Dynamic Ultrasound Assessment of the Effects of Knee and Ankle Position on Achilles Tendon Apposition Following Acute Rupture

Qureshi, Assad; Ibrahim, Talal; Rennie, Winston J.; Furlong, Andrew

doi:10.2106/jbjs.j.01757

Cited by 19 publications

(15 citation statements)

References 14 publications

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“…5 Ultrasound may be used to identify the location of the rupture, the amount of tissue torn and, importantly, the ability of the torn tendon tissue to oppose in varying positions of equinus. 6,7 This is therefore an essential investigation. For patients who are treated conservatively, knowledge of the optimum position for immobilisation is obtained by using ultrasound to place the ankle in a position in which the ends of the tendon ends oppose, rather than overlap or fail to approximate.…”

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confidence: 99%

The treatment of a rupture of the Achilles tendon using a dedicated management programme

Hutchison

Topliss

Beard

et al. 2015

The Bone & Joint Journal

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The Swansea Morriston Achilles Rupture Treatment (SMART) programme was introduced in 2008. This paper summarises the outcome of this programme. Patients with a rupture of the Achilles tendon treated in our unit follow a comprehensive management protocol that includes a dedicated Achilles clinic, ultrasound examination, the use of functional orthoses, early weight-bearing, an accelerated exercise regime and guidelines for return to work and sport. The choice of conservative or surgical treatment was based on ultrasound findings. The rate of re-rupture, the outcome using the Achilles Tendon Total Rupture Score (ATRS) and the Achilles Tendon Repair Score, (AS), and the complications were recorded. An elementary cost analysis was also performed. Between 2008 and 2014 a total of 273 patients presented with an acute rupture 211 of whom were managed conservatively and 62 had surgical repair. There were three re-ruptures (1.1%). There were 215 men and 58 women with a mean age of 46.5 years (20 to 86). Functional outcome was satisfactory. Mean ATRS and AS at four months was 53.0 (sd 14), 64.9 (sd 15) (n = 135), six months 67.8 (sd 16), 73.8 (sd 15) (n = 103) and nine months (72.4; sd 14) 72.3 (sd 13) (n = 43). The programme realised estimated cost savings exceeding £91,000 per annum. The SMART programme resulted in a low rate of re-rupture, a satisfactory outcome, a reduced rate of surgical intervention and a reduction in healthcare costs.

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confidence: 99%

The treatment of a rupture of the Achilles tendon using a dedicated management programme

Hutchison

Topliss

Beard

et al. 2015

The Bone & Joint Journal

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“…Despite the fact that distal tendinous length has smaller change, it is still difficult to accurately locate the broken position because the tendon sheath remained relatively intact and distal tendon can slide up and down in the lumen of the sheath as well as due to local swelling [38]. Ultrasound can position broken end in surface of projection location, but errors may also occur with ankle joint plantarflexion or dorsiflexion [39]. Some doctors used ultrasound for positioning during surgeries, but they need to have ultrasound knowledge which makes it hard to promote this practice [40].…”

Section: Discussionmentioning

confidence: 99%

Application of Computed Tomography Processed by Picture Archiving and Communication Systems in the Diagnosis of Acute Achilles Tendon Rupture

Han

Tian

et al. 2016

BioMed Research International

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The applications of CT examination in the diagnosis of the acute Achilles tendon rupture (AATR) were investigated. A total of 36 patients with suspected acute Achilles tendon rupture were tested using physical examination, ultrasound, and 3DCT scanning, respectively. Then, surgery was performed for the patients who showed positive result in at least two of the three tests for AATR. 3DVR, MPR, and the other CT scan image processing and diagnosis were conducted in PACS (picture archiving and communication system). PACS was also used to measure the length of distal broken ends of the Achilles tendon (AT) to tendon calcaneal insertion. Our study indicated that CT has the highest accuracy in diagnosis of acute Achilles tendon complete rupture. The length measurement is matched between PACS and those actually measured in operation. CT not only demonstrates more details directly in three dimensions especially with the rupture involved calcaneal insertion flap but also locates the rupture region for percutaneous suture by measuring the length of distal stump in PACS without the effect of the position of ankle. The accuracy of CT diagnosis for Achilles tendon partial rupture is yet to be studied.

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“…Finally, several authors have recommended using an above the knee cast with a knee flexion to relax the gastrocnemius, which further reduces the gap distance. However, recent studies have indicated that tendon gap distance decreases by only 1 mm with a knee flexion in the order of 30°. Furthermore, this method has no clinical significance on the magnitude of change in gap distance and increases the risk of a thromboembolism because it is cumbersome.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous Repair Technique for Acute Achilles Tendon Rupture with Assistance of Kirschner Wire

Chai²,

Liu

et al. 2015

Orthopaedic Surgery

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The aim of this study is to introduce a self-designed, minimally invasive technique for repairing an acute Achilles tendon rupture percutaneously. Comparing with the traditional open repair, the new technique provides obvious advantages of minimized operation-related lesions, fewer wound complications as well as a higher healing rate. However, a percutaneous technique without direct vision may be criticized by its insufficient anastomosis of Achilles tendon and may also lead to the lengthening of the Achilles tendon and a reduction in the strength of the gastrocnemius. To address the potential problems, we have improved our technique using a percutaneous Kirschner wire leverage process before suturing, which can effectively recover the length of the Achilles tendon and ensure the broken ends are in tight contact. With this improvement in technique, we have great confidence that it will become the treatment of choice for acute Achilles tendon ruptures.

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Dynamic Ultrasound Assessment of the Effects of Knee and Ankle Position on Achilles Tendon Apposition Following Acute Rupture

Abstract: Maximum ankle equinus alone significantly reduces the gap distance after acute Achilles tendon rupture. Increasing knee flexion further reduces the gap distance by small increments that, although significant, may not be clinically important.

Cited by 19 publications

References 14 publications

The treatment of a rupture of the Achilles tendon using a dedicated management programme

The treatment of a rupture of the Achilles tendon using a dedicated management programme

Application of Computed Tomography Processed by Picture Archiving and Communication Systems in the Diagnosis of Acute Achilles Tendon Rupture

Percutaneous Repair Technique for Acute Achilles Tendon Rupture with Assistance of Kirschner Wire

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