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Achilles tendon rupture

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  #31  
Old 9th September 2010, 01:56 PM
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Default Re: Achilles tendon rupture

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Surgical interventions for treating acute Achilles tendon ruptures.
Khan RJ, Carey Smith RL.
Cochrane Database Syst Rev. 2010 Sep 8;9:CD003674.
Quote:
BACKGROUND: There is a lack of consensus on the best management of the acute Achilles tendon rupture. Treatment can be broadly classified into surgical (open or percutaneous) and non-surgical (cast immobilisation or functional bracing).

OBJECTIVES: To evaluate the relative effects of surgical versus non-surgical treatment, or different surgical interventions, for acute Achilles tendon ruptures in adults.

SEARCH STRATEGY: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (July 2009), the Cochrane Central Register of Controlled Trials (The Cochrane Library 2009, Issue 3), MEDLINE (1966 to 20th July 2009), EMBASE (1966 to 2009 week 29), CINAHL (1983 to July 2007) and reference lists of articles.

SELECTION CRITERIA: All randomised and quasi-randomised trials comparing surgical versus non-surgical treatment or different surgical methods for acute Achilles tendon ruptures in adults.

DATA COLLECTION AND ANALYSIS: Two review authors independently selected potentially eligible trials; trials were then assessed for quality using a 10-item scale. Where possible, data were pooled.

MAIN RESULTS: Twelve trials involving 844 participants were included. One trial tested two comparisons.Quality assessment revealed a poor level of methodological rigour in many studies, particularly with regard to concealment of allocation and the lack of assessor blinding.Open surgical treatment compared with non-surgical treatment (6 trials, 536 participants) was associated with a statistically significant lower risk of rerupture (risk ratio (RR) 0.41, 95% confidence interval (CI) 0.21 to 0.77), but a higher risk of other complications including infection (RR 4.89, 95% CI 1.09 to 21.91), adhesions and disturbed skin sensibility (numbness). Functional status including sporting activity was variably and often incompletely reported, including frequent use of non standardised outcome measures, and the results were inconclusive.Open surgical repair compared with percutaneous repair (4 trials, 174 participants) was associated with a higher risk of infection (RR 9.32, 95% CI 1.77 to 49.16). These figures should be interpreted with caution because of the small numbers involved. Similarly, no definitive conclusions could be made regarding different tendon repair techniques (3 trials, 147 participants).

AUTHORS' CONCLUSIONS: Open surgical treatment of acute Achilles tendon ruptures significantly reduces the risk of rerupture compared with non-surgical treatment, but produces significantly higher risks of other complications, including wound infection. The latter may be reduced by performing surgery percutaneously.
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  #32  
Old 20th October 2010, 11:23 AM
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Default Re: Achilles tendon rupture

American Academy of Orthopaedic Surgeons Clinical Practice Guideline on Treatment of Achilles Tendon Rupture
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  #33  
Old 20th October 2010, 01:51 PM
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Default Re: Achilles tendon rupture

Reconstruction of achilles tendon rupture with combined V-Y plasty and gastrocnemius-soleus fascia turndown graft.
Ponnapula P, Aaranson RR.
J Foot Ankle Surg. 2010 May-Jun;49(3):310-5
Quote:
A reconstructive technique for treatment of Achilles tendon rupture with an extensive defect is presented. The primary goal of this salvage procedure is to create functional length and anatomic continuity among muscle, tendon, and bone. The procedure uses a combination of fascial advancement techniques: the V-Y advancement and the gastrocnemius-soleus fascia turndown graft. In this technique, the inverted "V" inscribed on the proximal gastrocnemius fascia is partially elevated from the underlying soleus and twisted 180 degrees on itself to augment the repair. Advancing the musculotendinous junction and creating a turndown graft provide substantial length. This combined technique allows the surgeon to repair ruptures with segmental defects greater than 10 cm in length.
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  #34  
Old 2nd November 2010, 01:20 AM
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Default Re: Achilles tendon rupture

Treatment of acute Achilles tendon ruptures with Achillon device: Clinical outcomes and kinetic gait analysis
Ignacio Martínez Garrido MDa, Juan Cervera Deval, Marta Navarro Bosch, Daniel Herrero Mediavilla, Vicente Pellicer Garcia and María Sánchez González
Foot and Ankle Surgery
Volume 16, Issue 4, December 2010, Pages 189-194
Quote:
Background

We reviewed the outcomes of the Achillon minimally invasive suture system and an early semi-functional rehabilitation program for the treatment of acute Achilles tendon ruptures.
Methods

From December 2006 to April 2008, 18 consecutive patients with acute Achilles tendon ruptures were retrospectively reviewed with an average follow-up of 22 months. Clinical data were assessed with the patient satisfaction and the AOFAS hindfoot score. Biomechanical gait parameters were obtained using the NedAMH/IBV dynamometric platform.
Results

At last follow-up the AOFAS score was 98 (range, 89–100) and correlated well with kinetic gait analysis. All patients regained normal range of motion and were able to resume their previous activities after six months, with a high rate of satisfaction. Three patients had scar adhesions. There were no cases of recurrent rupture or nerve injury.
Conclusions

The Achillon device allows semi-functional rehabilitation and provides satisfactory results with a low rate of complication.
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  #35  
Old 4th November 2010, 06:22 PM
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Default Re: Achilles tendon rupture

Autologous Platelets Have No Effect on the Healing of Human Achilles Tendon
Ruptures: A Randomized Single-Blind Study

Thorsten Schepull, Joanna Kvist, Hanna Norrman, Marie Trinks, Gosta Berlin,
and Per Aspenberg
Am J Sports Med published 3 November 2010,
Quote:
Background: Animal studies have shown that local application of platelet-rich plasma (PRP) stimulates tendon repair. Preliminary results from a retrospective case series have shown faster return to sports.

Hypothesis: Autologous PRP stimulates healing of acute Achilles tendon ruptures.

Study Design: Randomized controlled trial; Level of evidence, 2.

Methods: Thirty patients were recruited consecutively. During surgery, tantalum beads were implanted in the Achilles tendon proximal and distal to the rupture. Before skin suture, randomization was performed, and 16 patients were injected with 10mL PRP (10 times higher platelet concentration than peripheral blood) whereas 14 were not. With 3-dimensional radiographs (roentgen stereophotogrammetric analysis; RSA), the distance between the beads was measured at 7, 19, and 52 weeks while the patient resisted different dorsal flexion moments over the ankle joint, thereby estimating tendon strain per load. An estimate of elasticity modulus was calculated using callus dimensions from computed tomography. At 1 year, functional outcome was evaluated, including the heel raise index and Achilles Tendon Total Rupture Score. The primary effect variables were elasticity modulus at 7 weeks and heel raise index at 1 year.

Results: The mechanical variables showed a large degree of variation between patients that could not be explained by measuring error. No significant group differences in elasticity modulus could be shown. There was no significant difference in heel raise index. The Achilles Tendon Total Rupture Score was lower in the PRP group, suggesting a detrimental effect. There was a correlation between the elasticity modulus at 7 and 19 weeks and the heel raise index at 52 weeks.

Conclusion: The results suggest that PRP is not useful for treatment of Achilles tendon ruptures. The variation in elasticity modulus provides biologically relevant information, although it is unclear how early biomechanics is connected to late clinical results.
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  #36  
Old 26th November 2010, 01:31 PM
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Default Re: Achilles tendon rupture

Rehabilitation of the Operated Achilles Tendon: Parameters for Predicting Return to Activity
Amol Saxena, Brynn Ewen, Nicola Maffulli
Journal of Foot and Ankle Surgery
Quote:
Return to activity (RTA) following Achilles tendon surgery assessment criteria has not been generally adopted. A well-defined postsurgical rehabilitation regimen with 3 distinct criteria, yet easy to measure, can be used to assess the ability of patients undergoing Achilles tendon surgery to return to activity. We studied whether if patients were able to meet all 3 criteria, would this show significance in predicting the ability to RTA within a normal range. A total of 219 patients undergoing surgery on the Achilles tendon from 1990 to 2005 were retrospectively studied to evaluate for the ability to perform 5 sets of 25 single-legged concentric heel raises, along with symmetry of calf girth and ankle range of motion. Time of RTA and the ability to meet all 3 parameters was studied. If patients could meet all 3 criteria, they were allowed to RTA. This time postsurgery was recorded in weeks. Of the 219 surgeries reviewed, 149 were on males and 70 on females. Fourteen patients were unable to meet all 3 parameters evaluated above within the proposed time frames. The inability to meet all 3 criteria resulted in a delay to RTA (P = .03). Eleven females had a delay in RTA as compared with 2 males (P < .0001). RTA was different based on procedure. Meeting all 3 criteria was helpful in assessing if patients were able to RTA in the normal range. Patients who were unable to meet all 3 had a delay in RTA. Females were more likely to have a delay in RTA.
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  #37  
Old 1st December 2010, 01:47 PM
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Default Re: Achilles tendon rupture

Treating Achilles Tendon Rupture in Rats with Bone-Marrow-Cell Transplantation Therapy
Naofumi Okamoto et al
The Journal of Bone and Joint Surgery (American). 2010;92:2776-2784.
Quote:
Background Bone marrow cells possess multipotentiality and have been used for several treatments. We hypothesized that bone marrow cells might differentiate into regenerated tendon and that several cytokines within bone marrow cells might accelerate tendon healing. Therefore, we treated Achilles tendon ruptures in a rat model with transplantation of whole bone marrow cells.

Methods Nine F344/Nslc (Fisher) rats were the source of bone marrow cells and mesenchymal stem cells as well as normal Achilles tendons. Eighty-seven Fisher rats were used for the experiments. The rats were divided into three groups: the BMC group (bone marrow cells injected around the tendon), the MSC group (mesenchymal stem cells injected around the tendon), and the non-treated control group (incision only). Outcome measures included mechanical testing, collagen immunohistochemistry, histological analysis, and reverse transcription-polymerase chain reaction to detect expression of transforming growth factor-β (TGF-β) and vascular endothelial growth factor (VEGF).

Results The ultimate failure load in the BMC group was significantly greater than that in the non-treated or the MSC group at seven days after incision (3.8 N vs. 0.9 N or 2.1 N, p < 0.016) and at fourteen days after incision (10.2 N vs. 6.1 N or 8.2 N, p < 0.016). The ultimate failure load in the BMC group at twenty-eight days after incision (33.8 N) was the same as that of normal tendon (34.8 N). The BMC group demonstrated stronger staining for type-III collagen at seven days after incision and stronger staining for type-I collagen at twenty-eight days than did the MSC group. Expression of TGF-β and VEGF in the BMC group was significantly increased compared with that in the other groups at four days after incision (TGF-β: 1.6 vs. 1.3 or 0.6, p < 0.01; VEGF: 1.7 vs. 1.1 or 0.9, p < 0.01).

Conclusions Transplantation of whole bone marrow cells may be a better and more readily available treatment for Achilles tendon rupture than cultured mesenchymal stem cells.

Clinical Relevance The present study provides evidence that transplantation of bone marrow cells may be a promising therapy for the treatment of Achilles tendon rupture.
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  #38  
Old 1st December 2010, 01:49 PM
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Default Re: Achilles tendon rupture

Operative versus Nonoperative Treatment of Acute Achilles Tendon Ruptures
A Multicenter Randomized Trial Using Accelerated Functional Rehabilitation

Kevin Willits et al
The Journal of Bone and Joint Surgery (American). 2010;92:2767-2775.
Quote:
Background To date, studies directly comparing the rerupture rate in patients with an Achilles tendon rupture who are treated with surgical repair with the rate in patients treated nonoperatively have been inconclusive but the pooled relative risk of rerupture favored surgical repair. In all but one study, the limb was immobilized for six to eight weeks. Published studies of animals and humans have shown a benefit of early functional stimulus to healing tendons. The purpose of the present study was to compare the outcomes of patients with an acute Achilles tendon rupture treated with operative repair and accelerated functional rehabilitation with the outcomes of similar patients treated with accelerated functional rehabilitation alone.

Methods Patients were randomized to operative or nonoperative treatment for acute Achilles tendon rupture. All patients underwent an accelerated rehabilitation protocol that featured early weight-bearing and early range of motion. The primary outcome was the rerupture rate as demonstrated by a positive Thompson squeeze test, the presence of a palpable gap, and loss of plantar flexion strength. Secondary outcomes included isokinetic strength, the Leppilahti score, range of motion, and calf circumference measured at three, six, twelve, and twenty-four months after injury.

Results A total of 144 patients (seventy-two treated operatively and seventy-two treated nonoperatively) were randomized. There were 118 males and twenty-six females, and the mean age (and standard deviation) was 40.4 ± 8.8 years. Rerupture occurred in two patients in the operative group and in three patients in the nonoperative group. There was no clinically important difference between groups with regard to strength, range of motion, calf circumference, or Leppilahti score. There were thirteen complications in the operative group and six in the nonoperative group, with the main difference being the greater number of soft-tissue-related complications in the operative group.

Conclusions This study supports accelerated functional rehabilitation and nonoperative treatment for acute Achilles tendon ruptures. All measured outcomes of nonoperative treatment were acceptable and were clinically similar to those for operative treatment. In addition, this study suggests that the application of an accelerated-rehabilitation nonoperative protocol avoids serious complications related to surgical management.
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  #39  
Old 14th December 2010, 12:11 PM
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Default Re: Achilles tendon rupture

Operative versus Nonoperative Treatment of Acute Achilles Tendon Ruptures: A Multicenter Randomized Trial Using Accelerated Functional Rehabilitation
Kevin Willits, Annunziato Amendola, Dianne Bryant, Nicholas G. Mohtadi, J. Robert Giffin, Peter Fowler, Crystal O. Kean, and Alexandra Kirkley
J Bone Joint Surg Am. 2010;92:2767-2775.
Quote:
Background To date, studies directly comparing the rerupture rate in patients with an Achilles tendon rupture who are treated with surgical repair with the rate in patients treated nonoperatively have been inconclusive but the pooled relative risk of rerupture favored surgical repair. In all but one study, the limb was immobilized for six to eight weeks. Published studies of animals and humans have shown a benefit of early functional stimulus to healing tendons. The purpose of the present study was to compare the outcomes of patients with an acute Achilles tendon rupture treated with operative repair and accelerated functional rehabilitation with the outcomes of similar patients treated with accelerated functional rehabilitation alone.

Methods Patients were randomized to operative or nonoperative treatment for acute Achilles tendon rupture. All patients underwent an accelerated rehabilitation protocol that featured early weight-bearing and early range of motion. The primary outcome was the rerupture rate as demonstrated by a positive Thompson squeeze test, the presence of a palpable gap, and loss of plantar flexion strength. Secondary outcomes included isokinetic strength, the Leppilahti score, range of motion, and calf circumference measured at three, six, twelve, and twenty-four months after injury.

Results A total of 144 patients (seventy-two treated operatively and seventy-two treated nonoperatively) were randomized. There were 118 males and twenty-six females, and the mean age (and standard deviation) was 40.4 ± 8.8 years. Rerupture occurred in two patients in the operative group and in three patients in the nonoperative group. There was no clinically important difference between groups with regard to strength, range of motion, calf circumference, or Leppilahti score. There were thirteen complications in the operative group and six in the nonoperative group, with the main difference being the greater number of soft-tissue-related complications in the operative group.

Conclusions This study supports accelerated functional rehabilitation and nonoperative treatment for acute Achilles tendon ruptures. All measured outcomes of nonoperative treatment were acceptable and were clinically similar to those for operative treatment. In addition, this study suggests that the application of an accelerated-rehabilitation nonoperative protocol avoids serious complications related to surgical management.
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  #40  
Old 14th December 2010, 12:13 PM
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Default Re: Achilles tendon rupture

Treating Achilles Tendon Rupture in Rats with Bone-Marrow-Cell Transplantation Therapy
Naofumi Okamoto, Taketoshi Kushida, Kenichi Oe, Masayuki Umeda, Susumu Ikehara, and Hirokazu Iida
J Bone Joint Surg Am. 2010;92:2776-2784
Quote:
Background Bone marrow cells possess multipotentiality and have been used for several treatments. We hypothesized that bone marrow cells might differentiate into regenerated tendon and that several cytokines within bone marrow cells might accelerate tendon healing. Therefore, we treated Achilles tendon ruptures in a rat model with transplantation of whole bone marrow cells.

Methods Nine F344/Nslc (Fisher) rats were the source of bone marrow cells and mesenchymal stem cells as well as normal Achilles tendons. Eighty-seven Fisher rats were used for the experiments. The rats were divided into three groups: the BMC group (bone marrow cells injected around the tendon), the MSC group (mesenchymal stem cells injected around the tendon), and the non-treated control group (incision only). Outcome measures included mechanical testing, collagen immunohistochemistry, histological analysis, and reverse transcription-polymerase chain reaction to detect expression of transforming growth factor-β (TGF-β) and vascular endothelial growth factor (VEGF).

Results The ultimate failure load in the BMC group was significantly greater than that in the non-treated or the MSC group at seven days after incision (3.8 N vs. 0.9 N or 2.1 N, p < 0.016) and at fourteen days after incision (10.2 N vs. 6.1 N or 8.2 N, p < 0.016). The ultimate failure load in the BMC group at twenty-eight days after incision (33.8 N) was the same as that of normal tendon (34.8 N). The BMC group demonstrated stronger staining for type-III collagen at seven days after incision and stronger staining for type-I collagen at twenty-eight days than did the MSC group. Expression of TGF-β and VEGF in the BMC group was significantly increased compared with that in the other groups at four days after incision (TGF-β: 1.6 vs. 1.3 or 0.6, p < 0.01; VEGF: 1.7 vs. 1.1 or 0.9, p < 0.01).

Conclusions Transplantation of whole bone marrow cells may be a better and more readily available treatment for Achilles tendon rupture than cultured mesenchymal stem cells.

Clinical Relevance The present study provides evidence that transplantation of bone marrow cells may be a promising therapy for the treatment of Achilles tendon rupture.
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  #41  
Old 2nd February 2011, 08:54 PM
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Default Re: Achilles tendon rupture

Effect of Complications After Minimally Invasive Surgical Repair of Acute Achilles Tendon Ruptures: Report on 211 Cases
Roderik Metz et al
Am J Sports Med February 2, 2011 0363546510392012

Quote:
Background: Complications of acute Achilles tendon rupture treatment are considered to negatively influence outcome, but the relevance of these effects is largely unknown.

Purpose: The Achilles Tendon Total Rupture Score (ATRS) was used to determine level of disability in patients with minimally invasive surgical Achilles tendon rupture repair with a complicated postoperative course.

Study Design: Case series; Level of evidence, 4.

Methods: The charts of 340 consecutive patients treated for an acute Achilles tendon rupture by minimally invasive surgical repair were reviewed. Complications were categorized as rerupture, severe wound infection, sural nerve injury, and other. Level of disability was evaluated by the 10-item ATRS with a sum score of minimum 0 to maximum 100 points.

Results: A total of 211 patients returned a completed questionnaire: mean follow-up was 6.2 years (range, 3-10 years). Mean ATRS for all 211 patients was 84 (95% confidence interval: 82, 87). The mean ATRS for the 135 (64%) uncomplicated cases was 89 of 100 points, 71 points for the 17 (8%) patients with a rerupture (95% confidence interval: 63, 79; P < .0001), 79 points for the 41 patients (19%) with a sural nerve injury (95% confidence interval: 74, 85; P = .0008), and 75 points for the 17 patients (8%) with another complication (95% confidence interval: 67, 83; P = .001). Of these other complications, 13 patients (6%) suffered a wound-healing complication considered minor. Their average ATRS score was 80 points (95% confidence interval: 71, 88.7; P = .0445). One patient suffered a severe wound infection as well, scoring 28 of 100 points. Rerupture significantly increased the risk of quitting or changing sport participation on the long term.

Conclusion: Long-term outcome after minimally invasive Achilles tendon rupture repair is excellent. Rerupture and severe wound infection are the most important complications with lasting negative effect on outcome. It justifies the use of rerupture as a relevant outcome measure in treatment evaluation.
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Old 3rd March 2011, 07:37 PM
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Default Re: Achilles tendon rupture

Is Percutaneous Repair Better Than Open Repair in Acute Achilles Tendon Rupture?
Henríquez H, Muñoz R, Carcuro G, Bastías C.
Clin Orthop Relat Res. 2011 Mar 2. [Epub ahead of print]
Quote:
BACKGROUND: Open repair of Achilles tendon rupture has been associated with higher levels of wound complications than those associated with percutaneous repair. However, some studies suggest there are higher rerupture rates and sural nerve injuries with percutaneous repair. QUESTIONS/PURPOSES : We compared the two types of repairs in terms of (1) function (muscle strength, ankle ROM, calf and ankle perimeter, single heel rise tests, and work return), (2) cosmesis (length scar, cosmetic appearance), and (3) complications.

PATIENTS AND METHODS: We retrospectively reviewed 32 surgically treated patients with Achilles rupture: 17 with percutaneous repair and 15 with open repair. All patients followed a standardized rehabilitation protocol. The minimum followup was 6 months (mean, 18 months; range, 6-48 months).

RESULTS: We observed similar values of plantar flexor strength, ROM, calf and ankle perimeter, and single heel raising test between the groups. Mean time to return to work was longer for patients who had open versus percutaneous repair (5.6 months versus 2.8 months). Mean scar length was greater in the open repair group (9.5 cm versus 2.9 cm). Cosmetic appearance was better in the percutaneous group. Two wound complications and one rerupture were found in the open repair group. One case of deep venous thrombosis occurred in the percutaneous repair group. All complications occurred before 6 months after surgery. We identified no patients with nerve injury.

CONCLUSIONS: Percutaneous repair provides function similar to that achieved with open repair, with a better cosmetic appearance, a lower rate of wound complications, and no apparent increase in the risk of rerupture.
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Old 24th June 2011, 12:12 PM
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Default Re: Achilles tendon rupture

Use of an Anti-gravity Treadmill in the Rehabilitation of the Operated Achilles Tendon: A Pilot Study
Amol Saxena & Allison Granot
Journal of Foot and Ankle Surgery published online 24 June 2011.

Quote:
Achilles surgical patients were evaluated using an “anti-gravity” Alter-G (AG) treadmill that allows for reduction of weightbearing pressure on the lower extremity. We studied our hypothesis, which was based on our prior clinical findings, that being able to run on the AG treadmill at 85% of body weight is sufficient to clear patients to run with full body weight outside. Patients undergoing Achilles tendon rupture or insertional repair surgery were prospectively studied. They were compared with a control group that had similar surgeries and a similar rehabilitation program during the same time period: the variable was not using the AG treadmill. The criteria for the study group to be allowed to run outside was being able to run for at least 10 minutes on the AG at 85% of body weight. Each group had 8 patients who underwent surgery for 2 complete tendon ruptures and 6 insertional repairs. There was no significant difference between the AG and control group as to age and postoperative follow-up. AG patients began their initial run on the treadmill at 70% of their body weight at 13.9 ± 3.4 weeks, 85% at 17.6 ± 3.9 weeks, and outside running at 18.1 ± 3.9 weeks. The control group's return to running outside time was 20.4 ± 4.1 weeks. This was not significantly different (P = .27). We confirmed our hypothesis that being able to run at 85% of body weight after Achilles surgery was sufficient to clear patients to run outside.
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Old 16th August 2011, 03:36 PM
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Default Re: Achilles tendon rupture

Epidemiology and outcomes of acute Achilles tendon rupture with operative or nonoperative treatment using an identical functional bracing protocol.
Gwynne-Jones DP, Sims M, Handcock D.
Foot Ankle Int. 2011 Apr;32(4):337-43.
Quote:
BACKGROUND:
This study reports on the demographics of acute Achilles tendon rupture in our region and compares the results of a selective approach to operative and nonoperative treatment using an identical rehabilitation program with functional bracing.

MATERIALS AND METHODS:
A consecutive series of 363 patients, aged 15 to 60 years, treated over 8.5 years by either open operative repair (143) or nonoperatively (220) were compared with respect to demographics, re-rupture rate, and major wound complication.

RESULTS:
There was an almost equal number of males (159) and females (152) up to age 50 years but males comprised 73% of patients aged 51 to 60 years. Netball was the most common cause of injury and explains the relatively high incidence in females. In the 143 patients treated surgically there were two re-ruptures (1.4%) and two reoperations for wound complications (1.4%). In the 220 patients treated nonoperatively there were 19 re-ruptures (8.6%), 13 of 113 males (11.5%) and six of 107 females (5.6%). There was a significantly lower re-rupture rate, and reoperation rate in the surgical group (p < 0.05). In the nonoperative group there was a significantly lower rate of re-rupture in patients over 40 (six of 119) (4.1%) compared with those 40 years and under (13 of 99, 13.1%) and between females over 40 when compared with males 40 years and under.

CONCLUSION:
In our region there is a high incidence of Achilles tendon rupture among women due to netball and results in a younger age of injury than previously reported. Our results support surgery in patients less than 40 years, particularly males, if there are no contraindications. Functional bracing as part of nonoperative treatment can result in low re-rupture rates in patients over 40, especially in females.
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Old 16th August 2011, 04:02 PM
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Default Re: Achilles tendon rupture

From latest Lower Extremity Review:
Return to football after Achilles tendon rupture
Quote:
Only two-thirds of National Football League players ever come back, and those who do find their performance significantly affected. But research suggests a prodromal period may offer opportunities for early intervention.
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Old 18th August 2011, 11:39 PM
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Default Re: Achilles tendon rupture

Persistent disability despite sufficient calf muscle strength after rerupture of surgically treated acute achilles tendon ruptures.
Metz R, van der Heijden GJ, Verleisdonk EJ, Andrlik M, van der Werken C.
Foot Ankle Spec. 2011 Apr;4(2):77-81
Quote:
Rerupture after treatment of acute Achilles tendon rupture is considered a serious complication. Yet data on long-term outcome after rerupture are limited. This study evaluated outcome after rerupture and compares it to a reference of uncomplicated cases. Thirteen patients with a rerupture following minimally invasive surgical Achilles tendon rupture repair were evaluated using Leppilahti score and resumption of work and sport. Mean follow-up was 8.7 years. Results were compared with a reference group of 23 uncomplicated cases with a follow-up of at least 1 year. The study was designed as a follow-up study. The relative risk for a fair/poor outcome by Leppilahti score after a rerupture when compared with uncomplicated cases is 2.83 (95% confidence interval=1.17-6.87; P=.0185). Although rerupture did not affect ultimate resumption of professional life, the relative risk for quitting sport or resuming sport at a lower level after a rerupture is 3.33 (95% confidence interval=1.71-6.51; P=.0001). In contrast, the plantar flexion strength deficit is 5% to 10% in the rerupture group and up to 20% in the reference group. Despite sufficient recovery of calf muscle strength, rerupture after acute Achilles tendon rupture treatment results in significant long-term functional disabilities.
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Old 9th September 2011, 10:40 PM
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Default Re: Achilles tendon rupture

In-Shoe Plantar Pressures Within Ankle-Foot Orthoses: Implications for the Management of Achilles Tendon Ruptures
Rebecca S. Kearney et al
Am J Sports Med September 9, 2011
Quote:
Background: Advances in the management of Achilles tendon rupture have led to the development of immediate weightbearing protocols. These vary regarding which ankle-foot orthoses (AFOs) are used and the number of inserted heel wedges used within them.

Purpose: This study was conducted to evaluate plantar pressure measurements and temporal gait parameters within different AFOs, using different numbers of heel wedges.

Study Design: Controlled laboratory study.

Methods: Fifteen healthy participants were evaluated using 3 different AFOs, with 4 different levels of inserted heel wedges. Therefore, a total of 12 conditions were evaluated, in a sequence that was randomly allocated to each participant. Pressure and temporal gait parameters were measured using an in-shoe F-Scan pressure system, and range of movement was measured using an electrogoniometer.

Results: Ankle-foot orthoses that were restrictive in design, combined with a higher number of inserted heel wedges, reduced forefoot pressures, increased heel pressures, and decreased the amount of time spent in the terminal stance and preswing phase of the gait cycle (P = .029, .002, and .001).

Conclusion: The choice of AFO design and the number of inserted heel wedges have a significant effect on plantar pressure measurements and temporal gait parameters. The implications of these changes need to be applied to the clinical management of acute Achilles tendon ruptures. This clinical management requires a balance between protected weightbearing and functional loading, requiring further research within a clinical context.

Clinical Relevance: The biomechanical data from this research imply that a carbon-fiber AFO, with 1 heel raise, protects against excessive dorsiflexion while facilitating the restoration of near-normal gait parameters. This could lead to an accelerated return to function, avoiding the effects of disuse atrophy. This is in contrast to the rigid rocker-bottom AFO design with a greater number of heel-wedge inserts. However, research within a clinical context would be required to ascertain if these biomechanical advantages translate into a functional benefit for patients. The results should also be considered in relation to the amount of force a healing Achilles tendon can withstand.
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Old 20th September 2011, 08:56 PM
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Default Re: Achilles tendon rupture

From Lower Extremity Review:
Strategies for rehab after Achilles tendon surgery
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Old 21st September 2011, 02:44 PM
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Default Re: Achilles tendon rupture

Intra-operative ultrasonography in the percutaneous tenorraphy of acute Achilles tendon ruptures
S. Lacoste, B. Cherrier and J. M. Féron
European Journal of Orthopaedic Surgery & Traumatolog; DOI: 10.1007/s00590-011-0867-x
Quote:
The management of acute Achilles tendon ruptures is still controversy. Some current recommendations are in support of the surgical option with early rehabilitation. The percutaneous technique is a compromise between the conservative treatment and the open surgery. It allows a correct connection of the tendon ends with a lower skin and infection complications. According to some studies, reruptures and sural nerve injuries rates are still significant with the percutaneous technique. We tried to find a way to improve the percutaneous option. The subcutaneous position of the tendon makes its ultrasonographic exploration easy. The ultrasonography seemed to represent a non-invasive tool for guiding the percutaneous tenorraphy. The aim of our study is the evaluation of the intra-operative ultrasonography in the Achilles tendon percutaneous technique. We compared two groups according to the percutaneous tenorraphy and early rehabilitation. The first group (group A, 21 patients) was ultrasound-controlled during the operation, and the second one (group B, 12 patients) without control. The mean follow-up in the group A was 12 months and 24.5 months in the second group. In the ultrasonography group, we did not find neither general complication, neither iterative rupture nor sural nerve injury. The return to work was observed earlier in the group A at 45 days. There was no significant difference between skin necrosis, return to sport, plantar flexion strength and calf muscle atrophy. The economic impact was considered lower by patients in the group A. The ultrasonography contribution is certain, making the surgical technique more reliable and accurate.
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Old 3rd October 2011, 01:32 PM
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Default Re: Achilles tendon rupture

The non-operative functional management of patients with a rupture of the tendo Achillis leads to low rates of re-rupture
R. G. H. Wallace, et al
Journal of Bone and Joint Surgery - British Volume, Vol 93-B, Issue 10, 1362-1366.
Quote:
Controversy surrounds the most appropriate treatment method for patients with a rupture of the tendo Achillis. The aim of this study was to assess the long term rate of re-rupture following management with a non-operative functional protocol.

We report the outcome of 945 consecutive patients (949 tendons) diagnosed with a rupture of the tendo Achillis managed between 1996 and 2008. There were 255 female and 690 male patients with a mean age of 48.97 years (12 to 86). Delayed presentation was defined as establishing the diagnosis and commencing treatment more than two weeks after injury. The overall rate of re-rupture was 2.8% (27 re-ruptures), with a rate of 2.9% (25 re-ruptures) for those with an acute presentation and 2.7% (two re-ruptures) for those with delayed presentation.

This study of non-operative functional management of rupture of the tendo Achillis is the largest of its kind in the literature. Our rates of re-rupture are similar to, or better than, those published for operative treatment. We recommend our regime for patients of all ages and sporting demands, but it is essential that they adhere to the protocol.
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Old 22nd October 2011, 02:46 PM
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Default Re: Achilles tendon rupture

A meta-analysis of randomised controlled trials comparing conventional to minimally invasive approaches for repair of an Achilles tendon rupture
Samuel E. McMahon, Toby O. Smith
Foot and Ankle Surgery; Volume 17, Issue 4, December 2011, Pages 211-217
Quote:
Achilles tendon ruptures are a common injury afflicting predominantly the young male occasional sportsman. Previous studies have shown that outcome is better with surgical repair for the young active patient. There is no consensus as to whether there is a difference in outcome between open and percutaneous minimally invasive surgery (MIS). A meta-analysis was undertaken to compare the clinical outcomes of MIS with conventional open surgical repair. Six randomised controlled trials of 277 Achilles tendon repairs were eligible for review. This included 136 minimally invasive repairs and 141 conventional open repairs. On analysis, there was no significant difference between the two surgical approaches in respect to the incidence of re-rupture, tissue adhesion, sural nerve injury, deep infection and deep vein thrombosis (p > 0.05). However, MIS had a significantly reduced risk of superficial wound infection, with three times greater patient satisfaction for good to excellent results compared with conventional open surgical approaches.
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Old 1st November 2011, 11:56 PM
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Default Re: Achilles tendon rupture

Chronic Achilles tendon rupture reconstruction using a free semitendinosus tendon graft transfer.
Sarzaeem MM, Lemraski MM, Safdari F.
Knee Surg Sports Traumatol Arthrosc. 2011 Oct 29.
Quote:
PURPOSE:
The purpose of this study was to evaluate the outcomes following reconstruction of the chronic Achilles tendon ruptures with large gaps (>6 cm) using free semitendinosus tendon graft transfer.

METHODS:
There were 11 consecutive patients underwent the above-mentioned surgical technique for the treatment of chronically ruptured Achilles tendon contributed in current study and were followed up prospectively for a mean of 25 ± 3 months. The intraoperative tendon defect was greater than 6 cm in all of the patients. Functional and clinical assessment was performed using The American Orthopaedic Foot and Ankle Society (AOFAS) and Achilles Tendon Rupture Score (ATRS).

RESULTS:
The average AOFAS and ATRS improved significantly from 70 ± 5 and 32 ± 6 preoperatively, to 92 ± 5 and 89 ± 4 points post-operatively (P = 0.001). The range of dorsiflexion was significantly limited on the operated side (13 ± 4° vs. 17 ± 4°) (P = 0.04). All patients were able to stand on the tiptoe of injured leg, and no patient walked with a visible limp. Post-operative complications included one patient with symptomatic DVT and 2 patients with superficial infection treated nonoperatively.

CONCLUSIONS:
The technique offers good clinical and functional outcomes and is safe. Reconstruction of the chronic Achilles tendon ruptures with free semitendinosus tendon graft in patients with defects greater than 6 cm is recommended.
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Old 2nd November 2011, 09:11 PM
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Default Re: Achilles tendon rupture

Hi All
Not one reply!
No one should let this go through to the keeper!

The post surgical people could stand tip toe on the surgically corrected leg.

Hey
cannot most people irrespective of age and fitness who have a complete rupture of the Achilles stand tip toe on the affected leg?

That is why using standing on tip toe is a useless test for Achilles Rupture in the first place....

Time to read the literature me thinks.

About to snow in Queenstown NZ.. a bit like USA odd weather. Supposed to last for 24 hours

Regards
Paul Conneely
www.poeraleducation.com

Last edited by musmed : 2nd November 2011 at 09:12 PM. Reason: wrong spelling
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Old 2nd November 2011, 09:14 PM
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Default Re: Achilles tendon rupture

[quote=musmed;232679]Hi All
Not one reply!
No one should let this go through to the keeper!

The post surgical people could stand tip toe on the surgically corrected leg.

Hey
cannot most people irrespective of age and fitness who have a complete rupture of the Achilles stand tip toe on the affected leg?

That is why using standing on tip toe is a useless test for Achilles Rupture in the first place....

Time to read the literature me thinks.

About to snow in Queenstown NZ.. a bit like USA odd weather. Supposed to last for 24 hours or so.

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www.portaleducation.com
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Old 7th November 2011, 11:22 AM
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Default Re: Achilles tendon rupture

A Case of “Fresh Rupture” after Open Repair of a Ruptured Achilles Tendon
Paul R.P. Rushton, Alok K. Singh, Rajiv G. Deshmukh
Jnl Foot Ank Surg (in press)
Quote:
We present the case of Achilles tendon rupture in a 54-year-old man while rehabilitating after end-to-end open repair of an acute Achilles tendon rupture. Re-rupture after surgical repair of Achilles tendon is well known. The present case, however, is atypical, because the second rupture occurred significantly proximal to the first rupture. To our knowledge, this is the first time this has been described in English language studies. We have termed this incident a fresh rupture. A gastrocnemius turndown flap was used to repair the fresh rupture, which led to a satisfactory recovery. This case report serves to inform surgeons of the existence of this type of Achilles tendon rupture, while considering the possible etiologies and suggesting a technique that has been shown to be successful in the present case.
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Old 14th November 2011, 01:29 PM
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Default Re: Achilles tendon rupture

This clinical trial was just registered:

Non-operative Treatment of Acute Achilles Tendon Rupture Using Dynamic Rehabilitation. Influence of Early Weight-bearing Compared With Non-weight-bearing
Quote:
Acute achilles tendon rupture is relatively frequent (11 to 37 per 100,000). There are great social benefits in optimizing treatment and shortening recovery.

There is no consensus concerning the best treatment of acute achilles tendon rupture. Traditionally, surgical treatment is considered superior, but more recent studies show evidence that non-operative treatment with early dynamic rehabilitation gives the same functional outcome with fewer side effects.

Traditionally non-operative treatment involves non-weightbearing for 6 weeks. This is not evidence based rather due to tradition. It is well documented that mechanical load improves tendon healing in general and has no detrimental effect on the healing of operated achilles tendons.

The objective of this randomized study is to compare early weight-bearing with non-weight-bearing following non-operative treatment of acutely ruptured Achilles tendons.
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Old 16th November 2011, 12:11 PM
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Default Re: Achilles tendon rupture

A systematic review of patient-reported outcome measures used to assess Achilles tendon rupture management: What's being used and should we be using it?
Rebecca S Kearney, Juul Achten, Sarah E Lamb, Caroline Plant, Matthew L Costa
Br J Sports Med doi:10.1136/bjsports-2011-090497
Quote:
Background Currently, there is no consensus regarding the optimal management for patients following an Achilles tendon rupture. To allow comparisons between different treatments, a universally accepted outcome measure is required. However, there are currently a range of these reported within the literature.

Objective To recommend the most suitable patient-reported outcome measure for the assessment of patients following an Achilles tendon rupture, based on a systematic review of first what is currently used and second evidence of validity.

Methods The electronic databases MEDLINE, EMBASE and AMED were searched up to September 2010. Predefined inclusion and exclusion criteria were applied to identify what outcome measures are reported in the literature. Aspects of validity were defined and a checklist used to determine which aspects have been evaluated.

Results Twenty-one outcome measures in 50 research papers were identified. The most commonly used was the American Orthopaedic Foot and Ankle Society hind-foot score. Of the 21 outcome measures, only 4 cited independent validation data. Of these four, only the ‘Achilles tendon Total Rupture Score’ reported evidence to support multiple facets of validity, as defined by a predetermined criteria checklist.

Conclusions The Achilles tendon Total Rupture Score was identified as the only outcome measure which has demonstrated multiple facets of validity for use in this patient group. However, even this tool has limitations. Researchers should be aware of the limitations of the available outcome measurement tools and check on their validity before use in clinical research.
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Old 21st December 2011, 09:26 AM
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Default Re: Achilles tendon rupture

"Hey
cannot most people irrespective of age and fitness who have a complete rupture of the Achilles stand tip toe on the affected leg?"

Hi
Just saw this post.
No, if you have a rupture of the achilles you cannot stand tip toe.
Steve
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Old 24th January 2012, 01:41 PM
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Default Re: Achilles tendon rupture

A systematic review of early rehabilitation methods following a rupture of the Achilles tendon.
Kearney RS, McGuinness KR, Achten J, Costa ML.
Physiotherapy. 2012 Mar;98(1):24-32
Quote:
OBJECTIVES:
Rupture of the Achilles tendon is a debilitating injury. Advances have led to the development of immediate weight bearing rehabilitation. A range of early rehabilitation methods exist, but further research is required into this new area. The first stage in the investigation of a complex intervention is to identify its defining components. The aim of this review was to systemically identify and summarise, from clinical studies, the individual components that define immediate weight bearing rehabilitation protocols for the treatment of acute Achilles tendon rupture's.

DATA SOURCES:
The electronic databases MEDLINE, EMBASE, CINAHL, AMED and the register of current controlled trials were searched up to March 2010.

REVIEW METHODS:
All study designs and languages were included. Two independent reviewers used pre-defined inclusion and exclusion criteria to identify all eligible articles. Eligible articles were summarised and critically reviewed, using the extension of the CONSORT statement for non-pharmacological interventions.

RESULTS:
Two hundred and fifteen articles were screened, nine were included. These studies, presented the results of 424 patients; 236 who had surgery and 188 who were managed non-operatively. There were a range of rehabilitation protocols that were defined by four components. These components consisted of the degree of maintained plantarflexion, whether daily range of movement exercises were permitted, the type of orthotic and for how long it was worn.

CONCLUSIONS:
The efficacy of different immediate weight bearing rehabilitation protocols following an acute rupture of the Achilles tendon remains unclear. Further research is required to evaluate the identified components to optimise rehabilitation.
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Old 24th January 2012, 05:16 PM
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Default Re: Achilles tendon rupture

Hi all
It just shows how much rubbish it out there.
only 9 papers considered out of 400+
Even then they could not make up their minds one way or the other.
Reader beware!
Regards from Aussie
Paul Conneely
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