Surgical Treatment of the Neglected Achilles Tendon Rupture with Hyalonect

2014 ◽  
Vol 104 (5) ◽  
pp. 434-443 ◽  
Author(s):  
Cem Zeki Esenyel ◽  
Cagri Tekin ◽  
Murat Çakar ◽  
Kursat Bayraktar ◽  
Selcuk Saygili ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Major Complication ◽  
Benzyl Ester ◽  
Foot And Ankle ◽  
Fascial Flap ◽  
Neglected Achilles Tendon Rupture ◽  
The Mean ◽  
American Orthopaedic

BackgroundThe purpose of this study was to report the management and outcomes of ten patients with chronic Achilles tendon rupture treated with a turndown gastrocnemius-soleus fascial flap wrapped with a surgical mesh (Hyalonect).MethodsTen men with neglected Achilles tendon rupture were treated with a centrally based turndown gastrocnemius fascial flap wrapped with Hyalonect. Hyalonect is a knitted mesh composed of HYAFF, a benzyl ester of hyaluronic acid. The Achilles tendon ruptures were diagnosed more than 1 month after injury. The mean patient age was 41 years. All of the patients had weakness of active plantarflexion. The mean preoperative American Orthopaedic Foot and Ankle Society score was 64.8.ResultsThe functional outcome was excellent. The mean American Orthopaedic Foot and Ankle Society score was 97.8 at the latest follow-up. There were significant differences between the preoperative and postoperative scores. Ankle range of motion was similar in both ankles. Neither rerupture nor major complication, particularly of wound healing, was observed.ConclusionsFor patients with chronic Achilles tendon rupture with a rupture gap of at least 5 cm, surgical repair using a single turndown fascial flap covered with Hyalonect achieved excellent outcomes.

Division Tenorrhaphy: A Novel Technique for Chronic or Failed Nonoperatively Treated Achilles Tendon Rupture

2017 ◽  
Vol 10 (3) ◽  
pp. 242-245
Author(s):  
Jesse Doty ◽  
Yoshihiro Katsuura ◽  
Nicholas Richardson
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
High Strength ◽  
Nonoperative Treatment ◽  
Poor Quality ◽  
Myotendinous Junction ◽  
Foot And Ankle ◽  
Open Technique ◽  
American Orthopaedic

Here we describe a modified open technique for the repair of a ruptured Achilles tendon using multiple looped sutures with the creation of interdigitating tendon stumps maximizing surface area for suture application as well as allowing for significant tissue overlay. This technique produces a high strength repair that is useful in cases of extensive degeneration or poor-quality tissue. Degenerative tissue may be encountered with chronic ruptures or failed nonoperative treatment, as well as those ruptures that occur at the proximal myotendinous junction. We present 2 cases in which the technique was utilized: one of a failed nonoperatively treated rupture and another of a chronic rupture. The technique was found to be successful for both patients with improvement in visual analogue scale, Achilles tendon total rupture score, American Orthopaedic Foot and Ankle Score, and Foot and Ankle Disability Index. Levels of Evidence: Level IV

scholarly journals Ankle Hindfoot Scale vs Comprehensive SRMC Scoring System in Acute Achilles Tendon Rupture

2015 ◽  
Vol 2 (2) ◽  
pp. 77-79 ◽  
Author(s):  
Jambu Nageswaran ◽  
Samuel Chittaranjan Bedford ◽  
Ganesan Ganesan Ram
Keyword(s):  
Achilles Tendon ◽  
Scoring System ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Asia Pacific ◽  
Foot And Ankle ◽  
Medical College ◽  
American Orthopaedic

ABSTRACT The existing scoring system like American Orthopaedic Foot and Ankle Society (AOFAS)-ankle hindfoot scale, Leppilahti et al scoring system, Achilles tendon total rupture score, foot and ankle outcome score, the physical activity scale (PAS) questionnaire and Tegner activity score were not designed to evaluate all the parameters following surgical treatment of Achilles tendon rupture. Hence, we developed a comprehensive score called the comprehensive Sri Ramachandra Medical College (SRMC) scoring system. We compared the results of 60 patients who were surgically treated for acute Achilles tendon rupture using our comprehensive SRMC scoring system with the most commonly used AOFAS-ankle hindfoot scale. Results We found that there was 6.7% poor results using our scoring system, whereas no poor results using AOFAS scoring system mainly because our scoring system also assesses quality of life, patient satisfaction and tendon strength. Similarly, there was 10% fair results in our scoring system compared to 3.3% in AOFAS scale indicating that our scoring system is more sensitive. Comprehensive SRMC scoring system was found to be reliable statistically as per alpha method (α = 0.7787) and was statistically significant at p < 0.001. Conclusion Comprehensive SRMC scoring system was found to be superior to AOFAS scale specifically for analyzing Achilles tendon repair. Poor results are likely to be picked up by our scoring system which has been shown in our results. How to cite this article Nageswaran J, Ram GG, Bedford SC. Ankle Hindfoot Scale vs Comprehensive Srmc Scoring System in Acute Achilles Tendon Rupture. J Foot Ankle Surg (Asia- Pacific) 2015;2(2):77-79.

scholarly journals Outcome of surgical management of ruptured Achilles tendon

2018 ◽  
Vol 5 (2) ◽  
pp. 18-22
Author(s):  
Balakrishnan M Acharya ◽  
Pramod Devkota ◽  
Amrit Shrestha ◽  
Abhishek Kumar Thakur ◽  
Toya Raj Bhatta ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Surgical Management ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
First Year ◽  
Foot And Ankle ◽  
Aofas Score ◽  
The Mean ◽  
Second Year

Introductions: The incidence of Achilles tendon rupture has been increasing worldwide. The optimal management of this problem is controversial but the surgical intervention is being applied widely. Methods: We retrospectively analyzed patients who had Achilles tendon (AT) rupture treated surgically at Patan Academy of Health Sciences from January 2010 to December 2015. Functional outcome assessment of ankle was done by using American Orthopedic foot and Ankle Society Score (AOFAS). Results: Total 71 patients (male 45, female 26) had surgery for AT, 38 right and 33 left side. The mean age of the patient was 36.14 years (range 18-67 years). The mean AOFAS score was 83.32 (range 75-93) after first year follow up and 90.36 (range 80-99) after second year, difference was statistically significant (p<0.05). Conclusions: The study showed high AOFAS score for surgical management of ruptured Achilles tendon.

The Percutaneous Surgical Approach for Repairing Acute Achilles Tendon Rupture

2010 ◽  
Vol 100 (4) ◽  
pp. 270-275 ◽  
Author(s):  
Shay Tenenbaum ◽  
Niv Dreiangel ◽  
Ayal Segal ◽  
Amir Herman ◽  
Amnon Israeli ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Demographic Data ◽  
Achilles Tendon Rupture ◽  
Treatment Modalities ◽  
Main Concern ◽  
Complication Rates ◽  
Percutaneous Surgery ◽  
Significant Difference ◽  
The Mean

Background: Treatment modalities for acute Achilles tendon rupture can be divided into operative and nonoperative. The main concern with nonoperative treatment is the high incidence of repeated ruptures; operative treatment is associated with risk of infection, sural nerve injury, and wound-healing sequelae. We assessed our experience with a percutaneous operative approach for treating acute Achilles tendon rupture. Methods: The outcomes of percutaneous surgery in 29 patients (25 men; age range, 24–58 years) who underwent percutaneous surgery for Achilles tendon rupture between 1997 and 2004 were retrospectively evaluated. Their demographic data, subjective and objective evaluation findings, and isokinetic evaluation results were retrieved, and they were assessed with the modified Boyden score and the American Orthopaedic Foot and Ankle Society Ankle-Hindfoot Scale. Results: All 29 patients demonstrated good functional outcome, with no- to mild-limitations in recreational activities and high patient satisfaction. Mean follow-up was 31.8 months. Changes in ankle range of motion in the operated leg were minimal. Strength and power testing revealed a significant difference at 90°/sec for plantarflexion power between the injured and healthy legs but no difference at 30° and 240°/sec or in dorsiflexion. The mean modified Boyden score was 74.3, and the mean Ankle-Hindfoot Scale score was 94.5. Conclusions: Percutaneous surgery for Achilles tendon rupture is easily executed and has excellent functional results and low complication rates. It is an appealing alternative to either nonoperative or open surgery treatments. (J Am Podiatr Med Assoc 100(4): 270–275, 2010)

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.

Operative versus Nonoperative Management of Acute Achilles Tendon Rupture

2002 ◽  
Vol 30 (6) ◽  
pp. 783-790 ◽  
Author(s):  
Mininder S. Kocher ◽  
Julius Bishop ◽  
Ryan Marshall ◽  
Karen K. Briggs ◽  
Richard J. Hawkins
Keyword(s):  
Decision Making ◽  
Achilles Tendon ◽  
Operative Treatment ◽  
Management Strategy ◽  
Tendon Rupture ◽  
Nonoperative Management ◽  
Achilles Tendon Rupture ◽  
Back Analysis ◽  
Major Complication ◽  
Optimal Management

Background The optimal management strategy for acute Achilles tendon rupture is controversial. Purpose To determine the optimal management by using expected-value decision analysis. Study Design Cross-sectional study. Methods Outcome probabilities were determined from a systematic literature review, and patient-derived utility values were obtained from a visual analog scale questionnaire. A decision tree was constructed, and fold-back analysis was used to determine optimal treatment. Sensitivity analyses were used to determine the effect of varying outcome probabilities and utilities on decision-making. Results Outcome probabilities (expressed as operative; nonoperative) were as follows: well (0.762; 0.846), rerupture (0.022; 0.121), major complication (0.030; 0.025), moderate complication (0.075; 0.003), and mild complication (0.111; 0.005). Outcome utility values were well operative (7.9), well nonoperative (7.0), rerupture (2.6), major complication (1.0), moderate complication (3.5), and mild complication (4.7). Fold-back analysis revealed operative treatment as the optimal management strategy (6.89 versus 6.30). Threshold values were determined for the probability of a moderate complication from operative treatment (0.21) and the utility of rerupture (6.8). Conclusions Operative management was the optimal strategy, given the outcome probabilities and patient utilities we studied. Nonoperative management was favored by increasing rates of operative complications; operative, by decreasing utility of rerupture. We advocate a model of doctor-patient shared decision-making in which both outcome probabilities and patient preferences are considered.

scholarly journals Bearing Weight at the Same Day in Conservatively Treated Acute Achilles Tendon Rupture Patients

2014 ◽  
Vol 2 (11_suppl3) ◽  
pp. 2325967114S0020
Author(s):  
Murat Korkmaz ◽  
Sadiye Yolcu ◽  
Özlem Balbaloğlu ◽  
Zekeriya Öztemur ◽  
Fatih Karaarslan
Keyword(s):  
Surgical Treatment ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Treatment Protocol ◽  
Early Mobilization ◽  
Treated Group ◽  
Plaster Cast ◽  
Wound Complications ◽  
American Orthopaedic

Objectives: Achilles tendon rupture (ATR) often occurs in 40- to 50-year-old men.. At treating there has been considerable research interest in attempting to identify the optimal treatment strategy, surgical or non-surgical, combined with functional early mobilisation or plaster cast immobilisation. Our aimed to compare the outcomes of bearing weight at the same day in conservatively treated and surgically treated groups of ATR patients. Methods: Thirty-two conservatively treated ATR patients and twenty nine surgically treated ATR patients were included to our study. Patients were over 18 years old who had been followed for 12 months by our clinic. All patients underwent knee supporting cast at four week and both group was asked for walking with bearing weight (%30-40) at same day. Results: In all groups 2nd and 12th months’ AOFAS (American Orthopaedic Foot and Ankle Society) scorings of the patients had significant differences (p<0.001). Return to work time results were significantly different and shorter in conservatively treated group (p= 0.035). This study founded a relatively high complication percentage of (6 patients) 20.6% in the surgically treated group. On the contrary the wound complications non-surgical group has not been be observed. Conclusion: In conclusion, this study adds to evidence that a well conducted non-surgical treatment protocol (early mobilization treatment regimen) gives a good clinical outcome and complication rate is not higher than after surgical treatment.

scholarly journals Return to Play and Player Performance After Achilles Tendon Rupture in UEFA Professional Soccer Players: A Matched-Cohort Analysis of Players From 1999 to 2018

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110241
Author(s):  
Enrico M. Forlenza ◽  
Ophelie Z. Lavoie-Gagne ◽  
Yining Lu ◽  
Connor C. Diaz ◽  
Jorge Chahla ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Performance Metrics ◽  
Cohort Analysis ◽  
Achilles Tendon Rupture ◽  
Return To Play ◽  
Soccer Players ◽  
Professional Soccer ◽  
The Mean ◽  
Player Performance

Background: Achilles tendon rupture (ATR) is a potentially career-ending injury in professional athletes. Limited information exists regarding return to play (RTP) in professional soccer players after this injury. Purpose: To determine the RTP rate and time in professional soccer players after ATR and to evaluate player performance relative to matched controls. Study Design: Cohort study; Level of evidence, 3. Methods: We evaluated 132 professional soccer players who suffered an ATR between 1999 and 2018. These athletes were matched 2:1 to uninjured controls by position, age, season of injury, seasons played, and height. We collected information on the date of injury, the date of RTP, and player performance metrics (minutes played, games played, goals scored, assists made, and points per game) from official team websites, public injury reports, and press releases. Changes in performance metrics for the 4 years after the season of injury were compared with metrics 1 season before injury. Univariate comparisons were performed using independent-sample, 2-group t tests and Wilcoxon rank-sum tests when normality of distributions was violated. Results: The mean age at ATR was 27.49 ± 4.06 years, and the mean time to RTP was 5.07 ± 2.61 months (18.19 ± 10.96 games). The RTP rate was 71% for the season after injury and 78% for return at any timepoint. Overall, 9% of the injured players experienced a rerupture during the study period. Compared with controls, the injured players played significantly less (-6.77 vs -1.81 games [ P < .001] and -560.17 vs -171.17 minutes [ P < .05]) and recorded fewer goals (-1.06 vs -0.29 [ P < .05]) and assists (-0.76 vs -0.02 [ P < .05]) during the season of their Achilles rupture. With the exception of midfielders, there were no significant differences in play time or performance metrics between injured and uninjured players at any postinjury timepoint. Conclusion: Soccer players who suffered an ATR had a 78% RTP rate, with a mean RTP time of 5 months. Injured players played less and demonstrated inferior performance during the season of injury. With the exception of midfielders, players displayed no significant differences in play time or performance during any of the 4 postinjury seasons.

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