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Achilles tendon was evaluated by B scan ultrasound in 54 cases (20 normal and 34 symptomatic subjects). The ultrasonographic features of tendon's diseases were correlated with the anatomical patterns. On the basis on their experience, the authors concluded that ultrasonography is a simple and highly accurate method for the diagnosis of Achilles tendon diseases and that it should be the initial imaging procedure.
Soft tissue and tendon reconstruction after Achilles tendon rupture:Adipofascial sural turnover flap associated with cryopreserved gracilis tendon allograft for complicated soft-tissue tendon losses.A case report and literature review Achilles tendon rupture is often complicated by skin substance loss around the tendon, which is a poorly-vascularized site. Treatment may be conservative or surgical, but the former is not generally accepted by the orthopedic community and is reserved for selected cases, while surgery remains the most widely-used approach. Soft tissue repair at this site is a crucial reconstruction problem, and becomes very complex if skin reconstruction has to be associated with a complex tendon repair. The Authors describe a new approach to the repair of Achilles tendon substance loss compounded by a soft tissue defect, using a cryopreserved gracilis tendon allograft in combination with a distally-based adipofascial sural flap.
The ankle is the site of many sports-related injuries. There is, however, continued debate over which treatment strategies are most effective for various conditions. This article reviews the relevant literature from the past year to shed some light on the ongoing controversy regarding the best treatment options along the treatment continuum, from conservative to operative management, for three common ankle conditions: lateral ankle sprains, Achilles tendonitis, and Achilles tendon rupture.
The effect of Achilles tenotomy on resting blood flow of rat gastrocnemius muscle and Achilles tendon was studied by radioactive microspheres. Tenotomy produced an immediate, marked decrease in both intramuscular and intratendinous blood flow and it remained significantly lowered at both sites till the end of the observation period, i.e., day 18 after tenotomy. The decrease in the resting blood flow was more rapid and pronounced in the Achilles tendon than in the gastrocnemius muscle. Although the blood flow of the Achilles tendon started to recover after the 4th postoperative day, it was still 33% (statistically not significant) lower than that in the controls 18 days after tenotomy. In the gastrocnemius muscle, the 18-day deficit was 38% (p < 0.001), respectively. The results indicate that after division of a rat Achilles tendon the resting blood flow to the gastrocnemius muscle and Achilles tendon is not adequately restored, remaining at a significantly lowered level even 18 days after tenotomy.
This study aims to investigate applicability of poly(epsilon-caprolactone) (PCL) biodegradable films for repair of gaps in Achilles tendons in a rat model, also comparing surgical repair versus no repair approaches. PCL was synthesized with tailor-made properties, then, PCL films were prepared by solvent casting. Seventy-five outbred Sprague-Dawley rats were randomly allocated into five groups: (i) sham operated (skin incision only); (ii) no repair (complete division of the Achilles tendon and plantaris tendon without repair); (iii) Achilles repair (with a modified Kessler type suture); and (iv) plasty of Achilles tendon defects with the biodegradable PCL films, and (v) animals subjected to 1 cm mid-substance defect with no repair. Functional performance was determined from the measurements of hindpaw prints utilizing the Achilles functional index. The animals were killed 8 weeks after surgery and histological and biomechanical evaluations were made. All groups subjected to Achilles tendon division had a significant functional impairment that gradually improved so that by day 28 there were no functional impairments in any group whereas animals with a defect remained impaired. The magnitude of the biomechanical and morphological changes at postoperative 8 weeks were similar for no repair group (conservative), Achilles repair group and tendonplasty group (biodegradable PCL film group). The initial rate of functional recovery was significantly different for primary suture, Achilles repair group and PCL film group (p>0.01). But, at the 28th day, functional recovery was quite similar to the other groups. In summary, our results suggest that the PCL film can be an alternative biomaterial for tendon replacement.
Achilles tendon ruptures are common, and their incidence is increasing. The evidence for best management is controversial, and, in selected patients, conservative management and early mobilization achieves excellent results. Surgery is associated with an increased risk of superficial skin breakdown; however, modern techniques of percutaneous repair that are performed under local anesthesia and followed by early functional rehabilitation are becoming increasingly common, and should be considered when managing such patients.
BACKGROUND: Rupture of the patellar tendon after total knee arthroplasty is a rare and debilitating complication. Proper surgical management of this condition remains controversial. The purpose of this study was to review the results of reconstruction of a ruptured patellar tendon with an Achilles tendon allograft following total knee arthroplasty. METHODS: We reviewed our experience with the use of a fresh-frozen Achilles tendon allograft with an attached calcaneal bone graft to restore extensor function in nine patients with patellar tendon rupture following total knee arthroplasty (five primary and four revision). All patients were examined clinically and radiographically at an average of twenty-eight months. RESULTS: The average knee and functional scores improved from 26 and 14 points, respectively, before the surgery to 81 and 53 points after the surgery. The average extensor lag decreased from 44 degrees preoperatively to 3 degrees postoperatively, and the average range of motion of the knee increased from 88 degrees to 107 degrees. Two grafts failed in the early postoperative period. Both were repaired successfully. Radiographs showed an average proximal patellar migration of 17.8 mm, which did not appear to affect extensor function. CONCLUSIONS: This short-term follow-up study showed that once an Achilles allograft has healed, it can serve as a reliable reconstruction of a ruptured patellar tendon following total knee arthroplasty. This technique may be particularly suited for patients in whom the extensor mechanism was compromised by multiple prior operations. Continued follow-up is necessary to determine the long-term durability of these results.
This is a case report of two children with congenital dislocation of the knee. They have been treated surgically with Z-lengthening of the quadriceps tendon and additional reconstruction of the quadriceps tendon with Achilles tendon allograft to fill in the remaining average 6 cm gap of the tendon. The patients were two girls, 6 and 9 years old. One of them had an operative treatment previously with a tendon lengthening procedure and it was failed and the other patient was untreated before. Preoperatively, untreated case was unable to walk. The other patient was limping. None of them was able to flex their knees beyond the neutral extension position. Postoperatively, both patients were able to walk and the knees were reduced to a range of motion of 0 degrees -95 degrees of flexion. The mean follow-up time was 20 months.
Achilles tendinous collagen fibrils insert into the calcaneus by first passing through a zone that is defined histologically as fibrocartilaginous. This zone consists of four regions: tendon proper, non-mineralized and mineralized fibrocartilage and bone. The function of this zone has not yet been clearly defined. To gain more insight into the role of this fibrocartilaginous zone, collagens present in the zone of the Achilles tendon-calcaneus interface were isolated and characterized. Types II, IX and X collagens were identified in the pepsin digests of the tissue harvested from the bovine Achilles tendon-calcaneus interface. Western blotting using specific antisera to types II, IX and X collagens confirmed the identity of these collagens. Immunofluorescence localization placed type X collagen predominantly in the mineralized zone of the tendon-calcaneus junction, while type IX collagen was distributed throughout the the insertion site. The presence of the cartilage-specific collagens at the Achilles tendon-calcaneus-interface suggests that this zone is cartilaginous in nature. The presence of type X collagen at this junction is not clear, but our present findings go along with the previous report which showed that type X collagen is present in the mineralized zone of the medial collateral ligament femoral insertion site. These data suggest that type X collagen may be a resident of mineralized fibrocartilaginous zones of tendon or ligament-bone junctions and may participate in anchoring ligament or tendon to bone.
The authors present early results of conservative treatment in congenital clubfeet connected with the percutaneous tendon Achilles tenotomy in 10 children (16 feet). 9 feet were of type III and 7 of type IV according to the Dimeglio scale. Minimum follow up was 6 months, with an average follow up period of 10 months. All cut Achilles tendons regenerated completely. On follow up 9 feet were completely corrected, 5 presented with mild forefoot adduction and 2 feet required surgery because of recurrent equinovarus deformity. The authors claim that the percutaneous tendon Achilles tenotomy is a safe and valuable procedure which allows to avoid early surgery in 88% of clubfeet.
Acute ruptures of the Achilles tendon are common. Treatment for such ruptures is well documented. Treatment for chronic ruptures with a significant defect poses a surgical dilemma. The authors present the use of a tendon allograft to replace an Achilles tendon defect with a 2.5-year clinical follow-up inclusive of isokinetic testing.
Multiple surgical techniques for repair of neglected Achilles tendon ruptures have been described in the literature. The authors present a case using a freeze-dried Achilles tendon allograft for repair of a neglected rupture of the Achilles tendon with a defect of 10 cm. At 1-year follow-up, the patient achieved pre-injury functional use of the affected limb.
A study was undertaken to compare the in vitro strengths of percutaneous Achilles tendon repair to open Achilles tendon repair. Ten fresh frozen cadaver below-the-knee specimens underwent Achilles tenotomy. The specimens were divided into two groups of five specimens each. Group I specimens underwent open Achilles repair using a Bunnell suture technique. Group II specimens underwent percutaneous repair. Each specimen was placed on an apparatus which produced progressive ankle dorsiflexion. Measurements of anastomotic gap were correlated with angle of dorsiflexion. Group I anastomoses were able to resist almost twice the amount of ankle dorsiflexion compared to Group II anastomoses (P less than .05). Entrapment of the sural nerve occurred in three out of five specimens in Group II. Percutaneous anastomoses were malaligned in four out of five specimens. Based on this study, percutaneous repair of Achilles tendon ruptures provides approximately 50% of the initial strength afforded by open repair. Percutaneous repair places the sural nerve at risk for injury.
PURPOSE: The purpose of this study was to compare clinical results of arthroscopic posterior cruciate ligament (PCL) reconstructions using double-loop hamstring tendon autograft and Achilles tendon allograft while preserving the original PCL remnant. TYPE OF STUDY: Case-control study of results of treatment. METHODS: From September 1997 to December 2000, 36 patients who received only PCL reconstruction were reviewed retrospectively. Of these, 18 patients received autogenous double-loop hamstring tendon reconstruction (group I) and 18 received Achilles tendon allograft reconstruction (group II). The same PCL reconstruction procedure was performed in both groups. At final follow-up at a minimum of 2 years, patients were evaluated by 4 measures: the International Knee Documentation Committee (IKDC) evaluation, Lysholm knee scores, the posterior draw test, and Telos stress radiography. RESULTS: Between the 2 groups, preoperative demographic factors (age, gender, activity level, and mean duration to surgery) showed no statistically significant difference (P > .05). According to IKDC evaluation of group I, 16 of the 18 knees rated normal or nearly normal, whereas 2 fell into the abnormal category. By the same criteria, 14 of the 18 knees in group II were normal to nearly normal, 3 were abnormal, and 1 was severely abnormal. IKDC scores showed no statistical difference between the 2 groups (P = .98). Postoperative mean Lysholm knee scores were 90 points (range, 78-100) for group I and 85 (range, 70-95) for group II; improvements of 22 and 17 points, respectively. According to the Lysholm knee scores, group I showed slightly better results than did group II, with a statistical significance of P < .01. Telos stress radiography showed the mean difference in posterior translation between the injured and uninjured knees to be 2.2 mm (range, 0 to 7.0 mm) for group I and 2.9 mm (range, 1.0 to 7.0 mm) for group II. The Telos stress test showed no statistical difference between the 2 groups (P = .14). CONCLUSIONS: The clinical outcome was the same for both groups. Despite its comparatively short length and small diameter, the double-loop hamstring tendon autograft was as good as Achilles tendon allograft in PCL reconstruction. LEVEL OF EVIDENCE: Level III, case-control study.
Achilles tendon injuries are common in runners. The aim of the present study was to analyse the training programme, any Achilles tendon problems, muscle tightness and range of motion of the ankle joint, and concentric and eccentric muscle torques of the calf muscles in middle-distance runners with and without Achilles tendon problems. Eighty-three middle-distance runners answered a questionnaire on their sports background, training habits and any injuries. Thirty-four percent had suffered from some type of problem relating to the Achilles tendon. Ten of the athletes who had suffered from Achilles tendon problems and ten who had never had any Achilles tendon trouble were randomly selected. These 20 runners underwent a clinical examination. The range of motion of the ankle joint was recorded objectively by a hydraulic and computerised isokinetic dynamometer by measuring resistance to passive motion. Concentric and eccentric muscle torques of the gastrocnemius-soleus complex were recorded. The runners with Achilles tendon problems had trained for significantly more years and covered significantly longer distances per week than runners without Achilles tendon problems. There were no significant differences in other training methods or in best results over 800 m and 1500 m. Runners with Achilles tendon problems had a significantly lower range of motion of the ankle joint. They also had significantly lower eccentric torques of the gastrocnemius-soleus complex, but no differences in concentric torques were found between the groups.
The great increase in the number of persons engaged in sports in the 30-50 years age group has led to a marked increase in injuries of the tendon of Achilles. In this case there is tearing loose of the Achilles tendon; the bone and the tendon come apart, as in a rupture of Sharpey's fibres. The tack was made in webbing the tendon of Achilles with polydioxanone ligaments to the tuberosity of calcaneus. The question about prophylactic webbing of the degenerated tendon of Achilles on the other side has to be discussed. Assessment of this injury from the viewpoint of the accident insurance company is explained.
INTRODUCTION: Is operative shortening of the achilles tendon an adequate therapy in cases of elongation following conservative treatment of achilles tendon rupture? METHODS: From 11/89 to 12/97, 12 patients underwent achilles tendon shortening (9 male, 3 female, average age 43 years). All patients had an elongated tendon following conservative treatment of achilles tendon rupture. We were able to examine 8 patients (67%) after the operation. The average follow-up period was 35 (7-103) months with an average span between the primary trauma and surgery of 22 (8-45) months. RESULTS: Prior to surgery, all patients complained of weakness, gait disturbance and limitation of activity. At follow-up a subjective weakness of the plantar flexion remained in five and an objective weakness in all patients. We found a decrease of the isometric plantar flexion strength to 52% of the non-operated lower extremity while the maximum calf circumference was only 5% decreased. Only two patients reported of a gait disturbance and activity limitation whereas three patients were free of complaints. Using a modified Trillat score (1,967), 7 patients rated good or very good (1 poor). CONCLUSIONS: Achilles tendon shortening in case of elongation following conservative treatment of achilles tendon rupture helps to decrease gait disturbance and limitation of activity whereas a lack of the isometric plantar flexion strength persists. In our opinion an early decision for achilles tendon shortening might prevent this deficit.