Neuropathic foot ulcer

Objective: To determine the microbiological profile and antimicrobial susceptibility patterns of organisms isolated from chronic osteomyelitis secondary to neuropathic foot ulcers; secondarily, to describe the clinical outcomes of 52 patients admitted to a neuropathic foot referral center. Methods: Retrospectively chart review of 52 patients with clinically infected neuropathic foot ulcers admitted to our service for treatment between 2005 and 2013. Tissue samples were collected for culture at the operating room after extensive debridement in order to determine the infectious agents and their resistance profile using the disk-diffusion technique, following CLSI criteria. Results: A total of 52 patients were analyzed (40 males and 12 females). The mean age was 58 (37-72) years. Each patient presented with an average of 2.13 microorganisms, distributed as follows: 51% Gram-positive cocci, 43% Gram-negative bacilli. Among Staphylococcus aureus isolates, the prevalence of methicillin resistance was almost 50%, and the prevalence of coagulase-negative staphylococci (CoNS) was more than 75%. Conclusion: S. aureus, E. faecalis, and CoNS were the most frequently isolated pathogens. Methicillin resistance was highly prevalent. A combination of extensive surgical debridement and prolonged antimicrobial therapy led to remission of infection in 77% of patients. Level of Evidence IV; Therapeutic Studies; Case Series.

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Methicillin-Resistant Staphylococcus aureus (MRSA) Infection of Diabetic Foot Ulcers at a Tertiary Care Hospital in Accra, Ghana

Pathogens ◽

10.3390/pathogens10080937 ◽

2021 ◽

Vol 10 (8) ◽

pp. 937

Author(s):

Ramzy B. Anafo ◽

Yacoba Atiase ◽

Nicholas T. K. D. Dayie ◽

Fleischer C. N. Kotey ◽

Patience B. Tetteh-Quarcoo ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Multidrug Resistance ◽

Teaching Hospital ◽

Diabetic Foot ◽

Foot Ulcer ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Coagulase Negative Staphylococci ◽

Methicillin Resistant ◽

Mrsa Infection

Aim: This study investigated the spectrum of bacteria infecting the ulcers of individuals with diabetes at the Korle Bu Teaching Hospital in Accra, Ghana, focusing on Staphylococcus aureus (S. aureus) and methicillin-resistant S. aureus (MRSA), with respect to their prevalence, factors predisposing to their infection of the ulcers, and antimicrobial resistance patterns. Methodology: This cross-sectional study was conducted at The Ulcer Clinic, Department of Surgery, Korle Bu Teaching Hospital, involving 100 diabetic foot ulcer patients. The ulcer of each study participant was swabbed and cultured bacteriologically, following standard procedures. Antimicrobial susceptibility testing was done for all S. aureus isolated, using the Kirby-Bauer method. Results: In total, 96% of the participants had their ulcers infected—32.3% (n = 31) of these had their ulcers infected with one bacterium, 47.9% (n = 46) with two bacteria, 18.8% (n = 18) with three bacteria, and 1.0% (n = 1) with four bacteria. The prevalence of S. aureus and MRSA were 19% and 6%, respectively. The distribution of the other bacteria was as follows: coagulase-negative Staphylococci (CoNS) (54%), Escherichia coli (24%), Pseudomonas spp. (19%), Citrobacter koseri and Morganella morgana (12% each), Klebsiella oxytoca (11%), Proteus vulgaris (8%), Enterococcus spp. (6%), Klebsiella pneumoniae (5%), Proteus mirabilis and Enterobacter spp. (4%), Klebsiella spp. (2%), and Streptococcus spp. (1%). The resistance rates of S. aureus decreased across penicillin (100%, n = 19), tetracycline (47.4%, n = 9), cotrimoxazole (42.1%, n = 8), cefoxitin (31.6%, n = 6), erythromycin and clindamycin (26.3% each, n = 5), norfloxacin and gentamicin (15.8% each, n = 3), rifampicin (10.5%, n = 2), linezolid (5.3%, n = 1), and fusidic acid (0.0%, n = 0). The proportion of multidrug resistance was 47.4% (n = 9). Except for foot ulcer infection with coagulase-negative Staphylococci, which was protective of S. aureus infection of the ulcers (OR = 0.029, p = 0.001, 95% CI = 0.004–0.231), no predictor of S. aureus, MRSA, or polymicrobial ulcer infection was identified. Conclusions: The prevalence of S. aureus and MRSA infection of the diabetic foot ulcers were high, but lower than those of the predominant infector, coagulase-negative Staphylococci and the next highest infecting agent, E. coli. Diabetic foot ulcers’ infection with coagulase-negative Staphylococci protected against their infection with S. aureus. The prevalence of multidrug resistance was high, highlighting the need to further intensify antimicrobial stewardship programmes.

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Antibiotic Impregnated Cement Spacer for Salvage of Diabetic Osteomyelitis

Foot & Ankle International ◽

10.3113/fai.2012.0213 ◽

2012 ◽

Vol 33 (3) ◽

pp. 213-219 ◽

Cited By ~ 15

Author(s):

Eyal A. Melamed ◽

Eli Peled

Keyword(s):

Case Series ◽

Severe Infection ◽

Diabetic Patients ◽

Skin Closure ◽

Cement Spacer ◽

Retrospective Case ◽

Level Of Evidence ◽

Patient Dissatisfaction ◽

Extensive Debridement ◽

Antibiotic Release

Background: Florid infection and osteomyelitis of the forefoot in patients with diabetic neuropathy often requires minor amputation, with risk of subsequent reulceration, reamputation, and patient dissatisfaction. We investigated use of an antibiotic-impregnated cement spacer (ACS) to release antibiotic locally to resolve residual infection and to fill the cavity created by debridement. Methods: We report 23 cases of osteomyelitis and associated severe infection of forefoot joints in 20 consecutive patients, age 60.3 ± 13.4 years. Antibiotic-impregnated cement, extensive meticulous debridement, and ACS placement to fill the gap were employed in all cases. Deep cultures were taken routinely. Fixation with Kirschner wires was used as necessary. Mean followup was 21.2 ± 10.2 months. A successful result was resolution of infection and wound healing to full skin closure without amputation. Results: Of 23 cases, 21 (91.3%) healed and two required toe amputation. ACS was left permanently in 10 patients, removed with arthrodesis in six, and removed without arthrodesis in five. One patient recovered but subsequently underwent transtibial amputation due to infection of a different site. Conclusion: Severe infection associated with osteomyelitis of the foot in diabetic patients was successfully treated with extensive debridement and use of ACS, which filled the void created by debridement. Amputation was avoided in most patients. This procedure allowed extensive debridement through filling large voids with ACS, with prolonged antibiotic release. Level of Evidence: IV; Retrospective Case Series

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Tissue on the Transferred Coracoid Graft After Latarjet Procedure: Histological and Morphological Findings

The American Journal of Sports Medicine ◽

10.1177/0363546518819825 ◽

2019 ◽

Vol 47 (3) ◽

pp. 704-712

Author(s):

David L. Haeni ◽

Thibault Lafosse ◽

Charles Haggerty ◽

Johannes Plath ◽

Yoshikazu Kida ◽

...

Keyword(s):

Case Series ◽

Future Application ◽

Anterior Shoulder Instability ◽

Latarjet Procedure ◽

Level Of Evidence ◽

Tissue Samples ◽

Proliferation Capacity ◽

Morphological Findings ◽

Safranin O

Background: Anterior shoulder instability is a debilitating condition that can require stabilization via a Latarjet procedure. Purpose: The aim of this study was to characterize the histological composition of the articular-sided surface of the coracoid bone graft after Latarjet procedure. Specific features of cells isolated from the coracoid and graft tissues were assessed. Study Design: Case series; Level of evidence, 4. Methods: Tissue samples were harvested from 9 consecutive patients undergoing arthroscopic debridement and screw removal after arthroscopic or open Latarjet procedure. Tissues were processed histologically. In 2 patients, the samples were analyzed to assess specific cellular properties. Results: Safranin O staining indicated that glenoid tissues contained variable amounts of glycosaminoglycan (GAG) and round chondrocytic cells mainly organized in clusters. Graft tissues contained less GAG and were more cellular but were not organized in clusters and had variable morphological features. An association appeared to exist between the cartilage quality of glenoid tissues and that of the graft tissues. Cells isolated from glenoid and graft tissues exhibited similar proliferation capacity. Conclusion: The results of our analysis show that cells located at the articular-sided surface of transferred coracoid grafts demonstrate fibrocartilaginous properties and may have the capacity for chondral proliferation. Further studies are needed to confirm this observation and future application.

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PO 18105 - Diabetic foot ulcer PEDIS III

Scientific Journal of the Foot & Ankle ◽

10.30795/scijfootankle.2019.v13.1014 ◽

2019 ◽

Vol 13 (Supl 1) ◽

pp. 13S

Author(s):

Alexandre Leme Godoy dos Santos ◽

Guilherme Honda ◽

Priscila Rosalba ◽

Rafael Barban Sposeto ◽

Tulio Diniz Fernandes ◽

...

Keyword(s):

Diabetic Foot ◽

Chronic Osteomyelitis ◽

Foot Ulcer ◽

Surgical Debridement ◽

Foot Ulcers ◽

Diabetic Patients ◽

Bone Culture ◽

Microbiological Profile ◽

Neuropathic Foot

Introduction: Infectious agents are associated with amputation of the infected diabetic foot if not promptly treated. It is estimated that 25% of patients with diabetes will present with a foot ulcer at some point of their lives. Our hypothesis is that the microbiological profile isolated from chronic osteomyelitis (CO) secondary to neuropathic foot ulcers is different from the standard profile relayed in the literature. Objective: To determine the microbiological profile and antimicrobial susceptibility patterns of organisms isolated from chronic osteomyelitis (CO) secondary to neuropathic foot ulcers. Furthermore, we aimed to describe the clinical outcomes of 52 patients admitted to a referral diabetic foot center. Methods: Medical charts of 52 patients with clinically infected neuropathic foot ulcers between 2005 and 2013 were reviewed. Osteomyelitis was diagnosed based on suggestive changes on radiographs and magnetic resonance imaging (MRI), and confirmed with a microbiological exam. All cases were followed for at least six months. Only results of bone culture obtained at the time of surgical debridement following antisepsis were considered for microbiological characterization. Results: One hundred and eleven bacterial isolates were identified as causative agents of infection, with a mean 2.13 isolates per patient. There was a predominance of Gram-positive cocci (51%), followed by Gram-negative bacilli (GNB) (43%). The most prevalent agents were Staphylococcus aureus (18%), Enterococcus faecalis (18%) and coagulase-negative Staphylococci (CoNS) (14%). Among S. aureus isolates, the prevalence of methicillin resistance (MRSA) was 48%, and 77% CoNS were methicillin resistant (MRCoNS) with 100% susceptibility to sulfamethoxazole/trimethoprim (SMT/TMP). At 6-month follow-up, 75% of patients were in remission, without signs of infection, 23% of patients presented recurrence of infection, and 2% were lost to follow-up. Conclusion: In diabetic patients with chronic osteomyelitis secondary to neuropathic ulcers, S. aureus, E. faecalis and CoNS were the most frequent agents. The occurrence of MRSA and MRCoNS was high, but with 100% susceptibility to SMT/TMP. Extensive surgical debridement associated with prolonged antimicrobial therapy led to infection remission in 77% of patients after 6 months of follow-up.

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Midfoot Ulcers Treated with Gastrocnemius-Soleus Recession

Foot & Ankle International ◽

10.3113/fai.2009.0842 ◽

2009 ◽

Vol 30 (9) ◽

pp. 842-846 ◽

Cited By ~ 35

Author(s):

James M. Laborde

Keyword(s):

Case Series ◽

Primary Treatment ◽

Foot Ulcers ◽

Transfemoral Amputation ◽

Retrospective Case ◽

Medical Problems ◽

Level Of Evidence ◽

Common Cause ◽

Tendon Lengthening ◽

Resolution Level

Background: Foot ulcers in patients with neuropathy are a common cause of hospital admission for infection sometimes resulting in amputation in patients with neuropathy. Tendon lengthening alone has been reported to be successful in treating neuropathic forefoot ulcers. Tendon lengthening has also been recommended as an adjunct to bony procedures (exostectomy or fusion) for treating midfoot ulcers. The author reports the results of gastrocnemius-soleus recession as the sole treatment of diabetic midfoot ulcers. Materials and Methods: This study evaluated the results of 11 patients with 11 neuropathic plantar midfoot ulcers who were treated primarily with gastrocnemius-soleus recession with an average followup of 39 months. Potentially risky bony procedures were done after tendon lengthening if ulcers did not heal or recurred. Results: Ten of the ulcers healed but one patient was lost to followup after his ulcer healed. One ulcer did not heal and one ulcer recurred but healed again after midfoot fusion. One patient later had a transfemoral amputation due to gangrene. Two patients later died from medical problems unrelated to their surgery. There were no incision problems, or transfer ulcers. Conclusion: The author believes gastrocnemius-soleus recession as a primary treatment of diabetic midfoot ulcers is a low risk method of promoting ulcer resolution. Level of Evidence: IV, Retrospective Case Series

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MANAGEMENT OF DIABETIC FOOT ULCER: A LITERATURE REVIEW

Jurnal Keperawatan Indonesia ◽

10.7454/jki.v21i2.634 ◽

2018 ◽

Vol 21 (2) ◽

pp. 84-93

Author(s):

Angger Anugerah Hadi Sulistyo

Keyword(s):

Literature Review ◽

Diabetic Foot ◽

Randomized Control Trial ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Foot Ulcers ◽

Diabetic Foot Ulcers ◽

Assessment And Treatment ◽

Randomized Control ◽

Neuropathic Foot

This article explores the effective management of diabetic foot ulcer. A literature review was conducted by analyzing scholar papers including systematic review, clinical and a randomized control trial published between 2000 to 2016 in the English language. Data were searched through CINAHL, PubMed, Proquest and Google Scholar. The keywords used were diabetic foot ulcer or diabetic foot ulcers or diabetic foot or neuropathic foot ulcer combined with assessment and treatment. There were two kinds of assessment used in diabetic foot ulcer which are risk assessment and wound assessment. The treatments that frequently used in diabetic foot ulcer are systemic treatment and local treatment. This literature review can be used as a guideline and literature for further experimental studies. Keywords: diabetic foot ulcer, management of foot ulcer, assessment of foot ulcer, treatment of foot ulcer Abstrak Artikel ini dibuat dengan mencari sumber literatur dari manajemen luka kaki diabetes. Tujuan studi literatur ini adalah untuk mencari manajemen luka diabetes yang paling efektif. Studi literatur ini dibuat dengan melakukan analisis artikel-artikel ilmiah meliputi systematic review, clinical and a randomized control trial dalam bahasa inggris yang dipublikasikan pada tahun 2000 sampai 2016. Data didapatkan dengan mencari di beberapa database meliputi CINAHL, PubMed, Proquest and Google Scholar. Kata kunci pencarian data yaitu dengan menggunakan kata kunci diabetic foot ulcer or diabetic foot ulcers or diabetic foot or neuropathic foot ulcer combined with assessment and treatment. Pada studi literatur ini didapatkan 14 artikel yang sesuai dengan kriteria penelitian. Hasil pencarian artikel ditemukan 2 jenis pengkajian luka diabetes yaitu pengkajian resiko dan pengkajian luka diabetes. Sedangkan penanganan yang sering digunakan dalam luka diabetes adalah penanganan sistemik dan penaganan local. Studi literatur ini dapat dijadikan petunjuk dan tambahan referensi untuk penelitian experiment. Kata Kunci: luka kaki diabetes, manajemen luka kaki, pengkajian luka kaki, penanganan luka kaki

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STUDY OF SURGICAL MANAGEMENT AND COMPLICATIONS OF DIABETIC FOOT ULCER

International Journal of Medical and Biomedical Studies ◽

10.32553/ijmbs.v3i2.607 ◽

2019 ◽

Vol 3 (2) ◽

Author(s):

Dr. Devi Das Verma ◽

Dr. Anil Kumar Saxena

Keyword(s):

Health Problem ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

World Health ◽

Foot Ulcers ◽

Age Group ◽

Major Health Problem ◽

Split Skin Grafting ◽

Foot Problems

Introduction: Diabetes is one of the most prevalent metabolic chronic diseases due to the imbalance production of insulin. One of the studies reported that in 2010 worldwide 285 million adults had diabetes and this figure may be increase to 439 million by the year 2030. Globally Diabetic foot ulcers (DFUs) constitute major health problem in people that significantly contribute to morbidity and mortality in diabetes patients. Approximate 1.0% to 4.1% of the annual population-based incidences of a diabetic foot ulcer (DFU) were reported. Due to this the lifetime may be as high as 25%. In Asian countries diabetic foot ulcer are major problems which are different from European countries or developing countries. From many studies reported diabetic foot problems in India are infectious and neuropathic in nature as compared to developed countries. According to World Health Organization (WHO) diabetic foot is defined as lower limb of a diabetic patient characterized by infection, potential risk of pathologic consequences ulceration or destruction of deep tissues associated with neurological abnormalities, various changes in peripheral neuropathy vasculopathy and superimposed infection that are mainly responsible foot ulceration. Ulcers are one kind of abscess which is difficult to treat because of poor wound healing that result from a combination of neuropathy, ischemia and hyperglycemia. Aim: The main objective was to study the outcome of treatment modalities and it’s relating factors to complication in diabetic foot ulcer. Material and method: Total 60 diabetic foot ulcer patients with the age range from 20 to 70 years were included. From all the patients’ detailed past and present history were recorded. For all the patients, general, physical and local and systemic examinations were also done. Detail laboratory examination like Fasting and Post Prandial Blood sugar levels, blood count, ECG, ESR, complete urine examination for the presence of ketone bodies and sugar, x-ray as well as culture and sensitivity of the discharge from ulcer were also done. Patients were treated with various treatment methods like conservative treatment, split skin grafting and amputation. Result: In this study male patients were more in proportion as compared to female. This study showed that maximum with the age group 14 -50 (43.3%) years old followed by 18.3% in 31-40 years old, 16.7% in 61-70 years old. 6.7% showed the least age group as 20 -30 years old. Out of total 60 patients, 38.3% of the patients showed diabetic ulcer foot which was more whereas 15% showed diabetic gangrene foot which was least. 25% showed diabetic cellulites foot and 21.7% showed as diabetic abscess foot. Conclusion: Globally as diabetes mellitus cases are increasing and it became rapidly the public health problem. This may be due to burden on economy, health system and on society to manage the diabetic foot problems. Diabetic foot management guidelines must be made into our practice protocols which may preventing limb loss, and decrease mortality and increase the quality of life of the patient. Hence for this it is only possible with the help of foot care education and health care workers. Hence, foot infection is to put first and care for it like hands. Keywords: Diabetes, foot ulcers, infections, amputations.

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Healing below the ankle is possible in patients with diabetes mellitus and a forefoot gangrene

SAGE Open Medicine ◽

10.1177/20503121211029180 ◽

2021 ◽

Vol 9 ◽

pp. 205031212110291

Author(s):

Targ Elgzyri ◽

Jan Apelqvist ◽

Eero Lindholm ◽

Hedvig Örneholm ◽

Magdalena Annersten Gershater

Keyword(s):

Diabetic Foot ◽

Clinical Characteristics ◽

Foot Ulcer ◽

Major Amputation ◽

Severe Form ◽

Foot Ulcers ◽

Vascular Intervention ◽

Co Morbidity ◽

Patients With Diabetes

Background: Forefoot gangrene in patients with diabetes is a severe form of foot ulcers with risk of progress and major amputation. No large cohort studies have examined clinical characteristics and outcome of forefoot gangrene in patients with diabetes. The aim was to examine clinical characteristics and outcome of forefoot gangrene in patients with diabetes admitted to a diabetic foot centre. Methods: Patients with diabetes and foot ulcer consecutively presenting were included if they had forefoot gangrene (Wagner grade 4) at initial visit or developed forefoot gangrene during follow-up at diabetic foot centre. Patients were prospectively followed up until final outcome, either healing or death. The median follow-up period until healing was 41 (3–234) weeks. Results: Four hundred and seventy-six patients were included. The median age was 73 (35–95) years and 63% were males. Of the patients, 82% had cardiovascular disease and 16% had diabetic nephropathy. Vascular intervention was performed in 64%. Fifty-one patients (17% of surviving patients) healed after auto-amputation, 150 after minor amputation (48% of surviving patients), 103 had major amputation (33% of surviving patients) and 162 patients deceased unhealed. Ten patients were lost at follow-up. The median time to healing for all surviving patients was 41 (3–234) weeks; for auto-amputated, 48 (10–228) weeks; for minor amputated, 48 (6–234) weeks; and for major amputation, 32 (3–116) weeks. Conclusion: Healing without major amputation is possible in a large proportion of patients with diabetes and forefoot gangrene, despite these patients being elderly and with extensive co-morbidity.

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Minimum 10-Year Clinical Outcome of Lateral Collagen Meniscal Implants for the Replacement of Partial Lateral Meniscal Defects: Further Results From a Prospective Multicenter Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121994919 ◽

2021 ◽

Vol 9 (5) ◽

pp. 232596712199491

Author(s):

Alberto Grassi ◽

Gian Andrea Lucidi ◽

Giuseppe Filardo ◽

Piero Agostinone ◽

Luca Macchiarola ◽

...

Keyword(s):

Survival Rate ◽

Case Series ◽

Final Analysis ◽

Activity Level ◽

Long Term Results ◽

Level Of Evidence ◽

Unicompartmental Knee Arthroplasties ◽

Tegner Score

Background: The collagen meniscal implant (CMI) is a biologic scaffold aimed at replacing partial meniscal defects. The long-term results of lateral meniscal replacement have never been investigated. Purpose: To document the clinical outcomes and failures of lateral CMI implantation for partial lateral meniscal defect at a minimum 10-year follow-up. Study Design: Case series; Level of evidence, 4, Methods: This study included 24 consecutive patients who underwent lateral CMI implantation for partial lateral meniscal defects between April 2006 and September 2009 and who were part of a previous study with a 2-year follow-up. Outcome measures at the latest follow-up included the Lysholm score, Knee injury and Osteoarthritis Outcome Score, visual analog scale (VAS) for pain, Tegner activity level, and EuroQol 5-Dimensions score. Data regarding complications and failures were collected, and patients were asked about their satisfaction with the procedure. Results: Included in the final analysis were 19 patients (16 male, 3 female) with a mean age at surgery of 37.1 ± 12.6 years and a mean follow-up of 12.4 ± 1.5 years (range, 10-14 years). Five failures (26%) were reported: 1 CMI removal because of implant breakage and 4 joint replacements (2 unicompartmental knee arthroplasties and 2 total knee arthroplasties). The implant survival rate was 96% at 2 years, 85% at 5 years, 85% at 10 years, 77% at 12 years, and 64% at 14 years. Lysholm scores at the final follow-up were rated as “excellent” in 36% (5 of 14 nonfailures), “good” in 43% (6 of 14), and “fair” in 21% (3 of 14). The VAS score was 3.1 ± 3.1, with only 16% (3 of 19 patients) reporting that they were pain-free; the median Tegner score was 3 (interquartile range, 2-5). All clinical scores decreased from the 2-year follow-up; however, with the exception of the Tegner score, they remained significantly higher compared with the preoperative status. Overall, 79% of patients were willing to undergo the same procedure. Conclusion: Lateral CMI implantation for partial lateral meniscal defects provided good long-term results, with a 10-year survival rate of 85% and a 14-year survival rate of 64%. At the final follow-up, 58% of the patients had “good” or “excellent” Lysholm scores. However, there was a general decrease in outcome scores between the short- and the long-term follow-up.

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Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967121994550 ◽

2021 ◽

Vol 9 (3) ◽

pp. 232596712199455

Author(s):

Nicola Maffulli ◽

Francesco Oliva ◽

Gayle D. Maffulli ◽

Filippo Migliorini

Keyword(s):

Surgical Management ◽

Revision Surgery ◽

Case Series ◽

Sports Participation ◽

Patellar Tendinopathy ◽

Symptom Duration ◽

Level Of Evidence ◽

Training Time ◽

The Mean

Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points ( P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.

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