rectus femoris avulsion injuries. There were no differences in patient satisfaction, functional outcome scores, and quadriceps muscle strength between the treatment groups at 1- and 2-year follow-up.

scholarly journals Surgical treatment for insertional Achilles tendinopathy and retrocalcaneal bursitis: more than 1 year of follow-up

2021 ◽  
Vol 49 (3) ◽  
pp. 030006052199295
Author(s):  
Changgui Zhang ◽  
Jin Cao ◽  
Liu Yang ◽  
Xiaojun Duan
Keyword(s):  
Bone Marrow ◽  
Surgical Treatment ◽  
Achilles Tendon ◽  
Achilles Tendinopathy ◽  
Bone Marrow Oedema ◽  
High Signal ◽  
Retrocalcaneal Bursitis ◽  
Retrocalcaneal Bursa ◽  
Insertional Achilles Tendinopathy

Objective To analyse the imaging changes in bone marrow oedema of the calcaneal prominence, retrocalcaneal bursa and degenerative Achilles tendon after the surgical treatment of insertional Achilles tendinopathy (IAT). Methods This retrospective study analysed patients with IAT and retrocalcaneal bursitis that were diagnosed based on their symptoms and radiographic and magnetic resonance imaging (MRI) examinations. For patients that had received 3 months of conservative treatment but still presented with symptoms, arthroscopic debridement of the retrocalcaneal bursa and resection of calcaneal prominence were undertaken. Patients with degeneration of the Achilles tendon underwent debridement of Achilles tendon calcification with an open incision. The last follow-up included radiographic and MRI imaging, Visual Analogue Scale (VAS) pain scores and American Orthopedic Foot and Ankle Society (AOFAS)-Ankle and Hindfoot scores. Results Thirty patients were included (mean ± SD follow-up, 3.1 ± 0.5 years). The VAS pain and AOFAS-Ankle and Hindfoot scores were significantly improved after surgery. MRI showed that bone marrow oedema of the calcaneal prominence and the retrocalcaneal bursa was significantly reduced compared with preoperative values. There was no significant change in the high signal area of the IAT. Conclusion Surgical treatment of IAT and retrocalcaneal bursitis effectively alleviated local pain and restored function.

Surgical Treatment of Achilles Tendinitis by Decompression of the Retrocalcaneal Bursa and the Superior Calcaneal Tuberosity

2002 ◽  
Vol 30 (3) ◽  
pp. 318-321 ◽  
Author(s):  
Marilyn L. Yodlowski ◽  
Arnold D. Scheller ◽  
Lampros Minos
Keyword(s):  
Surgical Treatment ◽  
Achilles Tendon ◽  
Nonoperative Treatment ◽  
Achilles Tendinitis ◽  
Lateral Border ◽  
Pain Scores ◽  
Retrocalcaneal Bursa ◽  
Calcific Deposits ◽  
Calcaneal Tuberosity

Background Initial nonoperative treatment of pain at the Achilles tendon, often referred to as “tendinitis,” is not always successful. Hypothesis Surgical treatment is effective for patients with insertional tendinitis unrelieved by nonoperative measures. Study Design Retrospective cohort study. Methods Thirty-five patients (41 feet) who had painful Achilles tendon syndrome unrelieved by 6 months of nonoperative measures were treated surgically. The technique consisted of a single incision along the lateral border of the Achilles tendon. The dissection exposed the retrocalcaneal bursa and fat pad, which were completely excised along with any scarred and thickened paratenon. A partial calcaneal exostectomy of the tubercle was performed. Results At a minimum follow-up of 20 months (average, 39), the patients’ pain scores (rated from 0 to 6) improved from 4.7 (SD, 1.1) preoperatively to 1.5 (SD, 1.3); 90% had complete or significant relief of symptoms, 10% felt improved, and none felt unchanged or worse. Conclusions Surgical treatment of chronic Achilles tendon pain with resection of the prominent tuberosity, complete debridement of the bursa, excision of thickened, scarred paratenon, and removal of accessible calcific deposits within the tendon is an effective treatment.

scholarly journals Partial Tears of the Pectoralis Major Muscle

2020 ◽  
pp. 12-20
Author(s):  
S.S. Strafun ◽  
V.V. Haiovych ◽  
Yu.A. Kulyk ◽  
V.H. Lieskov
Keyword(s):  
Surgical Treatment ◽  
Conservative Treatment ◽  
Subjective Evaluation ◽  
Pectoralis Major Muscle ◽  
Pectoralis Major ◽  
Conservative Group ◽  
Partial Tear ◽  
Number Of Patients ◽  
Partial Tears

Summary. Partial tear of the pectoralis major muscle (PMM) is an extremely rare injury, but it needs to be studied. Objective: to carry out a comparative analysis of the clinic, diagnosis and treatment of patients with complete and partial tears of the PMM. Materials and Methods. A retrospective analysis of 9 patients with partial tears of the PMM who underwent surgical and conservative treatment at the Department of Microsurgery and Reconstructive Surgery of Upper Extremity of the SI “Institute of Traumatology and Orthopedics of NAMS of Ukraine” (Kyiv) from 2008 to 2018 was performed. The mean age of patients with partial tear of the PMM was 37.4±10.8 years (16 to 42 years); 8 were males and 1 was female. The follow-up period after surgical or conservative treatment was 12±2.8 months. The greatest number of injuries occurred during the bench press exercises – 55.6% (5 patients); on the uneven bars – 22.2% (2 patients) and in everyday life – 22.2% (2 patients). Results. Follow-up examination revealed that 55.6% (5 patients) had injuries of tendon-muscle transition IIC, 33.3% (3 patients) – of tendon part II D, and 11.1% (1 patient) – of muscle II B according to the Cordasco 2020 classification. All the patients deny taking steroids to increase muscle mass. Surgical treatment was performed within 10-643 days after the injury. Two operated on patients had acute injuries (up to 8 weeks after the trauma), and 3 had chronic injuries (more than 8 weeks after the trauma). The results on both the Quick DASH scale and the Subjective Evaluation of Patients with Pectoralis Major Muscle Injuries Questionnaire were negative in both groups during initial treatment. One year after the treatment, excellent and good results were observed in the operated on group; the conservative group showed unsatisfactory results. We did not note any complications after surgical interventions in operated on group of patients. Conclusions. Partial tears of the PMM require more careful differentiation and additional examination methods. Physically active patients with isolated tears of the PMM need surgical treatment. Such treatment gives excellent and good results, while conservative treatment – unsatisfactory. Due to the small number of patients in our study, partial PMM tears require further investigation.

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