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@#Introduction: To assess outcomes of FHL transfer and V-Y plasty for chronic Achilles rupture due to insertional Achilles tendinopathy. Materials and methods: A case series of 12 patients was conducted between 1st January 2017 and 31st December 2018. The patients had short flexor hallucis longus tendon transfer with gastrocnemius lengthening by V-Y plasty for Achilles tendon rupture. Patients were allowed full weight bearing at six weeks post-operatively, and were followed up at three months and six months post-operatively, when the range of motion of the ankle was examined, and the outcome was assessed using the EFAS score. Results: Of the 12 patients in the study, the majority were males; the mean age was 50.6±8.96 years. A significant improvement in dorsiflexion and plantarflexion was noted at the six-month follow-up compared to the three-month follow-up (P=<0.001 for both). When compared to the normal side, dorsiflexion and plantarflexion of the affected ankle were significantly less at three months but were comparable at six months post-operatively. A significant improvement was noted in the mean EFAS score at the sixmonth follow-up (25.5±5.71) compared to three months (18.6±0.90) post-surgery (P=0.001). Males were also noted to have significantly higher EFAS scores at their six-month follow-up than females (P=0.022). In contrast, a negative correlation was noted between the European Foot and Ankle Society (EFAS) score at the final follow-up and age (P=0.011). Conclusion: FHL tendon transfer with V-Y plasty in chronic Achilles rupture due to insertional Achilles tendinopathy is an effective procedure resulting in the restoration of the ankle range of motion and improvement in functional scores.
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Objective: To investigate the effectiveness of autogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture. Methods: Between June 2015 and June 2018, 16 patients with chronic Achilles tendon ruptures were treated by autogenous tendon reconstruction under total arthroscopy. Of the 16 patients, 11 were males and 5 were females. Their mean age was 40.7 years (range, 21-55 years). The disease duration was 14-20 months (mean, 16.4 months). Preoperative American Orthopaedic Foot and Ankle Society (AOFAS) score was 41.2±2.2 and the pain visual analogue scale (VAS) score was 7.9±1.2. MRI and B-ultrasonography examinations showed that the Achilles tendon was not continuous. The length of Achilles tendon defect was 5.0-10.3 cm, with an average of 5.8 cm. The rupture of the Achilles tendon happened on top of the insertion of the tendon in 4 cases and at the tendon-muscle belly connection in 12 cases. The operation time, intraoperative blood loss, hospital stay, and related complications were recorded. The AOFAS score and VAS score were used to evaluate the improvement of ankle joint function and pain. Results: The average operation time was 77.2 minutes (range, 60-90 minutes). The average intraoperative blood loss was 20.5 mL (range, 15-30 mL). The average hospital stay was 7.2 days (range, 5-10 days). All incisions healed by first intention. There was no skin necrosis, infection, or deep vein thrombosis. All the patients were followed up 8-18 months, with an average of 12 months; and 10 cases were followed up more than 12 months. During the follow-up, there was no Achilles tendon re-rupture, and the symptoms of pain and heel lifting failure significantly improved. MRI reexamination showed that the continuity of Achilles tendon recovered. At 1, 3, 6, and 12 months postoperatively, AOFAS scores significantly improved and VAS scores significantly reduced, except for 1 month postoperatively, the scores at other time points were superior to that before operation, the differences were significant ( P<0.05). Conclusion: Autogenous tendon reconstruction under total arthroscopy in the treatment of chronic Achilles tendon rupture has the advantages of small trauma, rapid functional recovery, and satisfactory surgical efficacy.
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Objective To compare the clinical effectiveness between the channel-assisted mini-invasion and open Achilles shortening for treatment of the elongated Achilles tendon following previous rupture.Methods The clinical data of 19 patients admitted from Dec. 2013 to Dec. 2015 and met the inclusion criteria were analyzed retrospectively. Eight patients were treated with shortening operation by channel-assisted minimally invasive repair system, while 11 patients received dissection of Krackow Achilles tendon shortening. There was no significant difference between the two groups in gender, age, injury to operation time, preoperative calf circumference and preoperative AOFAS (American Orthopaedic Foot & Ankle Society) score (P>0.05).Results The operation time, incision length and postoperative hospital days were significantly less in min-invasion group than in incision group (P0.05).ConclusionChannel-assisted minimally invasive Achilles tendon shortening operation has not only similar effectiveness to the incision shorting operation for the treatment of elongated Achilles tendon following previous rupture, but also has the advantages of shortening operation time and stay in hospital and avoidance of sural nerve injury.
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OBJECTIVE: This study reports long-term effects of chronic Achilles tendon rupture treatment, using reconstruction with peroneus brevis transfer (PBT), on sports activities based on an approximate 10-year follow-up study. METHODS: Twenty patients (6 women and 14 men; mean age, 43 ± 12.85 years at the time of operation) underwent chronic Achilles tendon repair with an average follow-up of 164.05 ± 5.07 months. Seven were involved in competitive sports, 10 participated in recreational activities and three were not involved in any sporting activities. All patients were Asians. Results were assessed using Cybex strength testing and the American Othopaedic Foot and Ankle Society (AOFAS) Score, the muscle manual test (MMT), sports activities and comprehensive satisfaction assessment. RESULTS: Cybex strength testing resulted in an average gain of 87.05 ± 14.83% in dorsiflexion strength (range 65-110%) and 98.05 ± 9.02% in plantar flexion strength (range 85%-120%). The AOFAS score average was 86.9 ± 7.27. There were no postoperative re-ruptures, no recurrences and no wound complications. Plantar flexion strength and the AOFAS score were negatively correlated with the age at the time of operation (r = "0.566, r = -0.669, respectively). Seventeen patients (85%) were level five of MMT in eversion strength. Following treatment, six patients (30%) returned to competitive sports, while 10 (50%) who, prior to the injury and surgery, were involved in recreational activities, returned to similar activities. The relatively younger group tended to continue sport activities as competitive athletes (p < 0.05). Significant differences were observed in age at the operation between non-satisfaction group and excellent group (p < 0.05). The under 40-year age group tended to show a poor value. CONCLUSION: Recreational athletes and non-athletes could return to their sports activities satisfactorily, while young competitive athletes found difficulties in certain actions, especially related to eversion.
OBJETIVO: Este estudio reporta efectos a largo plazo del tratamiento de la ruptura crónica del tendón de Aquiles mediante reconstrucción con transferencia del peroneo corto (TPC) en actividades deportivas, sobre la base de un estudio de seguimiento de aproximadamente 10 años. MÉTODOS: Veinte pacientes (6 mujeres y 14 hombres; edad promedio, 43 ± 12.85 años en el momento de la operación) fueron sometidos a una reparación de ruptura crónica del tendón de Aquiles con un seguimiento promedio de 164.05 ± 5.07 meses. Siete estaban en medio de competencias deportivas, 10 participaban en actividades recreativas, y tres estaban fuera de toda actividad deportiva. Todos los pacientes eran los asiáticos. Los resultados se evaluaron usando la prueba de Cybex para medir la fuerza, la puntuación de la escala de la Sociedad Ortopédica Americana de Pie y Tobillo (AOFAS) para la valoración quirúrgica, la prueba muscular manual (PMM), y la evaluación integral de la satisfacción y las actividades deportivas. RESULTADOS: La prueba de Cybex indicó una ganancia promedio de 87.05 ± 14.83% en fuerza de dorsiflexión (rango 65-110%) y 98.05 ± 9.02% en fuerza de flexión plantar (rango 85%-120%). El promedio de la puntuación de la escala de AOFAS fue 86.9 ± 7.27. No se produjeron re-rupturas post-operatorias, ni recurrencias, ni complicaciones de heridas. La fuerza de flexión plantar y la puntuación de la escala AOFAS fueron puestas en correlación negativa con la edad al momento de la operación (r = "0.566, r = -0.669, respectivamente). Diecisiete pacientes (85%) alcanzaron el nivel cinco de la PMM en fuerza de eversión. Tras el tratamiento, seis pacientes (30%) se reintegraron a las competencias deportivas, mientras que 10 (50%) que antes de la lesión y la cirugía participaban en actividades recreativas, se reincorporaron a actividades similares. El grupo relativamente más joven tiende a continuar las actividades deportivas como atletas de competencia (p < 0.05). Se observaron diferencias significativas en edad en la operación entre el grupo sin satisfacción y el grupo excelente (p < 0.05). El grupo por debajo de los 40 años de edad mostró valores más pobres como tendencia. CONCLUSIÓN: Tanto los atletas de actividades recreativas como los no atletas, pudieron regresar a sus actividades deportivas satisfactoriamente, mientras que los competidores jóvenes encontraron dificultades en ciertas acciones, en particular las relacionadas con la eversión.