Deformidad en equino del tobillo en edades pediátricas

La deformidad en equino del tobillo ocurre como consecuencia de múltiples entidades. Aunque la primera línea de tratamiento es la conservadora, las modalidades quirúrgicas son necesarias en la mayoría de los enfermos pediátricos. Estas últimas son las más empleadas por zonas del complejo músculo-tendinoso, en especial los alargamientos fraccionados y en forma de Z-plastia. El objetivo de este trabajo es actualizar y brindar información sobre los distintos procedimientos quirúrgicos en la corrección de la deformidad en equino del tobillo. En la búsqueda y análisis de la información se emplearon las siguientes palabras: equinus deformity, equino varus, equino valgus; drop foot deformity y Achilles tendon Z-lengthening. A partir de la información obtenida, se realizó unala revisión bibliográfica de un total de 187 artículos publicados en las bases de datos PubMed, Hinari, SciELO, EBSCO, Scopus, Medscape y Medline, mediante el gestor de búsqueda y administrador de referencias EndNote. De ellos se utilizaron 30, 28 de los últimos cinco años. Se hace referencia a la anatomía esencial de la zona, al igual que a la prueba de Silfverskiöld. Con relación a la imagenología, se describe la técnica para calcular la distancia del tendón a alargar. Se mencionan las técnicas quirúrgicas de alargamiento fraccionado, por Z-plastia, trasposición anterior del tendón de Aquiles y la hemiepifisiodesis.

Equinus deformity of the ankle occurs as a consequence of multiple entities. Although the first line of treatment is conservative, surgical modalities are necessary in most pediatric patients. The latter are the most used for areas of the muscle-tendinous complex, especially fractional and Z-plasty-shaped lengthening. The aim of this work is to update and provide information on the different surgical procedures in the correction of equinus deformity of the ankle. In the search and analysis of the information, the following words were used: equinus deformity, equinovarus, equinovalgus; drop foot deformity and Achilles tendon Z-lengthening. Based on the information obtained, a bibliographic review of a total of 187 articles published in PubMed, Hinari, SciELO, EBSCO, Scopus, Medscape and Medline databases was carried out using the search manager and reference administrator EndNote. Of these, 30 were used, 28 of the last five years. Reference is made to the essential anatomy of the area, as well as to the Silfverskiöld test. In relation to imaging, the technique to calculate the distance of the tendon to be lengthened is described. Fractional lengthening surgical techniques are mentioned, by Z-plasty, anterior transposition of the Achilles tendon and hemiepiphysiodesis.

Rotura aguda del tendón de Aquiles tratadas quirúrgicamente con Técnica de Mínimo Abordaje. Resultados clínicos y funcionales a un año de seguimiento / Acute rupture of the Achilles tendon surgically treated with the Minimal Approach Technique. Clinical and functional results at one year of follow-up

Se deben tener consideraciones especiales cuando se realizan reparaciones quirúrgicas del tendón de Aquiles. Su anatomía e irrigación particular plantean desafíos únicos para el manejo, y tener comprensión profunda de estas características es crucial para escoger el tratamiento adecuado y lograr resultados exitosos. El objetivo de este trabajo es analizar la eficiencia de la reparación quirúrgica de la rotura aguda del tendón de Aquiles con técnica de Dresden, entre el 2015 y el 2021. Se realizó un estudio de tipo analítico, observacional, longitudinal y prospectiva. El análisis del aspecto estadístico fue a través de estadística descriptiva y asociación de las variables. Se incluyeron 34 pacientes con un promedio de 42 años, la mayoría de sexo masculino. Al aplicar las escalas VISA-A se obtuvo un promedio de 12 puntos, 67,5 puntos a los 6 meses y 80,5 puntos a los 12 meses. En la encuesta SF-12 a los 6 meses se obtuvo un promedio de 68,5 puntos y 80 puntos a los 12 meses; un paciente presentó rechazo de la sutura y 6 afirmaron algún grado de edema residual aun al año de la cirugía. La reparación quirúrgica con técnica de Dresden mejora la funcionabilidad del tendón de malos resultados a regulares y buenos resultados al año de seguimiento. El 68% de la población estudiada afirmó que se encuentran satisfechos con la cirugía(AU)

Special considerations must be made when performing surgical repairs of the Achilles tendon. Its particular anatomy and blood supply pose unique management challenges, and a thorough understanding of these characteristics is crucial to choosing the right treatment and achieving successful results. The objective of this work is to analyze the efficiency of the surgical repair of the acute rupture of the Achilles tendon with the Dresden technique, between 2015 and 2021. An analytical, observational, longitudinal and prospective study was carried out. The analysis of the statistical aspect was through descriptive statistics and association of the variables. 34 patients with an average age of 42 years were included, most of them male. When applying the VISA-A scales, an average of 12 points was obtained, 67,5 points at 6 months and 80,5 points at 12 months. In the SF-12 survey at 6 months an average of 68,5 points and 80 points at 12 months were obtained; One patient presented rejection of the suture and 6 reported some degree of residual edema even one year after surgery. Surgical repair with the Dresden technique improves the functionality of the tendon from poor to regular results and good results after a year of follow-up. 68% of the population studied stated that they are satisfied with the surgery(AU)

Impacto do taping no Tendão de Aquiles nos parâmetros da marcha em indivíduos assintomáticos obesos e acima do peso / Impact of Achilles Tendon taping on parameters of gait in asymptomatic-overweight and obese individuals

INTRODUÇÃO: O taping do Tendão de Aquiles afeta os parâmetros da marcha em adultos com sobrepeso e obesos? O comprimento dos passos, o comprimento das passadas e a cadência são todos mais curtos nestes indivíduos, com maiores índices queda. OBJETIVO: Saber o efeito do taping do Tendão de Aquiles nos parâmetros de marcha em indivíduos obesos e com sobrepeso. MÉTODOS: Um ensaio clínico será realizado em um ambulatório de fisioterapia. Um total de quarenta participantes com Índice de Massa Corporal (IMC) maior que 25 serão recrutados pelo método de amostragem por conveniência. Cada grupo terá 20 participantes, com idade entre 18 e 35 anos, sobrepeso com IMC>25 a 29,9 e obesidade com IMC>30. Ambos os grupos caminharão por 10 metros e um minuto usando um analisador de marcha, e ambos os grupos terão taping nos Tendões de Aquiles. A variável preditora será o taping do Tendão de Aquiles e as variáveis de resultado serão o comprimento do passo, o comprimento da passada e a cadência, que serão medidos antes e imediatamente após a bandagem. O software SPSS 20.0 será utilizado para análise estatística, com nível de significância de p<0.05. PERSPECTIVAS: A conclusão do ensaio clínico fornecerá informações sobre o impacto da bandagem do Tendão de Aquiles na marcha em indivíduos com sobrepeso ou obesos. Além disso, poderia potencialmente demonstrar que a bandagem pode reduzir o risco de quedas e, assim, impactar positivamente na qualidade de vida.

INTRODUCTION: Does Achilles Tendon taping affect gait parameters in overweight and obese adults? Step length, stride length, and cadence are all shorter in these individuals, with increased fall ratios. OBJECTIVE: To know the effect of Achilles Tendon taping on gait parameters in overweight and obese individuals. METHODS: A clinical trial will be conducted in a physical therapy outpatient clinic. A total of forty participants with a Body Mass Index (BMI) greater than 25 will be recruited by convenience sampling method. Each group will have 20 participants, aged between 18 and 35 years old, overweight with BMI>25 to 29.9, and obese with BMI>30. Both groups will walk for 10 meters and one minute using a gait analyzer and both groups will have taping on the Achilles Tendons. The predictor variable will be the taping of the Achilles Tendon, and the outcome variables will be step length, stride length, and cadence, which will be measured before and immediately after taping. SPSS 20.0 software will be used for statistical analysis with a significance level of p<0.05. PERSPECTIVES: Completion of the clinical trial will provide information on the impact of Achilles Tendon taping on gait in overweight or obese individuals. In addition, it could potentially demonstrate that taping can reduce the risk of falls and thus positively impact the quality of life.

Efeito do taping no Tendão de Aquiles nos parâmetros da marcha em indivíduos assintomáticos obesos e acima do peso / Effect of Achilles Tendon taping on parameters of gait in asymptomatic-overweight and obese individuals

INTRODUÇÃO: Sobrepeso e obesidade afetam variáveis de marcha tais como cadência, comprimento do degrau e comprimento dos passos junto com a deterioração do tendão de Aquiles. A rígida rosca do tendão de Aquiles reduz a tensão e aumenta a estabilidade da articulação e pode ser empregada como suporte externo durante o treinamento da marcha para modificar os parâmetros da marcha. OBJETIVO: Descobrir se o taping modifica os padrões de marcha com o aumento do peso. MÉTODOS E MATERIAIS: Foram recrutados 40 sujeitos (20 acima do peso e 20 obesos) cujo comprimento dos degraus, comprimento dos passos e cadência foram medidos antes e depois da fita rígida do tendão de Aquiles. Cada pessoa completou o teste de caminhada de 10 metros usando o aplicativo Gait Analyzer. RESULTADOS: O teste Shapiro-Wilk é usado para avaliar a normalidade dos dados. O Wilcoxon Signed Rank Test e o Mann-Whitney U Test são usados para diferenças dentro e entre grupos. As diferenças dentro do grupo foram significativas nos parâmetros de marcha p <0,05 (Passo comprimento p<0,001, Stride comprimento p<0,001 e cadência p=0,009). Os parâmetros de marcha não diferiram estatisticamente entre os grupos. CONCLUSÃO: A aplicação de fita rígida no tendão de Aquiles tem um efeito semelhante nos parâmetros da marcha em indivíduos com excesso de peso e obesos. Após a aplicação da fita adesiva, verificou-se uma diferença significativa em termos de comprimento da passada, comprimento do passo e cadência na população estudada antes e depois da aplicação da fita adesiva para Aquiles. Isto implica que, independentemente do peso corporal, a intervenção com fita adesiva afeta a mecânica da marcha de forma comparável e destina-se a evitar movimentos articulares excessivos, a fornecer informações proprioceptivas durante as atividades e a diminuir o desconforto.

INTRODUCTION: Overweight and obesity affect gait variables such as cadence, step length, stride length, and Achilles tendon deterioration. Rigid Achilles tendon Taping reduces stress and enhances joint stability and can be employed as external support during gait training to modify gait parameters. OBJECTIVE: To find out whether taping modifies gait patterns with increasing weight. METHODS AND MATERIALS: 40 subjects were recruited (20 overweight and 20 obese) whose step length, stride length, and cadence were measured before and after rigid Achilles tendon taping. Each person completed the 10-meter walk test using Gait Analyzer application. RESULTS: The Shapiro-Wilk test is used to assess the normality of the data. Wilcoxon Signed Rank Test is used for within-group differences. Within-group differences were significant in gait parameters p <0.05 (Step length p<0.001, Stride length p<0.001 and cadence p=0.009). CONCLUSION: Rigid Achilles tendon taping have a similar effect on gait parameters in overweight and obese individuals. After taping, there was a significant difference in terms of stride length, step length and cadence in the study population before and after Achilles taping. This implies that regardless of body weight, the tape intervention affects gait mechanics in a comparable way and is intended to prevent excessive joint motion, provide proprioceptive input during activities, and lessen discomfort.

Complications in repairing acute closed Achilles tendon rupture with micro-incision percutaneous Achilles tendon suture system / 中国骨伤

OBJECTIVE@#To analyze the causes, management and prevention of complications after micro-incision percutaneous repair of acute Achilles tendon rupture.@*METHODS@#A retrospective study indentyfied 279 patients with acute Achilles tendon rupture who underwent a mini-invasive procedure using the micro-incision percutaneous Achilles tendon suture system(MIPAS) from August 2008 to November 2019, including 269 males and 10 female;96 cases on the right side and 183 cases on the left side;aged from 18 to 64 years old with an average of (36.9±11.4 )years old. Surgery was performed 0.5 to 7 days with an average of(2.7±0.9 )days after injury. The incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis, Achilles tendon adhesion, local pain, and ankle stiffness within 18 months after surgery were recorded, as well as the corresponding management and outcome, the causes and prevention measures were analyzed.@*RESULTS@#No superficial or deep infection was found in all patients, symptomatic Achilles tendon adhesion and ankle stiffness were not observed, delayed suture foreign-body reactions occurred in 2 cases (0.7%), re-rupture in 5 cases (1.8%), sural nerve injury in 3 cases (1.1%), 21 cases(7.5%) with skin invagination at puncture site, 2 cases (0.7%) with symptomatic vein thrombosis, and 45 cases (16.1%) of transient posterior medial malleolus pain. After individualized treatment, the function was good. American Orthopeadic Foot & Ankle Sciety(AOFAS) score was 93 to 100 with an average of(98.9±5.4) scores.@*CONCLUSION@#Despite the occurrence of unique complications with MIPAS, it shows low functionally-related complications rates, such as incision-related complications, re-rupture, sural nerve injury, deep vein thrombosis and ankle stiffness.

Flexor Hallucis Longus Transfer And V-Y Plasty: An Effective Treatment Modality for Chronic Achilles Rupture - A Case Series

@#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.

A prospective clinical controlled study of minimally invasive-locking block modified Krackow technique for repairing achilles tendon rupture / 中华骨科杂志

Objective:To investigate the clinical effect of minimally invasive-locking block modified Krackow (MI-LBMK) and open giftbox technique in the treatment of Achilles tendon rupture.Methods:Fifty-six patients with Achilles tendon rupture from January 2016 to December 2018 were collected, including 54 males and 2 females, aged 40.7±9.4 years (range 26 to 65 years). The MI group (30 patients) used two minimally invasive incisions without exposing the rupture site, and the LBMK technique was used to repair the Achilles tendon. The open group (26 patients) used a posteromedial longitudinal incision and the giftbox technique was used to repair the rupture tendon. The Achilles tendon was repaired with 6-strand sutures in both groups. Early rehabilitation programs were adopted for postoperative rehabilitation, and regular follow-up (6 weeks, 3, 6, 12 and 24 months after operation) was performed to record the Achilles tendon resting angle (ATRA), American Orthopaedic Foot and Ankle Society ankle-hindfoot score (AOFAS), Achilles tendon total rupture score (ATRS). The rupture gap and cross-sectional area (CSA) were measured by MRI at 6 weeks and 3 months after surgery.Results:A total of 30 patients in the MI group and 26 in the open group were enrolled. The differences between the two groups in age, body mass index, interval from injury to operation, and tendon rupture site were not statistically significant ( P>0.05). All patients were followed up to 24 months after surgery. There were no wound complications in MI group, and 2 cases of superficial infection and 1 case of wound skin necrosis occurred in open group. There was no re-rupture in both groups. The relative ATRA of MI group was -6.32°±0.99°, -3.90°±1.05°, -2.38°±0.84°, -0.25°±1.37° at 3, 6, 12 and 24 months after operation, respectively. The relative ATRA of open group was -7.88°±3.71°, -6.16°±1.10°, -4.53°±0.95°, -3.01°±0.95° at 3, 6, 12 and 24 months after operation, respectively. The differences between the two groups were statistically significant ( P<0.05). The ATRS of minimally invasive group at 6 months and 12 months were 72.70±7.41 and 92.97±3.35 respectively, and the ATRS of open group at 6 months and 12 months were 68.08±6.64 and 90.85±4.27 respectively, and the differences were statistically significant ( P<0.05). The AOFAS of minimally invasive group at 6 months and 12 months were 88.60±2.76 and 93.83±1.98 respectively, and the AOFAS of open group at 6 months and 12 months were 85.77±3.20 and 92.08±2.64 respectively, and the differences were statistically significant ( P<0.05). The difference in the gap between the tendon rupture ends measured by MRI sagittal plane T2WI between the two groups was not statistically significant ( P>0.05). The cross-sectional area of Achilles tendon in the MI group was higher than that of the open group at 12 weeks ( P<0.05). Conclusion:The MI-LBMK technique may protect the peritendon tissue and has fewer complications, and can enable the patient to return to daily life faster, with lower postoperative Achilles tendon elongation and better recovery of Achilles tendon function.

Early weight-bearing walking with inflatable boots after repair of acute Achilles tendon rupture based on the concept of rapid rehabilitation / 中华创伤骨科杂志

Objective:To evaluate early weight-bearing walking with inflatable boots after repair of acute Achilles tendon rupture based on the concept of rapid rehabilitation.Methods:A retrospective study was conducted to analyze the data of 69 patients with acute Achilles tendon rupture who had been treated at Department of Orthopaedics, The Second Fuzhou Hospital Affiliated to Xiamen University from April 2020 to July 2021. There were 56 males and 13 females with a mean age of 37.0(31.0, 47.0) years and a body mass index of (23.7±2.6) kg/m 2. There were 55 cases of closed injury and 14 cases of open injury; 62 cases had simple Achilles tendon injury and 7 cases were complicated with neurovascular tendon injury. The patients were divided into 2 groups according to their rehabilitation methods. The treatment group of 23 cases was subjected to weight-bearing walking with inflatable boots early after repair while the control group of 46 cases to traditional plaster bracket fixation for 4 weeks before weight-bearing walking with inflatable boots. The 2 groups were compared in terms of hospitalization time, wound infection rate, return to sports time, single heel lifting time, Achilles tendon re-rupture rate, Victorian Institute of Sports Assessment (VISA-A), Achilles tendon total rupture score (ATRS), and American Orthopaedic Foot & Ankle Society ankle-hindfoot score (AOFAS-AH). Results:There was no statistically significant difference in the comparison of preoperative general data between the 2 groups, showing comparability ( P>0.05). All patients were followed up for 11 (10, 11) months after surgery. In the treatment group, the hospitalization time [4 (3, 5) days] and single heel lifting time [(12.5±1.4) weeks] were significantly shorter than those in the control group [6 (5, 9) days and (17.0±1.5) weeks], the return to sports time [21 (20, 22) months] was significantly earlier than that in the control group [23 (22, 24) months], and the VISA-A score [(89.4±1.3) points] was significantly higher than that in the control group [(78.5±1.7) points] ( P<0.05). There was no statistically significant difference in the wound infection rate between the 2 groups ( P>0.05). At 3 and 6 months after surgery, respectively, the treatment group had significantly higher ATRS scores [(85.5±1.4) and (89.0±1.6) points] and AOFAS ankle-hindfoot scores [(89.0±1.7) and (92.0±1.5) points] than the control group [(79.3±1.8) and (87.0±1.3) points; (80.2±1.9) and (88.4±1.9) points] (all P<0.05). In all patients, the AOFAS ankle-hindfoot score at 6 months postoperatively was significantly higher than that at 3 months postoperatively ( P<0.05). Achilles tendon re-rupture occurred in none of the patients. Conclusion:After repair of acute Achilles tendon rupture, compared with traditional plaster bracket fixation, early weight-bearing walking with inflatable boots can lead to better short-term clinical outcomes to enhance recovery after surgery without increasing the rate of open wound infection or re-rupture.

Minimally invasive repair of acute closed Achilles tendon rupture with two-way needle suture technique / 中华创伤骨科杂志

Objective:To investigate the efficacy of two-way needle suture technique (TNST) in the minimally invasive repair of acute closed Achilles tendon rupture.Methods:From June 2019 to June 2021, 26 patients with acute closed Achilles tendon rupture were treated at Zhengzhou Orthopedic Hospital. They were 20 males and 6 females, with a mean age of 28 (23, 31) years. The rupture end was (4.2±1.3) cm away from the calcaneal insertion, and the interval from injury to operation 4.3 (2.0, 5.0) d. Preoperative MRI examinations revealed in all the patients closed Achilles tendon rupture which was to be repaired by TNST. The operation time, incision length, incidence of complications, ankle dorsiflexion and plantar flexion were recorded. The Arner-Lindholm scoring was used to evaluate the clinical efficacy.Results:The operation time was (20.0±5.0) min and the incision length (2.5±0.4) cm. Postoperatively, all incisions healed by the first stage, with no complications like incision infection, skin edge necrosis, deep vein thrombosis at lower limbs, injury to the sural nerve, or re-rupture of the Achilles tendon. All patients were followed up for (12.0±6.0) months. At the last follow-up, the patients walked normally, their incisions healed well, the continuity of the Achilles tendon was good by palpation, their heel lift was strong, and all their activities were restored to the levels before rupture of the Achilles tendon. The ankle dorsiflexion was 22.6°±3.7° and the plantar flexion 25.3°±3.7°, According to the Arner-Lindholm evaluation, the clinical efficacy was rated as excellent in 25 cases and as good in 1 case, giving an excellent and good rate of 100% (26/26).Conclusion:In the minimally invasive repair of acute closed Achilles tendon rupture, TNST shows the advantages of limited surgical invasion, a low incidence of postoperative complications, and reliable curative effects.

Sponge forceps assisted threading with Speedbridge technique for the treatment of acute closed Achilles tendon rupture / 中华创伤杂志

Objective:To explore the outcome of sponge forceps assisted threading with Speedbridge technique for the treatment of acute closed Achilles tendon rupture.Methods:A retrospective case series study was conducted on 20 patients with acute closed Achilles tendon rupture treated in Zhengzhou Orthopedic Hospital from December 2019 to December 2021. There were 18 males and 2 females, with age range of 24-43 years [(29.5±7.6)years]. All patients were with unilateral injury, involving the left side in 13 patients and right side in 7. Examinations revealed a palpable defect in the Achilles tendon and positive Thompson test. A longitudinal incision was made at the medial edge of the ruptured tendon. Three nonabsorbable sutures were passed through the proximal stump with sponge forceps, bypassed the rupture site and fixed directly into the calcaneal bone. The disrupted tendon ends were aligned by the tendon-bundle technique using 4-0 absorbable sutures. The operation time and incision length were documented. The ankle joint range of motion (dorsiflexion/plantar flexion), American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score and Achilles tendon total rupture score (ATRS) in the affected and healthy side were compared at 3, 6 and 12 months postoperatively. The wound healing and complications were observed.Results:All patients were followed up for 12-16 months [(13.2±2.5)months]. The operation time was 40-66 minutes [(52.0±10.3)minutes], with the incision length of 3-4 cm [(3.3±0.7)cm]. In the affected side at 3 and 6 months postoperatively, the ankle joint dorsiflexion [(5.6±1.5)°, (10.5±0.2)°] and plantar flexion [(28.4±3.2)°, (33.5±1.5)°] showed statistically significant difference compared with the healthy side (all P<0.05). The ankle joint dorsiflexion [(13.9±0.7)°] and plantar flexion [(38.3±4.4)°] in the affected side were not statistically different from that of the healthy side at 12 months postoperatively (all P>0.05). The AOFAS ankle-hindfoot score was (58.3±5.4)points, (84.9±7.1)points and (91.8±6.3)points at 3, 6 and 12 months postoperatively, showing a gradual rise (all P<0.05). The ATRS was (60.5±4.9)points, (85.5±9.0)points and (93.1±5.7)points at 3, 6 and 12 months postoperatively, showing a gradual rise (all P<0.05). All incisions were healed primarily. No patients had wound infection, nerve injury or re-rupture. Pain at the anchor insertion site occurred in 2 patients at 1 month after operation and relieved after active functional rehabilitation at 4 months after operation. Transient pain at the Achilles tendon insertion occurred in 1 patient at 6 months after operation, and relieved after 2 weeks of oral non-steroidal anti-inflammatory drugs treatment. Conclusion:For acute closed Achilles tendon rupture, sponge forceps assisted threading with Speedbridge technique can attain short operation time, small incision and good functional recovery, with few complications.

Flexibility and achilles tendon: a brief review / Flexibilidade e tendão de aquiles: uma breve revisão

Performing flexibility training in an exercise program is important to improve range of motion (ROM). Tendons have a profound impact on the general function of the musculoskeletal system, influence the limitation of ROM, and its structure and mechanical properties can benefit from stretching protocols. The systematic use of lower limbs in locomotion caused the Achilles tendon to become the largest and strongest tendon in the human body. Therefore, understanding the best prescription and frequency of flexibility exercise leads to changes in tendon properties is essential for an appropriate and effective exercise routine. Thus, the aim of this review was to organize and discuss publications about the implications of triceps surae stretching in ROM, as well as its influence on tendon properties. Acute studies show that continuous stretching times between five and 10 minutes cause decreased tendon stiffness, which is not seen in fractionated stretching times less than five minutes. Chronic studies, in turn, also don't present significant results in stiffness with fractionated times and studies with continuous times were not found. Thus, it is not possible to know if a continuous stretching time (longer than one minute) or a total time longer than five minutes but fractionated, can influence the tendon stiffness. (AU)

A realização de treino de flexibilidade como rotina em um programa de exercícios é importante para melhorar amplitude de movimento (ADM). Os tendões têm um impacto profundo na função geral do sistema musculoesquelético, influenciam na limitação da ADM, e sua estrutura e propriedades mecânicas podem se beneficiar de protocolos de alongamento. O uso sistemático dos membros inferiores na locomoção fez com que o tendão de Aquiles se tornasse o maior e mais forte tendão do corpo humano. Portanto, entender qual a melhor prescrição e frequência de exercício de flexibilidade para que ocasione alterações nas propriedades tendíneas é essencial para uma rotina de exercícios adequada e eficaz. Sendo assim, o objetivo dessa revisão de literatura foi organizar e discutir publicações sobre as implicações do alongamento do tríceps sural na ADM, bem como sua influência nas propriedades tendíneas. Estudos agudos mostram que tempos contínuos entre cinco e 10 minutos de alongamento estático causam diminuição da rigidez tendínea, o que não é visto em tempos intervalados inferiores a cinco minutos. Os estudos crônicos, por sua vez, também não apresentam resultados significativos na rigidez com protocolos de alongamento intervalados e estudos com protocolos contínuos não foram encontrados. Dessa forma, não é possível saber se um tempo contínuo de alongamento (superior a um minuto) ou um tempo superior a cinco minutos, intervalado, podem influenciar na rigidez tendínea. (AU)

Efficacy comparison of bundle suture and Krackow suture in the treatment of acute closed Achilles tendon rupture / 中华创伤杂志

Objective:To compare the clinical efficacy of bundle suture and Krackow suture in the treatment of acute closed Achilles tendon rupture.Methods:A retrospective cohort study was used to analyze the clinical data of 58 patients with acute closed Achilles tendon rupture admitted to Tongji Hospital of Tongji University from August 2014 to August 2021, including 53 males and 5 females, aged 27-55 years [(39.6±7.1)years]. The patients were treated with open repair and were assigned to bundle suture group ( n=30) and Krackow suture group ( n=28). The incision length and operative time were compared between the two groups. The healing of the Achilles tendon was observed. The difference in circumference between the affected and healthy side of the calf, ratio of width to anterior-posterior diameter at the cross-sectional area of Achilles tendon rupture, and ratio of scar tissue to tendinous fibrous tissue at the cross-sectional area of Achilles tendon rupture were measured at 12 months after surgery. At the same time, the complete Achilles tendon rupture score (ATRS) and American Foot and Ankle Surgery Society (AOFAS) ankle-hindfoot score were performed. The occurrence of complications was observed at follow-up. Results:All patients were followed up for 12-28 months [(17.9±4.2)months]. The incision length and operative time in bundle suture group [6.0(4.5, 9.0)cm, 77.5(60.0, 95.0)minutes] were significantly shorter or longer than those in Krackow suture group [8.0(7.0, 11.0)cm, 68.5(55.0, 86.0)minutes] (all P<0.01). After 3 months, healing of the Achilles tendon was obtained in both groups. After 12 months, the difference in circumference between the affected and healthy side of the calf was (2.0±0.9)cm in bundle suture group and was (1.9±0.9)cm in Krackow suture group ( P>0.05); the ratio of width to anterior-posterior diameter at the cross-sectional area of Achilles tendon rupture was 1.42±0.20 in bundle suture group, significantly greater than 1.27±0.16 in Krackow suture group ( P<0.01); the ratio of scar tissue to tendinous fibrous tissue at the cross-sectional area of Achilles tendon rupture was 8.6%(6.0%, 24.0%) in bundle suture group, significantly lower than 11.9%(9.0%, 33.0%) in Krackow suture group ( P<0.01); the ATRS and AOFAS ankle-hindfoot score were 91.5(80.0, 99.0)points and 93.0(82.0, 100)points in bundle suture group, similar to 89.0(75.0, 99.0)points and 91.5(77.0, 99.0)points in Krackow suture group (all P>0.05). During the follow-up period, the occurrence of complications were not significantly different between bundle suture group [no deep infection, early Achilles tendon rerupture in 2 patients (7%) ] and Krackow suture group [deep infection in 1 patient (4%), early Achilles tendon rerupture in 1 patient (4%)] (all P>0.05). Conclusions:Both bundle suture and Krackow suture can achieve satisfactory clinical efficacy in the treatment of acute closed Achilles tendon rupture. However, the bundle suture is more conducive to restoring normal anatomical shape of the Achilles tendon and reducing scar formation at the end of the Achilles tendon rupture.

Risk factors analysis of achilles tendon rupture in male by propensity score / 中国医师杂志

Objective:To investigate the risk factors of achilles tendon rupture in male patients and to verify them.Methods:Retrospective analysis was made on the medical records of male inpatients with achilles tendon rupture (242 cases in achilles tendon rupture group) and simple ankle joint injury (825 cases in control group) admitted to Qilu Hospital of Shandong University from May 2013 to June 2020. The tendency score matching method was used to balance the confounding factors at a ratio of 1∶1. After matching, 147 cases were in achilles tendon rupture group and 147 cases in control group. The baseline data and related indicators were compared before and after matching, and the risk factors of achilles tendon rupture were analyzed by constructing a multivariate logistic regression model.Results:The age, smoking rate, drinking rate, family history of hypertension and diabetes, previous history of hypertension, diabetes and coronary heart disease, and BMI of the achilles tendon rupture group before matching were significantly lower than those of the control group (all P<0.05). After matching, there was no significant difference in age, smoking proportion, drinking proportion, family history of hypertension, diabetes and coronary heart disease, previous history of hypertension, diabetes and coronary heart disease, and BMI between the two groups (all P>0.05). After matching, the levels of fasting uric acid (UA), cholesterol (TG) and triglyceride (TC) in achilles tendon rupture group were significantly higher than those in control group, and the differences were statistically significant (all P<0.05). Multivariate binary logistic regression analysis showed UA ( OR=1.006, 95% CI: 1.003-1.010, P<0.001), TC ( OR=2.462, 95% CI: 1.194-5.076, P=0.015) was an independent risk factor for achilles tendon rupture in male. Conclusions:Dyslipidemia and UA may be an independent risk factor for achilles tendon rupture in male.

How useful is elastography in the follow-up of achilles tendon repair? / Quão útil é a elastografia no acompanhamento do reparo do tendão do calcâneo?

ABSTRACT Introduction: In addition to conservative modalities in the treatment of Achilles tendon injuries, open, percutaneous and minimally invasive semi-open techniques, as well as biological open surgical repair methods are used as surgical options. Compression elastography is one of the methods used for the follow-up of treatment in Achilles tendon injuries. Methods: 23 patients were included in our study between July 2013 and June 2014, as long as they had at least 4 years of follow-up. In the final control, the intact side and the operated side were both examined and compared. The variables were the American Orthopedic Foot and Ankle Score (AOFAS) which is measured as a functional score considering plantar flexion and dorsiflexion; calf circumference; Achilles tendon anteroposterior (AP) diameter; and elastographic examination. Results: The strain ratio value and AP diameter of the patients was significantly higher on the operated side than on the non-operated side (p <0.001). There was no significant difference between the plantar flexion and dorsiflexion degrees on the operated side of the patients(p> 0.05). No correlation was observed between strain ratio and AOFAS (p: 0,995). Conclusion: Elastography is not a useful technique to evaluate functional results on long-term tendon healing. Level of Evidence III; Retrospective comparative study.

RESUMO Introdução: Além de métodos mais conservadores de terapia, utilizam-se, como opções cirúrgicas para o tratamento das lesões do tendão do calcâneo, técnicas abertas, percutâneas e semiabertas minimamente invasivas, bem como métodos cirúrgicos de reparo aberto. A elastografia por compressão é um dos métodos utilizados para o acompanhamento do tratamento das lesões do tendão do calcâneo. Métodos: Entre julho de 2013 e junho de 2014, 23 pacientes com pelo menos 4 anos de seguimento foram incluídos em nosso estudo. No controle final, o lado intacto e o lado operado foram examinados e comparados. As variáveis foram o American Orthopaedic Foot and Ankle Score, que foi medido como pontuação funcional por meio da flexão plantar e dorsiflexão; a circunferência da panturrilha; o diâmetro anteroposterior (AP) do tendão do calcâneo; e exame elastográfico. Resultados: O índice de tensão e o diâmetro AP dos pacientes foram significativamente maiores no lado operado do paciente que no lado não operado. Não houve diferença significativa entre os graus de flexão plantar e dorsiflexão dos pacientes no lado operado (p> 0,05). Não foi observada correlação entre strain ratio e AOFAS(p: 0,995). Conclusão: Acreditamos que a elastografia não seja uma técnica útil para avaliar os resultados funcionais na cicatrização do tendão em longo prazo. Nível de evidência III; Estudo comparativo retrospectivo.

Release of gastrocnemius aponeurosis and suture of the Achilles tendon end scar tissue managing the chronic Achilles tendon rupture / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of scar tissue suture at the broken end of Achilles tendon after gastrocnemius aponeurosis release in the treatment of chronic Achilles tendon rupture.@*METHODS@#The clinical data of 17 patients with old achilles tendon rupture treated from January 2017 to December 2019 were analyzed retrospectively, including 15 males and 2 females, aged 26 to 53 years with an average of (35.2±11.6) years old, and the time from injury to operation was 37 to 92 days with an average of (49.3±13.3) days. Myerson's classification included 6 cases of typeⅡ and 11 cases of typeⅢ. The defect of the broken end of Achilles tendon was 2 to 5 cm with an average of(4.1±1.5) cm after partial scar tissue was removed. All patients were treated with gastrocnemius aponeurosis, appropriate excision of scar tissue at the broken end of Achilles tendon and direct suture. The continuity and healing of Achilles tendon were evaluated by color Doppler ultrasound 3 months after operation. The ankle plantar flexor strength was measured by ankle plantar flexor strength tester before operation and 1 year after operation. American Orthopaedic Foot and Ankle Society ankle hindfoot score (AOFAS) and Achilles tendon rupture score were used before operation and 1 year after operation Achilles tendon total fracture score (ATRS) was used to evaluate the clinical rehabilitation of Achilles tendon rupture.@*RESULTS@#All patients were followed up for 12 to 18 months with an average of(13.6±1.8) months. The surgical incision healed in stageⅠ. Color Doppler ultrasound showed good continuity of Achilles tendon, local Achilles tendon slightly thickened and irregular fiber direction. The ankle plantar flexor force (92.2±3.9) N at 1 year after operation was significantly higher than that before operation (29.5±4.2) N (P<0.05);One year after operation, the AOFAS(91.20±3.30) was significantly higher than that before operation (42.20±4.40)(P<0.05);the ATRS (90.70±3.00) was significantly higher than that before operation(40.00±2.90)(P<0.05).@*CONCLUSION@#The gastrocnemius aponeurosis release combined with scar suture of Achilles tendon end is an effective technique for the treatment of chronic Achilles tendon rupture, avoid injury to hallux flexor longus or flexor digitorum longus, with the plantar flexor muscle strength of the ankle was recovered well, is an effective method to treat chronic Achilles tendon rupture.

Repair of KuwadaⅡand Ⅲ Achilles tendon defects through modified medial J-shaped approach with autologous fascia lata transplantation / 中国骨伤

OBJECTIVE@#To investigate the clinical effect of modified medial J-shaped incision of Achilles tendon combined with fascia lata transplantation in the treatment of Kuwada typeⅡand Ⅲ Achilles tendon defects.@*METHODS@#From January 2016 to August 2018, the clinical data of 15 patients with KuwadaⅡand Ⅲ Achilles tendon defects treated with modified J-shaped approach with autologous fascia lata transplantation were retrospectively analyzed, including 14 males and 1 female, with an average age of 31.7 years old ranging from 24 to 43. There were 9 cases of KuwadaⅡdefect and 6 cases of KuwadaⅢ defect. Postoperative observations were made for incision complications, and the Arner-Lindholm scoring standard was used to evaluate the function of the affected foot at the last follow-up.@*RESULTS@#All 15 cases were followed up from 3 to 16 months with an average of 9.2 months. No skin necrosis or infection occurred after operation, and no Achilles tendon rupture occurred again. According to the Arner-Lindholm scoring standard, 13 cases were excellent, 2 cases were good.@*CONCLUSION@#Modified medial J-shaped incision is a satisfactory approach for repairing Achilles tendon defects. It is helpful to prevent postoperative incision complications, which double-strengthen the Achilles tendon strength, so that patients can perform early rehabilitation and functional exercises with satisfactory clinical results.

Comparative analysis of pathological structure between acute closed and open Achilles tendon rupture / 中国骨伤

OBJECTIVE@#To investigate the morphological, histological and ultrastructural changes of acute closed rupture of Achilles tendon, in order to clarify the pathological basis of the injury and to explore the significance.@*METHODS@#From January 2015 to January 2019, 35 patients with acute Achilles tendon rupture who underwent the minimally invasive Achilles tendon suture technique were retrospectively analyzed. Among these patients, 12 cases in acute open Achilles tendon rupture group included 10 males and 2 females, with an average age of (35.1±9.7) years old ranging from 19 to 50, and the time from injury to operation was 2 to 8 hours with an average of(5.6±1.8);23 cases in acute closed Achilles tendon rupture group included 21 males and 2 females, with an average age of (35.5±6.6) years old ranging from 18 to 50, and the time from injury to operation was 3 to 15 hours with an average of (7.5±3.1). The gross appearance and imaging findings of the broken end of Achilles tendon tissue in the two groups were compared by naked eye observation and foot and ankle MRI at 4 to 6 hours before operation. HE staining, scanning and fluoroscopic electron microscopy, immunohistochemistry(Sirius red staining) were performed on the intraoperative Achilles tendon tissue specimens at 1 to 2 days after operation, the collagen fiber degeneration and local fat infiltration, collagen fiber shape, cell morphology and function, and the distribution of typeⅠand type Ⅲ collagen fibers in Achilles tendon were compared between the two groups.@*RESULTS@#Compared with the acute open Achilles tendon rupture group, the acute closed Achilles tendon rupture group had poor elasticity, hard texture, moderate edema, irregular shape of Achilles tendon broken end, horsetail shape, and more calcification around the broken end. HE staining results:the collagen fibers in the Achilles tendon of the acute open Achilles tendon rupture group were arranged irregularly, with hyaline degeneration and fat infiltration;The results of electron microscopy showed that collagen arranged disorderly and fibroblasts atrophied in the acute closed Achilles tendon rupture group. Immunohistochemical(Sirius staining) results:the proportion of collagenⅠin the acute open Achilles tendon rupture group and the acute closed Achilles tendon rupture group was(91.12±4.34)% and(54.71±17.78)% respectively, and the proportion of collagen Ⅲ was (8.88±4.34)% and (45.29±17.78)% respectively. The content of collagenⅠin the acute closed Achilles tendon rupture group was lower than that in the acute open Achilles tendon rupture group, and the content of collagen Ⅲ in the acute closed Achilles tendon rupture group was higher than that in the acute open Achilles tendon rupture group(P<0.05).@*CONCLUSION@#The morphology, histology and ultrastructure of the acute closed ruptured Achilles tendon are significantly altered compared with the normal Achilles tendon. The original fine and orderly spatial structure cannot be maintained, part of collagen Ⅰ is replaced by collagen Ⅲ, and the toughness and strength of the tendon tissue decreased, which may be the feature of degeneration of the Achilles tendon and an important pathological basis for closed Achilles tendon rupture.

Repair of composite tissue defect in Achilles tendon area with nutrient vessel of medial and lateral sural sutaneous nerve chimeric tissue flap based on posterior perforating branch of peroneal artery / 中华显微外科杂志

Objective:To investigate the efficacy of the nutrient vessel of medial and lateral sural subcutaneous nerve chimeric tissue flap based on posterior perforating branch of peroneal artery to repair the composite tissue defect in the Achilles tendon area.Methods:From January 2016 to June 2021, 12 patients suffering from infectious wound with defect of Achilles tendon were treated in the Department of Trauma and Microscopic Orthopaedics, 988th Hospital of the Joint Logistics Support Force of PLA. The area of soft tissue defect around Achilles tendon was 2.5 cm× 4.5 cm-8.0 cm×12.5 cm, and the length of the defect of Achilles tendon was 3.0-7.0 cm. The defect around the Achilles tendon were repaired with the nutrient vessel of medial and lateral sural subcutaneous nerve chimeric Achilles tendon flap (ATF) and the posterior perforating branch of peroneal artery was used as the vessel of blood supply. The size of flap was 3.0 cm×5.0 cm-9.0 cm×13.0 cm, and the size of the ATF was 3.0 cm×4.0 cm-3.0 cm×8.0 cm. The donor sites were sutured directly (8 cases) or repaired with skin graft (4 cases). External fixation were put on for 6 weeks after surgery. Then the external fixation was removed and the functional exercise gradually started. Outpatient clinic follow-ups were carried out regularly. Thermann Achilles tendon function assessment system was used to evaluate the last follow-up.Results:The chimeric ATF was harvested and the blood supply of each flap was good during the operation. There was no vascular crisis after surgery. The flaps survived smoothly and the wound achieved grade A healing. All patients were entered follow-up that lasted for 10-24 months. There was good appearance of flaps with minor bloating, and the colour of flaps was similar to the skin around the receiving site. The texture was soft with normal function of the lower legs and ankle. Tendon function was evaluated by Thermann Achilles tendon function assessment system, the result were 8 cases in excellent and 4 cases in good.Conclusion:The nutrient vessel of medial and lateral sural subcutaneous nerve chimeric tissue flap based on posterior perforating branch of peroneal artery can accurately repair a composite tissue defect in the Achilles tendon area, and it is one of the effective methods for the repair of a composite soft tissue wound with Achilles tendon defect.

Resultados funcionales en el tratamiento ortopédico de las roturas agudas del tendón de Aquiles / Functional results in the orthopedic treatment of acute ruptures of the Achilles tendon

Resumen: Objetivo: Analizar los resultados clínicos y funcionales de los pacientes con rotura aguda del cuerpo del tendón de Aquiles tratados de forma conservadora mediante bota ortopédica y carga precoz. Material y métodos: Estudio observacional prospectivo con 19 pacientes con rotura aguda de tendón de Aquiles tratados de forma ortopédica. Se analizaron las variables demográficas, la escala ATRS (Achilles tendon Total Rupture Score), la función mediante el test de puntillas, masa muscular gemelar y el equino en reposo residual. Los registros clínicos y funcionales se realizaron a las seis semanas, tres, seis y 12 meses. Se realizó un análisis estadístico mediante Stata 14. Resultados: A los 12 meses, 94% de los pacientes realizaban puntillas monopodales, la media de la atrofia gemelar fue de 1.03 cm ± 0.51 respecto a extremidad contralateral y la diferencia de equino residual respecto el lado sano era de 5.63 grados ± 4.17, 83.24% de los pacientes realizaban su práctica deportiva habitual previa a la rotura. La media de ATRS de la muestra era de 87.41 puntos ± 17.78. Se registraron dos rerroturas parciales (11%) a los tres meses de seguimiento que continuaron con tratamiento ortopédico. Conclusiones: El tratamiento ortopédico funcional mediante bota ortopédica y carga precoz presenta buenos resultados clínicos y funcionales, considerándolo un tratamiento válido para las roturas agudas del tendón de Aquiles.

Abstract: Objective: The purpose of this study is to assess the clinical and functional results of patients with acute middle third of Achilles tendon rupture treated conservatively by orthopedic boot and early weight-bearing. Material and methods: This is a prospective observational study with 19 patients with acute Achilles tendon rupture treated by conservative treatment. Demographic variables, ATRS score, function using heel-rise test, calf circumference and Achilles tendon resting angle were analyzed. The clinical and functional registration was performed at six weeks, three, six and 12 months of injury. A statistical analysis was performed. Results: At one year follow-up, the 94% of patients were capable of standing single heel rise, the mean of twin atrophy was 1.03 cm ± 0.51 compared to uninjured side and the difference of Achilles tendon resting angle was 5.63 degrees ± 4.17 compared to contralateral limb. The 83.24% of patients returned to play and the mean of ATRS score was 87.41 points ± 17.78. Two partial re-rupture (11%) were occurred at three months of follow-up, which continued with orthopedic treatment. Conclusions: Based on the results, functional orthopedic treatment using orthopedic boot and early weight-bearing presents good clinical and functional outcomes, considering it a valid treatment for acute Achilles tendon ruptures.

Oxidative Stress and Abnormal Tendon Sonographic Features in Elite Soccer Players (A Pilot Study) / Estresse oxidativo e características ultrassonográficas do tendão anormal em jogadores de futebol de elite (um estudo piloto)

Abstract Objective Sound experimental data suggest that oxidative stress plays an important role in the pathogenesis of tendinopathies. However, this hypothesis in humans remains speculative given that clinical data are lacking to confirm it. Recently, a new methodology has allowed to quantify the oxidative stress in vivo by measuring the concentration of hydroperoxides of organic compounds, which have been utilized as an oxidative stressrelated marker in several pathologic and physiologic conditions. Given the reliability of this test and the lack of information in subjects with tendinopathies, the aim of the present study was to assess the oxidative stress status in elite professional soccer players with and without ultrasonographic features of tendon damage. Methods In 73 elite players, blood metabolic parameters were evaluated and oxidative stress was measured by means of a specific test (expressed as U-Carr units). Therefore, an ultrasonographic evaluation of the Achilles and patellar tendons was performed. Results No significant relationships were observed between metabolic parameters and oxidative stress biomarkers. The Achilles and patellar tendons showed a normal echographic pattern in 58 athletes, and sonographic abnormalities in 15. The athletes with ultrasonographic alterations, compared to those with normal US picture, showed significantly higher U-Carr levels (p = 0.000), body mass index (BMI) values (p = 0.03) and were older (p = 0.005). The difference in U-Carr values among the subjects remained significant also after adjustment for age and BMI. Conclusion The results of the present study support the hypothesis that oxidative substances, also increasedat systemicand notonlyat local level, mayfavor tendon damage. Level of Evidence IV (pilot study).

Resumo Objetivo Dados experimentais ultrassonográficos sugerem que o estresse oxidativo desempenha um papel importante na patogênese das tendinopatias. No entanto, essa hipótese permanece especulativa em humanos, dado que faltam dados clínicos para comprová-la. Recentemente, uma nova metodologia permitiu quantificar o estresse oxidativo in vivo medindo a concentração de hidroperóxidos de compostos orgânicos, que tem sido utilizada como um marcador relacionado ao estresse oxidativo em várias condições patológicas e fisiológicas. Dada a confiabilidade desse teste e a falta de informação em sujeitos com tendinopatias, o objetivo do presente estudo foi avaliar o status de estresse oxidativo em jogadores profissionais de elite com e sem características ultrassonográficas de dano tendinoso. Métodos Em 73 jogadores de elite foram avaliados parâmetros metabólicos e o estresse oxidativo foi medido por meio de um teste específico (expresso como unidades U-Carr). Por isso, foi realizada uma avaliação ultrassonográfica dos tendões de Aquiles e patelar. Resultados Não foram observadas relações significativas entre parâmetros metabólicos e biomarcadores de estresse oxidativo. Os tendões de Aquiles e patelar mostraram um padrão ecográfico normal em 58 atletas, e anormalidades ultrassonográficas em 15. Os atletas com alterações, em comparação com aqueles com quadro normal, apresentaram níveis significativamente mais elevados de U-Carr (p = 0,000), índice de massa corporal (IMC) (p = 0,03) e eram mais velhos (p = 0,005). A diferença nos valores de U-Carr entre os sujeitos permaneceu significativa também após ajuste por idade e IMC. Conclusão Os resultados deste estudo corroboram a hipótese de que as substâncias oxidativas, também aumentadas a nível sistêmico e não apenas a nível local, podem favorecer danos no tendão. Nível de Evidência IV (estudo piloto).