Percutaneous Repair Followed by Accelerated Rehabilitation for Acute Achilles Tendon Ruptures

Al-Mouazzen, Louay; Rajakulendran, Karthig; Najefi, Ali; Ahad, Nurul

doi:10.1177/230949901502300320

Cited by 12 publications

(10 citation statements)

References 35 publications

(32 reference statements)

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“…The outcomes in this study are similar to others regarding symptoms reflected by the ATRS 1 , 5 , 6 , 33 , 36 and function, as well as the HRHI, except for at the 3-month time point when 30% of patients in this study were able to perform a single-heel rise compared with 50% in the series of Olsson et al 31 The reason could be differences in the rehabilitation or patient evaluation. In the series of Olsson et al, the evaluation was performed after a warm-up exercise period, including double-heel rise, prior to assessment.…”

Section: Discussionsupporting

confidence: 85%

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Functional Outcomes of Achilles Tendon Minimally Invasive Repair Using 4- and 6-Strand Nonabsorbable Suture: A Cohort Comparison Study

Carmont

Zellers

Brorsson

et al. 2017

Orthopaedic Journal of Sports Medicine

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Background:The aim of management of Achilles tendon rupture is to reduce tendon lengthening and maximize function while reducing the rerupture rate and minimizing other complications.Purpose:To determine changes in Achilles tendon resting angle (ATRA), heel-rise height, patient-reported outcomes, return to play, and occurrence of complications after minimally invasive repair of Achilles tendon ruptures using nonabsorbable sutures.Study Design:Cohort study; Level of evidence, 3.Methods:Between March 2013 and August 2015, a total of 70 patients (58 males, 12 females) with a mean age of 42 ± 8 years were included and evaluated at 6 weeks and 3, 6, 9, and 12 months after repair of an Achilles tendon rupture. Surgical repair was performed using either 4-strand or 6-strand nonabsorbable sutures. After surgery, patients were mobilized, fully weightbearing using a functional brace. Early active movement was permitted starting at 2 weeks.Results:There were no significant differences in the ATRA, Achilles Tendon Total Rupture Score (ATRS), and Heel-Rise Height Index (HRHI) between the 4- and 6-strand repairs. The mean (SD) relative ATRA was –13.1° (6.6°) (dorsiflexion) following injury; this was reduced to 7.6° (4.8°) (plantar flexion) directly after surgery. During initial rehabilitation at 6 weeks, the relative ATRA was 0.6° (7.4°) (neutral) and –7.0° (5.3°) (dorsiflexion) at 3 months, after which ATRA improved significantly with time to 12 months (P = .005). At 12 months, the median ATRS was 93 (range, 35-100), and the mean (SD) HRHI and Heel-Rise Repetition Index were 81% (0.22%) and 82.9% (0.17%), respectively. The relative ATRA at 3 and 12 months correlated with HRHI (r = 0.617, P < .001 and r = 0.535, P < .001, respectively).Conclusion:Increasing the number of suture strands from 4 to 6 does not alter the ATRA or HRHI after minimally invasive Achilles tendon repair. The use of a nonabsorbable suture during minimally invasive repair when used together with accelerated rehabilitation did not prevent the development of an increased relative ATRA. The ATRA at 3 months after surgery correlated with heel-rise height at 12 months.

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Section: Discussionsupporting

confidence: 85%

“… 3 , 12 The use of a modified Bunnell suture proximally and a modified Kessler suture distally is an established technique, 4 producing good functional outcomes when combined with accelerated rehabilitation. 1 , 6 , 17 , 26 – 28 …”

mentioning

confidence: 99%

Functional Outcomes of Achilles Tendon Minimally Invasive Repair Using 4- and 6-Strand Nonabsorbable Suture: A Cohort Comparison Study

Carmont

Zellers

Brorsson

et al. 2017

Orthopaedic Journal of Sports Medicine

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“…Para Al-Mouazzen et al [6] e Carmont et al [7], as rupturas tendíneas do pé e do tornozelo podem ser agudas (pós-traumáticas) ou lentas e progressivas por degeneração do tendão, e quando não tratadas ou diagnosticadas erroneamente são responsáveis por gerar deformidades e incapacidades funcionais no paciente. O tendão calcâneo, por exemplo, é o tendão no membro inferior que é rompido com maior frequência com a incidência de 5,5 a 10 para 100.000 pessoas na população norte americana.…”

Section: N T R O D U ç ã Ounclassified

“…Este estudo retrospectivo evidenciou a maior frequência de ruptura do tendão calcâneo em relação aos demais tendões analisados, corroborando dados da literatura preexistente de Al-Mouazzen et al [6] e Carmont et al [7]. Além disso, a média de idade dos pacientes e a etiologia traumática das lesões tendíneas também se mostraram semelhantes aos estudos prévios de Bertelli et al [2].…”

Section: I S C U S S ã Ounclassified

Tendinopatias do pé e tornozelo

Bittar¹,

Ricci²,

Costa³

et al. 2019

Rev. Ciênc. Méd.

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ObjetivoAvaliar a etiologia das tendinopatias e as diferentes técnicas cirúrgicas utilizadas na reparação dos tendões calcâneos, tibial posterior, tibial anterior, fibular curto e fibular longo e apresentar os resultados clínico-funcionais, grau de satisfação dos pacientes e as complicações pós-cirúrgicas.MétodosEstudo retrospectivo de 88 pacientes com lesões degenerativas ou agudas dos tendões calcâneo, tibial anterior, tibial posterior, fibular curto e fibular longo, entre o período de 2005 a 2017.ResultadosDos 88 pacientes analisados, 50 eram do sexo masculino e 38 do sexo feminino, com idade média de 49 anos. A frequência de lesão foi de 54% para o membro direito,40% para o membro esquerdo e 6% para ambos os pés. O mecanismo de ruptura predominante foi o degenerativo, em 56% dos pacientes. A maioria dos indivíduos (49%) apresentou lesões no tendão calcâneo e a técnica cirúrgica com a utilização do tendão semitendíneo foi empregada na maioria dos casos (41%). Os resultados clínicos funcionais obtidos pelo Questionário da American Orthopaedic Foot and Ankle Society no pós-operatório, após um tempo médio de 18 meses, foram de 87 pontos (variando de 65 a 92). Houve complicação na área receptora em apenas 5 pacientes.ConclusãoO reparo cirúrgico das tendinopatias mostrou-se extremamente efetivo na reabilitação funcional dos pacientes, com uma baixa taxa de complicações e elevado grau de satisfação dos pacientes.

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“…Biomechanische Tests finden weltweit aufgrund ihres finanziellen Aufwands eine geringe Anwendung, was sich in der geringen Anzahl vorliegender Studien widerspiegelt. Die Angaben in der Literatur zur Beurteilung des Operationsergebnisses nach Achillessehnenruptur anhand verschiedenen Operationsmethoden beschränkt sich hauptsächlich auf subjektive Scores, Re-Rupturen oder andere Komplikationsraten wie Wundinfektionen [1,6,12,23,24]. Viele der Evaluationen, die biomechanische Messver-fahren anwendeten, wurden erst 2 -5 Jahre nach Operation erhoben [5,8,14,17].…”

Section: Hintergrundunclassified

Biomechanische Evaluation des Rehabilitationsverlaufs nach operativer Versorgung der Achillessehnenruptur

Mauch¹,

Ulrich²,

Kaelin³

et al. 2017

Sportverletz Sportschaden

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Muscles and tendons are subjected to a high level of stress in everyday life and sports. This often leads to injuries and is associated with training failure and reduced performance as well as with high costs for treatment and rehabilitation. Fast and successful treatment is therefore very important, both from an athletic and economic point of view. This study aims to demonstrate the relevance of biomechanical procedures for the objective monitoring of rehabilitation. At the same time, the results are to be used to establish progress and evaluation criteria for an efficient and controlled rehabilitation. In a retrospective study, a total of 42 patients were evaluated biomechanically after surgical repair of a complete Achilles tendon rupture 18 (18 W) and 26 weeks (26 W) postoperatively. Ground reaction forces in barefoot walking on a treadmill as well as isokinetic maximum strength for the plantar flexors and dorsal extensors were assessed. The push-off force on the injured side increased from 0.88 (18 W) to 0.95 (26 W). The percentage of heel contact time on the injured side was 59 % at 18 W and 55 % at 26 W. Plantar flexion torque increased from 70 Nm (18 W) to 90 Nm (26 W) on average on the injured side. The percentage of the plantar flexion deficit (injured/non-injured side) decreased from 34 % to 21 % on the two postoperative measuring dates. The described biomechanical methods allow for a quantitative assessment and an objective control of the rehabilitation process. The results can also be used for the definition of evaluation and progression criteria in order to assess the progress of a patient's therapy and to guide the rehabilitation process in a controlled manner.

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Percutaneous Repair Followed by Accelerated Rehabilitation for Acute Achilles Tendon Ruptures

Cited by 12 publications

References 35 publications

Functional Outcomes of Achilles Tendon Minimally Invasive Repair Using 4- and 6-Strand Nonabsorbable Suture: A Cohort Comparison Study

Functional Outcomes of Achilles Tendon Minimally Invasive Repair Using 4- and 6-Strand Nonabsorbable Suture: A Cohort Comparison Study

Tendinopatias do pé e tornozelo

Biomechanische Evaluation des Rehabilitationsverlaufs nach operativer Versorgung der Achillessehnenruptur

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