Advance in Dynamic Functional Rehabilitation after Non-operative Treatment of Acute Achilles Tendon Rupture (review) / 中国康复理论与实践

There is no consensus on the best treatment for acute Achilles tendon rupture. Functional rehabilitation after surgical treatment has been widely recognized, but the functional rehabilitation of non-surgical treatment has not been specifically studied. Based on the clinical practice of all kinds of Achilles tendon rupture, the best dynamic functional rehabilitation scheme and evaluation method were discussed. In order to bring more effective rehabilitation strategies for patients with Achilles tendon rupture, and reduce the rate of re-rupture and complications.

Rotura aguda del tendón tibial anterior / Acute rupture of the tibialis anterior tendon

Resumen: Las roturas del tendón tibial anterior son lesiones infrecuentes, con diversas etiologías, que pueden causar déficits significativos en la funcionalidad del tobillo, lesiones a veces diagnosticadas tardíamente, siendo muchas veces la alteración de la marcha el síntoma que hace acudir al paciente a consulta médica. Seis semanas van a marcar el límite entre la lesión aguda y la crónica, precisando distintos enfoques terapéuticos, junto con otros parámetros como la edad, demanda funcional o patologías concomitantes. Objetivo: Presentar dos casos de rotura aguda, con distinta etiología, la técnica quirúrgica empleada y los resultados finales. Material y métodos: presentamos dos casos de rotura aguda del tendón tibial anterior en su zona crítica hipovascular, un varón y una mujer, con etiología postraumática y espontánea respectivamente, en las cuales se realizó reinserción tendinosa en el escafoides tarsiano con un tornillo de biotenodesis, seguido de una inmovilización con autorización de marcha a las tres semanas y posterior fisioterapia. Resultados: En ambos casos se obtuvo un resultado funcional satisfactorio, con una mejoría importante en la puntuación AOFAS, reincorporándose a sus actividades laborales y deportivas a los 3 y 4 meses de la cirugía, respectivamente, con un seguimiento de 7.5 años y 10 meses. Discusión: Esta técnica, dentro de la variedad descrita en la literatura, nos ha proporcionado excelentes resultados, restaurando la funcionalidad del tendón tibial anterior y mostrándose reproducible por su sencillez, proporcionando un alto grado de seguridad a la hora de realizar una fisioterapia precoz.

Abstract: Tibialis anterior tendon rupture is a relatively rare injury, with diverse etiologies, that can cause significant deficits in the functionality of the ankle. These injuries are sometimes diagnosed too late, being in many occasions the alteration in walking the symptom that makes the patient go to the doctor. The six weeks will mark the limit between acute and chronic injury, requiring different therapeutic approaches, along with other parameters such as age, functional demand or concomitant pathologies. Objective: To present two cases of acute rupture, with different etiology, the surgical technique used and the final results. Material and methods: We present two cases of acute rupture of the tibialis anterior tendon in the critical hipovascular area, a male and a female, with posttraumatic and spontaneous etiology, respectively, in which tendon reinsertion was performed on the tarsal scaphoid with a biothenodesis screw, followed by immobilization with permission to walk at three weeks and subsequent physiotherapy. Results: In both cases a satisfactory final functional result was obtained, with a significant improvement in the AOFAS score, returning to their work and sports activities at 3 and 4 months of surgery respectively, with a follow-up of 7.5 years and 10 months. Discussion: This technique, within the variety described in the medical literature, has provided us excellent results, restoring the functionality of the anterior tibialis tendon and being reproducible for its simplicity, providing a high degree of safety when performing an early physiotherapy.

A Comparative Evaluation of Absorbable and Nonabsorbable Sutures for Open Repair of Achilles Tendon Rupture: A Pilot Study / 체질인류학회지

This pilot study was performed to compare the functional and clinical results including complications after surgery in the open repair of Achilles tendon rupture with regard to the type of suture material. A consecutive series of twenty patients with acute Achilles tendon rupture who underwent open repair were enrolled in this pilot study. The patients were divided equally into 2 groups according to suture type. In the nonabsorbable suture group, No. 2 braided nonabsorbable polyethylene terephthalate sutures were used, and in the absorbable suture group, braided absorbable polyglactin sutures were used. The Korean version of the Foot and Ankle Outcome Score (FAOS) and complications were assessed to evaluate functional and clinical result. Mean total Foot and Ankle Outcome Score (FAOS) was 89.8 (range, 71.1~100) in the nonabsorbable suture group and 82.7 (range, 61.9~92.5) in the absorbable suture group (p=0.22). All patients returned to their previous life activity. The absorbable suture group had fewer postoperative complications (10%) than the nonabsorbable suture group (20%), but there was no significant difference between two groups (p=0.45). This pilot study showed that use of an absorbable suture for Achilles tendon repair had functional and clinical results comparable to those of the nonabsorbable suture. However, a use of an absorbable suture was associated with a lower incidence of complications than the use of nonabsorbable suture. Therefore, these results have to be confirmed in a randomized controlled cohort trial with larger population.

Minimally Invasive Repair Technique of Achilles Tendon Using Sponge Forceps: A Technical Report / 대한족부족관절학회지

Various minimally invasive repair techniques have been performed for acute Achilles tendon rupture. Despite this, it is difficult to use these techniques in common practice because of the necessity of special instruments. We propose a novel minimal invasive technique using sponge holding forceps, which are commonly used in the operating room for the acute Achilles tendon rupture.

Acute Rupture of Flexor Tendons as a Complication of Distal Radius Fracture / 대한정형외과학회잡지

Acute rupture of flexor tendons following distal radius fracture is very rare. We experienced four cases of acute rupture of flexor tendons that were treated surgically. Injured tendons included flexor pollicis longus, flexor carpi radialis, palmaris longus and third flexor digitorum profundus. A severely displaced fracture with a volar spike of the distal radius was detected on plain radiographs in all cases. Ruptures of flexor pollicis longus and third flexor digitorum profundus were diagnosed on preoperative examination but ruptures of other tendons were identified during the operation. Repairs of fractures and ruptured tendons were performed simultaneously and good functional outcomes were achieved.

Acute Simultaneous Ruptures of the Anterior Cruciate Ligament and Patellar Tendon

Acute simultaneous rupture of the anterior cruciate ligament (ACL) and patellar tendon is a rare injury. We present a case report of a 32-year-old male patient with ruptured ACL and ipsilateral patellar tendon rupture sustained while playing baseball. Surgery was performed on the patellar tendon and the ACL simultaneously. The clinical and radiological outcomes of the treatment were successful. We present this case with a review of the literatures.

Surgical Treatment of Achilles Tendon Rupture with Absorbable Suture Materials Only / 대한족부족관절학회지

PURPOSE: To report the clinical results from using absorbable suture materials instead of nonabsorbable materials which have been used more commonly to repair Achilles tendon. MATERIALS AND METHODS: We retrospectively reviewed 21 cases of acute Achilles tendon rupture, treated surgically from 2004 to 2011. Mean follow-up period is 6 months. We repaired Achilles tendon using size 1 Vicryl (Polyglactin 910, Ethicon) for core suture and size 3-0 Vicryl for epitendinous suture. At three months after surgery, we evaluated clinical results with single heel raise height by centimeters, differences of calf circumference and passive range of motion of ankle joint, compared to contralateral side. Also we recorded clinical results with subjective satisfaction grades. RESULTS: At three months after surgery, 20 of 21 patients were able to perform single heel raise over 5 cm in height. Calf circumference differences were less than 1 cm in 12 cases, between 1 cm to 3 cm in 5 cases, more than 3 cm in 4 cases. There was no difference in range of passive motion in 19 cases. All patients satisfied with daily activity except 2 cases with mild discomfort. There was no complication such as rerupture, elongation or infection. CONCLUSION: We experienced excellent clinical results from repairing Achilles tendon with using absorbable suture materials in terms of functional outcomes and patient's satisfaction without any complication. So we may consider using absorbable suture materials instead of nonabsorbable materials to repair Achilles tendon.

Surgical Treatment of the Ruptured Achilles Tendon: A Comparative Study between Percutaneous and Open Repair / 대한족부족관절학회지

PURPOSE: The purpose of the present study was to compare and analyze the clinical outcomes of the percutaneous and open repair of acute Achilles tendon ruptures. MATERIALS AND METHODS: We performed a retrospective study on 24 patients (group 1) managed with percutaneous repair, and 21 patients (group 2) managed with open repair for acute Achilles tendon rupture. The postoperative evaluations were done by an Arner-Lindholm scale and AOFAS score. Postoperative overall satisfaction and cosmetic satisfaction were also evaluated. RESULTS: By Arner-Lindholm scale and AOFAS score, there was no difference between two groups (p<0.05). As for postoperative overall satisfaction, 5 cases were very satisfied, 16 cases were satisfied and 3 cases were fair in group 1. In group 2, 12 cases were very satisfied, 9 cases were satisfied. For postoperative cosmetic satisfaction, 13 cases were satisfied, 11 cases were fair in group 1. In group 2, 9 cases were very satisfied, 12 cases satisfied. In open repair group, a case of deep wound infection and three cases of skin necrosis were reported as complication. 2 cases of sural nerve injury were seen in percutaneous repair group and were recovered within 3 months. CONCLUSION: Percutaneous repair of acute Achilles tendon ruptures have high level of cosmetic satisfaction compared with open repair without any significant difference in clinical outcomes.

Percutaneous Repair of Acute Achilles Tendon Ruptures / 대한정형외과학회잡지

PURPOSE: The purpose of the present study was to evaluate and analyze the clinical outcomes of the percutaneous repair of acute achilles tendon ruptures. MATERIALS AND METHODS: We performed a retrospective study on 14 patients with acute closed rupture of the Achilles tendon and they were managed with percutaneous repair from Jan. 2006 to Jun. 2007. The clinical outcomes were analyzed according to the causes of the injury and the postoperative functional performances. RESULTS: All the cases showed good or excellent outcomes, according to the Arner-Lindholm scale for the evaluation of acute Achilles tendon rupture. The average AOFAS score was 95.6 (range: 91-100). Nine patients were very satisfied and five patients were satisfied. They were satisfied especially because of the minimal postoperative scar. Two cases of sural nerve injury were reported as complications, and these cases fully recovered at postoperative three months. No evidence of surgical wound infection, necrosis of the wound or rerupture of the tendon was seen. CONCLUSION: The percutaneous repair of acute Achilles tendon rupture achieved high functional outcomes, a successful return to previous work and high satisfaction, with a relatively low incidence of complications.

Treatment of Acute Achilles Tendon Rupture Using Krackow Suture Technique / 대한족부족관절학회지

PURPOSE: We try to evaluate the clinical results of the acute Achilles tendon rupture treated with Krackow suture technique. MATERIALS AND METHODS:We reviewed 27 patients with acute Achilles tendon rupture treated between October 2005 and September 2007. There were 26 complete ruptures and 1 incomplete rupture. All were ruptured at tendinous area. There were 21 men and 6 women, and mean age was 38 years. We repaired ruptured Achilles tendon with Krackow suture technique. The results were evaluated with Arner-Lindholm scale for patients' satisfaction, strength of calf muscle power, calf circumference, and ankle motion. The average follow-up was 29 months. RESULTS:The patients' subjective clinical results was excellent in 25 cases and good in 2 cases. There were 15 cases of less than 1 cm, 6 cases of 1~3 cm, and 1 case of more than 3 cm in the calf circumference difference between the normal and affected leg. There were 20 cases of less than 5 degrees, and 2 cases of more 5 degrees in the difference of range of motion between the normal and affected ankle. We had an experience of postoperative deep infection in one diabetic patient. CONCLUSION: We had a good clinical result for acute Achilles tendon rupture treated with Krackow suture method. So we recommand Krackow suture technique for acute Achilles tendon rupture.

Surgical Repair of Achilles Tendon Rupture by Minimal Incision Technique / 대한족부족관절학회지

PROPOSE: There have been many debates about the ideal surgical technique for acute Achilles tendon rupture. The purpose of this study is to review and analyze the clinical outcome of the acute Achilles tendon ruptures that had been repaired by indirect suture technique with minimal incision that utilized an instrument called Achillon (Newdeal, France). MATERIALS AND METHODS: This study is based on the 14 cases (14 patients) of acute Achilles tendon total ruptures that have been repaired by minimal incision technique utilizing Achillon instrument from June 2003 to December 2004. Two cases were reruptured before 8 weeks and repaired again using Krackow suture which left 12 feet for postoperative functional evaluation with at least 6 months of follow-up. Ten cases were men and average age at time of injury was 34.4 (26-49) years. The time from injury to surgery was an average of 4.5 (1-9) days and the postoperative evaluations were done by an Arner-Lindholm scale and AOFAS score. The ability to return to original work and sports activities as well as patient satisfaction were also evaluated. RESULTS: The follow-up period was averaged for 13.2 (6-24) months. Seventy-one percent of cases were ruptured during sports activities. The ruptured level was the average of 5.1 cm (3.2-8 cm) above calcaneal attachment and the skin incision was averaged for 2.7 cm (2.5-3.0 cm) long. At final follow-up, standing on tip-toe was possible in all cases while the heel-floor height on ruptured side was shorter by 0.7 cm (0-2 cm). By Arner-Lindholm evaluation scale, 9 cases were excellent, and 3 cases were good. Overall AOFAS score was an average of 96.1 (94-100), and all patients were satisfied with the result. Patients returned to work at an average of 1.3 months after the surgery and pre-injury sports activities were all possible from at 6 months after operation. CONCLUSION: Since we have treated acute Achilles tendon ruptures with minimal incision technique utilizing the Achillon and gained encouraging functional results with all patients returning to previous work with high patient satisfaction, this technique could be recommended as one of the ideal surgical options for the Achilles tendon ruptures.

Surgical Repair of Achilles Tendon Rupture by Minimal Incision Technique / 대한족부족관절학회지

PROPOSE: There have been many debates about the ideal surgical technique for acute Achilles tendon rupture. The purpose of this study is to review and analyze the clinical outcome of the acute Achilles tendon ruptures that had been repaired by indirect suture technique with minimal incision that utilized an instrument called Achillon (Newdeal, France). MATERIALS AND METHODS: This study is based on the 14 cases (14 patients) of acute Achilles tendon total ruptures that have been repaired by minimal incision technique utilizing Achillon instrument from June 2003 to December 2004. Two cases were reruptured before 8 weeks and repaired again using Krackow suture which left 12 feet for postoperative functional evaluation with at least 6 months of follow-up. Ten cases were men and average age at time of injury was 34.4 (26-49) years. The time from injury to surgery was an average of 4.5 (1-9) days and the postoperative evaluations were done by an Arner-Lindholm scale and AOFAS score. The ability to return to original work and sports activities as well as patient satisfaction were also evaluated. RESULTS: The follow-up period was averaged for 13.2 (6-24) months. Seventy-one percent of cases were ruptured during sports activities. The ruptured level was the average of 5.1 cm (3.2-8 cm) above calcaneal attachment and the skin incision was averaged for 2.7 cm (2.5-3.0 cm) long. At final follow-up, standing on tip-toe was possible in all cases while the heel-floor height on ruptured side was shorter by 0.7 cm (0-2 cm). By Arner-Lindholm evaluation scale, 9 cases were excellent, and 3 cases were good. Overall AOFAS score was an average of 96.1 (94-100), and all patients were satisfied with the result. Patients returned to work at an average of 1.3 months after the surgery and pre-injury sports activities were all possible from at 6 months after operation. CONCLUSION: Since we have treated acute Achilles tendon ruptures with minimal incision technique utilizing the Achillon and gained encouraging functional results with all patients returning to previous work with high patient satisfaction, this technique could be recommended as one of the ideal surgical options for the Achilles tendon ruptures.

Over-the-top Augmentation with ABC Synthetic Ligament in the Treatment of Acute Rupture of Anterior Cruciate Ligament

PURPOSE: To evaluate the clinical outcome after the over-the-top augmentation with ABC synthetic lig-ament for the treatment of acute rupture of anterior cruciate ligament at least two years follow up. MATERIALS AND METHODS: From January 1992, authors have treated acute rupture of ACL with this method on 91 cases. Among these, 46 cases were available for full data acquisition. At the last follow-up, clinical results were analyzed subjectively and objectively by Lachman, pivot shift test and presence of joint effusion. Functional evaluation was performed by various knee ligament scoring systems and the side-to-side differences were measured with KT-2000 arthrometer. RESULTS: On Lachman test, 82.7% were under grade I&II; grade 0 : 17 cases(37%), grade I: 21 cases(45.7%), grade III: 8 cases(17.3%). 89.3% were under grade 0 & Ion pivot shift test. On measure-ment of side-to-side difference, 25 cases(54.3%) were showed difference less than 3 mmand the differences of 16 cases(34.8%) were 3~5 mm. On six cases joint effusions were present. Among these six cases, four cases were accompanied by anterior instability which were brought to second look arthroscopy. Two cases were treated with several times of aspiration and steroid instillation. The one case was failed its continuity which solved with ACL reconstruction with patellar bone-tendon-bone autograft. The other three cases showed only lax ACL which was cared with retightening of ligament at the femoral attach-ment site. At the last follow up, 37 cases(80.4%) were resulted excellent and good on Lysholm score and 41 cases(89.1%) were group A & B on IKDC score. On Tegner scale, 34 cases(73.9%) were above five point. CONCLUSIONS: Authors suggest this over-the-top augmentation of ACL with synthetic polyester ligament would be good treatment option with several advantages; early rehabilitation is possible to get maximal function of knee and no tunnel in the lateral condyle would be good for late ACL reconstruction even though failure of this artificial ligament.

The Surgical Treatment of Acute Rupture of the Lateral Ligaments of the Ankle / 대한정형외과학회잡지

Inappropriate treatment of the injury of the lateral collateral ligaments of the ankle produce residual instability, which causes serious disability. There is considerable divergence of opinion as to whether fresh rupture of the lateral ligaments of the ankle are best treated by conservative or opreative method. We have conducted a trial to analyze thirty patients, who were treated by immediate open surgical rupair of rupture of the lateral ligaments of the ankle between April 1991 and February 1992. The results were as follows: 1. All patients were active, young men, Injuries to left ankle were three times more than right side. The most common cause of injury is occurred during sports, especially association football. 2. The decision to operate was based on 1)Talar tilt angle of the injured ankle measures 8-10 degrees more than that of the stress uninjured ankle. 2)A positive arthrogram showing contrast leakage into peroneal tendon she-aths & anterolateral aspect of the lateral malleolus. 3. Diagnostic accuracy rate of arthrography is 94.5%, stress radiography 61.1 %. Arthrography is more reliable than stress radiography in the diagnosis of acute injuries to the lateral ligament of the ankle. 4. At operation, isolated rupture of anterior talofibular ligament was in 5 cases, isolated rupture of middle calcaneofibular ligament in 3 cases, concomittant ruptures of anterior talofibular and middle calcaneofibular ligements in 22 cases. 5. Location of tears of anterior talofibular ligament was mostly mid-portion, middle calcaneofibular ligament in mid-portion or distal portion. 6. On radiologic results, average angle of talar tilt was 14.4° preoperatively, 5.2 preoperatively. There was correction of talar tilt angle of average 9.2°. 7. Clinical results of treatment were excellent in 9 patients, good in 6 patients, fair in 4 patients, poor in 2 patients by authors rating system. The satisfactory result was achieved in 15 patients(71.4%). 8. Postoperative complication was reduced mobility in 4 cases, functional instability 1 case, neuroma in operation scar in 2 cases, minor sensory loss in 4 cases. 9. Primary surgical repair gave good results in the aspect of radiologic & fun ctional instability, but clinical results were not satisfactory, due to high incidence of postoperative complication.