Thomas E Klootwyk | Search PubMed

PubMed2005

Potential risk of rerupture in primary achilles tendon repair in athletes younger than 30 years of age.

BACKGROUND: Complete Achilles tendon ruptures are found more often in athletes who participate in sports involving explosive acceleration or maximal effort. In most studies, the consensus for athletes is surgery. This form of treatment has been shown to exhibit the best functional performance with a lower rerupture rate. HYPOTHESIS: Achilles tendon ruptures in a young population (<30 years) have a higher rerupture rate than similar injuries in an older age group (31-50 years), in which the injury is more common. STUDY DESIGN: Cohort study; Level of evidence, 4. METHODS: Retrospective study was carried out by chart review. Magnetic resonance images were obtained comparing appearance of repair in young and old patients at 8 to 12 weeks after operation. RESULTS: There were a total of 4 reruptures in the 89 Achilles tendon repairs. This was an overall rerupture rate of 4.5%, which was consistent with the literature. When the reruptures were critically analyzed, it was noted that the 4 reruptures of the repaired tendon occurred in a young population. Of the 89, there was a subgroup of athletes (n=24) who were 30 years of age or younger at the time of injury. The incidence of rerupture for these individuals was 16.6%. In the remaining athletes (n=65) older than 30 years, the incidence of rerupture was zero. There were no significant differences (P < or =.05) in all parameters measured (average days in a boot, average days to active range of motion, average time to full weight-bearing, average days to bike or use a stair climbing machine, average return to sports) between age groups except in the time from injury to surgery (7.1 days, for athletes < or =30 years vs 2.65 days for athletes >31 years). CONCLUSIONS: The results of Achilles tendon repair with an early weightbearing and an early range of motion rehabilitation program are good. However, caution may need to be taken in the younger athlete (< or =30 years) during rehabilitation. CLINICAL RELEVANCE: Although the authors recommend aggressive rehabilitation for Achilles tendon repairs, caution should be observed in the younger athlete.

Achilles Tendon↗

PubMed2002

Cryotherapy and Transcutaneous Electric Neuromuscular Stimulation Decrease Arthrogenic Muscle Inhibition of the Vastus Medialis After Knee Joint Effusion.

OBJECTIVE: Arthrogenic muscle inhibition (AMI) is a presynaptic, ongoing reflex inhibition of joint musculature after distension or damage to the joint. The extent to which therapeutic interventions affect AMI is unknown. The purpose of this study was to verify that the vastus medialis (VM) is inhibited using the knee joint effusion model and to investigate the effects of cryotherapy and transcutaneous electric nerve stimulation (TENS) on AMI using this model. DESIGN AND SETTING: A 3 x 6 analysis of variance was used to compare Hoffmann-reflex data for treatment groups (cryotherapy, TENS, and control) across time (preinjection, postinjection, and 15, 30, 45, and 60 minutes after injection). SUBJECTS: Thirty neurologically sound volunteers (age = 21.8 +/- 2.4 years; height = 175.6 +/- 9.6 cm; mass = 71.5 +/- 13.3 kg) participated in this study. MEASUREMENTS: Hoffmann-reflex measurements were collected using a percutaneous stimulus to the femoral nerve and surface electromyography of the VM. RESULTS: Hoffmann-reflex measurements from the cryotherapy and TENS groups were greater than measurements from the control group at 15 and 30 minutes after injection. Measurements from the cryotherapy group were greater than for the TENS group, and measurements for the TENS group were greater than those for the control group at 45 minutes. At 60 minutes, the cryotherapy group measurements were greater than the TENS and control group measures. Measurements at 15, 30, 45, and 60 minutes after injection were reduced compared with the preinjection and postinjection measurements in the control group. Measurements in the cryotherapy group at 30, 45, and 60 minutes were greater than the preinjection, postinjection, and 15-minute data. No differences between time intervals existed in the TENS group. CONCLUSIONS: Artificial knee joint effusion results in VM inhibition. Cryotherapy and TENS both disinhibit the quadriceps after knee joint effusion, and cryotherapy further facilitates the quadriceps motoneuron pool. Cryotherapy treatment resulted in facilitation of the VM motoneuron pool during the post-treatment phase. The TENS treatment failed to disinhibit the VM motoneuron pool by 30 minutes postinjection.

Journal Article↗