Concept: Achilles tendon
Negative pressure wound therapy in the management of late deep infections after open reconstruction of achilles tendon rupture
- The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons
- Published almost 4 years ago
Infection is a major complication after open reconstruction of Achilles tendon ruptures. We report on the use of vacuum-assisted closure (VAC) therapy in the treatment of late deep infections after open Achilles tendon reconstruction. Six patients (5 males [83.33%], 1 female [16.67%]; mean age, 52.8 [range 37 to 66] years) were been treated using an identical protocol. Surgical management consisted of debridement, lavage, and necrectomy of infected tendon parts. The VAC therapy was used for local wound preconditioning and infection management. A continuous negative pressure of 125 mm Hg was applied on each wound. For final wound closure, a split-thickness skin graft was performed. The skin graft healing process was also supported by VAC therapy during the first 5 days. The VAC dressings were changed a mean average of 3 (range 1 to 4) times until split-thickness skin grafting could be performed. The mean total duration of the VAC therapy was 13.6 ± 5.9 days. The mean hospital stay was 31.2 ± 15.9 days. No complications with regard to bleeding, seroma, or hematoma formation beneath the skin graft were observed. At a mean follow-up duration of 29.9 (range 4 to 65) months, no re-infection or infection persistence was observed. The VAC device seems to be a valuable tool in the treatment of infected tendons. The generalization of these conclusions should await the results of future studies with larger patient series.
Currently there is no effective approach to enhance tendon repair, hence we aimed to identify a suitable cell source for tendon engineering utilizing an established clinically relevant animal model for tendon injury.
There are two approaches available for surgical repair of the Achilles tendon: open repair, or percutaneous repair. However, there is controversy whether or not an open repair or percutaneous repair is superior. Focused Clinical Question: Which type of surgery is better in providing the best overall patient outcome, open or percutaneous repair, in physically active males and females with acute Achilles tendon ruptures? Summary of Search, “Best Evidence” Appraised and Key Findings: The literature was searched for studies of level 3 evidence or higher that investigated the effectiveness of open repair versus percutaneous repair on acute Achilles tendon ruptures in physically active males and females. The literature search resulted in four studies for possible inclusion. All three quality studies were included. Clinical Bottom Line: There is supporting evidence to indicate that percutaneous repair is the best option for Achilles tendon surgery, when it comes to the physically active population. Percutaneous repair has faster surgery times, less risk of complications, and has faster recovery times over having an open repair. This is acknowledging that every patient has a different situation and best individual option may vary patient to patient.
- The Journal of the American Academy of Orthopaedic Surgeons
- Published almost 2 years ago
Acute rupture of the Achilles tendon is common and seen most frequently in people who participate in recreational athletics into their thirties and forties. Although goals of treatment have not changed in the past 15 years, recent studies of nonsurgical management, specifically functional bracing with early range of motion, demonstrate rerupture rates similar to those of tendon repair and result in fewer wound and soft-tissue complications. Satisfactory outcomes may be obtained with nonsurgical or surgical treatment. Newer surgical techniques, including limited open and percutaneous repair, show rerupture rates similar to those of open repair but lower overall complication rates. Early research demonstrates no improvement in functional outcomes or tendon properties with the use of platelet-rich plasma, but promising results with the use of bone marrow-derived stem cells have been seen in animal models. Further investigation is necessary to warrant routine use of biologic adjuncts in the management of acute Achilles tendon ruptures.
Purpose. Knee pain and Achilles tendinopathies are the most common complaints among runners. The differences in the running mechanics may play an important role in the pathogenesis of lower limb overuse injuries. However, the effect of a runner’s foot strike pattern on the ankle and especially on the knee loading is poorly understood. The purpose of this study was to examine whether runners using a forefoot strike pattern exhibit a different lower limb loading profile than runners who use rearfoot strike pattern. Methods. Nineteen female athletes with a natural forefoot strike pattern and pair-matched females with rearfoot strike pattern (n = 19) underwent 3D running analysis at 4 m/s. Joint angles and moments, patellofemoral contact forces and stresses, and Achilles tendon forces were analyzed and compared between groups. Results. Forefoot strikers demonstrated 1ower patellofemoral contact force and stress compared to heel strikers (4.3 ± 1.2 vs. 5.1 ± 1.1 body weight, BW; P = 0.029 and 11.1 ± 2.9 vs. 13.0 ± 2.8 Mpa; P = 0.04). In addition, knee frontal plane moment was lower in the forefoot strikers compared heel strikers (1.49 ± 0.51 vs. 1.97 ± 0.66 Nm/kg; P = 0.015). At the ankle level, forefoot strikers showed higher plantarflexor moment (3.12 ± 0.40 vs. 2.54 ± 0.37 Nm/kg; P = 0.001) and Achilles tendon force (6.3 ± 0.8 vs. 5.1 ± 1.3 BW; P = 0.002) compared to rearfoot strikers. Conclusions. To our knowledge, this is the first study to show differences in patellofemoral loading and knee frontal plane moment between forefoot and rearfoot strikers. Forefoot strikers exhibit both lower patellofemoral stress and knee frontal plane moment than rearfoot strikers which may reduce the risk of running-related knee injuries. On the other hand, parallel increase in ankle plantarflexor and Achilles tendon loading may increase risk for ankle and foot injuries.
Most Achilles tendon ruptures are sports related. However, few studies have examined and compared the effect of surgical repair for complete ruptures on return to play (RTP), play time, and performance across multiple sports.
- The Journal of orthopaedic and sports physical therapy
- Published over 2 years ago
Study Design Level 4: Controlled laboratory study. Background Little is known regarding potential differences between treadmill and overground running in regards to patellofemoral joint and Achilles tendon loading characteristics. Objectives We sought to compare measures of loading to the patellofemoral joint and Achilles tendon across treadmill and overground running in healthy, uninjured runners. Methods Eighteen healthy runners ran at their self-selected speed on an instrumented treadmill and overground while three-dimensional running mechanics were sampled. A musculoskeletal model derived peak load, rate of loading and estimated cumulative load per 1 kilometer of continuous running for the patellofemoral joint and Achilles tendon for each condition. Data were analyzed via paired T-tests and Pearson’s correlations to detect differences and assess relationships, respectively, between the two running mediums. Results No differences (p>0.05) were found between treadmill and overground running for the peak, the rate of loading, or estimated cumulative patellofemoral joint stress per 1 kilometer of continuous running. However, treadmill running resulted in 21.5% greater peak Achilles tendon force (p<0.001), 15.6% greater loading rate of Achilles tendon force (p<0.001) and 14.2% greater estimated cumulative Achilles tendon force per 1 kilometer of continuous running (p<0.001) compared with overground running. There were strong (r>0.70) and moderate agreements (r>0.50) for most patellofemoral joint and Achilles measures, respectively, between treadmill and overground running. Conclusions No differences were observed in loading characteristics to the patellofemoral joint between running mediums, yet treadmill running resulted in greater Achilles tendon loading compared with overground running, Future investigations should determine if sudden bouts of treadmill running places the Achilles tendon at risk for mechanical overload in runners who habitually train overground. J Orthop Sports Phys Ther, Epub 12 May 2016. doi:10.2519/jospt.2016.6494.
The chronic painful Achilles tendon mid-portion was for many years, and still is in many countries, treated with intratendinous revision surgery. However, by coincidence, painful eccentric calf muscle training was tried, and it showed very good clinical results. This finding was unexpected and led to research into the pain mechanisms involved in this condition. Today we know that there are very few nerves inside, but multiple nerves outside, the ventral side of the chronic painful Achilles tendon mid-portion. These research findings have resulted in new treatment methods targeting the regions with nerves outside the tendon, methods that allow for a rapid rehabilitation and fast return to sports.
BACKGROUND: There is limited information about Achilles tendon disorders in professional football. AIMS: To investigate the incidence, injury circumstances, lay-off times and reinjury rates of Achilles tendon disorders in male professional football. METHODS: A total of 27 clubs from 10 countries and 1743 players have been followed prospectively during 11 seasons between 2001 and 2012. The team medical staff recorded individual player exposure and time-loss injuries. RESULTS: A total of 203 (2.5% of all injuries) Achilles tendon disorders were registered. A majority (96%) of the disorders were tendinopathies, and nine were partial or total ruptures. A higher injury rate was found during the preseason compared with the competitive season, 0.25 vs 0.18/1000 h (rate ratio (RR) 1.4, 95% CI 1.1 to 2.0; p=0.027). The mean lay-off time for Achilles tendinopathies was 23±37 (median=10, Q1=4 and Q3=24) days, while a rupture of the Achilles tendon, on average, caused 161±65 (median=169, Q1=110 and Q3=189) days of absence. Players with Achilles tendon disorders were significantly older than the rest of the cohort, with a mean age of 27.2±4 years vs 25.6±4.6 years (p<0.001). 27% of all Achilles tendinopathies were reinjuries. A higher reinjury risk was found after short recovery periods (31%) compared with longer recovery periods (13%) (RR 2.4, 95% CI 2.1 to 2.8; p<0.001). CONCLUSIONS: Achilles tendon disorders account for 3.8% of the total lay-off time and are more common in older players. Recurrence is common after Achilles tendinopathies and the reinjury risk is higher after short recovery periods.
BACKGROUND:A complete rupture of the Achilles tendon is a devastating injury. Variables affecting return to competition and performance changes for National Basketball Association (NBA) players are not readily evident. HYPOTHESIS:Players in the NBA who ruptured their Achilles tendons and who underwent surgical repair would have more experience in the league, and the performance of those who were able to return to competition would be decreased when compared with their performance before injury and with their control-matched peers. STUDY DESIGN:Cohort study; Level of evidence, 3. METHODS:Data for 18 basketball players with Achilles tendon repair over a 23-year period (1988-2011) were obtained from injury reports, press releases, and player profiles. Variables included age, body mass index (BMI), player position, and number of years playing in the league. Individual season statistics were obtained, and the NBA Player Efficiency Rating (PER) was calculated for 2 seasons before and after injury. Controls were matched by playing position, number of seasons played, and performance statistics. Univariate and multivariate analyses were performed to assess the effect of each factor. RESULTS:At the time of injury, the average age was 29.7 years, average BMI was 25.6, and average playing experience was 7.6 years. Seven players never returned to play an NBA game, whereas 11 players returned to play 1 season, with 8 of those players returning for ≥2 seasons. Players who returned missed an average of 55.9 games. The PER was reduced by 4.57 (P = .003) in the first season and by 4.38 (P = .010) in the second season. When compared with controls, players demonstrated a significant decline in the PER the first season (P = .038) and second season (P = .081) after their return. CONCLUSION:The NBA players who returned to play after repair of complete Achilles tendon ruptures showed a significant decrease in playing time and performance. Thirty-nine percent of players never returned to play.