Treatment of Catastrophic Infection After Surgery for Insertional Achilles Enthesopathy

Kane, Justin M.; Raikin, Steven M.

doi:10.1177/1938640014546864

Cited by 6 publications

(8 citation statements)

References 16 publications

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“…Complications from Achilles tendon surgery were reported previously 11,12,16 and include delayed wound healing, wound infection, sural nerve injury, rerupture, foreign-body reaction to sutures or implantations, and deep vein embolism. The complication rate was as high as 10%.…”

Section: Discussionmentioning

confidence: 99%

Optimal Outcomes for Acute Avulsion Fracture of the Achilles Tendon Treated With the Insertional Reattachment Technique: A Case Series of 31 Cases With Over 2 Years of Follow-up

Chen

et al. 2019

Am J Sports Med

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Background: Avulsion fracture of the Achilles tendon is a less common but debilitating disorder. There is a paucity of literature on this problem. Purpose: To present a retrospective case series assessing the clinical outcomes of avulsion fracture of the Achilles tendon after a reattachment procedure and to identify potential factors predicting postoperative outcomes. Study Design: Case series; Level of evidence, 4. Methods: A consecutive case series of 35 patients with acute insertional rupture of the Achilles tendon who received a reattachment procedure between 2011 and 2017 were reviewed. All patients were measured and classified by magnetic resonance imaging (MRI) and surgical findings. Patient-reported outcomes were evaluated using the visual analog scale (VAS) for pain, American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Scale, Foot Function Index (FFI), Tegner score, and Ankle Activity Score (AAS). The range of motion and single-legged heel raise test were also conducted for both ankles. Results: Thirty-one out of 35 (88.57%) patients were followed up for an average of 43.65 months. The VAS pain score and AOFAS Ankle-Hindfoot score improved from 4.87 ± 1.61 preoperatively to 2.07 ± 1.57 postoperatively and from 58.32 ± 18.66 preoperatively to 87.32 ± 7.53 postoperatively, respectively (both P < .001). The mean FFI, AAS, and Tegner scores after the operation were 11.84 ± 1.62, 5.71 ± 2.18, and 4.61 ± 1.31, respectively. Compared with the intact ankle, the mean deficit in dorsiflexion in the involved ankle was 9.54°± 6.25° (range, 0.59°-23.70°; P < .001) and the mean deficit in plantarflexion in the involved ankle was 6.31°± 4.02° (range, 0.24°-14.92°; P < .001). Thirty patients could perform the single-legged heel raise on the operative leg. A larger body mass index was associated with worse postoperative AOFAS and FFI outcomes. Longer follow-up predicted statistically significantly better FFI scores. Better postoperative dorsiflexion was associated with better postoperative FFI, AAS, and Tegner scores, and a statistically significant interaction was found between the VAS score and plantarflexion deficit. Age, preoperative insertional tenderness, Haglund deformity, and MRI classification showed little association with postoperative outcomes. Conclusion: This study demonstrated that the reattachment procedure for acute avulsion fracture of the Achilles tendon can achieve firm fixation and promising outcomes.

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Section: Discussionmentioning

confidence: 99%

Optimal Outcomes for Acute Avulsion Fracture of the Achilles Tendon Treated With the Insertional Reattachment Technique: A Case Series of 31 Cases With Over 2 Years of Follow-up

Chen

et al. 2019

Am J Sports Med

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“…These opinions range from extensive debridement with functional rehabilitation alone, 2,8 to local tendon/tissue transfer, 1,6,10,16,17,21 to free flaps. 7,9,11,13-15 Additional variations of treatment include single versus staged procedures, 3,12 the utilization of cement spacers, 3,12 tissue expanders. 12 and negative-pressure wound therapy.…”

Section: Rationalementioning

confidence: 99%

“…7,9,11,[13][14][15] Additional variations of treatment include single versus staged procedures, 3,12 the utilization of cement spacers, 3,12 tissue expanders. 12 and negative-pressure wound therapy. 18,20 Given the heterogeneity of the literature and the lack of any high-level of evidence publications on the subject matter, we are unable to formulate a definitive consensus statement with regard to soft tissue coverage of the infected Achilles tendon following a prior repair/reconstruction.…”

Section: Rationalementioning

confidence: 99%

“…3 Positive histologic findings include aggregates of inflammatory cells (neutrophils, lymphocytes, histiocytes and plasma cells), erosion of trabecular bone, marrow changes (fat necrosis, edema, fibrosis, and reactive bone formation). 3,7,12 Other causes of inflammation may give false-positive histologic results, whereas sampling errors can give a false negative result. Histologic analysis may have better sensitivity than bacteriologic cultures, as the latter is often performed under flawed conditions.…”

Section: Fundingmentioning

confidence: 99%

“…Histologic analysis may have better sensitivity than bacteriologic cultures, as the latter is often performed under flawed conditions. However, a study by Meyr et al 12 has questioned the statistical reliability of the histopathologic diagnosis of diabetic foot osteomyelitis using bone biopsies, quoting a 41% of clinically significant disagreement between diffierent pathologists,…”

Section: Fundingmentioning

confidence: 99%

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What Is the Treatment “Algorithm” for Infection After Achilles Tendon Repair/Reconstruction?

Winters

Lorenzo²,

Beck

2019

Foot Ankle Int.

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Recommendation: The initial treatment of an infected Achilles tendon reconstruction should include thorough debridement of all infected tissues with the removal of retained sutures or foreign material. Cultures should be taken at the time of debridement, and antibiotic administration should be dictated by the result of culture and continued until inflammatory markers and clinical symptoms normalize. If significant soft tissue defect in the overlying area remains, the choice of tendon reconstruction and/or transfer with soft tissue coverage should be left up to the discretion of the treating surgeon based on preference and expertise. Revision reconstruction should be delayed until the infection is cleared. Level of Evidence: Moderate. Delegate Vote: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).

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Komplikationen in der Therapie von Achillessehnenrupturen

Weisskopf

Röhm

2015

Sports Orthopaedics and Traumatology Sport-Orthopädie - Sport-T

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Treatment of Catastrophic Infection After Surgery for Insertional Achilles Enthesopathy

Abstract: Therapeutic, Level IV: Case report.

Cited by 6 publications

References 16 publications

Optimal Outcomes for Acute Avulsion Fracture of the Achilles Tendon Treated With the Insertional Reattachment Technique: A Case Series of 31 Cases With Over 2 Years of Follow-up

Optimal Outcomes for Acute Avulsion Fracture of the Achilles Tendon Treated With the Insertional Reattachment Technique: A Case Series of 31 Cases With Over 2 Years of Follow-up

What Is the Treatment “Algorithm” for Infection After Achilles Tendon Repair/Reconstruction?

Komplikationen in der Therapie von Achillessehnenrupturen

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