Soft tissue microcirculation around the healthy Achilles tendon: a cross-sectional study focusing on the Achilles tendon and dorsal surgical approaches to the hindfoot

Abstract

BackgroundDorsal approaches to the hindfoot are frequently used. Furthermore, the vascular supply is discussed as a possible cause for ruptures and degeneration of the Achilles tendon. The aim of this study was to evaluate the microperfusion of three possible posterior approaches to the hindfoot and different areas of the Achilles tendon.MethodsIn 111 subjects, a laser Doppler/white light spectroscopy was used to measure microperfusion in terms of blood flow (Flow) and capillary venous oxygen saturation (SO2) in the hindfoot and Achilles tendon. Measurements were performed at two measurement points (MP, proximal and distal) of three dorsal approaches (medial, lateral and central) and inside the Achilles tendon.ResultsMicroperfusion differed partially between the surgical approaches. The medial and the lateral approaches were significantly superior to the central approach with regard to Flow in both MP (p < 0.001), while SO2 was significantly higher at the proximal measurement point (MP 1; p < 0.001). In this area, the lateral approach was significantly superior to the medial approach regarding Flow (MP 1; p = 0.012).The Achilles tendon exhibited a significantly reduced microperfusion 5 cm proximal to the calcaneal tubercle (SO2 p = 0.001; Flow p = 0.048). Demographic factors, such as body mass index and age, had different effects. Microcirculation was partially superior in men and negatively affected by smoking.ConclusionsSoft tissue microcirculation on the lateral and medial side of the healthy Achilles tendon was better than centrally on the tendon. Proximally, the lateral approach was better than the medial approach. These circumstances could provide advantages regarding the surgical approach. The Achilles tendon exhibited significantly reduced microperfusion at the typical side of degeneration and rupture. This circumstance could be a possible cause of degenerative processes.

Influence of Achilles tendon rupture site on surgical repair outcomes

“…10 Recent studies have found reduced capillary oxygen saturation and microperfusion at 5 cm above the calcaneal tubercles compared with those at 1 cm above the calcaneal tubercles. 12 These reports on the avascular region have indicated that the proximal Achilles tendon rupture has insufficient blood supply and serves as a risk factor affecting the surgical repair outcomes. However, the relation between proximal Achilles tendon rupture and unsatisfactory postoperative outcome has not been reported.…”

Outcomes of U-shaped internal fixation in the treatment of avulsion fracture of calcaneal tubercle

“…The avulsion fracture of calcaneal tubercle was classified using the method described by Beavis et al [ 18 ]. The inclusion criteria for the research were as follows: [ 1 ] acute, avulsion fracture of calcaneal tubercle (grade I and II) determined according to the classification described by Beavis et al; [ 2 ] no more than 14 days of trauma; [ 3 ] signed informed consent. The exclusion criteria were as follows: [ 1 ] other types (grade III); [ 2 ] no signed informed consent; [ 3 ] previous surgery on the heel; [ 4 ] history of avulsion fracture of calcaneal tubercle or other heel trauma.…”

“…Calcaneal tubercle is an important part of heel, which is of great significance in maintaining foot arch and buffering weight [ 1 , 2 ]. Avulsion tubercle fracture of calcaneus is common in the elderly and athletes.…”

Microcirculation After Trochanteric Femur Fractures: A Prospective Cohort Study Using Non-invasive Laser-Doppler Spectrophotometry

“…In previous studies, differences in microcirculation were found between surgical approaches in spine surgery, i.e., less impairment of microcirculation in minimally invasive surgery of the spine compared to open surgery (Ganse et al, 2017). Distinctions in microcirculation between approaches in Achilles tendon surgery in healthy subjects (Klos et al, 2018), gender differences in skin microcirculation over the calcaneus (Carow et al, 2018) and effects of pulsed ultrasound therapy in the foot were published (Kösters et al, 2017).…”