Description of the surgical technique for repairing neglected Achilles tendon ruptures according to Bosworth

Neglected Achilles tendon ruptures are becoming more common. The etiologies are numerous, often complicating acute ruptures of the undiagnosed calcaneal tendon, whether by ignorance of the pathognomonic signs (loss of the physiological equine in prone position and Thomson’s maneuver) or by erroneous diagnosis of partial rupture often induced by an ultrasound. Also, it can be due to an iterative ruptures or ruptures on a pathological tendon. The treatment is always performed by a surgery. However, techniques are numerous and depend on the indications. We describe in this work the surgical technique of repairing neglected Achilles tendon ruptures according to Bosworth, performed in the Department of Traumatology-Orthopedics and Reconstructive Surgery of the Ibn Rochd University Hospital Center in Casablanca, Morocco.

Structural changes of the tendon in experimental tendinopathy and administration of autologous platelet-rich plasma

Objectives assessment of structural changes in the calcaneal tendon tissue in experimental tendinopathy under autologous platelet-rich plasma. Material and methods. Twenty mature Wistar rats, selected for the study, were divided into 5 groups. Rats of all groups received intra- and peritendinous injections of 0.5 ml of 10% sterile talc suspension to provide the experimental modeling of tendinopathy of the calcaneal tendon. Then the tendinopathy area was treated by injections of autologous platelet-rich plasma (PRP), a hyaluronic acid preparation "Rusvisk" (Rusvisk, Russia) and their sequential combination. The results were evaluated after 10 weeks in the autopsy preparations using a light microscopy method and morphometry. Results. The histological signs characteristic of tendinopathy were revealed, such as the disorganization of collagen structures, mucoid and lipoid degeneration, neovascularization, lymphoid and histiocytic infiltration. The injection of PRP, hyaluronic acid, or their sequential combination in the area of simulated tendinopathy led to changes in the histological presentation of the tissue. As a result, the collagen matrix had less signs of disorganization and less pronounced degenerative changes, as well as manifestations of the inflammatory process in the peritenon and the soft tissues surrounding the tendon, in comparison with the histological profile, which was observed in micropreparations in animals with tendinopathy who had no treatment. Conclusion. The introduction of PRP into the area of the calcaneal tendon has reduced the manifestations of the inflammatory process, disorganization of the collagen matrix, promoted the enhancement of collagen synthesis by cells and, ultimately, the processes of tissue remodeling.

Cerebrotendinous xanthomatosis with radiological abnormalities of the chest

A 55-year-old man with mental retardation and calcaneal tendon thickening was referred for a suspected genetic disease. His serum cholestanol was elevated and genetic analysis of his blood cells for CYP27A1 revealed a homozygous missense mutation. We diagnosed him with cerebrotendinous xanthomatosis (CTX). Chest radiography revealed diffuse micronodular and reticular opacities. Histological findings obtained from the transbronchial lung biopsy revealed foamy macrophages and multinucleate giant cells with marked lipid crystal clefts. Although there are few reports of pulmonary lesions in CTX, we concluded from the radiological and histopathological findings that the pulmonary lesions were indeed caused by the CTX. The patient was treated with chenodeoxycholic acid. His neurological findings and calcaneal tendon thickening were unchanged; however, his serum cholestanol and radiological abnormalities of the chest decreased.

Use of a Transarticular Calcaneo-Tibial Locking Plate for Temporary Immobilization of the Tarsocrural Joint following Surgical Repair of Common Calcaneal Tendon Rupture in Eight Dogs

Objective The purpose of this clinical communication is to report the management of common calcaneal tendon rupture in dogs using a transarticular calcaneo-tibial locking plate as a method of temporary immobilization of the tarsocrural joint to support primary repair of the common calcaneal tendon. Study Design Dogs presented with partial or complete common calcaneal tendon rupture treated with primary tendon repair supported by the transarticular calcaneo-tibial locking plate technique from July 2016 to December 2019 were included. The tarsus was placed at a standing angle of 150 degrees and the pre-contoured Fixin locking ‘L’ or ‘T’ plate was medially applied with two locking screws inserted in the calcaneus and two screws inserted in the distal tibia. Tendon healing judgement was mostly based on clinical palpation and ultrasound examination was not performed in all the cases. Plates were removed in all dogs 6 weeks postoperatively. Results All tendons healed and no complications at the level of the tenorrhaphy were noted in the postoperative period. All dogs returned to hunting activity with full function of the affected limb. No major complications requiring revision surgery were observed. Minor complications occurred in two cases; osteomyelitis and screw pull-out. Conclusion The use of a transarticular calcaneo-tibial locking plate for temporary immobilization of the tarsocrural joint after surgical repair of common calcaneal tendon rupture appears to be an effective technique with comparable results to other reported techniques.

Serial Ultrasonographic and Real-Time Elastosonographic Assessment of the Ovine Common Calcaneal Tendon, after an Experimentally Induced Tendinopathy

Real-time elastosonography (RTE) is a recently described, non-invasive, ultrasonographic technique developed to assess tissue elasticity. The main aim of this study was to investigate the ultrasonographic and elastosonographic appearance of the common calcaneal tendon (CCT) in an ovine model, and to monitor the progression of tendon healing after an experimentally-induced tendinopathy. Sound tendons were initially evaluated (T0) with a caliper and by a single operator with ultrasound. Ultrasonographic and elastosonographic images were then acquired. Subsequently, ultrasound-guided tendon lesions were induced by injecting 500 IU of Type IA collagenases proximally to the calcaneal tuberosity. Caliper measurement, ultrasonography and elastosonography were then repeated at 15 (T1), 30 (T2) and 60 (T3) days. Clinically measured width of the tendon, ultrasonographic thickness and width and percentage of hard (Elx-t%hrd) and soft (Elx-t%sft) tissue were recorded. Statistical analysis was performed on the data collected; statistical significance was set at p < 0.05. Intra-class correlation coefficient (ICC) revealed good (0.68) repeatability of elastosonographic evaluation of the CCT. The tendon width was significantly increased when comparing T0 with T1–2 and decreased when comparing T1–2 with T3. Ultrasound-assessed thickness was significantly increased between T0–T1 and decreased between T1-T2–3. Elx-t%hrd was significantly decreased at T1–2–3 and Elx-t%sft was significantly increased at T1–2–3. In conclusion, the ovine CCT is a highly stiff structure that undergoes a severe loss of stiffness during the healing process. Thickness and width of the tendon increased during the first 30 days and then reduced progressively along the subsequent 30 days. Ultrasonographic appearance of the tendon remained severely abnormal and the tendon showed severely reduced elastic proprieties 60 days after lesion induction.

COMPARISON OF 3-WEEK CALCANEAL TENDON REGENERATES AFTER TENOTOMY AND SUTURING IN EXPERIMENT IN VIVO

Background. Modern knowledge about tendon healing as well as possibilities of hand surgery does not solve the problem of tenogenic contractures. For the prevention of cicatricial process, the separation of the sliding surfaces of the tendon and its sheath with polymeric materials is used. However, regeneration of tendons in condition of isolation has not been proven. Aim of the research. In a laboratory animal model to perform a tenotomy and a calcaneal tendon suture, study 3-week regenerates formed in the mobilization regime and evaluate the regenerative capacity of the tendon isolated with a dissected polymer tube. Material and methods. On both paws of laboratory rats tenotomy and suturing of the calcaneal tendons were performed. The tendons on the right paws were isolated with dissected polymeric tubes. The appearance and the histological structure of the suture site were assessed after 3 weeks. Results. Tendon regenerates were distinguished by their maturity and tissue organization. Tendons without isolation healed faster, but lost their sliding surface. As a result of isolation, a sliding surface of the tendon and its sheath was formed, but the formation of the regenerate slowed down. Conclusions. Tendon healing in dissected tube is possible and occurs due to intrinsic repair. The fusion of the tendon demonstrates a well-vascularized regenerate in the suture site.

Medial pantarsal arthrodesis with Compact UniLock 2.0 locking plate system in a cat

Background: Pantarsal arthrodesis is a salvage procedure carried out for the treatment of tarsal joint disease, including severe osteoarthritis with intractable pain in the tarsocrural joint, tarsal fractures, shearing injuries, tarsocrural joint instability, and failure of the common calcaneal tendon. Although medial plating is preferable, the high incidence of post-surgery complications is possible. Using thin, pre-contouring or easy contouring, locking plates might reduce the incidence of such complications. However, to date, there are no pre-contouring and dedicated locking plates forpantarsal arthrodesis with medial placement.Case Description: The case of an 18-month-old female stray European cat has been referred because of a severe tibiotarsal injury improperly treated with an intramedullary pin. The patient was submitted for medial pantarsal arthrodesis, performed with the Compact UniLock 2.0™ locking plate systema (DePuy Synthes, Oberdorf, Switzerland). The authors hypothesized that this particularly innovative osteosynthesis system could present advantages compared to the systems already in use for medial pantarsal arthrodesis and therefore reduce the risk of complications.Conclusion: This innovative titanium locking system, because of its versatile contour function and thinness, allowed the good functional recovery of the limb and showed numerous advantages over traditional systems.