Outcome of a Simple Novel Technique to Reduce Soft Tissue Complications in Open Tendoachilles Injury: A Series of 20 Patients

@#Introduction: Open tendoachilles injuries are rare and associated with significant soft tissues complications. The objective of the present study was to assess the clinical outcome and safety of a simple and minimally invasive technique, with a goal to assess if it may help minimise flap and wound related complications in open tendoachilles injuries. Materials and methods: This prospective study of four years duration included 20 patients with open tendoachilles injuries managed with a simple minimally invasive tunnel technique. The primary outcome variable was occurrence of a major soft tissue complication. The secondary outcome variables included functional outcome measured using AOFAS Ankle hind foot score, re-rupture of tendoachilles and need for revision surgery. Results: None of the patients in the present series developed a serious soft tissue complication. Based upon the AOFAS hind foot scoring system, good to excellent outcome was achieved in 19 (95%) patients. All the patients were able to perform tip toe walking at six months post-surgery. None of the patients had a re-rupture of the tendoachilles and no patient needed a revision surgery. The complications encountered include thickening of the tendon at the repair site (15%), superficial wound infection (5%), stitch granuloma (5%) and hypertrophic scar (5%). Conclusion: This technique seems to be promising in reducing the soft tissue complications associated with the surgical management of open tendoachilles injuries. Most patients had a good final clinical outcome. The technique is safe, simple and reproducible. However, further randomised control studies with a larger sample size assessing the technique are recommended.

Morphometric Analysis Of Tendoachilles Tendon With Its Clinical Implications

Background: Tendoachilles tendon, the strongest and thickest tendon of the body, is formed by tendons of soleusand gastrocnemius begins near the middle of the back of leg and is inserted to the midpoint of the posteriorsurface of the calcaneum. Normal morphometric measurements of Achilles tendon serve as an important landmarkin its anthropometric evaluation and biomechanical attribute. The morphological changes in the tendon sizeprovide important health information for the management of various clinical conditions related to Achillestendons like simple tendinopathy or acute ruptures of it etc.Aim: The current study aimed at finding out the detailed morphometric measurements of the Achilles tendonwhich can be of substantial use to clinicians for determining any pathological conditions associated withtendoachilles.Materials and Methods: Total 108 lower limbs from 54 donated embalmed cadavers (31 males & 23 females) ofage between 55 to 85 years were procured for dissection. The study was carried out in the department of AnatomySMIMER Surat.Results: Present cadaveric study found that the length of tendoachilles was significantly high in male than infemale and no statistically significant difference in length of tendoachilles between right and left side werenoted. The width of the tendoachilles at origin between the right and left side tendons was statistically significant.Discussion: We found that the length of Tendoachilles was significantly high in male than in female and alsowidth of the tendoachilles at origin was more on right side. Being a frequent site for rupture, degenerative changeand inflammation, knowledge pertaining to normal morphometric measurements of Achilles tendon is imperativebefore determining any pathological variations associated with the tendon and

Morphological Study Of Achilles Tendon

Background: The calcaneal tendon is the thickest and strongest tendon in the human body which is attached tothe midpoint of the posterior surface of calcaneum. It is a frequent site of rupture, degenerative changes andinflammation.Aim: To study the anatomical and morphological details of attachment of Achilles tendon.Materials and Methods: The study was carried out on 70 adult cadaveric lower limbs in two Medical colleges.Various linear measurements were taken with the help of digital vernier caliper, accurate up to 0.01 mm.Results: Presence of Achilles tendon in all cadaveric limbs was observed in the present study. Bursa between thetendon at insertion and calcaneus was seen in all specimens. Length of tendon of gastrocnemius was observedto vary between 16.5 cm to 29.5 cm. The width at musculotendinous junction with gastrocnemius was observedto vary between 3.42 cm to 6.84 cm. Other measurements taken were minimum width, thickness at insertion,length of gastrocnemius aponeurosis medially and laterally.Conclusion: In the present study, variations in the morphology of Gastrocnemius were observed. Understandingthese variations of the gastrocnemius tendon and aponeurosis will aid the surgeon in performing surgicalprocedures such as pedicle tendon flap for reconstructive surgery and arthroplasty, Endoscopic GastrocnemiusRecession (EGR), on the Achilles tendon and prevent iatrogenic complications. It is also useful to the Anatomistsas it will help them integrate in their teaching the variations and thus better prepare the students for theirclinical tenures/work/future.

Distally based peroneus brevis muscle flap: A single centre experience / 中华创伤杂志(英文版)

PURPOSE@#Defects around the distal one third of the leg and ankle are difficult to manage by conservative measures or simple split thickness skin graft. Distally based peroneus brevis muscle flap is a well described flap for such defects.@*METHODS@#This is a retrospective analysis conducted on 25 patients with soft tissue and bony defects of distal third of lower leg and ankle, which were treated using distally based peroneus brevis muscle flap from January 2013 to January 2018. Information regarding patient demographics, etiology, size and location of defects and complications were collected. All patients were followed up for at least 3 months after surgery.@*RESULTS@#There were 21 males and 4 females with the mean age of 39 (5-76) years. The most common cause of injuries was road traffic accident, followed by complicated open injury. The average size of defects was 20 (4-50) cm. The mean operating time was 75 (60-90) min for flap harvest and inset. We had no patient with complete loss of the flap. Five patients (20%) had marginal necrosis of the flap and two patients have graft loss due to underlying hematoma and required secondary split thickness skin grafting.@*CONCLUSION@#The distally based peroneus brevis muscle flap is a safe option with reliable anatomy for small to moderate sized defects following low velocity injury around the ankle. The commonest complication encountered is skin graft loss which can be reduced by primary delayed grafting.

Cadaveric Study Of Aberrant Tendoachilles Tendon In South Gujarat Region And Its Clinical Significance

Background: The tendoachilles tendon is the strongest and thickest tendon in the body begins near the middle ofthe back of leg which is made up of the tendons of the soleus and two heads of the gastrocnemius muscles andis attached to the midpoint of the posterior surface of the calcaneum. An aberrant (abnormal) tendoachilles isattached to just posterior to the tendo-achilles tendon, calcaneal tuberocity and on medial aspect of calcaneum.An aberrant tendoachilles tendon is responsible for resistant equines deformity of club foot. The existence ofaberrant tendoachilles tendon should be kept in mind by the orthopedic surgeons, podiatrist, sports physiciansand physiotherapists. A lack of awareness such variations might complicate surgical repair.Aim: The current study aimed at finding out the attachment of tendoachilles tendon, presence of any aberrant(abnormal) tendoachilles tendon insertion and related clinical significance i.e. resistant club foot.Materials and Methods: 108 lower limbs, 54 right and 54 left lower limbs of 54 donated embalmed cadavers (31males & 23 females) of age group ranging from 55 to 85 years were procured for dissection. The study wascarried out for a period of 7 years in the department of Anatomy SMIMER Surat.Results: The length of the tendoachilles tendon is 0-2cm in 3.70% of cases, 2-4 cm in 25.92% of cases, 4-6 cm in53.70% of cases, 6-8 cm in 9.25% of cases, 8-10 cm in 5.55% of cases, >10 cm only in 1.85% of cases. In all cases,attachment of tendoachilles tendon was found on posterior aspect of calcaneun that is normal. In addition tothat one of the case of left lower limb (0.92% of cases), tendoachilles tendon was found attached on medialaspect of calcaneun that is called as aberrant tendoachilles tendon.Conclusion: Aberrant tendoachilles tendon is responsible for resistant equines deformity of club foot. Most ofresistant club foot can be treated with use of an extensive posteromedial release of aberrant tendoachillestendon with satisfactory functional results. The presence of such aberrant tendoachilles tendon should be keptin mind by the orthopaedicians. A lack of awareness such variations might complicate surgical repair.

Augmented Repair of Degenerative Tears of Tendo Achilles Using Peroneus Brevis Tendon: Early Results

Reconstruction of degenerated ruptures of the tendoachilles is a challenge. Ruptured tendons and the remaining tendon ends are abnormal. A number of methods have been described in literature reconstruct the tendoachilles, but with variable results1. We used peroneus brevis tendon in 20 patients to augment the repair of degenerated tendoachilles tears by creating a dynamic loop as described by Teuffer et al2. All patients were followed up for atleast 18 months. At the last postoperative visit, 18 out of 20 patients were able to do a toe raise. Eighty-five per cent of patients had excellent or good results and 15% had fair or poor results using modified Rupp scoring. Advantages offered by this procedure are the use of a single incision and mini incision and use of a dispensable tendon such as the peroneus brevis without entirely depending on the damaged tendon for healing.